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原帖由 小辣辣 於 2008-4-1 10:23 發表
中醫的臨床診治是醫術. 不是科學. 西醫的臨床醫學. 同樣的也是醫術而不是科學. 祗不過西醫較多地把現代科學運用到臨床而已. 那一個臨床醫生自己看病理? 自己做各種精密化驗. 自己做核磁? 西醫可以運用現代科學. 為什麼中醫就不能? 科學是為全人類服務的, 不屬於西醫一家.
因此中醫西醫的臨床部分. 都是醫術, 請參閱goodoctor先生最崇拜的劉易斯·托馬斯著《細胞生命的禮讚》.本版即有節選. 醫療技術- 選自劉易斯·托馬斯著《細胞生命的禮讚》http://club.backchina.com/main/v ... amp;extra=page%3D8.都不是科學. 大哥不必笑二哥.彼此彼此
小辣辣自稱是北大醫療系的畢業生，不止一次的說過臨床醫學是醫術. 不是科學。下面我就花些時間舉一個簡單的急性咽炎的例子，看看以循證醫學為基礎的現代臨床醫學是如何診斷，治療疾病的。看完后，請小辣辣想一想：臨床醫學是醫術還是科學？
病例：
A 54-year-old woman is evaluated for a 5-day history of sore throat, nonproductive cough, and low-grade fever. She has not had any contact with persons who are ill. She takes no prescription medications and has no drug allergies. The remainder of the medical history is noncontributory.
On physical examination, the patient is not in any acute distress, and the temperature is 37.3 °C (99.2 °F). Pulmonary examination is normal. The oropharynx is erythematous without exudates. She has no cervical lymphadenopathy.
選擇：
Which of the following is the most appropriate management of this patient?
1. Oral amoxicillin–clavulanate
2. Oral penicillin
3. Rapid streptococcal detection test
4. Throat culture
5. Symptomatic treatment
答案和討論：
(Correct Answer = 5)
Pharyngitis is one of the most common symptoms(diagnosis) in adult primary care, Antibiotic treatment is recommended only for patients with group A β-hemolytic streptococcus (GABHS) pharyngitis to prevent rheumatic fever, acute glomerulonephritis, and suppurative complications and to reduce contagion and symptom duration.
The prevalence of GABHS pharyngitis in adult primary care office is only 5% to 15%. However, approximately 75% of adults presenting with pharyngitis receive a prescription for antibiotics, most targeting GABHS. Consequently, clinical-prediction rules have been developed to efficiently guide antibiotic treatment and testing for GABHS.
The validated Centor prediction score assigns one point to each of four clinical findings:
1. fever
2. tonsillar exudates
3. tender anterior cervical lymphadenopathy
4. absence of cough.
The probability of GABHS in the original study of adults evaluated in an urban emergency room was:
1. 2.5% for a Centor score of 0, with associated likelihood ratios for GABHS of 0.16
2. 5% for a score of 1, likelihood ratios for GABHS 0.3
3. 15% for a score of 2, likelihood ratios for GABHS 0.75
4. 32% for a score of 3, likelihood ratios for GABHS 2.1
5. 56% for a score of 4, likelihood ratios for GABHS 6.3.
結論：
Although a narrow-spectrum antibiotic such as penicillin is more appropriate than a broad-spectrum antibiotic such as amoxicillin–clavulanate for treating GABHS, empirical antibiotic therapy and further diagnostic testing (rapid streptococcal testing or throat culture) are inappropriate in this case because the probability of GABHS is so low(patient had fever centor socre of 1, the probability of GABHS pharyngitis is only 5% ) .
文獻：
Bibliography
1. Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA. 2000;284:2912-8. [PMID: 11147989] [PubMed]
2. Cooper RJ, Hoffman JR, Bartlett JG, Besser RE, Gonzales R, Hickner JM, et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med. 2001;134:509-17. [PMID: 11255530] [PubMed]
請小辣辣想一想：臨床醫學是醫術還是科學？
[ 本帖最後由 goodoctor 於 2008-4-2 01:28 編輯 ] |
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