內(nèi)科學(xué)概述王吉耀

內(nèi)科學(xué)概述王吉耀內(nèi)科學(xué)概述王吉耀第1頁InternalMedicineSurgeryPediatricsgynecologyPathologyMicrobiologyGeneticsBiochemistryPharmacologyPathologic-physiologyDiagnosticsImmunology內(nèi)科學(xué)概述王吉耀第2頁Howtolearn1.Tocombineinternalmedicinewithbasicscientificknowledge2.Tocombinetheorywithpractice內(nèi)科學(xué)概述王吉耀第3頁LecturesIntroductionPathogenesisPathologyPathophysiologyClinicalfeaturesDiagnosisTreatment,PreventionBasictheoryBasicknowledgeEssentialskill內(nèi)科學(xué)概述王吉耀第4頁BedsideTeaching內(nèi)科學(xué)概述王吉耀第5頁WhatisexpectedofthephysicianNogreateropportunity,responsibility,orobligationcanfalltothelotofahumanbeingthantobecomeaphysician.

Tact,sympathyandunderstandingareexpectedofphysician.內(nèi)科學(xué)概述王吉耀第6頁TebeagoodDoctor

Inthecareofthesuffering,physicianneedstechnicalskill,scientificknowledge,andhumanunderstanding.

Thecombinationofmedicalknowledge,intuition,experience,andjudgmentdefinestheartofmedicine,whichisessentialtothepracticeofmedicine.

內(nèi)科學(xué)概述王吉耀第7頁Thepatient-physicianrelationshipPhysiciansneedtoapproachpatientsnotas“cases”or“diseases”,butasindividualswhoishuman,fearful,andhopeful,seekingrelief,helpandreassurance.內(nèi)科學(xué)概述王吉耀第8頁Idealpatient-physicianrelationshipBasedon:ThoroughknowledgeofthepatientMutualtrustAbilitytocommunicate內(nèi)科學(xué)概述王吉耀第9頁ClinicalSkillsTakinginformativehistory;Performingthoroughphysicalexamination;Usingdiagnostictoolsjudiciously,alwaysaskingwhethertheresultswillalterthemanagementandbenefitthepatient.內(nèi)科學(xué)概述王吉耀第10頁HistorytakenInlisteningtothehistory,thephysiciandiscoversnotonlysomethingaboutthediseasebutalsosomethingaboutthepatient.

Theprocessofhistory-takingprovidesanopportunitytoobservethepatient'sbehaviorandtowatchforfeaturestobepursuedmore.thoroughlyduringthephysicalexamination.內(nèi)科學(xué)概述王吉耀第11頁TodevelopeffectivereasoningskillsInformationgathering(informativehistory,thoroughphysicalexamination)ProblemsynthesisHypothesisgenerationDecisionmakingEssentialskill內(nèi)科學(xué)概述王吉耀第12頁LearningofEssentialSkillsInquiryskillsThinkingskillsProblemsolvingskillsEssentialskill內(nèi)科學(xué)概述王吉耀第13頁DealingwithclinicalproblemsMakingdiagnosisIdentifytheseverityofthediseaseAccordingtotheseverityofdisease,tomaketherapeuticprotocolFollowuptheresultsofthetreatment內(nèi)科學(xué)概述王吉耀第14頁Evidence-basedmedicine,EBMDefinedas:Theconscientious,explicitandjudicioususeofcurrentbestevidenceinmakingdecisionsaboutthecareofindividualpatientsPrinciplesofPatientCare內(nèi)科學(xué)概述王吉耀第15頁Evidence-basedmedicine,EBMBestresearchevidencebasicsciencesofmedicinepatient-centeredclinicalresearchClinicalexpertiseabilitytouseourclinicalskillsandpastexperiencetorapidlyidentifyeachpatient’suniquehealthstateanddiagnosis,theirindividualrisksandbenefitsofpotentialinterventionsPatientvaluestheuniquepreferences,concernsandexpectationseachpatientbringstoaclinicalencounterandwhichmustbeintegratedintoclinicaldecisionsiftheyaretoservethepatientWhenthesethreeelementsareintegrated,cliniciansandpatientsformadiagnosticandtherapeuticalliancewhichoptimizesclinicaloutcomesandqualityoflife.PrinciplesofPatientCare

內(nèi)科學(xué)概述王吉耀第16頁*MeansanyotherlettersANDmeansbothtermsrequiredCheckthequestiontypeChecktheemphasis內(nèi)科學(xué)概述王吉耀第17頁P(yáng)racticeGuidelines

Evidencebaseclinicalguidelinescanprovideausefulframeworkformanagingpatientswithparticulardiagnosesorsymptoms.PrinciplesofPatientCare內(nèi)科學(xué)概述王吉耀第18頁TheGrade&LevelofEvidence

GradesoflevelofRecommendationevidence Etiology/Therapy/PreventionA 1a SRofRCTs 1b IndividualRCTwithnarrowCI 1c AllornoneB 2a SRofCohortstudies 2bIndividualCohortstudy/lowqualityRCT 2c OutcomeResearch 3a SRofCase-controlStudy 3b IndividualCase-controlStudyC 4 Caseseries/poorqualitycohortstudy/case-controlstudyD 5 Expertopinionwithoutcriticalappraisal內(nèi)科學(xué)概述王吉耀第19頁.whenarelevantevidencebaseisunavailable,clinicalknowledgeandexperiencetogetherwithanunderstandingofthepatient'sneeds,supplementedbydiagnostictools,stillrepresentthebestapproachtopracticingmedicine.內(nèi)科學(xué)概述王吉耀第20頁MedicalDecision-Making

orderingofadditionaltests,requestsforconsults,decisionsregardingprognosisandtreatmentMedicaldecision-makingshouldbeevidence-basedPrinciplesofPatientCare內(nèi)科學(xué)概述王吉耀第21頁HistoryPhysicalExaminationLaboratoryTests,imagingSpecialdiagnosticstudiesDiagnosisEstimationRightdecisionmakingnecessaryselectedDiagnostictestsservetoreduceuncertaintyaboutadiagnosisinaparticularindividualandtohelpthephysiciandecidehowbesttomanagethatindividual'scondition.內(nèi)科學(xué)概述王吉耀第22頁ThePrinciplesofDiagnosticThinking

OneetiologyCommondiseasefirstOrganicdiseasesfirst,thenfunctionaldisordersExcludingmethodstododifferentialdiagnosis內(nèi)科學(xué)概述王吉耀第23頁ThePrinciplesforselectingDiagnostictests&ImagingstudyEffectiveness,safetyandpriceSelecttestwithhighsensitivitytoexcludediagnosisSelecttestwithhighspecificitytoconfirmdiagnosisNon-invasiveproceduresfirstIftheresultsfromtestisnotfittheclinicalconsiderations,detailedanalysisisneeded.內(nèi)科學(xué)概述王吉耀第24頁ThePrinciplesofTherapeuticThinkingTreatthemostseverecasefirstIngeneral,therapeuticprotocolfollowingconfirmeddiagnosisofdiseaseForlife-threateneddisease,savelifefirst,thentoconfirmthediagnosisFortreatment,thesimple,thebest.Payattentiontodrugside-effectsandcross-overeffects內(nèi)科學(xué)概述王吉耀第25頁ThePrinciplesof

TherapeuticThinkingTreatcurablediseaseassoonaspossibleDiagnostictherapycouldusedtoconfirmtheclinicaldiagnosisAccordingtoprinciplesofevidence-basedmedicinetomakedecisionfortreatment內(nèi)科學(xué)概述王吉耀第26頁AssessingtheOutcomeofTreatment

Useobjectiveandreadilymeasurableparameterstojudgetheoutcomeofatherapeuticintervention.Thepracticeofmedicinerequiresconsiderationandintegrationofbothobjectiveandsub