Volume 15

‘Where’s the evidence?’ It’s a question that most clinicians will ask themselves – or their team – every day. Good evidence requires good research, but it is often challenging to find high quality data pertaining to the AMU setting. It is encouraging that this journal has started to receive more research-orientated submissions over the past year, but the increase continues to be more of a trickle than a flood. The article by Louella Vaughan, published in this edition, highlights some of the difficulties which may arise when trying to undertake research in the AMU – along with some solutions. Engagement of the multidisciplinary team on the acute medical unit is a key part of this. Many of us will be familiar with the daily pressures to maintain patient flow through the unit, so anything which is perceived to increase workload will probably be met with resistance. A clear explanation of the local benefits which will arise from research is critical. Things are unlikely to change on a large scale until we have dedicated acute medicine research nurses, senior academics and junior doctors with protected time to write research proposals, organise ethics submissions and conduct studies. We have to be realistic in the context of the current financial pressures in our NHS; however, encouraging more acute medicine trainees to undertake research as their ‘special skill’ during higher speciality training would represent a step in the right direction.

I am delighted to have been able to include, in this edition, two papers from our acute medicine colleagues in the Netherlands. The Dutch Acute Medicine society has collaborated closely with the Society for Acute Medicine in recent years, and many members will recall the highly successful joint SAM / DAM conference in Amsterdam few years ago. The papers on sepsis management in the pre-hospital setting are highly topical, given the recent publication of NICE guidance in this area, proposed new definitions of sepsis and the current political drive to improve treatment of this condition. Although it is not particularly surprising that earlier recognition and documentation of sepsis reduced time to antibiotic administration following hospital arrival, this finding adds weight to the NICE proposals with regard to pre-hospital assessment. Early warning scores are already being used by some UK ambulance trusts as part of their initial patient assessment protocols. It was encouraging to note that the proportion of patients in whom sepsis was documented by paramedic crews was higher than had been noted in previous studies – the authors hypothesise that this may related to the educational benefits arising from their ongoing PHANTASi trial, the protocol for which is also included in this edition. The results of this study, investigating the impact of pre-hospital antibiotic administration for patients with severe sepsis, will hopefully be published in 2017.

I suspect that by the time this edition is published, Christmas and New Year will have passed, so I wish you all well for whatever Winter has left in store, and look forward to the warmer (and hopefully calmer) months which will follow.