Rare coronary artery phenotypes leading to acute coronary syndromes
Spontaneous Coronary Artery Dissection is an uncommon cause of acute coronary syndromes (ACS) primarily affecting young to middle-aged women, including around the time of childbirth. Coronary aneurysm ectasia is another uncommon cause of ACS due to coronary dilations. We have developed a broad research programme in both fields recruiting patients across the UK and Europe. This includes more basic science elements such as pathophysiological and biomarker studies as well as more clinically focused studies such as epidemiology and outcomes, imaging and phenotyping studies. Projects can be personalised in accordance with the experience and interest of the candidate. Successful candidates will be expected to prepare data for publication in international cardiovascular journals of high impact and to use the data to form the basis for an application for a research fellowship
Long term metabolic and cardiovascular health using UK primary care data [the Clinical Practice Research Datalink (CPRD)
This project is a retrospective cohort study using UK primary care data [the Clinical Practice Research Datalink (CPRD)], to explore maternal and neonatal outcomes in women with anaemia during pregnancy. Globally, about 50% of severe maternal outcomes including maternal deaths and near-miss complications are attributed to anaemia. Maternal anaemia is associated with a range of adverse pregnancy outcomes, including: fetal losses, neonatal deaths, pre-term births, small for gestational age, low birth weight and neuro-developmental problems. Women with anaemia in pregnancy are less likely to endure the effects of extreme blood loss in child birth, and are more likely to succumb to infection/sepsis, fatigue and depression in the antenatal and postnatal periods. Adverse effects of maternal anaemia often exacerbate in the postpartum stage and are associated with lactation failure. Finally, maternal anaemia is associated with long term maternal and fetal metabolic and cardiovascular morbidity and mortality. This project proposes identifying all pregnancies with maternal anaemia from 2000 to 2018 within CPRD along with a comparison group of time-matched non-anaemic controls. Both short and long-term maternal and fetal outcomes will be compared between the two cohorts and a secondary analysis stratifying by severity of anaemia will also be undertaken.
Understanding the clinical phenotype of aortic dissection
Aortic dissection is a condition involving catastrophic separation of the aortic wall which causes loss of circulation to vital end-organs. Its mortality rate is >1%/hour in the first 24 hours alone. Approximately 6,000 patients die from this condition each year in England and in Wales. To better understand clinical presentation, diagnostic approaches, treatment/management and outcomes of the condition, the International Registry of Acute Aortic Dissection (IRAD) was begun by the PI and others as an observational registry to understand the disease in 24 international centres. After 20 years and 70 publications (including the New England Journal of Medicine, JAMA and other top-tier journals), IRAD is presently recognized as the authoritative study group on this condition. British institutions have not been represented in this study, however. As an original investigator of the IRAD study, the PI will employ his experience and knowledge and the ACF will undertake investigative approaches to understand the clinical phenotype of aortic dissection in the institution by audit and further possibly to local/national levels including further comparison with global IRAD results. Using this clinical database, there is potential to further undertake phenotyping studies (e.g. metabolomics, imaging) to develop new blood- and imaging-based biomarkers of the condition.
Determining the clinically relevant anatomy to teach UG medical students
Human Anatomy has been a core component of undergraduate (UG) medical education for many years, and while it continues to be a key theme, the depth of anatomy taught has seen a steady decline. The need for a solid foundation of anatomical knowledge, while more readily appreciated as essential for those pursuing surgical careers, is important for any practicing clinician. Clearly, which areas of anatomy are most relevant will vary depending on the postgraduate speciality. With ever increasing pressures on space within the UG curriculum, there is obvious priority to ensuring what is taught best enables students to meet the demands of the breadth of future clinical practice.
While the GMC do not currently stipulate specific outcomes for the level of anatomy within the UG medical curriculum, the future introduction of the UK Medical Licensing Assessment will likely lead to efforts to better establish ILOs for the basic sciences, as a whole. In 2016, in response to the lack of consensus and guidance on the appropriate level of anatomy, the Anatomical Society defined a core regional anatomy syllabus of 156 ILOs, which were to help curriculum planners determine the clinically relevant anatomy to teach UG medical students. The proposed ILOs were determined by a Delphi panel of experts, which included surgeons, radiologists and anatomists.
The first step of the project will involve a series of focus groups and surveys with a variety of early clinical trainees from medicine, surgery and primary care. The purpose of this will be to identify whether there are elements of the 156 identified ILOs that represent a base of anatomical knowledge common across a breadth of specialities (surgical and non-surgical). The second step will be to explore how well they perceive (by self-report) to have retained knowledge of those areas of anatomy (identified in the first step of the project).
The findings from this project will help to better define areas of anatomy that are seen as most important, relevant and common to a breadth of clinical specialities. Further work/projects could explore how this anatomy could be prioritised or given greater attention within the UG medical curriculum, or early postgraduate period and whether there are any interventions that can be applied to improve retention of knowledge in those areas.