Certification Accreditation

Certification Accreditation
Accreditation & Disclosures
AMMG Training & Certification
Essential Knowledge in Age Management Medicine
Modules 2 & 3
April 25 & 26th Miami, Florida

OVERVIEW
This certification provides Physicians and Healthcare Providers evidence-based research and clinical protocols on new procedures, methods, and topics in Age Management Medicine that will increase competency, knowledge and provide treatment tools that improve patient outcomes and patient satisfaction.

OBJECTIVES

 Patient Assessment Protocols:

  • Formulate a definition of Age Management Medicine (AMM)
  • Describe assessment and evaluation protocols in AMM
  • Identify causes, prevention, and treatment strategies for chronic diseases, particularly cardiovascular metabolic diseases

Nutrition & Supplements:

  • Be able to describe how nutrition fits into the goal of age management medicine
  • Be able to discuss the evidence supporting nutrition and its effects on cardiovascular disease, inflammation, obesity and diabetes
  • Identify non-pharmacological ways to decrease cholesterol, including supplements shown to decrease LDL
  • Describe the pathways of pre-vitamin D-3 and pre-vitamin D-2 to 1,25 hydroxyvitamin D (calcitriol) and the conditions that interfere with this transformation.
  • Define and describe the following terms: included vitamin D intake, vitamin D supplement, calcidiol, calcitriol, cholecalciferol, ergocalciferol, calcium intake, calcium supplement, calcium carbonate, and calcium citrate.
  • Name the primary function of vitamin D, current recommended blood levels, and laboratory tests to appropriately measure plasma levels. Use the conversion for conventional [ng/mL] units to SI [nmol/L] units by multiplying by 2.5 to identify severely deficient, mildly deficient, optimal, and possible toxic levels of 25[OH]D.
  • List benefits associated with adequate amounts of vitamin D
  • Name and describe conditions associated with a deficiency or excess of vitamin D; describe the age groups and circumstances where deficiency is likely to occur.
  • Identify current prescribing regimen for amounts and frequency or excess of vitamin D
  • Discuss the role of calcium supplements associated with vitamin D intake, and cite research or other sources to support your position.
  • Apply research on vitamin D to the process of aging
  • Review common foods that are supplemented with vitamin D
  • Discuss the role of vitamin D as a hormone
    Exercise & Fitness:
  • Demonstrate an understanding of the importance of regular exercise for obtaining optimal health
  • Describe the co-relation between exercise and health maintenance
  • Discuss the importance of exercise in recovery from disease
  • Recognize the importance of regular exercise to control morbidity even over dietary weight loss or smoking cessation programs.
  • Accurately measure the body’s “energy systems” as a diagnostic tool for identifying disease
  • Demonstrate an understanding of the physics of exercise and oxygen consumption in relationship to health
  • Apply appropriate diagnostic exercise methods for optimal screening of patients.
  • Understand the clinical aspects of and science behind writing an evidence based prescription for exercise.

Motivating Patients and Managing Stress: 

  • Describe the clinician’s role in helping patients implement a healthy lifestyle.
  • Identify the appropriate tests for monitoring a patient’s progress.
  • Define Stress
  • Identify coping strategies to include; Hypnosis, Biofeedback, Mindfulness, Coping Therapy/cognitive behavioral therapy.

Hormonal Optimization and Therapies:

Cortisol:

  • Describe cortisol testing and reference ranges for serum and urine cortisol
  • Discuss the conditions caused by insufficient cortisol; excess cortisol.
  • Describe the conditions caused by hyper and hypo secretions of hormones influencing the role of cortisol
  • Describe the inactions of cortisol with other hormones
  • Describe the pathways between the pituitary gland and the adrenal cortex and the resultant hormonal interaction.
  • Describe dose-related effects of cortisol on drugs, surgery, stress and psychological well-being.
  • Describe management of patients who received corticosteroids.
  • Discuss the steroids produced by the adrenal cortex and their circulation and function
  • Evaluate recent studies in the relationship of cortisol to aging.

DHEA (dihydroepiandrosterone) and DHEA-S (DHEA-sulfate):

  • Define and describe the biological synthesis of DHEA and the influence of other adrenal hormones.
  • Describe the role of DHEA and DHEA-S in endocrine health of men and women.
  • Discuss the benefits related to age in research subjects on DHEA
  • Describe side effects of DHEA on health athletes; on elderly men; on women.
  • State the average normal range of serum DHEA in men and in women.
  • Cite research that supports DHEA used to increased lean body mass (LBM) and decrease fat and to increase mood.
  • Name at least 5 terms used for DHEA, both scientifically and over the counter.
  • Compare synthetic DHEA with serum DHEA.
  • Describe legal issues surrounding DHEA.

Dihydrotestosterone (DHT):

  • Describe the role of testosterone and 5 alpha-dihydrotestosterone (DHT)in embryonic development.
  • Describe the role of DHT during puberty.
  • Describe the clinical evaluation of male reproductive function.
  • Discuss laboratory analysis used to diagnose and monitor treatment of male reproductive function.
  • Compare FDA drugs used for testosterone replacement therapy.
  • Identify appropriate management of men for hormone replacement therapy.
  • Describe the use of DHT for women.
  • Identify research on DHT and testosterone that improves quality of life (QoL). 9. Discuss the use of androgenic steroids to enhance athletic performance.

Estrogen:

  • Describe the pathophysiology of menstruation and menopause and origin of symptoms related to the hormonal cycle.
  • Identify organic causes of amenorrhea.
  • Analyze the laboratory results obtained in the female hormone evaluation.
  • Describe current treatments to reduce the symptoms of post menopause, and discuss the risks and benefits of hormone replacement therapy (HRT) or menopausal hormone therapy (MHT) (aka Hormonal Optimization Therapy).
  • List at least 4 oral products available for estrogen replacement therapy.
  • List at least 4 oral products of combined estrogen/progesterone replacement therapy.
  • Describe the relationship between estrogen/hormone replacement therapy (HRT) related to other disease states.
  • Describe goals of hormone replacement therapy, drug use, dosing, and available delivery methods.
  • Cite the latest findings from current research to address concerns and side effects of hormone replacement therapy (HRT/MHT,HOT).
  • Define bio-identical hormones and discuss the differences between plant-derived and synthetic hormones.
  • Describe emotional symptoms of menopause and their management.
  • Describe absolute and relative contraindications to ERT/HRT (MHT) and alternative therapies.
  • Discuss female sexual dysfunction and available treatment therapies.

Growth Hormone (GH, hGH, AGHD):

  • Review the metabolic pathway of human growth hormone.
  • Identify the signs and symptoms of growth hormone deficiency in the aging adult.
  • Diagnose adult growth hormone deficiency (AGHD), including clinical presentation and laboratory studies.
  • Discuss the benefits and risk of GH supplementation for GH deficient adults.
  • Describe route of administration and dosing of GH.
  • Describe the relationship between hGH, muscle mass, visceral adiposity, strength and bone density; between hGH, cardiovascular disease, blood pressure and glucose metabolism; between hGH, cognitive function and mood.
  • Define and describe: AGHD, IGH-I, hGH, VAT.
  • Discuss research findings related to improved health and quality of life (QoL) in older adults.

Human Chorionic Gonadotropin (hCG):

  • Identify the hormone family and characteristics of human chorionic gonadotropin.
  • Discuss the significance of G protein-coupled receptors (GPCR) related to physiologic processes.
  • Name and describe hormone receptors.
  • Describe the use and process of hCG stimulation test.
  • Identify the origin and production of hCG.
  • Review hCG associated with pregnancy, abortion, hydatidiform mole, and choriocarcinoma.
  • Name the normal laboratory value for hCG in men; in women.
  • List complication associated with administration of hCG.
  • Describe use of hCG in older adults.

Insulin:

  • Describe the metabolic pathways of insulin production.
  • Discuss the influence of insulin on other hormones.
  • Discuss research associated with insulin as part of the metabolic syndrome.
  • Describe the development of insulin resistance associated with aging.
  • Describe how free fatty acids (FFA) contribute to insulin resistance.
  • Examine how patient lifestyles contribute to insulin resistance.
  • Explain the ADA Diet recommendations for glycemic control; discuss other diets used for glycemic control.
  • Select appropriate medications for different types of insulin resistance.
  • Apply knowledge of genetic and environmental factors to identification of pre-diabetes.
  • Describe diagnosis, management, and complications of type 1 and type 2 diabetes.

Insulin Growth-like Factor-1 (IGF-1):

  • List the five major classes of hormones.
  • Identify the effectors and signaling pathways for IGF-1.
  • Discuss current approved uses of IGF-1.
  • Describe the laboratory analysis for endocrine testing and collection of serum, plasma or urine samples.
  • Describe the physiology as IGF-1 affects other hormones.
  • Name four conditions related to the process of aging for which IGF-1 might be indicated (off-label).
  • Explain the relationship between IGF-1 and GH; and insulin.

Pregnenolone: 

  • Identify the biosynthesis pathways of pregnenolone.
  • Describe types of laboratory tests appropriate for differing quantities of hormones.
  • Review current research related to aging and pregnenolone.
  • Discuss the biogenesis, function, and action sites of neurosteroids.
  • Describe the availability of pregnenolone for human use.

Progesterone:

  • Trace the hypothalamic hormones that regulate anterior pituitary trophic hormones that determine target gland secretion,
  • Describe the role of progesterone in the ovulatory cycle.
  • Explain the role of pulsatile hormone systems to the collection of laboratory data on patients.
  • Describe the process of peri-menopause; menopause.
  • Identify current medications for treating symptoms of menopause and their actions and interactions.
  • Review research related to menopause (WHI, HERS).
  • Compare the use of opposed and unopposed estrogens in the menopausal woman.
  • Name drugs that are available to replace progesterone.
  • Describe the role of progesterone in cancer.

Testosterone (T):

  • Define and describe hypogonadism in the aging male; female.
  • Review hypo and hypergonadism in male physiology and the relationship of testosterone to other body hormones.
  • From recent research conclusions, describe the relationship between hypogonadism and muscle mass; strength; body composition; cardiovascular disease; blood pressure and glucose metabolism.
  • Discuss the guidelines for prostate screening by the American Cancer Society and the American Urologic Society and the decision for testosterone replacement therapy.
  • Describe the relationship among testosterone, libido and erectile quality.
  • Identify the relationship between testosterone and cognitive function and mood.
  • State the absolute and relative contraindications to testosterone replacement.
  • Explain laboratory values that guide testosterone replacement dosing and delivery method options.
  • Describe patient concerns and side effects of testosterone replacement therapy.
  • Describe the role of testosterone replacement in the menopausal female.

Thyroid:

  • Review the anatomy and physiology of the thyroid gland and the interaction of secreted hormones on other hormonal systems.
  • Define and describe the following: subclinical thyroid disease (SCTD); subclinical Hypothyroidism (SHypo); subclinical Hyperthyroidism (SHyper); laboratory reference range; T3; T4; TSH.
  • Describe subjective and clinical manifestations of thyroid imbalance.
  • Interpret laboratory results obtained in an evaluation of thyroid function.
  • List conditions that would cause or contribute to an “out of range” result in TSH laboratory analysis.
  • Explain the relevance of iodine intake to TSH levels.
  • Identify the relationship of age to TSH levels citing research sources.
  • Discuss research related to TSH levels and cardiac function and blood pressure.
  • Review research related to TSH measurements and lipid levels (both in cholesterol and metabolic syndrome).
  • Describe drug choice and treatment guidelines for SHypo.
  • List drugs used to treat Hypothyroidism and SHypo.
  • Legal Issues used to treat Hypothyroidism and SHypo.
  • Demonstrate an understanding of the criteria for legitimate human growth hormone (HGH) use, prescription, or distribution
  • Recognize the legal sources of HGH or HGH compounds
  • Identify the possible penalties associated with illegitimate HGH use, prescription or distribution
  • Describe basic methods of minimizing litigation risk in the prescription of hormones/HGH

Precision Medicine: New and Emerging Therapies; Genomics, Telomeres & Adult Stem Cells 

  • Define and describe the following terms: telomere, end replication problem; capping of telomeres; telomerase; TERT; TRNA; adult stem cells (ASC); totipotent; pluripotent; “plastic” stem cells;
  • Describe the process for collection and use of autologous stem cells.
  • Describe how telomeres affect aging.
  • Identify the location (current theory) of telomere activity.
  • Describe how human telomere shortening relates to aging.
  • Discuss gender differences related to telomere length.
  • Name 3 types of Adult stem cells and their characteristics.
  • Discuss collection and use of autologous stem cells. 9. Define the existing powers of the FDA in the Food, Drug and Cosmetic Act (FDCA, 1938, 21 USC §§301, et seq) and the USPHS through the Public Health Service Act (PHSA, 1944, 42 USC §201), and the impact upon the practice of medicine.
  • Give four examples of research into the use and application of ASC in treatment of human diseases and conditions.
  • Discuss ethics related to safe medical practice in use of autologous and homologous ASC.
  • Compare the benefits and risks of commercial ASC and autologous ASC use in medicine.
  • State treatment indications for genetic testing that shows unfavorable polymorphism for APOC3, APOA5, APOE.
  • Develop a personalized nutrition plan according to the patient’s genetic test results.
  • Describe genetic testing that is available, to help guide the clinician in determining appropriate pharmacological therapy.

Case-Based Examination:
The participant will be able to demonstrate accumulated essential knowledge by answering questions on a final examination covering patient evaluation and approaches to appropriate treatment and follow-up in an assortment of scenarios based on real-life cases.

ACCREDITATION:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Medical Academy and the Age Management Medicine Group (AMMG). Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

CREDIT HOURS: 25
Medical Academy designates this live activity for a maximum of 25.0AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

DISCLOSURE AND CONFLICT OF INTEREST RESOLUTION:
All conflicts of interest of any individual(s) in a position to control the content of this CME activity will be identified and resolved prior to this educational activity being provided. Disclosure about provider and faculty relationships, or the lack thereof, will be provided to learners.

AMMG PLANNING COMMITTEE
Florence Comite, M.D
Elliot Dinetz, M.D., ABFM, ABAARM
Mark Gordon, M.D.
Rob Kominiarek, D.O. FACOFP
Edwin Lee, M.D.
Luis Martinez, M.D.
Cesar M. Pellerano, M.D.
John J. Rush, M.D., FACEP, MBA, MHA
George Shapiro, M.D.

COURSE DIRECTOR
Gregory R. Fillmore, Director of Education, AMMG

COURSE FACULTY
Derrick DeSilva, Jr., M.D.
Elliot Dinetz, M.D., ABFM, ABAARM
Todd Fox, B.S.
Mark Gordon, M.D.
Rob Kominiarek, D.O.
Edwin Lee, M.D.
Daniel Stickler, M.D.

                          SUMMARY OF DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS
None of the following faculty, planners and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies who’s primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients

Educational Support:
AMMG received no educational support in the form of Grants for this educational course.