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.
    

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

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.

The Importance of Conflicts of Interest to Clinical Researchers
Drummond Rennie, University of California, San Francisco, CA

Discussion
 

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

Tom Tonniges will provide some background on the evolution of the relationship between the Department of Community Pediatrics at the American Academy of Pediatrics and the ABCD Institute of Northwestern University. He will give a brief introductory presentation on ABCD Principles and its applications to the health care arena. The ABCD Model essentially promotes the concept of recognizing and identifying the inherent assets in each community, in the form of community-based organizations (CBOs) and the need to integrate those assets into community improvement efforts.

Andrew Gold will discuss his involvement with the Community Child Health Partnership (CCHP) Collaboratives and his perspective on the applications of ABCD to achieving child health outcomes.

Richard Pan will provide insight into how he used ABCD principles as the basis for the advocacy program he developed (Community Partnerships with Pediatricians for Healthy Children) for pediatric residents at University of California, Davis Medical School. Specifically, he will discuss the merits of using the ABCD as the basis for fulfilling the ACGME Requirements in Community Experiences for pediatric residents.

Tom Tonniges will then ask participants to break into small groups and complete the following exercises:

1. List the associations that you belong to (not as a part of your job).
2. List the professional associations you belong to.
3. Describe one way you could use your association relationship to address one child health issue (ex. Obesity).

This workshop will address the following questions:

1. Do you think ABCD methodologies provide a useful framework for:
   1. pediatric resident community projects?
   2. Practicing pediatricians?
2. How can ABCD Concepts be used to promote the practice of Community Pediatrics?
3. How does the ABCD Concept help to identify and establish effective partnerships with Community Based Organizations(CBOs)?

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.
 

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
 

A report from the Institute of Medicine's Committee on Clinical Research Involving Children. Richard Behrman, chair of the IOM committee, will present the findings of this IOM report.

In July of 2003, the FDA approved the use of growth hormone for the long-term treatment of children with idiopathic short stature, also called non-growth hormone deficient short stature. This new indication restricts therapy to children who are at least 2.25 SD below the mean for age and sex, or the shortest 1.2% of children. This corresponds to adult heights of less than 5' 3" in men and 4' 11" in women. Data demonstrating the efficacy and safety of GH therapy for children with idiopathic short stature will be reviewed. Although "idiopathic" short stature has often been held synonymous with "normal" short stature, cases in which the underlying molecular defect(s) have recently been elucidated will be presented. With the new FDA ruling on GH, the challenges of deciding when and how to prescribe GH have become even greater. This symposium will address the potential impact of this ruling at a societal and individual level. We will discuss the dilemmas physicians face in using growth hormone and how the ethics of growth hormone therapy apply to our general practice of medicine.

Long at Last: 13 Years of Data on GH Treatment in Idiopathic Short Stature
Charmian Quigley, Eli Lilly & Company, Indianapolis, IN

Is There a Biological Rationale for Treatment of Idiopathic Short Stature?
Ron G. Rosenfeld, Lucile Packard Foundation For Children's Health, Palo Alto, CA

Everyday Ethical Dilemmas of Treating Short Stature: The Bread, Butter and Bane of Pediatric Endocrinology
David B. Allen, University of Wisconsin Hospital, Madison, WI

Ethical and Policy Issues in Access to HGH
Norman C. Fost, University of Wisconsin Medical School, Madison, WI

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

Prospects for a Vaccine Against Cytomegalovirus
Stanley A. Plotkin, Aventis Pasteur and the University of Pennsylvania, Doylestown, PA

Prospects for a Vaccine Against Herpes Simplex
Richard J. Whitley, University of Alabama at Birmingham, Children's Hospital, Birmingham, AL

Prospects for a Vaccine Against Parvovirus B-19
Neal S. Young, National Institutes of Health, Bethesda, MD

Prospects for a Vaccine Against Malaria
N. Regina Rabinovich, Bill & Melinda Gates Foundation, Seattle, WA

Discussion

Since 1993, the Family Advocacy Program at Boston Medical Center has provided legal assistance to low-income patient-families whose children's health is compromised by lack of access to basic needs such as housing, public benefits, family stability/safety, education services and health insurance. FAP also trains clinical staff and residents. We have helped start up dozens of medical–legal collaborations nationally in the past several years. The goal of this workshop is to teach participants how to initiate and/or support a similar effort in their own clinical setting. Participants will learn basic legal advocacy through tools and curriculum developed by FAP and participate in facilitated small group discussion on concrete strategies for implementing a collaboration, including: identifying stakeholders, navigating confidentiality and ethics, demystifying legal services for the health care provider, linking individual advocacy to systemic change and incorporating training for providers and residents. The workshop will utilize case examples and advocacy action plans to bring to life the integration of advocacy in the clinical setting.
 

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, 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

Patient safety has become a national focus and initiative from government to regulatory/accreditation bodies to institutions. A substantial proportion of the initial efforts are on understanding epidemiology and risk factors and developing organizational models and tools for identifying concerns and fostering safety improvements. Research to date has identified that children do experience medical errors, these events have unique risk factors and while some types of errors are comparable to adult populations, other types are unique to children. In this session we will examine several key elements in efforts to address safety now and in the future: how to tackle patient safety in real time and create cultural change, role of information technology, how to create and promote metrics to measure performance and sources of funding for ongoing work.

In specific, we will examine one institution’s successes and lessons learned from implementing a combined ‘top down’ and ‘bottom up’ system of teams to address safety. We will examine the history of information technology and hear work evaluating the use of information technology in the primary care setting. Next we will examine national efforts to create pediatric-specific measures of quality of care and how these measures are being promoted and implemented nationwide. Last we will hear an overview of research findings to date from the Agency for Healthcare Research and Quality’s $165 million investment in patient safety research and explore new and ongoing funding sources for this research.

The Josie King Patient Safety Program at Johns Hopkins University
Marlene R. Miller, Johns Hopkins University, Baltimore, MD

Role of IT in Patient Safety
Kevin B. Johnson, Vanderbilt University Medical Center, Nashville, TN

PediQS and National Efforts To Promote Measurement of Children’s Healthcare
Stephen Lawless, Nemours Foundation, Wilmington, DE

AHRQ’s Patient Safety Initiative and Findings to Date
Dan Stryer, Agency for Healthcare Research and Quality, Rockville, MD

Discussion
 

Every day, nearly 5,000 children in the United States smoke their first cigarette. Approximately 60% of smokers start by the age of 13 and fully 90% before the age of 20. Publicly the tobacco companies have always maintained that they do not target youth, but internal documents reveal that they set out to aggressively advertise to kids.

This session will describe litigation as a public health strategy for fighting Big Tobacco in the United States and provide examples of the techniques used to attract children to smoking. Global trends and counter-advertising measures will be discussed.

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

Fighting Big Tobacco in the United States: Litigation as a Public Health Strategy
Madelyn J. Chaber, Law Offices of Wartnick, Chaber, Harowitz & Tigerman, San Francisco, CA

Goliath Fleeing from David: The Global March of the Marlboro Man
Ronald M. Davis, Henry Ford Health System, Detroit, MI

Discussion
 

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

Lead Poisoning
Kevin Osterhoudt, The Children's Hospital of Philadelphia, Philadelphia, PA