Academic Book AMSA-Indonesia by AMSA-Indonesia

Regional Chairperson : Elvira Lesmana Secretary of Academic: Tharriel Jeremia

A-Team : Annisa Dewi Nugrahani Jeremy Rafael Tandaju Mahla Ayu Pratiwi Pramana Adhityo Steven Nanda Thasya Niken Saputri Titi Harkiana Tuasikal Trisnawati

Head Editor: dr. Matthew Billy

Head Designer/ Designer : Firshan Makbul

Foreword â&#x20AC;&#x201C; Regional Chairperson Greetings People of Tomorrow! Allow me to introduce myself, my name is Elvira Lesmana, a proud medical student from Universitas Indonesia and this year, I am honored to become the Regional Chairperson of AMSA-Indonesia 2017/2018. Medical students will soon become the healthcare professionals of tomorrow, someone who will be entrusted by the people of Indonesia in respects of health and wellbeing. Being a medical student itself is difficult, it takes courage, hard work and a lot of determination. Yet, one cannot imagine that surviving medical school would present greater adversities. As a medical student, there are a lot of opportunities and pathways leading towards different aspirations and goals. This year, in order to improve the knowledge of Indonesian medical students, AMSAIndonesia presents the A-Book, which stands for Academic book. A medium that will provide you guidance in making qualified scientific works, in order to help you broaden your scientific skills or join competitions and conferences. Through this A-Book, we hope that, as medical students, we would be able to sharpen our knowledge regarding the steps in making outstanding scientific works that will be impactful in the future. Happy reading and enjoy this book :)

Last but not least, I would like to give my greatest gratitude to all parties involved, the Executive Board AMSA-Indonesia 2017/2018 (especially Secretary of Academic AMSAIndonesia 2017/2018), and all AMSA-Indonesia seniors, alumnis and members who have fully contributed in the making of this A-Book. Thank you :)

Viva AMSA!

Elvira Lesmana

Foreword – Secretary of Academic

Dear People of Tomorrow, Viva Academic! First, I would like to thank God that this book may be finished and published, Without Him, this book would not have been created in the first place. I would also like to thank all of the writers, Committee, designers, and editors and that have contributed in the creation of this book. Finally we would like to thank everyone that supported this book from its conception. Knowledge has been an integral part for the growth of AMSA. One of the three philosophy of our beloved organization, Knowledge has been an important drive which breeds ardent members. It equips the members of AMSA with important ideas, concept, and even unique ways of thinking that In turn allows our member to shine in their respective career decisions. Even during their time in AMSA, some of our members have put their stamp on national and international competitions, both inside and outside our beloved organization. However, even the best of the best have to start somewhere. In the hopes that AMSA will become an enduring organization, we must understand that with the new faces that joined our beloved organization, they are starting from the bottom of a long ladder of learning and hardships. What better way for them to reach success than learning from those before them? That is the idea of the creation of this book. Hopefully, in the future, this book would teach, inspire, and become a basis of academic excellence in AMSA. That this book may guide those who stepped in the similar paths of the writers may achieve new and astounding heights that will bring pride to our organization. All in all, we hope that this book may show the impact of sharing a knowledge that each and every one that reads this book possesses to the surrounding, for we know that knowledge shared are not lost.

“The only thing to do with good advice is to pass it on. It is never of any use to oneself.” ― Oscar Wilde

Tharriel Jeremia

Table of Contents Chapter 1 : How to Begin Writing / Julius Albert Sugiarto How to Decide a Title for your research 1 Research Background – 2 Research Question – 4 Study Design (12–15) – 5 Hypothesis – 9 References – 14

1. Chapter 2 : Variables of Study, Measurement / Amadisto Gerindrawan Variables of Study – 17 Measurement Scales – 18 Interval – 20 Ratio – 20 References - 21

2. Chapter 3 : Statistics / Aditia Nurmalita Determining Sample Size – 23 Criteria of Inclusion – 31 References - 39 3. Chapter 4 : Ethics, Reference and Plagiarism / Steven Phillip (Editor: Agatha Claudia Rosaline) Ethical Concept – 39 Reference and Plagiarism – 41 Abstract Section – 45 Reference - 47

4. Senior Tips : How to Find Ideas / Joue Abraham How to Find Ideas – 48 Reference - 53 5. Senior Tips : Presenting your work within a scientific poster / Januar Er How to write a good conclusion – 54 Abstract Creation – 54 How to Design Your Own Scientific Poster – 56 Reference - 60

Chapter 1 – How to begin

Chapter 1 By : Julius Albert Sugiarto How to Decide a Title for your research Title is defined as “the name given to something (such as a book, song, or movie) to identify or describe it” (1). Before we can decide the title for your research, we need to understand that a title is meant to describe. Therefore, it needs to be able to summarize your whole paper in a few words. There are actually no hard rules about how short your title is neither the maximum of your title length but some journals does restrict the maximum words and/or characters that you could put into your title. As a general rule, your title should be as concise as possible and include at least: your research’s dependent variable, independent variable, and what you do with the variables (It could be written by directly mentioning the study design that you used or by giving a hint at what you do, for example: “comparison between”, “correlation of”, “difference between”, etc). As an example, here are some of the good titles that have fulfilled the above general guidelines (the citation is included if you would like to know further about the studies): 1. Status and methodology of publicly available national HIV care continua and 9090-90 targets: A systematic review (2) a. Dependent Variable : National HIV care continua and 90-90-90 targets b. Independent Variable : Status and Methodology c. What they did : Systematic review 2. Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: A cluster-randomized trial (3) a. Dependent Variable : Effectiveness of a live oral human rotavirus vaccine b. Independent Variable : Programmatic introduction in Bangladesh c. What they did : Cluster-randomized trial 3. Guided growth for angular correction in children: a comparison of two tension band plate designs (4) a. Dependent Variable : Clinical and Radiographic Outcomes b. Independent Variable : Total Shoulder Arthroplasty with Hybrid … Component c. What they did : Comparing Without one of the important components of the study’s title, the title would be unclear and would not be able to describe the study that you made. Apart from the basic structure, sometimes you may need to make your title more interesting by making creative titles. The main goal of “creative titles” is to make your research sounds more interesting rather than making a title that could describe your whole research. This is especially necessary to do if you are about to display your 1

Chapter 1 – How to begin

research at a conference where there are dozens or even hundreds of research posters on display and it is commonly used on review studies or case reports. Such titles are commonly made without including the three basic component of study titles and is made by emphasizing on the positive finding that you get from the research. Creative titles include adding words like “novel”, “high-specific”, “rare”, “unusual”, “breakthrough”, etc. These words tend to intrigue reader to read further but without making the whole study less formal. Some examples of creative titles: -

Emergence of a novel swine-origin influenza A (H1N1) virus in humans (5) Hemophilia B Gene Therapy with a High-Specific-Activity Factor IX Variant (6) An Unusual Cause of Leg Pain (7)

Research Background Every research needs an underlying problem that has not been solved that enticed the researcher to learn more regarding the problem so that he/she could solve it. That reason is elaborated in background section of your research. In order to be able to convey your research’s background clearly, it is necessary to be structured and to mention your background wholly. Stated below is the recommended points that you need to write on your background (8). (All examples for the list below are based on a research entitled “Aerosolized BCG Combined with Recombinant Antigen 85B (rAg85B): A Vaccination Breakthrough in Preventing Tuberculosis Transmission to Traveller Coming to Indonesia” (9)) 1. Definition Define in brief about the main components of your research Example: Aerosolized BCG and rAg85B 2. The root of the problem being studied Elaborate what causes the problem that you found that needs to be solved Example: A study about traveller showed that 10% of those travelling to South-East Asia (including Indonesia) contracted respiratory illnesses. Therefore, alternative vaccination which induce higher level of TB immune response is needed especially for travellers. 3. The extent to which previous studies have successfully investigated the problem Mention previous researches that have studied the similar topic and/or similar field and the result. The researches that you mention should depict the necessity of your research Example: The current commonly used BCG, which is administered subcutaneously, shows highly variable in protective effect and diminishes 10–15 years following administration. Aerosolized BCG vaccination via lungs have been proven to be able to provide better protection as it is delivered directly to the organ of disease’s transmission. 2

Chapter 1 – How to begin

4. Which gap that exists and your study is attempting to address Mention the study that needs to be done to establish the solution that you propose (the study that could “fill” the gaps or what the current study had not done). Example: The limited capability of the subcutaneous BCG and the strength of aerosolized BCG but further research on aerosolized BCG are minimal due to the lack of establishment of the evidence (no systematic review had been done to elicit its benefit over subcutaneous BCG). 5. Why this moment is the right time to do your research Commonly you should say the global and regional mortality and morbidity and/or the worst possibility if such problems were to be left unsolved and/or the current status of the problem. Example 1: Antivax organization’s member has grown by 2 fold in recent years and if the antivax movement in Indonesia were not suppressed, the incidence of diphteria would increase by 10-fold in 2 years… Example 2: Stroke is currently the leading cause of morbidity in the world. Therefore we need to conduct studies that could reduce the morbidity stroke causes… 6. Aim and scope of the study Mention your primary research question which specifies the population to be studied, the intervention to be implemented, and other circumstantial factors. Also, mention how you hope your research may be applied in daily lifes and/or the impact it will have toward the global community/other researchers/common people. Example: To do systematic review on the use of aerosolized BCG with rAg85B compared to other recombinant antigen to elicit its evidence, enable it to be researched further, and to draw interest on other researcher to study more about the topic.

A Personal Tips for finding a good background is to find similar research and take a look at what they say in the background. It can provide you with a lot of insight and inspiration about what to write and what are the important things in your field of research. You can also use the references they have in their background for further reading. Another tips, if finding the perfect background seemed still hard for you. Try to think simpler and go step by step from general to specific reason of your research. General reason is commonly found through the daily problems that we face on daily basis or the problems that we found during our practices as doctors. Afterwards, think 3

Chapter 1 – How to begin

about the possible cause of those problems and then the possible solution that you would propose to solve that possible problem. By then, most likely you would have come up with a specific reason of your research. Specific reason is commonly similar to the aim of your study written in active sentence. If your specific reason is achieved, it should be able to support or become the proposed solution that you propose. Below is an example:

General Reason

Possible Cause Proposed Solution Specific Reason

• High number of Maternity deaths in Indonesia • Breakout of Diphteria across Indonesia

• Lack of Public's Knowledge regarding pre eclampsia • Lack of Vaccination

• Campaign about pre-eclampsia • Campaign about awareness to use vaccine • To find the correlation of pre-eclampsia campaign and maternity deaths in certain population (Cohort study of 24 months) • To find the effect of vaccine awareness campaign toward vaccination rate

Research Question By creating your research background, you are going deeper into creating your specific research question. Appropriate research question should be able to determine which clinical uncertainties that could or should be studied. One of the ways you could be certain about your research question is to read the available systematic review regarding the topic you are researching or creating one yourself. Another way is to do in-depth interviews with experts on the field and/or the patients that had the problem that you are trying to solve. As you go deeper, you would most probably come up with a number of other questions but it is imperative to stay specific because additional questions would increase the complexity of your research and obscure the readers, and maybe even yourself, from answering the primary research question that you have made. Hulley and colleagues (10) suggested using FINER criteria as a checklist to assess research questions. In the criteria, good research questions should be supported by enough number of samples to support the result of the research, included enough experts and/or equipment to legitimize the result of the research, given enough time and resource, interesting, provides new findings, passes the ethical clearance, and be of interest to the scientific community, decision makers, and to the public (8). F

Feasible

Adequate number of subjects Adequate technical expertise Affordable in time and money Manageable in scope Interesting Getting the answer intrigues investigator, peers, and community 4

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N E R

Novel Ethical Relevant

Confirms, refutes, or extends previous findings Amenable to a study that institutional review board will approve To scientific knowledge To clinical and health policy To future research

While FINER criteria helps you build your research question in general. Other format that is important to consider is the PICOT format. PICOT outlines the important aspects to consider on your specific research question – consider the population (P), the intervention (I), the comparison (C), the outcome of interest (O), and the timing (T). By considering the five important aspects of your research question, it will help you identifiy the proper measurement tool, inclusion criteria, and exclusion criteria. It will also help in the interpretation and the generalizability of the research findings (11). P

Population (Patients I Intervention C Comparison Group O Outcome of interest T Time

What specific patient population are you interested in? What is your investigational intervention? What is the main alternative to compare with the intervention? What do you intend to accomplish, measure, improve, or affect? What is the appropriate follow-up time to assess outcome

Study Design (12–15) Choosing the appropriate study design could be hard. We would always try to use the best possible design, but sometimes the problem with the “best” design is the money, time, and/or the ethics (You cannot conduct an experiment directly on humans without previous supporting researches or sometimes some researches would take too much time and effort to pass the ethical clearance) that is needed to complete the study. Aside from the limitations that you may have, it is necessary to consider the level of evidence that you would like to create from your study and the kind of result that you would like to get from your research.

Chapter 1 â&#x20AC;&#x201C; How to begin

Figure 1 Study Designs in Medicine In medicine, Sut, N (13) divided study designs into five broad categories. Since observational and experimental studies are the two studies that we commonly do as a medical student, I will cover in detail only both categories: 1.

Basic studies Basic studies commonly studied about pure sciences related to medicine which is yet to be applicable in daily practices, such as: improvement of biochemical, development of new biometric methods, etc.

Observational studies Observational studies are studies which do not contain any experiment or intervention method. The variables that are used in the study is not controlled or intervened in a systematical manner. There are a lot of confounding factors in such study but it is consistent with real life. Observational are then divided into descriptive (studies which simply describes a population) and analytics (studies which aim to quantify the relationship between factors). Below described briefly the content of each study design a. Case Reports Case reports are studies that describes in detail about disease characteristic in a patient. Commonly reported are very rare cases, new cases, and/or unique manifestation of certain disease. Case reports only reports a case in a single patient b. Case Series Case series is equivalent to case reports but it reports more than one patient. CARE statement is used as a guideline on developing case reports or case series (16). c. Cross Sectional

Chapter 1 â&#x20AC;&#x201C; How to begin

Commonly examine prevalences, epidemiologies, or surveys of diseases or clinical outcome. The studies will be conducted in a specific time period with no follow up or analyzing prior data. The starting point of cross sectional studies is Figure 2 Cross Sectional Study Illustration a certain population. Afterwards, you find whether the samples are exposed to a certain cause and whether they had a certain outcome or not. We do this study when we would like to find causal associations between causes (exposure) and outcome (disease or clinical outcome). This study design is cheap, simple, and ethically safe but it does not find causality, disregards recall bias, confounding factors are not controlled, and group sizes may be unequal. STROBE statement is used as a guideline on developing cross sectional studies (17). d. Case Control / Diagnostic Accuracy Studies Case control studies are conducted retrospectively. The starting point of case control studies is certain population where all had a certain disease or clinical outcome. Afterwards, you would like to find what happened in the past. They will be compared based on the presence Figure 3 Case Control Study Illustration of certain factors. This is a cheap and quick method of study. This method can be used for extremely rare disorders, or long time between exposure and outcome. however, this study can be biased due to it's reliance on the subjects memory.. STROBE statement is used as a guideline on developing case control studies (17). Diagnostic Accuracy Studies is similar to case control but this study is designed specifically to investigate the effect of a diagnostic method compared to gold standard method. STARD statement is used as a guideline on developing Diagnostic Accuracy Studies (18) e. Cohort Cohort studies are also called follow up study. The starting point of cohort studies is whether or not certain group of people have had

Figure 4 Cohort Studies Illustration

Chapter 1 â&#x20AC;&#x201C; How to begin

certain characteristic or have been exposed to certain treatment or incidence. Afterwards, you would like to find what will happen in the future. These group of people would be followed up after certain period of time and would then be assessed whether or not they will have the certain outcome. This study is ethically safe, can establish timing and directionality of events, eligibility criteria can be pre-determined, and is cheaper and easier compared to RCTs but in this study, randomization is not present, blinding is difficult, and controls may be difficult to identify. STROBE statement is used as a guideline on developing cohort studies (17) 3.

Experimental Studies Experimental studies are studies that are used to compare the effect of treatments or interventions with control in humans. Placebo or gold standard treatment is commonly used as control. In experimental studies, it is also important to decide whether or not you are going to use blinding. Blinding means that one or more of the physicians, researchers, patients, and data analyst do not know which treatment the subject is receiving. Such system ensure the studyâ&#x20AC;&#x2122;s reliability and objectivity. There are three types of blinding: (1) Single-blind: either researcher or subject know the treatment received by the subject, (2) double-blind: both researcher and subject do not know which subject received which treatment, (3) triple-blind: neither researcher, subject, nor the statician do not know which subject received which treatment. a. Randomized Controlled Trial (RCT) RCTs produces strongest evidence among clinical trials because it used randomization on its intervention (equal chance). Randomization removes allocation bias and is therefore more applicable in real life and clinical practice. The drawdown is that it is very expensive and slow. It is also harder to pass the ethical clearance. CONSORT Statement is used as a guideline on developing RCTs (19). b. Non-Randomized Controlled Trial (NRCT) NRCTs is similar to RCT but without using randomization on its intervention. Therefore, NRCT are more prone to bias but is simpler and easier to conduct compared to RCTs. c. Self Controlled Self Controlled studies are experimental studies which do not include independent control group. One patient amongst the population that were studied is used as the control. At least two measurements are obtained at different times from the same patient (e.g. before treatment, after 1 month of repeated treatment, and after 3 months of repeated treatment). Afterwards, the effect of treatment or intervention is determined.

Chapter 1 – How to begin

d. Crossover In crossover studies, population of the research are divided into two groups. The first one will be given a placebo while the other will be given the experimental treatment. After the pre determined time, both group will Figure 5 Crossover Studies Illustration not receive any treatment for at least two weeks (This period is called the washout period). After the washout period, the first group will be given the experimental treatment and the second group will be given placebo. The effect of treatment or intervention is determined by comparing the outcome of each group’s resulted outcome after placebo and after experimental treatment. 4. Economic Evaluation Economic evaluation is commonly conducted for evaluating healthcare systems or for improving hospitals management. Economic evaluation studies in medicine includes cost analysis, cost minimization analysis, cost utility analysis, cost effectiveness analysis, and cost benefit analysis. 5. Meta-analysis / Systematic Review Individual studies will never have an impact on disease’s guideline nor diagnostic’s gold standard. Practitioners need to read multiple researches before accepting certain hypothesis brought up by individual researches as a guideline/gold standard. This is why meta-analysis and/or systematic review is needed. These studies compiled several clinical studies (RCTs or Cohort) that were conducted in a variety of places Figure 6 Level of Evidence Pyramid around the world and over a period of several years. These studies would then analysis the similarity of each study, extract it, and provide conclusion/analysis based on those results. a. Systematic Review Systematic Reviews interprets and evaluates the evidence of all studies about a certain clinical topic without combining the statistical result. b. Meta-analysis Meta-analysis combines the statistical results of different studies within a certain clinical topic. 9

Chapter 1 – How to begin

Hypothesis Hypothesis is an idea or explanation for something that is based on known facts but has not yet been proved (20). All research would have their own hypothesis which is the basis of their research. The research itself would then test their hypothesis using the result acquired from the research, proving whether the hypothesis stands or not. Commonly, the process of hypothesis testing involves (21,22): 1. Making initial assumption 2. Collecting Evidence (Through Research) 3. Rejecting or accepting initial assumption based on the available evidence. The decision to reject or accept a hypothesis is made based on the types of testing that we use. There are two ways we can determine whether our evidence is likely or unlikely supports our hypothesis: Note: in both of the approach. I will provide an example. Both example would use this case: suppose we are trying to find the average tibiofemoral angle (TFA) amongst a certain population (n=15) and let’s assume that the TFA is actually β. Type Null Alternative Right-Tailed H0 : μ = 3 H0 : μ > 3 Left-Tailed H0 : μ = 3 H0 : μ < 3 Two-Tailed H0 : μ = 3 H0 : μ ≠ 3  We would do the first hypothesis test (Using Right-Tailed) if we are interested to conclude whether or not the average TFA of the group is more than 3  We would do the second hypothesis test (Using Left-Tailed) if we are interested to conclude whether or not the average TFA of the group is less than 3  We would do the third hypothesis test (Using Two-Tailed) if we are interested to conclude whether or not the average TFA of the group is not 3 (without caring whether it is more or less than 7)

1. Critical Value Approach Critical Value Approach is an approach which determines the likeliness of certain hypothesis by determining whether the observed outcome’s test statistic is more extreme than the critical value if the null hypothesis is true. The steps in using the critical value approach are: a. Determine the null hypothesis and alternative hypothesis b. Determine the α “α” is a limit which you chose. If this limit is breached it means that your research’s result are beyond the acceptable probability of making type

Chapter 1 – How to begin

1 error and so your null hypothesis will be rejected. (Typically 0.01, 0.05, and 0.10 is chosen as the α) c. Determine the critical value. Critical value is determined by using the sample’s data and assuming the null hypothesis is true. We use t statistic which followed tdistribution with n-1 degrees of freedom to find the hypothesis test for the population’s mean, d. Compare the test statistic to the critical value. The null hypothesis will not be rejected if the test statistic is within the critical value. On the contrary, the null hypothesis will be rejected if the test statistic is above or below the critical value. Right Tailed Test Example: In our example concerning the TFA average, suppose we take a random sample of n = 15. Since n = 15, our test statistic t* has n - 1 = 14 degrees of freedom. Also, suppose we set our significance level α at 0.05. The critical value for conducting the right-tailed test H0 : μ = 3 versus HA : μ > 3 is the tvalue, denoted tα, n - 1 , such Picture 1 Right Tailed Test using Critical Value Approach that the probability to the right of it is α. It can be shown using either a t-table or statistical software that the critical value t 0.05,14 is 1.7613. Therefore, using the result of our study, we should find the t-value of our result. Then, if the test statistic t* is greater than 1.7613, we would reject the null hypothesis H0 : μ = 3 in favor of the alternative hypothesis HA : μ > 3

Two Tailed Test Example: The two tailed test is similar to the right tailed test but in this case we would have two critical values: one for the left-tail denoted -t(α/2, n - 1) (negative value) and one for the right-tail denoted t(α/2, n - 1) (Positive Value). The 11 Picture 2 Right Tailed Test using Critical Value Approach

Chapter 1 – How to begin

value -t(α/2, n - 1) is the t-value such that the probability to the left of it is α/2, and the value t(α/2, n - 1) is the t-value such that the probability to the right of it is α/2. It can be shown using either statistical software or a t-table that the critical value -t0.025,14 is -2.1448 and the critical value t0.025,14 is 2.1448. That is, we would accept HA : μ ≠ 3 over the null hypothesis H0 : μ = 3 in favor of the alternative hypothesis if the test statistic t* is less than -2.1448 or greater than 2.1448. 2. P-Value Approach P-Value Approach is an approach which determines the likeliness of certain hypothesis by determining whether the probability of observing the observed outcome’s test statistic is more extreme than the probability of having the null hypothesis true (determined as α). The steps in using the p-value approach are: a. Determine the null and alternative hypothesis b. Determine the α “α” is a limit which you chose. If this limit is breached it means that your research’s result are beyond the acceptable probability of making type 1 error and so your null hypothesis will be rejected. (Typically 0.01, 0.05, and 0.10 is chosen as the α) c. Calculate the P-Value This is done using the statistic test value, the sample’s data and assuming the null hypothesis is true. To conduct the hypothesis test (One Way Anova, Chi Square, Fisher, McNemar, etc) for the population’s mean, we use the t statistic which follows a t-distribution with n-1 degrees of freedom. d. Make a Conclusion If the P-value is small, say less than (or equal to) α, then it is "unlikely." and the null hypothesis is rejected (This is commonly called “statistically not significant”). Meanwhile, if the P-value is large (more than α), then it is "likely." and the null hypothesis is not rejected (This is commonly called “statistically significant”). Right Tailed Test Example: From the abovementioned research about TFA, after processing the data acquired, it is found that the statistic value to be tested is 2.5 (Called test statistic). The Pvalue for conducting the righttailed test H0 : μ = 3 versus HA : μ 12 Picture 3 Right Tailed Test using P-Value Approach

Chapter 1 – How to begin

> 3 is the probability that we would observe a test statistic greater than t* = 2.5 if the population mean μ really were 3. We would then convert the test statistic value into probability value. Recall that probability equals to the area under the probability curve (drawn using statistical software on Picture 3). The P-value is therefore the area under a tn - 1 = t14 curve and to the right of the test statistic t* = 2.5. It can be calculated using statistical software that the P-value is 0.0127 Meanwhile, we would like our study result to have had only 5% chance of having type I error (false negative) or, in other words, to have significance level α at 0.05. So, our study resulted in a P-value of 0.0127 but our significance level dictates us to have p-value < α (p-value < 0.05). Therefore, P-value of 0.0127 tells us it is "unlikely" that we would observe such an extreme test statistic value in the direction of HA if the null hypothesis were true. In conclusion, our initial assumption that the null hypothesis is true must be incorrect (we reject the null hypothesis H0 : μ = 3 in favor of the alternative hypothesis HA : μ > 3). Note that we would not reject H0 : μ = 3 in favor of HA : μ > 3 if we lowered our willingness to make a Type I error to α = 0.01 instead, as the P-value, 0.0127, is then greater than α = 0.01. Two Tailed Test Example: From the above-mentioned research about TFA, after processing the data acquired, suppose that we found the statistic value to be tested is -2.5. The Pvalue for conducting the twotailed test H0 : μ = 3 versus HA : μ ≠ 3 is the probability that we would observe a test statistic less than 2.5 or greater than 2.5 if the population mean μ really were 3. Picture 4 Two Tailed Test in P-Value Approach That is, the two-tailed test requires taking into account the possibility that the test statistic could fall into either tail (and hence the name "two-tailed" test). The P-value is therefore the area under a tn - 1 = t14 curve to the left of -2.5 and to the right of the 2.5. It can be shown using statistical software that the P-value is 0.0127 + 0.0127, or 0.0254 13

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Keep in mind that Two tailed test will possess a P-Value twice the P-value of a one tailed test. Since we found that the P-value, 0.0254, it means that it is unlikely that we would find that statistic test t* in the direction of HA if the null hypothesis were in fact true. Thus, we can conclude that the null hypothesis must be incorrect.. That is, since the Pvalue, 0.0254, is less than α = 0.05, we reject the null hypothesis H0 : μ = 3 in favor of the alternative hypothesis HA : μ ≠ 3.

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Kadhim M, Gauthier L, Logan K, El-Hawary R, Orlik B. Guided growth for angular correction in children. J Pediatr Orthop B [Internet]. 2017;1. Available from: http://insights.ovid.com/crossref?an=01202412-900000000-99044

Dawood FS, Finelly L, Lindstrom S, Gubareva L, Jain S, Shaw M, et al. Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in HumansNovel Swine-Origin Influenza A (H1N1) Investigation Team. N Engl J Med [Internet]. 2009;360:2605–15. Available from: https://www.researchgate.net/publication/216637088_Emergence_of_a_Novel_S wine-Origin_Influenza_A_H1N1_Virus_in_HumansNovel_SwineOrigin_Influenza_A_H1N1_Investigation_Team

George LA, Sullivan SK, Giermasz A, Rasko JEJ, Samelson-Jones BJ, Ducore J, et al. Hemophilia B Gene Therapy with a High-Specific-Activity Factor IX Variant. N Engl J Med [Internet]. 2017;377(23):2215–27. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1708538

Kelly NP, Vaidya A, Gerhard-Herman M, Desai AS. An Unusual Cause of Leg Pain. N Engl J Med [Internet]. 2017;377(20):e29. Available from: http://www.nejm.org/doi/10.1056/NEJMimc1616174

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Sugianto JA, Azmi Y. Aerosolized BCG Combined with Recombinant Antigen 85B (rAg85B): A Vaccination Breakthrough in Preventing Tuberculosis Transmission to Traveller Coming to Indonesia. In: Bundle Regular of AMSA-Indonesia National Competition (BRAIN). Jakarta: AMSA-Indonesia; 2014.

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Chapter 1 – How to begin

12.

Röhrig B, du Prel JB, Blettner M. Study Design in Medical Research. DtschÄrztebl [Internet]. 2009;106(11):184–9. Available from: C:\KARSTEN\PDFs\InfektiologiePDFs\Infekt-2009\Roehrig et al.-Studiendesign in der medizinischen ForschungTeil 2 der Serie zur Bewertung wiss.Publikationen.pdf

13.

Süt N. Study designs in medicine. Balkan Med J. 2014;31(4):273–7.

14.

Medicine Centre for Evidence Based. Study Designs [Internet]. 2017. Available from: http://www.cebm.net/blog/2014/04/03/study-designs/

15.

Sut N. How Can We Improve the Quality of Scientific Research and Publications? Guidelines for Authors, Editors, and Reviewers. Balkan Med J [Internet]. 2013 Jul 1;30(2):134–5. Available from: http://www.balkanmedicaljournal.org/pdf.php?&id=408

16.

Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al. The CARE guidelines: Consensus-based clinical case report guideline development. J Clin Epidemiol. 2014;67(1):46–51.

17.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol [Internet]. 2008 Apr;61(4):344–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18313558

18.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies. Clin Chem [Internet]. 2015 Dec;61(12):1446–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26510957

19.

Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ [Internet]. 2010 Mar 23;340(mar23 1):c332–c332. Available from: http://www.bmj.com/cgi/doi/10.1136/bmj.c332

20.

McIntosh C. Cambridge Advanced Learner’s Dictionary & Thesaurus. 4th ed. Cambridge: Cambridge University Press; 2013.

21.

The Pennsylvania State University. 3.0 - Hypothesis Testing [Internet]. Pennsylvania State University Press. 2017 [cited 2017 Dec 16]. Available from: https://onlinecourses.science.psu.edu/statprogram/node/136

Variables of Study, Measurement

Chapter 2 Variables of Study, Measurement By: Amadisto Gerindrawan

VARIABLES OF STUDY By definition, the variable of the study itself is the characteristics of studies' subject that could be changed from one subject to another (Sastroasmoro, 2014). For example, objects such as body diseases, immunization etc are not a variable. The variables are body weight or height, diseases prognosis, or immunization coverage as the characteristics of different subjects. In the most of research especially in experimental researchers, there are two variables that will determine your interest of the study and what you did to it. The two main variables are the independent and dependent variables. In doing research, you have to decide 2 or more object characteristics that you want to use in the study that you also want to compare. This is called independent variables. Independent variables are the variable that is being changed or controlled in your scientific experiment so therefore the result effects in the dependent variables can be identified. You can compare one variable to another variable, or simply you can compare one of your variables with the control variable, something that has already been used in present study, or even you can also compare your 2 or more variables with the control variable. These compare the experiment whether your research or invention is more effective than the present study or not. Meanwhile, the different result effects in the cause of the independent variables, whether it is the result that you hoped it would be or not, is called the dependent variables. In other words, the dependent variables depend on the independent variables. In discussing variable correlations in research, identifying the confounding variable is needed so that we can conclude the correct result. Confounding variable is a type of variable that is correlated with independent and dependent variable, but it is not an intervening variable. Identifying confounding variable is needed to confirm the

Variables of Study, Measurement

validity of our study. Confounding variables are not the variable that we observe but they have effects on our study results because of their correlation with the independent

and

dependent

result

(Dawson-Saunders

and

Trapp,

2004).

Diagram 1. Correlation between variables. As an example, these are some research that has been conducted using both independent and dependent variables, and also the type of study method: Profil Klinis dan Prognosis Neuroblastoma Anak di RSUP Dr. Sardjito, Yogyakarta (Clinical Profile and Prognosis Factors of Pediatric Neuroblastoma in RSUP Dr. Sardjito, Yogyakarta)(Ardianto, Purnomo, and Puspita, 2018). Background of Study: Neuroblastoma is one of the solid tumors that derived from primordial crista neuralis along the retroperitoneal nervous system and is currently ranked third place of the most common pediatric tumors. This study conducted the identification of clinical manifestation and several prognosis factors of pediatric neuroblastoma to decrease the mortality rate of patients. Independent Variables: Ages, Sex, Metastatic, Diameter of Tumor, Treatment

Variables of Study, Measurement

Dependent Variables: the Mortality rate of Pediatric Neuroblastoma Patients Confounding Factors: There are no confounding factors in this study Method: Case-control study Hubungan Antara Carotid Intima Media Thickness (CIMT) Dengan Kejadian Critical Limb Ischemia (Correlation between Carotid Intima Media Thickness (CIMT) with Critical Limb Ischemia Cases)(Ismail, Anggraeni, and Timothy, 2017). Independent Variables: Carotid Intima-Media Thickness dependent Variables: Critical Limb Ischemia Confounding Factors: Age, Gender, Hypertension, Dyslipidemia, Smoking, Drugs, Atrial Fibrillation, Heart Failure, Left Ventricle Ejection Fraction Method: Case-control study

MEASUREMENT SCALES In research, we have to observe our variables to identify the quality and quantity of our variables. Observation is essential and therefore our research is more systematic and objective rather than subjective. This process of observation is called measurement. Measurement is the quantification process of the result of observations considering certain references then defined with certain scales (Sastroasmoro, 2014) e.g. Visual Analog Scale, Cancer Stadium etc. That kind of scales are the one that we used in the questionnaire to gather data, thus to analyze the phenomenon in our study or research. The measurement scale is classified into 2 types, categorical scale and numeric scale. Categorical scale consists of nominal scale and ordinal scale, meanwhile Numeric scale consists of interval scale and ratio scale. Categorical Scale Nominal Nominal scales are simply variables with label or "name" form, without quantitative value. There are two types of labels, dichotomous (binomial) label and polychotomous label. Dichotomous or binomial labels are labels that only have 2 values. This type of label is more like "YES" or "NO" question e.g. patient is cured or patient is not cured, male or female. Polychotomous labels are labels that have more than 2 values e.g. blood group (A, AB, B, O), religions, nationality, etc.

Variables of Study, Measurement

Ordinal Next type of scale that often used in research is ordinal scale. The ordinal scale is values that are arranged in order, rank, or degree, but the interval of each value to another cannot be quantified. For example, you have to fill a questionnaire about how satisfied you are with the hospital's care and service (patient satisfaction): How was our services to you? 

5 - Very Good



4 - Good



3 - OK



2 - Bad



1 - Very Bad

This scale above is one of the examples of ordinal scale. Other examples are pain degree, sosio-economic scale, nutritional status, etc. Although there are information about the degree or rank, the value of ordinal variables cannot be manipulated mathematically. Numeric Scales Numeric scale rather consists of the quantitative degree of pieces of information that are measurable. The values of numeric scale can be manipulated mathematically, unlike categorical scale. The numeric scale can be classified into interval scale and ratio scale. In fact, there are other classifications of numeric scale which are continuum scale (contains a decimal number) and discrete scale (no decimal number), but we are only going to discuss interval and ratio scale. Interval Interval scale are numeric scales that we can manipulate mathematically, and we can count the exact number of an interval by counting differences (subtraction) between the values. But, in interval scales, we can only add or subtract the values, but we cannot multiply or divide it, because interval scales don't have true zero. In interval scales, we

Variables of Study, Measurement

can identify the mean, median, and mode of the data. For example, in Celsius temperature, we can count that the difference between 100 degrees and 60 degrees is 40 degrees Celsius. But, we cannot count the Celsius degree by its ratio and multiply or divide it, because there is no such thing as no temperature, we still called it 0 degree Celsius. Furthermore, there are various types of temperature scaling such as Celsius, RĂŠaumur, Kelvin, and Fahrenheit. Each 0 degree in those different temperature scale have a different scale, so the values are arbitrary since it has no true values. Another example of interval ratio is time. Ratio The last measurement scale is the ratio scale. Ratio scales have the exact values between units and they have the true or absolute zero. We can calculate them mathematically by adding, subtracting, multiplying, and dividing (ratio) it. We can also measure the mean, median, and mode of the data, including standard deviation and coefficient of variation of the scales. The examples of ratio scales are height and weight ratio, cholesterol rate, blood glucose rate, etc. All of the examples have absolute zero.

Variables of Study, Measurement

References Sastroasmoro, S. (2014). Dasar-dasar metodologi penelitian klinis. 5th ed. Jakarta: Bagian Ilmu Kesehatan Anak, Fakultas Kedokteran, Universitas Indonesia. Dawson-Saunders, B. and Trapp, R. (2004). Basic & clinical biostatistics. 4th ed. New York: Lange Medical Books/McGraw-Hill, Medical Pub. Division. Ardianto, B., Purnomo, E. and Puspita, A. (2018). Profil Klinis dan Prognosis Neuroblastoma Anak di RSUP Dr. Sardjito, Yogyakarta. Undergraduate. Fakultas Kedokteran Universitas Gadjah Mada. Ismail, M., Anggraeni, V. and Timothy, F. (2017). Hubungan Antara Carotid Intima Media Thickness (CIMT) dengan Kejadian Critical Limb Ischemia. Undergraduate. Fakultas Kedokteran Universitas Gadjah Mada.

Chapter 3 â&#x20AC;&#x201C; Statistics

CHAPTER 3 By : Aditia Nurmalita A.

Determining The Sample Size

A problem which has been a concern for every research is determining the sample size needed to do a research. The answer relies on a couple of factors. There are at least four general criteria that can help determine the necessary sample size. One, the degree of precision required between the sample and the population. The less accuracy needed, the smaller the sample can be. Two, the variability of the population influences the sample size needed to achieve a given level of accuracy or representativeness. In general, the greater the variability, the larger the sample should be. Three, the method of sampling to be used can affect the size of the sample needed. For example, stratified random sampling requires fewer cases to achieve a specified degree of accuracy than does simple random sampling. And four, the way in which the result is to be analyzed influences decision on sample size. Samples that are small place significant limitations on the types of statistical analysis that can be used. Nowadays, we can use various methods to determine sample sizes such as using nomogram, table, or formula. 1.

Harry King Nomogram

Harry King calculate the sample was not only based on an error of 5% but varies up to 15%. But the amount of the highest population is only 2000.

Example: When you want to do a research in a population of 200, and the confidence sample is 95% or 5% error, then the sample size is about 60% of the population. So, the sample size is 60% x 200 = 116.

Fig. 1 Harry King Nomogram

Chapter 3 â&#x20AC;&#x201C; Statistics

Krecjie and Morgan Table

In 1970, Krecjie & Morgan produced a table which can be used to determine the sample size on finite population target. This table was based on an error of 5%.

Table 1. Table Krecjie & Morgan

Chapter 3 – Statistics

Use Of Formula a.

Sample size calculation for cross sectional studies  Qualitative

Z21-/2 = standart normal variate (at 5% type 1 error or P<0.05 it is 1.96 and at 1% type 1 error or P<0.01 its is 2.58. P = Expected proportion in a population based on previous studies or pilot studies. d = Absolute error or precision (has to be decided by the researcher). Example: A researcher wants to estimate proportion of patients having hypertension in paediatric age group in a city. According to previously published studies, actual number of hipertensives may not be more than 15%. The researcher wants to calculate this sample size with the precision/absolute error of 5% and at type 1 error of 5%.

Sample size =

 Quantitative

Z21-/2 = standart normal variate (at 5% type 1 error or P<0.05 it is 1.96 and at 1% type 1 error or P<0.01 its is 2.58.

Chapter 3 – Statistics

SD = Standart deviation of variable. Value of standart deviation can be taken from previously done study or through pilot study. d = Absolute error or precision (has to be decided by the researcher). Example: A researcher wants to know the average systolic blood pressure in paediatric age group of a city with 5% of type 1 of error and precision of 5mmHg of either side (more or less than mean systolic BP) and standard deviation, based on previously done studies, is 25mmHg.

Sample size =

Sample size calculation for case control studies  Estimating the odds ratio with stated precision

Z21-/2 = standart normal variate (at 5% type 1 error or P<0.05 it is 1.96 and at 1% type 1 error or P<0.01 its is 2.58. P1* = The proportion exposed among the case

OR = Odds ratio P2* = The proportion exposed among the controls Ɛ = Precision (has to be decided by researcher).

Chapter 3 – Statistics

Example: What sample size would be needed in each of two groups for case-control study to be 95% confident of estimating the population odds ratio to within 25% of the true value if this true value is believed to be in the vicinity of 2, and the exposure rate among the controls is estimated to be 0.30?

Solution: The propotion among the cases (P1*) is

Sample size (n)

{

} {

}

70.26

 Hypothesis testing of the odds ratio

Z21-/2 = standart normal variate (at 5% type 1 error or P<0.05 it is 1.96 and at 1% type 1 error or P<0.01 its is 2.58. P1*

= The proportion exposed among the case

OR = Odds ratio P2* = The proportion exposed among the controls Ɛ = Precision (has to be decided by researcher).

Example:

Chapter 3 – Statistics

The efficacy of BCG vaccine in preventing childhood tuberculosis is in doubt and a study is designed to compare the immunization coverage rates in a group of tuberculosis cases compared to a group of controls. Available information indicates that roughly 30% of the controls are not vaccinated, and we wish to have an 80% chance of detecting whether the odds ratio is significantly different from 1 at the 5% level. If and odds ratio of 2 would be considered an important different betwen two groups, how large a sample should be included in each study group?

Solution: The exposure rate (proportion unvaccinated) among thr cases which yields and odds ratio of 2 (P1*)

Sample size (n)

√

129

Sample size calculation for cohort studies 1. Confidence interval estimation of the relative risk

Z21-/2 = standart normal variate (at 5% type 1 error or P<0.05 it is 1.96 and at 1% type 1 error or P<0.01 its is 2.58. P1 = Probability of outcome present in exposed group

RR = Relative risk P2 = Probability of outcome present in unexposed group Ɛ = Precision (has to be decided by researcher).

Chapter 3 – Statistics

Example: Suppose an outcome is present in 20% of the unexposed group of a cohort study, how large a sample would be needed in each of the exposed and unexposed study groups to estimate the relative risk to within 10% of the true value, which is believed to be approximately 1.75, with 95% confidence?

Solution: It follows from the given information that P2 is 0.2 P1=1.75×0.2=0.35

(

Sample size

) (

)

2026.95

2. Hypothesis testing of the population relative risk

Z21-/2 = standart normal variate (at 5% type 1 error or P<0.05 it is 1.96 and at 1% type 1 error or P<0.01 its is 2.58. P1 = Probability of outcome present in exposed group

RR = Relative risk P2 = Probability of outcome present in unexposed group Ɛ = Precision (has to be decided by researcher).

Example:

Chapter 3 – Statistics

Two competing therapies for a particular cancer are to be evaluated by the cohort study strategy in amulti-center clinical trial. Patients are randomized to either treatment A or B and are followed for recurrence of disease for 5 years following treatment. How many patients should be studied in each of two arms of the trial in order to be 90% confident of rejecting H0.RR=1 in favor of the alternative Ha:RR≠1, if the test is to be performed at the α=0.05 level and if it is assumed that P2=0.35 and RR=0.5.

Solution: P1= (RR).P2= (0.5)(0.35)= 0.175 P= (0.175+0.35)/2=0.2625

Sample size {

√

= 130.79

√

}

Chapter 3 â&#x20AC;&#x201C; Statistics

Criteria of Inclusion Important Question

The issue of participant selection is centrally concerned with this important question of who will participate in a particular research study. However, the composition of a particular study sample does not begin with random selection or any other selection technique; rather its usually a conceptual issue that is addressed by developing

well-defined,

study-specific

inclusion and exclusion criteria. Inclusion criteria, alongside the exclusion criteria is used to decide which population will be used for a research. Inclusion criteria consists of several specific characteristics which are predefined by the researcher .Inclusion criteria should respond to the scientific objective of the study and are critical to accomplishing it. Inclusion criteria selection will affect the validity of the study, minimize both costs and ethical issues, and increases the feasiblity of the study. A good criteria of selection can affect the confounding factor, as well as increase the likelihood of finding the true association between the two variables studied. Although there are no universally agreed upon guidelines

for

establishing

inclusion

and

exclusion criteria, there are at least four important question that should be considered when defining a research study's inclusion and exclusion criteria.

1) How do the criteria affect the internal and the external validity of the study? If the criteria are too broad and inclusive, the may add error variance to the study and reduce confidence in the studyâ&#x20AC;&#x2122;s finding. Alternatively, if the criteria are to narrow or circumscribed, the may imit the generalizebility of the finding of the population of interest. The researcher must decide how narrow or broad the criteria should be based on the specific objectives of the study. 2) Are the criteria necessary for the safety of the participants? It is necessary to consider safety issues when developing inclusion and exclusion criteria. These safety-related criteria are aimed at preventing undue arm or adverse effects that could potentially caused by participating in the experimental intervention. 3) Are the criteria ethical? Because research is designed to provide scientific evidence that could lead to a change in health policy or a standart of care, it is imperative to determine whether the intervention studied affects both genders and diverse racial and ethnic group differently. The inclusion of women and minorities in reserach will, among the other things, help to increase the generalizability of the studyâ&#x20AC;&#x2122;s finding and ensure the women and minorities benefit from the research. 4) How will the criteria be measured?

Chapter 3 â&#x20AC;&#x201C; Statistics

Randomization

Randomization either random allocation or random assignment, is a process where the participants are randomly assigned to a treatment. each has the same probability of being assigned to a treatment. If the design is based on N participants and n1 are to be assigned to treatment 1 then all possible samples of size n1 have the same probability of being assigned to

treatment 1. Example: Purely for simplicity of exposition

The Benefits of Randomization

Eliminates the selection bias

ii.

Balances the groups with respect to many known and unknown confounding or prognostic variables

iii.

Form the basis for statistical test

suppose there are N = 4 participants [Angela, Ben, Colin, Dee], two of whom are to be assigned to Treatment 1 and two to Treatment 2. The possible groups that could be assigned to Treatment 1 are; 1. [Angela, Ben], 2. [Angela, Colin], 3. [Angela, Dee], 4. [Ben, Colin], 5. [Ben, Dee], 6. [Colin, Dee]. Rolling a fair six-sided die would be one way of performing the random allocation. For instance, if the die lands on the

number 3 then Angela and Dee would be assigned to Treatment 1 and Ben and Colin would be assigned to Treatment 2.Randomization (random allocation or random assignment) is a procedure in which identified sample participants are randomly assigned to a treatment and each participant has the same probability of being assigned to any particular treatment. If the design is based on N participants and n1 are to be assigned to treatment 1 then all possible samples of size n1 have the same probability of being assigned to treatment 1. Example: Purely for simplicity of exposition suppose there are N = 4 participants [Angela, Ben, Colin, Dee], two of whom are to be assigned to Treatment 1 and two to Treatment 2. The possible groups that could be assigned to Treatment 1 are; 1. [Angela, Ben], 2. [Angela, Colin], 3. [Angela, Dee], 4. [Ben, Colin], 5. [Ben, Dee], 6. [Colin, Dee]. Rolling a fair six-sided die would be one way of performing the random allocation. For instance, if

Chapter 3 â&#x20AC;&#x201C; Statistics

the die lands on the number 3 then Angela and Dee would be assigned to Treatment 1 and Ben and Colin would be assigned to Treatment 2. 1.

Simple Randomanization

One common problem encountered occurs when a two-treatment is being compared with an overall sample of the size N, with N1 as the sample size, A for the treatment 1, and size N2 for treatment 2 (n1 + n2 = N). A total N opaque envelopes, n1 containing an identifier for treatment 1 and n2 containing an identifier for treatment 2, may be shuffled. The allocation of the participant is determined by a shuffle. it is a simple and easy to organize process which still preserves the parameter of design, and is flexible to complex situations which includes comparing multiple treatment 1.AABB, 2. ABAB 3. ABBA, 4. BAAB, 5. BABA, 6. BBAA

The next step consists of random selection from each blocks of four participant. this can be done using random generators, or software for statistics e.g. SPSS, Excel, Minitab, Stata, SAS. We can see an example of a random number sequence in the box shown: 9795270571964402603256331708242973 Since we only have six blocks, we can then remove all numbers outside 1 to 6. 52516464632563312423 Blocks are selected according to the above sequence. For example the first eighteen subjects would be allocated to treatments as follows:

BABA

ABAB

BABA

AABB

Here we can see that a group has two more participant than other groups. However,this may be insignificant. since we are using block randomization, there is a tendency for almost perfect matching of the size of groups and

Chapter 3 â&#x20AC;&#x201C; Statistics

keeping the concept of random selection. however this procedure is much more complex than the earlier process. for example, we cannot allocate the first four participants to A treatment, and thus disallows all possible assignment combination,

considering

that

sequential

randomization

similar

randomization with a 1 block size. 2.

Stratified Randomization

A Stratification factor can be described as a categorical covariate where the patient or population is divided by

EXAMPLE

their respective levels.

Sex, 2 levels: Male, Female Age, 3 levels: <40, 40â&#x20AC;?59, â&#x2030;Ľ 60 years

This

Recruitment centres

using

Menopausal status

methods.The advantages of using

Any

other

known

prognostic

approach

utilizes

the

allocation of treatments in stratums all

the

aforementioned

this approach are that it gives

allowance for prognostic factors and it is very easy to implement.

Chapter 3 â&#x20AC;&#x201C; Statistics

Statistic Analytical

There is a wide range of statistical test. Several factors which determine which test to use are the design of the research, data distribution and variable types. In general, if the data is normally distributed, we can use parametric test. If the data is non-normal distributed, we can use non-parametric test. ď&#x201A;ˇ

The number of variable

Statistical tests and procedures can be divided according to the number of variables that they are designed to analyze. Therefore, when choosing a test it is important that you consider how many variables one wishes to analyze. One set of tests is used on single variables (often referred to as descriptive statistics), a second set is used to analyze the relationship between two variables and the third set used to model multivariable relationship (a relationship between three or more variables). ď&#x201A;ˇ

Types of Data (continous, categorical, or binary)

A Difference in variable can cause a difference in the data and focus of analyisis. this is why it is important to understand the types of variables. It is helpful to decide the input variables and the outcome variables. For example, in a clinical trial, the input variable is a type of treatment (a nominal variable) and the outcome may be some clinical measure (an ordinal variable) perhaps normally distributed. The required test for this research is t-test.

Chapter 3 â&#x20AC;&#x201C; Statistics

ď&#x201A;ˇ

Distribution of Data

The standard normal distribution (Gaussian) curve is symmetrical bell-shaped. Test

that

follows

this

assumption

called

parametric

test.

Fig. 2 Curve of Data Distribution

Parametric statistic is an inference of parameter of distribution which came from one of the types of probablity distribution (e.g. normal distribution). One of the example, Gaussian distribution is a distribution which consists of both infinitely high positive and low negative numbers. This means that both numbers and biological data are limited in range. Gaussian is often known by a bell shaped biological data. Thus, we can conclude that most statistical tests, including ANOVA and T-Test can work well. This is why we see this kinds of tests used in many fields of researches. We do, however, have to be aware that small samples (e.g. < 10) or an outcome with variables such as a medical score (e.g. Apgar Score), may cause a misleading P-value. In this situation, we refer to a unique type of statistic, which we call nonparametric statistics. this type of statistic do not rely that the data came from a distribution of probablility. these tests are called nonparametric statistical tests. Keep in mind that almost all parametric tests have a corresponding nonparametric tests.

Chapter 3 – Statistics

Parametric and Nonparametric Test A huge dilemma occurs when we are tasked to decide whether to use a parametric or non parametric test. To help in deciding which test is appropriate, first, we must know whether our data is normal distribution or non-normal distribution. Few of the tests we can use to determine if a data is well-modeled to a normal distribution are the Normality tests. These tests will compare the data to a hypothesis, a null hypothesis, which has a normal distribution. There are few tests which we commonly use : 1. D'Agostino-Pearson normality test - This test identifies the normality of the test, seeing how far from normality distribution, using the kurtosis and skewness of quantity. after that a single P-value is calculated from the difference of value from expected normal value. this test is extremely useful, and is often recommended in modern statistic books 2. Kolmogorov-Smirnov test – is a test which accounts the cumulative distribution of a data. it then counts the P-Value from the discrepancy created from the cumulative distribution and the expected value. altough often used in the past, this test is not the most sensitive of tests to asses the normality of a data. Thus, we no longer use this test 3. Besides of these two, there are a relatively large number of other normality tests, such as Jarque-Bera test, Anderson-Darling test, Cramér-von-Mises criterion, Lilliefors test for normality (itself an adaptation of the KolmogorovSmirnov test), Shapiro-Wilk test, the Shapiro–Francia test for normality etc. It seems to us that in order for us to decide whether we use a parametric or a non-parametric statistical test, we only need to use normality test. However, this is not the case since we have to keep an eye out for the size of the samples used; Samples which are small are not compatible with such tests. With small samples, we cannot determine whether it is aGaussian or nonGaussian population. This is caused due to the nature of the sample. A sample too small does not posses information we needed in order to determine the distribution shape of the population. Hopefully, the table below which consists of the summary of the disscussion can be of use in understanding this predicament.

Chapter 3 – Statistics

Deciding on appropriate statistical methods for your research: To help in deciding which test would be appropriate for your research, you can use Table 2 for guidance. Table 2. Statistic Test

EXAMPLE 

Are height and weight related? Both are continous variables so Pearson’s correlation Co-efficient would be appropriate if the variables are both normally distributed.



Are patients taking treatment A more likely to recover than those on treatment B? Both treatment A or B and Recovery (Yes or No) are categorical variables so the Chisquared test is appropriate.



Is Diet 1 better than Diet 2? A researcher would randomly allocate subjects to two groups with one group following Diet 1 and the other Diet 2. Weight would be taken before and after the diet and the mean weight lost compared totwo groups. The dependent variable weight lost is continous and the independent variables is the group the subject is in which is categorical. If the data is normally distributed, use the independent t-test, if not use the Mann-whitney test.

Chapter 3 â&#x20AC;&#x201C; Statistics

Resources

Ali Z., & Bhaskar, S. B. (2016). Basic statistical tools in research and data analysis. Indian Journal of Anaesteshia. 60(9), 662-669. http://doi.org/10.413/00195049.190623 Kim, J., & Shin, W. (2014) How to do random allocation (randomization). Clinics in Orthopdic Surgery. 6(1), 103-109. http://doi.org/10.4055/cios.2014.6.1.103 Krecjie, R.V. & Morgan, D.W. (1970). Determining Sample Size For Research Activities. Educational and Pshychological Measurement J. 607-610. Nayak, B. K., & Hazra, A. (2011). How to choose the right statistical test. Indian Journal

Ophthalmology.

59(2),

85-86.

http:?//doi.org/10.4103/0301-

4738.77005 Sastroasmoro, S. & Ismael, S. (2008). Dasar-Dasar Metodologi Peneitian Klinis. Jakarta: CV. Sagung Setyo Sugiyono. (2012). Metode Penelitian Kuantitatif Kualitatif dan R&D. Bandung: Alfabeta

Chapter 4 - Variables of Study, Measurement

Academic Book Scientific Paper Chapter 4 Ethics,Reference and Plagiarism Author: Steven Philip Surya, S.Ked Editor: Agatha Claudia Rosaline, S.Ked Ethical concept In medical and health science, we always talk about high ethical standard and most of the time doing so is not a problem. Yet, there were moments; particularly in medical research, sometimes doing the “right things” are not as simple as they sound. Based on Merriam Webster, ethics is a set of moral issues or aspects (such as rightness). It deals with what is good and bad, moral duty and obligation. 1 Ethics was derived from the Greek word, Ethos, which can means habit, character, or disposition. Ethics concerned with what is good for individuals and society. Expert divided ethical theories in to three areas2 ; 1. Metaethics 2. Normative ethics 3. Applied ethics

= the nature of moral judgment = content of moral judgment and the criteria for right or wrong = looks at controversial topics including in research

Philosopher thinks that ethics could affect the way of human being behave, if a person realizes that it would be morally good to do something then it would be irrational for that person not to do it. However human being often behave irrationally, they often follow their 'instinct’ even when their heads suggest a different course of action. In our case, scientist puts knowledge superior than ethics. Before 1940s, ethical attitudes and research never been in the same side Since human experimental has been conducted, professional codes and laws were introduced to prevent scientific abuses of human lives.3 Nuremberg code (1947) was a result after catastrophic Nazi’s human experiments. This code discusses consent, both voluntary and informed, the freedom to withdraw from research, Protection from harm ,torture, or death as well as setting the limitations of research. Followed by the declaration of Helsinki in 1964 which emphasizes the well being of individuals over other interests. The long road of research and ethics issues finally comes out with conclusion of the major ethical issues in conducting research 3; 1. Informed consents 2. Beneficence do not harm

Chapter 4 - Variables of Study, Measurement

3. 4. 5. 6.

Respect for anatomy and confidentiality Respect for privacy Vulnerable group of people, and Skills of the researcher

One of the examples of ethical clearance procedure for medical science research in FKUI-RSCM4; 1. Fill in the ethical clearance form 2. Fill in the synopsis form (proposal summary) and full version of the proposal 3. Proposal should be signed by chief of the institution (for formal educational background, additional signed by the mentor) 4. Curriculum vitae of the principal investigator and co-investigator, and 5. Informed consent for the subject of the research and approval sheet In Indonesia, research ethical standard regulated by Undang – Undang Kesehatan no 23/1992 and further more in Peraturan Pemerintah no 39/1995 about Health research and development. Plagiarism and References Professional communities possess a code of ethics, usually described as formal documents which reminds them about moral standards in order to uphold the proffessional behavior which is normally called Research Integrity. The moral standards address them to be professional, especially in medical research. 5 In general, research integrity can be defined as research behavior that wa viewed from the perspective of professional standard. It is also responsible for the ideal behavior in research. The ideal behavior in research is a tool to prevent scientist for doing misconducting deliberately in medical research, includes6;  

 

Fabrication = making up data or results and recording or reporting them Falsification = manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represent in the research records. Plagiarism = the appropriation of another person’s ideas, processes, results, or words without giving appropriate credit Research misconduct does not include honest error or differences of opinion.

Plagiarism Plagiarism is one of the commonest ethical issues in the medical writing. Some of the reason the authors does a plagiarism are deadline and medico-marketing issues.7 Plagiarism is derived from Latin word “plagiere” which means to “kidnap”. The World Association of Medical Editors (WAME) defines plagiarism as “the use of other

Chapter 4 - Variables of Study, Measurement

published and unpublished ideas/words (or other intellectual property) without attribution or permission and presenting them as new and original rather than derived from an existing source”. There are some types of plagiarism in medical writings, such as plagiarism of text, plagiarism of the ideas, mosaic plagiarism, self-plagiarism and duplicate plagiarism.7 

 



Plagiarism of text (direct plagiarism) = “…copying a portion of text from another source without giving credit its author and without enclosing the borrowed text in quotation marks.”7 It is also called “world-for-word” described by Roig. Plagiarism of Ideas = copying someone ideas, thought, or intervention and presents it as his own without proper acknowledgment. Mosaic plagiarism = The American Medical Association Manual of Style describes mosaic plagiarism as “... borrowing the ideas and opinions from an original source and a few verbatim words or phrases without crediting the original author” Self-plagiarism = stealing one’s own work, the author borrow significantly from his/her own previous work.

Common tips for avoiding plagiarism7; 

   

 

They must remember to enclose within quotation marks, all the text that has been copied verbatim from another source. When paraphrasing, they must read the text, understand completely, and then use only their own words. Ethical medical writers must always acknowledge the original source of the idea, text, or illustration. Even when explaining somebody else’s ideas in their own words, it is important that they properly acknowledge the original source. When not sure if the idea/fact they wish to include is common knowledge, a medical writer must cite references. They must cite references accurately. The writer must read the instructions to authors to know what style they need to use. Biomedical journals commonly use the Vancouver style. Some textbook publishers prefer the Harvard referencing style. Acknowledgment that are insuficient or incorrect can also be classified as plagiarism A medical writer should avoid writing multiple separate articles if he can present a large complex study in a cohesive manner in a single article. Along with the manuscript, he should submit a cover letter to the editor, clearly stating any instances of overlapping from previous publications and asking for advice. Last, but not the least, if he feels he has unintentionally used somebody else’s ideas or text without appropriate referencing, he needs to write to the editor of the journal for advice. Confession is always better than to be caught stealing.

Chapter 4 - Variables of Study, Measurement

References Referencing is one of the actions to avoid plagiarism and helps the reader to identifying and finding used sources from the authors.8 Table 1. Monash University Library. Quick Reference Guide Vancouver Citing & Referencing style. http://guides.lib.monash.edu/citing-referencing/vancouver Print articles Article with 1 to 6 authors

Article with more than 6 authors

Electronic journal articles Electronic journal article

Electronic journal article with DOI

Books and book chapter Book : a.) Print book OR b.) Electronic book

Chapter : a. ) in an edited book OR b.) in an edited electronic book

Author AA, Author BB, Author CC, Author DD. Title of article. Abbreviated title of journal. Date of publication YYYY Mon DD;volume number(issue number):page numbers. Author AA, Author BB, Author CC, Author DD, Author EE, Author FF, et al. Title of article. Abbreviated title of journal. Date of publication YYYY Mon DD;volume number(issue number):page numbers. Author AA, Author BB. Title of article. Abbreviated title of Journal [Internet]. Date of publication YYYY MM [cited YYYY Mon DD];volume number(issue number):page numbers. Available from: URL Author AA, Author BB, Author CC, Author DD, Author EE, Author FF. Title of article. Abbreviated title of Journal [Internet]. Year of publication [cited YYYY Mon DD];volume number(issue number):page numbers. Available from: URL DOI a.) Author AA. Title of book. # edition [if not first]. Place of Publication: Publisher; Year of publication. Pagination. b.) Author AA. Title of web page [Internet]. Place of Publication: Sponsor of Website/Publisher; Year published [cited YYYY Mon DD]. Number of pages. Available from: URL DOI: (if available) a.) Author AA, Author BB. Title of chapter. In: Editor AA, Editor BB, editors. Title of book. # edition. Place of Publication: Publisher; Year of publication. p. [page

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numbers of chapter]. b.) Author AA, Author BB. Title of chapter. In: Editor AA, Editor BB, editors. Title of the book [Internet]. Place of publication: Publisher's name; Year of publication. [cited YYYY Mon DD]. p. #. [page or chapter number/s]. Available from: URL DOI [if available] Government and other reports Government reports

Article from online reference work

Article from electronic drug guide

Audio visual media DVDâ&#x20AC;&#x2122;s

Video file e.g Web streaming vdieo

From Internet Web page: a.) homepage b.) part of website

Author AA, Author BB. Title of report. Place of publication: Publisher; Date of publication. Total number of pages. Report No.: Title of encyclopedia [Internet]. Place of publication: Publisher; year. Title of article; [updated YYYY Mon DD; cited YYYY Mon DD]; [# of pages/screens]. Available from: URL Title of work [Internet]. Place of publication: Publisher/Website; year. Name of drug: [revision/review date; cited YYY Mon DD]; [# of pages/screens]. Available from: URL Author A. Title [Format]. Place of publication: Publisher; year of publication. Item description Author, A. Title [format]. Place of publication: publisher; date of publication [date it was viewed]. Available from: website address a.) Author/organization's name. Title of the page [Internet]. Place of publication: Publisher's name; Date or year of publication [updated yr month day; cited yr month day]. Available from: URL

b.) Title of the homepage [Internet]. Place of publication: Publisher's name; Date or year of publication. Title of specific page/part; Date of publication of part [Date cited of part]; [location or pagination of

Chapter 4 - Variables of Study, Measurement

Image from web

part]. Available from: URL Note: If the title of the image is not shown construct a title that describes the image shown. Use enough words to make the constructed title meaningful. Place the constructed title in square brackets. Author or organization. Title [Image on internet]. Place of publication: Publisher's name; date of publication [date cited]. Available from: URL

University course materials Lecture notes on Moodle

Custom textbook or unit reader

Author, A.A. Title of lecture [format]. Place of Publication: Publisher; Date of Publication [Date cited]. Available from: 'website address Author, A.A. Title of article. Publication details including original pages. Reprinted in: Smith, B editor, Title of course material. Place of publication: Publisher; Year of publication. Conclusion

A conclusion contains the authors brief summarize of the whole researchâ&#x20AC;&#x2122;s finding and generalize their importance. Do not simply summarize the points that was already made in the main content, shows whether, or to what extent, you have succeed in addressing the need that was stated at the introduction. In this section, the author can raise questions, discuss ambiguous data, and recommend places for further research. 10,11 An ideal conclusion will incorporate some of the goals10; 1. 2. 3. 4. 5. 6. 7. 8.

Interpret result, supporting conclusion with evidence Recognize the importance of negative result Move from the general to the specific Restrict or expand result Point out implications and/or draw inferences Defined unanswered questions, Mention practical application Give recommendation for further research

However, there are some typical pitfalls in conclusion section; 1. Overload the reader with unnecessary explanation (explanation overload)

Chapter 4 - Variables of Study, Measurement

2. Not explaining the finding means and let the reader jump to their own conclusion (empty finding) 3. Avoid negative result, instead the author need to discuss it (ignoring negative result) 4. Not limit the statement focus on author data (the broad statement) 5. Overstate the importance of your finding and speculate beyond the result (the expansive statement) 6. Not focus on the research question (the digression) 7. Not providing discussion of the error of the result, instead simply list them (the list of problem) Abstract section After the author finishes all section of the paper, the last part to do in medical science writing is abstract section. Abstract section in medical science writing is a summary of all other part in paper. Usually it contains around 300 words. Abstract contains source of the problem from the research (why or how important the issue), purpose of the research (how it can solve the problem), basic design or methodology, major finding / trends found of the research, and brief summary of author’s interpretation from the result and conclusion.12,13 There are 4 major types of abstract12:  

 

Critical abstract = describing main finding and information, a judgment or comment about the study’s validity, reliability, or completeness. Descriptive abstract = describing the type of information found in the work and it makes no judgment about the work nor does it provide results or conclusion of the research. Informative abstract = describing informative and explain all the main arguments, the important results and evidence in the paper. Highlight abstract Consists of Imbalanced or either complete or incomplete preview of the paper to spark the reader’s interest

The abstract should not contain12;     

Lengthy background information References to other literature Using elliptical or incomplete sentences Any terms, Abbreviations, or Jargons that may confuse the reader Any sort of image, illustration, figure, table, or references to them

Chapter 4 - Variables of Study, Measurement

References 1. Merriam-Webster. Ethic [Internet]. Springfield: Merriam-Webster Inc.; 10th Feb 2018 [cited 2018 Jan 14]. Available from: https://www.merriamwebster.com/dictionary/ethic. 2. BBC. Ethics: a general introduction [Internet]. London: BBC2014 [cited 2018 Jan 14]. Available from: http://www.bbc.co.uk/ethics/introduction/intro_1.shtml 3. Fouka G, Mantzorou M. What are the major ethical issues in conducting research? is there a conflict between the research ethics and the nature of nursing?. Health Science Journal. 2011;5(1):3-14. 4. Komite Etik Penelitian Kesehatan - Fakultas Kedokteran Universitas Indonesia. Komite Etik Penelitian Kesehatan [Internet]. Jakarta: Fakultas Kedokteran Universitas Indonesia; [cited 2018 Jan 31]. Available from: http://fk.ui.ac.id/risetpublikasi/komite-etik-penelitian-kesehatan.html 5. Dubravka K, Stjepan LM, Ana M. Research integrity and research ethics in professional codes of ethics: survey of terminology used by professional organizations across research disciplines. PLOS ONE. 2015 Jul 20th ;10 (7). 6. The Office of Research Integrity - U.S. Departement of Health and Human Service. Definition of research misconduct [Internet]. Rockville: U.S. Departement of Health and Human Services; [cited 2018 Jan 14]. Available from: https://ori.hhs.gov/definition-misconduct 7. Natasha D, Monica P. Plagiarism: Why is it such a big issue for medical writers?. Perspect Clin Res. 2011;2(2):67-71. 8. Izet M. The Importance of proper citation of references in biomedical articles. Acta Inform Med. 2013;21(i3):148-55. 9. Quick reference guide vancoiver citing & referencing style [Internet]. Melbourne: Monash University Library; [cited 2018 Feb 5]. Available from: http://guides.lib.monash.edu/ld.php?content_id=14570618 10. Introductions and Conclusions for Scientific Papers page [Internet]. Fairfax: The Writing Center; [cited 2018 Jan 13]. Available from: https://writingcenter.gmu.edu/guides/introductions-and-conclusions-for-scientificpapers 11. Scientific Papers [Internet] Michigan: Nature Education; 2014 [cited 2018 Jan 31]. Available from: https://www.nature.com/scitable/topicpage/scientific-papers13815490 12. Robert VL. Research Guides: Organizing Your Social Sciences Research Paper: 3. The Abstract [Internet]. Southern California; USC Libraries;[updated 2018 Feb 7;cited 2018 Feb 11]. Available from : http://libguides.usc.edu/writingguide/abstract 13. Chittaranja A. How to write a good abstract for a scientific paper or conference presentation. Indian J Psychiatry. 2011;53(2):172-5.

Chapter 5 – Senior Tips : How to get Ideas

Chapter 5 Senior Tips : How to Find Ideas By : Joue Abraham “If you wait for inspiration to write, you're not a writer, you're a waiter.” -Dan Poynter In making a scientific work, be it a scientific paper or scientific poster is not free from ideas. Before you start, you need ideas. Without them, that work won’t be so easy to create even if you know how. Basically both scientific paper and poster are the similar, in which the difference is in the media used. One AMSA-Indonesia senior, Matthew Billy of AMSA-UI, class of 2012 once said that to make a scientific work can be learnt by all, but in terms of coming up with ideas, it is not quite that easy. Some people can find ideas in a short time, while others might take days to come up with one. Therefore, this writing is meant to help readers find the right ideas or topics for them to write on. 1. You Should Know What To Do In a scientific competition, the time given to finish a single work is about a month. With that short of a time span, it is possible to do a direct research, but it is not enough if you are a beginner, and as medical students, you might not have much time. Therefore, your other choice is to review. What is meant by reviews here is to review and analyze the result of a research that has already been done. With a simplified language, making a "conclusion" from many researchers. There are three forms of reviews, they are literature review, systematic review, systematic literature review, and meta-analysis. Even though it is included in a review, meta-analysis can be seen as its own research. The difference between them can be seen in table 1.2 Method

Statistic Technique

Literature Review

Systematic Review

Chapter 5 â&#x20AC;&#x201C; Senior Tips : How to get Ideas Meta-Analysis

Tabel 1. Forms of Reviews If an idea acquired is still new and not much identified, such as the role of cholesterol reducing drugs in handling typhoid infection, can be made in the form of a literature review. Those new or fresh idea not able to made into a systematic review, nor meta-analysis yet. There are no conditions, but to make a systematic review, you need at least three researches. In conclusion, ideas used as systematic reviews are things that has already been researched, but is still controversial.

Look Around The earth we live in is not paradise filled with peace, but it is filled with problems. There is a gap between what should be and what is real especially health-related problems. All of these problems need answers and solutions. Identifying the problem is the first thing a researcher must do. In reality, there are a lot of health problems. The question is, can they be put into research? The answer is no, in which not all health problems can be enhanced to become a research topic in writing. So the identification of the problem must describe the issue of the topic or title of the research. Variables included in the research must also be clearly explained in the identification. Questions submitted in the research must be answered in the result and discussion. A problem can be made into a research with several criteria, called FINER (Feasible, Interesting, Novel, Ethical, and Relevant).3,4,5 The first is feasible. Problems or topics concocted must have adequate number of subjects, adequate technical expertise, affordable in time and money, and manageable in scope. Use a topic that is on the same level as other medical students and don't use one which is not. For example, drugs for HIV on TB

Chapter 5 â&#x20AC;&#x201C; Senior Tips : How to get Ideas

patients. This idea is good, but it will take a long time, moreover, a lot of subjects will be needed, as well as a great cost of money. Secondly, interesting. It is important to use a topic that is interesting, and interesting here does not mean that it is a common research topic or it has been found in many textbooks. What's important is that people are interested in reading it. You can use topics that are already used a lot, but it is still quite controversial in Indonesia. Interesting can also be defined as topics that are answers to a problem. For example, Calcium channel blockers can be used to stop early contractions in pregnant women. This has already been discussed in other countries but has not been conducted on pregnant women in Indonesia. This can be used to suppress the number of premature baby births. The third is novel. Results of a research can deny or confirm past researchers, or might even find something new. Therefore, in the background, writers often include the results of past researchers. Fourth is ethics, meaning a topic should not contradict with ethics, like beliefs, race, certain parties, or tribe. In Indonesia, this is quite a sensitive matter. For instance, topics about immunizations, which has those aspects, can be considered one because Indonesians tend to avoid them because it contains a part of a swine. Of course, these kinds of topics needs to be considered when making a scientific work. Fifth is Relevant, which means that the result of a scientific work can contribute to knowledge, health obligations, or become a basis for future researchers. For example, antibiotic research are done since the discovery of penicillin and are still being researched on till now. A good writer is one who can contribute to the world through his writings. An available problem can be used as a reason to write and can also serve as a background. For example, the incidence of tuberculosis in developing countries. The high incidence makes people, especially the government and

Chapter 5 â&#x20AC;&#x201C; Senior Tips : How to get Ideas

medical professionals, to be triggered in finding new and much simpler solutions to handle tuberculosis. The solution mentioned here is like new treatments, reducing adverse effects of a treatment, and analyzing the prognosis of the disease. To know what must be done, get used to using the word "why" and "how" because they will be needed. With this way of thinking, it will be easy for us to write a scientific paper or poster In making a writing used for competitions, do not prioritize winning. Think of winning as a bonus. Then what should be prioritized? Making a paper with good qualities. A good writing is not the most read but one that made a difference in the world and becomes the answer for all the problems around us. When we get an information, get used to using "why" and "how" that came to be. For example, the prevalence of tuberculosis. Ask yourself, "why does this happen?" and when you found the answer, ask yourself again, "How will the high prevalence of tuberculosis affect the world?" Questions like these can help you understand the problem and when you found the answers you need, it will be a great help when you are writing. If we have already thought that way, then we already know how to find a problem or topic that is fit to be researched. The next step is to find the solution. Questions like "how do we suppress the prevalence of tuberculosis?" This question will help us a lot so that it will be easier for us to find the right ideas to make a scientific work.Find the Solution a) Read Latest News By reading the latest news, we will know the hottest topics that are in store. For the latest development regarding the medical world, we can read: -

Science Daily

Medical News Today

CNN

Chapter 5 â&#x20AC;&#x201C; Senior Tips : How to get Ideas -

Cochrane Library

b) Joining Seminars, Symposiums, and Classes By joining these events, we can know about recent problems. For example, on hypertension classes, the doctors will definitely give the newest info regarding hypertension, such as diagnosis and tests, as well as treatments. c) Discuss with other Medical Students or Doctors As a member of AMSA, we will develop relations with others from other universities. When two or more heads join together in a discussion, there will be a lot of ideas that pop in. moreover, seniors and doctors from other universities might have more ideas when engaged in a discussion. So what are you waiting for? Take your notebook and start writing!

Chapter 5 â&#x20AC;&#x201C; Senior Tips : How to get Ideas

Reference: 1. Strength & Conditioning Research. (2018). Evidence hierarchy. [online] Available at: https://www.strengthandconditioningresearch.com/perspectives/evidence-hierarchy/ [Accessed 25 Feb. 2018]. 2. Dahlan, M. (2012). Pengantar Meta Analisis. 1st ed. Jakarta: Epidemiologi Indonesia, p.4. 3. Aslam, S. and Emmanuel, P. (2010). Formulating a researchable question: A critical step for facilitating good clinical research. Indian Journal of Sexually Transmitted Diseases and AIDS, 31(1), p.47. 4. Hulley S, Cummings S, Browner W, Designing clinical research. 3rd ed. Philadelphia (PA): Lippincott Williams and Wilkins; 2007. 5. PubMed. (2018). Research questions, hypotheses and objectives. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912019/ [Accessed 25 Feb. 2018].

Chapter 6 - Senior Tips : Presenting your work within a scientific poster

Chapter 6 Senior Tips : Presenting your work within a scientific poster By : Januar Er Scientific poster; or in the other name known as the academic poster; is one the best way to present our work, especially for common people or audiences. The poster that we made should be easy to be read, and concise enough to read in less than 10 minutes.[1] How to write a good conclusion Scientific poster; or in the other name known as the academic poster; is one the best way to present our work, especially for common people or audiences. The poster that we made should be easy to be read, and concise enough to read in less than 10 minutes.[1] How to write a good conclusion The conclusion is one of the main parts of the scientific poster body. This should be a brief explanation of the study objective(s). It should be viewing the big picture of the result(s). Make sure that your conclusion is logical and consistent with the data you have obtained from your study or research.[2][3] In another way, a conclusion could be determined as a place in your scientific poster that has function as a reminder to the reader about the poster or research's objective(s). Remember not to overstate your result(s) by inferring anything which is not supporting your data. Sometimes, the conclusion may discuss the other alternative interpretations of the data obtained from the study; or explaining about the evaluation from their methods, such as the effectiveness or limitations. It would be better if you add a suggestion for the future study similar to your study through this session. An effective conclusion usually in form of a bulleted list or short paragraph with no more than 200 words, so that the readers will be able to read this part in less than two minutes.[2][3][4] Take a look at an example below, this is an example of writing a conclusion in a scientific poster.

Figure 1. Example of Conclusion [5] Abstract creation

Chapter 6 - Senior Tips : Presenting your work within a scientific poster

An abstract is the summary of the whole scientific poster you have made. It should not re-state the other part that you have discussed through your poster but explain in the shortest way of the scientific poster. A good abstract should at least contain background, research question and results. Before creating an abstract, you have to make sure that the abstract is also included in the scientific poster rules. Sometimes it was not asked to be published in your scientific poster. If they asked to do so, we have to make sure that the abstract is written precisely in a very brief way.[1][3] There are several ways of making an abstract, but generally, it can be divided into two types, those are abstract for an original research study and abstract for case report or literature review. For original research, the abstract must at least contain several parts such as introduction/backgrounds, research objectives, methods, results, conclusions and/or implications. While for case report or literature review, the parts are almost the same, but remember for case report there are no research objectives, methods, and results, but case description.[2] One thing that we have to remember, do not copy or re-write the sentences you have discussed in your scientific poster, but paraphrase and explain it in other sentences as short as possible. There are ten steps to write an effective abstract: 1. Identify major objectives and conclusions; 2. Identify phrases with the keywords in the methods section; 3. Define the main idea or the main result embedded within the discussion or the result section 4. Assemble the above information into a single paragraph; 5. Write down your Hypothesis or method in the early sentences 6. Omit background information, literature review, and detailed description of methods; 7. Remove extra words and phrases; 8. Ensure that the paragraph in the abstract only contains the essential information 9. Check to see if it meets the guidelines of the targeted journal or event you join; 10. Give the abstract to a mentor or teacher and ask him/her whether it makes sense.[1] Last but not least, an abstract usually need the keywords. The function of keywords here are to describing the content of the scientific poster and will enable the content of your poster to be searchable online. Each keyword should be kept short, one word if possible (itâ&#x20AC;&#x2122;s okay to have two or three words for a keyword if necessary); and make sure that those keywords are already the specific words from your poster. Donâ&#x20AC;&#x2122;t be too general because it will make no sense for your poster. [6]

Chapter 6 - Senior Tips : Presenting your work within a scientific poster

There is an example of abstract below:

Figure 2. Example of Abstract

[5]

How to design your own scientific poster First of all, we have to know the tools. You can choose your own tools for creating your own poster, please make sure that you already familiar with those software. Many people use Microsoft Publisher or Microsoft PowerPoint, but you need to work a lot in the editing process. You may use Adobe Acrobat or Corel Draw too. After you already decided the program provider, you have to check for the poster specifications made by the organizers. Remember that each event may be having different specifications. Make sure you have enough time to take a look for the poster requirements and draw your sketch first will be a plus. Take a careful look for the requirements, whether it is asked in portrait or landscape. Then, you can continue to the next steps of poster designing. [5][7] It is important for you to spare a little inch of your poster less than the required format size to make your poster fit properly with the board. If the size is incorrect, it will hang off the board and make your poster looks untidy and unprofessional. Then, we can start to make the poster part by part. Headings: This part should be eye-catching and clear in bold. It is recommended to have a short title because a longer title of your poster might often bore your audience and distract them from the main idea of your scientific poster. Donâ&#x20AC;&#x2122;t forget to attach the compulsory logo for your poster such as your university logo and/or the event logo. They can be placed in each side of the headings. The authors and affiliations can be written under the title with a smaller font. [7] Main body: This is the most important part of your scientific poster. This part should follow the logical structure that bring the reader from each chapter to another. It is approximately 100 words for each chapter to be ideally readable. Donâ&#x20AC;&#x2122;t make your scientific poster too wordy because it will make your reader bored easily. Several points below will guide you to create your main body, but you have to check the points required by the event organizer:

Chapter 6 - Senior Tips : Presenting your work within a scientific poster



Introduction Make sure you write a short background, aims and objectives, and the novel of your scientific poster in this part.  Methods This part includes basic parameters, such as target sample, setting, duration of study, inclusion or exclusion criteria, statistical analysis, interventions, and primary outcome measures for the original research. You may create this part based on the type of your study, such as literature review or etc.  Results This includes the data analysis. You may show your key graphs, data, tables, graphics, or images. These need to be large enough for your reader to see as an attractive part and clutter-free as possible.  Conclusions This part should be derived from your results and answers for the research questions you have made. Don’t forget to include the limitations and key improvements for the further poster.  References Take a careful look for the guidelines from your event. Make sure you write the suitable format as required by the organizers. You may write this part in the smaller font compared to the other parts. [7] After you finish with your content, let’s start to design your scientific poster to be eye-catching and attractive by following these tips: a) Text type In this part you must give your full attention to several points. Those are:  Type style The usage of typefaces in an effective way will make your poster more visually interesting and provides you the way to express your creativity. It is acceptable for you to make an expressive typefaces in the headings section to gain your audience’s attention, but still you have to make sure that it is easy to read. For the main body, you have to consider the legibility of your typefaces. It is essential for you to write your paragraph here with simple, and easy-to-read font, such as the TNR or Arial.  Type alignment Avoid the all CAPS text and justified paragraph in all part of your text. Check and check for the text. It is better to use the ‘align left’ for your paragraph. It will make your text looks neat and better.  Font size and color Titles and headers need to be legible from at least five feet away. The body paragraph should be read easily from the distance of two feet in front of the poster. Giving a bold in your important part may attract the reader to read more of your poster, but don’t be too often. There are several points you may follow in making the font size. For the title, you may use 85 – 94 points, authors: 56 – 74 points, affiliations: 64 points or make it smaller

Chapter 6 - Senior Tips : Presenting your work within a scientific poster

than the authors, headings: 36 – 42 points, sub-headings: 30 – 36 points, body text: 24 – 28 points, references and caption: 18 – 20 points.[5][6][7] b) Appearance Use each of the elements in your scientific poster to make a path for the audience to read. A common guideline is for having 40% graphics, 20% text, and 40% open space. But you can modify it and make sure it is still aesthetically good. Scientific poster usually made into column, you have to make your reader read the entire poster flows from top to bottom and/or from left to right. Consider the following to make a better appearance of your scientific poster:  Provides visual cues Color, text style and size, and proximity of the elements can help to clarify between elements and group idea. Not only the simple black-and white, the use of soft and pale color and different hue (intensities) of the same color will make your poster readable for the audience and it’s not hurt their vision. Use 2 until 3 kinds of color, not more! The more color you use, the more distraction of your information will be. Better to use the dark type of text in the light color background. Be careful with your primary color palette. You may go to: http://www.colorschemer.com/online.html for the choice of color.  Make effective use of available space Do not make a crowded situation in your scientific poster. Please provide available space from each chapter of your text. It will make your audience easier for them to take a starting point and go on to the next part if you provide the available space for them to ‘breath’. Provide those ‘blank space’ between paragraph and within figures, and also around them. If you try to pack as much information as you can, it will make the reader hard to read the poster.  Use color and effects with restraint Please make sure that you always check and check for the color you have decided in your poster. As we mentioned before, two until three colors are better than the riot of colors and special effects that might hurt your audience’s vision.[5][6][7] c) Graphics elements It is good for you to include the graphics into your poster as it will the poster looks aesthetically pleasing. It will provide much information than the text. It is popular yet looks attractive for the figures interspersed within the text. Pick a good resolution-graphic to avoid blurring when you present it.  Line weight A line that contain the important information need to be visible; they should be heavier than the default weight of one point.  Patterns It is better to use the solid fills. Don’t forget to use the contrast color from your background to make a notice to your reader.  Symbols

Chapter 6 - Senior Tips : Presenting your work within a scientific poster

Use the closed symbols instead of the default, make it larger if possible.  Value Good contrast in hue and/or value aids in readability.  Pictures Avoid the bad resolution picture. Use at least 150 dpi, but not more than 300 dpi. Better you save the pictures in the .png format instead of .jpeg or .jpg format. If it is about a repro pictures from microscope, don’t forget to include a scale bar in the picture description.  Logos The official logo is an important part on an institution’s corporate. However, make sure that you attach your logo symmetrically from the original one. Be careful with the placement, remember the hierarchy of that organization.[5][6][7] Here is an example of a scientific poster template:

Figure 3. An Example of Scientific Poster Template

[5]

To end this chapter, the writer only shares the tips on making the design of scientific poster based on what the writer’s usually do. You are free to elaborate your poster styling and designing. Just check and check whether it is already readable and eye-catching or not. Consult with your lecturer also for the better suggestions and advices for your scientific poster. Happy trying! References: 1. Arratia, Juan F. n.d. Scientific Method, Scientific Abstract & Scientific Poster. San Juan: Ana G. Mendez University System.

Chapter 6 - Senior Tips : Presenting your work within a scientific poster

2. Wood, Gordon J. & Morrison, R. Sean. 2011. Writing Abstracts and Developing Posters for National Meetings. Journal of Palliative Medicine. 14(3):353-359. 3. Long, T.M. & Elzinga, C. 2009. Elements of a Scientific Poster. BioSci 110 Lab. Spring 2009:1. 4. Annon. n.d. Poster Presentations. Connecticut: University of Connecticut Writing Center. 5. Scientific Publications, Graphics & Media. 2015. Best Practices for Effective Scientific Posters. Frederick: National Cancer Institute. Available from: http://ncifrederick.cancer.gov/Services/Spgm 6. Annon. n.d. Guidelines for Preparing Abstracts and Keywords. Available from: https://mitpress.mit.edu/content/guidelines-preparing-abstracts-and-keywords 7. Gundogan, B; Koshy, K; Kural, L & Whitehurst, K. 2016. How to Make an Academic Poster. Annals of Medicine and Surgery. 16(3):1-10.