Part B

In this part of the test, there are six short extracts relating to the work of health professionals. For
questions 1-6, choose the answer (A, B or C) which you think fits best according to the text.

1. The manual extract tells us the information about

A. LMS should reduce the problems of healthcare

B. IT people will be employed more in the hospitals
C. Healthcare HRs should play a pivotal role in hospital management

Manual extract:

The healthcare industry may be the most risk-heavy and compliance-intensive sector of the
economy. With the potential for life-changing impact on patients and the need to manage
sensitive patient data—the stakes don't get much higher.

Regulations cover everything from equipment and facilities to processes and supplies. Adding
to the compliance challenge: Everyone from radiologists to IT people must have certifications.

Healthcare HR departments must meet compliance challenges with tools that offer
streamlined, trackable methods for delivering the necessary learning—and ensuring that staff
obtain the required certifications. Here's how a Learning Management System (LMS) for
healthcare can help reduce the administrative burden, centralize learning materials and
improve tracking of data.
 2. What does this manual extract emphasize that

A. the importance of ethics committee in hospitals

B. the role played by the surrogate decision maker involved in surgery
C. the importance of shared decision making between patient-surgeon

Manual extract:
Patient-Centered Informed Consent in Surgical Practice

To review the medical, ethical, and legal basis of the doctrine of informed consent for surgery
and its complications, particularly for an incapacitated patient who requires a surrogate decision
maker; to discuss the elasticity of the consent doctrine, whether surgical consent encompasses
consent for surgical complications, and emphasize the importance of communication and
shared decision making in the context of the patient-surgeon relationship; and to discuss patient
and surrogate refusal of treatment, standards of surrogate decision making, barriers to effective
communication, the role of the hospital ethics committee in resolving disputes over treatment,
and how to reconceptualize surgical consent in the context of patient-centered medicine.
3. The instructions provided to the medical staff shows that

A. Lack of sufficient medical staff to take care of the patients.

B. Failure of Emergency department in hospitals contributed to discharge of patients in
less than 30 days.
C. Medical staff is advised to provide pro-active care and follow up.

Instructions:

Patients with more complicated physical and/or mental illnesses are at increased risk of
potentially serious, even fatal, exacerbations and complications. They may benefit from more
intensive follow- up and management than can be done through repeated office visits. Many
patients being discharged from the hospital or Emergency Department fit this description.
Evidence suggests that well-organized care management by a nurse or other health
professional can reduce patients; risk of deterioration and readmission, and the associated
health care costs. One-half of patients readmitted to hospitals within 30 days of discharge
have not seen a community provider.
 4. What does this manual extract tells about medical instruments catalogue?

A. It may be helpful for guiding the one who do not have adequate knowledge about medical
equipment.
B. It covers the full range of medical instruments in use.
C. Its purpose is to provide technical support for all levels.

Manual extract: Guidelines for procurement

Procurement agencies and health facilities are required to prepare appropriate technical
specifications and descriptions of medical instruments or equipment whenever they conduct
tenders or prepare purchase orders. In order to accomplish this task effectively, knowledge of
the type, nature and specific characteristics of the instruments/equipment is essential. The main
purpose of this catalogue is, therefore, to provide technical guidance for procurement of medical
instruments/equipment by procurement agencies and health facilities. It is also hoped that this
catalogue can serve as a useful teaching aid for health personnel training institutions. The
catalogue is divided in to thirteen sections based on the areas of use of the
instruments/equipment or departments. Attempt has been made to illustrate each
instrument/equipment in picture followed by a catalogue number, specification/description and
use (where ever it is relevant). Some sections (e.g. diagnostics) are incomplete in terms of
coverage and will be treated separately in the future. At the end, an index is included for ease of
reference. The catalogue has a general nature and focuses on commonly used
instruments/equipment; it can be used by any level of health facility or procurement agency by
extracting information pertinent to its level. As it is the first attempt of its kind, the catalogue
needs improvement and updating from time to time
 5. What does this extract from a handbook tell us about physician employment?
A. Large employment of physicians are being done by Small hospitals
B. The rise of employment for physicians in hospitals would cost more
C. Paying for most productive physicians is not difficult, but to find them is difficult.

Extract from a handbook:

The healthcare industry saw a wave of physician employment by hospitals back in the 1990s,
and hospitals are again pursuing employment of physicians as a core strategy. Employing
physicians tends to work in a fee-for-service environment and should also work as hospitals
move forward into an ACO managed-care type of environment. The downside to a physician
employment strategy is that it is expensive for the hospital, and there are increasing anecdotal
discussions about the losses per physician that systems suffer as they employ physicians in
larger numbers. Here, the average productivity of the employed physicians seems to be
declining. Initially, as hospitals began to again employ physicians, there had been great focus
on hiring the most productive physicians. Now it seems as though many hospitals have an "all
in" strategy and have hired with less focus on the most productive physicians. Thus, the average
productivity per physician has regressed to a more average level.
 6. What does this manual extract emphasize that

A. the importance of ethics committee in hospitals

B. the role played by the surrogate decision maker involved in surgery
C. the importance of shared decision making between patient-surgeon

Manual extract:
Patient-Centered Informed Consent in Surgical Practice

To review the medical, ethical, and legal basis of the doctrine of informed consent for surgery
and its complications, particularly for an incapacitated patient who requires a surrogate decision
maker; to discuss the elasticity of the consent doctrine, whether surgical consent encompasses
consent for surgical complications, and emphasize the importance of communication and
shared decision making in the context of the patient-surgeon relationship; and to discuss patient
and surrogate refusal of treatment, standards of surrogate decision making, barriers to effective
communication, the role of the hospital ethics committee in resolving disputes over treatment,
and how to reconceptualize surgical consent in the context of patient-centered medicine.

Part C
In this part of the test, there are two texts about different aspects of healthcare. For questions 7-22,
choose the answer (A, B, C or D) which you think fits best according to the text.
________________________________________________________________________________

Text: 01 Teenage years risky for sports injuries

Adolescence is a vulnerable time for sports injuries and some young athletes are being pushed too
hard, the author of a new report says. The years around puberty aren't just a peak time for pimples
and mood swings; it's also when rapid changes in bones and muscle leave teens at increased risk of
injuries when they play sport. And this is bad news. Not only are injured young athletes predisposed
to health problems like arthritis later in life, but the experience can also lead them to drop out of sport
altogether and perhaps begin the downward spiral to being a couch potato.
It's something coaches need to recognise and they may need to reduce the volume of training for
certain teens, says paediatric sports medicine specialist Dr Carolyn Broderick. "I think some
coaches are overtraining adolescents at this vulnerable age. There isn't a 'one size fits all'. Some
children can cope with a higher training volume than others. It needs to be monitored. A player
who gets one overuse injury after another for example needs to have their training load reduced."

Broderick is a senior author of a new report which highlights for the first time just how common
such injuries are among the young. They make up 5 per cent of all GP visits in children, but this
jumps to 10 per cent during adolescence, the report led by researchers from the George Institute
for Global Health and the University of Sydney found. All up, 880,000 children and teens see a GP
for a musculoskeletal injury each year, it estimates. And after about age 10, more boys than girls
are affected.

Prior to puberty, sports injuries are very uncommon, says Broderick, who is also the medical
director of the Australian team for the 2014 Youth Olympic Games. But "the incredible change"
in muscles and bones around puberty is a key reason the injury rate jumps at this time. This
vulnerable phase actually starts a bit before puberty – around 10 in girls and around 12 in boys,
Broderick says. The rapid increase in the length of bones at this time seems to come at the
expense of bone strength, increasing the odds of fractures. "Because the bones are growing at a
great rate, then the muscles tend to be a bit tight too. It's a time of inflexibility."

This tightness in muscles means there is an increased pulling force on the growth plate of bones
(where muscles are attached), which can cause pain and inflammation. This is the basis of the
common conditions Sever's disease, which affects the heel of the foot, and Osgood-Schlatter
disease, which affects the knee. As well, the growth in weight and muscle bulk of teens,
particularly in boys, makes contact and collision sports more likely to result in injury – especially
when there is a mismatch in the size and weight of opposing players. (This may be a reason for
the higher injury rate of teenage boys.)

"The main problem we have in this generation is getting children and adolescents to be active,"
says Broderick, "We want them to play sport, but we need to make it as safe as it can be." Around
8 per cent of teens drop out of sport each year because of injury, and this may mean they miss
out on the health benefits exercise can bring like boosted self confidence, stronger bones, a
healthier weight, and reduced risk of diabetes and heart disease later in life.

Broderick says some measures that might help prevent injuries include:
  focusing more on skills training than excessive volumes of training around adolescence
 implementing modified rules in junior sports
 using protective equipment to stabilise joints (eg ankle braces for netball) or disperse force
(skin pads for soccer/hockey)
 incorporating into training programs specific exercises known to help reduce injury risk.

Dr David Hunter, an arthritis specialist at Sydney's Royal North Shore Hospital, says sporting
injuries in childhood are responsible for 20 to 30 per cent of osteoarthritis cases in adults, some of
whom are as young as 30. He was part of a group pushing for injury prevention exercises to
become standard in training offered for youth sports across Australia.

While this has not yet happened, the Australian Sports Commission (ASC) is currently introducing
a module on injury prevention in courses offered to coaches who become certified through the
commission, he said. However, rugby league is the only sport which has ruled that its coaches
must receive ASC accreditation, he said. Coaches from other sports may choose to but it is not
compulsory.

"It's one small step in the right direction, but there's still a lot of steps to go," he said. Children
were better off waiting until about age 15, before specialising and training hard in a single sport,
he said. "Kids specialise too early and train too hard before their bodies have a chance to properly
mature. They're often dong in excess of 20 hours a week of activity and their fatiguing and getting
overuse injuries as a result." Parents also needed to be sure to tell coaches if their kids were
getting overloaded through sport played both in and out of schools and suggest pulling back a bit
in training.

Text 1: Questions 7-14

7. What would be the reason that the author considered about young athletes are highly
prone to sport injuries

A. the addictive nature of continuous sport activities

 B. the impact of sports exercises during events

C. several factors may contribute to sport injuries

D. increasing trends of dangerous sport events

8. As per the sports medicine specialist Dr Carolyn Broderick, who he thinks are primarily
responsible for relieving stress of sport persons?

A. Coaches

B. Medical specialists

C. Event organizers

D. Sportsperson

9. What was significant about Georges institute research report?

A. Most of the younger people are not prone to fractures

B. Teenage boys are most affected than girls

C. Most adolescents are prone to sports injuries in their age after 23 years

D. The report doesn’t cover all aspects of the study

10. The phrase "the incredible change" in the fourth paragraph illustrates

A. The increased susceptibility of youth to sport injuries through physical change

B. Many people with sport injury are decreasing in recent times

C. The policymakers need to review athletes health policy

D. The athletes view on the sports injuries changed

11. What might be a reason for the higher injury rate in teenage boys?

A. Growth plates of bone

B. Size and weight mismatch of opposite players

 C. Strength muscles

D. Increased pulling speed

12. What do you understand from Broderick’s statement in the sixth paragraph?

A. He frustrated over the statements issued by the parents

B. He projected a good formula for healthy sporting

C. He advised the parents let their child play

D. He suggested the all athletes to follow healthy diet

13. Which league made their coaches compulsorily ASC accredited?

A. Cricket council

B. Football association

C. Rugby league

D. ASC Champions league

14. The word ‘It's’ defines?

A. Accreditation process

B. Rugby league

C. Australian Sports Commission

D. Training

Text-2 Cancer treatment

When Julie Marker was undergoing cancer treatment she rode her bike to and from her
chemotherapy sessions. "You would feel really seedy for a start, but then you found you actually felt
better by the time you got home," says Marker, an active member of the Cancer Voices SA cycling
group. Marker was a fit and active 45-year old when she was diagnosed with colon cancer in 2001.
Since then the cancer has returned twice, both times to her liver and both times she's had to
undergo chemotherapy and surgery. But each time, she has found exercise helped her to cope with
side effects of cancer treatment, such as fatigue and nausea. "A lot of the advice in the past from
clinicians – and not just clinicians, but also from your family and friends – has been like killing you
with kindness," Markers says.

Associate Professor Linda Denehy, head of physiotherapy at the University of Melbourne agrees the
importance of regular exercise during cancer treatment has previously been overlooked. "People,
quite rightly really, are really concerned about treating the cancer, getting the tumour to reduce in
size or getting rid of the tumour," she says. However, there are now more than 80 studies looking at
the effects of exercise training in patients following a cancer diagnosis. These have found not only is
the exercise safe, but it can also lead to significant improvements in day-to-day functioning, intensity
of symptoms, fitness, and overall health-related quality of life – a measure of how much the cancer is
impacting on wellbeing.

Cancer and exercise

Many of us are familiar with the notion that exercise reduces your chances of developing a range of
cancers. Over the past couple of decades, strong evidence has found physical activity reduces the
risk of colon, prostate, lung and gastrointestinal cancer in men, and breast and endometrial cancer in
women. It is also known that resuming regular exercise after cancer treatment can improve the long-
term prognosis for people who have had cancer. But it's only recently that researchers in the
burgeoning field of exercise oncology have started honing in on the benefits of exercise for those
currently undergoing cancer treatments, such as chemotherapy, radiotherapy and surgery.

Exercise and cancer-related fatigue

The strongest evidence for the benefits of exercise during cancer treatment is for cancer-related
fatigue, which is unlike that a healthy person experiences. "It's an unremitting fatigue, and it's not
alleviated by rest," explains Dr Catherine Granger, leader of physiotherapy research at Royal
Melbourne Hospital and lecturer at the University of Melbourne.

This fatigue is caused by a toxic mixture of chemotherapy and radiotherapy, as well as the
weakening effects of nausea, vomiting, anaemia and hormonal fluctuations that can result from the
treatments. "You'd think that by exercising you'd get tired, and that'd make it worse," says Denehy,
"but it's actually the other way around." Resting is understandably an automatic response for many
people when the fatigue sets in, but it promotes what Granger describes as a "vicious cycle" of
further losses in fitness and strength, and a worsening of symptoms. But a Cochrane systematic
review – the gold standard in weighing scientific evidence – concluded exercise is an effective of
way of reducing cancer-related fatigue both during and after cancer therapy.

Getting in shape for treatment

For someone with cancer, deconditioning, which includes a loss of fitness and muscle mass, can
begin before any diagnosis is made. This only becomes worse once treatments take their toll. A
number of studies have shown exercise programs that get people as fit as possible before starting
chemo- and radiotherapy can improve how they tolerate their treatments, as well as improve fitness
and day-to-day functioning after treatment. "The stronger you are, the higher the dose they can
give," says Denehy, "which is clearly going to be better for treating the cancer." While the benefits
are real, there is currently no recommendation to delay treatment for exercise. "But if there is a
delay," says Granger, "that's certainly a great time that we could try and get people as active as
possible."

Keeping treatment on track

Exercise during treatment can help to prevent further deconditioning, and ensure people are well
enough to continue with their treatment plans. "If you can start to recover more rapidly and you have
more days of feeling ok," says Marker, "then you can stick with the treatment." The precise reasons
why exercise is so beneficial aren't clear, although reducing inflammation, improving metabolism,
and lessening cancer-induced tissue damage and hormone fluctuations are all active avenues of
research. It's also possible that the mechanisms – and the benefits – could vary from one type of
cancer to the next. Genetic factors that influence how much benefit you gain from exercise are also
likely to be important.

As is the case with everyone, exercise also helps improve mood and mental health for people with
cancer. "If you go out for a run, it releases all of these endorphins, and you feel great," says Denehy.
"That happens in cancer, but they've got a lot more reason to have clinical depression." She and her
colleague Granger found lower levels of both anxiety and depression in lung cancer patients who
exercise. Marker agrees: "going for a walk around the block really gets you out of that negative
thinking, and relaxes you a bit".

The American College of Sports Medicine and the American Cancer Society have both published
guidelines – endorsed by Cancer Council Australia – recommending exercise for people diagnosed
with cancer. In general, the amount of physical activity recommended is the same as for the rest of
us: 30 minutes of moderate intensity exercise three to five times a week. (Australian guidelines
recommend at least five times a week.) It's not clear which mix of aerobic exercise – such as
walking, running and cycling – and strength training using weights or resistance works best.
"Currently we don't know whether one's better than another," says Denehy, "but what we tend to do
is do both." Given the vast differences between cancers and their treatments, an individual approach
is essential, according to Denehy.

Granger agrees, and hopes to see exercise integrated into cancer therapy with qualified exercise
physiologists and physiotherapists included in cancer treatment teams. For Marker, who now cycles
around 80 kilometres each week on top of her daily commute to work, exercise is about far more
than just the health benefits.

"Exercising for me was a way of being able to get back to normal, and get my life back on track
again," she says. "It was my freedom."

Questions 15-22
15. What does Julian marker felt about exercise role in her cancer treatment

A. It laid her route tasks to finish in time

B. It helped her in combating the side effects of cancer
 C. It had to start before chemotherapy for best results
D. Involving this into a part of treatment helped her to reduce weight loss

16. Associate Professor Linda Denehy, opines about exercise over cancer treatment is

A. Overlooked
B. Beneficial
C. Subsidized
D. Compounded

17. What inference can be drawn from the third paragraph?

A. Regular exercise plays a predominant role in reducing the cancer effects even after
the treatment was completed
B. Regular exercise is need not necessarily recommended by all doctors
C. Regular exercise is the only remedy for all cancers
D. Cancer treatments such as chemotherapy will have to be compounded with dietary
plan

18. The word ‘unremitting’ in the fourth paragraph defines

A. Endless
B. Effortless
C. Useless
D. Discomfort

19. What does the phrase "vicious cycle" describes in the fifth paragraph?

A. The loss of energy for exercise will further help to regain fatigue further
B. Without exercise fatigue never diminishes
C. Unbalanced exercises reduces the recovery power
D. In order to regain the energy, one has to lose energy.
 20. What was significant about exercise from the sixth paragraph?

A. Doing exercise is the ideal part of the chemotherapy

B. Significance of doing exercise before treatment will reflects in positive angle
C. Going for chemotherapy is the only ideal solution
D. Treatment does not involving the exercise plan

21. In the eighth paragraph, Marker agrees that?

A. Exercise will play a pivotal role in treatment process

B. Exercise will help you to feel good
C. Exercise will help to start positive nods
D. Exercise will enable us to start chemotherapy

22. What dies the word “It” in the last paragraph refers to

A. Treatment
B. Exercise
C. Chemotherapy
D. Surgery

END OF THE READING TEST