医学专业英语课件_17.ppt

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1、Medical system in the US-Mayo clinicZhi Hua RanDepartment of gastroenterologyRen Ji Hospital2021/9/101History of Mayo clinic Mayo Clinic evolved gradually from the frontier practice of Dr.William W.Mayo and his two sons-Dr.William J.Mayo and Charles H.Mayo.2021/9/102Dr.Mayo and his two sons Dr.Willi

2、am W.MayoDr.Charles H.MayoDr.William J.Mayo2021/9/103History-Key Dates Dr.William W.Mayo emigrated from England to the US in 1846 Became a doctor in 1863 Appointed as a Civil War examining surgeon for the Union enrollment board,first Minnesota district Moved to Rochester in 18642021/9/104History-Key

3、 Dates His two sons began their medical training early,first by observing,and later by assisting their father on patient visit and with autopsiesWe came along in medicine like farm boys do on a farm-Dr.William J.Mayo2021/9/105Dr.William J.Mayo The elder brother,graduated from University of Michigan

4、Medical School in 18832021/9/106Dr.Charles H.Mayo The younger brother,graduated from Chicago Medical College of Northwest University in 18882021/9/107History-Key Dates 1864-Dr.William Worrall Mayo moves to Rochester 1883 and 1888-Dr.Mayos two sons,William and Charles,join him in practice after they

5、had finished medical school 1883-A tornado strikes Rochester.Mother Alfred Moes,founder of the Sister of St.Francis,proposes to build and staff a hospital if Dr.W.W.Mayo and sons will provide medical care.1889-Saint Marys Hospital opens with 27 beds 1892-First partner added to Mayo family practice.M

6、ore physicians are involved to join,thus beginning the concept of medical teamwork.2021/9/108History-Key Dates 1905-Dr.Louis Wilson develops a rapid way to diagnose surgical specimens(quick-frozen tissue section stained with methylene blue),which allows Mayo surgeons to explore,diagnose,and repair a

7、ll in one operation 1907-Patient registration number“1”given out.5000 patients register at“Mayo clinic”,as it has come to known 1914-Mayo isolates throxin,the principle active component of the thyroid gland.This is only second time that a pure hormone has been isolated 1915-Organization of the world

8、s first formal graduate training program for physicians,the Mayo School of Graduate Medical Education 1919-The Mayo turn over the assets of the Mayo clinic to the nonprofit Mayo Properties Association,the forerunner of Mayo Foundation2021/9/109History-Key Dates 1920-Mayo develops a system for gradin

9、g cancer numerically,which is adopted worldwide and still used today 1925-Dr.William H.Goeckerman reports on the use of tar and ultraviolet light to successfully treat psoriasis.This is a therapeutic breakthrough that remains a highly effective treatment for psoriasis 1926-Mayo Clinic Proceedings be

10、gins publication 1930s-Mayo scientists pioneer methods for measuring motility of the esophagus and adapt them for clinical testing now used worldwide 1934-Edward C.Kendall,Ph.D,isolates cortisone,a hormone from the suprarenal cortex that will later be used to treat rhematoid arthritis with dramatic

11、results2021/9/1010History-Key Dates 1938-Dr.Frederick Moersch first reports median thenar neuritis(carpal tunnel syndrome)1939-William and Charles Mayo die within a few months of each other 1944-First therapeutic application of streptomycin to treat tuberculosis.1947-Discovery of Factor VII,a blood-

12、clotting component 1950-Drs.Edward C.Kendall and Philip S.Hench are awarded the Nobel Prize for isolation and first clinical use of cortisone First human diagnostic cardic catherization 1955-Mayo is among the first to perform successful open heart surgery to repair congenital heart abnormalities aft

13、er refining the Gibbon heart-lung bypass machine2021/9/1011History-Key Dates 1965-Computer monitoring of patients introduced in Cardiac Care Unit at Saint Marys Hospital 1966-Dr.Leonard Kurland introduces the Rochester Epidemiology Project,a medical records-linkage system that has made Olmsted Count

14、y one of few places in the world where the occurrence and natural history of disease can be accurately described.The project has generate more than 1,000 publication on long-term incidence,prevalence,and mortality rates for many diseases 1969-First FDA approved total hip replacement in the US 1972-M

15、ayo Medical School opens 1973-Mayo introduces the first CT scanner in North American2021/9/1012History-Key Dates 1976-The North Central Cancer Treatment Group is created 1980-Mayo researchers are among the first to propose intensive insulin therapy to reduce the complication of diabetes 1986-Mayo Cl

16、inic Rochester,Saint Marys Hospital,and Rochester Methodist Hospital integrate 1986-Mayo expands outside Minnesota for the first time with the opening of Mayo clinic in Jacksonville,Fla 1987-Mayo Clinic opens in Scottsdale,Ariz.And St.Lukes hospital,Jacksonville,Fla Mayo Clinic Rochester goes smoke-

17、free,of the first medical centers in the country to do so 1990-Mayo researchers help identify the source of illness affecting people taking health supplement L-tryptophan2021/9/1013History-Key Dates 1992-Mayo begins to form a regional network of clinics and hospital 1994-Mayo study finds no link bet

18、ween breast implants and connective tissue disease 1995-Mayo opens it web site 1996-Mayo Eugenio Litta Childrens hospital opens,part of Saint Marys Hospital in Rochester 1998-Mayo Clinic Hospital opens in Phoenix,Ariz.2000-Mayo Clinic Transplant Center opens in Rochester providing a single setting w

19、here patient receive all of their transplant service from evaluation to follow-up2021/9/1014The Beginning of Group Practice Pressed by the demands of their busy surgical practice and the exploding growth of medical knowledge,the Mayo brothers invited others to joint their practice:Augustus Stinchfie

20、ld (1892)Christopher Graham (1895)Melvin Millet (1898)Henry Plummer (1901)added diagnostic skillLouis Wilson (1905)developed the labMaud Mellish (1907)developed editorial services Harry J.Harwick (1908,local banker)improved business procedures2021/9/1015The Beginning of Group Practice The group was

21、the beginning of a new way to practice medicineIt has become necessary to develop medicine as a cooperative science;the clinician,the specialist,and the laboratory workers uniting for the good of the patientIndividualism in medicine can no longer exist 2021/9/1016Group PracticeNo one is big enough t

22、o be independent of others-A quote by Dr.William W.Mayo 2021/9/1017The Beginning of Group Practice Group practice was also a natural expression of the Mayo brothers personalities.As Harry Harwick,who worked alongside them for 31 years,wrote:The first and perhaps greatest lesson I learned from the Ma

23、yos was that of teamwork.For my brother and I was no mere convenient term of reference,but rather the expression of a basic,indivisible philosophy of life.2021/9/1018Architect of the Mayo Practice Dr.William Mayo claimed that the best days work he ever did for the clinic was the day he hired Henry P

24、lummer2021/9/1019Dr.Henry Plummer He introduced the dossier medical records system that facilitated sharing of information All of a patients data,from both clinic visits and hospital stays,was entered into a single file,which traveled with the patient and was stored in a central repositoryDivided a

25、diagnostic index to facilitate access to these records for research2021/9/1020First building for an integrated medical practice-1914On the site Harold W.Siebens buildingRegistered patients:30,0002021/9/1021Growth of Specialtes Orthopedics in 1912 Neurology in 1912 Thoracic surgery in 1915 Dermatolog

26、y in 1916 Pediatrics in 1917 Neurologic surgery/proctology in 19192021/9/1022Integrating research and education with practice The Mayo school of Graduate Medical Education opened in 1915 with an endowment from the Mayo brothers Their program became one of the first in the world to train medical spec

27、ialists2021/9/1023An integrated medical practiceMayo Clinic2021/9/1024A gift to the peopleThe Mayo brothers contributed the bulk of their life saving to a private,non-for-profit,charitable organization-Mayo foundation in 19192021/9/1025A gift to the people“We want the money to go back to the people,

28、from whom it came,and we think we can best give it back to them through medical education”Said Dr.William J.Mayo2021/9/1026A gift to the people From this point on the Mayos,their partners and all future Mayo Clinic physicians would receive a salary and would not profit personally from the proceeds o

29、f the practice All proceeds beyond operating expenses were contributed to education,research and patients care They established a board of governors and a committee system to provide effective oversight of many aspects of Mayo life,thereby reinforcing the cooperative spirit of the founders2021/9/102

30、7The present More than six million people have been treated at Mayo Clinic since its frontier founding It encompasses three clinics and four hospitals in three states,employing more than 40,000 physicians,scientists,nurses and allied health workers Through growth and change,Mayo Clinic remains commi

31、tted to its guiding principle“The best interest of the patient is the only interest to be considered”2021/9/1028Location of Mayo Clinic Rochester,Minnesota Jacksonville,Florida Scottsdale,Arizona2021/9/1029Rochester,Minnesota 1500 doctors and scientists Mayo Clinic Saint Marys Hospital Rochester Met

32、hodist Hospital 2021/9/1030Rochester,MinnesotaGonda building2021/9/1031Rochester,MinnesotaGonda building2021/9/1032Rochester,MinnesotaGonda building2021/9/1033Rochester,MinnesotaRochester Methodist Hospital2021/9/1034Rochester,MinnesotaPlummer building 2021/9/1035Plummer building Kahler HotelSiebens

33、-Plummer2021/9/1036Rochester Methodist Hospital Licensed beds available 794 Admissions 18,412 Average length of stay(days)4.5 Operating rooms 41 Surgical cases 18,1592021/9/1037Rochester,MinnesotaSaint Marys Hospital2021/9/1038Saint Marys Hospital Licensed beds available 1,157 Admissions 42,328 Aver

34、age length of stay(days)5.6 Operating rooms 58 Surgical cases 29,8492021/9/1039Rochester,Minnesota-2004 Statistics Mayo Clinic Unique patients 321,900 Outpatients visits 1.42 million Personnel Staff physicians and scientists 1,509 Residents Fellows 1,414 Temporary professionals Allied health staff(c

35、linic and hospital)21,077 Total Staff 24,000 2021/9/1040Rochester,Minnesota-2004 Statistics 80%of the patients-outpatients 20%-hospitalized 80%of Mayo Clinic patients:from Minnesota,Iowa,Wisconsin 2021/9/1041A typical day at Mayo ClinicNew(outpatients)arriving 266Admissions to the hospital 238Surgic

36、al procedures 204Lab tests 33,653Radiology procedures 4,064CT scans 563Chest X-rays 726MRIs 219Electrocardiograms 670Units of blood and blood components used 3262004 Statistics2021/9/1042Medical ResearchBiomedical research at Mayo Clinic includes strong programs in basic and clinic researchMost Mayo

37、 medical staff participate in some research activityResearch Funding Sources(in millions)Mayo funds$121 Extramural funds$251 National Institutes of Health Other federal sources Commercial sources Total$3722021/9/1043Medical Education Mayo School of Graduate Medical Education trained 17,000 alumni si

38、nce 1915 Clinical residents and fellows 1,390 Mayo Graduate School has granted 459 graduate degrees in seven specialties since 1917 Predoctoral students 150 Mayo Medical School has trained and graduated 1,000 students since 19722021/9/1044Jacksonville,FloridaMayo ClinicSt.Lukes Hospital2021/9/1045Ja

39、cksonville,Florida 325 doctors and scientists 253 Residents,fellows and temporary professionals Opened in 1986 Delivering health care services in 50 medical/surgical specialties cancer treatment organ transplantation heart surgery neurosciences 91,000 patients were diagnosed/treated in 2004 13,000 p

40、atients underwent surgery2021/9/1046Scottsdale,Arizona Mayo Clinic ArizonaMayo Clinic Hospital2021/9/1047Arizona Opened in 1987 Services in 65 specialty and surgical disciplines,including programs in cancer treatment and organ transplantation.Mayo Clinic is a premier academic medical center in the S

41、outhwest.Staff physicians/scientists 344 Residents,fellows and temporary professions 101 Served 100,000 patients2021/9/1048System in Mayo Clinic Clinic Bulletin Weekly announced;From Monday to Saturday As early as at 7 AM;Noon time(12:301:30);6 PM Medical grand rounds(every Wednesday)H.Lee-New Techn

42、ologies in criminal investigation GI grand rounds(every Thursday)2021/9/1049System in Mayo Clinic Well-organized and advanced system shuttle bus-every 5 min page-telephone everywhere Computer connected-included all patients information Humanity 2021/9/1050System in Mayo Clinic Residency 3 y Resident

43、 in chief:the forth year General Internal Medicine 2 mo (outside Rochester)Community Internal Medicine 2 mo(Rochester)Urgent Care 1 mo(outpatient w/o appointment)Primary Care Clinic 1 mo(outpatient w/appointment)Pulmonary 1 mo(inpatient)Oncology 1 mo(inpatient)Cardiology 2 mo(inpatient)MICU 1 mo2021

44、/9/1051Resident training Morbidity&Mortality(every Monday noon time)Journal club Friday 7:308:30 Morning report(teaching):8:00-8:30 8:30 11:30:work round Lectures:ground rounds morbidity and mortality 2021/9/1052GI fellow training Pick mentor 1st year Weekly core lectures Journal club Statistics End

45、oscopy 2rd year:research 3rd:clinic practice2021/9/1053Questions about Mayo Clinic Why do patients come to Mayo?Help with the diagnosis and treatment of a difficult medical problem-the main reason Because of its expertise,reputation for thoroughness and its team practice,which lets people get all th

46、e opinions,tests and treatments they need in one place,in a coordinated way2021/9/1054Questions about Mayo Clinic How much time will a medical evaluation require?six working days Does Mayo specialize in certain areas?Mayo specialized in virtually everything Mayos strength is its comprehensiveness,it

47、s ability to provide“one-stop shopping”for the diagnosis and treatment of virtually any medical problem 100 medical/surgical specialties2021/9/1055Questions about Mayo Clinic Do the Mayo still own Mayo Clinic?Mayo foundation was established in 1919.All Mayo staff members are paid a salary and there

48、is no profit-sharing Are there any Mayos still working at Mayo Clinic?The last family member on the medical staff was Charles W.Mayo(son of Dr.Charles H.Mayo),who retired in 1963.Robert Walters,a great-grandson of Dr.William J.Mayo is an administrator at Mayo Clinic Jacksonville.2021/9/1056President

49、 and CEO of Mayo ClinicDenis Cortese,M.D2021/9/1057Best Hospital 2005#1:Johns Hopkins Hospital,Baltimore 32 points in 16 specialties#2:Mayo Clinic,Rochester,Minn.28 points in 14 specialties#3:Massachusetts General Hospital,Boston 24 points in 13 specialties#4:Cleveland Clinic 23 points in 12 special

50、ties#5:UCLA Medical Center,Los Angeles 22 points in 14 specialties2021/9/1058Best Hospital 2005-Mayo Clinic#1 Digestive disorders U.S.News Score:100 Reputation:65.6%#1 Hormonal disorders U.S.News Score:100 Reputation:67.2%#1 Neurology and neurosurgery U.S.News Score:100 Reputation:52.5%#1 Orthopedic