Sheffield Teaching Hospitals Trust projects

Projects:

An investigation into the surveillance and outcomes for visceral aneurysms

Main Supervisor

Dr Saima Ehsan (saima.ehsan@nhs.net)

Second Supervisor

Dr Stephen Goode (stephen.goode3@nhs.net)

Aim and Objectives

The aim of this study is to look at the natural history of Visceral aneurysms detected at STH, observe the rate of growth and outcomes of intervention.

Research Methodology

Retrospective analysis of visceral aneurysms detected and manged at STH observing the rate of growth and outcomes of intervention. This will involve analysis using CT and Ultrasound imaging and interrogating local databases.

Expected Outcome

An informed and evidence based approach for the management of visceral aneurysms is needed. This study could lead to a change in surveillance intervals and modalities used. Some current evidence suggest that surveillance intervals can be safely increased but there have been no coordinated large-scale studies. Standardization of management could lead to better use of resources (scans/ appointments and intervention) and improve patient experience.

Type of Project

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

Additional Training

Training in vascular imaging and opportunity to be involved in the clinical vascular department from a vascular surgery and interventional radiology perspective

Complications of Hysterectomy

Main Supervisor

Professor Swati Jha (swati.jha1@nhs.net)

Second Supervisor

Dr Helen Burgess (helen.burgess13@nhs.net)

Aim and Objectives

To determine the safest route of surgery for hysterectomy for benign conditions. We also aim to assess if the trends of approach have changed over time e.g. increased laparoscopic hysterectomy rates

Our objective would be to add additional information to existing evidence which would aid the choice of route for women undergoing hysterectomy for benign conditions where no clear route preference is already defined by clinical factors

Research Methodology

This will be a single-centre study using operating theatre database and hospital episode data relating to complications of hysterectomy. All women undergoing hysterectomy either laparoscopically (total laparoscopic or lap assisted), abdominally, vaginally or robotically for benign disease over a 12 year period between 2010 – 2022 will be included using ORMIS database information from the time period identified.

Data collected from the ORMIS database and hospital episode data will include:
- Demographic data:
o Age
o BMI
o ASA
- Route of surgery (i.e. total abdominal hysterectomy, total laparoscopic hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy)
- Indication for surgery
- Intra-operative complications:
o Haemorrhage/EBL – major haemorrhage being classified as >1l
o Organ injury e.g. bowel, bladder, ureter
o Return to theatre
o Conversion to laparotomy (for minimally invasive approaches)
- Operating time
- Surgeon grade
- Length of stay in hospital
- Readmission

The proportion of hysterectomies carried out by each route will be calculated for each year overall and for each primary diagnosis by year. Comparisons between 2010 and 2020 will be using chi-square test. Rank correlation coefficients will be used to calculate trends over the study period.

When undertaking this project you will be involved in data collection, analysis and writeup of the project with support from supervisors. This project will aim to be submitted for publication

Expected Outcome

Recommendations for practice from the Cochrane review in 2015 were that vaginal hysterectomy is the approach with the lowest risks, quickest return to normal activity and discharge from hospital, and should therefore be performed whenever possible. However, the learning curve for laparoscopic hysterectomy has been suggested to exceed 25 cases. Therefore, the high complication rate observed in the data included in the Cochrane review could have been due to relative inexperience of surgeons in that technique, rather than an issue with the approach itself.

Given that, we expect our results to show a lower rate of intra-operative complications for laparoscopic hysterectomy. We would expect laparoscopic hysterectomy to have lower length of stay in hospital and lower rates of haemorrhage than other approaches.

We would also expect rates of laparoscopic to have increased over time, and rates of abdominal and vaginal hysterectomy to decrease over time.

Type of Project

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

Additional Training

Research Methodology; Analysis if large data sets; Understanding NHS databases. Attendance at Clinics and Theatres if the student wishes

SMuRFS 5 (Sheffield MUltiple RIb Fractures Study): Testing the Sh-Ch Classification

Main Supervisor

Mr John Edwards (john.edwards3@nhs.net)

Second Supervisor

Mr Ashok Kar (ashok.kar@nhs.net)

Aim and Objectives

Aim:
To test the clinical significance of the proposed Sh-Ch Classification

Objectives
1. Characterise the Sh-Ch Classification in a large institutional database
2. Test the Sh-Ch Classification according to clinical outcomes (e.g. clinical management, complications, in-hospital outcomes, resources utilisation)
3. Evaluate Patient Reported Outcome Measures for Sh-Ch injuries in a retrospective and prospective study using clinical outcome measures

Research Methodology

1. Evaluate the evidence for the relevant clinical issues pertinent to combined shoulder - chest injuries with a literature search
2a. Expand an existing database inputting routinely available radiological, clinical management and outcome data (Data Entry and Case Note review)
2b. Design and conduct a study investigating Patient Reported Outcome Measures relevant to Shoulder and Chest injuries, with retrospective and prospective components
3. Analysis of outcomes of 2a and 2b in order to test the relevance of the Sh-Ch Classification

Other avenues of investigation may be followed, depending on the progress of the study and the outcomes .

Expected Outcome

Abstract submission to National and International Societies (e.g. Society for Cardiothoracic Surgery in Great Britain and Ireland; Chest Wall Injury Society
Publication(s) in peer reviewed journals (e.g. Journal of Trauma and Acute Care Surgery)

The project supervisor has a proven track record of intercalated medical students presenting and publishing their work at this level, with 8 students achieving first class and two 2:1 intercalated degrees, and numerous national and international presentations and publications.

The outcomes of this research question will help to improve the management of trauma patients within the South Yorkshire Major Trauma Network and beyond

Type of Project

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

Additional Training

1. Management and analysis of Large Patient Databases (n=3000)
2. Systematic Literature Review
3. Exposure to thoracic surgery clinical environment including Lung Cancer MDTs, Clinics and operating theatres.

Role of Adjuvant Chemotherapy and Immunotherapy in Patients Undergoing Surgery for Non-Small Cell Lung Cancer

Main Supervisor

Mr Ashok Kar (ashok.kar@nhs.net)

Second Supervisor

Mr John Edwards (john.edwards3@nhs.net)

Aim and Objectives

Recent clinical trials and the development of novel targeted chemotherapy and immunotherapy drugs have demonstrated improved survival for patients after undergoing surgery for Non-Small Cell Lung Cancer (NSCLC) with curative intent. However there is already well established evidence for conventional chemotherapy in the adjuvant setting following surgery, albeit without as significant a survival benefit.

The aim of this study would be to retrospectively analyse the Sheffield Teaching Hospitals, Department of Thoracic Surgery Lung Cancer Surgery Database to:

1. Identify Factors that determine whether patients receive adjuvant chemotherapy following Surgery for Non-Small Cell Lung Cancer

2. Analyse the outcomes in surgical patients undergoing adjuvant medical oncological treatment and predictors of overall and disease free survival

3. Establish if their has been a change in practice, with the development of novel chemotherapy and immunotherapy agents, and whether this has impacted on survival.

This project will be used to evaluate the effectiveness of lung cancer operations followed by adjuvant chemotherapy and/or immunotherapy in South Yorkshire. It may help to identify barriers to being offered, receiving and completing adjuvant treatment and reduce health inequalities. The data will be used to compare outcomes to the wider literature and then be used to inform future practice.

Research Methodology

1. Evaluate the evidence for adjuvant chemotherapy and immunotherapy following surgery for Non-Small Cell Lung Cancer with curative intent (literature search)

2. Expand an existing database inputting available surgical, oncological, clinical management of lung cancer resections in STH between 2005 and 2023, specifically focusing on patients who are suitable for adjuvant medical oncology treatment (Data Entry and Case Note review)

3. Design pilot (n=25) to interrogate eligible patients for adjuvant chemotherapy from the surgical database before applying this to the entire series (N ~600) to understand the factors that determine whether patients are offered, receive and complete treatment.

4. Analysis of outcomes and develop a statistical predictive model for predictors of overall and disease free survival (SPSS statistical software)

5. Compare conventional chemotherapy with novel targeted chemotherapy and immunotherapy.

Expected Outcome

It is expected that this project will be presented at an International or National Meeting (abstract) leading to publication in peer reviewed journal.

The department of thoracic surgery at STH has a proven track record of intercalated students sharing their work at this level.

Moreover this specific research question will help to improve and evaluate the management of lung cancer surgery patients in the adjuvant setting within South Yorkshire.

Type of Project

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

Additional Training

1. Management of Large Patient Databases (n=3000)

2. Systematic Literature Review

3. Exposure to thoracic surgery clinical environment including Lung Cancer MDTs, Clinics and operating theatres.

Can longitudinal data from patients with cutaneous lymphomas provide insights into earlier diagnostic certainty?

Main Supervisor

Professor Ruth Murphy (ruth.murphy8@nhs.net)

Second Supervisor

Professor John Snowden (john.snowden1@nhs.net)

Other Supervisors

Dr Nicholas Lawrance

Aim and Objectives

To identify a retrospective cohort of patients referred to a SSMDT from 2015 to 2023 with a suspected diagnosis of cutaneous lymphoma. To provide longitudinal data about the diagnostic determinants and whether this changed with time.

Research Methodology

The student will identify all the patients presented and captured on the SSMDT database from 2015-2023. These are patients with a possible diagnosis of cutaneous lymphoma from South Yorkshire, Bassetlaw and North Derbyshire. The student will extract longitudinal data from these patients to provide a narrative of clinical, histological and immunophenotypes of the disease from the initial presentation of the disease to diagnostic certainty. This will map time to diagnosis, criteria leading to a definitive diagnosis and any changes in the disease phenotypes, and treatments given as the disease evolves.

Expected Outcome

This retrospective analysis provides longitudinal data to map the clinical, histological and immunological phenotypic evolution of cases referred with suspected cutaneous lymphoma to a regional specialised skin cancer MDT, which then may be tested in future work in larger super-regional/national datasets to generate hypotheses for possible markers for earlier disease diagnosis. This is important as treatment paradigms are evolving from symptomatic relief and disease control to disease modification and regression in both inflammatory skin diseases and lymphomas.

Type of Project

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

Additional Training

This project is based on descriptive analytics and serves to summarise a retrospective sample detailing patient demographics from a cohort of patients with suspected cutaneous lymphoma. SPSS should provide the necessary training for relevant analyses. Histopathology colleagues in will help to improve the basic understanading of histopathological diagnoses and disease immunophenotypes.

Deconditioning and sarcopaenia after stroke study - DECONSTRCKT

Main Supervisor

Dr Ali Ali (ali.ali@sheffield.ac.uk)

Second Supervisor

Dr Liz Williams (e.a.williams@sheffield.ac.uk)

Other Supervisors

Dr Simon Nichols

Aim and Objectives

To characterise the time course of the development of sarcopaenia after acute stroke and its determinants e.g. stroke severity, disability, physical activity, systemic inflammation and nutritional status.

Research Methodology

Twenty four patients with acute stroke will be recruited from the stroke units at Sheffield. Socio-demographic and clinical details will be recorded. Baseline blood tests for inflammatory markers and muscle markers (IL-6, IL-1, TNFa, IL-10, myostatin, irisin, IGF-1) will be drawn. Participants will undergo a weekly assessment (except ultrasound which will be undertaken every 3 days) of the following characteristics until discharge from hospital:
• Strength and function: grip strength, 5 x chair stand, timed up and go (TUG), gait speed, Barthel Index.
• Systemic inflammation: modified Glasgow prognostic score [Yoshimura 2018] – serum CRP and albumin.
• Nutrition: 24 hour food recall, review of nutritional charts for tube fed patients, Malnutrition Universal Screening Tool (MUST).
• Structural: Bioelectrical impedance analysis (BIA), thigh and humeral circumference, quadriceps thickness (muscle ultrasound).

Expected Outcome

Feasibility of undertaking the longitudinal analysis will be confirmed if > 80% of the intended measurements are completed. Longitudinal analysis of changes to muscle strength and function, structure, nutrition and systemic inflammation will be undertaken. Outcomes will be reported descriptively with statistical analysis using repeated measures along a time course (ANOVA) and comparisons from baseline assessment (students paired T-test). Multiple regression analysis will be undertaken to elucidate factors associated with the largest declines in muscle mass and strength.

Type of Project

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

Additional Training

Student will receive training on the following:
- Use of muscle ultrasound (Advanced Wellbeing Research Centre)
- Use of bioelectrical impedance analysers
- Blood letting and spinning in preparation for freezing
- Performing ELISA tests on serum
- Use of nutritional software analysis systems (myfood24)
- Various statistical analyses

Unmet needs of people with Multiple Sclerosis

Main Supervisor

Professor K. P. Sivaraman Nair (siva.nair@nhs.net)

Second Supervisor

Dr Esther Hobson (e.hobson@sheffield.ac.uk)

Aim and Objectives

1) To identify the unmet needs of people with MS
2) To study the impact of unmet needs on quality of life of people with MS
3) To identify geographical differences in nature and frequency of unmet needs

Research Methodology

People with multiple sclerosis (MS) experience a variety of biopsychosocial problems, many of which remain unmet by the current MS services. Currently there is no tool that can reliably identify patients’ unmet needs. We developed and evaluated the psychometric properties of a 29-item Questionnaire, Long-term Unmet Needs in MS (LUN-MS) to identify the unmet needs of people with multiple sclerosis (pwMS). Launched in 2011, the UKMSR was created by the Population Data Science team in Swansea University Medical School and was funded by the MS Society. The UKMSR collects data from directly from the NHS clinical record following informed consent and from pwMS via an online ‘portal’.
The student will be liaising with the UKMR. The student will get access to the UKMSR and post the questionnaire through the website. The student will collate the responses and collect data such as MS type, number of relapses, date of conversion to secondary progressive MS, past and current disease modifying medications , Hospital Anxiety and Depression scale , MS walking scale, European Quality of Life scale and MS Impact scale. The student will receive support for analysing the data

Expected Outcome

A nationwide study using LUN-MS on platforms such as the UK MS register could facilitate identification of unmet needs in pwMS in the UK. The student will also assess the impact of unmet needs on quality of life of people with MS.

Type of Project

Medical Humanities

Additional Training

Training in accessing and getting data from a nationwide data base
Statistical analysis on techniques like correlation and multiple logistic regression
Modelling of data to predict future needs

Reporting of ethnicity in randomised controlled trials in anaesthesia and critical care research

Main Supervisor

Dr Matt Wiles (matthew.wiles1@nhs.net)

Second Supervisor

Dr Paul Bramley (paul.bramley2@nhs.net)

Aim and Objectives

The aim is to determine if the ethnicity of participants is reported and (if so) is this reflective of the known prevalence of the disease condition.

Research Methodology

This will be a literature review of 10 years of RCTs published in anaesthesis and critical care.

Expected Outcome

This aims to highlight if specific ethnic groups are not included in research studies and to hypothetise as to what barriers exist in this regard.

Type of Project

Medical Humanities

Additional Training

All statistical methods needed will be taught as needed.

Emergency Department attendances with hypertension

Main Supervisor

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

Second Supervisor

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

Aim and Objectives

To describe the characteristics of patients attending the ED with hypertension, the tests and treatments they receive, and their subsequent referral and follow-up arrangements.

Research Methodology

This will be a single-centre, retrospective observational study. We will provide the student with a list of patients who attended the Northern General Hospital Emergency Department in 2023 with hypertension (probably around 400-500). The student will then access the hospital IT systems to collect data describing patient characteristics, tests and treatments received, and the planned referral and follow-up. They will develop an analysis plan, with statistical advice and support, before undertaking descriptive statistical analysis.

Expected Outcome

The project will produce new data to assist with development of guidelines for ED management of hypertension. We anticipate that it will lead to presentation at the Royal College of Emergency Medicine Annual Scientific Conference and publication in a peer-reviewed journal. The student will develop skills in project management, quantitative data collection, statistical analysis, interpretation of quantitative data, presentation of findings, and writing for publication.

Type of Project

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

Additional Training

Training will be provided in quantitative data collection and management, statistical analysis, and presentation of quantitative data.

Improving foot outcomes in people with diabetes

Main Supervisor

Dr Rajiv Gandhi (rajiv.gandhi1@nhs.net)

Second Supervisor

Dr Greig Marni (marni.greig@nhs.net)

Aim and Objectives

Diabetic foot ulceration is the commonest cause of hospitalisation in people with diabetes and also the commonest reason for lower limb amputation in the UK. Although there is now strong evidence regarding interventions to reduce ulceration and amputations, the incidence remains stubbornly high.

A key part of the project will be to try and determine factors that result in people with diabetes presenting with recurrent foot ulceration or progressing to amputation. Many also die prematurely. This is still a poorly understood area and better understanding of these factors could lead to the deployment of strategies to improve outcomes. This study will involve prospectively following up people who have presented with ulcers and determining what factors at baseline predict for how they are likely to progress. In particular, it will examine how illness beliefs and psychological barriers contribute to poor concordance and outcomes.

This is an ongoing study and the student will have access to a large database of cases collected by previous students.

Another project will involve looking at how redesign of footcare services post-Covid has impacted on the delivery of care and key foot outcomes.

Research Methodology

This study will use both qualitative and quantitative data from a variety of sources including primary and secondary care medical databases, as well as patient interviews.

The study examining factors affecting outcomes of foot ulceration will incorporate factors such as screening practices in primary care, referral patterns, management of risk factors, vascular interventions etc. The impact of interventions on these processes will also be assessed. It will also involve surveying patient attitudes, illness beliefs and other psycho-social factors and the impact these have on clinical outcomes.

Expected Outcome

Experience gained (in addition to obtaining BMedSci):

1. Insights into research practices within the NHS including governance
2. Understanding the role and value of Clinical Networks
3. Understanding the value of medical databases in conducting research
4. Recruiting, collecting and analysing data for a clinical study (patient contact). Previous students have commented on the tremendous confidence they have gained in how they interact with both patients and other HCPs
5. Results of this study have and will continue to be used to improve national guidelines and policy and the successful BMedSci will gain substantial insight into how clinical research can be used to influence national strategies to improve patient care.
6. An understanding of how to achieve service improvement and the challenges faced when the service bridges primary and secondary care
7. It is expected that the work will result in at least 3-4 first author abstracts and 1-2 publications

Type of Project

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

Additional Training

The successful BMedSci student will join a vibrant diabetes team with an active research arm and will be jointly supervised by 2 consultants with specialist expertise in the diabetic foot. Training will be provided in all research techniques and on how clinical research can be applied to directly improve patient care. Students will have weekly meetings with their supervisor to ensure close mentoring and support.

Deconditioning and sarcopaenia after stroke study - DECONSTRCKT

Main Supervisor

Dr Ali Ali (ali.ali@sheffield.ac.uk)

Second Supervisor

Dr Liz Williams (e.a.williams@sheffield.ac.uk)

Other Supervisors

Dr Simon Nichols

Aim and Objectives

To characterise the time course of the development of sarcopaenia after acute stroke and its determinants e.g. stroke severity, disability, physical activity, systemic inflammation and nutritional status.

Research Methodology

Twenty four patients with acute stroke will be recruited from the stroke units at Sheffield. Socio-demographic and clinical details will be recorded. Baseline blood tests for inflammatory markers and muscle markers (IL-6, IL-1, TNFa, IL-10, myostatin, irisin, IGF-1) will be drawn. Participants will undergo a weekly assessment (except ultrasound which will be undertaken every 3 days) of the following characteristics until discharge from hospital:
• Strength and function: grip strength, 5 x chair stand, timed up and go (TUG), gait speed, Barthel Index.
• Systemic inflammation: modified Glasgow prognostic score [Yoshimura 2018] – serum CRP and albumin.
• Nutrition: 24 hour food recall, review of nutritional charts for tube fed patients, Malnutrition Universal Screening Tool (MUST).
• Structural: Bioelectrical impedance analysis (BIA), thigh and humeral circumference, quadriceps thickness (muscle ultrasound).

Expected Outcome

Feasibility of undertaking the longitudinal analysis will be confirmed if > 80% of the intended measurements are completed. Longitudinal analysis of changes to muscle strength and function, structure, nutrition and systemic inflammation will be undertaken. Outcomes will be reported descriptively with statistical analysis using repeated measures along a time course (ANOVA) and comparisons from baseline assessment (students paired T-test). Multiple regression analysis will be undertaken to elucidate factors associated with the largest declines in muscle mass and strength.

Type of Project

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

Additional Training

Student will receive training on the following:
- Use of muscle ultrasound (Advanced Wellbeing Research Centre)
- Use of bioelectrical impedance analysers
- Blood letting and spinning in preparation for freezing
- Performing ELISA tests on serum
- Use of nutritional software analysis systems (myfood24)
- Various statistical analyses