Clin Med
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The health burden in most countries has changed. Although acute care is needed for trauma, acute illness and exacerbations of chronic disease, most of the burden is now long term. ⋯ The current hospital- and doctor-centric focus needs to change to one where specialists work in the community as much as in hospitals and share this different type of care with others. For potential future doctors, the scientific basis of medicine will still underpin their unique role in diagnosis and prescribing, but they will need to understand these other changes and to be selected according to attributes compatible with their future role, and then be trained and assessed accordingly.
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Case Reports
Lesson of the month 1: sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure.
Cholesterol embolisation syndrome (CES) is a rare but serious disease with high mortality caused by the formation of an embolus made up of cholesterol crystals from atherosclerotic plaques. Its clinical presentation is usually initially insidious and it often remains unrecognised because of its non-specific clinical presentation, which can cause delays in treatment and high mortality. The most common physical symptoms are cutaneous. We present a lethal case of CES to increase the awareness about this serious condition.
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Ambulatory emergency care (AEC) is an essential component of any acute medical unit (AMU). This statement is predicated on the clinical and financial benefits it confers. ⋯ The initial data collated demonstrates the impact the service has had locally on patient care and experience. It recommends ambulatory care as driver of better patient flow and enhanced patient experience within the AMU.