Clinical

Does fractal priming prior to ketamine assisted therapy improve response in adults with treatment-resistant depression?

Supervisor

Dr. Nicholas Hoeh (09 923 7703) 

Discipline

Clinical

Project code: MHS001

Depression is the most prevalent mental health disorder in New Zealand and is the second leading cause of disability in the world. In New Zealand, anxiety and depressive disorders account for 5.3% of all health loss as measured by disability adjusted life years. Despite the large range of behavioural and pharmacological therapies currently available, effective treatments for many depressed patients are often elusive. One therapeutic modality that shows early promise as a treatment for chronically depressed patients is Ketamine-assisted therapy (KAT).Offered by health professionals with both medical and psychological skill sets, KAT involves administering perception-altering doses of ketamine to patients within a therapeutic setting. The summer student will be play a role as part of the research team with involvement in recruitment and screening of potential participants. Additionally the student will be involved with data collection and analysis. The student should have an interest in mental health and clinical research.

Predicting neurodevelopmental outcomes in extremely preterm babies from their growth

Supervisor

Dr Barbara Cormack (09 923 6107)
Professor Frank Bloomfield

Discipline

Clinical

Project code: MHS005

Extremely preterm babies, born before 28 weeks' gestation (full term is 40 weeks) are at increased risk of adverse neurodevelopmental outcomes. Supporting growth in these babies is challenging and many babies demonstrate faltering postnatal growth. However, the interpretation of their growth depends to a large degree on how it is measured - different charts will provide very different perspectives on growth.

This project will use data from 434 extremely preterm babies enrolled in a randomised controlled trial and determine how their growth trajectories on a variety of commonly-used growth charts predicts their outcomes at two years of age. Findings will inform the planned development of national guidelines for neonatal nutrition and growth to ensure the best tools are used.

Approvals are all in place and the data have been collected and will be ready for use by the time this summer studentship commences.

Epidemiology of acute myeloid leukaemia in New Zealand

Supervisor

Dr Maggie Kalev

Discipline

Clinical

Project code: MHS012

This project will analyse data collected by the New Zealand Cancer Registry on patients with acute myeloid leukaemia (AML).

AML is an aggressive blood malignancy that remains poorly understood and treatments are suboptimal. There is limited information on AML incidence and outcomes in New Zealand. We have recently published that Polynesian patients with acute promyelocytic leukaemia (a form of AML) have a more aggressive disease (https://doi.org/10.1080/16078454.2021.1882146). Similar also applies to chronic myeloproliferative neoplasms where it translates into worse outcomes for Maori patients (https://doi.org/10.3390/curroncol28020146).

You will use statistical methods to analyse demographic data on approximately 3,000 patients with AML diagnosed in New Zealand between 2010 and 2017. We will determine capture rates of AML in New Zealand, patient ethnicity, gender, age of presentation, and outcomes of patients, including if there is any association between Maori ethnicity and presentation and outcomes of patients. The overriding aim is to better understand the scope of AML in New Zealand to assist further clinical research on AML in New Zealand.

Perspectives of Junior Doctors staffing a General Surgery Crisis Roster during the Alert Level 4 COVID-19 Lockdown in 2020

Supervisors

Dr Jamie-Lee Rahiri (021 463 695)
Prof Jonathan Koea

Discipline

Clinical

Project code: MHS013

Coronavirus disease (COVID-19) has brought about devastating outcomes for many countries worldwide. In Aotearoa, New Zealand, emergency rostering was implemented nationally in 2020 among the New Zealand district health boards. At North Shore Hospital, Waitemata District Health Board (WDHB), a General Surgery COVID-19 crisis roster was initiated over the four-week Alert Level 4 lockdown. This led to the coalescing of seven surgical teams into four pods, with a significant change in the rostering of junior surgical registrars and house officers. This project seeks to understand the experiences of those junior doctors who were rostered during the the nationwide lockdown from March to April 2020 through analysis of surveys and interpersonal interview transcripts. The overall aim of this body of work is to promote the welfare of junior doctors in general surgery particularly amidst significant rostering changes in a pandemic setting. Students will be learn how to employ qualitative research methods in a surgical setting and will also learn how to critically assess the impact of a COVID-19 crisis roster on junior staff.

Ocular anti-viral use across Aotearoa – trends in patient demographics and health service factors

Supervisors

Dr Isabella Cheung
Dr Jay Meyer

Discipline

Clinical

Project code: MHS022

Infection of the cornea with herpes simplex virus is one of the main causes of blindness in the developed world. Treatment often involves the use of ocular acyclovir, however, the patient and health service factors associated with its use across Aotearoa are unknown. By identifying specific factors associated with lower use of this medication, this can identify where strategies are needed to improve treatment access. This project will involve using statistical analysis software to analyze prescriptions of ocular acyclovir across Aotearoa and describing trends in patient demographics and health service factors. This project will be best suited to an individual who is comfortable with independently using and familiarizing themselves with possibly unfamiliar software.

Does a head elevation device reduce maternal and neonatal morbidity at Caesarean section at full dilatation? A retrospective cohort study

Supervisor

Lynn Sadler (021 535 187)
Robin Cronin
Meghan Hill

Discipline

Clinical

Project code: MHS023

Limited data support the use of a head elevation device (the "fetal pillow"TM) at Caesarean section at full dilatation to reduce maternal and neonatal morbidity. However the device is used widely in New Zealand. The aim of this study is to compare maternal and neonatal morbidity at Caesarean at full dilatation at one unit (Middlemore Hospital) where the device is in use with

  1. a similar period at the same unit immediately prior to introduction of the device
  2. the same period at a local hospital (Auckland) where the device has not been introduced.

The primary outcome is uterine tearing with extension into local organs.Cases and controls will be identified from clinical maternity databases at Middlemore and Auckland Hospitals. Some data will be extracted from clinical records and entered into a study database.

It is expected that approvals will be in place prior to the studentship period so that the student will be able to develop a data collection tool/database, extract the relevant data, and if time allows, begin data analysis. The project is supported by a clinical epidemiologist, obstetrician, and midwife.

Screening for dementia and delirium in older hospital inpatients

Supervisors

Dr Sarah Jane Cullum (027 410 0603)
April Clugston
Waitakere Hospital

Discipline

Clinical

Project code: MHS024

Delirium is characterised by an acute and fluctuating disturbance in attention, due to an organic medical condition or disease state. Delirium is found in 15-20% of older hospital inpatients and is associated with increased length of stay, functional decline, institutionalisation, mortality and health care costs. By contrast, dementia is a neurodegenerative disorder, that progresses slowly over a number of years. Dementia is also common in older hospital inpatients, occurring in 25-40% of those aged 70 and over, is poorly detected, and associated with adverse consequences and increased care costs.

Delirium and dementia have a complex relationship. Delirium occurs more frequently in patients with dementia but is also a risk factor for subsequent cognitive decline and dementia. This provides the rationale for joint dementia and delirium screening: one cannot be done without the other. The aim of our project is to assess the utility of the 4AT for detection of delirium and the Alzheimer’s Questionnaire (AQ) for detection of dementia in older medical inpatients at Waitakere Hospital and to link screen status to health outcomes.

Applicants must be able to communicate professionally with patients and their families and be interested in improving outcomes for patients affected by cognitive disorders such as dementia.

Classifications of Young Onset Dementia (YOD) using InterRAI Data

Supervisors

Dr Ryan San Diego (Social and Community Health) (09 923 8510)
Dr Gary Cheung (Psychological Medicine)
Dr Brigid Ryan (Centre for Brain Research and Department of Anatomy and Medical Imaging

Discipline

Clinical

Project code: MHS025

Young onset dementia (YOD) is defined as dementia with symptom onset before the age of 65. People living with dementia have different needs than their older counterparts. The aim of this project is to use routinely collected health data to identify sub-groups of YOD patients, based on clinical and sociodemographic measures. Identification of these sub-groups would allow improved management of people living with YOD.

This study will use the interRAI (International Residential Assessment Instrument) dataset. InterRAI is a comprehensive assessment that is mandated for all New Zealanders living at home who are assessed for needing care, and all New Zealanders living in long-term care facilities. All New Zealanders who had an interRAI assessment between 2016 and 2019, and had a diagnosis of YOD, will be included in this study. Latent class analyses will be used to cluster patients into sub-groups.

Tasks for the summer research project will include literature review, data entry, academic writing and basic quantitative data analysis. Depending on the student’s interest, there will be an opportunity to learn how to perform latent class analyses.

How our Favourite Words (‘f-words’) fit with Hauora for Children living with Disability – a Qualitative Study

Supervisors

James Hamill (021 753 081)

Discipline

Clinical

Project code: MHS028

Child disability covers a range of conditions that limit normal development as children grow and mature.

The World Health Organisation takes a more holistic view of disability in International Classification of Functioning, Disability and Health (ICF). In the ICF concept, the health diagnosis, body structure and function, and the person’s activity and participation are all interconnected within the context of the person themself and their environment.

Rosenbaum et al. developed the ICF framework further with six ‘f-words’: function, family, fitness, fun, friends and future (Rosenbaum & Gorter, 2012). This provided a practical way to apply the ICF framework to the care of children and their families. Charles et al. developed the f-words framework into the 'life wheel' designed as ‘an interviewing and coaching approach’.

The Maori view of health is embodied in hauora: taha tinana (physical wellbeing), taha hinengaro (mental and emotional wellbeing), taha whanau (social wellbeing) and taha wairua (spiritual wellbeing). The f-words model as it is applied in the Life Wheel may fit more closely with hauora than the medical model.

Therefore, the purpose of this study is to meet with and talk to Maori families and leaders about how child disability fits into hauora and specifically how the F-Words Life Wheel can be adapted for Maori.

Debriefing in children's operating theatres An observational study

Supervisors

James Hamill (021 753 081)

Discipline

Clinical

Project code: MHS029

Debriefing has been described as a ‘facilitated or guided reflection in the cycle of experiential learning’ (Fanning and Gaba 2007). Debriefing has also been defined as ‘a process in which people who have had an experience are led through a purposive discussion of that experience’ (Lederman 1992). Operating theatres provide a rich source of experience but it is doubtful how much the operating room team can process these experiences into learning in the absence of ‘guided reflection’ or ‘purposive discussion’.

At Starship Children’s Health the Paediatric Surgery team instituted routine debriefing at the end of elective operating lists. These debriefs were warmly received by the team and theatre nurses in particular felt heard more and valued as a result of the debriefings. Debriefs were a way of giving all members of the team a ‘voice’. Importantly, debriefings brought up issues of safety and efficiency that the OR team could either fix or escalate to an appropriate managerial group.

It is not known how often or how well debriefing is performed after operations. Therefore, this study will observe the operating theatre to quantify debriefing and will use tools to measure their effectiveness.

Broadening the state of play – the second national survey of Consultation-Liaison Psychiatry (CLP) Services in New Zealand (CLPSNZ-2)

Supervisors

A/Prof Frederick Sundram (09 923 7521)
Dr John Hopkins

Discipline

Clinical

Project code: MHS030

Consultation-Liaison Psychiatry (CLP) is the psychiatric specialty that focusses on the care of people presenting with both mental and physical health needs regardless of presumed cause typically within general hospitals. The first national survey of CLP services in New Zealand (CLPSNZ-1) was conducted in April 2018 using a multiple-choice online survey and results of this survey have already been published. This is the second iteration of the survey which was recently launched in May 2021 and aims to sample all services available in the 36 public hospitals in New Zealand with 24/7 Emergency Departments, for people presenting with comorbid mental and physical health needs. We are in the process of collating survey findings which will be analysed during the summer studentship.

The summer research student will be able to develop the following skills 

  • Reviewing the literature relating to consultation-liaison psychiatry
  • Analysing a national survey dataset
  • Summarising findings from various DHBs in a database
  • Working towards publication of findings together with the research team

Ideal applicants:

  • Students with prior research skills
  • Interest in mental health and the overlap with physical health
  • Keen to work towards future publication

Duration of preoperative fasting before major abdominal surgery: a prospective audit of current practice

Supervisor

Dr Cameron Wells
Chris Varghese
Prof Greg O'Grady
Prof Ian Bissett

Discipline

Clinical

Project code: MHS033

International ERAS and ESPEN guidelines recommend a preoperative fast of 2 hours for fluids and 6 hours for solids. These measures aim to decrease risk of aspiration and maintain low gastric content and pH. However, prolonged fasting over the recommended limits has been associated with adverse events and poorer outcomes. Preoperative fasting durations are variables, and in some cases, patients remain nil by mouth up to 24 hours preoperatively. This may be due to delays in theatres, changes in operating schedules, or the traditional practice of “fast from midnight” despite strong evidence that aspiration risk is rare in modern anaesthetic practice.

This summer studentship will involve prospectively auditing the compliance of preoperative fasting durations and the use of carbohydrate drinks before major abdominal surgery at Auckland City Hospital.

Goals of this study include:
1) understanding how long patients fast before surgery
2) understanding risk factors for prolonged preoperative fasts
3) understand the impact of fasting duration and preoperative carbohydrate drinks on inpatient, postoperative outcomes (e.g. postoperative ileus).

Data will be collected by talking to patients and nursing staff. Within 10-weeks the student will collect data, perform a literature review, statistical analysis (with guidance) and write a manuscript for publication.

Potentially inappropriate prescribing in hospitalised older adults with long-term conditions

Supervisor

Mohammed Mohammed (09 923 4458)
Nataly Martini

Discipline

Clinical

Project code: MHS035

Older adults tend to have higher rates of long-term conditions and therefore, are more likely to be prescribed concurrent multiple medications. The use of multiple medicines can lead to a higher risk of potentially inappropriate medicines and consequently to adverse health outcomes such as falls and fractures, increased visits to the emergency department and hospitalisations, poor adherence to treatment and quality of life outcomes. In New Zealand, research into medication errors, and appropriateness of prescribing has been focused on population-level data and patients in primary or long-term care settings, with less research in hospitalised patients particularly older adults, where the frequency and nature of prescribing errors may be different.

The proposed study will generate preliminary evidence that provides an insight into the prevalence and nature of potentially inappropriate prescribing among older adults in the hospital setting, and inform future areas of work on identifying strategies that best support clinicians and older people as they safely stop medications that are inappropriate/no longer needed.

Maori experiences of anaesthesia in the perioperative setting.

Supervisor

Dr. Courtney Thomas (021 301 764)
Prof. Jenny Weller
Dr. Jamie-Lee Rahiri

Discipline

Clinical

Project code: MHS035

Little is known about Maori experiences of anaesthesia. This project is part of a wider doctorate incorporating mixed methods research through quantitative and qualitative research methods. We would like to know what Maori think about their experiences of anaesthesia and identify what is being done well and what could be improved. We hope this will help improve the care Maori patients and their whanau receive when needing surgery and care from an anaesthetist.

We know that Maori experience more problems in accessing care, higher rates of hardship, disability and disease and poorer health outcomes than non-Maori. These inequalities also exist when we look at what happens after surgery. Research is needed to help us understand why and to look for ways to improve things for Maori.

The summer studentship will assist with the first stage of the wider doctoral study, which involves participant recruitment and administration of a survey about their experience of the anaesthetic care they received and their wider experiences within the health system. This work will contribute to the wider body of work already completed by the supervisor, Dr. Courtney Thomas. The summer student will also be required to summarize their findings and present them at the end of the summer studentship.

Life after brain injury: access to neurocognitive rehabiltiation services

Supervisors

Rebecca Slykerman (09 923 1132)

Discipline

Clinical

Project code: MHS056

Moderate to severe brain injury in childhood results in lifelong thinking and learning deficits. It was once thought that a child’s brain would recover better due to plasticity in the developing brain, it is now understood that early injury can result in poorer outcomes. Neuropsychological assessments are specialist assessment of the specific problems the child experiences. They generate individualized recommendations tailored to the child’s unique needs and goals and are an integral part of guiding post-injury rehabilitation.

The aim of this project is to investigate access to neuropsychological services post-brain injury. The project has a strong equity focus and seeks to determine whether equitable access to specialist neuropsychological services is achieved.

This project will involve examining existing clinical records for children seen at the National Starship Children’s Rehabilitation Service and collecting data about the child and their injury. It will also involve examining neuropsychological reports and collecting data about any deficits identified as a result of the injury.

The project is an excellent opportunity to gain research skills in an exciting and clinically relevant field.

If you are interested in this project, please email your CV and recent grades to Dr Rebecca Slykerman 

Exploring community pharmacist-led interventions to improve adherence to cardiovascular medicines and the tools used to measure adherence

Supervisors

Trudi Aspden (09 233 893)
Kebede Beyene
Dianne Vicary (HBDHB)

Discipline

Clinical

Project code: MHS061

Cardiovascular disease (CVD) is the leading cause of premature death and disability in New Zealand, and in 2010-12 Maori were more than 1.5 times as likely as non-Maori to be hospitalised for cardiovascular disease. Research has found that community pharmacist-led interventions can improve patients’ medication adherence and contribute to better blood pressure control and cholesterol management. This research will collate the literature describing community pharmacist interventions to improve adherence to cardiovascular medicines and identify tools measuring this adherence.

The research aims are to identify:

  1. the published literature describing the interventions used by community pharmacists to improve adherence to cardiovascular medicine.
  2. the tools used to assess adherence, including those measuring adherence in specific cultural groups.

Skills required for this project are an ability to pay attention to details and to work in a methodical manner. An interest in research and the topic would also be useful. This project will improve your literature searching, critical appraisal and report writing skills.

This is a New Zealand Pharmacy Education and Research Foundation (NZPERF) funded studentship so only part 2 and 3 BPharm students are eligible to apply.

Perinatal mortality in South Auckland: are we improving pregnancy outcomes and where to next?

Supervisors

Charlotte Oyston (027 668 7560)
Debbie Davies
Lynn Sadler
Robin Cronin
Sarah Wadsworth

Discipline

Clinical

Project code: MHS064

Pregnant women residing in Counties Manukau Health (CMH), South Auckland, are more likely to have their baby die before, or in the first 28 days following birth, compared to the national rate (PMMRC reporting). Women of Maaori, Pacific, and Indian ethnicities are also overrepresented in perinatal mortality statistics.

In 2011 a report looked at possible reasons for this, and an external review was commissioned by the DHB. Since then, a number of initiatives have attempted to address the recommendations made in the report, but it is unclear if these have resulted in improved outcomes.

This project aims to describe what has happened to perinatal mortality at CMH since the 2012 report, including the perinatal mortality rate, the ethnicity, gestational age and causes of perinatal mortality for women birthing at CMH compared to national rates.

You will further explore causes of perinatal death that appear to be more common at CMH than the rest of NZ (eg infectious causes) to try and identify why this is, and how we might improve pregnancy outcomes.

You will be well supported by a team including perinatal loss and research midwives, a perinatal epidemiologist, and obstetricians. Ethical /locality approvals will be obtained before you arrive. You will be responsible for extracting and entering perinatal mortality data from the clinical records, and some analysis (with support from the research team). This work needs to be completed on site at Middlemore hospital.

Defining normal reference values for cardiac structure and function among elite athletes in NZ

Supervisor

Professor Rob Doughty (09 923 9804)
Dr Katrina Poppe
Dr Mark Fulcher
Assoc Prof Malcolm Legget

Discipline

Clinical

Project code: MHS066

Athletic training results in physiological adaptation of the heart, typically these changes include increase in left ventricular size, wall thickness and mass, referred to as the “athletic heart”. Athletes competing in elite-level sport require a precompetition medical assessment. This includes a medical history and examination and a 12-lead electrocardiogram (ECG). FIFA recommend that an echocardiogram is undertaken at least once in an elite footballer’s career, as this can better detect structural abnormalities not identified on an ECG. Differentiating changes associated with the athletic heart from those due to cardiac pathology requires understanding of the normal reference ranges for athletes.

The aims of this summer studentship are to undertake a review of the international literature on reference ranges for elite footballers, and to aggregate the existing echocardiography data from NZ footballers who have had an echocardiogram as part of their preparticipation medical assessment.

Skills:

  • Undertake a literature review of echocardiography among athletes
  • Quantitative research to integrate echocardiography data for NZ footballers
  • Data interpretation and report writing

Outcomes for women following acute coronary syndromes: a meta-analysis

Supervisor

Dr Katrina Poppe (09 923 9200)
Professor Rob Doughty
Dr Nikki Earle

Discipline

Clinical

Project code: MHS067

Over recent decades the incidence of hospitalization for acute coronary syndromes has decreased in NZ for both men and women. While outcomes have improved over a similar time period, adverse clinical outcomes still occur in approximately one in three people post-ACS, and overall mortality at 1 year is approximately 19%. Adverse clinical outcomes are more common among women than men, representing an important gender equity gap.

The aims of this summer studentship are to undertake a systematic review of the international literature on outcomes for women, compared with men, following acute coronary syndromes. A literature-based meta-analysis will be undertaken and data from a NZ cohort study analysed.

Skills:

  • Develop understanding and skills in meta-analyses
  • Undertake a meta-analysis of outcomes post-acute coronary syndromes
  • Analysis of clinical data for patients presenting with acute coronary syndromes
  • Data interpretation and report writing

Eye Tracking in Contact Sports- A Clinical Study

Supervisors

Dr Matthew McDonald (021 229 1840)
Professor Helen Danesh-Meyer

Discipline

Clinical

Project code: MHS068

We invite you to take part in an exciting opportunity in the clinical utility of eye tracking technology. Using a wearable, portable eye tracker (PupilCore) with our in-house analysis software package, you will perform data collection from boxers and contact sports players pre- and post- matches, in addition to an ophthalmic patient population. You will be able to directly visualise the data and work in a multidisciplinary team of eye specialists, biomechanical engineers, and magnetic resonance imaging specialists.

The successful applicant will be required to travel to various sports club to undertake eye-tracking measures. Skills that will be acquired are an understanding of the neurological control of eye movements, the impact of concussion, and the clinical measures used to diagnose and monitor concussion. Option is available to consider an Honours project, although this is completely optional.

COSMOS and Magnetic Resonance Imaging of the Pancreas

Supervisors

Professor Max Petrov

Discipline

Clinical

Project code: MHS069

Magnetic resonance imaging (MRI) is well established for imaging the organs of the abdomen and pelvis. In recent years it has been having an increasingly important role in the evaluation of the pancreas. Although abdominal computed tomography remains valuable in investigation of the pancreas, the contemporary emphasis on decreasing patient radiation exposure is driving practice toward non-ionising modalities such as MRI. The inherent dynamic properties of MRI, its superior tissue contrast, and cross-sectional capabilities offer additional advantages.

The aim of this project is to contribute to advancing our knowledge on clinical usefulness of quantitative imaging biomarkers derived from MRI of the pancreas. Depending on the preferred learning goals of the successful candidate, the project may involve a quantitative analysis of the existing images and/or a meta-analysis of published studies. Either way, it is expected that results will be published in an international peer-reviewed journal. 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 prospective longitudinal cohort study of MRI in diseases of the exocrine pancreas.

Skills taught:

  • Working in a clinical research team environment
  • Management of a clinical study
  • Magnetic resonance image analysis
  • Conducting a meta-analysis of clinical studies
  • Preparation of a manuscript for publication in international peer-reviewed journal

Broken sleep and hospital bleeps: the effect of the postoperative ward environment on sleep and surgical recovery

Supervisors

Dr Cameron Wells 
William Xu
Armen Gharibans
Greg O'Grady

Discipline

Clinical

Project code: MHS071

The optimisation of perioperative care is critical, improving patient outcomes and accelerating recovery after surgery. Despite recent advancements in perioperative care exemplified by enhanced recovery after surgery (ERAS) protocols, sleep remains an important but often overlooked aspect of recovery. There are likely numerous contributing factors to poor sleep quality after surgery, some modifiable and some not. Previously suggested factors include the surgical stress response, clinician interruptions, postoperative pain, and disruptive environments with excessive light and noise. Environmental modifications to reduce disturbances are a potentially modifiable factor that may improve patient sleep after surgery. However, it remains unclear to what degree these factors contribute to impaired sleep on surgical wards.

This studentship will prospectively recruit patients undergoing elective major abdominal surgery. The primary aim of this project is to objectively quantify the effect environmental factors have on patient sleep quality. Secondary aims will be to investigate other factors affecting sleep quality such as pain and anxiety. Sleep will be measured by wearable devices and validated surveys. Environmental factors will be measured through ambient sensors.

Skills developed:

  • Literature review
  • Prospective recruitment of study participants
  • Working in a multi-disciplinary clinical research team
  • Academic writing

What coping strategies do children and adolescents who self-harm use?

Supervisors

Vartika Sharma (027 212 4641)
Sarah Hetrick

Discipline

Clinical

Project code: MHS072

We are a team of researchers at the Cochrane Common Mental Disorders – Children and Young People Satellite, in the Department of Psychological Medicine, FMHS. Most of our research work is focused on child and youth mental health, esp. self-harm and suicide. We are keen to have a summer student on-board to help us with a systematic review (i.e. evidence synthesis) to examine various coping strategies used by children and adolescents who engage in self-harm. Understanding of different coping strategies can help develop a youth-friendly intervention design and implementation plan to mitigate the risk of SH. The student will be guided to use a systematic approach (both rigorous and transparent) to identify relevant literature from different databases, critically appraise the literature and synthesize the findings with minimal bias. The expected outcome would be an exhaustive summary of current evidence related to coping strategies used by children and young people.

Digital inhalers and asthma - what do we want in an ideal digital inhaler?

Supervisors

Amy Chan (ext 85224)

Discipline

Clinical

Project code: MHS086

Asthma is one of the most common long-term conditions, affecting 1 in 5 children and 1 in 8 adults. Specifically, there are large disparities between Maori and non-Maori with Maori having a 3-fold higher risk of hospitalisation and poor asthma control. There has been an increase in the use of digital inhalers to support medication taking in asthma (e.g. Smartinhalers), however we do not currently know what key attributes influences people's decisions about whether or not they would use a digital inhaler as part of asthma management.

This project aims to identify the key attributes that influences people's decision making about whether or not to use a digital inhaler and how these trade-off decisions vary between different groups of individuals. The project will involve setting up an online experiment (called a choice experiment) where individuals are invited to make choices between different scenarios. The project is part of a multinational project with researchers based in Australia, Netherlands, UK and Singapore, and will be presented at the next European Respiratory Society (ERS) congress in 2022.

The studentship is suited for someone with good quantitative research skills, and with an interest in digital health and online experiments. Previous experience of setting up an online survey and use of statistical software such as SPSS is desirable but not essential.

In the studentship, you will have the opportunity to gain skills in:

  • Quantitative research
  • Design of choice experiments
  • Understanding of behavioural medicine and how individuals make decisions / trade-offs in healthcare
  • Written and verbal communication skills
  • Time management and organisational skills
  • Critical appraisal
  • Literature review
  • Data analyses
  • Data management
  • International collaborative research

The project can start as soon as Nov and will have received ethics prior to this. The project will be over a 10 week period over the Summer.

Understanding the factors affecting recruitment, retention and loss of Maori and Pacific participants within a clinical trial. A qualitative study using kaupapa Maori methodology.

Supervisors

A/Prof Matire Harwood (09 923 7866)
Dr Ben Albert (Liggins Institute)

Discipline

Clinical

Project code: MHS100

The Fish Oil in Pregnancy Study was a randomised controlled trial where women who were ‘overweight’during pregnancy took fish or olive oil during pregnancy with the aim of improving their children’s health. The study aimed to recruit 1/3 Maori and 1/3 Pacific participants. Recruitment was difficult, and while 14% Maori and 15% Pacific participants entered the study it was lower than targeted. Maori were also more likely to exit the study.

We have a responsibility to ensure that clinical trials have adequate Maori and Pacific representation, especially for conditions affecting more Maori and Pacific peoples. . This project will use qualitative kaupapa Maori methodology to investigate the reasons Maori and Pacific people chose to join the study, why they continued and why they exited, and also to explore barriers to consuming fish oil. This will be used to inform future studies, to ensure better representation.

You will work with A/Prof Harwood (Ngapuhi) an experienced researcher in Maori health and with Dr Ben Albert who led the trial. You will gain valuable experience in qualitative research and contribute to improving Maori representation in research and the relevance of future research findings for Maori.

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

Supervisors

Joy Marriott (021 179 6510)

Discipline

Clinical

Project code: MHS107

The GTA programme is a compulsory teaching session which Year 5 medical students complete before commencing their O&G clinical attachment. Rather than use pelvic models for teaching these sensitive examination skills, gynaecology teaching associates (GTAs, or professional patients) are employed to provide teaching in a simulated clinical environment. The aim of this study is to better understand the strengths, as well as the barriers, to confidence and competence in teaching and learning pelvic examinations skills.

This is a qualitative study, using semi-structured interviews (audio-recorded) of Year 5 medical students, GTA doctors, and GTAs. Thematic analysis of the transcribed interviews will then be undertaken by the student with assistance from the research team, which is designed to explore the views of the teachers and learners in the GTA programme.

This research project was commenced by a student undertaking a Student Summership in 2020. This included a literature review and interviews with 12 participants but here was insufficient time for thematic analysis. We propose that you undertake an update of the literature review, further interviews (aiming for a further 4 participants), with completion of a detailed thematic analysis.

Learning outcomes: Student engagement with medical education literature, real-world experience of interview-based research, critical analysis, with option to write draft manuscript for publication

Skills required: ideally some research experience, particularly qualitative or interview-based research

Poppy seed oil tubal flushing: does this improve the success rate of IUI (Intrauterine insemination) treatment?

Supervisors

Joy Marriott (021 179 6510)
Debbie Blake
Neil Johnson

Discipline

Clinical

Project code: MHS110

A hysterosalpingogram (HSG) with lipiodol (an iodised poppy seed oil, used as a contrast medium), has been shown by randomised controlled studies (RCTs) to have a fertility benefit. Whilst lipiodol is probably effective at flushing tubal debris that could hinder fertility, it also exerts immunobiological effects on the endometrium that may enhance receptivity to implantation.

In an RCT of lipiodol HSG versus no intervention to treat unexplained infertility in 158 women, there was overall benefit from lipiodol (pregnancy rate relative risk (RR) 2.3, P = 0.002). Within this cohort, there was a greater benefit amongst 62 women with endometriosis (live birth RR 3.7, P = 0.007) than amongst 96 women without endometriosis (live birth RR 1.6, P = 0.13) (Johnson et al, FLUSH trial, 2004). However, subsequent research on lipiodol pre-IVF in women with endometriosis or repeat implantation failure, did not show evidence of benefit (Reilly et al, 2019).

The effect of lipiodol uterine bathing for women undergoing intrauterine insemination (IUI) merits further investigation, as a less invasive fertility treatment option than IVF.

This research project would review the success rates of women having IUI following lipiodol HSG, compared to a matched group of women having IUI at the Auckland Repromed clinic.

Characterisation of Ocular Chemical Injuries treated through the ADHB

Supervisors

Dr. Jay Meyer (022 318 4958)
Dr. Alexandra Crawford

Discipline

Clinical

Project code: MHS113

Ocular chemical injuries are potentially blinding and are a significant public health concern as many of these injuries occur in the workplace. Determination of the causes of significant chemical injuries in NZ will allow interventions to be targeted toward prevention of future injuries. This project will determine the etiology, severity, and visual outcomes of ocular chemical injuries treated at the Auckland District Health Board over the past 20 years. The student's role will include chart review, data collection, data analysis, and report/manuscript generation.

Methylene blue use after cardiac surgery.

Supervisors

Rachael Parke (021 893 176)

Discipline

Clinical

Project code: MHS116

Methylene blue is an inhibitor of nitric oxide synthase and is sometimes used in patients with catecholamine refractory vasoplegic syndrome. Vasoplegic syndrome can occur following cardiac surgery and is characterised by high-output shock state with low systemic vascular resistance.

This project involves a literature review and retrospective chart review of patients administered methylene blue in a 6-month period in the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, to assess in which patients this drug has been used and the safety and outcomes of use.

Skills: The student will be supported by a team of researchers and learn skills of database design; data collection and entry; data analysis; presentation of data and manuscript preparation.

Can accelerometry measure sedentary data in older people?

Supervisors

Ruth Teh (09 923 7517)
Karen Campbell
Ngaire Kerse

Discipline

Clinical

Project code: MHS122

The AWESSoM programme is an integrated set of projects improving health for old people. Those at risk of functional decline in Howick and Tauranga. Physical activity will be measured by accelerometry attached at the L5 position and an established platform will identify gait characteristics. Identifying sit to stand transitions and sedentary time is challenging from the L5 position.

This studentship aims to establish the validity of accelerometry in identifying sedentary behaviour in older people at risk of functional decline.

The student will engage with older people, conduct video assessments of gait while the accelerometer is attached (in the Howick region), annotate the video and accelerometer data using novel interfaces and work with a team of experienced researchers: Ruth Teh, Karen Campbell, Lynne Taylor, Sue Lord, and Khalid Jabber, with the range of skills needed to support people and technical data collection and analysis.

Tasks and skills development will include interviewing older people, including privacy sensitive video-recording, gait assessment using accelerometry, technical data manipulation, basic descriptive statistics, Exploring and displaying data using visual and tabular forms. Preparation of a manuscript about that data with the support of experts.

Attendance at group meetings will enhance the appreciation of research with older people.

Vaccine decision-making - how people make decisions about whether to take a vaccine or not?

Supervisor

Amy Chan (ext 85224) 

Discipline

Clinical

Project code: MHS134

Vaccine hesitancy - defined as a delay in acceptance or refusal of vaccination despite availability of vaccination services - is one of the top 10 threats to global health recognised by the World Health Organisation. This is particularly pertinent in light of the global COVID-19 pandemic and efforts to support vaccine uptake worldwide, however the drivers of vaccine hesitancy are complex and varies across time, place and vaccine type.

This project aims to examine how factors related to vaccination can affect the public's preference for the uptake of the vaccination in different groups within New Zealand. Specifically, this project aims to identify the key attributes that influences people's decision making about whether or not to take a vaccine and how these trade-off decisions vary between different groups of individuals. The project will involve setting up an online experiment (called a choice experiment) where individuals are invited to make choices between different scenarios.

The studentship is suited for someone with good quantitative research skills, and with an interest in digital health and online experiments.

Previous experience of setting up an online survey and use of statistical software such as SPSS is desirable but not essential.

In the studentship, you will have the opportunity to gain skills in:

  • Quantitative research
  • Design of choice experiments
  • Understanding of behavioural medicine and how individuals make decisions / trade-offs in healthcare
  • Written and verbal communication skills
  • Time management and organisational skills
  • Critical appraisal
  • Literature review
  • Data analyses
  • Data management

The project will be over a 10 week period over the Summer.

Beliefs about antibiotics and antimicrobial resistance in Asian populations in Aotearoa : an interview study

Supervisors

Amy Chan (ext 85224)
Gigi Lim
Stephen Ritchie

Discipline

Clinical

Project code: MHS137

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 attitudes and beliefs, particularly their expectations for antibiotics in situations where antibiotics are not needed, such as for colds/flu.

We have previously conducted some work with Maori and Pasifika populations to explore the beliefs, experiences and attitudes that individuals and communities hold about antibiotics. However, this work has not been done with Asian populations in Aotearoa New Zealand. Identifying and understanding the beliefs that Asian populations 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 that Asian populations hold about antibiotics and antimicrobial resistance, and their role in treating infections commonly seen in primary care. We will do this by 1:1 and focus group interviews with patients recruited from 1-2 GP practices within the Auckland area.

This project would particularly suit someone with an interest or experience qualitative research (i.e. research with interview data) and in infectious diseases, or in supporting appropriate medicines use. Previous experience of conducting interviews or discussion groups, or other experience working with people (e.g. customer services or retail) would be desirable but not essential.

In the studentship, you will have the opportunity to gain skills in:

  • Qualitative research
  • Undertaking 1:1 interviews and focus groups
  • Conducting thematic analysis of interview data
  • Written and verbal communication skills
  • Time management and organisational skills
  • Critical appraisal
  • Literature review
  • Data management
  • Use of NVivo software to code interview data

The project will run for a 10-week period over the Summer Nov 2021-Feb 2022.

Phenotypic and molecular characterisation of patients with congenital stationary night blindness

Supervisors

Sarah Hull (021 081 87774)
Andrea Vincent

Discipline

Clinical

Project code: MHS141

Congenital stationary night blindness (CSNB) is an inherited retinal dystrophy presenting in infancy with reduced vision and nystagmus. Multiple genes are implicated and potential gene therapy approaches are in development. Detailed characterisation of patients with this condition is an essential prerequisite in eligibility for treatment trials and for understanding treatment outcomes.

This summer studentship project will investigate all patients with this condition ascertained from the New Zealand retinal dystrophy database.

The aims are to:

  • retrospectively review the detailed phenotype of patients including vision, retinal imaging, and electrophysiological characteristics
  • Characterise the molecular findings and highlight those patients for whom further investigation is needed

Skills needed:

  • Retinal imaging interpretation
  • Basic understanding of genetics/bioinformatics
  • Literature review

Feasibility and safety of a virtual imaging clinic to investigate children with swollen optic nerves

Supervisors

Sarah Hull (021 081 87774)
Andrea Vincent
Stuart Carroll

Discipline

Clinical

Project code: MHS142

Children are frequently referred from optometrists with an incidental finding of swollen optic nerves. They often require rapid review to rule out papilloedema that may indicate raised intracranial pressure. Optic nerve head imaging with colour photos, autofluorescence and OCT permits detailed analysis and serial monitoring.

This project would form 2 parts- firstly a retrospective audit over the last 2 years of all referrals meeting this criteria and their outcomes; secondly, development of a potential protocol for virtual imaging clinics to reduce the burden of clinical visits. This would benefit a stretched service as well as providing a streamlined and consistent approach to the assessment of these patients.

Skills: ability to interpret optic nerve head imaging after training

Hospital care of frail older adults undergoing inpatient rehabilitation

Supervisors

Katherine Bloomfield (021 159 1580)
Zhenqiang Wu
Himali Aikin

Discipline

Clinical

Project code: MHS144

There is a paucity of literature around hospital care and outcomes for variably frail older adults receiving multidisciplinary rehabilitation or sub-acute hospital care. We have recently developed and validated a frailty index from electronically recorded data to measure frailty in patients admitted to older adult rehabilitation wards at Waitemata District Health Board (WDHB). Initial analysis of outcome data revealed surprising findings, such as shorter length of in-hospital stay for the most frail, inconsistent with international literature. Previous, unpublished WDHB data also suggests those most frail receive less inpatient physiotherapy than those less frail. We wish to interrogate hospital data of a cohort of variably frail patients further to investigate if any differences in multidisciplinary management and intervention are present, and if so, why. Analysis will inform clinical staff where differences in management exist, and may help inform rehabilitation potential and service development.

Skills gained: Data handling, analysis and interpretation; Literature review/critical appraisal; Academic writing/manuscript preparation.

How do rural health outcomes differ from urban health outcomes?

Supervisor

Kyle Eggleton (021 686 487)

Discipline

Clinical

Project code: MHS146

The uncertainty, in the New Zealand context, of what is rural and what is not, has made it difficult to clarify, with any certainty, what differences in mortality and morbidity exist between rural and urban people. In many developed countries some increases in the incidence of suicide, cervical cancer, melanoma, prostate cancer, cardiovascular disease, obesity and motor vehicle accidents are noted in rural populations compared to urban populations. Conversely urban populations may have higher incidence of breast, stomach, liver cancers and respiratory conditions. The aim of this project is to undertake a literature review to determine what differences, if any, are present between rural and urban health locations in New Zealand. Developing a clearer understanding of differences in a New Zealand context, may help in developing a contextual model explaining rural health differences.

Skills:

  • Critical appraisal of the literature.
  • Development of theoretical models.

Predicting healthcare outcomes at Emergency Department triage

Supervisors

Dr. Zhenqiang Wu (021 153 1391)
Dr. Laura Chapman

Discipline

Clinical

Project code: MHS147

Emergency department (ED) overcrowding is a major global healthcare issue. The consequences are well-established, with poorer patient outcomes, staff stressors, and strained healthcare system. There are two responses in principle: to increase resources, e.g., the number of EDs and/or staff, or to be more effective with existing resources. Triage is the first point of contact in an ED and is a potential time point to alleviate the overcrowding issue by improving accuracy. This study intends to optimize the resources by developing a tool at this first contract point of ED for predicting healthcare outcomes (e.g., hospital admission). Both traditional regression and progressive modeling approaches – e.g., machine learning will be used.

A range of routinely collected big data will be extracted from Waitemata DHB’s health system, including structured and unstructured information (free text). The student will undertake a literature review on the triage tools in ED, and be involved in data analysis, e.g., assessing the predictive performance of triage score, identifying other potential predictors (if time allows). This research will be part of a post-doc research. A co-authorship will be offered in a future publication.

Skills: Literature review/critical appraisal; Data cleaning, analysis (logistic regression and/or machine learning), and interpretation; Academic writing/Manuscript preparation.

Impact of covid-19 on emergency department presentations: an interrupted time series analysis

Supervisors

Dr. Zhenqiang Wu (021 153 1391)
Dr. Laura Chapman

Discipline

Clinical

Project code: MHS148

Coronavirus disease 2019 (COVID-19) is a pandemic, which has caused many challenges to the health system, workers, and patients. The initial response of the healthcare system was to minimize the spread of COVID-19, manage infected patients, minimal harm to healthcare works and the general population. New Zealand used a COVID-19 elimination strategy, and the impact of this and the associated actions have not been fully quantified. This study aimed to measure the impact of COVID-19 on emergency department care at Waitemata District Health Board (WDHB), including adverse effects on non-COVID-19-related illnesses. The primary outcomes are the number of ED presentations, acute hospitalizations, and mortality.

The data will be extracted from Waitemata DHB’s health system, including one year before and one year after the first lockdown. The student will undertake a literature review on this area. The summer student will also be involved in data analysis, e.g., interrupted time series analysis. This research will be part of a post-doc research. A co-authorship will be offered in a future publication.

Skills: Literature review/critical appraisal; Data cleaning, analysis, and interpretation; Academic writing/Manuscript preparation.

Evaluating the change to misoprostol for induction of labour at Waitemata DHB

Supervisors

Dr Ngaire Anderseon (021 813 329)

Discipline

Clinical

Project code: MHS149

Induction of labour (IOL) is the process by which labour is artificially stimulated when there is a medical indication for birth. In NZ the standard medication used for IOL is vaginal application of a prostaglandin gel, usually dinoprostone.

International studies have shown that an oral prostaglandin gel, misoprostol, is at least as effective as dinoprostone gel in inducing labour and may be associated with a reduction in uterine overactivity (hyperstimulation) and Caesarean section rates. Misoprostol is also administered orally, which is a more acceptable formulation to women.

In February 2021, Waitemata District Health Board (WDHB) changed from dinoprostone gel to oral misoprostol for all IOL. This study aims to compare the labour and birth outcomes of all women undergoing IOL at Waitemata DHB before and after this change.

This study will include routinely collected retrospective data extracted from Waitemata DHB’s health databases, and prospective data collected after the change to misoprostol. The student will undertake a literature review, and be involved in data collection, input and cleaning as well as preliminary interim data analysis. A co-authorship will be offered in a future publication.

Skills: Literature review/critical appraisal; data collection, cleaning, analysis and interpretation; Academic writing/Manuscript preparation.

Trauma otucomes in Maori Youth at Counties Manukau Health

Supervisor

Andrew MacCormick (021 189 9953)

Shanthi Amerataunga

Project code: MHS156

The recent Post Operative Mortality Review Committee (POMRC) report showed a three-fold increase in the mortality of Maori youth sustaining major trauma. One of the recommendations is that DHBs undertake a review of the care offered this group. We would like to review the outcomes of all Maori aged 15-18 during 2018-2020. This project would suit someone with an interest or experience in equity issues especially relating to Maori. An interest in trauma care would also be beneficial. The applicant would look at type of injury and the circumstances of the injury the patient sustained. The project would include identifying key points of intervention in the patient's journey including predetermined performances indicators. The aim would be to identify aspects of the patients' care that may contribute to poor outcomes and help in the implementation of improvements to the care pathway.

Corneal nerve microstructure in children and adolescents

Supervisors

Dr Stuti Misra (09 923 6582)

Discipline

Clinical

Project code: MHS159

In the past two decades, an alarming rise has been noted worldwide in the incidence of type 1 and 2 diabetes in children and adolescent populations. There has also been a progressive increase of approximately 5% per year, particularly in Maori and Pacific peoples. An understanding of the normal evolution of sub-basal corneal nerves in growing children and adolescents needs to be investigated prior to studying the corneal nerves in young people with type 1 and 2 diabetes. The aim of the summer studentship will be to prepare corneal in vivo confocal microscopy imaging protocol specifically for children with an aim to scan a larger corneal region so that a continuous montage of images could be prepared.

Skills: Patient interaction; learn to use image processing software to ‘stitch’ several images for preparing confluent montages; preparation of manuscript draft

Improving assessment of Pregnancy of Unknown Location: A feasibility study.

Supervisors

Wendy Burgess (021 379 363)
Joseph Gudex

Discipline

Clinical

Project code: MHS163

In Aotearoa women experience 85 thousand pregnancies every year. Approximately 15% of those will experience the anxiety of a Pregnancy of unknown location (PUL). It may take weeks of serial blood tests and repeat ultrasound scans to find out whether this is a viable ongoing pregnancy. The addition of a common biomarker can confidently help early prediction of outcome. Waitemata propose to run a feasibility study into order to justify the introduction of this biomarker. This project will involve data extraction, analysis, and report writing. You will gain a detailed understanding of biochemical and emotional course of early pregnancy. Keywords: Pregnancy, Ectopic, Progesterone, Human chorionic gonadotropin

Skills required:

  • Excel
  • Basic report writing

Experience gained:

  • working directly with clinicians (doctors, nurses)
  • using clinical hospital systems
  • real-world problem-solving
  • implemention project

Incidence of Anaemia in Fracture Neck of Femur patients at ADHB

Supervisors

Dr Robyn Billing (022 307 2360)
Dr Simon Mitchell

Discipline

Clinical

Project code: MHS171

Patients undergoing surgery for fractured neck of femur are often elderly, with co-morbidities and a high risk of postoperative complications. Hip fracture has become an increasingly severe disease with reported mortality rates ranging from 8% to 36%. Recently, several studies reported close associations between anaemia and short- and long-term mortality in this patient population. Anaemia in hip fracture patients has been associated with increased risk of blood transfusion, poorer functional outcomes and increased mortality. Few studies have reported the prevalence of anaemia on admission or its progression prior to surgery in this cohort.

Treatment of anaemia by blood transfusion in an expensive and finite resource and optimum transfusion threshold in surgical patients is yet to be defined. Along with the knowledge that transfusion itself is an independent factor of morbidity and mortality.

The aim of this study is to describe the incidence of anaemia and transfusion on older persons who sustain a hip fracture and under go surgery over in the past 5 years at ACH.

Skills gained: Data handling, analysis and interpretation; Literature review/critical appraisal; Academic writing/manuscript preparation.