PubMed · 7804072
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D L Sackett. 1994-12-03. Cochrane Collaboration.. https://doi.org/10.1136/bmj.309.6967.1514c
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Clinical science research incorporates the fields of clinical investigation and health services research. With a focus on the use of either human specimens or subjects, clinical investigation research projects translate knowledge gained from basic science research based on animal models for disease. The goal of clinical investigation is to develop new prevention, intervention, and therapeutic approaches to improve patient clinical outcomes. In contrast, health services research focuses on the improvement of the efficacy, cost-effectiveness, and outcomes of care. Health services research projects examine options to improve the health care delivery system, organization, financing, and reimbursement mechanisms in place today. The purpose of this article is to review common terminology and methodologic approaches that are used in clinical science research. The process of designing a research project is reviewed. Beginning with the development of a research question and hypothesis, the steps for successful completion of the project are discussed. Different study design approaches are presented with their respective strengths and weaknesses. The challenges associated with conducting a clinical research study are discussed, including the development of an appropriate sampling strategy, the designing of data collection, instruments, and the assurance of study data integrity. Possible threats to study validity and generalizability are assessed.One the major advantages of clinical research is that it offers an opportunity to study clinical questions in the clinical setting without the expenses of a basic research laboratory and basic science technology. Thus important clinical questions related to patient care, new technology assessment, clinical practice management, health care administration, or health policy may be addressed.
With the recent increase in health care service delivery across state lines, national organizations have perceived the need for standardization of nursing practice. In 1995, the Pew Commission recommended that states standardize entry-into-practice requirements and adopt inter-state licensure by endorsement. Over the past two years, the National Council of Nursing has been in the process of developing approaches which would allow nursing licenses to be recognized across state lines. These recommendations and activities suggest that nursing regulation may be moving towards national standardization. This paper presents qualitative data from State Boards of Nursing in nine western states. A review of the priorities and activities of the nine boards indicates that the apparent movement towards standardization of nursing regulations is misleading. States continue to have distinctive approaches to nursing regulation based on unique political context and historical development of nursing regulatory agencies, population growth rates in the respective states, and access to rural health care. While managed care may be resulting in standardization of payment approaches and services purchased, it has not substantially impacted each state's unique nursing regulations and educational approaches.