关于改进和加强新形势下区社院培训工作的调研报告

本文在回顾总结上海市卢湾区社院近年来培训工作现状和特点的基础上,对新世纪、新阶段区社院的培训工作所出现的新情况、面临的新任务作了深入探索和分析,并就如何改进和加强新形势下区社院的培训工作提出了几点思考和建议。

Clinical presentation and endoscopic management of Dieulafoy's lesions in an urban community hospital

AIM:To identify rates of occurrence,common clinical and endoscopic features,and to review the outcome of endoscopic management of Dieulafoy's lesions in the upper gastrointestinal (GI) tract in an urban community hospital setting. METHODS:Endoscopic data from esophagogastroduo denoscopies (EGDs),done at Wyckoff Heights Medical Center,Brooklyn,NY between 2000 and 2006 were reviewed to identify patients with Dieulafoy's lesions. Demographic data,medical history,examination findings,lab data,endoscopic findings and details of therapy for patients treated for Dieulafoy's lesions were reviewed retrospectively. RESULTS:Dieulafoy's lesions were documented to be the cause of bleeding in approximately 1% of patients presenting with upper gastrointestinal bleeding,while they were detected in only 2 patients when the indications for EGDs were different from active GI bleeding. When we analyzed EGDs performed in patients above age 65 years presenting with gastrointestinal bleeding,prevalence of Dieulafoy's lesions approached 10 percent. The most common location of the lesion was the body of stomach (7),followed by the cardia (4) and the esophagus (2). One patient had this lesion in the fundus and one patient in the duodenal apex. All patients were initially treated endoscopically with epinephrine injection,in eight cases heater probe was applied following epinephrine and endoscopic clips were applied in two cases. All but one of the patients did well in near and intermediate term follow-up (average follow-up period of 18 mo). One patient died of multi-organ failure during the same hospital stay. Average length hospital stay was 7 d.CONCLUSION:Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy,especially in patients with multiple co-morbid conditions,can be very effective and life saving.

Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital

Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment （at minimum intravenously diuretics）. Results We included 102 patients （mean age 79 ± 12 years）. Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections （29%）, arrhythmias （25%）, acute coronary ischemia （22%）, and uncontrolled hypertension （15%）, miscellaneous causes were detected in 18% of the cases （progression of renal disease 60%, anemia 30% and iatrogenic factors 10%）. Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.

Motivating Community College Students When Teaching Argumentative Rhetorical Style Using a Documentary： Devil＇s Playground

Competence in academic writing in college is a challenging as well as an engaging task for many college students. Argumentative writing and acknowledging the counterargument is one of modes that is introduced in freshman classes; however, college students approach writing with a certain mindset. Learning to write in different modes could be exciting when taught utilizing a film or a documentary. Using a documentary, such as Devil＇s Playground, writing professors not only initiate interest in culture learning and cultural understanding but also motivate students to use argumentation to foster critical thinking as well as cultural understanding.

The Hungarian Community in Ferrara at the Estes Court （15-16th Centuries）

This paper, that has been introduced at the annual meeting of the Renaissance Society of America （Washington, March 22, 2012）, is a little part of a wider research about migration and movements of people between Western and Eastern Europe （and vice versa） that, started one year ago, is still in progress. Despite a common thought that had considered, still in 15th century, Hungarians as unculturished and violent people, the town of Ferrara, ruled by the Estes, had welcomed many of them during the 15-16th centuries. They were, above all, and as the sources testify, literati and students. This paper tries to show and analyze the cultural reasons and the background that have determined Hungarians＇ presence in Ferrara during the Renaissance, with the consciousness that if many sources have been studied, many others must be

Emergence of Temple Centered Society in Early Bihar： Mundesvari Inscription a Case in Point

In the early medieval economic and social circumstances religious centers developed in Bihar, which further led to the construction of temples by the rulers as well as by the locally powerful communities. It must be noted that these temples were not as gigantic or of great artistic value either as compared to the Buddhist monasteries of contemporary Bihar. The reason behind this was probably the fact that the Buddhist monasteries were built by the state or supported directly by them as well as patronized by the rich business community. On the contrary, few of the Brahamanical structures were getting these advantages and they were having support of the local followers. From the various excavation and exploration reports by archaeologists, temple structures of this period have been reported very often. But the ancient historiography of Bihar obsessed with the Buddhist, Jaina and other heterodox monuments, has tended to just ignore it. The question why such a large number of temples came up during this period, which is spread over the whole of modem Bihar, particularly near the important Buddhist sites, was never posed. Moreover, the question why the Pala rulers who were known for their Buddhist inclination later extended critical support to Brahmans has also remained unaddressed.

Pharmacist Integration into Transitions of Care at a Community Hospital： Skilled Nursing Facility Discharges

In 2012-2013, CMH （Community Memorial Hospital） had a 10.5% 30-day readmission rate from SNFs （skilled nursing facilities）. The focus of the Connections of Care Coalition was to review the medication reconciliation process and to involve pharmacists in the transition of patients to SNFs. The objective of the project was to work as an interdisciplinary team to improve the communication during transitions of care from our hospital to local SNFs by identifying key issues and initiating pharmacy practice change. This quality improvement project had a pre-post study design. Patients older than 18 years of age discharged to SNFs and/or readmitted from SNFs within 30 days were included. Baseline data was collected, specific pharmacist interventions were identified, educated on and implemented, and post-implementation data was collected. The number of interventions made and documented by pharmacists for patients being discharged from CMH to local SNFs did not significantly change during this quality improvement study. Clinically significant interventions were made on high risk medications, such as warfarin. Finally, a newly redesigned SNF workflow was implemented to include pharmacy, nursing, social work/case management to improve patient care and safety for discharges to SNFs.

＂Beyond the Dreams of Loveliness＂ --Film, Unionism, and Working Class Community Formation in Detroit, 1933-1939

Ever since Lawrence Goodwyn published The Populist Moment, social historians have been keenly aware of the power culture represents when it comes to resistance. Historically, ＂movement culture＂ has been used to create a collective climate and offered political activists a springboard to discuss with the masses the benefits of joining a social movement. ＂Beyond the Dreams of Loveliness＂ uses the cultural outlet of film and the labor movement in the city of Detroit as analytical tools to examine working class community resistance throughout the 1930s. In the midst of the ＂golden age of film＂ community activists and union organizers--some of whom were well-known radicals and some of whom were mainstream unionists--used the institution of cinema to instill a level of class consciousness in the masses and mobilize the working class community against exploitation of employers, reactionary politicians, and white supremacist organizations. Movie-going had been a very popular form of recreation in Detroit since the 1920s and downtown theatres increasingly became the destination of an eclectic array of workers. Movie theaters themselves were bastions of community activity around the thirties and many were located in the heart of the city＇s working class district. Yet it was the films themselves that offered community activists and unionists a chance to converse with workers regarding the socio-economic matters of the day. Hollywood released a good number of films that dealt with working class issues and provided activists with ample opportunities to ＂instruct＂ the audience and carry on the discussion into the factory or union halls. ＂Beyond the Dreams of Loveliness＂ relies on a combination of oral histories, movie reviews, film clips, and union and/or working class organizational records to illuminate how activists in Detroit＇s working class community used film as an outlet to inspire working class resistance. In sum, film provided an accessible form of entertainment that proved to be effective on two fronts： It promoted increased group cooperation, friendship, and alliances while it also fostered a shared culture, making it easier for activists to organize workers in the coming struggles for unionism.

English Christmas Pantomime： Theatre or Community Activism

How is English Christmas panto community activism？ The structure of pantomime has not changed in a hundred years, but allows for local creativity to work within its framework to be both family entertainment and social satire This basic structure is founded on a children＇s story like Puss ＇n ＇boots or Cinderella. The story and character types remain the same; but the community can add their own jokes and commentary to make the play relevant to themselves and their community. What is added by the community says a lot about who they are and what they care about. The company Price-Waterhouse-Coopers produces their pantomime as management training and team building while engaging the community. The Basel Swiss panto raises money for African Charities. The Maplewood, NJ panto raises money for the homeless and the Jaguar Charity panto in Birmingham performs to disadvantaged children and adults. The productions can be extravagant or threadbare, but share the same goal of raising cheer and goodwill to the benefit of the community. What is it, then, about panto that brings a community together in such civic mindedness？

Impact of a Pilot, Pharmacy-Led Tobacco Cessation Medication Protocol at Discharge in a Community Hospital

Purpose： To evaluate the implementation of a pharmacy-led tobacco cessation medication education protocol at discharge in a community hospital. Design： Single center, retrospective quality assessment study. Methods： A retrospective review of a pharmacy-led protocol was completed from November 2016 through April 2017. Data from one year prior to implementation of the protocol was analyzed against the study group. Results： A total of 607 tobacco cessation medication education interventions were made during the study period, 379 patients （62.4%） were given an OTC （Over The Counter） NRT （Nicotine Replacement Therapy） recommendation upon discharge and 148 （24.4%） were referred to the Ohio Tobacco Quit Line. TJC （The Joint Commission） TOB-3/3a measure was met in 44.1% of patients during the study period compared to 0% in the comparator group. Of the 75 patients who were reached via follow-up phone call, 23 （30.7%） purchased an OTC NRT and 22 （29.3%） completely quit using tobacco. Conclusions： Pharmacy-led tobacco cessation interventions during hospitalizations have a positive impact on TJC TOB-3/3a quality measure results and quit rates post-discharge. Our results encourage future studies in this area to further establish the importance of pharmacist involvement in tobacco cessation, specifically in the hospital setting.