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.
    

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.

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

Pediatric Pain and Symptom Management in Home Care and Hospice
Speaker To Be Determined
 

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need to Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

The Pediatric Emergency Medicine Program Directors SIG is composed of members of the APA involved in the administration or leadership issues related to pediatric emergency medicine. Section chiefs, department directors, fellowship directors and any and all members interested in leadership issues related to the management of pediatric emergency medicine are invited to attend. This year's meeting will focus on two topics: faculty incentive programs and electronic medical records (EMR).

The meeting will begin with a presentation on the current status of faculty incentive programs as they currently exist within pediatric emergency medicine programs, concentrating on structuring details, advantages, disadvantages, comparisons and relative outcomes (productivity, revenue, etc.). The second portion will involve a comparative visual presentation and hands-on exploration into the options, advantages, disadvantages, costs, comparisons and outcomes. It will also include the opportunity for discussion by those with recent experience of any EMR products.
 

Pediatric emergency medicine is a relatively new pediatric subspecialty. To this point the goals have been defining the field and developing a cadre of practitioners, teachers and researchers. But where do we go from here? What are the challenges and new directions facing our specialty?

Pediatric Emergency Medicine—Where Have We Been; Where Are We Headed?
Stephen Ludwig, Children's Hospital of Philadelphia, Philadelphia, PA
 

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

The National Children’s Study is a national prospective, longitudinal study of environmental effects, including physical, chemical, biological and psychosocial effects, on child health and development. The goal of the study is to improve the health and well-being of children. The study will examine these environmental effects on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services, including the National Institute of Child Health and Human Development (NICHD); the National Institute of Environmental Health Sciences (NIEHS); the Centers for Disease Control and Prevention (CDC); and the U.S. Environmental Protection Agency (EPA). For additional information, visit the website at http://www.nationalchildrensstudy.gov/.

The National Children’s Study—An Overview
Duane Alexander, NICHD, National Institutes of Health, Bethesda, MD

The National Children’s Study—Methods
Peter C. Scheidt, National Institutes of Health, Bethesda, MD

Children’s Health and Environmental Exposures: The Most Important Unanswered but Answerable Questions
Michael Weitzman, The AAP Center for Child Health Research at the University of Rochester, Rochester, NY

The application of imaging technologies to solving questions in biology and medicine is revolutionizing medicine by accelerating analyses in situ and in vivo and providing new perspectives on biological processes as diverse as development, neoplasia and injury repair. In this plenary session, three internationally recognized speakers will focus on developmental processes and discuss how these new imaging technologies are providing dynamic insights into the genetic and epigenetic mechanisms that underpin hematopoiesis and vascular development.

Introduction
Lisa M. Guay-Woodford, University of Alabama at Birmingham, Birmingham, AL

Dynamic Imaging of Fluid Forces in Developing Mouse Vasculature
Mary Dickinson, Beckman Institute–Caltech, Pasadena, CA

Microscopic Imaging of Angiogenesis
Donald M. McDonald, University of California, San Francisco, CA

Watching Hematopoietic Stem Cell Engraftment and Hematopoiesis in Living Animals
Christopher H. Contag, Stanford University School of Medicine, Stanford, CA

Questions from the audience
 

The Emergency Medicine SIG meeting will have two topics for discussion, one clinical and one administrative. The clinical topic is the cons and pros of intentional and unintentional injury prevention in the pediatric emergency department: "Not my job…or is it?" Denise Dowd, Dennis Durban, Joseph Wright and Michael Gittelman will lead the discussion.

The administrative topic will feature a discussion by Jane Knapp and Steve Ludwig on the proposed recertification process by the ABP. This topic was presented at the PEM leadership conference, and this is an opportunity for those who were unable to attend the conference to discuss their views. We are looking forward to another successful meeting and an interesting debate on both topics. Abstract posters will be available for viewing during our recess between the two topics.

Includes selected original science abstract presentations as well as the Presidential Address, the International Health Award and the George Armstrong Lecture presentations.
 

Worldwide, more than 1,500 children per day become infected with HIV through mother-to-child transmission. Currently there are 2.7 million children living with HIV infection across the globe, >90% of whom reside in developing countries. While there have been enormous successes in the prevention and treatment of pediatric AIDS in the United States and Europe, it remains an open question as to how effectively these public health gains can be replicated in the poor countries of the world, which bear the greatest burden of disease. Efforts to develop an HIV vaccine appropriate for preventing infection among the world's children and adolescents are finally under way on a global scale. We will discuss these issues and accompanying controversies as they apply to the children of the developing world.

AIDS in Children—A Global Public Health Crisis
David L. Pugatch, Hasbro Children's Hospital and Brown Medical School, Providence, RI

Preventing Mother-to-Child Transmission of HIV in Developing Countries—Successes, Failures and Challenges
Catherine M. Wilfert, Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA and Washington, DC

HIV Treatment for Children—Can the Successes of Rich Countries Be Duplicated in Resource-Poor Settings?
Mark W. Kline, Baylor College of Medicine, Houston, TX

Finding an AIDS Vaccine That Works for the World's Children
Richard A. Koup, Vaccine Research Center, National Institutes of Health, Bethesda, MD

Hot Topics in General Pediatrics is a potpourri of topics of interest to all pediatricians. The topics include lead poisoning, West Nile Virus infection, sleep disorders and esophagitis. Each of these conditions has varied symptoms, signs and manifestations. For each topic there have been new findings that are in the "need to know" category for all pediatric generalists and subspecialists.

Kawasaki Disease
Jane C. Burns, University of California, San Diego, CA

West Nile Fever
Janak A. Patel, Children's Hospital, University of Texas Medical Branch, Galveston, TX