EPICENTRE - Delivery of high quality acute medical care without transfer to hospital.

The NHS Five Year Forward View focuses on expansion and development of community services and out-of-hospital care. Hospital at Home is a concept that provides acute active treatment that would traditionally be provided in an inpatient setting, involving nursing staff and therapists. As well as being financially favourable, it is important to acknowledge that often, for a multitude of reasons, people prefer to remain at home rather than be admitted to hospital for treatment.

Recurring Lower Abdominal Pain and Fever as Initial Presentation of Adult Onset Still's Disease in the Absence of Arthralgia and Other System Involvement.

Unlabelled: A 34 year-old Afro-Caribbean female presented with recurring episodes of fever and lower abdominal pain over a period of two months not improving despite courses of antibiotics for possible recurrent urinary tract infections. On admission to hospital, patient was treated for a possible pyelonephritis or pelvic inflammatory disease (PID). Extensive investigations into possible source of infection were carried out.

Large size VSD with pulmonary stenosis.

Defect in the ventricular septum with obstruction to right ventricular outflow tract encompass a wide anatomic, physiological and clinical spectrum. Large ventricular septal defects occur with pulmonary stenosis that varies from mild to severe to complete (pulmonary atresia). Very large VSD (size 6.