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Inflammatory Bowel Diseases (IBD), Crohn's Disease (CD), and Ulcerative Colitis (UC) may have extraintestinal manifestations, including disorders of the urinary tract. The prevalence of lower urinary tract symptoms (LUTS) in IBD patients remains unclear. Assess the prevalence of LUTS in patients with CD or UC, evaluate the variables implicated in any difference in LUTS prevalence between CD or UC, and assess any relationship between disease activity and LUTS LUTS were evaluated in 301 IBD patients through standardised questionnaires: Bristol Female Lower Urinary Tract Symptoms (BFLUTS), NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Prostate Symptom Score (IPSS). IBD activity was determined through the Crohn's Disease Activity Index (CDAI), Partial Mayo Score (PMS), and Total Mayo Score (TMS). BFLUTS total score for females was 6 (3–11). Patients with a higher age at diagnosis had worse filling symptoms (p = 0.049) and a worse quality of life (p = 0.005). In males, 67.1% had mild, 28.5% moderate, and 4.4% severe IPSS symptom grades. The overall NIH CPSI prevalence of chronic prostatitis-like symptoms was 26.8%. The questionnaires revealed some significant differences in the subgroups analysed. LUTS should be evaluated in IBD patients by urologic-validated questionnaires for prompt diagnosis and early treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study investigates the risk factors for complications following transurethral resection of the prostate and provides a reference for reducing postoperative complications. PATIENTS AND METHODS: A retrospective analysis was conducted on 322 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate from April 2015 to January 2022. Among them, 214 patients had complete clinical and follow-up data. Clinical and follow-up data were collected, and both univariate and multivariate logistic regression analyses were performed to identify factors influencing the occurrence of postoperation transurethral resection of the prostate complications. RESULTS: The incidence of complications after transurethral resection of the prostate was 19.16% (41/214). Among them, the incidence of Grade I-II complications was 14.96% (32/214), and Grade III-IV complications were 4.2% (9/214). The preoperative Quality of Life score (p<0.001) was identified as an independent risk factor for the occurrence of Grade I-II complications after transurethral resection of the prostate. The International Prostate Symptom Score (p=0.006) was identified as an independent risk factor for the occurrence of Grade III-IV complications after transurethral resection of the prostate. CONCLUSIONS: The preoperative Quality of Life score is an independent risk factor for the occurrence of Grade I-II complications after transurethral resection of the prostate. The International Prostate Symptom Score is an independent risk factor for the occurrence of Grade III-IV complications after transurethral resection of the prostate. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this American Urological Association (AUA) Guideline amendment is to provide a useful reference on the effective evidence-based management of male lower urinary tract symptoms secondary/attributed to BPH (LUTS/BPH). Materials and Methods: The Minnesota Evidence Review Team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies relevant to the management of BPH. The guideline was updated in 2023 to capture eligible literature published between September 2020 and October 2022. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. Results: The BPH amendment resulted in changes to statements/supporting text on combination therapy, photoselective vaporization of the prostate (PVP), water vapor thermal therapy (WVTT), laser enucleation, and prostate artery embolization (PAE). A new statement on temporary implanted prostatic devices (TIPD) was added. In addition, statements on transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT) were removed and information regarding these legacy technologies was added to the background section. References and the accompanying treatment algorithms were updated to align with the updated text. Conclusion: This guideline seeks to improve clinicians' ability to evaluate and treat patients with BPH/LUTS based on currently available evidence. Future studies will be essential to further support these statements to improve patient care. [ABSTRACT FROM AUTHOR]

Myelodysplastic syndromes or myelodysplastic neoplasms (both abbreviated MDSs) (Leukemia 2022;36:1703–1719) have historically been challenging diseases to treat owing to their complex biology, molecular diversity, and a patient population that is elderly with comorbidities. As the patients are living longer, incidence of MDSs is rising, and challenges in selecting MDS treatments or lack thereof have been becoming more apparent. Fortunately, with better understanding of molecular underpinnings of this heterogeneous syndrome, numerous clinical trials reflecting the biology of disease and catering to the advanced age of MDS patients are in development to maximize the likelihood of identifying active drugs. Addressing this diverse nature of genetic abnormalities, novel agents, and combinations are in development to formulate personalized treatment approaches for MDS patients. Myelodysplastic syndrome is categorized into subtypes that are associated with lower or higher risk for leukemic evolution, and that knowledge helps with therapy selection. Currently, as it stands, for those with higher-risk MDSs, hypomethylating agents are the first-line therapy. Allogenic stem cell transplantation represents the only potential cure for our patients with MDSs and should be considered for all eligible patients with higher-risk MDSs at the time of diagnosis. This review discusses current MDS treatment landscape, as well as new approaches in development. [ABSTRACT FROM AUTHOR]

Risk stratification plays an essential role in treatment planning in myelodysplastic syndromes. For decades, the International Prognostic Scoring System and its revised version have provided unified consensus for clinical trial enrollment and design. These models relied on laboratory and cytogenetic data to estimate prognosis and dictate treatment paradigms. Critical developments in DNA sequencing techniques in recent years, as well as our growing understanding of the clonal dynamics of myelodysplastic syndromes and the role that specific mutations have in shaping disease-specific phenotypes and treatment susceptibilities, have made it possible to identify molecular markers that carry critical diagnostic and therapeutic relevance and remained unaccounted for in the older models. The Molecular International Prognostic Scoring System is a novel risk stratification model that integrates clinical, cytogenetic, and molecular data to devise a more refined prognostic tool that builds on the accuracy of the traditional models. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study is to report the results of treatment for symptomatic patients with early benign prostate hyperplasia (BPH) using transurethral incision of the prostate gland (TUIP), who had previously received medical treatment. Methods: Patients with ages from 50 to 70 years who had early BPH with lower urinary tract symptoms (LUTS) and had received alpha 1 blocker and, or 5-alpha-reductase inhibitor during the years 2018 to 2020 were included in the study. After receiving information regarding surgical treatment (TUIP) instead of using only medications, 30 patients were willing to change from receiving medications to submitting to surgical treatment. The results of treatment before and after surgery were compared. Collected data included measurements of lower urinary tract symptoms using International Prostatic Symptoms Score (IPSS), the maximum flow rate of the urine (Q-max) and the quality of life (QoL) scores. Results: There were 28 patients in the study. The mean IPSS scores obtained 3 months, 6 months, and 12 months after surgery were significantly lower than those before the surgery with p-values < 0.001 for all comparisons. The mean Q-max values obtained 3 months, 6 months, and 12 months after the surgery were significantly higher than those before the surgery. The mean QoL scores obtained 3 months after the surgery were significantly better than those before surgery. Conclusion: TUIP in the treatment of early BPH with lower urinary tract symptoms in the early stages was associated with good outcomes and should be considered as an option for these patients. [ABSTRACT FROM AUTHOR]

The shift of profit margins from products to services, has transformed traditional production equipment supplier industries to providers of Industrial Product-Service Systems (IPSS). IPSS is a new business model for consistent delivery of industrial products such as production equipment and manufacturing services (Manufacturing as a Service). However, procurement of IPSS between industrial companies (i.e. Business-to-Business - B2B) is more complicated compared to the case of products offered to consumers (i.e. Business-to-Consumer – B2C). The complexity in interaction between the involved B2B stakeholders, the lack of trust and high costs especially for Small Medium Enterprises have hampered the establishment of standardized e-marketplaces in a similar manner as in the business to consumer world. This research work presents an overview on the requirements to support supply-chain processes on a digital B2B platform as well as a discussion of the objectives and the benefits of this multi-sided platform. [ABSTRACT FROM AUTHOR]

Aim. The aim of the present study was to investigate the correlation between lower urinary tract symptoms (LUTS) and severity of depressive symptoms in patients treated for depression. Method. 102 patients (43 males, 59 females) aged 20-67 (M = 46.1) treated for depression were included in this cross-sectional analysis. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology -- Self Report (QIDS-SR). LUTS were examined with the International Prostate Symptom Score (IPSS). In order to analyze the impact of presented symptoms, both urological and psychiatric, on quality of life of analyzed individuals the 30-item General Health Questionnaire (GHQ-30) was used. Results. The average IPSS score in women was significantly higher than in men (9.59 vs. 6; p = 0.04). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly higher scores in IPSS (9.76 vs. 4.1; p = 0.002). Severity of all LUTS assessed with IPSS correlated with QIDS-SR score in examined men (p < 0.05). In women, the total IPSS score correlated with the QIDS-SR score (p < 0.05) and with the total GHQ-30 score (p < 0.05). A number of other significant (p < 0.05) correlations were observed between the total IPSS score and certain items' scores in the GHQ-30 both in men and women. Conclusions. LUTS are common among patients with depression. There is a correlation between severity of depressive symptoms and LUTS. LUTS affect quality of life and well-being as well as cause marked distress in depressed patients. Comorbidity of LUTS and depression should draw attention of both psychiatrists and urologists and enhance interdisciplinary treatment approach. Further prospective and cohort studies are essential to reveal more details of the correlation between LUTS and depression. [ABSTRACT FROM AUTHOR]

Industrial Product-Service Systems (IPSS) are an increasingly important and profitable part of the range of offerings of producing companies. Essential for the market success are not only specific design processes and methods but also the suitable integration of the customer. Therefore, a multitude of specific methods and processes have been published so far. The novel approach of this contribution consists in the consideration of the individuality of the design object and of the corresponding design process. Also, the individual requirements and basic conditions of the customer integration are considered. Results to be presented are (i) a procedure to analyze the concrete design object including the goals and risks as well as the basic conditions of the customer integration, (ii) a procedure to plan an individualized customer integration process based on the analysis results and finally, to support the planning procedure, (iii) a collection of current 35 methods for customer integration including a procedure to support the selection of suitable methods according to the individual case. Two use cases provide first indications for evaluation and further development. [ABSTRACT FROM AUTHOR]

By the development of product servitization in China, the idea of iPSS was accepted and applied in more and more field. The iPSS for cutting-tools (ct-iPSS for short) was proposed in recent years. Though the application of ct-iPSS, cutting-tools are transformed from tangible stuff to intangible service, and the value of cutting-tool service is improved remarkably. But during the cutting-tools servitization, the using cost of cutting-tools was transferred too. In order to analyze the value transfer paths of the cutting-tool under the ct-iPSS environment, an order-driven cutting-tool service demand network (CTDN for short) based on complex network theory is built and its characteristics are analyzed. Firstly, based on the manufacturing outsourcing, the order-driven CTDN was established though the production orders outsourcing. Secondly, the 6 characteristics indexes were defined to analyze the performance of the CTDN. Finally, A case study was given to show how does the CTDN work. [ABSTRACT FROM AUTHOR]

Abstract Introduction Contemporary studies examine the connection of Diabetes Mellitus (DM) with Lower urinary tract symptoms (LUTS), alone or associated with other factors of the metabolic syndrome. However, little research has occurred concerning patients with diabetes of both genders and sexes without other diseases of the lower urinary tract. The aim of this study is to examine the relationship between DM and LUTS. Methods The study enrolled 110 patients with DM and 134 healthy individuals. The IPSS questionnaire was used for the evaluation of symptoms from lower urinary tract. Data was analyzed with univariate and multivariate logistic regression using SPSS v.24. Results Analysis with moderate/severe LUTS as dependent variable and plausible confounding factors (age group, BMI, hypertension, dyslipidemia, years with DM and reported HbA1c) as covariates revealed that only HbA1c levels correlated independently with the presence of moderate/severe LUTS (p = 0,024, OR:2,729, CI:1,144–6,509) in diabetic women, while there was no statistically significant difference between male groups. HbA1c levels' correlation with IPSS-voiding and IPSS- storage score was not statistically significant. Quality of life is also affected in women with diabetes mellitus (p: 0,02). Conclusion Only an increase in HbA1c was independently connected with a deterioration of LUTS in the female group. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The benign hypertrophy of prostate (BPH) is a benign tumor of the prostate characterized by the appearance of LUTS (lower urinary tract symptoms). In Romania there are about 200 000 men registered under treatment, but the number of patients could exceed 900 000. The aim of the study was to re-evaluate the clinical relevance of the IPSS score in the BPH diagnosis and assessment of the quality of life during patients’ follow-up. Materials and Methods. Between October 2015 - September 2016 we conducted a population-based descriptive cross-sectional survey designed to assess the prevalence of clinical BPH amongst male adults in Arad County, Romania. The study group included male adults over 45 years; patients with any type of neoplasia were excluded. Additionally, 19 healthy patients were included in a control group. All patients were interviewed for LUTS using the IPSS questionnaire, and investigated for PSA level in conjunction with DRE (digital rectal examination) and transabdominal prostate ultrasonography. Results. We selected 181 patients with BPH. The mean age of patients with BPH was 68.31 ± 5.54 years, the youngest subject being 53 years old and the oldest 83. Most patients were enrolled between 61-70 years and 60.77% (n = 181). Our study show that the rate of BPH in Arad County using IPSS questionnaire were 2.00% in 51-60 age group, 30.0% in the 61-70 age group and 21.00% in > 70 age group. The prevalence of BPH based on DRE and abdominal ultrasound is 4.00% in the 51-60 age group, 41.5% in the 61-70 age group and 23.00% in > 70 age group. Conclusions. The IPSS score is an important factor both in the diagnosis of BPH patients for correct assessment of symptom severity and an indirect indicator in assessing the quality of life of patients both prior to treatment and in subsequent periodic evaluations. [ABSTRACT FROM AUTHOR]

Background: Benign prostatic hyperplasia (BPH) refers to increased size of prostate gland. When prostate enlarges, it compresses the urethra and leads to partial or complete obstruction of the urethra. Symptoms are urinary frequency, weak urinary stream, intermittency, and urgency. Materials and Methods: Study Design: 300 BPH patients attending the clinic were assessed by using International Prostate Symptom Score before the treatment and were assessed after the treatment period of 3 months. Study Population: All the BPH patients attending the clinic who have taken treatment for at least 3 months were assessed by using International Prostate Symptom Score before and after the treatment. Results: A total of 300 patients were assessed; among them, 37.6% belonged to the age group of 60 to 65 years and 33.3% were between 65 and 70 years; frequency was reduced always, more than half the time, and about half the time in 9.67%, 14.67% and 2%, respectively. Reduction in intermittency about half the time, more than half the time, and almost always were 17%, 6% and 4.67%, respectively. Symptoms of urgency were reduced always in 8%; reduced symptoms in more than and about half the time were 8.33%. Problem of weak stream was reduced always, more than half the time, and about half the time in 12.33%, 3.67% and 11.67%, respectively. Straining was reduced always and more than and about half the time in 4%, 12.67% and 11%, respectively. Nocturia was reduced always, more than half the time, and about half the time in 12%, 7.33%, and 4.33%, respectively. Conclusion: Patients suffering from BPH consulted for homeopathic treatment; most of them are benefited in the shortest duration by using 50 millesimal potency of medicines on the basis of symptoms totality and after proper assessment of the prescribed homeopathic medicines that give the desired result. [ABSTRACT FROM AUTHOR]

Accurate risk prognostication is central to the management of myelodysplastic syndromes, given the widely heterogeneous clinical outcomes of these bone marrow failure disorders. Over the past decade, the rapidly expanding compendium of molecular lesions in myelodysplastic syndrome (MDS) has offered unprecedented insight into MDS pathobiology. Recently, molecular prognostic models such as the Molecular International Prognostic Scoring System (IPSS-M) have leveraged the wellspring of genetic data to improve upon traditional risk models such as the Revised IPSS (IPSS-R), but also added substantial complexity. In this review, we highlight early MDS prognostic models, the significant advancements in MDS genomics since then, and the recent advent of molecular based prognostic models. We conclude by discussing important opportunities and challenges in the management of MDS as we arrive at the molecular frontier. [ABSTRACT FROM AUTHOR]

One of the most critical elements in the ‘productisation’ of service adopted by today's aero-engine Maintenance Repair and Overhaul (MRO) companies is the match between customer demands and the operational capabilities of the MRO shop. Currently, the service contract is offered based upon experience and intuition rather than on scientific approach. This paper presents an integrated decision making framework to design contracts that considers demand and operational parameters. In addition to literature survey, the approach adopted in building the framework is a case study research, which obtains data from semi-structured interviews, observations and the company archives. Two main perspectives, dynamic operational parameters and shop floor operational parameters, were identified as essential and pertinent to the design and management of the service contract in the productisation context. The framework will incorporate both perspectives to support productisation. [ABSTRACT FROM AUTHOR]

Maintenance service is the most important part in industrial product-service system (iPSS). To enhance the proactiveness of maintenance service, the failure time of product need to be predicted. This study provides insight into how the maintenance time can be predicted accurately for the service decision-making of IPSS based on the historical failure time data, avoiding the dependence on mechanical condition monitoring. An improved grey prediction model is introduced to obtain a predictive interval of maintenance service time which is used as basis for making a decision of proactive maintenance service. The method is applied in an instance of maintenance service for agricultural machinery. In three examples of different types of agricultural machinery, the predicted intervals of maintenance time are given and the fitted values have high accordance with the real ones. The result shows that this approach can be used effectively to predict production failure time. Moreover, the output results of this approach can provide the necessary support to make a decision for proactive maintenance service without the dependence on mechanical condition monitoring in a reliable way. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Child & Adolescent Psychology / Revista de Psicologia da Criança e do Adolescente is the property of Fundacao Minerva-Cultura-Ensino e Investigacao Cientifica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Myelodysplastic syndromes (MDS) are a heterogeneous group of myeloid disorders characterized by cytopenias and increased risk of acute leukemia transformation. Prognosis of MDS patients can be assessed by various scoring systems, the most common being the International Prognostic Scoring System (IPSS) now refined by the revised version (IPSS-R). Genomic information at baseline, that is currently not included in clinical prognostic scores, will, in the future, help us to stratify patients with various prognoses. Therapy of MDS is based on risk stratification. The aim of therapy in low-risk MDS is to improve anemia or thrombocytopenia, decrease transfusion needs, improve quality of life, attempt to prolong overall survival, and reduce the risk of progression. In higher-risk MDS, the goal of therapy is to prolong survival and reduce the risk of transformation into acute leukemia. Only a few drugs are currently available for treatment, but more drugs are now under clinical investigation, in line with new, recently discovered molecular and immunological pathways. This review describes potential new drugs for low and high-risk MDS. The increasing knowledge of immunological and signalling pathways in MDS will assist us in identifying targeted patient-oriented treatments. In the near future, initial molecular stratification will lead the way to a personalized approach and targeted therapy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Androgen replacement therapy (ART) has been applied to alleviate the various symptoms of late onset hypogonadism (LOH) patients. Japanese andrologists typically administer only testosterone enanthate injection, as newer testosterone agents are not permitted for current clinical use under Japanese regulations. Under these difficult circumstances, we discovered a testosterone ointment OTC (over the counter) and this ointment (Glowmin (GL): Daito Pharmaceutical Co. Ltd., Tokyo) contains 100mg of testosterone per 10g of matrix (1%). Methods: Firstly, the profiles of serum total testosterone (TT) and free testosterone (FT) levels were assessed after application of 3mg of GL to scrotal skin. Secondly, the clinical effects of GL in the LOH patients were estimated by the Aging Male Symptom (AMS) scale. Medical Outcomes Study, 36-item Short-Form Health Survey (SF-36) and International Index of Erectile Function (IIEF 5) questionnaire after 12 weeks of GL treatment. Thirdly, International Prostate Symptom Score (IPSS) and its sub-scores (post-voiding, storage, voiding symptoms and quality of care or QOL) were also analyzed before and after ART. Results: GL is a short-acting testosterone ointment capable of slight elevation of TT and FT. The clinical effects of G L observed in LOH patients include mental factor, physical factors and sexual function factor in AMS, erectile dysfunction in IIEF 5, and Role Physical, Social Functioning, Role Emotional and Mental Health in the SF-36 questionnaire. Total IPSS improved significantly after 3 months of ART and voiding disturbance have improved more than storage. Conclusions: ART by GL is effective in the improvement of not only LOH symptoms, but also lower urinary tract symptoms (LUTS). [Copyright &y& Elsevier]

Summary: Myelodysplastic syndromes show a profound heterogeneity regarding not only morphological features and clinical course but also cytogenetic findings. The great prognostic relevance of cytogenetics is generally appreciated, however, it is only known for the most frequent karyotype abnormalities, not for combinations of anomalies and not for more rare changes. To overcome these limitations multicentric cooperations are needed. Nevertheless, recent clinical and basic research allows for a delineation of myelodysplastic syndromes (MDS) subtypes defined by the most frequent chromosomal changes. Recently, the German–Austrian MDS study-group presented a database of cytogenetic findings in 2072 patients with MDS which serves as a basis for the characterization of the cytogenetic subgroups discussed in this article. In this analysis, 52.1% of patients displayed clonal chromosome abnormalities. The most frequent changes were 5q- (29% of abnormal cases), complex changes (27%), -7/7q- (24%), +8 (16%), 20q- (7%), -Y (5%). The advent of new therapeutic options for MDS targeted on distinct entities characterized by a specific chromosome abnormality, as shown paradigmatically for lenalidomide in patients with 5q- syndrome, underlines the important role of cytogenetics for the clinical management of MDS. The following cytogenetic subtypes will be presented in detail: subgroups (favourable, intermediate, unfavourable) defined by the International Prognostic Scoring System (IPSS), 5q-deletions, monosomy 7, and complex abnormalities. The discussion of these cyogenetic entities is focused on prognostic relevance, molecular background and recently established as well as potential future therapeutic strategies which may have promising potential and are feasible not only in low-risk MDS but also in high-risk myelodysplasia of elderly patients. [Copyright &y& Elsevier]

Summary: Myelodysplastic syndromes (MDS) belong to the most frequent bone marrow disorders with a median age about 70 years. The diagnosis of MDS relies on morphologic features of dysplasia of blood and marrow cytology and histology. Cytogenetic analyses of the marrow cells are mandatory in MDS. The assessment of the correct proportion of blasts and the degree of dysplasia is important for diagnosis as well as prognosis and therapeutic decisions. Patients with unilineage dysplasia (RA/RARS) and patients with a del(5q) Syndrome, have a median survival time of 5 years as compared to only 3 years in patients with multilineage dysplasia (RCMD, RSCMD). An increased proportion of blast up to 9% defines a RAEB I facing a survival time of about 18 months. Patients with RAEB II (medullary blasts >10%) have a bad prognosis of less than one year. We can stratify patients into four risk groups according to the International Prognostic Scoring System (IPSS), which uses medullary blasts, chromosomal findings and number of cytopenia. The WHO adapted Scoring System (WPSS) creates 5 risk groups by calculating survival and AML evolution using WHO type, cytogenetic findings and transfusion need. The prognosis of patients, in whom cytogenetic data are not available, can be assessed by using the Düsseldorf Score that is based on LDH, cell counts and proportion of medullary blasts. The most important clinical parameter is the age at diagnosis. Especially low risk patients aged less than 50 years have a better prognosis as compared to older patients. On the other hand, high risk patients of every age have a poor prognosis. Planning the treatments for MDS patients should take into account other parameters like comorbidity and the wish of the patient. [Copyright &y& Elsevier]