Matrix Metalloproteinase-9 Testing of Golden Rice Cookies With Piper Crocatum Active Extract for Preventing Foot Ulcers in Patients With Diabetes: Protocol for a Randomized Controlled Trial.

BACKGROUND: Diabetic foot ulcers (DFUs) present a formidable challenge to both patients and health care systems. DFUs significantly reduce the quality of life for patients, prolong hospital stays, and are the cause of approximately 70,000 lower limb amputations across the globe annually. Prevention of DFUs primarily involves the optimization of blood sugar levels and the effective management of complications, particularly peripheral neuropathy. Golden Rice has been proven to lower blood sugar levels due to its beta-carotene content, and Piper crocatum (P. crocatum) has been found to be effective in reducing the risk factors of DFUs through biomolecular regulation because of its polyphenol content. OBJECTIVE: The principal objective of this study is to identify the efficacy of P. crocatum-enriched cookies, with Golden Rice as their primary ingredient, in preventing DFUs. The evaluation will center on their impact on the expression of matrix metalloproteinase-9 (MMP-9), a pivotal factor in the development of DFUs. METHODS: This study is an experimental clinical research that follows the randomized controlled trial method and uses a single-blind design. The participants in the study are outpatients from primary health centers in Makassar, Indonesia, who have been diagnosed with diabetes mellitus. The sample for the study will be randomly selected and subsequently categorized into 2 groups: the intervention group and the control group. The intervention group consumes P. crocatum-enriched Golden Rice cookies, while the control group receives cookies without these additives. The participants from both groups will consume their respective cookies (packaged identically) twice a day for 14 days. The cookies will be prepared according to a modified recipe with an emphasis on low glucose content, resulting in 51 calories per cookie, comprising 1% carbohydrates, 6% fat, 4% cholesterol, and 4% fiber, excluding gluten, sugar, and salt. They will be baked at 158°C for 20 minutes. The process involves the addition of 20% Golden Rice and 10% P. crocatum ethanol extract, both prepared via maceration with 96% ethanol. The dependent variable in this study is the expression of gelatinases matrix metalloproteinase, to be assessed at 2 distinct time points-preintervention (pretest) and postintervention (posttest)-with the evaluation conducted through the western blotting method. RESULTS: The recruitment and testing phase started in January 2024. The study is scheduled to be completed by the end of March 2024. Data analysis will commence in April 2024, and the publication of the results is anticipated in the same year (2024). The study will report on the changes in primary data, encompassing gelatinases matrix metalloproteinase, as well as secondary data, including the ankle-brachial index, neuropathy score, and random blood glucose level. CONCLUSIONS: The findings of this trial are expected to significantly impact the selection of strategies by health care practitioners to enhance diabetes self-management, particularly in the domain of therapeutic snacking, for patients diagnosed with diabetes mellitus. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20230502001; https://www.thaiclinicaltrials.org/show/TCTR20230502001. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/49940.

Exploring herbal remedy utilization for wound healing: Patterns, patient preferences, and implications for nursing practice.

PURPOSE: The utilization of herbal remedies for wound healing is a notable aspect of traditional medicine practices. Understanding herbal use among patients yields insights for nursing care enhancement. This study aimed to investigate the utilization of herbal remedies for wound healing among diabetic patients. METHODS: A total of 453 participants were enrolled, with demographic data, including age, sex, occupation, education level, residence, ethnic group, distance from health service, herbal use duration, and wound duration presented. Descriptive statistics were used to analyze the data, including means, standard deviations, ranges, and percentages. FINDINGS: The average participant age was 55.39 years, with most being non-civil servant workers (60.3%) and having a low education level (67.1%). Indian almond wood (9.7%) and green betel (6.8%) were the most commonly used herbs for wound healing. Family members were the primary source of information (29.1%), and 43.7% obtained herbs from personal gardens. Although 94.2% of participants did not disclose herbal use to health liaisons, 53.4% used herbs specifically for wound healing. Users reported both positive and negative effects on wounds from various herbs, indicating variability in experiences. However, the consistency of herb usage by individual patients was uncertain. CONCLUSIONS: The study identified diverse herbal remedies used for wound healing among patients, driven by familial recommendations. Usage pattern diversity and effects signal necessity for researching herb safety and efficacy. Clarifying the impact of consistent herb usage on wound healing is essential for understanding patients' preferences and practices. IMPLICATIONS FOR CLINICAL PRACTICE: These findings emphasize the importance of open communication between patients and healthcare providers regarding herbal remedy use. Nurses should acknowledge patients' preferences for traditional healing practices while ensuring they receive evidence-based care. Patient-centered herbal strategies enhance nursing practice, fostering holistic wound care. Further research can guide nursing interventions, facilitate informed decision-making, and improve patient outcomes.

TUJUAN: Penggunaan terapi herbal untuk penyembuhan luka merupakan hal yang perlu diperhatian pada praktek pengobatan tradisional. Kualitas asuhan keperawatan pada pasien dengan luka diabetik dapat ditingkatkan dengan memahami pola penggunaan terapi herbal oleh pasien. Penelitian ini bertujuan untuk mengidentifikasi karakteristik penggunaan terapi herbal untuk menyembuhkan luka oleh individu dengan diabetes. METODE: Penelitian ini merupakan penelitian deskriptif dengan jumlah responden berjumlah 453 orang. Data demografis yang diidentifikasi mencakup usia, jenis kelamin, pekerjaan, tingkat pendidikan, tempat tinggal, suku bangsa, jarak rumah dari pelayanan kesehatan, durasi penggunaan terapi herbal, dan lama mengalami luka. Analisa data dengan menggunakan statiktik deskriptif yang terdiri dari rerata, standar deviasi, dan persentase. HASIL: Rata-rata usia responden adalah 55,39 tahun, dengan sebagian besar merupakan pekerja non-pegawai negeri sipil (60,3%) dan memiliki tingkat pendidikan rendah (67,1%). Kemiri (9,7%) dan sirih hijau (6,8%) adalah herbal yang paling umum digunakan untuk penyembuhan luka. Anggota keluarga menjadi sumber informasi utama (29,1%) dan mayoritas responden mendapatkan herbal dari kebun pribadi (43,7%). Meskipun 94,2% peserta tidak melaporkan penggunaan herbal kepada tenaga kesehatan, 53,4% menggunakan herbal dengan tujuan untuk menyembuhkan luka. Adanya efek baik positif maupun negatif dari penggunaan terapi herbal yang dilaporkan responden menunjukkan pengalaman penggunaan herbal yang masih bervariasi. Konsistensi penggunaan herbal yang mencakup dosis, cara konsumsi dan cara pengolahan oleh responden secara individu belum dapat disimpulkan. KESIMPULAN: Terapi herbal yang digunakan untuk penyembuhan luka oleh responden pada umumnya merupakan rekomendasi dari keluarga. Keragaman pola penggunaan dan efek menunjukkan perlunya penelitian tentang keamanan dan efektivitas herbal lebih. Teridentifikasinya efek terapi herbal yang konsisten pada penyembuhan luka dapat digunakan untuk pertimbangan mengintegrasikan preferensi pasien pada praktik kesehatan. IMPLIKASI UNTUK PRAKTIK KEPERAWATAN: Hasil penelitian ini menekankan pentingnya komunikasi terbuka antara pasien dan penyedia layanan kesehatan mengenai penggunaan terapi herbal. Perawat penting untuk menghargai preferensi pasien terhadap praktik penyembuhan tradisional dan memastikan bahwa pasien menerima perawatan yang tepat dan efektif. Strategi terapi herbal yang berorientasi pada pasien dapat meningkatkan kualitas praktik keperawatan dan mendukung perawatan luka dilaksanakan secara holistik. Penelitian selanjutnya diharapkan dapat dijadikan pedoman intervensi keperawatan, dapat memfasilitasi pengambilan keputusan yang terinformasi, dan meningkatkan kualitas hasil perawatan.

Topical Cream Derived From Hylocereus polyrhizus (Red Dragon Fruit) Extract Accelerates Wound Healing Through Increased Hydroxyproline and Fibroblast Growth Factor 2 Levels: A Pilot Study.

The red dragon fruit (Hylocereus polyrhizus) extract (RDFE) is frequently used for a variety of therapeutic purposes (e.g., boosting the immune system, promoting a healthy gastrointestinal system, improving wound healing). We investigated the effects of a topical cream containing 7.5% RDFE on hydroxyproline and fibroblast growth factor 2 (FGF-2) levels and wound healing. On Day 0, we divided a total of 36 albino male Wistar rats into two equal groups. Using an 8-mm punch biopsy, we created a circular excision to fascial depth on the back of each rat. On Day 1, we treated the control group (n = 18) with 20 mg of base cream and the RDFE group (n = 18) with 20 mg of 7.5% RDFE cream. We measured hydroxyproline and FGF-2 levels in the wound tissue using an ELISA method on Days 3, 7, and 14. We found that on Day 3, hydroxyproline levels were significantly lower in the treatment group than in the control group (p = .031). We also found a significant correlation between FGF-2 levels in the treatment group and wound diameter (p = .02). On the basis of the results of this study, we concluded that using a topical cream containing 7.5% RDFE has the potential to accelerate wound healing by increasing levels of hydroxyproline and FGF-2 in the wound.

Validity and Reliability Diabetic Foot Check-up as a Simple Screening Test of Diabetic Foot Ulcers in a Community.

Early detection of PAD and neuropathy is essential to prevent diabetic foot ulcers (DFU). The study aimed to identify the inter reliability of diabetic foot check-up (Ipswich touch test [IpTT] and palpation of the dorsal pedis and posterior tibialis) between nurses and caregivers. An inter-operator observation study between nurses and caregivers was conducted to evaluate the reliability of diabetic foot check-up in eight public health centers in eastern Indonesia. Patients with diabetes mellitus (DM) with and without diabetic foot ulcer (DFU, n = 144) were included in this study. The nurse demonstrates IpTT and palpation of the dorsal pedis and posterior tibial artery, followed by the caregiver. The McNemar test confirmed no difference in IpTT between nurses and caregivers on the left foot at the first, third, and fifth finger (P > 0.05), similar to the right foot (P > 0.05). The sensitivity of palpation dorsal pedis was (47.3%-50%) and (50%-52%) for the left and right foot, respectively. The insights gained from this study may assist in implementing diabetic foot check-up as an early screening tool for risk DFU in the community setting.

Validity and Reliability of a Vibration-Based Cell Phone in Detecting Peripheral Neuropathy among Patients with a Risk of Diabetic Foot Ulcer.

The aim of this study was to determine the validity and reliability of a vibration-based cell phone in detecting peripheral neuropathy among individuals with a risk of diabetic foot ulcer (DFU). The current study consisted of 3 phases: a pilot study, concurrent validity study, and interreliability study. A 128 Hz tuning fork and vibration-based cell phone using the Vibrations-Test app was compared in the primary care setting. The pilot study confirmed that the vibration-based cell phone has an adequate reliability (r > 0.70, P < .001). The concurrent validity test involved 96 participants (aged 55.78 ± 8.32 years). The Pearson correlation test found the highest correlation in the fifth metatarsal heads (r = 0.741, right feet; 0.772, left feet; P < .001). In the 4 primary care settings, the interrater reliability between nurses of the vibration-based cell phone were k = 1.000, 1.000, 1.000, and 0.720. The concurrent validity test found moderate to strong correlation results and that the interrater reliability had a strong agreement that was almost perfect. Thus, vibration-based cell phone applications can be used as screening tools for detecting neuropathy among individuals with a risk of DFU.

Nursing students' knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia.

Objective: The prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence. Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice. This study aimed to assess nursing students' knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them. Methods: A cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022. Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care. The data were analyzed using a Chi-square test and multivariate logistic regression analysis. Results: The results show that 43.2% (171/396) of nursing students had inadequate knowledge of diabetic ulcer care. However, 88.9% (352/396) had a favorable attitude toward the topic. Nursing students lacked knowledge about the characteristics of diabetic ulcers, diabetic neuropathy, wound infection, and adjunctive therapy for diabetic ulcers, and many of them believe that diabetic ulcer care is too time-consuming to carry out. Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase (aOR = 9.99, 95% CI 4.96-20.08, P < 0.001). Male nursing students were significantly less likely to have positive attitude toward the topic than female students (aOR = 0.42, 95% CI 0.19-0.96, P = 0.048), and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not (aOR = 2.76, 95% CI 1.40-5.41, P = 0.003). Conclusion: Findings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care. Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students' knowledge and attitudes based on the factors discovered in this study.

Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review.

GENERAL PURPOSE: To provide information on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injuries (PIs) in adult ICU patients. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: 1. Distinguish features of active and reactive support surfaces used in the ICU.2. Compare the PI incidence in patients using a variety of support surfaces.3. Synthesize recommendations for the use of support surfaces to reduce the risk of PI in adult ICU patients.

To identify and analyze scientific evidence on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injury (PI) in adult ICU patients. PubMed, ProQuest, ScienceDirect, Wiley Online Library, ClinicalKey for Nursing, Cochrane Library, and secondary searches. Studies were included if they related to support surfaces, involved adult ICU patients aged ≥18 years, and the primary outcome measured was incidence or prevalence of PI. The initial search resulted in 8,357 articles; after exclusions, 31 complete texts were assessed for feasibility. A total of eight articles were included in this review. A bias risk assessment was performed using the Cochrane Risk of Bias Assessment Tool. Data were extracted by one reviewer and summarized in a table of study results that was examined and verified by two other reviewers. Reactive (constant low pressure) support surfaces included viscoelastic foam mattresses, static air mattresses, and low-air-loss mattresses, whereas the active support surface consisted of alternating-pressure air mattresses. Alternating pressure mattress and viscoelastic foam mattress use both resulted in significantly lower PI incidence. Support surface use is limited, and no particular type is proven to be superior to others. Clinicians should select support surfaces based on their therapeutic features and how well they meet the patient's particular needs.

The cultural beliefs and practices of diabetes self-management in Javanese diabetic patients: An ethnographic study.

BACKGROUND: It is important to assess the cultural beliefs and practices of diabetic patients since such beliefs and practices greatly influence how patients self-manage the disease. However, how cultural beliefs and practices affect self-management in Javanese diabetic patients in Indonesia is still unclear since research about it is very limited. Therefore, the purpose of this study was to explore the cultural beliefs and practices of diabetes self-management in Javanese diabetic patients. METHODS: An ethnographic study was conducted between July 2020 and March 2021 in Banyumas Regency, Indonesia. Forty-seven participants were included, consisting of 36 type 2 diabetes mellitus (T2DM) patients as key informants and 11 family members and health providers as general informants. Purposive and snowball sampling methods were used, and data was collected through in-depth interviews, observations, and the writing of field notes. The data were analyzed by thematic analyses using NVivo 12 software. RESULTS: Four themes emerged from the data analysis: (1) misconception about diabetes and management, such as the belief of there being dry sugar and wet sugar types of diabetes; the belief that consuming a lot of cold rice does not increase blood glucose; the belief that insulin causes organ damage; the belief that diabetes can be completely cured; and the belief that walking barefoot is good for the body; (2) cultural beliefs and practices regarding treatment regimen, such as use of medicinal plants to lower blood glucose and home remedies to treat foot ulcers; (3) coping influenced by a blend of culture and religion, such as managing stress by submitting to God and being patients in dealing with their disease; (4) cultural influence on diet management, such as facing difficulties managing their diets at cultural events and difficulties managing the habit of eating sweet-tasting food. CONCLUSION: This is the first study to show that Javanese culture strongly influences how diabetic patients in Java self-manage their disease. Various aspects of Javanese culture were found to have either beneficial or detrimental effects on diabetic patients' health status. This study provides new insights for nurses in Indonesia and will help them design a culturally sensitive education program for their diabetic patients.

Effect of Family Empowerment on HbA1c Levels and Healing of Diabetic Foot Ulcers.

Objective. To evaluate the effectiveness of family empowerment through educational interventions against HbA1c level and healing progress of diabetic foot ulcers. Method. A quasi-experimental design was employed involving 33 participants from 4 wound care clinics in Makassar, eastern Indonesia. The intervention group consisted of 17 participants and their families; the control group was composed of 16 participants who received nonstructural education. Family empowerment was measured by the Indonesian version of the Family Empowerment Scale instrument. Glycemic control was evaluated with HbA1c levels, and the wound healing process was evaluated on the Diabetic Foot Ulcers Assessment Scale. Result. After 3 months, Family Empowerment Scale scores improved, particularly in the subdomain of family knowledge (16.59 ± 3.92 vs 13.38 ± 1.26; P = .005) and attitude (3.65 ± 0.93 vs 2.75 ± 0.45; P = .002). After 3 months of intervention, HbA1c decreased (from 10.47 ± 2.44% to 8.81 ± 1.83%), compared with the control group (P = .048). Meanwhile, an independent t test further revealed that the wound healing process tended to be better with the intervention group (4.71 ± 7.74) compared with the control group (17.25 ± 17.06), with P = .010 at the third month. Conclusion. Family-based education intervention creates family empowerment to control HbA1c levels and accelerate wound healing of diabetic foot ulcer.

The barriers and facilitators of foot care practices in diabetic patients in Indonesia: A qualitative study.

AIM: To investigate the barriers and facilitators of foot care practice in diabetic patients in Indonesia. DESIGN: A qualitative content analysis with an inductive approach. METHOD: Semi-structured interviews were conducted on 34 type 2 diabetes mellitus (T2DM) patients, health providers and family members in Purwokerto, Indonesia, between July 2020 and December 2020. The interview transcripts were coded using NVivo 12. RESULTS: Four themes emerged from data analysis, including personal barriers (low susceptibility of developing foot ulcer, limited knowledge about foot care, fatalistic practices, financial problems, glucose control taking priority over foot care, lack of motivation, lack of confidence, fear of being labelled), environmental barriers (lack of knowledge and time of health providers, lack of family support and climate conditions), perceived foot health benefits (intention to feel better and desire to stay socially active) and religious practices (foot washing as part of religious practice and intention to feel clean before praying).

Effect of interface pressure and skin surface temperature on pressure injury incidence: a turning schedule pilot study.

OBJECTIVE: This study aimed to evaluate the interface pressure and skin surface temperature in relation to the incidence of pressure injury (PI) using three different turning schedules. METHOD: This was a pilot study with a three-armed randomised clinical trial design. Participants at risk of PI and treated in the high dependency care unit in a regional hospital in Makassar, Indonesia participated in this study. Patients were repositioned at three different turning schedules (two-, three- and four-hourly intervals). Interface pressure measurement and skin surface temperature were measured between 14:00 and 18:00 every three days. The incidence of PI was assessed during the two-week observation period. RESULTS: A total of 44 participants took part in the study. A one-way ANOVA test revealed no difference in interface pressure among the three different turning schedule groups within two weeks of observations: day zero, p=0.56; day four, p=0.95; day seven, p=0.56; day 10, p=0.63; and day 14, p=0.92. Although the average periumbilical temperature and skin surface temperature were not significant (p>0.05), comparison between these observation sites was significant on all observation days (p<0.05). Regarding the incidence of PI, the proportional hazard test for the development of PI in the three groups was considered not different (hazard ratio: 1.46, 95% confidence interval: 0.43-4.87, p=0.54). CONCLUSION: No difference in interface pressure and incidence of PI on the three turning schedules was observed; however, there was a potential increase in skin surface temperature in comparison with periumbilical temperature for all three turning schedules.

The differences in health-related quality of life between younger and older adults and its associated factors in patients with type 2 diabetes mellitus in Indonesia.

BACKGROUND: It is well known that diabetes mellitus (DM) affects health-related quality of life (HRQOL) in both younger (aged 18-64 years) and older adults (aged ≥ 65 years). However, to date, no study has compared HRQOL and its predictors between younger and older adults with DM in Indonesia. Such a comparison is important because the results can guide nurses and clinicians to establish evidence-based educational programs that are specific and suitable for patients. Therefore, the aim of this study was to investigate the difference in HRQOL and its predictors in younger and older adults with DM in Indonesia. METHODS: A cross-sectional study was conducted on 641 patients with type 2 diabetes mellitus (T2DM) who were recruited via simple random sampling from 16 primary health centers in Banyumas Regency, Indonesia. A self-administered questionnaire containing the Summary of Diabetes Self-Care Activities, the DDS17 Bahasa Indonesia, the Beck Depression Inventory II, the Self-Efficacy for Diabetes Scale, the Family APGAR, and the 36-item Short-Form Health Survey was used to measure diabetes self-management (DSM), diabetes distress (DD), depression, self-efficacy, family support, and HRQOL, respectively. Independent t-tests were used to compare the physical component summary (PCS) and mental component summary (MCS) scores between younger and older adults with T2DM. Hierarchical multiple regression analyses were used to examine the factors associated with HRQOL in both groups. RESULTS: PCS scores were significantly different between the two groups. Older adults reported lower PCS scores than younger adults. No differences between the two groups were observed in the MCS scores. The hierarchical multiple regression analysis showed that level of education, employment status, number of diabetes-related complications, DSM, DD, depression, and self-efficacy were significant predictors of HRQOL in younger adults, while income, depression, DD, and self-efficacy were significant predictors of HRQOL in older adults. DD was the strongest predictor of HRQOL in younger adults, and depression was the strongest predictor in older adults. CONCLUSION: Older adult patients had lower PCS scores than younger adult patients. This study is the first to show that the predictors of HRQOL differ between younger and older adults with T2DM. It provides insights for nurses and clinicians in Indonesia to establish evidence-based, age-specific educational programs.

Ozone Therapy on Reduction of Bacterial Colonies and Acceleration of Diabetic Foot Ulcer Healing.

Diabetic foot ulcers (DFUs) are highly vulnerable to infection and pose risk for limb amputations. Studies have shown that ozone therapy reduces wound size and improves wound healing time better than standard treatments. We examined the effectiveness of combining standard wound care with ozone therapy to reduce bacterial colonization and accelerate healing of DFUs in the home care setting. The control group (n = 12) received standard wound care with antimicrobial dressings every 3 days for 21 days, and the intervention group (n = 15) received the same as control group plus ozone bagging therapy at 70 µg/mL for 10 minutes every 3 days for 21 days. Combining standard wound care with ozone therapy significantly decreased the number of bacterial colonies (p = 0.001). However, no significant difference in DFU assessment score was found between the intervention and control groups (p > 0.05). Combining standard wound care with ozone therapy reduced the number of bacteria in the DFUs but exerted no significant effect on wound healing. Future studies should examine the administration of ozone therapy with different concentrations and times of exposure to explore the right dose for healing DFUs.

Development and evaluation educational videos of diabetic foot care in traditional languages to enhance knowledge of patients diagnosed with diabetes and risk for diabetic foot ulcers.

AIM: This study aimed to develop an educational video for diabetic foot care in the traditional languages (Buginese and Makassarese) and evaluate the change in the patients' knowledge level after they viewed the video. METHODS: The study was performed in the following three phases: development of the video content using a Delphi Study that involved wound-care nurses, evaluation of the video's content validity by the expert panel, and evaluation of the video in the community setting by showing it to patients who spoke the traditional languages, were diagnosed with diabetes mellitus (DM), and were at risk of diabetic foot ulcers (DFU). RESULTS: Five themes emerged from the Delphi study, including observation of pre-ulcer signs, washing feet, cutting toenails, wearing socks, and checking footwear. Content validity evaluation recommended these items to be constructed for video education using the traditional languages. Evaluation in the community setting confirmed that there was a significant improvement (p = 0.001) in the knowledge about foot care among patients diagnosed with diabetes and at risk of DFU. CONCLUSION: This study produced an educational video that used the trans-cultural approach by using traditional languages to overcome the communication barrier in the process of knowledge transfer. We found that the educational video in traditional languages enhanced the patients' knowledge about diabetic foot care and thus could enable them to detect the risks for DFU and prevent DFU.

Microclimate and development of pressure ulcers and superficial skin changes.

This study aims to evaluate the microclimate and development of pressure ulcers and superficial skin changes. A prospective cohort study was conducted in an acute care ward in Indonesia. Risk factors for pressure ulcers and superficial skin changes were identified based on the Bergstrom Braden conceptual model. Microclimate data were collected every 3 days for 15 days while the development of pressure ulcers and superficial skin changes was observed every day. Pressure ulcers and superficial skin changes were developed in 20 of the 71 participants. Total mean difference in skin temperature was higher for patients with pressure ulcers and superficial skin changes (0·9 ± 0·6°C) compared with controls (0·6 ± 0·8°C) (P = 0·071). Binary logistic regression predictor values for pressure ulcers and superficial skin changes were 0·111 for type of sheet and 0·347 for Braden Scale results. In conclusion, difference in skin temperature seems to be a predictor for pressure ulcer development and superficial skin changes, while synthetic fibre sheets are able to maintain a beneficial microclimate.