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ThS.

on Th Ngc Hn
i hc Y Dc TP H Ch Minh

Mc tiu hc tp
Gii thiu v nghin cu khoa hc
Cc bc tin hnh mt nghin cu nh lng
Vit mc tiu nghin cu

Nghin cu l g?
Research: The organized quest for new knowledge,

based on curiosity or on perceived needs.


Nghin cu: Tm kim mt cch c h thng cc kin
thc mi, da trn s t m v nhu cu c cm
nhn.
Kin thc mi: cu tr li cho cu hi nghin cu

Last JM. A dictionary of Epidemiology. NewYork: International


epidemiology association 1997; 146
2

Cc loi nghin cu trong y khoa


Nghin cu c bn: tm hiu tt hn v t nhin
Nghin cu dch t: xc nh nhng yu t nguy c v

nguyn nhn ca bnh


Nghin cu lm sng: tm hiu qu trnh bnh v tc
dng ca nhng bin php iu tr

Yu cu ca mt nghin cu tt
Cu hi nghin cu xng ng
Mc tiu nghin cu xc nh r rng
Phng php c thit k tt
Nghin cu c tin hnh ng cch
Phn tch s liu thch hp v y
Vit bo co tt

Phng php nghin cu khoa


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

gii s liu gp phn gii quyt mt vn nghin


cu hay tr li mt cu hi nghin cu1
Th d: Thu thp s liu, phn tch v l gii s liu
nhn trc v tin s b sa m gp phn phng
nga bo ph tr em

NCKH
2008

Nghin cu phc v cho hnh ng

NCKH
2008

Phng php nghin cu khoa


hc
S liu (Data): Kt qu ca vic thu thp cc c
tnh hay i lng ca cc i tng
Thng tin (Information): S liu c phn tch
Kin thc (Knowledge) : Thng tin c l gii v
c s dng tr li cu hi nghin cu v
ng dng vo mt hnh ng c th.

NCKH
2008

S liu: gi tr ca bin s

Hemoglobin (g/100mL) ph n mang thai


10.2
13.3
10.6
12.1
9.3
12.0
13.4
11.9
11.2
14.6

13.7
12.9
10.5
12.9
13.5
12.9
12.1
11.4
15.1
11.1
9

10.4
12.1
13.7
11.4
14.6
11.1
10.9
12.5
10.7
13.5

14.9
9.4
11.8
12.7
11.2
8.8
11.3
13.0
12.9
10.9

11.5
13.2
14.1
10.6
11.7
10.2
14.7
11.6
13.4
13.1

12.0
10.8
10.3
11.4
10.9
11.6
10.8
13.1
12.3
11.8

11.0
11.7
13.6
11.9
10.4
12.5
13.3
9.7
11.0
12.2
NCKH
2008

Thng
tin:
s
liu
c
phn
tch
Hemoglobin
Tn sut Phn trm Phn trm cng dn
8-8,9

1.43

1.43

9-9,9

4.29

5.71

10-10,9

14

20.00

25.71

11-11,9

19

27.14

52.86

12-12,9

14

20.00

72.86

13-13,9

13

18.57

91.43

14-14,9

7.14

98.57

15-15,9

1.43

100.00

10

NCKH
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Kin thc: thng tin c l gii tr li


cu hi nghin cu v ng dng vo mt
hnh ng c th
C mt s ln ph n mang thai (26%) b thiu mu
Bit c t l ph n thiu mu gip BS khm tin

sn c chin lc ph hp sng lc thiu mu


ph n mang thai

11

NCKH
2008

B m v bo ph
Von Kries R, Koletzko B, et al. Breast feeding and obesity: cross-sectional study. BMJ
1999; 319:147-150

S liu:
Cc gi tr cn o v b cu hi ca 9357 tr 5-6 tui
Thng tin:
Thi gian b sa m

T l hin mc (%) ca
Qu cn
Bo ph
12.6 (12.4 to 12.9)
4.5 (4.4 to 4.6)
9.2 (9.0 to 9.3)
2.8 (2.7 to 2.8)

Khng bao gi (n=4022)


tng (n=5184*)
B m hon ton trong
<2 thng (n=2084)
3 -5 thng (n=2052)
6 -12 thng (n=863)
>12 thng (n=121)

11.1 (10.6 to 11.6)


3.8 (3.6 to 4.0)
8.4 (8.1 to 8.8)
2.3 (2.2 to 2.4)
6.8 (6.1 to 7.6)
1.7 (1.6 to 1.9)
5.0 (1.1 to 8.8) 0.8 (0.2 to 1.5)

Kin thc:
C th gim nguy c bo ph tr em bng vic cho b sa m: nu tr
c b m t 3 n 5 thng nguy c bo ph vo lc 5-6 tui s gim 35%
Hnh ng
Khuyn khch b m cho con b sa m gim nguy c bo ph
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NCKH
2008

Kt cu cng nghin cu
1. Gii thiu
1.1. Thng tin nn tng
1.2. t vn
1.3. Tng quan ti liu

2. Mc tiu
3. Phng php lun
3.1. Loi nghin cu, bin s v k thut thu thp s liu
3.2. Ly mu
3.3. K hoch thu thp s liu
3.4. K hoch x l v phn tch s liu
3.5. Xem xt v o c
3.6. Nghin cu dn ng

4. K hoch hot ng (bao gm m t nhm n)


5. Ti chnh (gii thch cc mc chi tiu chnh)
6. K hoch iu hnh, theo di v s dng kt qu
Ph lc1. Ti liu tham kho
Ph lc 2. Cc ch vit tt
Ph lc 3. Cc dng c thu nhn thng tin (bao gm questionnaire).
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Cu hi nghin cu, mc ch,


chin lc v thit k tng ng
Cu hi nghin
cu

Mc ch nghin
cu

Chin lc
nghin cu

Thit k nghin
cu

Hin tng sc
khe xy ra u,
khi no?

M t
Xc nh mi lin
quan nhn qu

M t s phn b
ca hin tng
sc khe

Nghin cu m t

Nguyn nhn ca
hin tng sc
khe l g?

Xc nh nguyn
nhn ca hin
tng sc khe

So snh tn s ca
nhng yu t

Nghin cu phn
tch

So snh tn s ca
hiu qu trong
nhm can thip v
nhm chng
kim nh gi
thuyt

Nghin cu can
thip

Can thip vo
nh gi hiu lc,
nguyn nhn c ci tc ng ca mt
thin c sc
bin php
khe hay khng?

14

Cu hi nghin cu
Cu hi nghin cu phi c th:
Tr li bng con s hay c/khng.
Khi nim phi r rng

Cu hi nghin cu l th v c ngha
Who care? So what?

Cu hi nghin cu cho nghin cu tt:


Tiu chun FINER

15

Tiu chun FINER

Mun c cu hi nghin cu tt
phi a ra kin ngh d kin
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Cu hi nghin cu
Cu hi nghin cu no l c th?
Tnh hnh i tho ng nh th no?-ko
T l hin mc i tho ng ngi trng thnh
thnh ph H Ch Minh l bao nhiu?-ok
C nn thay i cch iu tr i tho ng hin nay
hay khng?-no
bnh nhn i tho ng, iu tr tch cc (HbA1c
<6.0 %) c lm ci thin t l sng cn ca bnh nhn
hay khng so vi iu tr tiu chun (HbA1c <6.5 %)?ok

17

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

v iu chng ta mong mun


Vn nghin cu & Vn qun l
Nu c kin thc gii quyt vn : vn qun

l
Nu cha c kin thc tr li: vn nghin cu

Vn c hay khng? C quan trng hay khng?


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

19

Vo nm 2002 t l tim chng tr em di 1 tui

TP H Ch Minh ch vo khong 30%


iu ny c phi l vn hay khng?
iu ny c phi l vn nghin cu hay khng?

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NCKH 2008

21

Tiu chun chn vn nghin cu


1. Tnh xc hp:
2. Trnh trng lp:
3. Tnh kh thi:
4. Tnh c chp nhn t cc nh qun l:
5. Tnh ng dng ca kt qu v cc kin ngh:
6. Tnh cp thit ca ti:
7. Tnh chp nhn v o c:

22

NCKH
2008

Thang im nh gi u tin
Tnh xc hp:
1. Khng xc hp: bnh t gp v khng trm trng
2. Xc hp: bnh ph bin nhng t trm trng
3. Rt xc hp: ph bin c hu qu xu
Trnh trng lp
1. thng tin v vn nghin cu
2. C thng tin v vn nghin cu nhng cha
bao ph vn chnh
3. Khng c thng tin gii quyt vn
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NCKH
2008

Thang im nh gi u tin
Tnh kh thi
1. Nghin cu khng kh thi vi ti nguyn sn c
2. Nghin cu kh thi vi ngun lc sn c
3. Nghin cu rt kh thi vi ngun lc sn c
Tnh chp nhn ca cp lnh o
1. Ch khng chp nhn c vi lnh o
2. Ch t nhiu kh chp nhn
3. Ch c chp nhn hon ton
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NCKH
2008

Thang im nh gi u tin
Tnh ng dng
1. Khuyn co t c hi c thc hin
2. Khuyn co c t nhiu c hi c thc hin
3. Khuyn co c nhiu c hi c thc hin
Tnh cp thit
1. Thng tin khng cp thit cn thit
2. Thng tin cn thit ngay nhng c th tr hon
3. Thng tin rt cn thit ra quyt nh
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NCKH
2008

Thang im nh gi u tin
Tnh chp nhn v o c
1. C vn quan trng v o c
2. C mt t tr ngi v o c
3. Khng c vn o c

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NCKH
2008

Thc hin v li ch ca bnh nhn - Beneficence - a practitioner

should act in the best interest of the patient. (Salus aegroti


suprema lex.)
Khng lm tn hai bnh nhn - Non-maleficence - "first, do no
harm" (primum non nocere).
Bnh nhn c quyn t ch - Autonomy - the patient has the right
to refuse or choose their treatment. (Voluntas aegroti suprema
lex.)
Cng bng: phn phi cng bng ngun lc him trong y t Justice
- concerns the distribution of scarce health resources, and the
decision of who gets what treatment.
Phm gi: tn trng phm gi bnh nhn - Dignity - the patient
(and the person treating the patient) have the right to dignity.
Trung thc: Truthfulness and honesty - the concept of informed
consent has increased in importance since the historical events of
the Nuremberg trials and Tuskegee Syphilis Study

27

NCKH
2008

Vn 1

Vn 2

Vn 3

Vn 4

1. Tnh xc hp
2. Trnh trng
lp
3. Kh thi
4. c lnh
o chp nhn
5. Tnh ng
dng
6. Tnh cp
thit
7. Y c
Tng s
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NCKH
2008

Kt cu phn m u cho nghin cu can


thip
Vn y t l g? Tm quan trng ca vn

nghin cu (t l hin mc, t l mi mc, hu


qu)
Cc gii php iu tr (phng nga hoc chn
on) hin ti cho vn v ti sao cn cc gii
php iu tr (phng nga hoc chn on) mi
Nhng cu hi no ca gii php chn on mi
cn c tr li v trong nhng cu hi no
cha c tr li Nu cu tr li ny c tr
li s gip ch g cho cng ng, bnh nhn, bc s
a ra mc tiu nghin cu
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2008

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NCKH
2008

Kt cu phn m u cho nghin cu quan


st
Vn y t l g? Tm quan trng ca vn nghin

cu (t l hin mc, t l mi mc, hu qu)


Nhng yu t nguy c ca vn nghin cu l g?
Nhng yu t no c th nh hng n vn
nghin cu (da trn cc lp lun khoa hc) nhng
cha c xc nh? Nhng yu t nguy c no
c xc nh nhng cn cha r quy m?
Vic xc nh c cc yu t nguy c mi hoc quy
m ca cc yu t nguy c bit s gip ch g cho
cng ng, bnh nhn, bc s
a ra mc tiu nghin cu
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NCKH
2008

Phn tch vn
Cc bc:
Lm r quan im bng cch xc nh cc vn nh
Chn vn ct li; c t vn ct li (bn cht, phn

b, mc trm trng ca vn ct li)


Tm cc yu t lin quan

t vn ct li trung tm

Tm cc yu t nh hng n vn

Xc nh thm cc yu t gp phn

Phn thnh 3 nhm: kinh t x hi, y t v sinh hc

32

V d:
Vn b tr ARV ca bnh nhn HIV ti TpHCM
T k tr di 3 tui c pht hin tr

33

Tui

Ngh
nghip

Kin
thc

Mc

bnh

Tnh
trng
kinh t

B tr ARV
B
tr nhn
ARV
bnh
HIV

Dch
v y t
p ng
vi iu
tr

Cht
ln
g
dch
v

Thiu
kin
thc

Thiu
gim st

Thi
ca nhn
vin y t

Bs khng
ngh
quan
trng

Ni
sinh
sng
Tnh
trng
kinh t
gd

Gia nh
thiu
kin
thc

Bs
khng
quan
tm
Dv y t
km

Pht hin tr t
k tr di 3
tui

Tui m,
hc vn
cha m,
ngh
nghip

Thiu
phng t
vn,
truy th
thng

Bs thiu
kin
thc v
t k

Phn tch vn

Sp xp cc yu t thnh cc nhm ln v xy

dng s :
Yu t kinh t x hi: Gm tui, gii, hc vn, ngh

nghip, kin thc cng ng, cc loi hnh iu tr


cng ng,
Yu t dch v y t: tnh c c v tip cn c ca
dch v, qun l dch v y t, cht lng c s y t, thi
vi cc loi hnh iu tr
Yu t y sinh: trm trng ca bnh tt, p ng vi
iu tr, hin tng khng thuc

36

Xc nh trng tm v phm vi
1. Tnh hu dng thng tin: Thng tin c c t vn
ny c gip ci thin vn hay khng? Gii php gii
quyt c thc hin c hay khng?
2. Tnh kh thi: C th thu thp c nhng thng tin
no trong thi gian d tr thc hin nghin cu?
3. Tnh lp li: C thng tin no c ri? kha cnh no
ca thng tin cn c nghin cu thm.
4. Y c: qu trnh nghin cu c lm tn hi g n i
tng nghin cu hay khng?
Cn tham kho ti liu hoc hi kin chuyn gia

xc nh trng tm v phm vi ca nghin cu

Thng tin v cc yu t gp phn


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Mc tiu nghin cu
Mc tiu ca mt nghin cu nhm tm tt

nhng g s t c bi nghin cu
Mc tiu nghin cu l mnh khng nh th hin nghin

cu t c iu g tr li cu hi nghin cu:

Cc yu t no nh hng n vic b tr ARV ca bnh nhn


HIV ?

Mc tiu phi lin quan cht ch vi phn t vn

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2008

Phn loi mc tiu


Theo cp bao ph
Mc tiu tng qut
Mc tiu c th
Cc mc tiu c th c chia theo mc u tin
Mc tiu chnh (primary objective)
Mc tiu ph (secondary objective)

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2008

Mc tiu nghin cu
Phn loi mc tiu theo cp bao ph
Mc tiu tng qut (general objective, aim)

iu trng i t c bi nghin cu theo cch chung


nht
Khng thc s l mc tiu

Mc tiu c th (specific objectives):

Cc phn nh hn v c lin h hp l v gip t c


mc tiu tng qut

Th d v mc tiu nghin cu
Mc tiu tng qut (general objective, aim)
Xc nh cc yu t nh hng n vic b tr ARV ca bnh

nhn HIV

Mc tiu c th (specific objectives):


Xc nh mi lin quan gia cc c im dn s : tnh trng

kinh t ,hc vn , tui vi vic b tr ARV ca bnh nhn HIV


Xc nh mi lin quan gia thi ca nhn vin y t vi vic
b tr ARV ca bnh nhn HIV
Xc nh mi lin quan gia nng ca bnh vi vic b tr
ARV ca bnh nhn HIV

Mc tiu nghin cu
Phn loi mc tiu theo mc u tin
Mc tiu chnh (primary objective)
Tr li cu hi nghin cu quan trng nht
Phi t c mc tiu nghin cu chnh
L c s tnh c mu nghin cu
Mc tiu ph (secondary objective):
C th khng t c mc tiu nghin cu ph
Thng khng cn tnh c mu da trn mc tiu ph (c
th tnh lc mu cho mc tiu ph)

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

500 ml mu trong vng 2 gi sau sinh) ca misoprostol so vi


placebo ph n sinh con theo ng m o
Mc tiu ph (secondary objective):
Xc nh hiu qu phng nga bng huyt sau sinh cp tnh, nng
(mt trn 1000 ml mu trong vng 2 gi sau sinh) ca misoprostol
so vi placebo ph n sinh con theo ng m o
Xc nh hiu qu gim lng mu mt sau sinh ca misoprostol so
vi placebo ph n sinh con theo ng m o
Xc nh t l xut hin bin c bt li ph n sinh con theo
ng m o s dng misoprostol
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2008

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

mc tiu tng qut mt cch mch lc v hp l


S dng cc ng t hnh ng c hiu nh
gi:
Xc nh, c lng, tnh ton, (kho st, nghin

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

Yu cu ca mc tiu nghin cu
Phi c th:
Mc tiu c lng: Nu r (a) tham s cn c c

lng (b) ca vn (c) trn dn s c th


Mc tiu lin quan: Nu r (a) bin c lp cn c xc
nh tc ng ln (b) bin ph thuc (c) trn dn s c
th
Mc tiu so snh: Nu r (a) nhm c nh gi so
snh vi (b) nhm chng v (c) kt cuc no (d) trn
mt dn s c th

Nu c khi nim c th cha c hon ton

thng nht phi nh ngha khi nim ny ngay


sau mc tiu nghin cu.

Tng quan (correlation): H s c gi tr t -1 n 1 cho

bin s tng quan gia 2 bin nh lng


Lin quan (association): c hay khng yu t ny (bin
nh tnh hay nh lng) nh hng hay tc ng n
bin s khc. S o lin quan (OR hay RR) l s o c gi tr
dng c th <1, =1 hay > 1
C s lin quan gia ht thuc l v ung th phi

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


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

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2008

Mc tiu nghin cu c th l kim nh mt gi

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

cp tnh hay khng so vi placebo ph n sinh con theo


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

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2008

Gi thuyt nghin cu

Gi thuyt nghin cu l s tin on v mi quan

h gia mt hay nhiu yu t vi vn nghin cu


thai ph c nguy c, nhm s dng thuc chng

ngng tp tiu cu lm gim nguy c b sn git so vi


nhm dng gi dc

Gi thuyt nghin cu nn y cc thnh phn

PICO - PECO
P (Polutaion)
I (Intervention) E (exposure)
C (Control)
O (Outcome)

Th d ca gi thuyt nghin
cu
Phu thut ct cng mc su s t va chm v xo trn

vo t chc ni nhn nn kt qu s tt hn
Bnh nhn b glaucome gc m c iu tr bng

phu thut ct cng mc su s c t l ti pht thp


hn so vi bnh nhn c iu tr bng phu thut
ct b c in

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2008

Tn ti nghin cu
C 2 quan im chnh
Tn ti l mc tiu tng qut ca nghin cu
Tn ti l mt cm danh t th hin cc t kho ca
nghin cu
Tn ti phi th hin c nghin cu s a ra

c kt qu g.

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2008

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