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Annals design changes to enhance editorial goals
Editorials
A n n a l s D e s i g n C h a n g e s to Enhance E d i t o r i a l Goals Joseph F Waeckerle,MD, FACEP Expanding the Focus of Emergency Medicine Keith Wrenn, MD Computer Data Base for ED Visits Robert L Wears, MD, FACEP C a l c i u m P r e t r e a t m e n t to P r e v e n t V e r a p a m i l Induced Hypotension in Patients With SVT Stephen J Jameson, MD Stephen W Hargarten, MD, MPH S t r a t e g i e s to I n c r e a s e t h e N u m b e r Existing Training Programs Harold Thomas Jr, MD, FACEP Louis Ling, MD, FACEP
of Residents in
Annals Design Changes to Enhance
Editorial Goals The Editorial Board and staff of Annals of Emergency Medicine are committed to maintaining publishing standards and editorial policies that will result in the highest quality journal, one that is both educational and enjoyable to you, our readers. As your editor, my goals for Annals are to: • publish valuable and reliable information in both the clinical and basic sciences • publish pertinent information in nonclinical areas of the humanities and sciences • provide important and timely information on socioeconomic issues, especially as health care undergoes intense scrutiny and revolutionary changes in technology and delivery systems • provide a forum for responsible and provocative debate, and • report and forecast issues and trends of importance to emergency physicians. It has been tremendously gratifying for me, as editor, to see a significant increase over the last several years in the quantity and quality of papers submitted to Annals. As the specialty of emergency medicine matures, the content of Annals continues to become more sophisticated and diverse, and we continue to modify the journal's editorial processes and format to maintain our commitment to excellence. For example, Annals now regularly has "theme issues" to group contributions in the areas of EMS, toxicology, pediatrics, and laboratory investigations. I have appointed section editors for each of these topics, who oversee the peer review and editing of papers in those areas. We have created a new graphic design for Annals to ensure that the format complements and enhances the content and is functional and contemporary. We are pleased to present it to you in this issue. The new design is intended to allow the reader to more efficiently review and absorb the information presented. Some readily apparent changes in the design are the new "gatefold" cover, which presents the entire table of contents, and •
JANLIAR¥ 1992 21:1 ANNALS OF EMERGENCY MEDICINE
65/81 I
EDITORIALS
a new sequence for sections of the journal. The calendar section has been moved to the back of the journal, while editorials have
safest, and cheapest regimen with the least side effects. Although sublingual or oral nifedipine is undoubtedly effective in the ED,
been moved forward to follow original contributions. I believe that these changes greatly enhance the readability of the journal and
is this really the drug we want to send home with a patient? We
complement our editorial goals. This new graphic design is part of a three-year process to
of coexisting illnesses before we prescribe an antihypertensive agent. Nifedipine is efl'ective and relatively safe, but a sustained-
improve the journal format. Changes introduced in the last year include clustering advertisements between sections of the journal
release preparation may be expensive and result in side effects such as headache or pedal edema that may limit compliance.
and reformatting the size of tables and figures to make them more readable. The final step of the design process is phasing in elec-
better choice.
tronic publishing over the next year. As part of this change, authors are now required to submit manuscripts in disk format,
A second example involves the care of a patient with chest pain who gets "ruled-out" in the ED. There are new and innova-
as outlined in Information for Authors.
tive criteria that show us who is at risk for severe coronary artery
As the flagship journal for emergency medicine, Annals serves as an educational and communication vehicle for the specialty,
disease, 9 acute ischemic heart disease, 1° or acute myocardial infarction,n More sensitive ereatine phosphokinase-MB iso-
improving the quality of care by providing timely discussions of patient care issues. In addition, it is a forum for education,
enzyme assays 12 are also available, but after the patient is shown
research, and socioeconomic activities affecting the specialty. The editors and staff hope not only to educate and inform you, the readers, but to entice you to become involved, to promote and nurture the specialty, and to pursue and support such other important health care issues as prevention, wellness, and patient access to care. As always, we welcome and invite your comments regarding our goals and their pursuit. Joseph F Woeckerle, MD, FACEP Editor
Expanding the Focus of Emergency Medicine As emergency medicine continues to evolve as a specialty, we practitioners of emergency care need to continuously re-evaluate our focus. Up to now, much of the research and most of our prac-
Sometimes hydrochlorothiazide or low-dose reserpine may be a
not to have had a myocardial infarction, what happens next? When is further testing indicated, what testing is indicated, and who makes these determinations? A significant number of patients with "atypical" pain may have severe coronaW disease. 9 A significant number of patients who rule out may have unstable angina. 13 Another example is treatment of a patient with a sore throat. It is hard enough to decide whether you are going to treat for streptococcal pharyngitis, 14 but if you do decide to treat, what will be your treatment? It is relatively easy to decide if the patient is allergic to penicillin. Not only is erythromycin effective, but it treats some other organisms such as Corynebacterium, Mycoplasma, and Chlamydia, which may cause pharyngitis. 14,15 If penicillin is to be used, however, compliance with a four-timesdaily regimen over ten days is likely to be dismal. Why not use a single dose of benzathine penicillin, which is effective and sustains adequate levels for ahnost a month, ensuring compliance? 16-t7 Other examples include innovative and inexpensive ways to get
tice energy have naturally centered on the here-and-now diagno-
antibiotics into the patient for longer periods of time. What about
sis and treatment of problems seen in the emergency department. Although this has been an important early goal, I think the time
the use of longer-acting cephalosporins with probenecid (personal communication, Daniel Brookoff, MD, March 1991) or depot
is ripe to expand our focus. We should expand our vision of responsibility to include not only the time a patient spends within the ED ("treat 'em and/or street 'em") but also a reasonable peri-
antibiotic delivery systems fi)r pneumonia or cellulitis that does not necessarily require hospitalization? Should we be moving away from the use of acetaminophen-eodeine combinations in patients with fractures, migraines, and severe low back pain and
od of time after a patient leaves the ED (eg, one to two weeks). 1 am not speaking so much of arranging follow-up but rather of thinking about how our actions will impact and influence patients in the foreseeable future. A few examples may help clarify this position. There is a plethora of articles about how to reduce an ED patient's blood pressure in the setting of a hypertensive urgency. 1-6 A more fundamental question, however, is whether bringing down the blood pressure in the ED is all that important, r,8 The focus should be on providing the patient with the most effective, easiest,
82/66 I
should consider the patient's sex, age, and race and the presence
instead use the longer-acting oral morphine preparations? Although it is relatively easy to diagnose iron deficiency anemia, what is the best and most cost-effective approach to working up the cause and treating it in a homeless person? Maybe parenteral iron is not such a bad idea in some cases. The examples are endless. [ think that there are many problems confronting emergency physicians, but those problems represent fertile ground for research. As health care dollars become harder to come by and pressure is exerted to keep fewer patients in the hospital I~
ANNALS OF EMERGENCYMED[CINE
2 1 : 1 JANUARY1992
A n n a l s D e s i g n C h a n g e s to Enhance E d i t o r i a l Goals Joseph F Waeckerle,MD, FACEP Expanding the Focus of Emergency Medicine Keith Wrenn, MD Computer Data Base for ED Visits Robert L Wears, MD, FACEP C a l c i u m P r e t r e a t m e n t to P r e v e n t V e r a p a m i l Induced Hypotension in Patients With SVT Stephen J Jameson, MD Stephen W Hargarten, MD, MPH S t r a t e g i e s to I n c r e a s e t h e N u m b e r Existing Training Programs Harold Thomas Jr, MD, FACEP Louis Ling, MD, FACEP
of Residents in
Annals Design Changes to Enhance
Editorial Goals The Editorial Board and staff of Annals of Emergency Medicine are committed to maintaining publishing standards and editorial policies that will result in the highest quality journal, one that is both educational and enjoyable to you, our readers. As your editor, my goals for Annals are to: • publish valuable and reliable information in both the clinical and basic sciences • publish pertinent information in nonclinical areas of the humanities and sciences • provide important and timely information on socioeconomic issues, especially as health care undergoes intense scrutiny and revolutionary changes in technology and delivery systems • provide a forum for responsible and provocative debate, and • report and forecast issues and trends of importance to emergency physicians. It has been tremendously gratifying for me, as editor, to see a significant increase over the last several years in the quantity and quality of papers submitted to Annals. As the specialty of emergency medicine matures, the content of Annals continues to become more sophisticated and diverse, and we continue to modify the journal's editorial processes and format to maintain our commitment to excellence. For example, Annals now regularly has "theme issues" to group contributions in the areas of EMS, toxicology, pediatrics, and laboratory investigations. I have appointed section editors for each of these topics, who oversee the peer review and editing of papers in those areas. We have created a new graphic design for Annals to ensure that the format complements and enhances the content and is functional and contemporary. We are pleased to present it to you in this issue. The new design is intended to allow the reader to more efficiently review and absorb the information presented. Some readily apparent changes in the design are the new "gatefold" cover, which presents the entire table of contents, and •
JANLIAR¥ 1992 21:1 ANNALS OF EMERGENCY MEDICINE
65/81 I
EDITORIALS
a new sequence for sections of the journal. The calendar section has been moved to the back of the journal, while editorials have
safest, and cheapest regimen with the least side effects. Although sublingual or oral nifedipine is undoubtedly effective in the ED,
been moved forward to follow original contributions. I believe that these changes greatly enhance the readability of the journal and
is this really the drug we want to send home with a patient? We
complement our editorial goals. This new graphic design is part of a three-year process to
of coexisting illnesses before we prescribe an antihypertensive agent. Nifedipine is efl'ective and relatively safe, but a sustained-
improve the journal format. Changes introduced in the last year include clustering advertisements between sections of the journal
release preparation may be expensive and result in side effects such as headache or pedal edema that may limit compliance.
and reformatting the size of tables and figures to make them more readable. The final step of the design process is phasing in elec-
better choice.
tronic publishing over the next year. As part of this change, authors are now required to submit manuscripts in disk format,
A second example involves the care of a patient with chest pain who gets "ruled-out" in the ED. There are new and innova-
as outlined in Information for Authors.
tive criteria that show us who is at risk for severe coronary artery
As the flagship journal for emergency medicine, Annals serves as an educational and communication vehicle for the specialty,
disease, 9 acute ischemic heart disease, 1° or acute myocardial infarction,n More sensitive ereatine phosphokinase-MB iso-
improving the quality of care by providing timely discussions of patient care issues. In addition, it is a forum for education,
enzyme assays 12 are also available, but after the patient is shown
research, and socioeconomic activities affecting the specialty. The editors and staff hope not only to educate and inform you, the readers, but to entice you to become involved, to promote and nurture the specialty, and to pursue and support such other important health care issues as prevention, wellness, and patient access to care. As always, we welcome and invite your comments regarding our goals and their pursuit. Joseph F Woeckerle, MD, FACEP Editor
Expanding the Focus of Emergency Medicine As emergency medicine continues to evolve as a specialty, we practitioners of emergency care need to continuously re-evaluate our focus. Up to now, much of the research and most of our prac-
Sometimes hydrochlorothiazide or low-dose reserpine may be a
not to have had a myocardial infarction, what happens next? When is further testing indicated, what testing is indicated, and who makes these determinations? A significant number of patients with "atypical" pain may have severe coronaW disease. 9 A significant number of patients who rule out may have unstable angina. 13 Another example is treatment of a patient with a sore throat. It is hard enough to decide whether you are going to treat for streptococcal pharyngitis, 14 but if you do decide to treat, what will be your treatment? It is relatively easy to decide if the patient is allergic to penicillin. Not only is erythromycin effective, but it treats some other organisms such as Corynebacterium, Mycoplasma, and Chlamydia, which may cause pharyngitis. 14,15 If penicillin is to be used, however, compliance with a four-timesdaily regimen over ten days is likely to be dismal. Why not use a single dose of benzathine penicillin, which is effective and sustains adequate levels for ahnost a month, ensuring compliance? 16-t7 Other examples include innovative and inexpensive ways to get
tice energy have naturally centered on the here-and-now diagno-
antibiotics into the patient for longer periods of time. What about
sis and treatment of problems seen in the emergency department. Although this has been an important early goal, I think the time
the use of longer-acting cephalosporins with probenecid (personal communication, Daniel Brookoff, MD, March 1991) or depot
is ripe to expand our focus. We should expand our vision of responsibility to include not only the time a patient spends within the ED ("treat 'em and/or street 'em") but also a reasonable peri-
antibiotic delivery systems fi)r pneumonia or cellulitis that does not necessarily require hospitalization? Should we be moving away from the use of acetaminophen-eodeine combinations in patients with fractures, migraines, and severe low back pain and
od of time after a patient leaves the ED (eg, one to two weeks). 1 am not speaking so much of arranging follow-up but rather of thinking about how our actions will impact and influence patients in the foreseeable future. A few examples may help clarify this position. There is a plethora of articles about how to reduce an ED patient's blood pressure in the setting of a hypertensive urgency. 1-6 A more fundamental question, however, is whether bringing down the blood pressure in the ED is all that important, r,8 The focus should be on providing the patient with the most effective, easiest,
82/66 I
should consider the patient's sex, age, and race and the presence
instead use the longer-acting oral morphine preparations? Although it is relatively easy to diagnose iron deficiency anemia, what is the best and most cost-effective approach to working up the cause and treating it in a homeless person? Maybe parenteral iron is not such a bad idea in some cases. The examples are endless. [ think that there are many problems confronting emergency physicians, but those problems represent fertile ground for research. As health care dollars become harder to come by and pressure is exerted to keep fewer patients in the hospital I~
ANNALS OF EMERGENCYMED[CINE
2 1 : 1 JANUARY1992