This session will be the initial venue for release of the proceedings from the current NHLBI Working Group. The Working Group, appointed by the National High Blood Pressure Education Program, is presently conducting an update of the national guidelines for the evaluation and management of hypertension in children and adolescents. Presentations will include reports on the results of a re-examination of the national childhood blood pressure data and the rationale for definition of hypertension in childhood. Speakers will also address the impact of obesity on pediatric hypertension, methods to detect and evaluate target organ damage due to hypertension, blood pressure instrumentation issues and new data on treatment of hypertension in the young, including both pharmacologic and non-pharmacologic treatments.

Introduction
Ed Roccella, National Heart, Lung and Blood Institute, Bethesda, MD

Definition of Hypertension with a Re-examination of the National Data on Blood Pressure in Children and Adolescents
Bonita E. Falkner, Thomas Jefferson University, Philadelphia, PA

Relationship Between Cardiovascular Risk Factors and Sequelae in Hypertensive Children
Elaine Urbina, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Pharmacologic and Non-pharmacologic Management of Childhood Hypertension
Joseph T. Flynn, Children's Hospital at Montefiore, Bronx, NY

Measuring Blood Pressure: The Truth Revealed
Bruce Z. Morgenstern, Mayo Clinic, Rochester, MN

As defined by the American Academy of Pediatrics, a goal of the pediatrician is the promotion of children’s optimal growth and development. Efforts at the state and national levels to enhance the effectiveness of child health supervision services have focused on such strategies as the early detection of developmental and behavioral concerns through effective monitoring, the provision of anticipatory guidance to address parental concerns and the promotion of such skills as language and literacy development. Such strategies have been informed by a wealth of new findings in neurobiology. Furthermore, enhancing practice quality may be facilitated by the effective application of basic change principles drawn from the field of organizational development, planning and change. This mini course will examine the impact on children’s development of such components of child health supervision as anticipatory guidance, developmental monitoring and developmental promotion, as well as review techniques to incorporate and promote rapid change within the practice setting. Ample time will be allotted for discussion among speakers and the audience.

Overview/Introduction
Paul H. Dworkin, Connecticut Children's Medical Center, Hartford, CT

The Science of Developmental Promotion
William Greenough, University of Illinois College of Medicine, Chicago, IL

Optimizing Anticipatory Guidance To Enhance Children’s Development
Paula M. Duncan, University of Vermont, Burlington, VT

Strategies for Effective Developmental Monitoring and Early Detection
Michael Regalado, Cedars-Sinai Medical Center, Los Angeles, CA

Promising Strategies To Promote Development
Neal Halfon, University of California, Los Angeles, CA

Enhancing Service Delivery Through Rapid Practice Change
Peter A. Margolis, University of North Carolina School of Medicine, Chapel Hill, NC

Discussion

Where do generalists fit in the exploding field of genetics? Until recently genetics has played a relatively small part in the medical school curriculum. Its research has proceeded at a phenomenal rate along with its implications for enhanced patient care. Generalists’ expanding responsibilities to incorporate this thread of genetics through each patient encounter and acknowledge the role of genetics in every disease has become increasingly apparent. However the emerging gap in physician knowledge has created an enormous need for education in a previously underemphasized area of medical education.

As generalists, we are the gateway (not gatekeepers) to better health. This session is designed to help us understand the emerging importance of viewing each patient through a "genetic lens." Basic genetic concepts, core competencies and new paradigms will be discussed using a collaborative faculty presentation.

Strategies for teaching genetics and incorporating its practice into primary care will include "missed opportunities," case presentations and interactive educational games. Examples of resources, including internet user-friendly sites will be distributed.

Speakers:
Suzanne B. Cassidy, University of California-Irvine, Orange, CA
Marilyn C. Dumont-Driscoll, University of Florida College of Medicine, Gainesville, FL
Joseph Gigante, Vanderbilt University, Nashville, TN
Teri Lee Turner, Baylor College of Medicine, Houston, TX
 

Substance abuse remains a critical problem for children and adolescents. This mini course will focus on current epidemiologic, neuropharmacologic and management data of these drugs: cocaine, heroin, "club" drugs (i.e., MDMA {Ecstasy}, GHB), other designer drugs and sport doping drugs. The issue of the influence of the media on drug abuse in adolescents will also be presented. Questions from the audience will be encouraged.

Introduction
Donald E. Greydanus, Michigan State University College of Human Medicine, Kalamazoo, MI

Science of Cocaine and Heroin Abuse in Adolescents
Manuel Schydlower, Texas Tech University Health Sciences Center, El Paso, TX

Science of Designer Drugs and Date Rape Drugs
Pierre Paul Tellier, McGill University, Montreal, Canada

Science of Sports Doping Drugs
Dilip R. Patel, Michigan State University College of Human Medicine, Kalamazoo Center for Medical Studies, Kalamazoo, MI

The Media and Drug Abuse in American Adolescents
Victor C. Strasburger, University of New Mexico School of Medicine, Albuquerque, NM

The United States 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.
 

Our workshop is designed to be an intense experience that begins with a brief overview of NIH/NICHD opportunities and the basics of funding and review. Then, each participant is guided through refinement of her/his research question in a small group, using techniques that have worked well for pediatric researchers. By the end of the workshop, every particpant will have a very specific plan for obtaining research funding.
 

Community-based participatory research focuses on social, environmental and health inequities through active involvement of community members, health care providers and researchers in all aspects of the process. This promotes the reciprocal transfer of knowledge, skill, capacity and power between collaborators and helps define best practices in service delivery for the community. Workshop participants will review the key principles, identify community resources following an asset-based approach, develop guiding principles for partnering and conducting service delivery and research, address technical challenges and capacity building and prevent common sources of conflict. Columbia University faculty and two active community partners will share lessons learned in two projects: a home visitation program for families in a Latino immigrant community and a comprehensive asthma initiative for children in a 20-square block area of Central Harlem.
 

Clinical guidelines are a common vehicle used to promote health care processes and cost-effective practice. Workshop leaders will share their experiences with the process used at their institution in both the outpatient and inpatient arenas to develop evidence-based practice guidelines. Attendees will be asked to participate in a number of small group breakout sessions designed around the themes of: (1) developing consensus statements, (2) developing implementation strategies, and (3) designing outcomes measures and process improvement tools. Participants should be provided with the background to begin or improve upon the process currently being utilized at their own institutions.
 

In this workshop we will review some elegant observational designs and strategies that can provide a strength of causal inference close to that from randomized trials, much more quickly and less expensively. We will begin with an interactive discussion of some of these designs and strategies, presenting specific observational studies and trying to figure out what, if anything, makes them particularly convincing. In the second half of the workshop, participants will work together in small groups to design observational studies of research questions for which one or more of the covered designs or strategies might be suitable.

This is an intermediate-to-advanced workshop. Participants should already be familiar with basic observational study designs and multivariate analysis and concepts like bias, confounding and interaction.
 

The Children with Special Health Care Needs (CSHCN) Screener, a survey instrument developed by the Child and Adolescent Health Measurement Initiative at the Foundation for Accountability, is now included regularly in the child health supplement of the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey (MEPS), an annual nationally representative survey of American households, including approximately 7,000 children. The CSHCN Screener is also used to identify CSHCN in the Centers for Disease Control and Prevention (CDC) National Survey of Children with Special Health Care Needs, which was sponsored by the Health Resources and Services Administration (HRSA) and designed to collect data on a representative sample of 750 CSHCN in every State. Both surveys offer numerous opportunities to derive information about key aspects of children's health care for CSHCN. These aspects of health care include coverage and access, functional status and impact, use of care, health care expenditures and quality.

This workshop will provide demonstrations on how to score the CSHCN Screener and use it with selected other variables in the datasets, providing examples of key findings. The format will demonstrate use of the screener with other surveys and allow for interaction with the experts who are intimately familiar with how to use the CSHCN Screener with other survey components. Participants will be asked to look at materials in advance, including information about the surveys at http://www.cdc.gov/nchs/about/major/slaits/cshcn.htm (National Survey of CSHCN) and http://www.ahrq.gov/data/mepsix.htm (MEPS), an article about the screener (Bethell et al., Ambul Pediatr. 2002 Jan-Feb;2(1):49-57) and a guide to scoring the CSHCN screener tool (to be provided before the PAS meeting).
 

Physicians experience death of patients in a variety of settings, yet they are often uncomfortable and ill prepared to handle the event. In the emergency department (ED) the grief response is unique due to many factors including ethnic and cultural diversity, lack of continuity and limited time.

The goals of the workshop are to:

1. Define death utilizing a brief didactic lecture;
2. Use case scenarios and small group discussions to illustrate subtleties in the definitions as they relate to clinical practice;
3. Use small group discussions and role play to explore major emotions inherent to the grief response recognizing cultural, ethnic and religious differences as well as personal attitudes;
4. Identify the elements one might include to develop a grief response team through discussion and handouts.
    

Parents whose children have required intense or repeated health care encounters bring unique expertise and perspective to a research process, particularly in areas of inquiry such as patient/physician communication, parent/physician relationship and professionalism. The workshop presenters have involved parents in designing, implementing and interpreting research on topics such as competencies for medical education, shared medical decision-making, parent decision-making about complementary and alternative medicine and health-related quality of life. This workshop will explore topics of research that parents can inform and introduce participants to feasible research methodologies that involve parents as collaborators in designing research, generating data and interpreting results.
 

Toxic exposures to nuclear, biological and chemical (NBC) agents can be difficult to diagnose and treat. The workshop goals are to:

1. Improve clinical skills associated with diagnosing pediatric exposures to NBC toxins,
2. Teach an evidence-based approach to treatment based on pediatric pharmacology and toxicology principles, and
3. Review state of the art resources available to the pediatrician.

Emphasis is placed on current treatment modalities as well as their potential toxicities. Secondarily, the FDA's role in approving these pharmaceuticals for children is discussed. Additional NBC information from the AAP's policy statements is reviewed, with particular attention to chemical-biological terrorism and radiation disasters. Attendees will be given an information packet so they can promote educational development on the topic of NBC terrorism in children within their own communities.
 

The attendees will learn how to prepare a manuscript for submission to a scientific journal. They will also learn about the review process and how to respond to the reviewers' comments.

Many new developments are confronting pediatric residents, faculty and educators interested in effective and appropriate training of the next generation of pediatricians. In particular, the impact of the new ACGME work duty hours regulations and the impending effects of the move to Core Competency assessments for residents present a new paradigm for pediatric resident education. These developments offer both a challenge and an opportunity for pediatric faculty to improve pediatric resident education.

Ingrid Philibert, ACGME Director of Field Staff, will present The New Work Duty Hours Standards—Genesis, Implementation and Future Directions; Susan Guralnick, Program Director at SUNY-Stony Brook, will discuss The New RRC Core Competencies and what these new methods mean for pediatrics; John D. Mahan, Program Director at Children's Hospital, The Ohio State University, will discuss The Pediatric Residency Programs of the Future: In This Brave New World. Participants will be asked to provide feedback and, after discussion in small group settings, will provide a series of recommendations from pediatric faculty regarding the direction of pediatric residency education in the future. We look forward to a stimulating discussion and useful interchange.
 

This workshop will provide attendees with:

1. An overview of how manuscripts should be prepared for submission to the various journals that publish pediatric papers,
2. A "behind the scenes" view of how manuscripts are handled by the various journals,
3. Clues regarding "dos and don'ts" in submitting and interacting with editors,
4. Ample time for asking questions.
    

The challenge of accomplishing the Institute of Medicine's goal of safe, equitable, high-quality health care is a particularly difficult issue for academic pediatric health care centers. Basic principles of process improvement that have been used to effectively increase quality in industry have proven to be equally effective in health care. This workshop will present active process improvement techniques utilized by CCHMC to influence change in clinical settings, including the charting of data over time and statistical process control. Workshop leaders will provide experiential perspectives through several case studies. An overview of the processes of development, implementation, feedback and ongoing assessment of impact for each case study will be presented and discussed. Active involvement of participants will be encouraged during the didactic and case presentations. A subsequent interactive session will utilize participants' own clinical scenarios and experiences for general and individual discussion. At the end of the session participants should know:

1. The key principles of process improvement related to measurement and reduction of variation,
2. How to use these principles to integrate quality issues into clinical care in academic divisions/departments, and
3. How to measure the impact of the process.
    

The inpatient bedside is a complex, challenging and forever-changing milieu. Learners lament that the inpatient team spends little time at the bedside versus too much time in the conference room, and that they are not being observed performing critical bedside skills such as history-taking, physical exam and assessment. Faculty, on the other hand, feel increasingly stressed from their multi-tasking, which includes patient care, teaching, note writing, timely discharges and appropriate billing. They express discomfort with bedside teaching and may not always set examples as good role models at the bedside regarding what, when or how to teach. Therefore, it is not surprising that bedside teaching in many centers is either moribund or extinct. We suggest that a return to bedside teaching would enhance learning, promote a closer teacher–learner relationship to build trust and ensure competency and improve the overall educational experience of the inpatient unit.

In this workshop, we will focus on issues such as when to teach at the bedside, what should be taught, how to engage the learners, the art of questioning, how to make teaching learner centered, time management and involving patients. Participants will have several opportunities for practice and will be challenged to apply what they have learned to their own educational settings.

This workshop will focus on ethically problematic cases that arise in children's hospitals. We will cover cases from every pediatric age group. Our goal will be to model the sort of free-ranging ethical debate that we believe characterizes a vibrant ethics consultation service. Participants are welcome to bring cases from their own institutions. We will also bring some classic cases from our consult experience.
 

The Advocacy Training SIG will include:

1. Resident Advocacy Platform Session: We will solicit abstracts from Residents, including recipients of past Resident CATCH Planning Grants, and select up to eight residents to make a brief (5-minute) presentation of their work at the SIG.
2. "What’s up with your program" poster session: We will solicit abstracts from Residency Programs regarding their advocacy training curricula, looking for innovative approaches that could be replicated by other programs. Special consideration will be given to programs with a "deliverable" module or component that others can take home and adapt in their own program.
3. Advocacy Program Tune Up: A panel of national experts will facilitate a discussion of programmatic questions developed by SIG members and respond to issues raised in the faculty poster session.
    

The Managed Care SIG annual meeting will focus on research topics in the area of pediatrics and managed care. Selected papers from provider groups, academic institutions and health plans on the impact that managed care has had on providing health care to needy populations will be presented. I encourage students, housestaff and faculty to attend this meeting if you are interested in learning more about the current state of managed care and its effects on health care delivery to child populations.
 

The Medical Informatics Special Interest Group welcomes all APA members with an interest in developing, implementing and evaluating tools that enhance our ability to manage information in medicine. Last year, we had a fun and productive meeting that resulted in a number of new workshops being presented at this year's meeting. In addition, we reviewed some work in progress by our attendees. These presentations catalyzed very informative discussions that all appeared to enjoy!

At the spring meeting in San Francisco, we plan to continue the work we are doing to increase the overall integration of our research efforts and skills with the medical informatics community as a whole and with the needs of PAS participants in particular. We hope to have an invited guest to discuss with us upcoming funding opportunities that we might find of interest. Finally, because last year's abstract presentations were a success, we are planning to allow participants to present research ideas or research in progress, so that we all may contribute to the advancement of our field. Come join us! Any individuals planning to attend should email me if you have an interest in presenting your research ideas to the group.
 

Opening Remarks and Awards: Jewish Pediatricians in the Third Reich
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Lawson Wilkins Lecture:
The Mad Cow That Changed America
Stanley B. Prusiner, University of California, San Francisco, CA

Robert Blizzard Lecture:
The Molecular Basis of Congenital Hypothyroidsim
Annette Grueters, Humboldt University of Berlin, Campus Virchow Klinikum

Esoterix Lecture:
Growth Prediction Models in Clinical Practice
Michael B. Ranke, Department of Pediatric Endocrinology, University of Tuebingen, Tuebingen, Germany

Transpacific Lecture:
IGF's and the Ectoderm
George A. Werther, Royal Children's Hospital, Melbourne, Australia
 

There has been remarkable progress in our understanding of the development and function of the immune system in health and disease. The regulation of immunity impacts profoundly on many of the conditions that pediatricians treat. The objective of this program is to enable PAS attendees coming from diverse disciplines to understand the language of modern immunology and the translation of recent advances in basic science to the diagnosis and treatment of diseases of children. This course will address three areas: immunology of infectious diseases, immunology of auto-immunity and tumor immunology.

Opening remarks
Beverly J. Lange, Children's Hospital of Philadelphia, Philadelphia, PA
E. Richard Stiehm, UCLA Children's Hospital, Los Angeles, CA

Immunology of Infectious Disease
Katherine F. Luzuriaga, University of Massachusetts Medical School, Worcester, MA

Immunology of Autoimmunity
Betty Diamond, Albert Einstein College of Medicine, Bronx, NY

Tumor Immunology
Robert H. Vonderheide, University of Pennsylvania, Philadelphia, PA

This session will review the development and clinical usefulness of blood/blood products and derivatives used in the treatment of patients with hematologic and oncologic diseases and the bleeding patient. The role of these novel and often modified products in selected patient groups will be discussed.

Introduction
Naomi L. C. Luban, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC

Transfusion Support of the HSCT Patient
Terry Gernsheimer, Puget Sound Blood Center, Seattle, WA

Transfusion Support of the Chronically Transfused Patient with Sickle Cell Anemia
Naomi L. C. Luban, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC

Novel Therapies for Acute Bleeding
Guy Young, Children's Hospital of Orange County, Orange County, CA

Pathogen Reduction—Risks, Benefits and Hidden Benefits for GVHD
Lawrence Corash, Cerus Corporation, Concord, CA

Discussion

The pipeline of new therapies flowing from the bench to the bedside is extremely long and tortuous, with many "valves" that must be opened. Expertise is required in both basic and clinical research to conduct Investigational New Drug-directed early phase human clinical trials or to become skilled in the design and implementation of pre-clinical studies necessary to effectively progress basic observations into human trials. For the academician, the challenges can be legion. This session will begin with an example of the infrastructure required for an academic center to foster translational research. The symposium will then cover three of the major aspects of new drug development. First, we will explore the preclinical selection of appropriate targets and the models in which to test them. Second, we will explore the pharmaceutical pipeline to give participants knowledge of new clinical agents. Third, we will learn about coordinating the early stage clinical trials with regulatory agencies. We will close with an academician¹s perspective of the end of the pipeline based on recent gene therapy trials for hemophilia.

Introduction to Translational Research: Opening the Valves of the Pharmaceutical Pipeline
Timothy Cripe, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Pediatric Malignancies Provide Unique Cancer Therapy Targets
Jeffrey Toretsky, Lombardi Comprehensive Cancer Center, Washington, DC

Exploiting Genetic Defects for Targeting Oncolytic Viruses to Pediatric Cancers
Timothy Cripe, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

A Comparative and Preclinical Approach Toward Drug Development
Chand Khanna, National Cancer Institute, National Institutes of Health, Bethesda, MD

Developing Drugs in the Era of Targeted Therapy
Pamela S. Cohen, Novartis Pharmaceuticals Corporation, Florham, NJ

Ask Not What CTEP Can Do for You…Moving Agents Through the Pipeline
Barry Anderson, National Cancer Institute, National Institutes of Health, Rockville, MD

Special Delivery: Novel Approaches and Challenges to Gene Delivery
Mark Kay, Stanford University Medical Center, Stanford, CA

Clinical investigation is an exciting area of pediatric research. This workshop will explore various aspects of clinical investigation including the concept of bias, the impact of recent HIPAA regulations and two current multi-center trials in nephrology.

Bias in Clinical Decision Making
Debbie Gipson, University of North Carolina, Chapel Hill, NC

HIPAA Regulatory Challenges to Clinical Research
Joanne Pollak, Johns Hopkins Medicine, Baltimore, MD

Focal and Segmental Glomerulosclerosis Multicenter Trial
Sandra L. Watkins, University of Washington/Children's Hospital, Seattle, WA

Chonic Kidney Disease Trial
Susan L. Furth, Johns Hopkins Hospital, Baltimore, MD
 

Assessment of clinical competence in pediatric medical education presents both a challenge and an opportunity for teachers and learners. In the past, the emphasis on assessment has been primarily based on performance on standardized tests (e.g., Boards) and global summative evaluations by faculty. There is now increased demand for demonstrating clinical competence from national organizations as well as public outcry for accountability in medicine. In 2001 the ACGME defined the six core competencies in resident training, and pediatric residency programs are now required to assess competence in these areas. Residents, program directors and faculty now are confronted with a variety of new concepts in both curriculum development and competency evaluation. Much more work needs to be performed to develop useful curricula and methods for assessing clinical competence, and research projects are now underway to assess the validity of such methods and the impact on patient care.

We will discuss how the emphasis on core competencies is changing pediatric resident education and how pediatric educators can join in the effort. Participants will engage in an interactive project to demonstrate how pediatric faculty can contribute to the design and implementation of competency-based assessment in pediatric resident education.

The ACGME Six Core Competencies: The Prevailing Paradigm
John D. Mahan, Children’s Hospital, The Ohio State University, Columbus, OH

Designing Curriculum and Assessment Methods in a Competency-Based System
Carol Carraccio, University of Maryland School of Medicine, Baltimore, MD

Assessing Competence in Pediatric Medical Education: The Portfolio Approach
Robert Englander, Connecticut Children's Medical Center, University of Connecticut, Hartford, CT

Traditional newborn screening has successfully identified and allowed treatment for newborn infants with several inborn errors of metabolism including phenylketonuria, galactosemia and biotinidase deficiency since its advent in the 1960s. Novel methodologies have been developed that allow detection of a large group (>30) of inherited metabolic disorders that have not been screened for by traditional methodologies. Expanded screening has now been introduced in several states and will likely continue to be developed throughout the United States.

This workshop will review traditional approaches to newborn screening and summarize novel methodologies including tandem mass spectroscopy. The experience in public health programs will be described, and the outcome of several years of expanded newborn screening (tandem mass spectroscopy) will be summarized. Prospects for future screening methodologies will be reviewed. This workshop will bring the pediatrician rapidly up to speed on expanded newborn screening and describe the clinical benefits for patients who are identified at an early age.

Expanded Newborn Screening: The North Carolina Experience
Joseph Muenzer, University of North Carolina, Chapel Hill, NC

Newborn Screening and Public Health: Past, Present and Future Perspectives
Ken Pass, Wadsworth Center, NYS Department of Health, Albany, NY

Development of Novel Methodologies for Newborn Screening
David S. Millington, Duke University Medical Center, Research Triangle Park, NC

Questions & Discussion
 

Didactic and case-based discussion of obesity and new formulas focused on practical pediatric office-based issues.

Introduction
Michael R. Narkewicz, University of Colorado Health Sciences Center, Denver, CO

Obesity Treatment and Management in the Pediatric Office: What Can One Do?
William J. Klish, Baylor College of Medicine, Houston, TX

Obesity Detection and Prevention from Office Pediatrician Perspective
Robert Murray, The Ohio State University, Columbus, OH

Questions and Discussion

Break

Formula Additives: Probiotics to Trace Elements—What Parents and Pediatricians Should Know
Judith O'Connor, University of Colorado, Children's Hospital, Denver, CO

Fatty Acid Supplementation of Formulas: Facts and Fictions
Frank R. Greer, University of Wisconsin, Wisconsin Perinatal Center, Madison, WI

Questions and Discussion

Many children living with chronic and life-threatening conditions experience pain and other distressing symptoms. Control of pain and symptoms is the foundation upon which competent palliative care is built. Yet children and families suffer when they encounter pediatricians and other professionals who are ill-prepared to offer them competent and compassionate palliative and end-of-life care. The Institute of Medicine (IOM) report on Improving Palliative and End-of-Life Care for Children and Their Families (2002) calls upon pediatric health professionals to address the needs of children and families for comprehensive palliative care services. In addition, routine assessment and management of pain is now a required component of patient care according to the Joint Commission for the Accreditation of Health Care Organizations (JCAHO). This session will outline basic tenets of pain and symptom management for children and adolescents, their implementation across care settings and consideration of the continued barriers to full implementation of these care standards.

Overview
Nancy Hutton, Johns Hopkins University School of Medicine, Baltimore, MD

Assessment and Management of Pain in Children and Adolescents
Neil L. Schechter, St. Francis Hospital and Medical Center, Hartford, CT

Reducing Barriers to Effective Pain and Symptom Management at the End of Life
Nancy Hutton, Johns Hopkins University School of Medicine, Baltimore, MD

Palliative Pain and Symptom Management in Pediatric Tertiary Care Settings
Joanne Wolfe, Dana-Farber Cancer Institute and Children's Hospital, Boston, MA

Clinical Cases in Pediatric Pain and Symptom Management
Speaker To Be Determined
 

What does success mean to you? Achieving academic success can be difficult owing to the multiple, conflicting personal and professional responsibilities that compete for our time. It is a challenge to develop and apply techniques and practices that allow us to effectively achieve balance in our lives. Participants in this workshop will define individual success, set personal and professional goals and explore innovative techniques to achieve them. Through round table and small group discussion and through individual exercises, participants will consider successful approaches to defining their professional efforts. We will discuss working with a reduced FTE (part time), developing an educator's portfolio, establishing a relationship with a mentor, tackling the promotion and tenure process and successful negotiation techniques. Breakout sessions on individual topics provide opportunity to share experiences and problem solve. Creative ways to achieve success and maintain balance will be presented, discussed and practiced.
 

Humanism and professionalism are essential components of outstanding clinical work. The AAMC and ACGME have mandated they be explicitly included in medical student and resident curricula. Although schools and programs have begun to develop curricula to teach students and residents humane and professional behavior, evaluating these competencies has proven to be a difficulty challenge. A number of tools have been developed to assess the humanism and professionalism of individuals and of programs. These tools include competency-based checklists, which can be used to assess behavior in real life (bedside observations) and in standardized situations (OSCEs). There are also several different qualitative approaches, which use prompted collections of descriptions from multiple sources (patients, nurses, peers, faculty and self) to capture information that may be difficult to obtain from a checklist. Finally, there are tools that assess the humanism and professionalism within a particular program.

This workshop will identify a variety of different methods for evaluating humanism and professionalism. Working definitions for humanism and professionalism will be established through brainstorming and focused discussion. Competency-based checklists and qualitative assessments will be demonstrated and explored using videotape and paper case analysis. Participants will be challenged to develop short, written actions plans identifying how one or more of these assessment tools might be applied to their own programs and institutions.
 

Understanding the function of genes and other parts of the genome is known as functional genomics. The Human Genome Project is just the first step in understanding humans at the molecular level. Now that the sequencing phase of the human and mouse genomes is complete, many questions remain unanswered, including the function and regulation of most of the estimated 30,000–35,000 mouse and human genes. The mouse has a long and rich history in biological research and many consider it a model organism for the study of human development and disease. Over the past few years, exciting progress has been made in developing techniques for chromosome engineering, mutagenesis, mapping and maintenance of mutations and identification of mutant genes in the mouse. Additionally, whole genome sequence analysis of many different species is proving to be incredibly fruitful in identifying critical gene regulatory motifs. In this workshop, we will present a few of the techniques that are being applied to the daunting yet exciting task of functional genomic analysis in the mouse.
 

Develop animations with a little imagination and learn how to use it in various settings. Animations are exciting and offer visual enhancement of the learning process. Do animations really help learning? Hear from students and residents on the evaluation of animations as a teaching tool. This interactive workshop will cover an overview of animations as a teaching tool, view an animation entitled, "How does blood clot?" as well as "Understanding von Willebrand disease," and then go through the steps involved in developing animations. We will also teach you how to insert animations in PowerPoint presentations as well as how to further enhance your presentations by other means. On what subject do you spend the most time in your practice explaining to students, residents and patients? Can it be animated? Come with your ideas and we will explore how to develop an animation. A new feature added this year will be some animations of laboratory tests.

By the end of the workshop, the participant will:

1. Learn the various steps involved in making animations,
2. Be able to identify topics that may be presented using animations,
3. Learn about inserting animations into PowerPoint presentations as well as enhancing presentations.
    

The performance of minor procedures is important in pediatric residency and office practice. Training for these procedures varies between residency programs causing some residents and practitioners to avoid a procedure or call a consultant because they are uncomfortable with a procedure.

The goal of this workshop is to convey specific techniques and instruction methods for several minor office procedures. This hands-on workshop will demonstrate skills and allow practice as participants rotate through the following stations:

1. Wound repair (use skin glue, staples, sutures)
2. Foreign body removal from ears, nose, eyes. Reimplant avulsed teeth
3. Trouble-shoot G-tubes, trach tube complications
4. Vascular access (master IO lines, needleless systems and IV safety devices)
5. Skin extractions (embedded fishhooks, subungual hematomas, hair tourniquets
6. Genital issues—manage paraphimosis, rectal prolapse, zipper entrapment. Participants should become adept at several procedures and will be able to teach them to others.
    

This workshop will address multiple aspects of publication in scientific journals. Presenters will discuss preparation of materials, including the initial decision that the data are sufficient to justify publication. Issues related to manuscript writing will include length, focus, adherence to journal formats and referencing. The editorial process, from submission to publication, will be described in depth, with particular attention to ways in which authors can interact with journal editors. Another section of the workshop will cover ethical issues in publication, including review boards, authorship, duplicate publication, intellectual property rights and conflict of interest. There will be open discussion of sample cases and questions derived from the experiences of the participants.
 

The American Thoracic Society recently sponsored a workshop examining current literature, specific data from the NIH, an extensive carefully performed web-based survey and expert opinion in the area of physician-scientist training. This workshop will relay information including data from the NIH, a "roadmap" to success and ideas from PhD training and from Internal Medicine physician-scientist training. The workshop is intended to provide fellows and junior faculty as well as senior leadership in pediatric departments guidelines to improve recruitment and retention of physician-scientists in pediatrics. Specific objectives are:

1. Educate physician-scientists early in training about expectations and realistic targets in the course of a career as a physician-scientist;
2. Assist senior administrative leaders in clinical departments to identify reasonable academic and research goals for junior physician scientists.
    

Teaching individuals, small groups and large groups requires the ability to focus the topic and produce a clear and coherent explanation that students can follow. The steps in producing an explanation and use of enhancements such as examples will be presented in this interactive workshop. Participants will work together to produce their own personal explanation. Lectures are often a series of explanations, and an introduction to the structuring of a lecture and its presentation will be discussed.
 

Pediatric residency programs are adding residents projects to their curricula. The CATCH (Community Access to Child Health) Planning Funds program provides grants to pediatric residents to develop community-based initiatives that increase children's access to medical homes or to specific health services not otherwise available. We will teach program directors and their residents how to develop a community-based project curriculum, including project design and grant writing. Participants will:

1. Identify the steps necessary in preparing the components of a successful resident community based project,
2. Describe the features of successful and unsuccessful grant applications and
3. Identify tools available to residents for project development.

Resources available to residents planning community-based initiatives, including a copy of "A Pediatrician's Guide to Proposal Writing," will be provided.
 

There are approximately 200,000 school-aged children with diabetes in the United States. Pediatricians must be aware of the increasing complexities of the diabetes regimen and strategies that can be implemented in schools to improve management and prevention. This workshop will address how to set up a diabetes health care plan, empower families, improve the nutrition environment and promote physical activity. Numerous tools will be presented, including a guide for school personnel, materials to energize the student body to form nutrition clubs and support materials for families.
 

To help pediatric residency programs update their curricula and meet new ACGME competency requirements, the APA has created a new, web-based edition of the Educational Guidelines for Pediatric Residency (EG). This workshop will allow participants to explore the EG website in a computer lab setting. The workshop will begin with a live demonstration with role plays. Small groups will use the EG to create an educational plan for a selected residency experience or develop an evaluation tool. The small groups will discuss the challenges that they encountered. The workshop will conclude with a summary of results of initial beta tests of the EG and plans for future evaluation. Handouts will provide the website URL and sitemap and a practical set of instructions for new users.
 

The focus of the Culture, Ethnicity and Health Care SIG continues to be research, education and policy/advocacy about cultural issues (including race/ethnicity and linguistic issues) and how these issues impact children’s health and health care. Continuing our annual tradition, we will have a nationally renown guest speaker make a cutting-edge presentation, followed by an interactive discussion session with our SIG members. Next, the highest-scoring submitted abstracts on cultural issues will be presented. Finally, we will continue our discussion (initiated last year and continued on our list-serve) about a possible collaborative SIG project on educational/curricular issues.
 

The Integrative Pediatrics SIG of the APA will open with a presentation by David Steinhorn of the Division of Pulmonary and Critical Care at Children's Memorial Hospital in Chicago. Dr. Steinhorn is the Medical Director of the Judith N. Bernstein Center for Integrative Medicine. He will review how this center was conceptualized and created. The center's current set of services and research undertakings will be reviewed. Dr. Steinhorn will provide a model that can serve as a framework for the creation of Integrative Pediatric centers. His talk will be followed by a discussion of the challenges and expectations created by recently published guidelines for residency education in integrative pediatrics.
 

The Newborn Nursery SIG is a group of general and neonatal pediatricians who care for term newborns throughout our country and the world. We are working on problems in detecting and treating sepsis, jaundice and hypoglycemia in newborns and share our frustrations, best practice and solutions. We are striving to improve our family education and resident and medical student teaching in our nurseries. In our meetings, we have formal presentations, ask the expert sessions, planning discussions and question and answer exchanges. After our meetings, we continue our discussions through email questions and surveys. Our goal is to improve patient care, teaching and research questions in our term newborn nurseries.
 

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

1. The use of the telephone and e-mail in the delivery of patient care—what is the evidence?
2. Update on recent research in pediatric telephone care.
3. Update from the AAP Section on Pediatric Telephone Care.

Participants are also invited to present their research, works in progress or germinating ideas.

Participants interested in presenting should contact A. Kempe at kempe.allison@tchden.org. The current chair of this SIG has reached her term limit, so please come and get involved in a leadership role!
 

This year’s meeting of the Race in Medicine SIG will focus on Racial Disparities in Child Health, with presentations of ongoing research on child health disparities from around the country. We will provide a friendly forum for investigators at various stages in their research to present their work for discussion and feedback.

In the past, the SIG has also focused on Race in Research and Pediatric Workforce Diversi