HG-65END-OF-LIFE CARE OF CHILDREN WITH MALIGNANT PONTINE TUMOURS
Bibliographic record
Abstract
BACKGROUND: Children with diffuse intrinsic pontine gliomas and other malignant pontine tumours (MPT) face a dismal prognosis. OBJECTIVES: To describe (1) the course of children dying of MPT; (2) symptoms experienced and management strategies employed; (3) health professionals involved and interventions provided; (4) decision-making regarding end-of-life care. METHODS: This retrospective cohort included 41 of 48 consecutive children diagnosed under 18, who died between January 2001 and June 2010 with MPT, at a single institution. Disease-specific treatment and decision-making from initial diagnosis and symptoms/interventions/resources used in the final 3 months of palliation were studied. RESULTS: 95% received radiation and/or surgery/chemotherapy at diagnosis, whilst 54% were treated for progression. Ventriculoperitoneal shunts were placed in 5 patients (n = 2 in the final 3 months of life). A small subset received invasive/non-invasive (n = 4/n = 1) mechanical ventilation in their last 3 months. 68% agreed to a do-not-resuscitate order, instituted a median of 28 days before death. All patients experienced symptoms at the end-of-life, with ambulatory difficulties/dysphasia/dysphagia/visual impairment/fatigue affecting 70 to 90%. No child was given palliative sedation. A mean of 6.2 multidisciplinary teams were involved/patient. 39% were managed by a paediatric oncologist. The remaining patients were managed by family doctors/paediatricians/palliative care physicians and intensivists. 51% were referred to a specialist palliative care team. The majority of patients received in-home palliation, and 56% died at home. 30% had an autopsy. CONCLUSIONS: This study details the challenging palliative course of children dying of MPT. It will be of value to physicians managing complex symptoms and guiding end-of-life decision-making.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 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".