Objective To observe the outcomes of toe amputations in diabetic patients and to analyze the affecting factors.Methods Two-hundred and forty-five patients were divided into 2 groups:202 cases with the wound healed after toe amputation,and 43 patients whose wound did not heal after toe amputation.The factors related to healing were analyzed.Patients with healed wounds after toe amputations ( n =202 ) were followed,regarding reappearance of new ulcers,reamputations,mortality,activities of daily life,and the affecting factors.Results The rate of wound healing was 82.4％.The rate of follow-up in the healed group was 91.6％.The rates of reappearance of new ulcers after 1,3,and 5 years of observation were 27.3％,57.2％,76.4％,respectively.The rates of reamputations after 1,3,and 5 years of observation were 17.5％,22.3％,47.1％,respectively.The mortality rates by 1,3,and 5 years after the toe amputations were 3.8％,15.1％,32.7％,respectively.Mean survival time of the fatal cases after the first amputation was 3.8 (95％ CI 3.4-4.1 )years.Multivariate analysis showed that HbA1c (＞9％)was an independent predictor of wound healing,reappearance of new ulcers,and reamputations after toe amputations,and age ( ＞ 70 years ) was an independent predictor of reamputations,mortality,and hampered daily activities.Conclusion Despite a satisfactory initial healing process after the first amputation,the long-term outcomes of the followed-up patients are not optimistic.Senile patients are often with poor prognosis,and good blood glucose control may improve the prognosis.

Objective To investigate the effect of exercise prescription on foot perfusion and ulcer healing in patients with diabetic foot ulcer (DFU) accompanied with peripheral arterial disease (PAD).Methods Sixty patients with DFU and PAD were divided into exercise group and control group.The patients in the exercise group took exercise therapy training,ensuring that they could follow the exercise prescription.The patients in the control group had no exercise requirements.After the treatment for 12 weeks,ankle brachial index (ABI),transcutaneous oxygen tension (TcPO2),skin temperature,body mass index (BMI),HbA1C,and the ulcer healing rate in the two groups were compared,the satisfaction and compliance in the exercise group were evaluated,and the adverse events of the treatment were recorded.Results After the treatment for 12 weeks,the ABI,TcPO2,and foot skin temperature in the two groups increased and HbA1C decreased(P＜0.05 or P＜0.01).TcPO2 increased 5.25 mm Hg(1 mm Hg=0.133kPa),skin temperature increased 0.45℃,and BMI decreased 0.69 kg/m2 in the exercise group,while TcPO2 increased 2.59 mm Hg,skin temperature increased 0.28℃,and BMI increased 0.02 kg/m2 in the control group,showing significant differences in the three index changes between two groups (P＜0.01).The healing rate in the exercise group was higher than that in the control group (53.6％ vs 25.9％,P ＜0.05).The patients'compliance and satisfaction to the exercise therapy were 90％ and 94％,respectively.The incidence of adverse events in the exercise group had no causal relationship with the exercise prescription.Conclusion The exercise prescription in the study can improve the foot perfusion,and promote ulcer healing.It has the advantage of high safety,patients'compliance and satisfaction.

Objective To investigate the effect of healthcare cooperation model on the liver disease nursing specialist knowledge and quality of care .Methods The patients , from January 2012 to December 2013, with liver disease were implemented with the healthcare cooperation model .The patients from January to December 2011 were treated with routine care .The specialist nursing knowledge , healthcare cooperative attitude and physician care differences in staff satisfaction were compared .Results The scores of nursing specialist knowledge and practical operation after the implementation of the healthcare cooperation model were (92.36 ± 4.62) and (91.25 ±3.76), which were significantly higher than those of (85.78 ±5.02) and (85.32 ± 4.13) before the implementation (t=4.323, 4.116, respectively;P<0.05).The cooperative attitude scores of doctors and nurses were (65.36 ±10.46) and (64.33 ±11.27) after the implementation of the healthcare cooperation model, which were significantly higher than those of (52.36 ±8.28) and (51.98 ±9.75) before the implementation (t=5.986, 6.023, respectively;P<0.05).The rate of satisfaction of doctors, nurses and patients were 100.00%, 93.33% and 96.00% after the implementation of the healthcare cooperation model , which were significantly higher than those of 55.56%, 53.33% and 60.00% (χ2 =6.986, 7.129, 9.442, respectively;P<0.05).Conclusions The application of healthcare cooperation model can improve nursing specialist knowledge , and enhance nursing staff ’ s motivation and improve quality of care and satisfaction .It is worthy of promotion .