单选题According to the NAS’s report, one of the problems in end-of-life care is ______.A prolonged medical proceduresB inadequate treatment of painC systematic drug abuseD insufficient hospital care

共用题干 About End-of-Life CareDying patients are happier,less depressed,have less pain and survive longer when their end-of-life care wishes are known and followed,researchers report.This type of patient-centered care can also help keep health costs down________(51)patients who don't want aggressive treatment,the University of California,Los Angeles (UCLA) research team said."You can improve care while________(52)cost by making sure that everything you do is centered on what the patients want,what his or her specific goals are and tailor a treatment plan to ensure we_________(53)the specific care he or she wants,"Dr. Jonathan Bergman,a clinical scholar and fellow in the urology department,said in a university news release.__________(54)many cases,dying patients are given aggressive treatments that don't help them and_________(55)higher costs.Patients who want__________(56)care should receive it,but many don't want it and haven't been_________(57)about their wishes,according to Bergman and colleagues,who are testing patient-centered care__________(58)cancer patients.To change the situation,doctors need to be educated about patient-centered care,the researchers said. They also_________(59)that changes to Medicare should be considered.But this is a highly controversial topic that has been sidelined after recent suggested changes were characterized as creating"death panels"."Given the disproportionate cost of care at the very________(60)of life,the issue should be revisited,"Bergman and colleagues wrote."We should address goals of care,not to___________(61)aggressive care to those who want it,but to ensure that we deliver aggressive care only to those who__________(62).This reduces costs and improves outcomes."The study authors noted that,according to the results of a 2004 study,30 percent of Medicare dollars are________(63)on the 5 percent of beneficiaries who die each year,and one-third of the costs in the final year of life_________(64)during the final month.Previous research has shown that patient-centered care can reduce the costs in the last week of life________(65)36 percent and that patients who receive such care are less likely to die in an intensive care unit._________(63)A:spent B:costC:wasted D:got

单选题Most people in the United States buy insurance _____.A to pay for their own medical careB to help to live on their low incomesC to improve the national health care serviceD to solve one of the important political problems

Text 2 Death comes to all,but some are more sure of its timing,and can make plans.Kate Granger,a 32-year-old doctor suffering from an incurable form ofsarcoma,has"very strong ambitions"for her last hours.She plans to avoid hospital emergency departments and die at her parents'house-music playing,candles glowing,family by her side.Surveys show that over two-thirds of Britons would like to die at home.Like Dr Granger,they want to be with family and free of pain.Yet hospital remains the most common place of death.For some this is unavoidable-not every disease has as clear a tuming point as cancer-but for others a lack of planning is to blame.The government,motivated by both compassion and thrift,wants to help.In death,at least,public wishes align neatly with the state's desire to save money.The NHS has calculated that if roughly one more patient per general practitioner died outside hospital each year,it would save 180m（$295m）.In 2008 it introduced a broad end-of-life care strategy,which sought to increase awareness of how people die while improving care.Since then the proportion of people dying at home or in care homes（the split is about half-and-halfbetween them）has increased,from 38%t0 44%.To steer patients away from hospitals,general practitioners have been encouraged to find their l%-those patients likely to die in the next year-and start talking about end-of-life care.This can be difficult for doctors."As a profession we view death as failure,"says Dr Granger.Yet when there is no cure to be had,planning for death can be therapeutic for patients.Those who do plan ahead are much more likely to have their wishes met.A growing number of patients have electronic"palliative-care co-ordination systems",which allow doctors to register personal preferences so that other care providers can follow them.A paramedic called to a patient's home would know of a do-not-resuscitate order,for example.One study showed that such systems increase the number of people dying in their homes.But savings for the govemment may mean costs for charities and ordinary folk.At the end of life it is not always clear who should pay for what.Although Britons can get ordinary health care without paying out of pocket,social care is means-tested.People must ofien shell out for carers or care homes-or look after the terminally ill themselves.Disputes crop up over trivial things,like responsibility for the cost of a patient's bath.A bill now trundling through Parliament would cap the cost of an individual's social care.Still,some want it to be free for those on end-of-life registries.That would cut into the government's savings-but allow more people to die as they want.According to the text,people who die in the hospital will——.A.get more welfare than other choices B.be aware ofthe importance ofend ofcare approach C.cost more than die at home D.get an end of care life from the state

单选题We learn from the text that ______.A Canadians have easy access to any type of medical care they want.B the Canadian government compensates every citizen for medical expenses.C a medical care is issued once a citizen seeks medical care.D the principle of demand and supply does not apply in the Canadian system.

Text 3 Family caregivers provide essential,often unpaid work in the U.S.:they help family members with tasks like bathing and eating,coordinating insurance coverage and managing medications.But what a caregiver looks like in America is changing.Although the typical unpaid family caregiver is a 49-year-old white woman,about 10 million Americans between ages 18 and 34,of all different backgrounds,are now the caregivers for a family member or friend,according to a new report by AARP.One out of four family caregivers in the U.S.is a millennial.And as Baby Boomers age and need more support,this young group is becoming an increasingly important part of the caregiving workforce.More than half of millennial caregivers are now people of color,according to the report,and they are more likely than any other generation to balance caregiving with employment.Nearly three quarters of millennial caregivers are employed,according to the new report,and 53%work full time.They also spend an average of 21 hours per week on caregiving,or the equivalent of a part time job.More than one in four millennials spends over 20 hours each week providing care,and roughly one in five provides care for at least 40 hours each week."Many of these millennials are not just working and providing this care,but are trying to figure out,ihow do I balance all of this?"'says Jean Accius,an expert on long-term care services and supports at the AARP's public policy institute,which provides guides for different communities of caregivers."At this time in their life,a typical milleruual may be thinking about going on vacation,hanging out with friends and potentially getting married,but these millennials are doing things like wound care and bathing."The report finds that Latino millennials often face increased pressure,as they work more hours each week on average and spend more time providing care than young adults of other backgrounds.Some of this has to do with the fact that Hispanuc Americans are more likely to live in multi-generational households,Accius says.Tasks like navigating govemment health systems or coordinating care between multiple providers can also be particularly challenging for families that have members whose first language is not English.Another common source of stress is the impact that caregiving responsibilities can have on a person's career.54%of millennial caregivers say that caregiving has impacted their job in significant ways,according to the report.Yet millennials are much less likely to tell their supervisors or colleagues at work about their caregiving responsibilities,meaning they are often navigating alone.One sign of progress is that millennial men are nearly as likely to provide care as women,according to the report."The way that millennials think about gendered work or gendered care roles is changing,"says Whiting."The U.S.is already facing a shortage of caregivers,and the increasing gender and racial diversity of millennial caregivers will be necessary to support all those who need help in the future:'she says."We see,especially among millennials,that everybody bears some responsibility,and we need to care for each other." The millennial men's participation in caregiving would_____A.provide great help in the future B.be responsible to care for each other C.change people's opinion on gendered work D.be helpful to address shortage ofcaregivers

单选题Newly-born babies _____ in hospital.A are taken good careB are taken good care ofC take good care ofD take good care

Text 2 Death comes to all,but some are more sure of its timing,and can make plans.Kate Granger,a 32-year-old doctor suffering from an incurable form ofsarcoma,has"very strong ambitions"for her last hours.She plans to avoid hospital emergency departments and die at her parents'house-music playing,candles glowing,family by her side.Surveys show that over two-thirds of Britons would like to die at home.Like Dr Granger,they want to be with family and free of pain.Yet hospital remains the most common place of death.For some this is unavoidable-not every disease has as clear a tuming point as cancer-but for others a lack of planning is to blame.The government,motivated by both compassion and thrift,wants to help.In death,at least,public wishes align neatly with the state's desire to save money.The NHS has calculated that if roughly one more patient per general practitioner died outside hospital each year,it would save 180m（$295m）.In 2008 it introduced a broad end-of-life care strategy,which sought to increase awareness of how people die while improving care.Since then the proportion of people dying at home or in care homes（the split is about half-and-halfbetween them）has increased,from 38%t0 44%.To steer patients away from hospitals,general practitioners have been encouraged to find their l%-those patients likely to die in the next year-and start talking about end-of-life care.This can be difficult for doctors."As a profession we view death as failure,"says Dr Granger.Yet when there is no cure to be had,planning for death can be therapeutic for patients.Those who do plan ahead are much more likely to have their wishes met.A growing number of patients have electronic"palliative-care co-ordination systems",which allow doctors to register personal preferences so that other care providers can follow them.A paramedic called to a patient's home would know of a do-not-resuscitate order,for example.One study showed that such systems increase the number of people dying in their homes.But savings for the govemment may mean costs for charities and ordinary folk.At the end of life it is not always clear who should pay for what.Although Britons can get ordinary health care without paying out of pocket,social care is means-tested.People must ofien shell out for carers or care homes-or look after the terminally ill themselves.Disputes crop up over trivial things,like responsibility for the cost of a patient's bath.A bill now trundling through Parliament would cap the cost of an individual's social care.Still,some want it to be free for those on end-of-life registries.That would cut into the government's savings-but allow more people to die as they want. The best title of this text may be——A.Dying at Home B.Home Helpless C.Hospital Best D.End of Life Care

单选题Medical treatment aboard a ship should not go beyond examination and emergency care without first consulting（）.A the designated medic aboardB the shore based superintendentC a medical doctorD the approved company medical manual

Text 3 Family caregivers provide essential,often unpaid work in the U.S.:they help family members with tasks like bathing and eating,coordinating insurance coverage and managing medications.But what a caregiver looks like in America is changing.Although the typical unpaid family caregiver is a 49-year-old white woman,about 10 million Americans between ages 18 and 34,of all different backgrounds,are now the caregivers for a family member or friend,according to a new report by AARP.One out of four family caregivers in the U.S.is a millennial.And as Baby Boomers age and need more support,this young group is becoming an increasingly important part of the caregiving workforce.More than half of millennial caregivers are now people of color,according to the report,and they are more likely than any other generation to balance caregiving with employment.Nearly three quarters of millennial caregivers are employed,according to the new report,and 53%work full time.They also spend an average of 21 hours per week on caregiving,or the equivalent of a part time job.More than one in four millennials spends over 20 hours each week providing care,and roughly one in five provides care for at least 40 hours each week."Many of these millennials are not just working and providing this care,but are trying to figure out,ihow do I balance all of this?"'says Jean Accius,an expert on long-term care services and supports at the AARP's public policy institute,which provides guides for different communities of caregivers."At this time in their life,a typical milleruual may be thinking about going on vacation,hanging out with friends and potentially getting married,but these millennials are doing things like wound care and bathing."The report finds that Latino millennials often face increased pressure,as they work more hours each week on average and spend more time providing care than young adults of other backgrounds.Some of this has to do with the fact that Hispanuc Americans are more likely to live in multi-generational households,Accius says.Tasks like navigating govemment health systems or coordinating care between multiple providers can also be particularly challenging for families that have members whose first language is not English.Another common source of stress is the impact that caregiving responsibilities can have on a person's career.54%of millennial caregivers say that caregiving has impacted their job in significant ways,according to the report.Yet millennials are much less likely to tell their supervisors or colleagues at work about their caregiving responsibilities,meaning they are often navigating alone.One sign of progress is that millennial men are nearly as likely to provide care as women,according to the report."The way that millennials think about gendered work or gendered care roles is changing,"says Whiting."The U.S.is already facing a shortage of caregivers,and the increasing gender and racial diversity of millennial caregivers will be necessary to support all those who need help in the future:'she says."We see,especially among millennials,that everybody bears some responsibility,and we need to care for each other." According to AARP,family caregivers in America_____A.are limited to white women B.are usually without payment C.are more younger than before D.are paid by their friends

共用题干 Double EffectThe Supreme Court's decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.Although it ruled that there is no constitutional right to physician-assisted suicide,the Court in effect supported the medical principle of"double effect",a centuries-old moral principle holding that an action having two effects-a good one that is intended and a harmful one that is foreseen-is permissible if the actor intends only the good effect.Doctors have used that principle in recent years to justify using high doses of morphine to control terminally ill patients'pain,even though increasing dosages will eventually kill the patient.Nancy Dubler,director of Montefiore Medical Center,contends that the principle will shield doctors who"until now have very,very strongly insisted that they could not give patients sufficient mediation to control their pain if that might hasten death."George Annas,chair of the health law department at Boston Univeisity,maintains that,as long as a doctor prescribes a drug for a legitimale medical purpose,the doctor has done nothing illegal even if the patient uses the drug to hasten death."It's like surgery,"he says."We don't call those deaths homicides because the doctors didn't intend to kill their patients,although they risked their death.if you're a physician,you can risk your patient's suicide as long as you don't intend their suicide."On another level,many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying.Just three weeks before the Court's ruling on physician一assisted suicide,the National Academy of Science(NAS)released a two-volume report,Approaching Death:Improving Care at the End of Life.It identifies the under-treatment of pain and the aggressive use of"ineffectual and forced medical procedures that may prolong and even dishonor the period of dying" as the twin problems of end-of-life care.The profession is taking steps to require young doctors to train in hospices,to test knowledge of aggressive pain management therapies,to develop a Medicare billing code for hospital-based care,and to develop new standards for assessing and treating pain at the end of life.Annas says lawyers can play a key role in insisting that these well-meaning medical initiatives translate into better care."Large numbers of physicians seem unconcerned with the pain their patients are needlessly and predictably suffering,"to the extent that it constitutes"systematic patient abuse." He says medical licensing boards"must make it clear that painful deaths are presumptively ones that are incompetently managed and should result in license suspension."George Annas would probably agree that doctors should be punished if they______.A:manage their patients incompetently B:give patients more medicine than neededC:reduce drug dosages for their patients D:prolong the needless suffering of the patients

单选题According to the NAS’s report, one of the problems in end-of-life care is ______.A prolonged medical proceduresB inadequate treatment of painC systematic drug abuseD insufficient hospital care

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