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Passage
One
Until recently, questions about managed care focused
on the issues of access to services, choices of doctors
and waiting time. Now, though, patients and employers are
demanding to know more about their managed care plans. What
percentage of breast cancer sufferers in a given plan survive?
How many babies delivered are healthy? How many times a
year do asthma sufferers get rushed to the emergency room?
The emphasis on outcomes, though, is relatively new. The Foundation
for Accountability, a Portland (Ore.)- based group, is developing
the first comprehensive set of measurements. Patients, employers
and government purchasers of health plans formed the foundation
18 months ago to improve quality in health care delivery.
So far, the group has developed seven sets
of measurements about specific diseases such as asthma,
breast cancer, diabetes and heart disease. No community
has yet begun to use these measurements. But David Lansky,
the foundation's president, said that Medicare is preparing
to test them in Florida, Minnesota and Washington state.
It's a four-year project and involves gathering data for
analysis and giving feedback to doctors and managed care
plans.
Here's how the foundation's project works:
In a given community, health care purchasers—individuals,
companies and the federal government—will demand that
each health plan in the area provide uniform information
on the treatment of diseases. Health plans will comply to
stay competitive and keep their market share. Take breast cancer. The foundation measures
quality of care three ways. It tries to determine whether
the health plan has steps in place that lead to good care.
For example, does it allow mammograms as often and early
in life as the latest guidelines suggest? Does the patient
understand all of the treatment options available to her?
Patient satisfaction is another consideration.
Does the health plan communicate well with the patient?
Is the patient involved in treatment decisions? Does the
patient have access to specialists? How long does the patient
have to wait to get the results of a breast biopsy?
The result, or outcome, is the final question.
People want to know how long patients with breast cancer
live and avoid recurrence of their disease. Do they have
access to reconstructive surgery and counseling? Do they
return to normal life as soon as possible?
The ultimate goal, Lansky said, is to get
this information into the hands of consumers while they're
choosing a doctor, a hospital or a health maintenance organization
(HMO).
(400 words)
1. Which of the following statements is true
concerning people's attention to managed care service?
(
C
)
(a) They used to focus on outcomes.
(b) They don't care about access to services, choices of doctors and waiting
time for the time being.
(c) They begin to stress the outcomes.
(d) They begin to stress delivery time.
2. The Foundation for Accountability is an organization that _____________.
(
A
)
(a) was set up to improve quality in health care delivery
(b) has got its sets of measurements into effect
(c) is formed exclusively by patients and government purchasers of health
plans
(d) develops sets of measurements about minor diseases
3. The
sets of measurements will be tested ____________. (
B
)
(a) over half a decade
(b) in three states of the United States
(c) in Portland
(d) and the result will be reported to patients other than doctors
4. Regarding measuring quality of breast cancer care, it is mentioned in the
text that _________. (
C
)
(a) it takes three ways to measure, i.e., doctors' attitude, patient satisfaction
and outcome
(b) the Foundation worked out three sets of measurement
(c) the measurement should take the communication between patient and
the health plan into consideration
(d) the outcome is the least important.
5. The significance of measurements mainly lies in that _________.
(
D
)
(a) health care will be more popularly accepted by consumers
(b) the Foundation can make some profits by providing information
(c) consumers divert their attention on health care from choices of doctors
to outcomes
(d) consumers can have information about the quality of
health care when they need
TOP
Passage
Two Dramatically
increasing costs of developing new drugs and more stringent
regulatory requirements made by the U.S. Food and Drug Administration
further dampened the drug industry's appetite for jumping
into new antibiotic research and development.
The result was virtual paralysis in antibiotic
development just when the resistance was careering out of
control. "In 1991 an informal survey among pharmaceutical
companies in the United States and Japan suggested that
at least 50 percent of them had either diminished substantially
or totally gotten out of antibacterial research," says Shlaes.
"People simply sloughed off the problem of resistance."
But it's no surprise that bugs should develop
resistance to our efforts to wipe them out. It's only natural
for an organism to do everything it can to evade its killer.
By developing new drugs, we attempt to stay one step ahead
of our microbial enemies, and the microbes furiously return
the favor. Antibiotics actually promote resistance. For
example, let's say that Shoemaker's young patient was indeed
suffering from an ear infection. An antibiotic might wipe
out most of those bad bugs, but a few might survive. If
the child's besieged immune system were capable of mopping
up, all would be well. But if it weren't, with the susceptible
bacteria now dead, the resistant strains could spread like
weeds through a newly harvested field. And if the child
didn't take the entire prescribed course of drugs, or if
they were the wrong kind, more resistant strains might propagate.
To compound the problem, antibiotics don't
just kill bad bugs, they also cut down innocent bystanders.
That's unfortunate, says Levy. "Non-disease-causing bacteria
are essential parts of the body's natural armor against
invading infectious bacteria." These benign microbes limit
the spread of their dangerous brethren simply by being in
the way. With them gone, the field is even more wide open
for resistant bugs to grow rapidly.
All that may be the unintended result when
antibiotics are used to cure disease. But much of antibiotic
use is preventive—the penicillin given to the Vietnamese
prostitutes, say, or antibiotics prescribed before surgery.
Often the doses involved are comparatively low, and the
drugs are given over long periods. This regime can be even
more favorable for breeding resistance, as can low doses
in animal feed or in agriculture—or in antibacterial products
like plastics, household cleaners, soaps, and toothpaste,
a more recent menace.
(394 words)
6. One of the reasons
that made antibiotics research and development paralyzed is
that _____________. (
A
)
(a) the cost of developing new drugs kept rising
(b) regulatory requirements are not so strictly observed as before
(c) there aren't enough funds and labors for drug industry to develop in this
field
(d) the market demand is not high
7. The case of Shoemaker's young patient is taken to show that
____________. (
A
)
(a) antibiotics can promote resistance of bugs
(b) antibiotics can kill all the bad bugs
(c) antibiotics can prevent the bugs from reproducing for good
(d) antibiotic research is not well developed
8. According to the text, which of the following statements is
NOT true? (
D
)
(a) Antibiotics kill innocent bacteria as well as bad bugs.
(b) If drugs were not taken properly, more resistant strains might breed.
(c) A person's immune system plays a significant role in the effects of antibiotics.
(d) Antibiotics are not effective by and large.
9. If
non-disease-causing bacteria were killed, __________. (
C
)
(a) the spread of infectious bacteria would slow down
(b) the positive effect of antibiotics would be proven fully
(c) the spread of bad bugs would be freer and quicker
(d) resistant bugs would lose their ground to function
10. In the last paragraph, it is inferred that __________.
(
B
)
(a) preventive use of antibiotics leaves no room for bugs to develop resistance
(b) low-dosed or long-term use of antibiotics can be a threat to our health
as well
(c) low-dosed or long-term use of antibiotics is not likely to
breed resistance of bugs
(d) daily-used antibiotic products can thoroughly prevent
the breed of resistant bugs
TOP
Passage Three
Alprazolam
is an antianxiety agent, benzodiazepines. Used primarily
for short-term relief of mild to moderate anxiety and nervous
tension. Alprazolam is also effective in the treatment of
activity depression or panic attacks. It can be useful in
treating irritable bowel syndrome and anxiety due to a neurosis
as well. Alprazolam may help the symptoms of PMS if extreme,
some cancers pains if given with various narcotics, agoraphobia,
essential tremor, and ringing ears.
Dosages:
Actual dosage must be determined by the physician.
Normal dosage:
USE
UP TO EIGHT MONTHS ONLY!
If
under 18 years of age, DO NOT USE!
18
to 60 years of age, 0.25mg
to 1.5mg daily.
Over
60 years of age, Lower
dosage increased cautiously.
Dosage Depends on Disorder:
Oral ( For anxiety or nervous
tension): Start: 0.25 mg to 0.5 mg 3 times daily.
Maximum : 4 mg in 24 hours.
Oral ( For panic disorder):
Start : 0.5 mg 3 times daily. Increases: 1 mg daily in 3
to 4 day intervals.
Maximum: 10 mg in 24 hours.
If Stop Taking: Do not stop without
consulting your physician and never abruptly if you have
been taking for over three weeks.
Warnings
Do not stop taking abruptly.
Do not give this drug to anyone who is psychotic.
Narcotics may increase the sedative effects
of this drug. Do not take other sedative, benzodiazepines,
or sleeping pills with this drug. The combinations could
be fatal. Do not drink alcohol when taking benzodiazepines.
Alcohol can lower blood pressure and decrease your breathing
rate to the point of unconsciousness.
The habit-forming potential is high. It
is possible to become dependent in the first few days. Do
not stop taking this drug abruptly, this could cause psychological
and physical withdrawal symptoms.
Do not take this drug if you are pregnant
or planning to become pregnant. Do not take if you are breast-feeding.
Do not give this drug to anyone under eighteen and only
in small doses if over sixty with very close monitoring.
Do not use If: If you had negative
reactions to other benzodiazepines, if you have a history
of drug dependence, if you have had a stroke, if you have
multiple sclerosis, if you have Alzheimer's disease, if
you are seriously depressed, or if you have other brain
disorders. If you have myasthenia gravis or acute narrow-angle
glaucoma.
Inform Physician If: If you have
a seizure disorder, impaired liver / kidney function, history
of alcoholism / drug abuse, psychosis, palpitations, or
Tachycardia.
(412 words)
11. Alprazolam can be effective in treating
______________. (
C
)
(a) psychosis disease
(b) ear trouble
(c) anxiety
(d) serious depression
12. If Alprazolam is taken for normal dosage, which of the following
statements is true?
(
C
)
(a) Alprazolam can be taken continuously for a long time
(b) One bottle of Alprazolam should be used up within eight months
(c) Alprazolam is used for persons over 18 years old
(d) The maximum dosage for an adolescent is 1.5mg per day
13. Concerning disorder treatment, it's safe to say_____________.
(
D
)
(a) 4mg per day is the maximum dosage for any type of disorder
(b) panic disorder and nervous tension can be treated with the same dosage
(c) the dosage can be increased by 1mg per day
(d) 0.5mg 3 times daily is acceptable for treating anxiety and panic
disorder for a start
14. It is not suggested in the text that ____________. (
A
)
(a) if you've taken Alprazolam for three weeks, you'd better stop
(b) alprazolam used with sleeping pills can be dangerous
(c) if you stop using Alprazolam abruptly, undesired psychological or physical
problems could occur
(d) a pregnant person shouldn't use Alprazolam in case of its possible negative
effect
15. What can be said about using Alprazolam ? (
B
)
(a) Alprazolam can be used safely in small dosages by those over
60 years and it is not so necessary to consult the doctor for it.
(b) You should inform the doctor before using Alprazolam if you have
liver or kidney trouble.
(c) The users aren't prone to get dependent on Alprazolam.
(d) Alprazolam is over-the-counter drug and can be taken by stroke patients.
TOP
测验结果：15 题中 共答对题，
答错题， 还有题未答。
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