EPSRC-NIHR HTC Partnership Award 'Plus': IMPRESS

IMPRESSPlus旨在通过应用工程科学为失禁管理和治疗中存在的许多挑战提供新颖的解决方案，最大限度地扩大当前IMPRESS网络的影响。与血管、心脏和骨科医疗保健等领域相比，这一领域的科学研究严重缺乏，而这些领域都通过集中应用基础科学和转化科学取得了巨大的进展。大便失禁（FI）被定义为无法完全控制粪便通过肛门。这可能是由于肛门括约肌减弱（通常在分娩后）、神经供应问题（如中风、多发性硬化症）或与其他胃肠道疾病（如肠易激综合征）有关。这是一种常见且令人痛苦的疾病，会导致羞耻、尴尬、抑郁、社交孤立、保密、自卑和性回避。因此，超过54%的FI患者没有与医生讨论过他们的症状，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。其确切的患病率难以确定，但最好的估计表明，在成年人中约为10%，65岁以下为0.5% - 1%，65岁以上为3% - 8%，经常出现大便失禁。尿失禁（UI）被定义为不自觉的尿漏，UI是NHS资源的主要负担。这是一种常见且令人痛苦的疾病，影响着生活质量。尿失禁的主要形式是压力性尿失禁（SUI）和迫击性尿失禁（UUI），这是一种体力消耗的渗漏，是一种强烈的排尿欲望。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，在被收容的成年人中患病率更高，这些成年人往往年龄较大，并伴有相关的合并症。这通常是女性的问题，女性的患病率从4.5%到53%不等，而男性的患病率为1.5%和24%。虽然以前认为是孤立的，但越来越多的人认识到，许多形式的FI和UI具有共同的潜在病理生理，并且经常与盆腔器官脱垂共存。尿失禁给NHS带来了巨大的负担，并对英国成千上万患者的生活质量产生了重大影响。虽然医学工程的许多领域在工程师和科学家参与推动新兴技术开发方面都有增长，但可以说，这种疾病的本质使工程和科学研究的领导者看不到一些丰富的研究挑战的潜力。迄今为止，IMPRESS网络已经成功地实现了其目标，即增加英国领先的技术专家（来自学术界和工业界）参与研究与尿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，这些项目是从IMPRESS研讨会和活动中产生的，并得到了该网络竞争性资金的支持。IMPRESSPlus将保护现有IMPRESS网络的遗产。这将通过以下方式实现：1)用可行性项目资金战略性地支持新兴研究；2)举办国际IMPRESSPlus会议研讨会来建立网络；3)使用研究人员借调计划来帮助与行业和领先的国际研究中心之间的知识转移；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的研究结果；5)确定网络及其研究的长期资助。通过IMPRESS网络，我们的目标是解决目前的僵局，这种僵局扼杀了管理，治疗和预防失禁的新工程技术的创新和转化。

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.