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What is the risk of traumatic intracranial bleeding in patients with mild head injury taking antiplatelet medications presenting to emergency departments?

Current guidance from the UK National Institute for Health and Care Excellence (NICE), published in 2023, provides limited support for decision making for clinicians investigating patients with head injuries taking antiplatelets. Patients with more severe injuries will meet standard imaging criteria and undergo a CT head scan to detect and delineate any traumatic brain injury (TBI). However, most head injuries are classified as ‘mild’ and for patients that do not meet standard imaging criteria the guidelines recommend ‘considering’ a CT scan, with no further advice provided to inform decisions. 

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Supervisors

Professor Gordon Fuller (g.fuller@sheffield.ac.uk)

Professor Steve Goodacre (steve.goodacre@sheffield.ac.uk)

Abstract 

Routinely imaging all patients with mild head injury would detect any cases with intracranial haemorrhage (ICH). This would inform a risk/benefit decision to withhold or stop antiplatelets, and aid decisions on whether a patient requires admission to hospital for observation or requires follow up. More rarely, immediate treatment to reverse the effects of antiplatelets, or neurosurgery could be indicated if a higher acuity TBI was found. 

Conversely, the risk of intracranial bleeding appears to be extremely low in these patients and unnecessary CT head scans will result in increased NHS costs, prolonged patient stays, increased emergency department crowding, delayed access for other more relevant CT scans, and, in younger patients, radiation exposure that could cause iatrogenic cancer. Research providing evidence about when CT head imaging can be safely avoided is required to inform clinician management decisions and avoid these consequences.

Methodology

• The following research would be conducted:
• Literature review of existing research in this area
• Survey of UK emergency departments to determine current management in this area]
• Collecting data on mild head injury patients taking antiplatelets in the Northern General emergency department.
• Calculating the risk of intracranial bleeding and looking for an predictive clinical features.

Type of project

Clinical or Surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

Students could access STATA or R training for the analysis.

Systematic review training modules could be helpful for the literature review.

Ethics requirements

Secondary data or tissue samples that was not originally collected for research: UREC or NHS REC approval required

What is the risk of major trauma in patients who have fallen down a full flight of stairs?

What are the most common injuries and outcomes for these patients? What are the clinical predictors of major trauma?

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Supervisors

Professor Gordon Fuller (g.fuller@sheffield.ac.uk)

Professor Steve Goodacre (steve.goodacre@sheffield.ac.uk)

Abstract and methodology

Research activities will include:

• Updated literature/systematic review
• Coding of emergency department clinical records
• Analysis looking at the risk of major trauma in patients who have fallen down a flight of stairs

Type of project

Clinical or Surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

Systematic review and Stata or R training

Ethics requirements

Secondary data or tissue samples that was not originally collected for research: UREC or NHS REC approval required

Emergency department attendances with hypertension: retrospective observational cohort study

What are the characteristics of patients attending the emergency department (ED) with hypertension and how are these patients managed?

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Supervisors

Professor Steve Goodacre (steve.goodacre@sheffield.ac.uk)

Professor Gordon Fuller (g.fuller@sheffield.ac.uk)

Abstract and methodology

Background

Emergency Department (ED) attendances with hypertension in England and Wales have doubled in recent years. We know little about why patients are attending the ED with hypertension in increasing numbers or how they should be managed.

Aims and objectives

To describe the characteristics of patients attending the ED with hypertension, the tests and treatments they receive, and their subsequent referral and follow-up arrangements.

Research methodology

This will be a single-centre, retrospective observational study. We will provide the student with a list of patients who attended the Northern General Hospital Emergency Department in 2024 with hypertension (probably around 400-500). The student will then access the hospital IT systems to collect data describing patient characteristics, tests and treatments received, and the planned referral and follow-up. They will develop an analysis plan, with statistical advice and support, before undertaking descriptive statistical analysis.

The project will produce new data to assist with development of guidelines for ED management of hypertension. We anticipate that it will lead to presentation at the Royal College of Emergency Medicine Annual Scientific Conference and publication in a peer-reviewed journal.

Type of project

Clinical or Surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

The student will develop skills in project management, quantitative data collection, statistical analysis, interpretation of quantitative data, presentation of findings, and writing for publication.

Ethics requirements

Service evaluation: NHS Service Evaluation number required.

University of Sheffield ethics approval will additionally be required.

Global Limb Anatomic Staging System (GLASS) for chronic limb-threatening ischaemia (CLTI) - interobserver study

What is the interobserver variability for the Global Limb Anatomic Staging System (GLASS) for chronic limb-threatening ischaemia (CLTI) across different clinician groups?

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Supervisors

Dr Stephen Goode (stephen.goode3@nhs.net)     

Miss Saima Ehsan (Saima.ehsan@nhs.net) 

Abstract and methodology

This is a mixed methods study building on data and project performed from a previous BSc student. It will use qualitative and quantitative analysis on retrospectively and prospectively collected clinical, vascular imaging, intervention and quality of life assessment data. 

The student will analyse the imaging, collate and analyse the associated clinical and intervention data and compare the findings and outcomes with the published recommended GLASS scoring system and collate data from interobserver MRA GLASS analysis. 

Type of project

Clinical or Surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

Training and teaching will be provided to read the relevant vascular imaging and clinical information and interpretation of findings. This will provide exposure to clinical and radiological vascular assessment, treatments, understanding research methods used in clinical research. "

Ethics requirements

Secondary data or tissue samples: UREC or NHS REC ethics approval already received for the intended research project

Thermography and hyperspectral Imaging in critical limb ischaemia (CLI) – observational feasibility study

To evaluate the feasibility, diagnostic consistency, and clinical potential of thermal and hyperspectral imaging for assessing tissue perfusion and viability in patients with Critical Limb Ischaemia (CLI).

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Supervisors

Dr Stephen Goode (stephen.goode3@nhs.net)     

Miss Saima Ehsan (Saima.ehsan@nhs.net) 

Background

Accurate assessment of tissue perfusion is crucial in CLI for guiding revascularisation and predicting wound healing and amputation risk. Traditional imaging modalities (angiography, duplex ultrasound) primarily assess macrovessel flow but provide limited insight into microvascular tissue perfusion. Emerging optical techniques such as infrared thermography and hyperspectral imaging (HSI) offer non-invasive, rapid, and quantitative assessment of skin temperature and oxygenation patterns. These technologies may complement existing vascular imaging and provide new biomarkers for tissue viability.

Project overview

This is a mixed methods observational study combining quantitative imaging analysis and qualitative clinical correlation. The student will participate in data collection from patients with CLI undergoing endovascular (1 student) or surgical revascularisation (1x student). Thermal and hyperspectral images will be obtained pre- and post-intervention and compared with standard clinical outcomes and imaging findings (angiography, ABPI, wound scores).

The project will assess:

• Feasibility of thermographic and hyperspectral imaging in the vascular setting.
• Correlation between imaging metrics and clinical outcome measures (tissue loss, healing, amputation-free survival).
• Interobserver reproducibility and technical limitations.

Type of project

Clinical or Surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

Students will receive training in vascular physiology, optical imaging principles, and image analysis. They will be involved in

• collecting thermographic and hyperspectral data in vascular angio or theatre settings
• analysing imaging datasets and correlating with clinical outcomes
• contributing to statistical and visual data interpretation
• observing vascular surgery and interventional radiology procedures to understand the clinical context of CLI management

This project provides exposure to cutting-edge imaging technologies in vascular medicine, hands-on research experience, and opportunities for presentation and publication within a growing field of translational vascular imaging.

Ethics requirements

Secondary data or tissue samples: UREC or NHS REC ethics approval already received for the intended research project

The babyPHONO study: An observational study to assess the feasibility of incorporating phonocardiography within the newborn infant physical examination to improve screening for congenital heart disease

Can digitally recorded heart sounds be obtained in neonates and analysed with artificial intelligence to improve current screening for congenital heart disease (CHD)?

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Supervisors

Dr Neil Lawrence (n.r.lawrence@sheffield.ac.uk)     

Professor Tim Chico (t.j.chico@sheffield.ac.uk) 

Dr Louis Stokes (l.s.stokes@sheffield.ac.uk) 

Abstract and methodology

All babies born in the UK should have a newborn infant physical examination that includes listening to the heart. Babies that have a heart murmur often go on to have an ultrasound heart scan called an echocardiogram. These cost around £300, and over half are completely normal. 

The Littman Eko Core Stethoscope can record heart sounds. Artificial intelligence can be used to analyse these recordings. The number of heart scans could be reduced if we only scanned babies with particularly concerning sounds. We know that different clinicians may hear different sounds. Recordings could improve this, by making the test more objective.

We want to record the heart sounds of babies having their baby check and interview staff doing the checks after they have recorded heart sounds from at least ten babies. We will also survey the carers to understand what people think of how we get these recordings. We will then record the heart sounds of babies already scheduled for an echocardiogram to obtain preliminary data to help understand if artificial intelligence can use those measurements together to predict heart problems. 

Type of project

Clinical or Surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

Students will be trained in qualitative interview techniques by being directed to resources and by carrying out preliminary interviews with members of the research team. Students will be trained how to measure the heart rate, breathing rate and oxygen saturations of babies, as well as basic skills in examination of babies to complement their learning, by the main supervisor. Support will be given in statistical analysis should the student want to pursue this arm of the study, but training will be flexible dependent upon if the student would rather focus on the quantitative or the qualitative side of the project.

Ethics requirements

Original research involving human tissues/human participants and/or patient details and information: UREC or NHS REC ethics approval needed

Point-of-care ultrasound (POCUS) in suspected hip effusion in a limping child: a systematic review and meta-analysis of diagnostic accuracy

What is the diagnostic accuracy of POCUS in suspected hip effusion in a limping child?

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Supervisors

Dr Nick Mani (nickmani@nhs.net)     

Dr Amir Tahvili (amir.tahvili@nhs.net) 

Abstract and methodology

The overall aim is to completed a systematic review and meta-analysis in diagnostic accuracy

Objectives are to devise a literature search protocol based on the research question (see PICO below), complete the search, screen and identify the appropriate paper to include, critically analyse and extract data as per protocol, complete bias analysis, synthesises the results, and if deemed appropriate undertake meta-analysis (quantitative). This will be all based on the PRISMA-DTA standard guideline with the protocol registered on PROSPERO.

Patient: Child presenting to secondary health care settings with a limp 

Intervention: Point-of-care ultrasound of the hip joint

Comparison: Radiology department-performed comprehensive ultrasound (RADUS) or MRI.

Outcome: The primary outcomes are sensitivity and specificity (The target condition is hip effusion; the index test finding is a sonographic measurement)

Type of project

Clinical and qualitative project

Additional training or teaching

Introduction to systematic review and meta-analysis in diagnostic accuracy.

Ethics requirements

Non-human tissue: no ethics approval required

Bedside-focused cardiac point-of-care ultrasound in suspected myocardial infarction in acute and urgent settings in adults: a systematic review and meta-analysis of diagnostic accuracy

What is the diagnostic accuracy of cardiac point-of-care ultrasound in suspected acute myocardial infarction in acute, urgent and critical care settings in adults?

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Supervisors

Dr Nick Mani (nickmani@nhs.net)     

Dr Amir Tahvili (amir.tahvili@nhs.net) 

Abstract and methodology

The overall aim is to completed a systematic review and meta-analysis in diagnostic accuracy

Objectives are to devise a literature search protocol based on the research question (see PICO below), complete the search, screen and identify the appropriate paper to include, critically analyse and extract data as per protocol, complete bias analysis, synthesises the results, and if deemed appropriate undertake meta-analysis (quantitative). This will be all based on the PRISMA-DTA standard guideline with the protocol registered on PROSPERO.

Patient: adults with suspected acute myocardial infarction

Intervention: Cardiac Point-of-Care Ultrasound 

Comparison: A pre-specified, acceptable reference standard based on the universal definition of MI (troponin + clinical/ECG data +/- angiography)

Outcome: Primary outcomes are sensitivity and specificity (The target condition is AMI; the index test finding is mainly new regional wall motion abnormalities)

Type of project

Clinical and qualitative project

Additional training or teaching

Introduction to systematic review and meta-analysis in diagnostic accuracy.

Ethics requirements

Non-human tissue: no ethics approval required

Gastrointestinal BSc projects

Clinical coeliac disease or endoscopy

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Supervisors

Professor David Sanders (david.sanders1@nhs.net)     

Dr Imran Aziz (imran.aziz1@nhs.net) 

Abstract

There are numerous research projects to choose from in different areas: endoscopy, capsule endoscopy, inflammatory bowel disease, functional gut disorders, coeliac disease and many, many more. Every BSc student to date has published (with a PubMed ID – useful for points in future applications after foundation years). There have been 14x 1st class with honors 

Objectives

We wish to give you 

• a broad base of research learning in a friendly department with excellent support
• fantastic research opportunities and exposure to clinical practice
• clinical confidence from talking to and recruiting patients

During the intercalation application process, you will have the chance to meet with the consultant supervisors within our department who are offering upcoming projects. You may be working with a database or clinical letters, you may have the opportunity to get involved with departmental recruiting (if you wish) for other studies, you will work alongside our nursing and medical team and will gain clinical skills whilst supporting an endoscopy list. 

Type of project

Clinical or surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

You will have excellent in-house methodological support from your supervisor and clinical fellows (doctors who are registrars training to become gastroenterology consultants but undertaking extra research training for an MD) within the department. 

The unique clinical studies that you will have the opportunity to undertake often lead to changes in clinical practice. You will be well supported in a thriving NHS GI research environment. You may be taking bloods, putting cannulas in, watching gastroscopies or colonoscopies. There is plenty of patient contact and you will feel that you are contributing to the team.

Ethics requirements

Secondary data or tissue samples:UREC or NHS REC ethics approval already received for the intended research project

Deferiprone treatment in patients with infratentorial superficial siderosis

Is deferiprone an effective and safe treatment in patients with progressive ataxia caused by infratentorial superficial siderosis (iSS)?

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Supervisors

Dr Priya Shanmugarajah (p.d.shanmugarajah@sheffield.ac.uk)     

Dr Andrew Martin (andrew.martin29@nhs.net) 

Aims

• Identify aetiology and diagnostic criteria of infratentorial superficial siderosis by performing a literature review on infratentorial superficial siderosis in patients with progressive ataxia plus disorders and treatment options.
• Set up Sheffield Ataxia Centre Registry of patients with infratentorial superficial siderosis and design the data base for recording and monitoring.
• Determine objective outcome measures for deferiprone treatment and monitoring pathway by undertaking clinical assessments using the ataxia rating scale, MRI radiological regression/progression using radiology rating scales.
• Recognise safety monitoring profile of deferiprone.
• Compare outcome measures between those on treatment with deferiprone with those not on treatment by performing quality of life surveys/patient reported outcome measures. 

Type of project

Clinical or surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

• OPD clinic experience at Sheffield Ataxia Centre, one of 3 national ataxia centres in the UK
• How to perform ataxia, radiology and QoL rating scales
• Participation in neurology teaching sessions and academic meeting CPD sessions

Ethics requirements

Original research involving human tissues/human participants and/or patient details and information: UREC or NHS REC ethics approval needed.

Effect of direct oral anticoagulants on hip fracture surgery

What is the effect of direct oral anticoagulants on hip fracture surgery?

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Supervisors

Dr Matt Wiles (matthew.wiles1@nhs.net)     

Dr Paul Bramley (paul.bramley2@nhs.net) 

Aims

To determine if direct oral anticoagulants (DOACs) impact on hip fracture surgery in the following areas:

• Time to surgery.
• Anaesthetic technique.
• Blood loss and transfusion requirements.
• Incidence of complications (including mortality).

Methodology

Students will undertake database/notes review of all patients who underwent hip fracture surgery at Sheffield Teaching Hospitals (2021-2024) and who were on a DOAC on admission. The following data will be collected:

• Baseline demographics (age/sex/ethnicity/renal function)
• Haemoglobin on admission, day 1 and day 2 postoperatively
• Mode of anaesthesia
• Number of units of RBCs transfuse
• Time to surgery
• Intra-operative blood loss
• Duration of stay
• Incidence of complications (including death)
• Nottingham Hip Fracture Score

This study will determine the effect of surgical delay on mode of anaesthesia and outcomes. Sheffield has a protocol for deferral of surgery for 24 hours in patients on DOACs (which is not present in other centres). There is a paucity of data on the correct time for delay (especially in patients with low eGFR) and the results of this study will be of interest nationally.

Type of project

Clinical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

Students will be trained to access all relevant databases and in data analysis (including statistical tests).

Ethics requirements

Original research involving human tissues/human participants and/or patient details and information: UREC or NHS REC ethics approval needed

Frailty assessment in lung cancer

This project will correlate pre-treatment well-being and frailty assessment scores with short term outcomes including treatment-related toxicity in newly diagnosed lung cancer patients, to evaluate their utility in routine clinical practise.

Lung cancer is both the commonest cancer in Yorkshire & the Humber and is associated with the worst mortality rate. Complex multi-modality treatment options are increasingly used, involving combinations of surgery, radiotherapy, cytotoxic chemotherapy, immunotherapy and/or targeted therapy. These options improve outcomes but are associated with increased treatment-related adverse effects which can be serious. 

Frailty is the loss of physiological reserve resulting in a state of vulnerability to external stresses.  Frailty is commoner in older patients, but chronological age and performance status are poor estimates of physiological age and functional reserve. Frailty assessment scales have been developed, which incorporate measures from multiple domains, including functional status, cognitive status and emotional well-being, to more accurately evaluate patient frailty. Frailty assessments have been shown to predict for treatment-related toxicity from cytotoxic chemotherapy but to date there is little evidence to demonstrate their use with the newer systemic anticancer treatments or with multi-modality treatment regimens.

Depending upon the interests of the research student, the project could be tailored to focus more on oncology patients or surgical patients, with scope to create two parallel projects for two students each covering one of the patient settings, if there was sufficient interest.

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Supervisors

Dr Robin Young (robin.young@nhs.net)    

Mr John Edwards (john.edwards3@nhs.net) 

Abstract and methodology

The aim of the project is to measure well-being and frailty in a cohort of newly diagnosed lung cancer patients planned for multi-modality treatment and to correlate these assessments with short term outcomes including treatment-related toxicities.

This is a prospective observational study in patients with newly diagnosed lung cancer. 

Potential research participants will be identified by the supervisor from the weekly Lung Cancer MDT. The research student will attend clinics to undertake the frailty assessments in consenting patients and will collect data from clinical records on subsequent short term treatment related outcomes for correlation. 

Type of project

Clinical or surgical project: based in the clinical environment with patients/including service evaluation

Additional training or teaching

The student will receive appropriate training for undertaking the planned frailty assessments and will be supported in clinic by the supervisors to assess the participating patients. 

Ethics requirements

Original research involving human tissues/human participants and/or patient details and information: UREC or NHS REC ethics approval needed