A retrospective analysis of and proposed framework for palliative care discussions in patients with multiple system atrophy (P3.312)
Bibliographic record
Abstract
OBJECTIVE: The aim of this study is to evaluate the symptom burden of patients living with multiple system atrophy (MSA), the palliative care discussions that take place during their disease trajectory and the circumstances surrounding placement of a tracheostomy. BACKGROUND: MSA is a rare neurodegenerative disease involving parkinsonian features that generally carries a poor prognosis. Stridor is an uncommon, but potentially fatal, complication of MSA and leads to acute respiratory compromise requiring emergent tracheostomy. Advanced care planning and palliative care discussions in patients living with MSA are not well defined. DESIGN/METHODS: This is a retrospective chart review looking at patient characteristics and symptom burden as well as the focus and timing of palliative care discussions. RESULTS: 22 patients were included, 6 had stridor of which 3 received a tracheostomy. Of the patients that died, 83[percnt] had an identified substitute decision maker and palliative care discussions took place prior to death. However, these discussions took place very late in the disease trajectory. 36[percnt] of patients had a do-not-resuscitate order of which 50[percnt] were made in hospital as a result of significant clinical decline. Most discussions taking place touched on the diagnosis of MSA, symptom management and prognosis (56[percnt]). Only one patient (6[percnt]) had a discussion regarding tracheostomy. CONCLUSIONS: This study underscores the need for a systematic approach to advanced care planning and palliative care discussions in patients living with MSA. We propose a framework for advance care planning and palliative care discussions in MSA. Study Supported by: No funding was received for this study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".