MASTER OF SCIENCE IN CLINICAL NUTRITION

Transcription

1 The Philippine Women s University And Its Affiliate Schools for Men and Women MASTER OF SCIENCE IN CLINICAL NUTRITION COURSE SYLLABUS Course Title Clinical Nutrition I Course No. MSCN 619 No. of Units 3 COURSE DESCRIPTION: Study of the cellular and microcirculatory environment. Focus is on the major systems: cardiopulmonary, hepatobiliary, renal, gastrointestinal, and hemopoietic system and their relationship to the immune system. COURSE GOALS AND OBJECTIVES: Major Competency Value Objectives: 1. Analytical comprehension of the cellular metabolism and microcirculatory environment of the human body. 2. Comprehend the patho-physiologic role of the different organ systems functions on disease states. 3. Develop skill in understanding the role of nutrition in the microcirculation environment in both normal and disease states. 4. Critical appraisal of the role of immune system in health and in different critical conditions in hospital setting, including infection and sepsis. Discuss the patho-physiology of the intracellular and extracellular environment of critically ill patients. Understand role of different macro and micro nutrients in cell structure and function.. Explain the patho-physiology of different organ system disorders. Understand the role of the immune system in the treatment/management of different disease states. Identify nutrients and pharmaconutrients useful in the 1

2 management of these disorders. Illustrate the role of clinical nutrition in the management of different disease states. COURSE ORGANIZATION: TOPICS Week 1: Overview of the course, course requirements, student s interest and expectations. Week 2: Cell: structure and physiology Cell: energy dynamics CONTENT OUTLINE 1. To discuss the concept and principles of nutrition care 2. Explain the standards of care in the hospitalized and managed care environment CELL: STRUCTURE AND PHYSIOLOGY Cell membrane structure and transport mechanics Extracellular and intracellular differences in o Ions o Components Receptors structure and mechanism of actions (e.g. insulin receptors) Specialized membranes: o Nuclear membrane o Endoplasmic reticulum (smooth and rough) o Golgi apparatus (Packaging system process) Role of Eicosanoids o Description of enzyme systems o Mechanics of pro-inflammatory and anti-inflammatory status o Clinical correlations: fish oils and glutamine o CORRELATE: WHERE DO THE MICRONUTRIENTS COME IN? CELL: ENERGY DYNAMICS Anerobic glycolysis o Mitochondria (anatomy, enzymes as in Kreb s cycle) o Where do antioxidant properties occur and where are the different enzymes 2

3 located? Aerobic glycolysis Beta-oxidation ATP production Oxidation radicals CORRELATE: WHERE DO THE MICRONUTRIENTS COME IN? Week 3: Nucleus Protein synthesis Week 4: Microcirculation Week 5: Week 6: o Neurons o Muscle NUCLEUS: Nuclear Membrane Receptors and functions DNA o Composition o Function o Role in every activity of the cell PROTEIN SYNTHESIS AND BREAKDOWN o Mechanisms of synthesis o Peroxisome-ubiquitin o Role of heat shock proteins CORRELATE: WHERE DO THE MICRONUTRIENTS COME IN? MICROCIRCULATION AND RELATIONSHIP WITH NUTRITION Anatomy Physiology of nutrient and metabolite exchange Perfusion issues: Role of vasodilators or vasoconstriction PRELIMS NEURONS AND NERVES: ROLE OF NUTRITION Anatomy of nerve (cell and coating) Nerve impulse generation and propagation mechanics o Electrical component o Chemical component Synthesis and action of mediators and receptors CORRELATE: WHERE DO THE 3

4 MICRONUTRIENTS COME IN? MUSCLE Anatomy of the muscle cell Mechanics of muscle contraction CORRELATE: WHERE DO THE MICRONUTRIENTS COME IN? NEUROMUSCULAR JUNCTION Mechanics Types of muscles and energy correlates CORRELATE: WHERE DO THE MICRONUTRIENTS COME IN? Week 7: Digestion and absorption of nutrients Week 8: Immunology Week 9 Week 10: Immunologic processes and pharmaconutrients Week 11: Infection and sepsis DIGESTION AND ABSORPTION Macronutrients Micronutrients Fiber/Prebiotics/Probiotics CORRELATE WITH DIFFERENT AREAS OF THE GASTROINTESTINAL TRACT IMMUNOLOGY Innate immunity Adaptive immunity MIDTERMS DIFFERENT IMMUNOLOGIC PROCESSES Infection Hypersensitivity Transplantation Tumor immunology CORRELATE: WHERE DO THE MICRONUTRIENTS COME IN? PHARMACONUTRIENTS INFECTION AND SEPSIS Pathophysiology: cellular level, microcirculation changes Role of pharmaconutrients: glutamine, fish oils, 4

5 antioxidants, other new updates Week 12: SIRS and CARS Week 13 Week 14: SIRS - pathophysiology CARS pathophysiology CORRELATE: WITH NUTRITION AND PHARMACONUTRITION REVIEW AND COMPLETION OF ALL ASSIGNMENTS AND REPORTS FINALS INSTRUCTIONAL AND LEARNING METHODOLOGY AND STRATEGY: Professor s Input Enabling Activities Interactive and Collaborative Activities Mediated lecture PowerPoint presentation Extensive reading Internet surfing Class discussion Sharing of current literature Case studies Situational analysis Problem solving COURSE REFERENCES: S Basic and Extended Reading Guyton, Arthur C. Textbook of Medical Physiology. 11 th ed. Philadelphia: Elsevier Saunders, Murray, Robert K., Daryl K. Granner, Victor W. Rodwell. Harper's Illustrated Biochemistry. 27th ed. Boston, MA: McGraw-Hill, Ganong, William. Review of Medical Physiology. 22 nd ed. McGraw-Hill,

6 Kumar V, Cotran R, and Robbins SL, eds. Robbin s Basic Pathology. 7 th ed. Philadelphia, PA: Saunders, Merritt R., ed-in-chief. The A.S.P.E.N. Nutrition Support Practice Manual. 2 nd ed. Silver Spring, MD: A.S.P.E.N., Shills, Maurice E., ed. Modern Nutrition in Health and Disease. 10 th ed. Philadelphia: Lippincott Williams & Wilkins, Gibney, Michael J., ed. Clinical Nutrition. Oxford: Blackwell Science, Escott-Stump, Sylvania. Nutrition and Diagnosis-related Care. 6 th ed. Philadelphia: Lippincott Williams & Wilkins, Heimburger, Douglas C. Handbook of Clinical Nutrition. 4 th ed. Philadelphia: Mosby Elsevier, Nelms, Marcia Nahikian, et al. Nutrition Therapy and Pathophysiology. Australia: Thomson Wadsworth, Marian, Mary. Clinical Nutrition for Surgical Patients. Sudbury, MA: Jones and Bartlett Pub., Mahan, L. Kathleen. Krause s Food Nutrition Therapy. 12 th ed. St. Louis, Missouri: Saunders Elsevier, Heimburger, Douglas C. Handbook of Clinical Nutrition. 4 th ed. Philadelphia: Mosby Elsevier, Billon, Wayne. Clinical Nutrition Case Studies. 4 th ed. Australia: Thomson/Wadsworth, Marian, Mary. Clinical Nutrition for Surgical Patients. Sudbury, MA: Jones and Bartlett Pub., Wilson, Keith, ed. Principles and Techniques of Biochemistry And Molecular Biology. 6 th ed. Cambridge: Cambridge University Press, Stipanuk, Martha H., ed. Biochemical, Physiological, & Molecular Aspects of Human Nutrition. 2nd ed. St. Louis, MO.: Saunders Elsevier, Whitney, Ellie. Nutrition, Cancer, and HIV Infection. In Nutrition for Health and Health Care. 3 rd ed. Australia: 6

7 Thomson/Wadsworth, Boyle, Marie A. Nutrition and Cancer Prevention.: In Personal Nutrition. 6th ed. Australia: Thomson/Wadsworth, Brown, Judith E. Diet and Cancer. In Nutrition Now. 4 th ed. Australia: Thomson Wadsworth, Farrell, Marian L. Nutritional Needs of Cancer Patients. In Nutrition. 2 nd ed. Sudbury, MA: Jones and Bartlett, Hark, Lisa. Cancer. In Nutrition for Life. United Kingdom: Dorling Kindersley, Geissler, Catherine A. Cancers. In Human Nutrition. 11 th ed. Edinburgh: Elsevier Churchill Livingstone, Shils, Maurice E., ed. Prevention and Management of Cancer. In Modern Nutrition in Health and Disease. 10 th ed. Philadelphia: Lippincott Williams & Wilkins, Roth, Ruth A. Nutrition and the AIDS Client. In Nutrition & Diet Therapy. 8 th ed. Australia Delmar Learning, Sizer, Frances Sienkiewicz. Nutrition and Cancer. In Nutrition: Concepts and Controversies. 10 th ed. Australia: Thomson/Wadsworth, Srilakshmi, B. Diet incancer. In Dietetics. Rev. 5 th ed. New Delhi: New Age International (P) Limited, Whitney, Ellie. Cancer. In Understanding Nutrition. 10 th ed. Australia: Thomson/Wadsworth, Bozzetti, Federico. Nutritional Support in Patients with Cancer. In Clinical Nutrition. Ed. Michael J. Gibney. Oxford: Blackwell Science, Escott-Stump, Sylvania. AIDS and Immunology, Infections, Burns and Trauma. In Nutrition and Diagnosis-related Care. 6 th ed. Philadelphia: Lippincott Williams & Wilkins, Grodner, Michelle. Nutrition on Cancer, AIDS, and Other Special Problems. In Foundations and Clinical Applications of Nutrition: a Nursing Approach. 4th ed. St. Louise, Missouri: Mosby Elsevier,

8 Thomson, Cynthia A. Emerging Issues in Cancer Case and Nutrition. In Issues and Choices in Clinical Nutrition Practice. Philadelphia: Lippincott Williams & Wilkins, Peckenpaugh, Nancy J. Cancer: Nutrition Prevention and Treatment. In Nutrition Essentials and Diet Therapy. 10 th ed. St. Louis, Missouri: Saunders Elsevier, Coulston, Ann M., ed. Cancer. In Nutrition in the Prevention and Treatment of Disease. 2 nd ed. Amsterdam: Elsevier, Lysen, Lucinda K., ed. Nutrition Support in the Critically Ill Patient. In Quick Reference to Clinical Dietetics. 2 nd ed. Sudbury, MA: Jones and Bartlett Pub., Nix, Staci. Nutritional support in Cancer. In Williams Basic Nutrition and Diet Therapy. 12 th ed. St. Louis, Missouri: Elsevier Mosby, Nix, Staci, ed. Nutrition Management in the HIV/AIDS Patient. In Williams Basic Nutrition and Diet Therapy. 12 th ed. St. Louis, Missouri: Elsevier Mosby, Marotz, Lynn R. Management of Injuries and Acute Illness. In Health, Safety, and Nutrition for the Young Child. 6 th ed. Australia: Thomson/Delmar Learning, Mahan, L. Kathleen. Medical Nutrition Therapy for Cancer. In Krause s Food & Nutrition Therapy. 12 th ed. St. Louis, Missouri: Saunders Elsevier, Whitney, Ellie. Nutrition and Disorders of the Heart and Blood Vessels. In. In Nutrition for Health and Health Care. 3 rd ed. Australia: Thomson/Wadsworth, Boyle, Marie A. Diet and Heart Disease. In Personal Nutrition. 6th ed. Australia: Thomson/Wadsworth, Duyff, Roberta Larson. Smart Eating to Prevent and Manage Disease, Your Healthy Heart. In American Dietetic Association Complete Food and Nutrition Guide. 3 rd ed. Hoboken, NJ: John Wiley & Sons, Farrell, Marian L. Cardiovascular Nutrition Therapy. In Nutrition. 2 nd ed. Sudbury, MA: Jones and Bartlett,

9 Hark, Lisa. Cardiovascular Disease and Nutrition. In Nutrition for Life. United Kingdom: Dorling Kindersley, Shils, Maurice E., ed. Prevention and Management of Cardiovascular Disease. In Modern Nutrition in Health and Disease. 10 th ed. Philadelphia: Lippincott Williams & Wilkins, Roth, Ruth A. Diet and Cardiovascular Disease. In Nutrition & Diet Therapy. 8 th ed. Australia Delmar Learning, Sizer, Frances Sienkiewicz. Cardiovascular Diseases. In Nutrition: Concepts and Controversies. 10 th ed. Australia: Thomson/Wadsworth, Srilakshmi, B. Diet in Diseases of Cardiovascular System. In Dietetics. Rev. 5 th ed. New Delhi: New Age International (P) Limited, Whitney, Ellie. Cardiovascular Disease. In Understanding Nutrition. 10 th ed. Australia: Thomson/Wadsworth, Escott-Stump, Sylvania. Cardiovascular Disorders. In Nutrition And Diagnosis-related Care. 6 th ed. Philadelphia: Lippincott Williams & Wilkins, Grodner, Michelle. Nutrition Management in Cardiopulmonary Disorders and Immunology. In Foundations and Clinical Applications of Nutrition: a Nursing Approach. 3 rd ed. Singapore: Elsevier (Singapore) Pte Ltd., Bloch, Abby S., ed. Nutrition and Coronary Artery Disease. In Issues and Choices in Clinical Nutrition Practice. Philadelphia: Lippincott Williams & Wilkins, Coulston, Ann M., ed. The Role of Diet in the Prevention and Treatment of Cardiovascular Disease. In Nutrition in the Prevention and Treatment of Disease. 2 nd ed. Amsterdam: Elsevier, Peckenpaugh, Nancy J. Cardiovascular Disease. In Nutrition Essentials and Diet Therapy. 10 th ed. St. Louis, Missouri: Saunders Elsevier, Nix, Staci. Coronary Heart Disease and Hypertension. In 9

10 Williams Basic Nutrition and Diet Therapy. 12 th ed. St. Louis, Missouri: Elsevier Mosby, Billon, Wayne. Dietary Management of Atherosclerosis Resulting in Open-Heart Surgery. In Clinical Nutrition Case Studies. 4 th ed. Australia: Thomson/Wadsworth, DeVane, Matthew S. Heart Smart: a Cardiologist s 5-Step Plan For Detecting, Preventing, and Even Reversing Heart Disease. Hoboken, NJ: John Wiley & Sons, Reader s Digest. Cooking Smart for a Healthy Heart: Over 150 Flavorful Eat-right Recipes to Lose Weight, Live Longer. Pleasantville, NY: The Reader s Digest Assoc., Mahan, L. Kathleen. Medical Nutrition Therapy for Pulmonary Disease. In Krause s Food & Nutrition Therapy. 12 th ed. St. Louis, Missouri: Saunders Elsevier, Journals ESPEN Guidelines on Parenteral Nutrition. Clin Nutr 2009; 28(4): MacFie, Smith RC, Hill G. Glucose or fat as a nonprotein energy source? A controlled clinical trial in gastroenterological patients requiring intravenous nutrition. Gastroenterology1981; 80(1): Stoner et al. The effect of sepsis on the oxidation of carbohydrate and fat. Br J Surg 1983; 70(1): ESPEN Guidelines on Enteral Nutrition. Clin Nutr 2006; (25): Mirtallo J, Canada T, Johnson D, et al. Safe practice of parenteral nutrition. JPEN: J Parenter Enteral Nutr 2004; 28(6): S40. ESPEN Guidelines on Parenteral Nutrition. Clin Nutr 2009; 28(4): ESPEN Guidelines on Parenteral Nutrition. Clin Nutr 2009; 28(4): ESPEN Guidelines on Parenteral Nutrition. Clin Nutr 2009; 28(4): Pittiruti M et al. ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters. Clin Nutr 2009; 28(4): ESPEN Guidelines on Parenteral Nutrition. Clin Nutr 2009; 28(4): Sacks GL et al. ASPEN Nutrition Support Practice Manual 2nd ed 2005; Pittirutti M et al. ESPEN Guidelines on Parenteral Nutrition: 10

11 Web-Based Central Venous Catheters. Clin Nutr 2009; 28(4): Jones NE and Heyland DK. Pharmaconutrition: a new paradigm. Curr Opinion Gastroenterology 2008; 24: Gadek et al. Effect of enteral feeding with EPA, GLA, and antioxidants in patients with ARDS. Crit Care Med 1999; 27: Novak F, Heyland D, Avanell A, Drover J, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med 2002; 30: Luiking YC et al. Regulation of nitric oxide production in health and disease. Curr Opin Clin Nutr Metab Care 2010;13(1): Nathens AB et al. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002; 236(6): Pittiruti M et al. ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters. Clin Nutr 2009; 28(4): Solomon SM. The refeeding syndrome: a review. JPEN: J Parenter Enteral Nutr 1990;14:90-7. Gura K et al. Safety and Efficacy of a Fish-Oil-Based Fat Emulsion in the Treatment of Parenteral Nutrition-Associated Liver Disease. Pediatrics 2008; 121: e Mirtallo J et al. Safe practices for parenteral nutrition. JPEN (J Parenter Ent Nutr) 2004; 28(6): S39-S70. PHILSPEN. Available at Part1b_NST_SetUp.pdf, Accessed September 1, Llido EP et al. Comparison of standard values of nutrition screening and assessment using BMI percentiles from FNRI- PPS, IRS, CDC 2000, and WHO-MGRS child growth standards in the pediatric population of a tertiary care hospital in the Philippines admitted between the years 2000 and Available at Phil_PedStds_compare_ slmc. pdf. Accessed August 15, Prevalence of malnutrition in the Philippines. Available at accessed September 16, Standards of care for hospitalized patients. Available at: Accessed September 13, PHILSPEN: Resources for nutrition support development. Available at: Scroll down to the section: Forms in PDF format. Accessed September 21, Forms for use in the nutrition support team development. Available at: 11

12 Accessed November 30, COURSE REQUIREMENTS: Course Requirements and Computation of the Grades GRADING SYSTEM: Participation Individual Group (Cooperative and Collaboration Activities) Case Reports and Analysis Attendance. Examination Midterm (Preliminary) 20% 40% 20% Finals 20% Total: 100% 12