IMPORTANCE Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. OBJECTIVE To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. EVIDENCE REVIEW A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. FINDINGS A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. CONCLUSIONS AND RELEVANCE Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.

Objective.-To synthesize published literature describing the severity of body image disturbance (BID) in patients with head and neck cancer (HNC) over time, its psychosocial and functional associations, and treatment strategies as assessed by patient-reported outcome measures (PROMs). Data Source.-PubMed/MEDLINE, Scopus, PsycINFO, Web of Science, and Google Scholar. Review Methods.-A systematic review of the English-language literature was performed to identify studies of BID in patients with HNC using psychometrically validated PROMs to assess (1) severity of BID over time, (2) psychosocial and functional associations, and (3) management strategies.

Objective To assess the efficacy of the various therapies used for the prevention of vestibular migraine (VM). Methods Primary studies were identified though PubMed, Scopus, PsycINFO, and Cochrane Library by two independent investigators for articles published through April 2019. The search identified randomized comparison or observational studies pertaining to vestibular migraine treatment. Meta‐analysis was performed on pre‐ and posttreatment Dizziness Handicap Inventory, vertigo frequency, and percentage of perceived improvement. Results Literature search identified 13 studies that reported sufficient outcome measures to be included in the analysis. Patients with VM had a mean age of 43.3 years with female‐to‐male gender ratio of 2.1:1. Classes of therapeutic agents included antiepileptic drugs, calcium channel blockers, tricyclic antidepressants, β‐blockers, serotonin and norepinephrine reuptake inhibitors, and vestibular rehabilitation. All treatment options that were analyzed demonstrated improvement in all of the outcome parameters, but due to significant heterogeneity and lack of standardized reporting on outcomes, establishment of preferred treatment modality could not be determined. Conclusions Various treatment modalities have been evaluated for preventative treatment of VM. Physician familiarity, patient comorbidities, and the side‐effect profiles of various interventions likely influence the selection of intervention. Future randomized controlled trials with restrictive inclusion criteria and generalizable standardized outcome measures will allow for more robust meta‐analyses and for more evidence‐based treatment of vestibular migraines. Laryngoscope, 131:186–194, 2021

Background: International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. Research aim: To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC’s role. Methods: The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008–2019. Qualitative and quantitative studies were reviewed. Results: Twelve ( N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC’s role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. Conclusion: In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.

A biliary stricture is an abnormal narrowing in the ductal drainage system of the liver that can result in clinically and physiologically relevant obstruction to the flow of bile. The most common and ominous etiology is malignancy, underscoring the importance of a high index of suspicion in the evaluation of this condition. The goals of care in patients with a biliary stricture are confirming or excluding malignancy (diagnosis) and reestablishing flow of bile to the duodenum (drainage); the approach to diagnosis and drainage varies according to anatomic location (extrahepatic vs perihilar). For extrahepatic strictures, endoscopic ultrasound-guided tissue acquisition is highly accurate and has become the diagnostic mainstay. In contrast, the diagnosis of perihilar strictures remains a challenge. Similarly, the drainage of extrahepatic strictures tends to be more straightforward and safer and less controversial than that of perihilar strictures. Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.