Quantitative research is designed to test well-specified hypotheses, determine whether an intervention did more harm than good, and find out how much a risk factor predisposes persons to disease. Equally important, qualitative research offers insight into emotional and experiential phenomena in health care to determine what, how, and why. There are 4 essential aspects of qualitative analysis. First, the participant selection must be well reasoned and their inclusion must be relevant to the research question. Second, the data collection methods must be appropriate for the research objectives and setting. Third, the data collection process, which includes field observation, interviews, and document analysis, must be comprehensive enough to support rich and robust descriptions of the observed events. Fourth, the data must be appropriately analyzed and the findings adequately corroborated by using multiple sources of information, more than 1 investigator to collect and analyze the raw data, member checking to establish whether the participants' viewpoints were adequately interpreted, or by comparison with existing social science theories. Qualitative studies offer an alternative when insight into the research is not well established or when conventional theories seem inadequate. JAMA. 2000;284:357-362
for the Evidence-Based Medicine Working Group CLINICAL SCENARIOYou are a physician seeing a 62-yearold woman with postmenopausal osteoporosis. Her bone mineral density, as measured by dual-energy x-ray absorptiometry, is 2.5 SDs below the mean value in premenopausal women. Although she does not have back pain, a spinal radiograph shows an old vertebral fracture. The patient has not yet experienced problems as a result of her vertebral fracture, but she is disturbed by the prospect that she may end up like her mother whose osteoporotic fractures have resulted in severe, long-term back pain.The patient has reflux esophagitis and a past endoscopy revealed nonspecific gastritis. A specialist had prescribed alendronate, which the patient had to stop taking after several weeks because of dyspepsia. She searched the Web and discovered a new drug, raloxifene, and wonders whether this drug might be an alternative. You know that this drug has been licensed for the prevention of postmenopausal osteoporosis. You promise to examine the literature and to get back to her. THE SEARCHUsing MEDLINE you identify a study of raloxifene for the treatment of osteoporosis demonstrating an effect on bone mineral density. 1 You are wondering whether this warrants administration to lower your patient's risk of osteoporotic fracture.
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for the Evidence-Based Medicine Working Group CLINICAL SCENARIOYou are an experienced clinician working at a hospital emergency department. One morning, a 33-year-old man presents with palpitations. He describes the new onset of episodes of fast, regular chest pounding, which come on gradually, last 1 to 2 minutes, and occur several times a day. He reports no relation of symptoms to activities and no change in exercise tolerance. He is very anxious and tells you he fears heart disease. He has no other symptoms, no personal or family history of heart disease, and takes no medications. His heart rate is 90 bpm and regular, and physical examination of his eyes, thyroid gland, lungs, and heart is normal. His 12-lead electrocardiogram is normal, without arrhythmia or signs of pre-excitation.You suspect his anxiety explains his palpitations, that they are mediated by hyperventilation, and are possibly part of a panic attack. While he has no findings of cardiac arrhythmia or hyperthyroidism, you wonder if these disorders are common enough in the emergency department setting to consider seriously. You reject pheochromocytoma as too unlikely. Thus, you
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