The 1-minute walk test is as effective as the 6-minute walk test at predicting transplant-free survival in patients with idiopathic pulmonary fibrosis (IPF), based on data from 179 adults. The findings were presented at the CHEST annual meeting.

The 6-minute test is often used to evaluate functional capacity in IPF patients, but is not always practical in a busy clinic setting, according to Flavia S. Nunes, MD, of Inova Fairfax Hospital in Falls Church, VA, and colleagues.

czardases/Thinkstock

The 1-minute walk test is as effective as the 6-minute walk test at predicting transplant-free survival in patients with idiopathic pulmonary fibrosis (IPF), based on data from 179 adults. The findings were presented at the CHEST annual meeting.

The 6-minute test is often used to evaluate functional capacity in IPF patients, but is not always practical in a busy clinic setting, according to Flavia S. Nunes, MD, of Inova Fairfax Hospital in Falls Church, VA, and colleagues.

czardases/Thinkstock

The 1-minute walk test is as effective as the 6-minute walk test at predicting transplant-free survival in patients with idiopathic pulmonary fibrosis (IPF), based on data from 179 adults. The findings were presented at the CHEST annual meeting.

The 6-minute test is often used to evaluate functional capacity in IPF patients, but is not always practical in a busy clinic setting, according to Flavia S. Nunes, MD, of Inova Fairfax Hospital in Falls Church, VA, and colleagues.

czardases/Thinkstock

Trainee and early-career members made an impact in the GI field this past year, especially through contributing to and engaging in various collaborations via the American Gastroenterological Association’s member-only online discussion forum – the AGA Community.

We’re proud to announce that the title of 2017 top contributor is held by an early-career member: Meet Dmitriy Kedrin, MD, PhD, of Elliot Hospital in Manchester, N.H., and find out a little more about how the AGA Community is an important part of his routine in this brief Q&A session.

Thanks for being such an active member of the AGA Community! Why do you contribute?

“I think it is important for GI docs to be a part of a larger community, stay informed on the latest guidelines, research publications, and approaches to difficult cases, where more than one road can be taken. I feel that it is a great forum for someone like me, a relatively junior gastroenterologist.”

Why do you enjoy being part of the AGA Community?

“I find the case discussions informative. I learn a great deal about current trends and opinions on important topics in the GI world.”

What do you like to do in your free time?

“I bake bread and run a gastroenterology literature review podcast called ‘GI Pearls.’ ”

What’s your approach to handling a difficult patient case you come across in your practice?

“I often seek advice of other clinicians, some with more expertise in a particular area. I also go to the literature and try to learn more that way, to help expand my differential as well as figure out the best therapeutic approach.”

Was there a conversation in the AGA Community in 2017 that was your favorite?

“Oh, there were several. I recall a patient case where there were several thought leaders in the field who had a disagreement about the best approach to treatment. The work-life balance conversation was also very good. I also enjoyed reading about different opinions regarding the values of clinical versus observational trials that happened a while back.”



Here are other trainee and early-career members who made the list of top contributors in the AGA Community last year:

• Avinash Ketwaroo, MD
• Hüseyin Bozkurt, MD
• Peter Liang, MD, MPH
• Fola May, MD, PhD
• Richa Shukla, MD
• Arthur Beyder, MD, PhD
• Shazia Siddique, MD
• Brigid Boland, MD

Check the achievements section of your AGA Community profile to see whether you made the list. We look forward to seeing you all in the forum in 2018!

Trainee and early-career members made an impact in the GI field this past year, especially through contributing to and engaging in various collaborations via the American Gastroenterological Association’s member-only online discussion forum – the AGA Community.

We’re proud to announce that the title of 2017 top contributor is held by an early-career member: Meet Dmitriy Kedrin, MD, PhD, of Elliot Hospital in Manchester, N.H., and find out a little more about how the AGA Community is an important part of his routine in this brief Q&A session.

Thanks for being such an active member of the AGA Community! Why do you contribute?

“I think it is important for GI docs to be a part of a larger community, stay informed on the latest guidelines, research publications, and approaches to difficult cases, where more than one road can be taken. I feel that it is a great forum for someone like me, a relatively junior gastroenterologist.”

Why do you enjoy being part of the AGA Community?

“I find the case discussions informative. I learn a great deal about current trends and opinions on important topics in the GI world.”

What do you like to do in your free time?

“I bake bread and run a gastroenterology literature review podcast called ‘GI Pearls.’ ”

What’s your approach to handling a difficult patient case you come across in your practice?

“I often seek advice of other clinicians, some with more expertise in a particular area. I also go to the literature and try to learn more that way, to help expand my differential as well as figure out the best therapeutic approach.”

Was there a conversation in the AGA Community in 2017 that was your favorite?

“Oh, there were several. I recall a patient case where there were several thought leaders in the field who had a disagreement about the best approach to treatment. The work-life balance conversation was also very good. I also enjoyed reading about different opinions regarding the values of clinical versus observational trials that happened a while back.”



Here are other trainee and early-career members who made the list of top contributors in the AGA Community last year:

• Avinash Ketwaroo, MD
• Hüseyin Bozkurt, MD
• Peter Liang, MD, MPH
• Fola May, MD, PhD
• Richa Shukla, MD
• Arthur Beyder, MD, PhD
• Shazia Siddique, MD
• Brigid Boland, MD

Check the achievements section of your AGA Community profile to see whether you made the list. We look forward to seeing you all in the forum in 2018!

Trainee and early-career members made an impact in the GI field this past year, especially through contributing to and engaging in various collaborations via the American Gastroenterological Association’s member-only online discussion forum – the AGA Community.

We’re proud to announce that the title of 2017 top contributor is held by an early-career member: Meet Dmitriy Kedrin, MD, PhD, of Elliot Hospital in Manchester, N.H., and find out a little more about how the AGA Community is an important part of his routine in this brief Q&A session.

Thanks for being such an active member of the AGA Community! Why do you contribute?

“I think it is important for GI docs to be a part of a larger community, stay informed on the latest guidelines, research publications, and approaches to difficult cases, where more than one road can be taken. I feel that it is a great forum for someone like me, a relatively junior gastroenterologist.”

Why do you enjoy being part of the AGA Community?

“I find the case discussions informative. I learn a great deal about current trends and opinions on important topics in the GI world.”

What do you like to do in your free time?

“I bake bread and run a gastroenterology literature review podcast called ‘GI Pearls.’ ”

What’s your approach to handling a difficult patient case you come across in your practice?

“I often seek advice of other clinicians, some with more expertise in a particular area. I also go to the literature and try to learn more that way, to help expand my differential as well as figure out the best therapeutic approach.”

Was there a conversation in the AGA Community in 2017 that was your favorite?

“Oh, there were several. I recall a patient case where there were several thought leaders in the field who had a disagreement about the best approach to treatment. The work-life balance conversation was also very good. I also enjoyed reading about different opinions regarding the values of clinical versus observational trials that happened a while back.”



Here are other trainee and early-career members who made the list of top contributors in the AGA Community last year:

• Avinash Ketwaroo, MD
• Hüseyin Bozkurt, MD
• Peter Liang, MD, MPH
• Fola May, MD, PhD
• Richa Shukla, MD
• Arthur Beyder, MD, PhD
• Shazia Siddique, MD
• Brigid Boland, MD

Check the achievements section of your AGA Community profile to see whether you made the list. We look forward to seeing you all in the forum in 2018!

Nutrition within the first 1,000 days of childhood are pivotal in a child’s neurodevelopment and lifelong health, according to an American Academy of Pediatrics policy statement.

“Healthy, normal neurodevelopment is a complex process involving cellular and structural changes in the brain that proceed in a specified sequence,” wrote Sara Jane Schwarzenberg, MD and Michael K. Georgieff, MD, both of the University of Minnesota Masonic Children’s Hospital, Minneapolis, and the AAP Committee on Nutrition. “Changes that are too rapid or too slow in one part of the brain may result in the failure of crucial pathway connections to other parts of the brain. Timing is crucial; once a particular developmental sequence fails, it may not be possible to retrieve all the lost function,” the investigators and committee noted in a report published in Pediatrics (Pediatrics. 2018; 141[2]:e20173716).

©thinkstockphotos.com

[email protected]

Nutrition within the first 1,000 days of childhood are pivotal in a child’s neurodevelopment and lifelong health, according to an American Academy of Pediatrics policy statement.

“Healthy, normal neurodevelopment is a complex process involving cellular and structural changes in the brain that proceed in a specified sequence,” wrote Sara Jane Schwarzenberg, MD and Michael K. Georgieff, MD, both of the University of Minnesota Masonic Children’s Hospital, Minneapolis, and the AAP Committee on Nutrition. “Changes that are too rapid or too slow in one part of the brain may result in the failure of crucial pathway connections to other parts of the brain. Timing is crucial; once a particular developmental sequence fails, it may not be possible to retrieve all the lost function,” the investigators and committee noted in a report published in Pediatrics (Pediatrics. 2018; 141[2]:e20173716).

©thinkstockphotos.com

[email protected]

Nutrition within the first 1,000 days of childhood are pivotal in a child’s neurodevelopment and lifelong health, according to an American Academy of Pediatrics policy statement.

“Healthy, normal neurodevelopment is a complex process involving cellular and structural changes in the brain that proceed in a specified sequence,” wrote Sara Jane Schwarzenberg, MD and Michael K. Georgieff, MD, both of the University of Minnesota Masonic Children’s Hospital, Minneapolis, and the AAP Committee on Nutrition. “Changes that are too rapid or too slow in one part of the brain may result in the failure of crucial pathway connections to other parts of the brain. Timing is crucial; once a particular developmental sequence fails, it may not be possible to retrieve all the lost function,” the investigators and committee noted in a report published in Pediatrics (Pediatrics. 2018; 141[2]:e20173716).

©thinkstockphotos.com

[email protected]

New research gives more reasons for you to advise teenagers to avoid junk food and energy drinks, and even better reasons to encourage them to exercise.

The latest evidence on how the teenage brain is particularly vulnerable to environmental influences, both good and bad, as it matures into adulthood is marshaled into review articles featured in a special issue of the journal Birth Defects Research entitled “The dynamic and vulnerable teenage brain” issued by the Teratology Society.

Junk food – soda, potato chips, and the like – is one of the bad influences, and not just on the waistline, according to a review by Amy Reichelt, PhD, and Michelle M. Rank, PhD, of the Royal Melbourne Institute of Technology University in Melbourne (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1173).

Digital Vision./Thinkstock

Under construction

“Because key neurotransmitter systems in the brain responsible for inhibition and reward signaling are still developing during the teen years, existing primarily on junk food could negatively affect decision making, increase reward-seeking behavior and influence poor eating habits throughout adulthood,” Dr. Reichelt said in a press release about the special issue.

The good news is that “the heightened neuroplasticity during adolescence ... offers a window in which diet-induced cognitive decline may be particularly amenable to intervention. This provides opportunities for nutritional intervention strategies in high-risk individuals,” she and Dr. Rank concluded in the review.

Although the literature is thinner than with junk food, there are similar concerns about the effects of energy drinks and their high levels of caffeine and taurine. Energy drinks likely are detrimental to the brain function of children and adolescents, especially when mixed with alcohol, according a second review by Christine Perdan Curran, PhD, and Cécile A. Marczinski, PhD, of Northern Kentucky University, Highland Heights. (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1177).

“We don’t know enough about the effects of high consumption of energy drinks and the ingredients found in them at this critical time in mammalian brain development,” but “our recent findings in adolescent and young adult mice exposed to high taurine levels indicate there can be adverse effects on learning and memory and increased alcohol consumption in females,” Dr. Curran said in the press release.

In short, energy drinks in adolescence raise “serious concerns about adverse effects on the brain,” the researchers concluded in their review.

It’s a happier story with exercise, according to two more reviews in the teenage brain issue.
 

Less couch time

“It is clear that helping adolescents dedicate more of their time to exercise, especially high intensity or aerobic activities, may not only better their physical health but also positively influence the way their brain is structured and how it functions,” said Megan Herting, PhD, and Xiaofang Chu of the University of Southern California, Los Angeles (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1178).

Aerobic exercise in the teenage years seems to improve attention, planning, problem solving, working memory, and inhibitory control. MRI studies, meanwhile, suggest that higher aerobic fitness correlates with beneficial cortical, subcortical, and white matter structural connectivity profiles in older adolescents. In a functional MRI study of 15- to 18-year-old boys, Dr. Herting and B.J. Nagel, PhD, found that the hippocampus of 17 less fit adolescents was significantly more active than that their 17 fitter peers during a word recall test, suggesting “that exercise may influence how the brain encodes new memories and that lower-fit teens may need to utilize additional brain resources to learn something new” (J Cogn Neurosci. 2013 Apr;25[4]:595-612).
 

Boosting the benefit

Exercise also helps with substance abuse, an effect that “appears to be attributable to more than just time occupied by the activities,” according to a review led by Nora L. Nock, PhD, of Case Western Reserve University, Cleveland (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1182).

“Substance use in adolescence has been associated with adverse structural and functional brain changes, and may further exacerbate the natural imbalance” between inhibitory and excitatory neurotransmitters, “leading to further heightened impulsive and reward-driven behaviors,” the authors said.

Exercise offsets the effects by inducing structural and functional changes in the brain, including neurogenesis and angiogenesis. “If integrated during adolescence, a window of heightened reward sensitivity and neural plasticity, exercise may help to reinforce ‘naïve’ or underdeveloped connections between neurological reward and regulatory processes ... and, in turn, help offset or dampen reward seeking from substances while concomitantly improving cardiovascular health as well as academic and social achievement,” Dr. Nock and her colleagues said.

The team is studying “assisted exercise,” which helps people peddle about 35% faster on a stationary bike than they would be able to on their own. “It may be able to provide even greater effects in suppressing reward from substance use due to potentially larger increases in neurotransmitters (e.g., dopamine) and neurotrophic factors (e.g., BDNF [brain-derived neurotrophic factor]), which may be particularly beneficial in adolescents with SUD (substance use disorder) having a dopamine deficit due to genetic variation and/or lower levels of striatal dopamine receptors ... during substance abstinence,” they said.

Given those and other findings, Dr. Nock and her colleagues proposed that exercise “be initiated during early abstinence and, potentially, started before integrating other cognitive behavioral treatment components” in adolescents with SUDs.

The authors did not report any industry disclosures.

[email protected]

New research gives more reasons for you to advise teenagers to avoid junk food and energy drinks, and even better reasons to encourage them to exercise.

The latest evidence on how the teenage brain is particularly vulnerable to environmental influences, both good and bad, as it matures into adulthood is marshaled into review articles featured in a special issue of the journal Birth Defects Research entitled “The dynamic and vulnerable teenage brain” issued by the Teratology Society.

Junk food – soda, potato chips, and the like – is one of the bad influences, and not just on the waistline, according to a review by Amy Reichelt, PhD, and Michelle M. Rank, PhD, of the Royal Melbourne Institute of Technology University in Melbourne (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1173).

Digital Vision./Thinkstock

Under construction

“Because key neurotransmitter systems in the brain responsible for inhibition and reward signaling are still developing during the teen years, existing primarily on junk food could negatively affect decision making, increase reward-seeking behavior and influence poor eating habits throughout adulthood,” Dr. Reichelt said in a press release about the special issue.

The good news is that “the heightened neuroplasticity during adolescence ... offers a window in which diet-induced cognitive decline may be particularly amenable to intervention. This provides opportunities for nutritional intervention strategies in high-risk individuals,” she and Dr. Rank concluded in the review.

Although the literature is thinner than with junk food, there are similar concerns about the effects of energy drinks and their high levels of caffeine and taurine. Energy drinks likely are detrimental to the brain function of children and adolescents, especially when mixed with alcohol, according a second review by Christine Perdan Curran, PhD, and Cécile A. Marczinski, PhD, of Northern Kentucky University, Highland Heights. (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1177).

“We don’t know enough about the effects of high consumption of energy drinks and the ingredients found in them at this critical time in mammalian brain development,” but “our recent findings in adolescent and young adult mice exposed to high taurine levels indicate there can be adverse effects on learning and memory and increased alcohol consumption in females,” Dr. Curran said in the press release.

In short, energy drinks in adolescence raise “serious concerns about adverse effects on the brain,” the researchers concluded in their review.

It’s a happier story with exercise, according to two more reviews in the teenage brain issue.
 

Less couch time

“It is clear that helping adolescents dedicate more of their time to exercise, especially high intensity or aerobic activities, may not only better their physical health but also positively influence the way their brain is structured and how it functions,” said Megan Herting, PhD, and Xiaofang Chu of the University of Southern California, Los Angeles (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1178).

Aerobic exercise in the teenage years seems to improve attention, planning, problem solving, working memory, and inhibitory control. MRI studies, meanwhile, suggest that higher aerobic fitness correlates with beneficial cortical, subcortical, and white matter structural connectivity profiles in older adolescents. In a functional MRI study of 15- to 18-year-old boys, Dr. Herting and B.J. Nagel, PhD, found that the hippocampus of 17 less fit adolescents was significantly more active than that their 17 fitter peers during a word recall test, suggesting “that exercise may influence how the brain encodes new memories and that lower-fit teens may need to utilize additional brain resources to learn something new” (J Cogn Neurosci. 2013 Apr;25[4]:595-612).
 

Boosting the benefit

Exercise also helps with substance abuse, an effect that “appears to be attributable to more than just time occupied by the activities,” according to a review led by Nora L. Nock, PhD, of Case Western Reserve University, Cleveland (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1182).

“Substance use in adolescence has been associated with adverse structural and functional brain changes, and may further exacerbate the natural imbalance” between inhibitory and excitatory neurotransmitters, “leading to further heightened impulsive and reward-driven behaviors,” the authors said.

Exercise offsets the effects by inducing structural and functional changes in the brain, including neurogenesis and angiogenesis. “If integrated during adolescence, a window of heightened reward sensitivity and neural plasticity, exercise may help to reinforce ‘naïve’ or underdeveloped connections between neurological reward and regulatory processes ... and, in turn, help offset or dampen reward seeking from substances while concomitantly improving cardiovascular health as well as academic and social achievement,” Dr. Nock and her colleagues said.

The team is studying “assisted exercise,” which helps people peddle about 35% faster on a stationary bike than they would be able to on their own. “It may be able to provide even greater effects in suppressing reward from substance use due to potentially larger increases in neurotransmitters (e.g., dopamine) and neurotrophic factors (e.g., BDNF [brain-derived neurotrophic factor]), which may be particularly beneficial in adolescents with SUD (substance use disorder) having a dopamine deficit due to genetic variation and/or lower levels of striatal dopamine receptors ... during substance abstinence,” they said.

Given those and other findings, Dr. Nock and her colleagues proposed that exercise “be initiated during early abstinence and, potentially, started before integrating other cognitive behavioral treatment components” in adolescents with SUDs.

The authors did not report any industry disclosures.

[email protected]

New research gives more reasons for you to advise teenagers to avoid junk food and energy drinks, and even better reasons to encourage them to exercise.

The latest evidence on how the teenage brain is particularly vulnerable to environmental influences, both good and bad, as it matures into adulthood is marshaled into review articles featured in a special issue of the journal Birth Defects Research entitled “The dynamic and vulnerable teenage brain” issued by the Teratology Society.

Junk food – soda, potato chips, and the like – is one of the bad influences, and not just on the waistline, according to a review by Amy Reichelt, PhD, and Michelle M. Rank, PhD, of the Royal Melbourne Institute of Technology University in Melbourne (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1173).

Digital Vision./Thinkstock

Under construction

“Because key neurotransmitter systems in the brain responsible for inhibition and reward signaling are still developing during the teen years, existing primarily on junk food could negatively affect decision making, increase reward-seeking behavior and influence poor eating habits throughout adulthood,” Dr. Reichelt said in a press release about the special issue.

The good news is that “the heightened neuroplasticity during adolescence ... offers a window in which diet-induced cognitive decline may be particularly amenable to intervention. This provides opportunities for nutritional intervention strategies in high-risk individuals,” she and Dr. Rank concluded in the review.

Although the literature is thinner than with junk food, there are similar concerns about the effects of energy drinks and their high levels of caffeine and taurine. Energy drinks likely are detrimental to the brain function of children and adolescents, especially when mixed with alcohol, according a second review by Christine Perdan Curran, PhD, and Cécile A. Marczinski, PhD, of Northern Kentucky University, Highland Heights. (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1177).

“We don’t know enough about the effects of high consumption of energy drinks and the ingredients found in them at this critical time in mammalian brain development,” but “our recent findings in adolescent and young adult mice exposed to high taurine levels indicate there can be adverse effects on learning and memory and increased alcohol consumption in females,” Dr. Curran said in the press release.

In short, energy drinks in adolescence raise “serious concerns about adverse effects on the brain,” the researchers concluded in their review.

It’s a happier story with exercise, according to two more reviews in the teenage brain issue.
 

Less couch time

“It is clear that helping adolescents dedicate more of their time to exercise, especially high intensity or aerobic activities, may not only better their physical health but also positively influence the way their brain is structured and how it functions,” said Megan Herting, PhD, and Xiaofang Chu of the University of Southern California, Los Angeles (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1178).

Aerobic exercise in the teenage years seems to improve attention, planning, problem solving, working memory, and inhibitory control. MRI studies, meanwhile, suggest that higher aerobic fitness correlates with beneficial cortical, subcortical, and white matter structural connectivity profiles in older adolescents. In a functional MRI study of 15- to 18-year-old boys, Dr. Herting and B.J. Nagel, PhD, found that the hippocampus of 17 less fit adolescents was significantly more active than that their 17 fitter peers during a word recall test, suggesting “that exercise may influence how the brain encodes new memories and that lower-fit teens may need to utilize additional brain resources to learn something new” (J Cogn Neurosci. 2013 Apr;25[4]:595-612).
 

Boosting the benefit

Exercise also helps with substance abuse, an effect that “appears to be attributable to more than just time occupied by the activities,” according to a review led by Nora L. Nock, PhD, of Case Western Reserve University, Cleveland (Birth Defects Res. 2017 Dec 1. doi: 10.1002/bdr2.1182).

“Substance use in adolescence has been associated with adverse structural and functional brain changes, and may further exacerbate the natural imbalance” between inhibitory and excitatory neurotransmitters, “leading to further heightened impulsive and reward-driven behaviors,” the authors said.

Exercise offsets the effects by inducing structural and functional changes in the brain, including neurogenesis and angiogenesis. “If integrated during adolescence, a window of heightened reward sensitivity and neural plasticity, exercise may help to reinforce ‘naïve’ or underdeveloped connections between neurological reward and regulatory processes ... and, in turn, help offset or dampen reward seeking from substances while concomitantly improving cardiovascular health as well as academic and social achievement,” Dr. Nock and her colleagues said.

The team is studying “assisted exercise,” which helps people peddle about 35% faster on a stationary bike than they would be able to on their own. “It may be able to provide even greater effects in suppressing reward from substance use due to potentially larger increases in neurotransmitters (e.g., dopamine) and neurotrophic factors (e.g., BDNF [brain-derived neurotrophic factor]), which may be particularly beneficial in adolescents with SUD (substance use disorder) having a dopamine deficit due to genetic variation and/or lower levels of striatal dopamine receptors ... during substance abstinence,” they said.

Given those and other findings, Dr. Nock and her colleagues proposed that exercise “be initiated during early abstinence and, potentially, started before integrating other cognitive behavioral treatment components” in adolescents with SUDs.

The authors did not report any industry disclosures.

[email protected]

Anxiety disorders, including separation anxiety disorder, social anxiety disorder, and generalized anxiety disorder, are some of the most common psychiatric conditions of childhood and adolescence, affecting up to 20% of youth.¹ Patients commonly present with a mix of symptoms that often span multiple anxiety disorder diagnoses. While this pattern can present somewhat of a diagnostic conundrum, it can be reassuring to know that such constellations of symptoms are the rule rather than the exception. Further, given that both the pharmacologic and nonpharmacologic treatment strategies don’t change much among the various anxiety disorders, the lack of a definitive single diagnosis should not delay intervention. Be alert to the possibility that anxiety and anxiety disorders can be the engine that drives what on the surface appears to be more disruptive and oppositional behavior.

Although medications can be a useful part of treatment, they are not recommended as a stand-alone intervention. Nonpharmacologic treatments generally should be tried before medications are considered. Among the different types of psychotherapy, cognitive-behavioral therapy (CBT) has the most empirical support from research trials, although other modalities such as mindfulness-based treatments show some promise. As anxiety disorders often run in families, it also can be very useful to explore the possibility that one or more parents also struggle with an anxiety disorder, which, if untreated, might complicate the child’s course.

AGrigorjeva/Thinkstock

With regard to medications, it is being increasingly appreciated that, despite SSRIs being most popularly known as antidepressants, these medications actually may be as efficacious or even more efficacious in the management of anxiety disorders. This class remains the cornerstone of medication treatment, and a brief review of current options follows.
 

SSRIs and SNRIs

A 2015 meta-analysis that examined nine randomized controlled trials of SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) for pediatric anxiety disorders concluded that these agents provided a benefit of modest effect size. No significant increase in treatment-emergent suicidality was found, and the medications were generally well tolerated.² This analysis also found some evidence that greater efficacy was related to a medication with more specific serotonergic properties, suggesting improved response with “true” SSRIs versus SNRIs such as venlafaxine and duloxetine. One major study using sertraline found that, at least in the short term, combined use of sertraline with CBT resulted in better efficacy than either treatment alone.³ Dosing of SSRIs should start low: A general rule is to begin at half of the smallest dosage made, depending on the age and size of the patient. One question that often comes up after a successful trial is how long to continue the medications. A recent meta-analysis in adults concluded that there was evidence that stopping medication prior to 1 year resulted in an increased risk of relapse with little to guide clinicians after that 1-year mark.⁴

Benzodiazepines

Even though benzodiazepines have been around for a long time, data supporting their efficacy and safety in pediatric populations remain extremely limited, and what has been reported has not been particularly positive. Thus, most experts do not suggest using benzodiazepines for anxiety disorders, with the exception of helping children through single or rare events, such as medical procedures or enabling an adolescent who has been fearful of attending school to get to the building on the first day back after a long absence.

Guanfacine

In a recent exploratory trial of guanfacine for children with mixed anxiety disorders,⁵ the medication was well tolerated overall but did not result in statistically significant improvement relative to placebo on primary anxiety rating scales. However, a higher number of children were rated as improved on a clinician-rated scale. This medication is usually started at 0.5 mg/day and increased as tolerated, while checking vital signs, to a maximum of 4 mg/day.

Atomoxetine

A randomized control trial of pediatric patients with both ADHD and an anxiety disorder showed reductions in both symptom domains with atomoxetine dosed at an average of 1.3 mg/kg per day.⁶ There is little evidence to suggest its use in primary anxiety disorders without comorbid ADHD.

Buspirone

This 5-hydroxytryptamine _1a agonist has Food and Drug Administration approval for generalized anxiety disorder in adults and is generally well tolerated. Unfortunately, two randomized controlled studies in children and adolescents did not find statistically significant improvement relative to placebo, although some methodological problems may have played a role.⁷

Antipsychotics

Although sometimes used to augment an SSRI in adult anxiety disorders, there are little data to support the use of antipsychotics in pediatric populations, especially given the antecedent risks of the drugs.

Summary

Pharmacotherapy for anxiety disorders often includes the advice that, if medications are indicated in conjunction with psychotherapy, to start with an SSRI; and if that is not effective to try a different one.⁷ An SNRI such as venlafaxine or duloxetine may then be a third-line alternative, although for youth with comorbid ADHD, consideration of either atomoxetine or guanfacine is also reasonable. Beyond that point, there unfortunately are little systematic data to guide pharmacologic decision making, and increased potential risks of other classes of medications suggest the need for caution and consultation.

References

1. Merikangas KR et al. J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9.

2. Strawn JR et al. Depress Anxiety. 2015 Mar;32(3):149-57.

3. Walkup J et al. N Engl J Med. 2008 Dec 25;359(26):2753-66.

4. Batelaan N et al. BMJ. 2017 Sep 13;358:j3927.

5. Strawn JR et al. J Child Adolesc Psychopharm. 2017 Feb;27(1): 29-37..

6. Geller D et al. J Am Acad Child Adolesc Psychiatry. 2007 Sep;46(9):1119-27.

7. Strawn JR et al. J Child Adolesc Psychopharm. 2017 Feb;28(1): 2-9.




 

Anxiety disorders, including separation anxiety disorder, social anxiety disorder, and generalized anxiety disorder, are some of the most common psychiatric conditions of childhood and adolescence, affecting up to 20% of youth.¹ Patients commonly present with a mix of symptoms that often span multiple anxiety disorder diagnoses. While this pattern can present somewhat of a diagnostic conundrum, it can be reassuring to know that such constellations of symptoms are the rule rather than the exception. Further, given that both the pharmacologic and nonpharmacologic treatment strategies don’t change much among the various anxiety disorders, the lack of a definitive single diagnosis should not delay intervention. Be alert to the possibility that anxiety and anxiety disorders can be the engine that drives what on the surface appears to be more disruptive and oppositional behavior.

Although medications can be a useful part of treatment, they are not recommended as a stand-alone intervention. Nonpharmacologic treatments generally should be tried before medications are considered. Among the different types of psychotherapy, cognitive-behavioral therapy (CBT) has the most empirical support from research trials, although other modalities such as mindfulness-based treatments show some promise. As anxiety disorders often run in families, it also can be very useful to explore the possibility that one or more parents also struggle with an anxiety disorder, which, if untreated, might complicate the child’s course.

AGrigorjeva/Thinkstock

With regard to medications, it is being increasingly appreciated that, despite SSRIs being most popularly known as antidepressants, these medications actually may be as efficacious or even more efficacious in the management of anxiety disorders. This class remains the cornerstone of medication treatment, and a brief review of current options follows.
 

SSRIs and SNRIs

A 2015 meta-analysis that examined nine randomized controlled trials of SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) for pediatric anxiety disorders concluded that these agents provided a benefit of modest effect size. No significant increase in treatment-emergent suicidality was found, and the medications were generally well tolerated.² This analysis also found some evidence that greater efficacy was related to a medication with more specific serotonergic properties, suggesting improved response with “true” SSRIs versus SNRIs such as venlafaxine and duloxetine. One major study using sertraline found that, at least in the short term, combined use of sertraline with CBT resulted in better efficacy than either treatment alone.³ Dosing of SSRIs should start low: A general rule is to begin at half of the smallest dosage made, depending on the age and size of the patient. One question that often comes up after a successful trial is how long to continue the medications. A recent meta-analysis in adults concluded that there was evidence that stopping medication prior to 1 year resulted in an increased risk of relapse with little to guide clinicians after that 1-year mark.⁴

Benzodiazepines

Even though benzodiazepines have been around for a long time, data supporting their efficacy and safety in pediatric populations remain extremely limited, and what has been reported has not been particularly positive. Thus, most experts do not suggest using benzodiazepines for anxiety disorders, with the exception of helping children through single or rare events, such as medical procedures or enabling an adolescent who has been fearful of attending school to get to the building on the first day back after a long absence.

Guanfacine

In a recent exploratory trial of guanfacine for children with mixed anxiety disorders,⁵ the medication was well tolerated overall but did not result in statistically significant improvement relative to placebo on primary anxiety rating scales. However, a higher number of children were rated as improved on a clinician-rated scale. This medication is usually started at 0.5 mg/day and increased as tolerated, while checking vital signs, to a maximum of 4 mg/day.

Atomoxetine

A randomized control trial of pediatric patients with both ADHD and an anxiety disorder showed reductions in both symptom domains with atomoxetine dosed at an average of 1.3 mg/kg per day.⁶ There is little evidence to suggest its use in primary anxiety disorders without comorbid ADHD.

Buspirone

This 5-hydroxytryptamine _1a agonist has Food and Drug Administration approval for generalized anxiety disorder in adults and is generally well tolerated. Unfortunately, two randomized controlled studies in children and adolescents did not find statistically significant improvement relative to placebo, although some methodological problems may have played a role.⁷

Antipsychotics

Although sometimes used to augment an SSRI in adult anxiety disorders, there are little data to support the use of antipsychotics in pediatric populations, especially given the antecedent risks of the drugs.

Summary

Pharmacotherapy for anxiety disorders often includes the advice that, if medications are indicated in conjunction with psychotherapy, to start with an SSRI; and if that is not effective to try a different one.⁷ An SNRI such as venlafaxine or duloxetine may then be a third-line alternative, although for youth with comorbid ADHD, consideration of either atomoxetine or guanfacine is also reasonable. Beyond that point, there unfortunately are little systematic data to guide pharmacologic decision making, and increased potential risks of other classes of medications suggest the need for caution and consultation.

References

1. Merikangas KR et al. J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9.

2. Strawn JR et al. Depress Anxiety. 2015 Mar;32(3):149-57.

3. Walkup J et al. N Engl J Med. 2008 Dec 25;359(26):2753-66.

4. Batelaan N et al. BMJ. 2017 Sep 13;358:j3927.

5. Strawn JR et al. J Child Adolesc Psychopharm. 2017 Feb;27(1): 29-37..

6. Geller D et al. J Am Acad Child Adolesc Psychiatry. 2007 Sep;46(9):1119-27.

7. Strawn JR et al. J Child Adolesc Psychopharm. 2017 Feb;28(1): 2-9.




 

Anxiety disorders, including separation anxiety disorder, social anxiety disorder, and generalized anxiety disorder, are some of the most common psychiatric conditions of childhood and adolescence, affecting up to 20% of youth.¹ Patients commonly present with a mix of symptoms that often span multiple anxiety disorder diagnoses. While this pattern can present somewhat of a diagnostic conundrum, it can be reassuring to know that such constellations of symptoms are the rule rather than the exception. Further, given that both the pharmacologic and nonpharmacologic treatment strategies don’t change much among the various anxiety disorders, the lack of a definitive single diagnosis should not delay intervention. Be alert to the possibility that anxiety and anxiety disorders can be the engine that drives what on the surface appears to be more disruptive and oppositional behavior.

Although medications can be a useful part of treatment, they are not recommended as a stand-alone intervention. Nonpharmacologic treatments generally should be tried before medications are considered. Among the different types of psychotherapy, cognitive-behavioral therapy (CBT) has the most empirical support from research trials, although other modalities such as mindfulness-based treatments show some promise. As anxiety disorders often run in families, it also can be very useful to explore the possibility that one or more parents also struggle with an anxiety disorder, which, if untreated, might complicate the child’s course.

AGrigorjeva/Thinkstock

With regard to medications, it is being increasingly appreciated that, despite SSRIs being most popularly known as antidepressants, these medications actually may be as efficacious or even more efficacious in the management of anxiety disorders. This class remains the cornerstone of medication treatment, and a brief review of current options follows.
 

SSRIs and SNRIs

A 2015 meta-analysis that examined nine randomized controlled trials of SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) for pediatric anxiety disorders concluded that these agents provided a benefit of modest effect size. No significant increase in treatment-emergent suicidality was found, and the medications were generally well tolerated.² This analysis also found some evidence that greater efficacy was related to a medication with more specific serotonergic properties, suggesting improved response with “true” SSRIs versus SNRIs such as venlafaxine and duloxetine. One major study using sertraline found that, at least in the short term, combined use of sertraline with CBT resulted in better efficacy than either treatment alone.³ Dosing of SSRIs should start low: A general rule is to begin at half of the smallest dosage made, depending on the age and size of the patient. One question that often comes up after a successful trial is how long to continue the medications. A recent meta-analysis in adults concluded that there was evidence that stopping medication prior to 1 year resulted in an increased risk of relapse with little to guide clinicians after that 1-year mark.⁴

Benzodiazepines

Even though benzodiazepines have been around for a long time, data supporting their efficacy and safety in pediatric populations remain extremely limited, and what has been reported has not been particularly positive. Thus, most experts do not suggest using benzodiazepines for anxiety disorders, with the exception of helping children through single or rare events, such as medical procedures or enabling an adolescent who has been fearful of attending school to get to the building on the first day back after a long absence.

Guanfacine

In a recent exploratory trial of guanfacine for children with mixed anxiety disorders,⁵ the medication was well tolerated overall but did not result in statistically significant improvement relative to placebo on primary anxiety rating scales. However, a higher number of children were rated as improved on a clinician-rated scale. This medication is usually started at 0.5 mg/day and increased as tolerated, while checking vital signs, to a maximum of 4 mg/day.

Atomoxetine

A randomized control trial of pediatric patients with both ADHD and an anxiety disorder showed reductions in both symptom domains with atomoxetine dosed at an average of 1.3 mg/kg per day.⁶ There is little evidence to suggest its use in primary anxiety disorders without comorbid ADHD.

Buspirone

This 5-hydroxytryptamine _1a agonist has Food and Drug Administration approval for generalized anxiety disorder in adults and is generally well tolerated. Unfortunately, two randomized controlled studies in children and adolescents did not find statistically significant improvement relative to placebo, although some methodological problems may have played a role.⁷

Antipsychotics

Although sometimes used to augment an SSRI in adult anxiety disorders, there are little data to support the use of antipsychotics in pediatric populations, especially given the antecedent risks of the drugs.

Summary

Pharmacotherapy for anxiety disorders often includes the advice that, if medications are indicated in conjunction with psychotherapy, to start with an SSRI; and if that is not effective to try a different one.⁷ An SNRI such as venlafaxine or duloxetine may then be a third-line alternative, although for youth with comorbid ADHD, consideration of either atomoxetine or guanfacine is also reasonable. Beyond that point, there unfortunately are little systematic data to guide pharmacologic decision making, and increased potential risks of other classes of medications suggest the need for caution and consultation.

References

1. Merikangas KR et al. J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9.

2. Strawn JR et al. Depress Anxiety. 2015 Mar;32(3):149-57.

3. Walkup J et al. N Engl J Med. 2008 Dec 25;359(26):2753-66.

4. Batelaan N et al. BMJ. 2017 Sep 13;358:j3927.

5. Strawn JR et al. J Child Adolesc Psychopharm. 2017 Feb;27(1): 29-37..

6. Geller D et al. J Am Acad Child Adolesc Psychiatry. 2007 Sep;46(9):1119-27.

7. Strawn JR et al. J Child Adolesc Psychopharm. 2017 Feb;28(1): 2-9.




 

Each year, the American Gastroenterological Association travels throughout the country, hosting Regional Practice Skills Workshops to answer tough and practical questions that are rarely addressed during fellowship. Presentations from several of the 2017 workshops are now available on the AGA website for you to watch at your leisure (login required). Each presentation is 20 minutes or less and provides expert advice to help you succeed in your career.

Here’s a selection of what you’ll find at www.gastro.org/education:

• Physician Contracts and Negotiations – Jon Appino from Contract Diagnostics discusses the anatomy of physician employment agreements. He shares questions that are important for you to ask when reviewing a contract.
• Career in Hybrid Practice – John S. Hanson, MD, AGAF, from Carolinas HealthCare System reviews different practice types and provides insight into “hybrid practice” and how it compares to private practice and academic practice.
• Career in Private Practice – Rig S. Patel, MD, the president of Digestive Healthcare PA, builds a clear picture of what life is like in private practice and shares nine things to consider when reviewing a private practice.
• Wealth Management Perspectives – Two financial advisors from Morgan Stanley provide tips and strategies to help early career physicians stay “financially fit.”

See all of AGA’s on-demand education for trainees and early career GIs by visiting www.gastro.org/education and searching for the series Trainees and Early Career GIs.

The AGA Regional Practice Skills Workshops are organized by the AGA Trainee & Early Career Committee in support of early career GIs. In December 2017, workshops were held in California, Iowa, and New York. The spring 2018 workshops will take place in Columbus, Ohio (Feb. 24), and Philadelphia, Penn. (April 11).
 

Each year, the American Gastroenterological Association travels throughout the country, hosting Regional Practice Skills Workshops to answer tough and practical questions that are rarely addressed during fellowship. Presentations from several of the 2017 workshops are now available on the AGA website for you to watch at your leisure (login required). Each presentation is 20 minutes or less and provides expert advice to help you succeed in your career.

Here’s a selection of what you’ll find at www.gastro.org/education:

• Physician Contracts and Negotiations – Jon Appino from Contract Diagnostics discusses the anatomy of physician employment agreements. He shares questions that are important for you to ask when reviewing a contract.
• Career in Hybrid Practice – John S. Hanson, MD, AGAF, from Carolinas HealthCare System reviews different practice types and provides insight into “hybrid practice” and how it compares to private practice and academic practice.
• Career in Private Practice – Rig S. Patel, MD, the president of Digestive Healthcare PA, builds a clear picture of what life is like in private practice and shares nine things to consider when reviewing a private practice.
• Wealth Management Perspectives – Two financial advisors from Morgan Stanley provide tips and strategies to help early career physicians stay “financially fit.”

See all of AGA’s on-demand education for trainees and early career GIs by visiting www.gastro.org/education and searching for the series Trainees and Early Career GIs.

The AGA Regional Practice Skills Workshops are organized by the AGA Trainee & Early Career Committee in support of early career GIs. In December 2017, workshops were held in California, Iowa, and New York. The spring 2018 workshops will take place in Columbus, Ohio (Feb. 24), and Philadelphia, Penn. (April 11).
 

Each year, the American Gastroenterological Association travels throughout the country, hosting Regional Practice Skills Workshops to answer tough and practical questions that are rarely addressed during fellowship. Presentations from several of the 2017 workshops are now available on the AGA website for you to watch at your leisure (login required). Each presentation is 20 minutes or less and provides expert advice to help you succeed in your career.

Here’s a selection of what you’ll find at www.gastro.org/education:

• Physician Contracts and Negotiations – Jon Appino from Contract Diagnostics discusses the anatomy of physician employment agreements. He shares questions that are important for you to ask when reviewing a contract.
• Career in Hybrid Practice – John S. Hanson, MD, AGAF, from Carolinas HealthCare System reviews different practice types and provides insight into “hybrid practice” and how it compares to private practice and academic practice.
• Career in Private Practice – Rig S. Patel, MD, the president of Digestive Healthcare PA, builds a clear picture of what life is like in private practice and shares nine things to consider when reviewing a private practice.
• Wealth Management Perspectives – Two financial advisors from Morgan Stanley provide tips and strategies to help early career physicians stay “financially fit.”

See all of AGA’s on-demand education for trainees and early career GIs by visiting www.gastro.org/education and searching for the series Trainees and Early Career GIs.

The AGA Regional Practice Skills Workshops are organized by the AGA Trainee & Early Career Committee in support of early career GIs. In December 2017, workshops were held in California, Iowa, and New York. The spring 2018 workshops will take place in Columbus, Ohio (Feb. 24), and Philadelphia, Penn. (April 11).
 

We held a contest in the AGA Community forum asking members to share a piece of advice they learned or heard in the past year for a chance to win free registration to this year’s AGA Postgraduate Course in Washington, D.C., on June 2 and 3.

Here are some of our favorite responses from early career members, including our winner, Hüseyin Bozkurt from Medical Park Private Tarsus Hospital, Turkey:

• “We can provide healthy gut microbiome, don’t lose your hope. The future is changeable.” Hüseyin Bozkurt Sr., MD, contest winner.
• “Ambulatory reflux monitoring modalities can help phenotype GERD and guide optimal management.” Amit Patel, MD, 2018 AGA Postgraduate Course faculty.
• “One tip I heard from an attending in the first year of fellowship, which is particularly useful for IBS patients, is to set realistic expectations from the outset, for e.g. – when diagnosing patients with IBS and giving them advice, telling them ‘We are not looking to cure your GI symptoms, but to control them – you will have GI symptoms off and on despite treatment, my goal is to make sure you have more good days, than bad.’” Aakash Aggarwal, MD

Registration for the popular 1.5-day course is now open. Learn more at pgcourse.gastro.org and save $75 by registering before April 18.

The AGA Postgraduate Course takes place during AGA’s annual meeting Digestive Disease Week®, which is cosponsored by AASLD, ASGE, and SSAT. Learn more and register at www.ddw.org.

We held a contest in the AGA Community forum asking members to share a piece of advice they learned or heard in the past year for a chance to win free registration to this year’s AGA Postgraduate Course in Washington, D.C., on June 2 and 3.

Here are some of our favorite responses from early career members, including our winner, Hüseyin Bozkurt from Medical Park Private Tarsus Hospital, Turkey:

• “We can provide healthy gut microbiome, don’t lose your hope. The future is changeable.” Hüseyin Bozkurt Sr., MD, contest winner.
• “Ambulatory reflux monitoring modalities can help phenotype GERD and guide optimal management.” Amit Patel, MD, 2018 AGA Postgraduate Course faculty.
• “One tip I heard from an attending in the first year of fellowship, which is particularly useful for IBS patients, is to set realistic expectations from the outset, for e.g. – when diagnosing patients with IBS and giving them advice, telling them ‘We are not looking to cure your GI symptoms, but to control them – you will have GI symptoms off and on despite treatment, my goal is to make sure you have more good days, than bad.’” Aakash Aggarwal, MD

Registration for the popular 1.5-day course is now open. Learn more at pgcourse.gastro.org and save $75 by registering before April 18.

The AGA Postgraduate Course takes place during AGA’s annual meeting Digestive Disease Week®, which is cosponsored by AASLD, ASGE, and SSAT. Learn more and register at www.ddw.org.

We held a contest in the AGA Community forum asking members to share a piece of advice they learned or heard in the past year for a chance to win free registration to this year’s AGA Postgraduate Course in Washington, D.C., on June 2 and 3.

Here are some of our favorite responses from early career members, including our winner, Hüseyin Bozkurt from Medical Park Private Tarsus Hospital, Turkey:

• “We can provide healthy gut microbiome, don’t lose your hope. The future is changeable.” Hüseyin Bozkurt Sr., MD, contest winner.
• “Ambulatory reflux monitoring modalities can help phenotype GERD and guide optimal management.” Amit Patel, MD, 2018 AGA Postgraduate Course faculty.
• “One tip I heard from an attending in the first year of fellowship, which is particularly useful for IBS patients, is to set realistic expectations from the outset, for e.g. – when diagnosing patients with IBS and giving them advice, telling them ‘We are not looking to cure your GI symptoms, but to control them – you will have GI symptoms off and on despite treatment, my goal is to make sure you have more good days, than bad.’” Aakash Aggarwal, MD

Registration for the popular 1.5-day course is now open. Learn more at pgcourse.gastro.org and save $75 by registering before April 18.

The AGA Postgraduate Course takes place during AGA’s annual meeting Digestive Disease Week®, which is cosponsored by AASLD, ASGE, and SSAT. Learn more and register at www.ddw.org.

A career in inflammatory bowel disease promises to be challenging, exciting, at times frustrating, and always educational. We asked our expert faculty at the inaugural Crohn’s & Colitis Congress, which took place Jan. 18-20 in Las Vegas, to reflect on why a career in IBD is an excellent path to take.

Why pursue a career in IBD

1. “IBD is the fastest moving area of GI to integrate science (genomics, microbiome, immunology) into care that will change the natural history of disease. The physicians and scientists have an unusually collegial culture, and the patients really care.” – Jonathan G. Braun, MD, PhD



2. “Managing patients with IBD is becoming ever more complex. When patients move beyond having mild disease, complex decisions need to be made. Choosing the right medication at the right time for the right patient will lead to the best outcomes for patients with IBD. I have every reason to believe that specializing in the clinical care of patients with IBD will be intellectually challenging while offering great personal satisfaction in taking care of these ill patients.” – Francis A. Farraye, MD, MSc



3. “IBD research findings and the implications for patient care are evolving rapidly. Many recommendations that we made 5-10 years ago have changed as we are learning more about IBD every day. There are so many opportunities to participate in the expansion of that knowledge base and help us reach our goal of a cure for IBD in the lifetime of many of our patients. Take the challenge.” – Teri Lynn Jackson, MSN, ARNP



4. “IBD is an outstanding field led by great people who want to see fellows and junior faculty succeed. Identify a mentor and listen to them, meet and engage with new people, be curious, think big, and work hard!” – Michael J. Rosen, MD, MSCI



5. “The best career in the world! Such variety. A home for everyone with any interest. It won’t always be smooth, but it will be incredibly rewarding with hardly a dull moment.” – Dermot McGovern, MD, PhD, FRCP



For additional tips and advice, visit the AGA Community.
 

A career in inflammatory bowel disease promises to be challenging, exciting, at times frustrating, and always educational. We asked our expert faculty at the inaugural Crohn’s & Colitis Congress, which took place Jan. 18-20 in Las Vegas, to reflect on why a career in IBD is an excellent path to take.

Why pursue a career in IBD

1. “IBD is the fastest moving area of GI to integrate science (genomics, microbiome, immunology) into care that will change the natural history of disease. The physicians and scientists have an unusually collegial culture, and the patients really care.” – Jonathan G. Braun, MD, PhD



2. “Managing patients with IBD is becoming ever more complex. When patients move beyond having mild disease, complex decisions need to be made. Choosing the right medication at the right time for the right patient will lead to the best outcomes for patients with IBD. I have every reason to believe that specializing in the clinical care of patients with IBD will be intellectually challenging while offering great personal satisfaction in taking care of these ill patients.” – Francis A. Farraye, MD, MSc



3. “IBD research findings and the implications for patient care are evolving rapidly. Many recommendations that we made 5-10 years ago have changed as we are learning more about IBD every day. There are so many opportunities to participate in the expansion of that knowledge base and help us reach our goal of a cure for IBD in the lifetime of many of our patients. Take the challenge.” – Teri Lynn Jackson, MSN, ARNP



4. “IBD is an outstanding field led by great people who want to see fellows and junior faculty succeed. Identify a mentor and listen to them, meet and engage with new people, be curious, think big, and work hard!” – Michael J. Rosen, MD, MSCI



5. “The best career in the world! Such variety. A home for everyone with any interest. It won’t always be smooth, but it will be incredibly rewarding with hardly a dull moment.” – Dermot McGovern, MD, PhD, FRCP



For additional tips and advice, visit the AGA Community.
 

A career in inflammatory bowel disease promises to be challenging, exciting, at times frustrating, and always educational. We asked our expert faculty at the inaugural Crohn’s & Colitis Congress, which took place Jan. 18-20 in Las Vegas, to reflect on why a career in IBD is an excellent path to take.

Why pursue a career in IBD

1. “IBD is the fastest moving area of GI to integrate science (genomics, microbiome, immunology) into care that will change the natural history of disease. The physicians and scientists have an unusually collegial culture, and the patients really care.” – Jonathan G. Braun, MD, PhD



2. “Managing patients with IBD is becoming ever more complex. When patients move beyond having mild disease, complex decisions need to be made. Choosing the right medication at the right time for the right patient will lead to the best outcomes for patients with IBD. I have every reason to believe that specializing in the clinical care of patients with IBD will be intellectually challenging while offering great personal satisfaction in taking care of these ill patients.” – Francis A. Farraye, MD, MSc



3. “IBD research findings and the implications for patient care are evolving rapidly. Many recommendations that we made 5-10 years ago have changed as we are learning more about IBD every day. There are so many opportunities to participate in the expansion of that knowledge base and help us reach our goal of a cure for IBD in the lifetime of many of our patients. Take the challenge.” – Teri Lynn Jackson, MSN, ARNP



4. “IBD is an outstanding field led by great people who want to see fellows and junior faculty succeed. Identify a mentor and listen to them, meet and engage with new people, be curious, think big, and work hard!” – Michael J. Rosen, MD, MSCI



5. “The best career in the world! Such variety. A home for everyone with any interest. It won’t always be smooth, but it will be incredibly rewarding with hardly a dull moment.” – Dermot McGovern, MD, PhD, FRCP



For additional tips and advice, visit the AGA Community.
 

Unfathomable. Unspeakable.

These are among the terms used to describe children’s extreme traumatic experiences such as severe abuse and neglect. It is often most shocking when these acts are perpetrated by the children’s parents – the very ones that children should be able to depend on for their protection and safety.

Many believe that, in addition to the cumulative and serious nature of repetitive interpersonal traumas themselves, this betrayal of trust will result in irreparable psychological damage. Fortunately, this does not have to be the case. Children are more resilient than we realize; with safety, support, and effective treatment, they can recover from even the most extreme traumas and live healthy, productive lives.

The first priority is for child-serving systems to remove children from severely abusive situations and allow them to live in safe, stable, supportive settings while minimizing traumatic separation from siblings or further disruptions in their living situation. Acute medical problems need to be stabilized, and a thorough mental health assessment should be conducted.

Evidence-based trauma-focused psychotherapy is the first-line treatment for addressing pediatric posttraumatic stress disorder (J Am Acad Child Adolesc Psychiatry. 2010 Apr;49[4]:414-30). Several treatments are currently available. A few examples are trauma-focused cognitive-behavioral therapy, or TF-CBT, for children aged 3-18 years; child-parent psychotherapy (CPP) for children aged 0-6 years; a group school-based model, cognitive behavioral interventions for trauma in schools (CBITS); and Trauma Affect Regulation: Guide for Education and Therapy for teens (TARGET).

Common elements of evidence-based trauma-focused treatments are: 1) nonperpetrating caregivers are included in therapy to enhance support and understanding of the child’s trauma responses, and to address trauma-related behavioral problems; 2) skills are provided to the youth and caregiver for coping with negative trauma-related thoughts, feelings, and behaviors; and 3) children are supported to directly talk about and make meaning of their trauma experiences.

Through trauma-focused treatment, children become able to cope with their traumatic experiences and memories – make sense out of them. These traumas are no longer “unfathomable or “unspeakable,” but rather, manageable memories of bad experiences that the children have had the courage to face and master.

Children can recover from even extreme trauma experiences when they receive effective trauma-focused treatment in the context of a supportive environment. More information about evidence-based treatments is available from the National Child Traumatic Stress Network at www.nctsn.org/resources/topics/treatments-that-work/promising-practices.
 

Unfathomable. Unspeakable.

These are among the terms used to describe children’s extreme traumatic experiences such as severe abuse and neglect. It is often most shocking when these acts are perpetrated by the children’s parents – the very ones that children should be able to depend on for their protection and safety.

Many believe that, in addition to the cumulative and serious nature of repetitive interpersonal traumas themselves, this betrayal of trust will result in irreparable psychological damage. Fortunately, this does not have to be the case. Children are more resilient than we realize; with safety, support, and effective treatment, they can recover from even the most extreme traumas and live healthy, productive lives.

The first priority is for child-serving systems to remove children from severely abusive situations and allow them to live in safe, stable, supportive settings while minimizing traumatic separation from siblings or further disruptions in their living situation. Acute medical problems need to be stabilized, and a thorough mental health assessment should be conducted.

Evidence-based trauma-focused psychotherapy is the first-line treatment for addressing pediatric posttraumatic stress disorder (J Am Acad Child Adolesc Psychiatry. 2010 Apr;49[4]:414-30). Several treatments are currently available. A few examples are trauma-focused cognitive-behavioral therapy, or TF-CBT, for children aged 3-18 years; child-parent psychotherapy (CPP) for children aged 0-6 years; a group school-based model, cognitive behavioral interventions for trauma in schools (CBITS); and Trauma Affect Regulation: Guide for Education and Therapy for teens (TARGET).

Common elements of evidence-based trauma-focused treatments are: 1) nonperpetrating caregivers are included in therapy to enhance support and understanding of the child’s trauma responses, and to address trauma-related behavioral problems; 2) skills are provided to the youth and caregiver for coping with negative trauma-related thoughts, feelings, and behaviors; and 3) children are supported to directly talk about and make meaning of their trauma experiences.

Through trauma-focused treatment, children become able to cope with their traumatic experiences and memories – make sense out of them. These traumas are no longer “unfathomable or “unspeakable,” but rather, manageable memories of bad experiences that the children have had the courage to face and master.

Children can recover from even extreme trauma experiences when they receive effective trauma-focused treatment in the context of a supportive environment. More information about evidence-based treatments is available from the National Child Traumatic Stress Network at www.nctsn.org/resources/topics/treatments-that-work/promising-practices.
 

Unfathomable. Unspeakable.

These are among the terms used to describe children’s extreme traumatic experiences such as severe abuse and neglect. It is often most shocking when these acts are perpetrated by the children’s parents – the very ones that children should be able to depend on for their protection and safety.

Many believe that, in addition to the cumulative and serious nature of repetitive interpersonal traumas themselves, this betrayal of trust will result in irreparable psychological damage. Fortunately, this does not have to be the case. Children are more resilient than we realize; with safety, support, and effective treatment, they can recover from even the most extreme traumas and live healthy, productive lives.

The first priority is for child-serving systems to remove children from severely abusive situations and allow them to live in safe, stable, supportive settings while minimizing traumatic separation from siblings or further disruptions in their living situation. Acute medical problems need to be stabilized, and a thorough mental health assessment should be conducted.

Evidence-based trauma-focused psychotherapy is the first-line treatment for addressing pediatric posttraumatic stress disorder (J Am Acad Child Adolesc Psychiatry. 2010 Apr;49[4]:414-30). Several treatments are currently available. A few examples are trauma-focused cognitive-behavioral therapy, or TF-CBT, for children aged 3-18 years; child-parent psychotherapy (CPP) for children aged 0-6 years; a group school-based model, cognitive behavioral interventions for trauma in schools (CBITS); and Trauma Affect Regulation: Guide for Education and Therapy for teens (TARGET).

Common elements of evidence-based trauma-focused treatments are: 1) nonperpetrating caregivers are included in therapy to enhance support and understanding of the child’s trauma responses, and to address trauma-related behavioral problems; 2) skills are provided to the youth and caregiver for coping with negative trauma-related thoughts, feelings, and behaviors; and 3) children are supported to directly talk about and make meaning of their trauma experiences.

Through trauma-focused treatment, children become able to cope with their traumatic experiences and memories – make sense out of them. These traumas are no longer “unfathomable or “unspeakable,” but rather, manageable memories of bad experiences that the children have had the courage to face and master.

Children can recover from even extreme trauma experiences when they receive effective trauma-focused treatment in the context of a supportive environment. More information about evidence-based treatments is available from the National Child Traumatic Stress Network at www.nctsn.org/resources/topics/treatments-that-work/promising-practices.
 

Social media communication around lung cancer is focused primarily on cancer treatment and use of pharmaceutical and research interventions, followed closely by awareness, prevention, and risk topics, according to an analysis of Twitter conversation over a 10-day period.

Although awareness and risk prevention tweets were likely to contain cues toward action, “messages focused on treatment, end of life ... were significantly less likely to integrate cues for personal activity,” the investigators wrote. The report was published in Journal of the American College of Radiology.

©Huntstock/thinkstockphotos.com

SOURCE: Sutton J. et al., J Am Coll Radiol. 2018 Jan. doi: 10.1016/j.jacr.2017.09.043

Social media communication around lung cancer is focused primarily on cancer treatment and use of pharmaceutical and research interventions, followed closely by awareness, prevention, and risk topics, according to an analysis of Twitter conversation over a 10-day period.

Although awareness and risk prevention tweets were likely to contain cues toward action, “messages focused on treatment, end of life ... were significantly less likely to integrate cues for personal activity,” the investigators wrote. The report was published in Journal of the American College of Radiology.

©Huntstock/thinkstockphotos.com

SOURCE: Sutton J. et al., J Am Coll Radiol. 2018 Jan. doi: 10.1016/j.jacr.2017.09.043

Social media communication around lung cancer is focused primarily on cancer treatment and use of pharmaceutical and research interventions, followed closely by awareness, prevention, and risk topics, according to an analysis of Twitter conversation over a 10-day period.

Although awareness and risk prevention tweets were likely to contain cues toward action, “messages focused on treatment, end of life ... were significantly less likely to integrate cues for personal activity,” the investigators wrote. The report was published in Journal of the American College of Radiology.

©Huntstock/thinkstockphotos.com

SOURCE: Sutton J. et al., J Am Coll Radiol. 2018 Jan. doi: 10.1016/j.jacr.2017.09.043