Students on all of our undergraduate courses at Warwick Medical School conduct research as part of their degree, and last autumn 20 of them presented at the International Conference of Undergraduate Research (ICUR). We spoke to some of the students to find out more about their research and their findings.

Quantifying the abilities of an open-source high resolution microscope

Harriet Sharp and George Smith

Our research project was focused on quantifying the abilities of the eduWOSM, an open-source high resolution microscope developed by professors at the University of Warwick. We believe it could be extremely useful, potentially increasing accessibility of high-resolution microscopy, thus providing a vital tool for scientific discovery.

We conducted our research as a cohort of ten, performing quantifiable experiments like stroboscopy, point spread function, photobleaching of green florescent proteins (GFP) and fluorescent bead diffusion. We collated data between the group and, with the help of professors, formed conclusions and further hypotheses on the eduWOSM’s ability.

The overall conclusion from our research suggested the eduWOSM is a promising tool for accessible high-resolution microscopy. Preliminary results suggest it performs as well as some of the more expensive, less user-friendly microscopes. Furthermore, we found it can be controlled without specialist training and merits images and resolution qualities comparable to the world’s leading optical microscopes. Nevertheless, we also found scope for improvement, namely in image peripheral uniformity and brightfield florescence, with these issues being currently addressed and researched by undergraduate students and professors.

When doing the research, we didn’t expect to be presenting it, so to look at our research with the intent of sharing it was an interesting process for us. We had to change the way we communicated our topic as it’s easy to get very technical when you know a lot about the subject. The communicative side of academia is not something we would have thought about before and we enjoyed the opportunity to use these different skills.

Exploring the length of stay within forensic hospitals

Aóife Moffatt

My research topic explored the Length of Stay (LoS) within forensic hospitals. This is a subject which is not widely reported and is highly variable. Forensic hospitals are secure units for offenders who have been sectioned and range from low to high security. I undertook the research in my second year as part of my student selected component of my medicine degree.

My research aimed to understand the LoS, the factors which affect it and the implication for patients, clinicians, and commissioners. Understanding these factors can enable guidance and pathways to be updated to achieve the best possible outcomes for patients. This is important as streamlining and improving efficiency of services is beneficial to not only the institution and its finances but also the patients and their rehabilitation.

Due to the pandemic and working with NHS 111, my research was conducted from my bedroom, and I only spoke with my supervisor through Teams calls. I carried out a systematic review approach to answer the study aims and my results were summarised narratively. I searched databases looking at the length of stay in forensic hospitals and the factors which affect it. Prior to undertaking my project, the amount of reading required was daunting to me and I felt my dyslexia may impact my ability to complete the project, but I found with the right support from others and assisted technology, I could succeed.

The key findings I discovered can be split into intrinsic and extrinsic factors. Extrinsic factors such as the security level, resources and treatment received all affected the LoS. Intrinsic factors such as lower education status and previous crimes also increased LoS.

My research taught me new methods of conducting, sharing, and presenting research. Presenting to an audience taught me that I really had to know my research inside out to be able to explain it clearly and to answer the wonderful questions I might not have considered before.

Investigating the prognosis of patients on the alternatives to aspirin following a heart attack

Emmanuel Shofoluwe

My research investigates the outcomes of patients on alternative anti-platelet drugs for patients who can’t take aspirin following a heart attack (which is known as a myocardial infarction (MI)). I decided to focus on this area of research to shed more light on the research question. Furthermore, a significant number of patients experience an MI each year. Unfortunately, a small proportion of these patients cannot receive aspirin due to hypersensitivity. I wanted to know if the alternatives were just as effective as the gold standard.

Admittedly, the Covid-19 pandemic was another reason for conducting this research. My original research project (which is on-going) was suspended due to initial fears of increased transmission rates, and eventually the first UK lockdown came into effect. Thus, a project which could have been done virtually - ie a systematic literature review - was conducted instead.

For my systematic literature review, some of my inclusion criteria were patients who had suffered from an MI and had received either dual antiplatelet therapy or mono antiplatelet therapy. Other inclusion criteria included studies conducted in English, and preference was given to studies that were Randomised Controlled Trials.

Key findings from my research showed that alternatives to aspirin such as clopidogrel, ticagrelor and prasugrel are indeed viable options. An important finding is that the prognoses for these patients are like those on aspirin. Furthermore, the rates of major adverse cardiac events (MACE) for the aspirin patient group and the other antiplatelet drugs patient group were similar. Whilst this is very much good news for patients who have aspirin hypersensitivity, the risk of any drugs should always be weighed up with the benefits.

Discussing my research at the International Conference of Undergraduate Research was very encouraging. In academia there are many questions to be answered and presenting at the conference helps to shed some light on these questions. It also showed me that there was more for me to learn in terms of academia and how to conduct projects more efficiently. I am currently conducting further cardiac research with clinicians at University Hospital Coventry and Warwickshire and hope to share some results at the next conference.

Investigating the effects of improved quality of sleep on
cancer-related fatigue

Rogan Dean

My research was about Cancer-related Fatigue (CRF) which is the feeling of exhaustion that cancer patients feel because of their cancer and its treatment. I did a systematic review about whether improving the quality of sleep in this patient group can help relieve the symptoms of CRF. I chose to focus on this topic as it is a debilitating condition for cancer patients and is often overlooked in their treatment. CRF greatly impacts quality of life in cancer patients and managing it could go a long way in helping these patients feel like themselves again.

My research was done as a systematic review. Many weeks were spent developing a search term that would efficiently get as many papers as possible that were relevant for my research. I then combed through them to check if they matched my inclusion criteria. Papers were removed if they didn’t measure sleep or fatigue as primary outcomes, if the patients weren’t over 18, if the patients didn’t have cancer or a history of cancer and if the papers were written in a language other than English.

The key findings from my research were that improving the quality of sleep in patients with CRF does relieve the symptoms of fatigue that they feel. The most effective way of improving sleep was to use cognitive behavioural therapy (CBT), which has additional benefits of being able to be used remotely, requires no additional equipment or effort from the patient, and is accessible for all patients regardless of condition or disability.

The one thing I’d like people to know from my research is that cancer patients don’t have to live with CRF and that things can be done to combat this to improve their quality of life.

Presenting my research and being involved in academia is something I’ve always had a passion for and is something I wish to pursue in the future.

Examining the associations between undernutrition and the academic performance of school children

Emily Kidner and Kajani Subhaskaran

Our research project was a systematic review which aimed to assess associations between undernutrition and the academic performance of school children, exclusively in low-and-middle-income countries (LMICs).

We chose this topic as part of our Student Selected Component 2 (SSC2) module. We both have an interest in nutritional studies and child health. We found shocking statistics regarding undernutrition. Approximately a quarter of children under the age of five are undernourished, with this number continuously rising because of the Covid-19 pandemic. Moreover, 90% of children within this group reside in Africa or Asia. As well as leading to mortality, undernutrition is also linked to impaired mental development and poor academic performance in children, which affects their future wellbeing. Our aim was to focus on the impact of undernutrition on children’s academic performance, exclusively in LMICs where undernutrition is worst.

We used three electronic databases to identify papers which were relevant to our research, and which fitted our eligibility criteria. Following this, we extracted quantitative data from the selected studies, which included measures of undernutrition, academic performance, and associations between both.

Many of our studies showed that stunting (where height-for-age score is below 2 standard deviations of the average) was negatively associated with academic performance. This would suggest that children who are stunted have poorer academic performance than those who are not stunted. The associations between wasting (where weight-for-height score is below 2 standard deviations of the average) and underweight (where weight-for-age score is below 2 standard deviations of the average) were less clear. There were also several confounding factors which were found to be significantly and independently associated with academic performance.

Our research indicates that dietary-based interventions alone cannot successfully overcome the problem of undernutrition in LMICs. Multifactorial interventions which address the underlying determinants of undernutrition, such as poor socioeconomic status, are also vital. This is a message which can be translated into all aspects of research – it is crucial to always consider ‘the complete picture’ to tackle the essence of a problem.

This was our first experience of collaborating on a research project. Working together brought about many stimulating conversations and, by discussing our findings together, we could share varying ideas and opinions. We believe that this led to more thorough analysis and, therefore, to higher quality research.

Presenting our project at the ICUR conference demonstrated first-hand how academic research can have a huge global impact. We received questions from audience members across the world, which proves how our research has sparked important international discussion. This gave us a great sense of pride and achievement and has encouraged us to become involved in more research in our future careers.

Congratulations to Emily and Kajani, who were awarded the prize for Best Spoken Presentation at the ICUR Conference.

Improving the accuracy of predicting hip fracture in patients
with osteoporosis

Caitlin Murphy

Hip fractures are a common occurrence and as a result are a financial burden for the NHS. I wanted to see if there was something we could do as a population that would help reduce this burden, both at a national level but also for the individual patient. This led me to conducting a systematic review, looking at using the new technology of active shape modelling to improve the accuracy of predicting hip fracture in patients with osteoporosis.

Active shape modelling uses the 3D shape of a bone as a variable and can be combined with other parameters such as bone mineral density. The studies included in my review used hip X-ray images of osteoporotic patients and incorporated active shape modelling, as well as bone mineral density measurements, to predict future hip fracture and compared the predictions to bone mineral density measurement alone. I used databases such as EMBASE and OVID to look up the studies that have incorporated active shape modelling into analysing hip joints and fracture prediction in osteoporotic patients.

Current clinical practice for osteoporotic patients to determine disease progression and subsequent hip fracture is to use bone mineral density measurements of the hip joint itself and it vaguely looks at the shape. The research I conducted looked at whether adding an extra layer (looking at the 3D shape of the bone as well as the bone mineral density measurements) would be more accurate in the prediction of hip fractures. Analysis of the papers generated by this systematic review did indeed show there was an increase in accuracy in prediction of hip fractures with added dimensions of the measurement.

The research I conducted only generated two papers that were fit for analysis due to the criteria set. This was obviously less than ideal and limits how much can be taken away from this systematic review.

Presenting my systematic review at ICUR was very rewarding as it meant that independent researchers and likeminded individuals from all over the world came together. In the future I may consider research but hopefully this time next year I’ll be working as a junior doctor so most of my time is going to be dedicated to trying to be the best doctor I can be.

Evaluation of the NICE traffic light system at identifying serious illness in a febrile child

Juliette Pope

Fever in young children poses a clinical dilemma - only 7% are bacterial infections, a leading cause of death in children under five. Nevertheless, it’s the second most common reason for hospital admissions, with inappropriate antibiotic prescription causing a 9.9-fold increase in treatment cost. In 2007, the National Institute for Health and Care Excellence (NICE) established the assessment of fever in under-fives. This guideline has since become world leading yet has limited evaluation in clinical practice. There are currently no systematic reviews specifically for the NICE guideline, with predominantly expert opinion being used as evidence for practice. I therefore decided to perform a systematic review, analysing the diagnostic accuracy of its triage tool, the traffic light system (TLS). The traffic light system is utilised as a screening tool to determine how acutely unwell a child is. It categorises signs and symptoms the child presents with into green, amber, or red to enable appropriate management.

A systematic review was performed due to being under Covid-19 restrictions during the first lockdown and having to adapt to working from home for our Student Selected Component. For my study I created a search strategy and applied it to four databases: Web of Science, Medline, CINAHL and EMBASE.

In this study the main outcome was the diagnostic accuracy of the TLS. The overall sensitivity is good, proposing most serious bacterial infections will be identified. However, the positive likelihood ratio is not clinically significant as it is less than five, implying a patient with a serious illness identified by the TLS is only slightly more likely to have it than a patient without. Furthermore, the specificity range was 7-80% and the negative likelihood ratio range is 0.13-0.81. The broad range for specificity means it’s difficult to know the true value however the negative likelihood ratio is predominantly close to one, signifying a patient without serious disease is almost as likely to be classified as high-risk as someone with a serious bacterial infection.

I presented my systematic review at the international conference for undergraduate research (ICUR). The key finding from my research is the TLC will correctly identify bacterial infections but at the cost of over-treating viral illness. Therefore, future research needs to focus on how to safely discharge self-limiting viral disease in the under-fives.

The experience of presenting at a conference has enabled me to view a variety of research within medicine, inspiring myself to be involved in research throughout my career.

Examining the effect of physical activity on burnout and quality of life in medical students

Charlotte Taylor

My research examined the effect of physical activity on burnout and quality of life in medical students. I chose this topic during Phase II of the course, in the student selected component (SSC).

I have an existing interest in physical activity and its effect on health outcomes from my previous degree in Sport and Exercise Sciences. Throughout my time at medical school, many of my friends and I have experienced burnout due to pressures of the course. I think it is extremely important that we investigate strategies that can be used to maintain optimal wellbeing in medical school. By doing so, tomorrow’s doctors will be better prepared for the demands of being a junior doctor and hopefully have a more enjoyable time during medical school.

My project was a systematic review, completed remotely during the first Covid-19 lockdown period. Firstly, five online databases were searched using key terms such as ‘physical activity’. All papers were then screened to establish whether they met the inclusion criteria. Finally, data was extracted and synthesised into a narrative review.

Due to the nature of the rapidly evolving situation, we were sadly unable to undertake primary research of our own. I spent time researching several topics and establishing where there were gaps in the literature.

My systematic review included over 11,500 medical students from 13 countries across the world. I recognised that further research into the intensity, frequency, volume, and mode of physical activity is necessary to identify the minimum level of physical activity required to reduce burnout and increase quality of life significantly.

Physical activity is associated with improved wellbeing in medical students. This is an exciting prospect as I believe it is something that could be implemented widely into medical education once researched further.