First of two library lectures for Oral Research UGs at McGill

1. DENT-125/225
ORAL HEALTH
RESEARCH
Martin Morris | martin.morris@mcgill.ca

2. Objectives
By the end of this session you will have a
better understanding of:
• key points in the history of medical
information
• the research cycle and how medical
knowledge is produced; and
• how that evidence is disseminated
2

3. First things first…
• What is research?
• Have you ever conducted any?
• Do you read any?
• Why should you do research?
3

4. Did you know?
The word “research” comes
from the French “recherche”
which means to travel
through, or survey.

5. Definitions of “research”
• To search or investigate exhaustively
• To investigate or examine a subject from
different viewpoints
• Undertake to discover, establish or
confirm a fact or principle
• The systematic and rigorous study or
investigation into a field of knowledge
5

6. Some history…
…or 5000 years
in 5 minutes.
6

7. Medieval cures for toothache
Which of the following did
medieval dentists recommend
for toothache?
• Ground up ant eggs, blown
into the mouth with a quill?
• Baked newts and woodlice?
• Rosemary boiled in wine?
7

8. The Ancient World
• Evidence from the
ancient world of
empirical
observation
• Ancient Greeks rejected spirits/demons
as cause of disease
• Science based on logic and reason
8

9. Edwin Smith papyrus
c. 1500 BC

10. Greek/Roman medicine
Hippocrates (460 – 377 BC)
“The Father of Medicine”
Galen (129 – 200 AD)
Theories dominated
until the Renaissance
10

11. The Dark Ages
• In West: move
towards belief that
disease is “God sent”
• While in Arabic
world, empiricism
and investigation
thrive in medicine
11

12. Avicenna ( ا(بن سینا
• Avicenna (980 – 1037
AD) was a Persian
medical researcher
(and general polymath)
• Wrote the Canon of
Medicine, was still in
use 500 years later
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13. The Renaissance and beyond!
Scientific renaissance
• Andreas Vesalius (1514-1564)
• Giovanni Morgagni (1682-1771)
• William Harvey (1578-1657)
…and later on…
• Bacon, Copernicus,
Galileo, Newton
• Lind conducts first clinical trial
(1747 – related to scurvy)
13

14. We doctors have always
been a simple, trusting folk!
Did we not believe Galen
implicitly for more than 1500
years and Hippocrates for
more than 2000 years?
William OSLER
“
”

15. 20th Century Medicine
The biomedical model
• Health defined as “the absence of
disease”. Some now consider this to be
insufficient (e.g. First Nations Health)
• Disease caused by pathogens
• Behavioural sciences, interdisciplinarity
Plus
• The rise of information!
• Economics of providing health care
15
New viewpoints are
emerging about how
we define “health”

16. Some takeaways
• Science and dentistry/medicine
depend intimately on one another
• Knowledge and discovery have
accelerated since the Renaissance
• Medical knowledge is built on
previous evidence
• We cannot practice Evidence-Based
Dentistry without reliable evidence
16

17. Evidence-Based Dentistry
17
American Dental
Association:
“…an approach to oral health
care that requires the judicious
integration of systematic
assessments of clinically relevant
scientific evidence, relating to
the patient's oral and medical
condition and history, with the
dentist's clinical expertise and
the patient's treatment needs
and preferences
American Dental Association (2008). ADA Policy on
Evidence Based Dentistry.
Viewed: Oct. 1, 2012
Clinical Expertise
Patient‘s
Preference
Research
Evidence
(including
Resources)
EB
D

18. How is
scientific
knowledge
produced?
18

19. Research happens because…
• A problem to be solved
• A desire to find a solution
• Agreement on validity/paradigm
• Methods and techniques
appropriate to finding out
• A wish to disseminate the findings
19

20. What makes a
good research
question?
20

21. What makes a good question?
A good research question specifies:
• the boundaries of the research,
• the kinds of information that will
be sought, and
• the types of settings/people which
will be included
21

22. SMART objective
• Specific (or significant)
• Measurable (or manageable)
• Achievable
• Relevant
• Time-bound (or has a Timeframe)
22

23. What is PICO?
Patient or Population
Intervention
Comparison
Outcome
23

24. A PICO example
Martin is a 43-y/o librarian who
drinks way too much coffee and is
concerned at the staining this is
causing to his teeth.
He has heard that whitening
strips are a good alternative to
home bleaching kits. What do
you advise?
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25. Constructing the PICO
Martin is a 43-y/o librarian who drinks way too much coffee and is concerned
at the staining this is causing to his teeth.
He has heard that whitening strips are a good alternative to home bleaching
kits. Which therapy will you recommend?
Elderly female
stroke patient with
arm weakness
Virtual
Reality
Exercise
therapy
Improved arm
function
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In elderly stroke patients with arm weakness, does virtual reality as
compared to exercise therapy improve arm function?

26. A PICO example
In patients with tooth
discoloration would
teeth-whitening strips
compared to home
bleaching kits lead to
whiter teeth?
26

27. Good and Bad Questions
What causes tooth loss?
How can we make people in Montreal
clean their teeth more regularly?
Is there a connection between
repeated reuse of cooking oil and
increased incidence of oral cancers?
27

28. Good and bad research questions
EXERCISE

29. EXERCISE
Create examples of good and bad
research questions linked to:
• Encouraging better oral hygiene
• Materials for dental implants
• Oral health of prisoners, OR
• Your own area of interest!
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30. The agreed way
to investige
30

31. The Scientific Method
31
Question
Lit Search
Hypothesis
Method
Data Collection
Observations
Conclusion
What do we want to learn more about?
Gathering of information
A suggested explanation based on limited
evidence
A carefully planned and followed experiment
to test the hypothesis
Information collected during the experiment
A record of what was noticed during the
experiment
Does the hypothesis still hold, or not?
Possible new question?

32. Inductive, deductive research
32
Theory
Test,
experiment,
intervention
Results,
outcomes
Observations
Context
Hypothetico-deductive
Inductive
From: Allen, A.K., (2012) Research Skills for Medical Students, London: Learning Matters, SAGE. p.10

33. Basic types of research
QUALITATIVE
Descriptive
Interpretative
Oriented towards
reasons, emotions
Numbers not the
primary focus
QUANTITATIVE
About numbers
Statistical
Oriented towards
cause and effect
Quantifies data,
attempts to
generalise it
33

34. Basic types of research #2
• Examples of quantitative studies
– Clinical trials, meta-analyses of CT’s
–Epidemiological studies
• Examples of qualitative studies
–Psychological effects of oral cancer
– What does “good health” mean to First
Nations people?
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35. The evidence pyramid
is used to illustrate
the evolution of the
literature.
► As you move up the
pyramid the
amount of
available literature
decreases…
► …but the relevance
Sys Rev
RCT
Cohort study
Case-control study
Case series
Case report
Expert opinion
for its application in
Animal research
health related
settings increases. Bench-top research
Stronger
Weaker
Study Design
35

36. Matching design with question
Interventions
► (treatment, prevention)
Harm
► (etiology, cause)
Prognosis
Diagnosis, Assessment
Economics
Meaning
Quantitative
Systematic review of RCT or RCT
Quantitative: Cohort, case control
Quantitative: Cohort, case control
Quantitative: Comparison to standard
Quantitative: Cost-effectiveness Study
Qualitative: Case studies etc.
36

37. How is research
disseminated?
37

38. DEVELOP
an idea
PRESENT
preliminary
research
REPORT
research
PUBLISH
research
GENERALISE
INTEGRATE
38

39. DEVELOP
an idea
PRESENT
preliminary
research
REPORT
research
PUBLISH
research
GENERALISE
INTEGRATE
39
Lab Notebooks
Grant Proposals
Conference
Papers
Theses,
Dissertations
Journal
Articles
Books
Encyclopaedias
Textbooks

40. Scope of information sources
Encyclopedias Dictionaries
Books (General Topic)
Books (Specific Topic)
Books (Collections of essays)
Newspapers Magazines Journals
40
General
Specific

41. Choosing an info source
• Stage of your research
– Your level of background knowledge
– How focused your research question is
• What type of information you
are looking for
– Scope of the information (ex. encyclopedia vs.
journal article)
– Information time-line (current vs. retrospective)
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42. Key Resources at McGill
42
START HERE!

43. Don’t forget your librarian!
• Liaison librarians have expertise
in your area of research
• Available for one-on-one
research consultations
• Contact your librarian with your
questions!
43

44. Activity!
• Discover various types of resources
by completing the exercises on the
“Scavenger Hunt”
• I’ll ask for volunteers to show me
how they approached the tasks –
don’t be shy!
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45. Why all those databases?
• Subject areas
• Journal coverage
• Date coverage
• Geography
45

46. Databases
Medline Embase
J O U R N A L S
46

47. Database overlaps
9505 titles
Journal of Clinical
Bioinformatics
Gut Pathogens
Biomagnetic Research
and Technology
Thyroid Research
International seminars in
surgical oncology
Environmental Entomology
Conflict and Health
Journal of
Physiotherapy
Journal of the
History of Biology
Journal of Translational
Medicine
ACC Cardiosource
Review Journal
Advances in
Hematology
Actualites Pharmaceutiques
Hospitalieres
Journal of Pharmacy
Technology
Cancer Cell
International
ActaToxicologica
7687 titles
PubMed Embase
47

48. Grey Literature
“That which is produced on all levels of
government, academics, business and
industry in print and electronic formats,
but which is not controlled by commercial
publishers.”
(i.e. where publishing is not the primary
activity of the producing body.)
The Fourth International Conference on Grey Literature, (Luxembourg, 1997)
48

49. Grey literature
Type of Info Examples Helpful Links
Data and statistics • Statistics Canada
• Health Canada
http://www.mcgill.ca/librar
y/find/edrs
Government and
NGO information
• Canadian Laws
• United Nation policy
statements
http://www.mcgill.ca/librar
y/find/govinfo
Health technology
assessment
• Health tech assessment
websites
• Clinical trial registries
Grey Matters:
http://www.cadth.ca/en/re
sources/grey-matters
Theses and
dissertations
• McGill theses
• Other theses
http://www.mcgill.ca/librar
y/find/theses
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50. References
• Anderson, T. (2004) Dental Treatment in Medieval
England. British Dental Journal. 197, 419 – 425.
doi:10.1038/sj.bdj.4811723
• History of Medicine slides adapted from Giustini’s here:
www.slideshare.net/giustinid/libr534-history-of-medical-librarianship-
2013
• “Mad Scientist” – www.camelcitydispatch.com/wp-content/
uploads/2012/12/mad-scientist-movie1.jpg
• Edwin Smith Papyrus:
en.wikipedia.org/wiki/Edwin_Smith_Papyrus
• Various icons from the Noun Project (www.nounproject.com)
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