january 18,2008 boonsin tangtrakulwanich, md., ph.d
DESCRIPTION
How to Start Doing Research. January 18,2008 Boonsin Tangtrakulwanich, MD., Ph.D. Objective (s). Concept Clarify Stimulate Formulate. Why Starting Point is Important?. Good Start Past Half “เริ่มต้นดี มีชัยไปกว่าครึ่ง”. Causes of Manuscript Rejection. Research Design. Methodology. - PowerPoint PPT PresentationTRANSCRIPT
January 18,2008Boonsin Tangtrakulwanich,
MD., Ph.D
• Concept
• Clarify
• Stimulate
• Formulate
Objective (s)
Why Starting Point is Important?
Good Start Past Half
“ ”เริ่��มต้�นดี มชั�ยไปกว่�าคริ่��ง
Causes of Manuscript Rejection
Research Design
Methodology
Poor conceptualization
Inadequate control
DuplicationStatistical analysis
Poor literature
Number of response
0 2 4 6 8 10
Source of Human Knowledge
• Authority
• Tradition
• Intuitive
• Trial & error
• Reasoning
• Research
Why Have to Do Research
•Degree
•Learning
•Promotion
•Improve quality of care
What is Research?
A class of activity designed to develop
or contribute generalization knowledge
Last JM. Dictionary of Epidemiology, 2001
What is Research
• Tool for exploring truth
• Tool for learning
• Improve quality of care
Concept of Health
Genetic
Health care service
Environment
Behavior
- Biological- Psychological- Social
- Biological- Psychological- Social
PhilosophyTruth in
the universe
Research Question
StudyPlan
Actual Study
FindingTruth
in Study
Result of Research
Truth+
Systematic error+
Random error
ErrorRandom error = Chance
Systemic error = Bias
Valid, Precise Invalid, Precise
Valid, Imprecise Invalid, Imprecise
Step in Doing Research (І)
Research• Research question generation • Objectives• Rational (gap of knowledge)• Design type of research• Set hypothesis• Draft research proposal
Step in Doing Research (2)
Research plan - Materials and methods
• Define target population• Calculate sample size• Instrument• Statistical use• Data collection/analysis• Academic writing
Good Research Questions(FINER)
• Feasibility
• Interesting
• Novel
• Ethical
• Relevant
Component of Component of Research Research QuestionQuestionP=PopulationP=Population
I=InterventionI=Intervention
C=ComparisonC=Comparison
O=OutcomeO=Outcome
Process in Developing ResearchQuestion
Need
extensive
review
Select Topic of Interest
Define Research Problem
Evaluate; target, background
Research Objectives
Common Problems in ResearchQuestion Development
• Unclear
• Not feasible
- Too broad
- Sophisticate
- Repeat the same thing
• Ethical issue
Common Research Questions
Issue Question
Abnormality
Diagnosis
Frequency
Risk
Is the patient sick or well?
How accurate are test used todiagnose disease?
How often does a disease occur?
What factors are associated with increase risk of disease?
Common Research Question (П)
Issue Question
Prognosis What are the consequence of having a disease?
Treatment How does treatment changethe course of disease?
Prevention Does an intervention keepdisease from arising?
Common Research Question (Ш)
Issue Question
Cause What conditions lead to disease?
What are the pathogenesis of disease?
Cost How much will care for an illness cost?
Literature Review
Objectives
• Source of research ideas
• Orientation of what already known
• Provision conceptual frame work
• Information for the research
Tasks on Literature Reviews
• Identification
• Detection
• Critical analysis
• Written description of existing information
core y
z x•Dynamic Static
•Black - grey - white
KA P
Knowledge
Frontier
Level of Evidence
RealityTruthInformationData
Knowledge
Feeling
Believe, thought, common sense
Strength of Evidence
Study design• RCT
• Controlled trial
• Case-control, cohort
• Cross-sectional
• Case series, expert opinion
Bias
Commonly Used Website for Reference Research
• http:// www.cochranelibrary.com
• http://gateway.ovid.com
• http://www.ncbi.nlm.nih.gov
• http://202.28.30.163/medline
• http://www.sciencedirect.com
Useful Thai Web Site
• http://md3.md.chula.ac.th
• http://www.si.mahidol.ac.th
• http://thesis.tiac.or.th
• http://202.28.30.163/dao
• http//www.riclib.nrct.go.th
How to Choose the LiteratureHow to Choose the Literature
1. Look at the title: Useful ?
2. Review the authors: good record ?
3. Read summary: valid ?
4. Site: applicable ?
Read Materials and MethodRead Materials and MethodRead Materials and MethodRead Materials and Method
CMA 1981; 15: 703-710
Search Strategies for Systemic Reviews
• http://nhscrd.york.ac.uk
• http://www.pedro.fhs.usyd.edu.au
• http://clinicalevidence.com
• http://www.orthopaedicweblinks.com
• http://www.tripdatabase.com
Types of Research
• Basic science• Clinical•Qualitative
Types of Clinical Research
• Burden of illness, natural history
• Therapeutic
• Etiologic or risk factor
• Diagnostic
• Clinical economic
• Quality of care
Quality of Care Research
• Care: Holistic, multidisciplinary
• Quality: Efficiency, effectiveness,
accessibility, satisfaction, safety, equity
• Design: Descriptive, RCT
• Point: Care Map, CPG, CAI, QA, UR
• Indicator: Input, process, output, outcome
Examples of Quality of Care Research
• Result of using care map in femoral fracture
• Factor affecting satisfaction in orthopaedic patient
• Cost analysis in hip fracture using CPG
• Randomized controlled in HNP between with and without care map
Example of Cost Analysis Research
• Cost analysis of closed tibial fracture treatment
• Cost analysis of MRI in HNP
• Cost - utility of radiotherapy in metastasis spine
• Cost - effective analysis of deep vein
thrombosis prophylaxis in hip surgery
Research Design
• Descriptive study - Ecological
- Case series - Cross - sectional• Cohort study• Case - control study• Intervention study
Descriptive Study
• Hypothesis generation
• Effect of placebo, co intervention,
natural history
• Bias, confounder
• For fetal, rare, dramatic response disease
Cross - Sectional Study(Prevalence Study)
Reference PopulationReference Population
Cause+
Disease
Cause+
No Disease
No Cause+
Disease
No cause+
No disease
Descriptive or Analytic
Advantages and DisadvantagesAdvantages and Disadvantagesof Cross-Sectional Studyof Cross-Sectional Study
Advantages Disadvantages
• Short period of time
• Save cost
• Less recall bias
• No temporal relationship
• Not possible for rare
disease
• Bias
Case - ControlCase - Control
ExposedExposed
No Exposed
No Exposed
ExposedExposed
No Exposed
No Exposed
CasesCasesCasesCases
ControlsControlsControlsControls
Advantages and Disadvantages of Case - Control Study
Advantages Disadvantages
• Efficient
• Smaller sample size
• Less expensive
• Less time consuming
• Bias, confounder
• Temporal relationship
• Less accurate
Rare disease, long incubation
Randomized Control Trial
Treatment ATreatment A Treatment BTreatment B
Success Failure Success Failure
Defined PopulationDefined Population
Advantage and Disadvantages of RCT Study
Advantages Disadvantages
• Evidence - based
• Least bias, confounder
• Short duration
• Cost
• Ethic
• Limited application
Prevention and treatment
Study Design and Time
Past Present Future
Cohort, Control trial
Historical prospective
Cross-sectional
Case - control
What is the Characteristics of Good Paper?
• Relevant
• New information
• Valid
• Useful
• Interesting
• Easy to understand
Title
•Concise•Clear•Specific •Interesting
What, who, where
What is to come
Abstract
• Background
• Question
• What was done
• What was found
• Answer
• Implication
To provide an overview
Introduction (I)
• “Why you have to do”
• Significant of problems• High risk, high volume, high cost, high variation
• What is the gap of knowledge?
Need extensive review
Introduction (II)
• Background (should be short)
• Known unknown (funelization)
• Connectivity
• Why you are interested
• Signaling the question
To awaken interest !
Objectives
• The question) you want to know
• Should be concise and sensitive
• “Who , what , how”
• Major / minor
Plan
Materials and Methods (I)
• How you did your research/project ?
• Simplify, clarify, step by step
• Repeatability
• Picture or figure is better
To provide detail to enable to evaluate your workprovide detail to enable to evaluate your work
Materials and Methods (II)
• Materials» What was examined (material, animal,
human)
• Methods» Experimental protocol : variable » Purpose» Number» Evaluation criteria » Analysis
DoDo
Result (I)
• “What you have found”
• Only data that pertinent to question
• Table or graph
• Should not repeat
• Clear / easy to understand
• Chronologically
To state the outcome of the study / project
Result (II)
• Indicators / variables
• Accuracy and consistency
• Statistical analysis
• Most to least important
Check
Discussion (I)
• What is/are the result mean?
• “What is the benefit / new knowledge?”
• Explanation the discrepancy with other result
• Hit to the point
• SWOT
To answer the question and result
Discussion (II)
• Telling a story
• Focus on the question
• Signaling discuss answer
• Data information knowledge
• Step by step
• Make a point (implication)Fully, clearly, precisely and thoroughly
References
• Good reference ; valid, available, accurate, relevant, fewest
• Where ; introduction, discussion
• Style
• Detail; name, title, journal, year and page
Give credit to source of information
Anatomy and Function of Each Part of Medical Paper
Anatomy Function Anatomy Function
• AbstractAbstract What is to come What is to come
• IntroductionIntroduction Awake interest Awake interest
• Materials and methodsMaterials and methods What they did What they did
• Result Result What they found What they found
• DiscussionDiscussion Answerer the question Answerer the question
• ReferenceReference Give credit to source of Give credit to source of
informationinformation
Is the Study Worth Doing?
• What research questions are to the addressed?
• What do existing studies show?• Is a new study warranted?• Is the study design : appropriate?
: biased?
: sufficiently large?Carpinter LM., Lancet 1993
Common Problems for the Beginner
•Poor literature review• Poor research question generation (gap of knowledge)• Jumping• Poor research methodology
Pitfalls in Start Doing ResearchPitfalls in Start Doing Research
• Start from simple research
• Benchmarking
• Mentor
Obstacles in Doing Research
• Attitudes- Negativism- Reluctant- Fast food
- No curiosity
•Knowledge- Quantity- Quality
• Practice
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•ล�กษณะน�าเชั��อ•เป.นคริ่�เริ่า
“ พุ�ทธธรรม : พุระ”ธรรมปิฏก
Set a Goal for Set a Goal for YourselfYourself
Be ConfidentBe Confident
Everything is Everything is Possible If you TRY!Possible If you TRY!
SUMMARY
•Attitude Knowledge Practice Learning
•Plan Do Study Act
•Evidence-based > Commonsense-based
•Why,who,what,when,where,HOW?