УЕБ – БАЗИРАНА СИСТЕМА ЗА ОБУЧЕНИЕ НА ЛЕКАРИ И …



EDU NUTRI MED

GUIDE BOOK

for users

WEB - BASED SYSTEM FOR TRAINING OF MEDICAL DOCTORS AND STUDENTS IN NUTRITION

LEONARDO DA VINCI

ESPEN

C O T E N T S

I. “Edu Nutri Med “ system

1. Aims 2

2. Objectives 2

3. Training approaches 2

4. Advantages of Web - based education 2

5. Advantages of “Edu Nutri Med “ system 3

6. Entries of the system 3

II. Training content

1. Introductory Nutrition 3

2. Clinical Aspects of Nutrition 4

III. Learning steps:

1. Rules for applying and admission 4

2. How to start 5

3. Study approach 5

- Traditional approach 5

- Problem based approach 5

4. Description of Module menu 6

5. How to use a Module 6

6. How to prepare portfolio 7

7. Description of Clinical case Menu 7

8. General information about Complementary Practical Courses

- List of the courses 8

- Benefits of Practical courses 8

9. Rules for Credit accumulation and procedure

10. Rules for Certification 9

IV. Training Programme “ЕDU NUTRI MED” 9

V. General Module content

- Basic Concepts in Nutrition 13

- Diet and health 19

VI. Clinical case content 23

VII. Example of Clinical case: Stenosis pylori Gastrectomia 25

VIII. Example of Portfolio 27

IX. Subscription Form for admission and certification 28

WEB - BASED SYSTEM FOR TRAINING OF MEDICAL DOCTORS AND STUDENTS IN NUTRITION

“ЕDU NUTRI MED”

• Web - based training in Nutrition “Edu Nutri Med“ is a semi-virtual system using both on-line and real time courses

• Web - based training is non-formal, flexible form of education important for life - long learning and Continuing Medical Education (CME)

• The system aims at improving competence and skills of health related professionals in clinical nutrition

• It is developed by the European university network and ESPEN with support of the EU Leonardo da Vinci program

• The system provides credits and certificates for Continuous Medical Education, European Diploma in nutrition and im future Masters program

Internet address: lll-

Partners “ЕDU NUTRI MED”:

MEDICAL UNIVERSITY, PLEVEN, BULGARIA

Prof. R. Komsa-Penkova

NUTRISUB ASBL, ULB, BRUSSELS, BELGIUM

Prof. Y. A. Carpentier

CHARLES UNIVERSITY, PRAGUE, CZECH REPUBLIC

Prof. L. Sobotka

RF-W UNIVERSITÄT, BONN, GERMANY

Prof. W. Breipohl

EUROPEAN SOCIETY FOR CLINICAL NUTRITION AND METABOLISM

Prof. C. Pichard

ALLIANCE ‘ HEALTH IN OUR HANDS, BULGARIA

As. Prof. K. Kovacheva

MEDICAL UNIVERSITY, SOFIA, BULGARIA

Prof. N. Trifonova

I. “Edu Nutri Med “ system

1. Aims:

• Providing an opportunity to physicians, specialists and students to acquire new competences and skills in general and clinical nutrition.

• Encouraging the application of effective nutrition to promote the treatment of disease and better health.

• Facilitating life-long learning.

2. Objectives:

• Improve skills for practical management of nutritional support.

• Ameliorate knowledge of nutrition as a preventive and curative measure.

• Give tools to interpret new scientific information on disease mechanism and link with nutrition.

• Provide new knowledge of a link between genetic predisposition and nutrition.

3. Training approaches:

• Individual planning and Portfolio development: Individual list of modules, practical courses, lectures, consultations and tests

• Individual tutoring

• Case study approach and Problem-Based Learning

• Access to new educational technologies: computer based learning, Web tutorial; on-line curricula, interactive learning

• Self-training under individual plan: preparing reports, cases etc.

4. Advantages of Web - based education:

• Web - based training is a transnational form of education in accordance with a policy of globalization in Europe

• Web - based training is non-formal, flexible form of education important for life - long learning and Continuing Medical Education (CME)

• Web - based system provides world wide access for training

5. Advantages of “Edu Nutri Med “ system:

• European educational curriculum on nutrition developed by European university network

• Innovative training methods

• Individualized portfolio - based program and approach

• Modules assigned with credits organized in specific curricula

• Case study based approach with elements of problem-based learning

• Complementary courses at partners’ universities and under ESPEN initiative

• Forum for open discussion on hot topics and special cases in nutrition

6. Entries of the system:

The WEB system is organized with several entries: Study Navigator, Learning steps, Modules and Clinical cases.

Study Navigator guides through the system and explains the application and training procedure, module layout and description of its components, the rules for registration, application and certification.

Learning steps proposes in detail the methodology and content of the system. This entry allows starting a programme, explains system strategy, rules for preparation of individual portfolio and study program. It also provides links to modules and clinical cases as well as possibilities for communication with tutors and administrators.

Study Navigator: Study guide and Learning steps

Subscription: Rules and procedure for registration

Modules and Clinical cases: Educational content

Communication: Forum, access to tutors, experts and other users

Certification: Rules and procedures explaining evaluation, credit assigning, accumulation and certification

II. Training content

1. Introductory Nutrition

Basic Concepts in Nutrition

Nutritional Physiology and Biochemistry

Metabolism of Macronutrients

Metabolism of Vitamins and Micronutrients

Nutritional Requirements, Assessment and Support

Nutrition throughout Life Span

Nutrition and Public Health

Nutrigenomics

Economics of Nutrition

Analytical Methods

2. Clinical Aspects of Nutrition

Prevention of Chronic diseases - Diet and Health

Nutritional Disbalance

Substrates Used in Parenteral and Enteral Nutrition

Techniques of Nutritional Support. Enteral Nutrition

Techniques of Nutritional Support. Parenteral Nutrition

Nutritional Support in Critically Ill Patients

Nutritional Support in Patients with Chronic Diseases

Nutrition and Cancer

Exposure to Toxic Environment

Nutrition, Alcohol and Drug Abuse

The Eating Disorder Continuum

Endocrine Diseases

Nutrition in Disorders of Metabolism

III. Learning steps:

1. Rules for applying and admission:

Eligibility: Medical Doctor and students; Health Related Professionals

No age or geographic limitation

Working language: English

Two application levels are available:

▪ To Register for Free Access Complete the Registration Form

▪ To Subscribe for Full Access and certification complete the Subscription Form and Gain: “Module Certificate” for Continuous Medical Education and/or “Diploma in Clinical Nutrition“

After submitting of the Subscription Form you will receive the complete study guide and personalized contact to your tutor.

2. How to start:

• Register or subscribe

• Go to the Module Menu

• Go to the Clinical Cases Menu

• Communicate with a tutor (after subscription only)

• Chose your way of study: traditional or problem - based approach

• Prepare your portfolio

Discuss with a tutor your selected modules, clinical cases and develop portfolio: schedule, individual training program and tasks, make a schedule for certification and credit accumulation

3. Study approach

Traditional approach:

a. Application

b. Tutor assignment

c. Going through Module menu and module selection

d. Going through Module general rules to get acquainted with content, credits, training approaches and requirements for assessment.

e. Portfolio development – individual programme and individual approach

f. Training guided by tutor, expert and supervisor

g. To get the certificate you have to cover pass standards and to accumulate the credits needed for certification or diploma

Problem based approach

a. Application

b. Tutor assignment

c. Going through Clinical case menu and selection of cases that you have in your practice

d. Making a strategy to solve your problem

e. Portfolio development – individual programme (module selection) and individual approach

f. Training guided by tutor, expert and supervisor

g. To get the certificate you have to cover pass standards and to accumulate the credits needed for certification or diploma

4. Description of Module menu

Module menu contains selected modules on nutrition: introduction into nutritional science and clinical aspects of nutrition and health related problem. Modules contain presentation of theory, lectures, references to scientific sources, book chapters, reviews, reports and web links. To gain practical skills in nutritional assessment and management the modules are linked to proper clinical cases.

To assess the competence and skills of the students every module contains requirements for evaluation and assessment, which are proposed by the expert.

The main information on each module is available on – line and the students are expected to learn it by themselves. The questions/problems of student on theory and clinical cases could be discussed on line with a tutor (expert if there is a need), discussed on forum session, announced for specific problems, or at the real courses, which is organized by partners’ universities and under ESPEN initiatives.

Modules have several levels of competence and they are provided with tests for self-assessment.

The module are developed by experts and enriched by different training approaches: Problem solving, Case study, Trainers’ and learners’ presentations, Collaborative training, and Practical training, Consultation self-training.

Module selection depends on individual needs of an applicant/student. The general approach for selection is presented in “General approach for learning” and it is made on the basis of the clinical cases which applicant/student used to have in his everyday practice. In this selection he is guided by an individual tutor.

After the module selection is made, the student guided by tutor described his portfolio from the modules, clinical cases and individual tasks, materials, links, schedule and venues.

5. How to use a Module

To start a module you have to open a mod.htm file, containing a Front-page of the module. Front page is divided into 3 parts,

Very left column is used for the content and links within the system.

The central part of the page contains the general information on the module.

On the right side there is the detail information on the module presented in the linked files.

The information in the module is presented on 3 different levels:

General information - first level is placed in the central part of the Front Page, it allows you to get acquainted with the module.

Second level – background reading is hyperlinked in the right column of the front-page. It is also obligatory reading if you want to certify your knowledge. We used Power point presentations and texts from European guidelines, book chapters, etc to prepare it.

There are also tests for each module.

Third level it is an advanced reading, it is hyperlinked in the same way as background reading, but it contains more detail information on each topic of the module. It provides the opportunity to go more in depth in the topic.

There is also an optional reading, where you can find information linked to the topic.

All that information is prepared in a way to produce easily a printable version.

6. How to prepare portfolio:

For traditional approach you go to ‘Modules’, select the modules according to topics of interest, contact your tutor, develop individual program of study, guided by tutor and start your training.

In case you prefer Problem Based Learning, you start with a problem of your patient.. From clinical case menu find similar clinical cases solved by experts in nutrition and benefit from the system, applying the same strategy in your practice.

Contact your tutor, develop individual program of study, guided by tutor and start your training.

7. Description of Clinical case Menu:

Clinical case menu:

The entry into a clinical case menu allows the applicant/student to have the immediate benefits from the system. The comparison of his personal clinical case with a corresponding clinical case solved by a specialist provides him the “know how” for his practice. In this way the applicant/student improves his skills for better management of nutritional problems of his patients. This methodology is very beneficial for physicians as they can apply the adequate strategy in specific clinical situations.

Once the student starts from a clinical case and solves it, he goes through similar cases to gain more information on the problem. Evidently, he still will not have proper skills to manage more complicated situation. He iscome convinced that he needs some theoretical knowledge that could be gained from modules’ information. The student could have much more benefits from the system if he completes the study by means of total Problem based approach:

After he enters the system he is assigned by and individual tutor who helps him to develop the strategy how to ameliorate his knowledge and skills, what information should be learned and which problems have to be solved.

Communication with a tutor allows the student to study at his own rhythm and interests under supervision of tutor and highly qualified experts. As the system is provided on the web, there are no communication barriers and problems. The applicant learns how the problem is solved by a specialist that allows him to solve a similar case from his clinical practice.

8. General information about Complementary Practical Courses

There are annual thematic satellite-conferences of ESPEN and courses organized at partners’ universities, covering main topics of WEB based system.

List of the courses

How to attend Complementary Practical Courses (go to Subscription and then registration for the course)

The entire curriculum is divided into several general topics, which is mainly covered at these courses in 4-5 years.

The program of the courses is announced in advance so that students will have the opportunity to choose the courses, to prepare themselves from on-line materials and then to participate actively in intensive training and certification at the courses.

Benefits of Practical courses: All the modules are divided into several general topics which are delivered at annual satellite-conference courses organized by ESPEN and at partners universities. All curriculum - main topics is covered at this courses in 4-5 years. The programme of the courses is announced one year in advance so that student will have the opportunity to prepare themselves on-line and the at the courses to participate in intensive training and certification.

9. Rules for Credit accumulation and procedure

The modules are assigned by credits that system provides you in case you cover module requirements.. Credit accumulation from different modules brings you the opportunity not only to collect the for CME in your country, but also to get European Diploma in Nutrition.

10. Rules for Certification:

Certification levels

Certificate for nutritional module with credits in national CME system

ESPEN diploma “Specialist in Clinical Nutrition”

Master degree in nutrition

Certification Methodology

Accumulative certification: collection of marks from tests, exams, student developed materials and others

Tests for continuous assessment of theory and clinical cases

Student prepared materials according to individual program: reports, research and clinical cases.

Attending Complementary Practical Courses

Final test

IV. Training Programme “ЕDU NUTRI MED”

| | | | | | |

|Topics and Modules |ALL |Practical |Оn-line learning|Student |Final test |

| | |Courses | |developed | |

| | | | |materials | |

| |h | |h | |h | |h | | |

| | |c | |c | |c | |c | |

| |

|Basic Concepts in Nutrition |

| |

| |

|I. Basic Concepts of Nutritional Science |

|- Module 1 Principles of Nutritional Science |

|II. Nutrition throughout life span |

|III- Nutrition and Public Health |

|V. Economics of Nutrition |

|VI. Analytical Methods |

|Assessment of nutrients |

|Diet and health |

|- |

|I. Prevention of chronic diseases- Diet and health |

|II. Techniques of Nutritional support |

|III. Nutritional support in patients with chronic diseases |

|IV. Exposure to Food contamination toxic environment |

|V. The Eating Disorder Continuum |

V. General Module content

Basic Concepts in Nutrition

Module I: Principles of Nutritional Science

Credit: 6

Module Dates and Venues:

Aim of the unit To give students an overview of nutrition as a science, the main principles of nutrition, the biological value of nutrients and food

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: Partner, Department, Prof

Lecturers:

Content: Historical review of nutrition. Fundamental concept of nutrition: trends in food consumption. Nutritional requirements. Major food sources. Biological value of nutrients. Diet and food, and nutrients. Interaction of nutrition with physical activity. Nutrition and its function in health and disorders of health.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 2: Nutritional Physiology and Biochemistry

Credit: 12

Unit Dates and Venues:

Aim of the unit To give students an overview of nutrition physiology and biochemistry.

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: Partner, Department, Prof

Lecturers:

Content: The subject of Nutritional Physiology. Introduction to the function of the gastro-intestinal tract. Digestion and absorption of foods. The nutritional input and the physiological output. Intermediary metabolism of nutrients. Metabolic basis for the need for nutrients. The limitations of metabolism. The role of metabolism in the maintenance, growth and adaptability of the body. The metabolic processing of the carbohydrates, lipids and proteins. Specificity of nutrient metabolism in different organs: hepar, kidney, brain, skeletal muscle, cardio muscle, gut. Regulation of Metabolism and Specific nutrient needs .

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 3. : Metabolism of Macronutrients.

Credit: 6

Unit Dates and Venues

Aim of the unit To give students an overview of nutrient metabolism

Prior Knowledge: chemistry, biology, basic biochemistry

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: Partner, Department, Prof.

Lecturers: Staff

Content: Structure, function and metabolism of carbohydrates, lipids and proteins. Digestion and absorption of foods. Macronutrients and energy intake, expenditure (including physical activity) and body weight

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 4. : Metabolism of Vitamins and Micronutrients.

Credit: 6

Unit Dates and Venues

Aim of the unit To give students an overview of nutrient metabolism

Prior Knowledge: chemistry, biology, basic biochemistry

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: Partner, Department, Prof.

Lecturers: Staff

Content: Structure properties and source of vitamins. The role of vitamin and mineral in human metabolism and the maintenance of health. Factors affecting requirements and interrelationships between macro and micro minerals. The clinical signs of deficiencies or excesses of certain vitamins in humans. The trace element metabolism. The role of water and electrolytes in maintain of the homeostasis. The concept of antioxidants and cell injury.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 5. Nutritional Requirements, Assessment and Support

Credit: 6

Unit Dates and Venues: To introduce the students with criteria for nutritional requirements for different groups of European population, for assessment of nutritional status and principals of nutritional support.

Aim of the unit:

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Food and nutrient intakes in Europe. Nutrition Policies and Dietary Guidelines. Epidemiology and diet-disease relationships. Assessment of nutritional status.

Interaction among nutrition, lifestyle and other risk factors of disease, including genetics. Behavioral and biological control of body weight.

Concept of healthy nutrition

Role of diet in major European public health problems: obesity, cardiovascular disease, hypertension, cancer, dental disease, osteoporosis and nutritional deficiencies. Effecting dietary change. Health education and health promotion. Nutrition surveillance. Nutrition intervention programmes. The role of nutrition in the prevention of disease and the promotion of good health.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 6. Nutrition throughout life span

Pregnancy, Infants and Nutrition

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview of nutritional needs during the pregnancy and infants.

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Nutritional requirements and changes in nutritional intake at different stages of life. Nutritional needs in pregnancy and lactation. Nutrition in fetal and neonatal period and relation to disease in later life. Body composition and changes in composition during growth and development. Nutritional needs of the infants, children, adolescents.

Nutritional recommendations, nutritional assessment, nutritional planning and the importance of nutrition in maintaining good health are further explored

Assessment: Continuous Assessment, MCT, Exam

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 7. Nutrition throughout life span

Children and nutrition

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview of nutritional needs during the childhood

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Nutritional requirements of the children. Body composition and changes in composition during growth and development. Nutritional needs of the children and adolescents according standards of World Health Organisation. Obesity as a result of incorrect nutrition in childhood. Malnutrition of children from different ethnic and social groups.

Nutritional recommendations, nutritional assessment, nutritional planning and the importance of nutrition in maintaining good health are further explored

Assessment: Continuous Assessment, MCT, Exam

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 8. Nutrition throughout life span.

Nutritional support in the elderly

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview of nutritional needs of elderly people.

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Nutrient Needs of the Mature Adult. Theory of Aging: how people age. Body composition and changes in composition during aging. Nutrition aiming to Stay Young While Growing Older. Nutritional needs of elderly. Nutrition throughout the woman life cycle. Nutrition and the menopause. Prevention of osteoporosis. Malnutrition and poverty. Personalized nutritional and lifestyle recommendations from the genetic age.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 9. Nutrition and Public Health

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview of public health ideology

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Public health in historical perspective: Public health ideology of “human rights”, public health history.

Health systems: Evolution, legislation, comparison and criticisms of health systems in the European context.

Environment: Environment and health, implications of environmental policies for nutrition and physical activity.

Public health policy: Interactions between health, nutrition (including physical activity) and agricultural policies. European Dimension

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 12. Nutrigenomics. Evolution of genomic versus food patterns

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Nutrigenomics – the link between diet, genes and disease. Identification of the genes that influence the risk of diet-related diseases at a genome-wide scale and understanding the mechanisms underlying these genetic predispositions. Nutrigenetics – the challenge to understand polygenic diseases.

Role of nuclear sensors in dietary gene regulation. Genome microarray analysis. Biomarkers in nutrigenomics. Bioinformatics: metabolomics, proteomics, transcriptonics, genomics.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 16. Analytical Methods. Assessment of nutrients

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Biological value of carbohydrates and lipids; amino acids and protein, requirements of humans. Energy metabolism; measurement of energy expenditure; Energy Balance, Body Composition, and Weight Management. Recommended dietary allowances and dietary guidelines Energy expenditure and energy requirements.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 17. Analytical Methods. Protein analysis

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Analytical techniques and Research methods:

Protein analysis: electrophoresis, proteomics, two-dimensional electrophoresis; immunochemical techniques, chromatography. Modern approaches in Lipid analysis: isolation, ultracentrifugation, chromatography

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 18. Analytical Methods. Lipid analysis

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Analytical techniques and Research methods:

Methods of statistics; sampling, study size and power, uses of standards , reference materials and statistical quality control.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 19. Analytical Methods. DNA analysis

Credit: 6

Unit Dates and Venues:

Aim of the unit To give students an overview

Prior Knowledge: chemistry, biology

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Analytical techniques and Research methods:

DNA analysis: isolation, PCR, Muliple PCR, Restriction analysis, SSCR, Heteroduplex analysis, ARMS, Sequencing, Microarray, Evaluation of Gene expression .

Methods of statistics; sampling, study size and power, uses of standards , reference materials and statistical quality control:.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Diet and health

Module 20. Prevention of chronic diseases - Diet and health

Obesity and Nutrition.

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Food and nutrient intakes in Europe. Nutrition Policies and Dietary Guidelines. Epidemiology and diet-disease relationships. Assessment of nutritional status.

Interaction among nutrition, lifestyle and other risk factors of disease, including genetics. Behavioural and biological control of body weight.

Concept of healthy nutrition. Role of diet in major European public health problems: obesity, cardiovascular disease, hypertension, cancer, dental disease, osteoporosis and nutritional deficiencies.. Effecting dietary change. Health education and health promotion. Nutrition surveillance. Nutrition intervention programmes. The role of nutrition in the prevention of disease and the promotion of good health.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 21. Prevention of chronic diseases - Diet and health

Nutritional support of diabetic patient

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Type II Diabetes, Type I Diabetes, Obesitas. Genetic predisposition, evaluation of the risk, metabolism characteristics. Nutrition as a curative and preventive measure Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 22. Prevention of chronic diseases - Diet and health

Cardio-vascular disease

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Atherosclerosis, Dyslipidaemias, Coronary heart disease, Hypertension. Genetic predisposition, evaluation of the risk, metabolism characteristics. Nutrition as a curative and preventive measure.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 23. Prevention of chronic diseases- Diet and health

Allergy and Nutrition.

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Basic concepts of toxicity, risk, safety and risk assessment. Health hazards of food contaminants including pesticides, antibiotics, heavy metals, hormones and radioisotopes. Safety evaluation of food additives. Allergic and sensitivity reactions to food components. Naturally occurring food toxins. Process induced toxins

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 28 Nutritional support in critically ill patients

Trauma and Sepsis

Credit: 2

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Stress-related catabolism. Enteral or pareneteral nutrition. Post-operative patients, Patients with multiple organ failure ( Intensive Care Unit) : sepsis, multiple trauma. Metabolism characteristics in acute patients. Specific nutritional support.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 29 Nutritional support in critically ill patients

Postoperative nutrition

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Stress-related catabolism. Enteral or pareneteral nutrition. Post-operative patients, Patients with multiple organ failure ( Intensive Care Unit) : sepsis, multiple trauma. Metabolism characteristics in acute patients. Specific nutritional support.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 31: Nutrition support in patients with chronic diseases

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Co-ordinator: : Partner, Department, Prof

Lecturers:

Content: Cancer. Chronic obstructive pulmonary disease (COPD), Chronic heart disease (CHD), Chronic kidney failure. Chronic gastrointestinal disease. Metabolism characteristics and nutrition in clinical management of chronic disease. Specific nutritional support. Nutritional causes of cancer and other chronic diseases. Nutritional epidemiology of chronic diseases.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 43. Nutrition, alcohol and drug abuse.

Metabolic disturbance in drug addiction

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: Partner, Department, Prof

Lecturers:

Content: Metabolic disturbance in drug abuse. Specific nutritional support.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 44. Nutrition, alcohol and drug abuse.

Nutrition and alcohol.

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: History of Alcohol Use. Alcohol: Is It a Nutrient? The Chemistry and Character of Alcohol. Toxicological aspects of alcohol excess. Metabolic disturbance in alcohol abuse. Individual Differences in Alcohol Metabolism. Alcohol and Malnutrition. Does Alcohol Have Benefits?

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 45. The Eating Disorder Continuum

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Co-ordinator: : Partner, Department, Prof

Lecturers:

Content:. Anorexia mentale. Bulimia Nervosa. Vegetarianism and Eating Disorders. Smoking and Eating Disorders. Baryophobia

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

Module 51. Nutrition in hereditary metabolic disorders

Credit: 6

Unit Dates and Venues:

Aim of the unit

Prior Knowledge:

Methods of Training: Lectures 2 x 2hr; Practicals 2 x 3hr, self-training 6 hr, tutoring 2hr

Coordinator: : Partner, Department, Prof

Lecturers:

Content: Inborn errors of metabolism. Insulinoresistance, Syndrome of Malabsortion, Malnutrition,. Specific nutritional support.

Assessment: Continuous Assessment, MCT

Total Marks :

Pass Standard and any Special Requirements for Passing Module: %

VI. CLINICAL CASE CONTENT

1. Diabetes Mellitus type 1, ketoacidosis after incorrect therapy

2.Diabetes Mellitus type 1 ( hypoglycemic status )

1. Diabetes Mellitus type 1 associated with Familial hypercholesterolemia

2. Hypoglycemia in a patient with Insulinom

3. Familial hypercholesterolemia

4. Familial disbetalipoproteinaemia

5. Familial hypertriglyceridemia associated with alcoholism

6. Obesity in a teenager girl

7. Obesity in an adult man

8. Hypertension in an adult man

9. Lactose intolerance/ lactase deficiency in an infant

10. Fructose intolerance

11. Galactosemia in a newborn

12. Malabsortion in an infant with Cystic fibrosis

13. Podagra

14. Vitamin B 12 deficiency due to malnutrition

15. Iron deficiency anemia in a pregnant woman

16. Dysmenorrhea/Premenstrual syndrome

17. Menopausal symptoms

18. Osteoporosis

19. Acute myocardial infarction

20. Arthritis

21. Congestive heart failure

22. Bronchial asthma

23. Wound healing

24. Infection

25. Stomach resection

26. ICU patient-parenteral nutrition

27. ICU patient-case 2

28. Dehydratation in a patient post operation

29. Electrolytes disbalance in an infant after diarrhea

30. Electrolytes disturbance after vomiting

31. Electrolytes disturbance in a patient with cerebral trauma

32. Duodenal ulcer

33. Pyloric stenosis

34. Chronic hemorrhagic ulcerative colitis

35. Chronic constipation

36. Chronic pancreatitis

37. Hepatic jaundice in a patient with alcoholism

38. Acute hepatitis

39. Hepatic cirrhosis

40. Renal stone disease

41. Chronic renal failure

42. Wilson’s disease

43. Polyneuropathy in an young woman

44. Drug abuse

45. Anorexia neurosa

46. Breast cancer

47. Colon cancer

48. Acute non lymphoid leukemia

49. Eczema

50. Psoriasis

51. Allergy

52. Acute myocardial infarction

53. Arthritis

VII. Example of Clinical case: Stenosis pylori Gastrectomia

Georgi Yanev Georgiev – 49 yrs old

I. Case history

1. Complaints

▪ Upper abdominal distention after meal, more marked after consumption of liquids

▪ Vomiting after meal, usually vomiting of undigested food particles

▪ Complains escalated last 10 days. Last 3 days vomiting occurs after liquids consumption .

2. History of the disease.

▪ Duodenal ulcer since 1979.

▪ Weight loss - 20 кg for 3 mounts

3. Family history

4. Father and brother with Ulcus duodeni ( operation of perforated pyloric ulcer)

5. 4. Nutritional habits and diet

▪ Meals 3-4 times daily, mainly at the evening.

▪ Vomiting, mainly at night before slipping and in the morning.

▪ Defecation – 2-3 times per week.

▪ The patient prefers meet and spice food.

▪ Drinks hard drinks (100-200g) usually at the evening.

ІІ. Physical examination

▪ Body height – 178 см

▪ Body weight – 60 кg

▪ BMI – Body Mass Index = 60 : 178 2 =

▪ Fat mass index F (%) - ?

▪ Waist / hip ratio

▪ Skin fold - 2 сm at abdominal wall.

▪ Skin turgor - decreased

▪ Tongue – dry with coating

▪ Succucion splashing

▪ Blood pressure – 110/70

▪ Nutritional status

ІІІ. Laboratory tests

- transferin malnutrition

- prealbumin

- urea

- creatinine

- glucose

- cholesterol

- triglycerides

- insulin status

- corticosteroids

- albumin

- amino acids

ІV. Other tests

4. 1. X ray examination – Dilatatio ventriculi. Stenosis pylori.

5. 2. Ultrasonography – Dilatatio ventriculi .

6. 3. Fibrogastroscopy – Stenosis pylory

V. Diagnosis

Ulcus duodeni. Stenosis pylori. Dilatatio ventriculi. Malnutritia chronica. Kahexia. Hypoproteinemia. Diselectrolitemia. Alcalosis metabolica.

VІ. Differential diagnosis

VII. Therapy

1. Operation – stomach resection a mode Bilroth I. Severe postoperative anastomositis. Jejunostoma nutritiva.

2. X ray therapy. Corticosteroid and x ray therapy for anastomositis

3. Jejunostoma nutritiva

4. Total parenteral nutrition, later combined with enteral ( trough jejunostomy). Later only enteral nutrition with Suportan and Reconvan (Frasenius) х 1500 / daily continuous infusion. Losses from nasogastric tube are put back in the jejunostomy. After 20 days anastomositis fade out. Oral nutrition. Jejunostomic tube removed on 30 th day.

VІІІ. Nutrition

1. Nutritional diet

2. Nutritional supplements

IX. Assessment of quality of life

X. Following of the patient

VIII. Example of Portfolio

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IX. Subscription Form for admission and certification

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