The challenges of clinical nursing research: strategies for successful conduct

Although the literature is replete with stringent methodological guidelines for designing experimental and quasi-experimental studies, there is a paucity of literature addressing the challenges of conducting these studies in the "real world" of the clinical setting. This article describes the challenges experienced by a team of researchers conducting a study in the acute care setting, including those associated with navigating organizational restructuring and managing within a climate of uncertainty. The study focused on the evaluation of a nurse-delivered smoking cessation intervention for hospitalized cardiac patients. As each particular challenge emerged, strategies were developed. By explicating these challenges and strategies, we hope to help clinical researchers deal with challenges proactively rather than reactively.     

Formulating clinical research hypotheses as structural equation models: A conceptual overview.

Structural equation modeling is a comprehensive, flexible approach to research design and data analysis. Although in recent years there has been phenomenal growth in the literature on technical aspects of structural equation modeling, relatively little attention has been devoted to conceiving research hypotheses as structural equation models. The aim of this article is to provide a conceptual overview of clinical research hypotheses that invite evaluation as structural equation models. Particular attention is devoted to hypotheses that are not adequately evaluated using traditional statistical models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impending paradoxical embolus: clinical imaging and successful surgical treatment

AIM OF THE STUDY: Postoperative sensory component of the facial nerve after acoustic tumor surgery has received little attention in the literature. The object of the present investigation was to review this specific topic analyzing the postoperative frequency of taste and lacrimation (crocodile tears or dry eye) abnormalities. MATERIAL AND METHODS: 54 patients who underwent acoustic tumor removal were selected for this study. Each of these patients was recalled and pre and postoperative evolution of the sensory dysfunction were assessed. The latters were correlated with the facial function evaluated according to the House-Brackmann classification. RESULTS: Postoperative taste dysfunction (reduced or changed sensation) was complained by 38.5% of the patients. After surgery, 42.3% of the cases had crocodile tears, while in 59.6% altered tearing occurred. DISCUSSION: The present study, according to the Irving et al's experience confirmed a significant incidence of postoperative abnormal function of the sensory facial nerve. The influence of the motor component on these outcomes was variable. Lacrimation worsened when facial function was poor. On the other hand, grades V or VI did rarely manifest crocodile tears. Clinically, these findings implies the importance of a preoperative counseling of such particular aspect in the candidates to surgery of acoustic neuroma in order to adequately motivate them and, at the same time, to reduce their psychological discomfort.     

Directions for clinical research and genomic research into the next decade: implications for informatics

Managed care continues to revolutionize the provision of mental health services in the United States. Long-term, open-ended therapies have been replaced by short-term, highly focused interventions. Increasingly, managed care organizations rely on standardized preferred practice guidelines to give direction and focus to social work and other therapeutic interventions. Critics argue that changes effected by managed care, particularly the use of treatment guidelines, depersonalize the client-worker relationship and significantly reduce the role of empathy in the therapeutic process. Moreover, these critics suggest that overall client satisfaction with mental health services has deteriorated. This article presents a study that examined clients' perceptions of empathy and overall satisfaction with managed behavioral health care when the clients were in unstructured individual therapy or in time-limited standardized group therapy. The results reveal no significant difference in the clients' perception of empathy or of their overall satisfaction regardless of the type of treatment they received. This article describes the rationale and design of the study, presents the results, and discusses the implications for social work practice.     

Prospective research on fetal cholelithiasis: incidence, predisposing conditions, echographic diagnosis, and clinical features

The Authors report a prospective study on fetal cholelithiasis, analyzing its differences with the more widely known cholelithiasis of paediatric age. The study shows that the number of cases diagnosed by ultrasonography is higher than expected (0.39%, 3 cases on 764 pregnancies). The Authors could find no correlation between fetal cholelithiasis and any maternal, obstetrical and fetal factor. They have focused attention on sonographic imaging showing clinical-instrumental correlation between echogenic material, clinical features and their evolution. The study confirms that the most common evolution results in spontaneous resolution of fetal endocholecystic pathological images. Finally, wide review of the international literature is reported on the rare, but possible clinical manifestations and their complications.     

Ethics and research: ethical considerations in clinical research

Two subjects are discussed: the use of placebo controls in clinical trials and informed consent. Particularly in trials of drugs for disorders for which there exist effective treatments, the use of placebo is still controversial, although anyhow in violation of the Declaration of Helsinki. Informed consent aims at giving a subject all the necessary information to allow him to decide, with full knowledge, whether to accept a particular treatment or experimental protocol. Its importance would seem, albeit essential, to be rather illusory.     

A telecommunication monitoring system for clinical and research practice.

The telephone has been used in clinical and research practice for many years. A telecommunication monitoring system (TMS) provides an automated way to track patients' and participants' symptoms, compliance, and progress as they participate in therapy and research. Data demonstrating the usefulness, strong reliability and validity, and convincing sensitivity and specificity of a TMS are provided. Future applications of this type of technology are discussed, including the ability to integrate a system with the Internet to create a more comprehensive approach to monitoring patients in therapy and participants in research studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethics in clinical research: searching for absolutes

Recently botulinum toxin has been used with increasing frequency as a safe and effective treatment for many previously refractory conditions associated with excessive muscle activity. The indications for use of botulinum toxin injection continue to expand. This report describes the case of an 83-year-old woman with a history of diabetes mellitus and lumbar spinal stenosis who developed a severe focal dystonia of the left great toe, such that the toe maintained the extended position. Functionally, the resultant deformity prevented the patient from wearing shoes. In addition, the patient had significant pain in the left great toe. Under needle electromyographic localization, 50 units of botulinum toxin were injected into the left extensor hallucis longus muscle. Two weeks after the injection the patient was symptom free and could place her left foot into a shoe. Seven months later, she remained symptom free. This case illustrates that localized injection of botulinum toxin to a specific lower limb muscle can effectively result in decreased muscle activity and functional improvement.     

Fear-reduction research and clinical phobias.

Reviews research concerning the behavioral treatment of clinical phobias, and compares findings with related analog studies of Ss with mild fears. Despite the frequently expressed need for caution in generalizing from one population or type of fear to another, earlier reviews based largely on analog studies have tended to ignore this problem. Conclusions regarding the effects of nonspecific treatment variables, anxiety levels during treatment, imaginal or real exposure to phobic situations, and motivational variables in changing phobic behavior are qualified by reference to research with clinical populations. These findings suggest that analog studies may give misleading impressions of the relative importance of different components operating in clinical treatments. (66 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodology for interfacing results of basic science research and clinical practice

The importance of the integration of basic vision sciences and applied clinical research is discussed. Steps which must be taken in optometry and in the schools and colleges in particular are reviewed. Some of the problems that will be encountered are discussed.     

Glutamatergic neurotransmission involves structural and clinical deficits of schizophrenia

BACKGROUND: Phencyclidine and ketamine induce a syndrome closely resembling schizophrenia due to their blockade of N-methyl-D-aspartate (NMDA) receptor. These findings suggested that some aspects of schizophrenia are associated with decreased NMDA--glutamatergic function. We hypothesized that structural and symptomatic deficits in schizophrenia are related to glutamatergic neurotransmission. METHODS: We studied the relationships among cerebrospinal fluid (CSF) glutamatergic markers, clinical presentation of schizophrenia, and CT parameters of brain structure in drug-free schizophrenics. RESULTS: We found no significant differences between patients with schizophrenia and controls in CSF glutamatergic markers. When patients with schizophrenia were considered as a group, significant negative correlations between glutamatergic markers and brain structural measures as well as clinical measures were observed. Cluster analysis reveals a group of lower indices of glutamatergic neurotransmission, and more prominent thought disorder as well as ventricular enlargement, and a group with increased glutamate level. CONCLUSIONS: The findings support the hypothesis that altered glutamatergic neurotransmission plays a role in the brain structure and the clinical symptoms of schizophrenia.     

An overview of clinical policies with implications for clinical practice, medical education, and research

Clinical policies, also known as practice parameters or practice guidelines, are gaining notoriety out of a desire to control escalating medical costs, lessen wide practice variations, and improve quality of care. The clinical policies are supposed to influence medical decision making by summarizing scientific data about a clinical problem in a format that is easily understood by patient and physician alike. Developing an evidence-based policy involves: a clearly defined clinical problem, a comprehensive literature review, a summary table of the data (known as an evidence table), a presentation of this data as outcome possibilities from alternative decisions (in the form of a balance sheet), and creation of clinical recommendations that incorporate both financial costs and patient preferences. Well-developed policies can be used by family physicians as guides in areas of clinical uncertainty and by medical educators as up-to-date literature syntheses for teaching critical appraisal and for outlining approaches to common problems. Explicit policy formulation also highlights the shortcomings of existing literature and can suggest more appropriate future research. The future of the clinical policy movement rests on its ability to reduce costs of care and improve patient outcomes. Explicit clinical policy formulation incurs significant development and implementation costs and the evidence on which many policies are based is lacking. Nevertheless, clinical policies in some form are likely to play an increasing role in medical care.     

A marginal structural model analysis for loneliness: Implications for intervention trials and clinical practice.

Objective: Clinical scientists, policymakers, and individuals must make decisions concerning effective interventions that address health-related issues. We use longitudinal data on loneliness and depressive symptoms and a new class of causal models to illustrate how empirical evidence can be used to inform intervention trial design and clinical practice. Method: Data were obtained from a population-based study of non-Hispanic Caucasians, African Americans, and Latino Americans (N = 229) born between 1935 and 1952. Loneliness and depressive symptoms were measured with the UCLA Loneliness Scale—Revised and Center for Epidemiologic Studies Depression Scale, respectively. Marginal structural causal models were employed to evaluate the extent to which depressive symptoms depend not only on loneliness measured at a single point in time (as in prior studies of the effect of loneliness) but also on an individual's entire loneliness history. Results: Our results indicate that if interventions to reduce loneliness by 1 standard deviation were made 1 and 2 years prior to assessing depressive symptoms, both would have an effect; together, they would result in an average reduction in depressive symptoms of 0.33 standard deviations, 95% CI [0.21, 0.44], p     

The need for an outcomes research agenda for clinical laboratory testing

Aural papillomatosis has been infrequently reported in the English literature. It is a condition which can be very difficult to treat. We present the first reported case of aural papillomatosis successfully treated with the CO2 laser.