Involuntary Weight Loss and its Effects on the Body’s Ability to Heal

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Questions and Answer and Evaluation Form

Involuntary Weight Loss and Its Effects on the Body's Ability to Heal—Educational Program Information

Completion Time: The estimated time to completion for this activity is two hours.

Target Audience: This CME/CPME/ACPE/CE activity is intended for physicians, podiatrists, pharmacists, and nurses who treat spinal-cord injured, chronic obstructive pulmonary disease (COPD), and long-term acute care (LTAC) patients, patients with pressure, acute, or chronic wounds, or patients who otherwise experience involuntary weight loss.

At the conclusion of this activity, the participant should be able to:
1. Discuss current therapies for the prevention of involuntary weight loss
2. Describe the nutrition prescription in acute and chronic wound care
3. Be familiar with the use of adjunctive nutrition support for involuntary weight loss in LTAC and COPD patients and patients with wounds
4. Discuss the role of anabolic agents in wound care
5. Define significant weight loss and what type of weight is lost during metabolic stress
6. Describe how metabolic stress affects the amino acids, glutamine, and arginine resulting in loss of lean body mass
7. Describe the rationale for monitoring both serum albumin and prealbumin in the prevention and treatment of pressure ulcers
8. Define protein, calorie, fluid, and micronutrient needs for wound healing
9. Define the syndromes associated with delayed wound healing
10. Understand the pathophysiology of each syndrome
11. Identify patient populations at risk
12. Recognize medical/metabolic conditions associated with catabolic state
13. Discuss appropriate methods of assessment
14. Determine methods of intervention, including use of anabolic medication
15. Access further educational and clinical resources about this topic.

Disclosure: All faculty participating in Continuing Medical Education programs sponsored by HMP Communications are expected to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentation. Jennifer James, Evelyn Phillips, Paul Walaszek, Jeffrey Stone, and Bruce Friedman have disclosed that they are members of the speakers bureau for BTG Pharmaceuticals Inc.

Commercial Support Disclosure: This activity is financially supported through an unrestricted educational grant by BTG Pharmaceuticals Inc.

Accreditation (Physicians, Podiatrists, Pharmacists, Nurses): HMP Communications, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. HMP Communications, LLC is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine. HMP Communications, LLC is accredited by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education. HMP Communciations, LLC is approved by the California Board of Registered Nursing, Provider #13255.

Designation: HMP Communications designates this continuing medical education activity for 2 credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association. Each physician should claim only those hours he or she spent in the educational activity. HMP Communications designates this continuing medical activity for .2 CEUs available to participating podiatrists. HMP Communications designates this continuing education activity for 2 contact hours (0.20 CEUs) of the American Council on Pharmaceutcial Education (Universal Program Number 276-000-02-006-H04). A statement of credit will be issued only upon receipt of completed activity self test. HMP Communications designates this activity for 2 credit hours (CEs) for participating nurses.

Method of Participation: Read the article, take, submit, and pass post-test by November 15, 2003.

How to obtain educational credits by reading this publication: Participants must read all five articles in the supplement, "Involuntary Weight Loss and Its Effects on the Body's Ability to Heal," found online at www.woundsresearch.com [3]. Participants must score at least 70 percent on the questions (found below), successfully complete the entire evaluation form (found below), and submit answer and evaluation form online, or print it off and send it to the correct address listed below. Certificates will be mailed to those who successfully complete the learning assessment by November 15, 2003.

Submit form online, fax the completed form, or mail the completed form to:
Trish Levy, CME Director
HMP Communications
83 General Warren Blvd., Suite 100
Malvern, PA 19355
Fax (610) 560-0501

This activity has been planned and produced in accordance with the ACCME Essential Areas and Policies.

Release date: November 15, 2002
Expiration date: November 15, 2003

Questions

1. Studies have shown that the stage and severity of pressure ulcers correlate with the degree of patient malnutrition based on what laboratory test?
A. Albumin
B. Thyroid function
C. Skin biopsy
D. Urinalysis

2. Which mutually interdependent systemic factor is adversely affected by the catabolic state, thus deterring wound healing?
A. Endocrine system
B. Nutritional status
C. Immune system
D. Protein synthesis
E. All of the above

3. What is considered significant weight loss?
A. 2% weight loss in 10 days
B. 5% weight loss in 30 days
C. 7.5% weight loss in 3 months
D. 10% weight loss in 6 months
E. All of the above

4. Under catabolic stress, glutamine and arginine become:
A. Less important
B. Essential
C. Inactive
D. None of the above

5. Involuntary weight loss may be minimized by:
A. Optimizing nutrition to supply substrates for energy
B. Increasing protein intake to 1.5 to 2.5g/kg/day
C. Supplying a nutrient mix of 30% fat, 20% amino acids, and 50% carbohydrates
D. All the above

6. Which of the following drugs is approved by the FDA to prevent involuntary weight loss?
A. Oxandrolone
B. Human growth hormone
C. Megestrol acetate
D. Dronabinol

7. The mechanism of action of oxandrolone includes:
A. Promotes catabolism by binding to androgen receptors
B. Increases amino acid uptake, decreases amino acid release, and increases protein synthesis
C. Increases levels of growth hormone
D. All the above

8. Indications for the use of oxandrolone include:
A. Extensive surgery
B. Chronic infection
C. Weight loss without pathophysiologic reasons
D. All the above

9. Potential side effects of oxandrolone may include:
A. Mild fluid retention
B. Hypercalcemia
C. Increased cholesterol
D. All the above

10. Bacterial translocation refers to:
A. Bacteria mutations within the intestine
B. Organisms having different manifestations depending on where in the body they
proliferate
C. Spreading organisms hematogenously through the lack of the immunological barrier of the gut
D. Ability of an antitoxin to change the nature of the bacteria

11. Clinicians cannot impact a patient’s nutritional status without:
A. Providing high-protein/low-fat meals
B. Ensuring enhanced vitamin and mineral support
C. Reversing catabolism
D. Providing enteral support and oxygen-free modifiers

12. According to this article, nutritional support and adjunctive anabolic stimulation may have an impact on all but which of the following?
A. Chronic obstructive lung disease
B. Healing a decubitus ulcer
C. Burn wound closure
D. Liver dysfunction

13. Anabolic stimulation has been successful in patients with chronic obstructive lung disease because:
A. It helps reverse the negative effects of involuntary weight loss
B. As a steroid, it reverses the inflammation of lung disease
C. It helps the patient gain fat weight to increase pulmonary function
D. It is proven to reduce long-term disability

14. Oxandrolone is a more effective control for post-injury catabolism after severe burn injury than human growth hormone because:
A. It increases metabolic rate
B. It does not cause significant hyperglycemia
C. It is less complicated to administer
D. It creates fewer major toxicities

Answer Form and Evaluation

Involuntary Weight Loss and Its Effects on the Body’s Ability to Heal

Please complete (print clearly if submitting offline):

Name Degree Position/Title

Organization/Institute Department

Mailing Address for Certificate (H or W):

City State Zip Code Email Address

Social Security Number Phone (area code) Fax (area code)

Answers (Refer to questions above) Circle or click on one letter for each answer:

1. A B C D
2. A B C D E
3. A B C D E
4. A B C D
5. A B C D
6. A B C D
7. A B C D
8. A B C D
9. A B C D
10. A B C D
11. A B C D
12. A B C D
13. A B C D
14. A B C D

Evaluation (circle or click on one)
Excellent (4) Good (3) Satisfactory (2) Poor (1)

Accuracy and timeliness of content: 4 3 2 1
Relevance to your daily practice: 4 3 2 1
Impact on your professional effectiveness: 4 3 2 1
Relevance of the content to the learning objectives: 4 3 2 1
Effectiveness of the teaching/learning methods: 4 3 2 1
This activity avoided commercial bias or influence YES NO

Now that you have read this article, can you:

1. Discuss current therapies for the prevention of involuntary weight loss?
YES NO
2. Describe the nutrition prescription in acute and chronic wound care?
YES NO
3. Be familiar with the use of adjunctive nutrition support for involuntary weight loss in LTAC and COPD patients and patients with wounds? YES NO
4. Discuss the role of anabolic agents in wound care? YES NO
5. Define significant weight loss and what type of weight is lost during metabolic stress? YES NO
6. Describe how metabolic stress affects the amino acids, glutamine, and arginine resulting in loss of lean body mass? YES NO
7. Describe the rationale for monitoring both serum albumin and prealbumin in the prevention and treatment of pressure ulcers? YES NO
8. Define protein, calorie, fluid, and micronutrient needs for wound healing? YES NO
9. Define the syndromes associated with delayed wound healing? YES NO
10. Understand the pathophysiology of each syndrome? YES NO
11. Identify patient populations at risk? YES NO
12. Recognize medical/metabolic conditions associated with catabolic state? YES NO
13. Discuss appropriate methods of assessment? YES NO
14. Determine methods of intervention, including use of anabolic medication? YES NO
15. Access further educational and clinical resources about this topic?
YES NO

What questions do you still have?___________________________________

How will you use what you have learned from this activity?________________

All tests must be received by 11/15/03.