Ilizarov hybrid external fixation for fractures of the distal radius: Part II. Internal fixation versus Ilizarov hybrid external fixation: Stability as assessed by cadaveric simulated motion testing

The in vitro stability of an Ilizarov hybrid external fixator was compared with that of a dorsal 3.5-mm AO T-plate in 8 unpaired, fresh-frozen upper extremities. A specially designed testing device that used computer-controlled pneumatic actuators was used to simulate active finger, wrist, and forearm motions by applying loads to relevant tendons. A comminuted extra-articular distal radius fracture was modelled using a dorsally based wedge osteotomy. Fracture stability was assessed using an electromagnetic tracking device to measure motion across the fracture site after randomized application of the plate and the hybrid fixator. During simulated finger and wrist motions with the forearm pronated or supinated, motion of the distal fragment with the hybrid fixator applied was comparable to or statistically less than with the AO plate applied. During simulated forearm rotation, the stability provided by the 2 fixation types was similar, although the plate allowed statistically less radial-ulnar deviation of the fragment. In this model of a 2-part extra-articular distal radius fracture, the clinically meaningful stability of the Ilizarov hybrid external fixator was comparable to that of the dorsal AO plate.     

An Assessment Tool for Predicting Fracture Risk in Postmenopausal Women

Due to the magnitude of the morbidity and mortality associated with untreated osteoporosis, it is essential that high-risk individuals be identified so that they can receive appropriate evaluation and treatment. The objective of this investigation was to develop a simple clinical assessment tool based on a small number of risk factors that could be used by women or their clinicians to assess their risk of fractures. Using data from the Study of Osteoporotic Fractures (SOF), a total of 7782 women age 65 years and older with bone mineral density (BMD) measurements and baseline risk factors were included in the analysis. A model with and without BMD T-scores was developed by identifying variables that could be easily assessed in either clinical practice or by self-administration. The assessment tool, called the FRACTURE Index, is comprised of a set of seven variables that include age, BMD T-score, fracture after age 50 years, maternal hip fracture after age 50, weight less than or equal to 125 pounds (57 kg), smoking status, and use of arms to stand up from a chair. The FRACTURE Index was shown to be predictive of hip fracture, as well as vertebral and nonvertebral fractures. In addition, this index was validated using the EPIDOS fracture study. The FRACTURE Index can be used either with or without BMD testing by older postmenopausal women or their clinicians to assess the 5-year risk of hip and other osteoporotic fractures, and could be useful in helping to determine the need for further evaluation and treatment of these women. Received: 7 November 2000 / Accepted: 23 May 2001     

Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School

AIM: To describe the complications related to cataract surgery performed by phacoemulsification technique by third-year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior experience with extracapsular extraction. DESIGN: Retrospective, observational case series. METHODS: A retrospective chart review of 755 patients who underwent cataract surgery by third-year residents between July 2000 and June 2005 at the Institute of Ophthalmology and Visual Science was performed. Details of intraoperative complications (posterior capsular rupture, vitreous loss, subluxation of lens fragments into the vitreous, extracapsular cases converted to phacoemulsification, retinal detachment, vitreous haemorrhage and haemorrhagic choroidals) of the cases done by phacoemulsification technique were recorded. Results were analysed and compared with complication rates reported from other residency programmes and from experienced ophthalmologists. RESULTS: Of 755 cataract surgeries, 719 were performed using phacoemulsification technique. Posterior capsule disruption occurred in 48 (6.7%), vitreous loss in 39 (5.4%) and dislocated lenticular fragments in 7 (1.0%) of 719 cases that underwent phacoemulsification technique. Subsequent pars plana lensectomy was required in 5 (0.7%) cases; 1 case (0.1%) experienced retinal detachment and haemorrhagic choroidal detachment. CONCLUSION: The residents can perform phacoemulsification well with a very low complication rate, without prior training with extracapsular cataract extraction technique.     

The Constipation Severity Instrument: A Validated Measure

Purpose This study was designed to develop and test the validity and reliability of the Constipation Severity Instrument. Methods Scale development was conducted in two stages: 1) 74 items were generated through a literature review and focus groups of constipated patients and medical providers; and 2) a preliminary instrument was administered to 191 constipated patients and 103 healthy volunteers. Test-retest reliability of the constipated group was assessed (N = 90). Content, convergent, divergent, and discriminant validity were evaluated by using other validated measures by performing one-way analysis of variance and Pearson correlations. Results Exploratory and confirmatory factor analysis revealed three subscales: obstructive defecation, colonic inertia, and pain. Internal consistency (α = 0.88–0.91) and test-retest reliability (intraclass correlation coefficients = 0.84–0.91) were high for all subscales. Constipated patients were grouped by Rome II criteria: functional constipation (22 percent), pelvic floor dyssynergia (15 percent), constipation predominant irritable bowel syndrome (23 percent), and no specific criteria (40 percent). Those with constipation predominant irritable bowel syndrome or pelvic floor dyssynergia scored higher on the Obstructive Defecation and Colonic Inertia subscales than those with functional constipation or no specific criteria (P = 0.001–0.058). Subjects with functional constipation had much lower scores on the pain subscale than constipation predominant irritable bowel syndrome, functional constipation, or no specific criteria (P < 0.009).The Constipation Severity Instrument subscale and total score correlated very highly with the subscales and total score of the Patient Assessment of Constipation Symptom measure. The Constipation Severity Instrument subscales discriminated well between constipated patients and healthy volunteers (P < 0.001) and demonstrated excellent divergent validity. Higher Constipation Severity Instrument scores inversely correlated with general quality of life. Conclusions The Constipation Severity Instrument is a reliable and valid instrument for assessing constipated patients. Administration of the Constipation Severity Instrument to other constipated patients will further validate its use. Supported by the University of California San Francisco Hellman Family Award for Early Career Faculty. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007. Reprints are not available.     

Pilot Validation of a New Wireless Patch System as an Ambulatory,Noninvasive Tool That Measures Gut Myoelectrical Signals: Physiologic and Disease Correlations

Digestive Diseases and Sciences - Limited means exist to assess gastrointestinal activity in a noninvasive, objective way that is highly predictive of underlying motility disorders. The aim of this...     

Kinesio Tape and Shoulder-Joint Position Sense

Context

Joint position sense (JPS) is a key neuromuscular factor for developing and maintaining control of muscles around a joint. It is important when performing specialized tasks, especially at the shoulder. No researchers have studied how Kinesio Tape (KT) application affects JPS.

Objective

To investigate the effects of KT application and no tape on shoulder JPS at increasing shoulder elevations in athletes.

Design

Cross-sectional study.

Setting

University laboratory.

Patients or Other Participants

A total of 27 healthy athletes who did not participate in overhead sports (age = 20.44 ± 1.05 years, height = 175.02 ± 11.67 cm, mass = 70.74 ± 9.65 kg) with no previous pathologic shoulder conditions volunteered for the study. All participants were from 1 university.

Intervention(s)

Shoulder JPS was assessed at increasing elevations with and without KT application. Participants attempted to actively replicate 3 target positions with and without the KT and without visual guidance.

Main Outcome Measure(s)

We examined absolute and variable repositioning errors at increasing shoulder-elevation levels with and without KT application.

Results

Data revealed an interaction between tape and position for absolute error (F_2,52 = 4.07, P = .02); simple effects revealed an increase in error, with KT demonstrating a 2.65° increase in error at 90° of elevation compared with no tape (t₂₆ = 2.65, P = .01). The effect size was medium (ω² = .135). Variable error showed no interaction of tape and position (F_2,52 = .709, P = .50). Further analysis of simple effects was not needed. However, we still calculated the effect size and observed small effect sizes for tape (ω² = .002), position (ω² = .072), and tape by position (ω² = .027).

Conclusions

At 90° of elevation, shoulder JPS was impaired by the application of KT.Key Words: proprioception, taping, shoulder, neuromuscular, rehabilitation

Key Points

• Short-term Kinesio-Tape application to the shoulder reduced joint position sense acuity at 90° of elevation but did not affect JPS at 50° or 110°.
• Kinesio Tape may negatively affect shoulder joint position sense, especially as the shoulder position approaches 90° of elevation.

Athletes, especially those who participate in overhead activities, place much stress on their shoulder joints during activity, so they are at increased risk for developing shoulder injuries. Given that the shoulder allows for much mobility, stability is sacrificed; therefore, the shoulder is considered one of the most vulnerable joints in the body.¹ Numerous factors within the shoulder complex contribute to this lack of stability, including limited glenohumeral bony congruity, limited ligamentous support, and joint capsular laxity. However, stability is still needed to perform precise tasks for activities of daily living or sporting events.² Factors that provide stability to the joint include support of surrounding muscles, the intra-articular pressure of the joint, and the integration of the central nervous system with peripheral mechanoreceptors, a sensory system termed proprioception.³Proprioception is a specialized sensory capability that includes a person''s sense of movement, joint position, and tension.⁴ Joint position sense (JPS) consists of both static and dynamic abilities to detect the position of the joint in space.⁵ Researchers⁶ have suggested that increased muscle activation leads to increased afferent feedback from muscle spindles, resulting in enhanced JPS. The JPS is enabled via sensory feedback from peripheral receptors in sites such as skin, muscles, ligaments, and tendons that the central nervous system processes, and JPS is a key factor for controlling joint movement.⁴Investigators⁷ have observed that shoulder JPS improves as the shoulder-elevation angle approaches 90°. These results may indicate that as the elevation angle increases, the amount of gravitational torque increases, which increases muscle activation. Suprak et al⁷ hypothesized that this increase in muscle activation and the increase in activity from the musculotendinous mechanoreceptors contributed to improved JPS. Suprak et al⁸ supported these results, demonstrating that as resistance increased (via wrist weights) at a given shoulder position, shoulder repositioning error decreased. However, other authors⁵ have suggested that this effect of elevation on shoulder JPS may also be related to intrinsic factors of joint position, such as muscle-spindle and cutaneous-receptor activation.Researchers⁹ believe the application of tape may improve proprioceptive abilities by increasing stimulation of cutaneous mechanoreceptors within the skin, which increases pressure on underlying muscles and, therefore, affects the joint''s proprioception. Robbins et al¹⁰ reported that the application of ankle tape enhanced JPS when a person was on a surface with a slope greater than 10°. Traditional athletic tape can constrict joint range of motion (ROM) but can be a beneficial preventive measure; however, the integrity of the tape is not maintained for extended periods because of such extraneous factors as sweat, lotion, dirt, and hair. Therefore, the development of more specialized tapes that have longer-lasting effects and limit impairments has advanced in recent years. Effective tape application can last up to 1 to 2 days, and some of these specialty tapes can resist extraneous factors.Kinesio Tape (KT; Kinesio Precut, Albuquerque, NM) is a specialized elastic tape that mimics the elasticity of skeletal muscle as it stretches up to 140% of its original length, allowing for no ROM restrictions.^2,11 According to KT creator Kenzo Kase, it can strengthen an already weakened muscle by correcting the muscle''s function, improving circulation of blood and lymph, decreasing pain, repositioning subluxed joints, and improving joint position and kinesthetic awareness.¹² These effects allow the fascia and muscle to return to normal function by relieving the buildup of abnormal muscle tension and can improve joint function by increasing sensory mechanisms.^11,13The constant shear force produced by KT application against the skin leads to increased stimulation of the cutaneous mechanoreceptors.¹⁴ Murray¹⁴ observed an increase in electromyographic measurements after the application of KT to the thigh. He hypothesized that this increased mechanoreceptor activity would result in increased JPS acuity. His research also supported the claim that KT application to the thigh can improve active ROM of a joint compared with no tape.¹⁴ Murray¹⁴ asserted that KT can positively affect proprioception. However, other investigators¹¹ have demonstrated no effect of KT application on the ability to actively replicate a passive ankle position. This discrepancy in observations warrants further investigation given the popularity of KT use in athletics and rehabilitation. No one has examined how KT affects shoulder JPS. Therefore, the purpose of our study was to assess the effects of KT application on shoulder JPS at increasing shoulder elevations in athletes. We hypothesized that the application of KT (1) would result in enhanced shoulder JPS at all elevation angles tested and (2) would not alter the effect of increased JPS acuity with elevation.     

The development of an instrument to evaluate interprofessional student team competency

Healthcare institutions, accreditation agencies for higher learning, and organizations such as the National Academy of Medicine in the United States, support interprofessional education (IPE) opportunities. However, incorporating IPE opportunities into academic settings remains difficult. One challenge is assessing IPE learning and practice outcomes, especially at the level of student performance to ensure graduates are “collaboration-ready”. The Creighton-Interprofessional Collaborative Evaluation (C-ICE) instrument was developed to address the need for a measurement tool for interprofessional student team performance. Four interprofessional competency domains provide the framework for the C-ICE instrument. Twenty-six items were identified as essential to include in the C-ICE instrument. This instrument was found to be both a reliable and a valid instrument to measure interprofessional interactions of student teams. Inter-rater reliability as measured by Krippendorff’s nominal alpha (nKALPHA) ranged from .558 to .887; with four of the five independent assessments achieving nKALPHA greater than or equal to 0.796. The findings indicated that the instrument is understandable (Gwet’s alpha coefficient (gAC) 0.63), comprehensive (gAC = 0.62), useful and applicable (gAC = 0.54) in a variety of educational settings. The C-ICE instrument provides educators a comprehensive evaluation tool for assessing student team behaviors, skills, and performance.     

Changing Gender Norms and Reducing Intimate Partner Violence: Results From a Quasi-Experimental Intervention Study With Young Men in Ethiopia

Objectives. We assessed the effects of a community-based project in Ethiopia that worked with young men to promote gender-equitable norms and reductions in intimate partner violence (IPV).Methods. A quasi-experimental design was used to assign young Ethiopian men 15 to 24 years of age (809 participants were surveyed at baseline in 2008) to an intervention involving community engagement (CE) activities in combination with interactive group education (GE) sessions promoting gender-equitable norms and violence prevention, an intervention involving CE activities alone, or a comparison group.Results. Participants in the GE + CE intervention were twice as likely (P < .01) as those in the comparison group to show increased support for gender-equitable norms between the baseline and end-line points. Also, the percentage of GE + CE participants who reported IPV toward their partner in the preceding 6 months decreased from 53% to 38% between baseline and end line, and the percentage in the CE-only group decreased from 60% to 37%; changes were negligible in the comparison group.Conclusions. Promoting gender equity is an important strategy to reduce IPV.In addition to being a human rights violation, gender-based violence (GBV) is a widespread public health issue with numerous negative health consequences. GBV, including intimate partner violence (IPV), causes injury and death and decreases survivors’ use of health services.1,2 For example, violence and fear of violence can be barriers to effective HIV prevention, care, and treatment programs. IPV has also been associated with a lack of contraception use and HIV acquisition.3,4 Consequently, addressing and reducing GBV is an explicit component of the President’s Emergency Plan for AIDS Relief.5The number of women and girls affected by IPV is enormous. A seminal study conducted in 10 different countries demonstrated that between 15% and 71% of women of reproductive age had experienced physical or sexual IPV (and estimated that 30 % of women globally had experienced IPV).6,7 The highest rates of IPV were those among Ethiopian women: 53.7% had experienced IPV within the 12 months preceding the interview and 70.9 % over their lifetime. In addition, HIV prevalence in Ethiopia is higher among women (1.9 %) than men (1.0 %).8Certain gender norms—or social expectations about men’s and women’s appropriate roles, rights, and responsibilities—have been shown to be associated with the risk of IPV as well as the risk of HIV and other sexually transmitted infections (STIs).9–12 For example, 45% of men and 68% of women taking part in the 2011 Ethiopia Demographic and Health Survey reported that wife beating is justified for at least 1 reason.8Over the past decade, a series of programs attempting to address inequitable gender norms have been implemented across the globe; many have emphasized the importance of engaging boys and men in this process.13,14 A growing body of work has demonstrated that these gender-focused interventions can lead to reductions in violence and to other positive health outcomes (e.g., increased contraception or condom use).9,15–19 However, rigorous evaluations of only a small number of these programs have been documented in the scientific literature, and recent literature reviews have revealed that existing evaluations have various limitations, including a lack of comparison groups and standardized or validated measures, no exploration of effects across types of IPV, inadequate follow-up rates, and limited use of theoretical frameworks.16,17To help address these gaps, we describe the results of a theoretically grounded, quasi-experimental intervention study of a community-based project in Ethiopia, the Male Norms Initiative, that worked with young men to promote gender-equitable norms and reductions in IPV. Our goal was to assess the effects of the intervention using standardized measures of violence and gender norms.The 2 main intervention components were interactive group education and community mobilization and engagement activities aimed at raising awareness and promoting community dialogue. The interventions focused on promoting critical reflection regarding common gender norms that might increase the risk of violence or HIV and other STIs (e.g., support for multiple sexual partners and acceptance of partner violence). Through this reflection, the participants were able to identify the potential negative outcomes of enacting these norms and the potential positive aspects of more gender-equitable behavior.In addition, the activities engaged the wider community in supporting a shift in specific harmful norms. Engaging Boys and Men in Gender Transformation, a manual based on EngenderHealth and Promundo’s gender-transformative programming, was used to facilitate this process.20 Hiwot Ethiopia, a nongovernmental organization, led the implementation of the project with technical support from EngenderHealth. PATH led the evaluation in collaboration with Miz-Hasab, an Ethiopia-based research institute.Both intervention groups participated in community engagement (CE) activities, which took place over a 6-month period from June to November 2008. Beginning with a march on International Father’s Day, these activities involved entire communities and included distribution of monthly newsletters and leaflets (approximately 15 000 in total), music and drama skits reaching 8700 people, monthly community workshop meetings, and distribution of more than 1000 condoms.A second component of the intervention—group education (GE) activities—took place over 4 months at youth centers during regularly scheduled youth group hours, usually on weekends. The activities included role plays, group discussions, and personal reflection. Sessions enrolling about 20 participants were facilitated by 2 or 3 peer educators each, with oversight from a master trainer. In total, 8 sessions 2 or 3 hours in duration were conducted, drawing on 19 activities from the manual.This intervention and evaluation design was informed by the theory of gender and power, a social structural theory that addresses environmental and social issues relating to gender dynamics, particularly sexual division of labor, sexual division of power, and the structure of cathexis (which is similar to the concept of gender norms).21 According to this theory, various negative health and other outcomes stem from the socialization of women to be sexually passive, women’s economic reliance on men, and abusive partnerships. The theory affirms—as does the empirical evidence provided in the introduction—that addressing gender norms is a core factor in reducing both IPV and related health risks such as HIV and other STIs.22