Factors influencing University of Papua New Guinea medical imaging science students considering rural radiography careers.

INTRODUCTION: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. METHODS: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. RESULTS: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. CONCLUSION: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional non-digital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study.

Antimicrobial susceptibility of clinical isolates of Campylobacter jejuni from New South Wales, Australia.

OBJECTIVES: The aim of this study was to investigate the prevalence of resistance to commonly used antimicrobials in Campylobacter jejuni isolates from clinical faecal samples in New South Wales (NSW), Australia. METHODS: A total of 117 C. jejuni isolates from human faecal samples from regional and metropolitan NSW were examined for antimicrobial resistance. RESULTS: Of the 117 isolates tested, 15.4% were resistant to ampicillin, 5.1% to tetracycline and 13.7% to ciprofloxacin. Most of the isolates were susceptible to erythromycin, except for three that showed intermediate resistance. Furthermore, 9.4% of isolates were resistant (or intermediate-resistant) to more than one antimicrobial agent. Isolates that were resistant to ampicillin and tetracycline harboured the blaOXA-61 and tet(O) genes, respectively. A mutation in the gyrA gene, resulting in the T86I substitution, was identified in the majority of ciprofloxacin-resistant isolates. CONCLUSION: The data obtained in the current study demonstrate that the majority of C. jejuni isolates evaluated were susceptible to one or more antimicrobials tested. Apart from three isolates that demonstrated intermediate resistance, all of the isolates were susceptible to erythromycin, which is the drug of choice for treating Campylobacter infections.

Prevalence of Campylobacter spp. in diarrhoea samples from patients in New South Wales, Australia.

Campylobacteriosis is a leading cause of bacterial foodborne disease in many industrialized countries including Australia. New South Wales (NSW) is the most populous state in Australia yet the lack of any Campylobacter species surveillance programs has led to a knowledge gap in the importance of these pathogens as causes of diarrhoea. The data collected in this study demonstrated a need for such programs. In this study, 400 human clinical fecal samples were collected from two NSW locations, Western Sydney and Wagga Wagga, and tested for the presence of Campylobacter spp. Patients were clustered by location, age and gender to assess Campylobacter spp. prevalence within these groups between the two regions. The frequency of Campylobacter spp. was higher in males compared to females in the age groups 0-4 and 5-14 years; 6.4% and 1.0%, and 8.2% and none, respectively. A second peak was noted in elderly adults compared with those in younger age groups. Based on the findings of the quantitative PCR analysis it was estimated that the age-adjusted prevalence of Campylobacter spp. associated diarrhoea was 159 cases per 100,000 persons. [Int Microbiol 2016; 19(1):33-37].

Prevalence of Campylobacter spp. in diarrhoea samples from patients in New South Wales, Australia

Campylobacteriosis is a leading cause of bacterial foodborne disease in many industrialized countries including Australia. New South Wales (NSW) is the most populous state in Australia yet the lack of any Campylobacter species surveillance programs has led to a knowledge gap in the importance of these pathogens as causes of diarrhoea. The data collected in this study demonstrated a need for such programs. In this study, 400 human clinical fecal samples were collected from two NSW locations, Western Sydney and Wagga Wagga, and tested for the presence of Campylobacter spp. Patients were clustered by location, age and gender to assess Campylobacter spp. prevalence within these groups between the two regions. The frequency of Campylobacter spp. was higher in males compared to females in the age groups 0-4 and 5-14 years; 6.4% and 1.0%, and 8.2% and none, respectively (P < 0.05). A second peak was noted in elderly adults compared with those in younger age groups. Based on the findings of the quantitative PCR analysis it was estimated that the age-adjusted prevalence of Campylobacter spp. associated diarrhoea was 159 cases per 100,000 persons (AU)

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Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines?

BACKGROUND: A common procedure within intensive care units (ICUs) is the suctioning of respiratory secretions in patients who have been intubated or who have undergone tracheostomy. Previous studies have shown a wide variation in suctioning practices, and although current evidence does not support the routine practice of normal saline instillation (NSI), anecdotally, this is believed to be a common practice. OBJECTIVE: To examine the suctioning practices of registered nurses (RNs) and registered respiratory therapists (RRTs) in six hospital ICUs in Ontario, with special attention devoted to the use of NSI. METHODS: A 24-question, self-administered survey was distributed to 180 participants (90 RNs and 90 RRTs) working in the ICU of six hospitals in Ontario. The survey addressed individual suctioning practices within the ICU. RESULTS: The survey response rate was 96%. There were many similarities between the RRT and RN groups, with both reporting high use of NSI. Both groups observed side effects following NSI with suctioning including decreased oxygen saturation, patient agitation and increased volume of secretions. A significant number of participants from both the RN and RRT groups were unaware of the existence of suctioning and/or NSI protocols in the ICU. Some respondents reported that they routinely suctioned mechanically ventilated patients rather than as required. CONCLUSION: RNs and RRTs continue to practice NSI despite evidence-based practice guidelines suggesting that this therapy may be detrimental to patients. Increased awareness of best practices with respect to endotracheal tube suction generally, and NSI specifically, should be the focus of professional education in both groups of ICU staff.

HISTORIQUE: À l'unité de soins intensifs (USI), on aspire souvent les sécrétions respiratoires des patients intubés ou trachéostomisés. Des études antérieures ont démontré une importante variation des pratiques d'aspiration, et même si les données actuelles n'appuient pas le rinçage systématique par solution physiologique normale (SPN), les données empiriques révèlent que leur utilisation serait courante. OBJECTIF: Examiner les pratiques d'aspiration des infirmières et des inhalothérapeutes à l'USI de six hôpitaux de l'Ontario et s'attarder particulièrement à l'utilisation de la SPN. MÉTHODOLOGIE: Les chercheurs ont distribué un sondage auto-administré de 24 questions à 180 participants (90 infirmières et 90 inalhothérapeutes) qui travaillaient à l'USI de six hôpitaux de l'Ontario. Ce sondage traitait des pratiques d'aspiration individuelles à l'USI. RÉSULTATS: Le taux de réponse au sondage s'élevait à 96 %. Les groupes d'infirmières et d'inhalothérapeutes présentaient surtout des similarités, tous deux déclarant une forte utilisation du SPN. Les deux groupes observaient des effets secondaires après l'administration du SPN, l'aspiration entraînant une diminution de la saturation en oxygène, une agitation des patients et une augmentation du volume de sécrétions. Bon nombre des participants des deux groupes ne connaissaient pas de protocoles d'aspiration ou d'utilisation de la SPN à l'USI. Certains répondants précisaient qu'ils procédaient à l'aspiration systématique des patients sous ventilation mécanique plutôt que d'attendre les besoins. CONCLUSION: Les infirmières et les inhalothérapeutes continuent d'administrer un SPN malgré les directives cliniques fondées sur des données probantes indiquant qu'elle peut être néfaste au patient. La formation professionnelle de ces deux groupes d'employés de l'USI devrait s'attarder sur les pratiques exemplaires en matière d'aspiration des sondes trachéales en général et de l'administration de SPN en particulier.

An experience of the introduction of a blood bank automation system (Ortho AutoVue Innova) in a regional acute hospital.

This paper reports on an evaluation of the introduction of a blood bank automation system (Ortho AutoVue(®) Innova) in a hospital blood bank by considering the performance and workflow as compared with manual methods. The turnaround time was found to be 45% faster than the manual method. The concordance rate was found to be 100% for both ABO/Rh(D) typing and antibody screening in both of the systems and there was no significant difference in detection sensitivity for clinically significant antibodies. The Ortho AutoVue(®) Innova automated blood banking system streamlined the routine pre-transfusion testing in hospital blood bank with high throughput, equivalent sensitivity and reliability as compared with conventional manual method.

Obesity and Healthcare Avoidance: A Systematic Review.

This review addresses the issue of health care avoidance and obesity. English language journal articles published between 1990 and 2012 that addressed the review question; "is being overweight or obese an unrecognized factor in healthcare avoidance?" were located using major databases. A modified JADAD scoring system was then used to assess papers. Ten papers were identified which directly addressed the review question. A positive relationship exists between obesity and healthcare avoidance. The major contributory factors were being female, have a diagnosed mental health problem and perceived or actual bias and discrimination by health professionals. The review also highlights the importance of the relationship between healthcare professionals and their patients, and the physical environment in which interactions occur as these may contribute to avoidance behaviors. Concern about obesity is rising and while there has been much discussion about strategies to reduce obesity this review highlights the need for thinking more broadly about the way in which overweight and obese individuals interact with preventative health strategies.

Use of complementary and alternative medical therapies (CAM) by patients attending a regional comprehensive cancer care centre.

BACKGROUND: This study determined the prevalence, types, and attitudes towards complementary and alternative medicines (CAMs) and therapies in cancer patients actively undergoing conventional cancer treatment at a regional cancer centre. METHODS: Data were collected using a self-administered questionnaire provided to adult cancer patients attending a comprehensive cancer care centre in regional Australia over a 3-month period. RESULTS: A participation rate of 89% was recorded over the 3-month period with 285 of 320 cancer patients providing completed data. Mean age was 64 years and slightly more females responded (56%). CAM types used by patients were classified according to US National Centre for Complementary and Alternative Medicine (NCCAM) domains. Overall prevalence of CAM use was 49% (140/285). The NCCAM domains of biologically-based treatments (mainly herbal and vitamin/mineral supplements) and manipulative/body-based methods (chiropractic and massage) were the most popular. Most patients (61%) who used CAM prior to cancer diagnosis continued complementary practices afterwards, and 33% of participants became first-time CAM users only after diagnosis. CAM use appeared to be associated with high patient acceptance and satisfaction which was not related to either cancer diagnosis or prognosis. Patients who used CAM were mainly willing to disclose (77%) this practice to their conventional health care providers. CONCLUSIONS: CAM use is prevalent in regional Australia. Collaborative integration of some CAM practices into conventional cancer care pathways (a process known as integrative oncology) is likely to have substantial patient support.

The prevalence and experience of Australian naturopaths and Western herbalists working within community pharmacies.

BACKGROUND: Naturopaths and Western herbal medicine (WHM) practitioners were surveyed to identify their extent, experience and roles within the community pharmacy setting and to explore their attitudes to integration of complementary medicine (CM) practitioners within the pharmacy setting. METHOD: Practising naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations. RESULTS: 479 practitioners participated. 24% of respondents (n=111) reported they had worked in community pharmacy, three-quarters for less than 5 years. Whilst in this role 74% conducted specialist CMs sales, 62% short customer consultations, 52% long consultations in a private room and 51% staff education. This was generally described as a positive learning experience and many appreciated the opportunity to utilise their specialist knowledge in the service of both customers and pharmacy staff. 14% (n=15) did not enjoy the experience of working in pharmacy at all and suggested pharmacist attitude largely influenced whether the experience was positive or not. Few practitioners were satisfied with the remuneration received. 44% of the total sample provided comment on the issue of integration into pharmacy, with the main concern being the perceived incommensurate paradigms of practice between pharmacy and naturopathy. Of the total sample, 38% reported that they would consider working as a practitioner in retail pharmacy in future. CONCLUSIONS: The level of integration of CM into pharmacy is extending beyond the mere stocking of supplements. Naturopaths and Western Herbalists are becoming utilised in pharmacies.

Antimicrobial and antioxidant activities of traditional Thai herbal remedies for aphthous ulcers.

Four medicinal plants (Quercus infectoria, Kaempferia galanga, Coptis chinensis and Glycyrrhiza uralensis) as well as one traditional Thai treatment for aphthous ulcers based on these four plants were tested for antimicrobial activity. MIC values for a range of bacteria and Candida albicans were determined, with both type strains and clinical isolates being used. Antioxidant activity was determined using the ABTS radical scavenging assay. Among the four plants, Q. infectoria showed antimicrobial activity against Staphylococcus aureus with an MIC of 0.41 mg/mL, while C. chinensis showed antifungal activity against C. albicans with an MIC of 6.25 mg/mL. Activity was also shown against a range of other organisms including Salmonella typhi, Serratia marcescens, Vibrio cholerae, Vibrio parahaemolyticus, Pseudomonas aeruginosa and Enterococcus faecalis. The antimicrobial activity of the traditional aphthous ulcer preparation (a powder) was comparable to that for the individual plant extracts, however, incorporation of the powder into a gel formulation resulted in the loss of almost all activity. All extracts, with the exception of K. galanga, also showed good antioxidant activity. This study supports the traditional use of these plants and suggests that they may also be useful in the treatment of other infections.

Is acupuncture an acceptable option in stroke rehabilitation? A survey of stroke patients.

OBJECTIVE: Stroke is a leading cause of morbidity and mortality and stroke survivors make up the largest group of patients in rehabilitation. These individuals also have one of the longest lengths of stay in rehabilitation. It has been suggested that acupuncture may be beneficial in post-stroke rehabilitation and in this study we examine how stroke patients value acupuncture and their perceptions of acupuncture as a rehabilitation treatment option. DESIGN AND SETTING: A questionnaire was distributed to individuals undergoing post-stroke rehabilitation at three rehabilitation centers attached to hospitals in Toronto, Canada. RESULTS: Two hundred and seventy-three individuals completed the questionnaire with the respondent group comprising mainly males (62%) over 65 years of age (68%). Overall 29% had used acupuncture with 16% receiving acupuncture treatment for stroke related conditions. Almost all respondents (98%) wanted to know more about acupuncture in stroke rehabilitation and 87% would consider acupuncture as a treatment option. Few (8%) reported that they had advanced level knowledge about acupuncture, with most reporting a basic (48%) or intermediate (33%) level which recognized that acupuncture used fine needles to produce a therapeutic response. Those with prior acupuncture experience expected to pay more for treatment. The main factors influencing decisions to use acupuncture were practitioner competency (84%), cost (65%) and sterilization concerns (40%). CONCLUSION: This study demonstrates that there is willingness by patients attending conventional hospital-based rehabilitation centers to consider acupuncture in stroke rehabilitation and that lack of knowledge about this treatment is not a barrier to use.

Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice.

BACKGROUND: Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products. METHODS: Pharmacy customers randomly selected from sixty large and small, metropolitan and rural pharmacies in three Australian states completed an anonymous, self administered questionnaire that had been pre-tested and validated. RESULTS: 1,121 customers participated (response rate 62%). 72% had used CMs within the previous 12 months, 61% used prescription medicines daily and 43% had used both concomitantly. Multivitamins, fish oils, vitamin C, glucosamine and probiotics were the five most popular CMs. 72% of people using CMs rated their products as 'very effective' or 'effective enough'. CMs were as frequently used by customers aged 60 years or older as younger customers (69% vs. 72%) although the pattern of use shifted with older age. Most customers (92%) thought pharmacists should provide safety information about CMs, 90% thought they should routinely check for interactions, 87% thought they should recommend effective CMs, 78% thought CMs should be recorded in customer's medication profile and 58% thought pharmacies stocking CMs should also employ a complementary medicine practitioner. Of those using CMs, 93% thought it important for pharmacists to be knowledgeable about CMs and 48% felt their pharmacist provides useful information about CMs. CONCLUSIONS: CMs are widely used by pharmacy customers of all ages who want pharmacists to be more involved in providing advice about these products.

Adverse reactions to complementary medicines: the Australian pharmacy experience.

OBJECTIVES: The primary aim was to determine the prevalence of adverse reactions to over-the-counter complementary medicines and their severity, as described by consumers. Secondary aims were to identify consumers' reporting behaviours and understanding of the AUST L designation on product labels. METHODS: An anonymous, self-administered survey was completed by randomly selected pharmacy customers at 60 community pharmacy locations between August 2008 and February 2009. KEY FINDINGS: Of the 1121 survey participants (response rate 62%), 72% had used a complementary medicine product in the previous 12 months, and 7% of this group (n = 55) reported having experienced an adverse reaction at some time. Of these, 71% described the reaction as mild and not requiring treatment, 22% as moderate and/or requiring advice from a healthcare professional and 7% (n = 4) described it as severe and requiring hospitalisation. If they were to report the reaction, it was most commonly to a medical practitioner. Most (88%) of complementary medicine consumers had never noticed the term 'AUST L'. CONCLUSIONS: Complementary medicines are widely used by pharmacy customers. Adverse reactions to these products are under-reported to healthcare authorities. Most adverse reactions are mild and serious reactions are rare. Customers have little awareness of the designation AUST L.

Effect of acupuncture on induction of labor.

OBJECTIVE: The objective of this study is to review the existing scientific evidence on the potential role of acupuncture on induction of labor during pregnancy. DESIGN: The Medline, EMBASE, Cochrane Central Register of Controlled Trials, AMED (Allied and Complementary Medicine), and NCCAM (The National Center for Complementary and Alternative Medicine) databases were searched to identify relevant monographs from 1970 to 2008. INCLUSION CRITERIA: These criteria included all available human acupuncture studies on pregnant women carrying a viable fetus due for third trimester induction of labor. EXCLUSION CRITERIA: These criteria included studies not meeting the inclusion criteria, in languages other than English, or animal studies. RESULTS: Ten (10) studies on labor induction were identified. The duration of labor as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labor induction by acupuncture treatment. However, because two randomized controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. Furthermore, although the relationship between cervical ripening and interleukin-8 (IL-8), prostaglandin F(2alpha) (PGF(2alpha)), and beta-endorphin is well documented in the literature, there is no evidence to suggest that acupuncture alters these mediators. Serum levels of IL8, beta-endorphin, and PGF(2alpha) were not found to be significantly influenced by acupuncture. CONCLUSIONS: Although the definitive role of acupuncture in inducing labor is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labor induction. Further randomized clinical trials are needed to investigate this further.

Complementary and alternative medicine and the search for knowledge by conventional health care practitioners.

The use of complementary and alternative medicines (CAM) is growing rapidly within the western world and the nexus with conventional health care services is expanding. Many nurses and other conventional health care providers are not only using CAM themselves but see many of their clients using these medicines and therapies. The attitudes to CAM can influence client satisfaction and client use of different therapies and many practitioners of conventional health care are seeking education and information to enhance their knowledge and use of CAM. This paper reflects on the attitudes to CAM and the education needs and services in the field of CAM as identified by western health care providers, in particular nurses.

Complementary medicine use among attendees at a rural health screening clinic.

The objective of this study was to investigate the use of complementary and alternative medicines (CAM) in a group of older rural Australian attending a multi-disciplinary health screening clinic. The average age of all participants (n=102) was 66+/-10 years (range 49-89) and 61% were female. Three-quarters (78%) of respondents had used at least one CAM product within the past 12 months and 66% had visited a CAM practitioner. The most frequently used CAM were vitamin/mineral supplements (54%) followed by herbal supplements (28%). Among products named by respondents that they were currently using the most frequently cited were omega-3/fish oils (28%) and glucosamine (24%). The main source of information for most respondents (53%) was doctors and pharmacists followed by family and friends (28%). Almost half (46%) had not discussed their use of CAM with their doctor and only 15% had discussed their CAM use with a pharmacist. Respondents were not found to hold strongly pro-CAM or anti-CAM health beliefs. This study demonstrates that while older, rural Australians do not have significant pro-CAM beliefs they do have high use of CAM. Based on the types of products used it is suggested that CAM use forms part of these individuals' self-management strategies.

Evaluating the effects of the essential oils Leptospermum scoparium (manuka) and Kunzea ericoides (kanuka) on radiotherapy induced mucositis: a randomized, placebo controlled feasibility study.

This study evaluated the effects of an essential oil mouthwash on radiation induced mucositis of the oropharyngeal area during treatment for head and neck cancers. Nineteen adult patients completed the randomized placebo controlled trial which involved the use of a gargle containing 2 drops of a 1:1 mix of the essential oils of manuka (Leptospermum scoparium) and kanuka (Kunzea ericoides) in water. Those in the essential oil gargle group were observed to have a delayed onset of mucositis and reduced pain and oral symptoms relative to placebo (gargling with water) and the control ('usual care') groups. In addition those in the essential oil group were seen to have less weight loss (1% loss) than the other two groups (control 2.5%, placebo 4.5%). However a significant limitation in this study was the small sample size. Although the results from this feasibility study support the hypothesis that very small volumes of manuka and kanuka used in a gargle can provide a positive effect on the development of radiation induced mucositis, further research is required to confirm this finding. Randomization was applied according to the timing of the patient's entering the trial as well as their physical ability to gargle. Confirmation of these findings would pave the way for introduction of a simple, yet effective treatment for a condition which causes considerable discomfort and for which there is currently no definitive treatment.

Knowledge, beliefs, and use of complementary and alternative medicine by Australian podiatric physicians.

BACKGROUND: Complementary and alternative medicine (CAM) is one of the fastest growing areas of health care. This has necessitated an increased awareness and understanding of CAM by conventional health professionals. METHODS: A questionnaire seeking information about use of and attitudes toward CAM was mailed to 1,365 Australian podiatric physicians. RESULTS: Ninety-one percent of Australian podiatric physicians surveyed have used at least one CAM therapy in the past 12 months, and 93% have treated patients with CAM or have recommended its use to patients. Overall, the respondents rated their knowledge of various CAM therapies as "average," and responses on the CAM Health Belief Questionnaire indicated that respondents tended not to endorse CAM health beliefs, with statements about CAM therapies being seen as "a threat to public safety" and effects being "usually due to the placebo effect" producing the strongest responses. CONCLUSIONS: Complementary and alternative medicine therapies are already being used in podiatric medical practice, and there are significant opportunities for further research into CAM education and clinical research relevant to podiatric medicine.

A comparison of wound healing following treatment with Lavandula x allardii honey or essential oil.

The increased interest in complementary therapies has led to the investigation of products traditionally believed to have a beneficial effect in wound healing. Two such products are honey and lavender essential oil. In this study a rat excisional wound model was used to investigate the action of Lavandula x allardii honey and essential oil, and a standard therapeutic honey (Medihoney). Four 8 mm wounds were created surgically on the dorsal surface of each rat and honey or essential oil applied to the wounds twice a day for 4 days. Wound healing was analysed by wound contraction and capillary volume at 5 and 12 days post-surgery. Although no statistically significant difference in wound contraction was observed for the essential oil or honey treated wounds relative to the untreated control, both honeys were shown to reduce the capillary volume in the wound site at day 12 with no difference between the honeys (control 154 +/- 14 microm(3) vs L. x allardii honey 77 +/- 18 microm(3) and Medihoney 89 +/- 39 microm(3), p < 0.001; mean +/- SD). This suggests that scar maturation in these animals was more advanced than in other groups. These data suggest that L. x allardii honey, but not essential oil, has a beneficial action in wound healing.