Clinical

Sleep quality and other lifestyle factors in medical students

Supervisor

Dr Harsh Bhoopatkar (923 8862)

Discipline

Clinical

Project code: MHS001

Aims

This project aims to explore sleep quality and aspects of diet and exercise in medical students.

Skills that will be taught include

  • How to perform a systematic literature review
  • How to analyse data
  • How to write a paper
  • How to publish a paper in a peer reviewed journal

The project is ideal for a student with an interest in medical education in a clinical topic that could have an an impact on the medical student health and well-being.

Gender authorship bias in rheumatology publications

Supervisor

Prof Nicola Dalbeth (ext 82568)
Dr Sarah Stewart
Assoc Prof Andrew Grey

Discipline

Clinical

Project code: MHS015

Gender bias is a widely recognised problem in biomedical academic publications, with gender differences reported in publication rates, citations, and authorship position. In addition, country of origin or geographic location can also influence the publication of articles and their subsequent citation rate. We have recently completed an analysis of rheumatology journals, and our preliminary findings have indicated differences in author gender based on funding source. We wish to extend these findings to examine the effects of funding source on both gender and country of origin bias in rheumatology publications.

Aim

To determine whether gender or country of origin bias exists in authorship of rheumatology-related publications, and whether authorship patterns differ based on study sponsorship.

Methods

We propose a content analysis of original rheumatology-related research articles published in top rheumatology journals and clinical medical journals. For each article, gender of the first and last (senior) authors, country of affiliation, and funding source will be recorded and analysed. A manuscript describing the findings will be completed for submission to a medical journal.

This study will provide the following skills

  • Literature review and synthesis
  • Data extraction and management
  • Statistical analysis
  • Preparation of a manuscript for publication

Diagnosis and management of colorectal cancer in people under 50 years of age in New Zealand

Supervisor

Michael Findlay (923 4927)
Kate Gorton

Discipline

Clinical

Project code: MHS022

Background

Increasing incidence of colorectal cancer (CRC) in young adults under the age of 50 years has been reported in a number of high-income countries including the US, Australia, Canada and New Zealand. Research is needed to describe the pathways to diagnosis, management and outcomes for young adults with CRC in New Zealand.

The project

This project will involve analysis of an established dataset collected previously as part of the New Zealand PIPER Project. The PIPER dataset includes extensive diagnostic, management and treatment information for 4950 CRC patients diagnosed in New Zealand in 2007-2008. The project will aim to describe the patterns of presentation, pathology, staging, treatment delivered and outcomes in young adults with CRC (aged <50 years) compared to the older adult CRC population (=50 years), and identify differences by ethnicity, rurality and socioeconomic status.

Skills taught

The student will develop skills in the interpretation of quantitative data and writing skills for publication.

Timing

10 weeks over the summer period (start date is negotiable).

Cancer treatment in adolescents: effects on school and friendships

Supervisor

Dr Rebecca Slykerman (923 1132)

Discipline

Clinical

Project code: MHS024

Background

Treatment for cancer in adolescence can result in considerable disruption to school attendance. This impacts not only on educational progress but also on peer relationships. For some young people transitioning back to school and re-establishing connections with friends can after finishing treatment be difficult.

Aim

To better understand the experiences of young people that have been through cancer treatment in their adolescent years. The project also aims to understand what young people think would help to make it easier to transition to school and re-connect with peers.

Impact

To achieve this objective information will be collected from interviews with young people and surveying Paediatric Oncologists and nurses. The significance of this research is that it will inform more effective interventions to help young people re-integrate into school and peer groups when they finish treatment.

The project provides an excellent opportunity for a student to:

  • Develop skills in collecting information through surveys and/or interviews
  • Gain experience working with young people and health professionals
  • Participate in preparing a research article for publication in a peer-reviewed journal

This project would suit a student with good communication skills who is interested in the understanding the experiences of young people with cancer. Previous interviewing experience would be beneficial but not essential.

Resuscitation from Cardiac Arrest in the Emergency Department: Is there a role for ECMO?

Supervisor

Assoc Prof Peter Jones (021 537 646)
Dr Steve Waqanivavalagi

Discipline

Clinical

Project code: MHS031

Background

The Adult Emergency Department at Auckland City Hospital manages over 3000 patients per annum in the resuscitation room. Some of these patients suffer cardiac arrests and are in cardiogenic shock.

Complexities of managing patients with cardiogenic shock mean that successful resuscitation may be difficult to achieve. Delays mean that patients are at increasing risk of hypoxic brain injury or death. In targeted patients, the use of extracorporeal membranous oxygenation (ECMO) may buy time to definitive intervention because ECMO provides temporary artificial heart and lung function.

The Project

This project will suit a student who is interested in resuscitation, emergency medicine or intensive care. The project involves review of resuscitation case records. The purpose is to collate clinical parameters and outcomes of patients with cardiac arrest, and identify the number and proportion of patients who might have been suitable for ECMO. The student will then help develop a feasibility study protocol in which ECMO use in cardiac arrest patients will be examined.

Skills Taught

The student will gain an understanding of the importance of good clinical documentation, develop skills in data extraction and quantitative data analysis (including basic statistics). They will also gain experience in study design, teamwork and presentation of data. 

Disease prioritization in rheumatology publications: A content analysis

Supervisor

Sarah Stewart (ext 81747)
Nicola Dalbeth
Andrew Grey

Discipline

Clinical

Project code: MHS032

Background

Presentation order of articles within journal issues can influence the prominence of an article. Earlier listed articles are more likely to be seen, read and cited. Our recent analysis of top rheumatology journals demonstrated prioritization of certain rheumatic diseases, by prioritizing the presentation of these articles earlier in issues. Journals with content grouped by disease category exhibited greater disease category privileging compared to journals without disease category content groupings.

One highly ranked journal did not demonstrate disease category prioritization in our recent analysis. However, this journal introduced content grouped by disease category in early 2019. We hypothesize this change would lead to disease category prioritization and may impact the prominence of articles on disease categories appearing at the front of journal issues.

Methods

We propose a content analysis of original research articles. For each article, disease category, downloads and altmetric score will be extracted. Data will be analysed to determine whether content grouped by disease category influences disease prioritization, downloads and altmetric scores. A manuscript describing the findings will be completed for submission.

This study will provide the following skills:

  1. Literature review and synthesis
  2. Data extraction and management
  3. Statistical analysis
  4. Preparation of a manuscript 

Safety and efficacy of prone positioning for critically ill patients on veno-venous extracorporeal membrane oxygenation

Supervisor

Assoc Prof Rachael Parke (021 893 176)
Dr Shay McGuinness

Discipline

Clinical

Project code: MHS040

Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. This therapy is only offered in New Zealand in the Cardiothoracic and Vascular Intensive Care Unit (CVICU) at Auckland City Hospital.

Patients requiring VV-ECMO are critically ill and this therapy may be lifesaving. As part of their care, patients are sometimes turned prone in the belief that this may improve gas exchange by recruiting dependent lung areas. There is scant observational evidence to support this practice.

This project involves a retrospective chart review of patients receiving VV-ECMO over a 5 year period at CVICU, to assess the effect of prone positioning on gas exchange and to report safety and outcomes of this high risk procedure.

Skills

The student will be supported by a team of researchers and learn skills of:

  • database designdata collection and entry
  • data analysis
  • presentation of data
  • manuscript preparation

Improving gout management and exploring equity issues for gout patients

Supervisor

Prof Bruce Arroll (021 378 180)
Leanne Te Karu

Discipline

Clinical

Project code: MHS042

This project will have two components. Part 1. One will be to update a cohort of patients with gout at the Papakura Marae Health Clinic (95% patients are Maori). Gout is a major health issue particularly for Maori men. Control of serum uric acid (the cause of gout through deposits in body joints) is relatively simple through the taking of uric acid lowering medications such as allopurinol. However due to many system, provider and patient factors poor control is common among Maori. Analysis of this cohort to determine the predictors of good control such as a serum uric acid level < 0.36 mmol/l or regular collection of medication for gout using multivariate statistical modelling (this will be done by a statistician). Part 2 examining social factors and equity. There is some data from the clinic showing that patients have trouble getting time off work, have limited transport options etc. which make getting to the clinic difficult.

The summer project will involve interviewing patients about these issues using a qualitative interview format. Thus the student will get experience in both quantitative and qualitative research methods. The student will be based at the marae and ideally have an interest in Maori health.

Identifying the gaps in systematic reviews and wastage in primary research (Fertility)

Supervisor

Marian Showell (021 129 8061)
Vanessa Jordan
Cindy Farquhar

Discipline

Clinical

Project code: MHS045

This project will identify whether current systematic reviews, in the scope of fertility, are covering the important areas of current research as identified by by the topics of current random controlled trials (RCTs).To do this, we will first identify the fertility RCTs held in the Cochrane and Gynaecology and Fertility Group's (CGFG) specialised register. We will identify whether these RCTs have been used already in Cochrane systematic reviews (SRs). Those that have not been used in SRs will then be coded by their population and intervention and classified into the topics for the development of new review titles.

By analysing those areas in fertility that are not covered in the CGFG systematic reviews, we will be able to identify the gaps between RCTs and the systematic reviews being conducted and therefore reduce the numbers of RCTs that are not used. These gaps in evidence may or may not be clinically significant, which we aim to determine. We will present and disseminate these results by publication in a high profile peer review journal. This will act as a guide to identify new topics for future high-quality reviews, prioritise review proposals that cover these gaps in clinical evidence, and inform trialists on topics that are or are not clinically relevant, thus helping to reduce waste in primary research. This will bring forward new understandings of evidence for fertility treatments and other clinical interventions that have not yet be covered by CGFG reviews, and can be of significant benefit to clinicians and fellow researches in this field.

Design

Cohort of fertility trials from the Cochrane Gynaecology and Fertility specialised register published 2010-2013.

Methods

1st phase: We will take all those fertility trials published from 2010-2013 from the CGFG database and allocate them according to their intervention and condition, these will include full texts and conference abstracts.
2nd phase: We will then match these trials to existing Cochrane systematic reviews and protocols.
3rd phase: We will identify the gaps i.e. the trials that are not yet covered by Cochrane reviews. We also aim to search for non- Cochrane reviews to see if these topics are covered or not.
4th phase: We will assess the priority and clinical importance of the trials that are not incorporated into a review and develop a list of potential new review topics.

Targeted therapy for ALK rearranged non-small cell lung cancer. Cochrane Review

Supervisor

Michelle Wilson (021 156 1492)
Laird Cameron
Vanessa Jordan

Discipline

Clinical

Project code: MHS054

Lung cancer is New Zealand’s leading cause of cancer death. Non-Small Cell Lung Cancer (NSCLC) comprises 85% of lung cancers and is typically diagnosed at an advanced stage with 5-year survival estimated at 3-6%.

Understanding of molecular characteristics of lung cancer has led to tailored therapies and improved outcomes. In 2007, ALK gene rearrangements were discovered to occur in approximately 5% of patients with NSCLC. Since crizotinib was proven to be superior to chemotherapy, at least 6 next generation ALK inhibitors have now been developed. When ideally targeted with sequenced therapy, median survival is now estimated up to7 years.

This cochrane review will evaluate the safety and efficacy of different ALK inhibitors as monotherapy to treat advanced ALK-rearranged NSCLC. The title has been granted to an international team led by Dr Cameron with a completed protocol.

The student will attend a Cochrane methods course and join the research team in undertaking the systematic review and metanalysis. The student will receive valuable experience in Cochrane methods applicable to any research question. These skills include critique of papers, bias evaluation and statistics. The search strategy will be conducted in August. The student will join the team in November with completion in February. 

Diabetes and antipsychotic medications

Supervisor

Dr Rajendra Pavagada
Dr Lillian Ng

Discipline

Clinical

Project code: MHS055

More than 240,000 New Zealanders have diabetes. There is an increased risk of diabetes in patients with schizophrenia with some antipsychotic medications (for example clozapine and low potency conventional antipsychotics). The risk is higher with the specific classes of antipsychotics. Ethnic minority patients including Asians, Hispanics and African-Americans have a predisposition to developing diabetes and antipsychotics may precipitate diabetes. In clinical practice, close monitoring is necessary to prevent metabolic side effects of these drugs.

The aim of this research is to:

  • Compare the incidence of diabetes in South Asian, New Zealand Europeans and Maori and Pacific Island service users currently treated with atypical antipsychotic medications
  • Create a co-design care-model for the South Asian Indian patients who have both diabetes and psychosis (and taking psychotropic medication)

The study population are South Asian Indians who were referred to community mental health and early psychosis interventions services, treated with atypical antipsychotics in 2013. This project is based within mental health services at Counties Manukau District Health Board. The summer studentship in 2019-2020 will primarily involve the retrospective collection of clinical data from electronic notes.

Rapid diagnosis of acute promyelocytic leukaemia and treatment outcomes

Supervisor

Dr Maggie Kalev (ext 84484)

Discipline

Clinical

Project code: MHS056

We have recently reported contribution of a rapid diagnostic test for acute promyelocytic leukaemia (APL) introduced in Auckland in the year 2000 on treatment decisions. Our review collected comprehensive clinical data on 151 patients with acute leukaemia, including 70 with APL. All patients were managed at Auckland City Hospital during 2000-2017. APL is notorious for causing life-threatening bleeding complications at presentation and during the first month of treatment. However, the long-term outcomes are now excellent in patients treated rapidly with retinoic acid and in more recent years, arsenic trioxide.

The aim of this project is to help us finalise and prepare for publication the analysis of the predictors of short-term and long-term outcomes in our APL patients. The focus will be on the impact of the time to treatment initiation and the role of arsenic. Short-term outcomes include bleeding events, coagulation abnormalities, transfusion requirements and early death. Long-term outcomes are disease-free survival and leukaemia relapse. The Stratification according to ethnicity will be included to determine outcomes in Polynesian/Maori patients.

We are looking for a highly motivated, analytical student with good writing skills to help us prepare a paper for submission. Previous experience with xls, Photoshop and any form of scientific writing is preferred.

Complex Topics in the Medical Curriculum

Supervisor

Dr Lillian Ng (ext 83774)

Discipline

Clinical

Project code: MHS057

The purpose of this research is to design and develop resources in an electronic platform on complex topics for MBChB Year 2-6 students in the Faculty of Medical and Health Sciences programme. The topic we have chosen to focus on is suicide. Teaching complex topics involves a significant component of tacit learning, using modelling and reflection to enable students to develop clinical knowledge imbued with depth. We aim to develop a repository of resources (for example, graphics, clinician mini-TED talks, annotated videos, clinical scenarios, interactive question and answer sessions with clinicians) to enable students to feel confident and equipped to respond to a person who is suicidal, in clinical practice and in their personal life. This repository will also have elements of self-care and ways to seek personal and professional support. Feedback from staff and students will assist in evaluating the feasibility of the repository. We are seeking a motivated student to assist with generating ideas for study design and conducting a literature review. This project offers great opportunities to gain understanding about psychiatry and mental health services and developing research and presenting skills.

MRI-determined ectopic fat deposition in a multi-ethnic cohort

Supervisor

Assoc Professor Max Petrov (923 2776)

Discipline

Clinical

Project code: MHS058

Excess adiposity has reached global epidemic levels with increasing impact on public health, given its association with metabolic syndrome, diabetes, and cardiovascular disorders. Individuals with similar general adiposity can vary significantly in their fat distribution. The clinical importance of body fat distribution over total body fat content has become increasingly evident in recent years. In particular, central or abdominal adiposity measures predict increased risk of metabolic complications better than general adiposity. Modern magnetic resonance (MR) imaging enables accurate quantification of not only abdominal adiposity, but also ectopic fat phenotypes [1,2]. The aim of this project is to investigate ectopic fat deposition using MR images from a large multi-ethnic cohort. The project is part of a larger research theme of the COSMOS group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience.

Skills Taught

  • Working in a clinical research team environment
  • Management of a cross-sectional clinical study
  • MR image analysis
  • Preparation of a manuscript for publication in international peer-reviewed journal

Further reading:
[1] Cervantes A, Singh RG, Kim JU, DeSouza SV, Petrov MS. Relationship of anthropometric indices to abdominal body composition: a multi-ethnic New Zealand magnetic resonance imaging study. J Clin Med Res 2019;11:435-446.
[2] Singh RG, Nguyen NN, DeSouza SV, Pendharkar SA, Petrov MS. Comprehensive analysis of body composition and insulin traits associated with intra-pancreatic fat deposition in healthy individuals and people with new-onset prediabetes/diabetes after acute pancreatitis. Diabetes Obes Metab 2019;21:417-423.

Working with an IT company to look at electronic management of laboratory test results in primary care

Supervisor

Prof Bruce Arroll (021 378 180)
Samuel Wong (Vensa)

Discipline

Clinical

Project code: MHS065

Vensa is an IT company who are developing software to make working as a GP easier by automating some tasks such as laboratory test interpretation. Many of the lab tests that GPs order are normal so they wish to develop algorithms that enable computers to check and file normal results and safely interpret abnormal ones and flag them for clinicians to check.

The summer project will be doing a literature search on expert systems for interpreting laboratory tests to find out what is known about the process and to see what are the potential hazards. This will give the student an experience in conducting a review of the relevant literature and potentially getting a journal publication. They will also get a chance to work with people at the cutting edge of technology. An interest in IT would be helpful but not essential.

A pharmacist-led medicines review intervention in community-dwelling Maori older adults– a feasibility study

Supervisor

Nataly Martini (923 2150)
Jo Hikaka
Rhys Jones

Discipline

Clinical

Project code: MHS068

Medicines provide therapeutic benefit to those with long term conditions, however, they are also associated with harm. As people age, pharmacokinetic and pharmocodynamic changes, as well as increasing co-morbidities, increase the complexity of medicine regimens and can increase risk of medicine-related harm. Pharmacist-led medicines reviews lead to improved outcomes for older adults. These have not been investigated in Maori older adults, who experience poorer access to, and quality use of medicines than non- Maori.

The summer student will work on the feasibility study investigating the acceptability of medicines reviews services for community-dwelling Maori older adults. The study is informed by kaupapa Maori research methodology and is centred on the rights of Maori older adults to experience equitable health outcomes.

The study objectives are to test the:

  1. acceptability of the medication review to participants, prescribers and whanau (through ‘acceptability’ questionnaires).
  2. feasibility of using medicines knowledge, quality of life and medicines appropriateness tools in Maori older adults.

You will gain skills in:

  • literature review
  • academic writing 
  • research methods in kaupapa Maori context
  • Qualtrics
  • pharmacy practice research

This would suit those with:

  • interest in health equity
  • excellent communication
  • some medicines knowledge
  • ability to undertake some self-directed work

How many hours per night is enough? A systematic integrative review to identify optimal CPAP therapy use for sleep apnoea

Supervisor

Kim Ward

Discipline

Clinical

Project code: MHS069

Obstructive sleep apnoea (OSA) is a global health issue, and continuous positive airway pressure (CPAP) delivered overnight via face-mask, is the go-to treatment worldwide. However, concern exists that patients under-utilise this therapy, despite a lack of consensus about what is good therapy use. An array of studies are available regarding the hours per night and nights per week required for CPAP use, but which differ in opinion about what is optimal. This systematic review aims to identify from the current literature what constitutes optimal CPAP use for OSA.

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

  • Literature search and review
  • Basic research skills, including data collection methods and data quality appraisal
  • Data interpretation and presentation
  • Professional scientific writing and the publication process

The student will be based at the School of Nursing, University of Auckland.

Long-term outcome of Idiopathic Intracranial Hypertension

Supervisor

Professor Helen Danesh-Meyer (522 2125)

Discipline

Clinical

Project code: MHS071

Idiopathic Intracranial Hypertension is a neurological condition that primarily impacts young women. Increased intracranial pressure produces symptoms of headache, blurred vision, and tinnitus. It is associated with significant morbidity in that the headaches are often hugely debilitating. Blurred vision is secondary to papilloedema and can result in permanent visual loss and blindness. The definitive treatment is weight loss as this condition tends to occur in patients with BMI greater the 30. Medical treatments include acetozolamide which has significant side-effects. Surgical procedures that are undertaken are CSF shunting procedures and stunting. Patients often require long-term treatment. Patients require regular follow-up by ophthalmologists and neurologists. There is a paucity of data in the literature regarding the long-term outcome of these patients including visual outcomes, and follow-up.

This summer studentship will include 2 stages: 1) a chart review of patients over the last 10 years seen at Greenlane Eye Clinic with Idiopathic Intracranial Hypertension to determine their long-term outcome in terms of vision, headaches and weight loss. It will assess the percentage of patients lost to follow-up. 2) Stage 2 will include contacting patients lost to follow-up and arranging re-examination of them. This will include ophthalmic assessment, visual fields, and optical coherence tomography. The summer student will be taught these valuable skills for this stage.

The outcome of the summer studentship will be a research publication with the opportunity to present their research at Ophthalmological and Neurological Conferences.

The Eyes are the Window to the Brain: Can Eye Tracking Identify Concussion Injury and Predict Recovery

Supervisor

Professor Helen Danesh-Meyer (522 2125)

Discipline

Clinical

Project code: MHS072

Concussion is an increasing recognised health issue in our society impacting children, amateur and professional athletes, and those involved in accidents. The issues surrounding concussion include the ambiguity in making the diagnosis and determining when recovery has occurred. This has implications for athletes returning to play as well as individual returning to work and normal activities. Symptoms associated with concussion are often non-specific such as difficulty concentrating, headaches, dizziness, light sensitivity and difficulty coping in environments with significant levels of stimuli (such as driving, super markets). Present investigation of concussion involves complex and time-consuming neurological and psychological assessment. Furthermore, neuroimaging is usually normal and unable to identify specific changes. Some more recent advanced neuro-imaging modalities can identify changes in the white matter of the brain in patients experiencing concussion. However, it is not practical to undertake such imaging in all patient who have had concussion. There is also a large body of literature that demonstrates that patients with concussion have abnormalities in eye tracking, in particular, saccades, anti-facades, vestibulo-ocular reflex. These can be measured in a laboratory environment, although such testing is not-practical in a clinical setting.

This summer studentship is an exciting opportunity for a student to work on developing/refining eye tracking system that can be used in a clinical setting. This summer studentship would suit a student with an engineering background/interest. The student will be working on refining the present eye tracking system and comparing it to established systems. This will involve engagement with patients who have been involved in concussion to determine the sensitivity/specificity of the eye tracking system. The summer student will also be involved in preparing the research for scientific publication. They will also have the opportunity to submit their findings at local and international conferences.

Patient access to their electronic medical records via portals

Supervisor

Sue Wells (021 664 337)

Discipline

Clinical

Project code: MHS074

Patient portals are secure online sites where patients can book an appointment, order repeat prescriptions and interact with their GP via secure messaging as well as access to their laboratory results, medications, diagnoses, immunisations and visit notes. Where portals have been successfully implemented, patient access to their health records and messaging has been reported to improve communication, patient understanding of health information, engagement and self-management as well as improving safety due to capture and sharing of biomedical information. ProCare PHO has over 170 affiliated general practices cares for over 800,000 enrolled patients, making up 51% of Auckland region’s population and responsible for the largest Maori and Pacific communities in New Zealand (nearly 200,000). In December 2018, 22% of ProCare patients were registered for patient portals. However, there is no data on who has access (by age, gender, ethnicity and deprivation) and what portal functionalities are actually offered. Anecdotally many practices use the portal for appointment booking but few have allowed patients to access their visit notes. With a summer student, we wish to conduct of survey of all Procare practices to understand equity of uptake, portal features being offered and barriers and enablers to allowing full portal functionality.

Characterization of the Inherited Ciliopathies from the NZ Inherited Retinal Disease Database

Supervisor

Associate Professor Andrea Vincent

Discipline

Clinical

Project code: MHS076

 The inherited retinal dystrophies affect 1:2500 people, with onset at a young age, often resulting in legal blindness. Progressive rod-cone retinal degeneration (RCD) manifests as progressive deterioration of vision in dim light, visual field constriction and may be isolated, but can occur as part of a syndrome. Protein trafficking and signalling within cells are conducted by primary cilia. Photoreceptors rely on two cilia for their normal function. Disruption of these cilia causes photoreceptor death and results in vision loss. Mutations in ciliary genes cause cilia disruption, photoreceptor death, and a group of genetic disorders: ciliopathies, with features including deafness, diabetes, renal impairment, respiratory disease, cardiac and liver disorders, hypogonadism and obesity.

This summer studentship project will look specifically at ciliopathies identified from the NZ Database of IRD (Bardet Biedel, Alstrom, Usher, Senior Loken, RPGR-associated syndromes).

Aims

  • To characterize the demographics and frequency of the Ciliopathies in NZ
  • For specific genes, characterize the clinical spectrum
  • For specific families with novel changes -determine segregation, and genotype –phenotype correlation

Skills

  • Database searching
  • Review clinical notes / investigations/Imaging/Electrophysiology
  • Bioinformatics - human variation databases, protein pathogenicity
  • Literature review

Would suit medical student.

Informed Consent prior to Prostate cancer screening: Does is it actually happen?

Supervisor

Kamran Zargar-Shoshtari
Bashar Matti (021 054 0103)

Discipline

Clinical

Project code: MHS082

Population-based screening for Prostate cancer (Pca) with Prostate specific antigen (PSA), has been a controversial topic for decades. This is largely attributed to the lack of sufficient evidence that the benefits of screening, heavily outweigh the potential harms of overdiagnosis and treatment of non-clinically significant cancers. Accordingly, most international guidelines, including in New Zealand, recommend an individualised approach to the screening process. This must include providing culturally appropriate counselling prior to instigating screening with PSA testing.

Essentially, in additions to the benefits, each man needs to understand the potential harms and risks attributed to PSA testing such as unnecessary prostate biopsies.

Previous international reports have shown that the counselling process is far from perfect in the real-life clinical settings. Our observation, being on the receiving end of many referrals from the primary health care sector, is that many men arrive to our clinics not even knowing that they had a PSA test performed in the first place.

This study aims to prospectively survey all men referred to urology clinics, with abnormal Pca screening related results, to quantify and qualify their level of knowledge about the screening process.

Training will be given to the student hence no pre-requisite skills are necessary. However, we would like an enthusiastic student, who shows a high level of commitment to this project. 

Understanding the Modern Role of Ethics Review Boards

Supervisor

Tatjana Buklijas (021 190 8888)
Andrew Chen

Discipline

Clinical

Project code: MHS083

Research institutions have ethics review boards to ensure that research work is done in a way that respects the rights of research participants. Core principles include the need for voluntary and informed consent by human subjects, for experiments to have a purpose towards societal good, and for researchers to “avoid all unnecessary physical and mental suffering and injury”.

Continuing developments in science and technology, including the use of artificial intelligence, may require rethinking of the scope of ethics review. Some research may be missed by current ethics review processes, and sometimes we may not be asking the right questions.

As a first step in a larger project, this summer studentship research seeks to understand how ethics review is perceived by researchers at the University of Auckland (starting with FMHS), and what we could improve. With the assistance of the Office of Research Strategy and Integrity (ORSI) and Centre for Science in Policy, Diplomacy, and Society (SciPoDS), the student will collect and analyse qualitative data, both from existing data sources and in targeted interviews, engage with stakeholders throughout the university, and conduct a literature review of similar work.

The accuracy of Digital Rectal Examination for Prostate cancer screening in the primary care settings

Supervisor

Bashar Matti (021 054 0103)
Kamran Zargar-Shoshtari

Discipline

Clinical

Project code: MHS087

Digital Rectal Examination (DRE) and PSA are the two principal tests currently used in the New Zealand to screen for prostate cancer. Both tests carry their own share of controversies regarding efficacy and accuracy. Two recent systematic reviews assessing the accuracy of DRE in detecting prostate cancer, have raised questions regarding the validity of using DRE for screening in the primary care settings.

This study aims to investigate the diagnostic accuracy of DRE performed in the primary care settings, in the detection of prostate cancer, in men with and without lower urinary tract symptoms. We will be retrospectively reviewing data from all men who had a prostate biopsy, and compare DRE findings to biopsy outcomes.

Training will be given to the student hence no pre-requisite skills are necessary. However, we would like an enthusiastic student, who shows a high level of commitment to this project.

Minimally Invasive Glaucoma Surgery- short and medium term outcomes

Supervisor

Dr Hussain Patel
Professor Helen Danesh-Meyer

Discipline

Clinical

Project code: MHS092

Glaucoma is one of the leading cause sof preventable blindness in New Zealand. Initially glaucoma is treated with eye drops and laser with the aim of lowering the intraocular pressure. However, when this fails, patients require surgery. Traditionally glaucoma surgery is considered an invasive procedure with significant morbidity and recovery time. The most common operation is a trabeculectomy with mitomycin C which aims to lower the intraocular pressure. A trabeculectomy involves making a small hole in the eye wall (sclera), covered by a thin trap-door in the sclera. The aqueous humour, drains through the trap-door to a small reservoir or bleb just under the eye surface, hidden by the eyelid. The trap-door is sutured in a way that prevents aqueous humour from draining too quickly. Mitomycin C is used to prevent scaring of the trap door. There are significant risk with a trabeculectomy including hypotony (low pressure), haemorrhage, cataract formation, and an increased risk of infection life-long. Furthermore, vision may take up to 3 months to recovery following trabeculecotmy. Recently there have emerged new glaucoma procedures known as minimally invasive glaucoma surgeries (MIGS) which involve much less surgical manipulation of the eye with fewer complications and more rapid recovery of vision. These procedures have recently been introduced in New Zealand.

The aim of this summer studentship is to undertake a retrospective review of patients who have undergone a MIGS at Greenlane Hospital and evaluate the outcome in relation to intraocular pressure, stabilisation of glaucoma, and complications. A clinical audit will be undertaken of the different procedures including Xen implant, hydras, iStent, and Bypass. The student will collect and analyse the data in conjunction with supervisors and work towards preparation of a manuscript for submission for publication in international journal. The student will also have the opportunity to submit the study for presentation at local and international conferences.

How can we best train actors to teach communication skills in the undergraduate medical curriculum?

Supervisor

Miriam Nakatsuji (923 1527)
Anne O'Callaghan
Harsh Bhoopatkar

Discipline

Clinical

Project code: MHS093

How are actors integrated into the medical programme to ensure that they are effective in the teaching of communication skills to medical students? How are they trained? How do they give feedback? Can they be used to incorporate cultural competence teaching and assessment?

Skills you will learn

  • How to perform a systematic literature review
  • Scientific writing skills

You will also learn more about feedback and communication skills and have an opportunity to observe actors and communication skills facilitators at work.

The project is ideal for a student with an interest in medical education who wants to have an impact on teaching and learning in the medical programme. 

High Myopia treated with Implantable Intraocular Lens: Patient satisfaction and outcome measures

Supervisor

Dr Jay Meyer
Professor Helen Danesh-Meyer

Discipline

Clinical

Project code: MHS094

Myopia is one of the leading causes of visual impairment internationally and is growing at an exponential rate. Several new technologies have been used to treat myopia including laser refractive surgery. However, patients with very high myopia are often not suitable for laser treatment. Phakic intraocular lens implants have been used widely to correct moderate to high myopia. They have several advantages, such as fast visual recovery, excellent refractive accuracy and stability, improved visual acuity, and reversibility. This procedure involves implanting an intraocular lens in front of the patients own lens to correct myopia (as well as hyperopia and astigmatism). Given that this surgery is performed on young patients who otherwise have no significant ocular morbidity it is important to ensure there is a high level of success with minimal outcomes. The summer student will be involved in retrospectively reviewing patients who have undergone phakic posterior chamber intraocular lens implantation in Auckland and reviewing the notes to assess clinical outcomes. The student will learn the basics of optics and ophthalmic assessment. The student will also be involved in preparation of the manuscript and submission for publication. 

Optic nerve and Visual Field Changes in Uveitis Glaucoma

Supervisor

Dr Rachael Niederer
Professor Helen Danesh-Meyer

Discipline

Clinical

Project code: MHS095

Uveitis glaucoma is a sub-type of glaucoma where glaucoma is caused by inflammation (uveitis). This can lead to structural damage to the trabecular meshwork, the drainage outflow of the eye, and permanently elevated intraocular pressure. The consequences of long-term elevation in intraocular pressure is damage to the optic nerve, the nerve of site that connects the brain to the eye. This results in permanent visual field deficits and loss of vision. The aim of this study is to evaluate if the pattern of loss of vision from uveitis glaucoma is similar to primary open angle glaucoma. It will involve a retrospective review of patient charts, visual field tests and optical coherence scans to correlate the structural change to functional loss. The summer student will have the opportunity to be involved in uveitis clinics to understand the clinical features of uveitis glaucoma. The student will collect data and analysis the structure function correlation.

Risk factors for periprosthetic joint infection (PJI) following total knee arthroplasty (TKA)

Supervisor

Simon Young
Mark Zhu (021 616 183)

Discipline

Clinical

Project code: MHS096

Project Outline:
Prosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a major complication for the patient, surgeon and health care system. The New Zealand Joint Registry captures over 95% of all TKA in New Zealand and captures in-depth patient and intra-operative surgical data. However, a recent study found that the NZJR only captures around 63% of revision TKAs that are due to PJI. In contrast, the New Zealand Surgical Site Infection Improvement Programme (NZSSIIP) captures more in-depth data on any infections and subsequent revisions, but lacks the in-depth intra-operative data as captured by the NZJR. By combining data from the NZJR and NZSSIIP, this will allow for a more complete capture of the rate of revisions due to infection and more accurate analysis of the patient and surgical risk factors for failure.

The aims of this study are to combine both data sets to:

  • Clarify and compare the rates of PJI between the NZJR and NZSSIIP
  • Identify the patient risk factors for PJI (including age, gender, ethnicity, BMI etc)
  • Identify the surgical risk factors for PJI (including antibiotic cement, theatre spacesuits, laminar flow etc)

Skills Learnt/Required

  • Basic principles of orthopaedic intervention
  • Review of clinical notes
  • Basic statistical knowledge
  • Academic writing and manuscript preparation

It is expected that the student will achieve at least one and likely multiple submitted manuscripts for publication from the studentship. 

Is Waitemata Gynaecology Service up to scratch and up to date

Supervisor

Wendy Burgess (021 379 363)

Discipline

Clinical

Project code: MHS097

Abnormal/heavy uterine bleeding affects 17-25% of women of child bearing age and is the most common reason for admission to the Waitemata Gynaecology Service. Advancements in radiological imaging and new methods of treatment have changed the way Abnormal Uterine Bleeding is managed. Outpatient hysteroscopy and the introduction of the Levonorgestrel Releasing Intrauterine System (Mirena)has reduced the need for lengthy operative procedures.

During this project you will examine the current service provision and compare it to the recommended guidelines.

You will work alongside doctors and nurses involved in this service to come up with areas and suggestions for improvement. You will learn skills in research, data analysis, and writing skills for publication.

This will provide a wonderful learning opportunity in Gynaecology and in the practise of evidence-based medicine.

How well is Waitemata managing their patients referred with Pelvic Pain/Endometriosis? (Service Development Project)

Supervisor

Wendy Burgess (021 379 363)
Fiona Connell

Discipline

Clinical

Project code: MHS098

Pelvic Pain affects one in five women. Currently it takes 8-10 years to access a diagnosis. This delay results in significant impact to their fertility and quality of life. Waitemata DHB is developing a new patient centred service where these patients will receive care within optimal timeframe. You will be part of the team of doctors and nurses designing and delivering this service and measuring its outcomes. As part of this service development project you will be involved in retrospective audit and setting up of on-going auditing systems. You will learn skills in research, data analysis, and writing skills for publication. This is an exciting opportunity to be involved in a positive and meaningful change for the future.

Is there an association between the use of psychedelics and the development of a psychotic disorder?

Supervisor

Dr Nicholas Hoeh (021 456 856)
Professor Bruce Arroll
Associate Professor Suresh Muthukumaraswamy

Discipline

Clinical

Project code: MHS100

There is an active interest in the use of psychedelic agents including LSD, psilocybin, DMT, MDMA, and ketamine as a treatment for a variety of mental health conditions. Recently, a number of studies, including FDA Breakthrough Therapy Designation Phase 3 trials, involve the use of psychedelics in treatment resistant depression, post-traumatic stress disorder and alcohol and nicotine use disorders. Psychedelics have re-captured the interest of the general public and overcome a number of regulatory hurdles that have been in place for the past forty years. Outside of the research setting, psychedelics have been used recreationaly by a subset of the population despite legal restrictions.
There is a historic perception often dramatized by the media that the use of psychedelics result in the emergence of primary psychotic disorders.

This project aims to explore the evidence about overall rates of recreational psychedelic use in New Zealand as well as rates of psychedelic use among the New Zealand population with an identified early experience of psychosis.

Skills Learned

  • Literature review
  • interviewing
  • statistical analysis
  • scientific writing
  • oral and written presentation skills

Determining the effects of middle ear pressure changes on auditory and vestibular evoked potentials

Supervisor

Rachael Taylor (ext 81122)
Peter Thorne

Discipline

Clinical

Project code: MHS102

Aims

The amount of sound energy delivered to the inner ear depends on the air pressure in the outer and middle ear. This can alter as a result of an upper respiratory tract infection and other pathology of the nose and throat, or even following recent air-travel. Changes in air-pressure can affect the results of hearing and balance function tests that use sound energy as a stimulus. However, the degree of pressure variation necessary to disrupt these tests is unknown. To address this issue, we will use a continuous positive airway pressure device (CPAP) as a way of manipulating middle ear pressure in a controlled environment. Auditory and vestibular-evoked potentials will be recorded and analysed to determine how the responses are affected. The results will enable more accurate interpretation of these tests in clinical practice in the presence of changes in middle ear pressure.

This study will introduce the student to electrophysiological measures of hearing and vestibular function in humans.

Skills gained

  • Otoscopy
  • Tympanometry
  • Evoked-potential testing
  • data collection and analysis
  • oral presentation skills

'What is a good death’: A retrospective Quality of Death Audit

Supervisor

Dr Kathy Peri (021 810 269)
Dr Linda Huggins

Discipline

Clinical

Project code: MHS103

There is growing interest in understanding what a ‘good death’ means and the goal of health care services is to ensure patients have the opportunity to die comfortably and that families/Whanau are well supported. Recent studies have shown that a number of factors appear to contribute to a ‘good death’ which include good symptom management, an established relationship with members of the health team, adequate time to prepare for the end of life and lastly a sense of completion. Most of these studies have involved cancer patients little is known about patient who die from non-malignant disease.
Using a validated clinical audit tool this project will conduct a retrospective audit on a series of case files to evaluate the ‘quality of death’ for hospice and aged care residential (ARC) patients from the South Auckland Totara Hospice.

Skills

The student will get the opportunity to work alongside clinicians at the Totara hospice and academics and researchers at the University. The student will develop skills in critical reviewing literature and synthesizing this material, developing auditing skills. The student will also undertake the analysing data and report writing and preparing a peer reviewed article for publication.

New Zealand nurses' alcohol and other drug use

Supervisor

Andrew Jull
Marea Topp

Discipline

Clinical

Project code: MHS107

Anectotal evidence suggests that health professionals are at greater risk to alcohol and other drug (AOD) abuse and addiction than the general population (Wheeler, 1992; Murray, 1974; Fox, 1957), however evidence suggests that the risk for developing AOD abuse and addiction problems may reflect current general population trends although drugs of abuse may differ (Trinkoff Storr, 1998).

Alcohol use is widely accepted in New Zealand society. Other drug use, including designer drug use, has become increasingly acceptable in some sectors of NZ society. As nurses are a subset of the general population, it would be reasonable to expect their use of AODs reflects that of the general population.

There has been international interest in addressing the issue of AOD misuse within the discipline of nursing since the late 1970's (Smith, Taylor Hughes, 1998). Earlier international research in this area has focused on addiction in nursing (Hutchinson, 1996, 1999). Subsequent research has focused on the prevalence and patterns of AOD use, specialty and access issues, factors that contribute to nurses' use of AODs, early recognition, management and policy development and attitudes towards impaired nurses by their AOD use (Collins, Gollinich, Morsheimer, 1999; Howard Chung, 2000; Kenna Lewis, 2008; Kenna Wood, 2004, Lillibridge, Cox, Cross, 2002; Storr, Trinkoff, Hughes, 2000; Trinkoff, Storr Storr, 1999).

There have been few published studies internationally reporting registered nurses' use of AODs across the continuum of use and the subsequent impact on patient care, work performance and nurses wellbeing.

This study aims to estimate the current prevalence of self-reported AOD use by active RNs, and explore the implications for altered work performance and the delivery of safe patient care. Findings from this study will be compared with an earlier study estimating NZ nurses' use of alcohol and other drugs (Topp, 2016).

This summer student project will involve the analysis of survey data using SPSS.

Ethics Status

Ethics application in progress.

Skills

The student will develop skills in quantitative data analysis using SPSS as well as writing skills for publication. 

Pharmacists’ expanding roles in the primary health care setting: Perspectives of NZ DHB pharmacy portfolio managers

Supervisor

Associate Professor Jeff Harrison (ext 82144)
Dr Trudi Aspden
Mr Robert Haua

Discipline

Clinical

Project code: MHS112

The Pharmacy Action Plan 2016-20 has a vision of NZ pharmacists working in a broader variety of settings, and for their medicines management expertise to be fully recognised and utilised by healthcare teams (1). The Plan also wants pharmacists to be able to access professional development pathways in order to retain and attract pharmacists, and increase the capacity of the pharmacy workforce possessing the appropriate skill mix to support new models of care and offer higher-level medicines management services.

This project seeks to explore DHB pharmacy portfolio managers’ views of pharmacists expanding their roles in the NZ primary health care setting.

To investigate where and how DHB pharmacy portfolio managers think pharmacist-led medicines management services should be provided in primary care
To understand what DHB pharmacy portfolio managers think the role hospital pharmacy has, with respect to expanded roles of pharmacists in primary care
To understand what DHB pharmacy portfolio managers perceive as necessary education, training and experience requirements for pharmacists who hold expanded clinical roles in primary care.

This is a busy project and the student researcher will learn about:

  • reviewing literature
  • survey administration
  • telephone interviewing using a semi-structured interview guide
  • transcribing
  • qualitative and quantitative data analysis
  • report writing

Biomechanics in Heart Disease: A heart transplant sub-study

Supervisor

Malcolm Legget
Kat Gilbert

Discipline

Clinical

Project code: MHS118

Biomechanical factors play a significant role in many cardiac diseases. Many diseases that affect the heart can lead to changes in intrinsic myocardial properties, and hence altered biomechanical function of the heart. In heart failure, for example, patients may have increased muscle stiffness, reduced active tension and impaired relaxation. These tissue mechanical factors can influence cellular signalling processes that lead to hypertrophy and circulating biomarkers, such as B-type natriuretic peptide and troponins. However, these tissue factors are difficult to quantify clinically.

We are currently running a study involving patients at Auckland City Hospital who are undergoing cardiac catheterisation. In addition to their planned procedure, pressures are recorded inside the heart, and non-invasive imaging with an echocardiogram is undertaken. Those who have undergone heart transplants undergo cardiac catheterisation as part of their routine follow-up care and we have enrolled 19 in our study.

In this project you will be working with cardiologists from Auckland City Hospital and engineers from the Auckland Bioengineering Institute. You will be combining both clinical and biomechanical information to better understand cardiac function in those who have under-gone heart transplants. The studentship will include observation of the study.

An investigation into the accessibility of medicines for children in New Zealand

Supervisor

Sara Hanning (923 5386)
Sanya Ram

Discipline

Clinical

Project code: MHS123

Aim

To quantify the number of medicines and types of dosage forms licensed for use in children in NZ.

Background

Research has suggested that nearly 70% of children hospitalised in both Europe and the United States (US) receive at least one unlicensed or off-label medicine during their hospital stay [1, 2]. An unlicensed medicine is one that does not have a product license for use in children, whereas an off-label medicine is one being used outside of the terms of its product license. When a medicine is used in this way, it is unapproved and safety, quality and efficacy are uncertain.

In addition to medicines being licensed for use in children, they also need to be available in an acceptable dosage form.

In this project, medicines listed in The NZ Formulary for Children will be obtained and reviewed categorically by body system. Different dosage forms will be grouped and their suitability for use in children will be reviewed. Results will be compared to a study published in 2004, which reviewed medicines accessibility for children in NZ between 1998 and 2002 [3].

Note: This project is only available to BPharm students as the student stipend for this project is being provided by the NZ Pharmacy Education and Research Foundation (NZPERF).

References
1. Yang, C.P., et al., Food and Drug Administration approval for medications used in the pediatric intensive care unit: A continuing conundrum. Pediatric Critical Care Medicine, 2011. 12(5): p. e195-e199.
2. Conroy, S., et al., Survey of unlicensed and off label drug use in paediatric wards in European countries. British Medical Journal, 2000. 320(7227): p. 79-82.
3. Chui, J., et al., Trends in accessibility to medicines for children in New Zealand: 1998–2002. British Journal of Clinical Pharmacology, 2004. 57(3): p. 322-327.

The Incidence of Prostate Cancer detection following Trans Urethral Resection of the Prostate

Supervisor

Kamran Zargar-Shoshtari
Bashar Matti (021 054 0103)

Discipline

Clinical

Project code: MHS125

Trans Urethral Resection of The Prostate (TURP) is a surgical procedure for treating bladder outlet obstruction related symptoms due to prostatic enlargement. It involves resecting the median lobe of the prostate (transitional zone) in order to improve the man's urinary flow. Following each procedure, the prostatic tissue that was respected is sent to the laboratory for histological evaluation. In cases where there is no suspicion of prostate cancer, the evaluation involves reporting gross description and microscopy of 10% of the tissue received. Many international studies have reported an incidence of prostate cancer detection of 5 - 15 % in this settings. Some were advocating that in younger men (< 65 years of age), the entire specimen needs to be evaluated in order to maximise the chances of detecting Prostate Cancer.

In the Northern region of New Zealand, more than 200 TURP procedures performed per year. The aim of this study is to retrospectively analyse these cases to define the incidence of Prostate cancer in this population.

This project will provide an opportunity for the student to get involved with clinical research and data collection and analysis. Experience in data management is not necessary but welcomed.

Learning from death - how do doctors use patient deaths to improve care?

Supervisor

Laura Chapman (027 753 7991)
Alan Merry

Discipline

Clinical

Project code: MHS127

Death is the only guarantee in life. A good death is a fundamental part of healthcare and many patients receive excellent care in the time leading up to their deaths. However some patients experience poor care resulting from many factors including failings in leadership, team, resources, expertise and/or other system factors. The importance of learning from these deaths is universally agreed but there is no consensus view on how to achieve this or usefully disseminate the results.

This study will explore

  • Current processes for review and reflection on patient deaths
  • Current practise for using deaths to revise and improve future care
  • How this can be optimised to maximise learning from death

There are 3 parts to this study:

  1. A review of current guidelines on morbidity and mortality (M+M) meetings
  2. Quantitative data collection regarding current M+M processes in general medicine departments across NZ 
  3. Qualitative data collection via interviews

Skills to be taught/ used include

  • literature review
  • data collection and extraction
  • manuscript preparation
  • quality improvement 
  • clinical problem solving (with support)

Results will be used to prepare a manuscript for submission to a medical journal.

Integration of Patient Specific Radiology into The MBChB Year 2 First Patient Project

Supervisor

Miriam Scadeng (923 9659)

Discipline

Clinical

Project code: MHS132

Radiological examinations have become a huge part of patient clinical assessment and management, and the use of radiology is expected to continue to grow. As educators we need to ensure we deliver the relevant medical teaching to equip new doctors with the skills they need. The summer studentship would entail retrieval and preparation of relevant examples of the clinical radiological examinations that the MBChB Year 2 students' first patient underwent while alive. This would be made available to the students during the anatomy laboratory sessions. This resource would contribute to 1. The learning of radiological anatomy. 2. Gaining understanding of the different imaging modalities, and how imaging is used clinically. 3. Better understand the pathology present. The radiological examinations will also aid in the MBChB Year 2 students' presentation of their first patient at the end of the year.

Skills acquired during the summer studentship:

  • broad knowledge of radiological examinations
  • anatomy and pathology

This would be a useful project for students from a wide range of backgrounds including MBChB, and biomedical imaging.  

Medical Students and Graduates’ Career Intention in Psychiatry

Supervisor

Dr Yan Chen (923 1741)
Associate Professor Marcus Henning
Associate Professor Craig Webster

Discipline

Clinical

Project code: MHS135

Overview of the project

The Ministry of Health has projected a workforce shortage in mental health service for the next decade, compounded by high levels of work-related stress and burnout experienced by the workforce. It is vital to understand how to select, train, and sustain a specialist medical workforce to meet the rising demand for mental health services. In this project, we will use the Medical Schools Outcomes Database and Longitudinal Tracking Project’s (MSOD) surveys to track medical students’ and graduates’ preference for psychiatry as a specialist discipline. The project aims to 1) examine the trends in students’ and early postgraduate doctors’ preference for practising psychiatry and 2) explore the characteristics and reasons associated with respondents’ career preference.
Survey data have been collected and are available for further analysis. The successful candidate is expected to review and synthesize relevant literature in the first few weeks of the studentship and spend the remaining studentship linking survey data and conducting statistical analysis.

Skills learnt

  • Literature review and critical appraisal
  • Statistical analysis
  • Oral and written presentation skills

Dietary intake after bariatric surgery for morbid obesity and type 2 diabetes

Supervisor

Lindsay Plank
Rinki Murphy
Michael Booth

Discipline

Clinical

Project code: MHS136

Aims

We wish to compare dietary data from patients who have received either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) bariatric surgery for obesity and type 2 diabetes, to see whether dietary components differ by surgery type, alters over time, and whether certain components such as sugar or protein intake is associated with weight, body composition changes and remission of Type 2 diabetes. We also wish to see how dietary intake among our NZ patients compares with recommended international nutritional guidelines for bariatric surgery patients.

A total of 114 patients have taken part in a randomized clinical trial comparing RYGB with SG surgery for the treatment of morbid obesity and type 2 diabetes. Of those, 65 patients have taken part in a detailed sub-study which included providing 7 day food diaries pre-op, and at 1 and 5 years post-op, along with body composition assessment using DEXA scan, satiety and hunger questionnaires, fasting blood tests, and OGTT. The 5 year data collection is expected to be completed by October 2019.

Responsibilities

  • To enter dietary data into Foodworks software to code protein, fat, carbohydrate, fibre and estimated total caloric intake.
  • To complete the entry of non-dietary data including resting energy expenditure measurements, body composition, hunger and appetite scores and biochemical measurements such as Vit D, iron, B12, HbA1c, into the study database
  • To conduct statistical analyses to answer study questions
  • Contribute to draft manuscript preparation

Ideal project for students keen to gain more understanding of physiological changes after bariatric surgery. There is a potential for this research findings to inform national guidelines for better post-operative nutritional support for bariatric patients. 

Referrals for bariatric surgery

Supervisor

Rinki Murphy (923 6313)
Grant Beban
Nick Evenett
Michael Booth

Discipline

Clinical

Project code: MHS137

Aims: To examine the distribution, volume, demographics and comorbidities of patients referred from primary and secondary care for public funded bariatric surgery in the Auckland region over the past 3 years, relative to those accepted and proceeding to surgery.

While approximately 250 annual bariatric surgery procedures are performed at the three public hospitals in Auckland, there are over 50,000 morbidly obese adults residing in these regions. Numbers referred relative to numbers accepted and proceeding with bariatric surgery are only around 5:1, rather than 200:1. Understanding why there are relative low referral rates and whether there are only small hotspots of referrers located in primary and secondary care, is important to ensure equitable access to bariatric surgery.

The rarity with which some GP's refer for bariatric surgery, may reflect their reluctance to discuss this potential treatment option with their patients and may mean that further training is necessary to ensure all such clinicians have sufficient knowledge and confidence to discuss these treatment with patients and to ensure this does not reflect implicit health care rationing, particularly by ethnicity. The first step is to compare the characteristics of the population who are referred and where they are referred from, compared to those who are actually accepted for bariatric surgery and those who are potentially eligible. This information will assist in developing processes to ensure equitable access to bariatric surgery and more transparent prioritization pathways.

Responsibilities

  • Work with multidisciplinary bariatric surgery teams at Auckland DHB's to access data on bariatric surgery referrals vs accepted populations.
  • Design excel spreadsheet to record data and enter data.
  • Conduct statistical analyses to answer study questions
  • Contribute to draft manuscript preparation

PRESERVE Aotearoa A feasibility study of a non-pharmacological delirium prevention intervention for hospitalised Maori and non-Maori with advanced cancer

Supervisor

Aileen Collier (027 241 4390)
Annmarie Hosie

Discipline

Clinical

Project code: MHS142

Dr Collier’s program of research is aimed at improving safety and quality of palliative care. This study will recruit participants at two hospice sites in New Zealand. You will work alongside Dr Aileen Collier and Dr Annmarie Hosie as part of an international collaboration of world leading delirium researchers in NZ, Australia and Canada. Specifically you will assist with the entry, organization and analysis of qualitative and/or quantitative data.

This project would suit a health care student with an interest in delirium prevention and/or management. You will also have an interest in learning about mixed methods and gain skills in project management and preparing research outputs. Previous students working with our group have published first authored papers in international leading journals and been successful with prestigious external postgraduate scholarship applications. For more information about us please see Te Arai Research Group.

Please get in touch with Aileen to discuss further.

 

Assessment and management of autism spectrum disorder in New Zealand

Supervisor

Lisa Underwood (021 299 2207)

Discipline

Clinical

Project code: MHS151

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition that emerges during early childhood and has significant impacts on individuals and their families. It is estimated that ASD affects around 80,000 individuals in NZ. The assessment and management of ASD in NZ is under-researched and we know little about the presentation of ASD among Maori and Pacific families.

Evidence strongly suggests that early identification of ASD is key for improved outcomes. However, assessment and diagnosis varies across the country, as does access to ASD services and interventions. The student for this project will map current clinical practice and explore how this compares with advances in assessment and management of ASD in other countries, including Australia, the US and the UK.

Skills

This project will provide an opportunity for a student interested in child development to learn independent research skills, including literature review, data analysis, presentation of results, and communication of research findings.

Specific skills taught will be:

  • working as part of a multidisciplinary team
  • quantitative research methods, 
  • data processing 
  • statistical analysis 
  • writing skills for publication

There will also be an opportunity to engage with autism community groups, clinicians and service providers.

The project would most suit a third year student, especially someone interested in continuing with an honours project. Second year students will also be considered. Skills required are enthusiasm and initiative, an ability to communicate, and independence, combined with a genuine interest in research and a demonstrated ability to work in a team environment.

Incidence of type 1 diabetes from the Paediatric Diabetes Service

Supervisor

Craig Jefferies (021 957 877)
Ben Albert

Discipline

Clinical

Project code: MHS154

Type 1 diabetes has a relatively high incidence in NZ, and previous incidence information form our Paediatric diabetes regional service in Auckland evaluated the incidence over 20 years (1990 to 2009). This prior research highlighted the progressive increase in incidence for children <15 years with type 1 diabetes (See Derraik et al, 2012). However there were differential increases in new cases of type 1 diabetes in those 10-14 years compared to younger children, and the highest incidence in new cases were in NZ Europeans.

The aim of this present study is to data mine our Starbase diabetes database that prospectively records all new cases of diabetes in the <15 year age group in the great Auckland region (encompassing ADHB, WDHB and CMDHB); this will be for an additional 10 years from our current data and provide a 30 year incidence in our paediatric population: we are then one of the few sites in the world with such regional longitudinal data.

Sub analysis for Deprivation, Ethnicity, Age, seasonality, and Sex will be done in collaboration with our statistician.

The student would be expected to have ~500 cases to case ascertain for the 10 year period, inclusion criteria will be resident in the Auckland region, a confirmed diagnosis of type 1 diabetes, age <15 years.

References: Derraik et al (2012). Increasing incidence and Age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand) PLoS ONE 7(2): e32640. doi:10.1371. 

Immunoglobulin replacement in New Zealand children

Supervisor

Annaliesse Blincoe (021 490 611)
Jan Sinclair

Discipline

Clinical

Project code: MHS155

Immunoglobulin replacement therapy (IRT) has historically been developed to provide passive protection for children with underlying primary immune deficiency, but with time its use has expanded to include children with a range of autoimmune, auto inflammatory and hematologic conditions. There is no current national guideline as to who should be eligible for IRT in NZ. IRT is a valuable and limited resource, mostly derived from local blood donation.

The aim of the project is to describe children receiving IRT over a 3 year period. Data will include demographics, indication for IRT, dose of IRT, and route of administration. Indication will be audited against both the Australian and UK guidelines.

The successful student will be working with the Paediatric Immunology team at Starship. They will develop skills in data collection, literature review, analysis, presentation of results and communication of research findings. It is anticipated the results will be presented at the annual scientific meeting of the Australasian Society of Clinical Immunology and Allergy (Melbourne, September 2020).

The results will be useful in developing paediatric guidelines for IRT in NZ children and informing clinical practice.

Teaching and learning pelvic examination skills in Gynaecology Teaching Associates Programme: the views of medical educators, patient volunteers and Year 5 medical students

Supervisor

Phillipa Malpas (021 179 6510)
Joy Marriott

Discipline

Clinical

Project code: MHS156

Overview

At graduation it is expected that medical students will have learnt the necessary technical and communication skills to perform female pelvic examinations. A number of challenges exist for students, including anxiety (not wanting to hurt the patient, making mistakes), male gender (dealing with the intimate), lack of confidence, and the difficulty of the examination. The University of Auckland runs a Gynaecology Teaching Associates Programme (GTA) in the Year 5 OG attachment, which provides dedicated teaching time with the assistance of patient volunteers (professional patient educators).

This project aims to evaluate the personal experiences of Year 5 MbChB students, medical educators and patient volunteers, to establish a broader understanding of how sensitive examinations are leant and taught.

Using one-on-one interviews we will explore the experiences of medical students, medical educators and patient volunteers. Thematic analysis of transcribed interviews will be performed (with assistance from the project supervisors).

Skills you will learn

  • understanding the process of learning and teaching in the clinical environment
  • development of communication/interviewing skills
  • development of qualitative research 
  • writing skills

This project is ideal for a student with an interest in medical education who wants to have an impact on teaching and learning in the clinical environment.

Which bacterial species are causing prosthetic joint infections? A clinical study

Supervisor

Mark Zhu (027 365 4986)

Discipline

Clinical

Project code: MHS157

Project outline

Prosthetic joint infection is a serious complication following total knee arthroplasty and has significant costs for both the patient and the healthcare system. In order to improve our treatment of PJI, it is important to identify and analyse the bacterial species causing disease. The aims of this project are to identify the leading bacterial species causing PJI, and clarify the effect of this on treatment success.

Studentship goals

Currently, we have ethics approval and have gathered data on bacterial species and treatment outcomes. The student will add to this database, collate the results, perform statistical analysis and prepare a manuscript for submission in an orthopaedic journal.

Pre-requisites: Motivated student who can see the project to completion (including publication), ability to write academically and sound organisational skills.

Skills taught

  • Literature review
  • basic statistical analysis
  • database management 
  • academic writing

It is expected that the student will achieve at least one submitted manuscript for publication from this studentship. 

Evaluation of a stillbirth prevention public health awareness campaign in South Auckland

Supervisor

Professor Lesley McCowan (923 9192)
Dr Karen Falloon

Discipline

Clinical

Project code: MHS161

New Zealand and international research show that maternal sleeping position is an important modifiable risk factor for the prevention of late stillbirth. A maternal side-sleeping position from 28 weeks of pregnancy halves the risk of stillbirth compared with going to sleep in a supine position.

In 2018 the ‘Sleep on Side; Stillbirth Prevention Campaign’ was developed and initiated. It is a public health messaging campaign by the University of Auckland, Cure Kids and the Ministry of Health.

The evaluation phase of the campaign involves surveying health professionals and expectant women in the third trimester of pregnancy.

The role of the summer medical student will be to conduct surveys in pregnant women in their third trimester throughout birthing units in South Auckland and health professionals working in primary care clinics in South Auckland. This will enable evaluation of the effectiveness of the campaign.

This is an exciting opportunity for a student interested in General Practice, Obstetrics and Gynaecology or Pubic Health to gain practical “grassroots” research experience and exposure to the primary care and community health-care setting. The ideal candidate would be self-motivated, friendly, professional and culturally-sensitive.

Skills developed include

  • communication
  • research strategy
  • research design
  • research recruitment and teamwork

Optimising Treatment of Neonatal Hypoglycaemia (Based at Neonatal Unit Middlemore Hospital)

Supervisor

Chris McKinlay (027 472 5099)
Jane Harding

Discipline

Clinical

Project code: MHS163

Neonatal hypoglycaemia affects 15% of all babies and can cause permanent brain injury if not treated effectively. Some babies with hypoglycaemia respond to simple measures such as dextrose gel and additional feeding, but around 50% have episodes that are severe or recurrent. These babies are at highest risk for neurological sequelae and currently require admission to neonatal units for intravenous glucose, separating the mother and baby, which adversely impacts on breastfeeding. There are also concerns that rapid correction of hypoglycaemia with intravenous glucose may contribute to brain injury. Better treatment approaches are needed that promote glucose stability and earlier return to sucking feeds.

This project will be based at the Neonatal Unit at Middlemore Hospital and will focus on setting up a feasibility trial to assess i) a novel oral approach to management of hypoglycaemia using diazoxide and ii) improved monitoring of neonatal glucose using interstitial monitors and trend analysis. Specific aims of the studentship will be to establish a placebo comparator for the trial, test blinding procedures, establish a protocol for interstitial monitor use and recording; and assist with setting up trial protocols and procedures. There will be opportunity to participate in other clinical activities in the neonatal unit.

What happens to children with preschool wheeze in Waitemata emergency department?

Supervisor

Arun Gangakhedkar (021 492 065)
Tim Jelleyman

Discipline

Clinical

Project code: MHS165

Annually an estimated 250 children present to Waitemata Emergency Departments with preschool wheeze and are managed using treatment protocols. Response to treatment is variable with a proportion requiring admission. Phenotypes associated with bronchodilator responsiveness are described but may be difficult to apply in practice. This study aims to assess treatment outcomes for preschool wheeze using admission as a primary endpoint. Through systematic medical record review a range of relevant demographic and clinical characteristics will be collected to allow comparison between those requiring admission with those discharged from Emergency department.

This study will also include an audit of use of treatment protocols in the Emergency Departments. Waitemata Child Health is considering participating in a future multi-centre trial of OM-85 (bacterial lysate) to reduce impact of preschool wheeze, and so this studentship research provides useful descriptive background about pre-school wheeze and management in our setting. In summary, the research will review clinical records in a cohort of children with preschool wheeze to: 1) assess rate of hospital admission; 2) describe clinical and demographic characteristics for responders/non-responders; 3) audit use of management protocols.

Older adult participation in physical activity

Supervisor

Katherine Bloomfield
Martin Connolly
Zhenqiang Wu

Discipline

Clinical

Project code: MHS174

Exercise is of proven benefit in many medical conditions such as cardiovascular disease, type-2 diabetes, and depression, among others. Positive effects are also seen in older age, and exercise is beneficial in the prevention of falls, frailty and sarcopenia.

The aim of this project is to explore older adult participation in physical activity. This project consists of three components. First, a literature review assessing barriers and facilitators of older adult engagement in exercise will be undertaken. Following this, we will explore factors associated with participation in exercise amongst a cohort of older adults. Our research group has recently completed data acquisition from a large study of ~580 older adults residing in retirement villages. We have extensive health and social information about this cohort, including around exercise and retirement village facilities. Finally if time permits, based on the information identified in earlier phases, we will develop a survey exploring NZ older adult attitudes to exercise, including barriers/potential facilitating factors.

Results from the first two parts of this study will be used to prepare a manuscript for submission to a medical journal, and the final component for utilisation in a future study.

Skills

  • Literature review/synthesis
  • Data extraction/management
  • Statistical analysis
  • Draft manuscript preparation

Detecting eye pathology in elderly patients using novel vision assessment devices

Supervisor

Dr Stuti Misra
Dr James McKelvie

Discipline

Clinical

Project code: MHS175

Vision impairment is common in the elderly and can cause significant morbidity, impaired quality of life, loss of independence, and risk of falls. Many elderly people do not have easy access to ophthalmic assessment. The ability to accurately assess vision using new tools, including mobile technology, is essential for elderly people in care facilities with limited access to quality ophthalmic assessments. The project will involve testing visual acuity and contrast sensitivity in a retired population using novel mobile technology. Vision-related quality of life will be assessed and correlated with visual acuity and contrast sensitivity. It is envisaged that this project will result in a peer-reviewed journal publication in a scientific journal.

Skills

The successful student will learn:

  • basic clinical ophthalmic history and examination
  • measurement of visual acuity
  • application of statistics
  • data analysis
  • machine learning
  • how to structure and prepare the first draft of a scientific paper

Using mobile technology and machine learning to detect refractive error pre and post cataract surgery

Supervisor

Dr James McKelvie
Dr Stuti Misra

Discipline

Clinical

Project code: MHS176

Refractive error is a significant source of visual loss before and after cataract surgery. Assessing and correcting residual refractive error following cataract surgery is essential for optimal quality of life and good vision, however, it is a time consuming and expensive process for patients. There are several devices that have been developed for testing vision and refractive error including a novel smartphone coupled device. This new device has not been tested or compared with existing devices that measure refractive error in a clinical setting. This project is to assess and compare refractive error using several devices including a novel smartphone coupled device. Patients who are listed for cataract surgery will have their refraction tested before and after cataract surgery. The refractive results from all devices will be compared to assess the accuracy and repeatability of measurements. It is envisaged that this project will result in a peer-reviewed journal publication in a scientific journal.

Skills

The successful student will learn:

  • basic clinical ophthalmic history and examination
  •  measurement of visual acuity and refractive error
  • application of statistics
  • data analysis
  • machine learning
  • how to structure and prepare the first draft of a scientific paper

Risk communication in cardiovascular disease

Supervisor

Dr Amy Chan (ext 85524)
Dr Jeff Harrison

Discipline

Clinical

Project code: MHS182

How health risk is communicated can influence patient behaviour. One key example is the communication of cardiovascular risk. Good risk prediction models exist which can calculate an individual’s 5-year cardiovascular risk, yet many of the risk factors involve lifestyle and behaviour changes, or starting new treatment(s). The results of the risk models are commonly communicated as risk percentages, or via graphical formats, which people may find difficult to understand. How we can best communicate this risk to elicit behaviour change is not yet known, particularly in Maori and people from other high-risk ethnicity groups.

This project aims to compare the effect of using infographics versus ‘heart age’ versus the standard NZ Primary Prevention Equation and Your Heart Forecast output to communicate risk, and how this influences risk comprehension.

The study will recruit participants of varying ages, ethnicities and risk and randomly assign participants to one of three risk presentations. Participants will be asked to explain their perception of risk, and complete questions on risk perception and worry, behavioural intentions, and information evaluation after exposure to one of the three conditions.

Skills required

  • Good time management
  • Project management skills
  • Interpersonal skills
  • Communication skills – oral and written

Beliefs about antibiotics – an interview study in Maori

Supervisor

Dr Amy Chan (ext 85524)
Asoc Prof Matire Harwood

Discipline

Clinical

Project code: MHS183

Antimicrobial resistance (AMR) is one of the biggest public health threats. Inappropriate use of antibiotics is a key driver of AMR. One reason for inappropriate use is patient expectation and demand for antibiotics, particularly where antibiotics are not needed, such as for cold/flu.

In Maori, antibiotic use may be particularly high for conditions where antibiotics are of no benefit (e.g. cold/flu), but low for conditions where antibiotics are needed (e.g. strep throat). This may be driven by individual treatment beliefs, but we do not know what beliefs influence antibiotic use in Maori, and how these beliefs may differ to non-Maori.

Identifying and understanding the beliefs that Maori hold about antibiotics and how these influence patients' decisions to seek antibiotics (or not) is key to informing the design of effective interventions to ensure appropriate antibiotic use.
The aim of this project is to identify the beliefs Maori hold about antibiotics and their role in treating infections commonly seen in primary care. We will do this by 1:1 and focus group interviews with Maori recruited from a GP practice.

Useful skills

  • Knowledge of Kaupapa Maori research
  • Understanding of primary care
  • Interpersonal skills – particularly verbal/ interview skills
  • Organisational skills

Is there a change in in weight status of caregivers 5 years post baseline in a family-centred intervention for children and adolescents with weight issues?

Supervisor

Dr Yvonne Anderson (06 753 6139 ext 8736)
Tami Cave
Cervantée Wild

Discipline

Clinical

Project code: MHS187

Whanau Pakari is a multi-disciplinary assessment and intervention programme for children and adolescents with weight issues that commenced in Taranaki in 2012.1 As part of the assessment process, voluntary height and weight measurements of the primary caregiver of the children were collected at the baseline, 12 month, 24 month and 60 month (5 year) assessments. BMI was subsequently calculated.

The aim of this secondary analysis is to determine whether there was a change in accompanying adult BMI over time in participants of the Whanau Pakari programme (from baseline to 60/12). Secondly, whether any change affected BMI SDS outcome of participants in the trial. A literature review is also proposed looking at what is currently published with regards to the accompanying adult BMI of children/adolescents with obesity at long term follow up, both nationally and internationally.

This project would be ideally suited to a candidate who is interested in learning about and gaining skills in health research. A supportive team environment is provided, and the ideal candidate would be based in Taranaki for the duration of this project. Whilst full supervision will be provided, the ideal candidate would be self-motivated, with a willingness to learn. Basic word and excel skills essential.

Clinical project TBA

Supervisor

TBA

Contact: Heather Seal

Discipline

Clinical

Project code: MHS192

Further details available at a later date.