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Fitts MS, Cullen J, Kingston G, Wills E, Johnson Y, Soldatic K. Using research feedback loops to implement a disability case study with Aboriginal and Torres Strait Islander communities and service providers in regional and remote Australia. Health Sociol Rev 2023; 32:1-16. [PMID: 36998179 DOI: 10.1080/14461242.2023.2173018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/22/2023] [Indexed: 06/19/2023]
Abstract
While there is a well-developed body of literature in the health field that describes processes to implement research, there is a dearth of similar literature in the disability field of research involving complex conditions. Moreover, the development of meaningful and sustainable knowledge translation is now a standard component of the research process. Knowledge users, including community members, service providers, and policy makers now call for evidence-led meaningful activities to occur rapidly. In response, this article presents a case study that explores the needs and priorities of Aboriginal and Torres Strait Islander women in Australia who have experienced a traumatic brain injury due to family violence. Drawing on the work of Indigenous disability scholars such as Gilroy, Avery and others, this article describes the practical and conceptual methods used to transform research to respond to the realities of community concerns and priorities, cultural considerations and complex safety factors. This article offers a unique perspective on how to increase research relevance to knowledge users and enhance the quality of data collection while also overcoming prolonged delays of knowledge translation that can result from the research-production process.
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Affiliation(s)
- M S Fitts
- Institute for Culture and Society, Western Sydney University, Parramatta, Australia
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - J Cullen
- Synapse Australia, Brisbane, Australia
- College of Healthcare Sciences, James Cook University, Cairns, Australia
| | - G Kingston
- Townsville Hospital and Health Service, Townsville, Australia
| | - E Wills
- Institute for Culture and Society, Western Sydney University, Parramatta, Australia
| | - Y Johnson
- Institute for Culture and Society, Western Sydney University, Parramatta, Australia
| | - K Soldatic
- Institute for Culture and Society, Western Sydney University, Parramatta, Australia
- School of Social Sciences, Western Sydney University, Parramatta, Australia
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Fitts MS, Cullen J, Kingston G, Johnson Y, Wills E, Soldatic K. Understanding the Lives of Aboriginal and Torres Strait Islander Women with Traumatic Brain Injury from Family Violence in Australia: A Qualitative Study Protocol. Int J Environ Res Public Health 2023; 20:1607. [PMID: 36674368 PMCID: PMC9861732 DOI: 10.3390/ijerph20021607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 06/16/2023]
Abstract
Globally, there is growing recognition of the connection between violence and head injuries. At present, little qualitative research exists around how surviving this experience impacts everyday life for women, particularly Aboriginal and Torres Strait Islander women. This project aims to explore the nature and context of these women's lives including living with the injury and to identify their needs and priorities during recovery. This 3-year exploratory project is being conducted across three Australian jurisdictions (Queensland, Northern Territory, and New South Wales). Qualitative interviews and discussion groups will be conducted with four key groups: Aboriginal and Torres Strait Islander women (aged 18+) who have acquired a head injury through family violence; their family members and/or carers; and hospital staff as well as government and non-government service providers who work with women who have experienced family violence. Nominated staff within community-based service providers will support the promotion of the project to women who have acquired a head injury through family violence. Hospital staff and service providers will be recruited using purposive and snowball sampling. Transcripts and fieldnotes will be analysed using narrative and descriptive phenomenological approaches. Reflection and research knowledge exchange and translation will be undertaken through service provider workshops.
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Affiliation(s)
- Michelle S. Fitts
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia
| | - Jennifer Cullen
- Synapse Australia, Brisbane, QLD 3356, Australia
- College of Healthcare Sciences, James Cook University, Cairns, QLD 4878, Australia
| | - Gail Kingston
- Townsville Hospital and Health Service, Townsville, QLD 4814, Australia
| | - Yasmin Johnson
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
| | - Elaine Wills
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
| | - Karen Soldatic
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- School of Social Sciences, Western Sydney University, Parramatta, NSW 2751, Australia
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Fitts MS, Cullen J, Kingston G, Wills E, Soldatic K. "I Don't Think It's on Anyone's Radar": The Workforce and System Barriers to Healthcare for Indigenous Women Following a Traumatic Brain Injury Acquired through Violence in Remote Australia. Int J Environ Res Public Health 2022; 19:14744. [PMID: 36429463 PMCID: PMC9691172 DOI: 10.3390/ijerph192214744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Aboriginal and Torres Strait Islander women experience high rates of traumatic brain injury (TBI) as a result of violence. While healthcare access is critical for women who have experienced a TBI as it can support pre-screening, comprehensive diagnostic assessment, and referral pathways, little is known about the barriers for Aboriginal and Torres Strait Islander women in remote areas to access healthcare. To address this gap, this study focuses on the workforce barriers in one remote region in Australia. Semi-structured interviews and focus groups were conducted with 38 professionals from various sectors including health, crisis accommodation and support, disability, family violence, and legal services. Interviews and focus groups were audiotaped and transcribed verbatim and were analysed using thematic analysis. The results highlighted various workforce barriers that affected pre-screening and diagnostic assessment including limited access to specialist neuropsychology services and stable remote primary healthcare professionals with remote expertise. There were also low levels of TBI training and knowledge among community-based professionals. The addition of pre-screening questions together with professional training on TBI may improve how remote service systems respond to women with potential TBI. Further research to understand the perspectives of Aboriginal and Torres Strait Islander women living with TBI is needed.
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Affiliation(s)
- Michelle S. Fitts
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT 0871, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD 4878, Australia
| | - Jennifer Cullen
- Synapse Australia, Brisbane, QLD 3356, Australia
- College of Healthcare Sciences, James Cook University, Cairns, QLD 4878, Australia
| | - Gail Kingston
- Townsville Hospital and Health Service, Townsville, QLD 4814, Australia
| | - Elaine Wills
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
| | - Karen Soldatic
- Institute for Culture and Society, Western Sydney University, Parramatta, NSW 2751, Australia
- School of Social Sciences, Western Sydney University, Parramatta, NSW 2751, Australia
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Kingston G, Pain T, Murphy K, Bennett M, Watson M. Perceptions of acute hospital occupational therapy services: developing a new model of care for occupational therapy on acute medical wards. International Journal of Therapy and Rehabilitation 2019. [DOI: 10.12968/ijtr.2017.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims This study was conducted at a regional tertiary referral facility in Australia. It was part of a project to implement a new model of care for occupational therapy services on medical wards. Before the new model was implemented, focus groups were conducted to explore the perceived role of the occupational therapist on the acute medical ward, identify potential barriers to changing the service and garner support for the change in service. Methods Three focus groups were held. The groups consisted of nursing, physiotherapy and speech pathology staff who worked on acute medical wards. Participants were asked for their perception of the role of occupational therapy on the acute medical ward. Audio-recordings of the groups were transcribed and analysed. Results Qualitative content analysis highlighted the following themes: assessment of patient function; ‘safe discharge’; more than assessment; equipment and home modifications; collaboration and communication; delegating tasks to assistants; and specialist intervention strategies. Conclusions Multidisciplinary team members' overriding perception is that occupational therapists in acute care settings provide assessment of patient function for the specific purpose of safe discharge. Some participants recalled that occupational therapists had a greater role in ensuring patients returned to their chosen function through rehabilitation and home visits, suggesting support for a change to our proposed post-acute model of care. Concerns highlighted by focus group members regarding increased workload for multidisciplinary team members and loss of communication need to be addressed to ensure the change in service is successful.
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Affiliation(s)
- Gail Kingston
- The Townsville Hospital and Health Service, Queensland Health, Townsville, Australia
| | - Tilley Pain
- The Townsville Hospital and Health Service, Queensland Health, Townsville, Australia
| | - Kym Murphy
- Care Coordination Team, Sir Charles Gairdner Hospital, Perth, Australia
| | - Michelle Bennett
- Community Based Rehabilitation and Aged Care Services, Canberra Hospital and Health Service, ACT Health, Canberra, Australia
| | - Michelle Watson
- The Townsville Hospital and Health Service, Queensland Health, Townsville, Australia
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Kingston G, Williams G, Judd J, Gray M. The functional impact of a traumatic hand injury: a comparison of rural/remote and metropolitan/regional populations. International Journal of Therapy and Rehabilitation 2016. [DOI: 10.12968/ijtr.2016.23.9.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The aim of this research was to explore the commonalities and differences in the issues associated with the functional recovery and rehabilitation of a traumatic hand injury experienced by people in rural/remote and metropolitan/regional areas of North Queensland, Australia. Methods: Responses to a previously mailed survey exploring the functional impact on a rural/remote population and a metropolitan/regional population were used for analysis and comparison. Findings: Both populations reported a loss of movement, pain and stiffness, and a significantly greater percentage of metropolitan/regional respondents reported a loss of strength. Leisure and work tasks were affected for both groups as a result of their impairment. Rural and remote respondents would have liked more appointments but found that it was expensive to get to them. There was a significant reduction for both populations of respondents reporting their occupation as labourers after having a hand injury. There was also a significant increase in those who reported undertaking home duties, were pensioners or unemployed. Conclusion: A traumatic hand injury can have a moderate to extreme impact on work and leisure, regardless of residential location. Contextual factors related to living in rural and remote areas can be both a barrier and a facilitator to participation in functional activities. A review of service provision in rural/remote areas to address concerns regarding the expense of attending appointments and the minimal number of appointments required for rural and remote residents following a traumatic hand injury is recommended. Distance technology such as telehealth can increase flexibility of treatment and reduce the requirement to travel. The ongoing development and implementation of this technology is important to facilitate equitable health care between rural/remote and metropolitan/regional populations.
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Affiliation(s)
- Gail Kingston
- Adjunct lecturer, Occupational Therapy, College of Health Sciences. James Cook University; Occupational therapist, The Townsville Hospital, Queensland, Australia
| | - Gary Williams
- Lecturer, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Queensland, Australia
| | - Jenni Judd
- Adjunct principal research fellow, College of Medicine and Dentistry, James Cook University and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Queensland, Australia; adjunct associate professor, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Marion Gray
- Postdoc fellow, Washington, DC, USA; Professor, discipline and program leader, Occupational Therapy, School of Health and Sport Sciences, University of Sunshine Coast, Queensland, Australia
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Pain T, Kingston G, Askern J, Smith R, Phillips S, Bell L. How are allied health notes used for inpatient care and clinical decision-making? A qualitative exploration of the views of doctors, nurses and allied health professionals. Health Inf Manag 2016; 46:23-31. [PMID: 27574187 DOI: 10.1177/1833358316664451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inpatient care is dependent upon the effective transfer of clinical information across multiple professions. However, documented patient clinical information generated by different professions is not always successfully transferred between them. One obstacle to successful information transfer may be the reader's perception of the information, which is framed in a particular professional context, rather than the information per se. OBJECTIVE The aim of this research was to investigate how different health professionals perceive allied health documentation and to investigate how clinicians of all experience levels across medicine, nursing and allied health perceive and use allied health notes to inform their decision-making and treatment of patients. METHOD The study used a qualitative approach. A total of 53 speech pathologists, nurses, doctors, occupational therapists, dieticians and social workers (8 males; 43 females) from an Australian regional tertiary hospital participated in eleven single discipline focus groups, conducted over 4 months in 2012. Discussions were recorded and transcribed verbatim and coded into themes by content analysis. FINDINGS Six themes contributing to the efficacy of clinical information transference emerged from the data: day-to-day care, patient function, discharge and discharge planning, impact of busy workloads, format and structure of allied health documentation and a holistic approach to patient care. DISCUSSION Other professions read and used allied health notes albeit with differences in focus and need. Readers searched for specific pieces of information to answer their own questions and professional needs, in a process akin to purposive sampling. Staff used allied health notes to explore specific aspects of patient function but did not obtain a holistic picture. CONCLUSION Improving both the relationship between the various health professions and interpretation of other professions' documented clinical information may reduce the frequency of communication errors, thereby improving patient care.
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Affiliation(s)
- Tilley Pain
- 1 Queensland Health, The Townsville Hospital, Townsville, Queensland, Australia.,2 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Gail Kingston
- 1 Queensland Health, The Townsville Hospital, Townsville, Queensland, Australia.,2 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Janet Askern
- 1 Queensland Health, The Townsville Hospital, Townsville, Queensland, Australia
| | - Rebecca Smith
- 1 Queensland Health, The Townsville Hospital, Townsville, Queensland, Australia
| | - Sandra Phillips
- 1 Queensland Health, The Townsville Hospital, Townsville, Queensland, Australia
| | - Leanne Bell
- 1 Queensland Health, The Townsville Hospital, Townsville, Queensland, Australia
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Kingston G, Judd J, gray M. The experience of living with a traumatic hand injury in a rural and remote location: an interpretive phenomenological study. Rural Remote Health 2014. [DOI: 10.22605/rrh2764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Bell J, Gray M, Kingston G. The Longer Term Functional Impact of a Traumatic Hand Injury on People Living in a Regional Metropolitan Australian Location. International Journal of Therapy and Rehabilitation 2011. [DOI: 10.12968/ijtr.2011.18.7.370] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joanna Bell
- Department of Occupational Therapy, James Cook University
| | - Marion Gray
- Department of Occupational Therapy, James Cook University, Queensland, Australia
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Kingston G, Gray MA, Williams G. A critical review of the evidence on the use of videotapes or DVD to promote patient compliance with home programmes. Disabil Rehabil Assist Technol 2010; 5:153-63. [PMID: 20205545 DOI: 10.3109/17483101003671709] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this paper is to critically review published research in order to evaluate the evidence surrounding the provision of video or DVD technology to promote patient compliance with home exercise or health programmes. METHOD A literature search of the MEDLINE, CINAHL and Cochrane databases was undertaken. Critical appraisal of selected studies was undertaken using a previously validated tool. Inclusion criteria were: research related to DVD or videotape technology to improve compliance; published in peer-reviewed journals and full-text English language articles. Compliance was the main outcome measure. RESULTS Eleven eligible studies were reviewed. All but one, which used a before-after design, were randomised controlled trials. Study quality tended medium to high in the critical appraisal scoring system, but an overall low quality on the Jadad score for randomisation; with only one study from 11 scoring well on both these measures. Research into the use of video or DVD showed mainly positive effects on compliance; however, methodological issues limit clinical applicability. CONCLUSIONS Future well-designed randomised controlled trials with adequate sample sizes and reliable outcome measures will provide clearer evidence into the effectiveness of this technology in improving home exercise or health programme compliance, particularly for rural and remote populations.
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Affiliation(s)
- Gail Kingston
- Discipline of Occupational Therapy, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia.
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Kingston G, Tanner B, Gray MA. The functional impact of a traumatic hand injury on people who live in rural and remote locations. Disabil Rehabil 2010; 32:326-35. [DOI: 10.3109/09638280903114410] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shields CJ, Sookhai S, Winter DC, Dowdall JF, Kingston G, Parfrey N, Wang JH, Kirwan WO, Redmond HP. Attenuation of pancreatitis-induced pulmonary injury by aerosolized hypertonic saline. Surg Infect (Larchmt) 2003; 2:215-23; discussion 223-4. [PMID: 12593711 DOI: 10.1089/109629601317202696] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The immunomodulatory effects of hypertonic saline (HTS) provide potential strategies to attenuate inappropriate inflammatory reactions. This study tested the hypothesis that administration of intratracheal aerosolized HTS modulates the development of lung injury in pancreatitis. METHODS Pancreatitis was induced in 24 male Sprague-Dawley rats by intraperitoneal injection of 20% L-arginine (500 mg/100 g body weight). At 24 and 48 h, intratracheal aerosolized HTS (7.5% NaCl, 0.5 mL) was administered to 8 rats, while a further 8 received 0.5 mL of aerosolized normal saline (NS). At 72 hours, pulmonary neutrophil infiltration (myeloperoxidase activity) and endothelial permeability (bronchoalveolar lavage and wet:dry weight ratios) were assessed. In addition, histological assessment of representative lung tissue was performed by a blinded assessor. In a separate experiment, polymorphonucleocytes (PMN) were isolated from human donors, and exposed to increments of HTS. Neutrophil transmigration across an endothelial cell layer, VEGF release, and apoptosis at 1, 6, 12, 18, and 24 h were assessed. RESULTS Histopathological lung injury scores were significantly reduced in the HTS group (4.78 +/- 1.43 vs. 8.64 +/- 0.86); p < 0.001). Pulmonary neutrophil sequestration (1.40 +/- 0.2) and increased endothelial permeability (6.77 +/- 1.14) were evident in the animals resuscitated with normal saline when compared with HTS (0.70 +/- 0.1 and 3.57 +/- 1.32), respectively; p < 0.04). HTS significantly reduced PMN transmigration (by 97.1, p = 0.002, and induced PMN apoptosis (p < 0.03). HTS did not impact significantly upon neutrophil VEGF release (p > 0.05). CONCLUSIONS Intratracheal aerosolized HTS attenuates the neutrophil-mediated pulmonary insult subsequent to pancreatitis. This may represent a novel therapeutic strategy.
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Affiliation(s)
- C J Shields
- Department of Academic Surgery, Cork University Hospital, Wilton, Cork
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Staiano-Coico L, Krueger JG, Rubin JS, D'limi S, Vallat VP, Valentino L, Fahey T, Hawes A, Kingston G, Madden MR. Human keratinocyte growth factor effects in a porcine model of epidermal wound healing. J Exp Med 1993; 178:865-78. [PMID: 8350059 PMCID: PMC2191158 DOI: 10.1084/jem.178.3.865] [Citation(s) in RCA: 167] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Keratinocyte growth factor (KGF) is a member of the fibroblast growth factor (FGF) family (hence the alternative designation FGF-7). It is produced by stromal cells, but acts as a mitogen for epithelial cells. We examined the effects of topically applied KGF on healing of wounds in a porcine model. In partial-thickness wounds, KGF stimulated the rate of reepithelialization (p < 0.0002), associated with a thickening of the epidermis (p < 0.0001). Epidermis from KGF-treated full-thickness wound sites was significantly thicker (0.31 +/- 0.22 mm) compared with mirror image control sites (0.18 +/- 0.12 mm) (p < 0.0001). Moreover, the majority (77%) of KGF-treated wounds exhibited epidermis with a deep rete ridge pattern as compared with control sites. These effects were observed as early as 14 d and persisted for at least 4 wk. KGF treatment also increased the number of serrated basal cells associated with increased deposition of collagen fibers in the superficial dermis adjacent to the acanthotic epidermis. Electron microscopy revealed better developed hemidesmosomes associated with thicker bundles of tonofilaments in the serrated cells. The pattern of epidermal thickening observed in KGF-treated wounds resembled psoriasis. Psoriasis is a disease associated with epidermal thickening, parakeratosis as well as hyperproliferation that extends beyond the basal layer. In striking contrast to psoriasis, KGF-treated wounds exhibited normal orthokeratotic maturation, and proliferation was localized to the basal cells. Our present findings have significant implications concerning the role of KGF as a paracrine modulator of epidermal proliferation and differentiation.
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Affiliation(s)
- L Staiano-Coico
- Department of Surgery, Cornell University Medical College, New York 10021
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