Arthur Miller's masterpiece Death of a Salesman is a very clear attack on the American success myth.The most dominant theme running throughout the play is Willy Loman's philosophy of personal attractiveness an...Arthur Miller's masterpiece Death of a Salesman is a very clear attack on the American success myth.The most dominant theme running throughout the play is Willy Loman's philosophy of personal attractiveness and its doomed futility.This philosophy not only brings failure to Willy's career but also destruction to Willy's family members.展开更多
BACKGROUND As the population of the United States ages,there has been an increasing number of elderly patients with cirrhosis listed for transplant.Previous studies have shown variable results in terms of the relative...BACKGROUND As the population of the United States ages,there has been an increasing number of elderly patients with cirrhosis listed for transplant.Previous studies have shown variable results in terms of the relative survival benefit for elderly liver transplant(LT)recipients.There may be factors that are associated with a poor post-transplant outcome which may help determine which elderly patients should and should not be listed for LT.AIM To identify factors associated with futility of transplant in elderly patients.METHODS This was a retrospective study of all patients above the age of 45 who underwent liver transplantation at our tertiary care center between January 2010 and March 2020(n=1019).“Elderly”was defined as all patients aged 65 years and older.Futile outcome was defined as death within 90 d of transplant.Logistic regression analysis was performed to determine what variables,if any were associated with futile outcome in elderly patients.Secondary outcomes such as one year mortality and discharge to facility(such as skilled nursing facility or long-term acute care hospital)were analyzed in the entire sample,compared across three age groups(45-54,55-64,and 65+years).RESULTS There was a total of 260 elderly patients who received LT in the designated time period.A total of 20 patients met the definition of“futile”outcome.The mean Model of End-Stage Liver Disease scores in the futile and non-futile group were not significantly different(21.78 in the futile group vs 19.66 in the“non-futile”group).Of the variables tested,only congestive heart failure was found to have a statistically significant association with futile outcome in LT recipients over the age of 65(P=0.001).Of these patients,all had diastolic heart failure with normal ejection fraction and at least grade I diastolic dysfunction as measured on echocardiogram.Patients aged 65 years and older were more likely to have the outcomes of death within 1 year of LT[hazard ratio:1.937,confidence interval(CI):1.24-3.02,P=0.003]and discharge to facility(odds ratio:1.94,CI:1.4-2.8,P<0.001)compared to patients in younger age groups.CONCLUSION Diastolic heart failure in the elderly may be a predictor of futility post liver transplant in elderly patients.Elderly LT recipients may have worse outcomes as compared to younger patients.展开更多
One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care However, no agreement has ever been reached on what ...One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care However, no agreement has ever been reached on what the exact defmition of futility is, as it is not only based on temporary values but also evolves into different subtypes, making it harder to define. The difficulty in dealing with futility problem is how doctors evaluate the futile situation, which is further complicated by lack of standards for specific diseases and experience-based prognosis, leading to subjectivity in evaluation for futility.展开更多
Medical futility has been proposed for many years to define the procedure that simply prolongs the suffering of patients but heals nothing.To deal with the decision procedure for treatment,two ideas arise：patients＇a...Medical futility has been proposed for many years to define the procedure that simply prolongs the suffering of patients but heals nothing.To deal with the decision procedure for treatment,two ideas arise：patients＇autonomy and doctors＇authority.Widely recognized in 1960s,patients＇autonomy respected patients＇willingness over treatment,requiring specific consent for treatment and right to choose during medical procedure.Another idea for futility is doctors＇authority,explained from the paternalistic perspective as well.展开更多
When the historical data of the early phase trial and the interim data of the Phase II trial are avail-able,we should use them to give a more accurate prediction in both futility and efficacy analysis.The predictive p...When the historical data of the early phase trial and the interim data of the Phase II trial are avail-able,we should use them to give a more accurate prediction in both futility and efficacy analysis.The predictive power is an important measure of the practical utility of a proposed trial,and it is better than the classical statistical power in giving a good indication of the probability that the trial will demonstrate a positive or statistically significant outcome.In addition to the four predic-tive powers with historical and interim data available in the literature and summarized in Table 1,we discover and calculate another four predictive powers also summarized in Table 1,for one-sided hypotheses.Moreover,we calculate eight predictive powers summarized in Table 2,for the reversed hypotheses.The combination of the two tables gives us a complete picture of the pre-dictive powers with historical and interim data for futility and efficacy analysis.Furthermore,the eight predictive powers with historical and interim data are utilized to guide the futility analysis in the tamoxifen example.Finally,extensive simulations have been conducted to investigate the sensitivity analysis of priors,sample sizes,interim result and interim time on different predictive powers.展开更多
A method of activation roasting followed by acid leaching using titanium slag was introduced to prepare Ti-rich material. The effects of HaPO4 dosage, roasting temperature, and roasting time on TiO2 grade were investi...A method of activation roasting followed by acid leaching using titanium slag was introduced to prepare Ti-rich material. The effects of HaPO4 dosage, roasting temperature, and roasting time on TiO2 grade were investigated. A Ti-rich material containing 88.54% TiO2, 0.42% （CaO＋MgO） was obtained when finely ground titanium slag was roasted with 7.5% H3PO4 at 1000 ℃ for 2 h, followed by a two-stage leaching in boiling dilute sulfuric acid for 2 h. The XRD patterns show that the product is titanium dioxide with a rutile structure. Mechanism studies show that structures of anosovite solid solution and silicate minerals are destroyed in the roasting process. As a result, titanium components in titanium slag are transformed into TiO2 （futile） while impurities are transformed into acid-soluble phosphate and quartz.展开更多
Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to mak...Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.展开更多
Purpose: To explore anesthesiologists’ perceptions of the reasons underlying why physicians continue to provide care that they consider futile. Methods: A qualitative study was conducted utilizing a grounded theory a...Purpose: To explore anesthesiologists’ perceptions of the reasons underlying why physicians continue to provide care that they consider futile. Methods: A qualitative study was conducted utilizing a grounded theory approach. Four separate focus groups (2 resident physician groups and 2 attending physician groups) were conducted over a three week span. An interview guide was used consisting of a proposed definition of futility and five open-ended questions. Responses to the five open-ended questions were used to guide follow up questions. Transcribed audio recordings were then analyzed. Results: With data reduction, we were able to separate responses into definitions of futility, stories of cases where futile care was provided, and opinions as to the underlying causes of continuing to provide futile care. A variety of opinions was obtained, suggesting the possibility that different groups (surgeons, anesthesiologists, family members) view questions of futility differently. Conclusions: Complete agreement on a definition of futility does not exist. Even when some agreement exists, there is great difficulty in predicting outcomes in individual cases. Future quantitative studies may provide more evidence of trends in underlying reasons for providing futile care. Focused education efforts may then lead to more agreement between all involved.展开更多
In patients with epithelian ovarian cancer who have achieved remission after initial surgery and induction chemotherapy, the role of maintenance chemotherapy is controversial. We carried out a trial-sequential analysi...In patients with epithelian ovarian cancer who have achieved remission after initial surgery and induction chemotherapy, the role of maintenance chemotherapy is controversial. We carried out a trial-sequential analysis that included 4 randomised controlled trials. The end-point was progression at 3 years while the boundary for non-inferiority was set at ±20% in risk ratio. The results of our trial-sequential analysis indicated the futility of maintenance chemotherapy, i.e. proof of no effectiveness. Consequently, no further trials of this type should be performed to assess the effectiveness of this intervention in this clinical condition.展开更多
<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The decision to stop anti-cancer treatment is frau...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The decision to stop anti-cancer treatment is fraught with many challenges for the oncologist, the patient, and their caregivers. This review examines the special considerations surrounding the decision to cease chemotherapy in terminally ill cancer patient. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A comprehensive literature search was conducted to find relevant publications on chemotherapy cessation. A total of 2700 records were retrieved and 141 were identified as eligible for inclusion in this review. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Palliative chemotherapy does not achieve the goal of tumor-related symptom reduction for patients who have experienced progressive disease with more than two prior lines of chemotherapy. ECOG performance status is a crucial predictor of response to therapy and chemotherapy-related complications. Challenges to stopping chemotherapy at the end of life are multifactorial and are both patient and physician-driven. Racial, ethnic, and income-based disparities are seen in the timing and quality of end-of-life conversations offered by physicians to their patients. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> The decision to cease chemotherapy is one that should be approached with careful consideration and accurate information. Clear communication, compassion and empathy are important components to the therapeutic relationship. Early involvement of palliative care and clear conversations about prognosis and the expected utility of further chemotherapy is essential to conduct the best possible care for cancer patients at the end of life.</span></span></span></span>展开更多
“Objective Correlative”theory was first proposed by T.S. Eliot, who holds that people’s emotion can find expression in a series of objective correlative. In his poem The Love Song of J.Alfred Prufrock, the use of o...“Objective Correlative”theory was first proposed by T.S. Eliot, who holds that people’s emotion can find expression in a series of objective correlative. In his poem The Love Song of J.Alfred Prufrock, the use of objective correlative fully reflects and reveals modern people’s loneliness, futility and alienation.展开更多
TiN- Al2O3 composite powder was prepared by aluminothermic reduction- nitridation method with starting materials of aluminum-containing dross and rutile,and metallic aluminum in the aluminum-containing dross as reduce...TiN- Al2O3 composite powder was prepared by aluminothermic reduction- nitridation method with starting materials of aluminum-containing dross and rutile,and metallic aluminum in the aluminum-containing dross as reducer. The influences of synthesis temperature（600-1 400 ℃） and aluminum-containing dross addition（20% lower than theoretical value,theoretical value,20% higher than theoretical value,and 50% higher than theoretical value） on phase compositions and microstructure of the composites were investigated,and the reaction mechanism was analyzed. The results show that（1） TiN- Al2O3 composite powder can be synthesized under the experimental conditions; the main phases are TiN,α-Al2O3,a little bytownite,and MgAl2O4;（2）enhancing synthesis temperature or increasing aluminumcontaining dross addition favors the reaction of aluminothermic reduction- nitridation;（3） in the synthesized products,α-Al2O3 is platy or columnar; TiN is sub-micron granular,which reinforces and toughens the composite.展开更多
Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organiza...Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.展开更多
Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing ...Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing is considered to be an ethically important profession, and nurses aim to achieve ethical goals such as providing the best possible care to patients, achieving high quality outcomes, but it is common when there are insufficient numbers of staff, inadequately trained staff, and organizational policies and procedures that make it difficult, or even impossible, for nurses to meet the needs of patients and their families. This conflict results in moral distress for nurses, yet limited attention has been paid to this phenomenon. Objective: To explore the current phenomenon of moral distress and its triggering factors in nurses in tertiary grade A hospitals in Wuhan, by targeting root causes and understanding the interplay between nurses and settings where moral distress occurs, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care. Method: Totally 384 nurses from clinical departments in 2 tertiary Grade A hospitals in Wuhan were investigated with the Chinese version Moral Distress Scale-Revised (MDS-R). Result: The total score of moral distress was 47.41 ± 27.14, and the mean scores of moral distress frequency and intensity were 1.01 ± 0.53 and 1.19 ± 0.61, which were at a lower level. The main source of moral distress for nurses is related to end-of-life care and medical decision communication;Nurses’ moral distress scores were statistically significant (P Conclusion: Hospital facility leaders and nursing managers need to train nurses to develop competency development such as reflection, empathy, communication, positive thinking, and emotional intelligence to practice ethical dilemma response, and facilitate collaborative communication among healthcare members, so as to alleviate moral distress in nurses.展开更多
The commercial TiO2 nanopowder and micropowder of anatase phase and rutile phase have been characterized by X-ray diffraction （XRD） and electron spin resonance （ESR） spectroscopy. XRD patterns and ESR spectra of n...The commercial TiO2 nanopowder and micropowder of anatase phase and rutile phase have been characterized by X-ray diffraction （XRD） and electron spin resonance （ESR） spectroscopy. XRD patterns and ESR spectra of nano-TiO2 in rutile and anatase phases exhibit broad peaks whereas both phases of micro-TiOz demonstrate very sharp peaks. Furthermore, the anatase phase of both particle sizes provide ESR peak at a magnetic field around 3568.25G, On the other hand, this peak is not established in the rutile phase of both particle sizes.展开更多
Students in many parts of the world are heading back to school for a new semester. In the same vain, it is also time for trade trade hawks in Washington to start learning at least four lessons from their futile trade ...Students in many parts of the world are heading back to school for a new semester. In the same vain, it is also time for trade trade hawks in Washington to start learning at least four lessons from their futile trade war with China.展开更多
文摘Arthur Miller's masterpiece Death of a Salesman is a very clear attack on the American success myth.The most dominant theme running throughout the play is Willy Loman's philosophy of personal attractiveness and its doomed futility.This philosophy not only brings failure to Willy's career but also destruction to Willy's family members.
文摘BACKGROUND As the population of the United States ages,there has been an increasing number of elderly patients with cirrhosis listed for transplant.Previous studies have shown variable results in terms of the relative survival benefit for elderly liver transplant(LT)recipients.There may be factors that are associated with a poor post-transplant outcome which may help determine which elderly patients should and should not be listed for LT.AIM To identify factors associated with futility of transplant in elderly patients.METHODS This was a retrospective study of all patients above the age of 45 who underwent liver transplantation at our tertiary care center between January 2010 and March 2020(n=1019).“Elderly”was defined as all patients aged 65 years and older.Futile outcome was defined as death within 90 d of transplant.Logistic regression analysis was performed to determine what variables,if any were associated with futile outcome in elderly patients.Secondary outcomes such as one year mortality and discharge to facility(such as skilled nursing facility or long-term acute care hospital)were analyzed in the entire sample,compared across three age groups(45-54,55-64,and 65+years).RESULTS There was a total of 260 elderly patients who received LT in the designated time period.A total of 20 patients met the definition of“futile”outcome.The mean Model of End-Stage Liver Disease scores in the futile and non-futile group were not significantly different(21.78 in the futile group vs 19.66 in the“non-futile”group).Of the variables tested,only congestive heart failure was found to have a statistically significant association with futile outcome in LT recipients over the age of 65(P=0.001).Of these patients,all had diastolic heart failure with normal ejection fraction and at least grade I diastolic dysfunction as measured on echocardiogram.Patients aged 65 years and older were more likely to have the outcomes of death within 1 year of LT[hazard ratio:1.937,confidence interval(CI):1.24-3.02,P=0.003]and discharge to facility(odds ratio:1.94,CI:1.4-2.8,P<0.001)compared to patients in younger age groups.CONCLUSION Diastolic heart failure in the elderly may be a predictor of futility post liver transplant in elderly patients.Elderly LT recipients may have worse outcomes as compared to younger patients.
文摘One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care However, no agreement has ever been reached on what the exact defmition of futility is, as it is not only based on temporary values but also evolves into different subtypes, making it harder to define. The difficulty in dealing with futility problem is how doctors evaluate the futile situation, which is further complicated by lack of standards for specific diseases and experience-based prognosis, leading to subjectivity in evaluation for futility.
文摘Medical futility has been proposed for many years to define the procedure that simply prolongs the suffering of patients but heals nothing.To deal with the decision procedure for treatment,two ideas arise：patients＇autonomy and doctors＇authority.Widely recognized in 1960s,patients＇autonomy respected patients＇willingness over treatment,requiring specific consent for treatment and right to choose during medical procedure.Another idea for futility is doctors＇authority,explained from the paternalistic perspective as well.
基金The research was supported by National Social Science Fund of China[grant number 21XTJ001].
文摘When the historical data of the early phase trial and the interim data of the Phase II trial are avail-able,we should use them to give a more accurate prediction in both futility and efficacy analysis.The predictive power is an important measure of the practical utility of a proposed trial,and it is better than the classical statistical power in giving a good indication of the probability that the trial will demonstrate a positive or statistically significant outcome.In addition to the four predic-tive powers with historical and interim data available in the literature and summarized in Table 1,we discover and calculate another four predictive powers also summarized in Table 1,for one-sided hypotheses.Moreover,we calculate eight predictive powers summarized in Table 2,for the reversed hypotheses.The combination of the two tables gives us a complete picture of the pre-dictive powers with historical and interim data for futility and efficacy analysis.Furthermore,the eight predictive powers with historical and interim data are utilized to guide the futility analysis in the tamoxifen example.Finally,extensive simulations have been conducted to investigate the sensitivity analysis of priors,sample sizes,interim result and interim time on different predictive powers.
基金Project(NCET-10-0834) supported by the Program for New Century Excellent Talents in University,China
文摘A method of activation roasting followed by acid leaching using titanium slag was introduced to prepare Ti-rich material. The effects of HaPO4 dosage, roasting temperature, and roasting time on TiO2 grade were investigated. A Ti-rich material containing 88.54% TiO2, 0.42% （CaO＋MgO） was obtained when finely ground titanium slag was roasted with 7.5% H3PO4 at 1000 ℃ for 2 h, followed by a two-stage leaching in boiling dilute sulfuric acid for 2 h. The XRD patterns show that the product is titanium dioxide with a rutile structure. Mechanism studies show that structures of anosovite solid solution and silicate minerals are destroyed in the roasting process. As a result, titanium components in titanium slag are transformed into TiO2 （futile） while impurities are transformed into acid-soluble phosphate and quartz.
文摘Case description:Withdrawal of treatment is a common practice in critical care settings,perticularly when treatment is considered futile.The case study demonstrates an ethical dilemma,in which Danny is unlikely to make a functional recovery because of multiple organ dysfunction syndromes.Under such a circumstance,withdrawal of treatment will inevitably be considered,although his family refused to do so.Consequently,acritical question must be answered:Who should make the decision?Ethical dilemma identification:Danny decided to withdraw the use of life-support,whilst his wife and adult children refused to do so.The ethical dilemma is illustrated by the following question:Who decides the withdrawal of treatment in a critical care setting?Analysis:To provide an opotional solution to this case and make the best moral decision,the current study will critically discuss this issue in conjunction with ethical principles,philosophical theories and the values statement of the European and Chinese nurses'codes of ethics.Additionally,the associated literature relative to this case are analysed before the decision-making.Ethical decision-making:The best ethical decision is Danny can decide whether to withhold or withdraw life-sustaining treatment.If his family is involved in the discussion,the medical staff should balance the ethical principles when they make the decision and allocate reasonable resources for patients.Results:In Danny's case,health professionals opted to respect his decision to withdraw treatment.The medical staff maintained an effective communication with the family involved,and provided the appropriate intervention to collaborate with other health care professionals to perfect further care.
文摘Purpose: To explore anesthesiologists’ perceptions of the reasons underlying why physicians continue to provide care that they consider futile. Methods: A qualitative study was conducted utilizing a grounded theory approach. Four separate focus groups (2 resident physician groups and 2 attending physician groups) were conducted over a three week span. An interview guide was used consisting of a proposed definition of futility and five open-ended questions. Responses to the five open-ended questions were used to guide follow up questions. Transcribed audio recordings were then analyzed. Results: With data reduction, we were able to separate responses into definitions of futility, stories of cases where futile care was provided, and opinions as to the underlying causes of continuing to provide futile care. A variety of opinions was obtained, suggesting the possibility that different groups (surgeons, anesthesiologists, family members) view questions of futility differently. Conclusions: Complete agreement on a definition of futility does not exist. Even when some agreement exists, there is great difficulty in predicting outcomes in individual cases. Future quantitative studies may provide more evidence of trends in underlying reasons for providing futile care. Focused education efforts may then lead to more agreement between all involved.
文摘In patients with epithelian ovarian cancer who have achieved remission after initial surgery and induction chemotherapy, the role of maintenance chemotherapy is controversial. We carried out a trial-sequential analysis that included 4 randomised controlled trials. The end-point was progression at 3 years while the boundary for non-inferiority was set at ±20% in risk ratio. The results of our trial-sequential analysis indicated the futility of maintenance chemotherapy, i.e. proof of no effectiveness. Consequently, no further trials of this type should be performed to assess the effectiveness of this intervention in this clinical condition.
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> The decision to stop anti-cancer treatment is fraught with many challenges for the oncologist, the patient, and their caregivers. This review examines the special considerations surrounding the decision to cease chemotherapy in terminally ill cancer patient. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">A comprehensive literature search was conducted to find relevant publications on chemotherapy cessation. A total of 2700 records were retrieved and 141 were identified as eligible for inclusion in this review. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Palliative chemotherapy does not achieve the goal of tumor-related symptom reduction for patients who have experienced progressive disease with more than two prior lines of chemotherapy. ECOG performance status is a crucial predictor of response to therapy and chemotherapy-related complications. Challenges to stopping chemotherapy at the end of life are multifactorial and are both patient and physician-driven. Racial, ethnic, and income-based disparities are seen in the timing and quality of end-of-life conversations offered by physicians to their patients. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> The decision to cease chemotherapy is one that should be approached with careful consideration and accurate information. Clear communication, compassion and empathy are important components to the therapeutic relationship. Early involvement of palliative care and clear conversations about prognosis and the expected utility of further chemotherapy is essential to conduct the best possible care for cancer patients at the end of life.</span></span></span></span>
文摘“Objective Correlative”theory was first proposed by T.S. Eliot, who holds that people’s emotion can find expression in a series of objective correlative. In his poem The Love Song of J.Alfred Prufrock, the use of objective correlative fully reflects and reveals modern people’s loneliness, futility and alienation.
文摘TiN- Al2O3 composite powder was prepared by aluminothermic reduction- nitridation method with starting materials of aluminum-containing dross and rutile,and metallic aluminum in the aluminum-containing dross as reducer. The influences of synthesis temperature（600-1 400 ℃） and aluminum-containing dross addition（20% lower than theoretical value,theoretical value,20% higher than theoretical value,and 50% higher than theoretical value） on phase compositions and microstructure of the composites were investigated,and the reaction mechanism was analyzed. The results show that（1） TiN- Al2O3 composite powder can be synthesized under the experimental conditions; the main phases are TiN,α-Al2O3,a little bytownite,and MgAl2O4;（2）enhancing synthesis temperature or increasing aluminumcontaining dross addition favors the reaction of aluminothermic reduction- nitridation;（3） in the synthesized products,α-Al2O3 is platy or columnar; TiN is sub-micron granular,which reinforces and toughens the composite.
文摘Background: After more than a decade of the nursing profession contending that healthcare reform based almost exclusively on cost cutting was creating an array of serious ethical issues for nurses, healthcare organizations and other providers are now facing increasing demands primarily from payers to demonstrate improvement in both quality of care and patient experience along with continued cost reduction. Research Question: Have efforts by healthcare organizations to comply with these recently imposed requirements influenced the ethical environment faced by nurses and nurse leaders and if so, how? Materials and Methods: Data for assessing the current ethical environment was gathered with a close-ended survey mailed in October 2012 to a random sample of 3000 members of the American Organization of Nurse Executives. Results and Discussion: Statistical analysis of the data and comparison with the findings of a similar study conducted in 2000 indicated that along with five highly rated issues in the earlier study attributed largely to economic constraints imposed by healthcare organizations, the top-10 key ethical issues today included five issues primarily attributable to interprofessional conflict. Conclusion: Given the success of many ongoing efforts aimed at weakening these key sources of ethical conflict that have blocked many proposals to improve the quality of care, opportunities should arise for the nursing profession to more fully achieve its goals of improving the quality of care, safety and patient satisfaction and enhancing nurses’ work environments essential to that effort.
文摘Background: As medical technology has advanced, it has also made it possible to maintain end-stage life support for longer periods of time, but it has also been accompanied by a debate about ineffective care, nursing is considered to be an ethically important profession, and nurses aim to achieve ethical goals such as providing the best possible care to patients, achieving high quality outcomes, but it is common when there are insufficient numbers of staff, inadequately trained staff, and organizational policies and procedures that make it difficult, or even impossible, for nurses to meet the needs of patients and their families. This conflict results in moral distress for nurses, yet limited attention has been paid to this phenomenon. Objective: To explore the current phenomenon of moral distress and its triggering factors in nurses in tertiary grade A hospitals in Wuhan, by targeting root causes and understanding the interplay between nurses and settings where moral distress occurs, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care. Method: Totally 384 nurses from clinical departments in 2 tertiary Grade A hospitals in Wuhan were investigated with the Chinese version Moral Distress Scale-Revised (MDS-R). Result: The total score of moral distress was 47.41 ± 27.14, and the mean scores of moral distress frequency and intensity were 1.01 ± 0.53 and 1.19 ± 0.61, which were at a lower level. The main source of moral distress for nurses is related to end-of-life care and medical decision communication;Nurses’ moral distress scores were statistically significant (P Conclusion: Hospital facility leaders and nursing managers need to train nurses to develop competency development such as reflection, empathy, communication, positive thinking, and emotional intelligence to practice ethical dilemma response, and facilitate collaborative communication among healthcare members, so as to alleviate moral distress in nurses.
基金supported by the Department of Physics,Faculty of Science,King Mongkut's University of Technology Thonburi
文摘The commercial TiO2 nanopowder and micropowder of anatase phase and rutile phase have been characterized by X-ray diffraction （XRD） and electron spin resonance （ESR） spectroscopy. XRD patterns and ESR spectra of nano-TiO2 in rutile and anatase phases exhibit broad peaks whereas both phases of micro-TiOz demonstrate very sharp peaks. Furthermore, the anatase phase of both particle sizes provide ESR peak at a magnetic field around 3568.25G, On the other hand, this peak is not established in the rutile phase of both particle sizes.
文摘Students in many parts of the world are heading back to school for a new semester. In the same vain, it is also time for trade trade hawks in Washington to start learning at least four lessons from their futile trade war with China.
