How

to Write Your Thesis

• Introduction & Thesis Protocol Walid Ebeid. 3
• Review of Literature Khaled Fawzy. 22
• Patients & Methods Sherif Khaled 69
• Results Mostafa Mahmoud. 89
• Discussion & Conclusion Mahmoud Abdel Karim 109
• References Hisham Abdel Ghani 154
Department of Orthopaedics & Trauma
Kasr Al Ainy School of Medicine
 Thesis Protocol

Walid Ebeid, MD
Professor, orthopaedic department, Cairo university, Cairo, Egypt
walid.ebeid@kasralainy.edu.eg
 ‫اﻟﺧطوات اﻻدارﯾﮫ‬
‫اﻟﻛﻠﯾﮫ‬ ‫ﺑﯾﺎن ﺣﺎﻟﮫ ﻣن‬
‫ورﻗﮫ اﻟرﻏﺑﺎت‬
‫) اﻟﺗﻘدﯾر ﺛم اﻟﺟﺎﻣﻌﮫ( ﯾوزع ﻋﻠﻲ اﻟﺗﺧﺻص اﻟﻣﺧﺗﺎر‬
‫ﺑﺎﺧﺗﯾﺎر اﻟﻣوﺿوع اﻟﻣﻧﺎﺳب ﻣن اﻟﺧطﮫ‬ ‫ﯾﻘوم ﻣﻘرر اﻟوﺣده‬
‫اﻟﻣﻧﺎﺳﺑﯾن ﻟﻠﻣوﺿوع ﻣﻊ اﻻﺧذ‬ ‫اﻟﻣﺷرﻓﯾن‬ ‫اﻟﺑﺣﺛﯾﮫ وﯾﺧﺗﺎر‬
‫ﻓﻲ اﻻﻋﺗﺑﺎر اﻻ ﯾﺗﻌدوا اﻟﻛوﺗﮫ اﻟﻣﻧوطﮫ ﺑﮭم‬
‫اﻟﺑروﺗوﻛول وﻣراﺟﻌﺗﮫ ﺛم اﻣﺿﺎﯾﮫ ﻣن‬ ‫ﺑﻛﺗﺎﺑﮫ‬ ‫ﯾﻘوم اﻟطﺎﻟب‬
‫اﻟﻣﺷرﻓﯾن‬
‫اﻟﺑروﺗوﻛول اﻟﻰ اﻟﻠﺟﻧﮫ اﻟﻌﻠﻣﯾﮫ ﻓﻲ ﻣوﻋد اﻗﺻﺎه‬ ‫ﺗﺳﻠﯾم‬ ‫ﯾﺗم‬
‫ﺷﮭرﯾن ﻣن ﺗﺎرﯾﺦ ﺗوزﯾﻌﮫ‬
‫ﺗﺗﺎﻛد اﻟﻠﺟﻧﮫ اﻟﻌﻠﻣﯾﮫ ﻣن ﺳﻼﻣﮫ ﻛل اﻟﺧطوات اﻻدارﯾﮫ واﻟﻌﻠﻣﯾﮫ‬
‫ﻟﻠﻣواﻓﻘﮫ اﻟذي ﯾﺣﯾﻠﮫ ﺑدوره اﻟﻰ‬ ‫وﺗﺣﯾﻠﮫ اﻟﻲ ﻣﺟﻠس اﻟﻘﺳم‬
‫ﻟﻠﻣواﻓﻘﮫ‬ ‫ﻣﺟﻠس اﻟﻛﻠﯾﮫ‬
 How to write a protocol
• Introduction
• Aim of the work
• Methodology
If you don’t know where you are
going you are likely going to land
somewhere else
 Aim of the work

• Create a Question about your topic

?
how, where, why, when, which …
 Why choose a question?
• It requires an answer
• It could be yes or no
• It makes the research more focused.
• The more the question is specific, the more
the research will be valuable
 Introduction
• Introduces the idea
• Explains its significance
• Provides background info
• Provide a plan and present it clearly.
 Methodology
• Study design
• Sample size
 Study Design
• Meta-analysis
• Randomized controlled trial (RCT)
• Cohort study or prospective
• Case control or retrospective
• Case series

N.B: whatever the study is, its validity depends

on how well it is executed
 Meta-analysis
• Taking results from multiple studies and
combining them to reach a single conclusion
• It is as good as the data you put into it
 RCT
• Gold standard
• Experimental
• Randomized group assignment
• Nullifies all confounding variables

Confounding variable: alternative explanation to an observed relationship

 Cohort Study
• Start with a group and monitor them.
• Prospective
 Case Control
• Retrospective
• You start with the outcome and compare it
with another similar group who did not have
this outcome and look back to find out
causative factors
 Case Control Cohort
• Start with the disease and • You don’t know the future
look back for causation outcome
• Retrospective • Prospective
• Fast study • Slow
• Inexpensive • Expensive
• Useful for rare outcomes • Generally more useful
• Weaker evidence • Stronger evidence
 Case series
• Small group of cases
• No control group
 Sample size
• What is the sample size that could reveal
statistically significant data?
• Literature
• Experience
• Pilot study
… Statistician applies an equation to detect the
required number
 General requirements
1. Good grammar
2. Academic tone
3. Idea per sentence
4. Avoid fancy words
5. Use always same tense
6. Short sentence.
7. Short paragraphs
 Ethics of research
• Patients before research
• Patients should be informed about the
research
• Debriefing
• Patients are allowed to withdraw
• In case of undesirable consequences .. Detect
the problem .. Correct it or else abort
• Confidentiality
THANK YOU
 Review of the Literature

Khaled F M Abdel-Kader, MCh Orth L’pool, FRCS Eng Tr & Orth

 Review of the Literature
• Presents an important part of a thesis

• Overview of what we know and don’t know on a

selected topic

– Journal articles
– Books
– Thesis or dissertation
– Conference proceedings
– Reports
– Website
 Review of the Literature
• It must be selective.

• Focused.

• Relevant

• Capture the essence of current knowledge.

• Up to date
 Starting a Literature Review
• Select a topic
• Work backwards
• Collection of recent research
• Identify the core literature
• Which work is regarded as
– Classics
– Landmark
– Pioneering
– Path-breaking
 Get Started
• Define your subject and the scope of the review.
• Search the library, databases to find sources that
are relevant to your topic.
• Read and evaluate the sources and determine
their suitability
• Analyze, and interpret the findings and
conclusions of the sources you selected.
Start Collecting Data
Hospital University Library
Books
Journals
Hospital Library
 Online Search Engines

Medline
United States National Library of Medicine
(NLM)

• Free search engine

• Database of references and abstracts on life

sciences and biomedical topics
 Google Scholar
• Freely accessible web search engine

• Indexes the full text or metadata of scholarly

literature Peer-reviewed online academic journals
– Books
– Conference papers
– Theses
– Dissertations
– Preprints
– Abstracts
 Cochrane Library
• 53 review groups at research institutions
worldwide.
• 30,000 experts from around the world.
• Systematic reviews of health-care interventions
and diagnostic tests
– Addresses a specific question
– Peer reviewed
– Trusted
– Dynamic & Updated
 Web of Science
• Online subscription-based
• Scientific citation indexing service
• Selection is made on the basis of impact
evaluations
• Access to multiple database
– Over 50,000 scholarly books
– 12,000 journals
– 160,000 conference proceedings
– Citation from 1900+
 Scopus
• Elsevier’s abstract and citation database
• Subscription based
• Evaluate and validate articles for inclusion or
exclusion
• Citation index from 1996+
• Analyze search results
• Compare journals
• View secondary documents
 Gray Literature
• Reviews of Interventions

• Literature that is not formally published in

sources as books & journal articles

– government reports, conference proceedings

– graduate dissertations
– unpublished clinical trials
 Retrieve Articles
• Library

• Open access journal

• Subscriptions
– Hospital or institution library
– Colleagues
– Your own subscription

• Lib Gen
– http://libgen.io/scimag/index.php
 Evaluation
• Collect most of the papers needed for the study

• Identify classic and up to date information

• Identify whether your work is

– Original
– complimentary
– or additional to current information

• Forms the basis for your discussion

 Writing the Review
• Divide the review into sections
• Focused
• Concise (Brief but comprehensive)
• To the point
• Relevant
• Not more than 1/3 to ½ of your thesis
• Your work should be the main bulk of the thesis
 Writing the Review
• Prepare a list of papers for each section

• Prepare a list of diagrams for each section

• Cite the reference Vancouver style

• Manual numbering

• Software assisted numbering

– (Mendeley, or Endnote)
 Relevant Sections
• Anatomy
• Biomechanics
• Pathology
• Aetiology
• Clinical presentation (symptoms & signs)
• Investigations
• Treatment
• Results of different methods of treatment
 Meniscal Repair
• Anatomy, shape and attachments
• Histology
• Chemical composition
• Biomechanics & Function
• Classification
• Healing
• Diagnosis
– Clinical
– Radiological
– X-rays
– ?Arthrogram, x-rays or MRI
• Treatment
 Writing and Formatting
• Short sentences

• Short paragraphs

• Font neither small neither large

• Times new roman 12

• X1.5, or x2 spacing

• 4 cm right gutter, 2 cm top, left, & bottom

Heading & Sub-headings
Spelling & Grammar
 Word Dictionaries
Auto correction
• Color or Colour

• Gray or Grey

• Would or Could

• Find or Fight
Punctuation
Use Diagrams & Reference in Text
Avoid Plagiarism
 Final Revision
• Relevant information included
• Proper sentencing, and paragraphing
• Diagrams
• Formatting
• Spelling and grammar
• Punctuation
• Citation and referencing
 Summary
• Relevant, Concise, & Focused
• Not more than ½ to 1/3
• Collect data and abstracts (search engines)
• Evaluate the data
• Retrieve whole articles recent and classic
• Write it properly
• Revise and reference accurately
• Print and produce
• Histology
• Chemical composition
• Biomechanics & Function
• Diagnosis
• Clinical
• Radiological
• X-rays
• ?Arthrogram
• Finishing Touches: Revising and Editing Your Work
• Read your work out loud. That way you will be better able to identify where you need
punctuation marks to signal pauses or divisions within sentences, where you have made
grammatical errors, or where your sentences are unclear
• Since the purpose of a literature review is to demonstrate that the writer is familiar with
the important professional literature on the chosen subject, check to make certain that
you have covered all of the important, up-to-date, and pertinent texts. In the sciences
and some of the social sciences it is important that your literature be quite recent; this is
not so important in the humanities
• Make certain that all of the citations and references are correct and that you are
referencing in the appropriate style for your discipline. If you are uncertain which style to
use, ask your professor
• Check to make sure that you have not plagiarized either by failing to cite a source of
information, or by using words quoted directly from a source. (Usually if you take three
or more words directly from another source, you should put those words within
quotation marks, and cite the page.)
• Text should be written in a clear and concise academic style; it should not be descriptive
in nature or use the language of everyday speech
• There should be no grammatical or spelling errors
• Sentences should flow smoothly and logically
• In a paper in the sciences, or in some of the social sciences, the use of subheadings to organize
the review is recommended
• Filter your sources
• Determine the scope of your review
• what you will cover
• what you will not cover
 The 5 C’s
• Cite: keep 1ry focus on literature
• Compare: various arguments, theories,
methodologies
• Contrast: various arguments
• Critique: which arguments are more
persuasive
• Connect: to your own research
• Define your subject and your review’s scope.
• Look for your materials in the library catalogue.
You can also find them in search tools and
databases relevant to your topic.
• Read and then evaluate your sources so that you
can determine their appropriateness to help you
understand your topic better.
• Analyze, interpret and then talk about your
finding and conclusions of those sources you
have chosen.
 Evaluating the Articles
• Type of study and level of evidence
• Authors’ expertise
• Author's arguments
• Is the author too biased in one direction
• Is the author opposing other studies
• Does the selected source contribute to better
understanding of the subject?

• Which work is regarded as

– Classics
– Landmark
– Pioneering
– Path-breaking
• Objective of the literature review
• Overview of the subject under consideration.
• Clear categorization of sources selected into
those in support of your
• particular position, those opposed, and those
offering completely different arguments.
• Discussion of both the distinctiveness of each
source and its similarities with the others.
• Not to be confused with a book review, a
literature review surveys scholarly articles,
books and other sources (e.g. dissertations,
conference proceedings) relevant to a
particular issue, area of research, or theory,
providing a description, summary, and critical
evaluation of each work. The purpose is to
offer an overview of significant literature
published on a topic.
Patients & Methods
Prof. Dr. Sherif A Khaled
Prof. of Orthopedics
Cairo University
 Imagine this scenario
• Conclusion of a paper: the use of “Sherif
Khaled” technique for the treatment of open
fx tibia with bone defects up to 10 cm led to
union in 100% of patients.
• What do you want to know now?
• Which part of the paper will you read??
• “Sherif Khaled” technique??
• Open à G??
• Union à F up? Months??
Learning Outcomes

• Importance

• Writing:

1. Structure and organization of methods

2. Writing Style
 Importance
• Most important section of a research paper
or thesis
• Provides information by which validity of
study is ultimately judged
• Therefore, author must provide a clear and
precise description of how study was done,
and rationale for specific experimental
procedures chosen
 Importance
• Must be written with enough information so that:
1. Study could be repeated by others to evaluate whether results are
reproducible
2. Audience can judge whether results and conclusions are valid
3. Referees look in this section for evidence to answer the question:
• Do methods and treatment of results conform to acceptable scientific
standards?
 2 Distinct areas
1. “Patients ” 2. “Methods ”
Refer to: Refer to:
• What was examined (e.g., humans) in • How subjects were manipulated to answer
study experimental question
• Various treatments (e.g., drugs) and • How measurements & calculations were
instruments (e.g., Plates) used in study made
• When and where study was done • How data were analyzed
 Writing Methods

• Complexity of scientific question necessitates that writing of

methods be clear and orderly to avoid confusion
1. First: structure & organization of methodology section
2. Second: writing style
Structure
 First: Structure
Explain clearly how you carried out study:
1. Describing patients involved in study
2. Explaining how patients were prepared/
chosen
3. When and Where study was done
4. Describing study protocol
5. Explaining how measurements were made and
what calculations/scores were performed
6. How data was analyzed: statistical tests used
&/or qualitative analysis
 1. Patients
• Basic demographics of sample population
describing: age, gender, and possibly racial
composition

• Selection criteria & rationale for enrolling

patients into study stated explicitly:
• Inclusion / Exclusion criteria
 1. Ethical Consideration
• When working with human subjects, there must be a
declaration that medical center’s Institutional Review
Board (IRB) governing research has determined that
study protocol adheres to ethical principles
• Without such approval, no research project can be
conducted nor can it be published in a reputable, peer
review science journal
 2. Preparation
• When and where study was carried out
• Detailed description of preparations
made prior to beginning study protocol
• Include Hypothesis, controls, treatments,
& variables measured
• Instrumentation & equipment used by
vendor name, brand & category
• Describe modifications made to a
published method
 3. Protocol Design
• Description should follow exact sequence of how
procedures were executed
• 1st description of baseline conditions & any
associated baseline measurements
• 2nd sequence of manipulations of independent
variable and subsequent measurement of
changes in dependent variable
• It is also important to describe all relevant aspects
of clinical management not controlled by the
protocol in periexperimental period
4. Measurement & Calculation
• Next step in methods section is to describe
what variables were measured and how
measurements were made
• Description of measurement instruments
should include manufacturer and model, &
how measurements were made
• For scores name, details and author
 4. Measurement & Calculation

• It also may be necessary to justify

why and how certain variables were
measured
• A listing of all calculations used in
study typically follows description of
measurements
 5. Data Analysis
• Last step in methods section is to
describe how data will be presented in
results section (e.g., mean vs median)
• Which statistical test will be used for
inferential data, and what p value is
deemed to indicate a SSD
Writing Style
 Second: Writing style
• Writing should be precise, simple,
clear and in past tense
• Use 3rd person / Passive voice;
• “patients … were recruited” not “we
recruited patients”
• Avoid 1st person: reference to self &
pronoun ”I” is almost absent from
medical writing (Debatable)
• Compound sentences avoided
• Unimportant details avoided
 Writing style
• Present elements as clearly and logically as
possibly
• Description of preparations, protocol and
measurements organized chronologically (so
reader can understand logical flow of study)
• If large amount of detail must be presented,
information presented in subsections /
subheadings according to topic
• Organized by topic from most to least important
 Take Home Message
• Methods section is most important part of a research paper
• Provides a clear & precise description of how study was done
• 1st Structure:
1. Patients:
• Demographics
• Inclusion / Exclusion criteria
• Ethical Committee approval
2. Preparation: controls, treatment, equipment
3. Study protocol: exact technique
4. Measurements & Calculations
5. Statistical Data analysis
• 2nd Style: precise, simple, clear, past tense, 3rd person, passive voice,
logical flow, subsections
The Results Section

Mostafa Mahmoud, MD
Assistant Professor Orthopedics
• In theory, this is the easiest part to write,
because it is a straightforward commentary of
exactly what you observed and found.
• In reality, it can be a little tricky, because it is
very easy to include too much information and
bury the important findings
Results
ØClear, Concise and Objective
Description of findings
What you found è Past
NO Interpretation
Results
Dynamic interplay between
text and figures/tables
Avoid repetition
Results
Results
Think of the results section as mirroring the
methods section:
For every method (what you did)
Corresponding result (what you found)
Structure
ØRecruitment / Response
ØCharacteristics of the sample
ØFindings from the analyses and expression of
the differences
ØAny additional (unexpected) findings.
Recruitment/Response
• … … patients with …….( problem )……… presented
during the period of ……….( study )
• Clinical exclusion …….
• Radiographic exclusion ……..
• ….. patient refused to be part of the study or chose
certain treatment method
• … … patients met the inclusion criteria of this study
• … … in group A and …… in group B (in comparative
studies)
• … … of them were available to final evaluation.
(Flowchart ……….)
Characteristics of the study sample

Main characteristics are

– basic demographics
– major clinical and lifestyle variables
Characteristics of the study sample
• The mean age was …. +_SD
• They were ….. male and ….. female.
• Dominant side was affected in ….. patient (….%)
• ….. patients were bilaterally
• Analysis of the problem
• History of the cause
– In case of trauma
• Mode (table)
• The mean injury to surgery interval was …. +_SD (range from …. to….)
• Initial management and for how long
• The use of medications
• Previous rehabilitation
– Other causes ……..
Characteristics of the study sample

Table
Don’t repeat information in the text but only
highlight the findings that support your
hypothesis and those which are unexpected.
Analysis
• Clinically
– Look (eg. …. Had swelling of ……..)
– Feel (eg. … pt had tenderness in….., ….. sign was positive in ….. pt)
– Move
– Special tests
– Measurements
• The mean preoperative range of
• ….. was …. +_SD (range from …. to….)(p<?. ???)(CI *)
• The mean postoperative range of
• ….. was …. +_SD (range from …. to….)(p<?. ???) (CI *)
• GS improved from…. +_SD (range from …. to….) …. +_SD (range from …. to….)(p<?. ???)
– Functional evaluation
• VAS improved from…. +_SD (range from …. to….) …. +_SD (range from …. to….)(p<?. ???)
• MMWS improved from…. +_SD (range from …. to….) …. +_SD (range from …. to….)(p<?. ???)
• DASH Q improved from…. +_SD (range from …. to….) …. +_SD (range from …. to….)(p<?. ???)
• PRWE improved from…. +_SD (range from …. to….) …. +_SD (range from …. to….)(p<?. ???)
• Others………………………………………………..
• Radio-graphically
– X-rays, CT, MRI, other

• Complications clinical and radiographic

Analysis

Answer the study question

Retaining this focus will help you to be more concise,
that is, to decide which findings to present and
which to leave out
Present measures of central tendency together
with their appropriate measures of variability:
mean (standard deviation) or
median (range)
Analysis

Avoid words such as ‘‘remarkably’’ or

‘‘strikingly,’’ which imply an interpretation of the
findings.

Use similar sentences and words to present

similar results as this will only confuse the
reader.
Analysis

The word ‘‘significant’’ is often used in everyday

language to stress something that is important
or substantial

In a scholarly article, it is probably better to use

the words ‘‘statistically significant’’ if you want
to report a difference proven by a statistical test.
Difference

P- values Confidence Interval

• Info from the P-value
• the direction of the effect
• The size of the effect
• The degree of precision
Difference

Differences are better appreciated as a percentage

Always present the absolute number of cases in

addition to relative measures:
40/50 kg 80% of the normal side
33/40 patient 85% returned to previous occupation
-ve Results

Be sure to include

Writing a results section without them invalidate

the paper

The negative results, and how you handle them,

often gives you the makings of a great
discussion section, so do not be afraid to
highlight them.
Any additional (unexpected) findings.

End the results section, if applicable, with a

short paragraph on any additional (unexpected)
findings.
Make it clear that these findings result from
ancillary (post hoc) analyses and are intended to
generate new hypotheses.
Conclusion
Ø Clear, Concise and Objective
Description of findings
ØRecruitment / Response (flow chart)
ØCharacteristics of the sample (table)
ØFindings from the analyses and expression of the
differences (answer the study question)
ØAny additional (unexpected) findings. (hypothesis for
further study)

What you found è Past

NO Interpretation
How to Write An
Effective
Discussion
MAHMOUD ABDEL KARIM
Associate Professor
Cairo University Hospitals
Why is this lecture
important ???
 Discussion is
• The heart of the paper

• Probably most complex / Challenging section

• Shows Depth & Clarity of scientific thinking

• Usually requires several writing attempts.

 Learning outcomes
Ø What is discussion?

ØWhat is the Function of the discussion?

ØElements of An Effective Discussion

Ø Things to Avoid
What is Discussion?
 What is Discussion ?

Ø Explanation &

ØInterpretation of

Ø The meaning of the results

ØTo the reader

What is Function of the
Discussion?
 Function
• To answer Qs posed in the Introduction,

• Explain how the results support the answers

&

• How the answers fit in with existing

knowledge on the topic.
 Function
ØTo interpret your results in light of what was

ØAlready known about subject of investigation

ØTo explain our new understanding of problem

Ø After taking your results into consideration

Elements of the
Discussion ?
10
 Discussion Elements
1. Relate to Hypothesis & Qs raised in Introduction

2. State the Major Findings of the Study

3. Meaning of the Findings & Why are important

4. Relate &Compare Findings to Those of Similar

Studies

5. Alternative Explanations of the Findings

 Discussion Elements
6. State the Clinical Relevance of the Findings

7. Acknowledge the Study’s Strengths

8. Acknowledge the Study’s Limitations

9. Make Suggestions for Further Research

10. Give “Take-Home Message” in the Form of a

Conclusion
1. Relate to Hypothesis & Qs in the Intro
ØIt should always connect to Introduction by

ØQuestion(s) or Hypotheses you posed

ØLiterature you cited,

ØDoesn’t simply repeat/ rearrange introduction

ØIt tells how your study moved us forward

ØFrom place you left us at end of Intro

 2.State Major Findings of the Study
Ø Should be a direct, declarative, and succinct

Ø Interpretation of the study results.

Ø Avoid reiterating results for an interpretation

Ø Address each of the experiments

Ø In the same sequence as in the results

ØNo new results are presented here

 3. Meaning of the Findings &
Why are important
ØAs you have designed, conducted the study
ØResults meaning & importance seem obvious to U.
ØMight not be so clear for 1st time reader
ØExplain it clearly
ØYou want reader to think,

“ That makes perfect sense.

Why hadn’ t I thought of that?”
 3. Meaning of the Findings &
Why are important
ØExplain clearly without appearing arrogant,
condescending, or patronizing.

ØInterpret your results in light of other published

results,

Ø By adding additional information from sources

you cited in the Introduction section.
 Explanations for results:
• There are several possible explanations for this result.
• A possible explanation for this might be that .

Unexpected outcome
• Surprisingly, no differences were found in ....
• One unanticipated finding was that ....

Advising cautious interpretation

• These data must be interpreted with caution because .
• Results therefore need to be interpreted with caution
 4. Relate & Compare Findings to Those of
Similar Studies
ØU must relate yr work to findings of other studies

ØDo yr findings agree with what others ve shown?

ØIf not, do they suggest an alternative explanation

Øor perhaps design flaw in your exp (or theirs?)

ØMake reference to the findings of others in order to

support your interpretations.
 5. Alternative Explanations
of the Findings
Ø How the results of other studies may be combined
Ø with yours to derive a new or better substantiated
Ø understanding of the problem.
Ø Consider all possible explanations for study results,
Ø Rather than just those that fit your biases.

ØPurpose of research is to discover and not

to prove .
 6. State the Clinical Relevance of the
Findings
Ø We conduct studies is to improve patients care.

Ø Thus it is important to cast the findings of your study in

the context of clinical practice.

ØFor which patients do the results apply and

for which do they not apply?

 Distinguish between statistical &
clinical significance
Ø Statistical significance relates to how likely the

observed effect is merely due to chance

Ø (ie, sampling variation)

Ø Clinical significance relates the magnitude of the

observed effect; practical or meaningful to patient.

 7. Acknowledge the Study’s Strength

Strengths
• RCT

• Large sample

• Adequate follow up
 8. Acknowledge the Study’s Limitations

• All studies have limitations.

• Limitations of some studies are fatal flaws that
preclude publication.
• It is far better to identify & acknowledge your
study’ s limitations than to
• Have them pointed out by a peer-reviewer
/reader (letter to the editor after publication).
• Address them & recommend ways to overcome
• Honesty is the cornerstone of clinical research
 9. Make Suggestions for
Further Research
• Next step in your study, e.g., what
experiments would you do next?

• You may also choose to briefly mention

further studies you would do to clarify your
working hypotheses.
 9. Make Suggestions for
Further Research

Further research should be done to investigate the ..

However, more research on this topic needs to be

undertaken before the association between X and Y
is more clearly understood.
 10. Give “Take-Home Message” in the
Form of a Conclusion
ØWhat is the “ take-home message” ?

ØWhat do you want the reader to remember from

your study?

ØThe take-home message should be the first

sentence of your conclusions section.

ØLimit your conclusions to those that your data

can actually support.
 10. Give “Take-Home Message” in the
Form of a Conclusion

ØIn some journals conclusions section is a

paragraph or subsection at end of discussion,
Øother journals require separate conclusions
section.
Ø The conclusions section may also provide
suggestions for practice change, if appropriate.
ØYou should provide equal emphasis on positive
and negative findings.
 Discussion Elements
1. Relate to Hypothesis & Qs raised in Introduction

2. State the Major Findings of the Study

3. Meaning of the Findings & Why are important

4. Relate &Compare Findings to Those of Similar

Studies

5. Alternative Explanations of the Findings

 Discussion Elements
6. State the Clinical Relevance of the Findings

7. Acknowledge the Study’s Strengths

8. Acknowledge the Study’s Limitations

9. Make Suggestions for Further Research

10. Give “Take-Home Message” in the Form of a

Conclusion
 Style
Ø Many papers are rejected by journal editors
because of a faulty Discussion,
Ø Even though data of the paper might be both valid
and interesting.
ØDiscussion should be clear & concise.
ØUse subheadings, if need be, to help organize your
presentation.
ØRemember that each paragraph should present one
key idea or concept.
 Hedging Techniques

• To make our confidence level clear

• e.g. Proved vs Suggested

• May, might , could

• Weaker verbs; Show vs suggest
• Possibility; possibly, probably, likely that..
• Seem to , appear to , tend to..
 Discussion And Verbiage
ØSimplest statements evoke the most wisdom;

ØVerbose language and fancy technical words

are used to convey shallow thought.

ØWatch out for wordy phrases;

• Many scientific paper end

” Not with a bang but a whimper”

T. S. Eliot
Things to Avoid?
 Things to Avoid?
Ø Over interpretation of the Results

Ø Inflating the Importance of the Findings

Ø Unwarranted Speculation

Ø Tangential Issues

Ø The “Bully Pulpit”

Ø Conclusions That Ain’t Supported by the Data

 Over interpretation of the Results

Ø It is easy to inflate the interpretation of the

results.

ØBe careful that your interpretation of results does

not go beyond what is supported by data.

ØThe data are the data: nothing more,

nothing less.
 Inflating the Importance of the
Findings
Ø After all of the hard work that goes into a study,

Ø It is easy to attribute unwarranted importance to

study findings.

ØUnwarranted inflation of the importance of the

study results will disgust reviewers and readers.

ØModesty & Humility

 Unwarranted Speculation
• There is little room for speculation in the
discussion.

• The discussion should remain focused on the your

data and the patients and/or devices in your study.

• If you feel compelled to speculate, be certain that

you clearly identify your comments as speculation:

• “ We speculate that. . . . ”
 Tangential Issues

Ø It is important to remain focused on the

hypothesis and study results.

Ø Injecting tangential issues into the discussion

section distracts and confuses the reader.

ØTangential issues run the risk of diluting and

confounding the real message of the study.
 The “Bully Pulpit”

Ø Do not use discussion to criticize other studies.

ØAlthough you should contrast yr findings to others

ØThis should be done professionally.

Ø Do not use discussion to attack other investigators.

ØMoreover, never preach to the reader.

 Conclusions That Ain’t Supported by
the Data
Ø Hypothesis à Study à Data à Conclusions

Ø Should be a tight package.

ØAvoid the temptation to allow your biases

Ø To enter into the conclusions.

 Conclusions That Ain’t Supported by
the Data
• Always write the discussion for the reader;

• The discussion is not a forum to impress others

• You should be trying to convince the reader of the

merits of the study results.
 Things to Avoid?
Ø Over interpretation of the Results

Ø Unwarranted Speculation

Ø Inflating the Importance of the Findings

Ø Tangential Issues

Ø The “Bully Pulpit”

Ø Conclusions That Ain’t Supported by the Data

 Take Home Message
Ø What is discussion?

Ø What is the Function of the discussion?

Ø Elements of An Effective Discussion

Ø Style

Ø Things to Avoid
Hisham Abdel-Ghani
Prof. Pediatric Orthopedics
Cairo University
• What is referencing
• Terminology
• When to reference
• Value of referencing
• How to avoid plagiarism
• Citation and referencing styles
• How to cite and reference
• Software for citation and references
 What is referencing

• Acknowledging sources of information and

ideas that you have used in your assignment
 Terminology

Citing
Bibliographical
References
 Citing bibliographical references
• CITING =
– Acknowledging the
document from which
you have obtained
information within
your text .
 Citing bibliographical references

• REFERENCE =
– The detailed description of
the document you cited in
your text.
 Citing bibliographical references

• BIBLIOGRAPHY =
– The list of Bibliography list
publications or
sources you =
consulted, either References list
cited or not
 When should you reference?
• Whenever you use information as:
– As source of a particular theory, argument or viewpoint
– Classifications or grading systems
– Results or methodology of others
– Specific info, eg statistics, examples or case studies
– For direct quotations (reproducing authors exact words)
– For paraphrasing (rewrite in your own words)
– Your source of inspiration !!!!!

Personal communication (unpublished data) ?????

Adapted from; Cottrell, S. (2008) The Study Skills
Handbook. 3rd edn. Basingstoke; Palgrave.
 Value of referencing

• Enable readers to follow-up and read more

fully the cited author’s arguments.

• Helps avoid plagiarism (stealing of others

ideas)
 Plagiarism
• The use of ideas, concepts, words, or
structures without appropriately
acknowledging the source to benefit in
a setting where originality is expected

Gipp, Bela (2014). Citation-based Plagiarism Detection:

Detecting Disguised and Cross-language Plagiarism using
Citation Pattern Analysis. Springer Vieweg. ISBN 978-3-658-
06393-1. p.10
Copy and paste
sections even with
its citation
 How to avoid plagiarism?
• Refer to the actual paper
(may be the only
legitimate citation)

• Avoid citing only review

articles that broadly
cover subjects.
 Self Plagiarism (word recycling)
• Authors copy large parts of one of their
previous manuscripts word-for-word.

• Submitting it for publication is considered as

duplicate publication.
 Don’t do it!
• Rewrite the section, tailoring it to your new
set of experimental results.
 How to go????
• Bibliographic list

• Cite

• Reference list
Citation style
Two main styles
o Harvard (author, year stated) o Vancouver (Numerical)
Reference list styles
 Which style to use ???

The style of the journal you are going to publish in

 References variables
• Journal article
• Book
• Chapter in a book
• Quotation of an article in another journal
article or a book
• Web site
 How to cite web site
• Three elements absolutely necessary :
– Name (or title) of site
– Date of retrieval
– URL of Homepage (Internet address) (If hard to
find like on a government website, complete URL
can be used)
Build smarter with alternative materials. (n.d.).
Retrieved June 15, 2002, from
http://www.build-smarter.com
 Manuscript identifier
(thumbprint)

• PMID (PubMed ID)

• PMCID (Pub Med Central ID)
• DOI (Digital Object Identifier)
• PMID (PubMed ID)

• PMCID
 DOI
• Digital Object Identifier
Article with DOI (Digital Object Identifier)

DOI

DOI is a unique number that identifies

electronic documents. It can be used to cite
and link electronic documents. A DOI is
guaranteed never to change, so you can use it
to link permanently to electronic documents
 Referencing Software

• Easy to follow notes

• Easy to cite
• Rapid citation
• Wide varieties of styles
• Electronic citation
Web importer
Word Plugin
 Take home message

• No role for reference selection, Just say the truth

• Reference to the original one
• The journal determine the style
• Software make life easy