Faculty of Medical and Health Sciences


Externally Funded Projects


We are pleased to advertise the following 2018 - 2019 summer research projects. These projects have already secured funding from external sources.

If you are interested in any of the projects below, please contact the supervisor/contact person by email or phone in the first instance. The project supervisor will assess your suitability to undertake the research project and will select a student based upon their own independent eligibility requirements. Further opportunities will be added as they arise.

Once the proposal is finalised and agreed with the supervisor, please complete the 2018 FMHS external SRS application form and give to your supervisor with a copy of your current CV, academic transcript and a copy of your bank account details - screen print including bank logo, bank name, your name and bank account details

 

Waikato Clinical School

These summer research projects are available through the Waikato Clinical School.  You will be expected to spend the duration of the project at the Waikato Hospital.  The research projects are run over ten weeks from approximately late November 2018 to February 2019   

All student applicants should send a current CV and covering letter to Raewyn Wooderson  which will then be submitted to the pool of interested students.  Supervisors will contact those students they are interested in working with.

Value  of each project   $6,000.00.                 Closing Date:  Friday 28 September 2018 

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TITLE:  Isolated Antibodies Against Ro52 and their significance in the Waikato Hospital Systematic Sclerosis Cohort

SUPERVISOR:  Dr Douglas White

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TITLE:    Evolution of assessment and treatment of the posterior malleolus  in a Level 1 Trauma Centre

SUPERVISOR:  Dr Joe Baker

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TITLE:    The Harti Inhalator study (HIS):  The effects of provision of NRT inhalators on smoking cessation for intervention participants compared to usual care participants of the Harti Hauora Tamariki radomised control trial

SUPERVISOR:    Dr Nina Scott

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TITLE:    The Impace of New Zealand guidelines on Maternal and Neonatal outcomes in Gestational Diabetes Mellitus

SUPERVISORS:    Dr Ryan Paul    Dr Lynne Cheuplis    Dr Jade Tamatea    Dr Louise Wolmarans

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TITLE:    Investigating the psychological support needs of patients with newly diagnosed lung cancer

SUPERVISOR:    Prof Ross Lawrenson

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TITLE:    The Burden of Sinonasal disease in the Waikato region

SUPERVISORS:    Dr Gregory Jacobson    Dr Steve Bird    Mr Adam El Gamel    Dr Gerry Devlin

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TITLE:    EEG patterns during anaesthesia

SUPERVISOR:    Rebecca Pullon

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TITLE:    Observational study reviewing the impact of the first dedicated Interstitial Lung Disease Multi Disciplinary Meeting in New Zealand after the first 2 years.  

SUPERVISORS:    Dr Cat Chang    Dr Harry Gallagher

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TITLE:    Accuracy of ethnicity records at primary and secondary healthcare services in Waikato region, Aotearoa / New Zealand

SUPERVISOR:    Dr Jade Tamatea

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Counties Manukau District Health Board **FILLED**

Counties Manukau District Health Board CM DHB logo

These summer research projects are available through the Counties Manukau District Health Board - CMDHB.  The research projects are run over ten weeks from approximately late November 2018 to February 2019   

Fourth and fifth year MBChB students will be considered if they are able to commit to the research without jeopardising their study.  

 

Value  of each project   $6,000.00.                                  

 

Closing Date:  Friday 14 September 2018 

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TITLE:    An audit of clinical indications for urine culture requests at Middlemore Hospital.

Supervisor:    Chris Hopkins                                        Department:     Infectious Diseases

Telephone:        021 0617 252 or 51527                       email:  Christopher.hopkins@middlemore.co.nz

AIMS:     There is an urgent need to reduce unnecessary antibiotic use due to rising antibiotic resistance.  Asymptomatic bacteriuria (ABU), where bacteria are present in the urine in the absence of related symptoms, is very common in hospitalised patients.  Choosing Wisely NZ recommends avoiding antibiotic treatment of ABU because it is harmful without benefit in most patient groups, however this remains a common reason for overuse of antibiotics in hospitals.

Numerous studies have demonstrated that urine cultures (UC) are frequently requested without an appropriate clinical indication, and false positive results frequently result in unnecessary antibiotic prescriptions.  In addition to the harmful downstream effects, the laboratory processing of unnecessary UCs is also costly.  Choosing Wisely NZ recommends only requesting UC in patients with symptoms of urinary tract infection.

We plan to conduct a retrospective audit of a sample of UC requests on adult patients at Middlemore Hospital.  We will review the clinical notes for documented clinical symptoms and signs that led to the UC request, and reconcile these against international guideline-based appropriate indications for UC.  The rate and proportion of inappropriate UC requests will be calculated across the institution, and compared between different patient demographics, services, and other risk factors.

These results will be used to direct a future quality improvement campaign, the aim of which is to reduce harms from antibiotic overuse for ABU, and costs of unnecessary UC processing.  Since ABU is found more commonly in patients with diabetes, this may disproportionately affect Maaori and Pacific people.

SKILLS TAUGHT:

  • Clinical Audit Skills – comparing current practice to published guidelines.
  • Computer skills for research: spreadsheet design & data entry
  • Basic epidemiological/statistical analysis
  • Enhanced knowledge of symptoms/diagnosis of urinary tract infections versus asymptomatic bacteriuria, interpretation of test     results in different clinical contexts.
  • Antibiotic stewardship – contributory factors to overuse of antibiotics, including diagnostic error, and behavioural interventions     to improve antibiotic prescribing.
  • Medical Writing skills
  • Interpersonal, Team and Communication skills eg poster & presentations, liaison with team members, clinical records service.

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TITLE:  Staphylococcus aureus bacteraemia at Middlemore Hospital

Supervisor:    David Holland and Genevieve Walls                                        Department:    Infectious Diseases

Telephone:  021 476 562                                                                          email:  David.Holland@middlemore.co.nz

AIM:  To describe the demographic and clinical characteristics, and outcomes, of patients presenting to Middlemore Hospital with Staphylococcus aureus bacteraemia.

The incidence of Staphylococcus aureus disease is increasing in New Zealand. It accounts for an increasing number of admissions to hospital (particularly with skin andsoft tissue infections), and disproportionately affects people from areas of socio-economic deprivation, those of Maori and Pacifika descent, and those who live in the northern regions of New Zealand.

S. aureus bacteraemia (bloodstream infections) have high mortality and morbidity. Although S. aureus bacteraemia rates (as opposed to S. aureus skin and soft tissue infection rates) have been shown to be stable in New Zealand as a whole (from 2000 - 2011), we at Middlemore feel that we are seeing rising rates of S. aureus bacteraemia. We suspect that data from our hospital (serving a distinct population) are different from those seen for the rest of New Zealand.

In addition, we have one of the highest rates of methicillin resistant S. aureus (MRSA) bacteraem ia in the  country (25-35% as a rough estimate, compared with 10-14% throughout  New Zealand).

Patients with S. aureus and MRSA bacteraemia presenting to Middlemore Hospital are seen by all services, and the description of these patients would be of local, and national, interest.

SKILLS TAUGHT:

  • Audit skills including designing and maintaining a database, and the interpretation of data. Knowledge about the ethics of     retrospective audits.
  • Simple statistical analysis
  • Writing skills - in the design of a poster and hopefully also being part of the composition of a paper for publication.
  • Time management skills

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TITLE:  How well are we diagnosing and managing delirium at Middlemore Hospital in 2018-19; and does it really matter if we miss it?

Supervisor:  Dr John Hopkins                                          Department:  Adult / Old Age Consult-Liaison (Psychological Medicine)

Telephone:  021 816 786                                                email:  hopkinsj@middlemore.co.nz  

AIMS:    1.   Determine the point prevalence of delirium in 3 separate wards (e.g. a general medical ward such as Wards 33 North or East; a General surgical ward such as Wards 8 or 9; and an AT&R ward such as Wards 4 or 5) in Middlemore Hospital using the 4AT.

2.  Compare this with – The diagnosed prevalence of delirium in those same wards (based on recorded diagnosis of delirium in the WIMS Handover Sheet and the clinical notes); and

The point prevalence of the activation of the Delirium Management Pathway in the same wards (based on auditing of use of CAM Recording Sheet, CAM Intervention Checklist & Patient/Family Information Pamphlet from the clinical notes of patients with a recorded diagnosis of Delirium).

3.   ThenIdentify a group that has delirium based on 4AT but has not been diagnosed or managed clinically as having delirium. Identify likely reasons for the missed diagnosis (e.g. mild delirium vs hypoactive delirium).  Establish theircognitive baseline (by informant questionnaire); current morbidity; and outcome (follow-up at 6 weeks).

4.   Finally – Compare the missed delirium group with the triple threat group (i.e. those with 4AT and clinical diagnoses and activated delirium management pathways) on – severity and duration of delirium; cognitive baseline; behavioural disturbance; and outcomes.

SKILLS TAUGHT:

  • Critical thinking.
  • Engagement with patients, families/whanau, nursing and allied health staff, and medical teams.
  • Clinical diagnosis of delirium.
  • Assessment and management of delirium.
  • Establishing the person’s previous and new cognitive baselines.
  • Understanding the significance of delirium (i.e. poorer outcomes).
  • Familiarity with key standardized assessment tools (4AT & CAM; MoCA, RUDAS & ACE; Alzheimer’s Questionnaire & Short            IQCODE).
  • Data collection and analysis.
  • Report writing.

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TITLE:  Are we providing equity of access to breast reconstruction services?

Supervisor:    Ms Michelle Locke                                            Department:  Plastic and Reconstructive Surgery

Telephone:    021 963 533                                                    email:  Michelle.Locke@middlemore.co.nz

 

AIMS:  To ensure that the Plastic and Reconstructive Surgery service provides equity of access to all patients, aligned with our Annual DHB and Regional Plan, and the Maori and Pacific Health Plan.

To achieve this aim, we will analyze the referral patterns and reconstructive surgery we have provided to women over the past five years, broken down by their DHB of domicile and by ethnicity. We will also review the changing trends in breast reconstruction surgeries undertaken at CMDHB over the past five years.

BACKGROUND:  The Plastic and Reconstructive Surgery service based at CMDHB is a regional service, providing care to patients from NDHB, WDHB, ADHB and CMDHB. This means that some patients travel long distances to access treatment and post-operative care following surgery in our department. There are many potential barriers to this access, including time, transportation and childcare issues, among others. The department has never assessed the source of our referrals, nor the changing trends in the type of surgery requested, for example, implant reconstruction compared with autologous (own tissue) requests. Anecdotally we feel that referrals are not received at a similar rate from each of the DHBs we service, and that not all ethnicities are equivalently represented in the referrals received.

PROPOSAL:  In this Summer Studentship, the student will use the departments Breast Reconstruction Database and Plastic Surgery records to review and analyze the referral patterns for the past five years. They will work closely with the breast reconstruction CNS. Where possible, mastectomy data will be used to compare patients referred for reconstruction and those not referred, in conjunction with the breast surgeons. Data will be analyzed by area of domicile of the patient, as well as by patient ethnicity, to assess any trends in referral patterns or gaps in service delivery.

Alongside this, the type of reconstructive surgery undertaken will also be assessed. Changing trends in surgery will be reviewed, and the resource implications of any changes will be considered. The number of follow up visits will be analyzed for each type of reconstruction performed. The recovery period and number of outpatient visits can influence the decision of patients to have reconstructive surgery, especially if they live distant from the outpatient facilities. 

SIGNIFICANCE: Up to one in eight New Zealand women will be diagnosed with breast cancer in their lifetime. Many of these women will be treated with surgery, such as mastectomy. Loss of a breast can have significant personal and social impact. Having reconstructive breast surgery can help alleviate some of the impact and is a deeply personal decision for the women involved. Reasons for undertaking the surgery vary considerably, and similarly, choice of reconstructive method is individualised for each patient. However, the first step in the reconstructive process is the referral to our service. Identifying rates of referrals and reconstructive options by different patients area (DHB of domicile) and by ethnicity is the first step to ensuring that we do provide equity of access to breast reconstruction services.

The information gained through this Summer Studentship will allow the regional Breast Reconstruction Service to better understand and appreciate the current service delivery and areas we can improve to ensure all women appropriate for breast reconstructions have access to our services. We will use the knowledge gained to identify areas where we can potentially improve the likelihood of referral for breast reconstruction, and provide better care or support for our patients.

SKILLS TAUGHT:  The successful student will develop useful research skills including data collection; data sorting and analysis; descriptive statistics; and formal statistical analysis using SSPS or GraphPad software. They will also learn about medical administration and the process of change implementation and target achievement, in working towards the CMDHB goals of patient equity. This will provide the student with a better understanding of the diversity in patient population we serve, and the challenges that face different ethnicities in regards to achieving health equity.

As well as these skills, the student will also have the opportunity to increase their clinical knowledge in breast reconstruction and breast cancer care, with the opportunity to assist in the care of patients admitted for breast reconstruction surgery. They will increase their understanding of cultural issues surrounding tissue collection and handling. This project would suit a student with an interest in public health, and general surgery or plastic surgery.

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TITLE:  Limb Sarcomas:  Has improved management techniques resulted in improved survival

Supervisors:    Brendan Coleman, Shaneel Deo                                    Department:  Orthopaedic Surgery

Telephone:      021 533 343                                                               email:  Brendan.Coleman@middlemore.co.nz

AIM:  Middlemore Hospital is New Zealand’s largest musculoskeletal oncology department and is the leading tertiary referral centre for the management of sarcomas in New Zealand.   Over the past two decades there is an increasing burden of sarcoma presenting to the oncology service.  Surgical techniques and adjuvant therapies have evolved substantially during this time.

The aim of this study is to determine if the advancement in surgical and adjuvant therapy techniques has resulted in better outcomes for patients with soft tissue and bone sarcomas. 

SKILLS TAUGHT:  This retrospective study will involve reviewing the musculoskeletal oncology database and undertaking a clinical chart review on patients undergoing treatment for soft tissue and bone sarcomas during the last 20 years.  Primary outcomes for the study are local recurrence and long-term survival.  Secondary outcomes include survival of prostheses such as distal femoral replacement including requirement for implant revision, deep infection and perioperative complications.   Long-term complications from adjuvant therapy will also be reviewed.

Learning opportunities for the summer student include obtaining knowledge of soft tissue and bone sarcomas and their management and outcomes.  They will gain an understanding of utilization of databases in medical research, data collection, statistical analysis, preparation of manuscript and presentation of their research to orthopaedic and oncology colleagues. 

 

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TITLE:  Defining high-risk population in patients referred with microscopic Haematuria to Counties Manukau Health

Supervisor:    Kamran Zargar                                                    Department:  Urology

Telephone:    021 987 199                                                        email:  Kamran.Zargar@middlemore.co.nz

 

AIM:  To optimize assessment algorithms for patients referred with microscopic haematura to the urology outpatient clinics at CMH and to improve service delivery by rationalizing resource allocation.

Annually thousands of patients are referred to the urology clinics at CMH with microscopic haematuria. Assessment of these patients involves outpatient radiological imaging, followed by a flexible cystoscopy in the urology clinic. Unfortunately, our capacity to perform flexible cystoscopy is limited, and subsequently many patients wait significantly longer than planned before they undergo flexible cystoscopy. Currently some patients are seen10 months after GP referral, compared to the planned 8 weeks.

It is possible to improve this service without need for allocation of additional resources. This is due to the fact that in reality not all patients who present with microscopic haematuria will require a cystoscopy. Our challenge has been that we do not know which patient groups in our population can be considered low risk for cancer. The low-risk population can avoid cystoscopy and this has been demonstrated in international studies.

Our study will involve an audit of patients who were seen in the urology clinics for microscopic haematuria. We will create a comprehensive database of patients’ demographics, risk factors, clinical findings and outcomes. Subsequently we can assess:

1.     The incidence of malignancy in patients who present with microscopic haematuria to CMH

2.     Identify low-risk and high-risk patient populations for malignancy

3.     Create clear clinical algorithms to expedite cystoscopy for high risk group and potentially avoid cystoscopy for the low risk group.

This project can significant impact the waiting list for our patients and improve service delivery to the population of South Auckland.

The data is readily available on the electronic system, and there will be ample time for the student to collect the data and complete the preliminary analysis.

SKILLS TAUGHT:  

  • Understanding the risk factors associated with bladder cancer
  • Understanding of pathways involved in assessment of microscopic haematuria
  • Develop basic skills in data collection and management
  • Data analysis
  • Manuscript preparation and research presentation

 

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A+ TRUST ** FILLED**

ADHB LOGO colour 200mm

These summer research projects are available through the A+ Trust to the value of $6,000.00 each.  The research projects are run over sixteen weeks from approximately early November to March.   

Fourth and fifth year MBChB students will be considered if they are able to commit to the research without jeopardising their study.  

Value  of each project $6,000.00

Closing Date:  Friday 31 August 2018  (if not awarded prior)

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Outcomes of clinical trial participation in medical oncology and reasons driving participation

Application Number: FILLED

Abstract: One in three New Zealanders will have contact with cancer, either personally or through a relative or friend. Participation in clinical trials is promoted as the best treatment option for patients with cancer. Despite this, only approximately 1% of adult patients with cancer are involved in a clinical trial at Auckland City Hospital (ACH). There is a strong drive to increase trial opportunities for our patients. Cancer and Blood Research, ACH, is the largest clinical cancer research centre in New Zealand. In order to increase treatment opportunities for patients via clinical trials, we need to understand the outcomes of patients treated in our unit within the context of a clinical trial, and what the drivers were for their participation in the research in the first place. This study will provide the platform for us to achieve this. We need to understand the demographics and clinical characteristics of this cohort to identify how to increase clinical trials participation. Furthermore, we need to continually assess the quality of care for patients on trials. This study will integrate 30 day, 90 day and 120 day mortality rates to assess this. Patients who agreed to participate in clinical trials will also be asked for their feedback on their experience to allow a more complete assessment of this key area. Finally, understanding barriers to clinical trial participation are key. To address this, patients will be asked for the reasons why they participated in a clinical trial and also the reasons for declining clinical trial participation. It will be explained to those patients providing feedback that their responses will be anonymised and used only for the purpose of this research. Successful completion of this study will allow us to understand the benefits of trial participation for New Zealanders and to better recognise factors impacting participation. This will also allow us to design quality assurance tools to continually assess these outcomes prospectively. 

Primary supervisor: Michelle Wilson

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Relationship between flow reserve, severity of chronic obstructive pulmonary disease and outcomes of pulmonary rehabilitation

Application Number: FILLED

Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a major health and economic burden in New Zealand. Pulmonary rehabilitation is a key intervention in the management of COPD yet <50% of eligible patients complete the program and a proportion do not derive benefit. Assessment of the severity of COPD is based primarily on pulmonary function and format of a flow volume loop. In previous A+ summer studentships we have developed and applied a novel technique for quantifying the expiratory flow reserve (EFR). We hypothesise that in COPD patients reduced EFR at rest better indicates severity of COPD and a failure to improve exerside capacity following pulmonary rehab, and that this is due to a reduced capacity to "train" as a result of restrictions on inceasing ventilation. This study will retrospectively compare the quantitative assessment from spirometry records and a conventional classification of the severity of COPD from spirometry. Measurement of EFR may increase the utility of spirometry in the assessment and management of COPD. The result of this retrospective study will form the basis of a prospective study of the predictors of response to pulmonary rehab so that this scarce and relatively costly resource can be directed to those most likely to benefit.

Primary supervisor: 

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The association between heart rate variability and the severity breathlessness in COPD

Application Number: FILLED

Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of mortality and morbidity in New Zealand and most other countries. Exacerbations of COPD result in over 12,000 hospital admissions each year, with many of these exacerbations being potentially manageable in the community with early intervention. However, given the complexity of the symptoms of disease, people with COPD offer defer attending primary care until the exacerbation is such that hospitalisation is necessary. The proposed study aims to determine if the severity of COPD can be identified using heart rate variability (HRV) analysis. Individuals with COPD exhibit decreased HRV which is in keeping with changes in autonomic function. However, quantification of the changes with COPD with respect to the severity of COPD and the degree of breathlessness remain unclear. If significant correlations between decreased HRV and the severity of COPD are proven to exist, assessing the severity of the impairment using objective physiological measurements may be possible.

Primary supervisor: 

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Development of consumer information about financial supports for family and whanau caring for a relative with palliative care need

Application Number: FILLED

Abstract:  Family carers of people with palliative care needs incur significant economic costs associated with caregiving. A lack of knowledge regarding the financial support available to support people with palliative care needs and their caregivers contributes to a burden of caregiving that can result in significant distress. We are currently collaborating with a research team from the University of Sheffield on a study to identify and compare sources of financial support for family caregivers across six countries, including New Zealand.

Objective: To extract data regarding the New Zealand context from the international study in order to create a resource for NZ-based family carers on the financial supports available within a palliative care context.

Methods: The student will collaborate with the University of Sheffield team to collate all data relevant to the NZ context. This information will be presented to a group of approximately five bereaved family carers who have previously participated in our research and who had indicated they wish to be involved in future research projects. Using a co-design approach, a new resource will be developed which can be disseminated to family carers; this will comprise a written leaflet and online resource.

Benefits: This project will improve carers knowledge of the economic supports available when supporting someone with a life limiting illness. The leaflet produced will be disseminated to family and whanau members whose relative is under the care of the ADHB Hospital Palliative Care Team, as well as via local hospices and nationally through organisations such as Hospice New Zealand.

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Patient demographics and referral pathways at vulval skin clinics

Application Number: FILLED

Abstract: A number of inflammatory and neoplastic conditions involve the skin of the vulva. Often women have had symptoms for many years before presenting for medical help and having a correct diagnosis made. Little is known about the demographics of women presenting with vulval skin disease in New Zealand. We suspect, in particular, Māori and Pacific Island women are under-represented in specialist clinics. The aim of this study is to document referral pathways and characteristics of women presenting to vulval skin clinics at ADHB. We plan to review records of women presenting to the vulval skin clinics at National Women’s Health (combined Dermatology and Gynaecology clinic) and Auckland Regional Sexual Health Service in the last 12-months. The value of this research is to document any discrepancies in access to care for women with skin disease. It is hoped that this data, produced with the help of an A+ summer studentship, can be used as a starting point to identify barriers to care and address health inequalities for women with vulval skin disease.

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Diabetes Inpatient Audit

Application Number: FILLED

Abstract: Diabetes is a growing chronic condition; more hospital patients with diabetes are being managed. It’s called the Silent pandemic. Our Audit will be based on the UK National Audit (NADIA – Annual inpatient Diabetes Audit). Key questions to be answered in this audit:

  • What is the incidence in our institution or patients admitted with Diabetes? 
  • Which staff care for these patients and which specialties are involved in their care? 
  • What is our use of IV insulin infusions? 
  • Medication and prescription errors associated with prescribing insulin and fluids (sample review of notes).
  • Hypoglycaemia events. 
  • Patient survey to review satisfaction with Hospital management of their Diabetes. 

We are introducing updated guidelines and use of different fluid to the Variable rate Insulin infusions or older term GIK (Glucose/ Insulin/ Potassium infusion regime) and this will be an opportunity to review the implementation and use. We plan to use this information to look at improvement initiatives especially around staff education and possible e-learning. It would be useful to have data relating to our own specific hospital population. We need to identify patients with undiagnosed diabetes. Patient feedback important and feedback would indicate how we managing these patients. We would like to raise awareness of Diabetes within the hospital. 

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Outcomes following the treatment of prosthetic joint infections – are we choosing the right treatment strategies

Application Number: FILLED

Abstract: Diabetes is a growing chronic condition; more hospital patients with diabetes are being managed. It’s called the Silent pandemic. Our Audit will be based on the UK National Audit (NADIA – Annual inpatient Diabetes Audit). Key questions to be answered in this audit:

  • What is the incidence in our institution or patients admitted with Diabetes? 
  • Which staff care for these patients and which specialties are involved in their care? 
  • What is our use of IV insulin infusions? 
  • Medication and prescription errors associated with prescribing insulin and fluids (sample review of notes). 
  • Hypoglycaemia events.
  • Patient survey to review satisfaction with hospital management of their Diabetes.

We are introducing updated guidelines and use of different fluid to the Variable rate Insulin infusions or older term GIK (Glucose/ Insulin/ Potassium infusion regime) and this will be an opportunity to review the implementation and use. We plan to use this information to look at improvement initiatives especially around staff education and possible e-learning. It would be useful to have data relating to our own specific hospital population. We need to identify patients with undiagnosed diabetes. Patient feedback important and feedback would indicate how we managing these patients. We would like to raise awareness of Diabetes within the hospital. 

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The New Zealand Rheumatic Heart Disease Registry 

Application Number: FILLED

Abstract: Much is known about acute rheumatic fever (ARF) in New Zealand but less is known about the morbidity and mortality of its long term sequal, Rheumatic Heart Diseaae (RHD) involving damage to the heart valves. Mild RHD does not cause any symptoms but moderate and severe RHD damages the heart muscle (pumping of the heart) with many medical complications. Māori and Pacific peoples are disproportionally affected. The first stage of this project will be to establish the number of individuals in NZ with significant RHD by creating a national registry of RHD by age, ethnicity, region, and pattern of RHD. The registry began in late 2017 and is being established from cardiac surgical and echocardiographic databases, ARF and RHD clinics and discharge codings of admission to hospital with RHD. The second aim is to determine the quality of RHD medical and surgical care, as inequality of care appears to have been occuring. Comparisons with the Heart Foundation RF/RHD guidelines (2014) for clinical care will be made.

 

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Eosinophilic oesophagitis – Audit of practice since establishment of combined Gastroenterology/Allergy clinic and introduction of agreed management protocol 

Application Number: FILLED

Abstract: Eosinophilic esophagitis (EoE) is an increasingly prevalent clinical problem in paediatric practice. Children present with variable symptoms, including swallowing difficulties (dysphagia), food bolus obstruction and symptoms indistinguishable from gastro-oesophageal reflux. If left untreated, progressive fibrosis (scarring) of the oesophagus may occur, leading to development of strictures (narrowed areas) and risks of perforation. Diagnosis of EoE is made at upper gastrointestinal endoscopy by the finding of isolated oesophageal eosinophilia. Although not a simple IgE-mediated allergic disease, the oesophageal inflammation is commonly triggered by food allergens. Management of the condition aims to treat symptoms and limit progression of disease by removal of triggering dietary allergens or treatment of the oesophageal inflammation. As the condition has both gastrointestinal and allergic elements, a combined clinic between the Paediatric Gastroenterology and Allergy/Immunology teams was established in 2014. At the same time, a protocol for management of this complex disease was devised. As the clinic has been running for a number of years, an audit review of the protocol and patient outcomes is warranted.

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Outcome of paediatric liver transplant recipients after a switch of immunosuppression to generic tacrolimus

Application Number: FILLED

Abstract:  In 2014, PHARMAC changed the form of the drug tacrolimus used for all transplant patients in New Zealand to prevent them rejecting their transplant. They changed from using the original form of tacrolimus (Prograf) to a “generic” or copy form of tacrolimus made by another company (Tacrolimus Sandoz). This had never been done in large numbers of transplant patients before. Data regarding the use of generic tacrolimus in children with liver transplants were not available. As tacrolimus is a drug where the level in the blood is critical, there was some concern that the drugs would not be identical and therefore that the switch might lead to an increase in transplant rejection. However, generic tacrolimus is significantly more affordable and a successful switch would mean substantial cost savings which could be spent elsewhere in the drugs budget. We would like to look at the outcomes of children with liver transplants following the switch from Prograf to Tacrolimus Sandoz and in particular to see whether there has been more rejection in the children after the switch. It is our suspicion that the children have done just as well after the switch and that there was no excess of rejection. This is highly publishable as it is the largest case series to date and will be useful to liver transplant doctors in other countries, particularly those in the developing world where the cost of drugs can be prohibitive.

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Atopy and allergies acquired following paediatric liver, paediatric kidney and adult liver transplantation in New Zealand

Application Number: FILLED

Abstract:  Liver transplantation (LT) is a life-saving treatment and the current standard of care for most children with end stage liver disease (ESLD). It is now well established that outcomes following paediatric LT are very good with up to 94% patient survival at five years. This has resulted in a greater focus on improving non-hepatic outcomes of LT such as growth and nutrition, cognition, IQ and quality of life. Transplant-acquired allergies (TAA) is increasingly reported in literature following any solid organ transplantation, with a higher incidence in paediatric recipients of liver grafts in comparison to adult recipients as well as to other solid organ recipients. The different types of allergies that can occur after transplantation are food allergies, allergic rhinoconjunctivitis (hayfever), eczema, asthma and eosinophilic oesophagitis (allergic condition affecting the oesophagus). Several factors have been suggested in the pathophysiology of transplant-acquired allergies, with no clear cause identified to date. It is thought that the immune-suppression medication used in the post-transplant setting (particularly Tacrolimus) may play a role. The aim of our study is to describe the occurrence of transplant-acquired allergies (TAA) in our paediatric liver transplant cohort in New Zealand by comparing the above data to the adult liver and paediatric kidney transplant cohort in New Zealand and to identify possible risk factors associated with higher occurrence of TAA in paediatric liver recipients. This would potentially help formulate strategies to control and even prevent the occurrence of TAA in this cohort, thus improving their overall quality of life.

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Bronchiectasis in paediatric patients following renal and liver transplantation in New Zealand

Application Number: FILLED

Abstract: The study will identify children with a history of renal or liver transplantation who have subsequently developed bronchiectasis. We believe our cohort will be the largest group described in paediatrics and possibly in the adult literature also. We hope by reviewing this group of patients and comparing them to those who have not developed bronchiectasis, we might identify specific risk factors and diagnostic barriers which may improve the future clinical care of such patients. We will also obtain additional information regarding the clinical course and severity and prognosis of this group with regards to both their chronic lung disease and allograft survival thus potentially draw comparisons as to whether these specific outcomes are worse or comparable to those patients without the dual diagnosis. We hope to answer the following questions:

  1. How many children following liver or renal transplantation have developed bronchiectasis? 
  2. What are the characteristics of these children?

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ADHB / IDFNZ **FILLED**

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Management of immunoglobulin replacement therapy – best practice?

Discipline: Clinical - ADHB

Project aims: to assess current management of the cohort of immunology patients on immunoglobulin replacement therapy against international best practice guidelines.

Our department currently oversees immunoglobulin replacement therapy for about 90 adult patients, either through the immunology day stay or in the community. Most of these patients have primary immunodeficiencies (PIDs), which are rare conditions requiring specialist management that may not be available to them in their local DHB. As with other chronic diseases these conditions have significant impacts on the patients that we often underestimate. We are now aware that these patients are also at increased risk of non-infectious complications such as malignancy, enteropathy and autoimmune disease, conditions that we may fail to detect in a timely fashion, and in addition our understanding of disease pathogenesis as well as genotype/phenotype correlation is also evolving.

Various monitoring systems have been proposed nationally and internationally for on-going follow-up, but none are currently used routinely in the department. As part of benchmarking departmental performance we want to audit our immunoglobulin patient cohort against international best practice guidelines and identify areas where we can improve patient health and outcome. IDFNZ provide support and representation for these patients.

You will review current relevant literature and then in conjunction with departmental staff develop an audit tool, collect data and analyse it with the intent of presenting your findings.

Skills: literature review, study design, data collection, database administration, data analysis, preparation of material for presentation (written and/or oral)

This is an eight to ten week research project from early December to February. Fourth and fifth year MBChB students will be considered if they are able to commit to the research without jeopardising their study.

Value $6,000.00  - FILLED

 

Council of Medical Colleges - Choosing Wisely **FILLED**

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Choosing medications wisely for older people with dementia and palliative care needs

You will work with the bicultural international research group: Te Arai Palliative Care and End of Life Research

This project will contribute to a larger body of work focused on point 5 of the Australian and NZ society of palliative medicine and the Australasian chapter of palliative medicine: Tests, treatments and procedures health professional and consumers should question:

 To avoid adverse medication interactions and adverse drug events in cases of polypharmacy, do not prescribe medication without conducting a drug regime review

“Older patients disproportionately use more prescription and non-prescription drugs than other populations. Evidence shows that such polypharmacy increases the risk of adverse drug reactions and hospital admissions. Medication review with follow up is therefore recommended for optimising prescribed medication and improving quality of life in older adults with polypharmacy”.

As a first step to identifying opportunities for further investigation and intervention, this study will identify the medication patterns of older people with dementia (n=286) in NZ in the last year of life using quality of end of life data from The End of Life with Dementia Research (ELDER) study and MoH pharmacy data.  The ELDER project explored the quality of end life for older people living in 61 residential aged care facilities across New Zealand from Northland to Dunedin.

You will work alongside Associate Professor Michal Boyd, Dr Aileen Collier and Dr Jackie Robinson to:

  1. Review the literature 
  2. Collect and analyse data 
  3. Help write the academic manuscript for the study.

This project would suit a student with an interest in patient safety and quality of care for older people and/or palliative care and/or an interest in pharmacy. The student will have excellent communication skills and an eye for detail. Skills gained will include literature reviewing, data collection, analysis and writing for publication.  

Previous students working with our group have published first authored papers in international leading journals and been successful with prestigious external postgraduate scholarship applications. For more information about us please see: http://www.tearairesearchgroup.org. Please get in touch with Aileen or Michal to discuss further.

Please note that MDChB year 4 and 5 medical students are eligible to apply IF they are still able to commit to 8 - 10 weeks of research from November to January and does not affect this research project commitment or their Year 4 or 5 lectures or placements in early 2019.

Value: $6000.00  Primary Supervisors: Associate Professor Michal Boyd, Dr Aileen Collier and Dr Jackie Robinson 

Closing Date: closed

Auckland District Health Board - Service Improvement Team **FILLED**

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Supporting Strategic Clinical Programmes 

Discipline:  Clinical - ADHB    ** 2 research projects available **

Project aims: To support project workstreams within key strategic clicnical programmes such that they provide patient centred care, improve the patient journey and optimise clinical resources. Programmes include outpatients and models of Care and Patient Flow; offering a wide range of interaction with acute, inpatient/outpatient and long-term condition management. Successful candidates will have the opportunity to work and learn as part of a supportive and energetic team.

Skills Taught: Work will involve observational data collection (quantative and qualatative), data analysis, team based problem solving, change management and continuous improvement skills.  It may also involve aspects of co-design and working with patients.  

This is a 10 week research project from early December to February - UoA eligibility criteria valid (e.g., Medical students in year 2 and 3 of their study) Value $6,000.00

Primary Supervisor:    Dr Andrew Old

Co-supervisors: Tim Denison, Bret Vykopal, Ian d'Young

Primary Supervisor department: Performance Improvement Team

Research will be located at Auckland City Hospital, Grafton  

 

Closing Date:  closed

Auckland District Health Board - SPI Team ** FILLED **

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Co-design initiatives supporting an improved patient and family experience

Discipline:  Clinical - ADHB    

Project aims: To undertake a range of activities across the consultation to co-design continuum to obtain a deeper understanding of the three predominant issues affecting the patient experience identified from feedback. This includes the care domains of communication, coordination of care and preparation for discharge from hospital. The specific details of the work, method and location are to be confirmed depending on the opportunities identified closer to the summer break by the Director of Participation and Experience. 

Skills Taught: A range of qualitative and quantitative social research skills to understand patient, family and staff perspectives on what enables and hinders good communication, coordinated care and discharge to support the best possible clinical outcome and healthcare experience. Specifically work will involve observational audits; in depth patient, family and staff interviews;  the facilitation of focus groups and discussion panels with a range of stakeholders, survey design and administration, data collection, data analysis and formal reporting to support performance improvement initiatives leading to an enhanced overall patient experience of care.


This is a 10 week research project from early December to February - UoA eligibility criteria valid (eg Medical students in year 2 and 3 of their study) Value $6,000.00

Primary Supervisor:  

Co-supervisors: 

Primary Supervisor Department: Patient Experience and Participation Team (PET)

Closing date:  FILLED

Te Kupenga Hauora Māori (TKHM) ** FILLED **

Medical and health

Faecal Incontinence in NZ: Evaluating comparative outcomes for Māori

Discipline:  Public Health    

A large population study has demonstrated a high prevalence of faecal incontinence in NZ adults. Analysis by ethnicity identified that the prevalence was 50% higher in Māori than non Māori. About two thirds of this discrepancy was attributable to a lower deprivation index and co-morbidities in the Māori population but this did not account for all the difference. There has been no attempt to tease out the reasons for this difference and the interactions with other clinical variables needs further assessment.

This summer studentship will involve:

a.  further analysis of the dataset from the national study

b.  a literature search of ethnicity and Faecal Incontinence

c.  assisting in the preparation of the manuscript for publication

Skills to be learnt:

a.   Analysis of large databases

b.   Critical appraisal of literature

c.    Academic writing

d.    Communication and coordination between different investigators in research

Eligibility criteria - experience with epidemiology or biostatistics would be useful.  Applicants should acknowledge interest in eliminating Māori health inequities and Māori health research workforce development

This is a 10 week research project from early December to February - UoA eligibility criteria valid (e.g., Medical students in year 2 and 3 of their study) Value $6000.00

Primary Supervisor:     Prof. Ian Bissett (Dept. of Surgery) 

Project Advisor:           Prof. Papaarangi Reid (TKHM)

 

Closing date:  FILLED