Nutrition by lanyuehua


									Ambulatory Medicine Lecture
Dr. Ayers

                                   Clinical Nutrition

       In an upcoming class, you will be asked to discuss your approach to solving the
following problem statements that focus on clinical nutrition topics. You will need to
formulate relevant self-directed questions that will frame your solution(s), find the
necessary data to answer those questions, and come to a conclusion. Think broadly before
honing in on your solution.

Problem #1

In a popular daily newspaper a headline blares: “Knowledgeable Teens Still Starve for
Attention.” There is a picture of a thin, attractive young woman; the picture caption
reads, “Heidi Guenther: The 22 year old Boston Ballet dancer struggled with an eating
disorder, succumbed to a heart attack June 30.”

Problem #2

Obesity is both endemic and pandemic in this country. Management of obesity is
notoriously recalcitrant: What do you need to know about clinical obesity to help your
overweight patients from a nutritional aspect.

Problem #3

The U.S. Government puts millions of your tax dollars into cancer research. As a
concerned taxpayer, what questions would you like your Congressman to ask the Chief of
the National Cancer Institute (NCI) about dietary prevention of cancer when he testifies
next week?

Problem #4

A 59 year old white male underwent a successful angioplasty/atherectomy of a single
(LAD) coronary lesion. What questions do you need to ask the patient to plan a
nutritional approach to a secondary prevention program? Depending on the answers be
prepared to plan that program.
Ambulatory Medicine Lecture
Dr. Ayers


The “PBL small group” uses a PBL case which is divided into parts, each part given to
the students on each of the two or three days of PBL sessions. The process involves
students working together to pool ideas and information based on the case. One student
is appointed the “beadle” for the case and it is his/her job to get all the materials to and
from each session. Another student is the “reader” and presents the portion of the case to
be considered each day. A student “scribe” writes down all the information on large
sheets of paper mounted on a wall for easy access and referral. The four sequential lists
of collected and discussed information and outlined below:

DATA            After one student reads the first page of the case out loud to the group, the
scribe lists all the information or “data” about the patient, e.g., complaints, signs and
symptoms, etc., as the students identify this information. This is for visual learning and
“trapping” the data. For example: A 25-year old white female, pain in right knee,
swelling, began three days ago, no memory of injury, etc.

QUESTIONS            This is the most difficult part of the process initially. Questions
that may be answered “yes” or “no” are not very useful. Much more powerful are
question like “what is the cause…” (WIC) or “what is the significance…” (WIS).
Questions should be numbered. It is important that questions be directly related to and
confined to the DATA.

WORKING DIAGNOSIS [HYPOTHOSIS]                      Refer back to the Questions in
formulating Hypotheses and refer to the Question number(s) in listing them. A
Hypothesis is a “possibility” or reason to explain certain observed phenomena.
Hypotheses can be complex when combining a number of questions together.
Hypotheses must relate only to the observed data already listed.

LEARNING OBJECTIVES                    Using the Hypotheses, students formulate specific
areas about which they need information in order to test/support/reject the listed
hypothesis. The objectives should include specific parts of basic science concepts that
the students will review/learn. The Facilitator copy of each PBL Case includes a list of
Learning Objectives. One of the tasks of the facilitator in guiding the group, if necessary,
is to include these objectives as part of their learning. The students receive the Learning
Objective sat the end of the Case.

MAPPING is a graphic representation of the interrelationship between the data points
of the Case. It is a schematic that attempts to answer as many of the relevant questions
raised by the Case via conjoined pathways. Different Colors, arrows and varied line
forms (dots, dashes, etc.) are usually required. (This is the Law of Parsimony or Occam’s

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