Sheffield Children's Hospital projects

Projects:

Validation of a clinical algorithm for fitting children's NIV masks

Main Supervisor

Professor Heather Elphick (h.elphick@nhs.net)

Second Supervisor

Dr Sarah Shortland (s.shortland3@nhs.net)

Aim and Objectives

To validate a flowchart that directs the choice of the most suitable mask for children requiring NIV (Non-invasive ventilation)

Research Methodology

1. To undertake a review of currently available NIV masks for children
2. To work alongside the NIV clinical nurse specialists to design a flowchart for matching a child to the most suitable mask
3. To work with the SCH PPIE specialist to gain feedback from patients, parents and other NIV professionals in a focus group setting
4. To validate the flowchart using the NIV nurse specialist as the gold standard
5. This is part of a large NIHR funded project that is producing bespoke masks for children using NIV. The student would have the opportunity to work with the other members of the larger team: design research, software research, 3D imaging lab and the NIV clinical team.

Expected Outcome

The results will be presented at the British Sleep Society conference and will be published. The flowchart will be used y NIV teams nationally and will also inform the design of a software programme that may ultimately automate the process.

There will be opportunities to be involved in writing up other aspects of the project if interested.

Type of Project

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

Additional Training

Clinical teaching in respiratory and sleep medicine.
Opportunity to learn lab-based techniques from other members of the research team as well as learning about MedTech development

Risk factors associated with post viral respiratory morbidity in paediatric population

Main Supervisor

Dr Kelechi Ugonna (k.ugonna@nhs.net)

Second Supervisor

Dr Sonal Kansra (sonal.kansra@nhs.net)

Aim and Objectives

The primary objective of this study will be to understand what are the factors in acute bronchiolitis that are associated with prolonged hypoxia
The secondary objective will be To describe the clinical characteristics of children admitted with bronchiolitis who continue to be hypoxic(need oxygen)>3/4 weeks and identify is there are any predictors of Bronchiolitis obliterans.

Research Methodology

The main objective of this study will be to understand how quickly hypoxia results in children with bronchiolitis resolves and what factors are associated with prolonged hypoxia. The student will recruit patients during the bronchiolitis season, collect demographic information about them and perform an oximetry at discharge and then an oximetry every 2/4 weeks at home until the patients median/mean saturations >96%

The second part of the study is a service evaluation identifying all patients diagnosed with Bronchiolitis obliterans in our service and determine clinical and demographic details associated with this to see if there is a pattern.

Expected Outcome

The main underlying need for the study is to understand implication being to understand if there is a threshold after which if there is persistent hypoxia there is more likely to ongoing respiratory morbidity . This then helps us identify a window of opportunity to intervene in this small cohort of children to modify disease progression and help to prevent long term morbidity and bronchiolitis obliterans.

Type of Project

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

Additional Training

The student will have the opportunity to perform a prospective study in clinical environment from August till March during the bronchiolitis season whilst undertaking a detailed service evaluation spanning back several years to determine if there are any lessons to be learnt from previous patients who have been diagnosed with Bronchiolitis obliterans in Sheffield Children's hospital.

The student will also have the opportunity to attend respiratory clinics and do home visits with our specialist home oxygen nurses.

Identifying factors associated with azithromycin resistance in nasal microbiome in children.

Main Supervisor

Dr Kelechi Ugonna (k.ugonna@nhs.net)

Second Supervisor

Dr Fiona Shackley (fiona.shackley@nhs.net)

Other Supervisors

Dr Simon Hardman

Aim and Objectives

The primary objective will be to identify what the level of azithromycin resistance in nasal flora of children without respiratory co-morbidity and compare it with the level we have already observed in children with protracted bacterial bronchitis
The secondary objective will be to identify demographic features, prescribing patterns (in both primary and secondary care), and clinical factors in both groups that may be associated with azithromycin resistance.

Research Methodology

The student will prospectively recruit 20 children without respiratory co-morbidity between the ages of 1 and 7 years old. They will perform a single nasal swab and they will analyse this swab for microbiology and antimicrobial resistance. This will be compared to similar data already obtained for patients who have a diagnosis of bacterial bronchitis.
The student will then undertake a study to identify detailed clinical and prescribing history in both patient groups to see if there are any factors that are related to increased azithromycin resistance in these study groups.

Expected Outcome

Our research group has already identified that patients with bacterial bronchitis (even those who have not been treated with Azithromycin) have a really high rate of resistance to this antibiotic.
We would like to identify whether this rate is higher than the background rate of our population and we would further like to identify whether there are any clinical, demographic and prescribing factors that are associated with this resistance.

Type of Project

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

Additional Training

This will be a clinical project involving recruiting children and performing nasal swabs. The student will also benefit from being shown how to analyse nasal swabs for microbiology and also antibiotic resistance.
In addition, the student will be able to attend and sit in on paediatric respiratory clinics for their experience.

Quantitative MRI in children with hereditary spastic paraparesis

Main Supervisor

Dr Anthony Hart (A.R.Hart@sheffield.ac.uk)

Second Supervisor

Dr Paul Armitage (p.armitage@sheffield.ac.uk)

Aim and Objectives

To determine whether quantitative MRI techniques, including fractional anisotropy using diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) differ between children with hereditary spastic paraparesis (HSP) and those with cerebral palsy

Research Methodology

We have been collating MRI scans on children and young people with HSP since October 2020. This is a genetic condition that mimics cerebral palsy. The student will be expected to learn how to analyse the data from DTI and MRS with supervision. They can then compare these values to children without HSP, such as cerebral palsy. We can look at the genetic mutations these children have and the severity of their symptoms from medical notes. The student will also perform a literature review to look at presentations of HSP in children and the role of DTI.

Expected Outcome

The student will find out whether specialist MRI techniques are useful to diagnose HSP, speeding up the diagnosis process. We will also gain a better understanding of how this group of conditions presents in children and young people to ensure they get diagnosed correctly early on. We hope the work would lead to a review paper on the presentation of HSP in children and young people and also this pilot data from DTI.

Type of Project

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

Additional Training

Students will be training in literature search, the basics of what HSP is and the genes involved. Through the Academic Unit of Radiology, we will train students how to generate and calculate values from the MRI / DTI scans. Statistical support will be provided to compare these values between groups.

Quantitative markers of brain development and injury on MRI in children with ataxia

Main Supervisor

Dr Santosh Mordekar (Santosh.Mordekar@nhs.net)

Second Supervisor

Dr Paul Armitage (p.armitage@sheffield.ac.uk)

Aim and Objectives

To determine whether we can find microscopic changes to the cerebellum using sophisticated forms of MRI in children and young people with ataxia

Research Methodology

Sheffield hosts the UKs only ataxia clinic for children and young people. Since 2020, we have been collecting data using sophisticated MRI techniques, including diffusion tensor imaging. We have also been collecting this data in patients without ataxia who have scans for conditions like headaches. This pilot work will examine whether these techniques can identify abnormalities to the cerebellum before they become visually apparent on the conventional MRI scan, and see how they correlate to diagnosis / gene mutations and severity of ataxia. The student will be taught how to generate the values on DTI by radiology staff, and will be expected to collect data from the MRI-DTI scans of children and young people with and without ataxia. They will perform statistical analysis to compare these results. We also expect the student to perform a literature review to identify other papers using similar techniques in children with ataxia.

Expected Outcome

1) we expect a paper to be generated that would be publishable in a journal showing whether DTI values from MRI differ between children with and without ataxia, and looking at their correlation with clinical severity / features. 2) a literature review summarising previously published data on quantitative measures of the brain using MRI in children with ataxia.

Type of Project

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

Additional Training

Support will be provided on 1) literature search technique; 2) basics of MRI and DTI; 3) how to measure and calculate values from MRI-DTI; 4) statistical analysis of data; 5) writing thesis / scientific papers