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The Variable Life-Adjusted Display (VLAD) is a graphical tool for monitoring clinical outcomes. It has been widely adopted by UK cardiac surgery centres, and has helped a shift in culture towards more open outcome assessment in adult cardiac surgery, which has been credited with reduced mortality rates. VLAD is also being used for a broad range of other clinical outcomes by regulatory bodies worldwide. For example, Queensland Health uses VLAD as a major part of its Patient Safety and Quality Improvement Service to monitor 34 outcomes across 64 public hospitals, and NHS Blood and Transplant uses VLAD to monitor early outcomes of all UK transplants.
Neonatal extracorporeal membrane oxygenation (ECMO) is a complex procedure of life support used in severe but potentially reversible respiratory failure in newborn infants. In 1993 researchers in Leicester carried out the first and, to date, only large-scale randomised trial comparing the value of ECMO with other means of life support. The trial, with follow-up research at 4 and 7-year intervals, has shown ECMO to be a life-saving and cost-effective treatment, and has led to the establishment of a centrally funded neonatal programme that is estimated to have saved around 340 lives in the UK alone. In 2013 the University remains internationally renowned in the field of ECMO research, and since 2009 Glenfield Hospital has been home to the world's largest ECMO centre for the treatment of newborns, older babies and adults. The trial is still held up by advocates of fair clinical trials as an example of how evidence should translate into practice and policy.
Research in the Oxford University Clinical Research Unit (OUCRU) in Vietnam have spent the past two decades defining effective management strategies for dengue, which is the most significant mosquito-borne viral disease in humans. Dengue affects an estimated 50 million people and kills over 22,000 patients (mainly children) worldwide each year. OUCRU research directly underpins the clinical practice guidelines worldwide for the treatment of dengue shock syndrome (DSS), including the World Health Organization's (WHO) 2009 Dengue Guidelines, leading to faster, more effective and safer resuscitation of affected individuals.
pGALS (paediatric Gait, Arms, Legs, Spine) is a quick, accurate and child-friendly examination technique that identifies children who need to be referred to a paediatric rheumatology specialist. pGALS has been widely disseminated since 2008 and integrated into both undergraduate medical student teaching and the membership examination for the Royal College of Paediatrics and Child Health. pGALS was developed by Newcastle researchers in response to their findings of a self-reported lack of confidence among clinicians when conducting musculoskeletal examinations of children. Research also showed that delays and inappropriate investigations were being conducted before the child was referred to a specialist. pGALS is now taught in at least 15 of the 32 medical schools in the UK and has been described in a number of leading textbooks. It is becoming known and used worldwide, adapted for local cultural and social contexts.
Impact: Health and welfare; a UK clinical trial of uterine artery embolisation (UAE), with five-year follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations internationally and changed clinical practice. Women worldwide can now make an informed choice about their treatment; economic factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare providers.
Attribution: G. Murray, UoE, developed and delivered innovative trial methodology; clinical aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on clinical practice that will impact up to 25% of women.
Thyrotoxicosis (over-activity of the thyroid) affects up to 5% of the UK population and causes excess mortality, especially from vascular diseases, even in its mildest form. Thyroid cancer is the commonest endocrine cancer, its treatment being associated with adverse consequences which need to be minimised. A large programme of thyroid research in Birmingham led by Prof Jayne Franklyn has made major contributions to improving the management of thyrotoxicosis, specifically through optimal use of radioiodine treatment. Her group has developed and delivered a national training scheme to allow endocrinologists (hormone specialists) to give this treatment safely and effectively. Radioiodine is also a crucial part of treatment of thyroid cancer; Franklyn helped deliver a major trial showing that lower doses are as effective as higher doses in most cases but with fewer days in hospital and side effects. This research has changed clinical practice regarding more effective and safe use of radioiodine in thyrotoxicosis and thyroid cancer. It has been incorporated in national and international clinical guidance, patient information sources, and has directly affected clinician training and patient care pathways.
University of Bristol researchers at the Bristol Heart Institute (BHI) have pioneered the development and clinical take-up of the novel technique of off-pump coronary artery bypass (OPCAB) surgery. Over ten clinical trials and several large cohort analyses have assessed the impact of this technique on elective and high-risk patients. The results have shown that it is as safe as the conventional coronary artery bypass grafting (CABG) technique that uses a cardiopulmonary bypass pump and cardioplegic arrest. Most importantly, however, OPCAB significantly reduces the risk of post-operative complications, and reduces morbidity and mortality. It also uses less hospital resources, reducing time in intensive care and length of hospital stay. In 2011 (the last year for which data are available), 20% of CABG operations in the UK were carried out with the OPCAB technique and it has had significant take-up overseas (for example, 18% of CABG operations in the US and 21% in the EU in 2010). NICE has recommended the safety and efficacy of OPCAB surgery.
The epilepsy research group at the University of Liverpool (UoL) has undertaken a programme of work assessing treatment outcomes associated with antiepileptic drug treatment in patients with epilepsy. This includes two large pragmatic trials in patients with first seizures and newly diagnosed epilepsy, and cohort studies assessing malformations and cognitive development in children exposed to antiepileptic drugs in utero, and the work of the Cochrane Epilepsy Group.
This work has influenced prescribing in the UK and worldwide through the following impacts:
As a direct result of work led by Professor Rod Scott and colleagues at the UCL Institute of Child Health (ICH) midazolam, administered by the buccal cavity, has become first-line therapy in the NICE pathway for treating children, young people and adults with prolonged or repeated generalised, convulsive seizures in the community. It also forms part of the APLS guidelines. Buccal midazolam has demonstrated clinical superiority over the previous paediatric standard of care (rectal diazepam) with an equivalent safety profile and greater patient/social acceptability. Its use is now widespread in Europe and the USA and a licensed preparation is now available.
Researchers at the University of Bristol challenged 100 years of dogma, using meta-analysis; finding that feeding people within 24 hours of gastrointestinal surgery is safe, with fewer infections and a shorter hospital stay. This evidence is enshrined in Enhanced Recovery After Surgery programmes (2009, 2012) being rolled out across the UK benefiting patients and the health service. In 2009 The Dutch Institute of Healthcare Improvements considered these data and Cochrane update to `show unequivocally that early feeding after colonic surgery is feasible and safe'. Their project successfully introduced early feeding to over one quarter of all Dutch hospitals.