Evaluating Clinical Question Publication

Major depressive disorder (MDD) is a common condition in acute care settings. There are various therapeutic approaches for MDD management. However, there are concerns over the effectiveness of available therapies due to MDD developing treatment resistance. Treatment resistance to MDD and related symptoms are linked to higher costs, increased burden of care, adverse health outcomes, and lowered health-related quality of life (HrQOL) (Johnston et al., 2019). This paper describes a clinical question related to the treatment of MDD in acute care settings, its growth in research possibilities, potential publications for future research based on the clinical question, collaborative practice opportunities, and an overview of guidelines and discussion related to my PICO(T) question.

Clinical Question

Acute care nurse practitioners (ACNPs) are specialized in providing care to patients who are acutely unwell due to acute or chronic health conditions. As an acute nurse practitioner, I care for various patients with acute to chronic health issues. Major depressive disorder (MDD) is one of the most common conditions I have observed to be diagnosed in a majority of the patients visiting the acute care facility. There are various therapy options to treat MDD. However, the selection of the best alternative to treat MDD should be based on evidence of the therapy’s effectiveness over other alternatives.

Evidence-based practices (EBP) help nurses utilize the best available evidence from research to improve their clinical knowledge and expertise to make informed care decisions (Melnyk & Fineout-Overholt, 2019). Although EBP provides guidelines to evaluate research evidence in clinical studies, the available research evidence lacks a direct method of application in practice. Therefore, nurses need to utilize the patient, intervention, comparison, outcome, and time (PICOT) framework to formulate a clinical question to guide the collection and analysis of the available evidence on treatment efficacy and decide on the best choice of therapy for MDD.

Based on the PICOT format, my clinical question is: Regarding patients who have been diagnosed with major depressive disorder, how does electroconvulsive therapy compare with pharmacological therapy in terms of decreasing depressive symptoms throughout six months?

My clinical question is developed and refined based on the PICOT framework. The patients who have been diagnosed with MDD form the population of focus in the clinical question, and they will be recruited for the study. Electroconvulsive therapy (ECT) is the treatment that is considered the first-line therapy for the sample population, while pharmacological therapy is used as the control group to compare with ECT. Decreasing depressive symptoms is the measured outcome that will be used to evaluate the effectiveness of ECT as an intervention. A six-month period is the period that the evaluation of ECT as an intervention treatment for MDD will be carried out.

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The Growth of the Clinical Question in Research Possibilities

My clinical question is a foreground question. Foreground questions focus on developing specific knowledge of a particular patient population by comparing two treatments (Hung et al., 2019). The clinical context of the clinical question is to compare ECT as an intervention against pharmacological therapy. As an intervention question, the research and conclusions can be approached and drawn from both inferential and analytical perspectives. This means various investigations can be carried out based on my clinical question to develop various forms of evidence to inform various decisions on the use of ECT, improvement of ECT, and a better understanding of MDD after the use of ECT as first-line therapy.

The question can be researched as a therapy question. This can help develop clinical evidence on the effectiveness and efficiency of the use of electroconvulsive therapy in the management of major depressive disorder compared to pharmacological therapies. The question can also compare the costs of care for MDD using either ECT or pharmacological therapies. A double-masked, randomized controlled trial research method can be applied to determine the effectiveness and cost of ECT as an MDD therapy.

The clinical question can also be used in clinical research to improve the quality of ECT in the treatment of MDD. Clinical researchers can focus on identifying existing safety, effectiveness, and cost concerns and patient and healthcare providers’ experiences with the use of ECT. The research focused on the improvement of the quality of ECT in the treatment of MDD can employ clinical trials and randomized controlled trial research methodologies.

The clinical question can also be applied in research focused on the prognosis of MDD during and after treatment with ECT. The prognosis research can help identify risk factors and other influencing factors that determine the effectiveness of ECT and increase the risk of MDD treatment resistance and other complications that can be expected during and after treatment with ECT. Researchers can apply various research methods to explore the clinical question, such as the use of cohort studies, case-control, and case series research methods.

Potential Publications

Publication 1

The Journal of Electroconvulsive Therapy (ECT) is the priority journal publisher I would select to publish my research based on my clinical question. The Journal of ECT is the official journal of the International Society for ECT and Neurostimulation. It also publishes work focused on ECT in contemporary settings and developments in ECT research globally. The journal also covers various ECT-related subjects, such as social, ethical, and legal issues.

Publication 2

Another preferred publisher for my research is The International Journal of Neuropsychopharmacology. The journal is scientific and peer-reviewed. It is an official journal of the Collegium Internationale Neuro-Psychopharmacologicum (CINP) (International College of Neuro-Psychopharmacology). It primarily publishes research focused on advancing neuropsychopharmacology for psychiatric disorders to improve pharmacological treatment. It publishes original research on subjects including neuroimaging, genetics, psychoneuroendocrinology and neuropsychology, and other novel trends and perspectives in the management of psychiatric disorders.

Publication 3

The Journal of Psychiatric Research is my third preferred journal publisher. The journal publishes research from various fields focused on psychiatry and human behavior. It also publishes articles focused on influencing factors such as biochemical, physiological, genetic, environmental, social, psychological, and epidemiological factors.

Collaborative Practice Opportunities

The database search has indicated many opportunities for collaborative research practice. Most of the reviewed journals publish co-authored research from various disciplines and collaborating authors from varying backgrounds. This creates an opportunity for Interdisciplinary Research (IDR). IDR brings together researchers from various disciplines to pool their knowledge and research tools to advance understanding of a condition and create new solutions to the health issue or improve existing ones. Interdisciplinary collaboration in research and co-authorship supports the transformation of available scientific knowledge and accelerates the development of innovative solutions to existing and new problems (Fagan et al., 2018). Due to the improved knowledge coordination, responsibility, accountability, and communication across interdisciplinary research, collaborative practices in research are a sure way to enhance mental healthcare outcomes. Collaborative practice opportunities in psychiatric research can improve the understanding, prevention, and treatment of psychopathology (Fried & Robinaugh, 2020).

Overview of Guideline and Discussion

American Psychological Association. (2019). APA CLINICAL PRACTICE GUIDELINE for the Treatment of Depression Across Three Age Cohorts GUIDELINE DEVELOPMENT PANEL FOR THE TREATMENT OF DEPRESSIVE DISORDERS APPROVED BY APA COUNCIL OF REPRESENTATIVES. https://www.apa.org/depression-guideline/guideline.pdf

Overview of Guideline

The APA Clinical Practice Guideline for the Treatment of Depression provides guidelines for treating all types of major depression in children and adolescents, general adults, and older adult patient populations (American Psychological Association, 2019). The guideline recommends various initial treatments, such as combined antidepressant medication and psychotherapy for major depressive disorder and other disorder thresholds across the various population cohorts. It also recommends using ECT for severe major depressive disorder resistant to medication or psychotherapy. It also guides the application of EBP to provide individualized treatments within a diverse patient population by considering and modifying patient demographics, values and preferences, existing comorbidities, and care settings-related factors. It also guides clinicians on care in in-patient settings, discharge planning, follow-up to prevent relapse, and the transition of care from lower age cohorts to adults. It has also recommended approaches for future research and development of evidence.

Discussion of Guideline

The APA guidelines are critical and easy to adopt within my clinical practice settings. The guideline in itself has been developed by a panel of experts who reviewed existing research evidence to develop all the recommendations for treating major depressive disorder across all patient populations. The guideline provides evidence-based recommendations that can be applied in primary and acute care settings to improve the efficiency of care delivery for all patients with depressive symptoms. It can also be used as a practice collaboration tool among various healthcare providers to improve mental healthcare outcomes.

Conclusion

Clinical intervention questions in nursing practice can either be inferential or analytical. My clinical question aims to determine the effectiveness of ECT as an intervention in reducing depressive symptoms in patients diagnosed with MDD in six months compared to pharmacological therapy. The clinical question can help provide evidence to support the decision to use ECT over pharmacological therapy to manage depressive symptoms. The clinical question has various opportunities for growth and research and can be explored using various research methods to develop evidence on various perspectives of ECT and MDD. Further, there are various research publications and research collaboration opportunities on this question, which can improve the evidence from the research for improved support for future clinical decisions.

References

Fagan, J., Eddens, K. S., Dolly, J., Vanderford, N. L., Weiss, H., & Levens, J. S. (2018). Assessing Research Collaboration through Co-authorship Network Analysis. The Journal of Research Administration, 49(1), 76. /PMC/articles/PMC6703830/

Fried, E. I., & Robinaugh, D. J. (2020). Systems all the way down, embracing complexity in mental health research. BMC Medicine 2020 18:1, 18(1), 1–4. https://doi.org/10.1186/S12916-020-01668-W

Hung, H. Y., Wang, Y. W., Feng, J. Y., Wang, C. J., Lin, E. C. L., & Chang, Y. J. (2019). Evidence-Based Practice Curriculum Development for Undergraduate Nursing Students: The Preliminary Results of an Action Research Study in Taiwan. The Journal of Nursing Research, 27(4), e30. https://doi.org/10.1097/JNR.0000000000000298

Johnston, K. M., Powell, L. C., Anderson, I. M., Szabo, S., & Cline, S. (2019). The burden of treatment-resistant depression: A systematic review of the economic and quality of life literature. Journal of Affective Disorders, 242, 195–210. https://doi.org/10.1016/J.JAD.2018.06.045

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). 66, 37–39.

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Question

Description:

This assignment provides an opportunity to review the clinical question identified with a focus on research or publication opportunities on this question.

Evaluating Clinical Question Publication

Directions:
The clinical question is: Regarding patients who have been diagnosed with major depressive disorder, how does electroconvulsive therapy compare with pharmacological therapy in terms of decreasing depressive symptoms throughout six months?
Describe a clinical question as it relates to your practice setting.
Identify the growth of this clinical question in research possibilities.
Discuss journals that would be a potential publisher for your future authorship on the clinical question posed.
Review collaborative practice opportunities as they relate to the evidence determined in the database searches.
Provide an overview of the guidelines and the discussion in the paper.
Write a 3- to 5-page paper using APA format.