Omega-3 fatty acids effect on wound healing

Physiological events in the initial inflammatory stage of cutaneous wound healing influence subsequent stages. Proinflammatory cytokines coordinate molecular and cellular processes during the inflammatory stage. Polyunsaturated fatty acids (PUFA) alter proinflammatory cytokine production, but how this phenomenon specifically influences wound healing is not clearly understood. In the present study, effects of marine‐derived ω‐3 eicosapentaenoic and docosahexaenoic PUFA on proinflammatory cytokines in wound serum and time to complete healing in healthy, human skin were evaluated. We compared plasma fatty acid levels in two groups (N=30) at baseline and after 4 weeks of eicosapentaenoic/docosahexaenoic PUFA supplements (active) or placebo (control). Eight small blisters on participants' forearms were created. Proinflammatory cytokines interleukin‐1β (IL‐1β), IL‐6, and tumor necrosis factor‐α were quantified in blister fluid at 5 and 24 hours after creation. Wound area was calculated daily. Eicosapentaenoic and docosahexaenoic plasma fatty acid levels were significantly higher in the active group. Additionally, we found significantly higher IL‐1β levels in blister fluid in the active group and time to complete wound closure was somewhat longer. These results suggest that eicosapentaenoic and docosahexaenoic PUFA may increase proinflammatory cytokine production at wound sites and thus, depending on the clinical context, have noninvasive, therapeutic potential to affect cutaneous wound healing.     

Impact of the voluntary withdrawal of over‐the‐counter cough and cold medications on pediatric ingestions reported to poison centers

Purpose

To assess the impact of a voluntary withdrawal of over‐the‐counter cough and cold medications (OTC CCMs) labeled for children under age 2 years on pediatric ingestions reported to the American Association of Poison Control Centers.

Methods

Trend analysis of OTC CCMs ingestions in children under the age 6 years resulting from therapeutic errors or unintentional poisonings for 27 months before (pre‐) and 15 months after (post‐) the October 2007 voluntary withdrawal was conducted. The rates and outcome severity were examined.

Results

The mean annual rate of therapeutic errors involving OTC CCMs post‐withdrawal, in children less than 2‐years of age, 45.2/100 000 (95%CI 30.7–66.6) was 54% of the rate pre‐withdrawal, 83.8/100 000 (95%CI 67.6–104.0). The decrease was statistically significant p < 0.02. In this age group, there was no difference in the frequency of severe outcomes resulting from therapeutic errors post‐withdrawal. There was no significant difference in unintentional poisoning rates post‐withdrawal 82.1/100 000 (66.0–102.2) vs. pre‐withdrawal 98.3/100 000 (84.4–114.3) (p < 0.21) in children less than 2‐years of age. There were no significant reductions in rates of therapeutic errors and unintentional poisonings in children ages 2–5 years, who were not targeted by the withdrawal.

Conclusions

A significant decrease in annual rates of therapeutic errors in children under 2‐years reported to Poison Centers followed the voluntary withdrawal of OTC CCMs for children under age 2‐years. Concerns that withdrawal of pediatric medications would paradoxically increase poisonings from parents giving products intended for older age groups to young children are not supported. Copyright © 2010 John Wiley & Sons, Ltd.     

Case Management Models for Persons Who Are Homeless and Mentally Ill: The ACCESS Demonstration Project

Persons who are homeless and mentally illpresent unique challenges to service providers and humanservice systems. In vivo case management approaches suchas assertive community treatment (ACT) have shown promise in engaging this population. This paperexplores case management models employed within theACCESS program, a five year, 18-site demonstrationprogram enriching services for homeless persons with serious mental illness. We describe theimplementation of case management with ACCESS programsand determine the extent of variation across sites usinga measure of fidelity to ACT. While programs reported using four models, much similarity was foundamong programs on multiple dimensions.     

A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: A critical appraisal

The aim of this paper is to identify the major barriers hindering adequate pain management and critically review interventions aiming to overcome them. We searched relevant literature on PubMed published between January 1986 and April 2007. The most frequently mentioned barriers for both patients and professionals were knowledge deficits, inadequate pain assessment and misconceptions regarding pain. Four interventions were identified: patient education, professional education, pain assessment and pain consultation. These interventions were never combined in multidisciplinary study protocols. Most RCTs included small groups of patients and reported no power analysis. Studies on professional education and pain assessment did not evaluate patients’ outcomes. In 5 of 11 RCTs on patient education, pain intensity decreased statistically significantly. In two RCTs on pain consultation, patients’ pain decreased statistically significantly, although the adequacy of pain treatment did not change. In conclusion, international guidelines on multidisciplinary interventions in pain management are partly substantiated by clinical trials.