research question examples in medical

77 interesting medical research topics for 2024

Last updated

25 November 2023

Reviewed by

Brittany Ferri, PhD, OTR/L

Short on time? Get an AI generated summary of this article instead

Medical research is the gateway to improved patient care and expanding our available treatment options. However, finding a relevant and compelling research topic can be challenging.

Use this article as a jumping-off point to select an interesting medical research topic for your next paper or clinical study.

• How to choose a medical research topic

When choosing a research topic , it’s essential to consider a couple of things. What topics interest you? What unanswered questions do you want to address? 

During the decision-making and brainstorming process, here are a few helpful tips to help you pick the right medical research topic:

Focus on a particular field of study

The best medical research is specific to a particular area. Generalized studies are often too broad to produce meaningful results, so we advise picking a specific niche early in the process. 

Maybe a certain topic interests you, or your industry knowledge reveals areas of need.

Look into commonly researched topics

Once you’ve chosen your research field, do some preliminary research. What have other academics done in their papers and projects? 

From this list, you can focus on specific topics that interest you without accidentally creating a copycat project. This groundwork will also help you uncover any literature gaps—those may be beneficial areas for research.

Get curious and ask questions

Now you can get curious. Ask questions that start with why, how, or what. These questions are the starting point of your project design and will act as your guiding light throughout the process. 

For example: 

What impact does pollution have on children’s lung function in inner-city neighborhoods? 

Why is pollution-based asthma on the rise? 

How can we address pollution-induced asthma in young children? 

• 77 medical research topics worth exploring in 2023

Need some research inspiration for your upcoming paper or clinical study? We’ve compiled a list of 77 topical and in-demand medical research ideas. Let’s take a look. 

• Exciting new medical research topics

If you want to study cutting-edge topics, here are some exciting options:

COVID-19 and long COVID symptoms

Since 2020, COVID-19 has been a hot-button topic in medicine, along with the long-term symptoms in those with a history of COVID-19. 

Examples of COVID-19-related research topics worth exploring include:

The long-term impact of COVID-19 on cardiac and respiratory health

COVID-19 vaccination rates

The evolution of COVID-19 symptoms over time

New variants and strains of the COVID-19 virus

Changes in social behavior and public health regulations amid COVID-19

Vaccinations

Finding ways to cure or reduce the disease burden of chronic infectious diseases is a crucial research area. Vaccination is a powerful option and a great topic to research. 

Examples of vaccination-related research topics include:

mRNA vaccines for viral infections

Biomaterial vaccination capabilities

Vaccination rates based on location, ethnicity, or age

Public opinion about vaccination safety 

Artificial tissues fabrication

With the need for donor organs increasing, finding ways to fabricate artificial bioactive tissues (and possibly organs) is a popular research area. 

Examples of artificial tissue-related research topics you can study include:

The viability of artificially printed tissues

Tissue substrate and building block material studies

The ethics and efficacy of artificial tissue creation

• Medical research topics for medical students

For many medical students, research is a big driver for entering healthcare. If you’re a medical student looking for a research topic, here are some great ideas to work from:

Sleep disorders

Poor sleep quality is a growing problem, and it can significantly impact a person’s overall health. 

Examples of sleep disorder-related research topics include:

How stress affects sleep quality

The prevalence and impact of insomnia on patients with mental health conditions

Possible triggers for sleep disorder development

The impact of poor sleep quality on psychological and physical health

How melatonin supplements impact sleep quality

Alzheimer’s and dementia 

Cognitive conditions like dementia and Alzheimer’s disease are on the rise worldwide. They currently have no cure. As a result, research about these topics is in high demand. 

Examples of dementia-related research topics you could explore include:

The prevalence of Alzheimer’s disease in a chosen population

Early onset symptoms of dementia

Possible triggers or causes of cognitive decline with age

Treatment options for dementia-like conditions

The mental and physical burden of caregiving for patients with dementia

• Lifestyle habits and public health

Modern lifestyles have profoundly impacted the average person’s daily habits, and plenty of interesting topics explore its effects. 

Examples of lifestyle and public health-related research topics include:

The nutritional intake of college students

The impact of chronic work stress on overall health

The rise of upper back and neck pain from laptop use

Prevalence and cause of repetitive strain injuries (RSI)

• Controversial medical research paper topics

Medical research is a hotbed of controversial topics, content, and areas of study. 

If you want to explore a more niche (and attention-grabbing) concept, here are some controversial medical research topics worth looking into:

The benefits and risks of medical cannabis

Depending on where you live, the legalization and use of cannabis for medical conditions is controversial for the general public and healthcare providers.

Examples of medical cannabis-related research topics that might grab your attention include:

The legalization process of medical cannabis

The impact of cannabis use on developmental milestones in youth users

Cannabis and mental health diagnoses

CBD’s impact on chronic pain

Prevalence of cannabis use in young people

The impact of maternal cannabis use on fetal development 

Understanding how THC impacts cognitive function

Human genetics

The Human Genome Project identified, mapped, and sequenced all human DNA genes. Its completion in 2003 opened up a world of exciting and controversial studies in human genetics.

Examples of human genetics-related research topics worth delving into include:

Medical genetics and the incidence of genetic-based health disorders

Behavioral genetics differences between identical twins

Genetic risk factors for neurodegenerative disorders

Machine learning technologies for genetic research

Sexual health studies

Human sexuality and sexual health are important (yet often stigmatized) medical topics that need new research and analysis.

As a diverse field ranging from sexual orientation studies to sexual pathophysiology, examples of sexual health-related research topics include:

The incidence of sexually transmitted infections within a chosen population

Mental health conditions within the LGBTQIA+ community

The impact of untreated sexually transmitted infections

Access to safe sex resources (condoms, dental dams, etc.) in rural areas

• Health and wellness research topics

Human wellness and health are trendy topics in modern medicine as more people are interested in finding natural ways to live healthier lifestyles. 

If this field of study interests you, here are some big topics in the wellness space:

Gluten sensitivity

Gluten allergies and intolerances have risen over the past few decades. If you’re interested in exploring this topic, your options range in severity from mild gastrointestinal symptoms to full-blown anaphylaxis. 

Some examples of gluten sensitivity-related research topics include:

The pathophysiology and incidence of Celiac disease

Early onset symptoms of gluten intolerance

The prevalence of gluten allergies within a set population

Gluten allergies and the incidence of other gastrointestinal health conditions

Pollution and lung health

Living in large urban cities means regular exposure to high levels of pollutants. 

As more people become interested in protecting their lung health, examples of impactful lung health and pollution-related research topics include:

The extent of pollution in densely packed urban areas

The prevalence of pollution-based asthma in a set population

Lung capacity and function in young people

The benefits and risks of steroid therapy for asthma

Pollution risks based on geographical location

Plant-based diets

Plant-based diets like vegan and paleo diets are emerging trends in healthcare due to their limited supporting research. 

If you’re interested in learning more about the potential benefits or risks of holistic, diet-based medicine, examples of plant-based diet research topics to explore include:

Vegan and plant-based diets as part of disease management

Potential risks and benefits of specific plant-based diets

Plant-based diets and their impact on body mass index

The effect of diet and lifestyle on chronic disease management

Health supplements

Supplements are a multi-billion dollar industry. Many health-conscious people take supplements, including vitamins, minerals, herbal medicine, and more. 

Examples of health supplement-related research topics worth investigating include:

Omega-3 fish oil safety and efficacy for cardiac patients

The benefits and risks of regular vitamin D supplementation

Health supplementation regulation and product quality

The impact of social influencer marketing on consumer supplement practices

Analyzing added ingredients in protein powders

• Healthcare research topics

Working within the healthcare industry means you have insider knowledge and opportunity. Maybe you’d like to research the overall system, administration, and inherent biases that disrupt access to quality care. 

While these topics are essential to explore, it is important to note that these studies usually require approval and oversight from an Institutional Review Board (IRB). This ensures the study is ethical and does not harm any subjects. 

For this reason, the IRB sets protocols that require additional planning, so consider this when mapping out your study’s timeline. 

Here are some examples of trending healthcare research areas worth pursuing:

The pros and cons of electronic health records

The rise of electronic healthcare charting and records has forever changed how medical professionals and patients interact with their health data. 

Examples of electronic health record-related research topics include:

The number of medication errors reported during a software switch

Nurse sentiment analysis of electronic charting practices

Ethical and legal studies into encrypting and storing personal health data

Inequities within healthcare access

Many barriers inhibit people from accessing the quality medical care they need. These issues result in health disparities and injustices. 

Examples of research topics about health inequities include:

The impact of social determinants of health in a set population

Early and late-stage cancer stage diagnosis in urban vs. rural populations

Affordability of life-saving medications

Health insurance limitations and their impact on overall health

Diagnostic and treatment rates across ethnicities

People who belong to an ethnic minority are more likely to experience barriers and restrictions when trying to receive quality medical care. This is due to systemic healthcare racism and bias. 

As a result, diagnostic and treatment rates in minority populations are a hot-button field of research. Examples of ethnicity-based research topics include:

Cancer biopsy rates in BIPOC women

The prevalence of diabetes in Indigenous communities

Access inequalities in women’s health preventative screenings

The prevalence of undiagnosed hypertension in Black populations

• Pharmaceutical research topics

Large pharmaceutical companies are incredibly interested in investing in research to learn more about potential cures and treatments for diseases. 

If you’re interested in building a career in pharmaceutical research, here are a few examples of in-demand research topics:

Cancer treatment options

Clinical research is in high demand as pharmaceutical companies explore novel cancer treatment options outside of chemotherapy and radiation. 

Examples of cancer treatment-related research topics include:

Stem cell therapy for cancer

Oncogenic gene dysregulation and its impact on disease

Cancer-causing viral agents and their risks

Treatment efficacy based on early vs. late-stage cancer diagnosis

Cancer vaccines and targeted therapies

Immunotherapy for cancer

Pain medication alternatives

Historically, opioid medications were the primary treatment for short- and long-term pain. But, with the opioid epidemic getting worse, the need for alternative pain medications has never been more urgent. 

Examples of pain medication-related research topics include:

Opioid withdrawal symptoms and risks

Early signs of pain medication misuse

Anti-inflammatory medications for pain control

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Explore the Best Medical and Health Research Topics Ideas

Table of contents

• 1 How to Choose Medical Research Paper Topics
• 2 New Medical Research Paper Topics
• 3 Medical Research Topics for College Students
• 4 Controversial Medical Topics for Research Paper
• 5 Health Research Topics
• 6 Medicine Research Topics
• 7 Healthcare Research Topics
• 8 Public Health Research Topics
• 9 Mental Health Research Paper Topics
• 10 Anatomy Research Topics
• 11 Biomedical Research Topics
• 12 Bioethics Research Topics
• 13 Cancer Research Topics
• 14 Clinical Research Topics
• 15 Critical Care Research Topics
• 16 Pediatric Research Topics
• 17 Dental Research Topics Ideas
• 18 Dermatology Research Topics
• 19 Primary Care Research Topics
• 20 Pharmaceutical Research Topics
• 21 Medical Anthropology Research Topics
• 22 Paramedic Research Paper Topics
• 23 Surgery Research Topics
• 24 Radiology Research Paper Topics
• 25 Anatomy and Physiology Research Paper Topics
• 26 Healthcare Management Research Paper Topics
• 27 Medical Ethics Research Paper Topics
• 28 Environmental Health and Pollution Research Paper Topics
• 29 Conclusion

Writing an original and compelling research paper is a daunting task in such a complex and broad field as medicine. Each student decides where his interests lie, from investigating public care concerns to cancer treatment studies. We aim to help students find new angles to study and focus on relevant topics. With our resources, you can write an engaging and rigorous paper.

How to Choose Medical Research Paper Topics

Choosing good research paper topics is often more challenging than the writing process itself. You need to select a captivating subject matter that will grab the reader’s attention, showcase your knowledge of a specific field, help you progress in your studies, and perhaps even inspire future research.

To accomplish that, you need to start with brainstorming, followed by thorough research. Here are some great tips to follow:

• Pick an interesting topic – The key is to pick something that you find interesting, and yet make sure it’s not too general or too narrow. It should allow you to delve deep into the subject matter and show that you’re a professional who is ready to take on a challenge when it comes to your chosen field of medicine.
• Narrow down your focus – Once you have a list of potential topics, sift through recent medical research papers to get up-to-date with the latest trends, developments, and issues in medicine and healthcare. Check out textbooks, news articles, and other relevant sources for more information related to your potential topics. If a particular condition or disease interests you (perhaps something that drew you to a career in medicine), there’s your cue for narrowing down your topic.
• Pinpoint the “why,” “how,” and “what” – Whether you are looking into nutrition research paper topics , controversial medical topics, nursing research topics, or anything in-between, ask yourself why each of them is important. How could they contribute to the available medical studies, if any? What new information could they bring to improve the future of medicine? Asking these questions will help you pick the right medical research paper topic that suits you and helps you move forward and reach your aspirations.

To help you on that quest, we’ve compiled a list of topics that you could use or that might inspire you to come up with something unique. Let’s dive in.

New Medical Research Paper Topics

Are you interested in the newest and most interesting developments in medicine? We put hours of effort into identifying the current trends in health research so we could provide you with these examples of topics. Whether you hire a research paper writing service for students or write a paper by yourself, you need an appealing topic to focus on.

• Epidemics versus pandemics
• Child health care
• Medical humanitarian missions in the developing world
• Effectiveness of mobile health clinics in rural Africa
• Homeopathic medicines – the placebo effect
• Comparative study of the efficacy of homeopathic treatments and conventional medicine in managing chronic pain
• Virus infections – causes and treatment
• Trends in COVID-19 vaccine uptake
• Advancements in the treatment of influenza
• Is medical research on animals ethical
• Vaccination – dangers versus benefits
• Artificial tissues and organs
• Rare genetic diseases
• Brain injuries
• Long-Term Effects of COVID-19
• Social behavior shifts due to COVID-19

Medical Research Topics for College Students

You don’t know where to start with your medical research paper? There are so many things you could write about that the greatest challenge is to narrow them down. This is why we decided to help.

• Antibiotics treatments
• Efficacy of mRNA vaccines against viral diseases
• Viability and function of 3D printed tissues
• Chronic diseases
• Palliative treatment
• Battling Alzheimer’s disease
• How modern lifestyle affects public health
• Professional diseases
• Sleep disorders
• Changes in physical and mental health due to aging
• Eating disorders
• Terminal diseases

Controversial Medical Topics for Research Paper

In healthcare, new discoveries can change people’s lives in the blink of an eye. This is also the reason why there are so many controversial topics in medicine, which involve anything from religion to ethics or social responsibility. Read on to discover our top controversial research topics.

• Ethical debates on artificial tissue engineering
• Public opinions on vaccination safety
• Implementing food standards
• Telehealth’s Role in Chronic Illness Management
• Gluten allergy
• Assisted suicide for terminal patients
• Testing vaccines on animals – ethical concerns
• Moral responsibilities regarding cloning
• Marijuana legalization for medical purposes
• Abortion – medical approaches
• Vegan diets – benefits and dangers
• Increased life expectancy: a burden on the healthcare system?
• Circumcision effects

Health Research Topics

Students conducting health research struggle with finding good ideas related to their medical interests. If you want to write interesting college papers, you can select a good topic for our list.

• Impact of location, ethnicity, or age on vaccination rates
• Uses of biomaterials in vaccination technology
• Deafness: communication disorders
• Household air pollution
• Diabetes – a public danger
• Coronaviruses
• Oral health assessment
• Tobacco and alcohol control
• Diseases caused by lack of physical exercise
• How urban pollution affects respiratory diseases
• Healthy diets

Medicine Research Topics

Regardless of the requirements in your research assignment, you can write about something that is both engaging and useful in your future career. Choose a topic from below.

• Causes for the increasing cancer cases
• Insulin resistance
• How terrorism affects mental health
• AIDS/HIV – latest developments
• Treating pregnant women versus non-pregnant women
• Latest innovations in medical instruments
• Genetic engineering
• Successful treatment of mental diseases
• Is autism a disease
• Natural coma versus artificial coma
• Treatments for sleep disorders and their effectiveness
• Role of melatonin supplements in sleep quality

Healthcare Research Topics

Healthcare research includes political and social aspects, besides medical. For college students who want to explore how medicine is affected by society’s values or principles, we provide examples of topics for papers. Select yours from the list below.

• Government investment in healthcare services in the EU versus the USA
• Inequalities in healthcare assistance and services
• Electronic health records systems – pros and cons
• Can asylums treat mental issues
• Health care for prison inmates
• Equipment for improving the treatment of AIDS
• Correlation between economic development and health care services across countries
• Impact of smoking on organs
• Heart attacks – causes and effects
• Breast cancer – recent developments
• Materials used in artificial tissue and their impacts

Public Health Research Topics

For current examples of public health topics, browse our list. We provide only original, researchable examples for which you can easily find supporting data and evidence.

• Public versus private hospitals
• Health Disparities in Diabetes Management Across Different Socioeconomic Groups
• Health care professionals – management principles
• Surgery failures – who is responsible
• What legal responsibilities has the hospital administration
• Patient service quality in public versus private hospitals
• What benefits do national health care systems have
• Estimated costs of cancer treatments
• Public health in developing countries
• Banning tobacco ads – importance for public health
• Government solutions to the anti-vaccine’s movement
• How the COVID-19 pandemic has changed public health regulations

Mental Health Research Paper Topics

Mental health is one of the most complex areas of medicine, where things are never as clear as with other medical issues. This increases the research potential of the field with plenty of topics left for debate.

• Mental Health Impact of Social Media on American Teenagers
• Causes of anxiety disorders
• Bulimia versus anorexia
• Childhood trauma
• Mental health public policies
• Impact of Lifestyle Factors on the Progression of Dementia in the Elderly Population
• Postpartum Depression
• Posttraumatic Stress Disorder
• Seasonal Affective Disorder
• Schizophrenia
• Stress and its effects on sleep quality
• Insomnia and its relation to mental health disorders

Anatomy Research Topics

Anatomy covers everything about the human body and how it works. If you find that intriguing and want to pay for medical research paper, start by selecting a topic.

• Causes and treatments of virus infections
• Chemotherapy: how it affects the body
• Thyroid glands – functions in the body
• Human endocrine system
• Preventative Measures and Treatments for Common Liver Diseases
• Heart diseases
• How does the human muscular system develop
• Lymphatic system – importance
• Investigating genetic diseases
• Digestive system
• Role of the Spleen in the Human Immune System and Related Disorders

Biomedical Research Topics

Biology and medicine often work together. For the newest changes in the biomedical field, check our topics.

• Comparative Efficacy of Alternative Medicine Practices in Chronic Pain Management
• Alzheimer’s disease – paths for treatment
• Vaccines and drug development in the treatment of Ebola
• Antibiotic resistance
• Biological effects caused by aging
• Air pollution effects on health
• Infectious disease past versus present
• Regenerative medicine
• Biomedical diagnostics
• Biomedical technology
• Advanced biomaterials for vaccine delivery

Bioethics Research Topics

A controversial area of medicine, bioethics is where you get the chance to add personal input to a research topic and come up with new insights. You could consider these subjects.

• Organ donation
• Alternative or complementary medicine
• Assisted suicide or the right to die
• Artificial insemination or surrogacy
• Chemical and biological warfare
• Contraception
• Environmental bioethics
• In Vitro Fertilization
• Ethical considerations in medical research on animals

Cancer Research Topics

Are you writing a paper related to cancer causes, diagnosis, treatment or effects? Look below for a hot topic that it’s easy to research and important for medical advance.

• The ability of immune system cells to fight cancer
• Computational oncology
• Metastasis affected by drug resistance
• Stem cells – applications for cancer treatment
• Tumor microenvironment
• Obesity and age in cancer occurrence
• Early cancer detection – benefits
• Artificial intelligence predicting cancer
• Hematologic malignancies
• Pathogen-related cancers
• Impact of COVID-19 on cancer treatment studies

Clinical Research Topics

Learn more about clinical medicine by conducting more in-depth research. We prepared for you a list of relevant issues to touch upon.

• Ethical concerns regarding research on human subjects
• Subject recruitment
• Budget preparation
• Human subject protection
• Clinical trials – financial support
• Clinical practices for health professionals
• Using vulnerable populations in clinical research
• Quality assurance in clinical research
• Academic clinical trials versus clinical trials units
• Data collection and management
• Evolution of clinical symptoms in COVID-19 patients

Critical Care Research Topics

Critical care is a key area in medical studies. Explore these topics in your research paper to gain more valuable knowledge in this field. You can also get in contact with nursing research paper writers .

• Obesity and asthma – clinical manifestations
• Chronic obstructive pulmonary disease
• Rhythm analysis for cardiac arrest
• Traumatic brain injury – fluid resuscitation
• Hydrocortisone for multiple trauma patients
• Care and nutrition for critically ill adults
• Diagnosis of hypersensitivity pneumonitis
• Coma and sedation scales
• Artificial airways suctioning
• Arterial puncture and arterial line
• Long-term cardiac and respiratory effects of COVID-19

Pediatric Research Topics

Any topic that refers to health care for children, pregnant women, mothers, and adolescents goes under pediatric care.

• Early Intervention Methods for Children Diagnosed with Autism Spectrum Disorder
• Preventive healthcare strategies for children
• Impact of early childhood nutrition on long-term health
• Attention deficit hyperactivity disorder (ADHD)
• Congenital heart disease in newborns
• Adolescent medicine
• Neonatal medicine
• Rare diseases in children and teenagers
• Obesity and weight fluctuations
• Behavioral sleep problems in children
• Children with anemia
• Child healthcare enhancements and innovations

Dental Research Topics Ideas

Choose a topic on oral health or dental care from this list of the most interesting topics in the field.

• How smoking affects oral health
• Children’s risk for dental caries
• Causes of Dental Anxiety and Effective Interventions for Reducing Fear in Patients
• Types of dental materials – new advances
• Bad breath bacteria
• How diabetes affects oral health
• Oral cancer
• Dental pain – types, causes
• Dental implants
• Oral health-related quality of life
• Advancements in treatments for virus infections

Dermatology Research Topics

Find the best research topic for your dermatology paper among our examples.

• Atopic dermatitis
• Contact dermatitis
• Epidemiology behind uncommon skin disorders
• Cutaneous aging
• Risk factors of melanoma skin cancer
• Acne versus rosacea
• Genetic testing for skin conditions
• Effects of cosmetic agents on skin health
• Improving skin barrier with pharmaceutical agents
• Skin manifestations of autoimmune disorders
• Study of virus effects on skin health

Primary Care Research Topics

Write a primary care paper that can demonstrate your research skills and interest in powerful scientific findings.

• Primary care for vulnerable/uninsured populations
• Interpersonal continuity in care treatment
• How primary care contributes to health systems
• Primary care delivery models
• Developments in family medicine
• Occupational/environmental health
• Pharmacotherapy approaches
• Formal allergy testing
• Oral contraception side effects
• Dietary or behavioral interventions for obesity management

Pharmaceutical Research Topics

Pharma students who need paper topics can use one from our list. We include all things related to pharmacy life.

• Drugs that can treat cancer
• Drug excretion
• Elimination rate constant
• Inflammatory stress drug treatment
• Aspirin poising
• Ibuprofen – dangers versus benefits
• Toxicodynamics
• Opioid use disorder
• Pharmacotherapy for schizophrenia
• Ketamine in depression treatment

Medical Anthropology Research Topics

Medical anthropology unites different areas of human knowledge. Find powerful ideas for a paper below.

• Cultural contexts regarding reproductive health
• Women sexuality
• Anthropological aspects of health care
• Contributions of social sciences to public health
• Euthanasia and medical ethics across cultures
• Health-related behavior in adults across cultures
• Transcultural nursing
• Forensic psychiatry
• Symptoms of Celiac Disease – a disease with no symptoms
• Nursing ethics

Paramedic Research Paper Topics

Topics for paramedic research must be based on evidence, data, statistics, or practical experience. Just like ours.

• Trends and statistics in EMS
• Disaster medicine
• Mass casualties
• Pandemics and epidemics
• Infection control
• Basic versus advanced life support
• Scene safety in EMS
• Shock management
• Motor vehicle accidents
• Challenges in medical humanitarian missions during pandemics

Surgery Research Topics

Discover all the intricacies of surgeries that save lives by writing about our topics.

• Medical malpractice and legal issues
• Methicillin-resistant Staphylococcus aureus
• Early Detection and Management Strategies for Sepsis in Hospital Settings
• Pain management
• Perioperative nursing
• Wound management
• Colorectal cancer surgery
• Breast cancer surgery
• Minimally invasive surgeries
• Vascular disease
• Changes in surgical practices during pandemics

Radiology Research Paper Topics

Find a radiology topic related to your academic interests to write a successful paper.

• Using MRI to diagnose hepatic focal lesions
• Multidetector computer tomography
• Ultrasound elastography in breast cancer
• Assessing traumatic spinal cord injuries with MRI diffusion tensor imaging
• Sonographic imaging to detect male infertility
• Role of tomography in diagnosing cancer
• Brain tumor surgery with magnetic resonance imaging
• Bacterial meningitis imaging
• Advanced imaging techniques for virus infection detection

Anatomy and Physiology Research Paper Topics

Any ideas for a medical research paper? We have included the most important topics for an anatomy and physiology paper.

• What role has the endocrine system
• Staphylococcus aureus
• Environmental factors that affect development of human muscular system
• What role has the lymphatic system
• An investigation of genetic diseases
• Explaining the aging process
• The digestive tract
• Effects of stress on cells and muscles
• Evolution of the human nervous system
• What role has the cardiovascular system
• Impact of viruses on respiratory health in urban settings

Healthcare Management Research Paper Topics

There are numerous topics you could write about when it comes to healthcare management. There’s a wide range of options to pick, from infrastructure, staff, and financial management to HR and patient management. Here are some of the top healthcare management research paper options.

Medical Ethics Research Paper Topics

Medical ethics is a field that opens the door to numerous compelling topics for research papers. Here are some of the most appealing ones you could tackle.

• Clinical research on humans
• Vaccines and immunization
• Religious beliefs in healthcare
• Euthanasia and physician-assisted suicide
• Ethical issues across cultures
• Amniocentesis or prenatal birth defect testing
• Medical malpractice and going back to work
• Racial and ethnic preferences and perceptions in organ donations
• Racial and ethnic disparities in healthcare
• Ethical concerns of AI in healthcare
• Debates on animal ethics in medical research
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Environmental Health and Pollution Research Paper Topics

• Environmental Pollutants and Respiratory Health in Urban Areas of the USA
• How environmental changes affect human health
• Long-Term Impact of PM2.5 Exposure on Lung, Heart, and Brain Function
• Health Risks of Air Pollution Across Different Life Stages
• Hospital Admissions and Air Quality in the USA
• Risk Reduction Strategies for Indoor Air Pollution from Gas Stoves
• Impact of Air Pollution on Cognitive Development and Socioeconomic Achievements
• Long-Term Health Effects of Early Childhood Exposure to Air Pollution
• Impact of Traffic Noise on Cardiovascular Health

Selecting the right medical research topic is essential, but the writing process can be equally challenging. If you’re seeking expert help, professional research paper writing services can assist in crafting a well-researched and meticulously written paper.

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Research Topics & Ideas: Healthcare

F inding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Topics & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Need a helping hand?

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

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18 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you give me research titles that i can conduct as a school nurse

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

I have been racking my brain for a while on what topic will be suitable for my PhD in health informatics. I want a qualitative topic as this is my strong area.

Hi, may I please be assisted with research topics in the medical laboratory sciences

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Examples of Research Questions

Phd in nursing science program, examples of broad clinical research questions include:.

• Does the administration of pain medication at time of surgical incision reduce the need for pain medication twenty-four hours after surgery?
• What maternal factors are associated with obesity in toddlers?
• What elements of a peer support intervention prevent suicide in high school females?
• What is the most accurate and comprehensive way to determine men’s experience of physical assault?
• Is yoga as effective as traditional physical therapy in reducing lymphedema in patients who have had head and neck cancer treatment?
• In the third stage of labor, what is the effect of cord cutting within the first three minutes on placenta separation?
• Do teenagers with Type 1 diabetes who receive phone tweet reminders maintain lower blood sugars than those who do not?
• Do the elderly diagnosed with dementia experience pain?
•  How can siblings’ risk of depression be predicted after the death of a child?
•  How can cachexia be prevented in cancer patients receiving aggressive protocols involving radiation and chemotherapy?

Examples of some general health services research questions are:

• Does the organization of renal transplant nurse coordinators’ responsibilities influence live donor rates?
• What activities of nurse managers are associated with nurse turnover?  30 day readmission rates?
• What effect does the Nurse Faculty Loan program have on the nurse researcher workforce?  What effect would a 20% decrease in funds have?
• How do psychiatric hospital unit designs influence the incidence of patients’ aggression?
• What are Native American patient preferences regarding the timing, location and costs for weight management counseling and how will meeting these preferences influence participation?
•  What predicts registered nurse retention in the US Army?
• How, if at all, are the timing and location of suicide prevention appointments linked to veterans‘ suicide rates?
• What predicts the sustainability of quality improvement programs in operating rooms?
• Do integrated computerized nursing records across points of care improve patient outcomes?
• How many nurse practitioners will the US need in 2020?

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A well-developed and answerable question is the foundation for any systematic review. This process involves:

• Systematic review questions typically follow a PICO-format (patient or population, intervention, comparison, and outcome)
• Using the PICO framework can help team members clarify and refine the scope of their question. For example, if the population is breast cancer patients, is it all breast cancer patients or just a segment of them? 
• When formulating your research question, you should also consider how it could be answered. If it is not possible to answer your question (the research would be unethical, for example), you'll need to reconsider what you're asking
• Typically, systematic review protocols include a list of studies that will be included in the review. These studies, known as exemplars, guide the search development but also serve as proof of concept that your question is answerable. If you are unable to find studies to include, you may need to reconsider your question

Other Question Frameworks

PICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Did you know there are at least  25 other question frameworks  besides variations of PICO?  Frameworks like PEO, SPIDER, SPICE, and ECLIPS can help you formulate a focused research question. The table and example below were created by the  Medical University of South Carolina (MUSC) Libraries .

The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome. Research question : What are the daily living experiences of mothers with postnatal depression?

The SPIDER question framework is useful for qualitative or mixed methods research topics focused on "samples" rather than populations. SPIDER questions identify five concepts: sample, phenomenon of interest, design, evaluation, and research type.

Research question : What are the experiences of young parents in attendance at antenatal education classes?

The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a service, project, or intervention. SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest, comparison, and evaluation.

Research question : For teenagers in South Carolina, what is the effect of provision of Quit Kits to support smoking cessation on number of successful attempts to give up smoking compared to no support ("cold turkey")?

The ECLIPSE framework is useful for qualitative research topics investigating the outcomes of a policy or service. ECLIPSE questions identify six concepts: expectation, client group, location, impact, professionals, and service.

Research question:  How can I increase access to wireless internet for hospital patients?

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Systematic reviews for health: 1. formulate the research question.

• Handbooks / Guidelines for Systematic Reviews
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• 1. Formulate the Research Question
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Step 1. Formulate the Research Question

A systematic review is based on a pre-defined specific research question ( Cochrane Handbook, 1.1 ). The first step in a systematic review is to determine its focus - you should clearly frame the question(s) the review seeks to answer  ( Cochrane Handbook, 2.1 ). It may take you a while to develop a good review question - it is an important step in your review.  Well-formulated questions will guide many aspects of the review process, including determining eligibility criteria, searching for studies, collecting data from included studies, and presenting findings ( Cochrane Handbook, 2.1 ).

The research question should be clear and focused - not too vague, too specific or too broad.

You may like to consider some of the techniques mentioned below to help you with this process. They can be useful but are not necessary for a good search strategy.

PICO - to search for quantitative review questions

Richardson, WS, Wilson, MC, Nishikawa, J & Hayward, RS 1995, 'The well-built clinical question: A key to evidence-based decisions', ACP Journal Club , vol. 123, no. 3, pp. A12-A12 .

We do not have access to this article at UTAS.

A variant of PICO is PICOS . S stands for Study designs . It establishes which study designs are appropriate for answering the question, e.g. randomised controlled trial (RCT). There is also PICO C (C for context) and PICO T (T for timeframe).

You may find this document on PICO / PIO / PEO useful:

• Framing a PICO / PIO / PEO question Developed by Teesside University

SPIDER - to search for qualitative and mixed methods research studies

Cooke, A, Smith, D & Booth, A 2012, 'Beyond pico the spider tool for qualitative evidence synthesis', Qualitative Health Research , vol. 22, no. 10, pp. 1435-1443.

This article is only accessible for UTAS staff and students.

SPICE - to search for qualitative evidence

Cleyle, S & Booth, A 2006, 'Clear and present questions: Formulating questions for evidence based practice', Library hi tech , vol. 24, no. 3, pp. 355-368.

ECLIPSE - to search for health policy/management information

Wildridge, V & Bell, L 2002, 'How clip became eclipse: A mnemonic to assist in searching for health policy/management information', Health Information & Libraries Journal , vol. 19, no. 2, pp. 113-115.

There are many more techniques available. See the below guide from the CQUniversity Library for an extensive list:

• Question frameworks overview from Framing your research question guide, developed by CQUniversity Library

This is the specific research question used in the example:

"Is animal-assisted therapy more effective than music therapy in managing aggressive behaviour in elderly people with dementia?"

Within this question are the four PICO concepts :

S - Study design

This is a therapy question. The best study design to answer a therapy question is a randomised controlled trial (RCT). You may decide to only include studies in the systematic review that were using a RCT, see  Step 8 .

See source of example

Need More Help? Book a consultation with a  Learning and Research Librarian  or contact  [email protected] .

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• Next: 2. Identify the Key Concepts >>
• Last Updated: Sep 3, 2024 10:18 AM
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Capstone and PICO Project Toolkit

• Starting a Project: Overview
• Developing a Research Question
• Selecting Databases
• Expanding a Search
• Refining/Narrowing a Search
• Saving Searches
• Critical Appraisal & Levels of Evidence
• Citing & Managing References
• Database Tutorials
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• Finding Full Text
• Term Glossary

Defining the Question: Foreground & Background Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what  kind  of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground Questions

A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence. 

Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question. 

 Across most frameworks, you’ll often be considering:

• a who (who was studied - a population or sample)
• a what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
• a how ([how] did the [what] affect the [who] - an outcome, an effect). 

PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

PICO (Problem/Population, Intervention, Comparison, Outcome)

Appropriate for : clinical questions, often addressing the effect of an intervention/therapy/treatment

Example : For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations  (C) improve blood sugar control  (O)?

Framing Different Types of Clinical Questions with PICO

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements.  The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which produce or predispose toward a certain disease or disorder.

"Are_________________(P), who have_________________(I) compared with those without_________________(C) at_________________risk for/of_________________(O) over_________________(T)?" 

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In_________________(P) are/is_________________(I) compared with_________________(C) more accurate in diagnosing_________________(O)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Beyond PICO: Other Types of Question Frameworks

PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews.  Also consider:

PEO (Population, Exposure, Outcome)

Appropriate for : describing association between particular exposures/risk factors and outcomes

Example : How do  preparation programs (E) influence the development of teaching competence  (O) among novice nurse educators  (P)?

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type)

Appropriate for : questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)

Example : What are the experiences and perspectives (E) of  undergraduate nursing students  (S)  in clinical placements within prison healthcare settings (PI)?

SPICE (Setting, Perspective, Intervention/phenomenon of Interest, Comparison, Evaluation)

Appropriate for : evaluating the outcomes of a service, project, or intervention

Example : What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?

PCC (Problem/population, Concept, Context)

Appropriate for : broader (scoping) questions

Example : How do nursing schools  (Context) teach, measure, and maintain nursing students ' (P)  technological literacy  (Concept))throughout their educational programs?

Background Questions

To craft a strong and reasonable foreground research question, it is important to have a firm understanding of the concepts of interest.  As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc. 

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations  improve blood sugar control ?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

• What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
• What are the measures of effective blood sugar control?
• What kinds of interventions would fall under the umbrella of 'telehealth'?
• What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?
• << Previous: Starting a Project: Overview
• Next: Selecting Databases >>
• Last Updated: Aug 6, 2024 11:45 AM
• URL: https://guides.nyu.edu/pico

Literature Searching

In this guide.

• Introduction
• Steps for searching the literature in PubMed
• Step 1 - Formulate a search question
• Step 2- Identify primary concepts and gather synonyms
• Step 3 - Locate subject headings (MeSH)
• Step 4 - Combine concepts using Boolean operators
• Step 5 - Refine search terms and search in PubMed
• Step 6 - Apply limits

Formulating a Well-Defined, Answerable Research Question

It is important to develop a well-defined, answerable research question because it

• Defines the focus of your literature search
• Identifies the appropriate study design and methods
• Makes searching for evidence simpler and more effective
• Helps you identify relevant results and separate relevant results from irrelevant ones

Tips for developing a clinical research question:

• The question is directly relevant to the most important health issue for the patient
• The question is focused and when answered, will help the patient the most
• The question is phrased to facilitate a targeted literature search for precise answers

Adopted from CEBM:  what makes a good clinical question

Example of a vague question:

"Is mobile technology good at managing diabetes?"

• Mobile technology is very broad. Mobile apps, mobile phones, voice/text? 
• What does “good” mean? How will you determine if the technology is effective?
• What kind of diabetes? Type 1? Type 2? Both?
• Who are the “patients”? Adults? Adolescents? Women? Patients with specific diagnoses?
• Any time frame?

Example of a well-defined question:

"Are mobile health technology interventions more effective in managing patients with Type 1 or Type 2 diabetes than in-person care?"

PICO Framework

PICO or PICO(T) (patient/problem/population, intervention, comparison, outcome, time) is a well-known approach for framing a research question. It divides the research question into key components making it easy and searchable.

Example:  "Are mobile health technology interventions more effective in managing patients with Type 1 or Type 2 diabetes than in-person care?"

Other question formulation frameworks:

PIE  (Population, Intervention, Effect / Outcome)

SPIDER  (Sample, Phenomena of Interest, Design, Evaluation, Research type)

SPICE  (Setting, Perspective, Intervention, Comparison, Evaluation)

ECLIPSE (Expectation, Client group, Location, Impact, Professionals, Service)

• << Previous: Steps for searching the literature in PubMed
• Next: Step 2- Identify primary concepts and gather synonyms >>
• Last Updated: Jul 10, 2024 2:17 PM
• URL: https://laneguides.stanford.edu/LitSearch

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• Knowledge Base
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• Writing Strong Research Questions | Criteria & Examples

Writing Strong Research Questions | Criteria & Examples

Published on October 26, 2022 by Shona McCombes . Revised on November 21, 2023.

A research question pinpoints exactly what you want to find out in your work. A good research question is essential to guide your research paper , dissertation , or thesis .

All research questions should be:

• Focused on a single problem or issue
• Researchable using primary and/or secondary sources
• Feasible to answer within the timeframe and practical constraints
• Specific enough to answer thoroughly
• Complex enough to develop the answer over the space of a paper or thesis
• Relevant to your field of study and/or society more broadly

Table of contents

How to write a research question, what makes a strong research question, using sub-questions to strengthen your main research question, research questions quiz, other interesting articles, frequently asked questions about research questions.

You can follow these steps to develop a strong research question:

• Choose your topic
• Do some preliminary reading about the current state of the field
• Narrow your focus to a specific niche
• Identify the research problem that you will address

The way you frame your question depends on what your research aims to achieve. The table below shows some examples of how you might formulate questions for different purposes.

Using your research problem to develop your research question

Note that while most research questions can be answered with various types of research , the way you frame your question should help determine your choices.

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Research questions anchor your whole project, so it’s important to spend some time refining them. The criteria below can help you evaluate the strength of your research question.

Focused and researchable

Feasible and specific

Complex and arguable

Relevant and original

Chances are that your main research question likely can’t be answered all at once. That’s why sub-questions are important: they allow you to answer your main question in a step-by-step manner.

Good sub-questions should be:

• Less complex than the main question
• Focused only on 1 type of research
• Presented in a logical order

Here are a few examples of descriptive and framing questions:

• Descriptive: According to current government arguments, how should a European bank tax be implemented?
• Descriptive: Which countries have a bank tax/levy on financial transactions?
• Framing: How should a bank tax/levy on financial transactions look at a European level?

Keep in mind that sub-questions are by no means mandatory. They should only be asked if you need the findings to answer your main question. If your main question is simple enough to stand on its own, it’s okay to skip the sub-question part. As a rule of thumb, the more complex your subject, the more sub-questions you’ll need.

Try to limit yourself to 4 or 5 sub-questions, maximum. If you feel you need more than this, it may be indication that your main research question is not sufficiently specific. In this case, it’s is better to revisit your problem statement and try to tighten your main question up.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

Methodology

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

The way you present your research problem in your introduction varies depending on the nature of your research paper . A research paper that presents a sustained argument will usually encapsulate this argument in a thesis statement .

A research paper designed to present the results of empirical research tends to present a research question that it seeks to answer. It may also include a hypothesis —a prediction that will be confirmed or disproved by your research.

As you cannot possibly read every source related to your topic, it’s important to evaluate sources to assess their relevance. Use preliminary evaluation to determine whether a source is worth examining in more depth.

This involves:

• Reading abstracts , prefaces, introductions , and conclusions
• Looking at the table of contents to determine the scope of the work
• Consulting the index for key terms or the names of important scholars

A research hypothesis is your proposed answer to your research question. The research hypothesis usually includes an explanation (“ x affects y because …”).

A statistical hypothesis, on the other hand, is a mathematical statement about a population parameter. Statistical hypotheses always come in pairs: the null and alternative hypotheses . In a well-designed study , the statistical hypotheses correspond logically to the research hypothesis.

Formulating a main research question can be a difficult task. Overall, your question should contribute to solving the problem that you have defined in your problem statement .

However, it should also fulfill criteria in three main areas:

• Researchability
• Feasibility and specificity
• Relevance and originality

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Educational resources and simple solutions for your research journey

How to Craft a Strong Research Question (With Research Question Examples)

A sound and effective research question is a key element that must be identified and pinned down before researchers can even begin their research study or work. A strong research question lays the foundation for your entire study, guiding your investigation and shaping your findings. Hence, it is critical that researchers spend considerable time assessing and refining the research question based on in-depth reading and comprehensive literature review. In this article, we will discuss how to write a strong research question and provide you with some good examples of research questions across various disciplines.

Table of Contents

The importance of a research question

A research question plays a crucial role in driving scientific inquiry, setting the direction and purpose of your study, and guiding your entire research process. By formulating a clear and focused research question, you lay the foundation for your investigation, ensuring that your research remains on track and aligned with your objectives so you can make meaningful contribution to the existing body of knowledge. A well-crafted research question also helps you define the scope of your study and identify the appropriate methodologies and data collection techniques to employ.

Key components of a strong research question

A good research question possesses several key components that contribute to the quality and impact of your study. Apart from providing a clear framework to generate meaningful results, a well-defined research question allows other researchers to understand the purpose and significance of your work. So, when working on your research question, incorporate the following elements:

• Specificity : A strong research question should be specific about the main focus of your study, enabling you to gather precise data and draw accurate conclusions. It clearly defines the variables, participants, and context involved, leaving no room for ambiguity.
• Clarity : A good research question is clear and easily understood, so articulate the purpose and intent of your study concisely without being generic or vague. Ensuring clarity in your research question helps both you and your readers grasp the research objective.
• Feasibility : While crafting a research question, consider the practicality of conducting the research and availability of necessary data or access to participants. Think whether your study is realistic and achievable within the constraints of time, resources, and ethical considerations.

How to craft a well-defined research question

A first step that will help save time and effort is knowing what your aims are and thinking about a few problem statements on the area or aspect one wants to study or do research on. Contemplating these statements as one undertakes more progressive reading can help the researcher in reassessing and fine-tuning the research question. This can be done over time as they read and learn more about the research topic, along with a broad literature review and parallel discussions with peer researchers and supervisors. In some cases, a researcher can have more than one research question if the research being undertaken is a PhD thesis or dissertation, but try not to cover multiple concerns on a topic.

A strong research question must be researchable, original, complex, and relevant. Here are five simple steps that can make the entire process easier.

• Identify a broad topic from your areas of interest, something that is relevant, and you are passionate about since you’ll be spending a lot of time conducting your research.
• Do a thorough literature review to weed out potential gaps in research and stay updated on what’s currently being done in your chosen topic and subject area.
• Shortlist possible research questions based on the research gaps or see how you can build on or refute previously published ideas and concepts.
• Assess your chosen research question using the FINER criteria that helps you evaluate whether the research is Feasible, Interesting, Novel, Ethical, and Relevant. 1
• Formulate the final research question, while ensuring it is clear, well-written, and addresses all the key elements of a strong research question.

Examples of research questions

Remember to adapt your research question to suit your purpose, whether it’s exploratory, descriptive, comparative, experimental, qualitative, or quantitative. Embrace the iterative nature of the research process, continually evaluating and refining your question as you progress. Here are some good examples of research questions across various disciplines.

Exploratory research question examples

• How does social media impact interpersonal relationships among teenagers?
• What are the potential benefits of incorporating mindfulness practices in the workplace?

Descriptive research question examples

• What factors influence customer loyalty in the e-commerce industry?
• Is there a relationship between socioeconomic status and academic performance among elementary school students?

Comparative research question examples

• How does the effectiveness of traditional teaching methods compare to online learning platforms in mathematics education?
• What is the impact of different healthcare policies on patient outcomes in various countries?

Experimental research question examples

• What are the effects of a new drug on reducing symptoms of a specific medical condition?
• Does a dietary intervention have an impact on weight loss among individuals with obesity?

Qualitative research question examples

• What are the lived experiences of immigrants adapting to a new culture?
• What factors influence job satisfaction among healthcare professionals?

Quantitative research question examples

• Is there a relationship between sleep duration and academic performance among college students?
• How effective is a specific intervention in reducing anxiety levels among individuals with phobias?

With these simple guidelines and inspiring examples of research questions, you are equipped to embark on your research journey with confidence and purpose. Here’s wishing you all the best for your future endeavors!

References:

• How to write a research question: Steps and examples. Indeed Career Guide. Available online at https://www.indeed.com/career-advice/career-development/how-to-write-research-questions

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Developing Good Clinical Questions and Finding the Best Evidence to Answer Those Questions

Patricia b. burns.

1 Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System

Kevin C. Chung

2 Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System

Evidence based medicine (EBM) involves the integration of the best scientific evidence available with physician experience and patient preferences. One of the first steps in EBM involves developing a question based on issues encountered with patients or a disease and finding evidence to answer the question. This paper is a guide to plastic surgeons in how to begin the practice of EBM by developing clinical questions and finding evidence to answer these questions.

Clinical Scenario

You are a surgeon and your patient is a 25-year-old man with a severe type III open tibial fracture as a result of a motorcycle accident. The options for treatment are reconstruction or amputation. Understandably this is an emotional issue for the patient and he wants the leg to be saved using reconstructive surgery. Your preference is for flap reconstruction of the limb. Patient and physician preferences must be taken into account when making the decision whether to reconstruct the leg or amputate, but you question whether the decision is based on the best available scientific evidence.

In another scenario, you are a surgeon who is interested in researching outcomes in rheumatoid arthritis patients who elect to have arthroplasty to replace deformed joints in their hands. You have performed arthroplasty on numerous patients and find your patients to be very satisfied with how their hands look after surgery and report good outcomes. However, you question if their hands actually function better after surgery. You speculate that patients are reporting better outcomes because their fingers are less deformed and the improved aesthetic appearance prompts the patients to report being satisfied. You are interested in researching this topic to apply evidence to your clinical experience, but are not sure how to start.

In both cases, you have identified a gap in your knowledge, and need to identify research evidence to fill that gap. You could answer your clinical questions by reading an expert opinion article, or consulting a colleague. However, the current environment of evidence based medicine (EBM) stresses the need to develop a good question and finding high quality research to answer clinical questions. Sackett, one of the founding fathers of EBM, states that “studies show that busy clinicians who devote their scarce reading time to selective, efficient, patient driven searching, appraisal, and incorporation of the best available evidence can practice evidence based medicine”. 1 As part of the emphasis to introduce the concepts and practices of EBM to readers of Plastic and Reconstructive Surgery , we present this paper as a guide to developing a clinical question and how to find the best available evidence to answer the question.

Types of clinical questions

Before developing a specific question, it is important to think about the type of question you have. Clinical questions can be narrowed down to four types: therapy, prognosis, diagnosis and economic/decision analysis. For example, if you are comparing two treatments such as amputation and reconstructive surgery, this is a therapy question. If you are interested in understanding the outcomes for older patients after breast reconstruction, this is a prognosis question. A diagnosis question might inquire about the accuracy of a new diagnostic test such as the use of ultrasound to detect silicone breast implant ruptures. If you are asking if a treatment results in lower costs and improved quality of life, this is an economic/decision analysis question.

The type of question also determines the type of study that you should look for when searching for evidence. For example, in the scenario for arthroplasty, you may want to determine if arthroplasty on the joints in the hand results in better outcomes than no surgery on the affected joints. A randomized controlled trial (RCT) is the preferred study type for answering treatment questions. However due to feasibility and ethical concerns, many surgical procedures cannot be randomly allocated or blinded. In this case, prospective cohort studies would be a better choice. When questioning the prognosis for a disease, a prospective cohort study would be more appropriate. Patients are enrolled at the time of diagnosis or treatment and followed over time to determine if any factors are associated with prognostic outcomes. Diagnostic studies that evaluate new diagnostic tests are more likely to be cross-sectional or prospective cohort studies. Economic and decision analysis questions arise when the best available evidence concerning treatments is inconclusive and an RCT is not ethically practical or feasible.

Developing a question using PICO

The next step is developing a question. You want an answer to your question but you also want to avoid spending precious free time aimlessly searching through journals. Investing a few moments to craft a question can help to narrow the search for answers. ( Figure 1 ) The question must be clinically relevant, well thought out and answerable. For example, a treatment (e.g. anticoagulant treatment for deep venous thrombosis) or surgery (e.g. replanting an amputated thumb) that is widely accepted with outstanding results would not be a good subject for a clinical question. On the other hand, researching whether the use of costly tissue sealant can decrease the incidence of postoperative seroma is an important study question. Or whether a particular face lift technique is associated with better outcomes and less complication rate is a timely study question.

PICO is a tool to help develop focused clinical questions. 2 - 4 PICO is an acronym for Patient/Problem, Intervention, Comparison Intervention and Outcomes. The question will be more focused if you can be specific for each element. The first element in the question is a description of the patient population or problem of interest. The second and third elements contain the intervention and comparison intervention of interest respectively. An intervention is often a treatment but could also be a prognostic factor or a diagnostic test. In some cases, there will not be a comparison intervention. Lastly the question should consider the outcomes from the intervention. For example, will the intervention lead to fewer complications and less morbidity?

Using our scenarios as examples, we identify the pieces that will be used to formulate a question. In the case of tibial fractures, you consider the most severe types because these types of fractures are more likely to be considered for amputation. Based on Gustilo's classification system, 5 you decide to restrict your patient population to type IIIB and IIIC due to the lack of soft tissue coverage of the fracture that requires flap reconstruction. The intervention of interest in your question is limb salvage using reconstructive surgery. This surgical procedure will then be compared to amputation. You consider what outcomes you would like to compare between these two treatments. After reviewing several of your cases, you decide to concentrate on improved limb function and quality of life after surgery. Putting the four elements together we construct a focused question: Do patients with severe type IIIB and IIIC open tibial fractures have better limb function and quality of life than patients who have amputations?

In the arthroplasty scenario, you have decided to concentrate your research efforts on rheumatoid arthritis patients who elect to replace joints in their hands. Based on your personal experience with rheumatoid hand deformities, you further decide to concentrate on arthroplasty at the metacarpophalangeal (MCP) joint. After considering the different type of implants that can be used for MCP arthroplasty, you select silicone metacarpophalangeal arthroplasty (SMPA) because it is has been used for over 40 years and is not experimental. You consider alternate surgeries but decide to compare SMPA patients with those who do not have surgery. The outcome that you decide upon is improvement in hand function as shown in patient reported questionnaires and biomechanical measurements. We put the pieces of the question together: “Do rheumatoid arthritis patients who undergo SMPA have better functional outcomes and quality of life than patients who do not have SMPA or any other type of arthroplasty”?

Hierarchy of Evidence

Before searching for evidence, you will need to consider the hierarchy of evidence. ( Figure 2 ) The hierarchy of evidence ranks study types from those with the highest evidence to lowest evidence. RCTs, systematic reviews and meta-analyses are at the top (highest evidence) and expert opinions and case reports at the bottom (lowest evidence). Systematic reviews and meta-analyses combine or pool data from multiple individual studies using systematic, predetermined methods. This pooling of data, if done correctly, allows the reader an unbiased summary of the available research. A systematic review of RCTs is considered higher in the hierarchy than a systematic review of observational studies. A narrative review or expert opinion is also a summary of studies but is done in a non-systematic manner and therefore more likely to be biased.

Electronic Databases (MEDLINE, EMBASE, CINAHL, Cochrane)

The next step in practicing EBM is finding the best available literature to answer your question. This is accomplished by searching through electronic databases such as MEDLINE, EMBASE, CINAHL and the Cochrane Library.

The Cochrane Collaboration was founded in 1993 and produces the Cochrane Library. 6 The library consists of several EBM databases. Most notable is the Cochrane Database of Systematic Reviews, which consists of systematic reviews and meta-analyses. The library is updated on a quarterly basis and considered a reliable source of EBM. All systematic reviews must meet rigorous standards before publication. Because not every condition has been investigated with a systematic review, it is often necessary to look at other databases.

MEDLINE is maintained by the National Library of Medicine, contains over 11 million citations from journals dating back to 1950 and is updated weekly. 7 Articles are referenced using medical subject headings (MeSH). PubMed has over 19 million citations from life science journals and MEDLINE. PubMed has several search options that can help simplify your literature search. You can search specific journals or a single citation. Another search option is called Clinical Queries, which allows the user to narrow their search by subject and clinical study category (e.g. therapy, diagnosis, prognosis) or limit the search to systematic reviews. EMBASE contains biomedical and pharmacological articles from 1947 to the present. 8 It contains more than 19 million records from more than 7000 journals. Although EMBASE and MEDLINE overlap in their coverage of the literature, EMBASE has a better coverage of European journals. 9 CINAHL (Cumulative Index to Nursing &Allied Health Literature) covers 2960 journals and other citations related to nursing and allied health from 1981 to present. 10 CINAHL has over 2 million records.

The important thing when searching for evidence is to start at the top of the hierarchy and work your way down. You should begin by searching for systematic reviews or meta-analyses. The Cochrane Library is an excellent source for this type of evidence. 6 Another choice is the American College of Physicians (ACP) Journal Club which pre-appraises evidence for physicians. 11 If there is no systematic review or meta-analysis, the next step involves searching MEDLINE or one of the other databases for RCTs. Many questions are not appropriately answered by RCTs and therefore few if any RCTs exist. This is often the case for surgical procedures. 12 , 13 It will then be necessary to move down the hierarchy and gather evidence from prospective cohort studies, case-control studies and lastly case reports. Case reports are best for generating hypotheses. The reader needs to be aware of the lower quality of these types of studies and take that into account when evaluating the evidence.

Search terms and limits/filters

Although there may be abundant research on your question, it is necessary for expediency to restrict your search such that you have a manageable number of papers to read. When asking a clinical question that needs a timely answer, a few high quality papers are adequate. However, in the research setting, it is important to find all the relevant papers. Developing accurate search terms will aid in finding the evidence you need to answer your question. The search terms need to be specific enough to narrow your search but not so narrow so that you miss important articles. In MEDLINE, each article is assigned Medical Subject Headings (MeSH). MeSH terms can then be used to search for pertinent research. MEDLINE gives the option to explode on terms (to include more narrowly defined terms) to gather the most research. In addition to MeSH terms, it is sometimes helpful to include text words to gather evidence. MeSH terms are usually combined with Boolean operators (AND, OR) to maximize the number of articles selected. It may take several attempts using different combinations of search terms to get the most comprehensive and relevant list of articles.

All databases give you the option to put limits on your search. For example, you can limit your search by language (e.g. English), age (e.g. adults >18), humans, or type of article (e.g. review). If your search results in more than 200 articles, you may need to refine your search terms to reduce the number of articles. Medical librarians have a great deal of experience with developing search terms and it may be useful to consult one.

Once you have your list of possible articles, you can scan the titles and abstracts to determine if the article is relevant to your search. You can access the articles electronically or have them pulled and copied if necessary. If you find an article of particular interest in MEDLINE or PubMed, you have the option to find related articles that may not have been identified by your search.

Using the tibial fracture question as an example, we search MEDLINE using PubMed and select Clinical Queries as a tool. We select the systematic review option and use the following MESH terms: Tibial Fractures or Lower Leg Injuries. We further limit our search to humans and English language. A total of 176 articles are selected based on these search items. This is a reasonable number of articles and searching titles and abstracts should reduce the number further. An alternate search would be to access MEDLINE (in this case using the interface Ovid) and enter the terms (exp Tibial Fractures or Lower Leg Injuries) and (exp Amputation or exp Limb Salvage or exp Reconstructive Surgical Procedures). The exp in the search denotes that these terms were exploded. A total of 1659 articles were selected based on the search terms and limiting the search to English language, humans, and review articles brought the number down to 97 articles. After reviewing the titles and abstracts, we found a systematic review comparing the outcomes for amputation or reconstructive surgery after severe tibial fractures. 14 The systematic review paper did not find any difference in outcomes for the two treatments.

In the research setting, the search items should be broad enough to find as many articles as possible. Using the scenario for arthroplasty in RA patients, we decide to search the Cochrane Library first to see if there are any systematic reviews of this topic. We enter the terms (Rheumatoid Arthritis and Arthroplasty). The search yielded 25 systematic reviews. A quick search of the titles and abstracts of the articles selected by our search did not find any relevant review articles. Many of the review articles selected for this search concern knee replacement surgery. We would like to find more relevant research on this topic and therefore, restrict the search to surgery on the metacarpophalangeal joint. Using MEDLINE, we enter the terms (exp Rheumatoid Arthritis and (expArthroplasty/ or expArthroplasty, Replacement, Finger)) and (exp Metacarpophalangeal Joint/Surgery). The search results in 112 articles, which drop to 99 when we limit articles to English. Again we search the titles and abstracts, and identify a systematic review. 15 This systematic review is based mostly on retrospective studies and found improvement in hand function after SMPA. However, none of the clinical trials or prospective studies included in the review compared surgical cases to nonsurgical cases. We decide to widen our search using the same search terms but using the Boolean operator OR instead of AND in the search. For example, we change the search to: (exp Rheumatoid Arthritis AND (expArthroplasty/ OR expArthroplasty, Replacement, Finger)) OR (exp Metacarpophalangeal Joint/Surgery). This results in considerably more articles (2811). Restricting articles to the English Language drops the number of articles to 2322. Although this combination of search terms results in papers on other joints such as the knee and shoulder, we do find one prospective cohort study of SMPA patients that compared surgical cases to nonsurgical cases. 16 The paper along with the systematic review has the information available to help answer your question. Additionally, both articles provide a high level of evidence.

Reporting literature searches (STARLITE)

Although you may not be publishing the results of your literature search, it is important to know the elements needed for a good search. Standards for reporting literature searches were developed with the mnemonic STARLITE (sampling strategy, type of study, approach, range of years, limits, inclusion and exclusion criteria, terms, and electronic sources). 17 Standards have been developed for reporting RCTs (CONSORT - Consolidated Standards of Reporting Trials 18 ), meta-analysis of RCTs (QUOROM - Quality of Reports of Meta-analysis 19 ) and meta-analysis of observational studies (MOOSE - Meta-analysis of Observational Studies in Epidemiology 20 ). In a research paper, it is important to report the elements of the literature search so that your results can be reproduced.

STARLITE was developed for qualitative studies but could also be useful when searching for quantitative studies. ( Figure 3 ). The sampling strategy should state whether the researchers attempted to find all the available research or restricted the search in some format. The types of studies included in the search such as RCTs or prospective cohorts should be reported. This allows others to know the level of evidence that was included in your search. The approach states how you found the research (e.g. electronic data bases or other methods such as hand searching). The range of years, search limits or filters, inclusion and exclusion criteria, and terms used in the search should also be reported. If you used electronic databases they need to be listed.

As is often the case, one question leads to another. For example, in the tibia fracture question, the best available evidence found no difference in outcomes between amputation and reconstructive surgery. You could continue your practice of performing reconstructive surgery, confident that you are providing a good outcome to your patient by saving the limb. You may still question if there are any other studies that can distinguish the outcomes for the two treatments. For example, economically, does limb reconstruction have better outcomes than amputation? If searching for evidence provides no answer, you could propose your own research to answer the question.

This paper presents the initial steps for those interested in pursuing EBM. We have provided guidance and examples to help with developing a focused clinical question and finding the highest level of research to answer the question. It may be difficult to start the process but it is a skill that improves with practice and persistence. EBM is a new direction in American medicine 21 and will be used for quality improvement efforts in the US 22 By applying EBM principles to integrate with physician experiences, we should be able to provide better care for our patients by eliminating idiosyncrasies in our treatments.

Acknowledgments

Supported in part by a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (to Dr. Kevin C. Chung).

The Graduate Health & Life Sciences Research Library at Georgetown University Medical Center

Evidence-based medicine resource guide.

• Defining EBM

Types of Clinical Questions

Formulating a well built clinical question, type of clinical question and study design.

• Point-of-Care Tools
• Databases for Clinical Research
• Drug Information
• Books & eBooks
• EBM Journals
• EBM Organizations & Centers
• Health Sciences: The Research Process

Resources and Types of Clinical Question

Background questions are best answered by medical textbooks, point-of-care tools such as DynaMed Plus and Essential Evidence Plus, and narrative reviews.

Foreground questions are best answered by consulting medical databases such as MEDLINE (via PubMed or Ovid), Embase, Cochrane Database of Systematic Reviews and ACP Journal Club.

DML's Clinical Quick Reference page is a great place to locate EBM resources. Each resource has been labeled background and/or foreground, for you!

Clinical questions may be categorized as either background or foreground. Why is this important?

Determining the type of question will help you to select the best resource to consult for your answer.

Background questions ask for general knowledge about an illness, disease, condition, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc.

For example

• How overweight is a woman to be considered slightly obese?
• What are the clinical manifestations of menopause?
• What causes migraines?

Foreground questions ask for specific knowledge to inform clinical decisions. These questions typically concern a specific patient or particular population. Foreground questions tend to be more specific and complex compared to background questions. Quite often, foreground questions investigate comparisons, such as two drugs, two treatments, two diagnostic tests, etc. Foreground questions may be further categorized into one of 4 major types: treatment/therapy, diagnosis, prognosis, or etiology/harm.

• Is Crixivan effective when compared with placebo in slowing the rate of functional impairment in a 45 year old male patient with Lou Gehrig's Disease?
• In pediatric patients with Allergic Rhinitis, are Intranasal steroids more effective than antihistamines in the management of Allergic Rhinitis symptoms?

According to the Centre for Evidence Based Medicine (CEBM) , "one of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients' problems and phrased in ways that direct your search to relevant and precise answers."

A well-built clinical foreground question should have all four components. The PICO model is a helpful tool that assists you in organizing and focusing your foreground question into a searchable query. Dividing into the PICO elements helps identify search terms/concepts to use in your search of the literature.

P = Patient, Problem, Population (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?)

I = Intervention, Prognostic Factor, Exposure (What main intervention are you considering? What do you want to do with this patient?)

C = Comparison (What are you hoping to compare with the intervention: another treatment, drug, placebo, a different diagnostic test, etc.? It's important to include this element and to be as specific as possible.)

O = Outcome (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)

Small collection.  Updated monthly.

Two additional important elements of the well-built clinical question to consider are the type of foreground question and the type of study (methodology) . This information can be helpful in focusing the question and determining the most appropriate type of evidence.

Foreground questions can be further divided into questions that relate to therapy, diagnosis, prognosis, etiology/harm

• Therapy: Questions of treatment in order to achieve some outcome. May include drugs, surgical intervention, change in diet, counseling, etc.
• Diagnosis: Questions of identification of a disorder in a patient presenting with specific symptoms.
• Prognosis: Questions of progression of a disease or likelihood of a disease occurring.
• Etiology/Harm: Questions of negative impact from an intervention or other exposure.

Meta-analysis: A statistical technique that summarizes the results of several studies in a single weighted estimate, in which more weight is given to results of studies with more events and sometimes to studies of higher quality.

Systematic Review: a review in which specified and appropriate methods have been used to identify, appraise, and summarize studies addressing a defined question. (It can, but need not, involve meta-analysis). In Clinical Evidence, the term systematic review refers to a systematic review of RCTs unless specified otherwise.

Randomized Controlled Trial: a trial in which participants are randomly assigned to two or more groups: at least one (the experimental group) receiving an intervention that is being tested and another (the comparison or control group) receiving an alternative treatment or placebo. This design allows assessment of the relative effects of interventions.

Controlled Clinical Trial: a trial in which participants are assigned to two or more different treatment groups. In Clinical Evidence, we use the term to refer to controlled trials in which treatment is assigned by a method other than random allocation. When the method of allocation is by random selection, the study is referred to as a randomized controlled trial (RCT). Non-randomized controlled trials are more likely to suffer from bias than RCTs.

Cohort Study: a non-experimental study design that follows a group of people (a cohort), and then looks at how events differ among people within the group. A study that examines a cohort, which differs in respect to exposure to some suspected risk factor (e.g. smoking), is useful for trying to ascertain whether exposure is likely to cause specified events (e.g. lung cancer). Prospective cohort studies (which track participants forward in time) are more reliable than retrospective cohort studies.

Case control study: a study design that examines a group of people who have experienced an event (usually an adverse event) and a group of people who have not experienced the same event, and looks at how exposure to suspect (usually noxious) agents differed between the two groups. This type of study design is most useful for trying to ascertain the cause of rare events, such as rare cancers.

Case Series: analysis of series of people with the disease (there is no comparison group in case series).

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Health Humanities: Primary and Secondary Sources: Research Question

• Research Question
• Primary Sources
• Secondary Sources
• Wheel of Sources
• MHB 240/440 History of the Body

How to Develop your Research Question?

What is a research question? A research question is a question around which you center your research. It should be:

• clear : it provides enough specifics that one’s audience can easily understand its purpose without needing additional explanation.
• focused : it is narrow enough that it can be answered thoroughly in the space the writing task allows.
• concise : it is expressed in the fewest possible words.
• complex : it is not answerable with a simple “yes” or “no,” but rather requires synthesis and analysis of ideas and sources prior to the composition of an answer.
• arguable : its potential answers are open to debate rather than accepted facts.

You should ask a question about an issue that you are genuinely curious and/or passionate about.

The question you ask should be developed for the discipline you are studying. A question appropriate for Biology, for instance, is different from an appropriate one in Political Science or Sociology. If you are developing your question for a course other than the first-year composition, you may want to discuss your ideas for a research question with your professor.

Why is a Research Question Essential?

Why is a research question essential to the research process? Research questions help writers focus their research by providing a path through the research and writing process. The specificity of a well-developed research question helps writers avoid the “all-about” paper and work toward supporting a specific, arguable thesis.

Steps to developing a research question:

• Choose an interesting general topic.  Most professional researchers focus on topics they are genuinely interested in studying. Writers should choose a broad topic about which they genuinely would like to know more. An example of a general topic might be “Slavery in the American South” or “Films of the 1930s.”
• Do some preliminary research on your general topic.  Do a few quick searches in current periodicals and journals on your topic to see what’s already been done and to help you narrow your focus. What issues are scholars and researchers discussing, when it comes to your topic? What questions occur to you as you read these articles?
• Consider your audience.  For most college papers, your audience will be academic, but always keep your audience in mind when narrowing your topic and developing your question. Would that particular audience be interested in the question you are developing?
• Start asking questions.  Taking into consideration all of the above, start asking yourself open-ended “how” and “why” questions about your general topic. For example, “Why were slave narratives effective tools in working toward the abolishment of slavery?” or “How did the films of the 1930s reflect or respond to the conditions of the Great Depression?”
• Is your research question clear?  With so much research available on any given topic, research questions must be as clear as possible in order to be effective in helping the writer direct his or her research.
• Is your research question focused?  Research questions must be specific enough to be well covered in the space available.
• Is your research question complex?  Research questions should not be answerable with a simple “yes” or “no” or by easily-found facts.  They should, instead, require both research and analysis on the part of the writer. They often begin with “How” or “Why.”
• Begin your research .  After you’ve come up with a question, think about the possible paths your research could take. What sources should you consult as you seek answers to your question? What research process will ensure that you find a variety of perspectives and responses to your question?

Sample Research Questions

Unclear:  How should social networking sites address the harm they cause? Clear:  What action should social networking sites like Instagram and Facebook take to protect users’ personal information and privacy? The unclear version of this question doesn’t specify which social networking sites or suggest what kind of harm the sites might be causing. It also assumes that this “harm” is proven and/or accepted. The clearer version specifies sites (Instagram and Facebook), the type of potential harm (privacy issues), and who may be experiencing that harm (users). A strong research question should never leave room for ambiguity or interpretation. Unfocused:   What is the effect on the environment from global warming? Focused:   What is the most significant effect of glacial melting on the lives of penguins in Antarctica?

The unfocused research question is so broad that it couldn’t be adequately answered in a book-length piece, let alone a standard college-level paper. The focused version narrows down to a specific effect of global warming (glacial melting), a specific place (Antarctica), and a specific animal that is affected (penguins). It also requires the writer to take a stance on which effect has the greatest impact on the affected animal. When in doubt, make a research question as narrow and focused as possible.

Too simple:   How are doctors addressing diabetes in the U.S.? Appropriately Complex:    What main environmental, behavioral, and genetic factors predict whether Americans will develop diabetes, and how can these commonalities be used to aid the medical community in the prevention of the disease?

The simple version of this question can be looked up online and answered in a few factual sentences; it leaves no room for analysis. The more complex version is written in two parts; it is thought-provoking and requires both significant investigation and evaluation from the writer. As a general rule of thumb, if a quick Google search can answer a research question, it’s likely not very effective.

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• Open access
• Published: 26 November 2018

The 150 most important questions in cancer research and clinical oncology series: questions 94–101

Edited by Cancer Communications

Cancer Communications

Cancer Communications volume  38 , Article number:  69 ( 2018 ) Cite this article

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Since the beginning of 2017, Cancer Communications (former title: Chinese Journal of Cancer ) has published a series of important questions regarding cancer research and clinical oncology, to provide an enhanced stimulus for cancer research, and to accelerate collaborations between institutions and investigators. In this edition, the following 8 valuable questions are presented. Question 94. The origin of tumors: time for a new paradigm? Question 95. How can we accelerate the identification of biomarkers for the early detection of pancreatic ductal adenocarcinoma? Question 96. Can we improve the treatment outcomes of metastatic pancreatic ductal adenocarcinoma through precision medicine guided by a combination of the genetic and proteomic information of the tumor? Question 97. What are the parameters that determine a competent immune system that gives a complete response to cancers after immune induction? Question 98. Is high local concentration of metformin essential for its anti-cancer activity? Question 99. How can we monitor the emergence of cancer cells anywhere in the body through plasma testing? Question 100. Can phytochemicals be more specific and efficient at targeting P-glycoproteins to overcome multi-drug resistance in cancer cells? Question 101. Is cell migration a selectable trait in the natural evolution of carcinoma?

Until now, the battle against cancer is still ongoing, but there are also ongoing discoveries being made. Milestones in cancer research and treatments are being achieved every year; at a quicker pace, as compared to decades ago. Likewise, some cancers that were considered incurable are now partly curable, lives that could not be saved are now being saved, and for those with yet little options, they are now having best-supporting care. With an objective to promote worldwide cancer research and even accelerate inter-countries collaborations, since the beginning of 2017, Cancer Communications (former title: Chinese Journal of Cancer ) has launched a program of publishing 150 most important questions in cancer research and clinical oncology [ 1 ]. We are providing a platform for researchers to freely voice-out their novel ideas, and propositions to enhance the communications on how and where our focus should be placed [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. In this edition, 8 valuable and inspiring questions, Question 94–101, from highly distinguished professionals from different parts of the world are presented. If you have any novel proposition(s) and Question(s), please feel free to contact Ms. Ji Ruan via email: [email protected].

Question 94: The origin of tumors: time for a new paradigm?

Background and implications.

“There is no worse blind man than the one who doesn’t want to see. There is no worse deaf man than the one who doesn’t want to hear. And there is no worse madman than the one who doesn’t want to understand.” —Ancient Proverb

In the past half-century, cancer biologists have focused on a dogma in which cancer was viewed as a proliferative disease due to mechanisms that activate genes (oncogenes) to promote cell proliferation or inactivate genes (tumor suppressor genes) to suppress tumor growth. In retrospect, these concepts were established based on functional selections, by using tissue culture (largely mouse NIH 3T3 cells) for the selection of transformed foci at the time when we knew virtually nothing about the human genome [ 14 ]. However, it is very difficult to use these genes individually or in combinations to transform primary human cells. Further, the simplified view of uncontrolled proliferation cannot explain the tumor as being a malignant organ or a teratoma, as observed by pathologists over centuries. Recently, the cancer genomic atlas project has revealed a wide variety of genetic alterations ranging from no mutation to multiple chromosomal deletions or fragmentations, which make the identification of cancer driver mutations very challenging in a background of such a massive genomic rearrangement. Paradoxically, this increase the evidences demonstrating that the oncogenic mutations are commonly found in many normal tissues, further challenging the dogma that genetic alteration is the primary driver of this disease.

Logically, the birth of a tumor should undergo an embryonic-like development at the beginning, similar to that of a human. However, the nature of such somatic-derived early embryo has been elusive. Recently, we provided evidence to show that polyploid giant cancer cells (PGCCs), which have been previously considered non-dividing, are actually capable of self-renewal, generating viable daughter cells via amitotic budding, splitting and burst, and capable of acquisition of embryonic-like stemness [ 15 , 16 , 17 ]. The mode of PGCC division is remarkably similar to that of blastomere, a first step in human embryogenesis following fertilization. The blastomere nucleus continuously divides 4–5 times without cytoplasmic division to generate 16–32 cells and then to form compaction/morulae before developing into a blastocyst [ 18 ]. Based on these data and similarity to the earliest stage of human embryogenesis, I propose a new theory that tumor initiation can be achieved via a dualistic origin, similar to the first step of human embryogenesis via the formation of blastomere-like cells, i.e. the activation of blastomere or blastomere-like cells which leads to the dedifferentiation of germ cells or somatic cells, respectively, which is then followed by the differentiation to generate their respective stem cells, and the differentiation arrest at a specific developmental hierarchy leading to tumor initiation [ 19 ]. The somatic-derived blastomere-like cancer stem cell follows its own mode of cell growth and division and is named as the giant cell cycle. This cycle includes four distinct but overlapping phases: the initiation, self-renewal, termination, and stability phases. The giant cell cycle can be tracked in vitro and in vivo due to their salient giant cell morphology (Fig.  1 ).

One mononucleated polyploid giant cancer cell (PGCC) in the background of regular size diploid cancer cells. The PGCC can be seen to be at least 100 times larger than that of regular cancer cells

This new theory challenges the traditional paradigm that cancer is a proliferative disease, and proposes that the initiation of cancer requires blastomere-like division that is similar to that of humans before achieving stable proliferation at specific developmental hierarchy in at least half of all human cancers. This question calls for all investigators in the cancer research community to investigate the role of PGCCs in the initiation, progression, resistance, and metastasis of cancer and to look for novel agents to block the different stages of the giant cell cycle.

The histopathology (phenotype) of cancers has been there all the time. It is just the theory of cancer origin proposed by scientists that changes from time to time. After all, trillions of dollars have been invested in fighting this disease by basing on its genetic origin in the past half-century, yet, little insight has been gained [ 14 ]. Here are two quotes from Einstein: “Insanity: doing the same thing over and over again expecting different results”, and “We cannot solve our problems with the same thinking we used when created them”.

In short, it is time to change our mindset and to start pursuing PGCCs, which we can observe under the microscope. But with very little understanding about these cells, it is time for a shift in paradigm.

Jinsong Liu.

Affiliation

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4095, USA.

Email address

[email protected]

Question 95: How can we accelerate the identification of biomarkers for the early detection of pancreatic ductal adenocarcinoma?

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers in the world with a dismal 5-year overall survival rate of less than 5%; which has not been significantly improved since the past decades. Although surgical resection is the only option for curative treatment of PDAC, only 15%–20% of patients with PDAC have the chance to undergo curative resection, leaving the rest with only palliative options in hope for increasing their quality of life; since they were already at unresectable and non-curative stages at their first diagnosis.

The lack of specific symptoms in the early-stage of PDAC is responsible for rendering an early diagnosis difficult. Therefore, more sensitive and specific screening methodologies for its early detection is urgently needed to improve its diagnosis, starting early treatments, and ameliorating prognoses. The diagnosis so far relies on imaging modalities such as abdominal ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), and positron emission tomography (PET). One may propose to screen for pancreatic cancer in high-risk populations, which is highly recommended, however screening intervention for all the people is not a wise choice; when considering the relatively low prevalence of PDAC, and the difficulty for diagnosing it in its early stage [ 20 ].

Therefore, alternative diagnostic tools for early detection of PDAC are highly expected. Among the biomarkers currently used in clinical practice, carbohydrate antigen 19–9 (CA19–9) is among the most useful one for supporting the diagnosis of PDAC, but it is neither sufficiently sensitive nor specific for its early detection. Yachida et al. reported in 2010 that the initiating mutation in the pancreas occurs approximately two decades before the PDAC to start growing in distant organs [ 21 ], which indicates a broad time of the window of opportunity for the early detection of PDAC. With the advancement in next-generation sequencing technology, the number of reported studies regarding novel potential molecular biomarkers in bodily fluids including the blood, feces, urine, saliva, and pancreatic juice for early detection of PDAC has been increasing. Such biomarkers may be susceptible to detect mutations at the genetic or epigenetic level, identifying important non-coding RNA (especially microRNA and long non-coding RNA), providing insights regarding the metabolic profiles, estimating the tumor level in liquid biopsies (circulating free DNA, circulating tumor cells and exosomes), and so on.

Another approach to identifying biomarkers for the early detection of pancreatic cancer is using animal models. In spontaneous animal models of pancreatic cancer, such as Kras-mutated mouse models, it is expected that by high throughput analyses of the genetic/epigenetic/proteomic alterations, some novel biomarkers might be able to be identified. For instance, Sharma et al. reported in 2017 that the detection of phosphatidylserine-positive exosomes enabled the diagnosis of early-stage malignancies in LSL-Kras G12D , Cdkn2a lox/lox : p48 Cre and LSL-Kras G12d/+ , LSL-Trp R172H/+ , and P48 Cre mice [ 22 ].

These analyses in clinical samples or animal models hold the clues for the early detection of PDAC, however, further studies are required to validate their diagnostic performance. What’s most important, will be the lining-up of these identified prospective biomarkers, to validate their sensitivities and specificities. This will determine their potential for widespread clinical applicability, and hopefully, accelerate the early diagnosis of PDAC.

Mikiya Takao 1,2 , Hirotaka Matsuo 2 , Junji Yamamoto 1 , and Nariyoshi Shinomiya 2 .

1 Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan; 2 Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.

E-mail address

[email protected]; [email protected]; [email protected]; [email protected]

Question 96: Can we improve the treatment outcomes of metastatic pancreatic ductal adenocarcinoma through precision medicine guided by a combination of the genetic and proteomic information of the tumor?

Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant cancers, and nearly half of the patients had metastatic PDAC when they are initially diagnosed. When they are accompanied by metastatic tumors, unlike most solid cancer, PDAC cannot be cured with primary surgical resection alone [ 23 , 24 ]. Also, since PDAC has poor responses to conventional therapies, improvements in adjunctive treatment approach including chemo- and immuno-therapy are earnestly required. From this standpoint, recent results regarding the differences in the molecular evolution of pancreatic cancer subtypes provide a new insight into its therapeutic development [ 25 ], which may lead to the improvement of the prognosis of not only metastatic PDAC but also of locally advanced or recurrent PDAC.

In fact, new chemotherapeutic regimens such as the combination of gemcitabine with nab-paclitaxel and FOLFIRINOX have been reported to show improved prognosis despite a lack of examples of past successes in the treatment of patients with metastatic PDAC who had undergone R0 resection [ 26 ]. While many mutations including KRAS , CDKN2A , TP53, and SMAD4 are associated with pancreatic carcinogenesis, no effective molecular targeted drug has been introduced in the clinical setting so far. A recent report of a phase I/II study on refametinib, a MEK inhibitor, indicated that KRAS mutation status might affect the overall response rate, disease control rate, progression-free survival, and overall survival of PDAC in combination with gemcitabine [ 27 ].

While immunotherapy is expected to bring a great improvement in cancer treatment, until now, immune checkpoint inhibitors have achieved limited clinical benefit for patients with PDAC. This might be because PDAC creates a uniquely immunosuppressive tumor microenvironment, where tumor-associated immunosuppressive cells and accompanying desmoplastic stroma prevent the tumor cells from T cell infiltration. Recently reported studies have indicated that immunotherapy might be effective when combined with focal adhesion kinase (FAK) inhibitor [ 28 ] or IL-6 inhibitor [ 29 ], but more studies are required to validate their use in clinical practice.

As such, we believe that if the dynamic monitoring of drug sensitivity/resistance in the individual patients is coupled with precision treatment based on individualized genetics/epigenetics/proteomics alterations in the patients’ tumor, this could improve the treatment outcomes of PDAC.

Mikiya Takao 1,2 , Hirotaka Matsuo 2 , Junji Yamamoto 1 , and Nariyoshi Shinomiya 2.

Question 97: What are the parameters that determine a competent immune system that gives a complete response to cancers after immune induction?

Recently, cancer immunotherapy has shown great clinical benefit in multiple types of cancers [ 30 , 31 , 32 ]. It has provided new approaches for cancer treatment. However, it has been observed that only a fraction of patients respond to immunotherapy.

Much effort has been made to identify markers for immunotherapeutic response. Tumor mutation burden (TMB), mismatch repair (MMR) deficiency, PD-L1 expression, and tumor infiltration lymphocyte (TIL) have been found to be associated with an increased response rate in checkpoint blockade therapies. Unfortunately, a precise prediction is still challenging in this field. Moreover, when to stop the treatment of immunotherapy is an urgent question that remains to be elucidated.

In other words, there is no available approach to determine if a patient has generated a good immune response against the cancer after immunotherapy treatments. All of these indicate the complexity and challenges that reside for implementing novel man-induced cancer-effective immune response therapeutics. A variety of immune cells play collaborative roles at different stages to recognize antigens and eventually to generate an effective anti-cancer immune response. Given the high complexity of the immune system, a rational evaluation approach is needed to cover the whole process. Moreover, we need to perfect vaccine immunization and/or in vitro activation of T cells to augment the function of the immune system; particularly the formation of immune memory.

Edison Liu 1 , Penghui Zhou 2 , Jiang Li 2 .

1 The Jackson Laboratory, Bar Harbor, ME 04609, USA; 2 Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China.

[email protected]; [email protected]; [email protected]

Question 98: Is high local concentration of metformin essential for its anti-cancer activity?

Metformin was approved as a first line of anti-diabetic drug since decades. Interestingly, the fact that clinical epidemiological studies have shown that metformin can reduce the risk of a variety of cancers stimulates considerable recognition to explore its anticancer activity.

Although the in vitro and in vivo experimental results have demonstrated that metformin can have some potential anti-tumor effects, more than 100 clinical trials did not achieve such desirable results [ 33 ]. We and others believe that the main problem resides in the prescribing doses used. For cancer treatment, a much higher dose may be needed for observing any anti-tumor activities, as compared to the doses prescribed for diabetics [ 34 , 35 , 36 ].

Further, if the traditional local/oral administration approach is favored, the prescribed metformin may not be at the required dose-concentration once it reaches the blood to have the effective anti-cancer activities. We, therefore, propose that intravesical instillation of metformin into the bladder lumen could be a promising way to treat for bladder cancer, at least. We have already obtained encouraging results both in vitro and in vivo experiments, including in an orthotopical bladder cancer model [ 36 , 37 ]. Now, we are waiting to observe its prospective clinical outcome.

Mei Peng 1 , Xiaoping Yang 2 .

1 Department of Pharmacy, Xiangya Hospital, Central South University. Changsha, Hunan 410083, P. R. China; 2 Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, Department of Pharmacy, School of Medicine, Hunan Normal University, Changsha, Hunan 410013, P. R. China.

[email protected]; [email protected]

Question 99: How can we monitor the emergence of cancer cells anywhere in the body through plasma testing?

The early detection of cancer is still a relentless worldwide challenge. The sensitivity and specificity of traditional blood tumor markers and imaging technologies are still to be greatly improved. Hence, novel approaches for the early detection of cancer are urgently needed.

The emergence of liquid biopsy technologies opens a new driveway for solving such issues. According to the definition of the National Cancer Institute of the United States, a liquid biopsy is a test done on a sample of blood to look for tumorigenic cancer cells or pieces of tumor cells’ DNA that are circulating in the blood [ 38 ]. This definition implies two main types of the current liquid biopsy: one that detects circulating tumor cells and the other that detects non-cellular material in the blood, including tumor DNA, RNA, and exosomes.

Circulating tumor cells (CTCs) are referred to as tumor cells that have been shed from the primary tumor location and have found their way to the peripheral blood. CTCs were first described in 1869 by an Australian pathologist, Thomas Ashworth, in a patient with metastatic cancer [ 39 ]. The importance of CTCs in modern cancer research began in the mid-1990s with the demonstration that CTCs exist early in the course of the disease.

It is estimated that there are about 1–10 CTCs per mL in whole blood of patients with metastatic cancer, even fewer in patients with early-stage cancer [ 40 ]. For comparison, 1 mL of blood contains a few million white blood cells and a billion erythrocytes. The identification of CTCs, being in such low frequency, requires some special tumoral markers (e.g., EpCAM and cytokeratins) to capture and isolate them. Unfortunately, the common markers for recognizing the majority of CTCs are not effective enough for clinical application [ 41 ]. Although accumulated evidences have shown that the presence of CTCs is a strong negative prognostic factor in the patients with metastatic breast, lung and colorectal cancers, detecting CTCs might not be an ideal branch to hold on for the hope of early cancer detection [ 42 , 43 , 44 , 45 ].

Circulating tumor DNA (ctDNA) is tumor-derived fragmented DNA in the circulatory system, which is mainly derived from the tumor cell death through necrosis and/or apoptosis [ 46 ]. Given its origin, ctDNA inherently carries cancer-specific genetic and epigenetic aberrations, which can be used as a surrogate source of tumor DNA for cancer diagnosis and prognostic prediction. Ideally, as a noninvasive tumor early screening tool, a liquid biopsy test should be able to detect many types of cancers and provide the information of tumor origin for further specific clinical management. In fact, the somatic mutations of ctDNA in different types of tumor are highly variable, even in the different individuals with the same type of tumor [ 47 ]. Additionally, most tumors do not possess driver mutations, with some notable exceptions, which make the somatic mutations of ctDNA not suitable for early detection of the tumor.

Increased methylation of the promoter regions of tumor suppressor genes is an early event in many types of tumor, suggesting that altered ctDNA methylation patterns could be one of the first detectable neoplastic changes associated with tumorigenesis [ 48 ]. ctDNA methylation profiling provides several advantages over somatic mutation analysis for cancer detection including higher clinical sensitivity and dynamic range, multiple detectable methylation target regions, and multiple altered CpG sites within each targeted genomic region. Further, each methylation marker is present in both cancer tissue and ctDNA, whereas only a fraction of mutations present in cancer tissue could be detected in ctDNA.

In 2017, there were two inspiring studies that revealed the values of using ctDNA methylation analysis for cancer early diagnosis [ 49 , 50 ]. After partitioning the human genome into blocks of tightly coupled CpG methylation sites, namely methylation haplotype blocks (MHBs), Guo and colleagues performed tissue-specific methylation analyses at the MHBs level to accurately determine the tissue origin of the cancer using ctDNA from their enrolled patients [ 49 ]. In another study, Xu and colleagues identified a hepatocellular carcinoma (HCC) enriched methylation marker panel by comparing the HCC tissue and blood leukocytes from normal individuals and showed that methylation profiles of HCC tumor DNA and matched plasma ctDNA were highly correlated. In this study, after quantitative measurement of the methylation level of candidate markers in ctDNA from a large cohort of 1098 HCC patients and 835 normal controls, ten methylation markers were selected to construct a diagnostic prediction model. The proposed model demonstrated a high diagnostic specificity and sensitivity, and was highly correlated with tumor burden, treatment response, and tumor stage [ 50 ].

With the rapid development of highly sensitive detection methods, especially the technologies of massively parallel sequencing or next-generation sequencing (NGS)-based assays and digital PCR (dPCR), we strongly believe that the identification of a broader “pan-cancer” methylation panel applied for ctDNA analyses, probably in combination with detections of somatic mutation and tumor-derived exosomes, would allow more effective screening for common cancers in the near future.

Edison Liu 1 , Hui-Yan Luo 2 .

[email protected]; [email protected]

Question 100: Can phytochemicals be more specific and efficient at targeting P-glycoproteins to overcome multi-drug resistance in cancer cells?

Though several anticancer agents are approved to treat different types of cancers, their full potentials have been limited due to the occurrence of drug resistance. Resistance to anticancer drugs develops by a variety of mechanisms, one of which is increased drug efflux by transporters. The ATP-binding cassette (ABC) family drug efflux transporter P-glycoprotein (P-gp or multi-drug resistance protein 1 [MDRP1]) has been extensively studied and is known to play a major role in the development of multi-drug resistance (MDR) to chemotherapy [ 51 ]. In brief, overexpressed P-gp efflux out a wide variety of anticancer agents (e.g.: vinca alkaloids, doxorubicin, paclitaxel, etc.), leading to a lower concentration of these drugs inside cancer cells, thereby resulting in MDR. Over the past three decades, researchers have developed several synthetic P-gp inhibitors to block the efflux of anticancer drugs and have tested them in clinical trials, in combination with chemotherapeutic drugs. But none were found to be suitable enough in overcoming MDR and to be released for marketing, mainly due to the side effects associated with cross-reactivity towards other ABC transporters (BCRP and MRP-1) and the inhibition of CYP450 drug metabolizing enzymes [ 52 , 53 ].

On the other hand, a number of phytochemicals have been reported to have P-gp inhibitory activity. Moreover, detailed structure–activity studies on these phytochemicals have delineated the functional groups essential for P-gp inhibition [ 53 , 54 ]. Currently, one of the phytochemicals, tetrandrine (CBT-1 ® ; NSC-77037), is being used in a Phase I clinical trial ( http://www.ClinicalTrials.gov ; NCT03002805) in combination with doxorubicin for the treatment of metastatic sarcoma. Before developing phytochemicals or their derivatives as P-gp inhibitors, they need to be investigated thoroughly for their cross-reactivity towards other ABC transporters and CYP450 inhibition, in order to avoid toxicities similar to the older generation P-gp inhibitors that have failed in clinical trials.

Therefore, the selectivity for P-gp over other drug transporters and drug metabolizing enzymes should be considered as important criterias for the development of phytochemicals and their derivatives for overcoming MDR.

Mohane Selvaraj Coumar and Safiulla Basha Syed.

Centre for Bioinformatics, School of Life Sciences, Pondicherry University, Kalapet, Puducherry 605014, India.

[email protected]; [email protected]

Question 101: Is cell migration a selectable trait in the natural evolution of carcinoma?

The propensity of solid tumor malignancy to metastasize remains the main cause of cancer-related death, an extraordinary unmet clinical need, and an unanswered question in basic cancer research. While dissemination has been traditionally viewed as a late process in the progression of malignant tumors, amount of evidence indicates that it can occur early in the natural history of cancer, frequently when the primary lesion is still barely detectable.

A prerequisite for cancer dissemination is the acquisition of migratory/invasive properties. However, whether, and if so, how the migratory phenotype is selected for during the natural evolution of cancer and what advantage, if any, it may provide to the growing malignant cells remains an open issue. The answers to these questions are relevant not only for our understating of cancer biology but also for the strategies we adopt in an attempt of curbing this disease. Frequently, indeed, particularly in pharmaceutical settings, targeting migration has been considered much like trying “to shut the stable door after the horse has bolted” and no serious efforts in pursuing this aim has been done.

We argue, instead, that migration might be an intrinsic cancer trait that much like proliferation or increased survival confers to the growing tumor masses with striking selective advantages. The most compelling evidence in support for this contention stems from studies using mathematical modeling of cancer evolution. Surprisingly, these works highlighted the notion that cell migration is an intrinsic, selectable property of malignant cells, so intimately intertwined with more obvious evolutionarily-driven cancer traits to directly impact not only on the potential of malignant cells to disseminate but also on their growth dynamics, and ultimately provide a selective evolutionary advantage. Whether in real life this holds true remains to be assessed, nevertheless, work of this kind defines a framework where the acquisition of migration can be understood in a term of not just as a way to spread, but also to trigger the emergence of malignant clones with favorable genetic or epigenetic traits.

Alternatively, migratory phenotypes might emerge as a response to unfavorable conditions, including the mechanically challenging environment which tumors, and particularly epithelial-derived carcinoma, invariably experience. Becoming motile, however, may not per se being fixed as phenotypic advantageous traits unless it is accompanied or is causing the emergence of specific traits, including drug resistance, self-renewal, and survival. This might be the case, for example, during the process of epithelial-to-mesenchymal transition (EMT), which is emerging as an overarching mechanism for dissemination. EMT, indeed, may transiently equip individual cancer cells not only with migratory/invasive capacity but also with increased resistance to drug treatment, stemness potential at the expanse of fast proliferation.

Thus, within this framework targeting pro-migratory genes, proteins and processes may become a therapeutically valid alternative or a complementary strategy not only to control carcinoma dissemination but also its progression and development.

Giorgio Scita.

IFOM, The FIRC Institute of Molecular Oncology, Via Adamello 16, 20139 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), School of Medicine, University of Milan, Via Festa del Perdono 7, 20122, Italy.

[email protected]

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Cancer Communications. The 150 most important questions in cancer research and clinical oncology series: questions 94–101. Cancer Commun 38 , 69 (2018). https://doi.org/10.1186/s40880-018-0341-9

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• Tumor origin
• Polyploid giant cancer cell
• Pancreatic ductal adenocarcinoma
• Liquid biopsy
• Spontaneous animal model
• Chemotherapy
• Immunotherapy
• Precision treatment
• Vaccine immunization
• Circulating tumor cell
• Circulating tumor DNA
• CpG methylation
• Methylation haplotype block
• Phytochemicals
• P-Glycoprotein
• Multi-drug resistance
• P-Glycoprotein inhibitor
• Epithelial-to-mesenchymal transition
• Pro-migratory gene

ISSN: 2523-3548

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Writing for Healthcare Professionals: Creating a Research Question

• Finding Sources
• Creating a Research Question
• Search Terms
• Search Strategies
• Recording Your Research
• Journal Articles
• Books & Other Sources
• Online Help
• Publisher URL

Choosing a Topic

Sometimes the most difficult part of the research process is choosing a topic.  Here are some tips for selecting a research question that you will enjoy learning about and will ultimately lead to a good grade.

• Read through your assignment.   Professors design an assignment outline for a reason.  Make sure your topic can and will adhere to their requirements and guidelines.
• Choose a topic you are interested in.   If you don't like what you're researching, chances are you won't learn a whole lot or enjoy the process.  And really, what's the point of that?  
• Browse resources that relate to your course work.  Look through a newspaper, magazine, or database for current events or hot topics.  Browsing can spark a lot of great ideas and can help you refine your topic.
• Ask for help!   There is nothing wrong with asking your professor or a librarian to help you brainstorm ideas.

Where to Start

The links below are great places to start in developing a research question.  Browsing current events and hot topics can spark your interest and inspire a topic.

• Alvernia's "Opposing Viewpoints" Collection
• Alvernia's Reference Collection
• Anatomy & Physiology
• Athletic Training Websites
• Google Trends
• Health & Medicine
• Hot Paper Topics
• Hot Topics for Research Papers
• MedLinePlus This link opens in a new window
• National Library of Medicine
• Opposing Viewpoints in Context This link opens in a new window
• Human Diseases
• New York Times
• NPR Research News
• Pew Research Center
• Public Agenda's Programs and Reports

How to Formulate an Answerable Clinical Question

P opulation/patients

I ntervention/indicator

C omparator/control

• P I C O: Formulate an Answerable Question
• Formulating Answerable Clinical Questions

Developing your Research Question

Try asking yourself these questions to help develop a research question:

Topic:  Obesity

Who?  teenagers

What?  consumption of high fat foods

Where?  school cafeterias

Question :  How does the consumption of high fat foods in school cafeterias contribute to teenager obesity?

Topic: Smoke Exposure

Who?   children exposed to smoke

What?   developmental abilities

Question :  How does smoke exposure alter the developmental abilities of children?

Below is worksheet which will help illustrate how a research question develops from a broad topic to a focused question.  This could be a helpful resource for you during the process of creating your research question.

• Creating a Research Question Helps you to write a narrow, focused research question.

Subject Terms to Consider

Below is a list of subjects that often  relate to nursing issues .  Considering these subject terms can help you  develop a topic  or  focus your search .

• Nursing research
• Evidence-based nursing

Helpful Tools

• bubbl.us - Brainstorming Made Simple
• Critical Thinking Model
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University of Kansas Medical Center

A.R. Dykes Library

Nursing research guide.

• Introduction
• Scholarly vs Non-Scholarly
• Primary, Secondary, & Tertiary Research
• Qualitative & Quantitative Data
• Evidence-Based Practice
• Types of Study Designs
• Types of Reviews
• Searching Tips
• Books, Images, & More
• Open Educational Resources (OER)
• Finding Guidelines
• PICO Questions
• News, Blogs, & More
• CIting, Writing, & Publishing

Example Sources:

• UNC-Chapel Hill Health Sciences Library PICO Examples

What is PICO?

• P: Population, patient, or problem
• I: Intervention or indicator
• C: Comparison or control

PICO  is a formula used to develop a researchable clinical question. 

The purpose of a PICO question is to help breakdown a research question into smaller parts, making the evaluation of evidence more straightforward.

P:  Population, patient, or problem

I:  Intervention or indicator

C:  Comparison or control

O:  Outcome

Note: Not every question will have a time frame or a comparison. Outcomes should be a measure of clinical well-being/quality of life.

P: Population, patient, or problem

Who is the patient or population? (Think demographics: age, sex, gender, race).

What problem or disease or situation are you facing?

I: Intervention or indicator

What do you plan to do for your patient? (medications, diagnostic tests, therapies, procedures)

What intervention is implemented to help make a difference to your patient/population?

C: Comparison or control

What other interventions should be considered? What can we compare our research too?

Is there a control group you would like to compare your intervention with?

O: Outcome

What is the desired or effective outcome of the intervention compared to the control?

Forming Focused Question with PICO: Case Study

Case: patient education.

• You are a nurse working in a busy inpatient medical surgical unit. The patients on your unit are admitted for a wide variety of conditions: renal, GI, dermatologic, etc.
• All patients admitted that are chronic smokers are given brief counseling by an RN and a self-help brochure about smoking cessation, but no follow up counseling after that.
• You hear your coworkers complaining that they feel like they are wasting their time because they think the patients will resume smoking after discharge.
• You decide you want to find out if this minimal contact intervention works in the long term.

P: Consider when choosing your Patient/Problem/Population

• What are the most important characteristics?
• Relevant demographic factors
• The setting

I: Consider for your Intervention

• What is the main intervention, treatment, diagnostic test, procedure, or exposure?
• Think of dosage, frequency, duration, and mode of delivery

C: Consider for your Comparison

• Inactive control intervention: Placebo, standard care, no treatment
• Active control intervention: A different drug, dose, or kind of therapy

O: Consider for your Outcome

• Be specific and make it measurable
• It can be something objective or subjective

PICO: Putting It Together

Your full PICO question is:

"Among hospitalized chronic smokers, does a brief educational nursing intervention lead to long term smoking cessation [when compared with no intervention]?"

PICO Question Examples

• Infection Control
• Labor & Delivery

Patients on coronary artery bypass graft (CABG) waiting lists often experience anxiety and depression and your nurse manager wants to know if it would be a good idea to reach out to these patients with presurgical home visits and follow-up calls from a specialist cardiac nurse.

P: patients on CABG waiting lists I: program consisting of presurgical home visit and follow-up calls form a specialist cardiac nurse C: no intervention O: decreased patient anxiety and depression  

For patients on CABG waiting lists, does an intervention program consisting of presurgical home visits and follow-up calls from a specialist cardiac nurse lead to decreased patient anxiety and depression [when compared with no intervention]?

You work in the Big City Hospital ICU. Your mechanically ventilated patients sometimes contract nosocomial pneumonia, which leads to costly complications. You want to know if raising the head of the bed lowers the chance of the patient contracting pneumonia compared to letting the patient lie flat on their back.

P: mechanically ventilated ICU patients I: semi-fowlers position C: supine position O: lower incidence of nosocomial pneumonia In mechanically ventilated ICU patients, does positioning the patient in semi-fowlers result in a lower incidence of nosocomial pneumonia when compared to the supine position?

In the past few years, your hospital has installed antibacterial foam dispensers on all the nursing units. You’ve had nurses asking you if the foam is just as effective as washing their hands with water and soap.

P: hospital nurses I: using antibacterial foam C: hand washing with soap and water O: decreased bacteria count In hospital nurses, does antibacterial foam decrease bacteria count on hands as much as hand washing with soap and water?

You’re a new nurse on a labor and delivery unit. You’ve noticed that most women give birth in the lithotomy position at the encouragement of their doctors. However, you’re sure you heard in nursing school that other positions are less likely to lead to deliveries with forceps or a vacuum...or did you? You want to find some literature to back up your claim.

P: laboring women delivering in a hospital I: positions other than the lithotomy position C: lithotomy position O: decreased incidence of assisted deliveries In laboring women delivering in the hospital, do positions other than lithotomy position lead to a decreased incidence of assisted deliveries?

You’re the nurse manager of a NICU unit. One concern of parents of infants receiving tube feedings is being able to successfully breastfeed their child upon discharge. One of your staff nurses asks if it would be helpful to give the infants cup feedings instead of tube feedings during their NICU stay.

P: Infants in the NICU I: cup feeding throughout the hospital stay C: tube feedings throughout the hospital stay O: greater reported success with breastfeeding post-discharge In infants in the NICU, will cup feeding throughout the hospital stay lead to greater success with breastfeeding post-discharge when compared to tube feedings?

You work with patients with advanced cancer and have been taught to suggest pain diaries for your patients as a form of pain management. You’ve been wondering for a while now if these diaries actually improve pain control or make pain worse by making patients more aware of their pain.

P: patients with advanced cancer I: keeping a pain journal C: no intervention O: lower reported pain scores In patients with advanced cancer, does keeping a pain journal result in lower reported pain scores when compared to no intervention?

You work in a pediatrician’s office and give patients their routine vaccinations. The younger children are often fearful of needles, and some of the RNs use toys to distract the patients. You want to know if this technique actually has an effect on the children's pain response.

P: young children I: distraction techniques during immunization C: no intervention O: lower pain scores rated by the Faces pain scale In young children, do distraction techniques during immunization administration using toys result in lower pain scores when compared to no intervention?

You work on an inpatient psychiatric unit. One of your patients with chronic schizophrenia, Joe, normally mumbles to himself, but will occasionally speak to others when residents play games together. Noticing this, you say to a coworker that maybe social skills group training sessions would bring out Joe’s conversational skills. Your coworker shakes her head and says "I don’t think so. Joe is in and out of this hospital, he’s a lost cause."

P: Inpatient chronic schizophrenia patients I: social skills group training sessions C: standard care O: increased conversational skills as evidenced by greater number of interactions with peers In inpatient chronic schizophrenia patients, do social skills group training sessions increase conversational skills when compared to standard care?

A diabetic patient from a nursing home has recently been admitted with a stage III pressure ulcers on his heels. The unit nurses have called you in for a wound consult. You have to choose between standard moist wound therapy and using a wound vac.

P: elderly diabetic with stage III foot ulcers I: negative pressure wound therapy C: standard moist wound therapy O: improved wound healing as measured by pressure ulcer grading system guidelines In elderly diabetic patients with stage III foot ulcers, does negative pressure wound therapy lead to improved wound healing when compared to standard moist wound therapy?

The main concern for most of your patients coming out of anesthesia in your PACU is pain. You want to explore nursing interventions you can use on top of medication administration to decrease pain. One coworker mentions trying to make the PACU feel less clinical by playing soft music to relax patients.

P: PACU patients I: soft music as an adjunct to standard care C: standard care alone O: lower reported pain scores In PACU patients, will playing soft music in the PACU as an adjunct to standard care result in lower reported pain scores when compared to standard care alone?

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Evidence-Based Medicine: Ask a Clinical Question

• What is EBM?
• Study Design
• 6S Hierarchy of EBM Resources
• Searching Techniques
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Type of Questions

Clinical questions arise around the central issues involved in caring for patients. It is helpful to narrow down the type of clinical question you are asking. There are four main types of clinical questions:

    1. Therapy : questions concerning the effectiveness of a treatment or preventative measure.

    2. Harm/Etiology :   questions concerning the likelihood of a therapeutic intervention to cause harm.

    3. Diagnosis : questions concerning the ability of a test to predict the likelihood of a disease.

    4. Prognosis :   questions concerning the future course of a patient with a particular condition.

Why Spend Time Formulating Questions?

Well-formulated questions can help in many ways:

1. They help you focus on evidence that is directly relevant to patients’ clinical needs.

2. They help you focus on evidence that directly addresses clinicians' or learners' knowledge needs.

3. They can suggest high-yield search strategies.

4. They suggest the forms that useful answers might take.

5. They can help to communicate more clearly with clinicians and facilitate education and learning.

PICOTS Framework for Clinical Questions

When well built, clinical questions usually have four components:

P : The patient situation, population, or problem of interest. I : The main intervention, defined very broadly, including an exposure, a diagnostic test, a prognostic factor, a treatment, a patient  perception and so forth. C : A comparison intervention or exposure (also defined very broadly), if relevant. O : The clinical outcome(s) of interest, including a time horizon, if relevant.

In addition to the standard PICO components, the broader PICOTS framework is extremely useful and important for defining key clinical questions and assessing whether a given study is applicable or not. T refers to Timing and S refers to Setting or Study Design.

T : Timing, i.e. the time it takes to demonstrate an outcome OR the period in which patients are observed. S : Setting (e.g. ambulatory settings including primary, specialty care and inpatient settings), or sometimes Study Design (such as a randomized controlled trial).

Reference: Matchar DB. Introduction to the Methods Guide for Medical Test Reviews. AHRQ Publication No. 12-EHC073-EF. Chapter 1 of Methods Guide for Medical Test Reviews (AHRQ Publication No. 12-EHC017). Rockville, MD: Agency for Healthcare Research and Quality; June 2012.

• Research Medical Library Evidence-Based Prescription

You can use the Research Medical Library's PDF template linked above to help formulate a clinical question. Other resources for formulating clinical questions include:

PICO(T) Templates (McMaster University Health Sciences Library)

Example for Therapy question:

In ___ [ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

PICO Form (National Libra ry of Medicine)

The PICO form linked above can be used to search medical literature with your PICO terms.

Find Studies

Which type of question you're asking determines which type of study is most appropriate to consult.

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Experimental vs Observational Studies: Differences & Examples

Understanding the differences between experimental vs observational studies is crucial for interpreting findings and drawing valid conclusions. Both methodologies are used extensively in various fields, including medicine, social sciences, and environmental studies. 

Researchers often use observational and experimental studies to gather comprehensive data and draw robust conclusions about their investigating phenomena. 

This blog post will explore what makes these two types of studies unique, their fundamental differences, and examples to illustrate their applications.

What is an Experimental Study?

An experimental study is a research design in which the investigator actively manipulates one or more variables to observe their effect on another variable. This type of study often takes place in a controlled environment, which allows researchers to establish cause-and-effect relationships.

Key Characteristics of Experimental Studies:

• Manipulation: Researchers manipulate the independent variable(s).
• Control: Other variables are kept constant to isolate the effect of the independent variable.
• Randomization: Subjects are randomly assigned to different groups to minimize bias.
• Replication: The study can be replicated to verify results.

Types of Experimental Study

• Laboratory Experiments: Conducted in a controlled environment where variables can be precisely controlled.
• Field Research : These are conducted in a natural setting but still involve manipulation and control of variables.
• Clinical Trials: Used in medical research and the healthcare industry to test the efficacy of new treatments or drugs.

Example of an Experimental Study:

Imagine a study to test the effectiveness of a new drug for reducing blood pressure. Researchers would:

• Randomly assign participants to two groups: receiving the drug and receiving a placebo.
• Ensure that participants do not know their group (double-blind procedure).
• Measure blood pressure before and after the intervention.
• Compare the changes in blood pressure between the two groups to determine the drug’s effectiveness.

What is an Observational Study?

An observational study is a research design in which the investigator observes subjects and measures variables without intervening or manipulating the study environment. This type of study is often used when manipulating impractical or unethical variables.

Key Characteristics of Observational Studies:

• No Manipulation: Researchers do not manipulate the independent variable.
• Natural Setting: Observations are made in a natural environment.
• Causation Limitations: It is difficult to establish cause-and-effect relationships due to the need for more control over variables.
• Descriptive: Often used to describe characteristics or outcomes.

Types of Observational Studies: 

• Cohort Studies : Follow a control group of people over time to observe the development of outcomes.
• Case-Control Studies: Compare individuals with a specific outcome (cases) to those without (controls) to identify factors that might contribute to the outcome.
• Cross-Sectional Studies : Collect data from a population at a single point to analyze the prevalence of an outcome or characteristic.

Example of an Observational Study:

Consider a study examining the relationship between smoking and lung cancer. Researchers would:

• Identify a cohort of smokers and non-smokers.
• Follow both groups over time to record incidences of lung cancer.
• Analyze the data to observe any differences in cancer rates between smokers and non-smokers.

Difference Between Experimental vs Observational Studies

Choosing Between Experimental and Observational Studies

The researchers relied on statistical analysis to interpret the results of randomized controlled trials, building upon the foundations established by prior research.

Use Experimental Studies When:

• Causality is Important: If determining a cause-and-effect relationship is crucial, experimental studies are the way to go.
• Variables Can Be Controlled: When you can manipulate and control the variables in a lab or controlled setting, experimental studies are suitable.
• Randomization is Possible: When random assignment of subjects is feasible and ethical, experimental designs are appropriate.

Use Observational Studies When:

• Ethical Concerns Exist: If manipulating variables is unethical, such as exposing individuals to harmful substances, observational studies are necessary.
• Practical Constraints Apply: When experimental studies are impractical due to cost or logistics, observational studies can be a viable alternative.
• Natural Settings Are Required: If studying phenomena in their natural environment is essential, observational studies are the right choice.

Strengths and Limitations

Experimental studies.

• Establish Causality: Experimental studies can establish causal relationships between variables by controlling and using randomization.
• Control Over Confounding Variables: The controlled environment allows researchers to minimize the influence of external variables that might skew results.
• Repeatability: Experiments can often be repeated to verify results and ensure consistency.

Limitations:

• Ethical Concerns: Manipulating variables may be unethical in certain situations, such as exposing individuals to harmful conditions.
• Artificial Environment: The controlled setting may not reflect real-world conditions, potentially affecting the generalizability of results.
• Cost and Complexity: Experimental studies can be costly and logistically complex, especially with large sample sizes.

Observational Studies

• Real-World Insights: Observational studies provide valuable insights into how variables interact in natural settings.
• Ethical and Practical: These studies avoid ethical concerns associated with manipulation and can be more practical regarding cost and time.
• Diverse Applications: Observational studies can be used in various fields and situations where experiments are not feasible.
• Lack of Causality: It’s easier to establish causation with manipulation, and results are limited to identifying correlations.
• Potential for Confounding: Uncontrolled external variables may influence the results, leading to biased conclusions.
• Observer Bias: Researchers may unintentionally influence outcomes through their expectations or interpretations of data.

Examples in Various Fields

• Experimental Study: Clinical trials testing the effectiveness of a new drug against a placebo to determine its impact on patient recovery.
• Observational Study: Studying the dietary habits of different populations to identify potential links between nutrition and disease prevalence.
• Experimental Study: Conducting a lab experiment to test the effect of sleep deprivation on cognitive performance by controlling sleep hours and measuring test scores.
• Observational Study: Observing social interactions in a public setting to explore natural communication patterns without intervention.

Environmental Science

• Experimental Study: Testing the impact of a specific pollutant on plant growth in a controlled greenhouse setting.
• Observational Study: Monitoring wildlife populations in a natural habitat to assess the effects of climate change on species distribution.

How QuestionPro Research Can Help in Experimental vs Observational Studies

Choosing between experimental and observational studies is a critical decision that can significantly impact the outcomes and interpretations of a study. QuestionPro Research offers powerful tools and features that can enhance both types of studies, giving researchers the flexibility and capability to gather, analyze, and interpret data effectively.

Enhancing Experimental Studies with QuestionPro

Experimental studies require a high degree of control over variables, randomization, and, often, repeated trials to establish causal relationships. QuestionPro excels in facilitating these requirements through several key features:

• Survey Design and Distribution: With QuestionPro, researchers can design intricate surveys tailored to their experimental needs. The platform supports random assignment of participants to different groups, ensuring unbiased distribution and enhancing the study’s validity.
• Data Collection and Management: Real-time data collection and management tools allow researchers to monitor responses as they come in. This is crucial for experimental studies where data collection timing and sequence can impact the results.
• Advanced Analytics: QuestionPro offers robust analytical tools that can handle complex data sets, enabling researchers to conduct in-depth statistical analyses to determine the effects of the experimental interventions.

Supporting Observational Studies with QuestionPro

Observational studies involve gathering data without manipulating variables, focusing on natural settings and real-world scenarios. QuestionPro’s capabilities are well-suited for these studies as well:

• Customizable Surveys: Researchers can create detailed surveys to capture a wide range of observational data. QuestionPro’s customizable templates and question types allow for flexibility in capturing nuanced information.
• Mobile Data Collection: For field research, QuestionPro’s mobile app enables data collection on the go, making it easier to conduct studies in diverse settings without internet connectivity.
• Longitudinal Data Tracking: Observational studies often require data collection over extended periods. QuestionPro’s platform supports longitudinal studies, allowing researchers to track changes and trends.

Experimental and observational studies are essential tools in the researcher’s toolkit. Each serves a unique purpose and offers distinct advantages and limitations. By understanding their differences, researchers can choose the most appropriate study design for their specific objectives, ensuring their findings are valid and applicable to real-world situations.

Whether establishing causality through experimental studies or exploring correlations with observational research designs, the insights gained from these methodologies continue to shape our understanding of the world around us. 

Whether conducting experimental or observational studies, QuestionPro Research provides a comprehensive suite of tools that enhance research efficiency, accuracy, and depth. By leveraging its advanced features, researchers can ensure that their studies are well-designed, their data is robustly analyzed, and their conclusions are reliable and impactful.

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Breakthrough research identifies key microenvironments linked to kidney injury and disease

• Download PDF Copy

A study published in  Nature Communications  provides new insight into how damaged cells interact within disease-promoting microenvironments following acute kidney injury, or AKI. With limited treatment options, AKI frequently progresses to chronic kidney disease (CKD), which affects more than 1 in 7 U.S. adults-;an estimated 37 million people.

The new findings may contribute to future efforts to prevent CKD, which can lead to kidney failure. 

The study brought together scientists from Andy McMahon's lab at USC and Long Cai's lab at Caltech, with support from a USC Broad Innovation Award that funded the cross-institutional research collaboration. 

In the study, co-first authors Michal Polonsky from Caltech and Louisa Gerhardt from USC, leveraged a cutting-edge tool, called seqFISH, developed in the Cai laboratory. With this tool, researchers can gather information about genetic activity and study cellular interactions in intact kidney tissue in mice with AKI. This allowed the scientists to analyze the precise expression of over 1,000 genes in the injured kidney tissue, identify microenvironments associated with injury, and predict cellular interactions associated with the progression to CKD.

" Dr. Cai's seqFISH technology provides unprecedented insight into the cellular interplay in the kidney following injury, " said McMahon, who is the W.M. Keck Provost and University Professor of Stem Cell Biology and Regenerative Medicine at USC and will join the faculty of Caltech in October. " A better understanding of kidney injury is needed to identify targets for preventing the progression to chronic kidney disease ."

Cai, who is a Professor of Biology and Biological Engineering, added: "We're thrilled that our technology has enabled a deeper understanding of kidney injury and disease. This study exemplifies the importance of cross-institutional and cross-disciplinary collaborations to advance biomedical research." 

In the kidney's outermost layer, the scientists identified a likely pathological microenvironment, which they dubbed "ME-5." This microenvironment contained a type of kidney cell particularly vulnerable to injury, known as a proximal tubule cell or PT. 

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In ME-5, injured PTs and neighboring connective tissue cells, known as fibroblasts, exchanged signals that could drive injury progression. Key signals involved the genes Clcf1 and Crfl1, which encode proteins that can promote inflammation and fibrosis, or scarring. Additional signals detected in ME-5 could contribute to recruitment of immune cells, thereby further contributing to development of inflammation, fibrosis and other pathological changes.

The scientists also identified another important injury-associated microenvironment, which they named "ME-16," featuring aggregations of various immune cell types called tertiary lymphoid structures that are known to contribute to chronic inflammation. Rather than being confined to a specific region of the kidney, ME-16 was distributed throughout the injured organ. 

To share their discoveries, the team constructed a comprehensive map of cellular, molecular, and structural changes following AKI, which refines our understanding of the transition to CKD. This map is publicly available at  https://woldlab.caltech.edu/ci2-celltiles/Mouse-Kidney-Fibrosis/ .

Additional co-authors are Kari Koppitch from USC; Jina Yun, Katsuya Lex Colón, Henry Amrhein, Matt Thomson, and Barbara Wold from Caltech; and Shiwei Zheng and Guo-Cheng Yuan from the Icahn School of Medicine at Mount Sinai.

In addition to the USC Broad Innovation Award, the research was supported by the National Institutes of Health (grant NIDDK UC2DK126024), German Research Foundation (grant GE 3179/1-1), and German Society of Internal Medicine (DGIM) Clinician Scientist Grant.

Keck School of Medicine of USC

Polonsky, M., et al. (2024). Spatial transcriptomics defines injury specific microenvironments and cellular interactions in kidney regeneration and disease.  Nature Communications . doi.org/10.1038/s41467-024-51186-z .

Posted in: Cell Biology | Medical Research News | Medical Condition News

Tags: Acute Kidney Injury , Biotherapeutics , Cell , Cell Biology , Chronic , Chronic Kidney Disease , Fibrosis , Genes , Genetic , Genomics , Inflammation , Kidney , Kidney Disease , Kidney Failure , Laboratory , Medicine , Research , Technology , Transcriptomics

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Clinical Research Coordinator

• Madison, Wisconsin
• SCHOOL OF MEDICINE AND PUBLIC HEALTH/RADIOLOGY-GEN
• Partially Remote
• Staff-Full Time
• Staff-Part Time
• Opening at: May 31 2024 at 09:55 CDT
• Closing at: Sep 17 2024 at 23:55 CDT

Job Summary:

The Department of Radiology, University of Wisconsin - Madison, School of Medicine & Public Health is seeking a Clinical Research Coordinator (CRC) to help advance exciting medical imaging and disease-focused projects! The CRC works as part of a team, which includes physicians, PhD researchers, imaging staff, and other research support staff, to support and advance a portfolio of interesting research projects. Radiology projects focus on anything from the development of novel imaging techniques, to work towards understanding and curing disease. The role of a CRC is quite varied - an average day could include responsibilities ranging from recruiting and enrolling subjects into a study, to coordinating and conducting actual subject visits, to collaborations with the study team on a wide variety of topics.

Responsibilities:

Institutional statement on diversity:.

Diversity is a source of strength, creativity, and innovation for UW-Madison. We value the contributions of each person and respect the profound ways their identity, culture, background, experience, status, abilities, and opinion enrich the university community. We commit ourselves to the pursuit of excellence in teaching, research, outreach, and diversity as inextricably linked goals. The University of Wisconsin-Madison fulfills its public mission by creating a welcoming and inclusive community for people from every background - people who as students, faculty, and staff serve Wisconsin and the world. For more information on diversity and inclusion on campus, please visit: Diversity and Inclusion

Preferred Bachelor's Degree

Qualifications:

Required - Research experience. Preferred - At least one year experience with clinical research studies. - Experience working within a higher education setting. - Prior experience working within a healthcare setting. The ideal candidate will have strong attention to detail and ability to think critically and/or strategically to solve problems.

Full or Part Time: 80% - 100% This position may require some work to be performed in-person, onsite, at a designated campus work location. Some work may be performed remotely, at an offsite, non-campus work location. The incumbent must have schedule flexibility to occasionally work outside of standard 8:00AM- 5:00PM weekday hours. The position occasionally requires travel to other, local UW locations.

Appointment Type, Duration:

Ongoing/Renewable

Minimum $48,000 ANNUAL (12 months) Depending on Qualifications The starting full time salary for the position is $48,000 but commensurate with experience and qualifications. Actual pay is determined at hire and is based on experience and qualifications. Employees in this position can expect to receive benefits such as generous vacation, holidays, and sick leave; competitive insurances and savings accounts; retirement benefits. Benefits information can be found at ( https://hr.wisc.edu/benefits/ ).

Additional Information:

Applicants for this position will be considered for the titles listed in this posting. The title is determined by the experience and qualifications of the finalist. This position has been identified as a position of trust with access to vulnerable populations. The selected candidate will be required to pass an initial caregiver check to be eligible for employment under the Wisconsin Caregiver Law and every four years. University sponsorship is not available for this position, including transfers of sponsorship. The selected applicant will be responsible for ensuring their continuous eligibility to work in the United States (i.e. a citizen or national of the United States, a lawful permanent resident, a foreign national authorized to work in the United States without the need of an employer sponsorship) on or before the effective date of appointment. This position is an ongoing position that will require continuous work eligibility. UW-Madison is not an E-Verify employer, and therefore, is not eligible to employ F1-OPT STEM Extension participants. If you are selected for this position you must provide proof of work authorization and eligibility to work.

How to Apply:

To apply for this position, please click on the "Apply Now" button. You will be asked to upload a current resume/CV and a cover letter briefly describing your qualifications and experience.

Amanda Joncas [email protected] 608-262-2716 Relay Access (WTRS): 7-1-1. See RELAY_SERVICE for further information.

Official Title:

Clin Res Coord I(RE015) or Clin Res Coord II(RE016)

Department(s):

A53-MEDICAL SCHOOL/RADIOLOGY/RADIOLOGY

Employment Class:

Academic Staff-Renewable

Job Number:

The university of wisconsin-madison is an equal opportunity and affirmative action employer..

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