WEEK 1 AND 2

Question 1

What is the purpose of LITERATURE REVIEW?

Answer 1

• Identifies, evaluates and synthesises the relevant literature within a particular field of research
• It highlights:
• what has been done,
• what is generally accepted,
• what is the current state of thinking on a topic
• what is emerging
• what are the gaps in knowledge
• A critical analysis of published literature
• Integration of this information (don’t just summarise & report)

Question 2

Synthesis vs summary

Answer 2

Question 3

Narretive REVIEW vs. SYSTEMATIC REVIEW

Scope of focus
search protocol
study selection
grade
lack of evidenc

Answer 3

Question 4

advantaged and disadvantages of SYSTEMATIC REVIEW

Answer 4

ADVANTAGES
▪ Focused, specific research question (PICO)
▪ Comprehensive and Exhaustive
▪ Explicit Methodology (pre-specific criteria)
▪ Accurately assess quality & weight of evidence
▪ Reproducible

DISADVANTAGES
▪ Need to have a very specific question
▪ Need to be very specific about search criteria
▪ Long
▪ Generally requires pre-registration
▪ Requires multiple people
▪ Still subject to biases
▪ Reproducible

Question 5

what is PROSPERO?

Answer 5

▪ An international database of prospectively registered systematic reviews in health & social care
▪ Funded by the National Institute for Health Research, UK.
▪ Aims:
1. To provide a comprehensive listing of systematic reviews registered at inception to help avoid duplication
2. To promote transparency in the process and thus minimize the risk of bias in the review
▪ Free to register
▪ Ideally done before screening against eligibility criteria commences.
▪ However, reviews are currently accepted for registration as long as they have not progressed beyond the
completion of data extraction
▪ Scoping reviews and literature reviews are not eligible for inclusion in PROSPERO.

Question 6

META-ANALYSES

Answer 6

Meta-analyses
* Meta-analysis refers to the use of statistical techniques in a systematic review to
integrate the results of included studies
* Not a requirement & in some cases, it doesn’t make sense to perform one
* Generally NOT recommended to undertake a meta-analyses outside of a systematic
review

Question 7

ORIGINS OF A GOOD RESEARCH QUESTION

Answer 7

▪ Guiding judgements of mentors (supervisors) who are experts in the area
▪ A review of the literature is a great first step in identifying “gaps in knowledge”
▪ Be alert to new ideas and techniques
▪ Creativity
▪ Tenacity (returning to a troublesome problem repeatedly)
▪ Conclusion from the research (regardless of the exact findings) would be impactful

Question 8

STEPS IN A RESEARCH PROJECT

Answer 8

Question 9

FORMULATING THE RESEARCH QUESTION

FINER

Answer 9

Objective of the study
The uncertainty or gap that the investigator wants to resolve
Begin general but often needs to be narrowed down to be ‘testable’ / ‘feasible’
Needs to meet the FINER formula (Hulley et al., 2001)
✓ Feasible (can be done/tested)
✓ Interesting (of interest/importance)
✓ Novel (not already done)
✓ Ethical (essential)
✓ Relevant (an implication,
meets the “so what test” (should contribute meaningfully to knowledge)

Question 10

FINDING THE RIGHT BALANCE - NARROW VS. BROAD QUESTIONS

Answer 10

Very broad questions
Difficult to ‘test’
Challenges with methods &
recruitment

Very narrow questions
May have limited generalizability
Could lead to biased
interpretations/conclusions

Question 11

PICO

Answer 11

Question 12

DIFFERENT TYPES OF RESEARCH QUESTIONS

6 types,

Answer 12

1. INTERVENTIONS Treatments and therapies to treat a disease/condition
2. AETIOLOGY, RISK FACTOR What causes the problem? Outcomes of an activity/exposure
3. FREQUENCY What is the frequency of the problem?
4. DIAGNOSIS Does this person have the problem?
5. PROGNOSIS, PREDICTION Who will get the problem?
6. PHENOMENA Observations of a situation

Question 13

example of intervention, frequency, diagnosis and phenomena research question

Answer 13

Intervention : In people aged ≥70 years, is 100mg daily Aspirin, versus placebo,
effective in reducing the incidence of acute ischemic stroke
Frequency: In infants born prematurely, what is the subsequent lifetime prevalence
of sensory deafness compared to those born full-term?
Diagnosis : For pregnant women, is ultrasound plus serum biochemistry testing in the 1st
trimester as accurate (with equal or better sensitivity & specificity) as conventional
amniocentesis for diagnosing Down’s Syndrome?
Phenomena: contains P and O
Usually involve a population (P) and an outcome (O) but not an intervention or comparator.
Question is more open ended and informed by the study itself
For mothers of children with a fever, what are the principal concerns?

Question 14

HYPOTHESIS TESTING

What is hypothesis ?
when is it required

Answer 14

A proposed explanation made on the basis of incomplete evidence, but used as a starting point for further
investigation
▪ A simplified & specific version of the research question that summarises the main elements of the study.
▪ Hypotheses are NOT needed for descriptive studies or observations of a phenomena
▪ BUT essential when any test of statistical significance will be used to compare findings among groups
▪ At least one hypothesis is being ‘tested’ in all experiments & most observational studies
▪ If any of the following terms appear in the research question a hypothesis should be formulated: greater than, less
than, causes, leads to, compared with, more likely than, related to, similar to, correlated with
▪ It MUST be stated in advance

Question 16

what is the hypothesis for this
Research Project Title: Social media and medical education
Research Question 1: How can social media best facilitate student learning in medical education?

Answer 16

Hypothesis: Not needed because descriptive study (no use of following words within research question: greater than,
less than, causes, leads to, compared with, more likely than, related to, similar to, correlated with)

Question 17

WHY IS STUDY DESIGN IMPORTANT?

Answer 17

• Study design determines the way in which the study will be conducted
• Includes sampling (who, what, when) & types of information (data) gathered
• It will also govern:
  ✓ methods used to collect the data
  ✓ how the data are analysed
• It WILL directly affect your results & the conclusions drawn
• It will dictate more precisely the research question that your study will address

Question 18

WHY IS STUDY DESIGN IMPORTANT?

Answer 18

• Consider the differences between
  Your research question - What you want to answer ?
  Study plan & design - What the study is designed to answer?
  Given the errors/limitations of implementation etc. - What the study actually addressed?
• In many ways it is considered more important than the analysis
  A badly designed study→ can never be retrieved
  Poorly/incorrectly analysed data→ can usually be reanalysed

Question 19

HOW DO I DETERMINE THE MOST APPROPRIATE STUDY DESIGN?

Answer 19

It will depend on the type of research question
Aim is to optimise efficiency to answer the research question

Question 20

BROAD CATEGORIES OF RESEARCH QUESTIONS

Answer 20

Question 21

WHERE IS YOUR DATA COMING FROM?

Answer 21

Primary data
▪ Originated by the researcher for the specific purpose of addressing the research question
Secondary data
▪ Data have already been collected for purposes other than the specific research question

Question 22

SECONDARY DATA ANALYSIS

Answer 22

▪ Previous research studies may provide a rich source of secondary data
▪ Many studies collect more data than the investigators analyse
▪ Access to such data is controlled by principal investigator
▪ Other sources of data include national data sets and registries
▪ Ancillary studies where an investigator adds one or several measurements to
an existing study to answer a different research question

Question 23

ADVANTAGES / DISADVANTGES OF primary and secondary data

Answer 23

Question 24

YOUR RESEARCH PROJECT
You need to consider

Answer 24

Consider:
1. Primary or Secondary data analysis
2. Descriptive, analytical or causal study design?
3. Any further specification of the exact study design to be used?
4. How you will actually going about implementing the study?
5. What other aspects might you need to consider?

Question 25

HOW DO I DETERMINE THE MOST APPROPRIATE STUDY DESIGN?

Answer 25

The language of the research question can be helpful in deciding what
research design and methodology to use.

Question 26

DESCRIPTIVE – OBSERVATIONAL

Answer 26

• Quantify the information in terms of numerical data
  “How many mothers of children with a fever have concerns?”
  “How many mothers of children with a fever are concerned about the correct medication to use?”
  “How common is night shift work in health care?”

Question 27

DESCRIPTIVE – PHENOMENON

Answer 27

• Determine whether a phenomenon exists & describe it’s characteristics
• Through observation, analysis & description

“Do mothers of children with a fever have concerns?”
“What are the principal concerns for mothers of children with a fever?”
“What are the experiences of people working night shifts in health care?”

Question 28

RELATIONAL – ANALYTICAL
Study design

Answer 28

• Once the phenomena have been described
• Specific questions about how factors relate to one another
  “Are new mothers more likely to worry when their child has a fever?”
  “Is there a correlation between the duration of a fever and the extent of concern a mother has?”
  “Is night shift work among health care workers, associated with a poorer
  quantity and quality of sleep?”

Question 29

EXPERIMENTAL - CAUSALITY
Research question

when?
PICO

Answer 29

• Once the phenomena have been described & relationship been factors established
• Interested in whether an intervention or an activity affects something else
  “Does intervention X versus standard practice, reduce the ‘degree’ of a mother’s concern,
  when their child has a fever?”
  “Is drug X versus paracetamol, better at reducing fever in young children?”
  Remember PICO: Population, Intervention, Control, Outcome

Question 30

TWO MAIN APPROACHES TO A RESEARCH PROBLEM

Answer 30

Quantitative Research (late stage, narrow, focused, conclusive)
* Tries to find answers to concrete questions by generating numbers & facts
* Only measurable data are being gathered and analysed
* Research question often starts with “How many/often”, “Why” or includes terms like
“Effect/Influence/Correlation/Impact/Cause“
Qualitative Research ( early stage, broad, whole picture, exploratory)
* Exploratory or interrogative research: describe, discover, understand, tries to get “under the surface”
* Gathering of mainly verbal data rather than measurements
* Analysed in an interpretative manner, subjective, impressionistic or even diagnostic
* Research question often starts with “How” or “What”

Question 31

QUANTITATIVE STUDY DESIGN
Map

Answer 31

Question 32

HIERARCHY OF EVIDENCE PYRAMID

Answer 32

Question 33

DIFFERENT STUDY DESIGNS
Ecological
Case study
Cross sectional
Case control
Nested case control
Nested case cohort
Cohort
Clinical trials

Answer 33