Welcome to the second edition of Acute Medicine Volume 4 which, I regret to say, has probably reached you rather later in the year than you were anticipating. Unfortunately printing delays around the time of the change in our journal’s title have pushed back publication dates for both of this year’s editions so far, although I am hopeful that the third will reach subscribers soon after this one.
Our cycle of reviews, which began in 2002, is now nearing its end; by the end of next year this should be complete. Regular subscribers over the past 4 years will soon have the equivalent of a comprehensive textbook of up to date management of conditions presenting themselves on an acute medical ‘take’. How we proceed beyond this is still to be determined; management of many of the conditions described will not have changed dramatically in 5 years, so that simply repeating the cycle may be inappropriate. One option we are considering is to change the emphasis of review articles from ‘diagnosis’ to being ‘problem’ based. An edition may be themed around topics such as ‘The patient with palpitations’ or ‘The patient with pleuritic chest pain’, rather than starting with the diagnosis which may not be apparent at the time of initial assessment. In order to keep them practical for our ‘Acute Medical’ readership, it is essential that, wherever possible, such reviews are written from the perspective of those working within the field. I am therefore open to offers from anyone who has an interest in writing a review article along these lines who should contact me at the address or e-mail shown on this page.
This edition’s reviews represent a mixture of the common and extremely uncommon conditions facing the acute take physician. Ben Turner follows up his previous article on Thyroid Storm with a comprehensive review of the management of Myxoedema Coma. Although rare, its nonspecific presentation and serious consequences are highlighted; lack of ‘routine’ availability of thyroid function tests in the out of hours period or at weekends require that clinical vigilance is maintained. Mark O’Neill concludes his ‘tachyarrhythmia’ series with his review on the management of narrow complex tachycardia, while another cardiologist Dr Tim Wells embarks on a pair of articles describing inflammatory cardiac conditions; endocarditis will follow in a later edition.
Our ‘Regular Features’ section includes two examples of potential complications of commonlyused drugs, namely amiodarone and enoxaparin. Clare Sixsmith’s ‘Viewpoint’ paper entitled ‘Should physicians manage hip fractures?’ raises some interesting questions regarding the need for a specialist ‘Orthogeriatric’ service. More controversies follow in the final paper on the management of life-threatening asthma. We would happily consider publication of letters containing contradictory views on any of these subjects in a future edition of the journal: I would be particularly keen to hear from anyone who has a good word to say about aminophylline. I can’t believe I am the only physician who still thinks it is a useful drug!