Frequency and characteristics of errors by artificial intelligence (AI) in reading screening mammography: a systematic review.

PURPOSE: Artificial intelligence (AI) for reading breast screening mammograms could potentially replace (some) human-reading and improve screening effectiveness. This systematic review aims to identify and quantify the types of AI errors to better understand the consequences of implementing this technology. METHODS: Electronic databases were searched for external validation studies of the accuracy of AI algorithms in real-world screening mammograms. Descriptive synthesis was performed on error types and frequency. False negative proportions (FNP) and false positive proportions (FPP) were pooled within AI positivity thresholds using random-effects meta-analysis. RESULTS: Seven retrospective studies (447,676 examinations; published 2019-2022) met inclusion criteria. Five studies reported AI error as false negatives or false positives. Pooled FPP decreased incrementally with increasing positivity threshold (71.83% [95% CI 69.67, 73.90] at Transpara 3 to 10.77% [95% CI 8.34, 13.79] at Transpara 9). Pooled FNP increased incrementally from 0.02% [95% CI 0.01, 0.03] (Transpara 3) to 0.12% [95% CI 0.06, 0.26] (Transpara 9), consistent with a trade-off with FPP. Heterogeneity within thresholds reflected algorithm version and completeness of the reference standard. Other forms of AI error were reported rarely (location error and technical error in one study each). CONCLUSION: AI errors are largely interpreted in the framework of test accuracy. FP and FN errors show expected variability not only by positivity threshold, but also by algorithm version and study quality. Reporting of other forms of AI errors is sparse, despite their potential implications for adoption of the technology. Considering broader types of AI error would add nuance to reporting that can inform inferences about AI's utility.

Health benefits and harms of mammography screening in older women (75+ years)-a systematic review.

BACKGROUND: There is little evidence on the balance between potential benefits and harms of mammography screening in women 75 years and older. The aim of this systematic review was to synthesise the evidence on the outcomes of mammography screening in women aged 75 years and older. METHODS: A systematic review of mammography screening studies in women aged 75 years and over. RESULTS: Thirty-six studies were included in this review: 27 observational studies and 9 modelling studies. Many of the included studies used no or uninformative comparison groups resulting in a potential bias towards the benefits of screening. Despite this, there was mixed evidence about the benefits and harms of continuing mammography screening beyond the age of 75 years. Some studies showed a beneficial effect on breast cancer mortality, and other studies showed no effect on mortality. Some studies showed some harms (false positive tests and recalls) being comparable to those in younger age-groups, with other studies showing increase in false positive screens and biopsies in older age-group. Although reported in fewer studies, there was consistent evidence of increased overdiagnosis in older age-groups. CONCLUSION: There is limited evidence available to make a recommendation for/against continuing breast screening beyond the age of 75 years. Future studies should use more informative comparisons and should estimate overdiagnosis given potentially substantial harm in this age-group due to competing causes of death. This review was prospectively registered with PROSPERO (CRD42020203131).

Two-year follow-up of participants in the BreastScreen Victoria pilot trial of tomosynthesis versus mammography: breast density-stratified screening outcomes.

OBJECTIVE: This follow-up study of BreastScreen Victoria's pilot trial of digital breast tomosynthesis aimed to report interval cancer rates, screening sensitivity, and density-stratified outcomes for tomosynthesis vs mammography screening. METHODS: Prospective pilot trial [ACTRN-12617000947303] in Maroondah BreastScreen recruited females ≥ 40 years presenting for screening (August 2017-November 2018) to DBT; concurrent screening participants who received mammography formed a comparison group. Follow-up of 24 months from screen date was used to ascertain interval cancers; automated breast density was measured. RESULTS: There were 48 screen-detected and 9 interval cancers amongst 4908 tomosynthesis screens, and 34 screen-detected and 16 interval cancers amongst 5153 mammography screens. Interval cancer rate was 1.8/1000 (95%CI 0.8-3.5) for tomosynthesis vs 3.1/1000 (95%CI 1.8-5.0) for mammography (p = 0.20). Sensitivity of tomosynthesis (86.0%; 95% CI 74.2-93.7) was significantly higher than mammography (68.0%; 95% CI 53.3-80.5), p = 0.03. Cancer detection rate (CDR) of 9.8/1000 (95%CI 7.2-12.9) for tomosynthesis was higher than that of 6.6/1000 (95%CI 4.6-9.2) for mammography (p = 0.08); density-stratified analyses showed CDR was significantly higher for tomosynthesis than mammography (10.6/1000 vs 3.5/1000, p = 0.03) in high-density screens. Recall rate for tomosynthesis was significantly higher than for mammography (4.2% vs 3.0%, p < 0.001), and this increase in recall for tomosynthesis was evident only in high-density screens (5.6% vs 2.9%, p < 0.001). CONCLUSION: Although interval cancer rates did not significantly differ between screened groups, sensitivity was significantly higher for tomosynthesis than mammography screening. ADVANCES IN KNOWLEDGE: In a program-embedded pilot trial, both increased cancer detection and recall rates from tomosynthesis were predominantly observed in high-density screens.

Differential detection by breast density for digital breast tomosynthesis versus digital mammography population screening: a systematic review and meta-analysis.

BACKGROUND: We examined whether digital breast tomosynthesis (DBT) detects differentially in high- or low-density screens. METHODS: We searched six databases (2009-2020) for studies comparing DBT and digital mammography (DM), and reporting cancer detection rate (CDR) and/or recall rate by breast density. Meta-analysis was performed to pool incremental CDR and recall rate for DBT (versus DM) for high- and low-density (dichotomised based on BI-RADS) and within-study differences in incremental estimates between high- and low-density. Screening settings (European/US) were compared. RESULTS: Pooled within-study difference in incremental CDR for high- versus low-density was 1.0/1000 screens (95% CI: 0.3, 1.6; p = 0.003). Estimates were not significantly different in US (0.6/1000; 95% CI: 0.0, 1.3; p = 0.05) and European (1.9/1000; 95% CI: 0.3, 3.5; p = 0.02) settings (p for subgroup difference = 0.15). For incremental recall rate, within-study differences between density subgroups differed by setting (p < 0.001). Pooled incremental recall was less in high- versus low-density screens (-0.9%; 95% CI: -1.4%, -0.4%; p < 0.001) in US screening, and greater (0.8%; 95% CI: 0.3%, 1.3%; p = 0.001) in European screening. CONCLUSIONS: DBT has differential incremental cancer detection and recall by breast density. Although incremental CDR is greater in high-density, a substantial proportion of additional cancers is likely to be detected in low-density screens. Our findings may assist screening programmes considering DBT for density-tailored screening.

Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer.

OBJECTIVES: To determine screening outcomes in women who have no recorded risk factors for breast cancer. METHODS: A retrospective population-based cohort study included all 1,026,137 mammography screening episodes in 323,082 women attending the BreastScreen Western Australia (part of national biennial screening) program between July 2007 and June 2017. Cancer detection rates (CDR) and interval cancer rates (ICR) were calculated in screening episodes with no recorded risk factors for breast cancer versus at least one risk factor stratified by age. CDR was further stratified by timeliness of screening (<27 versus ≥27 months); ICR was stratified by breast density. RESULTS: Amongst 566,948 screens (55.3%) that had no recorded risk factors, 2347 (40.9%) screen-detected cancers were observed. In screens with no risk factors, CDR was 50 (95%CI 48-52) per 10,000 screens and ICR was 7.9 (95%CI 7.4-8.4) per 10,000 women-years, estimates that were lower than screens with at least one risk factor (CDR 83 (95%CI 80-86) per 10,000 screens, ICR 12.2 (95%CI 11.5-13.0) per 10,000 women-years). Compared to timely screens with risk factors, delayed screens with no risk factors had similar CDR across all age groups and a higher proportion of node positive cancers (26.1% vs 20.7%). ICR was lowest in screens that had no risk factors nor dense breasts in all age groups. CONCLUSIONS: Majority of screens had no recorded breast cancer risk factors, hence a substantial proportion of screen-detected cancers occur in these screening episodes. Our findings may not justify less frequent screening in women with no risk factors.

Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening.

OBJECTIVES: To estimate rates of screen-detected and interval breast cancers, stratified by risk factor, to inform discussions of risk-stratified population screening. DESIGN: Retrospective population-based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data. SETTING, PARTICIPANTS: All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 - 30 June 2017. MAIN OUTCOME MEASURES: Cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor. RESULTS: A total of 323 082 women were screened in 1 026 137 screening episodes (mean age, 58.5 years; SD, 8.6 years). The overall CDR was 68 (95% CI, 67-70) cancers per 10 000 screens, and the overall ICR was 9.7 (95% CI, 9.2-10.1) cancers per 10 000 women-years. Interactions between the effects on CDR of age group and five risk factors were statistically significant: personal history of breast cancer (P = 0.039), family history of breast cancer (P = 0.005), risk-relevant benign conditions (P = 0.012), hormone-replacement therapy (P = 0.002), and self-reported symptoms (P < 0.001). The influence of these risk factors (except personal history) increased with age. For ICR, only the interaction between age and hormone-replacement therapy was significant (P < 0.001), although weak interactions between age and family history of breast cancer or having dense breasts were noted (each P = 0.07). The influence of family history on ICR was significant only for women aged 40-49 years. CONCLUSIONS: Screening CDR and (for some risk factors) ICR were higher for women in some age groups with personal histories of breast cancer or risk-relevant benign breast conditions or first degree family history of breast cancer, women with dense breasts or self-reported breast-related symptoms, and women using hormone-replacement therapy. Our findings could inform the evaluation of risk-based screening.

Changes in Reoperation After Publication of Consensus Guidelines on Margins for Breast-Conserving Surgery: A Systematic Review and Meta-analysis.

Importance: The 2014 publication of the Society of Surgical Oncology-American Society for Radiation Oncology (SSO-ASTRO) Consensus Guideline on Margins for Breast-Conserving Surgery recommended a negative margin definition of no ink on tumor. Adoption of this guideline would represent a major change in surgical practice that could lower the rates of reoperation. Objective: To assess changes in reoperation rates after publication of the SSO-ASTRO guideline. Data Sources: A systematic search of Embase, PREMEDLINE, Evidence-Based Medicine Reviews, Scopus, and Web of Science for biomedical literature published from January 2014 to July 2019 was performed. This search was supplemented by web searches and manual searching of conference abstracts. Study Selection: Included studies compared the reoperation rates in preguideline vs postguideline cohorts (actual change), retrospectively applied the SSO-ASTRO guideline to a preguideline cohort (projected change), or described the economic outcomes of the guideline. Data Extraction and Synthesis: Study characteristics and reoperation rates were extracted independently by 2 reviewers. Odds ratios (ORs) were pooled by random effects meta-analysis. Analyses were stratified by study setting (institutional or population) and preguideline accepted margins. The economic outcomes of the guideline were summarized narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Main Outcomes and Measures: Odds ratios for postguideline vs preguideline reoperation rates. Results: From 1114 citations, 30 studies (with 599 016 participants) reported changes in reoperation rates. Studies included a median (range) of 487 (100-521 578) participants, and 20 studies were undertaken in the US, 6 in the UK, 3 in Canada, and 1 in Australia. Among 21 studies of actual changes, pooled ORs showed a statistically significant reduction in reoperation, with an OR lower in institution-based studies than in population-based studies (OR, 0.62 [95% CI, 0.52-0.74] vs 0.76 [95% CI, 0.72-0.80]; P = .04 for subgroup differences). Among 9 studies of projected changes, the pooled OR was lower for preguideline margin thresholds of 2 mm or more compared with 1 mm (OR, 0.47 [95% CI, 0.40-0.56] vs 0.85 [95% CI, 0.79-0.91; P < .001 for subgroup differences). Projected changes were likely to overestimate actual changes. Six studies that estimated the postguideline economic outcome found the guideline to be potentially cost saving, with a median (range) saving of US $3540 ($1800-$25 650) per woman avoiding reoperation. Conclusions and Relevance: This study found a decrease in reoperation rates after the publication of the SSO-ASTRO guideline; this reduction was greater at an institutional level than a population level, the latter reflecting the differences in guideline adoption between centers. These early outcomes may be conservative estimates of longer-term implications.

Mortality of ethnic minority groups in the UK: a systematic review protocol.

INTRODUCTION: Growing ethnic diversity in the UK has made it increasingly important to determine the presence of ethnic health inequalities. There has been no systematic review that has drawn together research on ethnic differences in mortality in the UK. METHODS: All types of observational studies that compare all-cause mortality between major ethnic groups and the white majority population in the UK will be included. We will search Medline (OvidSP), Embase (OvidSP), Scopus and Web of Science and search the grey literature through conference proceedings and online thesis registries. Searches will be carried out from inception to 2 August 2019 with no language or other restrictions. Database searches will be repeated prior to publication to identify new articles published since the initial search. We will conduct forward and backward citation tracking of identified references and consult with experts in the field to identify further publications and ongoing or unpublished studies. Two reviewers will independently screen studies and extract data. Two reviewers will independently assess the quality of included studies using the Newcastle-Ottawa Scale. If at least two studies are located for each ethnic group and studies are sufficiently homogeneous, we will conduct a meta-analysis. If insufficient studies are located or if there is high heterogeneity we will produce a narrative summary of results. ETHICS AND DISSEMINATION: As no primary data will be collected, formal ethical approval is not required. The findings of this review will be disseminated through publication in peer reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019146143.

Tutorial options for clinicians undertaking postgraduate degrees online.

This article was migrated. The article was marked as recommended. Purpose: To determine clinicians' preference for types of tutorial participation and their subsequent tutorial participation and performance. Methods: Part-time online students undertaking an introductory postgraduate unit of study in clinical epidemiology were offered different tutorial options across semesters. Results: Ungraded asynchronous online discussions were poorly attended with only 118/186 (63%) posting at least once across 10 tutorials. Allocating a 1% participation mark each week and allowing students to complete tutorial tasks individually increased participation with 148/190 (78%) completing at least 8 out of 10 tutorials. Moreover, the final assignment mark distribution lost the tail of poorly performing students. In semesters when two tutorial options were offered, 192/200 (96%) chose to work alone over asynchronous online discussion and 162/190 (85%) chose to work alone over intensive face-to-face workshops. Even when students self-selected to join graded asynchronous online discussion, only 2/8 (25%) completed at least 8 out of 10 tutorials. In students who selected to attend intensive workshops, both participation and final assignment grade were better than that observed in other students. Conclusions: The majority of clinicians studying online chose to work individually. Allowing students to work alone and awarding participation marks appeared to improve both participation and knowledge attainment.

Multiple Peri-Operative Complications are Associated with Reduced Long Term Amputation Free Survival Following Revascularisation for Lower Limb Peripheral Artery Disease: A Population Based Linked Data Study.

OBJECTIVE: To determine, in a population based linked data study, the relationship between peri-operative multiple complications and longer term outcomes, specifically the combined outcome of two year amputation or death, after lower limb revascularisation for peripheral artery disease (PAD). METHODS: State wide health administrative data and death records were probabilistically linked for all patients who had lower limb artery surgery between 2010 and 2012 in New South Wales, Australia. Multivariable Cox regression modelled the impact of medical and surgical complications on the combined outcome of amputation or death two years after discharge. RESULTS: Open surgery was performed on 3004 patients (26.7%), and endovascular on 8263 (73.3%). Of the 10 971 patients discharged alive, 3747 (34.1%) experienced at least one complication, and 2113 (19.3%) had multiple complications. Older patients, those with high comorbidity scores, or those with chronic limb threatening ischaemia were at increased risk of multiple complications. After adjusting for procedure type, patients with multiple complications experienced more than three times the hazard ratio (HR) of amputation or death two years after the procedure than those without complications (adjusted HR 3.4, 95% confidence interval 3.1-3.7), and increasing complications progressively multiplied the risk. In particular, non-surgical complications such as stroke, acute renal failure, delirium, and cardiac events were associated with the highest rates of two year amputation or death. CONCLUSION: Multiple complications after surgery for lower limb PAD carried a compounding risk of reduced long term amputation free survival. Patients experiencing at least one complication form a high risk group that requires increased attention to prevent the potential development of further complications.

Artificial Intelligence (AI) for the early detection of breast cancer: a scoping review to assess AI's potential in breast screening practice.

INTRODUCTION: Various factors are driving interest in the application of artificial intelligence (AI) for breast cancer (BC) detection, but it is unclear whether the evidence warrants large-scale use in population-based screening. AREAS COVERED: We performed a scoping review, a structured evidence synthesis describing a broad research field, to summarize knowledge on AI evaluated for BC detection and to assess AI's readiness for adoption in BC screening. Studies were predominantly small retrospective studies based on highly selected image datasets that contained a high proportion of cancers (median BC proportion in datasets 26.5%), and used heterogeneous techniques to develop AI models; the range of estimated AUC (area under ROC curve) for AI models was 69.2-97.8% (median AUC 88.2%). We identified various methodologic limitations including use of non-representative imaging data for model training, limited validation in external datasets, potential bias in training data, and few comparative data for AI versus radiologists' interpretation of mammography screening. EXPERT OPINION: Although contemporary AI models have reported generally good accuracy for BC detection, methodological concerns, and evidence gaps exist that limit translation into clinical BC screening settings. These should be addressed in parallel to advancing AI techniques to render AI transferable to large-scale population-based screening.

Low-dose chest computed tomography screening of subjects exposed to asbestos.

OBJECTIVES: The primary aim was to reveal the prevalence of lung cancer (LC) and malignant pleural mesothelioma (MPM) in subjects with past asbestos exposure (AE). We also examined pulmonary or pleural changes correlated with the development of LC. MATERIALS AND METHODS: This was a prospective, multicenter, cross-sectional study. There were 2132 subjects enrolled between 2010 and 2012. They included 96.2% men and 3.8% women, with a mean age of 76.1 years; 78.8% former or current smokers; and 21.2% never smokers. We screened subjects using low-dose computed tomography (CT). The CT images were taken with a CT dose Index of 2.7 mGy. The evaluated CT findings included subpleural curvilinear shadow/subpleural dots, ground glass opacity or interlobular reticular opacity, traction bronchiectasia, honeycombing change, parenchymal band, emphysema changes, pleural effusion, diffuse pleural thickening, rounded atelectasis, pleural plaques (PQs), and tumor formation. RESULTS: The PQs were detected in most of subjects (89.4%) and emphysema changes were seen in 46.0%. Fibrotic changes were detected in 565 cases (26.5%). A pathological diagnosis of LC was confirmed in 45 cases (2.1%) and MPM was confirmed in 7 cases (0.3%). The prevalence of LC was 2.5% in patients with a smoking history, which was significantly higher than that in never smokers (0.7%, p = 0.027). The prevalence of LC was 2.8% in subjects with emphysema changes, which was higher than that of subjects without those findings (1.6%); although, the difference was not statistically significant (p = 0.056). The prevalence of LC in subjects with both fibrotic plus emphysema changes was 4.0%, which was significantly higher than that of subjects with neither of those findings (1.8%, p = 0.011). Logistic regression analysis revealed smoking history, fibrotic plus emphysema changes, and pleural effusion as significant explanatory variables. CONCLUSIONS: Smoking history, fibrotic plus emphysema changes, and pleural effusion were correlated with the prevalence of LC.

Natural history of post-void residual urine volume over 5 years in community-dwelling older men: The Concord Health and Ageing in Men Project.

AIMS: To describe the natural history of post-void residual urine volume (PVR) in community-dwelling older men. METHODS: The Concord Health and Ageing in Men Project involves a representative sample of community-dwelling men aged 70 and older in a defined geographic area of Sydney, Australia. PVR were measured at baseline and 2-year and 5-year follow-up. The measurements were considered valid when the voided volumes were 150 mL and over. Three-hundred twenty-nine men without conditions that are likely to alter PVR (neurological disorders, prostate cancer, and a history of urological treatment) were included in the analyses. RESULTS: Baseline PVR were 0-49 mL in 183 men, 50-99 mL in 59 men, 100-199 mL in 72 men, 200-399 mL in 11 men, and 400 mL and over in 4 men. Thirteen out of 314 (4%) men with a baseline PVR of 0-199 mL and 2 out of 11 (18%) men with a baseline PVR of 200-399 mL had surgery for benign prostate enlargement (BPE) or indwelling catheterization over 5 years compared to three out of four men (75%) with a PVR of 400 mL and over. In all 101 men with a baseline PVR of less than 400 mL who did not receive urological treatment during follow-up and had valid PVR data for both 2-year and 5-year follow-up, PVR did not exceed 400 mL at either follow-up time point. CONCLUSION: Conservative management may be appropriate for most older men with incidentally found elevated PVR of up to 400 mL.

Chronic musculoskeletal pain and its impact on older people.

Musculoskeletal conditions are the leading cause of disability worldwide and also have a large impact on many other aspects of older people's health such as low physical activity level, poor mobility, frailty, depression, cognitive impairment, falls and poor sleep quality. Clustering of musculoskeletal pain with other pain conditions is also common, and the number of pain sites is an important prognostic factor. While musculoskeletal pain is usually nociceptive in origin, older people with musculoskeletal conditions may also experience neuropathic pain and central pain syndromes. Musculoskeletal burden of disease is increasing because of rapid ageing of populations, especially in developing countries. Interaction of musculoskeletal pain with co-existing conditions, including other types of pain, needs to be studied in longitudinal studies to identify modifiable targets for intervention. Additionally, potential impacts of musculoskeletal pain and prognostic factors need to be investigated in developing countries where evidence is scarce.

Natural history of non-neurogenic overactive bladder and urinary incontinence over 5 years in community-dwelling older men: The concord health and aging in men project.

AIMS: To describe the natural history of non-neurogenic overactive bladder (OAB) and urgency incontinence in community-dwelling older men. METHODS: A representative sample of 1,705 community-dwelling men aged 70 and older in a defined geographic area of Sydney, Australia, had their urinary symptoms assessed using the International Prostate Symptom Scores (IPSS) and the International Consultation of Incontinence Questionnaire (ICIQ) at baseline, 2-year follow-up, and 5-year follow-up. Four hundred and eighty-eight men without neurological diseases or prostate cancer during follow-up, or history of urological treatment at baseline were included in the analysis. Urgency incontinence was defined as leakage of urine occurring more than weekly in the above-defined population. OAB was defined as either urgency or urgency incontinence according to 2002 International Continence Society consensus. RESULTS: Of the men with OAB at baseline, 29% received treatment for OAB or benign prostatic enlargement over 5 years. Of the remaining men, 33% had sustained remission at 2-year and 5-year follow-ups without treatment. Of the men with OAB at 2-year follow-up, remission rate at 5-year follow-up was 53% in men without OAB at baseline and 27% in men with OAB at baseline (P = 0.23). No statistically significant difference was found in baseline characteristics between men with sustained remission and men with persistent symptoms. CONCLUSIONS: One in three older men with non-neurogenic OAB had sustained remission of symptoms without medical or surgical interventions. No significant predictor of sustained remission was identified. Neurourol. Urodynam. 36:443-448, 2017. © 2016 Wiley Periodicals, Inc.

Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project.

PURPOSE: We sought to determine which lower urinary tract symptoms are associated with incident falls in community dwelling older men. MATERIALS AND METHODS: The Concord Health and Ageing in Men Project involves a representative sample of community dwelling men 70 years old or older in a defined geographic region in Sydney, New South Wales, Australia. Included in analysis were 1,090 men without neurological diseases, poor mobility or dementia at baseline. Lower urinary tract symptoms were assessed using I-PSS (International Prostate Symptom Score) and incontinence was assessed using ICIQ (International Consultation on Incontinence Questionnaire) at baseline. I-PSS subscores were calculated for storage and voiding symptoms. Incident falls in 1 year were determined by telephone followup every 4 months. RESULTS: I-PSS storage and voiding subscores were associated with falls. Urgency incontinence was associated with falls (adjusted incidence rate ratio 2.57, 95% CI 1.54-4.30). In addition, intermediate to high I-PSS storage subscores without urgency incontinence were associated with falls (adjusted incidence rate ratio 1.72, 95% CI 1.24-2.38). Other types of incontinence and urgency alone without urgency incontinence were not associated with falls. CONCLUSIONS: Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls. Storage symptoms also contributed to the fall risk independently of urgency incontinence. Circumstances of falls among men with lower urinary tract symptoms should be explored to understand how lower urinary tract symptoms increase the fall risk and generate hypotheses regarding potential interventions. Furthermore, trials to treat lower urinary tract symptoms in older men should include falls as an end point.

A systematic review of the association between lower urinary tract symptoms and falls, injuries, and fractures in community-dwelling older men.

BACKGROUND: Lower urinary tract symptoms (LUTS) have been associated with falls in studies either exclusively or predominantly of women. It is, therefore, less clear if LUTS are risk factors for falls in men. METHODS: We conducted a systematic review of the literature on the association between LUTS and falls, injuries, and fractures in community-dwelling older men. Medline, Embase, and Cinahl were searched for any type of observational study that has been published in a peer-reviewed journal in English language. Studies were excluded if they did not report male-specific data or targeted specific patient populations. Results were summarized qualitatively. RESULTS: Three prospective cohort studies and six cross-sectional studies were identified. Incontinence, urgency, nocturia, and frequency were consistently shown to have weak to moderate association with falls (the point estimates of odds ratio and relative risk ranged from 1.31 to 1.67) in studies with low risk of bias for confounding. Only frequency was shown to be associated with fractures. CONCLUSIONS: Urinary incontinence and lower urinary tract storage symptoms are associated with falls in community-dwelling older men. The circumstances of falls in men with LUTS need to be investigated to generate hypotheses about what types of interventions may be effective in reducing falls.

Prevalence of the geriatric syndromes and frailty in older men living in the community: The Concord Health and Ageing in Men Project.

AIM: To describe the age at which the geriatric syndromes and frailty become common in community-dwelling men. METHODS: The Concord Health and Ageing in Men Project involves a population-based sample of 1705 community-dwelling men aged 70 and over from a defined geographic region in Sydney. Data were obtained by physical performance tests, clinical examinations, and questionnaire to determine the prevalence of the following conditions by five-year age group. RESULTS: Poor mobility, recurrent falls, urinary incontinence, dementia and frailty phenotype were all uncommon (less than 10%) in men in their 70s, but the prevalence of each of these conditions exceeded 10% in men aged 85-89. The prevalence of Frailty Index-defined frailty, multimorbidity, polypharmacy and instrumental activities of daily living dependence was constantly high in all age groups. CONCLUSIONS: The different health-care needs of the 'old old' aged 85 years and older should be accounted for in health service planning.

Voiding dysfunction in older men.

PURPOSE OF REVIEW: Voiding dysfunction in older men is an important health issue, with significant morbidity and biosocioeconomic burden. Treatment decisions are increasingly complex as many older men also suffer concurrent comorbidities and polypharmacy. A relatively sparse number of publications specifically examine this relevant topic. RECENT FINDINGS: Common geriatric voiding syndromes include overactive bladder (OAB) and underactive bladder, with nocturia and incontinence often the most bothersome lower urinary tract symptoms, and may represent a falls risk together with OAB and incontinence. The combination of detrusor overactivity and impaired contractility may coexist in older patients and can be particularly difficult to diagnose and treat clinically. A small but not insignificant proportion of older men experience spontaneous remission of OAB symptoms without treatment, and 'watchful waiting' may be a reasonable option. OAB treatment with mirabegron may have a preferable side-effect profile compared with anticholinergics in older men. Intravesical onabotulinum toxin A is effective but risk of retention is greater in the older adults. Benign prostatic obstruction (BPO) and underactive bladder may lead to urinary retention, necessitating surgery or catheterization. BPO surgery is a reasonable option in older men, with realistic counselling of postoperative expectations. Combination BPO surgery and medical OAB treatment is suitable for detrusor overactivity and impaired contractility. Stress incontinence in older patients is usually iatrogenic and treatment can include continence applicances, urethral bulking agents, suburethral sling or artificial urinary sphincter. SUMMARY: Management of voiding dysfunction in older patients need to take into account multiple factors including symptomatic and functional impairment, cognition, comorbidities and polypharmacy. Future research examining pathophysiology and treatment outcomes of voiding dysfunction in the older patient population is increasingly relevant.

Fabrication of submicrometer pores with an outer shell using modified poly(vinyl alcohol) and the molecular or particle collection effect.

Pores with an outer shell (POS) are fabricated on the submicrometer scale using modified poly(vinyl alcohol) (PVA). An aqueous solution is mixed with cationic PVA and a water-based colloidal suspension of polystyrene (PS) spheres of submicrometer diameter. The mixture is then spin-coated onto a substrate. The resultant structure is immersed in toluene, which dissolves the PS spheres. As a result, POS are formed by PVA on the substrate. By using PS spheres with 500 nm diameter, the pore openings have a diameter of about 300 nm and are surrounded by the outer shell. This structure exhibits beneficial molecular and particle collection effects, which are attributed to the peripheral shell rising from the surface. In addition, POS can be formed using a photo-cross-linkable PVA that is often used for enzyme-immobilized hydrogel matrices.