North Carolina medical journal
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Advance care planning maximizes the patient's chances of receiving the care he or she wants and minimizes confusion. Frank discussion, time, and persistence are needed to optimize this shared decision-making process. This article discusses the important components of advance care planning and the recommended documentation.
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Most cancer survivorship initiatives are designed for patients whose treatment is intended to be curative. For patients living with advanced cancer, in contrast, survivorship research efforts and programs are far less common. This neglected aspect of cancer survivorship requires particular emphasis on active symptom management and clarification of goals of care.
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Despite long-standing guidelines from the American College of Obstetricians and Gynecologists that call for avoiding elective births prior to 39 weeks of gestation, elective deliveries make up almost one-third of US births occurring in weeks 36-38. Poor outcomes are more likely for infants born electively before 39 weeks than for those born at 39 weeks. The Perinatal Quality Collaborative of North Carolina (PQCNC) undertook the 39 Weeks Project in 2009-2010 with the aim of reducing the number of early-term elective deliveries in North Carolina hospitals. ⋯ The PQCNC's 39 Weeks Project successfully decreased the rate of early-term elective deliveries in participating hospitals.
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This study examined trends in premature mortality--defined as years of potential life lost before age 75 years--in North Carolina during the period 2000-2010. ⋯ Public health professionals should focus attention on counties in which premature mortality is increasing or remaining constant and should address the specific underlying causes of such deaths. In counties in which premature mortality among whites is increasing, community health efforts should focus on prevention of smoking, suicide, and injury. In counties with large nonwhite populations, programs should focus on prevention of stroke, heart disease, diabetes, homicide, and kidney disease.