January 18,2008 Boonsin Tangtrakulwanich, MD., Ph.D

1. How to Start Doing Research January 18,2008 Boonsin Tangtrakulwanich, MD., Ph.D

2. Objective (s) • Concept • Clarify • Stimulate • Formulate

3. Why Starting Point is Important? Good Start Past Half “เริ่มต้นดี มีชัยไปกว่าครึ่ง”

4. Causes of Manuscript Rejection Research Design Methodology Poor conceptualization Inadequate control Duplication Statistical analysis Poor literature Number of response

5. Source of Human Knowledge • Authority • Tradition • Intuitive • Trial & error • Reasoning • Research

6. Why Have to Do Research • Degree • Learning • Promotion • Improve quality of care

7. What is Research? A class of activity designed to develop or contribute generalization knowledge Last JM. Dictionary of Epidemiology, 2001

8. What is Research • Tool for exploring truth • Tool for learning • Improve quality of care

9. Genetic Health care service Environment Behavior Concept of Health -Biological - Psychological - Social

10. Truth in the universe Truth in Study Finding Research Question Study Plan Actual Study Philosophy

11. Result of Research Truth + Systematic error + Random error

12. Error Random error = Chance Systemic error = Bias Valid, Precise Invalid, Precise Invalid, Imprecise Valid, Imprecise

13. Step in Doing Research (І) • Research • Research question generation • Objectives • Rational (gap of knowledge) • Design type of research • Set hypothesis • Draft research proposal

14. Step in Doing Research (2) • Research plan • - Materials and methods • Define target population • Calculate sample size • Instrument • Statistical use • Data collection/analysis • Academic writing

15. Good Research Questions(FINER) • Feasibility • Interesting • Novel • Ethical • Relevant

16. Component of Research Question P=Population I=Intervention C=Comparison O=Outcome

17. Select Topic of Interest Define Research Problem Evaluate; target, background Research Objectives Process in Developing Research Question Need extensive review

18. Common Problems in ResearchQuestion Development • Unclear • Not feasible - Too broad - Sophisticate - Repeat the same thing • Ethical issue

19. Common Research Questions Issue Question Abnormality Diagnosis Frequency Risk Is the patient sick or well? How accurate are test used to diagnose disease? How often does a disease occur? What factors are associated with increase risk of disease?

20. Common Research Question (П) Issue Question What are the consequence of having a disease? Prognosis How does treatment change the course of disease? Treatment Prevention Does an intervention keep disease from arising?

21. 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?

22. Literature Review Objectives • Source of research ideas • Orientation of what already known • Provision conceptual frame work • Information for the research

23. Tasks on Literature Reviews • Identification • Detection • Critical analysis • Written description of existing information

24. Knowledge K A P Frontier y core x z • Dynamic Static • Black - grey - white

25. Level of Evidence Knowledge Reality Truth Information Data Believe, thought, common sense Feeling

26. Strength of Evidence Study design • RCT • Controlled trial • Case-control, cohort • Cross-sectional • Case series, expert opinion Bias

27. 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

28. 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

29. How 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 Method CMA 1981; 15: 703-710

30. 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

31. Types of Research • Basic science • Clinical • Qualitative

32. Types of Clinical Research • Burden of illness, natural history • Therapeutic • Etiologic or risk factor • Diagnostic • Clinical economic • Quality of care

33. 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

34. 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

35. 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

36. Research Design • Descriptive study • - Ecological • - Case series • - Cross - sectional • Cohort study • Case - control study • Intervention study

37. Descriptive Study • Hypothesis generation • Effect of placebo, co intervention, • natural history • Bias, confounder • For fetal, rare, dramatic response disease

38. Cross - Sectional Study(Prevalence Study) Reference Population Cause + No Disease No Cause + Disease No cause + No disease Cause + Disease Descriptive or Analytic

39. Advantages and Disadvantagesof Cross-Sectional Study Advantages Disadvantages • Short period of time • Save cost • Less recall bias • No temporal relationship • Not possible for rare • disease • Bias

40. Case - Control Exposed Cases No Exposed Exposed Controls No Exposed

41. 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

42. Randomized Control Trial Defined Population Treatment A Treatment B Failure Failure Success Success

43. Advantage and Disadvantages of RCT Study Advantages Disadvantages • Evidence - based • Least bias, confounder • Short duration • Cost • Ethic • Limited application Prevention and treatment

44. Study Design and Time Case - control Cohort, Control trial Historical prospective Cross-sectional Past Present Future

45. What is the Characteristics of Good Paper? • Relevant • New information • Valid • Useful • Interesting • Easy to understand

46. Title • Concise • Clear • Specific • Interesting What, who, where What is to come

47. Abstract • Background • Question • What was done • What was found • Answer • Implication To provide an overview

48. 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

49. Introduction (II) • Background (should be short) • Known unknown (funelization) • Connectivity • Why you are interested • Signaling the question To awaken interest !

50. Objectives • The question) you want to know • Should be concise and sensitive • “Who , what , how” • Major / minor Plan