临床药师的病例分析选题与写作.

2015年10月29日武汉,临床药师的病例分析选题与写作,王 卓卫生部临床药师（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第二军医大学附属长海医院药学部,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,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 the case, often accompanied by a review of other cases previously reported in the biomedical literature to put the reported case in context./case+report,Case reportIn medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence.Types of case reportsMost case reports are on one of six topics1:An unexpected association between diseases or symptoms. An unexpected event in the course of observing or treating 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/Case%20report?cx=partner-pub-0939450753529744%3Av0qd01-tdlq&cof=FORID%3A9&ie=UTF-8&q=Case%20report&sa=Search#922,Usefulness and validityA case report is a type of anecdotal evidence. As such, it is less scientifically rigorous than controlled clinical data involving a larger sample size. Proponents argue that case reports have value within scientific method:They permit discovery of new diseases and unexpected effects (adverse or beneficial) as well as the study of mechanisms, and they play an important role in medical education. Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress; they provide many new ideas in medicine. (Vandenbroucke, 2001),Famous scientific case reportsSigmund Freud reported on numerous cases, including Anna O., Dora, Little Hans, Rat Man, and Wolf Man Frederick Treves reported on The Elephant 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).,Publishing case reportsMany international 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 Reports, an open-access peer-reviewed journal focusing on medical imaging.Use of term outside scienceThe term is also used to describe non-scientific reports usually prepared for their educational value.,EditorialA case report provides important and detailed information about an individual, which 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 literature, 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 knowledge.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 casualty 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 a dedicated home for these articles, which have the potential to contribute to and change clinical practice.,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,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,药学诊断 (Pharmaceutical diagnosis)定义（Culbertson 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,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,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,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,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,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,病例分析的写作,文体篇幅基本结构,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,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可靠性尽可能反映临床药师的作用,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,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,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,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,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,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,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