復(fù)旦學(xué)術(shù)英語(yǔ)(醫(yī)學(xué))課后問(wèn)答題期末復(fù)習(xí)課件

ReviewFor2015studentsJustforreferenceDoyouagreethatitissheerneuronoverloadonthedoctorsidethatleadstothecomplaintthatdoctorsdon’tlisten?(Pre.1)NeuronoverloadPatients’highexpectationsMistrustandmisunderstandingbetweenthepatientsandphysicianUnit1TextAPleaselistMrs.Osorio’scondition(Pre.2)A56-year-oldwomanSomewhatoverweightReasonablywell-controlleddiabetesandhypertensioncholesterolonthehighsidewithoutanymedicationsforthisNotasmuchexerciseassheshouldThinningofherbonesonlastDEXAscanStressfulbutgoodaboutkeepingherappointmentsandgettingherbloodtestsGenerallyhealthy

WhatthingsaboutMrs.Osorio’sconditionsrunthroughtheauthor’smind?(Pre.3)

GoodThingsBloodtestsdoneGlucosealittlebetterHerbloodpressuregoodbutnotgreatBadThingsHerweightalittleupHerbonesalittlethinontheDEXA

DoyouagreethatParagraph4justillustratesthatonestrayrequestfromMrs.Osoriosendsthedelicatelybalancedthree-ringcircustumblingdown?(Pre.4)Thekeyisinpara.4Theauthorwasinmoderatestateofpanic:jugglingsomanythoughtsaboutMrs.Osorio’sconditionsandtryingtoresolvethemallbeforetheclockrandownMrs.Osoriomadeatrivialrequest,notsoimportantascomparedtoherconditionsMrs.Osorioseemedtocareonlyabouther“innocent—andcompletelyjustified—request”:theformsignedbyherdoctorThedoctortriedtooratleastpretendtopayattentiontothepatientswhilecompletingdocumentationComplaintsthatdoctorsdon’tlistenmighthaveotherreasonsthanjustdoctors’neuronoverloadSee(Paras.7-8)Howcanyoucomparemultitaskinginhumanbeingsandcomputers?(pre.5)Multitaskingoriginatedincomputerscience.Microprocessorsinfactlinear,actuallyperformonlyonetaskatatime.Multitaskingseemsjustasanillusionbothincomputerandhumans.Atbest,ManjugglesonlyahandfulofthoughtsinthismannerThemorethoughtswejuggle,thelessweareabletoattunefullytoanygiventhought.Socanwesaymultitaskingisarecipefordisaster?How?

Whatistheuseofthenumbers?Usethesenumberstojustifythatitisthejugglingmindthatkeepsdoctorsawakeatnight.(pre.6)Whatarethereasonswhydoctorskeptawakeatnight?Aretheythereasonsoftheirneuronoverload?(Pre.6)7medicalissuestoconsider5separatethoughts,atleast,foreachissue7X5=35thoughts10patientsthatafternoon35X10=3505residentsundertheauthor’ssupervision4patientsseenbyeachresidents10thoughts,atleast,generatedbyeachpatients5X4X10=200350+200=550thoughtstobehandledintotalIfthedoctordoesagoodjobjuggling98%ofthetime,thatstillleavestenthoughtsthatmightgetlostintheprocess.

Explainthelastsentenceofthisparagraph.(page5)Arethoseproposedsolutions,likecomputer-generatedreminders,casemanagers,ancillaryservices,capableofsolvingtheauthor’sproblemofoverload?(Pre.7)Unit2TextAWhatdoestheauthorimplybymentioningtwochoices?(para.1,Pre.1)Whatfollowedeversincetheheadydaysofvictorydeclarations?(para.4,Pre.2)Whatdoesthejoinedbattlereferto?Andelaborateonit.(paras.5-12,pre.3)Thefirstquestionhassomethingtodowith…ornot?People’sinadequateconsciousnessabouttheconsequenceofneglectingtheemergingandreemerginginfectiousdiseases.Unjustifiabilityofpeople’scomplacencyaboutthepreventionandcontroloftheinfectiousdiseases.Unfinishedwaragainstinfectiousdisease.Aboveall,somethingtodowithmoney(budget).WhatfollowsOut-of-expectationoutcomeAppearanceofnewdiseasessuchasAIDSandEbola.Comebackoftheoldafflictions.DiphtheriaintheformerSovietUnion.TBinurbancenterslikeNewYorkCity.RisingGroupAstreptococcalconditionslikescarletfever.Thefearofapowerfulnewflustrainsweepingtheworld.

Elaborateonthejoinedbattle.(Pre.3)WHO:establishmentofanewdivisiondevotedworldwidesurveillanceandcontrolofemergingdiseaseinOct.1995CDC:launchingpreventionstrategyin1994Congress:raisingfundfrom$6.7millionin1995to$26millionfor1997Justify“therealizationthatworldhealthisindivisible”.(Pre.4)AttentiontothehealthconditionsoftheglobebeforesatisfyingOURmostparochial(地方范圍的)needsMeaninglessnessofborderstopathogenic(致病的)microbesWith24hoursoftime,fromacrowdedmarketplaceinKikwit,ZairetoaNewYorkCitysubwayExemplifythestatementthat“Everyreturning…”(pre.5)Examples(1)TBPrisonsandhomelesssheltersasidealvenuesforTBspreadDevelopmentofdrug-resistantstrainsorevenmulti-drug-resistantstrainArideontheHIVwagonbyattackingtheimmunocompromised(免疫功能不全的)Examples(2)GroupAstrepAchangeinvirulence（毒性）Mutationintheexteriorofthebacteriumfleshing-eatingbacteriaof1994rheumaticfeverscarletfeverfluConstantchangesinitscoat(surfaceantigens表面抗原)andresultantchangesinitslevelofvirulenceLooming(逼近)nextflupandemicasbadasthatof1918Whyarevaccinationpracticesattheheartofthemostinfectiousdiseases?Useexamplestoproveit.(Pre.6)WhatarethefourareasoffocusaccordingtoBobHoward?(Pre.7)ExamplesWaningimmunitySeriousdiphtheriasituationintheformerSovietUnionDeteriorationinsomeAmericancitiesIncreasedreportsofmalariaThefourareasoffocusNeedforsurveillanceUpdatedsciencecapableofdealingwithdiscoveriesinthefieldAppropriatepreventionandcontrolStrongpublichealthinfrastructure“Oldenemiesneverdie.”Justifyitmedically.DiscussingIstherea100%solutionforeveryproblem?Istherea100%cureforeveryailment?Whatdoesthetile“TheSeventyPercentSolution”mean?(Pre.6)Unit3TextAWith70%to90%oftheriskfordiabetes,heartdisease,cancer,andautoimmunitybeingduetoenvironmentalfactorsotherthangenetics,wecanprovidetherealsolutiontomanyhealthproblemsandthehealthcarecrisisbychangingourenvironment,forexample,optimizingournutritionandreducingourtoxicload.Whatdoesthetile“TheSeventyPercentSolution”mean?(Pre.6)AccordingtotheauthorHowwasTerry’slifebeforeshewasdiagnosedwithMS?(Pre.1)HowmuchdoyouknowaboutMSandautoimmunedisease?(Pre.2)

Causeasmentionedbytheauthortheassaultofimmunecellsonthebrain,withpossibleoriginingeneticmake-upor/andcombinationofenvironmentalfactorsTreatmentasmentionedbytheauthorinterferonandcopolymer-1HowmuchdoyouknowaboutMSandautoimmunedisease?(Pre.2)oBeginherownstudyoftheliterature,readingarticleafterarticleonPubMed.Relearnbasicsciencesuchascellularphysiology,biochemistryandneurophysiology.LookforrecentarticlestestingnewMSdrugsinanimalmodelsandreadarticlesconcerningneurodegenerationofalltypes—dementia,Parkinson’sdisease,Huntington’s,andLouGehrig’sdisease.WhatdidTerrydobeforesheself-experimented?(Pre.3)self-experimentationwithvariousnutrientstoslowneurodegenerationbasedonliteraturereportsonanimalmodelsself-experimentationwithneuromuscularelectricalstimulationstillbasedonliteratureonlinesearchtoidentifythesourcesofmicronutrientsreductionoffoodallergyandtoxicloadWhatapproachesdidTerrymainlyusetodealwithneurodegeneration?(Pre.4)With70%to90%oftheriskfordiabetes,heartdisease,cancer,andautoimmunitybeingduetoenvironmentalfactorsotherthangenetics,wecanprovidetherealsolutiontomanyhealthproblemsandthehealthcarecrisisbychangingourenvironment,forexample,optimizingournutritionandreducingourtoxicload.Oneexampletoillustratethecorrelationbetweentoxicloadanddisease(Pre.5)Unit4TextAGiveabriefexplanationofthetwoconcepts:complementarymedicineandalternativemedicine.(pre.1)Towhatextentdoyouagreewiththeauthor’sopinionontraditionalChinesemedicineasbeing“affordable,lowtech,safe,andeffective”？（pre.2）Theclinicalusesofacupuncture(Pre.3)

Anadjuncttreatment,anacceptablealternativeforpost-operativechemotherapyinducednauseaandvomitingpost-operativedentalpainaddictionstrokerehabilitationheadachemenstrualcrampstenniselbow–fibromyalgia–myofascialpain–osteoarthritis–lowbackpain–carpaltunnelsyndrome–andasthmaDoyouthinktheauthorisoveroptimisticinpredictingawiderfutureuseofacupunctureintheUS?(Pre.4)Moreintense____________Higher______________________Greater_____________________________________Stronger__________________Anincreasingnumberof_________________________researchadoptionofacupunctureinterestofhealthinsuranceindustries…pushforcoveragephysicianacupuncturistsExplainhowinappropriateusesofherbsmayresultincomplications.(Pre.5)AppropriateusesofherbsdependonproperguidanceProperTCMdiagnosisofthezhengofthepatientCorrectselectionofthecorrespondingtherapeuticstrategiesandprinciplesthatguidethechoiceofherbsandherbalformulasDigressionfromeitheroftheaboveconditions,misusesofherbs,willresultincomplicationsinpatient.Variousapproachestoherbalstudyarementionedinthetext.Pickonetodiscusstheadvantagesandlimitations.(Pre.6)RandomizedcontrolledtrialsQuasi-experimentscohortstudiescase-controlstudies“1”trialsWhatarethedifficultiesininvestigatingherbaltherapies?(Pre.7)DependenceofsynthesisofevidenceonThecompletenessoftheliteraturesearch(Unavailableforforeignstudies)TheaccuracyofevaluationNoanswerstobefoundforthequestionsofinterestRequirementofusinglessstringentinformationratherthan“harddata”Whatarethefactorstoconsiderwhenweintegrateeasternandwesternmedicine?(Pre.8)AssessmentoftheintrinsicvalueoftraditionalmedicineinsocietyResearchandeducationPolitical,economicandsocialfactorsUnit5TextAClarifythedifferencesbetweendiseaseanddis-ease.(Pre.1)Dis-easereferstotheimbalancearisingfromacontinuousstresspainhardshipsDiseaseisahealthcrisisascribabletovariousdis-easesPrompteliminationofdis-easescanalleviatesomediseasesYourpersonalunderstandingabouttheclaimthatHealthisamultidimensionalexperienceofbody,mindandspirit.(Pre.2)Wellnessasastateinvolvingeveryaspectofourbody:body,mind,andspiritManifestationsofahealthypersonEnergyandvitalityAcertainzipingaitAwarmfeelingofpeaceofheartseenthroughbehaviourIllustratetherelationshipbetweenlifeonautomaticpilotandwellness.(Pre.3)Constantmessages,positiveandnegative,senttoourmindaboutthehealthofourbodyPhysicalsymptomssuppressedBeingwellequaledtobeingdiseaseorillnessfreeWellnessconfusedwithanabsenceofsymptomsDescribethetimeofgreatconfusionwelivein.(Pre.4)People’smindinfectedbyspinhalf-truthfearfulfictionsblatantdeceit:someasaformofself-deceitSpinasaresultofunconsciouslivingPandemicfalsenessShowinguponeveryfrontinsocietyandthemediaSpreadingtoallcornersoftheglobeDeeplyembeddedinourmindsCommenton“aculturethatvaluesthinkingmorethanfeelingandemphasizesreasonoverintuitiveawarenessandknowing”.(Pre.5)OurbodyintelligencesuppressedanddormantTremendousamountofstressonadailybasisLimiting,self-defeating,andevenself-destructivebehaviorsthatunderminesourwell-beingandkeepsthemfromachievingourfullpotentialExplaintheprocesswherewechangefrom“playingfull-out”to“playitsafe,orplaynottolose”.(Pre.6)MorereluctanttotakerisksLossofabilitytofeelandacknowledgeourdeepestfeelingsandthecouragetospeakourtruthContinuingdenialandrepressionofourfeelingtoprotectthemselvesAnunconsciousandself-protectivehabit/adefaultresponsetolife:fear,denial,anddisconnectionfromourbodiesandfeelingEverythingcomesfinallydowntoHOW.

Explainhowwellnesscanbeestablished?(Pre.7)Amulti-facetedprocessIssuesrootedandresolvedindifferentdimensionsBuildingourwellnesstoolboxslowlyPicturingourwholestateofbeingAttentiontothelittlestuffWellnessnotagoalbutaprocessMaintenanceofabalanceofourmind,body,andspiritMakealistofthetipsonhowtobecomeafullyintegratedhumanbeing.(Pre.8)TrytoawakenandevolveinordertolivemoreconsciouslyGetintouchwithourgenuinefeelingsandemotionsCometotermswith/MakepeacewiththetoxicemotionsUnit6TextAHowhastheend-of-lifecarechangedovertime?(pre.1)Whatadvantagesdoesahospitalhaveoveranursinghomeforend-of-lifecare?(Pre.3)Availabilityofmedicalresources,includingdoctors,nursesandfacilityaroundtheclockAnythingelseyoucanaddtothat?AdvantagesofNursingHomePrearrangedplansforend-of-lifecareEstablishmentofarelationshipbetweenthestaffandfamilyMorepersonalizedcarePrivacyarrangement:timealoneWhat’stheroleoffamilyandfriendswhenthepatientiscaredathome?(Pre.4)Takingonajobwhichisbigphysically,emotionally,andfinancially；Hiringahomenurseforadditionalhelp;Arrangingforservices(suchasvisitingnurses)andspecialequipment(likeahospitalbedorbedsidecommode)Whatneedstobeconsideredtomakecomfortcareavailableathome?(Pre.5)HealthinsurancePlanningbyaprofessional,suchasahospitaldischargeplannerorasocialworkerHelpfromlocalgovernmentalagenciesDoctorsupervisionathomeHowhasthemeaningofpalliativecarechanged?(Pre.6)TraditionallyRecentlyonlysymptomcareclosetohospicecareWhatmightbeoneofthemisconceptionsaboutchoosinghospice?(Pre.7)StoppingtreatmentspecificallyaimedatcuringanillnessequalsdiscontinuingalltreatmentAgoodexample:AnolderpersonwithcancerDiscontinuationofchemotherapybutcontinuationofmedicationforhypertensionWhatmightbeoneofthemisconceptionsaboutchoosinghospice?(Pre.7)ChoosinghospiceisapermanentdecisionDeloresasanexampleEighty-twowithfailingkidneysBeginninghospicecarenotwantingtogothroughdialysis,soDeloresChanginghermindandbeginningdialysisinthehopesofonedayholdingherfirstgreat-grandchild.Whatmightbeoneofthemisconceptionsaboutchoosinghospice?(Pre.7)ChoosinghospiceisapermanentdecisionArtBuchwaldasanotherexampleeighty-onereal-lifehumoristandWashingtonPostcolumnistDecidedagainstthekidneydialysissuggestedbyhisdoctorBignewswithstabilizedconditionLeavinghospicewithoutthreatofdeathWhatdifficultsituationistheyoungdoctorfacing?(Pre.1)AdyingpatientDecisionwhethertowithdrawlife-supportmachinesandmedicationandstartcomfortmeasuresThefamily’srefusaltomakeanydecisionorwithdrawanytreatmentsUnit7TextADoctorsasexclusivedecisionmakerPatientsasparticipantswithoutlittlesayinthefinalchoiceThewaydoctorsandpatientsapproachmedicaldecisionshaschangedsharplyoverthelast50years.Whatispaternalisticdecision-makinginmedicine?(Pre.2)Respectforthepatient,especiallythepatient’sautonomyPatient-centeredcareThePatientsasdecisionmakerbasedontheinformationprovidedbythedoctorInwhatwaycanpatientempowermentbegoodforthepatient?(Pre.3)Thepatientsareforcedtomakedecisionstheyneverwantto.Patients,atleastalargemajority,prefertheirdoctorstomakefinaldecisions.Shiftingresponsibilityofdecisionmakingtothepatientswillbringaboutmorestresstothepatientsandtheirfamilies,especiallywhenthebestoptionforthepatientisuncertainWhydoestheauthorsaythattoomuchphysicianrestraintmaynotbethatgoodforthepatient?(Pre.4)Doctorsareverymuchcautiousaboutcommittingsomekindofethicaltransgression.Doctorsmaybegrapplingwiththeirownsetofworries.‘WhoamItopresumetoknowwhatmypatientsneed?’Whatkindofconsiderationsmayhavepreventeddoctorsfrommakingdecisionsfortheirpatients?(Pre.5)Doyouagreethatdoctorsshouldbepreparedtomakeanydecisionstogetherwiththeirpatients?(Pre.6)Shoulderingresponsibilitytogetherwiththepatientmaybebetterthanhavingthepatientmakedecisionontheirownalone.Balancingbetweenpaternalismandrespectforpatient’sautonomyconstitutesalargepartofmedicalpractice.Howareresearchandpracticerelatedtoeachother?(Pre.1)BlurreddistinctionbetweenpracticeandresearchCooccurrenceofresearchandpracticeasinresearchdesignedtoevaluateatherapyNotabledeparturesfromstandardpracticeas“experimental”withtheterms“experimental”and“research”arecarelesslydefinedHowareresearchandpracticerelatedtoeachother?(Pre.1)Practice:interventionssolelytoenhancethewell-beingofanindividualpatientorclientandthathaveareasonableexpectationofsuccess.toprovidediagnosis,preventivetreatmentortherapytoparticularindividualsHowareresearchandpracticerelatedtoeachother?(Pre.1)Research:anactivitytotesthypothesis,permitconclusionstobedrawn,andtherebytodeveloporcontributetogeneralizableknowledgeexpressedintheories,principles,andstatementsofrelationshipsWhatistheprincipleofrespectforpersons?(Pre.2)(InDiagramP194)BasicEthicalPrinciples________________________principleofjusticeAdilemma:Requirement1:acknowledgementofautonomyRequirement2:Rule1:________________________Rule2:maximizationofpossiblebenefitsandminimizationofpossibleharmsConception1:unjustifiabledenialofbenefitorundulyimpositionofburdenConception2:_____________________________________________anequalshareaccordingto________________accordingto________________accordingtosocietalcontributionaccordingtomeritprincipleofrespectofpersonsprotectionofpersonswithdiminishedautonomyinvolvementofprisonersassubjectsofresearchWhatistheprincipleofbeneficence?(Pre.4)“Donoharm”asafundamentalprincipleofmedicalethicsOneshouldnotinjureonepersonregardlessofthebenefitsthatmightcometoothers.Butbenefitsandrisksasaset“duet”inbothmedicalpracticeandresearchExposuretotherisksintheprocessesoflearningwhatisharmfulorbeneficialTheprincipleofbeneficence(Pre.5)BasicEthicalPrinciplesprincipleofrespectofpersonsprincipleofbeneficenceprincipleofjusticeeAdilemma:involvementofprisonersassubjectsofresearchRequirement1:acknowledgementofautonomyRequirement2:protectionofpersonswithdiminishedautonomyRule1:Rule2:Conception1:unjustifiabledenialofbenefitorundulyimpositionofburdenConception2:equaltreatmentofequalsanequalshareaccordingtoindividualneedaccordingtoindividualeffortaccordingtosocietalcontributionaccordingtomeritdonoharmmaximizationofpossiblebenefitsandminimizationofpossibleharmsTheprincipleofjustice(Pre.5)(InDiagramP194)BasicEthicalPrinciplesprincipleofrespectofpersonsprincipleofbeneficenceprincipleofjusticeAdilemma:involvementofprisonersassubjectsofres