Barnabas Panayiotou

Biography

BMedSci (Hons) (Nottingham University), 1981
BM BS (Nottingham University), 1983
MRCP (UK), 1988
Accreditation: General (Internal) Medicine & Geriatrics (JCHMT, RCPs-London), 1996
Honorary Title: Clinical Senior Lecturer, Keele University, 1997
MD (Keele University), 1998
FRCP (London), 2000
Postgraduate Certificate - Medical Education (Dundee University), 2009                       

Academic roles:
I have been Director of the Certificate/Diploma/MMedSci - Frailty & Integrated Care since 2017.  My involvement with the course began at its inception back in 1997 when I was appointed Honorary Clinical Senior Lecturer and member of the first Management Board and Examination Board of the newly established MSc-Geriatric Medicine.  Currently, I also lead the Clinical Geriatric Medicine Modules, and for many years I was Research Methods Module Leader.

As Senior Lecturer for over twenty years I pursued multiple research interests alongside my full-time clinical workload and commitments;  I have been supervisor for research projects of Senior Registrars, Specialist Registrars and MSc/MMedSci students;  Examiner for MSc / MMedSci / MPhil module assignments and research theses;  Teacher/ Mentor/ Examiner for the Physical Assessment and the Independent Nurse Prescribing courses (Masters Level); Lecturer on the undergraduate pre-clinical Ageing Module from 2013; and member of the Independent Peer Review Committee from 2014.

Clinical appointments:
In 2014-2015 I was Consultant Geriatrician in Primary Care, Stoke-on-Trent Clinical Commissioning Group. I led the successful implementation of an innovative clinical project that delivered Comprehensive Geriatric Assessment in seven GP practices, with follow-up data collection for one year.  Outcomes, especially regarding medicines optimisation, were well received and formed the basis of a publication in 2017 (BMJ Open).  For the period 2002-2014 I was Consultant Physician & Community Geriatrician, Combined Healthcare NHS Trust and University Hospital of North Staffordshire.  I was recruited to this new post to advance community geriatric services in Staffordshire Moorlands and the two local cottage hospitals (Leek and Cheadle).  I developed Multidisciplinary Assessment & Rehabilitation; Intermediate Care; a cost-effective service of sub-acute medical admissions directly from patients’ homes; outreach medical/geriatric clinics; community teams; domiciliary assessments and close collaboration with General Practitioners. Favourable service evaluations resulted in multiple publications.
From 1996 to 2002 I was Consultant Physician in Acute General Medicine, Geriatrics and Rehabilitation at Walsall Hospitals NHS Trust.  As Lead Clinician for Falls in older people I participated in the Walsall Health Authority Falls Prevention Steering Group and the formulation of a community programme comprising Primary Prevention, Secondary Prevention and Guidelines for Primary Care.  This gained acceptance beyond Walsall Health District, with the training and implementation pack being purchased by other Health Authorities.  Prior to this post I was Senior Registrar in the West Midlands Higher Specialist Training scheme (1993-1996) and completed a rotation in Acute General (Internal) Medicine, Clinical Pharmacology, Geriatrics, Psychiatry of Old Age, Rehabilitation.  I also served as Chairman of the West Midlands Geriatric Medicine Senior Registrars’ Group.

Research Registrar and Earlier Training:
In 1991-1992 I was Clinical Research Fellow in Stroke Medicine, Leicester University (see more under Research and Scholarship).  In 1990-1991 I worked as Senior Registrar in an accredited training post of Medicine for the Elderly, Barnet General Hospital, London.  During my earlier appointments in Registrar and Senior House Officer training posts I gained wide-ranging experience in Accident & Emergency Medicine, Acute General Medicine, Respiratory Medicine, Cardiology, Diabetes & Endocrinology, Infectious Diseases, High Dependency Care, Geriatrics and Rehabilitation.

Research and scholarship

Research has featured throughout my career, resulting in nearly thirty scientific conference presentations, and over sixty publications of manuscripts, scientific communications, reviews and clinical case reports.

My first experience of research was for a thesis in part fulfilment of my BMedSci degree, performed in the Department of Physiology & Pharmacology and titled ‘Metabolism of Salicylic Acid in Isolated Rat Hepatocyte and Kidney Tubules’.  The method of using intact cells was new and it involved specialized procedures including preparation of hepatocyte and renal tubule suspensions, assessment of cellular viability, incubation with radioactively-labelled salicylate, and separation and quantitation of metabolites by chromatography and a scintillation counter. The pathways and saturable kinetics of salicylate biotransformation were demonstrated. The major site of salicyluric acid synthesis (i.e. the main metabolite of salicylate in humans) was found to be the kidney rather than the liver.  By enabling the concurrent investigation of all metabolic pathways and accurate comparison between different tissues, the project also demonstrated the advantages of this new technique over previous in-vitro methods of drug metabolism.

As Clinical Research Fellow in Stroke Medicine, Leicester University, I set up a computerised database of over 400 consecutive acute stroke patients that enabled a variety of observational and interventional studies which led to multiple scientific conference presentations and journal publications.  Original research projects I carried out on the behaviour of blood pressure following acute ischaemic stroke formed a substantial part of my MD Thesis that I submitted subsequently to Keele.  Concurrently I was the local investigator for two multicentre clinical trials (European Atrial Fibrillation Trial of secondary stroke prevention; Phase II study of an ion channel modulator, Lifarizine, in acute cerebral infarction). Additionally, I carried out a pharmacokinetics and pharmacodynamics study of a new α-1 receptor antagonist for prostatic hypertrophy.

My MD thesis was titled ‘Blood pressure behaviour in the early period after stroke’ and comprised four original studies that examined clinical aspects of blood pressure (BP) behaviour and its assessment.  1: The largest study entailed prospective non-invasive 24-hour BP monitoring and showed that, whereas non-stroke control subjects had a significant nocturnal BP fall, in patients with acute stroke the normal day-night difference was abolished.  Long-term follow-up demonstrated that higher nocturnal than day-time BP post-stroke had a strong independent association with mortality.  This ‘reversed dipping’ was accompanied by abolition of the normal day-night heart rate variation, suggesting that autonomic nervous system dysfunction post-stroke carries a poor prognosis.  2: A study of postural BP responses revealed that, unlike older people without stroke, orthostasis in acute mild stroke does not cause a BP reduction, but it results in no significant change or even a BP rise. Furthermore, acute stroke patients who have been on antihypertensive medications had similar postural BP responses to untreated patients. These findings can be attributed to sympathetic nervous system over-activation resulting from acute stroke.  3: Simultaneous bilateral 24-hour BP monitoring demonstrated that, unlike previous studies of non-simultaneous bilateral readings which were less reliable and produced conflicting results, there is no systematic interarm BP difference in acute hemiplegia.  4: An investigation of actual clinical practice prevailing at the time evaluated the patterns of BP evaluation and use of antihypertensive therapy post-stroke.  Published papers from these studies have been extensively referenced by subsequent researchers in the field and some were also included in the well-known textbook ‘Stroke: A practical guide to management’ (Warlow CP et al; Blackwell Science Ltd).

I have also published work on various other aspects of acute cerebrovascular disease; certain aspects of blood pressure assessment in non-stroke populations; clinical pharmacology; and medical education. Two studies gained a prize for best paper i.e. ‘Effect of Antihypertensive therapy on postural blood pressure regulation in acute stroke’ (West Midlands British Geriatrics Society Conference, Birmingham, 1999), and ‘Sero-prevalence of chlamydia pneumoniae in elderly stroke and medical patients: a case-controlled Study (British Geriatrics Society Conference, London, 2001).  In more recent years, the focus of my clinical research activity and publications have been on various service elements of community geriatrics. A recent study 'Educational programmes for frail older people, their families, carers and healthcare professionals: a systematic review' was awarded a prize for best poster presentation at the British Geriatrics Society Spring Conference, 2021.

As member of the Keele Independent Peer Review committee since 2014 I have been providing constructive feedback (mostly on research methodology) and grade ratification for proposed projects.  I also provide expert peer reviews for submitted research proposals at Keele and the NIHR.  Over the years I have been a referee for a variety of Journals including International Journal of Stroke; Age and Ageing; Reviews in Clinical Gerontology; European Geriatric Medicine Journal.

Teaching

Delivering teaching and training, both at undergraduate and postgraduate level, have always been an integral part of my career and has included workplace formats; small-group tutorials; lectures; organising clinical placement programmes and timetables; and mock clinical examinations for MRCP candidates. In addition to my ongoing commitments to the MMedSci - Frailty & Integrated Care, and earlier contributions to the Physical Assessment and Independent Prescribing courses, I was for many years Educational Supervisor and Appraiser for Specialist Registrars and Staff Grade Physicians and served as Clinical Tutor for the Royal College of Physicians. My formal qualification in medical education was awarded by the Centre of Medical Education, Dundee University.