Lehrmaterialien zum Studiengang Angewandte

Lehrmaterialien zum
Studiengang Angewandte
Pflegewissenschaft
Schlüsselqualifikation
Medical English
Projekt OPEN – OPen Education in Nursing
Medical English
Medical
English
Vorlesungsskript, Medical English, Studiengang Angewandte
Pflegewissenschaften B.A.
Inhaltsverzeichnis
1 Basic principles in medicine – Anatomy versus physiology
1.1
What different body systems do you know? Can you explain the following?
1.2
Label the parts
1.3
How does the muscular system work?
1.4
What kind of systems can you identify here?
1.5
Identify the prefixes and their meaning? Can you think of others?
1.6
Body planes
1.7
Match the words and definitions
2 Causes and effects of disease – Describing graphs and figures
2.1
General expressions
2.2
Describe the following graph using the relevant vocabulary!
3 Clinial setting: Acute care – Integrated Care Pathway
3.1
Standards for integrated care pathways for mental health - adult and older adult
services
3.2
Robots, iPhones, and Windows XP—a personal journey through hospital IT
3.3
The patient journey
3.4
Clinical round
3.5
Phrases for meetings
S.4
S. 12
S. 15
4 Clinical setting: Primary care – The role of primary care
S.29
5 Current issues in medicine – Patient ethics
S. 30
5.1
Introduction
5.2
Code of Ethics and Patients Rights
6 The future of medicine – Implications of mapping the human genome
6.1
Human Genome Project
6.1.1 History
6.1.2 State of completion
6.1.3 Application and proposed benefits
6.1.4 Findings
2
S. 33
6.1.5 Public versus private approaches
6.1.6 Genome donors
6.1.7 Benefits
6.1.8 Advantages of the Human Genome Project
6.1.9 Ethical, legal and social issues
7 Job applications – Writing a CV and a covering letter
7.1
Nursing CV template
7.2
Covering letter
7.3
Tips
8 Conversational skills – Shift handovers
8.1
Introduction
8.2
Shift handovers
8.3
Reported speech
8.4
Physician referral letter
S. 42
S. 49
9 Quotations Academic English
S. 53
10 Diseases of affluence spreading to poorer countries
S. 60
11 Mission statements
S. 62
12 Patients' data
S. 64
13 Complementary and alternative medicine (CAM)
S. 66
14 Medical Guidelines
S. 67
15 Code of Ethics for Nurses
S. 72
15.1
Nurses and people
15.2
Nurses and practice
15.3
Nurses and the profession
15.4
Nurses and co-workers
3
1 Basic principles in medicine – Anatomy versus
physiology1
1
All graphs were taken from
4
1.1 What different body systems do you know? Can you explain the following?
5
1.2 Label the parts:
6
1.3 How does the muscular system work?
7
1.4 Over to you: What kind of systems can you identify here? Can you describe
them?
8
1.5 Over to you: Identify the prefixes and their meaning? Can you think of
others?
Cardiovascular
Cardiologist
Gastroenteritis
Gastrointestal
Gastroscope
Hyperclycaemic
Hypertension
Hyperventilate
Ingest
Internal
Physical
Physiology
Physiotherapy
Renew
Reproductive
reshape
9
1.6 Body planes
10
1.7 Over to you: Match the words and definitions
1 anterior
2 trunk
3 pelvis
4 forearm
5 superior
6 upper limbs
7 medial
8 superficial
a includes arms and hands
b closer to the median plane
c above another structure, opposite of inferior
d closer to the body surface, opposite of deep
e in front of another structure, opposite of posterior
f includes the chest, abdomen and pelvis
g lower part of the arm
h lower part of the abdomen located between the hip bones
11
2 Causes and effects – Describing graphs and figures
2.1 General expressions
In the English-speaking business world you may have to discuss the information on graphs.
Here we take a look at some of the vocabulary we use to describe graph trends.
Going Up
•
•
•
•
rose
increased
went up
grew
Going Down
•
•
•
•
decreased
fell
dropped
declined
No Change
•
•
•
•
stayed the same
remained constant
levelled off
stabilised
Up and Down
•
•
•
•
12
fluctuated
zig-zagged
fluttered
undulated
Small Changes - Adjectives / Adverbs
•
•
•
•
gently
gradually
slightly
steadily
Big Changes - Adverbs / Adjectives
•
•
•
•
•
suddenly
sharply
dramatically
steeply
a lot
Low Points
•
•
bottomed out
reached a low
What kinds of graphs do you know? What other vocabulary do you know for describing
graphs and figures?
13
2.2 Over to you: Describe the following graph using the relevant vocabulary! 2
Description Graph showing HIV copies and CD4 counts in a human over the course of a
treatment-naive HIV infection
2
http://commons.wikimedia.org/wiki/File:Hiv-timecourse.png
14
3 Clinical setting: Acute care – Integrated Care Pathway
3.1 Standards for integrated care pathways for mental health - adult and older
adult services
Over to you: Read the pdf-file and summarize!
Downloads
•
Integrated Care Pathways for Mental Health Standards Dec 2007 (PDF, 1512K) About
the standards
The integrated care pathways (ICPs) for mental health standards have four main
elements.
•
Process standards: describe the key tasks which affect how well ICPs are developed in a
local area.
•
Generic care standards: describe the interactions and interventions that must be offered
to all people who access mental health services.
•
Condition-specific care standards: build on the generic care standards and describe the
interactions and interventions that must be offered by mental health services to people
with a specific condition.
•
Service improvement standards: measure how ICPs are implemented and how variations
from planned care are recorded and acted on.
The standards for the five conditions build on and complement the key components identified
in the generic care standards. Considered alongside the process and service improvement
standards, the condition-specific care standards outline a set of expectations for the local
management and organisation of care in mental health services. Equally, the standards
represent an ongoing commitment to improving the quality of treatment and outcomes for
service users and their informal carers.
As part of a wider system of continuous quality improvement, the generic and conditionspecific care standards form the care elements of the ICP.
Published Date: 18 December 2007
Evidence3
Healthcare Improvement Scotland took over the responsibilities of NHS Quality Improvement
Scotland on 1st April 2011.
Mental health pathways
3
http://www.healthcareimprovementscotland.org/our_work/mental_health/icps_for_mental_health/adult_and_old
er_adult_services.aspx
3.2 Robots, iPhones, and Windows XP—a personal journey through hospital IT 4
Hospitals are cutting-edge in the operating room, but their IT is old school.
by Sean Gallagher - Dec 19 2012, 7:25pm -100
Aurich Lawson
On the Sunday after Thanksgiving, I rushed my wife Paula to the emergency room at
Baltimore's Sinai Hospital. What she thought was just the stomach bug du jour turned out to
be a life-threatening condition that would take her to nearly every corner of Sinai. Three
weeks later, I would find myself sitting in the surgical waiting room at Sinai as a rock-star
surgeon operated on her robotically in front of a crowd of other doctors.
It wasn't my first time wandering the halls of the hospital; 12 years ago, my son was
hospitalized at Sinai when he had appendicitis. Much has changed in those 12 years, but what
surprised me more is what hasn't.
I've spent a lot of time in the hospital over the past few weeks and have become all too well
acquainted with the technology there. I've covered health IT in the past, but there's a big
difference between talking with people about what's happening in the health industry with
technology as a whole and experiencing it from the chair next to a hospital bed.
4
http://arstechnica.com/information-technology/2012/12/robots-iphones-and-windows-xp-a-personal-journeythrough-hospital-it/
16
Don't get me wrong—I have nothing but praise for the people who treated Paula during her
stay. Sinai is not just another hospital, it's the flagship of one of Baltimore's biggest healthcare
systems and, while it doesn't have the sheer industrial size of Johns Hopkins, it's a major
teaching hospital in its own right. And Sinai's emergency room is one of the best in the city,
handling a huge volume of walk-ins and ambulance-delivered patients. But what I found is
that medical IT remains a patchwork quilt of Star Trek and steampunk—one that seems to
work almost despite itself.
Day 1: Back to the future
Enlarge / A rolling COW workstation at Sinai may be networked wirelessly, but it still needs
an outlet.
Sean Gallagher
When we arrive just after noon, we fly through the ER's triage—apparently so fast that the
receptionist checks off a box in my wife's electronic registration indicating she is
uninsured. Despite other people taking the information four more times, the insurance
information doesn't take until I talk to accounting later.
That is a minor annoyance; a larger one is not knowing what is going on. It's a busy Sunday,
and once they give Paula a painkiller and sedative, we see the ER doctor a few times in
passing. Having been in an emergency room frequently over the past decade thanks to kids'
extracurricular mishaps, I know the drill. But in this case, the only hint at where the diagnosis
is going is which test Paula is getting rolled off for next: ultrasound, CT scan, and multiple
blood draws.
17
So I start to poke around, trying to decipher what I can from the tech around me—mostly to
keep myself occupied as Paula's sedation and painkillers lull her to sleep. The first thing I
notice is that everything but the bed and chairs in the room is wirelessly networked—the
Computer On Wheels (COW) workstation, the IV infusion pumps, the machine taking Paula's
vitals. And there's a full Wi-Fi signal on my iPhone—the network is accessible with a guest
login.
While the wireless network is modern, the computing infrastructure is less so. The roll-around
COW workstation the nurses use to enter data—like every other computer I will encounter
during the next three weeks—is running Windows XP and a NetWare for Windows network
client.
Enlarge / A wall-mounted PC outside one of the many hospital rooms I spent time in shows its
NetWare colors.
Sean Gallagher
Hospitals are notoriously conservative about operating system upgrades, both for financial
reasons and because the medical software industry has been slow to certify their applications
for newer versions of the Windows OS; the infusion pump management software for the IVs
in my wife's room is still available only for Windows 2000 and XP, for example, and the data
connector to manage the system's software requires a nine-pin serial port.
18
The throwback nature of the computing infrastructure applies to the COW PCs and all the
other workstations in the hospital as well—nearly every one I look at is a vintage 2006
HP/Compaq small form factor system, and some still have the Compaq OEM Windows XP
wallpaper.
Three hours pass. Paula wakes up and asks me what's taking so long, so I go out to try to find
an answer. Out in the bullpen of desks at the center of the cluster of ER beds we're in, there's a
flat-screen display with a spreadsheet-like status chart for each patient. I deduce from the data
on it that Paula is being admitted—a room number pops up next to her name.
But it seems like more hours passed before we see the ER doctor and get the diagnosis: the
phrases "big-time pancreatitis" and "worst I've ever seen" are dropped casually.
I pull out my phone to Google "acute pancreatitis." It's not pleasant reading. I call home and
tell our kids what's going on as a transport technician arrives to roll Paula off to the elevator.
Bring your own, or wheel it in
Twelve years ago, the general ward of the hospital enforced a cell phone ban. But now, it
seems like everyone is carrying one—even the patients. I bring Paula her iPad and set up
Netflix so she has some other entertainment beside the basic TV service in her room.
(Unfortunately, Netflix was blocked by the hospital's network).
While the hospital staff isn't bringing their own devices to work, the physicians from Paula's
primary care provider's practice are. The gastroenterologist, surgeon, and "patient care
coordinator" are constantly texting each other with the latest information on the case; the
iPhone seems to be their tool of choice.
As of Monday morning, it's looking fairly routine, though the surgeon says Paula's pancreas
looks "scary." For now, though, Paula is just under observation, and everything we hear
indicates she'll be better soon, aside from needing her gallbladder removed. I begin to dig in
for the wait, bringing my laptop to the hospital to try to work while I keep her company.
The Wi-Fi network for guests is isolated from the hospital's general network at the access
points—at least the hospital has done a good job of hiding the SSIDs for its internal
network. It also has content filtering in place, as I find out when searching for an image for a
story I'm writing, and it blocks Flickr as "pornography." I quickly defeat the filter by
switching on a VPN connection.
I try again the next day and find that using a VPN connection going to an IP address in
Sweden has apparently caused some security concerns, and I'm blocked. (My apologies to any
network administrators at Sinai who may have thought Anonymous had infiltrated their
network.)
The nurses push COWs into the room to record each round of medication and vital signs
measurement, scanning Paula's wristband each time; there's a consistent problem with the
barcode reader, and the technicians doing blood pressure and temperature roll their eyes as if
this is a common problem.
19
For all this electronic medical record technology, a surprising amount of paper still gets
handled. Every time I see one of Paula's doctors on the case, they're working with a paper
chart in a binder, hand-noting instructions—since they're not hospital staff, they likely don't
get access to the hospital's EMR system.
There's also some confusion about what exactly the instructions are. On November 30, Paula
is told she can start to get clear liquids. But her surgeon quickly reverses that—just after Paula
orders up some jello.
Throughout all this, there's not a whole lot of information to work with on our end. Paula is
starting to get stir-crazy. The night of December 2, she goes for a CAT scan, posting to
Facebook from her phone afterward, "No actual cats are involved in a cat scan. :(" She jokes
that Guy Fiere could redeem himself if he came up with a better execution of the barium
contrast drink.
The next morning, I am driving my son and daughter to school when my phone plays my
wife's designated ringtone. My son picks it up for me: "Hi…he's driving. Oh? OK, I'll tell
him. Bye." He hangs up, and puts the phone down casually. "They're moving her to the ICU,
she said."
It turns out that there's been much more damage to the pancreas, and some of it has
necrotized. Paula's surgeon transfers her case to another doctor who can write orders at the
hospital—a young Lebanese surgeon who is an expert in robotic surgery and who has
experience in pancreatic surgery. He is also Sinai's "intensiveist" for the week. The move to
the ICU is to monitor Paula's condition more closely and bring as much attention and
technology to bear on the issue as possible.
Star Trek meets Siri
The ICU room Paula is in when I arrive looks more like a high-tech (and extremely clean) car
dealer's service bay than a hospital room. The consolidated monitor they hook Paula up to—a
Philips Intellivue—is more a workstation than a digital display, and it would be at home in a
network operations center. It keeps constant track of her pulse, blood oxygen levels, blood
pressure, and respiration, and it has a touch-screen that her nurse and technician can use to
adjust the readout. The hardware is networked into a centralized display at a desk outside her
room—a "clinical decision support" workstation that tracks all the vital signs of patients on a
scorecard to alert the staff when they fall outside a programmed range.
When I arrive, Paula shows me that they have gamified her pain meds with a patient
controlled analgesial (PCA) button. The PCA is hooked into a carbon dioxide monitor on an
oxygen line rigged to her nose—she has to keep her breathing steady to make sure the PCA
button turns green; at most, she can push the button once every six minutes, to administer
doses of Dilaudid. PCA has been around a long time—it was developed in the 1960s and
'70s—but the incarnation here has a definite Wii controller vibe.
The nurses and techs in the ICU (and in other areas of the hospital, as I see later) are walking
nodes on the hospital network. They're all wearing small devices on lanyards around their
neck that are actually VoIP communicators from a company called Vocera. They have built-in
20
voice recognition that allows the staff to call each other by name from anywhere in the
hospital:
A demonstration of the VoIP communications badge from Vocera.
It works most of the time—except when someone forgets how another person is entered in the
system, or their name is hard to pronounce. When Paula gets moved to the Intermediate Care
unit four days later, I watch the floor secretary try to voice-call a nurse for four minutes before
giving up and calling someone else whose name Vocera can recognize.
Rise of the machines
On our way to the Intermediate Care Unit (IMCU)—and on several other occasions moving
through the hospital—Paula's rolling bed has a near-collision with an unmanned filing
cabinet. The cabinet stops short coming out of an elevator, and says, "Waiting to proceed."
It's actually a TUG delivery robot from Aethon, used by the hospital's pharmacy to dispatch
drugs securely to nursing stations that aren't reachable by the hospital's computer-controlled
pneumatic tube system. Rather than following a line in the floor, the robot uses an onboard
map to navigate the hospital, tracking its location with sensors. It uses an array of light
sensors to detect people and obstacles, slowing and swerving. The TUG is also tied into the
wireless network to allow it to interact with the hospital's service elevator and door systems,
and can be dispatched and remotely tracked by a PC or an Apple iOS application.
A TUG robot navigates Sinai hospital, and calls for and boards an elevator.
The robotic system allows for chain of custody of narcotics and other medications; it's
basically a rolling safe that requires a nurse to identify themselves at the delivery point. As the
TUG rolls up to the nursing station in the IMCU, it announces in a recorded voice, "Your
delivery is here."
According to Aethon, the TUG costs less than a full-time employee's annual salary, and can
do the equivalent of nearly three humans—it doesn't work shifts, and it's on duty 24/7. It
keeps the nurses on the floor with the patients and keeps drugs from mysteriously
disappearing between the pharmacy and the patient. It is also just a little creepy.
But the TUGs aren't the only robots we'll encounter at Sinai. One of then is in the operating
room.
The Single-Site da Vinci
On December 12, the surgeon comes in with good news: Paula has dodged the bullet of
infection, and he won't need to perform pancreatic surgery. Now all that remains in the way of
going home is her gallbladder. She'll have surgery the next day and be home by the weekend.
What he doesn't mention is that the surgical method he's going to use is so new that the
hospital just issued a press release on it the day before. Paula will be his 12th patient to have
her gallbladder excised using a robot called the da Vinci Single Site, which requires only one
incision—through the belly button.
21
The da Vinci is paired with a surgeon's console that looks the spawn of an old coin-op video
game and an overgrown microscope; it gives the surgeon a three-dimensional view from the
robot's probe and precise direct control over its instruments, as shown in a video from Fresno,
California's Community Regional Medical Center:
A video on the single-incision da Vinci procedure from Fresno's Community Regional
Medical Center.
At 8:30am on the 13th, Paula is wheeled into surgery. After I leave her and head to the waiting
room, I'm given a number for her case to track her progress on a spreadsheet-like display as
she goes from pre-op to the operating room to the post-anaesthesia care unit. By 10:00am,
she's out, and soon I'm following her rolling hospital bed back to her room in Sinai's
gastrointestinal care ward—it's not nearly as high-tech as some of the rooms she has been in,
but it has the advantage of a nearby coffee machine.
The next afternoon, I trade in my final parking voucher and take Paula home.
Return on information
There's no question that Sinai's systems worked in our case, and the robots show the hospital
is investing in technology where it has the greatest impact: patient care and the bottom
line. But if there was one gap that was evident in how Sinai and other hospitals use
technology, it was in how they get information to patients and families.
In some cases, there is such a thing as too much information, or at least the wrong kind—with
a smartphone in reach of a patient, there's the hazard of Google-based second opinions. But
the alternative right now is a slow drip of data points.
Physicians (like tech people) have their own specialized language that they use to share that
information—and dispense it to patients in hit-and-run visits—but there's the need for
hospitals to do more to help patients and their families get a better handle on what’s going
on. The waiting room spreadsheet was the only nod toward keeping patients' families
informed.
Given how complex health IT is, I understand why Windows XP persists in the hospital. But
seeing it everywhere raised security concerns for me, as did the way outside physicians had to
rely on consumer devices to communicate with each other about cases. Sinai obviously has its
network locked down tightly, but as I've reported, viruses within hospital networks remain a
big concern—especially since they can infect PC-driven medical systems like IV pumps and
monitors.
More than anything, I'm just happy I won't be working from a hospital bedside anymore.
Over to you: What do you think? What is the state-of-the-art at your hospital?
22
3.3 The patient journey 5
There are many stages to a patient's journey through the health care system. These stages
include visits with a General Practitioner (GP) through to a stay in a Queensland Health
hospital.
When a patient receives care, they will not necessarily experience all stages of the patient
journey. The stages of the journey they experience will depend upon what level of care they
require at that time.
The image below illustrates the different stages in a patient journey. Each stage outlined in the
patient journey is explained in further detail below.
Over to you: Describe the
stages at your hospital!
5
http://www.google.de/imgres?imgurl=http://www.health.qld.gov.au/ehealth/images/patient_journey.jpg&imgref
url=http://www.health.qld.gov.au/ehealth/journey.asp&usg=__VGY5ott3Uv1Bc1BVj7ZXeEAtlck=&h=193
&w=650&sz=74&hl=en&start=4&sig2=iIOFR0Tfdo6bOTGhn2Lzsg&zoom=1&tbnid=LF9xPcSkmH16M:&tbnh=41&tbnw=137&ei=zCXZUYX8EtCSswafYHoBg&prev=/search%3Fq%3Dpatient%2Bjourney%2Bthrough%2Bhospital%26client%3Dfirefoxa%26sa%3DN%26hl%3Den%26tbm%3Disch&itbs=1&sa=X&ved=0CDIQrQMwAw
23
3.4 Clinical Round
Over to you: Role-play the following clinical using the phrases for meeting mentioned in 3.5!
In hospitals, rehabilitation clinics, or in a group practice, the different professions may have
regular meetings to discuss important points concerning patients, therapies, and the
distribution of tasks. Practice your English by simulating such a clinical round. Here is a
description of patients you can use as a basis of your discussion.
Rick Abbott (15)
Diagnosis ADHS
Further information: He has attention deficits at school, is always hyperactive.
Peter Brown (48)
Diagnosis: Pain in the shoulder
Further information. He is a computer specialist planning a new software for his firm.
Dick Carter (53)
Diagnosis: Status after amputation of the left leg
Further information: He is suffering from diabetes, must try to walk with crutches, stump
wrapping is necessary
Minnie Driver (36)
Diagnosis: Alcoholism
Further information: She has trouble with her husband, lost her job
Eric Garden (74)
Diagnosis: Apraxia after a stroke
Further information: He has only occasional difficulties in conversation pronouncing multisyllabic words. The main problem is that he has lost his wife three months ago.
Flora Harper (61)
Diagnosis: Herniation of the intervertebral disappearing
Further information: She has a lot of pain, feels depressive
John Jackson (32)
Diagnosis: Stuttering
24
Further information: The main characteristics of his stuttering are blocks; the sounds get stuck
and can't come out
Lucy Luck (25)
Diagnosis: Multiple Sclerosis
Further information: Actual episode, she cannot walk very well, especially climbing up the
stairs is difficult
Martha Mill (76)
Diagnosis: Dementia
Further information: The difficulties are still mild; she forgets things, can't remember dates
Mathew Myer (68)
Diagnosis: Parkinson's disease
Further information: He suffers from tremor and rigor
Paul Norton (43)
Diagnosis: Bipolar Disorder
Further information: He is in a manic episode; plays computer games all nights
Susan Patterson (12)
Diagnosis: Phonological disorder
Further information: She has her own rules for sounds produced at the back of the mouth; she
makes them all in front of the mouth (e.g., instead of saying 'cup', she says 'tup', instead of 'go'
she says 'doe')
Abby Pouter (37)
Diagnosis: Not yet known; she can't lift her right arm
Further information: She works as a nurse and has many overweight patients
Betty Pride (20)
Diagnosis: Depression
Further information: After she was left by her friend, she tried to commit suicide
Mary Talbott (19)
Diagnosis: Borderline
25
Further information: She cuts in her arms, is very agressive
Mick Vance (40)
Diagnosis: Low-back pain
Further information: He has worked in his garden for three days
26
3.5 Phrases for meetings
Stating purpose
The aim of the meeting is….
What we need to agree/decide is ….
The purpose of today’s meeting is ….
Our objective today is ….
Processing the agenda
The first item on the agenda is ….
Next,
Moving on,
Right, now the next item is ….
Inviting contributions
Dave, what do you think?
Has anybody got any ideas/suggestions?
Who’d like to start?
What’s your opinion?
How do you see it?
Controlling disruptive behaviour
I’m sorry, that’s not what we’re here to discuss.
Can I stop you there?
I’d appreciate it if you’d keep to the point.
I’m afraid if you are going to be disruptive, I’ll have to ask you to leave.
Please speak through the Chair!
Agreeing
I totally agree.
That’s a good point.
That makes sense.
Good idea!
Disagreeing
I must beg to differ.
I’m afraid I can’t agree.
You’re way off beam.
I think you’re barking up the wrong tree.
27
Weighing up pros and cons
On the one hand …, but on the other…
The advantages are …, however, the disadvantages ….
Taking all things into account….
On balance…
Summarising and concluding
To summarise/sum up.
In conclusion….
OK, just to go over what we’ve agreed,
So, what we’ve decided is ….
28
4 Clinical setting: Primary care – The role of primary care
in disease prevention 6
Over to you: What role does nutrition play in disease prevention?
You are what you eat? Is this right? What do you think?
Can nutrition prevent heart disease or diabetes or cancer? What about obesity and
weight management?
6
For a definition of global health and its indicatiors see:
http://www.who.int/gho/publications/world_health_statistics/2013/en/
29
5 Current issues in medicine – Patient ethics
5.1 Introduction
Well-known medical ethics cases include 7:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Albert Kligman's dermatology experiments
Deep sleep therapy
Doctors' Trial
Henrietta Lacks
Human radiation experiments
Jesse Gelsinger
Moore v. Regents of the University of California
Surgical removal of body parts to try to improve mental health
Medical Experimentation on Black Americans
Milgram experiment
Radioactive iodine experiments
The Monster Study
Plutonium injections
The Stanford Prison Experiment
Tuskegee syphilis experiment
Willowbrook State School
Greenberg v. Miami Children's Hospital Research Institute
Over to you: Find out about them! What other cases do you know? What about euthanasia
and planned suicide?
7
https://en.
30
5.2 Code of Ethics and Patients Rights 8
(approved on 25.2.1992 by the Central Ethics Committee of the Czech Ministry of Health)
1. Patients have the right to courteous and professional health care, provided in an
understanding manner by qualified personnel.
2. Patients have the right to know the name of the physician and other medical
personneltreating them. They have the right to request a level of privacy and services
within thecapacity of the facility, as well as the right to meet with their family members
and friends on a daily basis. Any restriction of these (continuous) visiting hours shall only
be imposed for goodreason.
3. Patients have the right to adequate information from their physician in order to enable them
tomake an informed decision as to whether they agree to any new diagnostic or
therapeutic procedure before it is initiated. With the exception of acute cases, they should
be duly informed of any risks associated with the procedure to be carried out. Should
alternative procedures exist, or should patients request to be informed of other treatment
options, they have the right to receive this information. They also have the right to know
the names of the people providing this treatment.
4. Within the limits laid down in the legislation, patients have the right to refuse treatment and
shall be informed of the medical consequences of this decision.
5. During outpatient and inpatient examinations, nursing care and treatment, patients have the
right to maximum consideration for their privacy and dignity during the treatment
program. Case discussion, consultation, examination and treatment are confidential
matters and shall be conducted with discretion. Patients shall approve the presence of
persons who are not directly involved in their treatment, even in teaching hospitals, if
they have not themselves selected these persons.
6. Patients have the right to expect that any reports and records relating to their treatment shall
be treated as confidential. Protection of patient records must be ensured, and this also
applies to their electronic version.
7. Patients have the right to expect that the hospital, within its capacity, will adequately
respond to their requests for treatment at a level reflecting their care needs. Where
8
http://www.nemdac.cz/download/prava_pacienta.pdf
31
necessary, patients may be transferred to another health care facility once they have been
fully informed of the reasons for and necessity of the transfer and any other options that
may be available. The institution to which a patient is being transferred must first approve
the transfer.
8. Patients have the right to expect an appropriate level of continuity of treatment. They have
the right to know beforehand which physicians they can call on and the times and place
they are available. On discharge they have the right to expect the hospital to establish a
plan for follow-up care and to provide information on future treatment for their own
practitioner.
9. Patients have the right to detailed and comprehensible explanations in the event their
physician decides to follow any non-standard or experimental procedures. An informed
consent form signed by the patient is required before any non-therapeutic or therapeutic
research is undertaken. Patients may withdraw from clinical trials at any time and without
providing a reason as long as they have been properly informed of any medical
consequences of such a decision.
10. Patients nearing the end of their lives have the right to sensitive care from all medical
personnel who shall respect their wishes where these do not conflict with the applicable
legislation.
11. Patients have the right and responsibility to know and comply with the rules and
regulations of the health care facility in which they are being treated (the Hospital Rules
and Regulations). Patients shall have the right to check their bills and to request an
explanation of its individual items regardless of the source of payment. These Patient
Rights were declared valid on 25.2.1992
Over to you: Discuss the points and how they are implemented into daily routines! For
more current versions go to http://europatientrights.eu/. Compare and find out what has
changed!
32
6 The future of medicine – Implications of mapping the
human genome
Over to you: Find out about HUGO and report to class! What opportunities and threats
do you see? For more information see also: http://www.genome.gov/10001772
6.1 Human Genome Project 9
DNA replication
The Human Genome Project (HGP) is an international scientific research project with a
primary goal of determining the sequence of chemical base pairs which make up DNA, and of
identifying and mapping the approximately 20,000–25,000 genes of the human genome from
both a physical and functional standpoint.[1]
The first official funding for the Project originated with the Department of Energy’s Office of
Health and Environmental Research, headed by Charles DeLisi, and was in the Reagan
Administration’s 1987 budget submission to the Congress.[2] It subsequently passed both
Houses. The Project was planned for 15 years.[3]
In 1990, the two major funding agencies, DOE and NIH, developed a memorandum of
understanding in order to coordinate plans, and set the clock for initiation of the Project to
1990.[4] At that time David Galas was Director of the renamed “Office of Biological and
Environmental Research” in the U.S. Department of Energy’s Office of Science, and James
Watson headed the NIH Genome Program. In 1993 Aristides Patrinos succeeded Galas, and
9
http://en.
33
Francis Collins succeeded James Watson, and assumed the role of overall Project Head as
Director of the U.S. National Institutes of Health (NIH) National Human Genome Research
Institute. A working draft of the genome was announced in 2000 and a complete one in 2003,
with further, more detailed analysis still being published.
A parallel project was conducted outside of government by the Celera Corporation, or Celera
Genomics, which was formally launched in 1998. Most of the government-sponsored
sequencing was performed in universities and research centres from the United States, the
United Kingdom, Japan, France, Germany and Spain. Researchers continue to identify
protein-coding genes and their functions; the objective is to find disease-causing genes and
possibly use the information to develop more specific treatments. It also may be possible to
locate patterns in gene expression, which could help physicians glean insight into the body's
emergent properties.
While the objective of the Human Genome Project is to understand the genetic makeup of the
human species, the project has also focused on several other nonhuman organisms such as
Escherichia coli, the fruit fly, and the laboratory mouse. It remains one of the largest single
investigative projects in modern science.
The Human Genome Project originally aimed to map the nucleotides contained in a human
haploid reference genome (more than three billion). Several groups have announced efforts to
extend this to diploid human genomes including the International HapMap Project, Applied
Biosystems, Perlegen, Illumina, J. Craig Venter Institute, Personal Genome Project, and
Roche-454.
The "genome" of any given individual (except for identical twins and cloned organisms) is
unique; mapping "the human genome" involves sequencing multiple variations of each
gene.[5] The project did not study the entire DNA found in human cells; some
heterochromatic areas (about 8% of the total genome) remain unsequenced.
Among the many social and ethical issues spurred by bio-genetic sciences is a concern
regarding bio-genetic warfare (e.g. ethnic bio-weapons targeted towards specific populations).
6.1.1 History
The project began with the culmination of several years of work supported by the US
Department of Energy, in particular workshops in 1984[7] and 1986 and a subsequent
initiative of the US Department of Energy.[8] This 1987 report stated boldly, "The ultimate
goal of this initiative is to understand the human genome" and "knowledge of the human is as
necessary to the continuing progress of medicine and other health sciences as knowledge of
human anatomy has been for the present state of medicine." Candidate technologies were
already being considered for the proposed undertaking at least as early as 1985.[9]
James D. Watson was head of the National Center for Human Genome Research at the
National Institutes of Health in the United States starting from 1988. Largely due to his
34
disagreement with his boss, Bernadine Healy, over the issue of patenting genes, Watson was
forced to resign in 1992. He was replaced by Francis Collins in April 1993, and the name of
the Center was changed to the National Human Genome Research Institute (NHGRI) in 1997.
The $3-billion project was formally founded in 1990 by the US Department of Energy and the
National Institutes of Health, and was expected to take 15 years.[10] In addition to the United
States, the international consortium comprised geneticists in the United Kingdom, France,
Australia, Japan and a myriad of other spontaneous relationships.[11]
Due to widespread international cooperation and advances in the field of genomics (especially
in sequence analysis), as well as major advances in computing technology, a 'rough draft' of
the genome was finished in 2000 (announced jointly by U.S. President Bill Clinton and the
British Prime Minister Tony Blair on June 26, 2000).[12] This first available rough draft
assembly of the genome was completed by the Genome Bioinformatics Group at the
University of California, Santa Cruz, primarily led by then graduate student Jim Kent.
Ongoing sequencing led to the announcement of the essentially complete genome in April
2003, 2 years earlier than planned.[13] In May 2006, another milestone was passed on the
way to completion of the project, when the sequence of the last chromosome was published in
the journal Nature.[14]
6.1.2 State of completion
The Human Genome Project was declared complete in April 2003. An initial rough draft of
the human genome was available in June 2000 and by February 2001 a working draft had
been completed and published followed by the final sequencing mapping of the human
genome on April 14, 2003. Although this was reported to be 99% of the human genome with
99.99% accuracy a major quality assessment of the human genome sequence was published in
May 27, 2004 indicating over 92% of sampling exceeded 99.99% accuracy which is within
the intended goal.[15] Further analyses and papers on the HGP continue to occur.[16]
6.1.3 Applications and proposed benefits
Potential benefits of sequencing the human genome expand to many fields from molecular
medicine to a better understanding of human evolution. The Human Genome Project through
its sequencing of the DNA can help us understand diseases including genotyping of specific
viruses to direct appropriate treatment; identification of oncogenes and mutations linked to
different forms of cancer; designing medications and predicting its response better;
advancement in forensic applied sciences; biofuels and other energy applications; agriculture,
livestock breeding, bioprocessing; risk assessment; bioarcheology, anthropology, evolution.
Another proposed benefit is the commercial development of genomics research related to
DNA based products, a multibillion dollar industry.[17]
The sequence of the DNA is stored in databases available to anyone on the Internet. The U.S.
National Center for Biotechnology Information (and sister organizations in Europe and Japan)
house the gene sequence in a database known as GenBank, along with sequences of known
and hypothetical genes and proteins. Other organizations, such as the Genome Bioinformatics
35
Group at the University of California, Santa Cruz,[18] and Ensembl[19] present additional
data and annotation and powerful tools for visualizing and searching it. Computer programs
have been developed to analyze the data, because the data itself is difficult to interpret without
such programs.
The process of identifying the boundaries between genes and other features in a raw DNA
sequence is called genome annotation and is the domain of bioinformatics. While expert
biologists make the best annotators, their work proceeds slowly, and computer programs are
increasingly used to meet the high-throughput demands of genome sequencing projects. The
best current technologies for annotation make use of statistical models that take advantage of
parallels between DNA sequences and human language, using concepts from computer
science such as formal grammars.
All humans have unique gene sequences. Therefore the data published by the HGP does not
represent the exact sequence of every individual's genome. It is the combined "reference
genome" of a small number of anonymous donors. The HGP genome is a scaffold for future
work in identifying differences among individuals. Most of the current effort in identifying
differences among individuals involves single-nucleotide polymorphisms and the HapMap.
6.1.4 Findings
Key findings of the draft (2001) and complete (2004) genome sequences include:
1.
There are approximately 20,500[20] genes in human beings, the same range as in
mice. Understanding how these genes express themselves will provide clues to how diseases
are caused.
2.
The human genome has significantly more segmental duplications (nearly identical,
repeated sections of DNA) than other mammalian genomes.[citation needed] These sections
may underlie the creation of new primate-specific genes.
3.
At the time when the draft sequence was published fewer than 7% of protein families
appeared to be vertebrate specific.[21]
How it was accomplished
36
The first printout of the human genome to be presented as a series of books, displayed at the
Wellcome Collection, London
The Human Genome Project was started in 1989 with the goal of sequencing and identifying
all three billion chemical units in the human genetic instruction set, finding the genetic roots
of disease and then developing treatments. With the sequence in hand, the next step was to
identify the genetic variants that increase the risk for common diseases like cancer and
diabetes.
It was far too expensive at that time to think of sequencing patients’ whole genomes. So the
National Institutes of Health embraced the idea for a "shortcut", which was to look just at sites
on the genome where many people have a variant DNA unit. The theory behind the shortcut
was that, since the major diseases are common, so too would be the genetic variants that
caused them. Natural selection keeps the human genome free of variants that damage health
before children are grown, the theory held, but fails against variants that strike later in life,
allowing them to become quite common. (In 2002 the National Institutes of Health started a
$138 million project called the HapMap to catalog the common variants in European, East
Asian and African genomes.)
chromosomes", or BACs, which are derived from bacterial chromosomes which have been
genetically engineered. The vectors containing the genes can be inserted into bacteria where
they are copied by the bacterial DNA replication machinery. Each of these pieces was then
sequenced separately as a small "shotgun" project and then assembled. The larger, 150,000
base pairs go together to create chromosomes. This is known as the "hierarchical shotgun"
approach, because the genome is first broken into relatively large chunks, which are then
mapped to chromosomes before being selected for sequencing.
Funding came from the US government through the National Institutes of Health in the
United States, and a UK charity organization, the Wellcome Trust, as well as numerous other
groups from around the world. The funding supported a number of large sequencing centers
including those at Whitehead Institute, the Sanger Centre, Washington University in St. Louis,
and Baylor College of Medicine.The genome was broken into smaller pieces; approximately
150,000 base pairs in length. These pieces were then ligated into a type of vector known as
"bacterial artificial
The Human Genome Project is considered a Mega Project because the human genome has
approximately 3.3 billion base-pairs.
37
If the sequence obtained was to be stored in book form, and if each page contained 1000 basepairs recorded and each book contained 1000 pages, then 3300 such books would be needed
in order to store the complete genome. However, if expressed in units of computer data
storage, 3.3 billion base-pairs recorded at 2 bits per pair would equal 786 megabytes of raw
data. This is comparable to a fully data loaded CD.
6.1.5 Public versus private approaches
In 1998, a similar, privately funded quest was launched by the American researcher Craig
Venter, and his firm Celera Genomics. Venter was a scientist at the NIH during the early
1990s when the project was initiated. The $300,000,000 Celera effort was intended to proceed
at a faster pace and at a fraction of the cost of the roughly $3 billion publicly funded project.
Celera used a technique called whole genome shotgun sequencing, employing pairwise end
sequencing,[22] which had been used to sequence bacterial genomes of up to six million base
pairs in length, but not for anything nearly as large as the three billion base pair human
genome.Celera initially announced that it would seek patent protection on "only 200–300"
genes, but later amended this to seeking "intellectual property protection" on "fullycharacterized important structures" amounting to 100–300 targets. The firm eventually filed
preliminary ("place-holder") patent applications on 6,500 whole or partial genes. Celera also
promised to publish their findings in accordance with the terms of the 1996 "Bermuda
Statement", by releasing new data annually (the HGP released its new data daily), although,
unlike the publicly funded project, they would not permit free redistribution or scientific use
of the data. The publicly funded competitor UC Santa Cruz was compelled to publish the first
draft of the human genome before Celera for this reason. On July 7, 2000, the UCSC Genome
Bioinformatics Group released a first working draft on the web. The scientific community
downloaded one-half trillion bytes of information from the UCSC genome server in the first
24 hours of free and unrestricted access to the first ever assembled blueprint of our human
species.[23]
In March 2000, President Clinton announced that the genome sequence could not be patented,
and should be made freely available to all researchers. The statement sent Celera's stock
plummeting and dragged down the biotechnology-heavy Nasdaq. The biotechnology sector
lost about $50 billion in market capitalization in two days.
Although the working draft was announced in June 2000, it was not until February 2001 that
Celera and the HGP scientists published details of their drafts. Special issues of Nature (which
published the publicly funded project's scientific paper)[24] and Science (which published
Celera's paper[25]) described the methods used to produce the draft sequence and offered
analysis of the sequence. These drafts covered about 83% of the genome (90% of the
euchromatic regions with 150,000 gaps and the order and orientation of many segments not
yet established). In February 2001, at the time of the joint publications, press releases
announced that the project had been completed by both groups. Improved drafts were
announced in 2003 and 2005, filling in to ≈92% of the sequence currently.
Many believe that the competition proved to be very good for the project, spurring the public
groups to modify their strategy in order to accelerate progress. The rivals at UC Santa Cruz
initially agreed to pool their data, but the agreement fell apart when Celera refused to deposit
38
its data in the unrestricted public database GenBank. Celera had incorporated the public data
into their genome, but forbade the public effort to use Celera data.
HGP is the most well known of many international genome projects aimed at sequencing the
DNA of a specific organism. While the human DNA sequence offers the most tangible
benefits, important developments in biology and medicine are predicted as a result of the
sequencing of model organisms, including mice, fruit flies, zebrafish, yeast, nematodes,
plants, and many microbial organisms and parasites.
In 2004, researchers from the International Human Genome Sequencing Consortium (IHGSC)
of the HGP announced a new estimate of 20,000 to 25,000 genes in the human genome.[26]
Previously 30,000 to 40,000 had been predicted, while estimates at the start of the project
reached up to as high as 2,000,000. The number continues to fluctuate and it is now expected
that it will take many years to agree on a precise value for the number of genes in the human
genome.
6.1.6 Genome donors
In the IHGSC international public-sector Human Genome Project (HGP), researchers
collected blood (female) or sperm (male) samples from a large number of donors. Only a few
of many collected samples were processed as DNA resources. Thus the donor identities were
protected so neither donors nor scientists could know whose DNA was sequenced. DNA
clones from many different libraries were used in the overall project, with most of those
libraries being created by Dr. Pieter J. de Jong. Much of the sequence (>70%) of the reference
genome produced by the public HGP came from a single anonymous male donor from
Buffalo, New York (code name RP11).[27][28]
HGP scientists used white blood cells from the blood of two male and two female donors
(randomly selected from 20 of each) -- each donor yielding a separate DNA library. One of
these libraries (RP11) was used considerably more than others, due to quality considerations.
One minor technical issue is that male samples contain just over half as much DNA from the
sex chromosomes (one X chromosome and one Y chromosome) compared to female samples
(which contain two X chromosomes). The other 22 chromosomes (the autosomes) are the
same for both sexes.
Although the main sequencing phase of the HGP has been completed, studies of DNA
variation continue in the International HapMap Project, whose goal is to identify patterns of
single-nucleotide polymorphism (SNP) groups (called haplotypes, or “haps”). The DNA
samples for the HapMap came from a total of 270 individuals: Yoruba people in Ibadan,
Nigeria; Japanese people in Tokyo; Han Chinese in Beijing; and the French Centre d’Etude du
Polymorphisms Humain (CEf) resource, which consisted of residents of the United States
having ancestry from Western and Northern Europe.
In the Celera Genomics private-sector project, DNA from five different individuals were used
for sequencing. The lead scientist of Celera Genomics at that time, Craig Venter, later
acknowledged (in a public letter to the journal Science) that his DNA was one of 21 samples
in the pool, five of which were selected for use.[29][30]
39
In 2007, a team led by Jonathan Rothberg published James Watson's entire genome, unveiling
the six-billion-nucleotide genome of a single individual for the first time.
6.1.7 Benefits
The work on interpretation of genome data is still in its initial stages. It is anticipated that
detailed knowledge of the human genome will provide new avenues for advances in medicine
and biotechnology. Clear practical results of the project emerged even before the work was
finished. For example, a number of companies, such as Myriad Genetics started offering easy
ways to administer genetic tests that can show predisposition to a variety of illnesses,
including breast cancer, hemostasis disorders, cystic fibrosis, liver diseases and many others.
Also, the etiologies for cancers, Alzheimer's disease and other areas of clinical interest are
considered likely to benefit from genome information and possibly may lead in the long term
to significant advances in their management.
There are also many tangible benefits for biological scientists. For example, a researcher
investigating a certain form of cancer may have narrowed down his/her search to a particular
gene. By visiting the human genome database on the World Wide Web, this researcher can
examine what other scientists have written about this gene, including (potentially) the threedimensional structure of its product, its function(s), its evolutionary relationships to other
human genes, or to genes in mice or yeast or fruit flies, possible detrimental mutations,
interactions with other genes, body tissues in which this gene is activated, and diseases
associated with this gene or other datatypes.
Further, deeper understanding of the disease processes at the level of molecular biology may
determine new therapeutic procedures. Given the established importance of DNA in
molecular biology and its central role in determining the fundamental operation of cellular
processes, it is likely that expanded knowledge in this area will facilitate medical advances in
numerous areas of clinical interest that may not have been possible without them.
The analysis of similarities between DNA sequences from different organisms is also opening
new avenues in the study of evolution. In many cases, evolutionary questions can now be
framed in terms of molecular biology; indeed, many major evolutionary milestones (the
emergence of the ribosome and organelles, the development of embryos with body plans, the
vertebrate immune system) can be related to the molecular level. Many questions about the
similarities and differences between humans and our closest relatives (the primates, and
indeed the other mammals) are expected to be illuminated by the data in this project.
6.1.8 Advantages of Human Genome Project:
1.
2.
Knowledge of the effects of variation of DNA among individuals can revolutionize the
ways to diagnose, treat and even prevent a number of diseases that affects the human
beings.
It provides clues to the understanding of human biology.
6.1.9 Ethical, legal and social issues
The project's goals included not only identifying all of the approximately 20,000-25,000[31]
genes in the human genome, but also to address the ethical, legal, and social issues (ELSI)
40
that might arise from the availability of genetic information. Five percent of the annual budget
was allocated to address the ELSI arising from the project.
Debra Harry, Executive Director of the U.S group Indigenous Peoples Council on
Biocolonialism (IPCB), says that despite a decade of ELSI funding, the burden of genetics
education has fallen on the tribes themselves to understand the motives of Human genome
project and its potential impacts on their lives. Meanwhile, the government has been busily
funding projects studying indigenous groups without any meaningful consultation with the
groups. (See Biopiracy.)[32]
The main criticism of ELSI is the failure to address the conditions raised by population-based
research, especially with regard to unique processes for group decision-making and cultural
worldviews. Genetic variation research such as HGP is group population research, but most
ethical guidelines, according to Harry, focus on individual rights instead of group rights. She
says the research represents a clash of culture: indigenous people's life revolves around
collectivity and group decision making whereas the Western culture promotes individuality.
Harry suggests that one of the challenges of ethical research is to include respect for collective
review and decision making, while also upholding the Western model of individual rights.
41
7 Job applications – Writing a CV and a covering letter
7.1 Nursing CV template 10
PERSONAL SUMMARY
An experienced and fully qualified registered nurse with over 5 years of
experience of working in busy hospital environments in both the NHS and
private sector. Able to work on their own initiative or in support of other
healthcare professionals, whilst ensuring that at all times patient care
procedures and practices are adhered to. Experience of looking after
patients with various illness from chronic conditions like Diabetes to
acute conditions like heart attacks or stroke. Currently looking for a staff
nurse position in a suitable hospital.
CAREER HISTORY
REGISTERED NURSE - Hospital name
May 2009 - present
10
http://www.dayjob.com/content/nursing-cv-template-282.htm
42
Playing a key role by being responsible for the delivery of basic practice
nursing services care to patients. Focusing upon supporting patients by
monitoring of their long-term conditions, administering treatment and
advising on health prevention.
Making patients aware of their treatment to ensure they are fully
informed and consent to their treatment. Having to communicate in a
caring manner with patients and their family members. Involved in
working in the intensive care units as well as general hospital wards.
Looking after patients of all ages from the very young to the very old.
Responsible for assessing the medical history of patients and their record
details and then evaluating patients and prioritizing their treatment.
Supervising and mentoring student and newly qualified nurses.
Involved in the administration procedures for a patients admission
and also their discharge.
Being the main point of contact for patients and communicating on their
behalf with hospital managers. Liaising with hospital physicians and
other healthcare professionals to write patient care plans.
Carrying out tests, evaluations and also investigations.
Carrying out administrative duties like updating and maintaining patient
records. In hospital wards administering daily drug and medicine
prescriptions to patients via injection or orally.
Educating patients on matters of hygiene.
PROFESSIONAL EXPERIENCE
Nursing
Able to contribute in practical ways to the success of my team and to
hospital targets.
Involved in providing direct patient care, including assessing their
needs and discussing their treatment and medical care with hospital
doctors and consultants. Making sure the working environment is safe in
a busy environment that is under pressure.
43
To varying degrees have worked in very busy Accident and
Emergency departments, operating theatres and post natal clinics.
Ability to remain calm in difficult situations whilst at the same time
being observant, adaptable and firm with patients.
Experience of creating individual patient care systems that look after a
patients physical, mental and social needs. Experience of using advanced
hospital equipment and procedures including administration of
intravenous fluids and vitamins to patients, operating different oxygen
apparatus, electric beds and administering tube feeding pumps.
Ability to respond quickly to emergencies.
Excellent organizational skills and having the ability to prioritize urgent
treatments. Having excellent communication skills, ability to empathize
to gain a patients trust and confidence. Able to prioritize busy workloads.
Experience of collecting and recording study data of ECG's, Blood Pressure, pulse,
temperature and samples.
44
7.2 Covering letter 11
Sender's name
Complete address
Contact details
Date
Dr. Samuel Wells
Physician
Hope Hospital
Chicago
Dear Dr. Wells,
I am very glad to learn about the job opening in your hospital through Washington Post
classified dated August 30, 2010. I want to take this opportunity to work with one of the
prestigious group of hospitals in United States of America. I am enclosing my resume with the
letter that you may consider for the job opening available for a medical assistant.
I have completed my diploma course in medical assistance from New York University. For the
past three years, I was working with Apollo Group of hospitals in Chicago. For some
personal reasons, I had to leave the previous organization. I have the experience in
performing following tasks •
•
•
•
•
•
Routine patient screening
Providing technical services
Filling insurance forms
Keeping medical records of patients
Arranging for hospital admissions
Providing laboratory services
Apart from this, I have excellent communication skills, as I have the experience of handling
and dealing with variety of patients. I have also attended a seminar on personnel management
and health care system in America. It helped me understand the nuances of medical
profession and public health care.
I would be very happy and proud to join your hospital. I assure you that I will use all my
knowledge, skills, and best of the abilities for the well-being of patients and betterment of the
hospital. I have always considered my job as noble and treated it as a service to mankind.
Knowing that your hospital received the Noble Cause Award last year, I would like to join the
hospital for its further endeavors.
If you would like to discuss my job profile further, you are most welcome to schedule a
meeting as per your convenience. Thank you for sparing your valuable time and considering
me for this job.
Awaiting a positive response.
Thank you.
11
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45
Yours sincerely,
-s/d
Sender's name
Enclosures: (refers to your mark sheets, relevant certificates, and resume)
46
Sender's name
Complete address
Contact details
Date
To
Human Resource Manager
Hope Hospital
Chicago
Ref: Job Opening for Medical Assistant (Job Code- AE0008)
Dear Sir,
This is with reference to the above mentioned job opening, the advertisement for which
appeared in the New York Times dated February 3rd, 2009.
I completed my Diploma course in Medical Assistance and Child psychology from University
of Chicago in the year 2006. Thereafter, I have worked for a year as a medical assistant in a
pediatrician's office and for two years in Midtown Hospital, Chicago as a senior medical
assistant. I have received an 'A' grade during the annual appraisal of 2008 held by Midtown
Hospital for its medical team. Considering my job experience and your job requirements, I
feel sure that I am eligible to apply for this post.
If you would like to discuss my job profile further, you are most welcome to schedule a
meeting as per your convenience. Thank you for sparing your valuable time for going through
my profile. Hoping for a positive response from your side.
Yours Sincerely,
-s/d
Sender's Name
Enclosures: (refers to your mark sheets, relevant certificates, reference letters, and resume)
47
7.3 Tips 12
•
It is recommended that, the length of a job application covering letter should not
exceed one page.
•
Start the letter my mentioning your name, address, contact number and letter date.
•
Next, mention the name of recipient, along with his designation and address. Most job
advertisements mention the name of the person or the designation to which the letter is to be
addressed. e.g. Dr. Wells, or Human Resource Manager.
•
It is not mandatory to mention the job reference number, unless specifically mentioned
in the job advertisement. Be careful to correctly mention the name of the position and its job
code. An incorrect code may lead to your disqualification, when multiple job openings are
advertised.
•
Write the salutations as 'Dear Mr./Dr._____', if you are specifically mentioning the
name of the recipient. If the letter is addressed to a human resource manager, then the
salutations should ideally be written as 'Dear Sir'.
•
The first paragraph of the letter should clearly mention the name of the media from
which you came to know about the job opening. Remember to mention the date of the
advertisement.
•
The second paragraph should give a brief overview of your qualification and career till
date. Do not go into too many details, as your certificates and reference letters are meant for
that purpose. This paragraph should also highlight the reason that makes you a perfect
candidate for the job opening.
•
The third and the last paragraph is a parting note that expresses your keen desire to
take up the job or appear for the job interview. Be careful to not appear too needy for the job,
as this can be a potential turn off for those viewing your resume.
•
End the letter with 'Sincerely' followed by your signature and name.
•
After leaving a couple of lines, mention a list of documents attached along with
covering letter, under the title 'Enclosures'. This list should be in a logical order. Be careful to
attach the documents in the exact order as mentioned under this list. e.g. resume, mark sheets,
certificates, copies of appointment letters, appreciation letters/certificates and reference
letters, if any.
Over to you: Write your own CV and covering letter!
Over to you: Think of interview questions and interview each other!
12
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48
8 Conversational skills
8.1 Introduction
1.
Ask quality questions: Avoid ‘yes’ or ‘no’ evoking responses by asking questions that
require detail; these will typically start with one of the five ‘Ws’.
2.
Actively listen: Don’t be thinking of a response while the other is still speaking. Wait 5
to 10 seconds before responding.
3.
Take turns: Balance talking and listening. Monitor yourself to make sure you’re not
dominating the conversation.
Expressions for Agreeing and Disagreeing
Stating an opinion
•
•
•
•
•
•
In my opinion...
The way I see it...
If you want my honest opinion....
According to Lisa...
As far as I'm concerned...
If you ask me...
Asking for an
opinon
•
•
•
•
•
•
•
What's your idea?
What are your thoughts on all of this?
How do you feel about that?
Do you have anything to say about this?
What do you think?
Do you agree?
Wouldn't you say?
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
I agree with you 100 percent.
I couldn't agree with you more.
That's so true.
That's for sure.
(slang) Tell me about it!
You're absolutely right.
Absolutely.
That's exactly how I feel.
Exactly.
I'm afraid I agree with James.
I have to side with Dad on this one.
No doubt about it.
(agree with negative statement) Me neither.
(weak) I suppose so./I guess so.
You have a point there.
Expressing
agreement
49
Expressing
disagreement
Interruptions
Settling an argument
50
•
I was just going to say that.
•
•
•
•
•
•
•
•
•
•
I don't think so.
(strong) No way.
I'm afraid I disagree.
(strong) I totally disagree.
I beg to differ.
(strong) I'd say the exact opposite.
Not necessarily.
That's not always true.
That's not always the case.
No, I'm not so sure about that.
•
•
•
•
•
•
Can I add something here?
Is it okay if I jump in for a second?
If I might add something...
Can I throw my two cents in?
Sorry to interrupt, but...
(after accidentally interrupting someone) Sorry, go ahead.
OR Sorry, you were saying...
•
(after being interrupted) You didn't let me finish.
•
•
•
•
Let's just move on, shall we?
Let's drop it.
I think we're going to have to agree to disagree.
(sarcastic) Whatever you say./If you say so.
8.2 Shift handovers in nursing units involve formal transmission of information and informal
conversation about non-routine events. Informal conversation often involves telling stories.
Direct reported speech (DRS) was studied in handover storytelling in two nursing care units.
The study goal is to contribute to a better understanding of conversation in handover and use
of DRS in storytelling in institutional contexts. Content analysis revealed that the most
frequent sources quoted were oneself and patients, followed by physicians and colleagues.
Further, DRS utterances are preceded by reports of situations, actions, and other reported
speech, often constituting the climax of a story. Conversation analysis revealed how DRS
participates in multimodal reenactments, complaints about patients, and justifying deviations
from medical protocols. Results inform understanding of the uses of DRS in institutional
storytelling, show how they index relevant membership categories and related knowledge and
expectations, and serve as resources for making sense of non-routine events.
8.2 Reported Speech
Tense
Direct Speech
present simple “I like ice cream”
present
“I am living in
continuous
London”
Reported Speech
She said (that) she liked ice cream.
She said she was living in London.
past simple
“I bought a car”
She said she had bought a car OR She said she
bought a car.
past
continuous
present
perfect
“I was walking along
the street”
She said she had been walking along the street.
past perfect*
will
would*
can
could*
shall
should*
might*
must
“I haven't seen Julie” She said she hadn't seen Julie.
“I had taken English
lessons before”
“I'll see you later”
“I would help, but..”
“I can speak perfect
English”
“I could swim when I
was four”
“I shall come later”
“I should call my
mother”
"I might be late"
"I must study at the
weekend"
She said she had taken English lessons before.
She said she would see me later.
She said she would help but...
She said she could speak perfect English.
She said she could swim when she was four.
She said she would come later.
She said she should call her mother
She said she might be late
She said she must study at the weekend OR She
said she had to study at the weekend
Over to you: Practise a sample handover conversation!
51
8.4 Physician referral letter13
[Date]
Re: [Patient’s Name] Letter of Medical Necessity
Dear Dr. [Bariatric Surgeon’s Name],
I am referring [patient’s name] for evaluation and consideration for a weight management
surgical procedure. (S)He currently weighs [# of lbs] pounds and is [# of in.] inches tall.
Her/His BMI is [BMI #].
I have been [patient’s name]’s primary care physician for the past [#of yrs] years. I have
supervised several of her/his weight control diets and programs. None of these have resulted
in any sustained weight loss. As a result of this persistent morbid obesity, her/his co-morbid
conditions are becoming more difficult to manage.
These co-morbid conditions are as follows:
Duration: Medication:
1. Hypertension 3 years Norvasc/Tenormin
2. Diabetes Mellitus 5 years Glucophage
3. Obesity Related Depression 3 years Prozac
4. Losing weight will certainly make these conditions easier to manage. Since non-surgical
programs have failed to provide any long-term benefits for the patient, I feel surgery is
her/his only option.
I hope you will find [patient’s name] a suitable candidate for the surgical weight reduction
program. It will provide a tool to assist her/him in losing weight, as well as maintain that
weight loss. I anticipate that this will provide her/him with a significantly improved quality of
life.
Sincerely,
[Physician signature]
Dr. [Physician’s Name]
13
http://www.bridgesaz.com/downloads/patient_center/Bridges_ReferralLetterSample.pdf
52
9 Quotations Academic English 14
Introduction
One of the most important aspects of academic writing is making use of the ideas of other
people. This is important as you need to show that you have understood the materials that you
have studied and that you can use their ideas and findings in your own way. In fact, this is an
essential skill for every student. Spack (1988, p. 42) has pointed out that the most important
skill a student can engage in is "the complex activity to write from other texts", which is "a
major part of their academic experience." For this reason, any academic text you read or write
will contain the voices of other writers as well as your own.
In your writing, however, the main voice should be your own and it should be clear what your
point of view is in relation to the topic or essay question. The object of academic writing is for
you to say something for yourself using the ideas of the subject, for you to present ideas you
have learned in your own way. The emphasis should be on working with other people’s ideas,
rather than reproducing their words. If your view is not clear, you will be told you have not
answered the question or something similar. It is essential therefore that it must always be
clear whose voice is speaking.
There are two main ways in which you can show your view (Tadros, 1993):
negatively
•
lack of mention of any other writer
positively
•
first person pronouns ("I")
•
comments and evaluations ("two major drawbacks", "of no
great merit", " as X insightfully states", )
It will always be assumed that the words or ideas are your own if you do not say otherwise.
When the words or ideas you are using are taken from another writer, you must make this
clear. If you do not do this and use another person's words or ideas as if they were your own,
this is Plagiarism and plagiarism is regarded as a very serious offence.
The ideas and people that you refer to need to be made explicit by a system of citation. The
object of this is to supply the information needed to allow a user to find a source.
You need to acknowledge the source of an idea unless it is common knowledge in your
subject area. It is difficult sometimes to know whether something is common knowledge in
your subject or needs acknowledging. In general, if your lecturer, in lectures or handouts, do
not acknowledge the source you can assume that it is common knowledge within your subject.
The object of academic writing is therefore for you to present your ideas in your own way. To
help you do this, however, you will need to use the ideas of other people and when you do
this, you need to say where the words and ideas are from.
There are several reasons for this (See Thompson, 1994, pp. 178-187 for more information).
1.
14
You need to show that you are aware of the major areas of thought in your specific
subject. This allows you to show how your contribution fits in, by correcting previous
research, filling gaps, adding support or extending current research or thinking.
http://www.uefap.com/writing/citation/citing.htm
53
2.
You need to support the points you are making by referring to other people's work. This
will strengthen your argument. The main way to do this is to cite authors that agree with
the points you are making. You can, however, cite authors who do not agree with your
points, as long as you explain why they are wrong. Do not make a statement that will
cause your reader to ask, "Who says?"
3.
If you are a student, you need to show that you have read and understood specific texts.
You need to show that you have read around the subject, not just confined your reading to
one textbook or lecture notes.
4.
You must not use another person's words or ideas as your own so you need to say where
they are from.
You usually do this by reporting the works of others in your own words. You can either
paraphrase if you want to keep the length the same, summarise if you want to make the
text shorter or synthesise if you need to use information from several sources. Do not
forget, though, that the central line of argument, the main voice, should be your own. This
means that you will need to comment on or evaluate any other works that you use. If you
do not do this, you will be accused of being too descriptive, of not being critical or
analytical enough, or of not producing a clear argument.
There are many ways of refering to other writers - check with your department for specific
information.
•
The most common system is called the Harvard system. There is no definitive version of
the Harvard system and most universities have their own. But the one used here - the
American Psychological Association style - is well known and often used, especially in
social sciences and business (American Psychological Association, 1983, 1994, 1999,
2001, 2010).
•
If you are a humanities student, click here or see Gibaldi (2003) and Modern Languages
Association (1998) for another version of the author-date system.
•
Many scientists use a numerical system, often called the Vancouver style or BS 1629. Click
here or see International Committee of Medical Journal Editors (1991) for more
information.
^
Citing - APA style
There are two ways in which you can refer to, or cite, another person's work: a) by reporting
or b) by direct quotation.
a) Reporting
This simply means reporting the other writer's ideas into your own words. You can either
paraphrase if you want to keep the length the same or summarise if you want to make the text
shorter. See Reporting: Paraphrase & Summary for more information. There are two main
ways (Swales, 1990, p. 148) of showing that you have used another writer's ideas:
integral
According to Peters (1983) evidence from first language acquisition indicates that lexical
phrases are learnt first as unanalysed lexical chunks.
54
Evidence from first language acquisition indicating that lexical phrases are learnt first as
unanalysed lexical chunks was given by Peters (1983).
OR non-integral
Evidence from first language acquisition (Peters, 1983) indicates that lexical phrases are
learnt first as unanalysed lexical chunks.
Lexical phrases are learnt first as unanalysed lexical chunks (Peters, 1983).
depending on whether or not the name of the cited author occurs in the citing sentence or in
parenthesis.
If you want to refer to a particular part of the source:
According to Peters (1983, p. 56) evidence from first language acquisition indicates that
lexical phrases are learnt first as unanalysed lexical chunks.
(At end of essay)
References
Peters, A (1983). The units of language acquisition. Cambridge: Cambridge University Press.
^
b) Direct Quotation
Occasionally you may want to quote another author's words exactly. For example:
Hillocks (1982) similarly reviews dozens of research findings. He writes, "The available
research suggests that teaching by written comment on compositions is generally ineffective"
(p. 267).
(At end of essay)
References
Hillocks, G. (1982). The interaction of instruction, teacher comment, and revision in teaching
the composing process. Research in the Teaching of English, 16, 261-278.
If you do so, keep the quotation as brief as possible and quote only when it is necessary. You
must always have a good reason for using a quote - and feeling unable to paraphrase or
summarise is never a good reason. The idea of an essay is for you to say something for
yourself using the ideas of the subject; you present ideas you have learned in your own way.
The emphasis should be on working with other people’s ideas, not reproducing their words.
Your paper should be a synthesis of information from sources, expressed in your own words,
not a collection of quotations. Any quote you use should not do your job for you, but should
add something to the point you are making. The quote should support your point, by quoting
evidence or giving examples or illustrating, or add the weight of an authority. It should not
repeat information or disagree with your point.
Please note, though, that some subjects, for example chemistry, hardly ever use direct
quotation (Robinson, Stoller, Costanza-Robinson & Jones, 2008, p. 545). Check with your
department.
Reasons for using quotations:
1.
55
quote if you use another person's words: you must not use another person's words as your
own;
2.
you need to support your points, quoting is one way to do this;
3.
quote if the language used in the quotation says what you want to say particularly well.
Reasons for not using quotations:
1.
do not quote if the information is well-known in your subject area;
2.
do not use a quotation that disagrees with your argument unless you can prove it is
wrong;
3.
do not quote if you cannot understand the meaning of the original source;
4.
do not quote if you are not able to paraphrase the original;
5.
do not use quotations to make your points for you; use them to support your points.
If you decide to use a quotation, you must be very careful to make it clear that the words or
ideas that you are using are taken from another writer.
This can be done in several ways, either integral or non-integral:
Widdowson (1979, p. 5) states that "there is a good deal of argument in favour of extending
the concept of competence to cover the ability to use language to communicative effect."
According to Widdowson (1979),"there is a good deal of argument in favour of extending the
concept of competence to cover the ability to use language to communicative effect" (p. 5).
According to Widdowson, "there is a good deal of argument in favour of extending the
concept of competence to cover the ability to use language to communicative effect" (1979, p.
5).
According to one researcher, "there is a good deal of argument in favour of extending the
concept of competence to cover the ability to use language to communicative effect"
(Widdowson, 1979, p. 5).
(In all cases at end of essay)
References
Widdowson, H. G. (1979). Explorations in applied linguistics. Oxford: Oxford University
Press.
When you are using a direct quotation of a single phrase or sentence, quotation marks should
be used around the words, which must be quoted exactly as they are in the original. However,
note the following:
1. You may wish to omit some of the author’s original words that are not relevant to your
writing. In this case, use three dots (...) to indicate where you have omitted words. If you
omit any of the author’s original words, make sure you do not change the meaning.
He stated, "The ‘placebo effect,’ ... disappeared when behaviours were studied in this
manner" (Smith, 1982, p. 276), but he did not clarify which behaviours were studied.
1. If you need to insert material (additions or explanations) into a quotation, use brackets,
([...]).
Smith (1982) found that "the placebo effect, which had been verified in previous studies,
disappeared when [his own and others’] behaviours were studied in this manner" (p. 276).
56
1. If the material quoted already contains a quotation, use single quotation marks for the
original quotation (‘...’).
He stated, "The ‘placebo effect,’ ... disappeared when behaviours were studied in this
manner" (Smith, 1982, p. 276), but he did not clarify which behaviours were studied.
1. If the direct quotation is long - more than two or three lines, it should be indented as a
separate paragraph with no quotation marks.
According to Smith (1982, p. 276):
The "placebo effect," which had been verified in previous studies, disappeared when
behaviours were studied in this manner. Furthermore, the behaviours were never exhibited
again, even when real drugs were administered. Earlier studies were clearly premature in
attributing the results to the placebo effect.
(In all cases at end of essay)
References
Smith, G. (1982). The placebo effect. Psychology Today, 18, 273-278.
^
Secondary sources
In all cases, if you have not actually read the work you are referring to, you should give the
reference for the secondary source - what you have read. In the text, you should then use the
following method:
According to Jones (as cited in Smith, 1982, p. 276), the ....
(At end of essay)
References
Smith. G. (1982). The placebo effect. Psychology Today, 18, 273-278.
Language
Reporting - Paraphrasing and Summarising
Reporting uses paraphrase and summary to acknowledge another author's ideas. You can
extract and summarise important points, while at the same time making it clear from whom
and where you have got the ideas you are discussing and what your point of view is.
Compare, for example:
Brown (1983, p. 231) claims that a far more effective approach is ...
Brown (1983, p. 231) points out that a far more effective approach is ...
A far more effective approach is ... (Brown, 1983, p. 231)
The first one is Brown's point of view with no indication about your point of view. The
second one is Brown's point of view, which you agree with, and the third is your point of
view, which is supported by Brown
Here are some more expressions you can use to refer to someone's work that you are going to
paraphrase:
If you agree with what the writer says.
57
The work of X indicates that ...
The work of X reveals that ...
The work of X shows that ...
Turning to X, one finds that ...
Reference to X reveals that ...
In a study of Y, X found that ...
As X points out, ...
As X perceptively states, ...
As X has indicated, ...
A study by X shows that ...
X has drawn attention to the fact that ...
X correctly argues that ...
X rightly points out that ...
X makes clear that ...
If you disagree with what the writer says.
X claims that ...
X states erroneously that ...
The work of X asserts that ...
X feels that ...
However, Y does not support X's argument that ...
If you do not want to give your point of view about what the writer says.
According to X...
It is the view of X that ...
The opinion of X is that ...
In an article by X, ...
Research by X suggests that ...
X has expressed a similar view.
X reports that ...
X notes that ...
X states that ...
X observes that ...
X concludes that ...
X argues that ...
X found that ...
58
X discovered that ...
Quoting
Sometimes you may want to quote an author's words exactly, not paraphrase them. If you
decide to quote directly from a text, you will need an expression to introduce it and quotation
marks will need to be used:
As X said/says, "... ..."
As X stated/states, "... ..."
As X wrote/writes, "... ..."
As X commented/comments, "... ..."
As X observed/observes, "... ..."
As X pointed/points out, "... ..."
To quote from X, "... ..."
It was X who said that "... ..."
This example is given by X: "... ..."
According to X, "... ..."
X claims that, "... ..."
X found that, "... ..."
The opinion of X is that, "... ..."
Concluding
After quoting evidence you reach a conclusion:
The evidence seems to indicate that...
It must therefore be recognised that...
The indications are therefore that...
It is clear therefore that ...
Thus it could be concluded that...
The evidence seems to be strong that...
On this basis it may be inferred that...
Given this evidence, it can be seen that...
(Source: UEFAP.COM)
59
10 Diseases of affluence spreading to poorer countries15
by Sam Wong 09 April 2013
High blood pressure and obesity are no longer confined to wealthy countries, a new study has
found.
These health risks have traditionally been associated with affluence, and in 1980, they were
more prevalent in countries with a higher income.
The new research, published in Circulation, shows that the average body mass index of the
population is now just as high or higher in middle-income countries. For blood pressure, the
situation has reversed among women, with a tendency for blood pressure to be higher in
poorer countries.
Researchers at Imperial College London, Harvard School of Public Health, and worldwide
collaborators studied data from 199 countries between 1980 and 2008 on the prevalence of
risk factors related to heart and circulatory disease. In 1980, a country’s income was
correlated with the population’s average blood pressure, cholesterol and body mass index
(BMI).
By 2008, there was no relationship between national income and blood pressure in men, and
in women blood pressure was higher in poorer countries. BMI was still lowest in the poorest
countries, but higher in middle-income countries than the wealthiest countries. Cholesterol
remained higher in higher-income Western countries.
Fasting blood sugar, which is linked to diabetes, was only weakly related with income and
affluence, but correlated with obesity.
Professor Majid Ezzati, from the School of Public Health at Imperial College London, who
led the research, said: “This study shows that non-communicable diseases are no longer
‘diseases of affluence’. They’ve shifted from being epidemic in rich countries to become a
truly international pandemic.
If current trends continue, developing countries will be confronted with a rising tide of
obesity, diabetes and high blood pressure.
– Professor Majid Ezzati
School of Public Health
“If current trends continue, developing countries will be confronted with a rising tide of
obesity, diabetes and high blood pressure. Meanwhile, developed countries will continue to
15
http://www.eurekalert.org/pub_releases/2013-04/icl-oa040913.php
60
face an epidemic of diabetes and high cholesterol.”
The study also found that BMI has consistently been related to the proportion of the
population living in cities, suggesting that urban lifestyles might be playing an important role
in the obesity problem, now and in the past.
The researchers suggest that the change in relationship between national income and blood
pressure might be caused by improved diagnosis and treatment of high blood pressure in
wealthier countries, and perhaps changes in diet and lifestyle.
“Developed countries have succeeded in reducing blood pressure,” said Dr. Goodarz Danaei,
one of the lead authors of the study from Harvard School of Public Health. “We need to
replicate that success in developing countries by improving primary health care services,
lowering salt intake and making fresh fruit and vegetables more available.
“High cholesterol is still linked to national wealth, probably because of the relatively high
cost of meat and other animal products. Lower income countries should encourage the use of
unsaturated fats over saturated fats to avoid the problems that richer countries have.
“Heart and circulatory diseases impose a huge cost on healthcare systems in high and middle
income countries. Redirecting some of these resources to prevention might lead to savings in
the long run.”
The research was funded by the Medical Research Council and the National Institute for
Health Research (NIHR) Imperial Biomedical Research Centre.
Reference
1. G Danaei et al. ‘The Global Cardiovascular Risk Transition: Associations of Four
Metabolic Risk Factors with National Income, Urbanization, and Western Diet in 1980 and
2008.’ Circulation, 2013; 127: 1493-1502. doi: 10.1161/CIRCULATIONAHA.113.001470
Over to you: What is your personal opinion on this topic? Discuss with your group!
61
11 Mission statements
Over to you: Read the following mission statement and compare it to your
hospital's. 16
Our Values…
Saint Vincent Hospital is committed to:
Dignity & Reverence – Safeguarded byrecognizing every life as a gift from God,
so each individual is inherently valued.
Trust – Honest and open communicationwith patients and among staff.
Teamwork – Recognizes the contributionof all but requires sacrifice for the
benefit of the patient so as to enhancethe health of the communities served
and works in cooperation with otherorganizations to protect vulnerable
populations throughout the region.
Cooperation – Between patient and staff,as well as the various clinical professions
and specialties.
Integrity – Honesty, fairness andself-scrutiny in everything we do, as the
ideal means to protect overall safety, aswell as assure confidentiality and privacy.
Heritage – Inspired by the example of the Sisters of Providence, the ideals and
tradition of Catholic healthcare still mconstitutes the foundation upon which
the tradition becomes better.
Our Vision…
To be the hospital of choice for patients,physicians and employees in Central
Massachusetts because of our preeminent mpatient care and teaching programs.
To be well recognized as a technologym,leader in New England.
To be the academic center of choice for residents and healthcare professionals.
To be a prominent community member known for meeting the healthcare needs
of the entire community through incomparable patient care and wellness
programs.
Our Mission…
Saint Vincent Hospital is a medical institution dedicated to providing quality
patient care with unrelenting attention to clinical excellence, patient safety and an
unparalleled passion and commitment to assure the very best healthcare for those
we serve.
16
http://www.stvincenthospital.com/about/mission-statement.aspx
62
12 Patients' data
Over to you: Read the text and find out about the situation in Germany:
NHS patient records in Heartlands hospital in Birmingham: the government wants the NHS to
share data with private life science companies. Photograph: David Sillitoe for the Guardian17
17
http://www.guardian.co.uk/healthcare-network-nihr-clinical-research-zone/patient-data-nhs-live-discussionroundup
63
Richard Corbridge is Clinical Research Network chief
information officer
Patients want to take part in research: In June 2011 an Ipsos Mori poll commissioned by
AMRC revealed that 97% of the public believe it's important for the NHS to support research
and that 72% would like to be offered opportunities to be involved in trials of new medicines
or treatments if they suffered from a health condition that affects their day-to-day life.
The life-sciences industry is one of our biggest allies: "Opening-up" the NHS data –
without compromising patient confidentiality – to researchers would put the UK in the
vanguard as a global clinical research destination and work is already underway on
sophisticated IT systems to join NHS databases together and make them accessible as a
research resource.
Learning from elsewhere: We must not forget that patients may know as much as the clinical
staff about their condition and we need to find ways to allow patients' own data to be valued.
There is a lot of great work being done across the country, and we need to share this work,
collaborate and learn lessons.
Nicola Perrin works as a senior policy adviser at the
Wellcome Trust
Getting rid of red tape: Of course there need to be appropriate safeguards in place to ensure
patient confidentiality, but patients overwhelmingly tell us that they would be happy for their
anonymised data to be used for research. As one cancer patient said to me: "Giving my data
anonymously is the most painless way I can help others get better." So we need to get the
systems in place to allow this to happen.
Uses of data: The NHS needs to process data for a number of different purposes – for
commissioning, for audit, for public health, to monitor the spread of infectious disease and for
research purposes. All these uses have the same underlying purpose: to improve the quality of
care and treatment, both for the individual patient and for the rest of the population
David Newton works as senior project manager for South
London and Maudsley NHS foundation trust's patient
access portal Myhealthlocker
The patient can be overlooked: The motivation behind the myhealthlocker project is to
empower patients by giving them better access to their health information and to provide an
environment where they can contribute to their healthcare experience.
Myhealthlocker: The project allows service users access to parts of both their mental health
record and also their GP record. The patient reported outcome measures are fed back to the
Maudsley's medical record system and anonymised, and so can be made available for research
in the trust's system.
John Parkinson is director of the Clinical Practice Research
Datalink (CPRD)
About the project: CPRD will be making anonymised data available for approved research
projects. This will be linked data where data from different datasets/parts of the NHS will add
additional detail that will help the research outcomes.
Eliminating suspicion: This online debate is just one of many ways we want to ensure
patients know how their anonymised data may be used for approved research projects and
how their anonymised data is protected by a comprehensive data stewardship programme at
all stages in the process from removal from an NHS IT system to the research use.
Ian Blunt is senior research analyst at the Nuffield Trust
Boundaries of consent: This online debate is just one of many ways we want to ensure that
patients know how their anonymised data may be used for approved research projects and
how their anonymised data is protected by a comprehensive data stewardship programme at
all stages in the process from removal from an NHS IT system to the research use.
Centralised health data in the NHS: One of the many great things about the NHS and the
way it is organised is its ability to generate centralised health data. This is an invaluable
resource for researchers looking at large-scale patterns of care, as opposed to specific clinical
trials.
Peter Knight is deputy director of research and development
and head of research information and intelligence at the
Department of Health
Uses of anonymous data: A recent example is the assessment of metal-on-metal hips where
the regulator was able to use linked anonymised data sets to assess the safety implications for
this type of implant. Without this type of linked anonymised data, these assessments will take
longer and may not be as comprehensive.
The NHS constitution: The NHS constitution consultation covers being informed about the
use of your data. Security and confidentiality of patient data is absolute for the NHS.
You can read all of the comments made in the discussion in full online here.
Why not join our community? Becoming a member of the Guardian social care network
means you get sent weekly email updates on policy and best practice in the sector, as well
as exclusive offers. You can sign up – for free – online here.
65
13 Complementary and alternative medicine (CAM)18
Over to you: Read the text and report on the situation in your hospital. What is your
personal opinion on CAM? Discuss!
Complementary and alternative medicine (CAM) is the term for medical products and
practices that are not part of standard care. Standard care is what medical doctors, doctors of
osteopathy, and allied health professionals, such as nurses and physical therapists, practice.
Complementary medicine is used together with standard medical care. An example is using
acupuncture to help with side effects of cancer treatment.
Alternative medicine is used in place of standard medical care. An example is treating heart
disease with chelation therapy (which seeks to remove excess metals from the blood) instead
of using a standard approach.
The claims that CAM treatment providers make can sound promising. However, researchers
do not know how safe many CAM treatments are or how well they work. Studies are
underway to determine the safety and usefulness of many CAM practices.
To minimize the health risks of a CAM treatment
•
•
•
•
Discuss it with your doctor. It might have side effects or interact with other medicines
Find out what the research says about it
Choose CAM practitioners carefully
Tell all of your doctors and practitioners which CAM and standard treatments you use
NIH: National Center for Complementary and Alternative Medicine
18
http://nccam.nih.gov/health/whatiscam
66
14 Medical Guidelines
Over to you: Choose one of the guidelines to summarize it. Then, report to class!
http://www.chw.org/display/PPF/DocID/46268/router.asp
Medical Care Guidelines
Disclaimer: Medical care guidelines are developed by clinicians using the best evidence.
Unlike policies, guidelines are not rigid rules. Clinicians must decide if the guideline is
appropriate for a specific patient. For the US see: http://www.buzzle.com/articles/cover-letterexamples-for-medical-assistant.html and for the UK go to: http://www.nice.org.uk/
Adolescent Medicine
Clinical Care Guidelines
•
Contraception (PDF).
Resources
•
Eating disorders reference card (PDF).
Asthma, Allergy and Immunology
Resources
•
Asthma care plan (PDF).
Birthmarks and Vascular Anomalies
Resources
•
67
Infantile Hemangioma reference card (PDF).
Dermatology
Clinical Care Guidelines
•
Acne Vulgaris (PDF).
Resources
•
•
•
Acne Vulgaris reference card (PDF).
PHACE Syndrome Handbook (PDF).
Wart reference card (PDF).
Diabetes
Resources
•
•
Diabetes Sick Day Chart (PDF).
Pediatric Diabetic Ketoacidosis (DKA) poster (PDF).
Down Syndrome
Clinical Care Guidelines
•
•
Health Care Guidelines for Children with Down Syndrome (English PDF)
Health Care Guidelines for Children with Down Syndrome (Spanish PDF)
Resources
•
Aging and Down Syndrome: A Health and Well-Being Guidebook (PDF)
Gastroenterology
Clinical Care Guidelines
68
•
Failure to Thrive Algorithm (PDF).
Resources
•
Stool Classification reference card (PDF).
Neonatology
Resources
•
Late Preterm Infant (35 - 37 Weeks) Newborn Nursery Discharge reference card
(PDF).
Neurology
Clinical Care Guidelines
•
•
•
•
Program resources.
Headaches.
Seizures, febrile.
Seizures, unprovoked.
Orthopedics
Clinical Care Guidelines
•
•
•
•
•
•
•
Femoral Anteversion (PDF).
Flexible Flat Feet (PDF).
Genu Varum (PDF).
Internal Tibial Torsion (PDF).
Lower Extremity Pain Guide (PDF).
Metatarsus Adductus (PDF).
Toe Walking (PDF).
Resources
69
•
•
Information sheet: Intoeing and Outtoeing Health Guide (PDF).
Information sheet: What is Intoeing and Outtoeing (PDF).
Primary Immunodeficiency
Resources
•
Primary Immunodeficiencies tests.
Psychiatry
Clinic Care Guidelines
•
•
•
•
ADHD, Anxiety, Depression Care Guidelines (As one PDF).
ADHD (PDF).
Anxiety (PDF).
Depression (PDF).
Sinusitis
Clinical Care Guidelines
•
Sick Plan for Respiratory Infections (PDF).
Sports Medicine
Resources
•
•
•
Concussion Information: When in Doubt, Sit them Out! (PDF).
Concussion reference card (PDF).
Shoulder, Knee and Ankle Exam (Video).
Urology
70
Clinical Care Guidelines
•
•
Bedwetting (PDF).
UTI (PDF).
Resources
•
71
Bedwetting reference card (PDF).
15 Code of Ethics for NursesS
Over to you: Read the following text and discuss its implementation at your workplace!
International Council of Nurses
Revised 2012
All rights, including translation into other languages, reserved. This work may be reprinted
and redistributed, in whole or in part, without alteration and without prior written permission,
provided the source is indicated.
Copyright © 2012 by ICN – International Council of Nurses,
3, place Jean-Marteau, 1201 Geneva, Switzerland
ISBN: 978-92-95094-95-6 Printing: Imprimerie Fornara
THE ICN CODE OF ETHICS FOR NURSES 19
An international code of ethics for nurses was first adopted by the International Council of
Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently
with this review and revision completed in 2012.
PREAMBLE
Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore
health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is a
respect for human rights, including cultural rights, the right to life and choice, to dignity and
to be treated with respect. Nursing care is respectful of and unrestricted by considerations of
age, colour, creed, culture, disability or illness,
politics, race or social status. Nurses render health services to the individual, the family and
the community and coordinate their services with those of related groups.
2
THE ICN CODE
The ICN Code of Ethics for Nurses has four principal elements that outline the standards of
ethical conduct.
ELEMENTS OF THE CODE
1. Nurses and people
The nurse’s primary professional responsibility is to people requiring nursing care.
In providing care, the nurse promotes an environment in which the human rights, values,
customs and spiritual beliefs of the individual, family and community are respected.
The nurse ensures that the individual receives accurate, sufficient and timely information in a
culturally appropriate manner on which to base consent for care and related treatment.
The nurse holds in confidence personal information and uses judgement in sharing this
information.
19
http://www.dsr.dk/ser/Documents/icncode_english.pdf
72
The nurse shares with society the responsibility for initiating and supporting action to meet
the health and social needs of the public, in particular those of vulnerable populations.
The nurse advocates for equity and social justice in resource allocation, access to health care
and other social and economic services.
The nurse demonstrates professional values such as respectfulness, responsiveness,
compassion, trustworthiness and integrity.
3
2. Nurses and practice
The nurse carries personal responsibility and accountability for nursing practice, and for
maintaining competence by continual learning.
The nurse maintains a standard of personal health such that the ability to provide care is not
compromised.
The nurse uses judgement regarding individual competence when accepting and delegating
responsibility.
The nurse at all times maintains standards of personal conduct which reflect well on the
profession and enhance its image and public confidence.
The nurse, in providing care, ensures that use of technology and scientific advances are
compatible with the safety, dignity and rights of people.
The nurse strives to foster and maintain a practice culture promoting ethical behaviour and
open dialogue.
3. Nurses and the professsion
The nurse assumes the major role in determining and implementing acceptable standards of
clinical nursing practice, management, research and education.
The nurse is active in developing a core of research-based professional knowledge that
supports evidence-based practice.
The nurse is active in developing and sustaining a core of professional values.
The nurse, acting through the professional organisation, participates in creating a positive
practice environment and maintaining safe, equitable social and economic working conditions
in nursing.
4
The nurse practices to sustain and protect the natural environment and is aware of its
consequences on health. The nurse contributes to an ethical organisational environment
and challenges unethical practices and settings.
4. Nurses and co-workers
The nurse sustains a collaborative and respectful relationship with co-workers in nursing and
other fields.
The nurse takes appropriate action to safeguard individuals, families and communities when
their health is endangered by a co-worker or any other person.
The nurse takes appropriate action to support and guide co-workers to advance ethical
conduct.
73
SUGGESTIONS FOR USE
of the ICN Code of Ethics for Nurses
The ICN Code of Ethics for Nurses is a guide for action based on social values and needs. It
will have meaning only as a living
document if applied to the realities of nursing and health care in a changing society.
To achieve its purpose the Code must be understood, internalised and used by nurses in all
aspects of their work. It must be available to students and nurses throughout their study
and work lives.
5
APPLYING THE ELEMENTS
of the ICN Code of Ethics for Nurses
The four elements of the ICN Code of Ethics for Nurses:
nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers,
give a framework for the standards of conduct. The following chart will assist nurses to
translate the standards into action.
Nurses and nursing students can therefore:
l Study the standards under each element of the Code.
l Reflect on what each standard means to you. Think about how you can apply ethics in your
nursing domain: practice, education, research or management.
l Discuss the Code with co-workers and others.
l Use a specific example from experience to identify ethical
dilemmas and standards of conduct as outlined in the Code.
Identify how you would resolve the dilemmas.
l Work in groups to clarify ethical decision making and reach
a consensus on standards of ethical conduct.
l Collaborate with your National Nurses Association,
co-workers, and others in the continuous application of ethical standards in nursing practice,
education, management and research.
6
Practitioners and Managers Provide care that respects human rights and is sensitive to the
values, customs and beliefs of people.
Provide continuing education in ethical issues.
Provide sufficient information to permit informed consent to nursing and/or medical care, and
the right to choose or refuse treatment.
Use recording and information management systems that ensure confidentiality.
Develop and monitor environmental safety in the workplace.
74
Educators and Researchers In curriculum include references to human rights, equity, justice,
solidarity as the basis for access to care.
Provide teaching and learning opportunities for ethical issues and decision making.
Provide teaching/learning opportunities related to informed consent, privacy and
confidentiality, beneficence and maleficence.
Introduce into curriculum concepts of professional values.
Sensitise students to the importance of social action in current concerns.
National Nurses Associations Develop position statements and guidelines that support
human rights and ethical standards.
Lobby for involvement of nurses in ethics committees.
Provide guidelines, position statements, relevant documentation and continuing education
related to informed consent to nursing and medical care.
Incorporate issues of confidentiality and privacy into a national code of ethics for nurses.
Advocate for safe and healthy environment.
Element of the Code # 1:
NURSES AND PEOPLE
7
Practitioners and Managers Establish standards of care and a work setting that promotes
quality care.
Establish systems for professional appraisal, continuing education and systematic renewal of
licensure to practice.
Monitor and promote the personal health of nursing staff in relation to their competence for
practice.
Educators and Researchers Provide teaching/learning opportunities that foster life long
learning and competence for practice.
Conduct and disseminate research that shows links between continual learning and
competence to practice.
Promote the importance of personal health and illustrate its relation to other values.
National Nurses Associations Provide access to continuing education, through journals,
conferences, distance education, etc.
Lobby to ensure continuing education opportunities and quality care standards.
Promote healthy lifestyles for nursing professionals.
Lobby for healthy workplaces and services for nurses.
Element of the Code # 2:
NURSES AND PRACTICE
8
Practitioners and Managers Set standards for nursing practice, research, education and
management.
75
Foster workplace support of the conduct, dissemination and utilisation of research related to
nursing and health.
Promote participation in national nurses’ associations so as to create favourable
socioeconomic conditions for nurses.
Educators and Researchers
Provide teaching/learning opportunities in setting standards for nursing practice, research,
education and management.
Conduct, disseminate and utilise research to advance the nursing profession.
Sensitise learners to the importance of professional nursing associations.
National Nurses Associations Collaborate with others to set standards for nursing education,
practice, research and management.
Develop position statements, guidelines and standards related to nursing research.
Lobby for fair social and economic working conditions in nursing.
Develop position statements and guidelines in workplace issues.
Element of the Code # 3:
NURSES AND THE PROFESSION
9
Practitioners and Create awareness of specific and overlapping functions and the potential for
interdisciplinary tensions and create strategies for conflict management.
Develop workplace systems that support common professional ethical values and behaviour.
Develop mechanisms to safeguard the individual, family or community when their care is
endangered by health care personnel.
Educators and Researchers Develop understanding of the roles of other workers.
Communicate nursing ethics to other professions.
Instil in learners the need to safeguard the individual, family or community when care
is endangered by health care personnel.
National Nurses Associations Stimulate co-operation with other related disciplines.
Develop awareness of ethical issues of other professions.
Provide guidelines, position statements and discussion fora related to safeguarding people
when their care is endangered by health care personnel.
Element of the Code # 4:
NURSES AND CO-WORKERS
10
DISSEMINATION
of the ICN Code of Ethics for Nurses
76
To be effective the ICN Code of Ethics for Nurses must be familiar to nurses. We encourage
you to help with its dissemination to schools of nursing, practising nurses, the nursing press
and other mass media.
The Code should also be disseminated to other health professions, the general public,
consumer and policy-making groups, human rights organisations and employers of nurses.
GLOSSARY OF TERMS USED
in the ICN Code of Ethics for Nurses
Co-worker
Other nurses and other health and non-health related workers and professionals.
Collaborative relationship
A professional relationship based on collegial and reciprocal actions and behaviour that aims
to achieve certain jointly agreed goals.
Family
A social unit composed of members connected through blood, kinship, emotional or legal
relationships.
Nurse shares with society
A nurse, as a health professional and a citizen, initiates and supports appropriate action to
meet the health and social needs of the public.
Personal information
Information obtained during professional contact that is private to an individual or family, and
which, when disclosed, may violate the right to privacy, cause inconvenience, embarrassment,
or harm to the individual or family.
Personal health
Mental, physical, social and spiritual wellbeing of the nurse.
Related groups
Other nurses, health care workers or other professionals providing service to an individual,
family or community and working toward desired goals.
11
77
5.2 Content für das Selbststudium
Auf den folgenden Seiten finden sich Auszüge verschiedener Arbeitsaufträge aus der
Lern-Plattform „Moodle“.
Gerne würden wir Sie vor Ort zu uns ins Studienzentrum Gesundheitswissenschaften &
Management einladen um Ihnen einen live-Eindruck unserer Moodle-Seiten zu
vermitteln. Dadurch dass die Arbeitsaufträge nicht statisch und streng chronologisch
stattfinden, ist es schwierig diese Inhalte einfach „auszudrucken“.
Auch die Thematik der Benutzerführung, der Anordnung und Struktur der Seite oder des
Rechtemanagements führen wir Ihnen gerne vor.
Arbeitsauftrag „Selbsttest: Testen Sie Ihr Englisch“
-
-
Dozentin forderte Studierende auf, den Test für sich auszufüllen und ihr das
erreichte prozentuale Ergebnis mitzuteilen – daraufhin legte die Dozentin ihr
Unterrichtsniveau fest.
Zeitraum: 2 Wochen nach erster Vorlesung
Arbeitsauftrag „Describing charts and graphs“
-
Studierende sollten folgende Aufgabe schriftlich bearbeiten und der Dozentin zur
Korrektur einreichen.
Zeitraum: 2 Wochen nach erster Vorlesung
Describing charts and graphs
In this unit we look at the language used to describe charts and graphs. Graphs or charts help
people understand data quickly. You can use them to make a comparison or show a trend.
At the end of this unit you should know some useful vocabulary for describing charts and
graphs.
Please do this unit to repeat the vocabulary we had together at the 17th July 2013.
1. The following link will lead you to a Website, there all necessary words are written down
in a nice way -and at the end of this page you can test yourself. The correct answers
will be shown immediately after filling all gaps.
2. Please choose one graph or chart (choose free which one you want to use) and write a short
explanation/description to this chart. Send this as a word document to Frau Baumann-Stephan
(please use Katrin Heeskens E-Mailaccount, she will forward them). You will find here the link
to the WHO website where you can find many different charts and graphs.
Medizinwitze auf englisch, kleiner Input auf Moodle-Seite von Dozentin
A psychology professor gives a talk on mental health and decides to test her
students. Speaking about manic depression, she asks, 'How would you diagnose a
patient who walks back and forth screaming loudly one minute, then sits in a chair
crying uncontrollably the next?' A young man in the back raises his hand and
answers, 'A football coach.'
A man returns from Africa feeling very ill. He visits his doctor, who sends the man to
hospital, where it is found that he has Ebola fever. 'Oh, no!' cries the man. 'What am I
going to do?' 'Don't worry, ' the doctor tells him. 'First, we're going to feed you mostly
pitta and pita bread.' 'Will that make me better?' the man asks. 'No, but it's the only
food we'll be able to get under the door.'
Patient: 'Doctor, doctor! I've got a terrible memory problem.'
Doctor: 'How long have you had this problem?'
Patient: 'What problem?'
A little boy is very excited because his mum has told him that he's going to get a
baby brother. Every day in school, he tells his teacher, 'I'm getting a brother.' One
day, his mum lets him feel the baby kicking inside her tummy. The next day at school,
he doesn't say anything to his teacher. The teacher asks him if everything is OK. The
little boy looks really sad and says, 'I think Mummy ate my brother.'
Doctor: 'I'm afraid I have bad news. You only have six minutes to live.'
Patient: 'Oh, my God. What am I going to do?'
Doctor: 'How about boiling an egg?'
A blonde walks into a doctor's surgery and complains that everything hurts. She
touches herself on the leg and says, 'Ouch! I hurt there.' She touches her shoulder
and says, 'Ouch! I hurt there, too.' She touches her hair and says, 'Ouch! Even my
hair hurts.' The doctor says, 'You've got a broken finger.'
A man walks into a doctor's office and says, 'Please, help me. I think I'm a moth.'
'You certainly need help, 'the doctor answers, 'but that sounds like a problem for a
psychologist. I'm a neurologist. Why did you come to my office?' 'Well, your light was
on, 'replies the man.
Doctor: 'I haven't seen you for a long time.'
Patient: 'I know. I've been ill.'
Patient: 'I've hurt my arm in several places.'
Doctor: 'Well, don't go to those places any more.'
Patient: 'It's been a whole month since my last visit, and I still feel miserable.'
Doctor: 'Did you follow the instructions on the medicine I gave you?'
Patient: 'Of course I did. On the bottle it said: 'Keep tightly closed.''
Patient: 'Doctor, I get heartburn every time I eat birthday cake.'
Doctor: 'Have you tried blowing out the candles before you eat it?'
Does an apple a day really keep the doctor away?
It does if you aim it well enough.
Patient: 'Doctor! Doctor! I feel pain in my eye whenever I have a cup of tea.'
Doctor: 'Take the spoon out of the cup before you drink.'
An old man is walking down the street, shouting. 'Why's he doing that?' asks a
passer-by. 'That's old Mr Thomson. He's just talking to himself again, 'replies a
woman. 'But why is he shouting? Asks the passer-by. 'He has to, 'replies the woman.
'He's deaf.'
A man goes to visit his doctor. 'Doctor, my arm hurts,'he says. 'Can you look at it,
please?'
The doctor rolls up the man's sleeve and suddenly hears the arm whisper. 'Hey, Doc,
could you lend me € 20? I'm desperate!'
The doctor says, 'Aha! I see the problem. Your arm is broke.' (broke = gebrochen;
pleite)
How many psychologists does it take to change a light bulb?
One, but the light bulb has to want to change.
A woman walks up to a little old man sitting happily on his chair.
'I couldn't help noticing how happy you look,'the woman says. 'What's your secret for
a long, happy life?'
'I smoke three packets of cigarettes a day, drink a case of whisky a week, eat fatty
foods and never exercise,'the man replies.
'That's amazing,'the woman says thoughtfully. 'How old are you?'
'Twenty-six,'he answers.
A man walks into a doctor's surgergy. He has a carrot in his right ear, a banana in his
left and part of an apple up his nose. 'What's wrong with me?' he asks the doctor.
The doctor replies, 'You're not eating properly.' (properly = richtig; ausgewogen)
Patient: 'Doctor, I think I've been bitten by a vampire.'
Doctor: 'Drink this glass of water.'
Patient: 'Will it make me better?'
Doctor: 'No, but I'll be able to see if your neck leaks.'
Late one night at the mental asylum, an inmate shouts, 'I am Napoleon!' Another one
asks, 'How do you know?' The first inmate says, 'God told me.' A voice from another
room shouts, 'I did not!'
What do you call a man who doesn't use condoms?
Daddy.
A man calls the hospital and says: 'You have to send help! My wife's gone into
labour!' The nurse says, 'Calm down. Is this her first child?' 'No, 'says the man. 'This
is her husband.'
An old snake goes to his doctor and says, 'I can't see so well these days. 'So the
doctor gives him a pair of glasses and tells him to return in two weeks. 'Two weeks
pass, and the snake goes back and tells the doctor he's depressed. The doctor asks,
'What's the problem? Didn't the glasses help?' 'The glasses are fine, 'says the snake,
'but Ive just discovered that I've been living with a garden hose for the past two
years.'
'Hello. This is the Incontincence Hotline. Can you hold', please?' (hold = dranbleiben;
den Toiletten-Drang unterdrücken)
Patient: 'How much will it cost to have this tooth pulled?'
Dentist: 'Two hundred pounds.'
Patient: 'What? Two hundred pounds for just a few minutes' work?'
Dentist: 'I can take it out very slowly, if you like.'
Arbeitsauftrag „Describing charts and graphs“
-
Studierende sollten folgende Aufgabe schriftlich bearbeiten und der Dozentin zur
Korrektur einreichen.
Zeitraum: 2 Wochen nach erster Vorlesung
Describing charts and graphs
In this unit we look at the language used to describe charts and graphs. Graphs or charts help
people understand data quickly. You can use them to make a comparison or show a trend.
At the end of this unit you should know some useful vocabulary for describing charts and
graphs.
Please do this unit to repeat the vocabulary we had together at the 17th July 2013.
1. The following link will lead you to a Website, there all necessary words are written down
in a nice way -and at the end of this page you can test yourself. The correct answers
will be shown immediately after filling all gaps.
2. Please choose one graph or chart (choose free which one you want to use) and write a short
explanation/description to this chart. Send this as a word document to Frau Baumann-Stephan
(please use Katrin Heeskens E-Mailaccount, she will forward them). You will find here the link
to the WHO website where you can find many different charts and graphs.
Arbeitsauftrag „Selbsttest: Testen Sie Ihr Englisch“
-
Studierende sollten eine 45 min Folge einer englischen Arztserie auf youtube
anschauen und hinterher folgenden Test durchführen.
Zeitraum: 2 Wochen nach erster Vorlesung