Difference between revisions of "Team:Oxford/TestDuke/Practices"

Approaching the Public

To decide on our project idea, we sent out an initial questionnaire to the public to hear about what they thought about synthetic biology. We asked what big problems they wanted solving. We took the questionnaire to schools, to the streets and to our friends.

Examples of their suggestions for the applications of synthetic biology include bacteria which:

• Remove carbon dioxide from the atmosphere
• Target and kill cancerous cells
• Help treat Alzheimer's disease
• Produce energy
• Sew up holes in clothes
• Produce teeth glue
• Indicate how long someone has been dead for
• Combat antibiotic resistance

Of our responses, around 40 were related to Medicine and Health [1]. This led us to choose that track for our project. However, it was our team member George Driscoll’s work at the UTI clinic in London which helped us to select UTIs as a specific cause. Due to the un-aesthetic nature of the infection, it often receives less attention with regard to research.

A large proportion of our responses expressed concern for how Synthetic Biology would be used in society, with several references to the issues of contamination and exploitation for profit. With this in mind, we constructed a second questionnaire about our project, to test whether the public would get behind it.

Initial Feedback

We sent a second questionnaire to find out more about whether the public would use a Solution from synthetic biology to treat Urinary tract infections. We asked more about whether they had heard of genetic engineering or synthetic biology, and how much they trust a recommended treatment by a doctor. In collaboration with UCL, we also filmed some of these responses on the street. The results were overwhelmingly positive.

Our Inspiration

Jorge Talk

Churchill Hospital, Oxford

Our first visit to the hospital was to the outpatient clinic during which we spoke with Jan, one of the nurses on the ward. Jan told us about a case of a person getting septicaemia as a result of a urinary infection. The patient had received antibiotics for seven days and had come back for a check up. Their urine sample was clear and all seemed fine but then the patient had started to shake. The bacteria were now in their blood as it had travelled back up the ureter to the kidney. Even though this was a rare case, it was shocking to hear about such a serious case and made our project feel very relevant.

Jan also made the following points:

• People with infections have a catheter because they need a way to empty the bladder; else the urine travels up the ureter and back into the bladder
• If a patient becomes septic the catheter has to be removed or can be fatal
• UTIs are not just contracted by the catheter and it is important to also consider community based UTIs
• “UTIs are very common and can be quite painful”
• No separate ward for UTIs – they are treated in every ward
• The protocol for treatment is to take a urine sample, see if there is an infection, and prescribe antibiotics that the bacteria are most sensitive to
• Elderly hospital wards are likely to have many cases of UTIs

We took a lot from this initial conversation. We went onto investigating the pros and cons of the current methods of treating urinary infections and compared these to what Solution could offer. We realized that we needed to consider the catheter more from a hospital/medical perspective as up to this point we had confused its function, thinking it was more to do with administering medication rather than emptying the bladder. Following this meeting, the design of the catheter became an integral part of the project.

John Radcliffe Hospital, Oxford

We still wanted to learn more about urinary infections as well as to get some feedback from nurses abourtour idea. We organized a trip to the Adams Ward (Geratology) to learn more about how urinary infections affect elderly people.

First interview with Laura Evans, Adams Ward

What is the procedure for treating UTIs?

1. Dip urine
2. If the test comes back as positive, treat with a wide spectrum antibiotic
3. Whether or not the catheter is inserted with prophylactic antibiotic treatment is the doctor’s decision

What happens when a patient tests positive for a urinary infection?

Whether or not the catheter is removed if a patient tests positive for a urinary infection depends largely on the reason that the catheter has been fitted. On the whole, the catheter remains fitted and the patient is treated with a large dose of antibiotics.

Is antibiotic resistance a problem?

Yes, particularly on this ward. As we treat elderly patients with recurring infections, their UTIs are frequently resistant to antibiotic treatment. We try different combinations of antibiotics but recurring infections are a significant problem.

Our project involves designing a catheter that prevents the formation of a biofilm on its surface. What do you think of this idea?

A catheter like that would be useful, but it depends on how long your catheter would work for. Patients can have catheters fitted for 3 months or longer. Catheters are also removed for other reasons, for example if they become blocked. Blockage is particularly an issue when the patient is suffering from a urinary infection.

Laura’s response regarding how long a catheter remains in place spurred us into researching how we could keep our Solution bacteria alive. This is what we found.

The Problem

Feedback from Oxford Experts

To gain a further insight into the feasibility of Solution, we gave two talks during the summer, one at the termly Corpus Christi College Biochemistry talks and another to a group of alumni from the Oxford Biochemistry department. Two important questions arose from these talks:

• Have you considered whether the proteins you planning on secreting are immunogenic?
• If you are to kill all of the pathogenic bacteria in the urinary tract, will that make fungal infections more likely?

Our Solution

Will Our Idea Work?

Ethics

To find out the public opinion on our project, we sent out a questionnaire to over 150 people, asking: 'If your doctor recommended a treatment for an infection, which involved the use of bacteria that had been engineered to treat the infection, would you use it?'. We also asked this question to a number of medical professionals during our visits to hospitals and clinics.

Whilst the majority of feedback was very positive, we did encounter some valuable criticism, as shown in the graph below. Most medical professionals we spoke to had positive responses, though one nurse did have certain reservations about our idea.

This proportion of negative feedback, although small, highlighted to us that our dialogue with the public needed to be improved. We believe that, through improving people's understanding of our project, we can convince pessimists that genetic engineering is now a force for good. This also led us onto holding talks to student groups, which you can find in the Increasing Awareness section below.

Nevertheless, this is very encouraging data for our project, and again highlights the importance of gaining support from doctors, because without their backing, this project is likely never to become as common a treatment as antibiotics.

The UTI Clinic

Delivery Method

Increasing Awareness

To promote Synthetic Biology and iGEM, we’ve used a variety of approaches.