Published on August 6, 2014

Author: profsatya48090



PowerPoint Presentation: Even thousands of miles of journey starts with a single step…….. lao tzu a chinese mystic RESEARCH: RESEARCH WHY FOR DOCTORS ?: WHY FOR DOCTORS ? KILLED ONE THIRD PEOPLE OF EUROPE: KILLED ONE THIRD PEOPLE OF EUROPE Bacteria keeps us from heaven and puts us there….  — Martin H. Fischer : Bacteria keeps us from heaven and puts us there….  — Martin H. Fischer PARTICIPATE IN DEVELOPING SCIENCE: PARTICIPATE IN DEVELOPING SCIENCE EVIDENCE-BASED PRACTICE: EVIDENCE-BASED PRACTICE EBM: EBM Clinical Circumstances Research Evidence Patients’ Preferences Clinical Expertise 24 Haynes et al. BMJ 2002;324:1350 5As of EBM: 5As of EBM 27 PowerPoint Presentation: Research Doing Using Research Methodology EBM 28 YOU CAN CONTRIBUTE TO RESEARCH EVIDENCE.. : YOU CAN CONTRIBUTE TO RESEARCH EVIDENCE.. PART OF THE PG COURSE: PART OF THE PG COURSE TO PUBLISH PAPERS: TO PUBLISH PAPERS “PUBLISH or PERISH”: “PUBLISH or PERISH” FOR CAREER ADVANCEMENTS..: FOR CAREER ADVANCEMENTS.. WHY RESEARCH?: WHY RESEARCH? Development of scientific attitude - Evidence based medicine Learning research methodology Curricular requirement Academic requirement ( publication ) RESEARCH CYCLE: RESEARCH CYCLE RESEARCH IDEA: RESEARCH IDEA RESEARCH PROBLEM: RESEARCH PROBLEM RESEARCH QUESTION: RESEARCH QUESTION FROM CHOOSING THE TOPIC TO FRAMING THE QUESTION – WHY?, WHAT?, HOW? : PROF. Dr. V. Sathyanarayanan M.D Department of Pharmacology, SRM MCH & RC FROM CHOOSING THE TOPIC TO FRAMING THE QUESTION – WHY?, WHAT?, HOW? SPECIFIC LEARNING OBJECTIVES: SPECIFIC LEARNING OBJECTIVES To apply the processes involved in choosing the appropriate research topic, problem, idea To formulate a good research question To assess the research question effectively To develop a hypothesis, aims, objectives for testing the research question To be inspired to participate actively in planning and doing good research projects WHAT IS RESEARCH?: WHAT IS RESEARCH? It Is a systematic and organised scientific process To find answers to questions RESEARCH IN EVERYDAY LIFE: RESEARCH IN EVERYDAY LIFE for example, want to buy a car in a proper way, we collect information about models and dealers, analyse it, then try to reach a “scientific” conclusion on which car to buy “The whole of science is nothing more than a refinement of everyday thinking.” –Albert Einstein : “The whole of science is nothing more than a refinement of everyday thinking .” –Albert Einstein TYPES OF RESEARCH: TYPES OF RESEARCH @ bajammal WHAT MAKES A GOOD RESEARCH PROJECT?: WHAT MAKES A GOOD RESEARCH PROJECT? First and foremost, it must be interesting You should learn something of value to you It should be productive KEY ATTRIBUTES OF GOOD RESEARCH : KEY ATTRIBUTES OF GOOD RESEARCH Proper planning Accuracy in data collection Proper unbiased interpretation . RESEARCH PROCESS: RESEARCH PROCESS PowerPoint Presentation: Research Problem Research Question Research Design Data Collection Data Analysis Research Dissemination @ bajammal Methodological, Ethical & Statistical Considerations at Each Stage RESEARCH PROBLEM: RESEARCH PROBLEM A CURIOUS RESEARCH SCHOLAR.. : A CURIOUS RESEARCH SCHOLAR.. An old scientist went home for a weekend as usual late on Friday evening He left his lab without cleaning and left a window open He arrived after vacation before his lab attender He saw some culture plates were infected with mold He developed a curiosity He didn’t clean it immediately H e found bacteria had grown all over the plate, except in an area where mold had formed . turning point in human history : turning point in human history YEAR : 1928 PLACE : St Mary’s Hospital Medical School RESEARCH SCHOLAR : Alexander Fleming DISCOVERY : penicillin SIGNIFICANCE : world's first antibiotic, leading to revolutionize all medicine AS A RESULT : Mrs . Fleming hiring a maid . DEVELOPING SCIENTIFIC CURIOSITY: DEVELOPING SCIENTIFIC CURIOSITY Key feature of success in research IDENTIFYING A RESEARCH PROBLEM: IDENTIFYING A RESEARCH PROBLEM as  you go about your  daily clinical  practice observe with curiosity and enquire…..  Sometimes it is the result of having  a disagreement  with a  colleague Define the problem well IDENTIFYING A RESEARCH PROBLEM: IDENTIFYING A RESEARCH PROBLEM Simple curiosity + enquiry “Why are things done this way?” “I wonder what would happen if…..?” “What characteristics are associated with….?” “What is the effect of…….on patient outcomes?” RESEARCH PROBLEM: Disease process Etiology and pathogenesis Pathophysiology Diagnosis Treatment prognosis Research problem Elucidate mechanisms Diagnostic approaches Therapeutic interventions Research into the prognostic factors RESEARCH PROBLEM Read general background information : Read general background information From standard text books Use article databases to scan current magazine, journal or newspaper articles on the topic Use Web   search engines  to find Web sites on the topic CHOOSE A SUITABLE GUIDE.. : CHOOSE A SUITABLE GUIDE.. Research idea: Research idea The man with a new idea is a crank until the idea succeeds….. TESTING THE RESEARCH IDEA: TESTING THE RESEARCH IDEA the ‘so what?’ test: the ‘so what?’ test the ‘who cares?’ test : the ‘who cares?’ test Focus on your topic: Focus on your topic Keep it manageable . Be aware if a topic is very recent discuss your topic with your guide IN THE ERA OF INFORMATION, IGNORANCE IS A CHOICE.. : IN THE ERA OF INFORMATION, IGNORANCE IS A CHOICE.. LIST KEYWORDS : LIST KEYWORDS   Look for words that best describe your topic Keep a list of these words to use later as you search Beginning the literature Review : Beginning the literature Review Concluding sections in the critically examined individual studies, systematic review Remaining gaps in literature Further define the research question MEDLINE, PUBMED, SCIENCEDIRECT, MEDSCAPE FIND OUT THE “KNOWLEDGE” GAPS: FIND OUT THE “KNOWLEDGE” GAPS To steal from one is steal from many is research… ---Steven Right: To steal from one is steal from many is research… ---Steven Right IN FAILURE..: IN FAILURE.. A Welsh hamlet was ground zero for a test on a pill to fight angina . Unfortunately for the afflicted, it had little success against the disease. Though it didn't work, the men taking part in the study refused to give up their medicine . THERE IS A WAY….: THERE IS A WAY…. YEAR : 1992 INTERVENTIONAL DRUG : Viagra INVENTORS : Scientists at Pfizer The scientists switched gears and marketed the drug , Viagra, for a very different purpose Define your topic as a focused research question: Define your topic as a focused research question You will often begin with a word, develop a more focused interest in an aspect of something relating to that word , then begin to have questions about the topic . Significance of the research question must be identified Research Question : Research Question     Trying to  turn  a  statement   into  a real question   What is a Research Question? : What is a Research Question? The uncertainty that you want to resolve Defines the area of interest to be addressed in your study Forms the foundation of your study Must be specified before you begin your Analysis RESEARCH QUESTION : RESEARCH QUESTION Key preliminary step of the research process Presents the idea that is to be examined in the study Foundation of the research study IS THE MOST DIFFICULT AND CRITICAL PART of the study HOW TO DEVELOP A RESEARCH QUESTION ? : HOW TO DEVELOP A RESEARCH QUESTION ? Literature Your previous research Mentor Conferences Patients HOW TO DEVELOP A RESEARCH QUESTION ? : HOW TO DEVELOP A RESEARCH QUESTION ? Do a thorough search of medical literature Identify the edge of knowledge related to that question Identify the gaps in knowledge Be certain that your question has not already been answered AND that filling the gaps is important Research is to see what everybody else has seen, and to think what nobody else has thought………. ----Albert Szent-Gyorgyi: Research is to see what everybody else has seen, and to think what nobody else has thought………. ---- Albert Szent-Gyorgyi  Refining a Research Question :  Refining a Research Question  Possibly the most difficult part   is to come up with a reasonable  question   and   focus it  to the point  where  it can be answered Refining a Research Question  : Refining a Research Question  defining  the goal  of your research ,  identifying  objectives ,  refining  and refining it some more and  refining  it even more until  you  have a  neat and simple  question    that is feasible to answer.  SAMPLE RESEARCH QUESTIONS : SAMPLE RESEARCH QUESTIONS QUESTION 1 :Should women take hormones to prevent bone loss? QUESTION 2 : Can a vegetarian diet reverse cardiovascular disease? Often begins with a general concern …. REFINING : REFINING Must be narrowed to something measurable and researchable QUESTION 1 : Is taking estrogen associated with a lower risk of osteoporosis in women 60 +? QUESTION 2 : Does a plant-based diet reduce serum cholesterol levels in patients with cardiovascular disease? REFINED SAMPLE QUESTION 1 : REFINED SAMPLE QUESTION 1 QUESTION 1 : Should women take hormones to prevent bone loss? REFINED QUESTION 1 : Does taking estrogen after menopause reduce the likelihood of bone density loss in women over 60 years of age, compared to women not taking estrogen ? REFINIED SAMPLE QUESTION 2 : REFINIED SAMPLE QUESTION 2 QUESTION 2 : Can a vegetarian diet reverse cardiovascular disease? REFINED Research question: Does an entirely plant- based vegan diet reduce blood serum cholesterol levels in men over 50 years old with lipid levels compared to a meat- based diet?  ask yourself :   ask   yourself   What is the  population  I want to study?  How do I  describe  it – age, sex, background?  What is the  intervention  I want to study?  Do I have all the  details  of the intervention?  What is the  outcome  I want to achieve?  How am I going to  measure  the outcome?  key features of well‐built questions: key features of well‐built  questions PICO  P ‐ Population  I ‐ Intervention  C ‐ Comparison  O – Outcome Measured  EXAMPLE 4: EXAMPLE 4 You are in OP department ( medicine/ENT/ Pediatrics ) A patient with otitis media comes Your Asst.Prof prescribes amoxycillin A scientific curiosity comes to your mind A research question IS AMOXYCILLIN EFFECTIVE FOR OTITIS MEDIA ? knocks your mind.. You want to proceed….. HOW ? EXAMPLE 5: EXAMPLE 5 You are sitting in Medicine/Surgery/ Orthopedics /OG OP A regular patient comes with pain on his back visits You feel pity on his pain you want to find out “What is the best treatment of back pain ?” How to proceed…..?!! Is this a good question?: What is the best treatment of back pain? 155 Is this a good question? Is this a good question?: Is this a good question? In adult patients younger than 50 years old with acute low back pain (< 6 weeks), does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy? P: Adult patients <50yr with acute LBP I: Bed rest C: Physiotherapy O: Recurrence of pain within one year 157 FINER Criteria:: FINER Criteria: F  – Feasible  I – Interesting  N – Novel  E – Ethical  R ‐ Relevant  FEASIBLE: FEASIBLE Adequate number of subjects Adequate technical expertise Affordable in time and money Manageable in scope INTERESTING: INTERESTING To you To the guide To the peers Editors of the journals Reviewers NOVEL..: NOVEL.. Newer topic or idea Not duplicated Provides new findings Confirms or refutes previous findings extends previous findings ETHICAL: ETHICAL Should follow existing guidelines like ICMR code of Ethics in biomedical research Clinical trials should follow  ICH –GCP guidelines Get the IEC approval RELEVANT: RELEVANT Addresses certain community needs Addresses issues that will have an impact for policy making Future research directions RELEVANT: RELEVANT To scientific knowledge To clinical and health policy To future research directions COMMON OBSTACLES: COMMON OBSTACLES Not interesting, relevant, novel.. : Not interesting, relevant, novel.. Consult with mentors review the literature again.. IF UNETHICAL..: IF UNETHICAL.. Consult with IRB/IEC revise research question Methods beyond your skills : Methods beyond your skills Collaborate with experts in those areas OTHER OBSTACLES and SOLUTIONS : OTHER OBSTACLES and SOLUTIONS Question too broad = Reduce variables of interest narrow focus Not enough subjects available = Expand inclusion criteria; lengthen time frame ; modify exclusion criteria Too expensive = Consider less costly study designs; fewer subjects; shorter duration ; fewer follow-ups FAILED AGAIN…: FAILED AGAIN… FAILED 10000 TIMES…: FAILED 10000 TIMES… A research scientist made 10,000 unsuccessful attempts at an invention One day, an assistant asked him why he didn’t give up…. After all, he failed over 10 thousand times…. the researcher replied that he had not failed once… OWNS 1093 ORIGINAL PATENTS….: OWNS 1093 ORIGINAL PATENTS…. Thomas Edison held a world record of 1093 patents for inventions including Telegraphs, electric lights, electric lamps, light bulbs, telephones, vacuum pumps, storage batteries, phonographs, transmitters ….. etc PowerPoint Presentation: Questions to ask yourself  Yes  No  Vague Is the question asked in a single sentence?  Is the question simple?  P Does the question specify the population?  I Does the question state the intervention?  C Is there a comparison group?  O Is there a clear outcome in the question?  O Has the measure for the outcome been specified?  F Is the question FEASIBLE?  I Is it INTERESTING ?  to you?  to others?  N Is it NOVEL?  ‐‐ new?  Innovative?  E ETHICAL?  ‐‐ is there a state of equipoise between competing therapies?  Will your investigations   harm?  R RELEVANT?  To policy makers?  To patients?  HYPOTHESIS: HYPOTHESIS Can be considered as intelligent hunches or predictions that help to answer a research question Provide a bridge between theory and real world  HYPOTHEIS :  HYPOTHEIS     single  statement  that  contains   sufficient   information  that  it  can be tested using  statistical   methodology Hypothesis tests: Hypothesis tests    are  procedures  for  making  rational decisions about  what  is real and  what  is opinion Hypothesis Testing (α & β errors): Hypothesis Testing ( α & β errors) Results in the Study Sample Truth in the Population Association Between Predictor & Outcome No Association Between Predictor & Outcome Reject null hypothesis Correct Type I error ( α ) Fail to reject null hypothesis Type II error ( β ) Correct Null Hypothesis: No association between predictor & outcome @ bajammal FORMULATE A THESIS STATEMENT: FORMULATE A THESIS STATEMENT This may be the answer to your research question and/or a way to clearly state the purpose of your research. Your thesis statement will usually be one or two sentences that states precisely what is to be answered, proven GOAL or AIM : GOAL or AIM     stated in broad  terms  and  covers the topic   that  interests  you  OBJECTIVES:   OBJECTIVES   more  focused  There could be  more than one   but   all would contribute   to  the overall  goal Define it   Randomized Controlled Trial (RCT): Randomized Controlled Trial (RCT) Patients with MI RANDOM Drug A Drug B F/U F/U Outcomes Outcomes @ bajammal WHAT NEXT? : WHAT NEXT? Designing a protocol FOR A SUCCESSFUL PROJECT…: FOR A SUCCESSFUL PROJECT… CHOOSE MENTOR..: CHOOSE MENTOR.. DO A FOCUSED LITERATURE SEARCH : DO A FOCUSED LITERATURE SEARCH ARTICULATE RESEARCH QUESTION: ARTICULATE RESEARCH QUESTION Focus on the mentor : Focus on the mentor BE FLEXIBLE: BE FLEXIBLE it is common to modify your topic Be aware of the depth of coverage and the due date. Your guide will provide DON’T Study something in which your mentor does not have expertise: DON’T Study something in which your mentor does not have expertise DON’T MAKE ASSUMPTIONS: DON’T MAKE ASSUMPTIONS MAKE SURE PROJECT IS ACHIEVABLE: MAKE SURE PROJECT IS ACHIEVABLE STAY FOCUSED: STAY FOCUSED Quick Links  : Quick Links  Hulley  SB, Cummings SR. “Designing Clinical Research: An  epidemiological  approach.  Centre for Health Evidence: “Users’ Guides to Evidence  Based  Practice”   Guidelines for graduate students: “Choosing and refining a  research  topic”  http ://  How to write Specific Aims :‐4.asp  SUMMARY : SUMMARY   you  can write the  one page description  required for the  assignment.   should write the  goal   of the research ,  what the   general objective   of the research is ,  try to formulate  specific  aims  which can be your refined question(s) and then ,  if you have a  hypothesis  that can be  tested,  write that down.   summarize your thinking on the   feasibility  and  general  plans  you have for conducting the research.  THANK YOU….: THANK YOU…. Things to think at this stage: Things to think at this stage What is the  sample size   you are looking for ?  would you have  access to the  population  you  wanted? Would the selected population  agree to   participate ? Would you be able  to obtain  the  drug samples?   Think through  what budget  you might  need? Will the  ethics committee  approve of your project ? How  novel  are the questions ? ( not repeated )

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