School of Medicine purchases state of the art ultrasound equipment to enhance clinical skills curriculum

Monroe Maximillian Broad, the son of an Alumnus of the School of Medicine in St Andrews University, kindly bequeathed part of his estate to the Medical School five years ago. This generous donation enabled the purchase of five state of the art cart-based ultrasound scanners manufactured by GE Healthcare. This has enabled our students to gain vital practical experience using ultrasound technology to integrate their Anatomy and Physiology teaching with Clinical Skills training. 

For the last 4 years staff at the School of Medicine in St. Andrews University have worked with MDi Medical and GE Healthcare to integrate Ultrasound into the Medical School teaching curriculum. All 3 years of BSc and both years of ScotGEM students are taught elements in Clinical Skills which involve utilising ultrasound. The curriculum, which was designed by Dr Enis Cezayirli, Dr Ourania Varsou, Dr Predrag Bjelogrlic, Mr Fraser Chisholm and Dr Robert Humphreys, continues to develop and improve. Whatever path a medical student takes when they qualify, Ultrasound is a vital skill in medical practice and used widely in many disciplines including Anaesthesia, Cardiology, Vascular and Musculoskeletal practice. In particular, ultrasound is used routinely in medical practice for minimally invasive surgical interventions such as ultrasound-guided biopsy or vascular access (central line insertion).  

Skills taught to undergraduate students include e-FAST (Extended Focused Assessment with Sonography in Trauma), Ultrasound of the Heart (Echocardiography), musculoskeletal ultrasound and upper abdominal ultrasound. A popular part of the training is when homemade phantoms using jelly and al dente penne pasta tubes are used with cocktail sticks to simulate ultrasound guided vascular access. This allows the students to develop and improve dexterity with using ultrasound safely. The ultrasound training has positively impacted on our students’ confidence in developing their skills in this practice. 

The School has purchased a further cart based ultrasound scanner to allow for teaching to continue in small groups with the increased intake of Medical Students. More recently the School has also acquired six VScan Air wireless hand-held ultrasound scanners. These state-of-the-art scanners have the ability to link via bluetooth to devices such as iPads running its app and allow more students to engage and participate in the ultrasound sessions. They have great versatility and are increasingly used in point of care ultrasound both in Primary and Secondary Care. Familiarity with this latest development in ultrasound scanning will be a major advantage for our students when they graduate. 

 

@MDi_Medical  

#GEHealthcare 

#VScanAir 

 

Students using an ultrasound in clinical skills

The World Rural Health Conference 2022 (“Rural Wonca”)

The World Rural Health Conference 2022 (“Rural Wonca”) will be hosted jointly by the University of Limerick, Irish College of General Practice and the Irish Rural, Island and Dispensing Doctors of Ireland from 17th-20th June 2022.   Dr. Robert Scully (Deputy Director, ScotGEM), has been invited to join the main organising committee, with responsibility for students and early career healthcare professionals.  He has been joined on the student sub-committee by ScotGEM Y3 student Ronald MacDonald.  This is the premier global rural health conference, and is expected to attract over 1000 delegates.   

 

Having supported the initial bid, ScotGEM are official partners for this conference, and as it commences the day after the first ScotGEM graduation, it is an excellent opportunity to celebrate the graduating Charter ScotGEM class.  As part of this celebration, Professor Roger Strasser (St Andrews Global Fellowship recipient 21/22) will attend the ScotGEM graduation and then travel to Limerick to deliver a keynote address regarding the role of undergraduate medical education on future healthcare delivery in rural areas.  

 

The conference will officially launch on October 13th.  For more information please see the conference website https://www.woncarhc2022.com/ or contact Robert Scully directly.  

 

Innovation for African Universities (IAU) grant awarded

SWAB Lab Group

 

Dr Wilber Sabiiti and partners at Ghanaian University of Health Sciences and University of Cape Coast have been awarded the Innovation for African Universities (IAU) grant.  The grant will facilitate the establishment of long-term institutional partnerships focusing on translation of biomedical research in Ghana & Africa at large into biotech solutions for health. The University of St Andrews Global Office in collaboration with the School of Medicine are expected to support the growth of this partnership and in making use of the newly established Eden enterprise park.   IAU network is funded by the British Council with a focus on UK universities and universities/small medium enterprises in Kenya, Ghana, Nigeria and South Africa:

British Council announcement

https://www.britishcouncil.org/education/he-science/opportunities/innovation-african-universities

 

 

New collaboration with the University of Bonn

Collaborative research is of growing importance at the University of St Andrews. One such initiative that encourages the development of cross-border conversations and networks is the collaborative research grant between the University of St Andrews and the University of Bonn. Piloting this year, the grant is designed to establish global partnerships. One of two recipients of the 2021 Collaborative Research Grant is a study led by Dr Silvia Paracchini (School of Medicine, University of St Andrews) and Professor Markus M. Nöthen (Institute of Human Genetics, School of Medicine, University of Bonn). 

The study aims to apply machine learning methods to the interpretation of large-scale genomic data in the context of psychiatric disorders. Machine learning will be used to model both clinical and genomic data. The goals are to identify better ways to categorise patients and to assess the contribution of multiple genetic factors, as opposed to current methods focusing on individual markers. The project builds on the established research interests and expertise of researchers in St Andrews and Bonn, particularly in machine learning, genomics, and psychiatry.  Within St Andrews, collaborators in this study are spread across the School of Medicine, the School of Computer Science and the School of Maths and Statistics. 

The study also joins forces with Canon Medical Research Europe, experts in big data and machine learning. They are established world leaders in the analysis of imaging data using artificial intelligence.  Their expertise will be particularly relevant for the integration of brain imaging data, pertinent in this project. The study draws on the UK Biobank, an important source of data for this study, and the grant will fund part of the access fees and computer requirements for this analysis. The project is very ambitious and it is not realistic to achieve the final goal in the next two years. However, the collaborative grant has allowed different Institutions and research groups to come together and start a new line of research. A key element of the project will be training and cross-disciplinary events aimed at early career researchers.  

While COVID-19 has demonstrated new ways to conduct cross-border research rendering some travel and travel costs unnecessary, the grant will be used to support PhD researchers in attending the European Society of Human Genetics Conferences, where results will be presented and in person satellite meeting will be organised to specifically support this collaboration.  

The collaborative research grant funding is now open for 2022. 

 

Dr Silvia Paracchini in her research lab

New School President

Anna Apara, 3rd year medical student at the University, has been appointed School of Medicine President for the academic year 2021/2022. Anna is from Toronto, Canada, although having grown up just outside of London. Aside from medicine, Anna is passionate about sport, cooking and Greys Anatomy! She prides herself on being open, friendly, and approachable.

Anna views her role as Student President vital in bridging relationships between students and staff throughout the school and representing the voice of the student body. Alongside chairing the SSCCs, Anna will host numerous faculty-wide events, which she hopes will create networking opportunities and lasting connections not only internally within the School of Medicine but amongst the wider University community. With the transition back to a new normal this academic year, Anna will be onside to lend a helping hand to students and societies navigating the adjustment.

Anna says “I understand that the past academic year has been extremely difficult for many students, and within my role, I strive to do all that I can to support students in the transition back to in-person learning. In my opinion, a student leader is someone who is trustworthy, dependable, and resilient, who listens to the opinions of their peers, in order to make student-centred decisions. At St Andrews, presenting students with leadership opportunities is vital in shaping future graduates and the reputation of the University nationally and internationally”.  The leadership team at the School of Medicine, looks forward to working closely with Anna and wishes her the best of luck within the role.

 

Anna Apara

Dr Hernandez Santiago appointed to SAPG

Dr Virginia Hernandez Santiago, Clinical Lecturer in General Practice at the School of Medicine, has recently been appointed to the Scottish Antimicrobial Prescribing Group (SAPG). The group, established in 2008 at the request of the Scottish Government, promotes the safe and effective use of antibiotics in hospital and community settings. Antibiotic resistance, a major global public health issue and a threat to the future of healthcare, is driven by the inappropriate use of antibiotics. The SAPG aims to reduce harm, waste, and variation in antibiotic prescribing practice by coordinating a national framework for antimicrobial stewardship. They provide guidance, not only for infection management in community and hospital settings but for the ongoing education and development of clinicians.

Dr Hernandez Santiago believes that as a registered GP in St Andrews and Tayside, Dundee, she has an important role as an advocate for the safe use of antibiotics. 80% of antibiotics are prescribed in the community, and it is thus essential to concentrate on this area when trying to optimise the use of antibiotics and combat antibiotic resistance. Dr Hernandez Santiago has seen first-hand how antibiotic resistance can cause havoc to the effective treatment of serious infections, worsening patient-related outcomes, and in some cases can even lead to fatality. In the community, practitioners do not always have the diagnostic capacities to identify whether an infection is bacterial or viral, often leading to the over-prescription of antibiotics, despite antibiotics having no effect on viral infection. This has a huge impact on antibiotic resistance in patients, and the SAPG endeavour to improve training and educate practitioners about the appropriate use of antibiotics. Dr Hernandez Santiago is also an out-of-hours GP and believes that this setting can see an increased level of antibiotic prescription, as the doctor does not have the same in-depth relationship with the patient.

Dr Hernandez Santiago’s research interests, which include infectious disease epidemiology and antimicrobial resistance, are closely aligned with the work that the SAPG do. She hopes that her role within the group will advance her research by being on the cutting-edge of development and allowing her to identify research gaps. As a GP, an out-of-hours doctor and an academic, Dr Virgininia Hernandez Santiago brings a unique, broad perspective to the SAPG and her students. She hopes that she can apply her experience with the group to her lectures, stating that infection, clinical reasoning, clinical communication skills, and patient history taking, which are important aspects of her teaching, are imperative in promoting practices that prevent antibiotic resistance from occurring.

 

Dr Virginia Hernandez Santiago

 

 

The global fight against tuberculosis

Medical research is one of the most important outputs for a university, with breakthroughs potentially saving lives around the world. Professor Stephen Gillespie and colleagues at the School of Medicine have done just this, developing global capacity to improve tuberculosis treatment by developing shorter, safer drug regimens, and improved diagnostics for monitoring treatment.

Heat map of tuberculosis cases, via WHO. Licensed under Creative Commons. 

Tuberculosis (TB) is a major global killer with approximately 9 million new cases and 1 million to 2 million deaths per year, disproportionally affecting low and middle-income countries. The School of Medicine has researched the disease, and the pathogen responsible for it, for the last decade, contributing to transformative changes in how TB is tackled around the world. These have encompassed the development of global TB networks, new treatment methods and increased clinical capacity. The research has improved diagnostics for monitoring treatment, which led to the development of a tool to monitor antibiotic treatment of TB patients in real time.

The foundation of their research involved conducting the first clinical trials for a selection of new and repurposed drugs. To achieve this, the group formed a series of international collaborations across Africa, South Asia, Europe and South America. With these consortia, the School carried out REMoxTB, the first regulatory study of the drug moxifloxacin as part of a TB treatment regimen, across nearly 50 sites in Africa and Asia.

REMoxTB began the team’s longstanding project to develop global capacity to improve tuberculosis treatment. Subsequent steps included the establishment of trial sites in Africa, Asia and South America to run therapeutic and diagnostic projects. These projects also addressed critical questions in tuberculosis management including the understanding of the toxicity of tuberculosis chemotherapy, especially regarding liver injury, the differing effectiveness of treatment across gender, and how to interpret positive blood culture tests after patients have completed therapy. The progress of the research has resulted in two further regulatory trials in collaboration with the Global Alliance for TB Drug Development. The first, STAND, was completed in 2018 and published recently; the second, SimpliciTB, began the same year and is currently ongoing.

In addition to regulatory trials, the Infection and Global Health group has made great strides in repurposing and optimising existing drugs. Gillespie is one of the three leads in the PanACEA consortium, one of the international tuberculosis research associations established in part by the School, which has performed a series of early phase trials. These include a process to determine the optimal dose of rifampicin, an antibiotic administered to treat tuberculosis which is the most important component of the current treatment regimen. This research has demonstrated the antibiotic’s effectiveness at killing TB bacteria and determined its optimum dose.

Aside from treatment itself, another critical barrier to the effective management and treatment of tuberculosis is diagnosing the disease and monitoring patient response during treatment. The diagnosis is especially crucial, given that the infecting bacteria grow very slowly and hence an early diagnosis can significantly increase survival rate. In response, the group developed a test known as the Tuberculosis Molecular Bacterial Load Assay TB-(MBLA), which not only diagnoses the disease definitively but can also determine whether the TB pathogen is alive or dead, allowing clinicians to monitor the patient’s response to treatment and adjust it accordingly. It has also significantly reduced the diagnosis timescale to just four hours, allowing for more up-to-date assessments of patient recovery. The TB-MBLA is now used in research laboratories in 16 countries across the world, with over 40 researchers and practitioners from Africa, Asia and Europe trained in its use. The team aims to have reached all ODA countries with a high TB burden by 2025.

The TB-MBLA was developed in Prof Gillespie’s laboratory, and the international evaluation study was led by Dr Wilber Sabiiti.  The team has also assisted in the development of the Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA). Led by Professor Matthew Holden, the project aims to tackle a problem that, by 2050, is predicted to cost 10 million lives and 100 trillion US Dollars worldwide each year. An interdisciplinary study, HATUA explores biological, socioeconomic, and behavioural drivers of antibacterial resistance in the East African context, but is generalisable to the rest of the world. The project enrolled nearly 2,000 UTI positive patients from 9 study areas across Uganda, Kenya and Tanzania, and the preliminary findings show a complex interplay of factors and pathways in how people seek healthcare and use antibiotics that has great potential for future research.

 

Blog post by

Research Impact Team

 

Research project using real-time COVID-19 data to track the pandemic in Scotland

New research is using real-time data to track the COVID-19 pandemic as it happens across Scotland. The Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE-II), funded by the Medical Research Council, Research and Innovation Industrial Strategy Challenge Fund, the Scottish Government and Health Data Research UK is analysing patient data to understand vaccine effectiveness and the impact that COVID-19 is having across Scotland.  

 

Dr. Utkarsh Agrawal, a research fellow in health data science from St. Andrews School of Medicine, has been involved in the EAVE-II project and is one of the lead authors on a recently published paper on the project. Utkarsh, who has a keen interest in employing data science and machine learning to analyse diseases, has been involved in researching vaccine effectiveness using population level data for Scotland linked to vaccinations, COVID-19 infections, hospital admissions and deaths. 


 

Working alongside a diverse team of researchers from across Scotland, Utkarsh has been using real-time data to track vaccine effectiveness for the past six months. For Utkarsh, this has been the most impactful part of working on the EAVE-II project, being able to see in real-time how the pandemic has unfolded in Scotland and how vaccine effectiveness has responded to the different waves.

 

Results from the EAVE II project have been shared with the Scottish and UK Governments to help inform decisions made throughout the pandemic. Being a part of this project and working to solve real-time problems during this pandemic has been a point of pride for Utkarsh and his work on the project continues as the team analyses the outcomes of serious cases of COVID-19 amongst vaccinated individuals.

Further information on the EAVE II study can be found here.

 

Dr Utkarsh Agrawal

 

The latest publication on the study ‘COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study‘ is now available in the Lancet Respiratory Medicine

Meet the newest NES GP Fellow: Eilish Hannah

Eilish Hannah, a GP currently practising in Edinburgh, is also joining the St. Andrews School of Medicine as an NES GP Fellow.  

 

Eilish is no stranger to St. Andrews as she initially trained at the School of Medicine before moving to Manchester to complete her studies before returning to St. Andrews in 2017-18 as a medical demonstrator. Eilish decided to embark on this NES GP Fellowship after finding an interest in research looking at the determinants of health in low-income countries. Global Health has always been an area of interest for Eilish as she found the intersection of politics and economics in medicine compelling and was encouraged to pursue her research interests during her GP training from fellow practitioners.  

 

Over the next year, Eilish plans to spend her NES GP Fellowship deepening her research experience, doing some more teaching, developing publications, and spending more time in St. Andrews. For Eilish, this NES GP Fellowship will hopefully build knowledge that she can bring back to her GP practice and hopes to continue developing in this area of research as a special interest, and maybe one day towards a future PhD.  

 

Over the next year, the two newest NES GP Fellows will bring their knowledge and expertise to the St. Andrews School of Medicine.  

 

Dr Eilish Hannah