Mechanisms of urethral continence and their clinical application

Controversy about the basic nature of urethral function does not preclude accurate clinical assessment of disorders of function. While the precise method of treatment of urethral continence dysfunction varies from institution to institution, the basic techniques are quite similar. It is the application of a treatment method to a particular case which causes difficulty. It is important, therefore, to have some understanding of the functional elements in the urethral continence mechanism to be able to determine which element does not function. Most cases of intractable incontinence are associated with poor function of the involuntary part of the sphincter. In general, peak urethral closing pressures are unrelated to continence function unless there is no pressure at all.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47059/1/345_2004_Article_BF00326702.pd

Course and Outcome of Eating Disorders in a Primary Care-Based Cohort

Objective: To Study the Course and outcome of patients with eating disorder detected in primary care Method: General practitioners (G P's) provided information on the course and outcome of eating disorders in patients (n = 147) diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) identified during a Dutch nationwide primary care-based incidence study The research team determined the outcome based on the data provided by the GP's The mean duration of the follow-up was 4 8 years Results: About 57% of the patients initially diagnosed with AN and 61% of those diagnosed with BN were fully recovered AN binge/purge subtype (ANBP) demonstrated the most extended median Survival time of all diagnostic Subgroups (the point at which half of the group has reached full recovery) Diagnostic crossover was low A younger age at detection predicted recovery at outcome for AN and BN One patient (AN) died Discussion: The results of this study on differences in outcome and low crossover support the diagnostic distinction between AN and BIN in the DSM-IV Early detection is of major importance for a favorable outcome (C) 2009 by Wiley Periodicals, In

Final transitions to place of death : patients and families wishes

Purpose: This four-country study ( Belgium, the Netherlands, Italy and Spain) examines prevalence and types of final transitions between care settings of cancer patients and the extent to which patient/family wishes are cited as a reason for the transition. Methods: Data were collected from the EUROSENTI-MELC study over a 2-year period. General practitioners within existing Sentinel Networks registered weekly all deaths of patients within practices using a standardized questionnaire. This registration included place of care in the final 3 months and wishes for the final transition to place of death. All non-sudden deaths due to cancer (+18 years) were included in the analyses. Results: We included 2048 non-sudden cancer deaths; 63% of patients had at least one transition between care settings in the final 3 months of life. 'Hospital death from home' (25-55%) and 'home death from hospital' (16-30%) were the most frequent types of final transitions in all countries. Patients' or families' wishes were mentioned as a reason for a final transition in 5-27% ( P<0.001) and 10-22% ( P = 0.002) across countries. Conclusions: 'Hospital deaths from home' is the most prevalent final transition in three of four countries studied, in a significant minority of cases because of patient/family wishes