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The present study characterizes national trends in the utilization of adjuvant chemotherapy to treat salivary gland malignancies.The National Cancer Database was queried for salivary gland malignancies treated by surgery with radiation in 2004-2019. Proportions of patients receiving adjuvant chemotherapy over the study period were analyzed by linear regression. The impact of chemotherapy on overall survival was assessed using Kaplan-Meier and Cox proportional hazards analyses.Among 15 965 patients meeting inclusion criteria, 2355 (14.8%) received adjuvant chemotherapy. Chemotherapy utilization significantly increased from 4.9% to 16.5% over the study period (p 0.001). No survival benefit was observed with adjuvant chemotherapy on propensity score-matched Kaplan-Meier analysis (HR: 0.98; 95% CI: 0.86-1.11; p = 0.72) or multivariable Cox regression (HR: 0.92; 95% CI: 0.78-1.09; p = 0.34).Adjuvant chemotherapy has been increasingly utilized to treat salivary gland malignancies in recent years. Our findings highlight the importance of obtaining high-quality prospective data regarding the benefit of chemotherapy.

Objectives To evaluate the role of hospital setting on outcomes in open airway surgery by comparing patients who underwent surgery (cricotracheal resection [CTR] or tracheal resection [TR]) at a publicly funded county hospital vs a private university hospital. Methods Retrospective chart review of patients undergoing CTR or TR at two institutions; a private university hospital and a publicly funded county hospital from September 2014 to September 2019. Length of intensive care unit (ICU) stay, total time to discharge, minor and major complications were the primary endpoints. Significance was defined as a P‐value less than .05. Results There were a total of 43 patients (17 county, 26 university) who had CTR or TR during the study period. Length of stay outcomes was reported as mean length of stay ± SD. There was a significant difference in ICU stay at the county hospital (7.17 (±5.36 days) compared to the university hospital (2.52 ± 1.85 days, P

ImportanceOver time, the American Thyroid Association (ATA) guidelines have increasingly promoted more limited treatments for well-differentiated thyroid cancers.ObjectiveTo determine whether the 2009 and 2015 ATA guidelines were associated with changes in the management of low-risk papillary thyroid carcinomas on a national scale.Design, Setting, and ParticipantsThis historical cohort study used the National Cancer Database. All papillary thyroid carcinomas diagnosed from 2004 to 2019 in the National Cancer Database were selected. Patients with tumors of greater than 4 cm, metastases, or clinical evidence of nodal disease were excluded. Data were analyzed from August 1, 2021, to September 1, 2022.Main Outcomes and MeasuresThe primary aim was to tabulate changes in the rates of thyroid lobectomy (TL), total thyroidectomy (TT), and TT plus radioactive iodine (RAI) therapy after the 2009 and 2015 ATA guidelines. The secondary aim was to determine in which settings (eg, academic vs community) the practice patterns changed the most.ResultsA total of 194 254 patients (155 796 [80.2%] female patients; median [range] age at diagnosis, 51 [18-90] years) who underwent treatment during the study period were identified. Among patients who underwent surgery, rates of TL decreased from 15.1% to 13.7% after the 2009 guidelines but subsequently increased to 22.9% after the 2015 changes. Among patients undergoing TT, rates of adjuvant RAI decreased from 48.7% to 37.1% after 2009 and to 19.3% after the 2015 guidelines. Trends were similar for subgroups based on sex and race and ethnicity. However, academic institutions saw larger increases in TL rates (14.9% to 25.7%) than community hospitals (16.3% to 19.5%). Additionally, greater increases in TL rates were observed for tumors 1 to 2 cm (6.8% to 18.9%) and 2 to 4 cm (6.6% to 16.0%) than tumors less than 1 cm (22.8% to 29.2%).Conclusions and RelevanceIn this cohort study among patients with papillary thyroid carcinomas up to 4 cm, ATA guideline changes corresponded with increased TL and reduced adjuvant RAI. These changes were primarily seen in academic institutions, suggesting an opportunity to expand guideline-based care in the community setting.

The objective of this chapter is to aid in the identification of factors that will affect the outcome of hair treatment and to highlight conditions that may make patients appropriate or poor candidates. Consultation of the hair transplant (HT) patient begins with a thorough and open discussion of the patients’ concerns and goals for treatment. Despite the benign effects of alopecia on physical health, hair loss patients can suffer significant psychosocial distress including decreased self-esteem, decreased satisfaction with their self-image, and decreased sexual quality of life [1, 2]. This distress may manifest in depressive symptoms and less frequent social engagement [3–5]. Experiments on the perceptions of alopecia also indicate that balding patients are more likely to be rated by others as less attractive, likable, and successful compared to non-balding peers, underscoring potential difficulties with finding romantic relationships and employment [6–8].

In the healthy scalp, hair is replenished commensurate with the rate at which hair is lost, resulting in a cosmetically stable hair pattern. In male and female patterned hair loss, two major disruptions to this equilibrium take place: hair cycle perturbation and follicular miniaturization. Androgen-driven alteration of the hair cycle truncates the anagen phase, which can effectively shorten total hair length until hair shafts no longer reach the surface of the skin. During the catagen/telogen phase, which is protracted in patterned hair loss, the follicular units miniaturize and form into thin vellus hairs from thick pigmented terminal hairs. The ratio of terminal to vellus hair also decreases, further contributing to the appearance of balding [1].

Summary Introduction Community-based health fairs can help identify at-risk populations, improve health literacy, and facilitate access to medical services. No community-based screenings specifically targeting vocal health were identified in the literature. The purpose of this study is to compare the results of community-based vocal health screenings across two populations: a group of community members with unknown risk of voice problems, and a group of actors belonging to a profession with a known increased risk of voice problems. Methods Vocal health screenings were conducted at two free, community-based health fair events in the Los Angeles area. One was open to the public, and one was organized specifically for actors who are members of the Screen Actors Guild-American Federation of Television and Radio Artists. A total of 142 community members (94 nonactors and 48 actors) were administered a questionnaire on current vocal health and voice-related quality of life indices (Vocal Handicap Index-10, Vocal Fatigue Index), followed by review and discussion with a laryngologist or a speech pathologist trained in assessment and treatment of voice disorders. Results A significantly higher percentage of actors (55.1%) reported current voice problems than nonactors (33.0%; χ2 = 7.122, df = 1, P = 0.008). Additionally, as measured by the Vocal Fatigue Index 2 subscale, actors reported a greater amount of perceived pain with phonation than the nonactors. Despite over half of the actors reporting current voice concerns, only 7% reported having sought medical advice regarding these concerns. Conclusions The results of this study suggest that vocal health screenings can help identify persons with voice complaints. However, in order to determine if vocal health screenings help close prevalence-presentation gap and are useful to both medical professionals and participants, more research is needed.