Patient safety and quality of care continue to loom large in our patients’ and public leaders’ views about health care. Despite widespread interest in providing safe and excellent care by clinicians, many are uncertain how to respond. This course will provide both a framework for thinking about safety and quality and up-to-date information about major initiatives affecting pediatric care. Course content will specifically include updates on government initiatives about patient safety, a national project to reduce errors in hospitals, an improvement project building on comparative data from neonatal intensive care units, and the current status of efforts at quality measurement for health care accountability.

Our group has planned a broad-based and provocative set of case presentations for the morning of 4/28/01, starting at 8:30 am. The format for each speaker’s 40 - minute presentation will be 10 minutes for case description, 20 minutes for background information, and 10 minutes for questioning of each speaker.

This SIG supports primary care programs to promote reading aloud and the developmental aspects of literacy, based on the Reach Out and Read (ROR) model. The three-hour meeting will focus on sharing innovations in physician and volunteer training, program organization, fund-raising, and regionalization. Time will be devoted to in-depth discussions of multi-cultural and multi-lingual aspects of literacy intervention, advocacy around literacy, and a review of the SIG's multi-site research project, the Before-and-After-Books-and-Reading (BABAR) study. A separate training session will be offered for programs just getting started. The SIG is coordinated by Perri Klass (BU School of Medicine and Reach Out and Read, Boston) and Robert Needlman (CWRU School of Medicine and DrSpock.com).

We have a busy agenda planned that will focus on the following areas and updates.

1. Pediatric training handbook for Family Practice Residents.

* SIG members have established that there is no widely used resource for the Pediatric component of Family Practice Residency. A handbook developed by the York Hospital Family Practice Residency (the Reilly Handbook) was reviewed. SIG members agreed that this resource would provide a good starting point and several members agreed to work on revisions. Efforts to develop a CD ROM format were also initiated. Our goal is to develop a resource that will have broad based appeal to Family Practice Residency programs across the country.

*Competency based questionnaire

*As an adjunct to the handbook, members felt it would helpful to have coordinated questions to help focus pediatric learning. Several members agreed to contribute questions.

How is pediatric training addressed in Family Practice Residencies?

This question was last addressed in a 1992 article by published by Baldour and Luckman. SIG members felt it would be useful to conduct a similar survey of current Family Practice programs.

*Annual review of Pediatrics Guidelines for Family Practice residents

*New members in particular have found this discussion useful in terms of providing a foundation for pediatric learning objectives.

The Serving the Underserved (STUS) SIG meeting will build on the momentum of last year's meeting and will include:

Research/program evaluation in the STUS arena. We will highlight several successful STUS community-based projects with a special emphasis on successful program evaluation. Presenters will highlight lessons learned and academic areas to be advanced in this area. Discussants will review related resources including the AAP Center for Child Health Research and the PROS Network.

STUS curriculum development. There has been a lot of progress with the STUS SIG web-based curriculum over the last year. We will discuss this project and other curriculum development advances in the STUS field.

Community and the underserved. We will follow up last year's program with a discussion of the progress being made in improving care and education in the community. Discussants from the Dyson Initiative and CATCH will be included.

Legislative update. We will review the status of key federal and state legislative efforts regarding health services for underserved pediatric/adolescent populations.

Come and join us as we work to improve health services and STUS related teaching for underserved pediatric and adolescent populations.

This 3-hour mini-course will update primary and subspecialty care providers on the advances in our understanding of von Willebrand Disease, the most common inherited bleeding disorder. The minicourse will provide an overview of both basic and clinical aspects of this disease, including discussion of the biochemistry and genetics of von Willebrand Factor, dilemmas in the diagnosis of this highly variable disease, and advances in the management of children and adolescents with von Willebrand Disease. Congenital platelet function abnormalities, which share clinical similarities with von Willebrand Disease, will also be discussed.

Clinician educators are those physicians whose career activities combine patient care and the teaching and supervision of medical students and residents, and whose scholarly activities promote excellence in medical education.

With this workshop, it is expected that participants will:

1. have a better understanding of the motivations and works responsibilities of clinician-educators, and will be able to compare the motives for their careers with those of other clinician-educators.

2. learn how a mentoring program can help the clinician-educator plan and develop his/her career.

3. have a better understanding of specific faculty development activities (workshops, microteaching, teaching evaluations, teaching consultations) and the evidence for the effectiveness of these activities.

4. have a better understanding of the evaluation of teachers and how these evaluations are used for faculty development, promotion and compensation, and will learn guidelines for developing an effective Teaching Dossier which can be the key to successful promotion.

Robert I. Hilliard, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Karen Leslie, Division of Adolescent Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Ann Jefferies, Division of Neonatology, Mount Sinai Hospital, Toronto, ON, Canada

Approaches to the diagnosis, prevention, and treatment of chronic conditions in childhood and adolescence have changed greatly with greater survival of most children, even with severe conditions. Thus, for most children, new issues include preparation for adulthood rather than expectation of early death. Community pediatricians have increasing numbers of children with chronic conditions in their practices and thereby face new challenges in the care of these children and their families. Advances in molecular biology and genetics will lead to more effective ways to identify and treat many conditions. At the same time, children and adolescents face a great rise in new epidemics of chronic conditions, with marked increases in obesity, asthma, Type 2 diabetes, mental health conditions (especially ADHD and depression). This session will examine new advances in the biology of chronic conditions, important changes in epidemiology, consideration of important outcomes for children and adolescents with chronic conditions, and new efforts to improve their pediatric care.

The U.S. is experiencing an epidemic of pediatric obesity. However, many primary care providers report that obesity is one of the most frustrating and difficult problems in their practices. In this workshop, we will provide practical strategies for evaluating and treating obese children in primary care. To maximize learning and relevance the session will be split. During the first third of the session, we will present expert committee recommendations for evaluation and behavioral treatment strategies. We will address skills for identification of obesity, screening for both rare endogenous causes of obesity and more common obesity-associated conditions or risk factors, assessment of emotional and psychosocial states, eating and activity assessment, and indications for consultation with an obesity specialist. For treatment, we will address the most successful strategies for diet and physical activity counseling, changing the household environment, self- monitoring, goal setting and contracting, parenting skills training, maintenance and relapse prevention, and the potential role of drug therapies. The second two-thirds of the session will consist of case discussions and group problem solving. Cases will be provided but attendees will be asked to bring their own cases as well. Several additional experienced obesity specialists will also be present to participate in the case discussions.

T. N. Robinson and S. E. Barlow, Department of Pediatrics, Stanford University, Palo Alto, CA & Department of Pediatrics, St. Louis University School of Medicine, St. Louis, MO

The repercussions of violence affect pediatric patients and their families every day. Many residency training programs struggle with how to address this new epidemic. This workshop presents a model of a creative, comprehensive violence assessment and prevention curriculum, encouraging medical educators to explore new teaching methods. We hope to stimulate a lively discussion of educational strategies: didactic presentations, multimedia demonstrations, standardized patient interviews, community resource displays and evaluation methods. Attendees will be trained in case-based role-play scenarios to facilitate learners' communication skills within the patient-physician encounter. The workshop will offer specific didactic outlines and examples of pertinent videotapes and community resource displays as springboards for conversation regarding improvement of resident violence education. The model suggests one evaluation method that reinforces the newly acquired competencies via the creation of learner contracts. Small group discussions will be used to generate new ideas in violence-related curriculum development and evaluation.

Shannon Phillips, Jill Mazurek, Mary Ciccarelli, Marilyn Bull, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN

This 3-hour minicourse will help the primary and subspecialty care providers understand better the changing field of diabetes mellitus: its pathophysiology, epidemiology, and advances in management. The availability of new treatments and devices for the care of patients with Type I diabetes has changed dramatically over the past decade. The rising prevalence of Type 2 diabetes, closely linked to the obesity epidemic, is bringing a formerly "adult" disease into the pediatricians' offices. This minicourse will provide an overview of four pertinent areas, by speakers who are leaders in the field.

Children are a vulnerable class of research subjects because they lack the developmental, intellectual and legal capacity to provide informed consent. Research information is given to parents who are asked to make a decision regarding participation based on their perception of what is in the best interest of their child and society at large. We propose to conduct a workshop for new investigators that will accomplish the following goals: (1) Workshop participants will be able to present the essential elements of informed consent to parents in both written and verbal format. (2) Participants will be able to discuss research involvement with children in a manner appropriate for the child's age, maturity and psychological state. (3) Participants will be able to evaluate the appropriateness of involving adolescents in research with/without parental permission. These goals will be accomplished using a combination of didactic and interactive methods. Case studies consisting of background information, case vignettes, discussion questions and references will be used to explore ethical principles and federal regulations guiding the consent process. Sample consent documents, and videotapes of investigators interacting with parents and potential subjects will be reviewed and critiqued by workshop participants for content, style and effectiveness of communication. The workshop evaluation will consist of pre and post-test questions designed to allow the participant to directly assess their knowledge and skill acquisition.

K. L. Meert, G. Deisinger and E. R. Stinson, Department of Pediatrics, and Office of Research and Graduate Studies, Wayne State University, Detroit, MI.

The School and Community Health Special Interest Group will be held on Sunday April 29, 2001 from 2:00 to 5:00 p.m. We will have presentations and discussions on various topics in this area. We will also devote time to planning a SIG long-term project that was discussed at last year's meeting, such as conducting a needs assessment of pediatricians regarding training in school health or creating a resource manual of programs. This promises to be an interesting, productive and interactive session and we welcome all meeting attendees. If you have any questions or suggestions for specific topics, please contact either Elisa Zenni at (904)244-7260 or elisa.zenni@jax.ufl.edu or Beth Edgerton at (202) 884-5000 or eedgerto@rand.org. We look forward to seeing you in Baltimore!

Meta-analyses are becoming increasingly popular as a way to summarize knowledge about clinical questions. Meta-analyses have an air of objectivity; but can their results be trusted at face value?

The goal of this workshop is to help clinicians interpret the findings of published meta-analyses. We will review the purpose of meta-analysis, and emphasize the importance of determining sources of heterogeneity among studies. We will discuss concepts such as publication bias and sensitivity analysis. The workshop will provide an overview of how meta-analyses are performed, focusing at each step on the elements that distinguish a good meta-analysis. The statistical methodology will be reviewed purely on a conceptual level. We will interpret funnel plots, and discuss the meaning of a random effects and fixed effects model. Workshop participants will be given examples of meta-analyses to critique, and will work through sample data analyses that illustrate key concepts. By the end, participants should be comfortable deciding when a meta-analysis is helpful, and when it may lead to false conclusions.

Yvonne W. Wu and Tom B. Newman, University of California, San Francisco, San Francisco, CA

In the late 1990s, there has been an epidemic of schoolyard shootings. Yet data seem to show that the rate of juvenile violence is decreasing. Why the discrepancy? Can adolescents who are prone to commit violent crimes be identified ahead of time? Why do they commit such crimes. Are we "teaching" our children how to kill? What role do the media play in these crimes?

This workshop will employ an informal approach to answering at least some of these questions, using data, case vignettes, role playing and video clips.

Dr. Strasburger is a nationally known expert on children, adolescents, and the media. Lt. Col. Dave Grossman is an Army Ranger, a West Point Psychology Professor, and a Professor of Military Science who wrote the Pulitzer-Prize-nominated book, On Killing, and the recent book, Stop Teaching Our Kids to Kill. He was a consultant after the Jonesboro, AR, Paducah, KY, Springfield, OR, and Littleton, CO school shooting incidents and testified in the trial of Timothy McVeigh.

Vic Strasburger, M.D., Professor of Pediatrics, Univ. of New Mexico School of Medicine and Lt. Col. Dave Grossman, U.S. Army (Ret.)

Hormones regulate critical biological functions including neurologic growth, sexual differentiation, and organ maturation, through intricate signaling mechanisms. Pregnant women, infants, and children are increasingly exposed to chemicals in the environment that mimic or block hormones, often at very small doses. Exposure to these endocrine disruptors occurs at home, in the workplace and the community, and even as a consequence of medical care. This session will review the growing evidence of adverse health effects due to exposure to endocrine disruptors and discuss new research efforts that will help fill in the gaps in our knowledge in this area.

The participation of children in research is a double-edged sword. Children are vulnerable and need protection, yet their participation is critical to ensure improvements in the medical care of this same population. The fundamental question is how to balance the need for protection and access in a manner that is ethically sound and yet pragmatically feasible.

In this workshop, we will look at various recent publications in pediatric journals and present several vignettes to explore ethical and policy issues regarding the participation of children as human subjects. Through the scenarios, we will discuss such issues as: 1) the questions raised by the need to balance access versus protection; 2) the potential impact on this balance of the new NIH and FDA policies that went into affect in the late 1990s; 3) ethical issues regarding consent to participation (e.g., should adolescents be able to consent to research without parental participation?); and 4) ethical issues in research design (e.g. when are placebos morally justifiable?). For each vignette and journal article, the workshop leaders will then present where there is and is not consensus between bioethicists.

L. F. Ross, J. D. Lantos, G. Koren, S. Leikin, University of Chicago, Chicago IL (LFR, JDL), University of Toronto, Toronto Canada (GK), Office of Human Protection Research, Department of Health and Human Services, Washington, DC (SL--probable).

Sudden, unexpected death among young athletes is receiving increasing attention by the press and public. This has created a need for physicians working with young athletes to understand the most common causative conditions, and how to respond appropriately.

Participants will understand common causes of sudden cardiac death in young athletes, learn about the natural history and clinical features of hypertrophic cardiomyopathy, and obtain the latest guidelines for athletic participation and information on prevention.

Co-sponsored by the AAP Sections on Sports Medicine and Fitness and Cardiology.

Ronald Feinstein, University of Alabama Birmingham, Reginald Washington, AAP Committee on Sports Medicine and Fitness, Barry I. Maron, Mayo Clinic

Increasingly, scientific evidence is becoming available that links chronic diseases such as atherosclerosis, neuropsychiatric disorders and certain malignancies with infectious roots. Faculty will expose the fascinating existing information and help put novel findings and theories in perspective.

The objective of this workshop is to address key issues concerning the use and safety of dietary supplements in infants and children. There is a growing body of evidence that nutrients and other bioactive components of foods play a significant role in health promotion and disease prevention in adults and this information has increased the use of dietary supplements in infants and children. However, little is known about the interaction between the use of many of these supplements and developmental physiology and behavior in children. Such knowledge is critical when evaluating either the justification or safety of this trend. Topics to be addressed at the workshop include: 1) Current usage patterns among infants, children and adolescents; 2) Evidence-based justification for dietary supplement use at various developmental stages; 3) Age-dependent factors influencing bioavailability, pharmacology and safety; 4) Behavioral factors that impact attitudes and beliefs about dietary supplements; 5) Biomarkers for the assessment of efficacy and safety; and, 6) Identification of research needs.

P. M. Coates, D. J. Raiten and M. F. Picciano, Office of Dietary Supplements, National Institutes of Health & Office of Prevention Research and International Programs, National Institutes of Child Health and Human Development, Bethesda, MD

Type 2 diabetes (DM2) is increasingly a pediatric disease, especially among minority youth. While there is extensive patient educational material available for adults, there is very limited information oriented toward youth. As a consequence, patient and family education for youth with DM2 is often haphazard - with the physician and diabetes educator being forced to select from materials that are behaviorally or intellectually inappropriate. For example, adult education literature focuses on avoiding long-term sequelae, like end stage renal disease; however, adolescents have a limited ability to undertake long-term planning and many have not yet been exposed to the important role of the kidneys.

In the workshop, an overview of contemporary educational material available for DM2 adults and a survey of DM2 materials used by pediatric diabetes specialist will be provided. Then, the participants will evaluate the style and content of 2 contemporary videotapes and 2 chapters from DM2 educational manuals. Finally, a roundtable discussion will be held to identify 8-10 key concepts to be communicated to youth with DM2, the format that would most effectively communicate these (e.g., manuals vs. videotapes) and potential barriers to translating concept into action.

Daniel E. Hale, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX

Assessing adolescents for use of alcohol and drugs presents a major challenge for clinicians in the current primary care environment that emphasizes patient volume. The goal of this workshop is to develop clinical skills in using brief structured assessment tools to assess adolescents for drug or alcohol use. The workshop is intended for pediatric clinicians and pediatric educators.

Participants will learn: (1) To use structured assessment instruments that have been validated for adolescents, and (2) Strategies for interviewing adolescents. This workshop will use a standardized case, The Pinpoint Pupil, along with additional audio-visual materials for skills development. Workshop participants will be invited to discuss the management of an adolescent who is brought to a Pediatricians office because of marijuana use. The CRAFFT mnemonic will be presented. Participants will then watch video tapes of interactions between clinicians and adolescents, and discuss the subtleties of interviewing techniques and their impact on information revealed by the patient. The workshop will conclude with a discussion of how these techniques can be applied in the office and in teaching pediatric residents. Each participant will receive a copy of the complete teaching module, with handouts and references, for use in his or home institution.

S. Levy, B. Vaughan, A. Arneill, J. R. Knight, Department of Pediatrics, Harvard Medical School; Division of General Pediatrics, Children's Hospital, Boston, MA

Despite increasingly prevalent curricula on cultural sensitivity and awareness in medical school, there are no published descriptions of faculty development programs to prepare primary care educators to teach students this material in community settings. This workshop will describe and involve participants in a curriculum developed at the UMASS Community Faculty Development Center that teaches primary care physicians to incorporate cultural competence and patient advocacy into their office-based teaching activities. The curriculum is delivered in 3 modules presented to our community faculty during a faculty development series. Participants will be provided with a concentrated version of our three modules.

Participants will be oriented to the educational planning process (GNOME) developed at our institution. We will discuss how to assess the needs of students with regard to cultural sensitivity, using an interactive format and videotaped examples. Teaching methods that assist with attitudinal objectives including collaborative and facilitative teaching styles, self-reflection and role modeling will all be emphasized. After a short break, 4 specific strategies that facilitate the development culturally competent students will be reviewed: the Patient-Centered Interview; the Social Review of Systems; the LEARN negotiation technique; and use of the community as teacher. Following a large group video demonstration role-play, participants will then break out into small groups. Teaching case vignettes that emphasize needs assessment, attitudinal objectives and teaching skill objectives will be role-played in the small groups, and discussed. Finally, we will reconvene to present workshop evaluation data and discuss ways in which this curriculum could be adapted to their home institution.

D. M. Keller, W. J. Ferguson. Departments of Pediatrics and Family Medicine/Community Health, UMASS Medical School, Worcester MA

The Human Genome Project is impacting every aspect of medicine. Dr. Craig Venter, President of Celera Genomics, one of the chief architects of this venture, will discuss the accomplishments of the human genome project and implications for future impact on health and disease in this special one-hour state of the art lecture.

Sequencing the Human Genome
J. Craig Venter, President, Celera Genomics, Rockville, MD

Supported in part by an educational grant from the Columbus Children's Hospital, Columbus, OH

Previously we have thought that most infections are the circumstance of "bad luck". This session will highlight the exploding information on our innate immunity, subtle defects that cause susceptibility to certain pathogens, and the remarkable mechanisms of microbial pathogenesis.

The roles of nature and nurture in shaping behavior are complex and our understanding of them is constantly expanding. Exciting recent findings have given us new perspectives on biologic influences on brain functioning and subsequent behavior. Genetic conditions can be reflected in clearly identifiable behavioral phenotypes. Prenatal exposure to nicotine can have effects that are measurable in adolescence, and low level exposure to environmental toxins are impacting cognitive and behavioral functioning of the current generation. Three outstanding speakers will discuss these advances in our knowledge of neuroscience and their implications for the identification and treatment of a variety of neurodevelopmental conditions.

Overview
Daniel Lee Coury, Children's Hospital, Columbus, OH

Fragile X Syndrome: A Model of Gene-Brain Behavior Relationships
Randi J. Hagerman, University of California at Davis Medical Center, Sacramento, CA

Tobacco, Nicotine and Fetal Brain Damage: The Smoking Gun in ADHD and SIDS
Theodore Slotkin, Duke University Medical Center, Durham, NC

Neurotoxicity of Low-Level Exposure to Pesticides and PCBs
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

Discussion

Sponsored jointly with the Society for Developmental Pediatrics

A major challenge of daily professional life is keeping abreast of the rapid changes in infectious diseases — pathogens, antimicrobial resistance, therapies and prevention. Four topics are selected because of their timeliness and the importance of new information.