Exploring technology to improve health care delivery to children in rural NZ

Project code:  MHS045

Department

Paediatrics: Child and Youth Health

Location

Auckland

Background

There are very high rates of bronchiectasis (chronic chest infection with lung scarring) in NZ children. In comparison to other countries, our children are diagnosed later, often having had up to 2 years of symptoms, and already have severe disease. This study will determine if we can use available technology to record cough and chest sounds of sufficient quality to screen children remotely and determine those that need a course of antibiotic treatment and/or further investigations for lung disease.

Aims

1. To determine if cough can be recorded with sufficient quality on readily available devices and sent remotely for interpretation
2. To determine if chest sounds can be recorded with sufficient quality on a new recording stethoscope and sent remotely for interpretation
3. To inform guidelines for interpretation following a sample of recorded coughs and chest sounds

Skills

1. Clinical skills with respiratory and cardiovascular assessment in children
2. Public health skills assessing health needs of children in rural NZ
3. Use of technology in health delivery
4. Research skills wit literature review, databasing, how to ask and answer research questions

NOTE: The student would need to have access to a car and drive to Northland for part of the project. Travel costs will be covered and accommodation organized.

We would be especially supportive of a student interested who had family in Northland, New Zealand.

(Cass Byrnes will be away but available on email when the jobs first appear on-line).

Peanuts, nuts and seeds – avoidance, ingestion, risk and decision making

Project code:  MHS065

Department

Paediatrics: Child and Youth Health

Location

Starship, Auckland

Supervisor

Dr Jan Sinclair

Peanut allergy is one of the three most common food allergies in children, and is often associated with adverse impact on quality of life and fear of allergic reaction.  Many children are advised to avoid other nuts and seeds to minimize risk, while others eat these happily.  How these factors interact is unclear.

The project will consist of an audit of infants, children and young people with peanut allergy, assessing how they manage peanut allergy in terms of avoidance or consumption of:

  • Foods with precautionary labels (eg “may contain traces”)
  • Tree nuts
  • Seeds

Factors to be considered include details of initial allergic reaction, interval allergic reactions, and results of allergy testing and supervised food challenges.  Other factors contributing to decision making will be assessed (medical advice, dietetic advice, food industry advice,  information from friends/family/support organisations).  Quality of life will be assessed using a validated tool.

Skills

Critical review of relevant literature, development of audit questionnaire, use of validated QOL tool, development and analysis of data, preparation of paper, presentation of results

Evaluation of management and outcomes of infants born to Hepatitis B infected mothers in Counties Manukau District Health Board

Project code:  MHS081

Department

Paediatrics: Child and Youth Health

Location

Auckland

Supervisor

Dr Rachel Webb

BACKGROUND

Hepatitis B can be passed from a mother to her newborn baby, and babies who acquire Hepatitis B in this way  have a high risk of chronic liver disease and hepatocellular cancer in adult life. For many years the mainstay of preventing mother-to-child transmission has centred around testing of mothers in pregnancy, and provision of hepatitis B immunoglobulin at birth followed by a full course of Hepatitis B immunisations. Mothers with highly infectious Hepatitis B are increasingly being offered antiviral treatment in pregnancy, to further reduce the risk of transmission. Currently, there is limited published, population-based understanding of the characteristics, management and outcomes of this group of mothers and babies in Counties Manukau DHB.

PROJECT AIMS

1- to describe the characteristics of Hepatitis B-infected mothers/babies in CMDHB ( country of origin, proportion of high risk E antigen positive mothers) over a one or two year period (2015 +/- 2014)

2- to measure the timeliness of administration of Hepatitis B immunoglobulin and vaccine to infants in the immediate newborn period

3- to assess the timeliness and completeness of routine immunisations in Hepatitis B exposed infants

4 -to determine proportion of infants having serology at 9 months (as per recommendations in the New Zealand Immunisation Handbook ) and actively communicate with GPs/ Public health regarding follow-up serology

5 -to describe infant outcomes  ( infections / failures of prophylaxis and particularly outcomes amongst any babies exposed to tenofovir in utero)

Skills

This project will involve & foster collaboration between paediatrics, neonatal, maternity and primary care sectors. Findings will be used to identify whether improvements in existing systems are required/desirable. Case ascertainment will occur via review of antenatal serology and postnatal hepatitis B serology results, blood bank records, and the national immunisation register (NIR) Skills learned during this project will include developing an excel spreadsheet, analysing data, understanding Hepatitis B infection, and critically considering issues from a population and systems perspective. This project will suit a student who is interested in infectious diseases, paediatrics and population health.

PORT CF:NZ – Improving the capture of clinical data in the New Zealand registry for persons with cystic fibrosis.

Project code:  MHS127

Department

Paediatrics: Child and Youth Health

Location

Auckland

Background

National registries of persons with cystic fibrosis have developed to capture a broad picture enabling national monitoring of health and management. They provide valuable opportunities for bench- marking and quality improvement. This was initiated by the CF Foundation USA in 1980, taken up by a number of countries worldwide with New Zealand operating the first registry data capture in 2011. We now have approximately 95% persons with CF in NZ opting in to the data registry. We have recently altered some of the questions to improve the ease of capturing the data. It would be timely to review the success and the gaps in the data collected.

Aims

  1. To review the revised questions in the database and determine their clarity and accuracy by canvassing the PORT CF: NZ steering group
  2. To determine the response rate for each question in the database
  3. To determine the response from each of the CF clinics
  4. To devise a number of scenarios and send to the in-putting medical, nursing and allied health staff to interpret response to questions to assess standisation of responses.

Skills

1. Public health skills assess the health of persons with CF in NZ
2. How to do a literature review
3. Use of registry data in health assessment
4. Learning database techniques and management
5. How to assess standardization in question interpretation
6. Clinical skills as the student will be invited to join the CF clinic at Starship Hospital.

Note: The student will likely need to travel to Christchurch on at least one occasion where the database is physically housed. The student will be supported by the CF teams at Starship & Christchurch Hospitals. The student will be working in conjunction with the CF association. Travel costs will be covered.

(Cass Byrnes will be away when the summer studentships first go live online but will be contactable by email).

Research, ethics proposal preparation for Probiotic Blis K12 in Group A Streptococcal infections in a high ARF risk area

Project code:  MHS125

Department

Whakatane Paediatrics

Location

Whakatane Hospital

Supervisor

Dr John Malcolm

Proposal preparation for Blis K12 trials   to prolong antibiotic efficacy in recurrent GAS, and school Acute Rheumatic Fever ARF programmes

Skills

Literature search, Methodology and trial design considerations, Consultation,  Proposal and ethics application writing

Student outcome; The summer student will  become familiar with NZ and BOP regional ARF interventions, research, audits and, previous probiotic trials and contribute  mainly through supervised proposal preparation, to studies  addressing site,  optimal timing  of intervention and systematic evaluation.

Reasons for patient non-attendance at BOPSASS appointments

Project code: MHS124

Department

Paediatrics: Child and Youth Health

Location

Tauranga Paediatric Department

Supervisor

Dr Kendall Crossen

Background

The Bay of Plenty Sexual Assault Service Bay of Plenty Sexual Assault Support Services (BOPSASS) is a free 24 hour service in the Bay of Plenty for adults, teenagers and children who have been sexually assaulted.  Despite many measures designed to ensure the service is accessible, a significant number of patients still “did not attend appointment” (DNA).  BOPSASS is committed to reducing this number.

Aims

Primary Aims

  1. To establish the DNA rate at BOPSASS.
  2. To investigate whether the DNA rate is associated with any specific patient demographic characteristics.
  3. To ascertain reasons why patients DNA and compare these with the literature.
  4. To make recommendations on how the DNA rate at BOPSASS can be decreased.

Secondary Aims

  1. To determine what aspects of care patients who attended their appointments valued.
  2. To determine what aspects of care patients who attended their appointments perceived as needing improvement.

Method

From July 2016 until January 2017 all patients who are offered appointments at BOPSASS will be phoned by a member of the BOPSASS team after their appointment and asked a standardised set of questions.  Those patients who did not attend will be asked questions pertaining to reasons for non-attendance.  Those patients who attended will be asked about aspects of care they valued and how the service could be improved.  A 6 month retrospective study of these questionnaires along with demographic information will be conducted.

Skills

Results and publication:  It is expected that the student will present their findings to the Tauranga Hospital Grand Round and the BOPSASS Continuing Education sessions in 2017.  In addition, it is expected that the student will submit the findings of this work to an appropriate journal for publication or present it as a poster to the Paediatric Society Scientific meeting in 2017.