Background
Pelvic floor muscle training is the most commonly used physical therapy treatment for women with stress urinary incontinence (SUI). It is sometimes also recommended for mixed and, less commonly, urgency urinary incontinence.

Objectives
To determine the effects of pelvic floor muscle training for women with urinary incontinence in comparison to no treatment, placebo or sham treatments, or other inactive control treatments.

Search methods
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL) (1999 onwards), MEDLINE (1966 onwards) and MEDLINE In-Process (2001 onwards), and handsearched journals and conference proceedings (searched 15 April 2013) and the reference lists of relevant articles.

Selection criteria
Randomised or quasi-randomised trials in women with stress, urgency or mixed urinary incontinence (based on symptoms, signs, or urodynamics). One arm of the trial included pelvic floor muscle training (PFMT). Another arm was a no treatment, placebo, sham, or other inactive control treatment arm.

Data collection and analysis
Trials were independently assessed by two review authors for eligibility and methodological quality. Data were extracted then cross-checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. Trials were subgrouped by diagnosis of urinary incontinence. Formal meta-analysis was undertaken when appropriate.

Main results
Twenty-one trials involving 1281 women (665 PFMT, 616 controls) met the inclusion criteria; 18 trials (1051 women) contributed data to the forest plots. The trials were generally small to moderate sized, and many were at moderate risk of bias, based on the trial reports. There was considerable variation in the interventions used, study populations, and outcome measures. There were no studies of women with mixed or urgency urinary incontinence alone.

Women with SUI who were in the PFMT groups were 8 times more likely than the controls to report that they were cured (46/82 (56.1%) versus 5/83 (6.0%), RR 8.38, 95% CI 3.68 to 19.07) and 17 times more likely to report cure or improvement (32/58 (55%) versus 2/63 (3.2%), RR 17.33, 95% CI 4.31 to 69.64). In trials in women with any type of urinary incontinence, PFMT groups were also more likely to report cure, or more cure and improvement than the women in the control groups, although the effect size was reduced. Women with either SUI or any type of urinary incontinence were also more satisfied with the active treatment, while women in the control groups were more likely to seek further treatment. Women treated with PFMT leaked urine less often, lost smaller amounts on the short office-based pad test, and emptied their bladders less often during the day. Their sexual outcomes were also better. Two trials (one small and one moderate size) reported some evidence of the benefit persisting for up to a year after treatment. Of the few adverse effects reported, none were serious.

The findings of the review were largely supported by the summary of findings tables, but most of the evidence was down-graded to moderate on methodological grounds. The exception was 'Participant perceived cure' in women with SUI, which was rated as high quality.

Authors' conclusions
The review provides support for the widespread recommendation that PFMT be included in first-line conservative management programmes for women with stress and any type of urinary incontinence. Long-term effectiveness of PFMT needs to be further researched.

/pdf/pelvic-floor-muscle-training-versus-no-treatment-or-inactive-6ve912sotz.pdf

Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women

ContextDiabetes is a serious and costly disease that is becoming increasingly
common in many countries. The role of diabetes as a cancer risk factor remains
unclear.ObjectiveTo examine the relationship between fasting serum glucose and diabetes
and risk of all cancers and specific cancers in men and women in Korea.Design, Setting, and ParticipantsTen-year prospective cohort study of 1 298 385 Koreans (829 770
men and 468 615 women) aged 30 to 95 years who received health insurance
from the National Health Insurance Corp and had a biennial medical evaluation
in 1992-1995 (with follow-up for up to 10 years).Main Outcome MeasuresDeath from cancer and registry-documented incident cancer or hospital
admission for cancer.ResultsDuring the 10 years of follow-up, there were 20 566 cancer deaths
in men and 5907 cancer deaths in women. Using Cox proportional hazards models
and controlling for smoking and alcohol use, the stratum with the highest
fasting serum glucose (≥140 mg/dL [≥7.8 mmol/L]) had higher death rates
from all cancers combined (hazard ratio [HR], 1.29; 95% confidence interval
[CI], 1.22-1.37 in men and HR, 1.23; 95% CI, 1.09-1.39 in women) compared
with the stratum with the lowest level (<90 mg/dL [<5.0 mmol/L]). By
cancer site, the association was strongest for pancreatic cancer, comparing
the highest and lowest strata in men (HR, 1.91; 95% CI, 1.52-2.41) and in
women (HR, 2.05; 95% CI, 1.43-2.93). Significant associations were also found
for cancers of the esophagus, liver, and colon/rectum in men and of the liver
and cervix in women, and there were significant trends with glucose level
for cancers of the esophagus, colon/rectum, liver, pancreas, and bile duct
in men and of the liver and pancreas in women. Of the 26 473 total cancer
deaths in men and women, 848 were estimated as attributable to having a fasting
serum glucose level of less than 90 mg/dL. For cancer incidence, the general
patterns reflected those found for mortality. For persons with a diagnosis
of diabetes or a fasting serum glucose level greater than 125 mg/dL (6.9 mmol/L),
risks for cancer incidence and mortality were generally elevated compared
with those without diabetes.ConclusionIn Korea, elevated fasting serum glucose levels and a diagnosis of diabetes
are independent risk factors for several major cancers, and the risk tends
to increase with an increased level of fasting serum glucose.

https://jamanetwork.com/journals/jama/articlepdf/200151/JOC41853.pdf

Fasting serum glucose level and cancer risk in korean men and women

was included in the ICI 5 edition PFMT (24) vs PFMT + resistance device (28) 52 Women with SUI or MUI (stress predominant) PFMT: As below without device PFMT +resistance; 5 quick and 5 slow (sustained), high-intensity contractions daily. Advised to hold contractions as long as possible, relaxing their PFM for an equivalent time before repeating the process. Intravaginal resistance: instructions to use the Pelvic-Toner Device concurrently whilst exercising. Two clinic visits and one phone call Reported cure (based on the Q11 of the ICIQFluts) PFMT 0/13 PFMT+resistance 1/15 Non-sign. difference btw groups (p=0.429) Improvement (post-Tx) PFMT 10/19 PFMT+resistance 11/21 Non-sign. difference btw groups 16 weeks of treatment, outcomes assessed at post-Tx and at 6 month follow-up Dropouts (at 6 month) PFMT 9/24 PFMT + resistance 15/28

/pdf/adult-conservative-management-23g1y2j6gw.pdf

Adult conservative management

/pdf/tmrynhy-dlt-khf-lgn-dr-mqbl-dm-drmn-y-drmnhy-khntrl-gyrf-l-sdhw7xtckr.pdf

تمرینهای عضلات کف لگن در مقابل عدم درمان، یا درمانهای کنترل غیرفعال، برای بیاختیاری ادرار در زنان

Objectives To assess the clinical effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence (SUI) through systematic review and economic modelling. Data sources The Cochrane Incontinence Group Specialised Register, electronic databases and the websites of relevant professional organisations and manufacturers, and the following databases: CINAHL, EMBASE, BIOSIS, Science Citation Index and Social Science Citation Index, Current Controlled Trials, ClinicalTrials.gov and the UKCRN Portfolio Database. Study selection The study comprised three distinct elements. (1) A survey of 188 women with SUI to identify outcomes of importance to them (activities of daily living; sex, hygiene and lifestyle issues; emotional health; and the availability of services). (2) A systematic review and meta-analysis of non-surgical treatments for SUI to find out which are most effective by comparing results of trials (direct pairwise comparisons) and by modelling results (mixed-treatment comparisons - MTCs). A total of 88 randomised controlled trials (RCTs) and quasi-RCTs reporting data from 9721 women were identified, considering five generic interventions [pelvic floor muscle training (PFMT), electrical stimulation (ES), vaginal cones (VCs), bladder training (BT) and serotonin-noradrenaline reuptake inhibitor (SNRI) medications], in many variations and combinations. Data were available for 37 interventions and 68 treatment comparisons by direct pairwise assessment. Mixed-treatment comparison models compared 14 interventions, using data from 55 trials (6608 women). (3) Economic modelling, using a Markov model, to find out which combinations of treatments (treatment pathways) are most cost-effective for SUI. Data extraction Titles and abstracts identified were assessed by one reviewer and full-text copies of all potentially relevant reports independently assessed by two reviewers. Any disagreements were resolved by consensus or arbitration by a third person. Results Direct pairwise comparison and MTC analysis showed that the treatments were more effective than no treatment. Delivering PFMT in a more intense fashion, either through extra sessions or with biofeedback (BF), appeared to be the most effective treatment [PFMT extra sessions vs no treatment (NT) odds ratio (OR) 10.7, 95% credible interval (CrI) 5.03 to 26.2; PFMT + BF vs NT OR 12.3, 95% CrI 5.35 to 32.7]. Only when success was measured in terms of improvement was there evidence that basic PFMT was better than no treatment (PFMT basic vs NT OR 4.47, 95% CrI 2.03 to 11.9). Analysis of cost-effectiveness showed that for cure rates, the strategy using lifestyle changes and PFMT with extra sessions followed by tension-free vaginal tape (TVT) (lifestyle advice-PFMT extra sessions-TVT) had a probability of greater than 70% of being considered cost-effective for all threshold values for willingness to pay for a QALY up to 50,000 pounds. For improvement rates, lifestyle advice-PFMT extra sessions-TVT had a probability of greater than 50% of being considered cost-effective when society's willingness to pay for an additional QALY was more than 10,000 pounds. The results were most sensitive to changes in the long-term performance of PFMT and also in the relative effectiveness of basic PFMT and PFMT with extra sessions. Limitations Although a large number of studies were identified, few data were available for most comparisons and long-term data were sparse. Challenges for evidence synthesis were the lack of consensus on the most appropriate method for assessing incontinence and intervention protocols that were complex and varied considerably across studies. Conclusions More intensive forms of PFMT appear worthwhile, but further research is required to define an optimal form of more intensive therapy that is feasible and efficient for the NHS to provide, along with further definitive evidence from large, well-designed studies.

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

/pdf/a-comparison-between-home-care-nursing-interventions-for-4p1yij9ccp.pdf

A Comparison between Home Care Nursing Interventions for Hospice and General Patients

/pdf/prevalence-and-risk-factors-for-diabetes-mellitus-and-492q54zi48.pdf

Prevalence and Risk Factors for Diabetes Mellitus and Impaired Fasting Glucose of Adults

/pdf/a-study-on-the-development-of-an-independent-hospice-center-4ginr98huw.pdf

A Study on the Development of an Independent Hospice Center Model

A comparison of effectiveness of bladder training and pelvic muscle exercise on female urinary incontinence

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A Comparison between Home Care Nursing Interventions for Hospice and General Patients

Prevalence and Risk Factors for Diabetes Mellitus and Impaired Fasting Glucose of Adults

A Study on the Development of an Independent Hospice Center Model

A comparison of effectiveness of bladder training and pelvic muscle exercise on female urinary incontinence