Đại cương nghiên cứu khoa học

8/10/2019 i cng nghin cu khoa hc

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ThS. on Th Ngc Hni hc Y Dc TP H Ch Minh

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Mc tiu hc tp Giithiuvnghin cukhoa hc

Cc bctinhnh mtnghin cunhlng

Vitmctiu nghin cu

2


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Nghin cu l g? Research: The organized quest for new knowledge,based on curiosity or on perceived needs.

Nghin cu: Tm kimmtcch c hthngcc kinthcmi, datrn st m v nhu cuccmnhn.

Kinthcmi: cu trlicho cu hinghin cu

3

2 Last JM. A dictionary of Epidemiology. NewYork: International

epidemiology association 1997; 146


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Cc loi nghin cu trong y khoa Nghin cu c bn: tm hiu tt hn v t nhin

Nghin cu dch t: xc nh nhng yu t nguy c v

nguyn nhn ca bnh Nghin cu lm sng: tm hiu qu trnh bnh v tc

dng ca nhng bin php iu tr

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5/51

Yu cu ca mt nghin cu tt Cu hi nghin cu xng ng

Mc tiu nghin cu xc nh r rng

Phng php c thit k tt Nghin cu c tin hnh ng cch

Phn tch s liu thch hp v y

Vit bo co tt

5


6/51

6NCKH

2008

Phng php nghin cu khoa

hc Nghin cu khoa hc l vic thu thp, phn tch v l

gii s liu gp phn gii quyt mt vn nghincu hay tr li mt cu hi nghin cu1

Th d: Thu thp s liu, phn tch v l gii s liunhn trc v tin s b sa m gp phn phngnga bo ph tr em


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NCKH2008

Nghin cu phc v cho hnh ng


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NCKH2008

Phng php nghin cu khoa

hcS liu (Data): Kt qu ca vic thu thp cc c

tnh hay i lng ca cc i tng

Thng tin (Information): S liu c phn tchKin thc (Knowledge) : Thng tin c l gii v

c s dng tr li cu hi nghin cu vng dng vo mt hnh ng c th.


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NCKH2008

S liu: gi tr ca bin s

10.2 13.7 10.4 14.9 11.5 12.0 11.0

13.3 12.9 12.1 9.4 13.2 10.8 11.710.6 10.5 13.7 11.8 14.1 10.3 13.612.1 12.9 11.4 12.7 10.6 11.4 11.99.3 13.5 14.6 11.2 11.7 10.9 10.4

12.0 12.9 11.1 8.8 10.2 11.6 12.513.4 12.1 10.9 11.3 14.7 10.8 13.311.9 11.4 12.5 13.0 11.6 13.1 9.711.2 15.1 10.7 12.9 13.4 12.3 11.014.6 11.1 13.5 10.9 13.1 11.8 12.2

Hemoglobin (g/100mL) phnmang thai


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NCKH2008

Thng tin: s liu c phn tchHemoglobin Tn sut Phn trm Phn trm cng dn8-8,9 1 1.43 1.43

9-9,9 3 4.29 5.71

10-10,9 14 20.00 25.7111-11,9 19 27.14 52.86

12-12,9 14 20.00 72.86

13-13,9 13 18.57 91.43

14-14,9 5 7.14 98.57

15-15,9 1 1.43 100.00


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11NCKH

2008

Kin thc: thng tin c l gii tr li

cu hi nghin cu v ng dng vo mthnh ng c th

C mt s ln ph n mang thai (26%) b thiu mu

Bit c t l ph n thiu mu gip BS khm tinsn c chin lc ph hp sng lc thiu mu ph n mang thai


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12NCKH

2008

B m v bo phVon Kries R, Koletzko B, et al. Breast feeding and obesity: cross-sectional study. BMJ

1999; 319:147-150

S liu:Cc gi tr cn o v b cu hi ca 9357 tr 5-6 tui

Thng tin:

Thi gian b sa m T l hin mc (%) caQu cn Bo phKhng bao gi (n=4022) 12.6 (12.4 to 12.9) 4.5 (4.4 to 4.6) tng (n=5184*) 9.2 (9.0 to 9.3) 2.8 (2.7 to 2.8)B m hon ton trong12 thng (n=121) 5.0 (1.1 to 8.8) 0.8 (0.2 to 1.5)Kin thc:

C th gim nguy c bo ph tr em bng vic cho b sa m: nu trc b m t 3 n 5 thng nguy c bo ph vo lc 5-6 tui s gim 35%

Hnh ngKhuyn khch b m cho con b sa m gim nguy c bo ph


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Kt cu cng nghin cu

1. Gii thiu1.1. Thng tin nn tng1.2. t vn 1.3. Tng quan ti liu

2. Mc tiu3. Phng php lun

3.1. Loi nghin cu, bin s v k thut thu thp s liu3.2. Ly mu3.3. K hoch thu thp s liu3.4. K hoch x l v phn tch s liu3.5. Xem xt v o c3.6. Nghin cu dn ng

4. K hoch hot ng (bao gm m t nhm n)5. Ti chnh (gii thch cc mc chi tiu chnh)6. K hoch iu hnh, theo di v s dng kt qu

Ph lc1. Ti liu tham kho Ph lc 2. Cc ch vit ttPh lc 3. Cc dng c thu nhn thng tin (bao gm questionnaire).

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Cu hi nghin cu, mc ch,

chin lc v thit k tng ngCu hinghincu

Mcchnghincu

Chinlcnghin cu

Thitknghincu

Hintngsckhexyra u,khi no?

M tXc nhmilinquan nhn qu

M tsphn bcahintngsckhe

Nghin cum t

Nguyn nhn cahintngsckhel g?

Xc nhnguynnhn cahintngsckhe

So snh tnscanhngyut

Nghin cuphntch

Can thipvonguyn nhn c cithincsckhehay khng?

nhgi hiulc,tc ngcamtbinphp

So snh tnscahiu qutrongnhm can thipvnhm chngkimnhgithuyt

Nghin cucan

thip

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15

Cu hi nghin cu Cu hi nghin cu phi c th:

Tr li bng con s hay c/khng.

Khi nim phi r rng

Cu hi nghin cu l th v c ngha

Who care? So what?

Cu hi nghin cu cho nghin cu tt: Tiu chun FINER


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16

Tiu chun FINER

Mun c cu hi nghin cu ttphi a ra kin ngh d kin


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17

Cu hi nghin cu

Cu hi nghin cu no l c th?Tnh hnh i tho ng nh th no?-ko

T l hin mc i tho ng ngi trng thnh

thnh ph H Ch Minh l bao nhiu?-okC nn thay i cch iu tr i tho ng hin nay

hay khng?-no

bnh nhn i tho ng, iu tr tch cc (HbA1c


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Vn nghin cuVn : thiu st, khong cch gia iu ang tn ti

v iu chng ta mong munVn nghin cu & Vn qun l

Nu c kin thc gii quyt vn : vn qunl

Nu cha c kin thc tr li: vn nghin cu Vn c hay khng? C quan trng hay khng?

Nhng yu t no nh hng n vn ? Nhng gii php no c th gip gii quyt vn ?

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Vo nm 2002 t l tim chng tr em di 1 tui TP H Ch Minh ch vo khong 30%

iu ny c phi l vn hay khng?

iu ny c phi l vn nghin cu hay khng?

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NCKH 2008 21


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22NCKH

2008

Tiu chunchnvnnghin cu1. Tnh xc hp:

2. Trnh trng lp:

3. Tnh khthi:4. Tnh cchpnhntcc nh qunl:

5. Tnh ngdngcaktquv cc kinngh:

6. Tnh cpthitcati:

7. Tnh chp nhn v o c:


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23NCKH

2008

Thang im nh gi u tinTnh xc hp:1. Khng xc hp: bnh t gp v khng trm trng

2. Xc hp: bnh ph bin nhng t trm trng3. Rt xc hp: ph bin c hu qu xuTrnh trng lp

1. thng tin v vn nghin cu

2. C thng tin v vn nghin cu nhng chabao ph vn chnh3. Khng c thng tin gii quyt vn


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24NCKH

2008

Thang im nh gi u tinTnh kh thi1. Nghin cu khng kh thi vi ti nguyn sn c

2. Nghin cu kh thi vi ngun lc sn c3. Nghin cu rt kh thi vi ngun lc sn c

Tnh chp nhn ca cp lnh o

1. Ch khng chp nhn c vi lnh o2. Ch t nhiu kh chp nhn

3. Ch c chp nhn hon ton


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25NCKH

2008

Thang im nh gi u tinTnh ng dng1. Khuyn co t c hi c thc hin

2. Khuyn co ct nhiu c hi c thc hin3. Khuyn co c nhiu c hi c thc hin

Tnh cp thit

1. Thng tin khng cp thit cn thit2. Thng tin cn thit ngay nhng c th tr hon

3. Thng tin rt cn thit ra quyt nh


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26NCKH

2008

Thang im nh gi u tinTnh chp nhn v o c1. C vn quan trng v o c

2. C mt t tr ngi v o c3. Khng c vn o c


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27NCKH

2008

Thc hin v li ch ca bnh nhn - Beneficence- a practitionershould act in the best interest of the patient. (Salus aegroti

suprema lex.) Khng lm tn hai bnh nhn - Non-maleficence- "first, do no

harm" (primum non nocere). Bnh nhn c quyn t ch -Autonomy- the patient has the right

to refuse or choose their treatment. (Voluntas aegroti supremalex.)

Cng bng: phn phi cng bng ngun lc him trong y tJustice- concerns the distribution of scarce health resources, and thedecision of who gets what treatment.

Phm gi: tn trng phm gi bnh nhn - Dignity- the patient(and the person treating the patient) have the right to dignity.

Trung thc: Truthfulnessand honesty- the concept of informedconsenthas increased in importance since the historical events ofthe Nuremberg trialsand Tuskegee Syphilis Study
http://en.wikipedia.org/wiki/Beneficencehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Justicehttp://en.wikipedia.org/wiki/Dignityhttp://en.wikipedia.org/wiki/Truthhttp://en.wikipedia.org/wiki/Honestyhttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Nuremberg_trialshttp://en.wikipedia.org/wiki/Nuremberg_trialshttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Nuremberg_trialshttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Nuremberg_trialshttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Honestyhttp://en.wikipedia.org/wiki/Truthhttp://en.wikipedia.org/wiki/Dignityhttp://en.wikipedia.org/wiki/Justicehttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Beneficence


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28NCKH

2008

Vn 1 Vn 2 Vn 3 Vn 4

1. Tnh xc hp

2. Trnh trng

lp3. Kh thi

4. c lnho chp nhn

5. Tnh ngdng6. Tnh cpthit7. Y c

Tng s


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29NCKH

2008

Kt cu phn m u cho nghin cu can

thipVn y t l g? Tm quan trng ca vn

nghin cu (t l hin mc, t l mi mc, huqu)

Cc gii php iu tr (phng nga hoc chnon) hin ti cho vn v ti sao cn cc giiphp iu tr (phng nga hoc chn on) mi

Nhng cu hi no ca gii php chn on mi

cn c tr li v trong nhng cu hi nocha c tr li Nu cu tr li ny c trli s gip ch g cho cng ng, bnh nhn, bc s

a ra mc tiu nghin cu


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30NCKH

2008


31/51

31NCKH

2008

Kt cu phn m u cho nghin cu quan

stVn y t l g? Tm quan trng ca vn nghin

cu (t l hin mc, t l mi mc, hu qu) Nhng yu t nguy c ca vn nghin cu l g?

Nhng yu t no c th nh hng n vn nghin cu (da trn cc lp lun khoa hc) nhngcha c xc nh? Nhng yu t nguy c no c xc nh nhng cn cha r quy m?

Vic xc nh c cc yu t nguy c mi hoc quym ca cc yu t nguy c bit s gip ch g chocng ng, bnh nhn, bc s

a ra mc tiu nghin cu


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V d:VnbtrARV cabnhnhn HIV tiTpHCM

Tk trdi3 tuicpht hintr

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BtrARVTnhtrng

kinh t

Dchvy t

Thi canhnvin y t

Chtln

gdchv

Mc

bnh

pngviiu

tr

Kinthc

Thiugim st

BtrARV bnhnhn

HIV

Nghnghip

Thiukinthc

Tui

ngh


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Pht hintrt

k trdi3tui

Dv y tkm

Bs thiukin

thcvtk

Bskhngquantm

Thiuphng t

vn,truyththng

Gia nhthiukinthc

Tnhtrng

kinh tgd

Nisinhsng

nghquantrng

Tuim,hcvncha m,

nghnghip


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Phn tch vn Spxpccyutthnh cc nhm lnv xydngs: Yutkinh tx hi: Gmtui, gii, hcvn, ngh

nghip, kinthccngng, cc loihnh iutrcngng,

Yutdchvy t: tnh c cv tipcnccadchv, qunl dchvy t, chtlngcsy t, thivicc loihnh iutr

Yuty sinh: trmtrngcabnhtt, pngviiutr, hintngkhng thuc

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Xc nhtrngtm v phmvi1. Tnh hudngthng tin: Thng tin c ctvnny c gip cithinvnhay khng? Giiphp gii

quytc thchinchay khng?2. Tnh kh thi: C th thu thp cnhng thng tin

no trong thigian dtr thchinnghin cu?

3. Tnh lpli: C thng tin no c ri? kha cnhnocathng tin cncnghin cuthm.4. Y c: qu trnh nghin cuc lm tnhig ni

tngnghin cuhay khng?

Cntham khoti liuhochi kinchuyn gia xc nhtrngtm v phmvi canghin cu

37 Thng tin v cc yu t gp phn


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38 2008

Mctiu nghin cu Mctiu camtnghin cunhmtm tt

nhngg stcbinghin cu Mctiu nghin cu l mnh khng nh th hin nghin

cu t c iu g tr li cu hi nghin cu: Ccyutno nhhngnvicbtrARV cabnhnhn

HIV ?

Mctiu philin quan chtchviphn t vn


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Phn loi mc tiu

Theo cp bao ph Mc tiu tng qut

Mc tiu c th

Cc mc tiu c th c chia theo mc u tin Mc tiu chnh (primary objective)

Mc tiu ph (secondary objective)

39 2008


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Mc tiu nghin cu Phn loi mc tiu theo cp bao ph

Mc tiu tng qut (general objective, aim) iu trng i t c bi nghin cu theo cch chung

nht Khng thc s l mc tiu

Mc tiu c th (specific objectives): Cc phn nh hn v c lin h hp l v gip t c

mc tiu tng qut


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Th dvmctiu nghin cu

Mctiu tngqut (general objective, aim) Xc nhccyutnhhngnvicbtrARV cabnhnhn HIV

Mctiu cth(specific objectives): Xc nhmilin quan giacc cimdn s : tnh trng

kinh t,hcvn, tuivivicbtr ARV cabnhnhn HIV Xc nhmilin quan giathi canhn vin y tvivic

btr ARV cabnhnhn HIV Xc nhmilin quan gianngcabnhvivicbtr

ARV cabnhnhn HIV


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Mc tiu nghin cu Phn loi mc tiu theo mc u tin

Mc tiu chnh (primary objective) Tr li cu hi nghin cu quan trng nht

Phi t c mc tiu nghin cu chnh L c s tnh c mu nghin cu

Mc tiu ph (secondary objective): C th khng t c mc tiu nghin cu ph

Thng khng cn tnh c mu da trn mc tiu ph (cth tnh lc mu cho mc tiu ph)


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Th d v mc tiu nghin cu Mc tiu chnh (primary objective) Xc nh hiu qu phng nga bng huyt sau sinh cp (mt trn

500 ml mu trong vng 2 gi sau sinh) ca misoprostol so viplacebo ph n sinh con theo ng m o

Mc tiu ph (secondary objective):

Xc nh hiu qu phng nga bng huyt sau sinh cp tnh, nng(mt trn 1000 ml mu trong vng 2 gi sau sinh) ca misoprostolso vi placebo ph n sinh con theo ng m o

Xc nh hiu qu gim lng mu mt sau sinh ca misoprostol sovi placebo ph n sinh con theo ng m o

Xc nh t l xut hin bin c bt li ph n sinh con theong m o s dng misoprostol

43 2008


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Yu cu ca mc tiu nghin cu Ph hp vi iu kin thc tin, kh thi Phi bao gm cc kha cnh khc nhau cho

mc tiu tng qut mt cch mch lc v hp l S dng cc ng t hnh ng c hiu nh

gi: Xc nh, c lng, tnh ton, (kho st, nghin

cu,..) So snh, kim chng, xc nh s lin quan, (kho st,

nghin cu,..)


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Yu cu ca mc tiu nghin cu Phi c th:

Mc tiu c lng: Nu r (a) tham s cn c clng (b) ca vn (c) trn dn s c th

Mc tiu lin quan: Nu r (a) bin c lp cn c xcnh tc ng ln (b) bin ph thuc (c) trn dn s cth

Mc tiu so snh: Nu r (a) nhm c nh gi sosnh vi (b) nhm chng v (c) kt cuc no (d) trnmt dn s c th

Nu c khi nim c th cha c hon tonthng nht phi nh ngha khi nim ny ngaysau mc tiu nghin cu.


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Tng quan (correlation): H s c gi tr t -1 n 1 chobin s tng quan gia 2 bin nh lng

Lin quan (association): c hay khng yu t ny (bin

nh tnh hay nh lng) nh hng hay tc ng nbin s khc. S o lin quan (OR hay RR) l s o c gi trdng c th 1 C s lin quan gia ht thuc l v ung th phi

T l ung th phi ngi ht thuc l cao hn t l ung th phi

ngi khng ht thuc l T l ht thuc l ngi ung th phi cao hn t l ht thuc l

ngi khng b ung th phi


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47 2008


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Mc tiu nghin cu c th l kim nh mt githuyt nghin cu

Gi thuyt nghin cu l cu tr li d kin cho cuhi nghin cu Misoprostol c lm gim nguy c bng huyt sau sinh

cp tnh hay khngso vi placebo ph n sinh con theong m o?

Misoprostol lm gim nguy c bng huyt sau sinh cptnh so vi placebo thai ph sinh con theo ng m o

48 2008


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Gi thuyt nghin cu Gi thuyt nghin cu l s tin on v mi quanh gia mt hay nhiu yu t vi vn nghin cu thai ph c nguy c, nhm s dng thuc chng

ngng tp tiu cu lm gim nguy c b sn git so vinhm dng gi dc

Gi thuyt nghin cu nn y cc thnh phnPICO - PECO

P (Polutaion) I (Intervention) E (exposure)

C (Control)

O (Outcome)


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50 2008

Th d ca gi thuyt nghin

cu Phu thut ct cng mc su s t va chm v xo trn

vo t chc ni nhn nn kt qu s tt hn

Bnh nhn b glaucome gc m c iu tr bngphu thut ct cng mc su s c t l ti pht thphn so vi bnh nhn c iu tr bng phu thutct b c in


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Tn ti nghin cu C 2 quan im chnh

Tn ti l mc tiu tng qut ca nghin cu

Tn ti l mt cm danh t th hin cc t kho canghin cu

Tn ti phi th hin c nghin cu s a rac kt qu g.

Date post:	02-Jun-2018
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