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A Hands On Approach to a Case of Low Back Pain Using Acupuncture and Osteopathic Manipulative Treatment
 

A Hands On Approach to a Case of Low Back Pain Using Acupuncture and Osteopathic Manipulative Treatment

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    A Hands On Approach to a Case of Low Back Pain Using Acupuncture and Osteopathic Manipulative Treatment A Hands On Approach to a Case of Low Back Pain Using Acupuncture and Osteopathic Manipulative Treatment Presentation Transcript

    • Developing Nutrition Curriculum in a Family Medicine Residency
    • Introductions
      • Tufts Family Medicine Residency
      • Boston area
      • 24 residents
      • 8 full time faculty
    • Road Map
      • Define our problems
      • What are the national recommendations
      • Discuss our solutions
      • Small group discussions
    • Defining the problem?
      • Identifying the lack of nutrition education in the residency setting
      • Identifying the lack of precepting by faculty on nutrition
      • Identifying the lack of communication with dietitians on our staff
    • What are the Guidelines?
      • American Academy of Family Physicians
      • Association of Departments of Family Medicine
      • Association of Family Practice Residency Directors
      • Society of Teachers of Family Medicine.
    • What are the Guidelines? Attitude
      • Nutrition is an integral part of:
        • Health promotion and disease prevention-Mortality and morbidity could be significantly reduced through primary prevention targeting dietary risk factors throughout the life cycle.
        • Medical treatment of disease-nutritional status has a large impact on the ability to respond to medical interventions.
        • Diagnosis and role-appropriate management of:
    • What are the Guidelines? Attitude
      • Dietary intake is influenced by a variety of patient factors, including:
        • Culture
        • Socioeconomic
        • Psychosocial and mental health
        • Knowledge
        • General health and lifestyle
    • What are the Guidelines? Attitude
      • Nutrition consultants should be utilized when appropriate to help provide counseling for at-risk patients.
    • What are the Guidelines? Knowledge
      • General principles of nutrition
      • Nutritional assessment
      • Nutritional issues of different stages of the life cycle
      • The role of nutrition in the prevention and treatment of specific diseases
      • Weight loss strategies and counseling
    • What are the Guidelines? Knowledge
      • Disordered eating
      • Use of dietary supplements
      • Preventing and recognizing and treating foodborne illness
      • Allergies and food intolerance
      • Physical activity and sports
      • Community Resources
    • What are the Guidelines? Skills
      • Integrating nutrition assessment and intervention into the medical history, review of systems, physical examination, laboratory evaluation and plan of care.
      • Assessing the nutritional status and writing diet prescriptions for inpatients
      • laboratory and metabolic studies related to nutritional assessment.
    • What are the Guidelines? Skills
      • Counseling patients and family members about specific nutritional needs related to stages of the life cycle, lifestyle and habits, disease prevention and/or disease.
      • Counseling patients on safe lifestyle approaches to weight management and balancing caloric intake and physical activity.
      • Advising on vitamin, mineral and other dietary and botanic supplements.
      • Collaborating with registered dieticians and certified diabetes educators
    • Bottomline Basically good family medicine
    •  
    • Nutrition Challenges in Practice
      • Can’t know or do it all, so need to know how to refer
      • Not strong reimbursement from Insurance
      • Understand that much of patient’s nutrition occurs outside your office
    • Challenges Particular to Family Medicine in teaching nutrition
        • Get buy in from residents that this is important
        • Many have no training in medical school
        • Culture of the residency
    • Challenges Particular to Family Medicine Teaching Nutrition
      • Faculty Training
      • Need buy-in of higher-ups
      • Need buy-in of patients
      • Where do you teach it in the curriculum
    • What we did at Tufts…
      • Started a Nutrition education taskforce
        • Got buy in from faculty
        • Got buy in from residency director
        • Got buy in from residents
    • Nutrition Curriculum Taskforce
      • Dr. Margo Woods (Tufts school for nutrition)
      • Erika Damon (nutritionist on staff)
      • 2 faculty
      • 1 resident
    • Nutrition curriculum goals
      • Goal 1 – increase the precepting of nutritional interventions by our faculty
      • Goal 2 – integrate more didactics and case based learning for the residents
      • Goal 3 – Use standardized patients with the residents and faculty
    • What is the dash diet
    • DASH Diet
    • Creation of the curriculm
      • Based on the Dash diet
      • 3 messages
      • Focus on 4 chronic conditions
      • Develop scripts
      • Develop patient information sheets
      • Posters for patient education
    • What is problem
      • Hypertension
      • Obesity
      • Diabetes
      • High Cholesterol
    • Phase 1 Faculty Development
      • Faculty in-services
      • Precepting skills
      • How DASH applies to 4 conditions
      • Piloting with own patients scripts
      • Piloting with their own patients the patient information sheets
    • Faculty Development
      • I think we did 4 inservces
      • Donuts to yogurt
    • Phase 2 Case Based Lectures
      • Jade please list the lectures that occurred in the curriculum
      • ???8 one-hour lectures to residents over 4 months
      • Topics
        • Personal nutrition assessment, usual intake, behavioral skills
        • DM, hypertension, obesity, CVD
      • Included case discussion, diet analysis and recommendations based on the DASH diet
    • Case Based Lectures
      • Cardiovascular disease
      • Jade what did you do for your lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general?
    • Case Based Lectures
      • Diabetes Mellitus
      • Jade what did you do for your lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general?
    • Case Based Lectures
      • Obesity
      • Jade what did you do for your lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general?
    • Case Based Lectures
      • Hypertension
        • Case example
        • Dietary history with usual intake
        • Analysis
        • Practical dietary revision ideas
    • Fit-day.com
      • Residents asked to keep their own record for one week.
      • Goals:
      • Benefits seen:
    • Standardized Patients
      • Faculty
      • Students
    • Physcial Exam Form changes
      • SOCIAL -
      • Occupation/Lives with –
      • Tobacco  Y  N ? Quit
      • ETOH –  Y  N CAGE Pos  Neg 
      • Drugs /Firearms
      • DV screen (safe?)
      • Nutrition: ? Weight concerns
      • Servings Fruits/veg ___ Soda____ Fiber_____
      • Exercise / x week
      • UV protection/ seatbelts
    • Nursing Inservices
      • BMI
    • Preceptors Chart Review
      • Changed routine chart review
    • How did we evaluate residents
      • Knowledge Questionnaire
      • Attitude Questionnaire
      • Behavior Questionnaire
    • Attitude Survey
      • McGaghie, W. et al
      • 45 items survey with 5 subscales
    • Behavior Survey
      • We developed our own
      • Jade Cut and paste a few example of some sentences
    • Knowledge Survey
      • Jade cut and past
      • Jade Cut and paste a few example of some sentences
    • How did we evaluate faculty
      • Knowledge Questionnaire
      • Attitude Questionnaire
      • Different questionnaires
        • Behavior Questionnaire
    • Obstacles
    • Solutions
    • Results residents
      • Knowledge Questionnaire
      • Attitude Questionnaire
      • Behavior Questionnaire
    • Results faculty
      • Jade
      • How many predicated
      • Any trends in their personal questionnaires
      • ETC
      • Jade can you put down unique faculty facts like how many precept,
      • how many had knowledge of nutrition
      • How did they get that knowledge
      • etv
    • Our future directions
        • Integrating Nutrition as a Basic Skill
        • Chart review
        • Faculty development
    • Transition to small groups
    • Create Your Own Curriculum
    • Challenges in your setting?
    • Think Outside the Box
      • What are your needs?
      • Who has skills your residents need or need to know about?
      • Who would be a good “dance partner”?
    • IDEAS
    • Resources
      • There are lots of them out there
    • STFM Group on nutrition
      • Guidelines and curriculum
      • Web base training
      • Model Curriculum
      • Supporting literature
    • STFM Nutrition Education
      • Integrating nutrition education within other STFM groups and maintaining resources for family medicine educators to use in enhancing nutrition education.
      • STFM Physician's Curriculum on Clinical Nutrition
      • The group maintains a password protected web site with new strategies for teaching nutrition in clerkships and residencies. Contact [email_address] for a free ID and password.
      • Listserve: contact [email_address] or [email_address] .
      • http://www.nhlbi.nih.gov/funding/training/naa/
      http://www.nhlbi.nih.gov/funding/training/naa/ Nutrition Curriculum Guide For Training Physicians
    •  
    • Nutrition Resources
      • Physician's curriculum in clinical nutrition- A competency based approach for primary care, Kansas City, MO: Group on Nutrition Education, Society of Teachers of Family Medicine, 1995.
      • Manual of Clinical Dietetics, 5th edition. Chicago, IL: The American Dietetic Association, 1996.
      • Mahan LK and Escott-Stump S. Krause's Food, nutrition and diet therapy, 10th ed. Harcourt, Brace and Co. 1999.
      • Modern Nutrition in Health and Disease, 9th Edition, Williams and Wickins, 1999.
      • Medical Nutrition and Disease, Blackwell Science Inc., 1996