The Doctor is in. Capire l'inglese delle riviste scientifiche by Il Pensiero Scientifico Editore

J ACQUELINE M. C OSTA will learn to read just as well in English”. Ciò

che contraddistingue le 20 unità del manuale è la praticità dell'approccio: il punto di partenza sono gli stessi abstract delle riviste di medicina che ogni operatore sanitario utilizza per aggiornarsi. Comprensione del testo, acquisizione di nuovi vocaboli, regole grammaticali e sintassi. Ma anche parole crociate, consigli e scorciatoie per rendere l'apprendimento di una lingua straniera il meno noioso possibile. A completare il libro un glossario, le definizioni dei termini statistici e relativi al disegno di uno studio e le soluzioni degli esercizi da svolgere. Per chiunque voglia migliorare la capacità di lettura e comprensione della letteratura scientifica in lingua inglese.

€ 32,00

The Doctor is in. Capire l’inglese delle riviste scientifiche

“Y

ou learned to read in your own language; you

J A C Q U E L I N E M . C O S TA

THE DOCTOR IS IN

Capire l’inglese delle riviste scientifiche

ARCHI

J A C Q U E L I N E M . C O S TA

THE DOCTOR IS IN

Capire lâ&#x20AC;&#x2122;inglese delle riviste scientifiche

Il Pensiero Scientifico Editore

Jacqueline M. Costa Docente e traduttrice di inglese medico-scientifico jaccosta62@gmail.com

Prima edizione: luglio 2010 © 2010 Il Pensiero Scientifico Editore Via San Giovanni Valdarno 8, 00138 Roma Tel: (+39) 06 862821 - Fax: (+39) 06 86282250 E-mail: pensiero@pensiero.it - Internet: www.pensiero.it Tutti i diritti sono riservati per tutti i Paesi Nessuna parte del presente volume può essere riprodotta, tradotta o adattata con alcun mezzo (compresi i microfilm, le copie fotostatiche e le memorizzazioni elettroniche) senza il consenso scritto dell’Editore La violazione di tali diritti è perseguibile a norma di legge Stampato in Italia dalle Arti Grafiche Tris S.r.l. Via delle Case Rosse 23, 00131 Roma Copertina e progetto grafico: Studio Rosa Pantone s.n.c., Roma Immagine di copertina: Tom Wesselmann, Five Spot, 2004 Impaginazione: Doppiosegno s.n.c., Roma Coordinamento redazionale: Benedetta Ferrucci ISBN 978-88-490-0328-4

Table of contents

Introduction

Introduzione

Reading

Vocabulary

Syntax

Text 1

Text 2

Text 3

Text 4

Text 5

Text 6 - Vocabulary review Texts 1-5

Text 7

Text 8

Text 9

Text 10

Text 11

Text 12 - Vocabulary review Texts 1-11

THE DOCTOR IS IN

Text 13

Text 14

Text 15

Text 16

Text 17

Text 18 - Vocabulary review Texts 1-17

Text 19

103

Text 20

109

Extra reading

113

Answer key

127

Answer key - extra reading

155

Glossary

161

Irregular Verbs - Medical English

169

Some definitions of study designs and statistical terms

171

Conclusions

175

Introduction

You learned to read in your own language; you will learn to read just as well in English. Trust me – I know my polli! I have been teaching healthcare professionals how to read in English for over 10 years, and I have been teaching English as a foreign language for over 20. It’s like learning to drive a car – at first, with so many things to remember and so many things to coordinate at the same time, it seems impossible that one day you will drive confidently and well. But you keep practicing because knowing how to drive gives you the freedom to go wherever you want, whenever you want! Consider English a means of transportation; you use it to get somewhere. There’s nothing mysterious or intellectual about it or anything that requires any particular talent. True, some people are better drivers than others, and some enjoy it more than others but anyone can learn to drive. Keep driving. Keep practicing. Keep reading. You can do this! In your most frustrated moments, when you want to quit because it’s hard, it’s bor-

ing, you’re tired, you don’t have time, or it’s a beautiful sunny day and your children want to go outdoors and kick a soccer ball with you, remember that you’re doing all of this because you need English to read the scientific literature; staying up-to-date on medical research, policy and opinion is one of the essential tools that will help you achieve your goal. Always remember what your ultimate objective is – to be a better healthcare professional. To be useful, helpful, and relevant. To make a difference. The aim of this self-study textbook is to give you the guidance and practice you need to improve your reading skills in English. There are 20 units based on texts from the scientific literature (usually Abstracts), with guided vocabulary, syntax and grammar practice, as well as reading comprehension practice. There is also an “Extra Reading” unit, with even more vocabulary and reading practice. At the back of the textbook is a glossary, (relatively) easy definitions of some study designs and some statistical terms, and an Answer Key so that

THE DOCTOR IS IN

you can check your answers to the various exercises. Start this self-study textbook by first reading the introductory section on tips and strategies for reading, vocabulary, and syntax, as well as “Grammar to go,” a short and easy explanation of the grammar you will find in the scientific literature. I recommend you then proceed in a linear fashion and do all 20 units – this would be the most effective and most beneficial approach – but it is not mandatory. The important thing is that you start and that you continue. The more you read in English, the easier it becomes, and the easier it becomes, the more you will read!

Think of me as your personal trainer at the gym or as your driving instructor. My job is to help you learn how to read more quickly, more confidently and more easily, and to better understand what you’re reading so that you can do your job – take care of sick people and help prevent healthy people from getting sick. Good luck and buona lettura! Jacqueline M. Costa Reggio Emilia, Italy March 2010

Introduzione

Hai imparato a leggere in italiano; imparerai a leggere allo stesso modo in inglese. Dammi retta: conosco i miei polli! Ho insegnato l’inglese ad operatori sanitari per oltre dieci anni e per oltre 20 ho insegnato l’inglese come lingua straniera. È come imparare a guidare; all’inizio, con tutte quelle cose da ricordare e da coordinare nello stesso momento, sembra impossibile che un giorno si sarà capaci di guidare con tranquillità e sicurezza. Ma decidi lo stesso di fare pratica perché sai che guidare ti darà la libertà di andare dove ti pare, quando ti pare! Considera l’inglese come un mezzo di trasporto; lo usi per andare da qualche parte. Non c’è nulla di misterioso o di intellettuale né qualcosa che richieda un particolare talento. È vero: c’è chi è più bravo a guidare e chi si diverte di più ad andare in giro in macchina, ma chiunque può imparare a farlo. Continua a guidare. Tieniti in allenamento. Continua a leggere: vedrai che ci puoi riuscire! Nei momenti peggiori, quando stai sul punto di buttare via tutto, quando sei stan-

co, non hai tempo, o quando la giornata è così bella e i figli ti chiamano per andare a giocare a palla con loro, ricorda che stai facendo tutto questo perché hai bisogno di conoscere l’inglese per seguire la letteratura scientifica; mantenersi aggiornati su cosa succede nei tanti campi della ricerca in medicina, sulle politiche sanitarie e sui diversi punti di vista è uno degli strumenti essenziali che ti aiuteranno a raggiungere il tuo obiettivo. Ricorda sempre che il tuo vero obiettivo è essere un professionista della sanità migliore. Per essere utile, per essere d’aiuto e per contare. Per fare la differenza. Lo scopo di questa guida all’autoapprendimento è indicarti la strada e i modi concreti di cui hai bisogno per migliorare le tue capacità di lettura dell’inglese. Il libro si compone di 20 unità basate su testi estrapolati dalla letteratura scientifica (solitamente riassunti – Abstracts) integrati da un vocabolario ragionato e da esercizi per la comprensione della sintassi e della grammatica. Una “Extra Reading Unit” fornisce un’ulteriore base lessicale e un’aggiuntiva

THE DOCTOR IS IN

opportunità di lettura. Al termine del libro troverai un glossario, con definizioni (relativamente) facili di alcuni disegni di studio e di termini statistici, così come la sezione “Answer Key” dove troverai i risultati dei diversi esercizi. Inizia questa guida leggendo per prima la sezione introduttiva sulle “tips and strategies” per leggere, per arricchire il vocabolario e migliorare la conoscenza della sintassi; anche la “Grammar to go” è importante: una breve e semplice spiegazione della grammatica che troverai usata negli articoli di medicina. Ti consiglio di procedere in sequenza lineare, completando le 20 unità; si tratterebbe

dell’approccio al libro più efficace, ma non è obbligatorio. La cosa importante è iniziare e continuare. Più leggi in inglese più diventa facile, e più diventa facile più leggerai! Considerami il tuo personal trainer di ginnastica o l’istruttore di guida. Il mio compito è insegnarti come leggere più rapidamente, con maggiore fiducia e con più facilità; ma anche farti capire cosa stai leggendo così che tu possa svolgere il tuo lavoro: prenderti cura dei malati e aiutare la gente sana a non ammalarsi. In bocca al lupo e buona lettura! Jacqueline M. Costa Reggio Emilia Marzo 2010

Reading

You read for only one of two reasons: for pleasure or for information. Remember that, always. You read the scientific literature for information – either to confirm what you already know or what you suspect, or to learn something new. Remember that, always. The scientific literature provides the evidence base for your work. What you learn by reading the scientific literature can improve the quality of the care you provide, generate hypotheses for research, change healthcare policy, and so on. Reading the scientific literature is essential to your continuing medical education. Good reasons not to read • It’s hard. • It’s boring. • I don’t know how. • I don’t have the time. • I’m too busy. • I’d rather do something else with my free time. • Being just good enough, professionally, is OK with me.

These are all very good, perfectly legitimate reasons. You are free not to read, if you don’t want to or you can’t. Remember that, always. Don’t stress yourself, and don’t worry. Reasons to read • You care about your work. • You care about yourself, personally and professionally. • You don’t want to be just good enough, professionally; you want to be better. • You want to make a difference. • You want to save the world! If you do decide to start a regular reading routine, consider the following: • Your knowledge of English may be an obstacle, but it is one that can be removed. Remember that, always, even when you’re discouraged, frustrated, and ready to give up. Keep reading. Don’t quit! Go slowly but don’t quit! • Learning to read the scientific literature so that it is a professionally useful and

THE DOCTOR IS IN

•

• •

relevant investment of your time is just like learning to play tennis or the piano or do yoga or drive or make perfect sfoglia – it takes time and practice. Be patient with yourself. Be kind to yourself. Keep your expectations regarding your progress and your performance very reasonable. You don’t have to be perfect. You don’t have to understand everything perfectly, immediately. It takes time. Just keep practicing, and you will make progress, I promise. One day reading the scientific literature in English will be so easy and natural and automatic that you will laugh when you remember how hard it seemed at first. To read the scientific literature you don’t need to know a lot of grammar and you don’t need to know a lot of vocabulary. What you do need is a method and a lot of practice – practice, practice, practice. Practice makes perfect. Remember that, always. The more you do it, the easier it becomes, the better you get. Remember that, always.

Getting ready 1. Set aside a period of time dedicated only to reading, for example one hour per week, or 15 minutes every Monday afternoon, or 30 minutes on the last day of every month. Consider this time “sacred” and always respect it. 2. Choose a place that is quiet and comfortable. 3. Close the door. 4. Turn off your telephone and your computer. Allow no distractions or interruptions. 5. Whenever possible, print the articles you find online; it is easier to read on paper. 6. Start an electronic archive where you save articles, and if you read an article of interest, forward it to your colleagues!

Share useful, helpful, and relevant information! 7. Taking notes and writing comments are an important part of the reading process – make sure you have pencils, pens and highlighters, as well as sticky notes (e.g., Post-it® notes), paper, and a notebook or binder. 8. Relax, breathe, and remember that you are reading because you want to, because it’s important to you, and because you want your work to be useful, helpful, and relevant.

Reading strategies 1. The first thing to do is to ask yourself Why read this paper? • Because it is relevant to my work? • Because my colleagues/chief asked me to? • Because I’m curious about the topic? • Because I want to increase my general knowledge? • Because I’m looking for some specific information? • Because I want to confirm what I already know? • Other reasons? You need a motivation to read. Once you have identified it, proceed. If, however, you can’t find a good reason to read a particular text, then don’t. Only read what is useful, helpful, and relevant. Your time and energy are precious – don’t waste them! 2. Now that you know why you are reading the text, the second thing to do is to identify the appropriate reading strategy: skimming, scanning, or careful reading. • Skimming (scremare, in Italian) means to read the text quickly and superficially; use this strategy if you want a general idea of the contents. • Scanning the text means to read only certain, limited parts of the text; use

Reading

this strategy to find specific information. • Read the text carefully, instead, if you want to fully understand the contents. Take notes, go through the tables and graphs, look at the references, and reflect on the scientific merit of the study and the applicability of its findings to your work. 3. The third thing to do is to go through the checklist below. This strategy will help you create a context, which facilitates comprehension. Do this every time you read, until the strategy becomes automatic. After going through the questions on the checklist, you may decide not to read this paper, which is OK! Only read what is useful, helpful, and relevant. Your time and energy are precious – don’t waste them!

THE CHECKLIST

1. Based on the title of the paper, what is the topic of this study? 2. Based on the title of the paper, what do I already know about this topic? 3. Based on the title of the paper, what do I think the authors will report? 4. What journal published this paper? 5. When was this paper published? 6. Who are the authors of this paper? 7. What institution or agency are they affiliated with? 8. Where is this institution or agency located? (Consult a map if necessary) 9. What do I know about that country and/or its healthcare system? 10. Are the aims of the study clearly stated?

The checklist Here is why the questions on the checklist are so important. 1. Based on the title of the paper, what is the topic of this study? • You have probably chosen this text based on its title. Beware: titles can be very difficult to understand because they are rarely complete sentences. Don’t panic. • Use the title to “predict content.” This will help you orient yourself and prepare for reading. 2. Based on the title of the paper, what do I already know about this topic? 3. Based on the title of the paper, what do I think the authors will report? • Bring your professional experience to the table. Use it both to overcome the language obstacle and to identify the value (to you) of the study. You are one of your most precious comprehension tools! • Hypothesizing content and conclusions gives your reading a sense of purpose and direction. It helps you stay focused and motivated. 4. What journal published this paper? • What do you know about this journal? Is it considered authoritative? Are the articles peer-reviewed? • Always consider the source of any and all information! (Your patients’ lives depend on it!) • If the journal is not known as a reliable source of information or if you suspect publication bias, don’t read the paper! (Your patients’ lives depend on it!) • Although the real value of a journal’s Impact Factor is under debate, it is still a general indication of a journal’s authoritativeness.

t idea! cellen An ex copy this Photo efer to it d r list an you read! n e wh

THE DOCTOR IS IN

5. When was this paper published? • In your field, is this paper “old” or is it still relevant? If it is “old,” don’t read it.

11. Do the authors’ conclusions correspond to the declared study aims? • If they do not, don’t waste your time reading this paper.

6. Who are the authors of the paper? • Are any of them recognized experts in their field? • Are they considered authoritative? • Are they in any way a “guarantee” of the scientific merit of the study?

12. Do the authors declare any conflict of interest or potential bias? • If they do, that is a point in their favor in terms of scientific integrity. If they do not, be cautious of possible bias.

7. What institution or agency are they affiliated with? • Is this institution or agency considered authoritative (for example, the ISS, the NIH, and so on)? • Is it in any way a “guarantee” of the scientific merit of the study?

(For tips on how to quickly evaluate the “quality” of a scientific paper, consult Attenti alle bufale by Tom Jefferson (Il Pensiero Scientifico Editore) or go to www.attentiallebufale.it)

8. Where is this institution or agency located? 9. What do you know about that country and/or its healthcare system? • Is it public? Private? Centralized? • This information helps evaluate whether the study’s findings are applicable to your professional setting. 10. Are the aims of the study clearly stated? • If they are not, don’t waste your time reading this paper.

Remember Abstracts are subject to word limits (usually 250 words). The information they provide is therefore not necessarily complete or clear! Always consult the Results section of the full text paper for complete data information and interpretation. A final word Sometimes the reason an article is difficult to understand is because it is poorly written, NOT because you’re English is so bad or so limited! Remember that the authors are scientists, not professional writers! Don’t underestimate yourself or your English! Be cautious but be confident!

Vocabulary

You read for information. Your want to be able to read the scientific literature as quickly as possible and to understand as much of the contents as you can. You don’t have time to waste. You have a million things to do. Reading in English is so hard! Vocabulary is Public Enemy Number 1, your main obstacle to reading. Relax. There is a strategy. First: vocabulary can be divided into three categories – words you know, new words, and words that are “vaguely familiar”; you’ve seen them a million times but you can never remember what they mean! Good news! Words you know are clearly not a problem and so that’s one group that has been eliminated! What to do about new or “vaguely familiar” vocabulary?

1. First, distinguish between essential and non-essential words. By this, I mean essential to understanding the general meaning of a sentence or paragraph. For the moment, invest your time and energy only in essential vocabulary. 2. Consider the following example (next page). The yellow boxes represent unknown words. Which of the 6 unknown words do you consider essential? (N.B. Word no. 2 is used 4 times.) 3. Can you understand the general meaning of the title and the paragraph? 4. If you can, then you have certainly inferred the meaning of unknown words from the context. Excellent! (When you infer meaning, you are probably thinking in Italian – that’s OK!) 5. If you can infer the meaning of an unknown word, just circle it and continue reading! You can go back to it later, if you want to.

THE DOCTOR IS IN

RES REP HEALTH EFF INST.

2009 Mar;(139):5-71; discussion 73-89.

Effects of long-term 1 exposure to traffic-related air pollution2 on respiratory and cardiovascular mortality in the Netherlands: the NLCSAIR study. Brunekreef B, Beelen R, Hoek G, Schouten L, Bausch-Goldbohm S, Fischer P, Armstrong B, Hughes E, Jerrett M, van den Brandt P. Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.

Evidence is increasing that long-term exposure to ambient air pollution2 is associated with deaths from cardiopulmonary diseases. In a 2002 pilot study, we reported clear indications that traffic-related airlution2, especially at the local scale, was related to cardiopulmonary mortality in adomly3 selected subcohort of 5000 older adults participating in the ongoing4 Netherlands Cohort Study (NLCS) on diet and cancer. In the current study, referred to as NLCS-AIR, our objective was to obtain more precise estimates5 of the effects of traffic-related air pollution2 by analyzing associations with cause-specific mortality, well as6 lung cancer incidence, in the full cohort of approximately 120,000 subjects. …

6. If, instead, you absolutely cannot infer the meaning of an essential word, use a dictionary or the glossary at the back of this textbook. The strategy, in other words, is to focus first on essential versus non-essential, and then on whether or not you can infer meaning. Break the GIANT vocabulary problem down into two smaller problems, and proceed. You now have a strategy!

7. Another helpful approach is to look at the prefix/suffix/ending of a word, as well as its position in the sentence. Knowing what the function of a word is can help you infer its meaning from the context. • Some common noun suffixes are -ment, -tion, -ance/-ence, and -hood (management, evaluation independence, reading, childhood). • Some common adjective suffixes are -able, -ful, -less, -ous, -y, -al, -ing and -ed (manageable, useful/useless, interested/interesting, dangerous, surgical, healthy). • A common adverb suffix is -ly, but beware: not all words that end in -ly are adverbs! 8. Here are some more tips to help you with new or unknown vocabulary: • A word that ends in “s” is probably either a verb (third person singular, present tense) or a plural noun. • A word that ends in -ed or -ing is probably a verb in the present or past participle, a noun, or an adjective. • If there is an article, then there is surely a noun. Keep reading until you find it. • If there is “either” then there is surely “or”. Keep reading until you find it. • If there is “both”, then there is surely “and”. Keep reading until you find it. • If there is “between” then there is surely “and”. Keep reading until you find it. • If there is “more” then there is almost surely “than”. Keep reading until you find it. • A word that ends in -er is almost surely a comparative adjective. Look for “than”. • A word that ends in -est and is preceded by “the” is almost surely a superlative adjective. • Will, would, can, could, should, may, might, can, and must are always followed by an infinitive. Keep reading until you find it.

Vocabulary

9. There is one category of words whose meaning you must never, ever try to infer – text organizers! If you guess wrong, the whole relationship between the pieces of information provided changes and thus so does the deeper meaning of the text. Simply your life! Don’t kill yourself trying to learn everything all at once! Keep this list handy (a portata di mano) when you’re reading and refer to it when necessary.

Tips on how to learn vocabulary 1. Invest your time and energy in what is useful! Study only those words that are useful to you and your work. 2. Study only the words that you find difficult to remember. 3. Do not study long lists of words. It’s heroic but not very effective. 4. Study only 5 words at a time. It is much more effective!

Text organizers ADDING INFORMATION

• furthermore • moreover • what’s more

inoltre inoltre inoltre

LOGICAL RELATION

• • • • •

hence as since therefore thus

perciò poiché poiché perciò perciò

5. There is no “right” or “wrong” strategy, only “effective” or “not effective.” Do what works for you! 6. Use any strategy that makes reading easier and faster! 7. Unit 6 of this textbook provides a lot of tips on how to study and learn vocabulary. 8. There is a glossary at the back of this textbook. Use it when you read!

CONTRAST

• • • • • • • • • •

although/though despite/in spite of even though however nevertheless/ nonetheless regardless of still whereas while whilst

sebbene nonostante anche se tuttavia tuttavia nonostante tuttavia mentre mentre mentre

t idea! cellen x e is n A opy th Photoc efer to it d r list an you read! when

GIVING EXAMPLES

• for instance • like • such as

ad esempio come, ad esempio come, ad esempio

Syntax

1. English syntax is very rigid. This is good news because it means that you know what a word’s function is based on its position in the sentence. This will make your life easier! 2. A sentence is made up of discrete pieces, like a train or a Lego® construction. Break it down and work with the individual pieces. 3. Basic English syntax is: subject verb complement. 4. When a sentence is long and complex, find the verb. Use the verb as your reference point to identify the subject and the complement. 5. Everything before the verb is the subject of the sentence. In that series of words, the last one is the noun; all the words before it are used as adjectives: adjective adjective adjective (etc.) noun verb complement.

6. Consider this example: premature COPD-related death. Death is the noun and premature COPD-related are the adjectives that describe it. Translation: morte prematura associata al COPD (Chronic Obstructive Pulmonary Disease) 7. Break a long and complex sentence into “information blocks.” Use articles, conjunctions, prepositions, and punctuation to do this. Consider this example: Chronic cough and sputum production are independently associated with more frequent exacerbations and increased risk of hospitalization. 8. Unit 5 of this textbook provides practice on syntax strategies.

THE DOCTOR IS IN

Grammar to go! Good news! The grammar you encounter in the scientific literature is quite limited, so you need to know just a few English grammar points if you only read. On top of that, remember that you don’t need to produce English, only recognize it. Remember that, always, and relax! You’re here to learn how to read better, faster, and more, not to learn how to write, speak, or listen. Remember what your objective is – reading – and relax! It’s really not that hard, once you’ve learned a few tricks. VERB TENSES

In the scientific literature you will find only 3 or 4 verb tenses, generally the Present Simple, the Past Simple, the Present Perfect, and the Future. You will also find two or three ways to express possibility/ probability. Remember that you only have to recognize the verb tenses, not produce them. It is very important that you bear this in mind – it will keep you relaxed and keep you in the game. Relax! You will see that it’s not that hard! 1. The Present Simple is used to express habitual action, state, or condition. • Breast cancer and prostate cancer account for 26% of all cancers in the United States. 2. The Past Simple is used to express completed action, with time defined. • In 1980, a white man’s lifetime risk of prostate cancer was 1 in 116.

February 1

3. The Present Perfect Simple is used to express an action that started in the past and that is still happening. Time is not defined, and action is not completed. The Present Perfect Simple is often used with the expression so far (finora). • Two decades of screening have resulted in a significant increase in detection of early cancers. • Screening for both cancers has been promoted on the assumption that… Compare • Yesterday I went to the cinema. (past, completed action, time specified) • I have been to the cinema 4 times so far this month. (present, incomplete action) 4. Will + infinitive is used to express the future. • Its effectiveness will be tested. 5. May + infinitive expresses possibility. • The risk of dementia may be higher. 6. Might + infinitive is the same as “may”. • The risk of dementia might be higher. 7. Would + infinitive is used in a conditional phrase. • An extensive prevention program would reduce treatment-associated costs.

Today

= I went to the cinema yesterday. = I have been to the cinema 4 times so far this month.

February 28

Syntax

8. Could + infinitive is the past, the conditional, and the subjunctive form of “can”. • An extensive prevention program could lead to lower treatment-associated costs.

and thus easy to learn! (There is a list of irregular verb paradigms at the back of this textbook!) MORE ABOUT VERBS!

9. Should + infinitive is used to recommend or give advice. • New approaches for screening and prevention should be considered. Relax! Remember that you just have to recognize the verb tenses, not produce them. GOOD NEWS!

1. In the scientific literature, the verb To Be is generally used only in the third person, singular or plural. Present Simple • The study is… • The results are… Past Simple • The study was • The patients were … Present Perfect Simple • The research has been … • The results have been … Future • The study will be … 2. The Passive voice is very common in English! To BE + past participle • Sixteen studies were identified. 3. Regular verbs end in -ed in the past simple and past participle. Remember that past participles are often used as adjectives. NOT BAD NEWS!

Irregular verbs must be memorized. The good news is that they are very common

1. The -ing form is used as a verb (present participle) in continuous tenses and as a noun (gerund). • She is studying to become a doctor. • Reading is one of my favorite activities. 2. The infinitive with to is used to express the purpose of an action. • I went to the market to buy some apples. ONE LAST THING ABOUT VERBS

Verbs are your friends. When you find a very complex sentence and you start to panic and want to quit reading, look for the verb! The verb is the pivot of the sentence. Find the verb, get oriented, and everything will become much easier. NOUNS

1. In English, nouns have no gender. This is good news! 2. The definite article in English is the, in the singular and plural forms. 3. The indefinite article in English is a/an. 4. In English regular nouns have a final “s” in the plural form, with only 5 exceptions you need to know: 1. man – men 2. woman – women 3. child – children 4. foot – feet 5. tooth – teeth

THE DOCTOR IS IN

5. The possessive form in English (the ‘Saxon genitive’) is • ……’s in the singular • …..s’ in the plural Irregular plural nouns: The children’s dog

EXPRESSING QUANTITY

1. little/few – poco/pochi 2. comparative/superlative forms: • little – less – the least • few – fewer – the fewest 3. much/many – molto/molti 4. comparative/superlative forms: • much/many – more – the most

ADJECTIVES AND ADVERBS

old interesting good/well bad/badly far quickly

comparative older than more interesting than better than worse than farther than more quickly

A final word As you can see, you don’t need to know a lot of grammar to read a scientific text in English. The more you read in English, the easier it becomes. Keep reading. Keep practicing. It’s like practicing the piano – not necessarily interesting or fun but absolutely essential if you want to play really well. Practice makes perfect.

superlative the oldest the most interesting the best the worst the farthest the most quickly

Do all 20 units of this textbook, plus the ‘Extra reading’ section. Check your answers to the exercises with the Answer Key at the back of the textbook. When you’ve finished all of the units in this textbook you will find that reading the scientific literature in English has become a lot easier, more gratifying, and maybe even fun!

Text 1

Why read this paper? • Because it is relevant to my work? • Because my colleagues/chief asked me to? • Because I’m curious about the topic? • Because I want to increase my general knowledge? • Because I’m looking for some specific information? • Because I want to confirm what I already know? • Other reasons?

BEFORE YOU READ

Vocabulary practice Exercise 1. Match the English word with its translation

1. affect

2. aging

_____

3. background _____ 4. compared with _____ 5. decline

_____

a) rispetto a, paragonato a b) calo, diminuzione c) invecchiamento d) incidere su, influire e) sfondo, premessa

THE DOCTOR IS IN

Exercise 2. As above.

1. double

_____

a) necessario

2. effort

_____

b) spiegare

3. explain

_____

c) raddoppiare

4. increase

_____

d) sforzo

5. needed

_____

e) aumento

Exercise 3. As above.

1. old

_____

a) ictus

2. purpose

_____

b) scopo

3. stroke

_____

c) senza

4. survival

_____

d) vecchio

5. without

_____

e) sopravvivenza

Exercise 4. Complete the chart.

ce is When a senten plex, m co d an ng lo . Use find the verb this as your t to reference poin ect bj su e th identify and the complement.

Noun 1 comparison

Verb compare

explain

3 increase

________________

_______________

identify

_______________

reduce

6 survival

________________

Exercise 5. What is the opposite of:

1. 2. 3. 4. d in a s t wo r The la s the noun; i before series words ves e th l l a adjecti it are they are f i n (eve )! n ou n s

_______________

go? increase? more? old?

come/stop ________________ ________________ ________________

Exercise 6. Look at the footnotes on p. 19

for new vocabulary.

GRAMMAR TO GO! 1. A final “s” is EITHER a verb, thirdperson singular, present simple (A history of stroke doubles the risk …) OR a plural noun (efforts). 2. Regular verbs end in -ed in the Past Simple and past participle. Remember that past participles are often used as adjectives. implicated – implicato characterized – caratterizzato conducted – condotto conferred – conferito identified – identificato 3. Irregular verbs must be memorized. The good news is that they are very common and thus easy to learn! 4. To BE – third-person singular/plural: is/are – present simple was/were – past simple 5. Passive voice (very common in English!) – To BE + past participle Sixteen studies were identified. Sono stati identificati 16 studi. 6. May + infinitive expresses possibility. The risk of dementia may be higher. Il rischio di demenza potrebbe essere più alto. 7. Will + infinitive expresses future. The incidence of stroke will affect the incidence of … L’incidenza di ictus influirà sull’incidenza di … 8. Basic English sentence structure: subject + verb + complement We conducted a systematic review. Abbiamo condotto una revisione sistematica. 9. Basic English sentence structure: adjective + adjective + adjective (etc.) + noun … cardiovascular risk factors… … prestroke cognitive decline…

Text

READ Exercise 1. Scan the text to find this information.

1. What journal published this paper? Stroke. 2. When was it published? 3. What kind of text is this? (Abstract? Editorial? Full text paper? Other?) 4. Who are the authors of this paper? 5. What institution are they affiliated with?

6. Why was the study conducted? (Aim/Objective/Purpose) 7. What kind of study was conducted? (Design/Methods) (Consult pp. 171-173 of this textbook for explanations of study designs.)

Knowing how is organized a text lets find the spec you ific information yo looking for qu u’re ickly.

8. Where were the original studies conducted? (Methods/Results) 9. How many studies were reviewed? (Methods/Results)

community setting – nel contesto della comunità (non in un ospedale); with time – nel tempo; those – coloro (pazienti); at this time of – in quest’epoca di; to what extent – fino a che punto.

THE DOCTOR IS IN

AFTER YOU READ Exercise 1. True, False, or Not Clear, based on this study?

1. Little is known about the excess risk of dementia in stroke patients. 2. The authors systematically reviewed studies that compared the risk of incident dementia in stroke patients with that in subjects without stroke. 3. All of the studies in the review were conducted in a healthcare setting. 4. All of the subjects enrolled in the studies reviewed were aged ⭓ 65. 5. All of the subjects (stroke and nonstroke) in the studies reviewed were matched for age and sex. 6. Older stroke patients have twice the risk of incident dementia than the general population the same age. 7. The excess risk of incident dementia decreases after the age of 85.

8. Based on the results of the studies reviewed, common risk factors do not explain the effect of stroke on dementia incidence in the population. 9. Stroke patients survive longer now than in the past. 10. The authors conclude that reducing incidence of stroke will not reduce the incidence of dementia.

Exercise 2. Reflection

• What have I learned by reading this paper? • Is the information provided clear? • Is the information provided complete? • Can I “take home” any of the information in this paper? • What is my opinion on the study and its conclusions? • Am I curious or interested enough to read the full text paper?

Text 2

Why read this paper? BEFORE YOU READ • Because it is relevant to my work? • Because my colleagues/chief asked me to? • Because I’m curious about the topic? • Because I want to increase my general knowledge? • Because I’m looking for some specific information? • Because I want to confirm what I already know?

Vocabulary practice Exercise 1. Match the English word with its translation

1. 2. 3. 4. 5.

account for anticipate beneficial breast burden

__d__ _____ _____ _____ _____

a) prevedere b) carico, peso c) seno, mammella d) rappresentare e) benefico

THE DOCTOR IS IN

Exercise 2. As above.

1. chance 2. change 3. decade 4. detection 5. disease

_____ a) riscontro, rilevamento _____ b) patologia _____ c) possibilità, occasione _____ d) cambiamento _____ e) decennio

Exercise 3. As above.

1. early 2. estimate

_____ a) crescere, aumentare _____ b) esito, prognosi

3. grow 4. outcome 5. overall

_____ c) presto, precoce _____ d) globale, complessivo _____ e) stima

Exercise 4. As above.

1. 2. 3. 4.

previously promote rate reduce

_____ _____ _____ _____

a) in precedenza b) ridurre c) notevole d) promuovere, favorire 5. remarkable _____ e) tasso; percentuale

Exercise 5. Complete the chart.

1. 2. 3. 4. 5. 6.

Infinitive be grow

Past simple was/were

Meaning essere

had made think potere

Exercise 6. Complete the chart.

Noun Verb 1. observation observe

Meaning osservare

2. assumption

———— ——————

3. detection

———— ——————

4. ————–

estimate

——————

5. explanation ———— —————— 6. increase

———— ——————

7. introduction ———— —————— 8. prevention

———— ——————

9. screening

———— ——————

10. testing

———— ——————

11. treatment

———— ——————

Past participle been

Exercise 7. Look at the footnotes on p. 24 for new vocabulary.

Text

GRAMMAR TO GO!

Verb tenses 1. Should + infinitive: used to recommend, give advice. New approaches for screening, early detection, and prevention for both diseases should be considered. 2. The Present Simple: used to express habitual action, state, or condition. Breast cancer and prostate cancer account for 26% of all cancers in the United States. 3. The Past Simple: used to express completed action, with time defined. In 1980, a white manâ&#x20AC;&#x2122;s lifetime risk of prostate cancer was 1 in 116. 4. The Present Perfect Simple: used to express an action that started in the past and that is still happening or when time is not defined, and action is not completed. N.B.This is a present tense in English, not a past tense! Two decades of screening have resulted in a significant increase in detection of early cancers. Screening for both cancers has been promoted on the assumption thatâ&#x20AC;Ś COMPARE: the Simple Past and the Present Perfect Simple: A. Yesterday I went to the cinema. B. I have been to the cinema 3 times this month. A. I bought a new book last weekend. B. I have bought 5 books so far this year. A. I spoke to my mother yesterday evening. B. I have spoken to my mother every evening this week.

2 Exercise 1. Do the verbs in these sentences refer to a past, completed action/state/condition (PS), or to an action/state/condition that is still true/still happening (PPS)?

1. The incidence of these cancers increased after the introduction of screening in 1980. 2. The incidence of these cancers has never returned to prescreening levels. 3. Screening has been promoted as the best way to reduce disease-associated morbidity and mortality. 4. Two decades of screening have resulted in a significant increase in detection of early cancers. 5. Prostate-specific antigen testing has nearly doubled the chance that a man will be diagnosed with prostate cancer in his lifetime.

Exercise 2. Translate these sentences.

Simplify you r life! Is the action fi nis or still happe hed ning? To read, you only have to unde rstand verb forms, not construct th em !

THE DOCTOR IS IN

Rethinking – ripensare, riprogettare; burden – peso, carico; breast – seno, mammella.

Text

READ

AFTER YOU READ

Exercise 1. Scan the text to find this information.

Exercise 1. True, False, or Not Clear, based on this study?

1. What journal published this paper? JAMA 2. When was it published? 3. What kind of text is this? (An Abstract? Editorial? Full text paper?) 4. Who are the authors of this paper? 5. What institution are they affiliated with? 6. When were breast and prostate screening (probably) introduced in the U.S.A.? 7. What percentage of all cancers in the U.S.A. is made up of breast cancer and prostate cancer? 8. What percentage of at-risk American men has a routine PSA test? 9. What percentage of American women aged > 40 years has reported recently having a mammogram? 10. What is a white American man’s lifetime risk of prostate cancer? 11. What was it in 1980? 12. What is an American woman’s lifetime risk of breast cancer? 13. What was it in 1980?

1. The authors are suggesting that current breast and prostate cancer screening programs do not reduce cancer morbidity and mortality. 2. The authors suggest three ways to improve current breast and prostate cancer screening programs. 3. Localized breast cancer has a better outcome than localized prostate cancer. 4. Screening has been promoted as a way to prevent breast/prostate cancer. 5. Breast and prostate cancer screening programs in the U.S.A. are free.

Exercise 2: Reflection

Text 3

Vocabulary practice Exercise 1. True or False? If False, write the correct Italian translation.

1. account for = commercialista? False – rappresentare 2. assess = assessore? _______________________________________

• Because I want to confirm what I already know?

3. background = sfondo?

• Other reasons?

_______________________________________

THE DOCTOR IS IN

4. both = barca? _______________________________________

6. death = morire? _______________________________________

1. 2. 3. 4. 5. 6.

7. health = sano? _______________________________________

Exercise 4. Complete the chart.

8. however = sebbene? _______________________________________

Noun Verb 1 association associate

9. husband = marito? _______________________________________

2 assess

5. causal = casuale? _______________________________________

10. increasing = crescente? _______________________________________ 11. predispose = favorire? _______________________________________

When a sentence is long and complex, find the verb. Use this as your reference point to identify the subject and the complement.

12. put = mettere, porre? _______________________________________ 13. second-hand = di seconda mano? _______________________________________ 14. should = dovrebbe? _______________________________________ 15. smoking = fumante? _______________________________________

Exercise 2. Match the English word with its translation d long an Break a sentence x comple tion nforma into “i cks.” blo cles, Use arti ons, ti c n ju con tions, preposi ation nctu and pu this. d to o

Exercise 3. What is the opposite of:

1. 2. 3. 4.

baseline __c__ development _____ elderly _____ household _____

5. lung 6. therefore 7. through

a) perciò b) attraverso c) inizio d) ambiente domestico _____ e) sviluppo _____ f) anziano _____ g) polmone

active? death? elderly? female? increased? wide?

passive ______________ ______________ ______________ ______________ ______________

Meaning associare

———— ——————

3 development ———— —————— 4 ————–

enroll

——————

5 exposure

———— ——————

6 ————–

predispose ——————

7 smoking

———— ——————

Exercise 5. Look at the footnotes on p. 29 for new vocabulary.

Syntax practice Exercise 1. Translate these sentences into Italian.

1. Five thousand females were enrolled in the study. 2. The relationship between passive smoking and the development of TB was assessed with adjustment for other baseline characteristics. 3. Increasing evidence has incriminated active smoking as a causal factor for tuberculosis (TB). 4. Passive exposure to secondhand tobacco smoke in the household was independently associated with obstructive lung disease. 5. The effect of secondhand tobacco smoke exposure on TB has not been elucidated.

Text

READ Exercise 1. Scan the text and find this information.

1. What journal published this paper? 2. When was it published? 3. What kind of text is this? (An Abstract? Editorial? Full text paper?)

4. 5. 6. 7.

Who are the authors of this paper? Why was the study conducted? What kind of study was conducted? How many subjects participated in the study? 8. What were the inclusion criteria? 9. What was the study setting?

secondhand (tobacco) smoke – fumo passivo; never-smokers – persone che non hanno mai fumato; territory-wide – territoriale

THE DOCTOR IS IN

AFTER YOU READ Exercise 1. True, False, or Not Clear, based on this study?

1. Smoking has been identified as a factor for TB. 2. TB incidence is increasing in China. 3. In Hong Kong more men than women smoke. 4. Almost 16 thousand middle-aged women resident in Hong Kong were enrolled in the study. 5. Obstructive lung disease and diabetes mellitus were associated with secondhand smoke exposure. 6. Almost 14% of study subjects had active TB accounted for by secondhand smoke.

7. Passive smoking is as dangerous as active smoking, in terms of health risks. 8. National TB programs in Hong Kong emphasize the risk of passive smoking.

Exercise 2: Reflection

Text 4

Vocabulary practice Exercise 1. What is a synonym for:

1. evaluate?

assess

2. prior to?

——————————

3. prove?

——————————

4. purpose?

——————————

5. rising?

——————————

THE DOCTOR IS IN

Exercise 2. Match the English word with its translation

1. 2. 3. 4.

advances grant shift surgical

5. thickness

the Do noT guess xt meaning of te organizers! Keep this list ata di handy (a port u’re yo n mano) whe fer re d an g in ad re n he w it to necessary.

__c__ _____ _____ _____

_____

a) chirurgico b) spessore c) progressi d) movimento (laterale); spostamento e) concedere

Exercise 3. As above.

1. 2. 3. 4. 5.

timing toward undergo whether yield

_____ _____ _____ _____ _____

a) sottoporre b) verso c) produrre d) se e) tempistica

Text organizers ADDING INFORMATION

• furthermore • moreover • what’s more LOGICAL RELATION

• • • • •

good? more? women? younger?

bad —————————— —————————— ——————————

hence as since therefore thus

perciò poiché poiché perciò perciò

CONTRAST

• • • • •

Exercise 4. What is the opposite of:

1. 2. 3. 4.

inoltre inoltre inoltre

• • • • •

although/though despite/in spite of even though however nevertheless/ nonetheless regardless of still whereas while whilst

sebbene nonostante anche se tuttavia tuttavia nonostante tuttavia mentre mentre mentre

GIVING EXAMPLES Exercise 5. Complete the chart.

1. 2. 3. 4. 5. 6. 7.

Noun change diagnosis evaluation ———— reduction surgery ————

Verb Meaning change cambiamento ———— —————— ———— —————— perform —————— ———— —————— ———— —————— mean ——————

Exercise 6. Look at the footnotes on p. 34 for new vocabulary

• for instance • like • such as

ad esempio come, ad esempio come, ad esempio

t idea! cellen An ex copy this Photo efer to it d r list an you read! n e h w

Text

GRAMMAR TO GO!

READ

Verb forms

Exercise 1. Scan the text and find this information.

1. The -ing form: used as a verb (present participle) in continuous tenses and as a noun (gerund).

She is studying to become a doctor. (sta studiando …) Reading is one of my favorite activities. (la lettura …) 2. The infinitive with “to”: used to express the purpose of an action.

I went to the market to buy some apples. (per comprare)

1. What journal published this paper? 2. When was it published? 3. What kind of text is this? (An Abstract? Editorial? Full text paper?) 4. Who are the authors of this paper? 5. What institution are they affiliated with? 6. Why was the study conducted? 7. What kind of study was conducted? 8. How many subjects participated in the study? 9. What were the inclusion criteria? 10. Were there any exclusion criteria?

Expressing quantity 1. little = poco: used for uncountable nouns.

She has little time for her hobbies. (poco tempo) 2. few = pochi: used for countable nouns.

She has few friends. (pochi amici) 3. comparative/superlative forms:

little – less – the least few – fewer – the fewest 4. much = molto: used for uncountable nouns, usually in the negative and interrogative forms.

She doesn’t have much time for her hobbies. (non molto tempo) 5. many = molti: used for countable nouns, usually in the negative and interrogative forms.

She doesn’t have many friends. (non molti amici) 6. comparative/superlative forms:

AFTER READ Exercise 1: True, False, or Not Clear, based on this study?

1. This was a prospective cohort study. 2. The findings are statistically significant. 3. There are two declared aims of the study. 4. The records of almost one thousand patients were examined. 5. The average age of the female subjects was nearly 40 years. 6. The average age of the male subjects was just over 50 years. 7. The authors reviewed five different kinds of reports, including CT, pathology, and surgery reports. 8. Significantly more preoperative CTs were performed in 2007 than in 1998. 9. More women ≤45 years underwent an appendectomy in 2007 than did in 1998. 10. The association of this finding to CT use cannot be demonstrated.

much/many – more – the most

THE DOCTOR IS IN

waiver – rinuncia a un diritto; HIPAA – Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding the privacy of medical records

Text Exercise 2: Reflection

Just for fun! Which is correct, make or do?

1. make a diagnosis fare una diagnosi 2. ______ laboratory tests fare esami di laboratorio 3. ______ a house call fare una visita a domicilio 4. ______ a mistake sbagliare 5. ______ a CT fare/eseguire una TAC 6. ______ rounds fare la visita di reparto 7. ______ an operation eseguire un intervento

Text 5

Vocabulary practice Exercise 1. Choose the correct translation for each word.

1. month a) mese 2. as a) come 3. collect a) raccogliere 4. implement a) iniziare

b) bocca b) perciò b) collegare b) attuare

THE DOCTOR IS IN

5. improve a) provare 6. mean a) media 7. measure a) misurazione 8. measurement a) misurazione 9. safety a) certezza 10. setting a) impostare 11. substantially a) sostanzialmente 12. sustain a) mantenere

b) migliorare b) significato b) misura, parametro b) misura b) incolumità b) contesto b) in modo significativo b) dichiarare

Exercise 2. Match the English word with its translation.

If you don’t know what a word means, look at its prefix/ suffix/ending, as well as its position in the sentence. Knowing if a word is a verb, noun, adjective, or adverb can help you infer its meaning from the context.

1. achieve __d__ a) cambiamento 2. bloodstream _____ b) ampio 3. broad _____ c) sangue; circolo ematico 4. change _____ d) raggiungere un obiettivo 5. median _____ e) mediana 6. main _____ f) esito 7. mean _____ g) media 8. outcome _____ h) tasso 9. rate _____ i) chi investe o ha interessi in un progetto 10. stakeholder _____ l) principale

Exercise 3. For each blank, choose the correct word from the options given.

1. Objectives: _____ (a) the extent to which intensive care units participating in the initial Keystone ICU project sustained _____ (b) in rates of catheter related bloodstream _____ (c). (a) to evaluate/evaluation (b) reduce/reductions (c) infects/infections

2. Design: _____(a) cohort study to _____(b) and evaluate _____(c) to improve patients’ safety. (a) collaboration/collaborative (b) implement/implementation (c) interventions/intervened 3. During the _____ (a) period, the mean bloodstream _____ (b) rate did not significantly _____ (c) from the initial 18 month post-implementation period (–1%, 95% confidence interval –9% to 7%). (a) sustain/sustainability (b) infect/infection (c) to change/change

Exercise 4. Based on the ending, what kind of word is missing, Verb, Noun, Adverb, or Adjective?

• The reduced rates of infection were (1) __ ed for an additional 18 months. • Intensive care unit teams were (2) ___ed to integrate this intervention into staff (3) ___tion, collect (4) __ly data from hospital infection control staff, and report infection rates to appropriate (5)___s. • Ninety (87%) of the original 103 intensive care units (6) __ed, reporting 1532 intensive care unit (7) ___s of data and 300 310 catheter days during the (8) ___ability period. • Broad use of this (9) ___tion could (10) ____ly reduce morbidity. 1. 2. 3. 4. 5.

verb _____________ _____________ _____________ _____________

6. 7. 8. 9. 10.

_____________ _____________ _____________ _____________ _____________

Text

Syntax practice Step 1. Start with the original – and impossible! – sentence.

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study Step 2. Identify articles, propositions, conjunctions, and punctuation to form “information blocks.”

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

5 Step 2. Identify the main verb(s).

To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter relatedbloodstream infections. Step 3. Identify articles, propositions, conjunctions, and punctuation to form “information blocks.”

To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Step 4. Translate each information block.

Step 3. Translate each information block.

• Sustaining reductions in: mantenere stabili le riduzioni in • catheter related bloodstream infections in: infezioni del sangue associate al catetere in • Michigan intensive care units: unità di terapia intensiva nel Michigan • observational study: uno studio osservazionale Step 4. Reconstruct the translated sentence.

Mantenere stabili le riduzioni delle infezioni del sangue associate al catetere nelle unità di terapia intensiva nel Michigan: uno studio osservazionale. E voilà! Step 1. Start with the original – and impossible! – sentence.

To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related-bloodstream infections.

• To evaluate: valutare • the extent to which: fino a che punto • intensive care units participating in the: unità di terapia intensiva partecipanti nel • initial Keystone ICU project: progetto Keystone ICU iniziale • sustained reductions in: mantennero stabili le riduzioni in • rates of: tassi di • catheter-related bloodstream infections: infezioni del sangue associate al catetere. Step 5. Reconstruct the translated sentence.

Valutare fino a che punto le unità di terapia intensiva partecipanti al progetto iniziale “Keystone ICU” mantennero stabili le riduzioni dei tassi di infezioni del sangue associate all’uso del catetere. E voilà!

THE DOCTOR IS IN

Text

READ

AFTER YOU READ

Exercise 1. Scan the text and find this information.

Exercise 1. True, False, or Not Clear, based on this study?

1. What journal published this paper? 2. When was it published? 3. What kind of text is this? (An Abstract? Editorial? Full text paper?) 4. Who are the authors of the paper? 5. What institution are they affiliated with? 6. Why was the study conducted? 7. What kind of study was conducted? 8. How many subjects participated in the study? 9. What were the main outcome measures?

1. This paper reports on the initial Keystone ICU project. 2. Almost 90% of the ICUs in Michigan participated in this study. 3. The initial Keystone ICU project lasted eighteen months. 4. Only one clinical problem was examined in this project. 5. ICUs participating in the project implemented a 6-step intervention. 6. This paper reports that the intervention’s positive results last over time. 7. The authors suggest that this intervention can reduce morbidity and costs related to catheter-related bloodstream infections.

Exercise 2. Complete this chart with the data reported in the text.

Infection rates Mean Median Interquartile range Incidence rate ratio Range

Baseline

16-18 months

34-36 months

7.7

1.3

1.1

Exercise 3. Reflection

Text 6 - Vocabulary review Texts 1-5

Exercise 1. Choose the correct word.

1. The purpose of this study was to __a__ the effectiveness of a new therapy. a. assess

b. assessment

c. assesses

d. assessed

2. A cancer registry _____ data on incidence of tumors. a. collection

b. collecting

c. collect

d. collects

b. detects

c. detected

d. detection

c. Enroll

d. Enrollment

c. evaluates

d. evaluate

3. No change was _____. a. detect

4. _____ in the study was very low. a. To enroll

b. Enrolled

5. All clinical parameters were _____. a. evaluation

b. evaluated

6. No patient showed any _____ after treatment. a. improve

b. improved

c. improving

d. improvement

7. Researchers found that ______ of new guidelines was difficult. a. to implement

b. implemented

c. implementation d. implements

8. The incidence rates were _____ using usual statistical models. a. to measure

b. measurable

c. measure

d. measured

9. The thoracic surgery team _____ 15 operations. a. perform

b. performed

c. performance

d. to perform

10. The study showed a _____ in baseline values. a. reduction

b. reduces

c. reducible

d. reduced

THE DOCTOR IS IN

Exercise 2. Complete the chart.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Infinitive be come do drink eat find go grow have know make put read think understand write

Past simple was/were

Past participle been

Meaning essere

Exercise 3. Choose the synonym.

1. anticipate 2. baseline 3. disease 4. elderly 5. main 6. outcome 7. prove 8. purpose 9. setting 10. woman

expect/move basic/start illness/health middle-aged/old primary/secondary demonstration/result demonstrate/attempt aim/proposal background/context female/male

Exercise 4. True or False? If False, write the correct translation.

1. 2. 3. 4. 5. 6.

achieve = starnutire affect = affettare as = asino breast = mammella burden = uccello develop = disegnare

â&#x20AC;&#x201D; Fâ&#x20AC;&#x201D;-

portare a termine, conseguire

Text

Exercise 5. Complete the text using one of the words in the box.

despite

enrollment is associated may

median months reduces women

is associated

THE DOCTOR IS IN

you Don’T panic if a at wh ow don’t kn word means. e not all words ar L IA nT eSSe ng, to understandi ten of n ca u and yo the infer (intuire) meaning t. from the contex

Exercise 6. Do you know what the highlighted words mean? Are they essential (E) or non-essential (N-E) to understanding the text?

kidney __E__ disorder ____

injury ____ however ____

relies on ____ still ____

Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD005426. DOI: 10.1002/14651858.CD005426.pub2.

[Intervention Review]

Nutritional support for acute kidney injury Yi Li2, Xi Tang2, Juqian Zhang2, Taixiang Wu1 1 Chinese Cochrane Centre, Chinese EBM Centre, West China Hospital, Sichuan University, Chengdu, China. 2 Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China

Abstract Background Treatment for acute kidney Injury (AKI) primarily relies on treating the underlying cause and maintaining the

tionary se a dic onLY u rd is o w e when th TIAL. n e S eS use a Do noT hen the ry w dictiona T essential. no is d r o w e word Circle th tinue and con g! readin

underlying ____

Further ____

recover ____

reliable ____

patient until kidney function has recovered. Enteral and parenteral nutrition are commonly used to treat nutritional disorders in AKI patients, however their efficacy in treating AKI are still debated. … Authors’ conclusions There is not enough evidence to support the effectiveness of nutritional support for AKI. Further high quality studies are required to provide reliable evidence of the effect and safety of nutritional support. Copyright © 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Exercise 7. What do you think these words mean, based on the context?

kidney ________

injury ________

recover ________

disorder ________

Further ________

reliable ________

relies on ________ however ________

underlying ________ still ________

Exercise 8. Consult the glossary at the back of this book only for the words that you have marked Essential, then re-read the text. Has your comprehension improved 100%? 50%? 20%?

Text

CROSSWORD Write the Italian translation for these English words in the squares.

2 3 4

Across 1. early 3. good 6. therefore 11. through 12. should 13. sustain 15. women 17. without 20. increasing 21. health 22. long 23. grant 24. treat 25. timing 28. diagnose 30. overall

5 6

7 8 10

9 11 12

15 16

Down 1. lung 2. undergo 4. survive 5. shift 7. safety 8. surgery 9. causal 10. grow 12. findings 14. compared to 16. prior to 18. yield 19. wide 26. leave 27. female 29. stroke

THE DOCTOR IS IN

ht” or There is no “rig only y, eg at str ” ng “wro ” ve cti “effe e.” or “not effectiv evidence-based learning: for do what works you!

Tips and strategies for learning vocabulary

1. Flashcards – ‘5 x 5 x 5’ = 5 cards,

Vocabulary can be divided into three categories: words you know, new words, and “vaguely familiar words.” Generally, words in this third group are the words you have to study. The question, of course, is how?

• Use 1 flashcard per word. • Write the English word on one side and the Italian word on the other side. • Repeat, repeat, repeat! From English to Italian, from Italian to English. Repeat, repeat, repeat! Five times a day for five days! Repeat, repeat, repeat! • Always keep your flashcards with you – in your pocket, in your bag, on your desk… Ask a friend, colleague or family member to test you! • Remember that your objective (for reading) is only to recognize the word, not to write it or say it. Don’t worry about spelling or pronunciation! • When you have learned these five words, start with a new group of five words.

Look at these 15 words. Which are useful for you personally? Which words do you need to learn? (There is no correct answer – the choice is subjective!) Invest your time and energy in what is USefUL! Study onLY those words that are useful to you and your work/life.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

cingolo della spalla miopia sangue cartella clinica rilevare chirurgia vescica pressione arteriosa dato preliminare esito erogazione cute diffusione (di una malattia) sottoporre articolazione

5 times a day, for 5 days!

2. Sticky notes (Post-it®)

Use sticky notes instead of flashcards. Put a sticky note on your computer screen, on the door to your office, on a wall, on the bathroom mirror – anywhere you can see it all day, every day! N.B. It’s better not to stick the sticky notes all in the same place. Distribute them around your office or home. This will help your memory! 3. Crib sheets

words nly the Study o nd difficult fi that you member. to re that strategy Use any ding easier ea makes r faster! and

What do the following 10 words mean? Learn the words you do not remember – they are all useful words! N.B. Do not use the glossary to do this exercise!

These are the indispensable bigliettini that students use during exams! For example, cut out the list of text organizers in Text 4 (p. 32) and refer to it when you read. 4. Associations

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

assess available detect doctor physician heart outcome likely finding wide

Associating a difficult word with an image, another word, or even a sound, can be very helpful. 5. Vocabulary notebooks

Vocabulary notebooks can be organized alphabetically – from English to Italian or from Italian to English – or chronologically. Chronological order creates a “context,” which can be helpful.

Text

For example, let’s say that you want to learn the highlighted words in the text below. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007169. DOI: 10.1002/14651858.CD007169.pub2.

[Intervention Review] Music therapy for end-of-life care Joke Bradt1, Cheryl Dileo2. 1The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia, USA. 2Department of Music Therapy and The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, Philadelphia,USA

Write them on the same page in your vocabulary notebook. It’s a good idea to write the title of the article at the top of the page, and the date you read this article.

Read regula rly.

• relieve – dare sollievo • address – trattare; porre l’attenzione • caregiver – colui che si occupa di un malato • cope – fare fronte a (psicologicamente) • grief – dolore, angoscia, pena • bereavement – lutto

ABSTRACT Background Music therapy in end-of-life care aims to improve a person’s quality of life by helping relieve symptoms, addressing psychological needs, offering support, facilitating communication, and meeting spiritual needs. In addition, music therapists assist family and caregivers with coping, communication, and grief/bereavement.

The more yo u read, the easier it becomes. Practice mak es perfect!

Text 7

Vocabulary practice Exercise 1. Match the English word with its translation.

1. acknowledgement 2. address 3. award 4. between 5. blinded

__c__ a. in cieco _____ b. tra _____ c. riconoscimento; ringraziamenti _____ d. indirizzo _____ e. premio

THE DOCTOR IS IN

Exercise 2. As above.

1. disclose 2. draft 3. expertise 4. likelihood 5. grant

_____ a. redigere _____ b. probabilitĂ _____ c. competenza â&#x20AC;&#x153;da espertoâ&#x20AC;? _____ d. finanziamento _____ e. dichiarare

Exercise 3. As above.

1. 2. 3. 4. 5.

major _____ pooled _____ reprint _____ source _____ surveillance _____

a. fonte b. raggruppati c. principale; grave d. sorveglianza e. ristampa

Exercise 4. As above.

1. thank 2. 3. 4. 5.

under well widely within

_____ a. diffusamente, comunemente _____ b. entro _____ c. ringraziare _____ d. sotto _____ e. bene

Exercise 5. How do you say these words in English?

1. 2. 3. 4. 5.

morte valutare esito eseguire chirurgia

de a t h e __ __ __ __ __ __ e o __ __ __ __ __ e p __ __ __ __ __ m s __ __ __ __ __ y

READ Exercise 1. Scan the text and find this information.

1. What journal published this paper? 2. When was it published? 3. What kind of text is this? (An Abstract? Editorial? Full text paper?) 4. What is a systematic review? (see Appendix) 5. Who are the authors of this paper? 6. What data sources did the authors use? 7. How were studies selected? 8. How many studies were reviewed? 9. What was the primary funding source? 10. Was there any potential conflict of interest? 11. Which author(s) were responsible for conception and design? 12. Which author(s) drafted this article? 13. Who provided administrative, technical, or logistic support? 14. Who collected and assembled the data?

Text

AFTER YOU READ Exercise 1. True, False, or Not Clear, based on this study?

1. This systematic review reports on the ability of RCRI to evaluate cardiac complications. 2. This systematic review examines the records of almost 800 thousand cardiac patients.

3. Major cardiac complications were defined as cardiac death, myocardial infarction, or nonfatal cardiac arrest. 4. The authors of this SR state that the studies they reviewed were not of very good quality. 5. The authors conclude that the RCRI is useful in predicting mortality after vascular noncardiac surgery.

THE DOCTOR IS IN

Exercise 2. Complete this chart with the data reported in the text. RCRI PREDICTION OF CARDIAC EVENTS

After mixed noncardiac surgery high vs low risk pts. AUC curve

0.65

C.I.

After vascular noncardiac surgery high vs low risk pts.

C.I.

0.46-0.81

Sensitivity Specificity

bject to ts are su ally Abstrac (u mits su word li rds). The w 250 o on they ti informa therefore is e provid ssarily not nece clear!... or complete

Positive likelihood ratio Negative likelihood ratio Exercise 3. Which is true for you?

Exercise 4. Reflection

• I understand the data provided in this Abstract. • I don’t understand the data provided in this Abstract and I need to consult the Tables in the full text paper. (Consult pp 173-175 of this textbook.)

...Alwa y Results s consult th e s full te ection of the xt pap e r f or compl inform ete data ation an interp retatio d n.

Text 8

Vocabulary practice Exercise 1. Match the English word with its Italian translation.

1. 2. 3. 4. 5. 6. 7.

closely common cough children occur length delay

__c__ _____ _____ _____ _____ _____ _____

a. bambini b. avvenire c. attentamente d. lieve e. comparsa, inizio f. frequente g. mediana

THE DOCTOR IS IN

8. median 9. mild 10. onset

_____ h. durata _____ i. ritardo _____ j. tosse

Exercise 2. How do you say the following in English?

Don’t forget! adjective + adjective + adjective (etc.) + noun

ile you otes wh Take n Underline, te read! ht, wri highlig nts … comme idencean ev s i th is st practice! e b d base

1. entrambi 2. entro 3. età 4. febbre 5. gamma 6. malattia 7. maschio 8. patologia 9. premessa, contesto 10. scopo

b o th w __ __ __ __ n a __ e f __ __ __ r r __ __ __ e i__ __ __ __ __ s m __ __ e d __ __ __ __ __ e b __ __ __ __ __ __ __ __ d p __ __ __ __ __ e

Exercise 3. Complete the chart.

Noun 1. confirmation 2. ______________ 3. ______________ 4. ______________ 5. duration 6. incubation 7. infection 8. ______________ 9. ______________ 10. ______________

Verb confirm detect diagnose document ______________ ______________ ______________ observe occur treat

Exercise 4. Look at the footnotes on p. 57 for new vocabulary.

Syntax practice Translate the following noun phrases.

1. The clinical features of the disease Le caratteristiche cliniche della patologia 2. The most common symptoms __________________________________ 3. 2009 Pandemic Influenza A (H1N1) Virus Infection __________________________________ 4. Positive real-time RT-PCR test results __________________________________ 5. Beijing Institute of Respiratory Medicine __________________________________ 6. The Shanghai Public Health Clinical Center __________________________________ 7. Chinese Center for Disease Control and Prevention __________________________________

READ 1. Where was this article published? 2. When was it published? 3. Who are the authors of this paper? 4. What institution are they affiliated with? 5. What kind of text is this? (An Abstract? Editorial? Full text paper?) 6. Is the topic, as indicated in the title, relevant to your practice? 7. How many subjects were observed in this study? 8. What test was used to confirm infection? 9. What was the median incubation period of the virus? 10. How many independent risk factors did the authors identify?

Text

feature – caratteristica; subsequently – successivamente, in seguito; in whom – nelle quali; port of entry – luogo di prima assistenza (es. medico di famiglia, pronto soccorso o altro) shorten – accorciare; rendere più breve; administer – somministrare.

THE DOCTOR IS IN

AFTER YOU READ Exercise 1. Complete this chart based on the data provided in the text.

• • • • • • •

Total n. patients observed Percentage females Average incubation period Percentage of pts with fever Percentage of pts with cough Incidence of nausea Percentage of pts with lymphopenia • … which resolved by day • Percentage of adult pts with hypokalemia • Duration of fever

________ ________ ________ ________ ________ ________

Exercise 3. Reflection

________ ________ ________ ________

Exercise 2. True, False, or Not Clear, based on this study?

1. The pandemic influenza A (H1N1) was first seen in China in the spring of 2009. 2. Suspected cases of infection were admitted to hospital and put in quarantine. 3. This study observed patients admitted to hospitals located in 20 Northern provinces in China. 4. Over half of the patients in this study were treated with oseltamivir. 5. The average age of patients in this study was about 24 years. 6. Most of the patients in this study were female.

7. The least common symptom was nausea. 8. Most symptoms resolved by day 7. 9. Treatment with oseltamivir in the first two days of onset of symptoms was critical to reduced duration of infection. 10. Surveillance of the 2009 H1N1 flu resulted in fewer cases of infection.

Just for fun! Do you know these symptoms?

1. 2. 3. 4. 5.

achy dizzy faint sweaty weak

__e__ _____ _____ _____ _____

1. 2. 3. 4. 5.

a chest cough a drippy nose a headache a sore throat earache

a) sudato b) con vertigini c) debole, fiacco d) sentirsi mancare e) dolente

_____ _____ _____ _____ _____

a) mal di gola b) mal d’orecchio c) naso che cola d) mal di testa e) tosse grassa

Text 9

Why read this paper?

Think

• Because it is relevant to my work? • Because my colleagues/chief asked me to? • Because I’m curious about the topic? • Because I want to increase my general knowledge? • Because I’m looking for some specific information? • Because I want to confirm what I already know? • Other reasons?

• What do you know about telemedicine monitoring? • Do you think it could reduce mortality and complications in the ICU?

THE DOCTOR IS IN

Exercise 3. Complete the chart. XXX means there is no form.

BEFORE YOU READ

Vocabulary practice Exercise 1. Match the English word with its Italian translation.

1. 2. 3. 4. 5.

monitor length stay several increasingly

__b__ _____ _____ _____ _____

a. diversi b. monitorare c. sempre pi첫 d. durata e. degenza

1. 2. 3. 4. 5.

little assess design setting large

_____ _____ _____ _____ _____

a. contesto b. grande, ampio c. poco d. valutare e. disegno

1. 2. 3. 4. 5.

illness main outcome measure only

_____ _____ _____ _____ _____

a. principale b. parametro c. esito d. solo e. malattia

1. threatening 2. 3. 4. 5.

_____ a. globale, complessivo rate _____ b. minaccioso decrease _____ c. tasso overall _____ d. miglioramento improvement _____ e. diminuire

Noun 1. length 2. stay 3. assess 4. setting 5. illness 6. measure 7. threatening 8. decrease 9. improvement

Verb lengthen _________ _________ _________ XXX _________ _________ _________ _________

Adjective long XXX XXX XXX _________ XXX _________ XXX XXX

Exercise 4. Look at the footnotes on p. 61 for new vocabulary.

Syntax Exercise 1. Translate the following noun clauses.

1. Intensive care patients pazienti in terapia intensiva 2. Telemedicine technology ___________________________________ 3. Large US health care system ___________________________________ 4. Local physicians ___________________________________

Exercise 2. True or false?

1. 2. 3. 4. 5. 6.

Between = tra due elementi Sick = cercare Less = pochi Worse = vocaboli Full = il contrario di empty Survivor = sopravvivenza

True _____ _____ _____ _____ _____

5. Life-threatening events ___________________________________ 6. Full treatment authority ___________________________________ 7. Observed hospital mortality rates ___________________________________

Text

enable (v) – rendere capace, mettere nelle condizioni di poter fare; intensivist (n) – medico specialista nelle cure intensive; off-site location – in un luogo esterno all’ospedale, in un altro luogo; delegate (v) – delegare, deputare; authority (n) – autorità, potere, responsabilità; remainder (n) – il restante.

THE DOCTOR IS IN

Exercise 2. Identify the information blocks in the sentences below. The first sentence has been done for you.

Knowing how is organized a text lets you find specif information ic quickly.

1. Association of Telemedicine for Remote Monitoring of Intensive Care Patients With Mortality, Complications, and Length of Stay 2. Observational study conducted in 6 ICUs of 5 hospitals in a large US health care system to assess the use of teleICU. 3. Local physicians delegated full treatment authority to the tele-ICU for 655 patients (31.1%) and authority to intervene only in life-threatening events for the remainder. 4. There were no significant differences between the preintervention and postintervention periods for hospital or ICU lenght of stay.

Exercise 3. Translate the sentences in Exercise 2 above.

1. Associazione della telemedicina per il monitoraggio a distanza dei pazienti in terapia intensiva con mortalità, complicanze e durata di degenza. 2. ____________________________________ ____________________________________ ____________________________________ ____________________________________

READ 1. Where was this article published? 2. When was it published? 3. Who are the authors of this paper? 4. What institution are they affiliated with? 5. Where was the study conducted? 6. What kind of text is this? (An Abstract? Editorial? Full text paper?) 7. How many subjects were enrolled? 8. Why was the study conducted? 9. How long did the study last? 10. What were the outcome measures?

AFTER YOU READ Exercise 1. True, False, or Not Clear, based on this study?

1. There is no evidence that telemedicine technology improves patient outcomes. 2. The aim of the study was to determine whether remote monitoring of ICU patients reduces mortality, complications, and LOS. 3. “Local physicians” were the patients’ family doctors. 4. Intensivists were fully responsible for all treatment decisions for about onehalf of patients. 5. Hospital mortality rates dropped. 6. Tele-ICU was significantly more useful in patients who were sicker. 7. Telemedicine had little effect on LOS.

3. ____________________________________ ____________________________________ ____________________________________ ____________________________________ 4. ____________________________________ ____________________________________ ____________________________________ ____________________________________

Exercise 2. Reflection

Text 10

BEFORE YOU READ

Vocabulary you need These words are highlighted in the following text (p. 64). 1. admit – ricoverare; ammettere 2. comanagement – co-gestione, gestione condivisa 3. engineer (v) – progettare/costruire 4. hip – anca 5. issue – numero di una pubblicazione

6. 7. 8. 9. 10.

provider – fornitore readmission – rientro ospedaliero reminder – promemoria, sollecitazione reply – risposta, replica scope – portata, sfera, ambito, ampiezza 11. survey – indagine, inchiesta 12. training – allenamento, esercitazione 13. “Penny wise and pound foolish” – detto inglese: “Oculati nelle piccole spese e sciocchi in quelle grandi”

Remember! Titles rarely compl are ete sentences an d can be very difficu lt!

Remember! Adj adjective, ad ective, jective + noun!

THE DOCTOR IS IN

READ Translate each of the article titles below.

Text 11

Vocabulary practice Exercise 1. Complete the chart with a synonym and the Italian translation.

1. 2. 3. 4. 5. 6.

aim allow main much physician setting

Synonym objective __________ __________ __________ __________ __________

Italian obiettivo __________ __________ __________ __________ __________

THE DOCTOR IS IN

Exercise 2. Match the English word with its Italian translation.

1. demand 2. drawn 3. enforce 4. enhance 5. framework

__b__ a) fare rispettare _____ b) richiesta _____ c) quadro, schema _____ d) accrescere _____ e) tratto da

3. Formal accreditation of CME providers is required in Austria, France and Italy, for instance/while/therefore in the other three countries accreditation is focused on activities. 4. Private sponsorship is allowed in all countries but Norway, although/moreover/still within certain limits. 5. However/Furthermore/Although further analysis is needed, this study may help clarify the domestic policies.

Exercise 3. As above.

1. 2. 3. 4. 5.

funding non-compliant manager overview panel

_____ _____ _____ _____ _____

a) commissione b) finanziamenti c) dirigente d) panoramica e) non conforme

Exercise 4. As above.

1. policy 2. provider

_____ a) campione _____ b) dirigente pubblico 3. public manager _____ c) offerta; fornitura 4. sample _____ d) fornitore 5. supply _____ e) politica, linea di condotta

Exercise 5. In each sentence, choose the correct linker.

1. CME is formally compulsory in Austria, France, Italy and the UK, although/ despite/however no sanctions are enforced against non-compliant physicians in practice. 2. The only two countries offered financial incentives to enhance CME participation are Belgium and Norway, thus/even/although limited to specific categories of physicians.

Exercise 6. Are these translations Correct or Incorrect?

1. The aim of this comparative study was to assess the main country-specific institutional settings applied by governments. L’obiettivo di questo studio comparativo era di valutare i principali contesti istituzionali specifici di un paese applicati dai governi. Correct 2. A common scheme of analysis was applied to investigate the following variables: … Fu applicato uno schema analitico comune al fine di studiare le seguenti variabili: … __________ 3. This comparative exercise provides an overview of the CME policies adopted by six EU countries to regulate both demand and supply. Questo esercizio comparativo prevede una sopravisione da parte di politici provenienti da 6 paesi UE che regolano sia la richiesta che l’offerta. __________

Text

THE DOCTOR IS IN

AFTER YOU READ Exercise 1. True, False, or Not Clear, based on this study?

1. This is the first published study that compares CME systems in the European Union. 2. The six countries in this study were selected because their CME systems are the best.

3. Five variables were analyzed for each country’s CME system. 4. Physicians in Norway and Belgium are paid incentives to participate in CME events. 5. CME systems would be more effective if CME policies were standardized throughout the E.U.

Exercise 2. Complete the chart based on the information provided in the abstract. CME SYSTEMS IN 6 EUROPEAN COUNTRIES

Austria Belgium France

Italy

Norway

Compulsory CME Sanctions Benefits Accreditation of activities Accreditation of CME providers Private funding and sponsorship

Exercise 3. Think.

1. What does “country-specific institutional settings” mean? 2. What does “CME funding and sponsorship” probably mean? Exercise 4. Reflect.

Just for fun! What language is spoken in the following countries?

1. England _____________________________________ 2. Belgium _____________________________________ 3. France _____________________________________ 4. Italy _____________________________________ 5. Germany _____________________________________ 6. Austria _____________________________________

Text 12 - Vocabulary review Texts 1-11

Exercise 1. Complete the chart.

Verb

Meaning

Noun

administer

somministrare

administer

assess

collect

compare

delay

detect

develop

enhance

estimate

evaluate

explain

find

grow

implement

improve

manage

perform

provide

THE DOCTOR IS IN

Exercise 2. Choose the correct word.

1. __a_ its proven benefits, many patients are reluctant to take this drug. a. despite b. however c. for instance d. while 2. _____ it has never been demonstrated, there seems to be an association between sunlight and hunger. a. furthermore b. although c. hence d. thus 3. Many people continue to smoke _____ the evidence that it causes cancer. a. like b. despite c. still d. although 4. Many chronic illnesses, _____ asthma and high blood pressure, can be managed effectively. a. whereas b. as c. like d. even 5. Everyone knows that driving under the influence of alcohol or drugs is illegal. ______, many people continue to do so. a. however b. although c. therefore d. thus 6. _____ everyone knows that driving under the influence of alcohol or drugs is illegal, many people continue to do so. a. however b. thus c. therefore d. although

Exercise 3. Complete the chart.

Infinitive

Past simple

Past participle

Meaning

was/were

been

essere

come

find

grow

have

know

make

put

show

undergo

Text

Exercise 4. Complete the text using one of the words in the box.

account for management

common disease pain within

estimated

Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD008340. DOI:10.1002/14651858.CD008340

Single dose antibiotics for treating uncomplicated urinary tract infection in non-pregnant women Jun Li Zhao2, Jian Qin Wang2, Lin Zhao2, Zhi Ping Wang1, Jing Yu Wang2, Jun Zhang2 1 Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou, China. 2The Second Hospital of Lanzhou University, Lanzhou, China. Contact address: Zhi Ping Wang, Institute of Urology, The Second Hospital of Lanzhou University, 80 Cui Ying Meng Street, Lanzhou, Gan Su, 730000, China. erywzp@lzu.edu.cn.

Editorial group: Cochrane Renal Group. Copyright ÂŠ 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Background Description of the condition Urinary tract _____ (UTI) is a very common infection and it is _____ 25% to 50%% of all women experience a UTI at some point in their lifetime (Naber 2001; Williams 1996). These infections _____

infection

health

known

more than eight million women annually in the United States (Kunin 1994; Patton 1991), and approximately 25% of all UTIs recur _____ six months (Nicolle 2003). Reported UTIs incidences are 15% and 10% per person-years in those aged 1539 and 40-79 years, respectively (Guay 2008). The annual _____ care expenditures in the _____ of UTIs exceed US$1 billion (Faro 1998). Uncomplicated UTIs are one of the most _____ clinical syndromes that occur in an otherwise healthy, non-pregnant, adult woman with no _____ anatomical or functional abnormalities of the urinary tract (Foxman 2003). They are the most common infectious _____ affecting young and sexually active women. Patients usually present with dysuria, urinary frequency, urinary urgency, and/or suprapubic pain (Mehnert-Kay 2005). In contrast, patients presenting with high fever, flank _____, and/or tenderness of the costovertebral angle which indicate upper urinary tract involvement and are classified as complicated UTIs (Tice 1999).

THE DOCTOR IS IN

Exercise 5. Complete the text using one of the words in the box.

achieving outcomes

affecting provide

among weight

common

JAMA Vol. 303 No. 6, February 10, 2010 CLINICIAN’S CORNER

Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents: A Randomized Trial Paul E. O’Brien, MD, FRACS; Susan M. Sawyer, MBBS, MD, FRACP; Cheryl Laurie, RN, BHSc; Wendy A. Brown, MBBS, PhD, FRACS; Stewart Skinner, MBBS, PhD, FRACS; Friederike Veit, MBBS, MD, FRACP; Eldho Paul, MSc; Paul R. Burton, MBBS, FRACS; Melanie McGrice, BSc, M Nutr Diet; Margaret Anderson, BHIM, Grad Dip HA; John B. Dixon, MBBS, PhD, FRACGP

Context Adolescent obesity is a _____ and serious health problem _____ more than 5 million young people in the United States alone. Bariatric surgery is being

compare

evaluated

life

_____ as a possible treatment option. Laparoscopic adjustable gastric banding (gastric banding) has the potential to _____ a safe and effective treatment. Objective To _____ the _____ of gastric banding with an optimal lifestyle program on adolescent obesity. … Conclusions _____ obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage _____ a loss of 50% of excess _____, corrected for age. There were associated benefits to health and quality of _____. Trial Registration ANZCTR Identifier: 12605000160639

Exercise 6. Complete the text using one of the words in the box.

compared with

estimated

illness

Arch Intern Med 4, February 22, 2010;170(4):321-331. CLINICIAN’S CORNER

The Effect of Exercise Training on Anxiety Symptoms Among Patients: A Systematic Review Matthew P. Herring, MS, MEd; Patrick J. O’Connor, PhD; Rodney K. Dishman, PhD

Background Anxiety often remains unrecognized or untreated among patients with a chronic _____. Exercise training _____ help improve anxiety symptoms among patients. We _____ the population effect size for exercise training effects on anxiety and determined _____ selected variables of theoretical or practical importance moderate the effect.

improvements

may

whether

… Results _____ no treatment conditions, exercise training significantly reduced anxiety symptoms by a mean effect of 0.29 (95% confidence interval, 0.230.36). Exercise training programs lasting no more than 12 weeks, using session durations of at least 30 minutes, and an anxiety report time frame greater than the past week resulted in the largest anxiety _____. Conclusion Exercise training reduces anxiety symptoms among sedentary patients who have a chronic illness. Author Affiliations: Department of Kinesiology, The University of Georgia, Athens. © 2010 American Medical Association. All Rights Reserved.

Text

Exercise 7. Complete the text using one of the words in the box.

burden care evaluated prevention treatment

findings

J Clin Psychiatry 2009 Dec;70(12):1621-1628.

Long-term effects of preventive cognitive therapy in recurrent depression: a 5.5-year follow-up study. Bockting CL, Spinhoven P, Wouters LF, Koeter MW, Schene AH; for the DELTA Study Group. Faculty of Social and Behavioral Sciences, Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands. c.l.h.bockting@rug.nl.

Objective: Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of _____ in 2030. A crucial part of the _____ of depression is the _____ of relapse/recurrence in high-risk groups, ie, recurrently depressed patients. The longterm preventive effects of group cognitive therapy (CT) in preventing relapse/recurrence in recurrent depression are not known. This article

Exercise 8. Match the English word with its Italian translation.

1. closely

_____

2. 3. 4. 5.

_____ _____ _____ _____

cough decade demand dizzy

a. domanda, pretesa b. vertigini c. attentamente d. decennio e. tosse

_____

2. headache _____ 3. household _____

outcome

reports on the long-term (5.5-year) _____ of a randomized controlled trial to prevent relapse/recurrence in patients with recurrent depression. We specifically _____ the long-term effects of CT in relation to the number of previous episodes experienced. Conclusions: Our _____ indicate that brief CT, started after remission from a depressive episode on diverse types of treatment in patients with multiple prior episodes, has long-term preventive effects for at least 5.5 years. _____ of brief relapse prevention CT should be considered in the continued _____ of patients with recurrent depression. TRIAL REGISTRATION: ccmo-online.nl Identifier: NTR454. ÂŠ Copyright 2009 Physicians Postgraduate Press, Inc.

4. less 5. mean

_____ _____

d. mal di testa e. febbre

Exercise 10. As above.

1. policy 2. prior to

_____ _____

3. purpose _____ 4. remainder _____ 5. safety _____

Exercise 9. As above.

1. fever

implementation

a. incolumitĂ b. prima, in precedenza c. restante d. linea di condotta e. scopo

a. nucleo familiare; ambito domestico b. media c. meno

THE DOCTOR IS IN

CROSSWORD

Write the Italian translation of these English words in the squares.

2 4 5

Across 1. setting 2. admit 6. early 8. anticipate 14. implement 16. disease 17. collection 19. undergo 21. development 22. assess 25. detect 26. enhance 32. broad 33. death 34. finding ** 36. therefore 37. blood

12 13

15 16

22 24

23 25

26 28

Down 1. affect 3. feature 4. baseline ** 5. worse 7. change 9. outcome 10. improve 11. associate 12. treat 13. elderly 15. background 16. likelihood 18. effort 20. compared to ** 23. sick 24. provide 27. perform 28. overall 29. mild 30. sample 31. delay 35. rate

32 33 34 36

** the Italian translation is 2 words; leave a space between them!

Text 13

Vocabulary practice Exercise 1. How do you say these words in English?

1. aumento

i __ __ __ __ __ __ e

2. chiave

k __ y

3. dati preliminari/ risultati f __ __ __ __ __ __ s 4. dovrebbe

s __ __ __ __ d

5. esigenza, bisogno

n __ __ d

THE DOCTOR IS IN

6. gestire

m __ __ __ __ e

14. supporto, sostegno

7. meno

l __ __ s

s __ __ __ __ __ t

8. paragonare

c __ __ __ __ __ e

15. sviluppare

d __ __ __ __ __ p

9. pratica

p __ __ __ __ __ __ e

16. tendenza

t __ __ __ d

10. ricerca

r __ __ __ __ __ __ h

17. valutare

a __ __ __ __ s

11. risorse

r__ __ __ __ __ __ __ s

12. salute

h __ __ __ __ h

13. sebbene

a __ __ __ __ __ __ h

Exercise 2. Look at the footnotes on p. 77 for new vocabulary.

Exercise 3. Look at these word groups. Notice the word endings (desinenze).

Verb

Meaning

Noun

Adjective

change

cambiare

change

changing

emerge

emergere

emergence

emerging

reimburse

rimborsare

reimbursement

reimbursed

train

allenar(si), esercitarsi; formare

training

trained

update

aggiornare

update

updated

Exercise 4. Look at these word groups.

Verb

Meaning

Noun (state, idea, condition)

Noun (person-agent)

educate

educare

education

educator

employ

impiegare

employment

employer

employee

interview

intervistare

interview

interviewer

interviewee

recruit

reclutare

recruitment

recruiter

research

ricercare

research

researcher

Noun (person-object)

Text

in light of – alla luce di; because of – a causa di; workforce – forza lavoro; personale; revised – rivisto, revisionato; self-identified – “auto-identificato”, auto-valutato, soggettivo; alumni – laureati presso una data facoltà e/o università; survey – inchiesta, questionario; elicit – suscitare, far emergere; concerns – preoccupazioni; funding cuts – tagli dei finanziamenti; policy – politica, linea di condotta; advocacy – patrocinio, appoggio; skills – competenze; lifespan – arco della vita; expenses – spese sostenute; address – porre/rivolgere l’attenzione.

THE DOCTOR IS IN

Exercise 5. Translate the title of the Abstract.

Assessing the professional development needs of public health educators in light of changing competencies

Think about what you read. s. Ask yourself question Look for parallels with your own experience. Sometimes you can t only hypothesize, bu oK t’s tha

Exercise 6. Translate the following phrases:

1. Well-trained public health workforce 2. National Health Educator Competencies Update Project 3. Self-identified training needs 4. Employer support 5. San Jose State University Master of Public Health alumni 6. Web-based survey 7. Policy advocacy skills 8. Lifespan approach to health issues 9. Health education professionals’ training needs

READ

AFTER YOU READ Exercise 1. Can you answer these questions? Can you at least hypothesize? Can you give some examples? Is there any connection between this information and your own professional setting, experience and/or knowledge?

• Who/what are “Public Health educators”? What do they teach? Who are their “students”? • What is “Public Health education”? What are the topics? Who are the learners? • What resources are being privatized? • What are “policy advocacy skills”? Can you think of an example? • What kind of “innovative technology” is being referred to? • What is a “lifespan approach to health issues”? Whose lifespan is being referred to? • Which students are being referred to – university students in a Masters program or the general public?

Exercise 1. Scan the text to find this information.

1. 2. 3. 4. 5. 6. 7. 8. 9.

What journal published this paper? When was it published? Who are the authors of the paper? Where was the study probably conducted (in what country)? What were the aims of the study? Who participated in the study? What tool or method was used to collect data? What areas were identified as key to training? What should be incorporated into the university Masters programs of public health?

Exercise 2. Reflection

Text 14

Vocabulary practice Exercise 1. How do you say these words in Italian?

1. 2. 3. 4. 5. 6. 7. 8.

aim among background begin data early health increased

obiettivo __________________ __________________ __________________ __________________ __________________ __________________ __________________

THE DOCTOR IS IN

9. 10. 11. 12.

less life likely more

________________ ________________ ________________ ________________

13. 14. 15. 16.

need (v) outcome report (v) sample

________________ ________________ ________________ ________________

Exercise 2. Complete.

Then

infanzia

childhood

età adulta

______________

salute

health

sano

______________

obesità

obesity

obeso

______________

meridionale

southern

meridione

______________

Exercise 3. What is the opposite of:

t the conten Predicting based on of a paper s orient p its title hel your t ec ir d d n a lso helps a It . attention the on s you focu nd not a on ti a inform r just on you the with y lt cu fi if d english!

1. 2. 3. 4.

good? low? overweight? presence?

__________________ __________________ __________________ __________________

Exercise 7. Think about the title. What do you think the authors will report?

READ Exercise 1. Scan the text to find this information.

Exercise 4. What is a synonym for:

1. begin? 2. gender?

__________________ __________________

1. 2. 3. 4. 5.

Exercise 5. Look at the footnotes on p. 81 for new vocabulary.

Exercise 6. Translate the title using the footnotes below.

Social inequalities1 in health among adolescents in a large southern2 European city.

1. inequalities – disugualianze 2. southern – meridionale

6. 7. 8.

What journal published this paper? When was it published? Who are the authors of the text? What institution are they affiliated with? Where was the study probably conducted (in what country)? What were the aims of the study? Who participated in the study? What tool or method was used to analyze the data?

Text

inequality – disuguaglianza; southern – meridionale; childhood – infanzia; perceived – percepito, soggettivo; overweight – sovrappeso; affluence – ricchezza.

THE DOCTOR IS IN

Just for fun! AFTER YOU READ Exercise 1. Are these notes correct?

1. Overall perceived good health status: More boys than girls reported good health. 2. Association between overweight/obesity and affluence: Low-affluence girls were 2.4 times more likely to be overweight/obese. 3. Association between perceived good health status and affluence: Boys whose fathers had a low level of education were less likely to report perceived good health.

Exercise 2. Reflection

I. Nouns 1. weight 2. height 3. length 4. depth 5. width

peso __________________ __________________ __________________ __________________

II. Word groups 1. weight 2. heavy 3. light 4. weigh

peso __________________ __________________ __________________

1. high/tall 2. short/low 3. raise

__________________ __________________ __________________

1. long 2. short 3. lengthen

__________________ __________________ __________________

1. deep 2. shallow 3. deepen

__________________ __________________ __________________

1. 2. 3. 4.

__________________ __________________ __________________ __________________

wide narrow widen narrow/shrink

Text 15

Vocabulary practice Exercise 1. Choose the correct translation.

1. for example: mentre/inoltre/ad esempio 2. although: sebbene/poiché/tuttavia 3. as: perciò/mentre/poiché 4. however: nonostante/tuttavia/ sebbene 5. such as: mentre/per cui/ad esempio 6. therefore: inoltre/come/perciò

THE DOCTOR IS IN

Exercise 2. True or False? If false, write the correct Italian translation.

1. arm = danno False! Braccio 2. at least = alla fine __________________________________ 3. blinded = in cieco __________________________________ 4. both = nave __________________________________ 5. detection = rilevamento __________________________________ 6. earlier = prima __________________________________ 7. effective = efficacia __________________________________ 8. general practitioner = medico di base __________________________________ 9. implementation = migliorare __________________________________

Syntax practice Exercise 1. Translate these noun phrases.

1. 2. 3. 4. 5. 6. 7. 8.

Educational intervention Evidence-based interventions Family care networks Primary care setting A pragmatic cluster-randomised trial Earlier recognition and response The National Dementia Strategy A computer decision support system and practice-based educational workshops 9. Two dementia-specific management reviews

Exercise 2. Translate the title.

Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED).

10. improve = provare __________________________________ 11. life = vivo __________________________________ 12. manage = gestire __________________________________ 13. network = rete __________________________________ 14. outcome = fuoruscita __________________________________ 15. response = responsabilità __________________________________ 16. successful = riuscito __________________________________

Exercise 3. Look at the footnotes on p. 85 for new vocabulary.

GRAMMAR TO GO! 1. Will + infinitive: used to express the future. Its effectiveness will be tested La sua efficacia sarà testata 2. Saxon genitive ( ___’s ): used to express possession • singular noun: The boy’s dog Il cane del ragazzo • plural noun: General practitioners’ diagnostic skills Le competenze diagnostiche dei medici di medicina generale • irregular plural: The children’s dog Il cane dei bambini

Text

cluster – grappolo, gruppo, ‘cluster’; seek – cercare, tentare; enhance – accrescere, potenziare; skill – competenza (pratica); allow – permettere; engage – ingaggiare, coinvolgersi; plan – pianificare, programmare; challenge – sfida; impresa; customized – personalizzato, su misura; workshop – corso pratico, laboratorio; practice – attività libero professionista; gain – guadagnare; feasible – fattibile; carer – chi si occupa di un malato, es. parente o badante; strain – affaticamento; build – costruire; in that – nel senso che.

THE DOCTOR IS IN

at ThInK about wh you read. estions. Ask yourself qu ls lle ra pa r fo ok Lo with your own experience. can Sometimes you e, but only hypothesiz that’s oK

READ

AFTER YOU READ

Exercise 1. Scan the text to find this information.

Exercise 1. Think.

1. 2. 3. 4. 5. 6.

7. 8. 9. 10. 11.

What journal published this paper? What is an “open access” journal? When was this paper published? Who are the authors of the text? What institution are they affiliated with? What type of study is this? (Consult the Appendix at the back of this textbook for information on study designs) Where will the study probably be conducted (in what country)? What problem exists in the medical community that justifies this study? What is the aim of this study? Who will participate in the study? What are the primary outcomes of this study?

• The authors mention “support services” for patients and their families; what type of services are they referring to? • Do such support services exist in Italy? What are they? • The authors mention “educational interventions”; what type of interventions are they referring to? • Do such educational interventions exist in Italy? What are they? For whom are they? • What is a “computer decision support system”? • What is a “practice-based educational workshop”? • Why weren’t these workshops effective in changing clinical management of dementia? • Why do the authors consider changing clinical management a challenge? • Are there “management guidelines” in Italy/the EU? • Why are patient quality of life and carer strain considered important secondary outcomes?

Exercise 2. Reflect.

Text 16

Vocabulary practice Exercise 1. Vocabulary you need.

1. condition – condizione; disturbo, patologia 2. deficiency – carenza 3. due to – dovuto a; a causa di 4. food – cibo 5. linked – associato a 6. may – potrebbe, è possibile 7. news – notizie, novità 8. pain – dolore

THE DOCTOR IS IN

9. painful – doloroso 10. paucity – pochezza, scarsità 11. poor – povero, scarso 12. relief – sollievo 13. retrieved – reperito 14. skin – cute 15. sunlight – luce solare 16. supplementation – integrazione 17. textbook – libro di testo 18. through – attraverso 19. undertaken – intrapreso

Exercise 2. Complete the paragraph with words from the box.

aetiology; chronic; exposure; produced; range; suggests Background: Vitamin D is ______ in the skin after sunlight ______ and can also be obtained through food. Vitamin D deficiency has recently been linked with a ______ of diseases including ______ pain. Observational and circumstantial evidence ______ that there may be a role for vitamin D deficiency in the ______ of chronic pain conditions.

Exercise 3. As above.

assess; events; objectives ______ : To ______ the efficacy and adverse ______ of vitamin D supplementation in chronic painful conditions.

Exercise 4. As above.

found; main; outcome; participants; treating ______ Results: Four studies, with a total of 294 ______, were included. The studies were heterogeneous with regard to study

quality, the chronic painful conditions that were investigated, and the ______ measures reported. Only one study reported a beneficial effect, the others ______ no benefit of vitamin D over placebo in ______ chronic pain.

Exercise 5. As above.

adults; Authors’; base; insufficient; low; research ______ Conclusions: The evidence ______ for the use of vitamin D for chronic pain in ______ is poor at present. This is due to ______ quality and ______ randomised controlled trials in this area of ______.

READ Exercise 1. Scan the text to find this information.

1. In what journal was this paper originally published? 2. What is a “systematic review”? (Consult pp. 171-173 of this textbook for information on study designs) 3. What institution are the authors affiliated with? 4. What was the rationale of the study? 5. What is the aim of this study? 6. What were the criteria for inclusion in the systematic review? 7. How many studies met the inclusion criteria?

Text

THE DOCTOR IS IN

Exercise 1. Think.

t what Think abou d. a you re

s. f question Ask yoursel arallels Look for p own with your . experience n you ca Sometimes ize, but es h ot p only hy that’s oK

• Do you know what a randomised double blind trial is? (Consult Appendix at the back of this textbook for information on study designs.) • Do you know how much exposure to sunlight is necessary to produce Vitamin D? • Do you know what the recommended daily amount of vitamin D is? • Do you know which foods provide vitamin D? • Have you ever heard about a possible beneficial effect of vitamin D in chronic pain conditions? • Do you know what adverse effects vitamin D supplements can cause? • Do you know how “methodological quality” is assessed? • Do you know what “pooled analysis” is? (Consult the Appendix at the back of this textbook for information on statistical data.) • Based on the authors’ conclusions of their systematic review will you prescribe vitamin D supplements to your patients with chronic pain?

Exercise 2. Reflect.

Just for fun! Do you know what any of these words or phrases mean? Can you give one or two examples of each?

1. beverage: __________________________ ______________________________________ 2. dairy products: _____________________ ______________________________________ 3. grains: _____________________________ ______________________________________ 4. meal: ______________________________ ______________________________________ 5. poultry: ____________________________ ______________________________________ 6. produce: ___________________________ ______________________________________ 7. seafood: ___________________________ ______________________________________ 8. shellfish: ___________________________ ______________________________________

Text 17

Vocabulary practice Exercise 1. True or False? If False, write the correct Italian translation.

1. blinded – blindato False: cieco, in cieco 2. concerns – preoccupazioni ___________________________________ 3. data – data ___________________________________ 4. early – precoce ___________________________________

THE DOCTOR IS IN

5. outcome – esito ___________________________________

7. physician – fisico ___________________________________

6. pain – doloroso ___________________________________

8. score – punteggio ___________________________________

Exercise 2. Put these words into the correct columns, and complete the chart. N.B. Sometimes there is no adjective.

assess; collect; delayed; findings; improve; management; need; shown; surgery; update Verb

Noun

Adjective

Meaning

assess

assessment

assessed (pp)

valutare

________________

Exercise 3. Choose the correct meaning.

1. 2. 3. 4. 5. 6.

although – mentre/tuttavia/sebbene even – nonstante/perfino/mentre nevertheless – perciò/tuttavia/come still – tuttora/inoltre/anche se thus – perciò/inoltre/sebbene whether – nonostante/se/mentre

Exercise 4. Look at the footnotes on pp. 93-94 for new vocabulary.

Syntax practice Exercise 1. Translate these sentences.

1. This is an important topic for postoperative pain management. 2. The authors explored the effects of multi-modal medication use in the early post-operative phase and found that it seems to accelerate the rehabilitation phase. 3. More research is needed on aggressive and early multi-modal pain control in post-operative patients.

Text

READ Exercise 1. Scan the text to find this information.

1. In what journal was this paper originally published? 2. What is a “prospective, randomized, controlled, double-blind study”? (Consult the Appendix at the back of this textbook for information on study designs) 3. What is the clinical evidence topic of this BMJ EvidenceUpdate? 4. How relevant is this paper considered to anesthesiology?

5. How relevant is this paper considered to orthopedic surgery? 6. What institution are the authors affiliated with? 7. What was the rationale of the study? 8. What is the aim of this study? 9. What were the criteria for patient selection? 10. How many subjects where enrolled in each arm of the study? 11. What treatment did each group receive? 12. What was the primary outcome?

hip – anca; -sparing – che riduce il bisogno (es. di un farmaco); consumption – consumo; assunzione; crutch – stampella; walking frame – deambulatore; at rest – a riposo; up to – fino a.

THE DOCTOR IS IN

EvidenceUpdates BMJ Evidence Centre

Clinical Evidence Topic: Osteoarthritis of the hip DISCIPLINE

RELEVANCE TO PRACTICE

IS THIS NEWS?

6/7 5/7 6/7 6/7

6/7 5/7 6/7 5/7

Anesthesiology Physical Medicine and Rehabilitation Special Interest - Pain–Physician Surgery – Orthopaedics

Comments from Clinical Raters Anesthesiology

This an interesting study in that the decrease in morphine use, although statistically significant, is not surprising and clinically the difference is not that great (19 ±12 mg in the placebo group to 14±13 mg study group). What is surprising is the benefit apparently conferred at 1, 3 and 6 months postoperatively for pain reduction in the ketamine group. Physical Medicine and Rehabilitation

As ketamine is getting hard to obtain in France, unfortunately the relevance of this study may be moderate. Physical Medicine and Rehabilitation

This is an important topic for postoperative pain management. The authors explored the effects of multi-modal medication use in the early post-operative phase and found that it seems to accelerate the rehabilitation phase. Also, the reduction in morphine consumption serves public health concerns about opioid addiction. More research is needed on aggressive and early multi-modal pain control in post-operative patients.

Special Interest - Pain–Physician

Ketamine infusion during 24 hours perioperatively decreased morphine consumption and decreased the number of patients experiencing long-lasting pain and discomfort after total hip replacement. Special Interest - Pain–Physician

Fascinating study that showed a 24-hr infusion of ketamine after hip arthroplasty reduced pain and improved function for 180 days of follow-up. It would be interesting to see this study repeated, although the authors mention similar findings in oncologic surgery. Special Interest - Pain–Physician

A well designed study whose most interesting finding was a secondary outcome related to the incidence of chronic pain. A follow-up study designed to specifically confirm these findings would be helpful.

Rater– valutatore; in that – in quanto; what – ciò che; get hard – diventare difficile; addiction– dipendenza; helpful – d’aiuto.

Text

AFTER YOU READ Exercise 1. Translate the clinical raters’ comments.

Anesthesiology 1. This an interesting study in that the decrease in morphine use, although statistically significant, is not surprising and clinically the difference is not that great (19 12 mg in the placebo group to 14 13 mg study group). 2. What is surprising is the benefit apparently conferred at 1, 3 and 6 months postoperatively for pain reduction in the ketamine group. Physical Medicine and Rehabilitation 3. As ketamine is getting hard to obtain in France, unfortunately the relevance of this study may be moderate.

Special Interest - Pain–Physician 4. A well designed study whose most interesting finding was a secondary outcome related to the incidence of chronic pain. 5. A follow-up study designed to specifically confirm these findings would be helpful.

Exercise 3. Reflect.

• What have I learned by reading this paper that I didn’t already know? • Is the information clear? • Is the information complete? • Can I “take home” any of the information in this paper? • What is my opinion on this topic? • Am I curious or interested enough to read the full text paper? Remember th at Abstract are subj to a world li ect m The informat it. ion provided in abstract is th an eref rarely compl ore ete. Consult the full text for complete details.

Exercise 2. Complete this chart based on the information provided in the abstract.

ketamine

placebo

morphine consumption at 24h

–––––––––––

day 30 – crutches or walking frame

–––––––––––

day 30-180 – no. of patients with pain at rest

–––––––––––

day 180 – no. of patients with pain at rest

–––––––––––

Text 18 - Vocabulary review Texts 1-17

Exercise 1. True or False? If False, write the correct Italian translation.

1. affect = affezionarsi

False

interessare, colpire

2. account for = contare

_______

______________________________

3. achy = dolente

_______

______________________________

4. address = rivolgere lâ&#x20AC;&#x2122;attenzione

_______

______________________________

5. admit = ricoverare

_______

______________________________

6. aging = agile

_______

______________________________

7. anticipate = aspettarsi

_______

______________________________

8. baseline = inizio; valore iniziale

_______

______________________________

9. blood = sanguinare

_______

______________________________

10. burden = carico

_______

______________________________

11. change = possibilitĂ

_______

______________________________

12. childhood = bambino

_______

______________________________

13. competency = competenza

_______

______________________________

14. concern = preoccupazione

_______

______________________________

15. condition = disturbo

_______

______________________________

16. cough = tosse

_______

______________________________

17. customized = costume

_______

______________________________

18. decline = calo

_______

______________________________

19. deficiency = deficienza

_______

______________________________

20. depth = morte

_______

______________________________

21. diagnose = diagnosi

_______

______________________________

22. disease = patologia

_______

______________________________ g

THE DOCTOR IS IN

23. double = dubitare

_______

______________________________

24. due to = a cause di

_______

______________________________

25. earlier = prima

_______

______________________________

26. elicit = sollecitare

_______

______________________________

27. enroll = arruolare

_______

______________________________

28. expense = caro

_______

______________________________

29. fever = febbre

_______

______________________________

30. full = folle

_______

______________________________

31. gain = guadagnare

_______

______________________________

32. height = alto

_______

______________________________

33. household = nucleo familiare

_______

______________________________

34. increase = crescere

_______

______________________________

35. inequality = iniquo

_______

______________________________

36. key = chi

_______

______________________________

37. less = poco

_______

______________________________

38. lifespan = arco della vita

_______

______________________________

39. likelihood = piacevolezza

_______

______________________________

40. little = poco

_______

______________________________

41. low = legge

_______

______________________________

42. major = sindaco

_______

______________________________

43. network = rete

_______

______________________________

44. only = solitario

_______

______________________________

45. overweight = sovrappeso

_______

______________________________

Text Exercise 2. Complete the text with one of the words in the box below.

admitted; background; effect; linking; mortality; relationship

ARCH INTERN MED

Vol. 170 No. 4, February 22, 2010

Health Care Reform The _____ of Multidisciplinary Care Teams on Intensive Care Unit Mortality Michelle M. Kim, MSc; Amber E. Barnato, MD, MPH; Derek C. Angus, MD, MPH; Lee F. Fleisher, MD; Jeremy M. Kahn, MD, MSc

_____ Critically ill patients are medically complex and may benefit from a multidisciplinary approach to care. Methods We conducted a populationbased retrospective cohort study of medical patients _____ to Pennsylvania acute care hospitals (N = 169) from July 1, 2004, to June 30, 2006, _____ a statewide hospital organizational survey to hospital discharge data. Multivariate logistic regression was used to determine the independent _____ between daily multidisciplinary rounds and 30-day _____.

Exercise 3. As above.

compared; illness; included; lowest; overall; reductions; were Results A total of 112 hospitals and 107 324 patients were _____ in the final analysis. _____ 30-day mortality was 18.3%. After adjusting for patient and hospital characteristics, multidisciplinary care was associated with significant _____ in the odds of death (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.76-0.93 [P = .001]). When stratifying by intensivist physician staffing, the _____ odds of death

were in intensive care units (ICUs) with high-intensity physician staffing and multidisciplinary care teams (OR, 0.78; 95% CI, 0.68-0.89 [P < .001]), followed by ICUs with low-intensity physician staffing and multidisciplinary care teams (OR, 0.88; 95% CI, 0.79-0.97 [P = .01]), _____ with hospitals with low-intensity physician staffing but without multidisciplinary care teams. The effects of multidisciplinary care _____ consistent across key subgroups including patients with sepsis, patients requiring invasive mechanical ventilation, and patients in the highest quartile of severity of _____.

Exercise 4. As above.

among; explained; survival; team Conclusions Daily rounds by a multidisciplinary _____ are associated with lower mortality _____ medical ICU patients. The _____ benefit of intensivist physician staffing is in part _____ by the presence of multidisciplinary teams in high-intensity physician-staffed ICUs. Author Affiliations: Department of Health Care Management and Economics, Wharton School of Business (Ms Kim), Leonard Davis Institute of Health Economics (Drs Fleisher and Kahn), Department of Anesthesia and Critical Care, School of Medicine (Dr Fleisher), Center for Clinical Epidemiology and Biostatistics, School of Medicine (Drs Fleisher and Kahn), and Division of Pulmonary, Allergy, and Critical Care, School of Medicine (Dr Kahn), University of Pennsylvania, Philadelphia; and Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, School of Medicine (Dr Barnato), CRISMA Laboratory, Department of Critical Care Medicine, School of Medicine (Drs Barnato and Angus), and Department of Health Policy and Management, Graduate School of Public Health (Drs Barnato and Angus), University of Pittsburgh, Pittsburgh, Pennsylvania. ÂŠ 2010 American Medical Association. All Rights Reserved.

THE DOCTOR IS IN

Exercise 5. As above.

administration; despite; few; incidence; prevention; rates; reluctant J EPIDEMIOL COMMUNITY HEALTH

Online First 8 December 2009

The effect of influenza vaccination on the _____ of chronic obstructive pulmonary disease (COPD) exacerbations in the immediate post-vaccination period Simon C H Ting*, Stephen W Crooks, Gail South. 1 Chesterfield Royal Hospital NHS Foundation Trust, United Kingdom Correspondence to: Simon Ting, Chesterfield Royal Hospital NHS Trust, Chesterfield Royal Hospital, Calow, Chesterfield, S44 5BL, United Kingdom.

Background: The _____ of influenza vaccination is an important strategy in the _____ of exacerbations in patients with chronic obstructive pulmonary disease (COPD). _____ the proven benefits, there are patients who are _____ to have this intervention for fear of triggering an exacerbation. There are very _____ studies looking at the effect of the vaccination on exacerbation _____ of COPD in primary care.

Exercise 6. As above.

both; diagnosis; matched; patients; records; sex; whilst Methods: We obtained medical _____ from 6 primary care practices in the Derbyshire area (UK) and obtained 293 pairs of _____. All patients had a _____ of COPD based on post bronchodilator spirometry. Patients were _____ according to age, _____, severity of COPD and comorbidities. The first group of patients received the influenza vaccination _____ the other group served as a control (either never received the vaccination or received it at a later date). The incidence of COPD exacerbations of _____ groups were recorded.

100

Exercise 7. As above.

compared to; increase; non; not; onset; rates; risk; safe; should Results: There were 21 exacerbations in the control group _____ 11 in the vaccinated group. The difference in exacerbation _____ between groups was _____ statistically significant (McNemarâ&#x20AC;&#x2122;s p=0.11). In the 2 weeks after receiving the influenza vaccination, the _____ of experiencing an exacerbation in this group of patients was 0.52 in the vaccinated group compared to the_____ vaccinated group (OR=0.52; CI 0.29-1.14) Conclusion: Patients with COPD _____ be reassured that the influenza vaccination is _____ and does not cause an _____ in exacerbations. They should be encouraged to take up the vaccination annually before the _____ of winter. ÂŠ 2009 by the BMJ Publishing Group Ltd.

Exercise 8. Choose the correct word.

1. __a_ the fact that most Americans are concerned about their weight, the national rate of obesity is the highest in the world. a. despite; b. however; c. for instance; d. while 2. Many people continue to adopt dangerous lifestyle habits, _____ smoking, excessive alcohol consumption, not exercising regularly and eating high-fat food. a. still; b. despite; c. like; d. although 3. It is _____ not surprising that obesity has become a public health emergency. a. furthermore; b. although; c. still; d. thus

Text

4. There had been an increase in diabetes and cardiac disease, _____, among American children and adolescents. a. whereas; b. as; c. even; d. for instance 5. Everyone knows that these lifestyle habits can lead to serious health problems. _____, many people continue to do so.

a. therefore; b. although; c. thus; d. however 6. _____ everyone knows that driving under the influence of alcohol or drugs is illegal, many people continue to do so. a. however; b. thus; c. therefore; d. even though

Exercise 9. Find the words â&#x20AC;&#x201C; horizontal, vertical, and diagonal! â&#x20AC;&#x201C; in this Word Search

1. 2. 3. 4. 5. 6. 7. 8. 9.

Make a diagnosis Make sure Mean Meaning Measure Narrow Network Old Overweight

10. Page 11. Perceived 12. Performance 13. Plan 14. Policy 15. Poor 16. Practice (x2) 17. Print 18. Prior to

19. Promote 20. Provide 21. Purpose 22. Range 23. Rate 24. Resource 25. Retrieve 26. Rising 27. Supply

28. Survey 29. Treat 30. Trend 31. Weak 32. Weight 33. What 34. Will 35. Worse 36. Yield

101

THE DOCTOR IS IN

CROSSWORD

Write the Italian translation in the squares of the words below. Across 3. engage 5. delay 8. high 9. framework 10. check 14. control 17. health 18. linked 19. evaluate 21. assessment 22. chance 24. day 26. broad 29. detect 30. improve 31. develop 33. explain 35. elderly 36. effort 37. effective 38. available 39. general practitioner 41. at least 43. both 44. finding 45. compare

2 3

4 5

6 7

13 14

16 17

18 19 20

21 22

24 25

28 29

30 31

35 36

Down 1. allow 2. collect 4. implement 6. challenge 7. main 11. feature 12. closely 13. background 15. enhance 16. feasible 20. estimate 23. affect 25. discharge 27. likely 28. early 32. deep 34. issue 40. as 42. last(v)

39 40

42 43 44

102

Text 19

Vocabulary practice Exercise 1. Match the English word with its Italian translation.

1. 2. 3. 4. 5.

another appear broad compared with ear

__d__ _____ _____ _____ _____

a) sembrare b) orecchio c) rispetto a d) un altro e) ampio

103

THE DOCTOR IS IN

Exercise 2. As above.

1. effective

_____

2. effectiveness 3. efficacy 4. found

_____ _____ _____

5. high

_____

Exercise 5. Choose the correct linker.

a) efficacia reale b) trovato c) efficace d) efficacia teorica e) alto

1. _____, when treatment needed to be extended beyond this point it was less effective. Although; However; Thus; Therefore 2. _____, patient symptoms lasted two days longer in the acetic acid group compared to antibiotic/steroid. As; Although; Still; In addition

Exercise 3. As above.

1. 2. 3. 4. 5.

less main pain rate source

_____ _____ _____ _____ _____

a) dolore b) fonte c) principale d) meno e) tasso

Exercise 4. How do you say these words in Italian?

1. assess

v __ __ __ __ __ __ __

2. between

t __ __

3. both

e __ __ __ __ __ __ __

4. date

d __ __ __

5. drawn

t __ __ __ __ __

6. evaluate

v __ __ __ __ __ __ __

7. find

t __ __ __ __ __ __

8. last (v)

d __ __ __ __ __

9. low

b __ __ __ __

10. relief

s __ __ __ __ __ __ __

11. report

r __ __ __ __ __ __ __ __

12. sample

c __ __ __ __ ___ __ __

13. show

m __ __ __ __ __ __ __

14. throat

g __ __ __

15. treatment

t __ __ __ __ __ __

104

3. The preferred choice of topical treatment may be determined by other factors, _____ risk of ototoxicity or risk of contact sensitivity. despite; in addition; therefore; such as

Exercise 6. Look at the footnotes on pp. 105-106 for new vocabulary.

READ Exercise 1. Scan the text to find this information.

1. In what journal was this paper published? 2. What institution are the authors affiliated with? 3. What is the aim of this study? 4. What is another name for acute otitis externa? 5. What were the selection criteria? 6. When was the most recent search conducted 7. How many studies were identified? 8. What was the total number of patients involved in these studies? 9. Who collected and analyzed the data?

Text

discomfort – fastidio, disagio; itchiness – prurito; discharge – scarico, emissione, spurgo; impaired – compromesso; hearing – udito; swimmer’s ear – “orecchio da nuotatore”; drops – gocce; nose – naso; cleaning – pulizia; medication – farmaco; eligible – idoneo, adatto;

105

THE DOCTOR IS IN

cure – guarigione; notable – degno di nota, importante; involve – coinvolgere, riguardare; paucity – scarsità, insufficienza; odds – probabilità; most of which – la maggior parte dei quali; size – dimensione, numero; wholly – interamente, completamente; unlikely – improbabile, difficilmente; reservations – riserva, restrizione; as distinct from – a differenza di, choice – scelta; appear – apparire, sembrare, comparire; any – qualsiasi; consistently – costantemente, regolarmente, coerentemente; as yet – finora; enough – abbastanza, sufficiente; further – ulteriore; sensitivity – sensibilità; schedule – orario, tabella di marcia; speed of healing – velocità di guarigione; are yet to – sono ancora da; useful – utile; beyond – oltre; failure – fallimento.

106

Text

AFTER YOU READ Exercise 1. Complete this chart based on the information provided in the abstract.

5. 6.

Interventions assessed topical antimicrobials with steroids vs placebo drops acetic acid vs antibiotic/ steroid drops steroid only drops oral antihistamine + topical steroid vs topical steroid alone steroid vs antibiotic/steroid quinlone vs non-quinlone antibiotic ear clearing (alone)

No. of studies 7. ___________ ___________ ___________

___________ ___________

10.

Exercise 2. True, False or Not Clear, based on this study?

1. The authors state that the overall quality of the studies found in their search was poor. 2. The authors mention no high quality study. 3. The authors give a clear definition of what they mean by “high,” “low,” and “moderate” quality studies. 4. There is no significant therapeutic difference between an oral

antihistamine with topical steroid or topical steroid alone. All topical treatments were similar in their effectiveness The 95% confidence intervals were very broad because few subjects were enrolled in the individual studies. The authors state that more research is needed before any conclusions regarding the most effective interventions for acute otitis externa can be drawn. Symptoms will persist for about one week after starting therapy with antibiotic/steroid drops. If symptoms persist for more than 3 weeks, patients should be given another kind of treatment. The authors state that no studies have been conducted that analyze pain relief.

Exercise 3. Reflect.

107

Take notes while you read! Underline or highlight information, write comments, and/or summarize results this is an evidencebased best practice!

Text 20

Vocabulary practice Exercise 1. Match the English word with its Italian translation.

1. aware 2. elderly

__a__ _____

3. instrument

_____

4. late 5. physician

_____ _____

a) consapevole b) tardi, tardivo c) medico clinico d) anziano e) strumento

109

THE DOCTOR IS IN

Exercise 2. As above.

1. 2. 3. 4. 5.

rating scale should thorough underlying

_____ _____ _____ _____ _____

a) completo b) dovrebbe c) sottostante d) classificare e) scala

Exercise 3. What is the opposite of the following?

1. 2. 3. 4. 5.

depressed high late mental old

happy ___________________ ___________________ ___________________ ___________________

GRAMMAR TO GO! Look at the comparative and superlative forms of adjectives and adverbs. Meaning

Comparative

Superlative

old

vecchio

older than

the oldest

early

presto

earlier than

the earliest

common

frequente

more common than

the most common

severe

severo

more severe than

the most severe

interesting

interessante

more interesting than

the most interesting

good/well

buono/bene

better than

the best

bad/badly

cattivo/male

worse than

the worst

far

lontano

farther than

the farthest

little

poco

less than

the least

few

pochi

fewer than

the fewest

a lot

molto/molti

the most

quickly

velocemente

more quickly

the most quickly

Exercise 1. Translate the following sentence into Italian.

Greater recognition and more aggressive treatment of depression in older patients are needed.

110

READ Exercise 1. Scan the text to find this information.

1. In what journal was this paper published? 2. What institution are the authors affiliated with? 3. What was the rationale of this study?

Text

Exercise 2. Reflect.

AFTER YOU READ Exercise 1. True, False or Not Clear, based on this text?

1. A worse quality of life leads to depression. 2. People who commit suicide tend to be older. 3. Physicians diagnose depression more often is younger patients than in older patients. 4. Depression should be treated more aggressively. 5. Physicians should be more aware of the possibility of depression in their elderly patients.

111

Extra reading

BEFORE YOU READ This section has 12 Abstracts from a number of different journals on a range of topics. In each text you will find some words that are highlighted. Before you read the text, go through all of the highlighted words – do you know what they mean? (The answers are on pp. 155-160 of this textbook.) This exercise is called a “drill” – a very fast, very repetitive exercise to improve your “agility” and speed. You do drills in sports, for example, and you do drills in vocabulary learning too! The objective of this exercise is to improve your “immediate recognition” of core vocabulary terms. Do this exercise quickly – if you know the word, great. If you don’t, don’t worry! You’ll see it again very soon! Do this exercise for all of the texts in this section, including those that you choose not to read. It’s good vocabulary practice, and practice makes perfect!

READING 1. Each text has footnotes with new vocabulary. 2. If necessary, also use the glossary at the back of this textbook. 3. You do not have to read all of the Abstracts in this section. Choose to read the ones that you consider useful, helpful, and relevant. Remember, your time and energy are precious – don’t waste them!

113

THE DOCTOR IS IN

Extra Text 1 NEJM

Volume 362:485-493 Number 6 February 11, 2010

Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death Paul W. Franks, Ph.D., Robert L. Hanson, M.D., M.P.H., William C. Knowler, M.D., Dr.P.H., Maurice L. Sievers, M.D., Peter H. Bennett, M.B., F.R.C.P., and Helen C. Looker, M.B., B.S.

Background The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly1 understood. Methods In a cohort of 4857 American Indian children without diabetes (mean age, 11.3 years; 12,659 examinations) who were born between 1945 and 1984, we assessed whether body-mass index (BMI), glucose tolerance, and blood pressure and cholesterol levels predicted premature death. Risk factors were standardized according to2 sex and age. Proportionalhazards models were used to assess whether each risk factor was associated with time to death occurring3 before 55 years of age. Models were adjusted for baseline age, sex, birth cohort, and Pima or Tohono O’odham Indian heritage4.

1. poorly – scarsamente 2. according to – secondo, in base a 3. occur – avvenire 4. heritage – popolo d’origine 5. strongly – fortemente

114

Results There were 166 deaths from endogenous causes (3.4% of the cohort) during a median follow-up period of 23.9 years. Rates of death from endogenous causes among children in the highest quartile of BMI were more than double those among children in the lowest BMI quartile (incidence-rate ratio, 2.30; 95% confidence interval [CI], 1.46 to 3.62). Rates of death from endogenous causes among children in the highest quartile of glucose intolerance were 73% higher than those among children in the lowest quartile (incidence-rate ratio, 1.73; 95% CI, 1.09 to 2.74). No significant associations were seen between rates of death from endogenous or external causes and childhood cholesterol levels or systolic or diastolic blood-pressure levels on a continuous scale, although childhood hypertension was significantly associated with premature death from endogenous causes (incidence-rate ratio, 1.57; 95% CI, 1.10 to 2.24). Conclusions Obesity, glucose intolerance, and hypertension in childhood were strongly5 associated with increased rates of premature death from endogenous causes in this population. In contrast, childhood hypercholesterolemia was not a major predictor of premature death from endogenous causes.

Extra

Extra Text 2 THE LANCET

Volume 374, Issue 9707, 19 December 2009-1 January 2010, Pages 2064-2071

Directly observed antiretroviral therapy: a systematic review and metaanalysis of randomised clinical trials Nathan Ford, Jean B Nachega, Mark E Engel, Edward J Mills

Background Directly observed therapy has been recommended1 to improve adherence2 for patients with HIV infection who are on highly active antiretroviral therapy, but the benefit and costeffectiveness of this approach has not been established3 conclusively. We did a systematic review and meta-analysis of randomised trials of directly observed versus self-administered antiretroviral treatment. Methods We did duplicate searches of databases (from inception to July 27, 2009), searchable websites of major HIV conferences (up to July, 2009), and lay4 publications and websites (March–July, 2009) to identify randomised trials assessing directly observed therapy to promote adherence to antiretroviral therapy in adults. Our primary outcome was virological suppression at study completion. We calculated relative risks (95% CIs), and pooled estimates using a random5-effects method.

reading

Findings 12 studies met our inclusion criteria6; four of these were done in groups that were judged to be at high risk of poor adherence (drug users and homeless people7). Ten studies reported on the primary outcome (n=1862 participants); we calculated a pooled relative risk of 1·04 (95% CI 0·91–1·20, p=0·55), and noted moderate heterogeneity between the studies (I2= 53·8%, 95% CI 0–75·7, p=0·0247) for directly observed versus self-administered treatment. Interpretation Directly observed antiretroviral therapy seems to offer no benefit over self-administered treatment, which calls into question8 the use of such an approach to support adherence in the general patient population. Funding: None9.

1. recommend – consigliare 2. adherence – conformità; aderenza, adesione 3. establish – stabilire 4. lay – laico, profano, per non addetti al settore 5. random – casuale 6. meet criteria – soddisfare criteri 7. homeless people – senza tetto 8. call into question – mettere in discussione 9. none – nessuno, niente

115

THE DOCTOR IS IN

Extra Text 3 BMC MEDICAL RESEARCH METHODOLOGY

2009, 9:79doi:10.1186/1471-2288-9-79Volume 9

Research article Extent of publication bias1 in different categories of research cohorts: a metaanalysis of empirical studies Fujian Song 1,2 , Sheetal Parekh-Bhurke 2 , Lee Hooper 1 , Yoon K Loke 1 , Jon J Ryder 1 , Alex J Sutton 3 , Caroline B Hing4 and Ian Harvey 1. 1 School of Medicine, Health Policy and Practice, University of East Anglia, Earlham Road, Norwich, NR4 7TJ, UK; 2 School of Allied Health Professions, University of East Anglia, Earlham Road, Norwich, NR4 7TJ, UK; 3 Department of Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; 4 Watford General Hospital, 60 Vicarage Road, Watford, Hertfordshire, WD18 0HB, UK

1. bias – pregiudizio; errore sistematico, difetto 2. threatened – minacciato 3. comprise – consistere; rappresentare 4. ascertain – stabilire; accertare 5. strength – forza 6. consistency – coerenza; omogeneità 7. track – seguire le tracce 8. inception – inizio 9. submit – sottoporre 10. fate – destino

Background The validity of research synthesis is threatened2 if published studies comprise3 a biased selection of all studies that have been conducted. We conducted a meta-analysis to ascertain4 the strength5 and consistency6 of the association between study results and formal publication. Methods The Cochrane Methodology Register Database, MEDLINE and other electronic bibliographic databases were searched (to May 2009) to identify empirical studies that tracked7 a cohort of studies and reported the odds of formal publication by study results. Reference lists of retrieved articles were also examined for relevant studies. Odds ratios were used to measure the association between formal publication and significant or positive results. Included studies were separated into subgroups according to starting time of follow-up, and results from individual cohort studies within the subgroups were quantitatively pooled.

116

Results We identified 12 cohort studies that followed up research from inception8, four that included trials submitted9 to a regulatory authority, 28 that assessed the fate10 of studies presented as conference abstracts, and four cohort studies that followed manuscripts submitted to journals. The pooled odds ratio of publication of studies with positive results, compared to those without positive results (publication bias) was 2.78 (95% CI: 2.10 to 3.69) in cohorts that followed from inception, 5.00 (95% CI: 2.01 to 12.45) in trials submitted to regulatory authority, 1.70 (95% CI: 1.44 to 2.02) in abstract cohorts, and 1.06 (95% CI: 0.80 to 1.39) in cohorts of manuscripts. Conclusion Dissemination of research findings is likely to be a biased process. Publication bias appears to occur early, mainly before the presentation of findings at conferences or submission of manuscripts to journals.

Extra

Extra Text 4 JAMA

Vol. 302 No. 24, December 23/30, 2009

Ginkgo biloba for Preventing Cognitive Decline in Older Adults: A Randomized Trial Beth E. Snitz, PhD; Ellen S. O’Meara, PhD; Michelle C. Carlson, PhD; Alice M. Arnold, PhD; Diane G. Ives, MPH; Stephen R. Rapp, PhD; Judith Saxton, PhD; Oscar L. Lopez, MD; Leslie O. Dunn, MPH; Kaycee M. Sink, MD; Steven T. DeKosky, MD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators

Context The herbal product Ginkgo biloba is taken1 frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking2 regarding its effect on long-term cognitive functioning. Objective To determine whether G biloba slows3 the rates of global or domain-specific cognitive decline in older adults. Design, Setting, and Participants The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling4 participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years. Intervention Twice-daily5 dose of 120mg extract of G biloba (n = 1545) or identical-appearing placebo (n = 1524).

reading

Main Outcome Measures Rates of change over time in the Modified MiniMental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores6 of individual tests. Results Annual rates of decline in z scores did not differ between G biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.0320.050), attention (0.043; 95% CI, 0.0370.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.0970.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment7), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education8, APOE*E4 allele, or baseline mild cognitive impairment (P > .05). Conclusion Compared with placebo, the use of G biloba, 120 mg twice daily, did not result in9 less cognitive decline in older adults with normal cognition or with mild cognitive impairment. 1. take – prendere; assumere (farmaco) 2. be lacking – mancare, essere assente 3. slow – rallentare 4. community-dwelling – residenti (di una località) 5. twice daily – due volte al giorno 6. score – punteggio 7. impairment – deterioramento, compromissione 8. education – istruzione 9. result in – comportare, avere come conseguenza

117

THE DOCTOR IS IN

Extra Text 5 STROKE

2010;41:187-190 Published online before print November 5, 2009

Low Pessimism Protects Against Stroke: The Health and Social Support (HeSSup) Prospective Cohort Study Hermann Nabi, PhD; Markku Koskenvuo, MD, PhD; Archana Singh-Manoux, PhD; Jyrki Korkeila, MD, PhD; Sakari Suominen, MD, PhD; Katariina Korkeila, MD, PhD; Jussi Vahtera, MD, PhD Mika Kivimäki, PhD From INSERM U687-IFR69 (H.N., A.S.-M.), Villejuif, France; the Department of Public Health (M. Koshenvuo), University of Helsinki, Helsinki, Finland; the Department of Epidemiology and Public Health (A.S.-M., M. Kivimäki), University College London, London, UK; the Department of Psychiatry (J.K.), University of Turku and Harjavalta Hospital, Turku, Finland; the Department of Public Health (S.S., J.V.), University of Turku and Turku University Hospital, Turku, Finland; Municipal Health Care (K.K.), Turku, Finland; and the Finnish Institute of Occupational Health (J.V., M. Kivimäki), Helsinki, Finland.

Background and Purpose The association between optimism and pessimism and health outcomes has attracted increasing research interest. To date, the association between these psychological variables and risk of stroke remains unclear1. We examined the relationship2 between pessimism and the 7-year incidence of stroke.

1. unclear – non chiaro 2. relationship – rapporto 3. lead to – portare a, avere come risultato 4. feeling – sentimento; sensazione; stato 5. stressfulness – stato di stress 6. behavior – comportamento

118

Methods A random sample of 23 216 adults (9480 men, 13 796 women) aged 20 to 54 years completed the pessimism scale in 1998, that is, at study baseline. Fatal and first nonfatal stroke events during a mean follow-up of 7.0 years were documented by linkage to the national hospital discharge and mortality registers leading to3 105 events. Results Unadjusted hazard ratio was 0.44 (95% CI, 0.25 to 0.77) for participants in the lowest quartile (a low pessimism level) when compared with those in the highest quartile (a high pessimism level). After serial adjustments for sociodemographic characteristics, cardiovascular biobehavioral risk factors, depression, general feeling4 of stressfulness5, and ischemic heart disease, the fully adjusted hazard ratio was 0.52 (95% CI, 0.29 to 0.93). Conclusions In this population of adult men and women, low level of pessimism had a robust association with reduced incidence of stroke. Key Words epidemiology • pessimism • psych & behavior6

Extra

Extra Text 6 AM J OBSTET GYNECOL

2010;202:266.e1-6

Effects of recommended levels of physical activity on pregnancy1 outcomes Katarina Melzer, PhD a b, Yves Schutz, PhD c, Nina Soehnchen, MD, PhD b, Veronique Othenin-Girard, RM b, Begoña Martinez de Tejada, MD, PhD b, Olivier Irion, MD, PhD b, Michel Boulvain, MD, PhD b, Bengt Kayser, MD, PhD a. a Institute of Movement Sciences and Sports Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; b Department of Obstetrics and Gynaecology, University Hospitals of Geneva, Faculty of Medicine, University of Geneva, Geneva, Switzerland; c Department of Physiology, University of Lausanne, Lausanne, Switzerland Reprints: Bengt Kayser, MD, PhD, Institute of Movement Sciences and Sports Medicine, Faculté de médecine, Université de Genève, 10 rue du Conseil Général, 1205 Genève Supported by a competitive Grant attributed to Drs Boulvain and Kayser by the Centre de Recherche Clinique, the Faculty of Medicine, University of Geneva, and the University Hospitals of Geneva, Switzerland.

Objective We sought to examine the relation between recommended levels of physical activity during pregnancy and pregnancy outcomes.

reading

Study Design We conducted an observational study with energy expenditure2, aerobic fitness3, and sleeping4 heart rate5 measured in 44 healthy women in late pregnancy. Medical records6 were examined for pregnancy outcome. Results Active women, who engaged in7 ⭓30 minutes of moderate physical activity per day, had significantly better fitness and lower sleeping heart rate compared to the inactive. Duration of second stage8 of labor9 was 88 and 146 minutes in the active vs inactive women, respectively (P = .05). Crude odds ratio of operative delivery10 in the inactive vs the active was 3.7 (95% confidence interval, 0.87–16.08). Birth weight, maternal weight gain11, and parity adjusted odds ratio was 7.6 (95% confidence interval, 1.23–45.8). Neonatal condition and other obstetric outcomes were similar between groups. Conclusion Active women have better aerobic fitness as compared to inactive women. The risk for operative delivery is lower in active women compared to inactive, when controlled for birth weight, maternal weight gain, and parity. Further studies with larger sample size are required to confirm the association between physical activity and pregnancy outcomes. Key words: delivery, labor, physical activity, pregnancy outcome

1. pregnancy – gravidanza 2. expenditure – dispendio 3. fitness – forma fisica 4. sleep – dormire 5. heart rate – battito cardiaco 6. medical record – cartella clinica 7. engage in – partecipare 8. stage – stadio 9. labor – travaglio; lavoro 10. delivery – parto; consegna, erogazione 11. gain – aumento; guadagno

119

THE DOCTOR IS IN

Extra Text 7 J THORAC ONCOL.

2010 Feb 5. [Epub ahead of print]

Self-Selection1 Effects in Smokers2 Attending 3 Lung Cancer Screening: A 9.5-Year Population-Based Cohort Study in Varese, Italy. Dominioni L, Rotolo N, Poli A, Paolucci M, Sessa F, D’ambrosio V, Paddeu A, Mantovani W, Imperatori A. Center for Thoracic Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy; Department of Medicine and Public Health, University of Verona, Verona, Italy; Department of Radiology, Ospedale S. Antonio Abate, Gallarate, Italy; Department of Human Morphology, University of Insubria, Varese, Italy; Thoracic Medicine Unit, Department of Medicine, Ospedale S. Antonio Abate, Gallarate, Italy; and Respiratory Care Unit, Department of Medicine, Ospedale S. Anna, Como, Italy.

Background: We hypothesize that mortality risk profile of participants and nonparticipants in nonrandomized lung cancer (LC) screening of smokers may be different. Methods: In 1997, a population-based cohort of 5815 smokers of Varese Province was invited to nonrandomized LC screening by annual chest4 x-ray5 examination for 4 years. LC risk factors and screening participation rate were recorded. Except6 for screening, the whole7 cohort received usual care. After 9.5-year observation, we compared mortality of participants versus nonparticipants by assessing agestandardized all-cause mortality rate ratio (MRR) and disease group-specific MRR with 95% confidence intervals (95% CI). 1. self-selection – autoselezione 2. smoker – fumatore 3. attend – frequentare; partecipare 4. chest – torace 5. x-ray – radiografia 6. except – eccetto, tranne 7. whole – intero 8. dual – duplice

120

Results: Self-selected screening participants were 21% of cohort. Participants were younger (p < 0.001), were more frequently current smokers (p = 0.019), had more pack-years of smoking (p < 0.0001), and had higher rate of LC family history (p < 0.0001) and of occupational LC risk (p < 0.0001) relative to nonparticipants. In logistic regression analysis familial LC, occupational risk and pack-years smoked were significant predictors of participation in screening and of developing LC. Participants displayed a healthy effect, as shown by allcause MRR = 0.67 (95% CI, 0.53-0.84), all cancers except LC MRR = 0.61 (95% CI, 0.41-0.91), cardiovascular diseases MRR = 0.38 (95% CI, 0.22-0.63), and noncancer disease other than cardiovascular or respiratory MRR = 0.57 (95% CI, 0.340.92). The LC mortality (MRR = 1.40; 95% CI, 1.03-1.91) was higher in participants relative to nonparticipants (p = 0.031). Conclusion: The selection effect in LC screening participants was dual8: healthy effect and higher LC mortality. In assessing the overall effectiveness of LC screening on a population level, a higher LC mortality risk in participants should be considered.

Extra

Extra Text 8 BMJ

2010;340: b5479 doi: 10.1136/bmj.b5479

Social variations in access1 to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics Rosalind Raine,1 Wun Wong,1 Shaun Scholes,1 Charlotte Ashton,1 Austin Obichere,2 Gareth Ambler 3. 1Department of Epidemiology and Public Health, University College London, London WC1E 6BT; 2University College London Hospital, London NW1 2PG; 3Department of Statistical Science, University College London

Study question2 Does type of hospital admission (emergency compared with elective3) and surgical procedure for colorectal, breast, and lung cancer vary by socioeconomic circumstances, age, sex, and year of admission? Summary4 answer5 Despite the implementation of the NHS Cancer Plan, social factors still strongly influence access to and the provision6 of care in England. What is known and what this paper adds7 The NHS Cancer Plan aimed8 to improve outcomes overall and to reduce health inequalities. In this study, living in deprived9 areas and being male were associated with lower likelihood of receiving preferred surgical procedures for cancers within the National Health Service (NHS); older people were more likely to receive the preferred surgical procedure for rectal cancer but less likely to receive breast conserving surgery and lung cancer resection. Participants and setting 564 821 patients aged 50 and above admitted to NHS hospitals in England between 1 April 1999 and 31 March 2006 with a diagnosis of colorectal, lung, and breast cancer. Design Repeated cross sectional study with data on individual patients from the hospital episode statistics (HES) dataset.

reading

Primary outcomes Proportion of patients admitted as emergencies and receiving recommended surgical treatment. Main results and the role of chance Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and that for patients with lung cancer aged 8089 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for deprived patients over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, over10 67% of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 76% of patients in the least deprived fifth (1.34, 1.22 to 1.47); and 54% of patients in the most deprived fifth had breast conserving surgery compared with 64% of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. The adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 0.52 (0.46 to 0.59). Bias, confounding11, and other reasons for caution12 Routinely collected data have limited completeness and accuracy13 of data coding14 but there is no reason15 to assume16 that these limitations should be correlated with deprivation, sex, or age of patients. We used the index of multiple deprivation (IMD), an established method of assigning17 socioeconomic characteristics based on area of residence that assumes individuals conform to the socioeconomic profile of their area. Data are unavailable on tumour stage, case mix, and preference

121

1. access – accesso 2. question – domanda 3. elective – facoltativo; programmato 4. summary – riassunto 5. answer– risposta 6. provision – erogazione 7. add – aggiungere 8. aim – mirare, avere come obiettivo 9. deprived – privato; povero 10. over – più di 11. confounding/confounders – che creano confusione, che distorcono 12. caution – cautela 13. accuracy – accuratezza, precisione 14. data coding – codifica dei dati 15. reason – ragione, motivo 16. assume – suppore; dare per scontato 17. assign – assegnare

THE DOCTOR IS IN

of patients, which are potential confounders. Generalisability to other populations These findings apply to18 patients admitted to NHS hospitals in England with colorectal, breast, or lung cancer.

18. apply to â&#x20AC;&#x201C; riguardare

122

Study funding/potential competing interests The research was funded in part by the Legal and General Group and the Institute of Actuaries. The authorsâ&#x20AC;&#x2122; work was independent of the funders.

Extra

Extra Text 9 ANN INTERN MED MARCH

16, 2010, vol. 152 no. 6 346-357

The Effects of Salsalate on Glycemic Control in Patients With Type 2 Diabetes Allison B. Goldfine, MD; Vivian Fonseca, MD; Kathleen A. Jablonski, PhD; Laura Pyle, MS; Myrlene A. Staten, MD; and Steven E. Shoelson, MD, PhD for the TINSAL-T2D (Targeting Inflammation Using Salsalate in Type 2 Diabetes) Study Team* Author Affiliations: Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts; Tulane University, New Orleans, Louisiana; The George Washington University, Rockville, Maryland; and the National Institute of Diabetes and Digestive and Kidney Diseases, Washington, DC.

Background: Salsalate, a nonacetylated prodrug of salicylate, has been shown to decrease blood glucose concentration in small studies. Objective: To compare the efficacy and safety of salsalate at different doses in patients with type 2 diabetes. Design: Parallel randomized trial with computer-generated randomization and centralized allocation. Patients and investigators, including1 those assessing outcomes and performing analyses, were masked2 to group assignment. (ClinicalTrials.gov registration number: NCT00392678) Setting: 3 private practices3 and 14 universities in the United States. Patients: Persons aged 18 to 75 years with fasting4 plasma glucose concentrations of 12.5 mmol/L or less (≤225 mg/dL) and hemoglobin A1c (HbA1c) levels of 7.0% to 9.5% treated by diet, exercise, and oral medication at stable doses for at least 8 weeks. Intervention: After a 4-week, singlemasked run-in period, patients were randomly5 assigned to receive placebo or salsalate in dosages of 3.0, 3.5, or 4.0 g/d for 14 weeks (27 patients each) in addition to their current therapy.

reading

Measurements: Change in HbA1c was the primary outcome. Adverse effects and changes in measures of coronary risk and renal function were secondary outcomes. Results: Higher proportions of patients in the 3 salsalate treatment groups experienced decreases in HbA1c levels of 0.5% or more from baseline (P = 0.009). Mean HbA1c changes were –0.36% (P = 0.02) at 3.0 g/d, –0.34% (P = 0.02) at 3.5 g/d, and –0.49% (P = 0.001) at 4.0 g/d compared with placebo. Other markers of glycemic control also improved in the 3 salsalate groups, as did6 circulating triglyceride and adiponectin concentrations. Mild hypoglycemia was more common with salsalate; documented events occurred only in patients taking sulfonylureas. Urine albumin concentrations increased in all salsalate groups compared with placebo. The drug was otherwise7 well tolerated. Limitation: The number of patients studied and the trial duration were insufficient to warrant8 recommending the use of salsalate for type 2 diabetes at this time. Conclusion: Salsalate lowers HbA1c levels and improves other markers of glycemic control in patients with type 2 diabetes and may therefore provide a new avenue9 for treatment. Renal and cardiac safety of the drug require further evaluation.

1. including – compreso 2. masked – celato, nascosto; bendato 3. private practice – attività di libera professione 4. fasting – a digiuno 5. randomly – in modo casuale 6. as did – così come 7. otherwise – altrimenti; per il resto 8. warrant – giustificare 9. avenue – strada, via

123

THE DOCTOR IS IN

Extra Text 10 PEDIATRICS

2006 Jun;117(6):e1263-71

Pediatric eye1 injury-related hospitalizations in the United States. Brophy M, Sinclair SA, Hostetler SG, Xiang H., Center for Injury Research and Policy, Children’s Research Institute, Columbus Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

1. eye – occhio 2. injury – lesione, infortunio 3. nearly – quasi 4. focus on – focalizzare, porre l’attenzione 5. rely on – fare affidamento; dipendere, contare su 6. charge – costo (al paziente/sistema/consumato re) 7. inpatient – paziente ospedaliero, ricoverato 8. guidelines – linee guida 9. expected – atteso, previsto 10. payer – colui che paga 11. determine – identificare, stabilire 12. weighted – pesato (termine statistico) 13. actual – reale 14. open wound – ferita aperta 15. crash – scontro, incidente 16. struck – colpito 17. by or against – da o contro 18. cut or pierced – tagliato o perforato/trafitto 19. at home – a casa 20. hazardous – pericoloso 21. goal - traguardo 22. eyewear – occhiali (generico)

Objective: An estimated 2.4 million eye injuries2 occur in the United States each year, with nearly3 35% of injuries among persons aged 17 years or less. Although previous research has identified some of the characteristics of pediatric eye injuries, many studies focused4 only on a specific patient population or type of eye injury or relied on5 self-reported data. In addition, little information has been reported on the total charges6 associated with treating pediatric eye injuries. Using a large national database, our aim was to examine hospitalizations for the treatment of pediatric eye injuries in the United States, including the demographic, medical care, and financial characteristics associated with major categories of eye injury. Methods: Cross-sectional data were derived from the 2000 Kids’ Inpatient7 Database of the Healthcare Cost and Utilization Project. Eye injury-related hospitalizations were identified by using International Classification of Disease, Ninth Revision, Clinical Modification codes. Discharges were selected if the eye injury was the principal or secondary diagnosis. Guidelines8 from the Centers for Disease Control and Prevention were used to group external-cause-of-injury codes into broader categories to allow meaningful comparison with previous studies. The reported charges for the treatment of eye injuries and the expected9 primary payer10 were determined11. Cases were statistically

124

weighted12 to produce national estimates of hospitalizations for pediatric eye injuries and to determine the characteristics of these injuries. Results: Data were collected by the Kids’ Inpatient Database for 3834 actual13 eye injury-related hospitalizations. These records represent an estimated 7527 eye injury-related hospitalizations among children aged 20 years or less in the United States during 2000. Inpatient charges for the treatment of these injuries were more than $88 million. The rate of hospitalization for pediatric eye injuries in the United States in 2000 was 8.9 per 100,000 persons aged 20 years or less. Young adults aged 18 to 20 years accounted for the highest percentage of hospitalizations (23.7%). Males accounted for 69.7% of hospitalizations. A majority of hospitalizations were for open wounds14 of the ocular adnexa. Motor vehicle crash15 was the most common cause of injury, followed by being struck16 by or against17 an object and being cut or pierced18. Conclusions: These findings illustrate the considerable morbidity, financial burden, and proximal causes for pediatric eye injury-related hospitalizations. Our data support the need for eye injury prevention efforts that consider the age, gender, and developmental stage of children. Educating parents and children about the potential for eye injuries at home19 and during hazardous20 activities is an important public health goal21. In addition, promoting the use of appropriate protective eyewear22 by children during activities with a high risk of ocular trauma will help prevent future eye injuries.

Extra

Extra Text 11 BMC MEDICINE

2010, 8:11doi:10.1186/1741-7015-8-11, Published:1 February 2010

Research article Incidence, detection, and tumour stage of breast cancer in a cohort of Italian women with negative screening mammography report recommending early (short-interval) rescreen Alessandra Ravaioli 1 , Flavia Foca 1 , Americo Colamartini 1 , Fabio Falcini 1 , Carlo Naldoni 2 , Alba C Finarelli 2 , Priscilla Sassoli de Bianchi 2 and Lauro Bucchi 1. 1 Romagna Cancer Registry, IRST, 47014 Meldola, Forlì, Italy, 2 Department of Health, Emilia-Romagna Region, 40127 Bologna, Italy

Background Although poorly described in the literature, the practice of early (short-interval) rescreen after a negative screening mammogram is controversial due to its financial and psychological burden and because it is of no proven benefit. Methods The present study targeted an Italian 2-yearly screening programme (Emilia-Romagna Region, 1997-2002). An electronic dataset of 647,876 eligible negative mammography records from 376,257 women aged 50-69 years was record-linked with the regional breast cancer registry. The statistical analysis addressed the following research questions: (1) the prevalence of recommendation for early (<24 months) rescreen (RES) among negative mammography reports; (2) factors associated with the likelihood of a women receiving RES; and (3) whether women receiving RES and women receiving standard negative reports differed in terms of proportional incidence of interval breast cancer, recall rate at the next1 rescreen, detection rate of breast cancer at the next rescreen and the odds of having late-stage breast cancer during the interscreening interval and at the next rescreen.

reading

Results RES was used in eight out of 13 screening centres, where it was found in 4171 out of 313,320 negative reports (average rate 1.33%; range 0.05%-4.33%). Reports with RES were more likely for women aged 50-59 years versus older women (odds ratio (OR) 1.33; 95% CI 1.25-1.42), for the first versus subsequent screening rounds (OR 1.91; 95% CI 1.792.04) and with a centre-specific2 recall rate below the average of 6.2% (OR 1.41; 95% CI 1.32-1.50). RES predicted a 3.51fold3 (95% CI 0.94-9.29) greater proportional incidence of first-year interval cancers, a 1.90-fold (95% CI 1.622.22) greater recall rate at the next screen, a 1.72-fold (95% CI 1.01-2.74) greater detection rate of cancer at the next screen and a non-significantly decreased risk of late disease stage (OR 0.59; 95% CI 0.23-1.53). Conclusion The prevalence of RES was in line with the maximum standard level established by the Italian national guidelines. RES identified a subset of women with greater incidence of interval cancers and greater prevalence of cancers detected at the next screen.

1. next – prossimo; successivo 2. centre-specific – riferito ad un centro di screening specifico 3. 3.51-fold – 3.51 volte (-fold = volte)

125

THE DOCTOR IS IN

Extra Text 12 BMC MEDICINE

2010, 8:15doi:10.1186/1741-7015-8-15 The electronic version of this article is the complete one and can be found online at: http://www. biomedcentral.com/1741-7015/8/15 Received: 27 January 2010, Accepted: 23 February 2010, Published: 23 February 2010 © 2010 Fässler et al; © 1999-2010 BioMed Central Ltd unless otherwise stated.

Research article Frequency and circumstances of placebo use in clinical practice - a systematic review of empirical studies Margrit Fässler1, Karin Meissner2,3, Antonius Schneider3 and Klaus Linde 3. 1 Institute of Biomedical Ethics, University of Zurich, 8008 Zurich, Switzerland; 2 Institute of Medical Psychology, Ludwig-Maximilians University, 80336 Munich, Germany; 3 Institute for General Practice, Technische Universität München, 81667 Munich, Germany

1. outside – al di fuori 2. summarize – riassumere 3. in order to – per, con lo scopo di 4. attitude – atteggiamento; opinione 5. reviewer – revisore, valutatore 6. summary – riassunto 7. shortcoming – limite; difetto 8. nurse – infermiere 9. much more – molto più 10. reliable – affidabile, attendibile 11. agreement – accordo; concordanza 12. judge – giudicare, valutare 13. towards – verso; nei confronti di 14. face – trovarsi davanti, affrontare 15. confusing – che crea confusione, confonde 16. at times – a volte 17. doubt – dubbio 18. negligible – insignificante 19. view – veduta; opinione

Background The use of placebo interventions outside1 clinical trials is ethically, professionally and legally controversial. Little is known about the frequency and circumstances of placebo use in clinical practice. Our aim was to summarize2 the available empirical studies addressing these issues. Methods We searched PubMed and EMBASE from inception to July 2009 in order to3 identify cross-sectional surveys, qualitative or longitudinal studies among health care professionals, students or patients which investigated at least one of the following issues - frequency of placebo use or attitudes4 to, or motivations for, the use of placebo interventions. At least two reviewers5 extracted information on the study methods, participants and findings. Descriptive summaries6 were prepared in an iterative process by at least two reviewers per study.

126

Results Twenty-two studies from 12 different countries met the inclusion criteria. Most studies had relevant shortcomings7. The proportion of respondents reporting that they had applied ‘pure’ placebos (for example, saline injection) during their professional life varied between 17% and 80% among physicians and between 51% and 100% among nurses8, but it seems that the actual frequency of such use seems to be rare. The use of ‘impure’ or ‘active’ placebos (for example, antibiotics for viral infections) is likely to be much more9 frequent. However, it is impossible to make a reliable10 estimation because there is no agreement11 of what an impure placebo might be. Studies using qualitative methods or asking participants to judge12 case examples suggest that motivations and attitudes towards13 placebo use are complex and health care providers are often faced14 with a dilemma. Conclusions Although the available evidence is incomplete and confusing15 at times16, there can be little doubt17 that the prevalence of placebo use outside of clinical trials is not negligible18 and that views19 and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues.

Answer key

Reading TEXT 1

Exercise 1.

Vocabulary practice Exercise 1.

1. 2. 3. 4. 5.

D – incidere su, influire C – invecchiamento E – sfondo, premessa A – rispetto a, paragonato a B – calo, diminuzione

1. 2. 3. 4. 5.

Exercise 2.

1. 2. 3. 4. 5.

C – raddoppiare D – sforzo B – spiegare E – aumento A – necessario

7. 8. 9.

Stroke. 2010 Abstract George M. Savva, PhD; Blossom C.M. Stephan, PhD The Alzheimer’s Society Vascular Dementia Systematic Review Group From the Department of Public Health and Primary Care, University of Cambridge; Institute of Public Health, Cambridge, UK To review studies on the excess risk of dementia in those with stroke compared with those without stroke is not well known. A systematic review. Original studies: unknown; Systematic review: probably the UK 16 studies

Exercise 3.

1. 2. 3. 4. 5.

D – vecchio B – scopo A – ictus E – sopravvivenza C – senza

Comprehension Exercise 1

Exercise 4.

1 2 3 4 5 6

Noun comparison explanation increase indentification reduction survival

Verb compare explain increase identify reduce survive

1. False 2. True 3. False 4. NC 5. NC 6. True 7. True 8. True 9. True 10. False

Exercise 5.

1. 2. 3. 4.

come/stop decrease less young

127

THE DOCTOR IS IN

Exercise 3.

TEXT 2

1. 2. 3. 4. 5.

Vocabulary practice Exercise 1.

1. 2. 3. 4. 5.

D – rappresentare A – prevedere E – benefico C – seno, mammella B – carico, peso

Exercise 4.

1. 2. 3. 4. 5.

Exercise 2.

1. 2. 3. 4. 5.

C – presto, precoce E – stima A – crescere, aumentare B – esito, prognosi D – globale, complessivo

C – possibilità, occasione D – cambiamento E – decennio A – riscontro, rilevamento B – patologia

A – in precedenza D – promuovere, favorire E – tasso, percentuale B – ridurre C – notevole

Exercise 5.

1. 2. 3. 4. 5. 6.

Infinitive be grow have make think can/be able to

Past simple was/were grew had made thought could

Past participle been grown had made thought been able

Meaning essere crescere avere fare pensare potere

Exercise 6.

Noun 1. observation 2. assumption 3. detection 4. estimate 5. explanation 6. increase 7. introduction 8. prevention 9. screening 10. testing 11. treatment

128

Verb observe assume detect estimate explain increase introduce prevent screen test treat

Meaning osservare supporre rilevare, riscontrare stimare spiegare aumentare introdurre prevenire vagliare testare trattare, curare

Answer

key

Grammar

Comprehension

Exercise 1

Exercise 1.

1. 2. 3. 4. 5.

Past simple PPS PPS PPS PPS

True False False False Not clear

Exercise 2

1. L’incidenza di questi tumori aumentò dopo l'introduzione dello screening nel 1980. 2. L’incidenza di questi tumori non è mai tornata ai livelli pre-screening. 3. Lo screening è stato promosso come il miglior modo per ridurre la morbilità e la mortalità associate alla malattia. 4. Due decenni di screening hanno avuto come esito un aumento significativo del riscontro dei tumori precoci. 5. Testare gli antigeni prostatici specifici ha quasi raddoppiato la possibilità che a un uomo venga diagnosticato un tumore della prostata nella sua vita.

Reading Exercise 1.

1. JAMA 2. October 21, 2009 3. Abstract 4. Laura Esserman, MD, MBA; Yiwey Shieh, AB; Ian Thompson, MD 5. Department of Surgery and Radiology (Dr Esserman) and School of Medicine (Mr Shieh), University of California, San Francisco, and Department of Urology, University of Texas Health Science Center, San Antonio (Dr Thompson).Corresponding Author: Laura Esserman, MD, MBA, Carol Franc Buck Cancer Center, University of California, San Francisco 6. The early 1990s 7. 26% 8. 50% 9. 70% 10. 1 in 6 11. 1 in 116 12. 1 in 8 13. 1 in 12

TEXT 3 Vocabulary practice Exercise 1.

1. False – rappresentare 2. False – valutare 3. True 4. False – entrambi 5. False – causale 6. False – morte 7. False – salute 8. False – tuttavia 9. True 10. True 11. True 12. True 13. True 14. True 15. False – tabagismo Exercise 2.

1. 2. 3. 4. 5. 6. 7.

C – valore iniziale, inizio E – sviluppo F – anziano D – nucleo familiare, ambiente domestico G – polmone A – perciò B – attraverso

Exercise 3.

1. 2. 3. 4. 5. 6.

passive life young male decreased narrow

129

THE DOCTOR IS IN

Exercise 4.

1. 2. 3. 4. 5. 6. 7.

Noun association assessment development enrollment exposure predisposition smoking

Verb associate assess develop enroll expose predispose smoke

Meaning associare valutare sviluppare arruolare esporre predisporre fumare

Syntax practice Exercise 1.

1. Cinquemila donne furono arruolate nello studio. 2. Fu valutato il rapporto tra il fumo passivo e lo sviluppo di TB, con correzioni per altre caratteristiche iniziali (baseline). 3. L’evidenza crescente ha identificato il fumo come fattore causale della tubercolosi (TB). 4. L’esposizione passiva al fumo di tabacco nell’ambiente domestico fu associata indipendentemente con BPCO. 5. L’effetto dell’esposizione al fumo passivo sulla TB non è stato chiarito/rivelato/spiegato.

Reading Exercise 1.

1. 2. 3. 4.

6. 7. 8. 9.

Archives of Internal Medicine February 8, 2010 Abstract Leung CC, Lam TH, Ho KS, Yew WW, Tam CM, Chan WM, Law WS, Chan CK, Chang KC, Au KF. Not explicitly stated; probably to study “the effect of secondhand tobacco smoke exposure on TB”. Not explicity stated; probably a prospective cohort study 15,486 women never-smokers; aged 65 to 74 years; living with their surviving husband Elderly Health Centers in Hong Kong

Comprehension Exercise 1.

1. 2. 3. 4. 5.

130

True Not clear Not clear True True

6. True 7. Not clear 8. False

TEXT 4 Vocabulary practice Exercise 1.

1. 2. 3. 4. 5.

assess before demonstrate aim; objective increasing

Exercise 2.

1. 2. 3. 4. 5.

C – progressi E – concedere D – movimento laterale A – chirurgico B – spessore

Exercise 3.

1. 2. 3. 4. 5.

E – tempistica B – verso A – sottoporre D – se C – produrre

Exercise 4.

1. 2. 3. 4.

bad less men older

Exercise 5.

1. 2. 3. 4. 5. 6. 7.

Noun change diagnosis evaluation performance reduction surgery meaning

Verb change diagnose evaluate perform reduce operate mean

Meaning cambiamento diagnosi valutazione esecuzione riduzione chirurgia significato

Answer

key

Reading Exercise 1.

1. Radiology 2. February 2010 3. An abstract 4. Courtney A. Coursey, MD, Rendon C. Nelson, MD, Mayur B. Patel, MD, Courtney Cochran, BSRT, RDMS, Leslie G. Dodd, MD, David M. DeLong, PhD, Craig A. Beam, PhD and Steven Vaslef, MD, PhD; 5. Departments of Radiology (C.A.C., R.C.N., C.C., D.M.D., C.A.B.), Surgery (M.B.P., S.V.), and Pathology (L.G.D.), Duke University Medical Center, Box 3808, Erwin Road, Durham, NC 6. To determine the frequency of preoperative computed tomography (CT) in the evaluation of patients suspected of having appendicitis at one institution during the past 10 years and to determine whether changes in CT utilization were associated with changes in the negative appendectomy rate. 7. Retrospective study 8. 925 9. Patients who underwent urgent appendectomy between January 1998 and September 2007. 10. Patients who were younger than 18 years of age at the time of surgery.

Comprehension Exercise 1.

1. False/Not clear 2. Not clear 3. True 4. True 5. Not clear 6. Not clear 7. Not clear 8. True 9. False 10. True

Just for fun! 1. 2. 3. 4. 5. 6. 7.

make a diagnosis do laboratory tests make a house call (visita a domicilio) make a mistake do a CT make rounds do an operation

TEXT 5 Vocabulary practice Exercise 1.

1. (a) mese 2. (a) come 3. (a) raccogliere 4. (b) attuare 5. (b) migliorare 6. (a) media 7. (b) misura, parametro 8. (a) misurazione 9. (b) incolumità 10. (b) contesto 11. (b) in modo significativo 12. (a) mantenere Exercise 2.

1. D – raggiungere un obiettivo 2. C – sangue; circolo ematico 3. B – ampio 4. A – cambiamento 5. E – mediana 6. L – principale 7. G – media 8. F – esito 9. H – tasso 10. I – chi investe o ha interessi in un progetto Exercise 3.

1. (1) to evaluate (2) reductions (3) infections 2. (1) collaborative (2) implement (3) interventions 3. (1) sustainability (2) infection (3) change

131

THE DOCTOR IS IN

Exercise 4.

1. verb 2. verb 3. noun 4. adverb/adjective 5. noun 6. verb 7. noun 8. adjective 9. noun 10. adverb

Reading Exercise 1.

1. 2. 3. 4.

BMJ February 4, 2010 An Abstract Peter J Pronovost, Christine A Goeschel, Elizabeth Colantuoni, Sam Watson, Lisa H Lubomski, assistant professor 1, Sean M Berenholtz, David A Thompson, David J Sinopoli, Sara Cosgrove, J Bryan Sexton, Jill A Marsteller, Robert C Hyzy, Robert Welsh, Patricia Posa, Kathy Schumacher, Dale Needham. 5. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, USA; Michigan Health and Hospital Association Keystone Center, Lansing, MI 48917, USA; Carey Business School, Johns Hopkins University, Baltimore, MD USA,

7. 8. 9.

Division of Infectious Diseases, Baltimore, MD USA; Department of Health Policy and Management, Baltimore, MD USA; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA; Thoracic Surgery, William Beaumont Hospital, Royal Oak, MI, USA; St Joseph Mercy Health System, Ann Arbor, MI, USA; William Beaumont Hospital, 10 Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA. To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Collaborative cohort study 90 ICUs Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention.

Comprehension Exercise 1.

1. 2. 3. 4. 5. 6. 7.

False Not clear True True False True True

Exercise 2.

Infection rates Mean Median Range Incidence rate ratio Range

132

Baseline

16-18 months

34-36 months

7.7 2.7 0.6-4.8 0.68 0.53-0.88

1.3 0 0-2.4 0.38 0.26-0.56

1.1 0 0.0-1.2 0.34 0.24-0.48

Answer

TEXT 6 Vocabulary review – Texts 1-5 Exercise 1.

1. A – assess 2. D – collects 3. C – detected

key

4. D – enrollment 5. B – evaluated 6. D – improvement 7. C – implementation 8. D – measured 9. B – performed 10. A – reduction

Exercise 2.

Infinitive 1. be 2. come 3. do 4. drink 5. eat 6. find 7. go 8. grow 9. have 10. know 11. make 12. put 13. read 14. think 15. understand 16. write

Past simple was/were came did drank ate found went grew had knew made put read thought understood wrote

Past participle been come done drunk eaten found gone grown had known made put read thought understood written

Exercise 3.

Exercise 5.

1. expect 2. start 3. illness 4. old 5. primary 6. result 7. demonstrate 8. aim 9. context 10. female

NEJM

Exercise 4.

1. 2. 3. 4. 5. 6.

False – portare a termine, conseguire False – influire, colpire False – come True False – peso, carico False – sviluppare

Meaning essere venire fare bere mangiare trovare andare crescere avere sapere, conoscere fare mettere, posare leggere pensare capire, comprendere scrivere

February 4, 2010 Number 5 Volume 362:427-439

Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2 C. Celum, A. Wald, J.R. Lingappa, A.S. Magaret, R.S. Wang, N. Mugo, A. Mujugira, J.M. Baeten, J.I. Mullins, J.P. Hughes, E.A. Bukusi, C.R. Cohen, E. Katabira, A. Ronald, J. Kiarie, C. Farquhar, G.J. Stewart, J. Makhema, M. Essex, E. Were, K.H. Fife, G. de Bruyn, G.E. Gray, J.A. McIntyre, R. Manongi, S. Kapiga, D. Coetzee, S. Allen, M. Inambao, K. Kayitenkore, E. Karita, W. Kanweka, S. Delany, H. Rees, B. Vwalika, W. Stevens, M.S. Campbell, K.K. Thomas, R.W. Coombs, R. Morrow, W.L.H. Whittington, M.J. McElrath, L. Barnes, R. Ridzon, L. Corey, for the Partners in Prevention HSV/HIV Transmission Study Team

Background Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and IS ASSOCIATED with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-

133

THE DOCTOR IS IN

2 REDUCES the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 MAY reduce the risk of transmission of HIV-1. Methods We conducted a randomized, placebocontrolled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, 250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of ENROLLMENT The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses. Results A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were WOMEN and the baseline MEDIAN CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P=0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log10 copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2–positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 MONTHS The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir were observed. Conclusions Daily acyclovir therapy did not reduce the risk of transmission of HIV-1, DESPITE a reduction in plasma HIV-1 RNA of 0.25 log10 copies per milliliter and a 73% reduction in the occurrence of genital ulcers due to HSV-2. (ClinicalTrials.gov number, NCT00194519 [ClinicalTrials.gov]

Exercise 6.

kidney E; injury E; relies on NE; underlying NE; recover E; disorder NE; however E; still NE; Further NE; reliable NE

134

Exercise 7.

kidney injury relies on underlying recover disorder however still further reliable

Rene Lesione Basarsi Sottostante Ristabilirsi Disturbo Tuttavia Tuttora Ulteriore Affidabile, attendibile

Crossword Across early – precoce good – buono therefore – perciò through – attraverso should – dovrebbe sustain – mantenere women – donne without – senza increasing – crescente health – salute long – lungo grant – concedere treat – curare timing – tempistica diagnose – diagnosticare overall – complessivamente Down 1. lung – polmone 2. undergo – sottoporre 4. survive – sopravvivere 5. shift – spostamento laterale 7. safety – incolumità 8. surgery – chirurgia 9. causal – causale 10. grow – crescere 12. findings – dati preliminari 14. compared to – rispetto a 16. prior to – in precedenza 18. yield – produrre 19. wide – ampio 26. leave – partire 27. female – femmina 29. stroke – ictus

Answer

key

Tips and strategies for learning vocabulary

TEXT 7

Exercise 1.

Vocabulary practice

1. shoulder girdle 2. myopia, near-sightedness 3. blood 4. chart 5. detect 6. surgery 7. bladder 8. blood pressure 9. finding 10. outcome 11. delivery 12. skin 13. spread 14. undergo 15. joint

Exercise 1.

Exercise 2.

1. Assess – valutare 2. Available – disponibile 3. Detect – rilevare, riscontrare 4. Doctor – medico 5. Physician – medico clinico 6. Heart – cuore 7. Outcome – esito, prognosi 8. Likely – probabile 9. Finding – dato preliminare 10. Wide – ampio

1. 2. 3. 4. 5.

C – riconoscimento; ringraziamenti D – indirizzo E – premio B – tra A – in cieco

Exercise 2.

1. 2. 3. 4. 5.

E – rivelare, dichiarare A – redigere, abbozzare C – competenza “da esperto” B – probabilità D – fondi, finanziamento, sovvenzione

Exercise 3.

1. 2. 3. 4. 5.

C – principale; grave, serio B – raggruppati, considerati insieme E – ristampa A – fonte D – sorveglianza

Exercise 4.

1. 2. 3. 4. 5.

C – ringraziare D – sotto E – bene A – diffusamente, comunemente B – entro

Exercise 5.

1. 2. 3. 4. 5.

death evaluate outcome perform surgery

135

THE DOCTOR IS IN

Reading Exercise 1.

1. Annals of Internal Medicine 2. January 5, 2010 3. An Abstract 4. ‘What is a systematic review?’ (see pp. 171-173) 5. Meredith K. Ford, MD, MSc; W. Scott Beattie, MD, PhD; and Duminda N. Wijeysundera, MD. 6. MEDLINE, EMBASE, and ISI Web of Science (1966 to 31 December 2008). 7. Cohort studies that reported the association of the RCRI with major cardiac complications (cardiac death, myocardial infarction, and nonfatal cardiac arrest) or death in the hospital or within 30 days of surgery. 8. 18

9. None 10. None disclosed 11. M.K. Ford, W.S. Beattie, D.N. Wijeysundera. 12. D.N. Wijeysundera. 13. W.S. Beattie, D.N. Wijeysundera. 14. M.K. Ford, W.S. Beattie, D.N. Wijeysundera.

Comprehension Exercise 1.

1. 2. 3. 4. 5.

False Not clear True True False

Exercise 2. RCRI PREDICTION OF CARDIAC EVENTS

After mixed noncardiac surgery high vs low risk pts.

C.I.

After vascular noncardiac surgery high vs low risk pts.

C.I.

AUC curve

0.75

0.72-0.79

0.64

0.61-0.66

Sensitivity

0.65

0.46-0.81

0.70

0.53-0.82

Specificity

0.76

0.58-0.88

0.55

0.45-0.66

Positive likelihood ratio

2.78

1.74-4.45

1.56

1.42-1.73

Negative likelihood ratio

0.45

0.31-0.67

0.55

0.40-0.76

136

Answer

key

Syntax practice TEXT 8 Vocabulary practice Exercise 1.

1. C – attentamente 2. F – frequente 3. J – tosse 4. A – bambini 5. B – avvenire, succedere 6. H – durata 7. I – ritardo 8. G – mediana 9. D – lieve 10. E – comparsa, inizio Exercise 2.

1. both 2. within 3. age 4. fever 5. range 6. illness 7. male 8. disease 9. background 10. purpose Exercise 3.

Noun 1. confirmation 2. detection 3. diagnosis 4. document; documentation 5. duration 6. incubation 7. infection 8. observation 9. occurrence 10. treatment

Verb confirm detect diagnose document last incubate infect observe occur treat

1. Le caratteristiche cliniche della patologia 2. I sintomi più comuni 3. Pandemia del 2009 da virus dell’influenza A (H1N1) 4. I risultati positivi al test “real-time RT-PCR” 5. L’istituto di medicina respiratoria di Beijing 6. Il centro clinico della salute pubblica di Shanghai 7. Il centro cinese per il controllo e la prevenzione delle malattie

Reading 1. NEJM 2. December 24, 2009 3. Bin Cao, M.D., Xing-Wang Li, M.D., Yu Mao, M.D., Jian Wang, M.D., Hong-Zhou Lu, M.D., Yu-Sheng Chen, M.D., Zong-An Liang, M.D., Lirong Liang, M.D., Su-Juan Zhang, M.D., Bin Zhang, M.D., Li Gu, M.D., Lian-He Lu, M.D., Da-Yan Wang, Ph.D., Chen Wang, M.D., for 4. the National Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China 5. An Abstract 6. ? 7. 426 8. Real-time reverse-transcriptase–polymerasechain-reaction (RT-PCR) testing 9. 2 days, range 1-7 10. 3: an age of less than 14 years, male sex, and a delay from the onset of symptoms to treatment with oseltamivir of more than 48 hours

Notes Total n. patients observed Percentage females Average incubation period Percentage of pts with fever Percentage of pts with cough Incidence of nausea Percentage of pts with lymphopenia … which resolved by day ___ Percentage of adult pts with hypokalemia Duration of fever

426 46.2% 2 days 67.4% 69.5% 1.9% 68.1% 7 (6-9) 25.4% 3 days (1-11)

137

THE DOCTOR IS IN

Comprehension Exercise 1.

1. True 2. False 3. Not clear 4. True 5. True 6. False 7. True 8. Not clear 9. True 10. False/not clear

1. 2. 3. 4. 5.

B – minaccioso C – tasso E – diminuire A – globale, complessivo D – miglioramento

Exercise 2.

1. 2. 3. 4. 5. 6.

True False – malato False – meno False – peggio True False – sopravvissuto

Just for fun! 1. 2. 3. 4. 5.

E - dolente B – con vertigini D – sentirsi mancare A – sudato C – debole, fiacco

1. 2. 3. 4. 5.

E – tosse grassa C – naso che cola D – mal di testa A – mal di gola B – mal d’orecchio

Exercise 3.

Noun length stay assessment setting illness measure; measurement 7 threat 8 decrease 9 improvement

1 2 3 4 5 6

Verb lengthen stay assess set XXX measure

Adjective long XXX XXX XXX ill XXX

threaten decrease improve

threatening XXX XXX

Syntax TEXT 9 Vocabulary practice Exercise 1.

1. 2. 3. 4. 5.

B – monitorare D – durata E – degenza A – diversi C – sempre più

1. 2. 3. 4. 5. 1. 2. 3. 4. 5.

C – poco D – valutare E – disegno A – contesto B – grande, ampio E – malattia A – principale C – esito B – parametro D – solo

138

Exercise 1.

1. pazienti in terapia intensiva 2. tecnologia della telemedicina 3. un grande sistema (centro) sanitario statunitense 4. medici locali 5. eventi che minacciano la vita 6. piena autorità per il trattamento 7. tassi osservati di mortalità ospedaliera Exercise 2.

1. Association of Telemedicine for Remote Monitoring of Intensive Care Patients With Mortality, Complications, and Length of Stay 2. Observational study conducted in 6 ICUs of 5 hospitals in a large US health care system to assess the use of tele-ICU. 3. Local physicians delegated full treatment authority to the tele-ICU for 655 patients (31.1%) and authority to intervene only in life-threatening events for the remainder.

Answer 4. There were no significant differences between the preintervention and postintervention periods for hospital or ICU LOS. Exercise 3.

1. Associazione della telemedicina per il monitoraggio a distanza dei pazienti in terapia intensiva con mortalità, complicanze e durata di degenza. 2. Studio osservazionale svolto in 6 unità di terapia intensiva di 5 ospedali in un grande sistema (centro) sanitario statunitense per valutare l’uso della tele-ICU (ICU a distanza) 3. I medici locali (di base) delegarono alla teleICU la piena autorità per il trattamento dei (loro) 655 pazienti (31.1%) e l’autorità di intervenire solo nel caso di eventi che minacciavano la vita dei restanti. 4. Non ci furono differenze significative tra il periodo pre-intervento e quello postintervento per la durata della degenza ospedaliera o nell’unità di terapia intensiva.

Reading 1. JAMA 2. December 23-30, 2009 3. Eric J. Thomas, MD, MPH; Joseph F. Lucke, PhD; Laura Wueste, RN; Lisa Weavind, MD; Bela Patel, MD 4. Departments of Internal Medicine and Pediatrics, School of Medicine, University of Texas Health Science Center at Houston; University of Texas at Houston–Memorial Hermann Center for Healthcare Quality and Safety 5. Texas? USA 6. An Abstract 7. 2034 patients in the preintervention period (January 2003 to August 2005) and 2108 patients in the postintervention period (July 2004 to July 2006) 8. To assess the association of remote monitoring of ICU patients (ICU telemedicine [tele-ICU]) with mortality, complications, and length of stay (LOS). 9. pre- + post-intervention = 2003-2006 10. Hospital and ICU mortality, complications, and hospital and ICU survivors’ LOS, with outcomes adjusted for severity of illness

key

Comprehension Exercise 1.

1. 2. 3. 4. 5. 6. 7.

False True Not clear False True True True

TEXT 10 1. Questo numero sarà disponibile online il 22 febbraio 2010 2. Diminuire i costi ospedalieri mantenendo la qualità: si può fare? 3. Progettare/costruire la salute nelle unità di terapia intensiva 4. L’effetto di (un programma di) allenamento fisico sui sintomi dell’ansia nei pazienti: una revisione sistematica 5. Pneumotorace in seguito a toracentesi: revisione sistematica e meta-analisi 6. Il costo all’ospedale dell’assistenza, assistenza/cure di qualità e tassi di rientro ospedaliero: oculati nelle piccole spese e sciocchi in quelle grandi? 7. Esiti clinici ed economici attribuibili alla sepsi e alla polmonite associate all’assistenza ospedaliera 8. Ridurre i danni evitabili: commento. 9. La portata e il target dei promemoria per la vaccinazione anti-influenzale tra gli adulti statunitensi: l’evidenza proveniente da un’indagine nazionale rappresentativa 10. Migliorare l’avviso ai fornitori di assistenza sanitaria: un sistema di alert (avvisi) a cascata. 11. Co-gestione di pazienti anziani ricoverati in ospedale per la frattura dell’anca 12. In replica

139

THE DOCTOR IS IN

Exercise 4.

TEXT 11 Vocabulary practice Exercise 1.

1 2 3 4 5 6

aim allow main much physician setting

Synonym objective let primary a lot doctor context

Italian obiettivo permettere principale molto medico contesto

Exercise 2.

1. 2. 3. 4. 5.

B – richiesta E – tratto da A – far rispettare D – accrescere C – quadro, schema

1. 2. 3. 4. 5.

E – politica, linea di condotta D – fornitore B – dirigente pubblico A – campione C – offerta, fornitura

Exercise 5.

1. 2. 3. 4. 5.

although although while although although

Exercise 6.

1. Correct 2. Correct 3. Incorrect

Exercise 3.

Comprehension

1. 2. 3. 4. 5.

Exercise 1.

B – finanziamenti E – non conforme C – dirigente D – panoramica A – commissione, gruppo

1. 2. 3. 4. 5.

Not Clear Not clear True True True/Not clear

Exercise 2. CME SYSTEMS IN 6 EUROPEAN COUNTRIES

Austria

Belgium France

Italy

Norway

Compulsory CME

√

Sanctions

Benefits

√

Accreditation of activities

√

Accreditation of CME providers

√

Private funding and sponsorship

√

Exercise 3.

Just for fun!

1. Type of healthcare service, i.e., public or private? The laws governing the medical profession? 2. Financial support by, for example, pharmaceutical companies?

1. 2. 3. 4. 5. 6.

140

English Dutch and French French Italian German German

Answer

key

TEXT 12 Vocabulary review – Texts 1-11 Exercise 1.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Verb Administer assess collect compare delay detect develop enhance estimate evaluate explain find grow implement improve manage perform provide

Meaning somministrare valutare raccogliere confrontare ritardare rilevare, riscontrare sviluppare accrescere stimare valutare spiegare trovare crescere; aumentare attuare migliorare gestire eseguire fornire

Noun administration assessment collection comparison delay detection development enhancement estimate evaluation explanation finding growth implementation improvement management performance provision/provider

Exercise 2.

1. A – despite 2. B – although 3. B – despite 4. C – like 5. A – however 6. D - although Exercise 3.

1 2 3 4 5 6 7 8 9 10 11 12

Infinitive be come do find go grow have know make put show undergo

Past simple was/were came did found went grew had knew made put showed underwent

Past participle been come done found gone grown had known made put showed/shown undergone

Meaning essere venire fare trovare andare crescere, aumentare avere conoscere, sapere fare posare, mettere mostrare sottoporre

141

THE DOCTOR IS IN

Exercise 4.

Exercise 5.

Cochrane Database of Systematic Reviews

JAMA

2010, Issue 1. Art. No.: CD008340. DOI:10.1002/14651858.CD008340

Vol. 303 No. 6, February 10, 2010

Single dose antibiotics for treating uncomplicated urinary tract infection in nonpregnant women

Laparoscopic Adjustable Gastric Banding in Severely Obese Adolescents: A Randomized Trial

Jun Li Zhao 2, Jian Qin Wang 2, Lin Zhao 2, Zhi Ping Wang 1, Jing Yu Wang 2, Jun Zhang 2

Paul E. O’Brien, MD, FRACS; Susan M. Sawyer, MBBS, MD, FRACP; Cheryl Laurie, RN, BHSc; Wendy A. Brown, MBBS, PhD, FRACS; Stewart Skinner, MBBS, PhD, FRACS; Friederike Veit, MBBS, MD, FRACP; Eldho Paul, MSc; Paul R. Burton, MBBS, FRACS; Melanie McGrice, BSc, M Nutr Diet; Margaret Anderson, BHIM, Grad Dip HA; John B. Dixon, MBBS, PhD, FRACGP

1 Institute of Urology, The Second Hospital of Lanzhou University, Lanzhou, China. 2 The Second Hospital of Lanzhou University,Lanzhou, China.Contact address: Zhi PingWang, Institute of Urology, The SecondHospital of Lanzhou University, 80 Cui Ying Meng Street, Lanzhou, Gan Su, 730000, China. erywzp@lzu.edu.cn. Editorial group: Cochrane Renal Group. Copyright © 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.

Background Description of the condition Urinary tract INFECTION (UTI) is a very common infection and it is ESTIMATED 25% to 50%% of all women experience a UTI at some point in their lifetime (Naber 2001;Williams 1996). These infections ACCOUNT FOR more than eight million women annually in the United States (Kunin 1994; Patton 1991), and approximately 25% of all UTIs recur WITHIN six months (Nicolle 2003). Reported UTIs incidences are 15% and 10% per person-years in those aged 15-39 and 40-79 years, respectively (Guay 2008). The annual HEALTH care expenditures in the MANAGEMENT of UTIs exceed US$1 billion (Faro 1998). Uncomplicated UTIs are one of the most COMMON clinical syndromes that occur in an otherwise healthy, non-pregnant, adult woman with no KNOWN anatomical or functional abnormalities of the urinary tract (Foxman 2003). They are the most common infectious DISEASE affecting young and sexually active women. Patients usually present with dysuria, urinary frequency, urinary urgency, and/or suprapubic pain (Mehnert-Kay 2005). In contrast, patients presenting with high fever, flank PAIN and/or tenderness of the costovertebral angle which indicate upper urinary tract involvement and are classified as complicated UTIs (Tice 1999).

142

CLINICIAN’S CORNER

Context Adolescent obesity is a COMMON and serious health problem AFFECTING more than 5 million young people in the United States alone. Bariatric surgery is being EVALUATED as a possible treatment option. Laparoscopic adjustable gastric banding (gastric banding) has the potential to PROVIDE a safe and effective treatment. Objective To COMPARE the OUTCOMES of gastric banding with an optimal lifestyle program on adolescent obesity. … Conclusions AMONG obese adolescent participants, use of gastric banding compared with lifestyle intervention resulted in a greater percentage ACHIEVING a loss of 50% of excess WEIGHT corrected for age. There were associated benefits to health and quality of LIFE Trial Registration ANZCTR Identifier: 12605000160639

Answer Exercise 6.

Arch Intern Med 4, February 22, 2010;170(4):321-331.

The Effect of Exercise Training on Anxiety Symptoms Among Patients: A Systematic Review Matthew P. Herring, MS, MEd; Patrick J. O’Connor, PhD; Rodney K. Dishman, PhD

Background Anxiety often remains unrecognized or untreated among patients with a chronic ILLNESS. Exercise training MAY help improve anxiety symptoms among patients. We ESTIMATED the population effect size for exercise training effects on anxiety and determined WHETHER selected variables of theoretical or practical importance moderate the effect. … Results COMPARED WITH no treatment conditions, exercise training significantly reduced anxiety symptoms by a mean effect of 0.29 (95% confidence interval, 0.23-0.36). Exercise training programs lasting no more than 12 weeks, using session durations of at least 30 minutes, and an anxiety report time frame greater than the past week resulted in the largest anxiety IMPROVEMENTS. Conclusion Exercise training reduces anxiety symptoms among sedentary patients who have a chronic illness. Author Affiliations: Department of Kinesiology, The University of Georgia, Athens. © 2010 American Medical Association. All Rights Reserved.

key

cognitive therapy (CT) in preventing relapse/recurrence in recurrent depression are not known. This article reports on the long-term (5.5-year) OUTCOME of a randomized controlled trial to prevent relapse/recurrence in patients with recurrent depression. We specifically EVALUATED the long-term effects of CT in relation to the number of previous episodes experienced. CONCLUSIONS: Our FINDINGS indicate that brief CT, started after remission from a depressive episode on diverse types of treatment in patients with multiple prior episodes, has longterm preventive effects for at least 5.5 years. IMPLEMENTATION of brief relapse prevention CT should be considered in the continued CARE of patients with recurrent depression. TRIAL REGISTRATION: ccmo-online.nl Identifier: NTR454. © Copyright 2009 Physicians Postgraduate Press, Inc.

Exercise 8.

1. 2. 3. 4. 5.

C – attentamente E – tosse D – decennio A – domanda, pretesa B – vertigini

Exercise 9.

1. 2. 3. 4. 5.

E – febbre D – mal di testa A – nucleo familiare; ambito domestico C – meno B – media

Exercise 7.

J Clin Psychiatry.

Exercise 10. As above.

2009 Dec;70(12):1621-1628.

1. 2. 3. 4. 5.

Long-term effects of preventive cognitive therapy in recurrent depression: a 5.5year follow-up study. Bockting CL, Spinhoven P, Wouters LF, Koeter MW, Schene AH; for the DELTA Study Group.Faculty of Social and Behavioral Sciences, Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands. c.l.h.bockting@rug.nl.

D – linea di condotta B – prima, in precedenza E – scopo C – restante A – incolumità

OBJECTIVE: Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of BURDEN in 2030. A crucial part of the TREATMENT of depression is the PREVENTION of relapse/recurrence in highrisk groups, i.e., recurrently depressed patients. The long-term preventive effects of group

143

THE DOCTOR IS IN

Crossword Across 1. contesto – setting 2. ricoverare – admit 6. precoce – early 8. prevedere – anticipate 14. attuare – implement 16. patologia – disease 17. raccolta – collection 19. sottoporre – undergo 21. sviluppo – development 22. valutare – assess 25. rilevare – detect 26. accrescere – enhance 32. ampio – broad 33. morte – death 34. dato preliminare – finding 36. perciò – therefore 37. sangue – blood Down 1. colpire – affect 3. caratteristica – feature 4. valore iniziale – baseline 5. peggio – worse 7. cambiamento – change 9. esito – outcome 10. migliorare – improve 11. associare – associate 12. curare – treat 13. anziano – elderly 15. sfondo – background 16. probabilità – likelihood 18. sforzo – effort 20. rispetto a – compared to 23. malato – sick 24. fornire – provide 27. eseguire – perform 28. complessivo – overall 29. lieve – mild 30. campione – sample 31. ritardo – delay 35. tasso – rate

144

TEXT 13 Vocabulary and syntax practice Exercise 1.

1. increase 2. key 3. findings 4. should 5. need 6. manage 7. less 8. compare 9. practice 10. research 11. resources 12. health 13. although 14. support 15. develop 16. trend 17. assess Exercise 5.

Valutare i bisogni professionali di formazione degli educatori della salute pubblica alla luce del cambiamento delle competenze Exercise 6.

1. Una forza lavoro/personale della salute pubblica ben addestrata/ben formata 2. Progetto nazionale per l’aggiornamento delle competenze degli educatori alla salute 3. Bisogni formativi auto-identificati/soggettivi 4. Sostegno del datore di lavoro 5. Laureati con un Master in salute pubblica dell’università statale (pubblica) San Jose State 6. Un’indagine svolta sul Web 7. Competenze pratiche sul sostegno alle politiche 8. Un approccio alle problematiche inerenti alla salute che dura per tutta la vita 9. I bisogni formativi dei professionisti che si occupano dell’educazione alla salute

Answer Reading Exercise 1.

1. Preventing Chronic Diseases 2. October 5, 2008 3. Demers AR, Mamary E. 4. The USA 5. This study compared the self-identified training needs of public health educators with the updated competencies and assessed employer support for continuing education. 6. A convenience sample of public health educators 7. a Web-based survey 8. organization development, evaluation, and management 9. emerging themes (organization development, evaluation, and management)

key

illness. The abstract does not give enough information. • Probably the Internet, online training courses, and other computer-based teaching/learning options. • It probably refers to the patient’s lifespan but this isn’t clear. It may refer to the healthcare professional’s professional career or “lifespan”. It probably means that a long-term approach or vision should be implemented. • Probably university medical students or practicing healthcare professionals are the students referred to in the text.

TEXT 14 Vocabulary practice

Comprehension

Exercise 1.

1. obiettivo 2. tra 3. premessa, sfondo 4. iniziare 5. dati 6. presto, precoce 7. salute 8. aumentato 9. meno 10. vita 11. probabile 12. più 13. necessitare 14. esito, prognosi 15. riportare, riferire 16. campione

• Probably professors in medical schools or teachers of continuing medical education; their students are probably medical students or practicing healthcare professionals, particularly in public health. • “Public Health education” probably refers to university or post-graduate programs in public health. The learners are probably healthcare professionals who work or will work in public health. • It’s not clear from the abstract what resources are being referred to. Possibly teaching facilities? Possibly external experts or teachers? • “Policy advocacy skills” are probably those skills needed to propose, support, implement, and/or defend a healthcare policy, for example for the poor or the disabled or some chronic

Exercise 2.

Then

infanzia

childhood

età adulta

adulthood

salute

health

sano

healthy

obesità

obesity

obeso

obese

meridionale

southern

meridione

south

145

THE DOCTOR IS IN

Exercise 3.

Just for fun

1. 2. 3. 4.

I. Nouns 1. peso 2. altezza 3. lunghezza 4. profondità 5. ampiezza

bad high underweight absence

Exercise 4.

1. start 2. sex Exercise 6.

Disuguaglianze sanitarie sociali tra adolescenti in una grande città dell’Europa meridionale. Exercise 7.

Probably that there is a difference in health status of teenagers in different social classes.

Reading

II. Word groups 1. peso 2. pesante 3. leggero 4. pesare 1. alto 2. basso 3. alzare 1. lungo 2. corto 3. allungare

Exercise 1.

1. J. Epidemiology of Community Health 2. Online December 8, 2009 3. Talita Duarte-Salles, M. Isabel Pasarin, Carme Borrell, Maica Rodriguez-Sanz, Lluis Rajmil, Montse Ferrer, Ferran Pellise, Federico Balague. 4. Center for Research in Environmental Epidemiology, Spain; Agencia de Salut Publica de Barcelona, Spain; Agencia d’Avaluacio de Tecnologia i Recerca Mediques, Spain; Hospital Universitari de la Vall d’Hebron, Spain; Hopital Cantonal, Fribourg, Switzerland. 5. Barcellona, Spain 6. To describe social inequalities in obesity and other health problems among adolescents by sex. 7. 903 adolescents aged 12-16 years old. 8. Generalized Estimating Equation (GEE) models.

Comprehension Exercise 1.

4. Correct 5. Correct 6. Correct

146

1. profondo 2. poco profondo 3. approfondire 1. 2. 3. 4.

largo, ampio stretto allargare restringere

Answer

key

Exercise 2.

TEXT 15 Vocabulary practice Exercise 1.

1. 2. 3. 4. 5. 6.

ad esempio sebbene poiché tuttavia ad esempio perciò

Exercise 2.

1. False: braccio 2. False: almeno 3. True 4. False: entrambi 5. True 6. True 7. False: efficace 8. True 9. False: attuazione 10. False: migliorare 11. False: vita 12. True 13. True 14. False: esito 15. False: risposta 16. True

Interventi sulla demenza basati sull’evidenza: un trial randomizzato pragmatico a grappolo di un intervento formativo per promuovere un riconoscimento e una risposta precoci alla demenza nelle cure primarie (EVIDEM-ED)

Reading Exercise 1.

1. Trials. 2. A journal that is free to readers. 3. 2010. 4. Steve Iliffe, Jane Wilcock, Mark Griffin, Priya Jain, Ingela Thuné-Boyle, Tamar Koch and Frances Lefford. 5. Research Department of Primary Care and Population Health, University College London, Royal Free Campus, UK. 6. A pragmatic cluster-randomised trial. 7. The UK. 8. There is evidence that dementia remains under-detected and sub-optimally managed in general practice. 9. To test a customised educational intervention developed for general practice, promoting both earlier diagnosis and concordance with management guidelines. 10. Twenty primary care practices have been recruited with the aim of gaining 200 patient participants. 11. An increase in the proportion of patients with dementia who receive at least two dementiaspecific management reviews per year.

Syntax practice Exercise 1.

1. Intervento educativo/formativo 2. Interventi basati sull’evidenza 3. Reti di assistenza sanitaria per la famiglia (di base) 4. Contesto delle cure primarie 5. Un trial pragmatico randomizzato a “cluster” (grappolo) 6. Un riconoscimento e una risposta precoci/anticipati 7. La strategia nazionale per la demenza 8. Un sistema computerizzato in supporto alle decisioni e laboratori formativi basati sulla pratica/attività professionale 9. Due revisioni specifiche sulla gestione della demenza

147

THE DOCTOR IS IN

Exercise 5.

TEXT 16 Exercise 2.

BACKGROUND: Vitamin D is PRODUCED in the skin after sunlight EXPOSURE and can also be obtained through food. Vitamin D deficiency has recently been linked with a RANGE of diseases including CHRONIC pain. Observational and circumstantial evidence SUGGESTS that there may be a role for vitamin D deficiency in the AETIOLOGY of chronic pain conditions. Exercise 3.

OBJECTIVES: To ASSESS the efficacy and adverse EVENTS of vitamin D supplementation in chronic painful conditions. Exercise 4.

MAIN RESULTS: Four studies, with a total of 294 PARTICIPANTS were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the OUTCOME measures reported. Only one study reported a beneficial effect, the others FOUND no benefit of vitamin D over placebo in TREATING chronic pain.

AUTHORS’ CONCLUSIONS: The evidence BASE for the use of vitamin D for chronic pain in ADULTS is poor at present. This is due to LOW quality and INSUFFICIENT randomised controlled trials in this area of RESEARCH

Reading Exercise 1.

1. Cochrane Database Systematic Review 2. What is a “systematic review”? (Consult pp. 171-173 of this textbook.) 3. Department of Occupational and Social Medicine, University of Göttingen, Germany 4. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions. 5. To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions. 6. Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults. 7. Four studies, with a total of 294 participants.

Just for fun! 1. 2. 3. 4. 5. 6. 7. 8.

148

beverage: dairy products: grains: meal: poultry: produce: seafood: shellfish:

bevande latticini cereali pasto pollame ortaggi pesce e frutti di mare molluschi

coffee cheese wheat breakfast chicken lettuce fish oysters

water milk maize lunch duck carrots squid clams

Answer 3. 4. 5. 6. 7. 8.

TEXT 17 Vocabulary practice Exercise 1.

1. False – in cieco, cieco 2. True

key False – dati True True False – dolore False – medico clinico True

Exercise 2.

1 2 3 4 5 6 7 8 9 10

Verb assess collect delay find improve manage need show operate update

Noun assessment collection delay findings improvement management need XXX (show) surgery update

Adjective assessed (pp) collected delayed XXX improved managed needed shown surgical updated, up-to-date

Exercise 3.

1. 2. 3. 4. 5. 6.

sebbene perfino tuttavia tuttora perciò se

Syntax practice Exercise 1.

1. Questo è un tema importante per la gestione del dolore post-operatorio. 2. Gli autori hanno indagato gli effetti dell’approcio farmacologico multi-modale nella prima fase post-operatoria e hanno rilevato che sembra accelerare la fase riabilitativa. 3. Sono necessarie ulteriori ricerche sul controllo multi-modale aggressivo e precoce del dolore in pazienti post-operatori.

Reading Exercise 1.

1. Anesthesia and Analgesia 2. (Consult pp. 171-173 of this textbook for information on study designs) 3. Osteoarthritis of the hip 4. 6/7 5. 6/7

Meaning valutare raccogliere ritardare trovare migliorare gestire necessitare, richiedere mostrare, dimostrare operare (chirurgia) aggiornare

6. The Department of Anesthesiology and Surgical Critical Care of Trousseau Hospital, Logipole of Trousseau Hospital, Department of Orthopedic Surgery and Traumatology, Department of Anesthesiology and Surgical Intensive Care of Bretonneau Hospital, University of François Rabelais, CHRU Tours, Tours, France 7. Ketamine has been shown to have a morphine-sparing effect soon after surgery. Nevertheless, whether this effect still exists after being combined with nonsteroidal antiinflammatory drugs and acetaminophen, and whether ketamine can decrease chronic pain after nononcologic surgery remain unclear. 8. To assess ketamine‘s effect on acute and chronic postoperative pain when combined with multimodal analgesia after total hip arthroplasty (THA). 9. Patients scheduled for primary nononcologic THA using standardized general anesthesia 10. placebo, 75; ketamine, 79 11. They received IV ketamine before incision (0.5 mg/kg), and a 24-h infusion (2 microg x kg(-1) x min(-1)) or a similar blinded saline bolus and infusion. Postoperative analgesia included IV acetaminophen, ketoprofen, plus morphine/droperidol patient-controlled analgesia for 48 h. 12. 24-h morphine consumption.

149

THE DOCTOR IS IN

Comprehension Exercise 1.

Anesthesiologia 1. Questo studio è interessante in quanto la diminuzione nell’uso di morfina, sebbene statisticamente significativa, non sorprende e clinicamente la differenza non è così grande (19±12 mg nel gruppo placebo rispetto a 14±13 mg nel gruppo in studio). 2. Ciò che sorprende è il beneficio apparentemente conferito a 1, 3 e 6 mesi nel postoperatorio per la riduzione del dolore nel gruppo trattato con ketamina.

Medicina fisica e riabilitativa 1. Poiché sta diventando sempre più difficile ottenere la ketamina in Francia la rilevanza di questo studio potrebbe essere ridimensionata. Interesse speciale – Dolore – Clinico 1. Uno studio ben disegnato il cui dato preliminare più interessante è un esito secondario relativo all’incidenza del dolore cronico. 2. Sarebbe utile uno studio di follow up disegnato specificatamente per confermare questi dati preliminari.

Exercise 2.

ketamine

placebo

morphine consumption at 24h

14±13 mg (p = 0.004)

19±12 mg

day 30 – crutches or walking frame

31% (p = 0.0035)

? 56%?

day 30-180 – no. of patients with pain at rest

? (p0 0.008)

day 180 – no. of patients with pain at rest

21%

TEXT 18 Vocabulary review Exercise 1.

1. False – interessare, colpire 2. False – rappresentare 3. True 4. True 5. True 6. False – che invecchia 7. True 8. True 9. False – sangue 10. True 11. False – cambiamento 12. False – infanzia 13. True 14. True 15. True 16. True 17. False – personalizzato 18. True 19. True (insufficienza) 20. False – profondità

150

21. False – diagnosticare 22. True 23. False – raddoppiare 24. True 25. True 26. True 27. True 28. False – spesa 29. True 30. False – pieno 31. True 32. False – altezza 33. True 34. True 35. False – disuguaglianza 36. False – chiave 37. False – meno 38. True 39. False – probabilità 40. True 41. False – basso 42. False – importante 43. True 44. False – solo 45. True

Answer

key

Exercise 2.

Exercise 4.

Arch Intern Med

CONCLUSIONS Daily rounds by a multidisciplinary TEAM are associated with lower mortality AMONG medical ICU patients. The SURVIVAL benefit of intensivist physician staffing is in part EXPLAINED by the presence of multidisciplinary teams in high-intensity physician-staffed ICUs.

Vol. 170 No. 4, February 22, 2010

HEALTH CARE REFORM

The EFFECT of Multidisciplinary Care Teams on Intensive Care Unit Mortality Michelle M. Kim, MSc; Amber E. Barnato, MD, MPH; Derek C. Angus, MD, MPH; Lee F. Fleisher, MD; Jeremy M. Kahn, MD, MSc

BACKGROUND Critically ill patients are medically complex and may benefit from a multidisciplinary approach to care. Methods We conducted a population-based retrospective cohort study of medical patients ADMITTED to Pennsylvania acute care hospitals (N = 169) from July 1, 2004, to June 30, 2006, LINKING a statewide hospital organizational survey to hospital discharge data. Multivariate logistic regression was used to determine the independent RELATIONSHIP between daily multidisciplinary rounds and 30day MORTALITY. Exercise 3.

RESULTS A total of 112 hospitals and 107 324 patients were INCLUDED in the final analysis. OVERALL 30-day mortality was 18.3%. After adjusting for patient and hospital characteristics, multidisciplinary care was associated with significant REDUCTIONS in the odds of death (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.76-0.93 [P = .001]). When stratifying by intensivist physician staffing, the LOWEST odds of death were in intensive care units (ICUs) with high-intensity physician staffing and multidisciplinary care teams (OR, 0.78; 95% CI, 0.68-0.89 [P < .001]), followed by ICUs with lowintensity physician staffing and multidisciplinary care teams (OR, 0.88; 95% CI, 0.79-0.97 [P = .01]), COMPARED with hospitals with lowintensity physician staffing but without multidisciplinary care teams. The effects of multidisciplinary care WERE consistent across key subgroups including patients with sepsis, patients requiring invasive mechanical ventilation, and patients in the highest quartile of severity of ILLNESS.

Author Affiliations: Department of Health Care Management and Economics, Wharton School of Business (Ms Kim), Leonard Davis Institute of Health Economics (Drs Fleisher and Kahn), Department of Anesthesia and Critical Care, School of Medicine (Dr Fleisher), Center for Clinical Epidemiology and Biostatistics, School of Medicine (Drs Fleisher and Kahn), and Division of Pulmonary, Allergy, and Critical Care, School of Medicine (Dr Kahn), University of Pennsylvania, Philadelphia; and Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, School of Medicine (Dr Barnato), CRISMA Laboratory, Department of Critical Care Medicine, School of Medicine (Drs Barnato and Angus), and Department of Health Policy and Management, Graduate School of Public Health (Drs Barnato and Angus), University of Pittsburgh, Pittsburgh, Pennsylvania. ÂŠ 2010 American Medical Association. All Rights Reserved.

Exercise 5.

J Epidemiol Community Health Online First 8 December 2009

The effect of influenza vaccination on the INCIDENCE of chronic obstructive pulmonary disease (COPD) exacerbations in the immediate post-vaccination period Simon C H Ting*, Stephen W Crooks, Gail South. 1 Chesterfield Royal Hospital NHS Foundation Trust, United Kingdom Correspondence to: Simon Ting, Chesterfield Royal Hospital NHS Trust, Chesterfield Royal Hospital, Calow, Chesterfield, S44 5BL, United Kingdom.

BACKGROUND The ADMINISTRATION of influenza vaccination is an important strategy in the PREVENTION of exacerbations in patients with chronic obstructive pulmonary disease (COPD). DESPITE the proven benefits, there are patients who are RELUCTANT to have this intervention for fear of triggering an exacerbation. There are very FEW studies looking at the effect of the vaccination on exacerbation RATES of COPD in primary care.

151

THE DOCTOR IS IN

Exercise 6.

METHODS We obtained medical RECORDS from 6 primary care practices in the Derbyshire area (UK) and obtained 293 pairs of PATIENTS. All patients had a DIAGNOSIS of COPD based on post bronchodilator spirometry. Patients were MATCHED according to age, SEX severity of COPD and comorbidities. The first group of patients received the influenza vaccination WHILST the other group served as a control (either never received the vaccination or received it at a later date). The incidence of COPD exacerbations of BOTH groups were recorded. Exercise 7.

RESULTS There were 21 exacerbations in the control group COMPARED TO 11 in the vaccinated group. The difference in exacerbation RATES between groups was NOT statistically significant (McNemar’s p=0.11). In the 2 weeks after receiving the influenza vaccination, the

RISK of experiencing an exacerbation in this group of patients was 0.52 in the vaccinated group compared to the NON vaccinated group (OR=0.52; CI 0.29-1.14) CONCLUSION Patients with COPD SHOULD be reassured that the influenza vaccination is SAFE and does not cause an INCREASE in exacerbations. They should be encouraged to take up the vaccination annually before the ONSET of winter. © 2009 by the BMJ Publishing Group Ltd.

Exercise 8.

1. A – Despite 2. C – Like 3. D – Thus 4. D – For istance 5. D – However 6. D – Eeven though

Word search P

S U R

C E

D R

152

O R

Answer

key

Crossword Across 3. ingaggiare – engage 5. ritardo – delay 8. alto – high 9. quadro – framework 10. verificare – check 14. regolare – control 17. salute – health 18. associato – linked 19. valutare – evaluate 21. valutazione – assessment 22. possibilità – chance 24. giorno – day 26. ampio – broad 29. rilevare – detect 30. migliorare – improve 31. sviluppare – develop 33. spiegare – explain 35. anziano – elderly 36. sforzo – effort 37. efficace – effective 38. disponibile – available 39. medico di base – general practitioner 41. almeno – at least 43. entrambi – both 44. dato preliminare – finding 45. confrontare – compare Down 1. permettere – allow 2. raccogliere – collect 4. attuare – implement 6. sfida – challenge 7. principale – main 11. caratteristica – feature 12. attentamente – closely 13. sfondo – background 15. accrescere – enhance 16. fattibile – feasible 20. stima – estimate 23. colpire – affect 25. dimettere – discharge 27. probabile – likely 28. precoce – early 32. profondo – deep 34. problematica – issue 40. poiché – as 42. durare – last (v)

TEXT 19 Vocabulary practice Exercise 1.

1. 2. 3. 4. 5.

D – un altro A – sembrare E – ampio C – rispetto a B – orecchio

Exercise 2.

1. 2. 3. 4. 5.

C – efficace A – efficacia reale D – efficacia teorica B – trovato E – alto

Exercise 3.

1. 2. 3. 4. 5.

D – meno C – principale A – dolore E – tasso B – fonte

Exercise 4.

1. valutare 2. tra 3. entrambi 4. data 5. tratto 6. valutare 7. trovare 8. durare 9. basso 10. sollievo 11. riportare 12. campione 13. mostrare 14. gola 15. terapia Exercise 5.

1. However 2. In addition 3. Such as

153

THE DOCTOR IS IN

Reading TEXT 20

Exercise 1.

1. Cochrane Database Systematic Reviews 2. Department of Otolaryngology, Head & Neck Surgery, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, UK. Department of Otolaryngology, Head & Neck Surgery, Derriford Hospital, Plymouth, UK. UCL Ear Institute & The Royal National Throat, Nose & Ear Hospital, Royal Free Hospital, London, UK. 3. To assess the effectiveness of interventions for acute otitis externa. 4. “Swimmer’s ear” 5. Randomised controlled trials evaluating ear cleaning, topical medication or systemic therapy in the treatment of acute otitis externa. 6. The date of the most recent search was 6 January 2009. 7. Nineteen randomised controlled trials 8. A total of 3382 participants were included. 9. Two authors assessed eligibility and quality.

Comprehension Exercise 1.

Interventions assessed

1. True 2. False 3. False 4. Not clear 5. True 6. True 7. False 8. True 9. False 10. Not clear

154

Exercise 1.

1. 2. 3. 4. 5.

A – consapevole D – anziano E – strumento B – tardi, tardivo C – medico clinico

Exercise 2.

1. 2. 3. 4. 5.

D – classificare E – scala B – dovrebbe A – completo C – sottostante

Exercise 3. What is the opposite of the following?

1. 2. 3. 4. 5.

happy low early physical young/new

Grammar No. of studies

topical antimicrobials with steroids vs placebo drops acetic acid vs antibiotic/steroid drops steroid only drops oral antihistamine + topical steroid vs topical steroid alone steroid vs antibiotic/steroid quinlone vs non-quinlone antibiotic ear clearing (alone) Exercise 2.

Vocabulary practice

1 1 2

Exercise 1.

Sono necessari un riconoscimento maggiore e una terapia più aggressiva per la depressione nei pazienti più anziani.

Reading 1 1 1 0

Exercise 1.

1. Journal of Clinical Psychiatry 2. Semel Institute for Neuroscience and Human Behavior, and the Geriatric Division of the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, USA. 3. Depression in the elderly contributes to decreased quality of life and increased mortality from both suicide and medical illnesses, yet it remains underdiagnosed and undertreated in these patients.

Comprehension Exercise 1.

1. 2. 3. 4. 5.

False Not clear Not clear True True

Answer key - extra reading

TEXT 1

TEXT 2

NEJM

The Lancet

Volume 362:485-493 Number 6, February 11, 2010

Volume 374, Issue 9707, 19 December 2009-1 January 2010, Pages 2064-2071

Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death

Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomised clinical trials

Paul W. Franks, Ph.D., Robert L. Hanson, M.D., M.P.H., William C. Knowler, M.D., Dr.P.H., Maurice L. Sievers, M.D., Peter H. Bennett, M.B., F.R.C.P., and Helen C. Looker, M.B., B.S.

1. childhood – infanzia 2. death – morte 3. background – sfondo 4. disease – malattia, patologia 5. without – senza 6. mean – media 7. between – tra 8. assessed – valutato 9. whether – se 10. blood – sangue 11. predicted – predetto 12. baseline – inizio, valori iniziali 13. median – mediana 14. rates – tassi 15. among – tra 16. highest – il più alto 17. double – il doppio 18. children – bambini 19. lowest – il più basso 20. associations – associazioni 21. seen – visto 22. scale – scala 23. although – sebbene 24. significantly – in modo significativo 25. increased – aumentato 26. major – principale, importante

Nathan Ford, Jean B Nachega, Mark E Engel, Edward J Mills

1. systematic review – revisione sistematica 2. background – sfondo 3. improve – migliorare 4. infection – infezione 5. benefit – beneficio 6. effectiveness – efficacia reale 7. administered – somministrato 8. major – principale, importante 9. assessing – valutare 10. outcome – esito 11. pooled – raggruppato 12. estimates – stime 13. done – fatto 14. poor – scarso 15. between – tra 16. funding – finanziamenti

TEXT 3 BMC Medical Research Methodology 2009, 9:79doi:10.1186/1471-2288-9-79 Volume 9

Extent of publication bias in different categories of research cohorts: a meta-analysis of empirical studies Fujian Song 1,2, Sheetal Parekh-Bhurke 2, Lee Hooper 1, Yoon K Loke 1, Jon J Ryder 1, Alex J Sutton 3, Caroline B Hing 4 and Ian Harvey 1.

1. background – sfondo 2. reported – riportato 3. odds – probabilità 4. retrieved – reperito, trovato 5. measure – misurare 6. association – associazione 7. significant – significativo

155

THE DOCTOR IS IN

8. included – incluso, compreso 9. according to – secondo, in base a 10. pooled – raggruppato 11. assessed – valutato 12. compared to – rispetto a, paragonato a 13. findings – dati preliminari 14. likely – probabile 15. appears – sembrare 16. occur – avvenire 17. early – presto, precoce 18. mainly – principalmente

TEXT 4 JAMA

25. baseline – inizio, valori iniziali 26. compared with – rispetto a, paragonato a 27. less – meno

TEXT 5 Stroke. 2010;41:187-190, Published online before print November 5, 2009

Vol. 302 No. 24, December 23/30, 2009

1. preventing – prevenire 2. decline – decline, decadimento 3. improving – migliorare 4. health – salute 5. aging – invecchiamento 6. however – tuttavia 7. whether – se 8. rates – tassi 9. setting – contesto 10. evaluation – valutazione 11. median – mediana 12. appearing – sembrare 13. main – principale 14. outcome – esito 15. measures – parametri 16. rates – tassi 17. change – cambiamento 18. over time – nel tempo 19. disease – malattia, patologia 20. assessment – valutazione 21. rates – tassi 22. between – tra 23. mild – lieve 24. treatment – trattamento, terapia

156

1. low – basso 2. stroke – ictus 3. health – salute 4. background – sfondo 5. purpose – scopo 6. association – associazione 7. health – salute 8. outcomes – esiti 9. increasing – crescente, in aumento 10. to date – ad oggi 11. between – tra 12. random – casuale 13. sample – campione 14. men – uomini 15. women – donne 16. scale – scala 17. baseline – inizio, valori iniziali 18. mean – media 19. discharge – dimissione ospedaliera 20. lowest – il più basso 21. compared with – rispetto a, paragonato a 22. highest – il più alto 23. disease – malattia, patologia 24. had – aveva 25. key – chiave

Answer

key

TEXT 6 Am J Obstet Gynecol 2010;202:266.e1-6.

Effects of recommended levels of physical activity on pregnancy outcomes Katarina Melzer, PhD a b, Yves Schutz, PhD c, Nina Soehnchen, MD, PhD b, Veronique Othenin-Girard, RM b, Begoña Martinez de Tejada, MD, PhD b, Olivier Irion, MD, PhD b, Michel Boulvain, MD, PhD b, Bengt Kayser, MD, PhD a.

1. effects – effetti 2. recommended – consigliato, raccomandato 3. physical – fisico 4. outcomes – esiti 5. sought – cercato, tentato 6. during – durante 7. conducted – condurre 8. healthy – sano, in salute 9. women – donne 10. late – tardi, tardivo 11. records – cartelle cliniche 12. better – meglio 13. lower – più basso 14. compared to – rispetto a, paragonato a 15. further – ulteriore 16. larger – più grande 17. sample – campione 18. size – dimensione

TEXT 7 J Thorac Oncol. 2010 Feb 5. [Epub ahead of print]

Self-Selection Effects in Smokers Attending Lung Cancer Screening: A 9.5-Year Population-Based Cohort Study in Varese, Italy. Dominioni L, Rotolo N, Poli A, Paolucci M, Sessa F, D’ambrosio V, Paddeu A, Mantovani W, Imperatori A.

1. lung – polmone 2. background – sfondo 3. may be – può essere 4. rate – tasso 5. recorded – registrato 6. care – cura 7. compared – confrontare, paragonare 8. assessing – valutare

extra

reading

9. disease – malattia, patologia 10. younger – più giovane 11. more frequently – più frequentemente 12. had – aveva 13. years – anni 14. higher – più alto 15. developing – sviluppare 16. healthy – sano, salutare 17. diseases – malattie, patologie 18. higher – più alto 19. healthy – sano, salutare 20. overall – globale, complessivo 21. effectiveness – efficacia reale 22. should be – dovrebbe essere

TEXT 8 BMJ 2010;340: b5479 doi: 10.1136/bmj.b5479

Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics Rosalind Raine,1 Wun Wong,1 Shaun Scholes,1 Charlotte Ashton,1 Austin Obichere,2 Gareth Ambler 3

1. admission – ricovero ospedaliero 2. compared with – rispetto a, paragonato a 3. surgical – chirurgico 4. vary – variare 5. age – età 6. year – anno 7. despite – nonostante 8. implementation – attuazione 9. still – tuttora 10. known – conosciuto 11. improve – migliorare 12. outcomes – esiti 13. overall – globale, complessivo 14. reduce – ridurre 15. health – salute 16. inequalities – disugualianze 17. male - maschio 18. likelihood – probabilità 19. older – più vecchio 20. likely – probabile 21. less – meno 22. surgery – chiurgia, intervento chirurgico

157

THE DOCTOR IS IN

23. setting – contesto 24. admitted – ricoverato 25. diagnosis – diagnosi 26. data – dati 27. outcomes – esiti 28. admitted – ricoverato 29. recommended – consigliato, raccomandato 30. treatment – trattamento, terapia 31. main – principale 32. chance – caso, fato 33. women – donne 34. for example – ad esempio 35. least – il meno, il minore 36. compared with – rispetto a, paragonato a 37. some – alcuni 38. improvements – miglioramenti 39. over time – nel tempo 40. findings – dati preliminari 41. improve – migliorare 42. with time – col tempo 43. most – il più 44. least – il meno 45. surgery – chirurgia, intervento chirurgico 46. undergo – sottoporre 47. bias – pregiudizio, difetto interno; distorsione 48. collected – raccolto 49. should be – dovrebbe essere 50. established – stabilito 51. unavailable – non disponibile 52. stage – stadio 53. findings – dati preliminari 54. funding – finanziamenti 55. funded – finanziato, sovvenzionato

TEXT 9 Ann Intern Med March 16, 2010, vol. 152 no. 6 346-357

1. background – sfondo, premessa 2. shown – mostrato, dimostrato 3. decrease – diminuire

158

4. blood – sangue 5. small – piccolo 6. compare – confrontare 7. efficacy – efficacia (teorica) 8. safety – incolumità, sicurezza 9. doses – dosi 10. assessing – valutare 11. outcomes – esiti 12. performing – eseguire, svolgere 13. assignment – assegnazione 14. setting – contesto 15. less – meno 16. treated – trattare, curare 17. at least – almeno 18. weeks – settimane 19. assigned – assegnato 20. in addition to – oltre a 21. therapy – terapia, cura 22. change – cambiamento 23. outcome – esito 24. measures – misure; parametri 25. higher – più alto 26. decreases – diminuire 27. baseline – inizio, valori iniziali 28. mean – media 29. compared with – rispetto a, paragonato a 30. improved – migliorare 31. mild – lieve 32. more common – più comune, più frequente 33. occurred – avvenire 34. taking – assumere (farmaco) 35. increased – aumentato 36. duration – durata 37. recommending – consigliare, raccomandare 38. use – uso 39. lowers – abbassare 40. improves – migliorare 41. therefore – perciò 42. provide – fornire 43. treatment – trattamento, terapia 44. safety – incolumità, sicurezza 45. further – ulteriore 46. evaluation – valutazione

Answer

key

TEXT 10 Pediatrics 2006 Jun; 117(6):e 1263-71.

Pediatric eye injury-related hospitalizations in the United States. Brophy M, Sinclair SA, Hostetler SG, Xiang H. Center for Injury Research and Policy, Children’s Research Institute, Columbus Children’s Hospital, the Ohio State University College of Medicne, Columbus, OH, USA

1. hospitalizations – ricoveri 2. estimated – stimato 3. occur – avvenire 4. less – meno 5. although – sebbene 6. previous – precedente 7. many – molti 8. self-reported – autoriferito; soggettivo 9. data – dati 10. in addition – inoltre 11. little – piccolo; poco 12. treating – trattare, curare 13. aim – obiettivo 14. treatment – trattamento, terapia 15. including – compreso 16. care – cura, assistenza 17. associated with – associato a 18. major – principale, importante 19. healthcare – assistenza sanitaria 20. disease – patologia, malattia 21. discharges – dimissione ospedaliera 22. diagnosis – diagnosi 23. broader – più ampio 24. allow – permettere 25. meaningful – significativo 26. comparison – confronto, paragone 27. reported – riportare, riferire 28. estimates – stime 29. collected – raccogliere 30. records – documentazione, cartelle (cliniche) 31. among – tra 32. children – bambini 33. rate – tasso 34. young – giovane 35. accounted for – rappresentare 36. highest – il più alto 37. males – maschi 38. majority – la maggior parte, la maggioranza

extra

reading

39. the most common – il più commune, il più frequente 40. followed – seguire 41. findings – dati preliminari 42. burden – peso, carico 43. need – necessità, bisogno 44. efforts – sforzi 45. gender – sesso 46. developmental – dello sviluppo 47. stage – stadio 48. educating – educare, istruire 49. in addition – inoltre 50. promoting – promuovere 51. help – aiutare 52. prevent – prevenire

TEXT 11 BMC Medicine 2010, 8:11doi:10.1186/1741-7015-8-11, Published: 1 February 2010

Incidence, detection, and tumour stage of breast cancer in a cohort of Italian women with negative screening mammography report recommending early (short-interval) rescreen Alessandra Ravaioli, Flavia Foca, Americo Colamartini, Fabio Falcini, Carlo Naldoni, Alba C Finarelli, Priscilla Sassoli de Bianchi and Lauro Bucchi.

1. incidence – incidenza 2. detection – rilevamento, riscontro 3. stage – stadio 4. breast – mammella 5. recommending – consigliare, raccomandare 6. early – presto, precoce 7. short – corto; breve 8. although – sebbene 9. poorly – scarsamente 10. due to – dovuto a, a causa di 11. burden – peso, carico 12. proven – dimostrato 13. targeted – bersagliare; mirare 14. eligible – idoneo 15. records – cartelle (cliniche), documentazione; registri 16. addressed – porre l’attenzione; rivolgere l’attenzione 17. following – in seguito a; il seguente 18. questions – domande

159

THE DOCTOR IS IN

19. among – tra 20. reports – referti; documentazione 21. likelihood – probabilità 22. whether – se 23. rate – tasso 24. detection – rilevamento, riscontro 25. rate – tasso 26. odds – probabilità 27. having – avere 28. late – tardi, tardivo 29. during – durante 30. out of – su (2 su 10) 31. found – trovare 32. average – media 33. range – gamma, estensione, intervallo 34. more likely – più probabile 35. older – più vecchio 36. subsequent – successivo 37. below – sotto 38. average – media 39. predicted – previsto, predetto 40. greater – maggiore 41. detection – rilevamento, riscontro 42. decreased – diminuire 43. late – tardi, tardivo 44. disease – malattia 45. stage – stadio 46. established – stabilire 47. guidelines – linee guida 48. detected – rilevare, riscontrare

TEXT 12 BMC Medicine 2010, 8:15doi:10.1186/1741-7015-8-15

Research article

Frequency and circumstances of placebo use in clinical practice - a systematic review of empirical studies Margrit Fässler, Karin Meissner, Antonius Schneider and Klaus Linde.

1. background – sfondo, premessa 2. little – piccolo; poco 3. known – conoscere, sapere 4. aim – obiettivo 5. available – disponibile 6. addressing – porre l’attenzione; rivolgere l’attenzione

160

7. issues – questioni, problematiche 8. inception – inizio 9. surveys – indagine, inchiesta 10. among – tra 11. health – salute 12. care – cura, assistenza 13. at least – almeno 14. following – seguente 15. issues – questioni problematiche 16. findings – dati preliminari 17. met the inclusion criteria – soddisfare i criteri (di inclusione) 18. most – la maggior parte 19. reporting – riportare, riferire 20. for example – ad esempio 21. life – vita 22. varied – variare, spaziare 23. between – tra 24. physicians – medici clinici 25. actual – reale, vero 26. such – tale 27. likely – probabile 28. more – più 29. however – tuttavia 30. estimation – stima 31. might – potrebbe 32. suggest – suggerire, far pensare 33. health care providers – “fornitori” di assistenza sanitaria 34. often – spesso 35. although – sebbene 36. available – disponibile 37. there can be – ci può essere 38. little – piccolo; poco 39. differ – distinguersi, differenziare 40. both – entrambi 41. further – ulteriore 42. needed – necessario 43. issues – questioni problematiche

Glossary

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37.

-fold – volte (4-fold = 4 volte) access – accesso according to – secondo, in base a account for – rappresentare accuracy – accuratezza, precisione achieve – compiere, conseguire, raggiungere uno scopo achy – dolente acknowledgement – riconoscimento (“ringraziamenti”) actual – reale, vero actually – veramente add – aggiungere; sommare addiction – dipendenza address – porre l’attenzione, rivolgere l’attenzione adherence – conformità; aderenza, adesione administer – somministrare admission – ricovero ospedaliero admit – ricoverare; ammettere adulthood – età adulta advances – progressi advocacy – patrocinio, appoggio affect – colpire, interessare, influire affluence – ricchezza against – contro age – età aging – che invecchia; invecchiamento agreement – accordo; concordanza aim – mirare, avere come obiettivo allow – permettere alumni – laureati in una data facoltà e/o università among – tra (più di 2 elementi) another – un altro answer – risposta anticipate – prevedere, aspettarsi any – qualsiasi appear – apparire; sembrare; comparire apply to – riguardare arm – braccio

38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77.

as – poiché; come; man mano che as did – così come (ha fatto…) as distinct from – a differenza di as yet – finora ascertain – stabilire; accertare assess – valutare assessment – valutazione assign – assegnare associate – associare assume – supporre; dare per scontato assumption – assunzione at home – a casa at least – almeno at rest – a riposo at times – a volte attend – frequentare; partecipare attitude – atteggiamento; opinione authority – autorità, potere, responsabilità available – disponibile avenue – strada, via award – premio, riconoscimento aware – consapevole background – sfondo, premessa bad – cattivo baseline – inizio, valore iniziale be lacking – mancare, essere assente because of – a causa di behavior – comportamento beneficial – benefico between – tra (2 elementi) beverage – bevanda beyond – oltre bias – pregiudizio; errore sistematico, difetto blinded – in cieco blood – sangue both – entrambi breast – mammella broad – ampio, largo, vasto build – costruire burden – carico, peso, fardello

161

THE DOCTOR IS IN

78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108.

109. 110. 111. 112. 113. 114.

162

by – da; per mezzo di call into question – mettere in discussione carer – chi si occupa di un malato, (es. parente o badante) causal – causale caution – cautela challenge – sfida; impresa chance – possibilità, caso fortuito change – cambiamento charge – costo (al paziente/sistema/consumatore) check – controllare, verificare chest – torace child – bambino; figlio childhood – infanzia children – bambini choice – scelta cleaning – pulizia closely – attentamente cluster – grappolo collect – raccogliere co-management – co-gestione, gestione condivisa common – comune, frequente community-dwelling – popolazione (non ospedaliera) compare – confrontare, paragonare compared with – rispetto a comparison – confronto competency – competenza comprise – consistere; rappresentare concern – preoccupazione condition – condizione; disturbo, patologia confirmation – conferma confounding/confounders – che creano confusione o distorsione (termine statistico) confusing – che crea confusione consistency – coerenza, conformità; omogeneità consistently – costantemente, regolarmente; coerentemente consumption – consumo; assunzione control – controllare, regolare cough – tosse

115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145.

146. 147. 148. 149. 150. 151. 152. 153. 154. 155. 156.

crash – scontro, incidente crutch – stampella cure – guarigione customized – personalizzato, su misura cut or pierced – tagliato o perforato/trafitto dairy products – latticini data coding – codifica dei dati date – data day – giorno death – morte decade – decennio decline – calo, declino, decadimento deep – profondo deepen – approfondire deficiency – carenza delay – ritardo delegate – delegare, deputare delivery – consegna, erogazione; parto demand – domanda, pretesa deprived – privato; povero depth – profondità design – disegno, progetto detect – rilevare, riscontrare detection – rilevamento, riscontro determine – identificare, stabilire develop – sviluppare development – sviluppo developmental – dello sviluppo diagnose – diagnosticare diagnosis – diagnosi discharge – dimettere; dimissione ospedaliera; scarico, emissione, spurgo disclose – rivelare, dichiarare pubblicamente discomfort – fastidio; disagio disease – malattia, patologia dizzy – avere le vertigini (agg.) double – raddoppiare doubt – dubbio doubtful – dubbioso; incerto draft – redigere, abbozzare; bozza drippy – gocciolante drops – gocce dual – duplice

Glossary

157. 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. 174. 175.

176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 196. 197. 198. 199. 200. 201. 202.

due to – dovuto a; a causa di duration – durata e.g. – ad esempio (exempli gratia) ear – orecchio earache – mal d’orecchio earlier – prima early – presto, precoce education – istruzione effective – efficace effectiveness – efficacia reale efficacy – efficacia teorica effort – sforzo elderly – anziano elective – facoltativo; programmato elicit – suscitare, far emergere eligible – idoneo, adatto employer – datore di lavoro empty – vuoto enable (v) - rendere capace, mettere nelle condizioni di poter fare enforce – fare rispettare engage – ingaggiare, coinvolgersi engage in – partecipare engineer – progettare, costruire enhance – accrescere, potenziare enough – abbastanza, sufficiente enroll – arruolare establish – stabilire estimate – stimare; stima evaluate – valutare evaluation – valutazione except – eccetto, tranne expected – atteso, previsto expenditure – dispendio expenses – spese sostenute expertise – competenze esperte explain – spiegare explanation – spiegazione exposure – esposizione eye – occhio eyewear – occhiali (generico) face – trovarsi davanti, affrontare failure – fallimento, non riuscita faint – sentir mancare; svenire fasting – a digiuno fate – destino feasible – fattibile

203. feature – caratteristica 204. feeling – sentimento; sensazione; stato 205. female – femmina 206. fever – febbre 207. findings – dati preliminari/risultati 208. fitness – forma fisica 209. focus on – focalizzare, porre l’attenzione 210. food – cibo 211. framework – schema, quadro 212. full – pieno 213. funding – finanziamento 214. further – ulteriore 215. gain – guadagnare; aumento; guadagno 216. gender – sesso 217. general practitioner (GP) – medico di base 218. get hard – diventare difficile 219. goal – traguardo 220. good – buono 221. grains – cereali 222. grant – sovvenzione 223. grant – concedere 224. guidelines – linee guida 225. hazardous – pericoloso 226. headache – emicrania 227. healing – guarigione 228. health – salute 229. healthy – sano, salutare 230. hearing – udito 231. heart rate – battito cardiaco 232. heavy – pesante 233. height – altezza 234. helpful – di aiuto 235. heritage – popolo d’origine 236. high – alto 237. hip – anca 238. HIPAA – Health Insurance Portability and Accountability Act of 1996 regarding the privacy of medical records 239. homeless people – senza tetto 240. household – nucleo familiare; ambito domestico 241. husband – marito 242. i.e. – cioè (id est)

163

THE DOCTOR IS IN

243. identification – identificazione, individuazione 244. identify – identificare, individuare 245. ill – malato 246. illness – malattia, patologia 247. impaired – compromesso 248. impairment – compromissione 249. implement – attuare 250. implementation – attuazione 251. improve – migliorare 252. improvement – miglioramento 253. in light of – alla luce di 254. in order to – per, con lo scopo di 255. in that – in quanto, nel senso che 256. inception – inizio 257. including – compreso 258. increase – aumentare; aumento 259. increasing – crescente 260. increasingly – sempre più 261. incubation – incubazione 262. inequality – disuguaglianza 263. infection – infezione 264. injury – lesione, infortunio 265. inpatient – paziente ospedaliero, ricoverato 266. instrument – strumento 267. intensivist (n) – medico specialista di cure intensive 268. involve – coinvolgere; riguardare 269. issue – numero di una pubblicazione; questione, problema 270. itchiness – prurito 271. judge – giudicare, valutare 272. key – chiave 273. kidney – rene 274. labor – travaglio; lavoro 275. large – grande 276. last – durare 277. late – tardi, tardivo 278. lay – per non-addetti al settore 279. lead to – portare a, avere come risultato 280. length – lunghezza 281. lengthen – allungare 282. less – meno 283. life – vita 284. lifespan – arco della vita 285. light – leggero; luce

164

286. 287. 288. 289. 290. 291. 292. 293. 294. 295. 296. 297. 298. 299. 300. 301. 302. 303. 304. 305. 306. 307. 308. 309. 310. 311. 312. 313. 314. 315. 316. 317. 318. 319. 320. 321. 322. 323. 324. 325. 326. 327. 328. 329. 330.

likelihood – probabilità likely – probabile linked – associato a little – piccolo; poco long – lungo low – basso lung – polmone main – principale major – maggiore; importante make a diagnosis – fare una diagnosi make a house call – fare una visita a domicilio make a mistake – commettere un errore make rounds – fare la visita di reparto male – maschio man/men – uomo/uomini manage – gestire management – gestione manager – dirigente masked – celato, nascosto; bendato match – abbinare may – potrebbe, è possibile meal – pasto mean – media aritmetica mean – significare meaning – significato meaningful – significativo measure – misurare measure – parametro measurement – misura median – mediana medical record – cartella clinica medication – farmaco meet criteria – soddisfare criteri mild – lieve monitor – monitorare month – mese most – la maggior parte much more – molto più narrow – stretto nearly – quasi need – esigenza, bisogno needed – necessario negligible – insignificante network – rete next – prossimo; successivo

Glossary

331. 332. 333. 334. 335. 336. 337. 338. 339. 340. 341.

342. 343. 344. 345. 346. 347. 348. 349. 350. 351. 352. 353. 354. 355. 356. 357. 358. 359. 360. 361. 362. 363. 364. 365. 366.

367. 368. 369. 370.

non-compliant – non conforme none – nessuno, niente nose – naso notable – degno di nota; importante nurse – infermiere observation – osservazione observe – osservare occur – avvenire occurrence – avvenimento, evento odds – probabilità off-site location – in un luogo esterno all’ospedale, in un altro luogo old – vecchio only – solo, soltanto onset – inizio, comparsa, insorgenza, esordio otherwise – altrimenti; per il resto outcome – esito, prognosi outside – al di fuori over – più di; sopra overall – complessivo overview – panoramica overweight – sovrappeso pain – dolore painful – doloroso panel – commissione paucity – pochezza, scarsezza, insufficienza payer – colui che paga perceived – percepito; soggettivo perform – eseguire performance – esecuzione; prestazione physician – medico clinico plan – pianificare, programmare policy – politica, linea di condotta pooled – raggruppato poor – povero, scarso poorly – scarsamente port of entry – punto d’ingresso (es. medico di famiglia, pronto soccorso, o altro) poultry – pollame practice – attività di libera professione; esercitazione, pratica pratice – esercitare, esercitarsi prediction – previsione

371. 372. 373. 374. 375. 376. 377. 378. 379. 380. 381. 382. 383. 384. 385. 386. 387. 388. 389. 390. 391. 392. 393. 394. 395. 396. 397. 398. 399. 400. 401. 402. 403. 404. 405. 406. 407. 408. 409. 410. 411.

predispose – predisporre pregnancy – gravidanza prevention – prevenzione previously – in precedenza print – stampare prior – prima, in precedenza private practice – attività di libera professione produce – ortaggi produce – produrre promote – promuovere, favorire prove – dimostrare provide – fornire, erogare provider – fornitore provision – erogazione, fornitura purpose – scopo question – domanda random – casuale randomly – in modo casuale range – gamma, estensione, intervallo rate – valutare, dare un punteggio; tasso, percentuale rater – valutatore rating – valutazione (graduatoria) readmission – rientro ospedaliero reason – ragione, motivo recommend – consigliare record – registrare; registrazione, documentazione (clinica) reduce – ridurre reduction – riduzione relationship – rapporto reliable – affidabile, attendibile relief – sollievo rely on – fare affidamento; dipendere, contare su remainder – il restante remarkable – notevole reminder – promemoria, sollecitazione reply – risposta, replica report – riportare, riferire; referto reservations – riserva; restrizione resource – risorsa response – risposta; reazione result in – comportare, avere come conseguenza

165

THE DOCTOR IS IN

412. 413. 414. 415. 416. 417. 418. 419. 420. 421. 422. 423. 424. 425. 426. 427. 428. 429. 430. 431. 432. 433. 434. 435. 436. 437. 438. 439. 440. 441. 442. 443. 444. 445. 446. 447. 448. 449. 450. 451. 452.

166

retrieve – reperire reviewer – revisore, valutatore revised – rivisto, revisionato rising – in aumento, crescente safety – incolumità, sicurezza sample – campione scale – scala schedule – orario; tabella di marcia scope – portata, sfera, ambito, ampiezza score – punteggio seafood – pesce e frutti di mare second-hand – di seconda mano self-identified – “auto-identificato”, auto-valutato, soggettivo self-selection – autoselezione sensitivity – sensibilità setting – contesto, quadro several – parecchi shallow – poco profondo shellfish – crostacei shift – spostamento, movimento laterale short – corto; breve shortcoming – limite; difetto shorten – accorciare; rendere più breve should – dovrebbe show – mostrare, dimostrare; illustrare sick – malato sickness – malattia, patologia size – dimensione; numero skill – competenza (pratica) skin – cute sleep – dormire slow – rallentare smoker – fumatore smoking – tabagismo sore throat – mal di gola source – fonte south – meridione southern – meridionale sparing – che riduce il bisogno (es. di un farmaco) speed – velocità stage – stadio

453. stakeholder – chi ha investito e/o ha interessi in un progetto 454. start – iniziare 455. stay – rimanere; alloggiare 456. stop – arrestare, fermare 457. strain – affaticamento 458. strength – forza 459. stressfulness – stato di stress 460. stroke – ictus 461. strongly – fortemente 462. struck – colpito 463. submit – sottoporre 464. subsequently – successivamente, in seguito 465. substantially – in modo significativo 466. successful – di successo, riuscito 467. summarize – riassumere 468. summary – riassunto 469. sunlight – luce solare 470. supplementation – integrazione 471. supply – fornire 472. surgery – chirurgia 473. surgical – chirurgico 474. surveillance – sorveglianza 475. survey – indagine, inchiesta 476. survival – sopravvivenza 477. survive – sopravvivere 478. sustain – mantenere; sostenere 479. sweaty – sudato 480. swimmer’s ear – “orecchio del nuotatore” 481. take – prendere; assumere (un farmaco) 482. test – verifica, esame 483. textbook – libro di testo 484. thank – ringraziare 485. therefore – perciò 486. thickness – spessore 487. thorough – completo, esauriente 488. threatened – minacciato 489. threatening – minaccioso 490. throat – gola 491. through – attraverso 492. timing – tempistica 493. to what extent – fino a che punto 494. toward – verso 495. towards – verso; nei confronti di 496. track – seguire le tracce

Glossary

497. training – allenamento, esercitazione; formazione 498. treat – curare, trattare 499. treatment – cura, trattamento 500. trend – andamento, tendenza 501. twice daily – due volte al giorno 502. unclear – non chiaro 503. under – sotto 504. underlying – sottostante 505. underweight – sottopeso 506. unlikely – improbabile, difficilmente 507. up to – fino a 508. useful – utile 509. view – vedere, visionare; veduta; opinione 510. waiver – rinuncia a un diritto 511. walking frame – deambulatore 512. warrant – giustificare 513. weak – debole, fiacco 514. weigh – pesare 515. weight – peso 516. weighted – pesato (termine statistico)

517. 518. 519. 520. 521. 522. 523. 524. 525. 526. 527. 528. 529. 530.

531. 532. 533. 534. 535.

well – bene what – ciò che whether – se whole – intero wholly – interamente, completamente wide – ampio, largo widely – diffusamente, comunemente with time – nel tempo within – entro without – senza woman/women – donna/donne workforce – forza lavoro; personale workshop – corso pratico, laboratorio workup – programma di esami strumentali e di laboratorio per definire una diagnosi worse – peggio wound – ferita x-ray – radiografia yield – produrre, fruttare young – giovane

167

Irregular Verbs â&#x20AC;&#x201C; Medical English

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37.

Infinitive be beat become begin bend bite bleed bring build burn buy catch choose come cost cut do draw drink drive eat fall feed feel find forget freeze get give go grow hear hide hit hold hurt keep

Past Simple was/were beat became began bent bit bled brought built burnt bought caught chose came cost cut did drew drank drove ate fell fed felt found forgot froze got gave went grew heard hid hit held hurt kept

Past Participle been beaten become begun bent bitten bled brought built burnt bought caught chosen come cost cut done drawn drunk driven eaten fallen fed felt found forgotten frozen got (gotten) given gone grown heard hidden hit held hurt kept

Translation essere battere diventare incominciare piegare mordere sanguinare portare costruire bruciare comprare prendere, afferrare scegliere venire costare tagliare fare trarre; disegnare bere guidare mangiare cadere nutrire, alimentare sentirsi trovare dimenticare gelare, congelare ottenere; diventare dare andare crescere, coltivare udire nascondere colpire tenere, contenere ferire, dolere tenere, conservare

169

THE DOCTOR IS IN

38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62.

170

Infinitive know lay lead leave let lie lose make mean meet pay put read rise run say see seek sell send set shake shoot undergo undertake

Past Simple knew laid led left let lay lost made meant met paid put read rose ran said saw sought sold sent set shook shot underwent undertook

Past Participle known laid led left let lain lost made meant met paid put read risen run said seen sought sold sent set shaken shot undergone undertaken

Translation sapere, conoscere porre, posare condurre lasciare, partire permettere giacere perdere fare significare, intendere incontrare, conoscere pagare mettere leggere sorgere; aumentare correre dire, pronunciare vedere cercare vendere inviare impostare, fissare scuotere; tremare sparare sottoporsi intraprendere

Some definitions of study designs and statistical terms Bias

Systematic error or deviation in results or inferences. Case study (synonyms: anecdote, case history, single case report) An uncontrolled observational study involving an intervention and outcome for a single person. Case-control study (synonyms: case refer-

ent study, retrospective study) A study that starts with the identification of people with the disease or outcome of interest (cases) and a suitable control group without the disease or outcome. The relationship of an attribute (intervention, exposure or risk factor) to the outcome of interest is examined by comparing the frequency or level of the attribute in the cases and controls. Case-control studies are sometimes described as being retrospective studies as they are always performed looking back in time. Clinical trial (synonyms: therapeutic trial,

intervention study) A trial that tests out a drug or other intervention to assess its effectiveness and safety. This general term encompasses randomized-controlled trials and controlled clinical trials. Cohort study (synonyms: follow-up, inci-

dence, longitudinal, prospective study) An observational study in which a defined group of people (the cohort) is followed over time and outcomes are compared in subsets of the cohort who were exposed or not exposed, or exposed at different levels, to an intervention or other factor of interest. Cohorts can be assembled in the present and followed into the future (a “concurrent cohort study”), or identified from

past records and followed forward from that time up to the present (a “historical cohort study”). Because random allocation is not used, matching or statistical adjustment must be used to ensure that the comparison groups are as similar as possible. Confidence interval (CI)

The range within which the “true” values (e.g., size of effect of an intervention) is expected to lie with a given degree of certainty (e.g. 95% or 99%). Note: Confidence intervals represent the probability of random errors, but not systematic errors (bias). Critical appraisal

The process of assessing and interpreting evidence by systematically considering its validity, results and relevance. Cross-sectional study (synonym: preva-

lence study) A study that examines the relationship between diseases (or other health related characteristics) and other variables of interest as they exist in a defined population at one particular time. The temporal sequence of cause and effect cannot necessarily be determined in a cross-sectional study. Gold standard

The method, procedure or measurement that is widely accepted as being the best available against which new interventions should be compared. It is particularly important in studies of the accuracy of diagnostic tests. Incidence

The number of new cases in a specific period of time, for example, the number of new cases of prostate cancer in one year in Italy.

171

THE DOCTOR IS IN

Likelihood ratio for a negative test result/ negative predictive value

The likelihood that a negative test comes from a person with the condition of interest rather than someone without the disorder. (ÂŠ 2010 by the BMJ Publishing Group Ltd. All rights reserved.) Likelihood ratio for a positive test result/ positive predictive value

The likelihood that a positive test comes from a person with the condition of interest rather than one without the disorder. Observational study (synonym: non-experi-

mental study) A study in which nature is allowed to take its course. Changes or differences in one characteristic (e.g., whether or not people received the intervention of interest) are studied in relation to changes or differences in other(s) (e.g., whether or not they died), without the intervention of the investigator.

Relative risk

In statistics and mathematical epidemiology, relative risk (RR) is the risk of an event (or of developing a disease) relative to exposure. Relative risk is a ratio of the probability of the event occurring in the exposed group versus a non-exposed group. â&#x20AC;Ś In a simple comparison between an experimental group and a control group, a relative risk of 1 means there is no difference in risk between the two groups. An RR of < 1 means the event is less likely to occur in the experimental group than in the control group. An RR of > 1 means the event is more likely to occur in the experimental group than in the control group. (From Wikipedia) Retrospective study

A study in which the outcomes have occurred to the participants before the study commenced. Case control studies are always retrospective, cohort studies sometimes are, randomized controlled trials never are. Risk ratio (RR)

Odds ratio (OR)

The ratio of the odds of an event in the experimental (intervention) group to the odds of an event in the control group; odds ratio of one indicates no difference between comparison groups. For undesirable outcomes an OR that is less than one indicates that the intervention was effective in reducing the risk of that outcome (protective).

The ratio of risk in the intervention group to the risk in the control group. The risk (proportion, probability or rate) is the ratio of people with an event in a group to the total in the group. A relative risk of one indicates no difference between comparison groups. For undesirable outcomes a RR that is less than one indicates that the intervention was effective in reducing the risk of that outcome.

Prevalence

Sensitivity

The percentage of a population that is affected with a particular disease at a given time, for example, on 31 December 2009, how many cases of Alzheimerâ&#x20AC;&#x2122;s Disease were there in Italy.

The sensitivity of a test is the proportion of people with the condition of interest who test positive (according to the diagnostic gold standard). Specificity

Relative Case series

An uncontrolled observational study involving an intervention and outcome for more than one person.

172

The proportion of people who do not have the condition of interest who test negative (according to the diagnostic gold standard).

Some definitions of study designs and statistical terms Statistical significance (P-value)

An estimate of the probability of an association (effect) … observed in a study occurring by chance, usually expressed as a P-value. …The cut-off for statistical significance is usually taken at 0.05, but sometimes at 0.01 or 0.10. … Systematic review

For more detailed information about study designs and statistics (in Italian!), consult Epidemiologia facile, by Pier Luigi Lopalco and Alberto Eugenio Tozzi (Il Pensiero Scientifico Editore) and Statistica medica facile – Alice nel paese del p-value, by Andrea Ripoli (Il Pensiero Scientifico Editore).

A review article in the medical literature, which summarizes a number of different studies and may draw conclusions about a particular intervention. [From SA Healthinfo, http://www.sahealthinfo.org/sahealthinfo.htm.SA HealthInfo is a research knowledge translation tool and service to support innovation and improved decision-making in southern African health sectors. It is hosted by the South African Medical Research Council (MRC)]

173

Conclusions

You have worked hard. Even when it was boring, even when you didn’t have a lot of time or interest in “working out,” you didn’t quit. You kept going! Great! And now you can see the results – your vocabulary has increased and your ability to read and understand a scientific text in English has improved. Reading in English is still difficult sometimes but overall, it’s much easier now than when you started this textbook.

I hope that it has been useful, helpful, and relevant. I hope that it will help you do your job – taking care of sick people and preventing healthy people from getting sick – better by permitting you to read the scientific literature more quickly, more effectively, and more confidently. I wish you the best of luck, and if I can help in any way, just let me know. Remember that, always. JMC

175

J ACQUELINE M. C OSTA will learn to read just as well in English”. Ciò

€ 32,00

The Doctor is in. Capire l’inglese delle riviste scientifiche

“Y

ou learned to read in your own language; you

J A C Q U E L I N E M . C O S TA

THE DOCTOR IS IN

Capire l’inglese delle riviste scientifiche