This document outlines five essential questions to ask when assessing the methodological quality of papers: 1) Was the study original? 2) Whom is the study about? 3) Was the design of the study sensible? 4) Was systematic bias avoided or minimized? 5) Was the study large enough and long enough to make the results credible? It discusses factors to consider for each question when evaluating a study's methods section such as sample size, duration of follow up, and completeness of follow up.
Clinical Research for Medical StudentsAhmed Negida
This presentation discusses (1) the importance of clinical research to medical students, (2) barriers towards student research, and (3) how to select a good mentor.
Clinical Research for Medical StudentsAhmed Negida
This presentation discusses (1) the importance of clinical research to medical students, (2) barriers towards student research, and (3) how to select a good mentor.
Systematic reviews at the peak of research designsNemencio Jr
This lecture explains why systematic reviews were catapulted to the peak of the study designs. Its advantages and limitations are discussed. The measures to overcome the limitations are also discussed.
M.Pharm (Pharmacology), Persuing PhD in Kumaun University Nainital (UK), Have 3 year experience in the field of Clinical Research and 4 year experience in the field of academic research and lecturer.
this is ppt of scientific , social and behavioral method of Research. this highlight all important task related to this. we can give my seminar by explaining it . Email id -govindkr456@gmail.com(for further detail)
HEALTHCARE RESEARCH METHODS: More on reviewing the literatureDr. Khaled OUANES
Once you have a good idea about the existing literature in general (Gather as many articles, reports and books as possible), You can start digging into individual articles.
in the field of science and technology especially health science we cannot say anything without proper research. Research should follow a scientific method. And here we tried to describe the scientific method for research especially for health science.
A brief, 3-minute, tutorial to help researchers understand the recent changes to the NCBI tool, My NCBI. In particular, it addresses adding citations to "My Bibliography".
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Systematic reviews at the peak of research designsNemencio Jr
This lecture explains why systematic reviews were catapulted to the peak of the study designs. Its advantages and limitations are discussed. The measures to overcome the limitations are also discussed.
M.Pharm (Pharmacology), Persuing PhD in Kumaun University Nainital (UK), Have 3 year experience in the field of Clinical Research and 4 year experience in the field of academic research and lecturer.
this is ppt of scientific , social and behavioral method of Research. this highlight all important task related to this. we can give my seminar by explaining it . Email id -govindkr456@gmail.com(for further detail)
HEALTHCARE RESEARCH METHODS: More on reviewing the literatureDr. Khaled OUANES
Once you have a good idea about the existing literature in general (Gather as many articles, reports and books as possible), You can start digging into individual articles.
in the field of science and technology especially health science we cannot say anything without proper research. Research should follow a scientific method. And here we tried to describe the scientific method for research especially for health science.
A brief, 3-minute, tutorial to help researchers understand the recent changes to the NCBI tool, My NCBI. In particular, it addresses adding citations to "My Bibliography".
Power Point Presentations With PizzazzDoug Devitre
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Biostatistics is one of the most unavoidable area in the modern day practice of evidence based medicine . In the ppt , trying to give a glimpse on how a clinician should approach Biostatistics
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Light House Retreats: Plant Medicine Retreat Europe
How To Read A Medical Paper: Part 2, Assessing the Methodological Quality
1. How to Read a Paper:
2 – Assessing the Methodological
Quality of Papers
Dr Luke Kane
May 2014
1
2. References
• This lecture was made from T Greenhalgh’s
papers in the BMJ Series “How to Read a
Paper”
• Greenhalgh, T. (1997) “How to read a paper”
British Medical Journal. Web, accessed April-
May 2014 at <http://www.bmj.com/about-
bmj/resources-readers/publications/how-
read-paper>
2
4. Five Essential Questions
• To decided whether methods used are valid:
1. Was the study original?
2. Whom is the study about?
3. Was the design of the study sensible?
4. Was systematic bias avoided or minimised?
5. Was the study large enough and/or long enough
to make the results credible?
4
5. Q1: Was the study original?
• Only a very small amount of research is done that
is entirely “new”
• You need to ask if the study adds to the literature
• For example:
– Is it bigger or longer than previous ones?
– Is the methodology more rigorous?
– Does it address methodological criticisms of previous
ones?
– Will the results add to a meta-analysis?
– Is the population studied different? Ages? Sex?
5
6. Q2: Whom is the Study about?
• How were the subjects recruited?
– Is it likely to bias the results?
• E.g. how happy are you with services of hospital?
• If you place an ad in a newspaper asking people to
email in their answers then you are only sampling
people that read the newspaper and are motivated to
email you
• Better to ask 1 in 10 people in a waiting room for
example
6
7. Q2: Whom is the Study about?
• Who was included?
– Most trials in the West only include healthy young adults
– Often trials are run on people with severe forms of a
disease – e.g. end stage heart failure
– This could mean that the results are not valid for those
with milder forms
• Who was excluded?
– Many studies exclude people who are illiterate
– People with co-existing illness
– People taking other medications
• Is it fair to extrapolate this to patients taking multiple medications
with numerous diseases?
7
8. Q2: Whom is the Study about?
• Were the subjects studied in “real life”
circumstances?
– Trials can often be run very differently to how
people practise medicine in the real world
– i.e. special equipment
– More time, more information
8
9. Q3: Was the design of the Study
Sensible?
• Critical appraisal:
• Start with two fundamental questions
– What specific intervention was being considered
and what was it being compared with?
– What outcome was measured and how?
– This isn’t always what is written down!
– You need to work this out for yourself
9
10. Q3: Is the design sensible?
• What specific intervention was being
considered and what was it being compared
with?
– Don’t take the written statements at face value
– Authors often misrepresent what they did
– They often overestimate importance
– For example…
10
14. Q3: Is the design Sensible?
• What outcome was measured, how?
– Is the outcome a sensible choice?
If not then why did they choose it?
– For example, the best way to see if a new drug works
is to see if it makes you live longer and whether the
quality of life it gives you is good
– If the trial is not based on the above outcome, what
and why?
– Is it based on a level of an enzyme in the blood which
the pharmaceutical company says is a good indicator
of survival?
14
15. Q4: Was Systematic Bias Avoided or
Minimsed?
• Systematic bias is anything that erroneously
influences the conclusions about groups and
distorts comparisons
• In any study the groups being compared must
be as similar as possible to each other
• Different types of study designs have different
steps to reduce bias:
15
16. Q4: Avoiding Bias in RCTs
• Importance
of random
allocation!
• Need to
check for
bias at
following
stages:
16
17. Q4: Avoiding Bias in Non-randomised
clinial trials
• You need to use common sense to decide if
differences between intervention and control
groups are likely to invalidate differences
ascribed to the intervention
• If non-randomised then "almost always" the
effects are biased
• e.g. testing a new drug between two groups:
one is 75% female, one is 30% female
17
18. Q4: Reducing Bias in Cohort Studies
• Reminder:
Cohort study
• Very difficult to
get two groups
who have same
age, sex,
socioeconomic
status etc with
only difference
the exposure
18
19. Q4: Reducing Bias in Cohort Studies
• In practice, much of the “controlling” in cohort
studies occurs at analysis stage
• Complex statistical adjustment is made for
baseline differences in key variables
• Unless this is done adequately, statistical tests
of probability and confidence intervals will be
dangerously misleading.
• Good example is alcohol and teetotallers
20. Q4: Reducing Bias in Case-Control
Studies
• Process most open to bias is not the
assessment of outcome, but the diagnosis of
the “cases” and the decision as to when the
individual became a case
20
21. Q4: Reducing bias, Was Assessment
Blind?
• Assessment bias from people who assess the
outcome if they know what group (treatment
or control) someone is in
• E.g. I knew that a patient had been
randomised to an active drug to lower blood
pressure rather than to a placebo, I might be
more likely to recheck a reading which was
surprisingly high.
21
22. Q5: : Were preliminary statistical
questions dealt with?
• Three important numbers can often be found
in the methods section of a paper:
1.the size of the sample;
2.the duration of follow up;
3.and the completeness of follow up.
22
23. Q5: Statistical Questions
• Sample size: How big?
• The sample needs to be big enough to have a
high chance of detecting a statistically
significant effect if one exists
• And therefore you can be reasonably sure that
no benefit exists if one is not found in the
study
23
24. Q5: Statistical Questions
• Sample size - how to calculate it
• Two things need to be decided:
• What level between the two groups would constitute a significant
effect?
• What is the mean and standard deviation of the primary outcome
variable
• Then with a statistical nomogram you can work out how large a sample
you need to have a moderate, high, or very high chance of detecting a
true difference between the groups—the power of the study
• It is common for studies to stipulate a power of between 80% and
90%.
25. Q5: statistical Questions, ERRORs
• Underpowered studies are common
• Usually because hard to recruit subjects
• Such studies typically lead to a type II or ß
error
• This is the erroneous conclusion that an
intervention has no effect.
• A type I or α error is the conclusion that a
difference is significant when in fact it is due
to sampling error
26. Q5: Stats, duration of follow up
• Even if sample size was adequate, a study must
continue long enough for the effect of the
intervention to be reflected in the outcome
variable
• A study looking at effect of a new painkiller on
degree of postop pain may only need a follow up
period of 48 hours
• Study of effect of nutritional supplementation in
the preschool years on final adult height, follow
up should be measured in decades
27. Q5:Stats, Completeness of Follow up
• Subjects who drop out ofstudies are less likely to have taken their
tablets as directed, more likely to have missed their checkups, and
more likely to have experienced side effects
• Reasons why patients withdraw:
• Incorrect entry of patient into trial (did not fulfil the entry criteria)
• Suspected adverse reaction to the trial drug
• Loss of motivation
• Loss of patient motivation
• Withdrawal by clinician for clinical reasons (such as concurrent
illness or pregnancy)
• Loss to follow up (patient moves away, etc)
• Death
28. Q5: completeness
• You still need to analyse the people who
dropped out
• This can be done on an intention to treat basis
29. Conclusion
• First essential question to ask about the methods
section of a published paper is: was the study
original?
• The second is: whom is the study about?
• Thirdly, was the design of the study sensible?
• Fourthly, was systematic bias avoided or
minimised?
• Finally, was the study large enough, and
continued for long enough, to make the results
credible?
30. References
• Bowers, D. (2008) Medical Statistics from Scratch: An
Introduction for Health Professionals. USA: Wiley-
Interscience.
• Grant, A. (2014) “Epidemiology for tropical doctors”.
Lecture (S6) from the Diploma of Tropical Medicine &
Hygiene, London School of Hygiene & Tropical
Medicine.
• Greenhalgh, T. (1997) “How to read a paper” British
Medical Journal. Web, accessed April-May 2014 at
<http://www.bmj.com/about-bmj/resources-
readers/publications/how-read-paper>
30