Nursing research
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Recent evidence points to the likelihood of heterogeneity in the presentation and, perhaps, etiology of fibromyalgia (FM). A clearer understanding of the symptomatology and consideration of potential FM subtypes could add insights regarding this condition. ⋯ The findings support the heterogeneity of the FM experience and the presence of symptom clusters within the greater spectrum of symptoms comprising the FM syndrome. These observations suggest the possibility of tailoring interventions based upon individual patient symptomatology. Further work is needed to develop symptom inventories that can be used in clinical trials as outcome metrics and by healthcare providers to describe clinical burden and effect of treatments.
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Comparative Study
Application of repeated-measures analysis of variance and hierarchical linear model in nursing research.
The aims of this study were to describe how repeated-measures analysis of variance (ANOVA) and the hierarchical linear model (HLM) are used to evaluate intervention effect and to compare these methods, especially in relation to their requirements regarding assumptions, number of repeated measures, completeness of repeated measures, and equal intervals between measurements. ⋯ Hierarchical linear model is a powerful statistical method that can be applied to longitudinal research to evaluate an intervention at multiple levels. The major differences between the repeated-measures ANOVA and the HLM can be summarized as follows: The HLM (a) has less strict assumptions, (b) has more flexible data requirements (dealing with the missing data), and (c) stresses individual change over group differences. More stringent assumptions should be satisfied in repeated-measures ANOVA than in the HLM. The HLM may resolve important statistical issues that have existed in repeated-measures ANOVA. The HLM has more flexible data requirements in that it (a) can be utilized when the measurement data collection points are unequal and (b) may be used when researchers do not have data for all follow-up points, whereas the repeated-measures ANOVA requires a fixed time series design (equal interval, equal number of time points).
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Analgesic trials have been advocated as a means to reduce pain in persons with dementia (PWDs), but few systematic studies have been reported. ⋯ Acetaminophen use reduced pain behaviors associated with musculoskeletal pain in this sample of PWDs. This provides preliminary evidence that acetaminophen is an effective pain reliever for this population. In addition, the study supports the use of a within-subjects design to examine daily variability in pain behaviors and to demonstrate treatment effects in PWDs.
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Clinical guidelines for the prevention of pressure ulcers advise that pressure-reducing devices should be used for all patients at risk of or with pressure ulcers and that all pressure ulcers should be documented in the patient record. Adherence to these guidelines among elderly hospital patients early in the hospital stay has not been examined in prior studies. ⋯ Use of preventive devices and documentation of pressure ulcers are suboptimal even among patients at high risk.
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The standard approach in a randomized controlled trial (RCT) is to randomize individuals to intervention and control groups. Yet, nursing and other health interventions are often implemented at the levels of health service organizational unit or geographical area. It may be more appropriate to conduct a cluster RCT. However, cluster randomization requires consideration of a number of important issues. ⋯ Cluster RCTs present special challenges in relation to design, conduct, and analysis. Nevertheless, they are an appropriate and potentially powerful tool for nursing research. With careful attention to the issues addressed in this article, researchers can use this approach successfully.