medicine - university of hull postgraduate study guide 2009

MEDICINE

Postgraduate study

THE UNIVERSITY OF HULL

ADMISSIONS OFFICE,THE UNIVERSITY OF HULL, HULL, HU6 7RX, UK

T 01482 466850F 01482 442290E [email protected]

www.hull.ac.uk

Medicine 1

CONTENTS

RESEARCH AND STUDY AT THE PGMI 2

STAFF AND THEIR RESEARCH INTERESTS 8

2 Medicine

The culture oforiginal research

fostered by thePostgraduate MedicalInstitute (PGMI) is a

major factor inunlocking theconsiderable

potential of theregion’s medical and

bioscience staff and its patient

population.Our research is

focused on key areasin which we haveproven expertise.

These include cancer,cardiovascular

disease,musculoskeletal

ailments,psychoneuro-

immunology andclinical psychology.

RESEARCH FOCUSBoth the PGMI and the Hull and East YorkshireHospitals NHS Trust have identified cancer andcardiovascular disease as key research areas in theregion. In the recent Department of Health review ofthe trust’s Research and Development programmes,both cancer and cardiovascular and pulmonary workwere rated as strong (the highest category).

The third focus is on musculoskeletal research.Thiswas identified as a key research area, and oneparticularly well placed for development throughinterdisciplinary projects, in the latest review ofresearch by the North and East Yorkshire andLincolnshire Health Authorities, Hull York MedicalSchool (HYMS) and the University.This activity willbuild on the expertise within the Medical Engineeringand Technology sub-unit and capitalise on recentappointments in HYMS as well as the University’sexpansion of Sport, Health and Exercise Science.

Cardiovascular research([email protected])The University of Hull has one of the most activecardiovascular research departments in Europe, withan international reputation for excellence in clinicalresearch.

The department boasts several world-renownedclinical scientists, including Dr Andrew Clark (clinical),Professor John Cleland (clinical), Dr Nikolay Nikitin(echocardiography and magnetic resonance imaging)and Dr Anne Tweddel (nuclear imaging).

The mission of the Cardiology Research Group is toclose the gap between clinical research and clinicalpractice, thus improving patient care by bringingclinical practice closer to how research is delivered inresearch trials and by ensuring that research is morerelevant to clinical practice.

The focus of our work is interdisciplinary researchinto major structural heart disease, includingpathophysiology, epidemiology, quality of life, anxietyand depression, cognitive dysfunction, advanceddiagnostics and therapeutics, interventionalprocedures and devices, surgery, decision supportanalysis and health services research. Each item in thisprogramme is supported by a mixture of doctors,nurses and postdoctoral non-clinical scientists.Thereare exceptionally strong programmes investigatingthe epidemiology of heart failure, cardiac magneticresonance imaging and echocardiography,psychological aspects of disease, exercise physiologyand novel data-analysis techniques.The CardiologyResearch Group has links with researchers in manyother areas, both clinical (e.g. renal, gastro-enterology,care of the elderly, diabetes, radiology) and non-clinical (e.g. biological sciences, engineering, computerscience, sport science).

Hull is the coordinating centre for several majorinternational trials investigating new treatments forheart failure, including cardiac resynchronisation(CARE HF), diastolic heart failure (PEP CHF),telemonitoring (TEN-HMS), revascularisation(HEART) and antithrombotic therapy (WASH andWATCH).

RESEARCH AND STUDY AT THE PGMI

Respiratory medicine ([email protected])Work on respiratory medicine makes us the world’sleading centre for the investigation and diagnosis ofcough.The Hull Cough Clinic has the literature’slargest collection of chronic cough patients, fromwhich we are able to study the pathology, physiologyand clinical pharmacology of the commonest medicalsymptom.The molecular pharmacology of clonedcough receptors and the influence of inflammationare studied in our new basic science laboratory.

Wound healing research ([email protected])The Hull and East Yorkshire Wound Healing Instituteis a new venture that has come about through aunique collaboration between HYMS, the PGMI,Smith & Nephew and the local acute and primarycare NHS trusts.The emphasis has been ondeveloping a centre of excellence for wound healingresearch by building on the established areas ofclinical excellence within nursing and medicalcommunities in the area, with the aim of impactingdirectly on the quality of care provided for thepatients of Hull and East Yorkshire. In addition to themore established areas of laboratory-based andclinical research, the institute will be particularlyinterested in research into community-based chronicwounds, and in this respect it is unique in the UK. Itwill also provide a focus for training and certificationfor the NHS and industry.

Oncology research ([email protected]; [email protected];[email protected])Clinical and research programmes have beenestablished in the fields of colorectal, breast, lung,melanoma, and head and neck surgical oncology, aswell as vascular surgery. A thematic approach totranslational research aims to improve patient care inall areas.There are three medical researchlaboratories dedicated to this work, two on the maincampus, the other on the Castle Hill Hospital site.

Our laboratory-based research portfolios alsoinclude programmes in cancer genetics, tumourimmunology and vascular biology.These programmesare led by a team of specialist scientists who work incollaboration with clinical partners.The threeresearch laboratories are managed by the Division ofCell and Molecular Medicine(www.hull.ac.uk/pgmi/cell_and_molecular/index.html). In order to maximise expertise andmake the best use of all facilities, each laboratory hasbeen given a distinctive focus: the R&D Laboratory(Castle Hill Hospital) specialises in molecular geneticsand histology; the Biomedical Research Laboratory(Containment Level 2) specialises in DNAmanipulation and expression; and the MedicalResearch Laboratory specialises in immunology andfunctional cell assays.

In the clinical arena, projects include approaches tohealth care delivery utilising minimally invasivetechnology and computer-based analysis of outcomeprognostication. Clinical programmes in all areas areconducted in state-of-the-art units, recognisedinternationally for clinical care, training and clinicalinnovation, that offer regionally based treatmentfacilities.

Medicine 3

4 Medicine

Two unique Oncology Health Centres have beenestablished in the last five years. Each year more than1,500 new patients now attend these unique clinicalfacilities, which, in addition, provide an infrastructurefor a programme of psychosocial oncology research.Currently, two psychoneuroimmunological (PNI)randomised clinical trials (RCTs) are being carriedout. Building on a previous trial in locally advancedbreast cancer, an RCT funded by Cancer ResearchUK is currently comparing the effects of relaxationand guided imagery, alone and in combination, inmen and women with colorectal cancer.The secondpsychoneuroimmunological RCT, funded by theNational R&D Cancer Programme, is evaluating theeffects of reflexology and scalp massage in womenwith breast cancer. In addition, biopsychosocialdatabases of colorectal cancer and brain cancer havebeen established with a view to developing novelcombinations of prognostic indices for the outcomesof these diseases.This work entails a high level ofmultidisciplinary teamwork, involving medical andsurgical oncologists, clinical psychologists, clinicalnurse specialists and basic scientists.

The PGMI is also leading on the psychologicalprotocols of two multi-centre studies funded by theMedical Research Council. One of these studies(MARIBS) is comparing the sensitivity and specificityof magnetic resonance mammography in women athigh risk of breast cancer.The psychological andfinancial costs of these two screening methods arekey components of the evaluation.The other studyfunded by the MRC (TOMBOLA) is a trial ofdifferent approaches to managing a borderline orlow-grade abnormal cervical smear.

Other ongoing RCTs are evaluating the psychosocialimpact of an innovative method of assessment (pre-surgical magnetic resonance mammography – fundedby the HTA) and new approaches to treatment(sequential versus continuous neoadjuvantchemotherapy, and the aromatase inhibitors – fundedby the pharmaceutical industry).These studies involvecollaborations with a number of other universities,including the Universities of Cambridge andNottingham.

Future studies are likely to focus on the evaluation ofcomplementary therapies and psychologicalinterventions in cancer patients and their families.

For opportunities inbiomedical science,see the Science and

the Environmentpamphlet.

Clinical biosciences ([email protected])Over recent years the University of Hull hasdeveloped a national and, in many cases, internationalreputation for translational research, particularly inthe fields of cancer and cardiovascular disease.TheUniversity has established an interdisciplinaryresearch institute with the aim of understandinghuman disease at a molecular, cellular and whole-animal level and thereby ultimately fosteringimprovements in patient diagnosis and therapy.

The Clinical Biosciences Institute is superbly equippedwith cutting-edge instrumentation and supportfacilities, with units both on the University’s HullCampus and at the local hospitals.

Students from the PGMI, Biological Sciences,Chemistry, Engineering and Computer Science are allworking in this unique multidisciplinary environment,contributing their individual skills and benefiting fromthe complementary expertise of world-class researchleaders.There is a vibrant and stimulating researchculture that welcomes postgraduate students whowish to contribute to translational clinical biosciences.

Three disease states act as foci of research activity:cancer (in particular photodynamic therapy andimaging), cardiovascular disease (heart failure) andmusculoskeletal disorder (biomedical engineering).Currently supported topics of work within theseareas include

• targeted tetra-aza-macrocycle conjugates fortherapy and imaging

• novel sensors of mitochondrial function• incorporation of advanced biological imaging into

the optimisation process for advanced treatmentof cancer by radiation

• three-dimensional computerised quantitativeanalysis of myocardial motion and deformationusing tagged magnetic resonance imaging

The institute has benefited from substantialinvestment in infrastructure over the past few years,which has allowed the development of state-of-the-art research facilities:

• a 500 MHz wide-bore NMR machine to enhancethe University’s biomedical NMR capabilities,allowing analysis of isolated cells and clinicalsamples as well as tissues in vivo and solidmaterials (such as bone)

• a biomechanical test and analysis laboratory and abiomechanical motion analysis laboratory, withprimary foci on musculoskeletal research inrelation to health and disease and fundamentalstudies of form and function

• refurbished and upgraded synthetic chemistrylaboratories to underpin much of the moleculardisease and therapy development studies

The PGMI is a leading member of the Hull MedicalImaging Science and Technology (HullMIST) ResearchGroup, hosting the Centres for Magnetic ResonanceImaging and Metabolic Bone Disease(www.hull.ac.uk/medphys/page2.html). It alsocontributes to the research activities of HIVE (HullImmersive Visualization Environment) in ComputerScience, along with Nuclear Medicine and RadiationPhysics within Hull and East Yorkshire Hospitals’Medical Physics Service.

The Centre for Medical Engineering and Technology(CMET: www.hull.ac.uk/cmet) undertakes a widerange of research from fundamental studies of theform and function of human and animalmusculoskeletal systems through the design anddevelopment of medical devices to computer-assisted diagnosis and surgery. Its research activitiesrelate to three broad themes: modelling andsimulation, visualization and devices.

Medicine 5

6 Medicine

Musculoskeletal research([email protected])A number of trials which evaluate the effectivenessand cost-effectiveness of physiotherapy formusculoskeletal disorders are conducted andcoordinated at the Institute of Rehabilitation in Hulland the surrounding area together with collaboratorsfurther afield, including the Department of HealthSciences at the University of York.The focus of theresearch is on biopsychosocial aspects ofrehabilitation. One trial on exercise for back pain(HULLEXPROB) and another on neck pain(SPRINTER) have recently been completed andpublished. Professor Moffett was one of the fourprincipal investigators on a large multi-centre trial ofphysical treatments for back pain funded by the MRCand conducted in 15 centres around the UK. It wasled by Professor Ian Russell from Health Sciences atYork.The main results were published recently in theBritish Medical Journal.

Current research includes the McKABI trial and theGET UP neck pain trial.

McKABI is a randomised controlled trial comparingtwo physiotherapeutic approaches which both aim toencourage self-management for patients with neckpain and back pain, the McKenzie system And a BriefIntervention.The latter incorporates cognitive-behavioural principles (a solution-finding approach);the McKenzie system is a predominantlybiomechanical approach. Participants are recruitedfrom physiotherapy departments in Hull, the EastRiding, Leeds and Dewsbury.

The GET UP neck pain trial is an RCT comparinggraded exercise treatment and usual physiotherapyfor patients with neck pain (see photo below).Theintervention is designed to include the use of spinalstabilisation exercises for the neck and gradedexercises for the upper limb which may be importantaspects of a rehabilitation programme.

PREFICS is another RCT which has recently beenfunded by HYMS pump-priming money. It is a pilotstudy to evaluate the prevention of falls and relatedinjuries in older people in a community setting bymeans of exercise. Balance will be measured by usingstate-of-the-art equipment at the University of Hull’sDepartment of Sport, Health and Exercise Science.

Another strand of research which is led by theInstitute of Rehabilitation relates to the allied healthprofessionals.This is an exploration ofphysiotherapists’ attitudes, knowledge and skillspertaining to the use of effective communicationstrategies within the initial consultation.

Other research projects currently being developedare collaborative projects with pharmacists in Hulland Leeds and with local practitioners ofcomplementary medicines.

Future plans include the development of psychosocialapproaches to improve the effective management ofmusculoskeletal disorders and the identification ofclinically effective and cost-effective treatments.

POSTGRADUATE STUDYThe PGMI supports the University’s strategic focuson multidisciplinary research ranging from moleculesto man, and it provides opportunities forcollaborative research with major national andinternational interests. Registration is available forMSc, MPhil, PhD and MD by research. Opportunitiesfor research towards MPhil and PhD degrees areoffered through both HullMIST and CMET.

For further details contact

Jane KitsonPostgraduate Medical InstituteT 01482 465348E [email protected]

Or alternatively contact members of staff directly inyour chosen area of research.

Clinical Psychologyis organised around the ClinPsyD training course,which includes taught, professional practice andresearch components. Clinical Psychology staff havesignificant research interests in mental health andhealth psychology across the full age range, and areavailable to supervise individual projects whichcoincide with our research objectives.

Staff also have international reputations in the area ofanaesthetic awareness, postoperative recall and otherpsychological aspects of general anaesthesia.ThePGMI works closely with the University’sDepartment of Psychology and with the local NHStrusts in clinical psychology training and research.Registration is available for MSc, MPhil, PhD, PsyDand ClinPsyD, but entry to the ClinPsyD is only viaundergraduate studies in psychology at the Universityof Hull.

Medicine 7

8 Medicine

Dr Lynn [email protected] 01482 875875has responsibility for the R&D Laboratory at CastleHill Hospital, which specialises in molecular genetics,histology and proteomics.The focus of research isthe identification of tumour markers associated withresistance chemotherapy and radiotherapy usingboth in vitro and in vivo approaches.Thecombination of microarray and proteomicstechnologies is a novel approach in this field.

Professor John F G [email protected] 01482 624084focuses on the clinical aspects of advanced heartdisease – ranging from epidemiology throughpathophysiology to clinical trials – to improvepatients’ well-being and to prolong survival.

Professor Philip J [email protected] 01482 623077is Smith & Nephew Professor of Tissue Engineeringand Repair and Director of the Hull and EastYorkshire Wound Healing Institute.

Dr John [email protected] 01482 466032leads an interdisciplinary group whose researchfocuses on three aspects of solid tumourimmunology – head and neck, colorectal, and breastand brain tumours:

• development and characterisation of novelantibodies from a bacteriophage display library arebeing used to target delivery of newly synthesisedporphyrin compounds for photodynamic therapyand imaging

• psychoneuroimmunology – analysis of immune cellfunction and changes in salivary and circulatingfactors in cancer patients following surgery,undergoing various interventions and psychologicalassessment

• development of novel prognostic/diagnosticmarkers to assess for the solid tumours

Professor Jennifer Klaber [email protected] 01482 675610leads a programme of musculoskeletal researchbased at the Institute of Rehabilitation and is theconvenor of the Musculoskeletal Research Group ofHYMS and the NHS partnership group (MRG).Theaims of this group are

• to bring together musculoskeletal researchers,including aspiring researchers and clinicians

• to raise awareness of different strands of workcurrently being carried out in musculoskeletalresearch

• to develop collaborative projects inmusculoskeletal research

• to enhance the quality and the profile ofmusculoskeletal research

For more information visit www.hull.ac.uk/instrehab.

Dr Chris M [email protected] 01482 675311is the world’s leading innovator in the field of bonedensitometry for the assessment of osteoporosis. Hepioneered the science, technology and clinical utilityof ultrasound measurements; he has also led thedevelopment of a computer simulation of boneremodelling and, more recently, developed FEXI, finiteelement analysis of x-ray images. As Head of theTechnology Development Group, he is also workingon the development of propensity-to-fall predictionand QA of portable blood pressure monitors.

Professor Mike J [email protected] 01482 676807investigates lung, breast and ovarian carcinoma andthe development and testing of new drugs for thetreatment of malignant disease.

Professor John R T [email protected] 01482 623225focuses on colorectal cancer.The department in Hullis the largest of its type in the UK and has a well-established research programme in various aspects ofrelevant molecular biology.

Professor Alyn H [email protected] 01482 624066has research interests that include study of thecough, the commonest of medical symptoms.TheHull Cough Clinic is one of the few such specialistfacilities and sees patients from all over the UK, witha success rate, based on our basic and clinicalresearch, of more than 90%.

Professor Leslie G [email protected] 01482 675046focuses on the development and evaluation of novelpsychological interventions for cancer patients,psychoneuroimmunology studies and work on thepossible relationship between psychological factorsand survival, and has a long-standing interest in thepsychological effects of breast screening and relatedprocedures.

STAFF AND THEIR RESEARCH SPECIALISMS

MAPSDATES OF SEMESTERS

For the current semesterdates please visit our

website at www.hull.ac.uk orcall Admissions on

01482 466850.

ADDRESS For general enquiries,

please write to

Admissions Service The University of Hull

Hull, HU6 7RX, UK01482 46685001482 442290

[email protected]

DISCLAIMERThe University of Hull will

use all reasonableendeavours to deliver

programmes in accordancewith their descriptions in

this publication. However, itreserves the right to make

variations in the contents ormethods of delivery or

assessment, to discontinueprogrammes and to merge

or combine them, if suchaction is considered

necessary. If the Universitydoes discontinue any

programme, it will usereasonable endeavours to

provide a suitablealternative.

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