Clin Med
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Case Reports
The ill, jaundiced patient: a triple whammy and the importance of waiting for all results.
There are many causes of raised liver function tests in HIV infection. This lesson discusses a case where autoimmune hepatitis, acute hepatitis B and acute toxoplasmosis were diagnosed in a lady presenting with abdominal pain and jaundice. Oral steroids for autoimmune hepatitis may have worsened the clinical picture as her hepatitis serology was not available at the time. This lesson highlights the importance of waiting for all serology results to return in an ill jaundiced patient before deciding on active management and treatment
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Ambulatory emergency care (AEC), ie managing emergency patients without an overnight hospital stay, offers an alternative to routine hospital admission and improved patient experience. The Directory of ambulatory emergency care for adults identifies 49 clinical scenarios which present acutely but could potentially be managed in an ambulatory manner. The Society for Acute Medicine and the NHS Institute for Innovation and Improvement conducted a national survey of 131 UK acute hospitals to understand the current level of AEC provision. ⋯ Weekend access was limited. Only deep vein thrombosis ambulatory protocols were well-established (65%), with other conditions formally implemented as ambulatory pathways at 0-35% of responding sites. There is a significant opportunity for further expansion of AEC through increased awareness and support.