Every Doc Can Do Research

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Every Doc Can Do Research

• OUCOM-Tulsa
• Department of Family Medicine
• Presented By
• Charles Henley, DO, MPH, Frances Wen, PhD and
• Karen Malnar, RN, CTR, CCRC

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THE RESEARCH WORKBOOK

• The research workbook is the road map
• It is the reference we will use when discussing
  your project
• Designed as a step wise approach to developing a
  project.
• Can plug your project into the workbook

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Workbook

• Uses an illustrative example that is carried
  through each section
• Make copies so you can fill in the blanks
• There are also sections on Case reports and
  Posters in the workbook
• A section on writing for publication.

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The PCP Process

• Divide into teams
• Choose faculty mentor
• Choose resident leader
• Choose topics
• Meet monthly with team
• Meet monthly with Research Team

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PCP Timelines

• July 26 begin research lectures and PCP process
• October 5 research questions due
• November 3 IRB protocols due
• January 10 Data due to statistician
• February 18 OU-Tulsa Health Research Forum
  abstracts due to Heather
• April_ OU Tulsa Research Day
• May 16 Family Medicine Research Day

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Research Workbook

• Will introduce each section to help with
  understanding the steps
• Will develop parts of the workbook in more detail
• This is the process to use in structuring a
  research project, although your PCP project might
  not need all the steps
• The research team will always reference the
  workbook in meetings

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Step 1

• Define Your Research Question.
• The question should be specific and well defined

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What is a Relevant Research Question?

• Things you see every day with patients
• Clinical questions about treatment, or diagnosis
• Example Does annual screening for PSA in men
  over 60 decrease morbidity and mortality from
  prostate cancer?
• Evidence Based

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The Research Question

• Begin by asking the question as a general
  statement
• Should we treat pregnant women who are carriers
  for group B strep (GBS), with antibiotics?
• Use PICO to help structure the question

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PICO

• P Population, Patient or Problem
• I Intervention
• C Control
• O Outcome

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The Research Question

• P Pregnant women who are GBS carriers
• I Treatment with antibiotics
• C Group of pregnant women with GBS
• who are not treated with antibiotics
• O Neonatal weight in grams, CBC,
• Cultures /-

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Step 2

• Hit the Library ( Lit Search)
• Learn about what others have done.
• Helps define research topic.
• Updates your knowledge about the subject.

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Step 2 (contd)

• Potential Sources
• Look at references cited in recent textbooks and
  articles in you personal library.
• Browse issues of pertinent journals in your
  medical library.
• Ask other providers to look at their journals and
  textbooks.
• Computerized Bibliographical Databases
• National Library of Medicine (NLM)
• PubMed Medline- www.pubmed.gov
• Gateway- http//gateway.nlm.nih.gov
• Entrez- www.ncbi.nih.gov/Entrez
• TOXNET- http//toxnet.mln.nih.gov
• OU-Tulsa Library- http//tulsa.ou.edu/library/lib
  rary.htm
• Database page- http//tulsa.ou.edu/library/databas
  es.htm
• OVID (Medline, EBM Reviews, Cochrane databases,
  ect.)
• MDConsultants
• STAT!Ref ( Full-text clinical textbooks)

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STEP 3

• Justify Your Study
• Based upon your Literature search, evaluate your
  initial question.

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STEP 4

• Refine Your Research Question
• Define the population to be studied.
• Define the period of time for the study.
• Select the variables to be measure.
• Change non-specific variables into specific
  variables that can be measured.

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STEP 5

• Look at What Resources are Needed to Complete
  this Project.
• Estimate the resources required to measure each
  of the variables mentioned in question 4.
• Estimate the feasibility of conducting your study
  by comparing resources needed with those
  available to you.

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STEP 6

• Refine the Question Again
• Restate the research question in a refined form
  that can be studied with available resources.

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STEP 7

• Write the Hypothesis
• Write what you expect to find from your study.
• What are the general relationships implied by
  your hypothesis?
• Are there any specific alternative relationships
  or explanations that would serve as competing or
  rival hypothesis?
• State your hypothesis in a clear, concise
  sentence.

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STEP 8

• Determine What You Are Going to Measure, and With
  What Instruments.
• Variables that you are going to need to measure.
• Reliability and validity of instruments.

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STEP 9

• Develop the Research Design
• Common Research Designs
• Descriptive Studies
• Observational Studies
• Observational Studies
• Case-Control Studies
• Cross-Sectional (Prevalence)
• Studies
• Cohort Studies
• Experiments

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STEP 10

• Select Your Sample (s)
• Describe the characteristics of the people (or
  subjects) who will be eligible for participation
  in your study.
• Describe the characteristics of the people (or
  subjects) who will be excluded from participation
  in your study.
• Describe the population (beyond your sample) to
  which you wish to generalize conclusion.
• Determining sample size.

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STEP 11

• Develop the Research Protocol
• How will you select the sample?
• Will you divide your sample into groups, if so
  how?
• Describe what will happen to each group.
• Who will gather the data, and how?

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STEP 12

• Eliminate or Control the Biases
• Effects of historical events
• Effects of Maturation
• Effects of repeated measurement
• Instrument decay
• Effects of statistical regression
• Subject selection
• Loss of Subjects
• Investigator Bias

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STEP 13

• Identify the Limitations of Your Study
• Potential sources of bias remaining
• Limitations to generalizability

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STEP 14 15

• Develop Data Collection Forms
• Reporting of Results

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STEP 16

• Pick Your Statistics
• Types of Data Types of Variables
• - Categorical - Demographic
• - Ordinal -
  Independent
• - Interval - Dependent
• Continuous - Confounding
• Things to be measured or counted
• 
  
  
  

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STEP 17

• Administrative Arrangements
• Who do you need to touch base with in order for
  all protocols of the research project to be met?
  (nursing staff, faculty, assistants, check in,
  check out?)

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STEP 18

• Protocol Approval and Initiation of Study

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Topic Ideas

• Dr. Tietze- Post Partum Depression
• Dr. Meixel- Health screening finding the most
  effective system to ensure that recommendations
  are being applied
• Dr. Millar- QA projects Diabetes care, Influenza
  immunizations, completion of childhood
  immunizations

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Common ICD-9 clinic diagnoses with no previous
PCP projects

• Psychiatric co-morbidities
• Allergic rhinitis
• Attention deficit disorder
• Chest pain
• CHF
• Dermatitis
• Esophageal reflux
• Headache

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more

• Hypothyroidism
• Osteoarthritis
• Pharyngitis
• Pneumonia
• Sinusitis
• Viral Hepatitis
• UTI/Urosepsis

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more

• Preventing medication errors and overuse of
  antibiotics
• Self management/ health literacy
• Pain management
• Children with special needs
• Geriatrics preventing falls, preventing pressure
  ulcers
• Value of the urine dipstick in prenatal care

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More

• Prevalence of asymptomatic bacturia, or mixed
  flora on initial urine culture in pregnancy
• Is the outcome of the pregnancies different in
  those women with mixed flora on initial culture
  compared to sterile cultures?
• Do women really deliver most often during the
  night? Or does it just seem that way.
• Circumcision study

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AN ADDENDUM STEP

• Sources for Potential Grants
• AAFP
• Academic Research Enhancement Award
• William T. Grant Faculty Scholars Program
• NRSA Fellowships for Training in Primary Care
  Disciplines
• Mental Health Services in General Health care
  Research Grants

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Every Doc Can Do A Case Report
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STEP 1

• Choose Your Topic Carefully
• Begin by asking, What do I have to say?
• Is the paper worth writing?
• Determine which category of case reports your
  project falls into.
• Determine the appropriate audience and journal

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STEP 2

• Hit the Library (Lit Search)

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STEP 3

• Justify Your Topic
• Based on your literature search, evaluate your
  initial question
• Key question for scholarly case reports
• Is the topic you are reviewing unique, or has it
  been beat to death already in the literature?
• How does your topic add to what already exists?

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STEP 4

• Look At What Resources Are Needed To Complete
  This Project
• TIME- Time is required to complete any project.
  You have to pick a narrow enough topic that you
  can succinctly write about.
• REVIEWERS-(This is optional but preferred) Find a
  person in your Clinic or Hospital that can give
  you an honest appraisal and feedback on your
  paper before submitting it for publication

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STEP 5

• Refine the Topic
• Restate the topic in a refined form that can be
  tackled with available resources.

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STEP 6

• Begin Writing
• Introduction
• Case
• Discussion
• Conclusion

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STEP 7

• Stop Writing
• After you have finished your first draft set it
  aside for a few weeks before beginning critical
  revision.

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STEP 8

• Begin Review
• A Five Part Review
• Initial review
• Organizational review
• Grammar review
• Style review
• Readability review

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STEP 9

• Submit Manuscript
• Remember Prepare
• Information for the authors section
• Manuscript
• Cover letters
• Any other forms necessary

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STEP 10

• Sit Back and Relax

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Every Doc Can Do A Poster
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STEP 1

• Choose Your Topic and Format
• Begin by asking What do I have to say?
• Is the poster worth creating/
• Determine which category your work falls into.
• Determine the appropriate audience and setting.

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STEP 2

• Hit the Library ( Lit Search)

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STEP 3

• Justify Your Topic
• Based on your literature search, evaluate your
  initial question and answer.

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STEP 4

• Oral Presentation versus Poster
• Posters are a visual, concise, appealing form of
  communication that allows one to share their
  scholarly work with others being, clinical
  investigations, case reports or
  curriculum/educational innovation.
• Creating a poster actually requires more
  expertise than generating a slide show
  presentation.
• A poster may attract a more diverse audience than
  an oral presentation therefore improving
  opportunities for networking and developing
  collaborative projects.

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STEP 5

• Look at What Resources are Needed to Complete
  this Project
• TIME
• REVIEWERS

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STEP 6

• Write Your Abstract
• Every poster requires an abstract be written for
  submission.
• For the best results follow
• I- Introduction
• M- Methods
• R- Results
• A- and
• D- Discussion/Conclusion

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STEP 7

• Planning the Poster
• Review the instructions and get clarification if
  needed.
• Think about how you are going to present your
  information in a visual way.
• Get Help Early.
• Create a checklist and adhere to it.
• Practice your presentation.

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STEP 8

• Write Your Text
• This is not a repeat of your abstract! Although
  you do continue to use the IMRAD format.
• Introduction/Background
• Methods/Intervention (Study Design/Case Report)
• Results/Outcomes/Evaluations
• Discussion/Conclusion

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STEP 9

• Begin Designing Your Poster
• Size and Font of Text
• Unnecessary data or text
• Informative headings and organization
• Poster material (laminated, banner material ect.)

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STEP 9 (contd)

• Useful Design Tips
• Never forget the posters purpose, audience and
  setting
• Allow for about 50 white space (areas without
  text or illustration), allow the eyes rest
• Organize the sections in reference on how people
  read
• Size your text and illustrations so they are very
  readable from six feet away
• Highlight the important sections by size position
  and color
• Creative illustrations that support your central
  purpose
• Experiment with alternative layouts to find the
  most effective one
• Study other posters that you liked for additional
  ideas

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STEP 10

• Supporting the Poster
• When presenting your poster remember
• Presenter
• Handout
• Sign-up list
• Business card
• Keep poster presentation checklist available

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STEP 11

• Sit Back and Relax!