Study Guide Special Topic - Fakultas Kedokteran Udayana Web viewSPECIAL TOPICS. AIMS. To introduce...

Study Guide Special Topics

SPECIAL TOPICS

AIMS

1. To introduce the existence of Special Topics in the curriculum of the medical profession.

2. To understand the science and it's practices of health ergonomics in the medical profession.

3. To understand the science and it's practices of travelers medicine in the medical profession.

4. To understand the science and it's practices of health care in elderly in the medical profession.

5. To understand the science and it's practices of the palliative medicine in the medical profession.

6. To understand the science and it's practices of the complementary and alternative medicine in the medical profession.

Udayana University Faculty of Medicine, MEU 1


PLANERS

NO NAME DEPARTMENT PHONE

1 Prof.Dr.dr.I Nyoman Adiputra, MOH,PFK,Sp.Erg (Head) Fisiology 0811397971

2 dr. N.K. Putri Ariani, SpKJ Psychiatrist 082237817384

LECTURER

NO NAME DEPARTMENT PHONE

1 Prof.Dr.W.Suardana. Sp.THTKL (K) ENT 0811385299

2 dr.AA Ayu Srikandhyawati, Sp.KFR Rehabilitation Medic 081560415053 dr. Putu Anda Tusta Adiputra,

SpB(K)OnkSurgery 08123826430

4 Dra. Retno Indaryati. S. Psi Rehabilitation Medic 081238318625 Dr. Tjokorda Gde Dharmayuda,

Sp.PD KHOM.Internal Medicine 0811394108

6 Prof.Dr.dr.I Nyoman Adiputra, MOH,PFK,Sp.Erg

Fisiology 0811397971

7 dr. Made Jawi, M.Kes Pharmacology 081797879728 DR.dr.Cok Jaya Lesmana, SpKJ Psychiatrist 0816295779



~ FACILITATORS ~Regular Class

NO NAME GROUP DEPT PHONE ROOM

1 dr. Ni Made Renny Anggreni Rena , Sp.PD A1 Interna 081803651656 2rd floor

R.2.09

2 Drs.I. N Toya Wiartha, Apt A2 Pharmacy 0811399886 2rd floor R.2.10

3 dr. I B. Putrawan, Sp.PD A3 Interna 081236194672 2rd floor R.2.11

4 dr. Sianny Herawati, Sp.PK A4 Clinical Pathology 081236172840 2rd floor

R.2.12

5 dr. Gede Kambayana, Sp.PD-KR A5 Interna 08124683416 2rd floor

R.2.13

6 dr. Gede Eka Rusdi Antara, Sp.B A6 Surgery 081337794803 2rd floor

R.2.14

7 dr. Gde Somayana, Sp.PD A7 Interna 081345136913 2rd floor R.2.15

8 dr. Tjokorda Gde Agung Senapathi, Sp.An A8 Anasthesi 081337711220 2rd floor

R.2.16

9 dr. Elysanti Dwi Martadiani, Sp.Rad A9 Radiology 081805673099 2rd floor

R.2.22

10 dr. I Wayan Losen Adnyana, Sp PD A10 Interna 08123995536 2rd floor

R.2.23

English ClassNO NAME GROUP DEPT PHONE ROOM

1Dr. dr. I Wayan Suranadi, Sp.An.KIC B1 Anasthesi 08123847675 2rd floor

R.2.09

2 Dr. dr. I Dewa Made Sukrama, MSi, Sp.MK(K) B2 Microbiology 081338291965 2rd floor

R.2.10

3 dr. Dewa Made Artika , Sp.P B3 Pulmonology 08123875875 2rd floor

R.2.11

4 dr. Desak Made Wihandani, M.Kes B4 Biochemistry 081338776244 2rd floor

R.2.12

5 dr. Cynthia Dewi Sinardja, Sp.An B5 Anasthesi 08175253037 2rd floor

R.2.13

6 dr. Anom Suardika, Sp.OG B6 Obgyn 0817561966 2rd floor R.2.14

7 dr. Nyoman Astika, Sp.PD-Kger-FINASIM B7 Interna 08123974128 2rd floor

R.2.15

8 dr. Anak Agung Mas Putrawati Triningrat, Sp.M B8 Opthalmology 08123846995 2rd floor

R.2.16

9 dr. I Wayan Sucindra Dewi, S.Ked B9 Pharmacology 081936043700 2rd floor

R.2.22

10 dr. A.A.Bagus Ngurah Nuartha, Sp.S(K) B10 Neurology 08179782240 2rd floor

R.2.23



CURRICULUM BLOCK :

Sub Topic Paliatif Medicine

Aims :

To understand Paliatif Medicine is Part of Medical Education.

Paliatif Medicine most important for patient with severe diseases, chronic illness, and in

terminal stage

To assess common forms of symptoms and sign patient in severe disease, chronic illness,

and patient in terminal stage.

To diagnose and manage common physical problem in severe disease, chronic illness, and

patient in terminal stage.

To aplly the basic principles of Palliatif medicine.for patient in severe disease, chronic

illness, and patient in terminal stage.

LEARNING OUTCOMES 1. Describe about Paliatif Medicine and its clinical implications

2. Describe the general principles of Paliatif medicine

3. Apply the general principles of Paliatif medicine for patient with severe diseases,

chronic illnees, and in terminal stage.

4. Recognize or identify common forms of problem patient with severe diseases,


5. Apply general principles the plan of Paliatif care for patient with severe diseases,




TIME TABLE

PALIATIVE MEDICINE

No DATE/ Lecture

LEC

LECTURE TOPIC

CLASS B CLASS A

TIME ACTIVITIES TIME ACTIVITIES

1 FridayConcept,

Philosophy and Principle of Palliative

medicine

08.00-09.00 Lecture 09.00-10.00 LectureJan, 9 2015 09.00-10.30

Individual learning 10.00-11.30

Student Project

Prof.Dr.W Suardana, SpTHTKL (K)

10.30-12.00 SGD 12.00-13.30Independent

Learning12.00-12.30 Break 13.30-15.00 SGD

12.30-14.00Student Project 1130-12.00 Break

14.00-15.00Planary Session 15.00-16.00

Plenary Session

2 Monday

In patient Hospice and Palliatif care

08.00-09.00 Lecture 09.00-10.00 LectureJan, 12 2015 09-00-10.00

Individuallearning 10.00-11.30

StudentProject

dr . AA Ayu Srikandhyawati, Sp.KFR

10.30-12.00 SGD 12.00-13.30Independent


12.30-14.00Student Project 11.30.12.00 Break

14.00-15.00Pleanary Session 15.00-16.00

Pleanary Session

3 TuesdayEmergency in Paliatif medicine

08.00-09.00 Lecture 09.00.10.00 LectureJan, 13 2015 09.00-10.30


Student Project

dr. Putu Anda Tusta Adiputra, SpB(K)Onk

10.30-12.00 SGD 12.00-13.30Independent

Learning

12.00-12.30 Break 13.30-15.00 SGD

12.30-14.00Student Project 11.30-12.00 Break

14.00-15.00Plenary Session 15.00-16.00

Plenary Session

4 Wednesday

Communica tion in

Palliatif Care

08.00-09.00 Lecture 09.00-10.00 Lecture

Jan, 142015 09.00-10.30


Student Project

10.30-12.00 SGD 12.00-13.30Indenpendent Learning



Dra. Retno Indaryati, S.Psi

12.00-12.30 Break 13.30-15.00 SGD



Pleanary Session

5 Thursday Modern supportive

care in Onkologi

Holistic approach for

Cancer patient

08-00-09.00 Lecture 09.00-10.00 LectureJan, 152015 09.00-10.30

Individual Learning 10.00-11.30

Student Project

Dr. Tjok Darmayuda, Sp.PD. KHOM

10.30-12.00 SGD 12.00-13.30Independent




Pleanary Session

Feb, 03, 2015 Examination Team



TIME TABLE

Complementary and Alternative Medicine (CAM)

English Class (Class B)

Day/date Time Activity Venue Conveyer

Friday16 Jan 2015

08.00-09.0009.00-10.3010.30-12.0012.00-12.3012.30-14.0014.00-15.00

Lecture 1Indiv. LearningSGDBreakStudent ProjectPleanary

Class room

Discussion Room

Class room

Dr.Md Jawi.

Facillitator

Dr.Md Jawi

Wednesday21 Jan 2015

08.00-09.0009.00-10.3010.30-12.0012.00-12.3012.30-14.0014.00-15.00


Class room

Discussion Room

Class room

Dr.Md Jawi.

Facillitator

Dr.Md Jawi

Thursday22 Jan 2015

08.00-09.0009.00-10.3010.30-12.0012.00-12.3012.30-14.0014.00-15.00


Class room

Discussion Room

Class room

DR.dr.Cok Jaya L, SpKJ

Facillitator


Friday23 Jan 2015

08.00-09.0009.00-10.3010.30-12.0012.00-12.3012.30-14.0014.00-15.00


Class room

Discussion Room

Class room

Prof. Adiputra

Facillitator

Prof. Adiputra

Monday26 Jan 2015

08.00-09.0009.00-10.3010.30-12.0012.00-12.3012.30-14.0014.00-15.00


Class room

Discussion Room

Class room

Prof. Adiputra

Facillitator

Prof. Adiputra



Study Guide Special TopicsReguler Class (Class A)

Day/date Time Activity Venue Conveyer

Friday16 Jan 2015

09.00-10.0010.00-11.3011.30-12.0012.00-13.3013.30-15.0015.00-16.00

Lecture 1Student ProjectBreakIndiv. LearningSGDPleanary

Class room

Discussion Room

Class room

Dr. Md Jawi

Facillitator

Dr. Md Jawi

Wednesday21 Jan 2015

09.00-10.0010.00-11.3011.30-12.0012.00-13.3013.30-15.0015.00-16.00


Class room

Discussion Room

Class room

Dr. Md Jawi

Facillitator

Dr. Md Jawi

Thursday22 Jan 2015

09.00-10.0010.00-11.3011.30-12.0012.00-13.3013.30-15.0015.00-16.00


Class room

Discussion Room

Class room


Facillitator


Friday23 Jan 2015

09.00-10.0010.00-11.3011.30-12.0012.00-13.3013.30-15.0015.00-16.00


Class room

Discussion Room

Class room

Pof. Adiputra

Facillitator

Prof. Adiputra

Monday26 Jan 2015

09.00-10.0010.00-11.3011.30-12.0012.00-13.3013.30-15.0015.00-16.00


Class room

Discussion Room

Class room

Pof. Adiputra

Facillitator

Prof. Adiputra




PALIATIF MEDICINE

Abstract

Palliative care is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure, particularly for the disease which is treatment is not curable. Palliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to from diagnosis to the end of life and bereavement.Concept and philosophy of Palliative care consist of provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. The goal of palliative care is relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, a support system to help the individual live as actively as possible, and a support system to sustain the individual's family in other word is holistic approach of care (bio-psycho-socio-cultural and spiritual aspect).Hospice care is other term for palliative medicine which focuses for terminal ill while palliative care services beginning from the diagnosis of the disease.

Learning task1. What is palliative medicine?2. What are the objectives of palliative care?3. Did you know about holistic approach in the palliative medicine?4. Who are the targets in the palliative care?5. Describe the concept and principle of palliative medicine!6. What is bereavement consultation? To who will be doing? 7. Describe of past model and modern model of palliative care! 8. Describe of hospice care and differentiation from palliative care!

Udayana University Faculty of Medicine, MEU

Lecture 1 : Concept, Philosophy and Principle of Palliative

medicineProf.dr.W.Suardana Sp.THT-KL(K)

9


Abstract

The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.Patients receiving palliative care may deteriorate suddenly due to their illness or another acute medical or surgical problem. At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted.

Major emergencies in palliative care :

Hypercalcaemia Bleeding Superior venal caval obstruction Spinal cord compression Bone fractures Seizure

Emergencies in palliative care also include sudden severe exacerbation of symptoms. Therefore, onset of severe pain, exacerbation of breathlessness, and worsening of other symptoms are also discussed with their appropriate treatment. A small armamentarium of appropriate medications is thus shown to cover treatment of the various emergencies that may arise. As palliative care deals with patients who are suffering from progressive fatal conditions, death is the expected end.


Lecture 2 :In Patient Hospice and Paliatif Caredr.AA Ayu Srikandhyawati, Sp.KFR

Lecture 3 :Emergency in Palliative Care

dr. Putu Anda Tusta Adiputra, SpB(K)Onk

Lecture 4 :Communication in Palliative care

Retno Indaryati Kusuma, Dra, Psikolog

10


.

COMPLEMENTARY AND ALTERNATIVE MEDICINE ( CAM )

AbstractPublic awareness and use of complementary and alternative medicine (CAM) are complex phenomena that have grown extraordinarily in the past decade. One reason for this phenomenon no doubt is the enormous increase in public access to worldwide information through the world wide web and widespread newsmedia coverage. Commercial advertising and an endless exposure through the lay press, ranging from tabloid publications to magazines, medical journals, and books, have vigorously promoted the concepts of disease prevention and healing by unconventional means, striking a sensitive (and highly lucrative) chord in a truly global population.Another reason for the popularity of CAM is the upwardly spiraling cost of modern allopathic medical care. New technologies have been developed at a record pace, producing many medical, surgical and diagnostic innovations, most of which are unquestionably improvements but which also are very expensive. The expense and the resulting rationing of these new modalities by managed care programs in an attempt to reduce the costs of medical care have placed them out of reach of a large segment of the population. One consequence appears to be the creation of a strong public desire for a wide range of complementary and alternative modalities to prevent and treat the full gamut of human illness. The younger generation, in particular, seems to be developing distrust of the technological innovations of the medical profession and their potential for adverse effects, while becoming more interested in CAM and preventive medicine. The elderly population has also turned to CAM, but perhaps for different reasons.Whatever the reasons, a veritable blitz of advertising and recommendations for CAM products has arrived and has received strong public interest and approval, with very little support or encouragement from the medical community. Many patients are more informed of alternative therapies than their physicians, a situation that, in itself, should encourage physicians to learn more about CAM. No matter how a physician feels about the usefulness of CAM, it is no longer adequate simply to brush off the patients' questions with an uninformed answer; doing so only serves to broaden the communication gap between the public and the medical profession.Therefore, as a medical student who will be leading the medical staff should know to bridge information gaps or provide correct information to the CAM. In this lecture (the learning process) will be discussed in outline on CAM, so that, future integrated treatment system can be achieved.


Lecture 5 :Holistic Approach for Cancer Patient

Dr. Tjokorda Gde Dharmayuda, Sp.PD KHOM

Lecture 1 :Complimentary and Alternative Medicine (CAM)

Dr. Made Jawi, M Kes

11

Study Guide Special TopicsReferences

1. The Journal of Alternative and Complementary Medicine2. BMC Complementary and Alternative Medicine3. Evidence-Based Complementary and Alternative Medicine

AbstractPlants had been used for medicinal purposes long before recorded history.In the early 19th century, when chemical analysis first became available, scientists began to extract and modify the active ingredients from plants. Recently, the World Health Organization estimated that 80% of people worldwide rely on herbal medicines for some part of their primary health care. Herbal medicine , also called botanical medicine or phytomedicine, refers to using a plant's seeds, berries, roots, leaves, bark, or flowers for medicinal purposes. Herbalism has a long tradition of use outside of conventional medicine. It is becoming more mainstream as improvements in analysis and quality control along with advances in clinical research show the value of herbal medicine in the treating and preventing disease.In many cases, scientists aren’t sure what specific ingredient in a particular herb works to treat a condition or illness. Whole herbs contain many ingredients, and they may work together to produce a beneficial effect. Many factors determine how effective an herb will be. For example, the type of environment (climate, bugs, soil quality) in which a plant grew will affect it, as will how and when it was harvested and processed.The herbs available in most stores come in several different forms: teas, syrups, oils, liquid extracts, tinctures, and dry extracts (pills or capsules). Teas can be made from dried herbs left to soak for a few minutes in hot water, or by boiling herbs in water and then straining the liquid. Syrups, made from concentrated extracts and added to sweet tasting preparations, are often used for sore throats and coughs. Oils are extracted from plants and often used as rubs for massage, either by themselves or as part of an ointment or cream. Tinctures and liquid extracts are made of active herbal ingredients dissolved in a liquid (usually water, alcohol, or glycerol). Tinctures are typically a 1:5 or 1:10 concentration, meaning that one part of the herb is prepared with 5 - 10 parts (by weight) of the liquid. Liquid extracts are more concentrated than tinctures and are typically a 1:1 concentration. A dry extract form is the most concentrated form of an herbal product (typically 2:1 - 8:1) and is sold as a tablet, capsule, or lozenge.Often, herbs may be used together because the combination is more effective and may have fewer side effects. Health care providers must take many factors into account when recommending herbs, including the species and variety of the plant, the plant's habitat, how it was stored and processed, and whether or not there are contaminants (including heavy metals and pesticides).

All medicinal agents have potentiallyunexpected effects including toxicity, andherbs are no different.As with otherdrugs, the risk of unexpected effects maybe influenced by a user’s age, gender,genetics, nutrition status, and concurrentdisease states and treatments.In clinicalpractice recognizing adverse effects of herbalmedicine is not routine and their reporting iseven less frequent.It is important to be aware of anysubstances that have the potential to causetoxicities and to interact with prescribedmedications. Most adverse reactions involvethe skin, liver, GI tract but can involve theheart (e.g.ephedra). Significant


Lecture 2 :Herbal Medicine

Dr. Made Jawi, M Kes

12

Study Guide Special Topicshepatotoxiceffects were reported with kava or Echinacea when taken concurrently with otherheptatoxic drugs. The use of a drug and aherb that are both associated with potentialhepatotoxic effects should be avoided.Herbal medicine is used to treat many conditions, such as asthma, eczema, premenstrual syndrome, rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue, irritable bowel syndrome, and cancer, among others. Herbal supplements are best taken under the guidance of a trained health care provider. For example, one study found that 90% of arthritic patients use alternative therapies, such as herbal medicine.Be sure to consult with your doctor or pharmacist before taking any herbs. Some common herbs and their uses are discussed in this lecture.

ReferencesJournal of Herbs, Spices & Medicinal PlantsJournal of Herbal Medicine

Abstract

Hypnosis is a way to harness the imagination to therapeutic strategies designed to help people feel and live better, from reducing pain and anxiety to controlling habits and dissociation. Hypnosis has occupied an unusual position in relation to both mainstream and complementary or, as it is now more often referred to, integrative medicine. It has a long history of being used both within and outside of medicine. Hypnotic capacity can be identified and mobilized as a valuable adjunct to a variety of psychotherapeutic strategies.

The word hypnosis comes from the Greek root hypnos, which means sleep. This is misleading, because hypnosis, as a phenomenon, is not a form of sleep; rather, it is a complex process of attentive, receptive concentration. Although peripheral awareness is reduced in sleep and hypnosis, focal attention, which is diffuse in sleep, is heightened during the hypnotic trance. Since the days of Franz Anton Mesmer, techniques of trance induction and the use of trance phenomena for psychotherapeutic change have been confused. This has led to a lack of understanding of the differences between aspects of the hypnotic experience that are influenced by the therapist and those that are due to the individual's degree of hypnotizability, personality style, and motivation. The hypnotist does not project hypnosis onto the subject. The role of the hypnotist is rather to assess an individual's inherent biological capacity for trance and to teach the patient how to use it in a given psychotherapeutic program.

The therapist must reassure the subject that he or she will not be embarrassed or humiliated, will not be asked to do anything he or she would not want to do in the waking state, and that it will be a temporary procedure only. Some subjects may be concerned that if they can be hypnotized, it shows they are weak or stupid. On the contrary, therapists explain that only subjects who can strongly focus their attention can be hypnotized. Hypnotherapy brings the patient to an awareness of the feelings and desires of their unconscious mind. It enables them to reframe an experience (e.g., with family, friends, coworkers) or proto-experience, laden with distressing feelings or conflict, into a positive one. The patient is brought to see and feel memories of the past, place them into their present, project them into their future life, and understand and reframe them. The patient actively expresses emotions from their unconscious mind, and develops a different


Lecture 3 :Hypnosis

Dr. dr. Cokorda Bagus Jaya Lesmana, SpKJ

13

Study Guide Special Topicsunderstanding of these memories. The hypnotic state further enables them to modify past situations and feelings, and record these as newly changed in conscious memory.

Treatment using hypnosis involves not merely abreaction of trauma, but also working through it by assisting with the management of uncomfortable affect, enhancing patients' control over it, and enabling them to cognitively restructure its meaning. Catharsis is a beginning but not an end in itself, and it can lead to retraumatization if it is not accompanied by support in managing affective response, control over the accessing of traumatic memories, and help in working through them.



Learning program

THE BALINESE TRADITIONAL MEDICINE

I Nyoman Adiputra

INTRODUCTION

In every nation or sub-nation there is a traditional way to remedy the aillment or illnesses or diseases. The intended knowledge is handed down generation to generation, informs of traditions and it's practices. The traditions might be written or spoken orally. In case the source of traditional healing knowledge is written, there is a factual thing that those information is written on a various of materials. For example in the Balinese the intended knowledge is written on a palm leaf (lontar). In other sub-ethnic may use skin of tree or other materials.The Balinese traditional knowledges had been known since those day. It is generally known as usadha, which is means medicines.

It is a matter of culture; culture of people who believe on that. Generally the Balinese do believe on traditional healing due to the fact that there are three basic elements for the it's efficacy. The elements are: 1) the source of knowledge; 2) the provider; and 3) the consumer.

The source of knowledge informs written materials which called usadha. There are many kinds of usadha. Belong to the usadha group are: 1) general knowledge (tatwa), such as brahmanda tatwa (cosmology), atma tatwa (soul), wrehaspati tatwa (philosophy), aji sangkhya (philosophy), wariga (caleder), agama (religion), rwa bhineda (philosophy); 2) medical knowledge: such as panca maha bhuta (medical physic), saraswati (anatomy), sastra sanga (anatomy), buwana mahbah (pathology), pinarah pitu (patophysiology), kahilangan kawah (pathopa=hysiology), and pati urip (patho-physiology)' taru premana, sundari siksa, (the great pharmacopea), budha kecapi, kalimaha usadha-usadhi (the complete medical knowledge; 3) summary (kaputusan) such as kaputusan punggung tiwas. The naming system of usadha is based on: a) the subject to be treated; b) by using the name of color. Based on subject to be treated there are classification of usadha as the followings: 1) usadha rare (paediatrics); 2) usadha dalem (internal medicine); 3) usadha buduh (mental illness); 4) usadha gondong (goitre disease); 5) usadha kecacar (smallpox); 6) usadha ila (leprozy), 6) usadha cukil daki (dermatology); 7) usadha manak (obstetrics), 8) usadha kamatus (venerology).


Lecture 4 :Why traditional healing still used in Bali?

Prof. Dr. dr. I Nyoman Adiputra, MOH,PFK,SpErg

15

Study Guide Special TopicsBased on color name, there are usadha classification as the followings: 1) usadha kuning/yelow (paediatrics); 2) usadha putih/white (for adolescent); 3) usadha bang/red ( for adult); 4) usadha cemeng/black (geriatrics).All of those subject must be studied by those who like to become a traditional healer or balian. Balian in this case is called Balian Usadha.

In fact in Bali there are many type of traditional healers, such as 1) Balian Usadha, who are equivalent to medical doctor; they become Balian after a long and hard study on the usadha. 2) Balian Ketakson, a traditional healer by incidently he (she) got a magical thing, by which he (she) has a power and capability to cure an illness person. This kind of Balian can not be duplicated. 3) Balian Manak, traditional healer who specializing in delivery as a midwife. 4) Balian elung, as a bone setter for patient suffering from a fracture. 5) Balian tenung, those who are offering the service as a fortune teller; 6) Balian engengan, those who are .........Who will become a Balian?

Theoretically, every body and both sexes, who learn about the sources of traditional knowledges could become a Balian. But, as a preference there are a certain pre-requirements such as there is a gynealogy; it means that the candidate should has ancester as a Balian; the candicate also should pass by the general knowledge first, and the age should at the late of thirty. The candidate also shoul directly to approach a Balian who will become his (her) teacher during the learning process. The process of learning is very very informal. Eventhough, there is a process of evaluation of the learning processs, which can be done by both ways (candidate and the teacher). When a candidate is allowed to practice what he or she being studied is depend on evaluation process.

Consumer in this case are the Balinese who are believe on the traditional healing, without considering the educational level, economic class, rescidences (in the town or rural). Usually, the Balinese may come to Balian at the beginning of suffering, or at the late stage after getting some medical doctor helps, but, without any improvement. The consumer in this case are aksing the help of the traditional healer not only for the illnesses, but also for other thing such as consultation in conducting a ceremony, asking time to start any activity for a better result. Or might be also for asking as a mediator for a certain porpuse.

In offering the service a Balian may examining the patient. The procedure for that is equivalent to what the MD is doing. It consist of: 1) interviewing (anamnesis); 2) inspecting (by watching or seing; 3) palpating; 4) percussing, 5) auscultating. Another additional examination such as environmental condition is also done. Usually interview is done in a longer time.After a diagnose had been done the Balian will give a treatment to the patient in hand. The treatment procedure consist of a) medication using herbals or other material such as minerals, oils, and part of animals' organ; it can be for causative therapy; symptomatic therapy and supportive therapy; b) religious ceremony such as purification. The drugs used is given by the traditional healer based on their prescriptions.

In doing their jobs the traditional healer has never seek for money. Therefore, there is no exact tariff; the patient usually offer the payment informs of in natural things.


Lecture 5 :A Balian is morally conduct

Prof. Dr. dr. I Nyoman Adiputra, MOH,PFK,SpErg

16

Study Guide Special TopicsAnother hint that the traditional healer do their job in moral conduct is that whenever he (she) knows the cause of the sickness , he or she will not tell to any others or if it must be open just for the limited one. He or she always advice to be kept secretly for the better future relationship. The traditional healer always to offer his or her service in accordance to the ethic and moral guidances. In doing so, he or she should also know the calender and it's practice. He or she is mastering on some other topics for example as mediator to the evil or devil spirits, knows about the future (fortune teller), as a consultant for the villiger, as an artist, as a priest, as a village council, as a village administrator and as a informal leader in the village.

The traditional healer knows about the basic concept of health and illness. An individual is considered in a healthy condition if there is harmony or in a balance between physical and mental one; or between micro-cosmic and macro-cosmic. If due to a certain thing there is disharmony or imbalance it will cause a sickness. Therefore the treatment is by change the disharmony into a harmony; or imbalance into a balance

The cause of the diseases traditionally, could be divided into two parts, namely internally and externally. Internal cause, it is due to a dysharmony between the kanda Pat (the four siblings), panca maha bhuta (the five principle elements), sad ripu (the six enemies), and sapta timira (the sevent sins). The external cause of disease interms of supra natural power, demons, evil spirits, toxic agents (from the plants, animals, metals, minerals); environmental aspect such as mal-construction or mal-composition of house, wind or sin.

One thing should keep in mind is that in the usadha as a reference for the traditional healer is not always the dose of drug written completely; how many leaves how many gram of roots and how many time given in a day.. That is as one disadvantage of the traditional healing process.



LEARNING TASKS

Case• Aunt Tilly is diagnosed with breast cancer and is recommended to start

chemotherapy and radiation treatments. Aunt Tilly knows that chemotherapy can make her feel horrible and radiation can be painful. She is referred to a palliative care program for symptom management and receives excellent treatment of her chemotherapy induced nausea, fatigue, and oral thrush (a yeast infection of the mouth common in chemotherapy patients). She is also visited by a Medical Social Worker who helps her complete her advance directives, just in case she loses the ability to speak for herself. She gets weekly visits from a chaplain who prays with her and discusses Aunt Tilly's theological questions. Well, Aunt Tilly endured three rounds of chemotherapy and a week of radiation but her breast cancer is aggressive and resistant to treatment. Aunt Tilly is told that she has six months to live and is referred to hospice care. Hospice comes to Aunt Tilly's home and continues with the expert symptom management that the palliative care team started. They address new symptoms as the arise and begin to talk to Aunt Tilly about her impending death and what her goals and priorities are. Hospice helps Aunt Tilly to fulfill her life-long dream of riding in a Porsche and helps her reconcile with her long estranged daughter Talula. Aunt Tilly dies peacefully surrounded by her family.

1. Describe the disease suffered aunt Telly!2. What is recommended by doctor to treat aunt Telly?3. Describe the effect of treatment which is recommended by doctor!4. Aunt Tilly knows that chemotherapy can make her feel horrible and radiation can be

painful. Discussed of this effect of treatment knows by aunt Tilly!5. Discussed of yeast infection of the mouth very common in chemotherapy patients!6. Describe what Palliative team will do to aunt Telly who’s suffered of late stage of

cancer disease! What objective of the strategies!7. Discuss why aunt Telly need hospice care! 8. What will the Hospice team take care for aunt Telly condition? 9. Aunt Tilly dies peacefully surrounded by her family. Discussed of this statement!


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Case : Mr. Ketut, 60 years old, hospitalized in Sanglah with Lung Cancer, stadium Paliative since one month ago.He know about his diagnosis and no other treatment (surgery or chemotherapy) for him. He want to die at home among his family. The primary doctor consult him to Paliative team.

LEARNING TASK :

1. Definition of Paliative Medicine.2. Taking and formulate a complete history of this case.3. Make the plan for this patient.4. What is your opinion when the patient feel short of breath at home.

SELF ASSESSMENT :

1. What do you know about Paliative Medicine?2. Explain about Paliative Care.3. Discribe 10 (ten) dimension of Quality of Life (Jennifer J . Clinich & Harvey

Schipper).

Where is the place of Paliative care and give the explaination.

.

Vignette 1A woman, 55 years old diagnosed with mestastastic breast cancer come to the emergency unit with chief complain of loss of consciousness.

1. Palliative care is necessarily multidisciplinary. What does the principles of palliative care?

2. Hypercalcaemia is the commonest life threatening metabolic disorder encountered in patients with cancer. What is the presenting features of hypercalcaemia?

3. What is the etiology of hypercalcaemia in patient with cancer? Explain about it!4. Explain the management of hypercalcaemia in the palliative care?


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Mrs. Ann is a 43-year-old woman with metastatic melanoma. She has completed two cycles of treatment with a combination therapy that she has tolerated not-quite well. Her major complaints had been fatigue, loss her weight and insomnia. Before starting a third cycle of treatment, she experienced some visual hallucination, and emotional disturbances. The doctor presumed there are another metastatic site of disease in the brain. The drug responses occur many disturbances in her metabolism, make her nausea, and sometime vomiting.

According to the family, all of information about the symptoms made her very anxious. That is the reason, her family meet and ask to the doctor to keep all the bad news about her disease. The doctor must let only the family know the reality, and the patient only know the good ones, so she will get better improve and recovery.

Learning Task

1. Please describe what must the doctor said and explain to the family2. Please give the best explanation to the patient, while you know she is in depressed

condition.3. Why Palliative care serves as a bridge between the therapist, the patient, and the

family?4. Depression and other mental disorders often complicate the treatment of medical

illness, and deviant illness behavior such as suicide is a common problem in patients who are organically ill. What will you suggest to the patient who suffered the disorders?

5. When the best time you give the worsening of symptoms to the patients? 6. Is that necessary to report all the side effects of the medication, so the patient can

be prepared before? 7. Why must we give much attention to the palliative staff and care-giver?

Soon will be added


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Learning Task

Cancer patients using or considering complementary or alternative therapy. The patients discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. As a doctor you could explain this problem.A. What benefits can be expected from this therapy? What are the risks associated with this therapy? Do the known benefits outweigh the risks? What side effects can be expected? Will the therapy interfere with conventional treatment? Is this therapy part of a clinical trial? If so, who is sponsoring the trial? Will the therapy be covered by health insurance?

B.What the role of complementary therapies bellow for Cancer patients? Acupuncture Exercise Expressive arts (art and writing)yoga Humor therapy Massage therapy Music therapy Qigong Reflexology

Learning task

Many patients use herbal medicine with conventional drugs in treating diseases, or use of herbal products and medications together. For example, diabetic patients might benefit from taking Korean red ginseng or Panax ginseng because this herb can lower blood sugar levels and might allow patients to rely on less medication.However, interactions between herbal products and medication can sometimes result in adverse clinical outcomes.

A. If you to be a medical doctor, what are your opinion about that case ?B.1. What is herbal medicine?2. How do herbal medicinework?3. How is herbal medicine sold in stores?4. What is the future of herbal medicine?


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Case IMrs. K. was a 44-year-old well-trained psychiatrist with 4 years of psychoanalytic training who had failed her board examinations 2 years in a row. This was especially disturbing because she was well informed and her colleagues knew her as a competent psychiatrist. Yet something happened in the examination process that led to blocking and intellectual paralysis.

Question:1. Explain treatment option for her condition2. Explain the role of therapist3. Explain how to assess her hypnotic capacity4. Explain the restructuring of the problems5. Explain how hypnotherapy can help her problems

Case IIAndy, 38 years oldwas a world-class athlete who collapsed suddenly inan alley. He was brought to a hospital emergency room,where he nearly died of internal bleeding from a lymphomathe size of a grapefruit in his abdomen. He was hospitalizedand placed on chemotherapy. He was extremely anxious,and increasing doses of opiates had little effect on hispain. He was literally “climbing the walls” and alienatingthe nursing staff charged with his care. His parents wereafraid that he was becoming a drug addict.

Question:1. Explain treatment option for her condition2. Explain the role of therapist3. Explain how to assess her hypnotic capacity4. Explain the restructuring of the problems5. Explain how hypnotherapy can help her problems

Self-assessment:1. Explain principles of psychotherapy with hypnosis2. Explain the use of hypnosis in forensic psychiatry3. Explain about hypnotic dissociation4. Explain some indication for hypnosis use5. Explain about hypnotic induction profile


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1. How does the traditional medicine still function in Bali?2. Mention the basic elements which make it function!3. Discuss the traditional knowledges of the Balinese traditional medicine you

know, and it’s correspondences to the modern medicine.4. Discuss how the classification of usadha is done, and give some example

accordingly!5. Classify the traditional healer in Bali you know and discuss what is (are) the

advantages & disadvantages of those types.6. Before some one become a traditional healer (Balian) could you summarize how

the process he or she did?7What do you thing, whether a Balian is a professional one or not?8 Elaborate how the diagnosis is made by a Balian Usadha?9 According to the traditional knowledges, could you summarize the cause of disease?10 Try to compare the modern aspect and the traditional aspect of disease aetiology?11Try to explain the pathogenesis of disease traditionally?12. How many roles or functions of Balian Usadha do you know?13. Try to find out that the Balian Usadha is morally conduct. Supports your opinion!14. Is there any fixed-tariff for Baliaj Usadha in offering his or her services?

1. How the process of healing is done by Balian Usadha in Bali?2. What kind of materials for medication used by a Balian Usadha that you

know?3. Is there any source of traditional knowledge for medicinal plants in Bali?4. Discuss the role of the medicinal plants you know!5. Discuss how the patient shall use the herbal medicine as you know!6. Discuss the dosage of drug used in the source of knowledges

traditionally!7. How the medicinal plants’ effect could be estimated? Is there any hint

practically?8. Try to compare the traditional medicine and modern medicine!.


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~ CURRICULUM MAP ~Smstr Program or curriculum blocks

10 Senior Clerkship

9 Senior Clerkship

8 Senior clerkship

7

Medical Emergency(3 weeks)

BCS (1 weeks)

Special Topic:-Travel medicine(2 weeks)

Elective Study III(6 weeks)

Clinic Orientation (Clerkship)(6 weeks)

6

The Respiratory System and Disorders(4 weeks)

BCS (1 weeks)

The Cardiovascular System and Disorders(4 weeks)

BCS (1 weeks)

The Urinary System and Disorders(3 weeks)

BCS (1 weeks)

The Reproductive System and Disorders(3 weeks)

BCS (1 weeks)

5

Elective Study II(1 weeks)

Alimentary& hepato-biliary systems& disorders(4 Weeks)

BCS (1 weeks)

The Endocrine System, Metabolism and Disorders(4 weeks)

BCS (1 weeks)

Clinical Nutrition and Disorders(2 weeks)

BCS (1 weeks)

Special Topic :- Palliative medicine-Complementary & Alternative Medicine- Forensic(3 weeks)

Elective Study II(1 weeks)

4

Musculoskeletalsystem &connectivetissue disorders(4 weeks)

BCS (1 weeks)

Neuroscienceandneurologicaldisorders(4 weeks)

BCS (1 weeks)

Behavior Changeand disorders(4 weeks)

BCS(1 weeks)

The Visualsystem &disorders(2 weeks)

BCS(1 weeks)

3

Hematologicsystem & disor-ders & clinicaloncology(4 weeks)

BCS (1 weeks)

Immunesystem &disorders(2 weeks)

BCS(1 weeks)

Infection& infectiousdiseases(5 weeks)

BCS (1 weeks)

The skin & hearing system& disorders(3 weeks)

BCS(1 weeks)

2

Medical Professionalism(2 weeks)

BCS (1 weeks)

Evidence-based Medical Practice(2 weeks)

Health System-based Practice(3 weeks)

BCS (1 weeks)

Community-based practice(4 weeks)

Special Topic- Ergonomi- Geriatri(2 weeks)

Elective Study I(2 weeks)

1

StudiumGenerale and Humaniora(3 weeks)

Medicalcommunication(3 weeks)

BCS (1 weeks)

The cellas bioche-mical machinery(3 weeks)

BCS(1 weeks)

Growth&development(4 weeks)

BCS: (1 weeks)

Pendidikan Pancasila & Kewarganegaraan (3 weeks)


Study Guide Special Topic - Fakultas Kedokteran Udayana Web viewSPECIAL TOPICS. AIMS. To introduce...

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Transcript of Study Guide Special Topic - Fakultas Kedokteran Udayana Web viewSPECIAL TOPICS. AIMS. To introduce...