Friday, July 02, 2010

Lessons Learned From ICEM 2010 (Part D)

Lessons learned from:
Overcoming the Barriers to Undertaking Research in Emergency Medicine and Creative Ways of Sustaining Your Academic Research Funding – A/Prof Kevin Ward

To create a sustainable research platform in emergency medicine within our local setting, the speaker repeatedly mentioned three basic ingredients:


One discipline that emergency medicine can collaborate with would be biomedical engineering. Experts in biomedical engineering would probably be interested in our projects. Ask them: “What can you do to help me save more lives?” Use “we”, not “I” or “you”. Some examples cited include microcirculation and oxygen transport, biomathematics and physics, tissue injury and repair, etc. He also shared on the need to protect our ideas early in the process of the research. Bottom line is to be creative, as no idea is just too crazy for innovation.

Lessons learned from:
How To Formulate a Good Research Question and Choose A Suitable Study Design by Dr. Henry Guly

I must say that this is the talk that I benefited the most from. Dr. Henry Guly stated that the very basic step in formulating a research question is to have the idea. And in order to generate an idea, one should always an inquisitive mind. One should always ask “Why?” “Why not?” For example, “why should treatment X better than treatment Y?” There are many areas or domains of research one can embark on:

  • Cellular level
  • Organs and system
  • Disease process
  • Patients, Family
  • Organization
  • Staffs
  • Treatment: Drugs, Surgery, etc.
  • Diagnosis
  • Prognosis – for example, management by ED doctor vs management by hand surgeon?
  • Prevention
  • Screening
  • Communication
  • Attitude
Other tips in formulating research questions:
1. Translate research done in one area into another area related to emergency medicine

2. Do validation studies of newly formulated clinical prediction rules, scoring systems, etc

3. If a drug or a mode of treatment works in one group, try postulating and ask whether the mode of treatment will work well in another group or not
3.1. Adult population vs pediatric population (for example, if drug A works in children, can it be work in pediatrics as well?)
3.2. Prehospital vs hospital care
3.3. Developed countries vs developing countries

4. What is the incidence for misdiagnosis?

5. Why do these errors occur?
5.1. Clinical?
5.2. Misleading X-ray findings? Missed radiological findings?
5.3. Subtle ECG abnormality, etc, etc.

6. Functional results? Think of how to measure this.

7. Return to work/schooling? Number of days absent from work/school

8. Economic cost

9. In many of these cases, it is about giving a tweak on what has been done and make it into something relevant.

Research methods
1. One should rigidly and clearly define the intention/research outcomes. Use PICO model.
2. Do thorough literatures search. What has been done? What’s not?
3. Ask advice – be willing to share ideas. As the speaker said, worrying that someone else may steal your research ideas is a recipe for sure disaster.
4. Lastly, be pragmatic. For rare diseases, ask, how often do you see these cases.

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