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Impact: Health and welfare: reducing morbidity; providing evidence to disinvest in an ineffective and damaging treatment; policy change.
Significance: Since 2009, applied clinical trial findings have resulted in approximately 6000 fewer complications (e.g., skin breaks) in the UK. Stocking use has decreased by 95%, which has saved the NHS in excess of £20M per annum.
Beneficiaries: Stroke patients worldwide, the NHS and healthcare delivery organisations, the economy.
Attribution: Trials were designed and led by Professor M Dennis, UoE.
Reach: Changed national guidelines in at least seven countries worldwide (Europe, N America, South Africa, Singapore).
Impact: Health and welfare; saving lives by determining that aspirin is an effective treatment for acute stroke and that heparin anticoagulation is ineffective.
Significance: In the UK, treating all acute stroke patients with aspirin and avoiding heparin means 1800 people avoid death or disability each year; aspirin is also highly cost-effective.
Beneficiaries: Stroke patients, the NHS, the economy.
Attribution: Sandercock, UoE, designed, led and reported the International Stroke Trial, and was on the steering committee of the Chinese Acute Stroke Trial.
Reach: Up to 15M stroke patients annually affected by guideline changes worldwide, encompassing Europe, North America and Australasia; educational events by the World Stroke Academy promote aspirin use.
Impact: Health and wellbeing; improvement in mortality and morbidity; changes in policy and guidelines.
Significance: Clinical trial findings have led to 1160 fewer deaths and 780 fewer severely disabled patients each year in the UK; rationalising feeding policies saves over £12M annually.
Beneficiaries: Stroke patients, the NHS and healthcare delivery organisations, the economy.
Reach: Worldwide: revised national guidelines in UK, Europe, North America, South Africa, Singapore, Australasia.
Narrowing of one of the carotid arteries in the neck (carotid stenosis) is an important cause of stroke, a major public health problem. The results of an international multicentre randomised clinical trial, organised and led by Professor Martin Brown at the UCL Institute of Neurology, have been incorporated into national and international guidelines on the treatment of carotid stenosis. The trial evaluated carotid artery stenting (CAS), a new treatment to prevent stroke from carotid stenosis, in comparison to the standard treatment, carotid endarterectomy (CEA) (carotid surgery). The number of patients treated by CAS in England did not increase between 2006 and 2012, whereas the numbers of patients treated by CEA increased by 30%, a finding consistent with a response to the findings of our trials indicating that CEA was safer than CAS.
Impact: Health and welfare; public health studies in Sri Lanka and clinical trials in a cohort of 35,000 pesticide self-poisoning patients have led to the withdrawal of high-dose pralidoxime as a WHO-recommended treatment and bans of three toxic pesticides in Sri Lanka.
Significance: Resultant changes in clinical practice and pesticide regulation have saved 3000 lives in the last four years in Sri Lanka alone; in the rest of Asia many times this as local guidelines and practice have changed.
Beneficiaries: Patients and communities, healthcare providers, policy-makers.
Attribution: Studies designed and led, with international collaborators, by Michael Eddleston, UoE.
Reach: International, particularly Asia, changes in WHO and international guidelines on pesticide use.
Two multicentre clinical trials conducted by Professor Potter have contributed to revised international guidelines for the management of hypertension following acute stroke, the single largest cause of adult disability worldwide. Before these trials, there was little evidence on the effects of using antihypertensive drugs immediately after stroke and there was concern that use of these drugs could extend the stroke. The trials found no serious adverse effects of using antihypertensive drugs immediately after stroke whilst mortality after 3 months was halved. The American Heart Association, the European Societies of Hypertension and of Cardiology, and the Royal College of Physicians all reference these trials in support of their recent Guidelines, thereby promoting better patient care and improved outcomes.
A Cardiff researcher has led an International 15 year programme resulting in multiple novel findings which have led to changes in the recommended diagnosis and treatment of acquired haemophilia A (AHA). The research has, for the first time, allowed the comparison of immunosuppressive regimens for inhibitor eradication and comparison of the efficacy of treatment strategies to control bleeds. Studies led directly to the production of UK and International guidelines on the management of AHA with 14 of the 18 specific recommendations in the UK guideline being underpinned by Cardiff-led research.
Stroke is a major health burden to patients, carers and the NHS, with UK costs estimated at £15.5bn annually. Clot-busting agents (thrombolytics) can substantially improve the consequences of ischaemic stroke, but only if administered rapidly. Newcastle research that recognised the importance of rapid referral to a stroke unit allowed reconfiguration of ambulance services for direct transport of victims to a specialised centre. Newcastle work also validated a test developed for paramedics to recognise the signs of stroke, which was developed as the nationwide Face-Arms-Speech-Time (Act FAST) campaign. Use of thrombolytics has increased eightfold between 2005 and 2012, and there has been a considerable increase in public awareness of FAST.
Forster, House and Young have played a leading role in establishing the importance of long-term psychological and social distress after stroke, shifting the clinical emphasis (and evidence base) in stroke care from a limited focus on physical recovery to acceptance of the importance of psychological and social factors. Evidence we have generated has informed the stroke care pathway in national and international clinical guidelines that influence stroke service delivery, by providing guidance to clinical teams on psychological treatments after stroke and information provision. In tandem we have developed the methodology of stroke rehabilitation research, involving clinical staff in delivery of multi-site studies and thereby enhancing evidenced-based stroke care.
Stroke affects 15 million people globally and is a leading cause of death and adult physical disability. King's College London (KCL) research has provided the evidence that underpins many of the present day policies, guidelines and clinical practice for stroke care, not only in the UK but also in other countries. KCL research has demonstrated that stroke units are effective and reduce mortality and dependence by 22%. The implementation of these findings in England has increased the number of patients managed on a stroke unit from 18% to 62% between 2000-2012, preventing 550 deaths, enabling 1,700 more patients to make a full recovery and saving £82 million per year.