Beyond statistical significance:Embracing minimal clinically important difference for better patient care

The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.

Application of Clinical Care Pathway in Perioperative Patients with Autologous Arteriovenous Fistula Balloon Expansion

[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.

Psychological and social aspects of infertility in men： an overview of the evidence and implications for psychologically informed clinical care and future research

Research concerning the psychosocial aspects of infertility and infertility treatment focuses more often on women than men. The aim of this review was to synthesize the English-language evidence related to the psychological and social aspects of infertility in men and discuss the implications of these reports for clinical care and future research. A structured search identified 73 studies that reported data concerning the desire for fatherhood and the psychological and social aspects of diagnosis, assisted reproductive technology （ART） treatment and unsuccessful treatment among men with fertility difficulties. The studies are diverse in conceptualisation, design, setting and data collection, but the findings were reasonably consistent. These studies indicated that fertile and infertile childless men of reproductive age have desires to experience parenthood that are similar to those of their female counterparts; in addition, diagnosis and initiation of treatment are associated with elevated infertility-specific anxiety, and unsuccessful treatment can lead to a state of lasting sadness. However, rates of clinically significant mental health problems among this patient population are no higher than in the general population. Infertile men who are socially isolated, have an avoidant coping style and appraise stressful events as overwhelming, are more vulnerable to severe anxiety than men without these characteristics. Men prefer oral to written treatment information and prefer to receive emotional support from infertility clinicians rather than from mental health professionals, self-help support groups or friends. Nevertheless, structured, facilitated psycho-educational groups that are didactic but permit informal sharing of experiences might be beneficial. There are gaps in knowledge about factors governing seeking, persisting with and deciding to cease treatment; experiences of invasive procedures; parenting after assisted conception; adoption and infertility-related grief and shame among men. Few resource-constrained countries have any data concerning male experiences of infertility.

Clinical decision making on the use of physical restraint in intensive care units

Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived alternatives.This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses.By reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases.However,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint.Besides that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated.Therefore,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Multimorbidity, defined as 2 or more chronic diseases, is of increasing importance for health professionals. Many factors are at play when it comes to multimorbidity, but we still know very little about how clinicians actually weigh up the different factors—medical, social, and psychological—to reach a particular course of action. Further research is therefore required to explore the ways in which clinical reasoning processes are involved in the follow up of patients suffering from multimorbidities, to highlight their potential risks of errors. A better understanding of these clinical processes will also enrich supervision of trainees and collaboration between healthcare professionals involved in primary care.

Relationship of Clinical Nursing Competence to Nursing Occupational Experience in Hospice/Palliative Care Nurses in Japan

Aim: The purpose of this research is to examine the relationship between the clinical nursing competence and nursing occupational experience in hospice/palliative care nurses (HPN) in Japan. Methods: A mail survey using an anonymous self-administered questionnaire was conducted on clinical nursing competence regarding communication, care and prediction of worsening of symptoms with the authors’ previous research as a framework. The subjects were nurses working in hospice/palliative care units in Japan, and the period of survey was January to February, 2014. Results: In this study, the relationship between the clinical nursing competence and nursing occupational experience of HPNs in hospice/palliative care which was clarified in the authors’ previous research was examined. The results showed that the amount of clinical nursing experience as a nurse was related to clinical nursing competence in the care of end-of-life patients and worsening of symptoms. The abundance of specialized nursing experience was also related to clinical nursing competence in communication in addition to care and prediction of worsening of symptoms. Training experience was also shown to be effective for hospice/palliative care. Conclusion: From these results, clinical nursing competence of HPNs in care of end-of-life patients and prediction of worsening of symptoms are possibly learned through the accumulation of clinical nursing experience as a nurse. However, HPN’s clinical nursing competence in communication was suggested to be developed through nursing practice in hospice/palliative care.

Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross-sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept. 2012 data from medical records, including results of clinical examinations and laboratory tests performed during the last one year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC&reg-723G8 Tosoh Corporation, Japan). Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2 diabetes in 95.7%. Co-morbid hypertension was present in 68.5%;90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2 h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%;55.5% and 28.2% had BP ≤ 140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥ 200 mg/dl, serum creatinine ≥ 1.2 mg/dl and macro albuminuria were noted in 39.8%, 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified were: reliance on 2 h PPG to measure control;non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system;and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA’s efforts can serve as an inspiration to others.

Medical care and clinical practice for disabled elderly

At preasent,with the continuous development of the trend of population aging worldwide,more elderiy people are increasingly facing s-erious life disorders caused by physical and mental disability.In this study,the common symptoms and the nursing practice related to diseases of the disabled elderly are reviewed with reference to the basic concepts of disability care and the current situation of domestic and foreign research,which is expected to provide the basis for the construction of a new model of disability nursing.

An Analysis of the Application of the Suggestions of Clinical Practice Guideline for Ostomy Care in China:A Cross-Sectional Investigation

Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.

Research Progress on Clinical Nursing of Hypertension

High-quality nursing care can greatly reduce the occurrence of nursing accidents and help patients maintain better physical and mental health.For patients with hypertension,special attention should be given to clinical nursing.Providing scientific medication guidance,along with psychological support,can improve their medication compliance and establish a good doctor-patient relationship,aiding in their faster recovery.Based on a review of relevant literature and the author's practical experience,this paper first analyzes the content and requirements of clinical nursing for hypertension,then discusses the main factors that restrict the effectiveness of clinical nursing for hypertension,and finally suggests improvements to the clinical nursing model for hypertension to serve as a reference for colleagues.

The Application of Psychological Nursing in Pediatric Clinical Nursing

Objective:To study the application effect of psychological nursing in pediatric clinical nursing.Method:100 pediatric patients who underwent treatment in our hospital from January 2019 to December 2020 were selected as the research subjects.They were randomly divided into a control group and an observation group,with 50 cases in each group.The control group received routine nursing care,while the observation group received psychological care based on routine nursing care.The nursing compliance,incidence of adverse events,and parental satisfaction of the two groups of pediatric patients were compared and analyzed.Result:Through psychological nursing intervention,it was found that the observation group had better nursing compliance,incidence of adverse events,and parental satisfaction than the control group,P<0.05,the differences are statistically significant.Conclusion:The application of psychological nursing in pediatric clinical nursing can improve the compliance of pediatric care,reduce the incidence of adverse events,enhance parental satisfaction,and have clinical promotion and application value.

Evaluation of the Effect of Endoscopic High- Frequency Electrocoagulation Electrodesiccation of Intestinal Polyps in the Clinical Nursing Pathway

Objective: To evaluate the effect of endoscopic high-frequency electrocoagulation electrodesiccation (HFEE) of intestinal polyps in the clinical nursing pathway. Method: A total of 120 patients who underwent HFEE of intestinal polyps were randomly divided into two groups of 60 cases. The control group received conventional nursing care while the observation group received the clinical nursing pathway of HFEE. Results: The average length of hospitalization, hospitalization costs, and mastery of the three health education of the observation group was lower than that of the control group (P < 0.01). The satisfaction of care in the observation group was significantly better than the control group (P <0.01). Conclusion: The clinical care path was suitable for HFEE of intestinal polyps, which shortened the patient’s length of hospitalization, improved their awareness of health education, improved their satisfaction with care, reduced medical disputes, and promoted the good development of nurse-patient relationships .

Experience of clinical pharmaceutical care carried out in pediatric respiratory department

Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department.Methods Supply pharmaceutical information,participate in clinical rounds,provide the rationalization proposal,help doctors to formulate correctly dose regimen,enhance medication efficiency;establish medicine record for the patient,record the drugs which were used,provide pharmaceutical care for the patient such as disease propaganda,medicine-use education,medicine consultation and so on.Results Promote rational administration,enhance the security of medical practice,the clinical pharmacists' work obtains the doctors' approval;improve the medication compliance,reduce patients' economy and spiritual burden,and obtain the patients' trust.Conclusions The pharmaceutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors,cut down the medication cost,shorten the time of patients to be hospitalized,raise the medication efficiency,and promote the doctor-patient relationship harmoniously.In a word the clinical pharmacists are indispensable.

A Study of Health Prescribing for Children with Tourette’s Disorders in Children’s Health Education Specialty Care Clinics

Objective:This study designs and implements the health prescription of children’s health education specialized nursing clinic based on the physical and mental characteristics of children with Tourette’s syndrome.Methods:Applying the evidence-based nursing model and nursing intervention theory based on the survey research by searching China Knowledge Network,Wanfang Database and Wipro Chinese Science and Technology Journal Database,the study collected the literature on the health prescription intervention research in children’s Tourette’s disorders health education in children’s health education of specialized nursing outpatient clinic for review and combined with the specialty characteristics to formulate“Children’s Tourette’s Disorder Health Education Prescription.”Results:Tourette’s syndrome in children is a common pediatric neurological disorder,mainly manifested as involuntary,rapid and repeated muscle twitching and vocal tics,which brings serious psychological pressure and life disturbance to the affected children.Conclusion:For children with Tourette’s syndrome,healthcare professionals should give enough care and understanding to the children and their parents,provide timely and effective health education to them,help them improve their bad behavioral habits,establish correct cognitive attitudes,enhance self-confidence,improve patient compliance,reduce the frequency of recurrence,reduce the incidence of complications and promote children’s physical and mental health development.

Disparity in clinical care for patients with inflammatory bowel disease between specialists and non-specialists

Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.

Level of Stress at Nurses Working in Emergency Clinic and Central Intensive Care: University Clinical Centre of Kosovo

Background: Emergency Clinic (EC) and Central Intensive Care (CIC) are high-stress environments that directly affect the health status of nurses. Methods: The aim of this study was to assess the level of stress at nurses working in the Emergency Clinic and nurses working in the Central Intensive Care. The study included 90 nurses, 45 nurses working in Emergency Clinic and 45 nurses working in Central Intensive Care. The study applied the Emergency Nurse Stress Questionnaire as an instrument to gather the data. This questionnaire was adopted from the Operational Police Stress Questionnaire in order to serve for the function and aim of the present study. Results: Nurses’ cohort-age ranged from 20 to 62 years. The largest proportion of respondents 40 (44.4%) was in the 20 - 30 age group, 58 (64.4%) were married, 60 (66.6%) hold bachelor degree and (33.3%) were with secondary school educational level. In terms of work-related fatigue, significant difference was found in working hours, participants reported that there was a significant difference in fatigue between 12 hours shift nurses (61 ± 10.5) compared to 8 hours nurses (41 ± 23.6) with P < 0.001. Results indicated that a vast majority of participants reported moderate to high levels of stress (81% of participants). There was no significant difference in the level of stress between the two groups of participants. There were also no significant differences compared to their demographic characteristics. Conclusion: These findings emphasize the role of using and assuring adequate strategies for ensuring quality management and finding ways of facilitating the increase in the number of nursing staff in these two departments because workplace overload and fatigue are potential factors that increase nurses’ stress levels.

Relationship between clinical performance and professional self-concept in critical care nurses

Objective:To determine the relationship between clinical performance and professional self-concept in critical care nurses.Methods:This study was conducted on 308 critical care nurses.Data gathering instruments were nurses’clinical performance questionnaire(NCPQ)and nursing professional self-concept measure(NPSCM).Independent sample t-test,one-way analysis of variance(ANOVA),and Pearson correlation coefficient were used for data analyses.Results:The average age of the nurses was 33.74±7.01 years.The clinical performance score of female nurses was significantly higher than male nurses.In the domain of clinical performance,clinical judgment and clinical inquiry had the highest and lowest scores,respectively.In the nurses’professional self-concept,the highest and lowest scores were awarded to the subscales of self-confidence and staff relations,respectively.In addition,there was a significant positive correlation between self-concept and clinical performance of nurses.Conclusions:Increasing professional self-concept improves the clinical performance of critical care nurses.Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.

Clinical nursing care of a nurse diagnosed with COVID-19in Wuhan Union Hospital

The coronavirus disease (COVID‑19) has claimed thousands of lives. The patients have been quarantined and treated in special shelter hospitals,and mild illness accounts for the majority of the total number of patients. This article reports one case of the first batches of infected medicalstaff, who got infected with 2019 novel coronavirus and later discharged 2 weeks after receiving treatment and nursing care in Wuhan UnionHospital. Considering all aspects of the patient’s hospitalization, the patient was performed ward environment management, medical nursing,symptomatic treatment, nutrition management, vital signs monitoring, observation and nursing, psychological assessment and support, andinfection protection and management. As the earliest successful case of cure, the patient’s manifestations are classical and common. Moreover,we hope to share it with colleagues to fight against COVID‑19 for reference. The treatment and nursing guidelines can be applied to treat a largenumber of mild cases, thus improving the discharge rate of patients and reducing the pressure of epidemic situation.

Progress of clinical decision support systems in stroke nursing care

Stroke is characterized by high incidence,high recurrence,high disability,and high morbidity and mortality in China,resulting in a heavy social and clinical burden.A clinical decision support system,as an intelli-gent computer system,can assist nurses in decision-mak-ing to collect information quickly,make the most suitable personalized decisions for patients,and improve nurses’decision-making judgment and quality of care.Promoting the development and application of decision support sys-tems in stroke nursing significantly enhances the nursing staff’s work quality and patients’prognosis.Therefore,this paper reviews the research progress of domestic and international clinical decision support systems in stroke nursing care to provide other researchers with specific research directions for developing and applying decision support systems in stroke nursing care.

Clinical Evaluation of Novel Natural Polysaccharides Sacran as a Skincare Material for Atopic Dermatitis Patients

Atopic dermatitis is a skin disease characterized by inflammation, pruritus, and chronic or relapsing eczematous lesions. Recently, ampholytic polysaccharide sacran has attracted a particular focus of attention as a novel biomaterial. In the present study, we investigated the effect of sacran solution on atopic dermatitis in the clinical study. Almost all of the average scores for atopic dermatitis symptoms of each patient treated with sacran solutions were improved. In addition, the scores of sleep disorder and itching were also significantly ameliorated by the sacran treatment for 4 weeks, compared with those of initial states. In immatured dermal skin model stimulated with 2,4-dinitrofluorobenzene (DNFB), the sacran treatment markedly down-regulated inflammatory cytokine and chemokine mRNA levels such as MCP-1, TNF-α, IL-1β, and IL-6 mRNAs, compared with that of DNFB alone. Furthermore, a sacran solution significantly suppressed the mRNA expression of TNF-α and COX-2 in RAW264.7 cells, a murine macrophage-like cell line, stimulated with phorbol-12-myristate-13-acetate (PMA). In RBL-2H3 cells, a rat basophilic leukemia cell line, a sacran solution significantly lowered β-hexosaminidase release, indicating the suppression of allergic response. These results suggest that a sacran solution may have the potential to improve atopic dermatitis through the impairment of production of inflammatory cytokine and chemokine mRNA.