Research Design1

Research lecture #4 Designing a Study I: Today we will talk about how to begin a research topic. By choosing the research question. We want to choose the main problem or question for your research. What does research question mean? It means when you answer questions, you do the research. Ya3ni in doing the research is the answer of that question. For example, what is the prevalence of Carabelli treat among the Jordanians? If we want to answer the question, we have to do a research. So finally, after the research has been done, then let say it is 50 %, so this is conclusion that we reach after doing a research. So choosing the research problem or choosing the main concept or the main idea of the research is the first step of research design. And you have to identify a research question. In other to be able to identify a research question, you have to determine the unknowns in your field. ( ... ) This (time of tooth eruption by the time the Dr. came back from Australia) has not been investigated yet. Thats why that prompt the Dr. to do the research. ( ) So you have to determine the unknowns in your field. And what do you wish you knew in the field. You have to ) .) So what do you wish you knew in the field and what does the available literature lack. ( )What do they lack? So you have to ask yourself this question it is very important. So through your research you are going to fill this gap. When you read a lot youre find there is a missing ring, so through your research, you are going connect the chain by this ring. By this youre also bridging the gap in the literature. ( ) ...

And also you have to determine your capacity and experience. Do you have the experience to do the research? Do you have the capacity to do the research? This is so important, sometimes you may have the experience but you don't have the money. (For example, during my PhD I was working on a machine that has three dimensional photographs, and it costs a lot that the Uni couldn't afford easily so I had to stop this research and start another one in another field) I dont have the capacity to continue, not because I dont have the capacity, because I didnt have let's say the capacity to apply for funds and to buy the device that I use to work with. Also, your experience is very important. Dont begin the research if you dont have enough experience to complete it. ( Muhim ya jama3ah hai nuqtah.) The research question can be descriptive or analytic. We will discuss that, what does descriptive research question mean? It explains clinical phenomena, for example if you want to investigate on the prevalence of disease, like the prevalence of caries among school children. ( ... ) You are answering a simple question, what is the prevalence of caries among school children? So you are explaining very simple clinical phenomena. This is called descriptive research. Sometimes, survival trends What is the percentage of men with prostate cancer who remain alive at five years? I want to determine the prognosis of the prostate cancer haza a simple question! Health service utilization What is percentage of seniors receiving H1N1 vaccination? I am answering the simple question which called descriptive. Clinical test characteristics what is the mean value of LDL among patients with ischemic heart disease? Barduh haza a simple question. so this is called descriptive research question. In analytic research question, sometimes you are making or what you are doing, you are not doing something simple or direct. You are comparing. For example, is the prevalence of caries higher among private or governmental school children? I

am comparing two phenomena. Thats why it is not descriptive, it is analytic. It is much more significant than descriptive questions. All the time the analytic research questions are more significant than descriptive research. This doesnt mean that you dont have to do the descriptive researches. We have to begin with descriptive researches. Alright? (It is the base line for Ex. The research that I've done: the timing of permanent tooth development among Jordanian. This is descriptive because it answers the question what are the timing of permanent tooth eruption among the Jordanians. But later on after I did that, I have to do something analytic, then I did another research. What is the difference between the timing of the tooth development between rural and urban school children?) I started with the descriptive research then I keep it to the analytic one. So we need, if a field of research has not been filled with the research, you have to start with the descriptive then you have to do the analytic. If there is subject that has not been studied before you have to start from the beginning You have to explain an existing phenomenon, later on you start to compare. So you start with descriptive and analytic. It is more significant than descriptive question because the answering, enable the researcher to develop intervention to prevent disease, target intervention to particular population. (When you know that the prevalence of caries is more in the school children of governmental schools for example the government directs the preventive program toward those students not the privet ones so you helped in targeting a particular population) Descriptive question must be answer first. As I said first you have to answer the descriptive question and then from this answer you may have concept in answering analytic question related to the main research. Choosing the research question If you want to choose a research question you have to specify the population. For example when I did my research is my population people who live in Irbid only? People who live in Al-agwar or Al-badeyeh may be different! You have to specify the population before starting the research.

You have to determine the length of the study and your willingness towards completion. (You should have a vision about your research could it be done in a limited period of time? are you going to have the motivation to continue all the way through?) Thats why it is important to determine the length of the study and also your willingness towards completion. (!) They have found that the median time from enrolling subjects to publication was found to be 5.5 years (to be done with research) it differs depending on how long the research takes and so on. Choosing a research questions 1st criterion Choose a question that keeps you excited all the way through. You have to choose a question that youre excited all the way through. You have to identify the obstacles to performing and publishing research. For example, do I have the financial obstacle? Obstacle can be subjects; are there enough subjects for example? Ethical approval (Ana bahki mathalan, will my research be approved by the ethic committee? For example some researches cannot be continued I cannot try a drug on people and cause a disease or for example I want to do a research and so I have to kill 100 goats!! It is not ethical this is the ethical approval. You have to identify the obstacles related to ethical approval. Collaborators; do I have people to work with or am I on my own? Lab capacity; does my lab have enough equipments? Review committees; is my research going to be published? Or when it is reviewed I will have some difficulties? Editors and missing data All of these are the obstacles that need to be identified before doing a research. Ya jamaa3aah u r a gd class :P (we r sleeping ya Dr. :P) Choose research question that will have an impact on the health and well being of the population. You have to select the research that will have a significant finding. The results of your research should be important, For example, what is the point of making a

research to find out who is taller, Males or females? And the result the conclusion males are taller than females, it is not significant. So thats why the answer of your research question or finding should be significant, should have an impact on health and well being of the population. It is difficult to fully appreciate the impact a study will have before doing it. (Sometimes it is hard to determine what the impact is before I start my research so I may have to modify a little pit) sometimes you may come out with groundbreaking result. (Sometimes you have a surprising result for example when I was a PhD student I found out that an average of 13 faces of a population is specific! for example if I want to have a 3D shape of the Jordanian average face I only need 13 person to identify it!). The purpose of clinical research is to improve health not for grantsmanship, publication and promotion not only for the funds from the government for example or only for promotion honestly in universities you rarely find someone who makes a research for the sake of science Enrollment of sufficient number of subjects It is important to choose a question that will have an impact on health. You want to provide the research with an impact on health to enroll a sufficient number of subjects. The third criterion is to consider what questions you are ready to answer based on. This is including the prevalence of the disease in your area, your prior experience, your colleagues, your community contacts. For example AIDS, which doesn't commonly occur in Jordan. Maybe it is wiser to do research on something else. It is wiser to do research on hepatitis B virus for example. It is better than do research on AIDS. Even AIDS is important but it is not very common in Jordan. So it is wiser to do research on the prevalence of the disease in your area. Your prior experience, you have to have an experience also you should to identify your colleagues who are ready to help you. Your community contacts. Do you have a sufficient contact with different area in your community during doing the research? (for example in my research I should've had a contact with the

education directors) You should have community contact in order to be able to perform the research. The fourth criterion, be sure it has not already been answered unless if you can do better. For example, research the prevalence of the Carabelli treat among the Jordanian. Do you remember cusp of carebilli that we had already studied? ala upper 6th. Ya3ni iza neraf what is the prevalence among the Jordanian population, which is the prevalence of the different forms, can be large, sometimes small sometimes ala syakkil pits and groove. So thats why I did this research although this research has been done before. There is colleague in jami3ah urduniah did the same research but the data provided by their research are surprisingly high. Thats why I did the research to do a review and the result actually less than that. Be sure it has not already being answered unless if you can do better. By this research, I did better. If I did the same research and the others results were perfect it is hard to do another one be careful, this is so important. Nowadays we have computerized literature searches. (By this you will have the data about the researches that has been done in your field before) Before doing research, you have to look to the literature. Which is adab fi tibbil asnan. We call dental literature. You have to look to dental literature to find out or to find any details in area that you want to investigate it has been done before to have the same research repeated with the same results so what is the point? Thats why you have to ask and consult the others in the field. (It is easy in Jordan because only the Dr.s of universities do researches!) Sometimes you can attend conferences. Scientific or academic relations are very important. Not all conference abstracts are electronically accessible (unfortunately) there are more than one method to be aware of the researches that have been done in your field for example by your relations, by attending conferences, by the computerized searches.

Choosing a study design. There is no best design for study. ( ) You have to determine the best study design to answer your question. so you have to see the feasibility of your research, the cost, length of time, risks and benefits on participant. For example, we talk about the timing of tooth development among Jordanian population. The way we do the design is quite different. But the idea of the design is to collect the sample representative of the whole Jordanian population. So this is called the study design, so you have to identify and put a study design before you start a research. If you want to do that you have to know your feasibility, the cost, the length of time, and the benefits on participant. Broad categories of study design. Either we classify them as randomized study or observational study. Observational study, you want to observe something in that population. I want to observe the timing of tooth emergence in the Jordanian population. This is called observational study. Randomized study, you have to do a clinical trial. but in my study, I didnt do an experiment. I just examine the school student to observe the existence of a phenomenon. In the observational, Investigator assesses a population without altering the condition or group assignment of the population. You are assessing the population but you are not interfering with the population. You are not altering the condition of that population. So, I didnt do anything, no extraction of teeth, no filling. This is called observational. But if I want to do a research on patient for example people will be treated with amalgam fillings, and the other group of people will be treated with composite filling. Finally I want to see which one is better. This is not observation because I alter the condition of my subject. Thats why this is called randomized. Ya3ni in randomized, the investigator manipulate the condition or group assignment.

Advantages and disadvantages of randomized studies It is better at dealing with confounding and bias But unfortunately, it will have less generalizability. If you want to do a research to see which is better, amalgam or composite fillings I can't have 3000 people and do fillings for them! So this is hard so I take 20 for each for example so because the number is less now the generalizability is less but it is easy in the observational researches you meet the patient once you do a fast examination and you're done so you can have large number of people more general! It is slower to conduct. (It takes a long time) for example we want to compare what is a better impression material alginate or impression compound? We bring a group of people 20-20 and do a bridge for each then if I want to see what is a better bridge I have to wait 5 years for example to determine which is better so it takes a long time! Also it is more expensive. Why more expensive? (For example when we do a drug research whom of people is ready to take a drug without any pay back?) But in an observational study you may have questionnaire or so and anyone can answer it. Cannot answer as broad a range of questions as observational studies It (observational studies) opens your horizon for more questions but the randomized study only answers one question (for example what is the S/E of an antibiotic on the kidneys?) The Confounding We discussed that previously, the association between a risk factor and an outcome is affected by relationship or the third variable. For example, the affect of dust for people who work in mines on lung cancer, but we have smoking as well (we call it confounder)

The confounder is associated with risk factor. It is causally related to the outcome. For example the affect of the mine dust on ling cancer, smoking is related to the outcome and also it can be related to dust. In randomized groups assignment the potential confounder is not related to risk factor. *we will talk about this later but know it as in the slides in the randomized research design it is better at dealing with confounding and bias The potential confounder only affect in this direction, ya3ni its affect the outcome but it doesnt affect the randomized group assignment. With randomization there should be no relationship confounder and group assignment. ~ But in the observational study it could be in two directions so I would be confused and won't know the affect of the confounder. ~ Elimination of confounding by randomizing subject - Randomization should be unbiased. - Randomized groups will be equal with respect to confounders. - Randomization eliminates known and unknown confounders. - Other techniques for minimizing known confounders. (E.g. Matching, stratification, multivariable adjustment) will be discussed later on as well in sha2 ALLAH

Minimizing bias - Randomization eliminates confounding only when unbiased randomization is good and lowers the confounding only when you don't have bias!

- Group assignment should be done: - At the time of enrollment (waqt al 2elte7aaq) not before or after. (qabel ma aballesh el ba7eth lazm aqassem el groups mesh 7asab el nta2ej!) No group assignment change by personnel. - By someone with no contact with the subject (you should not know the people that you are dealing with). - using a random number table or generator (computerized for example) - In observational studies, investigators and subjects usually know which group the subject / examiner were assigned to we talked about this we will continue next time ^_^ End. Done by: Nor Farahin Bakhtar
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