For the sake of understanding the deterioration behavior of concrete in actual railway tunnel structures subjected to aggressive sulfate medium in practice,detailed field investigations and tested analysis on sprayed ...For the sake of understanding the deterioration behavior of concrete in actual railway tunnel structures subjected to aggressive sulfate medium in practice,detailed field investigations and tested analysis on sprayed concrete linings of approximately 40-year-old railway tunnels in environments containing sulfate ion were carried out,respectively.The results show that the deterioration of concretes in the investigated area is serious,which involves complicated physicochemical process between the sulfate salt and concrete.Among them,the secondary sulfateminerals such as gypsum formation under very high concentration sulfate ion condition by accumulating and evaporation process dominate,followed by the crystallization of sulfate salt and formation of thaumasite.展开更多
Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Canc...Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Cancer-related Distress Management Guidelines in the context of the research site.Methods According to CAN-IMPLEMENT,the symptoms of cancer patients in Shanghai were investigated,and a work plan was formulated to adapt cancer-related distress management guidelines.The relevant clinical practice guidelines for distress management in cancer patients were searched,screened and assessed,the contents of the included clinical practice guidelines were screened,extracted and integrated,and the Cancer-related Distress Management Guidelines was developed.After peer review,the Cancer-related Distress Management Guidelines was finally formed.Results The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai.Two clinical practice guidelines related to distress management in cancer patients were included after searching,screening,assessment and selection systematically.The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II(AGREE II)were 73.75%–87.50%,respectively.The scores of most recommendations on feasibility,appropriateness,meaningfulness and effectiveness were at least 90%.The final guidelines included 13 recommendations.Conclusions The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted.The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility,suitability and effectiveness.展开更多
Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer pa...Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.展开更多
We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor...We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor.Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung.The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma.Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.展开更多
The Almighty created man for contentment, and not for suffering. Creation of the universe was a leap from absolute entropy to substance and the vital world. According to our hypothesis, the goal of creating the univer...The Almighty created man for contentment, and not for suffering. Creation of the universe was a leap from absolute entropy to substance and the vital world. According to our hypothesis, the goal of creating the universe and humans was to create enjoyment and pleasure by depressing the level of entropy. Current definitions do not adequately express the nature and origin of happiness or suffering, nor do they suggest how to treat, relieve, and prevent the torment of a healthy or sick individual. Our team developed and proposed the entropy theory as a new definition for human happiness and suffering. Entropy is a lack of order or a state of chaos. Human happiness may be defined as the complex of positive sensations, perceptions, emotions, or thoughts. These arise due to the depressed level of entropy of the individual＇s organism, empathy for others, or germane surroundings in the past, present, or in the future. Human suffering is the complex of negative sensations, perceptions, emotions, or thoughts that arise due to an increased level of entropy of a person＇s organism, empathy for others, or germane surroundings in the past, present, or future. A source of happiness and pleasure denotes depression of entropy in humans. Therefore, in order to treat suffering, one should ensure that the entropy level is reduced by complementing it with that which is missing.展开更多
Objectives:This study aimed to translate the revised 17-item Diabetes Distress Scale(DDS17,2017)into mandarin(simplified)Chinese and validate the Chinese version of DDS17(C-DDS17,2021)among adult patients with type 2 ...Objectives:This study aimed to translate the revised 17-item Diabetes Distress Scale(DDS17,2017)into mandarin(simplified)Chinese and validate the Chinese version of DDS17(C-DDS17,2021)among adult patients with type 2 diabetes in China.Methods:A scale translation and cross-sectional validation study was conducted.The DDS17 was translated into mandarin(simplified)Chinese through a five-step process:authorization,forward translation,synthesis,back translation,and amendment.During this session,59 patients assessed the understandability and readability of the translated scale.From June 7 to September 4,2021,a cross-sectional study that adhered to the COSMIN checklist was conducted with 400 individuals with type 2 diabetes from three Class A tertiary comprehensive hospitals in Beijing,China.The content,construct,convergent,discriminant validity,and reliability(Cronbach’s a coefficient and item-total correlation coefficients)of the C-DDS17 were evaluated.This study was a part of a project registered in the Chinese Clinical Trial Registry(no.ChiCTR2100047071).Results:Among the participants,33.3%(133/400)of them experienced moderate to high diabetes distress.The content validity indices of the C-DDS17 equaled 1.00.The scale yielded a four-factor structure.The average variances extracted were 0.42e0.57,which was lower than squared correla-tions.Cronbach’s a coefficient was 0.88 for the overall scale and ranged from 0.76 to 0.81 for sub-scales.Corrected item-total correlation coefficients ranged from 0.42 to 0.61.The eighth item(“Feeling that I am often failing with my diabetes routine”)was better fit to physician distress than regimen distress but had little influence on the validation results.Conclusions:The C-DDS17 is a reliable and valid instrument for assessing diabetes distress in patients with type 2 diabetes.It is a promising instrument for early identification and management of diabetes distress in clinical practice and trials.展开更多
If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. First...If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.展开更多
基金Project(2008G025-C) supported by the Ministry of Railway of ChinaProject(50708114) supported by the National Natural Science Foundation of China
文摘For the sake of understanding the deterioration behavior of concrete in actual railway tunnel structures subjected to aggressive sulfate medium in practice,detailed field investigations and tested analysis on sprayed concrete linings of approximately 40-year-old railway tunnels in environments containing sulfate ion were carried out,respectively.The results show that the deterioration of concretes in the investigated area is serious,which involves complicated physicochemical process between the sulfate salt and concrete.Among them,the secondary sulfateminerals such as gypsum formation under very high concentration sulfate ion condition by accumulating and evaporation process dominate,followed by the crystallization of sulfate salt and formation of thaumasite.
文摘Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Cancer-related Distress Management Guidelines in the context of the research site.Methods According to CAN-IMPLEMENT,the symptoms of cancer patients in Shanghai were investigated,and a work plan was formulated to adapt cancer-related distress management guidelines.The relevant clinical practice guidelines for distress management in cancer patients were searched,screened and assessed,the contents of the included clinical practice guidelines were screened,extracted and integrated,and the Cancer-related Distress Management Guidelines was developed.After peer review,the Cancer-related Distress Management Guidelines was finally formed.Results The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai.Two clinical practice guidelines related to distress management in cancer patients were included after searching,screening,assessment and selection systematically.The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II(AGREE II)were 73.75%–87.50%,respectively.The scores of most recommendations on feasibility,appropriateness,meaningfulness and effectiveness were at least 90%.The final guidelines included 13 recommendations.Conclusions The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted.The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility,suitability and effectiveness.
基金funded by Fudan-Fuxing Nursing Research Funds(No.FNF201701)JBI Evidence Based Clinical Fellowship Pro-gram Funds(No.FNF201861)from Fudan University,China.
文摘Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.
文摘We report a 43-year-old man who presented with a right painful shoulder mass and bilateral lung masses in computed tomography(CT).Scapular mass was excised and pathology report demonstrated high-grade metastatic tumor.Same side lung biopsy and histopathological study characterized tuberculosis but biopsy of the left lung lesion identified adenocarcinoma of the lung.The final diagnosis was right scapular metastatic lesion from left lung adenocarcinoma.Musculoskeletal symptoms are commonly encountered in lung malignancies due to paraneoplastic syndrome or hematogenous metastasis but scapular metastasis on the other side as the presentation of lung cancer is extremely rare.
文摘The Almighty created man for contentment, and not for suffering. Creation of the universe was a leap from absolute entropy to substance and the vital world. According to our hypothesis, the goal of creating the universe and humans was to create enjoyment and pleasure by depressing the level of entropy. Current definitions do not adequately express the nature and origin of happiness or suffering, nor do they suggest how to treat, relieve, and prevent the torment of a healthy or sick individual. Our team developed and proposed the entropy theory as a new definition for human happiness and suffering. Entropy is a lack of order or a state of chaos. Human happiness may be defined as the complex of positive sensations, perceptions, emotions, or thoughts. These arise due to the depressed level of entropy of the individual＇s organism, empathy for others, or germane surroundings in the past, present, or in the future. Human suffering is the complex of negative sensations, perceptions, emotions, or thoughts that arise due to an increased level of entropy of a person＇s organism, empathy for others, or germane surroundings in the past, present, or future. A source of happiness and pleasure denotes depression of entropy in humans. Therefore, in order to treat suffering, one should ensure that the entropy level is reduced by complementing it with that which is missing.
文摘Objectives:This study aimed to translate the revised 17-item Diabetes Distress Scale(DDS17,2017)into mandarin(simplified)Chinese and validate the Chinese version of DDS17(C-DDS17,2021)among adult patients with type 2 diabetes in China.Methods:A scale translation and cross-sectional validation study was conducted.The DDS17 was translated into mandarin(simplified)Chinese through a five-step process:authorization,forward translation,synthesis,back translation,and amendment.During this session,59 patients assessed the understandability and readability of the translated scale.From June 7 to September 4,2021,a cross-sectional study that adhered to the COSMIN checklist was conducted with 400 individuals with type 2 diabetes from three Class A tertiary comprehensive hospitals in Beijing,China.The content,construct,convergent,discriminant validity,and reliability(Cronbach’s a coefficient and item-total correlation coefficients)of the C-DDS17 were evaluated.This study was a part of a project registered in the Chinese Clinical Trial Registry(no.ChiCTR2100047071).Results:Among the participants,33.3%(133/400)of them experienced moderate to high diabetes distress.The content validity indices of the C-DDS17 equaled 1.00.The scale yielded a four-factor structure.The average variances extracted were 0.42e0.57,which was lower than squared correla-tions.Cronbach’s a coefficient was 0.88 for the overall scale and ranged from 0.76 to 0.81 for sub-scales.Corrected item-total correlation coefficients ranged from 0.42 to 0.61.The eighth item(“Feeling that I am often failing with my diabetes routine”)was better fit to physician distress than regimen distress but had little influence on the validation results.Conclusions:The C-DDS17 is a reliable and valid instrument for assessing diabetes distress in patients with type 2 diabetes.It is a promising instrument for early identification and management of diabetes distress in clinical practice and trials.
文摘If a patient is dying and still suffering great pain, what is the least harmful alternative? Here we prefer continuous sedation until death (CSD). CSD differs from physician-assisted death (PAD) in many aspects. Firstly, CSD is not used to shorten life or cause death, but instead its intention is to relieve suffering. Secondly, once CSD is associated with a reduction in or suspension of food intake, the duration of sedation is too short to have an impact on survival rate. Thirdly, CSD is titrated while PAD is often overdosed. Fourthly, the sanctity of life could be maintained since sedation is used merely as a means of quelling suffering. Last but no least, for unconscious patients, the same medicines are frequently used for both palliative sedation and standard surgical procedures.
