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Multiple births following in-vitro fertilisation (IVF) treatment leads to serious health risks in the mother and offspring. It is caused by replacing multiple embryos within the uterus. Concerns about reduced success rates have deterred patients and practitioners from transplanting a single embryo. A programme of research led from the University of Aberdeen established that a policy of replacing one embryo at a time minimises the risk of twins without compromising livebirth rates. This work has received international media coverage, influenced clinical guidance and resulted in an increased uptake of single embryo transfer in the United Kingdom and beyond.
The claimed impact, as defined by REF guidance, is therefore on public policy and services; practitioners and professional services and health and welfare.
Impact: Health and welfare; public policy; the work led to UK and international guidelines advising against progesterone use to prevent preterm birth in twin pregnancy.
Significance: Thousands of women now avoid this unpleasant procedure annually, with a saving to the NHS of £25M.
Beneficiaries: Pregnant women, policy-makers, the NHS and healthcare-providers.
Attribution: The work was initiated by a five-centre UK collaborative group including UoE. Data analysis, interpretation and translation into practice were led by Jane Norman, UoE.
Reach: The data are cited in guidelines and have changed clinical practice on three continents: Europe (NICE), North America and Australasia. Applies to 11,000 women annually in UK alone.
Clinical research is heavily dependent on individuals providing tissues for experimentation and therapeutic developments. Since the Declaration of Helsinki (1964) the ethical protection of tissue providers has been a central concern. However, tissue providers have rarely been included in designing those protections. Research at Newcastle (2001-2011) has contributed to changing this, since 2008 it has brought providers' perspectives to the attention of key audiences: clinical research funders, policy advisers, and practising scientists. In terms of significance and reach this research has:
The University of Southampton's lifecourse cohort studies have led to a paradigm shift in the medical approach to obesity and non-communicable diseases. Research linking maternal pre-conception and early years nutrition with health outcomes for later life has directly influenced public healthcare policy at international (United Nations), national (Scientific Advisory Committee on Nutrition) and local (Southampton City) levels. Dissemination through medical practice and Southampton-designed public education programmes such as LifeLab means this research has already led to health benefits for tens of thousands of people, providing them with the information and tools to help prevent themselves and their children from succumbing to a non-communicable disease.
Clinical trials designed and led by Professor Chris Twelves (University of Leeds) showed eribulin to be the first single agent cytotoxic to prolong survival in women with heavily pre-treated metastatic breast cancer (MBC).
Eribulin has been approved by European, U.S. and other regulatory authorities since 2010. Cancer treatment guidelines in the U.S., Europe and elsewhere now recommend eribulin. Sales of eribulin generated many millions of pounds in the first full year following approval. Already tens of thousands of women have been treated with eribulin, who collectively have gained up to ten thousand added life years. The U.S. regulatory authorities have advocated the EMBRACE trial design for future trials.
GTD is a group of pre-malignant and cancerous conditions that affect pregnancy occurring in 1800 women annually in the UK. The Charing Cross GTD centre at Imperial College is a world leader in this disease area and since 2008our impacts include the health and welfare benefits associated with the development of new combination chemotherapy regimens which have been recognised in national and international guidelines and the refinement of patient stratification to a particular treatment. Imperial researchers have taken a leading educational role both nationally and internationally on the disease and its management to help others to develop new centres in their own countries.
International obstetric practice has been changed by two large randomised controlled trials led from the University of Oxford's National Perinatal Epidemiology Unit, which demonstrated the efficacy of magnesium sulphate for both treatment and prevention of eclampsia during pregnancy, a condition characterised by fits in association with hypertension, and an important cause of maternal morbidity and mortality. Until the 1990s there was widespread geographical variation in the management of the condition, with magnesium sulphate used almost exclusively in North America. Following the publication of the results of these two trials magnesium sulphate is now in routine use globally, widely recommended in guidelines, and has been placed on the WHO Model List of Essential Medicines.
(1) Enhancing the awareness of (i) women of childbearing age suffering from epilepsy and prescribed new and/or older generation AEDs, and (ii) their healthcare professionals. Empowering both to make informed decisions through evidence-based practice that will reduce/prevent the risk of harm to unborn children potentially exposed to AEDs in early pregnancy.
(2) A change in the process by which GlaxoSmithKline (GSK) practices post-marketing epidemiological surveillance of the new generation AED `lamotrigine' in pregnancy.
(3) Benefit to the methodological practice of other researchers in Europe involved with AEDs and epidemiological surveillance
(4) Contribution to building European system for reproductive safety evaluation
Pre-eclampsia is a major contributor to death and disability in pregnancy. Diagnosis, based on accurate blood pressure (BP)/proteinuria determination, is limited by measurement errors and being late features of the disease. In collaboration with industry, King's College London (KCL) researchers have developed an inexpensive, accurate, simple BP device suitable for rural clinics. This device allows intervention to reduce mortality/morbidity and is currently being rolled out in a Gates Foundation project in Africa and Asia. KCL researchers have also helped the company Alere Inc. with the development of a diagnostically accurate test of placental growth factor (PlGF) in women with suspected pre-eclampsia: Alere Triage®PlGF. This demonstrates high sensitivity, superior to current tests, and following commercialisation is being adopted internationally. Their work is additionally reflected in guidelines of international standards for BP device accuracy.
Impact: Health and wellbeing; commerce; studies and clinical trials of the effects of progesterone receptor modulators (PRMs) underpinned their application for the benefit of women of childbearing age.
Significance: UoE studies underpinned the application of PRMs as emergency contraception including over-the-counter availability and the treatment of heavy menstrual bleeding (HMB); changed clinical guidelines; influenced Pharma R&D.
Beneficiaries: Women of reproductive age; the NHS and healthcare delivery organisations; pharmaceutical companies.
Attribution: Studies were conducted by Critchley, Baird and colleagues (UoE).
Reach: Worldwide; annually 4M women seek emergency contraception in the USA, and in the UK 1M women seek help for HMB. Drugs targeting the PR are licenced in 67 countries. Multiple global Pharma are active in the field of PRM biology.