SUMMARYThe risk of dying suddenly and unexpectedly is increased 24-to 28-fold among young people with epilepsy compared to the general population, but the incidence of sudden unexpected death in epilepsy (SUDEP) varies markedly depending on the epilepsy population. This article first reviews risk factors and biomarkers for SUDEP with the overall aim of enabling identification of epilepsy populations with different risk levels as a background for a discussion of possible intervention strategies. The by far most important clinical risk factor is frequency of generalized tonic-clonic seizures (GTCS), but nocturnal seizures, early age at onset, and long duration of epilepsy have been identified as additional risk factors. Lack of antiepileptic drug (AED) treatment or, in the context of clinical trials, adjunctive placebo versus active treatment is associated with increased risks. Despite considerable research, reliable electrophysiologic (electrocardiography [ECG] or electroencephalography [EEG]) biomarkers of SUDEP risk remain to be established. This is an important limitation for prevention strategies and intervention studies. There is a lack of biomarkers for SUDEP, and until validated biomarkers are found, the endpoint of interventions to prevent SUDEP must be SUDEP itself. These interventions, be they pharmacologic, seizure-detection devices, or nocturnal supervision, require large numbers. Possible methods for assessing prevention measures include public health community interventions, self-management, and more traditional (and much more expensive) randomized clinical trials.

ObjectiveTo undertake a case review of deaths in a 6-week period during the COVID-19 pandemic commencing with the first death in the hospital from COVID-19 on 12th of March 2020 and contrast this with the same period in 2019.SettingA large London teaching hospital.ParticipantsThree groups were compared: group 1—COVID-19-associated deaths in the 6-week period (n=243), group 2—non-COVID deaths in the same period (n=136) and group 3—all deaths in a comparison period of the same 6 weeks in 2019 (n=194).Primary and secondary outcome measuresThis was a descriptive analysis of death case series review and as such no primary or secondary outcomes were pre-stipulated.ResultsDeaths in patients from the Black, Asian and minority ethnic (BAME) communities in the pandemic period significantly increased both in the COVID-19 group (OR=2.43, 95% CI=1.60–3.68, p<0.001) and the non-COVID group (OR=1.76, 95% CI=1.09–2.83, p=0.02) during this time period and the increase was independent of differences in comorbidities, sex, age or deprivation. While the absolute number of deaths increased in 2020 compared with 2019, across all three groups the distribution of deaths by age was very similar. Our analyses confirm major risk factors for COVID-19 mortality including male sex, diabetes, having multiple comorbidities and background from the BAME communities.ConclusionsThere was no evidence of COVID-19 deaths occurring disproportionately in the elderly compared with non-COVID deaths in this period in 2020 and 2019. Deaths in the BAME communities were over-represented in both COVID-19 and non-COVID groups, highlighting the need for detailed research in order to fully understand the influence of ethnicity on susceptibility to illness, mortality and health-seeking behaviour during the pandemic.

AimsTo establish resilience support for paediatric trainees. Introduction Resilience, the capacity to recover, has never been more important in medicine. These have been exceptionally threatening times for trainees with contract changes resulting in unprecedented strikes. Doctors generally report problems of professional isolation, fragmentation of care for patients, and poor communication1. The opportunity to offer training was explored. Methods Two surveys were completed with outgoing paediatric trainees (and consultants) and the new intake. They asked what resilience meant to the doctors, what their personal strategies at work and home were and what they would like from resilience training.ResultsTwenty (28%) then 15 (75%) responded. Resilience was seen as a range of skills from the ability to battle stress, determination, to suffering in silence. Coping strategies included exercise, talking to family and praying. Only one person referenced drinking alcohol. Strategies fell into 5 groupsReflection/perspectiveTime out/balanceSpiritualExercise/activitiesTalking to family/friendsAll responders thought resilience training would be useful and a six week programme was set up following a successful pilot. The topics were given states of mind as titles including frustration, sadness, fatigue, happiness and optimism. Exercises have included using the arts, food, yoga and simply the opportunity to talk. From this and in support of all junior doctors, a multidisciplinary blog (‘recalibrat8’ on Tumblr and ‘Recalibrate’ on Facebook) was commissioned by the Trust Guardian of Safety which draws from national sources. Feedback has been extremely positive.ConclusionThe GMC recognizes that all NHS organisations including itself, could ‘do more to recognise the intense pressures on the profession and make it more acceptable for people to ask for help when they are struggling.’2 Resilience is built on personal qualities and early influences but can be taught. Equally important is recognition that doctors of all levels of training might struggle and they need a space to talk about fears, learn new skills and share their personal experience whilst developing an understanding of their mental health and physical limitations. In this way compassion for themselves and others can be allowed to grow and in so doing make for better doctors.ReferencesRimmer, A Overstretched doctors must be encouraged to seek help, GMC says. BMJ Careers. Dec 2016.GMC Medical Professional

IntroductionA history of missed healthcare appointments is a consistent finding in most of the serious case reviews of all children who have been seriously harmed through child abuse, particularly neglect.1Minimising missed clinic appointments is not only in the best interest of the child but also for the trust, financially. The National Audit Office found that missed first outpatient appointments cost the NHS up to £225 million in 2012/ 2013.Aims1. To classify the profile of children not brought to developmental clinic appointments.2. To investigate barriers to attendance.3. Identifying options to minimise such barriers and ways to support the family.MethodsData was collated from Trust records, the departmental databases, patient files and a questionnaire based telephone survey of parents/carers of children with missed developmental clinic appointments in August/September 2016.ResultsThe trust-wide, missed appointment rate (outpatient appointments) for 2015–2016 was14.2% vs 17.9% in Developmental paediatrics. There were 62 missed appointments in developmental paediatrics (24%). Of these, 61% were follow up appointments; 60% being morning appointments. Seventy three percent of children were male, 65% between 5–11 years, 40% had previously missed appointments and 11% attended special needs schools. Seventy three percent of children had multiple comorbidities. 24% had complicated social situations including inadequate housing and safeguarding concerns (13%). In total, 40 (65%) participated in the telephone survey. The most common reasons for missing were forgetting (46.5%). 40 percent want a ‘choose and book’ option. Only 12 percent preferred weekend appointment. All requested a reminder, preferably by text message [87%] a day or two days before [70%].ConclusionA majority of children not brought to the clinic had multiple comorbidity with some having additional safeguarding concerns. The major barrier to attendance is parents either for- getting or not able to change the date. Targeted interventions in the form of multiple reminders by text messages, an option of ‘choose and book’ and a venue closer to their address will be useful in supporting those families.ReferenceBrandon, M et al., 2009. Understanding Serious Case Reviews and their Impact: A biennial analysis of serious case reviews 2005–07.

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