内科学概述王吉耀.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,内科学概述王吉耀,Internal Medicine,Surgery,Pediatrics,gynecology,Pathology,Microbiology,Genetics,Biochemistry,Pharmacology,Pathologic-physiology,Diagnostics,Immunology,How to learn,1.To combine internal medicine with basic scientific knowledge,2.To combine theory with practice,Lectures,Introduction,Pathogenesis,Pathology,Pathophysiology,Clinical features,Diagnosis,Treatment,Prevention,Basic theory,Basic knowledge,Essential skill,Bedside Teaching,What is expected of the physician,No greater opportunity,responsibility,or obligation can fall to the lot of a human being than to become a physician.,Tact,sympathy and understanding are expected of physician.,Te be a good Doctor,In the care of the suffering,physician needs technical skill,scientific knowledge,and human understanding.,The combination of medical knowledge,intuition,experience,and judgment defines the art of medicine,which is,essential,to the practice of medicine,.,The patient-physician relationship,Physicians need to approach patients not as“cases”or“diseases”,but as individuals who is human,fearful,and hopeful,seeking relief,help and reassurance.,Ideal patient-physician relationship,Based on:,Thorough knowledge of the patient,Mutual trust,Ability to communicate,Clinical Skills,Taking informative history;,Performing thorough physical examination;,Using diagnostic tools judiciously,always asking whether the results will alter the management and benefit the patient.,History taken,In listening to the history,the physician discovers not only something about the,disease,but also something about the,patient.,The process of history-taking provides an opportunity to,observe the patients behavior,and to,watch for features,to be pursued more,.,thoroughly,during the,physical examination.,To develop effective reasoning skills,Information gathering(,informative,history,thorough physical examination),Problem synthesis,Hypothesis generation,Decision making,Essential skill,Learning of Essential Skills,Inquiry skills,Thinking skills,Problem solving skills,Essential skill,Dealing with clinical problems,Making diagnosis,Identify the severity of the disease,According to the severity of disease,to make therapeutic protocol,Follow up the results of the treatment,Evidence-based medicine,EBM,Defined as:,The conscientious,explicit and judicious use of current best,evidence,in making decisions about the care of,individual patients,Principles of Patient Care,Evidence-based medicine,EBM,Best research evidence,basic sciences of medicine,patient-centered clinical research,Clinical expertise,ability 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 interventions,Patient values,the unique preferences,concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient,When these three elements are integrated,clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.,Principles of Patient Care,*Means any other letters,AND means both terms required,Check the question type,Check the emphasis,Practice Guidelines,Evidence base clinical guidelines can provide a useful framework for managing patients with particular diagnoses or symptoms.,Principles of Patient Care,The Grade&Level of Evidence,Grades of level of,Recommendation evidenceEtiology/Therapy/Prevention,A 1aSR of RCTs,1bIndividual RCT with narrow CI 1cAll or none,B 2aSR of Cohort studies,2b Individual Cohort study/low quality RCT,2cOutcome Research,3aSR of Case-control Study,3b Individual Case-control Study,C 4 Case series/poor quality cohort study/,case-control study,D 5 Expert opinion without critical appraisal,.,when a relevant evidence base is unavailable,c,linical knowledge,and experience together with,an understanding of the patients needs,supplemented by,diagnostic,tools,still represent the best approach to practicing medicine.,Medical Decision-Making,ordering of additional tests,requests for consults,decisions regarding prognosis and treatment,Medical decision-making should be evidence-based,Principles of Patient Care,History,Physical,Examination,Laboratory,Tests,imaging,Special,diagnostic,studies,Diagnosis,Estimation,Right decision making,necessary,selected,Diagnostic tests serve to reduce uncertainty about a diagnosis,in a particular individual and to help the physician decide how best,to manage that individuals condition.,The Principles of,Diagnostic,Thinking,One etiology,Common disease first,Organic diseases first,then functional disorders,Excluding methods to do differential diagnosis,The Principles for selecting Diagnostic tests&Imaging study,Effectiveness,safety and price,Select test with high sensitivity to exclude diagnosis,Select test with high specificity to confirm diagnosis,Non-invasive procedures first,If the results from test is not fit the clinical considerations,detailed analysis is needed.,The Principles of,Therapeutic,Thinking,Treat the most severe case first,In general,therapeutic protocol following confirmed diagnosis of disease,For life-threatened disease,save life first,then to confirm the diagnosis,For treatment,the simple,the best.,Pay attention to drug side-effects and cross-over effects,The Principles of,Therapeutic,Thinking,Treat curable disease as soon as possible,Diagnostic therapy could used to confirm the clinical diagnosis,According to principles of evidence-based medicine to make decision for treatment,Assessing the Outcome of Treatment,Use objective and readily measurable parameters to judge the outcome of a therapeutic intervention.,The practice of medicine requires consideration and integration of both objective and subjective outcomes.,Principles of Patient Care,Informed Consent and Respect for the Patients Autonomy,The fundamental principles of medical ethics are to act in the patients best interest and to respect the patients autonomy,When patients require diagnostic and therapeutic procedures that are painful and that pose some risk,they are generally required to sign a consent form.,Continued Learning,It is the responsibility of a physician to pursue new knowledge continually by,reading,attending conferences and courses,and consulting colleagues and the Internet.,Continued learning is an integral part of,being a physician,and must be given the highest priority.,Thank you,