Editorial Volume 16 Issue 4

2017 ◽  
Vol 16 (4) ◽  
pp. 155-155
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Internal Medicine ◽  
Case Reports ◽  
Editorial Team ◽  
Research Committee ◽  
Acute Medicine ◽  
The Future ◽  
New Vision ◽  
The Uk

My time has come. After 15 years and over 50 editions it is time for me to hang up my metaphorical red biro, and hand over the role of Editor. It has been an interesting job, and I am extremely grateful to everyone who has contributed and supported the journal over this period. When I took on the position in 2002, this journal was very different to how it is today. Some readers may recall its original incarnation as the CPD journal of Internal Medicine, part of a series of publications produced at that time by Rila. Initially this was comprised predominantly of commissioned review articles, running over a 5 year cycle which was designed to cover the common conditions managed by ‘general’ physicians. As time progressed, the number of unsolicited submissions grew steadily – initially (and continually) dominated by case reports, but with a slowly increasing number of research-based articles as the readership expanded. The quality of these submissions improved further when we finally attained indexing in PubMed, which also attracted more international submissions. I am delighted that the current edition features research papers from the Netherlands and Singapore, both of which have a growing community of Acute Physicians. I remain hopeful that the number of acute medicine-related research submissions from the UK will rise as the speciality grows. The number of high quality abstracts presented at the Society for Acute Medicine (SAM) meetings is indicative of the amount of work that is going on, but it is disappointing that so few of these turn into publications in peerreviewed journals. Acute Physicians are busy people with constant and year-round operational pressures, which may mean that writing up research is continually pushed down the list of priorities. Perhaps also the fact that the number of consultant posts across the continues to exceed the number of Acute Internal Medicine trainees removes some of the ‘pressure to publish’ which is felt by trainees in other hospital specialities. My hopes for the future of this journal have been boosted by the appointment of Tim Cooksley as my replacement ‘Editor in Chief’, who will take over from the Spring 2018 edition onwards. Tim has been a hard working member of the editorial team over recent years, and prior to this was a regular contributor to the journal. He has a strong research background and is a leading member of the SAMBA academy and SAM research committee. I would also like to thank the other members of the editorial board without whose support and contributions this job would have been completely untenable. I understand that Tim plans to keep many of these colleagues in post, as well as bringing in some ‘new blood’ to create a fresh new vision for the future. I wish them all well, and will look forward to reading (as opposed to writing) these editorials. Thanks, finally, to all of the loyal readers who have stuck with the journal over the past 2 decades. I hope that we have managed to keep you entertained and educated on those occasional moments of respite during the acute medical on-call. I wish you all well for the future.

Editorial Volume 1 Issue 2

2002 ◽  
Vol 1 (2) ◽  
Keyword(s):  
Case Reports ◽  
Editorial Team ◽  
Original Research ◽  
Self Assessment ◽  
Acute Medicine ◽  
Questions And Answers ◽  
Medical Emergencies ◽  
Near Future

When I was invited to take over as Editor of this journal, I had little idea of the amount of work which went into its production. I am indebted to Paul Jenkins for staying on in the role of sub-editor, and for helping me up a very steep learning curve over the past few months. I am certain that regular readers will wish to join me in thanking Paul and his editorial team for all their hard work during the last three years. The new editorial board has been expanded to include physicians with a broad range of specialty interests. We will be making use of their expertise and their contacts within their fields to commission reviews on a range of topics relevant to Physicians involved in the Acute Medical take. The intention is to cover all of the common (and some less common) conditions presenting as medical emergencies over a four yearly cycle. Ultimately this will mean that regular subscribers will have access to a comprehensive ‘textbook’ of acute medicine, with ongoing regular updates. The cycle schedule has already been determined, and a provisional plan is listed on page 71. The second section of the journal will include some new features. Some of these will be commissioned, but we would also like to encourage submissions from the readership. Case reports of a ‘General Medical’ nature, pieces of original research and audits relevant to Acute Medicine would be most welcome for this section. ‘Viewpoint’ is intended as a soapbox for anyone with a strong opinion which they would like to air in around 1000 words. This edition contains reviews of the management of suspected pulmonary embolism, diabetic ketoacidosis, anaphylaxis and cellulitis, all relatively common presentations on an Acute Medical take. In addition, we have a detailed review of the management of severe asthma, written from an intensivist’s perspective. This should provide an insight into the management of this complex group of patients, for those of you who are unfamiliar with what goes on beyond the ITU doors. Our ‘How to do it’ feature for this edition is an ophthalmologists’ view of fundoscopy, and some key abnormalities of the optic disc. Self assessment questions and answers are included at the back of this edition. Unfortunately, external CPD credits cannot currently be accrued by completion of these, although we hope to remedy this in the near future. I am sure this will not detract from the enjoyment of reading the journal, which I hope you find as educational an experience as I have had in editing it.

Editorial

2006 ◽  
Vol 5 (3) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Medical Training ◽  
Case Reports ◽  
Junior Doctors ◽  
Acute Medicine ◽  
The Past ◽  
Acute Medical Unit ◽  
Application Service ◽  
Public House ◽  
The Uk

They say time flies when you’re having fun – and the 5 years since Paul Jenkins convinced me to take over as editor of this journal have certainly flown by. This period has seen a dramatic expansion in the numbers of physicians specialising in Acute Medicine, the confirmation of subspeciality status and development of a training curriculum. Addressing over 300 delegates at the recent Society for Acute Medicine meeting at the Royal College of Physicians, President Mike Jones reminded us that only seven years earlier the Society’s entire membership had sat around a small table in a public house just a few hundred yards from that spot. At that time many were predicting that recruitment to the speciality would be a major challenge. ‘Why would anyone choose to specialise in acute medicine?’ was a question, sometimes whispered in the corridors of St Andrew’s Place. And yet many have made this choice, and many more continue to do so. The Society for Acute Medicine now has upwards of 400 members, a figure which has doubled in the past 12 months. Even more encouraging was the large number of trainees who visited the Acute Medicine stand at the recent BMJ careers fair. Many junior doctors clearly view Acute Medicine as a positive career choice, not the ‘last resort’ which some predicted it may become. However, challenges remain. By the time this edition hits the press the Medical Training Application Service (MTAS) will be swinging into action to produce the first applicants for ‘post MMC’ training positions across the UK. For those of us who are involved in the shortlisting and interview process, the enormity of the task is rapidly becoming apparent. In Wessex, the Deanery has suggested that Acute Medicine shortlisting may take as much as a week, with a further week set aside for interviews of the hopeful candidates. Then comes ‘round two’, later in the year, when potentially we do it all over again. Suddenly the prospect of annual leave in the months of March or April looks like a forlorn hope. But before I break this news to my wife and family, I should spare a thought for those readers who find themselves on the opposite side of the process. To be part of the first cohort of trainees to be involved in this must be a daunting prospect. Many of those enthusiastic potential recruits to the speciality are clearly struggling to know where to turn to for advice on the process, confused by often contradictory messages and unanswered questions. Hopefully all will become clearer as the deadlines approach. A smaller ‘Reviews’ section in this edition reflects a dramatic increase in the number of articles submitted for consideration of publication in this journal over the past 6 months. As a result we have accommodated more case reports than normal, along with two papers in our new section for research and audit. I would encourage similar submissions in the future; case reports need not be rare or esoteric, provided they contain a clear teaching message clinicians involved in the acute ‘take’. Completed audits will be considered if they demonstrate clear evidence of how to improve practice in an acute medical unit. Owing to some software problems, Rila has temporarily suspended their submissions website which, until recently, had been the mechanism for submission of articles to this journal. Until these problems are resolved, I would be grateful if any articles could be e-mailed directly to me at the address shown on this page, so that I can arrange for peer review. Finally, a reminder that this edition concludes the cycle of reviews which started in 2002 and has now covered the majority of conditions presenting as emergencies on the acute medical ‘take’. The new cycle, starting in 2007 with volume 6 issue 1 will follow a modified pattern, with different authors hopefully providing a fresh perspective in their updated reviews. My thanks go to all of the authors who have produced material over the past 5 years as well as to the editorial board for their ongoing hard work in commissioning articles for the past and future cycles.

Editorial

2016 ◽  
Vol 15 (1) ◽  
pp. 2-2
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
The Netherlands ◽  
Editorial Team ◽  
Patient Specific ◽  
Service Improvement ◽  
Single Individual ◽  
National Goal ◽  
Acute Medicine ◽  
North West ◽  
The Past

Clinicians working in acute medicine will be familiar with change. The speciality and the environment we work in has changed continually over the past 15 years – I often reflect that no two years have been the same since I started working in the field back in 1999. Change is important, in order to achieve best practice, but sustaining such improvements can be an enormous challenge. The regular turnover of medical staff, local management restructuring and the constantly shifting National goal posts often conspire against us. It is easy for ‘changefatigue’ to set in. Submissions to this journal often describe local audits and service improvement projects which have raised standards: a low baseline may result in a statistically significant improvement from a relatively small intervention – often an education programme or poster campaign to raise awareness of the problem. However, what happens next is far more important: can the improvement be sustained when the key driver behind the project – the enthusiast – moves on, after their 4 month block of acute medicine comes to an end? One year on, we are often back where we started. Two articles in this edition appear to have achieved the Holy Grail of sustainability. In the paper by Joanne Botten from Musgrove Park, door to antibiotic time was improved for patients with neutopaenic sepsis by introducing a system whereby the antibiotics could be administered without waiting for a prescription to be written. The combination of a neutropaenic sepsis alert card and a patient-specific direction empowered the nurses and patients to ensure administration within an hour of arrival in over 90% of cases, a figure which has been sustained for over a year. Sustainable change is often facilitated by modifications in paperwork, but crucially the project’s success was not reliant on a single individual. The value of engaging with the wider team is also shown in Gary Misselbook’s paper describing sustained improvement in the layout and utility of an AMU procedure room. The authors describe how repeated attempts by different registrars had failed to achieve more than temporary reorganisation; the change was only sustained when nursing, infection control and administrative staff became involved in the process. The multiprofessional nature of the AMU is one of its greatest assets – we would all do well to remember this when instigating change. On a similar note, observant readers may have noticed some changes to the editorial board of this journal – I am delighted to welcome Dr Tim Cooksley, acute physician from Manchester and Dr Prabath Nanayakkara from the VUMC in the Netherlands. Tim came through the acute medicine training programme in the North West and his role in the acute oncology service at the Christie Hospital as well as his active involvement in the SAMBA project over recent years brings an important perspective to the editorial team. Prabath has been heavily involved with the development of acute medicine in the Netherlands and co-hosted the successful SAMSTERDAM meeting in 2014. His international perspective will be welcome as we attempt to extend the reach of Acute Medicine to our European neighbours over the coming years. I am very grateful to Nik Patel, Mark Jackson and Ashwin Pinto for their help and support during the past decade and wish them well for the future.

Editorial

2009 ◽  
Vol 8 (1) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Editorial Team ◽  
Political Agenda ◽  
Ageing Population ◽  
Demographic Shift ◽  
Letters To The Editor ◽  
Escape Route ◽  
Acute Medicine ◽  
Large Numbers ◽  
The Uk ◽  
The Impact

Milestones are often seen as opportunities for reflection and reminiscence. As this edition of the journal coincides with the 10th anniversary of my consultant appointment I hope readers will forgive a couple of paragraphs of self-indulgence. The phrase: ‘Where did all that time go?’ will probably be familiar to physicians at a more advanced stage of their career. With medical students now returning as specialist registrars, and former house officers appearing as consultant colleagues, the passage of time is increasingly apparent. I recently realised that our current third year students were born in the year I clerked my first patient: surprisingly I still remember his name, age and diagnosis, unlike many of those (and all of the students!) who I have seen since. On a more positive note, there have clearly been a lot of changes over these ten years: at the time of my appointment in June 1999 there was just a small handful of ‘acute physicians’ in the UK. SAM meetings attracted barely 100 delegates, despite providing free admission, and most of us had planned our escape route in case the acute medicine concept went ‘belly-up’ before our retirement. Now, with several hundred acute medicine consultants, similar numbers of trainees, and ‘full speciality’ status rapidly approaching, job security should no longer be a major concern. Indeed, the last 12 months has seen a further considerable expansion of the speciality; all of the first cohort of acute medicine trainees in Wessex have secured consultant positions, and I am told that SAM now has close to 700 full members. What the next ten years will bring remains to be seen, but with an ageing population and year-round pressures from rising emergency admissions, acute medicine will surely continue to strengthen. As I indicated last time, an increasing number of research-based submissions will be trickling into the journal over the next few editions. The impact of alcohol on the Health Service is a subject which has been at the top of the political agenda in recent months. So it is timely to include an article highlighting its impact on the Acute Medical intake in a busy Teaching hospital in this edition of the journal. The finding that one-in-five patients admitted to the AMU were considered ‘hazardous’ drinkers will probably come as no surprise to acute physicians working elsewhere in the UK. In fact this figure may have been an under-estimate given that the number of units consumer per week was not documented in 30% of clerking records. The demographic shift away from the stereotype ‘middle-aged male’ drinker is also apparent with large numbers of females aged 40-59 falling into this category. Recent editions of this journal would not seem complete without mention of training in practical procedures. In this issue the SAM trainee representatives have summarised the recent trainee survey in this area, providing some recommendations which will hopefully be incorporated into the new curriculum. Readers who are becoming tired of this subject can be reassured that this should be the final article relating to this for the time being! I hope this edition provides interesting reading and please keep the submissions coming – although the review articles are usually solicited by the editorial team, we will continue to consider any submitted article for publication, provided there is a clear teaching message for those working in the field of Acute Medicine. Any feedback on the articles included in this or previous editions would also be welcome, and may be included in a future ‘viewpoint’ or ‘letters to the editor’ section.

Shaping the future of Acute Medical training

2018 ◽  
Vol 17 (2) ◽  
pp. 113-113
Author(s):  
Mark Lander ◽  
Keyword(s):  
Internal Medicine ◽  
Medical Training ◽  
Training Programs ◽  
Quality Criteria ◽  
Identity Crisis ◽  
Specialty Training ◽  
Internal Medicine Training ◽  
The Future

Sir, I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs) and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training. Indeed, the recent Joint Royal Colleges of Physicians Training Board (JRCPTB) statement regarding quality criteria for GIM/AIM Registrars appears to regard the role of the AIM registrar as that of the DMR rather than a specialist in their own field.

scholarly journals Cruising through the journey without getting drowned: The saga of a PhD student in the Netherlands

2017 ◽  
Vol 16 (1) ◽  
pp. 43-45
Author(s):  
Louise Van Galen ◽  
◽  
Joyce Wachelder ◽  
Keyword(s):  
Internal Medicine ◽  
The Netherlands ◽  
Scientific Research ◽  
Acute Medicine ◽  
Medical Trainees ◽  
Scientific World ◽  
The World ◽  
Doctor Of Philosophy ◽  
The Uk

Young medical trainees all over the world are encouraged to investigate unknown areas of medicine that need clarification. This often leads them to undertake a PhD (Doctor of Philosophy). Being curious, critical, and creative are necessary competences which enable us to engender scientific research within acute (internal) medicine. Worldwide, huge numbers of professionals are pursuing a PhD, with the aim of receiving a ‘Doctor’-title. These PhD trajectories vary distinctly between countries. Since the distances in the scientific world are getting smaller and it is becoming more easy to work with each other across borders, it might be interesting to know what it requires to become an academic ‘doctor’ overseas. Hereby, we provide a concise insight in to the differences between doing PhD in (acute) medicine in the Netherlands and in the UK

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

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.

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.

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