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Infective endocarditis (IE) is a rare but life-threatening disorder that may arise as a consequence of bacteraemia following invasive procedures such as those of dentistry. Research at the UCL Eastman Dental Institute has detailed the dental causes, prevalence and character of bacteraemia following dental procedures and demonstrated that everyday oral health activities are more likely to be a cause of bacteraemia than invasive dentistry. The research outcomes informed 2008 NICE guidelines that recommended that antibiotic prophylaxis solely to prevent IE should not be given to people at risk of IE undergoing dental and non-dental procedures. This has since caused a 78.6% fall in related antibiotic prescribing, a cost-saving of approximately £4m to the NHS in England and will reduce the threats of fatal anaphylaxis and antibiotic resistance.
This programme of research has, through producing national guidance and improving understanding of professional behaviour, enabled delivery of evidence based practice by dental practitioners in primary care. Its impacts include:
The use of fluoride in preventive dentistry was previously fraught with controversy despite numerous primary studies. A series of Cochrane systematic reviews by Queen Mary's Marinho et al greatly reduced uncertainty in this field and has been used extensively in the UK (eg Department of Health, Scottish Intercollegiate Guidelines Network) and internationally (eg World Health Organization) since 2002 as strong evidence to support clinical and public health decisions on preventive use of fluorides. The research provided a knowledge framework that enabled decision-makers worldwide to significantly reduce variations in practice and policy, and also reduce burden of dental caries (tooth decay). The research has prompted new, more relevant trials and important advances in systematic review methodology (new statistical approaches for meta-analysis).
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.
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%.
Our research showed that powered rotation oscillation toothbrushes were superior to manual toothbrushes for the removal of plaque and reduction of gingivitis. This information has had impacts on national public policy, on commerce and on society.
Healthcare-associated infections (HCAI) and antimicrobial resistance pose a constant threat to patients accessing healthcare in a range of settings. HCAI prolong recovery; delay discharge from hospital and, in extreme circumstances, cause serious disability or death. This case study describes the impact of the Epic (evidence-based practice in infection control) research programme that focuses on the translation of evidence into national infection prevention and control guidelines for the NHS. Through evaluation of initiatives to reduce the threat of HCAI and associated disability to patients, and by generating evidence to support the development of government policy, Epic has led to safer care for people during periods of health-related vulnerability, and saved lives.
"One in 10 adults in Wales has no natural teeth" (BBC News), "Cost puts off some going to the dentist" (BBC News) and "Overall improvement masks dental health concerns", (British Dental Association, Press Release). These are examples of the sensational headlines which accompanied the publication of the findings of the 2009 Adult Dental Health Survey (ADHS). Researchers at Birmingham's Dental School were key members of the research consortium that carried out both the ADHS as well as the 2003 Child Dental Health Survey (CDHS). The findings from these surveys demonstrated an overall improvement in the nation's oral health but also highlighted areas of inequality. The Government regards these surveys as being of vital importance in providing gold-standard information about the nation's oral health and uses the findings to inform oral health policy in the areas of workforce planning, the provision of, and access to, dental services. The impact of these internationally-leading studies is reflected in Government policy documents and in public debates about the future provision of dentistry.
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).
Research carried out at Newcastle University in the mid-1990s showed that the dental health profile of older people was changing rapidly: the number of people with no natural teeth was falling and a cohort of people with complex restoration needs had emerged as an important patient group. Those trends were confirmed by analysis of the 1998 Adult Dental Health Survey data, with further changes shown in children in 2003. It became clear to policymakers that substantial reform of NHS dental services in England would be required if the projected future needs of the population were to be met. The 2009 Steele review of NHS dentistry analysed the problems with the existing dental contract, from which a set of recommendations for public policy reform were put forward, which have now been adopted into a prototype NHS dental contract which is currently being piloted.