Experimental and quasi-experimental designs for research

因果分析的英语作文Title: Causal Analysis: Understanding the Dynamics of Cause and Effect。

Introduction:Causal analysis, also known as cause and effect analysis, is a methodological approach used to examine the relationships between events or variables. It delves into understanding the root causes of phenomena and their subsequent effects. This essay will explore thesignificance of causal analysis, its methodologies, and its application in various fields.Significance of Causal Analysis:Causal analysis plays a pivotal role in various domains, including science, sociology, economics, and public policy. By identifying causative factors, researchers and decision-makers can devise effective strategies to address problems,mitigate risks, and optimize outcomes.Methodologies of Causal Analysis:1. Observational Studies: In observational studies, researchers observe and analyze natural phenomena without intervening. They collect data over time to identify correlations between variables and infer potential causal relationships. However, observational studies are prone to confounding variables, making it challenging to establish causality definitively.2. Experimental Studies: Experimental studies involve manipulating one or more variables while controlling other factors to determine causation. Through randomized controlled trials (RCTs) or quasi-experimental designs, researchers can establish causal relationships more rigorously. Experimental studies provide stronger evidence of causality compared to observational studies but may face ethical or practical constraints.3. Causal Models: Causal models, such as Bayesiannetworks and structural equation modeling, offer a formal framework for representing and analyzing causal relationships among variables. These models allow researchers to test hypothetical causal pathways, estimate causal effects, and predict the outcomes of interventions.Application of Causal Analysis:1. Public Health: In public health, causal analysis is vital for understanding the determinants of disease outbreaks, evaluating the effectiveness of interventions, and informing health policy decisions. For example, causal analysis helped identify the link between smoking and lung cancer, leading to tobacco control initiatives.2. Economics: Causal analysis is instrumental in economic research for assessing the impact of policies, market interventions, and external shocks on economic outcomes. Economists use econometric techniques to identify causal effects and guide policymaking.3. Environmental Science: Understanding causalrelationships in environmental systems is crucial for addressing environmental challenges such as climate change, pollution, and habitat loss. Causal analysis helps elucidate the drivers of environmental degradation and formulate sustainable management strategies.4. Social Sciences: In sociology, psychology, and anthropology, causal analysis elucidates the factors influencing human behavior, social phenomena, and cultural dynamics. By identifying causal mechanisms, researchers can develop interventions to address social issues and promote well-being.Conclusion:Causal analysis serves as a powerful tool for uncovering the complex interplay of causes and effects in diverse fields. Whether in scientific research, policymaking, or everyday decision-making, understanding causal relationships empowers us to make informed choices, solve problems, and create positive change. By embracing rigorous methodologies and interdisciplinary approaches, wecan harness the full potential of causal analysis to address the challenges of our time.。

U n i t 1 1、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 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 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 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 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. ·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, 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, andautoimmunity being due to environmental factors other than the genes, we can take 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, 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 comprehensive management program for a number of conditions: post-operative and 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, 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 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 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 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 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、·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 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 doctor 4、·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 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 “experimenta l”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。

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。

•综述•在如今复杂的医疗背景下，良好的沟通能力是临床医务工作者必须具备的核心技能[1]。

医护人员之间的沟通不畅容易造成患者的无意伤害[2]。

为提高医务人员之间的沟通有效性, 美国医疗机构评审联合委员会提出进行标准化的交接沟通, 可加强有效沟通[3]。

中国医院协会自2007年发布《患者安全目标》以来，一直将“加强医务人员之间的有效沟通”作为目标之一[4]。

Kaiser Permanente 于20世纪90年代最先在医疗领域医护间使用SBAR 沟通模式。

SBAR 即Situation （现状）、Background （背景）、【摘要】　目的　评价SBAR 模式在国内外护生护理教学中的应用效果。

方法　计算机检索并筛选出中国知网、万方数据库、维普数据库及Pubmed、W eb of Science、W iley Online Library、Cochrane Library、Embase、CINAHL 数据库中关于SBAR 应用于护生护理教学的随机对照试验和类实验研究，并对纳入文献的参考文献进行手动检索。

经研究者进行文献质量评价和资料提取后，采用RevMan 5.2软件对数据进行Meta 分析。

结果　初步检索获得相关文献1298篇，最终纳入14篇文献进行Meta 分析。

分析结果显示，SBAR 模式教学在一定程度上可以提高护生临床沟通能力［SMD=0.86，95% CI (0.59~1.14)，P <0.01］、加强沟通清晰度［MD=5.88，95% CI (4.67~7.10)，P <0.01］、增强交接信心［MD=0.88，95% CI (0.32~1.44)，P <0.01］以及提升评判性思维能力［MD=17.23，95% CI (13.77~20.68)，P <0.01］。

结论　SBAR 模式教学可以提高护生的临床沟通能力和沟通清晰度，并能增强护生交接信心、提升其评判性思维能力，优于传统教学模式。

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 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 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 ue 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, andautoimmunity being due to environmental factors other than the genes, we can take 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, 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 iproven and ensured.s·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-operative and 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, 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 anissue» Extremely heavy resources, requiring very large samplegroups• Quasi-experimentsAdvantages:» Control group comparisons possible» Reduced threats to external validity as natural environments donot suffer the same problems of artificiality as compared to awell-controlled laboratory setting.»Generalizations of the findings to be made about population sincequasiexperiments are natural experimentsLimitations：»Potential for non-equivalent groups as quasi-experimental designsdo not 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 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 wholepopulation» 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 arecared in hospitals 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, and facility.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 (likea 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 2、·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 having the patient make decisions on their own.·Balancing between paternalism and respect for patients autonomy constitutesa 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 “experimenta l”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 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。

学术英语医学课后问题答案集团文件发布号：（9816-UATWW-MWUB-WUNN-INNUL-DQQTY-Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients* high expectations·Mistrust and misunderstanding between the patient and the doctor 2、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 scan44、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 amultitasking 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, thatstill 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 What 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 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 cantravel 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 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, 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 proven and ensured.efficiency is·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-operative and 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, 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 groupTendency to produce comparable groupsGuaranteed validity of statistical tests of significance Limitations:Difficulty in generalizing the results obtained from the selected sampling to the population as a wholeA poor choice for research where temporal factorsare an issueExtremely heavy resources, requiring very largesample groupsQuasi-experimentsAdvantages:Control group comparisons possibleReduced threats to external validity as naturalenvironments do not suffer the same problems ofartificiality as compared to a well-controlled laboratorysetting.Generalizations of the findings to be made about population since quasiexperiments are natural experiments Limitations：Potential for non-equivalent groups as quasi-experimentaldesigns do not use random sampling in constructingexperimental and control groups.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 long periods 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 trials as it is observational in natureDifficult to establish the timeline of exposure to disease outcome“N=1” trialsAdvantagesEasy to manageInexpensiveLimitations：Findings difficult to be generalized to the wholepopulationWeakest 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 insociety·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 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 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 morepeople are cared in hospitals 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, includingdoctors, nurses, and facility.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、·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 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 ofethical 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 therapyNotable departures from standard practice being called “experimental” with the terms “experimenta l”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 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。

Unit11、Some factors that may lead to the complaint:·Neuron overload·Patients high expectations·Mistrust and misunderstanding between the patient and the doctor 2、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 almostover What 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 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-resistantstrain·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 havinga 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 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 inaddition 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 proven and ensured.efficiency is·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 ofa comprehensive management program for a number of conditions: post-operative and 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; 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 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 arean issueExtremely heavy resources; requiring very largesample groupsQuasi-experimentsAdvantages:Control group comparisons possibleReduced threats to external validity as natural environmentsdo not suffer the same problems of artificiality as comparedto a well-controlled laboratory setting.Generalizations of the findings to be made about population since quasiexperiments are natural experimentsLimitations：Potential for non-equivalent groups as quasi-experimentaldesigns do not use random sampling in constructing experimentaland 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 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 long periods 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 trials as it is observational in natureDifficult to establish the timeline of exposure to diseaseoutcome“N=1” trialsAdvantagesEasy to manageInexpensiveLimitations：Findings difficult to be generalized to the wholepopulationWeakest evidence due to the number of the subject7、Synthesis of evidence is completely dependent on:The completeness of the literature search unavailable for foreign studiesThe 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 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 dimensionsBuilding our wellness toolbox slowlyPicturing 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 spiritTaking small steps in the way to perceive and resolve conflict 8·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 peopleare cared in hospitals 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; and facility.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 commode5、·Health insurance·Planning by a professional; such as a hospital discharge plaimer ora 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 2、·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 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 therapyNotable departures from standard practice being called “experimental” with the terms “experimenta l”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 risk s 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 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。