Veterans Administration Hospital Research Articles

Abstract 302: Factors Influencing Heart Failure Readmissions at the Jesse Brown Veterans Administration Hospital

Background: Heart failure (HF) hospitalizations and readmissions are a major financial burden on patients, caregivers, and the healthcare system. The Jesse Brown Veterans Administration Medical Center (JBVAMC; Chicago, Illinois) has recently been scoring in the 90 th percentile in its HF risk-standardized readmission rate (RSRR) compared to other VA medical centers. Here, we present the factors influencing HF readmission at the JBVAMC. Methods: Veterans discharged from JBVAMC between 7/1/18 and 6/30/19 with a primary diagnosis of HF were identified per ICD-10 codes (I11.0, I13.X, and I50.X). For primary HF discharges between 7/1/18 and 12/31/18, retrospective chart review was performed to assess patient and hospitalization characteristics. Charts were excluded from review if the same veteran’s chart was reviewed for another admission within the preceding 30 days, or if a veteran was discharged against medical advice or to a skilled nursing facility. Continuous variables were analyzed using Student’s t-test and categorical variables with Pearson Chi-Square. Results: Between 7/1/18 and 6/30/19, there were 485 HF discharges resulting in 96 30-day readmissions. Of them, 51 (53%) were due to recurrent HF exacerbation, and 8 (8%) were due to hypotension, dehydration, or acute kidney injury. Only 32% of readmissions (8/25) during the first 7 days after discharge were due to recurrent HF, compared to 70% (19/27) during day 8-14 and 57% (13/23) during day 15-21. In characterizing the index hospitalizations between 7/1/18 and 12/31/18 (N=188), there were 42 (22%) admissions that resulted in readmissions (Table 1). Veterans in this cohort were 72 years old on average, 98% male, and 77% African-American. HF with reduced ejection fraction (HFrEF; EF≤40%) comprised 53% of non-readmitted and 57% of readmitted cohort. Readmitted patients had a higher prevalence of smoking (33% vs 16%, p=0.012) and less likely to have outpatient follow-up within 14 days of discharge (52% vs 29%, p=0.007). There was a low rate of sacubitril/valsartan utilization (N=6) and dietitian consultation (N=7). Conclusion: Over half of our HF readmissions are due to recurrent HF. An emphasis on timely outpatient follow-up after discharge, consideration for sacubitril/valsartan initiation, and dietary education may help reduce our HF readmissions.

Hepatitis C virus screening at a Veterans Administration Hospital in New York City

Asymptomatic hepatitis C virus (HCV) infection has the highest prevalence in "baby boomers" born in 1945 through 1965. New York State mandates that all persons born during this period be screened at least once for hepatitis C. Military veteran HCV screening is often missed during primary care visits. After baseline screening, provider education with and without an HCV education dashboard of information in the Electronic Medical Record system was used to determine if screening proportions could be improved. The Chi-square and Z-test for independent proportions compared after with before education screening. The odds ratio compared after versus before screening odds. Two interventions were tested. One was provider education with a 30-minute lecture. The second was the lecture with addition of an HCV education computer dashboard. The Chi-square test and Z-test comparing the month immediately after provider education was significant for increased screening (p < .01) compared with baseline. There was a 2.04-fold (95% confidence interval, 1.31-3.20) greater odds of screening in the month after education. If two or more months went by after education, the effect of education no longer improved screening proportions. Provider education plus the use of HCV education dashboard did not improve screening from baseline to the month immediately after screening (p = .95). Provider education significantly improved HCV screening the month immediately after education, then regressed toward baseline. Adding an HCV education dashboard to education did not improve screening. To maintain elevated screening proportions, provider screening education must be reinforced on a frequent basis for sustained effect.

Re: Overnight Urge Perception in Nocturia is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Hospital.

No AccessJournal of UrologyUrological Survey1 May 2020Re: Overnight Urge Perception in Nocturia is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Hospital Alan J. WeinMD, PhD (hon), FACS Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000782.03AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Overnight Urge Perception in Nocturia is Independent of Depression, PTSD, or Anxiety in a Male Veterans Administration Hospital." The Journal of Urology, 203(5), p. 889 Suggested Reading : Prevalence of nocturia in United States men: results from the National Health and Nutrition Examination Survey. J Urol 2011; 185: 998. Link, Google Scholar : Sleep related problems and urological symptoms: testing the hypothesis of bidirectionality in a longitudinal, population based study. J Urol 2014; 191: 100. Link, Google Scholar : The association of depression, anxiety and nocturia: a systematic review. J Urol 2013; 190: 953. Link, Google Scholar : Convenience voids: an important new factor in urinary frequency volume chart analysis. J Urol 2005; 173: 487. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue 5May 2020Page: 889-889 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF DownloadLoading ...

A History of the American Association of Pathologists’ Assistants: Creating an Organization, Winning Hearts and Minds, and Building an Invaluable Profession

Thomas D. Kinney and Duke University started the first formal university-based training program for pathologists’ assistants in 1969. Over the next 2 years, 2 more university-based programs were established. All 3 programs were affiliated with nearby Veterans Administration Hospitals and were funded as a pilot study by the US Veterans Administration to address a looming shortage of pathologists. Early graduates of these programs discovered that the concept of pathologists’ assistants with well-defined skill sets encompassing both surgical and autopsy pathology was not initially accepted by important elements of organized pathology. Indeed, many academic pathologists were opposed to the concept from the outset. In the face of such opposition, a group of practicing pathologists’ assistants created and incorporated their own professional organization, the American Association of Pathologists’ Assistants, to provide support, advocacy, and continuing education for individual practicing pathologists’ assistants. The history of the American Association of Pathologists’ Assistants and its role in the establishment and success of the pathologists’ assistant profession are described utilizing personal communications as well as published historical sources.

The prevalence of diabetes among male glaucoma patients

Introduction: The purpose of this study was to examine the relationship between diabetes and glaucoma.Methods: Consecutive 143 subjects with primary angle-closure glaucoma and 127 subjects with primary open-angle glaucoma (control) were studied retrospectively at an urban Veterans Administration Hospital. In addition to ocular examination findings, body mass index (BMI) and diabetes mellitus (DM) status were recorded.Results: All subjects in this study were male. The mean age was 72.3 years old in primary open angle versus 71.1 in primary angle-closure subjects. Half of the subjects with angle closure and 70% of open-angle subjects were self-identified as African–American. BMI was not significantly different between the two groups (28.2 in open angle vs. 28.7 in angle closure; P = 0.45). The percentage of DM was higher in subjects with primary angle closure than in those with primary open-angle glaucoma (43% vs. 29%, P = 0.001; Chi-square test). The odds of having DM were nearly two times higher in angle-closure subjects than open-angle subjects (Logistic regression, P = 0.01, 95% confidence interval: 1.17–3.30).Conclusion: In this retrospective study, diabetes was found to be associated with higher risk for primary angle-closure glaucoma.

Poor Compliance With Postvasectomy Semen Testing: Analysis of Factors and Barriers

To ensure procedure success, American Urological Association Guidelines recommend postvasectomy semen analysis (PVSA); however, current literature suggests poor compliance. We sought to measure PVSA compliance and assess barriers to completion. A retrospective review was performed of vasectomies at San Diego Veterans Administration Hospital and UC San Diego Health between 2006 and 2018. Patients received preprocedural counseling regarding semen analysis necessity. Postprocedural management included follow-up visit within 2-4 weeks and semen analysis after 15-20 ejaculations. Demographics and periprocedural variables were collected. Telephone interviews assessed patient reported reasons for noncompliance. Multivariable analysis was performed for factors associated with semen analysis. 503 men, mean age 38.8 years, underwent vasectomy at San Diego Veterans Administration Hospital (n = 331) and UC San Diego (n = 172). Overall, 80% completed clinical follow-up (n = 401) and 53% completed semen analysis (n = 268). The cohorts exhibited significantly different rates of semen analysis completion (46% vs 67%, P <.001) and clinical follow-up (64% vs 85%, P = .038). No difference was observed in age, fatherhood, or marital status. On multivariable analysis, fatherhood was the only factor associated with noncompliance of semen analysis (odds ratio 0.52, 95% confidence interval 0.33-0.83). Among men interviewed, the primary barriers to semen analysis completion were distance (38%), time constraints (34%), and forgetfulness (23%). Ninety-two% reported increased likelihood of completion with home-based semen testing. Patients demonstrated poor PVSA compliance despite preprocedural counseling. Given that distance and time constraints limited compliance, incorporating home-based semen testing may improve the quality of care for men undergoing vasectomy.

VA Program Allows Vets to Access MH Care in Community

VA Program Allows Vets to Access MH Care in Community

123 Single Day Low Residue Diet Prior to Colonoscopy Shows Improved Bowel Preparation Quality and Patient Tolerance Over Clear Liquid Diet: Final Results From a Randomized, Single-Blinded, Dual Center Study

INTRODUCTION: Patients often cite bowel preparation and associated dietary restrictions as the greatest deterrents to having a colonoscopy completed or performed. Large studies comparing low residue diet (LRD) and clear liquid diet (CLD) are still limited. The aim of this study was to compare LRD and CLD with regards to bowel preparation quality, tolerance, and satisfaction among a diverse patient population. METHODS: This study is a dual center, randomized, single blinded, prospective trial involving adult patients undergoing outpatient colonoscopy at the University of California Irvine Medical Center and a Veterans Administration hospital. Patients were randomized to consume either a CLD or a planned LRD for the full day prior to colonoscopy. Both groups consumed 4L split-dosed PEG-ELS. The adequacy of bowel preparation was evaluated using the Boston Bowel Preparation Score (BBPS). Adequate preparation was defined as a BBPS ≥7. Hunger and fatigue pre and post procedure were graded on a 10-point scale. Nausea, vomiting, bloating, abdominal cramping, overall discomfort, satisfaction with the diet, willingness to repeat the same preparation and overall experience were assessed. RESULTS: A total of 170 subjects who underwent colonoscopy from October 2014 to October 2017 were included. The mean BPPS for the LRD and CLD groups was 7.98 and 7.54, respectively. There was a significantly higher number of adequate preparations in the LRD group compared to CLD (P = 0.05). Evening hunger scores just before starting the bowel preparation were significantly lower in the LRD than CLD group, 5.5 vs 7.03, respectively (P = 0.006). Subjects in the LRD group showed significantly less nausea (P = 0.047) and bloating (P = 0.04). Symptom scores for vomiting, abdominal cramping, and overall discomfort were similar between the groups. Satisfaction with diet was significantly higher in the LRD group than CLD, 100% vs 33% respectively (P &lt; 0.001). The overall colonoscopy experience and the satisfaction with the preparation itself were also better reported in the LRD group (P = 0.002). CONCLUSION: This study demonstrated that the use of a LRD before colonoscopy achieves a superior bowel preparation quality compared to CLD. Low-residue diet also improves patient satisfaction and results in significantly better tolerability of bowel preparation. As a less restrictive dietary regimen, low-residue diet may help improve patient participation in colorectal cancer screening programs.

1006 Non-Alcoholic Fatty Liver Disease Is an Increasing Reason for Referral to Gastroenterology

INTRODUCTION: Non-Alcoholic Fatty Liver Disease (NAFLD) is increasing in prevalence. In integrated healthcare systems with limited clinic access, prior studies have utilized care pathways to triage patients to clinic in situations of suspected advanced fibrosis. Our aim was to study clinic utilization for NAFLD over time and assess how many patients could avoid specialty care using predictive scores such as the FIB4 and NAFLD fibrosis score (NFS). METHODS: Consecutive consultations to GI, 200 from 2012 and 300 from 2017, at a large Veterans Administration Hospital in Texas were retrospectively reviewed to determine reason for consultation, final diagnosis, additional workup, and follow up utilization. Weight 1 year after consultation was compared to the initial weight. Chi square testing and Student’s t test were used to compare categorical and quantitative data, respectively, using R. RESULTS: Among the 500 patients, the mean age was 57.4 years (+/- 13.9), 86.2% were male and 18.4% Hispanic. Of the 200 consults in 2012, 18 (9.0%) were for NAFLD compared to 53 (17.7%) of 300 consults from 2017 (P &lt; 0.01). Comparatively, the number of consultations for Hepatitis C was not significantly different from 2012 to 2017 (19.5% vs. 16.7%, P = 0.42). Neither liver biopsy (27.8% vs. 17.0%, P = 0.32) nor MR elastography (11.1% vs. 28.9%, P = 0.20) use was significantly different between 2012 and 2017. Using the FIB4 score, 31 (43.7%) were classified as low risk and 11 (15.5%) were classified as high risk for advanced fibrosis. Using the NFS, 18 (25.4%) were classified as both low and high risk. 27 patients underwent MR elastography or liver biopsy and 13 (48%) were found to have advanced fibrosis. The performance characteristics of NFS and FIB4 compared to results of liver biopsy or MR elastography is presented in Table 1 and 2, respectively. Mean weight change 1 year later was -0.8% (+/-4.7%). There was no difference in weight change between those found to have advanced fibrosis or not (-0.3% [95%CI: -3.0- 2.3%] vs. -2.0% [95%CI:-4.1- 0.1], P = 0.29). CONCLUSION:: One of every 6 consultations to gastroenterology is for NAFLD, now exceeding Hepatitis C referrals in 2017. Using the NFS could save 25% of these referrals without missing cases of advanced fibrosis. GI care was not associated with weight loss. Prospective studies are needed to determine the efficacy of these strategies to triage NAFLD patients for specialty care.

Microaggressions in Clinical Training and Practice.

Microaggressions in Clinical Training and Practice.

William “Ed” Kois: whistleblower who exposed substandard care at a US veterans hospital

Peter Biello/New Hampshire Public Radio A specialist in rehabilitation and pain management, William “Ed” Kois was not your typical doctor. He swore a lot,1 he wore a goatee and muttonchop...

The overlap between OCD and PTSD: Examining self-reported symptom differentiation

The role of stressful precipitating events has long been recognized in the genesis of obsessive-compulsive disorder (OCD). Posttraumatic stress disorder (PTSD) also necessitates the experience of a traumatic event (PTSD criterion A). Research has demonstrated a high degree of comorbidity between these two conditions. However, few studies have examined symptom overlap as a potential cause for this co-occurrence. Thus, the purpose of the present study was to examine symptom endorsement and overlap between OCD and PTSD using a sample of trauma exposed veterans. Veterans were administered self-report assessments, including the Dimensional Obsessive-Compulsive Scale (DOCS) and the PTSD Checklist for DSM-5 (PCL-5), as part of a routine clinical care at a Veteran's Administration hospital. Based on self-report assessment of clinical cut scores, 81% of participants met for probable PTSD and 74% for probable OCD. In addition, a series of chi square analyses revealed frequent overlap of endorsement across items with similar content. There is significant overlap between PTSD and OCD symptoms, and patients may find it difficult to differentiate between them on self-report measures. As such, caution should be used when using self-report solely to assess PTSD and OCD, particularly in traumatized samples.

Medical therapy does not confer stroke prevention for all patients: identification of high-risk patients with asymptomatic carotid stenosis is still needed.

Recent advances in best medical therapy (BMT) has been associated with reduced risk of stroke similar to that observed following surgical carotid revascularization (CR). Thus, it remains uncertain which subset(s) of patients would benefit from prophylactic CR+BMT for asymptomatic carotid stenosis (ACS) over BMT alone. The purpose of this study was to analyze the contemporary experience in the management of >70% ACS in an academic institution, to compare the short- and long-term outcomes of BMT alone against CR+BMT, and to identify risk factors for the development of future cerebrovascular events. A retrospective review of all patients with severe ACS between January 2005 and December 2012 at Loyola University Medical Center and its affiliated Edward Hines Jr. Veterans Administration Hospital was conducted. Baseline patient characteristics, medications, and follow-up data were collected from electronic medical records, and treatment outcomes were compared. The random forest method was performed to select potential important variables for the development of late stroke. The recursive partitioning regression analysis (RPRA) was performed to identify the patient subgroup at increased risk of future stroke. Of 409 patients identified; 247 were treated with CR and 162 with BMT. Between these groups with CR+BMT and BMT alone, the mean age was 69.1±8.2 versus 75.5±9.0, respectively (P<0.01). Mean follow-up was 60.7±37.5 months. Early (30-day) outcomes of stroke, acute myocardial infarction or mortality did not differ between the treatment modalities (2.0% CR vs. 0.6% BMT, P=0.41). Probability of freedom from ipsilateral stroke, and any stroke at 1- and 5-year follow-up were also comparable between CR+BMT and BMT alone. However, random forest method and RPRA demonstrated that patients with history of diabetes and remote stroke treated with BMT alone were at a high risk for future stroke (36.4% in total, 7.2% per year). The diabetics with contralateral carotid stenosis >50% who are active smokers are at the highest risk for stroke after CR (20.0% in total, 4.0% per year). Prophylactic CR+BMT does not provide overall late stroke prevention compared with BMT alone. Diabetics with a history of stroke, in particular, are at an increased risk of stroke despite BMT. Timely CR+BMT for high-risk patients is still indicated.

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Influence of Cognition on Length of Stay and Rehospitalization in Older Veterans Admitted for Post-Acute Care.

Evaluate the relative contribution of cognitive test performance to post-acute care (PAC) length of stay (LOS) and rehospitalization while controlling for key demographic, medical, and functional outcomes. Retrospective medical record review of 160 older Veterans, including cognitive test performance (Addenbrooke's Cognitive Examination-Revised [ACE-R]), on admission to a Veterans Administration Hospital Community Living Center (CLC) PAC. Individuals with impaired scores on the ACE-R had a longer LOS (10 median days longer; U = 2,547.00, p = .028). Of those rehospitalized, 71.4% (n = 20) screened positive for cognitive impairment. Key medical factors explained the largest amount of variance in CLC-PAC LOS (29.8%), followed by admission ADL (activities of daily living) dependency (4.6%) and ACE-R total score (3.30%). Cognitive screening should be considered on PAC admission, with impairment on ACE-R predicting geriatric rehabilitation outcomes such as risk of increased LOS and rehospitalization.

Epidemiology of ocular surface squamous neoplasia in veterans: a retrospective case-control study

BackgroundA number of risk factors have been evaluated in ocular surface squamous neoplasia, but few studies have assessed risk factors specific to the armed forces veteran population.MethodsWe conducted a retrospective case-control study on 55 patients and 55 age-matched controls with biopsy-proven ocular surface squamous neoplasia from the Miami Veterans Administration Hospital Eye Clinic to investigate potential risk factors encountered by veterans, including service-specific exposures. Veteran-specific risk factors included ionizing radiation exposure, Agent Orange exposure, deployment to Southwest Asia, and exposure to the series of biochemical warfare tests known as Project Shipboard Hazard and Defense. Data was analyzed with SPSS (SPSS Inc., Chicago, IL) using t-tests, chi-squared, and logistic regression analysis, with a p-value of < 0.05 considered statistically significant.ResultsThe strongest risk factor for ocular surface squamous neoplasia was lifetime sun exposure both directly assessed via historical quantification of exposure by dermatology practitioners (Odds Ratio (OR) 5.4, 95% Confidence Interval (CI) 2.27–12.847, p < 0.005), and using the surrogate markers of basal cell carcinoma (OR 3.157, 95% CI 1.286–7.748, p = 0.010) and pingueculae (OR 5.267, 95% CI 2.104–13.186, p < 0.005). Of the veteran-specific risk factors, Agent Orange exposure and Southwest Asia deployment were not associated with an increased risk of ocular surface squamous neoplasia. Exposure to ionizing radiation and involvement in Project Shipboard Hazard and Defense were not documented among any cases or controls.ConclusionsThe results of our study are consistent with prior established risk factors, namely highlighting the important role of sun exposure in ocular surface squamous neoplasia among veterans.

Exposure Therapy and Simultaneous Repetitive Transcranial Magnetic Stimulation: A Controlled Pilot Trial for the Treatment of Posttraumatic Stress Disorder.

This is a small preliminary but novel study assessing the feasibility of repetitive transcranial magnetic stimulation (rTMS) delivery to veterans with posttraumatic stress disorder (PTSD) while they simultaneously receive prolonged exposure (PE) therapy. A prospective, randomized, double-blinded, active sham-controlled design combined weekly sessions of rTMS and standard PE at the Veterans Administration Hospital. Eight adult patients received a full course of protocol-driven PE therapy and were randomly assigned to receive either rTMS or sham rTMS. Repetitive transcranial magnetic stimulation was delivered to the right or left prefrontal cortex with a figure-eight solid core coil at 120% motor threshold, 10 Hz, 5-second train duration, and 10-second intertrain interval for 30 minutes (6000 pulses) weekly for 5 weeks (30,000 stimuli). Of the 12 veterans consented, 8 completed the study treatment protocol. The dropout rate was 34%, roughly equivalent to the pooled average dropout rates observed in traditional PE therapy with Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD, suggesting that veterans had no difficulty tolerating the addition of rTMS to PE therapy and that this is a feasible study design for larger trials in the future. Clinician-Administered PTSD Symptom scores reflected a general nonsignificant trend toward improvement, and subjects with comorbid major depression appeared to experience significant antidepressant benefit with treatment despite the fact that the doses used in this protocol were much smaller than those used to treat patients with major depressive disorder. This pilot study demonstrates the safety and feasibility of rTMS delivery to PTSD patients while they simultaneously receive PE. This unique approach to the treatment of PTSD highlights the need for further studies with larger sample sizes to assess treatment outcomes.

Health literacy is a barrier to shared decision making in early prostate cancer (PCA) among African American (AA) men.

84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p &lt; 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.

Providers’ inability to estimate health literacy among African American (AA) patients (pts) with early prostate cancer (PCa).

77 Background: Providers’ estimates of a pt’s health literacy are important for communication and shared decision making among men with early PCa. We explored differences between providers’ estimates of health literacy and measured health literacy among AA pts in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Providers (n=18) estimated the health literacy of 124 newly diagnosed, early-stage, AA PCa pts after discussions with each pt regarding his PCa treatment options, categorized as ≤Grade (Gr) 3; Gr 4-6; Gr 7-8; and High school. At a subsequent visit, prior to choosing his cancer treatment, each pt’s health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), using the same categories. Domains of numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods. Concordance between estimated and actual health literacy was evaluated via Cohen’s Kappa coefficient (1.00 = perfect agreement). Results: Despite their discussions with the pts, providers consistently overestimated pts’ health literacy. Agreement between provider estimates and pts’ measured values was consistently low (32.0%-37.6%). These rates were approximately what would be expected by chance. Among the 75 patients with the lowest levels of health literacy, agreement was even lower (12.3%-35.6%). In this group 26.7% of provider assessments were off by ≥2 REALM categories. Conclusions: Healthcare providers are surprisingly ineffective at estimating the health literacy of their pts with early stage PCa. This poor accuracy may diminish providers’ ability to communicate successfully with pts and engage in shared decision making, especially among pts with poor health literacy. [Table: see text]

An Innovative Approach to Adequate Oral Hydration in an Inpatient Geriatric Psychiatry Unit.

Suboptimal hydration status and dehydration are problems that often exacerbate comorbid conditions in geriatric patients. At a Veterans Administration Hospital, it was observed that suboptimal hydration status in Veterans hospitalized in the geriatric psychiatry unit was a contributing factor in the worsening of their psychiatric and medical conditions. A quality improvement project was chartered to improve hydration in this group of patients. Using a three-pronged intervention approach (i.e., providing flavored water, providing larger cups, and increasing the prompting by nurses for patients to drink more), the project was successful. The goal was to increase average daily fluid intake by 125 mL; the result was an increase of 700 mL. This project has been sustained and the interventions have also benefitted non-geriatric psychiatry in-patients. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 15-20.].