内科学概述王吉耀

内科学概述王吉耀内科学概述王吉耀第1页InternalMedicineSurgeryPediatricsgynecologyPathologyMicrobiologyGeneticsBiochemistryPharmacologyPathologic-physiologyDiagnosticsImmunology内科学概述王吉耀第2页Howtolearn1.Tocombineinternalmedicinewithbasicscientificknowledge2.Tocombinetheorywithpractice内科学概述王吉耀第3页LecturesIntroductionPathogenesisPathologyPathophysiologyClinicalfeaturesDiagnosisTreatment,PreventionBasictheoryBasicknowledgeEssentialskill内科学概述王吉耀第4页BedsideTeaching内科学概述王吉耀第5页WhatisexpectedofthephysicianNogreateropportunity,responsibility,orobligationcanfalltothelotofahumanbeingthantobecomeaphysician.

Tact,sympathyandunderstandingareexpectedofphysician.内科学概述王吉耀第6页TebeagoodDoctor

Inthecareofthesuffering,physicianneedstechnicalskill,scientificknowledge,andhumanunderstanding.

Thecombinationofmedicalknowledge,intuition,experience,andjudgmentdefinestheartofmedicine,whichisessentialtothepracticeofmedicine.

内科学概述王吉耀第7页Thepatient-physicianrelationshipPhysiciansneedtoapproachpatientsnotas“cases”or“diseases”,butasindividualswhoishuman,fearful,andhopeful,seekingrelief,helpandreassurance.内科学概述王吉耀第8页Idealpatient-physicianrelationshipBasedon:ThoroughknowledgeofthepatientMutualtrustAbilitytocommunicate内科学概述王吉耀第9页ClinicalSkillsTakinginformativehistory;Performingthoroughphysicalexamination;Usingdiagnostictoolsjudiciously,alwaysaskingwhethertheresultswillalterthemanagementandbenefitthepatient.内科学概述王吉耀第10页HistorytakenInlisteningtothehistory,thephysiciandiscoversnotonlysomethingaboutthediseasebutalsosomethingaboutthepatient.

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

内科学概述王吉耀第16页*MeansanyotherlettersANDmeansbothtermsrequiredCheckthequestiontypeChecktheemphasis内科学概述王吉耀第17页PracticeGuidelines

Evidencebaseclinicalguidelinescanprovideausefulframeworkformanagingpatientswithparticulardiagnosesorsymptoms.PrinciplesofPatientCare内科学概述王吉耀第18页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内科学概述王吉耀第19页.whenarelevantevidencebaseisunavailable,clinicalknowledgeandexperiencetogetherwithanunderstandingofthepatient'sneeds,supplementedbydiagnostictools,stillrepresentthebestapproachtopracticingmedicine.内科学概述王吉耀第20页MedicalDecision-Making

orderingofadditionaltests,requestsforconsults,decisionsregardingprognosisandtreatmentMedicaldecision-makingshouldbeevidence-basedPrinciplesofPatientCare内科学概述王吉耀第21页HistoryPhysicalExaminationLaboratoryTests,imagingSpecialdiagnosticstudiesDiagnosisEstimationRightdecisionmakingnecessaryselectedDiagnostictestsservetoreduceuncertaintyaboutadiagnosisinaparticularindividualandtohelpthephysiciandecidehowbesttomanagethatindividual'scondition.内科学概述王吉耀第22页ThePrinciplesofDiagnosticThinking

OneetiologyCommondiseasefirstOrganicdiseasesfirst,thenfunctionaldisordersExcludingmethodstododifferentialdiagnosis内科学概述王吉耀第23页ThePrinciplesforselectingDiagnostictests&ImagingstudyEffectiveness,safetyandpriceSelecttestwithhighsensitivitytoexcludediagnosisSelecttestwithhighspecificitytoconfirmdiagnosisNon-invasiveproceduresfirstIftheresultsfromtestisnotfittheclinicalconsiderations,detailedanalysisisneeded.内科学概述王吉耀第24页ThePrinciplesofTherapeuticThinkingTreatthemostseverecasefirstIngeneral,therapeuticprotocolfollowingconfirmeddiagnosisofdiseaseForlife-threateneddisease,savelifefirst,thentoconfirmthediagnosisFortreatment,thesimple,thebest.Payattentiontodrugside-effectsandcross-overeffects内科学概述王吉耀第25页ThePrinciplesof

TherapeuticThinkingTreatcurablediseaseassoonaspossibleDiagnostictherapycouldusedtoconfirmtheclinicaldiagnosisAccordingtoprinciplesofevidence-basedmedicinetomakedecisionfortreatment内科学概述王吉耀第26页AssessingtheOutcomeofTreatment

Useobjectiveandreadilymeasurableparameterstojudgetheoutcomeofatherapeuticintervention.Thepracticeofmedicinerequiresconsiderationandintegrationofbothobjectiveandsub