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Objectives: Hospital discharge is a challenging time for residents, requiring the completion of many tasks to ensure safe transitions for patients. Despite recognition of the importance of hospital discharge planning, formal curricula are lacking. We sought to improve medicine residents' comfort and skills with discharge planning and enhance the quality of care by introducing a standardized approach to discharge on the medicine wards.Methods: The intervention included a didactic, a bedside rounds component, and a discharge checklist. Interns were surveyed at the end of rotations to measure confidence, attitudes, and frequency of completing discharge planning tasks. Results were compared with a control group of experienced interns from the previous academic year. Clinical outcomes included hospital readmission and emergency department return rates and patient satisfaction scores in discharge-related domains.Results: Study interns reported similar confidence to control group interns with discharge planning and endorsed completing four of five discharge tasks more frequently than control interns. There were no differences in clinical outcomes.Conclusions: We did not identify changes in clinical outcomes, although this finding likely reflects the multifactorial nature of hospital readmissions. Interns exposed to the curriculum early in the academic year had a higher reported frequency of completing key discharge tasks and similar confidence around discharge, when compared with end-of-the-year interns. These improvements suggest that the curriculum led to a change in culture surrounding discharge planning and perhaps accelerated learning of skills associated with discharge best practices. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 and associated social distancing has presented challenges for individuals engaging in face-to-face mutual help groups (MHGs) such as Alcoholics Anonymous for alcohol use recovery. Online MHGs may be particularly appealing to individuals with limited access or inclination to attend in-person MHGs. We examined engagement within the popular "StopDrinking" online MHG, hypothesizing that engagement would increase due to demand for virtual peer support as COVID-19 social distancing progressed. Methods: We collected publicly available engagement data for StopDrinking from February 19, 2018 through April 30, 2020 while considering March and April of 2020 as months initially impacted by voluntary or mandated COVID-19 social distancing. Using seasonal autoregressive integrated moving average models, we predicted daily engagement for this social distancing time period based on all available engagement data collected before April 2020. Kalman filtering with 95% prediction limits was employed to define significant thresholds for observed data to reside within. Results: All days of observed engagement in March and April 2020 were lower than corresponding predicted values. Observed engagement fell below the lower 95% prediction limit for 36% of days, with 15 days in March and 7 days in April having significantly lower than predicted engagement. Conclusions: Relatively low activity on StopDrinking may signal broader population trends of problematic alcohol use and recovery disengagement during the initial COVID-19 social distancing timeframe. Continued investigation of online MHGs is needed to understand their potential for monitoring population health trends and to understand how such groups might support alcohol use recovery in contexts of crisis and isolation. [ABSTRACT FROM AUTHOR]

Quality improvement (QI) plays a vital role in practice management, patient care, and reimbursement. The authors implemented a 3-year longitudinal curriculum that combined QI didactics, intervention development, and implementation at university-based, community-based, and Veterans Administration-based practices. Highlights included Plan-Do-Study-Act cycle format, team-based collaboration to brainstorm interventions, interdisciplinary QI council to select and plan interventions, system-wide intervention implementation across entire clinic populations with outcome monitoring, and intervention modifications based on challenges. A pre-post survey assessed residents' confidence in QI skills and interdisciplinary team participation, while quarterly quality data assessed patient outcomes. All 150 internal medicine residents participated. Confidence in QI and interdisciplinary team participation improved significantly (P < .001). Patient outcomes improved for 6 of 9 targeted projects and were sustained at 1 year. This curriculum is a systems-based innovation designed to improve patient care and encourage interdisciplinary teamwork and can be adopted by residencies seeking to improve engagement in QI. [ABSTRACT FROM AUTHOR]

Background: HIV is produced in lymphoid tissues (LT) and stored on the follicular dendritic cell network in LT. When antiretroviral therapy is started, plasma viremia decays in 2 phases; the first within days of starting therapy and the second over weeks. Raltegravir (RAL), an integrase inhibitor, has been associated with only a single rapid phase of decay, and we speculated this may be due to higher intracellular concentration (IC) of RAL in LT. We have previously measured suboptimal ICs of antiretroviral therapy agents in LT, which were associated with slower decay of both vRNA+ cells and the follicular dendritic cell network pool. Setting: Outpatient clinic at the Joint Clinical Research Center in Kampala, Uganda. Methods: We compared the rate of decay in LT in people starting RAL with those starting efavirenz (EFV). Results: There was no difference in the rate of virus decay in LT. The ratio of the ICs of RAL and EFV in lymph node to the concentration of drug that inhibits 95% of virus in blood was 1 log lower in lymph node for EFV and >3 logs lower for RAL. Conclusion: These data further highlight the challenges of drug delivery to LT in HIV infection and demonstrate that RAL is not superior to EFV as judged by direct measurements of the source of virus in LT. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of this study was to determine the biologic significance of tumor response and the prognostic value of molecular markers in a group of patients with rectal cancer treated with preoperative radiation therapy and radical surgery-. METHODS: Microsatellite instability, microvessel count, and immunohistochemistry for proliferating cell nuclear antigen, p53, p21, bcl-2, and vascular endothelial growth factor were performed in the preradiation biopsy specimen of 72 patients with rectal cancer treated by preoperative radiation therapy and radical curative surgery. Preoperative tumor stage by endorectal ultrasound was compared with pathology stage of the resected specimen. Mean follow-up was 50 months. RESULTS: Twenty-eight patients (39 percent) responded to radiation therapy. The response was complete in 8 (12 percent) and partial in 20 patients (27 percent). Tumors with positive nodes in the surgical specimen were less likely to have responded to preoperative radiation (P = 0.03). Only p21 expression was individually associated with response to radiation (56 vs. 30 percent; P = 0.03). Tumors that were p53-negative/p21- positive or p21-positive/bcl-2-positive were also more likely to respond to radiation (83 vs. 33 percent; P = 0.03 and 71 vs. 31 percent; P = 0.01, respectively). The tumor relapsed in 21 patients (29 percent): locally in 7 (10 percent) and distally in 14 (19 percent). Recurrence was associated with lack of response to radiation, female gender, distal tumor location, high proliferating cell nuclear antigen labeling index, and low microvessel count. Probability of survival was greater for patients with well or moderately differentiated tumors and tumors that responded completely to radiation. CONCLUSIONS; Tumor response to radiation is associated with improved tumor control and overall survival rate, and p21 expression is a marker of tumor radiosensitivity in patients with rectal cancer. Furthermore, a high proliferating cell nuclear antigen labeling index and a low microvessel count in the preradiation biopsy specimen may be prognostic indicators for tumor recurrence. [ABSTRACT FROM AUTHOR]

Hyaluronan mediates growth of SW620 colon cancer cells . Because hyaluronan is the active ingredient in Seprafilm®, we hypothesized that Seprafilm® would affect intraperitoneal tumor growth in a mouse model of peritoneal seeding. Immunodeficient mice underwent laparotomy and intraperitoneal inoculation of 105 SW620 cells. Seprafilm® (n = 22), Vicryl mesh (foreign body control; n = 24), or no material (sham; n = 19) was placed under the incision. Mice were killed after four weeks and tumors were dissected, counted, and weighed. Ninety-five percent of mice in the sham group and 96 percent in the Vicryl group developed intraperitoneal tumors. In contrast, only 64 percent of mice in the Seprafilm® group developed tumors ( P = 0.024), and these tumors were smaller than those in the sham group; (Seprafilm® = 42 ± 9 mg vs. sham = 82 ± 17 mg; P = 0.05). In contrast, tumors in the Vicryl group were dramatically larger (349 ± 49 mg; P < 0.001 vs. sham or Seprafilm®). Despite previous data that suggested that hyaluronan increases colon cancer cell growth, we found that Seprafilm® decreased tumor formation and tended to decrease size in this model. In contrast, Vicryl mesh increased tumor formation and size. Our results suggest that Seprafilm® does not promote intraperitoneal tumor growth, especially compared with Vicryl mesh. [ABSTRACT FROM AUTHOR]

To evaluate the clinical features, pathology, treatment, and outcome of patients with fistula-associated anal adenocarcinoma. We identified 14 patients with histologically proven fistula-associated anal adenocarcinoma. We reviewed their medical records and pathology specimens to characterize their presentation, treatment, and clinical outcome. Nine patients presented with a persistent fistula, 3 with a perianal mass, 1 with pain and drainage, and 1 with a recurrent perianal abscess. The average age at time of diagnosis was 59 (range, 37–76) years. Eleven patients had preexisting chronic anal fistulas. Ten had Crohn’s disease, and 1 had previously received pelvic radiation therapy. The diagnosis of cancer was suspected during physical examination in 6 of the 14 patients (43 percent). Twelve patients had extensive local disease at presentation. Primary abdominoperineal resection was performed in 11 patients, 7 following neoadjuvant chemoradiation. Six patients received postoperative chemotherapy, and 2 received postoperative radiation. Four patients died with metastatic disease. The remaining 10 patients are alive without evidence of disease at a mean follow-up of 64.3 (range, 14–149) months. The diagnosis of fistula-associated anal adenocarcinoma is often unsuspected. Most patients can be cured with aggressive surgical and adjuvant chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Worldwide, “centers of excellence” in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70–90 percent) after proctectomy. The rate of sphincter-sparing surgery with reestablishment of intestinal continuity in the general population of the United Stares is unknown. We used data from the Nationwide Inpatient Sample, a 20 percent stratified random sample of patients admitted to hospitals in the United States. We identified patients with rectal cancer from 1988 through 2003 who underwent sphincter-sparing surgery with reestablishment of intestinal continuity or proctectomy with colostomy. To determine predictors of sphincter-sparing surgery with reestablishment of intestinal continuity, we constructed a multivariate model that analyzed patients’ age, gender, race, insurance status, and income level. During our 16-year study period, radical extirpative procedures were performed in 41,631 patients: 16,510 (39.7 percent) sphincter-sparing surgery with reestablishment of intestinal continuity, and 25,121 (60.3 percent) sphincter-sacrificing procedures. The proportion of sphincter-sparing procedures increased from 26.9 percent in 1988 to 48.3 percent in 2003 ( P < 0.001). There has been no significant change in the rate of sphincter-sparing surgery since 1999 ( P = not significant). Logistic regression revealed that patients who were older, male, black, used Medicaid insurance, or lived in lower-income zip codes were less likely to have sphincter-sparing surgery with reestablishment of intestinal continuity ( P < 0.001). Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes. [ABSTRACT FROM AUTHOR]

PURPOSE: This study was designed to determine the efficacy of endorectal ultrasound in the management of patients with malignant rectal polyps removed by snare excision during colonoscopy. METHODS: A retrospective review of the medical records and endorectal ultrasound images of 63 patients with endoscopically removed rectal polyps containing invasive adenocarcinoma subsequently staged by endorectal ultrasound. Patients underwent surgery or were followed at a single institution. The polyp characteristics and ultrasound images were compared with the presence of residual tumor in the surgical specimen in patients who underwent further surgery or with recurrence in patients who did not. RESULTS: The morphology of the polyps was described in 31 patients (49 percent); they were sessile in 26 (41 percent) and pedunculated in 6 (9 per- cent). The margins were positive in 22 patients (35 per- cent), negative in 19 (30 percent), and not specified in 22 (35 percent). Most tumors were well or moderately differentiated; only 3 (5 percent) were poorly differentiated. Thirty-three patients underwent further surgery (3 low anterior resection, and 30 transanal excision); 30 had no further surgery. The accuracy of endorectal ultrasound in assessing the presence of residual cancer in the rectal wall in patients who had surgery was 54 percent, with a 39 percent positive predictive value and 65 percent negative predictive value. Endorectal ultrasound accurately identified metastatic lymph nodes in two of three patients who had radical surgery. Endorectal ultrasound was more useful than polyp morphologic or histologic criteria to determine the presence of residual cancer in the rectal wall. CONCLUSIONS: Endorectal ultrasound does not definitely exclude the possibility of residual tumor in the rectal wall or mesenteric nodes of patients who had a malignant polyp snared endoscopically. Consequently, decisions regarding the definitive management of these patients cannot be based exclusively on the endorectal ultrasound images of the polypectomy site. [ABSTRACT FROM AUTHOR]

PURPOSE: Neoadjuvant radiation therapy has been used increasingly to downstage rectal cancer and decrease local recurrence. Despite its efficacy, preoperative radiation therapy may inhibit healing and contribute to wound complications. This study was designed to evaluate perineal wound complications after abdominoperineal resection. METHODS: The clinical records of a consecutive series of patients who underwent abdominoperineal resection for rectal carcinoma between 1988 and 2002 were reviewed. Demographic data, disease stage, and use of preoperative radiation therapy were recorded. Major wound complications included delayed wound healing (>1 month), wound infection requiring drainage/debridement, or reoperation. RESULTS: A total of 160 patients underwent abdominoperineal resection with primary closure of the perineal wound (mean age, 63 ± 12 years); 117 (73 percent) patients received preoperative radiation therapy; 114 received radiation therapy for rectal cancer (radiation therapy + chemotherapy = 107, radiation therapy alone = 7); 3 received radiation therapy for other pelvic malignancies. Median radiation dose was 5,040 (range, 900-5,400) cGY. Overall wound complication rate was 41 percent. Major wound complication rate was 35 percent. Delayed healing was the most common complication (24 percent), followed by infection (10 percent). Radiation therapy increased the risk of any wound complication (47 vs. 23 percent; P = 0.005), risk of a major wound complication (41 vs. 19 percent; P = 0.02 1), and risk of infection (14 vs. 0 percent; P = 0.015). Risk of wound complications did not correlate with age, gender, disease stage, smoking, or diabetes. CONCLUSIONS: Wound complications are frequent after abdominoperineal resection and primary closure of the perineum. Preoperative radiation therapy doubles the rate of total and major perineal wound complications. Alternatives to primary perineal closure should be considered, particularly after radiation therapy. [ABSTRACT FROM AUTHOR]

PURPOSE: The beneficial effect of antibiotics in pouchitis suggests that an unidentified fecal bacterial product causes this condition. A candidate compound is hydrogen sulfide, a highly toxic gas produced by certain fecal bacteria, which causes tissue injury in experimental models. We investigated hydrogen sulfide release and sulfate-reducing bacterial counts in pouch contents to determine whether hydrogen sulfide production correlates with pouchitis. METHODS: During incubation at 37°C, the production of hydrogen sulfide, methylmercaptan, carbon dioxide, and hydrogen were studied using fresh fecal specimens obtained from 50 patients with ileoanal pouches constructed after total proctocolectomy for ulcerative colitis (n = 45) or for familial adenomatous polyposis (n = 5). Patients with ulcerative colitis were divided into five groups: a) no history of pouchitis (pouch for at least 2 years; n = 8); b) past episode(s) of pouchitis but no active disease for the previous year (n = 9); c) pouchitis in the past year but presently inactive (n = 9); d) ongoing antibiotic treatment (metronidazole or ciprofloxacin) for pouchitis (n = 11); e) currently suffering from pouchitis (n = 8). RESULTS: Release of hydrogen sulfide when pouchitis was active (6.06 ± 1.03 μmol g-1 4 h-1) or had occurred in the past year (4.71 ± 0.41 μmol g-1 4 h-1) was significantly higher (P < 0.05) than when pouchitis had never occurred (1.71 ± 0.43 mu;mol g-1 4 h-1) or had been inactive in the past year (2.62 ± 0.49 μmol g-1 4 h-1). Antibiotic therapy was associated with very low hydrogen sulfide release (0.68 ± 0.29 μmol g-1 4 h-1). Pouch contents from familial adenomatous polyposis patients produced significantly less hydrogen sulfide (0.75 ± 0.09 μmol g-1 4 h-1) than did any group of nonantibiotic-treated ulcerative colitis patients. Sulfate-reducing bacterial counts in active pouchitis (9.5 ± 0.5 log10/g) were significantly higher than in those who never experienced pouchitis (7.38 ± 0.32 log10/g), and these counts fell dramatically with antibiotic treatment. No statistically significant differences in carbon dioxide and hydrogen were observed among the groups not receiving antibiotics. CONCLUSIONS: Pouch contents of patients with ongoing pouchitis or an episode within the previous year released significantly more hydrogen sulfide than did the contents of patients who never had an attack of pouchitis and those with longstanding inactive disease. The response to therapy with metronidazole or ciprofloxacin was associated with marked reductions in hydrogen sulfide release and sulfate-reducing bacteria. These results provide a rationale for additional studies to determine whether the high sulfide production is a cause or effect of pouchitis. The lower hydrogen sulfide production by pouch contents of familial adenomatous polyposis vs. patients with ulcerative colitis suggests a fundamental difference in gut sulfide metabolism that could have implications for the etiology of ulcerative colitis as well as the pouchitis of patients with ulcerative colitis. [ABSTRACT FROM AUTHOR]

PURPOSE: In the United States, adjuvant radiation therapy is currently recommended for most patients with rectal cancer. We conducted this population-based study to evaluate the rate of radiation therapy and the factors affecting its delivery. METHODS: We used the Surveillance Epidemiology and End Results database to assess treatment of patients with nonmetastatic rectal cancer diagnosed over a 25-year period (1976 through 2000). We evaluated the rate of radiation therapy use and its timing (preoperative vs. postoperative) and the influence of factors such as tumor stage and grade; patient gender and race; and geographic location. RESULTS: In this 25-year period, 45,627 patients met our selection criteria. The rate of radiation therapy use increased dramatically over time: from 17 percent of advanced-stage patients in 1976 to 65 percent in 2000 (P < 0.0001). Until 1996, the increase was due almost entirely to postoperative radiation therapy. Since 1996, the rate of pro- operative radiation therapy use has increased (P < 0.0001) and the rote of postoperative radiation therapy use has begun to decline. We found, after controlling for the year of diagnosis, that female patients, African Americans, older pa- tients, and patients with low-grade lesions were less likely to undergo radiation therapy (P < 0.000l). Geographic location was also an important predictor of radiation therapy use. CONCLUSIONS: The use of radiation therapy for patients with rectal cancer has dramatically increased over the 25-year period studied, with a recent shift to the use of preoperative radiation therapy; however, in 2000, over 30 percent of patients with advanced-stage nonmetastatic rectal cancer did not undergo radiation therapy. Given the variation in radiation therapy tree that we found to be due to demographic factors, access to adjuvant radiation therapy can be improved. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of the Minnesota Colorectal Cancer Initiative is to implement risk-specific interventions to decrease colorectal cancer morbidity and mortality by 1) assisting clinicians to identify and educate individuals and families at high and increased risk for colorectal cancer; 2) providing professional and community education; 3) maintaining a database to evaluate the effectiveness of preventive intervention strategies; and 4) facilitating colorectal cancer research. METHODS: Two physician groups and the University Cancer Center founded the Minnesota Colorectal Cancer Initiative as a not-for-profit organization. Health care organizations, pharmaceutical companies, a consulting firm, and other practice groups provide continuing financial and other support. A database registry, risk-assessment survey, and consent document were developed and then were approved by an institutional review board. A trial enrollment was conducted. Minnesota Cob rectal Cancer Initiative services are available to the public. Participants are actively recruited through member organizations. Minnesota Colorectal Cancer Initiative assesses hereditary risk and will document family history in the medical record on request. A personally targeted reply letter reviews risk factors and recommends specific screening and surveillance strategies for participants and their family members, and when appropriate, provides information regarding genetic counseling and testing services. Minnesota Colorectal Cancer Initiative services are free to participants. RESULTS: Since 1999, Minnesota Colorectal Cancer Initiative has sent individually tailored reply letters providing risk-specific information about colorectal cancer to 717 participants and more than 3200 of their first-degree and second-degree relatives. More than 200 families, previously unidentified as having histories suggestive of hereditary colorectal cancer (attenuated familial polyposis and hereditary nonpolyposis colorectal cancer), have been identified; genetic services were explained and recommended. A formal program evaluation confirmed that Minnesota Colorectal Cancer Initiative provides useful information and materials and promotes intrafamilial communication about colon cancer risk and recommendations. CONCLUSIONS: Minnesota Colorectal Cancer Initiative is a model of effective collaboration between academic and community health care providers. A community-based registry is a unique way to identify and provide personal, risk-specific information to large numbers of people at increased or high risk for colorectal cancer. [ABSTRACT FROM AUTHOR]

PURPOSE:. This study was designed to investigate the role of a scheduled follow-up protocol using endorectal ultrasonography for the diagnosis of local recurrence after local excision and radical surgery for rectal cancer. METHODS:. A selected group of 275 patients with invasive rectal cancer followed prospectively by endorectal ultrasonography after curative-intent local excision (n = 108) or radical surgery (n = 167) was reviewed. For the radical-surgery group, results were compared with a group of 176 rectal cancer patients who had similar operations during the same period of time and were not entered in follow-up protocol. Excluded were patients with invasive cancers removed by snare excision, male patients treated by abdominoperineal resection, and patients treated by endocavitary radiation. Student’s unpaired t-test was used to compare tumor and patient characteristics. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS:. In the local-excision group, 32 patients developed local recurrence, 26 (81 percent) were asymptomatic, and 10 of them (31 percent) were diagnosed only by endorectal ultrasound. We found no difference in the rates of salvage surgery or survival between patients diagnosed of recurrence by ultrasound or other methods. In the radical-surgery group, 12 patients developed local recurrence, 5 (42 percent) were asymptomatic, and 4 of them (33 percent) were diagnosed only by endorectal ultrasound. More patients with isolated local recurrence in the follow-up group underwent salvage surgery (4/9 patients; 44 percent) compared with patients without follow-up (3/13 patients; 23 percent), but the differences were not significant. CONCLUSIONS:. Endorectal ultrasound identifies one-third of asymptomatic local recurrences that were missed by digital examination or proctoscopic examination. However, the impact of the earlier diagnosis in patient survival can only be determined by a larger, prospective, randomized trial. [ABSTRACT FROM AUTHOR]

This article presents the author's views on ability of clinical decision making of surgeons. Research into clinical decision making will allow us to teach more effectively and to better select trainees who can acquire clinical judgment and decision- making abilities in a reasonable period of time. We need to assess potential trainees to determine not just their cognitive capacity and their three-dimensional thinking and manual dexterity necessary to be a surgeon but also to identify those personality characteristics that predict successful development of appropriate clinical decision making.

SUMMARY: The measurement of fecal incontinence is challenging. Because fecal incontinence is a symptom, the subjective perception of the patient must be the foundation of any evaluation of incontinence or the impact of incontinence. The lack of a criterion standard makes testing measures for reliability and validity more difficult. Despite this, many measures are available and can be divided into three broad categories: descriptive measures that do not provide summary scores; severity measures that assess the frequency and type of incontinence; and impact measures that assess the effect of incontinence on quality of life. The strengths and weaknesses of currently available measures are presented in this review. [ABSTRACT FROM AUTHOR]

PURPOSE: This study was undertaken to evaluate a single-institution experience with the Acticon® artificial bowel sphincter for the treatment of intractable fecal incontinence. METHODS: At the University of Minnesota, 45 consecutive patients underwent artificial bowel sphincter placement (Group I, 1989–1992, n = 10; Group II, 1997–2001, n = 35). Group I was reviewed retrospectively and Group II prospectively. RESULTS: The outcome for Group I patients was initially reported in 1995 (mean age, 32; range, 15–52 years; 7 males). Of these 10 patients, 4 required explantation (2 required stomas), and 6 have a functional artificial bowel sphincter; 2 patients had devices successfully replaced for fluid leaks (at 6 and 10 years). In Group II, artificial bowel sphincter placement was attempted in 37 patients and was successful in 35 (mean age, 47; range, 18–72 years; 11 males). A total of 14 patients required explantation, 12 (34 percent) for infection and 2 (6 percent) for pain. In total, 13 patients have required 21 revisions, including 7 complete device replacements. The infection rate for revisions was 19 percent; four patients required explantation after revisions. Of 18 patients whose artificial bowel sphincter failed, 9 required a stoma. In all, 17 (49 percent) patients have a functional artificial bowel sphincter. In Group II fecal incontinence severity scores decreased from a mean of 103 preimplant to 59 at one year and to 23 at two or more years (P < 0.001) in patients who retained their devices. Quality of life scores improved in all patients at six months and at one year (P < 0.01). CONCLUSION: Artificial bowel sphincter therapy leads to long-term improved continence and quality of life in patients whose implantation is successful. Success rates have not improved in the two patient groups, with infection remaining a major challenge. However, once successfully established, artificial bowel sphincter function remains stable for many years. [ABSTRACT FROM AUTHOR]