Surgery is the most reliable method of treatment for incontinence – curing the condition in just over eight in ten cases; other types of treatment, meanwhile, do not deliver the same kind of success. These are the findings of a comprehensive systematic overview of cure rates for the treatment of incontinence around the world during the last ten years.

‘Unfortunately we are not actually curing the condition in that many cases. Surgery aside, the results delivered are poor. And the problems are only going to get worse in the future because the population, as we know, is aging,’ says Ian Milsom, Professor of Gynecology and Obstetrics at the Sahlgrenska Academy and Head of the Gothenburg Continence Research Center (GCRC).

He and a group of researcher colleagues have together studied thousands of research articles and other scientific documentation written about different treatments of urinary and faecal incontinence in adults around the world, published between 2005 and 2015.

The sheer scope of the research makes this work unique. The researchers sifted through the mass of material using harmonized criteria and ultimately came up with percentages indicating how well or poorly different methods had worked. For the results to be considered successful, the individual must have been cured of incontinence three months after the treatment.

Surgery ranks well ahead of other methods, delivering success in 82 percent of cases. Pelvic floor exercises rank second, with 53 percent, followed by drug treatment, with 49 percent.

Bottom of the pile was treatment using so-called bulking agents, which was only successful in 37 percent of cases. This method involves injections of fillers into damaged tissue around the urethra in order to keep the area tight.
Drugs are mainly prescribed to treat urinary incontinence and calm down overactive bladders. Ian Milsom finds it remarkable, including from a financial perspective, that these antimuscarinic drugs are not even helping half of all patients.

‘The results don’t look good at all considering the cost in billions that these drugs incur on health care systems. In contrast surgery on the other hand has become simpler and more effective and is delivering strong results even in the long term,’ he says.

Relatively few studies over the ten-year period focused on the elderly, despite their susceptibility to the condition. The same goes for people with neurological conditions. There were also insufficient studies into how individuals can live normal lives with incontinence by modifying their behaviour and using catheters and absorbent protection.

Urinary and faecal incontinence have an impact on well-being and quality of life and sometimes lead to people feeling isolated in life, both professionally and socially. They also have an adverse effect on sexual health and, as far as the elderly as a group are concerned, increase the risk of institutionalization.

‘This is a major issue for humans that we need to devote more research resources to, not just in Sweden but around the world. Five hundred million people on this planet are suffering from the condition; we need to improve treatment methods, not least for the elderly and those with neurological conditions, who it hits particularly hard,’ says Ian Milsom.

University of Gothenburg www.gu.se/english/about_the_university/news-calendar/News_detail//majority-of-incontinence-treatments-deliver-poor-results.cid1433832

Adding abiraterone to hormone therapy at the start of treatment for prostate cancer improves survival by 37 per cent, according to the results of one of the largest ever clinical trials for prostate cancer presented at the 2017 ASCO Annual Meeting (link is external) in Chicago.

The results from the Cancer Research UK-funded STAMPEDE trial could change the standard of care for men with prostate cancer, making abiraterone a first-line treatment alongside hormone therapy.

This part of the STAMPEDE trial recruited around 1,900 patients. Half the men were treated with hormone therapy while the other half received hormone therapy and abiraterone. In men who were given abiraterone there was a 70 per cent reduction in disease progression.

The drug is usually given to men with advanced prostate cancer that has spread and has stopped responding to standard to hormone therapy, but this study shows the added benefit to patients who are about to start long-term hormone therapy.

Professor Nicholas James, chief investigator of the Cancer Research UK-funded STAMPEDE trial from the University of Birmingham, said: ‘These are the most powerful results I’ve seen from a prostate cancer trial – it’s a once in a career feeling. This is one of the biggest reductions in death I’ve seen in any clinical trial for adult cancers.

‘Abiraterone is already used to treat some men whose disease has spread but our results show many more could benefit. In addition to the improvements in survival and time without relapse, the drug reduced the rates of severe bone complications, a major problem in prostate cancer, by more than a half. I really hope these results can change clinical practice.’

Prostate cancer cells usually depend on testosterone to grow. Standard hormone therapy blocks the action of male sex hormones, halting the disease. Abiraterone goes further and shuts down the production of the hormones that fuel prostate cancer’s growth.

Each year around 46,500 men are diagnosed with prostate cancer in the UK, and around 11,000 men die from the disease.

Sir Harpal Kumar, Cancer Research UK’s chief executive, said: ‘These results could transform the treatment of prostate cancer. Abiraterone can clearly help many more prostate cancer patients than was first thought.

Cancer Research UK www.cancerresearchuk.org/about-us/cancer-news/press-release/2017-06-03-adding-abiraterone-to-standard-treatment-improves-prostate-cancer-survival-by-40-per-cent

The first app and score to determine the one-year risk of a liver transplant patient dying or being hospitalized for a heart attack or other cardiovascular complication has been developed by Northwestern Medicine scientists.
“Knowing the patient’s risk is critical to help prevent the frequent cardiac complications that accompany liver transplant surgery and to determine which patients are likely to survive the transplant,” said Dr. Lisa VanWagner, an assistant professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.
Liver transplant surgery is among the highest-risk cardiac surgery. Unique blood flow changes occur in patients with end-stage liver disease. And during a liver transplant, massive changes in blood volume and adrenaline surges affect heart function.
“Identifying persons who are at highest risk may mean restricting transplantation so that we maximize the benefit of scarce donor organs to persons who have a lower risk of a cardiac event and are more likely to survive the stress of a liver transplant,” VanWagner said.
In those who are at higher risk, evaluation and consultation with a multidisciplinary team of physicians can help manage a wide array of cardiac conditions related to liver transplant patients.
The new app and method to establish risk is called the Cardiovascular Risk in Orthotopic Liver Transplantation (CAR-OLT). It’s intended for use in those ages 18 to 75 with liver disease who are undergoing evaluation for liver transplantation.
The app is both web-based (e.g., you can search the calculator and use it online) or you can download the app through a smartphone (iTunes or Google Play stores).
Prior to the new Northwestern risk-scoring method, physicians used several risk tools that had been developed in a non-liver transplant population. One such tool, the revised cardiac risk index, is no better at predicting cardiac risk in this population than flipping a coin (50 percent of the time the score predicts accurately, but 50 percent of the time it predicts inaccurately), VanWagner said.
The CAR-OLT method is thus the first liver transplant-specific risk tool for cardiac risk in liver transplant candidates.

Northwestern University
news.northwestern.edu/stories/2017/july/predicting-heart-events-after-liver-transplant/
 

Columbia University researchers have developed a personalized algorithm that predicts the impact of particular foods on an individual’s blood sugar levels. The algorithm has been integrated into an app, Glucoracle, that will allow individuals with type 2 diabetes to keep a tighter rein on their glucose levels-the key to preventing or controlling the major complications of a disease.

Medications are often prescribed to help patients with type 2 diabetes manage their blood sugar levels, but exercise and diet also play an important role.

‘While we know the general effect of different types of food on blood glucose, the detailed effects can vary widely from one person to another and for the same person over time,’ said lead author David Albers, PhD, associate research scientist in biomedical informatics at Columbia University Medical Center (CUMC). ‘Even with expert guidance, it’s difficult for people to understand the true impact of their dietary choices, particularly on a meal-to-meal basis. Our algorithm, integrated into an easy-to-use app, predicts the consequences of eating a specific meal before the food is eaten, allowing individuals to make better nutritional choices during mealtime.’

The algorithm uses a technique called data assimilation, in which a mathematical model of a person’s response to glucose is regularly updated with observational data-blood sugar measurements and nutritional information-to improve the model’s predictions, explained co-study leader George Hripcsak, MD, MS, the Vivian Beaumont Allen Professor and chair of biomedical informatics at Columbia. Data assimilation is used in a variety of applications, notably weather forecasting.

‘The data assimilator is continually updated with the user’s food intake and blood glucose measurements, personalizing the model for that individual,’ said co-study leader Lena Mamykina, PhD, assistant professor of biomedical informatics at Columbia, whose team designed and developed the Glucoracle app.

Glucoracle allows the user to upload fingerstick blood measurements and a photo of a particular meal to the app, along with a rough estimate of the nutritional content of the meal. This estimate provides the user with an immediate prediction of post-meal blood sugar levels. The estimate and forecast are then adjusted for accuracy. The app begins generating predictions after it has been used for a week, allowing the data assimilator to learn how the user responds to different foods.

The researchers initially tested the data assimilator on five individuals using the app, including three with type 2 diabetes and two without the disease. The app’s predictions were compared with actual post-meal blood glucose measurements and with the predictions of certified diabetes educators.

For the two nondiabetic individuals, the app’s predictions were comparable to the actual glucose measurements. For the three subjects with diabetes, the app’s forecasts were slightly less accurate, possibly due to fluctuations in the physiology of patients with diabetes or parameter error, but were still comparable to the predictions of the diabetes educators.

‘There’s certainly room for improvement,’ said Dr. Albers. ‘This evaluation was designed to prove that it’s possible, using routine self-monitoring data, to generate real-time glucose forecasts that people could use to make better nutritional choices. We have been able to make an aspect of diabetes self-management that has been nearly impossible for people with type 2 diabetes more manageable. Now our task is to make the data assimilation tool powering the app even better.’

Columbia University newsroom.cumc.columbia.edu/blog/2017/04/27/diabetes-app-forecasts-blood-sugar-levels/

“How long do I have, doctor?” For many cancer patients, following the initial shock of their diagnosis, thoughts quickly turn to estimating how much precious time they have left with family and friends or whether certain treatments could prolong their life.
While current methods of estimating mortality can be crude, patients with bowel cancer could soon more accurately predict their chances of survival, thanks to a new web calculator developed by academics at The University of Nottingham and medical software company ClinRisk Ltd.
The new tool, which can be accessed by doctors and patients alike, is intended to help people make more informed decisions around treatment and manage expectations following diagnosis.
Research to test the accuracy of the new calculator has shown that the tool can reliably predict both absolute survival rates for men and women with colorectal cancer.
The calculator also allows patients to update their mortality risk based on how long they have survived following a diagnosis of cancer.
The tool was developed by Professors Julia Hippisley-Cox and Carol Coupland in the University’s School of Medicine using the QResearch database, which gathers patient data from approximately 1500 general practices across England through EMIS Health’s clinical computer systems.
Professor Hippisley-Cox said: “Current methods of estimating survival tend to be unreliable and sometimes patients can be given a fairly misleading and unnecessarily gloomy prognosis based only on the grade and stage of their cancer, only to find that in reality they live much longer than these crude predictions when other information is taken into account.
“The good news is that this new calculator which doctors and patients can access will offer a far more realistic estimate. We understand that not everyone will want to do this, of course, but some patients are very keen on this approach so it’s an individual choice.”
Current methods of predicting survival are based on simple averages based only on age or the grade and stage of the cancer in the wider population.
The new tool looks at a range of additional risk factors including the patient’s, smoking history, body mass index, family history, other illnesses and treatments such as aspirin or statins as well as other information including whether they have had surgery or treatments such as chemotherapy to deliver a far more personalised prognosis.
The team used information from more than 44,000 patients from 947 practices to develop separate equations for men and women aged between 15 and 99 years old when diagnosed with bowel cancer.
They then tested the equations by using them retrospectively to predict the outcome at one year, five years and 10 years after diagnosis for 15,214 bowel cancer patients from 305 different GP practices and 437,821 colorectal cancer patients from the national cancer registry.
The results indicated that the team has devised strong models for the prediction of cancer survival outcomes.
They were also able to provide conditional survival estimates which show how mortality risks change over time, which are particularly important among patients where the initial prognosis is poor due to late stage disease.

University of Nottingham
www.nottingham.ac.uk/news/pressreleases/2017/june/new-web-calculator-to-more-accurately-predict-bowel-cancer-survival.aspx