How can we make self-sampling packs for sexually transmitted infections and bloodborne viruses more inclusive? A qualitative study with people with mild learning disabilities and low health literacy.

OBJECTIVES: 1.5 million people in the UK have mild to moderate learning disabilities. STIs and bloodborne viruses (BBVs) are over-represented in people experiencing broader health inequalities, which include those with mild learning disabilities. Self-managed care, including self-sampling for STIs/BBVs, is increasingly commonplace, requiring agency and health literacy. To inform the development of a partner notification trial, we explored barriers and facilitators to correct use of an STI/BBV self-sampling pack among people with mild learning disabilities. METHODS: Using purposive and convenience sampling we conducted four interviews and five gender-specific focus groups with 25 people (13 women, 12 men) with mild learning disabilities (July-August 2018) in Scotland. We balanced deductive and inductive thematic analyses of audio transcripts to explore issues associated with barriers and facilitators to correct use of the pack. RESULTS: All participants found at least one element of the pack challenging or impossible, but welcomed the opportunity to undertake sexual health screening without attending a clinic and welcomed the inclusion of condoms. Reported barriers to correct use included perceived overly complex STI/BBV information and instructions, feeling overwhelmed and the manual dexterity required for blood sampling. Many women struggled interpreting anatomical diagrams depicting vulvovaginal self-swabbing. Facilitators included pre-existing STI/BBV knowledge, familiarity with self-management, good social support and knowing that the service afforded privacy. CONCLUSION: In the first study to explore the usability of self-sampling packs for STI/BBV in people with learning disabilities, participants found it challenging to use the pack. Limiting information to the minimum required to inform decision-making, 'easy read' formats, simple language, large font sizes and simpler diagrams could improve acceptability. However, some people will remain unable to engage with self-sampling at all. To avoid widening health inequalities, face-to-face options should continue to be provided for those unable or unwilling to engage with self-managed care.

Tobacco and Alcohol Use in People With Mild/Moderate Intellectual Disabilities: Giving Voice to Their Health Promotion Needs.

BACKGROUND: Concerns have been raised about the use/misuse of tobacco and alcohol by people with mild/moderate intellectual disabilities. Aiming to address an identified gap in the current evidence base, this study sought to gain an understanding of the tobacco- and alcohol-related health promotion needs of this client group. METHODS: Informed by the principles of social cognitive theory, data were collected using focus group and telephone interviews. Participants were 16 people with intellectual disabilities, two family carers and 15 health and social care professionals. Data were analysed using the Framework approach. FINDINGS: Four themes were described: being like others; social and emotional influences; understandings, misunderstandings and learning from experience; and choices and challenges. Reasons for smoking and drinking alcohol echoed those of the general population; however, health promotion needs were more complex (e.g. linked to problems with consequential thinking; low levels of self-efficacy). CONCLUSION: This article provides insight into the tobacco- and alcohol-related health promotion needs of people with intellectual disabilities. There is a need for integrated service provision that addresses both personal and environmental influences on behaviour.

Outcome of ankle arthrodesis using a transfibular approach.

Variable union rates in ankle arthrodesis using different surgical techniques have been reported in the biomedical literature. However, the advantages of a transfibular approach with sagittal splitting of the fibula have not been widely reported, even though the technique is well known and even described in surgical textbooks. We analyzed outcomes in our practice for all patients who underwent ankle arthrodesis. Over a 5-year period, 2 surgeons using the same transfibular approach performed 26 ankle arthrodeses in 25 patients. The medical records and radiographs of the patients were reviewed for duration of hospital admission, time to union, and complications. All (100%) of the ankle fusions progressed to solid union in a mean postoperative duration of 4.5 ± 1.8 months (range, 2-10 months), and the only clinically significant complication involved 1 patient with suspected complex regional pain syndrome, who responded to treatment and recovered fully.

A Functional Angle of Up to 35° at the Distal Interphalangeal Joint Can Be Achieved with Headless Compression Screw Fusion.

BACKGROUND: Arthrodesis of the distal interphalangeal (DIP) joint reliably improves symptomatic arthritis. A range of successful surgical techniques including tension band wiring, plate fixation and headless compression screws have been described and produce stable painless unions. For best functional outcome, the fusion angle should be between 10 and 61 degrees. In the past, it has been difficult to achieve more than 10 degrees of flexion with a headless compression screw. Higher fusion angles have been reported using tension band wiring techniques. However, metalwork prominence is a common problem and may require revision surgery to rectify this. Headless compression screws are reported to cause iatrogenic fractures due to the size of the screw relative to the small diameter of the phalanx. This case series achieves an angle of up to 35 degrees with a good functional outcome. METHODS: Open fusion of the DIP joint with a headless cannulated compression screw, of 2.2 mm in diameter, was undertaken in fifteen digits. Patients received standard departmental follow up to radiographic union. Patients self-reported function using the Michigan Hand Questionnaire post operatively. The fusion angles achieved were assessed on postoperative radiographs. RESULTS: All patients went on to a stable union without any patients requiring revision surgery as a result of fracture or protrusion of metalwork. Complications were observed in two patients which included one superficial infection (n = 1) and a discomfort requiring removal of metalwork (n = 1). Functional scores measured post operatively showed favourable outcomes. CONCLUSIONS: In this series, successful fusions of the DIP joints, at an angle up to 35 degrees were achieved using small diameter headless compression screws, which provided benefits including early mobilization and favourable functional outcome scores.

Volar radiocarpal dislocation: case report and review of literature.

We describe here an unusual case of volar dislocation of the radiocarpal joint due to a complete tear of the dorsal radiocarpal ligament. Plain radiographs taken at initial presentation did not reveal any obvious abnormality. There was no associated bony lesion or intrinsic wrist ligament injury. Radiocarpal dislocations should be considered in the diagnosis of high-energy wrist injuries, even when initial radiographs look normal. The importance of a high index of suspicion in high velocity wrist injuries and need for further evaluation and imaging is highlighted.

Popliteal block with transfibular approach in ankle arthrodesis: a case series.

INTRODUCTION: Ankle arthrodesis is primarily undertaken to control severe pain in the ankle joint. Immediate postoperative pain is usually treated using oral analgesics, intravenous opiates and regional anaesthesia. The outcomes of ankle fusion, including patient satisfaction studies, are well documented in the literature. However, the advantage of popliteal block in the management of early postoperative pain after ankle fusion for osteoarthritis has not been widely reported. This study aims to determine the role of popliteal block using ankle fusion in the management of ankle osteoarthritis. CASE PRESENTATION: Ankle arthrodeses were performed in 27 patients over a five-year period. Eighteen patients were males (one had bilateral arthrodesis) and eight were females. Their mean age was 56 years and they were all Caucasians. The notes and radiographs of the patients were reviewed in retrospect for the duration of their hospital admission, time to union and complications. CONCLUSION: Popliteal block is a safe and effective technique for postoperative analgesia in ankle arthrodesis. By using this technique, we achieved a significant reduction in the duration of hospital stay for our patients after ankle arthrodesis. The resultant cost saving was GBP717 for each patient.