《内科学绪论课件.ppt》由会员分享，可在线阅读，更多相关《内科学绪论课件.ppt（35页珍藏版）》请在三一办公上搜索。
1、INTRODUCTION TO INTERNAL MEDICINE,INTRODUCTION TO INTERNAL MEDIC,Internal Medicine,Surgery,Pediatrics,gynecology,Pathology,Microbiology,Genetics,Biochemistry,Pharmacology,Pathologic-physiology,Diagnostics,Immunology,Internal MedicineSurgeryPediat,How to Teach Internal Medicine,Lecture (Bilingual tea
2、ching) Bedside teaching: including Respiratory system, Cardiovascular system, Gastrointestinal system, Kidney and urinary system, Endocrinology, Hematology, etc.,How to Teach Internal Medicine,Bedside Teaching,Cardiovascular system： Heart failure(心衰)； CHD(冠心病)/ Hypertension(高血压)； Cardiomyopathy(心肌病)
3、/ pericarditis(心包炎)； 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 Teachi
4、ngCardiovascular,Bedside Teaching,Kidney 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
5、)；Hyperthyroidism(甲亢)；hypothyroidism(甲减) 。,Bedside TeachingKidney and uri,TimeMon.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 o
6、f 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 2005,Reference Books希氏内科学精要 Cecil E,How to learn,1. To combine internal medicine with basic scientific knowledge2. To combine theory with practice,How to learn1. To combine i
7、nte,Start,Told what we Need to know,Learn it,Given problem to illustrate how to use it,Subject based learning,StartTold what we Learn itGive,Lectures,Approach to patientsPathogenesisPathologic-physiology & Clinical featuresDiagnosis Treatment,Basic theory,Basic knowledge,Essential skill,LecturesAppr
8、oach to patientsBa,Start,Problem posed,Identify what We need to know,Learn it,Apply it,Problem-based learning,StartProblem posedIdentify wha,To Learn How To Learn,An educational method that allow you to learn about medicine as you attempt to deal with real-life medicine situations.,To Learn How To L
9、earn An educ,To develop effective reasoning skills through,Information gatheringProblem synthesisHypothesis generationData analysisDecision making,To develop effective reasoning,Learning of skills,Inquiry skillsThinking skillsProblem solving skills,Learning of skillsInquiry skil,Clinical decision ma
10、king,4 steps for dealing with clinical problems:Making diagnosisIdentify the severity of the diseaseAccording to the severity of disease, to make therapeutic protocolFollow up the results of the treatment,Clinical decision making4 step,Clinical thinking (临床思维 ),Diagnostic (诊断思维)Therapeutic (治疗思维),Cl
11、inical thinking (临床思维 )Diagn,Diagnostic thinking skills,History TakingPhysical examinationHypothesis of diagnosis developing a differential diagnosisSearching the evidenceSelect the related lab. tests and other techniques,Diagnostic thinking skillsHist,A 45 year-old man presented on Jan. 28, 2004 to
12、 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-induced,A 45 year-old man presented on,The 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 Diag
13、nostic T,The 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 D,The Principles of Therapeutic 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 Therape
14、utic,The 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 Therapeutic,Evidence-based medicine, EBM,Best research evidencebasic sciences of medicinepatient-centered clinical researchClinical expertiseability to use our clinical skills and past experi
15、ence to rapidly identify each patients unique health state and diagnosis, their individual risks and benefits of potential interventionsPatient valuesthe unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if
16、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.,Evidence-based medicine, EBMBe,How to practice evidence-based medicine,Convert information need into an an
17、swerable question,How 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
18、综合分析及其评价,Professor 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 ,EBM,Level of evidence,Class 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
19、大样本、金标准 定义的病例、回顾性对照研究Class 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 of,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. In the care of the suffering, he needs
20、technical skill, scientific 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 physic,The patient-physician relati
21、onship,Physicians need to approach 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 d
22、o，you should like the things you have to do”。,“If you can not do the things,Stem cellRegeneration medicineBiopsychosocial medical model BPS,Stem cell,1进入病房学习前，对照大纲和示教的重点病例复习内科学的相关章节，准备在病例讨论中提出和回答问题；2进入病房后尽快熟悉重点讨论的病例，争取第一时间采集病史，进行体格检查，考虑相应的诊疗处理措施，以备讨论；3注重理论联系实际，重点是培养临床思维能力。,床旁教学学习过程中几个需要注意的事项,1进入病房学习
23、前，对照大纲和示教的重点病例复习内科学的相关,4尊重患者，对待患者要热情，富有同情心；5注重与患者及其家属的沟通，注意谈话方式，不刺激患者，对于不能回答的问题应找相应的病房医护人员来解决，不能敷衍了事或简单的回答“不知道”；6. 体检时动作应轻柔，对危重患者，应事先征得床位医生及患者同意方能进行，必要时由床位医生陪同进行；,4尊重患者，对待患者要热情，富有同情心；,一个优秀的医生,扎实的医学知识、先进的医学科技根据“循证医学”的原则办事面对具体患者个体进行深入交流与互动综合运用医学科学知识、社会知识、丰富的临床经验进行综合判断与决策科学与人文精神医学的科学与艺术（the science and art of medicine）,一个优秀的医生扎实的医学知识、先进的医学科技,考核方式：,床旁示教占30%，书面考试占70%。床旁示教考核由带教老师根据学生表现，从5个方面进行打分：纪律及对患者态度、病例讨论时回答问题情况、问病史、体格检查、病史书写等，每个病区评分总分为5分，共计30分。结束时进行书面考试，总分70分，其中20分左右为与病例讨论及示教相关的病例分析题，50分为本学期上的大课内容。,考核方式：床旁示教占30%，书面考试占70%。,
