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As a consequence of a research-based training programme developed at the University of Bristol, the rates of perinatal hypoxia and intrapartum fetal injury in Bristol and two pilot units in Australia and the US are now among the lowest in the world. The improvements achieved in Bristol, the US and Australia have also been successfully achieved in a low resource setting in Zimbabwe.
In response to demand from maternity units across the world, the Bristol team has developed PROMPT — a PRactical Obstetric Multi-Professional Training package, which has been successfully implemented in over 20 countries worldwide. PROMPT has had a major health and welfare impact on more than a million mothers and their babies, as well as bringing substantial economic benefits and supporting international development.
Maternity staff from hospitals in the UK and around the world have benefited from training to improve their communication and team-working skills in emergency situations. This has been achieved through input into a standard training manual now in wide use, and through the development of course content used in `train-the-trainer' sessions for consultant obstetricians, consultant anaesthetists and senior midwives who have in turn been able to train their colleagues. Research findings at UWE, Bristol, contributed to showing that clinically better results correlate with specific linguistic behaviours. The findings of the work made a direct contribution to this training content.
This case study is based on a series of major studies by academic staff at City University London relating to quality, safety, choice and organisation of birth in different settings. Their research has been widely cited and debated by policy, professional and user groups, nationally and internationally. The key impact has been on national and international guidelines for commissioning and on reconfiguration of services to include Midwife Units, to tackle the rising rates of intervention in childbirth and to underpin informed choice for patients. The research is being used by policy-makers, commissioners and managers to plan future services and by midwives to support informed choice discussions.
Every year 15 million babies are born premature and prematurity is the world's single biggest cause of newborn death. Babies born preterm cannot shiver and are dependent on interventions to prevent low body temperature (hypothermia). Implementing evidence-based interventions such as provision of thermal care at high coverage (99%) could increase survival of premature babies by 35-55% worldwide. In light of this, a Cochrane systematic review of evidence on low cost/low tech interventions to prevent low body temperature at birth in preterm and low birthweight babies was conducted. This produced strong evidence to support their routine use in practice, with particular support for use in low and middle-income countries. The findings and recommendations of the review are included in global action agendas of bodies such as the World Health Organization and UNICEF and they have been used as the foundation of numerous clinical practice guidelines worldwide.
This University of Liverpool (UoL) research programme has provided the first international guidance on pregnancy dosage regimes for the drug misoprostol. Although commonly used, its use in pregnancy is off-label. This has led to a wide variety of different dosage regimens. Professors Weeks, Alfirevic and Neilson (all UoL) have been at the forefront of research into its correct use since 1998. In 2007 they initiated a WHO expert conference to conduct dosage reviews, thus establishing an international consensus. These regimens were adopted by the International Federation of Gynecology and Obstetrics (FIGO) in 2009, and updated in 2012. Examples of resulting guidelines with social marketing are provided.
Policymakers in the government departments responsible for health and education, Local Safeguarding Children Boards (LSCBs) and many thousands of professionals with child-protection roles have benefited from Bristol's research into inter-agency training. The research provided crucial information on efficient organisational partnerships for training and strong evidence of the effectiveness of inter-agency training in promoting mutual understanding, changing attitudes and developing confidence. Bristol's findings underpinned statutory guidance in the Government's Working Together to Safeguard Children (2010) [b], which required LSCBs to provide such training. The research ended a 30-year period during which inquiries into the deaths of children at the hands of their parents consistently criticised the failure of professionals to communicate and work together effectively and advocated inter-agency training as a solution, but had little or no supporting evidence.
Specific impacts are evidenced in: the citation of the research findings in support of LSCBs' training strategies; the increased provision of training programmes in the three years since publication, in spite of budget restrictions; the successful targeting of previously disengaged groups, particularly GPs; and the use of an NSPCC-sponsored bespoke evaluation toolkit developed by the research team.
This systematic evidence, evaluating the effectiveness of midwife-led care, has helped to shape policy improvements in promoting access to midwifery care and reducing health inequalities nationally (e.g. NHS, Department of Health [DH]) and internationally (e.g. Australia, Brazil & US). The review was recognised by the DH and updated rapidly to inform NICE intrapartum guidelines. As part of the Commissioning, Service Delivery and Organisation theme, the Maternal and Early Childhood Health Research Group (MACHRIG) led by Professor Hora Soltani, in collaboration with the Sheffield Teaching Hospital-Jessop Wing (STH-JW) and maternity user representatives, has initiated an awareness campaign to encourage information sharing on types of maternity care and to enhance the implications of findings for women and staff via the hospital website and targeted seminars. It is envisaged that its impact will continue to grow through an extensive dissemination strategy and media coverage.
The Millennium Development Goals placed improvement of maternal health and reduction of maternal mortality high on global policy agendas. Our research at King's College London takes this aim forward by producing detailed analyses of health systems barriers to timely access to maternal healthcare in a variety of settings in Africa and Asia, complemented by synthetic reviews of evidence to inform governments and international agencies. Our contribution has drawn international policy attention to the impact of healthcare financing mechanisms on delivery of maternity care and subsequent wellbeing, and the importance of effective emergency maternity referral systems. Our work has directly informed the design of referral systems in several countries.
Research by the University of Southampton into maternal and child health in the developing world has contributed significantly to the design of better health policies by governments, international agencies, and non-governmental organisations. The research broke new ground in identifying the urban poor in developing countries as among the groups most at risk of poor maternal and child health. Its findings have informed policy and funding priorities at national and international organisations including the Department for International Development (DFID) and the United Nations; influenced health practitioners in Africa and Asia; and led to better health care outcomes in countries which were the focus of the research.
Domestic violence (DV) has a devastating public health, clinical and economic impact on women. It is also a major breach of human rights. IRIS (Identification and Referral to Improve Safety), a University of Bristol led randomised controlled trial of a training and support programme to improve the general practice response to DV, demonstrated a substantial increase in identification of victims and their referral to specialist DV services resulting in a subsequent reduction in recurrent abuse and improved quality of life. The programme has now been commissioned by clinical commissioning groups (CCGs) and local authorities in 12 English localities and the training delivered to 122 general practices. The current annual rate of referral of victims of domestic violence from IRIS practices in England to specialist domestic violence agencies is 683 per year, with trial data indicating that at least 600 of these would not have taken place without the IRIS programme. The programme started implementation in Scotland in June 2013.