Surgical projects

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

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

Surgery for blunt thoracic trauma: where does it lie in the hierarchy of other procedures, and why? 

Does the timing of surgery matter in patients with lung thoracic trauma?

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Supervisors

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

Mr Ashok Kar (Ashok.Kar@nhs.net) 

Aims and objectives

• Characterise the thoracic and other surgical procedures performed in patients with blunt thoracic trauma
• Assess outcomes according to the nature of surgical procedures undertaken
• Determine whether recommendations can be made regarding the order and timing of procedures, and whether there are further research questions on this topic.

Methodology

• Analysis of large existing databases
• Characterisation of the nature of thoracic trauma according to established methods
• Interrogation of HES and HRG data to determine outcomes

Potential

• Presentation of findings at departmental, national and international meetings
• Depending on merit, publication of findings in peer reviewed journals

Type of project

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

Additional training or teaching

Training and support in the appropriate research methodology will be provided.

Exposure to relevant clinical settings will be possible

Ethics requirements

Secondary data: new ethics approval being sought as the data is being used as part of a different research project to that for which the original ethics was sought.

Mixed methods study into the views of women regarding axillary surgery options following a positive sentinel node biopsy for breast cancer.

Hypothesis: Rates of axillary clearance are higher than necessary and might be reduced if better understanding of the informational needs and preferences of women facing a choice of axillary treatments was better understood.

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Supervisors

Miss Jenna Morgan (j.morgan@sheffield.ac.uk)     

Professor Lynda Wyld (l.wyld@sheffield.ac.uk) 

Aims

To determine

• the attitude of women with early breast cancer towards a range of different axillary treatment strategies
• the information needs and preferences when making this treatment choice
• their views about the decision making process they experienced
• the reasons for their ultimate treatment choice
• the factors that influenced their choice
• whether they felt they had enough information of the correct sort to make their choice
• what they felt could be improved
• any perceived barriers and facilitators to adoption of new axillary management strategies

Objectives

• Develop and validate a bespoke questionnaire about womens’ views about axillary treatment decisions (content, face validity, comprehension, ease of use)
• Pilot testing of the questionnaire with a small group of women to optimise it
• Application of the resulting questionnaire to a wider group of women.
• Triangulation of qualitative and quantitative data

This project is part of a larger program of work looking at this area of study. The student will be involved in disseminating the questionnaires to patients and analysing the returned questionnaires using excel spreadsheets and SPSS and combining these results with the results from the interviews (which will have been completed by a previous student) in a mixed methods analysis.

The student will be expected to hand out a minimum of 200 questionnaires in breast clinic to obtain a return of approximately 100 for analysis. The student will be expected to write up their findings for thesis but also for publication/presentation at a national or international conference"

Type of project

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

Additional training or teaching

Students will be taught how to use SPSS and Excel and will be trained in mixed methodology with an emphasis on the quantitative element of this project.

Ethics requirements

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

The burden of cosmetic implants on the two-week-wait breast cancer service

This study aims to explore the workload caused by women with symptoms caused by cosmetic breast surgery and/or cosmetic tourism in two-week-wait clinics. 

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Supervisors

Miss Jenna Morgan (j.morgan@sheffield.ac.uk)     

Professor Lynda Wyld (l.wyld@sheffield.ac.uk) 

Introduction

The two-week-wait breast service provides patients with rapid access to clinic when cancer is suspected, although 90% of referrals are not cancer. Breast symptoms are often caused by previous cosmetic breast surgery (implants, reductions, fillers) which may cause pain, tenderness, lumps, distortion and swelling and are often referred into breast services via the fast track two-week-wait service. There is also a recent surge in health tourism with women seeking low prices surgery abroad and returning with often serious complications, which the NHS is obliged to deal with. Our previous pilot audit found that rates of between 7 and 12% of attendees are presenting with cosmetic surgery related issues. 

Methods

A retrospective, single-centre, observational cohort study of patients referred into the 2week wait service at DBTH hospital over a 2 year period. All women presenting via two-week-wait clinics will be categorised as cosmetic surgery related or not, based on clinic letters. Data on reason for referral, examination findings, investigations and diagnosis were collected. Any addition investigations, such as MRI scans will be reported to allow costs to be calculated. If time allows data collection will be expanded to other trusts in the South Yorkshire area. 

Type of project

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

Additional training or teaching

The candidate will gain experience of data collection statistical analysis including means, medians, Chi2, correlation and regression analysis. Candidates will also be encouraged to attend breast clinics and theatres to learn about cosmetic and non cosmetic breast surgery.

Ethics requirements

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

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al needed

Should decisions relating to elective surgery for diverticular disease be based on health-related quality of life assessment?

We hypothesise that patient reported QoL measurements should be considered as a basis for deciding who should be offered surgery. To support this assertion, we aim to describe the QoL burden of this patient group and compare it to the QoL of patients undergoing surgery.

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Supervisors

Mr Tim Wilson (tim.wilson1@nhs.net)     

Mr Daniel Ashmore (dlashmore1@sheffield.ac.uk) 

Abstract and methodology

Diverticular disease (DD) is a common surgical problem that can result in bouts of inflammation affecting the colon (diverticulitis). Surgery can reduce this risk and has been shown to improve the quality of life (QoL) of selected patients. However, this operation is not without risk and is used relatively sparingly. There is no clear consensus about which patients should be operated upon.

A systematic review will be conducted to extract published QoL in the medical literature from patients with DD participating in clinical trials or observational studies. Data will be extracted from studies measuring QoL in unselected cohorts of patients following an episode of diverticulits. Separate data will be extracted from studies measuring QoL in patients undergoing surgery for DD. These two data sets will be analysed for patterns of change and compared to each other, as well as population normal data. Meta-analysis will be used to combined data where applicable.

This study is expected to improve our understanding of the QoL burden in patients with diverticular disease and may help to inform us how we can make more objective choices regarding the use of surgery for this condition. It is expected that the outcomes of the study will be presented to national conferences and may be suitable for publication if sufficient data was collected. 

Type of project

Qualitative, non-lab-based project

Additional training or teaching

This project would suit any trainee with an interest in surgery or anaesthetics. The project will be supervised from Doncaster, but will largely be library/online based. Specific training will be provided in systematic reviews, including development of a search strategy, data extraction and meta-analysis. Regular supervision meetings will be organised to guide the student through each stage of this research project. As part of the BSc, there are extensive opportunities for clinical experience in the surgical department.

Ethics requirements

Not known: contact Carolyn Staton in the first instance.

Are large language artificial intelligence (AI) models able to advise surgical patients? 

The aim of this study is to evaluate the accuracy, completeness, and readability of information produced by large language AI models in response to typical patient queries concerning common colorectal surgical procedures.

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Supervisors

Evri Tokidis (evripidis.tokidis2@nhs.net) 

Mr Tim Wilson (tim.wilson1@nhs.net)     

Abstract and methodology

Artificial intelligence is prominent in healthcare information systems, with large language models (LLMs) such as ChatGPT and Gemini, routinely accessed by the public to obtain medical explanations. These tools generate human-like, contextually responsive text that can appear authoritative, even when the underlying content lacks clinical rigour. 

The aim of this study is to evaluate the accuracy, completeness, and readability of information produced by large language models in response to typical patient queries relating to common surgical procedures. LLM-generated responses to a series of standardised patient-style prompts will be generated and then compared to explanations from official authoritative sources (eg Royal College of Surgeons of England) using a descriptive framework grounded in human evaluation methodology derived from the QUEST framework. This model provides a structured basis for assessing LLM outputs in healthcare across five principal domains: Quality of Information, Understanding and Reasoning, Expression Style and Persona, Safety and Harm, and Trust and Confidence. Readability will also be assessed using validated tools.

It is anticipated that this study will reveal notable differences between AI and official information sources that will have practical implications for clinical consultations with surgical patients.

Type of project

Qualitative, non-lab-based project

Additional training or teaching

This project would suit any trainee with an interest in surgery or anaesthetics. The project will be supervised from Doncaster, but will largely be library/online based. Specific training will be provided in systematic reviews, including development of a search strategy, data extraction and meta-analysis. Regular supervision meetings will be organised to guide the student through each stage of this research project. As part of the BSc, there are extensive opportunities for clinical experience in the surgical department.

Ethics requirements

Not known: contact Carolyn Staton in the first instance.