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Depression is a major public health problem, producing substantial deterioration in health and well- being and costing the UK £billions annually. A programme of research at Exeter, led by Professor Richards, (trials and Phase IV implementation studies) has changed national policy on the treatment of depression (NICE guidelines). It has also underpinned the UK's Improving Access to Psychological Therapies (IAPT) programme which has been widely implemented, leading to new treatment for over 1 million people, with a recovery rate in excess of 45%, and over 45,000 people coming off sick pay and benefits. The research has also achieved International impact.
A decade of research at the University of Southampton has given thousands of people around the world suffering from dizziness and balance disorders access to a self-management resource that can alleviate their symptoms. Professor Lucy Yardley has pioneered the use of a Balance Retraining (BR) booklet to transform the means of delivering cost-effective, life-changing treatment previously offered to less than one in ten UK patients. The booklet, translated into several languages, has been distributed to patients and practitioners as far afield as China and Japan. Yardley's findings have contributed the bulk of good quality evidence to the Cochrane Review on vestibular rehabilitation.
We have developed the first ever physiotherapy guidelines (2008-) for contracted (frozen) shoulder (CFS). CFS is painful and disabling, affects c.9% of the UK working-age population,1 and costs the NHS > £13.5 million annually.2 Appropriate physiotherapy could improve outcomes and reduce costs by up to £2,000 per case.b
Endorsed by the Chartered Society of Physiotherapy (CSP), the guidelines have generated great interest and already influenced practice and will improve the quality and cost-effectiveness of clinical management, as well as patients' experiences. They will also provide a better framework for research into the condition and, as a `live', electronic document, will evolve with future research.
Newcastle research into practical methods to reduce alcohol-related risk and harm has underpinned national policy, including the Government's Alcohol Strategy and a National Audit Office report. This has shaped public health practice concerning alcohol across England. A UK-specific screening and brief intervention (SBI) programme was developed by Newcastle University for use by GPs and nurses in primary care. This programme, which was designed to reduce alcohol-related problems, has been widely recommended and adopted. An evidence review commissioned by the National Institute for Health and Care Excellence (NICE) found that the use of SBI reduces alcohol consumption, mortality, morbidity and alcohol-related injuries. Department of Health figures show that SBI provides an estimated annual healthcare saving of around £100 million.
HIV-infected infants are at high risk of disease progression and death. Until 2008 guidelines recommended waiting until the infant displayed symptoms, or had a weakened immune system before starting treatment. The CHER trial found that starting infected infants on antiretroviral therapy as early as possible substantially reduced mortality compared with waiting until they developed symptoms or their immune system weakened. These results led quickly to changes in guidelines for treating HIV-infected infants issued by the US, World Health Organisation (WHO), Paediatric European Network for Treatment of AIDS (PENTA) and South Africa. These revised guidelines, if fully implemented along with early infant diagnosis, would reduce the number of infant deaths because of HIV by 76%, saving the lives of approximately 46,800 infants globally each year.
Research at the Liverpool School of Tropical Medicine (LSTM) has developed a successful approach to the rapid scale-up of HIV Testing and Counselling (HTC) services in high prevalence countries, a vital component of the global HIV response. The model combines comprehensive quality assurance with operational research and has led to HTC expansion in mobile, home and facility-based settings. It has also allowed for responsiveness to local needs leading to post rape care services linked to HTC, services for the deaf and HTC for men who have sex with men (MSM) and other hidden populations in Africa. The global impact of this model is reflected in WHO policy, Ministry of Health HTC guidelines in numerous countries in Africa, the on-going work of an indigenous Kenyan NGO and expansion of HTC through community outreach in the UK.
The SPARTAC study (Short Pulse Anti-Retroviral Therapy at HIV Conversion) was a randomised clinical trial of short (12 weeks) or long (48 weeks) pulsed antiretroviral therapy (ART) at primary or recent HIV infection, compared to deferred therapy (standard of care). The trial has shown a significant effect of 48 weeks ART, compared to deferred therapy; 12 weeks ART had no effect. This definitive result from the SPARTAC trial has informed HIV treatment guidelines nationally and internationally; patients identified with primary or recent HIV infection are now recommended to commence ART, based in whole or part on the evidence arising out of SPARTAC. As a consequence of the SPARTAC trial, it is no longer ethical to undertake research amongst individuals with recent HIV infection without offering immediate ART.
Research into primary care insomnia by the Community and Health Research Unit (CaHRU) has led to broad improvements in healthcare provision for insomnia, improved patient quality of life, informed national/international policy and practice in insomnia care and impacted directly on health professional practice and insomnia sufferers, initially in Lincolnshire spreading across the UK and internationally from 2008 to 2011. Direct effects on practice include changes in sleep management and reduced hypnotic prescribing through seminars, workshops, conferences and e-learning developed by the team; inclusion in UK policy, practitioner information, training materials and guidance on hypnotics has led to greater professional and public awareness of sleep management internationally.
Empirical evidence generated by UEL research has directly influenced the reform of health financing in two Indian states with total populations of 154 million through changes to provider behaviour, the organisation and use of funds, and treatment verification processes and package rates. The impacts of this work have been commended by the UK Department for International Development (DFID) and the World Bank, and attracted interest from states with similar healthcare schemes. More widely, it has helped policymakers in India and the UK recognise the importance of including high quality comprehensive primary care in India's strategic planning for universal health care, and the benefits to the UK in prioritising primary care collaboration with India.
Elevated blood glucose levels — the hallmark of diabetes — is estimated by the World Health Organization to be the third leading cause of premature death globally. Around 4 million people in the UK have been diagnosed with diabetes; their treatment accounts for 10% (£10 billion) of NHS expenditure. Self-management strategies and the promotion of a healthy lifestyle are fundamental to the treatment and prevention of type 2 diabetes (T2DM). Since 2008, Leicester's Diabetes Research Centre has developed, evaluated, disseminated and implemented a range of programmes based on a technique called structured education. The flagship DESMOND programme is run in over half of all clinical commissioning groups (CCGs), affecting thousands of people with newly diagnosed T2DM. The Walking Away prevention programme has been widely implemented in the UK, Ireland and Australia. These programmes are the only nationally available evidence-based structured education programmes for the prevention and management of T2DM.