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
 

This 6-hour mini course is intended for faculty who teach and do research on pediatric environmental health problems. We will use an evidence-based approach and focus on research that is needed to clarify unresolved issues. The challenges and controversies in the field of pediatric environmental health will be presented, and there will be time to discuss prevention strategies for the clinic and the community. The participants will develop and share ideas to use in teaching, research and practice. (There is a separate workshop for Chief Residents on May 4, 2003.)

Content of this session is similar to session 6200 An Introduction to Children's Environmental Health

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.
 

The U.S. rapidly is growing more culturally diverse. In several cities, whites already are in the minority. Culture has a profound impact on pediatrics, affecting multiple aspects of clinical care, including outcomes, processes, quality, satisfaction, obtaining an accurate history and adherence. Cultural competency is the ability to recognize and appropriately respond to key cultural characteristics that affect clinical care in the major cultural groups seen in your practice. In this workshop, participants will learn about a model of cultural competency that can be applied to any cultural group that might be encountered by the pediatrician. This model is based on five aspects of culture that affect clinical care: 1) normative cultural values; 2) language issues; 3) folk illnesses; 4) parent beliefs; and 5) provider practices. The spectrum of the world’s cultures will be used to illustrate the most important ways that culture impacts pediatric care, drawing on the rich available literature and the personal experience of the workshop leaders.

Using an evidence-based approach derived from critical studies on Latino and African-American culture, workshop participants will learn and master the cultural competency model. Illustrative cases (including videotapes) will be presented to challenge participants and further solidify their skills. Participants can expect to acquire practical skills for recognizing and appropriately responding to crucial aspects of culture and language that affect pediatric care.
 

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.
 

With an increasing emphasis on the training of pediatric residents within the community, curricular tools and strategies for educating and supporting residents in community-based projects are needed. This workshop will address the stages of project planning and implementation (needs assessment, engaging in true community partnerships and tools for asset mapping) in resident community-based projects. Faculty, community partners and residents from the Anne E. Dyson Community Pediatrics Training Initiative will share lessons learned for implementing community advocacy projects within their residency programs. Case presentations will illustrate a range of models. As a result of this workshop, participants will be able to: describe key elements in planning a resident community-based project, identify methods of needs assessment and asset mapping, understand common pitfalls, describe key components necessary from a resident training perspective, and identify resources available in their community.
 

To improve child health outcomes, pediatricians will need to expand their expertise to include population-based knowledge and skills. Collaboration with local health departments and public health practitioners can provide assets and resources to pediatricians to support them in these efforts. This workshop will: (a) establish a framework for linking pediatrics and public health on the local level; (b) identify and demonstrate the inventory, relevance and use of public health resources to child advocacy, clinical pediatrics and population-based child health; and (c) develop approaches for practitioners and pediatric educators that integrate pediatrics and public health to improve child health. Healthy People 2010 and Community Oriented Primary Care will be used to provide context to the discussion.

After an introductory didactic presentation, participants will be engaged in an interactive case study and scenario development process to demonstrate and generate potential strategies to improve child health. This will include: access to data relevant to clinical practice and child advocacy, introduction of population-based practices into clinical practice and the application of the principles and practice of public health to common health issues affecting children, e.g., asthma, obesity, diabetes, infant mortality, substance use. Names of local health officials in communities and a set of relevant websites will be provided.
 

Based upon our SIG meeting discussion, a number of newborn nursery topics will be addressed. A response by our group B streptococcous work group, headed by John Olsson, to the CDC guidelines will challenge us to prevention in our nurseries of sepsis and concepts for studies. We will discuss jaundice guidelines, screening, treatment and breastfeeding. Hypoglycemia detection and treatment will be surveyed and presented. Current screening with meconium and treatment of substance-exposed infants will be described. We will explore pain control in nurseries and circumcision.

During the session, Latha Chandran will distribute and discuss the results of the survey of our members needs and current practices. We will update our E-mail lists for our members and discuss new teaching ideas.
 

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.

This session will describe the epidemiology, clinical features and current initiatives for the study and treatment of rare pediatric tumors. Dr. Brad Pollock will discuss the epidemiology of rare tumors in pediatrics and will highlight the current COG initiative to improve reporting of these tumors through the COG Registry. Dr. Michael LaQuaglia will discuss the clinical and biological aspects of pediatric colorectal carcinoma. Dr. Carlos Rodriguez-Galindo will discuss the clinico-pathological features and therapeutic strategies for pediatric adrenocortical carcinoma and pediatric nasopharyngeal carcinoma, and Dr. Alberto Pappo will discuss the clinicopathological features and collaborative treatment initiatives for pediatric melanoma.

The goal of this interactive workshop is for participants to improve their teaching skills as they strive for teaching excellence. The characteristics of outstanding teachers will be defined and applied to a variety of different teaching scenarios. Several teaching methods used by expert instructors will be presented and discussed. Opportunity for practice will be provided. Participants will be challenged to apply what they have learned to their own teaching settings.
 

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.

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.

Cultural competence in medical practice implies the effective interaction of the cultures of patients and providers. However, medical training programs often focus solely on the culture of patients, assuming that providers maintain value neutral systems. This cultural competency curriculum is located at two urban hospitals affiliated with Columbia University and is unique in that it incorporates self-reflection regarding personal cultural backgrounds as well as a critical understanding of medical culture. Training spans all three years of residency and focuses on: community asset mapping and language skills development; provider and patient cultures; and cross cultural communication. Rather than utilizing passive didactic methods, this curriculum uses multiple innovative teaching methodologies such as: resident-initiated projects, interactive workshops, discussions of films, reading of narrative texts, service learning and home visits. Learning occurs both in the traditional clinical setting and at community-based organizations. Pediatrics and public health faculty, as well as partners from community-based organizations, are vital in teaching. Residents from various cultural backgrounds and two culturally disparate hospitals participate in the curriculum. Self-reflective exercises allow residents to document, share and learn from these activities. This educational workshop will be a "training of trainers" session on cultural competency that will demonstrate effective training methodologies and allow participants to share strategies to create their own curricula. The session will be led by faculty members, community partners and pediatric residents.

Pediatricians are often asked to evaluate children for sexual abuse, yet deciding when, where, how and by whom the evaluation should be done are problematic given the rapidly changing interpretation of physical findings and testing and the paucity of data regarding the optimal provision of health services for this population.

This workshop will address the multiple decisions facing the primary pediatrician in sexual abuse evaluation by using an interactive, case-based approach and clinical decision analysis in a 60–90-minute workshop session. Participants will receive a brief introduction to the literature regarding triaging sexual abuse cases based on child age, gender and recency of contact and will be updated regarding interview techniques, interpretations of findings and medical and legal outcomes.

Using predictive values for outcomes based on timing, behaviors, disclosure and physical findings, participants will then select and evaluate the effects of their various choices at each clinical decision point (triage, type of evaluation, testing, referral) in 4–6 test cases. Clinical decision analysis will be used to optimize health and legal outcomes based on the participants’ choices. Potential strategies for health services for child sexual abuse will be reviewed with participants based on locally available resources.
 

Pediatricians are in a unique position to identify and advocate for children's health care needs. To do so, pediatricians need to understand the psychosocial, economic and cultural forces that affect the health of their patients. Community-based training provides residents with the opportunity to gain firsthand knowledge and experience of these forces and, importantly, gives them the basis from which to identify and mobilize community resources to enhance health outcomes. The goals of this workshop are to 1) improve the participant's knowledge of innovative community-based curricula and 2) discuss strategies for successful implementation of these experiences. Using an interactive format, representatives from The Initiative's programs will discuss components of their advocacy and community-based curricula. Participants will be encouraged to share their experiences of similar efforts. Specific community pediatrics' competencies will be described in conjunction with training efforts designed to achieve them. Workshop participants will divide into small groups to discuss implementation of community pediatrics block rotations, longitudinal residents' projects and cultural competence experiences. At the closing, participants will review and reflect on key issues raised during this session.
 

The membership of this SIG is open to community-based physicians involved with resident or student teaching, patient care or research and to academicians who are sending residents or medical students to community sites for part of their ambulatory experience. The program emphasis has been on integrating residents and students into community office sites and the problems/benefits inherent within this pursuit. The SIG is co-chaired by two community pediatricians with experience in these areas (David Bromberg of Frederick, MD and Manny Doyne, of Cincinnati, OH). This year’s program will include:

1. 1. A presentation of the 2nd Annual Pediatric Community Teaching Award, sponsored by Mead Johnson Nutritionals
2. 2. An update from the AAP Resident Education and Training SIG
3. 3. A workshop to highlight issues in community teaching in the Northwest US

Any questions or suggestions should be forwarded to either Dr. Bromberg (dbromberg@peds.umaryland.edu) or Dr. Doyne (emanuel.doyne@chmcc.org)
 

This 6-hour mini course is intended for faculty who teach and do research on pediatric environmental health problems. We will use an evidence-based approach and focus on research that is needed to clarify unresolved issues. The challenges and controversies in the field of pediatric environmental health will be presented, and there will be time to discuss prevention strategies for the clinic and the community. The participants will develop and share ideas to use in teaching, research and practice. (There is a separate workshop for Chief Residents on May 4, 2003.)

Content of this session is similar to session 6200 An Introduction to Children's Environmental Health

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.
 

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
 

With their numbers continuing to grow at an alarming rate, health care needs of the more than 500,000 children in foster care often remain unmet. Children in foster care suffer from inordinately high rates of acute and chronic illnesses, lack of preventive health care, mental illness and developmental delays. Inefficient child welfare agencies, inadequate health care funding and a dearth of qualified health care and mental health care professionals willing to treat this population of children compound the problems.

Audience Questions

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.

American Indians and Alaska Natives (AI/AN) represent the smallest ethnic group in the United States. Large disparities exist between child health status indicators in this population and the rest of the U.S. population. The AI/AN population is also unique in that tribally enrolled AI/AN members have access to a unique healthcare system sponsored by the federal Indian Health Service (IHS). Increasingly, the IHS is turning over control of Indian health care to tribal health entities, thereby encouraging autonomy and self-determination. A consequence of this transfer of responsibility, IHS is providing fewer centralized administrative and consultative services to independent tribes. As a result, tribes will become increasingly reliant on alternative sources of assistance. Potentially rewarding new opportunities exist for pediatricians from universities and pediatric organizations to provide clinical and public health consultation to these newly independent tribes and their regional consortia. This workshop is aimed at clinician-teachers and investigators interested in developing closer ties to tribes and urban Indian organizations in their area. The following topics will be discussed during the session: 1. The evolution and devolution of the IHS: a contextual history of health services for AI/AN’s (didactic); 2. community-based participatory research in Indian communities: tribal expectations (panel discussion); 3. creating and optimizing educational opportunities for medical students and residents in AI/AN health sites (panel discussion). 4. advocacy for Native American health: how can we help? (interactive presentation).
 

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.
 

Objectives: 1) increase and promote skill acquisition on cultural competency among health care providers, 2) increase understanding of cultural values and health beliefs/practices among a culturally diverse populations. Participants will be given a brief introductory quiz to assess their previous experience on the subject. An ethnicity/cultural awareness exercise will follow. Video clips of case scenarios highlighting cultural issues and health practices, which may become important during a well-child visit, will be shown. Information on cultural education/training issues, culture-specific terminologies, common pitfalls for cultural bias/misunderstandings and practical ways to improve cultural sensitivity/proficiency will be offered. Demographic characteristics of the U.S. populations, guidelines for using interpreters and culture-bound syndromes will be reviewed. Participants will then divide into three stations to gain exposure to three featured cultures: Islamic, African-American and Hispanic. They will experience culture-specific items and participate in role-playing. The three groups will meet again for a panel discussion and problem-solving exercises. In conclusion, participants will summarize the propositions to employ the culturally specific therapies.
 

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.
 

Many of the leading causes of childhood illness and death are potentially preventable. Yet knowledge of how to encourage healthier behaviors has lagged behind knowledge of potential therapies and prevention strategies. Community intervention trials are the "gold standard" for large-scale health behavior change.

This workshop is designed for those interested in conducting community interventions. The workshop will have three sections: The first section discusses the design of intervention trials, including theory-based strategies, selection of relevant control groups and effectiveness measures. The second section reviews successful implementation strategies with illustrative examples. The third section reviews the evaluation of community trials, including the analysis of clustered data and time trends. Participants will work in teams to develop intervention trials to illustrate the concepts presented. Participants can expect to acquire practical skills and resources to aid in conducting a community intervention.
 

Pediatricians need to actively promote and help manage breastfeeding as recommended by the American Academy of Pediatrics and Healthy People 2010. Data show that residents are not adequately trained for this role and that 43% of responding residency programs rate their breastfeeding curriculum as inadequate or needing improvement.

The goal of this workshop is to give participants the tools necessary to design and implement a resident breastfeeding curriculum for their institution. Participants will discuss the status of breastfeeding education and the barriers to the education found in their institutions. A didactic presentation will cover new draft RRC guidelines, assessment tools, web-based learning modules, video excerpts, cases for discussion or role play and community resources. Use of live mothers and babies will be demonstrated. Participants in small groups will begin designing their curriculum and overcoming barriers in their program under direction of a workshop leader. All registered participants will get a notebook with resources.
 

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.
 

Over 132,000 children from 36 countries have been adopted by U.S. families since 1991. It is likely, therefore, that most pediatricians will encounter internationally adopted children in their practice. Prior to international adoption, parents tend to seek out expert pediatric advice regarding the health of their prospective child. However, addressing complicated pre-adoption issues with prospective parents, especially in the age of evidence-based medicine, can be extremely challenging. This workshop is designed to: 1) educate participants about issues critical to review with families at a pre-adoption visit; 2) identify the adoptee's unique medical needs; 3) clarify roles for practitioners caring for the internationally adopted child before and after adoption. Using an interactive approach, the workshop will address: 1) the pre-adoptive visit—keys to interpreting medical records/photos/video of the child from abroad, and how to counsel parents regarding specific issues such as FAS and HIV/Hepatitis B; 2) post-adoptive medical screening, diagnoses and treatment of medical conditions; 3) practice guidelines regarding immunizations; 4) assessment of growth, development and nutrition; and 5) guidance on adjustment problems, developmental delays and identifying more complex behavioral and developmental concerns.
 

This workshop is designed to help pediatricians identify and address common causes of adverse outcomes and threats to patient safety. A pediatric department’s experience at an academic medical center will be described and its methods for reviewing and aggregating data about causes of adverse events will be taught. Claims files opened by the institution’s insurer were analyzed to determine causes of pediatric adverse outcomes. Files were reviewed by a committee including a pediatrician and nurse risk managers. Events and outcomes for each file were outlined on a "cause-effect" diagram to identify events associated with adverse outcomes. Codes were assigned by consensus for each contributor to the event. Codes were analyzed via descriptive statistics. Poor communication, medication errors, housestaff supervision and IV monitoring were associated with a large proportion of adverse outcomes and risk management activity.

Following description of the methods, workshop participants will be assigned to small groups where they will identify, aggregate and analyze patterns of causes of adverse events associated with six hypothetical cases derived from actual files. A subsequent large group session will address how solutions to problem patterns might be achieved. Reviews of risk management files offer one source of data for driving patient safety and quality improvement efforts and, perhaps, reducing malpractice risk in pediatrics.
 

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.
 

This state of the art symposium will be of interest to practitioners, generalists, neonatologists and infectious diseases specialists and will explore current controversies in the diagnosis and management of neonatal HSV infection. Speakers will present maternal factors that may allow interruption of maternal–fetal transmission of the virus, the latest strategies for diagnosis and treatment of newborns and the potential prevention of neonatal HSV by use of pre-emptive antiviral therapy and vaccines.

Discussion

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 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.