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.

The 3rd PEM Directors SIG will be meeting to discuss academic issues in education and research for enhancement of the faculty growth within the field. One area of focus will be the mentoring of junior faculty. There will be a discussion on developing the future PEM Directors and enhancing the longevity in the field. Directors are encouraged to contact: richard.ruddy@chmcc.org for further details.

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

Shaken Baby Syndrome is the most common cause of morbidity and mortality in inflicted, abusive head injury; the leading cause of traumatic death in infancy. Recent medical and legal controversies involving high -profile court cases as well the fact that the syndrome is frequently overlooked or misdiagnosed will be focused issues in this workshop. The workshop is designed to guide the physician through the process of diagnostic evaluation, therapeutic intervention, working with a child protection team response that includes medical, psychosocial, law enforcement and legal components, collection of evidence, preparation for court and aspects of expert testimony.

Covered topics will include epidemiology, history taking, physical exam, differential diagnosis, laboratory, radiological and diagnostic testing, crime scene investigation, forensic evidence and the legal response. Factual educational material will be presented with varied audiovisual formats including videotapes of perpetrators as well as demonstrations of the physical dynamics of shaking. The audience will have the opportunity to directly participate through the utilization of role modeling, mock investigation and courtroom trial.

M. Frogel and D. Esernio-Jenssen, Schneider Children's Hospital, New Hyde Park, NY and M. Fisher, Special Victim's Bureau, District Attorney's Office, Queens, NY

The 3rd PEM Directors SIG will be meeting to discuss academic issues in education and research for enhancement of the faculty growth within the field. One area of focus will be the mentoring of junior faculty. There will be a discussion on developing the future PEM Directors and enhancing the longevity in the field. Directors are encouraged to contact: richard.ruddy@chmcc.org for further details.

1) Ongoing research projects
Descriptions of innovative educational and clinical programs

Studies from New York, Colorado and Utah, and Australia have demonstrated a high rate of adverse events in the inpatient setting related to medical error, in particular one-in-five related to medication error. A recent Institute of Medicine report stressed the importance of improving systems to reduce preventable adverse drug events in health care. CHAI is a collaborative of thirteen pediatric hospitals that have successfully improved their medication systems to reduce preventable adverse drug events. CHAI representatives will use a complement of short lectures and work sessions to introduce a conceptual framework for assessing medication systems and a model for improvement that will lead to successful change and reductions in preventable adverse drug events. The workshop will emphasize a non-punitive and systems-oriented approach to quality improvement. Participants will be expected to bring a pre-workshop assessment of their medication systems and will identify and work on a specific medication-related problem during the course of the workshop.

Institutional teams, in contrast to individuals, will be given priority admittance to the workshop.

G. Takata, C. Taketomo, and W. Mason (Childrens Hospital Los Angeles, Los Angeles, CA), L. Brodsky and M. Cimino (Children's Hospital Buffalo, Buffalo, NY), and M. Kirschbaum (Child Health Corporation of America, Shawnee Mission, KS), representing the Child Health Accountability Initiative (CHAI)

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

There is a growing body of research examining the prevention of child abuse and neglect. The link between domestic violence and child maltreatment has become increasingly clear, with important implications for pediatricians. Recent studies have demonstrated the potential impact that various strategies could have on the incidence of abuse and neglect. This symposium will present new information regarding the use of home visitors and the role of physicians in identifying and preventing abuse. The presenters will also discuss the need to establish child abuse prevention as a higher priority for funded research and as a major public health concern.

A National Call to Action To End Child Abuse
David Chadwick, Director, Emeritus Center for Child Protection, Children's Hospital, San Diego, CA, Emeritus, Center for Child Protection, Children's Hospital, San Diego, CA

Domestic Violence, Child Maltreatment, and the Pediatrician's Role
Howard Dubowitz, Professor of Pediatrics, Chief, Division of Child Protection, University of Maryland School of Medicine, Baltimore, MD

Building Systems To Improve Preventive Care: Linking Home and Office-based Prevention
Peter A. Margolis, Children's Primary Care Research Group, University of North Carolina School of Medicine, Chapel Hill, NC

Preparing Physicians To Identify and Prevent Abuse
Desmond K. Runyan, Professor and Chair of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC

The Injury Control Special Interest Group of the APA will hold its annual meeting on Tuesday, May 1st, from 8:45-11:45am in Baltimore, Maryland. A special presentation will be made by Dr. Michael Weitzman from the AAP's Child Health Research Institute concerning new research initiatives within the Institute and how injury control research issues might be addressed. A second presentation on PROS is also tentatively planned. Dr. Mort Wasserman (or another staff member) of the PROS Network, will discuss how PROS works and how it might be utilized to answer clinical questions concerning childhood injuries.

Reports from SIG members on their local activities in injury control will also be discussed. New funding opportunities will also be explored through the pertinent Federal agencies. All are invited to attend the SIG.

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

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

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