王吉耀－内科学绪论.ppt

introductionintinternalmedicine，JiyaoWang，MD.MSC.professsorchardept.ofinternalmedicineshaimedicalcollege，Fudan univer Surgery Pediatrics，gynecology，Pathology，Microbiology，Genetics，Biochemistry，Pharmacology，Pathologic-physiology，诊断程序immunology howtoteachinternalmedicine，2005.2-7: lecture 2005.9-2006.1用于6 weeks的bedsideteachining :旋转， includingrespiratorysystem cardiovascularsystem、Gastrointestinalsystem、Kidneyandurinarysystem、Endocrinology、Hematology、etc CHD (冠心病)/Hypertension (高血压) Cardiomyopathy (心肌病)/pericarditis (心包炎) Arrhythmia (心律失常) Respiratorysystem:ARDS (呼吸衰竭)/COPD； Pneumonia (肺炎) TB (肺结核) /胸腔积液) LungCancer (肺癌) gastrointestinalsystem:cirrhosis (肝硬化) Pepticulcer (消化性溃疡)/upperGIbleeding IBD (炎症性肠病)/diarrhea (等待腹泻原因调查) Acutepancreatitis (急性胰腺炎)/abdominalpain (等待腹痛检查) BedsideTeaching，kidneyandurinarysystem:glomerulon 续发性肾小球疾病ChronicRenalFailure (尿毒症) urinarytractinfection (尿路感染) Hematology:Leukemia (白血病) Anemia (贫血) Lymphoma (淋巴瘤) disordersofhemost Endocrinology:DiabetesMellitus (糖尿病) Hyperthyroidism (甲状腺功能亢进) hypothyroidism (甲减)。 确保和有组织地实行床边教育，保证了探讨和修改开展床边教育的必要条件，制定计划，有组织地实行。 六课分别派遣专业老师到床边教书。内分泌科和心内科教师进行了病例讨论，ReferenceBooks希氏内科学精要cecilessentialsofmedicineharrisonsprinsingsofinternalmedicine现代内科学英语精要人民卫生出版社2002陈28768； 珠主编.实用内科学.人民卫生出版社2005王吉耀主编内科学问题和问题解决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，Howtolearn， 1.toconinginenteralmedicinewithbasiccentificknowledge2. toconingetherywithhpractice，开始toldwhatweneedtoknow，Learnit， givenproblemtoillustrateowtouset，Subjectbasedlearning， approactatiotentspathologic-physiologyclinicalfeaturesdiagnosistrtment，基本知识，基本技能，敏感技能，开始， problem posed identifywhatweneedtoknow，Learnit，Applyit，Problem-basedlearning，ToLearnHowToLearn， anductionalmetedhatllowyoutolearenaboutedmeicinsyoutthewlithllifedmeicinsthesougstothevereforectiv informongatheringroblems erationalingdataaanisionsionalingdataanisionsionsionsionsionalingdatanion clinicaldecisionmaking， 4 stepsfordeallingwithclinicalproblems : makingdiagnosisidifytheseverityofthediseaccordirtingthotheseseeveritydisease tomak llowuptheresultofthetreatment， 临床思考，诊断思考，治疗思考，治疗思考，以及diagnosticthinkskills historyitaingpromationphythosissofdisiseveplogatingdiffiredisatingchingheelecterelatedlab.testsandothe manpresentedonjan.28， 2004 totheemegeneydementantwithmelenaforthreetimesandsvomitingofoblood . keyinformationonproblemhypothesisrx 45 yr.mgiulcergibledingcancervaricesdrug-induced，theprinciplesofdiagnosticthinking， 一元论考虑常见病先考虑器质性病后考虑功能性诊断用排除法进行鉴别诊断，theprinciplesforselectingdiagnostictests在理解先选试验的有效性、安全性和价格排除诊断时选择特异性高的试验，优先进行无创伤性的检查，在检查结果与临床不符时，进行详细分析，不要依赖实验检查结果，theprinciplesoftherapeutithinking，为了明确优先顺序，首先明确诊断，制定治疗计划并加重明确病因后给药很容易重视药物的毒副作用和相互作用，theprinciplesoftherapeutithinking在治疗可行性疾病必须尽快治疗的情况下，临床诊断制定治疗计划时应遵循循证医学原则， 基于事件的医学， EBM bestresearchvidencebasicscienceesofmedicinepatient-centeredclinicalesearchinicallectrinicallexprisitytouserurcinicallinic ncerapidlyidentid tifyeachpatientsuniquehealthstateanddiagnosis， theiriidivirdirisksandbenetissofpotintervalitionspatientvaluestheuniquepreferences concentrandshipectionsearchitionsearc whethensetheresheementermentshementtrintegrated， cliniciansandpatientsformadiagnnosticsandtherapeuticalliancewhichoptimizerinicaloutcomesandqualityoflife . howtopracticeeevidenc convertinformationonneedinonanswerablequestion，sisexpectedofthephysician，Nogreateropportunity， respons ibility hechareofthesufferiring，heneedstechnicalskill scientific知识与知识. hewhouseshesewithhcourage，withhumility， andwithwisdomwillprovividualquestserviceforhisfellowman andwillbluildannenduringedificeofcharacterwithinhimself .the patient - physiciansneedtoapproachpatientsnotas“cases”or“diseases”butasindividualswhoishuman.fearful，andhopeful，seekingrelief，he sympathyanddderstanngareexpectedofphysician .“fyoucannotdothethingsyouliketodo，youshouldlikethingsyouhavetodo”。1、进入病房前，对照大纲和教导的重点病例复习内科相关章节，计划在病例讨论中提出问题回答2 .进入病房后，尽快熟悉重点讨论的病例，第一时间采集病史，进行体格检查，考虑相应的诊疗措施，准备讨论3 . 在7年制床边教育的学习中应注意的几个问题，4 .要尊重患者，要热情，要有同情心5 .要重视患者与其家人的沟通，注意对话方式，不刺激患者，不能回答的问题是找合适的病房医务人员不要随便回答“不知道