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Peter Agger · Robert S. Stephenson
J. Michael Hasenkam

A Practical Guide
to Biomedical
Research for the
Aspiring Scientist
A Practical Guide to Biomedical Research
Peter Agger • Robert S. Stephenson •
J. Michael Hasenkam

A Practical Guide to
Biomedical Research
for the Aspiring Scientist

123
Peter Agger Robert S. Stephenson
Department of Clinical Medicine Department of Clinical Medicine
Aarhus University Aarhus University
Aarhus, Denmark Aarhus, Denmark
Department of Paediatrics and Adolescent
Medicine
Aarhus University Hospital, Skejby
Aarhus, Denmark

J. Michael Hasenkam
Department of Thoracic and Cardiovascular
Surgery and Department of Clinical
Medicine
Aarhus University Hospital, Skejby
Aarhus, Denmark
Department of Surgery
Witwatersrand University Hospital
Johannesburg, South Africa

ISBN 978-3-319-63581-1 ISBN 978-3-319-63582-8 (eBook)

DOI 10.1007/978-3-319-63582-8

Library of Congress Control Number: 2017951216

© Springer International Publishing AG 2017

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material
is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does
not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective
laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are
believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors
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and institutional affiliations.

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
 Preface

So you are intrigued by scientific research and what it has to offer, but you
do not know where to start? This book will help aspirational inexperienced
researchers turn their intentions into actions, providing crucial guidance for
successful entry into the field of biomedical research.
The world of science is exciting, and in contrast to what many people
think, it is not confined to the intellectual elite, extraordinary genius minds
or someone with a special gift. Science is something everyone can do. Like
any other craft you just need the right tools, the right guidance and the right
motivation.
Aimed at future researchers within the biomedical professions, be it under-
graduate students, young doctors, nurses, physiotherapists or engineers, this
book advises and supports novice researchers taking their first steps into the
world of scientific research. Through practical tips and tricks we describe the
entire research process from idea to publication, while also providing insight
into the vast opportunities a research career can provide.
We hope that this book will help you make a smooth start in research, and
aid and inspire you to create your own little piece of history in contributing
something truly novel to the world of science. Who knows, you might make
a career out of it!

v
vi Preface

Please help us improve this book for the benefit of future researchers. If you
have any comments, questions or feedback, we would be happy to hear from
you via [email protected].

Aarhus, Denmark Peter Agger

July 2017 Robert S. Stephenson
J. Michael Hasenkam
 Acknowledgements

During the writing process of this book we have benefited immensely from
the help of several key persons. First of all we would like to acknowledge
the work and insight of the contributing authors, and the invaluable input
of all our reviewers. Equally, we would like to thank Ken Peter Kragsfeldt
for designing the figures in this book. All photos presented are provided by
Shutterstock.com. The authors have obtained the relevant publication license
for the use of these images.

vii
 Contents

Part I Before You Start 1

1 The First Steps into Research 3

1.1 Why Do Research? 3
1.2 Initial Contact 5
1.3 The Project Life Cycle 5
1.4 Time is an Important Factor 8
1.5 Knowledge is Important Too! 8
1.6 Let’s Get Started 9

2 Approaches to Research 11
2.1 What are the Different Approaches? 11
2.1.1 Computer Simulations 12
2.1.2 Laboratory Investigations 12
2.1.3 Animal Experiments 13
2.1.4 Clinical Research 14
2.1.5 Registry-Based Studies 14
2.1.6 Clinical Trials 15
2.1.7 Meta-Analyses 16
2.2 A Global View of Research 16
2.3 The Right Research Environment 18

ix
x Contents

3 The Right Supervisor for You 21

3.1 A Good Place to Start 22
3.1.1 Defining Your Areas of Interest 22
3.1.2 Your Position in the Hierarchy of Research 22
3.1.3 The Type of Project 24
3.2 The Type of Supervisor 25
3.3 Research Your Supervisor 25
3.4 Meeting Your Potential Supervisor 27
3.4.1 Clear Mutual Expectations 27

4 Defining Your Project 29

4.1 The First Considerations 29
4.2 Practical Availability 31
4.3 Time Management of a Research Project 32
4.4 Redefining Yourself 33

Part II Conducting Your Research 35

5 Searching for Scientific Literature 37

5.1 Introduction 37
5.2 Developing a Systematic Literature Search 38
5.2.1 Search Techniques 38
5.2.2 Translating a Research Question into a
Search Strategy 41
5.2.3 Block Search 42
5.3 Reference Management 44
5.4 Databases 44

6 Advanced Literature Search 47

6.1 Controlled Subject Headings 48
6.2 Broadening or Narrowing Your Search 48
6.3 Supplementary Searching 50
6.3.1 Grey Literature 50
6.3.2 Citation Searching 50
6.3.3 Hand Searching 51
6.4 Search Documentation 51
 Contents xi

7 How to Read a Scientific Publication 55

7.1 Reading Scientific Papers 55
7.2 How to Read a Scientific Paper in 2 Minutes 56
7.3 To Print or Not to Print? 58
7.4 How to Read Reviews 58

8 The Scientific Protocol 59

8.1 Purpose of the Protocol 59
8.2 The Target Group 60
8.3 The Scientific Language 61
8.4 Writing the Protocol: Structure and Content 61
8.4.1 The Title Page 62
8.4.2 Objectives and Impact 62
8.4.3 The Introduction 64
8.4.4 Materials and Methods 65
8.4.5 Timetable 68
8.4.6 Resources and Feasibility 68
8.4.7 Ethical Concerns 69
8.4.8 Budget 69
8.4.9 Publication Strategy 70
8.4.10 Perspectives 71
8.5 Assessing the Quality of the Study and of the Protocol 71
8.6 Who Should Write the Protocol? 71

9 Ethics and Commercialisation 73

9.1 Always Consider Ethics 73
9.2 Know the Law 74
9.3 Working with Dangerous Substances 74
9.4 Animal Experimental Certification 75
9.5 Patient Related Research 76
9.6 Researching Drugs 76
9.7 Collaborations with the Industry 77
9.8 The Scientific Code of Conduct 77
9.8.1 Commercialising Your Research 78
xii Contents

10 Applying for Funding 79

10.1 How to Find a Potential Funder 80
10.2 Application Types 81
10.2.1 Applications with Application Forms 81
10.2.2 Applications Without Application Forms 81
10.3 The Contents of an Application 82
10.3.1 Summary 83
10.3.2 The Project Description 84
10.3.3 Importance of the Title 84
10.3.4 Keep Introduction and Methods Sections
Short and Inspiring 84
10.3.5 Lay Man’s Description 85
10.3.6 The Research CV Versus Other CV Types 85
10.3.7 Composing Your CV 86
10.3.8 List of Publications 87
10.3.9 Budget 88
10.3.10 Letter of Recommendation 89
10.4 A Couple of Final Tips and Tricks 89

11 Data Handling 91
11.1 What Is Data? 91
11.2 Structuring Your Data 92
11.3 Keeping Your Data Safe 94

12 Data Analysis 97
12.1 Work Flow for Data Analysis 98
12.2 Deciding on Appropriate Tools 98
12.3 Spread Sheets, Graphics and Statistics 100
12.3.1 Steps 1 and 2—Collate and Describe 100
12.3.2 Step 3—Depiction 100
12.3.3 Step 4—Comparison 102
12.3.4 Step 5—Final Visualisation 105

Part III Presenting and Publishing Your Research 109

13 The Scientific Conference 111

13.1 The Conference Abstract 111
13.2 When Your Abstract has been Accepted 115
13.3 The Conference Setting 116
 Contents xiii

13.3.1 The Scientific Session 116

13.3.2 Dressed for Success 116
13.3.3 After the Conference 117

14 The Poster Presentation 119

14.1 What Is a Poster? 119
14.2 How NOT to Design a Poster 120
14.3 How to Make a Poster 120
14.3.1 The Contents of Your Poster 122
14.3.2 Attracting Attention 123
14.4 Printing Your Poster 124
14.5 The Electronic Poster 125
14.6 How to Present a Poster 125

15 The Oral Presentation 127

15.1 Preparing Your Presentation 128
15.2 Composing a Slide Show 128
15.3 Arrival at the Conference Venue 130
15.4 On the Day of Your Presentation 130
15.5 Giving Your Presentation 131
15.5.1 Controlling Anxiety 131
15.5.2 Body Language 132
15.6 The Handheld Presenter and the Laser Pointer 134
15.7 Oh s…! Someone is Asking Questions! 134
15.8 Improving Your Presentation Skills 135

16 The Scientific Manuscript 137

16.1 Types of Manuscripts 137
16.1.1 The Original Article 137
16.1.2 Short Communication 138
16.1.3 Technical Note 138
16.1.4 The Systematic Review 138
16.1.5 Meta-Analysis 139
16.1.6 Case Report 139
16.1.7 Video Article 139
16.2 Reporting Guidelines 139
xiv Contents

16.3 The Contents of the Original Article 140

16.3.1 The Title Page 141
16.3.2 Abstract 144
16.4 The Elements of a Scientific Manuscript 144
16.4.1 The Introduction 145
16.4.2 Materials and Methods 145
16.4.3 Results 146
16.4.4 Figures 146
16.4.5 Discussion 147
16.4.6 References 148
16.5 Figure Legends 148
16.6 Acknowledgements 148
16.7 Supplemental Material 149

17 Scientific Writing 151

17.1 The Biggest Misunderstanding 151
17.2 Learn from the Best 152
17.3 Specific Writing Tricks 152
17.3.1 Put New Information Last 152
17.3.2 Active Versus Passive Voice 153
17.4 Important Grammatical Notions 154
17.4.1 Correct Use of the Tenses 154
17.5 Abbreviations 155
17.6 Numbers and Statistics 155

18 The Process of Publishing Your Research 157

18.1 The Process… 157
18.2 Choosing a Journal 159
18.2.1 What Type of Manuscript will You Produce? 159
18.2.2 The Journal Scope 159
18.2.3 Impact Factor 160
18.2.4 The Financial Cost of Publishing 162
18.2.5 Guidelines for Authors 162
18.3 Submission 163
18.3.1 The Cover Letter 163
18.4 Editorial Consideration 165
 Contents xv

18.5 The Review Process 165

18.5.1 The Editor’s Response 166
18.5.2 Your Response 166
18.6 Publication 167
18.7 Public Engagement 168

19 The Scientific Network 169

19.1 The Advantages of Networking 169
19.1.1 New Opportunities 170
19.1.2 Academic Freedom of Speech 171
19.1.3 Improve Your Efficiency 171
19.1.4 Keep Up to Date 171
19.1.5 Improving Your Future Prospects 172
19.1.6 Your Scientific Footprint 172
19.2 Developing a Scientific Network 173
19.2.1 Forming Collaborations 173
19.2.2 How to Network Effectively 174
19.2.3 How Do I Approach a Potential
Collaborator? 174
19.3 How to Improve Your Chances of Being Networked
with 175
19.4 Maintaining a Research Network 176
19.5 Data Sharing with Collaborators 177
19.6 Networking Online 177

Index 179
 Part I
Before You Start

The first part of this book will take you through all you need to know in
order to prepare a scientific project. It will guide you through the different
available research approaches and the process of finding a supervisor. You will
subsequently find advise on how to define and describe your project.
 1
The First Steps into Research

Throughout the history of mankind, curiosity and an open mind have been the
driving force behind discovery. What is over that hill? What is across that body
of water? What can be found in the dark depths of space? It was probably also
curiosity that made you open this book. Essentially, research is about pursuing
curiosity. Leaving no stone unturned, in an eternal search for new discoveries
that will improve the understanding of ourselves, and the world around us.
Imagine being the first person to describe a phenomenon that will forever
change the way we look at ourselves. You could be just months away from
producing something that lasts forever; a piece of science that will inspire and
stimulate the curiosity of future researchers.

1.1 Why Do Research?

Grandiose introduction aside, there are countless reasons to get involved in
research. On a personal level, maybe you wish to attain an academic degree
or qualification, maybe you would like to boost your CV, or perhaps you just
want to see what all the fuss is about? At this point you probably already know
why you would like to get involved in research, that is the easy part, but what
are the first steps you should take? Who should you talk to? Where do you go?
How do you start?
Before you can answer these questions there are a couple of things you
need to consider. First of all, which topic or field of research interests you the
most? Genuine interest is arguably the most important driver for sustained
engagement in research. A research project will take you through an entire

© Springer International Publishing AG 2017 3

P. Agger et al., A Practical Guide to Biomedical Research,
DOI 10.1007/978-3-319-63582-8_1
4 1 The First Steps into Research

spectrum of emotions, from extreme happiness to deep frustration, and

everywhere in between. An existing interest in your research field is not a
prerequisite for success, but in times of trouble your passion for the subject
is sometimes what gets you out of bed in the morning.
Second, you need to decide which type of research you would like to do.
An important aim during your initial steps is to determine who you are as a
researcher. How do you like to work?
Which approach is likely to suit you best? Are you a “lab rat” who likes
vials and Petri dishes? Do you get your kicks from working with experimental
animals? Are you intrigued by technical inventions and applications? Or would
you prefer a quiet day at the office working with databases or questionnaires?
Maybe you can only see yourself in the clinical setting, investigating fellow
human beings? Obviously, no choice is scientifically better than the other, but
some may be a better match with your personality and temperament. Just
to make this decision a bit more complex, it is not uncommon to combine
multiple approaches of research into a single project. It is important to consider
all possibilities in the early phase, prior to choosing your supervisor and
designing your study. In Chapter 2 we provide a thorough walkthrough of
the different approaches to research.
“Anything that can go wrong will go wrong”. In spite of the fairly negative
connotations of Murphy’s Law, it is indicative of one of the main challenges in
research: the art of preventing things from going wrong. A skilled researcher is
able to anticipate the obstacles and unexpected turns that are inevitably going
to occur, and is able to navigate their project elegantly past them. This skill is
based on one thing and one thing only: preparation.
Preparation is essential from the very first moment you consider starting a
research career. The more you know about your preferences, as outlined above,
the higher the likelihood of finding the right project, the right supervisor, and
the right research group.
 1.3 The Project Life Cycle 5

1.2 Initial Contact

There are many ways of establishing contact with a research environment.
You may already know someone who works in a group you would like to
join, or maybe you know a professor who is conducting research you are
particularly interested in. Face-to-face contact is always the most effective
way of instigating collaboration, but it is not always possible. An email to a
potential supervisor may do the trick, but it might also be lost in the hundreds
of other emails academics receive on a weekly basis. There are no golden rules
to follow in this matter, except that the lack of a response is not the same as
rejection. Sometimes, establishing initial contact requires equal measures of
perseverance and patience. In Chapter 3 we elaborate further on what you
need to consider when looking for a supervisor.

1.3 The Project Life Cycle

Your first project will allow you to journey through the entire life cycle of a
project. In the remainder of this book we will often refer back to the concept
of the “Project Life Cycle” when describing the time line from your initial
research ideas to the publication of your study. The Project Life Cycle is
outlined in Figure 1.1. In the following section you will be introduced to
some of the vocabulary used to describe the different stages of the cycle—yes,
6 1 The First Steps into Research

Hypothesis

Aim

Protocol

Data Acquisition

Data Analysis

Data Interpretation

Presentation

Publication

Fig. 1.1 Outline of the Project Life Cycle

scientists have their own special language—and it can even differ from one
research area to another.
To enter the cycle you must first have a solid hypothesis. This is a kind of
basic question or speculative statement specifically related to your research, it
may be something like “I anticipate this new drug can cure cancer”. Based
on this hypothesis you formulate an aim for your study, e.g. “the aim of
this study is to investigate whether drug X has a curative effect on cancer”.
Despite seeming to address the same issue, note the important linguistic
transformation from the hypothesis to the aim. These and the other aspects of
the Project Life Cycle are all put into context in your protocol, the description
of your planned scientific project, which will be outlined in more detail in
Chapter 8. The protocol is the cornerstone for planning and conducting your
research project. It is used to convey to others what, why and how you will
investigate your hypothesis, it is also the basis for applying for funding and
the relevant approvals to conduct the study.
Once the protocol is ready and approved by all collaborators, including
your supervisor, you are basically ready to go. Once all methods have been
established, equipment is working, etc., you start data acquisition. At this
point is it important to adhere strictly to the protocol. Do not make any
changes once the protocol is closed and data collection has been initiated!
This is one of the fundamental rules in science. If you change your procedure
for data collection, you have effectively started a new project. Therefore,
preparation at the protocol stage is extremely important—and pays off in the
long run.
 1.3 The Project Life Cycle 7

When all data has been collected according to the description in the
protocol, you start the data analysis phase (Chapter 12). Here you perform
all calculations, statistics, and graphic presentations, again, in accordance with
what you defined in the protocol.
Then comes one of the prime times in the whole research process: data
interpretation. What does the data actually tell you? Can your hypothesis
be accepted or rejected? Remember, either outcome is scientifically valid and
interesting. You must, therefore, analyse your data with an open mind and
be objective. In this phase, it is important not to be biased towards a desired
outcome. It is only human to hope your new drug works, but you must make
all efforts to assess your data objectively. You are the first person in the world
to see these data. Consider it a privilege to be the first to interpret them. Your
co-authors can comment on your interpretation and suggest modifications,
but you have the privilege of setting the scene.
Another important stage in the process is the publication of your findings.
Here you shall demonstrate your ability, in collaboration with your co-authors,
to disseminate your results to the wider community. This publication can
be in the form of a poster or an oral presentation at a conference or a
scientific manuscript. The highest-ranking publications are those, which
have undergone a peer review process. We provide separate chapters on the
various related topics later in the book.
No scientific process has been completed until the outcome of the study has
been published. The scientific publication is both the hallmark and the formal
end point for the Project Life Cycle. It is also a product, which is important in
measuring the quality of your scientific work. The stronger the message, the
higher the impact on the scientific community. At later stages the quality is
measured further by the number of times other scientists cite or refer to your
publication—more about this in Chapter 18.
Once you have completed a project life cycle for the first time, you have
earned your stripes. You can now consider yourself a successful scientist in
the making! You are now an acknowledged and skilled individual. You have
demonstrated your ability to conduct a research project, which has gained the
interest of the scientific community, and has conveyed an important scientific
message. You are now at a stage where you can provide the answers to the
questions you posed at the beginning of the cycle.
8 1 The First Steps into Research

1.4 Time is an Important Factor

It takes time to initiate a scientific project. This is extremely important to
remember. As you will appreciate from reading this book, there are many
things you need to consider before you can actually start a study. Depending
on the expected extent of your project, initial contact around a year before
you plan to start is not at all too soon. Try to imagine how long it will take to
find a supervisor, define a project, write up your project description, apply for
funding and approvals, recruit study subjects and so on. No matter how long
you may think it takes, it takes twice as long—at least!

1.5 Knowledge is Important Too!

As outlined in the Project Life Cycle, the cornerstone of every research project
is a hypothesis or a research question that needs to be answered. A good
hypothesis is very important, it is the key to success. Even negative results
cannot destroy a study with a good hypothesis. Coining the perfect idea for
a research project is difficult and often requires extensive knowledge within a
scientific field. As a newbie in research you are, therefore, most likely not in a
position to define the optimal hypothesis for your project.
This highlights an intrinsic dilemma in project planning. During the initial
phase of the project life cycle, you will experience a mismatch between the
importance of each decision that needs to be made, and the knowledge you
have on which to base these decisions (Figure 1.2). In the beginning of a
project, decisions need to be taken that will define the project from that
point onwards. Although your knowledge and insight are limited at this point,
these decisions still need to be the right ones. Conversely, at the end of a
project where your knowledge is extensive, the potential consequences and the
importance of a specific decision becomes less pronounced. In short, you need
to boost your knowledge as quickly as possible when starting a new project.
Again the word “preparation” comes into mind. This can be done by reading
papers and textbooks, and by discussing your project with your supervisor and
collaborators. Guidance on how to effectively search the scientific literature
and subsequently read a scientific paper is presented in Chapters 5 through 7. It
is evident that even at this early stage of your project, you are deeply dependent
on a supervisor that can provide the insights needed to conceive the perfect idea
or hypothesis. This is why we designate an entire chapter for finding the right
supervisor for you!
 1.6 Let’s Get Started 9

The importance of
decisions in the project

Knowledge
on the project

Time

Fig. 1.2 The importance of individual decisions in research projects over time plotted
together with the available knowledge. The latter can be improved by studying
and supervision, but will always improve during the course of the project. Modified
from Attrup and Olsson “Power i projekter & portefølje”. 2nd edition. Jurist- og
Økonomforbundets forlag 2008

1.6 Let’s Get Started

In the remainder of the book we will walk you through everything you need
to know to ensure a smooth journey through the Project Life Cycle. There
are many things to consider, and in spite of thorough preparation, it is almost
inevitable that you will forget some of them along the way. Do not worry about
making mistakes. Rest assured that there will be time to correct mistakes, this
book will, however, help you foresee most of the unexpected obstacles, and
give you the extra energy to focus on what is really important …stimulating
your curiosity.
 2
Approaches to Research

In the first chapter, we asked you to consider what kind of researcher you are.
But given the fact that you are most likely new in the field of research, how
on earth should you know what kind of researcher you are? Well, deciding
on which approaches to research suit you best is a good place to start. You
do not necessarily have to decide on only one approach. You will find that
projects often incorporate more than one approach, especially in the setting
of multidisciplinary research. This chapter will provide an overview of the
different research approaches involved in taking an initial idea all the way to
its implementation as a new technique, treatment or ground-breaking theory.
We then show how these approaches can be interconnected in a global view
of research. You will then be in a position to make an informed decision as to
which type of research activities are the best fit for you.

2.1 What are the Different Approaches?

Biomedical research has many faces and many fields of expertise exist in this
discipline. In the following section, we walk you through the most common
approaches. While reading this section try and identify which approach or
approaches sound most appealing. This exercise will prove useful for future
tasks such as finding a suitable supervisor (Chapter 3) and research group, and
in defining, planning and writing your protocol (Chapters 4 and 8).

© Springer International Publishing AG 2017 11

P. Agger et al., A Practical Guide to Biomedical Research,
DOI 10.1007/978-3-319-63582-8_2
12 2 Approaches to Research

2.1.1 Computer Simulations

Very often, the first step when testing new ideas and hypotheses involves run-
ning computer simulations. Simply put, the simulations use a mathematical
description, or model, to form a computer based dynamic analogue of the
behaviour of something from the real world. Such investigations are often
referred to as “in silico”, and are typically low cost studies that do not involve
patients or animals. A prerequisite for working with computer simulations
is often a background in mathematics or computer science, thus it is unlikely
that you as a biomedical researcher will be working first hand with this research
approach. It is, however, very common to engage in collaborations involving
computer simulations.

2.1.2 Laboratory Investigations

Most hypotheses in basic research are tested in the laboratory using cell lines,
specimens or the like. This is often referred to as “in vitro” experimentation,
referring to the notion that something is growing in a Petri dish. This setting
allows you to investigate many very specific hypotheses, while controlling
many extraneous variables, the human compatibility, however, is often low.
It is, nevertheless, a crucial approach, as your hypothesis will often need to be
validated “in vitro” before you can ethically justify an experiment in a living
creature.
 2.1 What are the Different Approaches? 13

2.1.3 Animal Experiments

After successful passage of the controlled “in vitro” phase, the next level
comprises a more complex biological investigation in experimental animals—
to again test your hypothesis, but this time in a more realistic, and also more
challenging setting. You now have less control over extraneous variables, but
you are edging closer to a clinically relevant message. Animal experiments fall
into two broad categories, “in vivo” and “ex vivo”. Experiments conducted
in living specimens, for example surgical interventions, are termed “in vivo”,
while experimentation on non-living tissue, for example genetic analysis of
biopsies, is classified as “ex vivo”.
14 2 Approaches to Research

2.1.4 Clinical Research

If you do not find the prospect of working in the lab or with animals
particularly appealing, you may find that working with actual human beings is
your preferred research approach. Often the hypotheses investigated in clinical
research have already been explored to some extent using lab-based approaches.
As the name suggests, this approach is more likely to provide results with direct
clinical implications within a single project life cycle. But bear in mind, such
studies are often a product of multiple previous studies. There are many types
of clinical research. Often you would think of a clinical experiment as a study
comparing variables between a group of healthy volunteers and a group of
patients with a disease, but here you should also consider registry-based studies
as a type of clinical research.

2.1.5 Registry-Based Studies

A very important side-branch of clinical research is the registry-based

approach. Using various registries of archived data, you can extract
information on a large number of human beings and compare numerous
parameters to find associations between events and disease. The biggest
difference from general clinical research is that you are working with very
clinically relevant data. Using this approach you could potentially change
the way patients are treated in a single Project Life Cycle. In this regard,
registry-based studies can often feel very rewarding.
 2.1 What are the Different Approaches? 15

2.1.6 Clinical Trials

You can take clinical research to the next level by testing your hypotheses
using a so-called clinical trial. Here you are not just comparing variables,
you are testing an intervention. You enrol patients into a study where they
are randomly selected to undergo either your new intervention, a placebo
intervention, or the conventional intervention. Often clinical trials span
several institutions and take several years to complete. Hence, it is highly
unlikely that you will be conducting such a trial as a new researcher, but
because they have a huge impact on how we treat patients, it is important
to acknowledge their existence. They are often the product of many project
life cycles, and can be seen as the ultimate goal for biomedical research. Some
researchers can spend their entire career working towards such an approach.
16 2 Approaches to Research

2.1.7 Meta-Analyses

Meta-analysis is a rigorous test of a research hypothesis. Here several studies,

which tested the same hypothesis are grouped together in one statistical
analysis, with the aim of testing the scientific strength of the research message.
It is common for studies testing the same hypotheses to draw different
conclusions. By grouping all of them together you can reveal the overall
tendencies toward one conclusion or the other. This is particularly useful if it is
difficult to gather large sample sizes in local communities. Like registry-based
analysis, you are working with very clinically relevant data that can potentially
change the way patients are treated.

2.2 A Global View of Research

In Chapter 1 we outline the concept of the Project Life Cycle. It is important,
however, to appreciate the position of a single life cycle in the Global View of
Research (Figure 2.1). Although your project may incorporate one, two or even
three different research approaches, it is still, but a small cog in the Global View
of Research. Many Project life Cycles, therefore, individually and in concert,
contribute to the global view of research. Note, the various cycles do not come
from you exclusively, they can derive from any scientist or research group in
the world.
 2.2 A Global View of Research 17

Research
idea

Meta-analyses Computer
simulation
New hypothesis
to new treatment
In-vitro
Clinical trial
laboratory

Clinical Animal
experimental experimental

Fig. 2.1 Global overview of research showing the different approaches in the stepwise
process from generation of a new research idea to implementation of a new treatment,
technique or acceptance of new scientific fact

This is an important consideration when deciding on a particular approach.

You have to appreciate that the impact of your work can often be dictated
by your approach. For example, if it is your desire to be involved in the
development of a new treatment, and your project implements an “in vitro”
approach, you cannot expect the drug to be commercially available by the end
of that particular Research Life Cycle. You will have to peddle a few more cycles
before clinical application, namely animal experiments, followed by clinical
experiments, and finally a successful clinical trial or two! The process from
idea to daily clinical use can often take 10 to 15 years. One researcher will not
be in a position to go all the way through the entire “Global view of research”
(Figure 2.1). Realistically you may take a hands-on role in only one or two of
the project life cycles. Research is a stepwise progression, where no single step
can be left out and no step is more important than any other. Regardless of
your approach you will be making a difference.
As a new researcher, you should aim to use the approaches, which make
you feel most comfortable and through which you can contribute most. Even
new hypotheses are conceived from existing knowledge. The global view of
research is a continuum based on building upon existing knowledge, concepts
and ideas to ultimately provide new and improved knowledge. This is not a
new concept, it is viewed as a fundamental principle of science:

If I have seen further it is by standing on the shoulders of giants.

- Sir Isaac Newton 1675
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