Fundamentals of Respiratory Care Research

Objectives - Describe the purposes for a research article, describe how a properly-written research article is structured, and describe the types of research.

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Overview of Respiratory Care Research

You may never conduct a study, but you must be familiar with the concepts of research. You need to become an educated consumer of medical research.

If you want to become a respiratory care scientist:

• Find a mentor, someone who has experience conducting scientific studies and publishing the results.
• A mentor can help you turn ideas into practical realities.

Importance of Research in Health Care

Academic medicine has three basic missions:

1. Heal
2. Teach
3. Discover

Stakeholder Involvement (R.A.C.E.)

The common skill all stakeholders must have is the ability to read and critically evaluate published scientific reports.

Without research, you cannot have meaningful evaluations of current practices and cannot plan research.

How to Review the Literature

Bibliographic databases contain books, book chapters, reports, citations, abstracts, and either the full text of the articles indexed or links to the full text. They provide search filters, automatic e-mailing of search updates, the ability to save records, and filters for search results using "My NCBI" (National Center for Biotechnology Information).

Search Engines

Synthesized Databases

The Cochrane Collaboration is the leading synthesized database.

• Pros: Pre-filtered records for particular topics; may provide the "best" evidence without extensive searches of standard bibliographic databases.
• Con: Subscription based with relatively large fees.

Portals

Portals are web pages that act as a starting point for using the Web or web-based services, providing access or links to other sites. Examples:

• MD Consult - Provides links to books, journals, Clinics in Medicine, patient education resources, and images.
• Ovid - Provides links to books, journals, evidence-based medicine databases, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).

Electronic Journals and Books

We are rapidly reaching the point where all medical journals are available online, and some are available only online due to cost restraints. Electronic versions of textbooks are also available on the Internet. Subscription services include:

• Oxford Reference Online
• STAT!Ref (a great source for nursing and drugs)
• Safari Books Online (an excellent source of technical reference books)
• Respiratory Care Journal (AARC)

General Internet Resources

Google.com is the most popular general search engine.

Suggestions for Conducting Literature Searches

• Talk to a professional librarian.
• Use bibliographic software, also known as reference management software - a database of the sources you use (books, journal articles, websites, etc.) when researching your assignments. Examples include EndNote, RefWorks, and Zotero.

Starting RT Research

A good starting point is device evaluation, particularly of a new device.

• It is usually very inexpensive, because vendors often donate or loan equipment and supplies.
• Approval is not required by the Institutional Review Board (IRB). The IRB is required for studies of human subjects.

Factors Affecting Feasibility of Research (M.A.D.S.A.K.)

• Measurability
• Availability of research subjects
• Duration and timing of study
• Significance or potential benefits to results
• Availability of equipment and funds
• Knowledge and experience of investigators

Steps in Research

• Find your motivation
• Find a mentor
• Find a good textbook on respiratory care research
• Develop a study idea
• Write a study protocol
• Analyze the data
• Publish a scientific paper

Develop a Study Idea

• Choose and define a research topic. This implies concern or doubt about some concept or observation and is usually based on the observer's experience from clinical practice.
• Clarify your study purpose through literature review.
• Develop a formal problem statement. From the problem statement comes either a brief statement of the study purpose(s) or a hypothesis statement. A hypothesis is a supposition or proposed explanation for an observation.

Write a Study Protocol

The process of writing it out will help you clarify the goals of the study and the methods of investigation. Permission may need to be sought from a funding source, IRB, department manager, or student advisor before a study may begin. The research plan, or research protocol, provides an operational guide for the entire research team.

Analyze the Data

Be familiar with the basics of statistical analysis:

Publish a Scientific Paper

Once you complete a project, you need to communicate the results. There are three basic ways to formally present your findings:

1. The abstract
2. The poster
3. The paper

The abstract is a condensed version of a research paper that appears at the beginning of the publication. Most journals restrict its length. It should include an introduction, background, study purpose, methods, results, and discussion. Start with a longer abstract and then edit - the idea is to decrease word count while increasing clarity.

The poster allows a bit more freedom in terms of space compared to an abstract. It is generally 4 feet tall by 6 feet long, and graphics should be at least 300 dots per inch (dpi). Posters are usually presented in a group of 10-15 in small rooms, hung on stands as visitors walk around reading and discussing them with the authors.

The research paper takes anywhere from 20 to 100 hours. It has the same basic outline as an abstract or poster but goes into much greater detail and has a references section. There is no word limit for the Introduction, but most journals have a maximum word count for the full text of the paper, usually in the range of 2000-3000 words.

Basic Structure of a Research Article

• Abstract/summary
• Introduction
• Materials and Methods
• Results
• Discussion
• Conclusion
• References

Peer Review Articles

A paper is usually reviewed by two or three peer reviewers. They read and critique any and everything about your paper, including what words you use, what measurements you made, and what statistical procedures you used.

They make a recommendation to the journal editor, with three possible outcomes:

• Should not be considered for publication
• Rejected with an opportunity to revise and resubmit
• Should be accepted as is

Types of Research

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High-Yield Review

• Even if you never conduct a study, you must become an educated consumer of medical research; if you want to become a researcher, find a mentor.
• Academic medicine has three missions: heal, teach, and discover.
• The R.A.C.E. stakeholders are researchers, administrators, clinicians, and educators; the common skill they all need is the ability to read and critically evaluate published scientific reports.
• PubMed is the most popular search engine and is a service of the U.S. National Library of Medicine; the Cochrane Collaboration is the leading synthesized database.
• The IRB is required for studies of human subjects, but not for inexpensive device evaluations.
• Feasibility factors are remembered by M.A.D.S.A.K.: measurability, availability of subjects, duration/timing, significance, availability of equipment/funds, and knowledge/experience of investigators.
• A hypothesis is a supposition or proposed explanation for an observation.
• Statistical basics: t-test compares two means, ANOVA compares more than two means, and chi-square or Fisher Exact tests compare proportions.
• Findings are presented as an abstract, a poster, or a paper; the article structure is abstract, introduction, materials and methods, results, discussion, conclusion, and references.
• Quantitative research answers "how many," qualitative answers "why"; descriptive research generates hypotheses while analytic ("explanatory") research tests them.