OETリスニング練習模試 9
| Doctor: | Hello Mr. Thatch. It’s nice to meet you. How are you today? |
| Patient: | Um, Okay, I guess. You can call me Jack, by the way. |
| Doctor: | Okay, thanks Jack. So you were referred by a doctor in the a&e for an episode of dizziness. |
| Patient: | Hmm, Yes, and I still feel a bit unwell, even though it’s been about an hour since the dizziness began. |
| Doctor: | So let’s talk about your health recently. How have you been feeling lately? |
| Patient: | I was feeling quite well until about six months ago. I’ve had a few falls, not often, but enough to worry me. |
| Doctor: | Hmm, I see, when you have fallen have you lost consciousness? |
| Patient: | Yes, a couple of times, and as I live alone. I don’t know how long I’ve been out when I come to. I’ve also grazed my knees a few times. |
| Doctor: | Okay. And have you also felt dizzy before? |
| Patient: | Yes. Sometimes I feel dizzy and have to sit down to avoid passing out.This has happened a few times after I was doing some work outside but it happened last week when I was just sitting there. |
| Doctor: | How long does it generally take for the episode to pass? |
| Patient: | I would say it takes about 10 to 15 minutes. |
| Doctor: | You said you left alone. Has anybody been with you when you have had one of these episodes? |
| Patient: | Most of the time, no but my granddaughter was with me once. She got so worried that she called an ambulance. She said I look so pale she thought I was dead. By the time they got me to the hospital. I’ve completely recovered. They told me I had a normal electrocardiogram and a normal chest X ray and they discharged me. |
| Doctor: | Okay, so I can see from the initial physical examination done in the a&e, you were pale when you presented in the a&e. No heart murmurs were detected. Let me look at the ECG that was just done. |
| Patient: | Um, well, what do you think it might be? |
| Doctor: | Well, your loss of color suggests the loss of cardiac output associated with arrhythmia, which is a problem with the rate of rhythm of your heartbeat. It means that your heart beats too quickly too slowly, or with an irregular pattern. Yes, your most recent ECG is showing a complete heart block. The episodes of loss of consciousness, are what we call Stokes Adams attacks and are caused by rapid heartbeat or tachyarrhythmia. You likely started out with a partial block, but now it seems that you are in a stable complete heart block. |
| Patient: | Does that mean the blood in my heart isn’t flowing. How is that possible? |
| Doctor: | No, a heart block is an abnormal heart rhythm that occurs when the electrical impulses that tell your heart when to beat are delayed or blocked as they travel through the heart. |
| Patient: | Oh, no. And what is the treatment for that? |
| Doctor: | A treatment is the insertion of a pacemaker, which will help monitor and control your heartbeat. With the pacemaker. If your heart rhythm is abnormal, the computer and the pacemaker will direct a generator to send electrical pulses to the heart. |
| Patient: | So you have to insert it in my chest. Is that a major surgery? |
| Doctor: | It does not require open heart surgery so it’s not as serious as you might think. In fact, most people go home within 24 hours. |
| GP: | Hello, Mrs. Halloway. It’s nice to meet you here today. |
| P: | Nice to see you too. |
| GP: | So I see here that you decided to make the appointment because of a lack of energy. Can you tell me a bit more about that? |
| P: | Yes, it’s awful. Over the past year and a half, I think I’ve become increasingly tired. I work as a solicitor and there have been a few times now where I have fallen asleep in my office. I have had to give up my weekly game of tennis because I’m just too tired, and it’s absolutely impossible for me to stay awake past half past nine at night or wake up before 7:30am. It’s also quite difficult for me to concentrate when I finally do get to the office. |
| GP: | So, you had an episode of depression, about 10 years ago, related to the breakup of your marriage. Are you currently experiencing any personal problems? |
| P: | No, not at all. |
| GP: | Any other physical symptoms like being constipated. |
| P: | Now that you mention it, I have been a bit constipated. Also I have put on a bit of weight over the past year, about six kilograms I think. One thing I wanted to ask about is the possibility of diabetes. My brother was diagnosed with Type One Diabetes, at the age of 13. And I know fatigue is the symptom of diabetes. |
| GP: | Let’s take a look at your latest blood tests. So, your glucose levels are within a normal range, so it isn’t diabetes. I see that your skin is a bit dry, and it’s also somewhat flaky. Is that normal for you? |
| P: | No, not really. I’ve been trying to do something about it. |
| GP: | Okay, so fatigue is associated with quite a few possible diagnoses but based on your lab results which show anemia, and hypercholesterolemia, which is an elevated amount of cholesterol in the blood, and a few other factors such as your general description of how you have been feeling, the appearance of your skin and your family history, my initial diagnosis is hypothyroidism. |
| P: | Does it explain why I’m so tired, even after sleeping the whole night. |
| GP: | Yes, it might. A part of the reason you may be feeling tired is sleep apnea, which is often associated with hypothyroidism and may contribute to daytime sleepiness and fatigue. It can also explain the weight gain, since that is also a feature of the condition. |
| P: | Is it common? |
| GP: | Well, it does typically present in the fifth or sixth decade, and it is five times more common in women than men. |
| P: | And I meet both of those criteria. |
| GP: | Yes, depending on the cause of your condition. It may also be related to your family medical history. Your brother has an autoimmune disease, diabetes, which makes you a more likely candidate for one as well. And a common cause of hypothyroidism is autoimmune thyroiditis. |
| P: | Well, what can I do about it? |
| GP: | Well, first we will have to confirm the diagnosis with thyroid function tests. If hypothyroidism is confirmed, we will then need to determine the cause in order to decide on treatment…[fade] |
| GP: | So, Mrs. Johnson, it seems that your diarrhea has not cleared up. |
| P: | Ah, um, no. I took the medicine you prescribed, but I’m still having diarrhea. I’ve lost quite a bit of weight as well. |
| GP: | I remember in your initial appointment you said that your diarrhea was watery yellow and foul smelling and that you were experiencing a loss of appetite and nausea. Now, along with this weight loss, I’m suspecting it is something else. Where was it you traveled to recently? Was it somewhere in Eastern Europe? |
| P: | To Russia, at St. Petersburg. |
| GP: | Okay, so I think what you have is giardiasis. It is most common in the tropics, but it is also found in Russia. I will need to…[fade] |
| Physician: | So, Mrs. Hardy. You’re complaining of abdominal pain. |
| Patient: | Yes, it won’t go away and has become more and more severe over the last day. I’m also feeling nauseated and hot and cold. |
| Ph: | You’re probably dehydrated. Have you had any surgeries in the past couple of years? |
| P: | Yes, I was treated for an ulcer about five years ago. |
| Ph: | Well, I can see that you are running a fever, and that you’re that you are tender in the right upper quadrant and epigastrium. I’m going to order an abdominal X ray and blood test to help us get a better look at what might be causing your pain. In the meantime, I’m going to put you on intravenous fluids to avoid dehydration. |
| Ph: | Okay. So, last night, a 35-year-old man was admitted, after he presented in the emergency department, because of a rapid onset painful swollen right knee. There is no history of trauma to the knee or previous joint problem, and there is no history of significant medical illnesses. |
| A patient feels generally unwell and has noticed that his eyes are sore. His initial examination of cardiovascular respiratory abdominal and neurological systems was normal. His right knee was swollen, hot, and tender with limitation in flexion. An X-ray showed soft tissue swelling around the joint. | |
| No other joint appears to be affected. Patient-reported having recently traveled to Thailand on business. The probable diagnosis is post-infective inflammatory mucositis and arthritis, likely triggered by nongonococcal urethritis. | |
| I have ordered urethral swabs to exclude chlamydia and gonococcal infections, to get a cause for the urethritis, and possibly for the inflamed knee… [fade] |
| Speaker: | I’m here today to introduce a new role at our facility, as well as discuss some of the problems this new role is intended to deal with. First of all, the new role is clinical nurse leader, we’re assigning a new clinical nurse leader to micro-units of around 12 beds throughout the hospital. |
| The clinical nurse leader will primarily function as a liaison between physicians and patients, as well as a mentor to other nurses, as you all know we’ve experienced a range of problems stemming from poor communication between providers. | |
| So one of the main purposes of this role is to get better information flowing faster. So that decisions can be made more efficiently and more effectively. | |
| We think this will result in patients having a better health care experience with fewer redundancies, and physicians having a better understanding of what happens to a patient when another provider takes over some other policies we are…[fade] |
| Trainee Dr: | Dr. James you’ve been a GP for 15 years right? |
| SR GP: | Yeah, that’s correct. I’ve seen general practice change quite a bit in that time. There is an increasing workload and pressure on general practice so much. So the many younger GPs are choosing to work as local GPs or choosing to work abroad. I mean the big part of the problem is from the lack of physicians choosing to go into general practice. |
| Tr Dr: | I’ve heard quite a few GPS talk about their days getting busier and longer in order to cope with increased demand which obviously makes it incredibly difficult to juggle working life and home life especially if one wants to have children. |
| SR GP: | Yes. 12 hour minimum working days have definitely become the norm not the exception. I’m of the opinion that the current state of general practice is completely…[fade] |
| Nurse: | So, Dr. Alex. I’ve already spent over an hour going through the list of patients for this morning’s diabetic clinic. I’m trying to decide which patients can be seen by the nurse, and which should be seen by the GP. |
| Dr: | Let me see if I can help with that. I mean we already have quite a busy day with the second year medical students coming in. Which is going to reduce the number of patients one of the doctors can see. |
| Nurse: | Yes. Everyday is a case of juggling priorities and complex needs. |
| Dr: | That is definitely true. I also have at least an hour of reports and routine administration with prescriptions waiting for me. I wish it were easier to get some temporary support until our colleague on sabbatical comes back, but…[fade] |
| Doctor: | Hello, everyone. Thank you very much for attending this session on podiatry education to empower patients to self care. The reason that this research was undertaken was due to the many surveys that have reported a high number of people suffering from foot problems. |
| For example, one survey showed that 95% of people over the age of 75 reported having problems cutting their toenails. Another survey found that 29% of people over the age of 65 reported experiencing problems with thick nails and or skin problems. | |
| Many of the conditions that patients present with, such as those just mentioned, could be safely and appropriately handled by the patient’s themselves if they had the confidence skills or knowledge to do so. | |
| Some of these and other foot problems have previously required NHS podiatry services, so empowering patients or their carers to deal with their own minor foot problems like nail care can reduce the burden on NHS podiatry services. And in turn, save money. | |
| This would also allow NHS podiatry services to concentrate more care on those with the greatest need, and highest risks, such as people with diabetic foot problems. With that in mind, this project was designed to identify and train patients suitable for self care, so they can be discharged from the service. | |
| Patients suitable for self care include those who do not have any high risk medical or podiatric needs, as well as those who are fit and able to provide their own foot care, or who have a family member or carer able to provide it for them. | |
| For this project, a system was designed to triage patients as high or low risk, as they enter what we call the empowerment pathway. | |
| Patients considered to be higher risk. Had one or more of the following: a history of non traumatic amputation, foot infection or foot ulcer, or on oral steroid therapy or had an infected ingrowing toenail among others. | |
| Examples of conditions considered to be low risk were painful callus or corns or thickened and deformed nails. | |
| Patients assessed as low risk are able to provide their own foot care safely, or discharged to selfcare with advice, as well as follow up awareness sessions. | |
| Awareness sessions were provided in local health centers, and up to 10 patients were invited to each. In addition, invited patients were encouraged to bring a family member, career, or spouse with them, if they felt they were unable to carry out daily living activities for themselves. | |
| The sessions covered the role of podiatrists, the type of conditions that are treated by the NHS, the podiatry service, and the types of common foot problems that can be self managed. | |
| Training was also provided to patients on safe nail filing and leaflets were provided to enforce the information. | |
| If at this time, patients revealed, they had a more serious foot problem or medical condition. They were offered an assessment by the podiatrist. After the initial phase of the project, which included the triaging system and awareness sessions just described. The first impact was noted in the first group of patients assessed. | |
| The benefit of the NHS was a saving of over 138,000 pounds for a population of 560,000. This savings resulted from enabling some patients to be discharged from podiatry service to selfcare. | |
| If we look at it on an individual level for every patient who can care selfcare NHS saves about 55 pounds per year, which is the cost of a 40 minutes assessment appointment conducted by a qualified podiatrist. | |
| This project also helps to reduce the caseload of podiatrist. The prior to the project had an average of more patients than comparable services like physiotherapy and psychology. The benefit to patients with serious foot conditions was also quite dramatic. As before the project began, there was a waiting list of approximately three years, due to the lack of spare capacity and very few people being discharged from the caseload. | |
| Once this initiative was fully implemented, all high risk referrals were seen within four weeks and all low risk referrals were seen in twelve weeks. | |
| And finally, for the patients involved in the project patients satisfaction has been improved because all patients were assessed to a podiatrist and given one-to-one foot-care advice. | |
| We have worked closely with patients including conducting surveys and one-to-one interviews to examine how patients feel about the empowerment pathway. As a result we are working to make some changes to this initiative. Which include…[fade] |
| Interviewer: | Hello everyone, I want to welcome you all today to this interview with the leader of the Australian Nursing Federation. Sally began her career in nursing in aged care. And she also has a background in oncology and emergency nursing, having held a variety of roles. Her areas of interest are standards and practice, leadership and patient safety. So, Sally. Tell us about what originally attracted you to the field of nursing. |
| Nurse: | Um, I always knew I wanted to do something in health care, but I think what drew me to nursing was the fact that nurses are uniquely positioned as advocates for patients. I like the idea of working for, and with patients to help in the planning and delivery of health services. |
| Interviewer: | That’s an interesting take on things. So, now in your role as president of the Australian Nursing Federation. You work to promote and protect the profession. |
| Nurse: | Yes, that’s what we do. I mean, it isn’t just me. I work with a strong and experienced team to improve the interests of nurses and midwives in the country. |
| Interviewer: | So you’re here today to talk about some of the challenges that nurses face in the hospital setting. So, what, in your opinion, is one of the biggest challenges facing nurses in this setting. |
| Nurse: | Well, it’s hard to say which is the biggest challenge, but one that we have been hearing more about lately is this desire for physician integration in care teams. We have more and more local physicians, which is good for the physicians because they get flexibility in terms of time and location. But this means that there is less of a chance for physicians to integrate with the rest of the team. It also means that we the nurses are doing double duty, because these physicians don’t communicate with the rest of the team very well. I mean, I think, health care systems are realizing more and more that an integrated care model is the best for patients. Having physicians coming and going, is not compatible with this trend. |
| Interviewer: | That’s interesting. I would have expected you to start with staffing shortages, which is the problem plaguing all areas of healthcare? I mean, general physicians have been trying to raise awareness for several years, about the dramatic rise in their caseloads. |
| Nurse: | Well yes, short staffing is definitely a challenge for nurses in any setting, but particularly hospitals, and this affects the profession in a number of ways. For example, nurses may not feel like they are doing enough, causing dissatisfaction and burnout. It can certainly be emotionally and physically draining when repeatedly you can’t provide the care you think is necessary. This can lead to significant turnover in many healthcare organizations and settings. Also most concerning is the fact that staffing issues are a hindrance to patient safety. Recent research shows that nursing shortages result in errors, as well as higher morbidity and mortality rates. |
| Interviewer: | And I would imagine that staffing shortages would lead to longer working hours. Is that true? |
| Nurse: | Yes, that is true. Nurses often work extended hours in overtime, which puts them at risk for making mistakes. A recent survey showed that 47% of nurses reported working regular overtime. |
| Interviewer: | What is your organization’s policy on this? Do you think that regular overtime is acceptable? |
| Nurse: | We know that nurses should not work more than 40 hours a week and we believe they should work no more than 12 hours in a day, ideally less because you reach a point where you start to have cognitive decline. It also creates situations where nurses start to treat each other poorly. |
| Interviewer: | What are some challenges that nurses face that people might not be aware of? |
| Nurse: | I would have to say workplace violence, and bullying and harassment. A report that came out last year from the Government Accountability Office found that health care workers in inpatient facilities such as hospitals, experienced high rates of non fatal injuries such as hitting kicking and beating. Nurses also regularly experienced bullying and harassment. The report I just mentioned, found that 71% of nurses, said that they had been harassed by a patient, which is far lower than the percentage reported by physicians. |