Fabricant P. Practical Clinical Research Design and Application. A Primer...2024
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Textbook in PDF format Every practicing physician, surgeon, advanced practice provider, and allied health professional interacts regularly with peer-reviewed literature: either while creating it, or consuming it. Despite the countless hours over many years spent in formal clinical training, many clinicians and clinician-authors lack advanced training or a working nuanced knowledge of research methodology and study design. Institutions have responded to this gap by reinforcing their ranks with statistical and methodological support in the form of data analysts, epidemiologists, and biostatisticians. However, clinicians are often unable to “talk the methodological talk” to guide them. This ultimately results in a stark disconnect between clinically relevant aspects of research and appropriate study design. Existing research methodology texts are largely written by statisticians, epidemiologists, and other academic public health experts. These are not easily digestible by practicing clinicians who need practical knowledge of this content to design their own research or enhance their understanding of the medical literature. Furthermore, these texts are often too detailed or “in the weeds” with regard to mathematics and statistical mechanics. Practical knowledge is not centrally located; rather, it is spread out among multiple books, articles, and other sources. This book is a concise, accessible, and practical guide for clinicians to read and reference when designing and reviewing clinical research. It is designed to be a standalone text, written “by a clinician, for clinicians” by a practicing clinical research expert who has had advanced formal training in research methodology, biostatistics, and epidemiology. Topics covered include descriptive and comparative statistics, power and sample size calculations, diagnostic tests, bias, and study design. In each chapter, consideration is given to study mechanics, advantages and disadvantages of each design, and illustrative analytical reviews of existing literature. Preface Acknowledgments About the Author Foundational Basics Descriptive Statistics Introduction Types of Descriptive Statistics Measures of Central Tendency Measures of Variability Measures of Distribution Importance of Descriptive Statistics Conclusion Reference Comparative Statistics: Categorical Data Introduction What Is Categorical Data? How Is Categorical Data Best Graphically Represented? Bivariable Statistics for Categorical Data Calculating Expected Cell Counts Post Hoc Pairwise Analyses Multivariable Statistics for Categorical Data: Logistic Regression Conclusion References Comparative Statistics: Continuous Data Introduction What Is Continuous Data? How Is Continuous Data Best Graphically Represented? Bivariable Statistics for Continuous Data Post Hoc Pairwise Analyses Multivariable Statistics for Continuous Data: Linear Regression Conclusion References Statistical Power and Power Calculations Introduction Selecting a Primary Outcome of Interest Statistical Power and Power Calculations Post Hoc Power Calculations Conclusion References Characteristics of a Diagnostic Test: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value Introduction Sensitivity Specificity Positive Predictive Value Negative Predictive Value Accuracy Versus Precision How Are Test Threshold Values Determined? ROC Curves Reference Chapter 6: Statistical Bias Introduction Selection Bias Incorporation Bias Financial Bias Information Bias Differential Misclassification Non-differential Misclassification Other Types of Information Bias Publication and Reporting Bias References The Iterative Process of Designing Successful Clinical Research Introduction Formulating a Study Question Operationalizing Variables Directed Acyclic Graphs (DAGs) Feasibility Peer and Mentor Review The Iterative Process References Choosing and Executing an Appropriate Clinical Study Design Randomized Controlled Trials Study Mechanics Ideal Scenario for Prospective Randomized Controlled Trial Study Design Statistical Analysis Analytical Review Reference Case-Control Studies Study Mechanics Ideal Scenario for Case-Control Study Design Statistical Analysis Analytical Review Reference Cohort Studies Study Mechanics Ideal Scenario for Cohort Study Design Cohort Study Patient Selection Statistical Analysis Analytical Review Analytical Review References Cross-Sectional Studies Study Mechanics Special Circumstances Ideal Scenario for Cross-Sectional Study Design Statistical Analysis Analytical Review Reference Case Series and Case Reports Study Mechanics Ideal Scenario for Case Series and Case Reports Statistical Analysis Analytical Review Analytical Review References Specialized Study Designs Propensity Score-Matched Studies Study Mechanics Ideal Scenario for Propensity Score-Matched Studies Statistical Analysis Conclusion Analytical Review References Interrater and Intrarater Reliability Studies Study Mechanics Statistical Analysis Percent Agreement Kappa Intraclass Correlation Coefficient Interpretation of Kappa and Intraclass Correlation Coefficient Values Analytical Review References Clinical Outcome Scale Development and Validation What Is a Clinical Outcome Scale? Patient-Reported Outcome Scale Development vs. Cross-Validation of an Existing Scale Scale Development and Pilot Testing Structure of Reliability and Validity Testing Reliability Testing Construct Validity Testing Translation and Cross-Cultural Adaptation Analytical Review References Glossary Index