Obesity delays functional recovery in trauma patients.

BACKGROUND: Obesity is known to complicate trauma hospital stays. We hypothesize that obesity delays functional recovery in trauma patients. MATERIALS AND METHODS: Between 2005 and 2007, adult patients with a hospital length of stay >24 h were prospectively recruited for the study. Functional Independence Measurement (FIM) scores were calculated at the time of admission, discharge, and 6 mo after discharge. Patients were classified as nonobese (body mass index [BMI] <25), overweight (BMI ≥25 and <30), obese (BMI ≥30 and <35), and morbidly obese (BMI ≥35). Multivariate analyses were performed to determine the impact of obesity on FIM scores. RESULTS: Two hundred thirty-five patients met the study inclusion criteria. Average injury severity scores was >18. We recorded no mortality at the time of discharge and follow-up. During acute hospital stay stage, nonobese patients had an average of 24 points increase on FIM scores compared with morbidly obese patients with 16 points improvement (P = 0.023). Compared with nonobese patients, the rate of recovery was reduced by 30% in overweight (P = 0.034), 37% in obese (P = 0.025), and 48% in morbidly obese patients (P = 0.003). Alternatively, we found that for every unit increase in BMI, the functional recovery rate was reduced by 4% (P < 0.001). Changes in FIM scores during the postdischarge period were not significantly different by obesity classification, and all groups achieve similar functional outcome at follow-up (P = 0.482). CONCLUSIONS: Most trauma patients achieve full functional recovery some time after hospital discharge, but the recovery is delayed in obese patients and the delay is directly correlated with the severity of obesity.

Effect of uniform consensus recommendations for PCa screening in older population: differential effects and perceptions of healthcare providers and patients.

OBJECTIVES: To develop and distribute consensus recommendations to encourage a uniform approach to screening for prostate cancer (PCa) in men >75 years old. We also surveyed healthcare providers and men >75 years old to determine whether provider attitudes toward continued PCa screening in older men had changed. METHODS: We mailed surveys to 2809 Iowa providers to assess their practice toward PCa screening and adoption of the consensus recommendations. The results were compared with those from a preintervention survey. We also surveyed 9000 Iowa men >75 years old to determine whether their providers had changed their screening methods. RESULTS: A total of 614 providers (29%) and 1650 men (18%) >75 years old responded. Only 48% of providers intended to screen men >75 years old, which was reduced from the 63% reported in the preintervention survey. Of the 31% of providers who had knowledge of the consensus recommendations, 72% indicated they had adopted, or intended to adopt, the recommendations. Of the men >75 years old, 84% had undergone a prostate-specific antigen test during their life, and 75% had continued to be screened after 75 years of age. Also, 54% indicated that their provider had discussed screening when they turned 75. Only 18% noted a change in their physician's approach to PCa screening after the consensus recommendations had been released. CONCLUSIONS: Provider-based education can assist in formulating a thoughtful approach to screening and treatment of older men. A combination of patient- and provider-directed education could help to encourage focused and appropriate PCa screening in older men.

Screening and management of prostate cancer in elderly men: the Iowa Prostate Cancer Consensus.

OBJECTIVES: The issue of prostate cancer screening and management is likely to assume greater importance with progressive aging of the population. Because there are no currently established guidelines for screening and management of prostate cancer in elderly men (older than 75 years), a multidisciplinary panel was convened to develop consensus recommendations. METHODS: The panel consisted of experts in urology, internal medicine/geriatrics, medical oncology, radiation oncology, family practice, law, patient advocacy and physician assistants. Four internationally known experts on prostate cancer served as external advisors. Relevant literature was reviewed and consensus was developed based on expert opinion, given the lack of level I evidence regarding most aspects of prostate cancer diagnosis and management in men older than 75 years of age. RESULTS: On the basis of the opinions of the expert panel, recommendations for screening and management of prostate cancer in elderly men older than 75 years of age was developed. In general, there was support for using greater discretion in screening for prostate cancer in elderly men. The lack of adequate patient education tools to facilitate discussion with patients was recognized. There was also agreement on the need for greater and renewed patient counseling regarding benefits and risks of prostate cancer screening beyond age 75. CONCLUSIONS: It is possible to build consensus around a standardized approach to prostate cancer screening and management in older men. Promulgation of such consensus recommendations and their widespread adoption may help engender a tailored approach to managing prostate cancer in older men, thereby decreasing health care costs and morbidity while limiting unnecessary therapy.