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Researchers at the University of Leeds have designed and developed new approaches and technologies for cancer patients to self-assess their symptoms and quality of life. The work focused on electronic methods for collecting patient-reported outcome measures (PROMs), developing PROMs for neglected areas of patient care, and running trials of these techniques. These approaches produced sizeable patient benefits including improved symptom control and better quality-of-life. These findings have influenced clinical guidelines in the UK and Canada, NHS policy and the endorsement of PROMs in the Health and Social Care Act (2012). Electronic PROMs systems based on the Leeds research have been implemented locally, nationally and internationally, making measurable improvements to patient welfare and health, such as a reported significant increase in completion of chemotherapy treatment.
Fallowfield designed, ran and demonstrated the long-term effectiveness of a comprehensive three-day training programme that significantly improved cancer doctors' communication skills. Publications from a major randomised trial showed that improvements transferred into the clinical setting and were enduring. These findings were pivotal and led to key components of courses being embedded in a Department of Health initiative called Connected; this trained facilitators, and provided materials for training all health-care professionals (HCPs). Attendance at Connected courses became mandatory for all consultant staff. Over 16,000 UK HCPs have participated since 2008.
Maternity staff from hospitals in the UK and around the world have benefited from training to improve their communication and team-working skills in emergency situations. This has been achieved through input into a standard training manual now in wide use, and through the development of course content used in `train-the-trainer' sessions for consultant obstetricians, consultant anaesthetists and senior midwives who have in turn been able to train their colleagues. Research findings at UWE, Bristol, contributed to showing that clinically better results correlate with specific linguistic behaviours. The findings of the work made a direct contribution to this training content.
As a consequence of a research-based training programme developed at the University of Bristol, the rates of perinatal hypoxia and intrapartum fetal injury in Bristol and two pilot units in Australia and the US are now among the lowest in the world. The improvements achieved in Bristol, the US and Australia have also been successfully achieved in a low resource setting in Zimbabwe.
In response to demand from maternity units across the world, the Bristol team has developed PROMPT — a PRactical Obstetric Multi-Professional Training package, which has been successfully implemented in over 20 countries worldwide. PROMPT has had a major health and welfare impact on more than a million mothers and their babies, as well as bringing substantial economic benefits and supporting international development.
There are an increasing numbers of people living into very old age. At the same time there is a drive to enable people to live within their own homes for as long as possible. Consequently, health and social care services that previously would have experienced very few people with dementia now have this as part of their core function. Yet there is no tradition in these services of supporting people with dementia and there are many reports of inadequate care. For example, Valleley reports that over half of people living in extra-care housing with dementia were admitted to other care settings during the first two years due to challenging behaviour, conflicts with staff and other residents, and distress on the part of the person with dementia.i Similarly, hospital patients with acute and chronic medical conditions concomitant with dementia are consistently reported to experience poorer quality outcomes than patients with similar conditions without dementia.ii The research described below has had significant benefits for those living with dementia both in extra-care housing and in hospital settings, primarily at the national level but also internationally. It has enhanced quality of life for individuals living with dementia, improved the practice of professionals working with people with dementia and had economic benefits.
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.
The Genomics Policy Unit (GPU) has led on research into genetics and health since 1996, and has made a significant contribution to this field at both a national and international level. As one of the first Research Units in the UK to focus on the preparedness of the public and healthcare professionals for the `new genetics', we recognised how genetic advances would radically alter how we understand health and disease. The impact of our research has been to show audiences who would not typically engage with genetics, what new opportunities are being offered to improve human health and the social and ethical issues that surround these.
The GPU was an early pioneer of new, interactive research methods, such as Citizens' Juries, to help ordinary people make their views known to policy makers. By 2003 we were engaging nurses and midwives with genetics by supporting them in developing competent practice, setting a benchmark that has influenced competency development programmes for nurses in the UK, Europe and the US. This is important because advances in genetics mean it is moving out of its specialist sphere into wider clinical practice and broader society. This case study describes the two strands of our work — professional and public engagement — and illustrates the significant impact that exposure to genetics has had on ordinary members of the public when they are given the opportunity to acquire genetic literacy and on the nursing profession by contributing to policy and education in this field.
The societal, economic and health benefits of breastfeeding include reduced infections in infants, cancers in mothers, cardiovascular disorders in both, and costs to the NHS (UNICEF UK 2012). Breastfeeding initiation rates in England improved from 66.2% in 2005/6 to 73.7% in 2010/11. Swansea work improved services, health and welfare because we:
We recommended that doses of analgesia be minimised and mothers receiving multiple medicines in labour targeted for additional breastfeeding support (R1-3). These recommendations reached most midwives and students in the English-speaking world through NICE (National Institute for Health and Care Excellence), Intrapartum Care Guideline 2007 (C1 p.123) and our textbooks (R4, 5). NICE guidelines form the basis of hospital policies and procedures in the UK and beyond. Doses were lowered (details below) and breastfeeding rates improved.
World leading research from the Bradford Dementia Group (BDG) has transformed policy and practice in dementia care by demonstrating the need to understand the experience and perspective of people living with dementia in order to ensure their well-being. It has provided a model of dementia care, Person-Centred Care (PCC), and an observational measure and practice development methodology, Dementia Care Mapping (DCM). In England, PCC and DCM are integral to the National Institute for Health and Care Excellence (NICE) guidelines and DCM is endorsed by the National Audit Office. Regulators use our DCM derivative, the Short Observational Framework for Inspection (SOFI) to audit care. Our research has wide international reach. Since 2008, 3616 practitioners have been trained in DCM in the UK and a further 3189 internationally.