ABSTRACT
Retroperitoneal abscesses are rare and life-threatening. The incidence of abscesses after open cholecystectomies is <1% disregarding location. 11 cases reporting post-cholecystectomy retroperitoneal abscesses were archived on PubMed, 7 associated with gallstone retaining or spillage. Hereby, we present a case of extensive retroperitoneal multiloculated abscesses after open cholecystectomy complicated with bile leak, while no gallstone was noted. Early evaluation for retroperitoneal abscesses is critical if the patient does not clinically improve after cholecystectomy. Early treatment with drainage of the abscesses, antibiotics, and endoscopic retrograde cholangiopancreatography intervention to achieve source control can greatly improve the clinical outcome.
ABSTRACT
High-quality and efficient sign-outs are essential to ensure patient safety. To evaluate the impact of a new handoff tool by objective measures of handoff quality and residents' subjective experiences. Internal medicine residents working on a medical ward service completed a handoff clinical evaluation exercise (CEX) questionnaire and an anonymous survey on handoff quality and experiences prior to implementing a new handoff tool and at 2 and 6 weeks after implementation. CEX scores significantly improved from 5.3 ± 1.1 to 6.9 ± 0.7 in 6 weeks ( P < 0.05). Residents reported that they were contacted less frequently after work, information needed by the receiving resident was more often found in the sign-out, and that tasks signed out to the oncoming team were more often executed. Before implementing the new handoff tool, 87% of residents reported that they were contacted after work hours 1-2 times per week with questions, while 75% of participants reported that they were almost never contacted after work hours after the new tool was implemented. A standardized handoff tool that utilizes smart phrases to provide residents with templates for sign-out significantly improved the quality and experience of sign-out in a short time period.
Subject(s)
Internship and Residency , Patient Handoff , Electronics , Humans , Patient Safety , Surveys and QuestionnairesABSTRACT
Erythema ab igne, also known as toasted skin syndrome, is an acquired asymmetric hyperpigmented dermatosis that is caused by repeated exposure to moderate heat or infrared radiation. Hyperpigmentation is caused by the degeneration of elastic fibers and basal cells resulting in the release of melanin. Historically found in bakers and industrial workers, this condition has recently resurfaced in medical literature with the use of novel heat sources such as laptops and heated car seats. While this condition can resolve spontaneously after removal of heat exposure, delay in diagnosis and persistent exposure can lead to permanent pigmentation or progression to Merkel cell carcinoma, basal cell carcinoma, and squamous cell carcinoma.
