Investigating the use of the neutropenic diet: a survey of U.K. dietitians.

BACKGROUND: Patients with chemotherapy-induced neutropenia are at increased risk of infection. Historically, dietary restrictions commonly referred to as 'clean', 'low bacteria', 'low-microbial' or 'neutropenic' diets have been prescribed to reduce the risk of foodborne infection. Although research does not support their effectiveness, they continue to be used in clinical practice. The present study aimed to investigate the use of dietary restrictions in patients with cancer in the UK by surveying registered dietitians (RDs). METHODS: An online questionnaire was distributed to 573 RDs via local and specialist interest groups of the British Dietetic Association. RESULTS: One hundred and ten questionnaires were returned. Of these, 67.8% of RDs prescribed dietary restrictions to patients, with 'neutropenic diet' being the most commonly used term. Specialist oncology or haematology RDs were more likely to use the diet than nonspecialist RDs (P < 0.005). The variety of foods restricted varied greatly and was often contradicting. Unpasteurised dairy products and raw or lightly cooked meat or fish were most commonly restricted. Less than half (43.6%) of RDs had a policy in place for the use of neutropenic diets, with specialist oncology and haematology RDs more likely to report this (P < 0.005). CONCLUSIONS: Neutropenic dietary advice provided by dietitians in the UK varies greatly. Further high-quality research is required to create an evidence base from which national clinical guidelines can be formed.

Open reduction and internal fixation of posterior wall fractures of the acetabulum.

The results of 94 patients with posterior wall fractures of the acetabulum associated with hip instability treated within 3 weeks of injury by open reduction and internal fixation were reviewed. Patients were followed up for an average of 3.5 years (range, 1-13 years). Fracture reductions were graded as anatomic (0-1 mm displacement) in 92 patients and imperfect (2-3 mm displacement) in two patients, as determined by plain radiography. However, postoperative computed tomography scans obtained in 59 patients revealed incongruency of more than 2 mm in six patients and fracture gaps of 2 mm or more in 44 patients. Complications included deep wound infection (one patient), deep vein thrombosis, (seven patients), and revision surgery to redirect an errant screw (one patient). Clinical outcome was graded as excellent in 34 patients (36%), good in 49 (52%), fair in two (2%), and poor in nine (10%). Radiographic results were excellent in 79 hips (84%), good in four (4%), fair in two (2%), and poor in nine (10%). There was a strong association between clinical outcome and radiographic grade. Variables identified as risk factors for an unsatisfactory result included age greater than 55 years, a delay greater than 24 hours from the time of injury for reduction of a hip dislocation, a residual fracture gap greater than 1 cm, and severe intraarticular comminution. The apparent disparity between the accuracy of surgical fracture reduction, as determined by plain radiographs obtained postoperatively, and clinical outcome is explained only partially by the limitations of plain radiography. Other variables are involved, many of which are under the surgeon's control but some are not. As is the case with other acetabular fracture types, the best results are predicated on anatomic fracture reduction.

Cardiac-locomotor coupling while finger tapping: Part II. A cross-over control study.

Cardiac-locomotor coupling (CLC) has been reported by us while people finger tap at cadences natural to them. Since then, we have developed a simple cross-over control strategy in which the heart rate of one subject is related to the finger-tapping rate of another. Of the 20 normal subjects previously studied while tapping a telegraph key at a comfortable rate for 10 min., reevaluation of their data showed that 9 (45%) and 4 (20%) of them, under test and control conditions, respectively, appeared to couple at a single-digit integer ratio. Neither the incidence nor the intensity of apparent CLC under the two conditions was significantly different. Raster plots of the most tightly related rates gave no evidence of phase locking. These results have two implications. First, previously published reports on CLC (and other entrainment phenomena) should be interpreted with caution, and cross-over controls should be considered in future research. Second, the absence of CLC during finger tapping suggests that CLC may only be functionally significant during exercise of large muscle groups (e.g., by minimization of cardiac afterload) or when impact-loading occurs (e.g., by enhancing cardiac ventricular emptying.

Cardiac-locomotor coupling while finger tapping.

Coupling between cardiac and locomotor rhythms has been identified while people walk, run, hop and cycle at cadences natural to them. To test the hypothesis that cardiac-locomotor coupling occurs during finger tapping, we studied 20 normal subjects tapping a telegraph key at a comfortable rate for 10 min. 15 subjects (75%) coupled significantly at one or more single-digit integer ratio (heart/tapping rate), the most common of which was 1:2. Such coupling should be considered a potentially confounding variable when studying finger tapping in subjects with disease or medication affecting heart rate. Also, the identification of coupling during the repetitive activity of small upper-extremity muscles suggests that neither increases in cardiac load nor impact-loading, two suggested explanations for why coupling occurs, are necessary for the phenomenon.