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Americanofficialshaveannouncedrulestohelppreventpeoplefromgettingsickfromthemedicinestheytake.TherulesrequirethemedicinesAmericansusemosttohaveinformationthatiseasytoreadandunderstand.Theofficialssaythenewsystemwillhelppeoplemakemoreinformeddecisionsaboutthedrugstheyuse.Moreandmorepeopleusemedicinesknownasover-thecounterdrugstotreatcommonhealthproblems.Americansbuy5’000000000suchproductseachyear.About100000over-the-counterdrugscanbepurchasedintheUnitedStateswithoutordersfromadoctor.Manypeopledecideontheirownwhichdrugtotakehowtotakeitandifitshouldbegiventotheirchildren.Over-the-counterdrugsaregenerallyverysafe.Howeverusingthemthewrongwaycanbedangerous.OfficialssayhospitalsintheUnitedStatestreat170000peopleeachyearbecausethedrugsmakethemsick.StudiesestimatethathalfofthesehospitalvisitscouldbepreventedifAmericanswerebettereducatedabouttheproducts.TheFoodandDrugAdministrationproposedthenewrulestwoyearsago.FDAofficialssaytheyworkedwiththedrugindustryandpublicinterestgroupstodeveloptherequirements.Theagencyalsoreceivedalmost2000publiccommentsabouttheproposals.Thenewinformationshouldmakeiteasierforpeopletoidentifyactivechemicalsusedinamedicine.Thisinformationwillbelistedatthetopoftheproductcontainer.Thelabelalsowilllistusesofthedrugwarningsanddirections.Chemicalsinthedrugwhicharenotactivealsowillbelisted.ThereasonforthisistoletAmericansselectproductsthatwillnotmakethemsick.Howmanypeoplegetsickbecauseoftakingover-the-counterdrugseachyear
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
Theideaoftest-tubebabiesmaymakeyoustarry-eyedwithdelightatthewondersofmodernmedicineorbleary-eyedwithconsideringthemoral/legalimplicationsofstartinglifeinalaboratory.Butifyou’veeverbeenpregnant怀孕yourselfonethingiscertain:Youwonderwhatit’sliketocarryatest-tubebaby.ArethesepregnanciesnormalArethebabiesnormalTheearliestanswerscomefromAustraliawhereagroupofmedicalexpertsattheQueenVictoriaMedicalCenterinMelbournehavetakenalookatthecontinent’sfirstnineseemedtoproceedaccordingtoplanbutatbirthsomeunusualtrendsdidshowup.Sevenoftheninebabiesturnedouttobegirls.SixofthenineweredeliveredbyCaesareansection剖腹产术.Andonebabyatwinwasbornwithaseriousheartdefectandafewdayslaterdevelopedlife-threateningabdominalproblems.WhatdoesitallmeanEventhedoctorsdon’tknowforsurebecausethenumbersaresosmall.Theproportionofgirlstoboysishighbutuntiltherearemanymoretest-tubebabiesnoonewillknowwhetherthat’spurecoincidence巧合orsomethingspecial.Thesamethingistrueofthesingleheartdefect;itusuallyshowsupinonly15outof60000birthsinthatpartofAustraliabutthefactthatitoccurredinoneoutofninetest-tubebabiesdoesnotnecessarilymeanthattheyareatspecialrisk.OnethingthedoctorscanexplainisthehighnumberofCaesareans.TheAustralianresearchersreportthattheyarequiteencouraged.Allthebabiesarenowmakingnomalprogress--eventhetwinwiththebirthdefects.Whichofthefollowingstatementbestdescribestheorganizationofthepassage
AnindependentinquiryintooutofhoursservicesoffamilydoctorsinScotlandhasconcludedthattheintroductionofGPcooperativeshasbeenapositivedevelopmentthatisbenefitingbothpatientsanddoctors.Theworkinggroupthatdrewupthereporthoweverhasexpressedsomeconcernaboutthetreatmentofchildrenanddifficultiesfacedbysomepatientsinarrangingtheirowntransporttotraveltoemergencycenters.ImprovementsarebeingsoughtbytheScottishOfficeontheseissuestoimprovethequalityfairnessandresponsivenessofthesystem.TheinquirywaspromptedbythedeathsoftwobabiesinAyrshireafterthelocalcooperativeAyrshireDoctorsonCallprovidedtelephoneadvicebutdeclinedrequestsforhomevisits.Parentsofthedeadchildrencriticizedthecooperativeforfailingtosendoutadoctor.Theparentssupportedacampaignthatcalledforautomatichomevisitstobeprovidedforcertaingroupsofpatientssuchaschildrenandelderlypeople.Thatideahasbeenrejectedbytheinquiryteamwhichsaidthatneitherpatientnorprofessionalgroupsacceptedthevalueofpoliciesthatwouldprovideautomatichomevisits.Insteaditisrecommendedthatcooperativescarryoutmoreeffectivemonitoringoftreatmentforchildrenincludingreviewingcomplaintsandcriticalincidents.ThefirstGPcooperativeswereformedthreeyearsagototakeoveroutofhourscallsfromindividualpracticesbuttheywereestablishedwithdifferentworkingpractices.Thereportnotesthatvariationexistsintransportarrangementswithsomecooperativesprovidingfreetransporttoemergencycentersandothersrequiringpeopleoftenmaketheirownarrangements.Healthboardhavebeenorderedtoreportonthefairnessoftransportarrangementsintheirarea.Guidelinesarealsotobeintroducedtoensurethatcooperativesareworkingtosimilarhighstandards.Theywillincludearrangementsthatwillallowpatientstomakecontactwithanoutofhoursservicewithasinglephonecall.InitiativesarealsoplannedtohelpGPsinruralareaswhohavebeenunabletobenefitfromthedevelopmentofcooperatives.Anextra540000isbeingprovidedtopayforthesedevelopments.Whatdoesthepassagemainlydealwith
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Theideaoftest-tubebabiesmaymakeyoustarry-eyedwithdelightatthewondersofmodernmedicineorbleary-eyedwithconsideringthemoral/legalimplicationsofstartinglifeinalaboratory.Butifyou’veeverbeenpregnant怀孕yourselfonethingiscertain:Youwonderwhatit’sliketocarryatest-tubebaby.ArethesepregnanciesnormalArethebabiesnormalTheearliestanswerscomefromAustraliawhereagroupofmedicalexpertsattheQueenVictoriaMedicalCenterinMelbournehavetakenalookatthecontinent’sfirstnineseemedtoproceedaccordingtoplanbutatbirthsomeunusualtrendsdidshowup.Sevenoftheninebabiesturnedouttobegirls.SixofthenineweredeliveredbyCaesareansection剖腹产术.Andonebabyatwinwasbornwithaseriousheartdefectandafewdayslaterdevelopedlife-threateningabdominalproblems.WhatdoesitallmeanEventhedoctorsdon’tknowforsurebecausethenumbersaresosmall.Theproportionofgirlstoboysishighbutuntiltherearemanymoretest-tubebabiesnoonewillknowwhetherthat’spurecoincidence巧合orsomethingspecial.Thesamethingistrueofthesingleheartdefect;itusuallyshowsupinonly15outof60000birthsinthatpartofAustraliabutthefactthatitoccurredinoneoutofninetest-tubebabiesdoesnotnecessarilymeanthattheyareatspecialrisk.OnethingthedoctorscanexplainisthehighnumberofCaesareans.TheAustralianresearchersreportthattheyarequiteencouraged.Allthebabiesarenowmakingnomalprogress--eventhetwinwiththebirthdefects.Whichofthefollowingwouldbethemostappropriatetitleforthepassage
1.NursingatBethIsraelHospitalproducesthebestpatientcarepossible.IfwearetosolvethenursingshortagehospitaladministrationanddoctorseverywherewoulddowelltofollowBethIsrael’sexample.2.AtBethIsraeleachpatientisassignedtoaprimarynursewhovisitsatlengthwiththepatientandconstructsafull-scalehealthaccountthatcoverseverythingfromhismedicalhistorytohisemotionalstate.Thenshewritesacareplancentredonthepatient’sillnessbutwhichalsoincludeseverythingelsethatisnecessary.3.Theprimarynursestayswiththepatientthroughhishospitalisationkeepingtrackwithhisprogressandseekingfurtheradvicefromhisdoctor.IfapatientatBethIsraelisnotrespondingtotreatmentitisnotuncommonforhisnursetoproposeanotherapproachtohisdoctor.WhatthedoctoratBethIsraelhasintheprimarynurseisatruecolleague.4.NursingatBethIsraelalsoinvolvesadecentralized分散的nursingadministration;everyflooreveryunitisaself-containedorganization.Therearenurse-managersinsteadofheadnurses;inadditiontotheirmedicaldutiestheydoalltheirownhiringanddismissingemployeeadvisingandtheymakesalaryrecommendations.Eachunit’snursesdecideamongthemselveswhowillworkwhatshiftsandwhen.5.BethIsrael’snurse-in-chiefranksasanequalwithothervicepresidentsofthehospital.ShealsoismemberoftheMedicalExecutiveCommitteewhichinmosthospitalsincludesonlydoctors.WhatthedoctoratBethIsraelhasintheprimarynurseisa______.
Domesticdemandmaythusdeceleratetoamoresustainablegrowthrateandtheunemploymentratemayriseslightly.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
Americanofficialshaveannouncedrulestohelppreventpeoplefromgettingsickfromthemedicinestheytake.TherulesrequirethemedicinesAmericansusemosttohaveinformationthatiseasytoreadandunderstand.Theofficialssaythenewsystemwillhelppeoplemakemoreinformeddecisionsaboutthedrugstheyuse.Moreandmorepeopleusemedicinesknownasover-thecounterdrugstotreatcommonhealthproblems.Americansbuy5’000000000suchproductseachyear.About100000over-the-counterdrugscanbepurchasedintheUnitedStateswithoutordersfromadoctor.Manypeopledecideontheirownwhichdrugtotakehowtotakeitandifitshouldbegiventotheirchildren.Over-the-counterdrugsaregenerallyverysafe.Howeverusingthemthewrongwaycanbedangerous.OfficialssayhospitalsintheUnitedStatestreat170000peopleeachyearbecausethedrugsmakethemsick.StudiesestimatethathalfofthesehospitalvisitscouldbepreventedifAmericanswerebettereducatedabouttheproducts.TheFoodandDrugAdministrationproposedthenewrulestwoyearsago.FDAofficialssaytheyworkedwiththedrugindustryandpublicinterestgroupstodeveloptherequirements.Theagencyalsoreceivedalmost2000publiccommentsabouttheproposals.Thenewinformationshouldmakeiteasierforpeopletoidentifyactivechemicalsusedinamedicine.Thisinformationwillbelistedatthetopoftheproductcontainer.Thelabelalsowilllistusesofthedrugwarningsanddirections.Chemicalsinthedrugwhicharenotactivealsowillbelisted.ThereasonforthisistoletAmericansselectproductsthatwillnotmakethemsick.Thenewrequirementsfortheactivechemicalsinamedicinemustbelabelled______.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
Theeffectofhigheroilpriceshasbeensubstantiallyoffsetbytherecentyenappreciation.
Attemptstounderstandtherelationshipbetweensocialbehaviorandhealthhavetheirorigininhistory.Dubos1969suggestedthatprimitivehumanswereclosertotheanimalsinthattheytooreliedupontheirinstinctstostayhealthy.Yetsomeprimitivehumansrecognizedacauseandeffectrelationshipbetweendoingcertainthingandalleviating减轻symptomsofadiseaseorimprovingtheconditionofawound.Sincetherewassomuchthatprimitivehumansdidnotunderstandaboutthefunctioningofthebodymagicbecameanintegralcomponentofthebeliefsaboutthecausesaridcutesofhealthdisorders.Soitisnotsurprisingthatearlyhumansthoughtthatillnesswascausedbyevilspirits.Primitivemedicinesmadefromvegetablesoranimalswereinvariablyusedincombinationwithsomeformofritualtoexpelharmfulspiritfromadiseasedbody.Oneoftheearliestattemptsinthewesternworldtoformulate系统地阐述principlesofhealthcarebaseduponrejectionofsupernaturalphenomenaisfoundintheworkoftheGreekphysicianHippocrates.LittleisknownofHippocrateswholivedaround400B.C.notevenwhetherheactuallyauthoredthecollectionofbooksthatbearshisname.Neverthelessthewritingsattributedtohimhaveprovidedanumberofprinciplesunderlyingmodernpractice.OneofhismostfamouscontributionstheHippocraticOathisthefoundationofcontemporarymedicalethics道德.Amongotherthingsitrequiresthephysiciantoswearthatheorshewillhelpthesickkeeponeselffromintentionalwrong-doingorharmandkeepsecretallmatterstokeepthedoctorpatientrelation-ship.Hippocratesalsoarguedthatmedicalknowledgeshouldbederivedfromanunderstandingofthenaturalsciencesandthelogicofcauseandeffectrelation-ships.InthisclassicthesisOnAirsWatersandPlacesHippocratespointedoutthathumanwellbeingisinfluencedbythetotalityofenvironmentalfactors:livinghabitsorlifestyleclimategeographyofthelandandthequalityofairandfood.Interestingenoughconcernsaboutourhealthandthequalityofairwaterandplacesarestillverymuchwritteninthetwentiethcentury.It’snotsurewhetherHippocratesactuallyauthoredthecollectionofbooksthatbearshisname.
AnindependentinquiryintooutofhoursservicesoffamilydoctorsinScotlandhasconcludedthattheintroductionofGPcooperativeshasbeenapositivedevelopmentthatisbenefitingbothpatientsanddoctors.Theworkinggroupthatdrewupthereporthoweverhasexpressedsomeconcernaboutthetreatmentofchildrenanddifficultiesfacedbysomepatientsinarrangingtheirowntransporttotraveltoemergencycenters.ImprovementsarebeingsoughtbytheScottishOfficeontheseissuestoimprovethequalityfairnessandresponsivenessofthesystem.TheinquirywaspromptedbythedeathsoftwobabiesinAyrshireafterthelocalcooperativeAyrshireDoctorsonCallprovidedtelephoneadvicebutdeclinedrequestsforhomevisits.Parentsofthedeadchildrencriticizedthecooperativeforfailingtosendoutadoctor.Theparentssupportedacampaignthatcalledforautomatichomevisitstobeprovidedforcertaingroupsofpatientssuchaschildrenandelderlypeople.Thatideahasbeenrejectedbytheinquiryteamwhichsaidthatneitherpatientnorprofessionalgroupsacceptedthevalueofpoliciesthatwouldprovideautomatichomevisits.Insteaditisrecommendedthatcooperativescarryoutmoreeffectivemonitoringoftreatmentforchildrenincludingreviewingcomplaintsandcriticalincidents.ThefirstGPcooperativeswereformedthreeyearsagototakeoveroutofhourscallsfromindividualpracticesbuttheywereestablishedwithdifferentworkingpractices.Thereportnotesthatvariationexistsintransportarrangementswithsomecooperativesprovidingfreetransporttoemergencycentersandothersrequiringpeopleoftenmaketheirownarrangements.Healthboardhavebeenorderedtoreportonthefairnessoftransportarrangementsintheirarea.Guidelinesarealsotobeintroducedtoensurethatcooperativesareworkingtosimilarhighstandards.Theywillincludearrangementsthatwillallowpatientstomakecontactwithanoutofhoursservicewithasinglephonecall.InitiativesarealsoplannedtohelpGPsinruralareaswhohavebeenunabletobenefitfromthedevelopmentofcooperatives.Anextra540000isbeingprovidedtopayforthesedevelopments.Theinquiryteam’sadvicetothecooperativesis______.
Attemptstounderstandtherelationshipbetweensocialbehaviorandhealthhavetheirorigininhistory.Dubos1969suggestedthatprimitivehumanswereclosertotheanimalsinthattheytooreliedupontheirinstinctstostayhealthy.Yetsomeprimitivehumansrecognizedacauseandeffectrelationshipbetweendoingcertainthingandalleviating减轻symptomsofadiseaseorimprovingtheconditionofawound.Sincetherewassomuchthatprimitivehumansdidnotunderstandaboutthefunctioningofthebodymagicbecameanintegralcomponentofthebeliefsaboutthecausesaridcutesofhealthdisorders.Soitisnotsurprisingthatearlyhumansthoughtthatillnesswascausedbyevilspirits.Primitivemedicinesmadefromvegetablesoranimalswereinvariablyusedincombinationwithsomeformofritualtoexpelharmfulspiritfromadiseasedbody.Oneoftheearliestattemptsinthewesternworldtoformulate系统地阐述principlesofhealthcarebaseduponrejectionofsupernaturalphenomenaisfoundintheworkoftheGreekphysicianHippocrates.LittleisknownofHippocrateswholivedaround400B.C.notevenwhetherheactuallyauthoredthecollectionofbooksthatbearshisname.Neverthelessthewritingsattributedtohimhaveprovidedanumberofprinciplesunderlyingmodernpractice.OneofhismostfamouscontributionstheHippocraticOathisthefoundationofcontemporarymedicalethics道德.Amongotherthingsitrequiresthephysiciantoswearthatheorshewillhelpthesickkeeponeselffromintentionalwrong-doingorharmandkeepsecretallmatterstokeepthedoctorpatientrelation-ship.Hippocratesalsoarguedthatmedicalknowledgeshouldbederivedfromanunderstandingofthenaturalsciencesandthelogicofcauseandeffectrelation-ships.InthisclassicthesisOnAirsWatersandPlacesHippocratespointedoutthathumanwellbeingisinfluencedbythetotalityofenvironmentalfactors:livinghabitsorlifestyleclimategeographyofthelandandthequalityofairandfood.Interestingenoughconcernsaboutourhealthandthequalityofairwaterandplacesarestillverymuchwritteninthetwentiethcentury.Primitivehumanslookedlikeanimals.
MostdoctorsaretoooptimisticinpredictinghowlongdyingpatientshavetoliveandthishasanegativeeffectonthecaretheyreceiveintheirfinaldaysAmericanresearcherssaidFriday.AstudybyscientistsattheUniversityofChicagoMedicalCenterinIllinoisshowedthatofthesurvivalestimatesfor486terminallyillpatientsgivenby343doctors46.47andinsomecasesdoctorspredictedpatientshadfivetimelongertolivethanprovedtobethecase.Doctorsareinaccurateintheirprognoses预后forterminallyillpatientsandtheerrorissystematicallyoptimisticprofessorNicholasChristakisandDrElizabethLamontsaidinareportinTheBritishMedicalJournal.Theresearchersaddedthatdoctorswhoknewtheirpatientsbestweremorelikelytogetitwrong.48...thetypeofsystematicbiastowardoptimismthatwehavefoundindoctors’objectiveprognosticassessmentsmaybeadversely不利地affectingpatientcaretheresearchersadded.Insteadofreceivingthreemonthsofhospicecarewhichisconsideredtobetheideal49.Patientswhothoughttheyhadlongertolivealsooptedformoreaggressivetreatmentinsteadofpalliative治标的carethereportsaid.Theresearchersuggesteddoctorsshouldgetsecondopinionsfromcolleagues50beforegivingaprognosis.Reliableprognosticinformationisakeydeterminantinbothdoctors’andpatients’decisionmakingtheysaid.A.manypatientsreceivedonlyonemonth’scarebecauseoftheoptimisticprognosis.B.AlthoughsomeerrorisunavoidableC.alotofpatientsareeagertoleavethehospital.D.only20percentwereaccurateE.particularlyiftheyknowapatientwell.F.Sixtythreepercentofthepredictionsoverestimatedthetimepatientshadleft.
Americanofficialshaveannouncedrulestohelppreventpeoplefromgettingsickfromthemedicinestheytake.TherulesrequirethemedicinesAmericansusemosttohaveinformationthatiseasytoreadandunderstand.Theofficialssaythenewsystemwillhelppeoplemakemoreinformeddecisionsaboutthedrugstheyuse.Moreandmorepeopleusemedicinesknownasover-thecounterdrugstotreatcommonhealthproblems.Americansbuy5’000000000suchproductseachyear.About100000over-the-counterdrugscanbepurchasedintheUnitedStateswithoutordersfromadoctor.Manypeopledecideontheirownwhichdrugtotakehowtotakeitandifitshouldbegiventotheirchildren.Over-the-counterdrugsaregenerallyverysafe.Howeverusingthemthewrongwaycanbedangerous.OfficialssayhospitalsintheUnitedStatestreat170000peopleeachyearbecausethedrugsmakethemsick.StudiesestimatethathalfofthesehospitalvisitscouldbepreventedifAmericanswerebettereducatedabouttheproducts.TheFoodandDrugAdministrationproposedthenewrulestwoyearsago.FDAofficialssaytheyworkedwiththedrugindustryandpublicinterestgroupstodeveloptherequirements.Theagencyalsoreceivedalmost2000publiccommentsabouttheproposals.Thenewinformationshouldmakeiteasierforpeopletoidentifyactivechemicalsusedinamedicine.Thisinformationwillbelistedatthetopoftheproductcontainer.Thelabelalsowilllistusesofthedrugwarningsanddirections.Chemicalsinthedrugwhicharenotactivealsowillbelisted.ThereasonforthisistoletAmericansselectproductsthatwillnotmakethemsick.Over-the-counterdrugsarethemedicines______.
1.NursingatBethIsraelHospitalproducesthebestpatientcarepossible.IfwearetosolvethenursingshortagehospitaladministrationanddoctorseverywherewoulddowelltofollowBethIsrael’sexample.2.AtBethIsraeleachpatientisassignedtoaprimarynursewhovisitsatlengthwiththepatientandconstructsafull-scalehealthaccountthatcoverseverythingfromhismedicalhistorytohisemotionalstate.Thenshewritesacareplancentredonthepatient’sillnessbutwhichalsoincludeseverythingelsethatisnecessary.3.Theprimarynursestayswiththepatientthroughhishospitalisationkeepingtrackwithhisprogressandseekingfurtheradvicefromhisdoctor.IfapatientatBethIsraelisnotrespondingtotreatmentitisnotuncommonforhisnursetoproposeanotherapproachtohisdoctor.WhatthedoctoratBethIsraelhasintheprimarynurseisatruecolleague.4.NursingatBethIsraelalsoinvolvesadecentralized分散的nursingadministration;everyflooreveryunitisaself-containedorganization.Therearenurse-managersinsteadofheadnurses;inadditiontotheirmedicaldutiestheydoalltheirownhiringanddismissingemployeeadvisingandtheymakesalaryrecommendations.Eachunit’snursesdecideamongthemselveswhowillworkwhatshiftsandwhen.5.BethIsrael’snurse-in-chiefranksasanequalwithothervicepresidentsofthehospital.ShealsoismemberoftheMedicalExecutiveCommitteewhichinmosthospitalsincludesonlydoctors.Para3______.
AnindependentinquiryintooutofhoursservicesoffamilydoctorsinScotlandhasconcludedthattheintroductionofGPcooperativeshasbeenapositivedevelopmentthatisbenefitingbothpatientsanddoctors.Theworkinggroupthatdrewupthereporthoweverhasexpressedsomeconcernaboutthetreatmentofchildrenanddifficultiesfacedbysomepatientsinarrangingtheirowntransporttotraveltoemergencycenters.ImprovementsarebeingsoughtbytheScottishOfficeontheseissuestoimprovethequalityfairnessandresponsivenessofthesystem.TheinquirywaspromptedbythedeathsoftwobabiesinAyrshireafterthelocalcooperativeAyrshireDoctorsonCallprovidedtelephoneadvicebutdeclinedrequestsforhomevisits.Parentsofthedeadchildrencriticizedthecooperativeforfailingtosendoutadoctor.Theparentssupportedacampaignthatcalledforautomatichomevisitstobeprovidedforcertaingroupsofpatientssuchaschildrenandelderlypeople.Thatideahasbeenrejectedbytheinquiryteamwhichsaidthatneitherpatientnorprofessionalgroupsacceptedthevalueofpoliciesthatwouldprovideautomatichomevisits.Insteaditisrecommendedthatcooperativescarryoutmoreeffectivemonitoringoftreatmentforchildrenincludingreviewingcomplaintsandcriticalincidents.ThefirstGPcooperativeswereformedthreeyearsagototakeoveroutofhourscallsfromindividualpracticesbuttheywereestablishedwithdifferentworkingpractices.Thereportnotesthatvariationexistsintransportarrangementswithsomecooperativesprovidingfreetransporttoemergencycentersandothersrequiringpeopleoftenmaketheirownarrangements.Healthboardhavebeenorderedtoreportonthefairnessoftransportarrangementsintheirarea.Guidelinesarealsotobeintroducedtoensurethatcooperativesareworkingtosimilarhighstandards.Theywillincludearrangementsthatwillallowpatientstomakecontactwithanoutofhoursservicewithasinglephonecall.InitiativesarealsoplannedtohelpGPsinruralareaswhohavebeenunabletobenefitfromthedevelopmentofcooperatives.Anextra540000isbeingprovidedtopayforthesedevelopments.TheservicesGPcooperativesprovideare______.
1.NursingatBethIsraelHospitalproducesthebestpatientcarepossible.IfwearetosolvethenursingshortagehospitaladministrationanddoctorseverywherewoulddowelltofollowBethIsrael’sexample.2.AtBethIsraeleachpatientisassignedtoaprimarynursewhovisitsatlengthwiththepatientandconstructsafull-scalehealthaccountthatcoverseverythingfromhismedicalhistorytohisemotionalstate.Thenshewritesacareplancentredonthepatient’sillnessbutwhichalsoincludeseverythingelsethatisnecessary.3.Theprimarynursestayswiththepatientthroughhishospitalisationkeepingtrackwithhisprogressandseekingfurtheradvicefromhisdoctor.IfapatientatBethIsraelisnotrespondingtotreatmentitisnotuncommonforhisnursetoproposeanotherapproachtohisdoctor.WhatthedoctoratBethIsraelhasintheprimarynurseisatruecolleague.4.NursingatBethIsraelalsoinvolvesadecentralized分散的nursingadministration;everyflooreveryunitisaself-containedorganization.Therearenurse-managersinsteadofheadnurses;inadditiontotheirmedicaldutiestheydoalltheirownhiringanddismissingemployeeadvisingandtheymakesalaryrecommendations.Eachunit’snursesdecideamongthemselveswhowillworkwhatshiftsandwhen.5.BethIsrael’snurse-in-chiefranksasanequalwithothervicepresidentsofthehospital.ShealsoismemberoftheMedicalExecutiveCommitteewhichinmosthospitalsincludesonlydoctors.FollowBethIsrael’sexampleifwearetosolvethe______.
Thecurrentexternalsurplusdeclinedfurther.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
MostdoctorsaretoooptimisticinpredictinghowlongdyingpatientshavetoliveandthishasanegativeeffectonthecaretheyreceiveintheirfinaldaysAmericanresearcherssaidFriday.AstudybyscientistsattheUniversityofChicagoMedicalCenterinIllinoisshowedthatofthesurvivalestimatesfor486terminallyillpatientsgivenby343doctors46.47andinsomecasesdoctorspredictedpatientshadfivetimelongertolivethanprovedtobethecase.Doctorsareinaccurateintheirprognoses预后forterminallyillpatientsandtheerrorissystematicallyoptimisticprofessorNicholasChristakisandDrElizabethLamontsaidinareportinTheBritishMedicalJournal.Theresearchersaddedthatdoctorswhoknewtheirpatientsbestweremorelikelytogetitwrong.48...thetypeofsystematicbiastowardoptimismthatwehavefoundindoctors’objectiveprognosticassessmentsmaybeadversely不利地affectingpatientcaretheresearchersadded.Insteadofreceivingthreemonthsofhospicecarewhichisconsideredtobetheideal49.Patientswhothoughttheyhadlongertolivealsooptedformoreaggressivetreatmentinsteadofpalliative治标的carethereportsaid.Theresearchersuggesteddoctorsshouldgetsecondopinionsfromcolleagues50beforegivingaprognosis.Reliableprognosticinformationisakeydeterminantinbothdoctors’andpatients’decisionmakingtheysaid.A.manypatientsreceivedonlyonemonth’scarebecauseoftheoptimisticprognosis.B.AlthoughsomeerrorisunavoidableC.alotofpatientsareeagertoleavethehospital.D.only20percentwereaccurateE.particularlyiftheyknowapatientwell.F.Sixtythreepercentofthepredictionsoverestimatedthetimepatientshadleft.
Microcomputerprovesitselfmoreandmoreimportantinthebusinesssoadditionalmachinesarepurchased.
Onlythreestrategiesareavailableforcontrollingcancerpreventionscreeningandtreatment.Lungcancercausesmoredeathsthananyothertypeofcancer.Amajorcauseofthediseaseis51known;thereisnogoodevidencethatscreeningisofmuchhelp;andtreatmentfailsinabout90percentofallcases.Atpresentthereforethemainstrategymustbe52.ThismaynotalwaysbetrueofcourseasforsomeothertypesOfcancerresearch53thepastfewdecadeshasproducedorsuggestedsomeimportantprogressinpreventionscreeningortreatment.54howeverweconsidernotwhatresearchmayonedayofferbutwhattoday’sknowledgecouldalreadydeliverthatisnotbeingdeliveredthenthemostpracticableandcost-effectiveopportunitiesforavoidingprematuredeathfromcancerespeciallylungcancerprobablyinvolveneitherscreeningnorimproved55butprevention.Thisconclusiondoesnotdependontheunrealisticassumptionthatwecan56tobacco.Itmerelyassumesthatwecanreducecigarettesalesappreciablybyraisingpricesorby57thetypeofeducationthatalreadyappearstohavehada58effectoncigaretteconsumptionbywhite-collarworkersandthatwecansubstantiallyreducetheamountoftardeliveredpercigarette.Thepracticabilityofpreventingcancerbysuchmeasuresappliesnotonlyinthosecountries59theUSwherebecausecigarettesmokinghasbeencommonfordecades25～30percentofallcancerdeathsnowinvolvelungcancerbutalsointhosewhereithasbecome60onlyrecently.InChinaforexamplelungcancer61accountsforonlyabout510percentofallcancerdeaths.Thisisbecauseitmaytakeasmuchashalfacentury62theriseinsmokingtoincreasetheincidenceoflungcancer.Countrieswherecigarettesmokingisonlynowbecomingwidespreadcanexpectenormousincreasesinlungcancerduringthe1990sorearlyinthenextcentury63prompteffectiveactionistakenagainstthehabit--indeed.suchincreasesarealreadyplainlyevidentinpartsof64.Therearefourreasonswhythepreventionoflungcancerisofsuchoverwhelmingimportance:firstthediseaseisextremelycommoncausingmoredeathsthananyothertypeofcancernowdoes;secondlyitisgenerallyincurable;thirdlyeffectivepracticablemeasurestoreduceitsincidencearealreadyreliablyknown;andfinally65tobaccoconsumptionwillalsohaveasubstantialimpactonmanyotherdiseases.
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