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

This minicourse will highlight new technologies in genetics and genomics that build on the mapping and sequencing of human and model organism genomes to define the function of genes and their clinical importance in normal health and disease.

Genetic Analysis of Hematopoiesis and Cancer
Leonard I. Zon, Howard Hughes Medical Institute, Children's Hospital, Boston, MA

Genetic Polymorphisms for Linkage and Association Studies
Aravinda Chakravarti, Johns Hopkins University School of Medicine, Baltimore, MD

Gene Expression: Expression Profiling and Microarray Technology
Jeffrey M. Trent, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD

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

Steroid-resistant nephrotic syndrome is one of the most common forms of primary nephrotic syndrome in childhood. Recent genetic and molecular studies indicate that the podocyte plays a central role in the pathogenesis of this disorder. This symposium will address recent advances in our understanding of the development, cell biology, and pathology of the glomerular podocyte. The recent identification of NPHS2, the gene encoding the glomerular protein podocin, and its role in autosomal recessive steroid-resistant nephrotic syndrome will be discussed. Finally, new strategies for therapeutic intervention in steroid-resistant nephrotic syndrome will be described.

Development of the Glomerular Capillary Wall
Dale R. Abrahamson, University of Kansas Medical Center, Kansas City, KS

Cell Biology and Pathology of Podocytes
Peter Mundel, Albert Einstein College of Medicine, Bronx, NY

The Genetic Basis of Steroid-Resistant Nephrotic Syndrome
Corinne Antignac, INSERM, Paris, France

This symposium will address a topic of considerable public debate, especially as it relates to research involving human subjects, among these clinical trials using children as subjects, and research involving gene therapy. A recent two-day meeting at NIH was devoted to this subject and it is likely that there will be new and more explicit guidelines promulgated by HHS. The symposium will address these issues from the perspective of academic pediatrics and pediatric research, in particular with regard to the impact on education at both the undergraduate and graduate levels and the availability of appropriate tests and therapies for children. The role of professional societies, such as the sponsoring members of the PAS meeting, will be examined. The symposium is planned to allow at least 30 minutes of interactive discussion between the members of the panel and the audience.

This symposium will provide a broad overview of the state of the pediatric AIDS pandemic. The results of recent trials investigating approaches to prevention and treatment of vertical HIV transmission in the developing world will be discussed. Collaborative approaches and opportunities for partnership in international pediatric AIDS treatment, education, and research will be highlighted.

Overview
Mark W. Kline, Baylor College of Medicine, Houston, TX

Pediatric AIDS: State of the Pandemic
Meg Gwynne Ferris, Baylor College of Medicine, Houston, TX

Approaches to Prevention of Mother-to-Child HIV Transmission in the Developing World
Lynne M. Mofenson, National Institute of Child Health and Human Development, Rockville, MD

Collaborative Approaches to International AIDS Training and Research
Kenneth Bridbord, Fogarty International Center, National Institutes of Health, Bethesda, MD

Models of Partnership in Pediatric AIDS Treatment, Education and Clinical Research: Romania and Botswana
Mark W. Kline, Baylor College of Medicine, Houston, TX

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.

Overview
Philip John Landrigan, Center for Children's Health & the Environment, Mt. Sinai School of Medicine, New York, NY

Evidence of Endocrine Disruption: Lessons from Wildlife
Louis Guillette, University of Florida, Gainesville, FL, University of Florida, Gainesville, FL

NHANES: A Rich Source of National Pediatric and Adolescent Exposure Data
Elaine Gunter, NHANES Laboratory, Centers for Disease Control & Prevention, Atlanta, GA

Biomarkers in Endocrine Disruptor Research
Cynthia F. Bearer, Case Western Reserve University, Cleveland, OH

Discussion

Each year there are thousands of injuries and deaths in US hospitals from medication errors. These blunders cost millions of dollars and result in loss of public confidence in our health care system. Medication errors are the second most frequent and the second most expensive event causing liability claims. Errant orders on the inpatient unit and incorrect prescriptions in the ED and clinics are common. Physicians, nurses, pharmacists, students, manufacturers and even caregivers all share responsibility. Many errors are preventable. This workshop will focus on common sources of medical errors and ways to prevent them. Workshop leaders will discuss specific issues including:

Root cause analysis looking at systems issues rather than individuals
Moving toward non-punitive approaches to reporting errors
Developing teaching programs for housestaff and students
The role of the pharmacist - how can they help?
New technology-are computer systems useful? Are the programs affordable?
Creating multidisciplinary medication use process improvement teams
Approaching the family after a medical error - legal and ethical implications

Participants will be asked to share their ideas and experiences. It is hoped that participants will be able to develop a multidisciplinary program in their own institutions to reduce and manage medical errors.

S. Selbst,* S. Levine,* J. Gould,* B. Taylor,* J. Fein,# K. Osterhoudt# A.I. duPont Hospital for Children,* Wilmington, DE and Children's Hospital of Philadelphia#, PA

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