ResNet
Magazine of the UQMS Research Network
In This Issue:
Burns, Trauma & Critical Care
Research Centre
UQ Centre for Clinical
Research
UQMS Call for Abstracts
Issue 1, 2009
Foreword by Professor David
Wilkinson
From the Editorial Team
From the UQMS President
Welcome to the first edition of ResNet – the
research magazine compiled by students for
students! Whatever your interest level or previous
experience in research, we hope you will find
something that appeals to you within.
Why should medical students be interested
in research? Isn’t there enough to do? The
MBBS program itself, family, friends,
interests, earning some dollars? Perhaps
research is something a bit distant from your
priorities right now, but that may not always
be the case, and for some students research is
an interest now for many reasons.
My own first exposure to research was when
I did an intercalated degree in pharmacology
between MBBS 2 and 3 at the University of
Manchester. That experience was lab research,
and to be honest it did not really excite
me. My next exposure was when working
in Africa after my intern year in the UK. I
found myself asking all sorts of questions:
why did these babies die this way? / how can I
improve outcomes of kids with malnutrition?
/ what is a better way to improve treatment
completion among kids with TB? And so on.
I then got excited because the questions and
answers were of direct relevance to my clinical
work. And, I found, I had a restless and
enquiring mind. I soon found that I HAD to
know the answers, and I soon found great joy
and satisfaction in designing and executing
studies well, so that the answers were ‘true’.
Publishing also led to a buzz.
For me a significant research career followed,
one that allowed me to meet some great
people, travel the world, and make some pretty
significant contributions to knowledge. Here
at the School we are keen to offer meaningful
research opportunities to students that want
them. The main mechanism in the future for
this is the 1 year MPHIL degree between
MBBS2 and 3, with a scholarship provided to
support living costs.
Well done to UQMS (again) for showing
initiative with ResNet, and here’s hoping that
for some of you, at some stage in your careers,
research forms a part of it.
ResNet is an initiative of the newly formed UQMS
Research Network, and is aimed at helping students
to get more involved in research. Throughout the
magazine you will find some high-quality abstracts
from both honours and research higher degree
students within the School of Medicine.
We have also endeavoured to allow the experts share
their experience with us. These articles will help
you integrate research into your clinical practice in
your future medical careers and demonstrate the
wide scope of possible research topics.
And of course, research is of no use if it is not
applied effectively. For this reason we have
included EBM corner. These articles are written
by students encountering clinical problems, with
expert commentary provided by the guru of all
things EBM - Dr David King.
You will also be able to read profiles on worldclass research facilities, book reviews on the latest
research textbooks, and almost anything else
related to research!
Finally, and perhaps most importantly, we have
started a ‘Research Classifieds’ section in the
magazine. In the future we hope this will evolve
to become a core hub of the student research
network, including advertisements for research
assistant positions, recruiting drives for subjects, as
well as interest groups within each clinical schoolwatch this space!
Welcome to the first edition of ResNet, the first
of many publications to promote medical student
research at the University of Queensland. Firstly
I would like to extend my congratulations to
the Research Subcommittee (Mike Tuppin and
Pete Stickler) for their hours of hard work and
initiative on this project and indeed, the plethora
of research support initiatives that UQMS is now
able to provide their students.
Why ResNet? It is our belief that our UQ medical
students produce amazing research of extremely
high quality which deserves recognition and
support form their student body. This publication
is about ensuring our wider community of fellow
peers, staff and beyond, are aware of the fascinating
work that our students produce; we believe it
is essential that our students set a standard of
excellence to inspire others to do the same. Only by
nurturing such a culture can we hope to encourage
all of our students to embrace medical research
and continue with this in their future directions.
We hope it will assist in informing, inspiring, and
above all, recognising that there are many, many
individuals out there that share the same passions
in research. These are your colleagues and this is
the amazing network you too will become a part
of, whether you make research a career in itself
or when you utilise these discoveries in your own
medical practice. We look forward to seeing your
name in ResNet in the near future.
Tanya Trinh, UQMS President
Michael Tuppin
&
Peter Stickler
If you would like to become more involved in ResNet,
then we would love to hear from you! Please email
your interest to the editor:
m.tuppin@uq.edu.au
Highlights This Issue
• This issue’s profile piece is on the Burns, Trauma and Critical Care Research Centre at the Royal
Brisbane & Women’s Hospital. Feature researcher is Dr Jason Roberts.
• We also profile the UQ Centre for Clinical Research at the Royal Brisbane and Women’s Hospitalmandatory reading for anyone considering a PhD!
• Dr Ian Yang gives us some insight into how to get started in research
• Dr Diann Eley shares her research examining the influence of character and temperament on rural
workforce shortages.
• Dr Mark Schubert shares his thoughts on qualitative research in ‘The Last Word’
• We review the book ‘Introduction to Research in the Health Sciences’
• Call for abstracts for the 2009 UQMS Research Network Colloquium
emergency physicians, scientists, physiologists,
nutritionists, physiotherapists and intensive
care nurses.
From Bench To Bedside...
In the Burns, Trauma & Critical Care Research
Centre, laboratory research is closely allied
with clinical research to ensure translation
from bench to bedside. The major themes
within the centre are:
Antibiotic resistance and infection control in the
critically ill.
Profile Piece
In hospitals today, especially in ICU, there
are a number of pathogens emerging which
are resistant to most drugs. These commonly
occur in long stay, debilitated patients and
contribute to increased risk of death, longer
hospital stay, further weakness and long term
dysfunction. Studies that address antibiotic
resistance and infection control are thus, an
imperative.
Pharmacokinetics and drug distribution in the
critically ill.
Bali Bombings Give Rise to the
Burns, Trauma and Critical
Care Research Centre...
In 2002, the devastation and tragedy of
the Bali bombings focused national and
international attention on burns victims. The
outstanding response from the critical care
and burns staff of Royal Brisbane & Women’s
Hospital (RBWH) and The University of
Queensland (UQ) highlighted the skill and
expertise possessed in this area. Nonetheless,
the event emphasised that there was a critical
need to improve the treatment and outcomes
of burns and critically ill patients.
In response, the Burns Trauma and Critical
Care Research Centre (BTCCRC) was
established to further advance and improve
the level of treatment and care given to burns
and critically ill patients through world-class
research-based clinical practice. Initially a
collaborative venture between the RBWH
Burns and Intensive Care Units (ICU) and
UQ, the Department of Emergency Medicine
(DEM) was incorporated into BTCCRC
in 2008. BTCCRC is headed by Director,
Professor Jeffrey Lipman, and chaired by Dr
Jenny Paratz.
The main aims of the research centre are to:
• Improve both the survival and outcome
of patients through high quality researchdriven evidence base for clinical practice in
the burns, trauma and critical care areas.
• Establish national and international
collaboration in the above areas, thus
increasing research opportunities.
• Enhance the research training and
knowledge base of postgraduate students
and staff.
Since its inception in 2002, the BTCCRC
has expanded from 3 staff to an impressive 46
staff and students in 2008. With this growth,
the research focus on burns, critical care and
trauma over the years has expanded to include
anaesthesia and, more recently, emergency
medicine.
Our clinical research is based on a solid
foundation of multidisciplinary collaboration
between intensivists, burns surgeons,
anaesthetists, cardiologists, neurosurgeons,
Critically ill patients often require different
doses of antibiotics and other drugs,
particularly if they are on renal dialysis.
Professor Jeffrey Lipman has pioneered work
that demonstrates that patients in ICU are
not receiving enough antibiotics to achieve
optimal levels to kill pathogens. Our centre
uses the specialized technique of microdialysis
for in vivo monitoring of local concentrations
of drugs and metabolites in tissue, in an
attempt to determine optimal antibiotic
administration.
Management and outcome of critically ill,
trauma, head injury and long stay ICU
patients.
Patients who survive intensive care often are
weak, debilitated and with a poorer quality of
life compared to their pre-morbid status. We
are actively investigating methods to prevent
weakness and loss of function in long stay
ICU patients ensuring the best quality of care
is offered.
Critically ill patients with renal dysfunction.
This is a relatively new area of collaboration
with the Department of Renal Medicine.
Patients with existing renal dysfunction can
have additional problems if they become
Intensive care unit (ICU) patients that
develop sepsis represent a huge financial
burden to the healthcare system. Sepsis
occurs in 12% of patients admitted to ICUs
and has mortality rates approaching 50% for
severe sepsis. Antibiotic therapy has been
shown to be the most effective intervention
available to clinicians and further efforts
to maximize antibiotic efficacy has been
suggested to provide greater reductions in
morbidity and mortality. Broad spectrum
β-lactam antibiotics are commonly used for
empiric treatment of sepsis, although little
is known about the pharmacokinetics (PK)
and pharmacodynamics (PD) of these
antibiotics in interstitial fluid which is the
‘target site’ of most infections. Significant
laboratory data suggests that administration
of β-lactams by a continuous infusion (CI),
as opposed to intermittent bolus (IB) doses,
maximizes antibiotic activity, although
this mode of administration is rarely used
clinically for these antibiotics.
The aims of this research were: (1) to
determine the comparative tissue PK and
PD of IB dosing and CI for two β-lactam
antibiotics, piperacillin and meropenem,
in ICU patients with sepsis, using a
novel technique called microdialysis;
(2) to determine the differences in
clinical outcome between both modes of
administration for another broad spectrum
β-lactam antibiotic, ceftriaxone, in a small
prospective pilot study; and (3) to metaanalyse the data from all known published
studies comparing clinical outcomes
between IB dosing and CI.
The first two studies demonstrated that
CI maintains a statistically significant
superior PK profile compared with IB for
critically ill especially with issues of drug
dosage, weaning from mechanical ventilation
and overall outcome.
Management and outcome of burns patients
including pain control, myocardial dysfunction,
exercise and metabolism, fluid and nutritional
management post burn.
Thermal injury is a devastating injury, not only
for the immediate concern of loss of life and
extreme pain, but in the long term cosmetic and
functional issues. Therefore a need to improve
treatment and outcomes of burns patients is
critical. Our burns unit, one of the largest in
Australia, has instituted a large number of
studies investigating initial cardiac function
ORIGINAL ABSTRACT
An investigation of the utility of
continuous infusion vs intermittent
bolus dosing of beta-lactam antibiotics
in critically ill patients with sepsis
Dr Jason Roberts
BAppSc, BPharm(Hons I), PhD
the antibiotics piperacillin and meropenem,
in the plasma and subcutaneous tissue of
ICU patients with sepsis (P<0.05) (Crit
Care Med 2009;37(3):926-33; J Antimicrob
Chemother 2009; in press). CI therefore
achieves superior PD targets at the target
site of infections in this patient population.
The third study demonstrated that in a
small cohort of ICU patients (n=58) with
severe infections requiring 4-or-more days
ceftriaxone therapy will have statistically
superior clinical (p<0.05) and bacteriological
(p<0.05) outcomes when administered by CI
( J Antimicrob Chemother 2007;59(2):28591). The final study, a meta-analysis that
combined the data from all clinical studies,
demonstrated no difference in mortality
(P=1.00) or clinical cure (P=0.83) between
β-lactam administration by IB or CI in all
hospitalized patients (Crit Care Med 2009;
with large burns, management of pain,
antibiotic efficacy, nutrition issues, exercise
post burns and prevention of heterotopic
ossificans (bone formation outside of the
skeleton, usually in soft tissue).
Anaesthesia.
Currently, there is a steady stream of research
in difficult airway management needed for
a growing teaching arm in this area. Our
research focuses on the need for classification
of difficult airways. Our proposed model “Model for Direct Laryngoscopy and Tracheal
Intubation” which has been used by others
- addresses the need for a structured, logical
approach to airway assessment. Additionally,
37(6) in press). The heterogeneity of
patient groups included in this study,
some of which were ICU cohorts with
inexplicably low mortality rates, may
have prevented any advantages of CI or
IB emerging. However, large confidence
intervals were observed suggesting that a
difference may still exist.
The research described above has
significant implications for world-wide
medical practice and future research in
this area. We have been able to show that
CI achieves superior PD targets in both
plasma and interstitial fluid providing
strong support for administration of
β-lactams by CI to ICU patients with
sepsis. Optimizing β-lactam activity,
using CI, in these patients may have
profound effects on patient morbidity and
mortality. The meta-analysis data suggests
this advantage of CI is likely to be limited
to ICU patients, with the greater hospital
population less likely to derive clinical
benefit. Validation of these results with a
large prospective multi-centre randomized
controlled trial in ICU patients with sepsis,
requiring at least 4-days β-lactam therapy,
is suggested.
Dr Jason Roberts completed his PhD
in the UQ School of Medicine in 2009,
under the supervision of Prof J Lipman.
He is a clinical pharmacist working at the
Royal Brisbane & Women’s Hospital, and
is an academic staff member of the Burns,
Trauma & Critical Care Research Centre.
in order to understand the changes in airway
morphology with different head and neck
positions, we have developed a new TwoCurve Theory which is the basis for the
development of clinically-relevant difficult
airway algorithms. Both areas of research and
development attempt to reassess the current
trends in this area.
Emergency medicine.
New to the research centre, DEM research
focuses on improving outcomes and evaluating
new processes for treating patients in the
Emergency Department.
ORIGINAL ABSTRACT
Can we alter risk factors for
oesophageal cancer with
exercise?
The BTCCRC boasts worldclass
facilities...
The BTCCRC boasts bioanalysis capabilities
that are out of the reach of most ICU’s
worldwide. For over a decade, they have been
measuring drug levels in plasma, ultrafiltrate,
urine and microdialysate by techniques of
HPLC and ELISA. With exclusive access to
an Applied Biosystems API2000 LC-MS/
MS, analysis of smaller and less concentrated
samples is now possible. Last year saw the
expansion of the bioanalysis facility into
the new University of Queensland Centre
for Clinical Research (UQCCR) building,
fitting accommodation for our new Shimadzu
Prominence HPLC system.
Additionally, the BTCCRC Tissue Culture
Laboratory also moved into the stylish,
advanced facilities of the new UQCCR. The
move has helped facilitate collaborations
between the centre and other researchers
within UQCCR and has allowed us access
to state-of-the-art equipment and facilities.
This, together with our links to the Tissue
Banking Facility at the RBWH, will help to
align our clinical research in tissue burns with
our lab-based cell culture research.
Dr Sia Athanasas-Platsis
WANT TO WRITE ARTICLES
FOR RESNET?
Do you want to get more out of ResNet?
Want to unleash your creative talents?
Then we want to hear from you!
You can contribute to ResNet through writing book reviews, profile
pieces, research abstracts, EBM articles, reflective commentaries
and so much more! You can also flex your creative muscle by helping
with the design and editorial process.
So what are you waiting for?
Contact the ResNet team today!
To contact, email your interest to the editor at: m.tuppin@uq.edu.au
Brooke Winzer
BPhty(Hons I), PhD candidate
Oesophageal adenocarcinoma is rising rapidly
in incidence as a consequence of populationwide increases in obesity. Barrett’s oesophagus
(BE), the precursor to adenocarcinoma, is
also rising in incidence, but currently there is
an absence of evidence about ways to reduce
the rate of progression to cancer.
Patients with BE are known to have
disturbances across an array of biochemical
and hormonal axes, including elevated serum
concentrations of the adipokine leptin,
insulin and the inflammatory mediators
interleukin-6 and tumour necrosis factoralpha. It is likely that these disturbances would
promote cancer development. There is some
trial evidence that moderate-intensity exercise
training can abrogate hormonal perturbations
in overweight people without BE, but to date,
no such evidence exists for patients with BE.
By randomising 120 overweight, sedentary
males with BE to either an exercise group or a
stretching control group, we aim to determine
whether 24 weeks of moderate-intensity
exercise training (1hr, 5 days per week) will
lead to changes in levels of certain hormones
associated with oesophageal adenocarcinoma
development.
This will be one of the first exercise intervention
trials with the goal of changing the hormonal
milieu of patients with BE to reduce
oesophageal adenocarcinoma risk. Through
studying a population with a pre-malignant
condition we also hope to gain information
regarding the capacity of exercise to prevent
cancer and the mechanisms involved.
Brooke Winzer completed her physiotherapy
degree at LaTrobe University in 2005. She
is a PhD student in the School of Medicine
under the supervision of Dr J Paratz from
the BTCCRC. Her study is funded by a
Wesley Research Institute Grant.
Thinking about medical research?
It’s time to ask questions!
Why do research?
For researchers in the field of biomedical
research, the lifelong journey of answering
important medical questions often starts
with a spark, and then grows to a passion.
The seeds for ideas most frequently come
from our patients, their health and disease.
Ultimately our goal as clinicians, researchers
and teachers is to improve outcomes for
our patients, by pushing the boundaries of
understanding disease pathogenesis, ensuring
early and timely diagnosis, and developing
and using the most effective prevention and
treatment. Answering these questions is both
challenging and exciting.
How to start
The best way to start is to develop curiosity,
interest and awareness about how research
works, and to find out about research
opportunities that are available. Biomedical
research covers many disciplines e.g.
epidemiology of acute and chronic diseases,
application of basic sciences to clinical
medicine, diagnostic strategies, development
of therapeutics and testing through clinical
trials etc - just to name a few. There are
many opportunities available for keen
early career researchers in the School of
Medicine’s Clinical Schools, Disciplines,
Research Centres and teaching hospitals.
Joining a multidisciplinary team that does
research can be made easier by making links
with established clinical researchers, such as
through the UQMS Research Network, or
through your colleagues and clinical tutors.
Research opportunities exist at any career
stage - for undergraduate students, higher
degree students, and for health professionals
after graduation.
factor), compared to weekday admissions
(Comparison) experience worse in-hospital
mortality (Outcome)? Another example is a
research project we’re working up with our
pharmacy colleagues: In patients on long
term oxygen therapy (Population), does
sesame oil (Intervention), compared to other
nasal barrier treatments (Comparison) reduce
nasal irritation and encourage adherence to
oxygen therapy in patients using nasal prongs
for oxygen delivery (Outcome)?
Once the question is framed, and the
hypothesis is defined, further details about
background information (literature review),
study design, methodology and statistical
analysis can be prepared for research proposals,
ethics applications and research grant
applications. Ethics approval is an important
process before commencing a research study,
and funding provides resources to undertake
research. The National Health and Medical
Research Council (NHMRC), the peak
national funding body for biomedical
research, recommends criteria for quality
assessment of research and research teams,
including:
• Significance and/or innovation: potential
to increase knowledge about human health,
and application of new ideas;
• Scientific quality: strengths and weaknesses
of the research plan and the experimental
design;
• Track record in relation to opportunity:
standing and skills of the research team, and
ability to undertake the project.
These quality criteria are useful to consider
when designing research projects.
Planning research
The ‘PICO’ framework helps to ask relevant
clinical questions, giving a structure for the
hypothesis of a research question in terms of
Population, Intervention, Comparison and
Outcome. For example, our team recently
helped an MBBS Honours student researcher
to ask the question: In patients with acute
illnesses such as cardiac disease or chronic
obstructive pulmonary disease (Population),
do weekend admissions (Intervention, or
Outcomes of translational
research
The eventual outcome of biomedical research
is to improve the health of the population.
Translational research can be thought of
as being in two phases 1: the first is ‘benchto-bedside’ in which scientific advances are
applied to understanding disease pathogenesis
and better ways of diagnosing and treating
Dr Ian Yang
MBBS, FRACP, PhD, Grad Dip (Clin Epi)
Dr Ian Yang is a consultant thoracic physician
at The Prince Charles Hospital, and is also
an Associate Professor and Head of the
Northside Clinical School in the UQ School
of Medicine.
disease; the second is ‘bedside to clinic’ in
which results from clinical trials are translated
into clinical practice.
It is well-recognised that translational
medical research is bidirectional in nature e.g.
from bench to bedside, and bedside to bench
2
. There is an inherent cross-fertilisation
between basic and clinical sciences, including
in respiratory sciences 3. Thus interdisciplinary
teams are required to work together to share
resources and skills, in order to synergise to
address complex human disease questions.
Shared knowledge and communication
are essential, with clinicians learning the
language and techniques of science, and basic
scientists acquiring knowledge of clinical
research design and aspects of clinical disease.
Translational biomedical research enables
knowledge from physiology, molecular and
cellular biology disciplines to be applied
to human disease 4. In this way, there is a
directed pathway of applied knowledge
from ‘molecules to models to humans’ 4.
This is seen particularly in the application
of genomics, epigenomics, transcriptomics
and proteomics to studying lung diseases 5.
For example, our PhD students and research
scientists in our team have recently used gene
expression microarrays on lung tumour tissue,
to study lung cancer outcomes 6-8. These and
other studies have identified gene signatures
that have predictive ability for susceptibility
to lung cancer and risk of recurrence after
surgery. Furthermore, other recent studies
have shown distinct gene signatures in chronic
lung disease such as COPD 9. All of these
features of translational research also apply
to ‘bedside to clinic’ research that focuses on
clinical practice.
ORIGINAL ABSTRACT
A pilot study into the
reproducibility of electrical
impedance tomography
Lawrence Caruana
BPhty, MPhil candidate
Caruana L1, 2, Barnett AG2, 3, Tronstad O2,&
Fraser JF1, 2
1 The University of Queensland, Brisbane.
2 The Prince Charles Hospital: Critical
Care Research Group, Brisbane.
3 Queensland University of Technology,
Brisbane.
The aim of this study was to assess the
reproducibility of electrical impedance
tomography, and is a within subject
observational design.
Five healthy male volunteers were placed
in the supine position and connected to
the Draeger Medical Electrical Impedance
Tomography Evaluation Kit 2 (Lubek,
Germany), which uses a 16 electrode
array and a pneumotachometer (Ventrak
Model No 1550: Novametrix Medical
Systems, Wallingford, USA). Concurrent
two minute recordings of tidal variations,
ventilation distribution and tidal volumes
Challenges and opportunities
Time and resources are major challenges for
any researcher. And of course, the results of
any proposed project can’t be predicted ahead
of time – the goal is basically to ask relevant
questions and then go ahead to answer them
in the best way possible. On the other hand,
beneficial outcomes for biomedical researchers,
including early career researchers, are research
training in developing and carrying out
research projects; learning new methodologies;
skills in communication, team work, time
were made in the morning and repeated
in the afternoon. Every effort to ensure
identical electrode placement was
made.
The Bland and Altman statistic was used
to determine the limits of agreement
for the tidal variations, tidal volumes,
and ventilation distribution. A Pearson
correlation between tidal variations and
tidal volumes was used to judge the
transferability of the limits of agreement.
Descriptive statistics were used to
compare actual and predicted tidal
volumes, and for comparison to fractal
ventilation.
Results
demonstrated
significant
correlation between tidal variations
and tidal volumes (Pearson correlation
= 0.72, p < 0.001), allowing for tidal
variations to be judged as in agreement
between readings. The tidal volumes
showed a coefficient of variation similar
to that of fractal ventilation at 26.7%.
The ventilation distribution showed
significant ‘clustering’ above or below the
zero line indicating a lack of agreement.
A number of possible causes for this
lack of agreement existed including that
regional distribution might be fractal.
Electrical impedance tomography tidal
variations are reproducible and could be
useful in clinically assessing the effects
of recruitment manoeuvres or positional
changes.
Lawrence Caruana completed his
physiotherapy degree at the University of
Queensland in 1987 and works at The
Prince Charles Hospital as an advanced
clinician. He is currently a MPhil candidate
in the School of Medicine under the
supervision of Dr J Fraser.
management and leadership; presentation
skills (e.g. poster or oral presentation at
scientific and clinical meetings); publications
in peer-reviewed journals; and satisfaction
from discoveries that lead to change in health
care practice. Research and teaching are
integral parts of clinical practice, and a track
record in research and teaching can boost job
applications and career advancement. So, if
you’re energetic, motivated to be involved
in research, and have the desire to learn and
discover, it’s time to ask questions!
UQ
Useful links
www.uq.edu.au/research/
Information and resources about research at
UQ
NHMRC
www.nhmrc.gov.au/
Information about the research activities of
the NHMRC
Nobel Prize for Medicine 2005: Barry
Marshall and Robin Warren
http ://no b elprize.org/no b el_prizes/
medicine/laureates/2005/
The most recent Australian Nobel Laureates
– fascinating videos to watch about how they
made their landmark discoveries
References
1. Woolf SH. The meaning of translational research
and why it matters. JAMA 2008;299(2):211-3.
2. Horig H, Marincola E, Marincola FM. Obstacles
and opportunities in translational research. Nat
Med 2005;11(7):705-8.
3. Farre R, Dinh-Xuan AT. Translational
research in respiratory medicine. Eur Respir J
2007;30(6):1041-2.
4. Sabroe I, Dockrell DH, Vogel SN, Renshaw SA,
Whyte MK, Dower SK. Identifying and hurdling
obstacles to translational research. Nat Rev
Immunol 2007;7(1):77-82.
5. Yang IA, Holloway JW. Asthma: advancing
gene-environment studies. Clin Exp Allergy
2007;37(9):1264-6.
6. Larsen JE, Fong KM, Hayward NK. Refining
prognosis in non-small-cell lung cancer. N Engl
J Med 2007;356(2):190.
7. Larsen JE, Pavey SJ, Bowman R, et al. Gene
expression of lung squamous cell carcinoma
reflects mode of lymph node involvement. Eur
Respir J 2007;30(1):21-5.
8. Larsen JE, Pavey SJ, Passmore LH, et al.
Expression profiling defines a recurrence
signature in lung squamous cell carcinoma.
Carcinogenesis 2007;28(3):760-6.
9. Yang IA, Francis SM. Deconstructing COPD
using genomic tools. Respirology 2009;14(3):3137.
Investigating the Influence of Temperament and
Character on the Rural Medical Workforce Shortage
Dr Diann Eley
BSc, MSc, PhD
Dr Diann Eley is the Director of Research at
the Rural Clinical School Research Centre,
UQ School of Medicine.
d.eley@uq.edu.au
Like most research, this work was born
out of a problem - specifically, why is it so
difficult to get doctors to work in rural and
remote areas? 1, 2 The literature reports on
several key indicators of rural recruitment
and retention such as rural origin, 3 spouse
and family influences, positive clinical and
lifestyle experiences 4, 5 and more recently the
generational factors associated with ‘X’ and
‘Y’. 6
Our research approaches the dilemma of
increasing the rural medical workforce by
investigating how individual temperament
and character traits may provide clues to
improve the recruitment and retention of
rural doctors.
Although acknowledged by anecdotal
narrative, the unique personality and lifestyle
of doctors in rural and remote locations
worldwide has received little attention in
the research literature. This is despite its
recognition as an entity in itself comprising
advanced skill sets different from urban
counterparts.
Personality is made up of two major
components; temperament and character.
Temperament is pre-disposition - a
configuration of inclinations. Character is
disposition - a configuration of habits. Each
of us develops the habits appropriate to our
temperament but those habits are influenced
by the innumerable external factors – good
and bad - we are exposed to as we develop. For
example; think of your brain as a computer
with temperament as its hardware and
character as its software. The hardware is the
physical base from which character emerges.
In other words, temperament is the inborn
form of human nature and character, the
emergent form which develops through the
interaction of temperament and environment.
The psychobiological theory of personality
underpins the main tool we employ for this
work, the Temperament and Character
Inventory (TCI) 7. The TCI assesses levels of
the seven scales of temperament and character
traits. Each trait is multifaceted with high and
low descriptors summarized in Table 1.
Our research is not about ‘typing’ people
or professions. There is no one ‘type’ of
person who chooses a profession or to work
in a particular location. Instead there are
particular combinations of temperament and
character traits that predispose individuals to
certain areas and interests in life and equip
them with the requisite ability to adapt to
their decisions. The specific and unique
combination of temperament traits, that are
mildly heritable, and character traits, which
are developmental and influenced by sociocultural learning contribute most strongly to
our personalities and influence our choices
throughout life. 7, 8
To date, our research findings from samples
of rural and urban doctors, medical students
and most recently nurses consistently depicts
them as highly ‘self directed’ (character),
‘cooperative’ (character) and highly
‘persistent’ (temperament) individuals.
In other words, they all possess traits that
contribute to a profile that would be expected
of successful professionals in the medical
sciences. It is interesting and significant that
apart from persistence, these are traits of
‘character’, meaning they have developed
through maturation and socio-cultural
learning. These traits would be familiar to
teachers as those of ‘good students’ and high
achievers. But although these character traits
may be omnipresent within the medical
profession – it is the temperament traits that
drive the personality, dictates the level of
adaptability and provides a unique ‘flavour’
to each individual. 9, 10, 11
The most significant findings from our
research are that three temperament traits
of ‘novelty seeking’, ‘harm avoidance’ and
‘reward dependence’ are integral to identifying
differences between various groups. This
indeed is an important finding in regards
to recruitment and retention efforts. The
utility of understanding the temperament
and character trait profiles of individuals and
groups is that temperament traits, being stable
and innate, may be predictive of individuals
with similar temperament profiles. For
example, identification of the temperament
profiles of successful doctors in various roles
and practice locations may be indicative
(predictive) of the traits conducive to coping
in those roles and locations. On the other hand,
the developmental nature of character would
allow modification or development of those
traits through training and education. Both
could be of value to educators, recruiters and
policy-makers through a better understanding
of which traits are most conducive to certain
disciplines and their environments.
Our data consistently demonstrates
that while high levels of core traits; self
directedness, cooperativeness and persistence
seem to be a prerequisite for success in rural
practice, the various levels and combinations
of novelty seeking, harm avoidance and
reward dependence are most essential to
understanding how individuals adapt in their
own way to rural medicine. And likewise
what separates those who stay and those who
leave rural practice i.e. retention issues.
There are a myriad of biological, environmental
and developmental factors, opportunities and
circumstances that influence our decisions
in life and make us what we are. There is no
one right or wrong trait profile that we could
‘clone’ to alleviate our rural medical workforce
shortages. Our research has begun to establish
a psychobiological profile of rural doctors.
Certainly a better understanding of the
temperament and character trait profiles of
the professionals who adapt and flourish in the
rural environment will provide educators and
policy makers with a better comprehension
of what it takes to be a ‘rural doc’ and inform
the development or modification of training,
initiatives and recruitment procedures
accordingly.
References
1. Wilkinson D. 2000. Inequitable distribution of
general practitioners in Australia: Analysis by
state and territory using census data. Australian
Journal of Rural Health, 8: 87-93.
4. Dunbabin, J., Levitt, L. 2003. Rural origin and
rural medical exposure: their impact on the rural and remote medical workforce in Australia.
Rural and Remote Health, 3 (online), Available
from: http://rrh.deakin.edu.au (Accessed 20 August 2007).
2. Humphreys JS, Jones MP, Jones JA, Mara P.
2002. Workforce retention in rural and remote
Australia: determining the factors that influence
length of practice. Medical Journal of Australia,
176: 472-476.
5. Eley, D., Baker, P. 2007. Will the Australian
Rural Clinical Schools be an effective workforce
strategy? Early indications of their positive impact on intern choice and rural career interest.
Medical Journal of Australia, 187:166-167.
3. Somers, G.T., Strasser, R., Jolly, B. 2007. What
does it take? The influence of rural upbringing
and sense of rural background on medical students’ intention to work in a rural environment.
Rural and Remote Health, 7: 706 (online), Available from: http://rrh.deakin.edu.au (Accessed
20 August 2007).
6. Twenge JM. 2009. Generational changes and
their impact in the classroom: teaching Generation Me. Medical Education, 43: 398-405.
7. Cloninger CR, Svrakic DM, Przbeck TR. Psychobiological model of temperament and character. Archives of General Psychiatry 1993; 50:
975-990.
8. Cloninger CR. Feeling Good 2004, Oxford Univ
Press: New York.
9. Eley D, Young L, Shrapnel M. Rural temperament and character: A new perspective on recruitment and retention of rural doctors. Australian Journal of Rural Health 2008; 16, 12-22
10. Eley D, Young L, Prysbeck T. Exploring temperament and character in medical students; a
new approach to selection and training to increase the rural workforce. Medical Teacher 1112-2008, 1-6, iFirst.
11. Eley D, Young L, Prysbeck T. Exploring the
temperament and character traits of rural and
urban doctors; implications for retention of the
rural workforce. Journal of Rural Health (USA)
2009, 25; 1: 43-49.
Table 1: Temperament and character descriptors
TEMPERAMENT is defined as those components of personality that are heritable, developmentally stable, emotion based and not influenced by
socio-cultural learning. The four dimensions of Temperament, all of which reflect a heritable bias are:
TEMPERAMENT
High Scorers
Low Scorers
Novelty Seeking: NS - observed as exploratory
activity in response to novelty, impulsiveness, and
extravagance
exploratory & curious
impulsive, disorderly
extravagant & enthusiastic
seeks challenge
indifferent, reflective
frugal & detached
orderly & regimented
Harm Avoidance: HA - observed as pessimistic
worry in anticipation of problems, fear of
uncertainty, shyness with strangers, and rapid
fatigability
worrying & pessimistic
fearful & doubtful
shy , fatigable
indecisive
relaxed & optimistic
bold & confident
outgoing, vigorous
opinionated, decisive
Reward Dependence: RD- indicates cues of social
reward and is observed as sentimentality, social
sensitivity, attachment, and dependence on
approval by others
sentimental & warm
dedicated & attached
dependent
needs to please
seeks approval from others
practical & cold
withdrawn & detached
independent
not influenced by others
socially insensitive
Persistence: PS - describes behaviour despite
frustration, fatigue and reinforcement. It is
observed as industriousness, determination and
perfectionism
industrious & diligent
hard-working
ambitious & overachiever
perseverant & perfectionist
determined
inactive & indolent
gives up easily
un-ambitious underachiever
quitting & pragmatist
CHARACTER traits reflect personal goals and values and are subject to socio-cultural learning. Each trait quantifies the extent to which an individual
displays certain related qualities
CHARACTER
High Scorers
Low Scorers
Self Directness: SD - quantifies the extent to which
an individual is responsible, reliable, resourceful,
goal-oriented and self-confident
responsible & reliable
purposeful, self accepted
resourceful & effective
habits congruent with long term goals
blaming & unreliable
purposeless, self-striving
inert & ineffective
habits congruent with short term goals
Cooperativeness: CO - quantifies the extent
to which individuals are cooperative, tolerant,
empathic and principled
socially tolerant
empathic, helpful
compassionate, constructive
ethical & principled
socially intolerant
critical, unhelpful
revengeful & destructive
opportunistic
Self Transcendence: ST - quantifies the extent to
which individuals conceive themselves in relation
to the universe as a whole. It is observed as
spirituality, practicality, materialism and modesty
wise & patient
creative, imaginative
self-effacing
united with universe
modest , humble, spiritual
impatient
unimaginative
proud & lack of humility
materialistic
practical
CALL FOR ABSTRACTS
ResNet
The UQMS Research Network is now
seeking abstracts from medical
students for inclusion in future issues
of ResNet. Abstracts can be in either
of the categories of original research
or evidence based medicine.
While this particularly suits Honours,
Masters and Doctorate research
students in the School of Medicine,
submissions from students without a
research background are strongly
encouraged.
There is no deadline for abstracts
submitted to ResNet. Acceptance for
publication will be subject to peerreview process.
THE UQMS RESEARCH
NETWORK AWARDS
UQMSResearch
ResNet Category
This award is given annually for the
best article submitted to ResNet, in
either the EBM or original research
abstract category. Each article
submitted will be judged by a panel
for its scientific content, writing style
and potential impact.
Colloquium Category
This award is given for the best oral
presentation at the UQMS Research
Colloquium. Each presentation is
judged for its scientific content,
presntation style and accompanying
abstract.
GUIDELINES FOR AUTHORS
1. Abstracts should be no more than 250
words, and include the following
headings (in bold): Background; Aims;
Methods; Results; Conclusion. Abstracts
outlining a proposed research project
will not have a results section.
2. Title should be no more than 20
words.
Colloquium 2009
The 2009 UQMS Research
Colloquium will be held on the
evening of September 30.
We are now seeking original research
abstracts for either oral or poster
presentations. Submissions may be
made by any MBBS, MPhil or PhD
student within the School of
Medicine.
The deadline for colloquium abstracts
for 2009 is midnight on August 31.
Please also indicate whether you
would prefer to make an oral or
poster presentation.
Oral presentations
3. Authors and affiliations must be
included beneath the title.
4. Abstracts should use scientific or
generic names for products where
possible.
5. Any research on human subjects must
15 minutes will be allowed for oral
presentations, with 5 minutes for
questions. Presentations must be
accompanied by powerpoint slides.
have been approved by the relevant local
Poster presentations
the abstract to be reproduced in ResNet.
Posters must be no larger than A0
size (841mm x 1189mm).
To submit to either ResNet Magazine or
the research colloquium, email your
abstract as an attachment (word file or
rich-text format) with the subject header
‘UQMS Abstract’. Please also include a
brief bio paragraph and photo for
inclusion with your abstract.
institutional ethics committee.
6. Submission of abstract signifies that
the author(s) have given permission for
Email: m.tuppin@uq.edu.au
EBM Corner
Visual Loss
in Giant Cell
Arteritis
Background:
An elderly male, aged 72, who presented
with sudden onset of visual loss in his
right eye due to giant cell arteritis (GCA).
This raises two immediate point-of-care
questions: firstly, what treatment should
be initiated; and secondly, what is the
prognosis for the sight in his right eye?
Clinical Questions:
Using the PICO format, these questions
could be posed as:
1. In a patient presenting with GCA and
visual loss (patient), what are the current
treatment guidelines (intervention)?
2. In a patient presenting with GCA and
visual loss (patient), and who receives
treatment (intervention), what is the
prognosis for return of vision (outcome)?
Search strategy:
A search was performed in Medline Ovid
using the fields (“giant cell arteritis” OR
“superficial temporal arteritis”).ti. AND
Expert Commentary
In many conditions of inflammatory
disease steroids are assumed to be of
benefit, but there is not always a sound or
large evidence base to support the nature
and size of benefit. For example, in Bell’s
palsy the benefit from corticosteroids is
modest and only if they are commenced
early in the course of disease. Due to
the serious implications of visual loss
following giant cell arteritis it would be
ethically difficult to undertake a RCT
without providing steroids to the control
group. However, the extant trials are
mostly small in size and many are case
series rather than prospective cohort
studies.
Of the first 3 studies chosen to answer the
(“amaurosis fugax” OR “vis* loss”).af. AND
treatment.af, yielding 70 results. A quick
scan of the titles of the first few indicated
four articles that were directly relevant –
three review articles of giant cell arteritis
and its treatment, 1,2,3 and one prognostic
study of outcome in patients with visual
loss due to GCA.4
nisolone daily for 3 days, followed by oral
prednisone. Patients with visual loss from
GCA. Unfortunately, visual deterioration
still occurred in 27% of eyes within the
first week despite corticosteroid treatment, and only 5% had an improvement
in both visual acuity and visual field.
Results:
Based on this point-of-care application
of EBM, we concluded that it would be
reasonable to admit this patient for intravenous administration of 1g methylprednisolone for three days, followed by
a slowly tapering oral prednisolone dose
commencing at 60mg. We are also able
to commence him on low-dose aspirin as
an adjunct to treatment that may help to
preserve sight in his other eye.
A brief look at the abstracts for the three
treatment review articles 1,2,3 gives us a
good guide to treatment. Unfortunately,
we note that there are no randomized
controlled trials specifically looking at
CGA patients with ocular complications
and comparing treatment modalities.
However, all three reviews seem to agree
that patients should be admitted to hospital for high-dose intravenous methylprednisolone. Additionally, two articles
mention a retrospective study concluding that aspirin appears to decrease the
likelihood of stroke or visual loss in GCA,
without increasing the complication of
bleeding. Other treatments (methotrexate and anti-TNF-a agents) are being trialed but have not yet had their efficacy
demonstrated.
Application:
References:
1. Fraser J, Weyand C, Newman N & Biousse V.
The treatment of giant cell arteritis. Reviews
in Neurological Diseases (2008); 5(3): 140-52.
2. Hall J. Giant-cell arteritis. Current Opinion
in Ophthalmology (2008); 19: 454-460.
3. Wang X, Hu Z & Lu W et al. Giant cell
arteritis. Rheumatology International (2008);
29:1-7.
The final prognostic study4 was a prospective evaluation of 34 consecutive
patients with biopsy proven GCA and visual loss (mean visual acuity was 20/400).
All patients were treated with a standard
protocol of 1 g intravenous methylpred-
4. Danesh-Meyer H, Savino P & Gamble G.
Poor prognosis of visual outcome after visual
loss from giant cell arteritis. Ophthalmology
(2005); 112(6):1098-103.
above clinical question, the second and
third are academic reviews rather than
systematic reviews, so important studies
could potentially have been overlooked.
I note that all 3 reviews are dated 2008
– beware rejecting older studies which
may actually be of better quality. I fairly
quickly located 2 other studies (Hayreh,
2002; Chevalet, 2000) that both found
no difference in outcomes at one year
between oral and intravenous steroids,
although Hayreh, et al. looked at visual
recovery rather than prevention.
equivocal that IV steroids are better than
oral delivery, and due to the inherent
dangers of hospitalization, I would prefer
to manage such a patient as an outpatient
with regular review.
A summary of the evidence supports
these points. Early treatment probably
prevents some visual loss, though we
have no evidence for the relative or
absolute risk reduction. Once visual loss
occurs, there is a very small recovery
rate even with steroid treatment. It is
2. Hayreh S, Zimmerman B, Kardon (2002)
R. Visual improvement with corticosteroid
therapy in giant cell arteritis. Report of a
large study and review of literature. Acta
Ophthalmol Scand 80(4):355-67
References:
1. Chevalet P, Barrier J. et al (2000) A
randomized, multicenter, controlled
trial using intravenous pulses of
methylprednisolone in the initial treatment
of simple forms of giant cell arteritis: a
one year followup study of 164 patients. J
Rheumatol. Jun;27(6):1484-91
Dr David King
ORIGINAL ABSTRACT
Fiona Simpson
BSc, MBBS candidate
A Comparison Of Middle Ear
Disease In Indigenous Children
In Urban And Rural Communities
Simpson F1, Spurling G1,2, Hayman N2
1 University of Queensland
2 Inala Indigenous Health
Background: Australian Indigenous
children have higher rates of middle ear
disease than have been described in any
other population in the world. While it
is well documented that prevalence is
highest in remote communities, there is
little research into indigenous children
living in an urban environment.
Aims: The primary aim of this study
is to investigate whether Indigenous
children living in an urban environment
have similarly high rates of middle ear
disease and exposure to risk factors
compared to Indigenous children living
in a rural environment. Secondary aims
of the study include a comparison of
severity, as measured by perforation
rates; differences in referral rates; and
variations in management.
Methods:
Data
was
collected
opportunistically by administering a
Child Health Check to approximately
250 children aged between 0 and 15
yrs who attended the Inala Indigenous
Health service between March 2007 and
December 2008. This information will be
compared to that obtained from Child
Heath Checks that were undertaken as
part of the Northern Territory Emergency
Response Child Health Checks Initiative.
This information is available on the
Australian Institute of Health and Welfare
website.
THE UNIVERSITY OF QUEENSLAND
CENTRE FOR CLINICAL RESEARCH
only translating high quality medical research
directly to the patient, but also providing
a ready avenue for clinicians to investigate
research questions arising from patient care.
This joint “bench to bedside” and “bedside
to bench” focus, addresses a critical area of
unmet need in the early 21st century, not
Fiona Simpson completed a Bachelor of
Science majoring in Biomedical Science at UQ
in 2006, and is currently in 3rd year medicine.
Her honours research project is under the
supervision of Dr G Spurling.
Conclusions: The results of this research
will improve our understanding of
the difference in health in indigenous
Profile Piece
The University of Queensland Centre for
Clinical Research (UQCCR) is a new Faculty
of Health Sciences centre pivotally located
on the Herston campus, alongside Australia’s
largest teaching hospital. UQCCR’s mission
is to embed clinical research at the interface
between the laboratory and the patient
bedside, by fostering innovation in clinical
research, and translating basic and applied
research into more effective outcomes for
patients.
children in urban and rural communities.
It is essential that health care practices
and health interventions are appropriate
for the target community, therefore an
understanding of whether the same
factors influence health in Indigenous
children, regardless of location, is
necessary. This information can provide a
basis for improvements in clinical practice
and for wider health interventions in
the community that aim to improve the
health status of Indigenous children.
Our research is organised along four primary
themes: Molecular and Cellular Pathology,
Clinical Neuroscience, Tissue Inflammation
and Injury Repair, and Clinical Outcomes
and Clinical Trials. Work in stem cell research
and perinatal medicine link these areas as
central cross-cutting themes.
Molecular and Cellular
Pathology
Research investigating breast, prostate,
oral and skin cancer will develop a better
understanding of the links between
pathological changes at the molecular and
cellular level and the clinical expression of the
disease seen at the bedside. Research groups
led by Professor Sunil Lakhani, Professor
Martin Lavin, Professor ‘Frank’ Gardiner
and A/Prof Camile Farah are paving the
way for development of novel or improved
diagnostic technologies, and better methods
of treatment.
Tissue Inflammation and
Injury Repair
Inflammation is a fundamental part of many
diseases and a prime target for therapeutic
interventions. Professor Nicholas Fisk,
Professor David Paterson and A/Professor
Kiarash Khosrotehrani’s tissue inflammation
and injury repair research program links basic
research on inflammation and repair with
new approaches to treating inflammation and
promoting repair. This research includes a
focus on a range of injuries such as infection,
burns, fractures and arthritis, as well as
damage caused by genetic and autoimmune
diseases.
BOOK REVIEW
• Brain development/injury/rescue
• Signal Processing
• Fetal Movement
• Gene expression in the brain in pregnancy
in rats
Introdution To Research In
The Health Sciences.
5th edition.
• Immune responses in human stroke
Polgar S & Thomas S
• Genetic factors predisposing to human
inflammatory neuropathy
Clinical Neuroscience
This program works on developing and
evaluating new modes of diagnosis and
treatment of brain disorders, particularly
dementia, stroke, movement disorders, and
brain injury in adults and babies. Research
includes the areas of neuroimmunology,
neuropharmacology, neuroimaging and
neuroprotection. Research groups are led by
Professor David Pow, Dr Judith Greer, A/
Professor Pamela McCombe, Professor Paul
Colditz, Dr David Copland, A/Professor
Stephen Rose and Professor Peter Silburn.
Clinical Outcomes and
Clinical Trials
Clinical trials are intrinsic to our mission
of delivering the benefits of new medical
research to patients. UQCCR’s location
alongside one of Australia’s largest hospitals
optimises opportunities to conduct intensive
investigation of how patients respond to
new treatments and modes of diagnosis.
The Centre will grow clinical trials research
particularly focusing on ambulatory Phase
Two – Early Phase Three trials and develop
new databases to monitor health outcomes.
Potential RHD projects
UQCCR is committed to training
translational researchers and clinical scientists
and a number of projects for PhD studies are
offered on the following topics.
• Pharmacotherapy for aphasia
• Mapping the neural mechanisms of language
treatment in aphasia
• Neurophysiological markers of language
recovery in acute stroke
• Influence of deep brain stimulation on
language in Parkinson’s disease
• Potential language markers of depression
and dementia in Parkinson’s disease
• ERP indices of developmental reading and
language disorders and treatment
• Perinatal Research
• Rate of loss of motor neurones in the SOD1
model of ALS
• Generation of new cortical atlases based on
functional connectivity information acquired
using MR diffusion tractography.
• Investigating the relationship between
white matter lesion (WML) load, cortical
atrophy and aging.
• Development of novel methods to
quantitatively measure white matter injury
and endogenous reorganisation / recovery
mechanisms associated with stroke and
hypoxic injury in neonates.
• Development of novel MRI markers of
early treatment response in patients with
brain tumours.
• Investigating novel fMRI and MR diffusion
tractography technology to improve
neurosurgical planning for patients with
brain tumours.
• Cancer association with reduced fetal stem
cell microchimerism
• Fetal stem cell transplantation
• Maximising homing and engraftment of
stem cells for bone repair
• Development of novel segmentation and
cortical mantle extraction techniques for the
neonate brain.
Our UQCCR Research staff and academics
are happy to advise or offer any further
information. Visit our website for contact
details www.uqccr.uq.edu.au or phone the
centre on 07 3346 6555.
Professor Nicholas Fisk
Description
According to the publisher Elsevier, the fifth
edition of An Introduction to Research in the
Health Sciences has two overall aims.
1) To introduce the fundamental principles of
research methodology and explain how these
principles are applied for conducting research
in the health sciences.
2) To demonstrate how evidence produced
through research is applied to solving problems in everday health care.
Review
This introductory text is great for anyone
contemplating research within health sciences
and doesn’t quite know how to go about it.
The book is divided into 7 key sections that
effectively outline the research process from
start to finish:
• The scientific method
• Research planning
• Research designs
• Data collection
• Descriptive statistics
• Inferential statistics
• Dissemination and critical evaluation of
research
Throughout the text, the emphasis on writing
is placed firmly on the application of key
concepts to research. This is in contrast to some
other texts that get caught up in providing
too much detail on the statistical analysis and
not enough on designing the research project.
The result is a book that delivers what it
primarily set out to achieve – an introduction
to research. The key strength of this book is
that it effectively discusses the entire research
process in a minimum of pages, allowing it to
be read in a very short period of time. There
is also some discussion of basic descriptive
statistics for those who have not studied this
at a tertiary level. Those who have might also
find it a useful and succinct summary of some
of the main concepts. Finally, there is some
brief discussion of choosing the appropriate
statistical test for analyzing data. Again, this
would be most useful for people who have
not studied more advanced tests at a tertiary
level, or for those who are only likely to be
using simple tests in their research project.
An interesting feature of this book is
the inclusion of qualitative research
methodologies in research in health
sciences. There has also been some attempt
at integrating this into the wider research
framework of using combined methodologies
to approach a research problem. However, as
the emphasis of the text is still firmly biased
towards quantitative research, the main use
of this discussion would be to get budding
researchers to at least think about qualitative
methodologies in their research. It would
certainly be nice to see further development
of the qualitative paradigms in future editions
of the text.
Strengths:
• Well written, easy to read and understand
in a short period of time
• Good, simple introduction to the use of
statistical analysis in research
• Introduces the concept of pragmatism – the
combined use of qualitative and quantitative
methodologies in solving problems
• Includes a chapter on qualitative research in
health sciences
• Discusses how to critically evaluate the
literature, and introduces systematic reviews
and meta-analyses
• Inclusion of questions and answers at the
end of each chapter to allow the reader to
test their understanding of the key concepts
presented
Weaknesses:
• Does not discuss more advanced statistical
techniques such as survival analysis and
logistic regression
• Sections discussing qualitative research
could be further developed
Conclusion:
This book provides an extremely useful starting
point for any student or clinician without a
solid grounding in the research process and
who is about to enter into a research project.
It would particularly suit any student who is
contemplating pursuing an honours project as
part of their medical degree.
Bibliographic Details
Paperback, 344 pages
Publication date: NOV-2007
ISBN-13: 978-0-443-07429-5
Imprint: CHURCHILL LIVINGSTONE,
ELSEVIER
The Last Word
Qualitative Research in EBM
The use of qualitative data in the practice
of evidence based medicine presents a
number of issues, such as its scientific
validity as well as its practical reliability
in being able to predict how patients will
respond in a clinical or other settings.
Indeed, as data, they represent what and
how people think, usually as a process,
not necessarily as a simple response to
a stimulus at one point in time, the way
EBM’s quantitative data sets measure,
under particular conditions (symptoms
and diseases), the body’s response to
an intervening stimulus (treatment) of
some kind.
Qualitative data, whether elicited from a
sociologist’s semi-structured interviews
with people or from ethnographic
research where an anthropologist,
embedded in an isolated community for
a year or more, describes everything seen,
heard, felt, tasted or smelled as data, are
concerned with people’s expressive lives.
They are a kind of data that, even in the
social sciences, sometimes has a difficult
time defending their usefulness. Not
because they aren’t useful. But such a
defence is usually against those who do
not appreciate the difference between
explanation of peoples’ behaviours
as distinct from understanding their
behaviours and their perceptions of
others’ behaviours as something that
has a particular meaning to them, a
meaning probably quite different from
the meaning you or I would attribute to
it.
EBM libraries now have a growing set
of qualitative studies that are ranked
in value according to some very well
developed principles that even social
scientists could do well to adopt.
However, I am not sure that ranking them
according to some type of qualitative
validity or any such other ill-conceived
and misleading term, is all that useful.
This is because, concerned as qualitative
data collection methods usually are
with people’s expressive lives, they are
continually picking up unpredictable
directions in which people’s eternally
Dr Mark Schubert
PhD
Dr Mark Schubert is a lecturer with the
School of Population Health. He holds a
PhD in the field of anthropology at the
University of Queensland in 2008.
creative awareness can send people’s
responses and behaviours. A qualitative
study, based on observation and semistructured interviews, of how terminally
ill patients’ relatives respond to such news
in one setting may reliably predict how
such relatives will respond in another;
but, there again, it may not. This is not
because the qualitative method and its
resulting data are no good, but simply
because human beings are eternally,
creatively aware and unpredictable,
including medical practitioners.
The power of creative awareness is not just
in its making of unpredictable behaviour.
All you have to is read Viktor Frankl’s
account of survival in concentration
camps, not being a result of better food
or health care, but whether or not people
actually even had a vision of their lives
after liberation; a vision out of creative
awareness.
Even an anthropologist, who has read
every other study of a village or region
that will be their next focus of study, can
find themselves quite naked and clueless
once the village of study is reached. I
once went on a project armed with an
idea based on what I understood was
happening in a region and also with
all the relevant studies under my belt;
but then, after one day in the location,
realised the people into whose lives I had
moved were not concerned with what I
thought they had been at all. The study
changed completely.
Then there is that other factor in every
social process – you. You do not stand
outside the creative awarenesses of those
with whose issues you deal and diseases
you treat; you are a part of their very
responses to these, just as in social science
research activities, the very presence of a
researcher can have an effect on the very
people under study in a manner analogical
to what the observer effect or Heisenberg
uncertainty principle attempts to
describe. For confirmation of this, why not
take a look at Robert Rosenthal’s studies
of the effect of teachers’, psychologists’,
medical
practitioners’ and
other
interveners’ attitudes and conduct and
communication modes on the outcomes
for students, clients, patients and others
whose lives are being helped.
This does not mean that qualitative
studies in EBM collections should not be
consulted. They should. However, like any
field anthropologist, you must be aware
that any patient consultation episode can
be as exploratory as the anthropologist’s
field work; and, if the best advice I can give
to anthropologists is to listen, listen, listen
…… be quiet and without resistance, give
the people you seek to portray your own
agency as a human being, so that you
can stand-under them, then such advice
is as important to you as future medical
practitioners. Why? ……….as medical
practitioners you will listen to and have
interaction daily with more people over
your careers than most anthropologists
ever will.
Research Classifieds
Journal Club
Clubs & groups
Want to keep up with the literature?
Interested in forming a journal club in
your local clinical school? Just email your
details along with your preferred location
and special interest group (eg surgery,
medicine, paediatrics) to the UQMS
Research Network, and we will provide
you with the necessary contacts and
guides.
UQCCR Open Day
Events
The UQCCR is holding an open day on the
25th September, and is definitely worth
checking out. Between 10am-2pm there
will be building tours, presentations by
group leaders and supervisors, and lunch
provided. Registration for catering and a
chance to win an iPod is online via:
www.uqccr.uq.edu.au
Also check the article in this issue outlining
potential PhD topics within the UQCCR.
Research Assistant Positions
Sorry! There are no research assistant positions available at the moment, but please
check again in the next issue!
Subjects Needed
Exercise & the prevention of oesophageal cancer
The EPOC study aims to determine if exercise can help prevent the development
of oesophageal cancer, and is currently
recruiting male subjects with Barrett’s Oesophagus. Goodlife Health Clubs Brisbane
in conjunction with UQ Sport are providing free 6 month gym memberships to all
participants randomised to the ‘exercise’
group of this study. The EPOC study is
also supported by a Queensland Health –
Health Practitioners grant.
Details: b.winzer@uq.edu.au
Attitudes, mood & decision making
Individuals for a lab-based study on attitudes, mood and decision-making at St
Lucia campus. This research may contain
death-related concepts that some may
find confronting.
Details: clinton.knight@uqconnect.edu.au
Tennis Elbow
People who have experienced tennis
elbow pain for at least six weeks.
Details: tenniselbow@uq.edu.au or ext.
54692
Chronic neck pain
Males/females (18-45 years) with chronic
neck pain to undertake one supervised
exercise session and undergo a MRI exam
of their neck. There is no cost to the participant and no side-effects from the MRI.
The study will be at The Wesley Hospital.
Volunteers reimbursed for participation.
Details:Dr James Elliott; 3365 4529 (Office).
Type 2 Diabetes
People with Type 2 diabetics but not
achieving adequate blood sugars control
on least 1.5g/day metformin (Diabex, Diaformin) only and close to needing insulin.
Trial of new additional therapy which promotes weight loss and may help control
blood sugars before Insulin is needed.
Details: d.colquhoun@uq.edu.au or Lara
Petelin, 3876 5688.
Whiplash Injury
People aged 18-65 with current neck pain
following whiplash injury incurred during
a motor vehicle accident three months to
two years ago, to participate in a study
investigating the effects of dry-needling,
exercise and advice. Each included participant receives $60 towards travel & time
for each assessment (five in total over one
year).
Details: s.valentin@uq.edu.au.
Carpal Tunnel Syndrome
Patients with carpal tunnel syndrome to
participate in a clinical trial evaluating
non-surgical interventions.
Details: carpaltunnel@uq.edu.au or ext.
54692
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Research Classifieds is free!
To advertise here, please contact the
ResNet team.
m.tuppin@uq.edu.au
UQMS Research Network
www.uqms.org