学术英语医学Unit6

Unitl1、Some factors that may lead to the complaint:•Neuron overload•Patients* high expectations・Mistrust and misunderstanding between the patient and the doctor2、Mrs. Osorio^s condition:•A 56-year-old woman・Somewhat overweight•Reasonably well-controlled diabetes and hypertension・Cholesterol on the high side without any medications for it•Not enough exercises she should take•Her bones a little thin on her last DEXA scan3、Good things:•Blood tests done•Glucose a little better•Her blood pressure a little better but not so great Bad things:• Cholesterol not so great•Her weight a little up•Her bones a little thin on her last DEXA scan 44、The situation:•The author was i n a moderate state of panic: juggling so many thoughts about Mrs.Osorio^s conditions and trying to resolve them all before the clock ran down.•Mrs. Osorio made a trivial request, not so important as compared to her conditions.•Mrs- Osorio seemed to care only about her “innocent — and completely justified 一request'5： the form signed by her doctor.•The doctor tried to or at least pretended to pay attention to the patient while completing documentation.5> Similarities:•In computer multitasking, a microprocessor actually performs only one task at a time. Like microprocessors, we human beings carft actually concentrate on two thoughts at the same exact time. Multitasking is just an illusion both in computers and human beings. Differences:•The concept of multitasking originated in computer science.•At best, human beings can juggle only a handful of thoughts in a multitasking manner, but computers can do much better.•The more thoughts human beings juggle, the less human beings are able to attune fully to any given thought, but computers can do much better.6、•7 medical issues to consider•5 separate thoughts, at least, for each issue•7 x 5 = 35 thoughts•10 patients that afternoon•35 x 10 = 350 thoughts•5 residents under the authors supervision•4 patients seen by each resident•10 thoughts, at least, generated from each patient•5 x 4 x 10 = anther 200 thoughts•350 + 200 = 550 thoughts to be handled in total•If the doctor does a good job juggling 98% of the time, that still leaves about 10 thoughts that might get lost in the process.7、Possible solutions:・Computer-generated reminders•Case managers •Ancillary services•The simplest solution: timeUnit21、The author implies:• Peoples inadequate consciousness about the consequence of neglecting the re- emerging infectious diseases•Unjustifiability of peoples complacency about the prevention and control of theinfectious diseases•Unfinished war against infectious diseases2、Victory declarations:-Surgeon General William Stewart1 s hyperbolic statement of closing "the book oninfectious disease,•A string of impressive victories incurred by antibiotics and vaccines•The thought that the war against infectious diseases was almost over Whatfollowed ever since:-Appearance of new diseases such as AIDS and Ebola•Comeback of the old afflictions:» Diphtheria in the former Soviet Union» TB in urban centers like New York City» Rising Group A streptococcal conditions like scarlet fever•The fear of a powerful new flu strain sweeping the world3、Elaborate on the joined battle:•WHO established a new division devoted to worldwide surveillance and control ofemerging disease in October 1995.•CDC la unched a prevention strategy in 1994.-Congress raised fund from $6.7 million in 1995 to $26 million in 1997.4、The borders are meaningless to pathogenic microbes, which can travel from one country to another remote country in a very short time.5、TB:-Prisons and homeless shelters as ideal places for TB spread•Emerging of drug-resistant strain or even multi-drug-resistant strain•A ride on the HIV w A on by attacking the immunocompromisedGroup A strep:•A change in virulence•Mutation in the exterior of the bacteriumFlu:Constant changes in its coat (surface antigens) and resultant changes in its level of virulence6、Examples:•Experiment in England is seeing the waning immunity because of no vaccination.-Due to poor vaccination efforts, the diphtheria situation in the former Soviet Union is serious. f• The vaccination rates are dropping in some American cities, and it will lead to more diphtheria and whooping cough.7、The four areas of focus:•The need for surveillance•Updated science capable of dealing with discoveries in the field-Appropriate prevention and control•Strong public health infrastructure8、The infectious diseases such as TB, flu, diphtheria and scarlet fever will never really go away, and the war against them will never end.Unit31、Teny's life before•She loved practicing Tae Kwon Do•She loved the surge of adrenaline that came with the controlled combat of tournaments.•She competed nationally, even won bronze medal in the trials for the Pan American Games.•She attended medical school, practiced as an internal medicine resident, and became an academic general internist.• She got married and got a son and a daughter.2、The symptoms of MS and autoimmune disease:•Loss of stamina and strength•Problems with balance•Bouts of horrific facial pain•Dips in visual acuity3、Terry did the following before she self-experimented:•She started injections.•She adopted many pharmacotherapies.•She began her own study of literature:» She read articles on websites such as PubMed.» She searched for articles testing new MS drugs in animal models.» She turned to articles concerning neurodegeneration of all types ——dementia, Parkinson's disease, Huntington^ disease, and Lou Gehrig's disease.» She relearned basic sciences such as cellular physiology, biochemistry, andneurophysiology.4、A pproaches Terry mainly used:•Self-experimentation with various nutrients to slow neurodegeneration based on literature reports on animal models-Self-experimentation with neuromuscular electrical stimulation which is not an approved treatment for MS•Online search to identify the sources of micronutrients and having a new diet •Reduction of food allergies and toxic load5、C ases mentioned in the text:-Increased mercury stores in the brains of people with dental fillings•High levels of the herbicide atrazine in private wells in Iowa•The strong association between pesticide exposure and neurodegeneration•The association of single nucleotide polymorphisms involving metabolism of sulfur and/or B vitamins•Inefficient clearing of toxins6、W ith 70% to 90% of the risk for diabetes, heart disease, cancer, and autoimmunity being due to environmental factors other than the genes, we can take many healthproblems and the health care crisis under our control, for example, optimizing our nutrition and reducing our toxic load.Unit41、Two concepts:•Complementary medicine refers to the use of conventional therapies together withalternative treatments such as using acupuncture in addition to usual care to help lessen pain. Complementary and alternative medicine is shortened as CAM.-Alternative medicine refers to healing treatments that are not part of conventional therapies 一like acupuncture, massage therapy, or herbal medicine. They are called so because people used to consider practices like these outside the mainstream.2•TCM does not require advanced, complicated, and in most cases, expensive facilities.•TCM employs need les, cups, coins, to mention but a few.•Most procedures and operations of TCM are noninvasive.•The substances used as medicine are raw herbs or abstracts from them, and they are indeed all natural, from nature.•TCM has been practiced as long as the Chin ese history, so the efficiency i s proven and ensured.-Ongoing research around the world on acupuncture, herbs, massage and Tai Chi have shed light on some of the theories and practices of TCM3^ It may be used as an adjunct treatment, an alternative, or part of a comprehensivemanagement program for a number of conditions: post-operative and chemotherapyinduced nausea and vomiting, post-operative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.4、 A well-justified NO:•More intense research to uncover additional areas for the use of acupuncture•Higher adoption of acupuncture as a common therapeutic m odality not only in treatment but also in prevention of disease and promotion of wellness-Exploration and perfection of innovative methods of acupuncture point stimulation with technological advancement•Improved understanding of neuroscience and other aspects of human physiology and function by basic research on acupuncture•Greater interest by stakeholders•An increasing number of physician acupuncturists5、-Appropriate uses of herbs depend on proper guidance:» Proper TCM diagnosis of the zheng of the patient» Correct selection of the corresponding therapeutic strategies and principles that guide the choice of herbs and herbal formulas•Digression from either of the above guidence will lead to misuses of herbs, and will result in complications in patient6、•Randomized controlled trialsAdvantages:» Elimination of the potential bias in the allocation of participants to the interventiongroup or control group» Tendency to produce comparable groups» Guaranteed validity of statistical tests of significanceLimitations:» Difficulty in generalizing the results obtained from the selected sampling to the population as a whole» A poor choice for research where temporal factors are an issue» Extremely heavy resources, requiring very large sample groups•Quasi-experimentsAdvantages:» Control group comparisons possible» Reduced threats to external validity as natural environments do not suffer the sameproblems of artificiality as compared to a well-controlled laboratory setting.» Generalizations of the findings to be made about population since quasi・ experiments are natural experimentsLimitations :» Potential for non-equivalent groups as quasi-experimental designs do not use random sampling in constructing experimental and control groups.» Potential for low internal validity as a result of not using random sampling methods to construct the experimental and control groups•Cohort studiesAdvantages:» Clear indication of the temporal sequence between exposure and outcome» Particular use for evaluating the effects of rare or unusual exposure» Ability to examine multiple outcomes of a single risk factorLimitations:» Larger, longer, and more expensive» Prone to certain types of bias» Not practical for rare outcomes•Case-control studiesAdvantages:» The only feasible method in the case of rare diseases and those with long periodsbetween exposure and outcome» Time and cost effective with relatively fewer subjects as compared to other observational methodsLimitations :» Unable to provide the same level of evidence as randomized controlled trials as it is observational in nature» Difficult to establish the timeline of exposure to disease outcome•“N=l" trialsAdvantages» Easy to manage» InexpensiveLimitations :» Findings difficult to be generalized to the whole population» Weakest evidence due to the number of the subject7、•Synthesis of evidence is completely dependent on:» The completeness of the literature search (unavailable for foreign studies)» The accuracy of evaluation-There are situations in which no answer can be found for the questions of interest in RCTs and database analyses.•There's the requirement of using less stringent information rather than “hard data^8、-Assessment of the intrinsic value of traditional medicine in society-Research and education•Political, economic, and social factorsUnit51、• Dis-ease refers to the imbalance arising from :» Continuous stress» Pain» Hardships•Disease is a health crisis ascribable to various dis-eases.-Prompting elimination of dis-eases can alleviate some diseases.2、•Wellness is a state involving every aspect of our being: body, mind and spirit.•Manifestations of a healthy person:» Energy and vitality» A certain zip in gait» A warm feeling of peace of heart seen through behavior3、•Constant messages, positive and negative, are sent to our mind about the health of our body.•Physical symptoms are suppressed by people who go through life on automatic pilot. •Being well eq uals to being disease- or illness-free in the minds of them.•They confused wellness with an absence of symptoms.4、-People's minds are infected by spin:» Half-truth» Fearful fictions» Blatant deceit: some as a form of self-deceit•Spin is a result of unconscious living.•The kind of falseness is pandemic.5•Our body intelligence is suppressed or dormant from a lack of use.-There are tremendous amount of stress on a daily basis.・Our bodies are easily ignored for years because of a lack of recreation time.•Limiting, self-defeating and even self-destructive behaviors undermine our wellbeing and keep them from achieving our full potential.6・We grow more reluctant to take risks.•We lose the ability to feel and acknowledge our deepest feelings and the c ourage to speak our truth.•We continue to deny and repress our feelings to protect ourselves.-Fear, denial and disconnection from our bodies and feelings become anunconscious, self-protective habit, a kind of default response to life.7•A multi-faceted process:» Looking for roots of and resolutions for the issues in different dimensions» Building our wellness toolbox slowly» Picturing our whole state of being•Attention to the little stuff:» Examining our lives honestly and setting clear intentions to change» Striving to maintain a balance of our mind, body and spirit» Taking small steps in the way to perceive and resolve conflict8•Try to awaken and evolve in order to live more consciously.•Get in touch with our genuine fe elings and emotions.・Come to terms with the toxic emotionsUnit61、In the past, most people died at home. But now, more and more people are cared inhospitals and nursing homes at their end of life, which of course brings a new set of questions to consider.2、•Sixty-four years old with a history of congestive heart failure•Deciding to do everything medically possible to extend his life•Availability of around-the-clock medical services and a full range of treatment choices, tests, and other medical care・Relaxed visiting hours, and personal items from home3、Availability of around-the-clock medical resources, including doctors, nurses, andfacility.4、•Taking on a job which is big physically, emotionally, and financially•Hiring a home nurse for additional help-Arranging for services (such as visiting nurses) and special equipment (like a hospital bed or bedside commode)5、•Health insurance-Planning by a professional, such as a hospital discharge plaimer or a social worker •Help from local governmental agencies•Doctor's supervision at home6、•Traditionally, it is only about symptom care.-Recently, it is a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases.7、•Stopp ing treatment specifically aimed at curing an illness equals discontinuing alltreatment.•Choosing a hospice is a permanent decision.Unit71、• A dying patient•Decision whether to withdraw life-support machines and medication and start comfort measures•The family's refusal to make any decision or withdraw any treatments2>•The doctor as exclusive decision-maker•The patient as participant with little say in the final choice3、-Respect for the patient, especially the patient s autonomy•Patient-centered care•The patient as decision-maker based on the information provided by the doctor4、•Patients are forced to make decisions they never want to.-Patients, at least a large majority of them, prefer their doctors to make final decisions.•Shifting responsibility of decision-making to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain.5、Doctors are very much cautious about committing some kind of ethical transgression.6、•Shouldering responsibility together with the patient may be better than having the patient make decisions on their own.•Balancing between paternalism and respect for patients autonomy constitutes a large part of medical practice.Unit81、•Research:An activity to test hypothesis, to permit conclusions to be drawn, and thereby todevelopor contribute to generalizable knowledge・Practice:Interventions solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success•Blurred distinction:» Cooccurrence of research and practice like in research designed to evaluate a therapy » Notable departures from standard practice being called "experimental" with the terms "experimental^ and "research^ carelessly defined2、-Autonomy :Individuals treated as autonomous agents .•Protection:Persons with diminished autonomy entitled to protection•A case in point:Prisoners involved in research3•"Do no hamT as the primary principle・Maximization of possible benefits and minimization of possible harms .・Balance between benefits and potential risks involved in every step of seeding the benefits4、•“Do no harm" as a fundamental principle of medical ethics•Extension of it to t he realm of research by Claude Bernard-Benefits and risks as a set "duct" in both medical practice and research5、•Unreasonable denial of entitled benefit and unduly imposed burden - Enrolment ofpatients in new drug trial: Who should be enrolled and who should not?•Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status6、•Definition:The opportunity to choose what shall or shall not happen to them •Application:» A process rather than signing a written form» Adequate information as the premise» A well-informed decision as the expected result7、•Requirements for consent as entailed by the principle of respect for persons•Risk/benefit assessment as entailed by the principle of beneficence•More requirements of fairness as entailed by the principle of justice:» At the individual level: fairness » At the social level: distinction between classes。

Unit 6 Life and MedicineDeath is an unavoidable and natural part of the life cycle. Medical advances and value changes have increased and acceptability of palliative care and hospice care, which can be provided to critically ill patients at home, hospitals or nursing homes.Text AUseful expressions●George and those closest to him had previouslydecided that, no matter what, the doctor should try to do everything medically possible to extend George’s life.●So, when George needed care, he went to ahospital, where doctors and nurses areavailable around-the-clock.Useful expressions●临终之际/生命垂危之时/生命终了之时/弥留之际at the end of life●生命垂危的人/临终者/弥留之际的人the dying person●临终看护end-of-life care●根据需要/按需as neededUseful expressions●home nurse●visiting nurses● a hospital bed●bedside commode●health insurance●hospital discharge planner●social worker●Area Agency on AgingUseful expressions●Recently, the term palliative care has come tomean more than just treating symptoms.e.g. Gradually, he has come to know his mistake.●…palliative care now often refers to acomprehensive approach to improving thequality of life for people who are living withpotentially fatal diseases. Signpost LanguageGiving examples●For example,...● A good example of this is...●As an illustration,...●To give you an example,...●…is a case in point.●Such as…Vocabulary Testnursing________ homes (养老院)___________care(临终关怀)congestive heart _________(充血性心衰) available________________ (24小时随叫随到)________ care unit (冠心病监护室)to ________ to treatment (对治疗有反应)skilled nursing ________ (专业护理机构)_________care(生命终末期护理)_________ care (舒适护理)hospicefailurearound the clockcoronaryrespondfacilityend-of-lifecomforthospital _________ planner (出院计划专员) symptom ___________ (症状护理)__________care(姑息疗法)__________illness(绝症)chronic obstructive __________ disease慢性阻塞性肺病____________treatment (实验性治疗)spiritual ________ (精神顾问)__________ all treatment (终止所有治疗)to go through _________(经历透析)dischargecarepalliativefatalpulmonaryexperimentaladvisorsdiscontinuedialysisWords to be remembered in Unit 61.personalized2.palliative3.anemia4.potentially5.multidisciplinary6.counselor7.veteran8.eligible9.transition10.pulmonary11. curative12. dialysis13. columnist14. articulate15. anticipation16. stubborn17. stumbling18. obstructive19. obstruction20. exhale幻灯片1021. in vitro22. fertilization23. obstetrician24. symposium25. ethics26. anthropology27. reproductive28. coax29. mammal30. sperm31. high profile32. infertility33. infertile34. visionary35. make sense36. permanent37. by no means38. terminal39. abnormality40. be free of。

Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients* high expectations·Mistrust and misunderstanding between the patient and the doctor2、Mrs. Osorio’s condition:·A 56-year-old woman·Somewhat overweight·Reasonably well-controlled diabetes and hypertension·Cholesterol on the high side without any medications for it·Not enough exercises she should take·Her bones a little thin on her last DEXA scan3、Good things:·Blood tests done·Glucose a little better·Her blood pressure a little better but not so great Bad things:·Cholesterol not so great·Her weight a little up·Her bones a little thin on her last DEXA scan 44、The situation:·The author was in a moderate state of panic: juggling so many thoughts aboutMrs. Osorio’s conditions and trying to resolve them all before the clock ran down.·Mrs. Osorio made a trivial request, not so important as compared to her conditions.and completely justified ·Mrs. Osorio seemed to care only about her “innocent —：the form signed by her doctor.—request”·The doctor tried to or at least pretended to pay attention to the patient whilecompleting documentation.5、Similarities:·In computer multitasking, a microprocessor actually performs only one task at a time. Like microprocessors, we human beings carft actually concentrate on two thoughts at the same exact time. Multitasking is just an illusion both in computersand human beings.Differences:·The concept of multitasking originated in computer science.·At best, human beings can juggle only a handful of thoughts in a multitasking manner, but computers can do much better.·The more thoughts human beings juggle, the less human beings are able to attune fully to any given thought, but computers can do much better.6、·7 medical issues to consider·5 separate thoughts, at least, for each issue·7 x 5 = 35 thoughts·10 patients that afternoon·35 x 10 = 350 thoughts·5 residents under the authors supervision·4 patients seen by each resident·10 thoughts, at least, generated from each patient·5 x 4 x 10 = anther 200 thoughts·350 + 200 = 550 thoughts to be handled in total·If the doctor does a good job juggling 98% of the time, that still leaves about 10 thoughts that might get lost in the process.7、Possible solutions:·Computer-generated reminders·Case managers·Ancillary services·The simplest solution: timeUnit21、The author implies:? Peoples inadequate consciousness about the consequence of neglecting the re-emerging infectious diseases·Unjustifiability of peoples complacency about the prevention and control of theinfectious diseases·Unfinished war against infectious diseases2、Victory declarations:·Surgeon General William Stewart's hyperbolic statement of closing “the book on infectious disease”.·A string of impressive victories incurred by antibiotics and vaccines·The thought that the war against infectious diseases was almost overWhat followed ever since:·Appearance of new diseases such as AIDS and Ebola·Comeback of the old afflictions:? Diphtheria in the former Soviet Union? TB in urban centers like New York City? Rising Group A streptococcal conditions like scarlet fever·The fear of a powerful new flu strain sweeping the world3、Elaborate on the joined battle:·WHO established a new division devoted to worldwide surveillance and controlof emerging disease in October 1995.·CDC launched a prevention strategy in 1994.·Congress raised fund from $6.7 million in 1995 to $26 million in 1997.4、The borders are meaningless to pathogenic microbes, which can travel fromone country to another remote country in a very short time.5、TB:·Prisons and homeless shelters as ideal places for TB spread·Emerging of drug-resistant strain or even multi-drug-resistant strain·A ride on the HIV w^on by attacking the immunocompromisedGroup A strep:·A change in virulence·Mutation in the exterior of the bacteriumFlu:Constant changes in its coat (surface antigens) and resultant changes in its levelof virulence6、Examples:·Experiment in England is seeing the waning immunity because of no vaccination. ·Du e to poor vaccination efforts, the diphtheria situation in the former Soviet Union is serious. '? The vaccination rates are dropping in some American cities, and it will lead to more diphtheria and whooping cough.7、The four areas of focus:·The need for surveillance·Updated science capable of dealing with discoveries in the field·Appropriate prevention and control·Strong public health infrastructure8、The infectious diseases such as TB, flu, diphtheria and scarlet fever will never really go away, and the war against them will never end.Unit31、Terry's life before·She loved practicing Tae Kwon Do·She loved the surge of adrenaline that came with the controlled combat of tournaments.·She competed nationally, even won bronze medal in the trials for the Pan American Games.·She attended medical school, practiced as an internal medicine resident, and became an academic general internist.·She got married and got a son and a daughter.2、The symptoms of MS and autoimmune disease:·Loss of stamina and strength·Problems with balance·Bouts of horrific facial pain·Dips in visual acuity3、Terry did the following before she self-experimented:·She started injections.·She adopted many pharmacotherapies.·She began her own study of literature:? She read articles on websites such as PubMed.? She searched for articles testing new MS drugs in animal models.? She turned to articles concerning neurodegeneration of all types — dementia，Parkinson's disease, Huntington's disease, and Lou Gehrig's disease.? She relearned basic sciences such as cellular physiology, biochemistry, andneurophysiology.4、Approaches Terry mainly used:·Self-experimentation with various nutrients to slow neurodegeneration based on literature reports on animal models·Self-experimentation with neuromuscular electrical stimulation which is not an approved treatment for MS·Online search to identify the sources of micronutrients and having a new diet ·Reduction of food allergies and toxic load5、Cases mentioned in the text:·Increased mercury stores in the brains of people with dental fillings·High levels of the herbicide atrazine in private wells in Iowa·The strong association between pesticide exposure and neurodegeneration·The association of single nucleotide polymorphisms involving metabolism of sulfur and/or B vitamins·Inefficient clearing of toxins6、With 70% to 90% of the risk for diabetes, heart disease, cancer, andautoimmunity being due to environmental factors other than the genes, we cantake many health problems and the health care crisis under our control, for example, optimizing our nutrition and reducing our toxic load.Unit41、Two concepts:·Complementary medicine refers to the use of conventional therapies together with alternative treatments such as using acupuncture in addition to usual care to help lessen pain. Complementary and alternative medicine is shortened as CAM.·Alternative medicine refers to healing treatments that are not part of conventional therapies —like acupuncture, massage therapy, or herbal medicine. They are called so because people used to consider practices like these outside the mainstream.2·TCM does not require advanced, complicated, and in most cases, expensivefacilities.·TCM employs needles, cups, coins, to mention but a few.·Most procedures and operations of TCM are noninvasive.·The substances used as medicine are raw herbs or abstracts from them, andthey are indeed all natural, from nature.·TCM has been practiced as long as the Chinese history, so the efficiency i s proven and ensured.·Ongoing research around the world on acupuncture, herbs, massage and Tai Chi have shed light on some of the theories and practices of TCM3、It may be used as an adjunct treatment, an alternative, or part of a comprehensive management program for a number of conditions: post-operativeand chemotherapy induced nausea and vomiting, post-operative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.4、A well-justified NO:·More intense research to uncover additional areas for the use of acupuncture ·Higher adoption of acupuncture as a common therapeutic modality not only in treatment but also in prevention of disease and promotion of wellness·Exploration and perfection of innovative methods of acupuncture point stimulation with technological advancement·Improved understanding of neuroscience and other aspects of human physiology and function by basic research on acupuncture·Greater interest by stakeholders·An increasing number of physician acupuncturists5、·Appropriate uses of herbs depend on proper guidance:? Proper TCM diagnosis of the zheng of the patient?Correct selection of the corresponding therapeutic strategies and principles that guide the choice of herbs and herbal formulas·Digression from either of the above guidence will lead to misuses of herbs, andwill result in complications in patient6、·Randomized controlled trialsAdvantages:?Elimination of the potential bias in the allocation of participants to the intervention group or control group? Tendency to produce comparable groups? Guaranteed validity of statistical tests of significanceLimitations:? Difficulty in generalizing the results obtained from the selected sampling to the population as a whole? A poor choice for research where temporal factors are anissue?Extremely heavy resources, requiring very large samplegroups? Quasi-experimentsAdvantages:? Control group comparisons possible?Reduced threats to external validity as natural environments do notsuffer the same problems of artificiality as compared to a well-controlledlaboratory setting.?Generalizations of the findings to be made about population since quasiexperiments are natural experimentsLimitations：? Potential for non-equivalent groups as quasi-experimental designs donot use random sampling in constructing experimental and controlgroups.?Potential for low internal validity as a result of not using random sampling methods to construct the experimental and control groups? Cohort studiesAdvantages:?Clear indication of the temporal sequence between exposure and outcome? Particular use for evaluating the effects of rare or unusual exposure? Ability to examine multiple outcomes of a single risk factorLimitations:? Larger, longer, and more expensive? Prone to certain types of bias? Not practical for rare outcomes? Case-control studiesAdvantages:? The only feasible method in the case of rare diseases and those with longperiods between exposure and outcome? Time and cost effective with relatively fewer subjects as compared to other observational methodsLimitations：? Unable to provide the same level of evidence as randomized controlled trialsas it is observational in nature? Difficult to establish the timeline of exposure to disease outcometrials? “N=1”Advantages? Easy to manage? InexpensiveLimitations：? Findings difficult to be generalized to the whole population? Weakest evidence due to the number of the subject7、? Synthesis of evidence is completely dependent on:? The completeness of the literature search (unavailable for foreign studies)? The accuracy of evaluation·There are situations in which no answer can be found for the questions of interest in RCTs and database analyses.·There's the requirement of using less stringent information rather than “hard data”8、·Assessment of the intrinsic value of traditional medicine in society·Research and education·Political, economic, and social factorsUnit51、·Dis-ease refers to the imbalance arising from：? Continuous stress? Pain? Hardships·Disease is a health crisis ascribable to various dis-eases.·Prompting elimination of dis-eases can alleviate some diseases.2、·Wellness is a state involving every aspect of our being: body, mind and spirit.·Manifestations of a healthy person:? Energy and vitality? A certain zip in gait? A warm feeling of peace of heart seen through behavior3、·Constant messages, positive and negative，are sent to our mind about the health of our body.·Physical symptoms are suppressed by people who go through life on automatic pilot.·Being well equals to being disease- or illness-free in the minds of them.·They confused wellness with an absence of symptoms.4、·People's minds are infected by spin:? Half-truth? Fearful fictions? Blatant deceit: some as a form of self-deceit·Spin is a result of unconscious living.·The kind of falseness is pandemic.5·Our body intelligence is suppressed or dormant from a lack of use.·There are tremendous amount of stress on a daily basis.·Our bodies are easily ignored for years because of a lack of recreation time. ·Limiting, self-defeating and even self-destructive behaviors undermine our wellbeing and keep them from achieving our full potential.6·We grow more reluctant to take risks.·We lose the ability to feel and acknowledge our deepest feelings and the courage to speak our truth.·We continue to deny and repress our feelings to protect ourselves.·Fear, denial and disconnection from our bodies and feelings become an unconscious, self-protective habit, a kind of default response to life.7·A multi-faceted process:? Looking for roots of and resolutions for the issues in different dimensions? Building our wellness toolbox slowly? Picturing our whole state of being·Attention to the little stuff:? Examining our lives honestly and setting clear intentions to change? Striving to maintain a balance of our mind, body and spirit? Taking small steps in the way to perceive and resolve conflict8·Try to awaken and evolve in order to live more consciously.·Get in touch with our genuine feelings and emotions.·Come to terms with the toxic emotionsUnit61、In the past, most people died at home. But now, more and more people are caredin hospitals and nursing homes at their end of life, which of course brings a newset of questions to consider.2、·Sixty-four years old with a history of congestive heart failure·Deciding to do everything medically possible to extend his life·Availability of around-the-clock medical services and a full range of treatmentchoices, tests, and other medical care·Relaxed visiting hours, and personal items from home3、Availability of around-the-clock medical resources, including doctors, nurses, andfacility.4、·Taking on a job which is big physically, emotionally, and financially·Hiring a home nurse for additional help·Arranging for services (such as visiting nurses) and special equipment (like ahospital bed or bedside commode)5、·Health insurance·Planning by a professional, such as a hospital discharge plaimer or a social worker·Help from local governmental agencies·Doctor's supervision at home6、·Traditionally, it is only about symptom care.·Recently, it is a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases.7、·Stopping treatment specifically aimed at curing an illness equals discontinuing all treatment.·Choosing a hospice is a permanent decision.Unit71、·A dying patient·Decision whether to withdraw life-support machines and medication and startcomfort measures·The family's refusal to make any decision or withdraw any treatments2、·The doctor as exclusive decision-maker·The patient as participant with little say in the final choice3、·Respect for the patient, especially the patient s autonomy·Patient-centered care·The patient as decision-maker based on the information provided by the doctor4、·Patients are forced to make decisions they never want to.·Patients, at least a large majority of them, prefer their doctors to make final decisions.·Shifting responsibility of decision-making to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain.5、Doctors are very much cautious about committing some kind of ethicaltransgression.6、·Shouldering responsibility together with the patient may be better than havingthe patient make decisions on their own.·Balancing between paternalism and respect for patients autonomy constitutes alarge part of medical practice.Unit81、·Research:An activity to test hypothesis, to permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge·Practice:Interventions solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success·Blurred distinction:? Cooccurrence of research and practice like in research designed to evaluate a therapy? Notable departures from standard practice being called “experimental” withl”and “research” carelessly definedthe terms “experimenta2、·Autonomy：Individuals treated as autonomous agents .·Protection:Persons with diminished autonomy entitled to protection·A case in point:Prisoners involved in research3·“Do no harm” as the primary principle·Maximization of possible benefits and minimization of possible harms .·Balance between benefits and potential risks involved in every step of seedingthe benefits4、·“Do no harm” as a fundamental principle of medical ethics·Extension of it to the realm of research by Claude Bernard·Benefits and risks as a set “duet” in both medical practice and research 5、·Unreasonable denial of entitled benefit and unduly imposed burden：Enrolment of patients in new drug trial: Who should be enrolled and who should not?·Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status6、·Definition:The opportunity to choose what shall or shall not happen to them·Application:? A process rather than signing a written form? Adequate information as the premise? A well-informed decision as the expected result7、·Requirements for consent as entailed by the principle of respect for persons ·Risk/benefit assessment as entailed by the principle of beneficence ·More requirements of fairness as entailed by the principle of justice: ? At the individual level: fairness? At the social level: distinction between classes。

医学人文英语第三版下册u6作文全文共3篇示例，供读者参考篇1Medical humanities is a field that explores the intersection of medicine and human experience, emphasizing the importance of understanding patients as individuals with unique stories, emotions, and perspectives. In the third volume of Medical Humanities in English, Unit 6 focuses on the topic of narrative medicine, which emphasizes the power of storytelling in medicine.Narrative medicine recognizes the importance of listening to patients' stories, understanding their emotional experiences, and integrating these narratives into the clinical practice. By doing so, healthcare providers can develop a more holistic andpatient-centered approach to care, fostering empathy, compassion, and trust between patients and providers.One of the key themes in Unit 6 is the impact of illness narratives on patients' experiences of health and illness. Patients often use narratives to make sense of their experiences, express their concerns and fears, and seek support and validation fromhealthcare providers. By listening attentively to these narratives, providers can gain insights into patients' beliefs, values, and priorities, which can inform their treatment decisions and improve patient outcomes.Another important aspect of narrative medicine is the use of reflective writing and storytelling as a tool for personal and professional development. Healthcare providers can use writing and storytelling to reflect on their own experiences, emotions, and challenges, gaining insight into their own biases, limitations, and strengths. By engaging in self-reflection and sharing their stories with colleagues, providers can enhance their communication skills, empathy, and resilience, ultimately improving the quality of care they provide to patients.In addition, Unit 6 explores the ethical considerations of narrative medicine, such as the importance of respecting patients' autonomy, confidentiality, and privacy when sharing their stories. Healthcare providers must ensure that patients feel comfortable and empowered to disclose their narratives, without fear of judgment or exploitation. By upholding ethical principles and values, providers can build trusting relationships with patients, fostering a therapeutic alliance that is essential for effective communication and collaboration in healthcare.Overall, Unit 6 of Medical Humanities in English highlights the transformative power of narrative medicine in healthcare, emphasizing the importance of storytelling in promoting empathy, understanding, and healing. By integrating narrative approaches into clinical practice, healthcare providers can enhance the patient-provider relationship, improve patient outcomes, and foster a more compassionate and humanistic healthcare system. As healthcare professionals, it is essential to recognize the value of patients' stories, listen with an open heart and mind, and honor the humanity of each individual we care for.篇2Humanistic Care in Medical PracticeIntroductionAs medical professionals, it is not enough to simply possess the technical knowledge and skills to diagnose and treat patients. In addition to the medical aspect of healthcare, it is crucial for healthcare providers to also incorporate humanistic care into their practice. Humanistic care focuses on the emotional, psychological, and social needs of patients, recognizing them as individuals with unique experiences and feelings. In this essay, we will explore the importance of humanistic care in medicalpractice and discuss how it can improve patient outcomes and overall healthcare delivery.Importance of Humanistic CareHumanistic care is important in medical practice for several reasons. First and foremost, it helps build trust and rapport between healthcare providers and patients. By showing empathy, compassion, and respect towards patients, healthcare providers can create a supportive and trusting environment in which patients feel comfortable sharing their concerns and seeking help. This, in turn, can improve patient satisfaction and compliance with treatment plans.Secondly, humanistic care contributes to better clinical outcomes. Research has shown that patients who receive humanistic care are more likely to adhere to treatment regimens, experience less pain and anxiety, and have faster recovery times. This is because when patients feel understood and supported by their healthcare providers, they are more likely to actively participate in their own care and take steps to improve their health.Furthermore, humanistic care is essential for addressing the emotional and psychological needs of patients. Illness and injury can have a profound impact on a person's mental well-being,leading to feelings of fear, anxiety, and depression. By providing emotional support, reassurance, and counseling, healthcare providers can help patients cope with their emotions and build resilience in the face of adversity.Practical Strategies for Incorporating Humanistic CareThere are several practical strategies that healthcare providers can use to incorporate humanistic care into their practice. Firstly, active listening is key. By listening attentively to patients and acknowledging their concerns, healthcare providers can show that they care about the patient as a whole person, not just as a set of symptoms or a disease.Secondly, healthcare providers should practice cultural sensitivity and respect diversity. Patients come from a variety of cultural backgrounds, each with its own beliefs, values, and practices. By respecting and understanding these differences, healthcare providers can ensure that care is tailored to meet the individual needs of each patient.Thirdly, empathy and compassion are essential components of humanistic care. Healthcare providers should strive to understand the patient's perspective, show empathy for their emotions, and offer words of comfort and support. By connecting with patients on an emotional level, healthcareproviders can build trust and strengthen the therapeutic relationship.Finally, healthcare providers should involve patients in decision-making regarding their care. By empowering patients to participate in their own treatment plans, healthcare providers can promote autonomy and encourage patients to take an active role in managing their health.ConclusionIn conclusion, humanistic care is an essential component of medical practice that focuses on the emotional, psychological, and social needs of patients. By incorporating humanistic care into their practice, healthcare providers can build trust and rapport with patients, improve clinical outcomes, and address the emotional needs of patients. Through active listening, cultural sensitivity, empathy, and patient empowerment, healthcare providers can provide holistic care that treats the patient as a whole person, not just a set of symptoms. Ultimately, humanistic care is about recognizing the humanity in healthcare and striving to create a compassionate and supportive environment for patients to heal and thrive.篇3The Importance of Medical Humanities in HealthcareIntroductionThe field of medicine has advanced significantly over the years, with groundbreaking technological innovations, specialized treatments, and cutting-edge research. However, in the midst of all these advancements, it is important not to overlook the human aspect of healthcare. This is where medical humanities come into play – the integration of humanities disciplines like literature, philosophy, ethics, and history into medical education and practice. In this essay, we will explore the significance of medical humanities in enhancing patient care and the overall healthcare system.Empathy and CompassionOne of the key benefits of incorporating medical humanities into healthcare is the cultivation of empathy and compassion among healthcare professionals. By studying literature, for example, medical students can learn to appreciate the human experience, understand different perspectives, and develop a greater sense of empathy towards their patients. This can lead to improved communication, better patient-provider relationships, and ultimately, better health outcomes.Ethical Decision-MakingMedical humanities also play a crucial role in helping healthcare professionals navigate complex ethical issues that arise in the field of medicine. By studying ethics and philosophy, medical students can develop critical thinking skills, moral reasoning, and a deeper understanding of the ethical dilemmas they may face in their practice. This can help them make informed and morally sound decisions that prioritize thewell-being of their patients.Cultural CompetenceIn today's diverse and multicultural society, it is essential for healthcare professionals to be culturally competent and sensitive to the needs and beliefs of patients from different backgrounds. Medical humanities provide a platform for exploring cultural diversity, understanding the social determinants of health, and promoting inclusivity in healthcare settings. This can help healthcare professionals deliver more effective andpatient-centered care that respects the values and preferences of individuals from diverse communities.Narrative MedicineAnother important aspect of medical humanities is narrative medicine, which emphasizes the power of storytelling in healthcare. By listening to and reflecting on patients' stories, healthcare professionals can gain valuable insights into their experiences, emotions, and values. This can humanize the healthcare experience, foster trust and rapport between patients and providers, and enable a more holistic approach to patient care that takes into account the patient's unique narrative and context.Professional Well-BeingLastly, medical humanities can also benefit healthcare professionals themselves by enhancing their well-being and resilience in the face of the challenges and stresses of the healthcare environment. Studying humanities disciplines like literature and art can provide a source of meaning, inspiration, and self-care for healthcare professionals, helping them cope with burnout, moral distress, and emotional exhaustion. This can ultimately promote a healthier and more sustainable work environment that prioritizes the well-being of both patients and providers.ConclusionIn conclusion, medical humanities play a vital role in enhancing patient care, promoting ethical decision-making, fostering cultural competence, and supporting the well-being of healthcare professionals. By integrating humanities disciplines into medical education and practice, we can create a more humane, empathetic, and patient-centered healthcare system that values the human aspect of medicine alongside technological advancements. As we continue to advance in the field of healthcare, let us not forget the importance of the human touch and the power of the humanities to enrich our understanding and practice of medicine.。

医学英语教程-生物医学Unit 6 Reading AThe Kidney and Its Working Unit肾及其工作单位For many diners, eating tender, pale green shoots of asparagus is a pleasurable springtime event, but the gastronomic experience has a peculiar sequel：The next time they urinate ,even if just 20 minutes after eating, they notice the characteristic scent of asparagus. A chemical in the food crosses the gut ,enters the bloodstream, is filtered out by the kidneys, and appears in the urine with amazing speed. Actually, the chemical is acted on no faster than any other compound. The kidneys are simply marvels at processing body fluids and filtering out the urea; the sodium ,potassium ,or chloride ions ;and the glucose, water ,and other materials that need to be excreted. The key to a kidney's rapid functioning lies in its complicated internal structure and in the effcient plumbing system of which it is a part.对许多用餐者来说，吃到浅绿鲜嫩的芦笋是春季的一大享受，但享用完这种美食后会有一个奇特的后续：即使饭后仅20分钟,人们便会在上厕所时注意到尿液中有芦笋特殊的气味。

A篇重点句子Unit 1 textA1、Although there are probably a few doctors who truly are tone-deaf, most are reasonably empathic human beings, and I wonder why even these doctors seem prey to this criticism.虽然可能会有那么几个医生确实充耳不闻，但是大多数医生通情达理，还是能够感同身受的人。

我就纳闷为什么竟然这些医生似乎成为批评的牺牲品。

2、Sometimes it feels as though my brain is juggling so many competing details, that one stray request from a patient—even one that is quite relevant—might send the delicately balanced three-ring circus tumbling down.如果病人冷不丁提个要求，即使所提要求十分中肯，也会让我那小心翼翼维系平衡的大脑乱作一团，就像井然有序同时演出三台节目的大马戏场突然崩塌一样。

3、From her prospective, this is probably the most important item in our visit, but the fact is that she’s caught one of my neurons in mid-fire.从她的角度来看，这可能是她此次就诊最要紧的事。

但事实是，她却让我的神经紧张起来。

4、My instinct is to put one hand up and keep all interruptions at bay.我的本能反应是举起一只手，阻止她打断我的思路。

Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients* high expectations·Mistrust and misunderstanding between the patient and the doctorcondition:2、Mrs. Osorio’s·A 56-year-old woman·Somewhat overweight·Reasonably well-controlled diabetes and hypertension·Cholesterol on the high side without any medications for it·Not enough exercises she should take·Her bones a little thin on her last DEXA scan3、Good things:·Blood tests done·Glucose a little better·Her blood pressure a little better but not so great Bad things:·Cholesterol not so great·Her weight a little up·Her bones a little thin on her last DEXA scan 44、The situation:·The author was in a moderate state of panic: juggling so many thoughts aboutMrs. Osorio’s conditions and trying to resolve them all before the clock ran down.·Mrs. Osorio made a trivial request, not so important as compared to her conditions.and completely justified ·Mrs. Osorio seemed to care only about her “innocent ——request”：the form signed by her doctor.·The doctor tried to or at least pretended to pay attention to the patient whilecompleting documentation.5、Similarities:·In computer multitasking, a microprocessor actually performs only one task at a time. Like microprocessors, we human beings carft actually concentrate on two thoughts at the same exact time. Multitasking is just an illusion both in computersand human beings.Differences:·The concept of multitasking originated in computer science.·At best, human beings can juggle only a handful of thoughts in a multitasking manner, but computers can do much better.·The more thoughts human beings juggle, the less human beings are able to attune fully to any given thought, but computers can do much better.6、·7 medical issues to consider·5 separate thoughts, at least, for each issue·7 x 5 = 35 thoughts·10 patients that afternoon·35 x 10 = 350 thoughts·5 residents under the authors supervision·4 patients seen by each resident·10 thoughts, at least, generated from each patient·5 x 4 x 10 = anther 200 thoughts·350 + 200 = 550 thoughts to be handled in total·If the doctor does a good job juggling 98% of the time, that still leaves about 10 thoughts that might get lost in the process.7、Possible solutions:·Computer-generated reminders·Case managers·Ancillary services·The simplest solution: timeUnit21、The author implies:Peoples inadequate consciousness about the consequence of neglecting the re- emerging infectious diseases·Unjustifiability of peoples complacency about the prevention and control of theinfectious diseases·Unfinished war against infectious diseases2、Victory declarations:·Surgeon General William Stewart's hyperbolic statement of closing “the book on infectious disease”.·A string of impressive victories incurred by antibiotics and vaccines·The thought that the war against infectious diseases was almost overWhat followed ever since:·Appearance of new diseases such as AIDS and Ebola·Comeback of the old afflictions:Diphtheria in the former Soviet UnionTB in urban centers like New York CityRising Group A streptococcal conditions like scarlet fever·The fear of a powerful new flu strain sweeping the world3、Elaborate on the joined battle:·WHO established a new division devoted to worldwide surveillance and controlof emerging disease in October 1995.·CDC launched a prevention strategy in 1994.·Congress raised fund from $6.7 million in 1995 to $26 million in 1997.4、The borders are meaningless to pathogenic microbes, which can travel fromone country to another remote country in a very short time.5、TB:·Prisons and homeless shelters as ideal places for TB spread·Emerging of drug-resistant strain or even multi-drug-resistant strain·A ride on the HIV w^on by attacking the immunocompromisedGroup A strep:·A change in virulence·Mutation in the exterior of the bacteriumFlu:Constant changes in its coat (surface antigens) and resultant changes in its levelof virulence6、Examples:·Experiment in England is seeing the waning immunity because of no vaccination. ·Du e to poor vaccination efforts, the diphtheria situation in the former Soviet Union is serious. 'The vaccination rates are dropping in some American cities, and it will lead to more diphtheria and whooping cough.7、The four areas of focus:·The need for surveillance·Updated science capable of dealing with discoveries in the field·Appropriate prevention and control·Strong public health infrastructure8、The infectious diseases such as TB, flu, diphtheria and scarlet fever will never really go away, and the war against them will never end.Unit31、Terry's life before·She loved practicing Tae Kwon Do·She loved the surge of adrenaline that came with the controlled combat of tournaments.·She competed nationally, even won bronze medal in the trials for the Pan American Games.·She attended medical school, practiced as an internal medicine resident, and became an academic general internist.·She got married and got a son and a daughter.2、The symptoms of MS and autoimmune disease:·Loss of stamina and strength·Problems with balance·Bouts of horrific facial pain·Dips in visual acuity3、Terry did the following before she self-experimented:·She started injections.·She adopted many pharmacotherapies.·She began her own study of literature:She read articles on websites such as PubMed.She searched for articles testing new MS drugs in animal models.She turned to articles concerning neurodegeneration of all types — dementia，Parkinson's disease, Huntington's disease, and Lou Gehrig's disease.She relearned basic sciences such as cellular physiology, biochemistry, andneurophysiology.4、Approaches Terry mainly used:·Self-experimentation with various nutrients to slow neurodegeneration based on literature reports on animal models·Self-experimentation with neuromuscular electrical stimulation which is not an approved treatment for MS·Online search to identify the sources of micronutrients and having a new diet ·Reduction of food allergies and toxic load5、Cases mentioned in the text:·Increased mercury stores in the brains of people with dental fillings·High levels of the herbicide atrazine in private wells in Iowa·The strong association between pesticide exposure and neurodegeneration·The association of single nucleotide polymorphisms involving metabolism of sulfur and/or B vitamins·Inefficient clearing of toxins6、With 70% to 90% of the risk for diabetes, heart disease, cancer, andautoimmunity being due to environmental factors other than the genes, we cantake many health problems and the health care crisis under our control, for example, optimizing our nutrition and reducing our toxic load.Unit41、Two concepts:·Complementary medicine refers to the use of conventional therapies together with alternative treatments such as using acupuncture in addition to usual care to help lessen pain. Complementary and alternative medicine is shortened as CAM.·Alternative medicine refers to healing treatments that are not part of conventional therapies —like acupuncture, massage therapy, or herbal medicine. They are called so because people used to consider practices like these outside the mainstream.2·TCM does not require advanced, complicated, and in most cases, expensivefacilities.·TCM employs needles, cups, coins, to mention but a few.·Most procedures and operations of TCM are noninvasive.·The substances used as medicine are raw herbs or abstracts from them, andthey are indeed all natural, from nature.·TCM has been practiced as long as the Chinese history, so the efficiency i s proven and ensured.·Ongoing research around the world on acupuncture, herbs, massage and Tai Chi have shed light on some of the theories and practices of TCM3、It may be used as an adjunct treatment, an alternative, or part of a comprehensive management program for a number of conditions: post-operativeand chemotherapy induced nausea and vomiting, post-operative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.4、A well-justified NO:·More intense research to uncover additional areas for the use of acupuncture ·Higher adoption of acupuncture as a common therapeutic modality not only in treatment but also in prevention of disease and promotion of wellness·Exploration and perfection of innovative methods of acupuncture point stimulation with technological advancement·Improved understanding of neuroscience and other aspects of human physiology and function by basic research on acupuncture·Greater interest by stakeholders·An increasing number of physician acupuncturists5、·Appropriate uses of herbs depend on proper guidance:Proper TCM diagnosis of the zheng of the patientCorrect selection of the corresponding therapeutic strategies and principles that guide the choice of herbs and herbal formulas·Digression from either of the above guidence will lead to misuses of herbs, andwill result in complications in patient6、·Randomized controlled trialsAdvantages:Elimination of the potential bias in the allocation of participants to the intervention group or control groupTendency to produce comparable groupsGuaranteed validity of statistical tests of significanceLimitations:Difficulty in generalizing the results obtained from the selected sampling to the population as a wholeA poor choice for research where temporal factors are anissueExtremely heavy resources, requiring very large samplegroupsQuasi-experimentsAdvantages:Control group comparisons possibleReduced threats to external validity as natural environments do notsuffer the same problems of artificiality as compared to a well-controlledlaboratory setting.Generalizations of the findings to be made about population since quasiexperiments are natural experimentsLimitations：Potential for non-equivalent groups as quasi-experimental designs donot use random sampling in constructing experimental and controlgroups.Potential for low internal validity as a result of not using random sampling methods to construct the experimental and control groupsCohort studiesAdvantages:Clear indication of the temporal sequence between exposure and outcomeParticular use for evaluating the effects of rare or unusual exposureAbility to examine multiple outcomes of a single risk factorLimitations:Larger, longer, and more expensiveProne to certain types of biasNot practical for rare outcomesCase-control studiesAdvantages:The only feasible method in the case of rare diseases and those with longperiods between exposure and outcomeTime and cost effective with relatively fewer subjects as compared to other observational methodsLimitations：Unable to provide the same level of evidence as randomized controlled trialsas it is observational in natureDifficult to establish the timeline of exposure to disease outcomeN=1” trials“AdvantagesEasy to manageInexpensiveLimitations：Findings difficult to be generalized to the whole populationWeakest evidence due to the number of the subject7、Synthesis of evidence is completely dependent on:The completeness of the literature search (unavailable for foreign studies)The accuracy of evaluation·There are situations in which no answer can be found for the questions of interest in RCTs and database analyses.·There's the requirement of using less stringent information rather than “hard data”8、·Assessment of the intrinsic value of traditional medicine in society·Research and education·Political, economic, and social factorsUnit51、·Dis-ease refers to the imbalance arising from：Continuous stressPainHardships·Disease is a health crisis ascribable to various dis-eases.·Prompting elimination of dis-eases can alleviate some diseases.2、·Wellness is a state involving every aspect of our being: body, mind and spirit.·Manifestations of a healthy person:Energy and vitalityA certain zip in gaitA warm feeling of peace of heart seen through behavior3、·Constant messages, positive and negative，are sent to our mind about the health of our body.·Physical symptoms are suppressed by people who go through life on automatic pilot.·Being well equals to being disease- or illness-free in the minds of them.·They confused wellness with an absence of symptoms.4、·People's minds are infected by spin:Half-truthFearful fictionsBlatant deceit: some as a form of self-deceit·Spin is a result of unconscious living.·The kind of falseness is pandemic.5·Our body intelligence is suppressed or dormant from a lack of use.·There are tremendous amount of stress on a daily basis.·Our bodies are easily ignored for years because of a lack of recreation time. ·Limiting, self-defeating and even self-destructive behaviors undermine our wellbeing and keep them from achieving our full potential.6·We grow more reluctant to take risks.·We lose the ability to feel and acknowledge our deepest feelings and the courage to speak our truth.·We continue to deny and repress our feelings to protect ourselves.·Fear, denial and disconnection from our bodies and feelings become an unconscious, self-protective habit, a kind of default response to life.7·A multi-faceted process:Looking for roots of and resolutions for the issues in different dimensionsBuilding our wellness toolbox slowlyPicturing our whole state of being·Attention to the little stuff:Examining our lives honestly and setting clear intentions to changeStriving to maintain a balance of our mind, body and spiritTaking small steps in the way to perceive and resolve conflict8·Try to awaken and evolve in order to live more consciously.·Get in touch with our genuine feelings and emotions.·Come to terms with the toxic emotionsUnit61、In the past, most people died at home. But now, more and more people are caredin hospitals and nursing homes at their end of life, which of course brings a newset of questions to consider.2、·Sixty-four years old with a history of congestive heart failure·Deciding to do everything medically possible to extend his life·Availability of around-the-clock medical services and a full range of treatmentchoices, tests, and other medical care·Relaxed visiting hours, and personal items from home3、Availability of around-the-clock medical resources, including doctors, nurses, andfacility.4、·Taking on a job which is big physically, emotionally, and financially·Hiring a home nurse for additional help·Arranging for services (such as visiting nurses) and special equipment (like ahospital bed or bedside commode)5、·Health insurance·Planning by a professional, such as a hospital discharge plaimer or a social worker·Help from local governmental agencies·Doctor's supervision at home6、·Traditionally, it is only about symptom care.·Recently, it is a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases.7、·Stopping treatment specifically aimed at curing an illness equals discontinuing all treatment.·Choosing a hospice is a permanent decision.Unit71、·A dying patient·Decision whether to withdraw life-support machines and medication and startcomfort measures·The family's refusal to make any decision or withdraw any treatments2、·The doctor as exclusive decision-maker·The patient as participant with little say in the final choice3、·Respect for the patient, especially the patient s autonomy·Patient-centered care·The patient as decision-maker based on the information provided by the doctor4、·Patients are forced to make decisions they never want to.·Patients, at least a large majority of them, prefer their doctors to make final decisions.·Shifting responsibility of decision-making to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain.5、Doctors are very much cautious about committing some kind of ethicaltransgression.6、·Shouldering responsibility together with the patient may be better than havingthe patient make decisions on their own.·Balancing between paternalism and respect for patients autonomy constitutes alarge part of medical practice.Unit81、·Research:An activity to test hypothesis, to permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge·Practice:Interventions solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success·Blurred distinction:Cooccurrence of research and practice like in research designed to evaluate a therapyNotable departure s from standard practice being called “experimental” withl”and “research” carelessly definedthe terms “experimenta2、·Autonomy：Individuals treated as autonomous agents .·Protection:Persons with diminished autonomy entitled to protection·A case in point:Prisoners involved in research3·“Do no harm” as the primary principle·Maximization of possible benefits and minimization of possible harms .·Balance between benefits and potential risks involved in every step of seedingthe benefits4、·“Do no harm” as a fundamental principle of medical ethics·Extension of it to the realm of research by Claude Bernard·Benefits and risks as a set “duet” in both medical practice and research 5、·Unreasonable denial of entitled benefit and unduly imposed burden：Enrolment of patients in new drug trial: Who should be enrolled and who should not?·Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status6、·Definition:The opportunity to choose what shall or shall not happen to them·Application:A process rather than signing a written formAdequate information as the premiseA well-informed decision as the expected result7、·Requirements for consent as entailed by the principle of respect for persons ·Risk/benefit assessment as entailed by the principle of beneficence ·More requirements of fairness as entailed by the principle of justice: At the individual level: fairnessAt the social level: distinction between classes。

首先介绍，在生命尽头的关爱有几种形式？Asked where they would like to spend their last days, most people always say at home, surrounded by people they love. In real life, though, only one in five achieves that. More than 30% die in a nursing home, where almost no one wants to be, and over half end up in a hospital, often in an intensive-care unit, heavily sedated and attached to life-saving equipment until their doctors give up the battle.【参考资料：有at hospitals and nursing homes，有at home，有hospice（临终关怀服务）。

】然后开始重点阐述“临终关怀”：一、什么是“临终关怀”服务的对象&目的？Hospice care is a system of care that helps those with an incurable illness（对象）to focus on making the most of whatever time is left（目的）. They offer a range of support, often alongside active treatment for an illness. The focus of modern hospice care is on helping people to live well until they die. Dying in a hospice care can bring families（对象）peace and allow a closeness which isn't always possible at home.【参考资料：临终关怀（palliative care = hospice care = terminal care）并非是一种治愈疗法，而是一种专注于在患者在将要逝世前的几个星期甚至几个月的时间内，减轻其疾病的症状、延缓疾病发展的医疗护理。

Unit 6 Text A寻求临终护理数十年前，大多数人在自己家中去世，但是医疗方面的进步已经改变了这一情况。

如今，大多数美国人在医院或是疗养院中度过生命的最终时光。

他们中有些人是为了治疗疾病进了医院，有些可能是选择长期住在疗养院。

越来越多的人在生命的尽头开始选择临终关怀。

死亡没有一个称得上“合适”的地点。

何况，我们死亡的地方，大多数情况下也并非我们可以决定的。

但如果有选择的机会，每个人及其家属，都应该考虑究竟怎样的临终护理最为适合，在哪里可以享受到这样的关怀，家人和朋友能否提供帮助，以及他们应该如何支付相应的费用。

医院及疗养院64 岁的 George 有充血性心力衰竭病史。

一天晚上，他因为胸痛被送入医院。

他与他最亲近的人事先便已决定，在任何情况下都要让医生使用最大努力来延续他的生命。

所以当他需要相应的治疗时，他选择了医院，因为那里有全天候工作的医生和护士。

医院提供一整套的治疗、检查及其他医疗照护。

一旦George的心脏出现持续衰竭，医院的重症监护病房（ICU）或冠心病重症监护病房（CCU）就可以提供及时的救护。

尽管医院有相关的规定，在有些情况下执行具有一定的弹性。

如果George的医生认为他的病情并没有因为治疗有所好转，并濒临死亡，他的家属可以要求更加宽松的探视时间。

如果他的家属想从家中给他带一些私人物品，可以向工作人员询问物品的尺寸限制或是是否需要消毒。

不论George住在ICU、CCU还是两病床的病房，其家属都可以要求更多的私人空间。

在医院环境中，对临终病人来说，身边永远会有知道该如何照料他的医务人员。

这一点令病人及其家属得以安心。

已有越来越多的人在生命尽头的时候选择疗养院，因为在这里，护理人员是随叫随到的。

疗养院有时也被称为专业护理所，在临终护理方面有利有弊。

与医院不同，疗养院里并不是全天候都有医生在场。

然而，由于临终护理可以事先安排，在病人濒临死亡时，不需要事先咨询医生而开展照护。

如果濒死病人已经在疗养院住了一段时间，家属很可能已经和护理人员建立了一定的关系，因而与医院相比，这里的护理工作更具个性化。

学术英语〔医学〕课后词组Unit11．overload神经过载2.a typical典型的诊所就诊3.DEXA DEXA扫描行医5. control血压控制6.health健康保持7. report乳房X线检查报告8. examination体检9. of a medication药物的副作用10.perpetual永久的恐慌11. physicians职业医生12. field移植领域13.medical医疗预算扑热息痛药片15. cap防孩子打开的盖子16. clinical trial随机临床试验17.Random随机分配18.patient病人的预后19. group对照组20.a10-year study10年的跟踪研究21.a medical内科病房传染性肝炎23.Severe身体严重不适24.bilirubin胆红素代谢damage永久的肝损伤加重病理生理状况27.Medical医学文献临床调查29. of relapse复发率临床流行病学严格的卧床休息32.hospital住院反复发作的黄疸34.clinical临床病程35 morphine静脉注射吗啡36 blood pressure舒张压大脑血灌输38. care初级保健39.aorto-coronary arterial 主动脉冠状动脉旁路40. treatment decision知情治疗决41.an international group 一个国际人道组织42.the Red红十字会43.The first major effort第一次重大援助工作44 of war战争中的人员伤亡45. relief efforts紧急援助、Unit21 disease(再现疾病)2.new flu新流感变种3.antibiotics and抗生素和疫苗4. disease传染病5 disease新现疾病6 strategy预防策略7.bubonic腺鼠疫8. microbes病原微生物9.public heath 公共卫生机构抗药性of antibiotic therapy抗生素治疗疗程猩红热13.the level of 毒性水平14.flu流感大流行15.surface外表抗原16. shift基因改变神经性并发症18.waning of 免疫力减弱19.public health公共卫生基础设施20.a malaria一个疟疾病例21. flu猪流感22. bacillus结核杆菌of morbidity发病率水平24.health保健专业人士25 tuberculosis潜伏结核病结核素皮试27. programmes筛查计划28. gamma testsγ干扰素测试29.drug药物毒性30.an disease一种可治愈的病31, infectious disease难治的传染病32.an unknown一种未知的病原体33.chronic gastric 慢性胃溃疡34 to carries of disease接触带病者35,genetic基因重组36.agent of 生物恐怖活动病原37. infections通过食物传播的传染病Unit31.the surge of肾上腺素激增2.an internal medicine 内科实习期disease自体免疫4.loss of丧失持久力5. weakness短暂的虚弱6.becoming卧床不起7.a building基本构件8.an animal动物模型9.to slow 减缓神经退化10.to toxins排除毒素11.to nutrition优化营养毒素载量13.the risk of复发危险14.physician医生自我实验15.a clinical 临床试验16. electrical stimulation神经肌肉电刺激理疗师18.the impact of微量营养素的影响19.brain脑功能2 the emotional flow跟踪情绪波动21 of emotions情绪协调22. reactions心血管反应23.feeling of t亲密感觉情绪传染27.a生物心理单元28.emotional情感慰藉resonance 功能性磁共振成像30.to brain zones激活该脑部区域31.to make it使之成为强制性project无把握的项目33.medical background医学背景4.proof of概念验证35.dose剂量方案36. or concomitant conditions 并发症与合并症37 agents抗肿瘤的药剂标准疗法39. properties药理学特性溶解性差41. pharmacology体内药理学Unit41.medicine补充医学2. medicine替代医学3.a medical医疗模式4. and herbs针灸和草药treatment辅助治疗6. a and vomiting恶心，呕吐7. dental pain术后牙痛. trials临床试验9. therapy物理疗法，理疗10 modalities治疗方法11.a therapeutic治疗干预12.Research design研究设计13.magnetic e磁共振tomography正电子发射型电脑断层成像15 effect止痛效果16.biomedical生物医学界17. unit康复中心18. acupuncturist持照针灸师19.therapeutic治疗策略20.herbal草药配方21.a wide array of各式各样的并发症22. East-West medicine中西医结合23. abdominal pain急性腹痛24.to medicines施药，用药25.surgical外科手术26.scientific科学评估27. statistics患病率统计prevalence28. therapies传统疗法29. models of care询证医学模式30.stress压力处理31 nervous system周围神经系统.peripheral32.physiologic生理机制33.mechanistic and studies 机制和复原式研究34. research效益研究35.clinical临床结果36. and clinical studies临床前及临床研究37 mechanisms可能的机制38 therapies推拿治疗39. medicine顺势疗法40. medicine自然疗法41. and yoga冥想与瑜伽Unit51.a health健康危机2.physical s身体症状3.Energy and能量和活力4.be completely I from sth.对某事完全免疫5. of falseness虚假的病毒6.stressful有压力的生活方式7. t emotion健全的感情8. health脆弱的健康9.to our mind,body and spirit平衡心理、身体和精神10. life精神生活11.the to wellness通向身心健康的“路障”12. emotions被压抑的感情13. feelings and emotion真情实感14. l influences心理影响human beings十全十美的人16. teeth蛀牙17 professor营养教授18.burgeoning迅速膨胀的腰围19. water瓶装水20.caloric热量摄入21.to curb节制食欲22.grains and谷物和蛋白质儿童肥胖症24 protein精益蛋白质25. habits饮食习惯26. of life生活质量27. category乳制品类28.prevention of 糖尿病的预防29.sodium钠的含量Unit61. homes养老院2 care临终关心3.congestive heart充血性心衰24小时随叫随到5 care unit冠心病监护室6.to to treatment对治疗有反应7.skilled nursing专业护理机构8. care生命终末期护理9. care舒适护理10.hospital planner出院计划专员11 care症状护理12 care姑息疗法13. illness绝症14.chronic obstructive disease慢性阻塞性肺病15. treatments实验性治疗16.spiritual精神参谋17.to all treatment终止所有治疗18.to go through经历透析19.A PAP 巴氏涂片检查relationship医患关系21.to provide 提供常规医护22. examinations预防性检查23.off the path离开熟路，另辟蹊径24.to into a shape塑形25.To a prescription照旧处方再开药26.in vitro体外受精27. biology基础生物学research胚胎干细胞研究29.to with an outside与圈外人合作baby试管婴儿31. sciences生殖科学32.to administer施用激素33.to isolate eggs别离未成熟卵子34. observations经验观察35. work首创研究36.a fibre-optic光导纤维内窥镜37. guidelines伦理原则38.societal社会关注39. couples不孕不育夫妇40. disease遗传疾病囊泡性纤维症42.ethical伦理困境Unit71.a nursing护士站2. machines生命维持系统3 fort 舒适护理措施4.to treatments停止治疗5. decision-making process家长式决策程序6.patient给病人授权7.medical医学伦理学家伦理准则9.clinical临床理念10. care以病人为中心的护理11.patient病人自主权12.treatment治疗选择13. purview专属领域14. decisions紧急状况下做的决定15.physician对医生的限制16. and confusion焦虑与困惑17.ethical违背伦理18.family家庭医疗19.widespread广泛转移20. treatment积极治疗21 lesion原发病灶22.to recommend 建议随访23.electronic电子病历24.pulmonary肺栓塞25 puterized电脑断层扫描CT双侧浸润27.a X-ray X线胸片28.left pneumonia左下肺叶肺炎29. breathing呼吸困难30.the hospice临终关心团队31. illness慢性病32 aspects社会心理学领域33.evidence-based循证临床指南a plan of care实施治疗方案Unit81.human人体研究对象2. research生物医学研究3.accepted公认的治疗4.a formal正式方案5.the principle of有利原则6.the principle of公正原则7. agents有自主能力的行为者8. autonomy自主性减弱9.be risk of harm使……面临受害危险10.Hippocratic希波克拉底誓言11.fairness in分配的公正性rmed知情同意13.fair and outcomes公正的程序和结果14.the table手术台15.an ethical伦理责任16.a neurosurgeon儿科神经外科医生pediatric17.to the surgery做手术血流19. care重症监护20. father义父21. father生父22. needs心理需要23. judgment医学判断24. therapy职业疗法25.to meningitis感染脑膜炎26.to die of an 死于感染27.blood血管28.imbalances in循环的不平衡29.the of human research subjects人类研究对象的安宁30.to approve or all research activit ies批准或不批准所有的研究活动31.to review a审查一个研究计划32.at risk of civil or criminal有民事或刑事责任的危险参考答案Unit 11. neuron 神经2. office visit(诊所)就诊3. scan 扫描4. medical practice 行医5. blood pressure 血压6. maintenance(健康)保持7. mammogram 乳房Ｘ线8. physical 身体9. side effect 副作用10. panic 恐慌11. practicing 执业12. transplant 移植13. budget 预算14. tablet 药片15. childproof 防孩子16. randomized 随机17. allocation(随机)分配18. prognosis 预后19. control 对照20. follow-up 跟踪21. ward 病房22. hepatitis 肝炎23. malaise 身体不适24. metabolism 代谢肝26.pathophysiology 病理生理27. literature 文献28. investigation 调查29. incidence 率30. epidemiology 流行病学31. bed rest 卧床休息32. hospital stay 住院33. jaundice 黄疸34. course 病程35. intravenous 静脉注射36. diastolic 舒张37. perfusion 灌注38. primary 初级39. bypass(冠脉)旁路40. informed 知情41. humanitarian 人道主义42. the Red Cross 红十字会43. relief 援助44. casualty 人员伤亡45. emergency 紧急Unit 21. re-emerging 再现2. strain 变种3. vaccine 疫苗4. infectious 传染性的5. emerging 新出现6. prevention 预防7. plague 鼠疫8. pathogenic 病原的9. authorities 机构10. drug resistanc 抗药性11. course 疗程12. scarlet fever 猩红热13. virulence 毒性14. pandemic 大流行15. antigen 抗原16. genetic 基因的17. neurological 神经性18. immunity 免疫力19. infrastructure 基础设施20. case 病例21. swine 猪22. tuberculosis 结核23. morbidity/incidence 发病率24. professionals 专业人士25. latent 潜伏26. skin test 皮试27. screening 筛查28. interferon 干扰素29. toxicity 毒性30. curable 可治愈的31. intractable 难治的32. pathogen 病原体33. ulcer 溃疡34. exposure 接触(带病者)35. recombination 重组36. bioterrorism 生物恐怖活动37. foodborne 生物传播Unit 31. adrenaline 肾上腺素2. residency 实习3. autoimmune 自身免疫4. stamina 持久力5. transient 短暂的6. bedridden 卧床不起7. building block 基本构件8. model 模型9. neurodegeneration 神经退化10.excrete 排除(毒素)11.optimize 优化12.load 载量13.relapse 复发14.self-experimentation 自我实验15.trial 试验16.neuromuscular 神经肌肉17.therapist 治疗师微量营养素19.function 功能20.track 跟踪21.coordination 协调22.cardiovascular 心血管23.rapport 亲密24.synchronization 同步25.contagion 传染26.regulate 调节生物心理28.solace 慰藉29.imaging ＭＲＩ30.activate 激活31.mandatory 强制性32.dubious 无把握的33.background 背景34.concept 概念35.regimen 方案36plications 并发症37.anti-tumor 抗肿瘤38.standard标准的39.pharmacological 药理学的40.solubility 溶解性41.in vivo 体内Unit 41. complementary 补充2. alternative 替代(医学)3. paradigm 模式4. acupuncture 针灸5. adjunct 辅助6. nausea 恶心7. post-operative 术后8. clinical 临床的9. physical therapy 理疗10. therapeutic 治疗(方法)11. intervention 干预12. design 设计13. resonance 共振14. emission 发射ＰＥＴ15. analgesia 止痛16. establishment(生物医学)界17. rehabilitation 康复18. licensed 持照(针灸师)19. strategies 策略20. formulas 配方21. wide array 各式各样的22. integrative(中西医)结合23. acute 急性的24. administer 给药25. procedure 程序26. evaluation 评估27. prevalence 患病率28. conventional 传统(疗法)29. evidence-based 循证的30. management(压力)处理31. peripheral 外周／外围32. mechanisms 机制33. reductionistic 复原式的34.cost-effectiveness 效益35. outcomes 结果36. preclinical 临床前37. plausible 可能的38. manipulative 推拿39. homeopathic 顺势40. naturopathic 自然(疗法)41. meditation 冥想Unit 51. crisis 危机2. symptoms 症状3. vitality 活力4. immune 免疫5. virus 病毒6. lifestyle 生活方式7. robust 健全的8. fragile 脆弱的9. balance 平衡10. spiritual 精神的11. blockages 路障12. repressed 被压抑的13. genuine 真实的(真情实感)14. physiological 心理15. integrated 整合的(十全十美)16. decaying teeth 蛀牙17. nutrition 营养18. waistline 腰围19. bottled 瓶装(水)20. intake 摄入21. appetite 食欲22. protein 蛋白质23. obesity 肥胖症24. lean 精益的(蛋白质)25. dietary 饮食(习惯)26. quality 质量27. dairy 乳制品28. diabetes 糖尿病29. content 含量Unit 61. nursing home 养老院2. hospice 临终(关心)3. failure(心)衰4.available around-the-clock24小时随叫随到5. coronary 冠心病6. respond(对治疗有)反应7. facility 机构8. end-of-life 终末期9. comfort 舒适的(护理)10. hospital discharge 出院11. care(症状)护理12. palliative 姑息的13. fatal illness 绝症14. pulmonary 肺的ＣＯＰＤ15. experimental 实验性的16. advisors 参谋17. discontinue 终止18. dialysis 透析19. smear 涂片20. provider 医患关系21. care-as-usual 常规医护22. preventive 预防性23. beaten 常用的off thebeaten path 离开熟路,另辟蹊径24. mold into the shape 塑形25. renew 重新开始torenew a prescription 照旧处方再开药26. fertilization 授精27. basic 基础的(生物学)28. stem cell 干细胞29. collaborate 合作30. test-tube 试管(婴儿)31. reproductive 生殖的32. hormones 激素33. immature 未成熟的34. empirical 经验(观察)35. pioneering 首创的36. endoscope 内镜37. ethical 伦理的38. concern(社会)关注39. infertile 不孕不育的40. inherited 遗传性的41. fibrosis 纤维化42. dilemmas 困境Unit 71. station(护士)站2. life-support 生命维持(系统)3. measures 护理措施4. withdraw 停止(治疗)5. paternalistic 家长式的6. empowerment 授权7. ethicists 伦理学家8. principles 准则9. ideal 理念10.patient-centered 以病人为中心的11. autonomy 自主权12. options 选择13. exclusive purview 专属的(领域)14. emergency 紧急(决定)15. restraint 限制16. anxiety 焦虑17. transgression 违背18. practice(家庭)医疗19. metastases(广泛)转移20. aggressive 积极的21. primary 原发22. follow-up 随访23. record 病历24. embolism 栓塞25. tomography 断层摄像ＣＴ26. infiltrates 浸润27. chest 胸28. lower-lobe 左下叶29. labored(呼吸)困难30. team 团队31. chronic 慢性的32. psychosocial 社会心理33. guidelines 指南34. implement 实施(治疗方案)Unit 1 动脉旁路1.neuron overload 神经过载2.a typical office visit 典型的诊所就诊3.DEXA scan DEXA扫描4.medical practicing 行医5.blood pressure control 血压控制6.health maintenance 健康保持7.Mammogram report 乳房X线检查报告8.physical examination 体检9.side effect of a medication药物的副作用10.perpetual panic 永久的恐慌11.practicing physicians 职业医生12.transplant field 移植领域13.medical budget 医疗预算14.paracetamol tablet 扑热息痛药片15.childproof cap 防孩子打开的盖子16.randomized clinical trial随机临床试验17.Random allocation 随机分配18.patient prognosis 病人的预后19.control group 对照组20.a 10-year follow-up study10年的跟踪研究21.a medical ward 内科病房22.infectious hepatitis 传染性肝炎23.Severe malaise 身体严重不适24.bilirubin metabolism 胆红素代谢25.permanent liver damage永久的肝损伤26.exacerbatepathophysiology 加重病理生理状况27.Medical literature 医学文献28.clinical investigation 临床调查29.incedence of relapse 复发率30.clinical epidemiology 临床流行病学31.strict bed rest 严格的卧床休息32.hospital stay 住院33.recurrent jaundice 反复发作的黄疸34.clinical course 临床病程35.intravenous morphine 静脉注射吗啡36.diastolic blood pressure舒张压37.brain perfusion 大脑血灌输38.primary care初级保健39.aorto-coronary arterialbypass主动脉冠状助工作rmed treatmentdecision 知情治疗决41.an internationalhumanitarian group一个国际人道组织42.the Red Cross 红十字会43.The first major reliefeffort 第一次重大援44.casualty of war 战争中的人员伤亡45.emergency relief efforts紧急援助Unit 31.the surge of adrenaline 肾上腺素激增2.an internal medicineresidency 内科实习期3.an autoimmune disease自体免疫4.loss of stamina 丧失持久力5.transient weakness 短暂的虚弱6.becoming bedridden 卧床不起7.a building block基本构件8.an animal model 动物模型9.to slow neurodegeneration 减缓神经退化10.to excrete toxins排除毒素11.to optimize nutrition 优化营养12.toxic load毒素载量13.the risk of relapse 复发危险14.physician self-experimentation医生自我实验15.a clinical trial 临床试验16.neuromuscular electrical stimulation 神经肌肉电刺激17.physical therapist 理疗师18.the impact of micronutrients 微量营养素的影响19.brain function 脑功能20.track the emotional flow 跟踪情绪波动21.coordination of emotions 情绪协调22.cardiovascular reactions 心血管反应23.feeling of rapport 亲密感觉24.rapid entrain 迅速同步25.emotional contagion 情绪传染26.to mutually regulation 互相调节27.a psychobiological unit生物心理单元28.emotional solace情感慰藉29.functional magneticresonance imaging功能性磁共振成像30.to activate brain zones激活该脑部区域31.to make it mandatory 使之成为强制性32.a(n) dubious project无把握的项目33.medical background医学背景34.proof of concept概念验证35.dose regimen 剂量方案36 plications orconcomitant conditions并发症与合并症37.anti-tumor agents 抗肿瘤的药剂38.standard therapy标准疗法39.pharmacology properties药理学特性40.poor solubility 溶解性差41.in vivo pharmacology 体内药理学Unit 51.a health crisis 健康危机2.physical symptoms 身体症状3.Energy and vitality 能量和活力4.be completely immunefrom sth.对某事完全免疫5.virus of falseness 虚假的病毒6.stressful lifestyle 有压力的生活方式7.robust emotion 健全的感情8.fragile health 脆弱的健康9.to balance our mind ,bodyand spirit平衡心理、身体和精神10.spiritual life精神生活11.the blockage to wellness通向身心健康的“路障”12.repressed emotions 被压抑的感情13.genuine feelings andemotion真情实感14.physiological influences心理影响15.fully integrated humanbeings 十全十美的人16.decaying teeth 蛀牙17.nutrition professor 营养教授18.burgeoning waistline 迅速膨胀的腰围19.bottled water 瓶装水20.caloric intake 热量摄入21.to curb appetite 节制食欲22.grains and protein 谷物和蛋白质23.childhood obesity 儿童肥胖症24.lean protein 精益蛋白质25.dietary habits 饮食习惯26.quality of life 生活质量27.diary category 乳制品类28.prevention of diabetes糖尿病的预防29.sodium content 钠的含量Unit 71.a nursing station 护士站2.life-support machines 生命维持系统3 fort measures 舒适护理措施4.to withdraw treatments停止治疗5.paternalistic decision-making process 家长式决策程序6.patient empowerment 给病人授权7.medical ethicists 医学伦理学家8.ethical principles 伦理准则9.clinical ideal 临床理念10.patient-centered care 以病人为中心的护理11.patient autonomy 病人自主权12.treatment options 治疗选择13.exclusive purview 专属领域14.emergency decisions 紧急状况下做的决定15.physician restraint 对医生的限制16.anxiety and confusion 焦虑与困惑17.ethical transgression 违背伦理18.family practice 家庭医疗19.widespread metastases 广泛转移20.aggressive treatment 积极治疗21.primary lesion 原发病灶22.to recommend follow-up 建议随访23.electronic record 电子病历24.pulmonary embolism 肺栓塞25 puterized tomography CT，电脑断层扫描26.bilateral infiltrates双侧浸润27.a(n) chest X-ray(X线胸片)28.left lower-lobe pneumonia左下肺叶肺炎borcd breathing呼吸困难30.the hospice team临终关心团队31.chronic illness慢性病32.psychosocial aspects 社会心理学领域33.evidence-based guidelines 循证临床指南34.to implement a plan of care 实施治疗方案。

Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients* high expectations·Mistrust and misunderstanding between the patient and the doctor2、Mrs. Osorio’s condition:·A 56-year-old woman·Somewhat overweight·Reasonably well-controlled diabetes and hypertension·Cholesterol on the high side without any medications for it·Not enough exercises she should take·Her bones a little thin on her last DEXA scan3、Good things:·Blood tests done·Glucose a little better·Her blood pressure a little better but not so great Bad things:·Cholesterol not so great·Her weight a little up·Her bones a little thin on her last DEXA scan 44、The situation:·The author was in a moderate state of panic: juggling so many thoughts about Mrs.Osorio’s conditions and trying to resolve them all before the clock ran down.·Mrs. Osorio made a trivial request, not so important as compared to her conditions.·Mrs. Osorio seemed to care only about her “innocent —and completely justified —request”：the form signed by her doctor.·The doctor tried to or at least pretended to pay attention to the patient while completing documentation.5、Similarities:·In computer multitasking, a microprocessor actually performs only one task at a time. Like microprocessors, we human beings carft actually concentrate on two thoughts at the same exact time. Multitasking is just an illusion both in computers and human beings. Differences:·The concept of multitasking originated in computer science.·At best, human beings can juggle only a handful of thoughts in a multitasking manner, but computers can do much better.·The more thoughts human beings juggle, the less human beings are able to attune fully to any given thought, but computers can do much better.6、·7 medical issues to consider·5 separate thoughts, at least, for each issue·7 x 5 = 35 thoughts·10 patients that afternoon·35 x 10 = 350 thoughts·5 residents under the authors supervision·4 patients seen by each resident·10 thoughts, at least, generated from each patient·5 x 4 x 10 = anther 200 thoughts·350 + 200 = 550 thoughts to be handled in total·If the doctor does a good job juggling 98% of the time, that still leaves about 10 thoughts that might get lost in the process.7、Possible solutions:·Computer-generated reminders·Case managers·Ancillary services·The simplest solution: timeUnit21、The author implies:• Peoples inadequate consciousness about the consequence of neglecting the re- emerging infectious diseases·Unjustifiability of peoples complacency about the prevention and control of the infectious diseases·Unfinished war against infectious diseases2、Victory declarations:·Surgeon General William Stewart's hyperbolic statement of closing “the book on infectious disease”.·A string of impressive victories incurred by antibiotics and vaccines·The thought that the war against infectious diseases was almost over Whatfollowed ever since:·Appearance of new diseases such as AIDS and Ebola·Comeback of the old afflictions:» Diphtheria in the former Soviet Union» TB in urban centers like New York City» Rising Group A streptococcal conditions like scarlet fever·The fear of a powerful new flu strain sweeping the world3、Elaborate on the joined battle:·WHO established a new division devoted to worldwide surveillance and control of emerging disease in October 1995.·CDC launched a prevention strategy in 1994.·Congress raised fund from $6.7 million in 1995 to $26 million in 1997.4、The borders are meaningless to pathogenic microbes, which can travel from one country to another remote country in a very short time.5、TB:·Prisons and homeless shelters as ideal places for TB spread·Emerging of drug-resistant strain or even multi-drug-resistant strain·A ride on the HIV w^on by attacking the immunocompromisedGroup A strep:·A change in virulence·Mutation in the exterior of the bacteriumFlu:Constant changes in its coat (surface antigens) and resultant changes in its level of virulence6、Examples:·Experiment in England is seeing the waning immunity because of no vaccination.·D u e to poor vaccination efforts, the diphtheria situation in the former Soviet Union is serious. '• The vaccination rates are dropping in some American cities, and it will lead to more diphtheria and whooping cough.7、The four areas of focus:·The need for surveillance·Updated science capable of dealing with discoveries in the field·Appropriate prevention and control·Strong public health infrastructure8、The infectious diseases such as TB, flu, diphtheria and scarlet fever will never really go away, and the war against them will never end.Unit31、Terry's life before·She loved practicing Tae Kwon Do·She loved the surge of adrenaline that came with the controlled combat of tournaments. ·She competed nationally, even won bronze medal in the trials for the Pan American Games.·She attended medical school, practiced as an internal medicine resident, and became an academic general internist.·She got married and got a son and a daughter.2、The symptoms of MS and autoimmune disease:·Loss of stamina and strength·Problems with balance·Bouts of horrific facial pain·Dips in visual acuity3、Terry did the following before she self-experimented:·She started injections.·She adopted many pharmacotherapies.·She began her own study of literature:» She read articles on websites such as PubMed.» She searched for articles testing new MS drugs in animal models.»She turned to articles concerning neurodegeneration of all types —dementia，Parkinson's disease, Huntington's disease, and Lou Gehrig's disease.»She relearned basic sciences such as cellular physiology, biochemistry, and neurophysiology.4、Approaches Terry mainly used:·Self-experimentation with various nutrients to slow neurodegeneration based on literature reports on animal models·Self-experimentation with neuromuscular electrical stimulation which is not an approved treatment for MS·Online search to identify the sources of micronutrients and having a new diet ·Reduction of food allergies and toxic load5、Cases mentioned in the text:·Increased mercury stores in the brains of people with dental fillings·High levels of the herbicide atrazine in private wells in Iowa·The strong association between pesticide exposure and neurodegeneration·The association of single nucleotide polymorphisms involving metabolism of sulfur and/or B vitamins·Inefficient clearing of toxins6、With 70% to 90% of the risk for diabetes, heart disease, cancer, and autoimmunity being due to environmental factors other than the genes, we can take many healthproblems and the health care crisis under our control, for example, optimizing our nutrition and reducing our toxic load.Unit41、Two concepts:·Complementary medicine refers to the use of conventional therapies together with alternative treatments such as using acupuncture in addition to usual care to help lessen pain. Complementary and alternative medicine is shortened as CAM.·Alternative medicine refers to healing treatments that are not part of conventional therapies — like acupuncture, massage therapy, or herbal medicine. They are called so because people used to consider practices like these outside the mainstream.2·TCM does not require advanced, complicated, and in most cases, expensive facilities.·TCM employs needles, cups, coins, to mention but a few.·Most procedures and operations of TCM are noninvasive.·The substances used as medicine are raw herbs or abstracts from them, and they are indeed all natural, from nature.·TCM has been practiced as long as the Chinese history, so the efficiency i s proven and ensured.·Ongoing research around the world on acupuncture, herbs, massage and Tai Chi have shed light on some of the theories and practices of TCM3、It may be used as an adjunct treatment, an alternative, or part of a comprehensivemanagement program for a number of conditions: post-operative and chemotherapyinduced nausea and vomiting, post-operative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.4、A well-justified NO:·More intense research to uncover additional areas for the use of acupuncture·Higher adoption of acupuncture as a common therapeutic modality not only in treatment but also in prevention of disease and promotion of wellness·Exploration and perfection of innovative methods of acupuncture point stimulation with technological advancement·Improved understanding of neuroscience and other aspects of human physiology and function by basic research on acupuncture·Greater interest by stakeholders·An increasing number of physician acupuncturists5、·Appropriate uses of herbs depend on proper guidance:» Proper TCM diagnosis of the zheng of the patient» Correct selection of the corresponding therapeutic strategies and principles that guide the choice of herbs and herbal formulas·Digression from either of the above guidence will lead to misuses of herbs, and will result in complications in patient6、·Randomized controlled trialsAdvantages:» Elimination of the potential bias in the allocation of participants to the intervention group or control group» Tendency to produce comparable groups» Guaranteed validity of statistical tests of significanceLimitations:»Difficulty in generalizing the results obtained from the selected sampling to the population as a whole» A poor choice for research where temporal factors are an issue» Extremely heavy resources, requiring very large sample groups• Quasi-experimentsAdvantages:» Control group comparisons possible» Reduced threats to external validity as natural environments do not suffer thesame problems of artificiality as compared to a well-controlled laboratorysetting.»Generalizations of the findings to be made about population since quasi-experiments are natural experimentsLimitations：»Potential for non-equivalent groups as quasi-experimental designs do not userandom sampling in constructing experimental and control groups.» Potential for low internal validity as a result of not using random sampling methods to construct the experimental and control groups• Cohort studiesAdvantages:» Clear indication of the temporal sequence between exposure and outcome» Particular use for evaluating the effects of rare or unusual exposure» Ability to examine multiple outcomes of a single risk factorLimitations:» Larger, longer, and more expensive» Prone to certain types of bias» Not practical for rare outcomes• Case-control studiesAdvantages:» The only feasible method in the case of rare diseases and those with long periods between exposure and outcome»Time and cost effective with relatively fewer subjects as compared to other observational methodsLimitations：» Unable to provide the same level of evidence as randomized controlled trials as it is observational in nature» Difficult to establish the timeline of exposure to disease outcome• “N=1” trialsAdvantages» Easy to manage» InexpensiveLimitations：» Findings difficult to be generalized to the whole population» Weakest evidence due to the number of the subject7、• Synthesis of evidence is completely dependent on:» The completeness of the literature search (unavailable for foreign studies)» The accuracy of evaluation·There are situations in which no answer can be found for the questions of interest in RCTs and database analyses.·There's the requirement of using less stringent information rather than “hard data”8、·Assessment of the intrinsic value of traditional medicine in society ·Research and education·Political, economic, and social factorsUnit51、·Dis-ease refers to the imbalance arising from：» Continuous stress» Pain» Hardships·Disease is a health crisis ascribable to various dis-eases.·Prompting elimination of dis-eases can alleviate some diseases.2、·Wellness is a state involving every aspect of our being: body, mind and spirit. ·Manifestations of a healthy person:» Energy and vitality» A certain zip in gait» A warm feeling of peace of heart seen through behavior3、·Constant messages, positive and negative，are sent to our mind about the health of our body.·Physical symptoms are suppressed by people who go through life on automatic pilot.·Being well equals to being disease- or illness-free in the minds of them.·They confused wellness with an absence of symptoms.4、·People's minds are infected by spin:» Half-truth» Fearful fictions» Blatant deceit: some as a form of self-deceit·Spin is a result of unconscious living.·The kind of falseness is pandemic.5·Our body intelligence is suppressed or dormant from a lack of use.·There are tremendous amount of stress on a daily basis.·Our bodies are easily ignored for years because of a lack of recreation time.·Limiting, self-defeating and even self-destructive behaviors undermine our wellbeing and keep them from achieving our full potential.6·We grow more reluctant to take risks.·We lose the ability to feel and acknowledge our deepest feelings and the courage to speak our truth.·We continue to deny and repress our feelings to protect ourselves.·Fear, denial and disconnection from our bodies and feelings become anunconscious, self-protective habit, a kind of default response to life.7·A multi-faceted process:» Looking for roots of and resolutions for the issues in different dimensions» Building our wellness toolbox slowly» Picturing our whole state of being·Attention to the little stuff:» Examining our lives honestly and setting clear intentions to change» Striving to maintain a balance of our mind, body and spirit» Taking small steps in the way to perceive and resolve conflict8·Try to awaken and evolve in order to live more consciously.·Get in touch with our genuine feelings and emotions.·Come to terms with the toxic emotionsUnit61、In the past, most people died at home. But now, more and more people are cared inhospitals and nursing homes at their end of life, which of course brings a new set of questions to consider.2、·Sixty-four years old with a history of congestive heart failure·Deciding to do everything medically possible to extend his life·Availability of around-the-clock medical services and a full range of treatment choices, tests, and other medical care·Relaxed visiting hours, and personal items from home3、Availability of around-the-clock medical resources, including doctors, nurses, andfacility.·Taking on a job which is big physically, emotionally, and financially·Hiring a home nurse for additional help·Arranging for services (such as visiting nurses) and special equipment (like a hospital bed or bedside commode)5、·Health insurance·Planning by a professional, such as a hospital discharge plaimer or a social worker ·Help from local governmental agencies·Doctor's supervision at home6、·Traditionally, it is only about symptom care.·Recently, it is a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases.7、·Stopping treatment specifically aimed at curing an illness equals discontinuing all treatment.·Choosing a hospice is a permanent decision.Unit71、·A dying patient·Decision whether to withdraw life-support machines and medication and start comfort measures·The family's refusal to make any decision or withdraw any treatments·The doctor as exclusive decision-maker·The patient as participant with little say in the final choice3、·Respect for the patient, especially the patient s autonomy·Patient-centered care·The patient as decision-maker based on the information provided by the doctor4、·Patients are forced to make decisions they never want to.·Patients, at least a large majority of them, prefer their doctors to make final decisions.·Shifting responsibility of decision-making to patients will bring about more stress to patients and their families, especially when the best option for the patient is uncertain.5、Doctors are very much cautious about committing some kind of ethical transgression.6、·Shouldering responsibility together with the patient may be better than having the patient make decisions on their own.·Balancing between paternalism and respect for patients autonomy constitutes a large part of medical practice.Unit81、·Research:An activity to test hypothesis, to permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge·Practice:Interventions solely to enhance the well-being of an individual patient or client and that have a reasonable expectation of success·Blurred distinction:» Cooccurrence of research and practice like in research designed to evaluate a therapy » Notable departures from standard practice being called “experimental” with the terms “experimental”and “research” carelessly defined2、·Autonomy：Individuals treated as autonomous agents .·Protection:Persons with diminished autonomy entitled to protection·A case in point:Prisoners involved in research3·“Do no harm” as the primary principle·Maximization of possible benefits and minimization of possible harms .·Balance between benefits and potential risks involved in every step of seeding the benefits4、·“Do no harm” as a fundamental principle of medical ethics·Extension of it to the realm of research by Claude Bernard·Benefits and risks as a set “duet” in both medical practice and research5、·Unreasonable denial of entitled benefit and unduly imposed burden：Enrolment of patients in new drug trial: Who should be enrolled and who should not?·Equal treatment of equals:Determining factors of equality: age, sex, severity of the condition, financial status, social status6、·Definition:The opportunity to choose what shall or shall not happen to them·Application:» A process rather than signing a written form» Adequate information as the premise» A well-informed decision as the expected result7、·Requirements for consent as entailed by the principle of respect for persons·Risk/benefit assessment as entailed by the principle of beneficence·More requirements of fairness as entailed by the principle of justice:» At the individual level: fairness» At the social level: distinction between classes。