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pGALS (paediatric Gait, Arms, Legs, Spine) is a quick, accurate and child-friendly examination technique that identifies children who need to be referred to a paediatric rheumatology specialist. pGALS has been widely disseminated since 2008 and integrated into both undergraduate medical student teaching and the membership examination for the Royal College of Paediatrics and Child Health. pGALS was developed by Newcastle researchers in response to their findings of a self-reported lack of confidence among clinicians when conducting musculoskeletal examinations of children. Research also showed that delays and inappropriate investigations were being conducted before the child was referred to a specialist. pGALS is now taught in at least 15 of the 32 medical schools in the UK and has been described in a number of leading textbooks. It is becoming known and used worldwide, adapted for local cultural and social contexts.
As a direct result of work led by Professor Rod Scott and colleagues at the UCL Institute of Child Health (ICH) midazolam, administered by the buccal cavity, has become first-line therapy in the NICE pathway for treating children, young people and adults with prolonged or repeated generalised, convulsive seizures in the community. It also forms part of the APLS guidelines. Buccal midazolam has demonstrated clinical superiority over the previous paediatric standard of care (rectal diazepam) with an equivalent safety profile and greater patient/social acceptability. Its use is now widespread in Europe and the USA and a licensed preparation is now available.
Bangor University staff (Neal & Wilkinson) are core members of a collaboration whose research since 2003 has had significant policy relevance and impact in the field of primary care oncology. Impact has been made in three areas:
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.
Around 1,000 children are born each year in the UK with cleft lip and/or palate. They need treatment from a range of clinical specialties. Bristol co-led a research survey commissioned by the Clinical Standards Advisory Group (CSAG) which was published in 1998. This informed a process of centralisation which by 2008 had reduced the number of centres from 57 to 11. The process of centralisation and service configuration has continued through 2008-13 leading to closer multi-disciplinary working, increased cases operated on per surgeon, less variation in surgical techniques and shorter stays in hospital. The impact for the individual is improved facial appearance, speech and psychological adjustment. This centralisation of care has resulted in care quality similar to the better cleft centres in Europe. Bone repairs to the palate were 85% successful in 2010 compared to only 58% in 1998 and there was poor jaw growth (linked to quality of surgery) in only 18% of cases in 2013 compared to 37% in 1998. The reach of this study has extended to several European countries and America.
Cancer treatment for children is one of the success stories of medical care in the twentieth century. Survival increased from almost zero in the 1950s to today, when treatment for some child cancers results in over 90% survival. These improved survival rates have, however, been achieved through use of highly aggressive treatment protocols, with adverse implications for the child's cognitive, emotional and social development and the burden of care on families. Nationally, researchers at Sheffield were among the first to identify the extent to which children continued to show psychological and behavioural problems, even long after the end of treatment. As such, they contributed significantly to discussions about how to balance medical treatment to control the cancer while taking into account the immediate and longer-term impacts on child quality of life and parents' psychological well-being. The work has had direct implications for both national and international clinical guidelines, and assessment of quality of life in national clinical trials. It has also resulted in user-friendly information for schools and families.
Novel methods of measurement developed by Marek Czosnyka, Peter Hutchinson, David Menon and John Pickard have provided new insights into the pathophysiology of brain injury, led to commercial applications, and influenced patient care in terms of improved outcome for clinical trials. Multimodality brain monitoring of intracranial pressure (ICP), brain oxygen and microdialysis; PET/MRI imaging of critically ill patients; and computerised CSF infusion tests for shunt function in hydrocephalus have each impacted on the clinical practice and the ability to evaluate novel treatments and interventions in brain injury. This work has led directly to the establishment of a National Institute for Health Research (NIHR) Health Technology Cooperative for Brain Injury.
Based on his research at the UCL Institute of Cognitive Neuroscience, Professor Paul Burgess invented and co-invented several cognitive tests (known as the Hayling and Brixton Tests, and the BADS and BADS-C assessment batteries) which are used to detect dysfunction of the frontal lobes of the brain. These were developed for commercial production by Burgess and are now produced and marketed by the largest test publisher in the world (Pearson Assessment). There are versions in several different languages, and they are used in clinics worldwide to diagnose problems in a wide variety of patients with neurological, psychiatric and developmental problems. The tests are now administered around the world to around 55,000 patients per year.
The emergency care team at Warwick Medical School has a strong track record of high-quality health sciences research encompassing evidence synthesis, health-services research and clinical trials. Our trials of a 03b2-agonist (salbutamol) in acute respiratory distress syndrome (ARDS) have influenced therapeutic recommendations in the International Sepsis Guidelines (2013), reducing the use of this potentially detrimental therapy. Our cardiac arrest research informed the 2010 international guidelines on cardiopulmonary resuscitation (CPR) led to the generation of new intellectual property, and prompted industrial collaborations to build new technologies, such as TrueCPRTM (2013). These have led to improved CPR practice and improved patient survival. Furthermore, our research has led to major policy changes and to a redesign of UK emergency healthcare, improving cost efficiency, the patient experience and clinical outcomes (e.g. 95% of patients were treated within 4 hours - up from 65%; and people leaving without been seen reduced to less than 5%).
This research has led to the introduction of widely disseminated and adopted guidelines which have clearly changed practice with regard to assessing risk of oral mucositis and the interventions used. The guidelines have led to improved mouth hygiene, a significant reduction in the use of ineffective interventions, specifically use of Nystatin (estimated to save the NHS a minimum of £463,000 per annum), and the delivery of individualised care to children and young people. These measures have directly led to (i) better mouth care with less discomfort and improved quality of life for the children, (ii) reduced risk of mouth infection, and (iii) reduction in readmissions consequent to mouth infection. This has reduced the cost of treating the acute oral side effects of chemotherapy regimens used in children who have cancer.