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The Moorfields Safer surgery System: new techniques revolutionise glaucoma surgery.

Summary of the impact

Glaucoma is the commonest cause of irreversible blindness world-wide and, in many parts of the world, surgery to create a new drainage channel is the only practical treatment. The commonest cause of surgical failure is scarring, and the use of injections of cytotoxic agents prevents scarring but has many complications. Our research identified how convenient single 5-minute treatments with cytotoxic drugs work and led us to carry out pilot and randomised trials, which showed they reduced post-operative scarring. Combined with other refinements of surgical technique (named the Moorfields Safer Surgery System) this has improved outcomes of glaucoma surgery world-wide.

Submitting Institution

University College London

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Ophthalmology and Optometry

Improving success rates in the surgical treatment of cataract

Summary of the impact

Cataract causes blindness in millions of people worldwide. It is treated surgically by replacing the clouded lens with an artificial lens and more than 30 million such operations per year are predicted by 2020. Unfortunately, many of these patients are subsequently blighted by posterior capsule opacification (PCO) a wound-healing response by lens epithelial cells to surgical trauma. Using human donor eyes, Wormstone and Duncan developed a technique that simulated cataract operations and provided an ideal system to understand PCO biology. This technology was a key platform in developing a novel commercial intraocular lens (IOL), which shows massive reductions in PCO rates.

Submitting Institution

University of East Anglia

Unit of Assessment

Biological Sciences

Summary Impact Type

Technological

Research Subject Area(s)

Medical and Health Sciences: Ophthalmology and Optometry

Changes to European Society of Cataract and Refractive Surgery guidelines reduces loss of sight for patients undergoing cataract surgery

Summary of the impact

Research at Strathclyde has brought about a change in eye surgery practice throughout Europe and worldwide. A four-year cross-Europe study in collaboration with the European Society of Cataract and Refractive Surgery (ESCRS) investigated antibiotic treatment to prevent endophthalmitis, a complication arising during cataract operations which typically results in loss of sight. The findings showed that when the treatment is given at the start of surgery it leads to a 5-fold reduction in the risk of endophthalmitis. The European Society of Cataract and Refractive Surgery has endorsed the discovery and widely promoted the uptake of the treatment through publications and guidelines, which over the last 6 years has led to the prevention of loss of sight in thousands of patients. In Europe alone it is estimated that each year there have been 7500 fewer cases of blindness following cataract surgery as a result of the ESCRS guidelines.

Submitting Institution

University of Strathclyde

Unit of Assessment

Mathematical Sciences

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Ophthalmology and Optometry, Public Health and Health Services

Applying epidemiology to understand visual impairment in childhood: burden, aetiology, diagnosis, management and outcomes.

Summary of the impact

Our research into the epidemiology of childhood visual impairment has transformed understanding of the epidemiology, outcomes and impact of childhood visual impairment in the UK. As a result, changes have been made to the Newborn and Infant Physical Examination Programme and the National Vision Screening Programme. Our work has underpinned the development of new quality standards for paediatric ophthalmology services issued by the Royal College of Ophthalmologists. Our studies on congenital cataract have improved the management of this condition nationally. We have involved visually impaired service users and patient groups directly in our research to improve quality of life measures and patient engagement.

Submitting Institution

University College London

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Ophthalmology and Optometry, Public Health and Health Services

Lower risks to patients, advances in international practice and substantial resource savings result from ‘beating heart’ off-pump coronary artery bypass surgery

Summary of the impact

University of Bristol researchers at the Bristol Heart Institute (BHI) have pioneered the development and clinical take-up of the novel technique of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical trials and several large cohort analyses have assessed the impact of this technique on elective and high-risk patients. The results have shown that it is as safe as the conventional coronary artery bypass grafting (CABG) technique that uses a cardiopulmonary bypass pump and cardioplegic arrest. Most importantly, however, OPCAB significantly reduces the risk of post-operative complications, and reduces morbidity and mortality. It also uses less hospital resources, reducing time in intensive care and length of hospital stay. In 2011 (the last year for which data are available), 20% of CABG operations in the UK were carried out with the OPCAB technique and it has had significant take-up overseas (for example, 18% of CABG operations in the US and 21% in the EU in 2010). NICE has recommended the safety and efficacy of OPCAB surgery.

Submitting Institution

University of Bristol

Unit of Assessment

Clinical Medicine

Summary Impact Type

Technological

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services

Widespread change in practice from nil by mouth to feeding within 24 hours after surgery aids recovery and reduces complications

Summary of the impact

Researchers at the University of Bristol challenged 100 years of dogma, using meta-analysis; finding that feeding people within 24 hours of gastrointestinal surgery is safe, with fewer infections and a shorter hospital stay. This evidence is enshrined in Enhanced Recovery After Surgery programmes (2009, 2012) being rolled out across the UK benefiting patients and the health service. In 2009 The Dutch Institute of Healthcare Improvements considered these data and Cochrane update to `show unequivocally that early feeding after colonic surgery is feasible and safe'. Their project successfully introduced early feeding to over one quarter of all Dutch hospitals.

Submitting Institution

University of Bristol

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Public Health and Health Services

Case Study 3. Establishing the effectiveness of laparoscopic surgery for colorectal cancer leading to safer implementation into the NHS and world-wide for greater a patient benefit

Summary of the impact

The MRC Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer trial (CLASICC) is the largest and most successful UK trial of a technology applied to general surgery. It addressed an area of huge clinical uncertainty, providing a rigorous evaluation of a new technology and enabling its safe and widespread implementation. The impact of CLASICC has been global, confirming the advantages for patients (quicker recovery) and healthcare providers (cost-effectiveness) and so influencing national and international policy in favour of the laparoscopic technique. It informed NICE guidance and led to a major DH initiative that has seen the UK become one of the largest providers in the world of laparoscopic colorectal cancer surgery. CLASICC is regarded as a benchmark surgical trial, combining high quality trial design with rigorous quality assurance, which has informed the design of many subsequent colorectal cancer studies.

Submitting Institution

University of Leeds

Unit of Assessment

Clinical Medicine

Summary Impact Type

Technological

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Oncology and Carcinogenesis

Changes to ophthalmic clinical practice to help reduce trips and falls

Summary of the impact

Falls are a common and serious health risk for older people and reducing falls is a priority for the NHS. Research at the University of Bradford on the link between vision and falls has led to new healthcare guidelines, specifically those from the College of Optometrists and the British Geriatrics Society and endorsed by Age UK and the Royal College of General Practitioners. Continuing professional development practices have changed and public awareness of this health risk has been raised by Which? reports and subsequent media coverage. These developments have impacted on the health and welfare of older people, particularly those at risk of falls.

Submitting Institution

University of Bradford

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Ophthalmology and Optometry, Public Health and Health Services

Diagnosis and treatment of Nystagmus: improving medical effectiveness and patient quality of care

Summary of the impact

Infantile nystagmus (IN), previously known as congenital nystagmus, is a condition that impairs vision by causing continual and involuntary oscillatory movements of the eyes. IN begins in infancy and is a lifelong disorder, affecting over 88,000 people in the UK. Leicester is the leading UK centre for research into the underlying mechanisms and treatment of IN: discovering the genetic mutations behind some of the common forms of nystagmus; pioneering early diagnosis of IN; and conducting randomised clinical trials into drug treatments and other therapies. The centre provides advanced scientific and medical knowledge, and support and advice to sufferers of this physically and psychologically debilitating condition. The work has resulted in new methods of diagnosis which are more comfortable and convenient for patients and enable cost-savings for healthcare providers; and has led to the testing and subsequent prescription of pharmacological treatments which offer patients improvements in quality of life.

Submitting Institution

University of Leicester

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Neurosciences, Ophthalmology and Optometry

Case Study 5. Pathology research led to an international reduction in rectal cancer recurrence and death by improving multidisciplinary clinical practice

Summary of the impact

Postoperative local recurrence affects 20-30% of patients with rectal cancer. Between 1993 and 2013, University of Leeds researchers identified the importance of pathology studies to show a disease-free margin around the excised tumour and how to predict this margin routinely and accurately using simple histopathology and preoperative MRI.

We also used photography in the pathological assessment of the quality of surgery and were instrumental in the adoption of modern techniques by professional organisations around the world.

Following adoption of our techniques in England and Scotland, local recurrence has halved with 10% better survival and cost savings of £60 million. Our methods have also become the gold standard in the treatment of rectal cancer patients around the world.

Submitting Institution

University of Leeds

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Oncology and Carcinogenesis

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