Surgery projects

A review of surgical outcomes for pressure ulcers involving hip joint in individuals with spinal cord injury

We will explore factors contributing to surgical outcomes following repair surgeries for pressure sores involving hip joint. No definite hypothesis is formulated. This exploratory exercise will aim to tease out factors which influence better healing of such wounds.

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Supervisors

• Dr Rohit Bidhe (rohit.bhide@nhs.net)
• Dr Lisa Grandidge (Lisa.Grandidge@nhs.net)

Objectives

• Identify factors which contribute towards the development of pressure ulcers extending into the hip joint in spinal cord patients
• Identify factors which influence better healing following repair of pressure ulcers with hip joint extension in spinal cord patients

Methodology

This will be a single-centre retrospective analysis of the existing repository of work related to pressure ulcer repair surgeries in patients with spinal cord injuries. The Princess Royal Spinal Injuries Centre is a supra-regional specialist spinal cord injury rehabilitation centre caring for patients with varying levels and severity of spinal cord injury on a lifelong basis.

Pressure ulcers are a known, common and debilitating complication that occurs following spinal cord injury. This project would entail a detailed retrospective analysis of the centre's surgical work related to one of the most complex presentations of pressure sores. 

Expected outcomes

Retrospective review of existing data to capture demographics, spinal cord injury details, factors contributing and specific to the development of pressure sores and factors influencing pressure ulcer healing and long-term outcomes.

Type of project

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

Additional training

• Two-week induction to understand the current spinal cord management pathway
• Detailed overview of the planned study with opportunities to steer the project direction and questions
• Use of SPSS and other sources for statistical analysis

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Unlocking Potential: Developing inclusive outcome measures for children with cerebral palsy

Children with cerebral palsy who have limited upper limb function often score inaccurately low on existing patient-reported outcome measures (PROMs) due to floor effects. By engaging these children and their caregivers in the evaluation of current PROMs, we aim to identify important daily activities and outcomes that matter most to them.

This process will help us develop a new, more sensitive outcome measure that better captures small yet meaningful improvements in upper limb function and enhances their overall quality of life.

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Supervisors

• Ms Sara Dorman (sara.dorman@nhs.net)
• Mr Sanjeev Madan (sanjeev.madan@nhs.net)

Objectives

There is a significant gap in the tools available to measure upper limb issues in children with cerebral palsy. Most patient-reported outcome measures (PROMs) are created by healthcare professionals and researchers, often based on tools originally designed for adults. However, the priorities and expectations of children and their parents regarding surgical outcomes often differ from what researchers assume. Even when children are involved in creating these tools, those with cerebral palsy are rarely included.

Children with severe disabilities often rely heavily on their hands and arms, especially in our digital age where devices like iPads and motorized wheelchairs are common. For many, upper limb function may be their only form of independence, so it’s crucial to have accurate methods for measuring and monitoring this function over time.

Currently, many children score zero on existing outcome tools due to significant floor effects, meaning the tools don’t accurately capture their abilities. Even small interventions, whether surgical or non-surgical, can greatly improve their quality of life and that of their families, but these improvements often go unnoticed because current PROMs fail to reflect them.

This study aims to evaluate how relevant current PROMs are for children with cerebral palsy and to gather information from these children about their daily activities and what outcomes matter most to them.

Primary outcome: The study seeks to identify a group of children with some hand function who still score low on current PROMs (ABILHAND-Kids and PROMIS Upper Extremity). It will also collect qualitative feedback and conduct clinical reviews to pinpoint achievable tasks in this low-functioning group, ultimately aiming to develop and validate a new outcome tool.

Methodology

The research methodology will involve evaluating upper limb outcome measures in children with cerebral palsy using a mixed-methods approach. The student will conduct structured interviews with parents and children in a clinical setting, guiding families in completing recognised patient-reported outcome questionnaires, such as the ABILHAND-Kids and PROMIS Upper Extremity.

The student will evaluate responses and record scores systematically. Following the questionnaires, a 10-minute qualitative interview will capture details about the child’s daily life and activities of daily living, assessing whether the current measures adequately represent their capabilities. This approach will provide both quantitative data and qualitative insights into their experiences.
Expected outcome
The expected outcome of this project is to develop a more relevant and inclusive outcome measurement tool tailored specifically for children with cerebral palsy. By capturing qualitative feedback from children about their daily activities and priorities, the project aims to better reflect their actual capabilities and needs. This new tool will enhance the assessment of upper limb function, making it more sensitive to the improvements that may result from minor interventions.

Ultimately, it will promote better understanding and recognition of these children's abilities and the impact of therapeutic strategies on their lives.

Type of project

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

Additional training

Students involved in this project will receive comprehensive training in qualitative research methods, focusing on effective interview techniques and data collection strategies. They will learn how to administer recognised patient-reported outcome measures and analyse both quantitative and qualitative data.

Additionally, training will cover ethical considerations in working with children with disabilities, emphasising communication skills to ensure a comfortable and supportive environment. This training will equip students with the necessary skills to engage meaningfully with participants and contribute to the development of a more relevant outcome measurement tool.

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Developing inclusive outcome measures for neurodiverse children with upper limb disabilities

Neurodiverse children with upper limb disabilities may report more accurate and relevant outcomes when using adapted patient-reported outcome measures (PROMs) that utilize symbols and pictures or mixed media, as opposed to traditional questionnaires.

This study will explore the potential for these inclusive measures to better capture the unique experiences and preferences of these children, thereby enhancing their engagement in their care and improving treatment outcomes.

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Supervisors

• Ms Sara Dorman (sara.dorman@nhs.net)
• Mr Sanjeev Madan (sanjeev.madan@nhs.net)

Objectives

Patient-reported outcome measures (PROMs) are questionnaires that capture how patients perceive their own health, symptoms, and quality of life. They are crucial because they offer insights into how treatments affect individuals from their own perspectives, ensuring care is more patient-centered and effective.

Neurodiverse children, including those with autism, ADHD, or cognitive challenges, often get excluded from research due to the difficulties in measuring their progress. When they are included, studies typically rely on parent reports, which can limit the understanding of their actual experiences.

Moreover, many children with upper and lower limb disabilities communicate non-verbally or use symbols and pictures to express their feelings and preferences. Currently, there are no suitable outcome measures for evaluating limb function in children who communicate in these non-traditional ways.

This study aims to gather information from neurodiverse children and young adults with upper limb issues, moving beyond conventional assessment methods to create more inclusive tools.

It will analyse both quantitative and qualitative data, comparing the performance of commonly used outcome questionnaires, with new approaches that incorporate picture-based or mixed media formats. By adapting existing outcome measures to better fit these children's communication styles, the project seeks to enhance their involvement in their care and improve treatment outcomes.

Methodology

The methodology for this project will involve a mixed-methods approach, combining quantitative and qualitative data collection. Initially, the study will assess existing patient-reported outcome measures (PROMs) for their effectiveness in capturing the experiences of neurodiverse children with upper limb disabilities. Researchers will gather quantitative data through modified questionnaires tailored for non-verbal communication, using symbols and pictures.

Additionally, qualitative interviews will be conducted with children and their families to gain deeper insights into daily activities and preferences. This dual approach aims to develop a more inclusive outcome measurement tool that accurately reflects the capabilities and needs of these children.

Expected outcome

The expected outcome of this project is to create a more effective and inclusive outcome measurement tool specifically for neurodiverse children with limb disabilities. By integrating feedback from both quantitative assessments and qualitative interviews, the project aims to understand how satisfied these children and families are with their current measures and which scoring methods they prefer.

This new tool will more accurately reflect their communication capabilities and experiences, enhancing the understanding of their functional abilities and the impact of interventions, ultimately improving communication in clinical settings and the quality of care they receive.

Type of project

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

Additional training

Students involved in this project will receive comprehensive training in both qualitative and quantitative research methods. They will learn how to adapt and administer modified patient-reported outcome measures (PROMs) tailored for neurodiverse children, focusing on effective communication techniques to engage participants.

Training will also cover ethical considerations when working with vulnerable populations, as well as strategies for conducting qualitative interviews to gather meaningful insights. Additionally, students will gain skills in data analysis to evaluate the effectiveness of current measures and assist in the development of the new, inclusive outcome tool.

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Global Limb Anatomic Staging System (GLASS) for Chronic Limb-Threatening Ischaemia (CLTI)

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 Eshen (Saima.ehsan@nhs.net)

Objectives

To perform interobserver study assessing the Global Limb Anatomic Staging System (GLASS) for Chronic Limb-Threatening Ischaemia (CLTI) across different clinician groups and collate the data and interobserver analysis. This validation will have significant important benefits for patients providing high quality evidence to inform treatments and decision making for limb salvage.

Methodology

This is a mixed methods study building on data and project performed from 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.

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.

Expected outcomes

The expected outcome is to validate the GLASS scoring system in the local population and collate the interobserver study across a number of clinicians, including consultants/ fellow, sprs/ shos. Interobserver analysis will help to validate the GLASS scoring system using MRI and provide data on its day to day utilisability for vascular clinicians.

Type of project

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

Additional training

Students will be trained in vascular imaging analysis required for the completion of the project. Students will observe a number of vascular interventions to understand the clinical component of the study.

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Acute appendicitis in pregnancy – a review of current guidance and insight into patients’ informational needs

Research into the management of acute appendicitis in pregnancy is limited and studies are of low quality. There are national and international guidelines on the best diagnostic and treatment approaches, but they differ in their recommendations. This is likely to lead to variations in practice amongst healthcare professionals; the information they provide to patients to aid the decision-making process may also vary.

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Supervisors

• Ms Nilofer Husnoo (nhusnoo1@sheffield.ac.uk)
• Dr Anmol Gangi (anmol.gangi2@nhs.net)
• Ms Jenna Morgan

Objectives

To systematically review current guidelines on the diagnosis and management of acute appendicitis in pregnancy
To explore the information needs of the pregnant patient with acute appendicitis through the conduct of focus groups

Methodology

The successful student will, under supervision, conduct a systematic review of guidelines on the diagnosis and treatment of acute appendicitis in pregnancy. This will involve writing and registering the systematic review protocol, working alongside other reviewers to conduct the review using established methods and performing a narrative synthesis of the data.

The student will undergo training in the conduct of focus groups, the analysis of qualitative data and in the recruitment and consent of patients for research. The student will conduct one or two focus groups with patients who have had appendicitis whilst pregnant and thematically analyse the data.

Expected outcomes

This work will generate novel data. We expect it to lead to two publications and several national/international presentations. This study will also complement a UK-wide retrospective cohort study on the management of acute appendicitis in pregnancy, that is currently in progress (@mamastudy2024). Together, these studies will help inform the creation of more robust guidelines and prioritise future research directions for this understudied population.

There will also be opportunities for the student to spend time in the clinical environment (ward, theatre, outpatient, endoscopy) in a busy general surgical unit in a tertiary referral centre.

Type of project

Qualitative Project/non-lab based - primarily using qualitative methods

Additional training

Training will be provided in the conduct of systematic reviews and in the conduct of focus groups. Training will be provided on thematic analysis of qualitative data and in the use of Nvivo for this purpose. The student will receive close supervision in the writing of manuscripts for publication. The student will be expected to complete Good Clinical Practice (GCP) training prior to starting their research.

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Mixed methods study into the choice of axillary clearance or axillary de-escalation following a positive sentinel node biopsy

What are the views of women and health care professionals regarding the choice of either further surgery or not following a positive sentinel node biopsy for breast cancer?

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Supervisors

• Miss Jenna Morgan (j.morgan@sheffield.ac.uk)
• Professor Lynda Wyld (l.wyld@sheffield.ac.uk)

Objectives

This study aims to understand the views of women who have faced this treatment choice, the factors that affected their choice and whether they felt adequately supported in making this choice.

Methodology

This project will use qualitative interviews, a questionnaire survey and focus groups to explore these issues.

Interviews and a questionnaire survey of women on their personal experience of being offered a choice of options and how they decided on management. Explore information received, their understanding of risk. How they would like the information presented. To better understand the risk factors for decisions a survey will also be developed, validated and conducted with a larger cohort of women recruited from multiple sites to correlate ultimate choice of treatment with a range of risk factors and generalise the results to a wider population.

Women will be recruited from several hospitals in our region. Up to 20 interviews will take place, these interviews will be analysed to develop emerging themes and issues of relevance. These findings will then be used to create a questionnaire survey which will be validated and pilot tested in a focus group of up to 6 of the previously recruited women. The validated questionnaire survey will then be sent out to a larger number of women to quantify the importance and strength of feeling on these issues. We hope to send out up to 100 questionnaires.

Expected outcomes

Improved understanding of the views and informational needs and wishes of women facing this decision.

Type of project

Qualitative Project/non-lab based - primarily using qualitative methods

Additional training

The student will be trained in qualitative research methods, including semi-structured interview techniques, coding and framework analysis. They will be trained to use NVivo software for the analysis and SPSS as required for the analysis of any survey work.

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Surgical use of performance-enhancing routines from sports psychology

Can sports psychology can improve surgical technical performance and reduce cognitive load?

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Supervisors

• Mr James Tomlinson (jamestomlinson1@nhs.net)
• Professor Steve Yule (steven.yule@ed.ac.uk)

Objectives

To assess the impact of sports psychology in improving surgeon performance in a simulated setting, and whether it can improve objective performance metrics in a surgical box trainer.

Methodology

The student will help co-design this longitudinal RCT. Participants will be randomised to either Non-Technical Skills teaching (control group) or training in performance enhancing routines (intervention group).

Study participants will be assessed on multiple occasions. Cognitive load will be assessed using a modified version of the NASA Task Load Index, and objective surgical performance data will be obtained from videos of the tasks performed.

It may also be possible to capture surgical sabremetric data (heart rate variability, skin conductance) subject to sensors being available to borrow from colleagues at the University of Edinburgh.

Expected outcomes

Surgical performance metrics (using a validated scoring system) and measures of cognitive load to prove/disprove the hypothesis that medium term use of performance enhancing routines can enhance surgical performance.

Type of project

Lab/Bench Project - primarily working in a lab environment.

Additional training

Students will be trained in how to teach performance enhancing routines, and given extensive surgical non-technical skills training including assessment of cognitive load. They will also be trained in the use of box trainers for surgical research and introduced to surgical sabermetrics.

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

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.

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)

Objectives

• To determine the health-related quality of life of patients following complicated and uncomplicated diverticulitis
• To determine the health-related quality of life of patients prior to undergoing surgery for diverticular disease
• To determine whether there is any difference in the health-related quality of life of these two groups

Methodology

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.

Expected outcomes

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 Project/non-lab based - primarily using qualitative methods

Additional training

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.