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My main research interests focus on health outcomes, risk-modelling and risk- stratification in the field of surgery.  More information on these areas can be found under the relevant sections of my website.

I am the Senior Analyst for the National Bowel Cancer Audit Programme (NBOCAP). I also hold an honorary contract with the Clinical Effectiveness Unit at The Royal College of Surgeons of England for this purpose. I have responsibilities for several national audits (Bowel Cancer, Pouch Registry & Laparoscopic Colorectal Surgery Registry). This includes collation, statistical analysis and publication of large volumes of national data.

I was invited by The Dutch Association of Surgery to help facilitate National Audit in Holland, and continue as a national advisor on behalf of the ACPGBI. I have also been invited to advise the Egyptian Group of Colorectal Surgeons on national audit and now represent the UK to EURECCA (European Registration for Cancer Care - a pan-european collaboration)

I have an interest in quality of life and patient related outcomes research.  This was a central part of a 2-year period of research studying health outcomes in varicose vein surgery, which was awarded an MD by The University of London. The abstract from this thesis is appended below in the box.

My bibliography of publications and presentations demonstrates my continued commitment to research, publishing and presenting work on an annual basis in high impact journals.

 

 

Higher Degree - MD, University of London
Awarded 2001
 "Improving Outcomes in Varicose Vein Surgery"
The indications and benefits of varicose vein surgery are a matter of great debate.  This is not because of improved technology or technique but due to exclusion.  Varicose veins are a very common condition accounting for 60,000 UK operations per year.  Varicose vein patients have real symptoms, but the operation is often seen as “cosmetic”, hence the potential for exclusion in the climate of Clinical Governance and ‘rationing’ of resources.

This study looks at four areas involved in the management of patients with varicose veins; quality of life (QOL), pre-operative duplex marking, satisfaction following surgery, and cost analysis.  QOL is measured to determine if these patients have a “true” problem and also to examine the impact of surgery.  A randomised trial is performed to determine whether pre-operative duplex marking improves the outcome of surgery in terms of reduced recurrence rates.  A satisfaction index is developed and used to measure post-operative satisfaction with surgery, and an extensive cost analysis is performed to determine economic effectiveness and identify any potential cost savings.

The patients entered into the study had primary varicose veins without venous ulceration.  All completed questionnaire booklets (SF-36, Aberdeen Questionnaire, EuroQol) prior to surgery and at 6-weeks and 12-months.  Patients were also randomised into duplex and non-duplex marking groups prior to surgery.  Also at 6-weeks patients completed a newly developed satisfaction index.  Pre-operative QOL was worse than age/sex matched UK norms.  This significantly improved after surgery, and improved beyond that of norms at 12-months.  Satisfaction levels post-surgery were high.  Pre-operative duplex marking confers no added advantage over clinical / Doppler marking in terms of final outcome.

If varicose vein surgery is ‘rationed’, patients will continue to complain of a very real problem.  Simple venous surgery can greatly improve QOL, but duplex confers no added advantage.

 

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