(BQ) Part 1 book Principles of ambulatory medicine presents the following contents: Issues of general concern in ambulatory medicine, preventive care, psychiatric and behavioral problems, allergy and infectious disease, gastrointestinal problems, renal and urologic problems, hematologic problems, pulmonary problems.
P1: PBU/OVY P2: PBU/OVY QC: PBU/OVY T1: PBU GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls PRINCIPLES May 16, 2006 OF Ambulatory Medicine SEVENTH EDITION i 16:21 Char Count= P1: PBU/OVY P2: PBU/OVY QC: PBU/OVY T1: PBU GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 ii 16:21 Char Count= P1: PBU/OVY P2: PBU/OVY QC: PBU/OVY T1: PBU GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 16:21 Barker, Burton and Zieve’s PRINCIPLES OF Ambulatory Medicine SEVENTH EDITION Edited by Consulting Editors Nicholas H Fiebach, M.D L Randol Barker, M.D., Sc.M., M.A.C.P Professor of Clinical Medicine College of Physicians and Surgeons, Columbia University Director, Medical House Staff Training Program Columbia University Medical Center New York Presbyterian Hospital New York, New York David E Kern, M.D., M.P.H Associate Professor of Medicine Johns Hopkins University School of Medicine Director, Division of General Internal Medicine Johns Hopkins Bayview Medical Center Baltimore, Maryland Patricia A Thomas, M.D Associate Professor of Medicine Associate Dean for Curriculum Johns Hopkins University School of Medicine Baltimore, Maryland Roy C Ziegelstein, M.D Professor of Medicine The Johns Hopkins University School of Medicine Executive Vice Chairman, Department of Medicine Director, Residency Program in Internal Medicine Johns Hopkins Bayview Medical Center Baltimore, Maryland iii Professor of Medicine Johns Hopkins University School of Medicine Division of General Internal Medicine Johns Hopkins Bayview Medical Center Baltimore, Maryland Philip D Zieve, M.D Professor of Medicine Johns Hopkins University School of Medicine Senior Advisor to the Medical Center Johns Hopkins Bayview Medical Center Baltimore, Maryland Char Count= P1: PBU/OVY P2: PBU/OVY QC: PBU/OVY T1: PBU GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Acquisitions Editor: Sonya Seigafuse Managing Editor: Nancy Winter Developmental Editor: Leah Hayes Project Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Angela Panetta Design Coordinator: Steve Druding Cover Designer: Larry Didona Production Service: TechBooks Printer: Quebecor World-Taunton C 2007 by LIPPINCOTT WILLIAMS & WILKINS 530 Walnut Street Philadelphia, PA 19106 USA LWW.com 6th Edition c 2003 Lippincott Williams & Wilkins, 5th Edition c 1999 Lippincott Williams & Wilkins, 4th Edition c 1995 Williams & Wilkins, 3rd Edition c 1991 Williams & Wilkins, 2nd Edition c 1986 Williams & Wilkins, 1st Edition c Williams & Wilkins All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Printed in the USA Library of Congress Cataloging-in-Publication Data Principles of ambulatory medicine / editors, L Randol Barker [et al.].—7th ed p ; cm Includes bibliographical references and index ISBN 0-7817-6227-8 Family medicine Ambulatory medical care I Barker, L Randol (Lee Randol) [DNLM: Ambulatory Care WX 205 P957 2007] RC46.P894 2007 616—dc22 2006011532 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins Customer service representatives are available from 8:30 am to pm, EST 10 iv 16:21 Char Count= P1: PBU/OVY P2: PBU/OVY QC: PBU/OVY T1: PBU GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls • May 16, 2006 16:21 Char Count= • C O N T R I B U T O R S Unless otherwise indicated, hospital appointments are at Johns Hopkins Bayview Medical Center, Baltimore, Maryland, and faculty appointments are at the Johns Hopkins University School of Medicine Ross E Andersen, Ph.D Associate Professor of Medicine John E Anderson, M.D Assistant Professor of Medicine Andrew F Angelino, M.D Assistant Professor of Psychiatry and Behavioral Sciences Medical Director—Acute Psychiatry Service Frank C Arnett, Jr., M.D Professor of Internal Medicine Division of Rheumatology and Clinical Immunogenetics University of Texas—Houston Medical School Houston, Texas Bimal H Ashar, M.D., M.B.A Assistant Professor of Medicine Paul G Auwaerter, M.D., M.B.A Associate Professor of Medicine Jennifer E Axilbund, M.S., C.G.C Senior Genetic Counselor Research Associate in Oncology Carlos A Bagley, M.D Senior Resident of Neurosurgery L Randol Barker, M.D., Sc.M., M.A.C.P Professor of Medicine Division of General Internal Medicine William H Barker, M.D., F.R.C.T, EDIN Professor Emeritus Department of Preventive Medicine and Gerontology University of Rochester Medical Center Rochester, New York Linda F Barr, M.D Assistant Professor of Medicine Pulmonary and Critical Care Associates of Baltimore Towson, Maryland R Graham Barr, M.D., Dr P.H Florence Irving Assistant Professor Departments of Medicine and Epidemiology Columbia University Medical Center New York, New York Anne E Burke, M.D Assistant Professor of Obstetrics and Gynecology Shehzad Basaria, M.D Assistant Professor of Internal Medicine and Endocrinology Ronald P Byank, M.D Associate Professor of Orthopedic Surgery Joan M Bathon, M.D Professor of Medicine Michele F Bellantoni, M.D Associate Professor of Medicine Medical Director O Joseph Bienvenu, III, M.D., Ph.D Assistant Professor of Psychiatry Associate Director, Anxiety Disorders Clinic James H Black, III, M.D Assistant Professor of Surgery Attending Surgeon, Vascular/Endovascular Surgery David W Blodgett, M.D., M.P.H Adjunct Faculty Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health David G Borenstein, M.D Clinical Professor of Medicine George Washington University Medical Center Washington, D.C Gary R Briefel, M.D Associate Professor of Medicine Chief, Division of Renal Medicine Robert E Bristow, M.D Associate Professor and Director of Obstetrics and Gynecology Arthur L Burnett, M.D Professor of Urology Hugh Calkins, M.D., B.A Professor of Medicine Professor of Pediatrics Director, Arrhythmia Service and Clinical Electrophysiology Laboratory Director, ARVD Program Nisha Chandra-Strobos, M.D Professor of Medicine Director, CUU Director, Clinical Cardiovascular Services Colleen Christmas, M.D Assistant Professor of Medicine Jeanne M Clark, M.D., M.P.H Assistant Professor of Medicine and Epidemiology The Johns Hopkins University School of Medicine and Bloomberg School of Public Health Karan A Cole, Sc.D Assistant Professor of Medicine Division of General Internal Medicine Director, Med-Psych Rotation Director, JHU Faculty Development Program and Teaching Skills Eugene C Corbett, Jr., M.D Bernard B and Anne L Brodie Professor of Medicine Professor of Nursing General Medicines, Geriatrics, and Palliative Care University of Virginia Health Science Center Charlottesville, Virginia v P1: PBU/OVY P2: PBU/OVY GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls vi QC: PBU/OVY T1: PBU May 16, 2006 16:21 Contributors Grace A Cordts, M.D., M.H.P., M.S Assistant Professor of Medicine Rima J Couzi, M.D., M.B., B.C.H., M.H.S Assistant Professor of Oncology Leonard R DeRogatis, Ph.D Associate Professor of Psychiatry Director, Center for Sexual Health and Medicine Christopher J Earley, M.D., Ph.D Associate Professor of Neurology Peter J Fagan, Ph.D Associate Professor of Medical Psychology Clare H Ferrigno, M.S.N., F.N.P., C.R.N.P NP/Program Coordinator Division of Medical Oncology Nicholas H Fiebach, M.D Professor of Clinical Medicine Columbia University College of Physicians and Surgeons Director, Medical House Staff Training Program New York Presbyterian Hospital Columbia University Medical Center New York, New York Michael I Fingerhood, M.D Associate Professor of Medicine Thomas E Finucane, M.D Professor of Medicine Chair, Ethics Committee Paul S Fishman, M.D., Ph.D Professor of Neurology University of Maryland Medical School Baltimore, Maryland John A Flynn, M.D., M.B.A Associate Professor of Medicine Clinical Director, Division of General Internal Medicine Howard W Francis, M.D Associate Professor of Otolaryngology—Head and Neck Surgery David S Friedman, M.D., M.P.H Associate Professor of Opthalmology Wilmer Eye Institute Ira M Garonzik, M.D Assistant Professor of Neurosurgery Director, Baltimore Neurosurgery and Spine Center Steve N Georas, M.D Associate Professor of Medicine Medical Director, Respiratory Care Department Robert L Giuntoli, II, M.D Assistant Professor of Gynecology/Obstetrics Attending Physician, Department of Gynecology/Obstetrics Sheldon H Gottlieb, M.D Associate Professor of Medicine Senior Cardiologist Constance A Griffin, M.D Associate Professor of Pathology, Oncology, and Medicine Richard J Gross, M.D., Sc.M Associate Professor of Medicine Acting Physician, Department of Medicine Uzma J Haque, M.D Assistant Professor of Rheumatology John W Harmon, M.D Professor of Surgery Staff Surgeon, Department of Surgery David B Hellmann, M.D., M.A.C.P Vice Dean Mary Betty Stevens Professor of Medicine Chairman, Department of Medicine H Franklin Herlong, M.D Associate Professor of Medicine Glenn A Hirsch, M.D Instructor of Medicine, Division of Cardiology George R Huggins, M.D Professor of Obstetrics and Gynecology Nada S Jabbur, M.D Associate Professor Department of Ophthalmology Johns Hopkins at Green Spring Station Lutherville, Maryland Nathaniel W James, IV, M.D Assistant Professor of Medicine University of Vermont College of Medicine Burlington, Vermont Attending Physician Maine Medical Center Portland, Maine Roxanne M Jamshidi, M.D., M.P.H Assistant Professor of Gynecology/Obstetrics Suzanne M Jan de Beur, M.D Assistant Professor of Medicine Chief, Division of Endocrinology Constance J Johnson, M.D Associate Professor of Neurology Vanderbilt University Nashville, Tennessee Peter W Kaplan, M.B.,B.S Professor of Neurology Director of Epilepsy and Nerve Physiology Matthew L Kashima, M.D., M.P.H Assistant Professor of Otolaryngology Head and Neck Surgery Chief of Service, Department of Otolaryngology Head and Neck Surgery David E Kern, M.D., M.P.H Associate Professor of Medicine Director, Division of General Internal Medicine Edward S Kraus, M.D Associate Professor of Medicine Associate Medical Director, Adult Kidney Transplant Program Bruce S Lebowitz, D.P.M Instructor of Orthopedic Surgery Frederick A Lenz, M.D., Ph.D Professor of Neurosurgery Attending Neurosurgeon Shari M Ling, M.D Assistant Professor of Rheumatology and Geriatric Medicine and Gerontology Staff Clinician, Clinical Research Branch, NIA Harbor Hospital Baltimore, Maryland Char Count= P1: PBU/OVY P2: PBU/OVY QC: PBU/OVY T1: PBU GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 16:21 Contributors Mark C Liu, M.D Associate Professor of Medicine Johns Hopkins Asthma and Allergy Center Staff Physician Rafael H Llinas, M.D Assistant Professor of Neurology Medical Director, Neurology Service Sara Love-Schlessman, C.R.N.P Certified Nurse Practioner Otolaryngology—Head and Neck Surgery Meredith B Loveless, M.D Instructor of Obstetrics/Gynecology Douglas K MacLeod, D.M.D Former Chairman, Department of Dentistry Baltimore City Hospitals Private Practice Raleigh, North Carolina Jeffrey L Magaziner, M.D Assistant Professor of Medicine Joseph E Marine, M.D Assistant Professor of Medicine Division of Cardiology Director of Electrophysiology Susan A Mayer, M.D Assistant Professor of Medicine Director, Echocardiography Laboratory Una D McCann, M.D Associate Professor of Psychiatry and Behavioral Sciences Director, Anxiety Disorders Clinic Simon C Mears, M.D., Ph.D Assistant Professor of Orthopaedic Surgery Chief, Division of Total Joint Arthroplasty and Trauma Esteban Mezey, M.D Professor of Medicine Myron Miller, M.D Professor of Medicine Redonda G Miller, M.D., M.B.A Associate Professor of Medicine Mack C Mitchell, Jr., M.D Associate Professor of Medicine Director, Division of Gastroenterology Francis M Mondimore, M.D Assistant Professor of Psychiatry and Behavioral Sciences Patrick A Murphy, M.D., Ph.D Professor of Medicine Attending Physician David N Neubauer, M.D Assistant Professor of Psychiatry and Behavioral Sciences Associate Director, Johns Hopkins Sleep Disorder Center John K Niparko, M.D George T Nager Professor of Otolaryngology Eric L Nuermberger, M.D Assistant Professor of Medicine Attending Physician Irina Petrache, M.D Assistant Professor of Medicine and Pathology Attending Physician Michael J Polydefkis, M.D Assistant Professor of Neurology Director, EMG Laboratory Co-Director, Cutaneous Nerve Laboratory Gregory P Prokopowicz, M.D., M.P.H Assistant Professor of Medicine Michael J Purtell, M.D., Ph.D Assistant Professor of Oncology Peter V Rabins, M.D., M.P.H Professor of Psychiatry Darius A Rastegar, M.D Assistant Professor of Medicine Robert P Roca, M.D., M.P.H Associate Professor of Psychiatry Vice President and Medical Director Sheppard Pratt Health System Towson, Maryland Annabelle Rodriguez-Oquendo, M.D Assistant Professor of Medicine Director, Diabetes Management Service Linda C Rogers, C.R.N.P Assistant, Department of OB/GYN Char Count= vii Glen S Roseborough, M.D Assistant Professor of Surgery Alvin M Sanico, M.D Assistant Professor of Medicine Medical Director, Asthma Sinus Allergy Program at Greater Baltimore Medical Center Baltimore, Maryland Larry N Scherzer, M.D., M.P.H., Sc.D Department of Pediatrics University of Connecticut East Hartford, Connecticut Chester W Schmidt, Jr., M.D Professor of Psychiatry Chairman, Department of Psychiatry and Behavioral Sciences Stephen D Sears, M.D., M.P.H Adjunct Associate Professor of Community and Family Medicine Dartmouth Medical School Chief Medical Officer Maine General Medical Center Augusta, Maine Edward P Shapiro, M.D Professor of Medicine Director, Noninvasive Cardiology Philip L Smith, II, M.D Professor of Medicine Professor, Asthma and Allergy Center Sharon D Solomon, M.D Assistant Professor of Ophthalmology David A Spector, M.D Associate Professor of Internal Medicine Director, Nephrology Program Robert J Spence, M.D Associate Professor of Surgery Director, Burn Reconstruction Kerry J Stewart, Ed.D Professor of Medicine Director, Clinical and Research Exercise Physiology Michael B Streiff, M.D Assistant Professor of Medicine Medical Director, Anticoagulation Management Services Patricia A Thomas, M.D Associate Professor of Medicine Associate Dean for Curriculum P1: PBU/OVY P2: PBU/OVY GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls viii QC: PBU/OVY T1: PBU May 16, 2006 16:21 Contributors Varsha K Vaidya, M.D Assistant Professor of Psychiatry and General Internal Medicine Director, Consultation Liaison Psychiatry Mark F Walker, M.D Assistant Professor of Neurology Larry Waterbury, M.D Associate Professor of Oncology and Medicine Robert S Weinberg, M.D Chairman, Department of Ophthalmology Laura S Welch, M.D Adjunct Professor of Environmental and Occupational Health George Washington University Medical Director, Center to Protect Workers Rights Silver Spring, Maryland Karen A Wendel, M.D Assistant Professor Division of Infectious Diseases University of Colorado Health Science Center Denver, Colorado E James Wright, M.D Assistant Professor of Urology Chief, Department of Urology S Elizabeth Whitmore, M.D., Sc.M Associate Professor of Dermatology Paul M Yen, M.D Associate Professor of Medicine Division of Endocrinology John H Wilckens, M.D Assistant Professor of Orthopaedics Chairman, Department of Orthopaedics Jonathan M Zenilman, M.D Professor of Medicine Chief, Infectious Diseases Division Jean Wu, M.D., M.H.S Instructor of Medicine Robert A Wise, M.D Professor of Pulmonary and Critical Care Medicine Roy C Ziegelstein, M.D Professor of Medicine Executive Vice Chairman Director, Residency Program in Internal Medicine Christopher L Wolfgang, M.D., Ph.D Assistant Professor of Surgery Attending Surgeon Philip D Zieve, M.D Professor of Medicine Senior Advisor Acknowledgment The Editors wish to acknowledge Ms Susan McFeaters, who has provided skillful and dedicated assistance on all editions of this book and, for the seventh edition, has become the Johns Hopkins administrative coordinator for the entire book Char Count= P1: PBU/OVY P2: PBU/OVY GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls • QC: PBU/OVY T1: PBU C O N T E N T S May 16, 2006 • 12 Geriatric Medicine: Special Considerations 177 • SECTION 1: ISSUES OF GENERAL CONCERN IN AMBULATORY MEDICINE 1 Ambulatory Care: Territory and Core Proficiencies 03 L Randol Barker Practicing Evidence-Based Medicine 13 Darius A Rastegar The Practitioner–Patient Relationship and Communication during Clinical Encounters 25 L Randol Barker Patient Education and the Promotion of Healthy Behaviors 38 Karan A Cole and David E Kern Complementary and Alternative Medicine 61 Bimal H Ashar Sexual Disorders: Diagnosis and Treatment 73 Leonard R DeRogatis, Arthur L Burnett, Linda C Rogers, Chester W Schmidt, Jr., and Peter J Fagan Sleep Disorders 100 David N Neubauer, Philip L Smith, III, and Christopher J Earley Occupational and Environmental Disease and Bioterrorism 118 Laura S Welch and David W Blodgett Selected Special Services and Programs: Disability Insurance, Vocational Rehabilitation, Family and Medical Leave Act, and Home Health Services 137 L Randol Barker 10 Care of the Patient with Cancer 144 11 Adolescent Patients: Special Considerations 153 Larry N Scherzer Char Count= • Acknowledgment viii Preface xv Color Plate falls between Sections 16 and 17 Michael J Purtell and Larry Waterbury 16:21 Colleen Christmas and Thomas E Finucane 13 Care at the End of Life 192 Grace A Cordts, Thomas E Finucane, and Clare H Ferrigno • SECTION 2: PREVENTIVE CARE 209 14 Integrating Prevention into Ambulatory Practice 211 • Gregory P Prokopowicz and David E Kern 15 Principles of Nutrition in Ambulatory Care 228 Eugene C Corbett, Jr 16 Exercise for the Healthy Patient 241 Ross E Andersen and Kerry J Stewart 17 Genetic Testing and Counseling 251 Jennifer E Axilbund and Constance A Griffin 18 Immunization to Prevent Infectious Disease 261 William H Barker • • SECTION 3: PSYCHIATRIC AND BEHAVIORAL PROBLEMS 277 19 Evaluation of Psychosocial Problems 279 Varsha K Vaidya and Chester W Schmidt, Jr 20 Psychotherapy in Ambulatory Practice 286 Robert P Roca and L Randol Barker 21 Somatization 293 Robert P Roca 22 Anxiety and Anxiety Disorders 306 Una D McCann and O Joseph Bienvenu, III 23 Personality and Personality Disorders 324 Robert P Roca 24 Mood Disorders 329 Francis M Mondimore ix P1: PBU/OVY P2: PBU/OVY GRBT129-FM GRBT129/Barker- 2568G GRBT129-Barker-v14.cls x QC: PBU/OVY T1: PBU May 16, 2006 16:21 Contents 41 International Medicine: Care of Travelers and 25 Schizophrenia and Related Psychotic Disorders 349 Foreign-Born Patients 609 Andrew F Angelino and Chester W Schmidt Jr Stephen D Sears and Nathaniel W James, IV 26 Cognitive Impairment and Mental Illness in the Elderly 359 Peter V Rabins 27 Tobacco Use and Dependence 368 David W Blodgett 28 Alcoholism and Associated Problems 382 Michael I Fingerhood 29 Illicit and Therapeutic Use of Drugs with Abuse Liability 411 • Alvin M Sanico 31 Approach to the Patient with Fever 457 Paul G Auwaerter 32 Bacterial Infections of the Skin 465 Patrick A Murphy 33 Respiratory Tract Infections 474 Nicholas H Fiebach and R Graham Barr 34 Tuberculosis in the Ambulatory Patient 501 Patrick A Murphy 35 Acute Gastroenteritis and Associated Conditions 513 Eric L Nuermberger 36 Genitourinary Infections 528 Patrick A Murphy 37 Sexually Transmitted Diseases 538 Karen A Wendel and Jonathan M Zenilman 38 Lyme Disease and Other Tick-Borne Illnesses 560 Paul G Auwaerter and John A Flynn 39 Human Immunodeficiency Virus Infection 571 Darius A Rastegar and Michael I Fingerhood 40 Ambulatory Care for Selected Infections Including Osteomyelitis, Lung Abscess, and Endocarditis 597 Patrick A Murphy 42 Disorders of the Esophagus: Dysphagia, Noncardiac Chest Pain, and Gastroesophageal Reflux 645 H Franklin Herlong and Mack C Mitchell, Jr Mack C Mitchell, Jr and H Franklin Herlong SECTION 4: ALLERGY AND INFECTIOUS DISEASE 435 30 Allergy and Related Conditions 437 • 43 Peptic Ulcer Disease 659 Michael I Fingerhood • • SECTION 5: GASTROINTESTINAL PROBLEMS 643 44 Abdominal Pain and Irritable Bowel Syndrome 670 Mack C Mitchell, Jr and H Franklin Herlong 45 Selected Gastrointestinal Problems: Constipation and Diarrhea 687 Mack C Mitchell, Jr and H Franklin Herlong 46 Selected Gastrointestinal Problems: Gastrointestinal Bleeding, Colorectal Cancer Screening, and Diverticular Disease 705 Mack C Mitchell, Jr and H Franklin Herlong 47 Diseases of the Liver 717 Esteban Mezey • SECTION 6: RENAL AND UROLOGIC PROBLEMS 731 48 Proteinuria 733 Jean Wu and Edward S Kraus 49 Hematuria 740 David A Spector 50 Hypokalemia 746 John E Anderson 51 Urinary Stones 754 David A Spector 52 Chronic Kidney Disease 766 Gary R Briefel 53 Selected Disorders of the Prostate 798 E James Wright 54 Urinary Incontinence 807 Thomas E Finucane and E James Wright • Char Count= ... 48 ,18 0 35,935 10 0.0 5.4 4.0 30 ,14 1 3.4 24,877 23,725 2.8 2.7 22,362 2.5 20,444 17 ,766 2.3 2.0 17 ,585 16 ,702 2.0 1. 9 15 ,6 51 14 ,19 7 14 ,10 1 12 ,692 11 ,883 11 ,767 1. 8 1. 6 1. 6 1. 4 1. 3 1. 3 11 ,670 1. 3 10 ,970... 9,622 10 3,974 10 0.0 24.2 17 .6 13 .5 7.9 5.6 4.3 3.6 2.4 2.3 1. 9 1. 9 1. 9 1. 1 11 .7 314 .4 76 .1 55.4 19 8 .1 60.9 17 .6 13 .4 11 .4 7.7 7.4 6 .1 6.0 6.0 3.4 36.7 From Woodwell DA, Cherry DK National Ambulatory. .. extremity 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 10 0.0 8.2 6.9 3.3 6.2 17 .6 5 .1 6.5 7.6 70.4 37.3 77.9 73.0 72.5 76.4 35.6 37.6 45.8 15 .4 15 .6 10 .6 18 .6 16 .5 4.7 19 .0 26.4 22.6 7.8 10 .3 2.3