Peek, Russell
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Biography
I am a consultant paediatrician and clinical academic with clinical interests in neonatal medicine and infant nutrition. I am an advocate for innovation and improvement in medical education, with research interest in the effects of complexity, uncertainty and stress on learner development and wellbeing.
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Publication PD01 First UK report of pregnancy and childbirth in X-linked erythropoietic protoporphyria(Oxford University Press, 2023-06-26) Schulenburg-Brand, Danja; Powell, James; Srivastava, Pushplata; Swingler, Rebecca; Peek, Russell; Swingler, Rebecca; Peek, Russell; Medical and DentalX-linked erythropoietic protoporphyria (XLEPP), an exceptionally rare form of cutaneous porphyria, is characterized by significant acute painful photosensitivity and a risk of both reduced bone mineral density and protoporphyric hepatopathy that may progress to liver failure. Diagnosis requires demonstration of significantly elevated red cell total porphyrins consisting of both zinc and free protoporphyrin analysed on venous whole blood. As the condition is X-linked, any offspring of an affected woman has a 50% chance of inheriting the disease-causing ALAS2 gain-of-function mutation. There are no reported cases of pregnancy in XLEPP in the literature, and no published experience of managing newborn infants that may have inherited XLEPP who develop neonatal jaundice, which requires treatment with phototherapy. Here we describe the clinical course of a 29-year-old woman with XLEPP (part of a four-generation XLEPP family) and idiopathic thrombocytopenia during pregnancy—the first documented case in the UK, to our knowledge. A multiprofessional team considered the potential risks posed by XLEPP and idiopathic thrombocytopenia for the pregnancy, birth and newborn. Haematological and biochemical indices were monitored throughout the pregnancy. The mother experienced increased photosensitivity and worsening idiopathic thrombocytopenia during the pregnancy, the majority of which occurred over summer. Idiopathic thrombocytopenia did not respond to treatment with steroids and immunoglobulin, necessitating a general anaesthetic for the planned caesarean section. A male infant was born in good condition at term. Maternal blood loss was only just above average. The baby remained well in the immediate postnatal period. Although the baby did not require treatment for jaundice, management planned in advance included minimizing factors predisposing to jaundice, including optimal timing of cord clamping and early feed support, the urgent analysis of cord blood erythrocyte porphyrins within 24 h, using a light-emitting diode phototherapy device with narrow spectrum emission between 450 and 470 nm and minimal emission at 400 nm, monitoring the baby closely for signs of distress and skin changes, and considering adjustment of the phototherapy thresholds or using alternative treatments should jaundice occur. Cord blood erythrocyte total porphyrin results suggested the baby had inherited XLEPP and would be photosensitive. This was later confirmed by mutation analysis.Publication Greater tolerance of uncertainty facilitates thriving in doctors entering postgraduate training(BioMed Central, 2025-07-16) Peek, Russell; Arnold, Rachel; Moore, Lee; Peek, Russell; Medical and DentalBackground: Medical curricula increasingly emphasise the need to prepare graduates to manage uncertainty. Uncertainty is an inevitable consequence of the complex nature of human health and illness but may be stressful for clinicians less able to tolerate it. Although work-related stress is prevalent in healthcare services, not all clinicians struggle under the pressures they face. Indeed, some thrive, experiencing success and development, observed through the joint experience of high levels of wellbeing and perceived performance. Therefore, this study aimed to explore relationships between tolerance of uncertainty, perceived stress, and performance and wellbeing (i.e., human thriving) in doctors entering UK foundation training. Methods: Sixty-six doctors entering UK foundation training completed validated self-report measures to assess tolerance of uncertainty, perceived stress, wellbeing and performance. Multiple linear regression analyses were used to investigate relationships between tolerance of uncertainty, perceived stress, and human thriving. Mediation analysis was then undertaken to explore whether the observed relationship between tolerance of uncertainty and thriving was mediated by perceived stress. Results: Tolerance of uncertainty and perceived stress predicted a significant proportion of variance in thriving, independently of sex, lifetime stress, and adverse childhood experiences (model adjusted R2 = 0.51). Additionally, tolerance of uncertainty accounted for a significant proportion of variance in perceived stress after controlling for covariates (model adjusted R2 = 0.43). Furthermore, the effect of tolerance of uncertainty on thriving was partially mediated by perceived stress. Conclusions: Tolerance of uncertainty may represent a novel enabler of thriving and act, at least in part, by reducing perceived stress. Medical educators should consider how best to equip doctors in training to face uncertainty in clinical practice. Further research is required to examine whether interventions can optimise tolerance of uncertainty, or reduce perceived stress in uncertain situations, to facilitate thriving in early career doctors.Publication Chronic cough in preschool aged children(BMJ Publishing Group, 2024-09-02) Peek, Russell; Walker, Louise; Singleton, Richard; Peek, Russell; Walker, Louise; Medical and DentalNo abstract availablePublication Psychophysiological fidelity: A comparative study of stress responses to real and simulated clinical emergencies(Wiley, 2023-07-01) Peek, Russell; Moore, Lee; Arnold, Rachel; Peek, Russell; Medical and DentalIntroduction: Experiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real-world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real-world clinical practice. Methods: In this within-subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real-world emergencies in a 6-month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (SD) participant age was 33 (8) years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20 min after simulated and real-world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State-Trait Anxiety Inventory, respectively. High-frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings. Results: Simulation was associated with greater likelihood of threat appraisal and higher state anxiety. High-frequency HRV reduced from baseline in simulated and real-world emergencies but recovered further towards baseline 20 min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post-simulation debrief and feedback. Discussion: This study identifies important differences in psychophysiological stress responses to simulated and real-world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real-world clinical practice.Publication Cord blood porphyrin analysis in neonates at risk of inheriting protoporphyria: An observational cohort study(Wiley, 2025-07-09) Schulenburg-Brand, Danja; Peek, Russell; Bentley, Lucy; Swingler, Rebecca; Pavlova, Yana; Dawe, Robert; McGuire, Victoria; Peek, Russell; Medical and DentalNo abstract availablePublication Growth concerns in the early weeks of life(BMJ Publishing Group, 2020-09-21) Peek, Russell; Wilson, Nicky; Cronin-Preece, Emma; Peek, Russell; Wilson, Nicky; Cronin-Preece, Emma; Medical and Dental; Additional Clinical ServicesNo abstract available