Discharge against medical advice (DAMA) in paediatrics: An approach to promote safety and ethics
Bibliographic record
Abstract
Requests for discharge against medical advice are often challenging for clinicians to navigate, especially when the patient is a child. An informed, standardized approach to managing situations where children and their families are requesting to leave against medical advice is essential to maximizing safety and ethics for patients and staff, yet such situations are often not handled this way. Paediatric discharge against medical advice (DAMA) requests are best managed when clinicians ensure the patient's best interests are met, understand and act upon their professional obligations, and engage in guided discussion with patients and families that involves both shared and informed decision-making strategies. A process map can capture these criteria and readily provide clinicians with a bedside reference tool when managing paediatric DAMA requests.
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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 | 0.034 | 0.076 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.014 | 0.016 |
| Scholarly communication | 0.017 | 0.016 |
| Open science | 0.003 | 0.024 |
| Research integrity | 0.007 | 0.011 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
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".