Editorial

2007 ◽  
Vol 6 (3) ◽  
pp. 94-94
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Heart Valves ◽  
Case Reports ◽  
Skills Training ◽  
Good News ◽  
Acute Medicine ◽  
Education Management ◽  
Practical Procedure ◽  
Previous Edition ◽  
Dramatic Rise ◽  
Training Programmes

As we look forward to the warmer months. Last year saw a dramatic rise in the number of training posts in Acute Medicine, a trend which will continue this August. The Department of Health considers Acute Medicine to be one of the few hospital specialities with the potential for future expansion, and additional funded NTNs have been made available. This is undoubtedly good news for the speciality; however, it is clearly important to ensure that any additional numbers can be accommodated without diluting the opportunities for our existing trainees. From discussions with trainers and trainees alike, it is clear that there remains wide variation in Acute Medicine training programmes across different regions. The recently formed Acute Medicine Programme Directors group has started to address these issues, and has presented proposals for a more formalised training structure to the JRCPTB. Speciality skills training remains one of the most contentious areas, which is likely to increase as trainee numbers rise. The feasibility of providing every acute medicine trainee with suffi cient exposure to a practical procedure such as echocardiography or ultrasound may require a rethink in future training plans. Development of a special interest in Medical Education, management or research may be more appropriate and arguably more useful to future consultants and employers. A respiratory fl avour fl ows through many of the articles in this edition of the journal. Alistair Proudfoot’s article on the treatment of pulmonary embolism follows on from his review of the diagnosis of this condition in the previous edition. If there were a prize for the most comprehensive referencing this review would certainly win by some margin. Of course this list would have been pruned, were it not for his inclusion of the editors own paper at citation number 106. It clearly pays to save the best until last! In another sequel Mayank Patel follows up the previous review on the management of acute symptomatic hyponatraemia with a comprehensive summary of the more common scenario of the asymptomatic hyponatraemic patient on the AMU. The article on pleural effusion is the fi rst of two papers on management of pleural disease; pneumothorax will follow in a future edition. As usual the case reports have been selected for publication to highlight important teaching messages. Orthodeoxia platypnoea may be unfamiliar to acute physicians, but the case illustrates the importance of apparently minor details in the history in this case the marked variation in symptoms relating to posture. The challenges of risk versus benefi t for anticoagulation in patients with metallic heart valves are highlighted by the case of fatal intra-hepatic haemorrhage; this month’s picture quiz demonstrates the importance of the history when considering intercostal tube insertion for a ‘radiological diagnosis’ of pneumothorax. ‘Viewpoint’ is intended as an opportunity to stir up debate, and the article by Clare et al in the last edition produced a ripple of disquiet amongst some readers. The interface between acute and emergency medicine remains a contentious area, and further contributions to this debate are welcomed for consideration in future editions.

Editorial

2002 ◽  
Vol 1 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Gastrointestinal Haemorrhage ◽  
Medical Emergency ◽  
Editorial Team ◽  
Original Research ◽  
Acute Medicine ◽  
Previous Edition ◽  
Interesting Paper ◽  
Medical Emergencies ◽  
A Minor

So the brief ‘respite’ of summer is over, and we find ourselves plunging, once more towards the abyss of winter bed pressures. Hopefully those of you working at the coalface will find time to browse through the following pages. The production of a third issue in this ‘shortened’ year, following the launch of the Journal in July, is a credit to the hard work of the editorial and publishing teams. I am, as ever, grateful for their support. Next year will see a return to the planned 4-monthly cycle, with issues anticipated in March, July and November. One casualty of the tight schedule has been a minor adjustment to the cycle of reviews – COPD will now appear next Spring. In its place we have included an interesting paper reviewing the management of Neuroleptic Malignant Syndrome and Serotonin Syndrome, submitted by Consultant Psychiatrist David McNamara. Gastrointestinal haemorrhage and atrial fibrillation will be more familiar to readers, while Dr Joanna Girling’s review of the management of medical emergencies in pregnancy is essential reading for any physician working close to a maternity unit. Myasthenia gravis may not be the commonest medical emergency; nonetheless it is important that physicians are able to suspect, diagnose and initiate treatment for this condition. As I mentioned in my last editorial, I am keen to encourage submissions of case reports, audits, and pieces of original research provided they would appeal to a general medical readership. Cases need not be rare conditions, but must contain a clear teaching message for the reader. In future editions case reports will be categorised as ‘Tales of the Unexpected’, and ‘A Case to Remember’ (a memorable case or one with a message that readers should remember in future). The report on page 106 is an example of the latter – an important reminder that a radiological diagnosis of ‘pneumonia’ does not always imply an infective cause. Finally, I would like to thank those of you who have written with feedback following the previous edition of CPD Acute Medicine. We are clearly attempting to appeal to physicians from a broad range of backgrounds, and I hope that all readers find something which appeals to them in the pages which follow. Please feel free to write with your comments on any issue which you would like to share with the editorial team – depending on the response we may consider including a correspondence section in future editions of the journal.

Acute Medicine Trainee Update

2011 ◽  
Vol 10 (3) ◽  
pp. 149-149
Author(s):  
Amy Daniel ◽  
◽  
Alice Miller ◽  
Keyword(s):  
Palliative Care ◽  
Medical Ethics ◽  
Advisory Committee ◽  
Skill Training ◽  
Skills Training ◽  
Training Programme ◽  
Acute Medicine ◽  
The Past ◽  
Training Programme Director ◽  
The Cost

We have been aware for a while that there are disparities in specialist skill provision both between and within deaneries – and the SAC is working hard to identify problems in this area. More recently, the issue of funding for specialist skills has been raised. It seems that some deaneries are happy and able to contribute towards the cost of training in a particular skill, while others are not; in at least one deanery, part-funding has now been withdrawn, leaving trainees to cover the entire cost of their chosen skills training. As specialist skill training is now a mandatory part of the Acute Medicine curriculum, we need to find a way to eliminate disparity both between different deaneries and between different skills. However, there is no easy solution, and for the time being, trainees will have to factor in the potential financial implications of a particular skill when they are considering their options. On a brighter note, the list of recognised specialist skills has increased over the past year. Palliative Care has been authorised as a suitable skill, and Medical Ethics and Law will soon also be added to the list. If you would like to propose a skill that is not currently listed in the Acute Medicine curriculum, you should discuss it with your training programme director, who can bring the proposal to the Acute Medicine Specialty Advisory Committee (SAC).

Editorial

2007 ◽  
Vol 6 (2) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Task Force ◽  
Elderly Care ◽  
Task Force Report ◽  
Acute Medicine ◽  
General Infirmary ◽  
Business Cases ◽  
The Media ◽  
Training Programmes ◽  
The Right

As the year draws to a close, it is traditional for an Editorial to reflect on the past 12 months, including some up-beat comments to lift the usual Winter gloom. In a year which began with the MTAS recruitment debacle and ended with a series of sporting disappointments, it may be hard to find too many positive messages on this occasion. It has been a year when bird flu and bio-terrorism disappeared from the tabloid front pages, to be replaced by hospital-acquired ‘superbugs’. In response to the media frenzy and a new set of government targets, hospitals adopted ‘nothing below the elbow’ policies: consultants were spotted entering wards without the customary Saville Row suit and tie, with a fob-watch becoming the new ‘must have’ fashion accessory. Gone are the days when a jacket was considered a ‘badge of office’ for any doctor at registrar level or above. It remains to be seen how patients will recognise ‘seniority’ when MMC produces its first 29 year-old consultant: a certificate of completed training may not have the same therapeutic effect as pin-stripes or padded shoulders… Acute Medicine’s arrival in the ‘big league’ was announced by the first International meeting of the Society for Acute Medicine, in Glasgow this autumn. The success of this meeting was an enormous boost to the speciality, and a great credit to its organisers. Having been initially sceptical about the ability of our young speciality to pull off such an ambitious event, it was a great relief to have been proven wrong. The momentum built up by the autumn meeting was continued with the publication of the RCP Acute Medicine Task Force report at the end of October. The document entitled ‘Acute Medical care: the right person in the right setting, first time’ should provide a major boost to the speciality, with strong recommendations for expansion of acute medical units and the need for increase in consultant numbers. Despite these positive signs for the speciality, anxieties about the future still remain amongst some of those training in acute medicine. At the SAM meeting in October, one trainee questioned deputy First Minister of the Scottish Parliament, Nicola Sturgeon as to whether central funding for new consultant posts would be made available. Another trainee asked whether competition from non-acute medicine specialists with dual accreditation in GIM would continue in the era of the ‘Specialist Acute Physician’. The first SpRs to have undertaken Acute Medicine training programmes will acquire their CCTs in the next few months, with many more to follow in 2008. It is essential that the existing consultants in acute medicine act quickly to develop business cases for additional colleagues, to recognise the likely rise in the number of suitable applicants over coming months. Finally a brief word of thanks to Dr Mike Bacon who recently stood down from his role on the editorial board; his contributions will be missed by the team, but hopefully admirably replaced by those of Dr Nicola Cooper, Consultant in Acute and Elderly Care medicine at Leeds General Infirmary.

Editorial

2005 ◽  
Vol 4 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Night Shift ◽  
Hospital Medicine ◽  
Phone Call ◽  
Junior Doctors ◽  
Exact Nature ◽  
Text Book ◽  
Acute Medicine ◽  
Junior Staff ◽  
Training Programmes ◽  
The Uk

The challenges and uncertainties of working in the developing field of Acute Medicine have been a regular theme for editorial comment in this journal since I took the helm in 2002. Almost four years on, with sub-specialty status confirmed, over 200 consultants and many SpRs enrolled in higher specialist training programmes throughout the UK, Acute Medicine finds itself in a much stronger position than any could have predicted at that time. Enthusiasm for the field is clear from the numbers of applicants for training programmes at SpR level, as well as the dramatic rise in attendances at acute medicine meetings across the country in the last year. However, on-going challenges remain. Eighteen months from now, Modernising Medical Careers will send shockwaves throughout hospital medicine. The exact nature of the change to our training programmes remains unclear, and will probably have changed again between my writing this and its publication. However it is essential that Acute Medicine is ready for whatever comes our way. We must work closely with our colleagues in Emergency Medicine and Critical Care to develop common stem training schemes which allow doctors to choose the area of ‘front door’ medicine which suits them best. Where possible we should seek to encourage dual accreditation in two or more of these areas. But most of all we need to maintain the momentum which has carried us so far in such a short space of time, and which has the potential to make Acute Medicine one of the largest hospital specialties. This edition’s review articles cover a varied mix of common and less common conditions on the acute medical ‘take’. Most medical admission units will be faced with at least one patient presenting with a seizure in each 24 hour period. Dr Kinton emphasises the importance of a good history in the management of this problem, but also provides some useful tips to help distinguish seizures from other causes of blackout. Distinction from syncope can be a particular challenge, not least because of the differing implications for driving, the loss of which can have devastating consequences. Acute ischaemic stroke is another common problem, the management of which is comprehensively reviewed by David Jarrett and Hemang Dave. As well as summarising some of the major trial data for thrombolytic and antiplatelet therapy, this review includes some advice on some of the common clinical challenges which don’t usually feature in text book descriptions of this condition. Less common, but no less important, Acute liver failure must be distinguished from decompensated chronic liver disease – the former often requiring discussion with a regional liver unit. Phil Berry has included a useful checklist to have to hand before making this phone call. Headache, palpitations and sweating is a common problem on the post-take ward round – particularly amongst the junior staff completing a night shift. Fortunately most junior doctors do not have a phaeochromocytoma – in common with every patient for whom I have ever requested 24 hour urinary catecholamine measurement. Having read Dr Solomon’s thorough review of the acute management of this condition I will now feel equipped to manage this condition when I finally get a positive result back from the laboratory! Apologies that this edition has been a little delayed – I hope you consider it to have been worth waiting for….

scholarly journals The Society for Acute Medicine (UK) Acute Medicine Training Survey 2007

2008 ◽  
Vol 7 (1) ◽  
pp. 50-54
Author(s):  
Hannah Skene ◽  
◽  
David K Ward ◽  
Keyword(s):  
Online Survey ◽  
Workforce Planning ◽  
Skills Training ◽  
Training Programme ◽  
Current Situation ◽  
Acute Medicine ◽  
Part Time ◽  
The Uk

An online survey of training in Acute Medicine was conducted to assemble a true picture of the current situation in the UK. The specialty is flourishing, with over 60 trainees having predicted CCT dates in Acute Medicine in 2010 and 2011 alone. 128 respondents highlighted a multitude of issues, including the need for improvements in management and special skills training and part time opportunities. We have used the results of this survey to suggest action points for Deaneries, Training Programme Directors, the Society for Acute Medicine (UK) and those involved in workforce planning.

Editorial Volume Editorial Volume 15 Issue 2

2016 ◽  
Vol 15 (2) ◽  
pp. 50-50
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Medical Education ◽  
Hospital Mortality ◽  
Junior Doctor ◽  
Organizational Factors ◽  
Skills Training ◽  
Weekend Effect ◽  
Quality Data ◽  
Mortality Statistics ◽  
Acute Medicine ◽  
Care Plans

Hospital mortality has been a hot topic in the medical and popular Press over recent years. Many readers will recall ‘scandals’ around hospitals whose mortality rates appeared higher than that which would be expected. The so-called ‘weekend effect’ whereby patients admitted to hospital between Friday and Monday appear more likely to die during their hospital stay has been regularly quoted in Parliament by the Secretary of State as justification for the Government’s manifesto pledge to create a ‘7 day NHS’. A number of recent publications have illustrated the complexity of this statistic, which – at least in part – is likely to reflect illness severity as much as organizational factors. The paper by Emma Mason in this edition further supports the concept that hospital mortality statistics may be hard to influence through structural or staffing changes. Those working in the acute medicine setting will not be surprised to read that almost half of those patients who die within 48 hours of arrival in hospital had solely palliative care needs at the time of admission. Many of these patients were elderly, frail and resident in a care home environment, but many also had undergone previous admissions within the months leading up to their death; the authors comment that this could have provided an opportunity to discuss end of life care plans, potentially enabling their final admission to hospital to have been avoided. Preventing ‘avoidable’ deaths in hospital from conditions such as sepsis and acute pulmonary embolism is a key component of the job of an acute physician. However, even when death in unavoidable we must do what we can to ensure patients die in the environment of their choice. Reducing deaths in hospital should not simply focus on those whose death can be prevented. Although mortality statistics may be misleading when interpreted in isolation, good quality data can be a powerful tool to influence changes in the acute medicine setting. By the time this edition is published, the 2016 Society for Acute Medicine Benchmarking Audit (SAMBA16) will already have take n place; previous years’ data were published in this journal and we hope to see a continued rise in the numbers of participating units this year. Tom Brougham and colleagues from Bristol have illustrated how an electronic system for data collection on their AMU enabled reorganization of their junior doctor rota, reducing waiting time for patients. Their data illustrate the problem which will be familiar to many acute physicians, whereby the surge in afternoon arrivals on the AMU often coincides with shift changeovers and reductions in junior doctor and other numbers. Matching staffing to workload can have significant benefits for patient care and may enable a reduced strain on the night shift team if patients are seen in a more timely fashion. Whether this can be linked to improved patient outcomes in the future will be interesting. Finally, I would like to welcome one more addition to the editorial board. Dr Nick Murch is an acute physician in the Royal Free hospital, with an interest in medical education and simulation skills training. With an increasing number of acute medicine trainees undertaking medical education as their specialist skill, I am keen to develop the training and education section of the journal over the coming years, and look forward to Nick’s input in this regard. We will continue to welcome submissions of research relating to acute medicine education and training, which we will consider for future publication in this section of the journal.

Editorial

2003 ◽  
Vol 2 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Emergency Services ◽  
Case Reports ◽  
Community Acquired Pneumonia ◽  
Rapid Expansion ◽  
Medical Specialties ◽  
Acute Medicine ◽  
General Internal ◽  
Competency Based ◽  
Exciting Time ◽  
The Uk

It could be said that the past 12 months have been an exciting time in the field of acute medicine. In addition to the high profile afforded by the publication of Reforming Emergency Care and the ongoing Emergency Services Collaborative, the significance of the recent acquisition of subspecialty status for Acute Medicine cannot be understated. This, in turn has enabled approval of a new competency-based training curriculum by the JCHMT. Hopefully within the next few months, specialist registrars in General Internal Medicine with Acute Medicine will be appointed to the first few numbered posts in this discipline. Clearly a rapid expansion in posts of this nature will be required in the next few years in order to meet the enormous demand for consultants in Acute Medicine. Recently, in common with other medical specialties, hospitals have experienced difficulties in recruiting suitable applicants for such posts resulting in many vacancies across the UK. One challenge for those of us already working in the field is to maintain enthusiasm for the concept, while we are waiting for the trainees to mature into competent consultants. This edition includes another varied selection of reviews. Community acquired pneumonia may be of particular relevance over the remaining winter months, although hopefully the brief mention of SARS in this paper will now only be of historical significance. Patients with hypercalcaemia, dysphagia and Guillan Barre syndrome may be less frequent attenders, but nonetheless often create management dilemmas with which the admitting physician needs to be familiar. In a departure from our previous format, we have included two case reports this time, both highlighting an important clinical scenario. Power kite flying may not be a familiar activity for many readers, but the outcome described by Merrison and colleagues justifies its inclusion as ‘a case to remember’. Mark Mallett, on the other hand, reminds us that syncope can, on occasions, reflect significant underlying pathology, even in an apparently healthy member of the hospital portering staff. Once again we would like to encourage similar submissions for future editions of the journal. After several years of association with CPD Acute Medicine and its predecessor, it is with great sadness that this edition is Paul Jenkins ’last as sub-editor. We wish him well as he moves on to new challenges in his role as President of the Society for Acute Medicine, and gratefully acknowledge all of his hard work in establishing the journal.

Editorial

2004 ◽  
Vol 3 (2) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Bacterial Meningitis ◽  
Medical Staff ◽  
Case Reports ◽  
Rapid Development ◽  
Working Party ◽  
Significant Shift ◽  
Multiple Choice Questions ◽  
Acute Medicine ◽  
Junior Staff ◽  
The Uk

Over the past three years it has become apparent to me that referring to ‘current affairs’ in these columns can be a mistake, serving only to highlight inevitable printing delays. By the time this edition arrives on your doormat Euro 2004, ‘Big Brother’ and the early summer heat wave will be nothing but a distant memory. However the ‘recent’ publication of the Royal College of Physicians document ‘Acute Medicine – making it work for patients’ cannot be allowed to pass without a mention. This report represents a significant shift in the position of the College in relation to Acute Medicine since the previous working party reported its findings in 2000. The value of consultants specialising in Acute Medicine is now clearly recognised and supported – every trust should now have one, with the minimum figure of three per hospital being proposed by 2008. Whether this is achievable will depend on the rapid development of training schemes across the UK, as well as the generation of enthusiasm for the specialty amongst junior staff. The number of applicants for our Wessex programme indicates no shortage of the latter. Although developing a training scheme takes a lot of hard work, it is vital that those already working in the specialty make this a high priority. We have already seen benefits from the appointment of high quality middle grade staff and are looking forward to a ‘flood’ of future applicants for local consultant posts, 4 years from now. This edition comprises four more important review papers on aspects of acute medicine, along with the first in our ‘Controversies in acute medicine’ series. The latter was designed to try to stir up some correspondence, for future publication. The confusion over oxygen delivery in the acute setting seems to reign fairly widely amongst junior, and indeed some more senior medical staff. Hopefully Dr Cooper’s well-written paper will serve to dismiss some of the misconceptions in this area. Our reviews cover relatively uncommon, but nonetheless important aspects of acute medicine. Tuberculosis and HIV are both on the increase in the UK. The success of anti-retroviral therapy will undoubtedly lead HIVrelated illness to be a significant part of our practice over the next decade. An understanding of the range of conditions specific to this group of immunocompromised patients is therefore crucial for physicians involved in the acute take. Hypoglycaemia and suspected bacterial meningitis are both conditions which require immediate action by medical staff. Both of these reviews comprehensively cover their respective topics with a combination of well written text, illustrations tables and algorithms. Dr Hartman highlights recent evidence supporting the use of dexamethosone in bacterial meningitis and re-iterates some of the points made in an earlier edition regarding the use (and abuse) of CT scanning prior to lumbar puncture. For a change we have no case reports this time, although Dr Macdonald’s audit of the innovative review clinic in the Emergency Assessment Area of Heartlands hospital provides a worthy substitute. Submission of similar articles in future would be most welcome. Once again, a reminder that multiple choice questions are for self assessment and ‘personal’ CPD only; I hope you will find this edition helpful in your clinical practice.

Editorial

2004 ◽  
Vol 3 (1) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Case Reports ◽  
Current Evidence ◽  
Diagnostic Dilemma ◽  
Acute Medicine ◽  
Interesting Insight ◽  
Firm Believer ◽  
Case Based Learning ◽  
Teaching Point ◽  
Significant Pathology ◽  
Coronary Syndromes

This journal now enters its third edition, which means we are now more than half way through our proposed four-year cycle of reviews. As previous readers may recall, our intention was to cover all aspects of acute medicine with review articles over this cycle. Although we have strayed from the original programme on occasions, we remain on track to achieve this goal. This edition contains five such reviews, including Part Two of the Acute Coronary Syndromes series, this time dealing with the ST elevation myocardial infarction. Dr Wallis guides us through the current evidence for management of this condition, concluding with a helpful paragraph outlining how she would like to be treated in this eventuality. In a comprehensive review, Booth and Leary give a critical care perspective on the investigation and treatment of the comatose patient. Readers should take particular note of the useful algorithm on page…., which provides a user-friendly approach to the management of this often challenging problem. A neurologist once told me that the ‘three F’s of Neurology’ were ‘fits, faints and headaches’, although ‘funny turns’ might perhaps also come into this category. Our next two reviews deal with each of these conditions. Sudden headaches often cause a diagnostic dilemma on our admissions ward – exclusion of subarachnoid haemorrhage is often the easy part; making a positive diagnosis after the CT and LP have proved negative is more of a challenge. Dr Griffin describes some of the less well known causes of this problem, emphasising the need to proceed to MR scanning if there remains a clinical suspicion of significant pathology. Mike Bacon’s review of ‘funny turns’ provides an interesting insight into the approach taken by a consultant experienced in the management of these problems in older people. The diverse nature of the problem is highlighted, along with the need for targeted investigations. Our ‘How-to-do-it’ article this month complements this paper with a detailed description of the Dix-Hallpike and Epley manoeuvres in the management of BPPV. Our final review is a comprehensive discussion of the management of pleural effusion from the Oxford Pleural Disease Unit. In this extensively referenced article, the diagnostic and therapeutic challenges of this condition are discussed in detail, emphasising some of the newer modalities now available. I’ll conclude with my usual plea for submissions. I remain a firm believer in the value of case-based learning and most of us see at least one patient each week which emphasises a teaching point worth sharing. Please encourage your colleagues and juniors to submit such case reports to us – anything which would appeal to a ‘generalist’ audience will be considered for publication. In an attempt to stir up some lively debate, future editions will also contain a feature entitled ‘Controversies in Acute Medicine’. Any reader who feels particularly strongly about an aspect of acute care which attracts controversy is encouraged to contribute to this section: anything except MMR!

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