DEVELOPING AND WRITING YOUR TRIOLOGICAL THESIS

1
DEVELOPING AND WRITING YOUR TRIOLOGICAL THESIS

• Maureen Hannley, PhD

2
(No Transcript)
3
SUCCESSFUL THESES2001 2006 (n 126)
4
THE MYTHOLOGY OF THE TRIOLOGICAL THESIS(or more
Urban Legends Debunked)
5
DONT DISS MY THESIS

• Claim The thesis has to be a production
  equivalent to a doctoral dissertation
• Status False
• Origins The Triological thesis guidelines
  describe a candidates thesis as a carefully
  written, comprehensive dissertation.. and in
  past years they were often vast productions
  several hundred pages long. But emphasis now
  is on timely publication
• Reality According to the guidelines, the thesis
  should be no more than 40 pages (including text
  and figures) double-spaced, with no more than 50
  references, in a format suitable for publication
  in The Laryngoscope. This is NOT equivalent to
  a doctoral dissertation!

6
Dissertation (n) a treatise advancing a new
point of view resulting from research document
that presents the authors research and findings
and is submitted in support of candidature for a
degree or professional qualifications. American
Heritage Dictionary of the American Language
7
HOW CAN I WRITE THEE? LET ME COUNT THE WAYS

• Claim The thesis work cannot have been used for
  any other purpose
• Status False
• Reality Candidates may use work begun in their
  residency that, in part, has been previously
  published. It is permitted to use work that has
  been submitted as a Masters thesis, as long as
  it meets the format, publication, and originality
  requirements.

8
(SOMETIMES) IT TAKES A VILLAGE

• Claim The thesis cannot have multiple authors
• Status False
• Reality Although the candidate may be assisted
  in his/her work, the candidate must state in
  writing at the time of submission that he/she is
  personally responsible for 70 or more of the
  text and 70 or more of the research.

9
SOME EXCELLENT REFERENCES

• Troidl, H et al., Surgical Research Basic
  Principles and Clinical Practice (3rd Ed.). New
  York Springer, 1998
• Stone, J., Conducting Clinical Research A
  Practical Guide. Cumberland, MD Mountainside MD
  Press, 2006
• Belsher, J, Jacobsen, J, From Idea to Funded
  Project. Phoenix Oryx Press, 1992
• Spilker, B., Guide to Clinical Trials. New York
  Raven Press, 1991
• Norman, G, Streiner, D, PDQ Statistics (2d Ed.).
  St. Louis B.C. Decker, Inc., 1999
• Hulley et al., Designing Clinical Research (3rd
  Ed). Baltimore Lippincott, Williams Wilkins,
  2007

10
MOTIVATIONS FOR DOING RESEARCH
5
Improve health through better medical practice
Influence others behavior or viewpoint
4
Change the body of knowledge
3
Gain personal satisfaction
2
Improve curriculum vitae
1
Kramer, 1995
11
(No Transcript)
12
BUILDING A THESIS
the-sis. A proposition stated or put forward
for consideration, especially one to be proved
or maintained against objections. Random
House College Dictionary
13
Practical Problem
motivates
helps to solve
?
Research Answer
Research Question
finds
defines
Research Problem
Booth, Columb, Williams, 1995
14
Clinical Problem
Research Question
Design
Method
Observation
Experiment
Consultation
Laboratory
Case Reports
Qualitative Research
Clinical
Series
Surveys
Troidl et al., 1998
15
INTERESTS, TOPICS, QUESTIONS, PROBLEMS

• Find an interest in a broad subject area
• What am I interested/expert in?
• Narrow the interest to a plausible topic
• What are unsolved gaps or inconsistencies in
  this area?
• Develop questions within the topic
• What do I want to know?
• Develop a rationale for the project
• Why is it important to know this?

16
DEVELOP AN IDEA

• Read the most authoritative sources until you
  come to a point where the sources disagree. This
  is where unsolved questions may reside.
• Talk with the leading figures in the area.
  Attend their lectures and be alert to problems
  they identify.
• Seek out and read strategic research plans of
  medical and research organizations.
• Contemplate your own experience. What are the
  problems or questions that frustrate you? Have
  you found a solution you think will benefit your
  peers and patients?

Naumann in Belcher Jacobsen, 1992
17
SIX STEPS TO DEVELOP A COMPELLING NOVEL IDEA

• Identify the niche area
• Collect and critically analyze background
  information related to the problem
• Develop a preliminary idea (dont force it)
• Assess the ideas potential for success and
  modify it, if necessary
• Seek constructive criticism from colleagues
• Refine the idea to maximize its potential for
  impact on your field

18
INVESTIGATIONAL CATEGORIES

• Descriptions of problems required for planning
  interventions
• Transtympanic vs. Sustained Release
  Administration of Gentamicin Kinetics,
  Morphology, and Function
• Carcinoma of the Oropharynx Factors Affecting
  Outcomes
• Improving Surgical Wound Healing with Basic
  Fibroblast Growth Factor After Radiation
• A Standardized Regimen of Antibiotics Prevents
  Infectious Complications in Skull Base Surgery
• Clinical and Symptom Criteria for the Active
  Diagnosis of Chronic Rhinosinusitis

19
INVESTIGATIONAL CATEGORIES

• Information required to evaluate ongoing
  interventions, assess progress
• The Long-term Effect of Adenotonsillectomy on
  Quality of Life in Pediatric Patients
• Therapeutic Selective Neck Dissection 25 Year
  Review
• Long-term Follow-up for Children Treated with
  Surgical Intervention for Chronic Sinusitis
• Intratympanic Dexamethasone for Sudden
  Sensorineural Hearing Loss Following Failure of
  Systemic Therapy
• Therapeutic Efficacy of the Epley Canalith
  Repositioning Maneuver
• Endoscopic Percutaneous Dilational Tracheotomy A
  Prospective Evaluation of 500 Consecutive Cases

20
INVESTIGATIONAL CATEGORIES

• Information required to define problems
• Direct Evidence of Bacterial Biofilms in Otitis
  Media
• Herpes Simplex Virus and Menieres Disease
• Analyze possible causes
• Direct Nasopharyngeal Reflux of Gastric Acid is
  a Contributing Factor in Refractory Chronic
  Rhinosinusitis
• The Role of Nitric Oxide in the Development of
  Distant Metastases from Squamous Cell Carcinoma
• or offer solutions
• Regular Tracheostomy Tube Changes to Prevent
  Formulation of Granulation Tissue

21
SELECT A TOPIC

• Relevance
• Avoidance of duplication originality
• Feasibility
• Ethical acceptability
• Applicability of possible results and
  recommendations
• Urgency of data needed
• The Big So-What

22
FOUR TESTS OF THESIS TOPIC

• Is it new?
• Is it true?
• So what?
• Who cares?

Fontanarosa, 2008
23
(No Transcript)
24
ASKING THE RIGHT QUESTION

• Ask a question with clinical relevance, not just
  clinical application
• Ask a question that interests you and will
  sustain your interest
• Ask the question in such a way that either a
  positive or negative answer will be interesting
• Be specific
• Make sure you have time, resources
• Subjects
• Database/access
• Collaborators if appropriate

25
REFINE YOUR RESEARCH QUESTION

• Define the population to be studied
• Define the period of time for the study
• Select the variables to be measured
• Change non-specific variables into variables that
  can be measured.

26
THE RESEARCH QUESTION

• Begin by asking the question as a general
  statement
• In patients with recurrent acute sinusitis by
  accepted criteria is ESS the best treatment
  option to improve symptoms and disease-specific
  QOL?
• Use PICO to help structure the question

27
PICO

• P Population, Patient or Problem
• I Intervention
• C Control or Comparison
• O Outcome

28
THE RESEARCH QUESTION

• P (Pediatric, adult) patients with recurrent
  acute sinusitis
• I Endoscopic sinus surgery
• C Medical treatment
• O Symptoms and disease-specific
  QOL
• In (age) patients with recurrent acute sinusitis
  by accepted criteria does ESS compared to medical
  treatment improve symptoms and disease-specific
  QOL?

Patients
Intervention
Comparison
Outcome
29
DETERMINE WHAT YOU ARE GOING TO MEASURE

• Variables that you are going to need to measure
• Be parsimonious if it wont add to your answer,
  dont do it
• Each additional variable complicates your
  statistics increases your sample size
  requirement
• Recognize the value of independent converging
  measures
• Reliability and validity of instruments

30
VARIABLES
Types of Variables
Dependent
Independent
Qualitative
Quantitative

(Reflux)
(Proton pump inhibitor vs pepsin antagonist)
Nominal
Interval
Confounding
(Sex, gender)
(36o 38o)
(Gastric ulcer)
Ratio
Ordinal
(Pulse rate, vital capacity)
(TNM stage)
Norman Streiner, 2003
31
SELECT VARIABLES

• Numerical
• Age
• Number of documented recurrences
• Categorical
• Involved site
• Disease outcome
• Tissue type
• Operational
• Dependent
• Independent
• Confounding
• Background

32
THE DOOMED DESIGN
v. A.1.a
V. A.1
..
v.A.1.b
Variable A
v.A.2.a
..
V. A.2
v.A.2.b
v.B.1.a
V. B.1
..
Variable B
v.B.1.b
v.B.2.a
..
V. B.2
v.B.2.b
33
Clinical Problem
Research Question
Design
Method
Observation
Experiment
Consultation
Laboratory
Case Reports
Qualitative Research
Clinical
Series
Surveys
Troidl et al., 1998
34
ESSENTIAL PRELIMINARIES

• Consult a statistician
• Question design statistical
  treatment
• Sample size estimations
• Involve sponsor/mentor in planning process
• Careful, comprehensive literature review

35
SELECT A STUDY STRATEGY

• Basic vs. clinical
• Prospective vs. retrospective
• Efficacy vs. effectiveness
• Duration of study
• Cross-sectional vs. longitudinal
• Medical vs. patient outcome

36
THE EVIDENCE PYRAMID
Systematic Reviews and Meta-analyses
Randomized Controlled Double Blind Studies
Cohort Studies
Case Control Studies
Case Series
Case Reports

Ideas, Editorials, Opinions
Animal research
In vitro (test tube) research
37
TYPES OF STUDIES
38
TYPES OF STUDIES
39
FORMULATE PROJECT OBJECTIVES, HYPOTHESES

• Formulation of objectives will help
• Focus the study, narrowing it to essentials
• Avoid collection of data not strictly necessary
  for solving defined problem
• Organize the study in clearly defined parts or
  phases

40
LINKAGE OF THREE KEY COMPONENTS

• Long-Term Goal Broadest (the Forest)
• Projects your continuum of research
• Overall Objective Narrower
• Step along the continuum
• Must be achieved regardless of how the hypothesis
  tests
• Central Hypothesis Narrowest (the Tree)
• Best bet, but could be invalid (alternative
  presented later, therefore)

41
STATE OBJECTIVES

• Cover different aspects of problem and
  contributing factors in coherent way and logical
  sequence.
• Use specific action-oriented verbs (to verify
  to compare to establish etc.) that correspond
  with goals and methodology.
• Avoid weak verbs (to find out, to
  characterize, to correlate) that give the
  impression of a hypothesis seeking project,
  a.k.a. a fishing expedition
• Objectives should be demonstrably achievable
  through selected methodology and subjects.
• State assumptions underlying your project.

42
WRITE THE HYPOTHESIS

• Write what you expect to find from your study.
• What are the general relationships implied by
  your hypothesis?
• Are there any specific alternative relationships
  or explanations that would serve as competing or
  rival hypothesis?
• State your hypothesis in a clear, concise
  sentence.
• Should be directional and quantifiable
• Should be simple, specific, and stated in advance

43
TYPES OF HYPOTHESES

• Null hypothesis (H0)
• There is no difference in symptom resolution or
  disease-specific QOL in children with recurrent
  acute sinusitis treated with ESS and those
  treated medically.
• Formal basis for testing statistical significance
• Alternative hypothesis
• Children with recurrent acute sinusitis treated
  with ESS will have significantly better symptom
  resolution and better disease-specific QOL than
  those treated medically.

44
SELECT YOUR SAMPLE(S)

• Describe the characteristics of the subjects who
  will be eligible for participation in your study
• Describe the characteristics of the subjects who
  will be excluded from your study
• Describe the population (beyond your sample) to
  which you wish to generalize your conclusions
• Determine sample size necessary for desired
  statistical power

45
ELIMINATE OR CONTROL THE BIASES

• Effects of historical events
• Effects of maturation, gender, ethnicity
• Effects of repeated measurement
• Instrument decay
• Effects of statistical regression
• Subject selection
• Loss of subjects
• Patient recall
• Investigator bias

46
TO ENHANCE CREDIBILITY

• Appropriate controls
• Appropriate operational definitions
• Appropriate measurement tools
• Appropriate design and analysis
• Balanced perspective
• Cite others work
• If there are 2 camps, make sure you cite both
  sides

47
Nothing improves the performance of an innovation
more than the lack of controls. Bearman et
al., 1974
48
CONDUCTING THE THESIS PROJECT
49
SCIENTIFIC INTEGRITY AND ETHICS

• Ethics in scientific design and conduct
• Ethical justifiability
• Clinical equipoise
• Informed, comprehending, voluntary consent
• Confidentiality
• Use of animals
• Scientific adequacy
• Conflict of interest

Riis, in Troidl, et al., 1998
50
MANAGE THE DATA

• Collect the data
• Maintain quality control over the data
• Enter the data to a database
• Store the data
• Analyze the data

51
DATA ANALYSIS

• Descriptive
• Numbers, demographics n, age, gender, ethnicity
• Central tendency mean, median, mode
• Variation range, standard deviation, percentile
• Inferential
• Process of inferring features of population from
  observations of a sample confidence interval
• Likelihood that observed effect/differences could
  be due to chance standard error of mean
• Many inferential tests depending on research
  design and whether data are normally distributed

52
A difference to be a difference should make a
difference. Gertrude Stein
53
WRITING THE THESIS
process, a uniform level of scientific rigor can
be attained to achieve three objectives 1)
provide support for the most meritorious research
in otolaryngology and head
54
THE MOST IMPORTANT RULE

• Read the guidelines for thesis format and
  submission
• Read them again
• Follow them to the letter

55
THE ABCs OF SCIENTIFIC WRITING

• Accuracy
• Brevity
• Clarity

56
APPROACH TO THESIS PREPARATION
Writing is easy. All you have to do is sit and
stare at the blank sheet of paper until the drops
of blood form on your forehead.
Gene Fowler
57
THE BAIT AND THE PUNCHLINE

• Introduction
• Opening quotation or fact
• Context of past research
• Condition of ignorance
• Cost of that ignorance
• Gist of solution

• Conclusion
• Gist of solution
• Larger significance or application
• What is still not known
• Call for further research
• Closing quotation or fact

Booth, Colomb, Williams, 1995
58
INTRODUCTION

• Clear and concise
• Justification for the study
• Establishes novelty and originality re salient
  research
• Intriguing and inviting
• Last sentence states study objective AND
  hypothesis

59
METHODS AND PROCEDURES

• Reveal how carefully you conducted your research
• Allow another researcher to replicate your study
• Sections
• Subjects or Participants
• Experimental design
• Equipment or measures
• Procedures
• Subject selection
• Measurement of dependent variables
• References to support choice of procedures

60
(No Transcript)
61
A USEFUL EXERCISE

• Convert pooled data to charts (bar, pie, scatter,
  etc.)
• Write 1-2 bullets/sentences about what chart
  tells you
• Write 1-2 bullets/sentences about any alternative
  explanations for the display
• This can serve as outline for Results and
  Discussion sections

62
RESULTS

• Report only results that bear on your question
  (not every analysis needs to be shown)
• A good Results section should tell a story
• Analyses that support the integrity of the study
  (internal consistency, variance, etc)
• Present analyses in logical sequence
• Use tables figures to relieve clutter of
  numbers
• For key data, present in both table and figure

63
ILLUSTRATIONS

• To illustrate this
• Process
• Logical relationships
• Object
• Parts of complex object
• Action, step in process
• Results

• Use this
• Flow chart, decision tree
• Diagram, matrix
• Photo, drawing
• Microscopic view, drawing
• Schematic, photo, diagram
• Photo, graph, matrix

64
DISCUSSION

• Considers findings in light of other theories and
  past research be objective!
• Begin with brief overview of problem and your
  findings should not reiterate Results, but
  state whether Hypothesis accepted or rejected
• Identify limitations of your research why they
  arent fatal flaws and can represent
  opportunities for further research

65
THE BEST DEFENSE..

• Your Answers
• I claim that
• I limit it to
• I offer as evidence
• I offer this principle
• I can rebut that. First.
• My claim stands as long as...
• Well, I have to admit that

• The Questions
• What is your point?
• What is your claims scope?
• What evidence do you have?
• What links evidence to claim?
• But what about.?
• But what if.?
• No problems at all?

66
JUST DO IT!
67
SCIENTIFIC INTEGRITY

• Scientific dishonesty
• Fabrication of data or analysis
• Selective, undisclosed rejection of undesired
  results
• Erroneous use of statistical methods to achieve
  desired outcome
• Distorted interpretation of results or
  conclusions
• Plagiarism of results or writings of other
  authors
• Distorted representation of other researchers
  results
• Wrongful or inappropriate attribution of
  authorship
• Omission of recognition of original observations
  made by other scientists

Riis, in Troidl, et al., 1998
68
CONTACT

• Maureen Hannley, PhD
• 414-805-8308
• mhannley_at_mcw.edu
• auntiemo_at_aol.com