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Brighton & Sussex Medical School

Impact Case Studies 2021

BSMS > Research > Impact Case Studies 2021

Impact Case Studies 2021

Our research is improving the health of people around the world.

BSMS researchers are tackling health, wellbeing and care challenges for the benefit of populations locally, nationally and internationally. These case studies demonstrate the impact that our work is having in the real world and how it is reaching diverse communities at every level. They give a brief overview of the breadth and depth of our research impact.


Asthma: personalised clinical care improves treatment and management 

Prof Somnath Mukhopadhyay with a patient in a yellow tshirt assessing asthma

Asthma is a common medical condition affecting the breathing of both children and adults, which can have a life-long negative impact on quality of life. The research led by Professor Somnath Mukhopadhyay (view his profile here) is helping to transform the management of asthma and allergy, change treatment practice and improve patient outcomes. 

By developing personalised medicine clinics, which explore specific genetics, allergic traits and other individual characteristics to provide tailored care, the work of Professor Mukhopadhyay and colleagues has enabled the provision of holistic care to children. These clinics are now a standard practice at the Royal Alexandra Children’s Hospital, Brighton. 

This work has changed patients’, parents’ and clinicians’ perceptions of asthma treatment plans, while also generating new understanding of the role of genetic variation in delivering tailored care, thus improving children’s overall quality of life and experience. In addition, using this individualised approach has helped clinicians gain parents’ trust as they feel understood and heard, making the work more meaningful. 

Reviewing childhood asthma deaths in New South Wales, the Medical Journal of Australia commented that Mukhopadhyay’s work might explain the reduced response to asthma medicines and consequent deterioration and death in some children, possibly as a result of their underlying adverse gene status. Thus, a distinct highlight of Mukhopadhyay’s work is that it has informed healthcare practitioners in Australia and the findings of his research influenced subsequent prescribing advice in the Asthma Australia Handbook (2015). Hence, the impact of this research has extended globally, beyond clinical applications within the NHS. 

Through participation in the Brighton Fringe Festival (2016), British Science Festival (2017) and New Scientist Science Forum (2018), the work has raised public awareness of and encouraged discussion on personalised medicine for asthma. The findings were received with great interest when presented to pupils and staff in schools in Portugal and West Bengal (India) and resulted in greater awareness and understanding of how asthma and allergy may affect each child in a different manner and how personalised management approaches may thus result in more holistic care for children with asthma.  

This work has attracted funding from Action Medical Research and the Henry Smith Charity, both known for bringing a positive change to personalised health care research.

Read more about our paediatric research here >

Turning the tide on the awareness, treatment and prevention of podoconiosis 

A women and two children pictured together on a clay path in Kenya
Have you heard of podoconiosis? Do you know where it is found or how it is caused? 
Professor Gail Davey (view her profile here), together with Dr Kebede Deribe, Professor Melanie Newport and colleagues, have been working to understand the extent of the problem and have helped to implement measures designed to raise awareness, reduce stigmatisation and improve the treatment of podoconiosis. 
Podoconiosis is a debilitating disease which causes swelling of the feet and legs. It is common in tropical areas, particularly in Africa, Central and South America, and Southeast Asia. It disproportionally affects the poorest people, in farming households, who work barefoot and are exposed to irritant red clay soil of volcanic origin. Those affected experience disabling consequences such as weeping swollen feet, which impacts their ability to earn a livelihood, often leading to depression and inability to care for their families. In addition, the disease brings stigma and exclusion. 
The team led by Professor Davey, has been focussing largely on Ethiopia and Rwanda, where podoconiosis is particularly prevalent. Their studies have brought in experts from genetics, ethics, law, mineralogy, biochemistry and geology. This multidisciplinary approach led to an increased awareness and understanding of this disease both locally and at the level of national government. This pioneering research has attracted implementation funding from the UK Big Lottery Fund and IZUMI Foundation. 
Much has changed since this programme of research commenced in 2002. It has drawn the attention of policymakers such that podoconiosis is one of the nine Neglected Tropical Diseases (NTD) prioritised in Ethiopia. What’s more, it has shed new light on how the role of simple treatment interventions such as foot washing, skin care, exercise, elevation, and the use of socks and shoes are effective in reducing the impact of this disease. This research has fed into key reports and policy documents, including the Rwanda NTD Master Plan (2019-2024) and in the Ethiopia NTD Master Plan (2020-2025). 
This research is helping improve our collective knowledge about the disease that has remained neglected for so long. The ongoing work and its impact on patients, health workers and policy makers give hope that the disease can be eliminated within our lifetime.
Read more about our podoconiosis research here >

How we are working with rough sleepers and people who use drugs to eliminate hepatitis C virus

A clinician named Sumita Verma carrying out a fibroscan on a patient with a nurse, looking at a computer screen in a yellow room

According to data from the homeless charity Shelter (2021), Brighton and Hove has one of the highest rates of homelessness in the UK, after London and Luton. Homelessness exposes individuals to many vulnerabilities such as poor health, unemployment and depression. In addition, alcohol and drug dependence can be very high amongst rough sleepers, thus increasing their exposure to infectious diseases such as hepatitis C virus (HCV) and HIV. 

Over the past decade, Professor Sumita Verma (view her profile here) and her team have reached out to these hard-to-reach, high-risk, populations to provide HCV treatment. HCV affects the liver and can lead to serious liver disease if left untreated. 

A unique aspect of this research is that the team chose to work in the community setting unlike the traditional hospital- based care. They used a ‘one-stop’ care model that included screening of people who use drugs and homeless individuals at the Brighton Pavilion, one of the largest addiction centres. A community-based nurse offered treatment and a painless liver scan to assess for liver scarring. Addiction teams, peer mentors and social workers joined in to ensure effective care and delivery of service. The work gradually expanded into Arch Healthcare, the only surgery in Brighton and Hove, providing specialised healthcare to people experiencing homelessness or using hostel services.  

The response to this community-based HCV service has been overwhelmingly positive. Patients really valued the personal, flexible, engaging, and non-judgemental approach, far more than going through hurdles to access care in hospitals. Cure rates have been comparable to hospital- based treatment. Deaths from hepatitis C virus related liver disease almost halved in Brighton, though other factors also contributed to this. This work also had a significant positive impact on the individual’s quality of life and understanding of their disease and their ability to access treatment. As a result, once the HCV was  treated, many were able to address other issues in their lives such as their drug or alcohol use. 

This research has changed the way patients, GPs, nurses, social workers perceive people who use drugs and rough sleepers and their associated health issues. The new HCV care model developed by Professor Verma and team has been rolled out in other UK centres, which shows the breadth and impact of their work. Their research-led interventions are playing a vital role in achieving the national goal of eliminating HCV by 2025; adoption of some of these interventions has enabled two of the largest HCV centres to achieve NHS England HCV elimination targets. Furthermore, Professor Verma has secured further funding from a leading international pharmaceutical company, Gilead Sciences to develop similar care models throughout East and West Sussex. 

This study has shone a light on some of the health inequalities that exist in marginalised communities in the UK. The work of Professor Verma and team and translated into a positive treatment and care experience in the lives of those enduring drug use, homelessness, poverty and ill health.


Transforming the management of hypertension in the over 80s age group 

A patient being examined by a doctor in blue scrubs with a stethoscope

High blood pressure (hypertension) is a prevalent condition in the elderly, which can lead to serious health risks such as heart attack and stroke. While several research studies had been conducted on the treatment and management of hypertension, very few have focused on the very elderly, people aged 80 years and over. Indeed, this group had been largely overlooked and under-studied in public health. 

Research led by Professor Rajkumar Chakravarthi (view his profile here) and colleagues over the last two decades has addressed this gap, through the international HYVET Trial (Hypertension in the very elderly trial). This trial was the first large trial of blood pressure-lowering treatment in the very elderly. The trial recruited 3845 participants across 195 centres in 13 countries in Europe, China, Australasia and North Africa. The trial set a target blood pressure threshold of under 150/90 mm/Hg to manage hypertension. Participants were prescribed the diuretic drug indapamide and the ACE inhibitor perindopril to achieve blood pressure below the target threshold. 

Working collaboratively with the British Heart Foundation and the Institut de Recherches Internationales Servier, the trial achieved some important outcomes. Two years into the treatment, 80% of patients successfully met the blood pressure target, which was associated with a 30% reduction in the rate of fatal or non-fatal stroke; a 21% reduction in the rate of death from any cause; a 23% reduction in the rate of death from heart and circulatory events; and a 64% reduction in the rate of heart failure. The success of this ground-breaking trial led to its incorporation into NICE clinical guidelines in the UK and wider adoption of its findings internationally. 

The team also carried out a parallel study on the findings that  older patients frequently exhibi high blood pressure when in a clinical setting; a phenomenon termed White Coat Hypertension (WCH). Traditionally, WCH was considered a benign condition not requiring antihypertensive treatment. However, it was estimated that between 40% and 60% of HYVET participants may have had WCH. Given the remarkable health benefits associated with the main HYVET study, it seems likely that this was also true for patients with WCH. 

This research represents a significant advancement in the quality of care of the population aged over 80 with hypertension. It has changed clinical practice and significantly improved health outcomes among those aged 80 and over with hypertension. What is more, the research confirms the importance of delivering appropriate healthcare for the very elderly.

Enabling a more rational approach to antibiotic prescribing and usage 

Large number of colourful capsules

Have you been prescribed antibiotics to treat a bacterial infection? Were you asked to complete the course and warned not to stop the treatment early? 

Antibiotics are some of the most commonly prescribed medicines in the UK but excessive or unnecessary use of antibiotics is leading to the emergence of new antibiotic resistant infections. This is reducing the effectiveness of antibiotics for current and future patients. 

Professor Martin Llewelyn (view his profile here) and colleagues found that the ‘Start Smart then Focus’ initiative, led by Department of Health, designed to review and revise hospital patients’ prescriptions is not implemented effectively in NHS hospitals. To address this pressing issue, his team developed the Antibiotic Review Kit (ARK) programme, an intervention to review and revise patients’ prescriptions within 24-72 hours with the aim of safely stopping or reducing the use of antibiotics based on clinical evidence. A key aspect of the work was challenging the dogma that stopping antibiotics earlier than dictated by traditional course-lengths increases rather than decreases resistance. 

Since its implementation, the ARK programme has had a tangible impact in changing the way both patients and front-line hospital staff perceive antibiotics dosage and effectiveness. It has empowered junior doctors, pharmacists, consultants and health care workers to, stop unnecessary use of antibiotics and make a difference to patients’ treatment. When introduced at the Trust, the antibiotic stop rate increased from 9 per cent to 36 per cent with no associated adverse outcomes. 

Since then, the intervention has been implemented in 40 ARK acute NHS trust from all four nations of the UK. Overall, the ARK intervention was associated with sustained reductions in antibiotic use of 4% year on year compared with the NHS target of 1% without evidence of patient harm. Furthermore, one of the leading providers of electronic prescribing systems to NHS hospitals (Wellsky) had implemented the AKR prescription approach into its antibiotic prescribing module. 

A unique aspect of this research is that the tools it has developed to support prescribers are now freely available and ready for adoption through a collaboration with the British Society for Antimicrobial Chemotherapy. The learning module and all associated materials can be accessed with registration here: 

Through evidence-based training, observational and behavioural interventions, the work of Professor Llewelyn and colleagues has provided a framework for rational antibiotic prescribing and evaluation of continued usage. This approach should help to reduce unnecessary antibiotic usage and prevent the emergence of antibiotic resistant bacteria.


Delayed umbilical cord clamping: a ray of hope for improved survival and better health outcomes for premature babies

Premature birth is one of the leading causes of death in babies and children up to the age of five. Early clamping of the umbilical cord, a traditionally standard practice, has been associated with neonatal complications, particularly in premature babies.

Research led by Professor Heike Rabe (view her profile here) on delayed cord clamping (DCC) has contributed to improved outcomes and health benefits, including reduced risk of premature deaths and increased survival rates among infants. A delay in clamping of at least 30 seconds and up to 3 minutes can enhance redistribution of placental blood in the baby, stabilise blood pressure, reduce brain haemorrhage and lower rates of anaemia. It can also contribute to better overall care outcomes for complex premature births.

This impactful research on DCC has been instrumental in shaping wider public health strategies to improve both infant and maternal health. It has directly influenced and informed 17 national and international clinical guidelines, including the WHO Care of the Newborn Infant and NICE Preterm Labour and Birth guidelines. Consequently, there has been a shift in understanding, acceptance and practice of DCC in preterm births in the EU, Canada and USA. 

An important feature emerging from this research is the development of British Association of Perinatal Medicine Optimal Cord Management Toolkit. It has been implemented in maternity and neonatal units across NHS England, which has contributed to the frequency of DCC rising from 30 to 85 per cent in preterm births in one year in West and South West England. See more here.  

A unique feature of this research is that it has contributed to translating scientific evidence into teaching sessions for health care practitioners. The midwifery team and junior medical staff within the NHS attend DCC sessions as part of their induction and mandatory study days. Furthermore, this research is being publicly acknowledged, shaping conversations on awareness of among consumer organisations, professional bodies, guideline developers and policy makers. 

Professor Rabe’s work has strengthened the evidence base supporting the routine adoption of DCC. This is seemingly minor change in clinical practice is giving premature infants the best opportunity to thrive during the crucial first few weeks of life.


Patients’ preferences for different methods of delivering trastuzumab in the treatment of HER2-positive breast cancer

A nurse preparing to put a needle into a patient's leg whilst the patient is sat on a hospital bed

Almost one in five breast cancers are HER2-positive. It can be treated successfully with a drug called trastuzumab which was usually given intravenously (an infusion into a vein). This treatment poses several challenges; patients who have completed their surgery and chemotherapy are required to continue attending hospital for trastuzumab infusions once every three weeks for 12 months. Setting up IV infusions and delivering the drug could sometimes take several hours and patients had to travel to cancer centres. This can be enormously burdensome for patients who just wish to resume everyday life as it involves such a significant amount their time. It is also costly and time-consuming for chemotherapy departments. A new method of administering the drug through a subcutaneous injection (under the skin) taking just five minutes was developed and research studies showed that it was safe to administer the drug in this way. An international study was then launched to find out which method of delivery patients preferred and why. 

In 2011, Professor Dame Lesley Fallowfield (view her profile here) and colleagues at the Sussex Health Outcomes Research and Education in Cancer Centre (SHORE-C) led the research finding out which system of delivery, intravenous or subcutaneous, patients preferred and reasons why. This was a large, randomised study, called PrefHER, conducted in 10 European countries, Turkey and Canada. A computer randomly sorted HER2- positive patients into 2 groups – Group 1) received SC treatment every three weeks for four months then crossed over to IV delivery Group 2) received IV treatment every three weeks for four months then crossed over to SC delivery.  Before starting treatment, patients were interviewed in their own languages by specially trained interviewers about issues such as their attitudes to needle and injections. At the end of study treatment patients completed further interviews regarding their experiences and preferences.

A challenging aspect of this study was the need for a multilingual approach. SHORE-C had to produce educational DVDs in 10 different languages explaining the study and a comprehensive manual for the use of all interviewers. which aided their ability to develop trust and rapport with the patients. Training DVDs were also produced for the healthcare professionals who were delivering trastuzumab subcutaneously.

The PrefHer study showed that patients had a strong and compelling preference for SC delivery as it saved so much time, caused less pain and discomfort and was more convenient then IV administration.

This research, led by Professor Dame Lesley Fallowfield contributed to the approval by NICE in the UK and health authorities in other countries of SC delivery of trastuzumab. The approach also offers the potential for treatment closer to patient’s home – a central tenet of the NHS Five Year Forward plan for improvement in health outcomes for cancer patients. 

Read more about SHORE-C here >