Week One: Starting Off

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My first week at William Harvey has been full of getting to grips with exactly what it is I’m going to be doing and trying to remember what the variety of terms being used by clinicians actually mean. I started off in the library, recognizable by the piles of stroke journals and medical statistics textbooks that I’d gathered up around me to read throughout the day. This really helped me to get a good grounding in what the topics I was working with actually meant and involved (plasminogen activators and subarachnoid haemorrhages anyone?!), as well as what previous research had been carried out into these areas. This gave me a much clearer idea about the reasoning behind my research projects and what gaps in the literature still exist, whilst providing me with some personal relief that I now had at least a small understanding of the upcoming work. I was also able to refresh my knowledge about how to choose and carry out statistical analyses, particularly inferential tests, something that will hopefully be of use later on!

On Thursday I was able to attend a morning MDT meeting to listen to neurologists and radiologists discussing recent patient brain scans and angiograms. I found it amazing how detailed and clear the scans were, with the clinicians able to zoom right in on patients’ individual vessels to check for clots. They were also kind enough to describe how to interpret the various scans, explaining how haemorrhages or ischaemic strokes may show up differently depending on the type of scan used. It made it clear how much experience clinicians must need to be able to interpret these, as well as how important MDT meetings are for sharing ideas about how to move forward. We were then taken through what our daily work for the project: ‘Strokes of Unknown Time of Onset (SUTO) and Image Based Selection of Reperfusion Therapy’ would involve, with a steep learning curve involving multiple spread sheets and piles of case notes. Although at first it seemed very overwhelming, after having a practice at extracting and entering the data that we will need for analysis, the reasons behind doing everything began to come together. We are first analysing whether patients clearly had either a SUTO or underwent CT brain perfusion imaging following their stroke. These are scans which are used to identify patients’ mismatch of cerebral blood flow and mean tissue transit times. These scans are relevant for our project as their indication of whether patients with a SUTO have brain tissue at risk due to a lack of oxygen can be used to guide provision of a treatment called thrombolysis (a reperfusion therapy which breaks down fibrin within clots). For these identified patients with either a SUTO or CT perfusion scan,  we are then using various client letters and patient notes to find out factors such as whether thrombolysis was given to them, what stroke risk factors the patient had, how they scored on various assessments and how long it took for them to be treated. Overall, we are hoping that this will show us how effective thrombolysis is when used for patients that have a SUTO, as currently it is only recommended for strokes with an onset time of < 4.5 hours. I’m sure it will take a while longer before I’m confident with all of this!

By the end of the week I was feeling a lot better about what was involved with the SUTO project and was able to independently fill my day with getting things done. Looking through all of the different brain scans by myself was also really interesting and I was able to read through neurologists’ reports to greater understand what I was looking at. I don’t yet have my own computer login or ID card which means I’m restricted with some of my work and need to ask people to help me with gaining access but luckily this hasn’t been a problem so far. Hopefully next week will continue to run so smoothly and I’ll get approval to begin working on the other project too!

William Harvey Hospital, Ashford

Image retrieved from: http://www.kentonline.co.uk/ashford/news/william-harvey-hospital-food-spa-a56947/

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