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Building a Program of
Research: 15 Tips
From Doctoral Student to Academic Faculty
1. Pick a topic you are passionate about
from your own clinical experience
Using ECG information to
improve patient care
Improving nursing practice
related to ECG monitoring
2. Determine unsolved problems by
searching the literature
Annals of Internal Medicine 1986
UCSF
Supraventricular Tachycardia (SVT)
Narrow normal QRS complex
SVT with aberrant conduction
Ventricular Tachycardia (VT)
Wide bizarre QRS complex
3. Search the literature on all research
directly related to the topic
Left “Rabbit Ear” Pattern = VT
Lead V1
Right “Rabbit Ear”Pattern = SVT
Lead V1
Wellens HJ, et al. Value of the ECG in the differential diagnosis of a tachycardia
with a wide QRS complex. Am J Med 1978.
Monitoring
Lead V1
Requires Five
Electrodes
LA
RA
C
RL
LL
“Of the conventional ECG leads, the one that
contains the most information…is V1, which
should therefore make the best lead for routine
monitoring. But V1 is inconvenient, since 5
electrodes must remain constantly attached. A
satisfactory compromise, conceived in theory and
confirmed in practice, employs a modified V1.”
Dr. Marriott’s modified V1 (MCL1)
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Can wide QRS tachycardia be accurately diagnosed
with V1 criteria when monitoring in MCL1?
MCL1
Left “Rabbit Ear” Pattern = VT
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4. Contact key scientists for advice
about your research ideas
In developing MCL1, I confirmed
that it matched V1 in an outpatient clinic population. I did
not compare these leads during
arrhythmias, but I would expect
them to be comparable during
wide complex tachycardias.
Henry J. L. Marriott, MD
Hein Wellens, MD
We did not evaluate
MCL1 in our study.
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5. Pick renown mentors for your
doctoral committees
Henry J. L. Marriott, MD
Kathy Dracup, DNSc
Mel Scheinman, MD
6. Publish on your topic (Quals papers) so
your name is associated with the topic
NURSING THERAPEUTICS
• Determine goals
of ECG monitoring
• Diagnose ECG
• Assess patient
(arrhythmia, ischemia,
QT interval)
• Notify MD
• Monitor ECG
• Document
(select appropriate
lead; place electrodes
accurately; evaluate
monitor alarms)
• Administer Rx
• Evaluate efficacy
POTENTIAL Health Problem
ACTUAL Health Problem
Health Continuum / Transitions
INDIVIDUAL
• Genetics
• Lifestyle (coronary
risk factors)
• Psychodynamic
factors (anxiety)
• Functional status
ENVIRONMENT
Internal/Cellular
• Work
•Acid-base
• Autonomic nervous system
•Electrolytes
•Drugs
Electrical Activity of the Heart
Normal ECG
External/Social
•Ischemia
Abnormal ECG
• Family
• Culture
• Religion
Arrhythmias, ST segment
changes of ischemia, QT
interval prolongation
Drew BJ Heart & Lung 1989;18:8-15.
7. Conduct studies as a doctoral student; publish &
present at national scientific conferences
How prevalent is inaccurate lead placement?
V1
II
V1
II
National random survey of
AACN members working in
critical care & telemetry units
N = 302
 Average age, 35 yrs
 Average yrs critical care
experience, 8.5 yrs
Drew, Ide, & Sparacino Heart & Lung 1991;20:597
Accuracy of lead placement in a random
survey of hospital nurses in the USA
300
250
# RNs
200
150
77%
100
50
23%
0
Correct
Incorrect
Drew BJ, et al. Heart & Lung 1999;20:597-609.
UCSF
8. Publish clinical articles as well as research
articles in order to influence practice
9. Publish ALL your dissertation findings
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WCT’s
n=133
SVT
VT
n=35
n=98
Drew & Scheinman, PACE 1995;18:2194
VT recorded during invasive cardiac
electrophysiology study (EPS)
Key dissertation findings re: wide
QRS tachycardia

Routinely-monitored Lead II was poor
Correctly identifies only 34% of WCTs

V1 was the best single lead; MCL1 should
not be substituted for V1
40% of VTs have different QRS morphology in MCL1 vs V1

12-Lead ECG was best
If it weren’t so cumbersome, it would be great to monitor
all 12 leads
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Disadvantage of 12-Lead ECG for
hospital monitoring
LA
RA
V1
V2
RL
V3 V
4
LL
V6
V5
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10. Design each subsequent
study to build logically upon
your prior studies
Apply for “friendly” funding for
initial studies (e.g., Sigma Theta
Tau, companies that make related
products, start-up funds from your
own school)
11. Collect data for > dissertation
12. Once you’ve published 4-5
preliminary research articles, think
of the next logical research
question and apply for MAJOR
funding (e.g., NIH).
How does EASI 12-lead monitoring
compare to routine CCU monitoring for
detecting acute myocardial ischemia in
acute coronary syndromes?
ST Analysis Trial (STAT Study)
(1993-96) n=490 Funded by NINR (R01 NR03436)
UCSF
STAT Study
47 y/o male awaiting cardiac cath, possible PCI
7:03 am
EASI 12-Lead ECG
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STAT Study
7:08 am
EASI 12-Lead ECG
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STAT Study
7:10 am
EASI 12-Lead ECG
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STAT Study
7:13 am
EASI 12-Lead ECG
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STAT Study
7:33 am
EASI 12-Lead ECG
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1.
4.
2.
5.
Routine CCU Monitoring Leads
3.
Before
During
Of 463 ischemic events detected with
EASI 12-lead ST monitoring:


67% had no evidence of ischemia
in routine CCU monitoring leads
80% were asymptomatic (“silent”)
Drew et al. Am J Crit Care 1996;5:198-206.
UCSF
Is ST-segment monitoring valuable
in patients who present to the ED
with possible acute MI?
ST Analysis & Monitoring of Patients & Evaluation
of a Derived ECG STAMPEDE Study
Funded by NINR (RO1NR03436), 1996-00, n=621
Ischemia Monitoring & Mapping in the Emergency
Department In Appropriate Triage & Evaluation of
Acute Ischemic Myocardium IMMEDIATE AIM Study
Funded by NHLBI (RO1HL69753), 2001-2006, n=1308
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IMMEDIATE AIM Study
Initial ECG in 40 y/o male presenting to the ER with
increasing chest pain episodes; Troponins negative
5:00 pm
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IMMEDIATE AIM Study
6 days following hospital discharge, patient was
brought to ER after witnessed collapse on golf course
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IMMEDIATE AIM Study
Rapidly developed profound shock, could
not be resuscitated, and died
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Synthesized Twelve-lead ST Monitoring
And Real-time Tele-electrocardiography
Prospective randomized clinical trial
2003-2009
Funding: NINR (RO1 NR007881), n=800
UCSF
ST SMART Study
Study Aim:
Determine whether individuals who call “911”
for chest pain will:
1. have shorter time to treatment
when they reach the hospital
2. have better survival over 5 yrs
if ED clinicians are provided with ECG ischemia
monitoring information from the field
UCSF
San Francisco
100 miles 
Santa Cruz
County
Dominican
Watsonville
Methods:
ST SMART Study
All EMS vehicles that respond to 911 calls in the
county are equipped with portable monitordefibrillator devices with special study software
16 Fire Department rigs
13 AMR ambulances
ST SMART Study
Special Study Software is designed to:
 Synthesize a 12-lead ECG from 5 electrodes

Analyze ST segments every 30 secs &
automatically transmit an ECG to the
destination ED by cell phone if ischemia
occurs

If the 1st transmission fails, automatic
redialing occurs for a total of 3 attempts
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Case
Example
ST SMART Study
50 y/o with onset of
chest pain on
Sunday a.m.
Attempted to drive to
hospital; was found by
motorist at roadside
on the ground
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ECG Transmitted from the Field
ST SMART Study
13. Become active in professional
societies that put you in touch
with experts in the field
 International Society for
Computerized Electrocardiology
 American Heart Association
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14. Contribute to key journals in your field
1. Publish in
journal
2. Serve as
manuscript
reviewer
3. Ask to be
considered for
editorial board
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15. Take leadership to publish clinical
guidelines and scientific statements
Implement Practice Standards & determine whether
it improves nurse behaviors & patient outcomes
Funded by NHLBI May, 2008-2013
Practical Use of the Latest Standards for
Electrocardiography – PULSE Study