Clin Med
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During the assessment of a patient with liver disease, finding the patient has decompensated cirrhosis, as defined by the presence of jaundice, ascites, variceal haemorrhage or hepatic encephalopathy, has major implications regarding management and prevention of cirrhosis-related complications, as well as consideration for a referral for liver transplantation evaluation. Prognosis is markedly worse in patients with decompensated compared with compensated cirrhosis. In general, any patient with decompensated cirrhosis should receive evaluation and medical care by a hepatologist. Since patients frequently present with more than one facet of liver decompensation, such cases pose a complex management challenge requiring input from a multidisciplinary team and close liaison with a liver transplant centre.
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Ward rounds are a vital part of hospital medicine and junior doctors play a key role in their delivery. Despite the importance of ward rounds to patient care and experience, we believe that junior doctors may lack the training and skills to carry them out most effectively. We designed a simulation-based training session focusing on ward round skills themed to key patient safety issues and have delivered the training to over 100 learners (medical students and foundation year one doctors). ⋯ In addition, 94% of final year medical students and 93% of doctors felt such training should be included in the undergraduate curriculum. We believe there is a current gap in training around ward round skills and would strongly encourage simulation-based ward round training to be developed for undergraduates. Further sessions following qualification may then consolidate and develop ward round skills adapted to the level of the doctor.
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Cellulitis is a common condition and several mimics exist which should be considered in patients who fail to respond to antibiotics. We describe the case of a patient with anaplastic large cell lymphoma masquerading as a lower leg cellulitis. ⋯ She died shortly afterwards from lobar pneumonia. This case highlights the importance of regularly reassessing patients with suspected cellulitis and considering alternative diagnoses in cases that fail to respond to treatment.