Pediatric blood & cancer
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Pediatric blood & cancer · Oct 2009
An assessment of the current state of palliative care education in pediatric hematology/oncology fellowship training.
Despite improved survival rates for pediatric oncology patients, childhood cancers continue to be the number one cause of non-accidental death in children. Studies show that many children receiving end-of-life care, and their families, believe that physicians can improve significantly in the delivery of palliative care. This has led to the recommendation that increased palliative care training for physicians taking care of terminally ill pediatric patients is needed. ⋯ Pediatric oncology fellowship directors believe it is very important for fellows to learn about palliative care during training; however, currently the majority of fellowship programs do not have a palliative care curriculum and lack significant formal education in end-of-life care.
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Pediatric blood & cancer · Oct 2009
Health care utilization and expenditures for privately and publicly insured children with sickle cell disease in the United States.
There are no current national estimates on health care utilization and expenditures for US children with sickle cell disease (SCD). ⋯ Children with SCD enrolled in Medicaid had lower expenditures than privately insured children, despite higher utilization of medical care, which indicates lower average reimbursements. Research is needed to assess the quality of care delivered to Medicaid-enrolled children with SCD and its relation to health outcomes.
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Pediatric blood & cancer · Sep 2009
Multi-modal intervention and prospective implementation of standardized sickle cell pain admission orders reduces 30-day readmission rate.
The National Association of Children's Hospitals (NACHRI) and the Centers for Medicare and Medicaid Services (CMS) recently introduced 30-day hospital readmission rate as a quality care indicator in children with sickle cell disease (SCD). Based on previous research identifying risk factors for 30-day readmission in our patient population, we designed and implemented a multi-modal intervention to reduce 30-day readmission rate in children with SCD and pain. ⋯ A multi-modal intervention was successful in decreasing 30-day hospital readmission rate for children with SCD and pain. Provider education was the most important component of the multi-modal intervention.
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Pediatric blood & cancer · Aug 2009
Off-label use of rFVIIa in children with excessive bleeding: a consecutive study of 153 off-label uses in 139 children.
Recombinant factor VIIa is a general hemostatic agent. Randomized trials have demonstrated effectiveness in adults; however, data in children are confined to case reports and series subject to publication bias. ⋯ rFVIIa is an effective general hemostatic agent for management of excessive bleeding in children and that with the exception of neonates has excellent safety.
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Pediatric blood & cancer · Aug 2009
ReviewTesticular stem cells for fertility preservation: preclinical studies on male germ cell transplantation and testicular grafting.
Spermatogonial stem cells open novel strategies for preservation of testicular tissue and fertility preservation in boys and men exposed to gonadotoxic therapies. This review provides an update on the physiology of spermatogonial stem cells in rodent and primate testes. Species-specific differences must be considered when new technologies on testicular stem cells are considered. ⋯ Further research is needed before an application in humans can be considered safe and efficient. Despite the current limitations in regard to the generation of sperm from cryopreserved male germline cells and tissues, protocols for cryopreservation of testicular tissue are available and reveal a promising outcome. Since future improvements of germ cell transplantation and grafting approaches can be assumed, bioptic retrieval and cryopreservation of testicular tissue fragments should be performed in oncological patients at high risk of fertility loss since this is their only option to maintain their fertility potential.