CRITICAL CARE

Pediatric Hospitalist practice is an evolving career option that combines the excitement and stimulation of high acuity patients without the limitation of sub-specialization in a specific organ system or age group. Hospitalists provide direct patient care, perform procedures, teach, conduct research, but spend too many nights and weekends in the hospital. Hear a panel of experienced pediatric hospitalists frankly discuss their varied career tracks and current employment settings ranging from the traditional academic "ward attending" to private practitioners who cover the Ward, Neonatal ICU, Pediatric ICU, ER, Nursery, and Labor and Delivery without the benefit of housestaff. Significant time will be allowed for questions to find out if a pediatric hospitalist career is in the cards for you or those you advise.

Jack Percelay, Chairperson, AAP Provisional Section on Hospital Care
Michael Ruhlen, Section Head, Pediatrics, National Association of Inpatient Physicians

This seminar will encourage discussion about the omission, withdrawal, or use of treatment for fetuses and newborn infants. The principles of benevolence, non-malfeasance, justice and autonomy will be briefly described and illustrated by; (1) a discussion of the recent Siamese twin case in England and, 2) surrogate decision making. It is hoped that these topics and their presentation will lead to a lively interactive debate.

David K. Stevenson, Harold K. Faber Professor of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

Randomized controlled trials are the gold standard for determining which treatments are superior. More and more, clinicians of all specialties are demanding that randomized trials show new treatments, such as surfactant and ECMO, to be superior to current therapy (or no therapy) before the new treatments are adopted.

This workshop will cover principles of clinical trials including defining the question, assessing outcomes, defining the study and control treatments, single- versus multi-center trials, reasons for and methods of randomization, eligibility and exclusions, blinding, analysis strategies, and early stopping. The format will be didactic with extensive open discussion. Real world examples of "what can happen if you don't watch out" will be utilized. Participants are encouraged, although not required, to bring an idea for a possible clinical trial. We will use these ideas as examples during the discussion. Statistical knowledge is definitely not required.

Mark A. Klebanoff, Director, Division of Epidemiology, Statistics and Prevention Research, NICHD, NIH, Bethesda, MD

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.

Overview
Charles J. Homer, National Initiative for Children's Healthcare Quality, Boston, MA

Collaborative Quality Improvement for Neonatal Intensive Care
Jeffrey D. Horbar, Vermont Oxford Network, Burlington, VT

Medication Safety in Children's Hospitals
Carol Haraden, Institute for Healthcare Improvement, Boston, MA

The Child and Adolescent Health Measurement Initiative
David Bergman, Lucile Packard Children's Hospital, Palo Alto, CA

Federal Role in Safety and Quality
Lisa Simpson, Agency for Healthcare Research and Quality, Rockville, MD

The focus of this group is on advancing the recognition, assessment, and management of pain in children. The orientation of the SIG is not on how to manage pain but on the development of strategies that will promote change in health care institutions and individual practice patterns. Presentations may concern the management of pain in specific age groups (e.g. infancy), specific settings (e.g. ambulatory, ED, NICU), specific populations (e.g. developmentally disabled), individuals with specific pain problems (sickle cell, cancer, RSD, headache) or on strategies to promote changes in institution or individual attitudes and practice. The SIG will allow a forum for discussion and sharing of ideas with the goal of reducing pain in pediatric practice.

This course will provide up-to-date information on genetics and epidemiology of renal and liver tumors in children, including Wilms tumor and hepatoblastoma. We will discuss recent findings in germ-line mutations and familial associations. The course will inform the clinician of the emerging association of hepatoblastoma and premature and low-birth weight infants and introduce strategies for cancer surveillance in the high-risk child.

Genetics of Wilms Tumor
Max J. Coppes, Alberta Children's Hospital, Alberta, Canada

Cytogenetics of Renal and Liver Tumors in Children
Nancy R. Schneider, University of Texas Southwestern Medical Center, Dallas, TX

Cancer Surveillance for Overgrowth Syndromes
Michael R. DeBaun, Washington University School of Medicine, St. Louis, MO

Providing pediatric subspecialty care to underserved rural communities has been a long-standing challenge. Several different health care delivery models have addressed this issue, the most common being outreach outpatient clinics with traveling Pediatric subspecialty teams based at tertiary children's centers. This workshop will expose the participant as to how we have utilized telemedicine, live 2 way video linkages, between the rural health care centers and our children's center. We provide 3 types of pediatric patient care: 1) Outpatient subspecialty consultation and follow-up, 2) PICU to rural adult ICU/adult intensivists for critically ill children, 3) Rural emergency rooms to our pediatric emergency room for acutely ill and injured children. Although the model of outpatient consultation is well established, the PICU to Adult ICU is a new model and has many challenges and opportunities that will be discussed. These include acceptance of a rural partner, ability of the PICU to triage and control all patient flow and beneficial relationships derived by supporting appropriate patients to remain in the local community. The rural ER to pediatric emergency room model involves a complex electronic network but is well received in rural communities. A limited discussion of technical details will also be available.

R. J. Dimand, J. P. Marcin, H. J. Kallas, Department of Pediatrics, University of California Davis, Sacramento, CA

Much attention has been given to advances in molecular biology, the genome project, immunobiology and rational drug design based on sound scientific discoveries. While there has been much excitement generated by such areas, an often expressed concern is "Where's the beef?" This session will attempt to describe several examples of how advances in laboratory science are now being translated into more effective treatments for diseases that have evaded more conventional therapeutic approaches.

Overview

AML as a Model for Novel Cancer Therapeutics
Robert J. Arceci, Director, Pediatric Oncology, Johns Hopkins Oncology Center, Baltimore, MD

Nonmyeloablative Transplants and Novel Conditioning Approaches
Stella M. Davies, University of Minnesota, Minneapolis, MN

New Therapeutic Approaches for Sickle Cell Disease
James F. Casella, Johns Hopkins School of Medicine, Baltimore, MD

Trauma is the leading cause of death in children and severe traumatic brain injury is a key contributor to this mortality and important morbidity. This session will focus on novel developments in our understanding of the mechanisms of secondary damage that evolve during the acute phase after injury and novel therapeutic approaches to this important condition-including therapies targeting brain swelling and delayed neuronal death. Finally, reorganization of the injured brain and potential therapeutic implications in the subacute/chronic phase will also be discussed.

Key Mechanisms of Secondary Damage After Traumatic Brain Injury in Infants and Children
Patrick M. Kochanek, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA

Secondary Cerebral Swelling and the Use of Hypertonic Saline
Bradley Peterson, Children's Hospital and Health Center, San Diego, CA

Understanding and Targeting Neuronal Death
Robert S.B. Clark, Children's Hospital of Pittsburgh, Pittsburgh, PA

Reorganization of the Injured Brain: Therapeutic Implications
Harvey Levin, Baylor College of Medicine, Houston, TX

Discussion