Stress incontinence.

cardial infarction must be explained in part by the relative frequency of cardiac failure as the cause of death, for which no more can be offered in the CCU than in the general ward. It is, however, surely important not to discard the opportunity of effective resuscitationthe stakes are high even though the number of patients benefiting may be small. It must also be remembered that the study was undertaken in two hospitals possessing CCUs and, as the authors concede, the CCU provides a valuable training ground for junior medical staff and nurses, so that it is reasonable to assume that the resuscitation in the wards in such a hospital would be better than where no CCU existed. Withdrawal of the CCU or failure to develop such a unit might well result in lower standards of resuscitation and create an entirely new clinical setting which would require further evaluation. We believe that while patients with acute coronary episodes continue to be admitted to hospital it is mandatory to provide the highest standard of care possible. At a time when the availability of doctors and nurses on the ward seems ever-diminishing some form of CCU organisation would appear to be the only answer. We must at least ask that any future studies of this question should define carefully the nursing and medical staffing arrangements involved so that valid comparisons may be made. B L PENTECOST P J CADIGAN