Most end-of-life decision-making studies have, until now, involved either the general population or newborn infants.
To assess the frequency of end-of-life decisions preceding child death and the characteristics of the decision-making process in the Netherlands.
Two studies were performed. The first was a death certificate study in which all 129 physicians reporting the death of a child aged between 1 and 17 years in the period August to December 2001 received a written questionnaire; the second was an interview study in which face-to-face interviews were held with 63 physicians working in pediatric hospital departments.
Some 36% of all deaths of children between the ages of 1 and 17 years during the relevant period were preceded by an end-of-life decision: 12% by a decision to refrain from potentially life-prolonging treatment; 21% by the alleviation of pain or symptoms with a possible life-shortening effect; and 2.7% by the use of drugs with the explicit intention of hastening death. The latter decision was made at the child's request in 0.7% and at the request of the family in 2% of cases. The interview study examined 76 cases of end-of-life decision making. End-of-life decisions were discussed with all 9 competent and 3 partly competent children, with the parents in all cases, with other physicians in 75 cases, and with nurses in 66 cases.
While not inconsiderable, the percentage of end-of-life decisions was lower for children than for adults and newborn infants. Most children are not considered to be able to participate in the decision-making process. Decisions are generally discussed with parents and other caregivers and, if possible, with the child.
[Show abstract][Hide abstract] ABSTRACT: The acute and comprehensive nature of the care provided in the PICU has made it a frequent point of entry into the hospi- tal system and a highly visible contact point for many types of emergency services for children. The circumstances that bring children and their families to the PICU often involve crises that summon the attention of entire families and have ripple effects throughout their communities. Care of the critically ill child therefore has a high impact factor with regard to society at large. Additionally, as a consequence of this important role, the PICU care team may have opportunities to interface with a large number of diverse perspectives and venues. If they are performed skillfully, these interface functions can have a pos- itive impact on the care of children, both within the walls of the PICU and beyond. The goals of this chapter include the enhancement of sen- sitivity, efficiency, and effectiveness in the PICU professional's interactions with the families that they serve. The major fo- cus points are the initial establishment of a working relation- ship,processpointsfordifficultsegmentsofthehospitalcourse, dealing with disability and death, and functions that the PICU practitioner may have in increasing societal awareness of child health and safety.
[Show abstract][Hide abstract] ABSTRACT: Sensor networks have emerged as a fundamentally new tool for monitoring inaccessible environments. They are distinguished from traditional sensors by strict limitations on system bandwidth and sensor energy resources. These constraints motivate the use of data compression at each sensor. Location finding is an important application of sensor networks, and estimation of the time delay between data from different sensors is a key step in localization. In this work, new quantizer designs specific to the time-delay estimation problem in sensor networks are presented. The goal for these new application-specific encoders is to achieve the best time delay estimate at a given bandwidth budget or latency bound, or minimize the rate required to reach an estimate with desired accuracy.
Statistical Signal Processing, 2003 IEEE Workshop on; 01/2003
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