how to start a research paper about disease

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How to Write a Medical Research Paper

Last Updated: February 5, 2024 Approved

This article was co-authored by Chris M. Matsko, MD . Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017. wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 89% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 201,968 times.

Writing a medical research paper is similar to writing other research papers in that you want to use reliable sources, write in a clear and organized style, and offer a strong argument for all conclusions you present. In some cases the research you discuss will be data you have actually collected to answer your research questions. Understanding proper formatting, citations, and style will help you write and informative and respected paper.

Researching Your Paper

• Pick something that really interests you to make the research more fun.
• Choose a topic that has unanswered questions and propose solutions.

• Quantitative studies consist of original research performed by the writer. These research papers will need to include sections like Hypothesis (or Research Question), Previous Findings, Method, Limitations, Results, Discussion, and Application.
• Synthesis papers review the research already published and analyze it. They find weaknesses and strengths in the research, apply it to a specific situation, and then indicate a direction for future research.

• Keep track of your sources. Write down all publication information necessary for citation: author, title of article, title of book or journal, publisher, edition, date published, volume number, issue number, page number, and anything else pertaining to your source. A program like Endnote can help you keep track of your sources.
• Take detailed notes as you read. Paraphrase information in your own words or if you copy directly from the article or book, indicate that these are direct quotes by using quotation marks to prevent plagiarism.
• Be sure to keep all of your notes with the correct source.
• Your professor and librarians can also help you find good resources.

• Keep all of your notes in a physical folder or in a digitized form on the computer.
• Start to form the basic outline of your paper using the notes you have collected.

Writing Your Paper

• Start with bullet points and then add in notes you've taken from references that support your ideas. [1] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
• A common way to format research papers is to follow the IMRAD format. This dictates the structure of your paper in the following order: I ntroduction, M ethods, R esults, a nd D iscussion. [2] X Research source
• The outline is just the basic structure of your paper. Don't worry if you have to rearrange a few times to get it right.
• Ask others to look over your outline and get feedback on the organization.
• Know the audience you are writing for and adjust your style accordingly. [3] X Research source

• Use a standard font type and size, such as Times New Roman 12 point font.
• Double-space your paper.
• If necessary, create a cover page. Most schools require a cover page of some sort. Include your main title, running title (often a shortened version of your main title), author's name, course name, and semester.

• Break up information into sections and subsections and address one main point per section.
• Include any figures or data tables that support your main ideas.
• For a quantitative study, state the methods used to obtain results.

• Clearly state and summarize the main points of your research paper.
• Discuss how this research contributes to the field and why it is important. [4] X Research source
• Highlight potential applications of the theory if appropriate.
• Propose future directions that build upon the research you have presented. [5] X Research source
• Keep the introduction and discussion short, and spend more time explaining the methods and results.

• State why the problem is important to address.
• Discuss what is currently known and what is lacking in the field.
• State the objective of your paper.
• Keep the introduction short.

• Highlight the purpose of the paper and the main conclusions.
• State why your conclusions are important.
• Be concise in your summary of the paper.
• Show that you have a solid study design and a high-quality data set.
• Abstracts are usually one paragraph and between 250 – 500 words.

• Unless otherwise directed, use the American Medical Association (AMA) style guide to properly format citations.
• Add citations at end of a sentence to indicate that you are using someone else's idea. Use these throughout your research paper as needed. They include the author's last name, year of publication, and page number.
• Compile your reference list and add it to the end of your paper.
• Use a citation program if you have access to one to simplify the process.

• Continually revise your paper to make sure it is structured in a logical way.
• Proofread your paper for spelling and grammatical errors.
• Make sure you are following the proper formatting guidelines provided for the paper.
• Have others read your paper to proofread and check for clarity. Revise as needed.

Expert Q&A

• Ask your professor for help if you are stuck or confused about any part of your research paper. They are familiar with the style and structure of papers and can provide you with more resources. Thanks Helpful 0 Not Helpful 0
• Refer to your professor's specific guidelines. Some instructors modify parts of a research paper to better fit their assignment. Others may request supplementary details, such as a synopsis for your research project . Thanks Helpful 0 Not Helpful 0
• Set aside blocks of time specifically for writing each day. Thanks Helpful 0 Not Helpful 0

• Do not plagiarize. Plagiarism is using someone else's work, words, or ideas and presenting them as your own. It is important to cite all sources in your research paper, both through internal citations and on your reference page. Thanks Helpful 4 Not Helpful 2

You Might Also Like

• ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178846/
• ↑ http://owl.excelsior.edu/research-and-citations/outlining/outlining-imrad/
• ↑ http://china.elsevier.com/ElsevierDNN/Portals/7/How%20to%20write%20a%20world-class%20paper.pdf
• ↑ http://intqhc.oxfordjournals.org/content/16/3/191
• ↑ http://www.ruf.rice.edu/~bioslabs/tools/report/reportform.html#form

About This Article

To write a medical research paper, research your topic thoroughly and compile your data. Next, organize your notes and create a strong outline that breaks up the information into sections and subsections, addressing one main point per section. Write the results and discussion sections first to go over your findings, then write the introduction to state your objective and provide background information. Finally, write the abstract, which concisely summarizes the article by highlighting the main points. For tips on formatting and using citations, read on! Did this summary help you? Yes No

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Successful Scientific Writing and Publishing: A Step-by-Step Approach

TOOLS AND TECHNIQUES — Volume 15 — June 14, 2018

John K. Iskander, MD, MPH 1 ; Sara Beth Wolicki, MPH, CPH 1 ,2 ; Rebecca T. Leeb, PhD 1 ; Paul Z. Siegel, MD, MPH 1 ( View author affiliations )

Suggested citation for this article: Iskander JK, Wolicki SB, Leeb RT, Siegel PZ. Successful Scientific Writing and Publishing: A Step-by-Step Approach. [Erratum appears in Prev Chronic Dis 2018;15. http://www.cdc.gov/pcd/issues/2018/18_0085e.htm .]  Prev Chronic Dis 2018;15:180085. DOI: http://dx.doi.org/10.5888/pcd15.180085 external icon .

Introduction

Basic recommendations for scientific writing, sections of an original research article, beginning the writing process, acknowledgments, author information.

Scientific writing and publication are essential to advancing knowledge and practice in public health, but prospective authors face substantial challenges. Authors can overcome barriers, such as lack of understanding about scientific writing and the publishing process, with training and resources. The objective of this article is to provide guidance and practical recommendations to help both inexperienced and experienced authors working in public health settings to more efficiently publish the results of their work in the peer-reviewed literature. We include an overview of basic scientific writing principles, a detailed description of the sections of an original research article, and practical recommendations for selecting a journal and responding to peer review comments. The overall approach and strategies presented are intended to contribute to individual career development while also increasing the external validity of published literature and promoting quality public health science.

Publishing in the peer-reviewed literature is essential to advancing science and its translation to practice in public health (1,2). The public health workforce is diverse and practices in a variety of settings (3). For some public health professionals, writing and publishing the results of their work is a requirement. Others, such as program managers, policy makers, or health educators, may see publishing as being outside the scope of their responsibilities (4).

Disseminating new knowledge via writing and publishing is vital both to authors and to the field of public health (5). On an individual level, publishing is associated with professional development and career advancement (6). Publications share new research, results, and methods in a trusted format and advance scientific knowledge and practice (1,7). As more public health professionals are empowered to publish, the science and practice of public health will advance (1).

Unfortunately, prospective authors face barriers to publishing their work, including navigating the process of scientific writing and publishing, which can be time-consuming and cumbersome. Often, public health professionals lack both training opportunities and understanding of the process (8). To address these barriers and encourage public health professionals to publish their findings, the senior author (P.Z.S.) and others developed Successful Scientific Writing (SSW), a course about scientific writing and publishing. Over the past 30 years, this course has been taught to thousands of public health professionals, as well as hundreds of students at multiple graduate schools of public health. An unpublished longitudinal survey of course participants indicated that two-thirds agreed that SSW had helped them to publish a scientific manuscript or have a conference abstract accepted. The course content has been translated into this manuscript. The objective of this article is to provide prospective authors with the tools needed to write original research articles of high quality that have a good chance of being published.

Prospective authors need to know and tailor their writing to the audience. When writing for scientific journals, 4 fundamental recommendations are: clearly stating the usefulness of the study, formulating a key message, limiting unnecessary words, and using strategic sentence structure.

To demonstrate usefulness, focus on how the study addresses a meaningful gap in current knowledge or understanding. What critical piece of information does the study provide that will help solve an important public health problem? For example, if a particular group of people is at higher risk for a specific condition, but the magnitude of that risk is unknown, a study to quantify the risk could be important for measuring the population’s burden of disease.

Scientific articles should have a clear and concise take-home message. Typically, this is expressed in 1 to 2 sentences that summarize the main point of the paper. This message can be used to focus the presentation of background information, results, and discussion of findings. As an early step in the drafting of an article, we recommend writing out the take-home message and sharing it with co-authors for their review and comment. Authors who know their key point are better able to keep their writing within the scope of the article and present information more succinctly. Once an initial draft of the manuscript is complete, the take-home message can be used to review the content and remove needless words, sentences, or paragraphs.

Concise writing improves the clarity of an article. Including additional words or clauses can divert from the main message and confuse the reader. Additionally, journal articles are typically limited by word count. The most important words and phrases to eliminate are those that do not add meaning, or are duplicative. Often, cutting adjectives or parenthetical statements results in a more concise paper that is also easier to read.

Sentence structure strongly influences the readability and comprehension of journal articles. Twenty to 25 words is a reasonable range for maximum sentence length. Limit the number of clauses per sentence, and place the most important or relevant clause at the end of the sentence (9). Consider the sentences:

By using these tips and tricks, an author may write and publish an additional 2 articles a year.

An author may write and publish an additional 2 articles a year by using these tips and tricks.

The focus of the first sentence is on the impact of using the tips and tricks, that is, 2 more articles published per year. In contrast, the second sentence focuses on the tips and tricks themselves.

Authors should use the active voice whenever possible. Consider the following example:

Active voice: Authors who use the active voice write more clearly.

Passive voice: Clarity of writing is promoted by the use of the active voice.

The active voice specifies who is doing the action described in the sentence. Using the active voice improves clarity and understanding, and generally uses fewer words. Scientific writing includes both active and passive voice, but authors should be intentional with their use of either one.

Original research articles make up most of the peer-reviewed literature (10), follow a standardized format, and are the focus of this article. The 4 main sections are the introduction, methods, results, and discussion, sometimes referred to by the initialism, IMRAD. These 4 sections are referred to as the body of an article. Two additional components of all peer-reviewed articles are the title and the abstract. Each section’s purpose and key components, along with specific recommendations for writing each section, are listed below.

Title. The purpose of a title is twofold: to provide an accurate and informative summary and to attract the target audience. Both prospective readers and database search engines use the title to screen articles for relevance (2). All titles should clearly state the topic being studied. The topic includes the who, what, when, and where of the study. Along with the topic, select 1 or 2 of the following items to include within the title: methods, results, conclusions, or named data set or study. The items chosen should emphasize what is new and useful about the study. Some sources recommend limiting the title to less than 150 characters (2). Articles with shorter titles are more frequently cited than articles with longer titles (11). Several title options are possible for the same study (Figure).

Figure 1. Two examples of title options for a single study. [A text version of this figure is also available.]

Abstract . The abstract serves 2 key functions. Journals may screen articles for potential publication by using the abstract alone (12), and readers may use the abstract to decide whether to read further. Therefore, it is critical to produce an accurate and clear abstract that highlights the major purpose of the study, basic procedures, main findings, and principal conclusions (12). Most abstracts have a word limit and can be either structured following IMRAD, or unstructured. The abstract needs to stand alone from the article and tell the most important parts of the scientific story up front.

Introduction . The purpose of the introduction is to explain how the study sought to create knowledge that is new and useful. The introduction section may often require only 3 paragraphs. First, describe the scope, nature, or magnitude of the problem being addressed. Next, clearly articulate why better understanding this problem is useful, including what is currently known and the limitations of relevant previous studies. Finally, explain what the present study adds to the knowledge base. Explicitly state whether data were collected in a unique way or obtained from a previously unstudied data set or population. Presenting both the usefulness and novelty of the approach taken will prepare the reader for the remaining sections of the article.

Methods . The methods section provides the information necessary to allow others, given the same data, to recreate the analysis. It describes exactly how data relevant to the study purpose were collected, organized, and analyzed. The methods section describes the process of conducting the study — from how the sample was selected to which statistical methods were used to analyze the data. Authors should clearly name, define, and describe each study variable. Some journals allow detailed methods to be included in an appendix or supplementary document. If the analysis involves a commonly used public health data set, such as the Behavioral Risk Factor Surveillance System (13), general aspects of the data set can be provided to readers by using references. Because what was done is typically more important than who did it, use of the passive voice is often appropriate when describing methods. For example, “The study was a group randomized, controlled trial. A coin was tossed to select an intervention group and a control group.”

Results . The results section describes the main outcomes of the study or analysis but does not interpret the findings or place them in the context of previous research. It is important that the results be logically organized. Suggested organization strategies include presenting results pertaining to the entire population first, and then subgroup analyses, or presenting results according to increasing complexity of analysis, starting with demographic results before proceeding to univariate and multivariate analyses. Authors wishing to draw special attention to novel or unexpected results can present them first.

One strategy for writing the results section is to start by first drafting the figures and tables. Figures, which typically show trends or relationships, and tables, which show specific data points, should each support a main outcome of the study. Identify the figures and tables that best describe the findings and relate to the study’s purpose, and then develop 1 to 2 sentences summarizing each one. Data not relevant to the study purpose may be excluded, summarized briefly in the text, or included in supplemental data sets. When finalizing figures, ensure that axes are labeled and that readers can understand figures without having to refer to accompanying text.

Discussion . In the discussion section, authors interpret the results of their study within the context of both the related literature and the specific scientific gap the study was intended to fill. The discussion does not introduce results that were not presented in the results section. One way authors can focus their discussion is to limit this section to 4 paragraphs: start by reinforcing the study’s take-home message(s), contextualize key results within the relevant literature, state the study limitations, and lastly, make recommendations for further research or policy and practice changes. Authors can support assertions made in the discussion with either their own findings or by referencing related research. By interpreting their own study results and comparing them to others in the literature, authors can emphasize findings that are unique, useful, and relevant. Present study limitations clearly and without apology. Finally, state the implications of the study and provide recommendations or next steps, for example, further research into remaining gaps or changes to practice or policy. Statements or recommendations regarding policy may use the passive voice, especially in instances where the action to be taken is more important than who will implement the action.

The process of writing a scientific article occurs before, during, and after conducting the study or analyses. Conducting a literature review is crucial to confirm the existence of the evidence gap that the planned analysis seeks to fill. Because literature searches are often part of applying for research funding or developing a study protocol, the citations used in the grant application or study proposal can also be used in subsequent manuscripts. Full-text databases such as PubMed Central (14), NIH RePORT (15), and CDC Stacks (16) can be useful when performing literature reviews. Authors should familiarize themselves with databases that are accessible through their institution and any assistance that may be available from reference librarians or interlibrary loan systems. Using citation management software is one way to establish and maintain a working reference list. Authors should clearly understand the distinction between primary and secondary references, and ensure that they are knowledgeable about the content of any primary or secondary reference that they cite.

Review of the literature may continue while organizing the material and writing begins. One way to organize material is to create an outline for the paper. Another way is to begin drafting small sections of the article such as the introduction. Starting a preliminary draft forces authors to establish the scope of their analysis and clearly articulate what is new and novel about the study. Furthermore, using information from the study protocol or proposal allows authors to draft the methods and part of the results sections while the study is in progress. Planning potential data comparisons or drafting “table shells” will help to ensure that the study team has collected all the necessary data. Drafting these preliminary sections early during the writing process and seeking feedback from co-authors and colleagues may help authors avoid potential pitfalls, including misunderstandings about study objectives.

The next step is to conduct the study or analyses and use the resulting data to fill in the draft table shells. The initial results will most likely require secondary analyses, that is, exploring the data in ways in addition to those originally planned. Authors should ensure that they regularly update their methods section to describe all changes to data analysis.

After completing table shells, authors should summarize the key finding of each table or figure in a sentence or two. Presenting preliminary results at meetings, conferences, and internal seminars is an established way to solicit feedback. Authors should pay close attention to questions asked by the audience, treating them as an informal opportunity for peer review. On the basis of the questions and feedback received, authors can incorporate revisions and improvements into subsequent drafts of the manuscript.

The relevant literature should be revisited periodically while writing to ensure knowledge of the most recent publications about the manuscript topic. Authors should focus on content and key message during the process of writing the first draft and should not spend too much time on issues of grammar or style. Drafts, or portions of drafts, should be shared frequently with trusted colleagues. Their recommendations should be reviewed and incorporated when they will improve the manuscript’s overall clarity.

For most authors, revising drafts of the manuscript will be the most time-consuming task involved in writing a paper. By regularly checking in with coauthors and colleagues, authors can adopt a systematic approach to rewriting. When the author has completed a draft of the manuscript, he or she should revisit the key take-home message to ensure that it still matches the final data and analysis. At this point, final comments and approval of the manuscript by coauthors can be sought.

Authors should then seek to identify journals most likely to be interested in considering the study for publication. Initial questions to consider when selecting a journal include:

Which audience is most interested in the paper’s message?

Would clinicians, public health practitioners, policy makers, scientists, or a broader audience find this useful in their field or practice?

Do colleagues have prior experience submitting a manuscript to this journal?

Is the journal indexed and peer-reviewed?

Is the journal subscription or open-access and are there any processing fees?

How competitive is the journal?

Authors should seek to balance the desire to be published in a top-tier journal (eg, Journal of the American Medical Association, BMJ, or Lancet) against the statistical likelihood of rejection. Submitting the paper initially to a journal more focused on the paper’s target audience may result in a greater chance of acceptance, as well as more timely dissemination of findings that can be translated into practice. Most of the 50 to 75 manuscripts published each week by authors from the Centers for Disease Control and Prevention (CDC) are published in specialty and subspecialty journals, rather than in top-tier journals (17).

The target journal’s website will include author guidelines, which will contain specific information about format requirements (eg, font, line spacing, section order, reference style and limit, table and figure formatting), authorship criteria, article types, and word limits for articles and abstracts.

We recommend returning to the previously drafted abstract and ensuring that it complies with the journal’s format and word limit. Authors should also verify that any changes made to the methods or results sections during the article’s drafting are reflected in the final version of the abstract. The abstract should not be written hurriedly just before submitting the manuscript; it is often apparent to editors and reviewers when this has happened. A cover letter to accompany the submission should be drafted; new and useful findings and the key message should be included.

Before submitting the manuscript and cover letter, authors should perform a final check to ensure that their paper complies with all journal requirements. Journals may elect to reject certain submissions on the basis of review of the abstract, or may send them to peer reviewers (typically 2 or 3) for consultation. Occasionally, on the basis of peer reviews, the journal will request only minor changes before accepting the paper for publication. Much more frequently, authors will receive a request to revise and resubmit their manuscript, taking into account peer review comments. Authors should recognize that while revise-and-resubmit requests may state that the manuscript is not acceptable in its current form, this does not constitute a rejection of the article. Authors have several options in responding to peer review comments:

Performing additional analyses and updating the article appropriately

Declining to perform additional analyses, but providing an explanation (eg, because the requested analysis goes beyond the scope of the article)

Providing updated references

Acknowledging reviewer comments that are simply comments without making changes

In addition to submitting a revised manuscript, authors should include a cover letter in which they list peer reviewer comments, along with the revisions they have made to the manuscript and their reply to the comment. The tone of such letters should be thankful and polite, but authors should make clear areas of disagreement with peer reviewers, and explain why they disagree. During the peer review process, authors should continue to consult with colleagues, especially ones who have more experience with the specific journal or with the peer review process.

There is no secret to successful scientific writing and publishing. By adopting a systematic approach and by regularly seeking feedback from trusted colleagues throughout the study, writing, and article submission process, authors can increase their likelihood of not only publishing original research articles of high quality but also becoming more scientifically productive overall.

The authors acknowledge PCD ’s former Associate Editor, Richard A. Goodman, MD, MPH, who, while serving as Editor in Chief of CDC’s Morbidity and Mortality Weekly Report Series, initiated a curriculum on scientific writing for training CDC’s Epidemic Intelligence Service Officers and other CDC public health professionals, and with whom the senior author of this article (P.Z.S.) collaborated in expanding training methods and contents, some of which are contained in this article. The authors acknowledge Juan Carlos Zevallos, MD, for his thoughtful critique and careful editing of previous Successful Scientific Writing materials. We also thank Shira Eisenberg for editorial assistance with the manuscript. This publication was supported by the Cooperative Agreement no. 1U360E000002 from CDC and the Association of Schools and Programs of Public Health. The findings and conclusions of this article do not necessarily represent the official views of CDC or the Association of Schools and Programs of Public Health. Names of journals and citation databases are provided for identification purposes only and do not constitute any endorsement by CDC.

Corresponding Author: John Iskander, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Atlanta, GA. Telephone: 404-639-8889. Email: [email protected] .

Author Affiliations: 1 Centers for Disease Control and Prevention, Atlanta, Georgia. 2 Association of Schools and Programs of Public Health, Washington, District of Columbia.

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Andrei V. Alexandrov; How to Write a Research Paper. Cerebrovasc Dis 1 August 2004; 18 (2): 135–138. https://doi.org/10.1159/000079266

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Background: Busy strokologists often find little time for scientific writing. They sometimes develop a mental condition equivalent to that known by neurologists as writer’s cramp. It may result in permanent damage to academic career. This paper provides advice how to prevent or treat this condition. Methods: Prepare your manuscript following the IMRaD principle (Introduction, Methods, Results, and Discussion), with every part supporting the key message. When writing, be concise. Clearly state your methods here, while data belong to Results. Successful submissions combine quality new data or new thinking with lucid presentation. Results: Provide data that answer the research question. Describe here most important numeric data and statistics, keeping in mind that the shorter you can present them, the better. The scientific community screens abstracts to decide which full text papers to read. Make your point with data, not arguments. Conclusions: Conclusions have to be based on the present study findings. The time of lengthy and unfounded speculations is over. A simple message in a clearly written manuscript will get noticed and may advance our understanding of stroke.

By now you probably wrote an abstract and submitted it to a stroke conference. Your mentor reminds you several times to start drafting a paper, and you have no idea where to start. As a simple trick, copy and paste your abstract so that Background becomes your introduction. For the rest, follow the IMRaD principle: Introduction, Methods, Results, and Discussion [ 1, 2, 3 ]. Think what ‘take home message’ you’d like to deliver and to whom. The title sells the paper.

‘Busy strokologists often find little time ... to treat this condition’: this introduction concisely describes the study hypothesis, rationale, purpose, and objectives. A three-paragraph introduction is plenty for most topics. Expand with facts from papers previously published by others, among whom you may occasionally find your mentor. Do a thorough literature search for earlier sources dealing with your subject [ 4, 5, 6 ]. Tell here what is known in the field. You do not need to refer to every paper ever written on this topic. Select key references and remember that for publishing purposes, less is better than more. Consult your mentor as often as possible – he is the senior author after all.

The third paragraph should state the research question [ 7 ]. You may take an original paper already published in Cerebrovascular Diseases to use as a template. Formulate the research question clearly since data presentation should provide equally clear answers.

The first author drafts the manuscript and determines co-authors [ 8 ]. Although general guidelines are available [ 8 ], the reality often demands seeking advice from your mentor. Inappropriate inclusion of authors will decrease the likelihood of manuscript acceptance.

Describe subject selection criteria and data collection tools. Make this description detailed enough so that if someone wants to repeat the study, it will be possible. If new imaging technology was used, tell how and by whom these tests were validated. Avoid presenting actual data in this section: ‘Study subjects were recruited from 1,215 patients admitted to our stroke unit from August 1999 through August 2002’. Instead say: ‘Study subjects were recruited from consecutive patients admitted to our stroke unit. Inclusion criteria were ...’. Methods may disclose power calculations, estimated sample size, and stopping rules.

Provide additional evidence that would increase confidence in the reliability of your methods. Control for biases, validation of research tools, ‘blinding’ of observers – all of these facts, if established before the study initiation, will strengthen the manuscript. Describe in detail the outcome models or dependent variables. For clinical outcomes or surrogate markers, reference a pivotal trial or study that established their relevance.

Documentation of protection of research subjects is essential. Clearly state if a local ethics committee approved your study. This ensures patients or animal rights protection, particularly if experiments were performed. The author also needs to disclose funding sources and potential for commercial bias such as connections with the pharmaceutical industry. Data safety monitoring, independent data acquisition and analysis during clinical trials and appropriate overseeing committees should be mentioned if applicable.

Major scientific journals currently accept less than 25% of submitted manuscripts. If rejected, it does not necessarily mean your manuscript is poor. Rejection means that reviewers did not give it a high enough priority. You should not be too disappointed because, after all, you got very good advice how to improve your manuscript. Follow reviewers’ suggestions and you increase the likelihood that another esteemed journal will accept it. The most important factors for publication are the quality, novelty, reliability and scientific or clinical importance of your work. A manuscript should disclose new information or a new way of thinking about old information. If not, it will not be published – regardless of how well it is written. Avoid redundant or duplicate publications since these should not be published. Scientific publishing is extremely competitive, and chances are that by the time you conceived the project, 10 other groups were already doing it and 5 others have already published it. Stay on top of current literature and know the limitations of research done by others.

The last paragraph of this section should describe tools of statistical analysis appropriate to study design. Consult a statistician before embarking on a project, work with a statistician to analyze and interpret the data, and have a statistician reviewing the whole manuscript for clarity of statistical analysis and data presentation.

Your results are the most important part of the manuscript. Present them clearly by avoiding long and confusing sentences. The shorter you can present your data in tables and figures, the better. Remain focused and disciplined. The flurry of numbers and ‘p’ values should follow simple logics. Start by describing your study subjects, use actual numbers for study demographics. Avoid opening sentences like: ‘Table 1 summarizes our findings in sub-group C’. This makes reviewers frustrated since they have to flip back and forth through pages to understand what was done to study subjects.

Make data presentation so clear and simple that a tired person riding late on an airplane can take your manuscript and get the message at first reading. Very few people can write a perfect manuscript on the first draft. Return to the draft, read it, change cumbersome parts, read other papers and change the draft again, and again, and again. I still do it before I give the manuscript to my co-authors. But do not hold it for too long. Remember, ‘10 other groups ...’.

Present results to colleagues since they would likely ask for more data or analyses. Most likely the reviewers of any esteemed journal would do the same, so include data in the first draft of your manuscript. The internal review is helpful to determine sufficient data to answer the research question.

Most importantly, provide data relevant to the research question. Observations beyond the primary research question can be included in the manuscript, if they strengthen your case. Remember to stay in focus. If you get lost from the aim of the study, so will be reviewers. Prestigious journals have a strict word limit for papers they accept. You need all this space to deliver the key message, so do not mess around but concentrate on the essential. Packing manuscript with data is better than splitting the paper into separate small ones.

Mention a statistical test that generated specific ‘p’ values or coefficients. Show absolute numbers as well as percentages so that reviewers can judge the significance of your observations. Remember that statistical difference does not necessarily translate into clinical significance.

Make your point with data, not arguments.

This section should start with: ‘Our study showed ...’ to lucidly summarize your study findings. Discussion is often the weakest part of the manuscript. Do not repeat the introduction. Do not present any new data that were not shown in the results section and avoid repeating data presentation. There is no reason to underline how terrific your results are – let them speak for themselves.

The second paragraph may describe the novelty of your findings or if they parallel previous research. Remember, only the beginners try to refer to all published papers in the field. No esteemed journal can afford the space needed for this. A skillful selection of the most pertinent references demonstrates a command of the relevant literature. Confirmatory research makes passing the review process more difficult. Arbitrarily, the ratio of abstracts to original papers in curriculum vitae should be less than 3 to 1. If there are too many abstracts, you either have writer’s cramp or the quality of your research is insufficient for publication.

The third paragraph may describe how your study contradicts previous research or established dogmas. If there was disagreement about study interpretation by co-authors, mention different conclusions drawn from your results or other studies [ 9, 10 ]. Avoid general statements that are not founded in data. Do not provide your opinion how to solve a problem that was not directly evaluated in your study. Do not write a review of all possible mechanisms that you have not accounted for in your study. You can write a short but to-the-point Discussion.

The fourth paragraph should describe study limitations. If you do not discuss study weaknesses, the reviewers will. Study limitations may be contrasted with study strengths. This part may also mention unresolved questions and direction of future research.

The concluding paragraph can summarize the potential significance of your findings and what changes to research or clinical practice your data may support. This is a critical part since it is easy to overestimate the significance of your research. Avoid broad claims and strong statements. Remember that even pioneer break-through studies require independent confirmation. Publication in a peer-reviewed journal means completion of your project and dissemination of research results [ 11, 12 ].

Clinicians need to develop skills in scientific writing. If you make a significant observation, a proper and fast scientific communication is required [ 12 ]. Improving your scientific writing is a life-long process. If and when your papers are rejected, remember that most manuscripts face the same fate. Avoid choosing an inappropriate journal for your manuscript submission. Common reasons for rejection include inappropriate or incomplete statistics; over-interpretation of results; inappropriate or sub-optimal instrumentation; a sample too small or biased; difficult-to-follow writing; insufficient problem statement; inaccuracy or inconsistency of the data reported; incomplete, inaccurate, or outdated review of the literature; insufficient data presented, and defective tables or figures [ 13, 14, 15 ]. When reading criticism, learn from your mistakes or the advice given to you. While wrestling with reviewers, you will become a better scientific writer but also a better, more critical scientist. In the long run this will make a major difference to your academic career, and probably will also improve your patient care. Most likely, your way of writing will become more evidence based.

An anonymous and probably frustrated academician once said: ‘Publish or perish!’. This brutally honest statement should motivate you to learn yet another set of useful skills. Good luck!

The author is not a native English speaker. I am indebted to John Norris, MD, FRCP, for – among many things during fellowship training – his patience with my ‘a’s and ‘the’s, and the first lessons in study design, analysis, and presentation. The infamous ‘Norris Rules’ that he taught his fellows are partly reflected in this paper.

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How to start your research paper [step-by-step guide]

1. Choose your topic

2. find information on your topic, 3. create a thesis statement, 4. create a research paper outline, 5. organize your notes, 6. write your introduction, 7. write your first draft of the body, 9. write your conclusion, 10. revise again, edit, and proofread, frequently asked questions about starting your research paper, related articles.

Research papers can be short or in-depth, but no matter what type of research paper, they all follow pretty much the same pattern and have the same structure .

A research paper is a paper that makes an argument about a topic based on research and analysis.

There will be some basic differences, but if you can write one type of research paper, you can write another. Below is a step-by-step guide to starting and completing your research paper.

Choose a topic that interests you. Writing your research paper will be so much more pleasant with a topic that you actually want to know more about. Your interest will show in the way you write and effort you put into the paper. Consider these issues when coming up with a topic:

• make sure your topic is not too broad
• narrow it down if you're using terms that are too general

Academic search engines are a great source to find background information on your topic. Your institution's library will most likely provide access to plenty of online research databases. Take a look at our guide on how to efficiently search online databases for academic research to learn how to gather all the information needed on your topic.

Tip: If you’re struggling with finding research, consider meeting with an academic librarian to help you come up with more balanced keywords.

If you’re struggling to find a topic for your thesis, take a look at our guide on how to come up with a thesis topic .

The thesis statement is one of the most important elements of any piece of academic writing. It can be defined as a very brief statement of what the main point or central message of your paper is. Our thesis statement guide will help you write an excellent thesis statement.

In the next step, you need to create your research paper outline . The outline is the skeleton of your research paper. Simply start by writing down your thesis and the main ideas you wish to present. This will likely change as your research progresses; therefore, do not worry about being too specific in the early stages of writing your outline.

Then, fill out your outline with the following components:

• the main ideas that you want to cover in the paper
• the types of evidence that you will use to support your argument
• quotes from secondary sources that you may want to use

Organizing all the information you have gathered according to your outline will help you later on in the writing process. Analyze your notes, check for accuracy, verify the information, and make sure you understand all the information you have gathered in a way that you can communicate your findings effectively.

Start with the introduction. It will set the direction of your paper and help you a lot as you write. Waiting to write it at the end can leave you with a poorly written setup to an otherwise well-written paper.

The body of your paper argues, explains or describes your topic. Start with the first topic from your outline. Ideally, you have organized your notes in a way that you can work through your research paper outline and have all the notes ready.

After your first draft, take some time to check the paper for content errors. Rearrange ideas, make changes and check if the order of your paragraphs makes sense. At this point, it is helpful to re-read the research paper guidelines and make sure you have followed the format requirements. You can also use free grammar and proof reading checkers such as Grammarly .

Tip: Consider reading your paper from back to front when you undertake your initial revision. This will help you ensure that your argument and organization are sound.

Write your conclusion last and avoid including any new information that has not already been presented in the body of the paper. Your conclusion should wrap up your paper and show that your research question has been answered.

Allow a few days to pass after you finished writing the final draft of your research paper, and then start making your final corrections. The University of North Carolina at Chapel Hill gives some great advice here on how to revise, edit, and proofread your paper.

Tip: Take a break from your paper before you start your final revisions. Then, you’ll be able to approach your paper with fresh eyes.

As part of your final revision, be sure to check that you’ve cited everything correctly and that you have a full bibliography. Use a reference manager like Paperpile to organize your research and to create accurate citations.

The first step to start writing a research paper is to choose a topic. Make sure your topic is not too broad; narrow it down if you're using terms that are too general.

The format of your research paper will vary depending on the journal you submit to. Make sure to check first which citation style does the journal follow, in order to format your paper accordingly. Check Getting started with your research paper outline to have an idea of what a research paper looks like.

The last step of your research paper should be proofreading. Allow a few days to pass after you finished writing the final draft of your research paper, and then start making your final corrections. The University of North Carolina at Chapel Hill gives some great advice here on how to revise, edit and proofread your paper.

There are plenty of software you can use to write a research paper. We recommend our own citation software, Paperpile , as well as grammar and proof reading checkers such as Grammarly .

Researching a Disorder

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When a disorder is first diagnosed, the doctor or other health care professional often gives a handout that summarizes key points of information. (See also Introduction to Making the Most of Health Care .)

If people want to learn more about their disorder, many other sources of information are available. In the United States, people typically turn to the internet, either searching on a term in a search engine (such as Google), or asking their contacts on social media. However, although the internet provides a huge volume of information, the accuracy of that information varies widely. It can be hard to judge the credibility of online sources. Other ways of finding information include asking doctors, nurses, or other practitioners to tell them about the disorder or to recommend reliable sources of information. Some local, university, or hospital libraries have useful resources, including a research librarian.

Generally, governmental medical sources are authoritative and reliable. On the internet, reliable resources that provide a large amount of useful and accurate information to the public include the

National Institutes of Health ( NIH )

Agency for Healthcare Research and Quality ( AHRQ )

Centers for Disease Control and Prevention ( CDC )

These sites also provide links to other helpful and reliable sites. Some major and regional health systems also maintain reliable, online disease and treatment resources for patients and physicians. Many disease-specific, patient-oriented sites (such as the National Multiple Sclerosis Society or the Alzheimer's Association) provide information for people with a particular disorder. In contrast, sites designed to sell specific products or a specific service may be less reliable. Their information may be biased or inaccurate.

Support groups may provide helpful information, as well as psychologic support. Such groups can be found through local newspapers, hospitals, offices of doctors or other health care practitioners, and the internet. Most cities in the United States have support groups, sometimes for specific disorders. For example, Gilda’s Club, which is located in several cities, offers support for people living with cancer. Other people who have the same disorder or who care for someone with the same disorder may have many practical and useful suggestions for day-to-day living, such as where to find pieces of specialized equipment, what equipment works best, and how to interact with or care for someone with a disorder.

Another resource is chat rooms on the internet. Such sites enable people to communicate with one another about specific disorders and to share possible resources; however, on these sites in particular, the scientific validity of the information should not be assumed. One person's individual illness experience or suggestions may not be appropriate for another person with the same disorder.

More Information

The following English-language resources may be useful. Please note that THE MANUALS is not responsible for the content of any but the last resource.

Agency for Healthcare Research and Quality (AHRQ): This organization produces evidence to improve the quality of health care by making it safer, as well as more accessible, equitable, and affordable.

Centers for Disease Control and Prevention (CDC): The CDC is part of the US Department of Health and Human Services and provides science-based, data-driven, health information.

National Institutes of Health (NIH): This site provides access to health information, updates on clinical research trials, and science education resources for students and educators.

STANDS—Commentary : This commentary succinctly explains what health care consumers should look for when scouring the internet for reliable health information.

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How to Write a Research Paper Introduction (with Examples)

The research paper introduction section, along with the Title and Abstract, can be considered the face of any research paper. The following article is intended to guide you in organizing and writing the research paper introduction for a quality academic article or dissertation.

The research paper introduction aims to present the topic to the reader. A study will only be accepted for publishing if you can ascertain that the available literature cannot answer your research question. So it is important to ensure that you have read important studies on that particular topic, especially those within the last five to ten years, and that they are properly referenced in this section. 1 What should be included in the research paper introduction is decided by what you want to tell readers about the reason behind the research and how you plan to fill the knowledge gap. The best research paper introduction provides a systemic review of existing work and demonstrates additional work that needs to be done. It needs to be brief, captivating, and well-referenced; a well-drafted research paper introduction will help the researcher win half the battle.

The introduction for a research paper is where you set up your topic and approach for the reader. It has several key goals:

• Present your research topic
• Capture reader interest
• Summarize existing research
• Position your own approach
• Define your specific research problem and problem statement
• Highlight the novelty and contributions of the study
• Give an overview of the paper’s structure

The research paper introduction can vary in size and structure depending on whether your paper presents the results of original empirical research or is a review paper. Some research paper introduction examples are only half a page while others are a few pages long. In many cases, the introduction will be shorter than all of the other sections of your paper; its length depends on the size of your paper as a whole.

• Break through writer’s block. Write your research paper introduction with Paperpal Copilot

Table of Contents

What is the introduction for a research paper, why is the introduction important in a research paper, craft a compelling introduction section with paperpal. try now, 1. introduce the research topic:, 2. determine a research niche:, 3. place your research within the research niche:, craft accurate research paper introductions with paperpal. start writing now, frequently asked questions on research paper introduction, key points to remember.

The introduction in a research paper is placed at the beginning to guide the reader from a broad subject area to the specific topic that your research addresses. They present the following information to the reader

• Scope: The topic covered in the research paper
• Context: Background of your topic
• Importance: Why your research matters in that particular area of research and the industry problem that can be targeted

The research paper introduction conveys a lot of information and can be considered an essential roadmap for the rest of your paper. A good introduction for a research paper is important for the following reasons:

• It stimulates your reader’s interest: A good introduction section can make your readers want to read your paper by capturing their interest. It informs the reader what they are going to learn and helps determine if the topic is of interest to them.
• It helps the reader understand the research background: Without a clear introduction, your readers may feel confused and even struggle when reading your paper. A good research paper introduction will prepare them for the in-depth research to come. It provides you the opportunity to engage with the readers and demonstrate your knowledge and authority on the specific topic.
• It explains why your research paper is worth reading: Your introduction can convey a lot of information to your readers. It introduces the topic, why the topic is important, and how you plan to proceed with your research.
• It helps guide the reader through the rest of the paper: The research paper introduction gives the reader a sense of the nature of the information that will support your arguments and the general organization of the paragraphs that will follow. It offers an overview of what to expect when reading the main body of your paper.

What are the parts of introduction in the research?

A good research paper introduction section should comprise three main elements: 2

• What is known: This sets the stage for your research. It informs the readers of what is known on the subject.
• What is lacking: This is aimed at justifying the reason for carrying out your research. This could involve investigating a new concept or method or building upon previous research.
• What you aim to do: This part briefly states the objectives of your research and its major contributions. Your detailed hypothesis will also form a part of this section.

How to write a research paper introduction?

The first step in writing the research paper introduction is to inform the reader what your topic is and why it’s interesting or important. This is generally accomplished with a strong opening statement. The second step involves establishing the kinds of research that have been done and ending with limitations or gaps in the research that you intend to address. Finally, the research paper introduction clarifies how your own research fits in and what problem it addresses. If your research involved testing hypotheses, these should be stated along with your research question. The hypothesis should be presented in the past tense since it will have been tested by the time you are writing the research paper introduction.

The following key points, with examples, can guide you when writing the research paper introduction section:

• Highlight the importance of the research field or topic
• Describe the background of the topic
• Present an overview of current research on the topic

Example: The inclusion of experiential and competency-based learning has benefitted electronics engineering education. Industry partnerships provide an excellent alternative for students wanting to engage in solving real-world challenges. Industry-academia participation has grown in recent years due to the need for skilled engineers with practical training and specialized expertise. However, from the educational perspective, many activities are needed to incorporate sustainable development goals into the university curricula and consolidate learning innovation in universities.

• Reveal a gap in existing research or oppose an existing assumption
• Formulate the research question

Example: There have been plausible efforts to integrate educational activities in higher education electronics engineering programs. However, very few studies have considered using educational research methods for performance evaluation of competency-based higher engineering education, with a focus on technical and or transversal skills. To remedy the current need for evaluating competencies in STEM fields and providing sustainable development goals in engineering education, in this study, a comparison was drawn between study groups without and with industry partners.

• State the purpose of your study
• Highlight the key characteristics of your study
• Describe important results
• Highlight the novelty of the study.
• Offer a brief overview of the structure of the paper.

Example: The study evaluates the main competency needed in the applied electronics course, which is a fundamental core subject for many electronics engineering undergraduate programs. We compared two groups, without and with an industrial partner, that offered real-world projects to solve during the semester. This comparison can help determine significant differences in both groups in terms of developing subject competency and achieving sustainable development goals.

Write a Research Paper Introduction in Minutes with Paperpal

Paperpal Copilot is a generative AI-powered academic writing assistant. It’s trained on millions of published scholarly articles and over 20 years of STM experience. Paperpal Copilot helps authors write better and faster with:

• Real-time writing suggestions
• In-depth checks for language and grammar correction
• Paraphrasing to add variety, ensure academic tone, and trim text to meet journal limits

With Paperpal Copilot, create a research paper introduction effortlessly. In this step-by-step guide, we’ll walk you through how Paperpal transforms your initial ideas into a polished and publication-ready introduction.

How to use Paperpal to write the Introduction section

Step 1: Sign up on Paperpal and click on the Copilot feature, under this choose Outlines > Research Article > Introduction

Step 2: Add your unstructured notes or initial draft, whether in English or another language, to Paperpal, which is to be used as the base for your content.

Step 3: Fill in the specifics, such as your field of study, brief description or details you want to include, which will help the AI generate the outline for your Introduction.

Step 4: Use this outline and sentence suggestions to develop your content, adding citations where needed and modifying it to align with your specific research focus.

Step 5: Turn to Paperpal’s granular language checks to refine your content, tailor it to reflect your personal writing style, and ensure it effectively conveys your message.

You can use the same process to develop each section of your article, and finally your research paper in half the time and without any of the stress.

The purpose of the research paper introduction is to introduce the reader to the problem definition, justify the need for the study, and describe the main theme of the study. The aim is to gain the reader’s attention by providing them with necessary background information and establishing the main purpose and direction of the research.

The length of the research paper introduction can vary across journals and disciplines. While there are no strict word limits for writing the research paper introduction, an ideal length would be one page, with a maximum of 400 words over 1-4 paragraphs. Generally, it is one of the shorter sections of the paper as the reader is assumed to have at least a reasonable knowledge about the topic. 2 For example, for a study evaluating the role of building design in ensuring fire safety, there is no need to discuss definitions and nature of fire in the introduction; you could start by commenting upon the existing practices for fire safety and how your study will add to the existing knowledge and practice.

When deciding what to include in the research paper introduction, the rest of the paper should also be considered. The aim is to introduce the reader smoothly to the topic and facilitate an easy read without much dependency on external sources. 3 Below is a list of elements you can include to prepare a research paper introduction outline and follow it when you are writing the research paper introduction. Topic introduction: This can include key definitions and a brief history of the topic. Research context and background: Offer the readers some general information and then narrow it down to specific aspects. Details of the research you conducted: A brief literature review can be included to support your arguments or line of thought. Rationale for the study: This establishes the relevance of your study and establishes its importance. Importance of your research: The main contributions are highlighted to help establish the novelty of your study Research hypothesis: Introduce your research question and propose an expected outcome. Organization of the paper: Include a short paragraph of 3-4 sentences that highlights your plan for the entire paper

Cite only works that are most relevant to your topic; as a general rule, you can include one to three. Note that readers want to see evidence of original thinking. So it is better to avoid using too many references as it does not leave much room for your personal standpoint to shine through. Citations in your research paper introduction support the key points, and the number of citations depend on the subject matter and the point discussed. If the research paper introduction is too long or overflowing with citations, it is better to cite a few review articles rather than the individual articles summarized in the review. A good point to remember when citing research papers in the introduction section is to include at least one-third of the references in the introduction.

The literature review plays a significant role in the research paper introduction section. A good literature review accomplishes the following: Introduces the topic – Establishes the study’s significance – Provides an overview of the relevant literature – Provides context for the study using literature – Identifies knowledge gaps However, remember to avoid making the following mistakes when writing a research paper introduction: Do not use studies from the literature review to aggressively support your research Avoid direct quoting Do not allow literature review to be the focus of this section. Instead, the literature review should only aid in setting a foundation for the manuscript.

Remember the following key points for writing a good research paper introduction: 4

• Avoid stuffing too much general information: Avoid including what an average reader would know and include only that information related to the problem being addressed in the research paper introduction. For example, when describing a comparative study of non-traditional methods for mechanical design optimization, information related to the traditional methods and differences between traditional and non-traditional methods would not be relevant. In this case, the introduction for the research paper should begin with the state-of-the-art non-traditional methods and methods to evaluate the efficiency of newly developed algorithms.
• Avoid packing too many references: Cite only the required works in your research paper introduction. The other works can be included in the discussion section to strengthen your findings.
• Avoid extensive criticism of previous studies: Avoid being overly critical of earlier studies while setting the rationale for your study. A better place for this would be the Discussion section, where you can highlight the advantages of your method.
• Avoid describing conclusions of the study: When writing a research paper introduction remember not to include the findings of your study. The aim is to let the readers know what question is being answered. The actual answer should only be given in the Results and Discussion section.

To summarize, the research paper introduction section should be brief yet informative. It should convince the reader the need to conduct the study and motivate him to read further. If you’re feeling stuck or unsure, choose trusted AI academic writing assistants like Paperpal to effortlessly craft your research paper introduction and other sections of your research article.

1. Jawaid, S. A., & Jawaid, M. (2019). How to write introduction and discussion. Saudi Journal of Anaesthesia, 13(Suppl 1), S18.

2. Dewan, P., & Gupta, P. (2016). Writing the title, abstract and introduction: Looks matter!. Indian pediatrics, 53, 235-241.

3. Cetin, S., & Hackam, D. J. (2005). An approach to the writing of a scientific Manuscript1. Journal of Surgical Research, 128(2), 165-167.

4. Bavdekar, S. B. (2015). Writing introduction: Laying the foundations of a research paper. Journal of the Association of Physicians of India, 63(7), 44-6.

Paperpal is a comprehensive AI writing toolkit that helps students and researchers achieve 2x the writing in half the time. It leverages 21+ years of STM experience and insights from millions of research articles to provide in-depth academic writing, language editing, and submission readiness support to help you write better, faster.  

Get accurate academic translations, rewriting support, grammar checks, vocabulary suggestions, and generative AI assistance that delivers human precision at machine speed. Try for free or upgrade to Paperpal Prime starting at US$19 a month to access premium features, including consistency, plagiarism, and 30+ submission readiness checks to help you succeed.  

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• Scientific Writing Style Guides Explained
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• Ethical Research Practices For Research with Human Subjects
• 8 Most Effective Ways to Increase Motivation for Thesis Writing 

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Basics of Writing a Research Paper on a Disease

Writing a research paper on a disease can look like an overwhelming task at the outset, but when you have a general topic it makes it a little easier to start out. There are so many different kinds of diseases and it’s such a well-researched topic that it should be a relatively simple set of tasks compared to other kinds of research papers.

Find a Topic

You already have the first struggle done: finding your umbrella topic, which in this case is diseases. Now you just have to narrow it down. There are several ways to do this.

• Consider your experience. Have you ever known anyone with a particular kind of disease? Has there been something in the news recently about an outbreak or epidemic? Do you yourself have any kind of disease?
• Chances are you are connected to someone with a disease in some way. Draw from your own experience to zero in on a topic.
• Ask a medical professional what diseases he or she most frequently comes across. This may be your best bet as far as finding information if it is widely known.

Researching

A simple internet search will get you far, but there are other ways to find information too.

• Take advantage of whatever resources are available in your school’s library. Most times, a school or university’s library will have access to journals and information databases that contain vast quantities of academic and research publications. Ask your librarian what sort of resources are available to you in this thread.
• It might be old school, but look through paper versions of publications too. Oftentimes there is information present in physical books that never get scanned and entered into an online database or published online. Look in your school’s library for this too, as well as looking at your local discount book store.
• Again, if you know people in the medical field, ask them for references as to how to find information. Most of them have to renew their license or do tests once every few years, so it is likely they would know where to find study information, text books, or information on new research. These people are valuable resources to you.

Once you’ve selected a topic and researched it thoroughly, treat your research paper on disease like any other paper. Do a thorough outline to organize your paper, write your paper with references and a reference page, and conclude strong. Once you’ve written it, read it aloud and have a friend read it, too, so you know what to revise.

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Top 100 Disease Research Topics For Paper Writing

Students have many disease research topics to consider when writing research papers and essays. A disease occurs when the body undergoes some changes. Science philosophy has pointed at pathogens and the causes of illness. Today, medicine focus on biochemical factors, nutrition, immunology levels, and environmental toxins as the causes of diseases. Research papers on disease topics can focus on specific illnesses independently or in groups. You can also write about infectious diseases like COVID-19 and HIV or non-communicable diseases. Non-communicable diseases are also known as chronic illnesses. These are diseases that you can’t get from a sick person. They include heart disease, cancer, stroke, and lung disease. These diseases account for up to 70% of global deaths. Nevertheless, whether you opt to write about advanced topics in Lyme disease or something simple like flu, research will be paramount. You  can also buy research papers cheap, if you don’t have time for it. So, d on’t put your grade at risk and get research paper online help .  

Why Choose Our Disease Research Topics?

Educators want you to convince them that you have taken the time to think about your topic and research it extensively. What’s more, your research should make a meaningful contribution to your study field. Therefore, select a good topic and research it extensively before you start writing. Analyze your information to determine what will make it to your research paper. Here is a list of 100 disease research paper topics worth considering for your paper or essay.

Top Disease Research Topics

Maybe you want to research and write a research paper on a topic that anybody will find interesting to read. In that case, consider ideas in this list of disease research topics.

• How NSAIDS lead to peptic ulcers
• What are pandemic diseases?
• What is the role of pandemic diseases in the mankind history?
• What are the symptoms of acute lung disease?
• Explain how Attention Deficit Hyperactivity Disorder affects children
• Discuss the AIDS pandemic in third world countries
• Describe the main causes of AIDS
• Explain how AIDS affects children
• Discuss the treatment of AIDS
• Is alcohol addiction a disease?
• Discuss the Alzheimer’s disease scope and how it affects the elderly persons’ brain
• How can you help dementia or Alzheimer’s disease patients and caregivers?
• What are the symptoms of Alzheimer’s disease?
• What is autoimmune disease?
• Explain how autoimmune thyroiditis begins
• Examine acute protective membrane inflammation in bacterial meningitis
• Compare pathology of AIDS and black death
• Discuss the effects of cancer in today’s society
• Autism and its causes
• Different types of cancer and their prevalence

These are topics disease experts will recommend researching and writing about. And because students can write about these topics without getting complex, anybody will find them interesting. If you’re searching for research topics on Alzheimer’s disease, this list also has some ideas for you to consider.

Infectious Disease Topics for Research Papers

Are you interested in infectious disease research topics? If yes, you will find this list interesting. This category comprises hot topics in infectious disease fields. Consider some of these ideas for your research paper.

• The virology, epidemiology, and prevention of COVID-19
• The diagnosis of COVID-19
• Prevention vaccines for SARS-CoV-2 infection
• Questions people ask about COVID-19
• Clinical features of COVID-19
• COVID-19 management in a hospital setting
• Infection control for COVID-19 in homes and healthcare settings
• Skin abscess and cellulitis in adults
• Clinical manifestation, diagnosis, and epidemiology of yellow fever
• Transmission and epidemiology of measles
• Role of untreated inflammation of genital tract in HIV transmission
• Racial inequities of COVID-19 and HIV in black communities
• Community-acquired pneumonia overview in adults
• The use of procalcitonin in the infections of lower respiratory tract
• Herpes simplex virus prevention and treatment
• Uncomplicated Neisseria gonorrhea treatment
• Society guidelines for COVID-19
• Why public education is crucial in fighting COVID-19
• Overview of Ebola over the last two decades
• Investigations into the use of monoclonal antibody in treating Ebola

This category also has some of the best infectious disease presentation topics. Nevertheless, learners should prepare to research extensively before writing academic papers on these topics.

Interesting Disease Topics

Maybe you want to research and write a research paper on a topic that most people find interesting. In that case, consider these disease topics for research paper.

• Discuss bulimia as a common eating disorder
• Why are so many young people suffering from anorexia?
• What causes most eating disorders
• How serious are sleep disorders
• Discuss rabies treatment- The Milwaukee protocol
• Is assisted suicide a way to treat terminal diseases?
• What are the effects of brain injuries?
• What are professional diseases?
• Is autism a norm variant or a disease?
• The history of pandemics and epidemics
• The role of antibiotics in treating diseases
• What causes insomnia?
• What are the effects of insomnia?
• How to cope with insomnia
• Can sleeping pills cure insomnia?
• Explain what causes long-term insomnia
• Using traditional medicine to fight insomnia
• How to deal with bulimia and nervosa
• How eating disorders affect self-harm behavior
• How feminism affect anorexic women phenomenon

This is a list of easy disease topics for papers. What’s more, most people will find these research paper disease topics interesting to read about. Nevertheless, students should take time to research their preferred topics to come up with brilliant papers on any of these human disease research paper topics.

Cardiovascular Disease Research Topics

Maybe you’re interested in topic ideas on heart disease. Perhaps, you want to write about an illness of the respiratory system. In that case, consider these heart disease research topics.

• An investigation of hypertrophic cardiomyopathy
• A research of the causes of coronary artery disease
• Antithrombotic therapy in surgical valve and prosthetic heart valve repair
• Intervention choice for severe cases of calcific aortic stenosis
• Prognosis and treatment of heart failure using preserved fraction of injection
• Infective endocarditis management in adults
• Risk assessment for cardiovascular disease for primary prevention
• Prognosis and treatment of acute pericarditis
• Treatment of reflex syncope in adolescents and adults
• Anticoagulant therapy for preventing thromboembolism in atrial fibrillation
• Cardiac manifestations of COVID-19 in adults
• Acute decompensated heart failure treatment
• What is hypertriglyceridemia?
• How to manage elevated low-density lipoprotein-cholesterol in cardiovascular disease
• Management and evaluation of cardiac disease
• Conduction system and arrhythmias disease and COVID-19
• Myocardial infarction in COVID-19
• Can somebody inherit a cardiac disease?
• How effective are treatments for irregular heartbeat?
• How to determine the risk for a sudden cardiac death

This list comprises some of the best special disease topics. That’s because most people reading about these topics might not have heard about them before. Nevertheless, this category also has interesting research topics for disease control that may help individuals that want to avoid or manage some illnesses.

Research Topics for Chronic Disease

You probably know somebody living with a chronic illness. Unlike controversial topics in infectious disease, people don’t talk much about chronic illnesses. And for this reason, some people don’t know about these illnesses. When writing about non-communicable illnesses, you can settle for human genetic disease topics or even research topics for sickle cell disease. Here are some of the topics about non-communicable diseases that you can write about.

• The risk of breast cancer after childbirth
• Postpartum PTSD- Effective preventative measures
• Experiences of females suffering from cardiac disease during pregnancy- A systematic review
• Husbands attendance and knowledge of wives’ postpartum care in rural areas
• Postpartum depression screening by perinatal nurses in hospitals
• Gestational diabetes mellitus screening from the rural perspective
• Maternal mortality- How to help cardiac and pregnant patients
• Sex differences in cardio metabolic disorders and major depression- Effect of immune exposures and prenatal stress
• Determinants and prevalence of anxiety and antepartum depressive symptoms in fathers and expectant mothers- Outcomes from perinatal psychiatric morbidity
• Evaluating the effect of community health workers on non-communicable diseases, tuberculosis, malnutrition, antenatal care, and family planning
• History of women with postpartum affective disorder and the risk of future pregnancies recurrence
• New self-care guide package and its effect on neonatal and maternal results in gestational diabetes
• Depressive symptoms and life events in pregnant women- Moderating the resilience role and social support
• Gestational diabetes and ethnic disparities
• Pregnancy and diabetes- Opportunities and risks
• Cardiovascular disease maternal death reduction- A pragmatic investigation
• Meta-analysis and systematic review of gestational diabetes mellitus diagnosis with a two-step or one-step associations and approaches with negative pregnancy outcomes
• Gestational diabetes mellitus treatment in women- A Cochrane systematic overview
• Research in non-communicable diseases in Africa- A strategic investment
• How to finance the national response to non-communicable diseases

Whether you opt to write about research paper topics in Huntington’s disease or non-communicable liver disease topics, you have to engage in extensive research to come up with a brilliant paper. We have more health research topics for you, so don’t hesitate to check them. Therefore, select an idea you will be comfortable researching and writing about. That way, you will avoid enduring a boring process of investing your topic and writing the paper. If you want to hire someone to help you with your assignment, just c ontact us with a “ do my research paper now ” request and we’ll get your papers done. 

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An Easy Way to Write Essays on Diseases

On the one hand, writing essays on diseases seems to be not that tricky. You have an opportunity to be original and even creative. Can you imagine the number of diseases that you can highlight in your disease essay? What is more, there is a lot of material available almost about every disease.

On the other hand, this great variety of ideas may confuse you. What particular disease should you choose to present in the disease essay (unless specified, of course)?

Well, there is just one thing we can advise you. Think of the disease that you are interested in most of all. Does someone you know suffer from Alzheimer’s disease? Do you have a neighbor who suffers from some kind of exotic disease? Choose whatever you want to learn more about.

Fine, you will pick a good idea for your essay on disease. What is next? Next, you need to think of how to disclose your topic. We can offer a simple plan that will help you create an informative essay on diseases.

Start with a brief overview of the chosen disease. Explain why you have selected this particular disease.

Tell about the causes of the disease, people who are more likely to have it, the main disease carriers, etc.

Describe the main symptoms of the disease in your essay. Here you can also tell about the major effects that the disease has on the human organism.

Finally, describe in your essay on disease the ways of preventing and treating it. Certainly, if you want to amaze your tutor with the essay on disease, this part of the paper should be based on the most up-to-date facts.

If you need more ideas for your essay on disease, make use of the following links: essays on alcoholism and an essay on HIV/AIDS .

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Prediction Models and Clinical Outcomes—A Call for Papers

• 1 Department of Medicine, University of Washington, Seattle
• 2 Deputy Editor, JAMA Network Open
• 3 Epidemiology, Rutgers The State University of New Jersey, New Brunswick
• 4 Statistical Editor, JAMA Network Open
• 5 Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
• 6 Editor, JAMA Network Open

The need to classify disease and predict outcomes is as old as medicine itself. Nearly 50 years ago, the advantage of applying multivariable statistics to these problems became evident. 1 Since then, the increasing availability of databases containing often-complex clinical information from tens or even hundreds of millions of patients, combined with powerful statistical techniques and computing environments, has spawned exponential growth in efforts to create more useful, focused, and accurate prediction models. JAMA Network Open receives dozens of manuscripts weekly that present new or purportedly improved instruments intended to predict a vast array of clinical outcomes. Although we are able to accept only a small fraction of those submitted, we have, nonetheless, published nearly 2000 articles dealing with predictive models over the past 6 years.

The profusion of predictive models has been accompanied by the growing recognition of the necessity for standards to help ensure accuracy of these models. An important milestone was the publication of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis ( TRIPOD ) guidelines nearly a decade ago. 2 TRIPOD is a reporting guideline intended to enable readers to better understand the methods used in published studies but does not prescribe what actual methods should be applied. Since then, while the field has continued to advance and technology improve, many predictive models in widespread use, when critically evaluated, have been found to neither adhere to reporting standards nor perform as well as expected. 3 , 4

There are numerous reasons why performance of models falls short, even when efforts are made to adhere to methodologic standards. Despite the vast amounts of data that are often brought to bear, they may not be appropriate to the task, or they may have been collected and analyzed in ways that are biased. Additionally, that some models fall short may simply reflect the inherent difficulty of predicting relatively uncommon events that occur as a result of complex biological processes occurring within complex clinical environments. Moreover, clinical settings are highly variable, and predictive models typically perform worse outside of the environments in which they were developed. A comprehensive discussion of these issues is beyond the scope of this article, but as physicist Neils Bohr once remarked, “it is very difficult to predict—especially the future.” 5

Although problems with accuracy are well documented, hundreds of predictive models are in regular use in clinical practice and are frequently the basis for critically important decisions. Many such models have been widely adopted without subsequent efforts to confirm that they actually continue to perform as expected. That is not to say that such models are without utility, because even a suboptimal model may perform better than an unaided clinician. Nevertheless, we believe that a fresh examination of selected, well-established predictive models is warranted if not previously done. JAMA Network Open has published articles addressing prediction of relatively common clinical complications, such as recurrent gastrointestinal bleeding. 6 We think there remains considerable opportunity for research in this vein. In particular, we seek studies that examine current performance of commonly applied clinical prediction rules. We are particularly interested in studies using data from a variety of settings and databases as well as studies that simultaneously assess multiple models addressing the same or similar outcomes.

We also remain interested in the derivation of new models that address a clear clinical need. They should utilize data that are commonly collected as part of routine care, or in principle can be readily extracted from electronic health records. We generally require that prediction models be validated with at least 1 other dataset distinct from the development dataset. In practice, this means data from different health systems or different publicly available or commercial datasets. We note that internal validation techniques, such as split samples, hold-out, k -fold, and others, are not designed to overcome the intrinsic differences between data sources and, therefore, are not suited to quantifying performance externally. While the population to which the models apply should be described explicitly, ideally any such models should be applicable to patients from the wide range of races, ethnicities, and backgrounds commonly encountered in clinic practice. Most importantly, we are interested in examples of models that have been evaluated in clinical settings, assessing their feasibility and potential clinical benefit. This includes studies with negative as well as positive outcomes.

Please see the journal’s Instructions for Authors for information on manuscript preparation and submission. 7 This is not a time-limited call for studies on this topic.

Published: April 12, 2024. doi:10.1001/jamanetworkopen.2024.9640

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Fihn SD et al. JAMA Network Open .

Corresponding Author: Stephan D. Fihn, MD, MPH, Department of Medicine, University of Washington, 325 Ninth Ave, Box 359780, Seattle, WA 98104 ( [email protected] ).

Conflict of Interest Disclosures: Dr Berlin reported receiving consulting fees from Kenvue related to acetaminophen outside the submitted work. No other disclosures were reported.

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Fihn SD , Berlin JA , Haneuse SJPA , Rivara FP. Prediction Models and Clinical Outcomes—A Call for Papers. JAMA Netw Open. 2024;7(4):e249640. doi:10.1001/jamanetworkopen.2024.9640

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Disease Research Paper

View sample disease research paper. Browse research paper examples for more inspiration. If you need a health research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Disease is a phenomenon that appears to have struck people globally at all times. However, the conceptions of what disease is have varied with time and place. This research paper gives an overview over various conceptions of disease and highlights what is at stake in the debates on the concept of disease. The core questions for the article are: what is disease and what are the ethical issues entangled in this question?

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Disease is a phenomenon experienced by most people during their lifetime, and it is something most people fear. Disease is a core concept in the health sciences, in philosophy, and in bioethics, but it is difficult to define. Broadly speaking there are three types of definitions of disease: descriptivist, normativity, and hybrid definitions of disease, claiming that disease is given by phenomena described in nature, by human norms, or both nature and human norms, respectively.

The concept of disease is ethically important as it sets standards and limits, e.g., to what a health-care system is supposed to do and who deserves access to certain goods. It also influences people’s self-conception, their relations to others, their social roles, and their social status. Disease also raises a series of ethical issues, especially related to overdiagnosis and underdiagnosis, undertreatment and overtreatment, medicalization, and just distribution of healthcare resources. This makes disease an important concept with far-reaching implications for individuals, health professionals, health insurers, health policy makers, bioethicists, and politicians.

History And Development

From the interest of understanding and helping people, a wide range of theories and conceptions of disease have emerged. Such theories have altered with time and place. Table 1 gives a brief outline of some theories of disease.

This eagerness to understand disease can make us wonder, why is it so important to understand what disease is? Why is the concept of disease needed? There appear to be many reasons why the concept of disease is important:

• Disease implies a right to attention and care, as disease is related to suffering.
• Disease (in many countries) implies a right to treatment and is thus of great importance to individuals, health professionals, health-care institutions, health insurers, and health policy makers.
• Disease (in many countries) implies exemptions from duties, such as the duty to work or to take care of others (e.g., relatives or friends).
• Disease (in many countries) implies a right to economic compensation (e.g., during sick leave) and therefore is important to individuals, employers, insurers, and health policy makers.
• Disease may exempt from accountability and moral responsibility (in cases of crime).
• Disease is important for individuals to understand their own situation: “I cannot do or be as I would like, because I am diseased.”
• Disease is important for individuals to explain  situation to themselves and others.
• Disease has been important to delimit the tasks of health care from other social tasks and topics.
• Disease has been important to classify and organize the tasks of health care, e.g., in taxonomies and hospital departments.
• Disease has been important to delineate the subject matter of health-related sciences.

Table 1 . Brief overview of some influential theories of disease throughout the history of medicine

Hence, disease is an important concept with far-reaching implications for individuals, health professionals, health insurers, health policy makers, bioethicists, and politicians. It sets standards, e.g., for how health professionals are educated and how health insurance is regulated, and it sets limits, e.g., who deserves access to certain goods. It also influences people’s self-conception, their relations to others, their social roles, and their social status (see below).

Conceptual Clarification/Definition

There have been many definitions of disease, all trying to highlight or clarify the various important aspects of disease given in the list above (Reznek 1987; Humber and Almeder 1997; Caplan et al. 1981; Cooper 2002; Murphy 2008; Ereshefsky 2009). At present, there is little agreement on how to define disease. The various definitions can be classified in descriptivist, normativist, and hybrid definitions.

Descriptivist positions define disease in terms of biological or mental phenomena which can be described in nature (Davies 2003). Hence, such definitions are often also called naturalist definitions. According to the most referred descriptivist definition, disease is an internal condition disturbing natural functioning. Hence, if a bodily or mental function is reduced below what is statistically normal, then there is disease. This definition is oftentimes called “the biostatistical theory of disease,” and it takes into account differences due to gender, age, and species, so that functional differences in such factors do not become diseases (Boorse 1975). That is, a person is not diseased although the person’s heart has reduced functioning at the age of 100 years old compared to the total population. Diseases are kinds that occur in nature, i.e., natural kinds, and they can be classified on the basis of characteristics that can be described in nature.

According to normativist definitions, disease is a social convention. Disease is the judgment that someone is harmed in a way that (is decided that) can be explained in terms of bodily or mental conditions or processes. Hence, human norms of harm decide what disease is and not biological or mental phenomena, therefore the name normativist. Accordingly, diseases are not natural kinds, although they may be classified according to phenomena which are considered to occur in nature. The reason is that the phenomena that is studied and classified in nature are so classified because they serve human interests, e.g., helping people. The electrical signals in the heart (measured by ECG) are of relevance for medicine because professionals think that they relate to something harmful that can be avoided. When the troponin level in the blood appears to be better in order to characterize, treat, or prevent disease, e.g., myocardial infarction, professionals (and subsequently laypersons) will pay attention to troponin. Correspondingly, it is because blood pressure is related to something harmful that hypertension is of interest in medicine. According to a normativist conception of disease, the phenomena that are measured and manipulated in medicine are relevant to medicine due to human interests (to understand and to help).

Table 2 . Three levels apparent in reflections on disease

Hybrid definitions of disease can be placed between descriptivist and normativist definitions of disease, as they combine elements from both. For example, disease has been defined as harmful dysfunction, where dysfunction is a description of phenomena in nature, while the issue whether it is harmful is a value judgment. Only those deviations from normal functioning that are harmful can be termed disease (Wakefield 1992).

The debates on the concept of disease are sometimes complex and confusing. One reason for this can be that it is not always clear what is discussed, e.g., because the three levels described in Table 2 are confused.

There are also a wide range of terms related to disease, which sometimes are used synonymously, such as malady, illness, sickness, injury, wound, lesion, defect, deformity, disorder, disability, impairment, deficit, etc. (Culver and Gert 1982). This research paper will not address all these terms but will try to clarify the relationship between some of them below, i.e., disease, illness, and sickness.

The Ethical Dimension Of Disease

Inherent in the debates on the concept of disease, there are a series of ethical issues, such as disease’s inherent imperative to help, over diagnosis, overtreatment, medicalization, and justice. These will be briefly discussed in the following.

The Imperative To Help

The most obvious ethical aspect of disease is the imperative to help persons who suffer from disease. The term disease indicates that there is something that may be eased. Hence, disease calls us to help persons who are diseased in the best possible manner, either from duty (deontology), in order to maximize the total well-being (consequentialism); from the character of the professional (virtue ethics); or from the calling in the sufferer’s face (proximity ethics).

Who Decides What Disease Is?

In clinical practice as well in public debates, there are controversies on whether specific conditions count as disease. Previously, drapetomania (slaves running away), homosexuality, and dissidence have been counted as disease. Today it is discussed whether obesity, sorrow, baldness, freckles, and caffeine-induced insomnia count as disease. Specific interest groups may argue that something is a disease, while professionals may be hesitant, or conversely professionals may measure certain biological conditions that are not experienced by persons at all (and may be never will). Correspondingly, society may consider something to be a disease, while persons and professionals disagree. Attention deficit hyperactivity disorder (ADHD) may be but one example. Hence, who decides? This is a moral question that relates to the debate between descriptivists and normativists.

Descriptivists tend to claim that nature decides. It is given by nature whether something is a disease or not, i.e., by abnormal functioning of some organ or process. But where to set the limits between normal and pathological? Does nature tell us the limit of glycated hemoglobin (A1C) in the blood for having diabetes type 1? Although hard core descriptivists claim that nature does, critiques argue that such limits are defined from human interests of trying to help people in the best possible manner. If they are right, there are normative aspects at the core of the descriptivists’ conception of disease. Normativists on the other hand are clear that disease is based on human interests and values. However, it is not clear how values and interests are to be balanced. Is it the patients’, the professionals’, relatives, or society’s values and interests that will decide what disease is?

In order to try to clarify some of the conceptual and normative issues, it has been suggested to differentiate between various perspectives of disease, as indicated in Table 3.

Table 3 . Characteristics of three perspectives of human ailment: disease, illness, and sickness

The three perspectives can explain some of the conceptual controversies, as it may be difficult to cover all perspectives of human ailment by one concept. Moreover, the perspectives may also clarify some of the normative issues in terms of conflict of interest between persons, professionals, and society (Hofmann 2002). Impotence (at the age of 70) may not be considered to be a disease from a medical perspective or a sickness from a social perspective, but it definitely may be perceived to be an illness, i.e., it is illness, but not disease and sickness. If all perspectives cohere, there is little controversy. If the perspectives diverge, there may be conceptual and ethical challenges.

Figure 1 indicates the relationship between the concepts of illness, sickness, and disease. Other perspectives, such as existential and risk-related perspectives, may be added.

Figure 1 . The relationship between the concepts of illness, sickness, and disease

As can be seen from vast and vivid debates on specific diseases, such as obesity, ADHD, and myalgic encephalomyelitis, there is no general agreement on whose perspective is prevailing. While descriptivist definitions of disease will favor the professional perspective, normativist definitions will have a higher affinity to social perspectives. Several positions in bioethics will favor the personal perspective on human ailment, i.e., illness (Toombs 1990; Carel 2008).

Underdiagnosis And Overdiagnosis, Undertreatment And Overtreatment

The concept of disease delimits diseased from non-diseased, and where this limit is set is of ethical significance. If the limit is set so that suffering persons who could have been helped are excluded, this is morally wrong. They are underdiagnosed, may be undertreated, and may experience unnecessary uncertainty, anxiety, pain, and death. Conversely, if the limits are too low, it is morally wrong as well. Then healthy persons are diagnosed as having a disease. They may become anxious from being diagnosed and they may be treated unnecessarily and have side effects from unnecessary treatment. While underdiagnosed persons oftentimes gain attention in the media (“could have been saved”), over diagnosed persons get little attention. They do not know that they are over diagnosed but are actually happy that “they found something and saved my life.” Ductal carcinoma in situ (DCIS) may be one example, as it can result in invasive breast cancers, but it does not always do so. When found, DCIS are oftentimes treated as breast cancer, although one does not know whether they would actually have caused symptoms, suffering, or death.

Making Risk A Disease

Another ethical issue related to the concept of disease is the predictive aspirations in modern medicine. A wide range of tests are able to predict diseases. The ethical drive for this is to detect disease before it becomes noticeable and, by prevention or early treatment, to avoid disease or diminish its consequences. However, very few tests are perfect. The outcomes of tests are uncertain and so are the outcomes of subsequent treatment. Hence, the test provides a risk, or a range of risks, for a certain disease. For example, 55–65 % of women who inherit a BRCA1 mutation will develop breast cancer by age 70 years, while about 12 % of women in the general population will develop breast cancer sometime during their lives. Hence, testing positive for the BRCA1 mutation significantly increases the risk of breast cancer but does not mean that the person will have breast cancer. It is a risk estimate. Such risk estimates do not only give people important opportunities to save their lives and reduce suffering; it also gives them difficult choices, as it is uncertain whether they will become diseased, e.g., should a woman prophylactically remove her breasts? Hence, handling risk factors as disease poses ethical challenges to health policy makers, health professionals, and, last but not least, to individual persons. This also connects to ethical challenges with the right to know and the right not to know. The issue of making risk a disease relates to another ethical issue in modern medicine: medicalization.

Medicalization

It has been widely argued that the conception of disease has become too wide and inclusive, e.g., that it has come to include conditions that are considered to be part of ordinary life, such as sorrow (Horwitz and Wakefield 2007), stress, unhappiness, and various kinds of social behavior. It may be ethically challenging when the conceptions of disease make ordinary life conditions or behaviors subject to medical attention. Hence, the critique of medicalization is closely connected to the (unreflective) expansion of the concept of disease.

Disease As An Existential Threat

As disease traditionally has been life threatening and because most people die from a disease, disease is an existential issue. Hence, getting the message of having a disease may be disturbing and challenging, meriting attention and care, beyond handling the disease. Moreover, some diseases have symbolic attributes. Cancer has been considered to be a death sentence and has been a stigma. While the existential aspects of disease have been were at the core in the hospital tradition and still are in many parts of the world, they have gained less attention in modern Western medicine.

Social Prestige And Stigma

Disease is normally considered to be something negative. However, it may also have some positive aspects, such as increased attention, right to treatment, economic compensation, and freedom from duties (work), as pointed out before. Specific disease labels may give identity and strong relations between persons with the same disease. Conversely, not being labeled diseased may make people feel deserted, in despair, and guilty. Hence, disease labeling may influence people’s self-conception and self-esteem.

Moreover, professionals appear to have a relatively stable prestige hierarchy for disease entities (Album and Westin 2008). Organ specific diseases have higher prestige than vague diseases. Diseases related to organs placed in the upper part of the body, such as brain and heart, have higher prestige than those related to organs in lower body parts. Acute diseases prevail over chronic diseases. Hi-tech diseases trump low-tech or no-tech diseases. Such prestige hierarchies of disease tend also to be present in laypeople and patients as well. When disease hierarchies influence how patients are handled or how resources are allocated or prioritized, it becomes ethically challenging.

Conceptions of disease also raise ethical concerns beyond prestige hierarchies. The 90–10 gap is ethically relevant, as 90 % of research resources go to diseases relevant for 10 % of the global population. Correspondingly, it may also be argued that the disease concepts used in the economically richer part of the world is of little relevance to the poorer part of the world. It appears to be ethically important to increase the attention to disease entities that prevail in poorer populations, as well as avoiding a general disease concept that is biased toward affluent populations.

Disease is a phenomenon experienced by most people during life. It is something most people fear, and it is a core concept in the health sciences, in philosophy, and in bioethics. Descriptivists tend to define disease as the malfunctioning of some organ or process and argue that diseases are natural kinds. Normativists, on the other hand, argue that disease is not discovered in nature but is the judgment that someone is harmed in a way that can be explained in terms of bodily or mental conditions or processes. Hybrid conceptions of disease claim that disease is both descriptive and normative, e.g., as harmful dysfunction.

The concept of disease sets standards and limits, e.g., to what a health-care system is supposed to do and who deserves access to certain goods. It also influences people’s self-conception, their relations to others, their social roles, and their social status. Hence, disease is an important concept with far-reaching implications for individuals, health professionals, health insurers, health policy makers, bioethicists, and politicians. It also raises a series of ethical issues, especially related to over diagnosis and underdiagnoses, under treatment and overtreatment, medicalization, and just distribution of health-care resources.

Bibliography :

• Album, D., & Westin, S. (2008). Do diseases have a prestige hierarchy? A survey among physicians and medical students. Social Science and Medicine, 66(1), 182–188.
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• Ereshefsky, M. (2009). Defining ‘health’ and ‘disease’. Studies in History and Philosophy of Biological and Biomedical Sciences, 40(3), 221–227.
• Hofmann, B. (2002). On the triad disease, illness and sickness. Journal of Medicine and Philosophy, 27(6), 651–674.
• Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness. New York: Oxford University Press.
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New state of mind: rethinking how researchers understand brain activity.

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Understanding the link between brain activity and behavior is among the core interests of neuroscience. Having a better grasp of this relationship will both help scientists understand how the brain works on a basic level and uncover what specifically goes awry in cases of neurological and psychological disease.

One way that researchers study this connection is through what are known as “brain states,” patterns of neural activity or connectivity that emerge during specific cognitive tasks and are common enough in all individuals that they become predictable. Another, newer, approach is the study of brain waves, rhythmic, repetitive patterns of brain cell activity caused by synchronization across cells.

In a new paper, two Yale researchers propose that these two ways of thinking about brain activity may not represent separate events but two aspects of the same occurrence. Essentially, they suggest that though brain states are traditionally thought of as a snapshot of brain activity while waves are more like a movie, they’re capturing parts of the same story.

Reconsidering these two approaches in this context, the researchers say, could help both fields benefit from the methods and knowledge of the other and advance our understanding of the brain.

Inspired by ecological, conservation, and Indigenous philosophies, Maya Foster, a third-year Ph.D. student in the Department of Biomedical Engineering, began pursuing this idea once she joined the lab of Dustin Scheinost , an associate professor in the Department of Radiology and Biomedical Imaging at Yale School of Medicine.

They are co-authors of the new paper , published April 5 in the journal Trends in Cognitive Sciences.

“ We’re arguing that rather than a brain state being one single thing, it’s a collection of things, a collection of discrete patterns that emerge in time in a predictable way,” she said.

In an interview with Yale News, Foster and Scheinost describe their proposal, and discuss how they might help researchers better understand the mysteries of the brain. This interview has been edited and condensed.

When did you start to consider these might be two aspects of the same occurrence?

Maya Foster: This has been on my mind even before I came to this lab. I was reading a book — “Erosion: Essays of Undoing” by Terry Tempest Williams — and she talks about how human-made machinery like helicopters cause vibrations that interrupt the natural pulse of things and cause things like rock formations to fall apart. Relatedly, there are a lot of Indigenous populations that believe everything has a pulse. And that got me thinking of the brain and whether we have some type of resonance or vibration that can be disrupted.

Then I joined this lab and Dustin let me experiment with a lot of different things. During one of those experiments, I input some data into a particular analysis and the outputs looked wave-like, and patterns emerged and then repeated. That took me down a whole rabbit hole of research literature and there was a lot of evidence for this idea of wave-like patterns in brain states.

What are the benefits of considering brain states as wave-like?

Foster: I think it creates a synergy where both sides — the brain state folks and the brain wave folks — benefit by learning from each other. And maybe the gaps in knowledge we have now when it comes to how brain activity relates to behavior might be filled by both groups working together.

Dustin Scheinost: Brain waves are newer in this field and they’re complex. And any time you can take something new and relate it to something old — brain states in this case — it gives you a natural jumping off point. You can bring along everything you’ve learned so far. It’s kind of like not throwing the baby out with the bath water. We don’t need to drop brain states. They’ve informed us, but we can go in a different direction with them too.

How are you proposing researchers consider brain states and brain waves now?

Foster: Borrowing from physics, when you analyze light, it can be a discrete point — a photon — or it can be wave-like. And that’s one way we’re thinking about this. Similarly, depending on how you analyze brain states you can get static patterns, much like a photon, or you if you look at activity more dynamically, certain patterns start to occur more than once over time, kind of like a wave.

So we’re arguing that rather than a brain state being one single thing, it’s a collection of things, a collection of discrete patterns that emerge in time in a predictable way.

For example, if we measured four distinct patterns in brain activity as someone completed a cognitive task, a brain state could be that pattern one emerges, then pattern three, then two, then four, and that series might repeat over time. And when that repetition stops, that would be the end of that particular brain state.

You also draw comparisons to the musical technique known as “fugue.” How does that fit with how you’re visualizing these phenomena?

Foster: I’m a music person, so that’s where this came from. In a fugue, you have a basic melody and then that melody emerges later in the music in different forms and formats. For instance, the melody will play, then some other music comes in, then the melody returns with the same rhythm and time sequence but maybe it’s in a different key.

Fugues are cyclical and wave-like, they have distinct groups of notes, and there’s a systematic repetition and sometimes layering of the main melody. We’re arguing that brain states are also wave-like, have distinct patterns of brain activity, and display systematic repetition and layering of sequential patterns.

How are you hoping other researchers respond to your argument?

Foster: I would love feedback, honestly. There is evidence for what we’re proposing but when it comes to implementing these ideas going forward, it would be helpful to have a conversation about how that might work. There are a lot of different strategies and I’m interested in a broader conversation about how we as researchers might go about studying this.

What’s it like as someone who has been in this field for a while to have a student come in with a new idea like this?

Scheinost: You can get set in your ways as a researcher and you need new ideas, new creativity. Sometimes they may sound outlandish when you first hear them. But then you ruminate, and they start to take form. And it’s fun. That’s really where the fun of this job is, to hear new ideas and see how people discuss and debate them.

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A Research Paper on Alzheimer’s Disease

This research paper will delve into Alzheimer’s Disease, covering its causes, symptoms, progression, and current treatments. It will also explore ongoing research in finding a cure and ways to manage this debilitating condition. On PapersOwl, there’s also a selection of free essay templates associated with Alzheimers Disease.

How it works

In this paper, Alzheimer’s disease will be delved into, investigated and dissected. This will include all that is known about the disease as much of it is unknown still, despite increasing efforts from the medical community to uncover its origin. The disease’s causes, symptoms and stages will be discussed and illuminated. The effects on other body systems, its signs and symptoms and any other complications will be highlighted as well. Additionally, advancements in treating this disease are carefully examined.

In this paper, I will be giving an overview of Alzheimer’s disease. This will include its history, prognosis and treatment available and recent advancements made towards finding a cure. Alzheimer’s disease is a somewhat recently discovered phenomenon. It is a specific type of dementia, a disease that impairs a person’s cognitive functioning and behavioral abilities to the point that it interferes with that person’s daily life. The disease was discovered in 1906 by Dr. Alois Alzheimer who noted shrinkage around nerve cells in his patient’s brain who had also reported,” symptoms of memory loss, paranoia and psychological changes.”, according to the National Institute of Aging. After the patient passed, Dr. Alzheimer dissected her brain, finding strange clumps which we now know are amyloid plaques as well as tangled fibers now called neurofibrillary. Alzheimer’s disease is characterized by the symptoms of the aforementioned patient’s, however the disease is a very slowly progressing one, so most afflicted don’t know until the symptoms become obvious to those around them. “Alzheimer’s disease is the most frequent cause of irreversible dementia in adults. The intellectual impairment progresses gradually from forgetfulness to total impairment.” (Mace, Rabins 15) Symptoms usually appear in a person’s mid-60’s, however there are rare cases of early on-set Alzheimer’s where symptoms are exhibited in a person’s 30’s and 40’s. The disease usually progresses to the point that a person afflicted is unable to take care of themselves due to severe memory loss and loss of motor skills, requiring full time assistance. They may also experience forms of delusion such as hallucinations or paranoia that cause them to act impulsively in the moderate stage of dementia, according to the National Institute of Aging. Most diagnosed with this disease will reach this point sadly, as they usually have an average of eight years left to live after the diagnosis as there is no cure, only treatments. The difficulty in treating Alzheimer’s is highlighted by the fact that the first FDA approved drug to treat it wasn’t available until 1993, almost a full century after its discovery. As of today, there are a total of five FDA approved drugs for treating Alzheimer’s disease, none of which truly treat the disease but only prolong the symptoms that will eventually surface. “If we had a drug or other intervention that made people with Alzheimer’s disease even a little better, nevermind curing the disease, I’d sing its praises to the rooftops.[…] But there is not.” (Dedsen 4)

Alzheimer’s disease affects every body system in humans due to the fact that it destroys the brain. It atrophizes, or shrinks, the brain’s neurons and their networks die off, resulting in shrinking of various brain regions. There is no cure as of yet because there is no known way to reverse deterioration of these precious cells. Warning signs of the disease include symptoms of memory loss, severe enough that it affects job performance, difficulty with familiar tasks, issues with language, difficulty with keeping track of time or place, decreased judgment skills, severe mood changes and inability to recognize loved ones, especially in the late stages of the disease, according to the Alzheimer’s Association. Even a change of a person’s sense of humor can be a warning sign. Most individuals who reach the late stages of this disease will require full time assistance such as live in nurses.

On the bright side, specialists typically accurately diagnose Alzheimer’s at a rate of 95%. The only true way to confirm Alzheimer’s disease is through autopsy, however there are a multitude of tests specialists utilize to differentiate Alzheimer’s from other forms of dementia. These include genetic testing, magnetic resonance imaging, urinalysis, blood tests, electroencephalogram, spinal tap, computed tomography scan, chest X-ray and a mental status test, according to the Alzheimer’s Association. In contrast, the prognosis with treatment for those affected is currently bleak. There are few medications available to those with Alzheimer’s and none prevent or cure the disease. Average life expectancy is eight years after diagnosis, but it can range from one to twenty years for some, all according to the Alzheimer’s Association.

Currently, there are hundreds of studies being conducted on treating and preventing Alzheimer’s disease. Most medications being proposed are modifying therapies, meaning that they could alter how the disease progresses. others include cognitive enhancers for improving memory or attentiveness and lastly symptomatic agents which may lessen symptoms such as hallucinations. The focus areas of research currently being conducted are clinical and laboratory research. Clinical research at the Mayo Clinic Study of Aging focus on normal aging, mild cognitive impairment and dementia disorders. This process is used in the hopes of discovering patterns or signs that may help specialists discover risk of Alzheimer’s even sooner than previously possible. Laboratory research includes studying amyloid and tau proteins. Both of these proteins have strong associations with those at risk for Alzheimer’s and other forms of dementia. Amyloid proteins are being studied with both human and mouse models to determine any genetic factors that might predispose people to this disease. Additionally, tau proteins are being studied to ascertain the possibility of preventing the build up of this protein that causes neurons to malfunction and die, according to the Alzheimer’s Association. Currently, there is no prevention of the disease itself, only medication that may slow down the progress of the disease in certain individuals. There are tests available to help determine if you or a loved one may be at risk, but no prevention. Alzheimer’s is a devastating disease due to the fact that it’s largely out of our control. Later generations may see improvements in treating it or preventing it or ideally finding a cure. However, the fact that it’s been known for over a century and there has yet to be substantial slowing of the progress of the disease through medication, no available prevention and no cure whatsoever is depressing to say the least. It is “the only one of the nation’s leading 10 causes of death for which there is no effective treatment.” (Dedsen 4) However, having said this, there has been a greater push and call for urgency in discovering a cure for the disease. President Obama signed The National Plan to Address Alzheimer’s Disease into effect in January of 2011. This initiative gave greater funding for new research projects, better tools for clinicians, easier access to information to help caregivers and created an awareness campaign, according to the National Institute of Aging. There has even been news about its awareness efforts in pop culture thanks to Seth Rogen and his wife Lauren MIller Rogen, who’s mother passed away due to complications from being diagnosed with Alzheimer’s disease, creating the program, “Hilarity for Charity”. This program is described as being,” a non-profit movement dedicated to raising awareness, inspiring change and accelerating progress in Alzheimer’s care, research and support through the engagement of millenials.” For six years in a row now, the Rogens have put on a stand-up special grouping together various comedians to help raise funds for Alzheimer’s research, the most recent of which can be streamed on netflix. While there is no cure, seeing such a push for progress in understanding and fighting this disease can only give one hope that major advancements will be made in the future.

• About Hilarity for Charity. (n.d.). Retrieved from https://hilarityforcharity.org/about/
• Alzheimer’s Disease Fact Sheet. (2016, August). Retrieved from https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
• Bredesen, D. (2017) The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline. New York, NY: Penguin Random House.
• R. C. (n.d.). Research and Prognosis on Alzheimer’s Disease. Retrieved from https://www.gulfbend.org/poc/view_doc.php?type=doc&id=3249&cn=231
• Mace, N. L., & Rabins, P. V. (2017). The 36-hour day: A family guide to caring for people who have Alzheimer disease, related dementias and memory loss. New York: Grand Central.
• Obama administration presents national plan to fight Alzheimer’s disease. (n.d.). Retrieved from https://www.nia.nih.gov/news/obama-administration-presents-national-plan-fight-alzheimers-disease
• What Is Alzheimer’s? (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/what-is-alzheimers

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How Does Research Start?

How does research start.

Clinical research aims to deliver healthcare advancements that are safe, beneficial, and cost-effective ( Ford & Norrie, 2016 ). Research requires a methodical approach to develop studies that generate high-quality evidence to support changes in clinical practice. The method is a step-wise process that attempts to limit the chances of errors, random and systematic, which can compromise conclusions ( Cummings, 2013 ) and invalidate findings. As healthcare professionals, nurses need to be versed in understanding the vast amount of information and available research in their field ( Pollock & Berge, 2018 ) to find the best evidence to guide their clinical practice and/or to develop their research. However, to effectively use the literature, it is imperative to understand the principles of critical appraisal and basic study designs.

There are many roles for nurses in research. Nurses can be consumers of research, by staying abreast of the current issues and trends in their specialty area; a nurse champion initiating quality improvement projects guided by the best clinical evidence ( Luz, Shadmi, & Drach-Zahavy, 2019 ) ( White, 2011 ); a member of an interprofessional research team helping to address a complex health problem; or an independent nurse scientist developing their scientific inquiry. Regardless of the nurse’s role in research, a common goal of clinical research is to understand health and illness and, to discover novel methods to detect, diagnose, treat, and prevent disease ( NCI, 2018 ).

This column is the first in a series focusing on the concepts of clinical research using a step by step approach. Each column will build upon earlier columns to provide an overview of the essential components of clinical research. The goal of the columns is to discuss the concepts that underpin evidence-based practice from research designs to data interpretation. Each article can serve as a review of the elements used to develop clinical research. The focus of this inaugural column is how to start the research process, which involves the identification of the topic of interest and the development of a well-defined research question. This article also discusses methods of how to formulate quantitative and qualitative research questions.

The inspiration for the Topic

The motivation to explore an area of inquiry often starts from an observation that leads one to question why does that occur or what if we did this instead? Speaking to patients and hearing their concerns about managing specific conditions or symptoms is another way to get inspired. Exploring new technologies, successful techniques, and procedures from other fields or disciplines and adapting them in a different area could be another source for new insights and discoveries ( Cummings, 2013 ). For example, those working in a cardiac setting may take an interest in fitness watches to monitor adherence to a walking program to reduce blood pressure and body weight. The ease of use, cost, and availability of fitness watches may be the draw to this technology. Staying curious and willing to explore ideas to solve or understand clinical issues is vital in engaging in clinical research since the goal of research is to improve the lives of patients.

Developing a research project requires knowing in depth the chosen area of inquiry (i.e., etiology, and treatment of hypertension). Methods to get immersed in the topic of interest include speaking to experts in the field and conducting a comprehensive literature review. Reading narrative review (NR) articles is one approach for updates on the latest issues and trends in the area of interest. NRs can address clinical, background, or theoretical questions. It can also summarize current findings, identify the gaps in research, and provide suggestions for the next steps in research ( Ferrari, 2015 ). On the downside, NRs can be biased based on the author(s) experience and interpretation of findings ( Pae, 2015 ). Systematic reviews (SR), another summary paper, differs from NRs, in that it uses a systematic approach to select, appraise, and evaluate the published reports ( Armstrong, Hall, Doyle, & Waters, 2011 ).

SRs start with a defined clinical question that is answered during the review ( Hoffmann et al., 2017 ). SRs use specific strategies for the inclusion criteria of papers to include or not to include. SRs help to understand what works or do not work in terms of intervention based-research ( Uman, 2011 ). SRs are excellent resources if your area of inquiry is leading towards an intervention based project. (See Table 1 for Classifications of Interventions).

Classifications Interventional Studies (Clinical Trials)

Source: ( National Institutes of Health (NIH, 2019 )

Reviewing citations from published papers is another method to find relevant publications. Highly cited publications in a particular area could indicate a landmark paper, wherein the author(s) may have made an important discovery or identified a critical issue in the area. An essential goal of the literature review is to ensure that previously conducted studies are located and understood. Previous studies provide insight into recent discoveries, as well as dilemmas and challenges encountered in conducting the research.

The Research Question

The two branches of research methods are experimental and observational. Under the experimental methods, randomized controlled trials and non-randomized controlled trials belong in this category, while the observational methods include analytical studies with control groups and descriptive studies with no control groups. The analytical studies are cohort and case-control studies and descriptive studies are ecological, cross-sectional and case reports. Despite the differences in research methods, the common thread among the various types of research is the research question. The question helps guide the study design and is the foundation for developing the study. In the health sciences, the question needs to pass the “So what?” test. In that, is the issue relevant and lead to the advancement of the field and feasible in terms of conducting the study? Cummings and colleagues ( Cummings, 2013 ) use the mnemonic FINER (Feasible, Interesting, Novel, Ethical, Relevant) to define the characteristics of a good research question.

Feasibility

Feasibility is a critical element of research. Research questions must be answerable and focused on using methods to measure or quantify change or outcome. For example, assessing blood pressure for a study designed to lower hypertension is feasible, because methods to measure blood pressure and results associated with normal, and stages of hypertension are established. For studies requiring human study participants, approaches to recruiting and to enrolling them into the research need careful planning. Strategies must consider where and how to recruit the best study participants who fit the study population under investigation. An adequate number of study participants must be available to implement the study. The allotted timeframe to complete the study, the workforce to perform the study, and the budget to conduct the investigation must also be realistic. Research studies funded by private or public sponsors usually have timeframes to complete an investigation (2 years, three years). Funders can also request for a timeline showing when aspects of the research are achieved (institutional review board approval, recruitment of participants, data analysis).

Interesting

Several reasons may drive interest in an area of inquiry. Cummings and colleagues ( Cummings, 2013 ), use the term Interesting to refer to an area of importance for the investigator to examine. For some investigators, an experience or an observation drives them to evaluate the underpinnings of a situation or condition. While for some, obtaining financial support either through private or public funding is an important consideration, and for others, the research question is the logical next step in their program of research.

Novel research implies that new information contributes to or advances a field of inquiry. It can also mean that research confirms or refutes earlier results. Replicating past research is appropriate to validate scientific findings. When repeating studies, improving previously used research methods (i.e., increase sample size, outcome measures, increase follow-up period) can strengthen the project. For example, a study replicating a hypertension study may add a way to physiologically assess dietary sodium intake instead of only collecting dietary food records to determine sodium intake.

Ethical research is mandatory, from the protection of human and animal subjects to the data collection, storage, and reporting of research results ( Applebaum, 2005 ; Grady, 2015 ). Research studies must obtain institutional review board (IRB) approval before proceeding with the investigation. IRB is known as an ethics committee. The committee reviews the proposed research plan to ensure that it has adequate safeguards for the well-being of the study participants, as well as evaluates the risk-benefits of the proposed study. If the level of the risk outweighs the benefits of the outcome, the IRB may require changes to the research plan to improve the safety profile or reject the study. For example, an IRB will not approve a study proposing to use a placebo when well-established and effective treatments are available. The National Institutes of Health (NIH) offers an excellent educational resource, titled, Clinical Research Training . This training is a free online tutorial for ethics, patient safety, protocol implementation, and regulatory research ( https://crt.nihtraining.com/login.php ). Registration is required to enter the NIH portal, and the course takes approximately three-four hours to complete.

Relevant research questions address critical issues. It will add to the current knowledge in the field. It may also change clinical practice or influence policy. The questions must be timely and appropriate for the study population under investigation. In continuing the hypertension example from above, for individuals diagnosed with hypertension, it is recognized that reducing the dietary intake of sodium and increasing potassium can lower blood pressure and reduce the risk for heart disease and stroke ( McDonough, Veiras, Guevara, & Ralph, 2017 ). Therefore, an investigator should target both the dietary intakes of sodium and potassium if conducting a dietary study to reduce blood pressure. Focusing solely on lowering dietary sodium intake does not take into consideration the best available evidence in the field.

Guidelines for Question Development: PICO, PEO

Guidelines are available to help frame the research question that clarifies the concepts of interest; common frameworks include PICO and PEO. PICO is best suited for quantitative studies, while PEO for qualitative studies ( Methley, Campbell, Chew-Graham, McNally, & Cheraghi-Sohi, 2014 ). Quantitative and qualitative methodologies view the research approach using different lenses. In quantitative research, numerical data is produced necessitating statistical analysis. While qualitative research generates themes using words, the outcome of interest for these studies is understanding phenomena and experiences. It is essential to recognize that some topics will not fit the PICO and PEO frameworks. Novice researchers should seek consultation from a mentor or academic research advisor to formulate the research question.

PICO incorporates the following components P opulation, I ntervention, C omparison, and O utcomes. Population considers the persons or community affected with a specific health condition or problem (i.e., middle-aged adults, aged 45-65 with stage 1 hypertension; older adults, aged 65 and older with stage 1 hypertension living in nursing homes). Intervention is the process or action under investigation in a clinical study. Interventions include pharmaceutical agents, devices, and procedures, such as education about diet or exercise. The intervention under study can be investigational or already available to consumers or healthcare professionals for use ( NLM, 2019 ). Comparison is the group assessed against the intervention (i.e., vegan diet versus the Mediterranean style diet). Outcome is the planned measure to determine the effect of an intervention on the population under study. Using the vegan versus Mediterranean style diet example, the Outcome of interest could be the percent of body weight loss and reduction of blood pressure.

PEO includes the following elements P opulation, E xposure, and O utcome. Population centers on those affected and their problems (i.e., middle-aged adults who smoke with hypertension). Exposure focuses on the area of interest (i.e., experience with smoking cessation programs; triggers of smoking). The Exposure viewpoint depends on the framing or wording of the research question and the goals of the project since qualitative studies can denote a broad area of research or specific sub-categories of topics ( Creswell, 2013 ). Outcome using the PEO model might examine a person’s experience with smoking cessation and the themes associated with quitting and relapsing. Since the PEO model is best suited for qualitative studies, Outcome tends to have elements of defining a person’s experiences or discovering processes that happen in specific locations or context ( Doody & Bailey, 2016 ). (See Table 2 for Sample Questions Using PICO and PEO).

Sample Questions Using PICO and PEO

To start in research, find an area of interest to study. For some, the inspiration for research comes from observations and experiences from the work-setting, colleagues, investigations from other fields, and past research. Before delving into developing a research protocol, master the subject of interest by speaking with experts, and understand the literature in the field. Use the FINER mnemonic as a guide to determine if the research question can pass the “So what?” test and use the PICO or PEO models to structure the research question. Formulating the appropriate research question is vital because the question is the starting point to select the design of the study, the population of interest, interventions, exposure, and outcomes.

Acknowledgments

This manuscript is supported in part by grant # UL1TR001866 from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program.

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Parkinson's Disease: New theory on the disease's origins and spread

The nose or the gut? For the past two decades, the scientific community has debated the wellspring of the toxic proteins at the source of Parkinson's disease. In 2003, a German pathologist, Heiko Braak, MD, first proposed that the disease begins outside the brain. More recently, Per Borghammer, MD, with Aarhus University Hospital in Denmark, and his colleagues argue that the disease is the result of processes that start in either the brain's smell center (brain-first) or the body's intestinal tract (body-first).

A new hypothesis paper appearing in the Journal of Parkinson's Disease on World Parkinson's Day unites the brain- and body-first models with some of the likely causes of the disease-environmental toxicants that are either inhaled or ingested. The authors of the new study, who include Borghammer, argue that inhalation of certain pesticides, common dry cleaning chemicals, and air pollution predispose to a brain-first model of the disease. Other ingested toxicants, such as tainted food and contaminated drinking water, lead to body-first model of the disease.

"In both the brain-first and body-first scenarios the pathology arises in structures in the body closely connected to the outside world," said Ray Dorsey, MD, a professor of Neurology at the University of Rochester Medical Center and co-author of the piece. "Here we propose that Parkinson's is a systemic disease and that its initial roots likely begin in the nose and in the gut and are tied to environmental factors increasingly recognized as major contributors, if not causes, of the disease. This further reinforces the idea that Parkinson's, the world's fastest growing brain disease, may be fueled by toxicants and is therefore largely preventable."

Different pathways to the brain, different forms of disease

A misfolded protein called alpha-synuclein has been in scientists' sights for the last 25 years as one of the driving forces behind Parkinson's. Over time, the protein accumulates in the brain in clumps, called Lewy bodies, and causes progressive dysfunction and death of many types of nerve cells, including those in the dopamine-producing regions of the brain that control motor function. When first proposed, Braak thought that an unidentified pathogen, such as a virus, may be responsible for the disease.

The new piece argues that toxins encountered in the environment, specifically the dry cleaning and degreasing chemicals trichloroethylene (TCE) and perchloroethylene (PCE), the weed killer paraquat, and air pollution, could be common causes for the formation of toxic alpha-synuclein. TCE and PCE contaminates thousands of former industrial, commercial, and military sites, most notably the Marine Corps base Camp Lejeune, and paraquat is one of the most widely used herbicides in the US, despite being banned for safety concerns in more than 30 countries, including the European Union and China. Air pollution was at toxic levels in nineteenth century London when James Parkinson, whose 269th birthday is celebrated today, first described the condition.

The nose and the gut are lined with a soft permeable tissue, and both have well established connections to the brain. In the brain-first model, the chemicals are inhaled and may enter the brain via the nerve responsible for smell. From the brain's smell center, alpha-synuclein spreads to other parts of the brain principally on one side, including regions with concentrations of dopamine-producing neurons. The death of these cells is a hallmark of Parkinson's disease. The disease may cause asymmetric tremor and slowness in movement and, a slower rate of progression after diagnosis, and only much later, significant cognitive impairment or dementia.

When ingested, the chemicals pass through the lining of the gastrointestinal tract. Initial alpha-synuclein pathology may begin in the gut's own nervous system from where it can spread to both sides of the brain and spinal cord. This body-first pathway is often associated with Lewy body dementia, a disease in the same family as Parkinson's, which is characterized by early constipation and sleep disturbance, followed by more symmetric slowing in movements and earlier dementia, as the disease spreads through both brain hemispheres.

New models to understand and study brain diseases

"These environmental toxicants are widespread and not everyone has Parkinson's disease," said Dorsey. "The timing, dose, and duration of exposure and interactions with genetic and other environmental factors are probably key to determining who ultimately develops Parkinson's. In most instances, these exposures likely occurred years or decades before symptoms develop."

Pointing to a growing body of research linking environmental exposure to Parkinson's disease, the authors believe the new models may enable the scientific community to connect specific exposures to specific forms of the disease. This effort will be aided by increasing public awareness of the adverse health effects of many chemicals in our environment. The authors conclude that their hypothesis "may explain many of the mysteries of Parkinson's disease and open the door toward the ultimate goal-prevention."

In addition to Parkinson's, these models of environmental exposure may advance understanding of how toxicants contribute to other brain disorders, including autism in children, ALS in adults, and Alzheimer's in seniors. Dorsey and his colleagues at the University of Rochester have organized a symposium on the Brain and the Environment in Washington, DC, on May 20 that will examine the role toxicants in our food, water, and air are playing in all these brain diseases.

Additional authors of the hypothesis paper include Briana De Miranda, PhD, with the University of Alabama at Birmingham, and Jacob Horsager, MD, PhD, with Aarhus University Hospital in Denmark.

• Parkinson's Research
• Chronic Illness
• Brain Tumor
• Diseases and Conditions
• Parkinson's
• Disorders and Syndromes
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• Deep brain stimulation
• Homosexuality
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Story Source:

Materials provided by University of Rochester Medical Center . Original written by Mark Michaud. Note: Content may be edited for style and length.

Journal Reference :

• E. Ray Dorsey, Briana R. De Miranda, Jacob Horsager, Per Borghammer. The Body, the Brain, the Environment, and Parkinson’s Disease . Journal of Parkinson's Disease , 2024; 1 DOI: 10.3233/JPD-240019

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Early and targeted treatment is important for tackling tularemia: Study

by Umea University

A new study at Umeå University in collaboration with Sunderby Hospital in Norrbotten County supports the recommendation to use ciprofloxacin for treatment of tularemia. It also identifies a need for more awareness about the disease among health care workers and the public to start effective antibiotic treatment early. The study is published in Clinical Infectious Diseases .

"In our study, we saw that 15% of study participants required retreatment even after appropriate antibiotics, especially those who had a longer duration between contracting tularemia and the start of correct antibiotic treatment. A few patients with persistently swollen lymph nodes despite antibiotics needed surgery to drain them, often with a prolonged healing process," says Dr. Martin Plymoth, MD, who is affiliated with the Department of Clinical Microbiology at Umeå University and first author of the study.

Tularemia is an infectious disease that can manifest in several different ways: hard-to-heal wounds, swollen lymph nodes, fever, eye inflammation, pneumonia and bacteremia. On average, around 300–500 cases are reported annually throughout the country, and northern Sweden is disproportionately more affected. Fluctuations in cases vary largely between years, and so do the geographical areas that are affected.

In Sweden, the spread of infection occurs mostly during the summer. Contact with infected animals (especially voles and hares) and contaminated water can lead to infection, although mosquitoes are suspected to be the main vector of infection in Sweden. Tularemia can also present as pneumonia through inhalation of bacteria.

Tularemia is treated with antibiotics, but due to the rarity of the disease, large scale studies comparing antibiotic treatments have not been possible to conduct. Antibiotics commonly used to treat skin and soft tissue infections and pneumonia are known to be ineffective against tularemia. In combination with the many ways the disease can manifest itself, this can lead to extended delays in time to diagnosis and correct antibiotic treatment.

In this study, the research team from Umeå University and Sunderby Hospital, in Luleå, Sweden, examined individuals in Norrbotten County who had tularemia during the period 2011 to 2021. During these years, Norrbotten experienced the second (2015) and third (2019) largest outbreaks of tularemia in Sweden. Most cases were reported in the area around Luleå and Boden, while the highest prevalence was found in the municipalities of Boden and Arjeplog.

The researchers identified 830 cases of tularemia during this period, just over half of whom participated in the study by answering a questionnaire and underwent a review of their medical records.

"We identified ulceroglandular tularemia, i.e., hard-to-heal wounds on the arms, legs, or neck/face with swollen lymph nodes as the most common form of the disease," says principal investigator Tomas Gustafsson, attending physician in infectious diseases medicine at Sunderby Hospital and researcher at the Department of Clinical Microbiology at Umeå University.

"Pneumonic tularemia was also common and was often initially mistaken for pneumonia caused by other bacteria or even cancer. Tularemia was common in all age groups among both men and women, but was most prevalent in the group 40 to 60 years of age."

Most cases were diagnosed in primary care centers around the county. 15% of patients were admitted to hospital, but serious infections were uncommon, and no fatalities were reported. Although serological blood tests are available for tularemia, these can be negative up to two weeks after onset of symptoms. Alternatively, so-called PCR tests can be done on wound swabs.

A high level of clinical suspicion is therefore needed by health care professionals. Antibiotics that are known to be ineffective against tularemia were prescribed to about 20% of patients initially because the physician suspected another disease; the proportion was even higher outside the epidemic years 2012, 2015 and 2019.

The researchers saw that individuals who had a longer time between contracting tularemia and appropriate antibiotic treatment tended to be re-treated more often, but that individuals who received the antibiotic ciprofloxacin tended to have less need for re-treatment.

The results support the recommendation to use ciprofloxacin as first-line treatment for tularemia and identify a need for increased awareness of tularemia among health care professionals and the general public to be able to commence effective antibiotic treatment early.

However, the retrospective study design is not ideal to make recommendations regarding antibiotic treatment, length of treatment, and need for surgical interventions, according to the researchers. To answer this, they would have to carry out a randomized controlled trial which tests different treatment options against each other.

"In future research, we also hope to be able to develop diagnostic scoring systems using clinical signs such as swollen lymph nodes and laboratory values such as white blood cells , which could give physicians an early indication of the likelihood of tularemia as opposed to other diseases. Based on this, clinical tools could be developed to help health care professionals identify tularemia cases early and start appropriate treatment," says Martin Plymoth.

"Perhaps the time is ripe to conduct a randomized clinical trial of different treatment options for tularemia in which case, we would need to conduct it in collaboration with several different centers in northern Sweden given the unpredictable and unusual nature of the infection," says Tomas Gustafsson.

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• Volume 110, Issue 9
• The role of COVID-19 vaccines in preventing post-COVID-19 thromboembolic and cardiovascular complications
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• Núria Mercadé-Besora 1 , 2 , 3 ,
• Xintong Li 1 ,
• Raivo Kolde 4 ,
• Nhung TH Trinh 5 ,
• Maria T Sanchez-Santos 1 ,
• Wai Yi Man 1 ,
• Elena Roel 3 ,
• Carlen Reyes 3 ,
• http://orcid.org/0000-0003-0388-3403 Antonella Delmestri 1 ,
• Hedvig M E Nordeng 6 , 7 ,
• http://orcid.org/0000-0002-4036-3856 Anneli Uusküla 8 ,
• http://orcid.org/0000-0002-8274-0357 Talita Duarte-Salles 3 , 9 ,
• Clara Prats 2 ,
• http://orcid.org/0000-0002-3950-6346 Daniel Prieto-Alhambra 1 , 9 ,
• http://orcid.org/0000-0002-0000-0110 Annika M Jödicke 1 ,
• Martí Català 1
• 1 Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS , University of Oxford , Oxford , UK
• 2 Department of Physics , Universitat Politècnica de Catalunya , Barcelona , Spain
• 3 Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol) , IDIAP Jordi Gol , Barcelona , Catalunya , Spain
• 4 Institute of Computer Science , University of Tartu , Tartu , Estonia
• 5 Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences , University of Oslo , Oslo , Norway
• 6 School of Pharmacy , University of Oslo , Oslo , Norway
• 7 Division of Mental Health , Norwegian Institute of Public Health , Oslo , Norway
• 8 Department of Family Medicine and Public Health , University of Tartu , Tartu , Estonia
• 9 Department of Medical Informatics, Erasmus University Medical Center , Erasmus University Rotterdam , Rotterdam , Zuid-Holland , Netherlands
• Correspondence to Prof Daniel Prieto-Alhambra, Pharmaco- and Device Epidemiology Group, Health Data Sciences, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK; daniel.prietoalhambra{at}ndorms.ox.ac.uk

Objective To study the association between COVID-19 vaccination and the risk of post-COVID-19 cardiac and thromboembolic complications.

Methods We conducted a staggered cohort study based on national vaccination campaigns using electronic health records from the UK, Spain and Estonia. Vaccine rollout was grouped into four stages with predefined enrolment periods. Each stage included all individuals eligible for vaccination, with no previous SARS-CoV-2 infection or COVID-19 vaccine at the start date. Vaccination status was used as a time-varying exposure. Outcomes included heart failure (HF), venous thromboembolism (VTE) and arterial thrombosis/thromboembolism (ATE) recorded in four time windows after SARS-CoV-2 infection: 0–30, 31–90, 91–180 and 181–365 days. Propensity score overlap weighting and empirical calibration were used to minimise observed and unobserved confounding, respectively.

Fine-Gray models estimated subdistribution hazard ratios (sHR). Random effect meta-analyses were conducted across staggered cohorts and databases.

Results The study included 10.17 million vaccinated and 10.39 million unvaccinated people. Vaccination was associated with reduced risks of acute (30-day) and post-acute COVID-19 VTE, ATE and HF: for example, meta-analytic sHR of 0.22 (95% CI 0.17 to 0.29), 0.53 (0.44 to 0.63) and 0.45 (0.38 to 0.53), respectively, for 0–30 days after SARS-CoV-2 infection, while in the 91–180 days sHR were 0.53 (0.40 to 0.70), 0.72 (0.58 to 0.88) and 0.61 (0.51 to 0.73), respectively.

Conclusions COVID-19 vaccination reduced the risk of post-COVID-19 cardiac and thromboembolic outcomes. These effects were more pronounced for acute COVID-19 outcomes, consistent with known reductions in disease severity following breakthrough versus unvaccinated SARS-CoV-2 infection.

• Epidemiology
• PUBLIC HEALTH
• Electronic Health Records

Data availability statement

Data may be obtained from a third party and are not publicly available. CPRD: CPRD data were obtained under the CPRD multi-study license held by the University of Oxford after Research Data Governance (RDG) approval. Direct data sharing is not allowed. SIDIAP: In accordance with current European and national law, the data used in this study is only available for the researchers participating in this study. Thus, we are not allowed to distribute or make publicly available the data to other parties. However, researchers from public institutions can request data from SIDIAP if they comply with certain requirements. Further information is available online ( https://www.sidiap.org/index.php/menu-solicitudesen/application-proccedure ) or by contacting SIDIAP ([email protected]). CORIVA: CORIVA data were obtained under the approval of Research Ethics Committee of the University of Tartu and the patient level data sharing is not allowed. All analyses in this study were conducted in a federated manner, where analytical code and aggregated (anonymised) results were shared, but no patient-level data was transferred across the collaborating institutions.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/heartjnl-2023-323483

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WHAT IS ALREADY KNOWN ON THIS TOPIC

COVID-19 vaccines proved to be highly effective in reducing the severity of acute SARS-CoV-2 infection.

While COVID-19 vaccines were associated with increased risk for cardiac and thromboembolic events, such as myocarditis and thrombosis, the risk of complications was substantially higher due to SARS-CoV-2 infection.

WHAT THIS STUDY ADDS

COVID-19 vaccination reduced the risk of heart failure, venous thromboembolism and arterial thrombosis/thromboembolism in the acute (30 days) and post-acute (31 to 365 days) phase following SARS-CoV-2 infection. This effect was stronger in the acute phase.

The overall additive effect of vaccination on the risk of post-vaccine and/or post-COVID thromboembolic and cardiac events needs further research.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

COVID-19 vaccines proved to be highly effective in reducing the risk of post-COVID cardiovascular and thromboembolic complications.

Introduction

COVID-19 vaccines were approved under emergency authorisation in December 2020 and showed high effectiveness against SARS-CoV-2 infection, COVID-19-related hospitalisation and death. 1 2 However, concerns were raised after spontaneous reports of unusual thromboembolic events following adenovirus-based COVID-19 vaccines, an association that was further assessed in observational studies. 3 4 More recently, mRNA-based vaccines were found to be associated with a risk of rare myocarditis events. 5 6

On the other hand, SARS-CoV-2 infection can trigger cardiac and thromboembolic complications. 7 8 Previous studies showed that, while slowly decreasing over time, the risk for serious complications remain high for up to a year after infection. 9 10 Although acute and post-acute cardiac and thromboembolic complications following COVID-19 are rare, they present a substantial burden to the affected patients, and the absolute number of cases globally could become substantial.

Recent studies suggest that COVID-19 vaccination could protect against cardiac and thromboembolic complications attributable to COVID-19. 11 12 However, most studies did not include long-term complications and were conducted among specific populations.

Evidence is still scarce as to whether the combined effects of COVID-19 vaccines protecting against SARS-CoV-2 infection and reducing post-COVID-19 cardiac and thromboembolic outcomes, outweigh any risks of these complications potentially associated with vaccination.

We therefore used large, representative data sources from three European countries to assess the overall effect of COVID-19 vaccines on the risk of acute and post-acute COVID-19 complications including venous thromboembolism (VTE), arterial thrombosis/thromboembolism (ATE) and other cardiac events. Additionally, we studied the comparative effects of ChAdOx1 versus BNT162b2 on the risk of these same outcomes.

Data sources

We used four routinely collected population-based healthcare datasets from three European countries: the UK, Spain and Estonia.

For the UK, we used data from two primary care databases—namely, Clinical Practice Research Datalink, CPRD Aurum 13 and CPRD Gold. 14 CPRD Aurum currently covers 13 million people from predominantly English practices, while CPRD Gold comprises 3.1 million active participants mostly from GP practices in Wales and Scotland. Spanish data were provided by the Information System for the Development of Research in Primary Care (SIDIAP), 15 which encompasses primary care records from 6 million active patients (around 75% of the population in the region of Catalonia) linked to hospital admissions data (Conjunt Mínim Bàsic de Dades d’Alta Hospitalària). Finally, the CORIVA dataset based on national health claims data from Estonia was used. It contains all COVID-19 cases from the first year of the pandemic and ~440 000 randomly selected controls. CORIVA was linked to the death registry and all COVID-19 testing from the national health information system.

Databases included sociodemographic information, diagnoses, measurements, prescriptions and secondary care referrals and were linked to vaccine registries, including records of all administered vaccines from all healthcare settings. Data availability for CPRD Gold ended in December 2021, CPRD Aurum in January 2022, SIDIAP in June 2022 and CORIVA in December 2022.

All databases were mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) 16 to facilitate federated analytics.

Multinational network staggered cohort study: study design and participants

The study design has been published in detail elsewhere. 17 Briefly, we used a staggered cohort design considering vaccination as a time-varying exposure. Four staggered cohorts were designed with each cohort representing a country-specific vaccination rollout phase (eg, dates when people became eligible for vaccination, and eligibility criteria).

The source population comprised all adults registered in the respective database for at least 180 days at the start of the study (4 January 2021 for CPRD Gold and Aurum, 20 February 2021 for SIDIAP and 28 January 2021 for CORIVA). Subsequently, each staggered cohort corresponded to an enrolment period: all people eligible for vaccination during this time were included in the cohort and people with a history of SARS-CoV-2 infection or COVID-19 vaccination before the start of the enrolment period were excluded. Across countries, cohort 1 comprised older age groups, whereas cohort 2 comprised individuals at risk for severe COVID-19. Cohort 3 included people aged ≥40 and cohort 4 enrolled people aged ≥18.

In each cohort, people receiving a first vaccine dose during the enrolment period were allocated to the vaccinated group, with their index date being the date of vaccination. Individuals who did not receive a vaccine dose comprised the unvaccinated group and their index date was assigned within the enrolment period, based on the distribution of index dates in the vaccinated group. People with COVID-19 before the index date were excluded.

Follow-up started from the index date until the earliest of end of available data, death, change in exposure status (first vaccine dose for those unvaccinated) or outcome of interest.

COVID-19 vaccination

All vaccines approved within the study period from January 2021 to July 2021—namely, ChAdOx1 (Oxford/AstraZeneca), BNT162b2 (BioNTech/Pfizer]) Ad26.COV2.S (Janssen) and mRNA-1273 (Moderna), were included for this study.

Post-COVID-19 outcomes of interest

Outcomes of interest were defined as SARS-CoV-2 infection followed by a predefined thromboembolic or cardiac event of interest within a year after infection, and with no record of the same clinical event in the 6 months before COVID-19. Outcome date was set as the corresponding SARS-CoV-2 infection date.

COVID-19 was identified from either a positive SARS-CoV-2 test (polymerase chain reaction (PCR) or antigen), or a clinical COVID-19 diagnosis, with no record of COVID-19 in the previous 6 weeks. This wash-out period was imposed to exclude re-recordings of the same COVID-19 episode.

Post-COVID-19 outcome events were selected based on previous studies. 11–13 Events comprised ischaemic stroke (IS), haemorrhagic stroke (HS), transient ischaemic attack (TIA), ventricular arrhythmia/cardiac arrest (VACA), myocarditis/pericarditis (MP), myocardial infarction (MI), heart failure (HF), pulmonary embolism (PE) and deep vein thrombosis (DVT). We used two composite outcomes: (1) VTE, as an aggregate of PE and DVT and (2) ATE, as a composite of IS, TIA and MI. To avoid re-recording of the same complication we imposed a wash-out period of 90 days between records. Phenotypes for these complications were based on previously published studies. 3 4 8 18

All outcomes were ascertained in four different time periods following SARS-CoV-2 infection: the first period described the acute infection phase—that is, 0–30 days after COVID-19, whereas the later periods - which are 31–90 days, 91–180 days and 181–365 days, illustrate the post-acute phase ( figure 1 ).

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Study outcome design. Study outcomes of interest are defined as a COVID-19 infection followed by one of the complications in the figure, within a year after infection. Outcomes were ascertained in four different time windows after SARS-CoV-2 infection: 0–30 days (namely the acute phase), 31–90 days, 91–180 days and 181–365 days (these last three comprise the post-acute phase).

Negative control outcomes

Negative control outcomes (NCOs) were used to detect residual confounding. NCOs are outcomes which are not believed to be causally associated with the exposure, but share the same bias structure with the exposure and outcome of interest. Therefore, no significant association between exposure and NCO is to be expected. Our study used 43 different NCOs from previous work assessing vaccine effectiveness. 19

Statistical analysis

Federated network analyses.

A template for an analytical script was developed and subsequently tailored to include the country-specific aspects (eg, dates, priority groups) for the vaccination rollout. Analyses were conducted locally for each database. Only aggregated data were shared and person counts <5 were clouded.

Propensity score weighting

Large-scale propensity scores (PS) were calculated to estimate the likelihood of a person receiving the vaccine based on their demographic and health-related characteristics (eg, conditions, medications) prior to the index date. PS were then used to minimise observed confounding by creating a weighted population (overlap weighting 20 ), in which individuals contributed with a different weight based on their PS and vaccination status.

Prespecified key variables included in the PS comprised age, sex, location, index date, prior observation time in the database, number of previous outpatient visits and previous SARS-CoV-2 PCR/antigen tests. Regional vaccination, testing and COVID-19 incidence rates were also forced into the PS equation for the UK databases 21 and SIDIAP. 22 In addition, least absolute shrinkage and selection operator (LASSO) regression, a technique for variable selection, was used to identify additional variables from all recorded conditions and prescriptions within 0–30 days, 31–180 days and 181-any time (conditions only) before the index date that had a prevalence of >0.5% in the study population.

PS were then separately estimated for each staggered cohort and analysis. We considered covariate balance to be achieved if absolute standardised mean differences (ASMDs) were ≤0.1 after weighting. Baseline characteristics such as demographics and comorbidities were reported.

Effect estimation

To account for the competing risk of death associated with COVID-19, Fine-and-Grey models 23 were used to calculate subdistribution hazard ratios (sHRs). Subsequently, sHRs and confidence intervals were empirically calibrated from NCO estimates 24 to account for unmeasured confounding. To calibrate the estimates, the empirical null distribution was derived from NCO estimates and was used to compute calibrated confidence intervals. For each outcome, sHRs from the four staggered cohorts were pooled using random-effect meta-analysis, both separately for each database and across all four databases.

Sensitivity analysis

Sensitivity analyses comprised 1) censoring follow-up for vaccinated people at the time when they received their second vaccine dose and 2) considering only the first post-COVID-19 outcome within the year after infection ( online supplemental figure S1 ). In addition, comparative effectiveness analyses were conducted for BNT162b2 versus ChAdOx1.

Supplemental material

Data and code availability.

All analytic code for the study is available in GitHub ( https://github.com/oxford-pharmacoepi/vaccineEffectOnPostCovidCardiacThromboembolicEvents ), including code lists for vaccines, COVID-19 tests and diagnoses, cardiac and thromboembolic events, NCO and health conditions to prioritise patients for vaccination in each country. We used R version 4.2.3 and statistical packages survival (3.5–3), Empirical Calibration (3.1.1), glmnet (4.1-7), and Hmisc (5.0–1).

Patient and public involvement

Owing to the nature of the study and the limitations regarding data privacy, the study design, analysis, interpretation of data and revision of the manuscript did not involve any patients or members of the public.

All aggregated results are available in a web application ( https://dpa-pde-oxford.shinyapps.io/PostCovidComplications/ ).

We included over 10.17 million vaccinated individuals (1 618 395 from CPRD Gold; 5 729 800 from CPRD Aurum; 2 744 821 from SIDIAP and 77 603 from CORIVA) and 10.39 million unvaccinated individuals (1 640 371; 5 860 564; 2 588 518 and 302 267, respectively). Online supplemental figures S2-5 illustrate study inclusion for each database.

Adequate covariate balance was achieved after PS weighting in most studies: CORIVA (all cohorts) and SIDIAP (cohorts 1 and 4) did not contribute to ChAdOx1 subanalyses owing to sample size and covariate imbalance. ASMD results are accessible in the web application.

NCO analyses suggested residual bias after PS weighting, with a majority of NCOs associated positively with vaccination. Therefore, calibrated estimates are reported in this manuscript. Uncalibrated effect estimates and NCO analyses are available in the web interface.

Population characteristics

Table 1 presents baseline characteristics for the weighted populations in CPRD Aurum, for illustrative purposes. Online supplemental tables S1-25 summarise baseline characteristics for weighted and unweighted populations for each database and comparison. Across databases and cohorts, populations followed similar patterns: cohort 1 represented an older subpopulation (around 80 years old) with a high proportion of women (57%). Median age was lowest in cohort 4 ranging between 30 and 40 years.

• View inline

Characteristics of weighted populations in CPRD Aurum database, stratified by staggered cohort and exposure status. Exposure is any COVID-19 vaccine

COVID-19 vaccination and post-COVID-19 complications

Table 2 shows the incidence of post-COVID-19 VTE, ATE and HF, the three most common post-COVID-19 conditions among the studied outcomes. Outcome counts are presented separately for 0–30, 31–90, 91–180 and 181–365 days after SARS-CoV-2 infection. Online supplemental tables S26-36 include all studied complications, also for the sensitivity and subanalyses. Similar pattern for incidences were observed across all databases: higher outcome rates in the older populations (cohort 1) and decreasing frequency with increasing time after infection in all cohorts.

Number of records (and risk per 10 000 individuals) for acute and post-acute COVID-19 cardiac and thromboembolic complications, across cohorts and databases for any COVID-19 vaccination

Forest plots for the effect of COVID-19 vaccines on post-COVID-19 cardiac and thromboembolic complications; meta-analysis across cohorts and databases. Dashed line represents a level of heterogeneity I 2 >0.4. ATE, arterial thrombosis/thromboembolism; CD+HS, cardiac diseases and haemorrhagic stroke; VTE, venous thromboembolism.

Results from calibrated estimates pooled in meta-analysis across cohorts and databases are shown in figure 2 .

Reduced risk associated with vaccination is observed for acute and post-acute VTE, DVT, and PE: acute meta-analytic sHR are 0.22 (95% CI, 0.17–0.29); 0.36 (0.28–0.45); and 0.19 (0.15–0.25), respectively. For VTE in the post-acute phase, sHR estimates are 0.43 (0.34–0.53), 0.53 (0.40–0.70) and 0.50 (0.36–0.70) for 31–90, 91–180, and 181–365 days post COVID-19, respectively. Reduced risk of VTE outcomes was observed in vaccinated across databases and cohorts, see online supplemental figures S14–22 .

Similarly, the risk of ATE, IS and MI in the acute phase after infection was reduced for the vaccinated group, sHR of 0.53 (0.44–0.63), 0.55 (0.43–0.70) and 0.49 (0.38–0.62), respectively. Reduced risk associated with vaccination persisted for post-acute ATE, with sHR of 0.74 (0.60–0.92), 0.72 (0.58–0.88) and 0.62 (0.48–0.80) for 31–90, 91–180 and 181–365 days post-COVID-19, respectively. Risk of post-acute MI remained lower for vaccinated in the 31–90 and 91–180 days after COVID-19, with sHR of 0.64 (0.46–0.87) and 0.64 (0.45–0.90), respectively. Vaccination effect on post-COVID-19 TIA was seen only in the 181–365 days, with sHR of 0.51 (0.31–0.82). Online supplemental figures S23-31 show database-specific and cohort-specific estimates for ATE-related complications.

Risk of post-COVID-19 cardiac complications was reduced in vaccinated individuals. Meta-analytic estimates in the acute phase showed sHR of 0.45 (0.38–0.53) for HF, 0.41 (0.26–0.66) for MP and 0.41 (0.27–0.63) for VACA. Reduced risk persisted for post-acute COVID-19 HF: sHR 0.61 (0.51–0.73) for 31–90 days, 0.61 (0.51–0.73) for 91–180 days and 0.52 (0.43–0.63) for 181–365 days. For post-acute MP, risk was only lowered in the first post-acute window (31–90 days), with sHR of 0.43 (0.21–0.85). Vaccination showed no association with post-COVID-19 HS. Database-specific and cohort-specific results for these cardiac diseases are shown in online supplemental figures S32-40 .

Stratified analyses by vaccine showed similar associations, except for ChAdOx1 which was not associated with reduced VTE and ATE risk in the last post-acute window. Sensitivity analyses were consistent with main results ( online supplemental figures S6-13 ).

Figure 3 shows the results of comparative effects of BNT162b2 versus ChAdOx1, based on UK data. Meta-analytic estimates favoured BNT162b2 (sHR of 0.66 (0.46–0.93)) for VTE in the 0–30 days after infection, but no differences were seen for post-acute VTE or for any of the other outcomes. Results from sensitivity analyses, database-specific and cohort-specific estimates were in line with the main findings ( online supplemental figures S41-51 ).

Forest plots for comparative vaccine effect (BNT162b2 vs ChAdOx1); meta-analysis across cohorts and databases. ATE, arterial thrombosis/thromboembolism; CD+HS, cardiac diseases and haemorrhagic stroke; VTE, venous thromboembolism.

Key findings

Our analyses showed a substantial reduction of risk (45–81%) for thromboembolic and cardiac events in the acute phase of COVID-19 associated with vaccination. This finding was consistent across four databases and three different European countries. Risks for post-acute COVID-19 VTE, ATE and HF were reduced to a lesser extent (24–58%), whereas a reduced risk for post-COVID-19 MP and VACA in vaccinated people was seen only in the acute phase.

Results in context

The relationship between SARS-CoV-2 infection, COVID-19 vaccines and thromboembolic and/or cardiac complications is tangled. Some large studies report an increased risk of VTE and ATE following both ChAdOx1 and BNT162b2 vaccination, 7 whereas other studies have not identified such a risk. 25 Elevated risk of VTE has also been reported among patients with COVID-19 and its occurrence can lead to poor prognosis and mortality. 26 27 Similarly, several observational studies have found an association between COVID-19 mRNA vaccination and a short-term increased risk of myocarditis, particularly among younger male individuals. 5 6 For instance, a self-controlled case series study conducted in England revealed about 30% increased risk of hospital admission due to myocarditis within 28 days following both ChAdOx1 and BNT162b2 vaccines. However, this same study also found a ninefold higher risk for myocarditis following a positive SARS-CoV-2 test, clearly offsetting the observed post-vaccine risk.

COVID-19 vaccines have demonstrated high efficacy and effectiveness in preventing infection and reducing the severity of acute-phase infection. However, with the emergence of newer variants of the virus, such as omicron, and the waning protective effect of the vaccine over time, there is a growing interest in understanding whether the vaccine can also reduce the risk of complications after breakthrough infections. Recent studies suggested that COVID-19 vaccination could potentially protect against acute post-COVID-19 cardiac and thromboembolic events. 11 12 A large prospective cohort study 11 reports risk of VTE after SARS-CoV-2 infection to be substantially reduced in fully vaccinated ambulatory patients. Likewise, Al-Aly et al 12 suggest a reduced risk for post-acute COVID-19 conditions in breakthrough infection versus SARS-CoV-2 infection without prior vaccination. However, the populations were limited to SARS-CoV-2 infected individuals and estimates did not include the effect of the vaccine to prevent COVID-19 in the first place. Other studies on post-acute COVID-19 conditions and symptoms have been conducted, 28 29 but there has been limited reporting on the condition-specific risks associated with COVID-19, even though the prognosis for different complications can vary significantly.

In line with previous studies, our findings suggest a potential benefit of vaccination in reducing the risk of post-COVID-19 thromboembolic and cardiac complications. We included broader populations, estimated the risk in both acute and post-acute infection phases and replicated these using four large independent observational databases. By pooling results across different settings, we provided the most up-to-date and robust evidence on this topic.

Strengths and limitations

The study has several strengths. Our multinational study covering different healthcare systems and settings showed consistent results across all databases, which highlights the robustness and replicability of our findings. All databases had complete recordings of vaccination status (date and vaccine) and are representative of the respective general population. Algorithms to identify study outcomes were used in previous published network studies, including regulatory-funded research. 3 4 8 18 Other strengths are the staggered cohort design which minimises confounding by indication and immortal time bias. PS overlap weighting and NCO empirical calibration have been shown to adequately minimise bias in vaccine effectiveness studies. 19 Furthermore, our estimates include the vaccine effectiveness against COVID-19, which is crucial in the pathway to experience post-COVID-19 complications.

Our study has some limitations. The use of real-world data comes with inherent limitations including data quality concerns and risk of confounding. To deal with these limitations, we employed state-of-the-art methods, including large-scale propensity score weighting and calibration of effect estimates using NCO. 19 24 A recent study 30 has demonstrated that methodologically sound observational studies based on routinely collected data can produce results similar to those of clinical trials. We acknowledge that results from NCO were positively associated with vaccination, and estimates might still be influenced by residual bias despite using calibration. Another limitation is potential under-reporting of post-COVID-19 complications: some asymptomatic and mild COVID-19 infections might have not been recorded. Additionally, post-COVID-19 outcomes of interest might be under-recorded in primary care databases (CPRD Aurum and Gold) without hospital linkage, which represent a large proportion of the data in the study. However, results in SIDIAP and CORIVA, which include secondary care data, were similar. Also, our study included a small number of young men and male teenagers, who were the main population concerned with increased risks of myocarditis/pericarditis following vaccination.

Conclusions

Vaccination against SARS-CoV-2 substantially reduced the risk of acute post-COVID-19 thromboembolic and cardiac complications, probably through a reduction in the risk of SARS-CoV-2 infection and the severity of COVID-19 disease due to vaccine-induced immunity. Reduced risk in vaccinated people lasted for up to 1 year for post-COVID-19 VTE, ATE and HF, but not clearly for other complications. Findings from this study highlight yet another benefit of COVID-19 vaccination. However, further research is needed on the possible waning of the risk reduction over time and on the impact of booster vaccination.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

The study was approved by the CPRD’s Research Data Governance Process, Protocol No 21_000557 and the Clinical Research Ethics committee of Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol) (approval number 4R22/133) and the Research Ethics Committee of the University of Tartu (approval No. 330/T-10).

Acknowledgments

This study is based in part on data from the Clinical Practice Research Datalink (CPRD) obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. We thank the patients who provided these data, and the NHS who collected the data as part of their care and support. All interpretations, conclusions and views expressed in this publication are those of the authors alone and not necessarily those of CPRD. We would also like to thank the healthcare professionals in the Catalan healthcare system involved in the management of COVID-19 during these challenging times, from primary care to intensive care units; the Institut de Català de la Salut and the Program d’Analítica de Dades per a la Recerca i la Innovació en Salut for providing access to the different data sources accessible through The System for the Development of Research in Primary Care (SIDIAP).

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

AMJ and MC are joint senior authors.

Contributors DPA and AMJ led the conceptualisation of the study with contributions from MC and NM-B. AMJ, TD-S, ER, AU and NTHT adapted the study design with respect to the local vaccine rollouts. AD and WYM mapped and curated CPRD data. MC and NM-B developed code with methodological contributions advice from MTS-S and CP. DPA, MC, NTHT, TD-S, HMEN, XL, CR and AMJ clinically interpreted the results. NM-B, XL, AMJ and DPA wrote the first draft of the manuscript, and all authors read, revised and approved the final version. DPA and AMJ obtained the funding for this research. DPA is responsible for the overall content as guarantor: he accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

Funding The research was supported by the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre (BRC). DPA is funded through a NIHR Senior Research Fellowship (Grant number SRF-2018–11-ST2-004). Funding to perform the study in the SIDIAP database was provided by the Real World Epidemiology (RWEpi) research group at IDIAPJGol. Costs of databases mapping to OMOP CDM were covered by the European Health Data and Evidence Network (EHDEN).

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• 10 Research Question Examples to Guide Your Research Project

10 Research Question Examples to Guide your Research Project

Published on October 30, 2022 by Shona McCombes . Revised on October 19, 2023.

The research question is one of the most important parts of your research paper , thesis or dissertation . It’s important to spend some time assessing and refining your question before you get started.

The exact form of your question will depend on a few things, such as the length of your project, the type of research you’re conducting, the topic , and the research problem . However, all research questions should be focused, specific, and relevant to a timely social or scholarly issue.

Once you’ve read our guide on how to write a research question , you can use these examples to craft your own.

Note that the design of your research question can depend on what method you are pursuing. Here are a few options for qualitative, quantitative, and statistical research questions.

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