BackgroundAnti-phospholipid antibody associated chorea is a rare cause of this movement disorder, with a higher incidence in females and children. Other causes include Wilson’s disease, Sydenham’s chorea and ataxia-telangiectasia. Aetiology is uncertain, but may involve anti-phospholipid mediated dysfunction of the basal ganglia. We report an unusual case of anticardiolipin antibody related chorea in an adolecent male presenting to secondary care services.Case reportOur patient is a 14 year old male who became unwell in December 2016 with gradual onset of uncontrolled movements in his arms, and behavioural changes. There was a notable history of minor head injury, preceding sore throat and recurrent tonsillitis. Over the next six months, he reported worsening of choreoathetoid movements affecting his gait and upper limb function.He presented in April 2017 with acute slurring of speech three weeks after starting baclofen. He was then referred to tertiary paediatric neurology services. No features of Lupus were present on examination. His functioning was monitored after baclofen was stopped, and he progressed to treatment with high dose steroids, penicillin V and sodium valproate. He improved following significant rehabilitation with multidisciplinary involvement from occupational therapy, physiotherapy and the school team. His final diagnosis was revised to anticardiolipin antibody related chorea following results of immunological tests and consideration of the chronic progressive history. He was treated successfully with aspirin and mycophenolate mofetil, and has been discharged home with ongoing clinc review.Results12 lead ECG, echocardiogram and MRI brain normal.ASO Titre: 400 units/ml (50–200)Anti-DNAse B: 100 units/ml (<240 units/ml)Anti-Mitochondrial Ab: positiveAnti-Nuclear Ab titre: 1:320 (Positive)Anti-cardiolipin IgG Ab 1184.2 units/ml (0–19.9)Anti-B2-GP-1 IgG 4269.7 units/ml (<20)ConclusionAs a patient’s disease continues to evolve, so should our diagnostic approach. Atypical progession of disease should prompt review. Generally, treatment of anticardiolipin related chorea falls into 2 pathways; anticoagulation and immunosuppression, with evidence limited to case reports and small case series.Acknowledgements to the local medical illustration team for performing serial videos showing improvement in function.

AimsMentoring is recognised by the RCPCH as a process which can provide valuable support to Paediatricians throughout their careers and is a process which is being introduced more widely in Paediatric training.The aim of this Quality Improvement Project was toIntroduce a Mentoring Programme into our local tertiary Children’s Hospital to ensure supportive and pastoral care for Junior Colleagues was availableTo implement a Mentoring Programme Deanery Wide for all trainees to accessMethodsA pilot scheme to mentor foundation year doctors/GP trainees was undertaken in December 2016. All paediatric trainees rotating into the Children’s hospital were contacted asking to express interest in mentoring. They were then matched with interested mentees. During induction week, information was provided to both mentors and mentees to explain the programme in further detail. Feedback was collected at two time periods during the 4 month process. A further programme has been rolled-out and we are currently creating a deanery wide scheme for all Paediatric trainees to access.ResultsA total of 18 mentoring partnerships were matched in the pilot scheme. Feedback for mentees was 4/18 and for mentors 5/15. This did not improve in the follow-up programme where feedback was 4/13 and 6/13 for mentors and mentees respectively.The feedback received included both positive and negative comments which have been acted upon to improve and develop the mentoring process.ConclusionThe main barrier we have encountered has been in relation to feedback which has been significantly suboptimal on both programmes. The feedback we have received has provided us with recommendations for improvement which we have attempted to integrate.Currently, we are creating a wider mentoring programme for all Paediatric trainees to access in the local Deanery. This will be rolled out in March 2018. There will be more active participation from mentees, including having a mentee-driven matching process. There will be a dedicated website for mentoring and we hope to provide local mentoring skills training. Our aim will be to seek permission to include compulsory (but anonymous) provision of feedback as part of the trainee’s responsibilities.

No abstract