Winter 2006

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1 Advanced Clinical Nutrition: AFNS 578

Department of Agricultural, Food and Nutritional Science, University of Alberta

Winter 2016

Dr. Diana Mager PhD RD

Course Description

*3 (3-0-3). The principles of clinical nutrition and the role of diet in the treatment and management of chronic disease. Emphasis will be on case studies and application of principles of advanced clinical nutrition for development of individualized nutritional care plans for clients with chronic disease.

Students in this course may have different/more extensive assignments than those given to students enrolled in NUTR 476.

Prerequisite NUTR 468/302

B. Objectives

This course will provide the students the opportunity to acquire knowledge and apply knowledge:

1) The role of nutrition in the prevention and treatment of selected diseases, nutritional disorders and clinical conditions

2) Assess, discuss and resolve clinical nutrition management problems. This will include the integration of knowledge and skills acquired from previous course work (nutrition,

biochemistry, physiology and behavioral science).

3) The role of the clinical dietitian as a member of the health care team in the provision of nutritional care.

C. Format:

Lectures Mon: 12-12:50; Location: ECHA L1-140; Wednesdays (1- 5 pm) :ECHA 2-430.

Lab/seminar: 3 hours/week; Wed 2-5 pm Location: ECHA 2-430

D. Instructor (Office hours: W 11-12) Teaching Assistant(s)

Diana Mager PhD RD Sabina Valentine (SV) MSc RD candidate

2-021 Li Ka Shing Centre for Research [email protected]

Phone: 492-7687 Abeer Alzaben MSc PhD (student)

Email: [email protected] [email protected]

ECHA 2-420 Office Hours: TBA

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Week: Tentative Lecture Schedule Lab

January 4-8 Enteral Nutrition: Adjunctive vs Treatment Reading 1-7

Case: Crohn’s Disease Lab: Enteral feeding/tube

Surgical vs Medical Therapy devices/feeding pump/

Product tasting: SV

DVD patient simulations:

Crohns and tube feeding

January 11-15 PN: How & when to order Readings: 8-13

Biochemical, Anthropometric and clinical Lab: Enteral calculation I

assessment TA: SV

Complications of PN: liver disease, sepsis, Overfeeding Case: Surgical Patient

January 18-22 Cancer/interpretation of blood work Lab: PN Cases, SV.

(slides 1-32 blood work) Readings 8, 9, 15-20 Trauma/Sepsis/ICU

January 25-29 Re-feeding Syndrome Readings: 21-24

Hypermetabolism: Burns Lab: Enteral/PN

Calculations, TA: SV Assignment 1 (20%) due Jan 27^th, 2016 in seminar

Feb 1-5 Transplantation Readings: 12, 25-27

Liver and small intestine Midterm/SV

Midterm exam Feb 3, 2016 in seminar

Feb 8-12 Hypermetabolism: ARDS Readings 28-30 Hypermetabolism Pulmonary Disease Lab: TBA ICU: chylothorax

Feb 15-19 Reading Week- No classes scheduled

Feb 22-26 Renal Disease: Role of the kidney Readings 31-36 Chronic Renal Failure/Renal Insufficiency Lab: Renal Diets I

Dialysis TA: AA

Feb 29-Mar 4 Renal Disease II: Renal Transplantation Lab: Renal Diets II.

Cases: CRF/transplantation TA: AA

No lecture Feb 29, 2016 due to student union elections

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3 March 2: Dialysis Laura White RD

March 7-11 Pediatrics: Inborn Errors of Metabolism Readings 37-38

Case(s): PKU/Tyrosinemia/MSUD/ Lab: Metabolic Disorders galactosemia- March 9,2016 Metabolics (2:30-4) TA: AA

March 14-18 Pediatric Nutrition Assessment Readings 39-41

Full term vs prematurity Lab: Pediatric Assessment

Use of PN vs Enteral DM

Failure to Thrive (FTT) DVD simulations

Assignment 2 Due Wed March 16, 2016(20%) Guest speaker: 3:30-5:00

Case: Hypermetabolism Home NS Program.

March 21-25 Developmental Disabilities Reading: 41

Energy Metabolism: Hypo-vs- Hypermetabolism Lab: Dysphagia Clinical

Dysphagia, Assessment

Gastroesophageal reflux disease (GERD) RD/SLP

Case: GERD and Dysphagia; IHEP Stanley Home Care DVD simulations

March 28 –April 1 TBA TBA

No classes on March 28, 2016

April 4-8 Food Allergies & Hypersensitivities. Reading: 42-43 IgEvs non IgE mediated intolerances TBA

Case: Milk/Protein Soy Allergies with NCP Geriatrics

(Last day of classes April 8, 2016)

E. Evaluation Date

Mid-term Exam: 25% February 3, 2016

Term Assignments: 40% 2 assignments (20% and 20%).

Final Exam: 35% April 14, 2016

Note: Final exam will be cumulative. The University grading system will be applied dependent upon the distribution of the final grades in the class and then absolute values will be attributed to the letter designations.

F. Late assignments will be accepted; however a deduction of 10% per day late will be made. For example if an assignment is due on a Monday at 4:00 pm, and it is received any time after that, up until 4:00 pm the following day, 10% will be deducted from total mark. If it is late a second day, an additional 10% will be deducted and so on. If an assignment is worth 30% of the years work (or 30 marks) then a 10% deduction is minus 3 marks. If assignments are more than 10 calendar days late,

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4 then a grade of zero will be assigned. Electronic submissions of assignments WILL NOT be

permitted. Students may NOT pick up other students assignments/tests and may only pick up the assignments during regularly scheduled office hours or in class when they are distributed. Only hard copies of assignments will be accepted. No faxed or email assignments. The assignments must be tightly stapled. No loose papers will be accepted. Assignments that are illegible will NOT be marked.

Font size for typed assignments must be adhered to as specified in the assignment.

G. The lab section of the course may include the need for supplemental lecture material from course instructor Dr. Diana Mager. Some lab will be conducted by Dr. Mager, the rest guest speakers or the TA. The lab will include hands-on experiential learning, videos, calculations and cased based

learning in addition to didactic approaches. Material from these seminars/labs WILL be included in the assignments/mid-terms/exams. The student is responsible to attend all of these seminars and all the material covered. Guest speakers in the seminar are NOT to be approached directly outside of the class times unless otherwise specified by the course instructor. Students should bring calculators to both lecture and labs as hands-on calculations will be done by students.

H. Student Marking requests regarding information about individual student grading will NOT be provided by email/telephone to students. This includes requests regarding final exam marks. Students may address any questions regarding tests/assignments results in regularly scheduled office hours with instructor. Tests/assignments will NOT be remarked. Only addition errors of total grade will be corrected. Assignments/mid-term will be returned in class/lab and/or may be picked up in regularly scheduled office hours of the instructor, unless otherwise specified.

I. Missed Mid-terms or Final Exam.

Students who are absent from mid-term exams due to illness only will NOT be provided with

alternative times to write the mid-term. Instead, the weight of the midterm will be added to the overall final exam (this will now be worth 60% of the entire grade for the course). No accommodation will be made for travel or outside commitments (other than illness) for missed midterms and a grade of zero will be assigned should the student miss the midterm for these reasons. All students must be approved through Academic and Student Programs in the Faculty of Agricultural, Life and Environmental Sciences to defer a final exam to the subsequent term. The timing of this exam will be contingent upon the Instructor and the availability of all of the students to write the exam in the subsequent semester. ONLY ONE TIME SLOT to write a deferred exam will be provided. Students are encouraged to contract the instructor in the first week of the subsequent semester regarding the scheduling of the deferred exam. Requests for remarking of illegible midterms or assignments will not be done.

J. Emails will be responded to within 24-72 hrs (not including weekends or statutory holidays). Use the question forum in Moodle as another way to ask questions and to see what new information has been highlighted.

K. Students who are late for class will be expected to enter the classroom quietly and to sit at the back of the class to avoid disrupting the class. While we encourage interactive group activities and class discussion at specific points in the lecture/lab, disruptive noise (such as talking) during non-group activities while instructor/TA/guest speakers are teaching, will not be tolerated.

L. Past evaluative material: Representative course evaluation materials from previous years will be posted on Moodle approximately one week before the mid-term and one week before the final exam.

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5 L. Reference Materials

Required Readings*

Week 1: Nutrition Support: Enteral

1. Miller KR, McClave SA, Kiraly LN, Martingale RB, Benns MV. A tutorial on enteral access in adult patients in the hospitalized setting. JPEN: 2014:38(3):282-295.

http://pen.sagepub.com/content/38/3/282.full.pdf+html

2. Soscia J, Freedman J. A guide to the management of common gastrostomy and gastrojejunostomy problems. Paediatr Child Health 2011: Vol 16(5):281-287

3. Bankhead R et al. ASPEN Enteral nutrition practice recommendations. JPEN 2009. Pages 131- 158; 162-167.

http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/content/33/2/122.full.pdf+html 4. Chen, Y and Peterson SJ. Enteral Formulas: Which one is right for your adult patient. Nutr Clin

Prac 2009; 24; 344

http://ncp.sagepub.com.login.ezproxy.library.ualberta.ca/content/24/3/344.full

5. Andrew Ukleja, Kevin L. Freeman, Karen Gilbert, Marty Kochevar, Michael D. Kraft, Mary K.

Russell, Melanie H. Shuster. Standards for Nutrition support: adult hospitalized patients. Nutr Clin Pract 2010 25:403-414.

6. Andrew Ukleja. Altered GI Motility in Critically Ill Patients: Current Understanding of Pathophysiology, Clinical Impact and Diagnostic Approach. Nutr Clin Pract 2010 25: 16-25.

7. Jensen G.L. Hsiao PY. Wheeler D. Adult Nutrition Assessment Tutorial. JPEN 2012; 36:267- 274. http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/content/36/3/267.full.pdf+html Foundational Knowledge IC: IC 1A-C, 11A-B, 14A,E-G, 15C-H, 16A-K.

Week 2: Nutrition Support: PN

8. Shenkin A, Biochemical Monitoring of Nutrition Support. Ann Clin Biochem 2006;269-272.

http://acb.rsmjournals.com.login.ezproxy.library.ualberta.ca/cgi/reprint/43/4/269

9. Gidden, F, Shenkin A. Laboratory Support of the Clinical Nutrition Service. Clin Chem Lab Med 2000;38(8): 693-714.

10. Kirby D.F, Corrigan M.L., Speerhas R.A, and Emery D.M. 2012: Home Parenteral Nutrition Tutorial. Journal of Parenteral and Enteral Nutrition 2012: Vol 36(6): 632-644.

http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/c/content/36/6.toc

11. Seida J.C, Mager D.R, Hartling L, Vandermeer B, Turner J.M. Parenteral -3 fatty acid lipid emulsions for children with intestinal failure and other conditions: A systematic review. JPEN 2013: 37:44-55.

http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/c/content/37/1/44.full.pdf

12. Tillman E. M. Review and Clinical Update on Parenteral Nutrition-Associated Liver Disease.

Nutr Clin Prac 2013: 28: 30-39.

13. Stephen Marc Stout and M. Petrea Cober. Metabolic Effects of Cyclic Parenteral Nutrition Infusion in Adults and Children Nutr Clin Pract 2010 25: 277-281.

Foundational Knowledge IC: 1A-C, 2A,E, 11A-C, 14A-C, 15C-H,16A-E,16J-K, 17A-D.

Week 3: Nutrition Support in Critical Care/Cancer

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6 14. Esper DH, Harb WA. The cancer cachexia syndrome: a review of metabolic and clinical

manifestations. Nutr Clin Practice 2005;20:369-376.

15. Raykher A, et al. Enteral Nutrition Support of Head and Neck Cancer Patients. Nutr Clin Prac 2007;22:68-73.

16. Todd SR, Kozar RA, Moore FA. Nutrition Support in adult trauma patients. Nutr in Clin Practice 2006;21:421-429.

17. Boitano M. Hypocaloric feeding of the critically ill. Nutr in Clin Practice 2006;21:617-622.

18. Frankenfield D. Energy expenditure and protein requirements after trauma injury. Nutr Clin Practice 2006;21:430-437.

19. Stephen A. McClave, Robert G. Martindale, Vincent W. Vanek, Mary McCarthy, Pamela Roberts, Beth Taylor, Juan B. Ochoa, Lena Napolitano, Gail Cresci, the A.S.P.E.N. Board of Directors and the American College of Critical Care Guidelines for the Provision and

Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN J Parenter Enteral Nutr 2009; 33; 277 (selected pages as per lecture)

http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/content/33/3/277.full

Foundational Knowledge IC: 1A-C,2A-B,E, 11A-C, 14A-G, 15C0H, 16A-F, J-K, 17A-E.

Week 4: Nutrition Support: Burn Patients/Refeeding Syndrome Continued.

20. Stanga Z, Brunner A, Leuenberger M, Grimble RF, Shenkin A, Allison SP, Lobo DN. Nutrition in Clinical Practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr 2008: 62:687-694.

http://web.ebscohost.com.login.ezproxy.library.ualberta.ca/ehost/pdfviewer/pdfviewer?sid=2b25 5713-f3bd-4957-8809-998704dd7144%40sessionmgr14&vid=2&hid=15

21. Kraft MD, Btaiche I, Sacks GS. Review of the re-feeding syndrome. Nutr Clin Practice 2005;20:625-633.

22. Lee JO. Benjamin D, Herndon, DN. Nutrition Support strategies for severely burned patients.

Nutr Clin Practice 2005;20:325-330.

23. Prelack, K, Dylewski, M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. J Burns 2006;2391

Foundational Knowledge IC: 1A-C, 2B,E, 11A-C, 14A,E-G, 15C-H, 16A-K, 17A-C.

Week 5: Nutrition Support in Intestinal and Liver Failure

24. Weimann A, Braga M, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 2006;25:224-244.

25. Jeejeeboy KN. Short bowel syndrome: a nutritional and medical approach. CMAJ 2002;166(10):1297-1302.

http://www.ncbi.nlm.nih.gov.login.ezproxy.library.ualberta.ca/pmc/articles/PMC111082/

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7 26. Matarese L. Nutrition and Fluid Optimization for Patients with Short Bowel Syndrome. Journal

of Parenter Enteral Nutr 2013: 37: 161-170.

http://pen.sagepub.com.login.ezproxy.library.ualberta/content/37/2/161.full.pdf

Foundational Knowledge IC: 1A-C, 2A-B, 11A-C, 14A-G, 15C-H, 16A-F, J,K. 17A-C.

Week 6: Feb 15-20, 2015. READING WEEK (no classes).

Week 7: Nutrition Support: Pulmonary Disease/Chylothorax

27. Anker, SD, John M et al., ESPEN guidelines on enteral nutrition: cardiology and pulmonology.

Clin Nutrition 2006; 25:311-318.

http://www.sciencedirect.com.login.ezproxy.library.ualberta.ca/science/article/pii/S02615614060 00379

28. Malone, A. M. Specialized enteral formulas in acute and chronic pulmonary disease. Nutr Clin Practice 2009:24:666-674.

29. Turner, KL, Moore FA, Martindate R. Nutrition Support for the Acute Lung Injury/Adult Respiratory Distress Syndrome Patient: A Review: Nutr Clin Prac 2011:Vol 26 (1):14-25.

http://ncp.sagepub.com.login.ezproxy.library.ualberta.ca/content/26/1/14 http://ncp.sagepub.com.login.ezproxy.library.ualberta.ca/content/22/1/68.full Foundational Knowledge IC: 1A-C, 11A-C, 14A, E-G, 15C-H, 16F-K, 17A-C.

Weeks 8 & 9: Nutrition Support in the Renal Patient

30. Rhoda KM, Porter MJ, Quintini, C. Fluid and Electrolyte Management: Putting a Plan in Motion. JPEN 2011: Vol 35(6):675-685.

http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/content/35/6/675.full.pdf+html

31. Steiber, A. Chronic Kidney Disease: Considerations for Nutrition Interventions. JPEN 2014:418- 426.http://pen.sagepub.com/content/38/4/418.full.pdf+html

32. Wooley JA, Btaiche I, Good KL. Metabolic and nutritional aspects of acute renal failure in critically ill patients requiring continuous renal replacement therapy. Nutr in Clin Practice 2005;20:176-191.

33. Legg, V. Complications of Chronic Kidney Disease: A close look at renal osteodystrophy, nutritional disturbances and inflammation. AJN 2005:105:40-49.

34. Ayers P & Dixon C. Simple Acid-Base Tutorial. JPEN: 2012:36:18-23.

http://pen.sagepub.com/content/36/1/18.full.pdf+html

Foundational Knowledge IC: 1A-C, 2B-C, E, 11A-C, 14A-C, E-G, 15C-H, 16A-K, 17A-C.

Week 10: Nutrition Support in Inborn Errors of Metabolism.

35. Nenad Blau, Francjan J van Spronsen, Harvey L Levy Phenylketonuria. Lancet Vol 376 October 23, 2010 1417-1427.

36. Morton DJ, Strauss KA et al., Diagnosis and treatment of maple syrup disease; a study of 36 patients. Pediatrics 2002;109:999-1008.

http://web.ebscohost.com.login.ezproxy.library.ualberta.ca/ehost/pdfviewer/pdfviewer?hid=119

&sid=fc37ecd9-699b-4ff5-9bfd-f0147c40aa81%40sessionmgr113&vid=3 Week 11: Nutrition Support in Pediatrics

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8 37. Nofal, A.A. Schwenk, F. Growth Failure in Children: A Symptom or a Disease? Nutrition in

Clinical Practice 2013: 28:651-658.

38. Axelrod D, Kazmerski K, Iyer K. Pediatric Enteral Nutrition. JPEN 2006;30:S1-S26.

http://pen.sagepub.com.login.ezproxy.library.ualberta.ca/content/30/1_suppl/S21.full

39. Johnson T, Sexton E. Managing children and adolescents on parenteral nutrition: challenges for the nutrition support team. Proceedings of Nutr Society 2006;65:217-221.

http://journals.cambridge.org.login.ezproxy.library.ualberta.ca/action/displayFulltext?type=1&pd ftype=1&fid=815180&jid=PNS&volumeId=65&issueId=&aid=815168

Foundational Knowledge: IC; 10A-B, 15A-H, 16A-K.

Week 12; Nutrition Support in Children and Adults with Neurological Impairment &

Dypsphagia

40. Mager D & Pencharz P.B. Nutritional Considerations in Children with Developmental

Disabilities. In: An Introduction to Developmental Disabilities in Ontario. Editor Front Porch Publishing, Toronto, Baltimore: Paul H Brookes Publishing Inc. Ontario 2011 (3^nd Edition).

41. Edwards S, Davis AM, Mousa H, Bruce A, Lyman B, Cocjin J, Dean K, et al. Caring for the tube fed children; a review of management, tube weaning and emotional considerations. JPEN 2015:

DOI: 10.1177/0148607115577449

http://pen.sagepub.com/content/early/2015/03/13/0148607115577449.full.pdf+html

42. Crary Ma, Groher M.E. Reinstituting Oral Feeding in Tube-Fed Adult Patients With Dysphagia.

Nutr Clin Prac 2006;21:576-586.

http://ncp.sagepub.com.login.ezproxy.library.ualberta.ca/content/21/6/576.full Foundational Knowledge: IC; 10A-B, 15A-H, 16A-K.

Week 13 Nutrition Support: TBA

Week 14: Nutrition Support in the Elderly.

43. Garcia-Careaga M, Kerner JA. Gastrointestinal manifestations of food allergies in pediatric patients. Nut in Clin Practice 2005;20:526-535.

44. Volkert D, et al. ESPEN guidelines on enteral nutrition: geriatrics. Clin Nutrition 2006;25:330- 360.

45. Foundational Knowledge: IC; 10A-B, 15A-H, 16A-K.

*Note most readings are available through the U of A library electronic access via the following link. You can access this link through your University of Alberta ccid and password.

http://www.library.ualberta.ca/ejournals/search/index.cfm

Additional Readings (optional). These may or may not be available via your University of Alberta electronic journal links.

1. Fessler T.A, Trace Elements in Parenteral Nutrition: A practical guide for dosage and monitoring for adult patients. Nutr in Clinical Practice 2013: Vol 28(6): 722-729.

2. Rhoda KM, Porter MJ, Quitini C. Fluid and electrolyte management; Putting a plan in motion.

JPEN. 2011:35:675-685.

3. Kelly D.G., Tappenden K.A, Winkler M.F. Short bowel syndrome: highlights of patient

management, quality of life and survival. JPEN: 2013: 1-11. DOI: 10.1177/0148607113512678.

Advance on line Nov 2013.

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9 4. Dhaliwal R, Cahil N, Lemieux M, Heyland D. The Canadian Critical Care Nutrition Guidelines

in 2013. An update on Current Recommendations and Implementation Strategies. Nutr in Clinical Practice Advance on line Dec 2, 2013.

5. Corkins M.R. Griggs K.C, Groh-Wargo S, Han-Markey T.L. Helms R.A. Muir L.V, Szesycki E.E. Standards for Nutrition Support; Pediatric Hospitalized Patients. Nutrition in Clinical Practice 2013 Vol 28(2):263-276.

6. Chan, LN. Drug-Nutrient Interactions (Tutorial): JPEN; 2013 37(4):450-459.

7. Gura K. Is there still a role for peripheral total parenteral nutrition. Nutr Clin Prac 2009:709-717.

8. Nightingale, J, Woodward JM. Guidelines for management of patients with a short bowel. Gut 2006;55:1-12.

9. Malone A, Hamilton, C. The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Application in Practice.

Nutr Clin Prac 2013, 28: 649-650.

10. Promoting optimal monitoring of child growth in Canada: Using the WHO growth charts.

Collaborative Public Policy Statement: CPS, DC, College of Family Physicians of Canada, CHNC, BCC. 2013. www.dietiitans.ca

11. Nutrition for Healthy Term Infants - Statement of the Joint Working Group: Canadian Paediatric Society, Dietitians of Canada and Health Canada 2013.

http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php

12. Laubereau B, Brockow I, et al. Effect of breast feeding on the development of atopic dermatitis during the first 3 years of life-results from the Gini-Birth Cohort Study. J Pediat 2003;144:602- 607.

13. von Berg, A et al. Preventative effect of hydrolyzed infant formulas persists until age 6 years:

Long term results from the German Infant Nutritional Intervention (GINI) Study. J Allergy Clin Immunol 2008:121: 1442-1447.

14. Christie L, Hine J, Parker JG, Burks W. Food allergies in children affect nutrient intake and growth. J Am Diet Associ 2002; 102:1648-1651

15. Marshall WJ. Nutrition assessment: its role in nutrition support. J Clin Pathol 2008; 61:1083- 1088.

16. American Society for Parenteral and Enteral Nutrition: The Science and Practice of Nutrition Support-A Case Based Core Curriculum; 2006.

17. Modern Nutrition in Health and Disease, 10^th Edition. Lippincott Williams & Wilkins, 2010.

18. American Dietetic Association. Manual of Clinical Dietetics, 6^th Edition, Chicago: American Dietetic Association, 2000.

19. A.S.P.E.N. Ethics Position Paper Task Force, Albert Barrocas, Cynthia Geppert, Sharon M.

Durfee, Julie O'Sullivan Maillet Cheryl Monturo, Charles Mueller, Kathleen Stratton, Christina Valentine and A.S.P.E.N. Board of Directors Nutr Clin Pract 2010 25: 672

20. Ellinger S et al. Efficacy of vitamin supplementation in situations with wound healing disorders:

results from clinical intervention studies. Curr Opin Clin Nutr Metab Care 2009:12:588–595 21. Morag J. Andrew and Peter B. Sullivan Growth in Cerebral Palsy Nutr Clin Pract 2010 25: 357-

361.

22. Lochs, H, Dejon C. et al. ESPEN Guidelines on Enteral Nutrition : Gastroenterology. Clin Nutrition 2006;25:260-274.

23. Mitch WE, Maroni BJ. Factors causing malnutrition in patients with chronic uremia. Am J Kid Dis 1999:33:176-179.

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10 24. Wooley JA, Btaiche I, Good KL. Metabolic and nutritional aspects of acute renal failure in

critically ill patients requiring continuous renal replacement therapy. Nutr in Clin Practice 2005;20:176-191.

25. Rex O. Brown, Charlene Compher and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of A.S.P.E.N. Clinical Guidelines : Nutrition Support in Adult Acute and Chronic Renal Failure JPEN J Parenter Enteral Nutr 2010 34: 366

26. Cichero J.A.Y, Steele, C, Duivestein J, Clave P, Chen J, Kayashita J, Dantas R, LEcko, C, Speyer R, Lam P, Murray J.M. The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative. Curr Phys Med Rehabil Rep 2013: DOI: 1008/s40141-01300024-z.

27. Chernoff R. Tube feeding patients with dementia Nutr in Clin Practice 2006;21:142-146.

28. Alan H. Silverman Interdisciplinary Care for Feeding Problems in Children Nutr Clin Pract 2010 25: 160

29. Nutrition Care Process Update: Part 1 JADA; 2008;108(7):1113-1117.

30. Nutrition Care Process Update: Part 2 JADA; 2008;108(8):1287-1293

M. Additional Information

1. Electronic Devices: Electronic devices during examinations are restricted. Only approved non- programmable calculators will be allowed. Please consult me regarding this issue PRIOR to any mid-term or final exam to avoid any problems with this during the exam. Programmable calculators are NOT allowed. Taping of lectures/lab-seminar cannot be done without prior permission of the TAs and the instructor. Permission must be obtained before each session. Calculators should be brought to all lectures and seminars as there are hands-on calculations that need to be performed.

3. Academic Integrity: Code of Student Behavior

“The University of Alberta is committed to the highest standards of academic integrity and honesty.

Students are expected to be familiar with these standards regarding academic honesty and to uphold the policies of the University in this respect. Students are particularly urged to familiarize themselves with the provisions of the Code of Student Behaviour (www.ualberta.ca/secretariat/appeals.htm) and avoid any behaviour which could potentially result in suspicions of cheating, plagiarism,

misrepresentation of facts and/or participation in an offence. Academic dishonesty is a serious offence and can result in suspension or expulsion from the University.” (GFC 2003)

Code of Student Behaviour

“All students at the University of Alberta are subject to the Code of Student Behaviour, as outlined at http://www.governance.ualberta.ca/en/CodesofConductandResidenceCommunityStandards/CodeofStudentB ehaviour.aspx. and on pages 652-672 on the 2005-2006 Calendar. Please familiarize yourself with it and ensure that you do not participate in any inappropriate behavior as defined by the Code. Key components of the code include the following statements.

30.3.2(1) Plagiarism: No Student shall submit the words, ideas, images or data of another person as the Student’s own in any academic writing, essay, thesis, project, assignment, presentation or poster in a course or program of study.

30.3.2(2) c. No Student shall represent another’s substantial editorial or compositional assistance on an assignment as the Student’s own work.”

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 Please speak to me if you have any questions or concerns about the Code, particularly as it pertains to team/group assignments, internet research using the same work as part of the assignments in more than one course, lab work and the definition of Plagiarism.

 Policy about course outlines can be found in section 23.4(2) of the University Calendar (GFC 29 Sept 2004).