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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.
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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.
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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.
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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.