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Hello, everyone. My name is Raymond Wong. I'm the national research director for MSF Scotland this year. Apologize for the delay, but welcome to the six part of our critical appraisal Webinar series. Today's topic will be formulation of research questions, and we are very happy to have Professor Steve Turner as our speaker today. Professor Turner is an academic pediatrician with a a specific research interest in lung diseases like asthma and cystic fibrosis. He currently works at any check NHS Grampian as a consultant pediatrician and also holds the title of honorary professor at the University of Aberdeen. He has over 400 publications and more than 8400 citations. Please feel free to type in any questions you have at any time during the presentation. Professor Turner will be addressing your questions during the Q and a session. Yet after the Q and A, it would be great if you could feel the feedback form, which I always send out the length. Later in the chart, a certificate of attendance will be automatically generated for you after completing the form. So without further a do, let's invite Professor Turner to share his presentation on the formulation of research questions. Thank you very much. Uh, thank you very much. I have to start with it with an apology. It's my fault that we didn't start on time. I had half past four in my diary. So Raymond was very kind and accepted a collective, uh, sort of responsibility, But the responsibilities or mine. So on your feedback forms, you can say, should have started on time. And Turner should have got himself more organized. So I'm I'm planning to be finished at five. I suspect that quite a fusion might have a night on the football. I haven't, um but there's lots of other things going on, but what? I'm hoping. Oh, just one second. I'm hoping to share my screen. I've only got eight slide to be pleased to hear. So grim. Can you just confirm that you can see that slide? Yeah, we could. Yeah. Excellent. Excellent. Brilliant. OK, so, uh, can you research Question right is not always very exciting. Uh, it might be the stage, particularly this time of day, when your caffeine levels are plummeting, that people get a little bit bored and switch off a bit, but it is really important. Uh, and I guess I would say that one night, but it's true. So what you are going to learn in the next 30 minutes, if you haven't already, is What are the differences between a research question of hypothesis, aims and objectives? And the second part is going to be how to write a good research question. Sorry, that's my phone going, and I should just ignore it. Um, so I can't see the question. So I because I've been so late, I'm not going to put you under pressure and ask you to do this. Uh, but but but a research question? I'm going to skip over that. You're going to hear a lot about research questions in the in the next 10, 15 minutes. But but a hypothesis is different from a research question because it's it's I'm going to do this. Yes, right. I'm going to ignore that one. Um, a hypothesis is not a research question. It doesn't have the same format, and it's not as robust as a research question, but it does sort of ask a question. An aim is a is a wish. It's a desire. I aim for that phone to stop ringing. But how am I actually gonna do it? An aim is a is an intent and a desire. So when you're writing down your aims, you can say whatever you like. A name to me is a very unuseful thing. An objective, however, is a lot more measurable. Um, it is you might have heard of Smart, which is an acronym which tells you about the components of an objective. So they've got to be specific. They've got to be measurable. They've got to be, uh, appropriate, realistic and timely. So, for example, in order to stop that phone from ringing, my objective is to get up with my laptop and walk away from the room where the phone is in and therefore remove myself from the noise. So an objective is is memorable. He's much more objective. Um, so So So just to recap, there are differences between research questions, hypotheses, aims and objectives. When you're filling in an application for for a grant, for example, you might be asked to put hypothesis in. Some people will aim some people what objectives But But what I hope you can see now is that there are differences and important differences between these three words, which are often conflated and confused and confused by experience researchers as well. So let's talk about writing a good research question, because when you are embarking on research, you need to get your research question right. You can fluff around and do your hypothesis, aims and objectives if you want. But please get your research questions sorted out. So getting the question right is key, too Good research, and it's key to everything that we do. If you don't know what you've been asked to do, you're not going to be able to do it very well. And in the research context, if you have the research question right, everything flows from that. So if you're doing a research project, the study design is too defined by the research question. Because the research question suggested you're either getting an observational study suggests that you need to do. A lab based study suggests that you might need to do a randomized control trial. All depends on the research question and also the format of your paper. And the structure of your paper is very much determined by your research question, because what you should do is haven't got your research question, right? You basically refer back to that whenever you're writing a paper, Uh, and so you might have a research question that is, uh, in consultants of 50 years and above. Does having new software platforms too? Interaction compared to teams make things easily understood by students. There you go. And what you do is you get in your in your introduction. You talk about people of a certain vintage. You then talk about different platforms and what the pros and cons are, You then come to the conclusion that the more recent ones are better. And then in your methods, you would talk about the different types of, uh, software platforms. You talk about how Doctory consultants in their sixth decade are etcetera, etcetera, etcetera, and your methods would similar business. So get your research question, right? If there's one thing I'd like to take home from this message from From this from this brief talk, it is that so I've designed this when I was using teams where I was able to see the questions, so it's not going to work out very well, so I might just just just skip over this bit. But this was going to be an interactive bit where I was going to say, If you don't have a research question, well, you end up wandering around like a zombie. You have no go. You have no aim. And all of your activity tends to be rather wasted, because if you don't have a clear research question, you can't answer the question. And and and and it's it's a common place for medical students in particular to have a very broad research question. So they will often come to me wanting to an elective project. And clearly that project probably needs a PhD. They need a three year program of research because the question is so broad. So if you think of a pie, get a very thin slice of the pie, be very precise. And if you don't know what the research question is, you end up collecting loads of data far too much data, and then you get lost amid a sea of data. If you don't know what the research question is, you might collect a lot of data, but you might not collect the right data, Uh, and and and it's unethical, uh, to to collect data but the wrong data. And if you haven't set out your analysis plan, which is based on your research question might have data and then all of a sudden realize you don't know how to analyze it. As I've previously mentioned, the the format of the paper makes it easier to write. Once you got your research question, and you will by Jove, you will not have a cat in hell's chance of getting any funding. So if you wanting to do any formal research that requires income, If you haven't got re re clear research question, you will fail at the first hurdle. Um, and and the the other thing is that that a lot of love, which only once you get the research question clear in your head that sometimes you realize that you need to get more governance. So, for example, you might need to get your ethics approval, whereas previously you'd hoped not to do that. So this is not an exhaustive list of reasons why you need to get the research question right. But it is a list of composite holes that people fallen and I've been in most of them up to my neck. So, you know, I said earlier on that there's a SEC format for for for research questions while this is it. And I'm hoping because Raymond was saying that that that you've had previous talks on research, I'm hoping that this is just revision for you, that you're familiar with the PICO former, so p population I intervention. Or it can be exposure, um, comparison and outcome. And it's a bit clunky, but it's it's and and it's clunky because you you you'd usually have the comparison right at the end. Uh, so it really should be P i O C. But there we go. I'm not going to change it. So So you need to have, uh, you need to mention the population. You need to mention the intervention. You need to mention what it's been compared to, um and what what the outcome is. And if you do an observational study, it's the exposure. So I think I'm just going to stop share ng now and see if I can, um, just come back to you. Um, So I'm hopeful that have you had a chance to circulate the papers? Yep. I have. So most of them have have rent for the papers already. Okay, Very good. Well, thank you very much. Just have interest. How many people have stayed the course? Because all I can see is Raymond myself just have interested. We double digits. So we have about nine people at the moment. Good. Excellent. High on quality. Um, so I'll just share this screen again. So your task, good people, um, is you've got to papers. Um, can I suggest that you spend 10 minutes? Um, looking at each of them, Uh, and for each paper, write down the research question, Um and yes, your mission. Should you choose to accept it? Well, yes, you. You've sort of accepted it because by virtue of you've been here. So if we could meet back here and and just does this format, Raymond, allow us to talk. Or do the people who are joining us remotely have to pop the questions in the box? Uh, no. They could only type through the chat box. Okay. Great. Yeah. Okay. So what I would ask you to do if you could please have a look at those papers, and then perhaps if you pop down in the in the message box. What the what the research question is, and let me give you a clue. The word Pekao should be at the forefront of your mind. Okay, so if you do that, I'm gonna wander over here, you'll be able to see me. And I hope that phone stopped ringing. And I'll see you at, uh, we'll join you back at 16. 48. Is that all right? Brilliant. OK, well, listen, have fun. I'm gonna put my microphone on and do some dictation from clinic that I just okay, I will look forward to hearing from you all, uh, at at 16. 48. Okay. Well, hello, everybody. I'm back. You were warned. Um, So, um, have you had a chance to come up with the research question And, uh, so could you pop it in the chat? So let's do, uh there's a swimming pool paper, and there's the air pollution paper. So, uh, couldn't we do the swimming pool paper first? Thank Suzy. That's assess the influence. Uh, so that's not really research question. So what I'm looking for is a is a research question in a PICO format. So I think what you've put there is probably an aim, Um, which in my hierarchy is that is the least waited the least robust type, but well done for putting it in the chat. I think you get bonus point for that. So So, in terms of in Terms of the P, if somebody could pop in the chat what what what's the population I'll give you? I'll give you a clue. It's It's Children and it's Children age. There we go. There we go. So so in, in in five year olds. So that's the population. Um, and it's it's not really an an an intervention. It's an exposure. So the question is, um, is well, yeah, told us, sort of hit the nail on the head. I mean this This is a rubbish paper. Ladies and gentlemen, this is punch. So the question is, in 5 to 6 year old Children is exposure to a swimming pool in the first two years of life associated with increased risk of other things compared to not being exposed. So if you look at the timeline here, the they're they're asking Children age or the parents of Children aged 5 to 6. Um, if by memory, their child had been in a swimming pool before the age of two. And if by memory they remember the child had any bronculitis. And it's just an absolute dog's dinner of a paper quite how this got published, I don't know. But the purpose of me showing you this is that I guess even if you get your research question completely lost and confused, you can still get it. You get get your work published. But this is a rubbish paper. They started off thinking, Oh, wouldn't be interesting to see if, um and then they cobbled together. Um, so So this study is flawed because they've got no objective measurement of swimming back in the day. So there's a measurement bias, and there's also recall bias. Who can remember what we're doing two weeks ago, let alone four years ago? Uh, however, this paper demonstrates another bias, which is publication bias. And what that means is that if you find something that might be sensational, you're much more likely to get it published. Um, even though this paper likes for power a robust, uh, research question and any credibility whatsoever, I hope none of you are on its authors. So anyway, so that's that's a rubbish paper. And I'm pleased that you struggle to work out what the research question was because it's so deeply buried. I don't think the I don't think the authors could could do it. OK, times moving on. So So the second paper, the the the the the air pollution paper, thanks to those who, um, pop something into a chat for the swimming pool paper. But when you read the air pollution paper and I only gave you five minutes, I'm sorry. Um, but what? What? What? What? What's your peak? Oh, question. What's the PICO question that this paper is trying to to answer? I'll give you a bit of time to type, So that's so thanks for putting that in there. So where's the PICO structure to that question? Um, so So So in the PICO question, the first thing you mentioned is the population. So, really, Do you want to just have a look and see What? What What What do you think is the population? Ah, yeah, that's very quick. Okay. Yeah. So So So it's well, it's not really neonate. Um, these are Children in you? Trow So these are these are still fetuses. A neonate is somebody who's, um, newly being born hunts neo Nate, Um, and the exposure. So this is a picture with an e? Um, And the the exposure is higher levels of air pollution compared to lower levels of air pollution. And you're quite right that the outcome is fetal growth. Um, so I've I've included this to contrast with the first paper because I think this is a fairly straightforward paper where it's been designed, um, in in the right way. And they've got an obvious research question and they've obviously answered it. And and I think that the the this study here low levels of ambient air pollution was from a study that was designed to relate low levels, uh, to to relate fetal growth to to maternal exposure during pregnancy. My suspicion is that the swimming pool paper was designed for another purpose. And then, at some stage, an enthusiast thought, Hold on a second. We can sort of piggyback onto this a swimming pool story. Low and behold, they found a tenuous, completely implausible relationship. Submitted it to to to publication. And now people know that going to a swimming pool is bad for you because it gives you bronchiolitis, which is obviously wrong. Yeah, the other bias I forgot to mention is, Well, it's reverse causation. And parents who have asthma are more likely to take their Children swimming because they know that it's good for them. But Children of parents with asthma are more likely to have asthma. Therefore, that explains the association between swimming pool and asthma. It's by a third party. It's by reverse causation. Okay, Um, the first. Yeah, well, that's a really good question. So, um and it's very kind of to call that fantastic talk. I've just waffled and I've been horribly late. So you've been very generous in your in your comics there. So, uh, the first paper is so when you submit a paper to publication it usually there's something called peer review. So it goes out, and usually two people to independent people would look at a paper and make an overall comment to the edit. Er, is it publishable or not? And if it is, are there some changes that need making to it? So what must have happened in in the in the lifetime of this, uh, the swimming pool paper was that it went out for for peers to look at it. So it had peer review, and they, for reasons beyond me, thought that it was a cracking paper. They thought that it was great, Uh, and they might have made a few checks suggestions. Um, but ultimately it made it often. So if you look at the paper, it said it's received in June July, um, 2009. And then it was accepted after revision on Christmas or New Year's Eve. Almost. Um, so there was There was there was a five month period, so that suggests that there were quite a few comments from peer review, so it didn't go through easily. Uh, and it took five months of submitting revisions, uh, and, uh, and to ing and throwing. But I think it's a very good question. What would be the comparison? So if you wanted to to to work out whether swimming pools caused asthma, you would take a group of Children at risk for asthma, and then you'd have to put them in a swimming pool that wasn't chlorinated, you'd have to randomize them to swim pools that were and weren't chlorinated, because if you if you just randomized into some other form of exercise, that wouldn't be a strict control. So if your question and this is where the peak is important, is the question is exposure to swimming pool causing asthma, or is it exposure to chlorination? That, uh, is important because based depending on what your question is, you study design. It differs. So that's a really good example of getting your research question right in the context of what your study design is. Because if your research question is, is it swimming? That inverted commas causes close inverted commas asthma? You randomize people to swimming or not swimming against cycling, for example? Um, but if it's chlorination, you put them in chlorinated pools or you randomize them to non chlorinated pools. I'll give you another example. There's something called bronchial thermoplastic, which is used for the treatment of asthma. What it involves is having a general anesthetic and a bronchoscopy, and then somebody essentially takes a red hot iron down your airways and applies heat to your trachea, Um, and and the randomized control trials that have looked at the effect of this on outcomes on lung function symptoms symptoms afterwards. Um, so so all of the participants have a general anesthetic. All of them have a bronchoscopy, and only some of them have the machinery that essentially is a red hot poker. So So that's an an an example of how you need to be very clear in your research question and therefore your study designed to make sure that you your comparison, comparing the right thing because if you just compared people who had bronchial thermoplastic e to people who sat in the waiting room outside, that would work because the people who had the bronchial thermoplastic would know jolly well that they had had it and any difference between the groups might be a placebo effect. It might be because people feel better, having had a general anesthetic and a red hot poker shut down their airway. So, uh, that's five o'clock just just popped over. So So So I'm going to wrap things up, So thank you very much for the chance to speak to you. And I am so sorry that, um, I was so horribly late. Well, don't you will for staying the 15 minutes. Uh, and if there's one thing I'd like you to remember, it's get your research question, right, PICO fashion, population intervention, comparison outcome. And on that, I'm going to finish. Oh, yes. Don't forget. Provide your feedback. Thank you very much, Professor, Uh, professor for the session today. Um, I've definitely learned a lot. So as Professor Turner said, we would really appreciate it if you could fill out the feedback for which the link is in the chat. Now, to help us improve, it will only take less than three minutes. Uh, certificate of attendance will be generated for you. After completing the phone, please look out for our promotion for our activities. Uh, promoted by our answer. Scotland. Uh, please look out for our promotion on an instagram at times a dash Scotland for other activities that we're going to hope. So we hope to see you again very, very soon. Thank you very much again for joining us today and have a good night by everybody. Bye. Thanks, Raven.