Description

Few will deny that the past 6 months have been particularly challenging for all clinicians
working in hospital medicine. The pressures of ward closures, which many acute hospitals
have faced recently, have undoubtedly increased the bottle-neck effect at the front door.
Any slack which might have existed in the past has now disappeared 82% occupancy, which
was once touted as the Holy Grail of bed-crisis prevention now seems a forlorn hope. One of
the Governments solutions is that chronic disease will be managed without admission to
hospital. In reality, this will require dramatic changes in the attitudes of patients, carers and
general practitioners and will not happen quickly. The impact of any pre-emptive reduction in
capacity will be felt long before any such changes take effect. In the meantime it will up to those
of us working in the AMU to sort-out and turf-out, where appropriate. Looking on the
bright side, at least when the next round of consultant redundancies is announced we should
have little difficulty in justifying our existence.

The request to rule-out serious pathology is a frequent justification for hospital referral.
When the problem is that of a sudden onset of headache the need to rule-out subarachnoid
haemorrhage becomes paramount. Most readers will not make the mistake I made once as an
SHO, in assuming that negative CT brain scanning is adequate in this context. However, CSF
analysis is not always straightforward. Stephen Hill and Ashwin Pintos excellent review of this
subject will help unravel some of the complexities in this area. Hopefully the reviews of the acute
management of chronic liver disease, psoas abscess and sickle cell disease will also be helpful in
your day-to-day working practices. I would also draw your attention to the postcard, which Dr
Snape has kindly submitted from a collection donated to him by a patient. Referring to the 1918
Avian Inf luenza outbreak the postcards author provides a chilling reminder of the impact of this
pandemic. If rule-out avian f lu becomes a reason for referral to hospital in the future, we will
hopefully be well prepared.

Finally in a slight change to the previous format there is now a special section of the journal
relating to the Society for Acute Medicine. I am aware that a large proportion of readers are
members of the society and this needs to be ref lected in the journals content. The Society
Pages will become a regular feature in the journal, hopefully providing readers with useful
information and updates on developments within Acute Medicine. In this edition I have
included the abstracts from the Free Paper session at the recent meeting in Hull, along with a
summary of the meeting and programme for the next meeting in the Royal College of
Physicians. Submissions for this section could include summaries of working practices within
different acute medicine units around the country, as well as experiences of trainees undertaking
the new acute medicine training programmes. All would be gratefully received.