I completed my clinical training in Emergency Medicine in Manchester, which included the three-year Critical Care rotation at Stepping Hill Hospital in Stockport. In 2005 I took up a Doctoral Research Fellowship and I completed my PhD in clinical decision rules to enable early exclusion of acute coronary syndromes in 2009. In 2010 I took up a post as an NIHR Academic Clinical Lecturer at The University of Manchester. During that time I was Chief Investigator for a prospective cohort study of 477 patients with the aim of externally validating the (subsequently renamed) Manchester Acute Coronary Syndromes decision rule (UKCRN 8376).
In January 2012 I took up a post as Consultant in Emergency Medicine at Central Manchester University Hospitals NHS Foundation Trust. I co-founded and became the Research Director for the Emergency Medicine and Intensive Care Research Group (EMERGING), overseeing a novel merger with Critical Care research at the Trust. Over the following 12 months, the EMERGING team developed a large portfolio of both academic and commercial studies with some notable successes, and the team now contains 4 research nurses, two trials co-ordinators, two doctoral fellows and an administration assistant. We are ideally placed to deliver late phase trials in Emergency Medicine and Critical Care. With excellent links with Clinical Trials Units, economists and statisticians and our passion to increasingly involve service users in our work, our aim is to be a world leading centre for the delivery of high quality translational research in Emergency Medicine and Critical Care.
My personal academic expertise is in analytical modelling, decisio support, diagnostics, the design and conduct of large observational cohort studies and late phase clinical trials. I was the first to report that high sensitivity cardiac troponin assays could be used to 'rule out' acute coronary syndromes in many patients who have high sensitivity cardiac troponin concentrations below the limit of detection of the assay (an unconventional cut-off). I have validated this approach in four different studies with high impact publications in the Journal of the American College of Cardiology, Clinical Chemistry, JAMA Cardiology and Academic Emergency Medicine. This pathway has since been recommended for clinical use by the European Society of Cardiology. Similarly, I was part of an international group of investigators that validated an algorithm to 'rule in' and 'rule out' acute myocardial infarction with high sensitivity cardiac troponin T within just 1 hour. Again, this algorithm has now been recommended for clinical use by the European Society of Cardiology.
However, I still believe that we can improve diagnostic technology in this field and have reported the development and validation of the Manchester Acute Coronary Syndromes (MACS) prediction model in over 2,000 patients across five studies including one pilot randomised controlled trial. A refined version of this model has been implemented at Central Manchester University Hospitals NHS Foundation Trust and I plan to achieve a phased implementation across a wider territory in Greater Manchester. My future work will focus on refining and improving the MACS models to facilitate dynamic risk stratification, machine learning and shared decision making.