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Research

My current areas of interest are

  • Wearable technologies for health and wellbeing. I will be undertaking a research project with the National Institute of Health Research 2016-2018
  • Use of computer vision to objectively assess facial expressions

Past projects include:

Stereophotogrammetry

In this era of evidence-based practice, it will surprise many that a majority of plastic surgical interventions have not been assessed objectively. Three-dimensional speckle pattern stereophotogrammetry offers a non-invasive method to evaluate surface topography and hence perform quantitative assessment of the results of plastic and reconstructive surgery. My interest in this technology covers two main areas: breast reconstruction and facial aesthetics/ symmetry. I have validated a system of rapid objective assessment of scar volume based on this technology that is clinically applicable.

In 2003 I established a new MSc project investigating the use of 3D surface imaging for objective evaluation of plastic surgical interventions. The first MSc student under my supervision, Helena van Dam, was awarded a distinction from the Universtiy of London in September 2004 for her work. The second research student, Marlene See won the 2006 Michael Hackett Memorial Prize for the best presentation at the annual meeting of the British Association of Aesthetic Plastic Surgeons. The last student, Adam Sawyer was also awarded a distinction of his project.
This research has generated a number of national and international presentations and four peer-reviewed papers thus far.

Psychological aspects of reconstructive breast surgery

We recently started a collaboration with the Professor Nicola Rumsey and Dr Diana Harcourt at the Centre for Appearance Research at the University of the West of England. I am co-supervisor of a suite of projects for which £100,000 has been raised through the Trust to fund a research fellow for 3 years. Three studies have ethics committee approval:

  • The psychosocial and informational needs of women undergoing surgery for congenital breast asymmetry
  • Psychosocial and support needs of med undergoing surgery for gynaecomastia and their expectations of surgery
  • The prevalence of decision regret and its association with body image, distress and information satisfaction in women who have undergone nipple reconstruction following mastectomy
    This is a new area of research for the hospital and its findings will inform future care pathways for breast surgery patients.

Telemedicine for assessment of skin lesions and wounds

Increasing numbers of patients with skin lesions and acute or chronic wounds are referred from the South East of England (population 4.5 million) to the Queen Victoria Hospital NHS Foundation Trust. The reason for the referrals are in the main suspected skin cancer, namely basal cell carcinoma, squamous cell carcinoma and malignant melanoma. These cancers are all subject to the two-week wait rule. Because of the natural history of these conditions the majority of these patients are elderly and many have significant co-morbidities and difficulties in mobilising.

In addition, there are another group of patients with acute and chronic wounds that community practitioners request management advice for such as pretibial lacerations, pressure sores, leg ulcers and chronic wounds often with similar co-morbidity and mobility issues who are also referred. The current management pathway involves a written referral from the patient’s GP to the Consultant, triage based on the letter, assessment of patient in clinic and a separate date arranged for surgery if necessary followed by a follow-up appointment 6 to 12 weeks later. This traditional pathway has several disadvantages in particular unnecessary delays in the patient receiving specialist attention and the need for patients and family/carers to travel often long distances repeatedly.

Telemedicine has the potential to specifically address these problems and improve communication, patient triage, delays in treatment and efficiency in health care as well as significant cost savings to both patient and provider. Combined with the impending Electronic Patient Record system it may also improve record keeping and audit. The purpose of this study is to see whether the telemedicine assessment and triage of patients with skin lesions and wounds by specialist consultants can reduce the expense and number of journeys patients make, reduce the time taken to complete treatment, improve patient satisfaction whilst at the same time maintaining diagnostic accuracy.

The QVH has an established track record in linking telemedicine with secondary care referring hospitals. By developing similar links with referring GPs, significant benefits for patient care are possible.