Outcome measures are a vital part of research design. Many studies continue to use morbidity and mortality, admission to the hospital, cost of care and other gross measures that do not define true outcomes for patients. A model for outcome determination using disease specific outcomes that define long-term outcomes, proximate outcomes, global long term outcomes and global proximate outcomes can serve as the conceptual framework for decisions about assigning specific outcome measures for a study. A conceptual framework using disease-specific and global outcomes based on diversity and severity of the process to be studied will be discussed. Quality of Care Measures will be differentiated from true outcome measures.

Applying the methods and tools of outcomes research and the evaluation of the impact of health care on the health outcomes or "end result" of patients and populations to various clinical domains are critical to research design. They are an integral part of translational research.

Translating, disseminating and implementing research results and applying them to clinical care and policies affecting clinical care are critical to improving patient outcomes. A hierarchy of research impact and an approach to translational/implementation research will be discussed. Implementation research examines the science of translating clinical and organizational research into practice and policy. Evidence-based implementation strategies are in turn based on the findings of implementation research. Results of implementation research, including research in children’s health care, will be discussed. Models will be given that can be applied to research protocols.

Discussion
 

Background: Many children present to the Emergency Department or other acute care setting with forensic-related issues, but few training programs prepare physicians to properly deal with these issues. Clinical forensic medicine is the branch of medicine that deals with cases involving both medical and legal aspects of patient care.

Objective: This workshop is designed to increase participant awareness of their patients’ forensic and legal needs and to review with them forensic techniques for initial evaluation.

Methods: Experts in the fields of pediatric emergency medicine, child abuse and neglect, toxicology and forensic medicine will work side-by-side with participants, teaching them to evaluate survivors of non-accidental injury. Workshop leaders will actively engage participants and provide hands-on instruction of the following skills: the detection, collection and preservation of evidence; documentation of injuries (including photography in the ED); pattern injury recognition; interpretation of injuries; and reporting requirements and regulations. All registrants will receive a comprehensive syllabus containing vital information and references related to the practice of Clinical Forensic Medicine.
 

Environmental health is an increasingly important field within public health. This course will focus on children's environmental health. Children are different than adults in their exposure and susceptibility to environmental hazards. The workshop will emphasize the special needs of children from epidemiologic, physiologic and public policy perspectives. Participants will be provided with several case studies and access to reference material. They will work through the cases to discover clinical information or public policy approaches to dealing with environmental health problems. Participants will be able to: identify the characteristics of children that make them especially vulnerable to environmental insults; describe the unique exposures that children have to environmental hazards; describe the effects of certain specific pollutants on children, and identify components of federal, state and local governments that have an impact on children's environmental health.

The creation of this workshop is funded by a grant from the Association of Occupational and Environmental Clinics.

Content of this session is similar to session 3151 Pediatric Environmental Health (Part I) and 3650 Pediatric Environmental Health (Part II)
 

Despite the high prevalence of developmental and behavioral disorders in children, limited medical services exist in most communities for the diagnosis and management of affected children. As a result, necessary specialized care may not be adequately rendered.

In this workshop, a pediatrician–nurse practitioner (NP) panel will present a model of collaborative care for affected children, including NPs as care providers to increase the availability of clinicians competent to provide these specialized services. An interactive discussion based on case vignettes will be held, delineating each professional’s role for provision of services in this collaborative model. Cases will include children with language delay, learning difficulties and disruptive behavior. Issues to be discussed will include service funding, specialized staff training and development of community networks. Upon completion of the workshop, the attendee will better understand issues in service delivery to children with neurodevelopmental and behavioral disorders and the use of a collaborative MD–PNP model for such care.
 

The educational portfolio in medicine functions both for learner assessment (ongoing authentic evaluation and self-reflection) and documentation of professional learning and career accomplishments. This selective and purposeful collection provides rich documentation of the medical educators’ practical and intellectual property as related to their professional learning and personal development.

The objectives of this workshop are to 1) understand the theoretical foundation and need for educational portfolios, 2) translate content to an electronic format and 3) provide a hands-on exercise to create e-portfolios using Lectora.

This interactive workshop will begin with a brief overview followed by small group discussions of the electronic portfolio within the context of learning processes and participants’ teaching environments. Lectora, an easy-to-use, versatile, powerful authoring tool, will then be demonstrated in the development of an e-portfolio, and participants will have the opportunity to develop their own e-portfolios using sample content and custom templates. Lectora’s potential will be demonstrated using a variety of media types (text, images, audio, video, animation) and popular Internet technologies such as Shockwave, Flash, HTML and JavaScript.
 

Recent financial scandals affecting successful and respected companies have focused public attention on conflicts of interest involving corporate officers, stockholders, and customers. In the medical research world, too, recent events have raised questions about conflicts of interest affecting investigators, research subjects and patients. Examples of the latter include the financial interests of gene-transfer experimenters (the Gelsinger case at the University of Pennsylvania) and study goals versus individual subject/patient interests in the Kennedy Krieger law suit (Hopkins lead abatement study). Despite the potential pitfalls, pediatric researchers receive only perfunctory training in handling them. This workshop will provide investigators with a framework for and experience with considering real and perceived conflicts of interest in their research. We seek to provide guidance and support for investigators who need to recognize and face ethical concerns that may arise from proposed and actual research. During the workshop, we will describe potential conflicts of interest affecting: (1) individual researchers, (2) institutions (hospitals and universities), (3) research subjects/patients and (4) the public at large, including the mass media. Short presentations will set the stage for attendees to participate in role playing with a variety of scenarios and to present and discuss their own cases.
 

Medical education studies reveal that medical students and residents often report data on clinical rounds without demonstrating higher levels of understanding, such as the ability to analyze or synthesize information. Workshop attendees will learn to address these learning gaps by diagnosing differing learning styles and cognition levels of trainees and then using adult learning models to move them to higher levels of cognition during clinical teaching sessions. Skills introduced include use of the concept attainment model as a diagnostic tool and the field of synectics to be able to "repackage" information in a manner tailored to individual learners’ preferences, all in the clinical setting. A brief active discussion of key adult learning concepts will be followed by group participation in evaluation of videotaped teaching interactions, focusing on learners’ cognitive levels. Attendees then will break into small groups to practice new skill sets via role-play exercises. Bibliographic resource lists and access to follow-up consultations from faculty of the CNMC/GWU Scholars in Medical Education Program will be provided.
 

The AAP policy, "The Pediatrician’s Role in Community Pediatrics," outlined pediatrician's responsibilities to their communities. While many pediatricians are enthusiastic about community pediatrics, their residency may not have equipped them to become community leaders or to work with community coalitions. The Section on Community Pediatrics Mentorship and Technical Assistance Program (MTAP) helps address this problem by facilitating mentorship experiences for pediatricians who want to learn from a more experienced colleague about becoming more effective community leaders.

Robert Haggerty, MD was the mentor for the first MTAP grant, enabling Jim Hughes, MD, to effectively engage the community board of the Kimball House School Based Health Center. Mary Ann Abrams, MD, MPH, incoming chairperson of the AAP Section on Community Pediatrics, is mentoring Robert Anderson, MD, in his effort to enhance the community coalition in Scott County, Iowa.

This workshop will draw upon the experiences of the panelists to reinforce to participants the value of participating in community pediatrics activities and will demonstrate the utility of mentorship relationships as a means for continuing professional development of community pediatricians.
 

Recent research has shown that medical professionals believe that they do not know enough about alternative therapies to answer patient questions about these treatment modalities. This is an important gap in their education, as mind–body therapies and stress management training have demonstrated effects such as decreasing health care utilization in both healthy and chronically ill populations. Medical professionals themselves suffer from overwhelming demands and unremitting stressors and could benefit from training in stress management. This workshop offers hands-on training for medical professionals to learn about several different mind–body stress management techniques to use themselves and discuss with patients. Meditation, biofeedback, yoga and cognitive-behavioral strategies will be reviewed and demonstrated. Participants will develop a familiarity with these therapies and know how to find further training.
 

The Pediatric RRC now requires that residents be prepared "for the role of advocate for the health of children within the community" by integrating community child health, cultural competency and child advocacy training into their program. The areas, which have not been part of traditional pediatric training, require a paradigm shift for physicians, in which the community is seen as a teaching resource and partner rather than a passive recipient of services or placement site. Over the past ten years, a substantial body of educational research has shown that service-learning (S-L) is the best method for the integration of new skills and knowledge with a new perspective of the role of professional in practice and within the community. Implementing this methodology involves new skills for program directors, including partnership building, curriculum design, structured reflection and outcome evaluation. In this workshop, participants will:

1. Discuss the evidence based of S-L with national leaders in the field.
2. Review the implementation of S-L in two programs, with and without external funding.
3. Work with experienced mentors to develop plans for the integration of S-L methodologies into their community pediatrics programs.
    

The Complementary and Alternative Pediatrics SIG will present faculty from Bastyr University, the premiere Naturopathic Medical School in the USA. Wendy Weber, ND, of the Bastyr University Research Institute will describe her successful pathway to becoming the first naturopathic physician to receive a Career Development Award from the NIH. She will review her research on the naturopathic treatment of pediatric depression, ADHD and upper respiratory infections. An additional speaker and discussion about projects of the SIG will complete the session.
 

The Faculty Development SIG is a forum for ongoing exchange in the area of medical education and faculty development. The SIG is open to anyone interested in these areas. The SIG members will be updated and will discuss the SIG’s role in the newly formed APA Faculty Development Program Task Force and the Faculty Development Website Task Force. The SIG will use its list-serve to finalize the focus of the meeting early in 2003. Please check for detailed information on this SIG at www.pas-meeting.org in early 2003. The SIG is co-chaired by Latha Chandran and Charlie Gaebler-Uhing. The list-serve is maintained by Michelle Barratt. To join the list-serve please contact Michelle at Michelle.S.Barratt@uth.tmc.edu or 713-500-5810.
 

The Injury Control Special Interest Group provides an opportunity for section members to review current pediatric injury control. This year's SIG meeting will focus on works in progress, and the agenda itself is still very much a work in progress! Our highlight will be Dr. Carden Johnson, president-elect of the AAP, who has made injury prevention a centerpiece of AAP efforts. Updates are planned on the national longitudinal cohort and the AAP Violence Injury Prevention Program. We will discuss the relationship between pediatric injury research and the Centers for Disease Control Injury Control Research Centers. Other updates and new programs will be discussed.

Please contact either of the SIG co-chairs if you have further topics that should be discussed. See you in Seattle!!
 

The Practice-Based Research Network (PBRN) SIG will continue to focus on supporting the development and collaboration of the member PBRNs. At this year’s meeting we will have updates from the members of projects completed and in development. As in previous years, we will discuss potential projects for collaboration. In addition, this year we hope to devote part of the session to discuss the in and outs of clinical trials and drug company support of the PBRNs.
 

The School and Community Health SIG is planning an exciting program for the spring 2003 meeting, and we welcome all meeting attendees. Based on a needs assessment of the SIG members and the residency program directors that we conducted at the past meeting, we are planning an informative and interactive session. The presentations and discussions will include: the CDC model of coordinated school health; overcoming roadblocks to working with the schools; when and how to involve the residents in the community. If you have any questions or suggestions, please contact Linda Grant at lmgrant@bu.edu, Mona Mansour at Mona.Mansour@chmcc.org or Nazrat Mirza at nmirza@cnmc.org. We look forward to seeing you in Seattle!
 

Topics for discussion at this year’s SIG will include:

1. Coding and Reimbursement for telephone care--Sandy Melzer, the Executive Committee Chairperson for the AAP Section on Telephone Care, will make a presentation and lead a discussion regarding reimbursement for pediatric telephone care. Questions discussed will include: What is the status of the national discussion regarding billing for telephone care? What options currently exist for coding and reimbursement? How are reimbursement problems affecting the way we are delivering telephone care? What evidence is needed to dictate policy in this area?
2. Update on recent research in pediatric telephone research--Allison Kempe and Shira Belman will present results assessing the consistency of nurse and physician triage decisions. Participants are also invited to present their research. Participants interested in presenting should contact A. Kempe at kempe.allison@tchden.org
    

This session will address the topic of "perinatal origins of adult disease." The three speakers will address different aspects related to the early origins of adult disease. Dr. Kent Thornburg will address the issues related to the fetal origins of adult-onset cardiovascular disease, Dr. Guiseppe Colasurdo will discuss the impact on adult-onset reactive airway disease due to postnatal exposure to environmental stimulants, and Dr. Pinchas Cohen will cover the influence of postnatal insulin-like growth factor on the development of carcinogenesis. All three speakers will shed light on the mechanisms underlying the phenomenon of "Perinatal Origins of Adult Disease" in three different disease states using various animal models. This session will provide cutting edge information that will help set the stage for future interventions targeted at the mechanisms outlined.

Discussion

Academic Medical Centers (AMCs) are the result of unique partnerships between medical schools, research institutes, and teaching hospitals and are among the treasures of our society. During the past century, AMCs have evolved in response to need and opportunity as well as to social and economic forces. They have made possible unprecedented advances in human health, in biological sciences, in medical technology, and in the education of a very specialized and knowledgeable cadre of scientists, physicians, and other health care professionals. In the process, AMCs have grown large and ever more complex and require continuous inputs of resources to sustain them. Despite the apparent success of AMCs and their widely appreciated intrinsic value, they are challenged as never before. The diversity and complexity of missions has created stresses upon the social order. Financial pressures resulting from a fragmented, market driven reimbursement system, lack of adequate attention to preventive services and to cost of care issues, questions about true measures of quality, ever more expensive research infrastructure requirements, changing social expectations combined with a relative illiteracy regarding science and health in the general public threaten AMCs existence as we know them. Despite fears that these factors have the potential to create a "perfect storm" that will derail the momentum for progress, a detailed understanding of AMCs history, current circumstances, and future prospects gives cause for optimism. With thoughtful leadership, commitment to values, and a willingness to lead change in many areas, AMCs can continue to thrive and achieve even greater success.

The speakers in this symposium are a practitioner of medicine and historian who has written two very widely read and highly acclaimed books about these issues, Learning to Heal and Time to Heal (Kenneth Ludmerer) and a former medical school clinician, teacher, investigator, and dean who is now one of the nations most ardent and eloquent spokespersons for AMCs in his role as president of the Association of American Medical Colleges (Jordan Cohen).

Discussion

Severe sepsis is an important and relatively neglected public health problem in the United States. National estimates show that more children die with severe sepsis than die with cancer. Despite improving national outcomes (10% mortality in 1995 and 9% mortality in 1999), the burden of severe sepsis continues to increase in the US with an estimated associated annual cost of 4 billion dollars. There is cause for continued optimism in the field. In 1968, 96% of children with severe gram negative sepsis died. Early recognition and aggressive fluid resuscitation has been credited with improved outcomes from septic shock (St. Mary’s Hospital reported a 5% mortality rate in meningococcal septic shock/purpura fulminans, and investigators in Vietnam reported a 0% mortality rate in Dengue shock in 2001). Unlike adults, who die of vascular failure, newborns and children who die of fluid refractory septic shock do so from cardiac failure. The American College of Critical Care Medicine published age-specific evidence-based guidelines for management of newborn and pediatric shock in 2002. Understanding of the pathophysiology and potential treatment of sepsis-induced multiple organ failure is also rapidly advancing. Thrombocytopenia-associated multiple organ failure has been further characterized as a thrombotic microangiopathy. Twenty percent of these patients have disseminated intravascular coagulation pathophysiology (unopposed tissue factor activity and consumptive coagulopathy), but 80% have thrombotic thrombocytopenic purpura pathophysiology (increased ultra large vWF multimers and decreased vWF cleaving protease activity). This has great therapeutic implications because recombinant technology is rapidly producing human coagulation-related proteins (e.g., activated protein C, vWF cleaving protease, tissue plasminogen activator), and prolonged plasma exchange therapy is a proven therapy that reverses TTP pathophysiology. Up to 80% of children who die with sepsis do so with multiple organ failure and uneradicated infection. Primary and acquired immunodeficiency states contribute to most of these poor outcomes. Prolonged neutropenia, lymphopenia and hypogammaglobulinemia are readily measured in the clinical laboratory but research measurements (monocyte HLA-DR expression, and ex vivo whole blood TNF a response to LPS stimulation) are required to diagnose prolonged monocyte deactivation and immunoparalysis. Diagnosis of these immunodeficiency syndromes can have great therapeutic implications as tapering of immunosuppression, and use of recombinant growth factors (e.g., G-CSF, GM-CSF, interferon) and prophylaxis strategies can improve outcome in these children.

Question and Answers

This session examines specific solutions to high-risk behavior in youth, beginning with an overview of current epidemiologic issues. Principles of resilience in adolescents are then examined, based on current research data. Finally, principles of caring for gay and lesbian youth are presented using an interactive approach with the audience. The emphasis in this hot topic session is on helping pediatric researchers and clinicians understand what high-risk behavior in youth is and what research is showing to be helpful.

Over the past several years, it has become increasingly apparent that there are major disparities in health status among different segments of our population. This is as true for children as it is for adults. The causal factors responsible for these differences are multiple and complex. They include genetic factors (e.g. susceptibility to disease, response to environmental challenges, and drug metabolism), cultural and environmental factors (e.g. diet, activity, and ecological exposures), and factors that determine access to health care services. If we are to have a positive impact on the incidence and outcomes of many of these major health issues for children, we will need to better understand the causes of these differences and to determine which interventions will provide the most positive results.

Discussion
 

Hot Topics in General Pediatric explores four topic areas that are of interest to all who care for children but particularly to those who provide primary care. The topics were chosen based on new issues and new information that the pediatrician should be aware of owing to their direct applicability to practice. We are fortunate to have experts presenting information of new immunization practices, the role of molds in allergic disorders, sudden infant death syndrome and new neurologic conditions and new treatments of existing conditions.

Necrotizing enterocolitis (NEC) is a devastating disease occurring primarily in low birth-weight premature infants and is of utmost importance to both neonatologists and pediatric surgeons. The etiology of NEC and many medical and surgical management issues remain controversial. Through close collaboration between neonatologists and pediatric surgeons, more progress will be made in resolving the many continuing controversies. This session will provide a forum for leading neonatologists and pediatric surgeons to discuss the latest work in this area.

Introduction

Discussion/Questions