Introduction to Research

• A systemized review of the literature followed by a critical appraisal of articles retrieved from the systematic review
• The best way  to answer questions is by searching for the evidence (literature) and using evidence-based principles (or practices) to answer these questions rather than hunches, opinions, or manufacturer-sponsored CEU events
• The primary goal of these pages is to walk the reader through the entire process of implementing, completing, presenting and publishing a Capstone project


• To follow established codes of ethics for protection of human subjects.  All studies must have IRB approval from its institution. Project also must undergo a review and re-approval each year. (More about this later)

The Importance of Research

• evidence based medicine - "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” 
• experimental design
• statistical analysis
• how to perform a systematized review of the literature
• how to critically appraise the results of a systematized review
• how to ask and answer critical questions

Introduction to the Research Process

• Evaluating the available research might appear to some as a time-consuming and laborious process, but methods are available to divide this effort into smaller, more manageable components.​

1. Generate a focused answerable clinical question
   1. Example: whether using directional microphones in open-fit hearing aids is beneficial for improving speech recognition in noise
   2. question can be outlined as: Patient, Intervention, Comparison and Outcome
      1. the patient describes the population (normal hearing from 250-2000Hz followed by mild-moderate severe SNHL above 2000Hz)
      2. the intervention is the use of directional microphones in open-fit hearing aids
      3. the comparison is what can be considered as intervention instead of a directional microphone (unaided or use of an omnidirectional microphone)
      4. the outcome identifies the expected or desired result (directional microphone in open-fit hearing aids provide improved speech recognition in the presence of background noise) 
2. Find the best available evidence through database searches
   1. search via several databases that will speed up a literature search
   2. posters, articles, dissertations, and monographs
3. Critically assess the evidence
   1. REAL; Research Evaluation for Audiology Literature is a user friendly tool to critically analyze the literature and provide the base for developing the evidence to answer a specific question
      1. the level of evidence based on the experimental design
      2. rationale for the sample size (power analysis)
      3. variability in the data; that is, what was the make-up of the subjects, how similar or dissimilar were the subjects, how reliable or stable were the measures
      4. determination of statistical significance
      5. determining practical significance (Cohen's d (the difference between two means divided by a standard deviation for the data)) *See 17 & 18
4. Generate a recommendation(s) by combining the results from the critical assessment of the evidence with clinician expertise and patient preferences
   1. the results of the critical appraisal of available evidence, clinical expertise of the practitioner and patient preference are combined to create a recommendation
5. Evaluate the result of the recommendation effort and seek other ways to improve the outcome
   1. once the recommendation is made to fit open-fit hearing aids with directional microphones, then the result (improved benefit in speech recognition in noise) can be evaluated agains other interventions such as an unaided or omnidirectional microphone

Frequently Asked Questions

1. Why should students and clinicians be interested in knowing how to critically evaluate the available literature?
   Students and clinicians should be knowledgeable of how to critically review and evaluate the available literature because it will make them better consumers of the information; that is, the more clearly the student or clinician can understand the methodologies and results of an article, the better they will be able to determine if the results apply to their specific research or patient population.
   
2. What defines a profession?
   A profession is defined by the responsibilities and privileges afforded it by society and by the consumers of the services and/or products rendered by members of the profession.
   
3. Is there an easy to understand process one can follow to help a student or clinician to evaluate the available literature?
   Yes. As a starting point and as a way to help the student or clinician systematically review an article or other piece of professional literature, one could use REAL. As outlined in detail in Chapter 15, the use of REAL will help the student or clinician to evaluate the level of evidence presented in the article, the variability in the data, and other issues that will allow the student or clinician to determine applicability to their own research or clinical practice.
   
4. What is evidence-based practice?
   Evidence-based practice, at its essence, is the use of clinical expertise, combined with knowledge of the best available research evidence, integrated with an understanding of the needs and preferences of a specific patient. By merging all three components, a clinician will more effectively provide contemporary care of patients.
   
5. What is PICO?
   PICO stands for patient (or problem), intervention, comparison, and outcome and it is a process used by clinicians to assist in systematically determining the effectiveness of a clinical procedure or treatment strategy based on clinical skills and knowledge, the patient's needs, and the best evidence.