Sheffield Children's Hospital projects

Identifying factors associated with azithromycin resistance in nasal microbiome in children

The primary objective will be to identify the level of azithromycin resistance in nasal flora of children without respiratory co-morbidity and compare it with the level we have already observed in children with protracted bacterial bronchitis.

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Supervisors

• Dr Kelechi Ugonna (k.ugonna@nhs.net)
• Dr Fiona Shackley (fiona.shackley@nhs.net)
• Dr Simon Hardman

Objectives

The primary objective will be to identify the level of azithromycin resistance in nasal flora of children without respiratory co-morbidity and compare it with the level we have already observed in children with protracted bacterial bronchitis.

The secondary objective will be to identify demographic features, prescribing patterns (in both primary and secondary care), and clinical factors in both groups that may be associated with azithromycin resistance.

Methodology

The student will prospectively recruit 20 children without respiratory co-morbidity between the ages of 1 and 7 years old. They will perform a single nasal swab and they will analyse this swab for microbiology and antimicrobial resistance. This will be compared to similar data already obtained for patients who have a diagnosis of bacterial bronchitis.

The student will then undertake a study to identify detailed clinical and prescribing history in both patient groups to see if there are any factors that are related to increased azithromycin resistance in these study groups.

Expected outcome

Our research group has already identified that patients with bacterial bronchitis (even those who have not been treated with Azithromycin) have a really high rate of resistance to this antibiotic.

We would like to identify whether this rate is higher than the background rate of our population and we would further like to identify whether there are any clinical, demographic and prescribing factors that are associated with this resistance.

Type of project

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

Additional training

This will be a clinical project involving recruiting children and performing nasal swabs. The student will also benefit from being shown how to analyse nasal swabs for microbiology and antibiotic resistance.

In addition, the student will be able to attend and sit in on paediatric respiratory clinics for their experience.

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What is the best initial pain clinic appointment model for autistic patients and families?

Our first appointment currently involves a minimum of four professionals in the room. Each takes a turn at asking questions about pain and what life looks like. We split up for separate physical and parental assessments and reconvene to discuss a diagnosis and management plan. We value this model which enables each professional to have maximum time and observation to make an assessment. However, we are seeing increasing numbers of autistic children and young people who find this assessment format or model difficult.

How do we optimise the multidisciplinary team's initial assessment and family experience in our first clinic appointment for autistic patients?

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Supervisors

• Dr Nina Plant (nina.plant@nhs.net)
• Dr Tara Pais (tara.pais@nhs.net)
• Dr Paul Manning (paul.manning6@nhs.net)

Objectives

• Compare patient and staff satisfaction and identify any issues arising from different models of undertaking first clinic appointments.
• Identify any features that could predict who would most benefit from a different clinic format.

Methodology

• Literature search about the provision of care in a clinical setting for autistic patients
• Identifying alternate models of delivery of initial clinic assessment
• Trial potential models in the clinic
• Qualitative/quantitative assessment of satisfaction and issues raised within model trials with families and staff
• Analyse and present data collected

Expected outcomes

One new model will likely be optimal for families with autism and staff, which will then become our secondary model used for the first appointment for autistic patients who would likely not have a good experience within our current model.

Type of project

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

Additional training

• Introduction to qualitative research methods
• Identifying any useful quantitative assessment tools that could be used for the project

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Retrospective analysis of necrotizing pneumonia in paediatric patients over a decade

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Supervisors

• Dr Kelechi Ugonna (k.ugonna@nhs.net)
• Dr Kansra Sonal (sonal.kansra@nhs.net)

Objectives

• To analyze the clinical presentation, demographics, and infecting organisms in paediatric patients admitted with necrotizing pneumonia over the past 10 years.
• To assess the severity of illness and identify any associated complications in the short, medium, and long term.
• To determine if there are specific clinical markers, laboratory findings, or other early indicators that can predict disease severity and prognosis.
• To evaluate the effectiveness of different management strategies and their outcomes in relation to early presenting signs and infecting organisms.

Methodology

This study will employ a retrospective cohort design, reviewing medical records of paediatric patients admitted to the children's hospital with necrotizing pneumonia over the last 10 years. Key data will include patient demographics, initial presenting symptoms, infecting organisms, illness severity (e.g., duration of hospital stay, ICU admission), and complications. Statistical analysis will be used to identify correlations between early clinical markers and outcomes, as well as to compare management strategies. Ethical approval and appropriate data protection protocols will be followed given the sensitive nature of patient data

Expected outcomes

This study is expected to provide insights into the clinical and microbiological factors that influence the prognosis of necrotizing pneumonia in children. It is anticipated that early predictors of disease severity will be identified, potentially improving prognostic models. Additionally, the results may highlight which management strategies are most effective, contributing to improved treatment protocols and better outcomes for paediatric patients. The findings could inform future clinical guidelines for the early identification of high-risk patients.

Type of project

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

Additional training

As part of this project, the student will receive training in retrospective data collection and management, including navigating hospital databases and medical records systems. They will also gain skills in statistical analysis, learning to use software like SPSS or R for analyzing correlations and outcomes.

The student will have the opportunity to collaborate with clinical teams to better understand patient management strategies and decision-making processes in paediatric care. Additionally, the student will be guided through the process of ethical approval applications and data protection principles in clinical research.

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Investigating dysanapsis in obesity

A pilot study using advanced lung function testing and hyperpolarised MRI.

Does dysanapsis (disproportionate growth between airway caliber and lung volume) contribute to altered lung function in obese patients, and can advanced lung function tests and hyperpolarised gas MRI provide deeper insights into the pulmonary mechanics of obesity?

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Supervisors

• Dr Kelechi Ugonna (k.ugonna@nhs.net)
• Professor Heather Elphick (h.elphick@nhs.net)
• Zoe Burton (zoeburton@nhs.net)
• Laurie Smith (laurie.smith@sheffield.ac.uk)

Objectives

• To investigate the presence and extent of dysanapsis in obese patients by conducting detailed lung function assessments.
• To correlate findings from spirometry, body plethysmography, diffusion capacity tests, and hyperpolarised gas MRI with patient demographics and obesity severity.
• To determine if dysanapsis is more prevalent or severe in obese individuals compared to population norms.
• To explore whether advanced imaging techniques (hyperpolarised gas MRI) can provide novel insights into the airflow dynamics and pulmonary structure in obese patients.

Methodology

This pilot study will recruit 10-20 patients from the preoperative care clinic and the obesity clinic over a one-year period. Each patient will undergo comprehensive lung function testing, including spirometry, body plethysmography, and diffusion capacity measurements. Additionally, hyperpolarised gas MRI will be used to assess pulmonary structure and airflow dynamics in greater detail. Data will be analyzed to investigate the relationship between lung function and obesity-related parameters (e.g., BMI, waist circumference). Ethical approval and patient consent will be obtained prior to participation.

Expected outcomes

This study expects to provide preliminary evidence regarding the prevalence and characteristics of dysanapsis in obese individuals. It is anticipated that advanced lung function testing and hyperpolarised gas MRI will uncover specific pulmonary abnormalities not easily detected through traditional methods. These findings could lead to a better understanding of respiratory mechanics in obese patients, which may guide future research into targeted interventions or management strategies for obesity-related lung dysfunction.

Type of project

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

Additional training

The student will receive training in advanced pulmonary function testing, including the use of spirometry, body plethysmography, and diffusion capacity measurements. They will also be introduced to the technical and clinical aspects of hyperpolarised gas MRI and its interpretation. Additionally, the student will learn to work with clinical trial protocols, recruit patients, and manage clinical data. Statistical analysis techniques and scientific writing for reporting findings will also be a key part of the student’s skillset development throughout the project.