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COMMUNITY
PEDIATRICS
Saturday, May 4, 2002
8:30am-11:30am
Special Interest Groups
4006
Managed Care
~ ~ ~ ~ ~ CANCELLED ~ ~ ~ ~ ~
Chair: Alan Bernstein, Ab-bernstein@compuserve.com
4009
Pediatric Telephone Care
Cochairs: Andrew Hertz, hertza@aol.com,
and Allison Kempe, Kempe.allison@tchden.org
10:00am-12:00pm
Educational Seminar
ES02
Bioethical Dilemmas: Making Decisions for the Not Yet
Competent
This seminar will be a
provocative interactive session on Bioethics. Through
the use of cases and excerpts from literary works,
participants will be encouraged to view decision-making
from the perspective of parents and health care
providers. The Principles of Bioethics will be
presented, as well as the contextual considerations that
force us all to wrestle with principles and theory, if
we choose to do so. The goal is to raise the
consciousness about the range of issues involved in
making the best decision for the pediatric patient. In
the end, choices must be made, and all those involved
must live with these choices.
Susan Albersheim, British Columbia's Children's
Hospital, Vancouver, BC, Canada; and John D. Lantos,
University of Chicago, Chicago, IL
12:00pm-3:00pm
Mini Course
4100
Adolescent Medicine - Part I—Current Research Issues
Chair: Donald E. Greydanus,
Michigan State University, Kalamazoo, MI
An update of various issues in
adolescent health care will be presented. Dr. Charles
Irwin Jr. will present current research on Preventive
Health Services in Adolescents. Dr. Anna-Barbara
Moscicki will discuss the changing Pap Smear guidelines
for adolescents, which are being developed by the
American Cancer Society. Finally, Dr. Renee Jenkins and
Dr. Tina Raine will review current research issues in
emergency contraception for adolescents. Questions will
be encouraged from the audience.
Preventive Health Care in Adolescents: Current
Research
Charles E. Irwin, University of California, San
Francisco, CA
Pap Smears and Cervical Cytology: New Guidelines
Anna-Barbara Moscicki, University of California, San
Francisco, CA
Research Issues in Contraception in Adolescents
Renee R. Jenkins, Howard University College of
Medicine, Washington, DC
Tina Renee Raine, University of California, San
Francisco General Hospital, San Francisco, CA
12:00pm-3:00pm
Mini Course
4101
Genetics for the Pediatrician: The Intersection of
General Pediatrics and Genetics
Chairs: Benjamin Siegel,
Boston University School of Medicine, Boston Medical
Center, Boston, MA and Jeff Milunsky, Boston University
School of Medicine, Boston Medical Center, Boston, MA
and
Approaches to the diagnosis,
management, and discussion of the psychosocial, legal
and ethical issues of genetics, from screening, to
giving bad news, to helping families understand and cope
with the impact of genetic diseases within a family
context, have always been challenges for the general
pediatrician. There are new technologies in the genetic
testing of children and family members that expand our
ability to accurately diagnose, provide anticipatory
guidance and genetic counseling to individuals and
parents, so that they may make more informed
reproductive choices. It is clear that pediatricians and
clinical geneticists need to work collaboratively as a
team to provide the most comprehensive care possible.
This session will examine the information needed from
the clinical assessment of the child, in relationship to
the family context that increases the likelihood that
the pediatrician is dealing with a possible genetic
issue. Exploration of the history, including the family
pedigree, aspects of the physical exam that alerts the
pediatrician to a possible genetic problem, the referral
process to a clinical geneticist, and the legal,
ethical, and psychosocial issues that should be
addressed with the individual or family member before
the referral to the geneticist will be presented. The
process of the clinical genetic evaluation will be
explored, highlighting the ethical, legal and
psychosocial issues. Current and newer genetic
technologies will be reviewed. The collaborative process
between the patient/family, the pediatrician, and
geneticist will be examined.
Overview
Benjamin S. Siegel, Boston University School of
Medicine, Boston Medical Center, Boston, MA
The Approach to the Genetic Evaluation of a Child
with a Suspected Genetic Disorder and the Use of Current
and Newer Genetic Technologies
Jeff M. Milunsky, Boston University School of
Medicine, Boston Medical Center, Boston, MA
Break
The Referral Process to a Clinical Geneticist: A General
Pediatric Perspective
Benjamin S. Siegel, Boston University School of
Medicine, Boston Medical Center, Boston, MA
The Ethical, Legal and Social Issues of Clinical
Genetics
Benjamin S. Siegel, Boston University School of
Medicine, Boston Medical Center, Boston, MA
12:00pm-3:00pm
Mini Course
4105
Update on Injury Control
Chair: Gary A. Smith,
Children's Hospital, Columbus, OH
The field of injury control
continues to evolve. Over the past decade new sources of
injuries have arisen, new information on old or
overlooked causes has been obtained, and new techniques
for preventing and minimizing the impact of certain
injuries have been developed and evaluated. This session
will review these advances and outline pertinent next
steps for health policy, research and clinical care.
Overview
Gary A. Smith, Columbus Children's Hospital,
Columbus, OH
Firearm Injuries: Just the Facts
M. Denise Dowd, Children's Mercy Hospital,
University of Missouri, Kansas City, MO
Update on Product-Related Injuries
Gary A. Smith, Columbus Children's Hospital,
Columbus, OH
Break
Prevention of Motor Vehicle-Related Injuries
Phyllis F. Agran, Pediatric Injury Prevention
Research Group, Health Policy and Research, University
of California, Irvine, CA
Current Federal Agency Priorities in Childhood Injury
Prevention Research
Richard A. Schieber, Centers for Disease Control and
Prevention, Atlanta, GA
12:00pm-3:00pm
Special Interest Group
4111
School and Community Health
The theme of the Baltimore
2002 SIG meeting will be "Keys to Collaboration in
School and Community Health." We’re looking
forward to presentations and discussions on various
topics that fall under this theme. In addition, we would
like to devote a portion of the meeting to a "works
in progress" session, during which APA members can
present educational initiatives, research studies or
community projects that are in the early stages of
development. It is our hope that SIG participants will
help each other with these projects by offering
suggestions, providing a sounding board for discussion,
or developing collaborative relationships for future
work. During this meeting we will also be handing over
the reigns to a new co-chair(s).
If you are interested in presenting at the SIG
meeting or if you have any additional suggestions for
the meeting, please contact Elisa Zenni at elisa.zenni@jax.ufl.edu
or (904) 244-7260 or Beth Edgerton at eedgerto@cnmc.org
or (202) 884-4859. In addition, if you are interested in
serving as SIG co-chair or in nominating a colleague,
please let us know. We welcome all APA meeting attendees
at the SIG meeting, whatever your interest in or
affiliation with school and community health might be.
Cochairs: Elizabeth A Edgerton, eedgerto@cnmc.org,
and Elisa Alter Zenni, elisa.zenni@jax.ufl.edu
3:15pm-5:15pm
Topic Symposium
4200
Cloning and Embryonic Stem Cells
Chair: Judith Hall,
University of British Columbia, Vancouver, Canada
There is enormous public
interest in cloning and embryonic stem cells. This
symposium will update the pediatric community on recent
developments and raises a variety of policy and ethical
issues.
Overview
Judith G. Hall, University of British Columbia,
Vancouver, Canada
Imprinting and Reprogramming
Arthur L. Beaudet, Baylor College of Medicine,
Houston, TX
Cloning
Brigid Hogan, Vanderbilt University Medical Center
and the Howard Hughes Medical Institute, Nashville, TN
Embryonic Stem Cells
Janet Rossant, Samuel Lunenfeld Research Institute,
Mount Sinai Hospital ON, Canada
3:15pm-5:15pm
Platform Session
4252
Health Services Research: Quality of Care
Chairs: Glenn Flores and
Richard C. "Mort" Wasserman
5:15pm-7:15pm
Poster Session I (Author Attended)
and Opening Reception
– Adolescent Medicine
– Education
Sunday, May 5, 2002
8:00am-10:00am
Topic Symposium
5001
Measuring and Improving Quality in Academic Medical
Centers
Chair: Michael Apkon, Yale
University School of Medicine, New Haven, CT
Applying scientific approaches
to quality management presents an important leadership
challenge for Academic Medical Centers to enhance health
care delivery. This symposium will review new paradigms
with which to examine opportunities for measuring and
improving the process of care delivery. The symposium
will also consider areas of congruence as well as areas
of opposition between the educational and care-delivery
missions of Academic Medical Centers where
often-competing interests of research, clinical care,
and education create a particularly challenging
environment for quality management.
The Case for Quality
Michael Apkon, Yale University School of Medicine,
New Haven, CT
Measuring the Quality of Care
Rita Mangione-Smith, University of California, Los
Angeles, CA
Comparing Quality Across Institutions
Murray M. Pollack, Children's National Medical
Center, George Washington University School of Medicine,
Washington, DC
Pediatric Outcomes Measurement in Academic Medical
Centers
Jeffrey H. Silber, The Children's Hospital of
Philadelphia and the University of Pennsylvania School
of Medicine, Philadelphia, PA
Aligning the Missions of Providing Care and Educating
Physicians
Martha Radford, Yale University School of Medicine,
Yale New Haven Health System, New Haven, CT
Discussion
8:00am-10:00am
Poster Symposium
5055
New Topics in Childhood Immunization Delivery
Chairs: Lance Rodewald and
Judith S. Shaw
8:00am-11:00am
Mini Course
5090
Adolescent Medicine - Part II—Eating Disorders
Chair: Donald E. Greydanus,
Michigan State University, Kalamazoo, MI
This presentation will present
an overview of the research on the diagnosis,
assessment, and treatment (therapy: including
psychological and pharmacological; settings: inpatient,
day treatment, and outpatient) of adolescents with
eating disorders. A brief comparison of the diagnostic
criteria used by the American Psychiatric Association
and the World Health Organization will be presented and
discussed regarding the relevance to research design and
diagnosis. Special issues (such as research design,
subject selection, research settings, geographical
location, definitions, terminology, race and culture,
managed care, and reimbursement) and their impact on our
current knowledge base and on treatment choices will be
addressed. Recommendations for future directions in
assessment, treatment, and research will be offered.
Overview
Donald E. Greydanus, Michigan State University
College of Human Medicine, Kalamazoo, MI
Diagnostic Criteria: American Psychiatric
Association, World Health Organization, Implications for
Diagnosing Adolescents
Helen D. Pratt, Michigan State University, Center
for Medical Studies, Kalamazoo, MI
Special Issues: Subject Selection: Gender, Race,
Ethnicity, Sexual Orientation
Helen D. Pratt, Michigan State University, Center
for Medical Studies, Kalamazoo, MI
Research Design: Research/Treatment Settings,
Inpatient, Day Treatment, Outpatient, Hospital, Clinic,
Community, Geographical Location, Definitions,
Disorders, Recovery
Helen D. Pratt, Michigan State University, Center
for Medical Studies, Kalamazoo, MI
Break
Treatment Interventions: Psychological, Psycho-pharmacologic
Helen D. Pratt, Michigan State University, Center
for Medical Studies, Kalamazoo, MI
Treatment Outcomes
Helen D. Pratt, Michigan State University, Center
for Medical Studies, Kalamazoo, MI
Recommendations for Future Research
Helen D. Pratt, Michigan State University, Center
for Medical Studies, Kalamazoo, MI
Discussion
8:00am-11:00am
Workshops
5101
Beyond Smoking Outside: The Pediatrician’s Role in
Helping Families To Stop Smoking
The effects of parental
smoking on children’s health are well known, yet
pediatricians are often hesitant to actively assist
parents to quit smoking. Recent research has identified
methods and windows of opportunity that can be most
effectively utilized by pediatricians. Brief
interventions in the context of pediatric primary care
have been shown to produce parental quit rates of 5–8%.
Pediatricians cite lack of confidence in their ability
to advise parents about how to stop, lack of true
physician–patient relationship with the parent,
concern that parents will receive the suggestions
negatively, and lack of time as reasons to not intervene
with parents who smoke.
Didactic content of this workshop includes the
biology of nicotine addiction and withdrawal, behavioral
and pharmacological treatment for nicotine addiction,
and the AHRQ Clinical Practice Guidelines for Smoking
Cessation. Effective strategies for implementing the
AHRQ guidelines in pediatric offices will be discussed.
There will be an opportunity to role-play smoking
cessation interventions for parents. The faculty will
share examples of practical office systems changes based
on their experience in training pediatricians and staff
to address parental tobacco use.
J. Groner, G. French, D. Moss, T. Syed, Departments
of Pediatrics, The Ohio State University, Columbus, OH
and University of Pittsburgh, Pittsburgh, PA
5102
Choosing and Using Health Status Instruments
The development of measurement
tools that obtain the perspectives of children and
parents about child health is the most concrete example
of the recent progress of pediatric outcomes research.
Although several generic and disease-specific health
status tools for children and adolescents are now
available for use in clinical and outcomes research, it
is not always obvious which measurement tool to use in a
given research project. Moreover, there are important
methodologic considerations inherent in obtaining
children’s and adolescents’ self-reports on their
health.
The purpose of this workshop is to provide
participants with the knowledge and skills needed to
select and use health status instruments in child health
research. The workshop leaders will present a framework
for choosing the right health status instrument for a
specific application. Topics covered will include:
conceptual models; psychometric issues unique to
obtaining child and teen self-reports; measurement
reliability and validity; sensitivity to developmental
differences and changes in health; child vs parent proxy
response; instrument scoring; and, an approach for
defining measurement requirements. This framework will
be used during a hands-on, interactive session during
which participants will review and evaluate a variety of
actual disease-specific and generic health status
instruments.
C. B. Forrest and A. Riley, Department of Health
Policy and Management, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD
5104
Developmental and Cultural Concepts: Children's and
Parents' Understanding of Illness
Numerous studies document
systematic developmental stages and cultural differences
in how children and adults understand physical and
psychological conditions. These developmental and
cultural differences are related to families’ health
seeking behaviors and coping strategies. They are
important to the recognition of symptoms, the
understanding of diagnoses, and compliance with
appropriate treatments.
In this interactive workshop, a panel of
investigators will briefly present research findings
from developmental psychology and pediatrics and medical
anthropology that inform clinical work with children and
adults across ages and cultural contexts. The panel will
include, in addition to ourselves, David Schonfeld, Lee
Pachter and Pradeep Gidwani whose research addresses
AIDS, cancer, asthma and ADHD among other conditions.
Videotaped interviews and role-plays will highlight key
concepts and guide a discussion of methods to improve
communications with families by integrating this body of
research into clinical interactions. Break-out groups,
led by each member of panel, will follow to discuss the
clinical implications of this research and to develop
ideas for future research.
J. M. McMenamy, E. C. Perrin, Center for Children
with Special Needs, Department of Pediatrics, Tufts
University/New England Medical Center, Boston, MA
5106
Reducing Medication Errors – Time To Take Action
Each year there are thousands
of injuries and deaths in U.S. hospitals from medication
errors. These blunders cost millions of dollars and
result in loss of public confidence in our health care
system. Medication errors are the second most frequent
and the second most expensive event causing liability
claims. Errant orders on the inpatient unit and
incorrect prescriptions in the ED and clinics are
common. Physicians, nurses, pharmacists, students,
manufacturers and even caregivers all share
responsibility. Many errors are preventable.
This workshop will focus on common sources of medical
errors and ways to prevent them. Workshop leaders will
discuss specific issues including:
- Root cause analysis looking at systems issues
rather than individuals
- Moving toward non-punitive approaches to reporting
errors
- Developing teaching programs for housestaff and
students
- The role of the pharmacist—how can they help?
- New technology—are computer systems useful? Are
the programs affordable?
- Creating multidisciplinary medication use process
improvement teams
- Approaching the family after a medical error—legal
and ethical implications
Participants will be asked to share their ideas and
experiences. It is hoped that participants will be able
to develop a multidisciplinary program in their own
institutions to reduce and manage medical errors.
S. Selbst, S. Levine, A.I. duPont Hospital for
Children, * Wilmington, DE, and J. Fein, J. Gould, M.
Friedman, C. Mull, Children’s Hospital of
Philadelphia, Philadelphia, PA
8:00am-11:00am
Special Interest Groups
5110
Complementary and Alternative Pediatrics
The Complementary and
Alternative Pediatrics SIG will present two speakers, followed by
planning for the creation of a web-based pediatric database /
curriculum in Integrative Pediatrics. Sharon McDonough-Means,
M.D., one of the first two graduates of the Integrative Pediatrics
Fellowship of the University of Arizona, will speak on “An
Integrative Approach to Attention Deficit Hyperactivity Disorder
Treatment: Evidence – Based Strategies.” The next speaker will
be the SIG’s co-leader, Sharon Riesen, M.D., Associate Professor
of Pediatrics at Loma Linda University. She will speak about
“Glyconutrients in the Treatment of Asthma: A Spoonful of Sugar
is the Medicine Going Down.” The third hour of the SIG will be
used to consider the creation of an Integrative Pediatric Database
and Curriculum accessible via the Internet. Please join us for
this exploration of alternative approaches to some common
pediatric problems and the ensuing discussion and planning period.
Cochairs: Scott Faber, sfaber@mercy.pmhs.org,
and Sharon Riesen, sriesen@ahs.llumc.edu
5114
Pain
The Special Interest Group on
Pain in Children focuses each year on an emerging area
in the management of children's pain. Topics at previous
meetings have included long-term consequences of
inadequately treated pain and development of
institutional approaches to promote pain management. The
focus this year will be on minimizing injection pain. It
is particularly relevant given immunization schedules
which cluster multiple injections at the same visit. The
session will attempt to address behavioral and
pharmacological approaches that decrease injection pain
as well as strategies for implementing such approaches
in busy ambulatory settings.
Chair: Neil Schechter, nschecht@stfranciscare.org
5115
Practice-Based Research Networks
Chair: Richard Pan, r.pan@ucdmc.ucdavis.edu
1:45pm-2:30pm
State of the Art Plenary
5590
Children as Victims of Bioterrorism: Protecting the
Fragile Host
Chairs: Phyllis Dennery,
Stanford University School of Medicine, Palo Alto, CA
and Tina Lee Cheng, Johns Hopkins University School of
Medicine, Baltimore, MD
With the recent world events
and new threats of biowarfare, what should pediatricians
know? Due to their size and physiology, children are at
higher risk of injury from bioterrorism. This session
will address the biology, clinical manifestations, and
possible preventive strategies for likely biowarfare
agents. The unique vulnerability of the child will be
addressed.
Overview
Phyllis A. Dennery, Stanford University School of
Medicine, Palo Alto, CA
Children as Victims of Bioterrorism: Protecting the
Fragile Host
Ralph D. Feigin, Baylor College of Medicine,
Houston, TX
Discussion
2:00pm-4:00pm
State of the Art Plenary
5701
Children as Research Subjects: Ethical and Regulatory
Issues
Chair: Myron Genel, Yale
University School of Medicine, New Haven, CT
A number of highly publicized
adverse events, including the death of two volunteers
participating in non-therapeutic research, and the
federal shutdown of research at many well-recognized
academic institutions because of inadequate compliance
with regulatory requirements have intensified scrutiny
of the protection afforded to human subjects
participating in research, including children.
Furthermore a Maryland court has recently decreed that
children cannot participate in research without the
potential for direct benefit. As a consequence there has
been increasing media attention and Congressional
concern regarding the adequacy of institutional
oversight and investigator attentiveness to established
standards and regulations. In addition, new regulations
issued under the Health Insurance Portability and
Accountability Act of l996(HIPAA) threaten the capacity
to conduct health services and outcomes research. These
issues will be addressed in the 9th annual Public Policy
Plenary Symposium in an interactive format intended to
stimulate dialogue among the members of the panel and
with the audience.
Overview
Myron Genel, Yale University School of Medicine, New
Haven, CT
Overseeing Research in Children: New Concerns and New
Regulations
Alan R. Fleischman, The New York Academy of
Medicine, New York, NY
International Health Research: Where Bioethics,
Politics and Economics Converge
Eric M. Meslin, Indiana University Center for
Bioethics, Indianapolis, IN
Compliance: What You and Your Institution Need to
Know (and Do)
Pearl O'Rourke, Partners HealthCare System, Inc.,
Boston, MA
HIPAA, Privacy & Confidentiality and Research In
Children?
Brian Kamoie, The George Washington University,
Washington, DC
Discussion
Sponsored jointly with the Public Policy Council
of the APS, AMSPDC, SPR and the Public Policy Committee
of the APA
Partially supported by an educational grant from
Columbus Children's Hospital
2:00pm-5:00pm
Workshops
5605
Handheld Computers in Clinical Pediatric Practice
Handheld computers are rapidly
evolving into an indispensable tool for the clinician.
Though handheld computers have been limited in the past
to scheduling, to-do lists, brief notes, and phone
lists, progressive application development is providing
reference tools, medical calculators, charge capture
programs, electronic prescription writing software,
procedure logs, web browsers, EMR integration, research
databases, evidence-based medicine tools, and multimedia
applications permitting access to telemedicine.
The purpose of our workshop is to provide
participants with hands-on experience employing a
variety of software applications on the most common
handheld computers. To demonstrate the utility of
applications, clinical cases will be employed.
Participants will be led through the cases step-by-step
so that firsthand experience in handheld computers will
be acquired. A brief discussion period will follow each
case to elaborate on the extended utility of presented
applications, as well as other commercially available
programs. In addition, guidelines will be introduced for
evaluating future software and technologies, as they
become available. Participants will receive a resource
list to facilitate ongoing education in the growing
field of handheld computing. No prior knowledge in the
use of handheld computers is required.
T. L. Courtney, Children¹s Hospital of The King¹s
Daughters and Eastern Virginia Medical School, Norfolk,
VA, K. Johnson, Johns Hopkins University, Baltimore, MD,
and A. Meyers, Boston Medical Center, Boston, MA
5608
Pediatric Obesity: Practical Evaluation and Treatment
Strategies for Primary Care Providers
The United States is
experiencing an epidemic of pediatric obesity. However,
many primary care providers report that obesity is one
of the most frustrating and difficult problems in their
practices. In this workshop, we will provide practical
strategies for evaluating and treating obese children in
primary care. To maximize learning and relevance the
session will be split. Approximately one-third of the
session will focus on expert committee recommendations
for evaluation and behavioral treatment strategies. We
will address skills for identification of obesity,
screening for both rare endogenous causes of obesity and
more common obesity-associated conditions or risk
factors, assessment of emotional and psychosocial
states, eating and activity assessment, and indications
for consultation with an obesity specialist. For
treatment, we will address the most successful
strategies for diet and physical activity counseling,
changing the household environment, self-monitoring,
goal setting and contracting, parenting skills training,
maintenance and relapse prevention, and the potential
role of drug therapies. The other two-thirds of the
session will consist of case discussions and group
problem solving. Cases will address practical evaluation
and management challenges facing primary care providers.
T. N. Robinson and S. E. Barlow, Dept. of Pediatrics,
Stanford University, Palo Alto, CA, and Dept. of
Pediatrics, St. Louis University School of Medicine, St.
Louis, MO
2:00pm-5:00pm
Special Interest Group
5613
Injury Control
The SIG on Injury Control
plans to have an update on the national Longitudinal
Cohort Study designed by Dr. Peter Scheidt. This study
will enroll more than 100,000 children and their
families and follow their progress for a number of
years, correlating their exposure status with certain
health outcomes. Dr. Scheidt has been instrumental in
bringing this massive research effort through its
current planning stage, and he will describe its
potential impact vis-a-vis research questions in
childhood injury control.
The SIG also plans to discuss the new APA policies on
proposals for issuing position statements through the
Association's new journal, Ambulatory Pediatrics. We
will explore whether position statements on topics in
injury control should be formulated by one or several
SIG subcommittees.
Chair: Alan Woolf, woolf@a1.tch.harvard.edu
2:30pm-4:00pm
State of the Art Plenary
5703
Insulin Resistance Syndromes
Chairs: Alan Rogol, Insmed
Pharmaceuticals, Inc., Glen Allen, VA and Charlotte
Boney, Rhode Island Hospital, Providence, RI
Insulin resistance is the
underlying factor in many of the consequences of obesity
in childhood and adolescence, including ovarian
hyperandrogenism, hypertension, hyperlipidemia, and Type
2 diabetes. Obesity, dyslipidemia, and Type 2 diabetes
are components of SyndromeX in adults, a serious public
health issue. In addition, insulin has a role in the
regulation of leptin, the major signal of adiposity to
the brain. Dr. Arslanian will discuss insulin resistance
in polycystic ovary disease and Type 2 diabetes. Dr.
Freedman will review the cardiac risk factors related to
insulin resistance, and Dr. Roemmich will discuss the
insulin-leptin axis in obesity and puberty.
Insulin Resistance: It's Not for Adults Only
Silva A. Arslanian, Children's Hospital of
Pittsburgh, Pittsburgh, PA
Clustering of Coronary Heart Disease Risk Factors in
Obese Children
David Freedman, Division of Nutrition and Physical
Activity, Centers for Disease Control, Atlanta, GA
The Insulin-Leptin Axis in Puberty
James Roemmich, School of Medicine and Biomedical
Sciences, University of Buffalo, Buffalo, NY
Sponsored jointly with the Lawson Wilkins Pediatric
Endocrine Society and the American Academy of Pediatrics
4:15pm-6:15pm
Topic Symposium
5800
End-of-Life Palliative Care
Chair: Marcia Levetown,
Independent Pain and Palliative Care Consultant,
Houston, TX
53,000 children die annually
in the United States and many more live with chronic,
life-threatening conditions. Yet, pediatric education
and subspecialty training do not currently prepare
practitioners to care for these needy children, their
parents, community and survivors. This symposium,
presented by a pediatric hematologist/oncologist,
pediatric palliative care physician and a bereaved
parent, will discuss how to incorporate palliative care
into pediatric care. Specific highlights are the
presentation of an integrated model of care, beginning
at the time of diagnosis of a potentially
life-threatening condition, parental and patient
perspectives on the fight against disabling symptoms and
death, and the ethics behind the decision-making process
that confronts the family and medical care team.
Overview
Marcia Levetown, Independent Pain and Palliative
Care Consultant, Houston, TX
Incorporating Pediatric Palliative Care Principles
into Oncology Care from the Time of Diagnosis
Joanne Hilden, The Cleveland Clinic Foundation,
Cleveland, OH
Community Resources for Pediatric Palliative Care
Sue Huff, Center for Hospice and Palliative Care,
Cheektowaga, NY
The Value of a Day in the Life of a Terminally Ill
Child
Jan Wheeler, Ed. D Candidate, University of Houston,
Houston, TX. Bereaved Mother
Ethical Issues in Medical Decision-Making: When the
Patient is a Child
Marcia Levetown, Independent Pain and Palliative
Care Consultant, Houston, TX
Sponsored jointly with the American Society of
Pediatric Hematology/Oncology
4:15pm-6:15pm
Platform Session
5901
Brain Imaging
Chair: William D. Gaillard
4:15pm-6:15pm
Poster Symposium
5906
Neonatal Epidemiology and Follow-Up
Chairs: Mark A. Klebanoff
and Saroj Saigal
Monday, May 6, 2002
8:00am-10:00am
Topic Symposium
6002
The Scholarship of Teaching: How Can Excellence Be
Judged?
Chair: Kenneth Roberts,
Moses Cone Health System, Greensboro, NC
It has been argued that the
education of future physicians is the only unique task
of an academic medical center, given that both clinical
care and research can be and are done in other settings
and institutions. Achieving this task requires excellent
clinical teachers, and such individuals constitute an
essential resource in a department of pediatrics.
Protecting and nurturing this resource by providing
appropriate recognition, promotion and compensation for
individuals who have achieved excellence as teachers is
therefore essential, but what criteria should be used to
determine excellence in teaching?
In this symposium, the presenters, all of whom are
interested in teaching and teachers, will address their
ideas regarding excellence and how it can be recognized.
Introduction: Framing the Question
Kenneth B. Roberts, Past President APA and APPD,
Moses Cone Health System, Greensboro, NC
Documentation of Excellence in Teaching: Expectations
of a Chair
F. Bruder Stapleton, University of Washington School
of Medicine, Seattle, WA
Demonstrating Excellence in Teaching
Richard Sarkin, Past President COMSEP, University at
Buffalo School of Medicine, Buffalo, NY
Discussion
8:00am-10:00am
Platform Session
6055
Infectious Diseases: Focus on Future Vaccines
Chairs: W. Paul Glezen and
Neal A. Halsey
8:00am-10:00am
Platform Session
6059
Underserved Populations I
Chairs: Carrie L. Byington
and Charles Feild
9:00am-12:00pm
Workshops
6100
Achieving Cultural Competency in Pediatrics
The United States rapidly is
growing more culturally diverse. In several cities,
whites already are in the minority. Culture has a
profound impact on pediatrics, affecting multiple
aspects of clinical care, including outcomes, processes,
quality, satisfaction, obtaining an accurate history,
and adherence. Cultural competency is the ability to
recognize and appropriately respond to key cultural
characteristics that affect clinical care in the major
cultural groups seen in your practice. In this workshop,
participants will learn about a model of cultural
competency that can be applied to any cultural group
that might be encountered by the pediatrician. This
model is based on five aspects of culture that affect
clinical care: 1) normative cultural values; 2) language
issues; 3) folk illnesses; 4) parent beliefs; and 5)
provider practices. The Latino and African-American
cultures will be used to illustrate the most important
ways that culture impacts pediatric care, drawing on the
rich available literature and the personal experience of
the workshop leaders.
Using an evidence-based approach derived from
critical studies on Latino and African-American culture,
workshop participants will learn and master the cultural
competency model. Illustrative cases (including
videotapes) will be presented to challenge participants
and further solidify their skills. Participants can
expect to acquire practical skills for recognizing and
appropriately responding to crucial aspects of culture
and language that affect pediatric care.
G. Flores and G. Askew, Department of Pediatrics,
Boston Medical Center and Boston University Schools of
Medicine & Public Health, Boston, MA
6101
Caring for Gay and Lesbian Youth in Pediatric Practice
Adolescents who are gay or
lesbian, or are questioning their sexual identity, may
look to health care providers for assistance with both
medical and psychosocial issues. Yet many practicing
pediatricians are uncomfortable with their skills in
caring for gay and lesbian adolescents. At the
University of Massachusetts Medical School, we have
developed a series of workshops for university and
community clinicians that provide knowledge of health
care needs of gay and lesbian youth and model supportive
interviewing techniques. Methods include slide
presentations, interactive discussion, videotapes of
interviews with gay and lesbian youth and their parents,
modeling of "live" interviews, and a
"Teaching Kit" for helping faculty to teach
students and residents about sexuality. Preceptor
support for this curriculum has led us to pilot the
workshop in community pediatric offices, training all
office staff, including providers, social workers,
managerial and clerical staff.
In this workshop participants will: 1) participate in
an interactive demonstration of our general and
office-based workshops; 2) discuss the barriers to
teaching about sexuality in an office setting, and how
to address them; and 3) develop a "Safe Office
Kit" for their own practices that will allow them
to train their own faculty and staff.
S. Sack, E. Ferrara, S. Starr, D. M. Keller, and E.
Perrin, University of Massachusetts Medical School,
Worcester, MA, and Tufts University School of Medicine,
Boston, MA
6103
Culture, Spirituality, and Complementary and Alternative
Pediatrics: An Applied Integrative Model
Growing attention in medical
literature has been dedicated to an increasingly
multicultural patient population, to intersections
between spirituality and medicine, and to the wide use
of complementary and alternative therapies in the United
States. Frequently, however, these three topics are
presented as unrelated to one another. Yet in practice,
they often represent intersecting fields of experience.
This workshop will introduce a model that integrates the
three topics and will present illustrative examples from
different areas of the United States.
Workshop participants will next apply this model to
their own family culture through a guided exercise. By
learning to work with a conceptual framework in direct
relation to their own experience, they will learn how an
otherwise abstract model looks in practice. They will
then engage in small group discussion of what they
observed through the exercise. During the third section
of the workshop, participants will engage in a role-play
of history-taking. They will apply the model both as a
family caretaker who has brought a child in for a
consultation, and as the pediatrician. Each role-play
will be followed by group discussion.
Through this workshop, participants will learn to
utilize a conceptual model that integrates
standard-of-care biomedical treatment, culture,
spirituality, and CAM and will recognize the importance
and rationale for adopting an integrative approach of
this kind in pediatric practice. They will also learn
tools with which to teach others this model.
L. Barnes and K. Fox, Department of Pediatrics,
Boston Medical Center, Boston, MA
6105
Early Identification and Assessment of Children with an
Autism Spectrum Disorder
Pediatricians play a crucial
role in identifying infants and toddlers who may have
significant developmental needs. Recently, there has
been a growing concern about possible increases in the
numbers of children with an autism spectrum disorder (ASD).
Early identification and intervention can significantly
improve the long-term outcome for these children and
their families. Unfortunately, although symptoms of the
ASDs are generally present before 3 years of age, the
average diagnosis is not made until 4.5 years of age.
Given the unusual patterns of development shown by
children with autism in communication, social, and
behavioral skills, parents often report frustration
associated with trying to identify the nature of their
child’s needs and with accessing appropriate services.
Pediatricians can provide helpful screening and
diagnostic referral information. The aim of this
workshop is to provide information about the early signs
of children with an ASD, to identify screening
instruments for the ASDs and to describe the referral
process in case further assessment and intervention are
warranted. Workshop activities will include presentation
and discussion, video observation of children with and
without ASDs and small group evaluations of clinical
vignettes profiling a child in need of more detailed
developmental assessment. The goal is to help
pediatricians implement guidelines recently established
for identifying children with an ASD by the American
Academy of Pediatrics.
C. E. Rice, O. Y. Ousley*, and M. Yeargin-Allsopp,
National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention
and *Emory University Department of Psychiatry, Atlanta,
GA
6106
Integrating Genetics Teaching into Daily Pediatric
Practice: Do I Really Need To Be Doing That?
Daily headlines flash new
genetic discoveries revolutionizing the practice of
medicine! What really has changed and what do we need to
know? The goals of this workshop are to emphasize the
relevancy of integrating genetics into every patient
encounter, enthuse participants about the impact of
rapidly exploding genetic knowledge/technology on
patient care and physician responsibility and discuss
the core genetic competencies our students need to
acquire.
During this workshop participants will have the
opportunity to review new advances in the field,
including ethical, legal and social implications. All
attendees will acquire the necessary tools and resources
to enhance their comfort in teaching genetics through
small sub-groups which will focus on stimulating
interest in this area by: 1) working through at least
two educational methods/materials that could be used at
the participant's own site; 2) discussing cases where
"missed opportunities" in genetics impacted
the physician and family in an ethical, legal or social
manner; and 3) locating at least three internet
user-friendly sites as resources for current genetic
information. The workshop, using a series of teaching
exercises, role-playing and short didactic sessions will
focus on our important role as generalists utilizing
genetics as a unifying thread in patient care.
T. Turner, M. Dumont-Driscoll, J. Gigante, and B.
Siegel
6107
Medical Homes for Children with Special Health Care
Needs: Partnership for Community-Based Care
The AAP and the MCH Bureau
advocate that community-based pediatric offices should
be designed as Medical Homes for Children with Special
Health Care Needs (CSHCN). Primary care physicians
should meet the health promotion and standard medical
care needs of children with a wide variety of medical
and developmental needs (e.g., cerebral palsy, Down
syndrome, inborn errors of metabolism, autism, HIV). Our
team (of physicians, parent coordinator and project
manager) will describe a partnership between the
Children’s Hospital, Boston and six pediatric
practices, focusing on components that have supported
and enhanced Medical Homes in the community. We will
discuss the following topics: 1) creating meaningful
coordination between primary and tertiary care through
electronic linkages, active referral networks,
Individualized Health Planning; 2) provision of relevant
continuing medical education programming for physicians
and nurse practitioners who care for CSHCN; 3) training
future physicians to practice using the medical home
model; 4) conducting research on epidemiology, systems
of care, condition specific issues, etc. that provide
necessary data for improving the health and functional
status of children with special health care needs; and
5) sponsoring consortia of physicians, parents and
others interested in improving services for CSHCN.
T. Silva, E. Davidson, L. Freeman, L. Sofis, and J.
Palfrey, Children’s Hospital, Boston and the East
Boston Neighborhood Health Center, Boston, MA
6110
Open Access Appointment Scheduling: The Cure for the
Ailing Pediatric Practice?
Same day appointment
scheduling systems, commonly referred to as Open Access
Scheduling (OAS), is offered as the solution to poor
pediatric office efficiency. Long waits, poor access to
services, malfunctioning telephone systems, disorganized
patient flow, miscommunication and strained finances are
reported symptoms of some ailing pediatric ambulatory
practices. OAS advocates in academic pediatric
continuity clinics, public sector neighborhood health
centers or in private pediatric practices heartily
endorse this novel appointment system as the cure for
these chronic problems. OAS purports to optimize access
to care while allowing the practitioner/practice to
track patients who do not re-appoint in a timely manner.
OAS relies on the themes of access, interaction,
reliability, and vitality. In its purest form, OAS
offers every patient an appointment on the day that an
appointment is requested. The motto for OAS is, "Do
today’s work today." During this workshop, OAS
experts will provide background information and specific
OAS examples from different pediatric practice settings.
A point–counterpoint debate involving workshop
participants will delineate and discuss the pros and
cons of this model. Is your ambulatory pediatric
practice in need of resuscitation? Come to this workshop
to see if OAS is the cure!
J. Brown, D. Laraque, J. Cox and G. Randolph,
Department of Pediatrics, Colorado School of Medicine,
Denver, CO, Dept. of Pediatrics, Mt. Sinai School of
Medicine, New York, NY, Dept. of Pediatrics, Harvard
Medical School, Boston, MA and Dept. of Pediatrics, U of
N. Carolina School of Medicine, Chapel Hill, NC and the
HCD Committee
Sponsored jointly with the APA Health Care Delivery
Committee
10:15am-12:15pm
Platform Session
6204
Underserved Populations II
Chairs: Paul L. McCarthy
and Ronald C. Samuels
2:45pm-4:45pm
Topic Symposium
6500
Antibiotic Resistance: The Race Is On (PIDS
Symposium)
Chairs: Joseph W. St. Geme
III, Washington University, St. Louis, MO and Richard F.
Jacobs, University of Arkansas, Arkansas Children's
Hospital, Little Rock, AR
In recent years there has been
an explosion in the prevalence of antibiotic resistance.
As a consequence, treatment decisions now are often
complicated, and treatment is more and more commonly
unsuccessful. In this symposium, speakers will review
the epidemiology of antibiotic resistance, the current
state in treating resistant Staphylococcus aureus
and resistant gram-negative bacteria, and new approaches
to antibiotic discovery.
The Evolving Epidemiology of Antibiotic Resistance
Daniel Sahm, Focus Technologies, Inc., Herndon, VA
The Challenge of Antimicrobial Therapy for the
Staphylococci: Our Backs to the Wall
Robert S. Daum, The University of Chicago, Chicago,
IL
Increasing Resistance in Gram-Negative Bacteria: The
Role of Extended Spectrum Beta Lactamases
David L. Paterson, University of Pittsburgh Medical
Center, Pittsburgh, PA
Genomic Approaches to Antibiotic Discovery
Molly B. Schmid, Integrative Proteomics, Inc.,
Toronto, Canada
Sponsored jointly with the Pediatric Infectious
Diseases Society
2:45pm-4:45pm
Platform Session
6552
Clinical Bioethics
Chairs: Susan Hintz and Jon
E. Tyson
Tuesday, May 7, 2002
8:00am-10:00am
Topic Symposium
7000
Advances in Autism: Etiology, Imaging and Treatment
Chairs: Daniel Coury,
Children's Hospital, Columbus, OH
The autistic spectrum
disorders have received increased attention from the
public and research communities over the past decade.
Theories regarding the possible etiology of the
disorder, techniques for better evaluating and
diagnosing persons displaying symptoms, and
evidence-based treatment options have all received
attention. Panel members will present the latest
thinking regarding these issues and discuss
controversial findings that have confused clinicians and
families.
Introduction
Daniel Lee Coury, Children's Hospital, Columbus, OH
Newborn Biologic Markers for Autism
Judith Grether, California Department of Health
Services, Oakland, CA
Neuroimaging in Autism
Pauline A. Filipek, University of California, Irvine
College of Medicine, Orange, CA
Alternative Biologic Treatments
Susan E. Levy, Children's Seashore House of the
Children's Hospital, Philadelphia, PA
Effectiveness of Behavioral Therapy
James Mulick, Columbus Children's Hospital,
Columbus, OH
8:00am-10:00am
Platform Session
7054
General Pediatrics III
Chairs: Carol D. Berkowitz
and Janet Serwint
8:00am-10:00am
Platform Session
7055
Health Services Research: The Practice and the Patient
Chairs: Paul M. Darden II
and Modena Wilson
8:00am-10:00am
Platform Session
7061
Underserved Populations III
Chairs: Jay H. Mayefsky and
John I. Takayama
8:45am-11:45am
Mini Course
7090
Controlling Asthma in the New Millennium
Chair: James S. Seidel,
Harbor-UCLA Medical Center, UCLA School of Medicine,
Torrance, CA
Although we have an
understanding of the pathophysiology and treatment of
asthma, the incidence, severity, and mortality from the
disease is increasing. Twice in the past 10 years the
National Heart Lung and Blood Institute has issued
Guidelines for Diagnosis and Management of Asthma. These
have not been widely adopted nor used. This mini course
will explore the management of asthma in the emergency
department and office setting and explore new methods to
form care partnerships between practitioners, families
and children to improve the care of asthma.
The NHLBI Guidelines on the Diagnosis and Management
of Asthma; Why Have We Failed to Use Them. Results of a
National Qualitative Study
James Seidel, Harbor-UCLA Medical Center, UCLA
School of Medicine, Torrance, CA
Management of Acute Asthma in the Emergency
Department
Ellen F. Crain, Albert Einstein College of Medicine,
Bronx, NY
Managing Asthma Over Time: Rescue Medication Versus
Therapeutic Interventions
Shirley A. Murphy, University of New Mexico School
of Medicine, Albuquerque, NM
Forming Care Partnerships with Patients and Families
David Evans, Columbia University College of
Physicians & Surgeons, New York, NY
8:45am-11:45am
Special Interest Groups
7109
Community-Based Physicians
The following is the agenda
for the Community-Based Physicians SIG which will be
meeting on Tuesday morning May 6 in the Baltimore
Convention Center:
- Presentation of the 1st Annual National Community
Teaching Award cosponsored by the AAP and APA to
recognize a community pediatrician who has dedicated
his/her career to the teaching of medical students
and residents in the office setting.
- A workshop entitled, "How To Overcome
Barriers to Community-Based Teaching—The Good, the
Bad and the Ugly," led by Dr. David Bromberg.
- A progress report from the AAP Resident Education
and Training SIG presented by Dr. Stan Fisch.
Any comments, suggestions or questions should be
addressed to Dr. Emanuel Doyne (513-636-8043 or doyne0@chmcc.org).
Chair: Emanuel Doyne, doyne0@chmcc.org
7110
Continuity Clinic
The Continuity Directors SIG
was organized by Jan Drutz 12 years ago and continues to
be a very active network for preceptors in resident
continuity settings. We’re very pleased that over the
years, the group has grown and completed projects that
none of us individually could have accomplished. The
annual SIG meeting, workshops, directories with clearing
house information, newsletters and research have
blossomed by the involvement of countless individuals
committed to enhancing resident education. Our group has
remained consistently enthusiastic and highly motivated
because of all the Continuity Directors’ and
preceptors’ attendance and active participation!
Our annual meeting is open to anyone interested in
continuity settings as sites for teaching and learning.
You do not need to be a continuity director—community
and hospital-based preceptors, residents, and
individuals interested in primary care and educational
research are welcome! Our meeting will provide an
opportunity to network and learn about current projects
and "hot topics" of interest. As usual, we
will focus on one interactive discussion about a current
topic of interest (selected from suggestions made at our
May 2001 meeting). Specific agenda information will be
available in the spring newsletter and on the APA
website. For more information, please contact one of the
SIG’s cochairs.
Cochairs: Marilyn Dumont-Driscoll, dumonmd@peds.ufl.edu,
and Diane Kittredge, diane.kittredge@hitchcock.org
7112
Pediatric Tobacco Issues
This inaugural meeting of the
"Cig SIG" will include an introductory session
during which members will briefly present their
interests and work in pediatric tobacco issues, a
presentation by members of the AAP's Center for Child
Health Research and presentation of a proposed APA
tobacco policy. A presentation by a potential funder is
being pursued. Other presentations will be considered.
if you are interested in suggesting a topic for
discussion or in making a presentation, please contact
either Dana Best, MD, MPH (dbbest@cnmc.org) or Deborah
Moss, MD, MPH (mossd@pitt.edu).
Cochairs: Dana Best, dbbest@cnmc.org,
and Deborah Moss, mossd@chplink.chp.edu
7113
Pediatrics for Family Practice
Iam looking forward to our May
meeting. Tentative plans are to discuss:
- a current survey of the pediatric training
component in Family Practice Programs
- best teaching approaches for pediatric training in
Family Practice Residency Programs
- ways to reduce barriers that might impede
pediatric training in Family Practice Residency
Programs
- efforts to revise and broaden the scope of the
Reilly Pediatric Training Manual for Family Practice
residents.
Please contact me if you have either been a past
participant in this SIG or a new member who would like
to contribute to this session. Iam very interested in
your feedback and your cooperative assistance with our
SIG program. In addition, let me know if there are any
other issues your would like to present. I look forward
to hearing from you. Contact: Dr. David Turkewitz,
Chairman Pediatrics, York Hospital, 1001 South George
Street, York, PA 17405, Phone: 717-851-3883, FAX:
717-851-3382, email: dturkewitz@wellspan.org
Chair: David Turkewitz, Dturkewitz@wellspan.org
1:45pm-3:45pm
Hot Topic
7700
Models for Building Mental Health Capacity in Pediatric
Primary Care
Chair: Anne M. Gadomski,
The Mary Imogene Bassett Research Institute,
Cooperstown, NY
This session will describe
three models presently under study for building the
capacity of pediatric primary care sites to manage
children’s mental health problems. Two models are
based on enhancements or extra resources for primary
care providers, and the third is based on primary
providers' skills.
Speakers will describe ongoing research, present
interim data, and outline replicable interventions.
Following the presentations there will be an opportunity
for questions and discussion.
Overview
Anne M. Gadomski, Bassett Healthcare, Cooperstown,
NY
Building and Maintaining a Therapeutic Alliance in
Pediatric Primary Care
Lawrence Wissow, Johns Hopkins School of Public
Health, Baltimore, MD
Promoting Evidence-Based ADHD Treatment Among
Pediatricians
Jeff Epstein, Duke University Medical Center,
Durham, NC
Youth Partners in Care: A Quality Improvement Model
for Primary Care Treatment of Adolescent Depression
Lisa Jaycox, RAND, Arlington, VA
Discussion
1:45pm-3:45pm
Hot Topic
7702
Disaster Preparedness: Beyond 9/11
Chairs: Tina L. Cheng,
Johns Hopkins University School of Medicine, Baltimore,
MD; Danelle Laraque, Mount Sinai School of Medicine, New
York, NY; and Benard Dreyer, New York, NY
The impact of 9/11 and the
public health aftermath have affected us personally and
professionally. This session will address what the child
health professional needs to know regarding disaster
planning and preparedness. Speakers will review and
provide updates on national and regional systems for
emergency management and how those systems interact with
local public health agencies, the pediatrician's role in
the community's preparedness including what the school
system, the pediatric office and the patient should be
doing to prepare and respond, recognition and management
of chemical and biologic agents of terrorism, and the
psychological reactions to disaster and stress.
Disaster Planning and Preparedness for Child Health
Professionals
George L. Foltin, New York University School of
Medicine and Bellevue Hospital Center, New York, NY
Biologic Agents of Terrorism
Anne Fine, New York City Department of Health, New
York, NY
Chemical Agents of Terrorism
Fred Henretig, University of Pennsylvania School of
Medicine and Children's Hospital of Philadelphia,
Philadelphia, PA
Helping Children Cope with Terrorism and Disasters
David J. Schonfeld, Yale University School of
Medicine, New Haven, CT
Discussion
1:45pm-3:45pm
Platform Session
7802
General Pediatrics IV
Chairs: Jeffrey M. Devries
and Susan Feigelman
1:45pm-3:45pm
Platform Session
7803
Health Services Research
Chairs: Denise M. Dougherty
and Thomas B. Newman
1:45pm-3:45pm
Platform Session
7805
Underserved Populations IV
Chairs: Thomas G. DeWitt
and Victoria Meguid
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