Development of Canadian National Guidelines for Pediatric Donation After Circulatory Determined Death (pDCD)
Bibliographic record
Abstract
Introduction/Hypothesis pDCD uptake has been slow in Canada, where most pediatric hospitals do not have active programs and pDCD represents only 8% of pediatric deceased donation. This project generated national, pediatric specific clinical practice guidelines (CPGs) to inform the development of ethical and effective pDCD practice. Methods We followed a process of CPG development based on World Health Organization (WHO) and Canadian Medical Association (CMA) methods. These included application of the Appraisal of Guidelines, Research and Evaluation (AGREE II) tool, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Questions requiring recommendations were generated based on: 1) 2006 Canadian DCD guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pDCD leaders, and 3) a scoping review of the pDCD literature (1). Input from these sources drove drafting of actionable questions and Good Practice Statements (GPSs), as defined by the GRADE group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using GRADE, and then formulated into evidence profiles that informed recommendations through the Evidence-to-Decision framework. Recommendations were revised through consensus among the members of 7 topic specific working groups (WGs), and finalized during meetings of WG leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies as well as patient partners. Results 65 GPS recommendations and 7 GRADEd recommendations covering: 1) Ethics, Consent and Withdrawal of Life Sustaining Therapy (WLST) 2) Eligibility 3) WLST Practices 4) Ante and Post Mortem Interventions 5) Death Determination 6) Neonatal pDCD 7) Cardiac and Innovative pDCD 8) Implementation. Conclusions This process showed that rigorous, evidence based CPGs are possible in the domain of pediatric deceased donation. We hope that these CPGs will increase access to pDCD across Canada and serve as a model for international CPG development in deceased donation. Reference: 1. Weiss MJ, Hornby L, Witteman W, Shemie SD. Pediatric Donation After Circulatory Determination of Death. Pediatr Crit Care Med. 2016 Mar;17(3):e88–108.
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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 | 0.056 | 0.151 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.008 | 0.006 |
| Science and technology studies | 0.004 | 0.004 |
| Scholarly communication | 0.006 | 0.003 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
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".