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Improving Bone‑Health Assessment in Parkinson’s Disease: A Completed Audit Cycle and Quality‑Improvement Project

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Meijia Xie, Fred Halliday, Nicholas Latcham
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Background Parkinson’s disease (PD) results in a 2-to-4-fold higher risk of hip and fragility fractures due to osteoporosis, falls, and motor dysfunction. Fractures in this group often cause loss of mobility, extended admissions, and higher mortality. Despite these consequences, bone-health assessment is inconsistently incorporated into routine PD care. Introduction The local analysis of 100 patients at York Hospital during the 2025 Parkinson’s UK audit, revealed bone health was considered in 10% of cases, compared with a national figure of 63% (2022 data for comparable services; p < 0.001)
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Evaluate doctors' knowledge and practice in managing Parkinson's disease during acute admissions.

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A R Bajgamage1, V. Paranjyothi2, M.Hayward3
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Introduction Patients with Parkinson’s Disease (PD) frequently experience delays or missed doses of time-critical medications, leading to worsened symptoms and prolonged stays. This issue is thought to be partly due to gaps in doctors’ knowledge and prescribing practices. Therefore, this project uses a survey to assess staff knowledge and practices and identify gaps in managing Parkinson’s medications in acute and complex clinical scenarios. Methods: A questionnaire was distributed to 26 doctors across adult medical wards and the Emergency Department, including consultants and trainees. The

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A Cerner-based Electronic Prescribing and Medicines Administration (EPMA) Parkinson’s Medicines Care Plan Reduces Time-Critical Medication (TCM) Errors

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T Lessware; D Trivedi; M Andrews; R Lal; T Boyle
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Introduction: Parkinson’s UK consistently report that over half of inpatients with Parkinson’s face challenges getting their medications on time. This is associated with patient harm, poorer outcomes and increased admission length. Although electronic prescribing has benefits, it has not solved these issues. We audited local practice and implemented an EPMA care plan to improve reliability. Method: A two-cycle clinical audit in a central London teaching hospital. Cycle 1 (n=29) and cycle 2 (n=23) reviewed electronic records over two 4-month periods for inpatients with Parkinson’s disease
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Improving smoking cessation assessment and support in geriatric medicine: a quality Improvement project

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E Carruthers1,2; KM Eyme1; R White1; WCE Woo1; D Park1; M T Lin1; R Mizoguchi1,2
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Introduction Smoking remains a major modifiable risk factor for chronic disease in older adults yet opportunities for smoking cessation are missed among older patients. The British Thoracic Society states that every inpatient should be asked if they smoke and that electronic records of tobacco dependency should be completed. Hospitalisation offers a chance to identify tobacco dependence and provide support. We conducted a quality improvement project on a Care of the Elderly (COE) ward to improve the documentation of smoking status and delivery of nicotine replacement therapy (NRT). Methods We
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The role of the STUMBL score as a tool for predictors of adverse outcomes in patients aged ≥ 65 who have sustained rib fractures

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Allan Bui, Katherine Gregorevic, Kwang Lim
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Introduction Rib fractures are the most common presentation of blunt chest trauma, with approximately 10% of patients requiring hospital admission. The STUMBL (STUdy of the Management of BLunt chest trauma) score was developed to guide admission decisions, but its ability to predict mortality and geriatric-relevant outcomes is unclear. This study evaluated whether the STUMBL score stratifies risk for mortality, delirium, and discharge destination in adults aged ≥65 years with rib fractures. Methods We conducted a retrospective single-centre cohort study of patients aged ≥65 years presenting
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DAT Imaging as a Clinical Decision Tool in Parkinsonism: A Two-Year Audit from a North Welsh UK Movement Disorder Service

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N Dutta1; P Chatterjee2; B Velamala3; G Davies4; P Hobson5
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Background: Diagnosing Parkinsonism remains a common and clinically significant challenge within movement disorder services, particularly in early disease and in atypical or non-motor–predominant presentations. Dopamine transporter (DAT) imaging is recommended by NICE where diagnostic uncertainty persists; however, real-world evidence demonstrating its impact on clinical decision-making beyond diagnostic confirmation remains limited. Methods: We conducted a retrospective audit of all DAT scans requested within a UK specialist movement disorder service between January 2023 and December 2024

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Transforming Parkinson's Disease Care Through Digital Wearables: A Patient-Centred Approach

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Deeksha Seth, Claire Gibbons, Sangeeta Kulkarni
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Introduction The Personal Kinetograph™ (PKG) is a remote monitoring device that provides objective evidence of motor control in Parkinson's disease (PD). It is conditionally recommended by NICE to aid clinical decision-making (1). Our hospital trust has developed a PKG service over two years. We present the results of patient questionnaires to demonstrate the role of PKG in patient education and mental wellbeing, alongside clinical care. Method Between August 2023-December 2025, 40 patients under the care of Geriatrics Parkinson's Team underwent PKG monitoring. Results were explained via
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Improving Quality of Movement Disorder Care for Nursing Home Residents

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Siobhan Coulter1, Emily Moy1, Samantha Pickles1, Laura Lawson 1, Jane Noble1
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Introduction Within the Older Person’s Medicine Movement Disorder service at Newcastle upon Tyne Hospitals, we were aware people with Parkinson's (PWP) living in nursing care were not necessarily receiving the same quality of care as other PWP. We have developed a nursing home movement disorder clinic to address this. Methods Practically, approximately 15% of PWP were identified as living in nursing care. After review of the geography and numbers, one consultant and specialist nurse clinic were allocated a month to facilitate care home visits to all PWP within 6 months. After identifying PWP

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A service evaluation of the methods and efficacy of the South Manchester Parkinson’s service in diagnosing and managing Parkinson's Disease Dementia

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Sonya Jones1, David Ahearn2, Elizabeth Hudson3
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Introduction Parkinson’s disease dementia (PDD) is characterised by years of motor symptoms preceding cognitive decline, particularly presenting with declining executive function, attention, visuospatial abilities, and psychiatric symptoms. The motor symptoms of Parkinson’s disease are managed under a Parkinson’s and movement disorder service led by geriatricians or neurologists and should involve a multidisciplinary team. When dementia symptoms develop, patients are generally referred to a memory service led by old age psychiatrists with dementia support advisors and admiral nurses available

From Assessment to Engagement: Inertial Gait Analysis and Remote Exercise for Fall-Risk Prevention

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L Ruiz-Ruiz1; M Neira-Álvarez2; A Curiel2; E Huertas3; R. García4; M. Pilla1; F Seco1; A R Jiménez1
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Introduction Ageing leads to subtle mobility changes that increase fall risk if not identified early. Most existing solutions intervene only after functional decline becomes evident. This work presents an integrated preventive approach combining clinically accurate gait analysis with remotely supervised exercise programmes, aiming to detect early deterioration and promote safer, more autonomous ageing. Methods The system includes: (1) a shoe-mounted inertial sensor (Moverics) enabling rapid gait assessment and extraction of validated fall- and frailty-related metrics; and (2) ViviFil, a mobile
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A Service Evaluation of the Barriers and Facilitators to rehabilitation faced by Hospitalised Older Parkinson’s Patients at Great Western Hospital (GWH); as viewed by clinicians

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Sara Egas-Kitchener
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Aims/Purpose: To assess the barriers and facilitators for rehabilitation in the older Parkinson’s Disease (PD) patient population that have been admitted to Great Western Hospital (GWH); as viewed by clinicians who work within the acute inpatient setting. This was accomplished through an internal service evaluation project designed to create a GWH-specific action plan, which may also have broader applicability. Methods: A review of the related literature informed the development of interview questions, which guided 20 semi-structured interviews with clinicians conducted in collaboration with

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Real-world effects of foslevodopa/foscarbidopa on gait and balance in people with Parkinson's​

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Bradley Lonergan1, Janina Kugathasan1, Poppy Waskett1, Elisabete Marques2, Sophie Molloy2, Ron Pearce2, Gavin Charlesworth2, Peter Bain1,2, Matteo Ciocca1,2, Barry M Seemungal1,2, Toby Ellmers1, Yen Tai1,2​
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Introduction: Foslevodopa-foscarbidopa (Produodopa) is a new subcutaneous infusion run continuously over 24 hours for people with Parkinson’s (PwP). Foslevodopa is a prodrug for levodopa, the most effective treatment for Parkinson’s symptoms. Studies demonstrate that Produodopa improves symptom fluctuations (i.e. less OFF time & less troublesome dyskinesia) compared to oral medications. Gait and balance impairment are key risk factors for falls in advanced Parkinson’s and are less levodopa responsive. However, the impact of Produodopa on gait and balance has not yet been described. Methods

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Analysing Motion Capture Kinematics to aid Clinical Assessment and Physiotherapy Strategies in Progressive Supranuclear Palsy

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Vanessa Ng1; Jade Donnelly2; Martin Warner1; Isobel Thompson1; Boyd Ghosh2
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Progressive supranuclear palsy (PSP) is a rapidly progressive neurodegenerative disease characterized by postural instability, vertical supranuclear gaze palsy, bradykinesia, extrapyramidal rigidity and dementia. Patients with PSP lose independent gait and ability to stand unassisted, often becoming wheelchair-bound within 1-3 years. Clinically recognized PSP movement features, including tendency to fall backwards, posterior weight distribution and a toe-up maneuver with weight shift to the heels in sit-to-stand transitions, have been used to track progression and consider physiotherapy needs
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Enhancing Electrolyte Management in Hospitalised Older Adults Through the Integration of a Trust-Specific Electronic Prescribing

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Shabnam Tariq, Jody Baxter, Nandkishor V Athavale
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Introduction: Electrolyte disturbances are common among older inpatients and are associated with increased risks of delirium, falls, cardiac arrhythmias, and prolonged hospital stays. Despite their prevalence and impact, local guidance for managing these imbalances is often lacking or inconsistently applied. At Rotherham NHS Foundation Trust, no standardised guideline existed for adult electrolyte correction, which disproportionately affected the older inpatient population. To improve the timely and accurate management of electrolyte derangements—particularly in older adults—by implementing a
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Motor profile and measures of physical function in people with Parkinson's disease in northern Tanzania

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T Neal1, C Dotchin2, B Haggie3, T Fothergill-Misbah4, M Dekker5, S Urasa5, W Eliamini5, R Walker6 on behalf of TraPCAf collaboration
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Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide and is often associated with frailty and sarcopenia. The cardinal motor features include bradykinesia, rest tremor, rigidity and postural instability. In low-resource settings such as Tanzania and sub-Saharan Africa (SSA), data on motor burden and physical function in PD are limited. Aims: To assess motor symptom burden and physical function in people with Parkinson's disease (PwP) in northern Tanzania. Methods: A cross-sectional study was conducted involving 28 PwP in the Hai district of
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Improving visual assessment of older people attending a falls assessment clinic, Whiteabbey Hospital

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J Livie1; A Mcloughlin1
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Introduction Falls are common in older adults, resulting in hospitalisation, and significant morbidity and mortality. NICE guidelines recommend that vision should be assessed in adults who fall. However, in a national survey of falls services, 54% of professionals checked vision. The falls assessment clinic allows adults to be assessed by a multiprofessional team including doctors, nurses, physiotherapists and occupational therapists. The aim of this quality improvement project was to improve documentation of visual assessment within the medical notes to >90%. Method and Results Baseline data

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Commitment to Residents’ Safe Steps Forward: Individualized Shoes

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Patricia Quigley1, Karen Kaminski Ciancio2
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Introduction. Two leading interventions for footwear when individuals are admitted as inpatients across healthcare settings are non-skid socks and their personal shoes, without assessment if non-skid socks or personal shoes are appropriate. These interventions are insufficient to meet complex needs for individualized footwear and population-specific footwear necessary for safe transfer and mobility. Two foot problem categories associated with falls are local factors (structural foot disorders affecting load-bearing bones), systemic factors (dermatologic, vascular, neurologic musculoskeletal
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The Frailty Factor: A QIP on Recognising Frailty in Acute Hospital Admissions

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S Deshmukh1; WMI Bin Wan Ismail1; I Cardoso1; N Olakkengil1; N Elech1
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Introduction Frailty is a common age-related condition marked by reduced physiological reserve and increased vulnerability to adverse outcomes. National guidance recommends use of the Rockwood Clinical Frailty Scale (CFS) for patients aged ≥65 years during acute hospital admissions to facilitate early recognition of frailty; however, documentation and accuracy remain inconsistent. This quality improvement project aimed to evaluate and improve CFS documentation within inpatient medical wards of a large hospital in London. Methodology Two Plan–Do–Study–Act (PDSA) cycles were undertaken using
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From Zero to Sixty: Revving Up Driving Safety Documentation

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Rachel Grainger
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Background: After an acute hospitalisation, driving limitations have significant medicolegal and safety ramifications. The need for improved driving guidance throughout the region was brought to light by recent community events. Methods: We used a PDSA cycle and informal focus groups to structure our project. Before and after a straightforward intervention consisting of clinician education and structured advice layouts, we examined the records of fifty patients. Documenting of driving status and giving suitable driving advice were the outcomes measured. We gathered data and developed materials
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A Rapid Community Response to Long Lies in Frail Patients: Reducing Hospital Admissions. A Prospective Service Evaluation.

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Dr Hussein Abu Rabia
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Admission Avoidance Through WROLL Background: Falls are common in older adults, with up to 35% of those aged ≥65 years falling each year. A long lie remaining on the floor for over 60 minutes conveys serious risks, including infection, muscle injury, functional decline, and hospitalisation. The Wigan Reduction of Long Lie Service (WROLL) was set up to respond quickly to these events and reduce unnecessary admissions. Methods: We prospectively evaluated 49 patients referred to WROLL. We recorded demographics, frailty scores, fall circumstances, length of lie, frailty blood tests, including CK
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