The Serious Illness Conversation Guide program developed by Ariadne Labs, a Joint Center for Health Systems Innovation, includes a list of patient-centered questions designed to assist clinicians to gain a more thorough understanding of their patient’s life in order to inform future care decisions. In July 2017, specialist pediatric palliative care clinicians at Canuck Place Children’s Hospice (CPCH) (Vancouver, BC, Canada), adapted the original guide to use with parents of children with serious illness. This tool is referred to as the Serious Illness Conversation Guide-Peds (SICG-Peds). Using the SICG-Peds, along with enhanced communication skills, can help illuminate the parents’ (child’s) understanding of illness and the values they hold. Expanding the application of the guide will promote goal-based, efficient, comprehensive and consistent communication between families and clinicians and help ensure that seriously ill children receive care that is tailored to their needs through the disease trajectory. This paper explores the guide through the lens of a case study. The steps—seeking permission, assessing understanding, sharing prognosis and exploring key topics (hopes, fears, strengths, critical abilities and trade-offs)—as well as formulating clinician recommendations, are described.

No abstract

Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children's Hospital during the 2014 outbreak. Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors. Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P = 0.03) and copathogens was associated with PICU admission (P = 0.02). Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

FRCPC a,b,d THE INSIGHTSCOPE TEAMCONTEXT: Urinary tract infections (UTIs) are the most common bacterial infections in infants <2 months of age. However, there are no clear guidelines on the appropriate duration of antibiotics in this age group. OBJECTIVE:In this living systematic review, we compared different durations of parenteral antibiotics (#3 vs >3 days) in neonates and young infants (<2 months) with UTIs. The secondary objective was to compare different durations of total antibiotic courses (#10 vs >10 days).