Chapter 1:
Introduction to Medical
Research
Chapter outlines:
1.1 Definition of research
1.2 Importance of medical research
1.3 Aims of medical research
1.4 Why we are doing research?
1.5 Types of research
1.6 Steps in medical research
1.7 Tools in medical research
1.7.1 What is Epidemiology?
1.7.2 What is Biostatistics?
By the end of this chapter we should be able to:
¾ define research.
¾ recognize the importance of medical research in disease prevention and
management
¾ identify the aims of medical research
¾ realize why we are doing research.
¾ understand the basic steps in research work
¾ define epidemiology and biostatistics and recognize their role in medical
research
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1.1: Definition of research
The research process is a complementary step. But, before involving in this process,
researchers need to know how to define research and what are the importances of doing
research. The Advanced Learner’s Dictionary of Current English lays down the meaning
of research as “a careful investigation or inquiry especially through search for new facts in
any branch of knowledge.” ( The Advanced Learner’s Dictionary of Current English,
Oxford, 1952, p. 1069).
The word research is composed of two syllables, "re" and "search"; re is a prefix meaning
again, a new or over again, search is a verb meaning to examine closely and carefully, to
test and try, or to probe. Together they form a noun describing a careful, systematic, event
study to express or to investigate a new problem or phenomenon.
Alternatively, '' re- search'' implying that the subject matter is already known but, for one
reason or another, needs to be studied again.
For this reason, research is considered as an academic activity, and as such the term
should be used in a technical sense. The process must meet certain methodological
requirements to be called research starting from defining and redefining problems,
formulating hypothesis, collecting, organizing and evaluating data; making deductions and
reaching conclusions; and at last carefully testing the conclusions to determine whether
they fit the formulating hypothesis.
In medicine, medical research refers to a search for new medical knowledge by a
scientific and systematic search for pertinent information on a specific topic in different
medical specialties. In fact, research is the art of scientific investigation and the soul of
new finding in medicines, it is the backbone of medical development, and actually was the
movement and voyage in all most all previous and current medical discoveries. Thus, we
seek only one type of research that can find new medical knowledge: good research.
1.2: Importance of medical research
With our current level of knowledge in different branches of medical specialties, there
are numerous problems that challenge our absolute comprehension and stay out of clear
explanation. Research is the activity guides for comprehension and explanation.
Finding from medical research frequently play the role in identification, description,
exploration, explanation, prediction and control of phenomena related to medical
professionals.
Medical research is an extended and valuable process that involves drug discovery,
laboratory development, clinical development, and health system evaluation. This process
is necessary not only for understanding the target disease but also for providing substantial
evidence regarding prevention and control. It provides assurance that the disease or health
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problem under investigation will possess good understanding such as occurrence,
distribution, management, prevention, and control.
From other side, applying the results of research to patients care is the major reason
practicing clinicians read or do the medical study. They want to know which diagnostic
procedures are best, which modes of treatment are optimal, and how the treatment regimen
should be design and implemented of course; they also read researches in medical journals
to stay aware and up to date in medicine in general as well as their specific area of interest.
Health professionals always look for prestigious journals and good researches for best
evidence. Comprehension and explanation of research results in the era of evidence-based
health care need to critically appraise the methodological and statistical aspects of
published articles in order to judge the implications and reliability of reported results.
1.3: Aims of medical research.
There are several aims to medical research which are a very powerful tool, come to
rescue because it allows us to:
1) Monitoring and surveillance of health and disease.
2) Detecting disease.
3) Establishing causes of disease or factors associated with death or disease.
4) Preventing death or disease.
5) Evaluating treatments for disease.
6) Evaluating health services and programs.
1.4: Why we are doing research
What makes people to undertake research? This is a question of fundamental importance.
The possible motives for doing research may be either one or more of the following:
1) Appeal to get a research degree along with its consequential benefits.
2) Seek for job promotion.
3) Wish for facing the challenge in solving the unsolved problems.
4) Desire to be of service to society.
5) Aspire to get respectability.
However, this is not an exhaustive list of factors motivating people to undertake
research studies. Many more factors such as directives of government, employment
conditions, curiosity about new things, desire to understand causal relationships, social
thinking and awakening, and the like may as well motivate (or at times compel) people
to perform research operations.
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1.5: Types of research
From the viewpoint of objectives, a research can be classified as:
1) Descriptive research attempts to describe systematically a situation, problem,
phenomenon, service or programme, or provides information about , say, living
condition of a community, or describes attitudes towards an issue.
2) Correlational research attempts to discover or establish the existence of a
relationship/ interdependence between two or more aspects of a situation.
3) Explanatory research attempts to clarify why and how there is a relationship
between two or more aspects of a situation or phenomenon.
4) Exploratory research is undertaken to explore an area where little is known or to
investigate the possibilities of undertaking a particular research study (feasibility
study / pilot study).
In practice most studies are a combination of the first three categories.
1.6: Steps in medical research
Step-by-step approach is the best way to understand medical research. The steps of a
research may be broken down into the following steps:
1) Select and specify the medical or health problem to be addressed. Put the research
question in the form of hypothesis.
2) Recognize data and identify which variables (exposure, out come) that can address
research question and which variables (confounding variables) that can affect the
answer.
3) Rule suitable research design that solves research question, find the real
relationship between exposure and outcome, and controls or randomizes the
confounding variables within available resources.
4) Identify sampling methods and do a power analysis to determine a good sample
size for the research.
5) Assign the methods of quantifying the occurrence of events or disease and identify
the suitable measurements (incidence, prevalence, proportion, average....etc.) that
are relevant to the research question and design.
6) Collect and gather data relevant to the research question by using an appropriate
tool (interview or questionnaire…..etc.)
7) Analyze and describe research data, present the result systematically, usually with
a text, table and/or graph. Communicate the results effectively and precisely. And,
choose the suitable statistical tools.
8) Write the research scientifically, and interpret the result.
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All these steps in the research process are dealt with in detail in the different chapters
of the book and actually the sequence of chapters in this book is according to these steps.
Outline the research
question clearly and
accurately
Interpret Select an
study Experience and appropriate
findings other research in method to
to answer measure the
the field
the variables
investigation
question
Choose suitable
Collect and analyze design to carry
data precisely out the study
Figure 1.1: Summery steps in research work.
1.7: Tools in medical research
In all of medical research the ultimate goal is to seek out true differences, associations
and causations between variables in group or groups of population. It has only been with
the aid of epidemiologic and statistical techniques that such relations introduced to society.
Epidemiology and biostatistics are indispensable tools in medical research; they are vital
components of the research process; from the earliest planning stages of a study to the
final presentation of its results. For this purpose, epidemiology and biostatistics play an
important role in medical research not only to provide a valid and fair assessment of the
disease or health problem under investigation prior to disease prevention measures but also
to ensure that the disease or health problem will be managed with the desired accuracy and
efficiency.
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1.7.1 What is Epidemiology?
Medical research requires the principles of epidemiology, which is concerned with the
study of the distribution and determinants of disease within and between populations. In
epidemiology there is an emphasis on empiricism, that is, the study of observable
phenomena by scientific methods, detailed observation and accurate measurement.
Acquiring these measuring essentially involves quantifying the relationship between two
or more variables.
The word epidemiology comes from the Greek words epi, meaning “on or upon,”
demos, meaning “people,” and logos, meaning “the study of.”Epidemiology is the study of
the distribution and determinants of health-related states or events in specified populations,
and the application of this study to control of health problems.
This definition of epidemiology includes several terms which reflect some of the
important principles of the discipline in medical research:
¾ Study: Epidemiology is a scientific discipline, sometimes called “the basic science of
public health.” It has, at its foundation, sound methods of scientific inquiry.
¾ Distribution: Epidemiology is concerned with the frequency of spreading of health
events in a population. Frequency includes not only the number of such events in a
population, but also the rate or risk of disease in the population. The rate (number of
events divided by size of the population) is critical to epidemiologists because it allows
valid comparisons across different populations.
¾ Pattern: Epidemiology is involved in the pattern of the occurrence of health-related
events by time, place, and personal characteristics.
• Time characteristics include annual occurrence, seasonal occurrence, and daily or
even hourly occurrence during an epidemic.
• Place characteristics include geographic variation, urban-rural differences, and
location of worksites or schools.
• Personal characteristics include demographic factors such as age, race, sex,
marital status, and socioeconomic status, as well as behaviors and environmental
exposures.
This characterization of the distribution of health-related states or events is one broad
aspect of epidemiology called descriptive epidemiology. Descriptive epidemiology
provides the What, Who, When, and Where of health-related events.
¾ Determinants: Epidemiology is also used to search for causes and other factors that
influence the occurrence of health-related events. This is the other aspect of
epidemiology which is called Analytic epidemiology. Analytic epidemiology attempts
to provide the Why and How of such events by comparing groups with different rates
of disease occurrence and with differences in demographic characteristics, genetic or
immunologic make-up, behaviors, environmental exposures, and other so-called
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1.7.2 What is Biostatistics?
Biostatistics, which is simply statistics as applied to the biological sciences, quantifies
variables and achieves the aims above in assessing a relationship between variables.
Biostatistics is a science that deals with the collection, organization, analysis,
interpretation, and presentation of information that can be stated numerically.
Biostatistics provides a framework of handling data. As data can come in many different
forms and statistical design and analysis are needed to collect and understand data
obtained from sample and we usually want to use this information to make inductive
inferences about the population. Perhaps the most difficult aspect of statistics is the logic
associated with these inductive inferences, yet all scientific evidence is based on this type
of statistical inference. All observations of subjects in a study are analyzed to determine
the beneficial in drawing conclusion regarding that study. It is important to know how to
recognize these forms and to use the correct statistical technique for that form as we will
read the next chapters. Concerns of biostatistics: There are 2 areas of statistics:
1) Descriptive statistics: Techniques that allow the researcher to 'describe' data. It
includes the collection, summarization, organization, presentation and description of
sample data. Descriptive statistics come in the form of charts, tables, graphs and
narrative.
2) Inferential statistics: Techniques that allow the researcher to offer conclusions about
collected data when only a part of the data is observed. Inferential statistics allow the
researcher to infer properties about entire group (population) of individuals from a
small number of those individuals (sample). This is usually done by:
¾ Use sampling techniques, experimental designs, and statistical tests to make
inferences about research data.
¾ Use observations to generalize from the sample to the population, perform
hypothesis testing, estimate confidence interval, determine relationships among
variables, and make predictions about variables.
It is essential to have the skills to decide whether research results are credible and
therefore have implications for current clinical practice or future research directions.
Without knowledge of these techniques, it is all too easy to draw the wrong conclusions
from research data which can be disastrous in health research, while understanding and
using these techniques correctly in analyzing research data help to draw robust
conclusions.