1. education

GERIATRIC LECTURE SERIES
NUTRITIONAL MISCONCEPTIONS
April 16, 2015
12:00 pm – 1:00 pm
CME Accreditation and Designation
The University of Nevada School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to sponsor continuing medical education for physicians.
The University of Nevada School of Medicine designates this live activity for a maximum of 1.0 AMA PRA
Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their
participation in the activity.
Continuing Education Credit
The State of Nevada Board of Examiners for Social Workers, and the State of Nevada Board of
Examiners for Long Term Care Administrators have approved this program for 1.0 continuing education
units. The University of Nevada School of Medicine approves this activity for 1.0 hours of Nursing
continuing education credit.
Disclosure Policy
The Nevada Geriatric Education Center (NGEC) is a program of the University of Nevada School of
Medicine (UNSOM). UNSOM is an accredited provider of continuing medical education through the
Accreditation Council for Continuing Medical Education (ACCME). Therefore, we follow the ACCME
guidelines to ensure balance, independence, objectivity, and scientific rigor in our educational activities.
In order to assure that information is presented in a scientific and objective manner, NGEC requires that
anyone in a position to control or influence the content of a continuing medical education/continuing
education activity disclose relevant financial relationships with any commercial or proprietary entity
producing health care goods or services relevant to the content being planned or presented. Following
are those disclosures.
Presenter Disclosures
CME Committee Disclosures
Evan Klass, MD, FACP – Nothing to disclose
Patricia Charles, DrPH – Nothing to disclose
Terry Henner, MA – Nothing to disclose
Melissa O’Brien, MS – Nothing to disclose
John Packham, PhD – Nothing to disclose
Stanley Shane, MD – Nothing to disclose
Jeanne Tremaine, BS- Nothing to disclose
Planning Committee Disclosures
Natalie Mazzullo, MEd - Nothing to disclose
Jeri Ostrander, BS - Nothing to disclose
Patricia Swager, MEd - Nothing to disclose
Disclosure of Off-Label Uses
The content of this educational activity may contain discussion of off-label uses of some of the agents
mentioned or devices mentioned. Please consult the product prescribing information for further details.
Acknowledgements
This project is supported in part by funds from the Bureau of Health Professions (BHPr), Health
Resources and Services Administration (HRSA), and Department of Health and Human Services (DHHS)
under Geriatric Education Centers grant #UB4HP19205 for a total award of $2,082,315. This information
or content and conclusions are those of the author and should not be construed as the official position or
policy of, nor should any endorsements be inferred by, the BHPr, HRSA, DHHS or the U.S. Government,
the Nevada Geriatric Education Consortium, University of Nevada School of Medicine, Desert Meadows
AHEC, or University of Nevada Las Vegas.
Participant Sign in and Certificate of Attendance
Participants are required to sign in at the beginning of the educational activity and are asked to return a
completed program evaluation and participant profile form to the registration desk at the conclusion of the
educational activity. These completed forms will be exchanged for a certificate of attendance at the end
of today’s program or via US mail (when necessary).
Replacement of Certificates of Attendance
In the event a certificate of attendance is lost, please contact the Nevada Geriatric Education Center for
a replacement.
Nevada Geriatric Education Center
1701 West Charleston Blvd., Suite 650
Las Vegas, Nevada 89102
(702) 671-6404
(702) 671-6425 – fax
[email protected]
Nevada Geriatric Education Consortium
Form #21: Evaluation of Geriatric Lecture Series Program
Name:
April 16, 2015
Date:
Program Title: GLS: Nutritional Misconceptions
1. Location:
Las Vegas
Reno
DHCFP
Rural:
2. Was the material presented in a manner that was free from commercial bias?
Please comment:
Yes
No
Overall Teaching Effectiveness
Excellent
3. Please evaluate the speaker(s).
Evan Klass, MD, FACP
Good
Fair
Poor
4. Please circle your level of knowledge/skill both before and after today’s discussion for each of the objectives below.
1-None
2-Very Little
Your knowledge/skill
BEFORE today’s discussion
3-Moderate Amount
4-Great Deal
5-Extensive
Objective
Your knowledge/skill
AFTER today’s discussion
1
2
3
4
5
Demonstrate the difference between medications and nutritional
supplements.
1
2
3
4
5
1
2
3
4
5
Distinguish between promotional health claims and facts.
1
2
3
4
5
1
2
3
4
5
Describe the limitations of FDA approval.
1
2
3
4
5
5. Please select the options below that best describe how you will use the content of today’s program, and for numbers
5 to 7, estimate the number of people who will directly benefit from your interaction with them:
Check ALL
that apply
As a result of today’s program, I will:
1. Expand or revise treatment guidelines/protocol for facility
2. Provide treatment or services in a new way
3. Interact with patients differently
4. Personal use
5. Educate patients/clients and their family members and/or friends
6. Educate/train health professionals, staff and/or students
7. Informally share information with health professionals, staff and/or students
8. Other (please explain):
6. Given the opportunity, would you attend geriatric lectures via webinar on your computer?
Estimated number of
people who will
directly benefit from
your interaction with
them in the next year
Yes
No
7. Suggested topics or speakers for future programs (please be specific):
8. Comments:
Thank you for taking the time to assist us in future planning and continued funding!
Form #21
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01/07/14 DJ
Nevada Geriatric Education Consortium
Form #10: Demographic of Consortium Program Participant
Thank you for completing this form! This information is crucial for our reports to our funding agencies.
The information you provide is reported in a group format only. We ask for your name to avoid duplication of data.
1. Name:
2. Date:
3. Current Place of Employment (or School if a Student):
Physical Address
of Employment:
4. Your Primary Role (Please select one)
Healthcare Professional/Provider
City:
University/College Faculty
State:
Fellow
Resident
5. Is your attendance today to acquire or maintain professional certification or licensure?
6. Your Employment or Practice Setting (Please select all that apply)
Health Professions Shortage Area
Medically Underserved Community
Yes
Primary Care Setting
Zip Code:
Student
No
Rural or Frontier Area
7. Your Primary Profession and Discipline – Current OR Prior to Retirement OR Program of Study if a Student (Please check only one)
MEDICINE
BEHAVIORAL HEALTH
DENTISTRY
Clinical Psychology
Dental Assistant
Family Medicine
Counseling Psychology
Dental Hygiene
Geriatric Psychiatry
Clinical Social Work
General Dentistry
Geriatrics
Marriage and Family Therapy
Other Dentistry:
Internal Medicine
Neurology
Pastoral/Spiritual Care
Other Psychology
Physician Assistant
Other Medicine:
Other Social Work or Substance Abuse/Addictions Counseling
NURSING
APRN
CNS
APRN or CNS, please select area of focus:
Family
Gerontology
Pediatrics
Psychiatric / Mental Health
Women’s Health
CNA / PCA
CNM (Nurse Midwife)
Community or Public Health Nurse
CRNA (Nurse Anesthetist)
Home Health Aide
LPN / LVN
RN
Nurse Administrator
Nurse Educator
Nurse Researcher
PUBLIC HEALTH
Biostatistics
Disease Prevention / Health Promotion
Environmental Health
Epidemiology
Health Policy & Management
Infectious Disease Control
Injury Control & Prevention
Social & Behavioral Sciences
OTHER PROFESSION NOT LISTED
Other:
8. Your Race/Ethnicity (Select all that apply)
American Indian or Alaskan Native
Black or African American
Asian
Native Hawaiian or Pacific Islander
9. Are you Hispanic, Latino/a, or Spanish?
Yes
No
10. Do you supervise or provide instruction to health professions students?
OTHER PROFESSIONS & ALLIED HEALTH
Chiropractic
Community Health
Dietitian / Nutritionist
Direct Service Worker / Paid Caregiver
Facility Administrator
First Responder / EMT
Lay / Family Caregiver
Health Education Specialist
Medical Assistant
Occupational Therapy
Office/Support Staff
Optometry
Pharmacy
Physical Therapy
Podiatry
Rehabilitation Therapy
Speech Therapy
White
More than One Race
Prefer Not to Disclose
Prefer Not to Disclose
Yes
No
11. Are you currently a recipient of a Health Resource Services Administration (HRSA), Bureau of Health Professions award (Career Award,
Fellowship, Scholarship, Traineeship, Loan, or Loan Repayment)?
Yes
No
Form #10
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12/12/14 DJ
4/14/2015
Learning Objectives
NUTRITIONAL MISCONCEPTIONS
Evan M. Klass, M.D.
Associate Dean, Statewide Initiatives
University of Nevada School of Medicine
A fact is something that has really
occurred or is actually the case. The
usual test for a statement of fact is
verifiability, that is, whether it can be
demonstrated to correspond to
experience…Scientific facts are verified
by repeatable careful observation or
measurement (by experiment)
Wikipedia
Understand the difference between
medications and nutritional supplements
Distinguish between promotional health
claims and facts
Learn the limitations of FDA approval
Questions I cannot answer today
Is a strict low fat diet good?
How much salt is too much?
Are high fructose corn sweeteners bad?
Are artificial sweeteners bad?
Are calcium supplements good?
Is Vitamin D supplementation important?
Are organic foods better?
Questions I can answer today
Is it bad to be overweight or obese?
– BMI > 25 = overweight
– BMI > 30= obese
Is it bad not to exercise?
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4/14/2015
Is there a diet that has been proven
to reduce the risk of heart disease?
If we know so little, why is there
some much talk?
Primary Prevention of
Cardiovascular Disease with
a Mediterranean Diet
Ramón Estruch, M.D., Ph.D., Emilio Ros, M.D., Ph.D., et al. N Engl J Med 2013; 368:1279‐1290April 4, 2013DOI: 10.1056/NEJMoa1200303
Delicious?
1906 Pure Food and Drugs Act
‐List any of 10 ingredients that
were deemed "addictive" and/or
"dangerous" on the product
label if they were present…
-Alcohol, morphine, opium, and
cannabis were all included
-FDA created by this legislation
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US Federal Food, Drug, and Cosmetic Act (1938)
Taste of Raspberries, Taste of Death: US Dietary Supplements Health
and Education Act- DSHEA(1994)
– A product (other than tobacco) intended to
supplement the diet and contains one of the
following:
The 1937 Elixir Sulfanilamide Incident
• Vitamin, mineral, herb, amino acid, a dietary
substance to supplement the diet or a concentrate,
metabolite, constituent or extract or combinations
of these…ingested by mouth
Who is most likely to take
supplements?
Supplement use is increasing
60
US Adults Reporting Dietary Supplement Use
50
% of Respondents
REGULATION
40
1971‐74
1976‐80
30
1988‐94
20
2003‐06
10
 Adults – 52% (Older adults: 50-70 yrs – 65%;
71+ yrs – 71%)
 Children– 32% (4-8 yrs – 49%; 14-18 yrs – 26%)
 Normal or overweight adults 56% (Obese 48%)
 Those with more than HS education - 61% (Less
than HS education - 37%)
 White - 59% (Black 36%; Hispanic 34%)
0
Females
Males
Source: National Health and Nutrition Examination Survey
From: Multivitamins in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II
Randomized Controlled Trial
JAMA. 2012;308(17):1751-1760. doi:10.1001/jama.2012.14805
Figure Legend:
Y-axis range shown in blue indicates cumulative incidence from 0 to 0.15.
Date of download: 4/12/2015
Copyright © 2015 American Medical
Association. All rights reserved.
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REGULATION (the Quack Miranda Warning)
1) Statement regarding nutrient deficiency must disclose the prevalence
2) Claims to prevent, treat or cure a disease are prohibited unless approved by FDA
3) Claims of “supporting structure and function” or “well being” must include:
– “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.”
Eric Schneiderman (the Attorney
General of New York)Asks Major
Retailers To Halt Sales Of Certain
Herbal Supplements As DNA Tests Fail
To Detect Plant Materials Listed On
Majority Of Products Tested
Dietary Supplement Safety
 Industry regulated by FDA, FTC
 Pre-market approval not required
 Dietary Supplement and Nonprescription Drug
Consumer Protection Act 2006 - manufacturers
must notify FDA of all serious adverse events for
OTC drugs and dietary supplements
 Good Manufacturing Practices Rules released by
FDA in 2007 with full implementation by 2010.
GNC Announces New Policy
After Facing Scrutiny Over
Mislabeled Products
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Most are safe, but not risk free
• 6,300 Adverse events reported 2007‐ 2012
– 10,300 serious outcomes (some multiple) • heart, kidney or liver problems
• Aches, fatigue, nausea, pains, vomiting, allergic reactions
– 115 deaths
– 2,100 hospitalizations
– 900 emergency room visits
– 1,000 serious injuries or illnesses
– 4,000 “other important medical events”
Consumer Reports magazine: September 2012 10 Surprising Dangers of
Vitamins and Supplements
Don't assume they're safe
because they're 'all natural'
American College of Physicians Ethics Manual, 6th Edition
Snyder L. Annals of Int Med 156(1):73‐101;2012
• Financial conflicts of interest
– The sale of products from the physician’s office might be considered self‐referral and undermine trust
– Does the product meet an urgent need of the patient, offer clear benefits compared to other products, and is it specifically relevant to care
• “A good reputation is more valuable than
money”
– Pubilius Syrus, Maxim 108 (42 BC)
• “A good name is better than riches”
– Cervantes: Don Quixote, part ii, book ii, chapt xxxiii
• Crutches vs. vitamins or cosmetics
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