Objectives In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow‐up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow‐up care. Methods This study included patients with biopsy‐proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety‐net hospital or adjacent private academic hospital. Components of follow‐up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals. Results Two hundred and thirty‐four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow‐up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow‐up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety‐net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow‐up. Non‐Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow‐up. Conclusion Safety‐net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow‐up service utilization. Quality improvement initiatives are needed to reduce these disparities. Level of Evidence 2b Laryngoscope, 129:2303–2308, 2019

PurposePrevious studies have indicated a relationship between functional status and comorbidity on overall survival when treating patients with bone and brain metastases. However, the degree to which these findings have been integrated into modern-day practice remains unknown. This study examines the impact of performance measures, including Karnofsky Performance Status (KPS) and comorbidity, on palliative radiation therapy treatment tolerance and fractionation schedule. The relationship between a shorter fractionation schedule (SFx) and pending mortality is examined.Methods and materialsThis study included patients who were treated with palliative intent to the brain or bone between January 1, 2016 and June 30, 2016. Demographic and medical characteristics collected included KPS score (stratified as good [90-100], fair [70-80], and poor (≤60]), socioeconomic status, comorbidity (binary measure using the Adult Comorbidity Evaluation-27 scale), site of metastatic disease, and treatment facility. Univariable analyses were performed using the Cox proportional hazards regression model to assess the impact of the variables on the prescribed number of fractions (binary measure, ≥10 [long fractionation schedule], and <10 [SFx]), and major treatment interruptions (MTIs; defined as missing ≥3 radiation therapy treatment days or ending treatment prematurely).ResultsA total of 145 patients were eligible for study inclusion, including 95 patients who were treated for bony metastatic disease and 50 patients for brain metastases. High comorbidity (P = .029) and both fair (P = .051) and poor (P = .065) functional status were associated with more frequent MTIs. However, high comorbidity and low KPS score were not associated with shorter treatment plans. In addition, patients with an earlier time to death were not more likely to receive an SFx (P = .871).ConclusionsLow KPS and elevated comorbidity scores predict for a poorer prognosis and more frequent MTIs; however, there was no indication that physicians incorporated this information in the fractionation scheduling.

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A search of the literature reveals no universally accepted classification system of psychodermatological conditions. Current systems vary in their aetiological perspective and precision of terminology, limiting their clinical and epidemiological utility due to a lack of clarity in the conceptualisation of the disease relationships. For example, the common category descriptions of "Dermatological disorders with psychiatric symptoms" and "Secondary psychiatric disorders" refer to the same aetiological relationship. Additionally, the first category should only list dermatological disorders and the second should only list psychological disorders, however this precision is generally not followed. Our proposed system has clear descriptive terminology and a causative-versus-exacerbatory structure to aid precision in clinical and epidemiological investigations. It is based on the following methodology: One, categories are named from a consistent perspective with aetiology referred to first. For example, a category is called "Psychological disorders causing dermatological symptoms", rather than the commonly used "Secondary dermatological disorders". Two, categories are named in unambiguous explanatory language. For example, "Psychological disorders exacerbating dermatological symptoms", rather than "Psychophysiological disorders". Three, the system presents the variables in both possible directions of influence (dermatology to psychology and psychology to dermatology). This yields a matrix of four categories which states the aetiology first with clear unambiguous titles that are mutually exclusive and collectively exhaustive: Type 1: Dermatological disorders causing psychological symptoms; Type 2: Dermatological disorders exacerbating psychological symptoms; Type 3: Psychological disorders causing dermatological symptoms; Type 4: Psychological disorders exacerbating dermatological symptoms. This classification system which enhances clarity of communication and conceptualisation may be useful in clinical and epidemiological research and communication in this challenging area. 183Association of atopic dermatitis, ultraviolet radiation and climate factors: a systematic review and ecological meta-analysis Previous studies found conflicting results about the relationship of ultraviolet radiation (UVR) and climate with atopic dermatitis (AD) prevalence. We examined the relationship of UVR and climate with lifetime and point AD prevalences globally. A systematic review was performed of all published observational studies in MEDLINE, EMBASE, LILACS, Scopus, Cochrane library and GREAT that analyzed AD prevalence. Mean UVR dose exposure was determined from the Tropospheric Emission Monitoring Internet Service. Mean daily temperature and total precipitation were obtained from the Intergovernmental Panel on Climate Change Data Distribution center. Linear and nonlinear associations (penalized spline term) of AD prevalence with mean and maximum UV dose exposures, temperature and precipitation were assessed using generalized linear mixe...

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