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Pleomorphic adenoma is the most common type of benign salivary neoplasm, which typically occurs in major salivary glands such as the parotid gland. This type of tumor is rarely found in the upper respiratory system, specifically within the nasal cavity. We present a rare case of pleomorphic adenoma of the left sided nasal septum occurring in a 47-year-old male who originally presented with chronic left nasal obstruction, congestion, and epistaxis. Diagnosis was made with tissue sampling in conjunction with computed tomography and magnetic resonance imaging, and the patient underwent surgical excision and reconstruction with the Head and Neck Surgical Oncology, Skull Base Surgery, and Facial Plastic Surgery teams. Although pleomorphic adenoma is rare within the nasal cavity, it should be considered in the differential diagnosis as a potential cause of nasal mass or obstruction.

The Patient Protection and Affordable Care Act (ACA) addresses use of clinical preventive services relative to evidence-based guidelines by mandating that most health insurance plans provide coverage without cost-sharing for services that receive an A or B rating. However, knowledge about and positive attitudes towards guidelines are extremely low. This study was a population-based randomized experiment to examine beliefs about and intentions to adhere to screening guidelines for the Prostate Specific Antigen (PSA) and Pap tests. The study had two objectives: (1) test reactions to and understanding of guidelines, and (2) experimentally compare receptivity to messages to promote PSA and Pap test recommendations. We first surveyed a population-based sample of (1) US adults age 18 and over, (2) subsample of women aged 65 or younger, (3) subsample of men aged 40 or older. A sample of 2923 completed an initial questionnaire. Next a subset of participants meeting eligibility criteria were recruited from the population-based sample into a message testing experiment: (1) women aged 65 or younger, (2) and men aged 40 or older. Participants meeting these eligibility requirements were randomized to gain, loss, or balanced PSA (men) or Pap test (women) message stimulus conditions and followed for 8 weeks. Data were collected through the GfK Custom Research panel. A total of 2401 were eligible, 2321 completed the baseline, and 1730 completed follow up. Mixed effect regression models revealed that higher receptivity to messages was associated with greater intentions to seek cancer information and to speak to a Doctor about PSA and Pap tests. The loss frame was associated with higher intentions to speak to friends and family about PSA and Pap tests. Finally, perceived importance and personal understanding of guidelines predicted intentions to seek more information about them. This study contributes to evidence on how best to inform and engage consumers regarding preventive services.

ObjectiveTo assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity.Data sourcesAdministrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006.Study designThe study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient's initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity.Principal findingsBlacks were less likely than whites to receive CABG (9.1% vs. 5.8%; pConclusionsCounty variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.