Demographics and deprivation in obstetric brachial plexus palsy: a retrospective cohort study.

The present study analyses the relationships between deprivation and obstetric brachial plexus palsy (OBPP). A retrospective observational study was conducted of infants with OBPP seen between 2008 and 2020 (n = 321). The index of multiple deprivation (IMD) was used to assign an IMD rank to patients based on birth postcode and the relationship with OBPP was analysed, including deprivation, gestational diabetes, age at referral and at first assessment. Quintile-based analysis demonstrated over-representation of patients from more deprived neighbourhoods (n = 109, 39%) living in the top 20% most deprived neighbourhoods. A total of 48 (15%) mothers had diabetes and 98 (31%) infants underwent surgical brachial plexus exploration (a marker of disease severity). Neither diabetes, age at referral nor age at first assessment were associated with IMD score. This suggests that neighbourhood deprivation is associated with OBPP, though the mechanisms are unclear. Further studies in this area may enable targeted health intervention for more deprived maternal and infant groups.Level of evidence: III.

Comparing everyday autonomy and adult identity in young people with and without intellectual disabilities.

AIM: This study was undertaken to investigate how young people with and without mild intellectual disabilities experience and perceive their own behavioural autonomy. METHOD: Fifty-six young people with mild intellectual disabilities and 49 young people without disabilities aged 16-19 participated in a novel picture card sorting task to investigate their participation in a range of activities, and the obstacles preventing them from doing so. RESULTS: School pupils with intellectual disabilities engaged in significantly fewer activities than their typically developing peers and were more likely to state not to be allowed to. In contrast, the college students with and without disabilities were equally as likely to undertake each activity, and those with intellectual disabilities were more likely to express lack of interest in doing so. CONCLUSIONS: The move from school to college may represent an opportunity for young people with intellectual disabilities to "catch-up" with their typically developing peers.

Transitioning to adulthood with a mild intellectual disability-Young people's experiences, expectations and aspirations.

AIM: Very little attention has been paid to the views and experiences of young people with mild intellectual disabilities on the broad topics of adulthood and adult identity. The following study was undertaken to explore how young adults with mild intellectual disabilities conceptualize, relate to, and experience the process of transition. METHOD: Eight young adults with mild to borderline intellectual disabilities participated in semi-structured interviews. Results were analysed using interpretive thematic analysis. RESULTS: Two umbrella themes were identified: "On a developmental pathway" and "Negotiations in the environment". CONCLUSIONS: The participants concerns were surprisingly similar to those commonly expressed by young adults without disabilities. Self-perceived adult identity appeared to be affected by the participants' personal definitions of adulthood, as well as by social comparisons with both peers and adults. Finally, while concerns were expressed about their capacity to cope with responsibility, most felt optimistic about adopting full adult status in the future.

The supportive care plan: a tool to improve communication in end-of-life care.

The End of Life Care Strategy (Department of Health, 2008a) states that acute hospitals need mechanisms in place to ensure that people who are approaching the end of life have their needs assessed, their wishes and preferences discussed, and an agreed set of actions reflecting these choices recorded in a care plan. The Supportive Care Plan was designed to encourage discussion of patients' preferences for end-of-life care, and to provide a tool for recording those preferences and communicating them to other healthcare professionals. Initial analysis of the results of a pre- and post-implementation audit of patient notes suggests that there has been an improvement in the documentation about preferred place of care and patient and family understanding of the illness. Fifty per cent of patients who died with a Supportive Care Plan in place died in their first choice of place of care and 22% in their second choice. Feedback from patients and relatives was positive. The main barriers to implementation were difficulties for staff in prognostication, especially for patients with a non-cancer diagnosis, and a reluctance from staff to initiate discussions that were perceived to be too time-consuming. There were also concerns about dealing with the emotions that such a discussion may generate in both patients and relatives.