In 2020 and 2021 my main focus, alongside clinical duties managing our emergency medical patients was to better understand the risk of venous thromboembolism/ pulmonary embolism in coronavirus disease. We worked closely with our colleagues in haematology to make sure patients are diagnosed appropriately (including protecting patients from unnecessary radiological investigations), treated quickly and safely and followed up appropriately.

 

I have worked with colleagues at King's, Guy's and St Thomas' and Addenbrooke's to improve the care of patients with sudden onset headache, and in particular subarachnoid haemorrhage. This is a devastating condition, 1/3 of patients die with their first haemorrhage, 1/3 are left with severe neurological damage - which can include hypothalamic and pituitary damage - and 1/3 have nothing apart from the severe headache. The challenge is to find those patients with a sub-arachnoid haemorrhage amongst the large population of people who have severe headaches and it requires very close working with the Emergence Department, neuroradiology, the laboratory and neurosurgery

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I have also been very fortunate to with colleagues in the Department of Respiratory Medicine at Guy's and St Thomas' Hospital to balance the benefits and harms of inhaled and oral glucorticoids (steroids), particularly in patients with asthma. This has become very important as new biologic therapies for the immune system in asthma have been developed, and patients can now have their disease controlled without the long-term effects of steroids - this falls under the banner of steroid stewardship.

 

Alongside the above I have worked with my colleague in acute medicine and the depeartment of diabetes here at King's College Hospital, particularly with my close colleague Dr Martin Whyte (also at The University of Surrey) to better understand the metabolic consequences of high dose oral glucocorticoids, used for asthma, smoking related lung disease (chronic obstructive pulmonary disease/ COPD).

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My colleagues and I studied the effectiveness of point of care testing for respiratory viruses using the BioFire FilmArray® utilising ward based quantitative real-time RT-PCR; which involved, and continues to support, a close collaboration with the Departments of Microbiology and Virology to improve the care of patients with respiratory infection.. This collaboration has been strengthened now with coronavirus infection and the Department of Virology and I are supporting the work of colleagues in cardiology to investigate the effects of SARS-CoV-2 on the heart.

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My interest in anaemia and avoiding unnecessary transfusion lead to a longstanding collaboration with NHS Blood and Transplant to introduce a single unit transfusion policy for suitable medical patients at King's College Hospital; this continues to preserve valuable blood stocks, protects patients from blood components and helps reduce length of stay. From this work I now Chair the London Regional Transfusion Committee within JPAC (Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee).

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During my specialist training I gained an MD from the University of London for my thesis investigating the influence of insulin like growth factor-1 on the gene and protein cyclooxygenase-2 in the colon of patients with and without acromegaly. This was a mixture of bench work, using cell culture and realtime quantitative RT-PCR as well as clinical characterisation of the patients and supervision of their surveillance colonoscopy.