Salivary pepsin may be used as a screening adjunct to supplement the RFS in the clinical workup of patients with extra-oesophageal symptoms and upper respiratory tract presentations of reflux.

Summary Background Vocal cord dysfunction (VCD) typically involves abnormal adduction of the vocal cords during inspiration, mimics the symptoms of asthma and leads to the prescription of ineffective medications. Objective We aimed to develop a clinical tool to monitor symptoms and response to treatment in confirmed VCD. Methods We collated symptoms of VCD from focus groups comprising patients and healthcare professionals; phrases describing these symptoms were assessed for face validity and internal correlation and rated for importance. The resultant 12‐item questionnaire (VCDQ) rated the impact of each on a 5‐point Likert scale (total score range 12–60) and was tested for reliability, concurrent validity and performance in 31 patients with endoscopically confirmed VCD (± asthma), 29 asthmatics with no history of VCD and 14 healthy controls. We assessed response to speech and language therapy and the minimal important difference by measuring the VCDQ pre‐ and post‐ therapy in a 20 new patients. Results The VCDQ had excellent test–retest reliability and differentiated VCD vs. healthy (Mann–Whitney U‐test: z = −5.390, P < 0.001) and asthma (z = −5.730, P < 0.001). All patients improved post‐therapy, assessed both by a global rating of change score (GRCS) and by the VCDQ [median (IQR) score pre‐therapy 50.5 (48.0 – 54.8), post‐therapy 35.0 (29.3 – 41.8), P < 0.001]. The minimal important difference in the VCDQ associated with a rating of ‘minimally better’ on the GRCS was 4 points. Conclusions and Clinical Relevance The VCDQ is a valid and responsive tool suitable for measuring changes in symptoms in patients with VCD. It also gives insight into which symptoms are important to patients and could guide future therapy refinements. Future assessments of novel therapies for this condition should use an appropriately validated tool such as the VCDQ to measure response.

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Conclusion Implementation of a collaborative AMT was associated with an 18% reduction in antibiotic consumption (DDD/1000 bed days) between the two periods within the respiratory directorate of a large urban university teaching hospital. The 2009/2010 swine origin influenza virus (H1N1) pandemic created a national helpline, vaccination program and advertising campaign that cost many millions of pounds. There were a number of deaths in young pregnant people and those with existing respiratory morbidity. In contrast, in the post pandemic we have seen budgetary cuts, no advertising campaign and a reluctance to give vaccination to anyone but clearly defined groups. Our experience during the December 2010 holiday period suggests this was ill advised.We analysed all admissions with H1N1 in December 2010eJanuary 2011. In total we had 63 cases in a take that has a mean of 27 (SEM 61.97) patients per day. Over 70% of patients presented between 30th December and 2nd January. These patients were young (mean age 47 (SEM 1.81)), had an increased length of stay (mean LOS 6.2 days (SEM 1.54)) and were from low risk populations (35/63 (56%) had no co-morbidities or risk factors). All had a significant fever (>388C) and most had a successful recovery (95% discharged home). CXR was normal in the majority (78%), mean WCC was normal (8.83 (SEM 0.51)) but most were lymphopaenic (mean lymph 1.01 (SEM 0.09)). Only one had a positive sputum culture, (Haemophilus influenzae) and all blood cultures were negative. Six were admitted to ITU (9.6%, but 100% of ITU beds available) and 3 died (4.8%), all of whom had significant respiratory co-morbidity.Our small DGH experienced a significant number of extra admissions over what is perhaps the busiest and least well staffed period the NHS has to deal with. These included a high number of young, previously well patients who had significant illness and lengths of stay. At one point 100% of critical care and level 2 beds were full of patients with H1N1. Vaccination would have prevented this crisis and at a reasonable cost and is as important in the post pandemic year as during a pandemic. It should be freely available to all on an annual basis. Introduction Suspected Pulmonary Embolism (PE) is a significant cause of admission to hospital. The objective of this study was to establish the feasibility and safety of managing suspected and proven PE in an out-patient setting. Methods Criteria for low risk patients with suspected PE suitable for treatment in an ambulatory setting were established based on modified Pulmonary Embolism Severity Score (PESI) criteria. Patients deemed low risk were referred to a nurse-led clinic. Clinical pre-test probability of PE was recorded for all patients and those with a low/intermediate probability had D-dimer testing. Patients with a high pre-test probability or D-dimer¼0.5 mg/ml had radiological investigations. Data were collected prospectively. Missing information was completed from pathology, imaging systems and case-note review. Results 362 patients (Median age ...