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How to write & publisha scientific paper
DR. MOHAMMED MOSTAFA EMAM
INAYA MEDICAL COLLEGE (IMC)NMT 472 - LECTURES
2
Course Outlines
• What is Research?
• Research Types
• Qualities for Researcher
• Research models and samples
• Theory & Research
• Qualitative & Quantitative Methods
• Research Ethics
DR. MOHAMMED MOSTAFA EMAM
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• References & Bibliography
• Literature Review
• Research Process
• Research questions & Hypothesis
• Measurement & scaling
• Reliability & validity
• Sampling Procedures
DR. MOHAMMED MOSTAFA EMAM
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• Questionnaire Design
• Research Proposal Writing
• Content Analysis
• Surveys
• Focus Group
• Experimental Methods
• Longitudinal Research
DR. MOHAMMED MOSTAFA EMAM
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• Participant Observation
• Case Studies
• Using Secondary Data
• Analysis of Qualitative data
• Analysis of Quantitative data
• Research Report Writing
DR. MOHAMMED MOSTAFA EMAM
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RESERACH
• Re ---------------- Search
• Re means (once more, afresh, anew)OR (back; with return to a previousstate)
• Search means (look thorough or go overthoroughly to look something) OR(examine to find anything concealed)
DR. MOHAMMED MOSTAFA EMAM
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Chief executive officer CEO of a company wants to launch its
company in KSA?
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Decision making Needs…
CONVICTION
There should be
no doubts
Knowledge to justify
your decisions
Goals achievement
DR. MOHAMMED MOSTAFA EMAM
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Research?
Research is an ORGANIZED and SYSTEMATIC way of FINDING
ANSWERS to QUESTIONS.
DR. MOHAMMED MOSTAFA EMAM
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• SYSTEMATIC ..
because there is a definite set of proceduresand steps which you will follow. There arecertain things in the research process whichare always done in order to get the mostaccurate results.
DR. MOHAMMED MOSTAFA EMAM
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• ORGANIZED..
in that there is a structure or method in goingabout doing research. It is a plannedprocedure, not a spontaneous one. It isfocused and limited to a specific scope.
DR. MOHAMMED MOSTAFA EMAM
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• FINDING ANSWERS..
is the end of all research. Whether it is theanswer to a hypothesis or even a simplequestion, research is successful when wefind answers. Sometimes the answer is no,but it is still an answer.
DR. MOHAMMED MOSTAFA EMAM
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• QUESTIONS..
are central to research. If there is noquestion, then the answer is of no use.Research is focused on relevant, useful, andimportant questions. Without a question,research has no focus, drive, or purpose.
DR. MOHAMMED MOSTAFA EMAM
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Research?
Research is an ORGANIZED and SYSTEMATIC way of FINDING
ANSWERS to QUESTIONS.
DR. MOHAMMED MOSTAFA EMAM
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Defining Research
Research must be systematic and followa series of steps and a rigid standardprotocol. These rules are broadly similarbut may vary slightly between thedifferent fields of science.
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Defining Research
Research must has a collection of methodsand methodologies that researchers applysystematically to produce scientifically basedknowledge about the social world.
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• Methodology & Methods:»Methodology & Methods, two terms are
often treated as synonyms.
DR. MOHAMMED MOSTAFA EMAM
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• Methodology :»Methodology is broader and envelops
methods. It is understanding the social-organizational context; philosophicalassumptions, ethical principals andpolitical issues of the enterprise ofresearchers who use methods.
DR. MOHAMMED MOSTAFA EMAM
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• Methods:»Methods are set of specific techniques
for selecting cases, measuring andobserving aspects of social life,gathering and refining data, analyzingdata and reporting on results.
DR. MOHAMMED MOSTAFA EMAM
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Contraire of (Alternative to)RESEARCH
• Authority
• Tradition
• Common sense
• Media myths
• Personal experience
DR. MOHAMMED MOSTAFA EMAM
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1). Authority
• When you accept something as true justbecause someone in a position of authoritysays it is true or it is an authoritativepublication, you are using authority as basisof knowledge.
• Parents, Teachers, Books.
DR. MOHAMMED MOSTAFA EMAM
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2). Tradition
• Tradition is a special case of authority-theauthority of the past.
• It means you accept something as being truebecause “it’s the way things have alwaysbeen”.
DR. MOHAMMED MOSTAFA EMAM
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3). Common Sense
• You rely on what everyone knows and what “just makes sense”.
• It is about ordinary reasoning.
• It can originate from tradition
DR. MOHAMMED MOSTAFA EMAM
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5). Personal Experience
• If something happens to you, if youpersonally experience it or see it, you acceptit as true.
DR. MOHAMMED MOSTAFA EMAM
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Types of Research
1. Quantitative Research
2. Basic Research
3. Applied Research
4. Longitudinal Research
5. Cross sectional Research
6. Qualitative Research
7. Descriptive Research
8. Classification Research
DR. MOHAMMED MOSTAFA EMAM
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Types of Research
9. Comparative Research
10. Explorative Research
11. Explanatory Research
12. Causal Research
13. Theory-testing Research
14. Theory-Building Research
15. Action Research
DR. MOHAMMED MOSTAFA EMAM
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1). Quantitative Research
• It is based on methodological principals.
• It obeys standards of strict research design.
• Statistical analysis is used in it.
DR. MOHAMMED MOSTAFA EMAM
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2). Basic Research
• Purpose of gaining knowledge
• It advanced understanding about social world
• Help in supporting & rejecting existing hypothesis & theories
DR. MOHAMMED MOSTAFA EMAM
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3). Applied Research
• Aims at solving specific problems
• Aims at establishing policy programs that will help to improve social life
• Types of applied research are action research, social impact studies, cost-benefit analysis, evaluation research
DR. MOHAMMED MOSTAFA EMAM
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4). Longitudinal Research
• It involves study of sample at more than one point in time or occasion
• e.g. Trend studies, Panel studies
DR. MOHAMMED MOSTAFA EMAM
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5). Cross sectional Research
• It involves study of many cases at one point in time or occasion.
DR. MOHAMMED MOSTAFA EMAM
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5). Qualitative Research
• It is based on methodological principals of phenomenology, symbolic interactionism, interpretational.
• It aims at exploration of social world; following elements are there….exploration, relationship discovery, establishing construct, testing hypothesis.
DR. MOHAMMED MOSTAFA EMAM
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7). Descriptive Research
• Usually it forms preliminary study of a research project.
• It aims at describe social events, relations and events.
• It provides background information about an event in question.
DR. MOHAMMED MOSTAFA EMAM
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8). Classification research
• It aims at categorization of units into groups
• To demonstrate differences
• To explain relationships
DR. MOHAMMED MOSTAFA EMAM
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9). Comparative Research
• To identify similarities and differences between units at all levels.
DR. MOHAMMED MOSTAFA EMAM
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10). Exploratory Research
• It aims at gaining information about an issue in hand.
DR. MOHAMMED MOSTAFA EMAM
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11). Explanatory Research
• It aims at explaining social relations and events.
• To build, test or revise a theory.
DR. MOHAMMED MOSTAFA EMAM
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12). Causal Research
• It aims at establishing cause and effect relationship among variables.
DR. MOHAMMED MOSTAFA EMAM
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15). Action Research
• It is application of fact findings to practicalproblem solving in a social situation with aview to improve quality of action within it,involving collaboration and cooperation ofresearchers, practitioners and laymen.
• It can be situational (diagnose a problem andattempts to solve it), collaborative,participatory (researcher take part inimplementation of findings) and self-evaluation (it involves constant evaluationand adjustment of research and practice)
DR. MOHAMMED MOSTAFA EMAM
How to Write a Critical Analysishttp://www.wikihow.com/Write-a-Critical-Analysis#Writing_an_Effective_Analysis_sub
https://youtu.be/ShKr_DfFSSg
• Critical Reading
• Writing an Effective Analysis
• Organizing the Review
DR. MOHAMMED MOSTAFA EMAM 46
I. Before start writing
II.Writing the article
III.Making the article to be published
How to write & publish a scientific paper
DR. MOHAMMED MOSTAFA EMAM 47
I. Before start writing
II.Writing the article
III.Making the article to be published
How to write & publish a scientific paper
DR. MOHAMMED MOSTAFA EMAM 48
Why an article is published?
It says something new: Original
It is well plotted: IMRAD structure
It was timely sent to the appropriate publication: “MARKETED”
DR. MOHAMMED MOSTAFA EMAM 49
Why an article is published?
It says something new: Original
It is well plotted: IMRAD structure
Introduction, Methods, Results, and Discussion
In scientific writing, IMRAD refers to a commonorganization structure. IMRAD is the mostprominent norm for the structure of a scientificjournal article of the original research type.
It was timely sent to the appropriate publication: “MARKETED”
DR. MOHAMMED MOSTAFA EMAM 50
What we need to write an article?
a) Knowledge
b) Norms of publication
c) Hardware and software
d) Matter
DR. MOHAMMED MOSTAFA EMAM 51
a) Knowledge
b) Norms of publication
c) Hardware and software
d) Matter
DR. MOHAMMED MOSTAFA EMAM 52
How many articles are sent to a journal?
How many are rejected?
Why are they rejected?
How many are reoriented to another journal?
DR. MOHAMMED MOSTAFA EMAM 53
How many articles are sent to a journal?
How many are rejected?
Why are they rejected?
How many are reoriented to another journal?
DR. MOHAMMED MOSTAFA EMAM 54
How many articles are sent to a journal?
How many are rejected?
Why are they rejected?
How many are reoriented to another journal?
DR. MOHAMMED MOSTAFA EMAM 55
How many articles are sent to a journal?
How many are rejected?
Why are they rejected?
How many are reoriented to another journal?
DR. MOHAMMED MOSTAFA EMAM 56
Select a group of journals of interest and read them periodically:
-Updated
-”Get the tempo”
For General Internal Medicine:
NEJM
BMJ
Arch Int Med
Med Clin
DR. MOHAMMED MOSTAFA EMAM 57
Select a group of journals of interest and read them periodically:
-Updated
-”Get the tempo”
For General Internal Medicine:
NEJM >> ASSIGNMENT >>
BMJ WHAT ARE THE
Arch Int Med MEANING OF
Med Clin THESE ACRONYMS ?
DR. MOHAMMED MOSTAFA EMAM 58
To know how to perform an up-to-date
Are you really discovering anything new?
State of the Art
DR. MOHAMMED MOSTAFA EMAM 59
• Give overview of a topic; print textbooks, electronic textbooks, narrative reviews in journals
1. Harrison’s Online 2. Scientific American Medicine Online 3. MD Consult 4. Medline articles
a. Ovid b. PubMed
DR. MOHAMMED MOSTAFA EMAM 60
• Give overview of a topic; print textbooks, electronic textbooks, narrative reviews in journals
1. Harrison’s Online 2. Scientific American Medicine Online 3. MD Consult 4. Medline articles
a. Ovid b. PubMed>> ASSIGNMENT >>
>>WHAT ARE YOU LOOKING FOR IN THESES SITES?
DR. MOHAMMED MOSTAFA EMAM 61
Knowledge of medical writing:
- It is concise, usually uses the passive form.
- The asseverations are based on other articles published.
- The conclusions are based on the results of the study.
- Inductive thinking.
DR. MOHAMMED MOSTAFA EMAM 63
Knowledge of medical writing:
- It is concise, usually uses the passive form.
- Complete:
- The asseverations are based on …
- The conclusions are based on …
DR. MOHAMMED MOSTAFA EMAM 64
a) Knowledge
b) Norms of publication
c) Hardware and software
d) Matter
DR. MOHAMMED MOSTAFA EMAM 65
Norms of publication
Make a folder with the norms of publication of your “target journals”
Make a list of “target journals”
DR. MOHAMMED MOSTAFA EMAM 66
a) Knowledge
b) Norms of publication
c) Hardware and software
d) Matter
DR. MOHAMMED MOSTAFA EMAM 67
a) Knowledge
b) Norms of publication
c) Hardware and software
d) Matter
DR. MOHAMMED MOSTAFA EMAM 69
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter
DR. MOHAMMED MOSTAFA EMAM 70
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 71
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 72
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 73
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 74
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 75
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 76
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis;
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 77
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
What is Meta-analysis?
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 78
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis; Technique or procedure ofillustration the results of a research by combiningthe results of a number of independent studies.
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 79
Clinical case
Series of clinical cases
Observational study
Trial
Randomized
Non randomized
Review
Meta-analysis
Opinion
Matter .. Could be
DR. MOHAMMED MOSTAFA EMAM 80
We are ready to start writing
We have an interesting subject
We know this finding had not been published before
We have a state of the art vision of the matter
We have a word processor and a web link
LET START WRITING!
DR. MOHAMMED MOSTAFA EMAM 82
We are ready to start writing
We have an interesting subject
We know this finding had not been published before
We have a state of the art vision of the matter
We have a word processor and a web link
LET START WRITING!
DR. MOHAMMED MOSTAFA EMAM 83
We are ready to start writing
We have an interesting subject
We know this finding had not been published before
We have a state of the art vision of the matter
We have a word processor and a web link
LET START WRITING!
DR. MOHAMMED MOSTAFA EMAM 84
We are ready to start writing
We have an interesting subject
We know this finding had not been published before
We have a state of the art vision of the matter
We have a word processor and a web link
LET START WRITING!
DR. MOHAMMED MOSTAFA EMAM 85
I. Before start writing
II.Writing the article
III.Making the article to be published
How to write & publish a scientific paper
DR. MOHAMMED MOSTAFA EMAM 86
I. Before start writing
II.Writing the article
III.Making the article to be published
How to write & publish a scientific paper
DR. MOHAMMED MOSTAFA EMAM 87
The title
Once of the most important items to publish an article. It has to have “catch up”
First impressions are strong impressions; a title oughttherefore to be well studied, and to give, so far as itslimits permit, a definite and concise indications of whatis to come
T Clifford Allbutt
DR. MOHAMMED MOSTAFA EMAM 88
Do:
Write the results of the article:
“Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease”
Write the aim of the study:
“Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea”
“Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly”
Ask a question:
“Exposure to Lead in Children — How Low Is Low Enough?”
DR. MOHAMMED MOSTAFA EMAM 89
Don´t
Use very long titles:
“On the addition to the method of microscopicresearch by a new way of producin colour-contrastbetween an object and its background or between partsof the object itself”
Use metaphoric sentences
DR. MOHAMMED MOSTAFA EMAM 90
Structure IMRAD
o Introduction
o Material and Method
o Results
o And
o Discussion
DR. MOHAMMED MOSTAFA EMAM 91
Introduction
It has the aim of giving a brief vision of the state-of-art of the matter and justifying the study.
“The situation about the matter is A.....There is a blank of the knowledge with respect to B......so...we did C”
All the asseverations will have to be supported by bibliographical references
DR. MOHAMMED MOSTAFA EMAM 92
Rheumatoid arthritis is a systemic autoimmune disease that affects approximately 1 percent of the
adult population.1 It is characterized by chronic inflammation in the synovial membrane of affected
joints that ultimately leads to loss of daily function due to chronic pain and fatigue. The majority of
patients also have deterioration of cartilage and bone in the affected joints, which may eventually lead
to permanent disability. Rheumatoid arthritis is associated with increased morbidity and mortality.2
Although the precise pathogenesis of rheumatoid arthritis remains unclear, it has been postulated that
multiple exogenous or endogenous antigenic triggers, or both, act in the presence of a background
genetic predisposition to initiate a self-perpetuating series of autoimmune responses in the synovial
compartment.3,4 Many cell populations, including monocytes, macrophages, B cells, T cells, endothelial
cells, and fibroblasts, participate in the ongoing inflammatory process.3 The precise contribution of B
cells to the immunopathogenesis of rheumatoid arthritis is not fully understood, although a number of
mechanisms have been proposed.4,5,6 However, strong evidence for a critical role of B cells in
rheumatoid arthritis came from a small open-label study of rituximab in combination with
cyclophosphamide and corticosteroids.7
Rituximab is a genetically engineered chimeric anti-CD20 monoclonal antibody that is approved for the
treatment of relapsed or refractory, low-grade or follicular, CD20+ B-cell non-Hodgkin's lymphoma.
CD20 is a B-cell surface antigen that is expressed only on pre-B and mature B cells. It is not present on
stem cells and is lost before differentiation of B cells into plasma cells. Therefore, rituximab causes a
selective transient depletion of the CD20+ B-cell subpopulation.7 To confirm the role of B cells in
rheumatoid arthritis, we evaluated the effect of rituximab in patients with active rheumatoid arthritis
in a multicenter, randomized, double-blind, controlled study.
DR. MOHAMMED MOSTAFA EMAM 93
Rheumatoid arthritis is a systemic autoimmune disease that affects
approximately 1 percent of the adult population.1 It is characterized by
chronic inflammation in the synovial membrane of affected joints that
ultimately leads to loss of daily function due to chronic pain and fatigue.
The majority of patients also have deterioration of cartilage and bone in
the affected joints, which may eventually lead to permanent disability.
Rheumatoid arthritis is associated with increased morbidity and
mortality.2
Says what is known about the disease
Highlights the importance of a fact
DR. MOHAMMED MOSTAFA EMAM 94
Although the precise pathogenesis of rheumatoid arthritis remains unclear,
it has been postulated that multiple exogenous or endogenous antigenic
triggers, or both, act in the presence of a background genetic predisposition
to initiate a self-perpetuating series of autoimmune responses in the synovial
compartment.3,4 Many cell populations, including monocytes, macrophages,
B cells, T cells, endothelial cells, and fibroblasts, participate in the ongoing
inflammatory process.3 The precise contribution of B cells to the
immunopathogenesis of rheumatoid arthritis is not fully understood,
although a number of mechanisms have been proposed.4,5,6 However, strong
evidence for a critical role of B cells in rheumatoid arthritis came from a
small open-label study of rituximab in combination with cyclophosphamide
and corticosteroids.7
Blank in the knowledge
Transition to the “so...”DR. MOHAMMED MOSTAFA EMAM 96
Rituximab is a genetically engineered chimeric anti-CD20 monoclonal
antibody that is approved for the treatment of relapsed or refractory,
low-grade or follicular, CD20+ B-cell non-Hodgkin's lymphoma.
CD20 is a B-cell surface antigen that is expressed only on pre-B and
mature B cells. It is not present on stem cells and is lost before
differentiation of B cells into plasma cells. Therefore, rituximab causes
a selective transient depletion of the CD20+ B-cell subpopulation.7 To
confirm the role of B cells in rheumatoid arthritis, we evaluated the
effect of rituximab in patients with active rheumatoid arthritis in a
multicenter, randomized, double-blind, controlled study
So...What we did?
DR. MOHAMMED MOSTAFA EMAM 97
Material and MethodHow we did it?
A short paragraph
Must include:
-What subjects we included,
-Definitions
-What parameters were assessed,
-What instrumentation was used to assess
-Was there a statistical study? What kind?
DR. MOHAMMED MOSTAFA EMAM 98
“We studied the patients with the characteristicsA and excluded those with the item B. Wemeasured C, D and F. We defined F as C+D. Tomake the measurements we used the device ABC.To study if there were statistical differencebetween the patients, we did the test X...”
DR. MOHAMMED MOSTAFA EMAM 99
Patients
Patients were recruited from 26 rheumatology centers in 11 countries (Australia,
Canada, Israel, and 8 European countries). Eligible patients were at least 21 years
of age, fulfilled the revised 1987 American Rheumatism Association criteria,1 and
had active disease despite treatment with at least 10 mg of methotrexate per week.
Active disease was defined by the presence of at least eight swollen and eight
tender joints and at least two of the following: a serum C-reactive protein level of
at least 15 mg per liter, an erythrocyte sedimentation rate of at least 28 mm per
hour, or morning stiffness lasting longer than 45 minutes. In addition, eligible
patients were seropositive for rheumatoid factor, as defined by a plasma
rheumatoid factor level of at least 20 IU per milliliter.
Patients were excluded if they had an autoimmune disease other than rheumatoid
arthritis (except concurrent Sjögren's syndrome), American Rheumatism
Association functional class IV disease,).
Inclusion criteriaDefinitions
Exclusion criteria
DR. MOHAMMED MOSTAFA EMAM 100
Study Protocol
Therapy with Patients were randomly assigned to receive one of fourtreatments: oral methotrexate at a dose of 10 mg or more per weekplus placebos for rituximab and cyclophosphamide (control group),rituximab plus placebos for methotrexate and cyclophosphamide,rituximab plus cyclophosphamide in an intravenous infusion of 750 mg ondays 3 and 17 plus placebo for methotrexate, and rituximab plusmethotrexate at a dose of 10 mg or more a week plus placebo forcyclophosphamide. In all three groups that received rituximab(MabThera, Roche; Rituxan, Genentech and IDEC Pharmaceuticals),rituximab was administered as a 1000-mg intravenous infusion on days1 and 15. Investigators and patients remained blinded to the assignedstudy medications.
Clinical assessments were performed at baseline (day 1) and at weeks12, 16, 20, and 24 according to the American College of
What was done?
DR. MOHAMMED MOSTAFA EMAM 101
Rheumatology (ACR) core set of disease-activity measures. These consisted of a count of swollen joints (66 joints evaluated),... andlaboratory evaluation of acute-phase reactants (serum C-reactiveprotein level and erythrocyte sedimentation rate).
Laboratory assessments (including complete blood counts and serum biochemical analyses) were performed at screening (three weeks before baseline), on days 1, 3, 15, and 17, and at weeks 4, 8, 12, 16, 20, and 24. ...
What instrument was used?
Definitions
DR. MOHAMMED MOSTAFA EMAM 102
Clinical Outcome Measures
The primary end point of the study was the proportion of patients with an ACR 50 response at week 24. ...and the value for one acute-phase reactant (either serum C-reactive protein level or erythrocyte sedimentation rate).9
Secondary outcomes included ACR 20 and ACR 70 responses (20 percent and 70 percent improvement, respectively, according to the ACR criteria), ... 10 and the response according to the criteria of the European League againstRheumatism (EULAR response).11
What do we study-measure?
DR. MOHAMMED MOSTAFA EMAM 103
Statistical Analysis
Sample-size calculations were based on the assumption..... On the basis of these assumptions and with the use of Fisher's exact test with a two-sidedsignificance level of 0.05, we calculated that a sample of 40 patients per treatment group would provide the study with 82 percent power to detect a difference between the two proportions.
What tools we use to detect differences?
How the assessed parameters were statistically treated
DR. MOHAMMED MOSTAFA EMAM 104
Results
Short and concise paragraph
Answers the questions on the section Material and Method
We might write it in the same order than it was in the section Material and Method.
Never try to explain the results or take any conclusion
DR. MOHAMMED MOSTAFA EMAM 105
“N patients were studed. A were included. B were excluded for having 1, demographical features being D, E and F. With respect to the parameter A the result was 1, with respect to B, the result was 2. With respect to C, the result was D....”
DR. MOHAMMED MOSTAFA EMAM 106
Of the 4164 hospital admissions sampled from theparticipating hospitals, 3745 patient charts (89.9%) wereeligible for a full screening by the stage 1 reviewers (Fig. 1).Of these, 1527 (40.8%) were assessed as positive for 1 ormore screening criteria (Table 1)...
Included & excluded
DR. MOHAMMED MOSTAFA EMAM 107
...the physician reviewers identified a total of 1133 injuries or complications in 858 charts. In 401 (46.7%) of these charts the injuries resulted in death, disability at the time of discharge or prolonged hospital stay. In 255 of the charts one or more of the AEs were rated 4 or higher on the 6-pointcausation scale (Box 1).
Enumerates results
DR. MOHAMMED MOSTAFA EMAM 108
Statistical analysis (if necessary)
There was a trend for AEs to occur more frequently in the teaching hospitals than in the large community or small hospitals (Table 2). The trend was significant for AEs across the 3 hospital types (p < 0.001) but not for preventable AEs (p= 0.8)...
DR. MOHAMMED MOSTAFA EMAM 109
Discusion
Highlights the importance of the subject. It may start with a short review.
Gives an explanation of the results
Compares the results with those of other studies
Result-comparation-explanation
Signs limitations of the study
A review of the state of the art can be done
DR. MOHAMMED MOSTAFA EMAM 110
“Is an extended version of the introduction, followed by a summary of the results, comparison with those of other studies, and what our results mean.”
“Starts where the introduction ended”
“It is the place for new hypotesis”
DR. MOHAMMED MOSTAFA EMAM 111
“ A is a very important parameter to determine B, as other studies have shown. Ours showed that A had the characteristics 1, 2 and 3, which is similar to
other studies carried out to this respect. Nevertheless, It had the characteristic 4, which was
different. We think that it may be due to...”
DR. MOHAMMED MOSTAFA EMAM 112
Incident rates of endometrial cancer vary more than 10-fold worldwide.18
In addition to host susceptibility, dietary factors may play an important role...
In our study population, the average intake of isoflavones from soya food was about 25 times that reported in a Western population....11 Some of these previous studies were not specifically designed to investigate the role of soya food...The sample sizes of the previous studies were relatively small, which limited the statistical power ...This population based case-control study... indicates that usual consumption of soya foods by adults, ... is associated with a significantly reduced risk of endometrial cancer....
Although not all associations were statistically significant in subgroup analyses, the different measurements produced similar results.
...Studies with measured oestrogen concentrations are needed to better understand the joint effect of soya and endogenous oestrogen on endometrial cancer risk.
DR. MOHAMMED MOSTAFA EMAM 113
Incident rates of endometrial cancer vary more than 10-fold worldwide.18 In addition to
host susceptibility, dietary factors may play an important role...
In our study population, the average intake of isoflavones from soya food was about 25
times that reported in a Western population....11 Some of these previous studies were not
specifically designed to investigate the role of soya food...The sample sizes of the
previous studies were relatively small, which limited the statistical power ...This
population based case-control study... indicates that usual consumption of soya foods by
adults, ... is associated with a significantly reduced risk of endometrial cancer....
Although not all associations were statistically significant in subgroup analyses, the
different measurements produced similar results.
...Studies with measured oestrogen concentrations are needed to better understand the
joint effect of soya and endogenous oestrogen on endometrial cancer risk.
ReviewResults of our study
Comparison with respect to other studies
Limitations of the study
Conclusion/Hypotesis
DR. MOHAMMED MOSTAFA EMAM 114
Introduction: Usually based on rarity.
Clinical case:
“A N yr-old wo/man was admitted for a featureof....his/her clinical history was....in the physicalexamination…the laboratory findings showed…theradiological techniques were…To exclude a…the A testwas asked, with the result 1. With the suspect of a B,test B, was asked….Thus, we diagnosed the pathology P”
DR. MOHAMMED MOSTAFA EMAM 116
A 28-year-old man was admitted to the hospital because of abdominal pain and fever.
The patient had been well until 10 days earlier, when mild epigastric pain developed.
Two days before admission...
On physical examination, the patient did not appear to be in severe pain, and there
was...
The urine was positive (+) for ketones; the sediment contained....
...Radiographs of the abdomen obtained both while the patient was supine and while he
was upright showed ..... A cystic mass, 1.5 cm in diameter, was contiguous with the
head and neck of the pancreas. The remainder of the pancreas was unremarkable
Oral intake was stopped. The patient was given fluid and electrolytes as well as
ranitidine, metronidazole, ampicillin, minidose heparin, and morphine, which was
administered...
DR. MOHAMMED MOSTAFA EMAM 117
I. Before start writing
II.Writing the article
III.Making the article to be published
How to write & publish a scientific paper
DR. MOHAMMED MOSTAFA EMAM 118
I. Before start writing
II.Writing the article
III.Making the article to be published
How to write & publish a scientific paper
DR. MOHAMMED MOSTAFA EMAM 119
The article has been written
And now....?
Cover page
Be sure it has the conditions required by the journal (length, structure....)
Submit it to the editor
Undergo the review process
DR. MOHAMMED MOSTAFA EMAM 120
Writing the first page
It is a cover with
the name of the article,
the names of the authors
and the institution,
in the lower left corner, coreespondence to...
DR. MOHAMMED MOSTAFA EMAM 121
Be sure it has the conditions required by the journal (length, structure....)
Submit it to the editor
Undergo the review process
DR. MOHAMMED MOSTAFA EMAM 122
Get the folder “target journals”
Be sure that:
This subject is at least occasionally treated in this publication.
Select the section were it fits better (Original papers, clinicalcase, letters to editor…).
Verify that the article has the structure required for thisformat.
Verify (once again) with the tool of “counting words” that thewhole do not exceed the maximum number of characters.
Verify that once again that the article “has to do” with his title.
DR. MOHAMMED MOSTAFA EMAM 123
The document is ready
Let´s send it:
By conventional mail:
Use first class paper
First class mail
Presentation letter
Original and 3 copies
CD or DVD.
Copy of photographs
DR. MOHAMMED MOSTAFA EMAM 124
By e-mail:
-Letter of presentation
-Attached file with text
-Attached file with photographs
DR. MOHAMMED MOSTAFA EMAM 125
Presentation letter:
Dear Dr….(Journal’s Reviewer),
“Enclosed are two complete copies of a manuscript by….and…. Titled “…….” which is going to be submitted forpossible publication in the “…” section of the “(name of thejournal)”
This manuscript is new, is not being considered elsewhereand reports new findings that extends results we reportedearlier in “(name of the Journal)”. An abstract of thismanuscript was presented earlier ( write Congress)
Sincerely yours
Author A Author B Author C Author D
DR. MOHAMMED MOSTAFA EMAM 126
Delays:
a) To the notification of receiving the article:
a) 1-7 days
b) To the rejection letter:
a) 2-3 weeks
c) To the acceptation letter:
a) 3-8 weeks
d) To the publication
a) Up to 2 years
DR. MOHAMMED MOSTAFA EMAM 127
The reviewer CHECK POINTS Yes No
1. Does the paper fall within the scope of a general interest quality assurance
journal?
2. Is this a new and original contribution?3. Is the title suitable and well worded?
4. Is the abstract clearly written and free of abbreviations?5. Are the keywords concise and appropriate to the material?
6. Are the methods sound and adequately described?7. Are the concepts appropriately defined and used?
8. Is the statistical treatment adequate?
9. Are the points of interpretation clearly separated from the results?
10. Are the conclusions and interpretations sound and justified by the data?
11. Are the figures adequate?12. Are the tables adequate?
13. Is the article unnecessarily long?
14. Are all the references necessary?
15. Is the English acceptable?
16. Is the paper addressed to an international audience?
DR. MOHAMMED MOSTAFA EMAM 129
In the event the manuscript is revised, would you like to serve as reviewer?
Yes
No
OVERALL RECOMMENDATION
1 Accept
2 Minor Revision - reassessment not required
3 Major Revision - reassessment required
4 Reject - Fair, but contributing little
5 Reject - Not acceptable
DR. MOHAMMED MOSTAFA EMAM 130
REVIEWER GUARANTEE: - IMPORTANT: PLEASE COMPLETE THIS SECTION
I, guarantee that, to the best of my knowledge, I have no conflictof interest in reviewing this paper that might influence thecomments I have provided on these pages.
Yes
No
PRIORITY OF PUBLICATION
Merits rapid publication
No urgency
Low priorityDR. MOHAMMED MOSTAFA EMAM 131
Kinds of acceptation: The “negotiation”
a) Unconditional acceptation:
“Dear Dr....We have read the article titled...and we have considered it acceptable for publication....In 4 weeks you will be sent the printing proofs for correction”
b) Conditioned acceptation.
“We have read the article and have found the following points that have to be set…”
1…..
2…..
3….
Consider it published.
Make the corrections suggested
DR. MOHAMMED MOSTAFA EMAM 133
Conditioned acceptation (cont)
After the corrections, verify that the article has the allowed length and send a letter:
DR. MOHAMMED MOSTAFA EMAM 134
Auther’s Reply:
“Dear editor. Thank you for your kind suggestions with respect to the article…with reference number….Following your instructions, the next points were restructured:
1. Write the point 1 of the letter 1 and write what you did:
“1. As it was suggested, the epidemiology of Salmonella was updated, the new result being…..”
2. Do the same with all the points.
Thank you again for these suggestions that have contributed to improve the quality of the article.Sincerely yours…”
DR. MOHAMMED MOSTAFA EMAM 135
Modified acceptation:
The article is accepted but to be published in anothersection.
“We have read your article and we considered itacceptable for publication. Nevertheless, we considerit has an excessive length. We advice you torestructure it to fit in the section…(usually is ashorter section Original papers---Clinical Cases----Letters to Editor)”
DR. MOHAMMED MOSTAFA EMAM 136
Rejection
a) Absolute rejection:
“We have read with interest your article…since we have to ponder many papers, yours has not been selected for publication…”
b) Relative rejection:
“We think your article is not appropriate to be published in our journal since it has the defects A, B and C…”
DR. MOHAMMED MOSTAFA EMAM 137
What to do with a “relative rejection’’?
Option A. Make the corrections the editor pointed toreject the article and resend the article as if it were a“relative rejection”. 80% new rejections.
Option B. Don´t desperate. Get advantage of thecommentaries and send to another publication (thereviewers are sometimes the same and they will like tosee the corrections they suggested done)
DR. MOHAMMED MOSTAFA EMAM 138
Resending the article
Most articles are not published for a lack of persistance
Think that once the article has been written making itto be published is only a question of time.
Look for another publication, make changes (ifneccesary) to fit the requirements and send it again
Before sending the article for the first time, it has tobe set that it will have to travel through a “spiral ofimpact factor” before being published
DR. MOHAMMED MOSTAFA EMAM 139
After an average of 3-4 tries, your article will be accepted for a publication
DR. MOHAMMED MOSTAFA EMAM 140
The printing proofs
Once the article has been accepted, a preliminar version is sent to the author
Don´t modify or add contents
Don´t make modifications on grammar
It is only done to correct ortography
Sent them back as soon as possible, since they are ussually sent just before being published
Preferable to be sent by Fax
DR. MOHAMMED MOSTAFA EMAM 141
Letters about the article
In the fisrt two months after the publication of the article.
Possitive or negative commentaries on the study
The author of the study has the right to answer the questions of the letter, but the authors are rarely allowed to reply.
A letter of the editorial together with the letter commenting the article is sent two months before the publication
DR. MOHAMMED MOSTAFA EMAM 142
Study protocolWhat is it?
• Describes every step of a study
• Answer relevant questions
- public health problem important?
- study question relevant to problem?
- objectives consistent with study question?
- study design achieves objectives?
- sufficient power?
- public health impact of the findings?
DR. MOHAMMED MOSTAFA EMAM 144
• The research protocol is considered as an essential guide; May be called the “operation manual for the study”.
DR. MOHAMMED MOSTAFA EMAM 145
A well-thought out and well-written protocol can be judged according to three main criteria:-
• Is it adequate to answer the researchquestion(s), and achieve the study objective?
• Is it feasible in the particular set-up for thestudy?
• Does it provide enough detail that can allowanother investigator to do the study and arriveat comparable conclusions?
DR. MOHAMMED MOSTAFA EMAM 146
Study protocol:
Why do it?
• Check
- can objectives be achieved?
- is study feasible?
• Ensure collect crucial information
• Lay down rules for all partners (quality)
• Obtain approval of ethical committee(s)
• Apply for funds
DR. MOHAMMED MOSTAFA EMAM 147
Study protocolHow to start ?
• Get
– good examples
– ideas from similar published studies
– ideas from colleagues
• Use a checklist of items to include
• Obtain requested format (grant application)
DR. MOHAMMED MOSTAFA EMAM 148
Protocol outline
1. Presentation (cover page)
2. Background and justification
3. Objectives
4. Methods
5. Ethical considerations
6. Project management
7. Timetable
8. Resources
9. References
10. Appendices
DR. MOHAMMED MOSTAFA EMAM 149
1. Presentation(cover page)
• Title
– short, accurate, concise
• Investigators
• Main centres
• Steering committee
• Summary of the protocol
DR. MOHAMMED MOSTAFA EMAM 150
2. Background and justification
• Statement of problem, study justification
importance of subject area
• magnitude, frequency
gaps in existing knowledge
principal question(s) to be addressed
contribution of results to existing knowledge
public health use of results
• Review relevant literature
DR. MOHAMMED MOSTAFA EMAM 151
3. Objectives
• Should answer the study question
• S.M.A.R.T.
Principal objective
• Must be achieved
• Dictates design and methods
Secondary objectives
• Of interest, but not essential
DR. MOHAMMED MOSTAFA EMAM 152
How to write SMART objectives
• An objective is a clear statement of something that needs to be accomplished over a period of time. SMART objectives are:
DR. MOHAMMED MOSTAFA EMAM 153
How to write SMART objectives
• An objective is a clear statement of something that needs to be accomplished over a period of time. SMART objectives are:
• Specific – states exactly what you need to achieve
• Measurable – includes a quality or quantity measure
• Agreed – between you and your Reviewer
• Realistic – can be challenging but must be achievable
• Timebound – with a clear end date or timescale
DR. MOHAMMED MOSTAFA EMAM 154
Here are some tips for ensuring that your objectives are SMART:
• SPECIFIC
• Objectives should clearly state what you are expected to achieve, using action verbs to describe
• what has to be done. For example:
• Not specific: Encourage more people to join the Sports Centre
• Specific: Increase membership of the Sports Centre
• Not specific: Conduct research
• Specific: Formulate plans for research on topic X
DR. MOHAMMED MOSTAFA EMAM 155
Here are some tips for ensuring that your objectives are SMART:
• MEASURABLE• Objectives should include a quality and/or quantity
reference so that you can measure whether or not you have achieved them.
• For example:• Not measurable: Increase membership of the Sports
Centre• Measurable: Increase membership of the Sports Centre
by 10%• Not measurable: Formulate plans for research on topic X• Measurable: Formulate plans for research on topic X and
submit grant application to X Research Council
DR. MOHAMMED MOSTAFA EMAM 156
Here are some tips for ensuring that your objectives are SMART:
• AGREED
• Objectives should be agreed between you andyour Reviewer, relevant to your job and driven byUniversity strategy and chool/Institute/Sectionplans.
Your Reviewer will help ensure that your objectivesare relevant and appropriate.
DR. MOHAMMED MOSTAFA EMAM 157
Here are some tips for ensuring that your objectives are SMART:
• REALISTIC
• Objectives should be challenging but achievable i.e.they should not be unrealistic. For example, it might berealistic to plan to lose 10 pounds in weight but itwould be unrealistic to plan to lose 10 pounds in oneweek.
• Objectives should also take account of the skills,knowledge and resources needed to achieve them.
You may need to consider whether you need any trainingor development (or other support) in order to achievethe objective.
DR. MOHAMMED MOSTAFA EMAM 158
Here are some tips for ensuring that your objectives are SMART:
• TIMEBOUND
• Objectives should include a time reference, such as a specific deadline. For example:
• Not timebound: Increase membership of the Sports Centre by 10%
• Timebound: Increase membership of the Sports Centre by 10% over the next six months
• Not Timebound: Formulate plans for research on topic X and submit grant application to X Research Council
• Timebound: Formulate plans for research on topic X and submit grant application to X Research Council by 1 June 2009.
• The time reference for other objectives might be in terms of frequency or turnaround time.
• For example:
• Timebound: Once a month, update all library web pages and printed guides
• Timebound: Circulate minutes of Committee Y within five days of the meeting.
• If there is a particularly long timescale involved, you may need to break your objective down, identify the steps you need to take to achieve your overall objective and work out how long each step is likely to take so that you can agree a target date.
DR. MOHAMMED MOSTAFA EMAM 159
3. Objectives
• Should answer the study question
• S.M.A.R.T.
Principal objective
• Must be achieved
• Dictates design and methods
Secondary objectives
• Of interest, but not essential
DR. MOHAMMED MOSTAFA EMAM 160
Principal objective
• To determine if sharing a haemodialysis machine with an HCV infected patient is a risk factor for HCV infection.
Secondary objective:
• To identify failures in procedures designed to prevent cross-infection via haemodialysis machines
3. Objectivesexample 1
DR. MOHAMMED MOSTAFA EMAM 161
Hypotheses
• Translation of the objectives in terms that allow statistical testing.
“The incidence of HCV infection in haemodialysispatients is higher in patients sharing machineswith HCV infected patients than in patients notsharing machines with HCV infected patients”
DR. MOHAMMED MOSTAFA EMAM 162
3. Objectivesexample 2
• To estimate the current mortality, among theInternally Displaced Population present inthe settlements at the time of the survey,in each of the three states of Greater Darfurregion.
DR. MOHAMMED MOSTAFA EMAM 163
Hypotheses
• Translation of the objectives in terms that allow statistical testing.
The current crude mortality rate in IDPs in Darfur is above 1 death per 10,000 per day
CMR > 1/10,000/day
DR. MOHAMMED MOSTAFA EMAM 164
Protocol outline
1. Presentation
2. Background and justifications
3. Objectives
4. Methods
5. Ethical considerations
6. Project management
7. Timetable
8. Resources
9. References
10. AppendicesDR. MOHAMMED MOSTAFA EMAM 165
4. Methods
• Procedures to achieve objectives
– what will be done?
– how?
• Information used to judge validity
DR. MOHAMMED MOSTAFA EMAM 166
4. Methods
• Study design cohort, case-control, cross-sectional…
brief justification
• Study population
definition
criteria for inclusion and exclusion
mechanisms of recruitment
accessibility, follow up, representativeness
DR. MOHAMMED MOSTAFA EMAM 167
4. Methods
• Sampling design frame: district, household, persons,…
method: random, cluster, stratified,…
randomisation procedures
replacement procedures (in case of refusal)
• Sample size
sample size, power calculations based on principal objective feasibility
DR. MOHAMMED MOSTAFA EMAM 168
4. Methods
• Selection and definition
exposures:
risk factors, protective factors, confounding factors
outcomes:
definition of case and the control group
• Items to be measured– scales used
• e.g: smoking ? lung cancer
- smoking: definition, quantification, categories- lung cancer: case definition, control group definition
DR. MOHAMMED MOSTAFA EMAM 169
MethodsData analysis plan
• Structured in terms of objectives
• Hypotheses tested, dummy tables
• Statistical tests used, adjustment, standardisation
DR. MOHAMMED MOSTAFA EMAM 170
MethodsData analysis plan
• Define
– indicators you will need to reach objectives
– data you will need to collect
• Better estimates of sample size for analysis of sub groups
DR. MOHAMMED MOSTAFA EMAM 171
MethodsData analysis
Dummy table: Food specific attack rates of Salmonella infection
in a day care centre, Paris, May 1999
ill
n
total
n
AR
%
RR 95%CI
ice-cream yes
ice-cream no
fruit cake yes
fruit cake no
pudding yes
pudding no
DR. MOHAMMED MOSTAFA EMAM 172
MethodsData analysis
Case-control study, risk factors for brucellosis in France
Cases Controls OR
Exposed Unexp Exposed Unexp
Age group < 15 15 – 25 26 - 60 > 60
Sex M F
Occupation
Travel
Cheese
DR. MOHAMMED MOSTAFA EMAM 173
4. MethodsData collection
• How interview, observation, record review
• By whom interviewers: selection, training
level of supervision
• Tools questionnaires, recording materials
questionnaires: self or interviewer administered, face to face or telephone interview
• Procedures for taking samples
DR. MOHAMMED MOSTAFA EMAM 174
4. MethodsData handling
• Coding
during data collection, afterwards?
by whom?
• Processing
software, hardware
entry
• during the study, afterwards?
• single entry, double entry?
• Validation and data cleaning
DR. MOHAMMED MOSTAFA EMAM 175
4. MethodsPilot studies, pre-testing
• No study without test
Feasibility of sampling
Data collection, measurement methods
Questionnaire
• Describe how to test
DR. MOHAMMED MOSTAFA EMAM 176
4. MethodsLimitations
• Identification of potential sources of biases
selection bias
information bias
• How to deal with them
possibilities for correcting
how they will affect the results
DR. MOHAMMED MOSTAFA EMAM 177
Protocol outline
1. Presentation
2. Background and justifications
3. Objectives
4. Methods
5. Ethical considerations
6. Project management
7. Timetable
8. Resources
9. References
10. Appendices
DR. MOHAMMED MOSTAFA EMAM 178
5. Ethical considerations
• Informed consent
• Confidentiality, record anonymity
• Data storage and protection
• Ethical committee
DR. MOHAMMED MOSTAFA EMAM 179
6. Project management
• Participating institutes and persons
• Responsibilities and tasks of each partner
• Data ownership
DR. MOHAMMED MOSTAFA EMAM 180
7. Timetable
Planning/organisation of the study• questionnaire design, recruitment, purchases
• permission
• obtain funding
“Pilot study”
Final study• data collection• analysis• presentation of results and write up
DR. MOHAMMED MOSTAFA EMAM 181
8. Resources
• Extent of this section depends on target audience
• Specify
available sources
requested sources
• Keep budget
reasonable
detailed
well justified
DR. MOHAMMED MOSTAFA EMAM 182
9. References
• Limit number of references to key articles
• Follow recommended style
Many sites provide sources to ease the process of finding references;
University of Southampton Library
http://www.southampton.ac.uk/library/
DR. MOHAMMED MOSTAFA EMAM 183
10. Appendices
• Methodological appendices
• List of definitions
• Questionnaires
• Introductory letters to study participants
• Forms for informed consent
…..
DR. MOHAMMED MOSTAFA EMAM 184
Common problems
• Too ambitious: too many questions
• Insufficient attention to literature
• Poor justification
why is it important to answer this question?
what impact does it have on public health?
• Poorly formulated objectives
• Inappropriate analysis
• Inadequate description
• Absence of pilot
DR. MOHAMMED MOSTAFA EMAM 185
Study protocoland now….
A PRACTICAL GUID FORHEALTH RESEARCHS
Open Discussion
DR. MOHAMMED MOSTAFA EMAM 186
Development of HSR
– In 1967, Division of Research inEpidemiology and Communication Science(RECS) was established for research works,under WHO.
– In 1972, RECS was restructured into Divisionof Strengthening Health Services (SHS) andHealth Services Research responsibilitiestransferred to SHS.
DR. MOHAMMED MOSTAFA EMAM 189
Development cont…
– In 1978, Global Advisory Committee onMedical Research and Sub-committee onHealth Services Research were formed-
• to achieve “Health for All by the year2000” and
• Implement the “Primary Health Care”approach successfully.
DR. MOHAMMED MOSTAFA EMAM 190
• In 1980, as per the recommendation ofHealth Services Research Sub-committee,WHO had recognized Health Service Researchas a priority area and established HealthSystem Research.
Development cont…
DR. MOHAMMED MOSTAFA EMAM 191
• In 1980, Health System Research wasconsidered as an organization with followingmandates-
– Promotion, coordination and informationexchange in the practice of HSR,
– Strengthening of national capabilities for HSRtraining and development
– Support to substantive research in priority areas.
Development cont…
DR. MOHAMMED MOSTAFA EMAM 192
• In 1990, Technical Discussions of Forty-ThirdWorld Health Assembly finalized thefollowing four major themes/issues in healthresearch-
–Health systems research,
–Nutrition research,
–Research capability strengthening, and
– Science, research and health care.
Development cont…
DR. MOHAMMED MOSTAFA EMAM 193
• In 2000, Health Policy and Systems Research wasofficially launched with the following objectives :
– Stimulate the generation and synthesis ofknowledge, encompassing evidence, tools andmethods
– Facilitate the development of capacity for thegeneration, dissemination and use of knowledgeamong researchers, policy makers and otherstakeholders
– Promote the dissemination and use of knowledgeto improve the performance of health systems.
Development cont…
DR. MOHAMMED MOSTAFA EMAM 194
• First time in 2002, under the umbrella ofHealth System Research there was initiated anew sub area Public Health System Researchby the public health system research interestgroup (PHSR-IG).
Development cont…
DR. MOHAMMED MOSTAFA EMAM 195
Outlines
• Introduction• Development • Objective • Areas• Designs, methods & techniques• Ethical issues• Limitations • Conflict of interest• Conclusion
DR. MOHAMMED MOSTAFA EMAM 198
Data Collection Techniques
• Using available information,
• Observing,
• Interviewing,
• Administering written questionnaire,
• Focus group discussion,
• Projective technique,
• Mapping scaling, and
• others
DR. MOHAMMED MOSTAFA EMAM 199
Using available information
• Routinely collected data,
• Secondary data: HMIS, NDHS, Census etc
• Unpublished record report,
• Publications
• Grey literature( rarely available published documents),
• Newspapers,
• Case histories, etcDR. MOHAMMED MOSTAFA EMAM 200
Observing
• Observation of human behaviours,
• Observation of objects
• Types of observation-
– Participatory vs non-participatory
– Open vs conceal
• Observation tool: checklist
– Structural
– Semi-structural
DR. MOHAMMED MOSTAFA EMAM 201
Interviewing
• High degree of flexibility: In-depth interview
• Semi-structural interview
• Low degree of flexibility: structural interview
• Exit interview, supplementary interview, etc
• Interview tools
– Guideline
– Structured schedule
DR. MOHAMMED MOSTAFA EMAM 202
Administering
• Ways of administering-
– Sending by mail/email and receiving by same ways,
– Hand-to-hand delivering and later collection,
– Gathering respondent and requesting to response and return immediately.
DR. MOHAMMED MOSTAFA EMAM 203
Projective technique (PT)
• Ask the participant to response the hypothetical or incomplete question.
• E.g.– Suppose your child suffered from ARI, what
would you do?
– If your wife was to propose that you use condoms, you would ...
• PT can be combined with other methods: FGD, questionnaire, interview etc
DR. MOHAMMED MOSTAFA EMAM 204
Mapping and Scaling
• Mapping is a valuable technique for visually displaying relationships and resources.
– Process mapping
– Service mapping
• Scaling is a technique that allows researchers through their respondents to categorise certain Variables.
DR. MOHAMMED MOSTAFA EMAM 205
Systematic/extensive review
• Online available literature review
• Published documents review
• Grey literature review
• Unpublished document/desk review
• Review focused on analytical question, etc
DR. MOHAMMED MOSTAFA EMAM 206
Case studies
• Examine to a great extent in order to find out and correct possible errors.
• Common used case studies techniques
– Use systemic rapid assessment toolkit
– Use conceptual framework
– Use unstructured questionnaire
– Participatory observation, etc.
DR. MOHAMMED MOSTAFA EMAM 207
System Review• systems review is a technique, used to elicit the situation
(Past and present) of an organization. • Common techniques of SR-
– Structural review– Narrative analysis of selective documents– Time and motion analysis– Cost analysis– Trend analysis– Demand and supply analysis– Gaps and surplus analysis– Disease burden analysis– Lot Quality Assurance Sampling(LQAS)
DR. MOHAMMED MOSTAFA EMAM 208
Program Evaluation
• Common techniques –– Content analysis: textual analysis
• both qualitative and quantitative studies
• Analysis: objective, scopes, outputs/outcome
– Cost analysis1. Cost-utility 2. Cost-benefit
3. Cost- effectiveness 4. Cost –minimization
– Budget analysis• Sources of revenue
• Areas of expenditure
DR. MOHAMMED MOSTAFA EMAM 209
Program Evaluation cont…
– Financing analysis• Government financing in health
• Corporate financing
• Private financing in health
• Per-capita health expenditure
• Catastrophic healthcare/expenditure
• Role of user fees, etc
Health expenditure= government financing + private expenditure
DR. MOHAMMED MOSTAFA EMAM 210
Demand and supply analysis
Supply side intervention Demand side intervention
Institutional Innovation
Financial incentives
Skill development
Improved infrastructure
Providers
Health
ServicesConsumers
/users
Empowerment
Awareness
DR. MOHAMMED MOSTAFA EMAM 211
Social Network Analysis (SNA)• It is defined as a distinctive set of methods used for
mapping, measuring and analysing the social relationships between people, groups and organizations.
• It consists of 3 stages:
– describing the set of actors and members of the network;
– characterizing the relationships between actors; and
– analysing the structure of the systems and generating information…
DR. MOHAMMED MOSTAFA EMAM 212
Meta-Analysis
• A systematic method of evaluating statistical data based on results of several independent studies of the same problem.
• Produces a stronger conclusion than can be provided by any individual study.
• Useful for quantitative as well as qualitative studies
DR. MOHAMMED MOSTAFA EMAM 213
Ethical issues in HSR
• Ethical approval and informed consent,
• Respect of participants,
• Autonomy of individual participants,
• Benefits and risks,
• Dissemination and publication of results,
• Unique human nature and implementation of protocol
• Conflict of interest, …
DR. MOHAMMED MOSTAFA EMAM 214
Limitations of HSR• Difficult in randomization and equal participation of
subject, • High turnover: retirement, transfer, change, etc • Difficult to match with relevance policy and
community’s expectation, • Cost and benefits: control and distribution• Implementation of results with scare resources• Donor interest and influence• Access/permission , publication and dissemination
of results
DR. MOHAMMED MOSTAFA EMAM 215
Conflict of Interest in HSR
• Among research team/s and members.
• Financial issues and quality of research.
• Disseminating and publishing of the results.
• Maintaining the distance and relationship with participants.
• Conflict with government’s regulations, policies, programs, interests…
DR. MOHAMMED MOSTAFA EMAM 216
Conclusion• HSR is a new discipline of research/ health
research.
• Health services research, health policy and system research and public health system research are very close terms with health system research.
• Health system research is being influenced by global politics and investments rather than its own philosophy.
DR. MOHAMMED MOSTAFA EMAM 217
At last…
• First Global Symposium on Health SystemsResearch (HSR), was organized inMontreux, Switzerland, 16–19 November2010
• Second Global Symposium was organizedfrom 31st Oct. to 3rd Nov. 2012, Beijing,People's Republic of China.
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Meaning of Research
• The word research was originated from ‘Research’
which means to travel through or survey.
• RE+SEARCH= Search after search and search
• Careful search or inquiry into any subject matter.
• To investigate thoroughly
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• Research is the process of finding solution to a
problem after a through study and analysis of the
situational factors.
• Research as a movement, a movement from
unknown to known.
– It is a systematic effort to gain of knowledge.
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Research is systematic collection, analysis and
interpretation of data to answer a certain question or
solve a problem.
Research need to conducted in a
systematic fashion,
Logical,
Orderly process.
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PURPOSES OF RESEARCH
• Generation new knowledge
• Improve understanding
• Application testing
• Comparing best practices
• Helping with decision making
Exploration
Description
Explanation
Generalization/prediction
Theory building
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CHARACTERISTICS OF
RESEARCH
• Demands a clear statement of the problem,
• Requires a scientific plan,
• Purposiveness,
• Relevance, testability, effectiveness,
• Ethnical,
• Collection and interpretation of data.
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OBJECTIVES OF RESEARCH
• To gain familiarity with a phenomenon or to gainnew insights into it.
• To describe the characteristics of a particular cause,situation or environment.
• To determine the relationship between two or morevariables.
• To test hypothesis.
• To solve the problems.
• It provides answers for questions like what, where,when, how and why.
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TYPES OF RESEARCHOn the basis of
Application of research study
• Basic research
• Applied research
Objectives in understanding the research
• Observational research
• Experimental research
Method of study
• Quantitative research
• Qualitative research
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RESEARCH PROCESS
• Identification of the research problem
• Review of literature
• Formulation of the objectives of the study
• Protocol preparation
• Conducting the study
• Analysis of the data
• Preparation of report
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CRITERIA FOR SELECTING A RESEARCH
PROJECT
Interest
Relevance
Avoidance of duplication
Feasibility
Political acceptability
Applicability
Cost-effectiveness
Ethical considerations
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FORMULATING STUDY PROBLEM
Formulating a study problem is thefirst and most important steps in thestudy process.
A study problem identifiesresearcher’s destination and decidewhat he want to find out.
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CRITERIA FOR DEVELOPING A GOOD
RESEARCH QUESTION
Feasibility
Interesting
Novel
Ethical
Relevant
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FINER
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ABSTRACT
The abstract should be written in about 200 words, it contentsbrief synopsis of activities to be carried out in the study. Ithelps to understand the frame of study activities for the reader.
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BACKGROUND
The background may provide general ideaabout formulating problem and linked betweenpresent situation and past experiences.
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OBJECTIVE
Objectives of Research should be
S=Specific
M=Measurable
A=Achievable
R=Reasonable
T=Timeliness
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Literature Review
A literature review is a written summary of articles,
books and other documents that describe the past
and current state ok knowledge about topic.
FORMULATING THE
HYPOTHESES
Hypotheses is always developed in response to the
purpose statement or to answer the research
question.
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METHODOLOGY
• Study design,
• Study area and population,
• Sampling and Sample selection,
• Study variables,
• Data collection,
• Data analysis.
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SAMPLING AND SAMPLE
SELECTION
There are different process of sampling methods;
• Probability sampling
• Non-probability sampling
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STUDY VARIABLES
• Dependent variables
• Independent Variable
Variables may take numerical (quantitative) or non-
numerical (qualitative) values.
Quantitative Variables
Qualitative Variables
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INSTRUMENTS
• Questionnaires
• Checklist
• Guidelines
• Lab equipment
• Medicines
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DATA COLLECTION
Process contains four interdependent elements;
• Defining a research methods,
• Defining and constituting the sample,
• Choosing and preparing data collection tools,
• Evaluating the tools-pre test.
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DATA ANALYSIS
• Entered into a database
• Editing and coding
• Computer software used; dBase IV, SPSS, Epi,Epinfo, STATA, Excel,
• Frequencies and cross-tabulations
• Selection of analytical techniques
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INTERPRETATION OF FINDINGS AND
REPORT WRITING
CONTAINS OF REPORT
• Research title• Acknowledgement• Abbreviations• List of table• List of figures• Introduction (background, statement of problem and its justification or rationale)• Objectives• Methodology• Results• Discussion• Recommendations• References• Annexes
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