-
Unit1
1
、
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 scan
3
、
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 4
4
、
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
—
reques
t
”
：
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: time
Unit2
1
、
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 diseases
2
、
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 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
world
3
、
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 $$
million in 1995 to $$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 immunocompromised
Group A strep:
·
A change in
virulence
·
Mutation in the exterior of
the bacterium
Flu:
Constant
changes
in
its
coat
(surface
antigens)
and
resultant
changes
in
its
level of
virulence
6
、
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 infrastructure
8
、
The
infectious
diseases
such
as
TB,
flu,
diphtheria
and
scarlet
fever
will
never really go away,
and the war against them will never
end.
Unit3
1
、
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
acuity
3
、
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 load
5
、
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
toxins
6
、
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.
Unit4
1
、
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
TCM
3
、
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
acupuncturists
5
、
·
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
patient
6
、
·
Randomized controlled
trials
Advantages:
? 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 si
gnificance
Limitations:
?
Difficulty
in
generalizing
the
results
obtained
from
the
selected
sampling
to the population as a whole
?
A poor choice for research
where temporal factors are an