A Backward Walking Training Program to Improve Balance and Mobility in Acute Stroke: A Pilot Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Strategies to address gait and balance deficits early poststroke are minimal. The postural and motor control requirements of Backward Walking Training (BWT) may provide benefits to improve balance and walking speed in this population. This pilot study (1) determined the feasibility of administering BWT during inpatient rehabilitation and (2) compared the effectiveness of BWT to Standing Balance Training (SBT) on walking speed, balance, and balance-related efficacy in acute stroke. METHODS: Eighteen individuals 1-week poststroke were randomized to eight, 30-minute sessions of BWT or SBT in addition to scheduled therapy. Five-Meter Walk Test, 3-Meter Backward Walk Test, Activities-Specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, and Function Independence Measure-Mobility were assessed pre- and postintervention and at 3 months poststroke. RESULTS: Forward gait speed change (BWT: 0.75 m/s; SBT: 0.41 m/s), assessed by the 5-Meter Walk Test, and backward gait speed change (BWT: 0.53 m/s; SBT: 0.23 m/s), assessed by the 3-Meter Backward Walk Test, preintervention to 1-month retention were greater for BWT than for SBT (P < 0.05). Group difference effect size from preintervention to 1-month retention was large for Activities-Specific Balance Confidence Scale, moderate for Berg Balance Scale and Function Independence Measure-Mobility, and small for Sensory Organization Test. DISCUSSION AND CONCLUSIONS: Individuals 1-week poststroke tolerated 30 min/d of additional therapy. At 1-month postintervention, BWT resulted in greater improvements in both forward and backward walking speed than SBT. Backward walking training is a feasible important addition to acute stroke rehabilitation. Future areas of inquiry should examine BWT as a preventative modality for future fall incidence.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A193).

Nature contact at school: The impact of an outdoor classroom on children's well-being.

Nature contact facilitates healthy child development and a disconnect with nature presents potential health risks. This study was designed to test a nature intervention at an elementary school among children. An experimental crossover design was implemented over six weeks; two teachers taught their respective kindergarten classes the daily language arts lesson in either the control (indoor classroom) or nature treatment (outdoor classroom) conditions. Child well-being measures were compared in the two conditions. Teachers' redirections of child behavior were significantly fewer in the nature condition (t = 2.49, p < 0.05) compared to the control. Also, fewer children were off task in the nature condition on average. There were mixed well-being results; children reported no significance difference in happiness in the two conditions, but teachers reported modest benefit in child well-being in the nature condition. The outdoor classroom is a promising method for increasing nature contact and promoting student well-being.

Ultrasound marking by gastroenterologists prior to percutaneous liver biopsy removes the need for a separate radiological evaluation.

BACKGROUND/AIM: Ultrasound marking by radiologists prior to percutaneous liver biopsy (PLB) results in biopsy site adjustment, decreased pain related complications and improved tissue yield. Minimal data exists on the impact of ultrasound marking by gastroenterologists on these parameters. The study aim was to evaluate whether ultrasound marking by gastroenterologists results in improved PLB tissue yield, fewer needle passes and decreased biopsy failure rates compared to blind biopsy, eliminating the need for a separate radiological evaluation. METHODOLOGY: All PLB performed by gastroenterologists from June 1999 to February 2003 at the University of Florida College of Medicine, Jacksonville, were reviewed retrospectively. Data collected included ultrasound marked or blind PLB, demographics, indication, number of passes performed, and specimen length, if obtained. RESULTS: Four hundred and eighty PLB were included: 328 performed with ultrasound marking and 152 blind. Ultrasound marking by gastroenterologists prior to PLB resulted in fewer passes and longer specimens as well as a decreased failure rate in ultrasound marked compared to blind PLB. CONCLUSIONS: Ultrasound marking by gastroenterologists prior to PLB provided significantly larger tissue samples, fewer needle passes and a decreased biopsy failure rate compared to blind PLB. This removes the need for a separate radiological evaluation on the procedure day.

Risk factors and predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR).

BACKGROUND: Reducing intracranial hemorrhage (ICH) can improve patient outcome in acute ischemic stroke (AIS) intervention. We sought to identify ICH risk factors after AIS thrombectomy. METHODS: This is a retrospective review of the Stroke Thrombectomy and Aneurysm Registry (STAR) database. All patients who underwent AIS thrombectomy with available ICH data were included. Multivariable regression models were developed to identify predictors of ICH after thrombectomy. Subgroup analyses were performed stratified by symptom status and European Cooperative Acute Stroke Study (ECASS) grade. RESULTS: The study cohort comprised 6860 patients. Any ICH and symptomatic ICH (sICH) occurred in 25% and 7% of patients, respectively. Hemorrhagic infarction 1 (HI1) occurred in 36%, HI2 in 24%, parenchymal hemorrhage 1 (PH1) in 22%, and PH2 in 17% of patients classified by ECASS grade. Intraprocedural complications independently predicted any ICH (OR 3.8083, P<0.0001), PH1 (OR 1.9053, P=0.0195), and PH2 (OR 2.7347, P=0.0004). Race also independently predicted any ICH (black: OR 0.5180, P=0.0017; Hispanic: OR 0.4615, P=0.0148), sICH (non-white: OR 0.4349, P=0.0107), PH1 (non-white: OR 3.1668, P<0.0001), and PH2 (non-white: OR 1.8689, P=0.0176), with white as the reference. Primary mechanical thrombectomy technique also independently predicted ICH. ADAPT (A Direct Aspiration First Pass Technique) was a negative predictor of sICH (OR 0.2501, P<0.0001), with stent retriever as the reference. CONCLUSIONS: This study identified ICH risk factors after AIS thrombectomy using real-world data. There was a propensity towards a reduced sICH risk with direct aspiration. Procedural complications and ethnicity were predictors congruent between categories of any ICH, sICH, PH1, and PH2. Further investigation of technique and ethnicity effects on ICH and outcomes after AIS thrombectomy is warranted.

Improving Practice Readiness Among Nurse Residents.

Background Recent evidence indicates a mere 8% of new graduate RNs are prepared to make entry-level clinical judgments. Residency programs, designed to overcome the academic-practice gap, lack universal guidelines for content, delivery, structure, and consistent assessment of practice readiness prior to independent practice. Method Virtual simulation to overcome practice gaps, with pre- and post-assessment of practice readiness prior to independent practice, was implemented in an existing nurse residency program. Results A 373% improvement in virtual clinical performance scores, as well as reductions in medication errors, sentinel events, and failures to rescue, was noted. These improvements readily translated to practice, as noted in a corresponding decrease in the rate of practice errors during actual clinical performance. Conclusion Transformed pedagogical technologies and learning methodologies are providing promising interventions to overcome the practice readiness deficit and set the stage for safer practice among new graduate RNs. [J Contin Educ Nurs. 2022;53(9):411-416.].

Lower albumin levels in African Americans at colon cancer diagnosis: a potential explanation for outcome disparities between groups?

BACKGROUND AND AIM: Colorectal cancer is the third most common cancer and 3rd leading cause of cancer-related death in the USA. African Americans (AA) have inferior outcomes when matched for diagnosis stage and socioeconomic situation. Nutritional status, at diagnosis and its contribution to the observed cancer outcome disparity, between AA and non-Hispanic whites (nHw) has not been evaluated to date. The aim of the investigation was to determine if differences in nutritional surrogate markers, such as serum albumin and body mass index (BMI), exist at the time of colorectal cancer diagnosis between AA and nHw. METHODS: The University of Florida College of Medicine-Jacksonville endoscopy database was reviewed for all patients with a biopsied colorectal mass between January 2000 and December 2007. Patients were excluded if histology did not reveal colorectal adenocarcinoma or albumin/BMI was unavailable. Demographic data, tumor location, serum albumin within 60 days of diagnosis, presence of diabetes along with serum HbA1c were obtained. RESULTS: During the study period, 321 patients had colorectal masses discovered and 156 met entry criteria. There was no difference between ethnic groups regarding gender distribution, tumor location, diabetes presence, or BMI. Mean albumin was significantly less in AA compared to nHw (p < 0.01). This persisted after adjustment for gender, presence/absence of diabetes, and BMI. CONCLUSIONS: Lower albumin levels in AA indicate poorer nutritional status at colorectal cancer diagnosis compared to nHw. This may contribute to the outcome disparities observed between AA and nHw. Aggressive nutritional interventions to reverse this disparity should be evaluated.

Poorly treated or unrecognized GERD reduces quality of life in patients with COPD.

BACKGROUND: The effect of gastroesophageal reflux disease (GERD) on health-related quality of life (HRQL) in COPD has never been assessed. AIM: To evaluate HRQL in patients with COPD alone compared with those with both COPD and continuing GERD symptoms. METHODS: A questionnaire-based, cross-sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting the criteria and agreeing to participate were asked to complete the Mayo Clinic GERQ and SF-36 questionnaires, by either personal or telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Study patients were divided into two groups for HRQL analysis based on the GERQ response: COPD+/GERD+ and COPD only. Statistical analysis was performed using the Mann-Whitney-Wilcoxon T test for unequal variables and linear regression was performed using ANOVA. All data are expressed as mean and standard deviation. RESULTS: Eighty-six patients completed both questionnaires. Males were 55% and COPD+/GERD+ patients comprised 37% of the study group. Compared with COPD only, HRQL was reduced across all measures for the COPD+ GERD+ patients and achieved significance for bodily pain (P < 0.02), mental health (P < 0.05), and physical component score (P < 0.05). CONCLUSION: Patients with COPD and continuing GERD symptoms have reduced HRQL in comparison with those with COPD alone.

Pediatric self-inflating resuscitators: the dangers of improper setup.

BACKGROUND: Self-inflating resuscitators (SIRs) are often used in pediatric resuscitation. Improper setup of the SIR can lead to inadequate ventilation and oxygenation. OBJECTIVES: To present clinical scenarios in which SIRs delivered inadequate tidal volumes due to improper use. Second, to evaluate tidal volumes delivered using SIRs at varying lung compliances with the manometer and pop-off valve port open and closed. Third, to suggest methods to overcome improper use. METHODS: Five pediatric resuscitators were tested under conditions simulating normal lungs, lungs with moderately decreased compliance, and lungs with poor compliance (0.015, 0.010, and 0.005 L/cm H(2)O, respectively) to determine volumes delivered with proper SIR setup (manometer and pop-off valve closed) and improper SIR setup (manometer or pop-off valve open). RESULTS: With each SIR, an open manometer port or an open pop-off valve (improper setup) led to significant decreases in volume delivered. In normal lung compliance, the proper setup delivered 149 ± 10 cc, vs. 112 ± 12 cc, 106 ± 25 cc, and 90 ± 14 cc (pop-off open, manometer open, and both open, respectively). In poor lung compliance, the proper setup delivered 122 ± 13 cc, vs. 56 ± 10 cc, 70 ± 17 cc, and 44 ± 7 cc (pop-off open, manometer open, and both open, respectively). All differences above are significant (p < 0.0001). CONCLUSIONS: In a normal lung, the volumes delivered by SIRs are significantly decreased with the pop-off valve and manometer port open. Proper set-up of the SIR becomes even more important when lung compliance is poor.

Implementation of possession laws and the social ecology of tobacco control.

The objective of this evaluation research was to assess the impact of programs intended to support the enforcement component of a comprehensive youth tobacco control. The research method was a survey of a randomly stratified cluster sample of law enforcement officers. Results of the evaluation showed that the enforcement behaviors of officers were increased through the state programs to support tobacco enforcement activities. The study showed that support for implementing a policy is important to achieve the objectives of a policy. The results of a study of the enforcement component of a Florida tobacco control program are reported and discussed within the ecological context of previously reported enforcement-linked decreases in youth tobacco use and funding and defunding of the Florida Tobacco Control Program.

Fall-related pediatric brain injuries: the role of race, age, and sex.

BACKGROUND: Falls remain a major cause of childhood morbidity and mortality. To improve effectiveness of our prevention program, we used our electronic injury surveillance database to analyze patient variables and the incidence of fall-related brain injury. METHODS: The database was queried for all injuries treated in the pediatric emergency department for which the word "fall" was listed as part of the chief complaint. Age, sex, and mechanism variables were cross tabulated for analysis with traumatic brain injury (TBI) codes. RESULTS: Between June 2005 and June 2008, the electronic surveillance system reported 39,718 injury-related visits to the pediatric emergency department. Falls were reported in 3,436 patients (2,107 males, 1,329 females). TBI occurred from falls in 171 patients. Although black children had a higher fall rate (69.24%) than white children (23.75%) and non-black, non-white children (7.01%), white children had the highest TBI rate from falls (9.47%). TBI from falls occurred at a lower mean age for females (5.40 +/- 4.45) than males (6.6 +/- 5.15) and for non-whites (5.98 +/- 4.88) than whites (6.21 +/- 4.93). Multiple logistic regression demonstrated a significant influence of age, race, and sex on the likelihood that a fall results in TBI. Females have a higher risk of TBI from falls than males from ages 0 to 11.5. This runs contrary to previous studies suggesting that toddler males are at highest risk for TBI. CONCLUSION: A disproportionate number of infants, toddlers, and adolescents sustain brain injury from falls. Race and sex group differences mandate enhanced focus on environmental safety and risk-taking behaviors.

A systematic review of outcomes in patients with staged carotid artery stenting and coronary artery bypass graft surgery.

BACKGROUND AND PURPOSE: Although current guidelines state that carotid endarterectomy is probably recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with carotid stenosis, significant controversies to this recommendation still persist. Carotid artery stenting has been recently introduced as an alternative revascularization modality in high-risk patients. The aim of this study was to define, based on the published information, if carotid artery stenting is beneficial in this setting. METHODS: A search of MEDLINE and a manual search of the literature from selected articles were performed. A total of 6 studies with 277 patients reporting carotid stenting followed by staged CABG were available for this clinical outcome analysis. All were retrospective and single-center studies. RESULTS: The mean age was 69 years; 78% were males. Asymptomatic carotid stenosis was present in 76% of patients. The mean time to CABG was 32 days. The incidence of stroke and death associated with the stent procedure was 4.7%. Only 6 patients (2.2%) developed stroke associated with CABG. The overall combined 30-day event rate after CABG, including all events during carotid artery stenting, were as follows: minor stroke, 2.9%; major stroke, 3.2%; mortality, 7.6%; and combined death and any stroke, 12.3%. CONCLUSIONS: In this pooled analysis, the combined incidence of death and stroke in patients undergoing carotid artery stenting and staged CABG remains elevated. These results confirm that the presence of carotid stenosis is per se a marker of risk that might persists independent of its treatment. A systematic or randomized evaluation appears warranted.

Factors associated with utilization of healthcare resources among epilepsy patients.

PURPOSE: To determine those variables associated with utilization of healthcare resources in epilepsy patients. METHODS: We interviewed 256 epilepsy patients. Target variables included the number of clinic visits, ER visits and in-patient admissions over the past year and AEDs currently being used. Predictor variables were age, race/ethnicity, marital status, education, income, insurance, seizure frequency and QOLIE-10 results. We used univariate analysis to determine those factors associated with the target variables and multivariate analysis to ascertain those independently significant. RESULTS: On univariate analysis, higher seizure frequency and poorer QOLIE-10 scores were associated with the number of clinic visits, ER visits and in-patient admissions. Increased seizure frequency and male gender were associated with higher use of AEDs. Using ordinal logistic regression, QOLIE-10 scores was the only variable associated with the number of clinic visits. Both seizure frequency and QOLIE-10 scores were independently associated with the number of in-patient admissions while seizure frequency and male gender remained independently associated with AED use. Using binary logistic regression, QOLIE-10 scores and seizure frequency were independently associated with the number of ER visits. CONCLUSION: Seizure frequency and quality of life are major factors associated with utilization of healthcare resources in epilepsy patients.

Influenza vaccine: awareness and barriers to immunization in families of children with chronic medical conditions other than asthma.

OBJECTIVES: Children with chronic medical conditions (CMCs) are considered to be at increased risk for influenza and its related complications. Despite this, influenza immunization rates in the United States for children with CMCs in the primary care setting remain between 7-10%. This was a survey study looking at the barriers to influenza immunization among children with CMCs other than asthma. We examined caregiver knowledge and perceptions regarding influenza vaccine in addition to assessing other barriers, such as availability and perceived safety of the vaccine. METHODS: The study was conducted during the fall-winter influenza seasons of 2002-2003 and 2003-2004 at five academic institutions across the southeastern US. Convenience samples of 100-150 families attending pediatric subspecialty clinics were surveyed. RESULTS: A total of 794 surveys were completed. Controlling for disease, failure to recommend vaccination was significantly associated with failure to get the vaccine (P < 0.0001). Of the children who did not receive the vaccine, 61% of their parents believed that the vaccine itself could give influenza, 54% cited other safety concerns, and 30% thought it did not work. Among vaccine recipients, 163 (43%) reported that the primary care provider had given the vaccine, whereas 171 (45%) reported that the vaccine had been given at the subspecialty clinic. CONCLUSION: This study highlights the importance of physician recommendation, as well as parental education, as some of the key elements crucial to the receipt of influenza vaccination in children with CMCs.

Factors associated with employment in epilepsy patients.

OBJECTIVE: The aim of the study described here was to determine those variables associated with employment in patients followed at a level 4 epilepsy center. METHOD: A survey was sent to patients seen at the University of Florida Health Science Center/Jacksonville Comprehensive Epilepsy Program. RESULTS: Two hundred sixty-two eligible subjects constituted the study population. By univariate analysis, variables that distinguished employed patients included: younger age, Caucasian race, higher education and household income, not receiving disability benefits, currently studying, fewer seizure medications, having no other medical conditions that interfere with work, previous work experience, perceived importance of work for personal and financial reasons, and decreased fears of workplace discrimination. By logistic regression, higher annual family income, perceived importance of work for personal reasons, and decreased fears of workplace discrimination were the only variables independently associated with employment. CONCLUSION: Psychosocial factors such as a high self-perceived importance of work and decreased fears of workplace discrimination are significantly associated with employment in epilepsy patients.

USMLE step 1 scores as a significant predictor of future board passage in pediatrics.

PURPOSE: To explore the relationship(s) between USMLE, In-Training Exam, and American Board of Pediatrics (ABP) board-certifying exam scores within a Pediatric residency-training program. METHODS: Data were abstracted from records of graduating residents from the Pediatric residency program at the University of Florida College of Medicine Jacksonville from 1999 to 2005. Seventy (70) residents were identified and their files reviewed for the following information: USMLE Step 1 and 2 scores, in-training exam results and eventual board scores as reported by the ABP. Correlation and regression analyses were performed and compared across all tests. RESULTS: The correlation coefficients between the three types of tests were all statistically significant. Using logistic regression, however, only USMLE Step 1 scores (compared to Step 2) had a statistically significant association with board performance. Interestingly, none of the three in-training exam scores had any additional impact on predicting board performance given one's USMLE Step 1 score. USMLE Step 1 scores greater than 220 were associated with nearly a 95 per cent passage rate on the board-certifying exam. CONCLUSIONS: The data suggests that performance on USMLE Step 1 is an important predictor of a resident's chances of passing the pediatric boards. This information, which is available when a resident initiates training, can be used to identify those at risk of not passing the boards. While Step 1 scores should not be used as a sole determinant in the recruiting process, individual learning plans can be developed and implemented early in training to maximize one's ability to pass the certifying exam.

Increase in invasive pneumococcal disease in children associated with shortage of heptavalent pneumococcal conjugate vaccine.

The authors investigated the impact of heptavalent pneumococcal conjugate vaccine (PCV7) shortage on the rate of invasive pneumococcal disease (IPD). Vaccination status and number of doses delivered was determined. Regression analysis using an exponential decay model was used to predict the expected rate of IPD in the shortage period if IPD continued to decline at the same rate as in the availability period. The rate of IPD decreased from 15.5 to 6.5 with vaccine availability (P < .00001) and increased to 7.2 with shortage (P = .69). Based on the model, IPD rate would have been 3.6 if the decrease continued at the same rate when there was no shortage; this was statistically significant (95% prediction interval, 2.7-4.1). The rate of IPD correlated directly with the number of PCV7 doses delivered, r = -.98. Continuous availability of the PCV7 would have resulted in a statistically significant lower IPD rate compared to the measured IPD rate in the vaccine shortage period.

Throat culture is necessary after negative rapid antigen detection tests.

This study was conducted to determine if culture confirmation is needed for a negative rapid antigen detection test. Data on 18,509 tests done in patients younger than 18 years old were reviewed. Of the 14,167 (76.5%) that were negative, 968 (6.8%) were associated with positive cultures. No significant seasonal variation was noted. Significant differences were found between hospital and pediatric practices in the percentage of patients with a negative rapid antigen detection test who actually had group A beta-hemolytic streptococcus (3.5% to 9.8%). This study supports the recommendation of culture confirmation of a negative rapid antigen detection test and validation of results within an individual practice if confirmatory cultures are not being performed. This study showed a high false-negative rate of the negative rapid antigen detection test and variation among hospital and pediatric practices for rates of positive culture after a negative rapid antigen detection test.

Survival times and complications of catheters used for outpatient parenteral antibiotic therapy in children.

Outpatient parenteral antibiotic therapy is routinely used in pediatrics, but few data are available on catheter-associated complications and survival times. Catheter-associated complications, defined as mechanical or nonmechanical, and survival times in peripherally inserted central catheters and central venous catheters used for outpatient parenteral antibiotic therapy in childhood were compared. The life test procedure was performed to determine survival time. Cox proportional hazards model was used to compare the independent effect of variables such as age and gender on catheter survival. There were 104 peripheral and 130 central venous catheters, of which 28 peripheral and 19 central catheters had mechanical complications, and 13 peripheral and 17 central catheters had nonmechanical complications. Peripheral catheters are more likely to develop mechanical complications and have a shorter survival time than central venous catheters. For outpatient parenteral antibiotic therapy longer than 6 weeks, central venous catheters appear to be a better choice.

Role of gastroesophageal reflux symptoms in exacerbations of COPD.

BACKGROUND AND AIMS: The impact of gastroesophageal reflux disease (GERD) on exacerbations of COPD has never been evaluated. The aims of this investigation were to determine the prevalence of gastroesophageal reflux (GER) symptoms in COPD patients and the effect of GER on the rate of exacerbations of COPD per year. METHODS: A questionnaire-based, cross sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting criteria and agreeing to participate were asked to complete the Mayo Clinic GERD questionnaire by either personal/telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Other outcome measures noted were frequency and type of COPD exacerbations. Statistical analysis was performed using the Fisher exact test for categorical data and the independent t test for interval data. RESULTS: Eighty-six patients were enrolled and interviewed (mean age, 67.5 years). Male patients accounted for 55% of the study group. Overall, 37% of patients reported GER symptoms. The mean FEV(1) percentage of predicted was similar in those with or without GER. The rate of exacerbations of COPD was twice as high in patients with GER symptoms compared to those without GER symptoms (3.2/yr vs 1.6/yr, p = 0.02). CONCLUSIONS: The presence of GER symptoms appears to be associated with increased exacerbations of COPD.

Prostate cancer screening and detection in inner-city and underserved men.

CONTEXT: In the era of serum prostate-specific antigen (PSA) screening, the incidence of prostate cancer has increased dramatically. Simultaneously however, stage migration has occurred, and treatment outcomes have improved. Inner-city men have lower screening rates and, thus, may be diagnosed with more advanced disease that it less likely to be successfully treated. OBJECTIVE: To assess the detection rate of prostate cancer and tumor stage at presentation in inner-city men. DESIGN, SETTING, AND PATIENTS: A retrospective cohort of 368 men underwent transrectal ultrasound needle-guided biopsy at an inner-city hospital from January 2003 to May 2005. Clinical and pathologic data were collected and analyzed. MAIN OUTCOME MEASURES: Clinic and hospital records were reviewed for several key outcomes, including prostate cancer incidence, tumor stage and tumor grade. RESULTS: The median age of the cohort was 67 +/- 9.1 years (range, 23-93 years). Prostate cancer was diagnosed in 44% of subjects (161/368). The median PSA level at the time of diagnosis was significantly higher in African-American men than in Caucasian men (9.82 vs. 5.97 ng/mL, P=0.008). Abnormally high serum PSA levels (>20 ng/mL) were present in disproportionately more African-American men than Caucasian men with prostate cancer (32.9% vs. 19.7% P=0.011). African-American men in this inner-city cohort also had a higher incidence of advanced disease or distant metastasis (T3/T4, N1, or M1) than did Caucasians (16.1% vs. 3.8%; P=0.045). CONCLUSIONS: Compared with inner-city Caucasian men, disproportionately more inner-city, African-American men present with advanced prostate cancer. This observation warrants prostate cancer education and consideration of early detection programs in underserved inner-city communities.