In low- and middle-income countries where more than 80% of the world’s population lives, birth defects and other perinatal problems cause more loss of healthy years of life to early mortality and disability than almost any other condition. Yet, development of strategies for the prevention and care of birth defects has received insufficient international attention to date. The reasons for this include: a general lack of knowledge of the problem and of the considerable social and economic toll it imposes; a lack of awareness of the potential for prevention; and, as important, the absence of an international framework of mechanisms for promoting cooperative actions and solutions.

This session will present statistics on the global toll of birth defects and discuss a recent report of the U.S. Institute of Medicine commissioned to identify cost-effective opportunities for care and prevention of birth defects in developing countries. Specific recommendations for priority research, capacity building and institutional efforts to reduce adverse birth outcomes will also be discussed. The session will explore the applicability of the report’s findings to developing countries. It will also suggest what actions are required to implement appropriate public health strategies. It will conclude with a presentation on research directions for care and prevention.

Attendees of this topic symposium will learn of the exciting new advancements in understanding the genetic contributions to a variety of gastrointestinal diseases such as intractable diarrhea, Hirschsprung’s Disease and inflammatory bowel disease.

New information is emerging that attests to the importance of the intrauterine environment on subsequent neonatal and child health. Although premature labor is one of the most acute outcomes that result from alterations in the normal intrauterine environment, more subtle outcomes include those affecting the respiratory and central nervous systems. Dr. Alan Jobe will discuss the exciting new insights that he and his colleagues have made concerning lung function and intrauterine inflammation. Dr. Van Marter will examine the epidemiological information available that highlights the role of intrauterine inflammation and subsequent neurological development.

Discussion
 

In this educational workshop we will provide a brief overview of NICHD priorities, funding and peer review, which will be followed by participant's presentations of their own research goals and ambitions to the workshop leaders and their peers. We will use an interactive group problem-solving approach using a flipchart to generate an outline of a research action plan for each presenting participant. We have used this approach with junior faculty immediately post-fellowship in another academic society venue with great success.

The participants will be divided into groups of ten and will critique each other's plans as they are presented. The focus will be on each investigator articulating specific aims and hypotheses, with support from the NICHD staff. Additionally, specific inquiry paths for funding opportunities will be made available to each participant. The initial overview of priorities for funding and review will take no more than 30 minutes, immediately followed by the first cohort of investigator presentations.
 

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 case-based 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. Emphasis will be placed on tools with which to teach others this model.
 

Recent studies suggest that pediatric sleep issues, despite their clinical importance, are inadequately addressed in the practice setting. Most medical schools and post-graduate pediatric training programs do not offer sufficient educational opportunities to allow students and residents to acquire the necessary knowledge and skills to diagnose and treat these problems. The goal of this workshop is to teach clinical pediatric faculty how to become more effective teachers of pediatric sleep medicine. Interactive presentations will focus on developing and adapting sample core curriculums for medical students and residents in pediatric sleep, development and application of teaching strategies in a variety of settings (inpatient, continuity clinics, behavioral pediatrics rotations, etc.), use of teaching materials and resources (sample cases, web-based materials, etc.) and evaluation tools (pre and post-tests, OSCEs, etc.) to enhance precepting skills of participants. Videotaped standardized patient encounters of common pediatric sleep problems will also be reviewed and discussed. Participants will also be encouraged to bring sample pediatric sleep cases from their own practices in order to offer participants the opportunity to review and operationalize acquired skills.
 

Family presence for procedures is a relatively new concept in pediatric medicine. Studies have shown that many parents prefer to be with their children when they undergo painful or invasive procedures. Some physicians are reluctant to accept this break with tradition and refuse to allow parents in the room. The purpose of this workshop is to develop an approach to successful procedures with parental presence. Workshop leaders (including physicians, social work, housestaff) will address critical issues such as:

• Review of the literature—what do parents/families want?
• What is best for the children?
• What rights do the parents have? How about the physicians?
• Are some situations/procedures (i.e., resuscitations) "off-limits"?
• How can we instill confidence in trainees when the family is watching?
• Can we preserve teaching opportunities?
• Are there safety risks? Legal issues?
• Enlisting the help of others: the role of liaisons, social workers, therapists

Using case scenarios and role-playing, workshop leaders will address the pros and cons of family presence for procedures. Participants will be expected to share their experiences and ideas to move forward with this "unconventional" approach to medical care. It is expected that through discussion and debate we will implement a system for success.

• Can we preserve teaching opportunities?
• Are there safety risks? Legal issues?
• Enlisting the help of others: the role of liaisons, social workers, therapists

Using case scenarios and role-playing, workshop leaders will address the pros and cons of family presence for procedures. Participants will be expected to share their experiences and ideas to move forward with this "unconventional" approach to medical care. It is expected that through discussion and debate we will implement a system for success.
 

Practicing evidence-based medicine (EBM) is an essential competency for lifelong learning and critical thinking among pediatric residents and practicing pediatricians. Yet, with multiple demands on curricular planning, programs have found it difficult to make time and space to incorporate this material. Drawing on our successful teaching of EBM to students, residents and faculty in a variety of settings, and sharing what we have learned from the occasional misstep, we have developed an interactive workshop to simplify the development and evaluation process for others wishing to launch a similar curricular program.

Through the workshop, participants will work in small groups to a) identify practical ways of integrating key EBM competencies into a variety of educational venues; b) develop a focused curriculum to teach EBM to students or residents in a specific setting at their home institution; and c) explore and discuss methods to evaluate this important competency.

The session will conclude with a participant-generated discussion of useful pearls for teaching and evaluating evidence-based medicine skills. Participants will receive sample curricular materials, examples of evaluation methods and a list of resources that can foster the teaching and practice of EBM.
 

Patients and their families in low-income communities require a multidisciplinary healthcare team that includes lawyers to protect the health of their children and to navigate the bureaucratic barriers to government benefits. These patients often require assistance that extends beyond the traditional training of physicians. Doctors must become familiar with advocacy resources and learn to use new tools to assist their patients with diverse social-medical problems. The goals of the workshop are to:

• Teach pediatricians and other health care providers about the basics of legal advocacy by providing them with the necessary tools and resources to proactively address the social issues that affect children’s health and wellness.
• Introduce pediatricians to new tools including eight innovative ‘Advocacy CPGs’ and the ‘Advocacy Code Card.’ These tools guide physicians’ assessment of families’ social needs and provide appropriate resources, general tips and a sample advocacy letter.
• Demonstrate and offer access to The Online Advocate – a new, web-based tool that prints ‘Rx for Advocacy’ prescriptions to facilitate the referral process and helps providers ascertain which referrals could help a family.
• Emphasize the unique ability of collaborations with legal services located within pediatric clinics to comprehensively care for children’s health. Participants will learn methods to establish legal liaisons and review cases involving medical-legal alliances.
   

The incidence of lawsuits in the United States continues to rise. Within this environment, pediatricians are vulnerable to litigation yet often have limited experience and information about the legal process and relevant principles of law. Legal dilemmas are particularly common in acute care settings and frequently are managed without the immediate advice of counsel. In this workshop, participants will explore basic legal issues that impact on medical practitioners, gain familiarity with the litigation process and examine strategies for testifying in court. A team of specialists in pediatric emergency medicine, malpractice issues, court testimony and forensic medicine will begin the workshop with an interactive presentation of case scenarios that highlight common statutory dilemmas, malpractice issues and the litigation process (civil and criminal). Participants will then view videotapes of court testimony and discuss strategies for testifying as a fact or expert witness. Workshop leaders and participants will conclude the session with small group discussions of individual experiences with civil or criminal proceedings and legal testimony. A complete syllabus will be provided for the workshop that is designed for use as a teaching manual.
 

The rates of overweight children and adolescents have steadily risen over the past 30 years. Many environmental factors contribute to the epidemic of overweight children. The Nutrition-Friendly School (NFS) program is an ecological model, which impacts the entire school environment including students, staff and families to promote good nutrition and physical activity. The NFS model builds upon school strengths to prevent the development of overweight in children. School community stakeholders collaborated with the UCLA Nutrition Friendly Group to develop the NFS certification criteria and self-evaluation tool.

The goals of the workshop are to introduce participants to the NFS model and demonstrate the NFS process. Participants will work in small teams in a participatory action research process used to develop the NFS criteria. Next, participants will work through the self-evaluation process to determine the strengths and areas in need of improvement for a school. Finally, participants will write a plan to achieve the NFS criteria. Development of the NFS model was funded by the California Nutrition Network through the Los Angeles Unified School District.
 

Research in infants and children requires special consideration of scientific, ethical and legal issues. Each of these issues, along with logistical and technical considerations, may require innovative study design. The practical and scientific implications of these modifications in clinical research will be discussed. Within this context, this interactive workshop will address approaches to clinical research, including development of research questions, subject selection and highlight consideration of study design with safe and effective solutions. This workshop will use didactic presentations, discussions and structured small group sessions. Participants in the small group sessions will actively evaluate selected research topics and present their considerations and clinical research proposal for discussion. A wide range of designs will be addressed, including translational research, all phases of clinical trials and observational studies. This interactive workshop is intended for fellows and junior faculty embarking upon a career in pediatric clinical research. Participants are encouraged, but not required, to bring clinical research ideas for discussion.
 

Pediatric residency programs are faced with the challenge of integrating the teaching and learning of ACGME competencies into residents’ educational experiences.

The workshop will focus on how competencies can be integrated into an established Teaching Resident Rotation for PL-3 pediatric residents. This rotation includes didactics in teaching techniques, direct observation of residents, including bedside teaching, and the review of taped feedback given by the resident to a medical student.

The workshop will include a short didactic on the experience of the presenters with emphasis on educational forums, faculty time requirements, development of evaluation tools such as 360 evaluations and a direct observation measure and residents’ perceptions of the rotation with the new emphasis on competency.

Participants will have the opportunity to observe a videotape of a resident–medical student encounter and use an evaluation instrument to rate the resident’s performance in terms of two ACGME competencies: professionalism and communication skills. Participants will then break into small groups to discuss additional educational forums in which to teach and assess competencies and explore implementation barriers.
 

The ability to share bad news effectively is an essential skill for pediatricians. The Accreditation Council for Graduate Medical Education has recently endorsed six competencies for resident education, one of which involves the development of interpersonal and communication skills. Bad news spans a variety of circumstances, from discussing an abnormal laboratory test, a physical examination finding with uncertain prognosis, the disclosure of a life-threatening diagnosis or a child’s death. During this interactive skills-based workshop, participants will identify important components of giving bad news by review of videotapes. The perspectives and reactions of parents, patients, and health care professionals in receiving and giving bad news will be explored. Useful techniques will be identified and practiced during self-reflections and role-playing with participants. Participants will develop ideas of implementation of teaching techniques and evaluation of this competency for their own institutions.
 

This session will review the basic principles of writing and publishing the results of a clinical research project. Starting with organizing ideas into a coherent manuscript with appeal for editors and reviewers, the workshop leader will interactively work with the audience to review writing principles and processes common to scientific reporting. Emphasis will be placed on writing full original reports, though comments on preparing other types of reports and presentations will also be included. The overall structure of manuscripts will be reviewed including purposes and content of the Abstract, Introduction, Methods, Statistics, Results and Discussion sections. Interactive projects to recognize and correct common errors will use examples from manuscripts submitted for publication (and also from published articles). These examples will illustrate major principles in writing sentences, paragraphs and organization of manuscripts overall. Handouts and slides will be the main audiovisual tools. Development of figures—graphics as well as half tones—and tables will also be discussed. Differences between graphics for presentation and publication and use of computer-generated materials will be emphasized. Journal selection and understanding the review process complete the workshop. Finally, the speaker will encourage seminar participants to submit, prior to the PAS, an article for personal review during the PAS meeting.

Support from Nature Publishing Group.
 

1. Resident Advocacy Poster Session: We will solicit abstracts from residency programs, including recipients of past Resident CATCH Planning Grants. We will select up to12 abstracts for poster presentation at the SIG.
2. APA Policy Statement: Last year, we discussed the idea of sponsoring a Policy Statement on Advocacy Training that reflects our understanding of the needs to nurture young advocates in the same way as the APA nurtures new researchers or educators. We will use the meeting to develop and refine such a consensus for submission to the Board.
    

Growth and development are the hallmarks of pediatrics, and with ever improving preventive services there is greater emphasis on monitoring and promotion of optimal behavior and development. This year's SIG will review the available instruments for developmental screening and strategies for implementing them in busy practices and residencies, as well as training residents in their use. The discussion will be led by Frances Glascoe, PhD, and will have ample time for questions and problem-solving. There will also be discussion of new requirements for developmental–behavioral pediatrics fellowship programs and the first round of board certification.
 

Our meeting will focus on general pediatrics coverage of in-patient activities. Colleagues from the SIG on Hospital Care will discuss the generalist as hospitalist. We also will discuss coverage of the Well Baby Nursery by the General Pediatrics Division.
 

The Pediatric Environmental Health Special Interest Group is looking forward to another excellent meeting at the Pediatric Academic Societies in Seattle in May 2003. We hope you will join us for an informative session. Our keynote speaker will be Dr. Michael Weitzman who will be discussing some of the latest information about children’s environmental health, including the neurocognitive effects of environmental tobacco smoke. Further program details are forthcoming. Since our May 2002 SIG meeting, we have slowly begun the process of looking to update and perform a major overhaul of a faculty teaching manual to teach Pediatric Environmental Health that was developed and initially revised by the Children’s Environmental Health Network—a Train the Trainers manual. We hope to invite additional participation when this project moves forward. We hope to see you in Seattle and sustain the momentum of increasing attendance annually at our sessions!
 

We will focus on three fronts this year. First, we will continue to disseminate new tools that facilitate real-time, bedside evaluation of competencies. Second, we will develop concrete proposals to disseminate methods to bring the core values of humanism and professionalism into our daily practices. This will include exploring individual patient encounters, the structure of teaching programs and the structure of institutions. And third, we will explore the parallels between student and resident education and patient education.

This year we will also invite other SIGs with similar interests to join us. In particular, we will explore and try to define areas of overlap and a possible joint agenda with Faculty Development, Advocacy, Resident, Pediatric ED Directors and others.

Finally, the SIG will continue to provide its members with a home that provides concrete advice about opportunities for faculty development, networking opportunities and updates from the world of medical student education (AAMC, COMSEP and other organizations). We will provide

information on how to document teaching contributions as scholarship for promotion, how to use new technologies and how to find new sources of teaching cases.
 

Faculty Participants: Tim Oberlander, University of British Columbia; Christine T. Chambers, University of British Columbia and British Columbia's Children's Hospital; James Rice, University of British Columbia

The Special Interest Group on Pain in Childhood will present a workshop entitled "Understanding pain in the child with a developmental disability." The workshop faculty are:

Pain assessment and treatment in children with developmental disabilities is complex, confusing and confounded by many aspects of the underlying condition and its sequelae. These children experience pain from a wide variety of sources, some of which are unique to them, yet the functional impairments associated with developmental disabilities challenge our ability to assess and manage their pain.

Using case-presentations, this workshop will review our current understanding of pain in particular childhood populations with developmental disabilities and provide some strategies for assessment and management. It is hoped that an interactive discussion with workshop participants will help move this emerging field forward.

Objectives:

1. Is the experience different? Discuss research findings describing the pain experiences among a variety of populations of children with developmental disabilities. Particular focus will be on describing acute pain experiences among children with cerebral palsy, cognitive impairments and autism.
2. Basics of Pain experience (Where and when does pain arise in this setting?): Provide an understanding of pain including its anatomy and physiology as well theories as to how an altered neurologic substrate may alter the pain experience in this setting.
3. What to do? Outline basics of pain assessment and management in this setting.
4. Future directions: Provide an opportunity to contribute to consideration of the pain research agenda related to this population.

Please join us for this important discussion.
 

Healthy bones in childhood are of vital importance, for they determine future bone health or disease in adulthood. In this symposium, recent advances in the understanding of the biology of bone formation and turnover will be discussed. Clinical disorders affecting pediatric bone health, and the assessment of their impact, will be presented. The controversial issue of whether breast-fed babies should be given supplemental vitamin D will be considered next. Finally, recent advances in the use of new anti-resorptive agents in the treatment of metabolic bone diseases of children will be presented.

Sponsored Jointly with the Lawson Wilkins Pediatric Endocrine Society
 

Contact for information:
David K. Stevenson, M.D.
Neonatal & Developmental Medicine
Stanford University School of Medicine
750 Welch Road, Suite 315, Palo Alto, CA 94305
Phone: (650)723-5711 Fax: (650)725-8351
EMail: dstevenson@stanford.edu

Contact for information:
Susan Albersheim, M.D.
Department of Pediatrics
British Columbia’s Children’s Hospital
4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada
Phone: (604)875-2135 Fax: (604)875-3106
Email: salbersheim@cw.bc.ca
 

Al Aynsley-Green, National Clinical Director for Children, Department of Health, Her Majesty's Government, Nuffield Professor of Child Health, The Institute of Child Health, University College London
University of London, Director of Clinical Research & Development, Great Ormond Street Hospital for Children and The Institute of Child Health, London

Discussion

Lessons he has learned and experiences he has lived will be shared to help pediatricians around the world with our quest to improve the lives and health of children. The goals, activities and experiences of the Children's Taskforce, as well as six external working groups, are exportable, practical and logical. Strategies used for developing opportunities not only to improve child health at a local level but also at a national level will be discussed.

Opportunities for questions and discussion will be provided so attendees can share effective techniques to improve child life and health.

Sponsored Jointly with the Presented by the March of Dimes Birth Defects Foundation

Includes selected original science abstract presentations as well as the Presidential Address, International Health Award and George Armstrong Lecture presentations.

Available for Viewing: 2:45pm–6:45pm
Author Attendance: 5:00pm–6:45pm
 

Newborn screening programs, which have been in place for more than 40 years, are facing major challenges. Technological advances permit the addition of an increasing number of diseases, including many for which the benefits are not as clear-cut as for PKU, congenital hyperthyroidism or sickle cell disease. As pilot projects evaluate the addition of new tests, the importance of involving parents in decision-making is being actively discussed. Originally established with a "public health imperative," the predominant state model has been one of "informed dissent." Various models for informing and involving parents will be discussed, as well as their feasibility and cost. There are a number of legislative developments under consideration locally and nationally, and these will be presented and analyzed. As new diseases are considered for addition to screening batteries, it is possible to screen for disorders that have no effective interventions defined. It is clear that if we do not screen for these diseases, no improvements in care will advance. We will discuss whether such arguments justify screening. In summary, technological advances are forcing policy decisions. We will discuss the impacts of these challenges.

In the past several years, considerable progress has been made in understanding the mechanisms by which nutrient availability controls cell growth and proliferation. While hormonal mechanisms have been carefully studied and are well established, the signal transduction mechanisms that account for nutrient responsiveness at the cellular level have only recently come under intense scrutiny. This symposium will focus on these cellular mechanisms. Topics will include the nutrient regulation of cell proliferation, nutritional control of mRNA translation and the developmental modulation of nutrient signaling. In particular, speakers will focus on the molecular nature and regulation of cell signaling mechanisms that are nutrient-responsive, the integration of these signaling pathways and their developmental modulation. A goal of the symposium is to provide a physiological context for these signaling mechanisms, thereby establishing their relationship to a critical area in pediatrics, the nutritional control of growth.

Sponsored Jointly with the Lawson Wilkins Pediatric Endocrine Society
 

This symposium covers four issues in vaccination. The American Academy of Pediatrics and CDC currently are moving toward a recommendation for universal annual vaccination of infants with killed or live influenza vaccine. Why is this? Now that Rotashield is off the market, a new rotavirus vaccine is needed and may be on the way. Despite good protection of children by vaccination, pertussis infections are rising in adolescents and adults. Can they be controlled? Recent disruptions in vaccine supply have caused pediatricians significant problems. What are the causes and solutions?

Sponsored Jointly with the Pediatric Infectious Diseases Society
 

Contact for information:
Roberta A. Ballard, M.D.
Department of Pediatrics, Division of Neonatology
Children’s Hospital of Philadelphia
34th and Civic Center Blvd.
Philadelphia, PA 19104
Phone: (215)590-1653 Fax: (215) 590-3051
EMail: ballard@email.chop.edu