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Background: Bachelor of Emergency Health (Paramedic) (BEH) students at Monash University undertake clinical placements to assist with the transition from student to novice paramedic. Anecdotally, students report a lack of opportunity to practise their clinical skills whilst on placements. The barriers to participation and the theory-practice gap have not been previously documented in Australian paramedic literature. The purpose of this study was to investigate the theory-practice gap for paramedic students by linking education and skill level to case exposure and skills praxis during clinical placements.

Background Throughout North West London policymakers recognised that an ageing population with an increasing burden of long-term conditions was leading to a rise in unplanned admissions. In 2011, this led three of the boroughs in Inner North West London (INWL) to develop an approach called the Integrated Care Pilot Key messages We implemented a system to integrate care for patients with diabetes and/or over the age of 75 in an urban area with a population of 1.2 million. Within five months, all the acute, mental health and community trusts, and all the local authorities had signed up to participate, along with 84% of GP practices in the area. Patients and practitioners found the system of benefit in improving communication and collaboration. Why this matters to us We are clinicians and managers who have been closely involved in the planning and implementation of the integrated care system described here. We feel that current systems are fragmented and do not support delivery of holistic, coordinated care. We are convinced of the benefits of multiple agencies working together to share their expertise of patients' social, psychological and physical needs.

The usefulness of small bowel enema X‐ray examination was evaluated in 11 patients in whom a provisional diagnosis of Incomplete small bowel obstruction was made. Dilute barium was introduced through a nasojejunal tube. In one patient intubation of the Jejunum was unsuccessful. In six patients the suspected obstruction was confirmed and information obtained about the site of obstruction. The small bowel enema X‐ray examination was normal in three patients and subsequent clinical outcome was uneventful. In one patient, with normal findings on small bowel enema X‐ray examination, acute obstruction developed after two days, necessitating operation. Small bowel enema X‐ray examination appears a worthwhile adjuvant to clinical assessment but decisions for operative intervention still need to be based on clinical evaluation of patients.

Summary A case of Budd‐Chiari syndrome due to metastatic carcinoma in the liver with an unusual collateral anastomosis demonstrated by inferior vena cavography.