January 18,2008Boonsin Tangtrakulwanich,

MD., Ph.D

• Concept

• Clarify

• Stimulate

• Formulate

Objective (s)

Why Starting Point is Important?

Good Start Past Half

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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?