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Glaucoma is one of the major causes of blindness world-wide and is characterised by visual loss arising from death of retinal ganglion cells. One important form, angle-closure glaucoma, is particularly prevalent in Asia. Based on experience of large-scale epidemiological surveys, UCL researchers devised a classification for angle-closure glaucoma that has become the international standard for this condition. The research been used as the basis for the development of the current framework for the management of angle-closure glaucoma, informing the development of both new and revised guidelines used around the world.
King's College London (KCL) researchers have created, refined and validated the Palliative care Outcome Scale (POS), a tool that measures the physical, psychological, spiritual and information needs of patients at the end of their lives and their families. The POS has had an outstanding impact on clinical competencies and knowledge, and has underpinned an international collaboration to develop standards for palliative care outcomes. The POS is embedded increasingly in everyday clinical practice, improving the care of patients affected by advanced conditions and providing support for their families. The POS, widely used regionally and nationally in the UK to evaluate and improve the quality of care, has been culturally adapted for use in 20 European Union countries, and in Africa and other countries around the globe.
Work on better management and identification of Medically Unexplained Symptoms (MUS) has led to the introduction of new treatments in primary care in England through the Improving Access to Psychological Treatment (IAPT) programme as well as having an impact on service planning and commissioning. These approaches have also been implemented into the routine training and practice of General Practitioners (GPs) in parts of Europe. A clinical and economic evaluation of a psychosocial approach to chronic fatigue syndrome using general nurses and development of a cognitive behaviour therapy approach has changed general practice and enhanced the patient experience for those with MUS.
Research at the UCL Institute of Ophthalmology over the last 15 years has developed new treatments for management of uveitis and its sight-threatening complications, which have subsequently become standard practice. Our work, in previously untreatable disease, has allowed restoration of vision in many patients and prevention of further visual loss in others. Many patients have been able to reduce systemic medication, limiting adverse effects of treatment.
Prevention of blindness caused by glaucoma requires an early diagnosis, for which we have developed new clinical techniques. The Moorfields Regression Analysis (MRA) is an algorithm that we developed for the Heidelberg Retina Tomograph, an imaging device for glaucoma diagnostics. The MRA made it possible, for the first time, to accurately quantify structural damage caused by glaucoma. The MRA allows earlier diagnosis of glaucoma, and has been adopted worldwide.
The PCI is a carefully designed Head & Neck (H&N) cancer pre-clinic consultation checklist and comprises aspects of care and outcomes that patients might wish to raise with the multi-professional healthcare team. The PCI is an innovative and effective tool whose development has been optimised for touch screen devices. (Full details on use of the PCI is given at http://www.patient-concerns-inventory.co.uk/PCI/Home.html.) The PCI has improved patient experiences of clinic consultations, helped development of quality indicators and improved professional practice. The impact of the programme of work has led to its wider implementation nationally as exemplified by its adoption by the British Association of Head and Neck Oncologists (BAHNO), its inclusion in the National H&N Cancer dataset, its emerging use internationally, and its development in other chronic conditions.
Between 1996 and 2013 researchers at Swansea University evaluated service initiatives and changing professional roles associated with the management of patients with debilitating gastrointestinal disorders. This work showed the clinical and cost effectiveness of two main innovations: open access to hospital services for patients with inflammatory bowel disease; and increased responsibility for nurses, particularly as endoscopists. Our evidence has had a broad, significant impact on: national policy through incorporation in NHS strategies, professional service standards and commissioning guides; service delivery through the provision of increasing numbers of nurse endoscopists and the wide introduction of nurse-led open access to follow-up; and patient care, as documented in sequential national audits in 2006, 2008 and 2010.
Work led by Professor Nick Barber at the UCL School of Pharmacy showed that a majority of patients have problems soon after starting a new medicine for a chronic condition, and this led to the development of a post-consultation intervention by pharmacists that was shown to be more effective and cheaper than normal care. This entered Department of Health policy for pharmacy in 2008 and Barber helped design the New Medicines Service that was launched in October 2011. This service is offered by community pharmacists in England and by the end of May 2013 over a million patients had received the service. The intervention increases patient adherence to medication, thus improving quality of care, and reducing cost to the NHS from wastage. It also improves patient safety through better identification and resolution of adverse effects.
Many hand surgical units worldwide have routinely used night-time splints in all patients after Dupuytren's contracture fasciectomy and dermo-fasciectomy, despite the lack of robust evidence to support its use.
Jerosch-Herold's programme of research identified that routine night-time splinting for all patients after fasciectomy or dermo-fasciectomy surgical treatments for Dupuytren's contracture is not beneficial. This finding is changing clinical practice, and informing guidelines and policies in the UK, New Zealand and the USA. As a result, health care organisations are ceasing to prescribe routine night-time splinting. This reduces inconvenience and discomfort for patients, relieves pressure on services and generates financial savings, all whilst maintaining equally good clinical outcomes.
The reach of the research findings impact is high, as Dupuytren's contracture is a common disorder of people of Northern European ancestry which results in surgical interventions for thousands of people annually (13,000 pa in the UK alone).
Beneficiaries of this research are patients in intensive care and healthcare staff. This research has had impacts in two distinct but related areas:
These advances are informed by our synthesis and application of rigorous, innovative methodologies relating to questionnaire development and real-time data collection.