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 Nutrition Special Interest Group of the Ambulatory Pediatric Association is currently preparing A Teacher’s Guide to Pediatric Clinical Nutrition.

The first part is "Pediatric Nutrition Notes." Dr. Karp wrote these in 1993 as an in-house project requested by Dr. Laurence Finberg for use by medical students at SUNY-Downstate. Since that time, the notes have been distributed to 3rd year medical students and residents. Pediatric Nutrition Notes provide essential vocabulary and knowledge of pediatric nutrition. The Notes were written at the level of medical student education. The cases that follow make the complete Teacher’s Guide a vehicle for resident and faculty education.

The second part of "A Teacher’s Guide to Pediatric Clinical Nutrition" is the subject of the current project. The main component of the second part of the Teacher’s Guide is a set of 21 case studies, prepared by authors within the SIG with editing by the editorial committee. These authors are leaders in the field of teaching nutrition. The case studies will draw on material presented in Pediatric Nutrition Notes and other sources for students and residents to use in clinical settings. The clinical settings will provide an opportunity to describe the influence of metabolism and thus nutrition, on the course, outcome and possible treatments of the children.

At Downstate, Dr. Karp is currently conducting a pilot study of the Teacher’s Guide using chapters already drafted. He plans on presenting a complete rough draft of the Teacher’s Guide to the Special Interest Group at the 2003 Pediatric Academic Meetings (APS-SPR-APA). Dr. Karp and colleagues estimate completing the Teacher’s Guide by May 2004.
 

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
 

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.
 

• Diagnostic Workup, Role of Genetic Testing
• Medical and Surgical Therapies
   

Supported by an educational grant from Ross Pediatrics

Contact for information:
Rebecca Simmons, M.D.
Children’s Hospital, Philadelphia, Abramson Research Center
Room 416, 34th & Civic Center Blvd.
Philadelphia, PA 19104-4318
Phone: (215)590-2895 Fax: (215)590-4267
Email: rsimmons@mail.med.upenn.edu
 

5:15pm–7:15pm
Poster Session I
Original Science Abstracts – Poster Session

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.

Growth failure is one of the onerous clinical manifestations of chronic renal insufficiency in infants, children and adolescents and is multifactorial in origin. Malnutrition can have a profound impact on growth and overall paatient outcome and neuropeptides such as alpha melanocyte-stimulating hormone and neuropeptide Y may play a role. The bone status is influential and control of secondary hyperparathyroidism and prevention of adynamic bone are needed to maximize growth velocity. Finally, new approaches to individualizing recombinant growth hormone therapy to address the pertubations of the GH/IGF axis may result in superior outcomes.

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 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 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.

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

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

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

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

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.

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

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).

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

Introduction