Maggots, breastfeeding and bunions

No time to read the journals? Let Dr Nicolette Price guide you through the latest research.

Maggot treatment heals foot ulcers - J Wound Care 2007; 16: 379-83
This study from Egypt assessed the use of live, sterilised maggots in the management of diabetic foot ulcers unresponsive to conventional treatment.

Each participant received maggot debridement therapy for three days a week over 12 weeks, or until the ulcer was healed. Mean ulcer size was 23.5cm at start of therapy, decreasing to 2.3cm over a mean of eight weeks.

The authors found that maggots were a good alternative to antibiotics for treating infected diabetic foot ulcers, because they took the bacterial burden below the threshold to permit healing. They suggest the technique could be useful in developing countries, and should not be kept as a last resort, as an alternative to amputation.

I wonder if this treatment may become commonplace in the UK primary care setting, or is it something that most people would be too squeamish to consider?

Postpartum anxiety and breastfeeding - J Reprod Med 2007; 52: 689-9
Despite most mothers being aware that 'breast is best' many fail in their attempts to breastfeed.

This study assessed the relationship between anxiety and breastfeeding rates. It was designed to see whether women without prior breastfeeding experience and with high levels of anxiety would be less confident at breastfeeding, if women with high anxiety levels were more likely to supplement breast milk with formula, and whether high anxiety levels were associated with decreased lactation performance.

Prior experience and knowledge of breastfeeding were not significantly associated with anxiety, but high anxiety was associated with decreased confidence in breastfeeding and increased formula use.

Targeting women with high anxiety levels for intervention may improve their chances of successful breastfeeding.

Drinking at home and addiction risk in teenagers - Addiction 2007; 102: 1, 597-8
I have always wondered if teenagers could be prevented from developing irresponsible drinking habits by being introduced to sensible alcohol consumption by their parents.

This paper considers availability of alcohol at home, and parental provision of alcohol to 12- to 14-year-olds, living in Chicago. Previous studies have found that parental provision predisposes adolescents to alcohol use.

In this study, parental provision of alcohol and availability of alcohol at home were found to predispose to various alcohol- related behaviours and intention to drink in future.

This trial only considered young adolescents, from a mainly low socio-economic background, and further studies of different populations are needed.

Sandals undermine satisfaction with bunion surgery - The Foot 2007; 17: 119-25
I was interested to read that over 25 per cent of patients are dissatisfied with the outcome of their bunion surgery. The authors of this paper examined women's pre- and post-surgical characteristics, in an attempt to determine the factors affecting outcome and satisfaction.

There were 95 women in this study, which included interviews and questions about whether patients hoped to wear unsupportive footwear that would expose the operation site, such as strappy sandals, following surgery.

The most important factor found to influence satisfaction was the post-operative appearance of the foot (closely linked to the range of footwear the patients could wear).

Perhaps addressing these unrealistic expectations prior to surgery is advisable?

The Quick Study
  • Maggot debridement therapy is a good alternative to antibiotic treatment for diabetic foot ulcers.
  • Postpartum anxiety is associated with problems breastfeeding.
  • Alcohol in the home can predispose teenagers to alcohol-related behaviour.
  • Bunion surgery patient satisfaction is linked to shoe selection after surgery.

Dr Price is a medical examiner for the Department for Work and Pensions, a former GP in Hampshire and a member of our team who regularly reviews the journals.

Research of the week
Occupational therapy improves stroke outcome - BMJ 2007; 335: 922-4

This systemic review and meta-analysis of nine randomised controlled trials assessed the benefit to stroke patients of occupational therapy aimed at improving their ability to carry out activities of daily living.

It compared outcomes of occupational therapy with no routine intervention in 1,258 patients following stroke.

Those given occupational therapy were significantly more independent, with better performance on personal activities of daily living, such as dressing and washing.

They also had reduced rates of death or deterioration.

The number needed to treat to avoid one person deteriorating in personal activities of daily living was 11.

The authors suggest that focused occupational therapy should be made available to all stroke patients.

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