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Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering obstructive sleep apnea and central sleep apnea associated with Cheyne-Stokes respiration as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of obstructive sleep apnea with continuous positive airway pressure improves not only patient-reported outcomes such as sleepiness, quality of life, and mood but also intermediate cardiovascular end points such as blood pressure, cardiac ejection fraction, vascular parameters, and arrhythmias. However, data from large-scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of 2 recent large randomized controlled trials, published in 2015 and 2016, raise questions about the effectiveness of pressure therapies in reducing clinical end points, although 1 trial supported the beneficial effect of continuous positive airway pressure on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multimodality therapies that also address adherence, and implementation of trials that are sufficiently powered to target end points and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among the cardiology, sleep medicine, and clinical trial communities., (© 2017 American Heart Association, Inc.)

The Patient- and Family-Centered Care (PFCC) method and practice has been developed over the past 4 years as a means of improving care experiences by viewing all aspects of a patient's care experience through the eyes of the patient and family. One of the most powerful components of the method, evaluating care through patient and family shadowing and the accompanying care experience flow mapping, is described. An overview of the PFCC method can be found in the authors' article in the December 2010 issue.

Current evidence suggests that productivity in biomedical research depends on the support that the research group enjoys from its parent institution, the composition of the group and the personal attributes of its members and leader. Supportive institutions provide adequate physical resources and allow substantial uninterrupted time for research. The effectiveness of the research group asa whole is also strongly influenced by the group's structure, the professional competence of the group leader, his leadership style and his ability to foster collaboration with other research groups and organizations. There is a good case for a flexible leadership style that is modelled on the situational theory of leadership. In addition, the personal characteristics of the individual members of the research group influence the quality and quantity of the research output. Effective groups are made of motivated individuals with research training and skills that are relevant to the objectives of the research group. Rehabilitation research is fundamentally different from traditional biomedical research. This study discusses how the factors that influence productivity of biomedical research relate to rehabilitation science and practice and examines the conditions that are necessary to create and maintain an academic environment that is conducive to large volume,high-quality research in rehabilitation medicine.

Translating the recommendations from the Institute of Medicine's landmark report, Keeping Patients Safe: Transforming the Work Environment of Nurses, into practice and healthcare policy will require an extensive collaboration among nurse administrators and nurse researchers. The insights and skills of both groups are critical for evaluating the recommendations and their implications for practice, for filling gaps in research, and for influencing significant health system change.

Purpose of Review: Conducting large-scale clinical trials in the field of acute respiratory failure requires substantial collaboration. Teamwork is still in its infancy within the realm of clinical research. This review evaluates the need for and grassroots process of teamwork and considers the challenges facing teamwork in the specific context of conducting acute respiratory failure research today., Recent Findings: Acute respiratory failure research demands complex, interdependent tasks, dictating a teamwork approach. The team is comprised of a sponsor, a leader and members. The sponsor provides essential administrative support, the leader performs many of the functions of a traditional manager in addition to adopting three distinct roles of initiator, role model and coach, and members are selected not only on their technical expertise, but also on their problem-solving and interpersonal skills., Summary: As large-scale (oftentimes international) multicenter trials are increasingly providing answers to our research questions, greater emphasis must be placed on team building within the clinical research environment. An urgent need for further work in this area is revealed. Critical care fellowships should integrate teamwork skills into the curriculum.

Purpose and Objectives: The purpose of this study was to use a collaborative process between Advanced Practice Nurses and a nurse researcher to identify barriers to incorporating sexuality assessment and counseling into nursing practice., Design/approach: This article provides an historical account of the collaborative group processes leading to the development and testing of the Sexuality Attitudes and Beliefs Survey (SABS)., Background/rationale: Nurses often are called upon to talk to patients about their sexuality and sexual concerns. Many nurses believe that sexuality assessment, evaluation, and counseling is a part of their professional role, however, nurses do not necessarily integrate this awareness into their patient care. Discomfort, embarrassment, or strongly held attitudes about the nurse's role in discussing sexuality with patients can act as barriers to responding to these patient concerns., Setting: A Midwestern urban healthcare facility, affiliated with a university served as the setting., Sample: : Thirty-five nurses working outpatient and inpatient settings in oncology and HIV/AIDS., Method: Instrument development and voluntary survey., Outcomes: The collaborative initiative developed and piloted an instrument to measure nurses' attitudes and beliefs about human sexuality. Results of the pilot study suggest that what nurses believe patients expect from them, time availability, and confidence in one's ability to address issues related to human sexuality present significant barriers to incorporating sexuality assessment and counseling into nursing practice., Conclusion: Successful collaboration among clinicians and researchers required administrative support as well as a individual commitment and is a model that can be adapted to other settings and for other projects., Implications for Practice: This study highlights the benefits of collaboration between clinicians and researchers to support evidenced based practice. The findings from this study will be used to develop strategies for removing barriers to sexuality assessment by nurses.

Cardiovascular research nurses play important roles in ensuring that subject recruitment is conducted in an ethically defensible manner. However, these nurses encounter many ethical challenges in the course of research. Sole reliance on regulatory mechanisms such as institutional review board oversight and adherence to legal requirements does not necessarily ensure human subjects' protection or the scientific integrity of researchers (J Law Med Ethics. 2002;30:411-419). Therefore, this article discusses 3 additional ethical considerations associated with recruiting hospitalized cardiovascular patients for research studies. These include (a) the role of the family and patient-delegated "gatekeepers," (b) the effect of transient and subtle mental status changes upon the consent process, and (c) the effect of conflicting patient priorities. This content is illustrated using the authors' experiences recruiting hospitalized coronary artery bypass graft surgical patients for a research study.

Clinical nurse specialists are expected to contribute to the development of new nursing knowledge through research activities. Competing demands require constant juggling of time and priorities, and activities, such as research, often do not receive the attention they deserve. Research requires specific skills and knowledge and significant time expenditure. Collaborative research is an appropriate way for the clinical nurse specialist to both contribute to research and improve his or her research skills. This article discusses two pediatric critical care clinical nurse specialists' participation in a collaborative research team led by university faculty. The study was designed to reduce family uncertainty and stress and to increase staff nurse competency in providing family care. The ability of the clinical nurse specialists to contribute to the research team was enhanced by knowledge of the research process, good communication skills, and clinical expertise in the specific population of interest. Challenges for the clinical nurse specialists included limited experience in conducting clinical research and balancing clinical and research priorities. Both clinical nurse specialists and the university faculty benefited from this collaboration. The clinical nurse specialist, with expertise in a clinical specialty, is able to bridge the gap between the academic and clinical sites, making clinical research more likely. At the same time, working with expert researchers allows the clinical nurse specialist to increase his or her research skills.

This article describes a clinical research protocol designed to determine the value of Radiofrequency Ablation (RFA) for the treatment of histologically proven primary or metastatic liver cancer. RFA is a localized thermal technique that destroys tumor tissue. The research protocol is described, including enrollment criteria, performance of RFA, and the follow-up necessary to ascertain protocol success or failure. The complementary and collaborative roles of the research nurse and clinic nurse in carrying out the RFA protocol are described.

Cardiologists and cardiovascular practitioners are facing significant reimbursement constraints. In this setting, increasing numbers of practitioners are looking to participate in clinical research as a new source of revenue. An aging population and consolidation among pharmaceutical companies, medical device companies, and contract research organizations are placing great emphasis on speed of new products to market. Opportunities exist for well-positioned and knowledgeable clinical investigators to enhance their practices, increase their professional knowledge, and expand their network of scientific colleagues. This article provides an overview of the drug and pharmaceutical industry referable to clinical investigation, the tools necessary to become a valued, principal investigator and an outline of challenges and opportunities for clinicians wishing to engage and enhance their clinical research activities.

The success of research utilization (RU) is a function of how well it has been incorporated into the cultural norm of the organization. The authors describe current and future nursing research utilization activities in various clinical agencies across the United States and identify barriers and facilitators to those activities. The most frequent RU projects focused on pressure ulcers and pain management. Barriers included lack of resources, organizational culture, change, and nurses' education. Facilitators were leadership commitment, available resources, and a supportive organizational culture.

Successful grant-writing in Alzheimer disease research, as with many other diseases, requires collaborative work among a group of individuals who represent various disciplines of relevance to the research problem. Interdisciplinary teams in Alzheimer disease research have the potential to explore more facets of a given research problem than teams that are not interdisciplinary in nature. Such teams also have the potential to produce better science and to disseminate results to a wider spectrum of relevant groups, may be more successful in achieving funding, and are stimulating and growth-enhancing for members. Building and maintaining these teams is a complex and challenging process, but identification and proactive resolution of challenges is essential. Important elements of success include establishing common goals, using a democratic group process, maintaining open communication, developing mutually acceptable policies for disseminating research results, and facilitating achievement of team members' personal and professional goals.

Located throughout academic institutions, private hospitals, and clinic settings, clinical research nurse coordinators often practice outside the purview of institutional nursing departments yet must adhere to established nursing practice standards. Nursing administrators have a professional and legal responsibility to recognize the educational needs and competency requirements of these individuals and provide them with tools for their professional development. Establishing a network for clinical research nurse coordinators provides a forum for education, problem-solving, benchmarking performance, and camaraderie.

The advanced practice nurse (APN)--nurse researcher collaborative model proposed in this article emerged through an APN and a nurse researcher working together on a pilot research study and a project to describe advanced nursing practice in the outpatient setting. The model demonstrates how, through the observation and discussion of practice and research, the needs of both the NR and the APN are identified. Further discussion identifies outcomes important for each professional role as well as for the discipline of nursing. Results of such collaboration include practice-relevant nursing research, research-based practice, and more reflective APNs and nurse researchers.

Objectives: To assess the effect of adding a shared research nurse on patient enrollment in an ongoing clinical study., Design: Before/after comparison of recruitment rates and consent rates involving patients eligible for a study of blood culture collection strategies for methods on the detection of bacteremia and determination of inter-rater agreement regarding study eligibility between the research nurse and primary investigator., Setting: An urban pediatric emergency department (ED)., Participants: Patients presenting to the ED between February 1, 1991, and February 1, 1993, with suspected bacteremia., Intervention: Addition of a research nurse to the study group to identify, educate, and enroll eligible study patients., Main Outcome Measure: Patient enrollment rates., Results: Successful enrollment of eligible study patients was 14% (40/281) during the year prior to the addition of the research nurse and 50% (126/253) after the addition (P < 0.001). Refusal rates were 21% (22/106) when recruitment was carried out by the nurse and 15% (13/86) when done by physicians (P = 0.41). Review of records to identify eligible study patients showed agreement between the study nurse and physician on 78/80 (97.5%) of the charts reviewed (kappa = 0.94)., Conclusions: Addition of a shared research nurse increased recruitment of patients and demonstrated equivalent judgment of the research nurse and physician investigators regarding patient eligibility for the study. This arrangement demonstrates a practical and effective means of increasing the efficiency of ED-based clinical research.

With limited resources, there is increased scrutiny of the contributions of leadership staff, such as nurse researchers employed in the clinical setting (NRECS). The authors describe activities that pertain to research, presentations, publications, and procurement of funds for studies. Major obstacles that impede NRECS from achieving their goals, job performance evaluation and indices (staff, organization, and personal) that NRECS use to determine success in enacting their role also are presented.

Implementing and evaluating professional practice models in dynamic healthcare settings is difficult and poses unique problems for nurse researchers and administrators. The authors describe issues associated with collaborating during the conduct of longitudinal studies.