Surgery

Ectopic fat accumulation and pancreatic cancer (COSMOS 1)

Supervisor

Associate Professor Max Petrov

Discipline

Surgery

Project code: MHS125

Obesity and other metabolic diseases comprise a significant burden to health care systems, particularly in New Zealand. There is a well-described association between obesity and ectopic fat deposition in parenchymatous organs such as the pancreas, liver, and heart. Historically, ectopic fat accumulation in the liver has been more extensively studied. However, with advances in imaging techniques, such as magnetic resonance (MR) imaging with high resolution proton MR spectroscopy, intra-pancreatic fat has become possible to assess and quantify non-invasively. Ectopic fat accumulation in the liver and pancreas has been associated with obesity, metabolic syndrome, and type 2 diabetes. These are established risk factors for pancreatic ductal adenocarcinoma. However, the association between ectopic fat accumulation and pancreatic cancer risk has been poorly investigated. Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide, and is projected to increase with the rising obesity epidemic. Given the high mortality and lack of effective management of established pancreatic cancer, more work is required on addressing its major risk factors and using this to formulate preventive strategies to its development. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience, including involvement in a case-control study of MR imaging after diseases of the exocrine pancreas.

Skills Taught:
• Working in a clinical research team environment
• Management of a case-control clinical study
• MR image analysis
• Systematic literature review
• Preparation of a manuscript for publication in international peer-reviewed journal

Architecture of the Infant gluteal muscles: Segmentation of a 3D Model

Revision arthroplasty for prosthetic joint infection - is one stage better than two stages?

Ageing pancreas and Maori health (COSMOS 2)

Supervisor

Associate Professor Max Petrov

Discipline

Surgery

Project code: MHS126

With improvement in health care, living standards and socioeconomic status, more adults in New Zealand are living to old age. As the population ages, it is increasingly important to identify the factors that might impact on the nutritional status and thus the health status of the elderly. Hence, it is important to understand how ageing affects the digestive system in order to allow appropriate interventions in the case of digestive functional impairment. The pancreas plays a central role in the digestive process due to the production of essential digestive enzymes and bicarbonate. The aim of this project is to summarize, for the first time, available literature on the peculiarities of diseases of the exocrine pancreatic diseases (i.e. acute and chronic pancreatitis, pancreatic cancer) in ageing adults, with a particular focus on Maori health. 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. Maori or Pacific students are particularly welcome to apply.

Skills Taught:
• Working in a clinical research team environment
• Systematic literature review
• Preparation of a manuscript for publication in international peer-reviewed journal

Use of social media for surgical education in Australia and New Zealand

Supervisor

Benjamin Loveday

Discipline

Surgery

Project code: MHS187

Social media are increasingly being used by doctors and medical students as a professional tool for networking, information sharing, and education. Many platforms are used for these purposes, such as Twitter and Facebook. There has been an explosion of educational content available on social media, and education paradigms are changing to incorporate social aspects of learning. This has given rise to practices such as conference live tweeting and journal clubs held on social media.

Postgraduate surgical education and training in Australia and New Zealand is overseen by surgical specialty societies and associations, while the Royal Australasian College of Surgeons is the umbrella organisation that represents the interests of all surgical specialties. Academic surgical departments are responsible for undergraduate surgical education, and some department also provide postgraduate surgical education. While each of these societies, associations and academic departments deliver educational content in conventional formats, it is unknown whether and how they also use social media to deliver education content.

Therefore, the aims of this research project are to:
1. Determine the social media presence of surgical specialty societies, associations and academic departments in Australia and New Zealand.
2. Categorise the social media content from surgical specialty societies, associations and academic departments in Australia and New Zealand, to determine the proportion of content that is categorised as educational.
3. Survey surgical specialty societies, associations and academic departments in Australia and New Zealand to determine their strategies for delivery of education content through social media.

This studentship would suit a student with an interest in surgery and/or education research.

This studentship will develop the following skills:
- Ethics application
- Study design
- Survey design and implementation
- Data collection, extraction and analysis
- Manuscript preparation for publication

Does Progress Testing predict performance in surgical clinical attachments?

Supervisor

Benjamin Loveday

Discipline

Surgery

Project code: MHS188

Progress Tests (PT) assess applied knowledge, promote deep learning and facilitate long-term knowledge retention. This form of testing allows students to demonstrate their knowledge growth over time (assessment of learning), and can help students identify knowledge gaps (assessment for learning). Clinical attachments catalyse learning within specific topic areas by providing an appropriate context for learning and feedback. This learning is facilitated by tutorials (which cover core topics), immersion in the specialty context, and a range of assessments of learning. This feedback allows subsequent learning to be more targeted towards knowledge gaps.

The surgical attachment in MBChB Year 4 incorporates learning across all domains of the programme curriculum, and requires acquisition of some knowledge and skills that are not assessed by the PT (our primary tool for the ‘Applied science for medicine’ domain). Therefore, there is only a partial overlap between the PT coverage and surgical attachment assessments. It is not known whether PT results predict performance in the surgical attachment, or how surgical attachment performance correlates with subsequent PT results. Our hypotheses are that there should be a relationship between the two assessments where there is content overlap, and that exposure to learning in the surgical setting should improve performance in surgical questions in the PT.

Therefore, the aims of this research project are to:
1. Determine the association between PT results and assessment outcomes in the MBChB Year 4 surgical attachment.
2. Determine the effect of completing the MBChB Year 4 surgical attachment on subsequent PT results mapped to surgery.
3. Use multivariate analyses to identify independent predictors of surgical attachment performance.

This study is a collaboration between the Department of Surgery and the Medical Programme Directorate. With supervision, support and training, the student will help with the ethics application process prior to starting the studentship, perform a literature review, work with a psychometrician (Dr Bradley Patten) to obtain and analyse the data from databases housed within the Medical Programme Directorate, perform statistical analyses, and prepare a manuscript for publication.

This studentship would suit a student with an interest in surgery and/or education research.

This studentship will develop the following skills:
- Ethics application
- Literature review
- Study design
- Data analysis
- Manuscript preparation for publication

Retrospective analysis of Prostate cancer treatment outcomes: Surgery or radiotherapy?

Supervisor

Mr Kamran Zargar
Dr Bashar Matti

Discipline

Surgery/Urology

Project code: MHS166

Prostate cancer is a common cause of morbidity and mortality for New Zealand men. The clinical significance of the cancer is established based on clinical, biochemical and histological factors. The current New Zealand guidelines for prostate cancer management recommend curative treatment for Intermediate risk disease. This is defined as men who have the following criteria: Gleason 7 prostate cancer, PSA 10 – 20 ng/ml, or clinical T2b/T2c on examination/MRI scan. The treatment options that are widely available are surgical or radiotherapy. Surgery is in the form of radical prostatectomy, can be performed open, laparoscopically or robotically, involve the removal of the prostate, seminal vesicles and to an extent the pelvic lymph node. Radiotherapy is image guided delivery of high intensity radiation to the prostate. This is done either via external radiation or brachytherapy. The evidence behind the selection of a treatment modality for this group of men are scarce.

The aim of this project is to retrospectively analyse the clinical outcomes of these treatments in the Auckland region. The outcomes of interests are: mortality, primary treatment failure, need for salvage therapy and major procedural complications. The population for this study will be men with intermediate risk prostate cancer diagnosed between 2008 and 2013. This means a 5 years outcome analysis can be performed. These men will be identified from the New Zealand Cancer Registry and the Regional Cancer and blood service (ADHB). Data will be collected using the electronic clinical records and validated with New Zealand Mortality database. Outcome definitions will utilise the standard international criteria.

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

Assessing the quality of pathology reporting for Prostate Biopsy.

Supervisor

Mr Kamran Zargar
Dr Bashar Matti

Discipline

Surgery/Urology

Project code: MHS167

Prostate biopsy, a procedure by which multiple cores of the prostatic tissue obtained, is considered the gold standard for the diagnosis of prostate cancer. This procedure is usually done under Trans Rectal Ultrasound Guidance. The number of cores vary but the current standard is to obtain at least 12 cores from different parts of the prostate gland to maximise diagnostic accuracy. Following the acquisition of the biopsy cores, these are usually inked and marked in separate pots prior to being sent for histological examination by the pathologists. The Prostate cancer Task Force had published in May 2013 recommendations for the minimum standards of reporting the results of prostate biopsies. This is done in order to improve consistency and reduce interobserver variation.

This project aims at analysing all the prostate biopsy pathology reports from 2014 to 2017. The minimum standard will be achieved if the report has the following: Presence or absence of tumour, tumour type, extent of involvement of the positive core by the tumour, presence or absence of extraprostatic extension and the grade of the tumour. The results for each laboratory will be analysed separately. A higher weighting will be given to scoring of the positive biopsies in contrast to negative ones (more important to adequately report the cancer population).

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

Can the Kattan Pre-Radical Prostatectomy calculator be applied to New Zealand men?

Supervisor

Mr Kamran Zargar
Dr Bashar Matti

Discipline

Surgery/Urology

Project code: MHS169

Prostate cancer is a common cause of morbidity and mortality for New Zealand men. Multiple management approaches depend highly on the risk category of the cancer at diagnosis. Curative radical prostatectomy is usually offered to surgical candidates with Prostate cancer that has an intermediate risk for progression. One of the difficulties, particularly for patients to absorb, is to categorise an Intermediate risk for the disease. A more objective approach over the past decade was to use predictive models to estimate the risk of cancer recurrence post operatively prior to undergoing surgery to help decision making and guide discussion with patients. Majority of these models are based on international data which makes the applicability to New Zealand men questionable due to populations’ heterogeneity.

One of the widely used and well validated nomograms is the Memorial Sloan Kettering Cancer center (MSKCC) developed by Kattan et al. This nomogram utilises few pre-surgery variables to predict recurrence at 2, 5 and 10 years intervals. These variables are: Adjuvant treatment, Age, Prostate Specific Antigen (PSA) and Prostate Biopsy information such as Gleason score and number of positive cores.

The aim of this study is to validate this nomogram using a New Zealand data. Results of all men who had radical prostatectomy from 2008 to 2013 will be entered into the calculator and percentages will be obtained. These will be compared to actual occurrences at the 2 and 5 years mark. Recurrence is defined using the biochemical marker (PSA values post-operatively). The predictability of MSKCC nomogram will be calculated and compared to published reports.

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

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

Supervisor

Mr Kamran Zargar
Dr Bashar Matti

Discipline

Surgery/Urology

Project code: MHS202

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

In the Northern region of New Zealand, more than 200 TURP procedures performed per year. The aim of this study is to retrospectively analyse these cases to define the incidence of Prostate cancer in this population. This will be adjusted to variables including: Age, Ethnicity, Digital Rectal Examination, Medications and Prostate Specific Antigen test results.

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