Clin Med
-
Bile acid malabsorption (BAM) is never life threatening but can cause chronic symptoms. A survey of senior British gastroenterologists was conducted to examine their approach to patients with potential BAM. Of the 706 gastroenterologists contacted, 62% replied. ⋯ Sixty-one per cent of patients are diagnosed with type 1 BAM (secondary to terminal ileal disease), 22% have type 2 (idiopathic bile acid malabsorption) and 15% type 3 (unrelated to terminal ileal disease). Only one third of gastroenterologists use a definitive diagnostic test for BAM. BAM (particularly type 2) is under-diagnosed because it is frequently not considered and even when considered, many patients are not subjected to definitive diagnostic testing.
-
Patients who are face, arm, speech test (FAST) positive may have a stroke mimic diagnosis. Careful attention to the speed of onset of symptoms is paramount. Magnetic resonance imaging is helpful in supplementing the clinical assessment.
-
Intermediate care (IC) has been government policy for implementation in the U. K. for almost 10 years. It was hoped that it would help free up acute hospital resources. ⋯ Typically, outcomes are very similar to traditional hospital care and they tend to be met with high patient satisfaction. Yet there is no evidence that they reduce acute hospital use or that they are cost efficient. Maybe it is time to rethink our national strategy on this issue?