title: Using honey to heal diabetic foot ulcers

authors: Molan, Peter C.

subjects: biology

abstract: Diabetic ulcers seem to be arrested in the inflammatory/proliferative stage of the healing process, allowing infection and inflammation to preclude healing. Antibiotic-resistant bacteria have become a major cause of infections, including diabetic foot infections. It is proposed here that the modern developments of an ancient and traditional treatment for wounds, dressing them with honey, provide the solution to the problem of getting diabetic ulcers to move on from the arrested state of healing. Honeys selected to have a high level of antibacterial activity have been shown to be very effective against antibiotic-resistant strains of bacteria in laboratory and clinical studies. The potent anti-inflammatory action of honey is also likely to play an important part in overcoming the impediment to healing that inflammation causes in diabetic ulcers, as is the antioxidant activity of honey. The action of honey in promotion of tissue regeneration through stimulation of angiogenesis and the growth of fibroblasts and epithelial cells, and its insulin-mimetic effect, would also be of benefit in stimulating the healing of diabetic ulcers. The availability of honey-impregnated dressings which conveniently hold honey in place on ulcers has provided a means of rapidly debriding ulcers and removing the bacterial burden so that good healing rates can be achieved with neuropathic ulcers. With ischemic ulcers, where healing cannot occur because of lack of tissue viability, these honey dressings keep the ulcers clean and prevent infection occurring.

text: Using honey to heal diabetic foot ulcers Diabetic ulcers seem to be arrested in the inflammatory/proliferative stage of the healing process, allowing infection and inflammation to preclude healing. Antibiotic-resistant bacteria have become a major cause of infections, including diabetic foot infections. It is proposed here that the modern developments of an ancient and traditional treatment for wounds, dressing them with honey, provide the solution to the problem of getting diabetic ulcers to move on from the arrested state of healing. Honeys selected to have a high level of antibacterial activity have been shown to be very effective against antibiotic-resistant strains of bacteria in laboratory and clinical studies. The potent anti-inflammatory action of honey is also likely to play an important part in overcoming the impediment to healing that inflammation causes in diabetic ulcers, as is the antioxidant activity of honey. The action of honey in promotion of tissue regeneration through stimulation of angiogenesis and the growth of fibroblasts and epithelial cells, and its insulin-mimetic effect, would also be of benefit in stimulating the healing of diabetic ulcers. The availability of honey-impregnated dressings which conveniently hold honey in place on ulcers has provided a means of rapidly debriding ulcers and removing the bacterial burden so that good healing rates can be achieved with neuropathic ulcers. With ischemic ulcers, where healing cannot occur because of lack of tissue viability, these honey dressings keep the ulcers clean and prevent infection occurring.

year: 2008

title: Knowing when we get there: An investigation into measuring success in new health service interventions for older people in Te Whatu Ora – Waikato region

authors: Guy, Graham

subjects: Success

abstract: Background: Health services are dynamic and undergo significant and ongoing changes.  The delivery of services to older people are no different and in many ways the changes are more dramatic as a consequence of the ageing population.  Monitoring whether health services meet the needs of the individuals that they serve is important as without such knowledge, it is not possible to determine the success of the interventions.  This research explores what does success look like from an older person’s perspective, the health professionals delivering that care, through to operational and executive managers.
Objective:  To explore the concept of success within health services for older people at Te Whatu Ora – Waikato.
Participants: One-to-one interviews were held with stakeholders, from executive and operational management and operational health professionals (n=7); focus groups with needs assessor service coordinators (n=10) and home care support services (n=6); and patient surveys with older participants (n=67).
Methods: Mixed methods research involving interviews and focus groups with stakeholders and surveys with older people receiving services.  Interviews and focus groups were transcribed verbatim and later analysed using a general inductive method of enquiry to generate key themes.  Surveys were analysed with descriptive statistics.
Results: The strategic direction of the health services and anticipated outcomes were well communicated and widely consulted and consequently there appeared to be alignment of views from those health professionals involved.  All believed that they were making a difference and felt personally rewarded by the role that they do and the contributions they make to the community, population in their care and individual patients.  Measures of success focussed on the assessment of quality of life and wellbeing for the older person.  This contrasted with the consumer perspective, who generally reported dissatisfaction with the services they received and on the whole their current quality of life. 
Conclusions: The research showed that health services tended to focus on an acute response and hospital services dominated conversations.  There was little awareness of the need to assess the broader aspects of service delivery.

text: Knowing when we get there: An investigation into measuring success in new health service interventions for older people in Te Whatu Ora – Waikato region Background: Health services are dynamic and undergo significant and ongoing changes.  The delivery of services to older people are no different and in many ways the changes are more dramatic as a consequence of the ageing population.  Monitoring whether health services meet the needs of the individuals that they serve is important as without such knowledge, it is not possible to determine the success of the interventions.  This research explores what does success look like from an older person’s perspective, the health professionals delivering that care, through to operational and executive managers.
Objective:  To explore the concept of success within health services for older people at Te Whatu Ora – Waikato.
Participants: One-to-one interviews were held with stakeholders, from executive and operational management and operational health professionals (n=7); focus groups with needs assessor service coordinators (n=10) and home care support services (n=6); and patient surveys with older participants (n=67).
Methods: Mixed methods research involving interviews and focus groups with stakeholders and surveys with older people receiving services.  Interviews and focus groups were transcribed verbatim and later analysed using a general inductive method of enquiry to generate key themes.  Surveys were analysed with descriptive statistics.
Results: The strategic direction of the health services and anticipated outcomes were well communicated and widely consulted and consequently there appeared to be alignment of views from those health professionals involved.  All believed that they were making a difference and felt personally rewarded by the role that they do and the contributions they make to the community, population in their care and individual patients.  Measures of success focussed on the assessment of quality of life and wellbeing for the older person.  This contrasted with the consumer perspective, who generally reported dissatisfaction with the services they received and on the whole their current quality of life. 
Conclusions: The research showed that health services tended to focus on an acute response and hospital services dominated conversations.  There was little awareness of the need to assess the broader aspects of service delivery.

year: 2023

title: How differing methods of ascribing ethnicity and socio-economic status affect risk estimates for hospitalisation with infectious disease

authors: Hobbs, Mark R.

subjects: Ethnicity/race

abstract: Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.

text: How differing methods of ascribing ethnicity and socio-economic status affect risk estimates for hospitalisation with infectious disease Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.

year: 2019