Pediatric Academic Societies and American Academy of Pediatrics Joint Meeting May 12-16, 2000 Hynes Convention Center, Boston

Expanded Schedules for: Friday Saturday Sunday Monday Schedule-at-a-Glance Affiliate Societies & Clubs TUESDAY, MAY 16

APA REGIONAL BREAKFASTS - Will be held at the Sheraton

TOPIC SYMPOSIA

¨Youth Violence: Causes and Prevention
Chair: Frederick P. Rivara, Harborview Injury Prevention and Research Center, University of Washington, Seattle

Over the last decade, much attention has been given to the "epidemic" of youth violence. The number of deaths to youth has brought this issue to the attention of the medical and public health community. For many years, however, juvenile delinquency and violence has been carefully studied by psychologists, sociologists, and criminologists.
The goal of this symposium is to bring together the health and criminal justice perspectives on the problem of youth violence and discuss the underlying causes of youth violence, reasons for the recent rise and decline in violence, the continuity of behavior from childhood through adolescence and into adulthood, and the effectiveness of interventions in early childhood. The panelists are members of the National Consortium on Violence Research.

Reasons for the Recent Rise and Decline in Violence
Alfred Blumstein, H.J. Heinz III School of Public Policy and Management, Carnegie Mellon University, Pittsburgh and National Consortium on Violence Research

Continuity of Anti-social and Violent Behavior
Daniel Nagin, H.J. Heinz III School of Public Policy and Management, Carnegie Mellon University, Pittsburgh and National Consortium on Violence Research

Early Childhood Interventions to Prevent Youth Violence
Richard E. Tremblay, University of Montreal, Quebec Canada and National Consortium on Violence Research

SUBSPECIALTIES/THEMES
(Original Science Abstract Programs)

• Adolescent Medicine III
• Breastfeeding
• Cardiology: Cardiac Electrophysiology from Mouse to Man
• Childhood Asthma
• Developmental Biology II
• Education: Resident
• Emergency Medicine: Assessment and Decision Making
• Health Services Potpourri
• Medical Informatics
• Neonatal Clinical Trials
• Neonatal Infectious Diseases

WORKSHOPS

TICKETS NECESSARY FOR THIS EVENT. NO FEE IS REQUIRED BUT PRE-ENROLLMENT IS ESSENTIAL TO ATTEND.

WS44 Changing The Culture Of Learning: Evidence-Based Medicine In A Residency Curriculum
Evidence-based medicine (EBM) requires teachers and learners alike to challenge the "we do it this way" approach to medical education. Just as EBM changes the way we view clinical data, we also must re-examine the methods of teaching and learning clinical care. As the volume of medical literature expands, identifying the important information and learning even a fraction of the vast field of pediatrics are daunting challenges. With restricted clinical hours and an emphasis on speed, today’s pediatric residents must be efficient learners. EBM provides a foundation to promote life-long learning while stressing efficiency and best clinical care. However, to practice evidence-based medicine requires a shift from passive, receptive learning to active, participatory learning.

Over the past two years, the department of pediatrics initiated and then revised a curriculum for teaching and learning EBM. Initial emphasis on introducing the concepts and methods of EBM evolved into incorporating EBM principles into morning report, lectures and journal club. This workshop will introduce the participant to this and demonstrate how EBM can be incorporated into morning report, daily rounds, noon lectures and journal club. The workshop will demonstrate mathematical tools developed to calculate absolute risk reduction, number needed to treat, confidence intervals, and cost savings. Emphasis will be placed on individual participation and mastering the concepts of forming a good question, searching for the best evidence and evaluating evidence for validity and importance. The workshop will use case scenarios and online searching to illustrate important EBM principles.

C. Foley, A. Zaritsky, D. Isaacman. Department of Pediatrics Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk

WS45 Early Brain Development: From Research To Practice
This workshop will concentrate on neuroscience and developmental research in early brain and child development and the ways in which research advances can be operationalized in the practice setting. Areas to be addressed include an overview of early brain neuroscience, the effects of stress on development; developmental practices, particularly for children with less than optimal developmental possibilities; and the need to be cautious in applying research findings to early brain and child development practices.

This program is supported by an educational grant from the Johnson & Johnson Pediatric Institute.

P. Dworkin, St. Francis Hospital & Medical Center, Department of Pediatrics, Hartford; M. Gunnar, University of Minnesota, Charles Nelson, University of Minnesota; J. Shonkoff, Brandeis University; Waltham

WS46 Ethics Education Regarding Children’s Health Care In A Managed Care Environment

Session has been cancelled

R. E. Kaplan and R. T. Sarkin, Department of Pediatrics, SUNY at Buffalo School of Medicine, Buffalo

WS47 Group A Strep: A Pathogen For Every Millennium
This program will present an overview of the important role that the group A streptococcus has played in children’s health in the past, present, and future. Newly identified diagnostic, treatment, and pathogenesis issues will be highlighted by a group of individuals who have been preeminent in this field.

M. T. Brady, The Ohio State University, Children’s Hospital, Columbus; M. A. Gerber, National Institute of Health, Bethesda; E. L. Kaplan, University of Minnesota Medical School, Department of Pediatrics, Minneapolis; S. T. Shulman, Northwestern University, Children’s Memorial Hospital, Division of Infectious Diseases, Chicago; D. L. Stevens, VA Medical Center, Boise; R. Tanz, Children’s Memorial Hospital, Chicago

WS48 Improving Health Care For America’s Children: The National Initiative For Children’s Healthcare Quality
Despite clinicians’ best intentions, health services delivered to children fall short of evidence-based recommendations, primarily due to inadequate systems of care. Several demonstration projects have identified promising approaches to revising office-based systems, allowing physicians to identify and track preventive care, monitor quality of care, and document improvement in process and outcome measures. To accelerate this improvement process, investigators from several academic centers have joined forces with the Institute for Healthcare Improvement and the American Academy of Pediatrics to form the National Initiative for Children’s Healthcare Quality (NICHQ). The goal of NICHQ is to advance the quality of children’s health care by raising the will to improve care, developing better strategies to accomplish change, and directly assisting practices in their improvement activities. The objectives of this workshop are to familiarize participants with the rationale, tools and strategies developed for this initiative, including dissemination methods for clinical practice improvement, and to discuss the barriers to improvement in ambulatory settings. We will present examples of successful projects that have improved systems for preventive services and asthma in over 100 primary care practices. We will also share current and future directions of this new initiative.

C. Homer, C. Haraden, Institute for Healthcare Improvement, Boston; J. Stout, University of Washington, Seattle; P. Margolis, C. Lannon, University of North Carolina, Chapel Hill; R. Wasserman, University of Vermont, Burlington

WS49 Is There A Doctor In The House?
Medical students and pediatric housestaff are constantly exposed to sophisticated technology, expensive equipment and full service hospitals. They are rarely trained to be the first responder to a medical emergency. However, sooner or later they may be called to the scene of an injury or illness without state of the art tools. Thus, it is imperative that students and housestaff understand first aid techniques/strategies. The purpose of this workshop is to develop a curriculum to train students and houseofficers to manage emergencies in "the field". Case discussions will include:
•The choking child in the toy store.
•The child ejected from the car in front of you.
•The three year old found at the bottom of the swim club pool.
•The toddler next door with a seizure.
•The child who fell off the swing at the playground.
•The nephew with anaphylaxis at the family picnic.

Workshop leaders and participants will use videotapes, slides and roundtable discussion to review priorities for management, activation of EMS, and simple ways to stabilize patients before arrival at a medical center. The approach to multiple victims will be discussed. Legal issues involving first aid will also be reviewed. The case scenarios and teaching tools presented can be used to develop a "mini course" on first aid for physicians in training.

S. Selbst, D. Baker, J. Callahan, P. Scribano, N. Tsarouhas, Divisions of Emergency Medicine,A.I. duPont Hospital for Children, Wilmington, Children’s Hospital at Yale New Haven, SUNY Health Sciences, Syracuse, Children’s Medical Center, Cooper Hospital, Camden

WS50 Newborn Screening: Controversies And Changes
Universal screening of newborn infants for treatable genetic and metabolic disorders is a cost effective program which has reduced pediatric morbidity and mortality substantially. This panel discussion will review the accomplishments of newborn screening. The issues of informed consent, privatization, and new technologies will be reviewed. Extension of newborn screening to disorders such as cystic fibrosis will be discussed.

This program will prepare the pediatrician to understand the change in newborn screening programs which will occur in the coming decade. As new disorders are added and technologies change, the pediatrician will be prepared to interpret results, participate as a member of the treatment team, and contribute to public debate of ethical issues.

E. McCabe, UCLA School of Medicine; Los Angeles; B. Therrell, University of Texas Health Sciences Center at San Antonio, San Antonio

WS51 Preparing Residents To Promote Sexual Health To Adolescents And Their Parents.
Adolescents have many choices regarding high-risk behaviors including when to initiate sexual intercourse. Physicians who are comfortable talking with adolescents and their parents about expected body changes, media impact, as well as the risks and benefits of sexual behaviors can best assist teens in making appropriate and life-saving decisions. The S.A.G.E. (Sexual Abstinence Guidance Education) Advice workshop models 5 to 8 minute age-appropriate interactions for physicians to use with their patients aged 9-17 years old and their parents. Participants will understand the barriers that providers might experience, including time constraints, discomfort with moral and ethical implications, accurate knowledge base and making discussions age appropriate. Skills covered include accurately counseling patients and their parents on changes to the youngster’s body during puberty; the focus in the media on sex and body image; the risks of pregnancy, sexually transmitted diseases and a broken heart. Also covered are assisting adolescents to reject sexual advances and realize that alcohol and drug use increases their vulnerability to sexual advances. Participants will experience a workshop they can take back to their residents including background materials, sexuality specific counseling techniques and video vignettes of typical visits with patients in early, mid and late adolescence. All the materials needed to provide the workshop at the participant’s home institution will be provided.

M. S. Barratt, G.B. Villarreal and A. L. Golden, Departments of Pediatrics, University of Texas-Houston; Houston and University of Texas Medical Branch, Galveston

WS52 The Approval Of Drugs For Use In Children: Special Populations, Research Needs, And Ethical Concerns
The Pediatric Provision of the Food and Drug Administration (FDA) Modernization Act of 1997 and the 1999 FDA regulations requiring manufacturers to assess the safety and effectiveness of new drugs in pediatric patients constitute a major milestone in solving the problems of children as "therapeutic orphans". Concomitantly, advances in molecular biology have resulted in an unprecedented surge in the number of new molecular entities and biologics available for testing in children. The explosion of enthusiasm generated for the inclusion of children in drug trials must be tempered by the recognition of the paucity of research in pediatric drug trial methodology.

Five topics important to all clinical drug trials in children will be addressed: 1) Development and validation of clinical endpoints, outcome measures, and surrogate endpoints, 2) Can adult drug efficacy studies be used to prove efficacy in children?, 3) The need for specific efficacy standards for special populations e.g. the preterm infant, 4) The ontogeny of drug metabolizing enzymes, 5) Current ethical standards for the use of placebo control groups.

J. Aranda, N. Frost, G. P. Giacoia, R. E. Kauffman, M. Lumkin, J. T. Wilson, Wayne State University, University of Wisconsin, National Institute of Health, University of Missouri, Food and Drug Administration, Louisiana State University

WS53 Time To Teach Something New—An Innovative Curriculum Designed To Teach Health Promotion Concepts To Residents
Bright Futures was developed to respond to emerging preventive and health promotion needs in pediatrics. With the increasing need to expand pediatric primary care interventions, to involve families in more of the process, and to identify community-based partners in care, it is recognized that these ideas need to be integrated into residency training. Hence, a national collaborative of pediatric educators and residency program directors has been working for a year to define "core" concepts – advocacy, communication, education, health, partnership, prevention/promotion, and time management as well as to create and implement curricular materials on health promotion.

The workshop will provide interactive experiences to explore these newly created curricular materials for residency training. Participants will have several opportunities to share in the testing and analysis of this unique curricular offering. Initially, the group will explore the curriculum in depth as learners by experiencing two teaching modules. This will be followed by the opportunity to rotate through stations where these learner-centered teaching materials, developed for use in continuity clinics, will be available for active dialogue with session authors. Finally, the group discussion will focus on effective methods of facilitating learning and implementing this curriculum into continuity clinics.

H.H. Bernstein, J. Hafler, and Bright Futures Health Promotion Work Group, Children’s Hospital and Harvard Medical School, Boston

WS54 What To Do Until The Child Psychiatrist Comes: A Primer For Pediatricians
With managed care restrictions and few child mental health resources in many communities, pediatricians face increased pressure to care for children with mild to moderate psychiatric problems. There is little teaching about the management of child mental health in most pediatric residencies. Many pediatricians are uncomfortable and ill-prepared to handle these clinical problems.

Attendees will be taught a framework to assess and manage common child mental health problems in the primary care setting. A paradigm for understanding common pediatric psychiatric conditions will be presented, including disorders of behavior (ADHD & others), mood (depression & bipolar disorders), anxiety (obsessive-compulsive disorder & others), and cognition (learning disorders & autism).

Using case vignettes, audience participation, and questions, the differential diagnosis, evaluation, examination, treatment options (including medications), methods to speed access to mental health services, and red flags for immediate psychiatric referral for these conditions will be discussed. The aim of the workshop will be to construct safe, effective treatment plans that may be instituted by pediatricians while waiting for psychiatric services to be arranged.

M. Potts and B. Sharp, Department of Pediatrics, University of Illinois College of Medicine, Rockford, R.P. Howston, Utah State University, Logan

SPECIAL INTEREST GROUPS

TICKETS NECESSARY FOR THIS EVENT. NO FEE IS REQUIRED BUT PRE-ENROLLMENT IS ESSENTIAL TO ATTEND.

SG25 Community-Based Physicians
Chair: Emanuel Doyne, MD

A new SIG has been formed as a result of a recent increase in the number of members who are community-based physicians. This will be the first meeting for the SIG and the agenda will include a discussion on organizational issues and an assessment of the needs of the group to develop the focus for future meetings. The SIG will provide the opportunity for community-based physician members to network with peers. Additional information about the agenda for the SIG will be available on the web site in early 2000.

SG26 Culture, Ethnicity & Health Care
Chair: Lee Pachter, Glenn Flores and John I. Takayama

This new SIG has been created to bring together 1) individuals who practice in culturally diverse settings, 2) clinical researchers interested in cultural influences in child health and development, and 3) faculty who are trying to incorporate cultural competency/cultural sensitivity training into med student, resident, fellow and faculty education. We see this SIG as providing a network for APA members who are interested in culturally sensitive/competent clinical service, research, and education. It is our hope that this first meeting will be used to set an agenda for the SIG in the coming months and years.

SG27 Managed Care
Chair: Alan Bernstein

Recognizing the special nature of this year’s combined pediatric meetings and the new millennium, the Special Interest Group on Managed Care will focus on new roles for pediatricians in the managed care environment. Speakers representing three types of medical organizations will discuss their individual roles as pediatricians  within their organization as well as projects they have developed. These organizations include an independent practice association (IPA) HMO, a pediatric practice management (PPM) company and pediatric provider network. Individuals interested in learning about these types of organizations should plan on attending this SIG.

SG28 School & Community Health
Chairs: Elizabeth Edgerton and Elisa Alter Zenni

For the Spring 2000 meeting, the School and Community Health SIG will be having a joint meeting with the School Health Section of the AAP Based on last year’s meeting, there was interest in the areas of education, teaching and research.  Thus we will begin the session with presentations on current topics in School and Community Health.  We will then break into smaller subgroups to discuss the areas of interest raised from last years meeting to begin setting an agenda for future meetings.  If you are interested in presenting at the Spring meeting please contact Beth Edgerton (co-chair) at 310-328-0720 or by email: eedgerto@ucla.edu.

SG29 Women in Medicine
Chair: Carol Berkowitz

The Women in Pediatrics SIG will focus on two areas. First the group will revisit the issue of mentoring, and the barriers that exist to establishment of mentoring relationships. The characteristics of successful mentor-mentee dyads will be discussed. MOMS (Mentors Over Miles) will again be explored.

Time management will also be discussed. Balancing professional and personal lives requires masterful time management skills, and we will discuss strategies for success.

POSTER SESSION V

HOT TOPICS

¨Neonatal Controversies
Chairs: William Keenan, St. Louis University, St. Louis and William Hay, University of Colorado School of Medicine, Denver

This session will review the biology and clinical experience related to corticosteroids and the lung, and considerable time will be available for audience discussion with the speakers and a panel. The goals of the program are to review: a) the rationale, physiologic basis and possible molecular mechanisms for corticosteroid use in lung maturation and prevention of CLD, b) doses of corticosteroids, plasma levels achieved, and effects on the adrenal, c) short and long term benefits of corticosteroid and observed adverse effects, and d) recommendations for corticosteroid use and possible future studies.

Glucocorticoids for Newborn Lung Disease - Rationale for Treatment and Mechanisms
Philip L. Ballard, University of Pennsylvania, Children’s Hospital of Philadelphia
Roberta A. Ballard, Children’s Hospital of Philadelphia

¨Underserved Children and their Families; Improvements or Impoverishment
Chairs: Benjamin Gitterman, Children’s National Medical Center, Washington and Peter Sherman, Montefiore Children's Hospital at Bronx

Over the past several years the United States has profoundly altered the manner in which health care and entitlement programs are delivered to our most vulnerable population; children growing up in poverty. This, along with an increased understanding of how the environment in which they live, impacts upon their health, has brought us to a cross roads in health care delivery as we enter the new millennium. What impact will these forces have upon this population? This panel will examine the question of whether we are entering an era of vast improvement or impoverishment in children’s health and welfare. Given the complexity and seriousness of these issues it is important that health care professionals have a strong voice in their outcome. This forum will lay the groundwork for planning future collaborative work in addressing the problems identified.

Serving the Underserved: Can Clinicians Meet the Needs?
Donna Bacchi, Texas Technical University, Lubbock

Status Report: The Health of Underserved Children in the New Millenium
Irwin Redlener, Montefiore Hospital and Medical Center, Bronx

The Impact of Environmental Health Issues on Underserved Children
Philip J. Landrigan, Mount Sinai School of Medicine, New York

Health of the Underserved in a Fiscally Conservative Political Environment
Richard Bucciarelli, University of Florida, Gainesville

¨What’s New in the Red Book?
Chair: Jon S. Abramson, Wake Forest University School of Medicine, Winston-Salem

This session will highlight substantial changes and additions in the diagnosis, treatment and prevention of infectious diseases that have been made in the Year 2000 Red Book. Some of the topics that will be discussed include meningococcal vaccine, ibuprofen and risk of systemic group A strep infection, herpes simplex disseminated and CNS disease, hepatitis A vaccine, lyme disease, mercury in vaccines, polio, rotavirus and pneumococcal disease.

Jon S. Abramson, Wake Forest University School of Medicine, Winston-Salem
Carol J. Baker, Baylor College of Medicine, Houston
Margaret Rennels, University of Maryland School of Medicine, Baltimore
Larry Pickering, Eastern Virginia Medical School, Norfolk

Supported by an educational grant from Merck Vaccine Division

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Last Modified: April 12, 2000