Myositis ossificans traumatica of the masseter muscle: Review of the literature and report of two additional cases

Myositis ossificans traumatica of the masseter muscle is uncommon. The condition is benign and results in reactive heterotopic bone formation, usually producing limitation of opening of the jaws. Radiographic and microscopic examination can confirm the diagnosis. Treatment of myositis ossificans traumatica of the masseter muscle is surgical, with other modalities used when occurring in other muscles of the body     

Inter-Rater Reliability of the PIPES Tool: Validation of a Surgical Capacity Index for Use in Resource-Limited Settings

Introduction

In response to the need for simple, rapid means of quantifying surgical capacity in low resource settings, Surgeons OverSeas (SOS) developed the personnel, infrastructure, procedures, equipment and supplies (PIPES) tool. The present investigation assessed the inter-rater reliability of the PIPES tool.

Methods

As part of a government assessment of surgical services in Santa Cruz, Bolivia, the PIPES tool was translated into Spanish and applied in interviews with physicians at 31 public hospitals. An additional interview was conducted with nurses at a convenience sample of 25 of these hospitals. Physician and nurse responses were then compared to generate an estimate of reliability. For dichotomous survey items, inter-rater reliability between physicians and nurses was assessed using the Cohen’s kappa statistic and percent agreement. The Pearson correlation coefficient was used to assess agreement for continuous items.

Results

Cohen’s kappa was 0.46 for infrastructure, 0.43 for procedures, 0.26 for equipment, and 0 for supplies sections. The median correlation coefficient was 0.91 for continuous items. Correlation was 0.79 for the PIPES index, and ranged from 0.32 to 0.98 for continuous response items.

Conclusions

Reliability of the PIPES tool was moderate for the infrastructure and procedures sections, fair for the equipment section, and poor for supplies section when comparing surgeons’ responses to nurses’ responses—an extremely rigorous test of reliability. These results indicate that the PIPES tool is an effective measure of surgical capacity but that the equipment and supplies sections may need to be revised.     

Grounded theory,feminist theory,critical theory: toward theoretical triangulation

Nursing and social science scholars have examined the compatibility between feminist and grounded theory traditions in scientific knowledge generation, concluding that they are complementary, yet not without certain tensions. This line of inquiry is extended to propose a critical feminist grounded theory methodology. The construction of symbolic interactionist, feminist, and critical feminist variants of grounded theory methodology is examined in terms of the presuppositions of each tradition and their interplay as a process of theoretical triangulation.     

Dose-ranging trial of N-acetylprocainamide in patients with premature ventricular contractions.

Ten patients with chronic premature ventricular contractions (PVCs) received short-term oral therapy with N-acetylprocainamide (NAPA) to determine its antiarrhythmic efficacy and side effects under the conditions of a placebo-controlled, dose-ranging trial. NAPA was effective in suppressing PVCs in 8 patients but caused a paradoxical increase in PVC frequency in one. Results were equivocal in the remaining patient because PVCs did not recur when NAPA therapy was withdrawn. Mean NAPA plasma levels as high as 41.1 microng/ml did not have untoward hypotensive or myocardial depressant effects, as judged by electrocardiographic and systolic time intervals. There was, in fact, a consistent reduction in PEP/LVET ratio, indicating that NAPA increases the force of myocardial contraction. The mean NAPA elimination half-life of 10.9 hr was longer than the 6.2 hr half-life reported for normal subjects, but its prolongation was predictably correlated with reductions in creatinine clearance. Gastrointestinal side effects experienced by 3 patients and insomnia noted by 2 patients are similar to known adverse reactions to procainamide.     

A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes

Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT) is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline) objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance.

Key points

• Specific, targeted interventions that isolate injury risk factors and can help correct modifiable neuromuscular deficits are essential.
• Current training interventions for anterior cruciate ligament (ACL) injury prevention have only demonstrated limited effectiveness and have not achieved the widespread acceptance necessary to promote full adoption to reduce ACL injury rates.
• The paper provides an overview of innovative strategies and technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement neuromuscular training (NMT) including electromyography, force plates, motion sensors, and camera-based motion capture systems.
• These strategies utilize biomechanical, physiological, or neuromotor variables for training, automate the quantitative measurement of those variables through a variety of technological modalities, and then feed those measured variables via software to provide information in simplified form for online, visual biofeedback displays.

Key words: Neuromuscular training, anterior cruciate ligament injury, biofeedback, electromyography, force platforms, motion sensors, 3D motion capture     

Specificity of Doppler echocardiography for the assessment of changes in valvular regurgitation: comparison of side-by-side versus serial interpretation

OBJECTIVES: We sought to determine the specificity of two different methods for assessing change in aortic (AR), mitral (MR) and tricuspid (TR) valvular regurgitation. BACKGROUND: Echocardiographic imaging with Doppler is the standard noninvasive diagnostic tool for assessing valvular structure and function. Change can be assessed using either independent evaluations (serial) or using a side-by-side comparison. METHODS: Subjects were from the placebo arm of a randomized, double-blind, clinical trial. Three echocardiograms over 10 months were performed. An initial and three-month echocardiogram were read as independent groups, blinded to all parameters except sequence. The initial and 10-month echocardiograms were read side-by-side, blinded to all parameters including sequence. RESULTS: Two hundred nineteen predominantly healthy, obese, white, middle-aged women had initial and three-month echocardiograms (acquisition interval 105 +/- 28 days) evaluated by the serial method (mean 167 +/- 61 days between interpretations). The same subjects had the initial and 10-month studies (acquisition interval 303 +/- 27 days) compared side-by-side. The specificity of the serial versus side-by-side method for determining change in MR grade was 55.8% versus 93.2% (p < 0.001); TR: 63.8% versus 97.6% (p < 0.001) and AR: 93.7% versus 97.6 (p = 0.08). Notably, most of the change occurred in a range (none versus physiologic/mild) that has limited clinical significance. Furthermore, the percentage of echocardiograms interpreted as nonevaluable was lower with the side-by-side method for MR (5.0% vs. 16.0%, p = 0.06), TR (4.6% vs. 15.5%, p < 0.001) and AR (4.1% vs. 12.3%, p = 0.002). CONCLUSIONS: The side-by-side method of assessing change in valvular regurgitation appears to be the more reliable method with a higher specificity and minimal data loss.