Racial disparities in the treatment of endometrial intraepithelial neoplasia in postmenopausal women.

Disparities in endometrial cancer has increased during the past decade with Black women more likely to be diagnosed at a later stage and have higher mortality. The majority of research has been focused on cultural barriers, socioeconomic status, lack of access to care, comorbidities, and tumor histology to explain these disparities. Limited studies have been conducted on the disparity in the treatment of endometrial intraepithelial neoplasia(EIN). We sought to analyze the differences in treatment used in the management of postmenopausal women with EIN to evaluate whether race/ethnicity is a contributing factor. An IRB approved retrospective study was conducted amongst women at a single institution diagnosed with EIN. Ethnicity/race was defined as non-Hispanic White, non-Hispanic Black, Hispanic, and Asian. Demographic and clinical data was extracted. Multivariable logistic regression was used to examine the association between ethnicity/race and treatment, adjusted for age, BMI, and underlying medical conditions such as cardiovascular disease and diabetes. In total, 254 patients were analyzed. A significant association between ethnicity/race and treatment with non-Hispanic Black women less likely to be treated with surgical management compared to non-Hispanic White women (OR = 0.326, 95 %CI 0.129-0.827, p = 0.026). Importantly, after adjusting for clinical risk factors(age, BMI, CVD, diabetes), non-Hispanic Black women remained at an increased risk of not undergoing surgical intervention (OR = 0.333, 95 % CI 0.125-0.882, p = 0.027). Future research is imperative to evaluate the root cause of this disparity in the healthcare system.

Antibiotic use review using the "target drug" method.

The "target drug" method was implemented to study the use of cefamandole and cefoxitin in a community hospital. There were no infectious disease specialists on staff, and restrictions on the use of individual agents was not a viable option for antibiotic control in this institution. Data was collected by the pharmacy staff and presented by the clinical pharmacy coordinator to individual medical specialties under the auspices of the P & T Committee. Appropriate literature was provided and discussed promoting the use of cefazolin in place of cefamandole and cefoxitin. As a result, cefamandole and cefoxitin use was reduced 41% and 12%, respectively, and cefazolin use increased fourfold. Net annual cost savings were in excess of $40,000, with costs of the pharmacists' time estimated to be $4,000.