Relationship between Wound Severity, Discomfort, and Psychological Problems in Patients with a Diabetic Foot Ulcer in Indonesia: A Cross-sectional Study / Relação entre gravidade da ferida, desconforto e problemas psicológicos em pacientes com úlcera diabética do pé na Indonésia: um estudo transversal / Relación entre la gravedad de la herida, la molestia y los problemas psicológicos en pacientes con úlcera del pie diabético en Indonesia: estudio transversal

ABSTRACT Objectives: The purpose of this study is to identify the relationship between wound severity, discomfort, and psychological problems in patients with a diabetic foot ulcer in Indonesia. Methods: A cross-sectional study is conducted in three general hospitals and one clinic in Indonesia. The Bates-Jensen wound assessment tool (BWAT), the discomfort evaluation of wound instrument (DEWI), and the depression, anxiety, and stress scale (DASS) are used to measure the variables of interest. Path analysis is performed to evaluate the association between wound severity, discomfort, and psychological problems. Results: Of 140 patients with diabetic foot ulcers who joined this study, the majority experienced immobilization (74.3 %), pain (69.3 %), and sleep disturbance (63.6 %). The means were as follows: discomfort (2.35 ± 0.33), depression (1.34 ± 0.41), stress (1.49 ± 0.48), anxiety (1.43 ± 0.40), and wound severity (31.35 ± 9.96). Discomfort partially mediated the relationship between wound severity and psychological problems, which indirect effect was 0.11. Conclusion: High prevalence of discomfort, both physical and psychological, was found in patients with a diabetic foot ulcer. Discomfort mediates the relationship between wound severity and psychological problems. Integrating comfort into wound care management may help to reduce the psychological burden.

RESUMEN Objetivos: el presente estudio tiene como objetivo identificar la relación entre la gravedad de la herida, la molestia y los problemas psicológicos en pacientes con úlcera del pie diabético en Indonesia. Métodos: se realizó un estudio transversal en tres hospitales generales y una clínica de Indonesia. La herramienta de evaluación de heridas Bates-Jensen (BWAT, por sus siglas en inglés), el instrumento de evaluación de molestia de la herida (DEWI, por sus siglas en inglés) y la escala de depresión, ansiedad y estrés (DASS, por sus siglas en inglés) se utilizaron para medir las variables de interés. Se realizó un análisis de ruta para evaluar la asociación entre la gravedad de la herida, la molestia y los problemas psicológicos. Resultados: de 140 pacientes con úlcera del pie diabético que participaron en este estudio, la mayoría experimentó inmovilización (74,3 %), dolor (69,3 %) y trastornos del sueño (63,6 %). Las medias fueron las siguientes: molestia (2,35 ± 0,33), depresión (1,34 ± 0,41), estrés (1,49 ± 0,48), ansiedad (1,43 ± 0,40) y gravedad de la herida (31,35 ± 9,96). La molestia medió en parte la relación entre la gravedad de la herida y los problemas psicológicos, cuyo efecto indirecto fue de 0,11. Conclusión: se encontró una alta prevalencia de molestias, tanto físicas como psicológicas, en pacientes con úlcera del pie diabético. Además, la molestia media la relación entre la gravedad de la herida y los problemas psicológicos. La integración de la comodidad en el manejo del cuidado de las heridas puede ayudar a reducir la carga psicológica.

RESUMO Objetivos: o objetivo deste estudo é identificar a relação entre a gravidade da ferida, o desconforto e os problemas psicológicos en pacientes com úlcera do pé diabético na Indonésia. Métodos: foi realizado um estudo transversal em três hospitais gerais e uma clínica da Indonésia. A ferramenta da avaliação de feridas Bates-Jensen (BWAT, por sua sigla em inglês), o instrumento de avaliação do desconforto da ferida (DEWI, por sua sigla em inglês) e a escala de depressão, ansiedade e estresse (DASS, por sua sigla em inglês) foram utilizados para medir as variáveis de interesse. Uma análise de rota foi realizada para avaliar a associação entre a gravidade da ferida, o desconforto e os problemas psicológicos. Resultados: de 140 pacientes com úlcera diabética do pé que participaram deste estudo, a maioria experimentou imobilização (74,3 %), dor (69,3 %) e transtornos do sono (63,6 %). As médias foram: desconforto (2,35 ± 0,33), depressão (1,34 ± 0,41), estresse (1,49 ± 0,48), ansiedade (1,43 ± 0,40) e gravidade da ferida (31,35 ± 9,96). O desconforto foi o mediador em parte da relação entre a gravidade da ferida e os problemas psicológicos, cujo efeito indireto foi de 0,11. Conclusões: verificou-se alta prevalência de desconforto, tanto físico quanto psicológico, em pacientes com úlcera diabética do pé. Além disso, o desconforto intermedeia a relação entre a gravidade da ferida e os problemas psicológicos. A integração do conforto na gestão do cuidado das feridas pode ajudar a reduzir a carga psicológica.

Pressure ulcers related to medical device in intensive care in Indonesia: A prospective study

OBJECTIVES: The aim of this study was to describe the MDrPU on patients with prolonged bed rest in the ICU. METHOD: A prospective cohort design was used in this study. We used non probabilility consecutive sampling. A total of 32 samples were included in this study. The Braden scale and NPUAP staging were used to predict the risk of pressure ulcers, and ulcers staging in 5 days. Statistical analysis were conducted using Chi-Square, Fisher Exact, and ROC Curve. RESULT: The result showed the prevalence of medical devices was 21.9%. Most pressure ulcers related to medical devices was stage 2 (57.1%) with the most common area for the wounds was on fingers (37.5%). Braden scale prediction score also showed specificity (56%) and sensitivity (92%). CONCLUSION: Numerous risk factors for pressure ulcer development were identified and Braden scale could to predict the risk of pressure ulcers related to medical devices

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Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study.

The aim of this study was to clarify the relationship between maceration and wound healing. A prospective longitudinal design was used in this study. The wound condition determined the type of dressings used and the dressing change frequency. A total of 62 participants with diabetic foot ulcers (70 wounds) were divided into two groups: non-macerated (n = 52) and macerated wounds (n = 18). Each group was evaluated weekly using the Bates-Jensen Wound Assessment Tool, with follow-ups until week 4. The Mann-Whitney U test showed that the changes in the wound area in week 1 were faster in the non-macerated group than the macerated group (P = 0·02). The Pearson correlation analysis showed a moderate correlation between maceration and wound healing from enrolment until week 4 (P = 0·002). After week 4, the Kaplan-Meier analysis showed that the non-macerated wounds healed significantly faster than the macerated wounds (log-rank test = 19·378, P = 0·000). The Cox regression analysis confirmed that maceration was a significant and independent predictor of wound healing in this study (adjusted hazard ratio, 0·324; 95% CI, 0·131-0·799; P = 0·014). The results of this study demonstrated that there is a relationship between maceration and wound healing. Changes in the wound area can help predict the healing of wounds with maceration in clinical settings.

Effectiveness of indonesian honey on the acceleration of cutaneous wound healing: an experimental study in mice.

The purpose of this study was to investigate the effectiveness of Indonesian honey in wound healing compared to Tegaderm hydrocolloid dressing and Manuka honey. Three groups of male mice were treated to produce 2 circular, full-thickness skin wounds on the dorsum. They were then randomly allocated to receive daily Indonesian honey, Manuka honey, or hydrocolloid (control). Macroscopic findings were observed from day 0 to 14 after wounding. Microscopic findings on days 3, 7, 11, and 14 after wounding were obtained. The ratios of wound areas for honey groups on day 3 were smaller than those of the control group. Wound areas of honey groups gradually decreased to almost the same wound area as the control group on day 14, while the control group wound area peaked on day 5 and rapidly decreased until day 14. On day 3, myofibroblasts and new blood capillaries in wound tissue of honey groups were observed, but were not seen in the control group. After day 7, microscopic findings were almost the same among the 3 groups. These results indicate that Indonesian honey is almost as effective for wound healing as Manuka honey and hydrocolloid dressing. .