Far

Eastern University – Nicanor Reyes Medical Foundation Deficiencies in the past literature
RESEARCH FINALS - May exist because topics have not been explored in a
MACARIO F. REANDELAR, JR., MD, MSPH, FPAFP particular group, sample or population; thus literature may
need to be replicated to see if the same findings hold, given a
WRITING THE INTRODUCTION new sample for people or new site for the study.
- Voice of the underrepresented groups has not been heard in
IMRAD published literature.
- Introduction – Why did you study? - Voice of the underrepresented groups has not been heard in
- Methods – Who, What, When, Where and How did you study? published literature.
- Results – What did you find? - Writing the Introduction in a Proposal
- Discussion – What do the findings mean? - Flaws in the methodology, like research design, sampling
methodology, absence of a control in clinical trial,
Purpose of the Introduction inappropriate statistical tests, etc.
- Familiarize and orient - Sample size many be small.
- It does so by providing context of your work, stating your - Mention too how the present study will remedy or address
focus and giving justification for your work the deficiencies.
- Provide context of your work - Writing the Introduction in a Proposal
o Introduce a specific topic
o Provide a background about what has already been Significance of the Study
done, supported by a limited number of relevant - Practical application of the study
references - Improvement in the practice of the profession
o Inform about the purpose of your work, what it will - Writing the Introduction in a Proposal
address, and how it relates to previous work/s.
o Define gap in knowledge by reviewing Purpose of the study
inconsistencies/deficiences in the literature - State the aim/direction of the study.
- State your focus by way of stating your research hypothesis or - State here too your hypothesis and objectives
research question
- Give justification for your work Writing the Introduction in a Medical Journal
o What is the rationale for your current study - The three paragraph rule
o Why your research is important
o Why your research will answer your question Introduction
- First paragraph – The Problem
Introduction o Describe the problem to be investigated
- The way the context, focus and justification of your work in o Summarize relevant research to provide context and
the introduction is written will set the direction you will take concepts
in the discussion o Show significance of your study
- Second paragraph – Gap in the Literature
Writing the Introduction in a Proposal o Review relevant research to provide rationale
- Consists of 5 parts o Show gap or inconsistency in the literature
o The research problem o Limitations of previous studies
o Studies that have addressed the problem - Third paragraph – Your Hypothesis/es
o Deficiencies/inconsistencies in the previous studies o Provide justification and rationale for your study
o The significance of the study o Describe your ideas, hypothesis/es, aim/s or objective/s
o The purpose/aim of the study
Pitfalls in the Introduction
The research problem - Overlong and unnecessary background in introduction section
- Background of the problem - Exaggerating (or understating) the importance of your work.
- Magnitude of the problem - Extensive listing of references and review
- Implications of the problem - Too many objectives and not clearly stated
- Writing the Introduction in a Proposal - Inclusion of results and conclusion in the introduction section
- Use of Improper tenses (Introduction is largely PRESENT tense)
Studies that have addressed the problem
- Review studies that have examined the problem CONCEPT PAPER
- In the review of literature found in the introduction, large
groups of studies are summarized instead of individual Concept Paper
studies; in contrast to the ROL section, individual studies are - One page
discussed. - 12 point Times New Roman font
- The purpose of the reviewing studies in the introduction is to - 1 inch margin on all sides
justify the importance of the study and create distinction
between past studies and the current study, Parts of a Concept Paper
- Writing the Introduction in a Proposal - Working Title

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 - Background Examples:
- Hypothesis(es) and Objective(s)
- Design Respondents’ characteristics Number (n) Percentage (%)
- Potential Impact Sex
• Male
Working Title • Female
- Description of what the paper is all about Race
• Filipino
Background • Chinese
- Discuss magnitude of the problem • Korean
- Describe the rationale and significance of the study • Others
- Provide supporting documentation for the importance of Preferred Learning Style
addressing this question, problem or need.
• Visual
- Use statistical data to support the problem statement
• Aural
- Describe what is not known about the problem (Research
• Reading
gaps) that the proposal intends to address
• Tactile

Hypothesis(es) and Objective(s)
- State the hypothesis(es) Age Mean age ± SD
- Then describe the aim(s) or objective(s) 6mos to 2 yrs 2-4 yrs n (%)
4-6yrs
Design >6yrs
- Description of the basic design Gender n (%)
- Description of the study participants including eligibility Male
criteria Female
- Data collection procedure Nutritional status n (%)
- Description of Outcome/s and how they will be measured Normal Underweight
Severely underweight
Potential Impact
Type of feeding difficulty n (%)
- Description of how results will benefit the target population,
Highly selective intake
will influence decisions or practices, will improve health
Poor appetite that is a parental misconception

Poor appetite in a child who is fundamentally

vigorous Fear of Feeding
DUMMY TABLES
Poor appetite due to organic disease

Poor appetite in a child who is apathetic and
- Important to clarify the information the researcher needs
withdrawn
before data collection

- Constructing dummy tables will aid him not only in data
collection but how analyses will proceed later Allergic disease Caesarean Vaginal Total p - value

n(%) n(%) n(%)
Definition and Use
- Dummy Tables are mock tables the researches create before Bronchial asthma alone
actual data collection and analysis. Intermittent
- They are one part of a Research
Persistent
- Proposal.
Both bronchial asthma &
- They are created to inform the reader how data will be
allergic rhinitis
presented once results are out.
- They guide the statistician how results will be analyzed. Intermittent both
- They also tell the reader how variables are measured or what Persistent either
is the unit of measurement of the different variables. Persistent both

How Dummy Tables are created STATISTICAL ANALYSIS
- Dummy tables have rows and columns that look exactly how
data are presented except that the tables are not populated Data Analysis
with data or values. - Statistical test to use in a study depends on data classification.
- They are created based on the objectives of the study. - Different data classifications entail different statistical tests.
- They outline how results of the study will be reported or
presented Data Classification
- Data can either be qualitative or quantitative.

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 - Examples of qualitative data: exposure or risk status, like Examples:
smoking status, smoker or non- smoker, with dyslipidemia or - Prevalence Ratio-the disease measure used for cross-sectional
without dyslipidemia, sedentary or active. studies.
- Examples of quantitative data: age in years, platelet count, - Risk Ratio-the disease measure used for cohortstudies.
blood lead levels in μg/dl, fasting blood sugar, cholesterol - Chi-Square
levels. - To determine whether levels of snoring behaviour is related
to heart disease
Relationship Among Variables
- Independent variable - also known as determinant or Chi-Square Computer Output
predictor variable.
- Dependent variable – also known as outcome, or response
variable.
- Independent variable – presumed to cause, effect, influence,
stimulate, or predict an outcome, the dependent variable.
- Dependent variable – the result or outcome in its relationship
with the independent variables.

Can be:
- Univariate – one independent and one dependent variable
o Example of a Univariate analysis: Relationship between
height and cardiovascular disease
- Multivariate – many independent variables,one dependent
variable
o Example of a multivariate analysis: Predictors of Control
of DM

Statistical Tests
Basic Principle:
- If both the independent and the dependent variables are
qualitative, the statistical tests to use is Chi- square test. - Note the footnote below the table that says 0% of cells have
Odds Ratio, Prevalence Ratio and Risk Ratio may also be expected count less than 5.
used to test association. - This is desirable. Because if more than 20% of cells have
- If the independent variable is qualitative and the dependent expected count less than 5, then computation of chi-square
variable is quantitative, the t- test for two means may be used value becomes unstable, making chi- square test not valid.
interchangeably with ANOVA.
- If there are more than two means to be tested, then ANOVA Chi-Square
will be the only choice. - When that happens, Fischer’s Exact test will be used when
- If the independent variable is quantitative and the dependent both the independent and dependent variables are
variable is qualitative, then Simple Logistic Regression is dichotomous, i.e., a two by two table.
used. - Fischer’s Exact test cannot be used if either one variable has
- And lastly if both the independent and the dependent more than two levels, (not dichotomous).
variables are quantitative, Simple Linear Regression is used. - In that case, levels may have to be combined into some
meaningful groupings so a two by two table can be
Summary of Statistical Tests to use: constructed.
Independent Dependent Statistical Test - The study on snoring is a 2 by 4 table. Snoring has 4 levels.
Variable Variable This can be made dichotomous by combining never with
Qualitative Qualitative
2
Chi , PR, RR, occasional and frequent with always.

OR
Level Snoring With Heart Disease, p-value
Qualitative Quantitative t-test/ANOVA
Behaviour n(%)
Quantitative Qualitative Logistic Regression
Never snore 4 (2.0) <0.001
Quantitative Quantitative Linear Regression
Occasionally snore 10 (5.0)
Quantitative, Independent, Dependent Variables Frequently snore 20 (10.0)
Statistical Tests to use: Always snore 24 (12.0)
- Chi-Square
Total 58 (7.3)
- Prevalence Ratio
- Odds Ratio Table 1. Association between levels of snoring behavior and heart
- Risk Ratio disease

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Risk Ratio/Prevalence Ratio - where y is the dependent variable, x, the independent
- If data come from a cross-sectional or a cohort study, then variable, b0, the intercept and b1, the slope
the Prevalence ratio or the Risk ratio is used. - If the slope is going up, the relationship between the
- If data come from a case-control study, Odds ratio is used. dependent and the independent variables is direct.
- If the slope is going down, the relationship is inverse.
Qualitative Independent Variable and Quantitative Dependent - If the slope is horizontal, no relationship exists.
Variable
- Statistical Test to use:
- t-test
- ANOVA
- To compare the efficacy of the three anti- hypertensive drugs
in terms of percent decrease in blood pressure.

ANOVA

- p-value is less than 0.05. The difference then in the decrease - The p-value (encircled), in the above relationship is greater
in BP is statistically significant, than 0.05, indicating that the relationship between age of the
mother and the babies’ birth weight is not statistically
significant.
Treatment Mean±SD p-value

A 26.8±5.45 0.020 Data Presentation
B 21.8±2.39 Risk Factor b p-value
C 21.47±5.80 Age of the Mother 12.4 0.219

- When ANOVA gives a p-value equal to or less than 0.05, the - Outcome: birth weight of the baby
result means there is a significant difference in the mean for - Interpretation: For every one unit increase in age, baby’s birth
at least one pair. weight increases by 12.4 grams
- Which of the pairs has significant difference, ANOVA does not
show. Logistic Regression
Multiple Pairwise Comparison - Dependent variable – qualitative, independent variable –
- There are many statistical tests that test the significance of quantitative.
the difference between pairs. - Closely related to odds ratio.
- The difference is, here we deal with
Quantitative Independent And Dependent Variables - quantitative independent variable.
- Linear Regression - In the determination of the relationship for instance between
bronchial asthma and BMI, we say that for every one unit
Linear Regression change in the BMI, the odds of developing bronchial asthma is
- Looking into the the relationship between the birth weight of multiplied by say, 2.
babies (dependent variable) and age of the mother - Logistic regression is rather difficult a concept to grasp.
(independent variable). - The concept however can be transformed into probability of
- The relationship can be summarized by this line formula: occurrence of the disease.
- y = b0+ b1 x - Once transformed, understanding the

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 - concept now becomes easy. Predictor Variables Odds Ratio
- Then we say that the probability of the disease say, B. asthma Estimate 95% Confidence Interval
is this much (value between 0 to 1) when the BMI is say 22.
BMI 0.87 0.85 - 0.88


Multivariate Analysis
Multiple Linear Regression
- Dependent variable – quantitative
- Independent variables – combinations of quantitative and
qualitative variables
- Maternal factors affecting Birthweight of Newborn babies.
- Dependent variable – Birthweight
- Independent variables – Gestational DM, HPN, Maternal
- The graph shows an S-shaped curve dividing the square into Infections, Maternal Age, Parity, Family history of Obesity.
two. The lower portion of the square indicates the value for B. - Dependent variable – qualitative
Asthma, symbolized by 1 in the right side. The upper portion - Independent variables – combinations of quantitative and
indicates absence of B. Asthma, symbolized by 2. qualitative variables
- The left side of the square corresponding to the y-axis - Predictors of Control of DM
denotes the probability of developing B. Asthma. - Dependent variable – Control of DM
- The graph shows that as the BMI increases the probability of - Independent variables – Age, Sex, BMI, Compliance to
Bronchial Asthma also increases. medication, Co-morbidity, Socio-economic status, Education,
- For example, if the BMI is say, 22, the probability of Occupation
developing B. Asthma is 0.80.
Write-up
Data Management and Analysis
- Data will be processed and encoded in Microsoft Excel.
Statistical Analysis will be done using SPSS, v.20.
Determination of predictors to DM will be analyzed initially
as univariate analysis using Chi- square test when the
independent variable is qualitative.
- Data will be processed and encoded in Microsoft Excel.
Statistical Analysis will be done using SPSS, v.20.
Determination of predictors to DM will be analyzed initially
as univariate analysis using Chi- square test when the
independent variable is qualitative and logistic regression
when qualitative.
- Multiple logistic regression will be then be utilized. Level of
significance will be set at α=0.05

- The relationship between BMI and B. Asthma is statistically
significant, p-value=0.0003, (encircled above).
Data Presentation

B S.E. Wald df Sig. Exp(B) 95% C.I.for
EXP(B)
Lower Upper
bmi -.144 .010 204.89 1 .000 .866 .849 .883

Constant 3.279 .241 184.86 1 .000 26.550

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