Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.
A thyroid abscess is an infrequently encountered condition with a rarity that is attributable to anatomic and physiologic characteristics of the gland that impart a unique quality of infection resistance. The differential diagnoses for a painful thyroid is limited, with subacute and chronic thyroiditis being the most often-encountered processes. Acute suppurative thyroiditis with abscess formation, although rare, is a formidable clinical scenario with morbid complications. Because the diagnosis of a thyroid abscess is often delayed in lieu of investigating other more common etiologies of thyroiditis, this disease entity may portend to a dismal clinical outcome. The authors report the case of a 53-year-old woman with a thyroid abscess yielding a single microbial isolate believed to be resultant from a urinary tract bacteremia. They also review the literature for discussion of abscess etiologies, presentations, and management strategies.
The transfusion service of a regional referral medical center issues a monthly blood and component wastage report to the Hospital Transfusion Committee. The report includes the amount and type of units wasted, who is responsible, and the cost incurred by the wastage. The individuals responsible for wastage include physicians, nurses, and laboratory personnel. Physicians are responsible for most wastage, principally by failing to administer thawed or pooled blood products. The Hospital Transfusion Committee initiated a wastage-reduction program that included a letter to physicians indicating the patient's name and the type of blood and/or components that the addressed physicians was responsible for wasting. Simple corrective actions results in a 73 percent reduction in our blood and component wastage. Monitoring of blood and component wastage should be routine quality assurance function of the Hospital Transfusion Committee.
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