Clinical

Applications are now closed

  1. » The microanatomy of the anterior and posterior gluteus medius insertion in humans
  2. » Revision ACL Reconstruction; Do Patients See a Different Surgeon?
  3. » Medical students speak up about discrimination in clinical settings
  4. » Using big data to estimate the prevalence of dementia
  5. » Comparing the outcome of critical congenital heart disease in New Zealand and Sweden
  6. » Exploring help-seeking in carers of those with an eating disorder
  7. » Do variants in renal sodium transporter genes influence urate handling in response to diuretics?
  8. » Magnetic resonance imaging and visceral obesity in a multi-ethnic cohort
  9. » Diseases of the exocrine pancreas in the elderly
  10. » Project withdrawn. Nebulisers versus metered dose inhaler and spacer, which is best? A systematic review
  11. » Project withdrawn. Why are nebulised bronchodilators chosen as treatment for asthma over metered dose inhaler plus a spacer in the hospital setting? A clinician survey
  12. » Between a rock, “some ice” and a hard place: Addicts in Strife.
  13. » Dementia Survival and Health Services Utilisation Linkage Study
  14. » A retrospective study of patients who have died from stroke at ADHB January 2016-January 2017
  15. » When severe mental illness and cancer collide: why do cancer patients with comorbid mental health issues fare more poorly?
  16. » Project withdrawn. Defining the Quality of Pancreatic Surgery
  17. » Systematic review of adverse event reporting in randomised trials of venous leg ulcer treatments
  18. » Validation of a personal breath test analyser for food malabsorption testing
  19. » The effect of Virtual Reality on the ocular surface
  20. » Bias in clinical decision-making: can compassion help?
  21. » The association between Health Literacy and Colorectal Cancer Outcomes
  22. » The Therapeutic use of Cannabis and Steroids in Hospice Care
  23. » Evaluation of visual impairment in stroke patients
  24. » Eye movements in virtual reality
  25. » The effect of feedback on measuring vision
  26. » Health Coaching in Counties Manukau: one size probably does not fit all!
  27. » Oral antibiotics prescribing after TKA, do prescribing patterns differ between surgeons and GPs?
  28. » Outcomes of older adults admitted to Intensive Care
  29. » What happens to octogenarians presenting to hospital with a fall?
  30. » Evaluating predictive tools for risk assessment in emergency abdominal surgery
  31. » Evaluating the impact of ethnicity on emergency abdominal surgery
  32. » Developing an evidence base for interprofessional palliative care education
  33. » What is the current nature, scope and delivery of palliative care education in undergraduate nursing programmes in New Zealand
  34. » Characterisation of cardiac structure and function in patients presenting with first time acute coronary syndromes: a substudy of the MENZACS study
  35. » Ethnic Variation in Pelvimetric Measures and Its Impact on Positive Surgical Margins at Radical Prostatectomy in New Zealand
  36. » 3D volumetric musculoskeletal atlas of the infant upper limb
  37. » Characterisation of nutrition status for patients presenting with first time acute coronary syndromes: a substudy of the MENZACS study
  38. » Ethnic skin-defining inequalities to accessing public funded dermatology service

The microanatomy of the anterior and posterior gluteus medius insertion in humans


Supervisor

Jacob Munro

Project type

Clinical

Department

Surgery/bioengineering

Location

Auckland

Project code: MHS085

Hip abductors consists of the gluteus medius and minimus muscles. Through their tendons, they initiate abduction and are critical for stabilising the hip joint during motion. Abductor tendons are susceptible to acute and chronic injury, resulting in pain and reduced mobility.

Hip abductor tendon tears usually starts in the anterior and middle portion of the gluteus medius tendon, with advanced tears resulting in complete detachment and retraction of the tendon from the greater trochanter. These clinical observations support the theory that the tendon bone interface (enthesis) may be intimately involved in tendinopathy and tendon tears of the gluteus medius.

Very little work has been done on this topic; the microanatomy structure of the enthesis has not been clarified and therefore, the structural changes that occur during the disease process is not known.

This study aims to 1. obtain samples of the gluteus medius tendon from cadavers, 2. Perform mapping of the microanatomy of the gluteus medius tendon insertion using differential interference contrast microscopy, 3. compare diseased enthesis with health controls to determine the structural changes that occur at the enthesis in abductor tendinopathy/tear.

Skills

1. Critical appraisal and summary of literature.

2. Dissection skills

3. Tissue processing and imaging skills

4. Scientific writing and referencing skills

5. Hypothesis generating and study design skills.

Revision ACL Reconstruction; Do Patients See a Different Surgeon?


Supervisor

Simon Young

Project type

Clinical

Department

Orthopaedics, North Shore Hospital 

Location

Auckland

Project code: MHS086

Anterior cruciate ligament (ACL) rupture is a common injury, with a reported incidence of 1/3000 – 1/3500 people per year and an estimated 200000 ACL tears occurring annually in the USA. Functional instability following ACL rupture commonly requires ligament reconstruction.

After ACL reconstruction, repeat ACL injury occurs in up to 20% of athletes, many of whom will undergo revision surgery. Studies investigating rates of revision ACL surgery often rely on patients returning to their original surgeon following a repeat injury. However it is unclear how many patients with reinjury choose instead to see a different surgeon.

In New Zealand, a national Accident Compensation Corporation (ACC) is the primary funder for most ACL procedures. In addition, if the primary ACL procedure was funded by ACC it is extremely likely any revision procedure will also receive ACC funding. This represents a unique opportunity to assess the frequency with which patients choose to undergo revision procedures with a different surgeon.

This study aims to answer the following questions:

  1. What is the incidence of revision surgery following primary ACL reconstruction in New Zealand?
  2. What percentage of patients proceed to revision surgeon with a different surgeon to the surgeon performing the primary procedure?
  3. What are the risk factor for revision surgery?

Skills

1. Critical appraisal and summary of literature

2. Database analysis and basic statistics skills

4. Scientific writing and referencing skills

5. Hypothesis generating and study design skills

Medical students speak up about discrimination in clinical settings


Supervisor

Lillian Ng

Project type

Clinical

Department

Psychological Medicine

Location

Auckland

Project code: MHS087

Discrimination may be defined as the unjust or prejudicial treatment of different categories of people. This qualitative project has two broad aims: to explore the experiences of discrimination that medical students may experience in their clinical training, whether it be on the grounds of ethnicity, gender, sexual orientation or disability; and, to identify strategies that medical students have developed or learned to cope with or address the experience of discrimination. The project idea arose from feedback from medical students, who requested formal tuition on the topic of prejudice and how to deal with it while working in clinical settings. 

Skills

It is envisaged that the student will learn the following from this research project:

1) Understanding of qualitative methods in research design

2) Data analysis through coding of de-identified transcripts 

3) Understanding and use of computer assisted qualitative data analysis software

4) Writing and editing skills for publication

5) Oral presenting skills

6) Development of critical thinking skills in considering how to link and make research meaningful to local policy

Using big data to estimate the prevalence of dementia


Supervisor

Sarah Cullum

Project type

Clinical

Department

Psychological Medicine

Location

Auckland

Project code: MHS088

To date there has been no prevalence study of dementia in New Zealand.  Current estimates of rates of dementia are based on research findings from US and Europe but New Zealand (and South Auckland in particular) has a very different demography to these countries.  There is an urgent requirement for accurate dementia prevalence data in New Zealand so that we can plan services that are culturally appropriate and sensitive.  Traditional prevalence studies are extremely time consuming and expensive, but analysis of data that is routinely collected by DHBs, PHOs and other healthcare organisations gives us the opportunity to pool resources and make informed estimates that may be more accurate than the current prevalence figures.

This project will link health data from CMDHB, InterRAI data and PHO data to estimate rates of dementia in South Auckland and will assess the utility of this approach.

Skills

Designing a research protocol, literature review, study design, methods, and analysis

Ethics application

Data linkage methods - big data analysis is in its infancy (which makes it exciting) but it will be the future of health services research

Writing reports and papers for publication

Presenting findings at conferences - confidence in public speaking

Use of routinely collected data to describe needs and make a business case for funding of services or for developing local policy - this is probably the most important skill for a clinician who wants to succeed in a health environment of increasing economic scarcity

Comparing the outcome of critical congenital heart disease in New Zealand and Sweden


Supervisor

Frank Bloomfield

Project type

Clinical

Department

Liggins Institute

Location

Auckland

Project code: MHS089

  1. Compare the postoperative Intensive Care Unit (ICU) and total hospital length of stay and mortality, both early (30 day) and late (1 year), for babies born with critical congenital heart disease (CHD) in New Zealand in 2014 and 2015, to those born with the same condition in Sweden.
  2. Compare the timing of diagnosis (antenatal, early postnatal but pre-discharge and post-discharge) between the two countries and relate this to the information above.

Critical CHD is the commonest life threatening congenital anomaly occurring in ~ 1.1 per 1000 live births. It is defined as CHD that requires intervention or results in death within the first 4 weeks after birth. The main time of risk for many of these babies is prior to surgery. This risk increases if diagnosis is delayed. Sweden and New Zealand have different systems for screening for critical CHD. Sweden has had universal pulse oximetry screening of newborn babies since 2014. New Zealand had no such screening over this time period, but may have a higher rate of detection before birth (from ultrasound scans).

Information for New Zealand babies is already available for 2014. The project will involve combining information from various hospital and governmental databases for babies born in 2015. The Swedish information will be provided by co-investigators in that country. 

Skills

  1. Develop a knowledge and understanding of common forms of congenital heart disease 
  2. Develop an understanding of the different approaches to diagnosis of critical congenital heart disease and of variation in approach between two countries
  3. Database interrogation and linkage
  4. Chart review
  5. Statistical analysis
  6. Manuscript preparation

Exploring help-seeking in carers of those with an eating disorder


Supervisor

Dr Marion Roberts

Project type

Clinical

Department

General Practice and Primary Healthcare

Location

Auckland

Project code: MHS090

This project is an initial exploratory study of the type of help-seeking engaged in by carers (parents/spouses/partners etc.) of those with an eating disorder in the New Zealand context. The project is a collaboration with a New Zealand wide support line for eating disorders run by carers.

Together with developing an understanding of the impact of eating disorders on the family, the student will lead data organization, management and analysis.

Skills

- Organisation and management of data

- Building & managing a research dataset in SPSS

- Qualitative & quantitative analysis

- Writing research for publication (if time allows)

- Liaison with clinical service users

Do variants in renal sodium transporter genes influence urate handling in response to diuretics?


Supervisor

Nicola Dalbeth

Project type

Clinical

Department

Medicine

Location

Auckland

Project code: MHS091

In clinical practice, diuretic medications are used for treatment of hypertension, heart failure, and other fluid overload states. These agents are commonly associated with elevated serum urate concentrations and gout.  We have recently completed a study examining acute renal urate handling in response to an oral frusemide load (Dalbeth et al RMD Open 2017).  This analysis has shown no evidence that variants in urate transporters influence renal urate handling in response to diuretics, but has implicated an indirect response related to sodium transport.  A number of renal sodium transporter genes have been associated with responses to diuretics in previous studies.  In this studentship, we wish to determine whether these renal sodium transporter genes influence urate handling in response to diuretics. 

This project will involve analysis of the oral frusemide loading study dataset, and also a large national gout genetics dataset to determine whether:
1. Renal sodium transporter genes influence fractional excretion of uric acid or serum urate changes in response to an oral frusemide load
2. Renal sodium transporter genes influence diuresis, fractional excretion of sodium or potassium changes in response to an oral frusemide load
3. Renal sodium transporter genes influence the risk of diuretic-associated gout in a large community population.

Skills

This project is suitable for students interested in clinical or biomedical research, particularly in the fields of rheumatology, cardiology, renal medicine or genetics.

This project offers a number of learning opportunities:
• General clinical research experience in gout
• Exposure to genetics research
• Experience with managing large datasets
• Data analysis in close collaboration with a clinical and genetics team

Magnetic resonance imaging and visceral obesity in a multi-ethnic cohort


Supervisor

Dr. Max Petrov

Project type

Clinical

Department

Surgery

Location

Auckland

Project code: MHS092

The current prevalence of obesity is described as an epidemic by the WHO, and New Zealand has the 3rd highest rate of adult obesity in the world. In addition, visceral obesity, characterised as excessive abdominal fat, is strongly associated with the development of cardiovascular and metabolic diseases. The aim of this project is to compare the parameters of abdominal body composition and fat distribution using magnetic resonance (MR) images from a cohort of multi-ethnic patients. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience, including involvement in a case-control study of MR imaging after diseases of the exocrine pancreas.

Skills

• Working in a clinical research team environment

• Management of a case-control clinical study

• MR image analysis

• Preparation of a manuscript for publication in international peer-reviewed journal

Diseases of the exocrine pancreas in the elderly


Supervisor

Dr. Max Petrov

Project type

Clinical

Department

Surgery

Location

Auckland

Project code: MHS093

With improvement in health care, living standards and socioeconomic status, more adults in New Zealand are living to old age. As the population ages, it is increasingly important to identify the factors that might impact on the nutritional status and thus the health status of the elderly. Hence, it is important to understand how ageing affects the digestive system in order to allow appropriate interventions in the case of digestive functional impairment. The pancreas plays a central role in the digestive process due to the production of essential digestive enzymes and bicarbonate. The aim of this project is to summarize, for the first time, available literature on the peculiarities of exocrine pancreatic diseases, i.e. acute and chronic pancreatitis and pancreatic cancer, in ageing adults. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience.

Skills

• Working in a clinical research team environment

• Management of a clinical study
• Systematic literature review
• Preparation of a manuscript for publication in international peer-reviewed journal

Project withdrawn. Nebulisers versus metered dose inhaler and spacer, which is best? A systematic review


This project is no longer available.

Project withdrawn. Why are nebulised bronchodilators chosen as treatment for asthma over metered dose inhaler plus a spacer in the hospital setting? A clinician survey


This project is no longer available.

Between a rock, “some ice” and a hard place: Addicts in Strife.


Supervisor

Dr Di Winstanley

Project type

Clinical

Department

Mercy Hospice Auckland and Faculty of Medical and Health Sciences 

Location

Auckland

Project code: MHS096

A qualitative and quantitative review of the management of palliative care patients, who have a background of substance abuse, with drugs of addiction potential.

Skills

Skills gained

  • Analysis of clinical notes
  • Evaluation of clinical data
  • Familiarisation with process in the management of symptoms seen in palliative care and addiction medicine as well as medications, doses and schedules

 

Dementia Survival and Health Services Utilisation Linkage Study


Supervisor

Gary Cheung

Project type

Clinical

Department

Psychological Medicine

Location

Auckland

Project code: MHS097

Dementia is one of the major health problems in New Zealand and with an ageing population the prevalence of dementia will increase. Despite its demands on the health system, there is no previous dementia prevalence study in New Zealand. A recent initiative in the public health system in New Zealand is the development and implementation of cognitive impairment pathway which is aimed to streamline services provided for people with dementia from the time of diagnosis to end of life care.

A systematic review found that survival after a diagnosis of dementia varies considerably and the survival time of people with late-onset dementia ranged from 1.8 years to 7.2 years (Broadty et al. 2012). Important predictors for survival included age, gender, subtypes and severity of dementia. There is currently no New Zealand data on the survival time of people with dementia. Such information is vital for policy makers and clinicians to plan for dementia services. The primary aim of this research is to investigate the 5 years survival rate of people who were diagnosed with dementia in the setting of a memory service, and compare to the survival rate of the general population published by New Zealand Statistics. The secondary aim is to estimate the cost of community dementia care, including linkage analysis with data routinely collected by Dementia Auckland.

Health resources utilisation include numbers of GP visits per year; prescription and cost of medication (GP record); specialist visits & hospital admission (hospital record); residential care; home care (data from hospital’s gerontology service/needs assessment service). Mean health care cost per person per year can be calculated.

Skills

-          Literature review

-          Data collection

-          Dataset development

-          Data analysis

-          Report writing

A retrospective study of patients who have died from stroke at ADHB January 2016-January 2017


Supervisor

Julia Slark

Project type

Clinical

Department

Nursing

Location

Auckland

Project code: MHS098

Project background and aims

Each year over 9,000 people in New Zealand suffer their first ever stroke. Of those, a third are likely to die directly from the symptoms of stroke. The aim of this project is to learn from our experiences and use the information from patient’s notes to identify the exact nature and best methods of identifying and managing end of life care for stroke patients.  The specific aims for this summer studentship project include:
(1)    Determine when and how decisions are made regarding stroke patient’s end of life care needs
(2)    Describe factors which indicate decision to change goals of care?
(3)    Identify key stakeholders and access to palliative care for stroke patients

Ethical approval will be required to access patient's case notes. This will be sought prior to the start of the project.

Skills

Opportunity to work with experienced stroke and palliative care researchers in a committed and passionate research environment within the school of nursing

Case note review techniques – working with case notes

Reviewing literature – searching multiple databases

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

When severe mental illness and cancer collide: why do cancer patients with comorbid mental health issues fare more poorly?


Supervisor

Lisa Reynolds

Project type

Clinical

Department

Psychological Medicine

Location

Auckland

Project code: MHS099

Despite having no greater incidence of cancer than the general population, people with a severe mental illness have a 30% greater likelihood of dying from cancer once diagnosed. The reasons for this severe disparity are unclear. Emerging evidence suggests that late stage presentation has a role, but other factors like difficulties coping and non-adherence to treatment, a lack of engagement, other medical comorbidities, and a lack of coordination between healthcare services, might also have an impact.

The aim of this study is to identify the factors associated with poor treatment outcomes in cancer patients with severe mental illness. The student will begin by conducting a review of the relevant literature to identify factors that might underpin the poorer outcomes in this disadvantaged population. The review will be followed by a retrospective audit of clinical notes at Counties Manukau Health to ascertain the extent to which factors identified in the literature are documented within patient records. The student should have good initiative, be able to work independently, be confident in dealing with others, have excellent attention to detail, and have good writing skills.

Skills

  • Review of literature
  • Audit of clinical notes
  • Data management
  • Statistical analyses
  • Writing skills for publication

Project withdrawn. Defining the Quality of Pancreatic Surgery


This project is no longer available.

Systematic review of adverse event reporting in randomised trials of venous leg ulcer treatments


Supervisor

Andrew Jull

Project type

Clinical

Department

Nursing

Location

Auckland

Project code: MHS101

Adverse events within a randomised controlled trial are defined as any untoward emdical event whether related or not to the trial treatment. Adverse events can be categorised using formal taxonomies eg ICD10 and CTCAE, but such systems do not include leg ulcer specific events such as pain, infection, extension of ulcer area, or maceration. Further, adverse events are poorly reported within randomised controlled trials generally and there has been no assessment of the extent or quality of adverse event reporting within venous leg ulcer (VLU) trials. The aims of this project are to use a systematic review process:

  1. To quantify the number of VLU reporting adverse events (any or all adverse events).
  2. To quantify the number of trials using formal taxonomies when reporting adverse events.
  3. To quantify the number of trials reporting VLU specific adverse events.
  4. To identify the VLU specific adverse events reported in trials.

Skills

  1. Systematic searching of electronically databases (principally CCTR but may be extended to include Medline, EMBASE, and CINAHL).
  2. Develop and refine electronic data collection tool (in Excel)
  3. Analysis using descriptive statistics (in Excel)
  4. Report writing  

 

Validation of a personal breath test analyser for food malabsorption testing


Supervisor

Amber Milan

Project type

Clinical

Department

Liggins Institute

Location

Auckland

Project code: MHS103

Malabsorption of carbohydrates (e.g. lactose, fructose, fibre) causes a range of digestive symptoms such as bloating, abdominal pain, and flatulence. However, in a usual diet, it can be difficult to identify the cause of digestive symptoms. While clinics can use validated breath hydrogen analysers to assess which carbohydrates may be malabsorbed, this may not be accessible to the average consumer.

A personal breath test analyser offers an easily accessible method of testing breath hydrogen and malabsorption for consumers and clinical research use. However, new assessment tools require validation against gold-standard methods of assessment.

The current project aims to validate the measurement of malabsorption through breath hydrogen using a personal breath test analyser against the gold-standard

Skills

  • Clinical trial experience
  • Data analysis
  • Reviewing literature

The effect of Virtual Reality on the ocular surface


Supervisor

Philip Turnbull

Project type

Clinical

Department

Optometry / Ophthalmology

Location

Auckland

Project code: MHS104

Virtual Reality (VR) headsets can provide users with an escape, by transforming them to a new world, but there may be additional benefits of wearing VR. This project investigates the micro-environment around the eyes while wearing a VR headset, as well as the effect it has on the ocular surface. The project will be based in the Tear and Ocular Surface laboratory, and the student will have access to the latest methods and technologies for investigating the changes to the tear film. The outcome of the project will be to determine whether VR headsets can help suffers of dry eye.

This project is best suited for an optometry or medical student with previous training in basic ocular examination techniques, such as slit-lamp biomicroscopy. 

Skills

Students will be trained in a range of assessments of the anterior ocular surface, including thermography for skin/eye surface temperature.

Interventional statistics will be used for comparing pre- vs post- measures. 

The results of study may be published in a peer-reviewed journal, so manuscript writing and preparation skills can also be taught. 

Bias in clinical decision-making: can compassion help?


Supervisor

Associate Professor Nathan Consedine

Project type

Clinical

Department

Psychological Medicine

Location

Auckland

Project code: MHS105

Background

Despite efforts to remain impartial, evidence suggests that (like most of us) clinicians are not immune to bias in their attitudes, diagnoses, and treatment decisions.  Rather, studies suggest that physicians exhibit negative biases as a function of race/ethnicity, gender, age and weight. Although efforts to reduce bias remain ongoing, one provocative possibility is that compassion may help.  Compassion, the desire to alleviate suffering, a core aspect of being a physician and may reduce bias by helping clinicians orient to patient suffering rather than their ethnicity, gender, age or weight.  Experimentally investigating whether compassion can reduce bias may provide guidance for studies seeking to reduce the effects of bias in healthcare.  This studentship will employ an experimental design to explore whether compassion can reduce bias in clinical decision making. A convenience sample of volunteers will be recruited to complete an online experimental study assessing compassion, bias, and clinical decisions.

Aim

Test whether compassion reduces bias in physician’s clinical decision making 

Skills

  • Develop the online study protocol
  • Recruit participants for the study
  • Carry out a literature review
  • Contribute to the write-up for publication
  • Data entry and analysis (SPSS)
  • Collaboration with a team of investigators
  • Appreciation of yum cha and other exciting culinary endeavours (optional if your diet and religion allows)

 

The association between Health Literacy and Colorectal Cancer Outcomes


Supervisor

Dr. Celia Keane

Project type

Clinical

Department

Surgery

Location

Auckland

Project code: MHS106

Health literacy has been defined as “the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions”.[1] The Adult Literacy and Life Skills Survey conducted in 2006 found that 56.2% of New Zealanders had poor health literacy.[1] This is currently the best data that we have regarding health literacy in New Zealand.

Low health literacy has been associated with poor health outcomes including increased hospitalization rates, increased use of emergency care, lower use of the influenza vaccination, poorer health status and higher mortality in the elderly.[2] The uptake and completion of colorectal screening[3] and likelihood of receiving chemotherapy for stage 3 or 4 colorectal cancer[4] has also been associated with health literacy.

The overarching aim of this study is to examine health literacy in a New Zealand colorectal cancer patient population using a validated health literacy questionnaire. This will enable a baseline measurement of health literacy and determination of the relationship between health literacy and colorectal cancer outcomes in this population. It may also inform recommendations to improve the current tools used to convey information to colorectal cancer patients under the colorectal service.

The aim of this studentship will be to:
1. Undertake a literature review assessing the literature regarding health literacy in relation to the colorectal cancer diagnosis and management.
2. Conduct a cross-sectional assessment of health literacy in colorectal cancer patients treated at Auckland City Hospital.
3. Use statistical analysis to assess the relationship between health literacy and colorectal cancer outcomes.
4. Disseminate the results via presentation(s) and publication(s).

References

1. Ko¯rero Ma¯rama: Health Literacy and Ma¯ori. Edited by Ministry of Health, Wellington; 2010.
2. Berkman ND SS, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E, Tant E, Wallace I, Viswanathan M.  (Prepared by RTI International–University of North Carolina Evidence- based Practice Center under contract No. 290-2007-10056-I. AHRQ Publication Number 11- E006.): Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technology Assesment No. 199. Rockville: Agency for Healthcare Research and Quality.; 2011.
3. Ferreira MR DN, Fitzgibbon ML, Davis, Terry C, Gorby N, Ladewski L, Liu D, Rademaker AW, Medio F, Schmitt BP, Bennett CL.: Health care provider-directed intervention to increase colorectal cancer screening among veterans: results of a randomized controlled trial. Journal of Clinical Oncology 2005, 23(7):1548-1554.
4. Busch EL MC, DeWalt DA, Sandler RS.: Functional Health Literacy, Chemotherapy Decisions, and Patient Outcomes within a Cohort of Colorectal Cancer Patients. . Cancer control: journal of the Moffitt Cancer Center 2015, 22(1).

Skills

This is a surgical/clinical project and will involve the following skills:

• Literature review
• Data collection and management
• Statistical analysis
• Critical appraisal
• Medical writing/preparation of publication
• Working in a clinical research team environment

The Therapeutic use of Cannabis and Steroids in Hospice Care


Supervisor

Dr Kathy Peri

Project type

Clinical

Department

Nursing 

Location

Auckland

Project code: MHS107

The use of cannabis for the treatment of chronic pain and cancer symptoms is beginning to hold great interest for both patients and health professional. Steroid use has a high level of interest from a clinical perspective as well.

This project will require a student to conduct a systematic review of the current evidence available on both the use of cannabis and steroids in hospice settings.

Skills

This project will provide an opportunity for a student to develop skills in:

  • Systematic literature searching using specific tools
  • Evidence synthesis
  • Critical thinking
  • Writing for publication
  • Presentation skills
  • Build relationships with clinical staff at Totara Hospice South Auckland

Evaluation of visual impairment in stroke patients


Supervisor

Lily Yu-Li Chang

Project type

Clinical

Department

Optometry and Vision Science

Location

Auckland

Project code: MHS108

Background

Stroke patients often suffer from visual impairments such as ocular alignment/movement impairment, visual field defect, low vision, and perceptual difficulty. Patients may not have access to eye care, or have communication difficulties (aphasia), which means they are unable to alert family members/clinicians of their visual impairments. This results in a delayed diagnosis and poor quality of life. The Centre for Brain Research (CBR) Stroke Research Clinic has an interdisciplinary team that assesses stroke patients for their neurological function, speech, mobility and vision. Understanding the prevalence of visual impairment following stroke in a NZ patient base will provide valuable information on how eye care could be delivered, to optimise quality of life.

Aim

To report the prevalence of visual impairment, and profile the type of visual impairment in stroke patients assessed at The CBR Stroke Research Clinic from 2011-2017.
The student will be working alongside researchers, clinical leaders, and contributing to publication(s).

Skills

• Communication skills

• Gaining knowledge in interdisciplinary research/healthcare

• Review of data-bases

• Data analysis

• Writing for publication

Eye movements in virtual reality


Supervisor

Philip Turnbull

Project type

Clinical

Department

Optometry and Vision Science

Location

Auckland

Project code: MHS109

In the real world, eyes make versional (yoked) movements to pan horizontally and vertically, and vergence movements in response to changes in distance. These movements arise from different areas of the brain, but are combined to a single input to the muscles - including one that changes the focus of the eye based on the depth of the target (accommodation).

In virtual reality, the same versional eye movements are required to look around the world, but as the distance of the screen is fixed, any vergence eye movements must occur without stimulating a change in accommodation. We have a headset with inbuilt eye tracking which allows us to monitor eye position when in a virtual world. Eye movements during various tasks will be compared in the real and virtual worlds, to see how the visual system behaves in virtual worlds.

With virtual reality becoming more mainstream, the results will be used to give clinical recommendations on the usage of such devices. 

Skills

  • Binocular vision concepts.
  • Statistical modelling.
  • Infrared eyetracking.

Experience or a willingness to learn Unity and/or Matlab is advantageous, but not essential. 

The effect of feedback on measuring vision


Supervisor

Nicola Anstice

Project type

Clinical

Department

Optometry and Vision Science

Location

Auckland

Project code: MHS110

When seeing patients in an eye clinic they often asked whether the answers they give are correct or incorrect.  Currently there is no published evidence on whether providing patients with feedback this affects the outcomes of their eye examination.  This project will explore the effects of telling a patient whether their answer to the letters on an acuity chart were right or wrong by looking at two factors: their visual acuity score and the test-retest variability of measurements when patients are provided with feedback.  This project has implications for real-world clinical eye practice as well as for measuring vision in a research environment.

Skills

1. Measuring visual acuity; 2. psychophysics; 3. written and verbal communication skills

 

Health Coaching in Counties Manukau: one size probably does not fit all!


Supervisor

Professor Harry Rea

Project type

Clinical

Department

Medicine

Location

Manukau

Project code: MHS111

Health coaching can be defined as helping patients gain the knowledge, skills, tools and confidence to become active participants in their care so that they can reach their self-identified health goals. Health Coaching is based on evidence based-clinical interventions such as motivational interviewing to facilitate behaviour change.  Embedding health coaches in general practices in Counties Manukau Health (CMH) will be piloted in the next 3 months.  The main objective will be to help patients and families with long term conditions to become better self-managers.

The summer student will help us explore the question—can we gather information about the patient and family that will allow the best style/form of health coaching to be delivered?  Clearly individual characteristics such as cultural background, language, health literacy, deprivation, family/whaanau support and health beliefs should influence the method of coaching and we need to explore others. 

The patients will be a random sample from the Planned Proactive model of care which has been running in CMH for the last 3 years. There are more than 25,000 patients enrolled in this form of enhanced primary / GP care.  This cohort has been evaluated using traditional biomedical markers.

We now wish to use some instruments that measure more qualitative features about patient experience—these have not been validated in such a widely diverse community as South Auckland e.g. Patient Reported Experience Measures (PREMS), Patient Reported Outcome Measures (PROMS). Some of these might also be useful in predicting the best form of health coaching for individuals and families. It is assumed that a change in these will also help us measure the success of the health coaching.

It is likely this research will lead to a publication and change in current model of care.

The successful candidate will be based at CMH (Lambie Drive, Manukau) and will work alongside the Primary and Community Services Integrated Care Team.

Skills

  • Qualitative interviewing with patients and families with the support of CMH staff
  • Evaluation of integrated care in long term condition management – patient reported measures PREMS/PROMS

Oral antibiotics prescribing after TKA, do prescribing patterns differ between surgeons and GPs?


Supervisor

Simon Young

Project type

Clinical

Department

Orthopaedics, North Shore Hospital

Location

North Shore

Project code: MHS112

Prosthetic joint infection (PJI) is a devastating complication after total knee arthroplasty (TKA). Despite improvements in peri-operative and intraoperative care, the infection rate has remained at 1-2% over the last 2 decades. PJIs are difficult to study due to its low incidence.

Joint registries are often used to study PJIs due to the large numbers of cases they record. However, our previous work have demonstrated clear deficiencies in registry reporting of revisions secondary to PJI, partcularly if it occurs with in 90 days. The New Zealand Surgical Site Infection Improvement Programme (NZSSIIP) records all infections that occur with in 90 days of TKAs, combining the New Zealand Joint Registry and the NZSSIIP data will ensure near complete capture of the available data.

Using this data, this project aims to determine the risk factors associated with PJIs following TKAs. This will be determined through multivariate analysis following careful review of both databases and the cases generated.

Skills

1. Basic principles of orthopaedic interventions for PJI

2. Review of clinical notes and database keeping

3. Formatting databases for statistical analysis

4. Scientific writing and referencing

5. Generating hypothesis and study design.

Outcomes of older adults admitted to Intensive Care


Supervisor

Dr Katherine Bloomfield

Project type

Clinical

Department

Freemasons Department of Geriatric Medicine

Location

North Shore

Project code: MHS113

Further research is needed on the outcomes of older adults admitted to ICU in the setting of an ageing population, increasing longevity and prevalence of chronic diseases. Data from Australasia published in 2009 illustrated the increasing rates of older adults admitted to ICUs, and predicted further increased projections of over 70% over the subsequent decade. What happens to older adults admitted to ICU, in terms of mortality but also in terms of independence and place of residence? It is important to understand longer term outcomes in order to plan appropriately for population changes. This project involves a retrospective audit of the outcomes of older adults admitted to the Intensive Care Unit (ICU) at Waitemata District Health Board (WDHB). 

Results from this study will potentially be used to inform a prospective study looking at frailty and disability in older adults admitted to ICU and functional and quality of life outcomes.

This project is based at the University of Auckland Waitemata Clinical Campus, North Shore Hospital, Takapuna.

Skills

Communication skills – working within a research group from different clinical backgrounds
Literature review
Data handling, analysis and interpretation
Understanding the impact of research
Report/manuscript preparation and writing

What happens to octogenarians presenting to hospital with a fall?


Supervisor

Dr Katherine Bloomfield

Project type

Clinical

Department

Freemasons Department of Geriatric Medicine

Location

North Shore

Project code: MHS114

Falling is a significant adverse event associated with morbidity and mortality, and is a marker of potential underlying frailty in older adults. We wish to explore what happens to octogenarians presenting to hospital with a fall. Do they receive appropriate follow up care? This project will involve a retrospective chart review of 100 patients presenting to Waitemata District Health Board documenting patient demographic information, hospitalisation and follow up details, and outcome events 1 year later, including death, readmissions to hospital (with further falls or other geriatric syndromes) or residential care.

This project is based at the University of Auckland Waitemata Clinical Campus, North Shore Hospital.

Skills

Communication skills – working within a research group

Literature review

Data handling, analysis and interpretation

Understanding the impact of research

Report/manuscript preparation

Evaluating predictive tools for risk assessment in emergency abdominal surgery


Supervisor

Professor Andrew G Hill

Project type

Clinical

Department

Surgery

Location

South Auckland Clinical School

Project code: MHS115

Emergency laparotomy is a common high-risk operation in general surgery. The term encompasses multiple different open abdominal operations. Currently, the mortality rate after such procedure is about 14%. The risk of leaving the hospital with a major complication is 33%.

Emergency laparotomy has had much attention worldwide especially the United Kingdom and the United States. More recently Australia and now New Zealand have turned their focus on Emergency laparotomy outcomes.

The aim of this research is to evaluate the use of current risk assessment scores in Emergency laparotomy surgery at Middlemore Hospital. We will compare various risk tools used in audit and quality improvement programmes for emergency laparotomy. This work will help develop a risk assessment score

A secondary aim of this research is to compare outcomes our Middlemore Hospital national and international emergency laparotomy cohorts. 

Skills

  • Data analysis (learn to use t-test, chi-square test and ANOVA analysis)
  • Apply risk assessment scores on patients to predict outcomes
  • Retrospective research methods
  • Involvement with audit of surgical practice
  • Writing for a peer-reviewed journal publication
  • Contribute to the development of predictive risk score (introduction to statistical modelling)

Evaluating the impact of ethnicity on emergency abdominal surgery


Supervisor

Professor Andrew G Hill

Project type

Clinical

Department

Surgery

Location

South Auckland Clinical School

Project code: MHS116

Emergency laparotomy is a common high-risk operation in general surgery. The term encompasses multiple different open abdominal operations. Currently, the mortality rate after such procedure is about 14%. We do not understand the impact of ethnicity on emergency laparotomy outcomes. 

Māori  have many known risk factors for adverse emergency outcomes, including a higher likelihood of undiagnosed comorbidities, higher incidence of acute presentation with cancer and delayed presentations. The most recent document from the PeriOperative Mortality Review Committee (POMRC) has shown higher 30-day mortality for Māori after acute operations. The recommendation from the Māori Caucus was that better risk assessment is applied to understand why the increased risk of Mortality was observed.

The aims of this study are:

  • To examine the impact of ethnicity on emergency laparotomy outcomes.
  • To evaluate the reason for poorer outcomes for Māori population.
  • To find any patterns of inequity in patient care to target future interventions.

Skills

  • Data analysis (learn to use t-test, chi-square test and ANOVA analysis)
  • Retrospective research methods
  • Understanding the role of ethnicity in emergency research
  • Writing for a peer-reviewed journal publication
  • Contribute to the development of predictive risk score (introduction to statistical modelling)

Developing an evidence base for interprofessional palliative care education


Supervisor

Cathleen Aspinall

Project type

Clinical

Department

Nursing

Location

Auckland

Project code: MHS117

It is estimated that 91 million people will die worldwide in 2050 compared to 56 million in 2009 (Gomes et al 2011).Health Workforce New Zealand (2011) projections suggest that the numbers of people in New Zealand requiring palliative care will increase by nearly 25 per cent over the next 15 years and this will double by 2061.Contemporary palliative care is now seen to be everyone’s job regardless of area of employment and it is not the work of specialists alone. This issue calls for undergraduate education in the core competencies and skills of palliative care for all health professionals. Wee (2001) suggest that the delivery of high-quality palliative care requires effective inter-professional team working by skilled health professionals and palliative care is an ideal subject for undergraduate interprofessional education.

This integrative review aims to identify the nature, scope and delivery of interprofessional palliative care education internationally, to contribute to an evidence base for development of interprofessional palliative care education in New Zealand

Skills

  • Systematic literature searching
  • Evidence synthesis
  • Writing for publication 
  • Presentation skills

What is the current nature, scope and delivery of palliative care education in undergraduate nursing programmes in New Zealand


Supervisor

Rosemary Frey

Project type

Clinical

Department

Nursing

Location

Auckland

Project code: MHS118

The New Zealand Palliative Care Strategy (Ministry of Health, 2001 [MOH]) outlines the need to develop a workforce that can meet the needs of patients and their families and Whanau requiring palliative care.The strategy states that the attitudes and behaviours that will enable nurses to respond to the needs of people who are dying should be taught in undergraduate programmes.It suggests that the Nursing Council of New Zealand should produce guidelines on the minimum content of palliative care training at undergraduate level and a professional development framework aligned with nursing council competencies has been developed.

It is not known if an evidence based,systematic approach to teaching palliative care is utilised by Schools of Nursing in New Zealand that reflects the unique requirements of the speciality as identified in the strategy and the professional development framework.Cunnigham,Copp,Collins & Bater (2006) found that despite the recent emphasis on the need for an effective and informed workforce at all levels in relation to palliative care,little is known on the pre- registration preparation of nursing students.

The aim of this project is to identify the current nature, scope and delivery of palliative care education in undergraduate nursing programmes in New Zealand creating a platform for an international comparison of best practise.

Skills

  • Qualitative research methods to describe palliative care education programmes.
  • Technical research skills in qualitative research
  •  Content analysis
  • Writing skills for publication. 
  • Presentation skills

 

Characterisation of cardiac structure and function in patients presenting with first time acute coronary syndromes: a substudy of the MENZACS study


Supervisor

Professor Rob Doughty

Project type

Clinical

Department

Medicine

Location

Auckland

Project code: MHS119

MENZACS, the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes, is a case-control study that aims to understand genetic factors and gene-environment interactions that contribute to disease, outcomes and response to therapy in New Zealand’s ethnically diverse population presenting with heart attacks. The study is run as a “registry-based study”. The All New Zealand Acute Coronary Syndrome – Quality Improvement register, ANZACS-QI, is a web-based hospital registry collecting data on patients experiencing heart attacks in New Zealand. Several studies, including MENZACS, are now underway in parallel to ANZACS-QI which allows for simple and cost-efficient means to conduct large scale multicentre research studies in NZ.  The clinically available data collected as part of the ANZACS-QI registry includes only relatively limited data from investigations such as electrocardiography and echocardiography. Thus, the aim of this substudy is to define cardiac structural and functional changes in patients with first time acute coronary syndromes.

The substudy will involve collection of pre-specified indices from 12-lead electrocardiograms and echocardiography. The data collection will be done at Auckland Hospital and will involve working with the MENZACS team.

Skills

  • Critical appraisal of the literature
  • Interpretation of electrocardiograms and echocardiography data
  • Data collation, analysis and presentation

 

Ethnic Variation in Pelvimetric Measures and Its Impact on Positive Surgical Margins at Radical Prostatectomy in New Zealand


Supervisor

Ali Mirjalili

Project type

Clinical

Department

Anatomy and Medical Imaging

Location

Auckland

Project code: MHS120

African men have a higher apical positive surgical margin (PSM) rate at radical prostatectomy (RP) compared with Caucasians. By controlling for clinical and pathologic parameters, this was the result of a narrower pelvis.  Anecdotally, New Zealand urologists also have reported a higher apical PSM rate at RP in Māori populations but this has not been investigated. 

It has been shown that the likelihood for a PSM in surgically treated rectalcancer patients is higher in patients with a narrow pelvis, presumably caused by the technical difficulty with smaller pelvic dimensions. It has also reported that men with a deep and narrow pelvis on magnetic resonance imaging (MRI) had a higher PSM.

The racial differences between Africans and caucasians in pelvic anatomy have been well documented with the finding that the pelvis is narrower in Africans. The aim of this project is to investigate the ethnic differences in bony and soft tissue pelvic dimensions in NZ European and Māori populations using archival CT and MR scans.

Skills

  1. Literature search
  2. Cross-sectional anatomy
  3. Data collection and analysis (Pelvimetric Measures)

3D volumetric musculoskeletal atlas of the infant upper limb


Supervisor

Ali Mirjalili

Project type

Clinical

Department

Anatomy and Medical Imaging

Location

Auckland

Project code: MHS121

Knowledge of paediatric anatomy is an essential component of clinical medicine for physical examination, diagnostic imaging, surgery, and interventional procedures. However, there is a lack of anatomical studies of paediatric anatomy, and as a result, current clinical practice applies knowledge of adult anatomy to children. This underlying assumption that adult anatomy can be directly applied to children is problematic as studies have found that pediatric anatomy is not proportional to adult anatomy.

There is no 3D volumetric musculoskeletal atlas of the infant that captures detailed architecture and spatial relationships of anatomical structures as in situ. The digitization and 3D modelling technique developed in our laboratory would enable the development of a comprehensive 3D musculoskeletal atlas of infant anatomy with correlation to pre-dissection medical imaging. This 3D atlas would provide a foundational understanding of pediatric musculoskeletal anatomy, enabling comparison to existing adult anatomical data from our laboratory. Clinically, this project will contribute to the advancement of clinical skills, simulation, and planning of surgical and interventional procedures.

To achieve this goal, we propose to start by compiling a 3D digital atlas of the infant upper limb. This involves digitizing all the muscles and aponeurosis/tendons of the upper limb, along with bony and fascial attachment sites. The infant anatomy will be compared to existing adult anatomical data from our laboratory and form the basis of preliminary comparisons of physical examination techniques.

Skills

  • Literature Review and Summary
  • Dissection Skills
  • Analysis of Data
  • Scientific Writing

Characterisation of nutrition status for patients presenting with first time acute coronary syndromes: a substudy of the MENZACS study


Supervisor

Professor Rob Doughty

Project type

Clinical

Department

Medicine and Nutrition

Location

Auckland

Project code: MHS122

MENZACS, the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes, is a case-control study that aims to understand genetic factors and gene-environment interactions that contribute to disease, outcomes and response to therapy in New Zealand’s ethnically diverse population presenting with heart attacks. The study is run as a “registry-based study”. The All New Zealand Acute Coronary Syndrome – Quality Improvement register, ANZACS-QI, is a web-based hospital registry collecting data on patients experiencing heart attacks in New Zealand. Several studies, including MENZACS, are now underway in parallel to ANZACS-QI which allows for simple and cost-efficient means to conduct large scale multicentre research studies in NZ. 

The study includes a research module with collection of additional research level data, stored blood samples are collected and a food frequency questionnaire is administered. The aim of this substudy is to define dietary patterns among patients with first time acute coronary syndromes.  The substudy will involve collation, analysis and interpretation of the food frequency questionnaire for patients in the MENZACS study. A literature review will be undertaken of the role of dietary patterns as risk factors for coronary disease and of the role of dietary patterns and biomarkers of nutrition on outcomes in patients post acute coronary syndromes.  The studentship will be undertaken at The University of Auckland (Grafton Campus) and will involve working with the MENZACS team.

Skills

  • Critical appraisal of the literature
  • Data collation, analysis and presentation
  • Interpretation of food frequency data

Ethnic skin-defining inequalities to accessing public funded dermatology service


Supervisor

Dr Denesh C Patel

Project type

Clinical

Department

Medicine

Location

Department of Dermatology, Greenlane Clinical Centre, Auckland District Health Board (ADHB)

Project code: MHS173

Project aims

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 taught

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.