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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.
Between 2006 and 2008 an evaluation carried out by the University of Sheffield of the National Infarct Angioplasty Pilot showed that primary angioplasty for ST-elevation myocardial infarction (heart attack) is feasible, cost-effective and acceptable to patients and carers. As a direct result, a new national strategy using primary angioplasty was published in the National Service Framework for Coronary Heart Disease. National audit data has since shown the proportion of patients receiving primary angioplasty increasing from 42% to 73% and mortality falling from 10.6% to 8.7%. An impact assessment based on our economic analysis estimated a £294 million net benefit to the NHS.
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.
Research conducted at the University of Aberdeen into the treatment of depressive disorder in primary care has directly led to the revision of health care policy by the Scottish Government Health Department. The work initiated debate over the validity of tools for the assessment of depression, contributing to revision of the Quality and Outcomes Framework (QOF), a system for the performance management and payment of GPs in the NHS in the UK. The findings are now being discussed in commentaries on the development of forthcoming disease classification systems for depression in the US (Diagnostic and Statistical Manual DSM-revision V) and Europe (International Classification of Disease — ICD revision 11).
Therefore the claimed impact is on: health and welfare; changes to public policy and on impact on practitioners and services.
Southampton's research into the management of depression highlighted deficits in the way GPs were assessing and treating depression, and demonstrated failure to improve their performance through education alone. The findings were included in guidelines drawn up by the National Institute for Health and Care Excellence (NICE) and led to incentives for questionnaire assessments of depression being introduced into the GP contract Quality Outcomes Framework (QOF). UK-wide QOF data from 2008-2013 demonstrated questionnaire assessments in 2.2 million cases of depression. Subsequent Southampton-led research showed that improved targeting of treatment resulted from questionnaire assessments, and trial evidence shows such assessments improve patient outcomes.
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.
York research showing that a) screening for depression in primary care is ineffective and b) collaborative and stepped care improves outcomes for depression in primary care, has changed national and international policy. The National Institute for Health and Care Excellence (NICE) revised its guidelines, the National Screening Committee altered its recommendations, and money has been saved by no longer paying GPs to screen for depression under the Quality and Outcomes Framework. US advisory bodies have also shifted away from recommending routine screening for depression. Treatment guidelines/programmes in the USA, Europe and Australia now recommend collaborative care for the management of depression. Our research has also resulted in an expansion of the NHS Improving Access to Psychological Therapies programme, with many patients benefitting from improved care. The computer support system (PC-MIS©) we developed to record treatments and to track patient progress over time is the most widely used in the NHS. The clinical performance benchmarks we derived from this form the basis of metrics used for NHS-wide performance management of depression services.
Heart failure affects more than 22 million people worldwide, including 6 million in Europe and 5 million in the United States, with approximately 500,000 new patients diagnosed each year.
The cardiac resynchronisation in heart failure trial (CARE-HF) demonstrated that, in patients with heart failure and cardiac dyssynchrony, use of an implantable pacemaker to improve heart contraction led to a 37% reduction in the risk of death and hospitalisations and significant improvements in patient quality of life. The benefits are in addition to those of standard pharmacologic therapy. As a result of the CARE-HF trial, international and NICE guidelines have recommended the use of cardiac resynchronization therapy in patients with heart failure and dyssynchrony resulting in an increased use of cardiac resynchronisation throughout the world and significant improvements in quality of life and survival for heart failure patients.
The epilepsy research group at the University of Liverpool (UoL) has undertaken a programme of work assessing treatment outcomes associated with antiepileptic drug treatment in patients with epilepsy. This includes two large pragmatic trials in patients with first seizures and newly diagnosed epilepsy, and cohort studies assessing malformations and cognitive development in children exposed to antiepileptic drugs in utero, and the work of the Cochrane Epilepsy Group.
This work has influenced prescribing in the UK and worldwide through the following impacts:
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.