health first introduction to clinical...
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Health First
Fudan University
Introduction to
Clinical Medicine
The Practice of Medicine
Dr. Chouwen ZHU
Director, Foreign Affairs Office, Fudan University
Associate Professor,
Zhong Shan Hospital, affiliated to Fudan University
Evidence-Based Medicine Centre, Fudan University
Sept 05, 2011
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Self-introduction
Associate Professor
(Gastroenterologist, Clinical Epidemiologist)
1984-1992 MD, Peking Union Medical College
1991 UCSF, School of Medicine (exchange student)
1992-Present Internal Medicine, Zhong Shan Hospital
1994-1996 Graduate School, Chulalongkorn University
MSc, Clinical Epidemiology
1999 Senior Scholar, Rochester University, NY
1999-2003 Deputy Director, Medical Affairs Office,
Zhong Shan Hospital
2003-2011 Deputy Director, Foreign Affairs Office, Fudan U
2008-2011Jan Director, Medical Center Office, Fudan U
2011Mar - Director, Foreign Affairs Office, Fudan U
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Fudan University Founder - Dr. MA Xiangbo
Dr. Sun Yat-Sen
1st President of
Republic of China,
Director of Fudan
Board
Fudan University, 1905~
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Shanghai Medical University
Found in 1927 by Dr. Fuqing Yan
Dr. Fuqing YAN,
a Yale MD and PhD in Public Health
The first modern
medical college
established by
Chinese scholars
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Fudan University Shanghai Medical University Merged in April 2000 a new national key research university
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Handan Campus (main)
Fenglin Campus (med)
Zhangjiang Campus
New Jiangwan Campus Campus Location
EXPO
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Please do be proud of your
medical background!
Medicine
Science & Art
scientific knowledge, technical skill,
evidence, experience, intuition,
social concerning, human understanding,
judgment, decision-making…
Very unique profession !
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Please do be proud of your
medical background!
Medicine
Care the human beings and their suffering
(“Quality of Life 生命质量”), not only the
“cases” or “diseases”
Ideal “Patient-Physician Relationship”
Thorough knowledge of patient,
Mutual trust,
The ability of communication
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Difference between Learning Medicine & Practicing Medicine
While learning,
Know the diseases first, then find the relevant
abnormalities
While practicing,
Explore the abnormalities first, then deduce the
conclusion with reasons and make solutions
Internal Medicine
The first essential step for such transition
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Principles of Patient Care
Evidence-Based Medicine 循证医学
"the conscientious, explicit and judicious use of
current best evidence in making decisions about
the care of individual patients." (David Sackett)
有意识地、明确地、审慎地利用现有最好的研究证据制定关于个体病人的诊治方案。
Practice Guidelines
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Principles of Patient Care
Medical Decision-Making
Current Best
Evidence
Current Available Resources
Patient & Social
Concerns expertise/
facilities/
…
value/
expense/
…
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Types of Evidence-based Information
Cohort Studies
Case Control Studies
Case Series
Case Reports
Ideas, Editorials, Opinion
Full-Text Journal Articles
Randomised Controlled
Double Blind Studies
Systematic Reviews and
Meta-analyses
Source: Medical Research Library of Brooklyn
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• MEDLINE
• Cochrane Library
• EBM Reviews
• Clinical Evidence
• Guidelines Clearing House
Online Evidence Bank
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BMJ: 临床决策(诊疗系统)
----Search based on “Disease 疾病”
----Search based on “Symptoms 症状”
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Principles of Patient Care
Some special features Language communication
Internet
Ageing
Death, Dying or Incurable
Informed Consent
Medical errors or malpractice
Clinical economics Cost-Effectiveness analysis
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Know something beyond the clinical
medicine
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Some China’s Characteristics
Decision generally made by patient’s
relatives, not the patient him/herself
Heavy personal burden
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NHE Trend in China
0
1000
2000
3000
4000
5000
6000
7000
78 80 82 84 86 88 90 92 94 96 98 oo o2
Personal
Governm
Society
658.4 bln
100 mln
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National Health Expenditure in country
groups, 2000(%)
Health Expdt of
GDP
Personal Burden
Gov or society’s burden
CHINA 中国 5.13 59.0 41.0
developed 8.5 27.0 73.0
transitional 5.3 30.0 70.0
Most undeveloped 4.4 40.7 59.3
Other developing 5.6 42.8 57.2
World average 5.7 38.2 61.8
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中国卫生筹资结构变化 Structure of health financing
资料来源:卫生部卫生经济研究所, 2008
36.24
25.0622.8420.8419.7519.4317.9717.0416.3816.0415.8415.4715.9315.6916.9617.0417.9318.0720.35
42.57
39.2239.6739.3438.0936.62
35.6332.3230.7829.1128.3125.5524.126.5927.1629.3229.8732.62
34.49
21.19
35.7337.539.8142.1743.9546.450.6452.8454.8555.8558.9859.9757.7255.8753.6452.2149.3145.16
0
10
20
30
40
50
60
70
80
90
100
80 … 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07
个人
社会
政府
individual
Govern’t
Social
/employer
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Some China’s Characteristics
Regional difference
Accessibility
Health statue indicators
Quality
Reimbursement
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Number of beds and physicians
per 1000 inhabitants
Bed
Shanghai 5.7 vs. Guizhou 1.47
Rural Shanghai 3.55 vs. Rural Guizhou 0.44
Physicians
Beijing 4.13 vs. Guizhou 0.97
Rural Shanghai 3.24 vs. Rural Guizhou 0.64
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Main health status indicators
Life expectancy:
71.4 years in 2000 (male 69.6, female 73.3)
(78.14 in Shanghai, 64 in Guizhou)
Infant mortality rate:
19.0‰ in 2005
(Shanghai 4‰ vs poor rural 64‰)
Maternal mortality rate:
47.7 per 100,000 in 2005
(Shanghai 10.8 vs poor rural 95.4)
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Life expectancy at birth by Gross Domestic Product
(GDP) per capita of 30 Chinese Provinces in 2000
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Goal of Healthcare System Reform:
Healthy and Wealthy for the Whole Nation 目标:全民族健康素质,全民小康社会
Ideology :
Scientific Concept of Development
Human-oriented harmonious society with
sustainable development
Aims:
Efficiency, Effectiveness, Fairness, Accessibility
理念:科学发展观;全面,协调,可持续发展; 以人为本,和谐社会
目的:效率、效果、公平、可及
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Five reform programs from 2009 to 2011
Accelerate the establishment of the basic medical
security system.
Set up, preliminarily, the national essential
medicines system.
Improve the grass-roots (community) health care
services system.
Press gradually ahead with the equalization of
basic public health services.
Push forward pilot projects for public hospital
reform.
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Special Assignment
Review and Presentations
After the serial courses for “one system”
Pulmonary, cardiovascular and digestive diseases
By students
Select one certain session in “one system”
10-minute talk
8 students in one presentation course
Evaluation
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Comments?
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