School of Health and Related Research projects

Projects:

Incidental findings in emergency department investigations

Main Supervisor

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

Second Supervisor

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

Aim and Objectives

(1) To determine the prevalence and significance of incidental findings in emergency department investigations, or (2) To explore patient or clinician perceptions of how incidental findings should be managed. Emergency department investigations often identify incidental findings, i.e. abnormalities that are unrelated to the condition that caused the patient to present to hospital. These vary in significance but create a substantial challenge for emergency department clinicians, who must decide whether to inform the patient of the findings and whether to recommend action on the basis of the findings. We currently know little about the frequency or significance of incidental findings, how clinicians currently manage incidental findings, or whether patients want to be informed of incidental findings when their significance is unclear. This project offers the opportunity to address one of these areas of uncertainty.

Research Methodology

The student will choose the specific research objective, after discussion with the supervisor, and develop skills in an appropriate methodology. Objective (1) would be addressed using quantitative methods, involving data collection from hospital records, and analysis using statistical techniques. Objective (2) would be addressed using qualitative methods, involving face-to-face semi-structured interviews with patients or clinicians, and analysis using a qualitative framework.

Expected Outcome

Objective (1) will provide estimates of the frequency of incidental findings in emergency department investigations and the impact on clinical work and patient experience. Objective (2) will provide insights into how clinicians manage incidental findings or how patients would like incidental findings to be managed. Either project would be expected to result in presentation at a national conference and publication in a peer-reviewed journal.

Type of Project

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

Additional Training

Objective (1) will involve additional training in information governance, data management, and statistical analysis using software, such as SPSS. Objective (2) will involve additional training in qualitative interview techniques, analysis of qualitative data, and use of analytical software, such as NVIVO.

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.

An evaluation of Emergency Department CT imaging of patients who present after 24 hours following head injury.

Main Supervisor

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

Second Supervisor

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

Aim and Objectives

To characterise the size of the population of head injury patients who present after 24 hours of injury and compare CT imaging indications and injuries identified in fully alert patients who present with and without a delay.

Research Methodology

Over 1.4 million patients attend Emergency Departments (EDs) annually following head injury in the UK. 95% of patients attend with an initial GCS of 13-15 and are defined as having a minor head injury. 1% of these patients have life threatening traumatic brain injury (TBI). We use the NICE guidelines to decide which of these patient require a CT scan in the ED due to their risk of serious injury. These guidelines are based on evidence collected on patients presenting within 24 hours of injury. Current CT imaging practice and outcomes in patients who present after this is not well characterised.

This project will involve a case note review of patients who present to the ED with a head injury. Analysis will be undertaken to estimate the proportion of head injured patients who present after 24 hours of injury. Population characteristics, adherence to NICE guideline indications for CT imaging and outcomes in patients presenting within and after 24 hours of injury will be compared.

We will also survey a population of ED clinicians nationally to assess current CT imaging practices for patients with minor head injury who present after 24 hours of injury.

Expected Outcome

The student is expected to complete a supervised case note review of head injury patients presenting to the ED and national survey of ED clinicians.

They will analyse the data collected and present it with a review of existing literature to form their thesis.

Type of Project

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

Additional Training

The student will be provided with additional training in statistical analysis including the use of packages such as STATA and in survey methodology.

Which patients need a CT scan following a minor head injury when taking direct acting oral anticoagulants?

Main Supervisor

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

Second Supervisor

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

Aim and Objectives

In patients taking direct acting oral anticoagulants following mild head injury:

1. What are the individual clinical predictors of adverse outcome?
2. Can clinical predictors be grouped into an accurate clinical decision rule to guide imaging decisions?

Research Methodology

A retrospective cohort study will be performed. Demographic, clinical and outcome data will be collected from clinical records of patients presenting with mild head injury to the Northern General Emergency Department. The cohort characteristics will be described. The risk of traumatic intracranial haemorrhage will be determined. The association between individual clinical predictors and adverse outcome will be explored. Clinical predictors will then be grouped into a clinical decision rule with a view to guiding emergency department imaging decisions.
 

Expected Outcome

• Poster presentation at the Royal College Emergency Medicine annual scientific conference
• Scientific paper published.

Type of Project

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

Additional Training

Training in STATA statistical package.

Investigating Underlying Acute Medical Events in Older Patients with Traumatic Brain Injury

Main Supervisor

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

Second Supervisor

Dr Michael Tonkins (m.tonkins@sheffield.ac.uk)

Aim and Objectives

Aim: to establish the prevalence of acute medical events in older patients with traumatic brain injury.

Objectives:

1. To identify a cohort of older adult patients with traumatic brain injury due to a fall from standing height.

2. To conduct a chart review of these patients to establish the presence nature of any acute diagnoses which may have precipitated the fall.

Research Methodology

This will be a retrospective cohort study based on patients' hospital data. The data set in question will be collected in collaboration with other B Med Sci students working on other research questions within the same patient cohort.

Students can expect the following roles in the project:

1. Assisting with refining the research question and project design. This is often the most important skill and one of the hardest to master.

2. Liaising with governance structures within the NHS surrounding research applications, ethical approval and information governance.

3. Data collection, in collaboration with other students. Whilst time-consuming, having experience of data collection gives insights into what is and is not possible, and how the data can be used.

4. Analysis. Students will be guided in conducting their own analysis of the data, including the application of appropriate statistical tests. The student's analysis will relate to their own uniqu research question, even though other students may be using the same data for other projects.

5. Writing up. Students will be supported in the process of writing up the results of the project for publication, if possible and desirable.

6. Dissemination. Students will be supported through the submitting of results to other fora for presentation, including as conference abstract or poster presentations.

Expected Outcome

Local outcomes include:
1. Presentation of the results to relevant local morbidity and mortality meetings
2. Poster for appropriate area: the Medical School, ScHARR or clinical areas.

Other outcomes include:
3. Submission of results to relevant conference for consideration as a poster or short verbal presentation
4. Submission of results for publication in peer-reviewed journal.

Type of Project

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

Additional Training

Students will receive mentoring and responsive support throughout the project. They will be directed towards further resources in clinical research as appropriate.