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King's College London (KCL) research has had an major impact on guidelines in the UK, USA, Sweden and worldwide — through the World Health Organization (WHO) — on managing HIV in pregnancy to balance the risk of transmitting HIV from mother-to-child against the toxicities of antiretroviral therapy and the need for Caesarean section. Specifically, KCL research led to guidance on when HIV-infected women should begin antiretroviral treatment and at what viral load they can deliver vaginally to minimise mother-to-child transmission (MTCT). This guidance has led to fewer Caesarean sections (a less acceptable mode of delivery compared to natural vaginal delivery, especially in many ethnic minority groups), a drop in MTCT rates in England and Ireland, and better advice to healthcare practitioners and patients.
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.
King's College London (KCL) researchers discovered that heroin overdose is a common and accidental occurrence which is usually witnessed. Risk of fatal overdose on prison release is exceptionally high with 1 in 200 dying of an overdose within four weeks. KCL researchers proposed and tested the acceptability of prior provision of take-home emergency supplies of the heroin antidote naloxone. KCL research created the stimulus for a national training project for families and carers to administer naloxone and as a result, lives are now being saved. KCL research had a substantial impact on national and international policy and service delivery with take-home naloxone programs introduced around the world. KCL researchers lead the first trial to assess the effectiveness of naloxone for prisoners on release.
Myeloproliferative neoplasms (MPN) are a group of blood disorders that affect more than 9,000 people in the UK every year. King's College London (KCL) research on the biology, diagnosis and treatment of MPN has had the following significant impacts:
King's College London (KCL) researchers contributed to the discovery that increased C fibre nerve activity in the bladder is a major cause of overactive bladder (OAB) syndrome. Based on this insight, KCL researcher Professor Dasgupta, a surgical urologist at Guy's Hospital, and his team pioneered a new surgical technique for micro-injecting Botulinum Toxin-A (BTX-A) directly into the bladder to suppress C fibres and improve bladder control. The KCL team then conducted the world's first successful clinical trials into the minimally invasive injection of BTX-A n OAB patients. These trials received significant international media coverage. This cost-effective OAB therapy is now licensed by the EU and FDA, is recommended in national and international guidelines, and has significantly improved the treatment of a common health problem.
The use of a formulary to influence prescribing practice is common, with almost all hospitals possessing one that attempts to provide advice on the safe, effective and economic use of medicines. The Maudsley Prescribing Guidelines to Psychiatry steps beyond the function of a mere formulary and provides evidence-based guidance on the use of psychotropic medicines that influences prescribing on both a national and international basis. Now in its 11th Edition and translated into nine languages, much of the evidence in The Guidelines is generated by King's College London research. Additionally, this research is used in other guidelines, in clinical handbooks and in prescribing practices around the world.
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.
King's College London researchers identified that the failure to supervise daily dosing of methadone for heroin addicts was associated with a high annual number of methadone-related deaths. Their research on newly-introduced supervised dosing showed major benefit from this policy initiative with greatly reduced levels of methadone overdose deaths per daily dispensed dose in the UK. Based on this research, guidelines from the National Treatment Agency and Department of Health now include clear direction for initial supervised consumption to prevent or greatly reduce methadone overdose deaths. Recent estimates suggest that the introduction of supervised methadone dosing has saved more than 2,600 lives in the UK.
King's College London (KCL) researchers developed cognitive behaviour therapy for psychosis (CBTp), which is now a National Institute for Health and Care Excellence-recommended psychological intervention. CBTp is now part of routine NHS treatment and an estimated 25,000 patients in England and Wales receive it annually. Implementation of CBTp has been steered by KCL researchers' involvement with the Government's Increasing Access to Psychological Therapies — Severe Mental Illness initiative. The KCL model for CBTp has been used to develop clinics in Australia and the US and information on this therapy is disseminated via a KCL-led website.
King's College London (KCL) has developed a generic test format which is being used to cheaply and easily detect a large number of single-gene disorders and chromosomal abnormalities in in vitro fertilised embryos — a highly significant impact. The test resulted from KCL's research to develop new strategies for preimplantation genetic diagnosis (PGD), which involved developing a small number of DNA probes targeted around a known area of genetic risk to identify mutations as well as methods to detect chromosomal translocations. Because the approach is cheap and easy to apply, it is being used by IVF clinics worldwide as well as by the NHS. The KCL/Guy's and St Thomas' Centre for PGD was licensed in 2008 by the UK Human Fertilisation and Embryo Authority to analyse over 50 genetic conditions affecting single genes and carries out more than half of all the UK's PGD testing. Embryos can now be tested using these techniques for virtually any inherited genetic disease prior to implantation with a 98% success rate, thus reducing the need for later prenatal diagnosis and termination of an affected foetus.