The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study

BackgroundOccupation-based intervention (OBI) in hand therapy has shown superior benefits in patient-reported performance and physical measures; however, only a few studies have used OBI. We developed a decision-aid to promote the use of an injured hand in the real world (Aid for Decision-making in Occupation Choice for hand; ADOC-H)PurposeTo investigate the clinical utility of the ADOC-H (paper version) in patients with distal radius fractures.Study DesignA prospective case series and a clinical survey for occupational therapists.MethodsThis study comprised a prospective patient case series of 8 patients with distal radius fractures, treated using Volar locking plates, and a clinical survey of 4 experienced occupational therapists.ResultsNo patient or therapist complaints or drop-outs were reported. Active range of motion (wrist), Grip strength, and Disabilities of the Arm, Shoulder, and Hand scores improved for all patients. The ADOC-H induced 158 activities using the injured hand, with activities of daily living (69.8%) selected earlier in the treatment period, and instrumental activities of daily living (63.3%) selected later. The feedback and case studies suggested that the ADOC-H was useful for patients who were afraid of using the hand and, interestingly, patients who were able to use their hand without pain or other problems. The clinical survey showed that most therapists found the ADOC-H effective in facilitating real-life use of an injured hand.ConclusionsThe ADOC-H paper version is an useful tool that can be applied to facilitate patients with distal radius fractures to use their injured hands in real-life settings.     

The Effect of Providing Audiovisual Surgical Information on Decisional Conflict in Patients Undergoing Plate Fixation for Distal Radius Fractures

BackgroudPatients experiencing acute trauma have limited time for their involvement in shared decision making, which may lead to decisional conflict. The purpose of this study was to evaluate whether providing audiovisual surgical information can reduce decisional conflict when deciding between surgical and nonsurgical treatment in patients with distal radius fractures (DRFs) and to evaluate factors that may affect decisional conflict.MethodsWe prospectively enrolled 50 consecutive patients who presented with acute DRFs and chose to undergo surgery, for which volar plate fixation was recommended. We randomized these patients into 2 groups. The test group was given a video clip of audiovisual surgical information in addition to regular information while the control group was only given regular information. The video clip consisted of the purpose, procedure, and effect of the surgery, precautions and complications after the operation, and other treatment options that could be performed if operation was not performed. At 2 weeks after the surgery, we evaluated patients'' decisional conflict using a decisional conflict scale (DCS). In addition, we evaluated factors that might affect decisional conflict, such as age, dominant hand, comorbidities, history of previous operations, perceived disability, and provision of the video clip.ResultsThe test group showed significantly lower DCS scores than the control group (19.6 vs. 32.1, p = 0.001). In multivariate analysis, younger age and provision of the video clip were associated with lower DCS scores.ConclusionsThis study has demonstrated that providing information through audiovisual media such as video clips could reduce decisional conflict in patients who chose to undergo plate fixation for DRFs. This study also suggests that older patients may need more careful doctor-patient communication as they have more decisional conflict than younger patients.     

Arthrodesis of the first metatarsophalangeal joint: The “when and how”

Arthrodesis of the first metatarsophalangeal (MTP) joint has been established as the “gold standard” for the treatment of several first ray disorders, due to its perceived efficacy and the consistently reported good results in the literature. Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis, rheumatoid arthritis with severe deformity, selected cases of severe hallux valgus (with or without signs of degenerative joint disease), as well as a salvage procedure after failed previous operation of the first ray. The goals of a successful 1^st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear. Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation. As with any given surgical procedure, various complications may occur after arthrodesis of the 1^st MTP joint, namely delayed union, nonunion, malunion, irritating hardware, etc.      

Improving community health and social care practitioners’ confidence,perceived competence and intention to use behaviour change techniques in health behaviour change conversations

Community health and social care practitioners play an increasingly important role in the health promotion agenda, but lack confidence in having effective health behaviour change (HBC) conversations with members of the public. This study reports the development and evaluation of a training intervention based on health psychology to improve health and social care practitioner self-rated confidence, competence and intention to use five behaviour change techniques (BCTs) in their HBC conversations. A 2-day behavioural science interprofessional skills training course plus online learning module was designed for health and social care staff across North East Scotland, teaching five evidence-based BCTs (e.g. Action Planning), plus person-centred communication skills. Participants rated confidence, competence and future intention to use the BCTs on likert scales (1–10) pre-course and post-course, and provided acceptability data. 177 participants aged 20–64 took part, qualitative and quantitative data suggested that the course had high acceptability. Paired samples t tests (n = 120 with complete data) showed significant improvements in confidence, competence and intention following the course, which remained significant with a conservative analysis (n = 174) assuming no change for missing data. Perceived competence in Action Planning increased most during the course (mean change 3.09). In conclusion, health psychology-based skills training can improve practitioner confidence, competence and intention to use evidence-based BCTs; further evaluation is needed to assess practice change.     

Adductor pollicis. The missing interosseous

Summary This paper highlights the many similarities between the adductor pollicis and the palmar interossei. In particular it compares their anatomy, innervation and function. It suggests that adductor pollicis should be considered as the first palmar interosseous and that this view simplifies the teaching of hand anatomy and the tests of ulnar nerve function. Further support for the view that adductor pollicis is the thenar counterpart of the second, third and fourth palmar interossei is gained from studies of the literature on hand evolution, in particular published details of fossil records and dissection of primate hands.

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L'adducteur du pouce : l'interrosseux perdu

Résumé Cet article souligne les nombreuses similitudes qui existent entre le m. adducteur du pouce et le m. premier inter-osseux palmaire. Il compare en particulier l'anatomie l'innervation et la fonction de ces muscles. Le m. adducteur du pouce semble bien devoir être considéré comme le m. premier inter-osseux palmaire et ce point de vue simplifie l'enseignement de l'anatomie de la main ainsi que l'évaluation de la fonction du nerf ulnaire. Des arguments supplémentaires en faveur de l'hypothèse d'un m. adducteur du pouce qui serait la contre-partie thénarienne des second, troisème et quatrième mm. inter-osseux palmaires proviennent de l'étude de la littérature concernant la phylogénèse de la main et en particulier des résultats d'études portant sur les fossiles et les dissections de mains de primates.

     

RU486配伍米索前列醇中止瘢痕子宫早孕的安全性及可行性探讨

采用RU486配伍米索前列醇中止早孕188例,其中27例为瘢痕子宫。结果显示188例用药后完全流产率为91．48％;27例瘢痕子宫组为100％;161例非瘢痕子宫组为90．06％,两组完全流产率的差异无显著性意义,P>0．05,且两者绒球排出时间及出血时间亦无明显差异,瘢痕子宫组无一例严重并发症。提示RU486配伍米索前列醇口服中止瘢痕子宫早孕者安全、有效,并非其禁忌证,推荐为首选方法之一。