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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.
The management of childhood pleural empyema has been standardised and improved as a direct result of research at the UCL Institute of Child Health (ICH). Pioneering trials demonstrated the clinical equivalence of chest drain insertion with fibrinolytic installation compared to video-assisted thoracoscopic surgery as a primary intervention. Chest X-ray and ultrasound scanning were shown to provide enough information and it was established that chest CT scanning had no role in the routine management of empyema. International guidelines have been modified to reflect this, reducing paediatric exposure to unnecessary general anaesthesia, invasive surgery and ionising radiation. Cost savings are estimated to be £1.5 million/year in the UK 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.
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.
Research led by Professor Roger Mackett of the Department of Civil, Environmental and Geomatic Engineering at UCL on children's physical activity has been used by central and local government, other public bodies and various advocacy groups to encourage children to be more active. It has been used to support policy documents and proposals aimed at improving children's health and wellbeing. It has led to improvements in the health, welfare and quality of life of many UK communities through, for example, their greater use of walking buses, which also contributes to reduced CO2 emissions.
A research programme of randomised controlled trials undertaken at the University of Southampton demonstrating the efficacy of the New Forest Parenting Programme (NFPP) played a crucial role in: (i) influencing the developers of clinical guidelines to recommend parent training in general as a core part of the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and (ii) establishing the NFPP, in particular, as a widely employed evidence-based treatment for ADHD, a condition estimated to affect up to 400,000 children in the UK alone. As a direct result of the trials, the programme, a novel therapeutic intervention that teaches parents of preschool children with ADHD how to modify their children's behaviour and improve their self-regulation, has been included in the National Institute for Health and Clinical Excellence (NICE) and other clinical guidelines and recommended internationally as an effective alternative to medication, which often brings only short-term benefits and is associated with a range of potentially debilitating side-effects.
Research led by Professor Shields and colleagues at Queen's University Belfast has resulted in changes in the treatment of children with cough and wheezing disorders and has been a major contributor to International Asthma and Cough Guideline statements.
Wheezing affects up to one third of children. Research studies that demonstrated that viral induced wheezing (VIW) or isolated cough were not associated with persistent airway inflammation led to a change in recommendations for anti-asthma therapy, such that the use of high dose inhaled corticosteroids (ICS) was no longer recommended in such cases. Furthermore, the dangers of very high dose ICS were better recognized and the upper recommended dose of steroids for use in treatment of classical childhood asthma was reduced accordingly.
Cardiff University has established the world's largest single cohort of children and young adults with Down's syndrome in which visual deficits have been characterised. Cardiff research studies over 20 years have informed evidence-based guidelines published by the Department of Health and national practitioner bodies for the recognition and practical management of common visual problems in children with Down's syndrome. Consequently, eye care specialists now recommend bifocals for these children. The Cardiff research has also supported changes to teaching methods and resources for children with Down's syndrome. Collectively these children are now benefiting from better eye care and improved learning and educational opportunities.
We have carried out research into children's perception and behaviour around dogs, which has led to the development of an effective safety training programme, as well as improving public understanding of child-dog interactions and risk contexts for dog bite injury in children. The `Blue Dog' (BD — www.thebluedog.org) project has led to changed educational and veterinary practice, public policy change and animal welfare benefits internationally. A key part of the project was the development and validation of an interactive DVD, with training tools that teach children how to be safe around dogs. The results of the research were integrated into the injury prevention messages disseminated by the BD project. The research programme has received publicity worldwide, and over 80,000 copies of the BD DVD have been distributed to 21 different countries, with the accompanying BD booklet translated into 17 different languages. The research was carried out from 2005 onwards, with the impact of the research accruing from 2008 to date.
This research provided the first evidence that long-chain polyunsaturated fatty acids (LCPUFAs) added to infant formula improve the development of specific cognitive abilities. Manufacturers of infant formula have included the research in their submissions to regulatory authorities to justify inclusion of LCPUFAs in infant formula. The research is also included in information and advice on infant feeding provided by manufacturers for the general public. Between 2008 and 2013, the research has been cited by national and international organisations in connection with recommendations for dietary intakes of LCPUFAs and policy on infant nutrition. Formulas enriched with LCPUFA are now available in most countries, and the formula-fed infants worldwide receive the benefits of LCPUFAs.