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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,INTRODUCTION TO INTERNAL MEDICINE,Jiyao Wang,MD.MSC.,Professor&Chair,Dept.of Internal Medicine,Shanghai Medical College,Fu Dan University,INTRODUCTION TO INTERNAL MEDIC,1,Internal Medicine,Surgery,Pediatrics,gynecology,Pathology,Microbiology,Genetics,Biochemistry,Pharmacology,Pathologic-physiology,Diagnostics,Immunology,Internal MedicineSurgeryPediat,2,How to learn,1.To combine internal medicine with basic scientific knowledge,2.To combine theory with practice,How to learn1.To combine inte,3,Lectures,Introduction,Pathogenesis,Pathology,Pathophysiology,Clinical features,Diagnosis,Treatment,Prevention,Basic theory,Basic knowledge,Essential skill,LecturesIntroductionBasic theo,4,Bedside Teaching,Bedside Teaching,5,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.,Tact,sympathy and understanding are expected of physician.,What is expected of the physic,6,Te be a good Doctor,In the care of the suffering,physician needs technical skill,scientific knowledge,and human understanding.,The combination of medical knowledge,intuition,experience,and judgment defines the art of medicine,which is,essential,to the practice of medicine,.,Te be a good Doctor In the car,7,The patient-physician relationship,Physicians need to approach patients not as“cases”or“diseases”,but as individuals who is human,fearful,and hopeful,seeking relief,help and reassurance.,The patient-physician relation,8,Ideal patient-physician relationship,Based on:,Thorough knowledge of the patient,Mutual trust,Ability to communicate,Ideal patient-physician relati,9,Clinical Skills,Taking informative history;,Performing thorough physical examination;,Using diagnostic tools judiciously,always asking whether the results will alter the management and benefit the patient.,Clinical Skills Taking informa,10,History taken,In listening to the history,the physician discovers not only something about the,disease,but also something about the,patient.,The process of history-taking provides an opportunity to,observe the patients behavior,and to,watch for features,to be pursued more,.,thoroughly,during the,physical examination.,History takenIn listening to t,11,To develop effective reasoning skills,Information gathering(,informative,history,thorough physical examination),Problem synthesis,Hypothesis generation,Decision making,Essential skill,To develop effective reasoning,12,Learning of Essential Skills,Inquiry skills,Thinking skills,Problem solving skills,Essential skill,Learning of Essential SkillsIn,13,Dealing with clinical problems,Making diagnosis,Identify the severity of the disease,According to the severity of disease,to make therapeutic protocol,Follow up the results of the treatment,Dealing with clinical problems,14,Evidence-based medicine,EBM,Defined as:,The conscientious,explicit and judicious use of current best,evidence,in making decisions about the care of,individual patients,Principles of Patient Care,Evidence-based medicine,EBMDe,15,Evidence-based medicine,EBM,Best research evidence,basic sciences of medicine,patient-centered clinical research,Clinical expertise,ability 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 interventions,Patient values,the unique preferences,concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if 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.,Principles of Patient Care,Evidence-based medicine,EBMBe,16,*Means any other letters,AND means both terms required,Check the question type,Check the emphasis,*Means any other lettersAND m,17,Practice Guidelines,Evidence base clinical guidelines can provide a useful framework for managing patients with particular diagnoses or symptoms.,Principles of Patient Care,Practice Guidelines Evidence,18,The Grade&Level of Evidence,Grades of level of,Recommendation evidenceEtiology/Therapy/Prevention,A 1aSR of RCTs,1bIndividual RCT with narrow CI 1cAll or none,B 2aSR of Cohort studies,2b Individual Cohort study/low quality RCT,2cOutcome Research,3aSR of Case-control Study,3b Individual Case-control Study,C 4 Case series/poor quality cohort study/,case-control study,D 5 Expert opinion without critical appraisal,The Grade&Level of Evidence,19,.,when a relevant evidence base is unavailable,c,linical knowledge,and experience together with,an understanding of the patients needs,supplemented by,diagnostic,tools,still represent the best approach to practicing medicine.,.when a relevant evidence base,20,Medical Decision-Making,ordering of additional tests,requests for consults,decisions regarding prognosis and treatment,Medical decision-making
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