Biography

I graduated from the University of Cambridge in 1978 with a first in Medical Sciences, and from the University of London (London Hospital Medical College) in 1981. I trained in General Medicine and Neurology in London (St Bartholomew's Hospital and St Mary's). From 1986-90 I was a Research Fellow at the MRC Cyclotron Unit, London and National Hospital Queen Square, where I studied the relationship between clinical features and PET scan appearances in various forms of degenerative dementia. As a Senior Registrar in Geriatric and General Medicine in London I became interested in stroke, and after completing clinical training in Manchester in  1995,  I was  appointed Consultant in Stroke Medicine in Salford. I was the first designated Stroke Physician in Manchester, and set up a nationally leading stroke service singlehandedly. In 1999, I was awarded my first research grant in collaboration with Professor Nancy Rothwell and was appointed Senior Lecturer in the University of Manchester in 2006. I am Clinical Lead to the Greater Manchester Clinical Stroke Network and have led a nationally leading redesign of stroke services. I was Clinical Advisor to the NICE guideline on Acute Stroke and TIA 2006-8, and lead the National Stroke Audit (SINAP) at the RCP. I was  RGL to the Clinical Neurosciences Group 2006-2009; Clinical Neurosciences Clinical Governance Lead 2004-2007;  and am Clinical Lead, NW Stroke Research Network. This is the leading Stroke LRN for recruitment into RCTs and has brought clinicians from across the NW into research. I led the recent successful bid for a Hyperacute Stroke Research Centre at SRFT. I am Lead for the Vascular and Stroke Centre in the Institute of  Cardiovascular Sciences and undertake  translational research with Professor Nancy Rothwell, Professor Stuart Allan, Professor Andrew King and Dr Steve Hopkins in neuroinflammation in stroke and subarachnoid haemorrhage. I am involved in studies on stroke dysphagia, quality improvement in stroke and rehabilitatation studies in stroke and brain injury.  One of our most important projects was the ACT-NoW study,  which demonstrated that there was no difference in patient outcome between people with communication problems after stroke randomised to early intensive speech and language therapy or attention control. This project has had significant impact and led to changes in National Guidelines. I  lead  the Stroke Implementation Programme of the GM CLAHRC and led on the development of the Greater Manchester Stroke Assessment Tool which is now in clinical use across many parts of the NHS . I am recognised nationally and regionally as an expert in clinical stroke management and lead an exciting and productive research programme. I am also very involved in the delivery of stroke services within SRFT to a high standard, improving delivery of acute services including  thrombolysis and interventional procedures to patients from across the NW.

Collaborators and affiliated staff

Faculty of Life Sciences:

Professor Dame Nancy Rothwell

Professor Stuart Allan

Dr Herve Boutin

FMHS Vascular and Stroke Centre:

Dr Stephen Hopkins

Professor  Andrew King

Dr Audrey Bowen

Professor Sarah Tyson

Mr Andy Vail (Biostatistics)

Mr Hiren Patel

Dr Craig Smith

Dr Adrian Parry-Jones

Mr James Galea

Brain Behaviour and Mental Health:

Professor Anthony Jones

Professor  Shaheen Hamdy

Salford Royal Foundation Trust:

Dr Steve Hopkins

Mr Andy Vail

Mr Hiren Patel

Mr James Galea

Mrs Sharon Hulme

GM CLARHC

Professor Bonnie Sibbald

Professor Ruth Boaden (MBS)

Ms Joanne Thomas

Ms Katy Rothwell

Imaging Science:

Professor Alan Jackson

Psychiatry:

Professor Alistair Burns

University of London

Professor Anthony Rudd

Professor Charles Wolfe

Professor Naomi Fulop

Memberships of committees and professional bodies

  • Member of the Scientific Committee, The Stroke Association (2006-2010)
  • Member of the Scientific Committee, British Association of Stroke Physicians 2000-2003; 2004-2007
  • Member of the British Association of Stroke Physicians
  • Member of the Executive Committee, British Association of Stroke Physicians 2009-12
  • Member IDSMC: STASH study
  • Member, IDSMC, NIHR funded DARS study
  • Clinical Lead, SINAP (RCP) and Associate Director, Stroke Programme, Royal College of Physicians
  • Clinical Lead, GM Clinical Stroke Network 2007-13
  • Chair, Scientific Committee,  Stroke Association, 2012-
  • Trustee, Stroke Association 2012-

Methodological knowledge

As lead for a translational programme of stroke research I have expertise in the design and conduct of difficult clinical trials in vulnerable groups, together with observational studies of inflammatory markers in plasma and CSF. I am aware of many of the pitfalls and difficulties of biomarker studies particularly inflammatory biomarkers. I have expertise in the design of imaging (MR and PET) studies in cerebrovascular disease, and in the basic science underlying the translational aspects of my work.

My role as Clinical Lead for the NW Stroke LRN means that I have experience in the adoption, design and conduct of a wide variety of RCTs and other well designed studies in stroke and subarachnoid haemorrhage. I am able to assess the feasibility of studies in a variety of service providers (Trusts) and understand the relationships between the Comprehensive Local Research Networks and the Topic Specific networks nationally. I have expertise in patient and public involvement through the clinical and research networks, and am frequently asked to talk to public groups about both research and clinical practice.

I have extensive clinical expertise in acute stroke and stroke rehabilitation, with a very active clinical practice including 24/7 cover for acute interventions, and I am nationally recognised as an expert in stroke care. I wrote the NICE Acute Stroke and TIA guideline in 2008, and I am lead for SSNAP, the national stroke audit. I have expertise in stroke rehabilitation studies, particularly dysphagia studies, as well as a specific interest in post stroke pain. I have expertise in implementation research and I am familiar with the role of qulaitative research in rehabilitation studies. I have been involved in the development of functional electrical stimulation studies with Dr laurence Kenney.

I have supervised a PhD student in inflammation and mild cognitive impirment and have expertise in some aspects of degenerative dementias.

Overview

I am Professor of Stroke Medicine and an Honorary Consultant in Stroke Medicine at the Comprehensive Stroke Centre at Salford Royal Foundation Trust. My research interests include translational studies of immunomodulation after acute ischaemic stroke and subarachnoid haemorrhage, studies in stroke rehabilitation and implementation studies in stroke. I was Clinical Lead for the NICE Acute Stroke and TIA Guideline (2006-8) and contributed to the 2012 National Clinical Guideline for Stroke. Until 2013 I was Clinical Lead for Stroke in Greater Manchester and led the Manchester stroke service redesign from 2007. I am Associate Director of the Royal College of Physicians Stroke programme with responsibility for the National Stroke Audit. I lead the Stroke and Vascular Centre in the Institute of Cardiovascular Sciences and I am Clinical Lead for the NW Stroke Local Research Network and the Hyperacute Stroke Research Centre in Salford. I am a Trustee of the Stroke Association and Chair of its Research Awards Committee.

Qualifications

  • BA (Hons) 1st Class University of Cambridge 1978
  • MB. BS (Hons) University of London 1981
  • MA (Cantab) 1982
  • MD (University of London) 1991
  • FRCP (London) 2000

Research interests

I am Clinical Lead for an internationally leading programme of Translational Research with colleagues in Faculty of Life Sciences (Professor Dame Nancy Rothwell, Professor  Stuart Allan) and the Institute of CV Sciences where I lead the Vascular and Stroke Centre.  Working with colleagues in stroke (Dr Craig Smith), neurosurgery (Professor Andrew King, Mr Hiren Patel) and inflammation (Dr Stephen Hopkins) we are studying the inflammatory response to stroke and subarachnoid haemorrhage, and its modulation by the naturally occurring cytokine antagonist, IL-1Ra. Our studies have demonstrated the variability of the immune response to stroke and its association with clinical outcome, the relationship between inflammation and delayed cerebral ischaemic following subarachnoid haemorrhage; the association of the inflammatory response with outcome following TIA; the penetration of IL-1Ra administered intravenously into central CSF, the pharmacokinetics of CSF penetration; the effect of iv IL-1Ra on CSF biomarkers of inflammation and the impairment of the immune response following stroke and its reversal with IL-1Ra. We have recently completed a MRC funded study to evaluate whether subarachnoid haemorrhage is a valid model for stroke, working to ensure that animal and clinical experimental models of stroke and SAH are as closely linked as possible. We have also demonstrated MR evidence of microvascular angiopathy in patients at risk of stroke, together with elevated PK11195 (PET) binding in these patients. This has led to a "reverse translation" study where co-morbid animals have undergone PET studies showing similar  distribution of microglial activation. Current studies include a MRC DCS/DPFS study of IL-1Ra in subarachnoid haemorrhage and a Stroke Association study of IL-1Ra in acute ischaemic stroke. I supervise two NIHR Clinical Lecturers, Adrian Parry-Jones (developing studies in intracerebral haemorrhage) and James Galea (studies in subarachnoid haemorrhage).

I am Clinical Lead for the Stroke Implementation theme of the Greater Manchester CLARHC. We developed a 6 month post stroke assessment tool, the GM-SAT, which is is now in use across the country, and woking on implementation of home monitoring of blood pressure in practices across N Manchester.  I am lead nationally for the Stroke Audit (SSNAP) which is an important source of research data.

I work with colleagues in psychology (particularly Dr Audrey Bowen, Reader) and rehabilitation (Professor Sarah Tyson), together with Professor Shaheen Hamdy.

Social responsibility

I have been involved in Science Stroke Art 2014 (www.sciencestrokeart.co.uk, #SSA14), a unique partnership between the University of Manchester and the Stroke association, together with a number of cultural organisations across the NW. This ran throughout May 2014 and included talks, theatre, story-telling, science and art demonstrations to capture people's imaginations and challenge misconceptions about stroke.

I am a Trustee of the Stroke Association. I chair my local transition town group and help organise a community garden, a project to restore a peat bog and other community activities related to raising awareness of climate change and sustainability.

 

Teaching

I teach undergraduate and post graduate students in stroke medicine. I am an Academic Advisor to 6 currently year 2 students, supervise year 1 Student Selected Components as part of the PEP programme, and teach year 2 students on the neurosciences module. I organise the year 3 Mind and Movement stroke afternoons, and teach on the year 5 revision course. I supervise 2 year 4 Project Option students each year. I am a tutor on the Pre Foundationer Communication Skills course and undertake ward teaching.

I teach FY1 and FY2 doctors, and lecture to postgraduates in neurology and geriatric medicine. I helped to set up the Stroke speciality training programme in the NW deanery. I am Academic Training Lead for Neurosciences.

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