Emphysematous cholecystitis (EC) is a rare but deadly variant of acute cholecystitis noted by the presence of gas in the gallbladder lumen or wall. This gas, emitted by bacteria, is thought to result from gallbladder ischemia caused by vascular compromise with subsequent bacterial invasion. The two most common bacteria responsible for EC are Clostridia perfringens and Escherichia coli. Symptoms of EC are similar, although often less overt, compared to those of acute cholecystitis (AC). Sonography and radiography are common methods of diagnosing EC, but computed tomography (CT) carries the highest diagnostic accuracy rate. Laparoscopic cholecystectomy is the most common method of treating EC, although conservative therapy and hyperbaric oxygen therapy have also been effective in some cases.
A vital component of clinical sonography is the approach the sonographer uses to analyze both the patient's clinical history and the sonographic findings of each examination. Although every study is different, the sonographer is obligated to obtain the optimal information from both clinical history assessment and sonographic imaging in order for the interpreting physician to make an accurate diagnosis. One of the essential roles of sonography education is to provide instruction that allows students to gradually develop into clinically aware and proficient sonographers who are consistently capable of exploiting critical thinking and reasoning skills. Teaching both critical thinking and reasoning skills is a challenge for sonography educators, as both of these abilities tend to steadily improve with clinical experience. For the student, frustration can manifest as a result of this inexperience. Consequently, a standard framework for analysis would allow the sonography student a fundamental approach to use for every sonographic examination, thereby gradually, but possibly more rapidly, improving both reasoning and critical thinking skills in the clinical and classroom setting. The Sonographic Reasoning Method is a process created to provide this essential framework, combining critical thinking with reasoning skills, establishing structured thought, and promoting both competent and accurate patient care.
Within the unpredictable economic environment and job market in America today, many medical facilities are finding that merely hiring qualified sonographers is much more straightforward than retaining them as loyal, satisfied employees. In 2001, one national researcher found that turnover rates for health care vocations such as imaging technologists were about 2% higher than that of registered nurses. 1 Hence, how can we keep people loyal to us and satisfied with their job? To answer this question, we must analyze feasible causes of poor retention in the sonography profession and the potential resolutions to this vast dilemma.Poor retention is often the result of high turnover rates. Turnover is the consequence of an employee leaving the organization. It can be subdivided into two sections, involuntary and voluntary. Involuntary turnover occurs when an employee is terminated by the organization, whereas voluntary
Radiologically guided balloon dilatation is straightforward to perform and is well tolerated, but there is a small risk of perforation. Relief of symptoms is likely to be temporary, requiring multiple subsequent dilatations. A minority of patients will obtain no symptomatic relief.
Blood establishment emergency plans tend to focus on responding to mass casualty events. However, consolidation of manufacturing to fewer sites combined with a reliance on national IT systems increases the impact of loss of function. Blood services should develop business continuity plans which include prevention of such losses, and the maintenance of services and disaster recovery.
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