PhDs seeking funding
The Centre for Trials Research aims to improve the health and well-being of society through recognised excellence in clinical trials and other well-designed studies. The unit has four divisions: cancer; infections inflammation and immunity; mind, brain and neuroscience; and population health.
The following studentship topics are led by Centre researchers and are seeking funding. Student-led applications/topics relevant to the Unit and divisions (i.e. on related topics with different supervisors) are also very welcome.
If you are interested in any of these PhDs please contact the lead supervisor.
UK guidelines, published in 2007, recommend the prompt diagnosis and treatment of childhood UTI in order to prevent long-term complications. Urinary tract infection (UTI) is one of the commonest causes of serious bacterial illness in young children and an important cause of hospital admission. In addition to significant short-term morbidity, childhood UTIs can also cause renal scarring and associated long-term complications including hypertension, chronic kidney disease, pre-eclampsia and renal failure. However, UTI is often missed in primary care.
A urine sample is necessary to diagnose UTI in childhood as the presenting symptoms are non-specific and similar to those found in many common childhood illnesses and guidelines promote a fairly broad urine sampling strategy. Approximately 6% of acutely ill children are found to have a UTI when all children are sampled. However, we have previously estimated that urine is sampled in less than 2% of acute illness consultations with children less than five years old and preliminary analysis of the recently completed LUCI study data suggests it is only sampled in 1.2% of GP consultations with children less than five years old in Welsh GP practices. We have also shown that sampling urine based on clinician suspicion is likely to miss 80% of childhood UTIs in primary care. However, we do not know whether increasing urine sampling would increase UTI diagnosis, or what the best way would be to increase urine sampling or improve UTI diagnosis.
There are barriers to considering the possibility of UTI, and requesting a urine sample when assessing an acutely ill child, and there are also barriers to obtaining a urine sample, particularly in non-potty trained young children. There is an urgent need to understand these barriers, along with other factors associated with low levels of urine sampling and UTI diagnosis.
This mixed methods PhD aims to determine the levels and variation in urine sampling in Welsh general practice using linked general practice and microbiology data from electronic health records; to explore doctor and parental barriers to requesting and obtaining urine samples from children; and to develop an intervention to improve urine sampling in primary care.
A key output of this research will be to use these findings to inform the development of an intervention to improve the situation in the diagnosis of UTI in children in primary care. This could impact health for children, reducing delay to UTI diagnosis and treatment; reducing morbidity, suffering and possibly avoiding hospital admission associated with the acute illness; and reducing the risk of developing renal scarring and possible long-term complications.
Dr Rebecca Cannings-John, Dr Kathryn Hughes, Professor Fiona Wood
Levels of C-reactive protein (CRP) rise in the blood in response to infection. CRP levels can therefore help healthcare professionals with decisions around the diagnosis and antibiotic treatment of infections. Traditionally, CRP testing was done in hospital laboratories with a 24-48 hour wait from the time the blood was taken to receiving a CRP result. This meant the test was less useful for GPs needing to make an immediate decision about a possible infection in a patient who was consulting with them at that time. However, we are now able to measure CRP with a finger prick blood test in GP surgeries.
This provides a result in 2-4 minutes and can help GPs to effectively diagnose and treat infection at the initial consultation. Clinical trials have shown that GPs can safely reduce unnecessary antibiotic prescribing and improve patients’ perceptions of their health by using CRP testing in their surgeries to help identify which patients may or may not have serious infection. However, it is likely that GPs will use CRP testing differently in normal clinical practice then they would in a clinical trial.
The purpose of this research is to determine whether the benefits of CRP testing are sustained long-term in normal clinical practice before it is rolled out more widely. For example, do GP surgeries with CRP testing facilities have sustained reductions in antibiotic prescribing, without an increase in rates of infection-related complications?
We will do this research using anonymised data from the SAIL databank by looking at rates of antibiotic prescribing and infection-related complications over time in surgeries with and without CRP testing. A key output of this research will be recommendations to help the NHS in Wales decide whether rolling out CRP testing is cost effective and beneficial to patients and the NHS.
Dr Rebecca Cannings-John, Dr David Gillespie, Dr Kathryn Hughes, Dr Harry Ahmed, Dr Emma Thomas-Jones
The main aims of this qualitative mixed method study are to:
- Understand and characterise how contextual factors and the organisation of care influence healthcare professionals end of life skin care related decision making in primary care
- Ascertain if they are differences in how healthcare professionals make decisions about key tenets of palliative care (e.g. symptom control, nutrition and hydration) compared to key care quality indicators (i.e.: pressure ulcers, medication errors and falls) in primary care
- Characterise the role that patients, their families and carers play in end of life care related decisions by healthcare professionals in different primary care settings
- Establish the impact of advance care planning on healthcare professionals end of life care related decision making in primary care
The project will build extend previous qualitative research conducted by Dr Ray Samuriwo on pressure ulcer care in the cancer patient palliative care setting to include other life limiting conditions, and will comprise the design and implementation of a survey and virtual/telephone one-to-one and/or focus group interviews of health and social care professionals, carers and workers at selected primary care sites (hospices, nursing homes and in the patient’s own home) in England and Wales.
Enterobics vermicularis (threadworm) is the commonest parasitic worm infection in the UK, with 40% of children estimated infected at some time in their lives (1). Diagnosis and treatment vary in developed and underdeveloped countries, and the UK approach has changed little in recent years.
Infection is usually mild, the main symptom intense perianal itching, but often asymptomatic, only becoming apparent following rare appearance of worms on perianal skin/stools. The female genital area can also be infected resulting in vulval itching. Nocturnal itching may lead to disturbed sleep, irritability and difficulty concentrating. UK diagnosis is usually via parental/self- diagnosis via symptoms alone either with or without local pharmacy advice, or less likely presentation to GP plus or minus diagnostic testing for eggs via a simple laboratory-based microscopy ‘tape test’ using samples taken by the parent/patient. Testing is generally only triggered upon presentation at GP following recurrent infection.
UK NICE guidance recommends Mebendazole as treatment for primary site intestinal infection. Mebendazole is one of six broad-spectrum anti-parasitic drugs known as benzimadoles with the same molecular action. This group is routinely used in human and veterinary medicine. Emerging drug resistance, and national human de-worming programmes in under-developed countries without routine resistance screening, are of increasing concern. However routine collection and screening of clinical isolates does not currently occur in the UK. Due to recommendations to dose all family members, Mebendazole is only available in the UK in ‘family’ size packs. It is sourced via local pharmacies either over the counter off-prescription or free of charge on-prescription via the Common Aliment Service (CAS; provides diagnosis and treatment of 27 common conditions), and less commonly GPs. Welsh CAS 2019-2020 data indicated threadworm as the 4th commonest condition supported via CAS; 9% of total consultations.
Threadworm can lead to a variety of complications ranging in severity if untreated or recurs, including secondary bacterial infection, migration of adult worms to ectopic sites, colitis, intestinal complications, and female infertility. It can also be misdiagnosed as dermatitis, pubic lice or candida infections, gastrointestinal and systemic disease, or more severe helminth infections, e.g. round, tape and hook worm.
Due to multiple routes of patient presentation, prescribing and treatment, routine UK data collected about this condition is disjointed and the true current incidence and prevalence of infection, complications and associated drug resistance is unclear.
The aim of this project is to synthesise evidence of the current incidence and prevalence of threadworm infection and resistance, and treatment and diagnosis practices in the Welsh population.
The project will comprise the following components:
- A systematic literature review of incidence and prevalence of threadworm infection and resistance in the developed world.*
- An observational study in the UK CAS/pharmacy setting to generate incidence data around symptomatic infection including symptoms, diagnosis and treatment practices, patient recovery, and compliance and follow up. This will comprise a survey completed by pharmacies, and ‘tape-test’ samples taken by service users for subsequent laboratory analysis to confirm actual infection status.
- An observational study to determine the current status of asymptomatic threadworm infection levels in Welsh primary school age children. Parents at participating primary schools will collect ‘tape test’ samples from all family members for subsequent laboratory analysis to confirm presence of asymptomatic infection.
- A qualitative study of patient experiences comprising questionnaire and/or survey sampling of pharmacy service users presenting in component 2) and/or parents participating in component 3).
Tape-test samples will be posted to a local laboratory (e.g. PHW) for analysis by the student using basic microscopy techniques to determine the presence of threadworm eggs.
It is anticipated that the results will be published and used as evidence synthesis to identify evidence of over- or under-treatment/prescribing and any associated need for change in current practices, ultimately aimed at supporting improved mebendazole drug stewardship in Wales. There is potential for the project to lead to a subsequent mutational analysis of threadworm stool isolates through liaison with the wider helminth UK research community.
References: McCormick, A., Fleming, D. and Charlton, J. (1995) Morbidity statistics from general practice. Fourth national study 1991-1992. Office of Population Censuses and Surveys. http://www.statistics.gov.uk
- Dr Joanna Smith, Trial Manager/Research Associate/Genitourinary tract I3 theme lead, CTR, School of Medicine, Cardiff University
- Dr Kathryn Hughes, Senior Lecturer, School of Medicine, Cardiff University
- Dr Efi Mantzourani, Reader in Pharmacy Practice, School of Pharmacy, Cardiff University