內(nèi)科學(xué)緒論課件

1、INTRODUCTION TO INTERNAL MEDICINE INTRODUCTION TO INTERNAL MEDICInternal MedicineSurgeryPediatricsgynecologyPathologyMicrobiologyGeneticsBiochemistryPharmacologyPathologic-physiologyDiagnosticsImmunologyInternal MedicineSurgeryPediatHow to Teach Internal Medicine Lecture (Bilingual teaching) Bedside

2、 teaching: including Respiratory system, Cardiovascular system, Gastrointestinal system, Kidney and urinary system, Endocrinology, Hematology, etc.How to Teach Internal MedicineBedside TeachingCardiovascular system： Heart failure(心衰)； CHD(冠心病)/ Hypertension(高血壓)； Cardiomyopathy(心肌病)/ pericarditis(心包

3、炎)； Arrhythmia(心律失常)； Respiratory system ： ARDS(呼衰)/COPD； Pneumonia(肺炎)； TB(肺結(jié)核)/ Hydrothorax(胸腔積液)； Lung Cancer(肺癌)； Gastrointestinal system ： Cirrhosis(肝硬化)； Peptic ulcer(消化性潰瘍)/ upper GI bleeding(上消化道出血)； IBD(炎癥性腸病)； Acute pancreatitis(急性胰腺炎)/ abdominal pain(腹痛待查)；Bedside TeachingCardiovascularBe

4、dside TeachingKidney and urinary system ： Glomerulonephritis (primary and secondary)(原發(fā)性腎小球疾病；繼發(fā)性腎小球疾病)； Chronic Renal Failure(尿毒癥)； urinary tract infection(尿路感染)Hematology ：Leukemia(白血病)；Anemia(貧血)；Lymphoma(淋巴瘤)；Disorders of hemostasis (出血性疾病)Endocrinology ：Diabetes Mellitus(糖尿病)；Hyperthyroidism(甲亢

5、)；hypothyroidism(甲減) 。Bedside TeachingKidney and uriTimeMon.Tues.Wes.Thurs.Fri.Mor-ning7:30-9:45Take history and physical examination, and follow morning round10:0011:30Bedside teachingAfternoon1:30-4:30LectureCase StudyLectureLectureTimeMon.Tues.Wes.Thurs.Fri.Mo確保床旁教學(xué)質(zhì)量組織上落實(shí)是開展床旁教學(xué)的必要條件 經(jīng)過反復(fù)討論和修正，制

6、訂計(jì)劃，保證了組織上落實(shí)。6個(gè)科各派出一位專職老師參加床旁帶教工作。內(nèi)分泌科和心內(nèi)科師生在進(jìn)行病例討論確保床旁教學(xué)質(zhì)量組織上落實(shí)是開展床旁教學(xué)的必要條件內(nèi)分泌科和Reference Books希氏內(nèi)科學(xué)精要 Cecil Essentials of MedicineHarrisons Principles of Internal Medicine現(xiàn)代內(nèi)科學(xué)英語精要 人民衛(wèi)生出版社 2002陳灝珠主編. 實(shí)用內(nèi)科學(xué). 人民衛(wèi)生出版社 2005王吉耀主編 內(nèi)科學(xué)試題與題解 上?？茖W(xué)技術(shù)文獻(xiàn)出版社，2002王吉耀主編 內(nèi)科臨床病例分析雙語學(xué)習(xí), 人民衛(wèi)生出版社 2005Reference Books希

7、氏內(nèi)科學(xué)精要 Cecil EHow to learn1. To combine internal medicine with basic scientific knowledge2. To combine theory with practiceHow to learn1. To combine inteStartTold what we Need to knowLearn itGiven problem to illustrate how to use itSubject based learningStartTold what we Learn itGiveLecturesApproach

8、 to patientsPathogenesisPathologic-physiology & Clinical featuresDiagnosis TreatmentBasic theoryBasic knowledgeEssential skillLecturesApproach to patientsBaStartProblem posedIdentify what We need to knowLearn itApply itProblem-based learningStartProblem posedIdentify whaTo Learn How To Learn An educ

9、ational method that allow you to learn about medicine as you attempt to deal with real-life medicine situations.To Learn How To Learn An educTo develop effective reasoning skills throughInformation gatheringProblem synthesisHypothesis generationData analysisDecision makingTo develop effective reason

10、ingLearning of skillsInquiry skillsThinking skillsProblem solving skillsLearning of skillsInquiry skilClinical decision making4 steps for dealing with clinical problems:Making diagnosisIdentify the severity of the diseaseAccording to the severity of disease, to make therapeutic protocolFollow up the

11、 results of the treatmentClinical decision making4 stepClinical thinking (臨床思維 )Diagnostic (診斷思維)Therapeutic (治療思維)Clinical thinking (臨床思維 )DiagnDiagnostic thinking skillsHistory TakingPhysical examinationHypothesis of diagnosis developing a differential diagnosisSearching the evidenceSelect the rel

12、ated lab. tests and other techniques Diagnostic thinking skillsHistA 45 year-old man presented on Jan. 28, 2004 to the emergency department with melena for three times and vomiting of blood. Key information Problem Hypothesis Rx 45 yr. M GI ulcer GI bleeding cancer varices drug-inducedA 45 year-old

13、man presented onThe Principles of Diagnostic Thinking 一元論多考慮常見病先考慮器質(zhì)性疾病，后考慮功能性診斷用排除法作鑒別診斷The Principles of Diagnostic TThe principles for selecting Diagnostic tests先了解所選試驗(yàn)的有效性、安全性和價(jià)格排除診斷時(shí)，選敏感度高的試驗(yàn)肯定診斷時(shí)，選特異度高的試驗(yàn)首選無創(chuàng)傷性的檢查當(dāng)檢查結(jié)果與臨床不符時(shí)，應(yīng)作詳細(xì)分析而不能片面依賴實(shí)驗(yàn)檢查結(jié)果The principles for selecting DThe Principles of Th

14、erapeutic Thinking分清輕重緩急一般而言，先明確診斷，再作出治療計(jì)劃危重疾病應(yīng)搶救在先，明確病因再后處理用藥力求簡單重視藥物的毒副作用和交互作用The Principles of TherapeuticThe Principles of Therapeutic Thinking可治性疾病應(yīng)盡早治療有時(shí)可用試驗(yàn)性治療來進(jìn)一步驗(yàn)證臨床診斷制訂治療計(jì)劃時(shí)應(yīng)遵照循證醫(yī)學(xué)的原則The Principles of TherapeuticEvidence-based medicine, EBMBest research evidencebasic sciences of medicinepa

15、tient-centered clinical researchClinical expertiseability to use our clinical skills and past experience to rapidly identify each patients unique health state and diagnosis, their individual risks and benefits of potential interventionsPatient valuesthe unique preferences, concerns and expectations

16、each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patientWhen these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.Evidence

17、-based medicine, EBMBeHow to practice evidence-based medicineConvert information need into an answerable questionTracking down the best evidenceIntegrate the evidence with clinical expertise, patient values and feasibilityCritically appraise the evidenceEvaluate and improve the process for future us

18、eHow to practice evidence-based醫(yī)學(xué)觀念的進(jìn)展 循證醫(yī)學(xué)Evidence-based medicine ,EBM 以國際上最新臨床科研成果, 和目前的最佳證據(jù) (Evidence)為每個(gè)患者制定診療方案 英國流行病學(xué)家 Archie Cochrane ，20世紀(jì)70年代提出，現(xiàn)有的臨床診治措施中僅20被證明有效，急呼臨床實(shí)踐需要證據(jù)，20世紀(jì)90年代循證醫(yī)學(xué)被公認(rèn)是醫(yī)學(xué)的重要領(lǐng)域 。 隨機(jī)、雙盲對(duì)照、多中心試驗(yàn)是EBM的基石（Randomised Controlled Trials RCTs） 薈萃分析是對(duì)多個(gè)設(shè)計(jì)良好的RCT的綜合分析及其評(píng)價(jià)Professor

19、Archibald Leman Cochrane, (1909 - 1988) He stressed the importance of using evidence from Randomised Controlled Trials (RCTs)醫(yī)學(xué)觀念的進(jìn)展 循證醫(yī)學(xué) 醫(yī)學(xué)觀念的進(jìn)展 循證醫(yī)學(xué)Evidence-based medicine ,EBMLevel of evidenceClass A 由隨機(jī)、雙盲對(duì)照、廣泛人群大樣本、 金標(biāo)準(zhǔn)定義的病例、前瞻性研究提供的證據(jù) Class B 證據(jù)來自小范圍人群的前瞻性研究； 或證據(jù)來自一個(gè)設(shè)計(jì)良好的大樣本、金標(biāo)準(zhǔn) 定義的病例、回顧性對(duì)照研究C

20、lass C 證據(jù)來自小范圍人群的、雙盲對(duì)照、回 顧性研究Class D 證據(jù)來自非雙盲對(duì)照試驗(yàn)；或單純?yōu)閷?家意見；或個(gè)案報(bào)導(dǎo)醫(yī)學(xué)觀念的進(jìn)展 循證醫(yī)學(xué)Level ofWhat is expected of the physicianNo greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needs technical skill, scientif

21、ic knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself.What is expected of the physicThe patient-physician relationshipPhysicians need to ap

22、proach patients not as “cases” or “diseases”, but as individuals who is human. Fearful, and hopeful, seeking relief, help and reassurance.Tact, sympathy and understanding are expected of physician.The patient-physician relation“If you can not do the things you like to do，you should like the things you have to do”?！癐f you can not do the things S