medgem training module

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This course is designed to teach you how to use the MedGem device to personalize your clients’ nutrition and exercise programs. At the completion of this training, you will be able to:

MedGem Training Module

• Define and understand resting metabolic rate (RMR).

• Be able to perform a measurement using the MedGem device.

• Interpret and apply the measurement.

• Answer frequently asked questions.


Your resting metabolic rate is the number of calories your body burn each day with no activity. It makes up the majority (60-75% in healthy individuals and 100% in critically ill) of calories burned each day.

Resting metabolic rate is unique to each individual and is affected by a number of factors:

• Age

• Body Weight

• Medications

• Fever and/or Infection

• Weight Loss

1 Danforth, E. LifeSci 28:1891-1897, 1981.

2 Fung EB, AACN Clinical Issues 11(4): 480-497, 2000.

• Gender

• Genetics

• Hormones

• Exercise

• Nutritional Supplements

Resting Metabolic RateThe Missing Link to Weight Management


Predictive Equations are inaccurate for Healthy and III Individuals

Healthy IndividualsRMR can vary significantly from person to person – up to 900 calories per day in healthy people.

Ill Individuals Several studies have indicated predictive equations are significantly different than measured RMR. Equations can overestimate RMR by as much as 59% and underestimate as much as 30% in sick individuals.

This variability can result in very different outcomes for individuals.

ADA’s Adult & Pediatric Weight Management Guidelines:“If possible, Indirect Calorimetry, should be used for assessing RMR when

developing energy plans.”

1. Foster, G, et al. Metabolism, 1988; 37(5), 467-4722. Mann et al, Crit Care Med 1985: 13: 173-1773. Weissman et al, Journal of Anesthesiology 1986: 64: 673 6794. ABA-EBL: www.ADAevidencelibrary.com


RMR Varies Among Healthy and Ill Individuals

Foster, G, et al. Metabolism, 37(5): 467-472, 1988

Hunter D, et al. Br J Surg, 75: 875-878,1988,

Welis, P. Am J Clin, 88; 959-970, 2008,


Clinical Benefits of Measuring RMR

• Measuring RMR enables you to gauge the effects of the client’s condition on his/her calorie needs and adjust your nutrition recommendations accordingly. Conditions that impact your RMR include:

• disease severity and point of time in disease process• change in medications/dosage• change in dietary regimen• change in weight (+/- 5%)

• Providing appropriate feeding minimizes the percentage of clients who are overfed and underfed.

• Patients following a diet plan established from measured RMR lose more weight compared to diet plans that estimate RMR.

• Measuring RMR to establish appropriate nutritional needs can result in direct cost savings by avoiding unnecessary nutritional support.

1. Alberda et al., Nutri Clin Pract 17: 38-42, 20022. McDoniel, et al., Obes Facts (1)6; 298-304, 2008.3. McClave et al, JPEN 22; 375-381, 1998.


Candidates for Metabolic Measurement

Some facilities use the device on every individual as part of their initial nutrition assessment to determine baseline calorie needs; others choose to use the device on individuals that meet certain criteria that put them at high risk for complications associated with overweight and obesity.

Sample criteria for determining medical necessity for diagnostic procedure (CPT 94690). Average payer reimbursement is $50-$80.

• 414 Chronic Pulmonary HT Disease • 428 Heart Failure*• 493 Asthma*• 496 COPD*• 51.8 Lung Involvement in other disease*• 780.5 Obstructive Sleep Apnea• 786.5 Dyspnea*• 786.9 Hypoventilation Syndrome*

• 244.9 Hypothyroidism• 250 Diabetes Mellitus• 272.1 Hypercholesterolemia• 22.4 Hyperlipidemia• 277.7 Metabolic Syndrome• 278 Obesity• 401 Hypertension• 414 Cardiovascular Disease

*CMS indicates medical necessity


Performing a Measurement

About the MedGem Device

The MedGem is a hand-held indirect calorimeter that measures oxygen consumption to determine resting metabolic rate.

The MedGem device is easy to use, providing measurements quickly and accurately. Useful as a tool for monitoring changes in metabolism, the MedGem gives you important information to help your clients achieve their personal weight management, nutrition, and exercise goals.

“The validation results suggest the MedGem can be used to accurately measure oxygen consumption and RMR in long-term healthcare facilities, low-capacity hospitals, athletic training centers, health clubs, and weight loss clinics.”

Richard Branson, MS, RTTUniversity of Cincinnati Medical Center, Cincinnati, OH

1. RMR is calculated using the Weir equation and a constant RQ value of 0.85 (RMR=6.931 X VO2),Weir,JB., New Methods for Calculating Metabolic Rate with Special Reference to Protein Metabolism. J Physiology, 1949, 109; 1-9.


Getting Acquainted with MedGem

• The start button and LED indicator light are located on top.

• The air vent is located on the bottom of the device.

• The device is powered by a DC power supply, which plugs into the side of the MedGem.


MedGem Measurement Protocol

Acceptable Conditions:

1. Measurement is performed in quiet environment.

2. Individual rests for 10-15 minutes prior to measurement.

3. Individual has not exercised for at least 4 hours.

4. Individual has not consumed caffeine for at least 4 hours.

5. Individual has not consumed nutrition supplements for at least 4 hours.

6. Individual has not used nicotine for at least 1 hour.

7. Individual is not taking acute medications. Chronic medications are OK.

8. Individual may have water prior to measurement.


1. Plug cord in wall outlet.

2. Plug cord in device.

3. Device will beep. LED light turns from red to green to orange.


4. Place MedGem on a table away from fans or vents.

5. Insert mouthpiece into the MedGem.

6. Push orange button to begin self-calibration process.


7. Self-calibration completed when device beeps and LED light turns to green.

8. Hand device to the client and ensure there is a tight seal around the mouthpiece.

9. Client should be seated or in a supine position and breathing normally into device.

10. The MedGem will beep when the measurement is completed.

11. Record RMR and discard mouthpiece and noseclip.


Tracking the Measurements

Codes beginning with “C-” (ie C-10) refer to the remaining number of measurements that may be performed with a particular MedGem device.

(C-10 means you have 10 remaining measurements).

A two-tone audible alert, combined with a flashing amber and green light indicates the MedGem is low on measurements. To acknowledge this warning and begin self-calibrating the device, press the Start button twice.

When you receive a low measurement warning, contact Microlife Medical Home Solutions to arrange for delivery of a replacement.


Error CodesErrors beginning with “0” (ie 01, 05) indicate user errors.

Refer to the user manual for instructions.

Solutions:

1. Ensure the flowtube is firmly placed into the device.

2. Ensure the single-use mouthpiece is firmly inserted into the flowtube.

3. Ensure the client has a proper seal around the mouthpiece and noseclip is properly positioned on their nose. The client should only be able to

breathe through their mouth.

4. Repeat the measurement.

Errors beginning with any other number (ie 11) may indicate possible internal error. Contact Microlife Medical Home Solutions for instructions.


Caring for the MedGem Device

Here are some guidelines for properly caring for the device.

Do not expose the inside of the MedGem to cleaning solutions or water. If necessary, the outside of the MedGem can be cleaned with any of the following:

• Soft, clean cloth

• Clorox disinfecting wipes

• Soap and water

Store you MedGem in its case when not in use.


The Missing Link

Through self-monitoring, health professionals have been able to help clients track how many calories they eat. But that’s only half of the energy balance equation. Your clients need to know how many calories they burn.

Purposeful exercise and lifestyle/occupation activities contribute to the number of calories burned by an individual.

Resting metabolic rate, however, accounts for the majority of calories burned and has been the missing link in nutrition programs.


“Is my RMR good or bad?”

Unlike other health assessments (ie: blood pressure, etc), RMR assessments are not good or bad. RMR is unique to your clients physiology. Therefore, RMR may be higher or lower than other like individuals.

The MedGem Analyzer will provide you metabolic range for each client. The metabolic range is based on the level of oxygen consumption and current body weight of your client.


“What do I do with the RMR number?”

Now you have information you need to develop a balanced, personalized nutrition and exercise plan for your clients.

Microlife Medical Home Solutions, Inc. offers several options for developing a calorie budget for individuals. Please visit our website at www.mimhs.com to learn how the MedGem Analyzer can help you develop a nutritional plan for your clients.


“What do I do with the measurement result?”

Weight Loss Case Study

Brian has a BMI of 32.3 kg/m. He was recently diagnosed with non-insulin dependent diabetes and hypertension. His physician recommends Brian lose 25 pounds by his next appointment in ~3 months. The MedGem Analzyer will generate an individual treatment plan for his weight loss goal.

• Current weight: 245 lbs

• Goal weight: 220 lbs

• RMR: 2300 kcals VO2: 332 ml/min

• Occupation: Computer Programmer (~45 hours/wk)

• Goal date: 12 weeks

• Exercise plan: Elliptical Trainer and/or walking moderate-intensity for 30 minutes, 5 days per week


“What do I do with the measurement result?”

Weight Loss Case Study

Personalized Program: For Brian to lose 25 lbs, he will need to consume

1685 calories per day.

• Daily Energy Expenditure: 2685 kcals (determined by Analyzer)• Rate of Weight Loss: -1000 kcal (2 lbs per week)• Daily Calorie Needs for weight loss:1685 kcals

With Brian’s exercise plan, he will burn an additional 245 kcals. Therefore, Brian could consume 1930 kcals on the days he exercises and still reach his weight goal by his goal date.

• Daily Calorie Needs for weight loss 1685 kcals• Exercise Program: +245 kcals• Daily Calorie Needs with exercise 1930 kcals


Why Re-Measure?

Resting metabolic rate can change significantly during a weight management program. Re-measuring RMR will ensure that your clients are on a successful track for long-term weight management success or appropriate recovery.

You should re-measure individuals:

• +/- 5% - 10% weight change during a weight management program

• If no weight loss has occurred in the first few weeks

• If individual has reached a weight loss plateau

• When there is a change in medications or a medical condition

• When there is no response to nutritional therapy


Avoiding Common Pitfalls

Problem: Lost ReadingsTim, a weight loss client, arrives for his RMR appointment. You seat him in a quiet room and allow him to relax as you review the measurement procedures and set up the MedGem device. You begin the measurement after calibrating the device. About 5 minutes later, the MedGem beeps indicating the measurement is complete.

You remove the noseclip and discard the single use mouthpiece. As you reach for the MedGem, you accidentally disconnect the power cord and the device shuts off before you have a chance to record the measurement reading.



Solution: Lost Readings

To recover Tim’s RMR reading, simply plug the power cord back into the MedGem. After the device powers up, the last RMR measurement will be displayed. Record the reading.



Problem: Inaccurate Measurements

Mona is anxious to lose the weight she gained from her first pregnancy. She decides to have her RMR measured. This allows you to develop a personalized program to help her reach her weight-loss goal.

When she arrives, you seat her in a quiet room and allow her to relax as your review the measurement procedures and set up the MedGem device. Then, you perform a measurement.

You make note of the reading, which is 2980, and discard the single-use mouthpiece and noseclip. The reading is suspiciously high.

What could have gone wrong?



Solution: Inaccurate Measurements

Enter the client’s RMR measurement into the MedGem Analyzer. Compare the client’s RMR to the listed normal range. Refer to the listed normal range in the MedGem Analyzer.

When using the MedGem to measure a client’s RMR, it is important to have the client adhere to proper resting conditions.

If the client has performed physical activity, taken acute medications, has eaten, or has not rested for 10-15 minutes prior to the measurement, the MedGem measurement will not be accurate to their actual RMR. Always determine that the resting conditions were followed before performing a measurement. Developing a weight loss plan based on this inaccurate reading will prevent the client from reaching their goals.



Problem: Undetected Air Leak

Brian enrolled in your weight management program. He is 25 pounds overweight and needs to lower his cholesterol levels and blood pressure.

You seat him in a quiet room and perform the MedGem measurement under acceptable conditions. You make a note of the reading, which is 1400, then you discard this single-use mouthpiece and noseclip.

Both you and Brian are suspicious that this RMR reading may be too low since he weighs 315 pounds.

What could have gone wrong?



Solution: Undetected Air Leak

Brian’s reading may be inaccurate due to an air leak that did not cause an error message to display. If an air leak occurs, some of the air is not measured by the device and Brian’s actual RMR would therefore not be determined.

When using the MedGem to measure a client’s RMR, it is important to insure that all resting conditions are followed. Your client should rest for 10-15 minutes prior to starting the measurement. Measure your client if he/she has:

• Not eaten or had anything to drink (water is OK) 4 hours prior

• Not exercised 4 hour prior

• Not consumed caffeine or stimulatory nutritional supplements 4 hours prior

• Not used nicotine for 1 hour prior

• Not taken acute medications (ie: antibiotics, pain medication)


Your Clients Will Have Questions!

Your clients will have questions about metabolism, the MedGem device, and RMR.

Microlife Medical Home Solutions has anticipated many of the questions that will be asked by you and your clients. The answers are provided in the MedGem User Guide.

Read the document: MedGem User Guide for answers to common questions. If you need further assistance, visit our website at www.mimhs.com.


The Complete Microlife Toolset for Comprehensive Weight Management Programs

Measure

Use the MedGemand MedGem Analyzer software to determine RMR and assess energy balance for a personalized nutrition program.

Monitor

Have clients self-monitor their food intake and exercise using MiHealthLoghealth management application.

Modify

Help you patients and clients adjust their nutrition and exercise plan by monitoring their daily health, nutrition, and activity goals with MiHealthCoach.

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