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.
 

There are many new technologies to help the primary care pediatrician more accurately diagnose genetic disorders. These newer diagnostic tests and their interpretation require a close working relationship between the pediatrician and the clinical geneticist. 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. 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. Newer diagnostic genetic technologies will be reviewed. Exploration of the history, including the family pedigree, aspects of the physical exam that alert 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 collaborative process between the patient/family, the pediatrician and geneticist will be examined.

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
 

With the recent technologic advances to treat spasticity, the care of children with motor disorders has changed dramatically. The physician now has new choices in oral medications, as well as the ability to offer the patients possibilities such as botulinum toxin, intrathecal baclofen and selective dorsal rhizotomy. This course will offer an overview of the current thought on spasticity and related movement disorders, as well as an update on the new treatment modalities and their efficacy. The pivotal role of the pediatrician in the comprehensive management plan will be discussed. Didactic information, case studies and video presentations will be utilized.

Discussion
 

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.

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.

Approximately 60% of families have concerns about children’s development and behavior, yet almost half do not share these concerns spontaneously, suggesting that they need to be actively elicited. While many concerns lack significance in terms of serious clinical diagnoses, they provide opportunities for parent support, an important intervention that may lead to improved outcomes. Best results are likely to be achieved by deploying a systems approach through which community agency involvement is well coordinated with health professionals. Working within a systems approach and collaborating with non-medical professionals present many challenges for pediatricians.

In this workshop, participants will be introduced to new models of working with families focusing on eliciting parent concerns. These models use a broader approach than the dichotomous pass/fail limitations of basic screening tests. A parent elicitation tool (PPDS) is a vehicle for parent support and a platform for communication and family/agency collaboration. Participants will also engage in an interactive community mapping exercise for improved collaboration with non-medical providers. Finally, the workshop will address organizational issues important to successful practice change. Drawing upon a model with demonstrated effectiveness, participants will work in small groups as they undertake a step-by-step planning exercise applying change principles to guide practice change in their own settings.
 

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.
 

Psychosocial problems (e.g., ADHD, school learning difficulties, somatic complaints, parent-child conflict, child and parent depression and adverse family relationships) constitute about 20% of all pediatric visits for 4- to 15-year olds, a 2.5 fold increase in the past 17 years. These problems impact family functioning and children’s behavior, development and mental health. When these problems prove resistant (recur or intensify) to traditional child-symptom interventions, clinicians should consider an approach that assesses the problem and develops solutions within the family context, which is the clinicians’ greatest resource. However, family systems interviewing skills are seldom or inadequately taught in resident training programs.

This workshop provides clinicians/educators with a primary care educational model for teaching family-oriented concepts and techniques for evaluating and treating these problems. The model is divided into six units for convenient teaching in the clinical setting, e.g., identifying suitable problems, specific interviewing techniques, making mental health referrals and dealing with difficult families. The workshop format will be short didactics, case studies, videotapes of family interviews, extensive interactive discussions and a teaching syllabus.
 

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.
 

Increasingly, extremely and very low birth weight preterm infants appear to have marked nutritional deficiencies that are associated with abnormal development. This symposium will focus on three nutrients—amino acids/protein, PUFAs, and iron—reviewing evidence for deficiencies in preterm infants, roles and requirements, and the potential for improving outcome by a more aggressive approach to feeding preterm infants with greater amounts of these nutrients. Scott Denne will discuss the important benefits and potential risks of more aggressive IV amino acid and enteral protein nutrition in preterm infants, focusing on studies of protein and nitrogen balance and growth. Shelia Innis will discuss the role of polyunsaturated essential fatty acids in neural development and neurodevelopmental outcome. Michael Georgieff will discuss the role of iron nutrition in brain development and present results of studies that have addressed neurodevelopmental and cognitive outcome.

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.

This 2-hour symposium will review two current topics in developmental neurogenetics using both mouse and human malformations to elucidate the molecular basis of normal and abnormal brain development. The two areas covered will be midbrain–hindbrain (brainstem and cerebellum) development and nonradial migration in the forebrain. For both topics, speakers will review existing mouse models and genes known to be involved in key developmental steps, review relevant human malformations and present the results of ongoing research.

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.
 

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.
 

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

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?

Contact for information:
Brian Rogers, M.D.
President, Society for Developmental Pediatrics
Director of the Children's Rehabilitation Center
Oregon Health & Science University
PO Box 574
Portland, OR 97207-0575
Phone (503) 494-8362
Email: rogersbr@ohsu.edu
 

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.
 

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.
 

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.
 

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.
 

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.

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.