Introduction: Delirium is frequently missed by inpatient health care providers despite the existence of a highly sensitive and specific assessment for delirium, the Confusion Assessment Method (CAM). The CAM, due to its test characteristics and ease of use, is an ideal physician instrument for systematic inpatient delirium screening; however, little is known about hospitalists' knowledge of the CAM. Methods: A short survey with items assessing respondents' perceptions of delirium detection, familiarity and proficiency with the CAM, and knowledge of the CAM algorithm was administered at a regional hospital medicine conference. Participants included a group of hospital medicine providers comprised of physicians (79.9%), nurse practitioners (7.2%), and physician assistants (12.9%). Results in the form of counts, percentages, and distributions of Likert scale responses and multiple-choice questions were reported. Results: Of 157 surveys distributed, 94% (n = 147) were returned. Approximately 3 of 4 of providers (77%) reported encountering delirium at least once per week, with 45% reporting encountering delirium more than once per week. Yet, 82% had never used or heard of the CAM; only 3 respondents felt proficient with its use. Of the knowledge items, 4 respondents were able to correctly indicate the 4 clinical features of the CAM. Only 1 respondent was able to answer all knowledge items correctly. The respondents also agreed that nurses have an important role in delirium detection (65%), delirium diagnosis is often delayed (68%), and reported that not knowing patients' baseline cognitive status (53%) and having difficulty separating delirium from dementia or psychiatric illnesses (25%) were important challenges to delirium diagnosis. Conclusion: Hospital medicine providers who responded to the survey reported encountering delirium often in their clinical practice; however, they also reported poor familiarity with and demonstrated poor knowledge of the CAM. These results suggest a potential barrier to systematic inpatient delirium screening and support increased delirium education and the use of validated delirium assessments among hospitalists.

Elmer Abbo Darrell R. Abernethy Surafeal Abraha Bo Abrahamsen Chris Adamopoulos Alyce S. Adams John S. Adams Karen E. Adams Daniel C. Adelman Philip A. Ades Deborah B. Adey Neill Adhikari Robert A. Adler Olivia Affuso Muhammad Afzal Anil K. Agarwal Shikhar Agarwal Rajesh Agarwala Joseph V. Agostini N.K. Agrawal Varun Agrawal Farah Ahmad Ameena T. Ahmed Lorena Airaghi Krittapoom Akrawinthawong Soham Al Snih Muhyi Al-Sarraf Graciela Alarcon Mark Albanese Thomas K. Aldrich Caleb Alexander Patrick Alguire Joseph Ali Joseph Alisky Hisham Aljadhey Ricardo Alkmim Teixeira Yannick Allanore Alessandro Allegra Carmen Allegra Matthew A. Allison Richard L. Allman Ban M. Allos W. Kemper Alston Keri N. Althoff Domenico Alvaro Beatrice R. Amann-Vesti Jacques Amar Devanand Anantham Paul Anaya Jessica S. Ancker Daren Anderson Garnet L. Anderson Lisa Anderson-Shaw Giuseppe Ando Raúl J. Andrade Ashish Aneja Jelili A. Apalara Alejandro Aparicio Peter C. Applebaum Allen I. Arieff Benjamin Armbruster Carmel Armon Katrina Armstrong Paul W. Armstrong Donald M. Arnold Robert Arnold Julia H. Arnsten Paul Aronowitz Vineet Arora Janet B. Arrowsmith Adnan Arseven David Arterburn Subhash C. Arya Keiko Asao Federico M. Asch John Astin Arne Astrup Haris Athar Vasilios G. Athyros Wendy S. Atkin Evan Atlantis Steven J. Atlas Julie Aultman Moises Auron Gregory L. Austin Najib T. Ayas Jonathan G. Ayres J. Carlos Ayus Judith Baars Hilary M. Babcock Peter B. Bach Richard Bach Lucas M.M. Bachmann Maha Badawi Larry M. Baddour Angela M. Bader Robert G. Badgett Hala Badran Rong Bai William B. Baine C. Noel Bairey-Merz David Baker William L. Baker Satish Balan Lodovico Balducci Ethan M. Balk Noel H. Ballentine Kenneth A. Ballew Stanley P. Ballou Heejung Bang Sripal Bangalore Wei Bao Srinivas R. Bapoje Tiziano Barbui Frances K. Barg Jeffrey H. Barker Judith C. Barker Alan Barkun Peter Barland Amber E. Barnato H. Verdain Barnes Peter F. Barnes Allison L. Baroco Jeremiah A. Barondess Michael S. Barr Brendan J. Barrett Eileen Barrett A. Sidney Barritt Jeremy S. Barron Michael J. Barry Gavin Bart Mary B. Barton Phoebe L. Barton Lori D. Bash Holly A. Batal Eric R. Bates Daniel C. Batlle Murray D. Batt Douglas C. Bauer Kenneth A. Bauer John H. Bauman Mona Baumgarten Anthony Bavry J. David Baxter Paul D. Baxter Ahmet Baydur Harold E. Bays Jeffrey Bazarian Mary Catherine Beach John C. Beck Howard B. Beckman Joshua A. Beckman Updesh Singh Bedi Vikram Behera David S. Bell Gardner Bemis Bradley Bender Christian Benedict Alexandre Benjo Joel S. Bennett Neal L. Benowitz Kaaron Benson Lionel Bercovitch Alfred Berg Christine Berg Lee Berkowitz Michelle Berlin Nancy Berlinger Amy Berning Jeffrey S. Berns David Bernstein Gerard T. Berry Roberta Berry Zail S. Berry Thomas Bersot Howard A. Bessen Jennifer A. Best Robert Bettiker Robert F. Betts Surya P. Bhatt Nina Bickell Barbara C. Biedermann Michael F. Bierer Daniel Bikle J.A. Billings Henry J. Binder Giuseppe Biondi-Zoccai Alan L. Bisno Maureen Bisognano Bruce R. Bistrian Johannes Bitzer George L. Blackburn Susan Blalock Jason P. Block Zachary Bloomgarden John Blosnich Chris Blosser Stephan Blossom John W. Blotzer Stanley Blumenthal Henry C. Bodenheimer Jr. Julia Bohlius Mark J. Bolland Alfred J. Bollet Chester M. Boltwood Lawrence R. Boly John S. Bomalaski Stefano Bonassi Kenneth Boockvar Romsai T. Boonyasai Jonathan Boote Michael Bornemann Susan E. Boruchoff Xavier Bosch Patrick M. Bossuyt Hayden B. Bosworth V. Alin Botoman Malaz Boustani Cynthia M. Boyd Keith M. Boyd Edward J. Boyko Gregory L. Braden Sara Bradley Steven M. Bradley Donald W. Brady Teresa J. Brady Bernard M. Branson Somjot S. Brar Patrice Brassard Norbert Brau Barbara I. Braun Daniel J. Brauner Dawn M. Bravata Lewis E. Braverman Miriam Bredella Francisco R. Breijo-Márquez John Breitner Beatrice Brembilla-Perrot Hermann Brenner Philip W. Brickner Ralph Brindis Allen D. Brinker Jeff Brinker Irwin Brodsky John T. Brooks James Brophy Daniel J. Brotman Rebecca Brown Natale Daniele Brunetti David R. Brush R. Nick Bryan Robert J. Bryg Chiara Bucciarelli-Ducci Rachelle Buchbinder Vardaman Buckalew Edwarda M. Buda-Okreglak Daniel S. Budnitz Matthew J. Budoff Raffaele Bugiardini Roswitha Vera Bugnon-Hartmann Zakeya Bukhary John B. Bulger Roger J. Bulger T. Jared Bunch Harry B. Burke Lillian P. Burke Wylie Burke John C. Burnham Francesca Bursi Harold J. Burstein John Buse Roger W. Bush Thanks to Reviewers—2010

The purpose of this study was to determine whether lower-extremity peripheral arterial disease (PAD) is an independent risk factor for falls among older persons. Men and women 55 years old and older participated. Subjects with PAD (n = 86) were identified from a noninvasive vascular laboratory and a general medicine practice. Randomly selected controls without PAD (n = 82) were identified from the same medicine practice. Subjects were categorized into PAD (ankle brachial index, <0.90) or controls (ankle brachial index, 0.90 to 1.50). Subjects underwent a comprehensive baseline evaluation for fall risk. Prospective fall data were obtained using monthly mail-in postcards and structured telephone interviews over a mean follow-up of 9.6 ± 2.9 months. Two independent investigators blinded to PAD status reviewed each fall incident for its eligibility. A total of 37 subjects (22%) had at least 1 eligible fall. In an unadjusted Cox regression model, the relative risk of falling was lower among PAD subjects than among controls (relative risk, 0.54; 95% confidence interval, 0.28 to 1.06). After adjustment for age, gender, history of frequent falls in the last year, number of comorbidities, and balance and gait abnormalities, PAD was significantly associated with a lower risk of falling (relative risk, 0.43; 95% confidence interval, 0.21 to 0.87) as compared with controls. PAD is associated with a lower risk of falling as compared with persons without PAD among older men and women. Future study is needed to determine whether reduced levels of physical activity among patients with PAD account for the lower rate of falling observed here.

OBJECTIVES:Among men with newly diagnosed prostate cancer, prostate-specific antigen (PSA) levels are higher and the cancer stage more advanced for African Americans than for whites. An earlier study found that after adjustment for literacy, race was no longer a significant predictor of advanced stage at presentation. We investigated whether, after adjusting for literacy, race was a significant independent predictor of greater PSA levels among men with newly diagnosed prostate cancer. METHODS:Consecutive patients with newly diagnosed prostate cancer from four outpatient care facilities in Chicago were interviewed and given a literacy assessment (n = 308). The PSA level at diagnosis was obtained from the medical charts. Logistic regression models were used to identify predictors of high PSA levels (greater than 20 ng/mL) at presentation. RESULTS:African-American men were three times more likely to have low literacy skills (sixth grade or less: 22.9% versus 7.1%; P <0.001) than were white men. In turn, men with low literacy skills were more than twice as likely to have a PSA level greater than 20 ng/mL at diagnosis (33.3% versus 13.5%; P = 0.009). On multivariate analyses, significant predictors of high PSA levels included low literacy (adjusted odds ratio 2.5, 95% confidence interval 1.5 to 4.2) and older age (age 65 to 74 years, adjusted odds ratio 2.6, 95% confidence interval 2.1 to 3.1 versus older than 74 years, adjusted odds ratio 3.4, 95% confidence interval 1.8 to 6.6), but not African-American race. CONCLUSIONS:In the current era in which PSA testing is common, low literacy may be an important and potentially overlooked factor associated with higher PSA levels at prostate cancer diagnosis among African-American and white men.

The strength of Annals of Internal Medicine depends in large measure on the ability and effort of many hundreds of reviewers. Below, we list the consultants who reviewed for Annals between 1 November 2004 and 31 October 2005. They have provided a servicefor the editors of Annals, to be surebut also for authors, readers, and the medical community as a whole. Peter H. Abbrecht Judith A. Aberg Darrell R. Abernethy Janet Abrahm Gary Abrams J. Gary Abuelo Ronald T. Ackermann Daniel C. Adelman Deborah B. Adey Neill Adhikari N.F. Adkinson Jr. Robert A. Adler Bruce Adornato Anil K. Agarwal Nanakram Agarwal Rajiv Agarwal Vincent Agnello Pierfrancesco Agostoni William S. Agras Francisco Aguilar Michael A. Ainsworth Stephen Akers Hamid Al-Mondhiry Muhyi Al-Sarraf Graciela S. Alarcon Dan Albert Peter Albertsen Valiere Alcena Louis M. Aledort Cathy A. Alessi Charles M. Alexander Erik Alexander G. Caleb Alexander John H. Alexander Giuseppe Aliperti Jeffrey R. Allen Richard L. Allman Jack B. Alperin Milton Alter Miriam J. Alter Diane L. Altkorn Peter Ammann Allen Anderson David C. Anderson David R. Anderson Robert N. Anderson Ruric C. Anderson Charles Anello Jack E. Ansell Nicholas R. Anthonisen Joseph H. Antin Alejandro Aparicio William B. Applegate Onyebuchi A. Arah Thomas A. Arcury Miguel A. Arias Gregory Arling James O. Armitage Robert Arnold Scott Arnold David C. Aron Paul Aronowitz Janet B. Arrowsmith-Lowe Adnan Arseven David Arterburn Keiko Asao Federico Asch Richard Asinger Fred Askari John Astin Brad Astor Ayse A. Atasoylu Steven J. Atlas Anne-marie Audet Mark Aulisio Andrew L. Avins Lloyd Axelrod J. Carlos Ayus Daniel L. Azarnoff Richard Bach Anthony L. Back Bruce R. Bacon Larry M. Baddour Juan N. Badimon Robert C. Bahler Colin Baigent John C. Bailar John Baillie William B. Baine C. Noel Bairey-Merz David W. Baker G. Ross Baker George L. Bakris Ethan Balk Eric M. Ball Noel H. Ballentine Kenneth A. Ballew Stanley P. Ballou James E. Balow Simmy Bank Paul Barach Daniel Baran Eve Bargmann Philip S. Barie L. Randol Barker Jamie S. Barkin Peter Barland Richard J. Baron Jeremiah A. Barondess Michael Barr R. Graham Barr Bruce Barrett Michele Barry Patricia P. Barry John G. Bartlett Phoebe L. Barton Uriel S. Barzel Lori A. Bastian Holly A. Batal David W. Bates Eric Bates Daniel C. Battle Tracy A. Battaglia Douglas C. Bauer Kenneth A. Bauer Karyn Baum Jeroen Bax Ahmet Baydur Gildon N. Beall James D. Bearden John C. Beck Laurence H. Beck Charles E. Becker Howard B. Beckman Joshua Beckman Benjamin Befeler Claudia Beghe Norman H. Bell Catherine Belling Bradley Bender Thomas G. Benedek R. Michael Benitez Charles L. Bennett Joel Bennett John E. Bennett William M. Bennett Neal L. Benowitz John A. Benson Stephen Bent John Bergan Marc L. Berger Steven L. Berk Nancy Berkman Samuel A. Berkman Michael Berkwits Seth Berney Jeffrey S. Berns Elmer Bernstam David Bernstein Steven Bernstein Monica Bessler David Bessman Robert F. Betts Ernest Beutler Rebecca J. Beyth Deepak L. Bhatt Frank Bia Italo Biaggioni Jesus Bianco Kirsten Bibbins-Domingo Michael F. Bierer Daniel Bikle Henny Billett Edmund Bini Giuseppe Biondi-Zoccai William Bishai John Bisognano Marvin J. Bittner Vera Bittner Edgar R. Black George L. Blackburn Craige Blackmore Jerry M. Blaine Donald C. Blair Thomas P. Bleck Bernard S. Bloom John W. Blotzer Leslie F. Blum Manfred Blum David Blumenthal Eytan Z. Blumenthal Jeremy H. Boal Bruce Bochner William Boden Henry C. Bodenheimer Jr. Olivier Bodenreider John Boehmer Alfred J. Bollet Chester Boltwood John S. Bomalaski Herbert Bonkovsky Kenneth Boockvar Daniel J. Booser Michael Bornemann Susan E. Boruchoff Lynn A. Bosco Ebony Boulware Martial Bourassa Edwin G. Bovill Anthony J. Bowdler William R. Bowie James E. Bowman Keith M. Boyd Thomas D. Boyer Edward J. Boyko Diane K. Boyle Samuel Bozzette James P. Bracikowski Gregory L. Braden Cathy J. Bradley Patrick Brady G. Richard Braen Scott Braithwaite William T. Branch Norbert Bru Kimberly Braxton-Lloyd George Bray Michael J. Brennan Edward Brettholz Philip W. Brickner Alan J. Bridges Ralph Brindis Dan Brock Michael A. Brodsky Robert Brodsky David S. Brody Howard Brody Marion B. Brody Robert H. Brook Ron Brookmeyer Benjamin R. Brooks Scott W. Brooks James Brophy Daniel J. Brotman Arthur E. Brown Kenneth M. Brown Lin A. Brown Robert S. Brown William V. Brown Elisha L. Brownfield Susan Brozena Bruce H. Brundage Margaret Brunt Reginald Bruskewitz R. Nick Bryan Richard E. Bryant Robert Bryg Dedra Buchwald Roswitha Vera Bugnon-Hartmann John B. Bulger Paul Bunn Jeffrey H. Burack Georgine S. Burke Harry B. Burke John P. Burke Wylie Burke John W. Burnside Jonathan L. Burstein Helen Burstin Elizabeth Burton John R. Burton John R. Butterly Joel N. Buxbaum Daniel Buysse Aman U. Buzdar John A. Byer Debra Bynum James C. Byrd John M. Byrne M.E. Cabanela John Cairns Catherine V. Caldicott Elizabeth A. Calhoun Robert Califf Hugh Calkins Christopher Callahan David J. Callans Bruce Camitta Jennifer Cancro Michael Cantor John P. Capelli Sarah Capes Anne Cappola Pedro J. Caraballo Roberto G. Carbone Timothy Carey Robert L. Carithers Jr. Ralph Carmel Kim A. Carmichael Christopher F. Carpenter Molly Carr Luis Carreo Jeffrey L. Carson Ronald A. Carson Sarah A. Carter Lawrence Casalino David Casarett Joan I. Casey Brooks Cash Valeria Caso Christine K. Cassel Robert J. Caswell Carlo Catassi Jane A. Cauley Randall D. Cebul Maurice A. Cerulli Bruce Chabner Donald B. Chalfin Tod S. Chambers Richard Champlin Thomas K.Y. Chan Prem K.G. Chandran Virginia W. Chang Nelson Chao Edward K. Chapnick Patricia Charache Mitchell H. Charap Suresh T. Chari R. Alta Charo Mark R. Chassin Joseph A. Chazan Melvin D. Cheitlin Mark Chelmowski Arnold Y. Chen Lan Chen Yi-hsiang A. Chen Eugene Y. Cheng Tsung O. Cheng Esther Chernak Neil S. Cherniack James D. Cherry Glenn M. Chertow Alexander C. Chester Shobhina G. Chheda Kingsley R. Chin Keith Chirgwin Gerald W. Chodak Joshua Chodosh Charles H. Chodroff Peter W. Choo Calvin Chou Roger Chou Jason Christie Wen-Hung Chung Larry R. Churchill Douglas B. Cines David J. Clain Carolyn M. Clancy Karen Clark Ralph R. Clark Daniel Clauw David W. Claypool Harris R. Clearfield Charles S. Cleeland Agatta Cleopas Linda H. Clever Eoin Coakley C. Glenn Cobbs Clay Cockerell Jay D. Coffman Cecil H. Coggins Brian Cohen Jonathan S. Cohen Jules Cohen Marc Cohen Mary Ann Cohen Ronald Cohen Jay N. Cohn Graham A. Colditz Carmella A. Cole Eric A. Coleman Virginia U. Collier Kim Collins Tracie Collins Theodore Colton Raymond Comenzo Richard J. Comi Philip C. Comp George W. Comstock John Concato Hari S. Conjeevaram William E. Connor Richard M. Conran David Cook Robert L. Cook Brian Cooper Gregory S. Cooper Lisa W. Corbin Andre Corriveau Benilde Cosmi Robert Cote J. James Cotter Ian Coulter Ken Covinsky Diane Cox Lawrence M. Crapo Michael H. Crawford Richard H. Creech Francis Creed Robert E. Cronin Alan Cross Carroll E. Cross Kent B. Crossley John Robert Crouse Mark Crowther David W. Cugell Kennith Culp Jennifer E. Cummings Mike Cummings Richard Cummins Burke A. Cunha Gary C. Curhan J. Randall Curtis Jeffrey A. Cutler Neal R. Cutler Ralph E. Cutler Samuel Cykert Elizabeth M. Cyran Ivan D'cruz John A. D'Elia Jennifer Daley Mary Daly David N. Danforth Stephen Daniels Michele David Bruce Davidson Colin Davidson H. Edward Davidson Robert C. Davidson Andrew M. Davis John S. Davis Gabriel M. Davovitch Susan Day Raphael J. De Horatius Paul de Jong James de Lemos Giovanni de Simone Robert F. Debusk G. William Dec Anton G. Decker Kevin DeCock Jon Deeks Steven G. Deeks Chris Defilippi Ettore C. degli Uberti Joseph M. Delehanty Charles Dennis Norman Desbiens Kenneth DeVault Beth Devine Darren DeWalt Diane Dewar Dawn E. Dewitt Vinod K. Dhawan Adrian M. Di Bisceglie George A. Diamond Herbert S. Diamond Philip T. Diaz Andrew K. Diehl Douglas T. Dieterich Daniel F. Dilling Joel E. Dimsdale Eric L. Ding Donald DiPette S. Edwards Dismuke Deborah G. Dobrez Gregory C. Doelle Edward F. Domino Betty J. Dong John H. Donohue Gerald R. Donowitz Sam T. Donta Gerald J. Dorff Marcus Dorr Steven D. Douglas Steve Downs Andre Dubois P. Barton Duell Daniel Duffy Robert A. Duncan Stephanie Dunlap Andrew Dunn David L. Dunner Teresa S. Dunsworth Richard M. Dupee Herbert L. DuPont Asim K. Dutt Ben A. Dwamena Mark Dworkin Sydney Morss Dy Carmel B. Dyer Kim A. Eagle Mark A. Earnest Charles B. Eaton Stephen Eck Robert Eckart Robert Eckel Elizabeth Eckstrom David Eddy Norman H. Edelman Kathleen Egan George E. Ehrlich Thomas R. Einarson Seth Eisen Jon Eisenberg Robert A. Eisenberg Hasham El-Serag Uri Elkayam Mitchell S.V. Elkind Richard Elledge Susan S. Ellenberg Edward E. Ellerbeck Myrvin Ellestad Greg Elliott Rebecca Elon Robert J.F. Elsner Kurt S. Elward Ezekiel Emanuel Jack Ende Robert S. Enelow Jennifer Eng-Wong Michael M. Engelgau Scott K. Epstein Stephen B. Erickson Edzard Ernst Joseph J. Eron Carmen P. Escalante Guy Eslick Emilio Esteban Carlos A. Estrada Bruce Ettinger Bradley A. Evanoff Alison A. Evans Arthur Evans Denis Evans Douglas G. Evans James E. Everhart Gordon A. Ewy Michael Ezekowitz Shereen Ezzat Julie Fagan Myles Faith Ronald Falk Harold J. Fallon Carmine G. Fanelli Bruce F. Farber Harrison W. Farber Stu Farber Thomas Fears Alan M. Fein Arthur W. Feinberg Lawrence E. Feinberg Donald Feinstein Thomas Fekete Harvey A. Feldman Ross D. Feldman David T. Felson Linda Fentiman Gary S. Ferenchick Alicia Fernandez Victor Ferrari Carlos M. Ferrario Gianluigi Ferretti W. Jeffrey Fessel John R. Feussner Stanley B. Fiel David A. Fiellin John F. Fieselmann Robert W. Finberg Michael I. Fingerhood Arlene Fink Howard A. Fink Jeffrey Fink Jordan N. Fink Kenneth S. Fink Merton D. Finkler Thomas E. Finucane Paul A. Fiore Kevin Fiscella Gary Fischer Daniel B. Fishbein Alfred P. Fishman David N. Fisman Rachel B. Fissell Faith T. Fitzgerald Kim Fitzpatrick John P. Flaherty Keith Flaherty Timothy Flanigan Michael T. Flannery Jerome L. Fleg Barbara Fleming Cr

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 25, 2005, 8:00am - 12:00 pm1 Apr 20051468: Relation between Literacy, Race, and PSA Level Among Men with Newly Diagnosed Prostate Cancer Michael S. Wolf, Sara J. Knight, Ramon Durazo-Arvizu, A. Simon Pickard, Elizabeth A. Lyons, Adnan Arseven, Ashan Arozulla, Kathleen Colella, Whitney Witt, and Charles L. Bennett Michael S. WolfMichael S. Wolf More articles by this author , Sara J. KnightSara J. Knight More articles by this author , Ramon Durazo-ArvizuRamon Durazo-Arvizu More articles by this author , A. Simon PickardA. Simon Pickard More articles by this author , Elizabeth A. LyonsElizabeth A. Lyons More articles by this author , Adnan ArsevenAdnan Arseven More articles by this author , Ashan ArozullaAshan Arozulla More articles by this author , Kathleen ColellaKathleen Colella More articles by this author , Whitney WittWhitney Witt More articles by this author , and Charles L. BennettCharles L. Bennett More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35602-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1468: Relation between Literacy, Race, and PSA Level Among Men with Newly Diagnosed Prostate Cancer." The Journal of Urology, 173(4S), p. 398 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 398 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Michael S. Wolf More articles by this author Sara J. Knight More articles by this author Ramon Durazo-Arvizu More articles by this author A. Simon Pickard More articles by this author Elizabeth A. Lyons More articles by this author Adnan Arseven More articles by this author Ashan Arozulla More articles by this author Kathleen Colella More articles by this author Whitney Witt More articles by this author Charles L. Bennett More articles by this author Expand All Advertisement PDF downloadLoading ...

In this paper, we examine how the management of prostate cancer lends itself to a disease state management (DSM)-based approach, and propose a framework that emphasizes the patient-provider-caregiver triad in managing the long-term implications of the condition. There is often no clearly superior approach to the management of patients with prostate cancer (eg, watchful waiting and hormonal therapy), and each option entails different trade-offs in quality of life. Ideally, the physician and patient discuss the options, issues, and patient preferences for treatment through the shared decision-making process. A family caregiver such as the spouse of the patient is often involved in the treatment decision and in the long-term management of the cancer experience. In order to develop a DSM program supporting both patient and caregiver, educational, psychosocial, and health care system support needs should be tailored to each phase of cancer treatment/management. To embrace the unique aspects of prostate cancer management, the proposed framework emphasizes communication among the patient-caregiver-provider triad, inclusion of family caregivers in the program, cancer phase-specific support, and psychosocial services as a basis for implementation and evaluation of a DSM program in prostate cancer.

6019 Background: African Americans present with a higher stage of disease for prostate cancer. Multivariate analysis indicates that low literacy rather than race, is the most likely predictor of advanced stage (Bennett, JCO 1998). We evaluate the relation of race and literacy with Gleason score, PSA level and treatment. Methods: Newly diagnosed prostate cancer patients were recruited from three Chicago Hospitals (N=143), including two equal access healthcare systems. Patients completed a demographic questionnaire and a literacy evaluation, using a 66 word standard list, the Rapid Estimate of Adult Literacy in Medicine (REALM). Stage of presentation and treatment decision were abstracted from medical records. Results: Patients were primarily African American (76%), of lower socioeconomic status (72%) with an income < $20,000, with low literacy skills (65% with <9th grade) and were older than 65 years of age (60%). Bivariate analysis indicated that race and low literacy were significantly associated with Gleason score and PSA respectively. In a multivariate analysis using literacy, race and age, low literacy was the only significant predictor of PSA > 10ng/mL (OR= 2.8, 95% CI: 1.1–7.7). Of literay, race and age, race was the only predictor for a high Gleason score (OR= 3.0, 95% CI: 1.2–7.1). Neither race nor literacy were significant predictors of treatment for younger or older patients. Conclusions: Low literacy, rather than African American race, is the most significant predictor of elevated PSA at presentation, while race is the most significant predictor of a high gleason score. In order to increase informed decision making about PSA screening, new strategies for health communication need to address the needs of men with lower literacy levels. No significant financial relationships to disclose.

6086 Background: Shared decision making may be difficult for older prostate cancer patients of lower SES. Although physicians and patients make shared treatment decisions about the option of radiation, surgery, or watchful waiting, functional and psychosocial obstacles may limit the effectiveness of this process among older men of lower socioeconomic status with newly diagnosed prostate cancer. Methods: A cohort (n= 85) of lower socioeconomic status White (25%) and African American patients (75%), 65 year and older with newly diagnosed prostate cancer were queried on social support and evaluated for health literacy, hearing, vision, activities of daily living, nutrition, depressive mood, and cognitive and mobility function using validated tools including the Rapid Estimate for Adult Literacy in Medicine, Mini Nutritional Assessment Short Form, and the Vulnerable Elderly Survey. Results: Subjects were mainly low SES (29% within the poverty range) and African American (74.2%). Mean age was 72 years (SD = 5), and one third lived alone. Impairments identified included: <7th grade health literacy (30%); cognitive impairment (32%); vulnerable (increased risk of decline in activities of daily living and death) (15%); mobility (19%); poor nutrition (22%); visual impairment (8%); hearing impairment (21%); depressive mood (10%); and lack of social support (4%). Overall, 73% of patients had at least one impairment. Conclusions: We conclude that among older, lower SES prostate cancer patients, three quarters have functional and psychosocial impairments that may limit the feasibility of shared decision making approaches. No significant financial relationships to disclose.

OBJECTIVE: Factors associated with impaired functioning in patients with lower extremity peripheral arterial disease (PAD) are not fully understood. The purpose of this study was to determine the relationship between depressive symptoms and objective measures of lower extremity functioning in persons with PAD. DESIGN: Cross-sectional. PATIENTS/PARTICIPANTS: Four hundred twenty-three men and women with PAD identified from 3 Chicago area medical centers. MEASUREMENTS AND MAIN RESULTS: PAD was defined as ankle brachial index (ABI) <0.90. The Geriatric Depression Scale short form (GDS-S) (0–15 scale, 15 = worst) was completed by all participants. A clinically significant number of depressive symptoms was defined as a GDS-S score ≥6. Six-minute walk distance and usual-and fast-pace walking velocity were determined for all participants. A GDS-S score ≥6 was present in 21.7% of participants with PAD. Adjusting for age, increasing numbers of depressive symptoms were associated with an increasing prevalence of leg pain on exertion and rest ( P =.004). Adjusting for age, sex, race, ABI, number of comorbidities, current smoking, and antidepressant medications, increasing numbers of depressive symptoms were associated with shorter 6-minute walk distance ( P <.001), slower usual-pace walking velocity ( P =.005), and slower fast-pace walking velocity ( P =.005). These relationships were attenuated slightly after additional adjustment for presence versus absence of leg pain on exertion and rest and severity of exertional leg symptoms. CONCLUSIONS: Among men and women with PAD, the prevalence of a clinically significant number of depressive symptoms is high. Greater numbers of depressive symptoms are associated with greater impairment in lower extremity functioning. Further study is needed to determine whether identifying and treating depressive symptoms in PAD is associated with improved lower extremity functioning.

The objective of this study was to determine whether lower extremity peripheral arterial disease (PAD) is associated with depressive symptoms and whether PAD-related disability mediates the association between PAD and depressive symptoms. The study used a cross-sectional design set in an academic medical center. A cohort of men and women aged 55 years and older with (n = 93) or without (n = 74) PAD was recruited. PAD subjects were identified from a blood flow laboratory and a general medicine practice. Non-PAD subjects were identified from the same general medicine practice. PAD was diagnosed and quantified using the ankle-brachial index (ABI). Depressive symptoms were assessed by the 15-item short version of the Geriatric Depression Scale (GDS-S; score range 0-15, 0 = no depressive symptoms). The six-minute walk test and the Walking Impairment Questionnaire (WIQ) distance score (score range 0-100, 100 = better walking ability) were measures of walking impairment. PAD subjects had depressive mood (DM) (defined by GDS-S score ≤5) twice as often as controls (24% vs 12%, p = 0.06). After adjustment for age, education, and number of comorbidities, the prevalence of depressive mood among PAD subjects was increased, but this association was not significant (OR = 1.8, 95% CI 0.7-4.4). The WIQ distance score weakened the association between PAD and DM, and higher distance scores were associated with a lower likelihood of DM (OR = 0.98 per one unit of the WIQ, 95% CI 0.96-0.99). Among PAD subjects, severe PAD (ABI >0.5) was not significantly associated with DM (OR = 1.4, 95% CI 0.5-4.1), but a greater 6-min walk distance was associated with a lower likelihood of DM (OR = 0.8 per 100 feet, 95% CI 0.70-0.97). Substituting the WIQ scores for six-min walk distance in the model showed that higher WIQ scores were associated with lower likelihood of DM among PAD subjects (OR = 0.98 per one unit of the WIQ, 95% CI 0.95-1.0), though the association did not achieve statistical significance. In conclusion, these data suggest that PAD may be associated with an increased risk of DM and that this relationship may be related to PAD-associated disability. An evaluation for depression may be appropriate in men and women with PAD. Findings should be evaluated in a larger study cohort.

Background: Despite the near ubiquitous use of morning report in academic medical centers, little is known regarding its value as a learning format for medical students. Purpose: To objectively assess the educational impact of an ambulatory clerkship morning report.Methods: During 6 consecutive months of a primary care clerkship, students met weekly in a morning report format. Two separate groups were constituted each month. An examination was created based on material specific to each group's discussion and given to all students. One hundred five students participated.Results: Students' mean scores on exam items discussed in their morning report group (5.80 of a possible 9) were significantly higher than on items discussed in the other group (3.92 of a possible 9), p <.0001.Conclusion: Morning report appears to objectively enhance the medical knowledge of students in a primary care clerkship. Copyright 1998 by Lawrence Erlbaum Associates, Inc.