The following information list my academic pedigree and research interests.  The links on the left of the screen give access to all my publications:

RESEARCH

Prior to appointment as a Lecturer/Senior Registrar:
I had two periods of full time research. The first was for six months at the Hunterian Institute at the Royal College of Surgeons of England in 1986 where I was involved in investigating factors involved in nerve regeneration and repair. During this time I learnt microsurgical techniques.
In 1990, I worked on the evaluation of factors influencing the outcome of femorodi¬stal bypass at the Vascular Studies Unit at the Bristol Royal Infirmary. Techniques involving Doppler and duplex assessment of blood vessels and grafts have been used. Morphological investigation of vein samples was performed using light microscopy and immunocytoche¬mistry. I was instrumental in setting up an angioscopy service.
I was also involved and collaborated in studies involving the non-invasive evaluation of patients prior to and during carotid endarterectomy. I supervised several projects which have been completed by junior members of staff.
Computer skills were acquired during this period.

During appointment as a Lecturer/Senior Registrar:

1.  Vein quality and angioscopy in femoro-distal bypass.
2.  Factors affecting intimal hyperplasia including vein
    culture.
3.  Audits of vascular surgery.
4.  Evaluation of carotid plaque morphology and transcranial
    Doppler.  
5.  Co-supervision of research fellow (Miss Y. Wilson – MD
    submitted to University of Bristol) on vein quality
    project.
6.  Co-supervision of research fellow (Mr C.D.Irvine - MD to
    be submitted to University of Bristol in 1997) on
    transcranial Doppler and microemboli project.
 
RESEARCH PROGRAMMES BEEN ESTABLISHED - since current appointment commenced on 1st April 1995


Vein graft intimal hyperlasia

1.     Changes in long saphenous vein following insertion into the arterial system.  Looking at the effect of stretch on smooth muscle cells in a flow rig and in a flexicell system has been used.  Evaluations of potassium channels have been performed.  Furthermore the effect in the clinical series of seriological factors on pre-existing vein and vein graft occlusion have been performed.  The effects of shear stress and flow on the production of matrix metalloproteinases by smooth muscle cells.

    Personnel:
    Mr David Beattie: 1st April 1995 to October 1997: MD thesis
     Mr Justin Sturge: February 1996 to September 1999: PhD thesis

2.    Hypoxia and pre-conditioning in an in vitro and in vivo model of vein grafts. Effect of various modulations on the development of intimal hyperplasia

    Personnel:
    Ms Lucy Wales: 23 November  1998: PhD student
   

Carotid plaque behaviour

1.    The epidemiological factors affecting the performance of carotid endarterectomy.  This project looks at the epidemiology of carotid artery disease, in conjunction with The Public Health Department at Chelsea & Westminster Hospital and subsequently at the University of Surrey, related to looking at the under-performance of carotid endarterectomy in the United Kingdom.  Further work is being performed looking at transcranial Doppler and its influence on outcome. Carotid plaques are being evaluated for chlamydia titres.

    Personnel:
Mr Richard Gibbs: 1 May 1996 to 30 September 1998: MD student

2.    Evaluation of carotid plaque morphology by 3 Dimensional scanning.  Transcranial Doppler of the middle cerebral artery velocity and emboli in the evaluation of stroke risk. With the use of immunohistochemistry to evaluate the effect of factors affecting plaque stability. Molecular biology techniques to characterize smooth muscle responses and activity. The effect of statins on plaque stability.

Personnel:
   
    Mr Dean Barratt: 3 October 1995 to December 1998:PhD student

     Miss Gill Clayton: 1 October 1999 till March 2002:MD student
    Miss Carrie Rodd: 1 October 2001:     MD  student

    Mr Soni Suiman: 1 December 2001: MD student

    Mr Shak Venestratum: 1 October 2003: MD student

Venous ulcer healing & Aetiology of Varicose veins & Outcomes

1.    Factors involved in improving the treatment of venous ulcers.  This study is designed to look at the effect of various treatment modalities on the outcome of treatment judged by ulcer healing, recurrence rates and quality of life measures.  Immunological studies have been performed to look at the effect of innervation, b-TGF, VGEF, macrophages in the healing process of the ulcers.In conjunction with dept of Dermatology, Dr C Bunker. Identification of vein wall factors that may contribute to the development of varicose veins.

    Personnel:
    Mr Michael Guest: 1 November 1997 – September 1999: MD
    Mr Adam Howard: 1 July 2000 –
    Mr Timothy Beresford: 1 September 2001
    Mr Biju Arwaind: 15 October 2003

Outcome Evaluation

Venous

1.    Project on the benefit of colour Duplex and evaluation of varicose vein surgery.  This project is looking at the benefit of colour Duplex in the pre-assessment of varicose vein surgery.  It also involves the development of a specific questionnaire for the assessment of patients with varicose veins.  It is also being involved in the assessment of Quality of Life.  The project is being conducted in conjunction with the Department of Health Economics in the University of York. 
   
    Personnel:
    Mr Jason Smith: 1 August 1996 to 30 September 1998: MD student
    Mrs Lorna Brown: BSc,RGN.

2.    Evaluation of patients with venous ulcers and varicoses veins. Development of disease specific questionnaires for assessment of venous ulcers. Development of surgical satisfaction questionnaire.

Personnel:
    Mr Jason Smith: 1 August 1996 to 30 September 1998:
    MD student
    Mr Michael Guest: 1 November 1997 – September 1999:
    MD student



Intermittent claudication

1.    Evaluation of patients with intermittent claudication.  The development of symptom specific questionnaire for patient evaluation and assessment of different methods of patient evaluation. The effect of different excerise regimens on claudicants.
2.   
    Personnel:
    Mr Patrick Chong: December 1998 - October 2000 MD student
    Mr Drostan Cheetham: 10 October 2000 -  MD student       

Multicentre Trials

1.    Does vein graft surveillance improve the outcome of femoro-distal bypass?  Multicentre (pan european) study commenced 1 November 1997. This study is designed to see whether there is any benefit in performing Duplex surveillance after bypass surgery.  The outcome measures will be graft patency, limb salvage and quality of life. BHF study.

    Personnel:
        Dr Paula Kirby: 1 November 1997 to September 1999: Research Assistant
     Dr Catherine Watson: October 1999: Research Assistant
    Dr Joanne Palmer: September 2000: Research Assistant
    Dr  Anne Hawdon: June 2001: Research Assistant

2.    Comparison of bandage techniques in the treatment of chronic venous ulcers. NHS R&D Study

    Personnel:
    Miss Julie Mitchell,RGN   

3.    Does venous surgery offer any adjuvant benefit over four layer compression in the treatment of venous ulcers? Study involving 32 studies with the recruitment of 1000 patients funded by MRC.

    Personnel: Dr Joanne Palmer/Dr Anne Hawdon

4.    Multicentre trials are being established:

a)    Comparison of open surgery vs VNUS in long saphenous vein ablation   

b)    Use of Viagra in the management of lower limb ischaemia    

These are all multicentre studies for which funding has been requested from the MRC, NHS R&D, British Heart Foundation and Pfizer Pharmacuticals.

Assorted clinical projects and reviews are in progress.

COLLABORATOR: 
1.    Asymptomatic Carotid Surgery Trial
    (MRC funded)
2.    Micro-embolic Asymptomatic Carotid Trial
    (MRC funded)
3.    Endovascular Aneurysm Graft Repair
(NHS R&D funded)
4.    Micro-emboli study with clopidogrel
(Bristol Myers Squibb)


LONGTERM RESEARCH STRATEGIES:

1. Molecular Group
To establish a large group to further evaluate the mechanisms governing vascular smooth muscle cell behaviour with direct application to atherosclerosis, plaque stability and vein graft stenoses.


2. Outcomes Assessment, Health Economics/Quality Assurance Group
The remit of this group would be to access precise measures to evaluate disease processes and treatment modalities, the costs of health care and to collaborate with other centres in establishing patterns of efficient best practice.  A significant collaboration is underway with the Health Research Institute at the University of York.