What relationship do debt and available income sources have on health career preferences?

Project code:  MHS010

Department

Medicine

Location

Auckland

Supervisor

Phillippa Poole

Each year since 2006, the University of Auckland Faculty of Medical and Health Sciences Tracking Project has collected information on career intention, debt and income sources from healthcare students at entry to, and exit from, their respective programmes. Data relate to the disciplines of medicine, nursing, pharmacy, health science and optometry. The specific aims for this summer studentship project include:

  1. Determining whether students with high vs. low debt levels have different numbers or patterns of available income sources
  2. Determining whether debt level or patterns of available income sources lead to particular career preferences – for example, whether students with high debt have a preference for higher paid specialties within their discipline

Ethics approval is not required for this summer studentship project since approval is already covered by the Tracking Project. Please send a copy of your CV with a cover letter outlining reasons for wanting to undertake this project, as well as your current degree and GPA.

Skills

Use of large databases – data manipulation and cleaning

Statistical analysis – summary statistics, predictive statistics, Excel, SPSS

Writing for publication – it is intended that this project will result in a published research paper to which the student will contribute and received authorship

What factors consolidate a regional-rural career intention in medical students?

Project code:  MHS011

Department

Medicine

Location

Auckland

Supervisor

Phillippa Poole

This builds on a 2015/6 summer project, in which we found that medical students from a regional rural (RR) background are about three times more likely than urban students to intend to work in a RR setting.1 Yet, a significant proportion of RR medical students switch to having an urban career intention, which is more than offset by the number of urban students who switch to a RR career intention. We need a better understanding of the factors that promote or detract from a RR career choice. The University of Auckland Faculty of Medical and Health Sciences Tracking Project has over 10 years of data on student demography and career intentions at entry and exit from the medical programme along with self-reported influencing factors. These may be linked with details on curriculum, such as location of placements.

This particular study aims to:

  • Describe key factors that influence medical student choice of career location;
  • For students who change their career intention towards or away from an RR career, ascertain the effect of individual and curriculum factors on that change;
  • Determine whether these factors are the same for students whose intended practice location remains the same as their backgrounds.

The project has ethics approval, and would suit a student interested in career development with mathematical / statistical skills. Please send a copy of your CV with a cover letter outlining reasons for wanting to undertake this project, as well as your current degree and GPA.

  1. Poole P, Stoner T, Verstappen A, Bagg W. Medical students: where have they come from; where are they going? NZ Med J 2016 (in press)

Skills

Literature searching and appraisal

Data handling and statistics

-data collection, data entry, data collation.

-use of large datasets

-summary statistics, univariate and multivariate analysis, factor analysis

Writing for publication

- The student is expected to contribute significantly to a research paper

 

Microvascular complications of type 2 diabetes and other comorbidities after bariatric surgery

Project code:  MHS023

Department

Medicine

Location

Auckland

Supervisor

Rinki Murphy

Bariatric surgery provides the most effective and durable treatment for type 2 diabetes in terms of glycaemia, however, its effects on microvascular complications such as diabetic retinopathy, nephropathy and neuropathy are poorly characterized. In addition, there are several other comorbidities such as gout, asthma that may also improve with weight loss.  Data is being collected from a prospective, randomized clinical trial comparing sleeve gastrectomy (SG) versus gastric bypass (GBP) surgery among patients with morbid obesity and type 2 diabetes on remission of diabetes and weight loss. Baseline and 1 year follow up has been completed and included 114 patients who received either GBP or SG surgery at North Shore Hospital.  5 year follow up is due to begin in October 2016.

Aim: To evaluate the impact of Roux-en-Y gastric bypass or sleeve gastrectomy types of bariatric surgery, on microvascular complications of type 2 diabetes and other comorbidities.

Skills

Skills to be developed: Use of clinical databases such as Concerto, diabetes retinal screening records, searching Access research databases.  Setting up research xcel database.  Using statistical analysis tools and graphical displays

Method:  Bariatric surgery patient records will be examined to determine the status of comorbidities and diabetic retinopathy, nephropathy, and peripheral neuropathy, at baseline and at annual intervals after surgery.  Other preselected variables such as type of surgery (RYGB or SG), sex, age, baseline BMI, and change in BMI, baseline HbA1c and change in HbA1c, diabetes remission status, baseline microvascular complication grade, duration of T2D, BP, smoking status and ethnicity will also be recorded and used to determine predictive factors.

Intermittent fasting intervention for overweight patients with prediabetes

Project code:  MHS024

Department

Medicine

Location

Auckland

Supervisor

Rinki Murphy

Background: Daily caloric restriction is the basis of all weight loss strategies, and has been shown to reduce pancreatic fat and liver fat, leading to remission of type 2 diabetes.  There is some evidence that the benefits of intermittent fasting match those of continuous daily caloric restriction and may be more achievable and sustainable.

Aim: to assess factors associated with successful adoption of intermittent fasting among overweight New Zealanders with prediabetes

Skills

Skills to be developed:  literature review on intermittent fasting, design of questionnaires to evaluate acceptability and adherence of intermittent fasting, conducting focus groups with endusers (participants, diabetes dietitians), assist with the conduct of a randomized controlled trial.

Methods:  A feasibility study is to be conducted among 44 overweight adults with prediabetes of 4 different ethnic groups (Maori, Pacific, Asian Indian and NZ European) to test the effectiveness of probiotics and intermittent fasting in achieving weight loss, reduction in HbA1c, improvement in OGTT and in pancreatic fat (measured using magnetic resonance spectroscopy).  Participants will be completing food diaries and questionnaires regarding acceptability, satiety, adherence.

Clinical Outcomes in Youth Diagnosed with Type 2 Diabetes

Project code:  MHS032

Department

Medicine

Location

Auckland

The goal of this project is to provide a comprehensive and up-to-date overview of the progress of youth diagnosed with type 2 diabetes in the Auckland region, anticipating that this data will influence future screening, management, and education programmes.  This will include evaluation of micro- and macro-vascular complications, glycaemic control, cardiovascular disease risk factors, mortality, and health service engagement determined by prescription pickup, attendance at diabetes clinics and primary care services. Micro- and macro-vascular (small and large vessel) complications and mortality will be compared to young adults with type 1 diabetes of similar duration, matched for age and glycaemic control.  Finally, we will also aim to evaluate the changing incidence of type 2 diabetes diagnosed in youth, hypothesising that the proportion of youth diagnosed with type 2 diabetes has further increased over the past decade.

Skills

The student will be involved in a large retrospective diabetes project and learn about the principles of study design and data collection and analyses.  Participation would also strengthen the student’s knowledge in the field of Diabetes and its complications and he/she would gain research experience.  The student would be listed as a co-investigator in publications. 

An effort will also be made to provide addition teaching in diabetes to this student and enhance the student’s experience in medical research.

Paediatric Cardiopulmonary Resuscitation (CPR): Knowledge and perceptions of surf lifeguards

Project code:  MHS064

Department

Medicine

Location

Auckland

Supervisor

Jonathon Webber

Drowning remains a leading cause of unintentional death in the paediatric age group. As a consequence, public education in bystander CPR is extensively advocated in schools and the community.

While lifeguards are routinely trained in basic life support (BLS) and CPR, little is known about their understanding/ competency of child CPR. Previous studies by the authors have analysed CPR performance using protocols designed for adult resuscitation via the use of electronic recording manikins.

This project is a cross sectional, comparative study design, using standard survey methodology followed by a practical assessment of paediatric CPR skills using a resuscitation training manikin with electronic data collection ability.

Skills

Enhanced understanding of the research process via data collection, data entry, testing and assessment methodologies, and statistical analysis.

A student with a background in surf life saving or interest in paediatrics/resuscitation is preferred, but not essential.

Recovery from cerebellar stroke

Project code:  MHS071

Department

Medicine

Location

Auckland

This project aims to understand recovery from cerebellar stroke, and how this can be measured using both clinical and lab-based assessments. Working with the Neurology group in Auckland City Hospital, you will be engaged in daily reviews of patients in the Stroke Unit, and observe clinical, neurophysiological and neuroimaging assessments. You will also use our established database to characterise patients with cerebellar stroke, and estimate their admission rates to Auckland City Hospital. You will review the literature relating to recovery from cerebellar stroke and the therapies applied to assist recovery. You will also identify appropriate clinical and lab-based tests of cerebellar function, then test and develop these for use by our group. This project will provide an essential platform for the design of future trials of novel therapies to promote recovery after cerebellar stroke.

In addition to working on this project, you will also have the opportunity to engage with other work being carried out by the group. This includes various projects that aim to predict and promote recovery of movement after stroke, which use combinations of clinical, neurophysiological (transcranial magnetic stimulation) and neuroimaging (magnetic resonance imaging) techniques. This will provide you with a broad experience of clinical neuroscience carried out in the hospital environment.

Skills

  • Professional research interactions with patients
  • Basic transcranial magnetic stimulation and MRI skills
  • Data processing and analysis
  • Literature review skills
  • Assessment testing and implementation
  • Research writing and presentation skills

ENIGMA Stroke Recovery Project

Project code:  MHS072

Department

Medicine

Location

Auckland

This project aims to prepare and process our neuroimaging and clinical data of stroke patients, so that it can be shared with the ENIGMA Stroke Recovery Project. ENIGMA aims to create a worldwide network of stroke neuroimaging centres focused on understanding mechanisms of stroke recovery. ENIGMA will compute and analyze brain shape and brain volume from thousands of patients worldwide. This will allows us to identify the effects of stroke on brain structure and its relationship to recovery of movement, on an unprecedented scale. This is expected to lead to exciting new insights into recovery from stroke.

This project will involve preparing and processing the neuroimaging data we have from several projects involving patients at the sub-acute and chronic stages of stroke recovery. You will learn to analyse these data, and prepare them for ENIGMA by collating them with the patients' clinical and demographic information. All information will be coded to ensure patient privacy. 

In addition to working on this project, you will have the opportunity to accompany members of the research team when they review patients admitted to the Auckland City Hospital Stroke Unit. You will also be able to engage with ongoing projects involving people recovering from stroke, and observe clinical, neurophysiological and neuroimaging assessments of these patients. This will provide a broad experience of clinical neuroscience carried out in the hospital environment.

Skills

  • MRI image processing using a variety of software applications
  • Basic Linux coding
  • Database management
  • MRI acquisition
  • Professional research interactions with patients
  • Basic skills in clinical and neurophysiological assessments

A retrospective analysis of the use of HALOPERIDOL in delirium at Mercy Hospice Auckland

Project code:  MHS107

Department

Medicine

Location

Auckland

Supervisor

Dr Di Winstanley

The overall aim of the project is to apply a Case Study research paradigm. The specific aim of this project is to review the case notes of patients who have received haloperidol for the management of delirium. This review will require the application of content analysis so that the key elements from the notes can be identified regarding the use of haloperidol and its impact on patient outcome. First, the notes will be inspected and coded. These codes will then be developed into meaningful themes that can best describe the application and use of haloperidol and its impact on patient outcome. It is envisaged that up to 150 patient notes will need to be scrutinised for relevant content.

Skills

The student will learn valuable clinical and research skills. The clinical skills learnt will be in the form of making significant clinical inferences from patient notes about medication use and patient outcome. The research skills learnt will be in the form of using qualitative research methods to describe a process of patient care. The student will learn technical research skills in the areas of document and content analysis. The student will also be taught how to write these findings up into an organisational report and a paper for publication.

Bariatric surgery for obesity - identifying barriers to success

Project code:  MHS109

Department

  • Medicine
  • Surgery
  • Clinical Psychology

Location

Auckland

Supervisor

Dr Tim Cundy

Bariatric surgery is the most effective way of achieving and maintaining weight loss in people with morbid obesity, and can produce highly significant clinical improvements in obesity-related morbidities such as sleep apnoea, type 2 diabetes, polycystic ovarian disease and fatty liver that are unattainable by medical management.   However, the process leading up to surgery is demanding.  Some people referred for surgery may be declined on medical grounds; those accepted have to undergo medical, psychological and nutritional counselling and achieve a target weight loss, and immediately before surgery have to take a very low calorie diet for 2-6 weeks to reduce hepatic steatosis.

ADHB has offered public sector bariatric surgery since 2009 and the rate of referral has increased substanially.  Despite increased capacity (80 surgeries per year) we found in a small pilot study of patients with type 2 diabetes that fewer than half the patients referred actually went through with surgery, although almost all would have undoubtedly benfitted.   In this project we hope to understand what the barriers are to successful surgery, where in the process patients may falter, and why.  We hope this will lead to identifying potential candidates at high risk of defaulting, so that in the future they can be offered more support.

 

Skills

The student undertaking this project will establish a database of all referred patients from 2009 to 2016, recording demographic data and reasons for referral, and medical morbidities.  The patients' progress through the system will be tracked, noting the point at which drop outs occurred and the reasons recorded at the time.  The student will also examine psychologists' reports identifying factors such as previous mental illness, socioeconomic deprivation and family support that may impact on the ability to complete the process.  Finally, the long-term outcomes of patients who dropped out and those who successfully underwent surgery will be examined and compared.

The student will learn about database management and statistical analysis, the medical co-morbidities attached to obesity, surgical management and the impact of psychological and social factors on chronic conditions.  We anticipate that at least two major publications will emerge from this project.

Communication between bone and muscle cells

Project code: MHS129 

Department

Medicine

Location

Auckland

Supervisor

Dorit Naot

Bone and muscle metabolism are tightly coupled throughout life. Both bone and muscle respond to mechanical loading by an increase in tissue mass and strength, whilst loss of bone and muscle mass occurs in states of inactivity due to ageing, chronic disease or skeletal injury. The tight coupling between bone and muscle is also evident in fracture healing. The presence of a healthy muscle adjacent to a fracture site accelerates healing and increases union strength, while injury to the muscle impairs bone healing.

Studies in our lab focus on muscle as a source of cells and factors for the improvement of bone health. The project will involve a review of the literature describing experimental systems used to study muscle-bone communication. We are specifically interested in evaluating the relevance of in vitro model systems to physiology.  

Skills

  • Conducting literature searches
  • Data collection
  • Defining research questions
  • Critical evaluation of studies
  • Writing for publication

Ethnic Skin: Defining inequalities to accessing public funded dermatology service

Project code:  MHS153

Department

Medicine

Location

Greenlane Clinical Centre, Auckland

Supervisor

Dr Denesh C Patel

Primary Aim

To assess if public funded dermatology provide equal access to all ethnic groups it serves.

Secondary Aims

To assess the demographics, the reason for referral to dermatology service, the wait time for first specialist appointments and diagnoses of each ethnic group.

Skills

This will be a retrospective chart review. The student will be involved in designing a robust medical record review using data stored in the electronic notes of patients visiting the Dermatology Department, ADHB. The student will need to be aware of the limitations of this study design and formulate ways to minimise these to optimise the value of this research project. The student will need to enter data into appropriate software to allow ease of analysis, which will involve working with a statistician as well colleagues in population health. The student will be asked to present at the national Dermatology meeting and this may be published in peer reviewed publications.  This project will lay the foundation for further research in the field of ethnic dermatology and skin of colour. Ultimately, my hope is that the student will contribute valuable research so that all ethnic groups have equal and fair access to our service in the future.

A systematic evaluation of lifestyle interventions which may reduce heart disease risk

Project code:  MHS166

Department

Medicine

Location

Auckland City Hospital

Although ‘lifestyle’ is an important determinant of the risk of heart disease, the quality of evidence on the benefits of different ‘lifestyle’ interventions, which include diet, exercise, weight reduction, stress management, and treatment of depression, is modest.  Much of the evidence for common interventions is from observational studies which are prone to bias.  Some clinical trials have been undertaken but even randomised trials can be misleading if they have low statistical power, or if conclusions are based on surrogate measures.

The summer student will assist with a systematic analysis of observational and randomised studies of selected ‘lifestyle’ interventions for secondary prevention of coronary heart disease. With the team the student will choose one lifestyle intervention (eg weight reduction, or depression screening and treatment).  The aim will be to evaluate the strengths and weaknesses of the available evidence. This will involve a review of observational data and randomised trials to identifying key information on outcomes, for calculation of effect sizes and statistical power, and meta-analysis when appropriate.

Skills

The student would work with Prof. Ralph Stewart, a biostatistician, and members of the cardiovascular research unit.  The studentship would provide an opportunity to understand cardiovascular disease prevention, research methods, clinical ‘evidence’ based guidelines, statistics and scientific publication, as part of a research team.