临床药师的病例分析选题与写作

1、.第二届“专科临床药师药学服务技能及病例分析论坛”,1,临床药师的病例分析选题与写作,卫生部临床药师（师资）培训基地 国家临床药学重点专科（军队建设） 中国人民解放军全军临床药学中心,.,2,临床药学病例分析 病例分析的选题 病例分析的写作 病例分析的评价,.,3,Case Report,A report of a single case of a disease, usually with an unexpected presentation, which typically describes the findings, clinical course, and prognosis of

2、the case, often accompanied by a review of other cases previously reported in the biomedical literature to put the reported case in context. http:/medical-,.,4,Case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual pat

3、ient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. Types of case reports Most case reports are on one of six topics1: An unexpected association between diseases or symptoms. An unexpected event in the course of observing or treat

4、ing a patient. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect. Unique or rare features of a disease. Unique therapeutic approaches. A positional or quantitative variation of the anatomical structures.,/definitions/C

5、ase%20report?cx=partner-pub-0939450753529744%3Av0qd01-tdlq they provide many new ideas in medicine. (Vandenbroucke, 2001),.,6,Famous scientific case reports Sigmund Freud reported on numerous cases, including Anna O., Dora, Little Hans, Rat Man, and Wolf Man Frederick Treves reported on The Elephant

6、 Man Proteus综合征 Paul Broca reported on language impairment following left hemisphere大脑左半球lesions in the 1860s. Joseph Jules Dejerine reported on a case of pure alexia失读症. William MacIntyre reported on a case of multiple myeloma多发性骨髓瘤(described in the 1840s).,.,7,Publishing case reports Many internat

7、ional journals will publish case reports, however there are very few that are devoted to publishing case reports alone. Journal of Medical Case Reports 1 and Cases Journal 2 are two such journals, publishing Open Access peer reviewed case reports in all areas of medicine. Another is Radiology Case R

8、eports, an open-access peer-reviewed journal focusing on medical imaging. Use of term outside science The term is also used to describe non-scientific reports usually prepared for their educational value.,.,8,Editorial A case report provides important and detailed information about an individual, wh

9、ich is often lost in larger studies. Moreover, case reports can serve as an early warning signal for the adverse effects of new medications, or the presentations of new and emerging diseases. Although a number of medical journals publish case reports, these articles are underrepresented in the liter

10、ature, and there has not been a journal specifically devoted to these valuable reports. Journal of Medical Case Reports fills this void. It is an online, open access journal dedicated to the publication of high quality case reports, and aims to contribute to the expansion of current medical knowledg

11、e. Since antiquity, clinicians have learnt from their more experienced peers as well as from their own work with their individual patients 1. Accurate recounting of clinical experience continues to be essential to the progress of medicine. In recent years, however, case reports have become a casualt

12、y of the pursuit of the impact factor. Case reports tend to have low citation value and therefore can negatively affect a journals impact factor, and prevalence of these articles in high impact journals has been reported as being in decline 2. With Journal of Medical Case Reports we intend to create

13、 a dedicated home for these articles, which have the potential to contribute to and change clinical practice.,.,9,药学病例分析,临床医学病例分析以疑难疾病、罕见疾病的临床诊治得失总结为主要内容 临床药学病例分析以具体病例药物治疗得失及其相关问题的分析总结为主要内容,.,10,病例分析的选题,来源于临床药学实践 反映临床药师工作得失 围绕药物治疗各类问题（药学诊断） 重点讨论一个问题,.,11,药学诊断 (Pharmaceutical diagnosis) 定义（Culbertson

14、 et al）：“用来鉴定病人特定的药物相关问题的、以问题为中心的认识过程。” 处方问题 药物治疗评价相关问题 药物治疗的不良反应问题 监测相关问题 病人相关因素 病人教育问题,.,12,处方问题 剂量不足 剂量过大 疗程过长 疗程不足 给药的具体时间表不当,给药剂型或给药途径不当 经济学不当 医疗保险问题 难辨认药物 医嘱缺项或不详 不易得药品,.,13,药物治疗评价相关问题 未处置问题 是否有必要使用预防性用药、继续用药或长期维持用药 治疗反应不佳 适应证不明确或有疑问 替代药物的选择 重复治疗 药动学评价,.,14,药物治疗的不良反应问题 药物不良反应或不良事件 潜在的禁忌证 潜在的不良

15、药物-饮食相互作用 潜在的不良药物-药物相互作用 潜在的不良药物-实验室检查相互作用,.,15,监测相关问题 临床情况不完善 临床检查数据不完善 临床检查数据过多 尚需进一步观察,.,16,病人相关因素 依从性差 用药过度 用药精神依赖 用药身体依赖（停药后可能出现撤药反应） 药品储存不当 病人教育问题 病人教育不足 特殊教育问题,.,17,病例分析的写作,文体 篇幅 基本结构,.,18,.,19,.,20,.,21,.,22,.,23,.,24,病例分析的基本结构 题目 前言 病史摘要 分析讨论 小结 参考文献,.,25,题 目,突出重点问题，言简意赅 注意题目的适用范围 注意结论的严谨性和

16、可靠性 尽可能反映临床药师的作用,.,26,前 言,交待主要背景 引出讨论话题 说明写作目的 做到前呼后应,.,27,病史摘要,介绍患者基本资料 简要介绍与所讨论问题相关的疾病情况 重点介绍与所讨论问题相关的药物治疗 介绍临床药师的参与及干预处置过程 重点注意客观、全面、准确 必要时可以利用一些图表辅助,.,28,分析讨论,围绕选定问题重点讨论 结合理论与患者实际情况分析对比 体现药师的推理逻辑与分析思路 注意文献的引用和分析 注意相关因素的全面甄别,.,29,小 结,总结问题结论 归纳规律性问题 评价药师工作得失 提出相关缺陷与不足,.,30,参考文献,引用全面准确 注意文献新颖与权威 尽量国内外文兼顾 著录格式规范,.,31,病例分析的评价,基本评价点 病例选择适宜 讨论的问题选择适宜 病史摘要简明扼要 分析讨论证据充分 心得体会深刻 文字用语规范,.,32,质量缺陷评价表 基本要求: 字迹潦草难以辨认、不能通读（重度缺陷） 有证据证明系拷贝行为导致的原则性错误（重度缺陷） 专业用语不规范（5） 药物名称未使用通用名（重度缺陷） 未针对明确的药物治疗事件展开讨论（重度缺陷） 主要参考文献未注明（2）,.,33,质量缺陷评价表,病史摘要: 病史介绍内容与讨论问题要点不能紧密结合（5） 疾病发展变化过程描述不清（5） 相关药物治疗情况描述不清（