Week 4: Halfway through

Posted on August 15, 2014 by erp3

This has been quite a stressful week! I’ve had a lot going in the past few days, including moving house, interviews and examinations (so I’ve been kept quite busy!). Luckily everyone’s been really supportive though and by managing my time well and having a number of late nights I’ve managed to stay on top of everything.

We had a meeting this week to go through the  next set of TIA letters for the OSA project. We’re all a lot more in sync now with identifying how patient presentation during TIA events (as described in TIA patient follow-up letters) can be categorised using symptomology-based keywords.  For example, someone described as having had a ‘tingling sensation’ would be categorised under paraesthesia and someone described as having been ‘unable to find the correct words ‘ would be categorised under dysphasia. A few examples of these symptoms have been illlustrated below. However, these categories can sometimes be harder to identify from the letters if doctors instead describe the symptoms with broader terms such as ‘sensory’ or ‘speech’ disturbances and sometimes can’t be identified at all if the consultant only talks about their clinic meeting rather than how the TIA originally presented. Having this meeting was really helpful in allowing us to clarify any queries that we had regarding both TIA symptom categorisation, as well as which medications are typically prescribed for hypertension. We are now going to each individually work on categorising these patient letters, with our supervisor uploading new ones as often as possible for us to get on with.

In regards to the SUTO project, this week we were also looking at the patients who had either had a SUTO or undergone a CT perfusion scan between 2010 and 2014, as identified last week.  We have now filled in as much of these patients’ information as we can (such as CT results and risk factors) using only the online patient databases. Hopefully this will give us a much clearer template of what remainding patient information we need to look for when going through their paper patient files and will speed things up a bit. However, we still have a huge backlog of patient files that require booking out and are thus limited with the amount of new ones that we can continue requesting before we completely run out of space to store them all! We are hoping to get permission to begin physically collecting and returning patient files from the patient record offices within the next few days, as its starting to limit the project’s progress (and get a bit annoying!). Once this is done though there’ll be no stopping us!

121

Image retrieved from: http://www.patient.co.uk/health/stroke-leaflet

 

Posted in Emily Pettifor | Leave a comment

Anti-vaccine conspiracy theories

Posted on August 14, 2014 by Richard Barber

Researchers Daniel Jolley and Dr Karen Douglas, of the School of Psychology, surveyed 89 parents about their views on anti-vaccine conspiracy theories and then asked them to indicate their intention to have a fictional child vaccinated. It was found that stronger belief in anti-vaccine conspiracy theories was associated with lower intention to vaccinate.

In a second study, 188 participants were exposed to information concerning anti-vaccine conspiracy theories. It was found that reading this material reduced their intention to have a fictional child vaccinated, relative to participants who were given refuting information or those in a control condition.

The research, titled ‘The effects of anti-vaccine conspiracy theories on vaccination intentions’, was carried out by Daniel Jolley, Postgraduate Researcher, and Dr Karen Douglas, Reader in Psychology, at the University of Kent. It is published in the open-access, online journal PLOS ONE and is available here: http://dx.plos.org/10.1371/journal.pone.0089177.

Posted in news | Leave a comment

Uncovering secrets of cell fine-tuning

Posted on August 14, 2014 by Richard Barber

New research has shown for the first time how structures inside cells are regulated – a breakthrough that could have a major impact on cancer therapy development. A team from the School of Biosciences uncovered the mechanism whereby the physical properties of the internal structures within cells – known as actin filaments – are ‘fine-tuned’ to undertake different functions.

While some of these actin filaments appear to completely stable, providing a framework for the cell, others are more dynamic, allowing the cell to respond rapidly to changes in its environment.

The researchers – PhD students Matthew Johnson and Daniel East, who were led by Dr Daniel Mulvihill – used yeast cells to mimic those in humans. They utilised a novel biology ‘trick’ to switch the location of molecules which bind to, and stabilise, the actin polymer and modulate the movement of molecular motors. In this way, they uncovered the mechanism which determines the functional characteristics of actin filaments in all cells and orchestrates cellular activity. It is expected the breakthrough could have a major impact on the development of therapies for a variety of diseases, including cancer.

The research, titled Formins Determine the Functional Properties of Actin Filaments in Yeast, by Matthew Johnson, Daniel A. East and Daniel Mulvihill, is published in the current issue of the journal Current Biology. See here. 

For more information please contact Dr Daniel Mulvihill.

Posted in news | Leave a comment

Ebola treatments likely in next decade

Posted on August 14, 2014 by Richard Barber

But Dr Rossman said that more research funding will need to be made available to develop these new drugs. He commented: ‘Western Africa is currently experiencing the world’s worst documented outbreak of the deadly Ebola virus, with over 1200 suspected cases and 672 deaths. Presently there are no approved vaccines or therapeutics for Ebola infection and current medical practice is limited to quarantine and supportive care.

‘Since Ebola virus was first discovered in 1976 there has been much research aimed at understanding how the virus works and how it causes disease. However, this research has yet to translate into any licensed treatments because research on Ebola virus is hindered by safety concerns and a broad lack of funding.

‘Despite these limitations, there are currently several vaccines that have been developed that may prevent infection or mitigate the disease if given post-exposure. There are also multiple new therapeutic agents in various stages of development, including a treatment from the Canadian company Tekmira that has been undergoing initial human safety trials in the US.

‘With additional research funds, it is likely that we will have several vaccines or therapies available to treat Ebola virus infections in the decade to come. These treatments may not completely cure the virus, but it may be possible to significantly reduce the loss of life in a future outbreak.’

For more information please contact Dr Rossman, who is a Lecturer in Virology within the University’s School of Biosciences.

Posted in news | Leave a comment

CHSS 25th anniversary lecture update

Posted on August 13, 2014 by Richard Barber

On Friday 4 July 2014 the Centre for Health Services Studies (CHSS) celebrated twenty-five years since its 1989 re-launch. To celebrate our work and history we invited Nick Black, Professor of Health Services Research, London School of Hygiene and Tropical Medicine to give a talk ‘Health services research: the gradual encroachment of ideas’. The presentation is now available to download in Power Point format.

We couldn’t pass up the chance to take photos of the many CHSS staff, both past and present, and our guests who were there on the day, and a photo gallery has been assembled.

Visit the CHSS website to view the photo gallery.

Posted in news | Leave a comment

Week 4 and we have stacks of files!

Posted on August 12, 2014 by cls205

I’m now at the start of my fifth week here at the William Harvey and halfway through my placement. Last week we finished filling in all the patient data that we could get off the computer, so now we’re down to the hard bit of relying of patient files to fill in the gaps. Whilst some files are really detailed, others aren’t as much, so it can be quite annoying when you’ve filled in almost all of the columns and then realise that one detail, like the patients weight is missing. It can also be quite difficult when it comes down to determining a patients score on the modified Rankin Scale (mRS). mRS is used to measure a patients disability and it ranges between 0 (no symptoms and no disabilty) and 6 (dead). In our spreadsheet we have to enter a patient’s pre-morbid (pre-stroke), discharge and 3 month post discharge mRS. These can be recorded in the Ocupational Therapy notes or sometimes they are noted down in a random place in amongst the patient’s other notes. More often than not though none of the 3 required mRS value are written so we have to deduce from the notes what the values are. Since many of the patients are older we cannot simply assume that they have an mRS of 0 as many of them are likely to have some impairment. For example, it may be written that a patient arrived to an appointment walking with the aid of a stick which would indicate an mRS of 2 or 3.

NHS-patient-records-007

Image from: http://www.theguardian.com/ healthcare-network-nihr-clinical-research-zone/patient-data-nhs-live-discussion-roundup

 Midway through the week another huge lot of files arrived so we’re having to find different places to store them. We now have files filling up one large shelf and piled underneath a table. We’re still waiting on our ID cards, but fingers crossed that we’ll have a breakthrough this week!

 We’ve made further progress with the OSA study and have begun taking it in turns to input groups of 10 anonymised letters. The letters are about patients who have attended a TIA clinic after being referred by a doctor, however not all the patients have necessarily had TIAs, which make it both very interesting, and also a little tricky.

These past four weeks have flown by and I’m now halfway through my placement. Everything has become quite familiar here and so far it’s been really interesting to see a work environment that I haven’t experienced before. I’m looking forward to the next four weeks and I’ll see you the same time next week with another blog post!

Posted in Charlotte Simpson | Leave a comment

So, it’s week 1 of my project!

Posted on August 11, 2014 by njh54

I had a brief introduction day last week to get me accustomed to the site and the staff (most of whose names I promptly forgot…sorry!) which was a lot to take in, but definitely got me excited to get started.

Job one would be to sort and analyse the data. However, before this step it was important for me to have a comprehensive understanding of exactly what our research question was, what it entails, and a good background on the topic as a whole, meaning I’ve spent the first week up at the library on campus. I started by researching chronic kidney disease (CKD) and dialysis from a wider view, just to enable me to build up a background of the department I am working in and a better understanding of why it is important for research projects such as this one to be carried out. Due to the focus on the Hepatitis B vaccination within our project my next step was to research this.

After building my knowledge on the area as a whole I began to look more in depth at our specific research question ‘amongst non-dialysed CKD patients who have completed and responded to a full course of hepatitis B vaccination, what proportion continue to have immunity against hepatitis B at 6, 12, 18 and 24 months after initial vaccination?’ I used websites such as PubMed and openAthens to enable me to search for research papers/articles etc already published on this topic area. I used a variety of search terms and looked over titles/abstracts of hundreds of potentially relevant resources, however, the majority of work I found was directly related to patients already receiving haemodialysis treatment. Our target group is specifically undialysed patients, so the amount of literature out there that concerns the same objectives as we do is very minimal, if there at all.

After gathering papers that were of some relevance I started to write what would be the introduction to the paper. For someone that hasn’t done much in this area before I found it quite a challenging task! Scientific writing is very different from that of Humanities or English, it’s very concise and specific and takes a lot of practice to get just right. I re-read and changed it, then re-read and changed it over and over till I felt it was the best I could produce at this stage and something I would be happy to share with my supervisors.

So despite it being a rather lonely, library filled week I feel like I’ve already learnt a lot and picked up skills that will be invaluable for my 3rd year. Next week I will be spending a day in the Labs at Kent and Canterbury Hospital (very exciting!) and also meeting with both Dr Doulton and Dr Strutt to look at what I’ve done so far and discuss the next steps, so i’ll hopefully have something more exciting than literature reviews to share with you next week!

Posted in Natasha Hood | Leave a comment

Supervision – Week 5

Posted on August 8, 2014 by mw434

During my fifth week spent working for the HTS I got to sit in on a supervision meeting with the assistant psychologists who meet up monthly to talk about their past week and generally discuss what is going on in their lives and the workplace. It was interesting to listen and learn more about HTS team dynamics and to get to know the psychologists on a personal level. I also read a chapter of a book by Tim Kitwood who is renowned for being a pioneer for person-centred care. The book told focused on social reasons as to why dementia is a characteristic of the 20th century such as the fact that science largely effects our political, economic and social lives with negative or positive effects, for instance, the treatment and diagnoses of mental illnesses can be seen as science trying to make society conform and think in the same way and stop individualism, even though some mental illnesses are not dangerous to others or harmful to the person. This is week I also completed 400 inputs and should finish entering data this week.

That’s all for now.

Melissa

Posted in Melissa Wills, Placements 2014 | Leave a comment

Week 3: Piles and Piles of Patient Files

Posted on August 8, 2014 by erp3

Having now completed my third week at the William Harvey, time is certainly going faster than I expected. I’ve spent much of my week concentrating on the same SUTO work and completing more practice OSA questions. We also finally finished checking through all of the relevant patients from 2010-2013 to see if they had undergone a CT perfusion scan – a big relief! This was the most repetitive part of the work so far and so it was nice to see it completed, allowing for more time to spend diving into patient notes and filling in our corresponding spreadsheet. With no set deadlines to meet across the weeks I feel that we had made finishing this an important target for ourselves in terms of measuring progress. This has thus allowed us to break down the project into smaller goals and more importantly, spurred us on to finish data collection.

The patient files that we’ve been ordering have continued to flow in and so there’s been lots of interesting work to do. I’m feeling much more confident with finding specific  patient information and am getting faster at going through the files (leaving piles and piles of patient files covering our designated shelves). However, with the amount of random notes from clinicians made across pages in the files and multiple assessment forms having not be completed, it’s always going to take multiple read throughs per person before as much as possible can be gleamed from the available information. We also decided to take a few hours this week to catch up with relevant project reading. Finding similar project papers to our own is a lot easier now compared to our first week. This is due to both having a greater understanding of the projects’ theoretical bases,  as well as being able to actually now use various keywords within searches. Doing this reading has also allowed me to expand my knowledge regarding what some of the information that we have been collecting from patient data actually means (beyond a general overview). For example, I now have a much clearer understanding of the components that make up patient scores against the National Institute of Health Stroke Scale (NIHSS) and what types of questions a clinician may ask in order to assess these. I’ve included an example graphic of these NIHSS components below.

It will be interesting to see how things progress now that we’re concentrating on case files. Although the work’s repetitive it’s hard to get bored. Each new case requires concentration to find the relevant data and shows me something new and interesting, whether it’s different scan results or treatment patterns.

strokeScoreVisualAid

Image retrieved from: http://911stroke.info

Posted in Emily Pettifor | Leave a comment

Week 3 and I’m almost halfway through my placement!

Posted on August 5, 2014 by cls205

So I’m already almost halfway through my placement and the past three weeks have flown by! Not too much has really changed since last week. We still don’t have our ID cards, but as everyone here says “It’s the NHS…”, which is just their way of saying don’t expect things to happen quickly as everyone is always so busy. We found out that the delay is due to the F1 doctors starting at the hosptial, so at least we know that once they’re storted hopefully we’ll be next. On Friday we had our pictures taken for our cards, so that’s a start at least! Since we can’t order anymore folders as we’ve already taken up a lot of space with the ones that we already have, we’ve instead started to fill in the spreadsheet with patient data that’s only on the computer. This means that whilst there’s lots of gaps, it’ll make our job easier later on when we have the patient folders. Early on this week, we finally finished the long task of determining out of all the patients over the past 3 years, which had had strokes of unknown time of onset, and which hadn’t. After completing that list we rearranged all of our spreadsheets to include the new SUTO patients and we reorganised and reheaded some of the columns so that it all just made a bit more sense.

One thing that I started doing last week was making myself a list of keywords, because I’ve constantly found myself googling the definitions of things, whether it’s to find out if a drug is an antihypertensive,  e.g. Amlodipine, or what exactly a stroke of cardioembolic origin is. I’ve found my keyword list to be really helpful and it’s given me physical evidence of just how much I’ve learnt! Here are just a few examples,

    •  Atrial Fibrulation (AF), where the atria, the two chambers at the top of the heart spasm and beat out of rhythm from the rest of the heart. This prevents the blood from circulating properly through the heart and can lead to blood clots. This is a major risk factor for stroke.
    • Cardioembolic Stroke,where a blood clot forms in the heart and travels to the brain, leading to a stroke. Can be caused by AF.
    • Aponea-Hyponea Index (AHI), used to measure the severity of sleep aponea (pauses in breathing whilst sleeping, may be possible stroke risk factor and is the basis of the OSA study). It is measured in the number of events lasting longer than 10 seconds per hour of sleep. Anything over 30 is considered to be severe.

Last week we also did some more work on the OSA study. As it’s a brand new project, we’re still trying to iron out some of the kinks in the spreadsheet, so me, Emily and Dr Webb have been filling in the data for the same patients separately and then comparing our work. It’s been really useful as I’ve been able to see where I’ve gone wrong, so I can correct it before the project starts properly.

I definitely feel like I know what I’m doing now, which is a really nice feeling. I’ll see you again next week with another update from the William Harvey!

Posted in Charlotte Simpson | Leave a comment