School of Health and Related Research projects

Projects:

"Best Interests" in Medicine - a Historical and Ethical Investigation

Main Supervisor

Dr Chris Millard (c.millard@sheffield.ac.uk)

Second Supervisor

Professor Ian Sabroe (i.sabroe@sheffield.ac.uk)

Aim and Objectives

Tie uncover the roots of the concept of "best interests" in medicine, and how it has been used as a foundation-stone of ethical problem-solving and practice in medicine.

To understand such a concept as rooted in a particular time, place and context, that can be understood historically.

To write an extended historical account of the ideas that fed into "best interests" across a number of areas in medicine, including psychiatry, care for individuals with limited capacity, palliative care, intensive care, geriatric medicine, care for people with disabilities, bioethics, medical ethics, and medical research.

Research Methodology

The student will undertake literature searches to find instances of this term and related concepts. The student will contextualise these instances of the concept being used, and also note the particular areas in which it becomes most prominent. The student will be supervised by Dr Millard and Prof Sabroe, who will set essay questions, provide readings, and comment on draft work, as well as discussing the ideas.

The student will read widely in the history of medicine, the history of various medical specialisms, the history of bioethics and medical ethics, and also curate a robust primary source base (potentially of medical journal articles, government reports, Royal (and other) Commissions set up to deal with patient's rights and patient activism.

Expected Outcome

A historical account of the emergence and use of the term "best interests" in medicine that helps to understand where the concept came from, how it functions in the context of nineteenth- and twentieth-century medicine, and how it functions today. A key outcome will be to understand where concepts come from, and why they emerge at a particular time and place, in response to specific problems. This will help to see how - as times change - concepts might become bent out of shape, or change their meanings.

Type of Project

Medical Humanities

Additional Training

Introduction to, and practical supervision concerning, doing humanities research, and managing an independent research project.

Optimising New Roles in NHS Mental Health Services

Main Supervisor

Professor Scott Weich (s.weich@sheffield.ac.uk)

Second Supervisor

Professor Damian Hodgson (d.hodgson@sheffield.ac.uk)

Aim and Objectives

The principal aim of this funded research is to better understand what happens when new roles are introduced into mental health services on a large scale. We are interested in how new roles are integrated into mental health services and how professional boundaries and relationships are managed and optimised.

We would also like to know how the introduction of new roles (many of which have unfamiliar job titles) this affects patient experience and outcomes, and the latter will be the focus for the student's research.

Research Methodology

The study involves both evidence synthesis (in the form of a realist review, to which the student will contribute) and primary research, including interviews and focus groups with staff and patients. This primary research will be qualitative in nature. We expect that the student will play a leading role in the patient interviews, and in analysing and reporting the data that arises from these.

Expected Outcome

The student will produce a thesis and at least one first author peer-reviewed publication. They will also be included as a co-author on the main study report and at least 2 other peer-reviewed papers. The student will also have the opportunity to contribute to policy-relevant documents and briefing papers.

Type of Project

Qualitative Project/non-lab based - primarily using qualitative methods

Additional Training

The student will have the opportunity to attend a range of short courses at ScHARR, including methods in evidence synthesis and qualitative research (including qualitative interviewing and data analysis.

Health and well-being among older people in England during the Covid-19 pandemic: a longitudinal analysis using the English Longistudinal Study of Ageing

Main Supervisor

Professor Peter Bath (p.a.bath@sheffield.ac.uk)

Second Supervisor

Dr Madina Hasan (m.hasan@sheffield.ac.uk)

Aim and Objectives

The overall aim of the project is to develop a better understanding of the risk factors for changes in health and well-being and/or multimorbidity in older people during the Covid-19 pandemic. More specifically, the objectives are to:


i) undertake an extensive review of the research literature to identify studies of health and well-being in older people and identify potential arreas of interest for further exploration;
ii) develop skills in data analytics (e.g., statistical methods) and apply these to a systematic series of analyses to develop a better understanding of risk factors for changes in health and well-being and multimorbidity in older people;
iii) prepare reports on the analyses and draft papers for submission to a conference and for peer-reviewed journals.

Research Methodology

Initially you will undertake a literature review to identify previous research in this field, identify gaps in knowledge and refine your research questions.

The project itself involves a secondary analysis of an existing data-set, the English Longitudinal Study of Ageing (ELSA), which contains a large nationally-representative sample. The methods of analysis will include bivariate and multivariable statistical methods, e.g., Chi-squared tests, logistic regression, cluster analysis. You could also use AI methods, such as machine learning, to develop predictive models, if that interests you and aligns with the research questions.

Expected Outcome

The project will identify risk factors for health outcomes (e.g., health service utilisation, multimorbidity) and changes in health and well-being in older people.
In collaboration with your supervisor, you will be able to write this up for presentation at an appropriate conference and/or for publication in a peer-reviewed journal(s).

Type of Project

Medical Humanities

Additional Training

You will have the opportunity to have training in statistical methods and the principles of applying them, and this will include practical sessions. Further training in using AI and data mining methods can be arranged if you are wishing to use these methods.

Effectiveness of ketogenic (low carbohydrate) diets in the treatment of people with serious mental illness

Main Supervisor

Professor Scott Weich (s.weich@sheffield.ac.uk)

Second Supervisor

Dr Viren Ranawana (viren.ranawana@sheffield.ac.uk)

Other Supervisors

Dr Reem Abed

Aim and Objectives

To establish the acceptability, feasibility and potential effectiveness of ketogenic (low carbohydrate) diets for people with serious mental illness

Research Methodology

The research will comprise two elements: (i) evidence synthesis (in the form of a systematic review) of published and grey literature, including both research using animal models as well as studies in humans; and (ii) establishing the acceptability and feasibility of undertaking a trail of ketogenic diets in people with SMI through consultation with lived experience experts, and through interviews and focus groups with people with SMI and professionals responsible for their care.

Expected Outcome

There will be two outcomes: (i) a systematic review suitable for publication in a peer-reviewed journal; and (ii) a qualitative paper reporting the findings of the acceptablity and feasibility study. This report will also be used to inform the desgn of a grant application for a randomised clinical trial, which the student will be invited to contribute to (and be credited for) beyond their BMedSci year.

Type of Project

Clinical project - based in the clinical environment with patients/including service evaluation

Additional Training

The student will be provided with training in evidence synthesis and qualitative research methodds. They will also have the opportunityof placements with the R&D team at Sheffield Health and Social Care NHS Foundation Trust, to learn about clinical trials (including training in Good Clinical Practice in Research).

Hospital admission with sepsis and the sepsis-3 definition

Main Supervisor

Professor Steve Goodacre (s.goodacre@sheffield.ac.uk)

Second Supervisor

Dr Gordon Fuller (g.fuller@sheffield.ac.uk)

Aim and Objectives

Sepsis is a common reason for hospital admission in which the body's reaction to infection leads to major organ failure and life-threatening illness. Sepsis has recently been defined using the sepsis-3 definition as a combination of evidence of infection alongside organ failure, determined using the Sequential Organ Failure Assessment (SOFA) score. The SOFA score was developed in the critical care setting and may not be useful for diagnosing sepsis in the majority of patients, who are not admitted to critical care. In these patients the combination of infection and organ failure may more commonly reflect underlying long term conditions, such as chronic lung, heart or kidney disease, rather than a reaction to infection.

This study aims to explore how the sepsis-3 definition applies to patients admitted to hospital with sepsis. The specific objectives are:
1. To determine the proportion of patients admitted with an International Classification of Diseases (ICD10) diagnosis of sepsis who meet the sepsis-3 definition.
2. To determine what elements of the sepsis-3 definition are most frequently met among people admitted with sepsis.
3. To determine the extent to which organ failure in people with the sepsis-3 definition represents new organ failure or worsening of a long term condition.

Research Methodology

This will be a retrospective observational study using hospital record review. The student will review a sample of adult patients admitted to hospital with an ICD10 diagnostic code for sepsis and collect data to calculate the SOFA score. Descriptive statistical analysis will determine the proportion of patients meeting the sepsis-3 definition and identify whether the SOFA score criteria reflect an acute response to infection or underlying long term conditions.

Expected Outcome

The study will determine how well the sepsis-3 definition, and specifically the SOFA score, identifies organ failure due to infection or underlying long term conditions. This will have important implications for clinicians who treat sepsis and research into sepsis outside the critical care setting. It should result in peer reviewed publication and presentation at a national conference.

Type of Project

Clinical project - based in the clinical environment with patients/including service evaluation

Additional Training

Training opportunities in research methods, data management, and statistical analysis will be available in the School of Health and Related Research. The student will also have the opportunity to learn about the diagnosis and management of sepsis in the emergency department of the Northern General Hospital.

Urgent and Emergency Care (UEC): managing demand and flow

Main Supervisor

Professor Suzanne Mason (s.mason@sheffield.ac.uk)

Second Supervisor

Mr Colin O'Keeffe (c.okeeffe@sheffield.ac.uk)

Aim and Objectives

To identify opportunities for improving management of demand in the urgent and emergency care (UEC) system

Research Methodology

After an iterative process with the supervisors a topic and research questions for the project will be decided. This will focus on either 1) an understanding of demand from a selected patient group (e.g. frail older people, mental health) or the impact of a particular service model (e.g ED frail older model, ED psychiatric liaison). A literature review will be undertaken to determine a comprehensive understanding of the agreed topic. The project will also include a further research methodology to be determined by the research question, but may include statistical analyses of datasets, survey or interviews with health professionals.

Expected Outcome

This work is part of the ARC Urgent and Emergency Care Research Theme, based in ScHARR. The work will be a project within the research programme which started in October 2019 and is developing knowledge and interventions to improve urgent and emergency (UEC) care within Yorkshire and Humber. The outcomes of the project will be to produce outputs and undertake dissemination activities to key stakeholder groups in UEC. An example would be delivering an abstract to the Royal College of Emergency Medicine Scientific Conference (RCEM). A journal article may also be produced from findings of the study.

Type of Project

Qualitative Project/non-lab based - primarily using qualitative methods

Additional Training

As part of a thriving and busy research environment within ScHARR, the student will have guidance of experienced researchers within their chosen methodology.

Do blood biomarkers predict clinically important deterioration in alert (GCS13-15) patients with traumatic brain injury identified on CT imaging?

Main Supervisor

Dr Carl Marincowitz (c.marincowitz@sheffield.ac.uk)

Second Supervisor

Professor Fiona Lecky (f.e.lecky@sheffield.ac.uk)

Aim and Objectives

We aim to assess whether blood biomarkers:
1) predict clinical deterioration including need for neurosurgery or death in GCS13-15 patients with traumatic brain injuries identified on CT imaging
2) whether use can improve clinical decision making regarding need for hospital admission in this group.

Research Methodology

We have previously identified a cohort of 1050 GCS13-15 patients with with traumatic brain injuries identified on CT imaging in the large multi-centre CENTRE TBI cohort study and used this to validate a decision rule to select low risk patients for early discharge from the Emergency Department.

A student conducting this project would be expected to complete a short literature review regarding potential biomarkers that may predict clinical deterioration in this population of patients with traumatic brain injury.

All patient recruited to the CENTER-TBI cohort study had a range of biomarkers measured in blood samples taken at time of hospital attendance. With supervision regarding use of statistical methods and software packages like SPSS and STATA the association between presence/concentration of biomarkers and clinical deterioration will be assessed in the cohort of 1050 patients. We would assess whether inclusion of biomarkers improves performance of our previously derived decision rule.

Expected Outcome

1) Literature review regarding biomarkers and prediction of clinical outcomes in traumatic brain injury
2) Analysis regarding whether biomarkers predict deterioration in this group
3) Analysis regarding whether inclusion of biomarkers improves performance of decision rule to select low risk patients for discharge from the Emergency Department

This would be expected to be submitted as a conference abstract and form the basis of a journal submission.

Type of Project

Clinical project - based in the clinical environment with patients/including service evaluation

Additional Training

Training in relevant statistical methods.

Evaluation of NEWS2 as an Emergency Department Triage Tool

Main Supervisor

Professor Steve Goodacre (s.goodacre@sheffield.ac.uk)

Second Supervisor

Dr Gordon Fuller (g.fuller@sheffield.ac.uk)

Aim and Objectives

The National Early Warning Score version 2 (NEWS2) is a simple clinical score based on routinely recorded clinical measurements that is used across the NHS as a standardised way of assessing acute illness severity. NEWS2 is recorded on all patients arriving at the Emergency Department (ED) with acute illness. It can be used to assist ED triage decisions, involving prioritising patients for urgent treatment, but it is not known how well NEWS2 predicts the need for urgent treatment. This project aims to determine the accuracy of NEWS2 in predicting the need for urgent treatment among patients attending the ED.

Research Methodology

Quantitative retrospective observational cohort study. The student will use the ED IT system to select a cohort of patients who attended the ED with acute illness, and extract data recording their characteristics, NEWS2 scores, treatments, and outcome. They will then review ED records of cases with selected treatments or outcomes to determine whether they needed urgent treatment. Statistical analysis will involve estimating the accuracy of NEWS2 in predicting the need for urgent treatment, and decriptive analysis of false negatives (patients requiring urgent treatment not prioritised by NEWS2) and false positives (patients prioritised by NEWS2 but not requiring urgent treatment).

Expected Outcome

The study will determine the potential role of NEWS2 in ED triage. It will inform ED care and the development of future research in this area. Previous emergency medicine BSc projects have resulted in presentation at a national conference and publication in a peer-reviewed journal. If successfully completed, this project would be expected to achieve the same.

Type of Project

Clinical project - based in the clinical environment with patients/including service evaluation

Additional Training

The project will involve additional training in information governance, data management, and statistical analysis using software, such as SPSS.

Urgent and Emergency Care (UEC): managing demand and flow

Main Supervisor

Professor Suzanne Mason (s.mason@sheffield.ac.uk)

Second Supervisor

Mr Colin O'Keeffe (c.okeeffe@sheffield.ac.uk)

Aim and Objectives

To identify opportunities for improving management of demand in the urgent and emergency care (UEC) system

Research Methodology

After an iterative process with the supervisors a topic and research questions for the project will be decided. This will focus on either 1) an understanding of demand from a selected patient group (e.g. frail older people, mental health) or the impact of a particular service model (e.g ED frail older model, ED psychiatric liaison). A literature review will be undertaken to determine a comprehensive understanding of the agreed topic. The project will also include a further research methodology to be determined by the research question, but may include statistical analyses of datasets, survey or interviews with health professionals.

Expected Outcome

This work is part of the ARC Urgent and Emergency Care Research Theme, based in ScHARR. The work will be a project within the research programme which started in October 2019 and is developing knowledge and interventions to improve urgent and emergency (UEC) care within Yorkshire and Humber. The outcomes of the project will be to produce outputs and undertake dissemination activities to key stakeholder groups in UEC. An example would be delivering an abstract to the Royal College of Emergency Medicine Scientific Conference (RCEM). A journal article may also be produced from findings of the study.

Type of Project

Qualitative Project/non-lab based - primarily using qualitative methods

Additional Training

As part of a thriving and busy research environment within ScHARR, the student will have guidance of experienced researchers within their chosen methodology.