Editorial

Abstract

Welcome to the first summer edition of Acute Medicine which became a ‘quarterly’ journal this year. Some readers may be relieved to have survived the passing of spring, with Bank Holidays and a Royal wedding bringing the challenges of 7 day working into sharp focus. There have been times in the past when it felt like acute medicine was the only in-patient speciality with its ‘finger in the dyke’ during holiday periods. The recent e-mail traffic on this issue suggests that greater planning and support from other hospital specialities may have helped limit the impact of the lost ‘working days’ in April. It certainly felt much better than Christmas – perhaps the good weather also helped! Weekend and out-of-hours working are likely to be key areas for acute medicine over coming years. As numbers of trainees obtaining CCTs rises we have a great opportunity to bid for greater consultant numbers; this should enable us to extend the hours of consultant-led acute medical care on AMUs across the UK while maintaining a work-life balance – and our sanity! The interface with specialities on the AMU is another area which has been creating discussion over recent months. A workshop at the Edinburgh SAM meeting last autumn spawned a plenary session on this subject at the spring meeting in Bristol. Two articles in this edition provide different perspectives on this problem. Charlotte Cannon describes the service in Swindon where patients on the AMU remain under the care of the acute medical team; Jo Southgate’s model in Norwich involves much earlier involvement by speciality teams, facilitated by much larger numbers of speciality consultants. Both models have their merits and have been developed to deal with the specific local challenges; earlier involvement of speciality teams may improve continuity of care for those who remain in hospital, but this may be at the expense of delays to treatment and discharge decisions for those who do not. Readers may find the experiences described in these papers helpful in developing their own services. Patients with anorexia nervosa commonly present on the acute medical take and can be difficult to manage. The case series and review published in this edition may help acute physicians to understand better how to prevent, identify and manage refeeding syndrome in these patients. This potentially fatal condition appears to be particularly common where malnutrition relates to anorexia nervosa, affecting 13 of 14 patients in this series despite very careful control of nutritional intake. Three patients required high dependency care. The need for close monitoring of electrolyte levels and raised awareness of the serious nature of the condition appear to be the key messages from this paper. Finally, a piece of good news for aspiring authors who may be considering submission to Acute Medicine. The journal was recently approved for listing on MEDLINE, and articles will now be archived on-line on PubMed. This is a great step forward and I hope will lead to a further increase in the number of high quality submissions we receive. I would like to pass on my thanks to all of those who have been involved in making the journal a success over the past 10 years and helping to take us up to this new level. We remain particularly keen to publish more AMU-based research articles, and those describing completed audit cycles which demonstrate improved practice – so please keep them coming!