About
37
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Introduction
I am interested in clinical evaluation of the role of technology and pathways in remote patient monitoring. My main clinical work is in the areas of Complex/ Difficult to treat asthma, Unexplained Dyspnoea and Cardio-Pulmonary Exercise testing
Skills and Expertise
Current institution
Publications
Publications (37)
Objectives
The objective of this study is to report the pilot phase of the Targeted Prostate Health Check programme that aims to identify men in the Surrey and Sussex region who have prostate cancer and who failed to be detected during the Covid era.
Subjects and methods
Men aged 50 to 70, or 45 to 70 if Black or with a family history of prostate...
Introduction
In the midst of a global climate emergency and with health care systems across the world facing extreme pressure, interest in digital approaches as a potential part-solution to these challenges has increased rapidly. The evidence base to support the role that digitalization can play in moving towards more sustainable models of healthca...
Desaturation on exercise has been suggested as a predictive feature for deterioration in COVID-19. The objective of this paper was to determine the feasibility and validity for the 40-steps desaturation test.A prospective observational cohort study was undertaken in patients assessed in hospital prior to discharge. One-hundred and fifty-two partici...
https://onlinelibrary.wiley.com/share/author/FQ3QEKVFJX62Z7AMQYFV?target=10.1111/anae.15635 link to the paper
The utility of the Livzon LFIA in COVID-19
Background
Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19.
Main research questions
What exercise te...
Introduction
Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking.
Methods
Multivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute...
Objective
Identify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.
Design
Real-world prospective observational study.
Setting
VH remote assessment service in West Hertfordshire NHS Trust, UK.
Participants
Patients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergenc...
Introduction and Objectives
The disease spectrum of COVID-19 ranges from mild viral illness to devastating lung injury that heralds the acute respiratory distress syndrome. Different risk factors of adverse outcomes have been identified but prospectively stratified and externally validated studies of prognosis are lacking. We set out to identify in...
Objective
Secondary spontaneous pneumothorax (SSP) is traditionally managed with an intercostal chest tube attached to an underwater seal. We investigated whether use of a one-way flutter valve shortened length of patients’ stay (LoS).
Methods
This open-label randomised controlled trial enrolled patients presenting with SSP and randomised to eithe...
Objectives
Digital remote patient monitoring (RPM) can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Healthcare providers are overwhelmed resulting in clinical teams spread more thinly. We aim to assess the impact of the introduction of an app-based RPM (Huma Therapeutics) on a clinician's worklo...
Objectives
To assess the real-world diagnostic accuracy of the Livzon point-of-care rapid test for antibodies to SARS-COV-2
Design
Prospective cohort study
Setting
District general hospital in England
Participants
173 Patients and 224 hospital staff with a history of COVID-19 symptoms, and who underwent PCR and/or reference antibody testing for...
Objective
Identify predictors of adverse outcome in a Virtual Hospital (VH) setting for COVID 19.
Design
Real-world prospective observational study.
Setting
Virtual hospital remote assessment service in West Hertfordshire NHS Trust, UK.
Participants
Patients with suspected COVID-19 illness enrolled directly from the community (post-accident and...
Background
Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We sought to summarise the literature on the performance of different rapid tests for exertional desaturation.
Main research question
What tests have been formally evaluated for the rapid assessment of exertional hypoxia in pa...
Background
Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute COVID-19.
Main research questions
1. What exercise...
Ambulatory management of PSP significantly reduced duration of hospitalisation, including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests PSP can be managed as an outpatient using ambulatory devices in those who require intervention.
Background
Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We sought to summarise the literature on the performance of different rapid tests for exertional desaturation.
Research question
What tests have been formally evaluated for the rapid assessment of exertional hypoxia? What is...
Risk stratification of patients presenting with Covid-19 to urgent care/ hot hub settings to idnetify suitablility for out of hospital remote monitoring versus escalation to hospital assessment or admission.
Introduction Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores,...
Provides a clear framework for primary care practitioners reviewing patients with ongoing symptoms following infection with SARS-COV-2
Abstract
Introduction
The complication rate of Pleural procedures is reduced from 8% to 1% when managed by a pleural specialist. We reviewed pleural disease managed by the department of medicine at our hospital in London to assess the potential effect a dedicated pleural service on patient safety, doctor training and on reducing length of stay.
M...
BACKGROUND
Digital remote patient monitoring (RPM) can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Healthcare providers are overwhelmed resulting in clinical teams spread more thinly. We aim to assess the impact of the introduction of an app-based RPM (Huma Therapeutics) on a clinician's worklo...
Background
Digital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a...
Background
Primary spontaneous pneumothorax occurs in otherwise healthy young patients. Optimal management is not defined and often results in prolonged hospitalisation. Data on efficacy of ambulatory options are poor. We aimed to describe the duration of hospitalisation and safety of ambulatory management compared with standard care.
Methods
In t...
Two tests have potential: the 1-minute sit-to-stand test (in which the patient goes from sit to
stand as many times as they can in one minute) and the 40-step test (in which the patient takes 40 steps on a flat surface). The former correlates well with the validated 6-minute exercise test. The latter is less demanding (hence safer) and in more wide...
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Introduction
Respiratory infection, predominantly due to viral pathogens, poses a huge burden on the NHS especially during winter. An earlier definitive microbiological diagnosis should allow more rapid clinical decision-making on aspects of care, including hospital admission (versus discharge) and antibiotic use, and prevention of nosocomial infec...
Introduction
Primary Hyperparathyroidism (PHPT) has a prevalence of 1/1000, with only 20% of patients being symptomatic, and was previously considered to be a benign condition. Recent evidence shows increased mortality in PHPT patients, primarily from cardiovascular disease, peptic ulcers and osteoporotic fractures. Parathyroidectomy reduces morta...
