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Health professionals neglect needs of family when dealing with sudden death
SCIENCE AND MEDICINE
Obstructive sleep apnoea in children might impair cognition and behaviour just counting the number of apnoeic parents completed two paediatric episodes per hour of sleep. We need quality-of-life questionnaires. 6 to look at other factors relating to months after tonsillectomy and sleep disturbance and to gauge the adenoidectomy, the same questionimpact on cognitive function and naires were given to the parents. behaviour as well as Results showed a quality of life. I don’t significant correlation Rights were not think that’s something between the severity of people take into considsleep apnoea and five granted to eration when they are aspects of cognition and include this planning how to take behaviour, including image in care of kids with sleep intelligence, memory, electronic media. apnoea.” and academic perPlease refer to Parents have been formance. Behavioural anecdotally telling us problems and quality of the printed that their child’s life improved or reversed journal. behavioural problems after tonsillectomy and resolved after treatment adenoidectomy; howof sleep apnoea, points ever, cognitive improveout Lynn D’Andrea ment was only partial. School performance affected (University of Virginia, This is preliminary Charlottesville, VA, USA). “This is information, explains Glaze, which the first study to give us objective shows how these collective variables measures before and after managerelating to sleep apnoea have an ment of the sleep apnoea”, she says. effect on children’s functioning, and “But of concern is that cognitive the changes that occur after treatdeficits only partially improved folment. lowing treatment, suggesting that “In the future we’ll present data on some of the impairment from sleep the different parameters and how apnoea may be more permanent.” we can determine significant sleep apnoea and long-term outcome at 1 year”, says Glaze. “It’s more than Roxanne Nelson Science Photo Library
bstructive sleep apnoea syndrome could significantly affect a child’s cognitive skills, school performance, and behaviour, reported US researchers at the Annual Meeting of the American Society of Pediatric Otolaryngology (Boca Raton, FL, USA; May 9–14). These factors should be considered when establishing the severity of obstructive sleep apnoea and the decision for intervention, since results from a new study suggest that tonsillectomy and adenoidectomy could improve the quality of life of both children and their families. Daniel Glaze (Baylor College of Medicine, Houston, TX, USA) and colleagues studied 23 children, aged 5–13 years with obstructive sleep apnoea syndrome, before tonsillectomy and adenoidectomy. Each child had an overnight polysomnography to establish the number of apnoea and hypopnoea events, respiratory-related arousals, minimum oxygen saturation SaO2 value and number of O2 desaturations less than 90%, and the maximum end tidal CO2 value per hour of sleep. The children participated in a battery of neuropsychological tests, and their
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Health professionals neglect needs of family when dealing with sudden death
A
lthough the main obligation of a health professional is to the patient, when the patient dies suddenly, the family members’ needs should take precedence, argue US investigators. “Ignoring the interests of a bereaved family is neither humane nor cost effective, and can lead to tragic results”, asserts lead researcher David Bishai, an emergency physician and economist at Johns Hopkins University’s Bloomberg School of Public Health (Baltimore, MD, USA). Bishai and co-worker Andrew Seigel describe a case in the May issue of the Journal of Clinical Ethics, in which paramedics pronounced a 38-year-old woman dead at her home—in the presence of her young daughters who had attempted cardiopulmonary resuscitation— instead of immediately transporting her to a hospital emergency department. The daughters stayed with their mother’s body for 2 h while their father drove home from work, after which the body was taken directly to the medical examiner.
1754
In addition to dealing with their mother’s death, the daughters felt fear of being in the home where their mother died, guilt that their efforts at cardiopulmonary resuscitation were inadequate, and anger that more efforts were not made to help her. The researchers note that transportation of the woman to hospital probably would have done little, if anything, to benefit her. But it would not have caused her additional harm and would have been beneficial for the family, since paramedics are not trained in bereavement counselling, whereas emergency department staff are trained to provide such support. Bishai concedes that for the purposes of cost–benefit analyses, “saving a life is only worth what that life is worth to the patients themselves, and I have a sneaking suspicion that paramedics and physicians are reflecting some of that. The argument is that it’s not cost effective to transport dead bodies around town because they’re dead and so there’s no benefit—and what I’m trying to do
is point out the fallacy of that because there is a benefit. You have almost no chance of saving your patient, but you have an incredible chance of having an outcome for the family. As physicians, especially in cases of sudden death, it’s important to start asking ourselves, ‘who is the patient now?’” Bishai is exploring economic tools that bring the effect on the family into cost-effectiveness analyses in a soon-to-launch study of the cost of AIDS in the Netherlands. “The questionnaire we started with was to ask the patient, ‘did you lose work or experience depression today?’ Now we’re adding questions, and asking ‘which of your household members lost work or were depressed this week because of your illness?’ The bottom line”, warns Bishai, “is that there’s a lot of harm being done every day in our economic and clinical decisions by ignoring families”. Marilynn Larkin
THE LANCET • Vol 359 • May 18, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Obstructive sleep apnoea in children might impair cognition and behaviour just counting the number of apnoeic parents completed two paediatric episodes per hour of sleep. We need quality-of-life questionnaires. 6 to look at other factors relating to months after tonsillectomy and sleep disturbance and to gauge the adenoidectomy, the same questionimpact on cognitive function and naires were given to the parents. behaviour as well as Results showed a quality of life. I don’t significant correlation Rights were not think that’s something between the severity of people take into considsleep apnoea and five granted to eration when they are aspects of cognition and include this planning how to take behaviour, including image in care of kids with sleep intelligence, memory, electronic media. apnoea.” and academic perPlease refer to Parents have been formance. Behavioural anecdotally telling us problems and quality of the printed that their child’s life improved or reversed journal. behavioural problems after tonsillectomy and resolved after treatment adenoidectomy; howof sleep apnoea, points ever, cognitive improveout Lynn D’Andrea ment was only partial. School performance affected (University of Virginia, This is preliminary Charlottesville, VA, USA). “This is information, explains Glaze, which the first study to give us objective shows how these collective variables measures before and after managerelating to sleep apnoea have an ment of the sleep apnoea”, she says. effect on children’s functioning, and “But of concern is that cognitive the changes that occur after treatdeficits only partially improved folment. lowing treatment, suggesting that “In the future we’ll present data on some of the impairment from sleep the different parameters and how apnoea may be more permanent.” we can determine significant sleep apnoea and long-term outcome at 1 year”, says Glaze. “It’s more than Roxanne Nelson Science Photo Library
bstructive sleep apnoea syndrome could significantly affect a child’s cognitive skills, school performance, and behaviour, reported US researchers at the Annual Meeting of the American Society of Pediatric Otolaryngology (Boca Raton, FL, USA; May 9–14). These factors should be considered when establishing the severity of obstructive sleep apnoea and the decision for intervention, since results from a new study suggest that tonsillectomy and adenoidectomy could improve the quality of life of both children and their families. Daniel Glaze (Baylor College of Medicine, Houston, TX, USA) and colleagues studied 23 children, aged 5–13 years with obstructive sleep apnoea syndrome, before tonsillectomy and adenoidectomy. Each child had an overnight polysomnography to establish the number of apnoea and hypopnoea events, respiratory-related arousals, minimum oxygen saturation SaO2 value and number of O2 desaturations less than 90%, and the maximum end tidal CO2 value per hour of sleep. The children participated in a battery of neuropsychological tests, and their
O
Health professionals neglect needs of family when dealing with sudden death
A
lthough the main obligation of a health professional is to the patient, when the patient dies suddenly, the family members’ needs should take precedence, argue US investigators. “Ignoring the interests of a bereaved family is neither humane nor cost effective, and can lead to tragic results”, asserts lead researcher David Bishai, an emergency physician and economist at Johns Hopkins University’s Bloomberg School of Public Health (Baltimore, MD, USA). Bishai and co-worker Andrew Seigel describe a case in the May issue of the Journal of Clinical Ethics, in which paramedics pronounced a 38-year-old woman dead at her home—in the presence of her young daughters who had attempted cardiopulmonary resuscitation— instead of immediately transporting her to a hospital emergency department. The daughters stayed with their mother’s body for 2 h while their father drove home from work, after which the body was taken directly to the medical examiner.
1754
In addition to dealing with their mother’s death, the daughters felt fear of being in the home where their mother died, guilt that their efforts at cardiopulmonary resuscitation were inadequate, and anger that more efforts were not made to help her. The researchers note that transportation of the woman to hospital probably would have done little, if anything, to benefit her. But it would not have caused her additional harm and would have been beneficial for the family, since paramedics are not trained in bereavement counselling, whereas emergency department staff are trained to provide such support. Bishai concedes that for the purposes of cost–benefit analyses, “saving a life is only worth what that life is worth to the patients themselves, and I have a sneaking suspicion that paramedics and physicians are reflecting some of that. The argument is that it’s not cost effective to transport dead bodies around town because they’re dead and so there’s no benefit—and what I’m trying to do
is point out the fallacy of that because there is a benefit. You have almost no chance of saving your patient, but you have an incredible chance of having an outcome for the family. As physicians, especially in cases of sudden death, it’s important to start asking ourselves, ‘who is the patient now?’” Bishai is exploring economic tools that bring the effect on the family into cost-effectiveness analyses in a soon-to-launch study of the cost of AIDS in the Netherlands. “The questionnaire we started with was to ask the patient, ‘did you lose work or experience depression today?’ Now we’re adding questions, and asking ‘which of your household members lost work or were depressed this week because of your illness?’ The bottom line”, warns Bishai, “is that there’s a lot of harm being done every day in our economic and clinical decisions by ignoring families”. Marilynn Larkin
THE LANCET • Vol 359 • May 18, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.