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Improving delirium assessment in gastroenterology inpatients: a two-cycle quality improvement project in a district hospital

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Lowri Edwards1
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Introduction Delirium prevalence is approximately 15-20% in medical inpatients and potentially higher within gastroenterology inpatients due to increased prevalence of liver disease. Delirium causes longer admissions, worse morbidity and mortality outcomes and distress to patients, families and staff. The National Institute for Health and Care Excellence (NICE) recommends that inpatients are assessed for delirium within 24 hours of admission. Assessment on admission was outside the remit of this project but there was an opportunity to improve assessment from the point of admission to a
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Are we prescribing antibiotics on paper charts safely? A QIP assessing antibiotic prescribing on geriatric wards in Wales.

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Luigi Medri 1; Huda Mohammed 2; Sit Aung Lwin 2
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Introduction: Antimicrobial stewardship is a key patient safety priority within the NHS, particularly in older adults who are at increased risk of adverse drug reactions, Clostridioides difficile infection, and harm related to polypharmacy. NICE antimicrobial stewardship guidance (NG15) and the “Start Smart – Then Focus” framework recommend that all antibiotic prescriptions include clear documentation of the clinical indication and duration to support safe and appropriate use. In hospitals where paper drug charts remain in use, adherence to these standards may be variable. This quality
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Artificial Intelligence–Informed Exercise Prescription: Perspectives from People with Long-Term Conditions, Carers and Staff

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J Keast1,2; L Smith2; H Dambha-Miller2.
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Introduction Physical activity is central to healthy ageing and long-term condition (LTC) management, yet older adults with multimorbidity, frailty, and fluctuating symptoms face barriers to safe, individualised exercise support in primary care. Exercise prescription (EP) is often limited by time constraints, variable access to specialist input, and clinician confidence in tailoring recommendations. Artificial intelligence (AI)–informed EP tools offer a route to personalised, scalable physical activity support, but raise questions regarding safety, trust, equity, and integration into routine
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Improving future care planning (FCP) discussions and documentation in Hospital at Home (H@H)

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James Holland1, Katherine Ralston1; Alex Stirzaker1; Latana Munang1
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Introduction: The West Lothian H@H team is based at St John’s Hospital, Livingston providing acute assessment and care to approximately 130 patients monthly, the majority of whom are frail. Future care planning should be included in clinical interactions,1,2 and all members of the multidisciplinary H@H team should have the competence and confidence to do this well for every patient. Aims: To improve the quality and rate of FCP discussions with patients and families, including resuscitation, escalation to hospital and preferred place of care (PPC). To improve the communication of FCP
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Quality Improvement Project on Fragility Fracture Risk Assessment using FRAX score in Older Adults in Inpatient Psychiatry Unit

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Noel Shaju1,Alice Thankachan2
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Introduction Annually, around 130,000 people in Wales are reported to have at least one fall incident. Existing evidence suggests that Mental Health inpatient units, on average exhibit higher incidence of fragility fracture than acute hospital wards which could be contributed by medication such as antipsychotics and anti-depressants. Consequently, a quality Improvement project was formulated to evaluate fragility fracture risk among Elderly inpatient Mental Health unit and to analyse their adherence of treatment to the National Standards. Method Patients admitted to old age psychiatry ward at
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Cognitive function in people with Parkinson’s disease in northern Tanzania.

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I Terry; C Dotchin; N Fothergill-Misbah; W Eliamini; M Dekker; S Urasa; R Walker
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Background: Cognitive impairment (CI) is a common non-motor symptom of Parkinson’s Disease (PD), but little is known about its profile and assessment in Sub-Saharan Africa (SSA). This study aims to characterise cognitive function in a cohort of people with PD (PwP) in northern Tanzania, and evaluate the feasibility and acceptability of cognitive screening tools in a low-resource, community setting. Methods: Twenty-eight PwP identified in a previous door-to-door survey were followed up. Cognitive function was assessed using the Identification and Intervention for Dementia in Elderly Africans
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Known, and unknown, hypertension in the Transforming Parkinsons care in Africa ( TraPCAf) cohort: pilot data

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Jessica Walker 1; Yasin Okkaoglu 2; Catherine Dotchin 3; Natasha Fothergill-Misbah 2; Njideka Okubadejo 4; Richard Walker 1,2 on behalf of TraPCAf collaboration
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Introduction There are few data on Parkinson’s disease (PD) in Africa, particularly in sub-Saharan Africa (SSA). The NIHR Global Health Research Group Transforming Parkinson’s Care in Africa (TraPCAf) is a four-year study, running from September 2022, investigating PD in seven African countries (1). In SSA, hypertension is highly prevalent, with many individuals remaining undiagnosed and, among those diagnosed, many untreated or poorly controlled (2). Method The TraPCAf project is recruiting a target of 1,000 people with PD (PwP) and 2,000 age- and sex-matched healthy controls. Data collected
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Mortality and Institutionalisation Following de Novo Use of Rotigotine Patches in Hospitalised Patients with Parkinson’s Disease

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EKaye1; KMillington2; RSkelly2
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Objective: Guidelines recommend use of rotigotine patches as an option if Parkinson’s patients are unable to take their usual oral medication, but this strategy has not been tested in clinical trials. We audited outcomes for such patients in a large UK teaching hospital. Background: This project was undertaken at University Hospitals of Derby and Burton. Method: In this retrospective study, data was extracted from the hospital’s electronic prescribing and medication administration system, Lorenzo. We examined data on every hospitalised Parkinson’s patient prescribed rotigotine at Royal Derby
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Music: Reclaiming the Sense of Self in People Living with Alzheimer's Disease

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Shriya Karlapudi1
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Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disease, characterised by memory and cognitive impairment. Autobiographical memory, or the memory of oneself, consists of episodic, self-defining and semantic components. AD profoundly disrupts autobiographical memory, causing individuals to lose their self-identity. Although previous research has shown that music can facilitate the recall of autobiographical memories, the extent and nature of this effect in AD is unclear. Specifically, it is debated whether music preserves neural networks involved in autobiographical

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Systematic Review of Cardiovascular Autonomic Dysfunction in Lewy Body Dementia

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C Gibbons1; E Georgiou 1; D Mockler 1; R R Ortuno 1; I Leroi 1
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Introduction: The Lewy Body Dementias (LBD) incorporate both Parkinson’s Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB). These conditions have a heterogeneous presentation and disease trajectory with much inter-individual variability. Accurate diagnostics and prognostication are becoming increasingly important in the potential disease modifying era. Cardiovascular autonomic dysfunction is a supportive diagnostic feature of DLB and a well-known non-motor phenotype of Parkinson’s Disease. It most commonly presents with orthostatic hypotension (OH) which can be easily measure
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Opportunistic Review of CT scans to Identify Unreported Vertebral Fractures in Patients with Parkinson’s Disease

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S Ow1; A Kitson1; H Ali2; B Mohammed3; J Boylan3; S Jones4
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Introduction Patients with Parkinson’s Disease (PD) are at an increased risk of developing osteoporosis. Vertebral fractures (VFs) are the commonest type of osteoporotic fracture and are frequently underdiagnosed, up to 70% going unreported. Individuals with VFs are at a significantly higher risk of experiencing subsequent fractures (relative risk increase of 2.8 for hip fractures and 5.4 for additional VFs). The presence of VFs are often not formally reported. VFs are also associated with an eightfold increase in morbidity. These complications could result in reduced independence and

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Survey Of General Practitioners' Attitudes To Using Blood-Based Dementia Markers

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J Lynch1; N Hart2; P Passmore1; E Cunningham1.
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Introduction Blood-based biomarkers (BBMs) of Alzheimer’s and other dementia-causing diseases will be available for clinical use in Northern Ireland (NI) within the next five years. Globally, it has been proposed that BBMs will be utilised in primary care before referral to memory services. This study assessed GP willingness to use BBMs and identified requirements for implementation. Method Ethical and governance approvals were granted by QUB. A short, anonymous questionnaire assessing GP attitudes towards BBMs was distributed primarily via email. The Eastern GP Federations Support Unit (FSU)

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Improving Advance Care Planning Completion in Primary Care

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E Saudella1; A Biju1
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Introduction Advance care planning (ACP) is a patient-centred discussion involving the patient, family, and healthcare professional to ensure care aligns with patient wishes. In Wales, this includes two recognised documents for those with capacity, and a best interests form for those without, completed by a Lasting Power of Attorney or IMCA. ACPs in the elderly population enhance quality of life, communication, and reduce hospital admissions. This project aimed to improve ACP completion in primary care. Method Forty-one residents, who were registered to Roath House Surgery, were sampled from

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A Quality Improvement Project to incorporate routine Bone Health assessment into a Parkinson’s Clinic

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A Kitson1; H Ali1; S Page2; B Mohamed2
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Introduction People with Parkinson’s (PWP) are twice as likely to fracture and over twice as likely to develop osteoporosis (1. Henderson et al, Parkinsonism & Related Disorders, 2019, Vol.64, pp.181-187). This is associated with significant morbidity (1). Assessment of bone health is often overlooked in clinic (2. UK Parkinson’s Excellence Network, 2019, pp.4-56), deeming it a priority area for improvement. Our project focuses on implementing routine bone health assessment for PWP in clinic, to achieve better standards of care. Methods This was a 12-week medical student led project, supported
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Improving Medication Safety in Dysphagic Parkinson’s Disease Patients through the Dysphagia Alert Card Initiative

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Dr N Silva1; Dr S Ulikova1
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Introduction: Dysphagia in Parkinson’s disease (PD) increases the risk of aspiration pneumonia and medication harm during acute admissions. When patients are made nil by mouth (NBM), time critical PD medicines may be delayed while clinicians calculate levodopa equivalent dose (LED) and convert to alternative formulations. We introduced a patient held Dysphagia Alert Card to provide a specialist approved emergency prescribing plan and improve timely prescribing and review. Method: Patients with established dysphagia or high risk were identified during routine specialist reviews and inpatient
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Improving Inpatient Sleep in orthogeriatric patients - Quality Improvement Project

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C Pang1; O Abu Baker1; Y Abdelmegeid2
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Background: In orthogeriatric patients, sleep quality is often overlooked despite its association with pain, mobility, and rehabilitation outcomes. This project assessed inpatient sleep quality on Elm Ward at Trafford General Hospital and evaluated interventions to improve sleep. Aim: To assess inpatient sleep quality and implement non-pharmacological and pharmacological interventions. Methodology: Baseline sleep quality data were collected from eligible inpatients using a sleep questionnaire prior to two Plan–Do–Study–Act (PDSA) cycles. The first cycle introduced non-pharmacological
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Co-designing an intervention to promote shared decision-making with older people, with frailty, in planning discharge from hospital

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Kerrie McLarnon1, Deirdre McGrath1, Peter O'Halloran1, Anita Mallon1, Christine Brown Wilson1
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Background: Effective planning for hospital discharge can best be achieved through shared decision-making to make fully informed decisions. However shared decision-making is challenging for both healthcare professionals and older people with frailty. There is limited consensus on the optimum way to achieve shared decision-making. This project aims to develop a multi-component intervention to prepare healthcare professionals, older people, and relatives/carers of older people to engage in shared decision-making. We will test the feasibility of implementing the intervention in Northern Ireland
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Taking dementia care to the high street: Dementia UK and Nationwide Building Society clinics programme

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LWilliamson1; RGuild2
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Introduction When facing a sharp rise in the number of people living with dementia in Northern Ireland, delays in receiving a timely diagnosis and accessing specialist dementia support, it is imperative to find new ways to bring dementia care closer to home. An innovative 3-year partnership, established in 2024, between Dementia UK and Nationwide Building Society, aims to provide specialist nursing support to 100,000 families living with dementia across the UK. Recurrent clinics are delivered in Nationwide high street branches across Northern Ireland by a specialist dementia nurse, known as an
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A Qualitative Audit of ReSPECT Form Discussions in Dementia Inpatient Units

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Dr Alexander Jelloo
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Introduction: What is the most significant conversation you’ve ever had? A question for which everyone reading will have their own answer. You may vividly recall what was said, where, by whom, and in what manner. In a healthcare setting, a clinician must always consider the ways in which our daily work can involve conversations as salient as this for our patients, their families and carers. Discussing ceiling of care is one such instance. With ReSPECT now reflected in HPFT policy as standard practice, this audit explores how patients and carers experience these discussions. ReSPECT forms
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Factors Impacting The Experiences of Dementia Patients & Carers when Accessing Emergency Department Care in Northern Ireland

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Abbie Magowan
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Introduction It is acknowledged that older people with a background of dementia are frequent attenders of Emergency Departments (EDs), where overcrowding, long waits and an unfamiliar environment can create a distressing experience for these patients and their carers. By identifying and understanding modifiable factors that shape these patient’s experiences, healthcare systems and professionals can aim to improve experiences for both this patient group and their carers. This qualitative analysis aims to identify and explore the factors that can impact the experiences of patients with dementia

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