Prelims-P373874.qxd 8/23/07 2:59 PM Page i RESEARCH METHODOLOGY IN THE MEDICAL AND BIOLOGICAL SCIENCES http://avaxhome.ws/blogs/ChrisRedfield This page intentionally left blank Prelims-P373874.qxd 8/23/07 2:59 PM Page iii RESEARCH METHODOLOGY IN THE MEDICAL AND BIOLOGICAL SCIENCES Edited by Petter Laake Haakon Breien Benestad and Bjørn Reino Olsen AMSTERDAM • BOSTON (cid:129) HEIDELBERG (cid:129) LONDON (cid:129) NEW YORK (cid:129) OXFORD PARIS (cid:129) SAN DIEGO (cid:129) SAN FRANCISCO (cid:129) SINGAPORE (cid:129) SYDNEY (cid:129) TOKYO Academic Press is an imprint of Elsevier Prelims-P373874.qxd 8/23/07 2:59 PM Page iv Academic Press is an imprint ofElsevier 84 Theobald’s Road,London WC1X 8RR,UK 30 Corporate Drive,Suite 400,Burlington,MA 01803,USA 525 B Street,Suite 1900,San Diego,CA 92101-4495,USA First published as Forskningsmetode i medisin og biofagby Gyldendal Norsk Forlag 2004 English translation by M.Michael Brady copyright © Gyldendal Norsk Forlag 2007 Published by Elsevier Ltd No part ofthis publication may be reproduced,stored in a retrieval system or transmitted in any form or by any means electronic,mechanical,photocopying, recording or otherwise without the prior written permission ofthe publisher Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford,UK:phone ((cid:2)44) (0) 1865 843830;fax ((cid:2)44) (0) 1865 853333; email:[email protected] you can submit your request online by visiting the Elsevier web site at http://elsevier.com/locate/permissions,and selecting Obtaining permission to use Elsevier material Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter ofproducts liability,negligence or otherwise,or from any use or operation ofany methods,products,instructions or ideas contained in the material herein.Because ofrapid advances in the medical sciences,in particular,independent verification ofdiagnoses and drug dosages should be made British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library ofCongress Cataloguing in Publication Data A catalogue record for this book is available from the Library ofCongress ISBN:978-0-12-373874-5 For information on all Academic Press publications visit our web site at http://books.elsevier.com Typeset by Charon Tec Ltd (A Macmillan Company),Chennai,India www.charontec.com Printed and bound in Great Britain 07 08 09 10 11 10 9 8 7 6 5 4 3 2 1 Prelims-P373874.qxd 8/23/07 2:59 PM Page v CONTENTS Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv List of abbreviations and symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii CHAPTER 1 PHILOSOPHY OF SCIENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bjørn Hofmann,Søren Holm and Jens-Gustav Iversen 1.1 Philosophy of the natural sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Philosophy of the social sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 CHAPTER 2 ETHICSAND SCIENTIFIC CONDUCT . . . . . . . . . . . . . . . . . . . . . . 33 Søren Holm 2.1 A brief introduction to ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.2 Scientific conduct and misconduct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.3 Misconduct and why it occurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 2.4 Fabrication and other forms of misconduct affecting the truth claims of scientific findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 2.5 Authorship issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 2.6 Salami,imalas and duplicate publication . . . . . . . . . . . . . . . . . . . . . . . . . 46 2.7 The investigation and punishment of scientific misconduct . . . . . . . . . . 47 Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 CHAPTER 3 ETHICS IN HUMANANDANIMAL STUDIES . . . . . . . . . . . . . . . . . . 53 Søren Holm and Bjørn Reino Olsen 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 3.2 Basic principles of human research ethics . . . . . . . . . . . . . . . . . . . . . . . . 54 v Prelims-P373874.qxd 8/23/07 2:59 PM Page vi CONTENTS 3.3 International regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 3.4 The ethics of animal research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Appendix 1 World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects . . . . . . . . . . . . . 74 Appendix 2 Oviedo Convention (Council of Europe,European Treaty Series 164) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Appendix 3 Oviedo Convention –Additional Protocol Concerning Biomedical Research,Chapter I–IX (Council of Europe,European Treaty Series 195) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 CHAPTER 4 RESEARCH METHODOLOGY:STRATEGIES,PLANNINGANDANALYSIS 93 Haakon Breien Benestad and Petter Laake 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 4.2 Your scientific problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 4.3 More on scientific problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 4.4 Literature,methods and techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 4.5 Research conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 4.6 Data types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 4.7 Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 4.8 Repeatability,reproducibility and reliability . . . . . . . . . . . . . . . . . . . . . . 109 4.9 Validity,effect measure and choice of statistical test . . . . . . . . . . . . . . 112 4.10 Experimental protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 4.11 Experimental routine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 CHAPTER 5 LITERATURE SEARCHAND PERSONAL REFERENCE DATABASES . . . . 125 Anne-Marie B.Haraldstad and Ellen Christophersen 5.1 Information literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 5.2 Systematic literature search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 5.3 How to formulate a query:PICO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 5.4 Search technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 5.5 Methodology filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 5.6 Quality:critical appraisal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 5.7 Impact factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 5.8 Principal bibliographic databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 5.9 Staying up to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 5.10 Medical and scientific internet search engines . . . . . . . . . . . . . . . . . . . 154 5.11 Personal reference databases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 vi Prelims-P373874.qxd 8/23/07 2:59 PM Page vii CONTENTS CHAPTER 6 METHODS IN MOLECULAR BIOLOGY . . . . . . . . . . . . . . . . . . . . . 161 Sigbjørn Fossum and Erik Dissen 6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 6.2 Recombinant DNA technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 6.3 DNA and RNA:isolation,identification,synthesis and analysis . . . . . . . 168 6.4 Practical applications of DNA/RNA technology . . . . . . . . . . . . . . . . . . . 174 6.5 Protein analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 6.6 Bioinformatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 CHAPTER 7 STRATEGIESAND METHODS OF BASIC MEDICAL RESEARCH . . . . . . 199 Bjørn Reino Olsen and Haakon Breien Benestad 7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 7.2 Long-term goals and specific aims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 7.3 Background and significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 7.4 Experimental strategies and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 7.5 Pilot studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 7.6 Rules for basic medical research projects . . . . . . . . . . . . . . . . . . . . . . . . 209 CHAPTER 8 CLINICAL RESEARCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Eva Skovlund and Morten H.Vatn 8.1 Controlled clinical trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 8.2 Publication bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 8.3 Estimating sample size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 8.4 ‘Non-inferiority’ studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 8.5 Generalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 CHAPTER 9 EPIDEMIOLOGY:CONCEPTSAND METHODS . . . . . . . . . . . . . . . . 241 Dag S.Thelle and Petter Laake 9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 9.2 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 9.3 The role of epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 9.4 Population and sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 9.5 Measures of disease occurrence,association,risk and implications . . . . 246 9.6 Vital statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 9.7 Study designs of epidemiological studies . . . . . . . . . . . . . . . . . . . . . . . . . 254 9.8 Effect measures in epidemiological studies . . . . . . . . . . . . . . . . . . . . . . . 261 vii Prelims-P373874.qxd 8/23/07 2:59 PM Page viii CONTENTS 9.9 Experimental studies and randomized control trials . . . . . . . . . . . . . 268 9.10 Measurement error and sources of error . . . . . . . . . . . . . . . . . . . . . . 268 9.11 Tests and validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 9.12 Causes of disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 9.13 Association versus causality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 CHAPTER 10 QUALITATIVE RESEARCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Harald Grimen and Benedicte Ingstad 10.1 Qualitative versus quantitative research . . . . . . . . . . . . . . . . . . . . . . . 281 10.2 Using qualitative research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 10.3 What qualitative research cannot be used for . . . . . . . . . . . . . . . . . . 284 10.4 Samples in qualitative studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 10.5 Reliability and validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 10.6 Ethical challenges in qualitative research . . . . . . . . . . . . . . . . . . . . . . . 287 10.7 Qualitative data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 10.8 Triangulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 10.9 Analyses of qualitative data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 10.10 Releasing qualitative data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 CHAPTER 11 STATISTICAL ISSUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Petter Laake,Thore Egeland and Eva Skovlund 11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 11.2 Effect measure,hypothesis testing and confidence interval . . . . . . . . 312 11.3 Bernoulli trial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 11.4 Comparing two proportions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318 11.5 Measures of association in 2 (cid:3)2 tables . . . . . . . . . . . . . . . . . . . . . . . 323 11.6 Normal distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 11.7 Comparison of means . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 11.8 Non-parametric methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 11.9 Regression analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350 CHAPTER 12 EVIDENCE-BASED PRACTICEAND CRITICALAPPRAISAL OF SYSTEMATIC REVIEWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 Liv Merete Reinar and Peter M.Bradley 12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 12.2 Systematic reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366 12.3 Critical appraisal of a systematic review:one example . . . . . . . . . . . . 368 12.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380 viii Prelims-P373874.qxd 8/23/07 2:59 PM Page ix CONTENTS CHAPTER 13 SCIENTIFIC COMMUNICATION . . . . . . . . . . . . . . . . . . . . . . . . 383 Haakon Breien Benestad 13.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 13.2 The scientific paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 13.3 Posters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 CHAPTER 14 SUCCESSFUL LECTURING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 Heidi Kiil Blomhoff 14.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415 14.2 Preparing the lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 14.3 Lecture content and form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418 14.4 Manuscript . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424 14.5 Delivering a lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427 CHAPTER 15 GUIDETO GRANTAPPLICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 433 Bjørn Reino Olsen,Petter Laake and Ole Petter Ottersen 15.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433 15.2 Getting started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 15.3 The postdoctoral fellow and junior scientist . . . . . . . . . . . . . . . . . . . . 437 15.4 What goes into a successful grant application? . . . . . . . . . . . . . . . . . . . 443 15.5 The investigator-initiated research grant . . . . . . . . . . . . . . . . . . . . . . . . 445 15.6 Multiproject grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448 15.7 International research collaborations . . . . . . . . . . . . . . . . . . . . . . . . . . 451 15.8 The European Union’s seventh Framework Programme . . . . . . . . . . . 454 15.9 Summary and perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 ix