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Palliation in pediatric otorhinolaryngology is a rarely discussed but important aspect of care. This review encapsulates current thinking on pediatric palliative care (PC) and demonstrates, through one case, the impact of integrating PC into clinical care. We encourage early consideration of pediatric palliative care approaches for children with complex otorhinolaryngologic disorders.

Objectives The United States declared the opioid crisis a Public Health Emergency in 2017 and recommended increasing access and availability of naloxone, a reversal agent for opioid overdose. In Massachusetts, there is a statewide standing order for naloxone, which allows pharmacists to dispense it without a prescription to any person at-risk of experiencing an opioid overdose or other persons who can assist individuals at-risk. The objective of this study was to determine whether pharmacists in Massachusetts have sufficient education and training to fulfill the duties associated with dispensing naloxone in community pharmacy settings. The researchers investigated the pharmacists’ ability to counsel patients both on naloxone and management of patients with an opioid overdose. Methods At the time of the study, pharmacies could elect to have a standing order for naloxone. A randomized sample of 100 pharmacies was generated from the 792 pharmacies with a standing order. From this sample, 79 of the 100 pharmacies were visited on the basis of convenience and distribution in eastern and central Massachusetts. At each pharmacy, a validated 25-item survey was administered to pharmacists. Results Fewer than half of participants knew that different formulations of naloxone possess different quantities. Although 52% of pharmacists indicated the need to call 9-1-1 when witnessing an opioid overdose, 8% knew to start rescue breathing, and 4% knew to place patients in the recovery position. Conclusion Despite regulations requiring all pharmacies with a standing order to provide training on naloxone, many of the pharmacists surveyed did not have a strong understanding about naloxone products or its pharmacology. The level of education Massachusetts pharmacists possess on naloxone products and administration is not sufficient to counsel patients regarding this medication. Increasing training requirements in pharmacy schools and continuing education offers potential solutions to the lack of knowledge in the community pharmacy setting.

Objective To describe auxologic, physical, and behavioral features in a large cohort of males with 47,XYY (XYY), ages newborn to young adult. Study design This is a cross-sectional descriptive study of male subjects with XYY who were evaluated at 1 of 2 specialized academic sites. Subjects underwent a history, physical examination, laboratory testing, and cognitive/behavioral evaluation. Results In 90 males with XYY (mean age 9.6 ± 5.3 years [range 0.5-36.5]), mean height SD was above average (1.0 ± 1.2 SD). Macrocephaly (head circumference >2 SD) was noted in 28/84 (33%), hypotonia in 57/90 (63%), clinodactyly in 47/90 (52%), and hypertelorism in 53/90 (59%). There was testicular enlargement for age (>2 SD) in 41/82 (50%), but no increase in genital anomalies. No physical phenotypic differences were seen in boys diagnosed prenatally vs postnatally. Testosterone, luteinizing hormone, and follicle stimulating hormone levels were in the normal range in most boys. There was an increased incidence of asthma, seizures, tremor, and autistic spectrum disorder (ASD) compared with the general population rates. Prenatally diagnosed boys scored significantly better on cognitive testing and were less likely to be diagnosed with ASD ( P Conclusions The XYY phenotype commonly includes tall stature, macrocephaly, macroorchidism, hypotonia, hypertelorism, and tremor. Physical phenotypic features were similar in boys diagnosed prenatally vs postnatally. Prenatal diagnosis was associated with higher cognitive function and less likelihood of an ASD diagnosis.