Clinical

Project

Accurate ethnicity data is important for monitoring Māori health equity.

The Ministry of Health recommends that hospital ethnicity data should be audited every three years.

The majority of those who present to Emergency Departments (EDs) are not admitted to hospital, so ED ethnicity data accuracy may be different from overall hospital data accuracy.

In Te Tiriti o Waitangi me Te Ratuaki Manaaki Mana, the Australasian College for Emergency Medicine’s (ACEM)’s guide for upholding Te Tiriti commitments in the ED setting, ensuring accurate ethnicity data is included as an obligation.

In this proposed summer studentship, our research team will use the Hospital Ethnicity Data Audit Toolkit resources to audit accuracy of ethnicity data at multiple EDs in the Auckland region, but the student(s) would be primarily based at Te Whatu Ora Waitemata, so North Shore and/or Waitakere Emergency Departments.

The student(s) would repeat a literature search on ethnicity data accuracy in the ED setting and maintain an EndNote library for references relevant to the study, would be involved in setup of data collection at each site on study shifts, collect data by briefly interviewing study participants and checking hospital databases, collate and analyse data for each site.

We aim to create a resource that will be useful for Emergency Departments in the motu.

This project would suit students interested in equity and emergency care.

Project

Asthma is one of NZ's most common lung conditions affecting 1 in 7 children and 1 in 8 adults in NZ. There is some evidence that asthma education can improve health outcomes.

Asthma NZ is NZ's largest not-for-profit education provider for patients and families with asthma, delivering personalised asthma education to patients in their homes or at school. Asthma nurse educators provide free education about optimal self-management of asthma, identifying any gaps in treatment and recommending a plan to align with current national guidelines, providing personalised information about asthma control tailored to the patient's lifestyle, and a comprehensive demonstration how to use respiratory devices such as inhalers and spacers. Asthma NZ has been delivering education for over 30 years, however the effect of the programme they deliver has not yet been evaluated.

This project aims to:

• Describe the sociodemographics of the patients that are being referred and seen by Asthma NZ nurses
• Evaluate the effect of the personalised asthma education programme delivered by Asthma NZ on asthma outcomes such as asthma control, medication use (adherence) and hospitalisation
• Provide recommendations to inform future interventions to improve asthma outcomes in research and practice.

The summer student will be working with an existing dataset with information already collected by nurses as part of their routine practice. The aim of the project is to evaluate the effect of asthma education on outcomes using data from this dataset.

The student will also have the chance to work with the Asthma NZ team, including the opportunity to accompany nurse educators on home and school visits to see how asthma education is delivered.

The student will learn data cleaning and management skills, quantitative data analysis skills, and verbal and written presentation skills. Some previous experience or knowledge of Microsoft Excel, and working with numerical and health data is preferred, but not essential.

Project

Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) are rare autoimmune diseases characterised by inflammation of small to medium blood vessels, typically with multi-system involvement most commonly affecting the lungs and kidney. Vasculitis is a significant cause of morbidity and mortality overseas and in Aotearoa New Zealan. A review of systemic vasculitidies in Aotearoa New Zealand has identified some gaps in reporting of the epidemiology of these disease.

The primary aim of this study is to determine the incidence, and prevalence of AAV in Auckland, Aotearoa New Zealand between 2011 and 2020.

ANCA testing is performed in a number of laboratories in Auckland. All positive results between 1st January 2009 and 31st December 2020 will be determined.
A retrospective case notes review of all positive cases will occur.

Project

Methotrexate is a medication that is frequently used to treat inflammatory arthritis in rheumatology clinics. Non-adherence with methotrexate is associated with poorer control of arthritis and lower health-related quality of life in patients with rheumatoid arthritis.

The Intentional Non-adherence Scale (INAS) is a scale that assesses patients' reasons for non-adherence to a medication using a set of questions. These questions explore potential reasons for non-adherence, such as: "Because my body is sensitive to the effects of medicine” and “To see if my illness is still there”, which patients score on a scale from strongly agree (5) to strongly disagree (1).

Aims

This study will aim to explore reasons for intentional non-adherence with methotrexate in patients with inflammatory arthritis.

This study will involve interviewing patients with inflammatory arthritis who have been prescribed methotrexate about reasons for intentional non-adherence, part of which will include completing the Intentional Non-adherence Scale with them.

The student would be expected to see study participants and complete study questionnaires with them, and assist with data entry.

This project offers a number of learning opportunities

• General clinical research experience
• Experience with seeing participants in a research study
• Opportunity to work with patients with inflammatory arthritis
• Communication skills
  

Project

Clinical audit is a crucial component of healthcare, ensuring that the highest standards of care are consistently met. In recognition of its importance, the University of Auckland Obstetrics and Gynecology department includes audit as part of its year 6 program.

As a summer student, you will have the opportunity to work with experienced professionals and learn about the importance of quality and clinical audit in healthcare.

You will be involved in identifying key guidelines used in Aotearoa, the current standards that should be being met and compiling a list of relevant audit topics that year 6 students will undertake on their O&G run.

Don’t miss out on this amazing opportunity to gain experience and make a difference in healthcare.

Apply now for our 10-week summer studentship and take the first step towards an exciting career in Obstetrics and Gynecology.

Project

Resource constraints in the Aotearoa New Zealand (AoNZ) public health system led to development of a national prioritisation tool (NPT) which combines clinician-determined and patient-determined scores. The NPT aims to determine whether a hospital should offer surgery for benign disease, including common general surgical conditions. Inequity in health outcomes for Māori occurs across many domains of healthcare delivery in AoNZ. It is possible that the NPT exacerbates health inequity for Māori.

Potential barriers to surgical treatment include access to primary care services, ability to attend a first specialist appointment, minimisation of symptoms on the quality-of-life questionnaire and being unable or unwilling to “game the system” by artificially inflating quality-of-life scores, unconscious bias in a predominantly non-Māori clinical workforce, co-morbidity that decreases the chance of an optimal clinical outcome and employment status (a work-centric view is often taken in estimating benefit from surgical treatment).

The objective of this study is to identify barriers to Māori accessing surgery for benign general surgical conditions thereby exacerbating Māori health inequity. Specific focus will be on impact of the national prioristisation tool.

Project

Clinical trial research requires informed consent from participants, even in situations where significant challenges exist to obtaining that consent.

Research into intrapartum (in labour) interventions are particularly tricky, as there may be limited time for information to be provided and considered, and the additional factors of pain and anxiety impact on the capacity of individuals to consider, reflect, and provide consent. Irrespective of these challenges, for important and relevant research, eligible patients should still be offered the opportunity to participate.

The purpose of this studentship is to describe the different approaches that researchers have taken for obtaining consent in research of intrapartum interventions.

The summer student will be supported to undertake a systematic literature review, summarise and evaluate the timing and processes around informed consent that published clinical trials of intrapartum interventions have described. This information will be useful for planning and conducting future studies that involve intrapartum interventions.

Project

Over one-third of women in our health district deliver their babies via Caesarean section, primarily under neuraxial anaesthesia (spinal or epidural nerve blocks). A recent systematic review showed that many women experience pain during Caesarean section, requiring supplemental analgesia or anaesthesia, with rates of 10% for spinal anaesthesia and 30% for epidural anaesthesia. We do not know this incidence in New Zealand or how it affects vulnerable groups such as Māori or Pacific Islanders.

Aims

This retrospective cohort study aims to determine the incidence of failed and incomplete neuraxial anaesthesia during Caesarean section with the type of nerve block as the primary variable.

Secondary variables include ethnicity (specifically Māori wahine), case acuity, and clinician level of training.

The study involves reviewing anaesthetic records for patients who have undergone Caesarean section under neuraxial blockade, noting supplemental analgesia used, rates of conversion to general anaesthetic, and other qualitative or quantitative documentation. In addition, the student will spend ½ day a week in the operating theatre with the anaesthetic team.

Skills taught during summer studentship

• Data collection
• Data and basic statistical analysis
• Introductory clinical experience.
  

Project

What are lived experiences of Faculty of Medical and Health Sciences LGBTQ+ staff and students, as well as staff and students whose whānau includes LGBTQ+ persons?

The successful applicant will support our research team with a range of tasks that may include literature reviews, research ethics, instrument development (survey and semi-structured interviews), and (potentially) data analysis for a mixed methods project.

Familiarity with both quantitative and qualitative methods and software strongly preferred.

You should be self-directed, intellectually curious, and fun! There may be opportunities to contribute to one (or more) publications.

Project

Background: Prehabilitation (a holistic suite of interventions to prepare patients for surgery) in the cancer care continuum can encompass exercise, nutrition optimization, smoking cessation, and stress reduction. For example, exercise programs are known to mitigate, or even prevent, some short-term and long-term side effects patients experience due to cancer and its treatment. We are in the process of co-designing prehabilitation interventions for people and whanau with breast cancer.

Objective: To co-design prehabilitation program for patients with breast cancer.

Methods: Co-design is an iterative process wherein we assess:

1. Needs and want of patients
2. What is currently known in international literature (review)
3. Co-design sessions with patients, whanau, researchers and health care professionals.

Research impact: The co-designed program will subsequently be pilot tested and ultimately improve prehabilitation care for patients with breast cancer.

Skills learnt during summer studentship

• Teamwork and research coordination skills
• Knowledge on how to undertake a literature review
• Qualitative data analysis with Nvivo
• Oral presentation and scientific writing skills.
  

Project

Obstructive sleep apnoea (OSA) complicates 10-32% of pregnancies. The prevalence of OSA is higher in pregnancies impacted by obesity, and obesity rates differ by ethnicity. OSA increases the likelihood of developing preeclampsia, which can result in significant morbidity and/or mortality. Preeclampsia complicates 4.7% of Māori pregnancies, 3.1% of NZ European pregnancies, and 4.5% of Pacific pregnancies.

The prevalence of OSA during pregnancy in New Zealand is unknown. One study found that around 45% of pregnant people in New Zealand snore, which is a symptom of OSA. Another study found ethnic differences in snoring during pregnancy which were associated with infant outcomes.

Given that OSA is not screened for during pregnancy in New Zealand, it is likely underdiagnosed. If the rates of OSA differ by ethnicity, this may contribute to ethnic differences observed in hypertensive disorders of pregnancy in Aotearoa. Diagnosing and treating OSA may potentially reduce the likelihood of developing preeclampsia and thereby reduce ethnic disparities in this adverse pregnancy outcome.

The student’s role will be to visit clinics and invite pregnant people to complete a questionnaire. The student will be trained to identify people who are high risk to aid referral for sleep testing (and treatment).

Project

Corneal transplantation is the most successful organ transplantation currently available and allows patients with corneal conditions such as keratoconus to regain their eyesight. There have been several reports in the literature of corneal graft rejection secondary to COVID-19 vaccination and we aim to investigate this using our own NZ Eyebank transplant database.

This project involves

• Clinical based data collection of vaccination dates and transplant outcomes
• Working in the Department of Ophthalmology
• Basic Excel skills
• Assistance in the preparation of a research paper.
  

The successful applicant will gain

• Exposure to clinical ophthalmology and the NZ Eyebank
• Opportunity to work under one of New Zealand's leading ophthalmologists Dr Rachael Niederer
• A journal publication and/or the opportunity to present findings at an ophthalmology conference
• Equity based research experience into potential ethnic disparities in corneal graft resource distribution.
  

Project

Familial Exudative Vitreoretinopathy (FEVR) is a genetic eye condition resulting in bilateral abnormal and incomplete vascularization to the periphery of the retina, similar to that observed in very premature babies. This interaction of this abnormally developed peripheral retina and vessels can result in significant leaking, retinal detachment, dragging of the macula, the sweet spot of the retina, with subsequent loss of vision, often in young children. If detected early, particular in at risk families, and monitored and treated early with laser, severe complications and vision loss can be avoided.

Pathogenic variants can occur in 5 known genes, and be inherited in an autosomal recessive, autosomal dominant, and X-linked mode, with a further syndromic form described.

For patients and families with FEVR identified from the New Zealand Database of Inherited Retinal and Optic Nerve Disease, the summer student will review clinical notes to determine age of onset, presenting signs and symptoms, visual acuity, treatments and progression, and also collate imaging (OCT, Optos photos and electrophysiology). In addition, the genetic variants will be collated and degree of pathogenicity determined using online bioinformatics. This work is unique for New Zealand, with novel variants identified, particularly in the Polynesian population, and the impact and spectrum of FEVR-associated disease is not characterised.

Project

Currently more than 13,000 joint replacements are performed in Aotearoa New Zealand every year, predominantly for patients with osteoarthritis (OA). The prevalence of OA is increasing worldwide due to population aging as well as increased prevalence of risk factors, particularly Metabolic Syndrome. This is of particular concern for Aotearoa New Zealand due to our high prevalence of Metabolic Syndrome.

In patients with knee OA where the osteoarthritic lesion is restricted to a single compartment, unicompartmental knee arthroplasty (UKA) may be considered instead of total knee arthroplasty (TKA). UKA is associated with fewer risks and faster recovery time than TKA but the risk of revision is higher. The reasons for the higher UKA failure rate are unknown.

In lab-based studies examining patient tissue following joint arthroplasty, we have found that patients with Type II Diabetes Mellitus (T2DM) show pathological changes in chondrocyte (cartilage cell) activity even in histologically normal cartilage regions. This, coupled with epidemiological evidence that patients with T2DM are more likely to have a faster rate of OA progression, suggests that patients with T2DM may be at higher risk of UKA failure and TKA rather than UKA may be more appropriate in these patients.

This project will involve combining data from the NZ Joint Registry (which contains details of almost all joint replacements performed in Aotearoa New Zealand since 1999) with patient comorbidity data to determine the prevalence of metabolic syndrome pathologies (T2DM, hyperlipidemia etc) in patients presenting for arthroplasty in New Zealand and the rate of UKA failure in patients with T2DM.

Project

We aim to retrospectively audit electronic case notes for adult patients who presented to Auckland City Hospital between November 2020 and October 2023 with suspected community acquired CNS infection.

The student will extend the audit previously conducted by a summer student Miriam George during 2020-2021. In the initial audit, for the period October 2017 to October 2020, Miriam identified 147 patient presentations. Her findings included: mean time to collection of blood cultures (n=112 patients) = 53 minutes; mean time to head CT scan (n=98) = 2 hours, 50 minutes; mean time to first appropriate antibiotic treatment (n= 92) = 4 hours, 8 minute; and mean time to LP (n= 135) = 5 hours, 40 minutes. These findings showed that many patients had long delays before lumbar puncture and start of appropriate treatment. Furthermore less than 50% of patients were treated with an initial empiric antibiotic treatment that complied with guidelines.

We wish to extend the duration of the data collection to determine whether implementation, in late 2020, of a new protocol for management of adult patients with suspected community-acquired CNS infections has had a significant impact on the rate of guideline adherence.

Project

Germ cell tumours are the most common malignancy affecting adolescent and young adult males in Western countries. Although most patients with good prognostic features have excellent outcomes, the international cure rates for male patients with advanced disease and intermediate or poor prognostic features are only 79 and 48% respectively.

We aim to conduct a retrospective audit of outcomes for men with germ cell tumours (all stages of disease) under the care of the Te Toka Tumai Auckland medical oncology regional service since 2008. This will be the first retrospective audit of outcomes for men with germ cell tumours from Auckland, and will evaluate stage of disease at presentation, ethnicity, treatment received and outcomes including survival.

Project

Aim: The general aim of the research group is to explore the cost-effectiveness of mindfulness-based intervention approaches in relation to its efficacy in promoting wellbeing amongst medical students.

Methods: The successful applicant would be asked to employ a scoping review method to search for relevant literature and screen reference lists guided by established exclusion criteria. The student will then compile an annotated bibliography.

It is anticipated that the student will be a co-author in submitting this review to a peer reviewed journal. The review process will be audited by all researchers (i.e., A/P Marcus Henning, the summer student, A/P Frederick Sundram, Drs Lillian Ng, Mataroria Lyndon and Yan Chen).

Significance to Health

Medical students encounter heavy workloads and stressful learning experiences. These encounters can have a detrimental impact on their quality of life and ultimately on their wellness. Systems of ameliorating stress such as mindfulness-based intervention approaches have been shown to have a positive impact on student wellbeing.

Creating a comprehensive review of literature pertaining to the cost-effectiveness of mindfulness-based intervention approaches for medical students will enable researchers to better inform medical students, their student support systems, and create innovative ideas for further research in this area.

Project

In New Zealand, 1 in 8 adults are re-admitted to hospital. Each re-admission places significant strain on the patient, their whānau and the healthcare system. Yet some re-admissions are preventable. Re-admissions can be prevented by identifying who is at risk of re-admission and why. This information can be used to prioritise patients and help develop a risk prediction model to estimate how likely someone is to experience a re-admission. However, most re-admission risk prediction models use routinely collected data and do not consider modifiable risk factors such as patients’ health beliefs. Exploring the beliefs patients hold about their illness and medication could improve our understanding of re-admissions.

This summer research project will explore the health beliefs of patients after hospital discharge from Te Toka Tumai Auckland using a short questionnaire.'

This project aims to:

• Identify the illness and treatment beliefs patients hold after discharge
• Explore the differences in illness and treatment beliefs for those who were re-admitted and those who were not.

You will have the chance to work in a passionate and supportive research team, experience real world data collection and analysis.

You will develop key verbal, written and research skills and skills in participant recruitment, data collection, data cleaning and analysis.

Project

Heart failure (HF) is a common condition, which is associated with poor quality of life, frequent hospitalisations, and high mortality. Considerable advances have occurred in the treatment for patients with HF, particularly for those with reduced ejection fraction (HFrEF) for whom 4 classes of medications now form the foundation of therapeutics. Long-term adherence to medical therapy can be challenging for patients with long-term conditions and can adversely affect clinical outcomes.

This project aims to:

• Assess long term HF medication possession in a cohort of patients with HFrEF
• Assess quality of care indicators in this cohort
• Assess the changes in LVEF associated with therapy.

The summer student will integrate HF medication possession at 3 and 6 months following an exacerbation of HF by extracting data from the clinical record. The patients will be those who are managed through the Heart Function Team at Te Toka Tumai Auckland Hospital. This will provide opportunity to work with the Heart Function team to gain experience of the pathway of care for patients with HF, and to work with the research team at the University on work relating to quality of care improvement for patients with HF.

The student will gain experience finding relevant data from the clinical record and will learn data management skills, quantitative data analytical skills (including the opportunity to learn the statistical programme “R”), and verbal and presentation skills. Basic experience with Excel will be an advantage.

Project

The aim of this research is to identify healthcare needs and characteristics of 100 women under the care of specialist community mental health services.

Methods: In this ethics approved study, a randomised sample of women who have presented to community mental health services within a one-year timeframe (2022-2023) will be drawn from the five Te Whatu Ora Counties Manukau community mental health clinics. We will collect information on demographics, psychiatric, medical, social and substance use history, role in parenting role, family violence and health resource utilisation.

Analysis: The summer student will be involved in data collection and writing an annotated bibliography for an already conducted scoping review of literature on interventions to support maternal-infant attachment.

Significance to health: The findings from this study will capture important information about the health status of a diverse sample of 100 women accessing community mental health services at Te Whatu Ora Counties Manukau. The analysis will assist with understanding concerns for women and formulate key questions for future research.

There is no pre-requisite knowledge required.

Project

Objective: The primary aim of this project is to systematically analyze and review existing research concerning the application of eye tracking technologies for the detection or study of mood disorders, including anxiety, depression, and burnout.

Outlined goal: Completion of a systematic review of existing literature.

Student Learning Outcomes: Students involved in this project will learn valuable skills, such as:

• Navigating and conducting searches on research databases and reviewing both mainstream and grey literature
• Evaluating and critically analyzing academic literature
• Writing comprehensive and clear reports
• Potentially drafting a research article suitable for peer-review and subsequent publication.

Research techniques: This review will rely on various research techniques, including systematic searches of library catalogs and key academic databases. These databases, such as Google Scholar, Scopus, PubMed, and Medline, serve as repositories for a wide range of materials, including scholarly articles, conference papers, reports, and dissertations. These resources will provide a rich source of information for our review.

Project

Diabetes is the most common pregnancy complication, affecting approximately 1 in 7 pregnancies. There is a dose-dependent relationship between poor maternal and fetal outcomes and the degree of hyperglycemia.

People who experience higher levels of social need/stress are more likely to develop diabetes in pregnancy, even after adjusting for other factors. Stress is associated with release of counter-regulatory hormones (glucocorticoids and catecholamines) which result in increased glucose levels.

We hypothesise that increased levels of stress in pregnancy may negatively impact glycemic control, and contribute to worse pregnancy outcomes.

The cost of living is rising, there are high rates of food and housing insecurity. People diagnosed with diabetes in pregnancy have a higher burden of healthcare related costs (relating to additional healthcare visits, medications, and investigations) compared to people without diabetes. However, we have no data on how common higher social needs/social stressors are amongst pregnant people with diabetes and how this might influence their glycemic management and pregnancy outcomes.

The student will help conduct a survey of social needs amongst people with diabetes in pregnancy. We will calculate the prevalence of social needs in different domains, and determine the association between these and pregnancy outcomes.

Project

The absence of explicit teaching about disability from a human rights framework is a well-documented, international concern regarding medical education curricula. This problem converges with longstanding inequitable health outcomes for disabled people.

There have been numerous calls to incorporate disability curricula into medical education as well as documented curriculum initiatives. Yet, the theoretical position(s) from which this work emerges have not been critically examined.

We are conducting an international critical literature review to better understand the positioning of existing work and what remains untouched by these efforts. We anticipate using theory from disability studies (ontological erasure) and philosophy (epistemic injustice) to make sense of the literature.

This project aims to create a critical literature review of medical education disability curricula by:

• Critically evaluating the disability curriculum literature in medical education
• Identifying the philosophical underpinnings of disability curricula and associated calls-to-action
• Interpreting the impact of current educational approaches and remaining absences

The successful applicant will assist the researchers to search the literature for relevant publications, extract information from these papers, and critically interpret findings. Depending on interest and contribution to writing, the summer scholar could be a named author on a publication resulting from the literature review.

Project

Premature babies have incomplete retinal vascularisation at birth. For some the retina never fully vascularises. These areas of peripheral avascular retina may increase the chance of detachment in teenage/young adult years but the evidence is limited.

This project aims to investigate risk factors for detachment in patients under 30 in Auckland specifically focusing on a history of retinopathy of prematurity. Data will be derived from clinical records, surgical notes and retinal imaging. More than 40% of babies undergoing ROP screening in Auckland are Māori/Pasifika and this project will also analyse detachment by ethnicity.

There will be opportunity for presentation/publication from this work.

Project

Respiratory related illness in cerebral palsy (CP) is the most common cause of mortality, morbidity and poor quality of life, especially in more severely affected individuals.

Recent data from a NZ Cerebral Palsy Register (NZCPR) project has highlighted an inequity for whaikaha Māori tamariki in respiratory hospitalisations and increased antibiotic prescription. The pathway to respiratory disease in tamariki with CP is complex and multifactorial, but one potentially modifiable risk factor is improved oral health.

Poor oral health for the general population of tamariki in Aotearoa NZ has been well documented, but there is a lack of data for those with disability. For people with CP their oral health may be impacted by not only the physical condition (eg. Restrictions in opening their mouth for brushing; lack of independent arm function) but also by medication side effects, eg. excessive saliva and drooling.

The aim of this project is to complete a pilot data linkage between Te Whatu Ora oral health datasets (Titanium); Medical Records and the NZCPR to document the prevalence for Māori and non-Māori tamariki on key oral health indicators (plaque, caries, extractions) in relation to CP functional classification tools.

Project

Days Alive Out of Hospital at 90 Days (DAOH90) is a patient-centred outcome measure, used increasingly in studies of critical illness. It is a composite measure including hospital length of stay, mortality, and re-admission to hospital within 90 days of the index event.

A recent audit found a large difference in DAOH90 for Māori compared to non-Māori with sepsis in our hospital, but this finding was uncertain due to a small sample size.

We plan to determine the distribution of DAOH90 for severe sepsis patents and whether DAOH90 after sepsis differs for different ethnicities matched for key demographic and disease related variables, with a focus on outcomes for Māori, using an appropriate sample size.

This retrospective research will also inform the sample size calculation for a planned study of sepsis outcomes nested within an international multicentre sepsis RCT which is currently underway.

The student will gain skills in research methodology, good clinical research practice, clinical notes review and data extraction.

Based in the Emergency Department of Te Toka Tumai Auckland City Hospital, they will learn about recognition and management of severe sepsis and will work alongside clinical researchers in the ED screening and recruiting participants for a major sepsis RCT.

Project

Project aims: Each year since 2012, the Medical School Outcomes Database and Longitudinal Tracking (MSOD) project has collected demographic and career intention data from University of Auckland (UoA) and University of Otago (UoO) MBChB students at entry and exit to their programme in addition to follow-up surveys in the postgraduate years. As a part of the MSOD project, we can link these data to the Ministry of Health and Medical Council information regarding career outcomes in terms of specialty and location of practice. Since 2020, qualitative questions have been included to collect data on the impact of the Covid-19 pandemic on medical graduates specialty and location of practice intentions.

This study aims to:

1. Describe the current literature on the impact of the Covid-19 pandemic on medical graduates education and career intentions
2. Use the New Zealand MSOD data to describe the impact of the Covid-19 pandemic on medical graduate career intentions.

Skills taught during summer studentship

• Data processing and exploration techniques for large datasets: Anonymised data will be processed to relate career intentions and medical school experiences to career outcomes and identify key predictors
• Statistics: Summary statistics, non-parametric and parametric comparisons, regression analysis
• Data visualisation: Data visualization techniques to illustrate associations
• Writing for publication: The student is expected to contribute significantly to a research paper
  

Expected research impact: Analysis of national student exit and postgraduate data identifying:

• Career specialty intentions
• Career speciality training/outcomes
• Career location of practice intentions.

Project

Emergency department (ED) overcrowding is a significant healthcare challenge that has far-reaching implications for patient safety and quality of care. Leaving without being seen is one of the concerning issues that arise due to overcrowding.

The objective of this summer study is to describe the characteristic of patients who leave an ED without being seen by a physician, explore potential risk factors for their leave, and shed light on this phenomenon in New Zealand.

A range of routinely collected data for patient care had been collected by the hospital system, including both structured and unstructured information (free text). The student is expected to undertake a literature review on associated factors of leaving without being seen, and explore a retrospective ED presentation cohort in WDHB hospitals. This research is part of a post-doc study. 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.
  

Project

The Emergency Department Information System plays a crucial role in facilitating the workflow of emergency departments (EDs). It is essential to provide a comprehensive description of the various information systems and the services they offer across the country to identify the strengths and weaknesses of these systems.

The primary objective of this summer study is to thoroughly describe and evaluate the information systems utilized by EDs across New Zealand.

The aim is to identify the strengths and weaknesses of these systems and ultimately enhance their quality. During 2022, a variety of key characteristics pertaining to different ED systems were gathered.

The student undertaking this study will be expected to conduct a literature review on the ED Information Systems and make comparisons with the ED systems in New Zealand. If there is additional time available, we would also like to explore the ED "workload", which includes identifying the most prevalent Chief Presenting Complaints, commonly diagnosed conditions, frequently performed procedures, admission rates, length of stay etc.

This project offers the opportunity for co-authorship in a future publication.

Skills

• Literature review/critical appraisal
• Data cleaning, descriptive statistic analysis, and interpretation
• Academic writing/Manuscript preparation.
  

Project

Resting-state fMRI is a relatively new MRI technique that can measure spontaneous neural connectivity across different brain regions. The patterns of connectivity are known to change in disease states, including acute and chronic stress. This is one of the methods we are using to assess recovery.

This project would involve researching the literature on an aspect of current methods for assessing recovery from either PTSD or meth addiction and data processing.

The successful applicant is someone who is interested in MR imaging, and likes the idea of data analysis. The student may also have the opportunity to become involved in imaging itself.

Skills to have or learn

• How to perform a literature review
• Data analysis.
  

Project

Neuroendocrine neoplasms (NEN) are cancers that often express somatostatin receptors. Peptide receptor radionuclide therapy (PRRT) is a treatment for metastatic NEN which takes advantage of receptor expression by delivering a radioactive particle bound to a somatostatin analogue to the tumour. PRRT is provided through a national service based at Auckland City Hospital. The treatment is typically given as four cycles 2-3 months apart. Blood tests are performed regularly between cycles to monitor for renal and bone marrow toxicity. Optimising when surveillance tests should be performed and on whom will improve the patient's experience during treatment.

This project will involve

• Collating blood tests preformed pre- and post each PRRT cycle
• Analysing whether an abnormality or change from baseline was detected
• For those in whom an abnormality is detected, identifying whether there are predictors that can identify patients who need closer monitoring
• Identifying blood tests that can be excluded from the monitoring program

The project offers the opportunity to skills in data collection and analysis, and exposure to nuclear medicine therapies, not usually available to medical students.

Outcomes of the project will be used to change care.

Project

Neuroendocrine tumours are a heterogenous group of cancers, arising in a variety of organs and have the potential to metastasize. Bone metastases have been reported to occur in around 20% of those with metastatic disease. Bone metastases cause pain, and have the potential to cause major morbidity, such as spinal cord compression and pathological fracture. The national Neuroendocrine Tumour multidisciplinary meeting (NETMDM) receives referrals from throughout Aotearoa and makes recommendations for management.

Aim

• Report on the frequency of bone metastases in patients referred to the NETMDM
• Report on whether any bone directed therapy was recommended in the NETMDM
• Report on the outcomes from bone directed and systemic therapy (response and complications).

This study will involve identifying patients with skeletal metastases from past NETMDM records, and reviewing the NETMDM outcome, including patient demographics, and whether the NETMDM made a recommendation for bone directed treatment. Prescribing records will be used to identify those who were prescribed bisphosphonates. Relevant outcome data on the response of bone directed therapy and systemic therapy on bone metastases will be collected from patient records. This data will be used for planning future studies for patients with bone metastases.

Project

Neuroendocrine neoplasms (NEN) are a unique type of cancer. While they can have an indolent course, at the time of diagnosis around half of patients will have metastatic disease, and around 20% will have bone metastases. Some patients with NEN live for years with bone metastases that cause symptoms and significantly impact quality of life. Bone modifying therapies are established in the management of metastatic breast and prostate cancer. The efficacy of bone modifying treatments in NEN has not been investigated to the same degree due to the rarity of NEN, and bone modifying therapy is not part of standard treatment.

Key questions include

• Is bone modifying therapy is an effective treatment for metastatic NEN to bone?
• What is the optimal treatment regimen to avoid serious side-effects such as osteonecrosis of the jaw?

This systematic review will gather and evaluate the evidence for bone modifying therapy in NEN. Performing a systematic review is a valuable experience for any student. Critically appraising literature is a difficult skill, but essential for all clinicians to develop.

Project

The Raise the Flag sepsis program at Waikato and Waitaha Canterbury regional emergency departments has shown that change can be made in resuscitation endpoints for people presenting with infection and high risk clinical features in keeping with sepsis. A large cohort of patients with haemodynamic instability, a subset of patients with high risk sepsis, has been identified and studied in detail.

This project will allow a student with an interest in use of statistical packages to conduct regression analysis to determine the impact of individual resuscitation exposures to important outcomes, including mortality.

This research will allow the student to provide important insight into a major cause of morbidity amongst New Zealanders, particularly tangata whenua.

The project is a first for New Zealand and will lead to a publishable report based on other original work being conducted by the supervisor team.

Project

Keratoconus is a disease that alters the shape of the front layer of the eye, the cornea, and can lead to loss of vision, including legal blindness.

Aotearoa has one of the highest prevalence rates of keratoconus worldwide. This condition typically develops in late childhood during the teenage years, and can go undetected until there is advanced loss of vision, particularly among individuals who are less likely to seek medical care.

If keratoconus is detected at an early stage, there is a treatment that can prevent the progression of the disease to more advanced stages and reduce or eliminate the loss of vision. Therefore, detection of this disease at an early stage is paramount to reducing visual loss from this condition.

This is a clinical project that will involve performing screenings for keratoconus in clinical and community settings.

The student will learn how to perform and interpret testing and gain experience interacting with patients.

Skills to be developed include: data collection, data management, data interpretation, responsiveness to Māori, and scientific writing.

Project

Acute aortic dissection (AAD) is a life-threatening condition that if not diagnosed and managed promptly, can be associated with high mortality and morbidity. Previous work from our unit revealed that NZ Māori in the Te Manawa Taki region had 3-4 times the incidence of AAD compared to non-Māori.

While there are some known and common predictors of AAD such as genetic predisposition and hypertension, the majority of AAD occurs spontaneously and therefore the natural history of patients prior to major aortic events are limited.

A complete national registry comprising some 1,500 patient-level data from 2010-2021 has been developed and linked to relevant national datasets. The aim of this exploratory study is to determine preoperative factors and cross-sectional medical imaging features of patients prior to presenting AAD.

The research impact and responsiveness to Māori: We believe that a substantial proportion of patients have risk factors that are not identified and therefore not addressed. Exploring these factors in this population and setting up mechanisms are initial steps to reduce the disparities and inequalities in cardiovascular disease burden and patient outcomes in this group.

The project can be completed in 10 weeks and the student will be supported with radiological measuring techniques and statistics.

Become Manaaki Manawa student researcher!

Our Manaaki Manawa summer research scholars will have the opportunity to become a part of the Manaaki Manawa Centre for Heart Research. Manaaki Manawa will provide:

• A welcome event for our summer scholars so that you have a chance to meet each other, learn about the Centre’s work, have some kai and meet the Centre team, including our Pou Tikanga.
• A celebration at the end of the scholarships with students doing presentations or posters about their research
• Continued connection with Manaaki Manawa after your project ends, with opportunities to continue with some research if you are interested, with support from our team and researchers, and to participate in Manaaki Manawa events throughout the year.

There are also two Manaaki Manawa scholarships open to Māori, Pacific or women students, that have a $2,000 supplement in addition to the standard scholarship.

Project

Iron deficiency (ID), with or without anaemia, is a prevalent condition in over half of all heart failure (HF) patients. ID is associated with advanced symptoms, reduced quality of life, poorer clinical outcomes, and implications for the progression of HF. International HF guidelines strongly recommend routine screening of iron studies and anaemia in all HF patients and treatment with intravenous iron, regardless of the presence of anaemia. However, primary care practices in NZ limit IV iron therapy to only anaemic HF patients. To improve the management of ID in HF patients, it is crucial to understand local testing practices, patterns, and outcomes.

The primary objective of this summer studentship project is to retrospectively audit patient data to investigate the frequency of ID and anaemia testing in HF patients within our local healthcare setting.

The student will collaborate with the research team to ensure comprehensive data collection and analysis. Access to patient records and relevant databases will be provided, and necessary training on data collection and analysis techniques.

A meticulous approach to data collection, critical thinking, and effective communication are essential. While knowledge of heart failure and iron deficiency is not mandatory, a basic understanding of these conditions will be beneficial.

Project

Healthy tear film function is required for un-interrupted clear vision. Non-invasive measurement of the tear film break-up time is one of the critical components of tear film health assessment. Typically, this is measured with the help of rather expensive diagnostic equipment. Although accurate and efficient, these non-portable devices, may not always be practical for screening purposes.

Recently, a smaller smartphone aided clip-on device called the Smart phone based Placido Disk Attachment (SPDA, by Barodawala et al.) was developed using 3D Printing as a potentially more accessible alternative for screening purposes.

This project is intended to evaluate the diagnostic accuracy of the novel clip-on device and compare it with a routinely used clinical equipment, Keratograph 5M (Oculus, Germany) in healthy, non-contact lens wearing participants, in a randomised order.

The outcome of this study has potential to be published in peer reviewed scientific journal and will inform further investigation to assess the sensitivity and specificity of the novel, portable, tool against more established methods.

Skills

The student will gain experience in patient interaction, history taking, external eye examination, data processing, and basic statistical analysis.

Project

Paediatric neuro-ophthalmology conditions include demyelinating optic neuropathies, optic nerve gliomas (often with neurofibromatosis type 1), optic atrophy, and glaucoma. In addition, a number of neurological conditions including perinatal stroke cause visual field defects.

In adults, visual field testing (perimetry) gives valuable information on field loss. But it is difficult to get reliable visual fields in children. A recently funded perimetry machine (Octopus) has programmable options that should enable child-friendly perimetry to monitor progression and help understand visual field loss and need for support.

This project within the Greenlane Eye Clinic will investigate the reproducibility, accuracy and time taken for visuals fields in children. It is expected to provide clinically useful protocols for our patients to enable improved care.

There will be opportunity for presentation and publication.

Project

Māori and Pacific Island populations are disproportionately burdened with liver disease in New Zealand, this is multifactorial due to a higher burden of specific diseases such as Hepatitis B as well as higher rates of socioeconomic deprivation in addition to cultural barriers to accessing care.

The New Zealand Liver Transplant Unit has been fortunate to have recently employed a dedicated Māori Nurse Specialist to look at ways to address these inequities. However this project is designed to highlight the issues / need in this population for targeting future interventions.

This project will involve collation, analysis and write up of data from the New Zealand Liver Transplant unit. The first few weeks will involve data collation on information around liver disease, treatment and outcomes.

The successful candidate will need to be familiar with excel and be able to create and manage spreadsheets. There will be a significant statistical analysis component using excel and statistical software. Experience would be beneficial but not essential, this could be learnt on the project.

After statistical analysis, findings and potential implications for Pasifika patients will be presented to the New Zealand Liver Transplant Unit with the opportunity for mulitdisciplinary input into addressing any issues identified.

Once analysis and local discussion has been undertaken it would be expected that one or more papers be written for publication / presentation.

This would be a good opportunity for anyone with an interest in Māori / Pacific Health, Medicine, Hepatology, Transplantation or Surgery to gain experience in clinical research and add formal presentations / publications to their CV. The New Zealand Liver Transplant Unit has a strong reputation for high quality research and clinical service. Any student will be well supported during their time.

Project

The cornea is clear front tissue of the eye and is critical to vision as it both allows light to enter the eye and focuses it. Corneal diseases such as keratoconus result in the loss of function of the cornea as they alter the shape and clarity of the tissue. Corneal transplantation from human donors is a life changing operation and restores vision to patients who suffer from corneal diseases. However, being a solid tissue transplant and the cornea being an immune privileged site means that the immune system can attack the tissue known as graft rejection. This can result in a loss of tissue clarity and thus function.

This study will consist of a retrospective review of all the corneal transplantations performed in Auckland in the last 5 years to determine whether one or more rejection events results in poorer visual outcomes. As a rejection event can reduce the clarity of the cornea it is hypothesised the rejection events may reduce visual outcomes compared to transplants that do not experience a rejection event.

Project

Project aims: Each year since 2012, the Medical School Outcomes Database and Longitudinal Tracking (MSOD) project has collected demographic and career intention data from University of Auckland (UoA) MBChB students at entry and exit to their programme in addition to follow-up surveys in the postgraduate years. As a part of the MSOD project, we can link these data to Ministry of Health information regarding career outcomes in terms of specialty. This study aims to:

1. Describe how prepared for practice and satisfied with their medical training NZ medical graduates at the end of medical school and into their post-graduate years
2. Describe the patterns in the key factors that influence medical graduates preparedness for practice, including person-specific factors vs contextual factors.

Skills taught during summer studentship:

• Data processing and exploration techniques for large datasets: Anonymised data will be processed to relate career intentions and medical school experiences to career outcomes and identify key predictors
• Statistics: Summary statistics, non-parametric and parametric comparisons, regression analysis
• Data visualisation: Data visualization techniques to illustrate associations.
• Writing for publication: The student is expected to contribute significantly to a research paper.

Expected research impact: Analysis of UoA student exit, PGY3 and Ministry of Health data identifying:

• Preparedness for practice at student exit, PGY3 and PGY5
• Medical student satisfaction with their medical training at exit
• Career specialty intentions
• Career speciality training/outcomes.
  

Project

Project aims: Each year since 2012, the Medical School Outcomes Database and Longitudinal Tracking (MSOD) project has collected demographic and career intention data from University of Auckland (UoA) MBChB students at entry and exit to their programme in addition to follow-up surveys in the postgraduate years. At PGY1 and beyond, the response rate to these surveys declines significantly. It is very important that the samples collected from these surveys are representative of the overall population of MBChB graduates. This study aims to:

1. Describe the characteristics of consenting participants in the project who did not respond to the MSOD at the PGY3 and PGY5 survey points but for whom we have other available information
2. Describe the patterns in the key factors that influence non-response
3. Determine the extent that the information available from other sources fills key gaps in responses.

Skills taught during summer studentship:

• Data processing and exploration techniques for large datasets: Anonymised data will be processed to relate demographics, career intentions and medical school experiences to likelihood of subsequent survey participation and identify key predictors
• Statistics: Summary statistics, non-parametric and parametric comparisons, regression analysis
• Data visualisation: Data visualization techniques to illustrate associations.
• Writing for publication: The student is expected to contribute significantly to a research paper.

Expected research impact:

Analysis to build a picture of who is not being represented by the MSOD postgraduate survey data – as these groups may be overlooked when MSOD data is used to inform workforce planning.

Analysis of MSOD participants who do not respond to a PGY3 / PGY5 survey, identifying:

• Whether an annual practicing certificate is held at time of non-response
• Practice location at PGY3 / PGY5
• Career intentions at medical school
• Career specialty intentions
• Early postgraduate placements
• Satisfaction with medical education / training.
  

Project

Project aims: Each year since 2012, the Medical School Outcomes Database and Longitudinal Tracking (MSOD) project has collected demographic and career intention data from University of Auckland (UoA) MBChB students at entry and exit to their programme in addition to follow-up surveys in the postgraduate years. As a part of the MSOD project, we can link these data to Ministry of Health information regarding career outcomes in terms of location of practice and specialty. This study aims to:

1. Relate the career intentions of UoA medical graduates at the end of medical school to their early postgraduate practice outcomes
2. Describe the patterns in the key factors that influence UoA medical graduate career choices.

Skills taught during summer studentship

• Data processing and exploration techniques for large datasets: Anonymised data will be processed to relate career intentions and medical school experiences to career outcomes and identify key predictors
• Statistics: Summary statistics, non-parametric and parametric comparisons, regression analysis
• Data visualisation: Data visualization techniques to illustrate associations between categorical variables and geographical distributions.
• Writing for publication: The student is expected to contribute significantly to a research paper

Expected research impact

First analysis of UoA student exit, PGY3 and Ministry of Health data identifying:

• Practice location at PGY3
• Career intentions at medical school
• Placements during the final years of medical school
• Career specialty intentions
• Early postgraduate placements.

This analysis can be used to better understand the predictors of rural career outcomes to inform wider areas of workforce planning.

Project

The student will assist with an evaluation of our group’s Cochrane reviews in Gynaecology and Fertility with a plan to list them in the order of importance.

Tasks will include assessing the number of times each review was downloaded and cited, as well as surveying stakeholders as to the importance of the various topics covered by the reviews.

The student will have an opportunity to learn about Cochrane reviews, and about evidence in the area of gynaecology and obstetrics.

Cochrane reviews are internationally recognised as the highest standard in evidence-based health and our reviews assist policy makers, clinicians and patients to make fully informed decisions regarding medical decisions.

The aim of the project is to produce a scientific publication reporting this work.

Skills gained would include familiarity with the format and content of Cochrane reviews, data collection using Excel, and understanding of the measures used to score the impact of reviews beyond direct citations and usage data.

Project

Cerebral palsy (CP) is a life-long, predominantly physical condition, with potential associated conditions impacting speech, vision and communication. In Aotearoa New Zealand little is known about the communication methods for people living with CP, and in particular the impact for whaikaha Māori.

A 2022 in-house survey from the Cerebral Palsy Society of NZ (CPS) highlighted communication as one of the top 3 challenges for people living with CP. The aim of this project is to describe the everyday communication performance and methods for people with lived experience of CP, with an equity lens and enhance the NZ Cerebral Palsy Registry dataset to enable future advocacy.

Research activities include:

• Analysis of NZ Cerebral Palsy Register Speech and Communication existing child and adult dataset
• Targeted survey of people living with CP, covering demographics; clinical CP related classifications, including the Communication Functional Classification System (CFCS); assessment of communication needs and augmentative and alternative communication (AAC) usage, barriers, and facilitators. Descriptive analysis of communication ability and relationship between CP Functional Classification tools and Communication, with thematic analysis of free text section.
  

Project

There is renewed interest in the clinical use of psychedelic-assisted therapies in terminal illness. Due to their legal status, psychedelics are not available for use in Australia and New Zealand, but this is about to change. Understanding clinicians’ attitudes toward these medicines will inform debate and help to identify education needs for doctors in training.

In this AHREC-approved study, Australasian palliative care doctors will be invited to complete an online survey of opinions regarding psychedelic medicines. Those completing the survey can also opt to participate in a qualitative interview over Zoom. This study is being undertaken by two Waikato-based psychiatry registrars supervised by a University of Auckland academic psychiatrist.

The student will be supported to assist in data collection, analysis and interpretation of results.

Our aim is to publish the findings in a peer-reviewed journal; if substantial, the student's input will be recognised with co-authorship.

Relevant skills (prior experience preferred)

• Data management using Excel and SPSS
• Basic descriptive statistics and hypothesis testing
• Qualitative data analysis using NVivo
• Academic writing/manuscript preparation.
  

Project

Post-pancreatitis diabetes mellitus is an exemplar secondary diabetes. It develops following an attack of pancreatitis – the most common disease of the exocrine pancreas. There has been a fundamental shift in our understanding of the pathogenesis of post-pancreatitis diabetes mellitus over the past quinquennium.

The overall aim of this project is to provide deeper insights in relation to the metabolic pathways underlying PPDM.

The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience.

Skills taught during summer studentship

• Working in a clinical research team environment
• Extraction of clinical, diabetes-related data from a database
• Laboratory bench work
• Preparation of a manuscript for publication in an international peer-reviewed journal.
  

Project

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, 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 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 during summer studentship

• Working in a clinical research team environment
• Magnetic resonance image analysis
• Preparation of a manuscript for publication in international peer-reviewed journal.
  

Project

Persistent pain is associated with adverse consequences including depression and reduced quality of life and pain is increasingly prevalent with age. Identifying the physical, psychological and social risk factors associated with changes in pain may help improve pain management in older adults.

Our research group has undertaken a large study of the health, functional and psychosocial needs of ~570 older adults residing in retirement villages over recent years. In our cross-sectional baseline analysis we found pain was common, with 47% reporting daily pain.

For this study we wish to analyse the pain data recorded in the second assessment to address the following aims:

1. Compare the prevalence of pain at two points of time
2. Explore factors associated with change in reported pain
3. Assess the relationship between pain change and resilience and quality of life.

Previous summer students within our team have had high rates of progressing research to publication.

Skills gained during summer studentship

• Literature review/critical appraisal
• Quantitative research methods including working with databases, data cleaning, descriptive statistical analysis and presentation
• Academic writing/manuscript preparation.

This would suit those with

• Good communication skills and ability to work within a team
• The ability to undertake some self-directed work.
  

Project

Retirement village (RVs) are attractive to some older people due to purpose-built facilities, frequently with social, lifestyle opportunities and a secure environment. The perceived provision of additional health and long-term care is often a factor in relocating to RVs for many older people.

We have been studying health, psychosocial function and frailty among older adults residing in RVs, with detailed data collection completed. Frailty describes a state of increased vulnerability to adverse health outcomes, such as hospital admissions, and can be objectively measured.

The aims of this study are to investigate how satisfied older adults living with frailty are with various aspects of RV-living compared to those who are not frail. This information could be used to inform older people making housing decisions and the RV industry itself in terms of meeting expectations of older people.

Previous students within our team have had high rates progressing their research to publication.

Skills gained during summer studentship

• Literature review/critical appraisal
• Quantitative research methods including working with large databases, data cleaning, descriptive statistical analysis and presentation
• Academic writing/manuscript preparation.

This would suit those with

• Good communication skills and ability to work within a team
• The ability to undertake some self-directed work.
  

Project

Every day one patient loses their leg due to peripheral artery disease or diabetes in Aotearoa New Zealand. Previous research has highlighted that Māori and Pacific communities, people living in rural areas and those residing in higher deprived locations are independently associated with higher rates major lower limb amputation.

Current non-invasive arterial assessment of lower limbs includes palpation of pulses, ankle pressures and toe pressures. However, for patients with diabetes and renal disease these assessments are often inaccurate, hence research into newer techniques is necessary to improve diagnosis.

In our unit, we have been validating foot perfusion methods in the last 3 years to complement existing standard methods and to predict foot wound healing.

The aim of this study is to validate foot perfusion tests being performed at our vascular laboratory and correlate the findings with clinical patient outcomes.

Research impact and responsiveness to Māori: This research has a focus on improving the health equity for Māori patients and will ensure Māori are well represented in the study. This representation will ensure that the early perfusion screening tools are accurate in Māori patients with high-risk foot disease, and thus when used early can help prevent amputation and improve equity.

Project

Aims: For coronary artery bypass grafting surgery, certain surgeons will use sequential grafts where the one conduit (e.g. saphenous vein) is used to bypass blockages in multiple coronary arteries. It is hypothesised that sequential grafts carry more blood flow so are more likely to remain patent in the long term. Other surgeons prefer to use separate bypass grafts as they are concerned that sequential grafts may lead to steal of blood flow particularly if one blockage is significantly greater than another blockage.

In this study, we aim to compare the clinical results between sequential and separate bypass grafting arrangements.

This retrospective cohort study will examine more than 5 years follow-up with clinical outcome measures including death, myocardial infarction, cerebral events, need for repeat revascularization and need for repeat coronary angiography. Within the sequential grafting group, comparisons will be made between operations where the surgeon has respected the notion that the most distal coronary target grafted should have the tightest stenosis versus where this has not been followed.

Skills

Ability to collect retrospective data from patient records and analyse with the help of a statistician.

At the conclusion of the research project, with the aid of supervisors, the ability to write a manuscript for peer-review publication and ability to deliver an oral presentation at a local or international conference.

Project

With 7,000 births and around 700 early pregnancy losses per year, Waitematā’s Early Pregnancy Clinic is dedicated to providing the highest levels of empathy and kindness to individuals and their whānau during this distressing time. Despite the growing number of referrals, our medical and nursing staff strive to ensure patient satisfaction.

Join us in our patient journey audit and analysis to improve decision-making and processes, and help us continue to provide exceptional care.

The successful applicant will have the opportunity to work along clinical nurses and doctors who work in this clinic.

You will also be able to compare how other clinic around the country run their clinics. With a large geographic catchment and widely diverse ethnic population, equity and paitent satisfaction is paramount. We look forward to having you on our team.

Project

The human intestine contains a huge range of bacterial species, which collectively are called the microbiome. The gut microbiome is important to many areas of health, including digestion, gut and general health, control of inflammation, immunity, hormone regulation and brain function. People use probiotics to improve gut health by altering the bacteria in the microbiome.

Recent research studies show that the gut microbiome can affect how well some cancer treatments work, especially the ones targeting tumours through the immune system, and can reduce some side effects. Exciting small clinical trials found that transferring samples of the gut microbiome from donors to cancer patients changed their gut microbiome and improved outcomes from specific treatments. The samples of gut microbiome came from the faeces of healthy people or cancer patients.

This project will use questionnaires to ask cancer patients having treatment with chemotherapy, immunotherapy or radiation about their thoughts and feelings if they were offered gut microbiome transfer as part of their treatment, or if they were asked to be gut microbiome donors for other patients.

This project is based in Hamilton at Waikato Hospital.

Project

Background: Approximately 2,600 adults receive cardiac surgery operations in New Zealand annually (1). Of those patients on average approximately 800 of those patients require a heart valve replacement surgery (1).

Once a patient requires cardiac surgery for valve replacement there are several discussions which take place, including the different types of valves we can replace their native valve for.
The choice of valve prosthesis is a complex shared decision-making process based on the consideration of several factors including expected durability, potential need for long term Warfarin management, and patient values and preferences. Evidence suggests that the younger you are, the greater risk of structural deterioration of a bioprosthetic valve and therefore requiring a redo sternotomy and redo valve replacement is much higher (2).
AHA International guidelines strongly suggest that the choice of prosthetic valve should be based on a shared decision-making process that accounts for the patient’s values and preferences but also includes discussion and understanding of the risk of each valve choice (including understanding adherence to Warfarin medication, and potential need for valve reintervention). (3)

Aim: To understand the factors that influence patient’s prosthetic heart valve choice, their knowledge of anticoagulation and subsequent experience with prosthetic heart valves and anticoagulation.

Objectives:

• To understand factors that influence the patient’s choice of prosthetic heart valve, particularly physician factors, preoperative education and patient beliefs.
• To understand patient’s knowledge base concerning the risks and benefits of bioprosthetic and mechanical heart valves.
• To investigate patients’ knowledge base concerning anticoagulation, particularly warfarin.
• To investigate patient’s experience with their current prosthetic valve
•  To investigate the experience of patient’s taking warfarin.

Methods:

Design: A qualitative study design utilising a semi-structured interview guide conducted via telephone.

Patients: Adult patients (18 - 60 years) who have undergone an open surgical valve replacement (bioprosthetic or mechanical) at Waikato Hospital between 1st January 2015 and 1st September 2022. Patients will be identified from a prospective clinical registry of all patients undergoing cardiac surgery.

Exclusion criteria: emergency surgery, infective endocarditis

Data Collection and Analysis: Interviewees will be asked to share their experiences with prosthetic heart valves and warfarin in relation to four specific content areas or themes: decision-making, knowledge and education, impact on daily life and patient satisfaction.

Become Manaaki Manawa student researcher!

Our Manaaki Manawa summer research scholars will have the opportunity to become a part of the Manaaki Manawa Centre for Heart Research. Manaaki Manawa will provide:

• a welcome event for our summer scholars so that you have a chance to meet each other, learn about the Centre’s work, have some kai and meet the Centre team, including our Pou Tikanga.
• a celebration at the end of the scholarships with students doing presentations or posters about their research
•  continued connection with Manaaki Manawa after your project ends, with opportunities to continue with some research if you are interested, with support from our team and researchers, and to participate in Manaaki Manawa events throughout the year.

There are also two Manaaki Manawa scholarships open to Māori, Pacific or women students, that have a $2,000 supplement in addition to the standard scholarship.

References:
1. The New Zealand National Cardiac Surgery Clinical Network. Cardiac Surgery in New
Zealand Public Hospitals. 2018 Annual Report; Report Number 4. Access by https://www.health.govt.nz/system/files/documents/publications/new-zealand- cardiac-surgery-national-report-2018-nov20.pdf
2. J. Etnel. Bioprosthetic Aortic Valve Replacement in Nonelderly Adults. 2019. Circulation
3. Otto CM, Nishimura RA, Bonow RO et al. 2020 ACC/AHA Guideline on the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2021;143:e72–e227.  

Project

Background: Acute aortic dissection (AAD) is a life-threatening emergency due to an intimal tear in the aorta leading to a redirection of blood flow into the media splitting the aorta into two channels – the true and false lumens. This results in malperfusion, organ injury, aortic rupture and/or death. Following emergency surgical repair, 50% of patients will remain with a patent false lumen and chronically dissected descending aorta. This is associated with aortic expansion, need for reoperating and reduced survival.

Objective: The objective of this study is to determine whether preoperative coagulopathy is a risk factor for postoperative false lumen thrombosis

Methods
Design: Case controlled study using patients from an established aortic registry. Cases will be patients with patent false lumens and controls will be patients with thrombosed false luments

Exploratory variable: Coagulation based on preop lab tests and also TEG & ROTEM.

Become Manaaki Manawa student researcher!

Our Manaaki Manawa summer research scholars will have the opportunity to become a part of the Manaaki Manawa Centre for Heart Research. Manaaki Manawa will provide:

• a welcome event for our summer scholars so that you have a chance to meet each other, learn about the Centre’s work, have some kai and meet the Centre team, including our Pou Tikanga.
  
• a celebration at the end of the scholarships with students doing presentations or posters about their research
  
• continued connection with Manaaki Manawa after your project ends, with opportunities to continue with some research if you are interested, with support from our team and researchers, and to participate in Manaaki Manawa events throughout the year

There are also two Manaaki Manawa scholarships open to Māori, Pacific or women students, that have a $2,000 supplement in addition to the standard scholarship.

Project

Cardiogenic shock complicates between 4-6% of acute myocardial infarction. In hospital mortality can approach 50% in this population of patients. Internationally, there is a drive to standardize the care of patients with cardiogenic shock through the development of a “shock team” to promote the early recognition of cardiogenic shock and implement a management plan driven by experienced clinicians to improve outcomes.

The Midland region operates as a hub and spoke model with patients with acute myocardial infarction presenting to their primary hospital and then transferring to Waikato Hospital for further management. Waikato Hospital has 24/7 access to coronary angiography and intervention, echocardiography, a tertiary intensive care unit and cardiothoracic surgery. There is also the ability to establish basic mechanical support with intra-aortic balloon counter pulsation.

This study seeks to understand the epidemiology of cardiogenic shock in the Midland Region, including the frequency and patient characteristics. Additionally, it seeks to review the current model of care to determine whether specialist care is being implemented in a timely fashion to prevent adverse outcomes.

Become Manaaki Manawa student researcher!

Our Manaaki Manawa summer research scholars will have the opportunity to become a part of the Manaaki Manawa Centre for Heart Research. Manaaki Manawa will provide:

• a welcome event for our summer scholars so that you have a chance to meet each other, learn about the Centre’s work, have some kai and meet the Centre team, including our Pou Tikanga.
  
• a celebration at the end of the scholarships with students doing presentations or posters about their research
  
• continued connection with Manaaki Manawa after your project ends, with opportunities to continue with some research if you are interested, with support from our team and researchers, and to participate in Manaaki Manawa events throughout the year.

There are also two Manaaki Manawa scholarships open to Māori, Pacific or women students, that have a $2,000 supplement in addition to the standard scholarship.

Project

Tinnitus "ringing in the ears" is a bothersome and potentially debilitating phenomenon. It often accompanies hearing loss and affects over 13% of the population aged over 65 years. Rating scales of different qualities of tinnitus are frequently used alongside questionnaires in the assessment of tinnitus. At face value these are simple assessments that are useful for quantifying tinnitus at a point of time, but what do they really assess? This study will examine a large data set of rating scales with questionnaire answers to examine convergent and divergent reliability of the scales. This research will assist in the development of more reliable measures of tinnitus and an understanding of the benefits and shortcomings of different existing assessment processes. Secondary data from several past research projects will be examined. The rating scales will be related to hearing assessments, gender, ethnicity, psychological and tinnitus related measures. The research will aid in the development of an understanding of tinnitus as a disorder. The student will learn about the complex nature of tinnitus, how it is assessed and develop some skills in the psychometrics of tinnitus questionnaires and some of the statistics used in assessing questionnaire validity.