内科学绪论课件

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(高血压)； Cardiomyopathy(心肌病)/ pericarditis(心包

3、炎)； Arrhythmia(心律失常)； Respiratory system ： ARDS(呼衰)/COPD； Pneumonia(肺炎)； TB(肺结核)/ Hydrothorax(胸腔积液)； Lung Cancer(肺癌)； Gastrointestinal system ： Cirrhosis(肝硬化)； Peptic ulcer(消化性溃疡)/ upper GI bleeding(上消化道出血)； IBD(炎症性肠病)； 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)(原发性肾小球疾病；继发性肾小球疾病)； Chronic Renal Failure(尿毒症)； urinary tract infection(尿路感染)Hematology ：Leukemia(白血病)；Anemia(贫血)；Lymphoma(淋巴瘤)；Disorders of hemostasis (出血性疾病)Endocrinology ：Diabetes Mellitus(糖尿病)；Hyperthyroidism(甲亢

5、)；hypothyroidism(甲减) 。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确保床旁教学质量组织上落实是开展床旁教学的必要条件 经过反复讨论和修正，制

6、订计划，保证了组织上落实。6个科各派出一位专职老师参加床旁带教工作。内分泌科和心内科师生在进行病例讨论确保床旁教学质量组织上落实是开展床旁教学的必要条件内分泌科和Reference Books希氏内科学精要 Cecil Essentials of MedicineHarrisons Principles of Internal Medicine现代内科学英语精要 人民卫生出版社 2002陈灏珠主编. 实用内科学. 人民卫生出版社 2005王吉耀主编 内科学试题与题解 上海科学技术文献出版社，2002王吉耀主编 内科临床病例分析双语学习, 人民卫生出版社 2005Reference Books希

7、氏内科学精要 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 (临床思维 )Diagnostic (诊断思维)Therapeutic (治疗思维)Clinical thinking (临床思维 )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 一元论多考虑常见病先考虑器质性疾病，后考虑功能性诊断用排除法作鉴别诊断The Principles of Diagnostic TThe principles for selecting Diagnostic tests先了解所选试验的有效性、安全性和价格排除诊断时，选敏感度高的试验肯定诊断时，选特异度高的试验首选无创伤性的检查当检查结果与临床不符时，应作详细分析而不能片面依赖实验检查结果The principles for selecting DThe Principles of Th

14、erapeutic Thinking分清轻重缓急一般而言，先明确诊断，再作出治疗计划危重疾病应抢救在先，明确病因再后处理用药力求简单重视药物的毒副作用和交互作用The Principles of TherapeuticThe Principles of Therapeutic Thinking可治性疾病应尽早治疗有时可用试验性治疗来进一步验证临床诊断制订治疗计划时应遵照循证医学的原则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医学观念的进展 循证医学Evidence-based medicine ,EBM 以国际上最新临床科研成果, 和目前的最佳证据 (Evidence)为每个患者制定诊疗方案 英国流行病学家 Archie Cochrane ，20世纪70年代提出，现有的临床诊治措施中仅20被证明有效，急呼临床实践需要证据，20世纪90年代循证医学被公认是医学的重要领域 。 随机、双盲对照、多中心试验是EBM的基石（Randomised Controlled Trials RCTs） 荟萃分析是对多个设计良好的RCT的综合分析及其评价Professor

19、Archibald Leman Cochrane, (1909 - 1988) He stressed the importance of using evidence from Randomised Controlled Trials (RCTs)医学观念的进展 循证医学 医学观念的进展 循证医学Evidence-based medicine ,EBMLevel of evidenceClass A 由随机、双盲对照、广泛人群大样本、 金标准定义的病例、前瞻性研究提供的证据 Class B 证据来自小范围人群的前瞻性研究； 或证据来自一个设计良好的大样本、金标准 定义的病例、回顾性对照研究C

20、lass C 证据来自小范围人群的、双盲对照、回 顾性研究Class D 证据来自非双盲对照试验；或单纯为专 家意见；或个案报导医学观念的进展 循证医学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”。“If you can not do the things S