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Exam Code: CGRN Practice exam 2022 by Killexams.com team
CGRN ABCGN Certified Gastroenterology Registered Nurse

The Examination: There is one ABCGN certification examination for RNs. The examination is based on role delineations -- surveys of practitioners, which define the scope of practice and the knowledge and skills required to function in the field. All examination items are written by certified individuals with expertise in the field of gastroenterology and/or gastroenterology endoscopy nursing practice.

Test Items (Questions): Test items are reviewed, referenced and validated by the ABCGN Item Writers Committee and, finally, edited by the testing company for construction, grammatical correctness and clarity. Examination Content The CGRN examination each consist of 175 multiple-choice questions. Each question has four choices and one correct answer. Candidates have three hours to complete their examination.

The CGRN examination contains questions from four major content areas: general nursing care, gastroenterological procedures, patient care interventions and environmental safety, infection prevention and control. All questions are directly related to the GI specialty. More specific information regarding the content of the examinations is included in the Appendix of the Certification Handbook.

Preparation for the Examination: ABCGN does not sponsor or endorse test preparation or review courses for the certification examinations. SGNA, ABCGN's sister organization, offers both courses and materials for the exam and recertification. Visit the SGNA website for more details.

1. General Nursing Care 24%
2. Gastroenterological Procedures 33%
3. Patient Care Interventions 27%
4. Environmental Safety, Infection Prevention and Control 16%

Domain I: General Nursing Care
Task A: Assess and analyze the patients health status through data collection.
Knowledge of:
1. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
2. Physiological, psychological, social, cultural, and spiritual aspects of their wellness
3. Pharmacology (e.g. Prescription medication, OTC, supplements-herbal)
Task B: Monitor and assess the patients health status to determine necessary nursing interventions.
Knowledge of:
Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
2. Physiological, psychological, social, cultural, and spiritual aspects of their wellness
3. Pharmacology (e.g. compliance/noncompliance issues, education, drug interaction)
4. Advocating and protecting patients rights and privacy (e.g. HIPAA, ethics)
Task C: Educate the patient through effective communication to develop a plan of care directed to the patients level of understanding.
Knowledge of:
1. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
2. Physiological, psychological, social, cultural, and spiritual aspects of their wellness
3. Pharmacology (e.g. Prescription medication, OTC, supplements-herbal)

Domain II: Gastroenterological Procedures
Task A: Collaborate with the health care team during endoscopic procedures to provide safe and effective care.
Knowledge of:
1. Endoscopic procedures ( e.g. diagnostic, interventional)
2. Equipment and accessories
3. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
4. Environment of care (e.g. thermal burns, chemical spills, radiation, time out)
5. Pharmacology(e.g. sedation medication, reversal agents, procedure medications, resuscitative medication)
6. Physiological, psychological, social, spiritual, and cultural aspects of wellness
7. Potential complications and anticipated interventions (e.g. hemorrhage, perforation, compromised airway, medication reaction)
8. Specimen processing and handling (e.g. labeling, storage, transportation)
Task B: Collaboration with the health care teamduring non-endoscopic procedures to provide safe and effective care.
Knowledge of:
1. Non-endoscopic procedures (e.g. diagnostic, interventional)
2. Equipment and accessories (e.g. needles, probes, capsules, ligature, PEG exchange)
3. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
4. Environment of care (e.g. spills, time out)
5. Pharmacology(e.g. learning needs, sedation medication, reversal agents, procedure medications, resuscitative medication)
6. Physiological, psychological, social, spiritual, and cultural aspects of wellness
7. Potential risks, complications, and interventions
8. Specimen processing and handling (e.g. labeling, storage, transportation)
Task C: Perform non-endoscopic procedures to promote optimal patient outcomes.
Knowledge of:
1. Non-endoscopic procedures (e.g. diagnostic, interventional)
2. Equipment and accessories (e.g. probes, capsules, PEG exchange)
3. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
4. Environment of care (e.g. time out, spills)
5. Pharmacology (e.g. biologics)
6. Physiological, psychological, social, spiritual, and cultural aspects of wellness
7. Potential risks, complications, and interventions
8. Specimen processing and handling (e.g. labeling, storage, transportation)

Domain III: Patient Care Interventions
Task A: Recognize and respond to emergent changes in the patients status to prevent complications and maximize positive outcomes.
Knowledge of:
1. Potential risks, complications, and anticipated interventions (e.g. underlines conditions)
2. Resuscitation procedures and equipment
3. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
4. Emergency medications (e.g. Romazicon, Atropine, Narcan, Epinephrine)
5. Sedation guidelines and principles (e.g. ASA, airway status)
Task 2: Promoting wellness by managing GI health care needs.
Knowledge of:
1. Diet and Nutrition (e.g. supplements, high fiber diet, other specialized diets, diet modifications)
2. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
3. Therapeutic interventions in pain management (e.g. ambulation, medication, positioning)
4. Patients rights and responsibilities (e.g. advanced directives)
5. Pharmacology (e.g. PPI, laxative, pro-biotics, biologics, timing of medication)
6. Potential complications (e.g. flare ups, drug reactions/interactions)
7. Physiological, psychological, social, sexual, spiritual, and cultural aspects of wellness
8. Resources (e.g. palliative, support group, financial and social assistance)
Task C: Administer medications and fluids consistent to provide safe and effective care.
Knowledge of:
1. Established standards for administering medications and fluids (e.g. safe injection practices)
2. Normal and abnormal gastrointestinal anatomy, physiology, and pathophysiology
3. Pharmacology (e.g. biologics infusions/injections, antibiotic, timing of medication)
4. Physiological, psychological, social, cultural, and spiritual aspects of wellness
5. Potential adverse reactions, complications, and anticipated interventions

Domain IV: Environmental Safety, Infection Prevention and Control
Task A: Procedure related infection prevention and control.
Knowledge of:
1. Standard for infection control in an endoscopy setting (e.g. validation of competencies, manufactures guidelines, PPE, spills)
2. Equipment reprocessing (e.g. Scopes and accessories, bioburden)
3. Sterilization and high level disinfection (e.g. Spaulding classification, single use devices vs. reusable devices, minimal effective concentration of disinfection solutions
4. Safe Injection practices (e.g. multi-dose vial)
5. Body mechanics (e.g. ergonomics, patient pressure, repetitive injuries)
6. Electrical, Laser, Radiation, Chemical (e.g. grounding pad placement, piercings, return electrode)
Task B: Environmental Safety, Infection Prevention and Control in Gastroenterology
Knowledge of:
1. Patient education related to disease (e.g. Crohns, C-DIFF, VRE, CRE)
2. Bloodborne pathogen (e.g. Hepatitis C, transmission)
3. Multidrug resistance organisms (e.g. MDRO, VRE, CRE)
4. Personal Protective Equipment (e.g. standard precautions, communication devices, attire)

ABCGN Certified Gastroenterology Registered Nurse
Medical Gastroenterology thinking
Killexams : Medical Gastroenterology thinking - BingNews https://killexams.com/pass4sure/exam-detail/CGRN Search results Killexams : Medical Gastroenterology thinking - BingNews https://killexams.com/pass4sure/exam-detail/CGRN https://killexams.com/exam_list/Medical Killexams : 9 Things Only People With IBS Will Understand

Even though irritable bowel syndrome affects between 25 and 45 million people in the United States (and approximately 5% to 10% of people worldwide), it’s still not taken totally seriously. To someone who doesn’t have it, IBS may seem like no big deal — like a run-of-the-mill stomachache.

But for people with IBS, a condition that may present with symptoms of chronic abdominal pain, bloating, diarrhea, constipation or some combination of these, it can quickly become what your entire life revolves around.

“People with IBS are often physically and emotionally exhausted by their symptoms and by repeated efforts to get answers and treatments that could help,” Dr. Lauren Tormey, a gastroenterologist at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, told HuffPost. “Not only can it be challenging to make a diagnosis of IBS, but symptoms can change over time, causing confusion and frustration for both patients and doctors.”

This can lead to an all-consuming cycle of avoiding trigger foods, social gatherings that involve food and drinks (so, all of them) and any situations that entail not knowing where the nearest bathroom is — along with the following things only people with IBS would understand:

1. Being so thinking you’ll experience gastro symptoms, you make them come true

“I wish I could say having IBS is always in the back of my mind, but truthfully, it’s front and center — all day, every day,” Lauren Schneider, senior PR and communications manager at Compt, told HuffPost. “The only time I’m not thinking about it is if I know for a fact I won’t be leaving home that day.”

When we’re stressed about our gut health and anticipate a flare-up or a worsening of symptoms, it sends signals from our brain to our gut, which can actually affect our digestive system. The result? Tightened abdominal muscles, colon spasms and an uptick in discomfort.

“The stress associated with the fear of experiencing IBS symptoms can even result in an inability for the body to properly digest food,” Dr. Vanessa Méndez, a board-certified gastroenterologist and founder of Planted Forward, told HuffPost. “This can lead to bloating and diarrhea or even a slowing down of the digestive system that triggers constipation.”

2. Eating or drinking something spontaneously — and immediately paying for it

With IBS, because of the hyper-responsiveness of the enteric nervous system (the part of the nervous system located in our digestive tract), symptoms can often be unpredictable. This means turning down the chance to try a new menu item at a restaurant, or cocktails at happy hour, so as to not risk an attack of symptoms.

For people who have never dealt with IBS, these boundaries might seem like overkill. But they can mean the difference between enjoying time spent with others, or being so focused on masking your symptoms you miss out on the experience (or spend the bulk of the experience in the bathroom).

“That one scoop of ice cream is enough to make me feel like I’ve had food poisoning,” Abi Cowell, a vegan food blogger, told HuffPost. “Will it kill me like a food allergy would? No. But it will cause an awful lot of pain and misery.”

3. Socializing is filled with mental — and intestinal — anguish

“Having IBS and socializing is filled with emotional landmines, especially when meals are involved,” Lindsay Barnes, media relations manager at Evoke Kyne, told HuffPost.

There’s the frustration of people not understanding that needing to go to the bathroom means you need to go now. The fear of entering the dating world and having to explain why you go so much. The awkwardness when you’re having a good time and suddenly need to make a run to the loo.

“When you just want to sit down and have a normal meal, whether by yourself or with family and friends, these things can be emotionally exhausting,” Tormey said. “The pain experienced by individuals with IBS is in part due to visceral hypersensitivity.”

Visceral hypersensitivity is pain or discomfort coming from internal organs (like those in the abdomen), under circumstances that wouldn’t normally be painful (like eating or during a bowel movement). The nervous system experiences these sensations and communicates them to the brain for processing via the gut-brain connection.

“Food ― eating it, even thinking about it ― regardless of the food type, [it] stimulates normal digestive function and can therefore result in pain in IBS,” Tormey said. “Sometimes eating is accompanied by the immediate urge to have a bowel movement because of a heightened stomach-colon reflex.”

Putting food or fluid in the stomach sends a signal via the nervous system to the colon. The colon understands this as a stimulus to empty whatever waste is there — and doesn’t care if you’re mid-sentence on a first date.

10'000 Hours via Getty Images

Social outings, like dates or meals with friends, can cause emotional and physical discomfort.

4. Changing so many ingredients in a recipe or food order, it becomes a different meal

The average person can control the effects of what they put into their body, and can adapt to food-centric situations, because their sensitivities to certain foods remain relatively consistent and clear-cut.

“I don’t have that luxury,” Barnes said. “I have absolutely no control over my body anymore — I can be as mindful as possible and work really hard on my diet, but at the end of the day, my gut controls my body now, and not in a good way.”

Food intolerances are common in IBS, and dietary modifications can help manage symptoms for some people. But for others, “visceral hypersensitivity and abnormal gut-brain communication can cause flare-ups to happen anyway, despite watching what you eat,” Tormey said.

“And who knows how long the flareup will last?” Barnes said. “A half hour? Two hours? The rest of the day?”

5. Mapping out where every public bathroom is before you leave the house

When Schneider leaves her home, she’s always planning — always conscientious of where she can find a restroom if she needs to stop. “If I’m going to be driving somewhere without quick access to a bathroom, I won’t eat before my trip,” she said. “I’ll wait until I get there.”

These coping strategies are actually pretty common, and can be a normal response to a situation that’s outside of our comfort zone, even for people who don’t suffer from IBS.

“When anxiety levels are high in a situation such as traveling, your digestive processes can get dysregulated,” Méndez said. “During stress, the brain sends signals to the gut that influences motility and digestion, which can lead to diarrhea or constipation.”

Because the gut is constantly at work, the brain typically filters out the nerve signals it sends (paying attention and responding to some in order to regulate gut activity, while not focusing on others). Normal gut-brain communication can go wrong when something disturbs the nervous system or the brain for a long period of time — like when traveling, working a stressful job or rushing to get errands done.

“In these circumstances, the brain perceives stronger signals from the gut, and even the mildest stomach cramp can immediately trigger the brain to start worrying about the potential for worsening pain or a bowel movement coming on,” Tormey said. “The brain subsequently sends inappropriate signals back that disrupt gut function and can worsen symptoms.”

As a result, you might find yourself doing the same as Schneider: scouting bathrooms on your route or delaying meals.

6. Maintaining excuses for why you’re taking so many bathroom breaks

“Something I want others to understand about how IBS impacts my life is the daily secrecy and diversions that surround my use of the bathroom,” Amanda Dexter, 36, told HuffPost. “There’s a lot of sneaking (multiple) trips to the bathroom or making excuses as to why it took you so long.”

Eating food and having bowel movements are essential to our survival — and across cultures, food is social and often enjoyed and shared with others. But unless you’re potty training a toddler, bowel movements aren’t exactly a typical subject of dinner-table conversation.

“These aspects of daily life pose regular challenges for those with IBS,” Tormey said, and can lead to a loss of enjoyment around food, a fear of eating and even disordered eating habits, such as skipping meals to avoid needing to use the bathroom.

If more people were to open up about their own horror stories, Dexter believes it would help alleviate the unnecessary embarrassment that many people with IBS feel. “Commiseration can go a long way into helping IBS sufferers not feel so alone,” she said.

7. Having flare-ups so exhausting, you need to take the rest of the day off

IBS is a disorder of “dysmotility,” meaning that movement of food, fluid and waste through the gut is altered.

“This leads to irregular bowel habits (diarrhea, constipation or both),” Tormey said. “You might spend a lot of time in the bathroom, either having bowel movements, trying to have a bowel movement or dealing with pain around the time of bowel movements.”

It’s not uncommon for people with IBS to miss days of work or school because of these exhausting, intrusive symptoms ― only to be further stressed out over the resulting lost productivity and wages.

“There have been times where I feel so emotionally drained and frustrated that I’ll just cry in the bathroom,” Barnes said.

PixelsEffect via Getty Images

Flare-ups can be so painful and taxing, it's hard to motivate yourself to leave the house.

8. The relief of knowing you don’t have anywhere to go that day

For Schneider, being able to work from home has alleviated much of the anxiety associated with her condition. She’s able to eat more intuitively and with a bathroom always nearby.

“Work trips are a little difficult, especially when the whole group goes out to dinner,” Schneider said. “That’s when I just resort to my old ways, and either barely eat or only eat my tried-and-true few things that won’t upset my stomach.”

Because IBS symptoms can be intermittent and unpredictable, varying in both nature and severity, the condition can leave you with a great deal of uncertainty and anxiety about what might happen outside the home.

“To compound matters, there’s a well-established recognition that the central nervous system, or brain, also has a significant role in regulating not only gastrointestinal motility, but sensation — from both an unconscious and a higher emotional level,” Dr. Brooks Cash, professor of gastroenterology at the University of Texas McGovern Medical School, told HuffPost.

This typically leads to people with IBS becoming hyper-vigilant about their symptoms, and trying to be as ready for them as possible — including doing everything in their power to avoid potential triggers.

“Sometimes these triggers are absolutely accurate, and other times they’re merely innocent bystanders,” Cash said. “Either way, we often see patients changing their lifestyle, daily activities, diet, habits and social activities for the sake of avoiding them.”

9. Losing count of how often you’ve been told your IBS symptoms are all in your head

Schneider has done what’s recommended to treat IBS. She’s seen doctors, done the tests. The endoscopy and colonoscopy didn’t show anything helpful ― just that she also has gastroesophageal reflux disease.

“I’m on an SSRI, so it isn’t anxiety-related, like one doctor so unhelpfully assumed,” she said. “She literally said to me, ‘Well, nothing’s shown up in your bloodwork or other tests — you have IBS-D but it’s probably all in your head.’ Thanks, super helpful.”

After being poked and prodded enough, Schneider gave up. “I’m tired of advocating [for] myself to doctors who won’t listen and paying co-pays that are essentially a waste of money to hear the same things over and over.”

While doctors don’t have an IBS biomarker to test for, there are formal diagnostic criteria for IBS called the Rome IV criteria.

“To make a diagnosis of IBS, patients should meet Rome IV criteria and not have any other ‘alarming’ signs such as blood in the stool, unintentional weight loss or new onset symptoms over the age of 50 without prior colon cancer screening,” Tormey said.

These criteria must be fulfilled for the past three months, with symptom onset at least six months prior to diagnosis. “IBS should then be sub-classified by the predominant bowel pattern ― such as IBS-C, or IBS with constipation ― which helps guide treatment,” Tormey said.

A diagnosis of IBS can be made confidently after a detailed history, a complete physical exam and a few thoughtfully selected diagnostic tests to evaluate for conditions that can present with similar symptoms.

So if your doctor implies — or straight-up tells you — your symptoms are all in your head, Méndez encourages you to get a second, third or even fourth opinion. “You know they’re not in your head and that IBS is a very real condition,” she said. “In fact, IBS is the most common functional digestive disorder. If you have symptoms, please keep seeking help until you find a health care provider you trust.”

Wed, 13 Jul 2022 01:45:00 -0500 en text/html https://www.huffpost.com/entry/ibs-signs-understand_l_62cd99c0e4b094232780e5cc?d_id=4349752&ncid_tag=tweetlnkushpmg00000074
Killexams : Determined to become a doctor against all odds

Being deafblind would be more than enough to contend with as a trainee doctor, let alone all the doubters and discrimination.

Yet, Alexandra Adams wrestles with other physical challenges too. During the pandemic, these conspired to put her in hospital for 17 months and brought her studies to a screeching halt.

Now, after a two-year interruption, she is back at medical school in Cardiff, doing clinical placements at a hospital where she was a long-term patient, fighting off the flashbacks.

Even now that her health has stabilised, she is on 24-hour oxygen, has a gastrostomy tube and drain, and is sick many times a day. She is also highly prone to joint dislocation and has had sepsis seven times in one year. ‘My life is definitely not boring,’ she says.

In it all, Alexandra’s determined to stay positive. Unexpectedly, she found herself thrust back into the role of diversity advocate recently after she introduced herself to TikTok as a deafblind medical student and went viral.

But she is still coming to terms with what’s happened in the past two years.

23 ICU visits

Alexandra would like to be able to trot out unreserved truisms about her experiences as a patient preparing her to be a better doctor. They have, of course, but it is not quite as straightforward as that.

The truth is that the 17 months she spent in three different hospitals, during the COVID pandemic, left her traumatised – and doubting her choice of career.

‘It is something that I thought about every day as a patient,’ she says. ‘At one minute, I’d be feeling I’m learning so much about medicine and how to treat my future patients. But the next, I wanted to run as far away from medicine as possible.’

The respiratory and digestive issues she has had since her mid-teens had been growing progressively worse. Respiratory muscle weakness has landed her in ICU 23 times.

During the first lockdown and her fourth year at medical school, her condition had deteriorated so far that she was admitted to ICU three times. On the day of her first discharge, her rental agreement was terminated with immediate effect on the grounds that her health and hospital visits were ‘putting other tenants at risk’.

When Alexandra was admitted in July 2020, just after her parents had managed to find her new accommodation, she was severely malnourished, fitting and fighting to breathe. This time she stayed in.

‘My fault’

It took three months in hospital for her to be diagnosed with Ehlers-Danlos syndrome, a rare genetic condition resulting in faulty connective tissue. In Alexandra’s case, this has affected her immune, cardiovascular, respiratory and gastrointestinal systems, causing, among other things, intestinal failure and gastroparesis (delayed gastric emptying and stomach paralysis). She also has extreme joint hypermobility.

Then, on Boxing Day, she tested positive for COVID. ‘The hospital was drowning in COVID by then: pretty much every ward became a red ward. I was in gastroenterology when I caught COVID. The patient next to me basically said it was my fault and “now you’re going to spread it to the rest of us”.’

In fact, the three other patients on her bay all caught COVID; Alexandra was the only one who survived, after a month in the red zone. ‘I knew it wasn’t my fault, but I felt really guilty that the three others didn’t make it. It destroyed me.’

In early March 2021, she was transferred to a hospital in London for six months, then after a brief respite at home in Kent, she was back in hospital in Wales. For much of the time, Alexandra was very unwell, strongly medicated, bedbound, unable even to lift her head. COVID meant she couldn’t have visitors for many months; playing the piano in the hospital chapel, when she grew stronger, was her only respite.

‘There were nights when I was bawling my eyes out and thinking: I don’t have a future, I don’t have a purpose. I didn’t want to be here any more.’

What kept me going was a voice reminding me: ‘This is one hell of a journey but it’s all lived experience you’re going to learn from.’

‘It’s going to be valuable, whether it’s through being able to help people, making you resilient, or making you more grateful for the little things”.’

Contrasting care experiences

Some of the care she received, especially from nurses at St George’s Hospital in London, was first-rate. Nurses in Wales brought her ICU bed outside so she could meet Winnie, the new family Cavapoo puppy.

But some experiences she found deeply distressing. What she saw on the COVID ward was ‘horrific’, though beyond anyone’s control.

But she has found it harder to come to terms with what she feels was unkindness and neglect from some.

Alexandra knows staff everywhere were – and remain – under extreme pressure. But she felt some expected her to ‘just get on with it’ and deal with things better because she was a medical student.

Before she was diagnosed with the rare condition Ehlers-Danlos syndrome, she felt medical staff believed her condition was ‘all in her head’. Frequently afterwards, she was made to feel a nuisance – even when she was in excruciating pain or genuine distress. 

At one point, when she had a painfully infected central line site, which turned out to be severe sepsis, she was told: ‘Your neck’s not fractured! Move it!’

And when she asked about the long-term prognosis for people with Ehlers-Danlos, scared for her future, a doctor replied, ‘You’re a medical student: surely you’re competent enough to work it out for yourself.’

‘The doctors were in a very difficult position because I was a complex case and nothing seemed to be working but I did get a lot of sarcastic comments,’ she says.

Months after requesting mental health support, she saw a psychologist who offered only dietary advice and suggested she try kefir. And the promised discharge letter to her GP and referral to a specialist hospital never materialised. She now has a drainage tube in the wrong place and no overseeing consultant.

‘As a patient I feel I’ve slipped through the net – but as a medical student I still love the NHS and couldn’t think of a better place to work.’

Financial pressures

Towards the end of last year, Alexandra decided to ignore her health challenges and resume her studies. She says she had ‘reached a point where I felt nobody cared for me’ so she stopped caring for herself. She was passed fit to return in January and began catch-up placements in June, with a view to restarting her fourth year in September. Her previous year group has since graduated.

There are other pressures. She’s not sure how she can fully fund her accommodation. Her requirements are specific: her blindness and chronic fatigue mean that she can’t live too far from the university, so rooms tend to be more expensive. 

The extra equipment and tech she needs are costly too. Her parents can’t afford to help: the whole family has been hit hard emotionally, physically and financially by events of the past two years.

In 2020, Alexandra took the ‘uncomfortable’ step of crowdfunding for her accommodation and was able to fund a two-year rental contract. Unfortunately, she was in hospital for much of that time.

To help with her finances, she’s taken on bank work as a phlebotomist at the same hospital where she was admitted as a patient in July 2020.

‘I took a little detour after my shift the other day and went into the chapel to play the piano again. I cried because I saw the old me in the distance, a patient in a gown and a wheelchair. But I just have to get over that.’

Alexandra has set herself an 870-mile sponsored walking challenge this year to raise money on GoFundMe for pianos in NHS hospitals.

Social media star

In public and on social media Alexandra is resolutely cheerful. Unexpectedly, she has attracted the attention of a new audience by posting a short video on TikTok about returning to medical school as a ‘deafblind medic’. It triggered a familiar storm of disbelief and trolling: some impressed by her resolve, others ridiculing her ambition.

‘It was proof that ableism is very much still out there,’ she says. ‘But people were asking some genuine questions too, such as: How would you take blood if you can’t see or how would you hear someone’s heart?’ Alexandra has been deaf from birth; she has no sight in one eye and only 5 per cent in the other.

She started making videos addressing these questions, explaining, for example, how her stethoscope links by Bluetooth to her hearing aids, how she accesses veins by touch or uses magnification to read scans. The first TikTok went viral, with 2.4 million views and counting.

I do believe you don’t need the best vision or hearing to be a good doctor: having insight and empathy is the most important thing.

‘But wait till I tell TikTok I stick needles into people as a phlebotomist. That’ll really tee some people off!’

Diversity advocate

This major setback is not Alexandra’s first. In her early teens she was part of the GB Paralympic swimming team, training for the London 2012 games. But complications following stomach surgery left her in hospital for a year and ended her swimming career.

From promoting disability inclusion in sport alongside the likes of Baroness Tanni Grey-Thompson as a teenager, she is now an advocate for diversity in the NHS. Sadly, she has faced discrimination from the public, peers and doctors alike.

Her Faces of the NHS campaign and photo exhibition celebrating diversity in 2019 led to a TEDx talk, and she’s given regular media interviews.

Consistently, it’s her ability to turn tough circumstances to good that has propelled her forward. The year she spent in hospital at 16 inspired her to become a doctor.

This new chapter, marked by chronic illness, has proved far more challenging than her deafblindness. But, if anything, it has made her more determined.

‘I’m not going to lie: there are times when I think: “Oh, stuff it, I hate this,” and you do feel like giving up. But then you remind yourself of the goal and keep going. I’m just trying to focus on the good stuff.’

You can donate to Alexandra’s initiative to buy pianos for hospitals at GoFundMe.

Wed, 13 Jul 2022 01:26:00 -0500 en-gb text/html https://www.bma.org.uk/news-and-opinion/determined-to-become-a-doctor-against-all-odds
Killexams : Colorectal Cancer News
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  • Soft Drinks Once Again Associated With Premature Death Soft drinks, both sugar- and artificially sweetened, linked again to increased mortality in large European study; researchers say this is further evidence supporting public health campaigns to limit intake.

    Medscape Medical News, September 04, 2019

  • Antibiotics Use and Increased Risk of Colon Cancer? Even a single course of antibiotics was associated with an increased risk of colon cancer, especially in the proximal colon, in a matched case-control study.

    Medscape Medical News, August 21, 2019

  • Obesity Effect on Cancer Risk Twice That Currently Thought A new analysis of genetic data suggests that the effect of obesity on cancer risk is much higher than currently estimated from observational studies.

    Medscape Medical News, August 16, 2019

  • Biomarkers Can Help Predict Response to Immune-Checkpoint Blockade in GI Cancer Serological markers can help predict how patients with metastatic gastrointestinal-tract cancer will respond to immune-checkpoint blockade (ICB), according to Chinese researchers.

    Reuters Health Information, August 03, 2019

  • Mayo Gets Perfect Score for Gastroenterology, GI Surgery Mayo Clinic earned top marks for quality and patient experience outcomes and was recognized by gastroenterology experts as one of the top hospitals for challenging cases.

    Medscape Medical News, July 31, 2019

  • In a Disease of Aging, Patients in Trials Get Younger and Younger Randomized clinical trials in oncology have participants who are substantially younger on average than typical real-world patients, which may limit the applicability of findings.

    Medscape Medical News, July 25, 2019

  • More People Developing Colorectal Cancer Before Age 50 More people in the US are developing colorectal cancer before age 50, a trend that has also been seen in Europe.

    Reuters Health Information, July 24, 2019

  • Colonoscopy Modifications Don't Improve Detection of Serrated Adenoma Distal attachments or electronic chromoendoscopy do not generally Improve detection of serrated adenomas during colonoscopy, according to pooled data from 17 randomized trials.

    Reuters Health Information, July 23, 2019

  • WCGC 2019 Skipping Surgery in Rectal Cancer: Better or Worse? 'Unreliable' assessment of complete clinical response after neoadjuvant chemoradiotherapy for rectal cancer means a watch-and-wait strategy should be followed with caution, suggest results of an expert debate.

    Medscape Medical News, July 17, 2019

  • 'Born Bad': Some Cells Spread Before Cancer Is Diagnosed Tumor metastases may not be a late event as the current thinking goes, but may be seeded years before cancer is even diagnosed by clones that were 'born to be bad.'

    Medscape Medical News, July 16, 2019

  • Cold Snare Polypectomy Safe Without Heparin Bridge? A randomized controlled trial found the method was not inferior to the hot snare method plus heparin bridging and was linked with shorter procedures and hospital stays.

    Medscape Medical News, July 15, 2019

  • Sun, 03 Jul 2022 12:00:00 -0500 text/html https://www.medscape.com/index/list_1060_18
    Killexams : The Fifth Card, Love
    Troy and Jennifer Florence and their children

    Troy and Jennifer Florence and their children

    When Troy Florence was diagnosed with stage IV pancreatic cancer in April of 2021, he had specific instructions for friends and family who wanted to help.

    “No lasagnas,” he told all who would get in touch. “Go research and find a survivor phone number because we want to talk to them tomorrow.”

    He had dozens of conversations with people across the country -- some he connected with just once or twice, while others he is still in contact with today. Talking to survivors was his “medicine” at a critical moment – providing hope and solace at a time when so much of life was upended.

    While Troy put together a network of survivors, his wife, Jennifer, sprang into action. She worked to locate certified and others whom she calls their “A-Team” to help Troy tackle pancreatic cancer. This group included medical professionals – oncologists, radiologists, gastroenterology certified – but also friends, family and PanCAN.

    “Embracing the help that came to us was a big learning lesson,” she said. “We saw that when we accepted help and had other people do things for us, whether it was picking up medications or walking the dog, we were giving them a gift to be involved, to be part of the journey towards a miracle. So, we quickly saw the beauty in it.”

    They also got in touch with PanCAN Patient Services, who helped them to find clinical trial options right for Troy.

    “A Case Manager at PanCAN sifted through 600 trials and narrowed it down to 10 or 12 for us,” he said. “I mean, it was really amazing.”

    The goal was to supply Troy the opportunity to tackle the disease by focusing on the present while planning for every contingency they could imagine. Their doctor talked to them about the five-year survival rate, which although improving still hovers at 11%.

    “We knew that we were not going to sit back and say, ‘Oh, okay, this is our path.’ We immediately started talking about, ‘We’re going to be a trailblazer. We’re going to be the miracle,’” said Jennifer.

    Troy wasn’t a candidate for surgery due to the location of the pancreatic tumor and because it had spread to his liver, so he enrolled in a clinical trial that combined a standard chemotherapy with two immunotherapies. After several months in the trial, scans showed a new tumor in his liver, prompting Troy, Jennifer and their healthcare team to move to Plan B.

    In August of 2021, Troy went off the trial and started a chemotherapy regimen of FOLFIRINOX, which required a total of 14 treatments every other week for two months. By October, scans showed that the tumors had shrunk significantly and no new ones had emerged.

    “It was October 10th,” Troy said. “It was a Saturday morning when I got my results. It was one of the best days of my life. I just kind of floated around all day -- really happy and grateful. Then we went into treatment mode.”

    As a next step, Troy and his healthcare team used the results of earlier biomarker testing to inform his next treatment option: A maintenance pill to inhibit tumor growth that targets a specific genetic mutation his cancer had.

    “Reach out, network, find as many resources as possible. The PanCAN ‘A-Team’ is a big part of that.” – Troy Florence

    Meanwhile, Troy and Jennifer continued to explore their network and got in touch with Michael Chuong, MD, medical director of radiation oncology at the Miami Cancer Institute.

    Called MRIdian SMART, the technology uses magnetic resonance imaging (MRI) to track the tumor throughout treatment and control the radiation beam in real time. This allows for high doses of radiation to be delivered with great accuracy, preserving healthy tissue and decreasing side effects.

    In October of 2021, Dr. Chuong and co-authors presented a study at the Annual Meeting of the American Society for Radiation Oncology showing improved survival and quality of life in patients with pancreatic cancer. In a press release announcing the study, PanCAN President and CEO Julie Fleshman, JD, MBA, said: “These findings offer hope for those facing an inoperable pancreatic cancer diagnosis and are bringing us one step closer to achieving our vision to create a world in which all patients with pancreatic cancer will thrive.”

    For Troy and Jennifer, MRIdian offered what they asked for: A chance for Troy to become a long-term survivor. Since surgery and standard radiation were not options for him because of his stage IV diagnosis, the treatment he received at the Miami Cancer Institute opened additional doors.

    Now, the Florences live by what Troy calls his “five-card poker hand.”

    “In the beginning, we thought, ‘Okay, I’m a poker player. This is the hand we’re dealt. How are we going to play it?’ So, we came up with five things. They’re focused on medicine, community, holistic health and mental health. And then the final one is love.”

    For the medical card, they recommend seeking out a pancreatic cancer specialist to provide care and treatment options.

    “Reach out, network, find as many resources as possible,” Troy said. “The PanCAN ‘A-Team’ is a big part of that.”

    Accept help from friends and family; they want to support you. Say yes when they do offer their time and energy. That’s the community card.

    When it comes to holistic health, Jennifer and Troy sought out a naturopath and resources about nutrition and exercise. He worked with a personal trainer to stay strong during chemotherapy. This goes hand in hand with the next card: Mental health.

    “The mental game is probably the toughest,” he said. “Any number of things can help, whether it’s prayer or chanting or breathing, meditation, psychiatrists. For me in the beginning it was talking to survivors.”

    And then there’s the fifth card, love.

    “I actually get choked up just thinking about it and the love that was given,” he said. “The time, the energy, the support. I can’t put into words what it’s meant to me.”

    The experience has changed him in ways he can’t quantify.

    “I love differently now. I truly do,” Troy said. “I’ve always said those words, but I say them a lot more now and it means something different to me now. It’s just more intense. I don’t know. I don’t know how to explain it other than that.”

    Now, buoyed by what he received, he’s speaking to people newly diagnosed with pancreatic cancer, offering the same support and hope he sought earlier in his journey.

    “The people that I’ve reached out to, the cancer survivors that spend time with me, that’s why I want to supply back in that way now,” he said.

    For Jennifer, the journey has been a lesson in accepting the unknown.

    “If you gave me the choice, I would take my old life back,” she said. “But we can certainly acknowledge that by adapting to our new situation, we have a whole new level of awareness, gratitude and magnitude of love.”

    Connect with others affected by pancreatic cancer. Contact PanCAN Patient Services to be matched with Survivor & Caregiver Network volunteers or to offer to volunteer.

    Any treatments, including clinical trials, mentioned in this story may not be appropriate or available for all patients. Doctors take many things into account when prescribing treatments including the stage and type of cancer and the overall health of the patient. Contact PanCAN Patient Services for personalized treatment options.

    Wed, 13 Jul 2022 01:00:00 -0500 en text/html https://www.pancan.org/stories/the-fifth-card-love/
    Killexams : SLU Medical Students Value Research Opportunities

    ST. LOUIS – Top research from Saint Louis University School of Medicine students was showcased recently as the school held its 52nd annual Alpha Omega Alpha Honor Medical Society medical student research forum.

    The competition began with a poster presentation during which the medical students shared their research findings. Finalists delivered an oral presentation before students and faculty.

    Research offers students a chance to delve into a Topic of interest to them.

    “Research has enhanced my medical education by training me to think like a scientist: to make measurable claims based on evidence and to scrutinize the arguments and claims of others,” said first-place winner Kevin Bockerstett. “This is an invaluable skill for any person who wants to make evidence-based decisions, whether it be about medicine or anything else.”

    Bockerstett was awarded first place for his paper, “Interleukin-17A Acts Directly on Gastric Epithelium and Promotes Atrophy and Metaplasia. Rich DiPaolo, Ph.D., associate professor of molecular microbiology and immunology, acted as Bockerstett’s faculty mentor.

    Bockerstett said he was interested in the role of a cytokine (IL-17A) made by the gastric system in gastric cancer development.

    “There are roughly 1 million cases of gastric cancer diagnosed every year and the five-year survival rate is abysmal: only around 10 percent, mostly because the cancer is already late-stage at the time of diagnosis,” he said.

    “My presentation outlined data that showed for the first time that IL-17A acts directly on the gastric epithelium and contributes to cancer development. These results are important because they identify IL-17A as a potential biomarker for gastric cancer risk and may help us diagnose patients earlier, which could significantly increase the survival rate.”

    Ariel Axelbaum was awarded second place for his paper, “A Mechanism by which Menopause Promotes Low-Grade Chronic Inflammation.” He focused on the mechanism by which the loss of estrogen with menopause leads to a state of low-grade inflammation in women. This state of inflammation is linked to problems like osteoporosis and cardiovascular disease for which postmenopausal women are at higher risks.

    Rajeev Aurora, Ph.D., associate professor of molecular microbiology and immunology, acted as Axelbaum’s faculty mentor.

    “Research is how humans – together – learn about our world. Our lab built off the work of other labs and hopefully there will be others who will take our work and add to it,” Axelbaum said. “As a group, we’re all working towards understanding nature and human life more fully and ideally this will lead to better quality of life for us and more respect for nature.”

    SLU will send the first and second place winners to present their research at the annual National AOA Student Research Forum in Galveston, Texas.

    Research has enhanced my medical education by training me to think like a scientist: to make measurable claims based on evidence and to scrutinize the arguments and claims of others.” 

    Kevin Bockerstett, winner of SLU's AOA medical research forum

    Third place winner Emily Cybulla said her research experience challenged her to critically think about a question, namely the causes of a particular disease affecting patients.

    “I think that the critical thinking skills fostered by research experiences are essential to my medical education because asking questions and seeking answers alongside patients will be an integral part of my role as a clinician,” she said. 

    Cybulla’s paper explored inflammatory response in Hutchinson Gilford Progeria Syndrome (HGPS), a rare genetic accelerated aging disease affecting children. The molecular mechanisms underlying HGPS are poorly understood, and there is currently no cure for the disease. Susana Gonzalo, Ph.D., associate professor of biochemistry and molecular biology, acted as Cybulla’s faculty mentor.

    “The importance of research in medicine cannot be overstated. As physicians, we 'practice' medicine everyday on patients based on the extent of our current knowledge,” said Natalie Gaio, the winner of an honorable mention. “The only way to enhance our practice is to extend our current knowledge, namely through research. Basic science, translational and clinical research all contribute to our growing knowledge base that allows us to Improve our practice and provide better care to our patients.

    “Research forced me to think about new ways of doing things and to test these methods out. The knowledge was not something already published, that I needed to memorize, but instead something that I needed to create. There was no book or article where I could look up an answer, and I found this to be the biggest challenge and also the biggest reward in conducting a new project.”

    Love of research began as an undergraduate for Taryn While, who also received an honorable mention for her work with Debra Zand, Ph.D., a SLUCare psychologist and associate professor of pediatrics, on Triple P parental intervention aiming to reduce problematic behaviors in children newly diagnosed with autism spectrum disorder.

    “As an undergraduate, I discovered that I loved the process of research as I conducted organic chemistry research. I knew research would be part of my medical school career when I began at SLU but I hoped to get involved with clinical research that had direct patient applications,” she said.

    “Working with Dr. Zand has been an invaluable part of my medical school career because I learned about the nuts and bolts of conducting clinical trials and witnessed how research can be implemented to directly help patients. After graduating from medical school this May, I plan to continue doing research in residency and beyond and I know working with Dr. Zand these last four years will supply me an advantage.”

    An honorable mention was also awarded to Wint Yan Aung for the development of a risk assessment tool to predict renal failure among patients undergoing liver transplant.

    Students are elected into AOA, a national Honor Medical Society, based on scholastic achievement, personal integrity, ability to work well with their peers and promise for significant contributions to the medical profession. The research forum is an annual event sponsored by Saint Louis University School of Medicine.

    The judging panel consisted of Paul Hauptman, M.D., assistant dean of clinical and translational research; Angel Baldan, Ph.D., assistant professor of biochemistry and molecular biology; Michael Rauchman, M.D., professor of internal medicine and biochemistry and molecular biology; Joyce Koenig, M.D., professor of pediatrics and molecular biology and immunology; John Edwards, M.D. Ph.D., professor of nephrology; Mark M. Voigt, Ph.D., professor and vice chairman of pharmacological and physiological science; and Marie Philipneri, M.D., Ph.D., professor of internal medicine.

    Discussants included Edwards; Henry Randall, M.D., surgical director of abdominal transplant at SSM Health Saint Louis University Hospital and associate professor of surgery; Katherine Mathews, M.D., MPH, MBA, associate professor of obstetrics, gynecology and women's health; Brent Neuschwander-Tetri, M.D. director of the division of gastroenterology and hepatology; Daniel Hoft, M.D., Ph.D., director of the division of infectious diseases; and Leslie Hinyard, Ph.D., associate director for academic affairs for SLUCOR.


    Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease and heart/lung disease.

    Fri, 03 Mar 2017 08:31:00 -0600 en text/html https://www.slu.edu/news/2017/february/aoa-research-awards.php
    Killexams : Your Top Questions About Hepatitis A, B, C, D and E, Answered No result found, try new keyword!If you know about hepatitis, it might be because you recently got your children vaccinated for hepatitis A and hepatitis B, as recommended by the Centers for Disease Control and Prevention (CDC). Or ... Fri, 15 Jul 2022 03:00:21 -0500 en-us text/html https://www.msn.com/en-us/health/medical/your-top-questions-about-hepatitis-a-b-c-d-and-e-answered/ar-AAZCkKc Killexams : Former 3M Executive Brings Healthcare Marketing Expertise Agencyside

    Former 3M Executive Brings Healthcare Marketing Expertise Agencyside

    QooQoo onboards Bob LaRoche as new staff Senior Business Strategist

    QooQoo, a growing healthcare marketing agency in Southern California, announced the staff addition of Bob LaRoche as Senior Business Strategist. The position is a new one at the agency. The role goes beyond brand promotion and leverages healthcare industry insights, strategies, and tactics that impact the clients’ overall growth metrics.

    Clay Daniells, QooQoo founder and CEO, says adding this new capability is particularly advantageous for new and existing clients. “With his 20-plus years’ experience, this role is made for Bob LaRoche. He has exceptionally good insight into how clients’ businesses and brands need to work together,” Daniells explains. “Most healthcare marketing agencies don’t think this way. Bob is really creating something new. Clients are excited.”

    Bob LaRoche built his career through a unique combination of sales, sales management, and marketing leadership. During his impressive tenure in the healthcare field, he has honed his unique strategic perspective through service in multiple clinical specialties, including gastroenterology, cardiology, orthopedics, dermatological surgery, and wound care. Bob’s industry experience includes Bard, Vision Sciences, Circe Biomedical, Cambridge Heart, InfraReDx, Candela Corporation, US Endoscopy, Momelan Technologies, and 3M™/Acelity.

    “We are extremely fortunate to have Bob join QooQoo,” Daniells says. “His expertise and insights are beyond measure. His understanding of the business of medical device and diagnostics is what our agency needs — and what our clients need in this time of heightened competition.”

    The agency reports that LaRoche’s primary role will be to provide QooQoo clients marketing communication strategies and tactical execution plans. His first assignments include participating in current projects with his former employer and QooQoo account, 3MTM, and bolstering new business initiatives.

    About QooQoo
    QooQoo is a creative brand agency that identifies, creates, and manages the real-time impact of ideas throughout the marketing cycle, giving clients the power to spread the QooQooness through one-to-one, one-to-some and one-to-many interactions that change minds and markets. QooQoo services include strategic planning, creation, execution and delivery in branding, digital social media, sales, and traditional channels for healthcare manufacturers.
    www.itsqooqoo.com

    Media Contacts:
    Gala Struthers
    Chief Marketing Officer
    949.278.4581
    gala@itsqooqoo.com

    Avalon Ansara
    Account Coordinator
    949.558.4132
    avalon@itsqooqoo.com

    View source version on businesswire.com: https://www.businesswire.com/news/home/20220629005001/en/

    Wed, 29 Jun 2022 05:35:00 -0500 en text/html https://www.morningstar.com/news/business-wire/20220629005001/former-3m-executive-brings-healthcare-marketing-expertise-agencyside
    Killexams : Athos Therapeutics Announces Research Collaboration to Advance Precision Medicine in Inflammatory Bowel Disease | Morningstar Athos Therapeutics Announces Research Collaboration to Advance Precision Medicine in Inflammatory Bowel Disease

    PR Newswire

    LOS ANGELES, July 11, 2022

    Athos to perform molecular analysis of biopsies from de-identified Inflammatory Bowel Disease patient samples from Lahey Hospital & Medical Center based in Burlington, Massachusetts.

     LOS ANGELES, July 11, 2022 /PRNewswire/ -- Athos Therapeutics, Inc. ("Athos"), a late-stage preclinical biotech company using artificial intelligence to develop small molecule therapeutics for immune-mediated diseases and cancer, announced today a comprehensive Master Research Agreement for a collaborative project on Inflammatory Bowel Disease (IBD) with Lahey Hospital & Medical Center ("Lahey"). This collaboration will advance systems biology and computational analyses in the field of Inflammatory Bowel Diseases (IBD).

    (PRNewsfoto/Athos Therapeutics)

    Athos will perform multi-omic molecular and genetic analyses using biopsies from archived and de-identified Lahey IBD patient samples with the following clinical descriptions: Crohn's disease (CD) active, CD inactive (in remission), Ulcerative colitis (UC) active, UC inactive (in remission), and controls. The results of the biopsy analyses will be correlated with detailed clinical information including the patient's age, sex, disease location, prior treatments, and status.

    "We are excited to collaborate with Dr. Randall Pellish and his team to identify novel molecular targets and subtypes of IBD patients," said Dimitrios Iliopoulos, PhD, MBA, President & CEO. "Lahey's IBD patient biomaterials will be fed into our Athos Learning Computational Ensemble

    (ALCE) engine to further elucidate the complexity of IBD and the heterogeneity of drug responses."

    "Athos Therapeutics is developing a precision medicine approach to the treatment of IBD and other autoimmune disorders," said Allan Pantuck, MD, MS, FACS, Chairman, Founder & CMO. "The availability of high-quality tissue resources linked to Tested clinical data, which forms the basis for our collaboration with Lahey Hospital, will make this possible and allow for the identification of new disease sub-types and for the identification of novel drug targets." 

    "We are very excited about our research initiatives with Athos Therapeutics," said Randall Pellish, MD, Director, Lahey Inflammatory Bowel Disease Center, Division of Gastroenterology, Lahey Hospital and Medical Center. "This collaborative research project will allow us to work on vital questions addressing new ways of classifying and treating inflammatory bowel disease with the goal of developing meaningful, perhaps paradigm shifting, treatment strategies."

    About Athos Therapeutics

    The Mission of Athos Therapeutics is to develop first-in-class medications that will significantly impact the lives of patients with autoimmune disorders, chronic inflammatory diseases, and cancer. Athos is a late-stage preclinical biotech company developing small molecule therapeutics for immune-mediated diseases and cancer using artificial intelligence-generated innovative chemistry and computational platforms. The co-founders of Athos include one of the founders of Kite Pharma (acquired for $12B), the medicinal chemist behind two multi-billion-dollar FDA-approved drugs (Xtandi & Erleada), and the discoverer of the miR-124 drug target, currently in a Phase III IBD trial. Athos identifies novel drug targets (hubs) by integrating clinical and molecular datasets into the biological network of a disease (the disease interactome) and matches them to its small molecule computational chemistry platform. ATH-63, the Company's lead drug compound, is moving into a Phase Ia human clinical trial in 2022. The Athos pipeline includes small molecule approaches for various autoimmune disease and cancer. 

    Additional information about Athos Therapeutics can be found at https://athostx.com/

    Cision View original content to download multimedia:https://www.prnewswire.com/news-releases/athos-therapeutics-announces-research-collaboration-to-advance-precision-medicine-in-inflammatory-bowel-disease-301583267.html

    SOURCE Athos Therapeutics

    Mon, 11 Jul 2022 03:25:00 -0500 en text/html https://www.morningstar.com/news/pr-newswire/20220711la12391/athos-therapeutics-announces-research-collaboration-to-advance-precision-medicine-in-inflammatory-bowel-disease
    Killexams : US Hot, Cold Spots of Young-Onset CRC May Help Target Interventions

    A new geographic analysis of US death rates from young-onset colorectal cancer (CRC) found distinctive regional patterns that varied by age.

    The so-called hot and cold spots of mortality from young-onset CRC differed slightly for people younger than 50 and those younger than 35, report the researchers, who say such studies may lead to better understanding of the underlying factors as well as to targeted interventions.

    The authors suggest that deaths in the youngest young-onset CRC individuals "may be driven by a distinct set of factors as compared to deaths among older young-onset CRC and average-onset CRC patients."

    They add that "unmeasured factors...may drive anomalous young-onset CRC mortality rates, either independently or in conjunction with demographic [and] modifiable variables accounted for here."

    The research was published online in Gastroenterology.

    Incidence, Mortality Rates on the Rise

    The incidence and mortality rates of young-onset CRC have been increasing for decades, the authors write, but it has only recently begun to attract public health attention.

    Risk factors and prognostic indicators, such as smoking, obesity, alcohol consumption, diabetes, sex, race, and socioeconomic factors, have been implicated in the development of the condition.

    Geospatial distribution of young-onset CRC adds an "important [layer] for understanding the underlying drivers of mortality and allocating public health resources," the authors write.

    It is "too soon" to draw conclusions about the cause of the hot and cold spots, cautioned senior author Stephanie L. Schmit, PhD, vice chair of the Genomic Medicine Institute at the Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.

    Speaking to Medscape Medical News, she said, "Additional factors like proximity to primary care, gastroenterology, and cancer care facilities or novel environmental exposures may contribute to hot spots."

    On the other hand, "lifestyle factors like diet and exercise might contribute to some extent to cold spots," she added.

    While Schmit said it would be "challenging" to replicate the findings nationally, "further analyses at more granular geographic levels would be incredibly helpful."

    Exploring the Geographical Distribution

    To explore the geographical distribution of young-onset CRC mortality, the researchers gathered 20 years of data on more than 1 million CRC deaths from 3036 US counties. With aggregated county-level information from 1999–2019, they derived mortality rates from CDC WONDER underlying cause of death data.

    Over the study period, there were 69,976 deaths from CRC among individuals diagnosed before age 50, including 7325 persons diagnosed younger than 35. Most CRC deaths (1,033,541) occurred in people diagnosed at age 50 and older.

    The researchers calculated an average county-level young-onset CRC mortality rate of 1.78 deaths per 100,000 population, compared to a CRC mortality rate of 56.82 per 100,000 population among individuals 50 and older.

    Overall, for individuals younger than 50 at diagnosis, the researchers found two hot spots — in the Southeast (relative risk [RR]: 1.24) and in the Great Lakes region (RR: 1.10). They identified cold spots in lower Wisconsin (RR: 0.87), the Northeast (RR: 0.92), southwest Texas (RR: 0.90), and Western counties more broadly, including Alaska (RR: 0.82).

    Further analysis of those diagnosed when younger than 35 revealed two significant young-onset CRC mortality hot spots — in the Northeast (RR: 1.25) and the upper Midwest (RR: 1.11). In this youngest group, the team also found three significant cold spots ― in the Southwest (RR: 0.74), in California (RR: 0.78), and in the Mountain West (RR: 0.82).

    Among those aged 35–49 years at diagnosis, researchers found three hot spots — two in the Southeast (RR: 1.20 and 1.16) and in the Great Lakes region (RR: 1.12). Several cold spots emerged from the mortality data on young-onset CRC in this age group — in the Pacific/Mountain West (RR: 0.90), in California (RR: 0.82), southern Texas (RR: 0.89), and the Southwest more broadly (RR: 0.86).

    "Though cold spots were similar across strata, young-onset CRC hot spots shifted southward in the 35–49 age stratum in comparison to the <35 group," the team notes.

    They acknowledge several limitations to the study, including its "ecological nature" and the lack of adjustment for stage at diagnosis.

    In comments to Medscape Medical News, Andrew T. Chan, MD, MPH, of Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, said the approach used by the researchers was "very interesting."

    Chan said that this is "one of the first studies that has given us insight into whether there is potential geographic variation in the incidence of young-onset colorectal cancer."

    This, he continued, is "very helpful in terms of thinking about potential risk factors for early-onset cancer and giving us more information about where we might want to focus our efforts in terms of prevention."

    Chan added that another interesting aspect of the study was that "the patterns might be different, depending on how you define early-onset cancer," whether as "very early onset," defined as onset in those younger than 35, or the "less stringent definition" of 35–49 years.

    He said that "within the group that we're calling very early onset, there may be enriched factors" compared with people who are "a little bit older."

    The research was supported by a National Cancer Institute of the National Institutes of Health grant to Case Comprehensive Cancer Center. Schmit reports no relevant financial relationships. Other authors have relationships with Exelixis, Tempus, Olympus, Anthos, Bayer, BMS, Janssen, Nektar Therapeutics, Pfizer, Sanofi, and WebMD/Medscape. Chan reports no relevant financial relationships.

    Gastroenterology. Published online June 18, 2022. Abstract

    For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

    Fri, 15 Jul 2022 01:38:00 -0500 en text/html https://www.medscape.com/viewarticle/977273
    Killexams : An Elimination Diet Might Be The Answer To All Of Your Stomach Troubles—If You Do It Right

    Photo credit: Richard Drury - Getty Images

    Food is fuel and you need balanced nutrients to stay healthy and active, but sometimes your body doesn’t love everything you eat. Here's the tricky part: Which food is the culprit? Luckily, an elimination diet can help you figure that out.

    Food allergies, intolerances, or sensitivities may provoke unpleasant symptoms such as bloating, gas, severe diarrhea, constipation, unexplained changes in weight, or nutritional deficiencies, says Maxine Yeung, RD, CPT, the founder of The Wellness Whisk. And sometimes, they may also cause non-GI woes such as headaches, migraines, skin rashes, acne, joint pains, mood changes, low energy levels, runny noses, hives, and itchy eyes, says Kerry Clifford, RD, LDN, with Fresh Thyme Farmers Market.

    But before you panic, let’s get to know the differences between a food allergy, food sensitivity, and food intolerance.

    Food allergies occur when your immune system reacts to certain proteins in food and causes a physical reaction. It's typically accompanied by "hives, itching, sometimes swelling of the tongue and lips, and rarely anaphylaxis,” says Joel Pekow, MD, a gastroenterologist and associate professor of medicine at the University of Chicago. They can also sometimes come with GI issues like abdominal discomfort, diarrhea, nausea, or vomiting, he adds.

    Now, food sensitivity and intolerance are basically the same thing. Food intolerance or sensitivity means your gut is sensitive and thus intolerant to certain foods. You can expect diarrhea, bloating, and stomach discomfort, says Dr. Pekow.

    While it is possible to be allergic to or intolerant of anything, the most common offenders are alcohol, coffee, corn, dairy, eggs, peanuts and tree nuts, shellfish, soy, and wheat.

    That said, not everyone reacts to these foods the same way. An elimination diet, which involves cutting out certain foods from your diet then gradually reintroducing them to identify the troublemaker, can provide clarity on what foods are causing discomfort. But when done right, finding out what is best for your body takes time, patience, planning, and expert advice.

    Meet the experts: Joel Pekow, MD, specializes in treating digestive disorders, with a focus on irritable bowel disease (IBD). He performs research to learn more about ways to prevent disease progression and Improve therapy response in IBD patients.

    Samantha Nazareth, MD, is board-certified in both internal medicine and gastroenterology/hepatology. She is a noted researcher, writer, and speaker on nutrition, wellness, the gut microbiome, and health tech. Her research has been featured in the New York Times.

    What is an elimination diet?

    Despite being called a "diet," it has nothing to do with weight loss or dieting in the traditional sense. Rather, an elimination diet is a two-part process lasting anywhere from three to eight weeks.

    First, you remove potential food triggers and then carefully add them back into your diet to determine whether they're to blame for your reactions, says WH advisor Samantha Nazareth, MD, a gastroenterologist who practices in New York City. "Sometimes symptoms, which range from belly pain to nasal congestion, can be delayed, therefore reintroduction of each food group has to be for at least three days."

    "Once [triggering] foods are identified, we can modify an individual’s diet to help Improve their symptoms and other body functions such as digestion, absorption, microbial balance, and inflammation," Yeung adds.

    There are also specific types of elimination diets such as a low-FODMAP diet, which is used for patients with conditions like irritable bowel syndrome (IBS) and small intestine bacterial overgrowth (SIBO). "The low-FODMAP diet eliminates certain short-chain carbohydrates—gluten, lactose, fructose, and sugar alcohols—that ferment in our gut and can cause bloating, abdominal pain, diarrhea, and/or constipation," says Liz McMahon, MPH, RDN, a gut health-focused dietitian in Philadelphia.

    Patients with IBS don't absorb short-chain carbs, according to research, which can be why they experience gas, severe bloating, and altered bowel habits (think: diarrhea, constipation, or both). "Eliminating the FODMAPs allows them to first of all, feel better, but then add them back in slowly to figure out what specific carbs/foods are causing their issue," McMahon explains.

    Can I do an elimination alone or do I need help from a pro?

    Before undertaking an elimination diet, consult a professional so they can ensure that you’re conducting the diet effectively and that you’re still able to meet your nutritional needs, Clifford says. After all, if you decide to try cutting out gluten, it's easy to not get the fiber you need. And if you eliminate dairy, you could be putting yourself at risk of too-low vitamin D and calcium levels. Your RD won't let those issues happen.

    And the same goes for more specific elimination diets such as a low-FODMAP diet—best to do it under the care of a physician and/or nutritionist.

    It's also important to talk to your doctor about any issues that you've had in the past (or currently have!) with disordered eating or anxiety, Yeung says. Especially in those with a tendency to control their eating, an elimination diet may trigger food restriction or a hyper-focus on "good" and "bad" foods. Your health professional can help you ensure that you follow your elimination diet in the healthiest way possible, both physically and emotionally.

    How should I begin an elimination diet?

    “Before starting an elimination diet, keep a food and symptom diary to help identify patterns between eating habits and symptoms,” says Yeung. This will help you and your healthcare professional figure out which food or foods you should try to eliminate.

    For example, if you notice that you regularly get itchy after eating walnuts and almonds, you might decide that you want to try eliminating tree nuts. It's totally possible that you will decide to eliminate multiple foods or types of foods.

    The important thing is to eat normally and thoroughly document both everything you eat and how you feel after eating it. Track for at least a couple of weeks before making any decisions about what you'll try cutting.

    The second you spot a potential link in your log, it can be tempting to jump right into your elimination diet. Don't. Instead, keep eating normally, track your symptoms, and start planning. On day one of your diet, you should feel knowledgeable about the exact foods you'll need to avoid, prepared with lots of well-rounded recipes, and ready to read food labels with confidence, says Meghan Sedivy, RD, LDN, with Fresh Thyme Farmers Market.

    Okay, so I've kept a food journal for a few weeks—now what?

    When it comes to picking an actual day to start, choose a time when you know that you will easily have complete control over what you do (and don't) eat. So, no, vacation isn't the best time to try out something like this.

    Once you do choose a time to press play on this program, make sure to avoid making simultaneous lifestyle changes. "I’ve often seen people make many other lifestyle and medication changes [at the same time that they start an elimination diet]," says Yeung. "This makes it much more challenging to determine dietary sources of the symptoms."

    For example, if you start taking probiotics at the same time you eliminate soy, it will be hard to know if you’re feeling differently because of the supplement or because of the elimination, she says. During your elimination diet, it should be your only lifestyle change in progress.

    And when this kick-off day finally arrives, go ahead and eliminate all food and food groups at once. Again, it's important to do this with a doctor or RD's supervision. After all, if you're cutting dairy, gluten, shellfish, and nuts...getting the nutrients you need is going to require some help, says Sedivy.

    Umm, how can I make sure to get all my nutrients if I'm not eating so many things?

    Hey, you—breathe! It's a lot. But keeping up your intake of essential nutrients while on an elimination diet really isn't as hard as it might seem.

    In addition to working with a pro like a dietitian or doc, start (if not continue!) taking a standard multivitamin that doesn't have an added "superfoods" or "food powders," as they may actually have the ingredients you're trying to avoid, McMahon says. Depending on what food(s) you're eliminating, it's not a bad idea to go for a vitamin that has calcium with vitamin D if you're ditching dairy or one with B-vitamins if you're eliminating wheat and gluten.

    McMahon also encourages elimination dieters to keep it as simple as possible to help de-stress the whole process by making sure each meal has three basic components: protein—lean options like chicken or fish—healthy fats—avocado or EVOO—and carbs—veggies like spinach or broccoli or grains like brown rice or quinoa. Together, these components will keep you energized and feeling satisfied, which is a must especially when you're eliminating foods.

    What can I eat during the elimination phase?

    Elimination diets are deeply individualized, so it’s important to work with a registered dietitian to formulate the best plan for you. What you can eat really depends on what you’re eliminating and the indication that you’re eliminating the food for, says Dr. Pekow.

    However, there are some foods that are low FODMAP and usually safe to eat during a simple elimination phase, says Amber Pankonin, RD, and the founder of Stirlist.

    • Grains: Quinoa, brown rice, and polenta

    • Protein: Chicken, tuna, beef, and pork

    • Nuts and seeds: Pumpkin seeds, walnuts, almonds, flax seed

    • Vegetables: Arugula, broccoli, cucumbers, green beans, kale, radishes

    • Oils: Avocado, olive, and coconut oil

    How long does an elimination diet last?

    There's no hard-and-fast rule as to the exact length of an elimination diet. On average, it can last anywhere from three to eight weeks. However, in most cases you should see (and feel) a difference fairly rapidly, says Dr. Pekow. “For food intolerances to certain food groups, the benefit [of elimination] can be within days,” he adds.

    But don’t rush the process. An elimination phase of a few weeks "gives the body time to adjust to a new diet and also allows the gut lining—the barrier from what we put into our mouths and the rest of the body—to regenerate," Dr. Nazareth says.

    Irritants like food allergens can damage the lining, weakening the "security system" so that things that shouldn't enter the body (think: bugs) can now do just that and cause inflammation, bloating, gas, diarrhea, Dr. Nazareth explains.

    That being said, your doctor or dietitian can help you determine the appropriate time period for your elimination diet, which will largely depend on the food(s) you’re cutting out. However, your body requires a good week or two to recoup from any potentially triggering foods.

    It will be tempting to quit the process early, but Yeung says it’s important to stick it out. “Many people stop the elimination diet early because they are feeling better shortly after starting, but by doing this, you risk eliminating foods that you do not necessarily need to because you didn’t go through the reintroduction phase,” she says. "This could cause imbalanced diets and stop you from eating foods that you may really enjoy and can tolerate."

    When can I start reintroducing foods—and how?

    “We usually recommend patients to spend four to six weeks on an elimination diet prior to reintroducing foods,” says Dr. Pekow. There can be a lot of variability in when you would expect to see results (or not) based on the food you are removing from your diet and why you’re doing it, but working with a registered dietitian will help guide you on timing, he says.

    So, about four to six weeks after eliminating everything that's a potential trigger for you, begin the challenge phase of reintroducing one food group at a time. I repeat: one. At. A. Time. You do this with the intention of provoking symptoms, Yeung says. But if you find that the food that you reintroduced has caused issues, then it's best to hold off eating it and seek medical advice.

    While you're at it (read: throughout the entire process of elimination and reintroduction), remember to log everything. Hey, hey, I know what you're thinking: again with the logging?! But take it from the pros like Clifford, who emphasizes the importance of tracking, tracking, tracking. "Write down what foods you ate, how much, and where you got it," she says.

    Also take time to reflect on how you feel after eating, whether there are any changes to your digestion or energy levels, and whether you can tolerate certain serving sizes, but not others. You could keep this record in a journal or on your phone or download a food tracking app.

    What about the foods that still bother me? Should I keep eating them?

    It’s important to know if you have a food allergy, intolerance, or sensitivity—but it’s even more important to know how to respond to that information.

    For example, she says, if you’re lactose intolerant, you won’t cause harm to yourself if you eat lactose. (Although you might experience some uncomfortable side effects like gas or diarrhea.) But if you have celiac disease (confirmed by an intestinal biopsy) and eat gluten, you could harm your gut's ability to properly take in the nutrients your body needs, thereby putting you at risk for vitamin deficiencies, Dr. Nazareth explains. Your MD or RD can help you fully understand your condition so that you can keep your body safe and healthy.

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