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There is anecdotal evidence of a role for insulin in promoting wound healing. The senior author (CJK) gained experience in using topical insulin in the management of intractable wounds during his training days, often in the face of stern resistance, with excellent results. An empirical dose of 20 units of U-80 strength soluble insulin was used without clinical trial, and found to be an adequate dose to promote healing in diverse wounds, such as chronic pressure sores and amputation stump ulcers, without systemic hypoglycaemia.Thus, recently, in the face of a chronic non-healing wound following laparotomy in an 80-year-old female patient (Fig. 1), that had resisted all conventional attempts with various dressings and a 3-week trial of negative-pressure vacuum pump dressing, after taking fully informed consent from the patient and relatives, dressings were replaced by daily irrigation with 20 ml normal saline containing 2 units of human soluble insulin (actrapid) for 7 days. There was visible improvement (Fig. 2) in wound healing with no change in other patient variables such as nutritional status. There were no episodes of hypoglycaemia.A review of the literature demonstrates that, despite evidence of a significant role for topical insulin in the promotion of wound healing in several animal models, 1-6 there has been little work done in humans. 7 More research is needed to investigate a potential role for topical insulin in the management of wound healing.

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This PDF document was made available from www.rti.org as a public service of RTI International. More information about RTI Press can be found at http://www.rti.org/rtipress. RTI International is an independent, nonprofit research organization dedicated to improving the human condition by turning knowledge into practice. The RTI Press mission is to disseminate information about RTI research, analytic tools, and technical expertise to a national and international audience. RTI Press publications are peer-reviewed by at least two independent substantive experts and one or more Press editors. Suggested CitationDarcy, N., Kelley, C., Reynolds, E., Cressman, G., and Killam, P. (2010 All rights reserved. Please note that this document is copyrighted and credit must be provided to the authors and source of the document when you quote from it. You must not sell the document or make a profit from reproducing it. AbstractElectronic medical records (EMRs) present a multitude of potential benefits for health systems, especially those in low-income developing countries. For instance, EMR systems can improve patient care by allowing medical personnel to access patients' records throughout the geographic area; they can increase medical personnel's efficiency by reducing the time required for data management and record keeping. Benefits for the overall health care system include easier collection of data for surveillance and rich data sets for further health research. Successful implementation means facing significant challenges, however, including a lack of human capital, low levels of physical and material resources, and low use once the system is implemented. This report advocates deployment of an electronic patient referral system as a reasonable first step in deploying a complete EMR system, because implementers of the smaller system can address and overcome many of the obstacles that full EMR systems commonly face. The report discusses the participatory and user-driven design, implementation, and results of an installed electronic perinatal patientreferral system supporting health personnel who referred patients through a closed-network, Web-based system in the Lusaka health district in Zambia. It demonstrates how the patient referral module laid the groundwork for a larger EMR system.