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1、临床医学英语Chapter 1 Patient-Physician Interaction Page 1第一章 医患沟通 第页The patient-physician interaction proceeds through many phases of clinical reasoning and decision making. proceed 进行、开展 reasoning 推论、推理 clinical reasoning 诊断 clinical decision 确定治疗方案 making decision 做出决定医患沟通在临床诊断和治疗决策的许多阶段中进行着。The intera
2、ction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.elucidation 说明、阐明 inquire 询问、调查 evaluation 评估、评价这种沟通开始于病人诉说或所关注问题，然后通过询问、评估不断精确地确定这些问题。The process commonly requires a careful history or physical ex
3、amination, ordering of diagnostic tests, integration of clinical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans.integration 综合 consultation 磋商、会诊 这个过程通常需要细致的病史询问和体
4、格检查，进行诊断性化验，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，并与病人及家属反复磋商以形成治疗方案Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized,while respecting individual variations among different patientsrespecting 注意到、关系、说到 evidence-based medicin
5、e 循证医学 医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化，但要考虑到不同病人中个体差异是存在的。The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not be equated with “cookbook” medicineavailability可利用性， 可得到 randomize 随机的 cookbook 食谱，烹调书 approach 接近 越来越多的可用于指导临床诊断与治疗的随机试验资料不应变成“烹调
6、书”医学。Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.Evidence 证据，迹象 guideline指导方针 emphasize 强调 因为随机试验获得的现象和思路是着重于特征性病人的求证过程。Substantial clinical judgment is required to determine whether the evidence and guidelines apply to
7、individual patients and to recognize the occasional. substantial clinical 真实的，实在的 individual 个体 occasional 偶尔的，特殊的实际的临床判断需要确定这些现象和思路能否应用于某个病人个体，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inconclusive.inconclusive 不确定性，非决定性许多情况下，临床表现缺乏或不典型，需要考虑更多的判断。Ev
8、idence also must be tempered by patients preferences, although it is a physicians responsibility to emphasize when presenting alternative options to the patient. temper 脾气，调音 preference 偏爱 emphasize 强调，详述，阐明 presenting 提出 alternative 可选择的，二选一病人还会根据自己的倾向调节着临床症状，但医生有责任通过选择性问题搞清事实。The adherence of a pa
9、tient to a specific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option.adherence 坚持、固执 regimen 养生法、食物疗法enhance 提高、加强 rationale 基本原理假如病人也懂得医生问题的基本原理和表现，有特殊生活方式病人的固执容易被强化。To care for a patient as an individual, the physician must u
10、nderstand the patient as a person. care for 喜欢、照料 为了把病人作为一个个体进行治疗(为了个体化的照料病人)，医生必须理解病人是一个人（不是一群人）。This fundamental precept of doctoring includes an understanding of the patients social situation, family issues,financial concerns, and preferences for different types of care and outcomes, ranging from
11、 maximum prolongation of life to the relief of pain and suffering. fundamental 基本的，根本的 precept 训戒 doctoring 行医 prolongation 延长 这个最基本的行医原则包括了解病人的社会地位，家庭问题，资金状况以及对不同治疗方法、不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和折磨。If the physician does not appreciate and address these issues, the science of medicine cannot be appl
12、ied appropriately, and even the most knowledgeable physician fails to achieve appropriate outcomes. appreciate 欣赏、感谢、评价 appropriate 适当的、恰当的 假如医生没有正确理解和定位这个问题，医学就不可能恰当地应用于临床，甚至一个知识最渊博的医生也不能取得理想的治疗结果。Even as physicians become increasingly aware of new discoveries, patients can obtain their own informa
13、tion from a variety of sources, some of which are of questionable reliability.aware of 意识到，知道 questionable 可疑的、成问题的、不可靠的 reliability 可靠、可信赖的 甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种资源得到他们的信息，当然，某些信息是不可靠的。The increasing use of alternative and complementary therapies is an example of patients frequent dissatisfa
14、ction with prescribed medical therapy.alternative 选择，替代 complementary 补充的、相配的 prescribe 规定、指定、开处方 替代疗法和辅助疗法的应用不断增加就是病人对常规疗法经常不满意的一个例子。Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, inclu
15、ding the risk that they may relied on to substitute for proven approachessubstitute 代替、代用 rely on 依赖、信任 医生对未证实的疗法应该保持开放的思想，但是，如果这些疗法可能带来任何程度的潜在风险，医生都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of option
16、s that either may considercrucial 严酷的、决定性的 either 两者任一对医生来说，对病人及家属开诚布公地介绍所有能考虑的治疗选择，是极及关键的。The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and pubic health.vacuum 真空 extensive 广阔的、大量的 医生不是生存在真空中的，而是复杂而庞大的医疗和公共健康体系中的一部分。In premodern ti
17、mes and even today in some developing countries, basic hygiene, clean water, and adequate nutrition have been the most important ways to promote health and reduce disease.adequate 足够的、恰当的 在未发达时代，甚至当今在一些发展中国家，基本卫生、清洁饮用水和最低营养保障是促进健康减少疾病的最重要措施。In developed countries, the adoption of healthy lifestyles,
18、 including better diet and appropriate exercise, are cornorstones to reducing the epidemics of obesity, coronary disease, and diabetes.adoption 采纳、采用 epidemic 流行、传染 而在发达国家中，健康的生活方式包括合理饮食和适当锻炼，是减少肥胖、冠心病和糖尿病盛行的基础。Public health interventions to provide immunizations and to reduce injuries and the use o
19、f tobacco, illicit drugs, and excess alcohol collectively can produce more health benefit than nearly any other imaginable health intervention.illicit 非法的、违禁的 collectively 全体地、共同地 produce 生产、创造公共健康干预如进行疫苗接种、减少损伤、减少吸烟、减少吸毒、减少酗酒等措施共同产生的健康效果几乎比可想象的任何其它健康干预措施都要好。Chapter 5 Clinical Preventive Services Pa
20、ge 11 第五章 临床预防服务Clinical preventive services include counseling, immunization, screening tests, and reduction of the susceptibility to disease by interventions such as therapeutic lifestyle changes and pharmacotherapy.counseling 咨询immunization 使免除screening 遮敝，屏敝、选拔susceptibility 对敏感临床预防服务包括对疾病的咨询、防疫
21、、筛查以及通过治疗性的生活习惯改变和药物治疗来减少易感性。Preventive service often are classified as primary, secondary, or tertiary. tertiary 第三，第三纪tertiary industry 第三产业临床预防服务常分为一级预防、二级预防和三级预防。Primary prevention is directed toward preventing disease or injury before it develops, whereas secondary prevention deals with early d
22、etection and treatment to impede the progress of overt disease.deal with 解决impede 妨碍overt 公开Primary prevention is directed toward preventing disease or injury before it develops, whereas secondary prevention deals with early detection and treatment to impede the progress of overt disease.一级预防是直接针对疾病
23、或损伤发生前的预防，而二级预防是解决疾病或损伤发生后的早期发现和早期治疗，以防止临床疾病的进一步发展。In contrast, tertiary prevention refers to rehabilitative activities after the onset of disease to minimize complications and disability.rehabilitative 可修复的，康复disability 残疾，病残对比之下，三级预防是指疾病发生后的康复治疗，以减少并发症和病残。Because of considerable overlap, distingui
24、shing among these phases of prevention may be confusing. overlap 互搭，重叠，错叠，交叉distinguishing 区别，区分，特征，特色因为（三级预防之间）有相当大的交叉，这些预防阶段的区分可能有些混淆。Detecting and treating hypertension could be considered secondary prevention of hypertensive cardiovascular disease but primary prevention of heart failure and stro
25、ke. hypertensive cardiovascular disease 高血压性心血管疾病发现和治疗高血压可以认为是对高血压性心血管疾病的二级预防，但也可是对心力衰竭和中风的一级预防。Prevention may be perceived best along a continuum from modification of predisposing factors, to preventing a disease, to avoiding premature death and disability.perceive 感知，认为continuum 统一体,一致性predisposin
26、g factors 易感因素along 沿着，前行modification 修改，变性premature 过早，过早发生，夭折，草率长期一贯地减少易感因素可能是防止疾病、避免早死早残最好的预防。The sooner the prevention, the more likely unnecessary illness, disability, and premature death can be avoided. unnecessary 不必要的，多余的预防得越早，越不易发生不必要的疾病，病残和早死就能够避免。Increasing emphasis has been placed on pre
27、venting risk factors themselves.emphasis 重点，强调越来越多的重点已经集中到对危险因素本身的预防。The term primordial prevention has been introduced for this concept.primordial 基本的，原始的，初生的，初发的 术语-根源预防（病因预防）已经引进了这个概念。Indiscriminate screening for risk factors or disease without adequate advice and follow-up serves no useful purpo
28、se.indiscriminate 无差别的，不加区别的advice 忠告，劝告 没有引导和随访的毫无选择地远离危险因素或疾病是没有实用价值的预防。The periodic health examination has evolved from an annual, broad-based, uniform protocol to an approach that targets the prevention, detection, and treatment of specific diseases or risk factors for particular age, gender, an
29、d ethnic groups at appropriate intervals. periodic 周期的，定期的broad-based 无限的，基础深厚的，运用广泛的uniform 一致的，统一的，制服protocol 规章制度，草案，协议ethnic 民族的，种族的，有民族特色的interval 间隔，区间 定期体检逐渐从一年一度的、全面的、统一的规定项目改进成以恰当的周期对特定年龄、性别和种群的特殊疾病或危险因素有目的地预防、发现和治疗。Current recommendations by the U.S. Preventive Services Task Force are base
30、d on systematic evidence reviews that distinguish procedures likely to prove effective and to have substantially more benefit than harm.Task Force 特遣部队distinguish 区别，辨认，使显著 substantially 非常，本质上，大体上 美国预防服务特别局的最近建议是基于全面的回顾性研究，这些研究选出了易于证明有效、确实是利大于弊的预防措施。Changes in the health care system and the develop
31、ment of national guidelines for management of disease are likely to draw greater attention to health promotion, disease prevention, and the interface of physician-based medical care with the public health care system.health care 卫生保健guideline 指导方针，准则interface 接口，界面，联系卫生保健系统的改进和国家疾病控制政策的完善使人们更重视健康促进、
32、疾病预防，以及接受医疗人员为主的公共卫生系统的保健服务。Physicians should consider each disorder in terms of the potential for prevention, including the possibility of adverse effects and cost-effectiveness.in terms of 就而言, 从方面说来，从角度来讲cost-effectiveness 成本效益医生应该以有无需要预防的角度考虑每一种疾病，包括可能发生的副作用和付出代价是否值得。A concept useful for clinica
33、l decision making is the number of patients needed to treat to prevent one adverse event, which is based on absolute risk reduction.concept 概念、看法、观念一个对临床决策有用的理念是需要治疗的病人数量决定一个不利因素是否要预防，这是基于绝对风险的下降。This number is based on efficacy and is calculated as the reciprocal of the difference in event rates be
34、tween control and treatment groups for a specified period.efficacy 效力，效能，有效性reciprocal 相互的，互为倒数的 ，倒数这个数量是以效能为基础的，是对特定时期内对照组和治疗组之间发生率差异的倒数进行的统计。Ample evidence connects identifiable and often preventable factors to the morbidity and mortality associated with major health problems.ample 足够的，大量的identifi
35、able 可以确认的大量的试验证据找出了可确认的又常可预防的与主要健康问题相关的发病和死亡因素。About half of all deaths, morbidity, and disability can be attributed to such nongenetic factors.nongenetic 非遗传性的约一半死亡、发病和病残与这些非遗传性因素有关。Many lifestyle changes benefit multiple systems and disorders.许多生活习惯改变有利于多个系统和紊乱的改善。Cigarette smoking has been estim
36、ated to contribute to one in five deaths in the United States; dietary habits may affect the occurrence of cardiovascular disease, diabetes, osteoporosis, and cancer.osteoporosis 骨质疏松症美国五分之一的死亡估计与吸烟有关，饮食习惯可能影响心血管疾病，糖尿病、骨质疏松症和癌症的发生。Other important personal behavior factors influencing health include
37、physical activity, alcohol intake, illicit drug use, sexual practices, and exposure to environmental toxins.其它影响健康的重要个人行为因素有锻炼、饮酒、吸毒、性行为以及环境毒物的接触。The identification of informative DNA polymorphisms (e.g., single nucleotide polymorphisms) and further elucidation of candidate genes allow for detection
38、 of susceptible individuals and possible institution of measures to prevent the expression of these harmful genetic traits.informative 提供信息的 candidate 候选人polymorphisms 多态性 traits 特质，属性nucleotide 核苷酸 携带信息DNA多态性（例如，单核苷酸多态性）的认识和候选基因的进一步阐明允许我们发现易感人群和可能采取的措施，以预防这些有害基因特性的表达。Several common misconceptions i
39、mpede preventive health care.impede 妨碍，阻碍好几种错误观念妨碍了预防保健。Many believe that diseases with a strong heritable component cannot be altered, but susceptibility to disease often requires the interaction of multiple genes and environmental factors for expression.heritable 可遗传的，可继承的许多人认为有很强遗传性的疾病是无法改变的，但是对疾
40、病的易感性经常需要多种基因和环境因素的相互作用才能表达。In addition, chronic diseases are multifactorial, so other factors can be changed to compensate for an elevated genetic risk.multifactorial 多因子的compensate 补偿， 弥补，赔偿 另外，慢性疾病是多因素的，所以，可以改变其它因素来弥补高基因风险。Although gene therapy holds much promise, preventive measures currently of
41、fer the best possibilities for limiting gene expression and avoiding disease.promise 承诺，诺言，希望，前途虽然基因疗法有着很大的希望，但目前的最有可能提供的预防措施是限制基因表达来避免疾病。The notion that prevention is less useful in older persons excludes many who would benefit most from prevention because elderly patients generally have a greater
42、absolute risk of disease and have been shown to adhere and respond favorably to preventive measures.favorably 顺利地，好意地，亲切地对老年人预防无用的观念排除了在预防上本应极为受益的许多人，因为老年病人一般有更高患病风险，并且一直对预防措施极为支持、反应积极。Also, life expectancy frequently is underestimated in the elderly; individuals who reach age 75 now can expect to l
43、ive an average of 11 more years.life expectancy 预期寿命并且，老年人的预期寿命经常是低估的，现在将到75岁的老人可以预期平均再活11年多。Chapter 8 Why Geriatric Patients Are Different Page 20第八章 老年病人的特殊性 第20页Older patients differ from young or middle-aged adults with the same disease in many ways, one of which is the frequent occurrence of co
44、morbidities and of subclinical orbidities 并存病 subclinical 亚临床的同样的疾病，老年病人在许多方面与青中年病人是有区别的，其中之一是并存病多、亚临床疾病多。As a function of the high prevalence of disease, comorbidity (or the co-occurrence of two or more diseases in the same individual) is also common. prevalence 流行、普遍 co-occurrence 同时发生作为高发疾病的结果，并存
45、病（两个或更多的疾病在同一个体同时发生）也是常见的。Of people age 65 and older, 50% have two or more chronic disease, and these diseases can confer additive risk of adverse outcomes, such as mortality. confer 授予、给予 additive 附加的、附属物65岁以上的老年人中，50%患有两种以上的慢性疾病，这些疾病能够增加不良预后的风险，如死亡的风险。In some patients, cognitive impairment may mas
46、k the symptoms of important conditions. cognitive 认知的、认识的 impairment 损害 mask 口罩、假面具、掩饰在一些病人中，认知损害可以掩盖重要病情的症状。Treatment for one disease may affect another adversely, as in the use of aspirin to prevent stroke in individuals with a history of peptic ulcer disease. stroke 中风 peptic ulcer 消化性溃疡对一种疾病的治疗可
47、能会加重另一种疾病，例如，对有消化性溃疡病史的病人使用阿斯匹林预防中风。The risk for becoming disabled or dependent also increases with the number of diseases present. disabled 残废的、有缺陷的 dependent 依靠的、依赖的病残或生活不能自理的发生率也随着并存的疾病数而增高。Specific pairs of diseases can increase synergistically the risk of disability. synergistic 协同的特殊的成对疾病可以协同增加病残的风险。Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability are increased by th