The use of handheld computers in medicine has grown dramatically. This session is intended for those who have a handheld computer (Palm or Pocket PC), or are considering purchasing one, but who have not yet learned how to use it. The goal of the session is to help the beginner achieve a working familiarity with handheld computing such that they will leave the session ready, able and eager to use their own device in their daily life and clinical practice. Ideally, all participants should bring their own handheld. The session will include an overview of the devices and their desktop software; mastery of the basic (built-in) functions: datebook/calendar, address book, memo pad, to-do lists; and add-on applications: where to find them, how to install them and what applications are available specific to clinical pediatrics. Participants should be familiar with the use of personal computers and the Internet, but no prior knowledge of handheld computing is assumed.

• Introductions and Overview of Mini Course
• Lecture (with Audience Participation)—PDA Basics, Hardware and Software, the Palm OS and Its Functions
• Palm OS Functions, Continued; PPC OS
• Medical and Pediatric Applications for the PDA
   

In the current climate of funding opportunities, the ability to successfully obtain extramural support involves applying for grants that are appropriate for an investigator's career stage and drafting a clear and focused application. In this session, we will discuss career-stage-appropriate funding opportunities from the NIH. We will also address how to write a grant application, focusing on strategies with proven success. The working of NIH study sections will be reviewed along with how to best address the concerns of review panels. We will also focus on how to obtain funding for fellowship postdoctoral training and early stages of an academic career.
 

Background: Observational research studies have become increasingly complex. The results of observational research studies can be driven by properties other than chance or causation. While these factors may drive the p values of the results, they also change the appropriate interpretation.

Workshop Methods: In the first half of this workshop, we will formally define confounding, effect modification, restriction vs. heterogeneity of exposure, intermediate variables, selection bias and differential vs. nondifferential information bias. In the second half, we will use a case-based approach to illustrate examples of studies in which the results are driven by these factors and compare differences in the appropriate interpretation in the presence and absence of these factors. Minimal math skills will be needed, however, familiarity with basic concepts of study design and data analysis (case control vs. cohort study, interpretation of Ors, etc.) is recommended. We will specifically illustrate examples of effect modification vs. confounding, intermediate variables vs. confounding, selection bias, underpowered studies, and the role of measurement error in determining effect estimates.

The primary objective of this mini course is to convey the array of issues intrinsic to caring for older adolescents and young adults with chronic, life threatening disease. For several reasons, cancer provides an ideal paradigm for this adolescent/young adult challenge.

1. The spectrum of disease is broader for cancer at many levels of biological organization than it is for any other disease. Virtually all organ systems and organs may be diseased in patients with cancer, whether due to the disease or its treatment. The affected organs include CNS, hematopoeitic, cardiovascular, hepatic, renal, endocrine, musculoskeletal, immune, pulmonary, gastrointestinal, cutaneous, ocular, otic and oral tissues.

2. The affected levels of biological organization include molecular, cellular, tissue, organ, organ system, connective, and psychological. The latter is particularly challenging among adolescents with cancer.

3. The clinical and translational research programs in oncology are among the most organized medical enterprises at the national and tertiary center level in all of medicine, with the cooperative infrastructure that has supported this success among the most successful in the history of science. The advances among children with cancer have been among the most dramatic in the history of medicine.

4. Despite the organizational achievements, there is emerging evidence that patients with cancer in this age group have been ignored relative to the scientific and clinical focus that has been successfully applied to younger and older patients with malignant disease.

The field of medicine is replete with examples of ways that handheld computers may be used to educate, organize and inform clinicians. There are also examples of how researchers may benefit from this technology. During this more advanced session, we will discuss some of these uses of handheld computers. We will provide examples of software in a variety of domains and discuss their historical, current and future use. We also will demonstrate some future technology and discuss its implications. At the conclusion of this session, participants will have increased familiarity with state-of-the-art applications, techniques to install them and the future of handheld computers and wireless networking.

• Introductions and Overview of Mini Course
• Lecture with Audience Participation: The Top 10 Novel Uses of PDAs in Health Care
• Exercises and Demonstrations
   

Tobacco, marijuana and alcohol have long been recognized as the "gateway drugs" or the drugs adolescents first begin to abuse. Each drug has inherent dangers, one of which is they can serve as stepping stones to abuse of other drugs. This session will review current issues involved with each of these three drugs—issues that involve the pediatric researcher and clinician as well as society itself. The first hour will be devoted to tobacco, the second to marijuana and the final to alcohol. Questions and answers will be encouraged from the audience.

The period of adolescence encompasses dramatic changes, both physical and emotional. Taking care of these youth requires not only patience, compassion and flexibility but also knowledge of the biologic, psychological and cultural transformations. Adolescents aged 11–21 years made 61.8 million visits to physicians in 1994 and continue to see their primary care providers for continuity health care. There is a terrific opportunity for preventive health interviewing in these visits. In this workshop, the participants will become familiar with GAPS and Bright Future Guidelines for the adolescent visit, as well as effective coding and billing procedures. There will also be a panel of adolescents who will talk about how they want to be interviewed and provide insight into positive and negative experiences that they have had during their health visits.
 

Clinician-educators are those physicians whose career activities combine patient care and teaching and whose scholarly activities promote excellence in medical education. With this interactive workshop, it is expected that participants will learn a practical approach to their career development and will:

1. have a better understanding of the motivations, career plans and challenges of clinician-educators;
2. be able to develop a career ‘map’ for junior clinician-educators;
3. learn how a mentoring program can help the clinician-educator plan and develop his/her career, including suggestions on how mentors and ‘mentees’ can contribute to enhancing professional academic skills;
4. be able to identify faculty development needs and participate in useful and effective faculty development activities, having a better understanding of specific faculty development activities and the evidence for the effectiveness of these activities; and
5. have a better understanding of the evaluation of teachers and how these evaluations are used for faculty development and promotion and will learn guidelines for developing an effective Teaching Dossier.

This workshop will be of interest to both junior faculty with an interest in developing their academic careers as clinician-educators and to administrators responsible for supporting junior faculty in the areas of teaching and education.
 

This interactive session will provide the attendee with basic information on publication of a manuscript, as derived from the perspective of an editor. Issues (with data provided when possible) to be discussed are:

A. View from the Inside

1. Characters involved
2. Manuscript flow
3. Peer review process
4. Working with the author

B. View From the Outside

1. How to choose the right journal for your paper
2. How to prepare the cover letter
3. How to prepare the abstract
4. How to prepare the body of the manuscript
5. How to prepare the references

C. Conflict of Interest and Ethics
 

The 21st century heralds a paradigm shift in medical education with a focus turned to competence and outcomes. The Accreditation Council for Graduate Medical Education (ACGME) is spearheading a competency-based system of graduate medical education coincident with the American Board of Pediatrics’ (ABP) initiative to transition from periodic "recertification" to "maintenance of certification." Our greatest challenge as educators lies in developing tools to evaluate competence during training and to equip all trainees with the skills necessary to achieve quality continuous professional development in order to maintain their certification in pediatrics.

The overarching goal of this workshop is to explore the value of using technology as a tool for promoting self-assessment and lifelong learning in continuous professional development. We will demonstrate how physicians can use an innovative web-centered tool to document competence in practice-based learning and improvement. Participants will discover how to create and manage a personal list of educational needs based on their professional experiences, develop individualized learning plans to address these needs and then document the impact of learning on their practice.

The outcome of implementing this web-based technology will be the ability to demonstrate competence of our trainees in the domain of practice-based learning and improvement to the ACGME and the preparation of tomorrow’s physicians to demonstrate evidence of continuous professional development in maintaining their certification.
 

What should you do when parents want you to continue burdensome treatments, which you think are futile? What should you do when parents want you to stop intensive care treatment, the continuation of which you think is in the best interests of the child? Who ought to make decisions for the not yet competent? Is it the parents, the doctors, the ethics committee, society or some other disinterested third party? The goal of this seminar is to consider the complexity of these difficult decisions, looking at factual and evaluative considerations. Through interactive case discussion we will identify the problems and potential pitfalls in decision-making for the pediatric population.
 

The purpose of this symposium is to describe the benefits to pediatricians of collaborating with public health specialists and to offer examples of some effective collaborations. Speakers will identify resources available to pediatricians who want to engage in public health efforts.

Discussion
 

This program will give a "pediatric perspective" to smallpox bioterrorism preparedness planning efforts now under way within federal, state and local public health agencies. It will include a review of smallpox epidemiology, clinical disease, smallpox (vaccinia) vaccine and lessons learned from the WHO Smallpox Eradication Program. The nature of the current threat and responses to that threat will be discussed.

The use of psychopharmacologic agents in children and adolescents has increased significantly over the past decade. Clinicians are becoming more involved in using these various medications, and this trend will continue in the future. What is the evidence-based medicine (EBM) for these medications as they apply to children and adolescents? This mini course will review the current research as applied to antidepressants, stimulants, mood stabilizers and antipsychotics. Applications to mental disorders in children and adolescents will be discussed. Questions from the audience will be encouraged.

Organ transplantation remains the final therapeutic option for many patients with chronic diseases of many organ systems. Extraordinary advances in molecular and cellular biology have led to new immunological approaches which should make the holy grail of immune tolerance a reality for the 21st century. This symposium will focus on the exciting advances in four areas of pediatric solid organ transplantation: pancreatic organ and islet transplantation as a cure for diabetes, hepatic transplantation for chronic hepatic and metabolic disease, renal transplantation for end stage renal disease and small bowel transplantation for previously untreatable catastrophic bowel injury. This symposium is proudly sponsored by the American Society of Pediatric Nephrology (ASPN), the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), and the Lawson Wilkins Pediatric , and supported by funding from the American Society of Transplantation and the Juvenile Diabetes Research Foundation International

Receive helpful pointers to make your talks memorable and useful. This session will introduce methods of planning and organizing presentations, preparing and designing visual aids, handouts and clear delivery.
 

The performance of minor procedures is an important part of pediatric residency and office practice. However, training and performance of certain procedures varies between residency programs. Because of limited exposure, pediatric residents and practitioners may avoid a procedure, or call a consultant, when uncomfortable with a technique. The goal of this workshop is to convey specific techniques and instruction methods for minor office procedures. This hands-on workshop will demonstrate skills and afford practice as participants rotate through the following stations:

1. Newer concepts in wound repair—use of glue, fast absorbing sutures, staples.
2. Remove foreign bodies from ears, nose, eyes; reimplant an avulsed tooth.
3. Troubleshoot gastrostomy tube and tracheostomy tube complications.
4. Skin extrications: embedded fishhook, subungual hematomas, hair tourniquet.
5. Vascular access—learn the technique and new indications for intraosseous infusions; master new needleless systems and safety devices for IV.
6. Genital issues: fix paraphimosis, zipper entrapment, rectal prolapse.

Workshop leaders will underscore the importance of learning technical skills in pediatrics. Participants should become adept at several procedures and will be able to teach them to others. The participants will also be asked to share their ideas and experiences in teaching and practicing common technical procedures.
 

The 2001 World Trade Center and anthrax attacks established terrorism as a reality in this country. In addition to anthrax, critical biological agents include smallpox, plague, tularemia, botulinum toxin, and viral hemorrhagic fever. Release of sarin nerve gas in the Tokyo subway system by the Aum Shinrikyo cult in 1995 resulted in some 5,000 casualties, including 12 deaths, and the threat of a radiation incident perpetrated by terrorists is also real. Pediatricians have a key role in the management of illness after a terrorist incident, including biological, chemical or nuclear releases. Effective preparedness requires an increased index of suspicion for unusual diseases or clusters of illness, with prompt reporting to public health authorities to facilitate recognition of an outbreak and subsequent intervention. Psychological effects of a domestic terrorist disaster on children will also need to be managed appropriately. This workshop will address the epidemiologic, clinical, preparedness and response issues relevant to biological, chemical and nuclear threats to children, who are especially vulnerable. Specific and detailed diagnostic and management information will be provided, as well as emergency contact and educational resource information.
 

In the face of dramatic alterations in health care delivery during the 1990s, the roles of pediatric generalists and subspecialists have changed. This has led to national debate as to how general pediatricians and subspecialists should be trained, how they should interact and what final product or solution is desired. Both the United States and Canada are affected by these changes. In this session three experts will cover important aspects of this emerging problem.

Discussion

This course will review the evaluation and treatment of lipid disorders in children. Although diet and obesity are the most common causes of lipid disorders in children, the practitioner needs to be able to distinguish familial from acquired hyperlipidemias. The format will include four speakers who will present 1) lipoprotein biosynthesis and metabolism, primary (familial) versus secondary (acquired) disorders and selective screening; 2) dyslipidemia of obesity and insulin resistance; 3) non-pharmacologic treatments of managing dietary changes and obesity; and 4) the pharmacologic treatment of primary hyperlipidemias. Each session will include examples of the practical application of the material. The course will conclude with a panel discussion of the speakers with plenty of time for questions.

This session reviews current research principles in selected sexually transmitted diseases. First, clinical epidemiology and prevention issues for Chlamydia trachomatis are considered, emphasizing rescreening (delayed retesting of infected persons), novel strategies for ensuring partner treatment, and the role of male screening in disease control. Then, new directions in public health and prevention aspects of genital herpes are outlined. An update of the HSV vaccine is presented. Finally, human papillomavirus (HPV) is considered, including new recommendations in human papillomavirus testing, triage of abnormal Pap smears and the current status of HPV vaccines. Questions are encouraged from the audience.

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.
 

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 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!

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.

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

What happens when there is a public national concern about excessive poor outcomes at a Children's Medical Center? This was the scenario in Bristol, England, where a crisis in the outcome of children after cardiac surgery developed even when well–trained, committed, concerned clinicians and subspecialists were intimately involved. Because of this, Professor Al Aynsley-Green, President of the Academic Paediatricians, was appointed to the new post of National Clinical Director for Children by Parliament and to Chair a Children's Taskforce to answer the question of how can such a negative experience like this be turned into positive outcomes for children? He is charged to secure the health and well-being of all children throughout childhood into adult life by developing a National Service Framework for children's services across health, social care and education.

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.

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?

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.
 

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.

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 

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.