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The COVID-19 pandemic has placed significant pressures on healthcare services and professionals delivering patient care. Consequently, postgraduate medical training has been interrupted, with limited opportunities for supervised workplace-based assessments.1 Therefore, additional knowledge and skills gained, particularly those outside the scope of respective training curriculum, may not be robustly captured. This project aimed to identify trainees’ views on additional capabilities gained during the pandemic and the value of self-certification, in order to inform the design of a COVID self-certification template. A SurveyMonkey® questionnaire was emailed to all postgraduate trainees in the East Midlands and Wessex deaneries. The survey was also …

Background Isolated diaphragmatic palsy in the absence of progressive neuromuscular disease is uncommon. It poses diagnostic challenges and limited data are available regarding prognosis. We present retrospective cohort data from two large teaching hospitals in the United Kingdom. Method 60 patients who were assessed either as inpatients or outpatients were included in this study. Patients with progressive neuromuscular disease were excluded. Clinical presentation, tests of respiratory muscle function (sitting/supine vital capacity, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP)) and outcomes were recorded. Results For patients with diaphragmatic palsy, mean±sd seated and supine vital capacity pre-noninvasive ventilation (NIV) were reduced at 1.7±1.2 L and 1.1±0.9 L, respectively, with a mean±sd postural fall in vital capacity of 42±0.16%. The mean MEP/MIP and MEP/SNIP ratios for diaphragmatic palsy were 3 and 3.5, respectively. After a year of treatment with NIV, mean±sd upright and supine vital capacity had increased to 2.1±0.9 L and 1.8±1 L, respectively, and the mean±sd fall in vital capacity from sitting to supine reduced to 29±0.17%. MEP/MIP and MEP/SNIP ratios reduced to 2.6 and 2.9, respectively, from the pre-NIV values. The values of postural fall in vital capacity correlated (p, Tests of respiratory muscle strength are valuable in the diagnostic workup of patients with unexplained dyspnoea. A triad of 1) orthopnoea with 2) normal lung imaging and 3) MEP/MIP and/or MEP/SNIP ratios ≥2.7 points towards isolated diaphragmatic palsy. https://bit.ly/2SpOXW2

Background: Isolated bilateral diaphragmatic palsy (BDP) in absence of progressive neuromuscular disease is not easy to diagnose. There are limited data on clinical presentation and prognosis. We present retrospective cohort data from 2 large teaching hospitals from United Kingdom.. Results: A total of 56 patients (37 men) with mean age of 58.5 years. Method: can be diivded into 3 groups. Post-op (Heart or Lung transplant)or post-ICU admission (24), Acute hypercapnic respiratory failure 12 Out-patient Clinic with symptoms 12. 2 patients developed BDP following radiofrequency ablation for arrhythmia. mode of presentation was missing in 6 patients. Except post op patients, orthopnoea or inability to lie supine was seen in most patients. Breahtlessness, somnolence and sleep disturbanvce was also present in most patients who presented acutely or in lcinic. 10 patients (post op or post ICU) presented as 9difficult to wean9 from mechanical ventilation. Method: Mean Upright Vital Capacity (VC) was 1.7 L (48% predicted) and mean drop VC when patients were Supine was 42.5%. In a proportion of these patients we measured mouth inspiratory and expiratory pressure (MIP and MEP respectively ) as well as sniff nasal inspiratory pressure (SNIP). MEP was relatively preserved with mean value 108.5 cm H2O. mean MIP was 43 cm H2O and SNIP was 35.3 cm H2O. Ratio of MEP:MIP was 2.88 and MEP to SNIP was 3.22. Conclusion: In patients with BDP without progressive neuromuscular condition, inability to lie down was associated with > 25% Postural drop in VC. MEP/MIP and MEP/SNIP ratio of nrealy 3 was associated with postural drop of 25% in VC and can be a diagnostic tool.

The COVID-19 pandemic has caused significant disruption to patient care delivery and medical training in the UK.1 However, the views of healthcare professionals on the impact of the pandemic has not been fully explored. This study aimed to identify the challenges experienced by healthcare professionals during the COVID-19 pandemic and proffer potential solutions, from the perspectives of postgraduate trainees. A SurveyMonkey® questionnaire was emailed to postgraduate trainees through Health Education England (HEE) deanery databases, to capture their experiences during the pandemic. The survey was also circulated informally via WhatsApp®, to include the views of individuals in non-training posts. Ethics review was …