Lecture 03: Defining Your Research Questions (SoHP503) PDF

Lecture 03: Defining your research questions SoHP503 Project studies Dr Daniela Oehring  S4 Code of the day ADD CODE Agenda What are we goi...

Lecture 03: Defining your research questions SoHP503 Project studies Dr Daniela Oehring  S4 Code of the day ADD CODE Agenda What are we going to do? Intended learning outcomes Using evidence to make Explain what PICO is & what the decisions and to answer letters stand for practical/clinical/ research Apply PICO framework to a specific questions topic or scenario Formulate an answerable clinical Formulating searchable question using PICOTE questions Identify the components of a successful research question. Create a viable research question. Finding evidence Project Studies | SoHP503 | Dr Daniela Oehring 2 Virtual Meeting Etiquette SoHP503 Turn off your phone Leave the keyboard alone (unless you are typing something in the chat, or you are doing an activity) Dress appropriately (Don’t wear your pyjamas, have a shower before the session starts and something to eat and drink) Be aware of your surroundings (No beds, No messy rooms, No inappropriate posters/ backgrounds) Mute your microphone when you’re not talking Speak up Stay seated and stay present (Position your camera so that your whole head is visible and not just your forehead, chest or the room) Project Studies | SoHP503 | Dr Daniela Oehring 3 Any questions Project Studies | SoHP503 | Dr Daniela Oehring 4 Anatomy of the research process SoHP503: Journey from choosing a topic to developing the research project proposal SoHP603: Journey from collecting the data to communicating your findings (via your dissertation) Project Studies | SoHP503 | Dr Daniela Oehring 5 Using evidence to make decisions and to answer practical/clinical/ research questions SoHP503 Project studies Dr Daniela Oehring Decision making process According to Hastie and Dawes (2010) the process to make a decision is built of three parts: 1.There has to be more than one possible course of action 2.The decision maker considers the possible or excepted outcomes 3.The consequences are assessed of each possible outcome based on personal beliefs and goals Project Studies | SoHP503 | Dr Daniela Oehring 10 Use of evidence to decide Thomson & Stapley (2011) characterised the different types of decision in clinical practice: Decisions about intervention Decisions about which patients will benefit most from an intervention Decisions about the best time to intervene Decisions about when to deliver information Decisions about how to manage a service or care delivery Decisions about how to reassure patients Project Studies | SoHP503 | Dr Daniela Oehring 11 Consequences and implications of decisions Some decisions will be more important than others. This depends on the nature of risk or potential for harm involved for the patient and the costs. In clinical practice: Can you identify areas with higher risk? Are the interventions commonly used in this areas based on EBP? What if there is no research evidence available? Project Studies | SoHP503 | Dr Daniela Oehring 12 Types of evidence Statistical General practice: you should adopt the most appropriate Evidence care and be able to justify it with reference to the most appropriate evidence. Testimonial Evidence Types: Primary research or review of research Anecdotal Policy, guidelines, care pathways Evidence Clinical or professional judgement Patient experience, reflective judgment, Analogical expertise of others Evidence Project Studies | SoHP503 | Dr Daniela Oehring 13 Types of evidence Statistical evidence: research Anecdotal evidence: You would use this to prove a point Something you tried before that worked (without checking evidence to support it) Testimonial evidence: eye- From colleagues or supervisors: “We’ve always done it like this” whiteness, correspondence From discussion papers, opinion articles You would use this to support a point or editorials Expert opinions You would use this to support a point or to disprove a generalisation Analogical evidence Avoid this Project Studies | SoHP503 | Dr Daniela Oehring 14 Examples - Which evidence do you need to help you make a decision? My hospital patient has been diagnosed as an alcoholic and shows first signs of vision loss regards to alcohol overuse but wants self-discharge against the judgment of staff. What should I do? You work with a student colleague on a placement. Your colleague has considerable personal issues and don’t appear to be coping well. How should you handle it? My patient has asked me about a particular vision therapy to improve …(visual) performance of their child. What should I advise? I want to know if it is better to use specific optotypes/ exercise/ occupation/ treatment in assessing diabetic patients. What should I do? My patient with …(glaucoma) shows very fluctuating …(IOP) values over the last three months. I wonder if I need to change the medication? Project Studies | SoHP503 | Dr Daniela Oehring 15 Which type of evidence do I need? Evidence about “Does it work?” Effectives of an intervention or therapy Evidence: RCT, systematic review A manufacturer always tells you a product is effective! If you can't find a RCT to back this up, be wary! Evidence about “What is it like?” Peoples/patients experience, symptoms Evidence: research report using qualitative approach, interviews Evidence about “What do they do in practice?” Patient's compliance/ use of medications, treatments Evidence: studies specifically about the use or compliance, also survey, interviews, observational studies Project Studies | SoHP503 | Dr Daniela Oehring 16 Research that has not been conducted in your particular setting or patient group Research undertaken with patients in a related area For example: you want to know the physiological variation in (… (IOP) using …(GAT) for healthy Caucasian adults, but you only can access a study about the physiological variation in ….(GAT IOP) of Asian healthy eyes Research undertaken in a laboratory: For example: you want to know how much … (corneal swelling) after the application of a certain medication is expected but can only access a study with mice assessing the … (corneal swelling) behaviour with this drug Research adopted from other disciplines: For example: you want to know how much of a … (corneal) pain sensation (sensitivity) loss is expected in diabetes patients, but you only have access to a study which assessed the sensitivity loss in fingertips in diabetic patients Project Studies | SoHP503 | Dr Daniela Oehring 17 Where can I get this from? ClinicalTrials.gov Public Library of Science (PLOS) Cochrane Library Plymouth Primo NHS evidence PubMed Google Scholar ScienceDirect MEDLINE The British Library Catalogues & MedicalStudent.com Collections Merriam-Webster Dictionary Zetoc and Thesaurus NICE Project Studies | SoHP503 | Dr Daniela Oehring 18 Where can I get this from? Find out where you can get high-quality concrete details about drug information, safety information, health services, health statistics? Drug information: British National Formulary (bnf.org); US Food and Drug Administration (fda.gov) Safety information: Medicines and Healthcare Products Regulatory Agency (mhra.gov.uk); European Medicines Agency (ema.europe.eu/ema); WHO Health services: NHS; US Department of Health & Human Service (hhs.gov); WHO Health statistics: UK National Statistics (statistics.gov.uk); National centre for Health Statistics (cdc.gov/nhs/); WHO Statistical Information Service (who.int/countries/en/) Project Studies | SoHP503 | Dr Daniela Oehring 19 Key points Every time you make a decision, you need to consider what evidence you need to base your decision on There are different types of decisions and different types of evidence to use for Use in first instance research paper! If not applicable, use other rationales like ethical principles, clinical judgement Sometimes research is not directly linked to your questions Guidelines etc. should be based on research (and should be available) Use anecdotal evidence as a last resort Always remember: if you can't find any evidence, you are the best evidence available! Project Studies | SoHP503 | Dr Daniela Oehring 20 References Hastie, R. and R. M. Dawes (2010). Rational Choice in an Uncertain World: The Psychology of Judgment and Decision Making, SAGE Publications. Thompson, C. and S. Stapley (2011). "Do educational interventions improve nurses’ clinical decision making and judgement? A systematic review." International Journal of Nursing Studies 48(7): 881-893. Project Studies | SoHP503 | Dr Daniela Oehring 21 Formulating searchable questions SoHP503 Project studies Dr Daniela Oehring Good questions & bad question Searching for evidence starts with a questions, this can be about treatment, guideline, policy, research… Think about the structure of question. What could be meant by bad in regard to questioning? What could be a bad question (not answerable)? Project Studies | SoHP503 | Dr Daniela Oehring 24 Types of questions Clinical questions can be divided into background and foreground questions Background questions: Asking about general knowledge of a topic Usually involves who, what, when, why, where or how Examples: What are the side effects of medications A or B? What causes disease C? How is virus D transmitted? Can be answered using textbooks, encyclopaedias, dictionaries, or other references source Project Studies | SoHP503 | Dr Daniela Oehring 25 Types of questions Foreground question: Applies to a specific patient or problem Examples: Will a change in contact lens material help a heavy smoker of 30 years with high myopia to gain more wearing comfort? Among children with amblyopia, does treatment with visual training affect symptoms? What is the risk of diabetic retinopathy for adults who are obese and take little exercise? Need to be answered by primary and secondary literature primary: original sources of information like journal articles secondary: interpreters of original sources like textbooks Project Studies | SoHP503 | Dr Daniela Oehring 26 Type of foreground question Aetiology: Questions of aetiology help us to determine the causes of disease (including harm caused by previous medical therapy). Diagnose: These questions help us to select and interpret the results of diagnostic tests (including taking patient histories and physical examination). Therapy: These questions help us work out the best interventions for our patients - what will deliver the most benefit and cause the least harm. Prognosis: These questions are designed to help us to estimate the likely progress or resolution of the disease, and the likelihood of any complications. Magnitude: Questions that seek to determine the size of a health problem in terms of patient numbers, or indeed the magnitude of costs associated with treating them. (EBP projects in nursing, 2001) Project Studies | SoHP503 | Dr Daniela Oehring 27 Outlook: Research question and research design Project Studies | SoHP503 | Dr Daniela Oehring 28 Breaking down the clinical scenario The PICO framework may help phrase your clinical question: P Patient/ Meaning the individual (e.g. gender, age group, Problem/Population race), the condition/ disease or the group that is the subject of the clinical question I Intervention The treatment that might be applied to the patient, problem or population C Comparison An alternative treatment that might provide similar if not greater benefits to the intervention. Please note: There might not always be a comparative intervention O Outcome The expected result of the intervention (something referred to as exposure) Evidence-Based Medicine—How to Practice and Teach EBM. D. L. Sackett, W. S. Richardson, W. Rosenberg, and R. B. Haynes. New York: Churchill Livingstone, 1997 Project Studies | SoHP503 | Dr Daniela Oehring 30 PICO Example 1 Does hand washing among healthcare workers reduce hospital acquired infections? Patient/ Problem Intervention Comparison Intervention Outcome hospital acquired hand washing no hand washing; reduced infection infection other solution; masks Project Studies | SoHP503 | Dr Daniela Oehring 31 Identifying keyword Your patient is a 72-year-old female with age-related disease. She read online that taking “antioxidant pills” from oranges and carrots may slow down the progression of the disease. She has visited your clinic for guidance on whether this is true, and if so, which are the best “pills.” Project Studies | SoHP503 | Dr Daniela Oehring 32 PICO Example 3 Your 10-year-old patient has myopia. Over the past 3 years, her myopia has increased by approximately 0.75D at each annual eye exam. The patient’s father asks whether anything could be done to prevent further increase. He read online about antimuscarinic medications and wants to know if it could be effective for his daughter. Patient/ Problem Intervention Comparison Outcome Intervention Answerable question: Project Studies | SoHP503 | Dr Daniela Oehring 36 Tips for writing a clinical question in practice P: Person, Patient, Population or Problem. Who are the relevant patients? Describe the ones that come into contact with you and are relevant to your practice. These populations might be the most relevant in writing your next clinical question. I: Intervention. What is the intervention, treatment, test etc. that you are interested in? Interventions can be types of dressings, drug therapies, placebos or counselling. Also they can be about the provision of differing environmental factors or deal with the way in which information is given to patients. They can also be diagnostic tests. Depending on what you already know about the topic you may want to investigate the name of a particular treatment or test (for example, laser treatment or lutein supplementation). Alternatively if the patient or population is relatively new, you can keep this general and ask "what intervention" rather than specifying a specific known treatment or test. Project Studies | SoHP503 | Dr Daniela Oehring 37 Tips for writing a clinical question in practice C: Comparison Intervention. Is there an alternative strategy to compare with the intervention? This can be a standard therapy, though it may also be no intervention a placebo or an alternative treatment, exposure or diagnostic test. O: Outcomes. What are the consequences of the interventions you are interested in? Make a distinction between the outcome which is relevant to your patient or problem and the outcome measures deployed in studies. Spend some time working out exactly what outcome is important to you, your patient, and the time-frame which is appropriate. Project Studies | SoHP503 | Dr Daniela Oehring 38 PICO Example 4 You are an … (Your Profession) pre-reg student on your first hospital placement on the … ward. You have been advised that between patients you must always wash your hands with medicated soap as this is the most effective means of reducing the spread of infection. However, you are sure that you have heard somewhere that an alcohol-based solution would be more effective from infection control perspective. Patient/ Problem Intervention Comparison Outcome Intervention Project Studies | SoHP503 | Dr Daniela Oehring 39 Common search frameworks depending on the type of research area Framework Components Primary usage PICO(S) Population/Problem/Phenomenon; Medical/ Health evidence-based Intervention; Comparison; Outcome; questions when comparing Study type interventions PEO Population; Exposure; Outcome Useful for qualitative research SPIDER Sample; Phenomenon of Interest; Used for qualitative and mixed Design, Evaluation; Research type methods research ECLISPSE Expectation; Client group; Location; Policy or service evaluation Impact; Professionals; Service SPICE Setting; Perspective; Intervention; Service, project or intervention Comparison; Evaluation Project Studies | SoHP503 | Dr Daniela Oehring 40 Finding evidence SoHP503 Project studies Dr Daniela Oehring How questions influence search results: Broad questions (not = lots of irrelevant articles High = lots of specific) articles Retrieval (# of search results) Narrow = few directly questions relevant articles (specific) Low = very few articles Relevancy Low = mostly High = directly irrelevant articles relevant articles Project Studies | SoHP503 | Dr Daniela Oehring 43 Building a search strategy 1. Phrase searchable questions and identify the PICO 2. Identify synonyms 3. Identify resources 4. Truncations and wildcards 5. Combine terms 6. Combining final search strategy 7. Refining search results Project Studies | SoHP503 | Dr Daniela Oehring 44 Identify synonyms Consider: Spelling: Research published in English may use different words depending whether its UK English or US English Terminology: Different databases use different indexing terms Colloquial phrases: E.g. myopia is also known as short-sightedness or negative refractive error Project Studies | SoHP503 | Dr Daniela Oehring 45 Terminology (Database indexes, filters) Embase = Evidence-base medicine database Project Studies | SoHP503 | Dr Daniela Oehring 47  Excursus: Databases Medline CINAHL PsycINFO Cochrane Library Years 1966 to present 1982 to present 1872-present NA Journals Covered 4,800 2,960 (55% not in Medline) 2,450 NA Other Sources Covered None Websites, Legal cases, Books, Book Chapters, a collection of databases that contain high- (But treats the Cochrane Database Accreditation, Research Dissertations quality, independent evidence to inform of Systematic Reviews as a journal Instruments, Audiovisual Materials, healthcare decision-making so Cochrane Reviews and Protocols Computer Programs, Dissertations, are indexed) Books, Book Chapters, Critical Paths, and Reviews and Protocols from the Cochrane Database of Systematic Reviews Citations Over 19 million Over 2 million Over 2.8 million NA Languages 30 (40 for older journals) 18 29 English Subjects Covered Medicine Nursing (546 titles) Psychological Literature Cochrane Database of Systematic Reviews Nursing Allied Health (424 titles) Behavioral Sciences (Cochrane Reviews) Allied Health Biomedicine (668 titles) Mental Health Database of Abstracts of Reviews of Effects Dentistry Psychiatric Care (112 titles) Psychological Aspects of (Other Reviews) Veterinary Medicine OT, PT, Rehab (247 titles) medicine, psychiatry, nursing, Cochrane Central Register of Controlled Trials Pre-clinical Sciences Consumer Health sociology, education, (Clinical Trials) Life sciences including, biology, Alternative/Complementary pharmacology, physiology, Cochrane Database of Methodology Reviews environmental science, marine Medicine linguistics, anthropology, (Methods Reviews) science, plant and animal Chiropractic business, and law The Cochrane Methodology Register science Dental Hygiene (Methods Studies) Behavioral Sciences Nutrition Health Technology Assessment Database Chemical sciences, including Speech, Language/Audiology (Technology Assessments) chemistry NHS Economic Evaluation Database (Economic Bioengineering Evaluations) Biophysics About The Cochrane Collaboration (Cochrane Groups) Project Studies | SoHP503 | Dr Daniela Oehring 48 Terminology (Database indexes, filters) CINAHL Embase MEDLINE Conception to approx 6 months after adults Child: birth-18 years delivery older people Newborn: birth-1 month Conception to birth all children, children Infant: birth-23 months Up to one month old Infants Infant: 1-23 months 1-23 months preschool children Preschool Child: 2-5 years 2-5 years school-age children Child: 6-12 years 6-12 years adolescents Adolescent: 13-18 years 13-19 years Adult: 19+ years 19-44 years Young Adult: 19-24 years 45-64 years Adult: 19-44 years 65-79 years Middle Aged + Aged: 45+ years 80+ years Middle Aged: 45-64 years Aged: 65+ years 80 and over: 80+ years Project Studies | SoHP503 | Dr Daniela Oehring 49 Sources for synonyms Medical encyclopaedias/ dictionaries: http://www.thesaurus.com/ http://www.merriam-webster.com/ https://en.wikipedia.org/wiki/Synonym http://dictionary.reverso.net/ http://www.online-medical-dictionary.org/ http://www.medilexicon.com/ http://www.oxfordreference.com/ http://www.nhs.uk/Conditions/Pages/hub.aspx Colleagues: In your practice, university student colleagues, supervisors, lecturers, group meetings, panel discussions… Patient information: Flyer, brochures Reading level (reading ease, grade level) Project Studies | SoHP503 | Dr Daniela Oehring 50 Identify synonyms Your patient is a 72-year-old female with age-related macular disease. She read online that taking “antioxidant pills” from oranges and carrots may slow down the progression of the disease. She has visited your clinic for guidance on whether this is true, and if so, which are the best “pills.” Patient/ Problem Intervention Comparison Outcome Intervention In older-age adults can antioxidant when compared lead to slower with age-related supplements to no progression of the disease intervention/ disease? placebo Project Studies | SoHP503 | Dr Daniela Oehring 51 Identify synonyms PICO Synonyms Patient/ In older-age adults with Older people Problem 70 and older 70+ years age-related disease … Intervention can antioxidant supplements ascorbic acid OR vitamin C carotene OR carotenoids Comparison when compared to no intervention placebo Intervention Outcome lead to slower progression of the prevention disease? control Project Studies | SoHP503 | Dr Daniela Oehring 52 Identify your resources Patient information – sponsored by J&J, Novartis, iLasik, CreditCare All topics have different sponsors Patient information, advertisement for patients Informative article about myopia in children, non-peer reviewed, General information about myopia (non-professional) Patient information/ News Peer-reviewed article (review) about treatment of myopia Food advertisement Food advertisement Project Studies | SoHP503 | Dr Daniela Oehring 53 Identify your resources Project Studies | SoHP503 | Dr Daniela Oehring 54 So from now on…. do not use Google search, Bing, Yahoo….. for searching about professional content! Project Studies | SoHP503 | Dr Daniela Oehring 55 Truncations and wildcards Shortcuts for free-text searching Truncations: Symbols to expand the search and reduce the search steps while increasing the number of hits * or ? most commonly used Wildcards: Question marks to replace letter(s) in a word E.g. to search for UK and US English words ? or # most commonly used Project Studies | SoHP503 | Dr Daniela Oehring 56 Truncations and wildcards Shortcuts for free-text searching Truncation Symbol Example Finds (number of characters) EBSCO DATABASES * (one or more) comput* computer, computing, compute, etc… (PubMed, ScienceDirect…) ? (exactly one) ne?t neat, next, nest, newt, etc... ??? (multiple ? ok) bank??? bankers, banking LEXIS-NEXIS ! (one or more) comput! computer, computing, compute, etc… (Newspapers, legal research, etc..) * (exactly one) ne*t neat, next, nest, newt, etc... ***(multiple * ok) bank*** bankers, banking OCLC + (plurals) cat+ wax+ cat, cats wax, waxes First Search * (one or more) comput* computer, computing, compute, etc… # (exactly one) ne#t neat, next, nest, newt, etc... ?(0-9 characters) colo?r color, colour, colonizer, colorimeter ?2(specify number) colo?2r color, colour (only) Project Studies | SoHP503 | Dr Daniela Oehring 57 Combine terms Boolean operator And/and = narrow the search results Or/or = broaden the search results Not/not = Limits the search results by restricting the terminology searched ADJ/adj = Searches for all the words side by side (adjacent), as a phrase, in any order () = Brackets can be used in two ways Project Studies | SoHP503 | Dr Daniela Oehring 60 Combine terms – AND (both, all) Search for: myopia AND children Hits: 4162 myopia children treatment Search for: myopia AND children AND treatment Hits: 1718 myopia children Project Studies | SoHP503 | Dr Daniela Oehring 61 Combine terms – OR (either, any) Search for: myopia OR children Hits: 2,140,538 myopia children treatment Search for: myopia OR children OR treatment Hits: 10,417,398 myopia children Project Studies | SoHP503 | Dr Daniela Oehring 62 Combine terms – NOT Search for: myopia NOT children Hits: 15,397 myopia children treatment Search for: myopia NOT children NOT treatment Hits: 5,641 myopia children Project Studies | SoHP503 | Dr Daniela Oehring 63 Combine terms - Nesting When more than one element is in parentheses, the sequence is left to right This is called "nesting" (myopia OR children) AND treatment myopia OR children AND treatment (myopia OR children) NOT treatment treatment treatment treatment myopia children myopia children myopia children Project Studies | SoHP503 | Dr Daniela Oehring 65 6. Combining final search strategy Your patient is a 72-year-old female with age-related macular degeneration. She read online that taking “antioxidant pills” from oranges and carrots may slow down the progression of the disease. She has visited your clinic for guidance on whether this is true, and if so, which are the best “pills.” Patient Problem Intervention Comparison Outcome Type Intervention Older age adults Age-related- Antioxidant No intervention Slower progression macular supplements OR OR degeneration OR OR Older people placebo Prevention OR Ascorbin acid OR AND AND AND AND AMD OR OR 70 and older Control OR vitamin C carotene OR Macular 70+years dystrophy OR carotenoids OR maculopathies Project Studies | SoHP503 | Dr Daniela Oehring 72 6. Combining final search strategy (Oder age adults OR older people OR 70 and older OR 70+years) AND (Age-related-macular degeneration OR AMD OR Macular dystrophy OR maculopathies) AND (Antioxidant supplements OR Ascorbin acid OR vitamin C carotene OR carotenoids) AND (* OR placebo) AND (Slower progression OR Prevention OR Control) Hits: 7 Project Studies | SoHP503 | Dr Daniela Oehring 74 Refine the search strategy - Filters PubMed Google Scholar Science Direct Web of Science Article type x x x Text available x x Publication x x x x Date Species x Language x x Sex x Subjects x Journal x x x Ages x Topic x x Project Studies | SoHP503 | Dr Daniela Oehring 75 Refine the search strategy - Filters Type of evidence? In older-age adults with age-related macular degeneration can antioxidant supplements when compared to no intervention/placebo lead to slower progression of the disease? Foreground or background question? Project Studies | SoHP503 | Dr Daniela Oehring 76 Refine the search strategy - Filters Type of evidence? In older-age adults with age-related macular degeneration can antioxidant supplements when compared to no intervention/placebo lead to slower progression of the disease? Patient Problem Intervention Comparison Outcome Type Intervention Older age adults Age-related- Antioxidant No intervention Slower progression RCT macular supplements Systemic reviews OR OR degeneration OR OR Older people placebo Prevention OR Ascorbin acid OR AND AND AND AND AMD OR OR 70 and older Control OR vitamin C carotene OR Macular 70+years dystrophy OR carotenoids OR maculopathies Project Studies | SoHP503 | Dr Daniela Oehring 83 Refine the search strategy - Filters (Oder age adults OR older people OR 70 and older OR 70+years) AND (Age-related-macular degeneration OR AMD OR Macular dystrophy OR maculopathies) AND (Antioxidant supplements OR Ascorbin acid OR vitamin C carotene OR carotenoids) AND (* OR placebo) AND (Slower progression OR Prevention OR Control) + Applying Filter ”Article type” to Review, systematic Review, Clinical trial, Controlled clinical trial, Meta Analysis, Randomised control trial Project Studies | SoHP503 | Dr Daniela Oehring 84 Refine the search strategy - Filters (Oder age adults OR older people OR 70 and older OR 70+years) AND (Age-related-macular degeneration OR AMD OR Macular dystrophy OR maculopathies) AND (Antioxidant supplements OR Ascorbin acid OR vitamin C carotene OR carotenoids) AND (* OR placebo) AND (Slower progression OR Prevention OR Control) + Applying Filter ”Article type” to Review, systematic Review, Clinical trial, Controlled clinical trial, Meta Analysis, Randomised control trial + Applying Filter “Age” to 65+years + Applying Filter “Publication dates” to 5 years Hits: 3 Project Studies | SoHP503 | Dr Daniela Oehring 85 Comparison Most common search strategy EBP search strategy Search term: age-related macular degeneration (Oder age adults OR older people OR 70 and older OR antioxidant supplements 70+years) AND (Age-related-macular degeneration OR AMD OR Macular dystrophy OR maculopathies) AND Google Search Hits: 394,000 (Antioxidant supplements OR Ascorbin acid OR vitamin C carotene OR carotenoids) AND (* OR placebo) AND (Slower progression OR Prevention OR Control) Google Scholar Hits: 19,100 + Applying Filter ”Article type” to Review, systematic PubMed Hits: 75 Review, Clinical trial, Controlled clinical trial, Meta Analysis, Randomised control trial Science Direct Hits: 1,619 + Applying Filter “Age” to 65+years + Applying Filter “Publication dates” to 5 years Hits: 3 Project Studies | SoHP503 | Dr Daniela Oehring 86 Answer question In older-age adults with age-related macular degeneration can antioxidant supplements when compared to no intervention/placebo lead to slower progression of the disease? - Answer is given by a randomized double-masked placebo-controlled clinical trial question answer Project Studies | SoHP503 | Dr Daniela Oehring 87 Comparison - Answer Most common search strategy EBP search strategy Search term: age-related macular degeneration (Oder age adults OR older people OR 70 and older OR antioxidant supplements 70+years) AND (Age-related-macular degeneration OR AMD OR Macular dystrophy OR maculopathies) AND Google Search Hits: 394,000 (Antioxidant supplements OR Ascorbin acid OR vitamin C carotene OR carotenoids) AND (* OR placebo) AND Page 56 (Slower progression OR Prevention OR Control) + Google Scholar Hits: 19,100 Applying Filter ”Article type” to Review, systematic Page 21 Review, Clinical trial, Controlled clinical trial, Meta Analysis, Randomised control trial PubMed Hits: 75 + Page 5 Applying Filter “Age” to 65+years + Science Direct Hits: 1,619 Applying Filter “Publication dates” to 5 years Page 19 Hits: 3 - Second result Project Studies | SoHP503 | Dr Daniela Oehring 88 Summary search strategy 1. Phrase your question (specific, focused, clearly formulated, well defined) 2. Problem formulation (What do I need to find out?) 3. Make keywords/ phrase synonyms 4. Identify your resources (Where are your going to look for evidence? Which kind of evidence do you need?) 5. Area of evidence/ research? 6. Write down your filter strategy 7. Refine your search 8. Read the evidence and decide whether it is useful or not Project Studies | SoHP503 | Dr Daniela Oehring 90 Phrase your aims and objectives SoHP503 Project studies Dr Daniela Oehring Terminology Research question: The question which you proposed after you identified the gap in the literature using PICO (or others). Research aim: Your research aims are the answer to your research question, addressing: Why is this research necessary? What is the purpose of this study? Usually, a research project will have only one broad aim. Research objectives: Specific statements indicating the key issues to be focused on in a research project. Usually, a research project will have several specific research objectives. Research hypothesis: A prediction of a relationship between two or more variables, usually predicting the effect of an independent variable on a dependent variable. The independent variable is the variable assumed to have causal influence on the outcome of interest, which is the dependent variable Project Studies | SoHP503 | Dr Daniela Oehring 93 Research aim The aim is about what you hope to do, your overall intention in the project. It signals what and/or where you aspire to be by the end. It’s what you want to know. It is the point of doing the research. Are broad statements of desired outcomes, or the general intentions of the research, which 'paint the picture' of your research proposal Emphasize what is to be accomplished, not how it is to be accomplished Address the long-term project outcomes, i.e. they should reflect the aspirations and expectations of the research topic Do not need to be numbered Once aims have been established, the next task is to formulate the objectives. Generally, a project should have no more than two or three aim statements, while it may include a number of objectives consistent with them. Project Studies | SoHP503 | Dr Daniela Oehring 94 Research objectives The objectives, and there are usually more than one, are the specific steps you will take to achieve your aim. This is where you make the project tangible by saying how you are going to go about it. Your aims answer the question, ‘What are you doing?’ - The objectives are the answer to the question, ‘How are you doing it?’ Research objectives refer to the goals or steps that you will take to achieve your aim(s). When you write them, make sure they are SMART. Specific: talk in a precise and clear way about what you are going to do. Measurable: how will you know when you have achieved your aim? Achievable: make sure that you aren’t overly ambitious. Realistic: recognise the time and resource constraints that come with doing a dissertation project and don’t attempt to do too much. Time constrained: determine when each objective needs to be completed. Project Studies | SoHP503 | Dr Daniela Oehring 95 What is the difference between research aims and objectives? The aims of a study describe what you hope to achieve. The objectives detail how you are going to achieve your aims. Example: Aim: To understand the contribution that local governments make to national health policy. Objectives: 1. Conduct a survey of local politicians to solicit responses. 2. Conduct desk-research of local government websites to create a database of local health policy. 3. Interview national level politicians to understand the impact these local policies have had. 4. Data will be coded using a code book derived from dominant theories of governance. Project Studies | SoHP503 | Dr Daniela Oehring 96 What not to do: There are too many aims. One or two is usually enough. (I might stretch to three for other people’s projects if pushed, but I usually have only one for my own projects.) Aims and objectives waffle around, they don’t get to the point and the reader doesn’t have a clue what is intended and will be done – aims and objectives need to be concise and economically expressed. Aims and objectives don’t connect – the steps that are to be taken don’t match up with the overall intention. The aims and the objectives are not differentiated, they are basically the same things but said in different words. The objectives are a detailed laundry list rather than a set of stages in the research. The objectives don’t stack up with the research methods – in other words they are either not do-able, or what is to be done won’t achieve the desired results. Project Studies | SoHP503 | Dr Daniela Oehring 97 Table of words to be used Understanding Applying Analysing Synthesising Evaluating (Understanding and organising (Solving problems using (reaching conclusion from (Breaking down into (Judging merit) information) information) evidence) components) Review Interpret Analyse Propose Appraise Identify Apply Compare Design Evaluate Explore Demonstrate Inspect Formulate Compare Discover Establish Examine Collect Assess Discuss Determine Verify Construct Recommend Summarise Estimate Select Prepare Conclude Describe Calculate Test Undertake Select Relate Arrange Assemble Project Studies | SoHP503 | Dr Daniela Oehring 98 Example A research study designed to assess the accessibility Checking Objectives Against Recommended Approach: and acceptability of the Voluntary Counselling and Q: Are they specific? Testing (VCT) Services for HIV infection in Plymouth had A: Yes, it is clear what they intend to do, why they intend the following aim and objectives: to do it and their parameters have been well-defined. Aim: To identify factors that affects the acceptability Q: Are they measurable? of VCT services and to assess community attitudes A: Yes, it is clear that the research objective will be towards comprehensive care and support for people achieved. living with HIV/AIDS in Plymouth between 2000 and 2020. Q: Are they achievable? A: No, it is not stated HOW it will be achieved Objectives: Q: Are they relevant? 1. To assess the knowledge, attitude and practice of A: Yes, the objectives are fundamental to the overall aim. the community towards HIV/AIDS and VCT Q: Are they timebound? services. A: No as it is not clear which methods will be used. 2. To identify barriers and concerns related to VCT Q: Do they start with a verb? and its uptake. A: Yes, they starts with verbs, which makes the intent of 3. To assess the awareness and perception of the the objective immediately clear. study community regarding comprehensive care Q: I Are they numbered? and support for people living with HIV/AIDS. A: Yes, there are three objectives. Project Studies | SoHP503 | Dr Daniela Oehring 99 Example A research study designed to assess the accessibility Checking Objectives Against Recommended Approach: and acceptability of the Voluntary Counselling and Q: Are they specific? Testing (VCT) Services for HIV infection in Plymouth had A: Yes, it is clear what they intend to do, why they intend the following aim and objectives: to do it and their parameters have been well-defined. Aim: To identify factors that affects the acceptability Q: Are they measurable? of VCT services and to assess community attitudes A: Yes, it is clear that the research objective will be towards comprehensive care and support for people achieved. living with HIV/AIDS in Plymouth between 2000 and 2020. Q: Are they achievable? A: Yes, it is stated HOW it will be achieved Objectives: Q: Are they relevant? 1. Conduct focus groups with stakeholders and A: Yes, the objectives are fundamental to the overall aim. patients to assess the knowledge, attitude and Q: Are they timebound? practice of the community towards HIV/AIDS and A: Yes, as it is not clear which methods will be used. VCT services. Q: Do they start with a verb? 2. Conduct interviews with patients to identify A: Yes, they starts with verbs, which makes the intent of barriers and concerns related to VCT and its the objective immediately clear. uptake. Q: I Are they numbered? 3. Conduct a survey to assess the awareness and A: Yes, there are three objectives. perception of the study community regarding comprehensive care and support for people living with HIV/AIDS. Project Studies | SoHP503 | Dr Daniela Oehring 100 Example – SoHP503 Research question: What are the feelings and perceptions of health care students when delivering bad news to patients, relatives and carers? The aim of this study is to gain understanding about personal views and feelings on breaking bad news (BBN) of health care students, in the context of the pre-hospital setting. Objectives 1. Conducting one-to-one semi structured interviews to: a) To explore student perceptions of what ‘bad news’ is. b) To explore student perceptions on how they deliver bad news. c) What their personal negative and positive experiences of BBN are. d) To explore opinions on how tools and resources to aid BBN can be improved. 2. Conduct desk-research of educational material provided within HE to create a database of what training and education student received in BBN. Project Studies | SoHP503 | Dr Daniela Oehring 101 Please use the discussion board in case of questions. Thank you! Thanks J