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Research by the University of Huddersfield's School of Applied Sciences has played a major role in addressing the difficulties experienced by people who use inhalers. The work has adapted existing methodologies so they can mimic how patients use nebulisers and dry powder inhalers, thereby enhancing understanding of a problem that affects millions globally. Findings and insights have been incorporated in "gold standard" guidelines that are influencing practice and policy around the world, while lead researcher Professor Henry Chrystyn's methods and techniques have become central to academic, practitioner and industry efforts to tackle the issue at national and international level.
Research by Cardiff University is contributing to initiatives within the NHS and across Europe to safely reduce unnecessary antibiotic prescribing and thus help contain antimicrobial resistant bacteria. Our researchers conducted observational studies of prescribing patterns linked to local resistance data and qualitative research with GPs and patients on their perceptions of acute respiratory tract infections and antibiotic use and resistance. This enabled the Cardiff team to develop clinician training and patient education resources (covering issues such as communication skills, point of care testing, and typical duration of infections) to reduce unnecessary prescribing. Our trials proved these interventions were effective, at times cutting prescribing by as much as two-thirds. Our research has provided the basis for new clinical guidelines, antibiotic stewardship initiatives and policies, and educational tools for clinicians and patients that are being used in the UK and internationally.
Research at Hull into hypersensitivity of the airways has provided novel insights into the epidemiology and causes of cough, and its burden on patients. This was achieved by the development of novel methodologies that allow the rigorous and objective testing of new and existing drugs. Patients benefit through the online provision of a diagnostic tool, and Proctor & Gamble have successfully exploited the cloned cell receptors in their drug development programme resulting in a new range of pharmaceuticals for cough. The work has underpinned the standardisation of cough challenge methodology through incorporation in national and international healthcare guidelines leading to a widespread improvement in patient treatment.
Impact: Health and welfare; public health studies in Sri Lanka and clinical trials in a cohort of 35,000 pesticide self-poisoning patients have led to the withdrawal of high-dose pralidoxime as a WHO-recommended treatment and bans of three toxic pesticides in Sri Lanka.
Significance: Resultant changes in clinical practice and pesticide regulation have saved 3000 lives in the last four years in Sri Lanka alone; in the rest of Asia many times this as local guidelines and practice have changed.
Beneficiaries: Patients and communities, healthcare providers, policy-makers.
Attribution: Studies designed and led, with international collaborators, by Michael Eddleston, UoE.
Reach: International, particularly Asia, changes in WHO and international guidelines on pesticide use.
Research at the University of Nottingham has defined the clinical phenotype and management of lymphangioleiomyomatosis, a rare and often fatal multisystem disease affecting 1 in 200,000 women worldwide. The group has led the development and evaluation of new therapies and diagnostic strategies which are now part of routine clinical care. The research has underpinned the transformation of this previously under recognised and untreatable disease into a condition recognised by respiratory physicians, with international clinical guidelines, patient registries, clinical trials, specific treatments and a UK specialist clinical service.
Original research carried out by The University of Nottingham has shown that both knowledge and practice related to perioperative fluid prescribing was poor, resulting in significant and avoidable postoperative morbidity. We have shown that maintaining patients in as near a state of zero fluid balance as possible reduces hospital stay by 3.4 days and complication rate by 41%. Our work guided the formulation of the British Consensus Guidelines and NICE Guidelines on intravenous fluid therapy for adult surgical patients. It has also reduced the frequency of postoperative fluid overload, and led to improved patient outcome and potential financial benefits of £122m per year for NHS England.
A new intervention has been developed and trialled in patient groups characterised by mucus obstruction of the airways. Outcomes for these patient groups have improved, and health service decisions have been informed by the underpinning research. A spin-out business, Ockham Biotech Ltd., was created and has generated overseas investment.
A novel mucolytic application and inhaled route of administration for heparin has provided a simple and cost-effective therapeutic means of relieving the symptoms of mucus obstruction in diseases including CF and COPD, which cost the NHS ~£600m and £1bn, pa, respectively.
Glaucoma affects around 2% of people over 40 years of age and almost 10% of those over 75. There are more than one million glaucoma-related outpatient visits to hospital eye services annually. Once lost through glaucoma, sight cannot be restored. Therefore early detection (mainly by optometrists) and appropriate management of the condition are crucial to maintaining a sighted lifetime. Uncertainty and variation exist in clinical practice and service delivery. Research undertaken by academic staff at City University London has led to:
In addition, City research on the scope of therapeutic practice by optometrists and the development of clinical management guidelines (CMGs) strongly influenced the decision to extend independent prescribing to optometrists. CMGs developed at City were incorporated into the Map of Medicine and other national ophthalmology primary care pathways. Research on a repeat-measurement-enhanced glaucoma scheme generated a National Institute for Health and Care Excellence (NICE) Quality, Innovation, Productivity and Prevention (QIPP) Case Study and informed Joint College Commissioning Guidance on Glaucoma and Local Optical Committee Support Unit (LOCSU) schemes. City's Standardised Patient research, where actors play the role of patients to collect evidence on actual clinical practice, is unique in optometric research and has been referred to by experts and relied upon in the defence of optometrists' actions in several clinico-legal cases before the General Optical Council.
Non-steroidal anti-inflammatory drugs (NSAIDs) are valuable analgesics, but cause dyspepsia, ulcers and hospitalisation (UK: 3,500pa, USA: 100,000pa) for complications that can lead to death (UK: 400-1,000pa, USA: 16,500pa). Acid inhibition by proton pump inhibitors (PPIs), the only widely accepted preventative strategy, was proposed and systematically proved by studies from Nottingham. NICE now recommends PPIs for all patients using NSAIDs and PPIs are central to all major international guidelines. PPI co-prescription has increased worldwide (from 27.6% in 2008 to 44.1% in 2012, in the UK); and reduces the risk of hospitalisation for gastrointestinal bleeding by 54% and symptomatic ulcer by 63%, thereby preventing up to 540 deaths per annum in the UK.