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Effective Management Strategies for Chronic Constipation: Reviewing the Evidence Release Date: March-20-12 Credit Expiration Date: March-20-13 . Primary and long-term care physicians, pharmacists, physician assistants, nurse practitioners, and nurses involved in the care of older adults who may suffer from chronic constipation. 1.0 Online Presentation Chronic constipation is highly prevalent and can have a significant negative impact on quality of life, yet new and effective treatment options have only recently emerged. Due to its varying etiologies, it is often interpreted differently by clinicians and patients, but generally it can be diagnosed when a patient is experiencing fewer than 3 bowel movements per week and at least two of the following are present in at least 25% of defecations for a period of 3 months or more: hard or lumpy stools, straining with defecation, a sensation of incomplete evacuation, a sensation of anorectal obstruction, or the use of manual maneuvers to assist defecation. Chronic constipation can be caused by primary or secondary factors, and treatment will vary accordingly. This roundtable discussion will update learners’ knowledge of evidence-based treatment based on chronic constipation’s varying etiologies. With an improved understanding of the condition and its management, primary, geriatric, and long-term care providers can help lessen the burden of chronic constipation and significantly improve the lives of the older adults in their care. Upon completion of this educational activity, the participant should be able to: 1. List ways to improve the treatment of chronic constipation based on the latest clinical evidence. 2. Review the latest evidence regarding the safety and efficacy of single and multiple drug therapy for older patients with chronic constipation. 3. Describe a stepwise management strategy for patients with chronic constipation who are not experiencing symptomatic relief. Louis Kuritzky, MD Family Physician Clinical Assistant Professor Dept. of Community Health and Family Medicine University of Florida Gainesville, FL Anthony Lembo, MD Associate Professor of Medicine Department of Medicine Division of Gastroenterology Beth Israel DeaconessMedical Center Harvard Medical School Boston, MA David R. Thomas, MD, FACP, AGSF, GSAF, CMD Professor of Internal Medicine Division of Geriatrics/Gerontology St. Louis University St. Louis, MO It is the policy of AKH Inc. and ASCP to ensure independence, balance, objectivity, scientific rigor, and integrity in all of their continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activities or with the commercial supporter of these continuing education activities. Identified conflict of interest is resolved by the providers prior to accreditation of the activities. AKH Inc. and ASCP planners and reviewers have no relevant financial relationships to disclose. Dr. Kuritzky serves as a consultant and on the speakers’ bureau for Takeda Pharmaceuticals North America, Incorporated. Dr. Lembo serves as a consultant for Ironwood/Forest, Salix, Prometheus, Ardelyx, and Alkermes. Dr. Thomas has no relevant financial relationships to disclose. PHYSICIAN CONTINUING EDUCATION: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of AKH Inc. and Medical Communications Media. AKH Inc. is accredited by the ACCME to provide continuing medical education for physicians. AKH Inc. designates this enduring podcast 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. NURSING CONTINUING EDUCATION: AKH Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s COA. AKH Inc. designates this educational activity for 1.0 contact hour (0.1 CEU). Accreditation applies solely to educational activities and does not imply approval or endorsement of any commercial product by the ANCC-COA. AKH Inc. is a provider approved by the California Board of Registered Nursing, Provider Number CEP12070, for 1.0 contact hour. PHARMACY CONTINUING EDUCATION: The American Society of Consultant Pharmacists (ASCP) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This knowledge-based activity (UAN 0203-9999-12-065-H01-P) was developed by ASCP and is approved for 1.0 Contact Hour (0.1 CEU). There is no fee to participate and receive credit. Supported by an educational grant from Sucampo Pharmaceuticals, Inc. and Takeda Pharmaceuticals North America, Inc. Minimum System Requirements: Pentium III, 600 MHz or Equivalent Processor • 512 MB of RAM • Windows XP, Vista, or 7. Or, Mac OS X • 800x600 Monitor Resolution • 16-bit Color • 16 bit Sound Card with Speakers 1. Please turn off all pop-up blockers to assure access to the educational activity. 2. Click on the "Start program" icon at the bottom of this page. If you are not already registered as a user of this website, this will bring you to the login/registration page where you will be able to register as a new CMEcorner.com member or check existing registration information. When ready, click on the "Continue to Program" icon at the bottom of the screen. 3. The next screen will permit you to check for or download the Flash player required to run this program and to begin the program presentation. The activity will take approximately 60 minutes to complete. 4. After the program has finished, click on the "Post-test" button. 5. Participants must view the presentation in its entirety, successfully complete the post-test, and submit an evaluation to receive continuing education credit. Credit will be awarded for a score of 80% or better and a statement of credit may be printed immediately after passing the post-test. $0.00 This educational activity may contain discussion of published and/or investigational uses of pharmaceutical agents. Some uses of these agents may not have been approved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. The opinions expressed in this educational activity are those of the faculty and do not necessarily reflect the opinions or recommendations of their affiliated institutions, the publisher, AKH Inc., ASCP, Sucampo Pharmaceuticals, Inc. or Takeda Pharmaceuticals North America, Inc. Any medications, diagnostic procedures, or treatments discussed by the faculty should not be used by clinicians or other health care professionals without first evaluating their patients’ conditions, considering possible contraindications or risks, reviewing any applicable manufacturer’s product information, and comparing any therapeutic approach with the recommendations of other authorities.

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