EPSRC-NIHR HTC Partnership Award 'Plus': IMPRESS

IMPRESSPlus旨在最大限度地扩大当前Impress网络的影响，通过应用工程科学提供新的解决方案，以应对失禁管理和治疗中存在的许多挑战。与血管、心脏和骨科保健等领域相比，这一领域的科学研究严重不足--通过应用专注的基础科学和翻译科学，每一个领域都显示出巨大的收益。大小便失禁(FI)的定义是无法完全控制粪便通过肛门的通道。这可能是由于肛门括约肌虚弱(通常在分娩后)、神经供应问题(例如中风、多发性硬化症)或与其他胃肠道疾病(例如肠易激综合征)有关。这是一种常见的令人痛苦的情况，会导致羞愧、尴尬、抑郁、社会孤立、秘密、自尊低下和性回避。因此，超过54%的FI患者没有与医生讨论他们的症状，只有四分之一的FI患者由他们的全科医生转介进行专科治疗。它的确切患病率很难确定，但最好的估计表明，在成年人口中，它约为10%，65岁以下有0.5%-1%，65岁以上有3%-8%。尿失禁被定义为非自愿性尿漏，尿失禁是NHS资源的主要负担。这是一种常见而令人痛苦的情况，影响着生活质量。尿失禁的主要形式是压力性尿失禁(SUI)和急迫性尿失禁(UUI)，前者是体力消耗导致的渗漏，后者是渗漏并伴有强烈的排尿欲望。混合性尿失禁是SUI和UUI的结合。尿失禁的患病率随着年龄的增长而增加，在住院的成年人中更高，他们往往年龄较大，并患有相关的共同疾病。这更多的是女性的问题，女性尿失禁的患病率从4.5%到53%不等，而男性的患病率为1.5%和24%。尽管以前是单独考虑的，但人们越来越认识到，许多形式的FI和UI具有共同的潜在病理生理学，并且经常与盆腔器官脱垂共存。大小便失禁给NHS带来了巨大的负担，并严重影响了英国数千名患者的生活质量。虽然医学工程的许多领域都有工程师和科学家参与推动新兴技术开发的增长，但可以说，这种疾病的性质阻止了工程和科学研究领导人看到一些丰富的研究挑战的潜力。到目前为止，Impress网络已经成功地实现了其目标，即增加英国领先技术专家(来自学术界和工业界)的数量，这些专家致力于研究与大小便失禁相关的临床变化。这一点通过一系列令人兴奋的新合作项目得到了证明，这些项目来自令人印象深刻的研讨会和活动，并得到了来自网络的竞争性启动资金的支持。IMPRESSPlus将保护现有Impress网络的遗产。这将通过以下方式实现：1)通过可行性项目资金从战略上支持新兴研究2)举办国际IMPRESSPlus会议研讨会以建立网络3)使用研究人员借调计划来帮助与业界和领先的国际研究中心进行知识转移4)向研究人员、患者、医疗保健提供者和政策制定者传播网络结果5)为网络及其研究确定长期资金5)总而言之，我们的目标是通过IMPRESS网络解决目前阻碍创新和转化用于管理、治疗和预防大小便失禁的新工程技术的僵局。

IMPRESSPlus has been designed to maximise and extend the impact of the current IMPRESS network by applying engineering sciences to deliver novel solutions to the many challenges that exist in the management and treatment of incontinence. There is a critical lack of scientific research in this area compared to areas such as vascular, cardiac and orthopaedic healthcare - each of which have shown huge gains through the application of focussed basic and translational science.Faecal Incontinence (FI) is defined as the inability to fully control the passage of faeces through the anus. This may arise due to a weakened anal sphincter muscle (typically following child birth), problems with nerve supply (e.g. stroke, multiple sclerosis), or in association with other gastrointestinal conditions (e.g. irritable bowel syndrome). It is a common and distressing condition that causes shame, embarrassment, depression, social isolation, secrecy, poor self-esteem, and sexual avoidance. As a result, more than 54% of patients with FI have not discussed their symptoms with a physician , and only one-quarter of patients with FI are referred by their GP for specialist treatment . Its exact prevalence is difficult to determine but best estimates suggest that in the adult population it is around 10%, and that 0.5% - 1% below 65 years and 3% - 8% over 65 years' experience regular faecal incontinence. Urinary Incontinence (UI) is defined as involuntary leakage of urine, UI presents a major burden on NHS resources. It is a common and distressing condition, which impacts of quality of life. The main forms of UI are stress incontinence (SUI), which is leakage with physical exertion, and urge incontinence (UUI), which is leakage with a strong desire to void. Mixed urinary incontinence is a combination of SUI and UUI. The prevalence of UI increases with age and is higher in institutionalised adults, who tend to be older and suffer associated co-morbidity. It is more often a problem for females, with prevalence rates of UI ranging from 4.5% to 53% in women, as compared to 1.5% and 24% in men. Although previously considered in isolation, it is increasingly recognised that many forms of FI and UI share a common underlying pathophysiology and frequently co-exist with pelvic organ prolapse.Incontinence places a massive burden on the NHS and impacts significantly on quality of life for thousands of patients in the UK. Whilst many areas of medical engineering share a growth in the engagement of engineers and scientists to push forward the exploitation of emerging technologies it is arguably the case that the nature of this disease prevents engineering and science research leaders seeing the potential for some rich research challenges. To date the IMPRESS network has been successful in fulfilling its objectives of increasing the number of leading UK technologists (from academia and industry) that are engaged with research into the clinical changes associated with incontinence. This is demonstrated through a range of exciting new collaborative projects that have arisen from IMPRESS workshops and events and have been supported by competitive pump-priming funding from the network. IMPRESSPlus will secure the legacy of the existing IMPRESS network. This will be achieved by:1) strategically supporting emerging research with feasibility project funding 2) running international IMPRESSPlus conference workshops to build the network3) using a researcher secondment scheme to aid knowledge-transfer with industry and leading international research centres4) disseminating the networks findings to researchers, patients, healthcare providers and policy makers5) identifying long-term funding for the network and its researchIn summary, through the IMPRESS network we aim to resolve the current impasse that stifles innovation and translation of new engineering technologies for the management, treatment and prevention of incontinence.