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CME: Child and adolescent Crohn’s disease: Updates in medical and nutritional strategies

Activity Description / Statement of Need:

In this online, self-learning activity:

Crohn’s disease (CD) is an inflammatory bowel disease (IBD) that is defined by a transmural process that often occurs in the terminal ileum but may occur in any portion of the GI tract. Although the exact etiology of CD is unknown, a handful of genetic, immunological, and environmental risk factors have been identified, including an impaired immune response to commensal or pathogenic intestinal microbiota that drives mucosal inflammation in patients who are genetically susceptible.

Intestinal and abdominal complications such as strictures, abscesses, and fistulas are common among pediatric patients and increase as the disease progresses. Vitamin and mineral deficiencies have also been attributed to IBD due to mucosal inflammation in the gut, low oral intake, and malnutrition resulting in complications such as poor bone health, delayed puberty, anemia, and stunted growth. The annual direct healthcare costs – accounting for the majority of costs in the U.S. – are about $18,000 to $19,000 per patient. CD shares a number of clinical characteristics with other disease states, and initial misdiagnosis and delayed diagnosis of pCD are not uncommon, which may have a dramatic impact on a patient’s clinical course because pCD is often more severe and associated with a higher incidence of complications than adult CD.

This learning activity has been designed to bring healthcare professionals’ knowledge of the strategies to manage pCD up to date and to improve their competence and performance in treating it.

Target Audience:

The following healthcare professionals: pediatricians, pediatric gastroenterologists, and those who specialize in adolescent medicine; physician assistants, nurse practitioners, and pharmacists; and any other healthcare professionals with an interest in or who clinically encounter patients with pCD.


Commercial Support Disclosure: This program is supported by an educational grant from Abbott Nutritional.

This activity is free of charge.


Release Date: September 11, 2021 -- Expiration Date: September 11, 2023

Faculty: Sonia Michail, MD

Agenda

Faculty introduction, disclosures

Primer and updates on pCD epidemiology, etiology, presentation, and diagnosis

  • Pediatric IBD: Statistics by subtype; geographic prevalence in the U.S., worldwide
  • Etiology of CD
  • Risk factors for CD and related morbidity and mortality
  • pCD disease natural history
  • Diagnostic tests and endoscopic studies
  • pCD severity and risk stratification
  • Patient case(s)

Treatment of pCD

  • Goals of therapy
  • Induction and maintenance of clinical remission and mucosal healing
  • Control of extra-intestinal manifestations
  • Improvement/maintenance of QOL
  • Prevention of complications
  • Nutritional intervention and treatment protocols
  • EN (including tube-feeding) and parenteral nutrition, where applicable
  • Pharmacotherapeutic considerations: extent and severity of disease; presence of extra-intestinal disease manifestations; prior treatment success/failures; fit of an agent’s safety profile for specific patients’ medical histories
  • Approach, and medication class, by disease severity
  • Presently available medications
  • Salicylates
  • Glucocorticoids
  • Immunomodulators
  • Biologic agents and biosimilars
  • Concomitant health concerns that may impact drug therapy: vaccination status, stress
  • Clinical pearls: Difficult-to-patients
  • Patient case(s)

Best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Recall best practices in the diagnosis of pCD and the effects of misdiagnosis and delayed diagnosis.
  • Describe the role of nutrition in the management of pCD, and design a treatment plan that includes them.
  • Identify best practices in the pharmacotherapeutic of pCD, and formulate a treatment plan incorporating them.

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME-MOC_badge

ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABP MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Pediatric's (ABP) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABP MOC credit.

 

PhysiciansFor maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: Not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in this section, then it does NOT provide MOC credit.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.0 contact hours (0.1 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-21-031-H01-P.  This is an Knowledge (K)-type activity. 

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure: Sonia Michail, MD, AGAF, FAAP, Professor of Clinical Pediatrics, The University of Southern California, has no relevant financial disclosures.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.

Faculty will discuss unlabeled/investigational uses of a commercial product.

All relevant financial relationships have been mitigated.

ScientiaCME adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

Commercial Support Disclosure: This program is supported by an educational grant from Abbott Nutritional.

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version


Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.


Additional Courses That Are Related To This Activity

Closing the gap in the treatment of constipation-predominant irritable bowel syndrome (IBS-C): From recognition to treating the patient

Ulcerative Colitis (UC): Optimizing Pharmacotherapeutic Management Strategies

Employing biosimilars in the treatment of inflammatory health conditions: How to and should I?

Medical and nutritional management of eosinophilic esophagitis in adolescents and adults: Therapeutic updates and best practices