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Impact: Health and welfare: reducing morbidity; providing evidence to disinvest in an ineffective and damaging treatment; policy change.
Significance: Since 2009, applied clinical trial findings have resulted in approximately 6000 fewer complications (e.g., skin breaks) in the UK. Stocking use has decreased by 95%, which has saved the NHS in excess of £20M per annum.
Beneficiaries: Stroke patients worldwide, the NHS and healthcare delivery organisations, the economy.
Attribution: Trials were designed and led by Professor M Dennis, UoE.
Reach: Changed national guidelines in at least seven countries worldwide (Europe, N America, South Africa, Singapore).
Impact: Health and welfare; saving lives by determining that aspirin is an effective treatment for acute stroke and that heparin anticoagulation is ineffective.
Significance: In the UK, treating all acute stroke patients with aspirin and avoiding heparin means 1800 people avoid death or disability each year; aspirin is also highly cost-effective.
Beneficiaries: Stroke patients, the NHS, the economy.
Attribution: Sandercock, UoE, designed, led and reported the International Stroke Trial, and was on the steering committee of the Chinese Acute Stroke Trial.
Reach: Up to 15M stroke patients annually affected by guideline changes worldwide, encompassing Europe, North America and Australasia; educational events by the World Stroke Academy promote aspirin use.
Impact: Health and wellbeing; improvement in mortality and morbidity; changes in policy and guidelines.
Significance: Clinical trial findings have led to 1160 fewer deaths and 780 fewer severely disabled patients each year in the UK; rationalising feeding policies saves over £12M annually.
Beneficiaries: Stroke patients, the NHS and healthcare delivery organisations, the economy.
Reach: Worldwide: revised national guidelines in UK, Europe, North America, South Africa, Singapore, Australasia.
Impact: Health and welfare; a large randomised controlled trial (third International Stroke Trial (IST)-3) and meta-analysis determined that the thrombolytic agent recombinant tissue plasminogen activator alteplase is a long-term effective treatment for acute ischaemic stroke in a wide range of patients.
Significance: Thrombolysis would result in 1488 more stroke patients being alive and independent per year in the UK.
Beneficiaries: Stroke patients, the NHS and healthcare delivery organisations, the UK economy.
Attribution: The IST-3 trial was led from UoE (Sandercock), with UoE (Wardlaw, Dennis) and University of Sydney (Lindley) colleagues.
Reach: Worldwide. Applicable to 4 million stroke patients per year; guidelines changed in Europe, N America, Asia, Australia.
Stroke is the leading cause of disability and a major cause of death in the developed world. Hypertension (high blood pressure) is the single most important modifiable risk factor for stroke, contributing to around 50% of all events. University of Glasgow researchers have played lead roles in the design, conduct and analysis of pivotal clinical trials on treatment regimens for hypertension. These research findings have informed European and UK hypertension and stroke guidelines, advancing treatment strategies, and contributed to the observed ~25% reduction in the incidence of primary (first) and secondary (recurrent) stroke.
Approximately 152,000 strokes and 49,000 stroke-related deaths occur in the UK every year; of these, 85% are caused by blockage of a blood vessel in the brain (acute ischaemic stroke). The economic burden of stroke in the UK is estimated at £3.75bn with hospital inpatient care accounting for 82% this cost. Since the 1990s advances in thrombolytic treatments (which dissolve blood clots) have limited the extent of damage and subsequent impairment; however their use has been restricted due to ambiguity between stroke onset and stroke symptom presentation. University of Glasgow research has challenged the restrictions associated with thrombolysis treatment which has significantly influenced the wider use and applicability of thrombolytic treatment. This research has influenced new guideline recommendations and emergency stroke care patterns, through the implementation of dedicated acute stroke centres, and contributed to the on-going improvement in stroke survival rates.
Two multicentre clinical trials conducted by Professor Potter have contributed to revised international guidelines for the management of hypertension following acute stroke, the single largest cause of adult disability worldwide. Before these trials, there was little evidence on the effects of using antihypertensive drugs immediately after stroke and there was concern that use of these drugs could extend the stroke. The trials found no serious adverse effects of using antihypertensive drugs immediately after stroke whilst mortality after 3 months was halved. The American Heart Association, the European Societies of Hypertension and of Cardiology, and the Royal College of Physicians all reference these trials in support of their recent Guidelines, thereby promoting better patient care and improved outcomes.
Research in Oxford by Rothwell and colleagues since 2000 has radically changed how minor strokes and transient ischaemic attacks (TIAs) are managed. First, the risk of a major stroke in days after a minor stroke/TIA was found to be much higher than thought. In consequence, these `warning' events were rebranded as a medical emergency in clinical guidelines. Second, Rothwell showed that a delay in treating individuals at high risk of major stroke substantially reduced the benefits. Third, the Rothwell group developed a simple risk score (`ABCD system') to triage high-risk individuals, showing that more urgent treatment reduced the 90-day risk of major stroke by 80%. This strategy has been implemented in the National Stroke Strategy and NICE and international guidelines. In the UK it is estimated to prevent 10,000 strokes per year, and to save the NHS £200 million in acute care costs alone.
The University of Oxford's International Subarachnoid Aneurysm Trial (ISAT) changed clinical practice worldwide by showing that endovascular coiling is a more effective and safer treatment than neurosurgery following subarachnoid haemorrhage, with fewer complications and improved quality of life. Subarachnoid haemorrhages account for 1 in 14 strokes and are caused by bleeding in and around the brain; approximately 85% occur when cerebral aneurysms rupture. ISAT was the first trial to compare neurosurgery, or neuroradiological endovascular coiling in patients with ruptured cerebral aneurysms causing acute subarachnoid haemorrhage.
Researchers at the University of Manchester (UoM) have made a significant impact nationally and internationally on improving the outcome for children with acute lymphoblastic leukaemia (ALL) (~450 pa in the UK). The changes in clinical practice based on our research are now national standards of care for children with de novo and relapsed ALL in the UK and Ireland. Other international groups have adopted key findings from the results of our frontline trials. Our relapse protocol for childhood ALL underpins European and North American strategy for the management of relapsed disease.