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Community-Acquired Pneumonia is the opening subject of this edition and important lessons remain to be learned. The epidemiological statistics enumerated by Drs Bianchi and Woodhead are striking in themselves and notice the mortality figures for pneumonia in general and pneumococcal infection in particular. There are many messages in this paper, not least the need to be obsessional in assessing severity of illness and identifying (promptly) the need for Intensive Care. Stroke management promises exciting innovations over the next decade with the real possibility for reducing mortality and morbidity. Andy Johnston has produced a splendid exposition, a successful blend of fact and practical management: prevention of secondary brain injury, indications for CT scanning, where we are with thrombolysis and the multidisciplinary approach…watch this space.

We are all familiar with the spectre of pulmonary thromboembolism; the variability of its clinical presentation, the difficulties in obtaining specific investigations promptly and out-of-hours, the considerable mortality of the condition and the knowledge that it has been underdiagnosed in the past (probably still is). Praveen Bhatia and John O’Reilly contribute an admirable practical overview of the condition including clinical features, investigations, treatment and preventative measures. There have been recent advances in investigation (CT angiography) and treatment (low molecular weight heparin) of course, and it seems likely that as the investigative approach becomes more refined (and more available), improved ‘anatomical’ imaging of the site and size of emboli will result in more frequent use of thrombolytic agents for this condition.

Drs Tang and Shapiro from Papworth Hospital have kindly written the ‘Emergency Management’ article this time, choosing the Acute Coronary Syndrome as their subject. The authors have managed to summarize the salient findings of many of the alphabetically challenging cardiological studies of recent years and to combine this with a practical guide to management of one of the most common medical emergencies. I particularly enjoyed the rhetorical conclusion, ‘If I had unstable angina…’ In our “How to do it” series, Sarah Clarke has described the techniques of central venous cannulation and who better to do this than an anaesthetist with a special interest in Intensive Care. Sarah recently spent 6 months in acute medicine as part of her anaesthetic training and we hope to be able to persuade her to write about her experiences in a future edition of the Journal.

Which brings me to my final paragraph. Training in Acute Medicine continues as a popular subject for debate. It is certainly high on the agenda for the Society for Acute Medicine UK (SAMUK), a Society now proudly 6 months old! Most of the subscribers to this Journal will have professional responsibilities in Acute Medicine and might be expected to be interested in SAMUK. If you are interested in joining, feel free to contact Dr Derek Bell (the President) or me (Vice-President). Our contact details are given with our mug-shots on this page and please note that RILA publications have kindly agreed to discount the subscription rate to this Journal for members of SAMUK. The society is multidisciplinary, nurses and PAMS involved in Acute Medicine are warmly invited to become members.

Enjoy this edition…… I’m back to work on the next one!