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Faecal incontinence (FI) has a huge impact on patient quality of life. It can lead to feelings of shame and degradation and affect relationships, self esteem and body image. Its causes are multi-factorial, but so much can be done to improve or cure this embarrassing symptom. Despite this, it can take many years for patients to open up and admit to friends, relatives or healthcare professionals that they are suffering. FI should never be accepted as normal -- all too often in the author's experience this is seen to be the case. There are treatment options even for those patients who are bedbound. This article reviews the latest research and highlights the need for sensitive and supportive consultations with this patient group. [ABSTRACT FROM AUTHOR]

Objectives: To determine what constitutes a clear resection margin (R0) in patients with LRRC. Summary of Background Data: R0 is the most important predictor of survival in patients with LRRC. However, it is not clear what constitutes an R0. A 1–2 mm margin is often used to define R0 but this is based on primary rectal cancer studies. The same definition of R0 is likely inappropriate considering the anatomy and etiology of local recurrences. Methods: A prospective maintained database was reviewed. A R2 margin was defined as macroscopic residual disease. R1 was defined as a microscopically involved margin (0 mm margin) and R0 as at least a 0.1 mm margin. Associations between R status and local recurrence was explored using X 2 test. Associations between margins and overall survival and local recurrence free survival were explored using Kaplan-Meier analysis. Results: There were 210 patients eligible for inclusion for analysis. Of these, 165 (78.6%), 35 (16.7%), and 10 (4.8%) patients had R0, R1, and R2 margins, respectively. Overall survival was significantly different between patients with R0 versus R1 margins but wider resection margins do not confer a survival benefit [57 months (95% confidence interval 38.5–75.5) vs 33 months (95% confidence interval 20.3–45.7), P = 0.03]. Local recurrence free survival was significantly different between patients with R0 versus R1 margins (2- and 5-year local recurrence free survivals of 53.5% and 20.4% vs 25.9% and 14.8%, respectively, P = 0.001 for both). Margins >0.5 mm were not predictive of local recurrence free survival. Conclusions: A microscopically clear resection margin is most important in predicting overall survival. Margins up to 0.5 mm offers a local recurrence benefit but does not confer survival benefit. [ABSTRACT FROM AUTHOR]

Bladder and bowel difficulties affect 20% and 10% of the UK population, respectively (Percival et al, 2021). This is most likely not an accurate reflection of the true scale of this often under-reported health issue. Pelvic floor dysfunction can cause symptoms relating to many different systems and its management involves numerous modalities. The management of bladder, bowel and pelvic floor dysfunction should be delivered in the community via general practitioners, pelvic health physiotherapists and bladder and bowel services. An effective multidisciplinary approach using pathways to reduce secondary care involvement unless required should be adopted. Post Covid, community bladder and bowel services are recovering from prolonged redeployment, a backlog of cancelled patients and a rising waiting list. Acute services are the same, with even bigger backlogs for benign lower urinary tract dysfunction and prolapse assessment. Scrutiny of current bladder and bowel services across new clinical commissioning group (CCG) collaborations will undoubtedly uncover the disparity in quality of service provision. [ABSTRACT FROM AUTHOR]

Abstract Background There is uncertainty about the role of preoperative physical activity (PA) level and its influence on postoperative outcomes, especially for patients undergoing cancer surgery. Aim: To investigate if the level of preoperative PA in patients undergoing cancer surgery is associated with postoperative complication rates, length of hospital stay (LOS) and quality of life (QOL). Methods An electronic search was performed from inception to 26th November 2017 in MEDLINE, Embase, AMED and CINAHL. Studies investigating the association between objective or subjective level of PA and postoperative complication rates, LOS and QOL were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When possible, summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using random-effect models. Results 13 studies (5523 unique patients) were included. Overall, most studies were rated as having low or moderate risk of bias. Higher preoperative level of PA was not significantly associated with absence of postoperative complications (OR = 2.60; 95%CI = 0.59 to 11.37) but was significantly associated with shorter LOS (OR = 3.66; 95%CI = 1.38 to 9.6) and postoperative QOL (OR = 1.29; 95%CI = 1.11 to 1.49). Conclusions The available literature suggests higher levels of preoperative PA in patients undergoing cancer surgery may be associated with better postoperative outcomes, particularly shorter LOS and better QOL. There is a need for high-quality studies investigating the association between preoperative PA and postoperative outcomes. Systematic review registration PROSPERO 2017 CRD42017082334. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017082334. [ABSTRACT FROM AUTHOR]

Qualitative research examining healthcare experiences and needs of people with advanced (metastatic or recurrent) colorectal cancer CRC-A is limited. This study aimed to fill this gap in CRC-A survivors treated with surgical or palliative chemotherapy, through a qualitative study. Australian adults treated for CRC-A were recruited 0.5–2 years post-surgery or post-diagnosis of CRC-A (for palliative chemotherapy groups). Semi-structured telephone interviews, analysed via framework analysis, explored healthcare experiences. Demographic, clinical, and quality of life data characterised the sample and informed framework analyses. Data was compared against the Institute of Medicine's framework for quality healthcare. Interviews from 38 participants (22 female) of median age 59 years (range 27–84) revealed six overarching themes relating to the safety , effectiveness , timeliness , patient-centredness , efficiency , and equity of CRC-A care: 1) Early experiences influence later perceptions ; 2) Trusting the system, trusting the professionals ; 3) The benefits of multidisciplinary care co-ordination; 4) Feeling lost in follow-up ; 5) Whose role is it anyway? Gaps in responsibility for survivorship care ; and 6) Useful or useless? Perceptions of psychosocial support. Healthcare systems for CRC-A can be improved through delivery of repeated information, upskilling general practitioners and/or implementing written survivorship care plans or survivorship clinics, to ensure quality healthcare. • Advanced colorectal cancer survivors may feel lost in follow-up. • There is confusion about which doctor is responsible for survivorship challenges. • Repeated information delivery may help survivors to feel supported and informed. • Multidisciplinary care can be beneficial, yet burdensome for survivors. • GPs can provide quality care co-ordination following upskilling and training. [ABSTRACT FROM AUTHOR]

Objective: Physical activity is associated with improved health outcomes for people with cancer. We aimed to identify physical activity correlates, barriers, and preferences among women with gynecological cancer. Methods and Materials: A self-administered questionnaire was completed by 101 women diagnosed with gynecological cancer (mostly ovarian cancer [59%] and endometrial cancer [23%]) within the previous 2 years, at 2 major hospitals in Sydney, Australia. Physical activity was measured for the past 7 days. Thirteen potential barriers were scored on a 5-point scale. Associations with physical activity were assessed using Spearman correlations (r s) and multivariate logistic regression. Results: Factors associated with being sufficiently active (≥150 min/wk physical activity) were being in the follow-up phase of the cancer trajectory (odds ratio [OR], 7.0; 95% confidence interval [CI], 1.5 to 33.4 compared with other phases) and prediagnosis physical activity (OR, 4.6; 95% CI, 1.1 to 18.5 for the highest vs lowest tertile). The most common barriers were "too tired" and "not well enough," and both were associated with lower physical activity (r s, −0.20 and −0.22, respectively). The odds of having disease-specific barriers was higher for women with ovarian cancer (OR, 4.6; P = 0.04) and women receiving chemotherapy or radiation therapy (OR, 8.3; P = 0.008). "Lack of interest" (r s, −0.26) and "never been active" (r s, −0.23) were also inversely correlated with physical activity, although less common. Forty-three percent of women indicated that they were extremely or very interested to have a one-to-one session with an exercise physiologist. Participants' preferred time of starting a physical activity program was 3 to 6 months after treatment (26%) or during treatment (23%). Walking was the preferred type of physical activity. Conclusions: Strategies to increase physical activity among women with gynecological cancer should include a focus on reducing disease-specific barriers and target women who have done little physical activity in the past or who are in the treatment phases of care. [ABSTRACT FROM AUTHOR]

Background Colorectal stents have been available as a management option in obstruction for 23 years, yet there is little randomized evidence of their effectiveness. This study investigated current surgeon-related barriers to conducting a randomized, controlled trial (RCT) of colorectal stent insertion for obstruction in patients with colorectal cancer. Methods A binational survey of current members of the Colorectal Surgical Society of Australia and New Zealand was conducted by a mailed questionnaire assessing perceived barriers to adoption of colonic stents and willingness to participate in future multicentre randomized controlled trials, and surgeons' treatment preferences in 16 hypothetical clinical scenarios. Results Of 148 eligible surgeons, 96 (65%) responded. Colonic stenting was available to 98% of respondents. In the clinical setting of colorectal obstruction, only 29% (95% CI, 20–39%) of surgeons expressed a willingness to participate in a RCT involving colonic stents in the curative setting. More than 70% of surgeons preferred the use of stents in unfit patients for palliation, and preferred surgery in fit patients with curable disease. In the curative setting, most respondents considered colonic stents not cost effective (90%; 95% CI, 82–94%) and believed that their patients would not prefer stents over surgery (80%; 95% CI, 71–87%). Conclusion This study highlights the limitation to conducting a future randomized controlled trial to assess the efficacy of colonic stenting, especially in the curative setting, based on surgeon preference, despite the lack of level I evidence. [ABSTRACT FROM AUTHOR]

Modern treatments, including surgery and palliative chemotherapy without surgery, enable longer survival for people with advanced/recurrent colorectal cancer (CRC). Qualitative research comparing the physical and psychosocial outcomes of these different treatments is lacking. This study therefore aimed to explore and compare the physical and psychosocial challenges and survivorship experiences of people who receive different treatments for advanced CRC, through a qualitative study. Adults with CRC who have undergone treatment for advanced/recurrent CRC were recruited 0.5–2 years post-surgery or, for palliative chemotherapy participants, 0.5–2 years post-diagnosis of advanced CRC. Qualitative semi-structured telephone interviews, analysed via framework analysis, explored quality of life (QoL) experiences. Demographic, clinical, and QoL data (Functional Assessment of Cancer Therapy – Colorectal (FACT-C), Distress Thermometer) were collected to characterise the sample and inform the framework analysis. A diverse sample of 38 participants (22 female) participated, with ages ranging 27–84 (Median = 59), FACT-C 56–132 (Median = 102), and distress 0–10 (median = 3). Analysis of interviews revealed three overarching themes: 1) the overwhelming impact of protracted, complex illness ; 2) compounding and interacting effects of multiple treatments, impacts, and multimorbidity ; and 3) the long haul is unpredictable, bumpy, and wearing. These themes reveal that people with advanced CRC experience many challenges due to the complex nature of the illness, its treatment, and side effects. Survivors require continued multi-disciplinary supportive care throughout follow-up to manage survivorship challenges. Guideline-led survivorship care and routine monitoring of physical and psychosocial wellbeing throughout follow up is imperative to manage patient expectations and support advanced CRC survivors. • Survivors of advanced colorectal cancer experience many challenges in survivorship. • Pelvic exenteration survivors may require tailored care for their unique challenges. • Treatment complexity makes survival an unpredictable, bumpy, and wearing long haul. • We need tailored services to meet the needs of advanced colorectal cancer survivors. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether the distance of residence from a Gynecological Oncology Service (GOS) was associated with a better survival from ovarian cancer.We linked cancer registry records to hospital records for 3749 women with ovarian cancer diagnosed between 2000 and 2008 in New South Wales, Australia. Access to a GOS was measured in kilometers from a woman’s geocoded address to the geocoded address of the closest public GOS hospital. Flexible parametric survival, Cox proportional hazards, and logistic regression models were fitted to examine whether better access to a GOS was associated with a better survival and whether extensive surgery was received for ovarian cancer after adjustment for patient, tumor, and treatment factors.Hazard of death from ovarian cancer was greater in women who were treated in a public general hospital than in women treated in a GOS hospital (hazards ratio, 0.77; 95% confidence interval [CI], 0.64-0.95), and greater in those who did not have extensive surgery than in those who did (hazards ratio, 0.47; 95% CI, 0.38-0.58). The further women with ovarian cancer lived from a public GOS hospital, the more likely they were to be treated in a public general hospital. Women were 19 times more likely (odds ratio, 19.40; 95% CI, 13.92-27.04) to be treated only in a general hospital when they lived 187 km or more from a public GOS hospital than women who lived within 5 km of one.Distance of residence from GOS hospitals in Australia is an important determinant of access to GOS hospitals. Treatment in a public or private GOS hospital and having surgery were the strongest predictors of survival from epithelial ovarian cancer. Research is required into the barriers to referral of patients with ovarian cancer for care in GOS hospitals; low population density limits options for supply of GOS in rural areas. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effect of patient age on receipt of stage-appropriate adjuvant therapy for colorectal cancer in New South Wales, Australia. Materials and Methods A linked population-based dataset was used to examine the records of 580 people with lymph node-positive colon cancer and 498 people with high-risk rectal cancer who underwent surgery following diagnosis in 2007/2008. Multilevel logistic regression models were used to determine whether age remained an independent predictor of adjuvant therapy utilisation after accounting for significant patient, surgeon and hospital characteristics. Results Overall, 65–73% of eligible patients received chemotherapy and 42–53% received radiotherapy. Increasing age was strongly associated with decreasing likelihood of receiving chemotherapy for lymph node-positive colon cancer ( p < 0.001) and radiotherapy for high-risk rectal cancer ( p = 0.003), even after adjusting for confounders such as Charlson comorbidity score and ASA health status. People aged over 70 years for chemotherapy and over 75 years for radiotherapy were significantly less likely to receive treatment than those aged less than 65. Emergency resection, intensive care admission, and not having a current partner also independently predicted chemotherapy nonreceipt. Other predictors of radiotherapy nonreceipt included being female, not being discussed at multidisciplinary meeting, and lower T stage. Adjuvant therapy rates varied widely between hospitals where surgery was performed. Conclusion There are continuing age disparities in adjuvant therapy utilisation in NSW that are not explained by patients' comorbidities or health status. Further exploration of these complex treatment decisions is needed. Variation by hospital and patient characteristics indicates opportunities to improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

The article presents information on a study for identifying predictors of variation in colorectal cancer care as well as outcomes in New South Wales. The study was conducted on data from 6890 people. It has been suggested to include patient characteristics in risk-adjustment models for comparing the outcomes.

Objective: To identify predictors of variation in colorectal cancer care and outcomes in New South Wales. Design, setting and patients: Multilevel logistic regression analysis using a linked population‐based dataset based on the records of patients with cancer of the colon, rectosigmoid junction or rectum who were registered in 2007 and 2008 by the NSW Central Cancer Registry and treated in 105 hospitals in NSW. Main outcome measures: Six outcome measures (30‐day mortality, 28‐day emergency readmission, prolonged length of stay, 30‐day wound infection, 90‐day venous thromboembolism, 1‐year mortality) and five care process measures (discussion at multidisciplinary team [MDT] meeting, documented cancer stage, recorded pathological stage, treatment within 31 days of decision to treat, treatment within 62 days of referral). Results: We analysed data for 6890 people. There was wide variation between hospitals in care process measures, even after adjusting for patient and hospital factors. Older adults were less likely to be discussed at an MDT meeting and receive treatment within suggested time frames (all P < 0.001 for colon cancer). Increasing patient age, greater extent of disease, higher Charlson comorbidity score and resection after emergency admission consistently showed strong evidence of an association with poor outcomes. Much of the variation between hospitals in outcome measures was accounted for by patient characteristics. Conclusions: Patient characteristics should be included in risk‐adjustment models for comparing outcomes between hospitals and for quantifying hospital variation. Further exploration of the reasons why certain hospitals and patients appear to be at risk of poorer care is needed. [ABSTRACT FROM AUTHOR]

The article presents a study of the potential association of the introduction of tobacco plain packaging in Australia from October 1, 2012 and the number of calls to smoking cessation helpline, Quitline, compared to the graphic health warnings introduced in March 2006. Results showed that the increase in calls to the Quitline is not attributable to ant-tobacco advertising campaigns, cigarette price increases nor other causes, but was due to incremental step in comprehensive tobacco control.

Need is a pivotal concept within health systems internationally given its driving force in health care policy, development, and delivery at population and individual levels. Needs assessments are critical activities undertaken to ensure that health services continue to be needed and to identify new target populations that demonstrate unmet need. The concept of need is underpinned by varied theoretical definitions originating from various disciplines. However, when needs are assessed, or health interventions developed based on need, little, if any, detail of the theoretical or conceptual basis of what is being measured is ever articulated. This is potentially problematic and may lead to measurement being invalid and planned health services being ineffective in meeting needs. Seldom are theoretical definitions of need ever compared and contrasted. This critical review is intended to fill this gap in the literature. Interpretations of the concept of need drawing from areas such as psychology, social policy, and health are introduced. The concept and relevance of unmet need for health services are discussed. It is intended that these definitions can be used to operationalize the term 'need' in practice, theoretically drive needs assessment, and help guide health care decisions that are based upon need. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Major upper gastrointestinal surgery results in permanent alterations to the gastrointestinal tract, and previously been shown to impair nutritional status. The aim of this study was to assess long term nutritional status and quality of life in people having had major upper gastrointestinal surgery, and the relationship between the two measures. Methods: People having had major upper gastrointestinal surgery greater than 6 months ago were recruited. Nutrition assessment included weight, anthropometry, Subjective Global Assessment, dietary intake and assessment of gastrointestinal symptoms; quality of life was assessed using the EORTC QLQ-C30 questionnaire. Associations between nutritional status, type of surgery and quality of life were analysed. Results: Thirty people were recruited with fourteen people showing a degree of malnutrition according to subjective global assessment. Total gastrectomy and oesophagectomy surgery resulted in significantly higher percent weight loss than those having undergone pancreaticoduodenectomy (p = 0.01). Subjective global assessment correlated with quality of life (p = 0.003). Subjective global assessment and gastrointestinal symptoms were both significant variables in explaining quality of life (p < 0.001). Conclusions: Nutritional status in this group was significantly compromised, and impacted on quality of life. Individualised nutrition intervention to address malnutrition and gastrointestinal symptoms should be integrated into post surgery management. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Major upper gastrointestinal surgery results in permanent alterations to the gastrointestinal tract, and previously been shown to impair nutritional status. The aim of this study was to assess long term nutritional status and quality of life in people having had major upper gastrointestinal surgery, and the relationship between the two measures. Methods: People having had major upper gastrointestinal surgery greater than 6 months ago were recruited. Nutrition assessment included weight, anthropometry, Subjective Global Assessment, dietary intake and assessment of gastrointestinal symptoms; quality of life was assessed using the EORTC QLQ-C30 questionnaire. Associations between nutritional status, type of surgery and quality of life were analysed. Results: Thirty people were recruited with fourteen people showing a degree of malnutrition according to subjective global assessment. Total gastrectomy and oesophagectomy surgery resulted in significantly higher percent weight loss than those having undergone pancreaticoduodenectomy (p = 0.01). Subjective global assessment correlated with quality of life (p = 0.003). Subjective global assessment and gastrointestinal symptoms were both significant variables in explaining quality of life (p < 0.001). Conclusions: Nutritional status in this group was significantly compromised, and impacted on quality of life. Individualised nutrition intervention to address malnutrition and gastrointestinal symptoms should be integrated into post surgery management. [Copyright &y& Elsevier]

4-H volunteers and staff are often faced with providing educational programs and opportunities for youth with wide ranges of age and ability. To address this challenge, researchers from the University of California Cooperative Extension developed and tested a Best Practices Matrix that outlines domain-specific, age-appropriate characteristics of youth and their applications to 4-H programming. Post-implementation surveys that included six forced-response and five open-ended questions were collected from 48 adult volunteers who attended volunteer development workshops. Outcomes indicated that participants improved their understanding of youths' developmental characteristics and how to use the matrix to help improve their project and activities. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the link between compensation factors and health care utilisation following major trauma in Australia. The study covers a study population of trauma patients admitted in a metropolitan trauma centre in New South Wales. Based on the statistical analysis, health care utilisation was higher among patients who engage the services of a lawyer after an injury, chronic illness, presence of a head injury and employment status.

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there is little long-term follow-up and functional outcome data available. Patients who had abdominal surgery for prolapse during a ten-year period were identified and interviewed to ascertain details of prolapse recurrence, constipation, incontinence, cosmesis, and satisfaction. Additional details on recurrences that required surgery and mortality were obtained from chart review and the State Death Registry. Of 321 prolapse operations, laparoscopic rectopexy was performed in 126 patients, open rectopexy in 46, and resection rectopexy in 21 patients. At a median follow-up of five years after laparoscopic rectopexy, there were five (4 percent) confirmed full-thickness recurrences that required surgery. Actuarial recurrence rates of laparoscopic rectopexy were 6.9 percent at five years (95 percent confidence interval, 0.1–13.8 percent) and 10.8 percent at ten years (95 percent confidence interval, 0.9–20.1 percent). Seven patients underwent rubber band ligation for mucosal prolapse and seven required other surgical procedures. There was one recurrence after open rectopexy (2.4 percent) and one after resection rectopexy (4.7 percent), and there was no significant difference between groups. Overall constipation scores were not increased after laparoscopic rectopexy, with no significant difference to open rectopexy or resection rectopexy. This study has demonstrated that laparoscopic rectopexy has reliable long-term results for treating rectal prolapse, including low recurrence rates and no overall change in functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Australian breast cancer specialists'' involvement in multidisciplinary team (MDT) treatment planning meetings was ascertained in a cross sectional survey. The format of MDT meetings was also investigated. Medical specialists were regular attendees (≥78%) compared to allied health staff and psychologists (≤28%). Clinicians based in a major city (AOR 1.90; 95%CI: 1.01–3.58) and who treated ≥50 new cases a year (AOR 7.34; 95%CI: 3.38–15.96) were more likely to attend. Over 69% reported that the proportion of time devoted to case discussions was ≥75%. Topics always discussed were pathology, extent of disease, surgery performed and a treatment plan (≥83%). The majority of respondents stated that MDT meetings were effective and improved referrals. Suggested improvements included that all key personnel attend, meetings are structured and that the views of all be heard. Work is needed to ensure MDT''s function and co-operate as intended in treatment planning meetings. [Copyright &y& Elsevier]

One of the major barriers to randomized trials in the field of surgery is the presence of strong preferences for one of the treatment options. Patients and surgeons who favor strongly a particular treatment approach are usually reluctant to participate in trials where operative intervention is determined on the basis of randomization. This then affects both the feasibility of the trial in terms of achieving the required sample size as well as the generalizability of the study''s findings. Therefore, measurement of patient and surgeon preference is a crucial component of the feasibility assessment for surgery trials. In this article, we introduce the Prospective Measure of Preference, which is a novel method to measure preferences that has been designed to accommodate the complexity of surgical decision-making. We also present a simple method to measure individual and community equipoise among expert clinicians to assess the feasibility of future randomized trials in surgery. [Copyright &y& Elsevier]

Background: The assessment of patients’ and clinicians’ willingness to participate in clinical trials is advisable as part of a feasibility exercise prior to the commencement of randomized controlled trials (RCTs) to ensure adequate support in terms of likely accrual to achieve the required sample size in a timely fashion. Furthermore, understanding why patients are unwilling to enter RCTs is imperative before the current trend of low participation can be reversed. Methods: Patients, colorectal surgeons, and medical and radiation oncologists, were presented with 5 different, detailed treatments for locally advanced rectal cancer. They were asked whether they would be willing to enter an RCT comparing each treatment choice. Patients who would not participate were asked to indicate their reason for refusal. Results: Patients’ willingness to participate in each trial was consistently low (19% to 32%). Similar low levels of participation were indicated by each clinical subspecialty (15% to 38%). Of the scenarios, patients and clinicians were most willing to enter a trial investigating surgery plus preoperative radiotherapy. A dislike of randomization, a desire to be involved in decision-making, and quality of life considerations were the most commonly stated reasons for refusal. Conclusions: This study highlights the difficulties in performing RCTs in surgery and oncology. However, results suggest that improvements in communication regarding randomization and clinical trial processes and the actual, rather than perceived, side effects of treatments are strategies that may enhance patient participation. [Copyright &y& Elsevier]

Crohn’s disease poses difficult choices in which the most appropriate treatment option is not always obvious. When this state of uncertainty exists, patients’ preferences should have an increasingly important part of clinical decision making. The purpose of this study was to compare patients’ preferences for surgical intervention in Crohn’s disease with the preferences of surgeons and gastroenterologists. Outpatients with Crohn’s disease were interviewed to quantify their preferences for six scenarios by using the prospective preference measure. An identical questionnaire was mailed to all Australian and New Zealand colorectal surgeons and a random sample of 300 Australian gastroenterologists. Forty-one of 123 patients with Crohn’s disease (33 percent), 92 of 127 colorectal surgeons (72 percent), and 74 of 272 gastroenterologists (27 percent) participated. There were significant differences between patients and gastroenterologists for three of six scenarios and between surgeons and gastroenterologists in four of six scenarios. Seventy-six percent of gastroenterologists were willing to gamble to avoid an ileocolic resection compared with 37 percent of surgeons (chi-squared = 25.44; P < 0.0001) and 39 percent of patients (chi-squared = 15.44; P < 0.001). Patients and clinicians were able to trade and gamble life expectancy as a measure of preference for varying hypothetical surgical treatments, even though these treatment options impacted on quality of life rather than survival. Patients’ preferences did not align with clinicians. For most scenarios, colorectal surgeons’ preferences were significantly different to those of gastroenterologists. [ABSTRACT FROM AUTHOR]

Biofeedback is well established as a treatment for fecal incontinence but little is known about factors that may be associated with its effectiveness. This study assessed short-term outcomes, predictors of patients who completed treatment, and predictors of treatment success. This study was a retrospective review of consecutive patients treated with biofeedback at a tertiary referral colorectal clinic during ten years. Clinical, physiologic, and quality of life measures were collected prospectively at the time of treatment. Regression analysis was performed. Of 513 patients, 385 (75 percent) completed the treatment program. Each outcome was improved for more than 70 percent of patients. Incontinence scores decreased by 32 percent (from 7.5 to 5.2 of 13), patient assessment of continence increased by 40 percent (from 5.3 to 3.2 of 10), quality of life improved by 89 percent (from 0.34 to 0.67 of 1.0), and maximum anal sphincter pressure increased by a mean 12 mmHg (14 percent; from 90 to 102 mmHg). Patients who did not complete treatment were younger, were more likely to be male, and had less severe incontinence. Treatment success was predicted by completion of all treatment sessions (odds ratio, 10.34; 95 percent confidence interval, 4.46–24.19), female gender (odds ratio, 4.11; 95 percent confidence interval, 1.04–7.5), older age (odds ratio, 1.02 per year; 95 percent confidence interval, 1–1.04), and more severe incontinence before treatment (odds ratio, 1.19 per unit increase in St. Mark’s score; 95 percent confidence interval, 1.05–1.34). More than 70 percent of patients in this large series demonstrated improved short-term outcomes. Treatment success was more likely in those who completed six training sessions, were female, older, or had more severe incontinence. Patients were less likely to complete treatment if they were male, younger, or had milder incontinence. [ABSTRACT FROM AUTHOR]