Aims: Parkinson’s disease is a neurodegenerative condition with a lifetime risk of 2.7%, with a rise in prevalence expected in line with an ageing population. Whilst characteristically associated with motor symptoms, it is a multi-system disease with neuropsychiatric sequelae which are frequently missed by non-psychiatric specialists. Patients face barriers to access psychiatric services.

We describe a 15-month pilot of a novel integrated service for people with Parkinson’s disease in the Bristol Royal Infirmary. A monthly joint outpatient clinic was established whereby old age psychiatrists from the later life liaison psychiatry team and geriatricians saw patients within the same appointment. Additionally, we collaborated for weekly multidisciplinary team (MDT) meetings, inpatient reviews and wider liaison. Our aim was to develop a holistic integrated service with the hypothesis that this would offer value to our joint patient cohort and the wider healthcare service.

Methods: Patients were identified through triage of outpatient referrals, as inpatients and at MDT meetings. Clinical outcomes from the integrated clinic were measured using the Clinical Global Impressions (CGI) scale. Patient and professional quantitative feedback was gathered. Hospital admission data was measured against baseline admission rates for similar outpatient groups.

Results: Between November 2023 and January 2025, eleven integrated clinics were run and 33 patients attended; some patients were seen on multiple dates. The rationale for integrated working included new psychiatric symptoms (17%), pre-existing psychiatric diagnosis complicated by dopamine treatment (28%), cognitive conditions (39%) and complex psychotropic prescribing (33%). Major treatment outcomes included medication adjustment (78%), diagnostic reformulation and psychological therapy provision. There was a clear positive trend in CGI data showing benefit to patients, with overwhelmingly positive patient and professional feedback. Formal analysis of data looking at hospital admissions was inconclusive – but case series analysis shows examples of admission avoidance.

Conclusion: We believe the development of this service shows that close working between psychiatrists and physicians enhances patient care in Parkinson’s disease. Our integrated service is acceptable and beneficial for patients. It is valued by professionals and appears to be cost-effective through medication rationalisation and admission avoidance. In terms of future direction, we have applied for additional funded psychiatrist hours from the Trust to ensure sustainability of the clinic and are in the process of developing linked psychological therapy and clozapine prescribing services as a result of the success of the pilot clinic.

We reviewed infection prevention policies using an adapted Equity Impact Assessment tool. Thirty-one percent of policies had substantial potential to impact marginalized groups and create or sustain inequities, and most lacked existing equity considerations. Systematic policy review for equity implications can result in actions to improve care and quality.

There are many health and nutrition implications of suffering from multimorbidity, which is a huge challenge facing health and social services. This review focuses on malnutrition, one of the nutritional consequences of multimorbidity. Malnutrition can result from the impact of chronic conditions and their management (polypharmacy) on appetite and nutritional intake, leading to an inability to meet nutritional requirements from food. Malnutrition (undernutrition) is prevalent in primary care and costly, the main cause being disease, accentuated by multiple morbidities. Most of the costs arise from the deleterious effects of malnutrition on individual’s function, clinical outcome and recovery leading to a substantially greater burden on treatment and health care resources, costing at least £19·6 billion in England. Routine identification of malnutrition with screening should be part of the management of multimorbidity together with practical, effective ways of treating malnutrition that overcome anorexia where relevant. Nutritional interventions that improve nutritional intake have been shown to significantly reduce mortality in individuals with multimorbidities. In addition to food-based interventions, a more ‘medicalised’ dietary approach using liquid oral nutritional supplements (ONS) can be effective. ONS typically have little impact on appetite, effectively improve energy, protein and micronutrient intakes and may significantly improve functional measures. Reduced treatment burden can result from effective nutritional intervention with improved clinical outcomes (fewer infections, wounds), reducing health care use and costs. With the right investment in nutrition and dietetic resources, appropriate nutritional management plans can be put in place to optimally support the multimorbid patient benefitting the individual and the wider society.

This editorial monograph explores the advances and pitfalls of the common forms of purposeful sampling. Purposeful sampling is a common research design in qualitative research.

The objective of this study was to describe changes in sustainable dietary behaviours (those that support environmental, economic, and physical health) among a sample of US adults during the COVID-19 pandemic and to examine differences in changes by individuals’ race/ethnicity and socioeconomic status. Therefore, a cross-sectional online survey study was conducted in April 2021 (N = 1,488, mean age = 42.7 (SD = 12.6)) receiving outpatient care from Michigan Medicine, the University of Michigan health system. Enrolment quotas were established to ensure a diverse sample—one-third of participants identified as African American/Black, one-third Hispanic/Latino, one-third White, and one-third low-income. Participants reported engaging in more behaviours that are supportive of a sustainable diet one year into the COVID-19 pandemic compared to before. This is particularly true regarding ecologically and economically sustaining behaviours such as taking fewer trips to the grocery store, increased use of home grocery delivery, increased cooking at home, and greater consumption of healthy foods. Not all behaviour changes promoted sustainable food systems; namely, the use of farmer’s markets and Community Supported Agriculture (CSAs) declined. White and high-income participants were more likely than African American/Black, Hispanic/Latino, and low-income individuals to engage in ecologically and economically sustainable dietary behaviours during the pandemic. Meanwhile, African American/Black participants reported large increases in physical health sustainable dietary behaviours. To support the continuation of greater engagement with sustainable diets, policies that increase access to public transportation, limit the frequency with which consumers have groceries delivered, increase work-from-home options, and improve access for low-income populations should be prioritised.

The recently published Model Core Content of Disaster Medicine introduces proposed curriculum elements for specialized education and training in Disaster Medicine. This editorial comments on the publishing decision for the manuscript.

The present study uses variationist quantitative methods to examine the evolution of the semantic field of third-person male adult noun referents from Old English to Middle English, covering a time depth of approximately six hundred years. Results show a shift from the favored variant wer in Old English to man in Middle English, with the diachronic change in frequency following a prototypical s-shaped distribution. Although the replacement seems to take centuries to be complete, lexical frequency and written transmission are proposed as influential explanatory factors, and a homonymic clash is suggested to have accelerated the process of replacement in Middle English. Text type and text origin contribute to variation, with alliteration significantly influencing lexical choices in Old English verse texts. When combined with findings from recent synchronic work, this study highlights a heterogeneously structured semantic domain, which has undergone lexical replacement and change over time, providing some evidence for the applicability of s-shaped patterns for lexical change.

The aim of this study was to determine the causes of loss from active duty amongst German shepherd dogs in service with the New Zealand Police Dog Section. Current or previous police dog handlers (n = 149) completed a postal survey for each dog they had worked with during their career including their current dog. Causes of loss were categorised as either retirement, euthanasia whilst still in active duty, death from illness/natural causes, or being killed whilst on duty. Of 182 dogs with completed questionnaires, 48 dogs were still in service, leaving 134 that were retired (94), had been euthanased (24), had died (11) or had been killed (5). The mean and median age at loss for all dogs no longer in service was 6.6 years. The nominal age for planned retirement (8 years) was only reached by 40% of dogs. The single most important cause of retirement was the inability to cope with the physical demands of the job (61/94 dogs or 65%). Degenerative musculoskeletal disease was cited as the primary factor in 42/61 of these dogs (69%). When both retired and euthanased dogs where considered together, 27% were retired or euthanased due to back/spinal problems, and a high proportion of these were believed to have involved the lumbosacral joint. Greater research efforts should be targeted at identification of the factors that lead to degenerative musculoskeletal and lumbo-sacral disease to determine methods of lowering their incidence in police working dogs. Such research could lead to increasing the average working life and ‘in work’ welfare of a police German shepherd dog in New Zealand.