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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。
