METHODOLOGY IN MEDICAL RESEARCH—The Need for Controlled Clinical Studies

Too many medical researchers vitiate their work by ignoring the problem of uncontrolled variables. They therefore publish clinical impressions “dressed up” in scientifically meaningless numbers. A prototypical example of this practice is contrasted with a controlled study, each employing the same (small) number of patients. It is shown how the use of controls can convert a meaningless experiment into one that has assessable scientific significance.A survey of current literature revealed that in only 21 of 100 articles studied were adequately controlled experimental conditions employed.Since they usually deal with very complex systems, it is urged that medical researchers exercise more scientific rigor with regard to control problems.     

Safe and efficacious probiotics: what are they?

Each year, >20 billion doses of probiotics are used by healthy people and by those diagnosed with a range of medical conditions. Compared to many pharmaceutical agents, probiotics are well tolerated and extremely safe, and serious adverse effects rarely occur. Nevertheless, as many new researchers enter the field and companies launch "probiotic" products, it is essential that standards are set for naming a product "probiotic" to show that it meets an acceptable level of safety and efficacy, and to understand the strengths and limitations of its activity. In this Opinion article, recommendations are made based upon the current understanding of scientific, clinical and regulatory issues, with a special focus on safety.     

"I think we have a problem in Victoria": MDs respond quickly to toxoplasmosis outbreak in BC.

More than 110 people, including 12 newborns, were infected with Toxoplasma gondii in Victoria last year. A team of doctors, researchers and public-health officials determined that the source of the world''s largest recorded outbreak of the infection was the water supply. Anne Mullens looks at how the BC medical and scientific communities responded to a unique challenge.     

Implementing academic detailing for breast cancer screening in underserved communities

Background

Canadian funding agencies are no longer content to support research that solely advances scientific knowledge, and key directives are now in place to promote research transfer to policy- and decision-makers. Therefore, it is necessary to improve our understanding of how researchers are trained and supported to facilitate knowledge translation activities. In this study, we investigated differences in health researcher characteristics and knowledge translation activities.

Methods

Our sample consisted of 240 health researchers from three Alberta universities. Respondents were classified by research domain [basic (n = 72) or applied (n = 168)] and faculty [medical school (n = 128) or other health science (n = 112)]. We examined our findings using Mode I and Mode II archetypes of knowledge production, which allowed us to consider the scholarly and social contexts of knowledge production and translation.

Results

Differences among health researcher professional characteristics were not statistically significant. There was a significant gender difference in the applied researcher faculty group, which was predominantly female (p <.05). Research domain was linked to translation activities. Applied researchers reported engaging in significantly more Mode II activities than basic researchers (p <.001), and scored higher than basic researchers regarding the perceived importance of translation activities (Mode I, p =.01; Mode II, p <.001). Main effects of faculty were limited to engaged dissemination (medical school < other faculties; p =.025) and number of publications (medical school > other faculties; p =.004). There was an interaction effect for research domain and faculty group for number of publications (p =.01), in that applied researchers in medical faculties published more than their peers in other faculty groups.

Conclusion

Our findings illustrate important differences between health researchers and provide beginning insights into their professional characteristics and engagement in Mode I and Mode II activities. A future study designed to examine these dimensions in greater detail, including potential covariates across more varied institutions, would yield richer insights and enable an examination of relative influences, needs and costs of each mode of activity.     

« Biology/medicine 2.0 »: an overview

In the last decade, the applications known as "web 2.0" (Facebook, Youtube, Twitter…) have changed our daily life and gradually influence the field of research. This article aims at proposing a critical overview of these new services, and emphasizes the changes induced for researchers (practice of scientific publication, sharing and mutualization of research data and discussion between researchers…) especially in the field of biology/medicine. A focus is done on the limitations that prevent most of scientists from using these services in their common practice (lack of knowledge about these tools, time-consuming, fear of sharing data and ideas). Despite these restrictions, some mutations affecting researcher's information uses are unavoidable, and these new tools may rapidly contribute to scientific advances.     

Why we need observational studies to evaluate the effectiveness of health care.

The view is widely held that experimental methods (randomised controlled trials) are the "gold standard" for evaluation and that observational methods (cohort and case control studies) have little or no value. This ignores the limitations of randomised trials, which may prove unnecessary, inappropriate, impossible, or inadequate. Many of the problems of conducting randomised trials could often, in theory, be overcome, but the practical implications for researchers and funding bodies mean that this is often not possible. The false conflict between those who advocate randomised trials in all situations and those who believe observational data provide sufficient evidence needs to be replaced with mutual recognition of the complementary roles of the two approaches. Researchers should be united in their quest for scientific rigour in evaluation, regardless of the method used.     

Experimental Evidence for Phonemic Contrasts in a Nonhuman Vocal System

The ability to generate new meaning by rearranging combinations of meaningless sounds is a fundamental component of language. Although animal vocalizations often comprise combinations of meaningless acoustic elements, evidence that rearranging such combinations generates functionally distinct meaning is lacking. Here, we provide evidence for this basic ability in calls of the chestnut-crowned babbler (Pomatostomus ruficeps), a highly cooperative bird of the Australian arid zone. Using acoustic analyses, natural observations, and a series of controlled playback experiments, we demonstrate that this species uses the same acoustic elements (A and B) in different arrangements (AB or BAB) to create two functionally distinct vocalizations. Specifically, the addition or omission of a contextually meaningless acoustic element at a single position generates a phoneme-like contrast that is sufficient to distinguish the meaning between the two calls. Our results indicate that the capacity to rearrange meaningless sounds in order to create new signals occurs outside of humans. We suggest that phonemic contrasts represent a rudimentary form of phoneme structure and a potential early step towards the generative phonemic system of human language.     

CAMbase – A XML-based bibliographical database on Complementary and Alternative Medicine (CAM)

The term "Complementary and Alternative Medicine (CAM)" covers a variety of approaches to medical theory and practice, which are not commonly accepted by representatives of conventional medicine. In the past two decades, these approaches have been studied in various areas of medicine. Although there appears to be a growing number of scientific publications on CAM, the complete spectrum of complementary therapies still requires more information about published evidence. A majority of these research publications are still not listed in electronic bibliographical databases such as MEDLINE. However, with a growing demand by patients for such therapies, physicians increasingly need an overview of scientific publications on CAM. Bearing this in mind, CAMbase, a bibliographical database on CAM was launched in order to close this gap. It can be accessed online free of charge or additional costs.The user can peruse more than 80,000 records from over 30 journals and periodicals on CAM, which are stored in CAMbase. A special search engine performing syntactical and semantical analysis of textual phrases allows the user quickly to find relevant bibliographical information on CAM. Between August 2003 and July 2006, 43,299 search queries, an average of 38 search queries per day, were registered focussing on CAM topics such as acupuncture, cancer or general safety aspects. Analysis of the requests led to the conclusion that CAMbase is not only used by scientists and researchers but also by physicians and patients who want to find out more about CAM.Closely related to this effort is our aim to establish a modern library center on Complementary Medicine which offers the complete spectrum of a modern digital library including a document delivery-service for physicians, therapists, scientists and researchers.     

The science behind pre-Columbian evidence of syphilis in Europe: research by documentary

This article discusses the presentation of scientific findings by documentary, without the process of peer review. We use, as an example, PBS's "The Syphilis Enigma," in which researchers presented novel evidence concerning the origin of syphilis that had never been reviewed by other scientists. These "findings" then entered the world of peer-reviewed literature through citations of the documentary itself or material associated with it. Here, we demonstrate that the case for pre-Columbian syphilis in Europe that was made in the documentary does not withstand scientific scrutiny. We also situate this example from paleopathology within a larger trend of "science by documentary" or "science by press conference," in which researchers seek to bypass the peer review process by presenting unvetted findings directly to the public.     

医学院校本科生进行基础科研能力培养的意义

随着我国科学技术的迅猛发展,生命科学领域对专业人才的需求愈加迫切,要求亦愈加严格。部分医学院校为适应目前我国对基础科研工作者的需求现状,积极调整医学与生命科学专业本科生专业设置,改善完善课程设置,在本科生中有计划的进行科研训练,对学生毕业后的选择就业去向或者进一步深造具有重要指导作用,培养具有科研能力的高素质的医学从业人员,有助于推动医疗卫生事业的发展。     

Donald J. Reis, MD: Research Mentor Extraordinaire

Donald J. Reis, M.D., the late internationally reknowned neuroscientist, had a special talent for mentoring researchers early in their academic careers. His hands-on approach to laboratory investigation, his extraoridinary patience with novice researchers, his commitment to the scientific method, and his enthusiastic approach to the art of neuroscience all combined to make him the ideal mentor for many budding academics over the past four decades. The beauty of his scientific legacy is that he loved to each research. The following tribute is personal from one whose career was changed by a great mentor.     

Response to William Domhoff's comments on "Meteorite or gemstone?…".

My paper, “Meteorite or Gemstone…” is not trying to divide dream theories into two categories as Dr. Domhoff appears to believe. Rather, it is an effort to nudge dream theory and dream work into new directions. I review many reasons why we often consider dreams “totally different” from daydreams, fantasies, etc. (the meteorite position). For each reason, I show that there is actually considerable overlap, and that the forms of mental functioning are best considered as a continuum. I point out that many dream researchers, from different perspectives, are taking the “totally different” (meteorite position) even though they may not explicitly endorse it. For instance those who insist that dreams are meaningless are taking the meteorite position since they obviously do not consider daydreams and fantasies meaningless. Very different researchers, including Dr. Domhoff's group, spend thousands of hours doing detailed analyses of dreams, counting number of words, number of characters, number of interactions, etc. I consider them too to be taking the meteorite position since they almost never analyze daydreams, fantasies, etc. in this way. I compare their efforts to spectroanalysis, which is worthwhile when studying a meteorite (but not a gemstone), since it may yield secrets about the world the meteorite came from. I am not criticizing these researchers, who have made some important discoveries, but rather trying to nudge them toward noticing the continuum, and perhaps broadening their studies to include daydreams, fantasies, and other forms of mental functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pondering the future.

Despite growing tensions as the Canadian health care system evolves, the system will survive over the next decade and strengthen its societal objectives, sometimes dragging physicians along. With the shift of the intellectual centre away from the universities, research and researchers will find funding security but career insecurity in the private sector. The independent investigator will become rare as "big science" becomes the norm, and basic science departments will have a decade of confusion as they struggle for a new place in the renewed medical schools. The move toward problem-based, community-oriented medical education will be completed, clinical faculty will become salaried and the smaller numbers of graduates will be more controlled in their practices. Medicine as a profession will adopt a renewed philosophical framework and will broaden in its scope to the benefit of Canadians.     

Human guinea pigs and the ethics of experimentation: the BMJ's correspondent at the Nuremberg medical trial.

Though the Nuremberg medical trial was a United States military tribunal, British forensic pathologists supplied extensive evidence for the trial. The BMJ had a correspondent at the trial, and he endorsed a utilitarian legitimation of clinical experiments, justifying the medical research carried out under Nazism as of long term scientific benefit despite the human costs. The British supported an international medical commission to evaluate the ethics and scientific quality of German research. Medical opinions differed over whether German medical atrocities should be given publicity or treated in confidence. The BMJ''s correspondent warned against medical researchers being taken over by a totalitarian state, and these arguments were used to oppose the NHS and any state control over medical research.     

First International Meeting on "Stem Cell Applications in the Craniofacial Region"

During the 1st International Meeting on "Stem Cell Applications in the Craniofacial Region" promoted in Naples (Italy), invited researchers presented theirwork and the most innovative methods regarding stem cells (SCs) and their application to the craniofacial region of the human body. In addition, some researchers showed their case-reports on craniofacial reconstruction using either osteo-distraction or reconstruction surgical methods. The aim of this biannual meeting is to stimulate discussion, improve knowledge and promote scientific collaboration among basic and clinical scientists in the main topics of SC use in therapy. A summary of this meeting is given.     

The Use of Statistics in Health Sciences: Situation Analysis and Perspective

Statistics plays a crucial role in research, planning and decision-making in the health sciences. Progress in technologies and continued research in computational statistics has enabled us to implement sophisticated mathematical models within software that are handled by non-statistician researchers. As a result, over the last decades, medical journals have published a host of papers that use some novel statistical method. The aim of this paper is to present a review on how the statistical methods are being applied in the construction of scientific knowledge in health sciences, as well as, to propose some improvement actions. From the early twentieth century, there has been a remarkable surge in scientific evidence alerting on the errors that many non-statistician researchers were making in applying statistical methods. Today, several studies continue showing that a large percentage of articles published in high-impact factor journals contain errors in data analysis or interpretation of results, with the ensuing repercussions on the validity and efficiency of the research conducted. Scientific community should reflect on the causes that have led to this situation, the consequences to the advancement of scientific knowledge and the solutions to this problem.     

Survey of Argentine Health Researchers on the Use of Evidence in Policymaking

Objective

In this study, Argentine health researchers were surveyed regarding their perceptions of facilitators and barriers to evidence-based policymaking in Argentina, as well as their publication activities, and research environment satisfaction.

Methods

A self-administered online survey was sent to health researchers in Argentina. The survey questions were based on a preceding qualitative study of Argentine health researchers, as well as the scientific literature.

Results

Of the 647 researchers that were reached, 226 accessed the survey, for a response rate of 34.9%. Over 80% of researchers surveyed had never been involved in or contributed to decision-making, while over 90% of researchers indicated they would like to be involved in the decision-making process. Decision-maker self-interest was perceived to be the driving factor in the development of health and healthcare policies. Research conducted by a research leader was seen to be the most influential factor in influencing health policy, followed by policy relevance of the research. With respect to their occupational environment, researchers rated highest and most favourably the opportunities available to present, discuss and publish research results and their ability to further their education and training. Argentine researchers surveyed demonstrated a strong interest and willingness to contribute their work and expertise to inform Argentine health policy development.

Conclusion

Despite Argentina’s long scientific tradition, there are relatively few institutionalized linkages between health research results and health policymaking. Based on the results of this study, the disconnect between political decision-making and the health research system, coupled with fewer opportunities for formalized or informal researcher/decision-maker interaction, contribute to the challenges in evidence informing health policymaking in Argentina. Improving personal contact and the building of relationships between researchers and policymakers in Argentina will require taking into account researcher perceptions of policymakers, as highlighted in this study.     

How to engage medical students in chronobiology: an example on autorhythmometry

This contribution describes a new laboratory experience that improves medical students' learning of chronobiology by introducing them to basic chronobiology concepts as well as to methods and statistical analysis tools specific for circadian rhythms. We designed an autorhythmometry laboratory session where students simultaneously played the role of researchers and experimental subjects. During this session, which lasted 24 h, students recorded their own arterial pressure, heart rate, oral temperature, forced expiratory flow, glucose tolerance, muscular strength, reaction time, and sensorimotor coordination at regular intervals and also took the Horne and Ostberg test, after which they analyzed their own data. Furthermore, to gather information from subjects under normal sleep and eating schedules, some students acquired data at home. To guide and help students with their work, a dedicated web page was implemented with scientific references, cosinor analysis software, and other valuable information. All these "raw" data were combined into a single database that students could use to evaluate whatever aspect of the data they seemed fit. A number of suggestions were offered to them as guidance. Students were then instructed to write a scientific article on the subject they had chosen. The experience was highly rewarding for both instructors and students alike. In view of the high level of absenteeism in Spanish universities and the fact that 93% of the students attended the exam and 95% of these passed, the experience was considered a great success.     

现代生物医学研究中医学研究生“大数据”利用能力的培养

科研能力的水平是我国研究生教育质量的重要指标。现代生物医学研究中呈现的"大数据"特点给研究生科研能力培养提出了新的要求。本文在分析"大数据"基本特点和总结医学科研思维模式在"大数据"影响下发生的转变的基础上,对提高医学研究生获取和利用"大数据"信息的能力提出一些具体建议,希望能够推动医学研究生科研能力的培养。