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Preventing the Preventable: Enhancing VTE Risk Assessments in Geriatrics Wards

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Hassan Nauyan1, Qian Yan Liaw2
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Background Venous thromboembolism (VTE) is a leading cause of preventable hospital morbidity and mortality. Older adults admitted are at particularly high risk due to immobility, frailty, and comorbidities. NICE guideline NG89 recommends all hospital inpatients undergo a documented VTE risk assessment on admission and reassessment within 24 hours. An initial audit identified incomplete VTE assessments on prescription charts across two geriatric wards in our hospital. Aim To improve the completion rate of VTE risk assessments on two wards from baseline (80–86%) to 100%. Methods Prescription
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Increasing FRAX Score Assessments for Patients Meeting NOGG/ NICE Criteria

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Mariam Sabry1, Emine Fraser2
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Introduction: Osteoporosis is a leading cause of morbidity in the elderly, with fragility fractures risking mortality, loss of independence and lengthy hospital stays. Patients admitted to hospital are often frail, with numerous risk factors for osteoporosis. The NOGG (2021) and NICE (CG146) recommend fracture risk assessment using the FRAX score in all women ≥65 years, men ≥75 years, and any adult ≥50 with risk factors such as previous fragility fracture, glucocorticoid use, smoking and high alcohol, low BMI, parental hip fracture, or relevant comorbidities. Despite clear guidance, FRAX
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Evaluation of inpatient checklist to improve administration process and follow up communication of zoledronic acid

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I Collins1; M Sareen1; N Weerasuriya2
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Background: Zoledronic acid (Zol) is used in the prevention and treatment of osteoporotic fractures. Once IV Zol has been administered as an inpatient, discharge documentation and GP communication should be completed. However, this can be inconsistent and can compromise continuity of care. A checklist produced by the HCOP (Health Care of Older People) team aimed to standardise osteoporosis management. In addition to the metrics reviewed in the previous 4 audit cycles, this audit looked at vitamin D correction before Zol. Methods: Data was collected from 55 patients receiving their first dose

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Improving ReSPECT Form Completion in a Urology Department: Findings from a Two-Cycle Audit and Clinician Survey

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Umang Thakrar1; Rory Garbutt1; Rishabh Ray2
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Background This project was conducted within the Urology inpatient department at Leicester General Hospital, led by resident doctors under consultant supervision. Introduction ReSPECT forms summarise personalised recommendations for a patient’s care in an emergency setting, outlining their priorities and fears. Incomplete ReSPECT forms risk inappropriate interventions that do not align with patients’ wishes or clinical needs. Locally, the completeness and quality of ReSPECT forms varied, with missing patient preferences or unclear escalation plans, contributing to miscommunication between
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Assessing the Impact of Online Simulated Prescribing on Medical Students’ Confidence in Geriatric Prescribing

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R Jaafar, J Maclachlan, D Cripps
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Introduction Prescribing for older adults is complex due to frailty, multimorbidity, altered pharmacokinetics, and high risk of adverse drug reactions. Newly graduated doctors write most inpatient prescriptions but often feel underprepared, with error rates up to 10% (Nazar et al., 2015). Simulated prescribing platforms, such as Better Meds, offer a safe, realistic environment to practice. We designed progressive tutorials within geriatrics placement to address prescribing challenges in delirium and polypharmacy. Method Two cohorts of medical students participated: Year 3 (n=20): During the
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An Audit on Timing of Zoledronic Acid/Denosumab Initiation After Fragility Fractures in Older Adults

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Hamritha Manoharan, Ashwag Gebril, Tammy Lee
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Abstract Content : Introduction Fragility fractures are common in older adults and carry a high risk of refracture and mortality. Evidence shows that intravenous zoledronic acid can reduce refracture risk by up to one-third, with early initiation proven safe. Yet, real-world practice is often delayed by factors such as vitamin D deficiency, frailty, and system-level gaps. This audit assessed current practice at our centre and evaluated improvements after service changes. Method A retrospective audit was conducted at Heartlands Hospital. Patients aged ≥60 years admitted with fragility fractures
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Quality Improvement Project- Sitting out of Older Patients on chair in the ward at General Hospital, Chester

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Ann Maria Jojy
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Introduction Sitting out of bed plays a crucial role in preventing deconditioning, muscle wasting, pressure injuries and thrombosis among older inpatients. It also fosters social interaction and cognitive engagement, reducing hospital stay duration and combating 'PJ Paralysis'. Objective To improve the number of older patients sitting out of bed during lunchtime in the COTE ward, thereby supporting their functional recovery and overall well-being. Methods Direct observations were conducted over two consecutive days at baseline and again three weeks after intervention were implemented. Patients

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“Let’s Talk Research” – Improving Older Adults’ Understanding of Opportunities for Research Involvement

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Lucy Rimmer1,2; Helen Atkinson1; Fionnuala Johnston2; Avan A Sayer 1
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Introduction Older adults have historically been excluded from research, in part due to preconceived notions from researchers, clinicians and patients themselves about research being for younger patients or those with certain medical conditions. These assumptions persist despite “Healthy Ageing” being a priority theme for the National Institute for Health and Care Research and the extensive body of evidence that involvement in research benefits clinical care for older adults. This quality improvement project (QIP) aimed to improve older adults’ understanding of opportunities for research
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Utilisation Of FRAX Tool For Primary Prevention Of Fragility Fracture In Older Person Assessment Unit At Morriston Hospital

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A Awuzie1; H Y Sanda2; A Slowinski1; Y Mon1; M Danish1; S Chenna1
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Introduction Osteoporosis poses a significant health challenge in older adults, especially due to fragility fractures that increase morbidity and mortality. The FRAX tool, designed to estimate a 10-year risk of major osteoporotic and hip fractures, is a key resource for guiding treatment decisions. This audit evaluated how effectively FRAX scoring and primary prevention strategies were being used in a Front Door Frailty ward. Methods: Two retrospective audit cycles were conducted. The first included 51 patients (May–August 2024), and the second 50 patients (January–April 2025), admitted with
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Improving Stroke Induction Information for Resident Doctors in a District General Hospital: A Quality Improvement Project

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Hafsa Panhwer 1; Sana Hamid 1; Kyaw Myat Thu 1;
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Background General Medical Council (GMC) recommends effective departmental inductions to support doctors to transition and work in complex, unfamiliar situations with sick patients. Acute stroke care is time critical, multidisciplinary, multi-specialty clinical work and requires doctors to fully comprehend and be able to perform assessments and interventions correctly and timely. This requires effective and tailored clinical induction. Introduction In our hospital, stroke medicine induction is delivered in large group teaching as part of geriatric medicine and general medicine induction
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Falls, frailty and fractures - Adherence of the Acute Medical Unit to Guidelines

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Sujata Lama1, Aye Thinzar Moe1, Kyaw Soe Tun2
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Introduction A significant proportion of hospital admissions among the elderly are attributed to falls, contributing to morbidity and mortality. NICE guidelines recommend a comprehensive assessment in elderly patients presenting with fall including lying standing blood pressure (LSBP) test, carrying out structured medications review and osteoporosis risk assessment. While a large proportion of patients are reviewed and assessed by frailty team after hospital admission, there are a considerable number of elderly patients with falls admitted to Acute Medical Unit especially during out-of-hours
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Are NHS Junior Doctors Requesting CT Scans Appropriately? Evaluating Compliance with Royal College Guidelines for CT Scan Requests

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S KANDEL¹; R NUAMAH¹;I BODAGH¹;M VASILELIS¹; M ARAFAT¹
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Introduction: The appropriate use of CT scans is essential for patient safety and effective healthcare delivery. This audit aimed to evaluate whether resident doctors in the NHS are requesting CT scans in line with the Royal College of Radiologists (RCR) guidelines, and to assess the impact of educational interventions on improving compliance. Method: A retrospective audit was conducted in two cycles. Cycle 1 involved reviewing CT scan requests made by resident doctors (up to ST2 level) for patients aged 80+ fin August,2024. The compliance with RCR guidelines was assessed on several criteria
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Rationalising Blood Tests in the Elderly: An Audit of Routine Blood Investigation Requests in Geriatric Wards

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Joy Lam Ern Hui1, Deepika Kumanan1, Ahmed Fayed1
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Introduction Blood tests are frequently ordered in geriatric wards, often without clear clinical justification. This can lead to patient discomfort, increased costs, and unnecessary workload on staff and laboratory services. This audit aimed to evaluate the frequency and appropriateness of blood test ordering and reduce unnecessary investigations in geriatric wards. Method We reviewed blood tests ordered over a 2-week period across the four geriatric wards at Leicester Royal Infirmary. Seven commonly requested tests were included: full blood count (FBC), urea and electrolytes (U&E), C-reactive
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Improving the appropriateness of polypharmacy reviews during hospital admissions: A three-stage retrospective quality improvement project

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Emily George 1, Alisha Maini 2, Dula Alicehajic-Becic 3
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Introduction: Inappropriate polypharmacy is the use of medications with no evidence-based indication, unmet treatment goals, high risk of adverse drug reactions, or when the patient is unwilling / unable to take treatment as intended. This is particularly concerning in geriatric care, due to increased risk of hospital admissions, adverse drug reactions and significant healthcare costs. To address these risks, clinicians should conduct patient-focused medication reviews. This project aimed to assess and improve polypharmacy reviews at Royal Albert Edward Infirmary (RAEI), with a focus on

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Use of Intravenous Furosemide in Patients Presenting with Symptoms of Acute Heart Failure in the Acute Setting: A Quality Improvement Project

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Saeed Hussain1; Muhammad Kamran1; Muhammad Shakeel2
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Introduction Acute heart failure (AHF) is a life-threatening condition that frequently necessitates emergency hospital admission. Intravenous (IV) diuretics, particularly furosemide, are vital in initial management, with early administration shown to improve outcomes. Despite guideline recommendations, delays or deviations in prescribing practices are common. This quality improvement project aimed to assess compliance with European Society of Cardiology (ESC) guidelines regarding the timely administration of IV furosemide in patients with AHF. Method A retrospective audit was undertaken at
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Quality Improvement Project Assessment of PAIN in Acute and Frailty Geriatrics in-patients at a district Hospital in South Wales

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S SAXENA1; A PARBHOO2; J JAMES3
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Introduction Pain is a common yet under-recognised and debilitating symptom among elderly patients, particularly with dementia, cognitive impairment, or communication barriers. Inadequate assessment can result in adverse outcomes, including reduced mobility, falls, and prolonged hospitalisation. This Quality Improvement Project aims to improve compliance with pain assessment and documentation on acute and frailty geriatric wards. At our hospital, a gap in systematic pain assessment was identified, hence we sought to address this by implementing standardized protocols, enhancing timely
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The motor profile of patients with idiopathic Parkinson’s disease in the Hai district of northern Tanzania

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K Harrington1; C Dotchin2; M Prakash1; E Scott1; R Morton2; N Fothergill-Misbah3; J Josephat4; M Dekker4; D Mushi4; R Walker2.
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Introduction Parkinson’s disease (PD) is the second most common neurodegenerative condition globally. Its cardinal motor signs are bradykinesia, rest tremor, rigidity, and postural instability. The motor symptoms of PD often lead to dependence on others to perform daily activities. Globally, the incidence of PD is rising. However, for countries in sub-Saharan-Africa such as Tanzania, research on the motor aspects of PD and the associated disability is sparse. The primary aim of this study was to determine the motor symptoms, and burden of motor symptoms, in newly diagnosed people with

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Readmissions after Frailty Emergency Squad discharge in the Emergency Department

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J ALVAREZ-MARTIN1; CJ MILLER1; SJ Clark2
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INTRODUCTION The increasing prevalence of frailty in the ageing UK population poses significant challenges for healthcare systems, particularly in emergency departments (EDs). Frailty is a leading factor in hospital readmissions among individuals over 65 years old. This project aims to analyze readmissions of frail patients within 7 and 30 days of ED discharge following comprehensive geriatric assessments (CGAs). METHOD This retrospective audit aimed to identify 7 day and 30 day readmissions of patients discharged by the Frailty Emergency Service (FES) at Leicester Royal Infirmary over a six

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DIAGNOSTIC ABILITY OF SARC-F ACCORDING TO MUSCLE STRENGTH AND PHYSICAL PERFORMANCE TESTS

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Deniz Cengiz 1, 2: , Arzu Okyar Baş.1 : Yelda Özturk 3; Ceyda Kayabasi 1 ; Murat Pehlivan1; Özge Özgun.1; , Okan Turhan1 , Mert Eşme1 ; Cafer Balcı1 ; Burcu Balam Doğu1 ; Mustafa Cankurtaran1 ; Meltem Gülhan Halil1.
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Background: Sarcopenia, a prevalent geriatric syndrome with multifactorial origins, is strongly influenced by malnutrition alongside immobility and chronic illness and contributes substantially to falls, disability, and mortality. The SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls) questionnaire is widely used to screen for probable sarcopenia; however, the conventional cut-off of ≥4 has yielded insufficient sensitivity across studies. Objective: To evaluate how SARC-F scores correspond to muscle strength and physical performance tests endorsed by the

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Does the frailty index applied to randomised controlled trials really measure frailty?

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Rîme Bousetta 1,2, David A McAllister 2, Heather Wightman 2, Jim Lewsey 2, Peter Hanlon 2
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Background Cumulative deficit frailty indices from randomised controlled trials (RCT) are increasingly used to assess whether trial findings are applicable to people living with frailty. The aim of this study was to examine the range and type of deficits included in these frailty indices and compare these to those from cohort studies. Methods We identified RCTs assessing treatment effect modification using the cumulative deficit frailty index, as well as cohort studies assessing mortality risk associated with frailty, from recent systematic reviews. We extracted the deficits included in the

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