Answer key - BAL Laziobal.lazio.it/wp-content/uploads/2015/11/soluzioni-Text-1-20.pdf · 4. George M. Savva, PhD; Blossom C.M. Stephan, PhD 5. The Alzheimer’s Society Vascular Dementia

TEXT 1

Vocabulary practiceExercise 1.

1. D – incidere su, influire2. C – invecchiamento 3. E – sfondo, premessa 4. A – rispetto a, paragonato a 5. B – calo, diminuzione

Exercise 2.

1. C – raddoppiare 2. D – sforzo 3. B – spiegare 4. E – aumento 5. A – necessario

Exercise 3.

1. D – vecchio 2. B – scopo 3. A – ictus 4. E – sopravvivenza 5. C – senza

Exercise 4.

Noun Verb1 comparison compare2 explanation explain3 increase increase4 indentification identify5 reduction reduce6 survival survive

Exercise 5.

1. come/stop 2. decrease3. less4. young

ReadingExercise 1.

1. Stroke. 2. 20103. Abstract4. George M. Savva, PhD; Blossom C.M. Stephan,

PhD 5. The Alzheimer’s Society Vascular Dementia

Systematic Review Group From theDepartment of Public Health and PrimaryCare, University of Cambridge; Institute ofPublic Health, Cambridge, UK

6. To review studies on the excess risk ofdementia in those with stroke compared withthose without stroke is not well known.

7. A systematic review.8. Original studies: unknown; Systematic review:

probably the UK 9. 16 studies

Comprehension Exercise 1

1. False2. True3. False4. NC5. NC6. True7. True8. True9. True10. False

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Answer key

TEXT 2


1. D – rappresentare 2. A – prevedere 3. E – benefico4. C – seno, mammella5. B – carico, peso

Exercise 2.

1. C – possibilità, occasione 2. D – cambiamento 3. E – decennio4. A – riscontro, rilevamento 5. B – patologia

Exercise 3.

1. C – presto, precoce 2. E – stima3. A – crescere, aumentare 4. B – esito, prognosi 5. D – globale, complessivo

Exercise 4.

1. A – in precedenza 2. D – promuovere, favorire 3. E – tasso, percentuale 4. B – ridurre5. C – notevole

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T H E D O C T O R I S I N

Exercise 5.

Infinitive Past simple Past participle Meaning1. be was/were been essere 2. grow grew grown crescere 3. have had had avere4. make made made fare5. think thought thought pensare 6. can/be able to could been able potere

Exercise 6.

Noun Verb Meaning1. observation observe osservare 2. assumption assume supporre3.detection detect rilevare, riscontrare4. estimate estimate stimare5. explanation explain spiegare6. increase increase aumentare7. introduction introduce introdurre8.prevention prevent prevenire9. screening screen vagliare10. testing test testare11. treatment treat trattare, curare

GrammarExercise 1

1. Past simple2. PPS3. PPS4. PPS5. PPS

Exercise 2

1. L’incidenza di questi tumori aumentò dopol'introduzione dello screening nel 1980.

2. L’incidenza di questi tumori non è mai tornataai livelli pre-screening.

3. Lo screening è stato promosso come il migliormodo per ridurre la morbilità e la mortalitàassociate alla malattia.

4. Due decenni di screening hanno avuto comeesito un aumento significativo del riscontrodei tumori precoci.

5. Testare gli antigeni prostatici specifici haquasi raddoppiato la possibilità che a un uomovenga diagnosticato un tumore della prostatanella sua vita.

Reading Exercise 1.

1. JAMA2. October 21, 2009 3. Abstract4. Laura Esserman, MD, MBA; Yiwey Shieh, AB;Ian Thompson, MD

5. Department of Surgery and Radiology (DrEsserman) and School of Medicine (MrShieh), University of California, SanFrancisco, and Department of Urology,University of Texas Health Science Center,San Antonio (Dr Thompson).CorrespondingAuthor: Laura Esserman, MD, MBA, CarolFranc Buck Cancer Center, University ofCalifornia, San Francisco

6. The early 1990s7. 26% 8. 50% 9. 70% 10. 1 in 6 11. 1 in 11612. 1 in 8 13. 1 in 12

ComprehensionExercise 1.

1. True 2. False3. False4. False5. Not clear

TEXT 3


1.False – rappresentare 2.False – valutare3.True4.False – entrambi 5.False – causale 6.False – morte 7.False – salute 8.False – tuttavia 9.True 10.True 11.True 12.True 13.True14.True15.False – tabagismo

Exercise 2.

1. C – valore iniziale, inizio2. E – sviluppo 3. F – anziano 4. D – nucleo familiare, ambiente domestico 5. G – polmone 6. A – perciò 7. B – attraverso

Exercise 3.

1. passive2. life 3. young 4. male 5. decreased 6. narrow

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Exercise 4.

Noun Verb Meaning1. association associate associare 2. assessment assess valutare3. development develop sviluppare4. enrollment enroll arruolare5. exposure expose esporre 6. predisposition predispose predisporre7. smoking smoke fumare

Syntax practice Exercise 1.

1. Cinquemila donne furono arruolate nellostudio.

2. Fu valutato il rapporto tra il fumo passivo e losviluppo di TB, con correzioni per altrecaratteristiche iniziali (baseline).

3. L’evidenza crescente ha identificato il fumocome fattore causale della tubercolosi (TB).

4. L’esposizione passiva al fumo di tabacconell’ambiente domestico fu associataindipendentemente con BPCO.

5. L’effetto dell’esposizione al fumo passivo sullaTB non è stato chiarito/rivelato/spiegato.

ReadingExercise 1.

1. Archives of Internal Medicine2. February 8, 2010 3. Abstract4. Leung CC, Lam TH, Ho KS, Yew WW, Tam

CM, Chan WM, Law WS, Chan CK, Chang KC,Au KF.

5. Not explicitly stated; probably to study “theeffect of secondhand tobacco smoke exposureon TB”.

6. Not explicity stated; probably a prospectivecohort study

7. 15,486 women 8. never-smokers; aged 65 to 74 years; living

with their surviving husband 9. Elderly Health Centers in Hong Kong


1. True2. Not clear 3. Not clear 4. True5. True

6. True 7. Not clear8. False

TEXT 4


1. assess2. before3. demonstrate4. aim; objective5. increasing

Exercise 2.

1. C – progressi 2. E – concedere 3. D – movimento laterale4. A – chirurgico 5. B – spessore

Exercise 3.

1. E – tempistica 2. B – verso 3. A – sottoporre 4. D – se 5. C – produrre

Exercise 4.

1. bad2. less3. men4. older

Exercise 5.

Noun Verb Meaning1. change change cambiamento2. diagnosis diagnose diagnosi3. evaluation evaluate valutazione4. performance perform esecuzione5. reduction reduce riduzione6. surgery operate chirurgia7. meaning mean significato

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ReadingExercise 1.

1.Radiology2.February 20103.An abstract4.Courtney A. Coursey, MD, Rendon C. Nelson,MD, Mayur B. Patel, MD, Courtney Cochran,BSRT, RDMS, Leslie G. Dodd, MD, David M.DeLong, PhD, Craig A. Beam, PhD and StevenVaslef, MD, PhD;

5.Departments of Radiology (C.A.C., R.C.N.,C.C., D.M.D., C.A.B.), Surgery (M.B.P., S.V.),and Pathology (L.G.D.), Duke UniversityMedical Center, Box 3808, Erwin Road,Durham, NC

6.To determine the frequency of preoperativecomputed tomography (CT) in the evaluationof patients suspected of having appendicitis atone institution during the past 10 years and todetermine whether changes in CT utilizationwere associated with changes in the negativeappendectomy rate.

7.Retrospective study 8. 9259.Patients who underwent urgentappendectomy between January 1998 andSeptember 2007.

10. Patients who were younger than 18 years ofage at the time of surgery.


1. False/Not clear2. Not clear3. True4. True5. Not clear6. Not clear7. Not clear8. True9. False10. True

Just for fun! 1. make a diagnosis 2. do laboratory tests3. make a house call (visita a domicilio)4. make a mistake5. do a CT6. make rounds 7. do an operation

TEXT 5


1. (a) mese2. (a) come3. (a) raccogliere4. (b) attuare5. (b) migliorare6. (a) media7. (b) misura, parametro8. (a) misurazione9. (b) incolumità 10. (b) contesto11. (b) in modo significativo 12. (a) mantenere

Exercise 2.

1.D – raggiungere un obiettivo2.C – sangue; circolo ematico3.B – ampio4.A – cambiamento5.E – mediana6.L – principale7.G – media8.F – esito 9.H – tasso 10. I – chi investe o ha interessi

in un progetto

Exercise 3.

1. (1) to evaluate(2) reductions(3) infections

2. (1) collaborative(2) implement(3) interventions

3. (1) sustainability(2) infection(3) change

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A n s w e r k e y

Exercise 4.

1. verb2. verb3. noun4. adverb/adjective5. noun6. verb7. noun8. adjective9. noun10. adverb

ReadingExercise 1.

1. BMJ2. February 4, 20103. An Abstract4. Peter J Pronovost, Christine A Goeschel,

Elizabeth Colantuoni, Sam Watson, Lisa HLubomski, assistant professor 1, Sean MBerenholtz, David A Thompson, David JSinopoli, Sara Cosgrove, J Bryan Sexton, Jill AMarsteller, Robert C Hyzy, Robert Welsh,Patricia Posa, Kathy Schumacher, DaleNeedham.

5. Department of Anesthesiology and CriticalCare Medicine, Johns Hopkins University,USA; Michigan Health and HospitalAssociation Keystone Center, Lansing, MI48917, USA; Carey Business School, JohnsHopkins University, Baltimore, MD USA,

Division of Infectious Diseases, Baltimore, MDUSA; Department of Health Policy andManagement, Baltimore, MD USA;Department of Internal Medicine, Division ofPulmonary and Critical Care Medicine,University of Michigan, Ann Arbor, MI, USA;Thoracic Surgery, William Beaumont Hospital,Royal Oak, MI, USA; St Joseph Mercy HealthSystem, Ann Arbor, MI, USA; WilliamBeaumont Hospital, 10 Division of Pulmonaryand Critical Care Medicine, Baltimore, MD,USA.

6. To evaluate the extent to which intensive careunits participating in the initial Keystone ICUproject sustained reductions in rates ofcatheter related bloodstream infections.

7. Collaborative cohort study 8. 90 ICUs9. Quarterly rate of catheter related bloodstream

infections per 1000 catheter days during thesustainability period (19-36 months afterimplementation of the intervention.


1. False2. Not clear3. True4. True5. False6. True7. True

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Exercise 2.

Baseline 16-18 months 34-36 monthsInfection ratesMean 7.7 1.3 1.1Median 2.7 0 0Range 0.6-4.8 0-2.4 0.0-1.2Incidence rate ratio 0.68 0.38 0.34Range 0.53-0.88 0.26-0.56 0.24-0.48

TEXT 6

Vocabulary review – Texts 1-5Exercise 1.

1. A – assess2. D – collects3. C – detected

4. D – enrollment5. B – evaluated6. D – improvement 7. C – implementation 8. D – measured9. B – performed10. A – reduction

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Exercise 2.

Infinitive Past simple Past participle Meaning1. be was/were been essere 2. come came come venire3. do did done fare4. drink drank drunk bere5. eat ate eaten mangiare6. find found found trovare7. go went gone andare8. grow grew grown crescere9.have had had avere10.know knew known sapere, conoscere11.make made made fare12.put put put mettere, posare13. read read read leggere14. think thought thought pensare15.understand understood understood capire, comprendere16.write wrote written scrivere

Exercise 3.

1. expect2. start3. illness 4. old 5. primary6. result7. demonstrate8. aim9. context 10. female

Exercise 4.

1. False – portare a termine, conseguire2. False – influire, colpire 3. False – come 4. True 5. False – peso, carico 6. False – sviluppare

Exercise 5.

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

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

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

2 REDUCES the frequency of reactivation ofHSV-2 as well as HIV-1 levels, suggesting thatsuppression of HSV-2 MAY reduce the risk oftransmission of HIV-1. Methods We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2(acyclovir at a dose of 400 mg orally twice daily)in couples in which only one of the partners wasseropositive for HIV-1 (CD4 count, 250 cells percubic millimeter) and that partner was alsoinfected with HSV-2 and was not takingantiretroviral therapy at the time ofENROLLMENT The primary end point wastransmission of HIV-1 to the partner who was notinitially infected with HIV-1; linkage oftransmissions was assessed by means of geneticsequencing of viruses. Results A total of 3408 couples were enrolled at14 sites in Africa. Of the partners who wereinfected with HIV-1, 68% were WOMEN and thebaseline MEDIAN CD4 count was 462 cells percubic millimeter. Of 132 HIV-1 seroconversionsthat occurred after randomization (an incidenceof 2.7 per 100 person-years), 84 were linkedwithin couples by viral sequencing: 41 in theacyclovir group and 43 in the placebo group(hazard ratio with acyclovir, 0.92, 95% confidenceinterval [CI], 0.60 to 1.41; P=0.69). Suppressionwith acyclovir reduced the mean plasmaconcentration of HIV-1 by 0.25 log10 copies permilliliter (95% CI, 0.22 to 0.29; P<0.001) and theoccurrence of HSV-2–positive genital ulcers by73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36;P<0.001). A total of 92% of the partners infectedwith HIV-1 and 84% of the partners not infectedwith HIV-1 remained in the study for 24MONTHS The level of adherence to thedispensed study drug was 96%. No seriousadverse events related to acyclovir wereobserved. Conclusions Daily acyclovir therapy did notreduce the risk of transmission of HIV-1,DESPITE a reduction in plasma HIV-1 RNA of0.25 log10 copies per milliliter and a 73%reduction in the occurrence of genital ulcers dueto HSV-2.

(ClinicalTrials.gov number, NCT00194519 [ClinicalTri-als.gov]

Exercise 6.

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

Exercise 7.

kidney Reneinjury Lesionerelies on Basarsi underlying Sottostanterecover Ristabilirsidisorder Disturbohowever Tuttavia still Tuttora further Ulteriore reliable Affidabile, attendibile

Crossword

Acrossearly – precoce good – buono therefore – perciò through – attraverso should – dovrebbe sustain – mantenere women – donne without – senza increasing – crescente health – salute long – lungo grant – concedere treat – curare timing – tempistica diagnose – diagnosticare overall – complessivamente

Down1. lung – polmone 2. undergo – sottoporre 4. survive – sopravvivere 5. shift – spostamento laterale7. safety – incolumità 8. surgery – chirurgia9. causal – causale 10. grow – crescere 12. findings – dati preliminari14. compared to – rispetto a 16. prior to – in precedenza 18. yield – produrre 19. wide – ampio 26. leave – partire 27. female – femmina29. stroke – ictus

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Tips and strategies for learning vocabularyExercise 1.

1. shoulder girdle2. myopia, near-sightedness 3. blood 4. chart5. detect6. surgery7. bladder8. blood pressure9. finding10. outcome11. delivery12. skin13. spread 14. undergo15. joint

Exercise 2.

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

TEXT 7


1. C – riconoscimento; ringraziamenti 2. D – indirizzo 3. E – premio 4. B – tra 5. A – in cieco

Exercise 2.

1. E – rivelare, dichiarare 2. A – redigere, abbozzare 3. C – competenza “da esperto” 4. B – probabilità 5. D – fondi, finanziamento, sovvenzione

Exercise 3.

1. C – principale; grave, serio 2. B – raggruppati, considerati insieme 3. E – ristampa 4. A – fonte 5. D – sorveglianza

Exercise 4.

1. C – ringraziare 2. D – sotto 3. E – bene 4. A – diffusamente, comunemente 5. B – entro

Exercise 5.

1. death2. evaluate 3. outcome4. perform5. surgery

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A n s w e r k e y

ReadingExercise 1.

1. Annals of Internal Medicine2. January 5, 20103. An Abstract4. ‘What is a systematic review?’ (see pp. 171-173)5. Meredith K. Ford, MD, MSc; W. Scott Beattie,MD, PhD; and Duminda N. Wijeysundera, MD.

6. MEDLINE, EMBASE, and ISI Web of Science(1966 to 31 December 2008).

7. Cohort studies that reported the associationof the RCRI with major cardiac complications(cardiac death, myocardial infarction, andnonfatal cardiac arrest) or death in thehospital or within 30 days of surgery.

8. 18

9. None10. None disclosed 11. M.K. Ford, W.S. Beattie, D.N. Wijeysundera. 12. D.N. Wijeysundera.13. W.S. Beattie, D.N. Wijeysundera.14. M.K. Ford, W.S. Beattie, D.N. Wijeysundera.

Comprehension

Exercise 1.

1. False2. Not clear3. True4. True 5. False

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Exercise 2.

RCRI PREDICTION OF CARDIAC EVENTS

After mixed noncardiacsurgery high vs low risk pts.

C.I.After vascularnoncardiac surgery high vs low risk pts.

C.I.

AUC curve 0.75 0.72-0.79 0.64 0.61-0.66

Sensitivity 0.65 0.46-0.81 0.70 0.53-0.82

Specificity 0.76 0.58-0.88 0.55 0.45-0.66

Positive likelihoodratio 2.78 1.74-4.45 1.56 1.42-1.73

Negative likelihoodratio 0.45 0.31-0.67 0.55 0.40-0.76

TEXT 8


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

Exercise 2.

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

Exercise 3.

Noun Verb1. confirmation confirm 2. detection detect3. diagnosis diagnose 4. document; documentdocumentation

5.duration last6. incubation incubate7. infection infect8. observation observe9. occurrence occur10. treatment treat

Syntax practice1. Le caratteristiche cliniche della patologia2. I sintomi più comuni 3. Pandemia del 2009 da virus dell’influenza A

(H1N1)4. I risultati positivi al test “real-time RT-PCR” 5. L’istituto di medicina respiratoria di Beijing 6. Il centro clinico della salute pubblica di

Shanghai 7. Il centro cinese per il controllo e la

prevenzione delle malattie

Reading1.NEJM2. December 24, 2009 3. Bin Cao, M.D., Xing-Wang Li, M.D., Yu Mao,M.D., Jian Wang, M.D., Hong-Zhou Lu, M.D.,Yu-Sheng Chen, M.D., Zong-An Liang, M.D.,Lirong Liang, M.D., Su-Juan Zhang, M.D., BinZhang, M.D., Li Gu, M.D., Lian-He Lu, M.D.,Da-Yan Wang, Ph.D., Chen Wang, M.D., for

4. the National Influenza A Pandemic (H1N1)2009 Clinical Investigation Group of China

5. An Abstract6. ?7. 4268. Real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) testing

9. 2 days, range 1-7 10. 3: an age of less than 14 years, male sex, and

a delay from the onset of symptoms totreatment with oseltamivir of more than 48hours

NotesTotal n. patients observed 426Percentage females 46.2%Average incubation period 2 daysPercentage of pts with fever 67.4%Percentage of pts with cough 69.5%Incidence of nausea 1.9%Percentage of pts withlymphopenia 68.1%… which resolved by day ___ 7 (6-9)Percentage of adult pts with hypokalemia 25.4%Duration of fever 3 days

(1-11)

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A n s w e r k e y


1. True2. False3. Not clear4. True5. True6. False7. True8. Not clear9. True10. False/not clear

Just for fun! 1. E - dolente 2. B – con vertigini 3. D – sentirsi mancare 4. A – sudato 5. C – debole, fiacco

1. E – tosse grassa 2. C – naso che cola 3. D – mal di testa 4. A – mal di gola 5. B – mal d’orecchio

TEXT 9


1. B – monitorare 2. D – durata 3. E – degenza 4. A – diversi 5. C – sempre più

1. C – poco 2. D – valutare 3. E – disegno 4. A – contesto 5. B – grande, ampio 1. E – malattia 2. A – principale 3. C – esito 4. B – parametro 5. D – solo

1. B – minaccioso 2. C – tasso 3. E – diminuire 4. A – globale, complessivo 5. D – miglioramento

Exercise 2.

1. True2. False – malato3. False – meno4. False – peggio 5. True 6. False – sopravvissuto

Exercise 3.

Noun Verb Adjective1 length lengthen long2 stay stay XXX3 assessment assess XXX4 setting set XXX5 illness XXX ill6 measure; measure XXX

measurement7 threat threaten threatening8 decrease decrease XXX9 improvement improve XXX

Syntax

Exercise 1.

1. pazienti in terapia intensiva 2. tecnologia della telemedicina 3. un grande sistema (centro) sanitario

statunitense 4. medici locali5. eventi che minacciano la vita 6. piena autorità per il trattamento 7. tassi osservati di mortalità ospedaliera

Exercise 2.

1. Association of Telemedicine for RemoteMonitoring of Intensive Care Patients WithMortality, Complications, and Length of Stay

2. Observational study conducted in 6 ICUs of 5hospitals in a large US health care system toassess the use of tele-ICU.

3. Local physicians delegated full treatmentauthority to the tele-ICU for 655 patients(31.1%) and authority to intervene only inlife-threatening events for the remainder.

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4. There were no significant differences betweenthe preintervention and postinterventionperiods for hospital or ICU LOS.

Exercise 3.

1. Associazione della telemedicina per ilmonitoraggio a distanza dei pazienti in terapiaintensiva con mortalità, complicanze e duratadi degenza.

2. Studio osservazionale svolto in 6 unità diterapia intensiva di 5 ospedali in un grandesistema (centro) sanitario statunitense pervalutare l’uso della tele-ICU (ICU a distanza)

3. I medici locali (di base) delegarono alla tele-ICU la piena autorità per il trattamento dei(loro) 655 pazienti (31.1%) e l’autorità diintervenire solo nel caso di eventi cheminacciavano la vita dei restanti.

4. Non ci furono differenze significative trail periodo pre-intervento e quello post-intervento per la durata della degenzaospedaliera o nell’unità di terapia intensiva.

Reading

1. JAMA2. December 23-30, 20093. Eric J. Thomas, MD, MPH; Joseph F. Lucke,

PhD; Laura Wueste, RN; Lisa Weavind, MD;Bela Patel, MD

4. Departments of Internal Medicine andPediatrics, School of Medicine, University ofTexas Health Science Center at Houston;University of Texas at Houston–MemorialHermann Center for Healthcare Quality andSafety

5. Texas? USA6. An Abstract7. 2034 patients in the preintervention period

(January 2003 to August 2005) and 2108patients in the postintervention period (July2004 to July 2006)

8. To assess the association of remotemonitoring of ICU patients (ICU telemedicine[tele-ICU]) with mortality, complications, andlength of stay (LOS).

9. pre- + post-intervention = 2003-200610. Hospital and ICU mortality, complications,

and hospital and ICU survivors’ LOS, withoutcomes adjusted for severity of illness


1. False2. True3. Not clear4. False5. True6. True7. True

TEXT 10

1. Questo numero sarà disponibile online il 22febbraio 2010

2. Diminuire i costi ospedalieri mantenendo laqualità: si può fare?

3. Progettare/costruire la salute nelle unità diterapia intensiva

4. L’effetto di (un programma di) allenamentofisico sui sintomi dell’ansia nei pazienti: unarevisione sistematica

5. Pneumotorace in seguito a toracentesi:revisione sistematica e meta-analisi

6. Il costo all’ospedale dell’assistenza,assistenza/cure di qualità e tassi di rientroospedaliero: oculati nelle piccole spese esciocchi in quelle grandi?

7. Esiti clinici ed economici attribuibili alla sepsie alla polmonite associate all’assistenzaospedaliera

8. Ridurre i danni evitabili: commento.9. La portata e il target dei promemoria per la

vaccinazione anti-influenzale tra gli adultistatunitensi: l’evidenza proveniente daun’indagine nazionale rappresentativa

10. Migliorare l’avviso ai fornitori di assistenzasanitaria: un sistema di alert (avvisi) acascata.

11. Co-gestione di pazienti anziani ricoverati inospedale per la frattura dell’anca

12. In replica

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A n s w e r k e y

TEXT 11


Synonym Italian1 aim objective obiettivo 2 allow let permettere3 main primary principale4 much a lot molto5 physician doctor medico6 setting context contesto

Exercise 2.

1. B – richiesta 2. E – tratto da 3. A – far rispettare 4. D – accrescere 5. C – quadro, schema

Exercise 3.

1. B – finanziamenti 2. E – non conforme 3. C – dirigente 4. D – panoramica 5. A – commissione, gruppo

Exercise 4.

1. E – politica, linea di condotta 2. D – fornitore 3. B – dirigente pubblico 4. A – campione 5. C – offerta, fornitura

Exercise 5.

1. although2. although 3. while4. although5. although

Exercise 6.

1. Correct 2. Correct 3. Incorrect


1. Not Clear2. Not clear3. True4. True5. True/Not clear

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Exercise 2.

CME SYSTEMS IN 6 EUROPEAN COUNTRIES

Austria Belgium France Italy Norway UK

Compulsory CME √ No √ √ No √

Sanctions No No No No No No

Benefits No √ No No √ No

Accreditation of activities No √ No No √ √

Accreditation of CME providers √ No √ √ No No

Private funding and sponsorship √ √ √ √ No √

Exercise 3.

1. Type of healthcare service, i.e., public orprivate? The laws governing the medicalprofession?

2. Financial support by, for example,pharmaceutical companies?

Just for fun!1. English2. Dutch and French3. French4. Italian5. German6. German

TEXT 12

Vocabulary review – Texts 1-11

Exercise 2.

1. A – despite 2. B – although 3. B – despite4. C – like 5. A – however 6. D - although

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A n s w e r k e y

Exercise 1.

Verb Meaning Noun1 Administer somministrare administration 2 assess valutare assessment3 collect raccogliere collection4 compare confrontare comparison5 delay ritardare delay6 detect rilevare, riscontrare detection7 develop sviluppare development8 enhance accrescere enhancement9 estimate stimare estimate10 evaluate valutare evaluation11 explain spiegare explanation12 find trovare finding13 grow crescere; aumentare growth14 implement attuare implementation15 improve migliorare improvement16 manage gestire management17 perform eseguire performance18 provide fornire provision/provider

Exercise 3.

Infinitive Past simple Past participle Meaning1 be was/were been essere 2 come came come venire3 do did done fare4 find found found trovare5 go went gone andare6 grow grew grown crescere, aumentare7 have had had avere8 know knew known conoscere, sapere9 make made made fare10 put put put posare, mettere11 show showed showed/shown mostrare12 undergo underwent undergone sottoporre

Exercise 4.

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

Single dose antibiotics for treating uncom-plicated urinary tract infection in non-pregnant womenJun Li Zhao 2, Jian Qin Wang 2, Lin Zhao 2, Zhi Ping Wang1, Jing Yu Wang 2, Jun Zhang 2

1 Institute of Urology, The Second Hospital of LanzhouUniversity, Lanzhou, China. 2 The Second Hospital ofLanzhou University,Lanzhou, China.Contact address: ZhiPingWang, Institute of Urology, The SecondHospital ofLanzhou University, 80 Cui Ying Meng Street, Lanzhou,Gan Su, 730000, China. [email protected].

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

BackgroundDescription of the conditionUrinary tract INFECTION (UTI) is a verycommon infection and it is ESTIMATED 25% to50%% of all women experience a UTI at somepoint in their lifetime (Naber 2001;Williams1996). These infections ACCOUNT FOR morethan eight million women annually in the UnitedStates (Kunin 1994; Patton 1991), andapproximately 25% of all UTIs recur WITHIN sixmonths (Nicolle 2003). Reported UTIs incidencesare 15% and 10% per person-years in those aged15-39 and 40-79 years, respectively (Guay 2008).The annual HEALTH care expenditures in theMANAGEMENT of UTIs exceed US$1 billion(Faro 1998).Uncomplicated UTIs are one of the mostCOMMON clinical syndromes that occur in anotherwise healthy, non-pregnant, adult womanwith no KNOWN anatomical or functionalabnormalities of the urinary tract (Foxman 2003).They are the most common infectious DISEASEaffecting young and sexually active women.Patients usually present with dysuria, urinaryfrequency, urinary urgency, and/or suprapubicpain (Mehnert-Kay 2005). In contrast, patientspresenting with high fever, flank PAIN and/ortenderness of the costovertebral angle whichindicate upper urinary tract involvement and areclassified as complicated UTIs (Tice 1999).

Exercise 5.

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

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

Context Adolescent obesity is a COMMON andserious health problem AFFECTING more than5 million young people in the United States alone.Bariatric surgery is being EVALUATED as apossible treatment option. Laparoscopicadjustable gastric banding (gastric banding) hasthe potential to PROVIDE a safe and effectivetreatment. Objective To COMPARE the OUTCOMES ofgastric banding with an optimal lifestyle programon adolescent obesity. …Conclusions AMONG obese adolescentparticipants, use of gastric banding comparedwith lifestyle intervention resulted in a greaterpercentage ACHIEVING a loss of 50% of excessWEIGHT corrected for age. There wereassociated benefits to health and quality of LIFE

Trial Registration ANZCTR Identifier:12605000160639

142


Exercise 6.

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

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

Background Anxiety often remainsunrecognized or untreated among patients with achronic ILLNESS. Exercise training MAY helpimprove anxiety symptoms among patients. WeESTIMATED the population effect size forexercise training effects on anxiety anddetermined WHETHER selected variables oftheoretical or practical importance moderate theeffect. …Results COMPARED WITH no treatmentconditions, exercise training significantly reducedanxiety symptoms by a mean effect of 0.29 (95%confidence interval, 0.23-0.36). Exercise trainingprograms lasting no more than 12 weeks, usingsession durations of at least 30 minutes, and ananxiety report time frame greater than the pastweek resulted in the largest anxietyIMPROVEMENTS. Conclusion Exercise training reduces anxietysymptoms among sedentary patients who have achronic illness.

Author Affiliations: Department of Kinesiology, The Uni-versity of Georgia, Athens.

© 2010 American Medical Association. All Rights Re-served.

Exercise 7.

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

Long-term effects of preventive cognitivetherapy in recurrent depression: a 5.5-year follow-up study.Bockting CL, Spinhoven P, Wouters LF, Koeter MW, Sch-ene AH; for the DELTA Study Group.Faculty of Social andBehavioral Sciences, Department of Clinical Psychology,University of Groningen, Grote Kruisstraat 2/1, 9712 TSGroningen, The Netherlands. [email protected].

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

cognitive therapy (CT) in preventingrelapse/recurrence in recurrent depression arenot known. This article reports on the long-term(5.5-year) OUTCOME of a randomizedcontrolled trial to prevent relapse/recurrence inpatients with recurrent depression. Wespecifically EVALUATED the long-term effectsof CT in relation to the number of previousepisodes experienced. CONCLUSIONS: Our FINDINGS indicate thatbrief CT, started after remission from adepressive episode on diverse types of treatmentin patients with multiple prior episodes, has long-term preventive effects for at least 5.5 years.IMPLEMENTATION of brief relapseprevention CT should be considered in thecontinued CARE of patients with recurrentdepression.

TRIAL REGISTRATION: ccmo-online.nl Identifier:NTR454.

© Copyright 2009 Physicians Postgraduate Press, Inc.

Exercise 8.

1. C – attentamente2. E – tosse 3. D – decennio 4. A – domanda, pretesa 5. B – vertigini

Exercise 9.

1. E – febbre 2. D – mal di testa 3. A – nucleo familiare; ambito domestico 4. C – meno 5. B – media

Exercise 10. As above.

1. D – linea di condotta 2. B – prima, in precedenza 3. E – scopo 4. C – restante5. A – incolumità

143

A n s w e r k e y

Crossword Across1. contesto – setting2. ricoverare – admit6. precoce – early8. prevedere – anticipate14. attuare – implement16. patologia – disease17. raccolta – collection19. sottoporre – undergo21. sviluppo – development22. valutare – assess25. rilevare – detect26. accrescere – enhance32. ampio – broad33. morte – death34. dato preliminare – finding36. perciò – therefore37. sangue – blood

Down1. colpire – affect3. caratteristica – feature4. valore iniziale – baseline5. peggio – worse7. cambiamento – change9. esito – outcome10. migliorare – improve11. associare – associate12. curare – treat13. anziano – elderly15. sfondo – background16. probabilità – likelihood18. sforzo – effort20. rispetto a – compared to23. malato – sick24. fornire – provide27. eseguire – perform28. complessivo – overall29. lieve – mild30. campione – sample31. ritardo – delay35. tasso – rate

TEXT 13

Vocabulary and syntax practice

Exercise 1.

1. increase

2. key

3. findings

4. should

5. need

6. manage

7. less

8. compare

9. practice

10. research

11. resources

12. health

13. although

14. support

15. develop

16. trend

17. assess

Exercise 5.

Valutare i bisogni professionali di formazionedegli educatori della salute pubblica alla luce delcambiamento delle competenze

Exercise 6.

1. Una forza lavoro/personale della salutepubblica ben addestrata/ben formata

2. Progetto nazionale per l’aggiornamento dellecompetenze degli educatori alla salute

3. Bisogni formativi auto-identificati/soggettivi

4. Sostegno del datore di lavoro

5. Laureati con un Master in salute pubblicadell’università statale (pubblica) San JoseState

6. Un’indagine svolta sul Web

7. Competenze pratiche sul sostegno allepolitiche

8. Un approccio alle problematiche inerenti allasalute che dura per tutta la vita

9. I bisogni formativi dei professionisti che sioccupano dell’educazione alla salute

144


ReadingExercise 1.

1. Preventing Chronic Diseases2. October 5, 2008 3. Demers AR, Mamary E. 4. The USA5. This study compared the self-identifiedtraining needs of public health educators withthe updated competencies and assessedemployer support for continuing education.

6. A convenience sample of public healtheducators

7. a Web-based survey 8. organization development, evaluation, andmanagement

9. emerging themes (organization development,evaluation, and management)


• Probably professors in medical schools orteachers of continuing medical education;their students are probably medical studentsor practicing healthcare professionals,particularly in public health.

• “Public Health education” probably refers touniversity or post-graduate programs in publichealth. The learners are probably healthcareprofessionals who work or will work in publichealth.

• It’s not clear from the abstract what resourcesare being referred to. Possibly teachingfacilities? Possibly external experts orteachers?

• “Policy advocacy skills” are probably thoseskills needed to propose, support, implement,and/or defend a healthcare policy, for examplefor the poor or the disabled or some chronic

illness. The abstract does not give enoughinformation.

• Probably the Internet, online training courses,and other computer-based teaching/learningoptions.

• It probably refers to the patient’s lifespan butthis isn’t clear. It may refer to the healthcareprofessional’s professional career or “lifespan”.It probably means that a long-term approachor vision should be implemented.

• Probably university medical students orpracticing healthcare professionals are thestudents referred to in the text.

TEXT 14

Vocabulary practice

Exercise 1.

1. obiettivo2. tra3. premessa, sfondo4. iniziare5. dati6. presto, precoce7. salute8. aumentato 9. meno10. vita11. probabile12. più 13. necessitare 14. esito, prognosi15. riportare, riferire16. campione

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A n s w e r k e y

Exercise 2.

If Then

infanzia childhood età adulta adulthood

salute health sano healthy

obesità obesity obeso obese

meridionale southern meridione south

Exercise 3.

1. bad2. high3. underweight4. absence

Exercise 4.

1. start2. sex

Exercise 6.

Disuguaglianze sanitarie sociali tra adolescenti inuna grande città dell’Europa meridionale.

Exercise 7.

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

Reading

Exercise 1.

1. J. Epidemiology of Community Health2. Online December 8, 20093. Talita Duarte-Salles, M. Isabel Pasarin, Carme

Borrell, Maica Rodriguez-Sanz, Lluis Rajmil,Montse Ferrer, Ferran Pellise, FedericoBalague.

4. Center for Research in EnvironmentalEpidemiology, Spain; Agencia de SalutPublica de Barcelona, Spain; Agenciad’Avaluacio de Tecnologia i Recerca Mediques,Spain; Hospital Universitari de la Valld’Hebron, Spain; Hopital Cantonal, Fribourg,Switzerland.

5. Barcellona, Spain6. To describe social inequalities in obesity and

other health problems among adolescents bysex.

7. 903 adolescents aged 12-16 years old. 8. Generalized Estimating Equation (GEE)

models.

Comprehension

Exercise 1.

4. Correct5. Correct6. Correct

Just for funI. Nouns1. peso 2. altezza3. lunghezza4. profondità5. ampiezza

II. Word groups1. peso2. pesante3. leggero4. pesare

1. alto2. basso3. alzare

1. lungo2. corto3. allungare

1. profondo2. poco profondo3. approfondire

1. largo, ampio2. stretto3. allargare4. restringere

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TEXT 15

Vocabulary practice

Exercise 1.

1. ad esempio2. sebbene3. poiché4. tuttavia5. ad esempio6. perciò

Exercise 2.

1. False: braccio2. False: almeno 3. True4. False: entrambi5. True6. True7. False: efficace8. True9. False: attuazione10. False: migliorare11. False: vita12. True13. True14. False: esito15. False: risposta 16. True

Syntax practice

Exercise 1.

1. Intervento educativo/formativo2. Interventi basati sull’evidenza3. Reti di assistenza sanitaria per la famiglia

(di base)4. Contesto delle cure primarie5. Un trial pragmatico randomizzato a “cluster”

(grappolo) 6. Un riconoscimento e una risposta

precoci/anticipati 7. La strategia nazionale per la demenza8. Un sistema computerizzato in supporto alle

decisioni e laboratori formativi basati sullapratica/attività professionale

9. Due revisioni specifiche sulla gestione dellademenza

Exercise 2.

Interventi sulla demenza basati sull’evidenza: untrial randomizzato pragmatico a grappolo di unintervento formativo per promuovere unriconoscimento e una risposta precoci allademenza nelle cure primarie (EVIDEM-ED)

ReadingExercise 1.

1.Trials.2.A journal that is free to readers. 3. 2010.4. Steve Iliffe, Jane Wilcock, Mark Griffin, PriyaJain, Ingela Thuné-Boyle, Tamar Koch andFrances Lefford.

5.Research Department of Primary Care andPopulation Health, University College London,Royal Free Campus, UK.

6.A pragmatic cluster-randomised trial. 7.The UK. 8.There is evidence that dementia remainsunder-detected and sub-optimally managed ingeneral practice.

9. To test a customised educational interventiondeveloped for general practice, promotingboth earlier diagnosis and concordance withmanagement guidelines.

10. Twenty primary care practices have beenrecruited with the aim of gaining 200 patientparticipants.

11. An increase in the proportion of patients withdementia who receive at least two dementia-specific management reviews per year.

147

A n s w e r k e y

TEXT 16

Exercise 2.

BACKGROUND: Vitamin D is PRODUCED inthe skin after sunlight EXPOSURE and can alsobe obtained through food. Vitamin D deficiencyhas recently been linked with a RANGE ofdiseases including CHRONIC pain.Observational and circumstantial evidenceSUGGESTS that there may be a role for vitaminD deficiency in the AETIOLOGY of chronic painconditions.

Exercise 3.

OBJECTIVES: To ASSESS the efficacy andadverse EVENTS of vitamin D supplementationin chronic painful conditions.

Exercise 4.

MAIN RESULTS: Four studies, with a total of 294PARTICIPANTS were included. The studieswere heterogeneous with regard to study quality,the chronic painful conditions that wereinvestigated, and the OUTCOME measuresreported. Only one study reported a beneficialeffect, the others FOUND no benefit of vitaminD over placebo in TREATING chronic pain.

Just for fun!

Exercise 5.

AUTHORS’ CONCLUSIONS: The evidence BASEfor the use of vitamin D for chronic pain inADULTS is poor at present. This is due to LOWquality and INSUFFICIENT randomisedcontrolled trials in this area of RESEARCH

ReadingExercise 1.

1. Cochrane Database Systematic Review2. What is a “systematic review”? (Consult pp.

171-173 of this textbook.)3. Department of Occupational and Social

Medicine, University of Göttingen, Germany 4. Observational and circumstantial evidence

suggests that there may be a role for vitaminD deficiency in the aetiology of chronic painconditions.

5. To assess the efficacy and adverse events ofvitamin D supplementation in chronic painfulconditions.

6. Studies were included if they wererandomised double blind trials of vitamin Dsupplementation compared with placebo orwith active comparators for the treatment ofchronic pain conditions in adults.

7. Four studies, with a total of 294 participants.

148


1. beverage: bevande coffee water2. dairy products: latticini cheese milk3. grains: cereali wheat maize 4. meal: pasto breakfast lunch5. poultry: pollame chicken duck6. produce: ortaggi lettuce carrots7. seafood: pesce e frutti di mare fish squid8. shellfish: molluschi oysters clams

TEXT 17


1. False – in cieco, cieco2. True

3. False – dati 4. True 5. True6. False – dolore 7. False – medico clinico 8. True

149

A n s w e r k e y

Exercise 2.

Verb Noun Adjective Meaning1 assess assessment assessed (pp) valutare 2 collect collection collected raccogliere3 delay delay delayed ritardare4 find findings XXX trovare5 improve improvement improved migliorare6 manage management managed gestire7 need need needed necessitare, richiedere8 show XXX (show) shown mostrare, dimostrare9 operate surgery surgical operare (chirurgia)10 update update updated, up-to-date aggiornare

Exercise 3.

1. sebbene 2. perfino 3. tuttavia4. tuttora5. perciò6. se

Syntax practiceExercise 1.

1. Questo è un tema importante per la gestionedel dolore post-operatorio.

2. Gli autori hanno indagato gli effettidell’approcio farmacologico multi-modale nellaprima fase post-operatoria e hanno rilevatoche sembra accelerare la fase riabilitativa.

3. Sono necessarie ulteriori ricerche sul controllomulti-modale aggressivo e precoce del dolorein pazienti post-operatori.

ReadingExercise 1.

1. Anesthesia and Analgesia2. (Consult pp. 171-173 of this textbook for

information on study designs)3. Osteoarthritis of the hip 4. 6/75. 6/7

6.The Department of Anesthesiology andSurgical Critical Care of Trousseau Hospital,Logipole of Trousseau Hospital, Department ofOrthopedic Surgery and Traumatology,Department of Anesthesiology and SurgicalIntensive Care of Bretonneau Hospital,University of François Rabelais, CHRU Tours,Tours, France

7.Ketamine has been shown to have amorphine-sparing effect soon after surgery.Nevertheless, whether this effect still existsafter being combined with nonsteroidalantiinflammatory drugs and acetaminophen,and whether ketamine can decrease chronicpain after nononcologic surgery remainunclear.

8. To assess ketamine‘s effect on acute andchronic postoperative pain when combinedwith multimodal analgesia after total hiparthroplasty (THA).

9. Patients scheduled for primary nononcologicTHA using standardized general anesthesia

10. placebo, 75; ketamine, 7911. They received IV ketamine before incision

(0.5 mg/kg), and a 24-h infusion (2 microg xkg(-1) x min(-1)) or a similar blinded salinebolus and infusion. Postoperative analgesiaincluded IV acetaminophen, ketoprofen, plusmorphine/droperidol patient-controlledanalgesia for 48 h.

12. 24-h morphine consumption.


Anesthesiologia1. Questo studio è interessante in quanto la

diminuzione nell’uso di morfina, sebbenestatisticamente significativa, non sorprende eclinicamente la differenza non è così grande(19±12 mg nel gruppo placebo rispetto a14±13 mg nel gruppo in studio).

2. Ciò che sorprende è il beneficioapparentemente conferito a 1, 3 e 6 mesi nelpostoperatorio per la riduzione del dolore nelgruppo trattato con ketamina.

Medicina fisica e riabilitativa

1. Poiché sta diventando sempre più difficileottenere la ketamina in Francia la rilevanza diquesto studio potrebbe essere ridimensionata.

Interesse speciale – Dolore – Clinico

1. Uno studio ben disegnato il cui datopreliminare più interessante è un esitosecondario relativo all’incidenza del dolorecronico.

2. Sarebbe utile uno studio di follow updisegnato specificatamente per confermarequesti dati preliminari.

150


TEXT 18

Vocabulary review Exercise 1.

1. False – interessare, colpire2. False – rappresentare 3. True4. True5. True6. False – che invecchia 7. True8. True9. False – sangue 10. True11. False – cambiamento 12. False – infanzia 13. True14. True15. True16. True17. False – personalizzato 18. True19. True (insufficienza)20. False – profondità

Exercise 2.

ketamine placebo

morphine consumption at 24h 14±13 mg 19±12 mg(p = 0.004)

day 30 – crutches or walking frame 31% (p = 0.0035) ? 56%?

day 30-180 – no. of patients with pain at rest ? (p0 0.008) ?

day 180 – no. of patients with pain at rest 8% 21%

21. False – diagnosticare 22. True23. False – raddoppiare 24. True 25. True 26. True 27. True28. False – spesa 29. True 30. False – pieno 31. True 32. False – altezza 33. True 34. True 35. False – disuguaglianza 36. False – chiave 37. False – meno 38. True39. False – probabilità 40. True41. False – basso 42. False – importante 43. True 44. False – solo45. True

Exercise 2.

Arch Intern Med Vol. 170 No. 4, February 22, 2010 HEALTH CARE REFORM

The EFFECT of Multidisciplinary CareTeams on Intensive Care Unit MortalityMichelle M. Kim, MSc; Amber E. Barnato, MD, MPH;Derek C. Angus, MD, MPH; Lee F. Fleisher, MD; JeremyM. Kahn, MD, MSc

BACKGROUND Critically ill patients aremedically complex and may benefit from amultidisciplinary approach to care. Methods We conducted a population-basedretrospective cohort study of medical patientsADMITTED to Pennsylvania acute carehospitals (N = 169) from July 1, 2004, to June 30,2006, LINKING a statewide hospitalorganizational survey to hospital discharge data.Multivariate logistic regression was used todetermine the independent RELATIONSHIPbetween daily multidisciplinary rounds and 30-day MORTALITY.

Exercise 3.

RESULTS A total of 112 hospitals and 107 324patients were INCLUDED in the final analysis.OVERALL 30-day mortality was 18.3%. Afteradjusting for patient and hospital characteristics,multidisciplinary care was associated withsignificant REDUCTIONS in the odds of death(odds ratio [OR], 0.84; 95% confidence interval[CI], 0.76-0.93 [P = .001]). When stratifying byintensivist physician staffing, the LOWEST oddsof death were in intensive care units (ICUs) withhigh-intensity physician staffing andmultidisciplinary care teams (OR, 0.78; 95% CI,0.68-0.89 [P < .001]), followed by ICUs with low-intensity physician staffing and multidisciplinarycare teams (OR, 0.88; 95% CI, 0.79-0.97 [P =.01]), COMPARED with hospitals with low-intensity physician staffing but withoutmultidisciplinary care teams. The effects ofmultidisciplinary care WERE consistent acrosskey subgroups including patients with sepsis,patients requiring invasive mechanical ventilation,and patients in the highest quartile of severity ofILLNESS.

Exercise 4.

CONCLUSIONS Daily rounds by amultidisciplinary TEAM are associated withlower mortality AMONG medical ICU patients.The SURVIVAL benefit of intensivist physicianstaffing is in part EXPLAINED by the presenceof multidisciplinary teams in high-intensityphysician-staffed ICUs.

Author Affiliations: Department of Health Care Manage-ment and Economics, Wharton School of Business (MsKim), Leonard Davis Institute of Health Economics (DrsFleisher and Kahn), Department of Anesthesia and Criti-cal Care, School of Medicine (Dr Fleisher), Center forClinical Epidemiology and Biostatistics, School of Medi-cine (Drs Fleisher and Kahn), and Division of Pulmonary,Allergy, and Critical Care, School of Medicine (Dr Kahn),University of Pennsylvania, Philadelphia; and Section ofDecision Sciences and Clinical Systems Modeling, Divisionof General Internal Medicine, School of Medicine (Dr Bar-nato), CRISMA Laboratory, Department of Critical CareMedicine, School of Medicine (Drs Barnato and Angus),and Department of Health Policy and Management, Grad-uate School of Public Health (Drs Barnato and Angus),University of Pittsburgh, Pittsburgh, Pennsylvania.

© 2010 American Medical Association. All Rights Re-served.

Exercise 5.

J Epidemiol Community Health Online First 8 December 2009

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

BACKGROUND The ADMINISTRATION ofinfluenza vaccination is an important strategy inthe PREVENTION of exacerbations in patientswith chronic obstructive pulmonary disease(COPD). DESPITE the proven benefits, thereare patients who are RELUCTANT to have thisintervention for fear of triggering anexacerbation. There are very FEW studieslooking at the effect of the vaccination onexacerbation RATES of COPD in primary care.

151

A n s w e r k e y

Exercise 6.

METHODS We obtained medical RECORDSfrom 6 primary care practices in the Derbyshirearea (UK) and obtained 293 pairs of PATIENTS.All patients had a DIAGNOSIS of COPD basedon post bronchodilator spirometry. Patients wereMATCHED according to age, SEX severity ofCOPD and comorbidities. The first group ofpatients received the influenza vaccinationWHILST the other group served as a control(either never received the vaccination or receivedit at a later date). The incidence of COPDexacerbations of BOTH groups were recorded.

Exercise 7.

RESULTS There were 21 exacerbations in thecontrol group COMPARED TO 11 in thevaccinated group. The difference in exacerbationRATES between groups was NOT statisticallysignificant (McNemar’s p=0.11). In the 2 weeksafter receiving the influenza vaccination, the

RISK of experiencing an exacerbation in thisgroup of patients was 0.52 in the vaccinatedgroup compared to the NON vaccinated group(OR=0.52; CI 0.29-1.14) CONCLUSION Patients with COPD SHOULD bereassured that the influenza vaccination is SAFEand does not cause an INCREASE inexacerbations. They should be encouraged totake up the vaccination annually before theONSET of winter.

© 2009 by the BMJ Publishing Group Ltd.

Exercise 8.

1. A – Despite 2. C – Like 3. D – Thus 4. D – For istance 5. D – However6. D – Eeven though

152


Word search

P R O V I D E P O L I C Y O

R P R O M O T E P L A N V

A E R E S O U R C E E N

C M A K E A D I A G N O S I S R A

T N W P W R

R A N G E I T O E P E R

M N C R P R R U I O

E G E E E S C R G W

A R I S I N G M E A N R E E P P H

S Y I E L D D F I A O T

U N E T W O R K W O V G S O

R E T R E I V E I E R L E E E R

E P L A M D A

M R L K A P R I O R T O

P R A C T I C E W H A T N E

N L C S U R V E Y

T R E A T D E S U P P L Y

Crossword Across3. ingaggiare – engage5. ritardo – delay8. alto – high9. quadro – framework10. verificare – check14. regolare – control17. salute – health18. associato – linked19. valutare – evaluate21. valutazione – assessment22. possibilità – chance24. giorno – day26. ampio – broad29. rilevare – detect30. migliorare – improve31. sviluppare – develop33. spiegare – explain35. anziano – elderly36. sforzo – effort37. efficace – effective38. disponibile – available39. medico di base – general practitioner41. almeno – at least43. entrambi – both44. dato preliminare – finding45. confrontare – compare

Down1. permettere – allow2. raccogliere – collect4. attuare – implement6. sfida – challenge7. principale – main11. caratteristica – feature12. attentamente – closely13. sfondo – background15. accrescere – enhance16. fattibile – feasible20. stima – estimate23. colpire – affect25. dimettere – discharge27. probabile – likely28. precoce – early32. profondo – deep34. problematica – issue40. poiché – as42. durare – last (v)

TEXT 19


1. D – un altro 2. A – sembrare 3. E – ampio 4. C – rispetto a 5. B – orecchio

Exercise 2.

1. C – efficace2. A – efficacia reale3. D – efficacia teorica4. B – trovato5. E – alto

Exercise 3.

1. D – meno2. C – principale3. A – dolore4. E – tasso5. B – fonte

Exercise 4.

1. valutare2. tra3. entrambi4. data5. tratto6. valutare 7. trovare8. durare9. basso10. sollievo 11. riportare12. campione13. mostrare14. gola15. terapia

Exercise 5.

1. However 2. In addition3. Such as

153

A n s w e r k e y

ReadingExercise 1.

1. Cochrane Database Systematic Reviews2. Department of Otolaryngology, Head & Neck

Surgery, Stockport NHS Foundation Trust,Stepping Hill Hospital, Stockport, UK.Department of Otolaryngology, Head & NeckSurgery, Derriford Hospital, Plymouth, UK.UCL Ear Institute & The Royal NationalThroat, Nose & Ear Hospital, Royal FreeHospital, London, UK.

3. To assess the effectiveness of interventionsfor acute otitis externa.

4. “Swimmer’s ear”5. Randomised controlled trials evaluating ear

cleaning, topical medication or systemictherapy in the treatment of acute otitisexterna.

6. The date of the most recent search was 6January 2009.

7. Nineteen randomised controlled trials 8. A total of 3382 participants were included.9. Two authors assessed eligibility and quality.


Interventions assessed No. of studies

topical antimicrobials with steroids vs placebo drops 1acetic acid vs antibiotic/steroid drops 1steroid only drops 2oral antihistamine + topical steroid vs topical steroid alone 1steroid vs antibiotic/steroid 1quinlone vs non-quinlone antibiotic 1ear clearing (alone) 0

Exercise 2.

1. True2. False3. False4. Not clear5. True6. True7. False8. True9. False10. Not clear

TEXT 20

Vocabulary practice Exercise 1.

1. A – consapevole 2. D – anziano 3. E – strumento 4. B – tardi, tardivo 5. C – medico clinico

Exercise 2.

1. D – classificare2. E – scala 3. B – dovrebbe4. A – completo 5. C – sottostante

Exercise 3. What is the opposite of the following?

1. happy2. low3. early4. physical5. young/new

GrammarExercise 1.

Sono necessari un riconoscimento maggiore e unaterapia più aggressiva per la depressione neipazienti più anziani.

ReadingExercise 1.

1. Journal of Clinical Psychiatry2. Semel Institute for Neuroscience and Human

Behavior, and the Geriatric Division of theDepartment of Psychiatry and BiobehavioralSciences, David Geffen School of Medicine,University of California, Los Angeles, USA.

3. Depression in the elderly contributes todecreased quality of life and increasedmortality from both suicide and medicalillnesses, yet it remains underdiagnosed andundertreated in these patients.


1. False2. Not clear3. Not clear4. True5. True

154


Documents

Answer key - BAL Laziobal.lazio.it/wp-content/uploads/2015/11/soluzioni-Text-1-20.pdf · 4. George M. Savva, PhD; Blossom C.M. Stephan, PhD 5. The Alzheimer’s Society Vascular Dementia