Professor of Emergency Medicine at the University of Manchester

Honorary Consultant in Emergency Medicine and

Group Director of Research & Innovation at Manchester University NHS Foundation Trust

Lead for Business Engagement & Innovation for the School of Medical Science

• Member, International Federation for Clinical Chemistry Committee for the Clinical Application of Cardiac Biomarkers (IFCC-CCB)
• Founder, Manchester Acute Coronary Syndromes (MACS) Academic Group
• Founder and Research Director, Manchester Emergency Medicine & Intensive Care Research Group (EMERGING)
• Fellowship of the Royal College of Emergency Medicine
• Membership of the Royal College of Surgeons of Edinburgh
• Research & Publications Committee, Royal College of Emergency Medicine
• Research Committee, European Society for Emergency Medicine

My research interest is in the early diagnosis of acute coronary syndromes, particularly with biomarkers. I am internationally renowned for my work with high sensitivity cardiac troponin. My methodological expertise is in clinical epidemiology (with interests in diagnostics, cohort studies and late phase clinical trials) and analytical modelling (particularly the derivation, validation and implementation of novel technology to support clinical decision making).

I am currently Chief Investigator for:

• The Bedside Evaluation of Sensitive Troponin (BEST) Study. This large cohort study (n=1,575; recruitment in progress) essentially represents a programme of research with six separate workstreams incorporating two PhDs, a H2020 project grant, a project grant from the Royal College of Emergency Medicine and a research grant from Abbott Point of Care. In this study we will evaluate:
  • The diagnostic accuracy of point of care troponin testing within 3 hours of arrival in the Emergency Department
  • The diagnostic accuracy of point of care heart-type fatty acid binding protein (H-FABP) testing in the Emergency Department
  • The accuracy of the Manchester Acute Coronary Syndromes (MACS) prediction model and the HEART score
  • A novel prediction model to optimise electrocardiographic (ECG) diagnosis of acute coronary syndromes
  • Highly sensitive and super sensitive cardiac troponin assays for the diagnosis of acute coronary syndromes
• A pilot randomised controlled trial of the Manchester Acute Coronary Syndromes Decision Rule.  Feasibility study & pilot randomised controlled trial at two centres.  (Write up phase)

I am currently Principal Investigator for:

• The CAMEO trial: icatibant for the treatment of ACE-inhibitor induced angio-oedema. Multi-centre, international randomised controlled trial, sponsored by Shire. Write up phase.
• The TRAPID-AMI study, a multinational, industry sponsored prospective cohort study designed to evaluate a novel algorithm to enable early exclusion of acute coronary syndromes.  Write up phase.  [UK Chief Investigator]
• Efficacy and safety of relaxin for the treatment of acute heart failure (RELAX-2 AHF).  Multicentre randomised controlled trial, sponsored by Novartis. 
• The CRASH-3 trial: randomised controlled trial comparing tranexamic acid to placebo for traumatic brain injury
• The DiPEP (Diagnosis of Pulmonary Embolism in Pregnancy) study. Cohort study
• The Pandemic Influenza Triage in the Emergency Department (PAINTED) study.Prospective cohort study, sponsored by The University of Sheffield, funded by NIHR. 

• Analytical modelling
• Clinical epidemiology
• Medical decision making
• Diagnostic studies
• Clinical Trials

• Senior Editor, St. Emlyn's Medical Education Blog (www.stemlynsblog.org)
• Integrated Academic Training Lead for Emergency Medicine, North Western Deanery
• I offer Research Project options to medical students. My students have achieved some excellent publications and several presentations at national conferences over the past 8 years.
• PhD supervision. I currently supervise or co-supervise five PhD students.

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.

• 2010 FRCEM (Fellowship of the Royal College of Emergency Medicine)
• 2009 PhD, Manchester Metropolitan University: Clinical decision rules for the rapid exclusion of acute coronary syndromes
• 2003 MRCSEd(A&E) (Membership of the Royal College of Surgeons of Edinburgh, Emergency Medicine section)
• 2000 MB ChB, University of Manchester