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Saturday, April 29
8:00am–11:00am
2120—Management of Childhood Hypertension:
Guidelines and Controversies
PAS/ASPN/IPHA Mini Course
Room 2003-2005, Moscone West
Chairs: Steven R. Daniels, University of Colorado, Denver, CO; and
Ronald J. Portman, University of Texas Medical School,
Houston, TX
Target Audience: General
pediatricians, emergency medicine physicians, hospitalists,
intensivists, nephrologists and cardiologists.
The 2004 NHLBI guidelines for the
evaluation and management of childhood hypertension answered
many questions about how to approach hypertensive children,
but left others unanswered. This mini course is designed to
address some of the more controversial aspects of managing
hypertensive children, with the hope of stimulating further
discussion about the optimal approach to these patients.
Practical approaches to clinical management will be
emphasized.
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Overview
Stephen R. Daniels, The Children's Hospital/University of Colorado,
Denver, CO
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Overview of Treatment Guidelines
from the 4th Report
Bonita E. Falkner, Thomas Jefferson University, Philadelphia, PA
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Management of Pre-hypertension:
Lifestyle Changes or Pharmacologic Treatment?
Shawna D. Nesbitt, University of Texas Southwestern Medical Center,
Dallas, TX
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Choice of Agent for Children with
Primary Hypertension
Joseph T. Flynn, Children's Hospital at Montefiore, Bronx, NY
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Treatment of Severe Hypertension
in Ambulatory and Inpatient Settings
Joshua Samuels, University of Texas, Houston, TX
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Treatment of Hypertension in
Special Populations
Donald L. Batisky, Columbus Children's Hospital/The Ohio State
University College of Medicine, Columbus, OH
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Discussion
Sponsored jointly by
the American Society of Pediatric Nephrology, the
International Pediatric Hypertension Association and the
Pediatric Academic Societies
8:00am–11:00am
2125—New Considerations for the Growth Rate
of the Preterm Infant: Too Fast or Not Fast Enough?—A Review
of the Evidence
PAS Mini Course
Room 3002-3008, Moscone West
Chairs: Frank R. Greer, University of Wisconsin, Madison, WI; and
William W. Hay, Jr., University of Colorado, Aurora, CO
Target Audience: Neonatologists,
hospitalists who take care of preterm infants, nutritionists
and general pediatricians.
Recent nutritional emphasis in
the NICU has been to achieve the normal intrauterine growth
rate with more aggressive nutritional support for the low
birth weight infant. In general, this has been difficult to
achieve, and new evidence from long-term follow up studies
shows that preterm infants are at an increased risk of
developing the metabolic syndrome including obesity, type 2
diabetes and cardiovascular disease. This implies that the
organs in the early life of the preterm infant may be
programmed adversely by nutritional therapy. This raises the
questions of how fast these infants should grow (including
catch up growth), the importance of the composition of this
growth and the urgency for defining the necessary balance
between growth of the brain and the rest of the body.
Ultimately, providers may want to revise the long-term and
short-term goals for feeding very low birth weight or
extremely low birth weight infants. This mini course will
present evidence to help answer these questions and provide
discussion about related practice recommendations.
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Overview
Frank R. Greer, University of Wisconsin, Madison, WI
William W. Hay, University of
Colorado Health Sciences Center, Aurora, CO
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Macronutrient Requirements for
Growth of Preterm Infants—Upper and Lower Limits
(Energy, Fat, CHO, Protein)
Scott C. Denne, Indiana University School of Medicine, James Whitcomb
Riley Hospital, Indianapolis, IN
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Aggressive Nutritional Support of
the Preterm Infant Revisited—Evidence for Efficacy and
Safety
Patti J. Thureen, University of Colorado Health Sciences Center,
Denver, CO
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Adverse Outcomes of Rapid Somatic
Growth and Alterations of Body Composition in the Low
Birth Weight Infant
Frank R. Greer, University of Wisconsin, Madison, WI
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Fatty Acids and Neuronal
Development
Susan E. Carlson, University of Kansas Medical Center, Kansas City, KS
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Iron and Development of the Brain
Michael K. Georgieff, University of Minnesota School of Medicine,
Minneapolis, MN
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Nutritional Influences on
Structural and Functional Maturation of the Developing
Brain During Extended Postnatal Period
Steve H. Zeisel, The University of North Carolina, Chapel Hill, NC
8:00am–11:00am
2157—I Can Do That! Preparing Residents To
Perform Minor Procedures
PAS Educational Workshop
Yerba Buena Gardens Salon 12, SF Marriott
Leader: Steve Selbst, Wilmington, DE; Co-leader: Joel Fein
Target Audience: Trainees,
fellows, junior faculty, mid-level faculty, senior faculty,
and community practitioners.
Minor procedures are important in
pediatric residency and office practice. Training and
performing certain procedures varies between residency
programs. With limited exposure, peds residents and
practitioners may avoid procedures or call consultants when
uncomfortable. The goal of this hands-on workshop is to teach
techniques and instructional methods for minor office
procedures. Workshop leaders will demonstrate skills and allow
practice of: 1) Wound repair- use glue, fast absorbing
sutures, staples 2) Remove foreign bodies from ears, nose,
eyes; reimplant avulsed teeth 3) Troubleshoot G- tube and
trach-tube complications 4) Extricate embedded fishhooks,
subungual hematomas, hair tourniquets 5) Master intraosseous
infusion, new needleless systems and IV safety devices 6)
Manage paraphimosis, zipper entrapment, rectal prolapse.
Participants will become adept at several procedures and be
able to teach them to others.
Objectives:
– Participants should improve
their own technical skills during the workshop.
– Participants will become aware of teaching modalities and
be able to conduct similar teaching sessions at their own
institutions.
Format: Lecture, demonstration,
hands-on practicing, and question-and-answer period.
11:45am–2:45pm
2430—Hospital Medicine
APA Special Interest Group
Room Pacific Suite A, SF Marriott
Chairs: Dan Rauch, daniel.rauch@med.nyu.edu;
and Jeffrey Sperring, jsperrin@iupui.edu.
The Hospital Medicine SIG
provides an opportunity for providers dedicated to the care of
hospitalized patients to discuss the latest updates in
research, education and program development. This year's
meeting promises to be another exciting and interactive
session. We will start as usual with updates from the previous
year in pediatric hospital medicine, including the Pediatric
Hospital Medicine 2005 Meeting in Denver and experiences from
New Orleans and Houston. Small group discussion groups will
focus on research (PRIS and how to develop research skills)
and education (follow-up from last year's meeting). We will be
joined by an APA Board member to discuss the role of
hospitalists in the APA. We will talk about future Pediatric
Hospital Medicine meetings and also have a poster session.
Tables will be available to share information about programs.
3:15pm–5:15pm
2725—Integrating Genetic Susceptibility and
Environmental Influences in Pediatric Research
PAS Topic Symposium
Room 2008, Moscone West
Chair: Bruce P. Lanphear, Cincinnati Children's Environmental Health
Center, Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH
Target Audience: A broad
pediatric audience with the goal of promoting
interdisciplinary understanding and greater integration of
genetic and environmental research.
Asthma, preterm birth, ADHD and
other prevalent pediatric conditions are widely recognized to
result from interactions of environmental influences and
genetic susceptibility. Tremendous progress has been made in
measuring both environmental and genetic risk factors.
Increasingly, researchers are moving beyond ecological methods
(e.g., questionnaires, air monitoring) to directly measure in
humans hundreds of environmental chemicals, from nicotine to
metals to DDT and phthalates. Similarly, unprecedented
innovation has led rapidly to high-throughput methods that
assess DNA variation across large cohorts. New
interdisciplinary collaborations that integrate state of the
art approaches to both environmental and genetic influences
should greatly improve our ability to predict and prevent
disease and disability. Such studies will be critical for
understanding mechanistic pathways, defining susceptible
subpopulations and developing effective interventions. This
session will provide an overview of gene–environment
research, describe recent advances in biomarkers of
environmental exposure and review new methods for measuring
genetic variability.
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Gene–Environment Interaction in
Common Pediatric Conditions: Conceptual Overview and
Recent Evidence
Robert S. Kahn, Cincinnati Children’s Hospital Medical Center,
University of Cincinnati College of Medicine, Cincinnati,
OH
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Advances in Biomarkers of
Environmental Exposure in Pediatric Research
Bruce P. Lanphear, Cincinnati Children's Environmental Health Center,
Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH
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Measuring Genetic Susceptibility
to the Environment: Study Designs and Genotyping Methods
Robert O. Wright, Harvard Children's Environmental Health Center,
Boston Children's Hospital and the Harvard School of
Public Health, Boston, MA
3:15pm–5:15pm
2735—Update on Therapeutic Monoclonal
Antibodies
PAS Topic Symposium
Room 3014, Moscone West
Chair: E. Richard Stiehm, UCLA School of Medicine, Los Angeles, CA
Target Audience: Immunologists,
rheumatologits, hematologists, oncologists and general
pediatricians.
The first talk will be an overview of the various therapeutic monoclonals and some general principles of their use. Then a discussion of Rituximab in refractory immune cytopenias and other disorders will be presented. Then the use of anti-tumor necrosis factor treatment including infliximab and adalimumab (Ramicade and Humira) for rheumatic diseases in children. The final talk will discuss the adverse effects of these therapies and some projections for the future. Discussion will be held after each presentation.
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Overview
E. Richard Stiehm, Mattel Children's Hospital at UCLA, Los Angeles, CA
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Use of Anti-CD20 (Rituximab) in
Hematology and Autoimmunity
James B. Bussel, New York Hospital, Cornell Medical Center, New York,
NY
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Use of Anti-TNF and Other
Cytokine Inhibitors in Rheumatology and Related Illnesses
Christy Irene Sandborg, Stanford University Medical Center, Stanford,
CA
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The Downside and Future of
Monoclonal Antibody Therapy
Susan Lee, University of California, San Diego, CA
3:15pm–5:15pm
2740—Use of Ultrasound in the Pediatric
Acute Care Setting
PAS Topic Symposium
Room 2006, Moscone West
Chairs: Dee Hodge III, St. Louis Children's Hospital and Washington
University School of Medicine, St. Louis, MO; and Mary A.
Hegenbarth, Children's Mercy Hospitals and Clinics, University
of Missouri-Kansas City School or Medicine, Kansas City, MO
Target Audience: Pediatric
emergency medicine physicians, academic generalists and
pediatric radiologists.
Ultrasonography is a noninvasive,
portable form of imaging with many applications in pediatric
and emergency practice. It is an established part of the
curriculum of the training of physicians in emergency medicine
residency programs and integrated in day-to-day practice.
However, the use of ultrasound performed by pediatricians and
pediatric emergency medicine physicians in settings such as
the emergency department is controversial and remains a hot
topic at many centers. The primary issues of controversy
include training, credentialing, billing, costs and
applications. This session will explore these issues through
an introduction by the moderator followed by three
presentations and audience discussion.
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An Introduction to Ultrasound in
the Pediatric Acute Care Setting
Dee Hodge, St. Louis Children's Hospital and Washington University
School of Medicine, St. Louis, MO
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Training
Ann Dietrich, Children's Hospital, Ohio State University, Columbus, OH
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Potential Applications of Bedside
Ultrasonography in the Pediatric Acute Care Setting
Jay K. Pershad, University of Tennessee Health Sciences Center &
LeBonheur Children's Medical Center, Memphis, TN
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Obtaining Privileges in Limited
Bedside Ultrasound
Mary A. Hegenbarth, Children's Mercy Hospitals and Clinics, University
of Missouri-Kansas City School of Medicine, Kansas City,
MO
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Discussion
Sunday, April 30
8:00am–10:00am
3100—Advances in Pathogenesis, Diagnosis
and Management of Kawasaki Disease
PAS/PIDS Topic Symposium
Room 3001, Moscone West
Chairs: Marian Melish, University of Hawaii, Kapiolani Children's
Hospital, Honolulu, HI; and Stanford T. Shulman, Children's
Memorial Hospital, Northwestern University, Feinberg School of
Medicine, Chicago, IL
Target Audience: Infectious
disease specialists, cardiologists, rheumatologists,
immunologists and primary care pediatricians.
Cloning the IgA antibody response
in acute Kawasaki Disease has led to exciting new insights
into the etiology and pathogenesis of this enigmatic illness.
The diagnosis of incomplete Kawasaki Disease remains a
significant clinical problem, and new guidelines have been
published to help the clinician in making this diagnosis.
Approximately 10–15% of children with acute Kawasaki Disease
do not respond to conventional intravenous gammaglobulin and
aspirin therapy, and new data regarding treatment with
steroids and Remicade are emerging. Knowledge regarding
optimal management of cardiac complications and long-term
outcome continues to evolve as patients diagnosed with
Kawasaki Disease in the 1970s and 1980s age.
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Overview
Marian E. Melish, University of Hawaii, Kapiolani Children's Hospital,
Honolulu, HI
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IgA Response in Acute Kawasaki
Disease Targets Inclusion Bodies in Acute Kawasaki Disease
Bronchial Epithelium
Anne H. Rowley, Northwestern University, Children's Memorial Hospital,
Chicago, IL
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Clinical Dilemma of Diagnosing
Incomplete Kawasaki Disease
Jane C. Burns, University of California, San Diego, CA
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Treatment of Refractory Kawasaki
Disease
Stanford T. Shulman, Children's Memorial Hospital, Northwestern
University, Feinberg School of Medicine, Chicago, IL
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Management of Cardiac
Complications and Long-Term Outcome
Jane W. Newburger, Harvard University, Children’s Hospital of Boston,
Boston, MA
Sponsored jointly by
the Pediatric Infectious Diseases Society and the Pediatric
Academic Societies
2:00pm–5:00pm
3761—Enhancing Education with Medical
Journals
PAS Educational Workshop
Willow, SF Marriott
Leader: Graham McMahon, Boston, MA; Co-leader: Julie Ingelfinger
Target Audience: Fellows, junior
faculty, mid-level faculty, senior faculty, and community
practitioners.
This workshop will explore some
novel approaches to learning using medical journals. We will
explore some innovative uses of primary data to address core
competencies together. We will examine the use of primary data
for teaching statistics in real time, compare original data to
textbook and database material and demonstrate how original
articles can be used to teach study design and stimulate new
research questions. We will present an exercise using case
material for interactive discussions of management and will
show how educators can harness the unique power of audiovisual
material to optimize learning. We will participate in an
exercise to illustrate the peer-review process, illustrate a
series of resources that are available online and share our
experience using medical essays to generate reflection and
introspection in small groups.
Objectives:
– Learn novel approaches to
teaching with medical journals.
– Teaching core competencies using medical journals.
Format: Presentation, discussion,
and interactive exercises.
2:00pm–5:00pm
3762—Family-Centered Rounds: Overcoming
Barriers To Get Back to the Bedside
PAS Educational Workshop
Yerba Buena Gardens Salon 15, SF Marriott
Leader: William Brinkman, Cincinnati, OH; Co-leaders: Mike Vossmeyer
and Stephen Muething
Target Audience: Trainees,
fellows and junior, mid-level and senior faculty.
At academic medical centers,
attending physician rounds (patient presentations and
discussions) commonly occur in a conference room. A recent AAP
policy statement entitled, "Family-Centered Care and the
Pediatrician's Role," calls for rounds of all
hospitalized patients to occur at the bedside in the presence
of the patient and family. 'Family-Centered Rounds' are meant
to facilitate information sharing and encourage active family
involvement in decision-making. Drawing on their own
experience as well as the Cincinnati Children's Hospital
experience during the Robert Wood Johnson Pursuing Perfection
initiative, workshop participants will develop practical
strategies to overcome barriers to teaching and learning while
delivering family-centered care at the bedside of the
hospitalized patient.
Objectives:
– Participants will understand
the basic principles of family-centered care in the inpatient
setting.
– Participants will develop practical strategies to overcome
barriers to teaching and learning while delivering
family-centered care at the bedside of the hospitalized
patient.
Format: Small group discussion,
didactic presentation, videotaped rounding vignettes, question
and answer, and small group problem solving sessions.
2:00pm–5:00pm
3765—High-Fidelity Pediatric Simulation:
Setting a National Human Performance and Patient Safety
Research and Training Agenda
PAS Educational Workshop
Yerba Buena Gardens Salon 2, SF Marriott
Leader: Louis Halamek, Palo Alto, CA; Co-leaders: Mary Patterson,
Joseph Lopreiato
Target Audience: Trainees,
fellows, junior faculty, and mid-level faculty, senior
faculty.
The goal of this workshop is to
bring together those who are interested in using high fidelity
multidisciplinary pediatric simulation to improve the training
of healthcare professionals and in establishing the evidence
base to support the use of this methodology. This will be an
interactive panel-led session coupled with video presentations
and small breakout group discussions that will allow
participants to identify the elements of a national
simulation-based research and training agenda and a strategy
for implementation of such a plan. Participants will learn
what they can do on the local and national levels to validate
and disseminate its use.
Objectives:
– Define high fidelity
simulation.
– Describe the unique challenges of pediatric simulation.
– Understand why a national research and training agenda is
indicated.
– Develop the major elements of this agenda and develop an
action plan.
Format: I plan to use the three
panelists to lead a facilitated, interactive discussion with
the audience in order to accomplish the workshop objectives
(setting a national agenda and creating an action plan).
2:00pm–5:00pm
3774—What We Have Is Failure To
Communicate—Teaching Residents the Art of Effective
Communication
PAS Educational Workshop
Yerba Buena Gardens Salon 13, SF Marriott
Leader: Steven Selbst, Wilmington, DE; Co-leader: Lindsey Lane
Target Audience: Trainees,
fellows, junior faculty, mid-level faculty, senior faculty,
and community practitioners.
Poor communication leads to
errors/lawsuits. ACGME requires residents demonstrate
competence in communication. This workshop proposes a dynamic
curriculum to teach residents effective communication.
Workshop leaders discuss (1) Listening skills to address
parental concerns, (2) difficult patients, (3) delivering bad
news, (4) informed consent, (5) feedback to residents and
students, (6) essential info at morning rounds, signout, and
(7) professionalism with nursing staff, consultants. Case
scenarios, videotape, role-playing demonstrate successful
communication techniques, underscore pitfalls.
Objectives:
– Understand how to effectively
deliver bad news to families.
– Know how to obtain informed consent from parents.
– Be able to give effective feedback to students and
residents.
– Work well with nurses and staff.
Format: Videotape, discussion,
and question-and-answer period.
Monday, May 1
8:00am–10:00am
4110—Pediatric Fluids and Hyponatremia: Are
We Giving Too Much Water?
PAS/ASPN/LWPES Topic Symposium
Room 3007-3011, Moscone West
Chairs: John W. Foreman, Duke University Medical Center, Durham, NC;
and D. Michael Foulds, University of Texas Health Science
Center at San Antonio, San Antonio, TX
Target Audience: Nephrologists,
general pediatricians, emergency room doctors, intensivists,
hospitalists, endocrinologists and anyone who administers IV
maintenance fluids.
In the 1950s, Holiday and Segar
devised formulae for calculating intravenous maintenance
fluids for infants and children who were unable to drink.
These formulae have been taught and used now for over 40 years
and have generally stood the test of time. However, several
recent investigators have challenged these formulae and argued
that they put children at risk of hyponatremia. Since Holiday
and Segar devised these formulae, new information has arisen,
such as the concept of non-osmotic stimulation of ADH release
in sick children and our ability to measure ADH levels in
plasma on a routine basis. Arieff and Ayus were the first to
point out that children and women are at particular risk for
developing hyponatremic encephalopathy. Moritz and Ayus have
subsequently argued that hypotonic parenteral fluid should not
be used unless there are ongoing free water losses or
hypernatremia. In addition to this new clinical data,
Verkman’s group has exciting data identifying molecular
mechanisms of cerebral edema, including after water
intoxication. Dr. Arieff will review who is at risk and why.
Dr. Verkman’s group has developed data regarding mechanisms
of cerebral edema in experimental animals. Dr. Moritz will
describe the new concepts of maintenance fluids. Dr. Friedman
will defend the current practice. At the end there will be
time for an exchange between the speakers and the audience on
the right fluid to use in today’s children.
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Hyponatremic Encephalopathy:
Special Risk Factors for Children and Women
Allen I. Arieff, University of California San Francisco, San Francisco,
CA
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Aquaporin 4 and Cerebral Edema
Alan S. Verkman, University of California San Francisco, San Francisco,
CA
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0.9% Sodium Chloride: The New
Approach to Maintenance Fluids in Pediatrics
Michael L. Moritz, Children's Hospital of Pittsburgh, Pittsburgh, PA
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Maintenance Therapy: Tried and
True
Aaron L. Friedman, Brown Medical School, Hasbro Children's Hospital,
Providence, RI
Sponsored jointly by
the AAP Section on Nephrology, the American Society of
Pediatric Nephrology, the Lawson Wilkins Pediatric Endocrine
Society and the Pediatric Academic Societies
8:00am–10:00am
4128—Hospital Medicine
PAS Platform Session
Room 2009-2011, Moscone West
Chairs: Daniel Rauch and John D. Tobin
9:00am–12:00pm
4220—Competency-Based Evaluation of EBM
Skills in Pediatric Residency and Fellowship Programs
PAS Educational Workshop
Yerba Buena Gardens Salon 6, SF Marriott
Leader: Hans Kersten, Philadelphia, PA; Co-leaders: E. Douglas
Thompson, John Frohna, Robert McGregor, Tahniat Syed, Erin
Giudice, Susan Guralnick, Nancy Spector
Target Audience: Trainees,
fellows, junior faculty, mid-level faculty, and senior
faculty.
This interactive workshop will
provide a framework for evaluation of EBM skills throughout
pediatric educational programs and three different residency
programs' approach to the development of an evaluation system
for their EBM curricula. Participants will use three validated
tools that measure EBM knowledge and EBM skills (e.g.,
formulating a question and searching and critiquing an
article) by rotating through 30-minute small group sessions.
Objectives:
– Participants will learn an
EBM evaluation framework.
– Participants will use validated EBM evaluation tools.
– Participants will develop EBM evaluation implementation
strategy for their EBM curricula.
Format: Small group discussion,
videotape, problem solving, and hands-on experience with
tools.
Designed to meet elements of the
core curriculum for pediatric fellowship subspecialty
training.
3:00pm–5:00pm
4662—Standardizing Prescription of Fluids
and Medications in the NICU: Principles, Practical Tools and
Applications
PAS Educational Workshop
Yerba Buena Gardens Salon 3, SF Marriott
Leader: Joaquim Pinheiro, Albany, NY; Co-leaders: Amy Mitchell, Vinay
Vaidya
Target Audience: Trainees,
fellows, junior faculty, mid-level faculty, senior faculty,
community practitioners, pharmacists, and nurses.
Emphasis on patient safety has
led some NICUs to implement standardized dosing methods,
replacing customized fluid and medication dosing in neonates.
JCAHO has mandated a transition from
"rule-of-6"-based prescription to standardized
concentrations. Without national standards, NICU practitioners
are struggling to comply with the mandate.
Workshop goals are to review
principles of error prevention in NICU, focusing on
standardized methods of prescription and administration. The
leaders will share their experience with paper, electronic and
logistic systems for standardizing fluid, medication and TPN
prescription.
Objectives:
– Participants will learn a
variety of practices and tools used to implement standardized
prescription in NICUs.
– Participants will have practiced multidisciplinary
development of solutions to standardized prescription relevant
to their institutions.
– Participants will learn about computerized methods for
rapid implementation of standardized infusions.
Format: Short presentations,
question-and-answer periods, and problem solving in groups.
5:15pm–6:45pm
Poster Session III
PAS Poster Session
Levels 1 and 2, Moscone West
Posters Available for Viewing:
12:00pm–6:45pm
Author Attendance: 5:15pm–6:45pm
Level 1:
– Critical Care
– Gastroenterology
– Genetics
– Neonatal Epidemiology and Follow Up
– Neonatal Pulmonology
– Neonatology
– Nephrology
– Pulmonology
Level 2:
– Developmental–Behavioral Pediatrics
– Emergency Medicine
– General Pediatrics
– Medical Education
Includes:
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SPR Student Research Award: Metal
Contamination of Blood Bank Blood
Allison Blatz, Case Western Reserve University, Rainbow Babies &
Children's Hospital, Cleveland, OH
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SPR House Officer Research Award:
Pathogenesis of Measles Virus Infection in Simian
Immunodeficiency Virus-Infected, Measles Virus-Vaccinated
Rhesus Monkeys
Sallie R Permar, Children's Hospital and Boston Medical Center, Boston,
MA
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