Sheffield Children's Hospital projects

Projects:

Digital twin of a Fracture Surgery Robot

Main Supervisor

Mr Sanjeev Madan (s.madan@sheffield.ac.uk)

Second Supervisor

Professor Reza Saatchi (r.saatchi@shu.ac.uk)

Other Supervisors

Prof Sanja Dogramadzi

Aim and Objectives

This project will aim to build a digital twin of a Fracture Surgery Robot that will then be trained using Machine Learning (ML) to perform surgery and autonomously correct surgeon's mistakes in order to optimise the outcome for patients.

Research Methodology

They will look at X-ray and CT scans of Tibia, knee and ankle fractures, classify them and upload it to a server. They will work with a PhD student and robotic professor to analyse the data. There will be assessment of tissue forces using robotic tools in cadavers. This will help to build tools and instruments for surgery.

Expected Outcome

Pre-operative images and intra-operative optical trackers will allow the fragments to be simulated in space and the robot to know it’s current position in the body, therefore enabling it to calculate positional vectors of a target alignment.
The use of Digital Twins (DT) in healthcare provides a way for researchers to investigate new technologies in a low cost way without having to disrupt ongoing medical treatment. The use of a DT in this application would be highly advantageous as it would allow a highly precise robot to be built and trained using ML without having to continuously test on expensive material replicas of human fractures.

Type of Project

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

Additional Training

The students will be assisting in operating theatre and scrubbing whenever they can. They will attend clinics and ward rounds. They will get clinical experience and will be taught basic surgical techniques like suturing and closure of wounds in operation theatre. The students are flexible as and when they can attend and as much as they want to attend. There are no restrictions on their clinical experience.

A digital application to support sick day management in type 1 diabetes

Main Supervisor

Dr Neil Wright (neil.wright1@nhs.net)

Second Supervisor

Dr Elspeth Ferguson (elspethferguson@nhs.net)

Other Supervisors

Dr Astha Soni

Aim and Objectives

Primary objectives: To demonstrate that using the app in sick-day scenarios results in correct insulin doses being calculated.

Secondary objectives: To demonstrate that using the app improved confidence in managing sick days. Secondly to determine how acceptable using the app is to our participants and thirdly to gain qualitative views on managing sick-days amongst young people with T1DM and their parents.

Research Methodology

We plan to recruit two groups of participants (one group of adolescents with type 1 diabetes and one group of parents/guardians of younger children with diabetes), from our diabetes clinics at Sheffield children's hospital to our study. This will be a randomised cross-over trial with participants completing questions on hypothetical scenarios relating to sick-day management on two separate occasions. On one occasion traditional methods will be used for support and on the other occasion the app will be used for support.

The student will be expected to recruit participants from clinic and conduct the sessions where participants will complete the questionnaires. The student will also complete a number of qualitative interviews in a small subset of participants exploring their views around managing sick days. Support will be given where required in qualitative interviewing techniques.

Following data collection the student will analyse the data and present the findings in their thesis. It is hoped the findings from this study, if demonstrating the app is accurate and acceptable, will lead to a larger study with real world use of the app.

Expected Outcome

The project is expected to provide evidence as to whether the app is safe and effective. If this is found to be the case it is hoped this will lead to a larger study with real world use of the app.

Type of Project

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

Additional Training

Students will be supported in learning qualitative research methods required for the structured interviews. Support will be given for statistical analysis if required but statistical methods are likely to fall within the remit of the statistical course.

Aerobic Fitness in Paediatric Narcolepsy and control of symptoms

Main Supervisor

Dr Kelechi Ugonna (k.ugonna@nhs.net)

Second Supervisor

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

Aim and Objectives

1) To determine if increased physical activity is associated with better control of Paediatric Narcolepsy symptoms
2) To determine if increased aerobic fitness (VO2 peak) is associated with better control of Paediatric Narcolepsy symptoms.

Research Methodology

We will aim to recruit 20 Narcolepsy paediatric Narcolepsy patients and perform and assessment of their current physical activity, aerobic fitness and narcolepsy control with a combination of questionnaires and clinical tests (Cardiopulmonary exercise test).
The student will be expected to recruit participants, conduct clinical questionnaires and help with the clinical testing.

Expected Outcome

Each patient will have a Narcolepsy sleep assessment including Ullanlina Narcolepsy Scale, Epworth Sleepiness Scale , Daytime Sleepiness Scale and a Cataplexy Scale as well as a Physical Activity assessment. The expectation is that there will be a negative correlation between amount of physical activity taken and sleepiness and cataplexy.
A selection of these patients will go on to have a CPET which will accurately measure markers of aerobic fitness including a VO2 peak. Again the expectation is that there will be a negative correlation between this and sleepiness and cataplexy.

Type of Project

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

Additional Training

Student will learn how to undertake qualitative research with clinical questionnaire. They will learn statistical methods on how to present this data meaningfully.

They will participate in cardiorespiratory exercise testing and learn how to analyse this data and interpret it.
The student will also have the opportunity to integrate into paediatric clinical teams including respiratory and sleep teams and attend selected clinical activities that are not necessarily directly related to their project as time allows.

Materials Development and Pilot Evaluation of 3D-designed Custom-made Integrated Mask/Headgear for Children using Non-Invasive Ventilation

Main Supervisor

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

Second Supervisor

Dr Nicki Barker (n.barker@nhs.net)

Aim and Objectives

1. Patient/parent participation will be secured using focus groups which will advise on study documents and the final materials choice for the mask/headgear

2. Facemask and headgear prototypes have already been developed using 3D technology separately but an up-to- date review of 3D printing materials will be carried out by an expert in materials for additive manufacturing

3. A pilot trial of 10 children will answer the research question.

Research Methodology

Ethics approvals are already in place. NIHR CRN portfolio adoption will be obtained.
A pilot trial of ten children aged 0-16 years with a long-term condition requiring NIV will de-risk a future multicentre clinical trial. A custom-made mask/headgear will be produced for each child and compared with the patient’s usual mask using a cross-over design. 

Outcome measures:
• Comfort, measured by diary-cards
• Mask fit, measured by ventilator SD-card leak data
• QOL, measured by questionnaire
• Ventilator efficacy, measured using respiratory gas measurements (SpO2/TcpCO2)
• Sleep quality measured using actigraphy

Expected Outcome

The patient engagement sessions and pilot study will produce data to support an application for a NIHR research grant for a multicentre trial.
The data will be written up and published.

Eventually it is anticipated that the custom-made mask/headgear will become adopted into clinical services for children using non-invasive ventilation.

Type of Project

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

Additional Training

The student will be trained in PPIE (Patient and Public Involvement and Engagement) techniques, will have the opportunity to observe the additive manufacturing materials work, will learn to 3D scan patients' faces and will learn how to carry out a clinical trial including recruitment, consent, evaluation - all under supervision from the research team.

The student will also be able to be involved in the clinical management of children using non-invasive ventilation including clinics, ward rounds, lung function testing and sleep studies.

Can indocyanine green accurately predict testicular torsion in children?

Main Supervisor

Dr Caroline MacDonald (carolinemary.macdonald@nhs.net)

Second Supervisor

Mr Prasad Godbole (p.godbole@nhs)

Other Supervisors

Dr Simon Hardman

Aim and Objectives

Torsion of testis is a time critical condition which requires urgent operation. Unfortunately, in children is difficult to diagnose. With missed torsion leading to testicular loss and overdiagnosis leading to excessive numbers of scrotal explorations with a normal lying testis. At present there is no test validated to improve the diagnostic pathway. Indocyanine green is an exciting possibility with early case reports showing its ability to expose flow versus no flow in a testicle. We aim to investigate the technology in its ability to diagnose testicular flow in comparison to surgical findings, and its acceptability to families.

Research Methodology

All children booked for exploration of scrotum over a 12 month period, for suspected torsion will undergo indocyanine green imaging and image capture prior to scrotal exploration. Images will be analysed by the successful applicant, blinded to the surgical findings, for an absolute and graduated scale. Demographic and comparative analysis will be performed using whichever stats package the student feels comfortable with (STATA/ SPSS / Medcalc) to assess diagnostic accuracy for the new technology for objective testicular torsion.

Expected Outcome

The project will confirm or refute the diagnostic accuracy of ICG for torsion of testis. The project will not affect the management pathway for torsion of testis. We aim to produce sensitivity, specificity, negative predictive value, positive predictive value for ICG for torsion of testis in children.

Type of Project

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

Additional Training

N/A

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.