RM (Myanmar)

8/19/2019 RM (Myanmar)

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သေတသနလပၿပ ဆ ရငျဖင (၁)

ေမငေနလငေဒတခ ႀကႀကက ယ ယ ေခငစဥ ေလတ တပေနပ ႔ အထငေတ

ေမစၾကပန ႔။ ထ စအတ င ထငလတ ေမ!ပခင" ။ ေ# ႔ ေ အၾကငလတ $! ႔ပ။ မ!တလတ %မင&င ' ေထက%ပၾကပ။

ဒေနမ!တင (ပ ႔စ%#စ (အလတက ေ)ကန ( ) င ( (*ေတ*န က ပ ) ခ င ပ။ လလယ'ယေ%ပင Final Part 1 Residential Field Trip မ!ပ (Survey ေလတ+အပ,င-./0.မ! ပ (

Survey ေလတ+12 ႔လ/က&င မ1 ေမလ*င- 3င&မယ ( က မပ4* ေတ*နမ က 567 ယ'ေ3ၾကငပ။ * ေတ*န ႔ ေ%ပင' 3အပ (အစတ8ပ ငလတ အမ ၾက$! ေပမ ႔ ေအ9ခခအ#င (ေတ :ေလတမ! ပ *:႔က

Anatomy န ႔ Physiology ႔;ခ ေ%ပပ*။ Research Questions

?။Bacground and Signi!cance

@။ "esign A။ Study Su#$ects B။ %aria#les C။ Statistical &ssues ေလတယ'3႔$! 9ပ

Physiology မ!တ >။ &n'erence 1 concerns internal validity ?။ &n'erence concerns e*ternal validity (also called generali+a#ility) @။ The ,rrors o' Research ယ' 3႔ အၾကမ# ငမ!တ'3႔ပတယ။

D ( ..အၾကမ# ငမ!တငE9ပ$! 4ပေန9ပ။ ေအခ ) ငေတ *7ပတ8 F ကေတမ!ပ ယ'3ေ႔မၾကကၾကပန ႔ခင" ။ ခ $! ေ4ပG !နင& !င) ထ*က ။ ေနင& !ငမ$!ငတမ*2: ။ အခ $! 4ပ ' 3ကၾေကအင။ -P

အ ...*9ပ**:မ က *5H5ခ ေပၾကပ။ အခ မ! က7ပIင (တ /မ ႔ပ။ -"

အ ဒအထကG !ခ ( တ ( အမ!တEဥ ေလတDအစဥ 8တ ငစဥ စ9ပ အစဥ 8တ င ပI 3႔ ေအႀကပတယ။ *ပ 3လက မက 7င ,9ပ) ငေတ * ငပငပ/ေလတ လကကေပ ကေလတ * ေ႔*င အခ ေတ

က&3အတ ငပ မ!တေစခ ငJတယ။ >။ Research Questions ေ႔%ပမ! အ ဒ* ေတ*နက 2#စ' 3႔ ပK င , + 2က *ခ င +

2#စ' 3႔*ခ င&* ) တကစပတယ။ )တစJ လက /ေတက က* တ ႔မ ေကတ 2ၾကင (မ!မDတ0 Fမင&င+ 12 ႔လ/G !အ ဒ Protocol

) တႀက9ပ "issertation တငG !စမ;ပ ေပ#မ!မ ႔ ပ + ေခငေစဥ တ )ႀကခ ငတ ပ ' 3ကပ + 2မ! မ*ခ ငေပင' 3ေ႔တ ေပတEပ ေမ%ပန ေ႔န+ *)ကေ%ပ ႔မ!မDတ0F။ (အ ဒ: ေတတ) *


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"oes eating !sh loer the ris o' cardiovascular disease/

&s there a ris o' mercury to*icity 'rom increasing !sh intae in older

adults/

"o !sh oil supplements have the same e2ects on cardiovascular disease

as dietary !sh/

3hich !sh oil supplements don4t mae people smell lie !sh/


3/36

ဥပမ ? Title- Relationship #eteen 5evel o' ,*perience and "egree o' 6linical 7tility o'

Third 0eart Sound Auscultation.

Research uestions-

"o auscultatory assessments o' third heart sound #y more e*periencedphysicians result in higher sensitivity and speci!city 'or detecting le't ventricular

dys'unction than assessments #y less e*perienced physicians/

ဥပမ @

Title- ,2ects o' 0ormone Treatment a'ter 8enopause on 5ipoprotein

Research uestion- 3hat are the e2ects o' treatment ith estrogen plus

progestin (compared to place#o) on 5p(a) levels in postmenopausal omen/

အ ဒ research uestion တခ 2ယ* ) တ ( ေနမ! က ယ ( 2*ေပ8ပP/! ႔စပG ! 4ယ+ စ:စမ$!7#မ! 4ယ8 %ပင *က- 3င&2*ပG !က ယေ7ခ ယ ( က ယ (က မလH/%ပ/ င (ေအလတ႔အၾက 4$! တ ( ) =အက:အH အမ ႀက ပတယ။

အခ ေကတ 2*ေပ8ပP/! ႔စပG ! 4 က နပတ ? အခ က Bacground and Signi!cance မ!ပခ င ' 3႔research uestion =$! *င (တ ( .ေ*ေ*လတပ )ကJမယ။ အတ ေကက F&9,R ႔မ!တJတယ။

F&9,R 6riteria 'or a :ood Research Question

Feasi#le

Adeuate num#er o' su#$ects

Adeuate technical e*pertise

A2orda#le in time and money

8anagea#le in scope&nteresting

:etting the anser intrigues the investigator and her 'riends

9ovel

6on!rms; re'utes or e*tends previous !ndings

Provides ne !ndings

,thical

Amena#le to a study that institutional revie #oard ill approve

Relevant

To scienti!c noledge

To clinical and health policy To 'uture research

ဒမ!တE3က "esigning 6linical Research;


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သေတသနလပၿပ ဆ ရငျဖင (၂)

ေမနေ႔က%ပခ ( တ ( Research uestion =$! *င (တ ( .ေ*ေ*လတ (F&9,R 6riteria) က )က&င

>။ Feasi#le ) တက လကL/ေတေကတ @က လယEမ/ င (အတ ငအတထ ကပ * ေတ*န ပJ ႔@အလယေ%ပခ င ပ။ 2 ႔ ) ေတ တခ 4=ေခငစဥ ေလတ စတFစတ,/လတDေကငပငေကင*င

ကေလတ႔ ပ (အခက ယ' 3ပQ3င ထက ပ 9ပ အပK ကေလတ$! / ငJတယ။ အစထ က အပ ကေ3%ပတတမDတJ။ လကL/ေတတ ႔)မ!ပ *တခ ပI 3႔ ပတယ+ အလယေ%ပင ဒ* ေတ*နတခအလတက အခ / +ေ7င+

အပ (စအ ပEတမ+ * ေတ*နမ!ပ.ငGယ (*: ေအအလတက+ *:တ ႔က 5a# &nvestigationေလတ ပ&မယ- 3င က /Gယ (စတ အ ဒလတအ က ယ./ R :/ င (ေ2ငS မ! $! # ႔ ပတယ။ / ႔မ ႔) ေ႔ကတ

က ယEမတ ( Nတ ေစစGကေ*2: %မ!ကက 7/ ,မ!ပ။ *:တ ႔)မ! တ./K sponsor ေပမယ(:$! တတင ဒလတကစဥ စပ*တယ။ ဥပမ ေ%ပင 12 ႔လ/က အလ/ -3 @/!စG !* ေတ*န ပI 3႔အခ / အမ )

?/!စ&ပတယ+ အ ဒထ မ! ႀက တင%ပင -ငK / န ႔ တ ( ေအ%ေ#လတ စ စ59ပ က မခ /+ တင%ပခ / အန ) @ က

C ၾကလ*/ ငJတယ။ အ ဒေတ တကယ"ata

ေကကK / >/!စ >/!;စK ပ က / ယ။အ ဒထ မ! ေအၾကငအမL 4မL 4န ႔ မ ပ%#စ ႔အခ /Gပ*ပ2: ။ အ ဒ/!စ8ပ ငအ%ခအလတငမ! က ယ (* ေတ*နမ!ပ.ငGယ (: အ ေအက&ပမ ) တ ပထမ%ပTနပ။ က ယ ပK င (ေM.ဒန$!ငေလတက$!ပတ ( ေMမ 4#စGယ တ/!စG !>Uဥ

>BဥကJ $! တ+ က ယIတK (တ ( က မက လတထ မ!က 8ulti 6entres ေလတမ! :နထငQ ႔ခ 9ပ ေ( မ!လထက'တ ( ေအ%#မ 4 လတ%#စယ+ Statistician ဒ မ!မD တ က ယ 3ယ 3င 8inimum Reuired Sample Si+e

လတကၾက5(တ ႔အခမ! အန ) MV/ မယ- 3င %ပ/Eဥ စပတ။ မDတJ န ႔ 2ယ,Fမ!နမ5Q3င ( 'ormulaေလတထ ထ ( 9ပ Sample Si+e က မန5န5အလင ကGယ (အစ+ ဒ patients ေလတက ေ( ၾက5(တ ( အခ

ဒ ေလတ႔ပတယ+ 8inimum Reuired Sample Si+e မ/ င (အလတက ေ*က3 ေ( ထတပ+ ဒၾကင(မ ႔ ဒ* ေတ*န ႔= ေလတ႔$! ခ ကေလတ ေကကK ကေလတDတ#င ( ဒအပ င ဒအပ ငမ!တ#င (

အန5/ ငJတယ' 3႔ ေ/ ငJတယ de'end ပQ 3 ငJတယ- 3မ!* ပJ။ ()တ ႔ 2*ပ - 3င& က မႀကၾကပ,Fန ႔ *က-3င& တက W* & = Academic Board က ကK =မခ ေကတ#င( အမမခပ။

တခ ပ $! ပတယ+ က ေယက င*#စ (အလတက *:တ ႔ကK မ! က ယ (က မ9ပမ!ပ။ -P )ကေ%ပင လကL/ေတနမ(မယ" ။-" )

အ တက Su#$ect န5ငJ+ က patients ေလေတကတ#င ( ငတ ႔)မ! တ/!စ/!စ 3 ေထငQ ႔က $! ပ*1က ႔"ata မ ကကEမပမ ( ) ငေလကယ။အမယ ဒ ငG ေ*တပ


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2ယ'3မ!မ%#စQ3 င0F ) ငေတ *မ*2:


6/36

5engthen the time 'rame

7se strategies to decrease sample si+e

c. 8ethods #eyond the Sills o' &nvestigator

6olla#orate ith colleagues ho have the sills

6onsult ,*perts and Revie 5iterature 'or alternative methods5earn the sills

d. Too ,*pensive

6onsider less costly study designs

Feer su#$ects and measurements

5ess e*tensive measurements

Feer 'olloup visits

B. 9ot &nteresting; 9ovel; or Relevant

6onsult ith 8entor8odi'y Research Question


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သေတသနလပၿပ ဆ ရငျဖင (၃က)

အခ note မ!တ Research Question တခ မ! ေအအႀက) 9#စ (*က- 3င& 2*ပ 3 2ယ' 3

ခ ဥ ကပၾကမယ- 3တ လကL/ေတအ%မငS က ေ%ပခ ငJတယ။ ပထမ) ပခ င က ဒDလကL/ေတအ%မင *က,ကJ %#စJတယ။ မ!/ေကငမ! မ!/Jမ (မယ။ အပ+ အ%မငGတ:တ+ မ!နတလတ ေထက%ေပ.#/ေပ/ ငJတယ။

Research တခက ပ ယ-3တ ( မ:567 ယK က 3ကအ*စ8*စေ* ေလတ႔$! ခ ကေလတက $!ခ င ' 3႔ပ။ * *ထ9ပ* အန5န ႔အမ မ!/ေနတယ-3တ ( ေလတ႔$! ခ ကေလတက ထပ& !9ပ *ကေ*%ပဥမယ-3င အခ / 3/

:ပ/ၾက 4မနပJ။

အ ေ%ပတ အ%ငင7ပစ စ%#စ 'ပတယ။ *ထ9ပ*) တက 2လတ ။အ ဒလတကမ!/Jတယ- 3တ 2ယ,Fေလတက 2ယG !* ေတ*န ပ9ပ 2ယ'ေ3ကကK 1က- ထတ ။ အ ဒအတ င က ယ (./က ငG ! %#စေန။ က ယ ()မ! အပ '။

ေအစလတ ေအစလတ 1) ထတ&င ထ ေတ,က လထကJတယ။

ဥပမ အM9M 4 )ႀကက စၾက.[#ငေဒ$!ငႀက = ေအထက8ပ႔န ႔ ေ%မလကL/*:ေလတ = မလတငမခငေ*/! 4/ က ေ( ထတ ဒ ဒ Prevalence န႔ Ris Factors ေေလတလတ= ႔ D ကလကယေ လတ အ*ပHပလတ \တ'3လတ ေ. က ေကငလ**တ ( ။ ငတ ႔ ေတလင /မ!

အ ဒ\တ'3.ယ3က'3က9ပတပ * ေတ*န ပEမ ေပင ) င%#င ( စဥ စပဥ။ D ကမ ကQ !# ]%# ] /!ခင7ခ 7/KL/ မ!အက 4ပတ ( \တ' က ခင" )ကH 4ေခ လတ)မ! 2#စ, ႔ 2ယ,Fေ( ထ* ႔။

ေမနန %႔#/႔ၾက5(ေတ D ေအနလက /က )*မမ က *:$ =)က မ မ *:ေကလတ)မ!ပ ေ( ထတပ ထပေလတ႔မ!။ စကတ5ကမ! *ခ င (*: မတ:ပ န ႔ Social တ ႔ ,conomic တ ႔ #lah

#lah ေလတခVထပဥ။ ပထမက က ယ (ေတလင L/မ! ေအ%ခခ #aseline data ကစ9ပ studyပSတ$! အင& !။ မ$! 2:) ေ*င အ ဒကစ။ $! တယ^ပမယ ( က ယ' 3ပK င (အ)င(အထေတ ေမကေ*2:) င

အ ဒေနကစ။ အ ဒ "ata ေလတ2ယG !/ ငG ) င+ ေ)တက W* ေလတ ေ)*ေတ*နဥစလတမ!က မစငေကနစ$!။ "8R မ! Pu#lication 5ist $! ပ*


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ပခ ပP ႀကတင ' 3က ႔အခ................။ 2လတ%#7စ ,ၾက ..ေ2အ%ေ#လတလထက'* ....Research6ulture 7#႔%# 4စ# ႔ ေအအႀက) အပ ႔ :အငအ%မစေလတ* ....လက /ေတေမ%ပခ ငJ။

အမနတမ *:တ ႔ေ2ကေန%ပမယ- 3င *:တ ႔တကယ'3ပGယ ) ငေတင *:တ ႔ တ %#5()5ပ/ င9ပ။ စအ ပEတမ + စၾက5 (တ က Facilities+ အ ဒအ%ပင အ ဒေက င*လတ

စၾက5(တ က, 3# ႔ *:႔ ႔မခင_နန ႔ *:႔)က တပတ 2ယQ !စQ7ခင(%ပ49ပ စၾက5 (တ က 2ယ8ခ ေ/ န2ယ8ခ / 8ထ * ႔* ) တကေတ ကလL/ေတ*ပတယ။

ဒ ေအ%ေခအနမ 4မ! 12 ႔လ/^M အလတက7င,ငတ ( * ေတ*နစတမလတ = ေနက 0idden C#$ective D အ ဒ 6andidate ေတယက3 * ေတ*န) တ စတ.ငE# ႔ * ေတ*နတခ ပ (ေနမ! အပ (

ေအ%ခခပS3ပQ5လတ တတေ%မလက,စ# ႔+ * ေတ*န ပ&ငန ႔ $!7##တ& ! 4တ ႔ စလတD*:)5ပ: နတ ( ပHပG ! ေအထက8 ပ ( %#7စ ,# ႔+ အ ဒကတ)င(%ပတ)င ( *:႔ ႔ 6areer ေတ ကG !* ေတ*ေနလတ)က'3ပK င ' ပ +

ဒမ!မDတ' ေ နကG 4)ကေလတ * ေတ*န ပ (အခ ႀကၾကပေပ/ င (အေ58 လ*$! *:ေလတ %#စI 3႔ ပ အပ*င (တယ'3႔ ထငပ။ အ ဒ 6andidate =႔အ7စမအစက က ေကငလ/ ႔ င,ပ6! ေ4မ7#ယ မႀက

* ေတ*/%ပ4/ င ' 3ေ႔ကတ လကL/ေတတ ႔ မ ဒတ7ပယ တင မက2: ဒမ!ငတ ႔)လတလက ေ႔တင ေကKမငထခတဥမ!။ (7MLမတထ #:န+ ေအန Body 3eight ႀကန =ေက ေမကင ၾကေမကင။ )

အ အ ..... ေမငေနလင နင0မ! DတDတ%ငငမ*ပ $!5ေၾေကမနန ႔ ငတ ႔တ /က ဒ ပ %#တ,/ခ ( တပ ။ *ငေပ/ င (*:ေေလတ + *င RFမယ (*:ေေလတ ပ ႔+ *က- 3င& တက W* ႀကလတမ!5 *:႔

Academic Board ေလတ 6ommittee ေလတ Faculty 8em#ers ေလတ အေအကQ ႔D ( ။ FB ေပP9ပ ေတမမ1ယ0 ေ႔လတ ေမန ႔ ) !ငေတ လ/ $! င .န`မေၾကငပ။

အတငတ ပK င လတ မ လ*တ ( အလတက တကယေမ ( literature searching and reading န ႔ပတ,ကက ေနက note ေမ!ပမယKင" ။ -P

9ay 5in8arch D; E1.


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သေတသနလပၿပ ဆ ရငျဖင (၃ခ)

က ဒေနေ႔တ ေအ*ေအထ( ေလတ တခ/ပ9ပ အလမNေတေကအင (D D ေ နကန။) တေကယတ

အမ *9ပ* ပေနတလတက ပ ထပ9ပ /!မ.င%#4တပ။ * ေတ*နတခအလတက အပ (စ67 ကEတမ 2ယ စ$!မ ) ေတ လက /ေတေကတ ခင&မငေၾကငလတ က

ကS $! တကစ$! ႔ အၾက ေပပတယ။ (အ ဒအခ /G !တ *:2ယQယJယ3 ပ စတ.ငE* ေတ အၾကမထ9ပ*$! မ!ပ။) 2ယ0*ပG !ပ %#စ%#စ ကS $! / င က %ပa/စအ ပJ ေေခPခP #တ 3#တ&မယ (စအပ' 3႔ပ

*မစဥ ပ လH/လH/ Te*t Boo စအ ပၾကလတေကတ$! ၾကပတယ။ အ ဒႀကလတထ ကမ! က ယ' 3ပK င ( ေအၾကငအက ေအ*စတIတJ။ ပ မ!/8#င ( စအ ပၾကလတ =အခ/အ) မ! က မလH/ ပတတJတယ။ အ ဒက

င-က& !#တJ။ မ6င ' မပ:ပန ႔ ခV ထ တ ႔ထပ။ ( ေနကခ က အ ဒDၾကလတကက ယ ( * ေတ*နအလတက ေအထက8က: %#စေစမယ ( *အ 2ေကbငအလတကေန+ က ယ (စတမထ မ! က မထ:ေအင ကၾကေကနအ အထ

$! *မ !ေ


10/36

ေလတထ ကက ယQ ႔အ) င -3 ႔ထင႔ re'erence က )က& !တ။ ခ 5S3ၾက $!ငင အစ တစ ခက ေအင S3တ9ပ က။ ေတတစစ ေတငတစEလ*1) ႔ကပ ၾကလ*မ!။

အ ဒ#တE M နယေလတ 9ပ+2ယ'3#တၾကမ ) ေတကတ ေနကပ ဒG !)ကJမယ။ 2 ႔ ) ေတ #တ'3က9ပ *:တ ေ႔ကတ အ ) *D ႔ကK ကR 3န ႔ 9ပလ*မ!မD တ' 3႔ပ။ တစK3ပ *တခ ပေစခ င က 2ယေန+ 2ယေဒ* 2ယJH$!ငေလတက ပ Sတ ( pu#lish ပပ ေ%ပပ မ ကE မ! တ မယ ပန ႔။ အD

:ေလတ%#စ ႔အလတက : ပ မ!တတJတယ။ အ ဒမ! ,vidence Based 8edicine တ ႔ 6riticalAppraisal တ ေေ႔လတ%ပၾကပတယ။

9ay 5in

8arch >; E1


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သေတသနလပၿပ ဆ ရငျဖင (၃ဂ)

ဒ note မ!တ evidence #ased medicine ) တႀကက န န ေ%ပပမယ။ ဒအပ ငက ေ# ႔

အမ!/ေ%ပင ေတတလက/႔ပတယ။ 2 ႔ ) ေတclinical

ေလတ#asic medical science

ေလတ န ႔ပတ,က'င လကL/ေတက နက/တ မ! မ*ေတ2: ႔ က ယ (#*က ယ, ႔ပ။ 2ပ %#စ%#စဒေနက ေက လ* ႔ မ%#စေတ ေပဥမယ။

အင 9ote မ! ေ%ပခ ( * ပ #တ'3က9ပ *:တ ေ႔ကတ အ ) *D ႔ကK ကR 3န ႔ 9ပလ*မ!မDတ' 3႔ပ။ တစK3ပ *တခ ပေစခ င က 2ယေန+ 2ယေဒ* 2ယJH$!ငေလတက ပ Sတ ( pu#lish

article ပပ ေ%ပပ မ ကE မ! တ မယ ပန ႔။ အD :ေလတ%#စ ႔အလတက : ပ မ!တတJတယ။ အ ဒအခမ! 2က ယ ႔2က ပ မ ေ႔မတ ( အခမ! က ယ 3ယ 3ငJ အ ဒ article ေလတက စနစ က အက %#တ9ပမ! ကK

*;စ ႔မ!ပ။

ဒေနက ေနစ9ပ %#စQ 3 ေင ,က3ပ %မ/Gမ! 4%ပ4ပမယ။ 2ၾကင ( ) ေတ တခ 4= စက လတD*:႔မ: 2*စကန ႔ ပ 9ပ)ေ တယ' 3႔ ခ စ =ပ။ (ဥပမ ,pidemiology က ကပေM


12/36

&&1 ,vidence o#tained 'rom elldesigned controlled trials ithout

randomi+ation.

&& ,vidence 'rom elldesigned cohort or casecontrol studies; pre'era#ly

'rom more than one centre or research group.

&&< ,vidence 'rom multiple time series ith or ithout the intervention.

&mportant results in uncontrolled e*periments (such as the introduction o'penicillin treatment in the 1HDEs) could also #e considered as this type o'

evidence.

&&& Cpinions o' respected authorities; #ased on clinical e*perience;

descriptive studies; or reports o' e*pert committees.

Strength o' recommendations

A. :ood evidence to support the intervention.

B. Fair evidence to support the intervention.

6. &nsuIcient evidence to recommend 'or or against the intervention; #ut

recommendation might #e made on other grounds.

". Fair evidence against the intervention.,. :ood evidence against the intervention.

ဒက အလယက: က:ထ ( ႔တ ႔Dက က:ထ ( ေပ ကပ။ (T0, 5A96,T J %ol H J Ganuary >;EE J .thelancet.com = An overvie o' clinical research- the lay o' theland #y "avid A :rimes; Kenneth F Schul+ ထ ကပ။) က / တလတက lin ထ ပပမယ။


13/36

1. :eneral Reading

http-==en.iipedia.org=ii=,vidence#ased?medicine

. The e# site o' the 6entre 'or ,videnceBased 8edicine in C*'ord in the 7K

http-==.ce#m.net=


14/36

H. American 8edical Association

http-==.$amaevidence.com=

2ယ'3ပ %#စ%#စ အ ဒ guideline ေလတ level o' evidence ေလတ ) င&) င& checlistေလတအ%ပ5(အစက အၾကမ#Lင( ၾက5 ( က&င Research "esign ေလတ =ေအ%ခခ +

2ယေနမ! 2ယ' 3 sample si+e န ႔ sampling method က ** + *ကေ*%ပ# ႔အလတက 2ယ' 3 ) င& statistical test က ** + တ ( result က interpret 2ယ' 3 ပ9ပ 2ယ'ေ3ကကK 1က- မ ) တ

detail မD တ&ငေတင အၾကမ# င*မယ ) တပ ေပPပတယ။ အ ဒလတက ေနက notes ေလတမ! တတQ3 ေင ,က )ကေလ*ပမယ။ အခ ေကတ )ကေ%ပင ေတတစတeစE ေကငလ*မ!စ ႔ပ။ -"

()တ ေ႔ေတလတတမ*2: လကL/ေတေကတ Biostatistics န ႔ Sample Si+e 6alculationေလတထ က 8athematical ,uations ေလတ Sym#ols ေလတ%မင&င အႀကခငက က,


15/36

သေတသနလပၿပ ဆ ရငျဖင (၄)

က အခ ေတ ဒN ငလတ#က !5(ၾေကအင။ ဒေနမ! ေ%ပခ င က အခ ဒN ငလတ) တက ,pidemiology

အ%မငQ ႔ အၾကမ# င ;ခ ထတယ- 3တ *တခ ပ&ပမယ။ 2 ႔ ) ေတ *က- 3င&နယJယေပPမ! မ:တ59ပတ *င(ေ * နမယေပထတ ဒမ!မDတ ဒN ငလတမတ:တ$! ပမယ။ ( ဥပမ Biomedical Researchေလတန ႔ Social Science Research ေလတ ,ducational Research ေလတမ! ေအ%ခခ

ေ*2*2. တ:တ $! မယ မတ:တ $! ပမယ။ Biomedical Research ထ မ!တငG !,pidemiology$! ေ4ထင (ကယ Biostatistics $! ေ4ထင (ကယ လ*တကမတ:ေ*ပ2:။ ) မDတ&င research design) တန ႔ ဒလတပ $! တယ+ က / ၾက ၾက#:ပင ႔ လကL/ေတ %ငငမေနမ! စ ႔ပ။ -)

Research design ေလတက epidemiology approach န ႔;ခ င ပငG M Vႀက ? ခ 1က လ*ပ*တ ( ။ တခ က အ ဒ* ေတ*နက ပ (*:က *:႔2**:%#စေနတက ေစင (ၾက5(ေ( တ (

အ ပE3န ႔ ေနကခက အ ဒ* ေတ*/%#စEဥ D *:႔2**:%#စေနတ မDတJ * ေတ*န*မက ပ ' 3႔

ေအၾကင အက 4ေ အကငအ) လတ %#စ 'တ ( အ ပE3 ) 9ပတပ။ အလယေ%ပင က ယ (ေပယMပ* မပ2: ေ႔%ပမယSငJတယ။

အ ဒက C#servational Study န ႔ ,*perimental Study ေ႔ခPပတယ။

ဒေနမ! ပHတေေလတနကG ကၾကပန ႔။ *:တ ႔က စထတ ( စနစခ မ! ဒနမ5 ဒ) တ */!င (9ပ*#စေန ႔ပ။ တေခတ က ယေလတကေအလတခင9ပတ ,*perimental ) တ Trial ) တ:ေလတက စမစD (

2D ( ဒနမ5ႀကမၾက 4ကေပင။ ေ%ပငဥ) တမ 4မ မ ပၾကပန ႔


16/36

ဒပမယ ( *:႔မ!အန5ခ က /! 4ငယ!ဥ Eအ ပE3မပတ ( အလတက ေကကK 1က- ႔မပ2: ။ (အ ဒေကကK က-3တႀကေနကG !)က& !ငပမယ။)

C#servational 6omparative (Analytical) Studies ေလတမ! * ေတ*န ( က ၾက5 (9ပတ

6rosssectional study- a snapshot in time6ohort study- looing 'orard in time

6asecontrol study- thining #acard ယ'3႔ထ;ပK ပတယ။

အ ဒက လက /ေတက အလယ̂ ေလတပတယ။ *ခ င က ဒ* ေတ*ေနလတမ! ေအၾကငယ+ အက 4ယ ?ခ $! ပတယ။ ဒေအၾကငက ဒအက 4#စေစ*ပ။

အ ဒအခမ! လကL/ေတတ ေ႔လတ ဒN င1) ေတဒ population ထ မ! ေM#စေစတ ႔ ေအၾကငယ ေM$! မ$! ) တ ( အက 4ယ တခ / S တ9ပ 4င S မ! စစမကကၾကတယ-3ပစ ႔။ အ ဒ 6rosssectional study

ပ။

တခ အစက ေMမ$! တ ( *:ေလတမ! ေM#စေစတ ( ေအၾကင $! တ ( :န ႔ မ$! တ ( : ?အ ပE3က အခ /8တ ငအတတခ ေစင (ၾက5(တယ+အ ဒ?အ ပE3မ! ေM#စ 'တ ( *:!!* ေMမ%#စ (*:! $! မ!ပ ။

အ ဒ ေအၾကငေကနအက 4)က3 ေစင(ၾက5(င 6ohort Study ပ။

ေနက- 3တခက 6asecontrol study ပ။ အ ဒက ေအပPကန ေ႔%ပငပ/G !တJတယ။ ေM$! တ ( *:ေလတန ႔ အ ဒေMမ$! တ ( *:ေလတမ! ေM#စေစတ ( ေနကေၾကင N.င%ပ/ ' 3ကက ) တပ။ (case ေလတန ႔

control ေလတန ႔ပ ႔ case control study ေ႔ခPတမD တJ2:)

ဒမ!တK င ' မ!တJတယ။&' e studieda. ,*posure and Cutcome at the same time- 6rosssectional Study

#. ,*posure to Cutcome ('olloup in time)- 6ohort Study

c. Cutcome to ,*posure (0istory)- 6ase 6ontrol Study

အ ေလတ2 ႔;ခ * +တခခ ငမ! 2အ* ႔ 2အန5 + 2ယ'3 criteria ေလတ$! ႔ 2လတလတကK ကၾက* က*ခပမယ။ 5ancet Articles ေလတ = 5in ေပပမယ။

ေနက ,*perimental Study ေအကG !တ ထပ9ပ;ခ လ*တက Randomi+ationေပPမ!ေအ%ခခပတယ။ (Randomi+ation ) တက က ယေ7ထတ ( study su#$ects ေလတက

assign ပ (အခ 2ယ အ ပE3မ! ေနခ မ treatment group place#o group ) တ ( ေနမ!randomly ေနခ တက ေ%ပတပ။ random sampling န ႔မတ:ပ2: ။ D Dက su#$ect ေ7တ။

ဒက ေ67 9ပ*က ေနခ တ ႔ အလယG !တJတယ။)

အ ဒအခမ! Randomi+ed controlled trial ယ 9onrandomi+ed controlled trialယ'3႔%#စ'ပတယ။(*:႔မ!က တကယ'3ပ&င ပမယ(အခ ကေလတကပ ေအ*စတ' 3႔ *ပ,ပေမ!ပ။ )

အခ ေခ ( တလတက .အၾကမထ5J။ ေနကခ က ဒ# င) တက က ယ,ခ င ( research uestion န ႔o#$ective ေနက3 က&မ!ပ။ န န ေ ေအ အတင ပ' 3ေ႔ပမယ ( * ေတ*နတခ မ! * ေတ*န*မ =

*ခ င (research uestion ကပငGပပ ) တ *တေပခ ငJတယ။ အ ဒေနမ!ထ က %ပငE$! တ %ပင ,င (တ %ပငJ။ ဒN င ေစတ( ခ ေကG !နမ5ေေလတ%ပင ပQ5 ပD/ေလတ%ပင+ ပ 9ပစ ေအင- 39ပ စ)န#လတထ5(ၾကတမ 4 မ ပၾက# ႔ ေမတYပJတယ။ က 4ယ) 7ငIင (တမ! မD တ


17/36

ဒ 9ote က ေတ အ ဒ 5ancet ထ ကနဒ/န =ပ ကE*တ'3ကJတယ။ -"

8any clinicians report that they cannot read the medical literature critically. To

address this diIculty; e provide a

primer o' clinical research 'or clinicians and researchers alie. 6linicalresearch 'alls into to general categories- e*perimental and o#servational;

#ased on hether the investigator assigns the e*posures or not. ,*perimental

trials can also #e su#divided into to- randomised and nonrandomised.

C#servational studies can #e either analytical or descriptive. Analytical studies

'eature a comparison (control) group; hereas descriptive studies do not.

3ithin analytical studies; cohort studies trac people 'orard in time 'rom

e*posure to outcome. By contrast; casecontrol studies or in reverse; tracing

#ac 'rom outcome to e*posure. 6rosssectional studies are lie a snapshot;

hich measures #oth e*posure and outcome at one time point. "escriptive

studies; such as caseseries reports; do not have a comparison group. Thus; inthis type o' study; investigators cannot e*amine associations; a 'act o'ten

'orgotten or ignored. 8easures o' association; such as relative ris or odds ratio;

are the pre'erred ay o' e*pressing results o' dichotomous outcomeseg; sic

versus healthy. 6on!dence intervals around these measures indicate the

precision o' these results. 8easures o' association ith con!dence intervals

reveal the strength; direction; and a plausi#le range o' an e2ect as ell as the

lielihood o' chance occurrence. By contrast; p values address only chance.

Testing null hypotheses at a p value o' EE> has no #asis in medicine and should

#e discouraged.

9ay 5in

8arch N; E1


18/36

သေတသနလပၿပ ဆ ရငျဖင (၄ က )

,*perimental Studies

တကယေတ စစဥ ေလတမ! ေအ%ခခ %#စ (C#servational Studiesေလတ+အ ဒအထ ကမ! "escriptive9ပမ! Analytical ယ' 3႔ အစဥ 8တ င $!ငပမယ ( ေ အၾကငလတ$! ႔အ ဒ Crder က ေ%ပငပ/ ' !/9ပ,*perimental Studies ေလတေကစ%ပပမယ။ ဒမ! ေ အစပ ငေက%ပခ ( တ ( 5evel o' ,videnceန ႔ပစတ:လ*မ!မ ႔ပ။

တကယေတ Study "esigns ေလတန ႔ပတ,က'င * ေ႔* ေ႔ မ$!ငမ$!င#စ (အထ မ!,*perimental Studies ေလတမ! ..ဒ အ1က ၾက) ပ။ 2 ႔ ) ေတ *:႔မ!ပ.င (

အစတ8ပ ငက ယQF က တ%ခDထကG ပတယ။ ဒၾကင (မ ႔ဒေနမ! လကL/ေတ 5ancet ,ditor အ;# ႔ ( အ2အတ ငပ လ*ပမယ။ တ $!ငအငJ။ တခ 4႔အပ င ေလတကဒေနမ!$!ငမ!မD တJ။ *5ခ ေပ9ပ ေက ကJ။

(

ဥပမ+Bias

DမL 46on'ounding

DမL 4ပ။)

ပေထမ%ပခ ( * ပ ,*perimental Study ) တက * ေတ*န*မက intervene ပ' 3႔တ ( Dပ။ အ ဒမ! ) ၾကပစ ႔ ေ)တခ န ႔ place#o က :ေလတမ!စမၾက5 (မယ-3ပစ ႔။ (,thical :uideline

ေအၾကငဒမ!ေမ%ပ*ပ။ စတ.ငEတ ( *:မ ေ ကတ :uidelines 'or Biomedical Research &nvolving0uman Su#$ects Prepared #y the 6ouncil 'or &nternational Crgani+ations o'

8edical Sciences (6&C8S) ) တ ( pd' # င 3 .cioms.ch=pu#lications=layout?guideEE.pd' မ!1) ခ 9ပ#တQ3ငJတယ။)

အ ဒအခမ! ဒ*ေတ*န*မက ပ.ငGယ( su#$ects ေလတက *က- 3င (criteria ေလတန ေ႔67 ပတယ။(တကယေတ အ ဒက R6T %#စ%ခင 9R6T %#စ%ခင+ C#servational %#စ%ခင ,*perimental%#စ%ခငန ႔ 2မ!မပတ,ကJ2:။ *ခအခ/ ေအနန ႔ ေပမယ။ တကယ'3႔မ ကလL/ေတက:ေခ နတ ( "esigning6linical Research ( မတကပ !/ႀက5(မင က ေလတ႔ပမ(မယ။ 6hoosing StudySu#$ects ) တက တခ/+ Sample Si+e န ႔ Poer အလတက ?ခ/ပ။ -P)

အ su#$ects ေလတက ေ79ပတ ( အခ ခ ေနက%ပတ ( treatment group ထ place#o groupထ *:တ ႔က ေနခ တ ( အခ Randomly Allocate ပ&င Randomi+ed Trial %#စ9ပ မ ပ&င9on Randomi+ed Trial %#စJတယ။ (ႀက4 တ /$!5'3ကJဥမယ။ 9C9 ပ။ 9C9, မDတJ။ အ ဒ?ခက

အ*လထကGတ:2:ထငJတယ။ အ2\/8မ စ မ!တမတ:ပ။) Randomly Allocate မပ0F) တ ( ေနမ! $!ငပတယ။ က ယ Alternate Assign ပ&င 3 9onRandomi+ed %#7စ,ပ9ပ။ အ ဒအခမ! #ias ပ/ ငJ9ပ။

အ ဒေတ*:တ ေ႔က%ပပတယ randomi+ed trial မ!*! င selection #ias န ႔ con'oundingက #ယQ3 ငJမယ'3႔။ (ဒလတ ခVထထပပ။)

&deal R6T တခ ( $! မယ ( $! *င (တ ( ေအၾကတ ( အစတ8 ပ င Bခ က >။ Randomi+ation- :eneration o' allocation seuences in randomi+ed trials-

chance; not choice

?။ Allocation concealment in randomi+ed trials- de'ending against deciphering @။ Blinding in randomi+e trials- hiding ho got hat A။ Sample si+e slippages in randomi+ed trials- e*clusions and the lost and

ayard

B။ 7neual group si+es in randomi+ed trials- guarding against guessing

အ ဒက 5ancet Article ေခငစဥ ေလတ က:ထ5 (ေပ ကပ။ -"


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Randomi+ation

@The hallmar o' randomi+ed controlled trials is assignment o'

participants to e*posures purely #y the play o' chance. Randomi+ed

controlled trials reduce the lielihood o' #ias in determination o' outcomes.

3hen properly implemented; random allocation precludes selection #ias.@

ဒပမယ(တ ( အ ဒေနမ!ထ ကစ9ပ မ$!ငၾကပတ ( ။ @Some medical researchers even thinthat they have randomi+ed #y a method that; hen descri#ed; is

o#viously not random. 8ethods such as assignment #ased on date o'

#irth; case record num#er; date o' presentation; or alternate assignment

are not random; #ut rather systematic occurrences.@

အ ႀကစလတက:တ ပ င9ပ


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To PR&9T; press ctrlP. To SA%,; clic on FileSave as.

Then close this indo.

Cptionally; delete these instructions #e'ore printing or saving

UUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU

UUUUUUUUUUUUUUUUU ,T6,T,RA %ersion .M>

Thursday; Hth 8arch E1; 1-


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သေတသနလပၿပ ဆ ရငျဖင (၄ ခ )

ေအ$!(မ!ပခ ( တ ( အခ/က R6T တခ ပGယ- 3င ပထမ) အခ က%#စ (Random 9um#er :eneration

အ)င(ပ။ အခ ေ%ပခ င က အ ဒလတက'3႔တ ( န ပတေလတက ကေလတ( 2ယ' 3** ) တပ။ ေနန ႔ က9ပအ)င(ေလတ1က %ပ/ ငJတယ။

အ ဒမ! အ)င ( ?ခ )ကJတယ။ @Allocation 6oncealment@ န ႔ @Blinding@ ပ။ အမ အ#င ( အ ဒေနမ! န5G ! 41 တတJတယ။

@Allocation concealment sees to prevent selection #ias (di2erent su#$ects #eing

entered into the di2erent groups). &n contrast; #linding sees to prevent

per'ormance and ascertainment #ias (di2erent response to treatment; or to

measuring e2ect o' treatment due to noledge o' hich treatment as

received).@

($!ငစ စၾလကလတကမ *ထကG ပ9ပ။ Sampling and Sample Si+e "etermination ယ BiasေလတယJ။ )

) ခ င က Allocation 6oncealment ) တက ပထမလတကK (တ ( Random 9um#ers ေလတက ကေလတ႔က င (*တ ( အခမ! 2ယ'3ေနခ * ) တပ။ Allocation concealment shields those

ho admit participants to a trial 'rom noing the upcoming assignments.

The decision to accept or re$ect a participant should #e made; and in'ormed

consent should #e o#tained; in ignorance o' the upcoming assignment.

က ယ ( ႔စတမမ! ဒမ!မDတ R6T ပ ႔ pu#lish ပ (paper မ! ဒအ)င (ေ လတက ေ က ေပမယ။ ဥပမလတ က:ပ ကJတယ။

,*ample 1

Random allocation techniue consists o' allocating consecutively num#ered

treatment #o*es 'or each oman; including in each #o* seven independent

#ottles; each o' them ith ta#lets 'or 'our ees o' treatment. ,ach #ottle

contains 1EE ta#lets. There'ore each su#$ect ill have seven #ottles ith the

same randomi+ation num#er. Treatment #o*es ill #e ept at the clinic. Bottles

ill #e provided consecutively as needed every month a'ter randomi+ation.3hen the oman comes 'or antenatal care; she ill return the used #ottle 'rom

the previous month and ill #e given the ne*t month4s #ottle 'rom her #o*. She

ill return the #ottle a'ter D ees; regardless o' hether she !nished the

ta#lets or not. ,ach #ottle is num#ered 'rom 1 to ithin the #o* and should #e

used seuentially.

,*ample

The +inc and place#o syrups ill #e supplied in #ottles that looed identical; and

the appearance and consistency o' the syrups ill #e similar. %itamin A andplace#o capsules ill #e identical in appearance. The randomisation code ill #e


22/36

ept sealed until the completion o' the study. The treatment allocations ill #e

disclosed a'ter the !nal analysis.

,*ample <

OThe various place#o and treatment #locs ere then issued ith a medication

num#er and assigned to consecutive patients in a seuential order. To copies

o' the randomisation list ere prepared- one as used #y the pacagingdepartment; . . . supplied in #lister pacs containing E capsules 'or morning

and evening administration over 1E days. These #lister pacs ere supplied in

la#eled #o*es; ie; one #o* 'or each patient and each dose.V

,*ample D

O. . . concealed in seuentially num#ered; sealed; opaue envelopes; and ept

#y the hospital pharmacist o' the to centres.V

,*amples o' 8inimum "escription o' Adeuate Allocation 6oncealment

,*panded "escriptions Providing :reater Assurance o' Allocation 6oncealment6entral randomi+ation

8echanism 'or contact is descri#ed (eg; telephone; email; 'a*). Precautions

taen to ensure

enrollment prior to allocation as ell as description o' training 'or

individuals sta'!ng the central o'!ce are provided.

Pharmacy controlled

"escription provides indications that the researchers developed or

validated a proper randomi+ation scheme 'or use #y the pharmacy.

"escription that the pharmacy as provided instruction in allocation

concealment.Seuentially num#ered containers

"escription provides details o' no detecta#le di2erences #eteen containers.

6ontainers ere eual in eight; similar in appearance; and tamperproo'.

Seuentially num#ered; opaue; sealed envelopes

(OS9CS,V)

"escription o' details on ho tampering and discovery as prevented (eg;

car#on paper lined to create an audit trail; aluminum 'oil or card#oard placed

inside to prevent Ohot lightingV).

ဒမ!အ*မ မ!က S9CS, method ပ။,nclosing assignments in seuentially num#ered; opaue; sealed envelopes can

also #e a good allocation concealment mechanism i' it is developed and

monitored diligently. &nvestigators should ensure that the containers=envelopes

are opened seuentially and only a'ter the participant4s name and other details

are ritten on the appropriate la#el=envelope.

Blinding

Blinding re'ers to eeping study participants; health care providers; and

sometimes those collecting and analysing clinical data unaare o' the assignedintervention; so that they ill not #e inuenced #y that noledge. Blinding is


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important to prevent #ias at several stages o' a controlled trial; although; it is

not alays possi#le to implement.

Blinding o' patients is important #ecause noledge o' group assignment may

inuence ho they respond or perceive they respond to treatment. Patients ho

no that they have #een assigned to receive the ne treatment may eitherhave 'avoura#le e*pectations or increased an*iety. Patients assigned to

standard treatment may 'eel discriminated against or reassured that they are

not #eing e*posed to something ne. Blinding is also used to protect against the

possi#ility that noledge o' assignment may a2ect ho the health

pro'essionals #ehave (per'ormance #ias) or ho outcome is assessed (detection

#ias). Blinding is not alays practical (e.g. hen comparing surgery to drug

treatment).

,*ample 1

The study ill #e a multicentre randomi+ed; place#ocontrolled; dou#le#lindtrial.

There ill #e three chea#le ta#lets containing >EE mg elemental calcium to #e

taen every day. 3omen ill #e instructed to che ta#lets at meals; #ut at least

< hours aay 'rom any iron supplements. The control group ill receive three

ta#lets a day o' identical characteristics; colour and taste as the intervention

ta#let prepared and paced #y the same pharmaceutical manu'acturer.

The need 'or un#linding should #e e*tremely rare as the trial intervention is not

associated ith severe side e2ects and it ill not delay or prevent standardmanagement o' the patient in the case o' a complication such as renal calculus.

&' the oman develops preeclampsia or eclampsia; she ill #e treated according

to routine treatment protocols regardless o' the supplementation status. &';

hoever; un#linding is needed 'or any reason the trial coordinator in :eneva ill

#e contacted to reveal the treatment. (30C 8ulticentre Randomi+ed Trial o'

6alcium Supplementation 'or the Prevention o' Preeclampsia go to protocol )

,*ample

:iven the nature o' the intervention; e cannot #lind the randomisation; and

data collectors ill no i' they #elong to an intervention=control hospital.Furthermore; intervention hospitals ill receive a computer to implement the

intervention; hich ill #e used; among other things; to monitor clinical data

(i.e.; episiotomy rate and active management o' the third stage o' la#our). As a

conseuence; it is e*pected that the intervention ill improve the capacity o'

intervention hospitals to collect and revie clinical data and #ias might #e

introduced in outcome assessment. To minimi+e this pro#lem; the data collection

system ill #e isolated 'rom the intervention instruments as much as possi#le.

(65AP Trial)

,*ample <6learly; the mothers recruited and the health educators ere not #lind to the

assignment o' mothers to di2erent groups. The outcome assessors ere alays


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#lind to the assignment at #oth the < and M month 'ollo up visits. Sta2s ho

ere involved in data collection at the < month 'ollo up ere not involved in

data collection at M months. The data analysts ere not #lind to the coding o'

the groups. (B8G 1HHNWX11 )


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Potential #ene!ts accruing dependent on those individuals success'ully #linded

Participants

5ess liely to have #iased psychological or physical responses to intervention

8ore liely to comply ith trial regimens

5ess liely to see additional ad$unct interventions

5ess liely to leave trial ithout providing outcome data; leading to lost to'olloup

Trial investigators

5ess liely to trans'er their inclinations or attitudes to participants

5ess liely to di2erentially administer cointerventions

5ess liely to di2erentially ad$ust dose

5ess liely to di2erentially ithdra participants

5ess liely to di2erentially encourage or discourage participants to continue trial

Assessors

5ess liely to have #iases a2ect their outcome assessments; especially ith

su#$ective outcomes o' interest.

Authors should e*plicitly state ho ill #e #linded and hat steps ill #e taen

to ensure #linding. Terminology such as single#lind; dou#le#lind; or triple#lind

should #e avoided unless they are e*plicitly de!ned hen riting a protocol

#ecause there are no agreed upon de!nitions 'or these terms.

9on#linded (open or open la#el) denotes trials in hich everyone involved

no ho has received hich interventions throughout the trial. Blinding

(masing) indicates that noledge o' the intervention assignments is hidden

'rom participants; trial investigators; or assessors. The terminology single #lind usually means that one o' the three categories o'

individuals (normally participant rather than investigator) remains unaare o'

intervention assignments throughout the trial. A single#lind trial might also;

con'usingly; mean that the participant and investigator #oth no the

intervention; #ut that the assessor remains unaare o' it.

&n a dou#le#lind trial; participants; investigators; and assessors usually all

remain unaare o' the intervention assignments throughout the trial. &n vie

o' the 'act that three groups are ept ignorant; the terminology dou#le #lind

is sometimes misleading. &n medical research; hoever; an investigator

'reuently also assesses so in this instance the terminology accurately re'ers toto categories.

Triple #lind usually means a dou#le#lind trial that also maintains a #lind data

analysis. Some investigators; hoever; denote trials as triple#lind i'

investigators and assessors are distinct people and #oth; as ell as

participants; remain unaare o' assignments.

&nvestigators rarely use uadruple #lind; #ut those that do use the term to

denote #linding o' participants; investigators; assessors; and data

analysts. Thus; uintuple #lind must mean that the allocation schedule has

#een lost and no#ody nos anything.

https-==my.syncplicity.com=share=pyg>dpygo=5ancet?,pidemiological?Series

https-==my.syncplicity.com=share=e+uatdgp=anthony1


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http-==.practihc.org=pst=pstcheclist.htm

ဒေန႔အ# ေ႔ကတ LLက စက:ခ တ ( *:%#7စ ,တက 7ခင (လတေပၾကပ။ -P


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က င က င က င

ခတ င ေနတ ( စလတ ခVခ 9ပ ဒေနေ႔တ ဒေအၾကင န န ေ%ပေပစ။ ဒေအၾကငက

တ ႔ထခ င ေကတတတၾကပ9ပ။ ဒ ပ* *ပေေတမ%ပခ င က က ယ (ေအအ*က H ( ေေတ ) က မ) ကJ အပ& !စG ကQ !က ေမတYထ ငJ 3႔ၾကမယ (ေအ ေလတလတ9ပမင' 3႔ပ။ အ ေ*တမ #င( ခလLတေခ တမစင9ပ ထခ ကေစမလ*တယ-3င%#င ( လကL/ေတမမg ႔ %#စယ'3႔ပ ေ *2ထပၾကပ။

2ယ,F႔2ယ,Fက မ! မ567 ယ' 3ငပ။

အခ အခ /G ! က 4$!င က 4$!င က 4$!င ) တ ( အ*က ေနတကၾကနတပ။ မ:ၾက 4က က 4$!င 12 ႔ႀက 4တ/က က 4$!င 12 ႔လ//က က 4$!င အ ပ.ငI 3႔ က 4$!င / င c %ခလ*# ႔ က 4$!ငQ ေ႔ပ။ D / င c

ဒ/ င c မ! 2လတ2ယ' 3 $! * ေတ လကL/ေတမ! ေက' ေမကIF+ * ေတ*န မ ပIF ႔ မ*ပခင" ။ *ခ င ,ပ ) င%#င ( M:MယK င ' Mယ .ကခ င ' ကေပ။ ေတတ ( ) Prepare ပSတ ပေပတလတ လယ'င (တက: ႔ ?။ ေအငI 3ေ႔*ခ ႔ (2ယQ5န ႔%#စ%#စ )

) တလတအ%ပင ေအလ*င9ပစဥ စစလတကအမ ႀကက /J*တယ။

တစ8ခ က3ပ စ9ပၾက5 (င ေတတ ( ) ( *ငၾကမ! 4 *: Prepare ပေပထတ *:႔ ( approachက *ခ င တတK င ေ က င* (အ%ပစ'။ အ မ!ပTနစပ9ပ။ D ( ေမငေနလင ငတ ႔က နင (က 4$!င - ေ2ေဒလတက

ေမတ2: ႔ နင အ ေ*ပ။ ငတ ႔ Prepare ပ&တ#တIတေမ *င&တ ငQ !စ%ခမ1က မတတ အ*ေေလတတင.င' 3႔ + ဒလတ%#င (မ*ပ န ႔အမနL!မက 4တ ဒငတနဥ အခက 7nFriend ပJ ကGယ' 3႔

ေ*2မထၾကပန ႔ခငG ။ -) အ ေ%ပတမDတ&ပ2: ။ လကL/ေတ)လတ ႀကငယ'တGက / *က- 3င& 2*ပG ! )တ): ပQ 3ငေကေအင လက မက င ယ- 3တ .ယ ပတယ။ ဒပ* *:မ က %ပ/ ,င ယ-3တက


28/36

ေနကစfတခ ပ။ 2*လပ Lမပမယ ( အ*င8 %ေပကငင ' ေ ကငမယ+ ေကငခ ငG ! ေကငမယ။ D )တပ စကယ:* င ဒ ပ Art ပပ ။ ေ( က င (ယ:တ $! မယ+ အထ အ)က ပမက

ပ ႔ %#စေကင#စေေတမပ။

2ယG !စ ႔ 2ယG !နမယ 2လတန ႔2ယ'ေ3%ပ ႔ ေက င* $!ငလ*/ ငေကယ ႔ က ယ Prepare ပေ*င အ ဒအတ င %#စ '*) တက ေတ ေက င*က) #တပ။ အ ဒကပ *:တ ႔က 1) ေ)ငပ။(လက /ေတ Final Part 1 PS8 မ! "emonstrator 2.န ႔ အ ပE.င ထ က aနမ! )အင8 ယယ

မေက'3႔ စစ*င&က စ9ပ C/!စေက စ*င (တ./ ထမခ ( #:ပတယ။ %ပ/ၾကတ ( Feed#ac အ လကL/ေတစ*ေငGကငပ။ -" အ ဒကနငe ( ႔ su#$ect မပ ငQ3 င ' 3႔ prepare မပ' 3႔%#စG !ပ ႔

ေ%ပင' *ပG%ငငပ။ ဒပ* က ယ,ေ*ကေ prepare ပ9ပပ *ပGထ:2:


29/36

2မ ထငEေအၾကင$! မ! ။ *:တ ေ႔လတထ မ! :ေလတပ %#စ ေ႔အ က စ /ပ4 ေလတ 6! / ငJတယ။ အ ဒက %ငငနတမDတJ2: ။ အ &ndividual ေေလတၾကင ( အ အ*ကေ7မ.မက င ေနတ ( :ေလတက ေအ%ပစင

တတၾက ေ႔%ပတပ။ 2က မ!စတG.ငE2: + ေ7ေငမ!7င ပ က- ေပမ!ငတပ5 (+ ေေ7ငပတ#စ+ င)မ!တကG ! ေအငGယ+ မDတ' 3ေ႔ကတ *ၾကမင နကငႀကန ႔ .ငေ%ေ#တင ေမအငေအငေမပ ကGယ ) တ ( *:ေလတ တကယ' 3႔ $! ခ ( မယ ) င ' အ ဒ:ေလတအလတက ဒစက ေတမD တJ2: ။ *:တ ႔%ပ4တ ( က

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)တ ႔./က င က 4$!င -မ က ေ( ၾက5 (/ ငJ*


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သေတသနလပၿပ ဆ ရငျဖင ( ၄ ဂ )

%မ/G/!စ,စG !အ *ခ စေလ)မ မMေအပင ေခHငၾကပစ ႔ ပVမေအနန ႔ စ* က&ပတယKင" ။ /!စေDငမ!

HစEလတထခ ( 9ပ အ*စ8*စေ* ေကငမတေပ စ ေအလတ႔အႀက 4မ $! / ငၾကပစ


31/36

Prospective ပ ) ) Retrospective=0istorical ႔ပ ေ%ပပ 6ohort Study D ေအၾကငေကန အက 4က ပ လ*ပတယ။

Cohort Study: looking forward in time

အ ဒအခမ! *:%ပ/ င (အ\က ပ c/စဥ ?ခ ေအနန ႔ >။ "escriptive ေအနန ႔ &ncidence o' certain outcome က ေ%ပ/ ငJတယ။

2 ေ႔%ပ/ င , ) ေတ su#$ect collection criteria မ!တက outcome မ%#စေ*တ ( *:ေလတက ပ e*posure $! တယG$! 2: ) တန ႔ ေ67 ခ ( တ ( အလတက %#စေပPတ ( outcome က &ncidence ႔* ႔တပ။ အလယေ%ပင all ne cases o' disease ေ။ &ncidence U ne cases;Prevalence U all cases ႔ Final Part & မ! မ!တK (ၾကတယSငJတယ။ -) ဒၾကင(မ ႔ တေခေတတ6ohort Study က &ncidence Study ႔ ) ၾကပ*တယ။

?။ Analytic ေအနန ႔ ေအၾကငန ႔အက 4ၾကက )လကQယG ! 4က Analy+e ပ' 3႔ပတယ။ RR တ ႔ CR တ ႔န ေ႔ -)

ဒ) င 6ase6ontrol studies ေလေတက2ယ'3ပ ။C#servational 6omparative (analytical) ပ ပ ။ ဒ type o' study မ!က အက 4 outcomevaria#le ေကန ေအၾကငခ e*posure history က ေနကေၾကငပ/9ပ ေ( တပ။ အ ဒအခမ!

အက 4 outcome varia#le $! တ ( အ ပE3က 6ase+ အက 4 outcome varia#le မ$! တ ( အ ပE3က 6ontrol ႔*တG !တ'3႔ 6ase6ontrol Study ယ'3႔) ခ ( ၾကတပ။ 6ase ေလတ 6ontrol ေလတ) 9ပ:roup ေလတ;ခ $ န ႔ 6asecontrol study ႔အမ!တG !9ပ နမယပ 1 တတJတယ။ မD တJ။ *:D

ခVက 6ohort Study န ႔ *2.မတ:ပ။ ဒမ!က Cutcome $! တ ( *:ေလတ(6ases) မ! 0istoryo' ,*posure $! =မ$! + Cutcome မ$! တ ( *:ေလတ(6controls) မ! 0istory o' ,*posure $! =မ$!

%ပ/%ပမမ/စစမတပ။ ဒၾကင( Study ( ("imension) D Bacard (Retrospective) ပ။ Thining Bacard ႔) ပတယ။

(ေေ**ခ ခ စဥ စၾက5(တ ( အခ မ: Article ေခ ( တ ( *:ေလတ စက စနစ က *ခ ( တ ေပPပတယ။6ohort Study မ! 5ooing Forard ႔* 9ပ 6ase control မ! တမင 3 Thining Bacardယ'3႔*ခ ႔တပ။)

*႔Fမ!တ ခVက cohort မ 4 &ncidence က ေ%ပ ႔ေမတ* Prevalenceက ပ ေ%ပ ႔ေမတပ2: ။ (က ယ ေအစ67 ကထ5က က 6ase 2ယQ !စေယက 6ontrol 2ယQ !စေယကယ' 3႔ %#တQ !င (9ပ9ပေ။) ေနကခ က *:႔မ! 6ohort Study မ! Ris o' e*posure ႔ ေ%ပ ႔မ%#စQ3 င%ပ/ ႔အလတက RR (Ris Ratio or Relative Ris) ယ'3႔လတက'3႔မပ2: ။

အ ဒအစ Cdds ေလတက ေအ%ခခတ ႔ CR (Cdds Ratio or Relative Cdds) န ႔ပ အက 4န ေ႔အၾကင ၾကက )လကQယG ! 4က %ပပတယ။ (6ohort "esign မ!က Ris #ased (RR) ေ


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Cdds #ased (CR) န ေ႔လတက'3႔%ပ ႔ပတယ။ RR န ႔ပ %ေပ( $! ပတယ။ CR လတက' 3႔တယ- 3တေ%ပခ င ပ။)

အ\က*:႔မ! အန5ခ ကႀကက ပ 9ပ Bias ေ႔ခPတ ( Systematic ,rror ေလတပ မ တပ။ 6ase န ႔6ontrol ေ67 တ ေ႔နမ!+ ေအၾကငငခ ,*posure ( 0istory က %ပ/ ' 3က&မ! Biasေလတ.င'/ ငJတယ။ အလယေ%ပင Selection Bias န ႔ &n'ormation Bias ႔မ!တQ3 ငJတယ။(Bias; 6on'ounding and 6hance ,rrorေ လတက *တ,တေ ပမယ။ )

ဒပမယ( *:႔မ! အ*ခ ကေလတက $! %ပ/Jတယ။ 6ohort Study Folloup time မ တ+ $!ပတ ( အ%#စQ တ ႔႔ ေMလတမ! 6ases ေလတ တစတစ5ထ5 ေ( / င + အ ဒအက 4တ outcome

န ႔)လကQယQ3င ႔ multiple e*posure varia#les ေလတက ေ( ခ/႔မ!// င ေလတၾကင ( ပ 6asecontrol Studies ေလတကအ*.ငေနတပ။ အ ဒ( ခ/႔မ!/ခ ကေလတကမ! ေ$!()က'3ပGယ( Studyေလတအလတက%#စQ3င (အ/ မနမ!/)ခ က (0ypothesis)ေ လတတပ။

Case-Control Study: thinking backwards


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အ ဒ 6ohort Study န ႔ 6asecontrol study ေလတက ေ *ေမ7မတ ( "esign %ariantsေလတ $! ပ*တယ။ 9ested 6ase6ontrol Study န ႔ 6ase 6ohort Study ယ (ခင" ။ မ$! 4ပ

$! 4ပေအလင ယ။ -P

9ested 6ase6ontrol Study ) တ ( Dက 6ase6ontrol Study က 6ohort Study ထ မ!6ohort ( outcome $! တ ( *:ေလတက case ေ႔7+ outcome မ$! တ ( *:ေလတက control ေ႔79ပ တ%ခ*ခ င (e*posure history က %ပ/ ' 3ကပ။ နင 3႔မ Dယ $! 4ပ&/ေက+ 6ohort ပ9ပမ 6ase6ontrol %ပ/'3ပ&တယ'3႔ အ%ပစG%မငၾကပန ႔ခင" ။ *:ေ႔အၾကင$! ႔ပ။ -"

တေခတမ! *ခ င (Primary Predictor %aria#le က 6ohort Study အစမ!ထ က measure ပI 3႔က အငGတ/ ./ ယJတယ။ 5ancet Article ထ က ဥပမအ *ခ င က #ody concentrations o'organochlorines န ႔ non0odginYs lymphoma ၾကက)လကQယG ! 4ပ။ အ ဒအခမ! *:တ ႔ကentire cohort o' >NE patients ေလတ ( #lood sample က ယ: ကJတယ။ ပ မ!/ cohortstudy အ) င အ ဒ #lood sample ေလတအ concentrations o' organochlorinesက စစ9ပ 905 %#စ,မ%#စ, ေစင (ၾက5(ေပ။ ဒပမ ( အ ဒ မ ပK (ပ အ ဒ 6ohort ေလတထ က 905%#စ (*: hAေယကQ ႔ မ%#စ (*: >Ah ေယက3ပ 6ase န ႔ 6ontrol ယ'3႔%ပ/RFခ ႔9ပ အ ဒ*:မ ( #loodsample ေလတမ!ပ concentrations o' organochlorines က စစ9ပ analy+e ပ%ပခ ( ပတယ။

ဥVG ခ ကG ။ က / စတ 2ယေကေ လ*မ Dင။ ??>ေယကေလ*စစန ႔ ?BiU?ေယကေလ*စစ န ႔။ -P

6ase 6ohort Study က ပ မ: 6ohort အႀကထ ေကန9ပတ Su#set 6ohort ေကက အစကထ က Randomly select ပ9ပ အ ဒအထ ကမ! outcome $! တ ( *:က 6ase + မ$! တ ( *:ေလတက 6ontrol ယ'3႔ analy+e ပ (အခ ေ/ တမ! *တG !တ9ပလတကK က#စJ*တ (


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ဒေန႔အ# ေ႔တ႔ #တG *:ေအပင ေခင$! 4ပေက9ပမ ႔နပဥမယ။ -"

ေမငေနလင။ %မ/G*ကYN >@Ah+ တ/KF%ပ5(ေက >>က (%မ/G/! စ -/>ကေန႔)

1DE1


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သေတသနလပၿပ ဆ ရငျဖင (၄ ဃ)

ဒေန႔ Study "esign န ႔ပတ,က'3ေ႔%ပခ ( တလတ ကE *တJမယ။ ("esign တခ ခ ငမ! ေ)င&/

ေ$!င&/ေလတက ေတ*ပ,ပJ ေမ ႔ပ။ ေနကခ က%#စ (Sample Si+e "etermination

အပ ငက )လက,ခ င ' 3႔ပ။)

အခ ေ%ပပေ*က R6T ယ+ 6ohort Study န ႔ 6ase6ontrol Study ယQ န စ စခ ( 9ပပ9ပ။အကခ က / လတန န )ကG !ပ။

6rosssectional Studies ေလတမ!တ ေအၾကင e*posure varia#les န ႔ အက 4 outcomevaria#les ေလတက ေ( တက တ9ပ 4င S ပ။ (6ohort Study မ!က ေအၾကင e*posurevaria#le ေပPေအ%ခခ +အ ပE3;ခ + Folloup အခ / 8ပ ငအ%ခတခ 9ပမ! အက 4 outcome varia#lesေလတက ေ( တပ။ 6ase6ontrol Study ေလတမ!က Cutcome ေပPေအ%ခခ + အ ပE3;ခ %ပမ!

*:႔က %#စေစတ ( ေအၾကငe*posure varia#le (

က ယ (0ypothesis

အ )

N.င& ! မ$! %ပ/& !တပ။)

ဒၾကင(မ ႔ ႔ *:႔က ဒ population ထ မ! 2 e*posure ေလတန ႔2ယ' 3 outcome ေလတ $! ေန* ) တက %#တ9ပ( တ %#စ (အလတက Snap Shot in Time ယ'3႔႔ *:႔ Study (

"imension က ) ပတယ။ (အလယ ဥပမပင Final Part & မ! F06 visit လထက&ငန ႔ အ ဒလပ ကcommunity ထ မ! 2 0ealth Related Ris Factors ေလတ$! * + 0ealth "e!citေလတ2လတ$! ေန* ) တက တခL/ S တ9ပ 4င S ေ ( ခ ( တမ 4ပ။ )

အ ဒအခမ! 2လတ*/ င , ) ေတ အခ ေနက%ပတ ( အ ဒ community ထ မ! တကယ& ! ေနမယ ( Social"emographic "ata ေ လတ+ 0ealth 6are Service and 7tili+ation ေလတ 8or#idityေလတ 8ortality ေဒတလတ+စ*%#င ( ေအ%ခခအက ) Base 5ine "ata ေလတကဒမ!တပ။

ဒ 6rossSectional Study က ေ$! ()က,ေ3တ*ေနလတ ပI 3႔အလတက တကယေတ အငGတ/ ေအပတ ("istri#ution Pattern o' ,*posure န ႔ Cutcome ေလတ က ယကယ,ေ3တ*န ပGယ (6ommunity ထ မ! 2ယ' 3%#စ5ေနၾက* ) တ *မ!ပ။ (,pidemiology မ!တ 6rossSectional Study (အ\ကတ/I 3D "isease Prevalence က တ#စ ႔အလတက PrevalenceStudiesေ လတ ႔ ) ပတယ။ )

လကL/ေတေအလတ႔အၾက 4ေအ%ပင ဒမ! 6rossSectional Studyေလတက ေအမပၾကပ2:။ 2 ႔ ေကတ က ယ ( ) င& ) င& )မ * *ၾကပမ (မယ။အ ဒေတ2လတ%#စ'* ။ ဒ ေအ%ခခအက )

Baseline "ata ေလတမ!မ$! ပ 2က ေ$! ()က9ပ *ခ ငၾကတ ။

"isease Prevalence မ! က ယ ( 6ommunity မ!ပSတ မ$! ေ*င အန ) တ က ယ ပGယ(* ေတ*နမ! :2ယQ !စေယက&/ ငG 2ယ'3 ပ9ပခ/႔မ!/မ ။ က ယ (:မ 4မ! Biochemical

Parameter ေလတ အ%ခ 6linical Parameter ေလတ 9ormal Range 2ယေက& ! * 2ယ' 3 ပ9ပ*မ ။ အ ဒအခမ 4 လတ ႀက 4#/G တ မငတ ႔ Research ေလတကေ2ယ8%ေ#လတလထလကSက

ငတ ေ႔အလတ႔အႀက 4ေကေတ မ!/Jဥမ!) တလတ %#စ 'ေၾက။ 2ၾကင( ။ ေအ%ခခက က စမ!လ*ခ ( တပ။ လကL/ေတ အေစကတ အ တလတမ*ခ ( * စဥ မစဥ စ#စJ2: ။ စအ ပေလတထ က article ေလတထ ကအတ င

*5j ေမ67 %ပ/ေ%ပ က "esign ေလတက နမ5ေ ကပေပ က+ Sample Si+e ေ ေ#မ4ထ ထ5( ကQ ႔ 9ပခ ( တ။ တကယေတ ေတတက မ! ေတတက 1 ခ ( တပ။ တ%#5#5န ႔

အ*ကေ တ အ ပ S မ! ၾက) %မင-လတ ေ႔က N:လတ+တ ငJငၾကတ ( *:ငယ ခ င ပေ#က ငIကေလတ ေ႔က N: လတ ယေၾကင ( စအ ပေလတက #တ%#စေလတ#7စ ,တပ။ အက ေက N:ပ။ -)

(ေၾကင.ငပခင" ။ )


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က / ("escriptive Study မ #စ (6ase Report တ ႔ 6ase Series Report တ ေ႔ကတ မ:5ancet Article မ ထ *#တ'3ကJ။ ေအလထအထ: ေ%ပစမ$! ႔ပ။- "

အ\က ေ%ပခ င က 6linical Trial ေလတ Analytical Studies ေလတ ပၾကပ။ ဒပမ ( က ယ ()မ! တကယ3 အပေနတယ ( Base 5ine "ata ေလတ*ေအင "escriptive Study ေလတက

ပI 3႔အပၾကပ။ ေေ**ခ ခ *ပ,ပ&ပ&ပ စနစေက ပ။ မ$! 2: ႔ ) ငမD တJ။ ပ 3 ပ&မယ ( အ ပ%#စေၾကင ပH$! *တ%#စK မ%#ေစ&ေအင တင%ပ%ခင*#စJတယKင" ။ / ႔မ ႔) * ေတ*ေနတစင

%ပ4စ မယ ၾကတ င အက အက စ67 ကEတမလတက ေ%မလကL/ တ ႔ ေအနလကL/တ ႔ ေအ$! (လကL/ တ ႔က Dလတန ႔ပ Basic မ!*5 Advance အထ။ D ႔ တ ႔ ပGယ႔ N

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