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Reading Studies

Discussion in 'Advanced Medical Discussions' started by NPO, Jul 7, 2018.

  1. NPO

    NPO Forum Deputy Chief

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    I'd like to get better at reading and understanding the methodologies and verbage used in many studies. For example I understand, basically, level of evidence and class of recommendation, but I don't know how studies are done, what different types of studies are called, what some of the terms like level of confidence mean, etc... basically have to skip to the "Conclusion" to get what I want then skim how they did the study.

    Are there classes that teach this sort of thing?
     
  2. StCEMT

    StCEMT Forum Deputy Chief

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    I think flightbridgeed did something on this, but I'd have to find it.
     
  3. mgr22

    mgr22 Forum Asst. Chief

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  4. NPO

    NPO Forum Deputy Chief

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    That's a great start and covered a lot of the basics to help me.

    Eventually I'd like to be able to do my own studies. Nothing ground breaking (maybe) but my agency is data driven. If I can prove something, there's a good chance I can get them to buy it.

    (I'm working on TXA and push dose epi, for example)
     
  5. mgr22

    mgr22 Forum Asst. Chief

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    NPO, I'm very much in favor of publishing legitimate (i.e., statistically significant), data-driven conclusions. It's good for our industry to share results, even -- as you say -- if they're not ground-breaking. I think you'll find major EMS media fairly eager to do that.
     
  6. Summit

    Summit Critical Crazy

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    If you look at what nursing does, college statistics is a required course to get in most BSN programs, the the curriculum includes a research and EBP course. The goal of that is mainly to understand, evaluate, and apply evidence. BSN is supposed to prepare enterprising types for designing and implementing simple process improvement projects at a unit or organizational level, usually based on established work with no risk. Doing more advanced studies typically needs a research design and methodology course (typically graduate level), IRB approval, and either a consulting statistician and/or an advanced/graduate level statistics course.

    You should be able to find an online stats course through your local community or state college. A research fundamentals course should also be available (i.e., nobody is peer reviewing or citing my work).

    I've done process improvement studies up to the organizational level, but was only motivated to present the results at a regional conference level.
     
    Last edited: Jul 7, 2018
    Gurby likes this.
  7. Gurby

    Gurby Forum Asst. Chief

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    I feel like you guys are reinventing the wheel here. The best way to get things done is to have mentors who will help guide you through the process.

    Physicians at academic hospitals very often need to publish research to get promotions/keep their jobs, and residents hoping to go into academics will be hungry for publications as well. If there are any docs you have a good relationship with, you might reach out to them and see if they have any research going on you could help out with. You could also try reaching out to your medical director.

    Working on someone else's project can be a good way to learn about how the process works. Then if you come to someone with a clear idea of what you want to study, how to do it, and it seems like it will be impactful, they may be on board with helping you get it done because they'll get to put their name on it too.
     
  8. mgr22

    mgr22 Forum Asst. Chief

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    Gurby, not sure I understand. The OP says he wants to study his agency's data. Are you saying you don't think a little reading about how to do that is worthwhile?
     
  9. Gurby

    Gurby Forum Asst. Chief

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    I think a little reading could never hurt!

    Further down he says he'd like to do his own studies - I feel like trying to go it alone and figure things out for yourself is a tough row to hoe though. Your chances of success go way up if you can work on a project with somebody who has done it a few times. I bet it wouldn't be that hard to find an EM resident or EMS fellow willing to offer some guidance and logistical help in exchange for getting their name on something with minimal effort.

    Maybe I'm thinking on too big a scale - if he just wants to analyze his own company's data and convince the higher-ups to buy King tubes instead of LMA's maybe that's not so unreasonable a thing to undertake.
     
  10. NPO

    NPO Forum Deputy Chief

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    Well, let me offer some additional insight.

    In the short term, I'd like to become better at reading and digesting studies so that I can improve and guide my own clinical practice and stay current in evidence.

    In the mid-term, I can forsee taking data from studies available and compiling it into presentations to provide to our Clinical Standards and Practices Committee to suggest changes for our agency. They are typically very responsive to evidence based practice if you can put it in front of them and make a compelling argument with consideration for operational requirements.

    In the long term, I don't know where my career will take me. But I want to be able to analyze clinical data and be able to present it in a professional format. I like the idea of publishing studies from within my own agency, but that's a big fish. I don't think studies have to be ground breaking or anything, but being able to confirm or refute current practice is important too.

    My two big things I'd like to see my agency adopt are push dose epi and TXA. If I present it well enough, I'm sure I could make headway.
     
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  11. Gurby

    Gurby Forum Asst. Chief

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    I guess my experience is colored by the fact that I’m a MD student, and research is just something that pretty much everybody does at least a little of in this career path. I had no experience in it prior to school, and barely know what an IRB is, but I’ve already given a presentation at a national conference and have 3 papers in the works that will hopefully eventually make it into journals. This is mostly thanks to getting lucky and connecting with a really solid lab/mentors who are well-known in the field and know how to play the game. I’m pretty sure I’d just be flailing around wasting time and energy if I was trying to figure this out on my own.

    I still feel like your medical director or an EMS-minded resident at a hospital you transport to could be your best ally here. Even if you are just trying to do things on the organizational level, that’s still something your medical director might be interested in or might be able to connect you with someone with more time/interest. Or maybe start by contacting the Clinical Standards committee and see if there is a way you can get involved / if they can connect you with someone.
     
  12. Remi

    Remi Forum Deputy Chief Premium Member

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    The best way to do this is just to start reading studies. Stick to things that directly relate to your practice, and/or that interests you personally. There are lots of online resources for learning how to read studies (I just Googled "how to read clinical research" and saw a bunch of articles pop up). There are easy to read and understand books on the topic, too.

    Personally, I think trying to learn the stats that are used in clinical research is a time-consuming and low-yield exercise. There are statistical terms that you have to become familiar with (mean, median, population, N, n, p-value, NNTT, etc), but you can look those up and learn them as you go along. The statistical tests themselves are complex and varied and few clinicians really get them. We generally just trust that the statisticians who run the numbers for these studies are objective and use the appropriate tests. For the most part, it's a good understanding of basic research methodology and basic statistical principles (and of course all the related jargon) that you are after.

    Good goal and exercise for developing an understanding of clinical research.

    Doing research of sufficient quality to be accepted for publication is a big fish, but it certainly isn't beyond the realm of possibility. It's a great career goal, IMO. You'll need access to the resources of a university or major medical center library, a clinical statistician, and as Gurby pointed out, someone experienced with the process to mentor and assist you.
     
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  13. NPO

    NPO Forum Deputy Chief

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    I was reviewing my degree pathway and one of the recommended electives is "Research Methods for Health Professionals."

    So I'm excited for that.
     
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