Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.

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Quality improvement project (QUIP) concepts are becoming embedded into medical school curricula, with many students now expected to conduct a QUIP as part of their progression. This study aimed to assess whether student-led QUIPs can be effective and sustainable. A systematic literature search was conducted using 5 databases: MEDLINE, Embase, Ovid, CINAHL, and PsycINFO. The authors searched for articles published between January 28, 1978, and January 28, 2018. In all, 3965 articles were identified through database searching, and an additional 9 articles through hand searches. After screening and full-text analysis, 12 articles were included. Greater than 50% of QUIPs described a statistically significant improvement in the primary outcome. However, effective student-led QUIPs were not necessarily sustainable, with a mean final audit at 4.4 months. Medical students have the potential to produce effective QUIPs. There now needs to be a structured approach to give medical students the freedom to test and validate more unique interventions.

Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.

Objective SUDEP is one of the causes of mortality in patients with epilepsy. We investigated SUDEP discussion practices among neurologists in the EMR to identify gaps in knowledge and to increase awareness. Methods An online survey was sent out to neurologists practicing in the EMR through registered emails and to attendees of local neurology conferences. Results: 132 practitioners completed the survey. 19.7% respondents were from Egypt, 15.2% from Sudan, 8.3% from KSA, and 4.5% from Syria. Only 1.5% of the respondents discussed SUDEP with their patients nearly all of the time, while 46.2% rarely discuss SUDEP. 18% of the respondents had experienced definite or probable SUDEP in the past 24 months of their clinical practice. Top three reactions to SUDEP discussion were distress (74%), anxiety (70.5%), and depression (65.9%). 77.3% of the respondents believe that patients are at minimal risk of SUDEP, 37.9% fear it would affect patients’ mood or quality of life, and 27.3% believe SUDEP is so rare and the risks of discussion outweigh potential benefits. We found no significant association between years of independent practice, number of patients seen annually, number of SUDEP in the past 24 months and how often respondents discussed SUDEP. Conclusion Neurologists in the EMR rarely discuss SUDEP with their patients / caregivers. Negative reactions and underestimating the risk of SUDEP may be the reason, suggesting lack of awareness among practitioners, patients, and caregivers. Framing the discussion positively and using different resources to support patients / caregivers around SUDEP may minimize negative reactions.