Editorial
Authors:   University Hospital Southampton Foundation Trust Tremona Road, Roseveare Chris 
Published: June 2021

Summer has been a busy time for the British media – phone hacking, atrocities in Norway, famine in Africa, riots, financial crises….hardly the usual ‘silly season’. The lack of health stories on the front pages might suggest that all is calm on the hospital front line. I suspect that most readers will disagree. Certainly in my hospital summer has f lown past with little respite from the pressures of emergency admissions, which now seem to continue all year round. However the wide variety of different conditions presenting on the acute medical take helps maintain our sanity and keeps the grey cells ticking over. The three case reports in this edition highlight this variety. Tanuj Lad reminds us that type 2 respiratory failure does not always mean COPD, while Desai and Sivaramakrishnan present an important differential diagnosis for a patient with diarrhoea. Haemophagocytic syndrome might not be a common cause of fever and rash, but the importance of maintaining a broad differential diagnosis in patients with HIV should noted, even when the CD4 count is not particularly low. These cases also illustrate the excellent learning opportunities for junior doctors on the AMU. Although it is often hard to find the time to teach on our ward rounds, such opportunities must not be missed. Nicola Cooper’s article provides some useful advice on how to maximise these opportunities amidst the continued work pressures. Recognition of the patient whose condition is likely to deteriorate is an important aspect of patient safety on the AMU. Early warning scores have become part of our daily practice and the article by Perera and colleagues from the University of Colombo, Sri Lanka, gives an interesting new dimension to this issue. Their data suggest that addition of biochemical parameters into the score improves its sensitivity in predicting the patient’s deterioration, as well as length of stay. Albumin, C-reactive protein and platelet count were particularly valuable in this respect – given that all of these are measured in the majority of UK patients admitted during the medical ‘take’ these results are likely to be of interest to many readers. MEWS (soon to be NEWS when the NHS National score is finally agreed) will still be required as a repeatable, bedside track-and-trigger mechanism. However if these data are replicated in a UK population, perhaps an initial score incorporating these could become part of our assessment armoury. Finally, some readers will be aware that I will be taking over as President of the Society for Acute Medicine after this autumn’s International conference in London. This means and end to Phil Dyer’s impressive 2 year tenure in this role. He will be a hard act to follow, although the council will continue to benefit from his involvement as ‘Immediate Past President’ for the next 2 years. I am planning to continue in my role as editor of this journal during this period, which will maintain the relationship which SAM has enjoyed over the past decade. SAM members will continue to receive 4 editions of the journal per year; this autumn on-line access for the current and future editions will also be available to full SAM members. Those who would like to take advantage of this should email sam@rcpe.ac.uk to obtain their access code.