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.

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 of 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.
 

This workshop will introduce a new teaching tool that can be used to improve the skill of cardiac auscultation. The Cardiac Auscultatory Recording Database (CARD) is an interactive, internet-based virtual cardiology clinic designed to improve the skill of cardiac auscultation among trainees at all levels. By providing the teaching module to health profession trainees and educators, it is envisioned that study of this clinical skill, which has traditionally been possible only during limited hours, on certain clinical rotations, in an often suboptimal learning environment, can proceed at any time, in any location, at the student's convenience and pace. Workshop participants will use infrared stethophones to allow for simultaneous auscultation. This program can be used for individual study or teaching by logging onto our CARD website at www.murmurlab.com.
 

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.
 

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.
 

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.
 

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

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

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

Formulas 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

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
 

Check for information on this Workshop in early 2004.
 

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 Child Abuse SIG welcomes all physicians who are interested in the issues that face maltreated children and the physicians who care for them. Each year we meet to discuss subjects that are controversial or challenging and share research that informs our practice. We also try to highlight work being done by colleagues in our host city. This year in San Francisco is no different. We will meet on Sunday afternoon, May 2, 2004, for an afternoon of education and collegial controversy! Please save the date, and plan to join us.
 

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 Diversity. Currently in our third year, we are at a critical stage of development, and the second half of this year’s meeting will focus on growing the SIG for the future. Your ideas are needed to determine the SIG’s agenda and activities to better serve its members and the APA at large. Possibilities include information dissemination, educational and funding opportunities and collaborations with other SIGs. We look forward to seeing you in San Francisco!
 

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

Potential conflicts of interest litter the halls of academic medical centers like unexploded ordnance. This symposium will discuss both non-financial and financial conflicts of interest and will demonstrate their power to erode trust. There is now overwhelming evidence for systematic bias due to conflicts of interest associated with financial links between researchers and their institutions to commercial entities. We will discuss managing and eliminating conflicts of interest and propose steps to regain public trust.

Overview
Ruth A. Etzel, George Washington University School of Public Health and Health Services, Washington, D.C.

Should Researchers Care About Trust? Climbers Do—Their Lives Depend on It
The Importance of Conflicts of Interest to Clinical Researchers
Drummond Rennie, University of California, San Francisco, CA

Discussion
 

The Perfect Academic Out-Patient Offices—New and Old Ideas in Re-making Your Physical Plant

Speakers will include Benjamin S. Yabut, MD, MS, PhD, Chief Business Officer and Chief of Research, Dykstra Consulting Group; and Benard Dreyer, MD, Vice-Chair of Pediatrics at Bellevue Hospital; among others.

The APA Pediatric Tobacco Issues SIG (the "CIG SIG") brings APA members together for networking, dissemination of information and programs, funding opportunities, etc. By participating in the SIG, APA members are able to:

1. Discuss opportunities for tobacco-use interventions in the pediatric setting, including prenatal counseling, post-partum maternal relapse prevention, parental cessation counseling and youth prevention and cessation counseling;
2. Explore research activities and findings in the areas of tobacco prevention and cessation;
3. Gain understanding of the epidemiology of tobacco use, its related health hazards and the benefits of cessation; and
4. Provide an evidence-based foundation for advocacy and tobacco control efforts.

Our meetings are lively and attended by new members, fellows, residents, experienced researchers and mid-career pediatricians, brought together by their shared interests.
 

The Practiced-Based Research Networks SIG has representation from Practice-Based Research Groups (PBRNs) from all geographic regions. PBRNs are networks for practices that do office-based research that generally relates to primary care and day-to-day problems. Our SIG offers the networks a forum to share ideas, brainstorm about solving common problems and the potential to collaborate on research projects. In years past we have had at least a dozen networks present and had outside speakers, as well as original research presented. This year we will have several groups report studies in progress or completed.
 

For this year, the School and Community would like to continue the format of "residency" and "roadblocks and school partnerships" that was begun at the 2003 meeting. This year we would like to frame these topics by focusing on a particular theme. One of the hottest public health concerns currently is obesity and its relationship to nutrition and exercise. There is a great deal of local, regional and federal funding of initiatives dealing with these issues; many of these require a school or community component. Addressing these issues within a residency program almost ensures a connection with school or community. The SIG would like to explore initiatives that have included residents and or addressed obesity, nutrition and exercise within a school system or community.
 

Pain that is recurrent or persistent can create difficulties in diagnosis and treatment. Since research in pediatric pain is relatively recent but expanding, physicians may not have sufficient state of the art knowledge upon which to evaluate and treat their patients with chronic pain. There have been significant advances in the neurobiology of pain and the many factors that magnify and maintain the pain experience, pain behaviors and pain pathophysiology. The interface between mind, body and the environment, as well as new diagnostic tools, is creating new paradigms in our understanding of pain. For example, barostat and imaging studies have revealed new models for thinking about irritable bowel syndrome (IBS) as a condition of neuroenteric dysfunction. Other conditions, such as juvenile fibromyalgia and myofascial syndromes, are thought to be caused by central neurodysregulation. Many of these conditions are magnified and confounded by co-morbid anxiety disorders, learning disabilities and family system issues, among other factors. Why do some children with chronic pain develop a downward spiral of decreasing function and develop PADS? These conditions are not as difficult to evaluate and treat once they are understood from a biopsychosocial perspective. We will discuss the neurobiology, clinical assessment and approach to treatment of chronic pain and PADS, using IBS, juvenile fibromyalgia and myofascial pain as examples.

Overview of Pain Systems: A Mind–Body Perspective
Lonnie K. Zeltzer, David Geffen School of Medicine at UCLA, Mattel Children's Hospital, Los Angeles, CA

Neurobiology of Chronic Pain: Irritable Bowel Syndrome as a Model
Carlo Di Lorenzo, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA

How Do We Understand Disorders Such as Fibromyalgia and Myofascial Pain?
David D. Sherry, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA

Pain-Associated Disability Syndrome (PADS): What Is It and How To Evaluate and Treat It
Brenda Bursch, David Geffen School of Medicine at UCLA, UCLA Neuropsychiatric Institute & Hospital, Los Angeles, CA

Discussion
 

Micronutrients are essential to normal growth and development in infancy. Preterm and small-for-gestational-age infants are especially vulnerable to deficiencies. This symposium will focus on two fundamental nutrients: zinc and iron. Michael Hambidge will discuss the physiologic and metabolic importance of zinc during the perinatal period and the methods that can be used to assess zinc requirements. Nancy Krebs will discuss recent information about zinc homeostasis and requirements in premature and small-for-gestational-age infants. Stanley Zlotkin will discuss the etiology of iron deficiency in preterm infants during the first year of life and interventions to prevent it.

The Importance of Zinc in the Perinatal Period: An Overview
Kenneth Michael Hambidge, University of Colorado Health Sciences Center, Denver, CO

Zinc Requirements in Premature and Small-for-Gestational-Age Infants
Nancy F. Krebs, University of Colorado Health Sciences Center, Denver, CO

Meeting the Iron Needs of the Preterm Infant Throughout the First Year of Life
Stanley H. Zlotkin, The Hospital for Sick Children, Toronto, Canada

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 symposium will provide the state of the art approach to these two common and intimately related conditions. The session will start with discussion of the genetics and embryology of vesicoureteral reflux and their implications in its management. New observations on the modes of treatment and the imaging studies indicated in the infant and child with UTI will be addressed next. As those requiring long-term intervention are mostly children with vesicoureteral reflux, a pediatric urologist point of view of it will follow. Both, long-term medical and surgical management will be reviewed, and the new information on the use of non-surgical endoscopic intervention as a new tool to treat vesicoureteral reflux will be discussed. Finally, our increasing understanding of the role of bladder function and dysfunction in the development, progression and resolution of vesicoureteral reflux and urinary tract infections will be reviewed.

Vesicoureteral Reflux as a Developmental Disorder
Anthony Atala, Children's Hospital, Boston, MA

Acute Urinary Tract Infection—Evaluation and Treatment
Alejandro Hoberman, University of Pittsburgh School of Medicine, Pittsburgh, PA

Surgical and Non-surgical Management of Vesicoureteral Reflux
Linda Shortliffe, Stanford University, Stanford, CA

Dysfunctional Voiding
Seth L. Schulman, Children's Hospital of Philadelphia, Philadelphia, PA
 

The Nutrition Friendly (NF) school process has been developed to help address the rising rates of childhood overweight. It is an ecological model based on the coordinated school health model, which impacts the entire school environment including students, staff and families to prevent the development of overweight in children. School community stakeholders in collaboration with the UCLA School of Public Health Nutrition Friendly Schools and Communities Group developed the NF school certification process and self-evaluation tool.

The goal of the workshop is to report on the continued development and preliminary results of the NF School pilot study and introduce the NF School model to any new participants. Participants will also gain an understanding of the participatory action research method used to develop the NF School model.
 

The BIOECOGRAM is a tool used to record child, family, social and environmental factors in a standardized method, placing the child at the very center of the consultation. The workshop will review the AAP recommendations for family-centered care and offer a number of case studies to help participants to use this graphic tool in their day-to-day practice when challenged by both simple and complex behavioral and developmental problems.
 

Participants will utilize the APA's web-based Educational Guidelines for Residency Training in Pediatrics to identify specific educational topics relevant to the continuity experience. Four preventive screening topics will be used as the educational goals. Participants, working in small groups, will determine in which of the six ACGME competencies the educational goals fit best. Practice-based learning and systems-based practice will be emphasized. Guidelines for teaching and evaluating resident competencies will be developed. The teaching and assessment tools developed will be generalizable to other curriculum topics, including QI projects.
 

This year the Ethics SIG will discuss two different but important topics:

1. Ruth Etzel, from the Alaska Native Medical Center, will present the draft version of a code of ethics for general pediatric research which was developed by the Ambulatory Pediatric Association in cooperation with the Association of American Medical Colleges.
2. James Jarvis, from the University of Oklahoma, will discuss autonomy and the enlightenment origins of medical ethics.
    

The Literacy Development Programs in Primary Care SIG provides information, support and networking for clinicians interested either in research or implementation projects related to pediatric interventions to encourage or support early childhood literacy. The SIG is an opportunity to review research in progress, stimulate new research directions, including collaborative and multisite projects, and enhance provider training and knowledge related to early literacy and to the Reach Out and Read (ROR) model of intervention. This year we will focus on new research directions in early literacy and learning and in closely related areas, with presentations on current research and on techniques for addressing promising new questions. The session will also include a discussion of new directions and initiatives for Reach Out and Read.
 

The Environmental Health SIG is looking forward to another excellent and informative meeting at the Pediatric Academic Societies' Annual Meeting in San Francisco. In keeping with the tradition of past Environmental Health SIG meetings, leading experts in children’s environmental health will give presentations on important and timely issues. Building on the success of last year’s meeting, we will again invite the APA Environmental Health Fellows to present their research works in progress. Further program details are forthcoming. Please see the PAS meeting website for an agenda as the meeting approaches. We hope to see you in San Francisco and sustain the momentum of increasing attendance annually at our sessions!
 

The session addresses AAP Guidelines on breastfeeding, current research findings and applications to pediatric practice.

The AAP Breastfeeding Policy Statement: The 2004 Version
Lawrence M. Gartner, University of Chicago, Chicago, IL

Breastfeeding: Does it Protect Against Obesity in Childhood?
Kathryn Dewey, University of California at Davis, Davis, CA

Contact for information:
Ardythe L. Morrow, Ph.D.
Cincinnati Children’s Hospital Medical Center
Phone: (513) 636-7626
Email: Ardythe.Morrow@chmcc.org
 

All PAS attendees are invited to an informational session on the ABP's Revised Subspecialty Training Requirements, which will apply to fellows beginning training July 1, 2004, and thereafter.

An overview of the changes will be provided by ABP staff. Ample time for questions will be allowed. The session will be useful for program directors, department chairs and trainees planning subspecialty careers.

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/.

Introduction
Elena Fuentes-Afflick, University of California, San Francisco, CA

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

Discussion

Pediatricians bring a unique mix of legitimacy, prestige and expertise to advocacy work. Many pediatricians know the benefits of advocacy to themselves, their patients and their communities but are unable to incorporate advocacy into busy clinical practices or academic career development. Of the 28 physicians funded by the OSI Soros Advocacy Fellowship, 10 are pediatricians. Workshop leaders will facilitate small group brainstorming sessions on advocacy skills such as communicating with media and policy makers, using research for advocacy and integrating practical advocacy experience into medical education. Participants will discuss areas of interest for advocacy and potential projects and community partners.

This workshop is intended for physicians at all stages in their careers with experience, insight or interest in advocacy and public policy.
 

Practicing evidence-based medicine (EBM) is an essential competency for lifelong learning and critical thinking among pediatric residents and practicing pediatricians. Yet, with multiple demands on curricular planning, programs have found it difficult to make time and space to incorporate this material. Drawing on our successful teaching of EBM to students, residents and faculty in a variety of settings and sharing what we have learned from the occasional misstep, we have developed an interactive workshop to simplify the development and evaluation process for others wishing to launch a similar curricular program. Throughout the workshop, participants will work in small groups to:

1. Identify practical ways of integrating key EBM competencies into a variety of educational venues,
2. Develop a focused curriculum to teach EBM to students or residents in a specific setting at their home institution and
3. Explore and discuss methods to evaluate this important competency.

The session will conclude with a participant-generated discussion of useful pearls for teaching and evaluating evidence-based medicine skills. Participants will receive sample curricular materials, examples of evaluation methods and a list of resources that can foster the teaching and practice of EBM.
 

The Minority Faculty Development workshop will engage junior, mid-career and senior faculty in the discussions of how to promote and actively support minority faculty in choosing academic careers and/or sustaining them through the academic promotion system. In this, the third year of this workshop, prominent faculty at institutions from around the country will respond to key questions on mentorship, success in obtaining research and program funding and maintaining focus on the commitment to medicine and community. The panelists will also emphasize leadership in academics, presented against the backdrop of the current AAMC statistics on minority faculty. As in the previous two years, this workshop will be highly interactive with participants actively engaged in discussions with the moderators and the panelists.
 

Most formal instruction in professionalism and communication occurs in the pre-clinical years of medical school, with an acknowledged need to fortify and apply these competencies during the clinical years. Role modeling provides a powerful way to teach professionalism, particularly when mentors identify specific learning goals and focus the learner's observations. This workshop will teach participants a process called the Students' Clinical Observations of Preceptors (SCOOP), which reverses the traditional direction of structured observations. With written cues to focus their observations, students observe their preceptors, who intentionally model professionalism and communication during clinical encounters. Students and preceptors discuss the observed patient/physician interaction during post-encounter sessions. Film clips, video presentation, group discussion and role play will be utilized to ensure participants gain the knowledge and skills necessary to perform SCOOPs.
 

The use of rubrics for performance-based (competency-based) assessment is widely used in the social sciences but is new to medical education. This workshop will present the concept of rubrics in performance-based assessment including assessment trends in medical education. Guidelines for the development of rubrics will be provided and discussed using medical examples developed by the program leaders. Participants will then work in small groups to develop a rubric assessing one of the ACGME core competencies. The products of this hands-on session will be shared and discussed with the rest of the participants. Participants will then use these rubric-based competency assessment tools to evaluate actual resident–patient encounters videotaped in a primary care setting.
 

The Continuity SIG is the academic home for pediatricians, both academic and community-based, who provide patient care and resident education in a longitudinal primary care setting. The Residency Review Committee/ACGME has mandated the requirement of a continuity experience for all pediatric residents since the 1970s. It has been a challenge for all of us to develop curricula, organize resident practices, obtain required data and yet continue to grow professionally as faculty. Over the past 13 years, the Continuity SIG, led by a task force, has addressed these challenges in SIG meetings and workshops. Our meetings are intended to facilitate the transfer of ideas among members and other individuals interested in optimizing the continuity experience for preceptors and residents alike.
 

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 use of psychopharmacologic agents in children and adolescents has increased significantly over the past decade. Clinicians and researchers 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. This is a continuation to the popular session held in May 2003 in Seattle.

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

Antidepressants
Susan Smiga, Langley Porter Child and Adolescent Psychiatric Center, University of California, San Francisco, CA

Stimulants
Glen R. Elliott, Langley Porter Child and Adolescent Psychiatric Center, University of California, San Francisco, CA

Mood Stabilizers
Glen R. Elliott, Langley Porter Child and Adolescent Psychiatric Center, University of California, San Francisco, CA

Antipsychotics
Chris K. Varley, University of Washington Medical Center, Children's Hospital and Regional Medical Center, Seattle, WA

Vaccines have an important function in preventing birth defects. The most obvious one is rubella vaccine and its application for the purpose of preventing congenital rubella syndrome (CRS) will be discussed. In addition, prospects of the development of other relevant vaccines will be presented. These will include: cytomegalovirus, parvovirus, herpes simplex and malaria. The first three, because they affect the fetus directly; the last, because of its adverse effect on pregnancy that results in small-for-gestational-age newborns.

Elimination of Rubella from the Americas by the Year 2010
Mirta Roses Periago, Director of PAHO, Panamerican Health Organization (PAHO), Washington, DC

Prevention of CRS by Universal Application of the Rubella Vaccine
Susan E. Reef, Center for Disease Control, Atlanta, GA