Biomedical subjects

Willie Underwood

Publications and source records attributed to Willie Underwood.

At least 19 recordsLinked to original sources

PubMed2006

Obesity and prostate cancer screening among African-American and Caucasian men.

BACKGROUND: Differential prostate-specific antigen (PSA) testing practices according to obesity-related comorbid conditions may contribute to inconsistent results in studies of obesity and prostate cancer. We investigated the relationship between obesity and PSA testing, and evaluated the role of prior diagnoses and disease screening on PSA testing patterns. METHODS: Men, 40 and 79 years old and without prior prostate cancer were recruited from 25 health centers in the Southern US (n = 11,558, 85% African-American). An extensive in-person interview measured medical and other characteristics of study participants, including PSA test histories, weight, height, demographics, and disease history. Odds ratios (OR) and (95% confidence intervals) from logistic regression summarized the body mass index (BMI) and PSA test association while adjusting for socio-economic status (SES). RESULTS: BMI between 25 and 40 was significantly associated with recent PSA testing (past 12 months) (OR(25.0-29.9) = 1.23 (1.09, 1.39); OR(30-34.9) = 1.36 (1.18, 1.57); OR(35.0-39.9) = 1.44 (1.18, 1.76); OR(> or =40) = 1.15 (0.87, 1.51)). Prior severe disease diagnoses, such as heart disease, did not influence the obesity and PSA test association. However, adjustment for prior high blood pressure or high cholesterol diagnoses reduced the BMI-PSA testing associations. Physician PSA test recommendations were not associated with BMI, and results did not appreciably vary by race. CONCLUSIONS: Overweight and obese men were preferentially PSA tested within the past 12 months. BMI was not associated with physician screening recommendations. Data suggest that clinical diagnoses related to obesity increase clinical encounters that lead to preferential selection of obese men for prostate cancer diagnosis. This detection effect may bias epidemiologic investigations of obesity and prostate cancer incidence.

Adult↗

PubMed2006

Risk factors for adverse outcomes after transurethral resection of bladder tumors.

BACKGROUND: Risk factors for adverse outcomes after transurethral resection of bladder tumors (TURBT) have not been identified to date. Such information would facilitate preoperative risk stratification and case-mix-adjusted outcome comparison, and lead to the development of processes of care directed at improving outcomes and ultimately the quality of care for bladder carcinoma patients. METHODS: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. Since 1991, a total of 21,515 TURBTs have been prospectively registered by the NSQIP; these cases compose the current study population. Using multivariable logistic regression, the authors determined the independent association between preoperative patient risk factors and perioperative elements of structure/process and morbidity, mortality, and prolonged length of stay (LOS) outcomes. RESULTS: The postoperative complication, 30-day, and 90-day mortality rates were 4.3%, 1.3%, and 3.3%, respectively. The median, 75th percentile, and 90th percentile for LOS among patients undergoing TURBT was 2 days, 3 days, and 8 days, respectively. Robust preoperative patient risk factors that were found to be uniformly associated with all adverse outcomes included the presence of disseminated disease (odds ratio [OR], 1.9-5.2) weight loss (OR, 1.8-3.8), low serum albumin (OR, 2.3-7.1), elevated serum creatinine (OR, 1.3-2.9), a dependent functional status (OR, 1.5-2.7), and emergent case status (OR, 1.8-3.1). Compared with models using preoperative patient factors alone, models including perioperative structure and process measures explained further variation in surgical outcomes (each likelihood ratio test, P < .0001). CONCLUSIONS: The findings of the current study highlight the fact that there are a wide array of patient risk factors that are associated with adverse outcomes after TURBT. Validation of those processes implemented to modify such elements can provide a basis for quality metrics in the context of TURBT.

Aged↗

PubMed2006

Racial disparity in bladder cancer: trends in tumor presentation at diagnosis.

PURPOSE: White Americans have a 2-fold higher incidence of bladder cancer than black Americans but the latter have a higher mortality rate. This survival disparity has been attributable largely to the late stage presentation of black patients but other factors likely exist. We examined trends in bladder cancer presentation and survival in white and black patients in a 27-year period to gain additional insight into these factors. MATERIALS AND METHODS: Using Surveillance, Epidemiology, and End Results Program data trends in tumor presentation, treatment and survival were defined in 93,093 patients, including 89,481 white and 3,612 black patients, with bladder cancer. Parameters were measured during 5 and 7-year intervals from 1973 to 1999. Bivariate relationships between patient/disease characteristics, and the time and survival were explored. Cox proportional hazard models were used to examine the independent effect of parameters on disease specific survival. RESULTS: Median followup was 10 years. Black patients consistently presented with higher stage and grade tumors (each p <0.001). This was most pronounced in black women. A trend toward earlier stage presentation was observed in black and white patients with time (p = 0.05 and <0.001, respectively). Ten-year survival in black and white patients with similar tumor stage and grade was consistently worse in black patients, except those with metastasis. An adjusted multivariable model demonstrated a persistent survival disadvantage in black patients (HR 1.35, p <0.001). CONCLUSIONS: Racial disparities in bladder cancer stage, grade, treatment and adjusted survival continue to exist between white and black Americans despite improvements in stage presentation and survival of localized and regional disease. These data provide the rationale to study treatment decision making, access, delay and potential bias in the black community.

Black or African American↗

PubMed2006

The effects of adjusting for case mix on mortality and length of stay following radical cystectomy.

PURPOSE: Prior studies evaluating quality of care following radical cystectomy have been constrained by the use of retrospective reviews of single institutional series and limited ability to examine risk factors in a comprehensive manner. Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care. MATERIALS AND METHODS: The National Surgical Quality Improvement Project is a prospective quality management initiative at 123 Veterans Affairs Medical Centers nationwide. The project collects preoperative clinical and intraoperative data, and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomies have been captured by the National Surgical Quality Improvement Project. Modeling using logistic regression was performed to identify preoperative risk factors associated with mortality and prolonged length of stay (greater than 90th percentile) after radical cystectomy. RESULTS: The 30 and 90-day mortality rates following cystectomy were 2.9% and 6.8%, respectively, and median hospital stay was 11 days (90th percentile 30). Robust preoperative factors associated with mortality and prolonged length of stay that uniformly increased risk were older patient age (OR 1.2 to 1.4), American Society of Anesthesiologists class 3 or greater (OR 1.5 to 3.3), dependent functional status (OR 1.7 to 2.0) and low serum albumin (OR 2.1 to 12.0). CONCLUSIONS: A defined set of preoperative risk factors is independently associated with greater mortality and hospital stay following radical cystectomy. The breadth of these factors suggests that complex case mix adjustment is mandatory when comparing outcomes. Implementation of novel processes directed toward minimizing patient risk has the potential to improve outcomes following cystectomy.

Age Factors↗

PubMed2005

Gender and geographic influence on the racial disparity in bladder cancer mortality in the US.

BACKGROUND: In 2005, there were an estimated 63,210 new cases of bladder cancer and 13,180 related deaths in the US. African Americans reportedly have a lower incidence of bladder cancer, but a higher mortality. The objective of this study was to evaluate the gender and geographic differences in bladder cancer survival between Caucasians and African Americans to better understand the racial disparity in bladder cancer survival. STUDY DESIGN: Surveillance Epidemiology and End Results Program (SEER) data were used to evaluate racial differences in bladder cancer survival from 1973 to 1999. Bivariate and multivariate Cox proportional hazard models were performed to determine the relationship between race and survival, adjusting for cancer stage and grade, marital status, region of country, treatment received, and the interaction between race and region. RESULTS: African Americans were diagnosed with higher grade (p < 0.001) and higher stage (p < 0.001) tumors, compared with Caucasians. In the multivariable model, African-American race was an independent predictor of poor survival, adjusting for age, marital status, region of the country, stage, grade, treatment received, and interaction between race and region. Surprisingly, African Americans diagnosed in the Atlanta metropolitan area had a substantially worse survival. CONCLUSIONS: African Americans were diagnosed with more aggressive and more advanced tumors. Adjusted multivariable models demonstrated a survival advantage for Caucasians, with African-American race being an independent predictor of poor survival, especially when diagnosed in the Atlanta metropolitan area. Racial disparity continues to exist in bladder cancer presentation and survival in the US.

Black or African American↗

PubMed2005

PSA testing in office-based clinics: are we testing as much as we think?

BACKGROUND: Self-report studies of widespread use of routine prostate-specific antigen (PSA) testing have fueled concerns about overuse and possible harm. The purpose of this study was to examine use of PSA testing during physician office visits in a national sample of prostate-cancer-free men ages 40 years and older. METHODS: Bivariate and multivariate logistic regression models of receiving a PSA test by prostate-cancer-free men ages 40 years and older were performed using the 2000 National Ambulatory Medical Care Survey. RESULTS: There were 2,709 primary care and urology office visits by prostate-cancer-free men 40 years of age and older, and 10.2% resulted in a PSA test. In a multivariate model, men in their 70s had considerably higher odds (odd ratio, 1.60; 95% CI, 1.11-2.32) and men with multiple medical comorbidities had considerably lower odds (odds ratio, 0.28; 95% CI, 0.10-0.65) of receiving a PSA test. CONCLUSIONS: We report lower use of PSA testing than previously published. Greater insight into use of PSA testing based on clinic and hospital administrative data are required to determine the impact of PSA testing on the cost of health care and prostate cancer incidence and mortality.

Adult↗

PubMed2005

Impact of brachytherapy on regional, racial, marital status, and age-related patterns of definitive treatment for clinically localized prostate carcinoma.

BACKGROUND: The impact of the increased use of permanent prostate brachytherapy compared with other treatment modalities (such as radical prostatectomy and external-beam radiation therapy [EBRT]) for the treatment of clinically localized prostate carcinoma, and the previously reported regional, racial, and age-related variations in prostate carcinoma treatment, have not been well characterized to date. Therefore, the authors evaluated the impact of permanent prostate brachytherapy on the relative rates of the use of specific prostate carcinoma treatment modalities over time. METHODS: Surveillance, Epidemiology, and End Results (SEER) cancer registry data from 1995 to 2000 were analyzed in a longitudinal, observational study utilizing bivariate and multivariate techniques. RESULTS: Differential changes in the use of specific definitive treatment modalities were noted by region, age group, racial/ethnic group, and marital status. Increasing use of permanent prostate brachytherapy, with and without concomitant EBRT, was proportional to the decreasing use of radical prostatectomy alone and EBRT alone over time. CONCLUSIONS: The current study revealed that permanent prostate brachytherapy appears to be replacing other treatment modalities in increasing numbers of clinically localized prostate carcinoma cases. Persistent regional, racial/ethnic, marital status, and age-related differences in the use of permanent prostate brachytherapy merit further investigation.

Adult↗

PubMed2005

Effects of work hour reduction on residents' lives: a systematic review.

CONTEXT: The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents. OBJECTIVE: To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life. DATA SOURCES: We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings. STUDY SELECTION: Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States. DATA EXTRACTION: For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form. DATA SYNTHESIS: Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct. CONCLUSIONS: Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.

Education, Medical↗

PubMed2005

Racial treatment trends in localized/regional prostate carcinoma: 1992-1999.

BACKGROUND: African-American men have a greater incidence of and mortality from prostate carcinoma compared with white men, and they are less likely to receive definitive therapy (radical prostatectomy or external beam radiation therapy). During the 1990s, the use of brachytherapy increased; however, its influence on racial and ethnic prostate carcinoma treatment trends remains unclear. The objective of this study was to describe treatment trends over the period 1992-1999 for localized/regional prostate carcinoma among white, Hispanic, and African-American men. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) registry data from 1992 through 1999, logistic regression models were used to determine whether the odds of receiving a specific treatment modality differed by racial and ethnic group and whether the differences changed over time when the models were adjusted for age, marital status, tumor grade, and SEER site (geography). RESULTS: The authors identified 142,340 men, including white men (81.6%), Hispanic men (6.4%), and African-American men (12.0%). Racial and ethnic differences in the rates of use of androgen-deprivation therapy/expectant management were noted; however, these differences appeared to lessen over time (P < 0.001). The rate of utilization of radical prostatectomy increased for Hispanic men, remained flat for African-American men, and decreased for white men. The utilization of brachytherapy and combination therapy increased for all three groups; however, the greatest increase in utilization was among white men. CONCLUSIONS: Further research will be required to determine the patient-level and provider-level variables that influence racial and ethnic treatment differences in localized/regional prostate cancer.

Black or African American↗

PubMed2005

Behavioral associations between prostate and colon cancer screening.

BACKGROUND: Despite the controversy over the utility of routine prostate-specific antigen (PSA) screening in reducing prostate cancer-specific mortality, it has gained widespread use throughout the United States. Although colorectal cancer (CRC) screening reduces CRC mortality and appears to be cost effective, CRC screening adherence is suboptimal. To better understand screening behaviors among men, the Behavioral Risk Factors Surveillance Survey was used to identify potential relationships that would allow interventions to enhance CRC screening. STUDY DESIGN: We included in our analysis 22,304 men, 50 years and older, who participated in the 2002 Behavioral Risk Factors Surveillance Survey. Chi-square and multivariate analyses were performed to determine the independent correlates of adherence to CRC screening. Independent variables evaluated were age, race, educational level, employment status, income, health insurance, the presence of a personal physician, self-reported general health, current smoking status, and receiving a PSA test. RESULTS: Men were more adherent with PSA screening than CRC screening (50.4% versus 47.6%;p < 0.002). In multivariate analysis, adherence to PSA screening (adjusted odds ratio [OR] 3.24, p < 0.001) exerted the largest independent effect on CRC screening adherence. Other positive correlates of adherence to CRC screening were having health insurance (adjusted OR 1.39, p < 0.01) and a personal physician (adjusted OR 2.01, p < 0.01). Age predicted CRC screening with an inverse-U correlation. Failure to adhere to CRC screening was associated with self-reported good health (adjusted OR 0.87, p < 0.01) and being a current smoker (adjusted OR 0.65, p < 0.01). Even in men who were compliant with PSA testing, CRC screening remained suboptimal (65%). CONCLUSIONS: More men received PSA testing than CRC screening. Men who received PSA testing were more likely to adhere to CRC screening. Taken together, PSA testing may represent a "teachable moment" for a behavior-related intervention aimed at reducing the risk of colon cancer. Targeting men who already accept one form of cancer screening can potentially increase CRC screening adherence.

Aged↗

PubMed2005

Learning to improve safety: false-positive pathology report results in wrongful surgery.

BACKGROUND: A patient experienced a wrongful surgical resection, specifically, a radical retropubic prostatectomy because of a false-positive pathology report. FINDINGS FROM THE ROOT CAUSE ANALYSIS (RCA): The RCA team identified three antecedent events that contributed to this medical error: (1) a second (concurring) pathologist did not provide a written opinion, (2) a single pathologist who reviewed and signed the final report, and (3) a pathologist who did not review the case and reconfirm the diagnosis immediately prior to the surgical resection. RECOMMENDATIONS: The RCA team recommended that the concurring pathologist write his or her diagnostic findings on the referral form, two pathologists review and sign the final typed report, and a pathologist rereview the slides on the business day prior to a surgical resection. Because the prostate specific antigen (PSA) value can be helpful in select cases of prostate cancer, the team recommended the PSA value be referenced when reviewing prostate specimens obtained through fine-needle biopsy. TRACKING COMPLIANCE: Because a wrongful surgical resection is a rare event, emphasis was placed on measuring compliance with distinct elements that were part of the revised procedure. During a 12-month span, practitioners demonstrated sustained compliance to the enhanced process for analyzing and reporting results.

Aged↗

PubMed2005

Identifying risk factors for potentially avoidable complications following radical cystectomy.

PURPOSE: Morbidity after radical cystectomy is common and associated with increased health care resource use. Accurate characterization of complications after cystectomy, associated patient specific risk factors, and perioperative processes of care are essential to directing changes in perioperative management that will reduce morbidity and improve the quality of patient care. MATERIALS AND METHODS: The National Surgical Quality Improvement Program (NSQIP) is a prospective quality management initiative of 123 Veterans Affairs Medical Centers nationwide. The NSQIP collects clinical information, intraoperative data and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomy procedures have been captured by the NSQIP. Modeling using logistic regression was performed to identify patient specific risk factors and perioperative process measures associated with postoperative morbidity. RESULTS: Of the 2,538 subjects at least 1 postoperative complication developed in 774 (30.5%). The most frequent complication was ileus (10%). Several factors were associated with the development of a complication, including age, dependent functional status, preoperative dyspnea, preoperative acute renal failure, chronic steroid use, preoperative alcohol consumption, American Society of Anesthesiology score, use of general anesthetic, operative time, intraoperative blood requirement and surgeon level of training. CONCLUSIONS: Morbidity remains high after cystectomy with 30.5% of subjects experiencing at least 1 complication. Measurable patient specific risk factors and perioperative processes associated with postoperative morbidity following cystectomy are now delineated which allows for improved risk stratification, patient counseling, and the development of novel processes that may incrementally reduce risk and improve outcomes.

Acute Kidney Injury↗

PubMed2004

Systematic review: effects of resident work hours on patient safety.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) mandated new work hours rules for all residency programs in July 2003. PURPOSE: To critically evaluate the evidence that adhering to the ACGME standards will improve patient safety. DATA SOURCES: Searches of electronic databases (MEDLINE, EMBASE, PREMEDLINE, and Current Contents) and other methods to identify the English-language literature for studies on resident work hours for the years 1966 to 2004. STUDY SELECTION: Studies that assessed a system change designed to counteract the effects of work hours, fatigue, or sleep deprivation and that included an outcome related to patient safety were included. Seven studies met these criteria. DATA EXTRACTION: Two investigators abstracted data from all included studies by using a standard data abstraction form; each study was rated according to established criteria to assess study design quality. DATA SYNTHESIS: Interventions used were float systems, other cross-coverage systems, or unspecified schedule changes. Outcomes included mortality, adverse events, and medication errors. The results suggest that introducing such interventions has an unclear effect on selected patient safety indicators. Specifically, some indicators (such as mortality) may not change after interventions, while other indicators may improve or worsen. LIMITATIONS: This analysis is limited by the study designs of the included studies, the diversity of interventions in the studies, and the possibility of publication bias favoring studies that demonstrated statistically significant differences. CONCLUSION: Evidence on patient safety is insufficient to inform the process of reducing resident work hours.

Continuity of Patient Care↗

PubMed2004

Viewpoints from generation X: a survey of candidate and associate viewpoints on resident duty-hour regulations.

BACKGROUND: The American Medical Student Association, the Committee of Interns and Residents, and Public Citizen petitioned the Occupational Safety and Health Administration for national resident duty-hour limitations. Subsequently, federal legislation was introduced to limit resident duty hours. To preempt the federal government, the Accreditation of Graduate Medical Education implemented resident duty-hour guidelines. STUDY DESIGN: To evaluate the viewpoints and attitudes of surgical resident and staff physicians as they pertain to the national resident duty-hour guidelines, we asked attendees of the American College of Surgeons' Candidate Associate Society Forum during the American College of Surgeons Clinical Congress meeting in 2001 to complete a self-administered questionnaire. Analyses were performed to determine the frequency of response for each survey item. RESULTS: Eighty-six of the 102 (84%) surgeons who attended the American College of Surgeons Forum completed the survey. Most disagreed with the federal government involvement in regulating duty hours. Although most agreed that residents should not be on call more than every third night, viewpoints varied on the other duty-hour guidelines. Most (63.4%) reported that residents should work 81 to 100 hours per week, but 11% reported that residents should work > 101 hours per week and 25.6% reported that <or= 80 hours per week was optimal. CONCLUSIONS: As future guidelines are considered, further studies must be done to determine the viewpoints and attitudes of surgical resident and staff physicians with regard to resident duty-hour reform. These "front line" individuals may have unique insights into the benefits and barriers of duty-hour regulations.

Attitude of Health Personnel↗

PubMed2004

Inguinal bladder hernia masking bowel ischemia.

Displacement of the bladder outside of the pelvis by way of the inguinal canal represents an infrequent presentation of an inguinal hernia that rarely causes urinary tract obstruction. However, bladder hernias can become bothersome, painful, and potentially dangerous. We report a 56-year-old man with a chronic bladder hernia who became acutely unable to empty his bladder from its position in the right hemiscrotum after a motor vehicle accident. At hernia repair, bladder and ischemic bowel were discovered, mandating significant small bowel resection. This case presents interesting considerations and potential pitfalls when evaluating a patient with a bladder hernia.

Accidents, Traffic↗

PubMed2004

Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older.

OBJECTIVES: To examine the impact of various treatment modalities on survival among patients with bladder cancer who were 80 years old or older compared with younger patients. A compendium of evidence suggests that bladder cancer surgery is safe among octogenarians; however, the benefit of such treatment in a population with limited life expectancy has not been well documented. METHODS: Subjects with the primary diagnosis of bladder cancer were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry between 1988 and 1999. Of the 13,796 patients diagnosed with bladder cancer, 24% were older than 80 years of age. Proportional hazards regression modeling was performed to determine the independent association of treatment strategy on overall and bladder cancer survival while adjusting for multiple covariates. RESULTS: Of patients 80 years old or older, bladder cancer management included watchful waiting (7%), radiotherapy alone (1%), full or partial cystectomy (12%), and transurethral resection (79%). Patients 80 years old or older were less likely to be treated with extirpative surgery than their younger counterparts (P <0.0001). Cox proportional hazards models demonstrated that, among patients 80 years old or older, radical cystectomy/partial cystectomy had the greatest risk reduction in death from bladder cancer (hazard ratio 0.3) and death from any cause (hazard ratio 0.4) among the primary treatment modalities (both P <0.0001). CONCLUSIONS: Disparities in practice patterns between younger and geriatric patients with bladder cancer exist. We provide compelling evidence that aggressive surgical management of bladder cancer in these patients may improve survival. Risk adjustment tools should be used to identify patients (young and old) who would be better served by less aggressive management.

Age Factors↗

PubMed2004

Racial/ethnic disparities in the treatment of localized/regional prostate cancer.

PURPOSE: Racial/ethnic disparities in the utilization of definitive therapy for prostate cancer are well recognized in the United States. The effect of race on the use of contemporary definitive therapies, including brachytherapy, and the assessment of Hispanic men with regard to racial/ethnic disparity has not been fully characterized. MATERIALS AND METHODS: We evaluated treatment patterns using Surveillance, Epidemiology and End Results registry data on 142340 localized/regional stage cases between 1992 and 1999 in white, black and Hispanic American men. Definitive therapy was defined as radical prostatectomy, external beam radiation, brachytherapy or combinations thereof. Logistic regression models were constructed to determine the odds of receiving definitive treatment, adjusting for age, marital status, tumor grade, and Surveillance, Epidemiology and End Results site. RESULTS: Black and Hispanic men were less likely to receive definitive therapy than white men (p <0.001). Higher tumor grade was associated with decreasing odds of definitive therapy for black and Hispanic men (p <0.001) compared to white men. The racial/ethnic disparities in the use of definitive therapy decreased between 1992 and 1999 with the greatest decrease in Hispanic men. CONCLUSIONS: Hispanic and black men were less likely than white men to receive definitive therapy. The disparity in the use of definitive therapy between 1992 and 1999 decreased significantly in Hispanic men, although a significant disparity in the use of definitive therapy persisted in black men. Our observation of an association between tumor grade and the racial/ethnic disparity in definitive therapy ties together relevant biological and social factors that may contribute to the observed racial/ethnic disparity in mortality.

Aged↗

PubMed2004

Benign paratesticular Schwannoma.

Scrotal masses are common findings on genitourinary exam. The majority of these masses are benign and can be identified via history and physical exam alone. Question as to the origin of these masses merits additional evaluation that typically consists of an imaging study (e.g., ultrasound) and possibly serum tumor markers (e.g., HCG and AFP). In the end, surgical exploration may be necessary. Herein, the authors describe a rare case of benign paratesticular Schwannoma and discuss the clinical presentation and treatment of scrotal masses.

Humans↗