医学英语第九讲.ppt
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医学英语第九讲.ppt
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范文阅读范文阅读ModelEssayReading观察点观察点PointsofObservationlUseofwordslStructurelImplicationlConnectionExample1(注意句与句之间连接注意句与句之间连接)NosocomialInfectionMedical,surgical,andneonatalcriticalcareareasprovideaconcentrationofpatientsathighriskfordevelopingnosocomialinfection.Thisisareflectionofpatientsunderlyingdisease,thefrequentuseofinvasivemonitoring,andalterationofnormalflorabyantibiotics.Oftenpatientsareincloseproximitytoeachother,promotingtransmissionbybusymedicalpersonnelwhofailtowashtheirhandsbetweencontacts.Cross-infectionhasbeenreportedtobeparticularlycommonamongthermallyinjuredpatients.Furthermore,thewidespreaduseoftopicalantibioticsmayselectforcolonizationandinfectionwithmultiplyresistantorganisms.lProperdesignofcriticalcareunitswithregardtoseparationofpatientsbypartitionsandplacementofsinksattheentrancewaytoindividualcubicles,aswellasoptimalnursing-to-patientratios,mayberequiredtominimizetherisksofcrossinfection.lOtherssuggestedinfectioncontrolmeansinclude1)thenotificationoftheinfectioncontrolteambytheunitofallnewproceduresorproducts,and2)useofaclinicalflowsheetlistingallcatheters,datesofinsertion,andrationaleforcontinueduse.Example2NutritionandSurgeryPrepoperativeevaluationofthecardiovascular,pulmonary,hepatic,andrenalfunctions,togetherwithanassessmentoftheimmunologicstatusandphysiologicage,isperformedroutinelyinthepreparationofapatientforoperationinordertominimizeoperativeandpostoperativerisks.lHowever,anequallycriticalthoughsometimesdisregarded,factoraffectingsurgicaljudgmentisthenutritionalconditionofthepatient.lNutritionalstatusisveryimportantinsurgerybecausecertainformsofmalnutritionincreasethemorbidityandmortalityofoperations;becauseparticulartypesofsurgicalproceduresnecessitateperiodsofrelativeorcompletestarvationpreoperativeand/orpostoperatively;andbecausespecificpathologicconditionsorlesionsthathavecausedorcontributedtothestateofmalnutritionoftenrequireoperativetherapy.lMoreover,accidentalorsurgicaltraumaprecipitatesthecatabolicresponsedescribedbyCuthbertsonandhisassociatesin1935,promotingexcessivenitrogenlossesandaccentuatinganyexistingproteindeficits.lCertainspecificnutritionalproblemsthatoccurlessfrequentlyinotherdisciplinesofmedicineoftenconfrontthesurgeon.lTheremaybeprolongedperiodsoftimeduringwhichpatientscannotbefedbymouthorbyintestinaltubebecauseofbowelobstruction,primarilygastrointestinaldisease,peritonitis,orotheralimentarytractconditions.Suchpatientsusuallyrequireparenteralmeansofnourishment.Example3ClinicalApproachtoNeurologicalDisorderslPatientwithsymptomsandsignsreferabletothenervoussystemplacespecialrequirementsonthephysiciansclinicalapproach.lThemostimmediatetaskistoconsiderwhetherthesymptomsaremerelythenonspecificsignalsofasystemicdisorderorreflectsintrinsicneurologicaldisease.lPain,headache,nausea,dizziness,fatigue,andweaknessalllackspecificityuntiltakenintocontextwiththerestofthehistoryandphysicalfindings;asoftenasnot,suchsymptomscanreflecttheemotionalravagesofdisturbedpsychologicaladjustment.lTounderstandandtreathumanbeingsrequiresthatthedoctorknowwhoissickasmuchasormoreoftenthanwhatissick.PutinPeabodyswords:
”Thesecretofthecareofthepatientiscaringforthepatient.”lAsecondconsiderationistorealizethatalthoughallpatientsaretosomedegreefrightenedofillness,concernoverthepossibilityofparalysis,severepain,ormentalimpairmentinstillsanespecialterrorwhichrequiresthedoctorsattentionandreassurance.lWhenexaminingsuchpatients,ifatallpossible,Oslersdictumshouldbefollowed:
“Dothekindthinganddoitfirst.”Example4InfectionControlinSurgicalSettingslTheevolutionofmodernsurgeryhasreachedalevelwhereeveryorgancanbesuccessfullyinvaded,wheremonitoringdevicesdisplaythestatusofeveryphysiologicalactivity,andwhereagrowingnumberofdevicesandtransplantsexistthatcantemporarilyorevenpermanentlyreplacevitalorgans.lOnegreatlimitingfactor,however,threatensthesuccessofalmosteverysurgicalprocedureinfection.Infectionresultswhenmicrobesovercomethedelicatebalancebetweenthebodysnormalprotectiveimmunologicprocessandtheinvadingmicroorganismspathologicproperties.lInfectionisathreatnotonlytothenewandtechnicallyinnovativeproceduresdoneinlargehospitals,butisalsotheenemyofeventhesimplestprocedures,suchathosedoneinoutpatientsurgeryfacilities.Awoundinfectioncanbeasdevastatingtoaherniarepairoracutfingerasitcanbetoahearttransplantpatient.Example5AStatementofPathologicalConditionDr.LawrenceC.C.Wong(M.B.
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