Journal of palliative medicine
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The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. ⋯ We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions.
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Prognostic tools are available to predict if terminally ill cancer patients have days or weeks to live. Tools for predicting the prognosis in ambulatory patients at an earlier stage are lacking. The Number of Risk Factors (NRF) score developed in ambulatory cancer patients receiving palliative radiation therapy may be suitable for this purpose but has not been tested in a palliative care setting. ⋯ In cancer patients referred to palliative care earlier in their disease trajectory, the NRF score may be a useful prognostic tool. Further validation in other palliative care populations is needed.
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There is a paucity of research evidence to guide health care providers' practice in pediatric palliative care. At the same time, some clinicians and Institutional Review Boards are reluctant to approve such studies because of concerns about further burdening families. Yet, there is some evidence that research participation can have positive effects for families. ⋯ Participation in research for families with children who have a life-threatening condition is not only acceptable to parents, but may in fact have a positive effect. Although clinicians and Institutional Review Boards may be hesitant to fully support such research, it is clear that conducting research in the field of pediatric palliative care is important.
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Case Reports
Metastatic endometrial adenocarcinoma to the larynx: a case report and discussion of upper airway management.
The aim was to achieve endoscopic debulking surgery with regional low-dose radiotherapy as an alternative to tracheostomy for the management of metastatic endoluminal laryngeal tumor. ⋯ We suggest endoscopic debulking surgery with regional low-dose radiotherapy as an alternative to tracheostomy for the management of metastatic endoluminal laryngeal tumors.
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Many adolescents are having sex and adolescents with life-limiting illnesses are no exception. It is therefore important for health care professionals to take a sexual history and provide advice about sexually transmitted diseases, unintended pregnancies, and ways of reducing high-risk sexual behaviors. Consultations should provide a forum for discussion and education. A literature review revealed no previous studies on this topic. ⋯ Sexual health is described by the World Health Organization as a basic human right. Clinicians may struggle to accept that adolescents with life-limiting illnesses may want to talk about sex, and this study has highlighted it as a topic that is generally ignored. Health professionals should include sexual health in routine palliative assessments. Adolescents with life-limiting illnesses should not be denied the right to holistic health care.