Research, Ethics And Publications; Overview

1. AIIMS-REAPAIIMS-REAP
Workshop on Research,
Ethics and Publication

2. Introduction
 Nurses are the backbone of
any hospital and can greatly
contribute to improving
patient outcome by doing
research on their day-to-
day clinical activities thus
not only proving
professional gain but also
personal satisfaction.

3. What Is Research?
 Systematic inquiry using disciplined
methods to solve problem
Nursing research
 Systematic inquiry to develop
knowledge about issues of importance
to the nursing profession
Research

4. Research
 Basic: Extend information for sake of
knowledge
 Applied: Discovering solutions to
immediate problems

5. Consumer–Producer
Continuum
Consumers: Nurses who read
and evaluate research reports
or summaries
Producers: Nurses who design
and undertake research studies

6. Sources of Evidence for
Nursing Practice
 Tradition
 Authority
 Clinical experience, trial and error,
intuition
 Logical reasoning (inductive and
deductive)

7. Key Evidence-Based Practice
 Treatment/therapy/intervention
 Assessment and diagnosis
 Prognosis
 Harm and etiology
 Meaning and process

8. Research Utilization (RU)
Versus
Evidence-Based Practice (EBP)
 Research utilization (RU)
The use of study findings in a practical
application unrelated to the original
research
 Evidence-based practice (EBP)
Basing clinical decisions on best possible
evidence—especially high-quality research

9. Resources for Evidence-
Based Practice
 Systematic reviews
 Clinical practice guidelines
 Care bundles
 Other preappraised evidence

10. Research Integration
and Synthesis
Forms of integrative reviews:
 Narrative, qualitative integration
(traditional review of quantitative or
qualitative results)
 Meta-analysis (statistical integration of
results)
 Metasynthesis (theoretical integration
of qualitative findings)

11. Key Challenges of Doing
Research
 Conceptual
 Financial
 Administrative
 Practical
 Ethical
 Clinical
 Methodologic

12. Barriers to Using Research
in Nursing Practice
Quality and nature of the
research
Characteristics of nurses
Organizational factors

13. Why Research is Essential?
• Writing for publication in nursing is
essential to disseminate evidence, share
initiatives and innovations with others,
provide new information to keep nurses
up-to-date, communicate the findings of
research studies, and develop the science
base of the profession.
• Writing an effective scientific paper is not
easy, but the process can be simplified by
understanding how to develop a
manuscript and submit it for publication

14. How Will REAP -AIIMS Help You?
 A major goal of this course is the ability
to conduct research and development of
effective technical writing skills.
 After the course, you will be better
motivated to conduct research, write the
research into a paper and have it
presented at conference.

15. AIIMSONIAN OF AMERICA AWARD
Ms. Anjusha Thomas
Best Research Nurse 2009
Ms. Metilda Robin-
Best Nurse 2009
Ms Sonia Chauhan
Best Research Nurse 2010
Ms Anu Susan
Best Nurse In Community
Health 2010

16. Mrs. Jacintha Gunjiyal
(HICN)
NATIONAL FLORENCE
NIGHTINGALE AWARD 2011

17. Nurses’ Role in Using
Research Evidence
 Read widely and critically
 Attend professional conferences
 Learn to expect evidence that a
procedure is effective
 Become involved in a journal club
 Pursue and participate in Research
Utilization/Evidence Based Practice
projects

18. If its not published, it
didn’t happen

19. Why do research?
• Curiosity
• Question in day to day life
• Build upon previous work
• Do good

20. Why Do Research?
• Promotion?
• Fame?
(Desire to be known among peers)
• Altruistic?

21. Tell Others?
 Desire to inform
 Basic instinct
 Ideas- Communicate

22. Communication
 Why?
 Tell others, learn from others
 2-way process
 Exchange information

23. Scientific Communication
 Purpose same, Style different

24. Types of Research
 Written
 Research paper, review, letter,
comment, editorial….
 Oral
 Research, Oration…
 Poster
 Research

25. Written Communication
 Most Important
 For posterity: factual, comprehensive
 Can be referred to repeatedly
 Change not possible
 Writing skills
 Limited interaction, delayed
 Demanding: write and re- write

26. Communicate
 Do it all the time:
 informal, unstructured, on the job
 Not taught

27. Importance
• Necessary : inform, educate
• Unending process
• Learn ground rules
• Get past ‘gatekeepers’
• Build on a strong base
• Creative

28. Quality Communication
• Get Noticed : Recognition
• Effective
• Accurate, brief, complete, ‘story’
• Poor communication
• Criticism, hurts ego

29. Why Publish?

30. IMRAD Format,
Introduction

31. Parts of a Paper
 Beginning
 Main Body
 End

32. Parts of a Paper
I Introduction
M Methods
R Results
A And
D Discussion

33. Bradford Hill’s Questions
Introduction Why did you start?
 Methods What did you do?
Results What did you find?
 And
Discussion What does it all mean?

34. Introduction (Why did you start)
 Rationale of the study
 Supply sufficient background information to
allow a reader to understand and evaluate
the results of present study without
referring to previous publications on the
topic
 Concise, adequate, not a detailed review.

35. Introduction
 Review pertinent literature to orient the
reader.
 Define lacunae and shortcomings in current
state of knowledge.
 Provide rationale for the current study
 What gap in knowledge did you try to
fill?
 What controversy did you try to resolve?
 State the aim of the study.

36. Introduction
Brief, clear, to the point
Written in present tense
Clearly defines nature and scope of the
problem investigated
May state the study group, study design
and methods used
( How and why are these better than those of
previous studies)
May state the principal result/conclusion

37. Introduction
 Key references to support the
background information provided
 Refer to your
 Previous preliminary work
 Closely related papers appearing
elsewhere
 Define any specialized terms,
definitions or abbreviations you
intend to use

38. Introduction: Common problems
 Historical details
 Frequently too long
 Too general and vague
 Contains ‘discussion’ material
 Imitative

39. Summary
 Why did you start?
 4 sentences
 Background
 Gap in knowledge
 Question
 Study design
 Be brief and focused

40. LANGUAGE AND
WRITING STYLE

41. Scientific Writing: Orwell’s Rules
 Never use a metaphor, simile or figure of
speech
 Never use a long word, if a short one will
do
 If you can cut a word out, do it
 Never use the passive, when you can use
the active
 Never use a foreign phrase, a scientific
word or a jargon word if you can think of
an everyday English equivalent

42. Language
 Precise
One and only one interpretation
 Familiar
Easier to read
 Concise
Short, brief
 Fluid
Smooth and logical flow of thoughts

43. Writing Style: Elements
 Structure
Uniformity
Placement and emphasis
Brevity and simplicity
 Language
Spellings
Grammar
 Illustrations

44. Structure : Uniformity
 Formerly, hemoglobin was measured
by colorimetry, but now an automated
analyzer is employed.
 Formerly, hemoglobin was measured
by colorimetry, but now it is done using
an automated analyzer.

45. Structure : Placement
Place the most important elements at the
start or the end
 Word(s) in sentence
 Sentence in paragraph
 Paragraphs in composition

46. Structure:
Emphasis and Placement
The currently available vaccine for disease X is ineffective
when used post-exposure. However, it is not safe enough
for universal pre-exposure prophylaxis. In the current study,
we found that the new polysaccharide vaccine
--------------------------------------------------------------------------
----. The vaccine was useful even when administered up to 10
days after exposure. The efficacy of the vaccine in this situation
was ------------------------------------------------. Our findings
are thus likely to have a major impact on the prevention
and epidemiology of disease X.

47. Paragraphs
 Divide a written piece into logical segments
 Make text less intimidating and easier to
read
 Each deals with one topic/thought
 Need transitions to connect thoughts or
separate them logically
 Avoid one sentence paragraphs except as
transition
 Begin with a sentence that either suggests
the topic or helps the transition
 Logical mind + Good eye

48. Paragraphs And Transitions
Essential hypertension is associated with
renal retention of salt. The salt retention
is due to a disturbed renin-angiotensin-
aldosterone axis. This disturbance may
be due to several causes.
The most important cause of this
distubance is------------. This has been
studied in detail and -----------

49. Sentence Parts
The jailor beat him hard with an iron rod
Subject Verb Object Adverb Adjective
Noun Tense Pomposity
Pronoun Voice Verbosity
Dangling modifiers Split infinitives

50. Grammar: Noun- Pronoun
Which noun does the pronoun
substitute?
The Prime Minister’s emissary talked to
Mr. Amarinder Singh. Mr Singh
admitted that he had not consulted the
Prime Minister before he got the new
act about river water passed in the
state assembly. The emissary told him
that he was very upset about it.
Gender neutral language (plural form
helps)

51. Nouns: Expressions To Avoid
 Colloquialism
Mom, kid, lab, minilap
 Contrived long words
Maternal parent, pediatric patient,
liquid imbibitions
 Long string of nouns
Doctor workload reduction program
(Program to reduce the workload of
doctors)

52. Missing (‘Understood’) verbs
 Polly loves cake more than me
 Polly loves cake more than I
 Polly loves cake more than she loves
me
 Polly loves cake more than I do

53. The Voice: Active Or Passive
 We discussed the
therapeutic potential of
fish oil.
 The therapeutic
potential of fish oil was
discussed

54. Dangling Modifiers
Dr Young treated the patients
using antidepressants.
 Dr Y treated patients who
were using antidepressants.
 By using antidepressants Dr
Y treated the patients.
 She told me that he was
dead on the phone.
She told me on the phone
that he was dead.

55. Dangling Participles
 Having a temperature of 42o
C, we gave
patient a cold bath.
 After being whipped fiercely, the cook
boiled the egg.

56. ‘Only’
I hit him in the eye
Only I hit him in the eye
I only hit him in the eye
I hit only him in the eye
I hit him only in the eye
I hit him in the only eye

57. Redundancy
 already existing alternative choices
 at the present time basic fundamentals
 completely cured currently underway
 first began introduced a new
 mix together never before
 none at all still persisted

58. Redundancy
 The question as to whether Whether
 In spite of the fact that Though
 In almost all cases Nearly always
 Due to the fact that Because
 In only a small number of cases Rarely
 With the possible exception of Except
 As compared to Than

59. Pompous Words
Accomplish Do
Performed Done
Visualize See
Initiate Begin, start
Prior to Before
Quantitation Measurement

60. Fewer vs. lesser
 The patient undergoing laproscopic
surgery had less pain than those
undergoing open surgery
 The patient undergoing laparoscopic
surgery spent fewer days in hospital
than those undergoing open surgery.

61. Grandiloquence
 Abstract words(juxta, sphericity)
 Vague words(of the order of)
 Foreign words(circa, vide supra)
 Fancy words(beauteous)
 Offbeat words(upright, hep)
 Non-words(aspirinize, normalized,
electrophoresed)

62. Grandstanding
 Pre-eminence claims
 Precede claims
 Prejudice
 Superlatives
 Unindicated italics, underline
 Exclamation(’shriek’)marks

63. Verbosity
 At this moment of time, it is believed
that X is the major causative factor for
disease Y
 Currently, it is believed that…….

64. Spelling: common errors
 Vomitting Vomiting
 Inflamation Inflammation
 Occuring Occurring
 Upto Up to
 Principal Principle
 Mucus Mucous
 Illium Ileum
 Ilitis Ileitis
 Coastal Costal

65. Emphasis : Illustration
 When the infusion of drug A was
started, blood levels of substance C
initially fell to reach a nadir at 12
hours; however, thereafter,the levels
again increased to close to the pre-
infusion levels and remained so for the
remaining of the infusion.

66. Other Common Errors
 ‘And’ and ‘but’ to join unconnected
thoughts
 Overuse of indirect speech
 Overuse of passive voice
 Switching tenses
 Switching persons
 Improper punctuation

67. Miscellaneous Issues
 Abbreviations and acronyms
 Group names vs labels
 Numbers: numerals vs words
 Punctuation

68. One should not aim at being possible to
understand but at being impossible to
misunderstand
- Quintilian

69. ‘The greatest invention of the
nineteenth century was the invention
of the method of invention.’
-AN Whitehead
Material & Methods

70. Basic Terminology
Research problem
An enigmatic, perplexing, or troubling
condition
Problem statement
A statement articulating the research
problem and indicating the need for a
study

71. Basic Terminology
(cont’d)
Research questions
The specific queries the researcher wants to
answer in addressing the research problem
Hypotheses
The researcher’s predictions about
relationships among variables

72. Basic Terminology
(cont’d)
Statement of purpose
The researcher’s summary of the overall
study goal
Research aims or objectives
The specific accomplishments to be
achieved by conducting the study

73. Methods: Goal
The purpose of the methods section
is to describe in sufficient detail
what you did to answer your
research question so that another
researcher can replicate the study

74. Methods
 What all was done ?
 How was it done?
 When was it done?
 Who did it?
 How were the results analysed?
 Did you have ethical clearance to do
so?

75. Major Classes of
Quantitative Research
Experimental research
Researchers actively introduce an
intervention or treatment
Nonexperimental research
Researchers collect data without
intervening or introducing
treatments

76. Methods: Types of Studies
 Primary research studies
-clinical trials
-surveys
-laboratory experiments
-evaluation of a new test
 Secondary research studies
-reviews
-meta-analyses
-Cost -efficacy analyses

77. Method : Study Design
 Randomized
 Controlled: placebo/active drug
 Open/blinded
 Cohort/case control
 Prospective/retrospective

78. Phases in a Quantitative
Study
 Phase 1: Conceptual Phase
 Phase 2: Design and Planning
Phase
 Phase 3: Empirical Phase
 Phase 4: Analytic Phase
 Phase 5: Dissemination Phase

79. Major Steps in a Quantitative
Study
 Phase 1: Conceptual Phase
1. Formulating the problem
2. Reviewing related literature
3. Undertaking clinical fieldwork
4. Defining the framework and developing
conceptual definitions
5. Formulating hypotheses

80. Major Steps in a
Quantitative Study (cont.)
 Phase 2: Design and Planning
Phase
6. Selecting a research design
7. Developing intervention protocols
8. Identifying the population
9. Designing the sample plan

81. Major Steps in a
Quantitative Study (cont.)
 Phase 2: Design and Planning Phase
(cont.)
10. Specifying methods to measure research
variables and collect data
11. Developing methods to protect
human/animal rights
12. Finalizing and reviewing the research plan

82. Major Steps in a
Quantitative Study (cont.)
 Phase 3: Empirical Phase
13. Collecting data
14. Preparing data for analysis

83. Major Steps in a
Quantitative Study (cont.)
 Phase 4: Analytic Phase
15. Analyzing the data
16. Interpreting results

84. Major Steps in a
Quantitative Study (cont.)
 Phase 5: Dissemination Phase
17. Communicating the findings
18. Utilizing findings in practice

85. Criteria for Evaluating
Quantitative Research
 Reliability
The accuracy and consistency of
obtained information
 Validity
The soundness of the evidence—whether
findings are convincing, well-grounded

86. Activities in a Qualitative
Study
1. Conceptualizing and planning the
study
2. Conducting the study
3. Disseminating the findings

87. Research Journal Articles
Summarize the context, design, and
results of a study; the primary
method of disseminating research
evidence

88. Material: Reviews/Meta-
analysis
 Information on searches
-source
-time period
-selection: exclusion criteria
 Validity assessment
 Data abstraction
 Additional data from authors

89. Methods: Intervention
 Details of procedure
 Mention the special circumstances
 After fasting
 Indoor/outdoor procedure
 Time of the day

90. Methods
Provide sufficient details
New method
 Provide all details
Previously described
 Provide reference
 Describe in brief
 Don’t cite an abstract/obscure journal
 Describe any modifications
Inter and intra-assay variability, sensitivity

91. Define outcome
 Intervention trials
 Primary outcomes
 Secondary outcomes
 Toxicity
 Parameters used
 Follow up
 Frequency
 Method
 Duration
 Laboratory experiments
 Define cut-off for positive
 Sensitivity and specificity of assay tested
 Define significant change

92. Methods : Analysis of Data
 Sample size calculation
 Estimate of power: β error
 Exact tests used for analysis
 Chosen a priority
 Common tests: give name
 Advanced/unusual test: provide reference
 Details of software used
 p value to disprove the null hypothesis

93. Methods:
Ethical considerations
 Approve of ethics committee
 Human subjects
 Animals
 Consent

94. Methods
 Present methods in chronological
order
 Subheadings should match those in
results
‘internal consistency’
 In past tense
 Be precise

95. Methods : language
 ‘Employing a straight platinum wire
rabbit, sheep and human blood agar
plates were inoculated’
 ‘Blood samples were taken from 48
patients aged 6 months to 22 years; all
patients gave informed consent.’
 ‘After standing in boiling water for an
hour, examine the flask’
 ‘All endoscopic procedures were done by
an experienced endoscopist, after
intravenous sedations’

96. Methods
 Do not mix results and methods
 ‘Colleague treatment ’

97. Methods: Checklist
 Does it describe
 What questions was asked?
 What was being tested?
 How reliable was the measurement?
 Were the parameters recorded and
analyzed correctly?
 Would a reader be able to repeat the
same experiment?

98. GROUP EXERCISE

99. Materials and Methods-
Rough Draft
 The study was conducted in two
phases. The first phase was before
the introduction of Vibrators from the
month of January 2011 to March
2011 and the second phase was from
April 2011 to June 2011 after the
introduction of Vibrators.

100. Materials & methods-
Final
 This retro-prospective study was carried
out in all ventilated head & spinal injured
patients over 6 months in Neurosurgery
ICU. The clinical (demographics,
admission GCS & in hospital mortality) &
microbiological data (Modified Tracheal
Culture) was collected over the two time
periods.

101.  The ‘control’ group consisted of patients in
whom data was retrospectively collected
from January 2011 to March 2011 (before
the introduction of Vibrators). The ‘test’
group consisted of patients in whom data
was prospectively collected from April 2011
to June 2011 (following introduction of
Vibrators). All chest physiotherapy using
mechanical vibrators was done by bedside
nurses every 2 hourly.

102. RESULTS

103. Results: Before Writing
 Collect data
 List variables mentioned in Methods
 Place data for each under them
 Avoid missing information
 Are there any additional data?
 Are these relevant to the study?
 Matrix plan

104. Results: Before Writing
 Recheck tables for accuracy
 Analyze
 List all findings, study their relationships
 Identify the important ones
 Think and plan
 Sequence
 Identify subheadings
 Tables/text/figure

105. Measurements
 Science is measurement!
 Report the who, what, when, where
 How (in methods)
 Why (in discussion)
 Precision, reliability and validity of
measurements

106. Statistics
 Use % if n>100
 Restrict decimal points to 1 or 2
 No adjectives (most, some, often..)

107. p Values
 Nothing like significant, highly
significant or very highly significant
 All p<0.05 are significant; give value
of p
 Give exact p values: p=0.02 vs
p<0.05
 Smallest p value that need be
reported is p<0.001
 Many journals require 95% CIs

108. Report Study Findings-
Follow Methods
Who Patients / controls / rats / age /
gender / weight
What Procedure / Measurements
When Time period / morning
Where Hospital / Clinic

109. Results of Clinical Studies
 Schematic summary of study
 Show study design
 Indicate flow of subjects through the
study
 Account for all subjects or
observations

110. Participants / Controls
 Age/ gender distribution
 Whether matched for baseline
characteristics (usually as table)
 If different, whether correction
applied

111. Order in Results
 Report results of primary
comparisons first

112. Evaluation
 Compliance with therapy/protocol
 Response with respect to outcome
measures
 All evaluated parameters
 Adverse reactions
 Follow up data
 Correlations / differences between
parameters / groups

113. Results
 Give numerators and denominators of all
percentages
 (“In all, 33% of the rats lived, 33% died,
and the last one got away.”)
 What does 12% of 6 patients mean?
 What is
normal/abnormal?
raised/high/low?
 Cite all tables/figures in text

114. Results: Do not
 Omit unexpected findings
 Give results to a greater degree of
accuracy than each measurement
 Make groups/patients
appear/disappear
 Use abbreviations??

115. Results
 What did you find?
 Should answer all the points raised in
the methods
 No new parameters
 Text / tables / figures
 No mismatch in numbers

116. Results: Study Specific?
 Variations: depends on type of study
 Drug trial
 Animal experiment
 Clinical trial
 Cohort, case-control
 Randomised controlled trial
 Meta-analysis

117. Length of Manuscript
 Typical scientific manuscript:
 Text pages(double space) 12 (10-15)
 References 23 (15-32)
 Tables 3 (1-4)
 Figures 4 (2-6.5)
 Total pages 20 (16-27)

118.  Shortest sections
 Title
 Results

119. “The fool collects facts, the
wise selects them”

120. Text or Tables
 Number of items
 Few variabes: Text
 Many variables: Table

121. Example
Bacteria N Stool Urine Blood
Strep
aureus
12 6 0 6
Str
viridans
4 1 1 2
Str
faecalis
2 2 0 0
Pseudom
onas
8 1 7 0
E coli 9 3 4 2
S typhi 0 0 0 0

122. Tables : Common errors
 Title: none, too long, too brief
 Effect of adrenaline on cirrhotic and
non-cirrhotic rats at 20,40 and 60
days
Effect of adrenaline on cirrhotic and
non-cirrhotic rats
 Adrenaline and rats

123. Figures
 Types
 Graphs
 Photographs
 Flowcharts
 Location in relation to IMRAD
structure
 Results
 Methods: technique, study design

124. Figures
 Purpose-specific
 Graphs
 Line : usually event in relation to time
 Bar : comparisons
 Pie : parts of a whole
 Histogram : frequency distribution
 Scatter : associations between variables

125. Figures
 What do I want to say?
 Is there a better method?
 Type of figure?
 Less better than more
 Only if necessary

126. Figures
 Photographs, pictures
 Technique
 Before and after
 Show an event
 Flow charts
 Process, sequence, systems
 Algorithms

127. Table or figure
 Prefer tables
 Use figures only for illustrative
 Bar, histogram, pie: ?table
Difference in written and oral
communication

128. Figure : Guidelines
 2 axes : 2 types of information
 Curves : not more than 5 lines, thick
 Label axes : quantity, units
 Simple symbols (,) not ,
 Crossing curve : show break

129. Figure : Guides
 Good contrast
 Label
 Stain used
 Mask identity
 Magnification and scale
 No clips or staples
 Use colour, if absolutely essential

130. Figure : Legend
 Brief but complete
 Explain label
 Full form of abbreviations
 Write separately (Journal
instructions)
 Usually not with the figure

131. Figure : Details
 Indicate the TOP of the figure
 Place a mark 
 Name of the author
 Brief title of article
 Figure number
 Not within the figure

132. Summary
 Illustrations : adjuncts
 Convey a message
 Various types: use appropriately
 Ask: Is it needed?
 Simple, consistent, clear, focussed,
visually effective

133. Recommend
 Look at recent issue of journal
 Use a similar published table/figure as
a template
 Read journal instuctions
 Read Vancouver style (www.icmje.org)

134. GROUP EXERCISE

135. WRITING THE ‘DISCUSSION’ SECTION

136. Discussion of a Paper
What does it all mean?
‘
IMPLICATIONS’
‘SIGNIFICANCE’ vs.
‘RELEVANCE’

137. Discussion: Purpose
 Brings together all the pieces of the
puzzle
 What was known before
 What we learned
 This interpretation through inter-relation
bridges the data with the conclusion

138. Discussion: Problems
 Difficult to write
 Tend to be verbose, too long
 Issues not addressed by the
study
 Sequence: does not flow
 Introduce new information
 Harp on trivial or obvious points
 Ignore difficult to explain results

139. Discussion: Structure
 State major findings
 Strengths: design, technique, results
 Discuss
 Findings re: existing information
 “important” minor findings
 Implications: of findings, for practice/future research
 Limitations
 Summary(conclusion)

140. Discussion
 Summary of findings without
quantitative results WHAT WAS FOUND
 Making points
 First point
 Second point WHAT CAN BE FOUND
 (Potentially a third point)
 Limitations WHAT ONE CANNOT SAY
 Last paragraph of conclusion and
recommendations WHAT YOU MAKE OF IT

141. First Paragraph Of The
Discussion
 DO
 Announce the points that will be discussed
 Summarize the results in big picture terms
 Avoid
Interpreting
Repeating results in great details
Initiating the discussion of the results per se

142. Last paragraph of the
discussion
 DO
Summarise conclusion points
Propose recommendations
 Add action points
 Future studies
 Implications for patient evaluation and care
 Avoid
Proposing recommendations disconnected from conclusions
Repeating results without adding a layerof interpretation

143. Middle Part: Interpretation
 Starting from the results, bridge to
conclusions through interpretation
 Describing and interpreting
 Before you interpret, describe
 imagine you are talking on the phone
 the person you talk to has not seen the evidence
 Interpreting in light of initial hypotheses

144. Strengths
 Study design
 Sample size, controls, variables
assessed
 Duration of follow up
 Technique
 New, established but not
previously used in subset
 Better standardization

145. Comparison with Others
 Check that the comparison is valid
e.g. comparable methods, study groups
 Build arguments around consistency
 If differences, provide posssible explanations
 Discuss opposing views equally well
 A must: good grasp of information
 Do not hesitate to criticize
 Reasoned, logical arguments
 Avoid rhetoric, be diplomatic

146. Unexpected Findings
 Do not ignore
 Explain; if no
explanation, state so.

147. Limitations
 Selection bias
 Generalizable, applicable
 Drop outs
 Discuss unexpected findings
 Do not ignore, offer explanation
 If none plausible:say so

148. Place of the ‘limitations’
section
 Recommended location
 After summarizing the results in the discussion
 Before the conclusions
 Location to avoid
 After the conclusions
We want to conclude after we have taken the
limitations into account

149. For each limitation,
specify:
 What is the limitation
 What are the consequences of the limitation
 What did you do to control/address the
limitation
 How do you interpret the data in view of the
limitation

150. Example of a “limitations”
section
 Limitation
 We could not isolate the pathogen
 Consequence
 We cannot rule out another diagnosis
 Address the limitation
 The serology that is specific (ref) was positive
 signs/symptoms were compatible(ref)
 The disease is endemic in our region(ref)
 Interpret in view of the limitation
 Our diagnosis is the most probable
hypothesis(despite the limitation)

151. Focus the Discussion
 Begin with the most important point,
then move to less important points
 Confine to the subject studied
 Focus on key issues
 Provide link sentences between
paragraphs: ensure flow

152. Implications
 Alteration in clinical practice, public
policy
 Understanding of pathogenesis,
mechanism of disease
 Geographical
 Financial
 Consider alternative explanations
 Speculate, but intelligently
correlation≠causation

153. Discussion
DO NOT
 Start with history
 Repeat all your results
 Provide new data
 Extrapolate results
 Superlatives

154. Conclusions
 Answer
 So what?
 Who cares?
 Only those supported by data
 Avoid sweeping statements

155. Is the job done?
 Ask a colleague to read
 Get feedback from ‘worst enemy’
 Re-work

156. Summary
 Difficult to write
 Break into sections
 Provide link sentences : ensures
continuity
 Short, clear, key issues

157. GROUP EXERCISE

158. DEEPAK AGRAWAL
Assoc Prof Neurosurgery,
JPNATC,AIIMS
HANDWASHING

159. How to handwash…

160. Handwash with…

161. Why to handwash…

163. PaniPuri (Gol guppa)
Vendor

164. Comments on Youtube:
 येः इंिडयन दुिनया मे जहाँ भी जाते है गंद फै लाते है
 अपना घर तो साफ़ रखते है और कचरा बहार डालते है

165. Comments on Youtube:
 it is gross for sure. but it does look
like a setup. Why on earth was this
female ankitha rane filming a pani
puri vendor at that time. Now they
will politicize this matter against
some communities .
 Already over 300 vendors were
beaten black 'n blue 'n their stalls
were broken.

166. Comments on Youtube:
 They need to be educated about
sanitation and its our responsibility to
secure their livelihood...
 These videos are good if it gonna
make people think that these poor
people need training and if it is going
to divert people to Mc.Donald sort of
shops then its sad...

167. Why? (Panipuri vendor)
 Normal ‘guy’
 Nobody watching
 No concern/ empathy with the people
who come to him (Haves & have nots)
 Just earn his livelihood & go home

168. Why? (Healthcare
professional)
 Normal ‘guy/ girl’
 Nobody watching
 No concern/ empathy with the patients who
depend on them completely
 Just earn his livelihood & go home

169. Consequences of the Act-
unsuspecting people
Eating contaminated Panipuri
99.9% of times- Nothing
If vendor has UTI- then maybe
infection???

170. Consequences of the Act-
unsuspecting people
Not handwashing/ not handwashing
properly
Extremely dangerous
Patients- Resistant infection- death
Loved ones- resistant infection- death

171. Incidence
 Roadside vendors :1% ?? (No data
available)
 Healthcare professionals: >50%
(data on file)

173. Be the change you
want to see in the
world

174. THANK YOU