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["Firstname","Host supervisor title","Host supervisor first name","Host supervisor last name","Host supervisor email","Host address1","Host address2","Host postcode","Host town","Host country",{"$nulls":7},"title"]
["u05ca8","Prof","Alex","Bune","abune@med.usyd.edu.au","Royal North Shore Hospital","Reserve Rd  St Leonards","Reserve Rd  St Leonards","Sydney","Australia",{"$nulls":7},"A retrospective analysis of 30 day outcomes following transcatheter aortic valvw implantation at Royal North Shore Hospital, Sydney, Australia","Introduction  Valvular heart disease (VHD) encompasses a number of common cardiovascular conditions that accounts for 10-20% of all cardiac surgical procedures in developed countries. A better understanding of the history of VHD along with major advances in diagnostic imaging, interventional cardiology and surgical approaches have resulted in accurate diagnosis and appropriate selection of patients for therapeutic interventions. Decision making for intervention is complex since VHD is often seen at an older age, particularly in developed countries where degenerative valve disease is most common, resulting in a higher frequency of comorbidity leading to increased risk of intervention. Because of this complexity, in 2012 the European Society of Cardiology published guidelines on the management of valvular heart disease.   The aim of this audit is to compare the management of aortic and mitral valve disease management to that of the newly published guidelines to highlight any areas of discrepancies, which could improve the management of VHD in Syndey Royal North Shore Hospital.   Methods  Using the hospitals database to select patients with aortic or mitral valve disease, and attend clinic for newly presenting patients, I will use the patientsâ€™ notes to assess their management by the cardiologists in valve clinic, assess how this is organised, assess the criteria for review and criteria for surgery. A detailed outline of this is given in the European guidelines with particular reference to both aortic and mitral disease. Indications for valve replacement are divided systematically into classes I, IIa, IIb and class A, B, C within this depending on imaging and severity of symptoms. This evidence is taken from a variety of randomised controlled trials to assess the need for surgery and follow up in the most clinically appropriate manner. The size of this audit will not be clear until arrival at the hospital as it is dependent on the number of patients seen for VHD and how many newly presenting patients there is.  Outcomes   I hope to highlight areas of these newly published guidelines that are not being followed in Sydney Royal North Shore hospital and could therefore provide an increased quality of care for those being treated for VHD. Furthermore I hope to publish a simple, easy to follow flow-chart with the help of the European guidelines and the evidence found to simplify the complex process of managing VHD.  Literature  Vahanian A., Alfieri O., Andriotti F., Antunes M.J., Price S. et al. Guidelines on the Management of Valvular Heart Disease: ESC/EACTS Guidelines. European Heart Journal 33: 2451-2496, 2012.  Maganti K., Rigolin V.H., Sarano M. E., Bonow R. O. Valvular Heart Disease: Diagnosis and Management. Symposium of Cardiovascular Diseases. Mayo Clinic Proceedings 85(5): 483-500, 2010.  Bonow R. O., Carabello B. A., Chatterjee K., Faxon D. P., Freed M. D. et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology 48(3): 1-148, 2006.   ","approved",null,"2013-02-15T15:54:26"]
["u01asa9","Miss","Leoine","Alley","Leonie.Alley@bopdhb.govt.nz","Cameron Road","Private Bag 12024",null,"Tauranga","New Zealand",{"$nulls":7},"Trends of acute orthopaedic admissions at Tauranga Hospital","Introduction   There is accumulating evidence that delays in restarting pre-operative medications can increase peri-operative morbidity in a number of settings, including atrial fibrillation post cardiac surgery. Atrial fibrillation (AF) is a common arrhythmia and is a recognized complication of cardiac surgery (Kaireviciute, Aidietis et al. 2009).  Timing of beta-blockers has been shown to be very important in the development of post-operative AF after Coronary Artery Bypass Grafting. It has been shown that patients who only received pre-op or post-op beta-blockers have a higher incidence of developing AF in comparison to patients who had beta-blocker treatment prior to and after surgery (Haghjoo 2012).  Amiodarone, statins and calcium channel antagonists have all been shown to reduce the risk of developing post-operative AF (Kaireviciute, Aidietis et al. 2009).  Interestingly, there is evidence that statins have a protective effect in the development of postoperative AF following Coronary Artery Bypass Grafting; however how statins influence the incidence of AF after other cardiac surgeries including valve replacements, is less clear (Liakopoulos, Choi et al. 2008)â€\u009d   Methods   Retrospective case note review will be undertaken. Data will be collected and assessed to determine â€¢ What preoperative medication was taken â€¢ When pre-op medications were restarted following different types of cardiac surgery (assessing the delay) â€¢  The impact this has on the development of post-op atrial fibrillation.  The medications that will be considered include beta-blockers, calcium channel antagonists, amiodarone and statins (the latter being especially interesting in view of the above).  Overall, I hope to establish whether or not a delay in restarting medication will increase possibility of developing AF post cardiac surgery   Outcomes   Previous studies have shown that having peri-operative prophylaxis reduces the risk of developing AF in comparison to having only pre-op or post-op.  Therefore, based on the evidence already collected in this area, I would expect the results to show that a delay in restarting medications would increase the risk of developing AF post cardiac surgery.  Literature  HAGHJOO, M., 2012. Pharmacological and nonpharmacological prevention of atrial fibrillation after coronary artery bypass surgery. The journal of Tehran Heart Center, 7(1), pp. 2-9.   KAIREVICIUTE, D., AIDIETIS, A. and LIP, G.Y.H., 2009. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. European heart journal, 30(4), pp. 410-425.   LIAKOPOULOS, O.J., CHOI, Y., HALDENWANG, P.L., STRAUCH, J., WITTWER, T., DÃ–RGE, H., STAMM, C., WASSMER, G. and WAHLERS, T., 2008. Impact of preoperative statin therapy on adverse postoperative outcomes in patients undergoing cardiac surgery: a meta-analysis of over 30 000 patients. European heart journal, 29(12), pp. 1548-1559.   ","approved","Ensure will have access to cardiac surgical patients at host institution","2013-02-18T19:18:53"]
["u18la9","Dr","Grant ","Stone","Grant.Stone@mater.org.au","Mater Childrens hospital","South Brisbane","Qld 4101","Brisbane","Australia",{"$nulls":7},"Bronchiolitis. An investigation into the value of nebulised 3% hypertonic saline in the management of bronchiolitis","Introduction   Currently there are no clear cut guidelines on the management of acute bronchiolitis in an emergency paediatric setting. The aim of this elective is to design a protocol for a randomised control trial with the idea of a host hospital- the Mater childrenâ€™s hospital in Brisbane carrying out the trial. There is already some research in this area;  however no significant conclusions could be drawn from the emergency settings. This protocol could not only be utilised in Australia but also in the NHS as the UK have no definitive management guidelines, and are querying the existing protocol.   The Mater childrenâ€™s hospital will be an ideal institution for an RCT because the emergency department sees around 45000 patients per annum.  Methods   The following issues will be considered:  1. Which indices should be used in clinical evaluation of this treatment?  2. Is there potential for a primary outcome to measure? 3. Is this form of treatment restricted to the hospital emergency care or ward setting, or is there potential for it to be utilised in a home setting? 4. How may tolerability of the treatment be measured? 5.  Is there a requirement for a control \"no nebuliser\" group? 6. How can an economic evaluation be undertaken? 7. How may knowledge be translated during and following the trial?  Discussion of current management with emergency department staff and respiratory physicians will take place, in order to find out what they perceive as being important factors in the holistic management of paediatric acute bronchiolitis.  A protocol design and a summary of the field will be used for presentation of information. In terms of ethical approval, this project is of low risk so will not need assessed by a council.  Outcomes   Paediatrics is a real passion, I hope to pursue a career in it so any experience will be excellent. I have a Bsc in Medical Biology, I hope to combine the skills I learned in my degree with my skills I have learned throughout my medical degree and produce a project that will be of use. I hope to design a protocol that can be directly applied to my host institution and used to conduct a randomised control trial. This could assist in developing a definitive management guideline. Should this guideline result in a reduction in hospital stay it would not only benefit the hospital in terms of cost, but it would also be beneficial to patients on an individual level. I feel if I could contribute even a small amount to improving the care of children and infants in the future it be a truly satisfying experience. I understand hospitals are terrifying places for both children and parents, so in designing a protocol, I hope to take the first step in establishing definitive management of children with acute bronchiolitis in an emergency setting.   word count: 460  Literature  1) Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006458. DOI: 10.1002/14651858.CD006458.pub2.  2) http://www.library.nhs.uk/DUETs/ViewResource.aspx?resID=411069 3) http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=1295&EncHid=&modid=&compid=','1295det'     ","approved",null,"2013-02-15T16:39:51"]
["u17sa8","Dr","Michael ","Murphy","mmurphy6@partners.org ","Child Psychiatry Service, YAW 6A","Massachusetts General Hospital","MA 02114","Boston","USA","(617) 724-3163","(617) 726-5567",{"$nulls":5},"Using a brief parent-report measure to assess outcomes for children and teens with ADHD at an out patient clinic in Boston, USA","Introduction   The Paediatric Symptom Check-list (PSC) is a screening tool of child psychosocial functioning that has a global score and sub-scale scores in three areas; internalizing, externalizing and attentional problems (1). Recent studies have shown that the PSC sub-scales and global scores have registered significant improvement in outpatients treated from intake and 3- and 6-month follow-up suggesting there is potential for the PSC to track progress and outcome of treatment (2, 3). This study will evaluate whether the previously validated externalizing sub-scale of the PSC check-list can be used to assess the impact of interventions for children referred for treatment of externalizing disorders at an outpatient Child and Adolescent Psychiatry clinic at Massachusetts General Hospital (MGH).  Methods   I will analyse cross sectional and longitudinal outcome data on the PSC externalising sub-scale (PSC-ES) at the beginning of outpatient mental health treatment and at subsequent 3-month follow-up appointments. Data has been collected in a Child and Adolescent Psychiatry Clinic over the course of a four year period and ethical approval will not be required for this study. Throughout this period, collection of an electronic Outcome Rating Form (e-ORF) which contains the PSC, the Brief Psychiatric Rating Scale for Children (BPRS-C) and the Childrenâ€™s Global Assessment Scale (CGAS), has been required for all cases at intake and every three months thereafter to track the outcomes of treatment. I will analyse the externalizing sub-scale and examine treatment of a sample of 1, 586 children attending the outpatient clinic. Preparation of the dataset and running the analysis will be completing over a 5-week period. Analysis will compare the change in PSC-ES scores from intake to 3-month follow-up for externalising and non-externalising patients. Intake scores on the BPRS-C and CGAS will provide comparisons to PSC scores.   Outcomes   The rate of agreement between case classifications based on the PSC-ES and cliniciansâ€™ externalising diagnoses using the DSM-IV, and the degree of improvement on the PSC externalising sub-scale after three months for patients with externalising vs. non-externalising diagnoses in a child psychiatry outpatient clinic.   Literature  1. Jellinek MS, Murphy JM, Little M, Pagano ME, Comer DM, Kelleher KJ. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: A national feasibility study. Archives of pediatrics & adolescent medicine. 1999;153(3):254-260. 2. Kolko DJ, Campo JV, Kelleher K, Cheng Y. Improving Access to Care and Clinical Outcome for Pediatric Behavioral Problems: A Randomized Trial of a Nurse-Administered Intervention in Primary Care. Journal of Developmental & Behavioral Pediatrics. 2010;31(5):393-404. 3. Murphy JM, Kamin H, Masek B, et al. Using brief clinician and parent measures to track outcomes in outpatient child psychiatry: Longer term follow-up and comparative effectiveness. Child and Adolescent Mental Health. 2012;doi: 10.1111/j.1475-3588.2011.00642.x.    ","approved","3 months seems a short period to assess outcome if feaseble with data set she is looking at allows 6 month or longer outcome measure or 3/6/12 month changes to PSC-ES score would seem more robust measure.  ","2013-02-13T17:57:03"]
["u12db8","Prof","Dr JW ","Roos-Hesselink"," j.roos@erasmusmc.nl","Thoraxcentre","Erasmus MC, Room Ba 583a, 's Gravendijkwal 230","3015CE","Rotterdam","The Netherlands","+31 10 7032432","+31 10 7035498",{"$nulls":5},"A Retrospective Study of Patients with Ebstein's Anomaly at the Erasmus MC","Introduction   Ventricular septal defect (VSD) is the most common congenital heart disease, occurring in 34% of children with a congenital heart disease. The incidence of VSD varies depending on diagnostic tools used but is generally reported as around 3 per 1000 live births worldwide.(1) They can vary in size and severity and may close spontaneously or require major surgery to repair. Complications later in life may occur in patients with a VSD such as infective endocarditis.(2) It is unclear with current research what the incidence of these complications is, whether further surgery is required and how life limiting the disease is. This information would be useful for patient education and risk management. This project will aim to determine the incidence and types of complication associated with isolated VSD after patch closure of the VSD through sternotomy with cardiopulmonary bypass.  Methods   Using surgical records collected between 1990 and 2010, the incidence of isolated VSD requiring surgery will be derived. This data is stored in a MicrosoftÂ® Access 2000 database and any data gathered will be added to it. Given the size of the database and the published incidence of severe VSD, the patient numbers are expected to be around 200. Patient's hospital numbers will be recorded and their notes will be obtained. Rates of infective endocarditis, arrhythmias or other admissions for a cardiac cause will be collected retrospectively from their hospital records. The research database is in English but the hospital records may be in Dutch and English so this may be a barrier which will be overcome by learning basic Dutch before my elective and also with the help of my colleagues in the Erasmus MC. The study proposal will be submitted to the Erasmus University Medical Center review board to receive ethical review prior to the beginning of the project.  Outcomes   I will be able to gain an insight into medical care in the Netherlands. This will be beneficial for me because I am considering spending a period of time working in Europe in the future. The cardiology team that I will be attached to produces a lot of high quality research and my supervisor feels that analysing this existing data will be very helpful to the team and will be of benefit to me. It will allow accurate, local data to be given to patients and could contribute to a larger study which may have an impact on a larger scale.  References  (1) van der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, et al. Birth Prevalence of Congenital Heart Disease Worldwide: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2011 11/15;58(21):2241-2247. (2) Penny DJ, Vick III GW. Ventricular septal defect. The Lancet ;377(9771):1103-1112.  ","approved",null,"2013-01-28T20:40:17"]
["u38ab8","Prof","Jaishanker ","Raman ","JAI_RAM@rush.edu","Rush University Medical Centre, Department of Cardiac Surgery ","1653 W Congress Parkway ","IL 60612","Chicago, Illinois","United States of America ","001-312-5636672","001-312-9423666","Rush University Medical Centre, Professional Building, Suite 1156 ","1725 W Harrison Street","IL 60612","Chicago, Illinois ","United States of America ","Neurological risk in urgent valve replacement for infective endocarditis with cerebrovascular complications at Rush Medical Centre, Chicago","Introduction  In most developed countries the elderly population is one of the fastest growing.  One example is the USA where census suggest that by 2050, 21% of its population will be 65 years or older.  This is a 147% rise from 2000;  in comparison the overall population will have increased by 49%.  The increasing numbers of elderly will result  in more of them accessing medical care including surgical treatments. While it has been shown that octogenarians are surgically at a higher risk with poorer outcomes with cardiac surgery (1), and in fact with any surgery, many would also be expected to have independent and active lifestyles with good quality of life measures post surgery (2).  Improved health post surgery will in the long term be more cost effective along with a happier healthier older population.  With continually improving surgical techniques including minimally invasive approaches to valvular surgery and improved intra and postoperative care, it is likely that outcomes with elderly patients have improved over the years and are continuing to do so.    Aim  To compare patient demographics and medical risk factors, the indications and types of cardiac surgery, the surgical approaches and the outcomes with cardiac surgery on patients >/= 80 years of age over two time periods-between Jan to Dec 2002 and Jan-Dec 2012.    Methods  All patients >/= 80 years who underwent any cardiac surgery (isolated single or combined operations, open or minimally invasive procedures) in the year 2002 and 2012 will be identified from the Hospital Databases.  Background demographics including age, gender, other pre-existing medical complications like hypertension, diabetes, previous surgery, BMI, smoking will be collected (from the database or from case note reviews).  Details of the procedures performed, early post operative outcomes, including length of hospital stay, any complications (e.g. myocardial infarction, cardiac failure, stroke, arrhythmias) will be collected and compared to see if there are any statistical differences between the two time periods.  If there are sufficient numbers, the outcomes will be stratified by indications / or types of procedures performed.  If it is possible to look at longer term outcomes (from follow-up appointments) then these too will be compared.  I am also hoping to discuss with the staff in the unit their attitudes to surgery in the older patient and if this has changed over the years.       Outcomes   It is anticipated that the results will show that cardiac surgeons are more willing to consider surgery in the octogenarian (and above) population and that the outcomes with surgery are better in 2012 as compared with 2002.  I will aim to quantify this difference if it is confirmed.  Staff attitudes and any differences (for e.g. between medical and nursing staff) will also be analysed.      Literature  1. Bhamidipati CM et al. Outcomes and cost of cardiac surgery in octogenarians is related to the type of operation: a multi-institutional analysis. Ann Thorac Surg 2011 Feb: 91(2): 499-505 2. Alexander KP et al. Outcomes of cardiac surgery in patients > or =80 years: results from the National Cardiovascular Network. J Am Coll Cardiol. 2000Mar 1; 35(5): 731-8.  ","approved","In discussion new technics developed over the period of the 10 years,both in cardiology and cardiac surgery and their influence on patient selection ( bias) have to be taken into account.","2013-01-30T16:45:44"]
["u01elb9","Dr","Irena","Nulman ","irena.nulman@sickkids.ca","The Hospital for Sick Children ",null,null,"Toronto","Canada",{"$nulls":7},"Neurodevelopmental Outcomes in Children Following, in Utero, Exposure to Valporic Acid - A Systematic Review","Introduction  The â€˜Motherrisk Programâ€™ is a clinical research and teaching programme based in the Hospital for Sick Children in Toronto, Canada. It provides advice and support for pregnant woman and healthcare professionals with regards to drug exposure during pregnancy and also provides counselling to woman with substance misuse issues and HIV. The programme is currently involved in a study into the reproductive safety of antiepileptic drugs. It is widely known that antiepileptic drugs are teratogenic, however many women need to continue the drugs during pregnancy. A preliminary study carried out in Israel suggests that developmental outcomes, such as fine and gross motor function in children exposed, in utero, to Topiramate are significantly poorer than those in a control group.Â¹.  As part of my elective I aim to do a literature review looking at the neurodevelopmental outcomes in children following exposure to antiepileptic drugs during pregnancy.  I also hope to do a review of the services for women with epilepsy at the Hospital for Sick Children in Toronto (including follow up of the children), and compare these to services at Aberdeen.       Methods  A relevant literature search and systematic review on antiepileptic drugs in pregnancy to review the following questions: â€¢ Effect of single antiepileptic drugs (primarily valproic acid and topiramate) on neurodevelopmental outcomes in children  â€¢ Effect of multiple antiepileptic drug combinations on neurodevelopmental outcomes in children  If time permits I will also evaluate outcomes for pregnant women with epilepsy including risks of seizures during pregnancy, association with any other adverse obstetric outcomes.  Databases: Medline, Embase, PubMed                                                                                                                          Search Engines: Google Scholar                                                                                                                                 Key Words: â€œantiepilepticsâ€\u009d, â€œpregnancyâ€\u009d, â€œchild developmentâ€™â€™                                                                    I will present my findings in appropriate text and graphs. I expect to get many relevant search returns however I aim to narrow these down by focussing primarily on exposure to valproic acid and topiramte. As well as completing my project I will also be attending educational events including medical case discussions, lectures and toxicology clinics. This will give me the opportunity to review the services including referral pathways, preconception care, evaluation of the neonates and children, and review the unit guidelines.  I hope to look at the services in Aberdeen first to allow a descriptive comparison.      Outcomes Undertaking my elective with the Mother Risk program will give me the chance to experience healthcare in a different setting and give me the chance to focus on a particular area of medicine that I am interested in pursuing in the future. I also hope that through the completion of this project, I can contribute somewhat to the larger ongoing study that is currently being carried out by the Motherrisk Programme and ultimately help the many women and healthcare professionals throughout Canada who turn to the program for help and advice.  References 1. Reproductive Toxicology. 34(3):308-11, 2012 Nov. 2. Current Opinion in Neurology: April 2005 - Volume 18 - Issue 2 - p 135-140  ","approved",null,"2013-03-08T14:05:09"]
["u24sb7","Dr","Wendy ","Watson","w.a.watson@abdn.ac.uk","Aberdeen Royal Infirmary",null,null,"Aberdeen","UK",{"$nulls":7},"The management of delirium in geriatric patients with hip fracture","Introduction  Alzheimerâ€™s disease (AD) is now the most common form of dementia, responsible for around 70% of all cases. Age is a major risk factor for AD, with the risk of developing the disorder increasing twofold every five years following the age of 65. In addition evidence from epidemiological studies have demonstrated that cardiovascular risk factors, such as smoking, hypercholesterolaemia and diabetes, are also associated with AD. In fact patients with type II diabetes have a two-fold increased risk of developing AD compared to healthy individuals. Subsequently this decline in cognitive function may have an effect on day-to-day functioning and their ability to adequately manage their Diabetes in an outpatient setting. Therefore this project will focus on the overlap between Diabetes and AD and the impact this has on patient care.   Methods  The details of my project have not been finalised however I will be based in the Diabetes department at ARI. I plan to undertake a clinical project relating to my previous intercalated degree last year. Using the available data set I will record the number of diabetic patients with documented cognitive impairment as well as using a questionnaire-based screening tool such as the mini mental state examination (MMSE) to determine cognitive function in patients attending the outpatient clinic.  Outcomes  I hope to achieve further insight into this interesting topic and gain some clinical and research experience.   Literature Sims-Robinson, C. et al. 2010, \"How does diabetes accelerate Alzheimer disease pathology?\" Nature Reviews Neuroscience, vol. 6, no. 21, pp. 551-559. Li, L. & Holscher, C. 2007, \"Common pathological processes in Alzheimer disease and type 2 diabetes: A review,\" Brain Research Reviews, vol. 56, pp. 384-402 Biessels, G.J. & Kappell, L.J. 2005, \"Increased risk of Alzheimer's disease in type II diabetes,\" Biochemical Society Transactions, vol. 33, pp. 1041-1044     ","approved",null,"2013-02-15T01:15:10"]
["u01rtb9","Dr","D","Saraswathy","e_student@hkl.gov.my ","Hospital Kuala Lumpur",null,50586,"Kuala Lumpur","Malaysia"," +60 (03) 2921044","+60 (03) 32989845",{"$nulls":5},"Audit Pain as the fifth vital sign","Introduction  Head injury remains a leading cause of death and severe disability in young adults throughout the world (1) and its management presents a complex and costly challenge to healthcare systems everywhere. Approximately 1 million people attend an emergency department in the UK due to head injury every year and severe traumatic brain injury, defined as Glasgow Coma Score (GCS) <9, occurs in approximately 11,000 people per year in the UK and has a mortality rate approaching 50% (2). Most of these cases are a direct result of road traffic accidents (RTAs) (3), which accounted for 14% of all trauma admissions in Scotland in 2011 (4). Despite these somewhat alarming figures, the total number of deaths due to transport accidents in Scotland in 2011 was 211 (5) and accidental death (which includes RTAs) isnâ€™t included on the list of the ten most common causes of mortality in Scotland (6). This is in stark contrast to Malaysia where the incidence of RTA is amongst the highest in the world (~22 deaths per 100,000 population) and was raked as the third most common cause of hospitalisation (7) and ninth commonest cause of death in 2008 (8) . Despite this (and the fact that head injury accounts for 48.2% of trauma deaths (9)) there is a lack of publications addressing management of traumatic brain injury in Malaysia.  Methods  This project will be carried out at the Emergency Department of Hospital Kuala Lumpur (HKL). Anonymised data from admissions over a set period (6 months prior to arrival) concerning traumatic brain injury will be provided by a Data Manager and the Malaysian National Trauma Database. Corresponding UK data will be obtained from the Scottish Trauma Audit Group.   It is proposed to compile the following information for quantitative comparison between the two institutions using t-tests and chi squared tests where appropriate: â€¢ Demographics â€“ Age, Gender. â€¢  Injury â€“ date, time, mechanism, method of transfer, time admitted to ED, Trauma team response. â€¢ Hospital Assessment/Intervention â€“ classification of TBI, radiological examination, time of surgical intervention. â€¢ Outcomes â€“ number of days in hospital/ICU, mortality, date of discharge, follow up and complications.  Analytical software SPSS will be used to store and compare the data.  All data stored will be anonymised.    Outcomes  I hope to produce work which is useful to both institutions whilst gaining experience of emergency medicine within a different healthcare system and an appreciation of the difficulties and complexities of providing trauma care in urban area of a developing nation.  Literature (1) Pickett W, Ardern C, Brison RJ. A population-based study of potential brain injuries requiring emergency care. Canadian Medical Association Journal 2001 August 07;165(3):288-292.  (2) Hammell CL, Henning JD. Prehospital management of severe traumatic brain injury. BMJ 2009;338:09/02/2013.  (3) Wasserberg J. Treating head injuries. BMJ 2002;325(7362):454-455.  (4) Scottish Trauma Audit Group. Audit of Trauma Management in Scotland 2012. 2012.  (5) General Register Office for Scotland. Accidental Deaths - List of Tables and Charts. 2013; Available at: http://www.gro-scotland.gov.uk/statistics/theme/vital-events/deaths/accidental-deaths/list-of-tables-and-charts.html. Accessed 11/02/13.  (6) ScotPHO. Deaths: most frequent causes of death. 2012; Available at: http://www.scotpho.org.uk/population-dynamics/deaths/data/top-10-causes-of-death. Accessed 02/11, 2013.  (7) Ministry of Health Malaysia.  Annual Report 2008 2008.  (8) World Health Organisation.  Mortality estimates by cause, age, and sex for the year 2008 2008.  (9) Sim S, Lim S, Lee H, Liew D, Wong A. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward. The medical Hournal of Malaysia 2011;66(2):138-41.    ","approved","This project is supported. However, as proposed it is an expansive piece of work and I would advise that it becomes more focused. ","2013-02-22T15:03:55"]
["u09lc9","Miss","Aneth","Nkya","international@kcmc.ac.tz","Kilimanjaro Christian Medical Centre","P.O. Box 3010",null,"Moshi","Tanzania","255-027-2754377/ 80   ","255-027-2754381       ",{"$nulls":5},"A comparison of the epidemiology and outcomes in echocardiography for suspected heart failure: between Scotland and Tanzania","Introduction  This project aims to compare the diagnostic outcomes of echocargiography for suspected heart failure in Raigmore Hospital, Scotland, and Kilimanjaro Christian Medical Centre, Tanzania.  Patients with clinically suspected heart failure often undergo echocardiography to examine ventricle and valve function. Usually, there is expected to be LV dysfunction. However, it is not uncommon to find preserved LV function, which may affect the final diagnosis.  Method  The main diagnostic symptoms for heart failure are dyspnoea (at rest, walking or exertion) and orthopnoea. It is assumed that the majority of patients with clinically suspected heart failure sent for echocardiogram will have these symptoms. In order to test this hypothesis, a note of clinical detail leading to echo prescription will be made. For Raigmore data, the record database will be refined to show only echocardiograms which were undertaken for suspected heart failure. From these records the findings, left ventricular function and final echo diagnosis of 40 patients will be noted.  For KCMC data, records will be searched manually for 40 patients with suspected heart failure prior to echocardiogram. From this, the outcome as noted by the radiology department and final diagnosis will be extracted.  The data from each hospital will be compared for clinical symptoms, LV function and final diagnosis. Any trends present will be examined in more detail with an aim to deduce a reason for this.   Outcomes  I expect to find that: 1. Patients sent for echocardiograms in Tanzania will have more symptoms or more severe clinical signs before being sent for echocardiogram than in the UK, as the investigation is not so readily available. 2. The majority of patients who have suspected heart failure will have that final diagnosis. However, I also expect to see some unusual outcomes. This may be especially relevant in Tanzania, where different genetics and environment might predispose them to conditions I will find unfamiliar. 3. The UK will have a higher rate of retained LV function, as patients are more likely to be sent for investigation at an early stage in the disease. (For a similar reason as 1.) 4. The project should allow for clinical experience during my time in Tanzania and an opportunity to experience a different culture and healthcare system.  References  http://www.aafp.org/afp/2000/0301/p1319.html   Soufer R, et al. Intact systolic left ventricular function in clinical congestive heart failure. The American Journal of Cardiology [Online]. April 1985; 55 (8) : 1032-1036. Available from: http://www.sciencedirect.com/science/article/pii/0002914985907416   [Accessed 1.4.13]  ","approved",null,"2013-04-03T13:21:58"]
["u01vbc9","Dr","Debbie","Leach","Debbie.Leach@easternhealth.org.au","Boxhill Hospital, 51 Nelson Road",null,"VIC 3128","Boxhill","Australia",{"$nulls":7},"Assessment and management of pain in paediatric fractures in Boxhill Hospitals Emergency Department"," Introduction Boxhill Hospital in Melbourne can receive over 46,000 admissions annually to its emergency department. A large percentage of these patients will experience pain, of varying degrees, and effective management of pain can have significant effects on reducing morbidity. Reassessment of pain following analgesia is an important part of patient care that is not always carried out.  This project will look at the management of pain in certain diagnostic groups in Boxhill Hospital, Melbourne and assess the departmentâ€™s adherence to local pain management guidelines.  Methods Analysis of pain management in patients admitted to the emergency department over a one year period. Two diagnostic groups of patients, namely abdominal pain and limb pain will be the focus for the audit.   Various factors will be looked at including adherence to local guideline recommendations, analgesia given prior to arrival in the emergency department and type and mode of analgesia administered (provided all of this information is available). The Eastern Health Emergency Department has set out a guideline for pain management that states how different severities of pain are managed. It states the medication options available as well as adjunct therapies to coincide with these medications such as elevation of limbs, splinting and topical anaesthesia. I will look at the management of pain in these two groups of patients and see how closely their management adheres to this guideline.   Outcomes The number of admissions to the emergency department with abdominal and limb pain.  The number of patients that received analgesia.  Type and route of analgesia administered.  Whether or not adjunct therpy was used, and if it was, which type.  The number of patients having pain reassessed following administration of analgesia.  Literature Australian Emergency Department Pain Management Audit, 2007.  College of Emergency Medicine, Guideline for the Management of Pain in Adults  Eastern Health Emergency Department Analgesia Guideline, July 2011  ","approved",null,"2013-04-09T20:43:50"]
["u02agc8","Dr","Kenneth  ","Wong","kkywong@hku.hk","The Duchess of Kent Children's Hospital at Sandy Bay ","12, Sandy Bay Road, PokfuLam, Hong Kong ",null,"Hong Kong","Hong Kong","(852) 2817 711",null,"Dr. Kenneth Wong","Clinical Associate Professor Department of Surgery The University of Hong Kong ",null,"Hong Knog","Hong Kong","The  Sensitvitiy of Oesophageal Intraluminal Impedance Monitors in the Diagnosis of Gastroesophageal Reflux Disease in Children","Introduction   The incidence of Gastroseophageal reflux disease (GORD) is a very common condition in children. A study by Nelson et al1 determined the incidence was 12.3% in children under one year old. 24-hour Oseophageal pH monitoring is the gold standard diagnostic tool and the mainstay of diagnosis. It measures the pH of reflux episodes, the duration and number of episodes. However its sensitivity and specificity is not well established and this technique is prone to misclassification2. pH monitoring also has significant limitations due to its inability to detect nonacidic retrograde bolus movement2. Mitchell et al3 found that the majority of reflux episodes went undetected by standard pH probe monitoring. Oesophageal Impedance monitoring detects GORD episodes based on changes in electrical resistance to the flow of an electrical current between 2 electrodes placed on a probe inserted to the childâ€™s Oesophagus when a liquid, semisolid, or gas bolus moves between them2.  This technique is superior to standard pH monitoring in a variety of ways:  â€¢ It is able to detect reflux into the Oesophagus regardless of its pH value.  â€¢ It is able to differentiate swallowing (anterograde flow) from authentic GOR (retrograde flow).   â€¢ It can differentiate whether the reflux is liquid, gas, or a mixture of both liquid and gas.   â€¢ It can detect accurately the height of the reflux2  Aims  The aim of this study is to determine the sensitivity and specificity of using pH monitor alone compared to dual studies (pH monitor and Oesophageal Impedance).  Methods   I will carry out a retrospective study of patients who have been referred to the surgical outpatient clinic of The Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong with suspected GORD. Patients will have a probe inserted into the oesophagus that measures impedance as well as pH. The instrument will record information on the patients reflux (details of what each monitor records is stated above). The host supervisor is recruiting patients and is it believed that by September 2nd 2013 between 20-30 patients will have undergone the diagnostic test. Recorded data will then be analysed and area under the receiver operator characteristic (ROC) curve will summarize the test's diagnostic ability. Ethical approval is required by the Hong Kong University Institutional Review Board and will be sought in the next month.  Outcomes   It is hoped the results of the study will help clarify the clinical worth of Oesophageal impedance in GORD and add to the growing body of evidence that this technique is superior to existing pH monitors. I also hope you gain first hand experience of healthcare in Hong Kong and pursue my fervent interest in Paediatric Surgery and medical research.  Literature  1. Nelson SP, Kothari S, Wu EQ, et al. Pediatric gastroesophageal reflux disease and acid-related conditions: trends in incidence of diagnosis and acid suppression therapy. J Med Econ 2009;12:348â€“55 2. Mousa, Hayat M., et al. \"Esophageal impedance monitoring for gastroesophageal reflux.\" Journal of pediatric gastroenterology and nutrition 52.2 (2011): 129. 3. Mitchell DJ, McClure BG, Tubman TR, et al. Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants. Arch Dis Child 2001;84:273â€“6.  ","approved","Clinically useful study in a major teaching centre","2013-02-14T15:18:06"]
["u03pdc8","Dr","Sara","Pai","spai@jhmi.edu","Johns Hopkins Medical Institutions","Sidney Kimmel Comprehensive Cancer Center- 601 N. Caroline Street","MD 21287","Baltimore","United States",null,null,"Aberdeen Royal Infirmary",null,null,"Aberdeen","Scotland","Immunotherapy in HPV associated head and neck cancer: Does the addition of an IL-10 blocking antibody enhance the antitumour effect of immune checkpoint blockade and therapeutic vaccine?","Introduction   Head and neck squamous cell carcinoma (HNSCC) is a worldwide public-health problem, with over 500,000 cases reported annually (1). In the past decade, significant evidence has established human papillomavirus (HPV) as the causative agent in a growing proportion of incident cases of oropharyngeal cancers (2). HPV-associated HNSCC (HPV-HNSCC) arise from the deep crypts within the lymphoid tissue of the tonsil and base of tongue and the majority can be distinguished from tobacco-related head and neck cancers by the characteristic infiltration of lymphocytes in the stroma and tumour nests (3). Nevertheless, despite this profound inflammatory response within the tumour microenvironment, the virus and its associated cancer cells are able to evade immune surveillance, persist, and grow. The group I shall visit was the first to report on the role of the Programmed Cell Death-1 immune checkpoint pathway as a mechanism of immune resistance in HPV-HNSCCs (3). The objective of this proposal is a natural extension of their initial work and this project focuses on discovering immune biomarkers associated with HPV-HNSCC in the setting of immune checkpoint activation.   Methods   We plan to perform immunocytochemical and/or multi-color flow cytometry staining to evaluate the frequency and distribution of the subset populations of immune cells (T cells, macrophages, dendritic cells, and myeloid-derived suppressor cells (MDSC)) and associated expression of immune checkpoint receptors and ligands in the tumour microenvironment in a cohort of HPV-HNSCCs. We then will correlate the expression of detected immune cell biomarker(s), both by the tumour and immune cell infiltrates, with overall and recurrence free survival to determine whether a single biomarker or a panel of biomarkers can be used as a prognostic biomarker for HPV-HNSCC.   Outcomes   Immune biomarker expression within the tumour microenvironment can potentially serve as a surrogate marker of an active anti-tumour response. Therefore, it might be predicted that, even though this immune checkpoint resistance mechanism ultimately allowed tumour to persist, tumour growth may be partially restrained, leading to improved survival relative to patients with little or no anti-tumour response. We expect that immune cell biomarker(s) expression will be associated with improved overall and recurrence free survival and expect that the lack of expression of the immune cell biomarker(s) may predict that a patient will have a worse prognosis.   Literature  1. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001;94(2):153-6.   2. Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and unrelated oral squamous cell carcinomas in the United States. J Clin Oncol 2008;26:612-619.  3. Lyford-Pike S, Pardoll DM, Pai SI. Evidence for a role of the PD-1:PD-L1 pathway in immune resistance of HPV-associated head and neck squamous cell carcinoma. Cancer Res 2013 [Epub ahead of print].   ","approved",null,"2013-02-13T02:57:36"]
["u02rsc9","Dr","Elizabeth","Hennessy","e.r.hennessy@abdn.ac.uk","Royal Aberdeen Children's Hospital, Westburn Road, Foresterhill  ",null,"AB25 2ZG","Aberdeen","Scotland",{"$nulls":7},"Introduction of continuous subcutaneous insulin infusion (CSII) to NHS Grampian","Introduction  In 2011 the Scottish government agreed to invest an extra Â£1.5 million to provide insulin pumps to 480 young people with type 1 diabetes.(1) In NHS Grampianâ€™s Annual Review of September last year (2012)  it was stated that only 7.74% of people aged under eighteen years have access to insulin pump therapy in Grampian.(2)   The target set for the health board was to increase insulin pump provision to 25% of people under eighteen by March 2013.(2) This represents significant financial increase in the diabetes service, considering that the annual cost of this therapy is on average between Â£2500-2800, with annual supply costs (excluding insulin) of about Â£1500.(3) There is some disagreement within the literature as to the success of insulin pump therapy. Whilst some studies find that the pump improves glycaemic control,(4) others conclude that, although having positive effects on quality of life, there is little evidence that control is enhanced when compared with injections.(5) I plan to spend my elective next year investigating whether the insulin pump improves diabetic control and quality of life as compared to other insulin regimens in a paediatric population within NHS Grampian.  Method  I intend to carry out a retrospective study based in the Royal Aberdeen Childrenâ€™s hospital. I plan to access computer databases to gather patient details and use diabetic programmes linked to the pumps which record in detail all aspects of glucose control to compile my data. I am also hoping to construct a questionnaire to assess the way(s) in which patient quality of life is affected by the insulin pump and how this compares to their lifestyle on an injection regime.  A literature search will reveal whether questionnaires which examine these aspects may already exist and, with permission, an existing one would be used if appropriate. Alternatively, a new questionnaire will be devised, in consultation with my clinical supervisor and local psychology staff.  I would hope to arrange for these questionnaires to be made available in diabetic clinics and/or to post them to patientsâ€™ home addresses. Ethical approval would be required to approach patients and parents in this way and that will require further discussion.  Outcome  This project will give me an insight into an area of medicine that I am interested in pursuing in the future. I have not yet undertaken a project like this on my own and so I hope that I will also gain skills both in writing up the project and compiling useful data.  In describing patient and parent appraisal of the paediatric insulin pump programme, positive and negative areas may be highlighted. These results may have future care implications for young people with diabetes in Grampian.  Literature  1. Global Diabetes Community. 1.5 million pound boost for more insulin pumps for            diabetes.    http://www.diabetes.co.uk/news/2012/Apr/1.5-million-pound-boost-for-more-insulin-pumps-for-      diabetes-99602178.html (accessed 2 Feb 2013) 2. NHS Grampian. Annual Review Letter 2012     http://www.nhsgrampian.org/nhsgrampian/files/AnnualReviewLetter2012.pdf (accessed 20 Jan 2013) 3. Diabetes Scotland. Insulin Pumps - Frequently Asked Questions    http://www.diabetes-scotland.org/ggc/html%20pages/pump_faq.html (accessed 20 Jan 2013) 4. Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin Pump Therapy â€“ A meta analysis.        Diabetes Care 2003; 26(4):1079-1087 5. Fox LA, Buckloh LM, Smith SD, Wysocki T, Mauras M. A randomised control trial of insulin pump     therapy in young children with Type 1 Diabetes. Diabetes Care 2005;28(6):1277-1281  ","approved","I would be willing to accept this elective outline in terms of what it plans to investigate. However, there are major issues which need to be clarified. Dr Mayo is not in RACH at this time and Rebecca has not discussed this study with her. Rebecca has been advised by me that she must discuss her plans with Dr Mayo as it is Dr Mayo who has the remit of care for children with diabetes in Grampian and who has the relevant data which she would have to decide to share, or not, with Rebecca for study purposes. At this time, Rebecca effectively has no host supervisor for her study, though my hope would be that she would be able to arrange a meeting with Dr Mayo extremely quickly to find out whether her project would be acceptable to Dr Mayo.It is not for me to make any decision on behalf of Dr Mayo. I have erred on the side of provisional acceptance with the need for urgent and fundamental discussion with Dr Mayo, but I am aware that, as Rebecca has not secured Dr Mayo's agreement, and that this could yet be refused, that the university may not consider this proposal acceptable.","2013-02-15T11:11:00"]
["u07ac8","Prof","Chim","Lang","binita.pande2@nhs.net","Ninewells Hospital",null,null,"Dundee","Scotland",{"$nulls":7},"The prognostic significance of surface ECG markers (PR and QRS prolongation) in the outcome of patients with chronic heart failure.","Introduction  Gestational Diabetes (GDM) affects upto 5% of all pregnancies and is usually first diagnosed in pregnancy during the second or third trimester and resolves after the baby is born [1]. Women who are at a higher risk of developing gestational diabetes are commonly overweight. It is diagnosed following an Oral Glucose Tolerance test where the Fasting level is >5.1mmol/l or the 120 minute level is > 8.5 mmol/l. It increases the lifetime risk of the mother developing Type-2 Diabetes by up to 30% [2]. This is usually controlled by diet and exercise; however some patients may need medication. It is important that GDM is detected early and well controlled to prevent birth complications such as macrosomia, shoulder dystocia and neonatal hypoglycaemia.  After the diagnosis is made, women usually regularly visit the antenatal clinic where they are given advice on lifestyle changes and informed about potential complications and implications. The current study explores the experiences and perceptions of women towards their diagnosis and care during the pregnancy along with future implications.    Methods  Around 8-10 patients with gestational diabetes will be recruited from antenatal clinics in Ninewells Hospital in Dundee based on an inclusion and exclusion criteria clearly defined beforehand. Patients eligible for the study will be mailed an information sheet to their address which explains the purpose of the study and will assure them of confidentiality and written informed consent will be obtained.  A semi-structured interview will be conducted in the hospital where these patients will be invited to discuss perceptions towards their diagnosis of GDM. The interview will consist mainly of open ended questions in order to elicit a broad range of experiences.  Questions will be divided into 3 wide categories:  â€¢ General lifestyle and health  â€¢ Perceptions about the information and care received since the diagnosis â€¢ Perceptions about the remainder of the pregnancy, the birth and the future.   The interview will last 30-45 minutes and will be digitally recorded. Ethical approval will be gained beforehand. A pilot study will be conducted on pregnant women in Aberdeen Maternity Hospital prior to the study to make any necessary alterations to the interview technique or questions. Once all the information is collected, a framework analysis will be conducted which will allow categorisation and organisation of data into key themes and concepts in order to identify emergent patterns and comparisons between the data.    Outcomes  The main outcomes of the project will be to explore attitudes and health perceptions towards receiving a diagnosis of gestational diabetes during pregnancy and the future. Therefore by investigating these perceptions extensively I hope to identify possible areas for health promotion that may be addressed in the future to improve the management plan of women with GDM further.   Literature [1] Lancet (2008). The global challenge of diabetes. The Lancet 371 9626; 1723 [2] Girling J & Dornhorst A (2004). Pregnancy and diabetes mellitus, in Pickup JC and Williams G (ed.) Textbook of Diabetes, (3rd edition). Oxford: Blackwell Science [3] Lindmark A, Smide B & Leksell J (2010) Perception of healthy lifestyle information in women with gestational diabetes. A pilot study before and after delivery. European Diabetes Nursing 7, 16â€“20. [ [Accessed] http://onlinelibrary.wiley.com/doi/10.1002/edn.150/pdf  ","approved",null,"2013-02-13T12:42:02"]
["u26lc9","Dr","David","Walbaum","david.walbaum@nhs.net","Renal ward 108, ARI","Aberdeen",null,"Aberdeen","Scotland",{"$nulls":7},"A retrospective observational study of the outcomes of synthetic arteriovenous grafts used for haemodialysis in NHS Grampian","Introduction  Participation in sports has increased over the past years, with investments into better facilities, health awareness and most notably the 2012 Olympics. The UK government reported that 8.1% of adults in England have been motivated by the 2012 Olympic Games to do more sport. A project looking at injuries is therefore very relevant to current popularity of sport and the injuries that are caused as a result. During my elective placement I plan to perform a retrospective data analysis looking at lower limb injuries that present to a sports clinic, in Wellington, New Zealand over a six month period. Specifically I am interested in which injuries are most common and if there are any associations between particular injuries and other factors such as age, gender or having sustained a previous injury.  Swenson et al. (2009) collected data on recurrent injuries amongst US high school athletes, highlighting the importance of assessing which injuries are the most prevalent in recurrent injuries for treatment advancement.  Methods  I plan to collect data from computerised records at the clinic.  Over the six month period expect to collect data on 250 lower limb injuries.  The date the injury was sustained, gender, age and type of injury will be entered into SPSS to easily allow statistical tests to be performed.  A random patient identifier will be given to all subjects to allow me to isolate individuals who return on multiple occasions with recurrent injuries.  All data collected will be anonymised. Once my data has been collected I plan to examine it using statistical methods such as Pearsonâ€™s Chi-squared and a logistical regression analysis to determine if any of the factors I have looked at are associated with an increased risk of injury.    Outcomes  Through undertaking this project, I hope to gain experience and understanding in medical research, as well as gain exposure to a different culture and healthcare system.  Furthermore enabling the clinic I am analysing an insight into the numbers of injuries they treat and what are the most common injuries that present to the clinic; this could give them focus into their training of management regarding those injuries. Data analysis on recurrent lower limb injuries has the potential to form the basis of further research into the treatments that are currently being used and to highlight areas for treatment advancement.  Literature Department for culture, Media and Sport 2013, Taking Part 2012/13 Quarter 1, Department for Culture, Media and Sport, England. Swenson, D.M., Yard, E.E., Fields, S.K. & Comstock, R.D. 2009, \"Patterns of recurrent injuries among US high school athletes, 2005-2008.\", American Journal of Sports Medicine, vol. 37, no. 8, pp. 1586-1593.   ","approved",null,"2013-02-13T16:55:19"]
["u01dgc9","Dr","Ma Irene","Tangco","mitangco@yahoo.com","Operation Smile Philippines,Manila Cleft Care Centre","8th floor Sta. Ana Hospital",null,"New Panaderos Street, Sta. Ana Manila","Philippines","(02) 516-6151",{"$nulls":6}," A retrospective study of multidisciplinary management of children receiving facial reconstructive surgery for cleft lip and palate in the Manila Cleft Care Centre, Sta. Ana Hospital, Philippines. ","Title A retrospective study of multidisciplinary management of children receiving facial reconstructive surgery for cleft lip and palate in the Manila Cleft Care Centre, Sta. Ana Hospital, Philippines.    Background Orofacial clefts (OFC) carry profound social and cosmetic implications, along with significant functional issues including those related to feeding and to speech production (1). There have been extremely impressive results of plastic surgery for these defects which can greatly improve a childâ€™s life as when untreated, OFCs can result in lifelong emotional distress for the affected person (2,3).  While cleft palate affects 1 child per 1000 overall, the Philippines has one of the highest rates of oral clefting in the world, with an incidence of 1 in 500 (4).   The Manila Cleft Care Centre has extensive experience of the management of children affected by OFC.  Aim This project will focus upon those children with OFC who have received facial reconstructive surgery. Pre-operative assessment for surgery will be described, as well as postoperative multidisciplinary management, follow-up duration and compliance. Cosmetic comparison by patient and parent(s) may also be possible.  Method Fifty patients of the Manila Cleft Care Centre with OFC will be selected for the study from the hospitalâ€™s records base.  Inclusion criteria for selection will be: â€¢ the presence of an orofacial cleft (lip and/or palate) â€¢ management by facial reconstructive surgery â€¢ age range 0 - 12 years â€¢ male or female No specific exclusion criteria will be applied.  Data retrieved from each patientâ€™s record will include age at presentation, sex, any genetic diagnosis, presence of co-existing congenital abnormalities, current age, family OFC history, form and number of surgical  procedures, as well as preoperative and postoperative input from speech and language therapy, audiology, orthodontics, nutrition service, cosmetic service and psychology. 1. Length of individual follow-up and number of clinic visits will be noted, including any default.  Scaled cosmetic assessment will be sought; this may require ethical approval.  Anonymised data will be stored securely in accordance with the Data Protection Act.  Outcome This study will indicate the multidisciplinary diversity involved in OFC management and will provide an indication of patient and parent cosmetic satisfaction  Literature 1. Speech and language in the patient with cleft palate. [Review]. Mildinhall, Sue. Frontiers of oral biology. 16:137-46, 2012. 2. Paediatrics: A Core Text on Child Health; Second Edition. Tony Waterston, Pete J Helms, Martin Ward Platt. Published by Radcliffe Publishing Ltd. In 2006. 3. Outcomes in facial aesthetics in cleft lip and palate surgery: A systematic review. V. P. Sharma, H. Bella, M.M. Cadier et al. Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 65, Issue 9, September 2012, Pages 1233â€“1245. 4. Paediatrics and Child Health; Third Edition. Mary Rudolf, Tim Lee, Malcolm Levene. Published by Wiley-Blackwell 2011.     ","approved",null,"2013-04-13T01:27:23"]
["u03adc9","Dr","C.P.","Visharadan","visharadcp@gmail.com","Dhanalakshmi hospital","Kannur",670005,"Kerala","India","+91 944 7078835","91  497 27065272",{"$nulls":5},"A study of Intravenous Cannulation and phlebitis, and a reflection on the personal experience of inpatient care in a moderately priced, private hospital in South India","Intro During my conversations with my host supervisor I have been asked to look at Nosocomial Infections and considering I will be based in a hospital, more specifically Hospital Acquired Infection. In India the nosocomial infection rate is >25% and itâ€™s been reported that a third of all such infections are preventable. Nosocomial infections are responsible for more mortality than any other form of accidental death. The WHO state that the â€œnosocomial infection rate in patients in a facility is an indicator of quality and safety of care.â€\u009d As a result of this it is very important for a hospital to have good infection control. It is also important to have good infection control as it can be very costly, both to the patient (morbidity and mortality) and to the hospital (in terms of financial costs and prolonged periods of hospital stay). As a result of this I plan to perform an audit of HAI in Dhanalakshmi Hospital in Kerala, India.  Method â€¢ Work out reasonable parameters for defining HAI â€¢ Decide on a reasonable population size and cohort to study â€¢ Using audit assess either the incidence of a department at one time or the prevalence throughout patientâ€™s stay in the hospital. â€¢ If a HAI is found then report any complications resulting from the infection (morbidity and mortality)  Outcome â€¢ To assess the rate of Hospital Acquired Infection â€¢ with the view of aiding Dhanalakshmi  hospital in improving their care and reducing the costs resulting from HAI â€¢ Compare this rate to the National/Regional Guidelines â€¢ Give a basis for which further studies can be done to monitor trends in the hospital  Literature Prevention of hospital-acquired infections. A practical guide. 2nd edition. WHO. http://www.who.int/csr/resources/publications/drugresist/en/whocdscsreph200212.pdf http://www.indianexpress.com/news/pgi-study-icu-infection-rate-doubles-in-3-years/987251/0 http://www.slideshare.net/amarjit38/nosocomial-infection-7577087 http://www.indianexpress.com/news/1183-per-cent-hospitalacquired-infections-in-india-report/856112 www.pitt.edu/~super7/22011-23001/22391.ppt    Things I need to work out: â€¢ My classification of HAI/ how will I define a HAI â€¢ What specifically I will be looking at: o Skin & Soft Tissue Infection (IV Cannula) o UTI (Urinary Catheter) o Surgical Site (Post-op) o Lower Respiratory Tract (ventilators) o Bacteraemia (IV Cannula/Central Line) â€¢ Will I be looking at: o one department in particular (e.g. General Surgery or Urology); or o only certain patients (e.g. patients with a urinary catheter or patients with ventilation) â€¢ Find out what (if any) audits of HAI have already been done in the hospital so that I could possibly continue that project with similar parameters if possible. This would also be good to see how others have done similar studies before.  ","approved",null,"2013-03-27T18:15:53"]
["u22jd9","Prof","Gagandeep","Kang","gkang.cmcvellore@ac.in","Division of Gastrointestinal Sciences","Christian Medical College",null,"Vellore","India","0091-416-228-2052","0091-416-228-2486",{"$nulls":5},"A consideration of the risk factors influencing malnutrition in rural-urban Vellore","Introduction:   Childhood malnutrition is a devastating problem in India with more than 45% of children under the age of 5 said to be moderately or severely malnourished. These rates are higher than elsewhere in the world and have grave implications on childhood mortality. Socioeconomic status, maternal literacy and maternal Body Mass Index (BMI) have been postulated to influence childrenâ€™s nutritional status.  However, a greater understanding is needed to properly address this issue. For my elective, I therefore will assist in a large cross-sectional study assessing whether there is a correlation between maternal BMI and childhood nutrition in India.   Methods:  My elective will be conducted at the Christian Medical College (CMC) hospital, a teaching and research hospital in Vellore, India.  Currently, there are teams collecting demographic data including height and weight of the population in the slum area being studied. By June 2013, it is hoped that data would have been collected from at least 30,000 individuals from 6000 households.  In order to analyse a manageable amount of data, I will calculate the sample size needed to produce a statistically significant result. Using mainly BMI calculations, I will compare maternal nutritional status to childrenâ€™s nutritional status and assess whether there is a correlation. The elective report will be based on the results of the subset of data I would have analysed.   Outcomes:  Personally, I have always been very interested in both Paediatric Gastroenterology and Obstetrics, so I feel very lucky to have found a project which encompasses both. The opportunity to work in a new healthcare system in a different environment will be an interesting and helpful learning experience. In the future, I hope to work in my native country of Trinidad and Tobago as well as other Caribbean countries, like Haiti, where malnutrition is a serious problem. Hence, doing research on malnutrition is particularly interesting to me.  Overall, the outcome of my elective is to partake in the data analysis of a large study, the results of which may influence change in techniques used to try to abate childhood malnutrition in India.    Literature:  â€¢Rahman M, et al. Maternal Nutritional Status as a Determinant of Child Health. Journal of Tropical  Pediatrics 1993;39(2): 86-88. â€¢Sanghvi U, et al. Assessing Potential Risk Factors for Child Malnutrition in Rural Kerala, India. Journal of  Tropical Paediatrics 2001;47(6): 350-355. â€¢Das KS. et al. Children in India 2012- A Statistical Appraisal. Ministry of Statistics and Programme     Implementation. 2012.  ","approved",null,"2013-02-13T17:05:38"]
["u01rdd8","Dr","Mark","Lawrence","Mark.Lawrence@BOPDHB.govt.nz","Touranga Hospital",null,null,"Touranga","New Zealand",{"$nulls":7},"Alcohol Dependence : an audit of comprehensive assessment performed in a specialist setting","Introduction: Alcohol dependence is both a debilitating and prevalent condition in Scotland (NICE CG115). This is also the case in New Zealand (Oakley et al 2006). Of the 1 million people in the UK who suffer from alcohol dependence only around 4% receive treatment per year (NICE CG115). This is a huge discrepancy which suggests a failure at a number of different management points from identification to effective treatment. An important part of this process is the assessment procedure that occurs at specialist facilities. NICE have produced specific criteria which should be addressed during the interview with the patient. This assessment includes examination of alcohol use, dependence and alcohol related problems, and advocates the use of a number of questionnaires including AUDIT, SADQ and APQ. Aim: Review of assessment procedure in patients with alcohol dependence in specialist setting compared to NICE guidelines. Method: Survey of alcohol dependence assessment in a specialist centre by review of case notes of patients identified with alcohol dependence and assessed in specialist centre. Population â€“ at least 50 case notes diagnosis between April 2013 and September 2013 within the Hospital Database Tauranga, New Zealand. Patients included within the study must be:  Referred to a specialist centre.  Diagnosed with alcohol dependence.  Have an AUDIT score (>15).  This population will then be assessed as to whether the NICE guidelines criteria were met during the assessment. Standards will be set for the individual parts of the guideline in discussion with the local specialists and after preliminary review of sample case notes. Results will be presented illustrating the proportions of patients meeting the specific individual standards. Outcomes: Criteria during assessment - alcohol use, including: consumption: historical and recent patterns of drinking (using, for example, a retrospective drinking diary), and if possible, additional information (for example, from a family member or carer) dependence  alcohol-related problems â€¢ other drug misuse, including over-the-counter medication â€¢ physical health problems  â€¢ psychological and social problems â€¢ cognitive function  readiness and belief in ability to change. References: CG115 Alcohol dependence and harmful alcohol use: NICE guidance MA Oakley Browne, JE Wells, KM Scott (eds). 2006. Te Rau Hinengaro: The New Zealand Mental Health Survey. Wellington: Ministry of Health. The management of harmful drinking and alcohol dependence in primary care. SIGN Guideline No 74. ","approved","Some details to be finalised with New Zealand supervising consultant.","2013-03-28T18:43:28"]
["u14cd8","Dr","Julie","Mooney-Somers","julie.mooneysomers@sydney.edu.au","K25 - Medical Foundation Building","The University of Sydney","NSW 2006","Sydney","Australia","+61 2 9036 3412",{"$nulls":6},"Pap smear rates among Australian community attached lesbian and bisexual women: some good news but disparities persist","Introduction  The Papanicolaou (Pap smear) test is used as the national screening program for cervical cancer in many countries. It allows early changes on the cervix to be detected before disease evolves. In Australia, women are encouraged to attend routine Pap smear every 2 years between the ages of 18 and 69. Despite this, there are still subgroups of women who do not attend regularly.  One particular group is women who have sex with women (1-4). Some of the literature suggests that there is confusion about this groupsâ€™ risk of transmitting the Human Papilloma Virus (HPV), which is associated with cervical cancer (3). However, studies have shown that HPV is transmitted between women and thus making it important that these women attend for regular smears (1-3). The aim of this study is to look at the smear rates of women who have sex with women in Sydney. This will also be broken down in to subgroups of women who have had sex with men and those who have never had sex with men. The Sydney Women and Sexual Health (SWASH) survey has been run biennially since 1996 and is a comprehensive survey of sexual health and wellbeing in women who have sex with women. Using this data will allow us to see if trends are improving among this group of women or if there is a need for more focused education and health promotion. The reasons why women in this group do not attend for cervical screening will be explored and possible interventions to improve uptake will be discussed.  Method  A retrospective data analysis will be carried out using the data from the SWASH from 1996-2010. This will look at over all trends and trends within each subgroup. These results will be compared with other literature and conclusions drawn. Recommendations will also be made.  Outcomes  With this project I hope to improve my analysis and data interpretation skills. I hope to produce a report that will be useful to the department I am working with and possibly have wider public health implications. I am also looking forward to working in an academic environment in a different country.  Literature  1.Henderson, H.J. Why lesbians should be encouraged to have regular cervical screening.  Journal Family Planning & Reproductive Health Care 2009: 35(1). Downloaded 5/02/13 http://jfprhc.bmj.com/content/35/1/49.long 2. Marrazzo J.M, Koutsky L.A, Kiviat N.B, Kuypers J.M, Stine K. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. American Journal of Public Health 2001 June; 91(6): 947â€“952. Cited 05/02/13 3. Bailey J.V, Kavanagh J, Owen C, Mclean K.A, Skinner C.J. Lesbians and cervical screening. British Journal of General Practice 2000; 50: 481-482.       ","approved","Catriona will be looking at existing data and comparing it to previous findings and published literature. This is a project that her host supervisor has suggested. Sounds very interesting and will give her an opportunity to improve her statistical skills.  ","2013-02-12T08:56:42"]
["u03cld8","Dr","Carl","Counsell","carl.counsell@abdn.ac.uk","Polwarth Building","Foresterhill",null,"Aberdeen","Scotland","+264-(0)61-225853","+264-(0)61-221539",{"$nulls":5},"Is infectious mononucleosis in winter a stronger risk factor for multiple sclerosis than in the summer? A case control study","Introduction: Stroke is becoming an increasingly important cause of morbidity and mortality in Namibia. The prevalence of hypertension, a well-documented modifiable risk factor for both ischaemic and haemorrhagic stroke, was estimated to be 43.4% in Namibia in 2008(1). Anti-hypertensive therapy is an efficacious intervention for the prevention of a first stroke, resulting in a recorded 35-44% reduction in the incidence of ischaemic stroke(2). Unfortunately, data from the USA suggests that hypertension is significantly under-diagnosed and under-treated, as 70% of Americans with hypertension aware of their condition, and only 34% adequately controlled (to a blood pressure <140/90mmHg)(2).   Aims: This project will aim to (a) determine the prevalence of hypertension in patients admitted with a first ischaemic stroke to Windhoek Central Hospital, (b) determine the proportion of these patients whose hypertension had previously been diagnosed, and who had been managed with anti-hypertensive medication, and (c) determine the prevalence of additional stroke risk factors in patients admitted with a first stroke.  Methods: The study population will comprise of patients admitted to Windhoek Central Hospital with an ischaemic stroke over a six week period. Demographic data, including patientâ€™s age, gender, and occupation will be collected. Medical records will be searched and the patient interviewed to identify whether (a) the patient had previously been diagnosed with hypertension, and (b) whether the patient had been taking anti-hypertensive medication prior to admission. Patientsâ€™ blood pressure will be recorded on two occasions one week following their stroke, and these values used to identify whether they are hypertensive (defined as a blood pressure over 140/90mmHg as measured on two occasions). If patients had previously received a diagnosis of hypertension but were not on adequate anti-hypertensive medication, the patient will be interviewed to explore the factors resulting in this. Patient information on additional stroke risk factors will be collected, to include smoking status, obesity, diabetes mellitus, atrial fibrillation, and hypercholesterolaemia. A literature review will be conducted using Medline, to find any similar work carried out before with which to compare the results of this project. Ethical approval for the project will be sought from the Research Ethics Committee at the Ministry of Health and Social Services in Windhoek.   Outcomes: Data collected will be analysed to determine the proportion of patients identified as hypertensive during admission who had received the diagnosis before suffering a stroke, and the proportion of these patients who had been receiving anti-hypertensive therapy. The prevalence of additional stroke risk factors in patients presenting with a first stroke will also be calculated.  Literature:  (1)World Health Organisation. (2013) Namibia- Analytical Summary [Online]. Available at: http://www.aho.afro.who.int/profiles_information/index.php/Namibia:Analytical_summary_-_Risk_factors_for_health [Accessed 10 February 2013].  (2)Goldstein,L.B., Adams,R. et al. (2006). Primary Prevention of Ischaemic Stroke [Online]. Available at http://stroke.ahajournals.org/content/37/6/1583.full [Accessed 11 February 2013].  ","approved",null,"2013-02-14T19:06:05"]
["u26cd8","Dr","Belinda ","Weller","B.Weller@ed.ac.uk","Department of Clinical Neurosciences","Western General Hospital, Crew Road","EH4 2XU","Edinburgh","Scotland",{"$nulls":7},"Mood disorders in multiple sclerosis: is there a correlation with physical disability?","Introduction Multiple Sclerosis (MS) is a debilitating and chronic neurodegenerative disorder of the Central Nervous System. Despite advances, little is still known about the exact aetiology and causes of the disease. It is suggested that the disease develops in individuals by a complex interaction between external environmental factors and a predisposing genetic susceptibility (1). Increasing interest has led to a growing drive to identify these possible environmental triggers, and links have been identified between previous EBV infection, Smoking Status and Vitamin D deficiency (2). Many studies have identified greater incidence and prevalence rates of MS in geographical areas further from the equator(2); therefore as of late much public interest has been raised in Scotland and the wider UK on the effects of Vitamin D deficiency, due to decreased sunlight, and the development of MS.  The aim of my study will be to conduct a systematic review of the current research and evidence available, investigating the link between Vitamin D deficiency and the development and/or progression of MS.  Methods A thorough literature search will be conducted, using the electronic databases MEDLINE, EMBASE and PUBMED. The Medical Subject Heading (MeSH) terms used will include Multiple Sclerosis, Neurodegenerative Disorders, Vitamin D, Vitamin D deficiency, Vitamin D supplements, Geographical Location, UVB exposure. Searches will be restricted to English only and include all age ranges and ethnicities and limited to epidemiological studies. Furthermore the references of any identified and suitable studies will be manually searched for further relevant papers. The relevant clinical guidelines will also be researched in order to identify further evidence to be included in the study  Outcomes  From my elective I hope to gain a further knowledge and understanding of MS and its aetiology. I feel that Vitamin D deficiency in Scotland, due to its geographical position, has been very topical and the centre of many news headlines lately. I have found reading them very interesting and I hope by dedicating my elective time to this I can go some way to finding what basis they may have, whilst also developing essential research skills which I will undoubtedly require in my future career. This elective project will also give me an opportunity to gain clinical experience and patient contact with patients diagnosed with neurological conditions.   References (1) Kallaur AP, Kaimen-Maciel DR, Morimoto HK, Watanabe MA, Georgeto SM, Reiche EM. Genetic polymorphisms associated with the development and clinical course of multiple sclerosis. International Journal of Molecular Medicine 2011; 28(4):467-479. (2) Ramagopalan SV, Dobson R, Meier UC, Giovannoni G. Multiple sclerosis: risk factors, prodromes, and potential causal pathways. The Lancet Neurology 2010;9(7):727-39.   ","approved",null,"2013-02-14T21:48:12"]
["u01ekf8","Dr","Fiona ","Miles","p.elgar@auckland.ac.nz","Starship Children's Health","Grafton","New Zealand",1023,"Auckland","+64 9-379 7440",{"$nulls":6},"A prospective audit of PICU hand hygiene amongst healthcare professionals in the Starship Childrens Hospital, Auckland","Introduction  The management of extremely premature infants is a controversial topic, with many ethical dilemmas surrounding it. However, guidelines for their management are primarily based on the evidence of infant outcomes at their particular gestational age, and therefore, good evidence of their outcomes is a vital area of research.   The aim of this study will be to assess whether the outcomes of infants born between the gestational ages of 22 and 28 weeks in Auckland's City Hospital have improved in the last 10 years, by collecting the mortality and morbidity rates at each gestational week between 22-28, and comparing the 2 sets of data. The gender outcomes will also be compared to see whether there is an improved survival rate for females compared to male, as some other studies have suggested.   Methods   The Auckland City Hospital (ACH) databases will be accessed, and spreadsheets constructed to record the data collected. Data collected will be the number of live births, stillbirths and neonatal deaths under 28 weeks in 2002 and 2012 in ACH, and the sex and gestational age for each of these infants. Morbidity outcomes will be assessed in terms of chronic lung disease, cerebral palsy and retinopathy of prematurity incidence.   This data will then be entered into two separate spreadsheets (one for 2003 and another for 2013) using a data collection system such as SPSS.    Once the two spreadsheets have been constructed, the two sets of data will be analyszed and compared. A table will be constructed to present the findings of the study, and the conclusion reached.   As a retrospective audit using hospital databases, no direct patient contact is expected and ethical approval should not be needed. Host supervisors are currently reviewing my proposal and confirming this. If ethical approval is needed it will be sought.  Outcomes  From my elective I hope to find out more about the improving outcomes and management of extreme prematurity and to explore the clinical and social implications surrounding extremely premature infants during my time at the hospital, as it is a topic which has always interested me. I also hope to prove that I am capable of conducting a successful research project, and cope with new tasks such as data collection, constructing spreadsheets and data analysis. Furthermore, to find out if medical advances are giving infants and their families a life that 10 years ago would not have been possible.   Literature Lorenz, JM, 2011, Survival and long-term outcome of the extremely premature infant. A systematic review. Saudi Medical Journal, Availalble at < HYPERLINK \"http://www.ncbi.nlm.nih.gov/pubmed/21894349\" http://www.ncbi.nlm.nih.gov/pubmed/21894349> [Accessed 03/02/2013]  Tyson, J.E., et al. , 2008, Intensive Care for Extreme Prematurity - Moving beyond Gestational Age, The New England Journal of Medicine, Available at < HYPERLINK \"http://www.nejm.org/doi/full/10.1056/NEJMoa073059\" http://www.nejm.org/doi/full/10.1056/NEJMoa073059> [Accessed 03/02/2013]  Wilkinson, A. et al, 2008, The Management of Babies Born Extremely Preterm At Less than 26 Weeks Gestation, British Association of Perinatal Medicine, ","approved","I am a provisional supervisor at this stage but I think this is an excellent project.  It is achievable in the time frame of an elective. ","2013-02-13T15:11:03"]
["u21jf9","Dr","Liz","McDonald","liz.mcdonald@eastlondon.nhs.uk","East London NHS Foundation Trust, Perinatal Mental Health,","City and Hackney Centre for Mental Health, Homerton Hospital","E9 6SR","London","United Kingdom",442085108071,442085108552,{"$nulls":5},"Maternal portpartum depression: Its effect on infant attachment","Introduction NICE guidelines state that the postpartum period is a vulnerable time for pregnant women to develop a new psychiatric illness or experience an acute attack of an already existing illness. In the MBU, most frequent diagnoses include BPAD, Puerperal psychosis, psychotic depression and depressive disorders. Additionally, a mentally ill mother is of great concern for the health of infants since mental illnesses do not only affect the mother but can also have a detrimental effect on the infantsâ€™ development, as has been demonstrated by various research studies. Therefore, attachment relationship between infants and their mentally ill mothers is an important issue to investigate; one of the tools frequently used to assess such relationship is the Louis MACRO (Mother and Child Observation) Scoring System.  Aim The aim of this study is to investigate the early mother-infant attachment relationship in mothers with serious mental illness by using the Louis MACRO Scoring System and whether this is a valid method of doing so.  Methodology This study will employ a meta-analytic qualitative methodology. The main method is the self-administered questionnaire (Louis MACRO) to the mothers, which investigates safety, infant characteristics, and motherâ€™s mental state, physical and emotional care. Another questionnaire will also be given to staff members to validate the use of the Louis MACRO Scoring System. Additionally, this study will conduct semi-structured interviews combined with mother-infant observations. The sample used will consist of mothers with severe mental illnesses admitted to the MBU and their infants (aged 0-6 months). There are no entry criteria other than being an inpatient to the MBU. A minimum of 10-14 patients will be included in this study.  Ethical Issues There are several ethical issues, which have to be addressed. According to the Data Protection Act (Information Commissionerâ€™s Office 1988), in regards to confidentiality, no names will be recorded during the study, making participation anonymous. This is important due to the personal content of this study. All procedures involving patients, will be done so, given their informed consent.  Literature 1. National Institute for Health and Clinical Excellence. CG45 Antenatal and postnatal mental health: full guideline. [Internet]. 2007. [cited 2013 January 10]. Available from: http://www.nice.org.uk/nicemedia/live/11004/30431/30431.pdf  2. Murray L, Cooper P. Effects of postnatal depression on infant development. Arch Dis Child [Internet]. 1997 [cited 2013 Jan 12]; 77(2):99-101. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717268/  3. Brenner, Laura (Barts and the London Medical School, London, United Kingdom). Clinical Audit â€“ The use of Louis Macro Assessments in the care of inpatient Mothers and Babies on MBU. Conversation with: Dr Liz McDonald (East London NHS Foundation Trust, Perinatal Mental Health, Homerton Hospital, London). 2012 Dec 11. 4. Information Commissionerâ€™s Office. Key definitions of the Data Protection Act [Internet]. 1988 [cited 2013 Jan 14]. Available from: http://www.ico.gov.uk/for_organisations/data_protection/the_guide/key_definitions.aspx ","approved",null,"2013-02-07T10:55:10"]
["u04ng9","Dr","Debbie","Leach","Debbie.Leach@easternhealth.org.au","Boxhill Hospital Emergency Department","Nelson Rd","VIC 3128","Boxhill, Melbourne","Australia","+61 3 9895 4861 ",{"$nulls":6},"Sun safety measures amongst health care workers","Introduction  This project seeks to define the patient demographic who present to A&E with sunburn, how they are managed, and the general publicâ€™s perception of sun health in Australia. Australians are exposed to high solar ultraviolet light levels, which is the main cause of skin cancer. Australia has one of the highest skin cancer incidence and mortality rates in the world. January and February is the peak tourist season in Australia, and Melbourne is a popular tourist destination, particularly with the Australian Open tennis tournament taking place. Are tourists more at risk of sunburn? Or do they take more precautions because they are aware of the risk? Is there a relationship between skin type and presentation to ED with sunburn? Sunburn is defined as injury to the skin, with erythema, tenderness, and in some extreme cases blistering, following excessive exposure to sunlight; produced by ultraviolet rays not filtered out by clouds or water. What symptoms do patients present to ED with? How are they managed? Hydration status and reducing the risk of infection are key features. Sun exposure can also cause heat stroke, a condition which is especially dangerous in the elderly.  Education into safe sun exposure is key in the prevention of skin cancer. Australian government campaigns such as â€œSlip Slap Slopâ€\u009d and â€œSun Smartâ€\u009d as well as hard hitting soap storylines, are all aimed at educating the public. Have these campaigns influenced peopleâ€™s behaviour in the sun?   Methods  Retrospective analysis of sun related ED admissions in Box Hill Hospital January-February 2014. Boxhill hospital database will be examined and details of patient demographics and management plans will be collected and recorded. I will seek to determine what precautions patients had taken, for example, sun cream, shade, appropriate clothing, high fluid intake. Survey of current sun related ED admissions and their attitudes towards sun safety. This will aim to seek the following details: skin type, age, tourist (country of living), precautions taken, are they aware of dangers of sun exposure, are they aware of sun safety campaigns?   Outcomes  I predict that there will be a lot of tourists presenting to ED with sunburn, despite taking precautions. I think that despite knowing the risk of sun damage, and awareness of government campaigns, people will still take risks in the quest to achieve that golden tan!   Literature Duke J et al. Trends in hospital admissions for sunburn in Western Australia, 1988 to 2008. Asia Pacific Journal of Public Health. 2013 Jan;25(1):102-9  ","approved",null,"2013-02-13T09:58:50"]
["u22ag8","Prof","Abass","Alavi","abass.alavi@uphs.upenn.edu","Hospital of the University of Pennsylvania","3400 Spruce Street","4283 Philadelphia","PA 19104","USA",{"$nulls":7},"The diagnostic accuracy of delayed time point F FDG PET/CT imaging in gastrointestinal cancers: a systemaic review"]
["u06hg9","Dr","Graeme","Currie","graeme.currie@nhs.net","Clinic C","ARI",null,"Aberdeen","UK",{"$nulls":7},"Local diagnostic sensitivity of consecutive endobronchial ultrasound transbronchial needle aspirations (EBUS-TBNA) at Aberdeen Royal Infirmary for malignant and benign disorders.","Aim  To determine what factors are of the greatest importance to patients when choosing an appointment in general practice.  Introduction  General practice is often the first point of contact a patient has with health care services making it important that they have easy and quick access. As part of the HEAT targets practices are to provide access to an appointment with a GP within 48hrs while retaining the ability to make an advanced appointment with a GP of the patientâ€™s choice. It is also recognised that continuity of care is valued by patients and is an important aspect of general practice.  In the RCGP policy paper on promoting continuity of care in general practice it is suggested that access and continuity are linked and that â€œprioritising one can unbalance the otherâ€\u009d. During my elective I plan to look at the patientâ€™s perspective on the importance of access and continuity of care in general practice by using a discrete choice questionnaire.  Method  Patients attending their GP surgery will be asked to complete a discrete choice questionnaire to determine what is the relative importance of several factors when choosing an appointment for two different scenarios.  The factors that will be looked at are; the time to the appointment (eg. same day, within 48hrs, within 1 week), the time of the appointment  (eg. a set  time or a time of their choice) and if they are able to see a GP of their choice.  The relative importance of these factors will compared for two different scenarios.  One scenario will be for a new complaint and the other will for a pre-existing medical condition.  The data will also be assessed to see if patient demographics affect what the relative importance of these factors are when making an appointment.    Outcome  By undertaking my elective I hope to improve my knowledge of research techniques and methods of result analysis.  I also hope that by undertaking this project I will further my understanding of general practice.  Literature  Hill, A.P. and Freeman, G.K. (2011) Promoting Continuity of Care in General Practice [Online] Available at: http://www.rcgp.org.uk/policy/rcgp-policy-areas/~/media/Files/Policy/A-Z%20policy/RCGP_Continuity_of_Care.ashx [Accessed on 12 February 2013]. Rubin, G., Bate, A., George, A., Shackley, P. and Hall, N. (2006) â€˜Preferences for access to the GP: a discrete choice experimentâ€™ , British Journal of General Practice [Online]. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1920713/ [Accessed 12 February 2013].  The Scottish Government (2013) GP Access. Available at: http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/GPAccessStandard [Accessed 12 February 2013].  ","approved","I think this is a promising project outline and I am happy to be the local supervisor. ","2013-04-10T21:45:50"]
["u01fg9","Dr","Michael","Norbury","michael.norbury@lothian.scot.nhs.uk","Craigmillar Medical Group","106 Niddre Main Road","EH16 4DT","Edinburgh","Scotland","0131 536 9500","0131 536 9545",{"$nulls":5},"An audit of whether patients newly diagnosed with depression in Craigmillar Medical Group during QOF 2012/13 and the 1st 6th months of QOF 2013/14 had an alcohol history recorded","Tackling alcohol abuse and alcohol related health issues are amongst the top priorities for the current Scottish Government.    Antidepressants are prescribed in general practice with intent to alleviate depressive symptoms.  If a patient subsequently abuses/misuses alcohol (a natural depressant) it is logical to presume that there is a distinct possibility it may interfere with the effects of antidepressants.  It is without doubt that alcohol related issues are most prevalent amongst more deprived areas, which has made the Craigmillar area of Edinburgh a suitable location to conduct this audit.  The criterion for the study will be patients with newly diagnosed depression over QOF year 2011/2012.  The standard will be 90% of patients having had a full alcohol history taken. The tool of \"full\" alcohol history taking I will be assessing will be the Alcohol Use Disorders Identification Test (AUDIT). It is a patient questionaire with 10 alcohol related questions which gives the patient a score out of 40, a score of >8 is suggestive of harmful alcohol intake (PATIENT).   There is a possibility that a partial alcohol history will have been taken from the patient. An alcohol history will be considered partial if the practioner has asked 3 or more questions featured on the AUDIT tool or has used the shortened form of AUDIT, AUDIT-C, which gives patients a score out of 12, but has a considerably lower sensitivity and specificity (PATIENT).       Craigmillar medical practice has a practice population of circa 8150 (ISD1), based on the Scottish national incidence of depression being circa 7.5% (ISD2), I forecast there would have been circa 611 newly diagnosed cases of depression in QOF year 2011/2012 at Craigmilar practice.  I expect that if I limited my audit only to include patients given antidepressant therapy, the number involved in the study would be considerably less than 611.  Therefore, giving a manageable number to process.   The aims of this study are in line with the standard audit cycle.  I aim to create an audit reproducible by anyone in the future.  I also aim to highlight the need for a mandatory alcohol history to be taken at the time of diagnosis of depression with the hope that patients may then receive the necessary support to minimalize the potential implications of alcohol abuse.    References PATIENT - http://www.patient.co.uk/doctor/Alcohol-Use-Disorders-Identification-Test-(AUDIT).htm   ISD1 -  http://www.isdscotland.org/Health-Topics/General-Practice/Publications/2010-09-28/QOF_Scot_200910_practices_mental_health.xls?20816601  ISD2 - http://www.isdscotland.scot.nhs.uk/Health-Topics/General-Practice/Quality-And-Outcomes-Framework/Information-for-users-of-QOF-register-and-prevalence-data.asp#Depression ","awaiting approval",null,"2013-03-26T11:21:04"]
["u11cg8","Dr","Carl","Counsell"," carl.counsell@abdn.ac.uk ","University of Aberdeen",null,null,"Aberdeen","UK",{"$nulls":7},"A Description of the Cumulative Incidence of Dementia in the PINE Parkinsons Disease Cohort","Background: Parkinsonâ€™s Disease (PD) is primarily considered a movement disorder; however non-motor manifestations are common. PD dementia (PDD) is a particularly devastating outcome where cognitive decline tends to succeed any motor problems to become the principal limiting factor of activities of daily living. PDD is clinically and pathologically distinct from other forms of dementia such as Alzheimerâ€™s Disease (AD) and Dementia with Lewy bodies (DLB) (1) and does show some symptomatic improvement with cholinesterase inhibitors(2).   The majority of epidemiological studies of PDD assess either point prevalence or incidence in highly selected cohorts so currently there are few data on the incidence of dementia in true incident PD cohorts. Cross-sectional prevalence data are of limited value mainly due to increased mortality in PDD compared to PD without dementia(3). Determining the incidence of PDD is beneficial in a number of ways, namely in addressing the demand for healthcare resources and distinguishing possible aetiological factors when compared to control groups.  Aims: This project aims to describe the rate of development of dementia in an incident PD cohort whilst assessing factors which may contribute to this. In addition, if time permits, a further aim is to compare this rate of dementia development with that of a control population.  Methods:  The Parkinsonism Incidence in North-East Scotland (PINE) study has previously identified and is prospectively following up an incident cohort of 363 patients with Parkinsonism (about 200 of whom have PD) in a well-defined population in and around Aberdeen. Predefined diagnostic criteria for dementia will be used to review the case notes of the PINE cohorts of PD patients and age-gender matched controls. This will include evaluation of clinical records, Mini-mental State Examination (MMSE) and Mini-mental Parkinsonâ€™s (MMP) scores. A Kaplan Meier plot of dementia development will be devised from the findings.  References: 1. Emre M, Aarsland D, Brown R, Burn D, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Movement disorders 2007;22(12):1689-707.   2. Rolinski M, Fox C, Maidment I, McShane R. Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson's disease dementia and cognitive impairment in Parkinson's disease. Cochrane Database of Systematic Reviews 2012;3:CD006504-CD006504.  3. Levy G, Tang M, Louis ED, Cote LJ, Alfaro B, Mejia H, et al. The association of incident dementia with mortality in PD. Neurology 2002;59(11):1708-1713.   ","approved",null,"2013-02-14T17:33:05"]
["u02mag8","Prof","Toshikazu","Ushijima","tushijim@ncc.go.jp","National Cancer Center Research Institute","5-1-1 Tsukiji, Chuo-ku","104-0045","Tokyo","Japan",-8709,-7240,{"$nulls":5},"TET in Helicobacter Pylori induced aberrant DNA methylation.","Introduction:  Globally, gastric cancer is the 3rd commonest cause of cancer death in males and the 5th commonest in females. Helicobacter pylori (H. pylori) infection is the most important risk factor for the development of gastric cancer. Importantly, gastric cancer is recognised as a primarily epigenetic disease; key tumour suppressor genes associated with gastric carcinogenesis are frequently found to be aberrantly methylated as opposed to mutated. Studies have demonstrated that gastric mucosa samples from H. pylori infected patients have greater levels of DNA methylation than non-infected gastric mucosa and this epigenetic change closely correlates with gastric cancer risk. Animal models have suggested that the specific immune response that accompanies H. pylori infection is essential for this process. However, the precise component(s) of H. pylori-associated chronic inflammation responsible for aberrant DNA methylation have not been fully elucidated.   Methods: This project will focus on the use of human gastric tissue samples from H. pylori infected patients. Previous work conducted by the host group successfully separated cells from surgical gastric tissue samples, and purified the epithelial component by FACS (Flow-Cytometry Assisted Cell Sorting). It is intended that a similar methodology will be employed to isolate the inflammatory cell component of the gastric tissue samples. Once isolated, the inflammatory cell component will be co-cultured with established normal gastric epithelial cells, and the induction of aberrant methylation measured. Following confirmation of DNA methylation induction, the inflammatory cell mixture will be further fractionated into neutrophils, macrophages and lymphocytes. Each of these sub-fractions will then be co-cultured individually with epithelial cells, and this will allow for identification of the culprit inflammatory cell subtype. Once a responsible cell fraction has been identified, the exact signals originating from the inflammatory cells can be investigated in depth.   Outcomes: Gastric cancer is a significant global cause of morbidity and mortality. Identification of the precise inflammatory elements which induce aberrant methylation is crucial for differentiating between \"malignant\" and \"benign\" inflammation. This will allow for the derivation of targeted anti-inflammatory agents that effectively prevent the development of gastric cancer. Furthermore, as infection is recognised as an important aetiological factor in the development of numerous different malignancies these results may have broader implications for the prevention of other inflammation-related cancers, such as liver, oesophageal, pancreatic and IBD-associated cancers.  Literature  Chiba, T et al. Inflammation-associated cancer development in digestive organs: mechanisms and roles for genetic and epigenetic modulation. Gastroenterol, 143: 550-563, 2012.  Niwa, T et al. Inflammatory processes triggered by Helicobacter pylori infection cause aberrant DNA methylation in gastric epithelial cells. Cancer Res, 70: 1430-1440, 2010.  Maekita,T et al. High levels of aberrant DNA methylation in Helicobacter pylori-infected gastric mucosae and its possible association with gastric cancer risk. Clin Cancer Res, 12: 989-995, 2006.  ","approved","This is an outstanding project in an outstanding unit and institution. The host Japanese group is one of the best in the world in this field. This is an amazing opportunity and I am sure Mark will thrive in this environment and gain so much valuable experience. Well done and good luck. Emad El-Omar ","2013-02-14T07:54:01"]
["u19mg8","Dr ","Richard","Russell","richardrussell@nhs.net","The Royal Hospital for Sick Children","Yorkhill","G3 8SJ","Glasgow","UK","00+01+416-813-7733",{"$nulls":6},"five-year incidence and outcomes of eosinophilic oesophagitis in the Royal Hospital for Sick Children (Yorkhill)","Introduction   Long-term survival is now the rule in paediatric liver transplantation. Thus, efforts must now focus on improving long-term outcomes. Metabolic syndrome has never been fully studied in children post liver transplant.  18 to 67% of paediatric patients who undergo liver transplants are found to be obese or overweight long-term (15 to 21% before transplant). Obesity is tightly linked to metabolic syndrome, defined as the presence of three or more of the following criteria:  1) central obesity; 2) high triglycerides; 3) low HDL; 4) impaired fasting glucose; 5) hypertension. In adults metabolic syndrome is associated with significant morbidity and poorer outcomes after liver transplantation.  There are no data on the prevalence of metabolic syndrome in children who have undergone liver transplantation, nor have the risk factors been identified.  Early detection and treatment could lead to improved outcomes.   Methods   We aim to retrospectively review prevalence of metabolic syndrome in children who have undergone liver transplantation at the Hospital for Sick Children and investigate potential risk factors.   At their anniversary clinic visits, patients followed in the SickKids Liver Transplant clinic routine undergo i) anthropometrics; ii) blood pressure measurements; iii) bloodwork (including fasting insulin, glucose, HbA1c, triglycerides, total cholesterol, and both HDL and LDH cholesterol). This falls in line with the factors in metabolic syndrome as described by the International Diabetes Association and World Health Organisation. Ideally patients will be stratified by reason for transplant, gender, age and pre-transplant weight and also investigated for prednisolone exposure. Number of participant patients will be determined closer to commencement of the project.  As the elective student participating in this project I will have the opportunity to retrospectively review medical charts (electronic and paper), collect data, create a â€œmetabolic syndromeâ€\u009d excel database and participate in descriptive statistics for analysis.  Time permitting, further opportunities to participate in an abstract submission and/or writing group for a scientific manuscript can be discussed.   Outcomes   The overarching goal of this project is to improve medical care and outcomes for these children in the future, and ultimately improve overall morbidity and mortality.    Outcome measures will be derived from the aforementioned measurements taken at anniversary clinic visits.   Literature  1- Post-transplant metabolic syndrome in children and adolescents after liver transplantation: a systematic review. Liver Transpl. 2012 Sep;18(9):1009-28. doi: 10.1002/lt.23478. Rothbaum Perito E, Lau A, Rhee S, Roberts JP, Rosenthal P.   2- The metabolic syndrome Lancet 2005; 365: 1415â€“28 Robert H Eckel, Scott M Grundy, Paul Z Zimmet   3- Post-transplant diabetes mellitus Diabetology & Metabolic Syndrome 2009, 1:14  MarÃ­lia B Gomes1* and Roberta A Cobas2    4- What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci. 2013 Jan 28. doi: 10.1111/nyas.12030.  Weiss R, Bremer AA, Lustig RH.   ","approved","I complete my own clinical training with CCT in March 2014 and will not certainly be continuing in Aberdeen after that date. I have explained this to Mark and am happy to continue providing support wherever I am come then, or to pass his Aberdeen supervision on to a colleague if necessary.","2013-02-13T22:12:29"]
["u01ekg9","Dr","Christopher","Burton","c.burton@abdn.ac.uk","Room 1:170 Polwarth Building","Foresterhill Campus","AB25 2ZD","Aberdeen","Scotland",{"$nulls":7},"Symptom impact hierarchy study","Introduction:Patients are often found to have multiple symptoms, with negative effect of quality of life, lacking organic basis1. In efficient health services, diagnostic tests are targeted at patients most likely to have abnormal results, thereby bringing about a change in their management. Patients experiencing multiple physical symptoms commonly receive numerous diagnostic tests in search for explanation or reassurance 2,3 despite the fact that for these patients diagnostic tests have minimal reassuring effects on patients with low pre-test probability of disease4. Elevated levels of anxiety are common in patients with multiple physical symptoms and the reassurance questionnaire5 has been developed to measure the extent to which patients feel reassured by their doctor. Aim: to study the association between diagnostic test use, both current and past, and reassurability among GP consulters  Methods:a pilot study to test the feasibility and acceptability of the methods for a larger6 study. It will be based in General Practice, involving a patient questionnaire and electronic case note review. Data collection: Patients arriving at routine consultations would be invited by the receptionist to take part in a student research project into reassurance. Those agreeable would be given a clipboard containing an information sheet, consent form and questionnaire. The student will be present in the waiting room, able to confirm that those with a clipboard are willing to partake and to collect the completed questionnaires. The questionnaire will include the 10-item reassurance questionnaire and the patientâ€™s primary reason for the appointment (new symptom, ongoing symptom, condition review, health maintenance, other). At a later date, case note review of the consenting patient will be conducted to extract data as to: age, sex, major medical conditions and diagnostic tests (with summary results) that were conducted within the last 5 years. Any test carried out by specialists out with the general practice, will be included where documented in correspondence. Certain tests such as cholesterol and HbA1c, where the aim is to monitor long-term conditions would be excluded.  Analysis: Data will be tabulated and plotted (RQ score vs number of investigation) and the correlation coefficient calculated between these measures. Further pre-specified exploratory analysis will be carried out with regard to age, sex and repeated negative tests. The target sample size is 60 patients to ensure that this study is feasible within the time available and returns reasonable heterogeneity of participants. If data collection proceeds quickly, the study may be extended to up to 180 participants, a comparable size to the arms in one of the original RQ studies.    Outcomes:this study will be a useful pilot study for further work in this area. If the larger target number is achieved then it may be suitable for a conference poster or research letter in a primary care journal.  Literature: 1. Hartz AJ, Noyes R, Bentler SE, Damiano PC, Willard JC, Momay ET. Unexplained symptoms in primary care: perspective of doctors and patients. Gen Hops Psych 2000; May;22(3):144-52.  2. McGorm K, Burton C, Weller D, Murray G, Sharpe M. Patients repeatedly referred to secondary care with symptoms unexplained by organic disease: prevalence, characteristics and referral pattern. Fam Pract 2010; 10;27(5):479-86.  3. Puri PR, Dimsdale JE. Health care utilization and poor reassurance: potential predictors of somatoform disorders. Psychiatr Clin North Am 2011; Sep;34(3):525-44.  4. Rolfe AB,C. Reassurance after diagnostic testing with a low pre-test probability of serious disease: systematic review and meta-analysis. JAMA Internal Medicine 2013;In Press.  5. Speckens AEM, Spinhoven P, Van Hemert AM, Bolk JH. The Reassurance Questionnaire (RQ): psychometric properties of a self-report questionnaire to assess reassurability. Psychol Med 2000; 07;30(4):841-7.  6. Morriss R, Kai J, Atha C, Avery A, Bayes S, Franklin M, et al. Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Fam Pract 2012; Jul 6;13:39,2296-13-39.   ","approved",null,"2013-04-13T11:12:55"]
["u13ah8","Mr","Alasdair","Sutherland","a.sutherland@deakin.edu.au","South West Healthcare","Ryot Street","Vic 3280","Warrnambool","Australia","00613 5564 4217",{"$nulls":6},"Measurement of acetabular component anteversion in a district hospital","Introduction     The dislocation rate of total hip replacements (THR) is approximately 3-5%.  A number of factors are thought to contribute to this.  The version (anterior or posterior orientation) of the acetabular component (cup) in total hip replacement is critical in maintaining hip stability.  Cups that are excessively anteverted or retroverted can have a higher risk of dislocation, not to mention wear and the range of motion in the joint.  Techniques to assess this radiologically have typically required complex radiological assessments and trigonometric functions that are not available in a small district hospital.    This study aims to trial the use of a simpler method to assess the version of total hip arthroplasties (THA) in a two year cohort done by a single-surgeon with a standardized surgical technique.   Methods    All patients having a THR by the senior author between Jan 2012 and Dec 2013 at the Warrnambool Base Hospital have been assessed prospectively and radiographs will be available for review on the hospitalâ€™s digital system.  It is expected that approximately 50 patients will be reviewed.    Radiographs will be assessed by the method of Widmer to determine cup anteversion.  Measurements will be repeated at two time points to assess intra-observer variability.  Any hips that have dislocated during follow-up (3 of 34 hips for the year 2011) will be compared with those that have not, and the results tested statistically with the Chi-square test to assess the impact of measured anteversion on joint stability.  The data collected will be stored in SPSS to allow easy analysis.    As this study is an assessment of current practice, rather than a new clinical technique, formal ethical approval is not required.  The study will, however, still be submitted for the consideration of the Local Research Ethics Committee prior to commencement.   Outcomes   Assess the precision (repeatability) of the technique by comparing the analysis of each x-ray at two time points (testing the clinical precision of the technique). Compare my results with the results of the operating surgeon (inter-observer variability). Compare intra-observer variability by comparing my own results found at two different time points for each x-ray. Compare the x-ray results with any hip replacements that suffered complications, especially dislocation.   Literature  Widmer, KH.  A simplified method to determine acetabular cup anteversion from plain radiographs.  J Arthroplasty 2004 April; 19(3): 387-390  Murray DW.  The definition and measurement of acetabular orientation.  J Bone Joint Surg Br. 1993 Mar;75(2):228-32  T. G. Goergen, TG and Resnick, D.  Evaluation of acetabular anteversion following total hip arthroplasty: necessity of proper centring.  British Journal of Radiology 1975, 48, 259-260  ","approved","No problems with project, achievable in time scale.","2013-01-23T12:03:20"]
["u08kh9","Dr","Andrew","Inglis","andrew.inglis@nhs.net","ITU, Southern General/ EMRS base, Clydeside Heli-port",null,null,"Glasgow","Scotland",{"$nulls":7},"A retrospective audit of severity scores in patients transferred to ICU from the Northern Isles; pre and post introduction of the Emergency Medical Retrieval Service","Introduction   The Emergency Medical Retrieval Service (EMRS) is a helicopter and land ambulance retrieval service that began operating in the north and west of Scotland in 2008, encompassing the Orkney and Shetland isles in October 2010. The EMRS teams consist of Intensivists, Anaesthetists and Emergency physicians along with specially trained nurses and advanced skilled paramedics.  Transfer of seriously ill patients is a critical time and often presents its own challenges. Research suggests that transfer under the supervision of skilled, and specifically trained professionals may improve patient outcomes (1) and decreases adverse events during transit (2).  The Orkney and Shetland Isles are situated 16km and 170km off mainland Scotland. Their geographical isolation can result in long delays in receiving specialist emergency care (3). This audit will examine whether the introduction of the EMRS has altered the referral rate and outcomes of patients transferred from the Orkney and Shetland isles to the Scottish mainland.  Methods   The project will be based in ITU in Aberdeen with two weeks based at the Southern General. Time will be spent at the EMRS base, to familiarise their protocols and procedures and access transfer data. There will be an opportunity to visit Shetland to view the challenges of remote and rural healthcare settings.  All data will be collated into and analysed using appropriate quantitative measures in SPSS. It is estimated that around 100 cases will be available since the implementation of the EMRS service in October 2010. These will be compared with 100 cases preceding the EMRS' deployment in Orkney and Shetland.  This project does not require ethical approval, as it is an internal, retrospective audit of patient data.   Outcomes   The primary aim of this project is to identify how the establishment of a professional critically ill patient transferring service has altered referrals and patient outcomes. Further analysis of adverse events before and after the implementations of the service will also be examined.  During the course of this elective there will be an opportunity to expand on existing knowledge of managing critically ill patients in a variety of settings. Furthermore it will allow development of an insight into the precise difficulties of looking after critically ill patients during inter-hospital transfers and the challenges this produces.    References  1. Wiegersma J S, Droogh J M, Ziijlstra J G, Fokkema J, Ligtenberg J J M. Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team. Critical Care 2011: 15;R75 2. Fried M J, Bruce J, Colquhoun R, Smith G. Inter-hospital transfers of acutely ill adults in Scotland. Journal of the Association of Anaesthetists of Great Britain and Ireland 2010: 65; 136-144 3. Remote and Rural steering group. Delivering for remote and rural healthcare the final report of the remote and rural work stream 2007. Accessed from http://www.scotland.gov.uk/Resource/Doc/222087/0059735.pdf 13:44 08/02/13.  ","approved",null,"2013-02-11T22:16:28"]
["u05rmh9","Dr","Lutz ","Beckert ","Lutz.Beckert@cdhb.health.nz","Deparment of Respiratory Medicine","Christchurch Hospital, Riccarton Ave, Christchurch Central",null,"Christchurch ","New Zealand",{"$nulls":7},"Iron deficiency and anaemia in patients with pulmonary arterial hypertension","Introduction  Sarcoidosis is a granulomatous multisystemic disorder which commonly affects the lungs. The cause of the disease still remains unknown and can present at any age but more commonly presents in young adults. When diagnosing sarcoidosis it is important to rule out any differentials that may cause enlarged lymph nodes in this age group such as lymphoma or infection.  About 90% of patients will have enlarged thoracic hilar lymph nodes on a chest radiograph which may be an incidental finding.  In suspected sarcoidosis, bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) when required should be performed initially. Mediastinoscopy may also be performed. Endobronchial biopsy samples in addition to TBLB are recommended since they are frequently positive, are associated with low morbidity and increase the diagnostic yield. A biopsy sample supporting the diagnosis of sarcoidosis would show non-caseating cell epitheloid granulomas.  EBUS is a relatively new technique which is less invasive and has increased the ability to biopsy smaller nodes which are not readily accessed by mediastinoscopy.   I intend to carry out a study comparing the methods in which patients with sarcoidosis were diagnosed, looking at the specificity of each procedure and if there were any complications.   Methods  I intend to carry this out as a retrospective quantitive study at Christchurch Hospital looking through the case notes of patients with suspected sarcoidosis who either had EBUS FNA or bronchoscopy with TBLB and compare  Outcomes   With my elective in New Zealand, I will be able to compare the Healthcare systems of New Zealand and the UK, the hospital set-ups of both countries, differences in the working style of doctors in New Zealand compared to the UK and I will gain the experience of carrying out and writing up a research project.    Literature   Dempsey.OJ, Paterson.E.W, Kerr.K.M et al, â€˜Sarcoidosisâ€™, British Medical Journal  2009;339:b3206   Wong. M, Yasufuku. K, Nakajima. T et al, â€˜Endobronchial ultrasound: new insight for the diagnosis of sarcoidosisâ€™, European Respiratory Journal 2007; 29:  1182-1186   Wells, AU, Hirani.N et al, â€˜Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Societyâ€™, BMJ Thorax 2008;63;v1-v58   Baughman RP, Culver D.A et al, â€˜A Concise Review of Pulmonary Sarcoidosisâ€™, American Journal Respiratory Critical Care Medicine 2011Vol 183. pp 573â€“581  ","approved",null,"2013-02-14T17:14:47"]
["u02kah9","Dr","Amanda ","Henry","amanda.henry@unsw.edu.au","St George Hospital  ","Gray St, Kogarah ","NSW 2217","Sydney","Australia",{"$nulls":7},"Third Trimester Ultrasound: an audit of current practices at St George Hospital, Sydney","Introduction  Currently, the use of routine third trimester ultrasound in low risk pregnancies is not standard practice in Australia. However, the evidence informing this practice is controversial and third trimester screening ultrasounds are increasingly used. A study by Sylvan et al.(1), showed that it seems that routine third trimester ultrasound screening in an unselected population does not reduce perinatal mortality or early neonatal morbidity. A Cochrane review by Bricker et al.(2), found that there is no evidence that routine ultrasound in late pregnancy improves perinatal outcome and it may increase the rate of caesarean sections.    Methods  I will be assisting with data collection and analysis in this audit that is being undertaken and aiming to look at 1200 women. It has two arms: a retrospective audit of all births occurring from October to December 2012 at St George Hospital and prospective audit of all patients attending antenatal booking visits from February to April 2013. In the prospective arm of the study, a questionnaire to be completed by the person ordering the third trimester ultrasound will be included in the files of women with an antenatal booking during the study period. By the time that I will joining this project, the women in the prospective arm will be having third trimester ultrasounds, which I will be collecting data on.  Data collection will be done via:  1) Patient medical records and 2) Obstetrix database, which lists all maternal and neonatal outcomes  This is mostly an observational study, but some t tests will be used to look at continuous variables. Ethical approval has been done.   Outcomes  The project aims are as follows. To find:  1) The percentage of the St George Hospital antenatal population with a singleton pregnancy who currently undergoes at least one ultrasound in the third trimester, and the indications provided 2) What proportion of third trimester ultrasounds currently being undertaken yield abnormal findings and/or information that is likely to change the clinical management of the pregnancy 3) Obstetric outcomes in women with singleton pregnancy who undergo third trimester ultrasound scanning versus those who donâ€™t.  By the end of my elective, I hope to have gained experience in research and data analysis and I hope to have helped the local team in their data collection and research.  Literature References:  1) Eik-Nes SH, Salvesen KA, Okland O, Vatten LJ. Routine ultrasound fetal examination in pregnancy: randomized controlled trial. Ultrasound in obstetrics & gynecology. 15(6):573-8, 2000 June. [Feb 5, 2013] http://www.sld.cu/galerias/pdf/sitios/genetica/ultrasonido.pdf  2) Bricker L, Neilson JP, Dowswell T. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database of Systematic Reviews 2008, Issue 4. [cited Feb 5, 2013] http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001451.pub3/full  ","approved",null,"2013-02-12T20:31:27"]
["u01rdb8","Dr","Colville","Laird","claird@basics-scotland.org.uk","Sandpiper House","Aberuthven Enterprise Park","PH3 1EL","Aberuthven","Perthshire","01764 663671",{"$nulls":6},"An audit of the BASICS Scotland Patient Report Form Database","Introduction  BASICS Scotland is a charitable organisation concerned with the provision of prehospital care in Scotland. They have an operational and educational role to support and educate individual remote and rural responders across the country, who are available to provide medical support to the Scottish Ambulance Service. After attending a patient, a responder returns an annonymised patient report form (PRF) to the BASICS office. The PRF contains details of the patientâ€™s injuries/medical problems; what interventions were performed; and recordings of vital signs. This elective project will utilise the PRF database as its data source.  Methods The PRF database is expected to contain details of approximately 1000 patients by the time the project begins. The data is currently stored in Microsoft Excel, however it is anticipated this will be exported to SPSS for statistical analysis. Suitable office accommodation will be available at BASICS Scotland to allow the researcher to securely access the data. Additionally, BASICS has invested in remote access and telepresence software to enable remote working where necessary.   Basic statistical techniques will be used to illustrate the incidence of: particular patient problems (for example, airway issues); specific interventions (for example, intubation); specific outcomes (for example, retrieval by helimed); etc. (Wyen 2012). Data integrity checks will be performed to assess the completeness of the data. This will be used to inform qualitative work around barriers to completion of the PRF by responders (Therien 2011).  This project does not require ethical approval; under the guidelines of the National Research Ethics Service as it falls under the category of service evaluation and is therefore exempt.   Outcomes  From this project, I hope to gain a better understanding of BASICS Scotland, an organisation I hope to work for. Additionally, my presence at their offices will afford me the more immediate opportunity to attend their prehospital emergency care courses, either as an observer or a simulated patient. These courses are not normally open to medical students and will give me a privileged insight into an area of medicine I wish to specialise in.  BASICS Scotland has been collecting PRF data for several years now, but as yet nothing systematic has been done with it. This project will give them a better understanding of what their responders attend, enabling them to tailor the objectives of their training courses to better meet the needs of delegates.  Literature Therien S, Nesbitt M, Duran-Stanton A, et al. Prehospital Medical Documentation in the Joint Theater Trauma Registry. J Trauma. July 2011. doi:10.1097/TA.0b013e3182218fd7 Wyen H, Lefering R, Maegele M, et al. The golden hour of shock â€“ how time is running out. Emerg Med J. Published Online First: 19 December 2012. doi:10.1136/emermed-2012-201962 ","approved","An excellent proposal. We are currently collecting vast amounts of prehospital medical care data through BASICS Scotland but it is important that it is analysed in detail not only to identify the problems we are dealing with in the prehospital environment but also to allow us to assess outcomes and ensure we are teaching appropriate knowledge and skills to our prehospital providers.  ","2013-02-04T20:31:25"]
["u06th9","Dr","Martin","Burton","director@cochrane.ac.uk","UKCC, Summertown Pavilion, ","18-24 Middle Way, ","OX2 7LG ","Oxford","UK","01865 516300  ","01865 516311  ",{"$nulls":5},"Oral Anticoagulants and Atrial Fibrillation: a panacea for the prevention of ischaemic stroke or merely bridging the gap to a better future?  A systematic review and meta-analysis of the novel oral anticoagulants versus Warfarin for the prevention of ischaemic stroke in patients with atrial fibrillation and an additional risk factor for stroke.","Introduction   Warfarin is a vitamin K antagonist that is currently the drug of choice for the prevention of ischaemic stroke in patients with Atrial Fibrillation (AF).  However in order to remain efficacious it has to be kept within a therapeutic range, which requires regular monitoring and careful dose adjustments. Coupled with poor compliance and numerous drug and food interactions this can be difficult for some patients to achieve.    Warfarin is however very effective in the prevention of ischaemic stroke and has the additional benefit of being cardioprotective in terms of reducing the incidence of MI.  However bleeding risk is increased, indeed of particular concern in the potential for the relatively uncommon, but devastating outcome of haemorrhagic stroke.  There have recently been several large phase III clinical trials investigating the use of the â€˜novelâ€™ oral anticoagulants [1,2,3], which have a more focused action on the clotting pathway, inhibiting either factor Xa or factor II.  There is also a phase III trial, which has completed recruiting participants which may publish results prior to the start of this proposed elective.  The aim of this study is to comprehensively evaluate each of the novel oral anticoagulants vs warfarin in terms of efficacy and safety for the prevention of ischaemic stroke in AF patients.  Methods   A systematic and repeatable literature search to identify appropriate primary studies for inclusion in the review searching the Cochrane library, Pubmed, EMBASE, clinicaltrials.gov, hand searching journals and consultation with experts in this field as well as identification of grey literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) [4] guidelines.    If the search yields primary studies, which satisfy the criteria for meta-analysis.  Data will be extracted and examined for publication bias with the construction of funnel plots.  If appropriate, the construction of forest plots from the log transformed hazard ratios and standard error using either fixed effects or random effects models (dependent on the extent of heterogeneity), using Revman5 software.  Outcomes   Ischaemic Stroke.  Haemorrhagic Stroke.  Thromboembolic Events.  Myocardial Infarction.  All Bleeding.  Major Bleeding.  Minor Bleeding.  Gastrointestinal Bleeding.  All cause mortality.   Literature  1. Connolly SJ, et al L; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009 Sep 17;361(12):1139-51.  2. Granger CB, et al ; ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981-92.  3. Patel MR, et al; ROCKET AF Investigators. Rivaroxaban versus  warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 Sep 8;365(10):883-91. Epub 2011 Aug 10.  4. Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009 Oct;62(10)e1-34.    ","approved",null,"2013-02-13T00:22:44"]
["u09rh9","Dr","Catherine Mary","Schooling","cms1@hkucc.hku.hk","Units 624-627, Level 6, Core F, Cyberport 3, 100 Cyberport Road",null,null,"Hong Kong","Hong Kong","(852) 3906 2032",{"$nulls":6},"Adolescent lung function and lifetime growth","Introduction The increasing prevalence of asthma in china has been noted for some years. One of the reported likely causes is the pollution in major cities, where the incidence of asthma is considerably higher. (1) A great deal of research is being carried out discovering the early life, foetal and pre-natal caused of asthma, however, most of the cohorts for these studies are Western, few based in China. (3) In 1997  a cohort study began collecting data on Hong Kong Chinese babies and their families in an attempt to research inter-generational changes and explain possible patterns of disease in this population due to environmental exposures.  (2) I intend to consider this isolated Chinese community based in the distinctly urban area of Hong Kong and the pattern of disease incidence. Method I intend to do a multi-variant regression analysis of the data continuing to be collected in the children of 1997 birth cohort, comparing socio-economic factors with hospitalisation for asthma from birth to age 14. As with other studies using this data, adjustments will have to be made for sex, birth-weight, gestational age, feeding method, maternal age. The cohort originally consisted of 8327 babies, 88% of babies born during April and May in 1997, of these, 7381 participants are still involved. (2) Whilst data for the prevalence of asthma in these children is not available, the incidence of hospitalization is, it is this that will form the basis of my study. Outcome From this study I hope to show a correlation between hospitalisation for asthma and differing socio-economic circumstances. I also hope that in doing this research, an indication as to whether the collators of the data base should consider further research into the prevalence of asthma in Hong Kong.  I hope to gain experience in using data and applying the appropriate analytical method.  Literature (1) Watts, Jonathan. â€˜Doctors blame air pollution for Chinaâ€™s asthma increasesâ€™. The Lancet. Volume 368, Issue 9537, Pages 719-720. Published 26/8/06. (2) Schooling et al. â€˜Cohort Profile: Children of 1997: a Hong Kong Chinese birth cohortâ€™. Intnational Journal of Epidemiology. Oxford University press. Published 11/1/11. (3)     Deveruex et al. 'Nutrition and development: asthma and allergic disease', Chapter unpublished.  ","approved","Having spoken with Rachel I understand the background to this proposal, very exciting. Will continue to work with Rachel to get the most from this opportunity","2013-02-13T21:35:36"]
["u01ach9","Dr","Luk","Rombauts","lukrombauts@hotmail.com","Monash Medical Centre","246 Clayton Road","Australia","Clayton","Melbourne VIC 3168",{"$nulls":7},"Does corifollitropin alfa improve viable pregnancy rates in poor ovarian responders undergoing IVF treatment?","Introduction: Controlled ovarian hyperstimulation (COS) is the first step of in vitro fertilisation (IVF), involving daily injections of urinary-derived, or recombinant follicle stimulating hormone (rFSH) in order to produce multiple mature follicles for egg retrieval.  However, there is a cohort of women who have a poor ovarian response to gonadotropins.  Despite research, there is still no standard practice for this group.  Corifollitropin alfa is a newly developed hybrid FSH with a longer half-life, and has confirmed safety and efficacy of follicular stimulation in â€˜normal responders.â€™(1-2)  It has a potential role in the management of this group of poorly responding patients because it reaches its peak serum concentration earlier than rFSH, and so exposes small antral follicles to maximum FSH for longer, theoretically resulting in a higher number of follicles post stimulation.(3)  The aim of this pilot study is to assess the efficacy of corifollitropin alfa in producing an ovarian response in this group of poor responders, and therefore whether a randomised controlled trial (RCT) is justified.  Methods: Data from n=30 patients at Monash Medical Centre, Melbourne who are poor responders (<6 oocytes at egg retrieval) and have been receiving cortifollitropin alfa for COS will be analysed retrospectively, assessing response to stimulation (number of eggs collected) and clinical pregnancy rate.  Complication rates will also be reviewed.    The results will be presented in a formal report and I hope to present my findings to the Department of O&G at Monash University, and also upon my return to Aberdeen.    Outcomes: I hope to gain an in-depth understanding of the IVF process, and of the subject of infertility in general.  I am considering pursuing a career in obstetrics and gynaecology, so this topic is particularly relevant to me.  Furthermore, Iâ€™m interested in comparing the Australian healthcare system to that in Scotland.  I also hope to discover more about the research process, including how data is analysed in a pilot study with a view of potentially carrying out an RCT.    Literature: (1) Mahmoud Youssef MA, van Wely M, Aboulfoutouh I, El-Khyat W, van der Veen F, Al-Inany H. Is there a place for corifollitropin alfa in IVF/ICSI cycles? A systematic review and meta-analysis. Fertility & Sterility 2012 Apr;97(4):876-885. (2) Rombauts L, Talmor A. Corifollitropin alfa for female infertility. Expert opinion on biological therapy 2012;12(1):107-112. (3) Polyzos NP, DeVos M, Humaidan P, Stoop D, Ortega-Hrepich C, Devroey P, et al. Corifollitropin alfa followed by rFSH in a GnRH antagonist protocol for poor ovarian responder patients: an observational pilot study. Fertil Steril 2013 2;99(2):422-426.  ","approved",null,"2013-02-11T21:34:03"]
["u01lrh8","Mr","Frank","Frizelle","frank.frizelle@cdhb.health.nz","Christchurch Hospital","Riccarton Avenue",null,"Christchurch","New Zealand",{"$nulls":7},"Retrorectal Tumpurs: A Retrospective Study of the Investigation and Management of Patients Presenting to Christchurch Hospital over a 15-year Period","Introduction  I will spend my elective in Christchurch Hospital, New Zealand where I will be based in the General Surgery department under the supervision of Professor Frank Frizelle, Colorectal Surgeon. I will be conducting a retrospective audit, reviewing the management and outcome of patients with retrorectal tumours with a view of developing improved pathways of management.   Retrorectal tumours are rare, found between the rectum and sacrum and can originate from a variety of tissues. There are several different types; tumours may be benign or malignant and can be cystic or solid in nature. Symptoms arising from these tumours are often non-specific, leading to a late diagnosis.   Christchurch hospital receives nationwide referrals for these tumours. Current practice is to perform an MRI scan primarily with EUA or flexible sigmoidoscopy, and FNA biopsy if the tumour is sold. The role of biopsy remains controversial due to the risk of tumour seeding and infection.(1)  Although several algorithms exist (1,3) no current national guidelines on the diagnosis and management of these tumours have been developed, in either the UK or NZ.  Recently Macafee et al. provided updated techniques for the investigation and management of retrorectal tumours. They directed management according to the results of primary MRI scans, eliminating the need for routine biopsies. (2) It is therefore crucial to examine current practice in Christchurch to determine whether MRI as the sole investigation is applicable here.   Method and Outcomes  This retrospective audit will comprise of examining the medical records of patients who presented with a primary retrorectal tumour to Christchurch hospital between 1997-2012. As this is a rare tumour, approximately one patient per month is seen at Christchurch hospital, allowing recruitment of 150-180 patients.  Prof. Frizelleâ€™s team will identify patients fulfilling the inclusion criteria.  Information extracted from medical records will be entered onto a secure database on a Christchurch hospital computer and will be anonymised.   Data collected will include patient demographics (age, sex, smoking status), symptoms, investigations and subsequent complications, radiological findings, histological grade at diagnosis, treatment and complications (peri-operative and long-term) and outcome in terms of survival and recurrence.   Analysis of the data will be performed using SPSS, and will include calculation of odds ratios for developing complications, and survival rates. A literature review and comparative analysis of larger studies will also be undertaken.  No ethical approval is required for retrospective audits in New Zealand.  Undertaking an audit during my undergraduate career will allow me to gain an understanding of a process which I can use to critically examine my practice throughout my career. I will also put into practice methodology learnt during my BSc MedSci.   During my elective I hope to increase my experience with general surgery patients and produce an abstract or presentation for a national conference.  References (1) Hassan I, Wietfield ED. Presacral Tumors: Diagnosis and Management. Clin Colon Rectal Surg 2009;22(2):84-93.  (2) Macafee DAL, Sagar PM, El-Khoury T, Hyland R. Retrorectal tumours: optimization of surgical approach and outcome. Colorectal Disease 2012;14:1411-1417.  (3) Woodfield JC, Chalmers AG, Phillips N, Sagar PM. Algorithms for the surgical management of retrrectal tumours. British Journal of Surgery 2008;95:214-221.    ","approved",null,"2013-02-04T14:12:33"]
["u05eh9","Mr","Niall","Small","Niall_Small@health.qld.gov.au","The Townsville Hospital","100 Angus Smith Drive","Qld 4814","Douglas, Queensland","Australia","+ 61 7 4433 1111",{"$nulls":6},"The impact of an indigenous health liaison officer service on indigenous patients who do not wait for services or leave after treatment is commenced from a North Queensland Emergency Department"," Introduction  In Australia most Indigenous health-care policies, research and other medical matters focus on primary health-care services (particularly those that are controlled by the Indigenous community) rather than looking at hospitals.   Indigenous Australians attend the Emergency Department twice as often as other Australians despite living in more remote parts of the country. They are much more likely to be admitted to hospital, spend a longer time in hospital and have more complex problems.   On top of this Indigenous Australians are 1.5 times more likely to leave emergency departments before being seen by a medical professional and 2.5 times more likely to self-discharge than other Australians. These people were found to be younger, mainly females arriving by ambulance and presenting on a Monday.  All of the literature and research suggests that the Indigenous people of Australia are not satisfied with the medical services provided. Investigation in to why this is could help to encourage use of all health services and break down some cultural barriers that seem to still exist.  Methods  I aim to conduct a qualitative study looking at the views of Indigenous Australians and Torres Strait Islanders towards the healthcare system in Townsville, Queensland and why there is such a high rate of people self-discharging or not waiting for treatment amongst these individuals.  I will start by looking at the presentations of Indigenous Australians to the ED in Townsville by looking at the data that the ED has collected in past years. I then plan to interview some of these individuals if they present to the ED over a four-week period. I plan to use a software package such as NVivo 10, which will allow me to record any interviews and then allow me to convert them to a hard copy. I then plan to interview some individuals at The Townsville Aboriginal and Islander Health Services (TAIHS) and investigate what the views of the Indigenous Australians are as a whole and to see if there are any common themes leading to why they seem to be dissatisfied with the health services.  I have considered the need for Ethical Approval and am in contact with the Townsville Human Research Ethics Committees, of which one member has a specialist interest in this field.   Outcomes  The main goal of this elective project is to find out why Indigenous people are dissatisfied with the ED specifically and health services in general.   I hope that from this project there can be an increase in awareness amongst medical professionals as to why the statistics are as they are and allow the Indigenous people to accept treatment when they present to the ED.  Finally a personal aim of mine is to experience the culture of this community of people and understand more about their history.   Literature and information    1. Anderson I, Clarke A, Renhard R, Otim M, Andrews S. Linking acute care to a strategy for improving Aboriginal health. Aust. Health Rev. 2002; 25: 118â€“29.  2. Wright L. â€œThey just donâ€™t like to waitâ€\u009dâ€”A comparative study of Aboriginal and non-Aboriginal people who did not wait for treatment or discharged against medical advice from rural emergency departments: Part 1. Australian Emergency Nursing Journal. 2009; 12: 78-85 3. â€œClosing the Gap in Queenslandâ€\u009d http://www.health.qld.gov.au/atsihealth/close_gap.asp    ","approved",null,"2013-03-24T17:07:11"]
["u05mj8","Dr","Stephan","Herodotou","amanda.geddes@nh.org.au","Northern Hospital","185 Cooper Street","Australia","Epping","Melbourne",{"$nulls":7},"A review of pain relief practice in an Australian emergency department ","Introduction Â· Acute abdominal pain is a common presentation in A&E departments, with many possible underlying causes.  There are a wide array of causes from intestinal obstruction to appendicitis and ectopic pregnancy to pancreatitis.  After the problem has been identified, patients can be treated medically or surgically.  This project aims to detect the percentages of patients who attend A&E with acute abdomen and how they are managed.    Methods Â· A&E departments receive over 100 patients each month presenting with â€˜acute abdomen.â€™  I will gather data on the age, gender, diagnosis and management over a 4-week period for patients attending A&E presenting as â€˜acute abdomenâ€™.    Outcomes Â· The results will be compared with other literature available, conclusions shall be drawn and recommendations regarding management will be discussed.    Literature Â· Acute Nonspecific Abdominal Pain; M Morino et al; Ann Surg. December 2006; 244(6): 881-888 Â· Clinical presentation ofAcute Abdomen: study of 600 Patients; Staniland et al; British Medical Journal 1972; (3); 393-398   ","approved",null,"2013-02-11T16:52:22"]
["u01mxk12","Dr","Malcolm","Metcalfe","mj.metcalfe@nhs.net","Cardiology Department","ARI",null,"Aberdeen","UK","0113 392 6476",{"$nulls":6},"Prognostication of cardiac patients with myocardial perfusion scan","Introduction  Coronary artery disease and consequent ischaemic events are common and widely understood by the population. Aortic stenosis, another major cause of considerable morbidity and mortality, is increasingly prevalent in the older population. Up to 15% of individuals, aged over 65 years old has this condition and approximately 5% of these will develop severe life-threatening symptoms each year. At present, the only effective treatment is to undertake a valve replacement operation. In the elderly, however, this can be hazardous, especially in the presence of co-morbidities. Transcatheter Aortic Valve Implantation (TAVI), a new method developed in Europe, potentially carries relatively less risks and offers hope to patients who are unsuitable for Surgical Aortic Valve Replacement (SAVR). The aim of this project is to find out whether TAVI is more superior to SAVR in the management of aortic valve disease.   Methods  This project will be carried out in the Yorkshire Heart centre, Leeds which serves a population of 6.5 million.  The desired sample size for this project is around 100 â€“ 150 patients.  There are two main outcomes that I would like to look at in this project:  1) Efficacy of TAVI vs SAVR 2) Safety profile of TAVI vs SAVR  1The proposed methods to measure efficacy are as follow:  a) Health status at 6 months post-replacement using the Short Form (36) Health Survey b) Hemodynamic status postoperatively at 1, 3 and 6 months  c) Length of hospital stay postoperatively d) Rate of readmissions  The proposed method to measure safety profile is as follow:  a) Incidents of perioperative complications b) Incidents of postoperative complications  Short Form (36) Health Survey will be sent to patients to obtain their health status at 6 months after the replacement. Other data will be collected from the respective storage system in Yorkshire Heart centre. All materials will then be compiled in a table using Microsoft Excel. Subsequently, SPSS will be used for statistical analysis and the results will be illustrated using several graphical presentations.   Outcome  From this project, I hope to gain more knowledge and experience regarding the impact of aortic valve disease on patients, the appropriate surgical procedure for different groups of patients, the discussion of treatment plan with the patient and family and the management of patients in a multi-disciplinary environment. Assisting consultants in a TAVI procedure is definitely a plus point as getting involved in the operation will be very beneficial for me.  In addition, I hope that this project will shed light as to which method of valve replacement is more beneficial for patients and the NHS and hence will be able to contribute when guidelines on the management of aortic valve diseases are amended.     Literature  1. Matthew R. Reynolds, MD, MScâ\u0081Ž, Elizabeth A. Magnuson, ScDâ€ , Kaijun Wang, PhDâ€ , Vinod H. Thourani, MDâ€¡, Mathew Williams, MDÂ§, Alan Zajarias, MDâˆ¥, Charanjit S. Rihal, MDÂ¶, David L. Brown, MD#,Craig R. Smith, MDÂ§, Martin B. Leon, MDÂ§, David J. Cohen, MD, MScâ€     Health-Related Quality of Life After Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis : Results From the PARTNER (Placement of AoRTic TraNscathetER Valve) Trial (Cohort A)   ","approved",null,"2013-02-07T18:58:47"]
["u01vml9","Dr","Patrick","Byrne","patrick.byrne@nhs.net","Belford Hospital","Belford Road","PH3 6BS","Fort William","Scotland","+255 754 318 371",{"$nulls":6},"The epidemiology of trauma adissions into a tertiary referral hospital in Northern Tanzania","Introduction:  Providing adequate, accessible healthcare in Africa is a continuing challenge, with limited resources and high incidences of trauma and infectious disease. I wish to gain insight into medical provision in a developing country, and thus, my elective is in the orthopaedic surgery department at the Kilimanjaro Christian Medical Centre (KCMC), Tanzania. KCMC is a tertiary referral hospital providing care for over eleven million people.(1)  Specifically, referral systems and emergency transport in Africa are inefficient, with â€œlow availability of trained personnelâ€¦and inadequate communication infrastructure.â€\u009d(2) Therefore, my project will focus on referral patterns to orthopaedics in KCMC. I am interested in documenting the time between injury and presentation, and average referral waiting times.  Considering the wide geographical area that KCMC covers, I will also investigate the accessibility of hospital care for the local population.   Methods:  I plan to collect epidemiological data on patients referred to the department. These will include those actually admitted as in-patients, as well as referrals not requiring admission. I hope to prospectively look at 100 consecutive patients.   Data collected will include: - Patient demographics: age, gender, ethnicity, occupation, location  - Injury mechanism - Injury presentation - Type of referral: self, emergency, district hospital - Time between injury event and hospital referral/admission - Time it took patient to reach hospital - Has patient been to hospital before?  I will gather data from patient referral notes by using a customised Performa. In order to get a better understanding of accessibility to hospital care, I hope to interview in-patients about their journey to KCMC. Ward rounds and patient records are in English, and conversations can be translated into English by the medical staff. I have emailed my host supervisor regarding access to patient records and referrals, and am awaiting a reply.  Furthermore, I hope to focus on the clinical management of one traumatic fracture that is commonly admitted, and intend to compare the presentation and management to that experienced in Scotland. I am aiming for 10 cases.  Outcomes:  I hope to gain insight about:  - The most common orthopaedic referrals, mechanisms of injury and patient population admitted to a tertiary hospital in a developing country - How accessible healthcare is for majority of the Tanzanian population.  - Differences in clinical management and available resources in Tanzania and Scotland   Hopefully, I shall provide the department with a thorough overview of their admissions and insight into any referral patterns that arise, which may aid doctors in their clinical management. Overall, I want to experience medicine in a different setting, and face the challenges of providing medical care in a developing country.    Literature (1)Kilimanjaro Christian Medical Centre [internet], c2001[updated Nov2012] <http://www.kcmc.ac.tz/> (12.02.12) (2)Macintyre K.Referral revisited: community financing schemes and emergency transport in rural Africa. Social Science & Medicine. 1999Dec 49(11):1473-87   ","approved","I think this should read \"trauma referrals\" rather than \"orthopaedic referrals\" but otherwise OK.","2013-02-12T23:50:25"]
["u01hkl9","Miss","Clare","Shakespeare","clare.shakespeare@gmail.com","Mulanje Mission Hospital,     ","PO Box 45",null,"Mulanje","Malawi","+265 9922 61569",{"$nulls":6},"Malaria Prevention: A questionnaire based, cross sectional study of insecticide treating net (ITN) used in those patients presenting with malarial symptoms and subsequently receiving malaria treatment","The WHO estimates that in 2010, malaria caused approximately 655,000 deaths in Malawi(1). It is thought to account for about 40% of all under-five hospitalisations and 40% of all hospital deaths. While it is estimated that availability of a bed net in the household is currently 49%, the proportion of children sleeping under an ITN is still around 23%.  One of the main challenges highlighted in the country cooperation strategy summary of health and development was very low usage of ITNs for both under-five children and pregnant women(2).  Centre for Disease Prevention and Control (CDC) has helped develop and evaluate interventions recommended by WHO and used by programmes worldwide to fight malaria, the first of which is insecticide-treated bed nets (ITNs) to protect people from mosquitoes(1). To achieve optimum malarial protection, high community coverage is required, therefore reducing the lifespan of mosquitoes and eventually achieving protection for the entire community whether they are using an ITN or not(3).  At MMH, ITNs are provided to all patients attending under-5 and antenatal outpatient clinics. The aim of this project is to ascertain what percentage of the population presenting with malaria are utilising ITNs, and whether the rest of their household sleeps under one. A data collection sheet collecting data regarding the patientâ€™s age, sex, ITN status and household status will be placed in each outpatient clinic. This will be completed on everyone presenting with the symptoms of malaria during the consultation with consent from the patient. This will enable collection of a wide range of ages. The same information will be obtained from any patient admitted to MMH on an inpatient basis with malarial symptoms. The data will be collected for the first four weeks of the placement at MMH, and the aim would be to pick up all presentations of malarial symptoms.   If the percentage usage of ITNs is very low, as was highlighted as a health challenge in 20092, then this will highlight the need for improved health education and malaria prevention measures.  References 1. Centre for Global Health, Division of Parasitic Diseases and Malaria, CDCâ€™s Malaria Program 2. World Health Organisation, Regional Office for Africa, WHO Country Cooperation Strategy 2008-2013 Malawi, 2009. 3. CDC Home [homepage on the Internet] > Malaria>Malaria Worldwide>How to Reduce Malaria's Impact>Insecticide-Treated Bed Nets [Updated 9 November 2012; cited 22 March 2013]. Available from: http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html  ","approved",null,"2013-04-02T14:10:08"]
["u01kml12","Prof","Maw Pin","Tan","mawpin.tan@gmail.com","Department of Medicine, Faculty of Medicine"," University Malaya Medical Centre, Lembah Pantai",59100,"Kuala Lumpur","Malaysia",{"$nulls":7},"Oral health of patient in an acute geriatric ward in a teaching hospital in Kuala Lumpur","Introduction The number and proportion of elderly is increasing globally. Elderly population in Malaysia was documented to increase from 6.4% to 7.0% from year 2000 to 2005, and is subsequently to be expected to increase to 12% by year 2020 [1]. Population ageing poses concerns with healthcare provision as ageing is associated with a number of health issues including chronic diseases such as hypertension, diabetes, ischemic heart disease and stroke. Several studies have documented that oral cavity could be a reservoir for pathogens which would lead to endocarditis and aspiration pneumonia[2][3]. Study conducted in Japan has proven that improving oral health hygiene could reduce the risk of infection and improves quality of life.[4]   The burden of oral health problems in the elderly in developing countries like Malaysia remains poorly defined. Routine dental screening is not widely available, and many older people do not see dental treatments.  Objective To determine the oral hygiene habits and oral health status of in-patients on the acute geriatric ward at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.   Methods All consecutive patients attending the geriatric unit at UMMC over 6 weeks of time will be given a questionnaire about their oral health and will then be examined by using the Oral Health Assessment Test (OHAT). The questionnaire will determine the oral hygiene habits during the admission period. OHAT is a validated questionnaire, which was modified from Kayser-Jones Brief Oral Health Status Examination. This tool allow non-dental professional to assess the condition of the lips, tongue, gums and tissues, saliva, natural teeth, dentures, oral cleanliness and dental pain. Patientâ€™s health conditions (co-morbidity & systemic infections) will also recorded.   This study is hypothesized that the oral hygiene of in-patient on the acute geriatric ward at UMMC is generally poor.  Outcome The collected data will be further analyzed by comparing with relevant studies conducted in Asia countries like Japan and non-Asia Countries like the United Kingdom to compare and contrast the overall oral hygiene status and practice in elderly admitted in hospital. Further analysis will be directed to explore the contributing factors towards the similarity or disparity found in each study.   Literature 1.Guidelines on Oral Health Care for elderly in Malaysia, Ministry of Oral Health. 2005 2.PB Lockhart et. al. Poor oral hygiene as a risk factor for infective endocarditis- related bacteremia. The Journal of the American Dental Association Oct 2009 Vol.140 no. 10 1238-1244  3.GW Taylor et al., Vol. 60, No 3, Fall 2000. Impact of oral diseases on systemic health in the elderly: Diabetes mellitus and aspiration pneumonia.  4. Koichiro UEDA, JMAJ 54(1): 39-43, 2011. Research and Reviews: Preventing aspiration pneumonia by oral health care.   ","approved",null,"2013-04-03T08:23:10"]
["u03asl9","Dr","Leslie","Samuel","leslie.samuel@nhs.net","Aberdeen Royal Infirmary",null,null,"Aberdeen","UK",{"$nulls":7},"The impact of time between finishing neo-adjuvant chemotherapy and starting definitive chemoradiotherapy on survival in patients with oesophageal cancer","Introduction  In the management of oesophageal cancer, there are various treatment modalities available depending on the stage and grade of tumour including surgery, chemotherapy and radiotherapy. One option is neoadjuvant chemotherapy followed by definitive chemoradiotherapy. The aim of this retrospective study is to determine whether a prolonged interval between receiving the two treatments will have an effect on patient outcome, in particular patient mortality.      Methods  A search will be conducted through the departmental database of all patients with oesophageal cancer who received neoadjuvant chemotherapy followed by concurrent chemoradiation. Patients will be divided into groups according to the interval time between them finishing neoadjuvant chemotherapy and then starting chemoradiation. The one year and five year survival rates of these patients will be compiled and compared between the groups, and also interpreted to determine whether it is of any statistical significance.  Outcomes  Survival rates of patients with oesophageal cancer who had longer interval between receiving neoadjuvant chemotherapy and subsequent chemoradiotherapy will be compared to survival rates of patients who had a shorter interval between receiving treatments. Any difference will be interpreted to determine statistical significance.   Literature There is evidence to suggest that for certain tumours, for example head and neck cancers, a prolonged interval between receiving treatments will negatively impact on patient outcome; while in other tumours there is no significant effect on outcome. Evidence for oesophageal cancer is still lacking, therefore this study would be useful in helping to determine whether patients with oesophageal cancer should be started on treatment with the aim of having as short an interval between treatments.  ","approved",null,"2013-02-10T22:28:04"]
["u01lbl8","Dr","Robert","Laing","r.laing@nhs.net","Infection Unit (Ward 111), Aberdeen Royal Infirmary",null,null,"Aberdeen","United Kingdom",{"$nulls":7},"A cross-sectional study to ascertain the prevalence of HIV associated neurocognitive disorder in patients over the sge of 50 in Grampian, Scotland","Introduction  HIVâ€™s effect on the central nervous system has long been known to include the development of subcortical dementia1. Although the introduction of highly active antiretroviral therapy (HAART) has contributed to limiting the proportion of seropositive patients who develop dementia, it is known that HIV services tend to overlook its development in their population of patients2. It is therefore important to detect cases of dementia in seropositive patients, especially as appropriate antiretroviral therapy is known to have a protective effect. This project aims to ascertain a baseline incidence figure for the patients attending the infection unit at the Aberdeen Royal Infirmary and the genitourinary medicine serviceâ€™s HIV clinics, using the HIV dementia scale as a screening tool. This questionnaire has a 80% sensitivity and 91% specificity in the detection of HIV dementia3.  Method  The projectâ€™s objective and method will be explained to patients attending the HIV clinic. Patients aged 55 and over will be invited to participate â€“ this reflects the fact that HIV dementia is unlikely to develop in younger patients.  Patients electing to participate will be interviewed in order to complete the HIV dementia scale questionnaire.  More information will be collated in order to enable a statistical analysis of the data collected. These will include time from diagnosis, therapeutic status (i.e. on HAART or not ), latest CD4 count (when available), latest viral load (when available), age, gender and educational attainment.  Since this project requires patients to be contacted directly, ethics approval will be sought.  Outcomes  This project will produce a baseline upon which further research activities in the field of HIV and dementia in Grampian can be based. Furthermore, it is a necessary part of the integrated care pathway the Infection Unit is currently developing for its HIV patients.  It will also allow me to use any free time I may have to obtain some clinical experience in the field of infectious disease.  References  1 McArthur J.C., et al., â€œDementia in AIDS patients: Incidence and risk factorsâ€\u009d in Neurology, 43(1993):pp.2245-52.  2 McArthur J.C., â€œHIV dementia: an evolving diseaseâ€\u009d in Journal of Neuroimmunology, 157(2004):pp.3-10.  3 Power C., et al., â€œHIV dementia scale: a rapid screening testâ€\u009d in Journal of Acquired Immune Deficiency Syndromes and Human Neurology, 8(1995):pp.273-8. ","approved",null,"2013-04-15T11:41:03"]
["u02irm9","Dr","Gillian ","Bell","gill.bell@ntw.nhs.net","Ferndene- Children and Young Peoples In Patient Service","Moor Road","NE42 5PB","Prudhoe, Northumberland","United Kingdom",1912232660,null,"Roycoft Unit, Lennox Ward","Jubilee Road","NE3 3XT","Gosforth, Newcastle upon Tyne","United Kingdom","Management of violence and aggression at Alnwood","Introduction:  Children with an intellectual disability in Scotland who exhibit levels of challenging behaviour to such a degree that they are unable to attend regular schools often require a period of assessment in an inpatient unit, before transferring to a residential school. The Psychiatric Inpatient Unit that children with a learning disability in Scotland are referred to is in Northumberland at The Prudhoe Hospital. There are multiple units within this hospital setting based on age range. Linn Moor Residential School in Peterculter is one of the specialist residential schools available locally. I shall compare and contrast how challenging behaviour is managed in the two settings.  Methods: Two weeks will be spent collecting data at Linn Moor School in Peterculter which has 24 pupils. Six weeks will be spent collecting data in the Northumberland inpatient units. Demographic data: â€¢Anonymised data on children  -Age, Sex  -Diagnoses  -IQ or Functional ability as a proxy for IQ  -Medication  â€¢Staff interviews and staff rotas  -Ratio of staff to children  -Number of years experience  -Professional background and training  â€¢Incident reports  -Frequency of incidents of challenging behaviour  A semi-structured interview will be devised and given to staff members who are directly involved in looking after the children at Linn Moor School and in the Units at Prudhoe Hospital.  Three types of challenging behaviour will be looked at: injury to self, damage to property and violence toward others. Semi-structured interviews will consider five aspects of dealing with each type of challenging behaviour: 1. Management strategies 2. Emotional response  3. Formal training  4. Practical support  5. Emotional support  No patient identifiable data will be collected.  Ethical approval for the project will be required.  Outcomes: On completion of my elective I will reach a conclusion on whether the staff at Linn Moor School receive the same level of support for dealing with challenging behaviour as the staff at Prudhoe Hospital.  I am optimistic that my project might also have wider implications for provision and tailoring of mental health services for residential schools in Grampian. My personal elective goal is to successfully complete my first research project; gaining invaluable research skills in the process. Learning Disability Psychiatry is a speciality in which I have particular interest, however there is little time in the undergraduate curriculum assigned to study of this specialty. Through my elective project I aim to gain a more detailed insight into the field.   Literature: Banks, R., Bush, A., Baker, P., et. al. 2007, Challenging behaviour: a unified approach, Royal College of Psychiatrists, London.   Berney, T. & Allington-Smith, P. 2010, Psychiatric services for children and adolescents with intellectual disabilities, Royal College of Psychiatrists, London.   ","approved","Happy to be the local supervisor for this project - Dee Rasalam","2013-02-14T16:31:11"]
["u04aam8","Prof","DAVID","COOPER","cooperdk@upmc.edu","THOMAS E. STARZL TRANSPLANTATION INSTITUTE","200 LOTHROP STREET",15261,"PITTSBURGH, PA","UNITED STATES OF AMERICA",{"$nulls":7},"Xenotransplantation in the treatment of Type I Diabetes Mellitus","INTRODUCTION  According to the International Diabetes Federation more than 371 million people worldwide were estimated to have diabetes in 2012. It is well known that this debilitating disease is a major burden for healthcare systems around the world and is not an issue to be taken lightly. Although the majority of diagnosed diabetes cases are type II, there are estimated to be over 30 million people worldwide suffering from type I, which affects people just as severely(1). Currently there is no cure for this life long illness.  The islets of Langerhans within the pancreas secrete insulin, in type I diabetes the islets fail to produce this hormone. One therapeutic option is the transplantation of islets from human donors into the hepatic portal vein of type I diabetics(2). However, as with all organ donation there is a large shortage of available human islet donors as more than one donor is necessary to recover enough healthy islets for transplantation. This shortage added to the immediate inflammatory response from the host body means that large numbers of available islets are needed in order for this option to become a successful treatment of the future(3).  The question of where to find a supply of islets which are readily available may be answered by cross species transplantation or â€˜xenotransplantationâ€™. The Thomas E. Starzl Transplantation Institute in Pittsburgh, USA, is involved in cutting edge research dedicated to this purpose, with the aim of one day offering successful xenotransplantation of animal organs into human recipients.   METHODS  During my elective I will be involved in research carried out in a laboratory at the Starzl Transplantation Institute and my focus will be on the recipientâ€™s immune response to donor islet cells. Studies conducted have shown that the mechanisms of host rejection are not completely understood and I will be involved in research which looks to enhance knowledge in this field.   In order to assess the pathophysiological events which take place when islets are transplanted into the portal vein an in vitro model of transplantation will be used. Islets will be exposed to autologous, allogeneic and xenogeneic blood. Blood clotting and islet damage will be assessed. I will be fully supervised during my time in the lab.  OUTCOMES  1. Islet-induced clotting of whole blood: clotting will be assessed after induction of islets to blood, a control of clotting in blood only will be used. 2. C-peptide release as an indicator of Î²-cell damage within the islets: A significant increase of C-peptide after a 60 minute period of contact between islets and blood may indicate islet membrane leakage as damage is occurring. 3. Binding of IgM and IgG antibodies and activation of Complement: Immunofluorescence staining to identify specific antibodies will be carried out. The highest antibody assays are expected for pig islets incubated in human blood.  CONCLUSION  I hope that my elective will expose me to some contemporary research in a field which will hopefully play a large role in the future of medicine and is also of interest to me. In addition to this I will get to spend some time in another developed country with a healthcare system which is very different from the one I am used to.   REFERENCES  1. International Diabetes Federation (2012) IDF DIABETES ATLAS: FIFTH EDITION [online] Available from: http://www.idf.org/diabetesatlas/5e/Update2012 (Accessed: 08/02/13) 2. Shapiro AM, Lakey JR, Ryan EA et al. (2000) Islet transplantation in seven patients with type I diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N. Engl. J. Med. 343(4) 230-238 3. Burcin E, Cooper DKC (2010) Overcoming the barriers to xenotransplantation: Prospects for the future. Expert Rev. Clin. Immunol. 6(2) 219-230  ","approved",null,"2013-02-13T22:26:08"]
["u25sm9","Dr","Abha","Maheshwari","abha.maheshwari@abdn.ac.uk","Aberdeen Maternity Hospital","Cornhill Road, Foresterhill","AB25 2ZL ","Aberdeen","United Kingdome",{"$nulls":7},"Is aetiology based diagnosis of subfertile couples still relevant in 2014","Introduction  The tendency for increasing numbers of women to delay their first planned pregnancy is leading, in most cases, to age related infertility (1). None of the treatments other than egg donation have proven to be effective. In addition to increasing healthcare costs, this has far reaching social and epidemiological consequences.  Existing studies suggest that most women would welcome information about the risks of delaying childbearing earlier in life, so as to make more informed choices (2).  At present there are no data on how young women would respond to such information, what format it should take or whether it would be effective. Moreover, any proposed dissemination strategy is fraught with potential problems. Firstly, the key message about avoiding teenage pregnancies must not be diluted. Secondly, in order for it to be effective, it is necessary to be clear about the target population (e.g. men, women or both), nature and timing of information provided, and the manner in which it is conveyed.  Currently, a BSc student is working on a qualitative study to determine tthe views of a small group of patients with Dr Maheshwari as supervisor. The data from this study (available in May 2013) will give insight into views of the patients. The next step would be to determine the views of healthcare professionals in order develop an effective intervention tool to provide information.  Methods  We propose to interview key health professionals in Aberdeen in the following areas General practice â€¢ Two doctors â€¢ Two nurses Sexual and Reproductive health clinics â€¢ Two doctors  â€¢ Two nurses Fertility clinics â€¢ Two doctors â€¢ Two nurses They will be asked about their views on information about delayed childbearing â€¢ Who should be providing it? â€¢ What is the best time to provide it? â€¢ Should men and women both be provided the information? â€¢ What information should be given? â€¢ How it should be given? Data will be transcribed and themes arising will be identified. This will be a pilot study which, along with the study on young women, will be used to develop an intervention tool (providing information to young women). As no patients are involved ethics approval will not be needed. However we will write to Grampian Research ethics committee to confirm this.  Outcomes  Through this elective project, I will learn about carrying out qualitative interviews, transcribing the data and identifying the themes. I will also be able to sit in a few fertility clinics and multidisciplinary meetings to see how age impacts on the treatment and prognosis of fertility treatments.  I will also input into the development of the intervention tool.   Literature 1. Maheshwari A, Hamilton MPR and Bhattacharya S. Effect of female age on the diagnostic categories of infertility. Human Reproduction 23; 538 â€“ 542 (2008) 2. Maheshwari A,  Porter M,  Shetty A and  Bhattacharya S. Womenâ€™s awareness and perceptions of delay in childbearing. Fertility Sterility 90: 1036-1042 (2008).    ","approved",null,"2013-02-14T19:26:02"]
["u02abm9","Dr","Sunita","Pereira","SPereira@tuftsmedicalcenter.org","Tufts Medical Center","Division of Newborn Medicine",2111,"Boston, Massachusetts","USA","001 617 636 4197",{"$nulls":6},"An audit of delayed cord clamping in premature babies born <32 weeks gastation at Tufts Medical Center and varriers to implementation of the protocol","INTRODUCTION  The optimal time at which the umbilical cord should be clamped after birth is the subject of ongoing debate. Early clamping allows for immediate transfer of the newborn to the neonatologist for resuscitation and stabilization.  However, delayed clamping allows for continued placental transfusion, resulting in an increased circulating volume and improved neonatal outcomes(1).  A Cochrane review found that delayed cord clamping (DCC) resulted in a lower incidence of intraventricular haemorrhage (IVH)(1), necrotizing enterocolitis (NEC)(1) and late-onset sepsis (LOS)(2), fewer transfusions due to anaemia or hypotension(1) and higher haematocrit levels post-delivery(1,2).   Tufts Medical Center introduced DCC in September 2010 for all premature newborns born less than 32 weeks gestation. This report will investigate the current compliance to this policy and also attempt to define the barriers to full implementation of this policy.   METHODS   I will aim to collect data on 50 preterm deliveries of 32 weeks or less gestation, from March of 2013 onwards. Data will include:  - Gestation  - Mode of delivery  - Apgar score at birth and 1 minute - Time until cord clamping - Whether the cord was milked  - Whether infant was held below level of placenta during placental transfusion - Reason given if cord was clamped early - Need for respiratory support / type / duration - Incidence of IVH, LOS, NEC  Data will be collected from patient charts, and will be stored on a data storage device that will remain locked away in the hospital when not in use.   Furthermore, neonatal and labour suite staff will complete a questionnaire in March 2013 and again a year later to assess barriers to DCC practice and any change in knowledge or views over the year.  Data will be analyzed using SPSS and results will be written up in a formal report. All significant findings will be presented to the Neonatology department for further follow-up.    OUTCOMES   I hope to gain further experience in research methods, particularly data collection and analysis. I wish to also gain further clinical experience in Neonatology, and the intricacies of caring for infants in the NICU.   Finally, I hope that my project will stimulate additional research into how staff can be better encouraged to implement DCC into their daily practice.  LITERATURE  1. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews 2012, Issue 8:CD003248.  2. Judith S. Mercer,  Betty R. Vohr,  Margaret M. McGrath, James F. Padbury, Michael Wallach, William Oh. Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized Controlled Trial. Pediatrics Vol.117 No.4,2006:pp.1235-1242.        ","approved",null,"2013-02-14T23:15:21"]
["u02fsm9","Dr","Philip","Moore","Philip.Moore@hawkesbaydhb.govt.nz"," Maternal, Child and Youth Service, Hawke's Bay Hospital, Omahu Road","Hastings ",null,"New Zealand",4120,{"$nulls":7},"Audit on the management of Bronchiolitis at the Hawke's Bay Hospital, New Zealand. ","Introduction  Bronchiolitis, a very common lower respiratory tract infection in infants under a year, is a self-limiting viral infection. Hence the mainstay of management is supportive(1).  In 2006-2010, compared to the overall New Zealand rate, bronchiolitis admission rates were significantly higher in Hawkes Bay; with increased incidence in Pacific and Maori infants. Bronchiolitis admission rates are also closely linked to deprivation; infants in the most deprived decile, having a 5.65 greater rate ratio(2). A clear example of health disparities related to ethnicity and deprivation common in the New Zealand health system.  The current Scottish Bronchiolitis of Infancy Study (BIDS), is investigating the safe level of oxygen saturation to discontinue therapeutic oxygen(3). Reducing the target oxygen saturation might reduce the average length of stay in hospital; potentially having an impact on both the cost and management.  The aim of this Audit is to look at the correlation between the current management at Hawkeâ€™s Bay hospital and the recommended guidelines to determine quality of care and trends in management.  Analysing current management of oxygenation will enable me to predict the likely impact on length of stay if the BIDS study ultimately supports this.   Methods  I plan to conduct a retrospective review of the management of 50 consecutive cases of infants presenting to Hawkeâ€™s Bay Hospital, during the winter of 2011 against the current New Zealand guidelines for the Management of Bronchiolitis. Ex-premature babies and those with congenital heart disease will be excluded. Software: PASW statistics. Spreadsheet headings:   â€¢ Age, sex, race, deprivation decile, birth weight, current weight, feeding, immunizations, smoking exposure, phone access. â€¢ Presenting features, length of history prior to admission. â€¢ Management  o Investigations. o  Treatment given e.g. IV fuids, Oxygen. â€¢ ICU/HDU admission. â€¢ Length of stay (hours). â€¢ Subsequent unplanned readmittance. Data Storage: Supervisorâ€™s office. The data will be analysed qualitatively by extracting the data mentioned above from each case in order to compare the management of these individual cases to the current guidelines.  No ethical approval required.  Outcomes   During my elective I aspire to gain the skills to enable me to conduct a valuable audit. Additionally, I hope to gain clinical experience in paediatrics that will be useful for my future career. I plan to discover new developments in the local management of Bronchiolitis since the current recommended guidelines were published in 2005. Placing particular emphasis on Oxygen Saturation levels at discharge should allow prediction of the impact on average length of stay if levels were decreased.    Literature (1) Scottish Intercollegiate Guidelines Network. Bronchiolitis in Children. 2006; Available at: http://www.sign.ac.uk/pdf/sign91.pdf.  (2) Child and Youth Epidemiology Service Report. The Health Status of Children and Young People In the Hawkes Bay.  (3) ISCRTN Register. Bronhiolitis of Infancy Discharge Study. 2011; Available at: http://www.controlled-trials.com/ISRCTN28405428.    ","approved",null,"2013-02-14T13:02:29"]
["u27dm8","Dr","Gareth","Davies","Gareth.Davies@bartshealth.nhs.uk","The Helipad, The Royal London Hospital","Whitechapel","E1 1BB","London","England",{"$nulls":7},"A retrospective analysis of burns victims and their pre-hospital management by a physician led pre hospital trauma service","Introduction   With the introduction of emergency ultrasound into the curriculum of the UK College of Emergency Medicine in 2007, its use has become well established in UK clinical practice (1). Focused Assessment with Sonography in Trauma (FAST) is used in the assessment of patients with suspected throaco-abdominal injuries and has been shown to decrease time to operative intervention, reduce the requirement for CT and decrease complication rates and length of hospital stay (2). Its use however in pre-hospital emergency medicine is not so widespread, where it could have potential additional benefits (3).  Londonâ€™s Helicopter Emergency Medical Service (HEMS) is a well established pre-hospital trauma service compromising a senior doctor and paramedic responding to the most critically injured patients throughout London. It has pioneered many aspects of pre-hospital trauma care with the philosophy â€“ â€˜bringing the hospital to the patientâ€™ (4). This philosophy includes carrying out imaging techniques such as pre-hospital emergency ultrasound at the roadside to inform the assessment and subsequent management of patients on scene, in transit and in-hospital.   Methods   During my elective I will be based at The Helipad on top of Royal London Hospital. Here I will have my own dedicated office space and access to IT facilities as well as the opportunity to attend real life incidents in the teams Rapid Response Car. I will also spend time in the ED, take part in regular training scenarios and attend twice weekly â€˜mission reviewâ€™ meetings.  I plan to carry out a detailed review of the services use of pre-hospital emergency ultrasound in trauma. This will involve looking at;   â€¢ training, â€¢ indications,  â€¢ incidence,  â€¢ technique, â€¢ the clinical information it provides,  â€¢ and how it alters patient management.   I plan to supplement this review with data from the literature and with illustrative case based examples of patients that I have seen on-scene with the HEMS team. Due to the high workload of the service I feel this is achievable. However if not the services trauma database will provide appropriate additional cases. It is not expected that ethical approval will be required as any cases will be completely anonymised. The project will be written up and presented as a self contained report.   Outcomes  Over the past number of years I have a taken a keen interest in pre-hospital care. By attending GICS evenings, helping out with BASICS and doing shifts with the SAS I have tried to expose myself to this evolving field of medicine. I feel this elective at a busy trauma service will be a fantastic opportunity to further expand my knowledge. Furthermore pre-hospital ultrasound was recently cited as one of the top five research priorities in physician provided pre-hospital critical care (5). To my knowledge London HEMS has never published any literature on their use of pre-hospital ultrasound.  Literature  1. Kwok T, Johnson S, Reed MJ. Impact of the introduction of emergency ultrasound to one large UK emergency department: the REBUS study. Emergency Medicine Journal 2013;30:87.  2. Smith ZA, Wood D. Emergency focussed assessment with sonography in trauma (FAST) and haemodynamic stability. Emergency Medicine Journal Published Online First: [13th February 2013].   3. Noble VE, Lamhaut L, Capp R, et al. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Education 2009;9:3.  4. http://www.londonsairambulance.co.uk/news  5. Fevang E, Lockey D, Thompson J, HM Lossius. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011;19:57.  ","approved",null,"2013-02-14T15:52:20"]
["u06mam9","Prof","Vasi","Naganathan","vasi.naganathan@sydney.edu.au","Department of Geriatrics","Concord Repatriation General Hospital","NSW 2006","University of Sydney","Sydney","0061 2 9767 7274","0061-2 9767 5419",{"$nulls":5},"Should vitamin B12 be measured in older patients with Type 2 Diabetes Mellitus who are on Metformin? - a pilot study to determine the prevalence of vitamin B12 deficiency in older patients with Type 2 diabetes mellitus who take Metformin","INTRODUCTION Metformin has long been used in the management of type 2 Diabetes Mellitus.  It is known to induce Vitamin B12 malabsorption, but the extent to which this progresses to Vitamin B12 deficiency remains unclear (de Jager et al., 2010).  Furthermore, to the best of our knowledge, no studies of prevalence have been conducted in an in-patient setting.  In a cross sectional study of out-patients, however, the prevalence of metabolically confirmed Vitamin B12 deficiency was found to be 22% (n = 44) (Pflipsen et al., 2009).  Vitamin B12 deficiency, therefore, is a potential co-morbidity being overlooked in the older diabetic population using Metformin. Considerations may need to be given to this as a routine part of clinical diagnosis and management.  METHOD Blood samples will be taken on admission from all patients admitted to the Geriatric Medicine department who consent to be part of the study and who meet the inclusion criteria.  Vitamin B12 level, Haemoglobin (Hb), Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin concentration (MCH) will be measured, and the presence of any hyper-segmented neutrophils on blood film will be noted.  Age, gender, duration of diabetes diagnosis, Metformin dosage and duration of use will also be recorded on a standard data collection form.  The following inclusion criteria will apply;   â€¢ Aged 80 years or older â€¢ Diagnosis of DM2 The independent variable in this study is Metformin use.  As a comparison, all patients meeting the above inclusion criteria will be asked to participate in the study to compare with those using Metformin. The following patient factors will be duly noted; â€¢ pernicious anaemia,   â€¢ prior bariatric surgery â€¢ gastrectomy  â€¢ B12 supplementation â€¢ Prior ileum resection  â€¢ Crohnâ€™s disease â€¢ Proton pump inhibitor use  Receipt of a Blood transfusion during current admission to hospital will exclude a patient from the study.   It is anticipated that 50 participants will enrolled who are on metformin and another 50 who have type 2 diabetes who are not on metformin. Assuming a prevalence of 10% Vitamin B12 deficiency in those on metformin, this gives a confidence interval width of 10% (precision)  ETHICAL APPROVAL An application is currently being prepared to the Concord Hospital Human Research Ethics Committee by Associate Professor Naganathan (host supervisor) and Mark McInerney.    OUTCOMES  This elective will allow me to gain excellent medical training in Geriatrics, whilst also allowing me to further develop my research skills.  This as an important step in my career development, as well as excellent preparation to work as an Academic Foundation Programme Trainee in the UK.   LITERATURE de Jager, J., Kooy, A., Lehert, P., Wulffele, MG., van der Kolk, J., Bets, D., program manager, Verburg, J., Donker, A., Stehouwer, C. (2010) Long term treatment with Metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomized placebo controlled trial BMJ 2010;340: c2181  Pflipsen,M., Oh ,R., MD, Saguil, A., Seehusen D., Seaquist, D., Topolski R (2009) The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study J Am Board Fam Med 2009;22: 528â€“534  ","approved",null,"2013-02-14T13:23:38"]
["u01gcm11","Mr","John","Duncan","john.duncan3@nhs.net","Raigmore Hospital",null,"IV2 3UJ","Inverness","Scotland",{"$nulls":7},"Podiatric care prior to amputation in Scottish diabetics","Introduction   Diabetic foot disease is a common complication of Diabetes Mellitus with the prevalence of neuropathy, vascular disease and foot ulceration being 23-42%, 9-23% and 5-7% respectively (1). Effective and pre-emptive foot care could delay or prevent the need to progress to lower limb amputation, thereby maintaining patient quality of life while also reducing NHS expenditure in this area.  However there is the suggestion that a proportion of patients going onto receive lower limb amputations have either, never seen a podiatrist or were discharged from/lost to follow up prior to their amputation(s). The aim of this elective would be to try and gain a measure of how many diabetic amputees this applies to and to look for possible weaknesses in the system that could be tightened up in future.   Methods   Data on major lower limb amputations in diabetic patients from 2005 to date (as collected by the vascular team at Raigmore hospital) will be cross referenced with podiatric data on the SCI-DC and PEAK computer systems. Information will be organised using Excel and stored on a password-protected external hard drive. Data will be analysed quantitatively looking at the percentage of diabetic amputees who have A) never seen a podiatrist, B) havenâ€™t seen a podiatrist in the last 3 months and c) were reviewed regularly vs. sporadically (i.e. is Podiatry used regularly prior to an index admission for amputation?). It is estimated that this project will contain ~180 patients (significantly more (~40/year) if minor amputations (e.g. toe) are included but this will be time dependant). The issue of whether ethical approval will be needed or not is currently being looked into.   Outcomes   This project aims to discover the percentage of diabetic amputees who have â€“ for whatever reason â€“not had optimal access to Diabetic Podiatry services prior to their amputation(s). â€˜Optimal accessâ€™ will be defined by SIGN and SDSP (Scottish Diabetes Specialist Podiatrists) guideline recommendations and is dependent on assessment of foot risk (1,2).  Additionally the current system of referral, and availability of patientsâ€™ Podiatric data to all concerned health professionals, will be studied in detail in an attempt to find potential weak points in the system where such patients could be falling through the net.    Literature 1. SIGN 55 section 7 2. http://www.sdsp.org.uk/guidelines.php  ","approved",null,"2013-02-13T20:44:45"]
["u01oam9","Ms","Judith","Ritchie","Judith.Ritchie@health.wa.gov.au","Royal Perth Hospital","197 Wellington Street",null,"Perth","Australia",{"$nulls":7},"How successful is the management of Colles' fractures in Royal Perth Hospital's Emergency Department?","Introduction Due to a disparity between Aboriginal and Western health belief systems, Western health professionals frequently experience difficulties in providing satisfactory healthcare to Aboriginal people (1). This has lead to a lower standard of health amongst indigenous populations in comparison with other Australians (2).Traditional Aboriginal beliefs regard supernatural intervention as well as social and spiritual problems as the primary causes of illness (1). These cultural differences may result in refusal of recommended treatments and decreased patient satisfaction.  Many causes of ill health and premature death are thought to be preventable in aboriginal people (1). Multiple factors have been identified that contribute to the poorer health outcomes in aboriginal populations. These include lack of access to culturally appropriate health services, exposure to racism, poor communication with health care professionals and poverty (2).  Appropriate measures must be taken during the management of Aboriginal patients to meet their cultural and spiritual needs and improve health outcomes. This project aims to investigate how the cultural beliefs of Aboriginal people affect their management in an accident and emergency department in Perth, Australia.  Methods All aboriginal patients presenting at the accident and emergency department in Royal Perth Hospital who are available and willing to take part at the times of data collection will be included in the study. Patients will be interviewed using the HOPE questionnaire (4), a tool for formal spiritual assessment. This tool includes questions that help uncover any spiritual issues that might be impacting on the patientâ€™s health and well being. It highlights when the patientâ€™s spiritual beliefs and medical advice may be conflicting, and gives the opportunity for the patient to state what resources help them when they are unwell. In addition, the patient will be asked if they feel satisfied with the care provided. Data will be collected over a four week period. Outcomes During my elective project I hope to gain insight to an unfamiliar culture. I aim to achieve an understanding of the social, emotional and cultural factors contributing to health. I wish to identify the factors that lead to the poorer health outcomes amongst aboriginal populations. I hope to enhance my understanding of emergency medicine by exploring the management of acute illnesses from a foreign countryâ€™s perspective. I will gain clinical experience and hope to participate in practical procedures.  Literature Cultural respect framework for Aboriginal and Torres strait islander health (2) describes policies that have been created in order to be culturally respectful in attempt to improve health outcomes for Aboriginal people. The Australian government department of human services (3) also describes a range of health measures specifically tailored to the needs of Aboriginal people and aims to improve access to their health services. References 1. Maher P, A review of â€˜traditionaâ€™l aboriginal health beliefs 1999 [cited 11/02/13] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10732513   2. Australian health ministersâ€™ advisory counsil, Culture respect framework for Aboriginal and Torres strait islander health 2004 [cited 10/02/12] Available from: http://www.sa.gov.au/upload/franchise/Seniors/Cultural%20Respect%20Framework.pdf  3. The Australian government department of human services, Indigenous health 2013 [cited 10/02/13] Available from: http://www.medicareaustralia.gov.au/provider/patients/indigenous.jsp  4. Hight E. et. al. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment, AAFP (2001)  [cited 24/03/13] Available from: http://www.aafp.org/afp/2001/0101/p81.html   ","awaiting approval",null,"2013-03-24T15:48:11"]
["u29jm9","Dr","Judith","Farquharson","judith.farquharson@nhs.net","30 Albyn Place",null,"AB10 1NW","Aberdeen","UK","01224 586829",{"$nulls":6},"A comparison of the management of patients taking DMARDs prior to implementing a trial of the care bundles endorsed by the Scottish Patient Safety Programmee","Introduction: The NHS is dedicated to improving patient safety, and although much research is focused on hospital management of patients, there is still a significant and overlooked risk in primary care, which includes medication prescribing(1). It is estimated that prescribing in primary care is responsible for 6.5% of all hospital admissions(2) of which over 50% are believed to be avoidable(3). Although aspirin, diuretics, (NSAIDs), warfarin, opioids, Î² blockers, and angiotensin converting enzyme inhibitors/angiotensin receptor blockers are the most commonly associated with ADRs, less commonly prescribed drugs such as methotrexate have warrented National Patient Safety Agency alerts due their implication in avoidable mortality(3). To minimise the harm resulting from primary care prescribing, the Scottish Safety Programme â€“ Primary Care has created Care Bundles, â€œa set of interventions that... work to deliver the best possible care supported by evidence-based research and practicesâ€\u009d, which aim to maximise patient care and safety(4). In May 2010, the Scottish Government launched the Healthcare Quality Strategy for NHSScotland, which resulted in the creation of care bundles for the prescribing of warfarin and disease-modifying anti-rheumatic drugs such as methotrexate(5).  Methods: The staff at Albyn Medical Practice granted me permission to use their IT facilities to search their patient database. By conducting searches of their database I hope to identify the patients taking warfarin or DMARDs and extrapolate the relevant information which will allow their treatment regime and follow-op  to be compared with the Care Bundles set out by Scottish Patient Safety Programme. Examples of information I hope to extract for patients taking DMARDs will include:  if the patient had a full blood count in the last 6 weeks of their attendance; if blood tests had been reviewed prior to prescription; if the patient received appropriate immunization etc. Examples of information I hope to attain on warfarinised patients include: if the patient been taking the advised dose since last blood test; if their INR been taken within 7 days of planned repeat INR; if the patient education been recorded every 6 months etc. My findings will be analysed using qualitative methods and presented as a series of tables. Following communication with my supervisor, it was revealed that Albyn Medical Practice has 60-70 patients on record who are prescribed warfarin or DMARDs. My project will be conducted from 28th October â€“ 20th December 2013. The primary aim of this elective is to produce the desired project but I also intend to gain invaluable GP experience by attending clinics and directly observing how a practice is run.  Outcomes: By the end of this elective I hope to gain deeper insight into the inner workings of a General Practice. I have a keen interest in becoming a General Practitioner, and since prescribing in primary care and its associated risks are a huge part of the job, by conducting my elective on this topic I hope this experience will help better prepare me for a future career as a GP. If the results of this project are significant, I hope my elective will be of benefit to the practice.  References:  1. http://www.bmj.com/content/342/bmj.d3514 2. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ2004;329:15-9 3. National Patient Safety Agency. Improving compliance with oral methotrexate guidelines. NPSA, 2006. 4. http://journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2011/03000/Understanding_care_bundles.9.aspx 5. http://www.healthcareimprovementscotland.org/our_work/patient_safety/spsp/patient_safety_in_primary_care/safer_medicines.aspx  ","approved","I have recommended to James that he includes DMARDS only for his elective as the present guidance for warfarin is more uncertain at this time.","2013-04-29T21:49:37"]
["u19em8","Dr","Tristan ","Yan","tristanyan@annalscts.com","Royal Prince Alfred Hospital ","Missenden Road","Australia","Camperdown","Sydney",{"$nulls":7},"Is video assisted thoracoscopic surgery an economically viable alternative to open lung resection in the treatment of primary lung cancer and lung metastases?","Introduction Coronary artery bypass grafting (CABG) is the preferred treatment for diseases of the left main coronary artery and multi vessel coronary artery disease and is generally a highly effective and safe procedure.  One of the main adverse effects of CABG is post-operative bleeding.  Severe post-operative bleeding requiring surgical re-exploration affects approximately 3% of patients undergoing CABG.  Pre-operative use of oral anti-platelet medications reduces the risk of intra-operative and early post-operative thrombotic complications such as myocardial infarction but has also been shown to increase the risk of post-operative bleeding.  There is a fine balance to be struck between minimising the risk of thrombotic complications, while not increasing the risk of bleeding, which is associated with significantly worse outcomes for patients.  Aims The aim of this project is to examine the relationship between pre-operative anti-platelet therapy and the incidence of bleeding following CABG.  Methods Approximately 800 CABG procedures are carried out each year at the Royal Prince Alfred Hospital in Sydney.  I plan to retrospectively analyse the notes of patients undergoing CABG in the three months prior to the start of my elective (December 2013 â€“ February 2014).  I would expect this to be approximately 200 patients.  I will gather information on pre-operative oral anti-platelet medication (aspirin, clopidogrel or other), whether it was stopped prior to surgery and if so, how long before surgery.  I will compare incidence of re-exploration for bleeding following surgery in patients taking different types of pre-operative oral anti-platelet medication and in those who stopped and didnâ€™t stop their anti-platelet medication prior to surgery.  I will analyse the data quantitatively using an appropriate statistical programme like SPSS.  Outcomes By completing this project, I hope to determine the relationship between pre-operative oral anti-platelet medication and incidence of post-operative bleeding requiring surgical re-exploration.  This is an area which has been extensively studied, and still no definitive guidelines have been established.  I hope that my project will add to a growing body of evidence to determine the safest and most effective pre-operative anti-platelet medication regime for patients undergoing CABG.  Literature Cannon CP, Mehta SR, Aranki SF. Balancing the benefit and risk of oral antiplatelet agents in coronary artery bypass surgery.  Ann Thorac Surg 2005 80(2): 768-779.  Shahar Lavi and Ronit Lavi. Perioperative Management of Antiplatelet Agents in Patients Undergoing Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia 2012 26(4): 680-686.  ","approved",null,"2013-02-12T18:20:38"]
["u01pem12","Prof","Chong Guan","Ng","chong_guan@um.adu.my","Pusat Perubatan Universiti Malaya","Lembah Pantai",59100,"Kuala Lumpur","Malaysia","+603-7950 2068",{"$nulls":6},"A Malaysian study of attitudes toward homosexuality and associated factors from a nursing students perspective","Introduction   Stigma is the negative evaluation of an individual as tainted or discredited on the basis of attributes such as that of mental illness (Goffman, 1963). Admittedly, mental illness patients suffer doubly - from their symptoms and discrimination. Consequently, they are robbed from the opportunities which define quality of life: jobs, safe housing, satisfactory health care, and a social life which all human deserves (Corrigan & Watson, 2002). The only escape from this vicious cycle is to brave themselves enough to reach out for help. But how many of them actually do? And does stigma plays any part in their attempt to seek help?   Aims  This project will aim to: 1. determine the extent of stigma of mental illness among Malaysians, 2. determine the correlation of stigma and help-seeking behaviour 3. determine differences in the perception of mental illness among the ethnicity groups in Malaysia, 4. provide data for future research on the topic among Asian countries 5. provide an insight of people with mental illnesses in Asian communities 6. enable targeted  health education to be planned in future   Methods   Ethical approval will be obtained before the following proceedings. Data will be collected on standard demographics (age, gender, ethnicity, religion, occupation), type(s) of psychiatric diagnosis, duration of their illness, treatment received, social habits (drinking, smoking, recreational drugs) in an outpatient clinic setting as well as inpatient over a period of four weeks. The target population includes adults age 18 and above. Each patient will be given a 28-item stigma scale questionnaire with a three-factor structure: discrimination, disclosure and potential positive aspects of mental illness from â€˜The Stigma Scale: development of a standardised measure of the stigma of mental illnessâ€™ by King et al, 2007, and a General Help-Seeking Questionnaire (GHSQ) (Ciarrochi, Deanne & Wilson, 2005). Both these questionnaires will be translated to Malay language to overcome language barrier. Data collected will then be analysed and compared between ethnicity groups, inpatient versus outpatient, and the different type of diagnosis obtained. All statistics will be carried out using SPSS. Then the p value will be obtained for the results of help-seeking behaviour and the stigma scale to determine if it is statistically significant. Some of the results will be further compared with other studies published in the western countries, conclusion drawn, and recommendations suggested.   References  Ciarrochi, J, Deane, F.P. & Wilson, C.J. (2005) Measuring Help-Seeking Intentions: Properties of the General Help-Seeking Questionnaire. Canadian Journal of Counselling. 39, 15 â€“ 28. Corrigan, P. W., & Watson, A.C. (2002) Understanding the impact of stigma with people with mental illness. USA.  Goffman, E. (1963) Stigma: Notes on the Management of Spoiled Identity. Penguin.  King, M., Dinos, S., Shaw, J., Watson, R., Stevens, S., Passetti, F., Weich, S. & Serfaty, M. (2007) The Stigma Scale: development of a standardised measure of the stigma of mental illness. The British Journal of Psychiatry. 190, 248 â€“ 254.  ","approved",null,"2013-02-07T23:34:38"]
["u03csm8","Mr","John","Cashman","john.cashman@cureinternational.org","Beit CURE International Hospital  ","PO Box 31236",null,"Blantyre 3"," Malawi",{"$nulls":7},"Malawi childs hip questionnaire. Initial development of a working pilot","Introduction  Chronic Osteomyelitis (COM) is a condition of infected bone characterised by â€œdraining sinus tracts, deformity, instability and local signs of impaired vascularity, range of motion and neurologic status.â€\u009d (1) With such a large burden of COM currently afflicting children in developing countries Jones et al recently highlighted the surprising lack research that has gone on into this area. (2)  For my project I will characterise the people who use the service and will look at what differences if any there are between those who require repeat surgery for their osteomyelitis and those who do not. I also hope to ascertain the reasons repeat operations occur in children undergoing treatment for COM.   Methods   I hope to conduct my project at Cure Intentional Hospital in Malawi using their English Language prospective database of COM cases collected over a 5 year period, the formation of which had ethical approval. I expect to categorise 100 cases over this time period.  I plan to use my own computer to collect the data with two encrypted USB sticks to independently back up the data ensuring against theft/loss.   I plan to collect following data on SPSS: - Age - Sex - Site of infection - Nature of first procedure - Complications and length of stay - Whether a repeat surgery was required and length of time till it was required - Nature of second surgery  Having consulting universityâ€™s statistics department as to the best method of analysis I plan to analyse the data quantitatively using descriptive statistics and comparative statistics that may include T tests ete. depending on the data. If possible I may do a multivariant analysis to consider how factors interrelate.   Outcomes  By studying why repeat operations are needed I hope to help my colleagues at the hospital identify areas where practices could be changed thus minimising the need for costly operations in an already tight budget. I am also hoping that by observing how people maintain good clinical care within a resource limited setting I will learn things which I can then implement into my own practice. In displaying a poster of my research at the next ASiT Conference the hospital will hopefully gain wider recognition and I will in a small way have helped to broaden peopleâ€™s knowledge of such an interesting but at the moment under researched area.   References  (1) Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician 2001 Jun 15;63(12):2413-2420.  (2) Jones HW, Beckles VL, Akinola B, Stevenson AJ, Harrison WJ. Chronic haematogenous osteomyelitis in children: an unsolved problem. J Bone Joint Surg Br 2011 Aug;93(8):1005-1010.   ","approved",null,"2013-02-05T23:29:54"]
["u21dm9","Dr","John","Snowden","john.snowden@sth.nhs.uk","Sheffield Teaching Hospitals","NHS Foundation Trust",null,"Sheffield","England",{"$nulls":7},"Service evaluation of recent clinical development in Myeloma Bone Disease: Zoledronic Acid","Introduction  The mainstay of treatment in myeloma bone disease is currently through the use of bisphosphonates(BP). In 2011 bone protection in patients with myeloma was switched from daily oral sodium clodronate as first line to monthly IV zoledronic acid. This switch was made because Myeloma IX study found it increased overall survival by 5.5 months and progression free survival by 2 months. In Sheffield this change is expected to have been implemented in all patients by 2014.   Methods  A survey of the change from daily oral BP to monthly IV infusions. I am going to create a survey in the form of a questionnaire to evaluate both quantitatively and qualitatively how this change has affected myeloma patients. By looking at; â€¢ From diagnosis which BP were they on? â€¢ Did they experience side effects on this BP? â€¢ Practicalities of taking an oral BP â€¢ What stage did they switch to IV zoledronic acid? â€¢ If on an alternative, why? i.e. risk factors for jaw osteonecrosis â€¢ Any side effects after switch? â€¢ Does the patient prefer current regime? â€¢ Are they on vitamin D supplements? â€¢ Were patients dentally reviewed before starting IV zoledronic acid? â€¢ The incidence of jaw osteonecrosis in the patients â€¢ Calcium levels â€“ past notes to see if calcium levels have changed since switching Because this is not a purely quantitative evaluation but also qualitative not all the questions will be answered with yes or no but instead will give the opportunity for the patient to give an opinion. Aim to survey about 10-15 patients per week at either myeloma clinics or their monthly BP infusions. Aim to have surveyed 100 patients by the end of the project. I will also be applying to ethics for approval ASAP when it has been approved by the university.    Outcomes To have collected adequate data to assess the impact of changing the BP regime in terms of symptoms and lifestyle. I hope this project will provide an opportunity for both a quantitative and qualitative evaluation of switching from oral BP therapy to IV zoledronic acid and how well the switch has been tolerated. I personally hope to, as well as carrying out my project, attend clinics, ward rounds and labs to get more experience in haematology to ensure I have made the right choice in wanting to follow a career in it. Sheffield has a world class laboratory in myeloma bone disease and it's a fantastic opportunity for me to carry out my project there.    JM Bird et al. Guidelines for the diagnosis and management of multiple myeloma 2011, British Journal of Haematology  JA Snowden et al. Guidelines for supportive care in multiple myeloma 2011. British Journal of Haematology  GJ Morgan et al. First-line treatment with zoledronic acid as compared with clodronic acid in multiple myeloma (MRC Myeloma IX): a RCT. Lancet  ","approved",null,"2013-03-13T17:38:34"]
["u02fjm9","Dr","Charlie","Siderfin","charles.siderfin@nhs.net","Balfour Hospital","New Scapa Road","KW15 1SU","Kirkwall, Orkney","Scotland","01856 888000",{"$nulls":6},"A retrospective audit of the treatment of stroke over a 1 year period and STEMI compared with SIGN guidelines in Orkney, a remote and rural location in the North of Scotland.","Introduction  STEMI and stroke are two occlusive arterial diseases which can have a devastating effect on the life of a patient.  It is known that the early identification, assessment and treatment of these conditions can reduce morbidity and mortality1.  In Scotland the standardised hospital discharge rate for MIs was 345.5 per 100 000 between 2011/20122.  For cerebrovascular disease the incidence was 156.0 per 100 000 in 2012 with an age standardised mortality of 47.7 in 20113.  The very nature of living on the islands around Orkney makes it difficult for patients to get to hospital quickly meaning that every second counts when they do eventually reach hospital.  The aim is to identify where changes can be made to clinical practice to better meet the standards set out in national guidelines.   Methods A retrospective audit of all patients entering Balfour Hospital A&E department with a STEMI or stroke over a 1 year period.  Relevant data will be extracted from patient notes including specific treatments to look at the hospital management from first arrival until discharge and the outcomes.  If the patient has not been identified as at risk by the GP then will also look for any risk factors which could suggest that they were at risk of a STEMI or stroke using the ASSIGN score, a scoring tool used to prioritise the prevention of cardiovascular disease. Data from ISD suggests there were 102 and 97 patients with MI and stroke respectively in Orkney 2011/20124,5.  Patient treatments will be compared to national guidelines.  A checklist of standards from national guidelines will be created from which to quickly note if guidelines have been met and the time taken to meet them.  For STEMIs this will include time at onset of pain, ECG and treatment with aspirin or thrombolysis.  For stroke this will include time at onset of symptoms, transfer to hospital and treatment times with aspirin and thrombolysis.  Weather conditions at the time will also be collected to see if they had an impact on the arrival to hospital.  As this is a service evaluation no formal ethical approval should be required.   Outcomes This audit will hope to identify both good practice in the initial management of stroke or STEMI and identify areas where changes can be made to better meet the national guidelines.  It is hoped that by presenting these to the medical staff they will be able to provide better care to their patients.   Literature 1. ATLANTID, ECASS, NINDS Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS and NINDS rt-PA stroke trials.   2. Information Services Division. Heart Disease Statistics Update. http://www.isdscotland.org/Health-Topics/Heart-Disease/Publications/2012-12-18/2012-12-18-Heart-Disease-Summary.pdf?  3. ISD. Stroke Statistics Update. http://www.isdscotland.org/Health-Topics/Stroke/Publications/2012-12-18/2012-12-18-Stroke-Report.pdf?27387636900.  4. ISD. http://www.isdscotland.org/Health-Topics/Heart-Disease/Topic-Areas/. (Accessed 06/02/2013).  5. ISD. http://www.isdscotland.org/Health-Topics/General-Practice/PTI-Statistics/index.asp.   ","approved","This project looks interesting and achievable.","2013-02-06T23:03:05"]
["u06jem9","Prof","Sheila ","Crowe","secrowe@ucsd.edu","Division of Gastroneterology, Department of Internal Medicine","Univeristy of California at San Diego","United States of America","9500 Gilman Drive","San Diego, California","00 1 619 534 3037","00 1 619 534 3338",{"$nulls":5},"Coeliac Disease and Non-Coeliac Gluten Sensitivity at a Californian Coeliac Disease Centre","Coeliac Disease (CD) is a chronic T-cell mediated enteropathy affecting the small bowel. It is precipitated by exposure to ingested gluten in genetically predisposed individuals (1). Diagnosis is by duodenal biopsy supported by positive serological tests and treatment is a lifelong gluten-free diet. There are however an increasing number of people who report symptoms related to ingestion of gluten but with negative coeliac serology and normal or near-normal duodenal biopsies. The term Non-Coeliac Gluten Sensitivity (NCGS) describes these patients who respond to a gluten-free diet but in whom both CD and food allergy have been excluded. The pathogenesis and long-term outcomes of NCGS are not fully understood, neither has a biomarker been identified but research in this field is continually growing (1-2).  This eight week elective project will be carried out at the University of California, San Diego (UCSD), recognized as a Centre of Excellence for CD. The project will aim to look at the relative frequency with which patients with CD, NCGS and other forms of intolerance to wheat present in the Gastroenterology clinics at UCSD and to characterise these groups in terms of their clinical features and laboratory findings.  Additionally, clinical and laboratory responses to treatment with the gluten-free diet will be assessed.   Data will be gathered from the UCSD CD and NCGS patient registry, a database of all patients diagnosed with CD or NCGS who are currently under the care of the UCSD Health System. This database holds information on patientsâ€™ diagnosis, demographics, medical history, laboratory tests, imaging studies, pathology reports and dietary adherence amongst other key data. This project will specifically look at patients presenting symptoms and signs, coeliac serology results (may include one or more of: tissue-transglutaminase, deamidated gliadin peptide or endomysial antibodies), HLA expression and biopsy results, as well as response to treatment. All information extracted will be anonymised.   The data gathered will be analysed and will allow these groups to be characterised; results will be compared with up-to-date literature on these conditions and conclusions will be drawn. It is hoped this will result in a greater understanding of the presentation, diagnosis, and optimal management of these gluten-related disorders.  References  (1) Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut 2012;62(1):43-52.  (2) Aziz I, Hadjivassiliou M, Sanders DS. Does gluten sensitivity in the absence of coeliac disease exist? BMJ 2012;345:e7907.  ","approved","Excellent proposal; top class.","2013-02-11T18:25:52"]
["u05bn9","Dr","Benjamin ","Chow","Bchow@ottawaheart.ca","University of Ottawa Heart Institute ","40 Ruskin Street","K1Y 4W7 ","Ottawa, Ontario","Canada ",{"$nulls":7},"Incremental Value of Left Ventricular Dyssynchrony over FDG-PET viability in Predicting Outcome and Response to Cardiac Resynchronisation Therapy","Introduction  There is growing momentum in the clinical use of nuclear imaging techniques within the field of cardiology. (1) Perfusion imaging with Positron Emission Tomography (PET) provides a non-invasive modality for the physiological assessment of the myocardium, quantifying relative stress and rest myocardial perfusion and left ventricular function for diagnostic and prognostic purposes.   While several studies have demonstrated the strength of PET myocardial perfusion imaging (MPI) as a tool for classification of prognostic risk in patients with known or suspected coronary artery disease (2), few studies have looked at the survival benefit with revascularization on the basis of PET results. This study aims to evaluate the strength of PET MPI as a tool for guiding therapy in patients with known or suspected coronary artery disease.    Methods  The study will be conducted retrospectively with access to the University of Ottawa Heart Institute PET registry of patients who were clinically referred for a pharmacological stress Rubidium-82 MPI. Patients who meet the inclusion criteria of having undergone a revascularization after PET MPI, both symptomatic and asymptomatic will be enrolled in the study. Demographic, historical information and stress haemodynamic data have been recorded systematically within the registry in accordance with the centreâ€™s protocols, and have been verified by medical records wherever possible.   Data will be extracted and analysed on-site via the spreadsheet programme Excel, and patients will be divided into 3 categories using previously established risk thresholds. Cardiac death is the primary end-point and all-cause death the secondary endpoint for this study. All data will be stored securely on-site as per site data handling protocols.   Cox proportional hazard models will be applied to the data and processed using SPSS data analysis package. The University of Ottawa Heart Institute has existing ethics approval from its institutional research ethics board to anonymously gather, analyze, and publish data that are prospectively collected before and after PET MPI. As such, individual patient consent is waived.    Outcomes  The primary purpose of organising an elective in Cardiology is to gain further exposure to a specialty I am interested in, and to immerse myself in an environment where primary research is conducted.   The location of the elective also allows me a glimpse into how different healthcare systems work, as I have arranged a minor clinical clerkship component to the elective. It would also provide an exciting opportunity to explore a different culture while undertaking the elective project.   While not expecting to get through the entire database registry within 8 weeks, it is hoped that by initiating database sub-analyses, my work during the elective will form the basis of a continuing academic involvement with the Institute, and contribute to ongoing database analysis work conducted there.    Literature (1) Tamarappoo B, Hachamovitch R. Myocardial perfusion imaging versus CT coronary angiography: when to use which?. J Nucl Med 2011. 52:1079-1086.  (2) Dorbala S, Di Carli F, Beanlands R et al. Prognostic value of stress myocardial perfusion positron emission tomography â€“ results from a multicenter observational registry. JACC 2013. 61:176-184.  ","approved",null,"2013-02-15T13:47:51"]
["u01atn8","Dr","Clare","Shakespeare","clare.shakespeare@gmail.com","Mulanje Mission Hospital",null,"PO Box 45","Mulanje","Malawi","+265 9922 61569",{"$nulls":6},"A population study of schistosoma haematobium infection in under 5 year olds presenting to rural health outposts in Mulanje, Malawi","Introduction  WHO estimates that approximately 200 million people of all ages worldwide are affected by schistosomiasis.  Of these, 11 million live in Malawi. Schistosoma haematobium(Sch. haem) is endemic in southern Malawi, with an estimated population prevalence rate exceeding 50%. However this estimate does not reflect the true disease burden, since infected children under 5 years are omitted from its calculation.   Undetected and untreated schistosomiasis carries a significant latent morbidity and an association with squamous cell bladder carcinoma has been demonstrated. Genital lesions caused by the parasites have also been implicated in the increased transmission of HIV infection. Additionally, the presence of iron deficiency anaemia, malnutrition, growth stunting and poor cognitive functioning have been linked to the chronic inflammation process which occurs in Schistosoma infection. Such multiple morbidity may be reduced by intensive efforts to detect and treat affected young people.  Infants harbouring Sch. haem infection may contribute to disease transmission through water source contact during bathing or clothes washing.   Recent studies for Sch. haem infection in children under 5 years, conducted in Mali and Ghana, have estimated infection prevalence rates of 30-50%. A similar study has yet to be conducted in Malawi.   Methods  Visits to rural child health clinics will be made with health care assistants who will aid in translation. Parents of children aged 0 - 5 years will be asked, after appropriate explanation of the study, if they will consent to their child providing a urine specimen for analysis. Consent will be verbal, due to the high local illiteracy rate.   Between 10.00 and 14.00hrs, 20ml of urine will be collected by the parent from the child in a tube provided for the purpose. Each urine sample will first be examined by  â€¢ (A) Colorimetric analysis for macroscopic haematuria â€¢ (B) Dipstick urinalysis for microscopic haematuria and proteinuria  If positive for (A) or (B), urine microscopy will be undertaken in Mulanje Hospital.   The anthelmintic, praziquantel, will be offered to affected children by a member of Mulanje medical team, using the updated dose pole for children under 5 years. Ethical approval for this study is currently being finalised with the Malawi supervisor.  Outcomes  This study, utilising the major clinical feature of haematuria, will provide an estimate of the prevalence of Sch.haem in children under 5 years presenting to rural health clinics in Mulanje, Malawi. This prevalence rate may be used as a pilot study within southern Malawi, to indicate potential need (or not) for more widespread investigation for Sch.haem infection in this age group, with a view to reducing future morbidity.   Literature Bosompem kM, Bentum IR, Otchere J et al, â€˜Infant Schistosomiasis in Ghana: A swing in a irrigation communityâ€™, Tropical Medicine and Infectious Diseases, vol 9 (2004) pp917-922  Dabo A, Badawi HM, Bary B et al, â€˜Urinary schistosomiasis among pre-school aged children in Sahelian rural communities in Maliâ€™, Parasites and Vectors, vol 4 (2011) pp1-7  Hotez PJ, Kamath A, â€˜Neglected tropical diseases in sub Saharan Africa: Review of the prevalence, distribution and disease burdenâ€™ PLOS Neglected Tropical Diseases, vol 3 (2009) pp412-421  Kapito-Tembo AP, Mwapasa V, Meshnik SR et al, â€˜Prevalence distribution and risk factors for Schistosoma haematobium infection among school children in Blantyre Malawiâ€™, PLOS Neglected Tropical Diseases, vol 3 (2009) pp261-368  ","approved",null,"2013-02-13T21:41:56"]
["u06ln9","Dr","Scott","D'Amours","Scott.Damours@sswahs.nsw.gov.au","Trauma Surgery Department","Liverpool Hospital","Australia","Elizabeth Street","Liverpool, Sydney",{"$nulls":7},"The use of c-spine collars for acute immobilisation in a major trauma centre","Introduction  The purpose of FAST is to identify free fluid in the intra-peritoneal cavity. Free fluid present after blunt abdominal trauma is very likely to be blood. FAST is a non-invasive, safe technique that is easily repeatable and can be performed quickly at the bedside.(1)  CT scanning remains the gold standard for detection of intra-peritoneal haemorrhage. In the case of the haemodynamically unstable patient who cannot be transferred to radiology, FAST scanning can provide early information useful for further surgical decision making.(2) I intend to investigate the sensitivity and specificity of FAST in the adult blunt abdominal trauma patient for the detection of moderate to severe haemorrhage, in comparison to results obtained by CT scanning.    Methods  I plan to conduct a retrospective study using existing databases of patient records to analyse the sensitivity and specificity of FAST in comparison to CT studies. I expect to record the results of 30-50 patients. The Liverpool is a modern facility so adequate resources (eg. power for laptop) will be available. Electronic reporting systems for radiological examinations are also available for ease of data collection.  I intend to record the outcome of any 4 view FAST scan undertaken in adult blunt abdominal trauma patients and the subsequent result of CT scan. CT result and FAST result will be obtained from reporting systems.   Result headings for FAST and CT will be â€“ â€¢ Haemorrhage detected  â€¢ Site of haemorrhage â€¢ Severity of haemorrhage â€¢ Identified cause of haemorrhage  â€¢ Other abnormalities noted  Moderate to severe blood loss will be qualified as classes II-IV of the American College of Surgeons ATLS classification of haemorrhage severity. Patients will be excluded if they have not sustained any degree of blunt abdominal trauma, do not receive a CT scan result or haemorrhage is mild.         Ethical approval will be sought in due course.  Outcomes  From this experience I hope to gain valuable clinical experience in a major trauma centre and receive teaching from experts in their field. My project should allow me to improve my data gathering, critical thinking and writing techniques as well as my understanding of an increasingly integral aspect of trauma assessment. Adding to the evidence base for this technique should be beneficial for the team and will help to critique current protocols and contribute to ongoing development.  Literature (1) - Brenchley J., Walker A., Sloan J. P., Hassan T. B., Venables H. 2006. Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emergency Medical Journal. 23: 446-448 (2) - Llngawl S. S., Buckley A. R. 2000. Focused Abdominal US in Patients with Trauma. Emergency Radiology. 217:426â€“429   ","approved","NB exclusion criteria might limit your database list. Other trauma to the patient may distract from the abdominal trauma. e.g. motorcyclist with a fractured femur, patient may have struck abdomen as ejected over handelbars during the crash.","2013-03-27T18:15:33"]
["u01unn8","Dr","Sohinee","Bhattacharya","sohinee.bhattacharya@abdn.ac.uk","Duguld Baird Centre ","Aberdeen Maternity Hospital",null,"Aberdeen","UK",{"$nulls":7},"Determinant factors of repeat abortion: is there a recurrant risk factor?","Introduction  Perinatal mental health has vast effects for the welfare of the mother, her baby and the family both psychologically as well as physically.(1) New onset and recurrence of mental health disorders during pregnancy and in the post-partum period are common; an estimated 10% of new mothers are likely to develop a depressive illness â€“ half of whom will suffer severe depression.(2)  In Britain, the UK Confidential Enquiry into Maternal Deaths (CEMD) reports suicide as one of the leading causes of maternal death, with an elevated suicide rate in those with serious mental illness.(3) This stresses the importance of effective detection and intervention programs.   Methods  The aim of this elective is to gauge the prevalence of mental health disorders in pregnancy within the local community as well as the awareness of perinatal psychiatry of the medical staff at the Sultana Amina Hospital, Johor using a simple survey and data from the Depression Anxiety Stress Scales implemented. The elective also aims to appreciate the local screening programs and interventions available â€“ in particular, the Singapore Early Intervention Scheme (KK Hospital, Singapore) following the cohort study published in 2011 on the Integration of Perinatal Mental Health Care into the Obstetric Setting.   Outcomes  A report will be written up on awareness and prevalence of perinatal mental health disorders in Johor. Additionally, the screening and intervention process in Singapore will be compared with the equivalent guidelines implemented in NHS Grampian.   Literature 1. Meltzer-Brody Perinatal depression: pathogenesis and treatment - Dialogues in Clinical Neuroscience - Vol 13 . No. 1 . 2011 2. Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality British Medical Bulletin 2003; 67: 219â€“229   3. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothersâ€™ Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl 1):1-203.  Scottish Intercollegiate Guidelines Network (SIGN) 127 â€“ Management of Perinatal Mood Disorders March 2012  ","approved",null,"2013-02-10T18:16:33"]
["u02rjo8","Dr","Brian","Ensor","Brian.ensor@marypotter.org.nz","Mary Potter Hospice","PO Box 7442",null,"Wellington South","New Zealand","04 3895017",{"$nulls":6},"An Audit on Anti-Emetic Prescribing in Palliative Care","Introduction  Nausea and vomiting are some of the most common and disabling symptoms found in the palliative care setting. Patients with end stage organ failure, cancer and other life limiting illnesses are all known to suffer from prolonged nausea. The treatment of these symptoms with anti-emetic medications can significantly improve the quality of life of palliative patients. 1 In theory the treatment of nausea is based on the understanding of the â€˜emetic pathwayâ€™ and the ability to manipulate the neurortransmitters involved in each emetic process. 2 However the complex nature of diseases such as cancer and the inevitable polypharmacy that accompanies this makes isolating the exact cause of nausea difficult and thus complicates the treatment process. 3 The Mary Potter Hospice based in Wellington, New Zealand services the people of Wellington, Porirua and the Kapiti Coast through three palliative care centres, combining both inpatient and community based palliative care. This audit will investigate and identify any trends in anti-emetic prescribing throughout the Mary Potter Hospice.  Methods  A retrospective audit will be performed. Data will be collected from a total of 30 patients who were treated for nausea prior to their death. Cases will be selected from within the Wellington area, combining data from both inpatient and community based patients. Data will be collected on anti-emetic prescribing from hospice databases and patient notes. Doses of anti-emetics, the duration of prescriptions, the success of treatment, previous anti-emetic prescribing, concurrent emetogenic medications and the use of adjuncts will be analysed where possible.  The adherence of prescribing with existing hospice guidelines will also be assessed. Data will be amalgamated using Microsoft Excel spreadsheets and quantitative analysis will be performed using SPSS. Data will be grouped and analysed according to primary medical condition requiring palliation, inpatient or community based care, primary/suspected cause of nausea and the success of treatment. In view of confidentiality data will be collected and stored under password protection and all patients will remain anonymous.  Outcomes  This audit aims to investigate the success of anti-emetic prescribing within the Mary Potter Hospice organisation. The primary outcome is to evaluate the range of medications used in the palliation of nausea. Secondary outcomes will include: highlight differences between inpatient and community based prescribing and how closely the anti-emetic prescribing guidelines are followed.  On a personal level I aim to gain a better understanding of the use of anti-emetics in palliative care and then transfer this knowledge to all areas of hospital based medicine where nausea remains a common, and often poorly treated problem. I also look forward to learning more about the different aspects of palliative care, particularly the differences between inpatient and community based care.  Literature 1. Nausea, Vomiting, and Retching: Complex Problems in Palliative Care. Rhodes VA, McDaniel RW. CA: A Cancer Journal for Clinicians. Volume 51, Issue 4, pages 232â€“248, July/August 2001 2. Treating nausea and vomiting in palliative care: a review. Glare P, Miller J, Nikolova T and Tickoo R. Clin Interv Aging. 2011; 6: 243â€“259. Published online 2011 September 12. doi:  10.2147/CIA.S13109 3. Palliative Care Guidelines â€“ Symptom Control â€“ Nausea and Vomiting. NHS Scotland. 2009 [Accessed 05/02/2013] Available from: http://www.palliativecareguidelines.scot.nhs.uk/symptom_control/nausea.asp   ","approved",null,"2013-02-10T11:31:10"]
["u03ep12","Dr","Kevin","Carter","kevincarter1@nhs.net","Acute Medical Initial Assessment Unit, Aberdeen Royal Infirmary","Foresterhill","AB25 2ZN","Aberdeen","United Kingdom",1224552121,1224555918,{"$nulls":5},"Audit on adherence of the Sepsis Six protocol in septic patients in the acute medical initial assessment unit, ARI","Severe sepsis is a major cause of mortality and morbidity in the UK. In 2004, the Surviving Sepsis Campaign published international guidelines for the management of severe sepsis and condensed them into two Bundles. Survive Sepsis later developed â€œSepsis Sixâ€\u009d, a protocol comprising six non-specialist or â€˜basicâ€™ tasks to be completed within an hour, which improved delivery of bundles and improved outcome. Sepsis Six has been adopted by a number of professional and public bodies across the country, and this includes NHS Grampian.    The aim of this project is to evaluate whether Aberdeen Royal Infirmary (ARI)â€™s Acute Medical Initial Assessment Unit (AMIA) is adhering to this protocol in its management of septic patients.   Patients who are admitted to the AMIA Unit with sepsis or severe sepsis during the elective period will be selected for this audit. Criteria for â€˜sepsisâ€™ and â€˜severe sepsisâ€™ will be based on the 1992 definition by the American College of Chest Physicians and the Society of Critical Care Medicine. The time taken to recognize sepsis or severe sepsis, to administer antibiotics and to complete all six tasks will be recorded and compiled statistically. In addition, the outcome in terms of correlating length of time patient persists in the state of sepsis or severe sepsis as well as 30-day mortality will be similarly recorded and compiled.   Since this project is not that of research in nature, but merely an audit or evaluation of adherence of ARIâ€™s AMIA Unit to this newly-accepted standard of practice, therefore ethical approval is not necessary.  [References] 1. Daniels R, Nutbeam I, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J 2010.doi:10.1136/emj.2010.095067. 2. Robson WP, Daniels R. The Sepsis Six: helping patients to survive sepsis. Br J Nurs 2008;17:16-21.  ","approved","Length of stay will be analysed rather duration of sepsis Kevin carter","2013-02-14T22:33:43"]
["u01ajp8","Prof","Bill","Deakin","bill.deakin@manchester.ac.uk","Neuroscience and Psychiatry Unit, G.907 Stopford Building,","Oxford Road","M13 9PT","Manchester","UK","+44 (0)161 275 7427      ","+44 (0)161 275 7429",{"$nulls":5},"Negative symptoms of Schizophrenia: How they come about and might be treated","Introduction While the positive symptoms â€“ delusions, hallucinations and bizarre behaviour respond to antipsychotic medication, patients are often left with social withdrawal, self neglect, loss of emotional  reactivity and apathy; the negative symptoms of schizophrenia. These residual symptoms do not respond to known treatments. They may result from an unknown neuropathic process affecting brain function but they could also result from some active inhibitory process. Recently two clinical trials reported that the antibiotic minocycline could help negative symptoms when added to treatment as usual for one year.1  Methods The BeneMin study (Benefit of Minocycline on Negative Symptoms of Schizophrenia; Extent and Mechanisms) aims to understand how minocycline might work. Patients have brain scans before and after treatment to determine whether the drug prevents the loss of grey matter that has been described in the disorder. Blood is taken to measure cytokines to determine if minocycline reduces an inflammatory process. Finally tests of intellectual function aim to determine whether the drug is acting as cognitive enhancing agent. The study will have been underway for a year during my project and I will join the team. I will learn how to carry out the research assessments and to run the imaging sessions. My time on elective will be spent contributing to the ongoing study to generate more data but also looking at previously collected data to explore relationships between negative symptoms and the tests carried out. I will have access to IT facilities equipped with relevant programs for data collection and analysis (Microsoft Excel and SPSS). As the study will have been underway for a year by the time I do my elective ethical approval will already have been obtained.  Outcomes I hope to gain a greater knowledge of research and the way in which clinical trials are run. By assessing any trends that may be apparent after one year, my elective project should provide valuable information for the ongoing study as to whether or not minocycline appears to be providing any benefit. I plan on following an academic career path and see this elective as a good chance to gain more experience of academia. I will pick up important skills over this 8 week period which will be useful over my future career. I hope that the research I undertake will eventually be published in a peer reviewed journal. It may turn out that minocycline is effective in treating the negative symptoms of schizophrenia and this elective might contribute to minocycline becoming part of an early treatment regime for patients.   1. Chaudhry IB, Hallak J, Husain N, et al. (2012) Minocycline benefits negative symptoms in early schizophrenia; a randomised double-blind placebo-controlled clinical trial in patients on standard treatment.  J Psychopharmacol 26: 1185â€“1193  ","approved",null,"2013-02-14T19:26:48"]
["u10sp9","Dr","Gordon","Faulds","Gordon_Faulds@health.qld.gov.au","Nambour Hospital","Hospital Road","4560 Australia","Queensland","Australia",{"$nulls":7},"Review of anti-depressant prescribing in haemodialysis patients - how evidence based is local practice? ","Introduction Up to 60% of patients diagnosed with psychotic illnesses are partially or totally non-adherent to their antipsychotic regimen.1 Long-acting antipsychotic medications (depots) were specifically developed to promote treatment adherence. They must be administered by a health care professional and therefore any patient who missed an appointment would be highlighted immediately. Additionally, the risk of an overdose would be eliminated. Yet since its advent in the 1960s, only 30% of patients are prescribed depots.2   The low prescribing rate of depots could be due to several reasons. It may take some time to achieve the optimum dose and there is evidence that the effect of dose changes may take many months to manifest.2 Patients may also feel embarrassment (as the depot is commonly administered to the buttocks), pain and lipohypertrophy.3  This project will look at whether patients who use antipsychotic depots have better symptom control than those who use oral second-generation antipsychotics and whether this significantly reduces in-patient admission to the mental health unit.    Methods Ethical approval will be applied for prior to the commencement of this project.   At least 30 suitable patients diagnosed with a psychotic illness such as schizophrenia (using ICD-10 criteria) will be selected for this project using the Nambour Hospital Database. These patients will either be prescribed an oral second-generation antipsychotic or a depot as part of their normal regimen. The two groups will be matched using parameters such as diagnosis, age and sex to aid statistical comparisons.  Using questionnaires and hospital records, both quantitative and qualitative data will be collected detailing symptom control and in-patient admission to the mental health unit.  Patients selected may be community based, a recent outpatient or an inpatient.   The results of this project will be shared with the psychiatry department at Nambour Hospital with the aim of highlighting this research question and stimulating further discussion.   Outcomes I hope to gain insight into how mental health units are run in Queensland and use this knowledge in my future role practising in the UK. I will utilise any additional opportunities to attend clinics and enhance my knowledge of psychiatry and medicine.   It is hoped that this research will elucidate further reasons as to why the prescribing of depot antipsychotics is so low and whether these rates could change with better information given to both psychiatrists and patients.  If the results are of interest to the department, it is hoped that they will be published.   References 1 Patel MX et al. Antipsychotic long-acting injections: mind the gap.  BJP 2009; 195:S1-S4.  2 West JC et al. Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatr Serv. 2005 Mar; 56(3):283-91.  3 National Clinical Guideline 82. Schizophrenia: The NICE guideline (Updated Edition). 2010  ","approved",null,"2013-02-14T21:45:55"]
["u01ajp9","Dr","Asha","Shetty","a.shetty@abdn.ac.uk","Aberdeen Maternity Hospital","Cornhill Road","AB25 2ZL","Foresterhill","Aberdeen",{"$nulls":7},"Maternal and foetal outcomes of twin births at Aberdeen Maternity Hospital. A comparison between monochorionic and dichorionic twins. ","INTRODUCTION â€“ Twin births come with higher risk both for the mother and the babies as compared to singleton pregnancies. Evidence suggests that chorionicity rather than zygocity is the main determinant of foetal outcome (1) and that perinatal mortality and adverse neonatal outcomes have a higher incidence in monochorionic as compared to dichorionic twinning. (2) This study will explore the outcomes of both monochorionic and dichorionic twins at Aberdeen Maternity Hospital (AMH) in the last 5 years.  OBJECTIVES â€“ The main aim of this retrospective study is to assess both maternal and foetal outcomes of approximately 300 twin births over the last five years (of both chorionicities) at AMH which will be compared with other evidence in literature on this subject.  METHOD â€“ AMH has around five thousand births every year and around 60 of these will be twin births. The prevalence of chorionicity of these twins is about 1/3 monochorionic to 2/3 dichorionic.  Details of twin births from the previous 5 years will be obtained over the elective period by using the AMH system, BADGER and then case notes for both mother and baby will be gathered to a full set of information is available. The baseline characteristics of the mothers including age, parity, BMI, chronic medical conditions, smoking status and any use of assisted conception will be recorded and evaluated to see if they are comparable between the mono and dichorionic twin pregnancies. Following this; the maternal outcomes (any complications like pre-eclampsia, antepartum haemorrhage, preterm contractions, induction of labour), foetal outcomes (gestation and mode of delivery, birth weight and Apgar scores at birth, admission to the neonatal unit, twin to twin transfusion, growth restriction or stillbirth in either twin) will be recorded. Results for monochorionic and dichorionic twins will be compared.  RESULTS â€“ The expectant results of this study are that they will correlate with the large studies available on this topic, but any differences or deviations from these will be explored and evaluated.  The results will also be discussed within the department to see if any changes need to be made in the current management of twin pregnancies. For example in the timing of delivery, or in the monitoring schedule.  REFERENCES -  1. Carroll SG, et al. Is zygosity or chorionicity the main determinant of fetal outcome in twin pregnancies? Am J Obstet Gynecol. 196, 2005 Sep, Vol. 3, 757-61. 2. Hack KEA, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large dutch cohort study. BJOG 2008;115:58â€“67.  ","approved",null,"2013-02-11T13:14:00"]
["u04cjp9","Mr","Donald","Thomas","donald.thomas@nhs.net","Anaesthetic Department","Aberdeen Royal Infirmary","AB25 2PA","Aberdeen","United Kingdom",{"$nulls":7},"Discharge documentation and delayed discharges in day case and short stay patients","Introduction  The aim of this project is to identify the incidence of anxiety in patients before elective surgery and to find the main causes of this anxiety. Literature shows that preoperative anxiety can impact on patients postoperative pain as well as postoperative analgesia requirements.(1) Certain things can be done pre-operatively by hospital staff to reduce patients anxiety, such as ensuring enough time for discussions and questions at the preoperative visit.(2) The aim is to find the number of patients with anxiety, identify the severity of the anxiety and identify factor which could alleviate the anxiety.  Methods  The assessment of preoperative anxiety will be done using the six-item short-form of the \"State-Trait Anxiety Inventory\" which has been shown to offer a briefer but just as acceptable scale as the full STAI.(3) In addition a further section of questions will be added to identify the cause of the anxiety, divided broadly into \"surgery\", \"anaesthesia\", \"pain\", \"loss of control\", \"strange environment\", \"unknown\" and \"other\". These questionnaires will be handed to the patient after the preoperative visit by the anaesthetist and before being brought to theatre. The patients that will be selected for this will be patients coming into hospital on the day of the surgery.  Outcomes  The expectation is that over a period of six weeks approximately three patients a day will fill out the questionnaires, giving an estimated ninety sets of results. The analysis of the results will show the incidence of pre-operative anxiety as well as the patients causes of anxiety. This will hopefully guide hospital staff in future to alleviate preoperative anxiety.  Literature (1)  Vaughn F.(2007) Does preoperative anxiety level predict postoperative pain?  (2)  Soltner C.(2011) Continuous care and empathic anaesthesiologist attitude in the preoperative period: impact on patient anxiety and satisfaction (3)  Marteau T.(1992) The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) ","approved","Realistic project. If all goes well, may be able to be published as a poster at a regional meeting","2013-02-26T14:09:17"]
["u15lr9","Mr","Malcolm","Smith","msmith6@nhs.net","ARI",null,null,"Aberdeen","Scotland","01392 411611","01392 403505",{"$nulls":5},"An audit on patient satisfaction regarding IBD management","Introduction  Osteoarthritis (OA) of the knee is a highly prevalent condition. Approximately a third of these patients suffer from unicompartmental OA, which is generally as a result of a malalignment of the mechanical axis of the leg. When conservative therapy fails to improve patients functional and clinical outcomes, surgery should then be considered. The surgical treatment options for unicompartmental OA of the knee are high tibial osteotomy (HTO), unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). HTOâ€™s alter the mechanical axis so to unload the pathological compartment and transfer the load to the unaffected compartment. The aims of HTO are to (1). Reduce knee pain and (2). Delay knee replacement by slowing the degenerative process (Brouwer et al. 2009; Lee and Byun 2012). The durability of TKA is approximately 15-20 years and it is even less for UKA (RÃ¶nn et al.2011). Therefore it is recommended that HTO is most effective in young and active patients as it can delay the need for a knee replacement by about 10 years (Zhang et al.2008). The aim of this paper is to look at how effective HTO is at improving patientâ€™s functional and clinical outcomes, including time to knee replacement.   Methods  I will compile data by distributing patient focused questionnaires (Oxford knee score and KOOS or WOMAC) to get patients pre and post operative scores. These questionnaires will look at patient outcomes such pain and function. The hospitals electronic database will be used to source out patients names and addresses for the questionnaires.  Baseline measurements will be collected from patient notes. These will include age at time of HTO operation, and gender. Suitable patients which fit the inclusion criteria will be identified by the hospitals electronic database and patientâ€™s notes. I shall do a literature search of several databases e.g. Ovid Medline, PubMed and the Cochrane Library, so to compare current publications with the data I collect.  My inclusion criteria will include patients between the ages of 18 and 50. This will provide approximately 150 osteotomies. They will be put into subgroups of those who have had knee replacements and those who have not. I am not yet sure if I need to seek ethical approval but I will look into this further.   Outcomes  â€¢ Pain â€¢ Function â€¢ Quality of life â€¢ Symptoms (Swelling,stiffness) â€¢ Time to knee replacement   Literature Brouwer, Reinoud W.,et al.2009.Osteotomy for treating knee osteoarthritis. The Cochrane Library.  Lee, D.,Byun.S.2012.High tibial osteotomy. Knee Surg Relat Res. 24(2), pp. 61â€“69.  RÃ¶nn, K.,et al.2011. Current Surgical Treatment of Knee Osteoarthritis. Arthritis.2011.  Zhang, W., et al. 2008.OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage. 16(2), pp. 137-162.  ","approved","Ethical approval  will be required to contact patients regarding oxford scores.  Good centre for research","2013-02-12T22:11:35"]
["u01efr9","Dr","Tony","Chankun","tonychankun@eqrmp.com","Queenâ€™s Road Medical Centre  ","Queen's Road","GY1 1RH","St Peter Port","Guernsey, United Kingdom","01481 724184 ",{"$nulls":6},"An observational study looking at reasons for admission in those aged 70 and over, with a focus on impaired cognition, at a Guernsey hospital.  ","Introduction   My project will take place at The Princess Elizabeth Hospital, Guernsey, being based around Care of the Elderly Medicine. It will be an observational study, looking at all admissions age â‰¥75 to the medical side of the hospital. I will see if reason for admission fits into any of the 5 â€˜geriatric giantsâ€™: immobility, impaired cognition, instability, incontinence and impaired vision/hearing, with there being an â€˜otherâ€™ category â€“ thus recording numbers admitted into each category, as these figures are not known in Guernsey. I will then focus on impaired cognition, using the Abbreviated Mental Test (AMT) and Confusion Assessment Method (CAM) to identify confusion and, further to that, delirium (1), with the aim of finding the incidence and prevalence of diagnosed and undiagnosed delirium. Diagnosis of delirium is often missed, plus it causes a great amount of morbidity and mortality, thus it is worthwhile to identify and manage(2).   Methods   â€¢ 8 week elective: 2 weeks at beginning to familiarise myself with Guernseyâ€™s healthcare system and 2 weeks at end for analysis of data. Data gathering will happen over a 4 week period.  â€¢ Host supervisor - GP who also works in the hospital - using the GP practice as a base, where I can input data into Microsoft excel spreadsheets, keeping the data secure.  â€¢ One spreadsheet will have the above admission reasons as headings, with tallies recorded for each week â€“ they receive 3-4 acute admissions each day with several routine admissions in this age group, to the medical side of the hospital. â€¢ Another spreadsheet will be used to record anonymised data for each admitted patient, with their AMT score on admission â€“ I will repeat the AMT on admitted patientâ€™s every other day to identify developing confusion. â€¢  In those who score <8 on AMT, I will carry out the CAM â€“ this may require a collateral history from nurses and/or relatives. This, combined with identifiable risk factors, helps recognise delirium.   â€¢ Using data gathered over four weeks, I will calculate the proportion of patients over 75 where the reason for admission is one of the geriatric giants. â€¢ Calculating the proportion of admitted patients with confusion (through AMT use) and the proportion of confused patients with possible delirium (by using the CAM) will give me incidence and prevalence of delirium, diagnosed or not.  â€¢ Host supervisor stated that I will not need ethical approval.  Outcomes   Over my time in Guernsey, I hope to gain an experience of a healthcare system different from the NHS, as it is partly private and partly state funded.   Through my project I hope to be able to gather data that is of clinical use and from which an audit could follow.     1) Young J, Inouye S. Delirium in older people. BMJ 2007;334: 842-846. doi: 10.1136/bmj.39169.706574.AD. (accessed 9 February 2013). 2) Nice Clinical Guidelines. Delirium (CG103). http://guidance.nice.org.uk/CG103 (accessed 9 February 2013).  ","approved","This is an interesting and feasible study that has potential to lead to recommendations on local service delivery. The findings ought to be noteworthy enough to be presented at a regional specialty meeting.","2013-02-12T23:02:05"]
["u08jr8","Dr","Matt","Sabin","matthew.sabin@mcri.edu.au","Royal Childrens Hospital, 50 Flemington Rd, Parkville",null,3052,"Melbourne","Australia"," T +61 3 9345 6972"," +61 3 9347 7763",{"$nulls":5},"Review of Obesity-induced Childhood Sleep Apnoea Syndrome","Introduction   There has been a dramatic increase in childhood obesity rates in the last decade, with prevalence rates ranging from 7% to 22% in Western countries, and the emerging epidemic is estimated to increase 1,2. Obesity is one of the main risk factors for developing obstructive sleep apnoea syndrome (OSAS)3-6.  It is thought that up to 60% of obese children are affected by OSAS 7.   OSAS is a sleep disorder characterised by periodic episodes of partial or complete upper airway occlusion leading to obstruction to the upper airway, which manifests in the patient as loud irregular snoring, frequent awakening and disrupted sleep. There is significant morbidity associated with paediatric OSAS which has a negative impact on the quality of life of obese children. This includes neurocognitive and behavioural disturbances, excessive daytime sleepiness, fatigue, reduced attention, poor social interaction and social withdrawal 8-10.  In the critical childhood neurodevelopment period, complications of OSAS can be very detrimental. There has been some evidence suggesting that enduring OSAS may lead to reduced or falling academic performance due to persistent disruption in cognitive function 11.   The goals of management are enhanced quality of life and prevention of short- and long-term complications. It is currently thought that weight loss strategies and health education form the main treatment however adeno-tonsillectomy is also recommended in children. This treatment is likely to fail in children with obesity, with nearly 50% continuing to have OSAS symtpoms 12. Positive airway pressure therapy has also become a part of care. This treatment modality carries some challenges such as dry mouth, nasal stuffiness/congestion, or local irritation where the mask or mask straps touch the skin. More effective and acceptable treatment should be sought.  Methods   Under the supervision of Dr. Matt Sabin, Senior Research Fellow at Murdoch Childrenâ€™s Research Institute, a review of current relevant literature will be undertaken. I will be using medical research databases to collect various studies identified through key word search. After a detailed search, the most useful and relevant studies will be chosen to review.  The focus of the review will be on assessing and prioritizing the potential solutions available and develop a strategy for treating OSAS. Clinical descriptions of how the Royal Melbourne Childrenâ€™s Hospital manages this condition will be included with specific details regarding this related to the review. In addition, important points identified from the review will be illustrated with anonymised clinical case reports. Ethical approval will not be required for this project.   Outcomes   The aim of the review is to provide insight into previous work, identify the management options available for obesity induced OSAS and clarify areas requiring further research.  Literature  1 Chervin RD, Ruzicka DL, Archbold KH, Dillon JE.Snoring predicts hyperactivity four years later. Sleep. 2005;28(7):885â€“890 2 Chervin RD, Archbold KH.Hyperactivity and polysomnographic findings in children evaluated for sleep-disordered breathing. Sleep. 2001;24(3):313â€“320 3 Spilsbury JC, Storfer-Isser A, Kirchner HL, et al.Neighborhood disadvantage as a risk factor for pediatric obstructive sleep apnea. J Pediatr. 2006;149(3):342â€“347pmid:16939744 4 Chervin RD, Ruzicka DL, Giordani BJ, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117(4).  5 Giordani B, Hodges EK, Guire KE, et al. Neuropsychological and behavioral functioning in children with and without obstructive sleep apnea referred for tonsillectomy. J Int Neuropsychol Soc. 2008;14(4):571â€“581  6 Chervin RD, Weatherly RA, Ruzicka DL, et al. Subjective sleepiness and polysomnographic correlates in children scheduled for adenotonsillectomy vs other surgical care. Sleep. 2006;29(4):495â€“503 7       J. M. Silvestri, D. E. Weese-Mayer, M. T. Bass, A. S. Kenny, S. A. Hauptman, and S. M. Pearsall, â€œPolysomnography in obese children with a history of sleep-associated breathing disorders,â€\u009d Pediatric Pulmonology, vol. 16, no. 2, pp. 124â€“129, 1993. 8 Centre for Evidence-Based Medicine. Levels of Evidence and Grades of Recommendations. Oxford, United Kingdom: Headington; 2001 9 American Academy of Pediatrics Steering Committee on Quality Improvement and Management. Classifying recommendations for clinical practice guidelines. Pediatrics. 2004;114(3):874â€“877 10 Bixler EO, Vgontzas AN, Lin HM, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32(6):731â€“736 11 Sogut A, Altin R, Uzun L, et al. Prevalence of obstructive sleep apnea syndrome and associated symptoms in 3--11-year-old Turkish children. Pediatr Pulmonol. 2005;39(3):251â€“256 12 L. C. K. Leung, D. K. Ng, M. W. Lau et al., â€œTwenty-four-hour ambulatory BP in snoring children with obstructive sleep apnea syndrome,â€\u009d Chest, vol. 130, no. 4, pp. 1009â€“1017, 2006.  ","approved","As long as you have confirmed with your Australia supervisor that ethical approval is not needed, that is fine.","2013-02-14T15:17:36"]
["u26sr9","Mr","Frank","Green","f.green.11@aberdeen.ac.uk","PO Box 67",null,"Tak 63110","Mae Sot","Thailand","+66 821635947","+66 55544655",{"$nulls":5},"Small incision extracapsular cataract extraction at Maw Tao Clinic, Thailand","Introduction  Mae Tao Clinic is a health service provider located at Mae Sot, a town near the Thai/Burmese border. Many Burmese people have crossed the border to seek better opportunities in Thailand. Because they have illegally moved into Thailand, they are not entitled to the health services available. Mae Tao Clinic have been providing healthcare to these less fortunate individuals free of charge. Since its establishment in 1989, the clinic has grown considerably, treating a population of approximately 150,000. Half are migrant workers in Mae Sot, the other half have travelled from Burma specifically for care. In addition to other departments, eye clinics are held and eye surgeries are performed. An audit of outcome of small incision extracapsular cataract extraction will be carried out.  Methods  The audit will start with a preoperative assessment of patients. Their vision will be examined and interviews will be made to find out about the nature of their condition and also to understand the patient demographics Mae Tao Clinic provides service to. Patientâ€™s vision will be assessed postoperatively by eye examination and by using an autorefractor to assess accuracy of biometry. Questionnaires will also be given to patients to evaluate how satisfied they are with the outcome of the procedure. All patients who undergo cataract extraction and will be staying at the clinic for at least 3 days between March and April 2014 will be asked to participate in the audit.   Outcomes  To evaluate the effectiveness of cataract surgery performed at Mae Tao Clinic. Patients will have their eyes examined before and after the procedure using an autorefractor. Questionnaires will be given to patient to assess satisfaction levels.   Literature Efficacy and safety of mass cataract surgery campaign in a developing country http://www.ncbi.nlm.nih.gov/pubmed/23262992   Manual small incision cataract surgery in a United Kingdom university teaching hospital setting. http://www.ncbi.nlm.nih.gov/pubmed/19129974  ","approved","Fantastic proposal. Very relevant to the intention of continuing charitable services in that part of the world.","2013-02-20T15:31:04"]
["u01mcr9","Dr","Tohru","Sekiya","elective@jikei.ac.jp","Jikei University School of Medicine","3-25-8 Nishi-shimbashi, Minato-ku","105-8461","Tokyo ","Japan","03-3813-6111",{"$nulls":6},"Incidental Brain MRI findings in a sample of the working population in Japan","Introduction  Hikikomori is a primary psychiatric condition of self-imposed social exclusion predominantly of young male middle class individuals. The condition was originally described in Japan in 1998 and is estimated to have prevalence as high as 1% of the population. In recent studies it was also found to occur in other industrialized cultures but is almost completely unknown in Britain. Since the 'discovery' of Hikikomori, media interest has exploded and the condition rapidly moved into the centre of the Japanese public eye. With its high profile it has raised many contentious, and fascinating, questions about the nature of Psychiatry. Is this condition precipitated by Japanese culture and society; or is it likely that there are, or soon will be, patients recognized with this condition in the UK and worldwide? Is this perhaps another example of over-medicalisation; or does true psychopathology underlie this condition? Hikikomori is such a multi-faceted and challenging condition that I feel much teaching value could be drawn from an extensive literature research and an in-depth dissection of the contentious issues surrounding it.  Methods  I plan to carry out a psychiatric research project at Tokyo Medical and Dentistry University (TMDU). During this time I will be attached to the Psychiatric team and will attend Psychiatric consultations of Hikikomori patients. Further to this I propose to perform a literature review into Hikikomori and to illustrate it with 3 to 5 case examples taken from discussions with Japanese psychiatrists and patients. If possible I will also try to obtain an interview with Saito Tamaki, a leading Hikikomori expert who first coined the term. The resulting report will aim to detail all aspects of the condition, its definition, aetiology, recognition, management and course. It will also aim to explore why Japan has the highest prevalence of Hikikomori cases. Any Japanese language barrier should be overcome through a combination of my own Japanese ability (JLPT 4) which I aim to further improve before the project and through the English proficiency of the Japanese doctors who are often fluent. Further help can be obtained through my contact Dr Kamoi or TMDU's international center.  Outcomes The aim of this project is to raise awareness of this relatively new psychiatric condition in the UK and the implications this might have for British Psychiatry. I personally hope to further my Japanese proficiency, develop my cultural interest in Japan and gain insight into Japanese Psychiatry. For my host institute I hope I will be able to impart knowledge of British culture, English language and insight into Western medicine.  Literature http://www.ncbi.nlm.nih.gov/pubmed/21706238 Hikikomori: Adolescence without End by Saito Tamaki Hikikomori: Investigations into the phenomenon of acute social withdrawal in contemporary Japan by Michael J. Dziesinski ","approved","This is rather ambitious and vague but to me is embracing the elective spirit of doing something different somewhere different. At interview you might like to flesh out the literature review, eg are you going to look at international prevalence? how do you diagnose this.","2013-02-13T21:39:43"]
["u01whs12","Mr","Paul","Broadhurst","paul.broadhurst@nhs.net","Aberdeen Royal Infirmary, Foresterhill, Aberdeen",null,null,"Scotland,United Kingdom","AB25 2ZN","01224 559308",{"$nulls":6},"Retrospective audit of the timeframe from the onset of symptoms to primary percutaneous intervention and the causes of delay in STEMI patients","Introduction Myocardial infarction (MI) or commonly known as a heart attack, causes heart cells to die due to insufficient blood supply. The cause of MI is mainly occlusion of the arteries of the heart by superadded thrombus on plaque formed by lipids and cholesterol. Symptoms of MI includes sudden retrosternal chest pain, shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety.  Diagnostic tests available to detect heart muscle damage are an electrocardiogram (ECG), echocardiography, cardiac MRI and blood markers such as troponin levels. Delay in intervention to reopen the occluded artery will result in increasing damage to more heart muscle cells; therefore, intervention should be carried out as soon as possible from the onset of symptoms. Percutaneous coronary intervention is the procedure where the acutely occluded artery is opened up during myocardial infarction. An alternative though less effective treatment is pharmacological thrombolysis.  Objective According to NICE guideline, primary PCI provides a better outcome for STEMI patients and should be carried out in preference to thrombolysis if patients can get access to primary PCI within 2 hours from time of first medical contact. This project aims to find out the number of patients who are able to make it in time for primary PCI in Aberdeen Foresterhill hospital.   Methods To conduct a retrospective study by analysing the time duration of 100 patients who have undergo coronary angiography in Aberdeen Foresterhill Hospital from year 2012 to 2013 using the computer in cardiology department and operation theatre for the observation of the procedure. Data will be collected and analysed using the SPSS software quantitatively and qualitatively. Percentage of patients who are able to receive the Primary PCI can be calculated with the data. Outcomes This project would show us the number of patients who are able to make it on time for Primary PCI. Percentage of patients who receive reperfusion with PCI within this time can be assessed and this can be related to the duration of travel from the site of MI to ARI.  The outcome of the patient is different between receiving primary PCI within 2 hours and receiving later than 2 hours. This study can be used to determine the efficiency of the system for management of ST elevation myocardial infarction patients in ARI and compare the results with national and international standards.   References 1) Nice Guideline : Myocardial infarction with ST-segment-elevation (STEMI) 2) Comparison of Primary Coronary Angioplasty and Intravenous Thrombolytic Therapy for Acute Myocardial Infarction( W. Douglas Weaver, MD; R. John Simes, MD; Amadeo Betriu, MD; Cindy L. Grines, MD; Felix Zijlstra, MD; Eulogio Garcia, MD; Lilliana Grinfeld, MD)  ","approved",null,"2013-03-19T17:42:31"]
["u04gs9","Dr","Kate","Grimwade",null,"Tauranga Hospital","Cameron Road",null,"Tauranga","New Zealand",{"$nulls":7},"An audit of the effectiveness of DAIR in treating prosthetic joint infections in Tauranga Hospital, New Zealand","Introduction   The aim of my elective is to evaluate the implementation of multi-media awareness programmes and school based throat swabbing programmes in Bay of Plenty, New Zealand, at reducing the rates of rheumatic fever.  Rheumatic fever is an uncommon condition in developed countries due, largely, to improvements in living standards during the 20th century. However, about 160 cases (4.5 per 100,000) of rheumatic fever are diagnosed in New Zealand per year. About 85-90% of these cases are in school aged Maori and Pacific children. This is thought to be mainly due to the low socioeconomic status and overcrowded living conditions that a large number of the population of these groups experience.  In particular, the North Island has the highest rates of rheumatic fever in New Zealand, including areas such as Bay of Plenty and South Auckland.  To combat the high levels of rheumatic fever, in Bay of Plenty, rheumatic fever awareness campaigns have been ran in 2010, 2011 and 2012 between the months of March and June, this has included press releases, radio adverts and pamphlets being given to schools.   School based throat swabbing programmes have also been created. These programmes began being rolled out amongst schools in 2009. The programmes mean that schools receive regular community health worker visits, to try to detect and treat strep. throat much earlier, thus decreasing the chance of rheumatic fever developing.  Methods   In 2008, Bay of Plenty had a rate of 34 per 100,000 of rheumatic fever cases, in a population of 214,910. I plan to look at the number of cases of diagnosed rheumatic fever in Tauranga Hospital, one of the main hospitals to serve the Bay of Plenty area, from 2005 to 2012. I will able to do this by accessing hospital patient records. Information will be securely saved on a laptop and backed up on a password protected USB stick.   The data will be analysed and plotted on a line graph (x-axis â€˜Yearâ€™ and y-axis â€˜No. Of diagnosed cases of rheumatic feverâ€™), to demonstrate if there has been any change in the number of diagnosed cases of rheumatic fever, since the awareness and throat swabbing programmes have been implemented. I will also go out to schools with health workers and distribute a questionnaire, which I will create. This will be used to help gauge the school childrenâ€™s and their familiesâ€™ awareness of rheumatic fever and the childrenâ€™s understanding of why they might have their throat swabbed. The results will be used to help establish the effectiveness of the multi-media awareness campaigns and throat swabbing programmes.  Outcomes   At the end of my elective, I hope to have enjoyed myself and learned from working in a different environment and culture. I hope to have improved my ability at collecting information and displaying it in an appropriate manner.  My elective will hopefully be of value to the local hospital and district health board, in providing them with more information to assess how successful their programmes have been at reducing the rate of rheumatic fever.  Literature  The National Heart Foundation of New Zealand. (2007). A Summary of the New Zealand Guidelines for Rheumatic Fever. The National Heart Foundation of New Zealand, Auckland.  Loring, B. (2008). Rheumatic Fever in the Bay of Plenty and Lakes Distic Health Boards: A review of the evidence and recommendations for action. Toi Te Ora â€“ Public Health, Tauranga.   ","approved",null,"2013-02-14T22:32:46"]
["u01iqs9","Mr","Mohd Faiz Abdul Latif",null,"pakutekan17@gmail.com","Klinik Kesihatan Tapah, Pejabat Kesihatan Daerah Batang Padang","Perak,","Malaysia","Malaysia","Tapah",6054010260,6054018467,{"$nulls":5},"The effectiveness of methadone maintenance therapy in Kelinik Kesihatan Tapah","f.garton@abdn.ac.uk","A Retrospective Study of Effectiveness of Methadone Maintenance Therapy in a District Clinic in Malaysia","A Study of Effectiveness of Methadone Maintenance Therapy in in a District Clinic in Malaysia  Introduction:   Heroin addiction has been a serious problem in Malaysia predated back to 1980â€™s and considered as national threat.  Methadone Replacement Therapy (MRMT) has been suggested as the solution to heroin addiction. Methadone Maintenance Therapy in Malaysia only started on 2005 after gaining a lot of controversy from the general public when it was first suggested. MMT in Malaysia is conducted in various centres including general hospital, private hospital, district clinics, community based drug rehabilitation centres and prisons1.     Objective:   1) To assess the effectiveness of MMT in reducing opioid dependency 2) To assess changes in quality of life of patients receiving  MMT 3) To assess the impact of MMT on patientâ€™s health 4) To assess problem and challenges in implementation of MMT is rural area 5) To gain clinical exposure of management of General Practitioner in rural area  Method:   During the 8 weeks of my elective block, I will attend the District Clinic in Tapah, Malaysia to observe the implementation of methadone maintenance therapy in the clinic. Information will be obtained from around 30-50 patientsâ€™ case notes. The effectiveness of MMT will be assessed based on these aspects2: 1) Use of illicit drug is detected from urine strip test and the result of the test is obtained from the case notes 2) Patients who drop out from the program is recorded and the reason for drop out is documented  3) Number of patients infected with HIV, Hep B, Hep C before program and any new case of infection will be recorded 4) Quality of life of patients on MMT will be assessed by distributing questionnaire to patients.  5) Numbers of patients employed before and after treatment is started is recorded Application of ethical approval will be made to the National Medical Research Register3 and is expected to be obtained within six months after application.   I also aim to gain some clinical experience on practicing in small and rural general practice by involving in the daily clinics.      Outcome:  I hope at the end of the project I will be able to: 1) Compare the implementation of MMT in Malaysia and in the UK (I would leave this out as your focus is on MMT in Malaysia) 2) Gain clinical exposure in small and rural health clinic 3) Acknowledge the challenges involved in MMT  4) Assess the effectiveness of MMT  References:   1) Naziah Mohd Nazri.  Challenges in Methadone Maintenance Therapy [online]. Malaysia:Ministry of health, 2006 [viewed 7 march 2013]. Available from: http://jknj.moh.gov.my/jsm/day1/Speciality%20Symposia/SS_11_Challenges%20in%20Methadone%20Maintainance%20Therapy.pdf 2) Ramli M, Ahmad Zafri A.B, Umeed A.K. Two Years Outcome of Methadone Maintenance Therapy at a Clinic in Malaysia. Asia Pac J Public Health. 2011; 20:1-7 3) National Medical Research Register. Ministry of Health,Malaysia, [viewed 14 March 2013]. Available from: https://www.nmrr.gov.my/fwbLoginPage.jsp   ","approved",null,"2013-04-11T11:48:29"]
["u23es9","Prof","Arduino","Mangoni","arduino.mangoni@flinders.edu.au ; richard.woodman@flinders.edu.au","Department of Clinical Pharmacology","Rm 6D302, Flinders Medical Centre","South Australia","Bedford Park, GPO Box 2100","Adelaide 5001","(+61 8) 8204 7495",{"$nulls":6},"Antichoolinergic drug prescribing in older fallers presenting to the emergency department at Flinders Medical Centre","Introduction   Our ageing population is ever increasing. According to the WHO, 2 billion people will be aged 60 and older by 2050(1).  In Adelaide, Australia, it has also been said that 80% of the older population have three or more  chronic conditions (2). Managing these chronic conditions is very difficult, often leading to polypharmacy. The latter is defined as the use of four or more concurrent medications. This is seen in 43-55% of older patients in Australia (3). As a result of polypharmacy, the risk of adverse drug events increases. Polypharmacy, especially the use of specific drugs, e.g. centrally acting and cardiovascular medications, increases the risk of falls, one of the four geriatric giants, with potentially fatal outcomes in the older population (4). Falls prevention guidelines exist in Australia (5) for managing these patients.  Aim  The aim of this audit based review is to consider the incidence of falls admissions linked to polypharmacy.  Methods  Software : SPSS software  I will conduct a structured review of 50 cases of patients aged >65 years presenting to Flinders Medical Centre with falls.  Data will be extracted from drug cardexes and patient notes using a study specific data extraction sheet.  All medication recorded for each patient will be compared with the Screening Tool of Older Persons' Prescriptions (STOPP). Due to the small sample size only descriptive data analysis will be conducted.  The data extraction sheet will include the patients age, type of admission, the presentation of the fall, previous falls, relevant past medical history and management of the patient.  No ethical approval is required.  Outcomes   1. To determine the proportion of patients with at least 1  prescription in the previous 6 months which is     potentially inappropriate for this age group  2. To determine, how many of those ( mentioned in point 1.) are potentially related to falls (due to impaired     balance, worsening eyesight, increased confusion etc.)  3. To determine any key characteristics associated with inappropriate prescribing (i.e. ie age, gender, past     fall history)   I hope to gain insight into healthcare systems in Australia and gain experience in elderly medication management. I think this will be of great benefit to my future career  Literature  (1). http://www.who.int/ageing/en/ (2). http://www.biomedcentral.com/1471-2458/8/221/ (3). Goldney R, Fisher L: Use of prescribed medications in a South Australian community sample.               Med J Aust 2005, 183(5):251-253.  (4). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885000/  (5). http://www.fallssa.com.au/documents/hp/2011_FF_Lucero.pdf  ","approved",null,"2013-02-14T18:34:10"]
["u01pjs9","Dr","Julie","Platt","julieplatt@nhs.net","Royal Cornhill Hospital ",null,"AB25 2ZH ","Aberdeen","UK",{"$nulls":7},"Analysis of extended opening hours in primary care","Introduction â€“ Substance abuse, especially alcohol, is a ubiquitous feature of student culture that many view as an integral part of the university experience.  With this come many social, mental and physical health problems in higher-education institutes worldwide.  With the estimate that just under 50% [1] of USA university students that drink alcohol, regularly binge-drink, presents a grave concern for many.  With the increasing prevalence of abuse many studies have been performed to test the efficacy of preventative measures such as pre-emptive education [2], self-management/monitoring [3], fear appeals and many others.    Despite this, alcohol abuse seems to be as much of a problem as ever.  What can be done to solve the problem of the dangerous drinking habits of the quintessential student?  Having studied at the University of Aberdeen for 4 years has brought a level of awareness to the drinking culture among students and the negative implications it imposes not only to those involved but the community as a whole.  This is even more relevant with medical students having a history of being particularly heavy drinkers [4].  Method - I plan to search PubMed, MANTIS, Cochrane, Medline, Embase, Scopus, and Web of Science for English-language sources using relevant keywords giving preference to more recent publications.  I also plan to search the bibliographies of the retrieved articles.  The information/findings from these articles will be summarised in a comprehensive manner and a critique of each shall also be performed and reported. As the results of such studies will provide data of various forms (quantitative/qualitative) I plan to bring together the results of statistically comparable papers and to summarise the effectiveness of such preventions.  Discussion of why different prevention methods are more effective than others, with consideration of factors which may contribute to such efficacy (e.g. cultural/social influences), will also be included.  In addition to the review itself a poster summarising review findings will be developed as an informative complement to the paper.  Outcome â€“ from this project I intend to further my ability to review and critically appraise literature, this being an important part of a career in healthcare.  My knowledge of alcohol abuse and prevention will be broadened by researching the topic thoroughly and examining the effectiveness of different strategies.  The aim of the project is to produce a useful article that pulls together the information of many studies into a readable format to present a broad perspective of the specified subject.  Whether the project may benefit higher educational institutes such as the University of Aberdeen itself is yet to be seen.  It may provide useful ideas and suggestions of whether current or future plans and methods to reduce alcohol abuse in the student population would be effective if implemented.  References -   [1] No specified author. \"College Drinking (College fact sheet)\" NIAAA (National Institute on Alcohol Abuse and Alcoholism). Apr. 2012. Web. 10 Feb 2013.  (http://pubs.niaaa.nih.gov/publications/CollegeFactSheet/CollegeFactSheet.pdf) [2] Perkins, H., Michael P. Haines, and Richard Rice. \"Misperceiving the college drinking norm and related problems: A nationwide study of exposure to prevention information, perceived norms and student alcohol misuse.\" Journal of Studies on Alcohol and Drugs 66.4 (2005): 470.  [3] Garvin, Royce B., John D. Alcorn, and Kim K. Faulkner. \"Behavioral strategies for alcohol abuse prevention with high-risk college males.\" Journal of Alcohol and Drug Education 36:1 (1990).  [4] Collier, D. J., and I. L. Beales. \"Drinking among medical students: a questionnaire survey.\" British Medical Journal 299.6690 (1989): 19-22.  ","approved",null,"2013-02-14T11:35:45"]
["u01pms9","Dr","David","Watson","david.watson@nhs.net","Hamilton Medical Group","4 Queens Road","United Kingdom","AB15 4ZT","Aberdeen","08444 778930","08444 778931",{"$nulls":5},"A STUDY OF THE EFFECTIVENESS OF DISEASE MANAGEMENT OF DIABETIC PATIENTS IN THE COMMUNITY WITH AN HbA1c > 64 MMOL/MOL","Introduction  Diabetes is a common life-long health condition. There are 2.9 million people diagnosed with diabetes in the UK and an estimated 850,000 people who have the condition but donâ€™t know it. Diabetes mellitus is a group of metabolic diseases in which a person has a high blood sugar level, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.Diabetes, especially if poorly controlled, can lead to many complications.Acute complications include diabetic ketoacidosis and ketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, and diabetic retinopathy. Thus, adequate management of diabetes is of vital importance.   Aim  This project aims to review patients at Hamilton Medical Group, Aberdeen, with poorly controlled diabetes (SIGN guidelines defines this as an HbA1c > 64 mmol/mol) and review variables that may contribute to poor control.   Method  The project will  gather demographic data from patient practice records on type of Diabetes Mellitus; age; sex; BMI recorded in last 12 months; the therapy each patient is prescribed and how it compares to SIGN guidelines, patient compliance with treatment and with attending appointments (hospital and practice). Treatment decisions in the last 12 months will be reviewed if documented in the consultation records.   In summary, this project aims to investigate the reasons for high Hb1Ac levels amongst a group of poorly controlled diabetics. ","approved","as the target HbA1C has been made tighter to fit in with SIGN the patient group will be tripled, roughly 60 patients rather than 20, this may help to make the study more valid as it will be higher powered ","2013-03-27T16:52:09"]
["u01jes8","Dr","Peter ","Murchie","p.murchie@abdn.ac.uk","University of Aberdeen Department of Applied Health Sciences","Polwarth Building","AB25 2ZD","Aberdeen","Scotland",{"$nulls":7},"Provider delay in the management of malignant melanomas in Grampian","Introduction A recent study conducted by colleagues at the University of Aberdeen found that place of residence influenced how patients diagnosed with primary melanoma between 1991 and 2007 were managed in the North of Scotland (1). Those who lived in suburban areas and remote small towns were more likely to have an initial melanoma excised in primary care, which is against guidelines recommending that all lesions suspicious of melanoma should be referred urgently and not be removed in primary care (2). Furthermore, those living in accessible small towns and rural areas were just as likely to receive management which adhered to guidelines compared to their urban counterparts. This suggests that factors other than proximity to tertiary cancer centres, such as patient and doctor characteristics, may determine how place of residence influences the way melanoma is managed in Northern Scotland.   This project aims to: 1.Investigate whether the introduction of the Scottish referral guidelines of suspected cancer in 2007 (2) has changed the way primary cutaneous melanoma is managed and whether place of residence still influences its management. 2.Investigate the views of general practitioners on the influence of place of residence on cancer diagnosis and management.  Methods  1.Using data from the NHS Grampian Cancer Care Pathway Database, which tracks all cancer patients from the point of referral onwards, a database of all primary melanomas diagnosed since 2007 will be generated. Data recorded will include patient demographics (age, gender, deprivation score and rurality), where the initial biopsy took place and details of the submitting clinician. Data will be analysed using quantitative methods to establish the likelihood of patients living in urban/rural areas in having their primary melanomas excised in primary care versus secondary care. 2.Six General Practitioners, from a mix of both urban and rural practices, will be invited to participate in a semi-structured interview which will seek to establish their views on the influence of place of residence on the diagnosis and management of cancer, with particular emphasis on primary cutaneous melanomas. This will be analysed using qualitative methods to identify different themes regarding how place of residence may influence cancer diagnosis and management.   Outcomes  From doing this project, I hope to gain valuable experience in conducting both qualitative and quantitative research. I am interested in following a career in general practice and research so I feel that a project like this will certainly be of benefit, with the added potential of gaining a published paper. The Division of Applied Health Sciences has become increasingly interested in the management of melanoma in Scotland, having conducted several studies in recent years. I hope that my project will help to address more questions they have yet to answer.  Literature 1. Green, J., Murchie, P. and Lee, A.J. Does place of residence affect the management of cutaneous melanoma? Analysis of a database from Northern Scotland. 2013. (in press) 2. Scottish Executive Health Department. Scottish referral guidelines for suspected cancer. 2007. (online) http://www.sehd.scot.nhs.uk/mels/HDL2007_09.pdf(accessed 13th February 2013) ","approved",null,"2013-02-13T12:55:50"]
["u20as11","Mr","Peter","Senior","petersenior@ualberta.ca","2000 College Plaza","8215-112 Street","T6G 2C8","Edmonton","Canada","00 1 780 407-1480",{"$nulls":6},"A Novel Scoring System for the Assessment of Graft Function Following Clinical Islet Transplantation (CIT)","Introduction  Diabetes mellitus has become an important cause of morbidity and mortality. Intensive control of blood glucose levels with exogenous insulin is successful in mitigating many sequelae of diabetes(1). However, a subgroup of patients experience glycaemic lability, hypoglycaemic unawareness and frequent hypoglycaemic episodes despite optimum medical therapy. Therefore, alternative treatments continue to be sought.  In 2000, a group from the University of Alberta demonstrated insulin independence in seven consecutive patients with type 1 diabetes after an infusion of islets into the portal vein and a novel immunosuppressive regimen(2). Unfortunately, subsequent studies demonstrated that insulin independence is often short lived. Furthermore, the nephrotoxicity of long term immunosuppression and burden on donor organ supply are concerning. However, mortality is low and even partial graft function reduces insulin requirements and may protect against the complications of diabetes(3).  Methods   This abundance of conflicting factors makes rigorous patient selection and education imperative. The aim is to evaluate the performance of the University of Alberta Clinical Islet Transplant Program's assessment and education process by interviewing patients who received an islet transplant in 2012 (n=62). Questionnaires will address their expectations of transplant, how their experience compared with their expectations, how well prepared they felt for transplant and which areas they felt under-prepared for. Suggestions for improvements to the assessment and education process will be solicited. Interviews will be conducted in person and over the phone, followed by collation of data with some descriptive statistics. An umbrella protocol covers ethical approval for quality of life assessments. The results will inform changes to the patient assessment process, improving patient understanding and promoting post-transplant treatment compliance.  Outcomes   While studying at St Andrews University, I wrote my BSc dissertation on pancreas transplantation (including Islets transplantation) in type 1 diabetes. I was struck by the potential of this novel approach, despite the many obstacles to be overcome. Therefore, I am very excited to have the opportunity to visit the place where it all started. Hopefully I will be able to help in some small way and gain a deeper understanding of an active research area.  Literature  (1)The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993 Sep 30;329(14):977-986.  (2)Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000 Jul 27;343(4):230-238.  (3)Senior PA, Kin T, Shapiro J,  Koh A; Islet Transplantation at the University of Alberta: Status Update and Review of Progress over the Last Decade; Canadian Journal of Diabetes 2012 Feb 36(1); 32-37   ","approved","Tbis study requires more work with the host to determine the outcomes required but should provide some interesting data.  Careful thought will need to be given to how the study is executed in the time available on the elective. ","2013-02-14T23:42:21"]
["u09cs8","Dr","Scott","Durum","durums@mail.ncifcrf.gov","Laboratory of Molecular Immunoregulation, Frederick National Lab, National Cancer Institute","Building 560","21702-1201","Frederick, Maryland","United States of America",{"$nulls":7},"A novel therapy for IBD: Does intra-luminal delivery of interleukin-27 protect against colitis induction?","Introduction  Interleukin(IL)-27 is a member of the IL-12 cytokine family composed of the IL-27p28 and EBI3 subunits. Initially thought to be pro-inflammatory driving production of Th1 cells, it is actually pleiotropic in function and exerts potent anti-inflammatory properties, with influence on both adaptive and innate cells.   Lactococcus lactis, a bacterium used in the food industry, has been engineered to deliver IL-27 intra-luminally to the gut following oral ingestion (LL-IL27). This system to deliver IL-27 as an anti-inflammatory cytokine has been efficacious in reducing colitis severity in murine models of inflammatory bowel disease (IBD) (T-cell transfer model of colitis and acute TNBS model) in the host laboratory. Thus, LL-IL27 can act therapeutically in established colitis. The question of whether it can act in a protective preventative manner remains. This is important in terms of maintenance therapy for human disease to prevent relapses of inflammatory activity.   Methods LL-IL27 and L. lactis control will be delivered daily by oral gavage for 5 days to 5-6 week old male SJL mice. Colitis will then be induced by intra-rectal 2,4,6-trinitrobenzensulfonic acid (TNBS) instillation. Effect of pre-treatment mucosal delivery of IL-27 will be assessed by clinical parameters, microscopic and macroscopic assessment of colitis, and systemic inflammatory activity through serum markers e.g. CRP. There will be five groups of mice to compare: healthy non-colitic controls/ethanol vehicle control/TNBS alone/TNBS+LL-IL27/TNBS+L. lactis control. If an effect is seen, the mechanism of action will be explored further by assessing cytokine expression at gene and protein levels, and potentially, inflammatory cell phenotype of colonic mucosa. The TNBS model of colitis and breeding colony of these mice are established in the facility and therefore this is achievable in the time allocated. If time allows, this preventative protocol will be tested in the oxazolone model of colitis, which induces a Th2 reaction and closely resembles ulcerative colitis.    Outcomes This represents an excellent opportunity to undertake an exciting research project on a potentially new therapy for IBD. Based at the NCI/NIH, I will contribute to the work of an internationally renowned immunology group, in one of the worldâ€™s leading centres for medical research. I will gain experience of pre-clinical murine models of disease and appreciation of the importance, and limitations, of these in identifying pathogenesis, new therapeutic targets in human disease, and testing potentially new therapies. I will achieve competency in a wide variety of laboratory research techniques (bacterial handling/culture, animal handling, RNA extraction, cDNA synthesis and downstream real-time PCR, protein extraction and ELISA).    Literature Wojno ED, Hunter CA. New directions in the basic and translational biology of interleukin-27, Trends in Immunology, February 2012, Vol. 33, No. 2 Lothar et al. Treatment of Murine Colitis by Lactococcus lactis Secreting Interleukin-10, Science 289, 1352 (2000)  ","approved","This is an excellent proposal and a very exciting project. Well done and good luck! Emad El-Omar","2013-02-14T07:37:56"]
["u02mrs9","Prof","Emad","El-Omar","e.el-omar@abdn.ac.uk","Institute of Medical Sciences, School of Medicine & Dentistry","Aberdeen University, Foresterhill","AB25 2ZD","Aberdeen","United Kingdom",{"$nulls":7},"Association between genetic variants in TLR1 and FCGR2A and risk of Helicobacter pylori susceptibility: a case control study","Introduction  The discovery of Helicobacter pylori and its role in peptic ulcer disease was one of the major medical advances of the late twentieth century. Treatment relies on a one week triple eradication regimen comprising twice daily Proton Pump Inhibitor with either amoxicillin and clarithromycin or metronidazole and clarithromycin.[1] Failure of eradication therapy is attributed to resistance of H. pylori to the antibiotics used. In the United Kingdom, H. pylori resistance has been examined in parts of England and Wales but there is limited data available for Scotland.[2] This project aims to assess the prevalence of H. pylori resistance to amoxicillin, clarithromycin and metronidazole in the Northeast of Scotland.   Methods  A laboratory based research study will be conducted in the Institute of Medical Sciences (IMS) in Aberdeen. This involves testing clinical isolates of endoscopically collected gastric biopsy specimens of H. pylori in patients presenting with dyspepsia. The biopsy specimens will be collected and frozen at -70Â°C over the next year in preparation for the elective. An estimate of 50 samples will be cultured and susceptibility testing will be performed for resistance to amoxicillin, clarithromycin and metronidazole over a 6-7 week period of the elective. This will allow 1-2 weeks to acquire the necessary skills required for culture/susceptibility testing and for analysis of the results. Patient demographics (age and gender) and the data obtained will be gathered to a SPSS spreadsheet and statistical analysis will be conducted. Additionally, it will be compared with published studies before conclusions and recommendations are made.   Outcomes  The results of the study will be beneficial in tailoring the antibiotics therapy to current resistance patterns of H. pylori. This will enable more successful eradication rates to be achieved and to minimise increases in antibiotic resistance of H. pylori in the Northeast of Scotland. It will also provide a baseline pattern of antibiotic resistance that can be monitored in future studies.    Literature 1. National Institute for Health and Clinical Excellence, 2004. Management of dyspepsia in adults in primary care. Clinical guideline 17. [Online] Available at: http://www.nice.org.uk/nicemedia/pdf/CG017NICEguideline.pdf. [Accessed 6 February 2013].  2. Chisholm SA, Teara EL, Davies K, Owen RJ. Surveillance of primary antibiotic resistance of Helicobacter pylori at centres in England and Wales over a six-year period (2000-2005). Euro Surveill. 2007; 12(7): E3-4.  ","approved",null,"2013-02-07T17:07:44"]
["u14bs9","Miss","Janet","Brady","Gareth.Davies@bartshealth.nhs.uk","Bart Health NHS trust ","The Helipad, Level 17, The Royal London Hospital","E1 1BB","Whitechapel, London","UK",2035940794,{"$nulls":6},"The relevance of the ATLS classifications of shock, vital signs and patient monitoring in the early phases of trauma: a systematic review","Introduction: The Helicopter Emergency Medical Service (HEMS) elective program is extremely popular, not only with medical students, but with doctors, paramedics, nurses and military personnel. For this reason they do not allow externally planned projects to be conducted during electives. They will provide a clinical supervisor on the day of arrival (also refused to do so before hand). They will then sit down with me and discuss a project that i am to plan and complete during my time there. the topic can not be assigned before hand as they require candidates to conduct projects that is relevant to the HEMS service at the time. This has been discussed with Andrew Dallas prior to accepting the place on the project.   Methods:  The information provided suggests the project is likely to take the format of an internal audit of the London Ambulance Service and HEMS service databases and practices. If this is not possible the other suggestion is a literature review.  The planning for how this will be conducted with be discussed on the day of arrival and all relevant paper work will be completed at that point. AS they are experienced in this I do no have any concerns that this project would be unsuitable for the Aberdeen elective program and would be best suited to allow for the completion of what is a busy elective program. I will ensure I understand the principles of conducting both types of project well in advance of arrival.   Outcomes:  The project I will complete must be presented at either the clinical Governance Meetings or Death and disability meeting conducted during my time at HEMS. Further to this if suitable there may be an opportunity to present my work outwith the service. I am not concerned the project would be unsuitable for the Aberdeen elective program but would allow me to complete and busy elective program and learn a lot about an area of medicine I am extremely interested in and that can not be covered within the University of Aberdeen's program.    Literature  Clearly this will be relevant to the project at the time and will include all major sources available at the Barts Medical School. Before embarking on my elective I will look up references for methodology to both literature reviews and audits so I am prepared to do a project well regardless of what I am assigned.  ","approved",null,"2013-01-22T21:03:08"]
["u08ps9","Dr","David","Watson","david.watson@nhs.net","Hamilton Medical Group","4 Queens Road","AB15 4ZT","Aberdeen","United Kingdom",{"$nulls":7},"An Analysis of Extended Opening Hours in an Aberdeen GP Surgery","Introduction  Since a piece of Scottish Government legislation was passed in April 2008, GP practices have had the option to agree to a contract which obliges them to offer extended opening hours to their patients. In accordance with the most recent contract, NHS Grampian offers to pay a GP practice Â£3.01 per registered patient per year in exchange for the practice creating an extra 30 minutes of consultation time per 1000 patients per week1. This time can be used for traditional face-to-face appointments or telephone consultations. The Scottish Government claims that this contract successfully created opportunities for the employed population to consult General Practitioners out with common working hours. This stance is contentious â€“ in reality, no barriers exist to prevent the unemployed and retired using this additional consulting time. This project seeks to profile the patients using additional consulting time; record what patients present to the extended hours service with; assess the opinions of both staff and patients as to how valuable the service is.  Methods  Two questionnaires will be produced â€“ one for completion by patients presenting to the practice during extended hours and one for completion by staff. These questionnaires shall be anonymous and confidential but shall request a few basic demographic details (such as age, sex and employment status); shall be developed to gauge the perceived value of extended opening hours in each group in a prompt and efficient manner; shall aim to achieve this by assessing opinion across a few domains using a small variety of question styles; shall be developed such that responses from both groups are at least partially comparable. The questionnaires shall be self-completed by patients and staff to reduce potential bias conferred by the administrant.  The completion of questionnaires shall run in parallel with analysis (using data from the Practice computing system) of the documented outcomes of each patient â€“ for example, advice on self-medication. Questionnaire responses shall be collated and a data spreadsheet created using Microsoft Excel. An impression of the response group shall be generated from data and appropriate analyses performed. The presentations of patients using telephone consultations shall be assessed and consequences (for example, the offer of a further appointment) analysed. From this information, each consequence shall be considered as a proportion of the total number and an assessment of the practical value of telephone consultations shall be made. Ethical and public health department input is pending.  Outcomes  The project seeks to gather evidence to prove or disprove notions which are currently anecdotal and to evaluate the impact of legislation. In achieving this, this student wishes to expand on his interest in the field of General Practice.   Literature 1. NHS Circular: PCA(M)(2012)5; Health and Social Care Integration Directorate; Primary Care Division     ","approved",null,"2013-04-01T16:47:28"]
["u08gs11","Mr","Nick","Smith","brnc-uoa@nrta.mod.uk","Uniformed Services University of the Health Sciences","4301 Jones Bridge Road",20814,"Bethesda, Maryland","United States of America",null,null,"Mr Nick Smith, RN Medical & Dental Cadet Manager","Britannia Royal Naval College, College Way","TQ6 0HJ","Dartmouth, Devon","United Kingdom","A comparison of military medical education in the United Kingdom and United States","Introduction  Military medical education in the United Kingdom is largely undistinguishable from that of colleagues destined for NHS or other civilian practice, with only occasional and minimal military contact in the pre-registration years of education and training. In contrast the vast majority of military bound medics in the United States of America attend the Uniformed Services University of the Health Sciences, the countryâ€™s only federal university, where militarisation forms a significant and constant part of the curriculum from day one. This project aims to make a descriptive comparison of the student experience in both countries, from the recruitment of potential armed forces doctors, their medical education and military training, assessment and examination, through to final preparation for initial deployment as military medical officers.   Methods  Published resources and past research will inform objective comparison of the UK and US military medical education systems. Recruitment policies, including funding packages, entry criteria, and selection methods will be contrasted, and the resulting demographic considered. Curriculum structure, including importantly the integration of military engagement and training to the medical curriculum will be compared, with total militarisation time before graduation contrasted. The varying approaches to assessment, with focus on examination of military medicine specific knowledge, skills and attitudes will also be considered.  Key insight into the US experience will be gained from eight weeks at USUHS, embedded with equivalent final year students, including a four week emergency medicine rotation at Walter Reed National Military Medical Center, Military Contingency Medicine, a two week didactic training course, and Operation Bushmaster a field based casualty management exercise undertaken in simulated combat conditions. This insight, contrasted against the UK perspective gained from my own experience as a Royal Navy Medical Officer Cadet, will inform a subjective comparison of the student experience in both systems.   Outcomes  A comparison, both descriptive and observational, of the process of military medical education in two distinct systems, with focus on the differing student experiences that result. Further, taken together it is hoped both objective and subjective elements will inform discussion and recommendation for the future direction of military medical education in the UK.  Literature  40 years of military medical education: an overview of the Long-Term Career Outcome Study (LTCOS). Durning SJ, Artino AR Jr, Dong T, Cruess DF, Gilliland WR, DeZee KJ, Saguil A, Waechter DM, McManigle JE. Mil Med. 2012 Sep;177(9 Suppl):3-6.  ","approved",null,"2013-03-27T08:40:49"]
["u01et12","Mr","John","Thomson","john.thomson@nhs.net","Emergency Dept, ","Aberdeen Royal Infirmary","AB25 2ZN","Aberdeen","Scotland","01224 553525","01224 550718",{"$nulls":5},"Attitudes towards violence and aggression incident reporting","Introduction  Violence and aggression against healthcare professionals in the Emergency Department is a significant and longstanding issue encountered on both a local and a global scale. With some studies demonstrating that 30% of reported violent incidences against healthcare professionals occur in the Emergency Department [1], it is a problem worth addressing especially with trends demonstrating an increasing number of total reported assaults on NHS staff â€“ 3.3% increase from 57,830 in 2010/11 to 59,744 in 2011/12 [2]. While some studies suggest that nurses are the commonest recipients of abuse [1,3], I would like to identify the group(s) of healthcare professionals that are most likely to experience abuse in the Emergency Department of Aberdeen Royal Infirmary. I would also like to explore the incident trends, focusing mainly on the aspect of frequency. I will not be analysing patient factors and will specifically focus on staff-related factors.  Methods  â€¢   Retrospective review of reported incidents of violence, via the DATIX system, occurring in the Emergency Department over a 1-year period    o   Estimated number of reported cases is approximately 80 â€“ 120 (The Queenâ€™s Medical Centre serving the city of Nottingham reported a total of 218 incidents in 2002/2003 [4])   â€¢   The data that will be quantitatively analysed from incident reports include:    o   Incidence of violence:      â€¢ Involving the patient or accompanying adult      â€¢ Verbal violence includes, but is not limited to, the use of foul language, personal insults and verbal threats      â€¢ Physical violence includes, but is not limited to, attempted or intentional application of force resulting in injury or discomfort    o   Position of the healthcare professional involved   (e.g. nurse or doctor)    o   Seniority of the healthcare professional involved  (e.g. junior or middle grade or senior grade)    o   Gender of the healthcare professional involved    o   Frequency of violence possibly demonstrating trends pertaining to:      â€¢ Time of the day      â€¢ Day of the week      â€¢ Month of the year  â€¢   A report will be produced from the findings  Resources required: â€¢   DATIX incident reports spanning a 1-year period â€¢   Access to IT facilities â€¢   SPSS Statistics software   Outcomes  â€¢   To identify the staff most at risk of encountering violence and aggression in the Emergency Department â€¢   To gain knowledge and experience in planning and conducting a research independently â€¢   To gain some clinical exposure in the Emergency Department  Literature [1] Winstanley S, Whittington R. Aggression towards health care staff in a UK general hospital: variation among professions and departments. J Clin Nurs 2004; 13:3-10. [2] NHS Business Services Authority. NHS Protect Publications. Available from:        http://www.nhsbsa.nhs.uk/3645.aspx [3] Jenkins MG, Rocke LG, McNicholl BP, et al. Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland. J Accid Emerg Med 1998; 15:262-5. [4] James A, Madeley R, Dove A. Violence and aggression in the emergency department. Emerg Med J 2006; 23:431-434.  ","approved",null,"2013-04-01T23:57:55"]
["u10ct9","Mr","Jan ","Jansen","n/a","Groote Schuur Hospital, Main road, Observatory",null,7935,"Cape Town","South Africa",{"$nulls":7},"An audit of management of severe sepsis in Groote Schuur Hospital Cape Town ","Sepsis is a common feature in Intensive Care Units around the world annually there is 1.8 million documented cases(1).  It is thought that early intervention increases the likelihood of a positive outcome. This project aims to assess whether the international guidelines for severe sepsis management(2) are followed and how this affects the outcome of the patient.  Groote Schuur hospital has a large Intensive Care Unit. I will gather data on patients referred to the unit and assess several parameters of whether the guidelines were followed.  Namely, if the following was completed after three hours of admission: â€¢ Measure lactate level â€¢ Obtain blood cultures before administration of antibiotics  â€¢ Administer road spectrum antibiotics â€¢ Administer 30 ml/kg crystalloid for hypotension or increased lactate  And the following completed after six hours: â€¢ Apply vasopressers to maintain a men arterial pressure over 65 mmHg â€¢ In the event of persistent hypotension despite adequate resuscitation; or an initial lactate greater than 4 to measure Central Venous Pressure and Central Venous Oxygen Saturation â€¢ Remeasure lactate if initial lactate was raised  I am going to use patient notes to ascertain if and when these measures were carried out. I then hope to follow up the patients and find out the outcome (namely survival) and how this correlates to adherence to the international guidelines.  What I hope to gain from this project is to experience first hand how to manage an acutely ill septic patient, and to gain insight into how and why each step of the management plan is done.  I also hope to prove that early intervention does indeed help the outcome of these patients.     1. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of sepsis in the US: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-1310. 2. Dellinger PR, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012  ","approved","Need to make it clear in the abstract that the patient group to be studied are those admitted to ITU with a diagnosis dr sepsis","2013-02-15T11:26:43"]
["u01ajt8","Mr","Paul ","Joice ","paul.joice@midcentraldhb.govt.nz","ENT department, Palmerston North Hospital, Midcentral DHB,",null,"4414 New Zealand","Palmerston North","New Zealand","00 64 0223528646",{"$nulls":6},"First cycle retrospective audit of the screening criteria for the detection of Vestibular Schwannoma's.  The practice in Palmerston North Hospital, New Zealand","Introduction   Vestibular schwanomma (VS) is a primary intracranial tumour arising from the myelin-forming cells of the vestibulocochlear nerve. They are typically benign and slow growing, but can cause symptoms through mass effect and pressure on local structures. The most common symptom of VS is asymmetrical sensorineural hearing loss (ASNHL) which is measured and defined by audiometric assessment. Once noted to have ASNHL patients are often readily sent for an MRI scan to screen for VS, however this is time consuming, expensive and not always necessary.   No universal definition of ASNHL is in place and different criteriaâ€™s are used by individual clinicians. As a result, diagnosing ASNHL and requesting further investigation by MRI becomes very inconsistent. A recent paper by Saliba et al. â€˜Rule 3,000â€™ has published a universal referral criteria which claims to aid patient selection for further investigation creating uniformity between clinicians for the detection of VS. The aim of this elective would be evaluate the sensitivity and specificity of screening criteria in the detection of VS whilst looking for possible weaknesses in the system that could be tightened up in future.1  Methods   Data will be collected by requesting a list of all MRI scans which have been arranged for the screening of potential vestibular schwannommas within the previous year. This will be available from the radiology department held on the PN PACS system. It will be noted whether each scan is positive or negative for VS followed by analysis of the corresponding audiometric assessment carried out before imaging. This will involve requesting patientâ€™s handwritten notes, looking through and entering whether or not the criteria have been met. Information will be organised using Excel and stored on a password-protected external hard drive. Data will be analysed quantitatively.  It is estimated that the project will contain approximately 200 cases. It is unlikely that ethical approval will be required for the completion of this project; however this is currently being looked into.  Outcomes   The project aims to:  1. clarify the sensitivity and specificity  of criteria being adhered to by clinicians when arranging MRI  scans for the screening of VS in symptomatic patients.  2.test the hypothesis claimed by Saliba et al. that by applying the â€˜Rule 3,000â€™ it may reduce the number of requested screening MRI scans, thus saving clinical time and money, without being detrimental to patient care and the pick-up rate of VS.1  Additionally the current system of referral will be studied in detail in an attempt to find potential weak points in the system and to clarify if the new simpler screening criteria laid out by Saliba et al. is effective in this cohort.1    Literature  1. Saliba, I., Bergeron, M., Martineau, G., Chagnon, M. 2010, â€œRule 3,000: a more reliable precursor to perceive vestibular schwannoma on MRI in screened asymmetric sensorineural hearing loss,â€\u009d Springer-Verlag ","approved",null,"2013-03-01T15:25:37"]
["u02ejt9","Dr","Abdulrashid","Siddique","asiddique@nhs.net","Denburn Medical Practice","Denburn Health Centre","AB25 1QB","Rosemount Viaduct","Aberdeen, UK",1224643333,12245553290,{"$nulls":5},"Patient satisfaction after the introduction of Doctor First telephone triage appointment system.","With the increasing demand on primary care for same day appointments, GP Practices are finding their appointment systems under inordinate pressure. Denburn Medical Practice has recently implemented a new telephone appointment system (Doctor First) produced by Productive Primary Care Ltd., a private company working with the NHS to help GP practices identify areas for improvement in their appointment systems. The companyâ€™s own research shows that Doctor First has had very positive feedback from practices currently using the system, including reductions in patient appointments, DNA rates and A&E attendance. This project aims to use questionnaire based semi-structured interviews to assess patient satisfaction with Doctor First in Denburn Medical practice.   Starting the week prior to my elective, the practice will identify a random selection of patients in contact with the practice (telephone/walk in) who are not arranged to be seen for an appointment. Verbal consent will be obtained for a medical student to contact them about participation in a research project (Group 1). During my elective, I will advertise my research project in the surgery and will approach a random selection of patients immediately after their consultation and seek consent for participation in a research project (Group 2).  Patients in Group 1 will be phoned to arrange an interview at the surgery. Those attending the surgery (Group 2) will be chosen at random and will be offered an interview immediately following the consultation or at an agreed time. Written consent will be obtained at the time of interview. The questionnaire used will be anonymous however will include responder details such as age, gender, occupation and nationality for analysis purposes. Audio recordings will be taken at each interview using an appropriate device and these will be given a unique identification number. Non-responders from both groups will be followed up by a postal questionnaire.  Questionnaire responses will be collated and entered into a database. Whole group and sub-group analysis will be carried out assessing patient satisfaction with the new appointment system and a comparison to the previous appointment system will be made. This analysis will include how many patients can receive telephone calls during surgery hours, how convenient the telephone consultation is, whether or not patients received continuity of care and patient satisfaction with the outcome of the telephone consultation. The results will be compared with those in published studies, conclusions drawn and recommendations made. No patient identifiable information will be used however ethical approval from the Local Research Ethics Committee has been applied for.  Literature 1. Bunn, F., Byrne, G. & Kendall, S. The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review. British Journal of General Practice, 2005; 55: 956â€“961. 2. Sampson, F., Pickin, M., Oâ€™Cathain, A., et al. Impact of same-day appointments on patient satisfaction with general practice appointment systems. British Journal of General Practice, 2008; 58: 641â€“643. ","approved",null,"2013-03-13T20:11:13"]
["u08st9","Dr","Michael","O'Connor","michael.oconnor1@hse.ie","cork university hospital",null,null,"cork","ireland",{"$nulls":7},"Audit of Proton Pump inhibitors in Geriatric medicine in Cork University teaching Hospitals","Introduction  The aim of this research project is to examine potential links between osteoarthritis, osteoporosis and vascular disease.   Osteoporosis and Osteoarthritis are the cause of significant morbidity and reduced quality of life. Trauma to an osteoporotic bone is the leading underlying cause of fractures to the femur. Osteoarthritis is the leading pathological cause for elective hip replacement surgery in the NHS (NICE, 2011).   Anecdotal evidence from Aberdeen suggests an excess of hypertension in patients undergoing hip replacement for osteoarthritis versus patients undergoing hemiarthroplasty for osteoporotic fractures.   In addition there appears to be a difference in the incidence of calcification of the femoral and Iliac vessels. A Simple Vascular Calcification Risk Score (SVCRS) from plain x-rays of the pelvis can be used as a predictor of cardiovascular risk. This method has previously been used to predict cardiovascular risk in haemodialysis patients (Adragao et al. 2004).  Methods:  Plain pelvic x-ray is a commonly used investigation in Cork University Hospital. I will aim to audit 100 plain pelvic x rays from an existing database from the orthopaedic department.   Two groups of 50 X- rays .  Group A : Subcapital neck of femur fracture (Plain Pelvic film).   Group B : Osteoarthritic hips (Plain Pelvic film).  I will determine the vascular risk score by looking for arterial calcification, in accordance with the above mentioned protocol outlined by (Adragao et al. 2004).  The additional information I will obtain  from patient medical records from groups A and B  will include: 1. Ischaemic heart disease  yes/no and grade   2. Hypertension (yes/no) 3.On anti-hypertensive treatment (yes/no).  I will apply for ethical approval from the Cork University Hospital.  Demographic data will be compared between the 2 groups.   Students t-test will be used to compare calcification, ischaemic heart disease and hypertension between the two groups.  Outcomes: I hope to further my understanding of the pathological processes involved in osteoarthrithis and osteoporosis of the hip joint.  References: 1. Adragao T, Pires A, Lucas C, et al. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients. Nephrol Dial Transplant 2004;19:1480-1488 2. National Institute for Clinical Excellence. The Management of Hip Fractures in adults 2011 CG124    ","awaiting approval",null,"2013-03-19T14:30:29"]
["u03pt9","Dr","Stephen ","Macleod","smacleod@lumc.edu","loyola University Chicago Stritch School of Medicine","2160 South First Avenue, Maywood","IL 60153","Chicago, IL","USA","(001312) 584-7888. ",{"$nulls":6},"Surgical management for temporomandibular joint dysfunction: a direct comparison of the characteristics of patients treated in the UK and USA","Introduction  Temporomandibular Joint disorders (TMD) affect the Temporomandibular joint (TMJ) and its related musculoskeletal components.TMJ dysfunction is the commonest condition which affects the TMJ and has a higher incidence in the developed world. TMJ dysfunction can progress to internal derangement of the joint and surgical intervention may be required. The management of TMJ dysfunction can vary in the USA and UK, particularly in primary care. This difference in initial treatment has cultural and economic aspects which reveal differences between US and UK populations. A direct comparison of patients who received TMJ treatment in Chicago and Aberdeen would illustrate any differences exist between the two populations. Methods  I will undertake my elective at Loyola Stritch medical school in Chicago where I will have access to the university facilities and to patient notes whilst attached to clinics. I will look at 50 cases of patients who received TMJ treatment and compare their age, gender, symptoms and clinical signs, who referred them, and procedure cost to those at ARI. I will collect the ARI data before my elective.  Any differences found between the two populations will be analysed using qualitative methods and evaluated. My findings will be presented as a series of tables. These will compare percentages and numerical data for patients in Aberdeen and Chicago. My project will be carried out over a 6-week period with the final 2 weeks for write up. I will attend outpatient clinics, observe in theatre, and attend teaching and lectures whilst at Loyola- Stritch  Outcomes  I personally hope to gain insight into another healthcare system and to see what medical practice is like in a big city. I have a keen interest in the specialty of Oral and Maxillofacial surgery and this elective will help to broaden my understanding of the profession. Vast amounts of research are currently being carried out at Loyola Stritch in Temporomandibular joint reconstruction, and my elective project will give them an insight into UK practice and management of similar problems. This project could identify differences between the two centers and allow conclusions to be drawn as to why these differences exist.  These conclusions could hence change current practice and management.  Literature Dimitroulis G; Temporomandibular disorders: a clinical update. BMJ. 1998 Jul 18;317(7152):190-4 Andrew J. Sidebotoom; Guidelines for the replacement of temporomandibular joints in the United Kingdom. BJOMS. 2008 46; 146-7 ASTMJS. Guidelines for Diagnosis and Management of Disorders Involving the Temporomandibular Joint and Related Musculoskeletal structureshttp://www.astmjs.org/guidelines.html  ","approved",null,"2013-02-15T12:26:13"]
["u01ajt9","Dr","Karen","Cranfield","Karen.Cranfield@nhs.net","Anaesthetic Department","ARI",null,"Aberdeen","UK",{"$nulls":7},"Assessing patient satisfaction with acute pain management after elective total hip replacement","For my elective project, I wish to undertake a study assessing patient satisfaction with acute pain management following surgery.   I hope to undertake this study in Toronto, Canada.   I am interested in this topic because patient satisfaction is essential in assessing quality of healthcare and in determining how to improve healthcare1.   Regarding acute pain management, pre-operative information about pain management can lead to increased patient satisfaction2.   Involving the patient in their pain management plan is important because it helps them to understand the plan better and the steps that may need to be taken post-operatively.   This should lead to improved patient care3.       To assess patient satisfaction with acute pain management, I am going to ask patients to fill in a questionnaire after their operation.   This should be an easy way of collecting information from lots of people and measuring their level of satisfaction with their pain management4.   The questionnaire will provide the patient the opportunity to assess their pain management, including pre-operative care, post-operative care and any side effects from pain medication.   I have designed the questionnaire myself.   It shouldnâ€™t take longer than 10 minutes to complete, so I would expect to gather at least 150 cases during my elective project.   To increase the number of cases available for my study I will not limit entrance to the study to patients having a particular surgery; any patient who has had an anaesthetic and is an in-patient post-operatively will be eligible.   I would expect to give the questionnaire to the patients personally, and to collect it from them as well a short time later.   I will log the results on a spreadsheet.   I would expect to present my overall result regarding patient satisfaction with pain management as a pie chart.     During my elective I hope to gain a greater understanding of prescribing of pain medication and to gain insight into how satisfied patients really are with their post-operative pain management.   I also look forward to hopefully experiencing a new hospital environment in Canada.     References   1. Niemi-Murola L et al. Patient Satisfaction with Postoperative Pain Management - Effect of Preoperative Factors. Pain Management Nursing 2007;8(3):122-129.  2. Sjoling M et al. The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Patient Education and Counseling 2003;51(2):169-176   3. Essence of Care 2010. Benchmarks for the Prevention and Management of Pain. DH, London 2010 (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_119977.pdf)   4. Patient Perspectives. Quality and Service Improvement Tools. NHS Institute for Innovation and Improvement (http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/patient_perspectives.html)  ","approved",null,"2013-04-12T15:27:33"]
["u01mtv8","Dr","Gabriella","Gobbi","gabriella.gobbi@mcgill.ca","Dept. Psychiatry Ludmer Research and Training Building","1033 Av des Pins Ouest ","H3A1A1","Montreal, Quebec","Canada",{"$nulls":7},"Investigating the antidepressant effect of the novel Melatonin-1 Receptor agonist UCM871 in a rat model","Introduction  Major depression is an important global health problem with a worldwide estimated prevalence of 4-10%. In the UK, the prevalence of mixed depression and anxiety is a staggering 11.4%. However, treatment of depression is only clinically effective in one third of patients with up to 30% experiencing significant side effects. It is therefore important that research is aimed towards the discovery and validation of new drug treatments. The melatonergic system has shown to be a candidate target for drug treatment in depression (Wu et al. 2013). In mammals, melatonin act through two G-coupled receptors MT1 and MT2. However the role of these receptors in mood disorders has not yet been elucidated. Previous work has shown that the MT2 receptor is mostly involved in the regulation of anxiety and NREM sleep, on the other hand, preliminary experiments suggest that the MT1 receptor may be involved in the pathogenesis of major depression (Weil et al. 2006; Wu et al. 2013)   The aim of this project is thus to examine the antidepressant potential of pharmacological activation of MT1 receptors. For the first time, a novel selective MT1 ligand, called â€œUCM871â€\u009d will be tested in animal models of depression and it will be used to demonstrate its antidepressant potential. Moreover, using in vivo electrophysiology we will analyse how the UCM871 modulate the firing activity of monoamines (serotonin, noradrenaline, dopamine), which are implicated in the pathogenesis of depression and in the mechanism of action of antidepressant drugs.   Methods  This project will use classical behavioural paradigms (e.g. forced swim test) and chronic unpredictable stress schedules to evaluate the antidepressant properties of MT1 agonist UCM871 in rats.  Since the final pathway of antidepressant drugs is to modulate the firing activity of monoamines we will also examine the electrical activity of monoaminergic neurons after administration of selective MT1 receptor agonist using in vivo electrophysiology. Specifically, serotonergic neurons of dorsal raphe nuclei, noradrenergic neurons of locus coeruleus and dopaminergic neurons of the ventral tegmental area.    Outcomes  This project will evaluate the selective activation of the MT1 receptor as a novel target for antidepressant drug treatment and drug discovery. Moreover, the effect of this drug on monoaminergic neuron pathways will be investigated to examine how specific brain areas are affected.   Personally, the research will give me an extremely valuable opportunity to work alongside and learn from one of the top teams in translational neurobiology/psychiatry at one of the best research-intensive universities in the world and conduct exciting and relevant research in a mental health and drug discovery context.  Ethical approval will be obtained and the research will comply with the guidelines mandated by the Canadian Institutes of Health Research and the Canadian Council on Animal Care.   Literature  Wu YH, Ursinus J, Zhou JN, Scheer FA, Ai-Min B, Jockers R, van Heerikhuize J, Swaab DF., 2013. Alterations of melatonin receptors MT1 and MT2 in the hypothalamic suprachiasmatic nucleus during depression. Journal of Affective Disorders, http://dx.doi.org/10.1016/j.jad.2012.12.025  Weil ZM, Hotchkiss AK, Gatien ML, Pieke-Dahl S, Nelson RJ., 2006. Melatonin receptor (MT1) knockout mice display depression-like behaviors and deficits in sensorimotor gating, Brain Research Bulletin, Volume 68, Issue 6, 15 February 2006, Pages 425-429  ","approved",null,"2013-02-14T22:57:59"]
["u01slv9","Dr","David","Macleod","dmacleod@abdn.ac.uk","Torry Medical Practice, Torry Neighbourhood Centre","Oscar Road, Torry","AB11 8ER","Aberdeen","UK","01224 894600","01224 230220",{"$nulls":5},"How successful is cardiovascular risk screening in a deep end practice?","Introduction  Cardiovascular Mortality Rates for Scotland are greater than those of all but one country in western Europe1. The problem is a major concern for healthcare providers as government funding of services is limited.   It has been demonstrated that the poorest in society often have the worst access to healthcare2. In terms of cardiovascular disease, it has also been shown that deprivation is inversely proportional to rates of cardiovascular events3. This has resulted in the establishment of various governmental and public health schemes to address these serious issues and potentially reduce the incidence of disease.  Methods  The aim of this project is to identify the percentage of patients at risk of IHD within a Grampian Deep End practice and assess the recording of preventative advice and actions for IHD. The method chosen for this practice is an audit of the use of ASSIGN using anonymised practice records.  Male and female patients between the ages of thirty and fifty will be identified using the practiceâ€™s computer system. Patients with existing IHD will be excluded and one hundred patients will be selected randomly from the remaining population. This study population will be randomised and each given a number. GP interviews will provide explanation of the current practice protocols for ASSIGN. Computer records will be individually checked for - Recorded family history of IHD, either positive or negative - The number of patients with an ASSIGN score - Prevalence of any IHD risk factors, other than those included in the ASSIGN calculation, in patients   with an ASSIGN score recording. These include BMI, alcohol intake, and levels of physical activity.  - Patient follow up in patients with an ASSIGN score of twenty To evaluate if these patients have been managed consistently according to practice protocols.  For those patients without a family history recorded and without an ASSIGN score, GP interviews may provide an explanation as to why these have not been done.  Since Deep End practices can be assumed to have a lower socioeconomic practice population, it could be suggested that life expectancy will be lower, morbidity higher and illness will occur at a younger age. Therefore, the aim of this project is to compare the prevalence of IHD and the preventative measures with, national data in addition to another Deep End Practice. Partnership with a Glasgow Deep End practice is in the process of being organised: a meeting with Prof Graham Watt, coordinator of the Deep End scheme, is currently being arranged.     Outcomes  By studying the challenges to disease prevention and health promotion in deprived communities, consideration of current medical school teaching will be made. The project will address whether current public health teaching in relation to health inequalities is adequate or in need of improvement.  Literature 1.Abayaratne D, Aresu M, Gharib W, et al. The Scottish Health Survey: Topic Report: Older People's Health. 2011. http://www.scotland.gov.uk/Publications/2011/11/24083430/30 2.Taylor R, Smith B, van Teijlingen E. Social Influences on Health. Health and Illness in the Community. Oxford University Press. Oxford. 2003. p61-67 3.Mitchell R, Fowkes G, Blane D, Bartley M. High rates of ischaemic heart disease in Scotland are not explained by conventional risk factors. J Epidemiol Community Health 2005;59:565â€“567 4.Watt G . Connecting with General Practice to Improve Public Health: Findings of the Primary Care Observatory and Deep End Projects. Report. 2011. www.gcph.co.uk/publications/277_gps_at_the_deep_end ","approved","We discussed this proposal and clarified the methodology planned. Headings might be helpful. ","2013-04-01T22:42:05"]
["u08kw9","Dr","Jane ","Morris","janemorris1@nhs.net","The Eden Unit, Block C Clerkseat Building, Royal Cornhill Hospital","Cornhill Road","AB25 2ZH","Aberdeen","Scotland","01224 557758",{"$nulls":6},"An Investigation into the Facilities and Support provided by Universities and Colleges across Scotland to Students with Eating Disorders","Introduction  The transition into university can be isolating, with many students experiencing life away from home for the first time while adjusting to increasingly competitive courses. Campuses are increasingly recognised as a hotspot for the development of eating disorders; with the highest risk age group, increased incidence in those with perfectionist characteristics and often higher socioeconomic backgrounds.   Aims The Royal College of Psychiatrists estimates that few students with eating disorders receive the help they require. This project aims to investigate individual universities across Scotland and evaluate the services and support they provide for students who both already suffer from an eating disorder on entry to their course and also students who develop a disorder further into their studies.  Methods  Information will be gathered via interviews with the Occupational Health Service in connection with the universities, initially Aberdeen and Robert Gordon University. This to determine what support is given and if any facilities exist for students with eating disorders, including student counselling services.  I will conduct a further interview with relevant specialist Eating Disorder units to determine the number of students referred to them and their experiences to identify areas of strengths and weaknesses.   Finally, I hope to distribute a simple questionnaire to patients who are current or recently graduated students to determine how they accessed these services and if the university helped and supported them. This process will be anonymised and envelopes pre-addressed to return to the Eden Unit.  Limitations to overcome include time constraints - I will have to plan carefully in advance and send letters to universities outlining my proposal before beginning my project. Another is obtaining results from the questionnaire, which will have to be minimally time-consuming and easy to complete to have the best chance of a higher number completing it as recruitment numbers will likely be small with up to 20 patients.  Outcomes  I aim to look at the differences between facilities provided by different universities, which strive to best accommodate those who suffer from eating disorders and look after the well being of their students.  Through all of this I aim to collate the data from each university and form a recommendation which will advise on the level support and facilities universities should provide for students with eating disorders.   Literature Royal College of Psychiatrists Recommendations on Eating Disorders \"Mental Health ofStudents in Higher Education\" www.rcpsych.co.uk/expertadvice/problems/eatingdisorders.Aspx (accessed 21 Jan 2013) NICE Guidelines Eating Disorders, www.nice.org.uk/cg009niceguideline (accessed 21 Jan 2013)  Parker SC et al. \"Eating disorders in Graduate Students: Exploring the SCOFF questionnaire as a simple screening tool\". J Am Coll Health 2005 Sept; 54(2): 103-7 Cotton MA et al. \"Four Simple Questions can help screen for Eating Disorders\". J Gen Intern Med, 2003 Jan; 18(1): 53-6 ","approved",null,"2013-04-01T08:42:52"]
["u01erw8","Prof","Andrew","Day","andrew.day@otago.ac.nz","Department of Paediatric Gastroenterology","Christchurch School of Medicine & Health Sciences, University of Otago","PO Box 4345","2 Riccarton Avenue, CHRISTCHURCH","New Zealand","64-3-364-0747","64-3-378-6355",{"$nulls":5},"Could the Presence of Granulomata Predict Disease Phenotype in a Paediatric Crohn's Disease Population?","Introduction  Approximately 25% of new presentations of Crohnâ€™s Disease (CD) are within the paediatric population (1). Due to its ability to affect any part of the gastrointestinal tract, CD is a heterogeneous disease with multiple clinical phenotypes.   Whilst it is accepted that patients with different phenotypes follow different clinical courses and share different prognoses, there is a need for the development of a robust scoring system to allow early prediction of these at the point of diagnosis. With proper development and validation this system could eventually lead to more targeted treatment for CD patients.  Granulomata are documented as being present in 15-36% of enteric biopsies of children with CD (2). It is currently unknown whether the presence of granulomata has any correlation with subsequent disease phenotype and individual prognosis. This study will retrospectively analyse data in both Aberdeen and Christchurch to examine whether any such correlation can be shown.   Methods  Databases on CD patients in the paediatric gastroenterology units in The University of Aberdeen and The University of Otago will be accessed and data extracted and analysed for patients presenting to each centre over a five year period.   Relevant anonymised data will be recorded for each patient in Microsoft Excel spreadsheets. Data will include:  â€¢ Initial clinical presentation â€¢ Date & method of diagnosis (e.g. colonoscopy) â€¢ Site(s) of active disease â€¢ Presence/absence of granulomata on biopsy microscopy â€¢ Disease phenotype (according to Paris Criteria (3)) â€¢ Frequency of clinical relapses â€¢ Frequency of extraintestinal manifestations â€¢ Growth pattern â€¢ Need for immunosuppressive therapy â€¢ Need for surgical intervention â€¢ Number of admissions to hospital   All data will be securely saved on encrypted hard-drives and as this undertaking can be classed as clinical audit, utilising existing clinical datasets, no ethical approval is required.   Quantitative statistical analysis will be completed using SPSS in order to demonstrate any correlation between the presence of granulomata in enteric biopsies and five main outcomes: disease phenotype, growth pattern, frequency of relapses, need for immunosuppressive therapy, and need for surgical intervention.   Outcome  This work will act as a pilot study for collaborative work between the two academic centres listed. The initial cohort studied should be sufficient to demonstrate any statistically significant relationship between the presence of granulomata in paediatric patients and their clinical phenotype and prognosis. The fact that the work will include patients from two different population cohorts will strengthen the significance of any positive findings. In time this work could provide the foundations for greater understanding in how best to stratify and treat paediatric CD patients.  On a personal level this elective will provide me with further research experience in paediatric gastroenterology â€“ a field which I am very enthusiastic about pursuing as a career.     447 Words   References  1. Griffiths AM: Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin         Gastroenterol 2004; 18: 509â€“523.  2. MolnÃ¡r T et al: Clinical Significance of Granuloma in Crohnâ€™s Disease. World J Gastroenterol 2005 May 28;11(20):3118-21.  3. Bie, CI de. Pediatric Inflammatory Bowel Disease: from diagnosis to transition. Diss. Erasmus University Rotterdam, 2012.   ","approved",null,"2013-02-14T19:31:20"]
["u07pw8","Dr","Clare","Shakespeare ","clare.shakespeare@gmail.com","Mulanje Mission Hospital",null,"PO Box 45","MULANJE","Malawi","+265 992261569",{"$nulls":6},"The uptake of antenatal care services at Mulanje Mission Hospital","Introduction  In Malawi, as with many developing countries, the maternal morality ratio sits significantly above the global average at 460/100,000 live births [1].  Antenatal care is a key strategy to improve maternal and infant health; however uptake of such services remains low in developing countries [2]. One factor, of many, which has been highlighted as affecting uptake, is the distance or travel time to reach healthcare [3]. In 2011 the Malawian government set out a number of healthcare goals in a health sector strategic plan, of relevance they aim to: ensure that the majority of Malawians live within 8km of a health facility; increase the percentage of woman attending antenatal care visits both in the first trimester and throughout pregnancy [4].  This elective aims to examine the impact of distance and travel time on uptake of antenatal care services at the Mulanje Mission Hospital, a rural hospital in Malawi.   Methods  The project will take the form of an audit comparing the aims of the Malawi government health sector strategic plan regarding distance to healthcare and antenatal care visits to the experiences of woman in Mulanje. Woman who are either currently pregnant or whom have had a pregnancy within 24 months will be interviewed using a hired local translator. The interview will cover: the number of antenatal care visits attended; antenatal care visits attended in the first trimester; the distance (in kilometres) to healthcare or time taken reach healthcare; transport method used to reach healthcare; birthing plans â€“ will there/ was there a skilled health personnel in attendance; any other reasons for not attending antenatal care. For each question covered answers will be categorised appropriately. The project aims to interview between 20 and 30 women at community clinics run by the public health care team for pregnant woman and children under 5. Data will be anonymously stored on a laptop using excel. The data will then be analysed quantitively, where possible, using percentages and other basic statistics. The project will be conducted ethically but no official ethical approval is required. Findings will be presented in comparison to Malawi government targets and highlight any other interesting findings.    Outcomes  The hope is that the project will help identify any barriers in Mulanje to accessing antenatal healthcare services. This may help in service planning and improving access to antenatal services at the Mulanje Mission Hospital, Malawi; thus increasing the potential benefit from antenatal services. Personally, I hope to gain an appreciation of the situation and difficulties which woman in Mulanje may face in receiving the best possible healthcare during pregnancy; it will be an excellent opportunity to experience the culture and way of life of a place very different from the UK.    Literature 1.  World Health Organisation. Malawi: health profile. [Internet] Available at: http://www.who.int/gho/countries/mwi.pdf Last updated May 2012. Accessed 9th  February 2013.  2. Pell C, Menaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P, and Pool  R. Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi. PLoSOne [Internet] 2013, 8(1):e53747. doi: 10.1371/journal.pone.0053747. Available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546008/  3. Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 2008, 61:244-60.  4. Ministry of Health, Government of Malawi, Lilongwe. Malawi: Health sector strategic plan 2011-2016, Moving towards equity and quality. September 2011. Available from http://www.medcol.mw/commhealth/publications/3%20Malawi%20HSSP%20Final%20Document%20(3).pdf  Cited 9th February 2013. ","approved",null,"2013-02-11T20:30:59"]
["u08aw9","Dr","Joanne","Harrison","jo.harrison@rch.org.au","Royal Children's Hospital","50 Flemington Road, Parkville","VIC 3052","Melbourne","Australia",{"$nulls":7},"Clinical Utility of Multiple Breath Washout Technique in Patients with Cystic Fibrosis","Introduction   Lung disease is a prominent feature in cystic fibrosis patients, presenting early in life. Lung function testing is routine, mainly by spirometry and plethysmography, which aim to monitor the severity of lung disease. However, multiple breath wash out technique (MBW), is now also being put to use. MBW involves the tidal inhalation of gases, to measure their elimination, providing information on gas mixing efficiency, referred to as lung clearance index (LCI)(2). It has been shown that this is a valuable assessment tool, as it is more sensitive at showing early lung damage(1,2,3). Unlike other tests, peripheral lung areas, where damage first occurs, are accounted for (1). However, even though LCI is proven to be abnormal in CF patients, it has not yet been established what a clinically meaningful change is.   Methods   To gauge clinical significance of MBW, the aim of this project is to establish the utility of LCI for assessing short term clinical response to IV therapy during pulmonary exacerbation, in paediatric cystic fibrosis patients.  Royal Childrenâ€™s Hospital, Melbourne, along with regular spirometry, is currently using MBW to measure LCI on admission and discharge, in CF patients over 5 years old. The technique (done a minimum of 3 times) involves a seated patient tidally breathing 100% oxygen through a mouthpiece, using EcoMedics Exhalyzer D equipment. It is complete when the natural nitrogen of the lungs has been reduced to 1/40th of its starting concentration. I will be collecting patientsâ€™ clinical data from the patient registry, such as antibiotic history and CT findings, and analysing it with the LCI values, using paired t-tests to detect mean differences between admission and discharge results. My findings of approximately 150 gathered cases will be presented in a peer reviewed journal. Ethical approval will be obtained.    Outcomes   Assessment will show whether or not the response to therapy for pulmonary exacerbations can be accurately gauged by LCI. Establishing what constitutes a clinically significant change in LCI in children and adolescents with cystic fibrosis will aid all aspects of clinical management (assessment of response to interventions, measurement of disease severity and progression) and clinical research.    Literature  1. Robinson P.D et al. Inert gas washout: theoretical background and clinical utility in respiratory disease. Respiration. 2009;78:339-355. 2. Horsley A.R et.al. Lung clearance index is a sensitive, repeatable and practical measure of airways disease in adults with cystic fibrosis. Thorax online. 2008; 63:135-140.   3 Aurora P. et al. Multiple breath washout as a marker of lung disease in preschool children with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine. 2004;171(3):249-256.  ","approved",null,"2013-02-14T10:20:10"]
["u02sw12","Dr","Roger ","Ho","roger_ho@nuhs.edu.sg","Department of Psychological Medicine,","Level 9, NUHS Tower Block, 1E Kent Ridge Road, ","Singapore 119228 ","Singapore","Singapore",6567724511,6567772191,{"$nulls":5},"Global prevalence of elder abuse: A meta-analysis and meta-regression","Introduction  Alzheimerâ€™s Disease (AD) is one of the biggest problems in aging populations like the UK and Singapore. It is estimated that 1 in 3 people above the age of 65 in the UK will develop dementia and 62% of that would be of Alzheimerâ€™s type.  There is currently very limited treatment for AD and these come in the form of two main classes of drugs, Acetylcholineesterase inhibitors(donepezil, galantamine and rivastigmine) and a NMDA blocker (memantine). Despite having been licensed for many years, there is a paucity of papers/trials that directly compare the clinical efficacy of one drug over the other. I therefore intend to carry out a meta-analysis to directly compare the clinical effectiveness of donepezil to galantamine(the two most widely used Acetylcholineesterase inhibitors) in the treatment of Alzheimerâ€™s disease.   Methods  I intend to gather studies that compare donepezil with placebo and galantamine with placebo. Study inclusion criteria will be: 1. Publication after 1990 2. Outcome measured via Mini-Mental State Examination( MMSE )and/or ADAS-cog (AD assessment scale-cognition) 3. Patients with mild to moderate Alzheimerâ€™s disease 4. Statistically valid sample sizes The results of the studies will be analysed with a statistical computer software(Comprehensive Meta-Analysis). My host supervisor  in Singapore who is familiar with meta-analyses will also offer teaching in meta-analyses as well as guidance on this particular project. The findings will be presented with a forest plot, which statistically combines the  results of similar studies (ie MMSE and ADAS-cog) to give an overall figure which points to the more clinically efffective drug.  Outcomes  I hope that this project will be able to help shed some light on the clinical effectiveness of two of the most commonly used drugs in treatment of AD and therefore better the clinicianâ€™s choice of AD treatment. Personally, I hope to gain more knowledge on statistical analysis of trials from my host supervisor and learn how to identify gaps in clinical research that are yet to be filled. Also, I hope that the clinical exposure in Psychiatry will be able to help determine the feasibility of a future career in it.   Literature Bond M, et al. 2012. The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimerâ€™s disease (review of Technology Appraisal No. 111): a systematic review and economic model. Health Technology Assessment 2012; Vol. 16: No. 21 10.3310/hta16210 Zhang, Melvin W.B. et al. 2011 Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression. General Hospital Psychiatry 2011; GHP-06336  ","approved",null,"2013-02-07T20:37:44"]
["u02ay9","Mr","Hiren","Patel","Hiren.Patel@srft.nhs.uk","Neurosurgical Department","Salford Royal Infimary","M6 8HD","Salford ","England",{"$nulls":7},"What is the burden and impact of comorbidity in patients with Subarachnoid Haemorrhage?","Introduction:  Subarachnoid Haemorrhage (SAH) most frequently affects a younger population and is often fatal (1). Salford is one of the ten metropolitan boroughs creating Greater Manchester. The approximate population of Greater Manchester is 2.68million. The suggested incidence of SAH has remained static over the last three decades and is between 6-8 per 100,000 per year (2). Therefore in gross terms the expected incidence of SAH in Greater Manchester would be approximately 161-214 over a one-year period. I am curious to examine outcome of SAH patients, in particular to determine if there are elements of past medical history and drug history affecting outcome.      Methods: My elective will take place at the Neurosurgical Department of the Salford Royal Infirmary, in Salford, North West England. It is an NHS facility, with the usual compliment of NHS staff. It is part of the Manchester Collaborative Major Trauma Centre. The project will be reviewing medicine reconciliation forms and documented past medical history of patients admitted to the department with SAH over a one year period. The latter being information that is routinely gathered by staff during a patientâ€™s admission. The outcome measures will be clinical outcome at discharge. Ideally multivariate analysis of drug history will be undertaken aiming to determine any predictors of good outcome. I plan to undertake anonymised data collection and analysis. However I would plan to take advice on the best software for, and methods of, executing this.        Outcomes: Ideally I would like to have collected the relevant data and undertaken interpretation of it with the aim of answering the question posed. In addition I would have liked to gain an understanding of what the workload of a large inner-city neurosurgical department in England is. Finally I would like to gain experience helpful in allowing me to determine if Neurosurgery is the career path for me.       Literature: 1. Van Gijn J,  Kerr RS, Rinke JGE ; Subarachnoid Haemorrhage. 2007. Lancet 2007; 369: 306â€“18 2. Linn FHH, Rinkel GJE, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke 1996; 27: 625â€“29.  ","approved",null,"2013-02-08T13:57:45"]
["u02ey9","Prof","Martin","Cowie","m.cowie@ic.ac.uk","Royal Brompton Hospital, Sydney Street",null,"SW3 6NP","London","UK",{"$nulls":7},"A broken heart - an observational study describing the clinical features of Takotsubo Cardiomyopathy","Introduction:   The prevalence of chronic heart failure is increasing with a mortality rate at five years as high as 50%. Most attention had been focused on reduced left ventricular ejection fraction (LVEF,) or systolic heart failure, however there is increasing consensus that as much as 50% of patients with chronic heart failure suffer from heart failure with preserved ejection fraction (HfpEF), or diastolic heart failure. (1)  HfpEF is thought to occur as a result of either stiff cardiac muscle or ventricular hypertrophy. Most drug therapies are aimed at treating systolic heart failure, the treatment of HfpEF is therefore less effective and no proven treatment guidelines exists. (2)   Methods:   This will be a retro-perspective study looking at management of diastolic heart failure. The information will be gathered from a database, looking at patient information (with established HfpEF and reduced LVEF) with permission from Professor Cowie at Royal Brompton Hospital. The collected information will include: â€¢ The treatment the patient is on â€¢ Number of hospital admissions  â€¢ Length of hospital stay â€¢ Morbidity and Mortality  I will also review literature on mortality and morbidity associated with diastolic heart failure.  Outcome: No guidelines exist for management of HfpEF and any treatment available is that of used for systolic heart failure.  My aim in this project is too to look at the effectiveness of the available therapeutic management of HfpEF by comparing the mortality and morbidity associated with diastolic heart failure and comparing this data to systolic heart failure for which there is already established literature on. From a personal perspective this busy heart and lung specialist hospital will give me a great opportunity to see lot of patients and good clinical exposure to cardiology which I hope will further give me insight into cardiology as a career option.    Literature 1. TT. Phan, GNShivu, K. Abozguia, JE. Sanderson M. Frenneaux: The pathophysiology of heart failure with preserved ejection fraction: From molecular mechanisms to exercise haemodynamics; (2012). International Journal of Cardiology, 158; (2012) 337â€“343  2. S. Scott, J. Thompson: Drugs acting on the heart: heart failure and coronary insufficiency; (2012). Anaesthesia and Intensive Care Medicine; 13:8   ","approved",null,"2013-03-25T17:43:02"]

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