Atenção: Para responder às questão, considere o texto abaixo.
Where are we letting our patients down?
By Rammya Mathew
October 20, 2020
A recent consultation has stayed with me. In many respects it was a run of the mill general practice consultation, but it made me reflect on health inequalities and why the care we provide for people with low levels of health literacy can be woefully lacking.
He was a patient with type 2 diabetes taking long term insulin, who had developed acute symptoms in the previous 24 hours. He had broken English, but he was able to communicate his history without too much difficulty, so I persevered without an interpreter. In response to some very direct questioning, it became apparent that he hadn’t had anything to eat or drink that morning, he hadn’t checked his blood sugar levels, and he hadn’t thought about adjusting his insulin dose. How was it feasible that a patient taking insulin for so many years had no idea about type 2 diabetes sick day rules? Could it really be that no one had ever taken the time to counsel him about this?
I looked online for a patient information leaflet that might be of use, but I abandoned the idea quite quickly, as I was unsure whether he’d be able to read it − and even if he could, I was worried that the information might be too complex for him to follow. I decided that giving him the minimum information to avert a crisis was the best course of action. So, I encouraged him to drink more, to check his blood sugar every four hours, and to call a health professional if it was over a certain threshold. I was firefighting, and it didn’t feel good to be in that position.
His lack of knowledge about type 2 diabetes sick day rules, however, probably reflected his overall understanding of the condition. It made me wonder where we’d let this man down. At diagnosis, was he enrolled onto a structured education programme? Even if he was, could he attend it around his shift work? And if so, was he able to take anything away from it, given his limited English?
Patients with long term conditions such as type 2 diabetes are meant to have annual reviews with their GP or practice nurse. Was anything meaningful happening at these reviews, or was his medication just being continuously titrated up? A significant part of these reviews is meant to focus on helping patients to set goals and take control of the aspects of their health that matter most to them. But, if you don’t understand your condition and your role in managing it, you can very quickly become a passive spectator in managing your health, and well intentioned tasks such as goal setting just become yet another meaningless, tick box exercise.
That single consultation and the patient journey behind it capture many of the gaps in our system, and they explain at least partly the stark health inequalities that have become so painfully visible in recent times. There’s a tendency to think that some patients can’t be helped, but the reality is that the system has let them down.
(Adapted from https://www.bmj.com)
Uma tradução adequada para o título desse artigo é
Atenção: Para responder às questão, considere o texto abaixo.
For days she couldn’t stop getting sick. At first she doubted the probable cause.
By Sandra G. Boodman
August 22, 2020
The first episode occurred on Halloween night 2016, as Alice Moon and a friend were strolling around her neighborhood admiring the trick-or-treaters. Suddenly Moon began to vomit. “It made no sense,” she said.
She went home and smoked some marijuana, which she knew could quell nausea and vomiting and is used by some people undergoing chemotherapy. Moon, who promotes cannabis products, had worked in the marijuana industry since 2011, including at a dispensary where she said she “saw all the people it was helping.” (California legalized cannabis for medical use in 1996 and for recreational purposes in 2016).
For several years Moon had used cannabis at night to combat long-standing insomnia and to moderate anxiety and depression. She described herself as a daily user who was not addicted. “I was never one of those people who was stoned all day,” she said.
A few days after the Halloween episode, which lasted a few hours, she saw a doctor who diagnosed reflux. He advised her to eliminate spicy or acidic foods, such as tomatoes, and to take a nonprescription acid-blocking drug.
For a few months, those measures seemed to work. But by early 2017 the vomiting returned. Moon noticed that the episodes, which occurred weekly, appeared to coincide with her consumption of alcohol, even in small amounts, so she stopped drinking.
The vomiting, however, continued. In late 2017 she read a blog item about an alarming condition affecting some regular users of cannabis: intractable and untreatable vomiting that could last for days.
“I did let it sit in my brain for a while but it didn’t make sense. I was throwing up the day after using weed.” Moon said.
As the episodes increased in frequency and severity, Moon discovered that the only thing that seemed to quell hours of vomiting was a hot bath.
In March 2018 she had one of her worst episodes and decided to see a gastroenterologist who performed a physical exam and questioned her closely after Moon told her she was a regular user of cannabis. Based on Moon’s symptoms and the relief hot baths provided, she suspected cannabinoid hyperemesis syndrome (CHS), the same disorder Moon had read about − and dismissed − a few months .
The unusual condition was first reported in 2004 by doctors in Australia, who described a small number of frequent cannabis users who developed severe vomiting relieved by hot showers or baths. Like Moon, a few had unsuccessfully tried to quell the vomiting by using marijuana, which has anti-emetic effects in some people. But in some heavy users cannabis, which affects the GI tract, has a paradoxical effect and can trigger severe uncontrolled vomiting. The only way to stop it, Australian researchers reported, was abstinence from marijuana.
Once thought to be rare, doctors in the United States are increasingly reporting CHS cases in states that have legalized cannabis.
The gastroenterologist advised Moon to stop using marijuana for three to six months and return if she was still having symptoms. Moon was reluctant. “I was unconvinced this was the cause,” she said. As she was mulling it over, Moon decided to attend a cannabis-themed dinner party in Malibu. A few hours after she got home, Moon began throwing up and didn’t stop for more than two weeks.
Four days into her ordeal, Moon went to an urgent care center near her home. The doctor on duty had never heard of CHS. He administered intravenous fluids to treat severe dehydration and gave her anti-nausea medication, which is typically ineffective against CHS. When she seemed better, he sent her home.
Several hours later, Moon began vomiting again. Three days later, still vomiting, a friend drove her to an urgent care center. The doctor hooked her up to an IV and called the gastroenterologist she had consulted. She ordered blood tests as well as CT and MRI scans; all were normal. The gastroenterologist reiterated her suspicion that Moon’s vomiting was caused by cannabis; she couldn’t predict when the vomiting would stop. A few days later, it did.
For the next five months Moon said she mostly avoided cannabis, while struggling with insomnia and depression. In late September she began intermittently using CBD capsules, hoping they might be less likely to trigger vomiting than edibles or vaped marijuana. That seemed to be the case until Dec. 22 when, on a holiday visit to her family, Moon developed the worst attack she had experienced. The vomiting was so severe Moon cut her trip short and returned to Los Angeles, where she spent four days in a hospital. She said she told her hospital team about her CHS diagnosis; they told her they had never heard of it.
“People said I looked like I was dying,” remembered Moon, who slowly recovered. It was the last time she used the drug in any form. “I have no desire to touch it,” she said. “It’s just not worth the consequence.”
(Adapted from https://www.washingtonpost.com)
Um sinônimo para dismissed (9º parágrafo), conforme empregado no texto, é:
Atenção: Para responder às questão, considere o texto abaixo.
For days she couldn’t stop getting sick. At first she doubted the probable cause.
By Sandra G. Boodman
August 22, 2020
The first episode occurred on Halloween night 2016, as Alice Moon and a friend were strolling around her neighborhood admiring the trick-or-treaters. Suddenly Moon began to vomit. “It made no sense,” she said.
She went home and smoked some marijuana, which she knew could quell nausea and vomiting and is used by some people undergoing chemotherapy. Moon, who promotes cannabis products, had worked in the marijuana industry since 2011, including at a dispensary where she said she “saw all the people it was helping.” (California legalized cannabis for medical use in 1996 and for recreational purposes in 2016).
For several years Moon had used cannabis at night to combat long-standing insomnia and to moderate anxiety and depression. She described herself as a daily user who was not addicted. “I was never one of those people who was stoned all day,” she said.
A few days after the Halloween episode, which lasted a few hours, she saw a doctor who diagnosed reflux. He advised her to eliminate spicy or acidic foods, such as tomatoes, and to take a nonprescription acid-blocking drug.
For a few months, those measures seemed to work. But by early 2017 the vomiting returned. Moon noticed that the episodes, which occurred weekly, appeared to coincide with her consumption of alcohol, even in small amounts, so she stopped drinking.
The vomiting, however, continued. In late 2017 she read a blog item about an alarming condition affecting some regular users of cannabis: intractable and untreatable vomiting that could last for days.
“I did let it sit in my brain for a while but it didn’t make sense. I was throwing up the day after using weed.” Moon said.
As the episodes increased in frequency and severity, Moon discovered that the only thing that seemed to quell hours of vomiting was a hot bath.
In March 2018 she had one of her worst episodes and decided to see a gastroenterologist who performed a physical exam and questioned her closely after Moon told her she was a regular user of cannabis. Based on Moon’s symptoms and the relief hot baths provided, she suspected cannabinoid hyperemesis syndrome (CHS), the same disorder Moon had read about − and dismissed − a few months .
The unusual condition was first reported in 2004 by doctors in Australia, who described a small number of frequent cannabis users who developed severe vomiting relieved by hot showers or baths. Like Moon, a few had unsuccessfully tried to quell the vomiting by using marijuana, which has anti-emetic effects in some people. But in some heavy users cannabis, which affects the GI tract, has a paradoxical effect and can trigger severe uncontrolled vomiting. The only way to stop it, Australian researchers reported, was abstinence from marijuana.
Once thought to be rare, doctors in the United States are increasingly reporting CHS cases in states that have legalized cannabis.
The gastroenterologist advised Moon to stop using marijuana for three to six months and return if she was still having symptoms. Moon was reluctant. “I was unconvinced this was the cause,” she said. As she was mulling it over, Moon decided to attend a cannabis-themed dinner party in Malibu. A few hours after she got home, Moon began throwing up and didn’t stop for more than two weeks.
Four days into her ordeal, Moon went to an urgent care center near her home. The doctor on duty had never heard of CHS. He administered intravenous fluids to treat severe dehydration and gave her anti-nausea medication, which is typically ineffective against CHS. When she seemed better, he sent her home.
Several hours later, Moon began vomiting again. Three days later, still vomiting, a friend drove her to an urgent care center. The doctor hooked her up to an IV and called the gastroenterologist she had consulted. She ordered blood tests as well as CT and MRI scans; all were normal. The gastroenterologist reiterated her suspicion that Moon’s vomiting was caused by cannabis; she couldn’t predict when the vomiting would stop. A few days later, it did.
For the next five months Moon said she mostly avoided cannabis, while struggling with insomnia and depression. In late September she began intermittently using CBD capsules, hoping they might be less likely to trigger vomiting than edibles or vaped marijuana. That seemed to be the case until Dec. 22 when, on a holiday visit to her family, Moon developed the worst attack she had experienced. The vomiting was so severe Moon cut her trip short and returned to Los Angeles, where she spent four days in a hospital. She said she told her hospital team about her CHS diagnosis; they told her they had never heard of it.
“People said I looked like I was dying,” remembered Moon, who slowly recovered. It was the last time she used the drug in any form. “I have no desire to touch it,” she said. “It’s just not worth the consequence.”
(Adapted from https://www.washingtonpost.com)
Preenche corretamente a lacuna I (9º parágrafo) o que se encontra em:
Atenção: Para responder às questão, considere o texto abaixo.
For days she couldn’t stop getting sick. At first she doubted the probable cause.
By Sandra G. Boodman
August 22, 2020
The first episode occurred on Halloween night 2016, as Alice Moon and a friend were strolling around her neighborhood admiring the trick-or-treaters. Suddenly Moon began to vomit. “It made no sense,” she said.
She went home and smoked some marijuana, which she knew could quell nausea and vomiting and is used by some people undergoing chemotherapy. Moon, who promotes cannabis products, had worked in the marijuana industry since 2011, including at a dispensary where she said she “saw all the people it was helping.” (California legalized cannabis for medical use in 1996 and for recreational purposes in 2016).
For several years Moon had used cannabis at night to combat long-standing insomnia and to moderate anxiety and depression. She described herself as a daily user who was not addicted. “I was never one of those people who was stoned all day,” she said.
A few days after the Halloween episode, which lasted a few hours, she saw a doctor who diagnosed reflux. He advised her to eliminate spicy or acidic foods, such as tomatoes, and to take a nonprescription acid-blocking drug.
For a few months, those measures seemed to work. But by early 2017 the vomiting returned. Moon noticed that the episodes, which occurred weekly, appeared to coincide with her consumption of alcohol, even in small amounts, so she stopped drinking.
The vomiting, however, continued. In late 2017 she read a blog item about an alarming condition affecting some regular users of cannabis: intractable and untreatable vomiting that could last for days.
“I did let it sit in my brain for a while but it didn’t make sense. I was throwing up the day after using weed.” Moon said.
As the episodes increased in frequency and severity, Moon discovered that the only thing that seemed to quell hours of vomiting was a hot bath.
In March 2018 she had one of her worst episodes and decided to see a gastroenterologist who performed a physical exam and questioned her closely after Moon told her she was a regular user of cannabis. Based on Moon’s symptoms and the relief hot baths provided, she suspected cannabinoid hyperemesis syndrome (CHS), the same disorder Moon had read about − and dismissed − a few months .
The unusual condition was first reported in 2004 by doctors in Australia, who described a small number of frequent cannabis users who developed severe vomiting relieved by hot showers or baths. Like Moon, a few had unsuccessfully tried to quell the vomiting by using marijuana, which has anti-emetic effects in some people. But in some heavy users cannabis, which affects the GI tract, has a paradoxical effect and can trigger severe uncontrolled vomiting. The only way to stop it, Australian researchers reported, was abstinence from marijuana.
Once thought to be rare, doctors in the United States are increasingly reporting CHS cases in states that have legalized cannabis.
The gastroenterologist advised Moon to stop using marijuana for three to six months and return if she was still having symptoms. Moon was reluctant. “I was unconvinced this was the cause,” she said. As she was mulling it over, Moon decided to attend a cannabis-themed dinner party in Malibu. A few hours after she got home, Moon began throwing up and didn’t stop for more than two weeks.
Four days into her ordeal, Moon went to an urgent care center near her home. The doctor on duty had never heard of CHS. He administered intravenous fluids to treat severe dehydration and gave her anti-nausea medication, which is typically ineffective against CHS. When she seemed better, he sent her home.
Several hours later, Moon began vomiting again. Three days later, still vomiting, a friend drove her to an urgent care center. The doctor hooked her up to an IV and called the gastroenterologist she had consulted. She ordered blood tests as well as CT and MRI scans; all were normal. The gastroenterologist reiterated her suspicion that Moon’s vomiting was caused by cannabis; she couldn’t predict when the vomiting would stop. A few days later, it did.
For the next five months Moon said she mostly avoided cannabis, while struggling with insomnia and depression. In late September she began intermittently using CBD capsules, hoping they might be less likely to trigger vomiting than edibles or vaped marijuana. That seemed to be the case until Dec. 22 when, on a holiday visit to her family, Moon developed the worst attack she had experienced. The vomiting was so severe Moon cut her trip short and returned to Los Angeles, where she spent four days in a hospital. She said she told her hospital team about her CHS diagnosis; they told her they had never heard of it.
“People said I looked like I was dying,” remembered Moon, who slowly recovered. It was the last time she used the drug in any form. “I have no desire to touch it,” she said. “It’s just not worth the consequence.”
(Adapted from https://www.washingtonpost.com)
Infere-se do texto que a Síndrome de Hiperêmese por Canabinoide
Atenção: Para responder às questão, considere o texto abaixo.
For days she couldn’t stop getting sick. At first she doubted the probable cause.
By Sandra G. Boodman
August 22, 2020
The first episode occurred on Halloween night 2016, as Alice Moon and a friend were strolling around her neighborhood admiring the trick-or-treaters. Suddenly Moon began to vomit. “It made no sense,” she said.
She went home and smoked some marijuana, which she knew could quell nausea and vomiting and is used by some people undergoing chemotherapy. Moon, who promotes cannabis products, had worked in the marijuana industry since 2011, including at a dispensary where she said she “saw all the people it was helping.” (California legalized cannabis for medical use in 1996 and for recreational purposes in 2016).
For several years Moon had used cannabis at night to combat long-standing insomnia and to moderate anxiety and depression. She described herself as a daily user who was not addicted. “I was never one of those people who was stoned all day,” she said.
A few days after the Halloween episode, which lasted a few hours, she saw a doctor who diagnosed reflux. He advised her to eliminate spicy or acidic foods, such as tomatoes, and to take a nonprescription acid-blocking drug.
For a few months, those measures seemed to work. But by early 2017 the vomiting returned. Moon noticed that the episodes, which occurred weekly, appeared to coincide with her consumption of alcohol, even in small amounts, so she stopped drinking.
The vomiting, however, continued. In late 2017 she read a blog item about an alarming condition affecting some regular users of cannabis: intractable and untreatable vomiting that could last for days.
“I did let it sit in my brain for a while but it didn’t make sense. I was throwing up the day after using weed.” Moon said.
As the episodes increased in frequency and severity, Moon discovered that the only thing that seemed to quell hours of vomiting was a hot bath.
In March 2018 she had one of her worst episodes and decided to see a gastroenterologist who performed a physical exam and questioned her closely after Moon told her she was a regular user of cannabis. Based on Moon’s symptoms and the relief hot baths provided, she suspected cannabinoid hyperemesis syndrome (CHS), the same disorder Moon had read about − and dismissed − a few months .
The unusual condition was first reported in 2004 by doctors in Australia, who described a small number of frequent cannabis users who developed severe vomiting relieved by hot showers or baths. Like Moon, a few had unsuccessfully tried to quell the vomiting by using marijuana, which has anti-emetic effects in some people. But in some heavy users cannabis, which affects the GI tract, has a paradoxical effect and can trigger severe uncontrolled vomiting. The only way to stop it, Australian researchers reported, was abstinence from marijuana.
Once thought to be rare, doctors in the United States are increasingly reporting CHS cases in states that have legalized cannabis.
The gastroenterologist advised Moon to stop using marijuana for three to six months and return if she was still having symptoms. Moon was reluctant. “I was unconvinced this was the cause,” she said. As she was mulling it over, Moon decided to attend a cannabis-themed dinner party in Malibu. A few hours after she got home, Moon began throwing up and didn’t stop for more than two weeks.
Four days into her ordeal, Moon went to an urgent care center near her home. The doctor on duty had never heard of CHS. He administered intravenous fluids to treat severe dehydration and gave her anti-nausea medication, which is typically ineffective against CHS. When she seemed better, he sent her home.
Several hours later, Moon began vomiting again. Three days later, still vomiting, a friend drove her to an urgent care center. The doctor hooked her up to an IV and called the gastroenterologist she had consulted. She ordered blood tests as well as CT and MRI scans; all were normal. The gastroenterologist reiterated her suspicion that Moon’s vomiting was caused by cannabis; she couldn’t predict when the vomiting would stop. A few days later, it did.
For the next five months Moon said she mostly avoided cannabis, while struggling with insomnia and depression. In late September she began intermittently using CBD capsules, hoping they might be less likely to trigger vomiting than edibles or vaped marijuana. That seemed to be the case until Dec. 22 when, on a holiday visit to her family, Moon developed the worst attack she had experienced. The vomiting was so severe Moon cut her trip short and returned to Los Angeles, where she spent four days in a hospital. She said she told her hospital team about her CHS diagnosis; they told her they had never heard of it.
“People said I looked like I was dying,” remembered Moon, who slowly recovered. It was the last time she used the drug in any form. “I have no desire to touch it,” she said. “It’s just not worth the consequence.”
(Adapted from https://www.washingtonpost.com)
Segundo o texto, Moon
Atenção: Para responder às questão, considere o texto abaixo.
For days she couldn’t stop getting sick. At first she doubted the probable cause.
By Sandra G. Boodman
August 22, 2020
The first episode occurred on Halloween night 2016, as Alice Moon and a friend were strolling around her neighborhood admiring the trick-or-treaters. Suddenly Moon began to vomit. “It made no sense,” she said.
She went home and smoked some marijuana, which she knew could quell nausea and vomiting and is used by some people undergoing chemotherapy. Moon, who promotes cannabis products, had worked in the marijuana industry since 2011, including at a dispensary where she said she “saw all the people it was helping.” (California legalized cannabis for medical use in 1996 and for recreational purposes in 2016).
For several years Moon had used cannabis at night to combat long-standing insomnia and to moderate anxiety and depression. She described herself as a daily user who was not addicted. “I was never one of those people who was stoned all day,” she said.
A few days after the Halloween episode, which lasted a few hours, she saw a doctor who diagnosed reflux. He advised her to eliminate spicy or acidic foods, such as tomatoes, and to take a nonprescription acid-blocking drug.
For a few months, those measures seemed to work. But by early 2017 the vomiting returned. Moon noticed that the episodes, which occurred weekly, appeared to coincide with her consumption of alcohol, even in small amounts, so she stopped drinking.
The vomiting, however, continued. In late 2017 she read a blog item about an alarming condition affecting some regular users of cannabis: intractable and untreatable vomiting that could last for days.
“I did let it sit in my brain for a while but it didn’t make sense. I was throwing up the day after using weed.” Moon said.
As the episodes increased in frequency and severity, Moon discovered that the only thing that seemed to quell hours of vomiting was a hot bath.
In March 2018 she had one of her worst episodes and decided to see a gastroenterologist who performed a physical exam and questioned her closely after Moon told her she was a regular user of cannabis. Based on Moon’s symptoms and the relief hot baths provided, she suspected cannabinoid hyperemesis syndrome (CHS), the same disorder Moon had read about − and dismissed − a few months .
The unusual condition was first reported in 2004 by doctors in Australia, who described a small number of frequent cannabis users who developed severe vomiting relieved by hot showers or baths. Like Moon, a few had unsuccessfully tried to quell the vomiting by using marijuana, which has anti-emetic effects in some people. But in some heavy users cannabis, which affects the GI tract, has a paradoxical effect and can trigger severe uncontrolled vomiting. The only way to stop it, Australian researchers reported, was abstinence from marijuana.
Once thought to be rare, doctors in the United States are increasingly reporting CHS cases in states that have legalized cannabis.
The gastroenterologist advised Moon to stop using marijuana for three to six months and return if she was still having symptoms. Moon was reluctant. “I was unconvinced this was the cause,” she said. As she was mulling it over, Moon decided to attend a cannabis-themed dinner party in Malibu. A few hours after she got home, Moon began throwing up and didn’t stop for more than two weeks.
Four days into her ordeal, Moon went to an urgent care center near her home. The doctor on duty had never heard of CHS. He administered intravenous fluids to treat severe dehydration and gave her anti-nausea medication, which is typically ineffective against CHS. When she seemed better, he sent her home.
Several hours later, Moon began vomiting again. Three days later, still vomiting, a friend drove her to an urgent care center. The doctor hooked her up to an IV and called the gastroenterologist she had consulted. She ordered blood tests as well as CT and MRI scans; all were normal. The gastroenterologist reiterated her suspicion that Moon’s vomiting was caused by cannabis; she couldn’t predict when the vomiting would stop. A few days later, it did.
For the next five months Moon said she mostly avoided cannabis, while struggling with insomnia and depression. In late September she began intermittently using CBD capsules, hoping they might be less likely to trigger vomiting than edibles or vaped marijuana. That seemed to be the case until Dec. 22 when, on a holiday visit to her family, Moon developed the worst attack she had experienced. The vomiting was so severe Moon cut her trip short and returned to Los Angeles, where she spent four days in a hospital. She said she told her hospital team about her CHS diagnosis; they told her they had never heard of it.
“People said I looked like I was dying,” remembered Moon, who slowly recovered. It was the last time she used the drug in any form. “I have no desire to touch it,” she said. “It’s just not worth the consequence.”
(Adapted from https://www.washingtonpost.com)
De acordo com o texto,