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Research at the University of Manchester (UoM) has changed the landscape of medical care and research in fungal infections internationally. The impacts include: the world's first commercialised molecular diagnostic products for aspergillosis and Pneumocystis pneumonia (£10m investment); pivotal contributions to the preclinical development (£35m investment), clinical developments and registrations of 3 new antifungals with combined market share of ~$2 billion; one (voriconazole, 2012 sales >$750m worldwide) now first line therapy for invasive aspergillosis with improved survival of 15-20%; and internationally validated methods to detect azole resistance in Aspergillus (an emerging problem partly related to environmental spraying of azole fungicides for crop protection).
One in ~1,000 children has significant short stature that needs medical evaluation, one in ~4,000 has growth hormone deficiency and one in ~≥10,000 has a genetic growth disorder. Research at the University of Manchester (UoM) has impacted on clinicians worldwide who manage growth disorders. UoM researchers have: characterised growth disorder phenotypes to ensure the right tests are used for the right child and verified the accuracy of diagnostic biochemical tests; discovered new genes associated with a primordial growth disorder and introduced new molecular diagnostic tests for international use; and generated clinical practice guidelines adopted by the worldwide paediatric endocrine community.
Although, by definition, individually rare, the cumulative burden of `rare disease' is significant, with as many as 3m affected individuals in the UK. The University of Manchester (UoM) has an exceptional record in rare disease gene identification, with 29 such genes defined since 1993. This research paved the way for clinical diagnostic testing for patients and their families, demonstrating the immediate translational impact of gene discovery. The research has resulted in a reduced diagnostic burden for patients and health services and has enabled the provision of more effective counselling. Testing for genes identified at UoM is now offered in more than 140 laboratories in more than 30 countries worldwide. More than 1,100 patients have been tested for mutations in TCOF1, BEST1, IRF6, SAMHD1 and C9ORF72 in UK NHS laboratories alone.
Falls are a common (30-40% >65 year olds fall each year) and important age-related health problem costing the NHS and social care >£5.6m each day. University of Manchester research has contributed to reducing the burden of falls worldwide.
We demonstrated that falls are better predictors of fracture than bone mineral density. We developed an effective intervention, reducing falls amongst older people by 30%; identified barriers to service use, and approaches to increasing uptake and adherence; and developed a fear of falling instrument (FES-I), now translated into 30+ languages and widely used in clinical practice.
By 2012, 54% NHS Trusts used training programmes based on our research. It moulded service provision nationally and internationally, changing the emphasis of how falls prevention services are presented, from "reducing risk" to "improving/maintaining independence".
People who develop psychosis (1% of population) typically experience lengthy delays (months to years) before treatment. Researchers at the University of Manchester (UoM) established a concrete and significant association between delay in treatment of the first episode of psychosis and outcome. We demonstrated that outcome of psychosis could be improved considerably if these lengthy delays were reduced. This research influenced policy and practice in the UK and abroad. Policy changes included the establishment of early psychosis teams dedicated to early detection and treatment (50 in England alone). Practice changes included amendments to clinical guidelines in the UK and abroad that now require clinicians to respond urgently to a first episode of psychosis. These changes to clinical practice have increased the proportion of patients with a short DUP from 55.6 to 77.4%.
15m people have a stroke each year worldwide. In England alone, stroke generates direct care costs of £3bn and a wider economic burden of £8bn. Service users report high levels of unmet need in relation to cognitive dysfunction (e.g. concentration). Improving cognition was the number one priority agreed by users and providers (James Lind Alliance, Lancet Neurology 2012). Research led by the University of Manchester (UoM) underpins recommendations in several recent clinical guidelines for stroke management and rehabilitation in the UK and internationally. Our 2012 aphasia trial and qualitative study made key contributions to the recommendations in the recent NICE (2013) and Intercollegiate Stroke Working Party (2012) guidelines. UoM-led Cochrane reviews (e.g., neglect, apraxia, perception) have directly influenced recommendations in guidelines produced by the Scottish Intercollegiate Guidelines Network, the European Stroke Organization and the Australian National Stroke Foundation.
Research at the University of Manchester (UoM) has, and continues to have, a direct impact on pharmacy policy and practice. From 1993, our work on the contribution of pharmacists to primary health care has helped improve patients' access to medicines and pharmacies. Our `Care@TheChemist' trial led to changes in the national pharmaceutical contract and now almost 5,000 pharmacies offer the service to several million primary care patients. Our skill mix research is used to inform regulatory control of pharmacies and our wider workforce research continues to inform national governments about how to forecast future requirements for pharmacist numbers.
The lasting impact of Professor Prag's work on facial reconstruction is that it has become a vital tool for archaeologists, helping them to understand the past better. Facial reconstruction now plays a major role in many museum exhibitions around the world and the techniques developed in Manchester have increased public interest in past civilizations. An important aspect in the reconstruction process is the ability to work across disciplines to produce a complete picture. Manchester has pioneered this method of collaborative working with some ground-breaking results. The facial recognition methods established by Professor Prag continue to impact on archaeological and museum practices around the world to bring history truly to life.
Schizophrenia affects 1 in 100 people, with costs to society of £12 billion in England alone. Prevalence is similar across the world, with two thirds of people experiencing relapses despite medical treatment. Researchers at the University of Manchester (UoM) pioneered and disseminated psychological interventions for schizophrenia and related mental health problems which have led to improved outcomes for patients and families (e.g. 20% improvement in symptoms over standard treatment). We have implemented and delivered our intervention protocols, outcome measures, treatment manuals, and training programmes (with over 200 training courses delivered across the UK, Europe, USA, Asia, Australia and Africa). The impact of the research has been commended nationally and internationally by professional bodies (e.g., British Psychological Society, American Association of Behavior Therapy).
Research by our group at the University of Manchester has impacted directly on policy addressing inequities in access to treatment for older women with breast cancer, affecting treatment for 10,060 older breast cancer sufferers in England each year. Our research has led to improvements in pre-operative nutrition and screening for malnutrition for nearly 100,000 patients in Greater Manchester. We have contributed directly to international guidelines on post-treatment follow up for breast cancer and management of cough in lung cancer. We have also contributed to development of national vocational rehabilitation, employer support and benefits advisors for cancer survivors, affecting 700,000 survivors across the UK. Our work has led to implementation of family carer support needs assessment in UK hospice services, to date supporting some 4,500 carers per year with wider roll out imminent.