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Clinical Research - Concept to Publication

Jul 16 | 1:30 PM

Research is what I'm doing when I don’t know what I’m doing - by Wernher von Braun. Learn the basic skill sets required by physicians to conduct medical research from renowned Dr. Sengupta who has published more than 85 papers in top rated peer-reviewed journals including Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, Eye and the British Journal of Ophthalmology.

so hello everyone uh i'm dr rucha and uh we are back with one interesting session on clinical research uh usually it is considered as a very uh tiresome topic by many but we have dr sabyasachi sengupta uh with us today to guide us on very interesting topic let's understand research from concept to publication and like how to go about it during your residency uh after your residency and during your ug life too it's a very important part i guess covid has taught us a lot about the importance of research which is really lacking in medical field but uh let's see how to go about it sir is consultant ophthalmologist and retina surgeon uh he's a founder and director at future vision eye care and research center uh he's the chief medical writer and a lead biostatistician of saint guptas research academy he has done a lot of research and he has published lot of research papers he's uh very interested in teaching uh and uh enlightening younger generation about the importance of research and is doing really great stuff uh so he has agreed to do this lecture for us today and introduce you as to the whole concept of research so welcome sir uh we're glad you're here and uh before i hand over the stage to you i just wanted you to tell us uh how important it is and how feasible do you think it is that tiring uh research during your residency and we can't really focus on that there are a lot of misconceptions so could you just tell us about that and i'll just hand over the stage to you thank you so much rucha for having me and thanks a lot to medflix i'm sure you know you are going to do a lot of good work going ahead in various domains of medicine but you know let's focus on today's topic that is research from concept to publication you know i think for uh to answer your question you know actually you can give about 45 minutes every day maybe even 45 minutes on alternate days and that is good enough right so i'll tell you that it's much easier to learn research than to actually learn surgery or to learn you know to interpret an ecg it takes a long time you know and you can't go wrong then right because if you make a mistake there it could be a matter of life and death for students uh i mean for your patients but you know for research you can do a lot of trial and error and that a lot of people learn it on the job and when they start doing and then they say will they be away let me do it the other way but then if you you know train yourself right at the beginning it is easier than any other medical sub specialty that you uh that you will take up so it is not hard and you know people find it hard and cumbersome and difficult simply because you're not trained like i tell my students you know if you try and insert an intraocular lens in the eye without even making an incision you are obviously going to fail or if you try to insert a stent into the into one of the coronary arteries without even making a nick into the radial or the femoral some somehow our livelihoods are also going to depend upon how well we do this so i think it's critically important to understand the importance and then go ahead and actually train yourselves and you can do wonders so you know let's keep it a bit uh friendly as well and you know let's not make it as formal as i have dressed but then you know let's keep it as uh as simple as possible all right so i usually like to start by saying that uh you know a bit of inspiration that the questions you ask define who you are and not the answers you know right so uh you know somehow we are not trained to ask questions right from our schooling days isn't it so you know a lot of people are look down upon if you don't ask questions you know if you ask too many questions uh you know say a quick example is uh uh basically you know let me give an example of the film three idiots where rancho asks that you know if uh you know if there's so much problem with an ink on in space why don't you design a pencil for it so you know so that's a question uh basically which it's a you know something that a question was asked only when you ask right questions will you get right answers to these so you know today we are here to discuss about uh clinical research concept of publication but this you know inspiration of asking questions remains and not only research but in pretty much all in all aspects of whatever you are doing i run gupta's research academy i'll tell you a little bit about it and i'm very happy to collaborate with medflix to come and discuss some of these concepts uh with all of you and so the you know finally publication really depends upon the journey that you take and the journey should be as you know it should be as enjoyable as the final uh outcome so every paper goes through this roadmap or every research study goes through this roadmap when you plan the study and execute it uh you know then you have data with you so annually you analyze and write it up and finally you review it and publish it a little bit about me so i'm primarily a physician or a clinician and i have my practice in mumbai i have done my research training at johns hopkins uh medicine and johns hopkins school of public health and i have so far about 96 publications and and counting hopefully and i'll have some more i have assisted more than 100 papers through my research academy where i provide services for ophthalmic papers i'm also the associate editor of the indian journal of ophthalmology and the igo case reports which is a sister journal and so i think i have a unique perspective in terms of uh training then being an author uh publishing plenty of papers and finally now on the other side of things on or on the editorial side of things so i think i can give you a unique perspective on all of this so i think you know i wanted to show you a quick clipping so i'll just play this you know it's from uh it's from a movie i'm sure you will recognize foreign [Music] [Applause] so i you know so the video really says uh you know so the video this video has really inspired me over many many years now and uh so he says you know so i think for me clinical research has been like that where uh in pursuing uh unknown uh sort of questions i mean questions for which we don't have answers and uh you know so i'll sink in and let it sink in a bit because i think that's you know this is sort of feeling which we should all have and be passionate about in whatever you do uh you know before we dive into research i thought you know we'll discuss a little bit about you know why this is important where we are going as a medical field so you know a quick look at how medical practice will look like in in 2030 is you know how i feel and how i see this is going uh you know so one word to sort of summarize it all is it's it is automations right uh this automations are going to revolutionize uh the way we you know automations are going to revolutionize the way we uh practice medicine and so sort of that take home messages don't put all your eggs in one basket so by automations what i mean is that there are five overall levels of automations where initially you know so this is a image of the retina if you see on the right that's an image of the retina and an artificial intelligence uh program is basically you know finding all the problems or all the diagnosis in that field in the bottom image if you see those you know blue dots so initially it was only you know humans and then there is a shadow mode where the machine is sort of learning from the human is what we call machine learning and then we have artificial intel you know assistance in in daily activities this is where we are later we are going to go into partial automation where in a lot of the work that we do is going to take over be taken over my machines and finally we're going to have full automations i think that's going to happen by about 2030 where you know a lot of these algorithms they are going to take over a lot of what we do especially in diagnostics or in in medical uh fields of medicine may not be in surgery so soon but and this is definitely upon us it's an i think this is how a lot of us might look like in 2030 where you know there is a lot of it happening on the on the monitor and you know a lot of different processes are happening but the physician is actually standing with his hands folded and just observing right so it happens a lot in lasik surgery and a lot of you know refractive surgery nowadays where we are really hardly doing much and you know just observing the machine that's doing all the job so ai is really every now it's everywhere we will change interaction between doctors and patients but most patients may not even be uh you know knowing about this they may not be involved but the physicians will definitely know so is this good or bad you know you might really ask so i think it's good for patients it's definitely good for patients there will be less mistakes probably better outcomes but as you can understand it's not so good for physicians because you know there are of course pros and cons of each but you know a lot of the jobs that we do today are going to be taken over by machines so you know i think this is a very important book that all of us should read so this is 21 lessons for the 21st century written by yuval noah harari and he talks about something called admit right so education and medicine which is absolutely going to change and you know how it will look in 2030 is what i have taken really from this book you know he's written pretty much everything that i have talked about but we can't even wildly guess today so how can we be prepared you know it's it's futile to uh you know stop trying to stop these things or it's you know when large corporations like google and apple are going to be involved uh it's almost impossible for us to uh you know push this back so how can we be prepared is you know ai integration into medicine cannot be stopped you know so all diagnostic medical fields diabetes so many are going to be involved you know it's going to uh happen in these fields like i said it won't happen overnight you know good news is that it's still evolving so we can assist this evolution and be part of it rather than push it back against it or oppose this right so how do we you know how do we become part of this main question really is can i be part of this you know you really need to break barriers to become part of large change that is happening today you need to find new ways to win right uh so you know if you want this is the great book that again you i recommend reading it's called think smart work smart you know so people say don't work hard but work smart right so uh what this book really tells you is you know how you can do a lot more in very little amount of time and sort of maximize all your efforts but how you can really be ready for these automations uh is like i said by assisting them and you know companies will choose or these people who are building these automations will choose people who are good at research or who are good with data or who are good with interpreting you know because we want to see how close these ais are getting to humans so they will choose some of the best humans to compare the best machines with you want to be one of those best humans and the only way you can do this is by doing good amount of clinical research having good publications and making a niche for yourself right so it's important to train yourself with data learn some analytics statistics everybody's talking about big data right but are we talking about it in medical school are we talking about it in hospitals in clinics i don't think so right at least not in india so we need to learn some basic analytics skills statistics we learn need to learn to present data well we learn to write well make an impression with what we are writing so be you know you have to be good at medical research be prepared for tomorrow today so this is something that i wanted to start with like i said this is a road map right so you can plan study execute it analyze data and review and submit so this is what we are going to discuss before that i thought you know i'll share a little bit about my journey where my actual training in clinical research methodology started in 2008 in a institution called arvinda hospital in in madurai which is in south india and uh you know it's important that you do that so i did that three day course at this lyco institution i wasn't uh you know i wasn't uh entirely satisfied with what i did so i went to a one-week course of research methodology training at cmc vellore and this was in 2010 and then i was still not satisfied i wanted to learn more so i went and did a whole one-year training at at the wilmer eye institute that's at johns hopkins uh university which is and i'm sure most of you have heard about uh you know johns hopkins and you know some of the people who are actually maintaining the covid database and very large numbers of covid happening all over the world i know some of them and they are good friends of mine so you know i did my training there and then i actually felt uh you know satisfied that okay now i have learned a few of these things uh like i said you know the learnings along the ways i i learned how to do biostatistics i learned to write how how to write manuscripts and finally now i am on the editorial board of many journals especially the indian journal of ophthalmology and you know i think the learning still continues like i said get trained in basic concepts uh i've given all this example even before but you know it's time trying to publish without training is like trying to insert a lens in the eye without even making an incision or you know putting a stent in in a damaged coronary artery without even puncturing the femoral or the radial artery right so it's really important that you learn the basics before you start and you know there are lots of courses nowaday nowadays which are available technology which is there there are hundreds even thousands of students who are learning together so you can brainstorm with them you know there are a lot of mentors teachers who are willing to teach right so uh you know so you know you can actually train yourself uh coming to the actual you know lecture today of you know concept to publication uh you know i thought i'd divide it into four simple very uh you know three simple very uh simple questions one is why do this research second is how to do this third is where can i do this i mean where can i publish and fourth finally i'll give you some important take home messages it's the first question is why should i publish uh you know you know this this was um this presentation was designed for you know very basic level even mbbs students so it's important to know what medical journals are so these are you know these are where research is published and some of the top journals are the new england journal of medicine lancet jama bmj and also all these studies you know these journals have carried major pivotal clinical trials which have actually guided how covid it is you know managed and how vaccines work and all of these so it makes sense to follow some of these journals so you know there is a hierarchy in study design where uh there are level you know different levels of scientific evidence where at the bottom say this is a pyramid right at the bottom if you see the animal studies then there are case reports on top of that then case control studies then cohort studies and randomized trials and on top of that there are meta-analysis so you know you really need to climb this ladder it's almost impossible to sit on top of that pyramid right away right so it's a good you know it's a good idea to start with case reports as you see at the bottom you know so uh you know case reports are a little easy to write they don't require a lot of analytics and you know they get you into a habit of publishing and you know importantly you will see your name in print uh and you know that's that's a very big wow moment and you will then want to have it again and again so it's a good idea to start with case reports but remember that you must graduate on to uh you know higher levels right so the question really is why should i publish right that's the first thing that we're going to look at today uh you know before we go into many reasons i think it's important to understand that work that remains unpublished in one form or the other is essentially incomplete or undone uh you know so many of us are going to do a thesis as part of our you know mandatory requirement for our degrees that is either ms or dnb or you know whatever you know mch or whatever that may be but then you know how many of us are actually going ahead and publishing this very few at least in india uh you know this is a this is sort of the you know the tip of the pyramid the tip of the iceberg is some of the thesis which are published but then a lot of that is not published in common reasons are there is not enough novelty and the design is not done well there is not enough training especially in the faculty as well as in the residence and then you know there is general apathy or there is no enthusiasm in doing these things and most likely people are also not aware of a lot of benefits which can you know which can come your way if you're good at doing this so uh you know if you look at uh some in the there is there are so many national conferences which are happening so this is some data from the uh national indian ophthalmic conference you know so only about 12 percent of papers which are you know presented as free papers and posters in this uh in this conference that actually go ahead and get published in a major uh journal right so that's really small number if you look at you know some continental meetings and that's about 30 percent and if you look at truly international meetings that's almost as high as 60 percent uh you know so why should we do research you know so sort of have put them in a mnemonic and i've called it famous you know so don't go on it literally obviously fame and recognition is part of that but we'll go through that so f stands for fame and recognition right because in meaningful research so that keyword here is meaningful right so which actually impacts patient care so meaningful research makes an impact and gain you know gains you peer respect fame and recognition a stands for you know patient care where your pivotal research studies have a potential to enhance patient care thereby influence millions of lives that is sometimes possible uh m is make yourself a good clinician you know a lot of these deliberations happen when you are you know going through this process of submitting to a journal uh going through the viewer comments answering them so thinking about you know your thought process definitely becomes better and i think most good researchers are definitely good clinicians then you know o stands for policy where some some of your impactful papers can help administrators make policy decisions allocate funds i'll show you some examples of these u stands for funding and grants right so you are eligible for these as well and s is basically personal index where a lot of citations that happen uh with your papers you know they make you an expert in the field you know so i'll give you examples so uh you know so you can actually go beyond one patient and you know your papers could influence hundreds of lives this is one paper which we published on you know you know how you've seen caterpillars and they have so many hairs on their bodies and actually some of those hairs can go inside the eye and cause a lot of you know a lot of trouble so you know some of these papers some of the paper that i have done are on these and i have gotten emails from in almost all continents saying that you know these papers have helped us manage uh patients and others and i remember one particular incident when an ophthalmologist from italy a lady she wrote to me that you know her daughter actually had one of these hair in the eye and because of this paper she was able to treat it well so you know that really makes you feel special this is another example of what your research can do it can actually influence a lot of clinical decision and thought process this was one of our papers which looked at you know some you know fake emulsification is a common method of cataract operation but then you know it can also cause drop in the intraocular pressure which can be sometimes good so you know this why this pressure drops was not known and a lot of people felt that it is the ultrasound energy which is used which is causing drop in the pressure but then this clearly study clearly showed that even a manual surgery can drop the interrogator pressure and it has nothing to do with the ultrasound energy so believe me lot of labs which were getting funding from the nih based on uh you know their theory that ultrasound works for drop in intraoculare lost funding so there's a lot of impact which this paper created this is another paper you know which we talked about some toxic reactions after cataract operations and you're looked upon as a as a expert in the field so you know i have reviewed almost 50 papers over the last decade on this topic itself so you are looked up as an expert and you know what happens is uh you know you end up influencing how literature is evolving in a particular field entirely right me and my colleagues must have reviewed at least 50 60 papers of this relatively uncommon entity so we have sort of sat almost on the top of the food chain on this disease and almost all literature that has evolved has gone through us you know so with great power comes a great responsibility we should also remember that but you know if you are good at a niche topic you will end up influencing literature as well uh like i said some of your research can influence policy so this is one of the papers which was published almost a decade ago which influenced a lot of the national prevention control of blindness uh you know funding which the government gave and uh yeah you know so this if you see this you know this paper talked about redefining blindness and it was picked up by one of the papers and sees they say number of blind to come down by 4 million as india said to change blindness definitions right so if the number of blind or less the amount of money which is going to be allocated this is also less right so a lot of don't think that only your peers are going to read these papers patients might read it lawyers might read it is officers will read it police officers will read it you know so it can actually have a lot you know of course newspapers like this will read it uh uh you know so what else is in it for you is like using how much impact you can have if you do good work right then of course like i said there is grants and funding there is fame and recognition uh you know if you are in training and you think about going to the future you know in the future if you ever think about going to the us or any other uh you know major uh institutions oxford cambridge and others and most of these ivy league residency programs in the us uk they all look for residents who have already published some papers so there's enough data or enough publications which clearly show that you know you should have a minimum of one full text or original article that's not really too much to ask for even in your undergrad right so it's not really that hard but it's essential to get into some of these ivy league institutions and also there's a current imbalance where ninety percent of the world population lives in the developed developing world like ours and 90 papers are all published from the developed world us uk australia canada etc so the onus is really on us to you know correct this balance we need to have studies on our own patient populations to see what works better so you know take home message from this part is you know you can go beyond one patient clinical research by doing meaningful work so we talked about why we should do it right now let's look at how we can uh do this well uh so this really is the core of the whole presentation on concept publications how from a concept do we take it to a publication right so the whole pipeline really goes like this where you have an idea so we'll talk a little bit about where you get ideas from then you design the study so what is the best study design for your study is something that you know we look at then how do you execute and analyze papers of some basics of biostatistics and you know how do you go ahead and write and publish papers so these are all individual sort of uh you know classes in each and you know we are planning a club on the medflix platform where you know we are going to have workshops where we are looking at a lot of aspects on each and every uh you know step of the way so that you can actually pick up and grasp these concepts so i'll give you a bit of uh you know a quick look at what we might do in these workshops but the idea is to sort of you know make you expert in all of these processes right so first is you know you have to choose a good research topic isn't it unless the topic is good uh you're not going to go anywhere so we'll quickly look you know this is really small let me blow it up now so first thing you can do to get research topics is you can subscribe to a table of contents so most of the major journals in your field of interest you know they have you know say five or six top journals which are publishing most of the impactful work so what you can actually do is i subscribe to the read table of contents i'll give you an example in the next slide the second thing is you can actually you know manipulate pubmed pubmed is the site which has almost all the medical literature on it and you can tell pubmed that you know i am interested in this topic you know say say tumor of uh or say some oncology topic or you know say some diabetic drug which has come up and you know i want to see all of the papers on this new therapy uh every saturday 5 pm you can tell pubmed and it will actually obey you it will send you again show you some examples but you know pubmed will keep sending you these every saturday so then you know you can actually really keep up and uh you can see what is hot and what is not right in that particular field and you might actually choose to do some of these papers right so this is an example of jama ophthalmology so jama medicine and all of these are look very similar if you see the red box on the right it says get the latest from java ophthalmology and just put your email address and when you do that this is from my own uh email box it's about a year back now but you know so these are all the topics which are published every month along with the link for the free abstracts you might actually go and uh you know sort of look just at the abstract and then um you know some of those are bound to interest you some of these topics and then you might say oh why don't i do this oh can i do this and there is some problem in this three ways that it looks great but you know i might be able to do a better job or i might be able to do more samples something like that this is an example of some other journals that i have subscribed to so they are from elsevier and various other publishers these are some of the top journals in ophthalmology but then you based on your field of specialization or interest you can actually subscribe to these uh these table of contents this is the pubmed customization that i was talking about so we'll have workshops on this where you can understand how exactly to do this and i can give you some you know live examples by sharing my screen and other things so this is the my npcb account and you and i actually can tell pubmed that oh i'm interested in optic neuritis i want to know everything that is happening about optic neuritis or you know say the first thing you can see is this retinopathy of prematurity so i want to know everything which is happening on this particular topic so i want uh you know updates every saturday you can say i want updates every day you can say i want updates every month and it'll you can choose literally which day which time and it'll actually send it to you so you know this is something you can open these you can go through the topics and you know something of these is bound to interest you to do and pursue you can of course have ideas from clinics i think this is sort of the you know the treasured row of information is in our clinics right because patients are coming in and they have diseases which are not there in the books so many of the times and you know sometimes they are not behaving as they should you've treated in a particular way but then you know they are not getting the response that you are intending and if that is happening over and over again that means there's something wrong right in what you're doing or what literature says so you know you can pursue some of those topics of course you can join collaborations there are many groups which are doing a lot of multi-center studies and they are always happy to have you know collaborators as well as more patients in their studies uh journal clubs are a good way of you know doing research where you actually dissect a journal article in your departments and then you know you critique that paper as well as try to learn something new from it and at the end you know you should all go back with at least one idea to do something new in that field so you know we'll have uh workshops on how to conduct journal clubs and you know how to make best use of all of those and of course meetings you know these conferences national state level conferences international conferences always think about or you know target to meet at least one expert in your field you know sort of write to them or maybe send them a whatsapp or something and fix up say a coffee meeting or something like that where you can you know brainstorm and you know you can say i know i'm interested in this and can i join you and you know things can work like that so these are some of the ideas of how you can get research topics then comes in on the study design so we've looked at the idea and where to get it wrong right it has to be novel that idea has to be very novel it has to be doable that it has to be feasible right and so that makes all this makes it publication worthy right then comes the design so you know a quick mnemonic you know remember design is called the picot approach uh so let's look at each of these so p stands for participants whenever you're designing a study think of picot first thing you should do is think of picot so when we have workshops on this you know i'll give you real examples and show you how actually it was done but for now you know remember the mnemonic of picot uh where p stands for participants which really nothing means uh nothing but uh inclusion and exclusion criteria right so who are the people that you want to study and who are the people who don't want to study so that really means participants are p i stands for intervention that really means the kind of you know the kind of technique you are doing it could be a surgical it could be medical or it could be something where there is exposure to a particular agent or it could be as easy as something like a questionnaire which you are using to gather data all of that under falls under intervention so it doesn't really mean a surgical intervention but intervention really means a tool which you are using to uh collect that data c stands for a comparison group remember that you know once you do a study and you don't have a comparison group it cannot be undone so say you are saying oh this is a great surgical procedure and i have brilliant results but then it is it better than what we are doing today is something that others are going to ask and so should you to yourself you know somebody a lot of people say i have a smartphone based imaging device for the eye or for a dermatological condition or something or that is giving great images why don't you use it but then oh i already have something which i'm already using is this better than that is something that we need to find out isn't it and also it may be visibly better but by how much is also important so without a comparison group you will never never know so always think about whether your study would do well with a comparison group o stands for outcome measures so you know outcome basically uh you need to really define it very well right so it could be uh you know anything depending on your study and you know we'll take examples when we do these in the workshops where i'll give you some ophthalmic and some non-ophthalmic examples but the outcomes is something which will make your study very very specific you know what are you actually looking for what are you actually studying is something that you will define as outcomes and t is the type of study so we have already looked at that pyramid the evidence based pyramid right where there could be retrospective studies there could be prospective studies and then there could be randomized trials so you know which is the one which really suits your study the best is something that we need to understand which will you know take up uh in subsequent workshops so after this uh ideation or the study idea you've done a basic uh intellectual input that okay this is novel this is publishable uh then you have actually thought about the design now that is the time to actually do it let's execute it once you start executing it you will come across some hurdles but uh you know where there's a will there's a way so you do the study and you start gathering data right each patient is coming and you are getting data you are going to probably put it into excel and you know then what you do with it is something that is falls under the gamut of okay i think i'll need to go to the next just give me a second all right yes so you know this falls under the gamut of biostatistics is it's what you do with data having simply having data is not good enough you know what you do with data is most important now the huge example is that there is so much data in india or in the developing world isn't it unless unless you do this well it's almost impossible to find the juice out from what your data is saying so it's important to understand some concepts of biostatistics and this is an ebook which is available on search academy facebook page or you can also you know look at it on the website it's a free ebook you can actually get it but you know we talk a little bit about uh some basic terminologies so what a variable means and so there are two types of variables a variable means everything that you are recording from a patient right and every column on the excel is a variable it's a simple thing like age or gender or something like that right so anything which is uh which you are recording from a patient is a variable right so that is what i mean by a variable it could be two types a continuous and a categorical variable by continuous variable what i mean is uh you know a variable which can vary from zero to infinity or from minimum to maximum value in in what your study is studying uh you know say height of a child or say a newborn it could be you know it could vary from anywhere between uh you know say you know say whatever say about you know 100 centimeters uh minimum of you know say 30 or 40 centimeters to 100 and 110 centimeters something like that as a you know i'm just giving you some examples say periodic populations but otherwise it could really vary but they always have a unit to it right it could be centimeters it could be in height in inches you know or in feet that's what we do in india age in years you know say blood pressure in millimeters of mercury that is a continuous variable now the type of variables are categorical variables where there can be only specific categories you know like gender it is either male or female right so there are only two categories in that you know say for example types of uh trauma after you know it could be say in the eye it is either two it is a closed globe injury or an open globe injury where there is actually you know opening of the globe so you know so these are categorical variables from the eye i can give you more examples say diabetic retinopathy so there is mild retinopathy moderate retinopathy severe retinopathy something like that you know so there are two types mainly it's continuous and categorical and the tests of significance you use to uh differentiate between whether there are significant differences in groups is based on whether it's a continuous or a categorical variable that's when we do workshops with live examples you will definitely understand better but uh you know so if it's a continuous variable and there are only two groups that are comparing across and it's normally distributed it's a student t test if it's not normally distributed it's a rank sum these are all sounding quite difficult to you but you know believe me when we do more examples it will make a lot of sense and then it's categorical variable we use the chi square and there are you know advanced kind of statistics where we do something called regression analysis again it depends on the type of outcome there is if you look on the left if it's continuous we use a linear regression if it's a categorical we use logistic regression uh if the count state and nowadays lot of these are coming in in terms of you know how many steps somebody has walked and others it's called poisson regression say a black fungus or something like that we use something called survival analysis right so uh you'll all understand this as we go along in the uh a club mention on two larger sample again you are not going to get great answers and it's very difficult to do if you take two smaller sample your results will not be applicable to you know the large population say for example there are 10 lakh tuberculosis cases in india you can't go up and study all those 10 lakhs you study 500 or 700 or 1000 that is that all those results that you do should be applicable to all those 10 lakh patients right so it's important to actually calculate it properly and what it influences is pretty much everything you know so whether whether this drug works you know if you take too small a sample you will never be able to show whether the drug works better or not if you take too large a sample uh you know even smaller differences will be significant you will say oh this drug is great you know so it really influences pretty much everything and when we take examples and do this you will have a much better idea but remember that every study should have a calculated sample size which is based on some sound scientific assumptions so you have the idea you design the study you have executed you have analyzed now you want to write it right so it's important to write it for particular journals you know so what are the best practices which journals to target from something that i'll quickly tell you the best way forward is to use a checklist approach right pretty much in anything that you do even when you're packing for a vacation it's good to have a checklist you know when you are uh you know planning for a surgery and want some specific raw materials it's again good to have you know checklists same when you're writing papers again it's good to have checklist they ensure quality objectivity thoroughness and uh also help you predict later on right so this is again a great book by atul gawande you know it's called checklist manifesto and if you haven't read it then you must so the outline of any paper really falls under under the headings of introduction methods results and discussion that's called the imrad format right so you know most papers will fall under this but how do you write specific papers is by going to this website it's called the equator network equator dash network.org and you know it will help you select yes uh so could you please switch off your video and on again it's just uh stuck for all of us so right okay so i need to switch it off yeah just switch it off and on yeah is that okay are you able to see uh not yet actually moving my hand i switched it off and switched it on uh it's visible for many of us yeah it's perfect now you can go ahead you know so to write you know you need to like i said use checklist so you how do you know what is the right checklist for a retrospective study or how do you know what is the right checklist for a prospective study or you know for even writing a simple case report so this is the website to go and you know you will get as you can see you know these are checklists called randomized trials so if you are if you see in the middle of the screen you will see reporting guidelines for main study types so if you go down you know see it says randomized trials on the right it's a consort and it's a hyperlink you can go and download that checklist you know observational studies it says strobe systematic reviews it says prisma so you can just go and download these and actually do it now so i've just jotted down some of the important ones that we use the strobe is for these are all mnemonics strobe is for observational studies consort is for randomized trials record is for retrospective studies and care is for case reports and imrad is pretty much common amongst all of these other than case reports where of course you have only one uh you know one case and you know remember that it's not only good for writing but also for reading papers you know when you are actually reading a paper and say there is a new instrument and you are thinking about or there is a new surgery or thing or about adopting it into your own practice first and foremost you know say for example now there are papers which so there is a new vaccine every other day there is a paper and new vaccine in nejm or these major journals now which of the ones are you going to adopt and which other ones you're going to not is something that most of us don't uh you know somehow we haven't been trained to do that you know how do you assimilate these papers into your practice so first thing is you need to understand whether these papers are good enough isn't it so have they been done well is the methodology robust is the statistics good uh are the conclusions believable is something that you first need to understand isn't it so these checklists will also help you actually interpret all these papers and you know how to actually apply it to patients is something that we can all do you know with some of the workshops that we have planned so this is a you know this is a flow chart uh on the equator network it looks very complicated but actually it's quite easy so if you look at the top left question so this is called the decision tree if you look at the first top question it is what's the research on human subjects it's a relatively simple question to answer yes no and then you go ahead and it'll take you to whatever you know checklist that you should be using uh strobe these are like i said mnemonic so strobe transfer stands for strengthening the reporting of observational studies in epidemiology initiative right so record stands for reporting of studies conducted using observational routinely collected health data or record statement right consort stands for consolid consolidated standards of reporting trials or you know randomized trials so there are so many of these at least 18 or 19 checklist which you can use to write your own papers the other applications of checklists you know you can actually use them for journal clubs like i already said it's a great way of actually you know discussing published literature purpose of general clubs can be to learn something new or to critically analyze that paper and to do this what you will use is checklists right so this is another website which actually you can use it's called the icmje as international committee of medical journal editor so editor you know people on the editorial board and editors in chief or associate editors like myself and go to this website say once a month and we see if anything new has come and you know all the instruction to authors uh that you have on journal websites actually is given by these but they also have a section on how to write papers right so uh you can go there as well this is another paper which i have written in way back in 2014 this has more than ten thousand uh reads and downloads i know it's in the indian journal ophthalmology to 2014 november issue it's all free on on the website it's called publisher perish the art of scientific writing and we have given a lot of points as to how to write the introduction how to write the methods how to write the results and how to write the discussion so there are six or seven points in each and you know it's a good starting point uh you know this is my website it's called sengupta’s research academy there are some free lectures and there are some you know paid lectures as well and there are certain you know e-learning modules that you can also uh you know sort of uh look at uh you know this is uh sort of the marquee module it's on biostatistics it i think makes it relatively easy uh you know then this is there are some modules on manuscript writing rejections and references etcetera you can actually explore some of these and there are many other you know resources on the website such as you know some blogs on uh p values regression analysis you know many other blogs on you know getting published from how to convert a thesis to an original journal article and so many others so feel free to sort of explore this and you know all these courses have been we have more than 3000 enrollments from about 79 countries so far so please feel free to sort of explore you know explore all of in the take home these you know to train yourselves uh there are a lot of you know scope for that like i already showed so mine is one and i'm sure medflix has a lot of resources which are also coming your way we can have you know workshops and lot of other learning resources are also there on online then you know design your study conducted well have collaborations as best possible and analyze data that is understand a bit of biostatistics and write the paper well use checklists and then finally you know publish the paper choose a journal which you know suits your paper the best so uh you know this is sort of the whole pipeline and i thought i'll give you a quick overview all of these and believe me each one of these can have at least two or three hour sessions though we don't have time but then you know if you join the club we are planning a lot more uh going forward so i look forward to having some of you on on the club uh you know so like i said break barriers and be future ready i think this is the time to sort of you know invest time and maybe some resources and get yourself ready for that so thank you so much i'm happy to take questions uh you know if there are any i'll just stop my presentation now so uh there are some questions uh riya has asked if uh people can still publish a paper on themselves after graduating if they are not affiliated with any institution is that possible so the couple of things is one is that you have enough data you know you need to have a sort of exposure to enough patients in your setting and if you have enough data that's this first starting point the second is uh you know you need to have an access to an ethics committee nowadays there are ethics committees which are uh there are many private ethics committees which are looking at uh you know sort of protocols from non-institutional practitioners uh there are some very large organizations you know say uh ruby hall in pune and others who actually have uh you know ethics committee meetings for extramural projects extramural are outside that own organization so you can approach them and get ethics clearances from them so these are two things you know first and foremost is that you need to have the data right unless so but then it's difficult for a solo private practitioner to have uh you know data from uh many patients but then uh uh you know if you have that then by all means you should think about publishing so uh there is one question can you name some grand opportunities for phd that i need in research so abhijit is there on stage hi doctor good evening sir i am a pathologist working in a hospital-based laboratory doing hematology work i am i have no idea how to start a research work and present a paper and publish it can you help me with some ideas for it pathology laboratory okay that's a great question let me tell you majority of the indian physician population is in your shoes uh you know because simply because we don't receive this kind of training in our basic mbbs course and even in our post graduation so uh you know the best way first like i said is to train yourself so uh there are resources in you know medflix is coming up with so many uh new things where you know we are having new discussions new techniques and they are forming small clubs right so we are going to have one club on uh research from concept to publication so you know you might think about going with joining this you need to train yourself you know that is the first and foremost unless you know you know if you don't know how to do H&E staining how will you say whether you know the pathology is there or not something like that so you learned that during your residency training in pathology but unfortunately research was not taught to you so you need to learn these things you need to educate yourself and there are a lot of resources you can look at my website you know medflix is that you can join our club we are going to discuss each and every aspect of this in in course of time so once you know how to do it you know the doors are automatically going to open up so i think you know first and foremost you need to have some basic or see let's call it formal training okay thank you sir thank you dr abhijit uh you can just step off stage yeah thank you uh so there is one more question uh can already research topic be re-researched and review to put out a viewpoint or different viewpoint maybe on what was proved see so that's what so you know whatever you are doing is done it has been done too many times you need to understand what has not been done so the concept of doing a literature review is to find what has not been done right so by doing a literature review and seeing you know what has been done you are never almost never going to find what has not been done so there are two or three ways of finding what has not been done one is to read some of the best people which have been published in that field right so most of the top papers and top journals will end up the last or last paragraph will be future studies are required for this and that is something which you can then sort of think about doing so that is something which has not been done is something which you will find out another thing if you have sort of you know even training or doing residency you're reading a book chapter make sure to jot all unanswered questions somewhere and then when you read the chapter try to find answers to those in the book chapter remember that everything in the chapter is from published papers isn't it so you will find say you will find answers two will still remain unanswered almost every chapter in every textbook so you will end up with by the end of the book so vishnu has asked as a student what can he do like uh what are the basics he can do when he when somebody wants to do a research as a student and that's all you know the first thing you need to understand is what topic you want to study so if you are a student you know if you are an mbbs student then you really need to sort of zoom in to what is your you know top what is your sort of speciality of interest and do something which is more general you know don't look at nephrology basically because it's going to be complicated right so look at something you know simple like something with maternal mortality or you know maybe something with with like say liver cirrhosis or something which is relatively common you're likely to see a lot of patients uh once you do that then you know think about a mentor right assistant professor or a post graduate maybe or even a professional level person who will be able to guide you so you know you have to sort of get these two in order and also when you take your proposal to this you know this person of interest or this mentor do a great job do a good literature review don't waste your time in the eyes do a good literature review you know make you know make a very concise sort of one page summary or you know this is the problem statement there are no answers to this that's why i want to do this can i do this you know so it all starts with thinking about it first you know sort of i call it you know ruminating you can't have the answer right you can't spit it out you need to think internalize it think again again internalize it you know so like cows ruminate so it's something like that so you need to think hard then do a proper literature review to see what has not been done once you have that concept in mind think about what design you want and how much sample other things and then you approach a mentor and you know if they agree to mentor you or have you on board then you can actually get started there are many research clubs in many you know institutions uh you know i have worked with many of them you know at least in maharashtra you know kem hospital pune and i've worked with many you know they call it research cell or they call it you know a research group or something like that where a lot of undergraduate students are getting together doing a lot of these things and believe me mentors are actually coming in and saying oh i have this project in mind can i get an undergrad student who can help me with this you know so that's really how it works in the u.s and other uh you know countries so that culture is coming in so you know if it isn't there think about establishing that culture take the first step right okay so it's very uh technical ketu has asked what is the difference between vancouver and style of referencing so there are many different styles of referencing vancouver is one style of referencing the commonly used in medicine are the ama style that is american medical association style or the vancouver style these are pretty much the two commonly used styles of referencing right yeah one raised hand is here i'll just accept that and maybe after that we can wrap up oh yeah i have accepted your request soma sri i have accepted the request kindly switch on the audio and ask your question yeah uh good evening sir and mam and thank you for accepting the request mam and uh so the session was really informative and uh to be a crisp uh it's a the website the academy which you started is like a one spot stop for uh everything that a research an mbbs graduate should start from it can be a blog or even it can be a courses that you provide it's really informative uh i'm looking forward to take them as a whole and uh coming to the questions i have basically three questions one is uh choosing a journal like for example for myself i have done in my ug have done across around six to seven publications and few more on paid review but the amount of the work that i have put in in each article while writing be it a case report or be it a original article or any kind i feel i deserve publishing it in a better journal compared to a journal which i'm actually working on like for example based on indexing not just the impact factor where we choose the journal is there any way because the guides whomever i have approached or worked with they never even come out of the copernicus i mean uh the higher indexing journals uh that is one shall i list the three questions and then will you answer like would that be fun for the yes uh the second question is like regarding the collaborations and my area of interest is like something about the nanotechnology on the biomimetics so where i would like to work on these aspects in the coming times when i would want to learn and get trained in these aspects of the research i would like to know how to go about with it i have tried researching on them like reaching out to the many institutes but they do not provide any as such courses for mbbs graduates or medicos so those are the three three queries which i have thank you thank you so i've actually thought of i need to recount think about you know so your first query was uh um i lost it i've lost it a bit but you know can you just choosing a journal choosing i'm on the editorial side of things now and this journals are basically looking at certain particular kind of papers at particular times uh you know see now there are journals which are looking for covid and then there are some journals which are not at all looking for covid so that is one thing so what they are interested in you can look at the previous two or three issues and see is there a theme in terms of what they are looking for ah second is please look at the journal scope right the scope of the journal on your website and you know that will also tell you you know say uh journal suggested is the new england journal of medicine where you know people are publishing from the nih studies and others there's almost no chance for uh for us getting if you have a study of 65 70 patients there's absolutely no chance so aim but then your aim has to be curtailed or you know it has to be matching uh you know your expectations cannot be uh beyond a certain point so uh you know and remember that whatever journal takes your article finally is the best house for that so uh you know if it's a permit index journal nowadays it really doesn't matter much one thing you will get there you will get a better job you know when i look at my papers published in 2015 some of them are laughable now but then that time i felt oh this is not so much better but that's not the case so you as you mature you'll you will keep learning and evolving uh yes the second question was training right so where do you get kind of training for the collaborations and the training for uh nanotechnology or biomimetics like uh like for example the first image which you have showed saying the medical futurists which has existing collaborations or you need to get to higher positions in these institutions for you to initiate collaborations okay so you know it's difficult to get into self-initiated collaborations at the present moment again uh do you think while uh in this process of reaching to that extent like whatever you're mentioning for a collaboration for aiming high do you think if i write in this process as a review articles from the information which i gained would be advisable again you know writing review articles a lot of journals want you to submit what you are actually going to review if you have not done any work on in that particular field then don't expect that your review article will get a lot of attention you know because people who have done five or six applications in a field and if they write a review it's entirely different journal looks at it entirely differently and so does the readership but if it comes from anyone and everyone who you know and if you think writing a review is easy it's not you need to have you need to be patient you need to read 180 200 full text articles and then sort of you know make whatever concepts uh so writing a systematic review is a very large process it's not easy so uh you know so writing a review when not having done any work in that field uh you know you are not going to get into some of the top journals okay sir got it the third question was uh case report while like for example if i'm practicing outside in a clinic the private clinic if i find a unique case or something that is interesting which i would love to document so do you think i would require that means if you can't go call the patient has to be there with you uh whether it's ethics committee or not you know that's a bit of a gray area a lot of international journals now want ethics community clearance even for case reports but then there's no hard and fast rule especially in journals with indian uh you know with the indian background where icmr or the dcgi as yet does not mandate taking ethics committee approvals for case reports there are some anecdotes mentions in shade of light but then it is not yet mandatory if you are part of an institution you should do it because remember that that data actually belongs to the institution and not yourself if you are part of an institution and you are different data you have to inform the institution and get approval from that committee a lot of the time these these kind of small communications are accepted that the committee will give you an approval so yes we have covered most of the questions and i guess the concept was pretty much clear to everyone

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dr. Sabyasachi Sengupta

Dr. Sabyasachi Sengupta

A Consultant Ophthalmologist & Retina Surgeon, Dr. Sengupta is an phenomenal teacher and loves to make the concepts of research, publication and statistics easy enough for all medicos and thereby insp...

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dr. Sabyasachi Sengupta

Dr. Sabyasachi Sengupta

A Consultant Ophthalmologist & Retina Surgeon...

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