The Theory of Planned Behaviour and dietary patterns: A systematic review and meta-analysis.

OBJECTIVE: Promoting adherence to healthy dietary patterns is a critical public health issue. Models of behaviour, such as the Theory of Planned Behaviour (TPB) allow programme designers to identify antecedents of dietary patterns and design effective interventions. The primary aim of this study was to examine the association between TPB variables and dietary patterns. METHODS: A systematic literature search was conducted to identify relevant studies. Random-effects meta-analysis was used to calculate average correlations. Meta-regression was used to test the impact of moderator variables. RESULTS: In total, 22 reports met the inclusion criteria. Attitudes had the strongest association with intention (r+=0.61) followed by perceived behavioural control (PBC, r+=0.46) and subjective norm (r+=0.35). The association between intention and behaviour was r+=0.47, and between PBC and behaviour r+=0.32. Moderator analyses revealed that younger participants had stronger PBC-behaviour associations than older participants had, and studies recording participants' perceptions of behaviour reported significantly higher intention-behaviour associations than did those using less subjective measures. CONCLUSIONS: TPB variables were found to have medium to large associations with both intention and behaviour that were robust to the influence of key moderators. Recommendations for future research include further examination of the moderation of TPB variables by age and gender and the use of more valid measures of eating behaviour.

Below-knee amputation through a joint-sparing proximal tibial replacement for recurrent tumour.

We report a case which highlights the progression of osteofibrous dysplasia to adamantinoma and questions whether intralesional curettage is the appropriate treatment. The role of a joint-sparing massive endoprosthesis using cortical fixation is demonstrated and we describe a unique biomedical design which resulted in the manufacture of an end cap to allow amputation through a custom-made proximal tibial replacement, rather than an above-knee amputation following recurrence.

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging.

OBJECTIVE: The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. DESIGN AND PATIENTS: Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. RESULTS: Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. CONCLUSION: Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in differentiating soft tissue from osseous impingement. Synovitic lesions in two control patients suggest that abnormal antero-lateral soft tissue does not necessarily imply the presence of symptomatic ALI. Synovitic lesions in excess of 10 mm were associated with symptoms. Ultrasound will not demonstrate osteocartilaginous lesions or stress fractures and may overlook some loose bodies. Ultrasound findings together with clinical correlation can be used to direct arthroscopic examination and surgical debridement.

Preparation for the next major incident: are we ready?

BACKGROUND: In 1996, Carley and Mackway-Jones examined British hospital's readiness for a major incident. In the light of recent terrorist events in London, our group has re-visited the issue and conducted a telephone survey of relevant parties to investigate whether the situation has changed almost 10 years on. MATERIALS AND METHODS: A proforma was devised, and registrars in anaesthesia, accident and emergency medicine, general surgery and trauma and orthopaedics were telephoned in trauma units across the UK and questioned about their readiness to respond to a major incident. Major incident co-ordinators for each of the units were contacted, and their planning, readiness, training opportunities, and recent rehearsals were assessed. RESULTS: A total of 179 registrars were contacted in 34 different units throughout Britain. One hundred and forty four responses were obtained. Sixty eight registrars (47%) had not read any of their hospitals major incident plan. Only 77 (54%) of the registrars questioned felt confident in the knowledge of their specific role during a major incident. Major incident co-ordinators were contacted at 34 hospitals, and 17 responses obtained. It was remarkably difficult to achieve even that level of response. Rehearsal of major incident plans varied widely between hospitals with 82% of hospitals having practised within the past five years but only 35% were planning for a rehearsal in the next twelve months. 25% of hospitals that responded did not hold any teaching on major incident planning at their introduction sessions for junior and middle grade doctors. Limitations to improvement of major incident planning included: lack of funds, lack of a designated full-time major incident co-ordinator, and lack of technology. There was no significant difference between units within London and those in other regions. DISCUSSION: Preparedness for major incidents in the UK remains poor 10 years after Carley and Mackway-Jones examined the issue. Effective major incident plans require forethought, organisation, briefing of relevant staff and regular rehearsal. Increased resources should be provided for this at a local level and more regular rehearsals undertaken to ensure our preparedness for future major incidents.

Mitoxantrone in refractory nonHodgkin's lymphoma. A Southwest Oncology Group study.

A phase II study of mitoxantrone in nonHodgkin's lymphoma was conducted by the Southwest Oncology Group between July 1981 and May 1982. The study involved 37 patients with histologically proven nonHodgkin's lymphoma, who were not eligible for higher priority protocols but had clearly measurable disease. Patients received mitoxantrone, 12 mg/m2 at intervals of 3 weeks, with a 10% increase in dose in the absence of myelosuppression and a 17% reduction for a WBC of less than 2 X 10(9) cells/L or a platelet count of less than 50 X 10(9)/L. The median number of previous regimens was three. Doxorubicin, in a median dose of 242 mg/m2 (range 12 to 650 mg/m2) had been previously given to 34 of the 37 patients. The Pathology Panel for Lymphoma Clinical Studies reviewed 31 (84%) of the lymphomas. Four of the ten follicular, small cleaved cell lymphomas responded compared with one of nine diffuse, large cell lymphomas. The median duration of response was 231 days. A median of two doses of mitoxantrone (range 1 to 18) was given. The median WBC nadir was 5.1 X 10(9)/L (range 04. to 9.4 X 10(9)/L), and the median lowest WBC for all doses was 2.4 X 10(9)/L (range 0.4 to 16 X 10(9)/L). Among 17 patients with a first WBC nadir of less than 3 X 10(9)/L, there were three partial responses compared with four responses (one complete, three partial) from nine patients with a WBC over 3 X 10(9)/L. There were seven responses (one complete, six partial) among 23 patients who had received up to three previous regimens, whereas only two of 14 patients receiving more than three previous regimens responded (one complete, one partial response). The response rate was independent of the previous dose of doxorubicin with five responses out of 23 patients who received a total dose of less than 300 mg/m2 and four responses out of 14 patients who received greater than 300 mg/m2. These data are compatible with the hypothesis that mitoxantrone alone is active against previously treated low-grade lymphomas and that the response rate is independent of the total dose of prior doxorubicin received and the degree of myelosuppression. Mitoxantrone may not be cross resistant with doxorubicin.