Every Doc Can Do Research

1. 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

2. 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

3. 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.

4. The PCP Process Divide into teams Choose faculty mentor Choose resident leader Choose topics Meet monthly with team Meet monthly with Research Team

5. 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

6. 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

7. Step # 1 Define Your Research Question. The question should be specific and well defined

8. 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 Every time you see a patient you are using evidence that was provided by someone making a determination about what to do from a study. Other examples: Do pap smears in women over 70 decrease morbidity and mortality from cervical cancer? Should I have treated this patient�s hypertension by pushing a single drug to its maximum therapeutic limits or should I have tried a combination of drugs at lower doses? Its anything you are interested inEvery time you see a patient you are using evidence that was provided by someone making a determination about what to do from a study. Other examples: Do pap smears in women over 70 decrease morbidity and mortality from cervical cancer? Should I have treated this patient�s hypertension by pushing a single drug to its maximum therapeutic limits or should I have tried a combination of drugs at lower doses? Its anything you are interested in

9. 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 This is just the initial question ? The research question will be further refined and defined from here.This is just the initial question ? The research question will be further refined and defined from here.

10. PICO P = Population, Patient or Problem I = Intervention C = Control O = Outcome In the workbook Step one asks us to start by stating the question as a general statement Should we treat Pregnant Women who are carriers for Group B Strep ? Using the PICO method In the workbook Step one asks us to start by stating the question as a general statement Should we treat Pregnant Women who are carriers for Group B Strep ? Using the PICO method

11. 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 +/-

12. Step #2 Hit the Library ( Lit Search) Learn about what others have done. Helps define research topic. Updates your knowledge about the subject.

13. Step #2 (cont�d) 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/library.htm Database page- http://tulsa.ou.edu/library/databases.htm OVID (Medline, EBM Reviews, Cochrane databases, ect.) MDConsultants STAT!Ref ( Full-text clinical textbooks)

14. STEP #3 Justify Your Study Based upon your Literature search, evaluate your initial question.

15. 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.

16. 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.

17. STEP #6 Refine the Question Again Restate the research question in a refined form that can be studied with available resources.

18. 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.

19. 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.

20. 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

21. 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.

22. 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?

23. 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

24. STEP # 13 Identify the Limitations of Your Study Potential sources of bias remaining Limitations to generalizability

25. STEP #14 & #15 Develop Data Collection Forms & Reporting of Results

26. 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*

27. 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?)

28. STEP #18 Protocol Approval and Initiation of Study

29. 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

30. 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

31. more Hypothyroidism Osteoarthritis Pharyngitis Pneumonia Sinusitis Viral Hepatitis UTI/Urosepsis

32. 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

33. 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

34. 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

35. Every Doc Can Do A Case Report

36. 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

37. STEP #2 Hit the Library (Lit Search)

38. 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?

39. 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

40. STEP #5 Refine the Topic Restate the topic in a refined form that can be tackled with available resources.

41. STEP #6 Begin Writing Introduction Case Discussion Conclusion

42. STEP #7 Stop Writing After you have finished your first draft set it aside for a few weeks before beginning critical revision.

43. STEP #8 Begin Review A Five Part Review Initial review Organizational review Grammar review Style review Readability review

44. STEP #9 Submit Manuscript Remember Prepare Information for the authors section Manuscript Cover letters Any other forms necessary

45. STEP # 10 Sit Back and Relax

46. Every Doc Can Do A Poster

47. 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.

48. STEP #2 Hit the Library ( Lit Search)

49. STEP #3 Justify Your Topic Based on your literature search, evaluate your initial question and answer.

50. 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.

51. STEP #5 Look at What Resources are Needed to Complete this Project TIME REVIEWERS

52. 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

53. 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.

54. 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

55. 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.)

56. STEP #9 (cont�d) Useful Design Tips Never forget the poster�s purpose, audience and setting Allow for about 50% white space (area�s 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

57. STEP #10 Supporting the Poster When presenting your poster remember: Presenter Handout Sign-up list Business card Keep poster presentation checklist available

58. STEP #11 Sit Back and Relax!