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The results of two major randomised trials and a cohort study based at the University of Manchester (UoM) have had a major impact on cervical screening in the UK and influenced thinking internationally. These trials evaluated two technologies which had the potential to improve cervical screening. As a result HPV primary screening has moved to a large national pilot study. HPV as a test of cure following treatment of cervical precancerous lesions has now been adopted as standard across the National Screening Programme. Automation assisted technology, which was shown to be inferior to manually read cytology, will not be adopted.
Research by Professor Judith Stephenson and colleagues at the UCL Institute of Women's Health into the effectiveness of chlamydia screening has led to guidance to health policy makers in the EU about national strategies for chlamydia control, and has influenced NICE guidelines on the subject. In particular, our work has informed debate on the value for money of the National Chlamydia Screening Programme (NCSP). Stephenson advised the National Audit Office on this topic, and a resulting report led to the NCSP focusing on chlamydia testing in sexual health services and primary care rather than screening in low risk groups. These changes are expected to make considerable cost savings to the NHS.
This research significantly improved the accuracy of antenatal screening for Down's syndrome and the extent to which maternal choices are informed by robust evidence. Tests developed by Professor Nick Wald's team at Queen Mary's Wolfson Institute of Preventive Medicine and validated in the SURUSS (Serum Urine and Ultrasound Screening Study) study were adopted as national UK policy in 2003 and remain an established gold standard worldwide. As a result, most Down's syndrome babies in UK are now born through parental informed choice, and (using age-adjusted figures) approximately 3,000 fewer babies with the syndrome were born between 2008 and 2013. Screening programmes in numerous countries are based on this research.
Congenital heart defects are a leading cause of infant death, accounting for more deaths than any other type of malformation and up to 7.5% of all infant deaths. Timely diagnosis is crucial for the best possible outcome for these children. However, the accuracy of current methods for screening for critical congenital heart defects (CCHD) before birth is variable and currently only detects these defects in between 35-50% of cases. Although around a third of remaining cases are picked up after birth, up to a third of children with a CCHD are sent home, where they may become unwell or die. Research led by Dr Andrew Ewer at the University of Birmingham has demonstrated that pulse oximetry is a rapid, safe, non-invasive, painless method of detecting the low blood oxygen levels associated with CCHD, and is also a cost-effective approach. As a result of Dr Ewer's research, Pulse Ox was recommended for adoption across the US in 2011 by the Secretary for Health and Human Services, and Dr Ewer has been instrumental in this screening approach being taken up worldwide. This research prompted a national UK review of screening for these conditions.
Abdominal aortic aneurysms (AAAs) affect more than 4% of British men aged 65-74 and are responsible for over 6,800 deaths annually. The MASS trial showed that screening could reduce AAA-related mortality by 42%, and the Health Economics Research Group (HERG) demonstrated, through the MASS trial, that AAA screening was cost-effective. HERG thus helped inform the policy announced by UK ministers in 2008 to introduce a national screening programme for all men reaching 65. By Spring 2013 it was fully introduced in England — offering screening to 300,000 men annually; the latest Annual Report (2011-12) claimed an uptake rate of 75%. In 2008 the DH estimated the health gain from a screening programme would be at least 130,000 QALYS over 20 years. Internationally, MASS is the most significant trial of AAA screening, and provides the most robust evidence-based model of its cost-effectiveness. It extensively influenced AAA screening guidelines, policies and services, including in the USA and Europe.
School dental screening was a statutory function of the NHS. University of Manchester (UoM) research demonstrated that the national screening programme was ineffective and likely to increase inequalities in health and service utilisation. As a direct result of UoM research, the National Screening Committee recommended that the national programme should stop. This changed Departments of Health policy resulting in new guidance to the NHS, which stopped the screening programme and redirected resources to treatment services for vulnerable groups and prevention programmes. In 2010 in England the costs of a national screening programme were estimated to be £17m per year; money released for reallocation to other dental services.
Congenital heart defects are a leading cause of infant death, accounting for more deaths than any other type of malformation and up to 7.5% of all infant deaths. Timely diagnosis is crucial for the best possible outcome for these children. However, the accuracy of current methods for screening newborn babies for critical congenital heart defects (CCHD) is variable and currently only detects these issues in between 35-50% of babies before birth. Although some cases are picked up after birth, up to a third of children with these problems are sent home undiagnosed, where they may become unwell or die. Research at the University of Birmingham has demonstrated that pulse oximetry is a rapid, safe, non-invasive, painless method of detecting the low blood oxygen levels associated with CCHD, and is also a cost-effective approach. As a result of our research, pulse oximetry was recommended for adoption across the US in 2011 by the Secretary for Health and Human Services. In the UK, our research is prompting a national review of screening for these conditions and some units are already using the approach, meaning that some patients are already benefitting.
A series of projects focusing on the medical, social, and emotional experience of pre-pregnancy, pregnancy, and early motherhood have been undertaken since 2006 at Plymouth University. The impact of these projects is wide ranging covering both policy and practice. The research has: changed the physical environment of the antenatal clinic specifically to suit the needs of pregnant women with pre-existing diabetes; developed an online leaflet for women with Polycystic Ovary Syndrome (PCOS); developed training programmes for health and social care professionals; provided baseline information to inform practitioners and patients involved in UK screening programmes; and, informed screening strategies for Downs Syndrome.
Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness. Research by Professors David Mabey and Robin Bailey, LSHTM, has shown that a single oral dose of azithromycin is an effective, feasible mass treatment and could eliminate trachoma from affected communities. As a result, the manufacturer Pfizer agreed to donate azithromycin to trachoma control programmes for as long as necessary and WHO established an Alliance for the Global Elimination of Blinding Trachoma by 2020. Since 2008, 205m azithromycin doses have been donated, and WHO elimination targets have been achieved in nine countries.
The Institute of Sound and Vibration Research (ISVR) has played an influential role in transforming testing for child deafness in Europe, North America and elsewhere. In England, the NHS drew on its findings in deciding to replace traditional testing methods with universal newborn hearing screening programmes. This form of testing is more accurate, cost-effective and can be conducted at an earlier age. In England alone more than four million babies will be screened between 2008 and 2013, with around 6,000 identified as having hearing impairments. Earlier clinical intervention has benefited children's language development and overall quality of life.