Advances in Scientific and Clinical Practice

Details

Title

Advances in Scientific and Clinical Practice

Type

Stage Two

Module code

HPS176

Requirement

Compulsory

Module objective

By the end of this module, the Clinical Scientist in HSST will be able to apply their knowledge, skills and experience in the clinical setting to review emerging evidence of new developments in scientific, technological and clinical practice. They will be able to identify opportunities for innovative approaches to the development, delivery and evaluation of new clinical services and lead these developments. In this leadership role they will present these new developments in a concise and appropriate manner to the multi-disciplinary team including healthcare management in order to influence and progress their implementation. They will be able to educate clinical vascular scientists, clinicians and other members of the healthcare team with respect to the principles behind the developments and interpretation of results using the professional attributes and insights required of a Consultant Clinical Scientist. They will be able to explain the principles and relevance of the novel procedures to patients at an appropriate level of complexity and involve patients in the development process appropriately.

This module is designed to ensure the Clinical Scientist in HSST is learning and working at the cutting edge of science. Where necessary, given the speed at which science and technology develops, those delivering training and the Clinical Scientist in HSST together are expected to identify emerging developments which may be outside those specifically detailed in this module and gain the knowledge and skills to take them forwards.

Knowledge and understanding

By the end of this module, the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge in novel developments in diagnosis and follow up of vascular disease including: 

Contrast Enhanced Ultrasound Imaging (CEUS)

Current evidence of the clinical importance of CEUS in diagnosis and follow up of vascular disease

• Properties of contrast bubbles and scientific principles behind the use of contrast agents.
• Safety issues associated with the use of contrast agents.
• Scanner optimisation for imaging of contrast agents.
• Interpretation of images and other physiological data provided by contrast imaging and evaluation of potential artefacts and measurements errors.
• The emerging role of CEUS for diagnosis and assessment for example in EVAR and carotid plaque assessment.
• Developments in use of contrast agents in the delivery of drug therapies for example targeted thrombolysis.

Analysis of Plaque morphology

• Current evidence of the clinical importance of plaque morphology in diagnosis and follow up of vascular disease.
• Automated ultrasound imaging techniques available for the assessment of plaque morphology for example grey scale median analysis, finite element analysis.
• Limitations and potential sources of error involved with assessment of plaque morphology using ultrasound.
• Other non-ultrasound imaging techniques (e.g. histology) for assessing plaque morphology.

3 and 4D imaging

• Current evidence of the clinical importance of plaque morphology in diagnosis and follow up of vascular disease.
• Techniques in acquiring 3D and 4D ultrasound data sets and associated transducer design.
• Techniques used for data segmentation.
• Methods for displaying 3D and 4D imaging data.
• Techniques and role of triggered data acquisition.
• Limitations and potential artefacts in 3D and 4D ultrasound imaging.
• Resolution of 3D and 4D ultrasound imaging and potential sources of measurement errors.

Fusion imaging

• Current evidence of the clinical importance of fusion imaging in diagnosis and follow up of vascular disease, for example, EVAR endoleak identification.
• Imaging techniques (e.g. CT, MRI) that may be fused with ultrasound or CEUS.
• Techniques used to form fusion imaging.
• Sources of artefact and potential errors.

Elastography

• Current evidence of the clinical importance of elastography (e.g. in assessment of plaque morphology) in diagnosis and follow up of vascular disease.
• The principles behind elastography imaging and measurement.
• Techniques used in elastography.
• Methods for displaying elastography data, image interpretation and potential sources of measurement errors.

Techniques of assessment of arterial wall compliance

• Current evidence for the role of arterial wall compliance in diagnosis and follow up of vascular disease.
• Techniques used to measure arterial wall compliance (e.g. tonometery, ultrasound).
• Equipment set up and optimization.
• Data analysis and interpretation, sources of artefacts and potential sources of measurement error.

Measurements on Intima Media Thickness

• Current evidence for the role of intima media thickness in diagnosis and follow up of vascular disease.
• Techniques used to measure intima media thickness.
• Equipment optimisation e.g. harmonic imaging.
• Data analysis and interpretation, sources of artefacts and potential sources of measurement error.

Arterial plaque motion tracking analysis

• Current evidence for the role of carotid plaque motion tracking in the assessment of stroke risk.
• Techniques used for plaque tracking including computer capture of plaque outline
• Equipment and image optimisation.
• Data analysis and interpretation including stroke risk.
• Potential sources of error and artefacts.

The Clinical Scientist in HSST will also be expected to keep up to date with basic scientific research that has the potential to explain the biological basis for vascular disease. This will include the underlying cellular and molecular mechanisms contributing to the pathological effects of vascular disease which have the potential to lead to the development of new diagnostic and therapeutic measures in vascular disease; examples include therapeutic angiogenesis, the use of biomarkers for risk stratification and stem cell therapy.

Technical and clinical skills

By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the development of new and innovative ultrasound and physiological measurement techniques for the diagnosis and follow up of vascular disease. They will be expected to apply their expert knowledge including equipment set up, sources of artefacts and measurement error and will:

• critically evaluate current guidelines and work with the multi-professional team to develop and implement guidelines in the clinical setting, recognising the need to ensure the safety of the patient
• critically evaluate ideas, innovations and inventions for their potential to have a positive impact on patient care, service delivery, education and training and the organisation etc.
• critically evaluate new technology, set up and optimise equipment.
• perform, adapt and master a range of new techniques.
• collect and analyse data including the selection and application of appropriate statistical techniques, seeking advice and support from a statistician where necessary.
• explore methods of presenting data in an appropriate format for use by the multi- professional team and the patient.
• interpret data, write reports and discuss and defend the conclusions drawn.
• disseminate findings including scientific data and the path of evidence leading to recommendations for future activity.
• perform critical assessment of competing priorities e.g. cost, performance to choose best solution.
• work in partnership with patients to develop patient information materials for the new service.

By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice appropriate novel vascular assessment techniques in a range of patients. They will have clinical and communication skills to advise and communicate effectively with patients, clinicians and other healthcare professionals and will:

• educate clinicians and clinical vascular scientist in the principles underpinning new techniques, present and justify the new procedure and explain the interpretation of data or images acquired.
• take a clinical history and perform clinical assessment of patients referred for investigation.
• choose and provide expert opinion on the most appropriate technique/test for the clinical presentation.
• perform the diagnostic test, optimise equipment and acquire physiological images and measurements.
• analyse and interpret physiological images and measurements.
• formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report cases and emphasise the key findings and diagnoses.
• compare all data to justify and validate the conclusion.
• communicate with the multi-disciplinary team and participate in MDTs.
• perform clinical audits to assess the effectiveness of a novel procedure to support diagnosis and treatment and assess the patients experience of the novel procedure.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations. They will also be expected to consistently demonstrate the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:

• adopt a mindset that actively seeks creative solutions to problems through engagement with individual creativity, approaches and techniques.
• work with and encourage others to find creative solutions to problems through engagement with group creativity approaches and techniques.
• be positive and confident about developing ideas and putting them into action.
• actively seek out opportunities for collaborative discussions and research being open to new developments, attending conferences and keeping up-to-date with the literature.
• adopt a forward looking, progressive approach and be receptive to new ideas looking out for emerging technologies.
• promote a sustainable, engrained culture of innovation in an individual, department and/or organisation.
• ensure clinical and scientist colleagues are kept up to date with novel techniques used within the service.
• ensure patients fully understand any procedure that is undertaken.be positive and confident about developing ideas and putting them into action.
• continue to monitor any safety issues relating to a novel procedure introduced to the diagnostic or follow up service.