title: An evidence-based pilot study exploring relationships between psychologic and physiologic factors in post-lung-transplant adolescents with cystic fibrosis.
abstract: After using an evidence-based approach to address clinical practice questions, a pilot study was designed to explore the relationships among anxiety and depression self-report data, cyclosporine (CSA) trough values, and biopsy rejection grades within a posttransplant sample of adolescents with cystic fibrosis. Thirteen study participants completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI), and had CSA trough levels and biopsy data collected. There was a statistically significant correlation between depression and inflammatory rejection levels. Adolescents with benign rejection scores had lower depression scores than adolescents with higher levels of rejection scores. The data also showed a statistically significant inverse correlation between CSA trough levels and inflammatory rejection levels. Posttransplant success depends on compliance with a strict, antirejection regimen. Adolescence is a turbulent time when many stressors can result in risk-taking behavior such as medication noncompliance and anxiety and depression. Regular psychologic monitoring of posttransplant adolescent patients may be warranted to identify increasing psychologic distress and proactive opportunities for health care intervention. This pilot study is an example of a clinical research question that evolved from a practice situation in which nurses caring for posttransplant adolescents with cystic fibrosis surmised that there were many psychologic issues influencing successful transplant outcomes. Nursing observations suggested a strong connection between poorer medication control, greater risk for rejection, and signs of depression and/or anxiety. The nurse researchers were interested in identifying significant relationships between psychologic factors and physiologic factors, and in discovering objective ways to better assess the psychologic needs of this patient population. A thorough search was conducted of the research literature, and the best clinical practices of other institutions were investigated. There was a lack of transplant research literature on adolescents, and although excellent ideas were generated from inquiries to other institutions, there was a lack of best evidence to answer the clinical questions about this group of patients. The initial clinical question became a research question to determine more about this specific patient population. This article is an example of a clinical research pilot study that resulted from an evidence-based practice process. Pilot studies are springboards for other, more refined research: They help to point the way, or to clarify what the real issues may be. For nurses, they serve as an opportunity to hone critical thinking skills and to contribute to the scientific foundation of our profession.
authors.affiliation: St. Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: Darlene
authors.initials: D
authors.lastname: Sredl
authors.forename: Tom
authors.initials: T
authors.lastname: Werner
authors.forename: Deborah
authors.initials: D
authors.lastname: Springhart
authors.forename: Donna
authors.initials: D
authors.lastname: Watkins
authors.forename: Margaret
authors.initials: M
authors.lastname: Shaner
authors.forename: Grace
authors.initials: G
authors.lastname: McBride
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D001007:Anxiety / Q000473:pathology / Q000523:psychology; D002648:Child; D016572:Cyclosporine / Q000097:blood; D003550:Cystic Fibrosis / Q000601:surgery*; D003863:Depression / Q000473:pathology / Q000523:psychology; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood; D016040:Lung Transplantation / Q000502:physiology* / Q000523:psychology* / Q000534:rehabilitation; D010865:Pilot Projects
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine