The influence of ethnicity on Gleason score

BackgroundTo determine if Gleason score exhibits any significant variation between African-Americans and Caucasian men with prostate cancer.MethodsWe conducted a retrospective cohort study. Inclusion required diagnosis of prostate cancer and reporting it to the TriHealth tumor registry from 1995–2005. We excluded individuals of any other ethnicity than the two of interest (N = 15) and individuals without a reported Gleason score (N = 82). For each patient we collected data on ethnicity, Gleason score, age, American Joint Committee on Cancer (AJCC) stage, insurance status, and surgery. Gleason score was divided into low-grade (1–6) and high-grade disease (7–10). Institutional Review Board approval was obtained prior to data collection.ResultsA total of 1916 patients, (1476 Caucasians, 440 African-Americans) were eligible for inclusion in the study. There was no significance difference between either ethnicity for age, insurance status, and the percentage of men needing a transurethral resection of the prostate (TURP). There was no difference between either ethnicity for stages 0, 1, and 4. African-Americans were more likely to have stage 2 disease, while Caucasian men possessed more stage 3 disease (p<0.05). African-Americans were significantly more likely to not have any prostate surgery (p<0.05). Caucasian men were more likely to have a prostatectomy. African-American men with prostate cancer were significantly more likely to have a high-grade Gleason score compared to Caucasian men (OR = 1.22, 95% CI = 1.11–1.35).ConclusionAfrican-American race is a predictor of more advanced Gleason score at the time diagnosis of prostate cancer.     

The Central Massachusetts Oral Health Initiative (CMOHI): a successful public–private community health collaboration

Objectives: The Central Massachusetts Oral Health Initiative (CMOHI) aimed to improve access to quality oral health care in central Massachusetts. Methods: A broad‐based public and private organization partnership with local and national funding created a steering committee to organize school administrators, community leaders, and a medical school to collaborate on five goals: advocate for changes in oral health policy, increase oral health care access, provide school‐based dental services for underserved children, establish a Dental General Practice Residency, and educate medical professionals about oral health. Results: A state legislative Oral Health Caucus helped secure sought‐after policy improvements; more regional dentists now accept Medicaid; community health center capacity to provide dental services was expanded; school‐based programs were designed and delivered needed dental services; a dental residency was created; and methods of educating medical professionals were established. Conclusions: Significant sustainable gains in oral health care access were created through our multifaceted approach, ongoing evaluation and communication, coordination of CMOHI partner resources, and collaboration with other involved parties.     

Intraosseous infusions through non-styletted needles

This pilot study investigated the potential use of non-styletted needles for intraosseous infusion using a cadaver model. The results suggested that, in emergency situations, fluids may be successfully infused intraosseously using non-styletted needles.     

Concussion in sport: Diagnosis, management, return to competition

Summary  Cerebral concussions are a rather frequent occurrence in the athletic arena, and physicians are often called upon to evaluate concussed athletes’ ability to return to the playing field. Although there are currently no universally accepted recommendations or standards for the management of concussion, several sets of guidelines have been proposed. As a result, physicians should be familiar with at least one set of guidelines, which will allow consistency and safety in the management of this type of head injury. Nevertheless, deviation from the chosen guideline should not be judged inappropriate; clinical judgment and conservatism should always prevail in rendering a decision. As always, the avoidance of further injury and tragic consequences should remain the primary aim when assisting any athlete. Certificate of Added Qualifications in Sports Medicine Doctor of Philosophy in Exercise Physiology