Guidelines for presentations and publications

The oral and written presentation of work arising from clinical practice, service development, quality improvement projects and research is presently encouraged and supported. Because this work may involve consumers, staff and the organization, it is important that proper consideration is given to how the work is disseminated, including any ethical implications. There is a need to ensure that consumers, staff, facilities, the organization and intellectual property are protected from any potential concerns that may arise. This research note provides protocols and a checklist that may be of interest and may be relevant for clinicians and researchers to review and appraise their work before oral or written presentation.     

Researchers' Understanding of the Federal Guidelines for Waiver of and Exception from Informed Consent

The survival of patients who present to the emergency department with severe injury or illness is dismal. Resuscitation researchers are interested in advancing the science of resuscitation, and clinical studies must be conducted to determine the best treatment protocols. These studies must reflect good science and must balance individual patient autonomy and safety with scientific progress that benefits society as a whole. Researchers find the present federal guidelines on waiver of and exception from informed consent to be time consuming and expensive. They see variability in the requirements as interpreted by institutional review boards. There is confusion regarding the requirements for public notification and response to community consultation. They believe that the majority of the public, as well as health care professionals, want resuscitation research to progress, but a minority of people and governmental regulators are uncomfortable with waiver of and exception from informed consent for research studies. There is concern and some evidence that the federal guidelines have impeded the advancement of resuscitation science. Several strategies have been suggested to improve the situation. These include 1) better education of resuscitation researchers regarding the federal guidelines, 2) a toolbox for resuscitation researchers clarifying the guidelines, 3) advocacy for the advancement of resuscitation science as a public good, and 4) a national research advisory board that provides unbiased reviews of clinical studies and guidelines for local institutional review boards regarding risks, benefits, and communication strategies for waiver of and exception from consent proposals.     

Apportioning our time and energy: oral presentation,poster, journal article or other?

There is a general expectation for health service employees to present their work in oral or written format to showcase clinical ideas, innovations, service developments, and quality and research initiatives. This research note outlines the types of forums where work can be presented and highlights their relative merits. It is anticipated that this discussion will be of interest to clinicians, managers and researchers when considering where best to present their work.     

Practice‐based Research Network Research Good Practices (PRGPs): Summary of Recommendations

Introduction

Practice‐based research networks (PBRNs) conduct research in community settings, which poses quality control challenges to the integrity of research, such as study implementation and data collection. A foundation for improving research processes within PBRNs is needed to ensure research integrity.

Methods

Network directors and coordinators from seven U.S.‐based PBRNs worked with a professional team facilitator during semiannual in‐person meetings and monthly conference calls to produce content for a compendium of recommended research practices specific to the context of PBRNs. Participants were assigned to contribute content congruent with their expertise. Feedback on the draft document was obtained from attendees at the preconference workshop at the annual PBRN meeting in 2013. A revised document was circulated to additional PBRN peers prior to finalization.

Results

The PBRN Research Good Practices (PRGPs) document is organized into four chapters: (1) Building PBRN Infrastructure; (2) Study Development and Implementation; (3) Data Management, and (4) Dissemination Policies. Each chapter contains an introduction, detailed procedures for each section, and example resources with information links.

Conclusion

The PRGPs is a PBRN‐specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings.     

Recent Trends and Controversies in Industry-sponsored Clinical Trials

In recent years, industry has become an important source of funding for biomedical research. Industry-sponsored clinical trials are a particular source of controversy. In light of recent developments, the authors reevaluate the 1995 SAEM guidelines for investigator involvement in industry-sponsored clinical trials. The authors divide industry-funded clinical trials into two categories: investigator-initiated and industry-initiated, and discuss the differences between them. They examine several areas of ethical debate, including exclusivity contracts between a principal investigator and a corporate sponsor, the size of per-patient reimbursements for recruiting patients into clinical trials, and authorship criteria. Finally, the authors oppose the assumption that industry-sponsored research is automatically biased, and suggest that multiple levels of review will help to uncover bias, whatever the source. Once mutual respect for ethical guidelines and practices are established, collaboration between emergency medicine researchers and industry should be encouraged.     

Transitioning Toward Evidence-Based Research in the Health Sciences for the XXI Century

This article discusses some of the misconceptions of evidence-based research in the health sciences. It proposes that since not all treatments in medicine and dentistry can be evidence-based, clinical applications of the evidence-based process should become a specialty. The case is particularly evident in dentistry. Therefore dentistry is taken in this article as a model for discussion. We propose that to approach dentistry from the viewpoint of the patient-oriented evidence that matters (POEM) is perfectly acceptable so far as we also engage in the process of research evaluation and appraisal in dentistry (READ). We distinguish between dentistry based on the evidence, and evidence-based dentistry. We argue that when invoking an evidence-based approach to dentistry or medicine, it is not sufficient to establish the ‘levels of evidence’, but rather that all evidence-based clinical intervention must undergo the stringent process of evidence-based research so that clinical practice guidelines be revised based on the best available evidence.     

临床专科护理指引在护理管理中的应用

目的探讨临床专科护理指引在护理管理中应用的效果。方法创新制订临床专科护理指引,各专科按照专科特点及需求制定本专科指引,指引主要分为两部分：疾病常规护理指引和症状护理指引。随机抽取呼吸内科、神经外科、肿瘤内科、骨外科、肿瘤放射治疗科5个护理单元为研究对象,实施指引前后进行对比。结果以神经外科为代表科室,实施指引前基础护理质量得分为（2．223±0．315）分,满意度得分为（41．26±3．25）分,实施指引后基础护理质量得分为（3．122±0．214）分,满意度得分为（46．12±5．26）分,两者比较差异有统计学意义（t分别为21．833,12．740;P〈0．05或P〈0.01）。结论应用临床专科护理指引,能规范临床护理行为;为临床一线护士,尤其是专科不熟悉的进修、新毕业、新转科等临床高危护士,提供科学、准确、专业、实用的专科护理指引,以提高工作效率,保证工作质量,减少护理风险,确保护理安全。     

提高护理论文的报告质量——原始研究论文的报告规范

为了增强科研论文的报告质量,提高科研论文投稿、审稿和发表的效率,报告规范被引入科研领域并越来越受到重视。本文介绍了包括随机对照研究、非随机对照研究、观察性研究、诊断试验准确性研究、病例报告研究和质性研究在内的六种常见原始研究设计的论文报告规范,旨在提升我国护理研究论文撰写的清晰性、完整性和透明性。     

Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions

Rationale, aims and objectives To explore the responses of primary health care professionals to guidelines in general, and to the UK national guidelines on the management and referral of women with breast conditions in particular. Methods Qualitative study using practice‐based, semistructured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practice; fifteen of the 34 study practices were audio‐taped. Groups comprised the available partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses 51% attended. In all, 86 professionals attended the meetings. Results A number of areas for comment arose consistently in each discussion. Guidelines in general were welcomed, although there was more support for evidence‐based than consensus‐based guidelines. The breast lump guideline was also welcomed, participants commenting that it was concordant with current practice. The breast pain guideline was more contentious, participants reflecting that it recommended more primary care management than was usual, and fell outside the experience and confidence of doctors or the expectations of patients. Participants felt it did not incorporate psychosocial factors into recommended management, despite this being an important part of primary care management. Conclusions There are concerns about consensus guidelines and doubts about the applicability of the breast pain guideline in this complex management area. The failure of these guidelines to address patient anxiety may limit their implementation.     

The views of primary health care professionals about the management of breast problems in clinical practice

Rationale, aims and objectives To identify primary health care professionals’ views about patients presenting with breast problems, and their approaches to clinical management. Methods Qualitative study using practice‐based semi‐structured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practices; 15 of the 34 study practices were audio‐taped. Groups comprised the partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses, 51% attended. In all, 86 professionals attended the meetings. Results A number of themes arose consistently from the discussions. Participants were concerned about the possible consequences of errors in diagnosis and about difficulties concerning the ‘management of uncertainty’. Doctors were influenced especially by adverse past experiences. Other difficult situations included referral decisions and the management of risk factors in isolation from clinical presentation. Outside influences on presentation and management, such as the media, were also noted. Conclusions The management of breast disease is perceived as a complex issue by health professionals. The patient and doctor contextual factors described must be taken into account in discussions about what constitutes appropriate clinical management and in the development and implementation of clinical guidelines to improve management.     

Developing nursing care guidelines for children with Hodgkin''s disease

Oncology patients are generally treated on therapeutic research protocols that detail medical treatment. Nursing care is not clearly defined in these protocols; therefore, the need to develop a set of guidelines specifically for nursing care was identified. To further enhance the specialized care that our pediatric oncology patients receive, we developed nursing care guidelines to accompany specific protocols. One of our most highly accruing protocols is designed to treat patients diagnosed with Hodgkin's disease. In an effort to increase understanding of this clinical trial, decrease potential for errors, and improve overall quality of patient care, nursing care guidelines were created. To develop the nursing care guidelines, nurses created a seven-step process: (1) studied the therapeutic protocol, established ongoing interactions with the principal investigator (brainstorming), reviewed benchmarking, (2) created the first draft of the guidelines, compared the formatting of this particular set of guidelines with those previously developed at this setting (drafting), (3) field tested guidelines, (4) revised the guidelines and subjected them to additional field testing, (5) examined the guidelines for implications related to teaching tools, (6) implemented the guidelines through in-services, and (7) developed an evaluation plan with pre- and post-tests that indicated improved disease and treatment knowledge among participating nurses. Potential contributions from implementing nursing care guidelines that parallel therapeutic protocols include more accurate and complete research data collection and a more defined role for nurses in the protocol development process. The guidelines also offer a useful, detailed resource to deliver complex protocol-directed care.     

Experts’ opinion on manual wheelchair adjustments for adults with diabetes

Diabetes is a global health concern that can lead to mobility limitations necessitating a wheelchair. However, there are currently no guidelines for wheelchair adjustments tailored to the diabetic population.

Purpose: To describe relevant manual wheelchair adjustments for adults with diabetes, and to explore how these adjustments apply to populations living in less-resourced countries.

Methods: Semi-structured interviews were conducted with 13 wheelchair experts from five different countries working with adult with diabetes. Interviews were analyzed using the constant comparison method.

Results: The most frequently mentioned wheelchair adjustments were related to neuropathies, skin integrity, decreased strength and amputations. Air cushions were preferred for managing seat sores. Lightweight wheelchairs could be advantageous for people with decreased strength and endurance. In less-resourced settings, wheelchair adjustment decisions prioritized durability and low maintenance.

Discussion: The recommendation of lightweight wheelchairs for adults with diabetes may be limited by the lack of adjustment possibilities compared to regular weight wheelchairs. In less-resourced settings, prioritizing durability and low maintenance may limit prevention and management of conditions associated to diabetes.

Conclusion: This study represents a first step towards the development of guidelines for manual wheelchair adjustments specifically tailored to adults with diabetes, in a global health context.

• Implications of rehabilitation

• When prescribing manual wheelchairs to persons with diabetes, expert clinicians agree that skin integrity, neuropathies and decreased strength are their primary concerns.

• Compromises are often necessary when adjusting a wheelchair for a person with diabetes, due to the complexity of their symptoms: same modification can be indicated for one symptom but contraindicated for another.

• Diabetes prevalence is high in less-resourced settings. There is a need for increased availability of affordable wheelchair equipment that is durable, reliable and adapted to persons with diabetes.