Research for Health challenges 2014
Sanjoy Shah - A multi-modal approach to prehabilitation in patients undergoing major surgery for cancer
The Pre-Operative Assessment Clinic at UHBristol sees over 6000 patients a year for major elective surgery. There is growing evidence that fitter patients have better surgical outcomes i.e. fewer complications and reduced target length of hospital stay.
Recent audit data shows < 30 per cent of patients reach the recommended level of aerobic exercise for an adult 150 minutes per week of moderate activity. To address this problem of the less fit patients there is growing interest in “prehabilitation”. This is a multimodal package of care implemented prior to surgery and exercise is a key component of this.
We would like to work with UoB researchers to :
i) develop an exercise and nutrition regime to suit patients of varying abilities
ii) use modern and innovative technologies to educate, implement and monitor compliance with the programme and
iii) develop tools to quantify benefits of a prehabilitation programme.
Paddy Horner - Can we diagnose pelvis inflamatory disease (PID) more accurately in an outpatient setting
Using bioinformatics to increase the accuracy of diagnosing pelvic inflammatory disease (PID) when women present with lower abdominal pain
The clinical accuracy of PID diagnosis based on symptoms and signs is poor. PID is diagnosed in one to two per cent of women (<40yrs) every year and is associated with serious sequelae such as tubal factor infertility and ectopic pregnancy which may not be apparent for many years. Early diagnosis and treatment improves outcome thus current practice is to over diagnose PID which leaves many women unnecessarily concerned about their future fertility.
Clinical algorithms are available for diagnosing irritable bowel syndrome and endometriosis, two of the principle differential diagnoses and there are potential biomarkers for PID which could be developed as point of care tests (POCTs). These include defensins and/or increased polymorphonuclear cells and/or lack of lactobacilli/presence of bacterial vaginosis in the vaginal secretions and POCTs for specific sexually transmitted infections. This offers the opportunity for a bio-informatic solution to increasing the accuracy of diagnosing PID when women present with lower abdominal pain.
Bozena Lassota - Acute renal injury after major orthopaedic operations.
The development of acute kidney injury (AKI) during the peri-operative period is associated with increases in morbidity and mortality. We would be very interested in evaluation of the incidence and determinants of postoperative AKI after major orthopaedic surgeries in patients with previously normal renal function.
The overall incidence of kidney dysfunction (KD) after elective or emergency orthopaedic surgical procedures is reported to reach 9.1 per cent.
With our research initiative we would like to understand what the trigger factors are that are most likely to lead to AKI in our patient population. This would significantly reduce the risk of developing AKI and would lead to better outcomes for the patient. During the last 2 years, there have been some national changes implemented and we would like to measure if there have been additional risks for the patients undergoing major orthopaedic surgeries.
Chris Bourdeaux - Can information flow be designed to change clinicians' behaviour and improve clinical outcomes in the intensive care unit? (Using “nudge” approaches to change clinician behaviour).
There is an increasing amount of evidence from controlled trials that informs us of the “best” care for patients. Unfortunately many patients fail to benefit from this research because the results are not translated into clinical practice. Improving outcomes in health care depends on reducing this clinical variation and changing clinicians’ behaviour.
Health care is increasingly digitalised and the options presented to doctors and nurses are almost entirely configurable within electronic charting and prescribing systems. We have done preliminary work demonstrating that the use of defaults, salient performance feedback and social norms can significantly improve adherence to evidence-based processes.
We are keen to work with behavioural scientists to understand how the environment in which clinical decisions are made can be modified to ensure the best outcomes for patients. We urgently require “field experiments” to evaluate if this approach can improve quality and safety in health care.
Jan Melichar - Designing a taste threshold device for use as a clinical biomarker in primary care.
We have developed a taste threshold test that could help choose the right medications for illnesses such as depression. It acts like a bed-side biomarker but the test is lab-based and cumbersome - we use cotton buds dipped in taste solutions that are made fortnightly.
As it could be used day-to-day by GPs, we need help to design a more portable, longer-lasting version so we can administer our test in a simple, neat but accurate manner. Specifically, we need to be able to apply, to the tip of the tongue, varying concentrations of bitter/sour/salt/sweet solutions via repeat dabs (up to 5 per concentration) which are held in an easily portable, readily storable device and can be prepared, potentially, well in advance.
The specific problem we would like to solve is the engineering of such a device or system which would allow easy repeat testing of patients.
Michael Whitehouse 1 - Bearing surfaces in Total Hip Arthroplasty
Total hip arthroplasty (THA) is one of the most common and successful surgical procedures performed in the NHS but they fail over time, usually due to wear of the bearing surface or loosening of the implants, which is often secondary to wear products. Common bearings include differential and similar hardness couples including metal-on-polyethylene, ceramic-on-polyethylene and ceramic-on-ceramic. Metal-on-metal bearings have gone out of favour due to higher risk of failure.
The results of revision (redo) surgery are less good than primary surgery in terms of pain relief and patient function and challenging due to soft tissue damage and bone loss. The optimum joint replacement would therefore last the patient for the rest of their life.
We seek a bearing couple that is cost effective, has very low wear, inert wear debris that does not cause local or systemic problems, is easy to implant and tolerant of variations in positioning.
Michael Whitehouse 2 - Measurement of Malrotation in Total Knee Arthroplasty
Total knee arthroplasty (TKA) is a cost effective and successful operation but 20 per cent of patients have persistent pain following TKA. When the cause of pain can be identified, revision (redo) surgery is often successful at relieving pain. If no clear cause for the pain can be identified, the results of revision are frequently poor. Malrotation of the femoral and tibial components in TKA is a potential cause of pain and other problems but it is difficult to investigate and currently requires the patient to undergo a CT scan. CT scans are expensive, expose the patient to ionising radiation and the images are poor quality due to the metal artefact.
We seek a low cost, reliable, repeatable means of determining the rotation of femoral and tibial components in TKA in relation to the bone landmarks of the patient (femoral epicondylar axis and the tibial tuberosity) that does not involve ionising radiation.
Katherine Walls - Understanding inequalities in oral health in Bristol
Dental decay is one of the most common and preventable of childhood diseases, causing pain, impeding quality of life, and requiring treatment. The inequalities in dental health within Bristol are clear, Ashley and Lawrence Hill experience > 93 dental fillings per 1,000 under 5 years old, compared to <33 per 1,000 in neighbouring Bishopston and Redland. Dental fillings in young children probably under represents dental caries in these children since decayed primary teeth may be lost without attending dental services. Links between parental awareness, low dental attendance, diet and oral health are established.
At the moment, data is not collected or analysed centrally about decay, extractions, nor dental procedures in young children. These data exist in a number of different places, but are not yet brought together. I would therefore like to work with research colleagues to establish access to these data (which will likely involve an application for ethical review), data harmonisation across data sets, and finally analysis of data by key population demographics.
Balint Hargitai - New approach of venous thromboembolism prophylaxis following joint replacement surgery – reducing the risk of wound oozing and bleeding
Orthopaedic patients are at a risk of venous thromboembolism and this risk needs to be reduced with mechanical and/or pharmacological methods. Despite the large amount of scientific research and generated evidence there is still no consensus amongst clinicians regarding the ideal method of venous thromboembolism prophylaxis. There needs to be a fine balance between the risks and benefits. Wound complications (oozing, bleeding) – partially as a side effect of chemical thromboembolism prophylaxis - apparently carry further risks of infection and delayed mobilization. This can result in poor clinical outcome and patient experience, prolonged hospital stay and increased healthcare. The introduction of oral Factor Xa inhibitors changed the previous approach to thromboembolism prophylaxis. However the research on these products focused mainly on major complications. With our research initiative we would like to evidence scientifically that our approach to thromboembolism prophylaxis is safe, cost effective and can improve the patients’ pathway.