Академический Документы
Профессиональный Документы
Культура Документы
Determine the unknowns in your field What do you wish you knew in your field? What does the available literature lack? Your capacity and experience
Research question
Descriptive Analytic
Prevalence of disease
Survival trends
E.g. (Prevalence of caries among school children) E.g. (% of men w prostate cancer alive at 5 years) E.g. (% seniors receiving H1N1 vaccination) E.g. (mean value of LDL among patients w IHD)
Comparative
E.g. (Is prevalence of caries higher among private or governmental school children?) Answering enable to
Specify the population Determine the length of the study and your willingness towards completion
Choose a question that keeps you excited all the way through
Choose a question that will have an impact on the health and well being of the population
will have before doing it
discoveriesetc
health not for grantsmanship, publication and promotion Enrollment of sufficient number of subjects
The prevalence of the disease in your area Your prior experience Your colleagues Your community contacts
Be sure it has not already been answered unless if you can do better
Computerized literature searches Consulting the others in the field Attending conferences
accessible
There is no best study design Determine the best study design to answer your question
benefits on participants
Feasibility, cost, length of time, risks and Randomized studies Observational studies
Randomized
Observational
Better at dealing with confounding and bias Less generalizability Slower to conduct More expensive Cannot answer as broad a range of questions as observational studies
Confounding
Association between a risk factor and an outcome is affected by the relationship of a third variable (confounder) to the risk factor or the outcome Confounder
Confounding
Risk factor Outcome
Confounder
Outcome
Potential confounder
With randomization there should be no relationship confounder and group assignment
Eliminating confounding
Randomizing subjects 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
Minimizing bias
Randomization eliminates confounding only when unbiased Group assignment should be done
by someone with no contact with the subject using a random number table or generator
Minimizing bias
In observational studies, investigators and subjects usually know which group the subject / examiner were assigned to
Minimizing bias
subject from knowing group assignment Double blinded vs. single blinded
Generalizability
Generalizability refers to the ability to apply the outcomes of a study to populations other than the study sample The results of a trial apply only to populations that resemble the study sample
Randomized subjects are different from the general population because they carry more burdens
Selection, blinding, previous exams and blood testsetc. Trial subjects receive more attention Treatment works under tight research protocol Treatment efficacy vs. treatment effectiveness
Efficacy: how well an intervention works in a research setting Effectiveness: how well an intervention works in a clinical setting
additional educational or testing than normal clinical patients Observational study patients may change their behavior (Hawthrone effect)
Especially
Minimizing expenses
impractical to randomize subjects (you cannot randomize persons to smoke or not to smoke) Randomized control studies are rarely helpful in identifying causes of disease outbreaks
Instances where it is unethical or impractical to perform a randomized study Time is of the essence in obtaining the results