BACKGROUND:Type 2 diabetes remission is an achievable, evidence-based therapeutic goal, yet its integration into routine care remains at an early stage. In China, where leading institutions are pioneering remission-oriented practice, healthcare professionals play a pivotal role in shaping its clinical implementation. Nevertheless, how healthcare professionals perceive, interpret, and enact remission-oriented care remains understudied. AIM:To explore healthcare professionals' perceptions and experiences regarding type 2 diabetes remission implementation and to develop a constructivist grounded theory explaining how remission-oriented care is supported and advanced in clinical practice. DESIGN:A grounded theory study. METHODS:Using constructivist grounded theory methodology, we conducted semi-structured interviews between March and November 2025. Participants were recruited from healthcare settings that implemented type 2 diabetes remission services in Hunan Province, China, including tertiary hospitals, community hospitals, and healthcare companies. Coding proceeded through three iterative phases: initial coding, focused coding, and theoretical coding, combined with constant comparative methods and reflective memo-writing. FINDINGS:We recruited 23 healthcare professionals, including physicians, nurses, dietitians, and healthcare service managers. The core category of the substantive theory, 'sustaining development towards remission', captured the process of remission-oriented care from its conceptual introduction to clinical implementation. This process comprised four interrelated phases: germination, emergence, branching, and flourishing. The theory illustrates how healthcare professionals navigate cognitive adaptation and behavioural transformation in implementing remission-oriented care, highlighting the developmental trajectory of type 2 diabetes remission within routine diabetes management. CONCLUSIONS:The findings emphasise that achieving type 2 diabetes remission holds significant practical implications for promoting proactive health globally, while also representing a challenging process. It advocates that this approach be incorporated into routine diabetes care pathways to support remission-oriented management of type 2 diabetes, improve patient health outcomes, and optimise the professional contribution of nurses in sustainable diabetes management. IMPLICATIONS FOR THE PROFESSION:This study contributes to global understanding of remission-oriented diabetes care by illustrating healthcare professionals' implementation experiences and highlighting the contribution of nurses in supporting remission-oriented management of type 2 diabetes. REPORTING METHOD:The COREQ guidelines for qualitative research reporting were followed. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

AIMS:To explore the perception of patients with high-risk diabetic foot on early access to medical care. DESIGN:Qualitative interview study. METHODS:We conducted a qualitative exploratory and descriptive study involving 11 community-based patients with high-risk diabetic foot residing in Hunan, China. Interviews were systematically coded and categorized into thematic groups using Colaizzi's method. RESULTS:There were five main themes and nine subthemes, namely, (1) Attitude toward healthcare-seeking, (2) Lack of disease knowledge: (a) low symptom alertness, (b) necessity of health education, (3) Hospital visits: (a) doctor-patient relationship, (b) level of medical institutions, (c) obstacles in seeking healthcare, (4) Financial consideration: (a) apprehension about adding to family burden, (b) medical insurance to ease financial stress, (5)Environmental impact: (a) family and social supports, (b) communication between patients. CONCLUSIONS:Patients with high-risk diabetic foot have barriers to early intention to seek medical care, and it is the result of a combination of many factors. Healthcare providers should provide relevant interventions for patients, and health insurance systems should be improved to increase coverage to facilitate timely access.

AIM(S):To evaluate the effectiveness of targeted interventions in optimising Beyond-Use Date (BUD) management and workload distribution to reduce intravenous (IV) medication errors and improve patient safety in a resource-limited hospital setting. DESIGN:This study employed a pre- and post-intervention observational design. METHODS:A four-month intervention was conducted at a large tertiary hospital in China, following a baseline assessment of IV medication practices. The intervention included the establishment of BUD guidelines, redistribution of staff workloads and targeted training sessions. IV preparation and administration errors were observed in Pharmacy Intravenous Admixture Services (PIVAS) centers and medical wards, and changes in error rates were recorded. RESULTS:In the PIVAS center, IV preparation errors decreased from 0.19% to 0.12%. Medical wards showed a decrease in administration errors from 38.3% to 30.0%, with improvements noted in areas such as adherence to BUD and storage protocols. The intervention demonstrated significant improvements in medication safety by enhancing BUD compliance and balancing workloads. CONCLUSION:The implementation of structured BUD guidelines, workload optimisation, and training significantly reduced IV medication errors, highlighting the effectiveness of management-driven interventions in improving safety practices within hospital settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:This study underscores the importance of BUD management and balanced workloads in reducing medication errors, contributing to safer and more efficient IV medication administration. IMPACT:This study addresses the challenge of medication errors in resource-constrained healthcare environments, providing evidence that structured management interventions can enhance patient safety. The findings are relevant to healthcare providers and managers in similar settings. REPORTING METHOD:This study follows the TIDieR and STROBE guidelines for structured reporting. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Objective To develop a concise screening tool for diabetic foot risk assessment in patients with diabetes, and rigorously evaluate its reliability and validity. Methods 390 adults diagnosed with diabetes were selected for a study in Changsha, China. The study was conducted in two phases. In the first phase, initial items were developed by amalgamating existing diabetic foot risk screening tools and group discussions. Additionally, diabetic foot experts established content validity during this phase. In the second phase, the validity and reliability of the developed items were evaluated through various methods such as item analysis, exploratory factor analysis, confirmatory factor analysis, Cronbach's alpha coefficient, retest reliability, inter-rater reliability, ROC curve and AUC. Results The Brief Diabetic Foot Risk Screening Scale consists of 6 dimensions and 19 items. An exploratory factor analysis was conducted on the scale, revealing six principal factors that accounted for 74.139% of the total variance. The I-CVI was greater than 0.8, indicating good content validity, while the S-CVI was 0.737. Confirmatory factor analysis showed that the model fit well. The scale's Cronbach's α coefficient was 0.770, indicating good internal consistency, and its test-retest reliability was 0.958. The AUC suggests that the Brief Diabetic Foot Risk Screening Scale is an effective measure for identifying diabetic foot. Conclusion The Scale is a reliable and valid tool for assessing foot risk.

Objective:Timely screening and intervention can prevent the development of the diabetic foot. However, delayed visits to the clinic are common among diabetic foot patients. The study aimed to develop and validate a questionnaire to assess healthcare-seeking behavior among patients with diabetic high-risk foot. Methods:The questionnaire of healthcare-seeking intention for patients with diabetic high-risk foot was developed in two phases: (1) Developing the questionnaire: 1) questionnaire items were formulated after literature review, group discussion and semi-qualitative interview; 2) a two-round modified Delphi method was to examine the content validity and the degree of consistency in questionnaire items; 3) conducting pre-survey to revise the questionnaire items. (2) Assessing the internal reliability and construct validity. Results:The final questionnaire consisted of five main themes and 28 items with a five-point rating. Cronbach's alpha coefficients for the five dimensions were respectively 0.937 (relevant knowledge of diabetic foot), 0.669 (attitudes toward seeking care), 0.896 (social support for seeking care), 0.621 (efficacy in coping with foot symptoms), 0.871 (intention to seek care). The Scale-level Content Validity Index of the five parts was 1.00, 0.80, 1.00, 1.00, and 1.00, respectively. The Kaiser-Meyer-Olkin values for each dimension was greater than 0.7, and the p-value for Bartlett's test of sphericity was less than 0.05. Conclusion:This questionnaire showed good validity, internal consistency, and reliability. It provided a potentially useful instrument to evaluate healthcare-seeking intention among patients with diabetic high-risk foot.

Objective To evaluate the effects of silver and iodine dressings on healing time, healing rate, exudate amount, pain and anti-infective efficacy.Design Systematic review and meta-analysis.Data sources Databases including PubMed, Cochrane Library, Embase, Web of Science and CINAHL were surveyed up to May 2024.Eligibility criteria Randomised controlled trials comparing silver and iodine dressings on wound healing in humans.Data extraction and synthesis Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data extraction was done independently by two reviewers, with the risk of bias assessed using the Cochrane tool. Narrative synthesis was performed to evaluate the effects of silver and iodine dressings on healing time, healing rate, pain, exudate amount and anti-infective efficacy. Meta-analysis using Review Manager V.5.4 calculated standardised mean differences for healing time and relative risks for rate to quantify the impacts of the treatments.Results 17 studies (18 articles) were included. The meta-analysis indicated that silver dressings significantly reduced healing time compared with iodine dressings (SMD=-0.95, 95% CI −1.62 to −0.28, I2=92%, p=0.005, moderate-quality evidence), with no significant difference in enhancing healing rate (RR=1.29, 95% CI 0.90 to 1.85, I2=91%, p=0.16, low-quality evidence). Based on low-quality evidence, for exudate amount (3/17), 66.7% (2/3) of the studies favoured silver dressings over iodine in reducing exudate volume. For pain (7/17), 57.1% (4/7) of the studies reported no significant difference between silver and iodine dressings, while 42.9% (3/7) studies indicated superior pain relief with silver dressings. For anti-infective efficacy (11/13), 54.5% (6/11) of the studies showed equivalence between silver and iodine dressings, while 36.4% (4/11) suggested greater antibacterial efficacy for silver.Conclusion Silver dressings, demonstrating a comparable healing rate to iodine dressings, significantly reduce healing time, suggesting their potential as a superior adjunct in wound care.PROSPERO registration number CRD42020199602.

Current assessment methods for diabetic foot ulcers (DFUs) lack objectivity and consistency, posing a significant risk to diabetes patients, including the potential for amputations, highlighting the urgent need for improved diagnostic tools and care standards in the field. To address this issue, the objective of this study was to develop and evaluate the Smart Diabetic Foot Ulcer Scoring System, ScoreDFUNet, which incorporates artificial intelligence (AI) and image analysis techniques, aiming to enhance the precision and consistency of diabetic foot ulcer assessment. ScoreDFUNet demonstrates precise categorization of DFU images into "ulcer," "infection," "normal," and "gangrene" areas, achieving a noteworthy accuracy rate of 95.34% on the test set, with elevated levels of precision, recall, and F1 scores. Comparative evaluations with dermatologists affirm that our algorithm consistently surpasses the performance of junior and mid-level dermatologists, closely matching the assessments of senior dermatologists, and rigorous analyses including Bland-Altman plots and significance testing validate the robustness and reliability of our algorithm. This innovative AI system presents a valuable tool for healthcare professionals and can significantly improve the care standards in the field of diabetic foot ulcer assessment.

Aims: In the early stage, we developed an intelligent measurement APP for diabetic foot ulcers, named Diabetic Foot Smart APP. This study aimed to validate the APP in the measurement of ulcer area for diabetic foot ulcer (DFU). Methods: We selected 150 DFU images to measure the ulcer areas using three assessment tools: the Smart APP software package, the ruler method, and the gold standard Image J software, and compared the measurement results and measurement time of the three tools. The intra-rater and inter-rater reliability were described by Pearson correlation coefficient, intra-group correlation coefficient, and coefficient of variation. Results: The Image J software showed a median ulcer area of 4.02 cm(2), with a mean measurement time of 66.37 +/- 7.95 s. The ruler method showed a median ulcer area of 5.14 cm(2), with a mean measurement time of 171.47 +/- 46.43 s. The APP software showed a median ulcer area of 3.70 cm(2), with a mean measurement time of 38.25 +/- 6.81 s. There were significant differences between the ruler method and the golden standard Image J software (Z = -4.123, p < 0.05), but no significant difference between the APP software and the Image J software (Z = 1.103, p > 0.05). The APP software also showed good inter-rater reliability and intra-rater reliability, with both reaching 0.99. Conclusion: The Diabetic Foot Smart APP is a fast and reliable measurement tool with high measurement accuracy that can be easily used in clinical practice for the measurement of ulcer areas of DFU.

截至2023年2月2日,全球新型冠状病毒(新冠病毒)病人已超过7.53亿,中国新冠感染病人超过9852万[1].一项横断面调查显示,27.5％的老年新冠感染病人有营养不良的风险,52.7％的病人存在营养不良[2].营养是支持免疫系统的关键,良好的营养状况能够增强机体免疫功能,从而抵御新冠感染、减缓疾病恶化进程、改善临床结局[3].国家卫生健康委员会印发的《新型冠状病毒感染重症病例诊疗方案(试行第四版)》[4]和中华医学会肠外肠内营养学分会《关于新型冠状病毒肺炎病人的医学营养治疗专家建议》[5]中也都强调了营养支持作为基础治疗之一的重要性.因此,本文通过对老年新冠感染病人的营养支持相关文献和研究进行查阅、回顾、总结,旨在为老年新冠感染病人的营养支持提供较为全面的参考.

Objective:To construct a non-weight-bearing exercise program suitable for patients with diabetic foot ulcer (DFU) in China and to evaluate its feasibility.Methods:Based on the heuristic framework, from September to October 2021, 109 DFU patients were recruited in Xiangya Hospital of Central South University as the research participants. A cross-sectional survey, qualitative interview, sinicization scheme and expert meeting methods were used to form a non-weight-bearing exercise program based on self-determination theory. From November to December of the same year, 15 patients with DFU were recruited to conduct a quasi-experimental study to evaluate its safety and feasibility. Glycated hemoglobin A 1c (HbA 1c), ankle brachial index (ABI), lower limb muscle strength and ulcer area were collected before and after non-weight-bearing exercise intervention. A paired sample t-test was used to compare the indicators before and after the intervention. Results:DFU patients had poor motor behavior, and their movement disorders included psychological, physical and environmental disorders. The non-weight-bearing exercise program focused on movement disorders of DFU patients was constructed through expert meetings. The courses on the topics of self, ability and environmental needs were set up, and exercise videos and manuals were provided. The results of the quasi-experimental study showed that 87% (13/15) of DFU patients completed the non-weight-bearing exercise program (exercise intervention at least twice a week). There were no adverse events such as cardiovascular events (angina attack, sudden death), metabolic disorders (hypoglycemia, hyperglycemia), or bone, joint and ligament injuries during the intervention period. Compared with those before the intervention, ABI and lower limb muscle strength were increased, HbA 1c and ulcer area were decreased in DFU patients after intervention ( P<0.05). Conclusion:The constructed non-weight-bearing exercise program is in line with the clinical situation and exercise psychology of Chinese DFU patients, and has good safety and feasibility.

2022 年12 月份以来,新型冠状病毒感染(新冠)疫情形势愈加严峻复杂,社会面感染率持续攀升,老年人抵抗力低、感染率高、基础病和合并症多,感染后病情发展快,易发展成重症、危重症.

Abstract Background Lifestyle changes are important for the prevention and management of metabolic syndrome (MetS), but studies that focus on gender differences in the lifestyle risk factors of MetS are limited in China. This research aimed to generate a healthy lifestyle index (HLI) to assess the behavioral risk factors of MetS and its components, and to explore the gender differences in HLI score and other influencing factors of MetS. Methods A convenience sample of 532 outpatients were recruited from a general hospital in Changsha, China. The general information and HLI scores [including physical activity (PA), diet, smoking, alcohol use, and body mass index (BMI)] of the subjects were collected through questionnaires, and each patient’s height, weight, waist circumference, and other physical signs were measured. Logistic regression analysis was used to analyze the risk factors of MetS and its components. Results The prevalence of MetS was 33.3% for the whole sample (46.3% in males and 23.3% in females). The risk of MetS increased with age, smoking, unhealthy diet, and BMI in males and with age and BMI in females. Our logistic regression analysis showed that lower HLI (male: OR = 0.838,95%CI = 0.757–0.929; female: OR = 0.752, 95%CI = 0.645–0.876) and older age (male: OR = 2.899, 95%CI = 1.446–5.812; female: OR = 4.430, 95%CI = 1.640–11.969) were independent risk factors of MetS, for both sexes. Conclusion Low levels of HLI and older ages were independent risk factors of MetS in both males and females. The association between aging and MetS risk was stronger in females, while the association between unhealthy lifestyles and MetS risk was stronger in males. Our findings reinforced the expected gender differences in MetS prevalence and its risk factors, which has implications for the future development of gender-specific MetS prevention and intervention programs.

糖尿病足溃疡是糖尿病患者最常见、最严重的并发症之一,具有发生率高、复发率高、致残致死率高和治疗费用高等特征.本文从糖尿病足截肢的流行病学和危害、截肢的影响因素以及糖尿病足患者的综合管理等方面进行综述,旨在帮助临床医务人员更好地评估糖尿病足患者的截肢风险,以进行有针对性的干预措施及综合管理,从而降低患者的截肢率和提高生活质量.

A diabetic foot ulcer(DFU) is a common chronic complication of diabetes because of the dysfunction of islets or receptors of insulin, and it has a high disability and mortality rate. Measuring diabetic foot ulcers is also one of the popular application areas where computer vision combines with deep learning techniques. However, some remaining defects in these studies prevent them from accurately visualizing the wound of different severity. Based on this, we used a multi-classification model to mark the wounds into five grades according to the Wagner diabetic foot grading method. It segmented the different grades in each different level wound using colorfully nested ring shapes to reflect the gradual change of wound grades. We collected 1426 DFU images, of which 967 had nested labels and 459 were single-level labels, with images marked with colored rings to show different degrees of wounds. And then, we constructed a deep learning model of diabetes foot ulcer wounds for semantic segmentation based on Mask Region-based convolutional neural networks (Mask R-CNN), and obtain different levels of diabetes nested segmentation results to reflect the different severity in one wound. Finally, we test and evaluate the performance data of the model. Compared with the state-of- the-art results concerning segmentation and classification and diagnosis of diabetic foot wounds, our model has achieved better performance data (specificity = 99.50%, sensitivity = 70.62%, precision = 84.56%, Mean Average Precision = 85.70%). It shows the effectiveness of our nested segmentation and multi-level classification method. It provides some suggestions and directions for the subsequent evaluation and diagnosis and treatment of diabetic foot ulcers.

Abstract Background Diabetic foot is a serious complication of diabetes with a high disability and mortality rate, which can be prevented by early screening. General practitioners play an essential role in diabetic foot risk screening, yet the screening behaviors of general practitioners have rarely been studied in primary care settings. This study aimed to investigate foot risk screening behaviors and analyze their influencing factors among general practitioners. Methods A cross-sectional study was conducted among 844 general practitioners from 78 community health centers in Changsha, China. A self-designed and validated questionnaire was used to assess the general practitioner’s cognition, attitude, and behaviors on performing diabetic foot risk screening. Multivariate linear regression was conducted to investigate the influencing factors of risk screening behaviors. Results The average score of diabetic foot risk screening behaviors among the general practitioners was 61.53 ± 14.69, and 271 (32.1%) always or frequently performed foot risk screening for diabetic patients. Higher training frequency (β = 3.197, p < 0.001), higher screening cognition (β = 2.947, p < 0.001), and more positive screening attitude (β = 4.564, p < 0.001) were associated with more diabetic foot risk screening behaviors, while limited time and energy (β=-5.184, p < 0.001) and lack of screening tools (β=-6.226, p < 0.001) were associated with fewer diabetic foot screening behaviors. Conclusion The score of risk screening behaviors for the diabetic foot of general practitioners in Changsha was at a medium level. General practitioners’ diabetic foot risk screening behaviors may be improved through strengthening training on relevant guidelines and evidence-based screening techniques, improving cognition and attitude towards foot risk screening among general practitioners, provision of more general practitioners or nurse practitioners, and user-friendly screening tools.

总结1例老年甲下黑色素瘤合并糖尿病足患者的护理经验.患者行右足趾截趾皮瓣转移腹股沟淋巴结清扫术,术后予以控制血糖、抗感染、护胃、营养支持、改善循环、及时换药等处理,术后经多次换药后创面大小为2.0 cm×1.5 cm×1.6 cm,基底黑色>75％,红色<25％;渗液潮湿、色浑浊、无臭.出院后临床随诊,最终创面伤口全部愈合,患者活动自如.这表明多学科团队合作能加速甲下黑色素瘤合并糖尿病足患者的康复.

OBJECTIVE:To investigate knowledge, attitude and practice of screening pre-ulcerative lesions among endocrinology healthcare workers. METHODS:A new questionnaire was developed and distributed online and 1004 valid questionnaires were returned. T-test, ANOVA, Pearson correlation analysis, and multiple linear regression were used for statistical analysis. RESULTS:A total of 1100 questionnaires were returned, and 96 were excluded. The scores of endocrinology healthcare workers' knowledge, attitude, and practice for screening for pre-ulcerative lesions were 45.46 ± 16.26, 92.11 ± 10.50, and 72.27 ± 17.63 respectively. 60.2% participants had been trained to screen for pre-ulcerative lesions, but 39.8% had not been trained. 31.8% of healthcare professionals claimed that their hospital did not have a screening project for pre-ulcer diabetic foot lesions. Positive relationships were found between knowledge and practice and between attitude and practice. Multiple linear regression analysis showed that: level II hospital and tertiary hospital were the main factors influencing the knowledge scores; Undergraduate and participating in relevant training were the main factors influencing the attitude scores; participating in relevant training, hospital conducts relevant projects, and patient cooperation, and working hours were the main factors influencing the practice score. CONCLUSIONS:Endocrinology healthcare workers need more knowledge regarding pre-ulcerative lesions, and their screening practices need to be strengthened. Increased education and training for pre-ulcerative lesion screening should be implemented among healthcare workers in endocrinology departments.

负压伤口疗法是老年糖尿病足创面治疗的辅助治疗技术之一,现被临床广泛用于老年糖尿病足创面的治疗.但是,我国对该技术在老年糖尿病足溃疡治疗中的临床应用缺乏规范化管理,导致其应用过程中出现创面出血、感染加重、组织缺血或坏死等并发症,进而影响治疗效果.2021年海峡两岸医药卫生交流协会烧创伤暨组织修复专委会组织相关专家撰写了《负压伤口疗法在糖尿病足创面治疗中的应用全国专家共识(2021版)》,"共识"以循证医学为基础,结合临床研究进展,对负压伤口疗法在糖尿病足创面治疗中的应用提出了最佳临床实践治疗方案.因老年病人为慢性创面的主要群体,本文结合老年人群特点对该"共识"的重点部分进行解读,以期为临床运用负压伤口疗法治疗老年糖尿病足创面提供参考.

从身体活动(PA)/运动影响的两面性,全球健康PA/运动建议,老年人的运动建议,PA/运动对骨骼健康、脂肪组织、肌肉质量以及力量的作用,PA/运动在疾病一、二和三级预防中的作用及PA/运动的个体间变异性和剂量反应的异质性等方面对《国际老年人运动建议(ICFSR):专家共识指南》进行要点解读.该指南重点突显了运动对于老年人是一剂良药的核心理念,以期为今后在中国老年人群中开展PA/运动来促进健康、预防疾病和治疗干预提供循证依据,也为随机对照试验中运动处方的具体方式和剂量提供参照.

Aim: This study was conducted to increase knowledge on the actuality of resilience, social support and quality of life among inflammatory bowel disease patients in China to provide evidence for psychological support. Design: Using convenience sampling, 249 outpatients and inpatients with inflammatory bowel disease from a hospital who completed the questionnaires were enrolled in the analytic questionnaire-based study. Methods: Demographic information forms, Resilience Scale for Inflammatory Bowel Disease, Social Support Rating Scale and Short Health Scale were administered. Results: It was found that the resilience of patients with inflammatory bowel disease should be enhanced. When considering factors that influence resilience, the place of residence (living in rural areas) and utilization of social support should be considered. Resilience demonstrated a positive correlation with utilization of social support, and different place of residence was related to resilience. Targeted interventions should be implemented to increase patients' resilience and quality of life.