Guest Editorial

Who is allowed to read and write?

Guest Editorial, Volume 19, Issue 3, Pages 113 – 172 (2020)

What makes us human? In 2015 Jeremy Vine asked this question to a selection of leading British thinkers and writers. The answers were as diverse as the people he interviewed. While you might have your own views about the complexity of being human I would suggest that being able to articulate thoughts and communicate them to others might be one of the characteristics that distinguishes us from other life forms. And if we think more about the achievements of human culture then being able to communicate thoughts in writing and reading other people’s thoughts is one of the unique abilities that humanity has acquired during its evolution: Young humans spend extensive time to learn how to read and write. They write on paper, they read books and they do the same on computers. They become adults. They read and write most days: they e-mail their telephone company, file online forms to the tax office and or write romantic notes to their partner.

Who is allowed to read and write? Read More

Which patients should be monitored, how should they be monitored, and why should they be monitored?

Guest Editorial, Volume 18, Issue 4, Pages 205 – 264 (2019)

Intensively monitoring severely ill patients is like placing a smoke alarm in a burning building: it makes no sense. Smoke alarms only makes sense if they are placed in buildings before a fire starts, or after a fire has been extinguished in order to make sure it does not start again. Therefore, logic suggests that it is more important to monitor sick patients with normal vital signs in order to detect any deterioration as early as possible, or AFTER a severe illness in order to ensure they do not relapse, and it is safe for them to be discharged from hospital and return home.

Which patients should be monitored, how should they be monitored, and why should they be monitored? Read More

Altered kidney function on the Acute Medical Unit

Guest Editorial, Volume 18, Issue 3, Pages 137 – 204 (2019)

Reduced kidney function, whether acute or chronic, is a highly significant biomarker of in most clinical settings. This is particularly true on the acute medical take where altered renal function is associated with a worse prognosis, and may also impact on immediate management strategies such as drug choice, dosing and suspension, and the use of contrast agents for imaging. In this edition of the Acute Medical Journal, Yang et al present the results of their study describing the renal function and associated characteristics in 2,070 consecutive patients presenting on the unselected medical take at their hospital over a 40 day period. In this study, the authors provide a wealth of information on the general characteristics of acute medical patients admitted with altered kidney function, be it CKD or AKI. Importantly, both chronic kidney disease (CKD) and acute kidney injury (AKI) are very highly prevalent. Indeed, in this study more than 5% of all medical admissions actually demonstrated evidence of both.

Altered kidney function on the Acute Medical Unit Read More

Death after Discharge – Every heart beat counts (probably)!

Guest Editorial, Volume 18, Issue 2, Pages 61 – 136 (2019)

The assumption would be that patients who are discharged from an emergency or acute medicine department have been thoroughly assessed and are good to return to the safety of their own home. An unplanned death after discharge from hospital is the worst-case scenario for patients, families and indeed clinicians. In order to prevent adverse events after patients leave hospital most units have a multi-layered system to capture risk that includes triage, recording of vital signs, basic blood tests, understanding of existing past medical history and assessment by a senior clinician to add experience and intuition. Discharge decisions depend on a balanced review of all these parameters and a discussion with patients about residual risks. Only after this will patients go home. Despite this a small percentage of patients pass away unexpectedly within days after leaving hospital.

Death after Discharge – Every heart beat counts (probably)! Read More

Ambulatory management in low risk neutropenic sepsis – A plea for integrated acute cancer care

Guest Editorial, Volume 18, Issue 1, Pages 1 – 60 (2019)

Neutropenic Sepsis (NS) is a well recognised treatment complication, typically occurring 7-10 days following cancer cytotoxic chemotherapy. Colleagues in acute medicine will be only too familiar with the scenario of cancer patients that present with fever in the absence of localising signs and symptoms and with a very low yield from microbiological cultures. The incidence and mortality of NS are poorly defined and historically, management guidelines have often been developed in relative isolation from the broader subject of infection and sepsis care. Despite the lack of a clear and pragmatic definition, NICE guidance CG151 (2012) identified suspected NS as a medical emergency requiring prompt empirical broad spectrum antibiotics.

Ambulatory management in low risk neutropenic sepsis – A plea for integrated acute cancer care Read More

Risk prediction in acute medical care: the potassium story

Guest Editorial, Volume 18, Issue 1, Pages 1 – 60 (2019)

The increased demand for secondary healthcare services has led to overflow in emergency departments and acute medical units throughout the world. And, as all patients therefore cannot be seen at once, most departments have introduced triage by experienced nurses at arrival. Triage is meant to predict time to be seen by a qualified healthcare professional and not – necessarily – to predict outcome.

Risk prediction in acute medical care: the potassium story Read More

Exploring the value of routinely measured hematology parameters for identification of elderly patients at high risk of death at the Emergency Department

Guest Editorial, Volume 17, Issue 4, Pages 173 – 240 (2018)

Common risk stratification tools, e.g. for triage, fail in older patients. Some attempts have been undertaken to improve triage of older patients with nonspecific markers such as lactate with or without combination with vital signs or other aggregated lab scores.

Exploring the value of routinely measured hematology parameters for identification of elderly patients at high risk of death at the Emergency Department Read More

HIV testing in Acute Care

Guest Editorial, Volume 17, Issue 2, Pages 57 – 116 (2018)

Readers may be aware of the need to improve uptake of HIV testing in health care-settings to reduce the number of individuals with undiagnosed infection who later present with advanced disease. Late presentation of HIV infection is associated with a poorer immune response to antiretroviral therapy, an increased morbidity and mortality with a resultant higher cost burden to health-care services. Individuals with undiagnosed HIV infection who inadvertently transmit their infection to others are thought to be responsible for more than half of new HIV infections in the USA.

HIV testing in Acute Care Read More

Getting information across the acute medicine and primary care interface – steps in the right direction

Guest Editorial, Volume 17, Issue 2, Pages 57 – 116 (2018)

In the acute care pathway, patients often need to move from home to hospital and for the majority, back again. This movement across care interfaces ensures that assessments and interventions are delivered to reduce risk of harm and enhance recovery. However, information needs to move across interfaces too, which enables the clinician taking over care to understand the problem, what has been done and what remains to be done. This is as important for the journey into hospital as it is for the journey home again and is highlighted in the forthcoming NICE guidance on Emergency and Acute Medical Care.

Getting information across the acute medicine and primary care interface – steps in the right direction Read More

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