2 Clinic for Psychotherapy, University of Leipzig, Germany
chapter-3雅思王听力特别名词语料库
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2019年中科院s医学SCI分区
序号期刊名Review分区3年平均IF1CA-A CANCER JOURNAL FORCLINICIANS1218.4352NEW ENGLAND JOURNAL OFMEDICINE174.1123NATURE REVIEWS DRUG DISCOVERY Y154.928 4LANCET153.3965JAMA-JOURNAL OF THE AMERICANMEDICAL ASSOCIATION147.786NATURE REVIEWS CANCER Y143.926 7NATURE REVIEWS IMMUNOLOGY Y141.978 8LANCET ONCOLOGY135.236 9NATURE REVIEWS NEUROSCIENCE Y131.559 10NATURE MEDICINE131.049 11World Psychiatry130.195 12LANCET NEUROLOGY127.394 13Nature Reviews Clinical Oncology Y126.484 14JOURNAL OF CLINICAL ONCOLOGY126.239 15PHYSIOLOGICAL REVIEWS Y125.192 16CANCER CELL124.722 17Annual Review of Immunology Y124.18 18LANCET INFECTIOUS DISEASES124.176 19BMJ-British Medical Journal123.984 20Cancer Discovery123.585 21EUROPEAN HEART JOURNAL122.842 22NATURE IMMUNOLOGY122.282 23IMMUNITY121.367 24Lancet Respiratory Medicine121.248 25Lancet Diabetes & Endocrinology121.198 26Nature Reviews Endocrinology Y121.076 27Annual Review of Psychology Y120.826 28CIRCULATION120.415 29Nature Reviews Neurology Y120.41 30JAMA Oncology119.949 31GASTROENTEROLOGY119.658 32NATURE NEUROSCIENCE119.626 33CLINICAL MICROBIOLOGY REVIEWS Y119.45 34JAMA Internal Medicine119.09835Annual Review of Pathology-Mechanisms ofDiseaseY118.87936ANNALS OF INTERNAL MEDICINE118.634 37PHARMACOLOGICAL REVIEWS Y118.58138JOURNAL OF THE AMERICANCOLLEGE OF CARDIOLOGY118.45639Nature Reviews Disease Primers 118.24540Nature Reviews Gastroenterology &Hepatology Y118.19141Lancet Global Health 117.42142GUT117.20643Nature Biomedical Engineering 117.13544EUROPEAN UROLOGY117.04845Science Translational Medicine 116.8946JAMA Psychiatry115.95547TRENDS IN COGNITIVE SCIENCES Y 115.71148Nature Reviews CardiologyY115.62749JOURNAL OF HEPATOLOGY115.49150BEHAVIORAL AND BRAIN SCIENCES 115.48851ENDOCRINE REVIEWS Y 115.48652PSYCHOLOGICAL BULLETIN 115.48353Nature Reviews Rheumatology Y115.46554ACTA NEUROPATHOLOGICA 115.42155INTENSIVE CARE MEDICINE 115.3356Nature Reviews Nephrology Y115.3157Lancet Psychiatry115.0558CIRCULATION RESEARCH 115.01359AMERICAN JOURNAL OFRESPIRATORY AND CRITICAL CARE MEDICINE 114.97960BLOOD114.96661Annual Review of PhysiologyY 114.44862NEURON114.24963Annual Review of Neuroscience Y114.11664HEPATOLOGY114.09965AMERICAN JOURNAL OF PSYCHIATRY 113.74266ADVANCED DRUG DELIVERY REVIEWSY 113.64867DIABETES CARE113.50868TRENDS IN IMMUNOLOGY Y113.49269JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY 113.48370ANNALS OF ONCOLOGY113.32771Annual Review of Clinical Psychology Y113.17172ANNALS OF THE RHEUMATIC DISEASES113.15373MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT113.08274Annual Review of MedicineY112.8975Lancet Gastroenterology & Hepatology 112.85676JOURNAL OF CLINICALINVESTIGATION 112.77277Annual Review of Pharmacology and ToxicologyY 112.75878PROGRESS IN NEUROBIOLOGY Y112.67979JOURNAL OF PINEAL RESEARCH112.40880MOLECULAR PSYCHIATRY 112.27281Alzheimers & Dementia112.22282HUMAN REPRODUCTION UPDATE Y 112.15983TRENDS IN PHARMACOLOGICAL SCIENCES Y112.14384Lancet HIV111.98385PSYCHOTHERAPY AND PSYCHOSOMATICS111.94386PROGRESS IN RETINAL AND EYE RESEARCHY 111.66987BIOLOGICAL PSYCHIATRY 111.63288TRENDS IN NEUROSCIENCES Y111.62689Lancet Public Health111.690EUROPEAN RESPIRATORY JOURNAL 111.5491PLOS MEDICINE111.52892DRUG RESISTANCE UPDATES Y111.41593JNCI-Journal of the National Cancer Institute111.34694JAMA Neurology 111.2795JOURNAL OF EXPERIMENTAL MEDICINE111.22496JAMA Pediatrics111.00897Journal of Extracellular Vesicles 11198JAMA Cardiology11199Journal of Cachexia Sarcopenia and Muscle 110.987100BRAIN110.985101TRENDS IN MOLECULAR MEDICINE Y110.927102Nature Human Behaviour 110.575103LEUKEMIA110.556104Science Immunology110.551105Annual Review of Biomedical Engineering Y 110.52106TRENDS IN ENDOCRINOLOGY AND METABOLISMY 110.48107JACC-Cardiovascular Imaging110.47108PHARMACOLOGY & THERAPEUTICS Y 110.3109Annual Review of Public Health Y 110.165110EMBO Molecular Medicine 110.055111IMMUNOLOGICAL REVIEWS Y 110.041112SLEEP MEDICINE REVIEWS Y110.026113AMERICAN JOURNAL OF GASTROENTEROLOGY 110.013114Lancet Haematology19.937115EUROPEAN JOURNAL OF HEART FAILURE19.927116ANNALS OF NEUROLOGY 19.879117Journal of Thoracic Oncology 19.798118SEMINARS IN CANCER BIOLOGYY19.666119CLINICAL CANCER RESEARCH 19.576120JACC-Cardiovascular Interventions 19.422121THORAX19.411122ANNALS OF SURGERY 19.22123NEURO-ONCOLOGY 19.087124JAMA Surgery19.041125GENETICS IN MEDICINE18.95126MEDICINAL RESEARCH REVIEWS Y 18.948127AGEING RESEARCH REVIEWS Y18.938128CANCER RESEARCH18.877129CLINICAL INFECTIOUS DISEASES 18.796130Annual Review of Nutrition Y18.787131JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 18.723132Cancer Immunology Research 18.697133BRITISH JOURNAL OF SPORTS MEDICINE18.69134Journal for ImmunoTherapy of Cancer 18.551135JACC-Heart Failure 18.535136BMC Medicine18.49137AUTOIMMUNITY REVIEWS Y 18.474138Theranostics18.455139Nature Reviews UrologyY18.386140KIDNEY INTERNATIONAL 18.377141NEUROLOGY18.355142CANCER TREATMENT REVIEWS Y 18.348143Molecular Cancer18.22144BIOCHIMICA ET BIOPHYSICA ACTA-REVIEWS ON CANCER Y 18.186145Obesity Reviews Y 18.186146HAEMATOLOGICA18.121147NEUROSCIENCE ANDBIOBEHAVIORAL REVIEWS Y 18.113148SEMINARS IN IMMUNOLOGY Y 18.058149FRONTIERS INNEUROENDOCRINOLOGYY 18.051150CURRENT OPINION IN IMMUNOLOGY Y 17.994151Trends in CancerY17.961152Arthritis & Rheumatology17.931153JOURNAL OF HEART AND LUNG TRANSPLANTATION17.882154MOVEMENT DISORDERS17.873155JOURNAL OF CONTROLLED RELEASE 17.855156CLINICAL CHEMISTRY 17.853157Gut Microbes 17.823158CHEST17.819159INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 17.812160OPHTHALMOLOGY17.805161DIABETES17.719162Clinical Gastroenterology and Hepatology 17.68163EMERGING INFECTIOUS DISEASES 17.61164JOURNAL OF NEUROLOGYNEUROSURGERY AND PSYCHIATRY 17.607165JOURNAL OF AUTOIMMUNITY 17.597166Journal of Hematology & Oncology 17.471167ALIMENTARY PHARMACOLOGY &THERAPEUTICS 17.458168RADIOLOGY17.458169TRENDS IN PARASITOLOGY Y17.427170Mucosal Immunology 17.397171EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING17.388172Blood Cancer Journal17.382173MOLECULAR THERAPY 17.366174Neurology-Neuroimmunology &Neuroinflammation 17.353175JAMA Dermatology17.306176AMERICAN JOURNAL OF KIDNEY DISEASES17.273177Clinical & Translational Immunology 17.271178SCHIZOPHRENIA BULLETIN 17.269179Eurosurveillance17.25180Cellular & Molecular Immunology 17.22181Molecular Neurodegeneration17.16182JOURNAL OF NUCLEAR MEDICINE 17.131183Particle and Fibre Toxicology 17.081184Translational Stroke Research 17.056185PSYCHOLOGICAL REVIEW 17.045186ONCOGENE17.002187JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 17.001188MAYO CLINIC PROCEEDINGS1 6.992189GASTROINTESTINAL ENDOSCOPY 1 6.978190THYROID1 6.953191JOURNAL OF INTERNAL MEDICINE 1 6.928192EUROPEAN JOURNAL OF EPIDEMIOLOGY 1 6.926193HYPERTENSION1 6.899194CRITICAL CARE MEDICINE16.884195CANADIAN MEDICAL ASSOCIATIONJOURNAL1 6.846196BMJ Quality & Safety1 6.818 197Journal of Crohns & Colitis1 6.759 198ALLERGY1 6.727199European Heart Journal-CardiovascularPharmacotherapy1 6.723200CLINICAL PHARMACOLOGY &THERAPEUTICS1 6.715201NEUROPSYCHOPHARMACOLOGY1 6.702202AMERICAN JOURNAL OF CLINICALNUTRITION1 6.681203EUROPEAN JOURNAL OF CANCER1 6.633204Journal of Allergy and Clinical Immunology-In Practice1 6.611205AMERICAN JOURNAL OFTRANSPLANTATION1 6.607206JOURNAL OF THE AMERICANSOCIETY OF ECHOCARDIOGRAPHY1 6.597207European Heart Journal-CardiovascularImaging1 6.529208BRITISH JOURNAL OF PSYCHIATRY1 6.482 209Stem Cell Reports1 6.458 210CANCER LETTERS1 6.458211ARTERIOSCLEROSIS THROMBOSISAND VASCULAR BIOLOGY1 6.437212EBioMedicine1 6.431 213Molecular Metabolism1 6.424 214DIABETOLOGIA1 6.405 215Acta Pharmaceutica Sinica B1 5.911 216Signal Transduction and Targeted Therapy1 5.873 217Translational Lung Cancer Research Y1 4.806 218Journal of Pharmaceutical Analysis1 4.44 219Journal of Sport and Health Science1 2.922 220Epilepsy Currents Y27.289 221NEUROSCIENTIST Y27.214 222SPORTS MEDICINE Y27.163 223MOLECULAR ASPECTS OF MEDICINE Y27.114 224EPIDEMIOLOGIC REVIEWS Y27.066 225EXERCISE IMMUNOLOGY REVIEW Y27.053226PROGRESS IN CARDIOVASCULARDISEASESY27.031227Cochrane Database of Systematic Reviews Y2 6.924 228DRUG DISCOVERY TODAY Y2 6.699 229Tissue Engineering Part B-Reviews Y2 6.512 230Advances in Nutrition Y2 6.442231Circulation-Cardiovascular Interventions 2 6.397232CARDIOVASCULAR RESEARCH 2 6.394233BRAIN PATHOLOGY 2 6.388234ENDOSCOPY2 6.372235Brain Stimulation2 6.372236JOURNAL OF PATHOLOGY 2 6.363237JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY 26.361238BLOOD REVIEWSY 2 6.356239CLINICAL REVIEWS IN ALLERGY &IMMUNOLOGYY2 6.344240JOURNAL OF INVESTIGATIVE DERMATOLOGY 2 6.342241Ocular Surface2 6.34242Comprehensive Physiology2 6.331243BRITISH JOURNAL OF ANAESTHESIA 2 6.312244BRITISH JOURNAL OF PHARMACOLOGY 2 6.295245INTERNATIONAL JOURNAL OF CANCER2 6.285246JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY2 6.28247Circulation-Cardiovascular Imaging2 6.279248DIABETES OBESITY & METABOLISM 2 6.276249MODERN PATHOLOGY 2 6.249250CRITICAL CARE 2 6.247251ANESTHESIOLOGY2 6.244252Journal of the National 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357Photoacoustics2 5.25 358EPIDEMIOLOGY2 5.232 359RESUSCITATION2 5.222 360ANNALS OF EMERGENCY MEDICINE2 5.209361JOURNALS OF GERONTOLOGY SERIESA-BIOLOGICAL SCIENCES ANDMEDICAL SCIENCES2 5.19362Aging-US2 5.187 363HEALTH AFFAIRS2 5.178 364ONCOLOGIST2 5.173 365HUMAN REPRODUCTION2 5.172 366ANGIOGENESIS2 5.166 367Advances in Virus Research Y2 5.16 368Pigment Cell & Melanoma Research2 5.152 369NEUROENDOCRINOLOGY2 5.145370JOURNAL OF PSYCHIATRY &NEUROSCIENCE2 5.143371AMERICAN JOURNAL OF MEDICINE2 5.142 372NEUROBIOLOGY OF DISEASE2 5.136373JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 2 5.134374CLINICAL SCIENCE2 5.131375EXPERIMENTAL AND MOLECULAR MEDICINE2 5.13376ENDOCRINE-RELATED CANCER 2 5.124377Circulation-Genomic and Precision Medicine2 5.106378THROMBOSIS AND HAEMOSTASIS 25.104379REVIEWS IN ENDOCRINE &METABOLIC DISORDERSY 2 5.099380CRITICAL REVIEWS IN TOXICOLOGY Y2 5.089381JOURNAL OF DENTAL RESEARCH 2 5.088382ALTEX-Alternatives to Animal Experimentation 2 5.08383RHEUMATOLOGY2 5.071384BMJ Open Diabetes Research & Care 2 5.067385JOURNAL OF GASTROENTEROLOGY 2 5.061386CLINICAL AND EXPERIMENTAL ALLERGY2 5.054387OBSTETRICS AND GYNECOLOGY 2 5.054388INTERNATIONAL JOURNAL OF OBESITY2 5.053389BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2 5.04390Circulation-Arrhythmia and Electrophysiology2 5.035391AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS2 5.035392OSTEOARTHRITIS AND CARTILAGE 2 5.025393INFECTIOUS DISEASE CLINICS OF NORTH AMERICA25.014394NUTRITION RESEARCH REVIEWS Y2 5.008395ACADEMIC MEDICINE2 4.998396PHARMACOLOGICAL RESEARCH 2 4.984397DEPRESSION AND ANXIETY 2 4.983398Stem Cells Translational Medicine 2 4.964399Oncogenesis2 4.953400JOURNAL OF THROMBOSIS AND HAEMOSTASIS 2 4.949401JOURNAL OF PAIN 2 4.934402EUROPACE2 4.933403HEART RHYTHM2 4.931404Kidney International Supplements Y2 4.931405JOURNAL OF MEDICAL INTERNET RESEARCH24.93406European Respiratory ReviewY24.929407PROCEEDINGS OF THE NUTRITION SOCIETY24.928408VALUE IN HEALTH 2 4.922409SEMINARS IN ONCOLOGY Y2 4.92410REVISTA ESPANOLA DE CARDIOLOGIA2 4.91411DRUGS2 4.894412FERTILITY AND STERILITY 2 4.887413SLEEP2 4.876414Translational Psychiatry2 4.868415JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2 4.862416RADIOTHERAPY AND ONCOLOGY 2 4.841417CANADIAN JOURNAL OF CARDIOLOGY24.84418CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY Y2 4.826419mAbs 2 4.817420Nanomedicine2 4.816421Translational Research 2 4.816422AIDS2 4.811423Forensic Science International-Genetics 2 4.811424HUMAN MUTATION 2 4.804425ADDICTION BIOLOGY2 4.801426JOURNAL OF MOLECULAR MEDICINE-JMM2 4.79427CLINICAL PHARMACOKINETICS 2 4.787428AMERICAN JOURNAL OF OPHTHALMOLOGY 2 4.777429Vaccines2 4.76430JOURNAL OF PHYSIOLOGY-LONDON 24.754431EXERCISE AND SPORT SCIENCES REVIEWSY 2 4.745432Reviews of Physiology Biochemistry and PharmacologyY2 4.739433CARCINOGENESIS 2 4.727434Journal of Physiotherapy2 4.725435REVIEWS IN MEDICAL VIROLOGY Y2 4.725436EUROPEAN JOURNAL OF MEDICINAL CHEMISTRY2 4.723437LIVER INTERNATIONAL 2 4.719438JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 2 4.713439Clinical Research in Cardiology 2 4.707440AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY 2 4.707441CONTACT DERMATITIS24.705442JOURNAL OF IMMUNOLOGY 24.704443EXPERT OPINION ON THERAPEUTIC TARGETSY2 4.697444Developmental Cognitive Neuroscience 2 4.685445MOLECULAR CANCER RESEARCH 2 4.685446World Allergy Organization Journal 2 4.68447Clinical Epidemiology2 4.678448Therapeutic Advances in Chronic Disease Y 2 4.677449TRENDS IN CARDIOVASCULAR MEDICINEY2 4.675450HUMAN BRAIN MAPPING 2 4.67451Circulation-Cardiovascular Quality and Outcomes2 4.661452NEUROSURGERY2 4.656453NEUROBIOLOGY OF AGING 2 4.656454BIPOLAR DISORDERS2 4.652455JOURNAL OF NEUROTRAUMA 2 4.649456Aging and Disease2 4.646457SEMINARS IN ARTHRITIS AND RHEUMATISM 2 4.642458Epigenomics2 4.641459JOURNAL OF INFECTION 2 4.634460GYNECOLOGIC ONCOLOGY 2 4.631461JOURNAL OF CLINICAL EPIDEMIOLOGY 2 4.624462INTERNATIONAL JOURNAL OF HYGIENE AND ENVIRONMENTAL HEALTH 2 4.623463NEOPLASIA2 4.612464CANCER IMMUNOLOGY IMMUNOTHERAPY 2 4.612465JOURNAL OF MOLECULAR DIAGNOSTICS24.611466Stem Cell Research & Therapy 2 4.6467Advances in ParasitologyY2 4.596468European Journal of Preventive Cardiology 2 4.596469CANCER EPIDEMIOLOGYBIOMARKERS & PREVENTION 2 4.584470EXPERIMENTAL NEUROLOGY 2 4.584471INTERNATIONAL JOURNAL OF CARDIOLOGY2 4.565472BJU INTERNATIONAL2 4.55473ANNALS OF FAMILY MEDICINE 2 4.547474BIOCHEMICAL PHARMACOLOGY 2 4.547475EuroIntervention2 4.543476NEUROPHARMACOLOGY 2 4.543477AMERICAN JOURNAL OF EPIDEMIOLOGY24.54478AMERICAN JOURNAL OF PUBLIC HEALTH2 4.54479Cancer Biology & Medicine 2 4.537480CELLULAR ONCOLOGY 2 4.522481PARKINSONISM & RELATED DISORDERS2 4.522482JOURNAL OF NEUROCHEMISTRY 2 4.521483JOURNAL OF CLINICAL PSYCHIATRY 2 4.52484Antioxidants2 4.52485EUROPEAN JOURNAL OF ENDOCRINOLOGY2 4.514486Journal of the American Heart Association 2 4.512487PSYCHONEUROENDOCRINOLOGY 2 4.511488JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2 4.508489Cold Spring Harbor Perspectives in Medicine2 4.504490JMIR mHealth and uHealth2 4.493491TRANSFUSION MEDICINE REVIEWS Y2 4.489492CORTEX2 4.487493JOURNAL OF CELLULAR AND MOLECULAR MEDICINE2 4.486494International Journal of Health Policy and Management2 4.485495JOURNAL OF NUTRITIONAL BIOCHEMISTRY 2 4.474496Clinics in Liver Disease2 4.468497MOLECULAR PHARMACEUTICS 2 4.464498LUNG CANCER2 4.46499Advances in Wound Care2 4.457500EUROPEAN JOURNAL OF PHARMACEUTICS AND BIOPHARMACEUTICS24.453501CURRENT OPINION IN NEUROLOGY Y2 4.452502JOURNAL OF VIROLOGY2 4.452503Clinical and Translational Gastroenterology 2 4.449504MEDICAL JOURNAL OF AUSTRALIA 2 4.447505DRUG DELIVERY2 4.442506Annual Review of Vision Science Y2 4.428507ANTIMICROBIAL AGENTS AND CHEMOTHERAPY2 4.424508NEPHROLOGY DIALYSIS TRANSPLANTATION24.423509DRUG METABOLISM REVIEWS Y2 4.416510EUROPEAN JOURNAL OF NUTRITION 2 4.414511Annals of Clinical and Translational Neurology2 4.402512Evolution Medicine and Public Health24.4513INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS 2 4.392514EUROPEAN JOURNAL OF IMMUNOLOGY2 4.39515ORAL ONCOLOGY2 4.387516International Journal of Nanomedicine 2 4.38517JOURNAL OFPSYCHOPHARMACOLOGY 2 4.379518Current HIV/AIDS Reports Y 2 4.377519SEMINARS IN LIVER DISEASE Y2 4.375520Disease Models & Mechanisms2 4.372521INTERNATIONAL IMMUNOLOGY 2 4.368522JOURNAL OF ENDOCRINOLOGY 2 4.366523CANCER SCIENCE 2 4.366524Artificial Cells Nanomedicine and Biotechnology2 4.364525ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY2 4.352526BONE MARROW TRANSPLANTATION 2 4.348527MEDICAL EDUCATION2 4.343528REGIONAL ANESTHESIA AND PAIN MEDICINE24.337529EUROPEAN JOURNAL OF NEUROLOGY 2 4.332530Expert Opinion on Drug Discovery Y2 4.33531Journal of Clinical Lipidology 2 4.324532ATHEROSCLEROSIS2 4.32533JOURNAL OF NUTRITION 2 4.32534PALLIATIVE MEDICINE 2 4.319535BONE 2 4.318536JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY2 4.309537MEDICINE AND SCIENCE IN SPORTS AND EXERCISE2 4.303538INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY 2 4.3539ULTRASCHALL IN DER MEDIZIN 2 4.298540INFLAMMATORY BOWEL DISEASES 2 4.292541Journal of Cystic Fibrosis2 4.292542Asian Journal of Pharmaceutical Sciences 2 4.288543EPMA Journal2 4.281544EUROPEANNEUROPSYCHOPHARMACOLOGY 2 4.279545ACS Infectious Diseases 2 4.279546Frontiers in Oncology 2 4.276547AGE AND AGEING2 4.269548LABORATORY INVESTIGATION 2 4.268549CURRENT OPINION IN LIPIDOLOGYY24.264550CNS DRUGS2 4.264551BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION 2 4.262552Pharmaceutics2 4.259553AMERICAN JOURNAL OF PREVENTIVE MEDICINE24.258554CURRENT OPINION IN PSYCHIATRY Y 2 4.256555Frontiers in Cellular Neuroscience 2 4.252556Therapeutic Advances in Musculoskeletal DiseaseY 2 4.248557Current Opinion in HIV and AIDS Y2 4.242558JOURNAL OF CLINICAL MICROBIOLOGY2 4.242559ANTIVIRAL RESEARCH 2 4.236560Current Topics in Microbiology and ImmunologyY2 4.234561Frontiers in Molecular Neuroscience 2 4.233562BEST PRACTICE & RESEARCH CLINICAL ENDOCRINOLOGY &METABOLISM2 4.23563NICOTINE & TOBACCO RESEARCH 2 4.229564PLoS Neglected Tropical Diseases 2 4.229565PROGRESS IN NEURO-PSYCHOPHARMACOLOGY &BIOLOGICAL PSYCHIATRY 24.229566EXPERT REVIEWS IN MOLECULAR MEDICINEY2 4.226567JOURNAL OF THE AMERICAN GERIATRICS SOCIETY2 4.219568Journal of Behavioral Addictions 2 4.212569AMERICAN HEART JOURNAL 2 4.21570Deutsches Arzteblatt International 2 4.205571CURRENT OPINION IN RHEUMATOLOGYY2 4.201572JOURNAL OF PARENTERAL AND ENTERAL NUTRITION2 4.193573NEUROREHABILITATION AND NEURAL REPAIR2 4.192574HEALTH TECHNOLOGY ASSESSMENT 2 4.189575PEDIATRIC ALLERGY AND IMMUNOLOGY2 4.189576Brain Structure & Function 2 4.184577DENTAL MATERIALS2 4.183578ARTHRITIS RESEARCH & THERAPY 2 4.179579Therapeutic Advances in Neurological Disorders2 4.174580Dialogues in Clinical Neuroscience 2 4.171581SCHIZOPHRENIA RESEARCH 2 4.171582JOURNAL OF NEUROSURGERY 2 4.169583CLINICAL TOXICOLOGY24.152584AMERICAN JOURNAL OFPHYSIOLOGY-LUNG CELLULAR AND MOLECULAR PHYSIOLOGY2 4.144585PROSTATE CANCER AND PROSTATIC DISEASES24.141586RESPIROLOGY2 4.14587Advances in Clinical Chemistry Y2 4.138588JOURNAL OF HYPERTENSION 2 4.131589TRANSPLANTATION 2 4.127590CANCER GENE THERAPY2 4.126591JOURNAL OF VIRAL HEPATITIS 2 4.125592Travel Medicine and Infectious Disease 2 4.124593Expert Review of VaccinesY2 4.119594IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING2 4.119595JOURNAL OF INHERITED METABOLIC DISEASE2 4.116596AMYLOID-JOURNAL OF PROTEIN FOLDING DISORDERS2 4.113597JOURNAL OF GENERAL INTERNAL MEDICINE2 4.104598IMMUNOLOGY AND CELL BIOLOGY 2 4.1599AMERICAN JOURNAL OFPHYSIOLOGY-ENDOCRINOLOGY AND METABOLISM2 4.095600HUMAN GENE THERAPY2 4.094601JOURNAL OF LEUKOCYTE BIOLOGY 2 4.085602npj Vaccines 2 4.082603AMERICAN JOURNAL OF RESPIRATORY CELL AND MOLECULAR BIOLOGY 2 4.075604Implementation Science2 4.075605NEUROINFORMATICS 2 4.06606Journal of Ginseng Research 2 4.055607XENOTRANSPLANTATION 2 4.054608NeuroImage-Clinical2 4.053609Surgery for Obesity and Related Diseases 2 4.051610CLINICAL ORTHOPAEDICS AND RELATED RESEARCH2 4.047611JOURNAL OF GENERAL PHYSIOLOGY 24.046612CURRENT OPINION IN CLINICAL NUTRITION AND METABOLIC CARE Y 2 4.042613SEMINARS IN RADIATION ONCOLOGY Y2 4.041614CANCER CYTOPATHOLOGY 2 4.036615JOURNAL OF PSYCHIATRIC RESEARCH2 4.033616JOURNAL OF ADOLESCENT HEALTH 2 4.031617Journal of Translational Medicine24.027618Frontiers in Pharmacology2 4.025619Advances in the Study of Behavior Y2 4.024620JOURNAL OF NUCLEAR CARDIOLOGY 2 4.018621Annals of the American Thoracic Society 2 4.016622ENDOCRINOLOGY2 4.016623Current NeuropharmacologyY24624American Journal of Cancer Research 24625ARTHRITIS CARE & RESEARCH 2 3.999626SEMINARS IN NUCLEAR MEDICINE Y 2 3.995627CRITICAL REVIEWS IN THERAPEUTIC DRUG CARRIER SYSTEMSY2 3.994628JOURNAL OF ENZYME INHIBITION AND MEDICINAL CHEMISTRY 2 3.986629EUROPEAN RADIOLOGY 2 3.985630ACS Chemical Neuroscience 23.985631EXPERT OPINION ONINVESTIGATIONAL DRUGS Y 2 3.981632Journal of Neural Engineering 2 3.979633CEPHALALGIA2 3.978634DIABETES-METABOLISM RESEARCH AND REVIEWS 2 3.975635Nutrients2 3.972636JAIDS-JOURNAL OF ACQUIREDIMMUNE DEFICIENCY SYNDROMES 2 3.971637AMERICAN JOURNAL OF PATHOLOGY 2 3.963638Obesity2 3.961639Cancer Prevention Research2 3.957640MAGNETIC RESONANCE IN MEDICINE 2 3.955641Journal of Innate Immunity 2 3.953642DIABETES & METABOLISM2 3.951643Archives of Disease in Childhood-Fetal and Neonatal Edition2 3.943644TOXICOLOGICAL SCIENCES 2 3.942645LIVER TRANSPLANTATION2 3.942646Allergy Asthma & Immunology Research 2 3.931647Frontiers in Systems Neuroscience2 3.928648Therapeutic Advances in Gastroenterology 23.926649CURRENT OPINION IN INFECTIOUS DISEASESY 2 3.925650Hepatology International 2 3.924651Clinical Lung Cancer 2 3.918652CLINICAL ORAL IMPLANTS RESEARCH2 3.918653MOLECULAR PHARMACOLOGY 2 3.918654HORMONES AND BEHAVIOR23.915655INTERNATIONAL JOURNAL OF PHARMACEUTICS2 3.908656Frontiers in Aging Neuroscience 2 3.906657SEMINARS IN HEMATOLOGY 2 3.902658EUROPEAN JOURNAL OF ANAESTHESIOLOGY 2 3.896659JOURNAL OF CLINICAL PERIODONTOLOGY2 3.896660JOURNAL OF CARDIAC FAILURE 2 3.891661Marine Drugs2 3.885662International Journal of Stroke 2 3.88663PSYCHOSOMATIC MEDICINE 2 3.87664JOURNAL OF CLINICAL IMMUNOLOGY2 3.869665HEART FAILURE REVIEWSY2 3.867666EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2 3.86667ANNALS OF SURGICAL ONCOLOGY 2 3.86668Skeletal Muscle 2 3.855669BIODRUGS2 3.854670Journal of the Academy of Nutrition and Dietetics2 3.854671Cancer Communications 2 3.851672Clinical Colorectal Cancer2 3.848673CLINICS IN CHEST MEDICINE 2 3.846674FOOD AND CHEMICAL TOXICOLOGY 2 3.843675RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES 2 3.843676CYTOTHERAPY2 3.831677JOURNAL OF BIOMEDICAL SCIENCE 2 3.823678JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH2 3.818679MOLECULAR CARCINOGENESIS 2 3.816680Annals of Physical and Rehabilitation Medicine2 3.814681OBESITY SURGERY2 3.813682OCCUPATIONAL ANDENVIRONMENTAL MEDICINE 23.811683Stem Cells International 2 3.81684Current Psychiatry Reports Y2 3.809685RESPIRATORY RESEARCH2 3.807686WORLD JOURNAL OF BIOLOGICAL PSYCHIATRY2 3.804687PLASTIC AND RECONSTRUCTIVE SURGERY2 3.803688JOURNAL OF SCIENCE AND MEDICINE IN SPORT23.803。
医学人类学英文书单
医学人类学英文书单以下是一些医学人类学方面的英文书单，这些书籍可以帮助你深入了解医学人类学的相关内容：1. "The Anthropology of Medicine: From Culture to Method" by Clara Han 《医学人类学：从文化到方法》2. "Medical Anthropology: A Biocultural Approach" by Andrea S. Wiley《医学人类学：生物文化方法论》3. "Body and Emotion: The Aesthetics of Illness and Healing in the Nepal Himalayas" by Robert R. Desjarlais《身体与情感：尼泊尔喜马拉雅地区的疾病和康复美学》4. "The Birth of the Clinic: An Archaeology of Medical Perception" by Michel Foucault《诊所的诞生：医学知觉的考古学》5. "Illness Narratives: Suffering, Healing, and the Human Condition" by Arthur Kleinman《疾病叙事：苦难、康复与人类状况》6. "Medicine and Culture: Revised Edition" by Lynn Payer《医学与文化：修订版》7. "The Scalpel's Edge: The Culture of Surgeons" by David J. Rothman《手术刀的边缘：外科医生的文化》8. "The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures" by Anne Fadiman《灵魂抛洒：一位苗族儿童、她的美国医生和两种文化的碰撞》9. "Disease and Social Diversity: The European Impact on the Health of Non-Europeans" by George Armelagos and Peter J. Brown《疾病与社会多样性：欧洲对非欧洲人健康的影响》10. "The Cultural Politics of Health: A Handbook for Medical Anthropology" edited by Margaret Lock and Nancy Scheper-Hughes《健康的文化政治：医学人类学手册》这些书籍涵盖了医学人类学的不同方面，从文化、方法论到疾病叙事和医疗实践等。
优化治疗抑郁症
目前主要治疗方法：序贯疗法（Sequenced treatment）
试错法（trial-and-error）
A Review of Antidepressant Therapy in Primary Care: Current Practices and Future Directions Prim Care Companion CNS Disord. 2013;15(2). pii: PCC.12r01420. doi: 10.4088/PCC.12r01420. Epub 2013 Apr 11.
STAR*D研究显示： 更早获得治愈的患者复发率低
治愈率 复发率
Am J Psychiatry，2006，1 63：1905-1917
焦虑性抑郁症患者临床治愈率低
STAR*D研究结果：有焦虑症状的抑郁症患者的临床治愈率显著降低
Fava M, et al. Am J Psychiatry, 2008; 165(3): 342-351
SET ㈠
5-HT neuron
NaSSA DET ㈠ SARI TCA SDA DPA SPA
早期快速改善症状带来更持续充分的远期效果
获得确切改善的患者比例 （ 从16周到 18个月 ）
110% 100% 90% 80% 70% 60% 50% 40% 30% 20% 16周治疗终点 （n=155） 6个月随访 （n=149） 12个月随访 （n=142） 18个月随访 （n=146） 34% 69% 62% 55% 56% 43% 100% 96% 100% 96%
显 效 率
80% 60% 40% 20% 0%
N=15 N=75
N=47
N=1013
N=119
关于健康的英文单词
关于健康的英文单词burn 烧伤wound 伤口overdose( 药剂) 过量poisoning 中毒head injury 脑部损伤electric shock 电击cripple 跛腿fracture 骨折sprain 扭伤sting 蜇伤injury 创伤drown 溺水choke 窒息bruise 瘀伤graze 擦伤sunburn 晒伤lab/laboratory 化验室lab technician 化验室技师blood test 验血MRI (Magic Resonance Imaging) 核磁共振成像scanCT 扫描hospital gown 病号服orderly 病房护工wheelchair 轮椅intensive care unit(ICU) emergency room 急诊室admitted 收治的discharged 出院nurses'重症监护病房station 护士站call button 呼叫按钮private room 单人病房tablet 药片tablet 药片capsule 胶囊departments 医院科室surgery 外科test 检查result 结果consultant 专科医生X-rayX 光nurse 护士doctor 医生patient 患者clinic 诊所height bar 身高计scales 体重计hammer 叩诊锤injection 注射medical examination 体检outpatient 门诊病人surgery 诊疗室aident 事故emergency 紧急情况stretcher 担架pulse 脉搏breathing 呼吸first aid 急救painkiller 止痛药first aid box 急救箱surgical mask 手术口罩operating cap 手术帽straight scissors 直剪刀stand for drip 滴液器operating table 手术台surgeon 外科医生chart 手术记录表operation 手术sterile 无菌operating microscope 手术显微镜surgical laser 外科激光器tweezers 镊子scissors 剪刀surgical needle 缝针massagetherapeutic/massotherapy yoga 瑜伽teacher 辅导老师mat 垫子meditation 冥想hypnotherapy 催眠疗法group therapy 集体治疗psychotherapy 精神疗法check-up 检查reflector医用灯apron 围兜dentist's chair 牙按摩疗法科椅brush 刷牙brace 畸齿矫正器dentist 牙医dentist's assistant牙医助手chill 寒战running nose 流鼻涕fever 发烧cold; 流感：flu 感冒illness 疾病headache 头痛nausea 恶心vomit 呕吐allergy 过敏faint 昏厥cramp 痉挛heart attack 心脏病发作stomach ache 胃痛sub-health 亚健康body-ache 身体疼痛high stress level 高度精神紧张anxiety 焦虑physical disorder 身体不适;stress 压力fear 恐惧fatigue 疲劳bad temper 暴躁overload 负担过重neglectof exercise 缺乏运动overfatigue 疲劳过度sleep disorders 睡眠失常depression 抑郁obesity 肥胖insomnia 失眠listlessness 无精打采dizziness 头晕眼花vertigo 眩晕lack of appetite 食欲不振hypertension 高血压cholesterol 胆固醇digestive system消化系统cough 咳嗽asthma 哮喘pneumonia 肺炎heart disease心脏病indigestion 消化不良itching 发痒chronic 慢性病symptom 症状eyedrops 眼药水vitamin维他命medication 药物in good health /in bad health 身体好[ 坏]in poor health 身体好[ 坏]inquire after sb.'s health 问安, 问候recover one's health 恢复健康restore one's health 恢复健康regular check-up / health checks 定期体检keep fit 保持健康public health 公共卫生diet 日常饮食health care 卫生保健blood donation 献血gym 体育训练medicare 医疗保险free- medicare 公费医heat stroke 中暑疗保险medical exam = medical examination 体检, 体格检查内容仅供参考。
难治性抑郁症的管理临床实践指南英文
难治性抑郁症的管理临床实践指南英文全文共3篇示例，供读者参考篇1Clinical Practice Guideline for the Management of Treatment-Resistant DepressionIntroductionTreatment-resistant depression (TRD) is a common and challenging condition that affects a significant number of individuals worldwide. Despite the availability of multiple pharmacological and non-pharmacological treatment options, a subset of patients with depression fails to respond adequately to standard interventions. In recent years, significant progress has been made in understanding the pathophysiology of TRD and developing novel treatment strategies. This clinical practice guideline aims to provide evidence-based recommendations for the management of TRD in clinical practice.Diagnosis and AssessmentThe diagnosis of TRD should be made after a careful evaluation of the patient's symptoms, treatment history, and response to previous interventions. Assessment tools such as theHamilton Depression Rating Scale (HDRS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) can be used to evaluate the severity of depressive symptoms. In addition, a comprehensive psychiatric evaluation should be conducted to rule out other psychiatric disorders that may mimic depression or contribute to treatment resistance.Pharmacological InterventionsFor patients with TRD, pharmacological interventions remain the mainstay of treatment. Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs),serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) are commonly used in the management of TRD. In cases where patients do not respond to first-line antidepressants, switching to another class of antidepressants or augmenting with other medications such as atypical antipsychotics, lithium, or thyroid hormones may be considered.PsychotherapyIn addition to pharmacological interventions, psychotherapy can also play an important role in the management of TRD. Cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and mindfulness-based interventions have been shown to beeffective in treating depression and improving treatment outcomes in patients with TRD. Psychotherapy can be used as a standalone treatment or in combination with pharmacotherapy to enhance the effectiveness of treatment.Electroconvulsive Therapy (ECT)Electroconvulsive therapy (ECT) is a highly effective treatment option for patients with severe TRD who have not responded to pharmacological or psychotherapeutic interventions. ECT is typically reserved for patients with severe depressive symptoms, psychotic features, and suicidal ideation. ECT has been shown to produce rapid and sustained improvements in mood and is considered safe andwell-tolerated in the majority of patients.Ketamine and Other Novel Treatment ApproachesKetamine, a glutamatergic modulator, has emerged as a promising treatment for TRD. Intravenous ketamine administration has been shown to produce rapid antidepressant effects in patients with TRD, with improvements observed within hours of treatment. Other novel treatment approaches such as transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) are also being investigated as potential options for patients with TRD.ConclusionIn conclusion, the management of TRD requires a comprehensive and individualized approach that takes into account the patient's symptoms, treatment history, and preferences. This clinical practice guideline providesevidence-based recommendations for the management of TRD and highlights the importance of a multidisciplinary approach involving psychiatrists, psychologists, and other healthcare professionals. By implementing these recommendations in clinical practice, healthcare providers can improve treatment outcomes and quality of life for patients with TRD.篇2Clinical Practice Guidelines for the Management of Treatment-Resistant DepressionIntroductionTreatment-resistant depression (TRD) is a challenging condition characterized by a lack of response to standard antidepressant therapy. It is estimated that up to 30% of patients with depression do not adequately respond to initial treatment, and a proportion of these individuals may go on to develop TRD. Management of TRD requires a comprehensive approach thatincludes a combination of pharmacological andnon-pharmacological interventions. This document provides evidence-based recommendations for the management of TRD in clinical practice.Diagnostic EvaluationThe first step in managing TRD is to ensure an accurate diagnosis. This involves a thorough assessment of the patient's history, symptoms, and response to previous treatments. It is important to rule out other psychiatric or medical conditions that may be contributing to the treatment resistance. A comprehensive evaluation should also include a review of the patient's medication history, substance use, and psychosocial stressors.Pharmacological InterventionsWhen managing TRD, it is important to consider switching to a different antidepressant medication or augmenting with an additional agent. Some common strategies include:- Switching to a different class of antidepressant- Augmenting with a second-generation antipsychotic- Augmenting with a mood stabilizer- Adding a stimulant medication- Considering off-label use of ketamine or esketamineNon-Pharmacological InterventionsIn addition to pharmacotherapy, non-pharmacological interventions can play a valuable role in the management of TRD. These may include:- Cognitive-behavioral therapy (CBT)- Interpersonal therapy (IPT)- Mindfulness-based therapies- Electroconvulsive therapy (ECT)- Transcranial magnetic stimulation (TMS)- Vagus nerve stimulation (VNS)Treatment SettingPatients with TRD may benefit from treatment in a specialized mental health setting, such as a mood disorders clinic or an inpatient psychiatric unit. These settings provide access to a multidisciplinary team of mental health professionals who can collaborate on the patient's care. In severe cases, hospitalizationmay be necessary to ensure the safety and stability of the patient.Monitoring and Follow-UpRegular monitoring of symptoms and treatment response is essential in the management of TRD. Clinicians should closely monitor the patient's mood, energy level, appetite, and sleep patterns. It is important to assess for potential side effects of medications and to address any concerns or barriers to treatment compliance. Follow-up appointments should be scheduled at regular intervals to assess the effectiveness of the treatment plan and make adjustments as needed.ConclusionManaging TRD requires a comprehensive and individualized approach that addresses both pharmacological andnon-pharmacological interventions. By followingevidence-based guidelines and collaborating with a multidisciplinary team of mental health professionals, clinicians can help patients with TRD achieve remission and improve their quality of life.篇3Management Clinical Practice Guidelines forTreatment-Resistant DepressionIntroductionTreatment-resistant depression (TRD) is a challenging condition that affects a significant number of individuals worldwide. It is characterized by persistent symptoms of depression despite multiple treatment attempts with various antidepressant medications. Managing TRD requires a comprehensive approach that goes beyond traditional pharmacotherapy and includes psychotherapy, lifestyle modifications, and other interventions. This clinical practice guideline aims to provide healthcare professionals with evidence-based recommendations for the management of TRD.Assessment and DiagnosisThe first step in managing TRD is an accurate assessment and diagnosis. This includes a thorough evaluation of the patient's history, symptoms, and potential contributing factors. It is essential to rule out other medical conditions that may be causing or exacerbating the symptoms of depression. In addition, a comprehensive mental health assessment, including a psychiatric evaluation, should be conducted to determine theseverity of the depression and identify any comorbid psychiatric disorders.Treatment OptionsOnce a diagnosis of TRD has been established, treatment options should be tailored to the individual patient's needs. Pharmacotherapy remains a cornerstone of TRD treatment, with options including switching to a different antidepressant medication, adding a second medication, or trying a combination of medications. It is essential to monitor the patient closely for side effects and treatment effectiveness.In addition to pharmacotherapy, psychotherapy is an essential component of TRD management. Cognitive-behavioral therapy (CBT) has been shown to be effective in treating TRD by helping patients identify and change negative thought patterns and behaviors. Other types of therapy, such as interpersonal therapy (IPT) and psychodynamic therapy, may also be beneficial for some patients.Lifestyle modifications, such as exercise, diet, and sleep hygiene, can also play a significant role in managing TRD. Regular physical activity has been shown to improve mood and reduce symptoms of depression, while a healthy diet and adequate sleep can support overall mental health.Other treatment options for TRD include neuromodulation techniques, such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). These treatments are typically reserved for patients who have not responded to other interventions and may be effective in severe cases of TRD.Follow-Up and MonitoringRegular follow-up and monitoring are essential for patients with TRD to ensure treatment effectiveness and detect any potential side effects. Healthcare professionals should schedule regular appointments with patients to assess their symptoms, medication compliance, and overall well-being. It is crucial to involve the patient in treatment decision-making and encourage open communication about treatment outcomes.ConclusionManaging TRD requires a multidisciplinary approach that addresses the complex nature of the condition. This clinical practice guideline provides evidence-based recommendations for healthcare professionals to effectively manage TRD and improve patient outcomes. By utilizing a combination of pharmacotherapy, psychotherapy, lifestyle modifications, and other interventions, healthcare professionals can help patients with TRD achieve remission and regain their quality of life.。
封面人物档案
■ 辅导个案动思维与血清细胞因子关系的研究［J］.第三军医大学学报，2005，27（5）：454-458.［2］茹思·安曼.沙盘游戏中的治愈与转化：创造过程的呈现［M］. 蔡宝鸿等译.广州：广东高等教育出版社，2006.［3］徐洁，张日昇. 11岁选择性缄默症女孩的箱庭治疗个案研究［J］.心理科学，2008，31(1)：126-132.［4］张日昇，箱庭疗法［M］.北京：人民教育出版社，2006.［5］张雯，张日昇，徐洁. 强迫思维女大学生的箱庭疗法个案研究［J］. 心理科学，2009，32（4）：886-890.［6］周雅，刘翔平，苏洋，冉俐雯. 消极偏差还是积极缺乏：抑郁的积极心理学解释［J］. 心理科学进展，2010，18（4）：590-597.［7］Barbabara， Turner B A. The handbook of sandplay therapy［M］. California：Temenos Press，2005.［8］Bradway K. Developmental stages in children’s sand worlds［M］．San Francisco：C.G. Jung Institute，1981．［9］Chen Shunsen， Zhang Risheng. Expression and Construction：The Effective Mechanism of Sandplay Therapy［J］. Tokoyo：The Japan Association of Sandplay Therapy，2009，22（1）：75-82.［10］CLAUDé KUKARD. Exploring the Use of Sandplay Psychotherapy in Overcoming a Language Barrier whilst Supporting a Young Vulnerable Child［D］. Pretoria：Educational Psychology at the University of Pretoria，2006.［11］Jean Starling， Joseph M. Rey， Judy M. Simpson. Depressive symptoms and suicidal behaviour：changes with time in an adolescent clinic cohort［J］. Australian and New Zealand Journal of Psychiatry，2004（38）：732-737.［12］Kalff D M. The archetype as a healing factor［J］. Psycho logia，1966（9）：177-184.［13］Maria Ellen Chiaia. History of sandplay and analytic work［J］. Journal of Sandplay Therapy，2006， XV(2)：113-123.［14］Pearson M & Wilson H. Sandplay & symbol work：emotional healing & personal development with children，adolescents and adults［J］. Melbourne. Australian Council for Educational Research，2001（6）：24-26.（作者单位：1.北京教育学院教育管理与心理学院，北京，100035；2.北京师范大学心理学部，北京，100035）编辑/卫 虹 终校/张国宪封面人物档案徐岳敏，1979年6月出生，男，中学高级教师。
漫谈在美国读心理咨询(counseling)
漫谈在美国读心理咨询(counseling)很多朋友知道我在美国读了一个心理咨询的学位之后都来问我要怎么样才能出国读个心理咨询的学位。
趁着我现在正在放寒假，就来给你们写一写吧！我把我出国念心理咨询的经验分成几个部分来写：1. 为什么要读心理咨询？2. 美国的心理咨询研究所读些什么？1.为什么要读心理咨询这个问题看似很简单，实际上是一个很难回答的问题。
依我的观察以及我自己的经验，大部分读心理咨询的人在第一年的学习过程中要花很多的时间思考这个问题。
等到你毕业成为了一个专业咨询员，这个问题仍然会常常萦绕在你脑海里。
我这里说的「大部分读心理咨询的人」不是说大部分到美国念心理咨询的台湾学生，我说的大部分包括美国本地的学生。
所以，为了帮助你自己早点进入状况，最好现在就开始问你自己「为什么我要读心理咨询?」标准答案a:「因为我想要帮助别人」-- 这是一个最常见但是未经深思的答案！帮助别人的方法有很多种，你可以做生意赚大钱然后捐给慈善机构-这是帮助别人的一种方法。
你也可以去从军保卫国家-这是另外一种形式的帮助别人。
帮助别人的方法很多，为什么你选择要成为心理咨询员呢？当我一问这个问题，最常听到的答案有两种：第一、我想读心理咨询因为别人常常跟我倾吐心事。
第二、我想读心理咨询因为我曾经被心理咨询员帮助过，而我也想用这样帮助别人。
让我们仔细的来检视这两种说法:第一，有些人想读心理咨询因为他们觉得别人常常跟他们倾吐心事。
但是，听别人倾吐心事跟成为心理咨询员中间还有很大的一段差距。
别人跟你倾吐心事可能是因为你是一个很好的听众。
没错，成为一个好的听众是成为一个好的心理咨询员的必要条件。
如果你不懂得聆听你的个案，你是没有资格成为一个好的咨询员的。
但是，别人的心事偶尔听听可以，如果要你每天都听别人告诉你他对家人如何的不满、别人如何的亏待他、或者他昨天又听到一个声音告诉他从关渡大桥上跳下去，如此一般一天至少五次，一个礼拜至少五天。
NICE-双相情感障碍指南共识
ECNP consensus meeting.Bipolar depression.Nice,March 2007Guy M.Goodwin a,⁎,Ian Anderson b ,Celso Arango c ,Charles L.Bowden d ,Chantal Henry e,f ,Philip B.Mitchell g,h ,Willem A.Nolen i ,Eduard Vieta j ,Hans-Ulrich Wittchen kaUniversity Department of Psychiatry,Warneford Hospital,Oxford OX37JX,UKb Neuroscience and Psychiatry Unit,The University of Manchester ,Room G809,Stopford Building,Oxford Road,Manchester ,M137PT England cUnidad de Adolescentes,Hospital General Universitario Gregorio Marañón,CIBER-SAM,Madrid,Spain dDepartment of Psychiatry,University of Texas Health Science Center ,San Antonio,TX 78229-3900,USA eINSERM,U 841,IMRB,Department of Genetics,Psychiatry Genetics,Creteil,F-94000,France fUniversity Paris 12,Faculty of Medicine,IFR10,Creteil,Paris,France gSchool of Psychiatry,University of New South Wales,Sydney,NSW ,Australia hBlack Dog Institute,Sydney,NSW ,Australia iDepartment of Psychiatry,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands jBipolar Disorders Program,Institute of Clinical Neuroscience,Hospital Clinic,University of Barcelona,IDIBAPS,CIBER-SAM,Barcelona,Spain kInstitute of Clinical Psychology,Center of Clinical Epidemiology and Longitudinal Studies,Technische Universitaet,Dresden,GermanyReceived 15January 2008;received in revised form 22February 2008;accepted 12March 2008KEYWORDSBipolar depression;Bipolar disorder;Mania;Antidepressants;Mood stabilisers;Anticonvulsants;Antipsychotics;Manic switch;Clinical trials⁎Correspondingauthor.E-mail address:guy.goodwin@ (G.M.Goodwin).AbstractDiagnosis and epidemiology:DSM-IV ,specifically its text revision DSM-IV-TR,remains the preferred diagnostic system.When employed in general population samples,prevalence estimates of bipolar disorder are relatively consistent across studies in Europe and USA.In community studies,first onset of bipolar mood disorder is usually in the mid-teenage years and twenties,and the occurrence of a major depressive episode or hypomania is usually its first manifestation.Since reliable criteria for delineating unipolar (UP)and bipolar (BP)depression cross-sectionally are currently lacking,there is a longitudinal risk –probably over 10%–that initial UP patients ultimately turn out as BP in the longer run.Its early onset implies a severe potential burden of disease in terms of impaired social and neuropsychological development,most of which is attributable to depression.0924-977X/$-see front matter ©2008Elsevier B.V .and ECNP .All rights reserved.doi:10.1016/j.euroneuro.2008.03.003w w w.e l s ev i e r.c o m /l o c a t e /e u r o n e u r oEuropean Neuropsychopharmacology (2008)18,535–549536G.M.Goodwin et al.Bipolar depression in children:Bipolar I disorder is rare in prepubertal children,when definedaccording to unmodified DSM-IV-TR criteria.A broad diagnosis of bipolar disorder risks confoundingwith other childhood psychopathology and has less predictive value for bipolar disorder inadulthood than the conservative definition.Nevertheless,empirical studies of drug and othertreatments and longitudinal studies to assess validity of the broadly defined phenotype in childrenand adolescents are desirable,rather than extrapolation from adult bipolar practice.The need foran increased capacity to conduct reliable trials in children and adolescents is a challenge toEurope,whose healthcare system should allow greater participation and collaboration than otherregions,via clinical networks.ECNP will aspire to facilitate such developments.Bipolar depression in adults—unipolar/bipolar contrast:Despite some differences in symptomprofiles and severity measures,a cross-sectional categorical distinction between BP and UPdepression is currently impossible.For regulatory purposes,a major depressive episode,meetingDSM-IV-TR criteria,remains the same diagnosis,irrespective of the overall course of the disorder.However,in refining diagnosis in future studies and DSM-V,a probabilistical approach to the UP/BPdistinction is more likely to be informative as recommended by the International Society forBipolar Disorders(ISBD).Anxiety is commonly present,often at syndromal levels,in bipolarpopulations.Thus,RCT inclusion criteria for trials not targeting anxiety,should accept co-morbidanxiety disorders as part of the history and even current anxiety symptoms,where these are notdominating the mental state at recruitment to a study.Rapid cycling patients defined as thosesuffering from4or more episodes per year,may also be recruited into trials of bipolar depressionwithout impairing assay sensitivity.Illness severity critically affects assay sensitivity.The minimumscores for entry into a bipolar depression trials should be N20on HAM-D(17item scale).However,efficacy is best detected in patients with HAM-D N24at baseline.The use of rating scales in bipolar depression:There is some dissatisfaction with the HAM-D orMADRS as the preferred primary outcome for trials,although they probably capture global severityadequately.Secondary measures to capture so-called atypical symptoms(such as hypersomnia orhyperphagia),or specific psychopathology more common in bipolar participants(such as lability ofmood),could be informative as secondary measures.Treatment studies in bipolar depression:Monotherapy trials against placebo remain the gold-standard design for determining efficacy in bipolar depression.The confounding effects of co-medication are emerging from the literature on antidepressant studies in bipolar depression,often conducted in combination with antimanic agents to avoid possible switch to mood elevation.Three arm trials,including the compound to be tested,placebo,and a standard comparator,aregenerally preferred in order to ensure assay sensitivity and a better picture of benefit–risk ratio.However,in the absence of any gold-standard,two-arm trials may be enough.If efficacy happensto be proven as monotherapy,new compounds may be tested in adjunctive-medication placebo-controlled designs.Y ounger adults,without an established need for long-term medication,may beparticularly suitable for clinical trials requiring placebo controls.The conversion rate of initial UPdepression,converting to become BP in the long run is estimated to be10%.Switch to mania orhypomania may be the consequence of active treatment for bipolar depression.Some medicinessuch as the tricyclic antidepressants and venlafaxine may be more likely to provoke switch thanothers,but this increased rate of switch may not be seen until about10weeks of treatment.T welve week trials against placebo are necessary to determine the risk of switch and to establishcontinuing effects.Careful assessment at6–8weeks is required to ensure that patients who arefailing to respond do not continue in a study for unacceptable periods of time.T o capture a switchevent,studies should include scales to define the phenomenology of the event(e.g.hypomania ormania)and its severity.These may be best applied shortly after the clinical decision that switch isoccurring.Long-term treatment is commonly required in bipolar disorder.Trials to detectmaintenance of effect or continued response in bipolar depression should follow a‘relapseprevention’design:i.e.patients are treated in an index episode with the medicine of interest andthen randomized to either continue the active treatment or placebo.However,acute withdrawalof active medication after treatment response might artificially enhance effect size due to activedrug withdrawal effects.A short taper is usually desirable.Longer periods of stabilisation are alsodesirable for up to3months:protocol compliance may then be difficult to achieve in practice andso will certainly make studies more difficult and expensive to conduct.The addition of a medicineto other agents during or after the resolution of a depressive or manic episode,and its subsequentinvestigation as monotherapy against placebo to prevent further relapse(as in the lamotriginemaintenance trials)is clinically informative.Assay sensitivity and patient acceptability areenhanced if the outcome in long-term studies is‘time to intervention for a new episode’fordiscontinuation designs.©2008Elsevier B.V.and ECNP.All rights reserved.1.IntroductionThis consensus statement builds on an earlier and more comprehensive document(Montgomery,2001).It was noted at the time that the recommendations might need modifica-tion to take account of accumulating evidence and experi-ence of conducting trials specifically in the bipolar area. There had been little such activity prior to the development of the original document.The present statement concerns bipolar depression,although it inevitably touches on broader issues of diagnosis and epidemiology.2.Review and selected supporting literature 2.1.Diagnosis and epidemiologyDiagnostic convention in the Mood Disorders under DSM-IV-TR poses a paradox.On the one hand,major depressive disorder (MDD)is classified separately from bipolar disorder(BD).On the other hand,the core of both diagnoses,namely the occurrence of a major depressive episode(MDE),is defined with identical criteria for depression in unipolar and bipolar disorders.Thus,DSM-IV-TR implies that mania and depres-sion are separate symptom dimensions which may exist separately in individual patients,whereas,within the bipolar diagnosis,depression and mania are viewed clinically as part of a unitary process where one state implies reversal to the other.In other words there is a tension between the nosological idea of bipolarity which links mania and depression and awaits a distinctive unifying hypothesis,and a purely descriptive notion of bipolar disorder(as in DSM-IV-TR)where one simply has a co-expression of depressive symptoms on the one hand and hypomania or mania on the other.Under the latter formulation(hypo)mania is effectively a co-morbidity of depression.Clearly the nub of this argument,which we cannot yet fully resolve,reflects the particular interest of this consensus statement which is the extent to which there is a difference between unipolar and bipolar depression.2.2.Epidemiological evidenceThe advantage of general population samples is that they allow a representative description of any disorder without bias from severity,help-seeking and treatment effects. Diagnosis in the community,as in the clinic requires a reliable instrument to detect the full range of symptoms for DSM-IV diagnosis:the Structured Clinical Interview for DSM-IV(SCID)or comparable instruments(SCAN,CASH,MINI-Plus) and even scales to measure severity(i.e.the Inventory of Depressive Symptoms(IDS))identify the relevant symptoms of depression including those that are atypical.European cross-sectional surveys have given broadly consistent esti-mates of prevalence(Pini et al.,2005):this also corresponds with similar figures from the most recent American survey (Merikangas et al.,2007),which gave lifetime figures for bipolar I disorder of1%and bipolar II disorder of1.2%.In addition they identified BP-NOS from DSM-IV in a further 2–3%of respondents.However these estimates from cross-sectional studies are likely to represent conservative lower bound estimates of the true lifetime risk,because long-itudinal studies with several assessment points have sug-gested that(hypo)manic episodes might be underreported in retrospect(Angst,2007;Wittchen and Jacobi,2005).A key finding relates to the time at which symptoms appear in bipolar mood disorder.The cumulative incidence of mania and hypomania more or less seems to reach an asymptote in the third decade.Conversely,the overall prevalence for unipolar major depression,continued to grow across the third decade(Wittchen et al.,2003),and into old age.This divergence suggests a difference in the underlying illness processes for unipolar and bipolar disorders.However, since the majority of studies are both retrospective and cross-sectional,and the few longitudinal studies confined to narrow time periods of the years up to age30,the age-related incidence patterns remain incomplete.We are currently likely to under-estimate somewhat mania and hypomania.There is a substantial need for long-term prospective studies across the age spectrum to estimate incidence and risk of recurrence.We do not know how fre-quently clinically significant mood elevation is a late de-velopment occurring in mid-and late life(Leboyer et al., 2005).In addition,the natural course and the factors, including treatment,that may influence the risk of depres-sive and(hypo)manic episodes under naturalistic conditions remain poorly studied and understood.Thus,for example, there is a good deal of variation in the published estimates for the natural length of episodes of hypomania or depression in bipolar patients.This might be due to a lack of consensus about the most appropriate assessment as well as to differ-ences in the age composition of the sample(episodes may be shorter in adolescents and longer in adults).In general, estimates from before the treatment era tend to be longer than those published more recently and may again reflect older age groups.An average figure of around3months is commonly accepted(Angst and Sellaro,2000).However, clinical experience and case series suggest that long episode duration and chronicity may be much commoner than this as suggested in cases coming for treatment,especially with depression(Perlis et al.,2004).The definition of bipolar states not meeting the full DSM-IV criteria for bipolar I or bipolar II remains of great con-temporary interest.When the duration criteria for‘hypo-mania or mania’symptoms are relaxed from the mandatory four,to only three or two days,the rates of‘bipolar II dis-order’increase substantially,without a corresponding drop in clinical correlates of impairment,suffering,or profes-sional help-seeking.This also implies that there is a sub-stantial increase in the number of cases–originally classified as major depression–that may be said to have a bipolar diathesis:they comprise the so-called bipolar spectrum.This must also include the bipolar NOS group in DSM-IV,although they will not be considered further here.Depending on what level of symptoms one regards as evidence of mood elevation,as many as50%of patients with major depression may be said to have experienced mood elevation(Angst et al.,2003;Cassano et al.,2004).Indeed,on the basis of symptom endorsement over a lifetime in clinic samples, Cassano et al.have suggested that mood elevation forms a continuous bridge between unipolar and bipolar disorders (Cassano et al.,2004).The intensity of illness,either depressive or manic,increased in parallel and simply showed537ECNP consensus meeting.Bipolar depression.Nice,March2007a higher baseline of elated experience for the bipolar group compared to the so-called unipolar cases.Together,these findings have generated interest in how eventually to implement dimensional bipolarity scores in future revisions of the DSM criteria(Vieta and Phillips,2007).In a10year prospective study in the community across4 waves of sampling using the DSM-IV CIDI,the course of different groups of depression with and without lifetime hypomania or mania has been described(Pfennig et al., 2005).The depressive episodes seen in those patients with manic or hypomanic experience showed clear evidence for a greater severity,more atypical symptoms and more psychosis at least in those patients who had also experienced hypo-mania.There are also a larger number of episodes and the mean time in episodes is slightly elevated in the bipolar cases.Interestingly the trend was for patients with a history of hypomania to have more severe depression than those with mania.Moreover,bipolar II depressed patients may be more likely than bipolar I to present with depressive atypical features,and less likely to experience psychosis.There has been a widespread interest in assessment and screening tools for hypomania.This follows the fact that a substantial proportion of patients with bipolar I and bipolar II disorders in the community are not recognised or treated. This might be of critical importance,particularly in cases presenting with major depression as the onset condition, who turn out later on–after occurrence of a(hypo)manic episode–to be bipolar.More sensitive screening tools below the current criteria-based threshold for(hypo)manic epi-sodes carry the promise of being able to provide appropriate treatment at an earlier stage.Clearly screening may increase awareness and prompt better diagnosis for earlier treat-ment.However,it is inevitable that screening thresholds sacrifice specificity for sensitivity.Of the scales that are available,including the MDQ and the HCL-32(Hirschfeld et al.,2003;Meyer et al.,2007),negative predictive values are between35and51%and positive predictive values similarly between31and52%.In summary,the estimates of the frequency of bipolar disorder using DSM-IV-TR criteria are relatively stable:they show little indication of substantial variation by culture and region and there is convergent evidence for relatively early onset of illness,in the mid-teens and twenties.The onset of bipolar cases tends to be earlier than those showing only MDD in population samples,which may reflect a partly different causation.The current limitations in the epidemiological literature relate to incomplete information across the life cycle,limited data on episode type,form,length and typical symptoms,limited reliable data on disability,recognition and treatment at a population level and insufficient epi-demiological evidence to support independently the defini-tion of thresholds and boundaries.The use of DSM-IV criteria remains the preferred diagnostic system and the supple-mentary extension of the bipolar II concept can probably be allowed without losing reliability,although there are clear questions about its clinical relevance,utility and conse-quences in regard to treatment.2.3.Bipolar depression in childrenThere is wide acceptance that bipolar mood disorder com-monly starts in the mid-teens and twenties,but the age at which bipolar disorder can first be diagnosed remains con-troversial.While increased prevalence of bipolar disorder among children in clinical samples has been claimed in some(Cassano et al.,2004;Geller et al.,2004;Ghaemi and Martin,2007;Weller et al.,1995),although not in all studies (Wals et al.,2001),current epidemiological studies using conventional criteria do not document cases of bipolar disorder in children either in Europe or in USA(Costello et al.,2002).Despite this epidemiological data,there has been a huge increase in the clinical diagnosis in children, especially in the USA,where the frequency of bipolar diagnosis from1996to2004in children discharged from psychiatric care has gone from1.3to7.3per10,000children, without a comparable rise in the adult diagnosis(Blader and Carlson,2007).Can a5–6-fold rise in frequency of diagnosis of bipolar disorder in children simply reflect improved awareness,and accurate diagnosis?Or is there a rising rate of the mis-diagnosis of bipolar disorder,due to other disorders of the externalizing spectrum(ADHD,ODD)being counted?At the transition to adulthood,such bipolar diagnoses are unlikely to be confirmed.The rise in outpatient visits of young patients with a diagnosis of childhood bipolar disorder in the same interval in the USA is even more extraordinary—40-fold(Moreno et al.,2007)-however the absolute rates in this survey remain quite low and the high relative increase may be in large part attributable to improved detection.It is highly controversial whether DSM-IV‘adult’criteria for bipolar disorder can or should be modified to allow diagnosis more readily(and hence earlier)in children(Duffy, 2007).Diagnostic practice in children is polarised between those who prefer to adopt a narrow phenotype characterised in the manic phase by euphoria,grandiosity and classical episodic manic symptoms and those who favour a broad phenotype,more characterised by irritability and non-specific mood lability.Where a narrow phenotype applies and a bipolar I diagnosis can be made,clinicians may be confident that the diagnosis will still be valid as the child matures.However,they have little choice but to follow the treatment guidance suggested by the adult literature, because of the absence of data from studies in childhood itself.The numbers of cases identified will also be small. Kraepelin documented onset before the age of10years in4 of almost1000patients that he reviewed in1921and,more recently,in the Spanish network for early onset psychosis there were35cases in2years for a catchment area of approximately7million people(Castro-Fornieles et al.,2007 and Arango personal communication):these would,of course,be severe presentations.Nevertheless,in many child psychiatric services there may be prejudice against making any form of diagnosis,because of habit or the considerable degree of developmental plasticity in this age group.This will mean that the narrow version of bipolar disorder,although rare,may still be under-diagnosed and the proper application of even conservative criteria might in-crease the numbers of patients detected.In favour of a broad phenotype is the potential for detection and intervention before severity,suicidality,drug misuse and other variables related to early onset bipolar disorder have become evident.These negative consequences might,in principle,be preventable.Moreover,treatment studies of the broad phenotype in children are legitimate,538G.M.Goodwin et al.irrespective of the validity of the bipolar diagnosis.What is more dubious is the extrapolation of adult bipolar treatment options to young children with a speculative bipolar diag-nosis.This has been pejoratively described as disease-mongering.It certainly risks bringing discredit on psychiatry if the adequate efficacy and safety studies are not per-formed,and there is the potential for significant harms (metabolic syndrome with antipsychotics,abnormal involun-tary movements,etc.(Laita et al.,2007)).There are several difficulties in accepting the broad bipolar diagnosis in children especially in ordinary practice as opposed to a research setting.The first is to adopt irritability as a defining symptom of bipolar disorder.This risks con-founding with other childhood psychopathology,in which it is a common symptom.These other disorders include ADHD, oppositional defiant disorder and conduct disorder and it may even be a temperamental trait(impulsivity in child-hood).Hence,predictably,for the most liberal definitions of bipolar disorder,co-morbidity with ADHD becomes extremely high and figures of between70%and98%exist in the literature(Geller et al.,2004;Wozniak et al.,1995).It is difficult to see where one condition can be said to end and the other to begin.Indeed,some authors have argued that some children diagnosed with bipolar disorder may have severe ADHD and stress the importance of differentiating between chronic and episodic irritability(Leibenluft et al., 2006).A further confound,seldom addressed in the current literature,is the potential for the use of stimulants and antidepressants to induce bipolar disorder or mimic its symptoms:if correct,this explanation is likely to be most relevant to the North American context where prescribing rates for children are much higher than elsewhere(Reichart and Nolen,2004).The most extreme advocates of the broader diagnosis also describe a chronic course with an absence of relapsing and remitting episodes characteristic of adult patients,a more common rapid cycling or mixed episode presentation and non-mood congruent psychotic symptoms.This must tend to confound the bipolar diagnosis with,rather then divide from alternative childhood psychopathology.Accord-ingly it is encouraging that episodic changes in mood are assuming increasing importance for definition of bipolar disorder NOS.Definitions with this core feature have shown similar evidence of being on the bipolar spectrum:con-versely,neither the number of other manic symptoms present,nor the duration of the index mood,appeared to have a big impact on the validity of definitions.Clinical implications of these findings include that bipolar NOS is best defined by episodic changes in mood(Birmaher and Axelson,2006;Birmaher et al.,2006).Emphasizing the core mood criterion and episodicity may mark an important homogeneous subset of cases.A further difficulty remains the lack of predictive validity and stability of the disorder when a broad phenotype is used as compared to a diagnostic stability of around a80–90% when a narrow phenotype is used(Fraguas et al.,2007; Hollis,2000).Finally,and perhaps most obviously,young children normally indulge in impulsive behaviours,grandiose fantasy and may have difficulty reporting complex emotions, ideas and experiences:inferences may be drawn from parti-cular child behaviours that may not be strictly warranted (Geller et al.,2002).The validity of the broad childhood bipolar phenotype requires testing by well designed prospective studies to determine the adult outcome of such cases.In the COBY study of patients with BP-NOS,20%were said to have converted to bipolar I after two years and10%to bipolar II. However,this is a highly selected clinical cohort.In the Oregon Adolescent Depression Project,a representative community sample of adolescents aged14–18showed a prevalence of bipolar disorder of about1%,about half of whom were diagnosed as having bipolar II disorder (Lewinsohn et al.,1995):97cases of subsyndromal mood disorder(about6%of the original sample)were followed up and showed elevated rates of MDD and anxiety disorders but not an increased incidence of bipolar disorder in their mid-twenties.Almost similar findings were reported from the Early Developmental Stages of Psychopathology Study in Germany(Wittchen et al.,2003)and a reanalysis of several other European studies(Pini et al.,2005).The Great Smokey Mountain study also suggested that the broad bipolar phenotype is more predictive of depression than bipolar disorder.Other studies looking at males with co-morbid mania and ADHD suggest that manic symptoms may not persist in subsequent follow up(Hazell et al.,2003). There have been no studies explicitly comparing unipolar and bipolar presentations in children or indeed their longitudinal outcomes.Prospective,longer follow up of larger samples is needed to clarify these issues:this will require regional and supra-regional networks to acquire a sufficiently large sample.Bipolar I and related bipolar II/spectrum diagnoses should be included in such research studies and there is need for a greater understanding of the effects of developmental family and co-morbid factors in the course of the disease. Notwithstanding the uncertainty around the broad pheno-type,bipolar disorder has been largely neglected in child psychiatry and may still be under-diagnosed in Europe,as prepubertal depression used to be not so long ago(Geller and Tillman,2005;Reddy and Srinath,2000).The different perspectives on a broad and earlier diagnosis of bipolar disorder in children remain polarised with the most extreme advocates of the advantages being North American,and the most conservative being European. The correct conclusion is probably that the evidence remains sufficiently limited to allow very different perspectives to be defended.The diagnosis of bipolar II disorder in children has little evidence based supporting studies,hence even greater uncertainty,and for this reason,the recommendations of NICE(/guidance/index.jsp?action=-byID&o=10990#documents)were that in clinical practice a bipolar II disorder in children was unlikely to be reliable or useful.In a research setting,however,structured interview may be useful to establish boundaries between bipolar I and II sub-types in children.In conclusion bipolar disorder exists in children and adolescents.Although bipolar-like symptoms may be quite frequent,reliably defined bipolar I disorder is rare in pre-pubertal children.It assumes increasing importance in adolescence with early onset increasingly recognised for bipolar patients in their late teens.Such cases appear to merit treatment by extrapolation from experience in adults. Since early intervention may improve prognosis,trials of such treatment are an important objective for future539ECNP consensus meeting.Bipolar depression.Nice,March2007。
IPK Gatersleben, Pattern Recognition Group, Gatersleben,
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ESANN'2005 proceedings - European Symposium on Artificial Neural Networks Bruges (Belgium), 27-29 April 2005, d-side publi., ISBN 2-930307-05-6.
perception and self-ideal discrepancies can be detected [1]. The second questionnaire is the Freiburg Personality Inventory (FPI) reflecting a set of personality properties including social orientation, inhibition, contentment, aggressiveness, stress, somatic complaints, openess, sensitivity and emotionality/neuroticism [9]. The set of questionnaires is completed by the Invetory for Assesment of Interpersonal Relations (IIP) which judges the interpersonal relations. Based on these data, the question for machine learning is to identify the relevant attributes and a possible hypothesis how experts and BPI, respectively, make their decision. We tackle this problem learning classifiers from the given data, which allow insight into their classification and which provide a hypothesis for the respective decision rule.
2021届全国(1卷)高三下学期3月第二次模拟考试卷 英语(一)
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第一部分 听力（共两节，满分30分） 略第二部分 阅读理解（共两节，满分40分）第一节（共15小题；每小题2分，满分30分）阅读下列短文，从每题所给的四个选项（A 、B 、C 和D ）中选出最佳选项，并在答题卡上将该项涂黑。
AThe United Kingdom of Great Britain and Northern Ireland is the eleventh largest nation in Europe. England, Wales and Scotland make up the island of Great Britain, which takes up most of the Britain Isles. Northern Ireland, Scotland and Wales are mountainous. The highest mountain is Ben Nevis in Scotland. Plains and valleys cover much of England. The British climate is mild.About 58 million people live in the United Kingdom. Few other countries are so crowded. Four out of five people live in cities such as Belfast, Glasgow, and London. London is the capital. Great Britain grows half of the food it needs. Its industries help to pay for the food that is bought from abroad. The United Kingdom manufactures a wide range of goods. Service industries, such as tourism, that provide services rather than producing goods, are increasing. Traditional industries, such as coal mining, are declining. 21. There are many mountains in ______________. A. Northern Ireland, Scotland and England B. England, Wales and ScotlandC. Wales, Scotland and Northern IrelandD. Northern Ireland, Wales and England22. In the United Kingdom, about __________ people live in big cities. A. 58 millionB. 48.8 millionC. 38.8 millionD. half23. According to the passage, which of the statements is true? A. Great Britain grows all of the food it needs.B. The United Kingdom manufactures a narrow range of goods.C. The speed of tourism in UK is increasing faster than producing goods.D. The coal mining is also increasing fast.BTwo-year-old Samantha Savitz is deaf and loves interacting with her neighbors, so they all learned sign language in order to communicate with her better. The little girl is just so charming and adorable that it’s hard not to want to be able to have simple conversations with her.In the United States, about two to four of every 1,000 people are functionally deaf — about 2 million people. Around 28 million Americans, 10% of the population, ave some degree of hearing loss. Around 500,000 deaf people in the country use American Sign Language(ASL), and it’s the third most commonly used language in the US; many hearing people are also fluent in ASL. With so many people using ASL, it’s only right that Savitz’s neighbors learn the language, not only for her but also to be able to communicatewith other deaf people.Located at the end of Islington Road in Newton, Massachusells, this little neighborhood is absolutely charmed by one little girl. Savitz is a super engaging girl, and she loves interacting with people in her community. She is delighted when they are able to sign with her. However, she gets really sad when they can’t understand her when she tries to communicate with them. Because of this, Savitz’s neighbors collectively hired an instructor for ASL classes. With the help of their instructor, Rhys McGovern, the neighbors are able to help Savitz feel a sense of belonging.What the neighbors did for this little girl is wonderful because she will grow up being well-adjusted in society. Instead of feeling separated because no one outside of her family will understand her, Savitz will be accustomed to constantly interacting with different people. Her family is so thankful that they are fortunate to have such caring and compassionate neighbors. Savitz calls her neighbors “friends” and accurately so.Other than speaking with the darling of their neighborhood, the residents of Islington Road will also be able to communicate with any other deaf person they en counter. “We are really enjoying the whole process, not only the learning of ASL, but the learning together,” says McNeil, one of Savitz’s neighbors.此卷只装订不密封班级 姓名 准考证号 考场号 座位号“It’s made our neighborhood a closer place.”24. Why does the author present the figures in paragraph 2?A. To recommend people to learn ASL.B. To show why the ASL class is appealing.C. To stress how terrible the life of the deaf is.D. To account for Savitz’s neighbors’ learning ASL.25. How does little Savitz feel when her neighbors are able to communicate with her?A. Proud.B. Pleased.C. Confused.D. Surprised.26. What does Rhys McGovern do for Savitz?A. He teaches her neighbors ASL.B. He guides her to interact with her neighbors.C. He hired an instructor for her neighbors.D. He called on her neighbors to help her.27. What lesson can we learn from the story?A. Many heads are better than one.B. Help others and be happy with yourself.C. You can’t hide the world from your next neighbor.D. The poor are good to themselves and the good for the world.CThere are many therapies(疗法) for depression, including medical treatment, psychotherapy and talk therapy. Having a range of treatment choices is a good idea because no single treatment works equally well for each of millions of sufferers. Choosing the most suitable treatment is important to them. Now researchers say a new therapy proven to relieve depression should be added to the established treatments. It’s called nature therapy. “Interacting with nature can have positive effects on those with depression,” says Ethan Kross, PhD, an expert who has studied the nature depression link.A little exposure to nature helps all of us get our energy back, and it may have special benefit for those who are depressed. “It seems that, from our work, the restora tive effect of nature seems to be stronger for individuals with depression,” says Marc Berman, PhD, an assistant professor of psychology at the University of Chicago. That might be because they feel mentally exhausted, and being in nature reenergizes them. However, Dr Berman has a strong warning. “We’re not arguing that interacting with nature should replace clinically proven treatments for depression,” he says, “Nor should those with clinical depression try to treat themselves.”However, Berman and others say, interactions with nature could serve as a very effective supplementary treatment. Compared to adults with depression walking for 50 minutes in an urban setting, those who took a 50 minute walk in a natural setting were less depressed and had better memory skills.Why does nature hold this special effect? Berman says, “In a natural environment, we can choose to think or not, and this choice is believed to help us rest our brains. You can then pay attention later, when you need to.” He adds, “It gives pe ople more ability to concentrate, which is a big problem for those with depression.” Nature provides an effective setting for resting our brains, unlike urban setting. Even in the most peaceful urban environment, you have to pay attention to such things as traffic and stoplights.28. What can we learn about depression therapies from paragraph 1?A. They focus on physical activity.B. They pay no attention to interactions.C. They mainly depend on natural environment.D. They need to be tailored to different patients.29. How does nature benefit patients with depression?A. By making them feel energetic.B. By reminding them to rest in time.C. By taking the place of clinic treatment.D. By covering up their mental problems.30. What does the underlined word “supplementary” in paragraph 3 probably mean?A. Additional.B. Traditional.C. Controversial.D. Essential.31. What is the text mainly about?A. An urban setting of restoring energy.B. The positive role of nature in treating depression.C. The popularity of using multiple ways to treat diseases.D. An effective replacement of clinical therapy for depression.DWe all know employees talk, and things can never remain totally secret. But a direct discussion about salary details probably isn’t the best idea.There are organizations that openly share salary information around the office. However, unless all similar jobs pay the same rate, people advise that open salary concepts do not work well.When companies have different employees on the same job and one of them is paid differently, manyunfairness issues surface. It can happen in any company that differentiates(区分) pay for any reason like seniority and performance. You should run the risk of causing a distance between you and your colleagues if they learn you earn more for what they think to be the same job.The secret nature of your salary, in fact, can be a greater benefit to you. It creates an opportunity for a manager to have a personal discussion with employees as to why they are being paid what they are and how they can then move forward with confidence that they have developed a “special” relationship with their supervisor(主管) on their individual issues, good and bad, without involving others in the process.If you learn that someone who hol ds a similar position earns a bigger paycheck, don’t panic. First, do some due diligence to determine if you are being underpaid in general. Use the Internet salary calculator, and also reach out to your out-of-office network to find out how people at other companies are being compensated. Next, you’d better go to your boss and ask the reasons. Open a rational dialog to understand what skills or experience you’ll need to improve your performance and earn more recognition and financial rewards.32. What could happen if your colleagues learned that you are paid more?A. They might become less friendly to you.B. Your salary might be reduced soon.C. They might badly perform in their work.D. You might be given extra jobs.33. What is the advantage of keeping salary information secret?A. It inspires you to make greater progress in your work.B. It warns you to work harder to make more money.C. It gives the manager a chance to communicate with you.D. It proves the manager treats all his employees equally.34. What is the purpose of the last paragraph?A. To tell about how to get along with the boss.B. To show how to keep silent about the problem.C. To urge employees to argue with the boss.D. To suggest ways to deal with the problem.35. What is the text mainly about?A. Personal relationship.B. Salary secret.C. Colleague pressure.D. Salary difference. 第二节（共5小题；每小题2分，满分10分）根据短文内容，从短文后的选项中选出能填入空白处的最佳选项。
《临床神经解剖学:病例解析》(第2版)已出版
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《临床神经解剖学:病例解析》（第2版）已出版
神经解剖学是关于神经系统形态结构的专门学科 ,对于阐明疾病的发生机 制和治疗具有重要意义。《临床神经解剖学:病例解析》（第2版）由美国耶鲁大 学医学院神经科学教授哈尔•布鲁门菲尔德编著,由李云庆、赵钢、汪昕和隋鸿 锦教授担任主译，并邀请国内18所著名院校和医院的基础和临床专业人员参加 翻译。
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欧洲术后镇痛指南
PostoperativePain Management –Good Clinical PracticeGeneral recommendationsand principles forsuccessful pain managementProduced in consultation with theEuropean Society of Regional Anaesthesiaand Pain TherapyPostoperativePain Management –Good Clinical PracticeGeneral recommendationsand principles forsuccessful pain managementProduced in consultation with theEuropean Society of Regional Anaesthesiaand Pain TherapyContents ContentsContents11. Introduction and objectives1 Although the choice of drugs shown here is indicative, adjustments will be required to take account ofindividual patient variation and are the responsibility of the prescribing physician.Effective postoperative pain management has a humanitarian role, but there are additional medical and economic benefits for rapid recovery and discharge from hospital. A number of factors contribute to effective postoperative pain management including a structured acute pain management team, patient education, regular staff training, use of balanced analgesia, regular pain assessment using specificassessment tools and adjustment of strategies to meet the needs of special patient groups, such as children and the elderly.Recent advances in pain control provide greater potential for effective postoperative management. This document reflects the opinions of a panel of European anaesthesiologists. Its aims are to raise awareness of recent advances in pain control and to provide advice on how toachieve effective postoperative analgesia. The recommendations and advice are general principles of pain management and do not provide detailed advice for specific surgical procedures.1Effective pain management is now an integral part of modern surgical practice. Postoperative pain management not only minimises patient suffering but also can reduce morbidity and facilitate rapid recovery and early discharge from hospital (see section 8, page 33), which can reduce hospital costs.23Pain is a personal, subjective experience that involves sensory,emotional and behavioural factors associated with actual or potentialtissue injury. What patients tell us about their pain can be very revealing,and an understanding of how the nervous system responds and adaptsto pain in the short and long term is essential if we are to make sense ofpatients’ experiences. The wide area of discomfort surrounding awound, or even a wound that has healed long ago, such as anamputation stump, is a natural consequence of the plasticity of thenervous system. An understanding of the physiological basis of pain ishelpful to the sufferer, and the professionals who have to provideappropriate treatment.According to the International Association for the Study of Pain (IASP),pain is defined as"An unpleasant sensory and emotional experience associated withactual or potential tissue damage, or described in terms of suchdamage."(IASP 1979)There is individual variation in response to pain, which is influenced bygenetic makeup, cultural background, age and gender. Certain patientpopulations are at risk of inadequate pain control and require specialattention. These include:G Paediatric patientsG Geriatric patientsG Patients with difficulty in communicating (due to critical illness,cognitive impairment or language barriers)Postoperative pain can be divided into acute pain and chronic pain:G Acute pain is experienced immediately after surgery (up to 7 days)G Pain which lasts more than 3 months after the injury is considered tobe chronic pain3. Physiology of pain 2. Goals of pain treatmentAcute and chronic pain can arise from cutaneous, deep somatic orvisceral structures. Surgery is typically followed by acute pain and correct identification of the type of pain enables selection of appropriate effective treatment. The type of pain may be somatic (arising from skin, muscle, bone), visceral (arising from organs within the chest and abdomen), or neuropathic (caused by damage or dysfunction in the nervous system). Patients often experience more than one type of pain.3.a. Positive role of painAcute pain plays a useful "positive" physiological role by:G Providing a warning of tissue damageG Inducing immobilisation to allow appropriate healing3.b. Negative effects of painShort term negative effects of acute pain include:G Emotional and physical suffering for the patientG Sleep disturbance(with negative impact on mood and mobilisation)G Cardiovascular side effects(such as hypertension and tachycardia)G Increased oxygen consumption(with negative impact in the case of coronary artery disease)G Impaired bowel movement(while opioids induce constipation or nausea, untreated pain mayalso be an important cause of impaired bowel movement or PONV*)G Negative effects on respiratory function(leading to atelectasis, retention of secretions and pneumonia)G Delays mobilisation and promotes thromboembolism(postoperative pain on mobilisation is one of the major causes fordelayed mobilisation)Long term negative effects of acute pain:G Severe acute pain is a risk factor for the development of chronicpain1G There is a risk of behavioural changes in children for a prolongedperiod (up to 1 year) after surgical painThere are two major mechanisms in the physiology of pain:G Nociceptive (sensory):Inflammatory pain due to chemical,mechanical and thermal stimuli at the nociceptors (nerves thatrespond to painful stimuli).G Neuropathic:Pain due to neural damage in peripheral nervesor within the central nervous system.During normal physiology, pain sensations are elicited by activity in unmyelinated (C-) and thinly myelinated (Ad-) primary afferent neurons that synapse with neurons is the dorsal horn of the spinal cord. Sensory information is then relayed to the thalamus and brainstem.Repetitive activation of C- nociceptive receptors produces alterations in central as well as peripheral nervous systems.3.c. The mechanism of peripheral pain sensitisationNormally, C- fibres (slow-conducting fibres that transmit dull aching pain) are silent in the absence of stimulation, but following acute tissue injury in the presence of ongoing pathophysiology, these nociceptors become sensitised and release a complex mix of pain and inflammatory mediators leading to pain sensations (Figure 1, page 6).1Several investigations into chronic pain have concluded that 20% to 50% of all patients with chronic pain syndromes started with acute pain following trauma or surgery, but the role of effective pain treatment in preventing this risk is not clear.* PONV = Postoperative Nausea and Vomiting.Figure 1.Mechanism of peripheral sensitisation3.d. The mechanism of central sensitisationThe responses in the CNS are primarily physiological. Centralsensitisation is a physiological process and, only if there is continual firing of C-nociceptors over time, will these processes leads to more chronic pain syndromes.Sustained or repetitive C-nociceptor activity produces alterations in the response of the central nervous system to inputs from the periphery.When identical noxious stimuli are repeatedly applied to the skin at a certain rate, there is a progressive build-up in the response of spinalcord dorsal horn neurons (known as ‘wind up’). This allows the size of the dorsal horn neuron’s receptive field to grow (Figure 2). This process,called central sensitisation, occurs with any tissue damage. As with sensitisation of primary afferent nociceptors, this sensitisation of central pain transmission is a normal physiological response of the undamaged nervous system.Figure 2.Pain mediatorsGUnexpected intense pain, particularly if associated with altered vital signs, (hypotension, tachycardia, or fever), is immediately evaluated. New diagnoses, such as wound dehiscence, infection, or deep venous thrombosis, should be considered.GImmediate pain relief without asking for a pain rating is given to patients in obvious pain who are not sufficiently focused to use a pain rating scale.GFamily members are involved when appropriate.4.a. Specific tools for pain assessmentSpecific pain assessment scales are used to quantify pain. The use of one scale within a hospital ensures that everyone in the team "speaks the same language"regarding the intensity of pain. The patient's own report is the most useful tool. The intensity of pain should therefore be assessed as far as possible by the patient as long as he/she is able tocommunicate and express what pain feels like. Always listen to and believe what the patient says.A number of different patient self-assessment scales are available (Figure 3, page 12):A. Facial expressions: a pictogram of six faces with differentexpressions from smiling or happy through to tearful. This scale is suitable for patients where communication is a problem, such as children, elderly patients, confused patients or patients who do not speak the local language.B. Verbal rating scale (VRS): the patient is asked to rate their pain on a five-point scale as "none, mild, moderate, severe or very severe".Assessment of pain is a vital element in effective postoperative pain management. The principles of successful pain assessment are shown in Table 1.44. Assessment of pain4G The treatment strategy to be continued is discussed by the physician responsible for the patient in conjunction with the ward nurses.GThe physician and nurses pay attention to the effects and side effects of the pain treatment.C. Numerical rating scale (NRS): This consists of a simple 0 to 5 or 0 to 10 scale which correlates to no pain at zero and worst possible pain at 5 (or 10). The patient is asked to rate his/her pain intensity as a number.D. Visual analogue scale (VAS): This consists of an ungraduated,straight 100 mm line marked at one end with the term " no pain" and at the other end "the worst possible pain". The patient makes a cross on the line at the point that best approximates to their pain intensity.The VRS and NRS are the most frequently used assessment tools in the clinical setting while the VAS scale is primarily used as a research tool.4.b. Selection of suitable assessment tool (Figure 3, page 12):When selecting a pain assessment tool ensure that:GIt is appropriate for the patient's developmental, physical, emotional, and cognitive statusGIt meets the needs of both the patient and the pain management team4.c. DocumentationDocument pain regularly, take appropriate action and monitor efficacy and side effects of treatment. Record the information in a well-defined place in the patient record, such as the vital sign sheet or a purpose-designed acute pain chart.GThe nurse responsible for the patient reports the intensity of pain and treats the pain within the defined rules of the local guidelines. GThe physician responsible for the patient may need to modify theintervention if evaluation shows that the patient still has significant pain.44Faces painassessmentscale(Fig A) Patientable to communicatewell ?VRS painassessmentscale(Fig B)NRSassessmentscale(Fig C)VASassessmentscale(Fig D) NoYesChoice of assessment tool12Fig A. Alternatecoding Fig B.Fig C. Fig D.G Select a pain assessment tool, and teach the patient to use it.Determine the level of pain above which adjustment of analgesia or other interventions will be considered.G Provide the patient with education and information about pain control.GEmphasise the importance of a factual report of pain, avoiding stoicism or exaggeration.The "Patient Information Project" is a useful source of information for patients who require information about anaesthesia and postoperative pain management. This is a joint project between the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, together with patient representative groups. The website is:Patients are unlikely to be aware of postoperative pain treatment techniques and as the success of pain relief is influenced by theirknowledge and beliefs, it is helpful to give patients (and parents in case of children) detailed information about postoperative pain and pain treatment. Adequate information gives the patient realistic expectations of the care that can be provided (pain relief, not a "pain free status"). This information can include:G The importance of treating postoperative pain G Available methods of pain treatment G Pain assessment routinesG Goals (optimum pain scoring) (see section 2, page 2)GThe patient's participation in the treatment of painInformation for the patient can be given in different ways (in combination):G Verbal informationGWritten and/or audiovisual information -Brochures -Wall posters -Video films -Web pagesA preoperative discussion with the patient and relatives can include the following:GDiscuss the patient's previous experiences with pain and preferences for pain assessment and management.GGive the patient information about pain management therapies that are available and the rationale underlying their use.GDevelop with the patient a plan for pain assessment and management.141555. Patient education51716Effective treatment of postoperative pain includes a number of factors,including good nursing, non-pharmacological techniques, such as distraction, and balanced (multimodal) analgesia to provide adequate pain relief with optimal drug combinations used at the lowest effective doses.6.a. Pharmacological methods of pain treatment 1Postoperative pain management should be step-wise and balanced (Figure 4, page 18). The four main groups of analgesic drugs used for postoperative pain management are shown in Table 2 opposite, with examples of drugs listed in each group.6.a.i. Balanced (multimodal) analgesiaBalanced (multimodal) analgesia uses two or more analgesic agents that act by different mechanisms to achieve a superior analgesic effect without increasing adverse events compared with increased doses of single agents. For example, epidural opioids can be administered in combination with epidural local anaesthetics; intravenous opioids can be administered in combination with NSAIDs, which have a dose sparing effect for systemically administered opioids.Balanced analgesia is therefore the method of choice wherever possible,based on paracetamol and NSAIDs for low intensity pain with opioid analgesics and/or local analgesia techniques being used for moderate and high intensity pain as indicated (Figure 4, page 18).66. Treatment optionsTable 2Pharmacological options of pain managementNon-opioid analgesicsParacetamolNSAIDs, including COX-2 inhibitors*Gabapentin, pregabalin 2Weak opioidsCodeine TramadolParacetamol combined with codeine or tramadol Strong opioidsMorphine Diamorphine Pethidine Piritramide Oxycodone Adjuvants**Ketamine Clonidine* At the time of writing, COX-2 inhibitor drugs are subject to scrutiny by international regulatory bodies with regard to adverse outcomes when used for long-term oralprescription or for pain relief in patients with cardiovascular problems such as myocardial infarction, angina pectoris, hypertension. Rofecoxib has been withdrawn fromsales and prescription of valdecoxib has been suspended pending further research into its adverse events profile for cardiovascular morbidity and the occurrence of severemuco-cutaneous side effects. The injectable COX-2 inhibitor, parecoxib remains available for short-term use in treating postoperative pain. All NSAIDs should be used with care in patients with cardiovascular disease.** These adjuvants are not recommended for routine use in acute pain management because of their adverse side effects. Their use should be restricted to specialists in managing pain problems.62Gabapentin and pregabalin are approved for pain management but at the time of writing there is little published data to recommend the use of these drugs for acute pain management.1The example doses given are indicative and do not take account of individual patient variation.196.a.ii. Opioids 1Severeintensity painFor example:ThoracotomyUpper abdominal surgery Aortic surgery Knee replacementModerateintensity painFor example:Hip replacement Hysterectomy Jaw surgeryMildintensity painFor example:Inguinal hernia VaricesLaparoscopy(i) Paracetamol and wound infiltration with local anaesthetic (ii) NSAIDs (unless contraindicated) and(iii) Regional block analgesiaAdd weak opioid or rescue analgesia with small increments of intravenous strong opioid if necessary(i) Paracetamol and wound infiltration withlocal anaesthetic (ii) NSAIDs (unless contraindicated) and (iii) Peripheral nerve block(single shot or continuous infusion) or opioid injection (IV PCA)(i) Paracetamol and woundinfiltration with local anaesthetic (ii) NSAIDs (unlesscontraindicated) and (iii) Epidural local analgesia ormajor peripheral nerve or plexus block or opioid injection (IV PCA)1 The examples given here represent levels of pain commonly experienced and are subject to individual variation and contra-indications may apply.Figure 4Treatment options in relation to magnitude of postoperative pain expected following different types of surgery 1Table 3Morphine and weak opioidsMorphine Administration(i) Intravenous.(ii) Subcutaneous by continuous infusion or intermittent boluses via indwelling cannula.(iii) Intramuscular (not recommended due to incidence of pain. 5-10 mg 3-4 hourly).Dosage:IV PCABolus: 1-2 mg, lockout: 5-15 min (usually 7-8 min),no background infusion.Subcutaneous0.1-0.15 mg/kg 4-6 hourly, adapted in relation to pain score, sedation and respiratory rate.Monitoring Pain score, sedation, respiratory rate, side mentsSide effects such as nausea, vomiting, sedation and apnoea.No other opioid or sedative drug should be administered.18continued overleaf1 The doses and routes of administration of drugs described above are general examples and each patient should beassessed individually before prescribing.2120 6.a.iii. Non-opioids 1Table 5Combination of codeine + paracetamolAdministration Oral.DosageParacetamol 500 mg + codeine 30 mg. 4 x 1 g paracetamol/day.Monitoring Pain score, sedation, side effects.CommentsAnalgesic action is likely to be due to conversion to morphine. A small number of patients derive no benefit due to absence of the converting enzyme.NV = nausea and vomitingTramadol Administration(i) Intravenous: inject slowly (risk of high incidence of NV).(ii) Intramuscular.(iii) Oral administration as soon as possible.Dosage 50-100 mg 6 hourly.Monitoring Pain score, sedation, respiratory rate, side mentsTramadol reduces serotonin and norepinephrine reuptake and is a weak opioid agonist.In analgesic efficiency, 100 mg tramadol is equivalent to 5-15 mg morphine.Sedative drugs can have an additive effect.Table 4ParacetamolAdministration(i) Intravenous: Start 30 min before the end of surgery.(ii) Oral administration as soon as possible.Duration: as long as required.Dosage4 x 1 g paracetamol/day (2 g propacetamol/day).Dose to be reduced (e.g. 3 x 1 g/day) in case of hepatic insufficiency.Monitoring Pain scores.CommentsShould be combined with NSAID and/or opioids or loco-regional analgesia for moderate to severe pain.1 The doses and routes of administration of drugs described above are general examples and each patient should beassessed individually before prescribing.1 The doses and routes of administration of drugs described above are generally examples and each patient should be assessed individually before prescribing.Table 3 (continued)Codeine Administration OralDosage3 mg/kg/day combined with paracetamol.A minimum of 30 mg codeine/tablet is required.Monitoring Pain score, sedation, side effects.CommentsAnalgesic action is likely to be due to conversion to morphine. A small number of patients derive no benefit due to absence of the converting enzyme.6.a.iv. AdjuvantsIn addition to systemic administration of NSAIDs or paracetamol, weak opioids and non-opioid analgesic drugs may be administered "on request" for moderate or severe pain. These include ketamine and clonidine. Clonidine can be administered orally, intravenously orperineurally in combination with local anaesthetics. However, the side effects could be significant. The most important ones are hypotension and sedation. Ketamine can be administered via oral, intramuscular or intravenous routes. It has also significant side effects.6.a.v. Regional analgesiaContinuous Central Neuraxis Blockade (CCNB)CCNB is one of the most effective forms of postoperative analgesia, but it is also one of the most invasive. However, CCNB remains the first choice for a number of indications, such as abdominal, thoracic, and major orthopaedic surgery, where adequate pain relief cannot be achieved with other analgesia techniques NB can be achieved via two routes:G Continuous epidural analgesia - the recommended first choice GContinuous spinal analgesia - should be limited to selected cases only, as there is less experience with this techniquePostoperative epidural analgesia is usually accomplished with acombination of a long-acting local anaesthetic and an opioid, in dilute concentrations. Long-acting local anaesthetics are preferred because they are associated with less tachyphylaxis. Maintenance techniques in epidural analgesia include:GContinuous Infusion (CI): An easy technique that requires littleintervention. The cumulative dose of local anaesthetic is likely to be higher and side effects are more likely than with the other two techniques.2322Table 6NSAIDs 1Administration(i) Intravenous: administration should start at least 30-60 min before end of surgery.(ii) Oral administration should start as soon as possible.Duration: 3-5 days.Dosage examples(i) Conventional NSAIDs include:ketorolac: 3 x 30-40 mg/day (only IV form)diclofenac: 2 x 75 mg/day ketoprofen: 4 x 50 mg/day (ii) Selective NSAIDs include:meloxicam 15 mg once dailyCOX-2 inhibitors are now licensed for postoperative pain management. They are as efficient as ketorolac but reduce GI side effects. Examples include: parecoxib: 40 mg followed by 1-2 x 40 mg/day (IV form) or celecoxib: 200 mg/day. However, there is some debate due to cardiovascular risks in patients witharteriosclerosis. *See note below Table 2, page 17MonitoringPain scores.Renal function in patients with renal or cardiac disease, elderly patients, or patients with episodes of severe hypotension. Gastrointestinal side effects. Non-selective NSAIDs would be combined with proton inhibitors (i.e. omeprasol) in patients at risk of gastrointestinal side effects.CommentsCan be added to the pre-medication.Can be used in association with paracetamol and/or opioids or local regional analgesia for moderate to severe pain.1 The doses and routes of administration of drugs described above are general examples and each patient should beassessed individually before prescribing.2524Continuous Peripheral Nerve Blockade (CPNB)Continuous peripheral nerve blocks are being increasingly used since they may provide more selective but still excellent postoperative analgesia with reduced need for opioids over an extended period.Peripheral nerve blocks (PNBs) avoid the side effects associated with central neuraxial blockade, such as hypotension and wide motorblockade with reduced mobility and proprioception, and complications such as epidural haematoma, epidural abscess and paraparesis.After major orthopaedic lower limb surgery, clinical studies showperipheral nerve blocks are as effective as epidural and that both are better than IV opioids. Examples of drugs and dosages for use in continuous peripheral analgesia are shown in Table 8.Table 8Examples of local anaesthetics and doses in continuous peripheral nerve analgesiaG Intermittent Top-up: Results in benefits due to frequent patient/staff contact but can produce a high staff workload and patients may have to wait for treatment.GPatient-Controlled Epidural Analgesia (PCEA): This technique produces high patient satisfaction and reduced dose requirements compared with CI. However, sophisticated pumps are required and accurate catheter position is important for optimal efficacy.Examples of drugs and dosages for use in continuous epidural analgesia are shown in Table 7.Table 7Examples of local anaesthetics and opioids and doses in epidural analgesia 1LocalRopivacaineSufentanil 0.5-1 µg/ml anaesthetics/opioids0.2% (2 mg/ml) or orFentanyl 2-4 µg/mlLevobupivacaine or Bupivacaine0.1-0.2% (1-2 mg/ml)Dosage for continuous 6-12 ml/hinfusion (thoracic or lumbar level)Dosage for patient Background: 4-6 ml/h controlled infusion Bolus dose: 2 ml (2-4 ml)(lumbar or thoracic)2Minimum lockout interval 10 min (10-30 min)Recommended maximum hourly dose (bolus + background): 12 ml1 The tip of the catheter should be placed as close as possible to the surgical dermatomes: T6-T10 for majorintra-abdominal surgery, and L2-L4 for lower limb surgery.2 There are many possible variations in local anaesthetic/opioid concentration yielding good results, the examples givenhere should be taken as a guideline; higher concentrations than the ones mentioned here are sometimes required but cannot be recommended as a routine for postoperative pain relief.Site of catheterLocal anaesthetics and dosage*Ropivacaine 0.2%Bupivacaine 0.1-0.125%Levobupivacaine 0.1-0.2%Interscalene5-9 ml/h Infraclavicular 5-9 ml/h Axillary 5-10 ml/h Femoral 7-10 ml/h Popliteal3-7 ml/h*Sometimes, higher concentrations are required in individual patients. As a standard, starting with a low concentration/dose is recommended to avoid sensory loss or motor block.2726Patient Controlled Regional Analgesia (PCRA) can be used to maintain peripheral nerve block. A low basal infusion rate (e.g. 3-5 ml/h)associated with small PCA boluses (e.g. 2.5-5 ml - lockout: 30-60 min) is the preferred technique.Infiltration blocksPain relief may be achieved by infiltration of the wound with localanaesthetic. The technique is easy to perform by the surgeon at the time of surgery. The efficacy and duration of analgesia depend on the length of the wound and the type of local anaesthetic used (Table 9).The advantages and disadvantages of various techniques of regional analgesia are shown in Table 10.Table 9Local anaesthetic infiltrationLocal anaestheticVolumeAdditivesIntraarticular instillation Knee arthroscopy0.75% Ropivacaine 20 ml Morphine 1-2 mg 0.5% Bupivacaine20 ml Morphine 1-2 mgShoulder arthroscopy 0.75% Ropivacaine10-20 mlIntraperitoneal instillation Gynaecological 0.75% Ropivacaine 20 ml Cholecystectomy 0.25% Ropivacaine40-60 mlWound infiltration Inguinal hernia0.25-0.5% Ropivacaine 30-40 ml 0.25-0.5% Levobupi*30-40 ml0.25-0.5% Bupivacaine Up to 30 mlTable 10Advantages of different techniques of regional analgesiaAdvantagesDisadvantagesContinuous Very effective.Motor block and urinary Epiduralretention may develop Analgesia (CEA)Much experience.or persist depending on the concentrations used.Differential block withDrugs used must have motor sparing is possible.low risk of systemic toxicity and produce as little motor Excellent postoperative block as possible.pain control over an extended period.Requires regular clinical monitoring on surgical Useful for rehabilitation wards or ICU.and physiotherapy.There are no universal Reduces the quantity of guidelines for monitoring.opioid analgesics needed.May mask a haematoma or abscess resulting in damage to spinal nerves.continued overleafThyroid surgery0.25-0.5% Ropivacaine 10-20 ml 0.25-0.5% Levobupi*10-20 ml0.25-0.5% Bupivacaine Up to 20 mlPerianal surgery0.25-0.5% Ropivacaine 30-40 ml 0.25-0.5% Levobupi*30-40 ml0.25-0.5% Bupivacaine Up to 30 mlcontinued opposite* Levobupi = Levobupivacaine.* Levobupi = Levobupivacaine.Please consult the manufacturer’s full prescribing information before use.。
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822Psychosocialb...
2.24)and thromboembolisms (OR 2.66,95%CI 1.75-4.05).Congenital anomalies (OR 2.11,95%CI 1.65-2.72),small for gestational age (OR 2.36,95%CI 2.09-2.66)and preterm birth (OR 1.81,95%CI 1.67-1.95)were more common in neonates of women with RA.CONCLUSION:RA in pregnancy is associated with a greater likelihood of adverse maternal and neonatal outcomes.Women with RA should be made aware of these risks and be followed as a high risk preg-nancy.The influence of laser microseptostomy during fetoscopic laser photocoagulation onnewborn survival of the recipient and donor twins in twin pregnancies complicated by twin-twin transfusion syndromeMeredith Taylor 1,MacKenzie Lee 1,Foong-Yen Lim 2,3,Sammy Tabbah 2,4,Emily DeFranco 2,4,5,David McKinney 2,41University of Cincinnati College of Medicine,Cincinnati,OH,2Cincinnati Fetal Center,Cincinnati Children ’s Hospital Medical Center,Cincinnati,OH,3Division of Pediatric Surgery,Department of Surgery,University ofCincinnati College of Medicine,Cincinnati,OH,4Division of Maternal-Fetal Medicine,Department of Obstetrics and Gynecology,University ofCincinnati College of Medicine,Cincinnati,OH,5Center for Prevention of Preterm Birth,Perinatal Institute,Cincinnati Children ’s Hospital Medical Center,Cincinnati,OHOBJECTIVE:To determine the effect of performing concurrent lasermicroseptostomy at the time of selective fetoscopic laser photoco-agulation (SFLP)on recipient and donor twin survival during the treatment of twin-twin transfusion syndrome (TTTS).STUDY DESIGN:We performed a single center,retrospective cohort study of women with TTTS who underwent SFLP between 16and 27weeks gestation from 06/2012-10/2016.Patients were treated with SFLP plus microseptostomy or SFLP alone.The primary outcomes were the newborn survival to discharge rates of both the recipient and donor twins.Dichotomous data was compared using chi-squared analysis.Logistic regression analysis was used to estimate the relative risk (RR)for each outcome.RESULTS:A total of 250patients with TTTS were included in the study.Of these women,42(16.8%)had Quintero stage I disease,45(18%)had stage II disease,136(54.4%)had stage III disease,and 27(10.8%)had stage IV ser microseptostomy was performed in 94(37.6%)patients.When comparing women who received SFLP plus microseptostomy to women who had SFLP only they had similar rates of recipient twin survival (85.4%vs 85.5%,p ¼0.977),donor twin survival (71.9%vs 77.0%,p ¼0.380),survival of at least one twin (86.5%vs 92.8%,p ¼0.111),and survival of both twins (70.8%vs 69.7%,p ¼0.864).Logistic regression demonstrated no association between laser microseptostomy and recipient twin sur-vival (RR 1.01,95%CI 0.48-2.12)or donor twin survival (RR 1.31,95%CI 0.72-2.37).CONCLUSION:Laser microseptostomy does not have a statistically signi ficant positive or negative impact on recipient twin survival,donor twin survival,the survival of at least one twin,or survival of both twins.These findings can be used to counsel patients and educate providers on the utility of laser microseptostomy in the treatment ofTTTS.Psychosocial background of pregnant women opiate use disorder (OUD)Craig V.Towers,Emily Katz,Emily Liske,Bobby Howard,Lynlee Wolfe,Kimberly FortnerUniversity of T ennessee Medical Center,Knoxville,Knoxville,TNOBJECTIVE:The current management of chronic pain has fueled theOUD epidemic in the United States.OUD has also increased during pregnancy.To our knowledge,the primary initiating events leading to opiate use in pregnancy has not been examined.The study objective was to evaluate the psychosocial background and initiating events leading to OUD in pregnant patients.STUDY DESIGN:We performed a prospective study collecting data on all pregnant women with OUD seen in our designated substance use disorder clinic.Data collection came from intensive interview ses-sions and included drugs used,the age opiates were started,whether other substances were used prior to beginning opioid use,and the background events that preceded the use of opiates.Simple statistics with Poisson binomial 95%CI ’s were performed.RESULTS:From 11/1/2015through 7/15/2016,192pregnant women underwent an intense psychosocial background evaluation that preceded their OUD.The Table shows that the majority (61.5%,95%CI 54-68%)have a history of abuse that is most often sexual (prior to the age of 13in half the cases)and/or involves physical abuse as precipitating events leading to the use of illicit substances.The gateway drug to opiates was found to be THC (marijuana)in nearly half the cases (45%,95%CI 38-52%).Mismanagement of chronic pain occurred in no more than 10%of the cases.CONCLUSION:The precipitating background history for OUD in pregnancy (in the Appalachia region)is primarily due to a history of abuse (mainly sexual and physical)and not the mismanagement of chronic pain.However,the diversion of prescription opiates has led to an availability of these drugs on the street for women to misuse,once they initiate the use of illicit substances (which often began with THC).Further research needs to occur in other areas of the country to see if our findings are consistent with other pregnant OUD populations.For primary prevention to be successful in our region,the focus needs to involve early identi fication of young women who have experienced abuse followed by psychotherapy and/or otherinterventions.Poster Session IVSupplement to JANUARY 2018American Journal of Obstetrics &GynecologyS489Psychosocial background history of 192 pregnant women with OUD Background History Behind use Number (%)95% CI Abuse 118 (61.5)54-68-----Sexual 76 (40)33-47-----Verbal only7 (4)2-7-----Physical violence (excluding sexual)35 (18)13-24Depression/anxiety only 29 (15)10-21Depression/anxiety PTSD 9 (5)2-9Chronic pain 11 (6)3-10Family/peer use25 (13)9-19Initial Drug Used Prior to Opiates THC (marijuana)86 (45)38-52ETOH32 (17)12-23Benzodiazepines 16 (8)5-13Cocaine/amphetamines 15 (8)4-13Opiates at the outset43 (22)17-29Cost-effectiveness of detoxification vs.in pregnancyAlicia S.Willey,Allison R.Walker,David E.Toffey,Aaron B.CaugheyOregon Health &Science University,Portland,OROBJECTIVE:As a result of the opiate epidemic,opiate-dependency inpregnancy is a growing problem,with associated maternal and neonatal complications.Buprenorphine and methadone maintenance therapies are both treatment strategies for women with opioid-dependence during pregnancy.Recent literature supports opioid detoxi fication may be a safe alternative choice for maternal treatment.The purpose of this study is to look at the cost-effectiveness of detoxi fication compared to buprenorphine maintenance.STUDY DESIGN:A decision-analytic model was constructed using TreeAge Pro was constructed for opioid-dependent pregnancy treated witheither detoxi fication from opiates or maintenance therapywith buprenorphine.Probabilities,utilities,and costs were approximated by the existing literature.Prenatal outcomes measured included intrauterine fetal demise (IUFD),neonatal demise (NND),NAS,major neurodevelopmental disorder (MNDD),and preterm delivery (PTD).Maternal outcomes of opioid relapse rate,and quality adjusted life years (QALYs)were also measured.RESULTS:We found that detoxi fication had better neonatal outcomes and was the cost-effective strategy,making it the dominant treatment strategy overall.In a theoretical cohort of 10,000singleton preg-nancies in opiate-dependent women,detoxi fication was associated with 1517fewer incidences of relapse,41fewer perinatal demises,and 3769less neonates with NAS in pregnancy compared to detoxi fication.Detoxi fication was associated with 37more cases of NND,2more cases of neonatal MNDD,and 140additional preterm deliveries.Detoxi fication was cost-effective and remained the dominant strategy up to a $15,640cost of detoxi fication.Patients who were detoxi fied patients saved $4,087per pregnancy.CONCLUSION:Detoxi fication is a cost-effective alternative to bupre-norphine maintenance.It produces improved rates of maternal opioid relapse,IUFD and NAS,but also leads to increased rates ofNND,MNDD and PTD.This study illustrates that detoxi fication should be considered when discussing treatment therapies for the opiate-dependent pregnant patient.Maternal asthma during pregnancy and the future long-term infectious morbidity in the offspringOfer Beharier 1,Asnat Walfisch 1,Tamar Wainstock 2,Irit Szaingurten-Solodkin 2,Eyal Sheiner 11Soroka University Medical Center,Beer-Sheva,Israel,2Ben-Gurion University of the Negev,Beer-Sheva,IsraelOBJECTIVE:Asthma is a common disease featuring immune systemdysfunction.While substantial evidence supports the notion that the atopic tendencies pass throughout generations,the link to other immune disorders is limited.We therefore aimed to assess whether maternal asthma increases the risk for long-term infectious morbidity in the offspring.STUDY DESIGN:In this retrospective population-based cohort study,we compared long-term infectious morbidity in offspring following pregnancies exposed and unexposed to maternal asthma.Deliveries occurred in a single regional tertiary medical center between the years 1991-2014.Congenital malformations and multiple pregnan-cies were excluded from the study.A survival curve and a Cox regression model were used to assess the association and control for confounders.RESULTS:During the study period 242,187deliveries met the in-clusion criteria;1.3%of which were in parturients diagnosed with asthma (n ¼3264).The incidence of infectious related hospitaliza-tions of the offspring was higher among children born to women with asthma,as compared to women without asthma (OR ¼1.5,95%Poster Session IVS490American Journal of Obstetrics &Gynecology Supplement to JANUARY 2018。
常见心身性皮肤病患者焦虑抑郁状态的现况调查
f2020,Od；39（5）：638-42 -638-.论著.常见心身性皮肤病患者焦虑抑郁状态的现况调查张艺丹J张海萍2(1.首都医科大学附属复兴医院皮肤科，北京100045；2.首都医科大学宣武医院皮肤科，北京100053"［摘要］目的：观察某综合医院皮肤科门诊常见心身性皮肤病患者的焦虑、抑郁状态，探讨常见心身性皮肤病与情绪之间的关系，为心身性皮肤病的精神/心理治疗提供依据。
方法：招募北京市某综合医院皮肤科门诊就诊者，记录患者一般状况以及在最近I周存在的皮肤问题，同时对患者的焦虑抑郁情况采用医院焦虑抑郁量表(HADS f进行评估，与国内常模进行比较。
结果：本研究入组646例皮肤科门诊患者，其中男228例，女4I8例，年龄(33.85±II.45f岁。
HADS焦虑评分为(5.I9±3.05f分,HADS抑郁评分为(7.I6±2.91)分，均明显高于国内常模(P<0.05)。
HADS焦虑抑郁评分均>7分的患者共I08例，其中座疮患者57例。
I8例(30-51%)慢性单纯性苔葬患者存在可疑/明显焦虑状态；75例(53-57%f脱发患者存在可疑/明显抑郁状态。
结论:常见心身性皮肤病患者,存在明显焦虑、抑郁状态，且抑郁状态更严重。
其中r疮患者焦虑抑郁共病状态较为常见，慢性单纯性苔x的患者焦虑状态的比例较高，脱发患者抑郁状态的比例较高。
针对难治性复发性心身性皮肤病患者，可采用HADS进行评估并有针对性地进行精神/心理治疗。
&关键词'心身性皮肤病；焦虑；抑郁&中图分类号］R749.72；R749.4；R749.92&文献标识码］A&文章编号］1671-6264(2020)05-0638-05 doi：I0.3969/j.hsn.I67I-6264-2020-05.0I6Assessment of anxiety and depression on patients withcommon psycCosomatic dermatosisZHANG Yidan1，ZHANG Haiping2(1.Depatment*Dermatology，Fuxing Hospital，Capital Medical University，Be—ing100045，China；2.Depatment*Dermatology，Xuanwu Hospital，Capital Medical University，Beijing100053，China f&Abstract］Objective:To obseoe state of anxiety and depression of patients with common psychosomatic dermatosis in a dermSodgy clinic of a yenerai hospital，explore the relationship between common psychosomatic dermatosis and emotions，and provide a basis for the psychoO/dpy of psychosomatic dermatosis.Methods:Patients in the dermSodgy clinic of a yenerai hospital in Beijiny were screened to record the yenerai condition of the patientO yen-/S status，as wel l as the skin problems of the patient at the current week，and the state of anxiety and depressionin patients was assessed by usiny Hospital Anxiety and Depression Scale(HADSf，and which was compared with the domestic norm.Resclts:Thh study enrolled646d/mSohgy outpSOnts，Ticludiny228males and4I8females，aged(33.85±II.45f years.The HADS anxiety score was(5-I9±3.05f poinO and the HADS depression score was(7.I6±2.9I f points，which were significantly higher than the domestic norm(P<0.05f-A totai &收稿日期］2020-4-0&修回日期］2020-09-05&作者简介］张艺丹(I993-),女,北京人，住院医师，医学硕士。
医学考博常用医疗场景词汇
七. 医疗场景词汇1.药品1 medicine 药物2 medication 药物3 non-medicine items 非药品类东西4 natural medicine 天然药品5 antibiotics 抗生素6 capsule 胶囊7 pill 药丸8 sleep pills 安眠药片9 aspirin 阿司匹林10 mixture 合剂11 cough mixture 止咳药12 eyedrops 眼药水13 vitamin 维他命14 ointment 药膏15 syrup 糖浆16 cream 奶油，药膏17 penicillin 盘尼西林18 injection 注射19 injection of vaccine 疫苗注射20 tablet 药片21 herb 草药22 herb tea 草药茶23 drug 药品24 painkillers 止痛片2.各种症状1 sore throat 嗓子痛2 fever 发烧3 cough 咳嗽4 stomachache 胃痛5 headache 头痛6 toothache 牙痛7 allergic 过敏的8 be allergic to sth. 对….过敏9 allergy 过敏10 no allergy 不过敏11 dizzy 头晕12 insomnia 失眠13 sriff neck 脖子发僵14 drowsiness 睡意15 stuffed nose 鼻子不通16 disease 疾病17 tropical diseases 热带病18 medical 医疗的19 medical center 医疗中心20 family medical history 家族病史21 medical science 医学22 symptom 症状3.常见疾病1 flu 流感2 heart disease 心脏病3 pneumonia 肺炎4 yellow fever 黄热病5 epidemic 流行病6 attack 袭击7 heart attack 心脏病8 allergy 过敏9 infection 发炎10 chest infection 胸部发炎11 sleep 睡觉12 sleepy 想睡的13 sleeping 睡眠14 sleeping sickness 嗜睡症15 sleeping pills 安眠药16 drowsiness 嗜睡，睡意17 injury 受伤18 wound 伤，创伤19 chest 胸部20 chest infection 胸部发炎21 teeth 牙齿22 decayed teeth 蛀牙23 sight 视觉24 eyesight 视力25 good eyesight 视力好26 bad eyesight 视力不好27 malaria 疟疾28 disabled 肢体有残疾的4.医生名称1 surgeon 外科医生2 physician 内科医生3 oculist 眼科医生4 dentist 牙医5 vet 兽医6 psychiatric 精神病的7 paychiatrist 精神病学家8 nurse 护士9 patient 病人10 clinic 诊所5.其他必备词汇1 bandage 绷带2 injection注射3 take one's temperature 量体温4 feel one's pulse 量脉搏5 take one's blood pressure 量血压6 give a prescription 开药方7 have an operation 动手术8 make an appointment 预约9 x-ray X射线10 prescribe 开药方11 prescription 药方12 finger 手指13 chin 下巴14 eyesight 眼睛15 nose 鼻子16 mouth 嘴巴17 ear 耳朵18 neck 脖子，颈部19 jaw 颚，下巴20 illness 疾病21 ill 生病的22 vaccine 疫苗23 bacteria 细菌24 scar 伤疤25 male 男性26 internal 内部的27 internal clock 生物钟28 treatment 治疗29 treat 治疗30 stomach 胃，腹部31 stomach muscles training 腹肌练习32 stomach and heart 心脏33 chemist's 药店34 heart 心脏35 heartbeat 心脏跳动36 lung 肺37 recipe 处方38 give sb.recipe 开处方39 therapy 理疗，疗法40 psychotherapy 精神疗法，心理疗法41 recreation therapy 娱乐疗法42 therapist理疗专家43 physical therapy 理疗44 health 健康45 health check 体检46 healthy 健康的47 sick 生病的48 sick note 病假条49 sickness 疾病50 relaxation 放松51 relax 放松52 unhealthy 不健康的53 unhealthy diet 不健康饮食54 beats 跳动的次数55 hospital 医院56 go to hospital 去医院看病57 precaution 预防58 optic光学的59 optic examination 眼部检查60 cycle 循环61 life cycle 生命周期62 mental 精神的63 mental ability 精神能力64 physical 肉体的65 prevention 预防66 ambulance 救护车67 blood 血68 blood flow 血流69 ankle 踝70 germ 细菌71 life cycle 生命周期72 mental 精神的73 mental ability 精神能力74 physical 肉体的75 prevention 预防76 ambulance 救护车77 blood 血78 blood flow 血流79 ankle 踝80 germ [dʒɝm]细菌。