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How to write discussion
- 1. How to write Discussion Dr. Ghizal Fatima, Assistant Professor, Department of Biotechnology [email protected]
- 2. • Explaining the meaning of the results to the reader is the purpose of the discussion section of Thesis. • There are elements of the discussion that should be included and other things that should be avoided. • Always write the discussion for the reader; remember that the focus should be to help the reader understand the study and that the highlight should be on the study data.
- 3. • You have carefully written the hypothesis. • You have designed the study and collected the data. • You have conducted the statistical analysis and grouped the summary results into table and graphs.
- 4. • Explaining the meaning of the results to the reader is the purpose of the discussion section. • Although the discussion comes at the end of the paper, you should be thinking about what you will write in the discussion section from the moment that the study is conceived.
- 5. • Questions that you will develop in the discussion should be considered from the study’s outset. • Why is the study important? • How does this study relate to previous studies? • What are the limitations of the study design?
- 6. Elements to Include in the Discussion • State the study’s major findings • Explain the meaning and importance of the findings. • Relate the findings to those of similar studies. • Consider alternative explanations of the findings. • State the clinical relevance of the findings. • study’s limitations. • Make suggestions for further research
- 7. Things to Avoid in the Discussion Over presentation of the results. Unwarranted speculation (form a theory about a subject without firm evidence) Inflation of the importance of the findings Tangential issues (divergence) Conclusions that are not supported by the data
- 8. Elements to Include in the Discussion • The discussion should begin with a statement of the major findings of the study. • This should be the very first paragraph in the discussion. • It should be a direct, declarative proclamation of the study results. • However, it should not include data or reference to the study design. Several examples illustrate the point
- 9. • In a paper by Anton et al the discussion begins with the sentence, “Our results confirm that these nasal and full-face masks are similarly efficient over 15 min of NPPV with COPD patients recovering from acute hypercapnic respiratory failure.” This clearly states the most important finding of that study. • Fluck et al began the discussion section of their paper with the sentence, “Our findings suggest that there is no circadian rhythm in the secretion of 5-HT and also it doesn’t play any role in triggering the symptoms of FMS patients.” That is a good example of a direct, declarative proclamation of the study results.
- 10. Explain the Meaning of the Findings and Why the Findings Are Important • No one has thought as long, and as hard, about your study as you have. • As the person who conceived, designed, and conducted the study, the meaning of the results and their importance seem obvious to you. • However, they might not be so clear for the person reading your paper for the first time.
- 11. • One of the purposes of the discussion is to explain the meaning of the findings and why they are important. • After reading the discussion section, you want the reader to think, “That makes perfect sense. Why hadn’t I thought of that?” Even if your study findings are provocative, you do not want to force the reader to go through the paper multiple times to figure out what it means; most readers will not go to that effort and your findings will be overlooked, disregarded, and forgotten.
- 12. Relate the Findings to Those of Similar Studies • No study is so novel and with such a restricted focus that it has no relation to other previously published papers. • The discussion section should relate your study findings to those of other studies. • Questions raised by previous studies may have served as the motivation for your study. The findings of other studies may support your findings, which strengthens the importance of your study results. • Stoller et al discussed their study results in the context of a previous study by others: “Our finding that changing in-line suction catheters less frequently is associated with lower cost and no higher incidence of VAP replicates the findings of a randomized controlled trial conducted by Kollef et al, upon which our amended policy was based.”
- 13. State the Clinical Relevance of the Findings The reason studies are conducted is usually to improve the care of patients. Thus it is important to cast the findings of your study in the context of clinical practice. Experimental studies conducted in the laboratory usually do not involve human subjects, but the results may have clinical implications, which should be stated.
- 14. Acknowledge the Study’s Limitations • All studies have limitations. Unfortunately, the limitations of some studies are fatal flaws that preclude publication. • However, even the best studies in the most prestigious journals have limitations. It is far better for you to identify and acknowledge your study’s limitations than to have them pointed out by a peer-reviewer or a reader (in a letter to the editor after publication).
- 15. • Fluck et al acknowledged a limitation of their study and used it to make a suggestion for further research: “We used only healthy white subjects, to minimize confounding variables. Future research should include testing subjects with darker skin and subjects whose oxygen saturation is below normal ( 95%).”
- 16. Make Suggestions for Further Research • Although a study may answer important questions, other questions related to the subject may remain unanswered. • Moreover, some unanswered questions may become more focused because of your study. • You should make suggestions for further study in the discussion section. • Laboratory experimental studies typically lead to suggestions for follow-up clinical studies with human subjects. • An example comes from a laboratory study of oscillating positive expiratory pressure (OPEP) devices by Volsko et al, who wrote, “One subject that remains to be explored is how to determine at the bedside whether a patient can perform OPEP and, if so, which device to select.”
- 17. Give the “Take-Home Message” in the Form of a Conclusion • What is the “take-home message”? What do you want the reader to remember from your study, the take home message should be the first sentence of your conclusions section. • In some journals the conclusions section is a paragraph or subsection at the end of the discussion only, whereas other journals (J.RESPIRATORY CARE, for instance) require a separate conclusions section.
- 18. Things to Avoid When Writing the Discussion • Overinterpretation of the Results: • It is easy to inflate the interpretation of the results. Be careful that your interpretation of the results does not go beyond what is supported by the data.
- 19. 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 the subjects in your study had asthma, it is usually not appropriate to speculate about how your findings might apply to other patient populations. • If your study used volume-controlled ventilation, it may not be appropriate to speculate about how the findings might apply to pressure-controlled ventilation. If you feel compelled to speculate, be certain that you clearly identify your comments as speculation: “We speculate that.... ”
- 20. Inflating the Importance of the Findings After all of the hard work that goes into a study, it is easy to attribute unwarranted importance to study findings. We all want our study to make an important contribution that will be cited for generations to come. However, unwarranted inflation of the importance of the study results will disgust reviewers and readers. A measure of humility goes a long way.
- 21. The “Bully Pulpit” • Do not use the discussion section to criticize other studies. • Although you should contrast your findings to other published studies, this should be done professionally. • Do not use the discussion to attack other investigators.
- 22. Conclusions That Are Not Supported by the Data • The hypothesis study data conclusions should be a tight package. Avoid the temptation to allow your biases to enter into the conclusions.
- 23. Summary • The discussion section gives you an opportunity to explain the meaning of your results. • When writing the discussion, remember that the focus should be to help the reader understand the study and that the highlight should be on the study data.
- 24. THANK YOU ALL THE BEST
- 25. • Discussion: • This study was designed to examine the hypothesis that female patients with FMS exhibit alterations in circadian rhythm of serum cortisol secretion. Although, the serum cortisol levels in patients with FMS have been studied extensively, however, to the best of our knowledge there are no previous reports on its circadian nature in women with FMS. The basis for selecting only women in this study was the high prevalence of FMS in females as compared to males (15). In this study we found, a significant difference in the mid-night level of serum cortisol in patients compared to control group, which revealed a disrupted circadian pattern in serum cortisol level in patients with FMS. However, we found no abnormalities in serum cortisol level in the morning, afternoon and evening time. A normal circadian cortisol pattern is one in which there is a rise before waking (before 7-8 AM), and then a gradual decline throughout the rest of the day (16,17,18). However, in FMS patients this normal circadian pattern was found deranged. Due to the circadian nature of cortisol secretion, identification of cortisol dysregulation may not appear if total cortisol levels are measured at a single time point. Therefore, we have measured the cortisol levels at four time points during a day.
- 26. • Our findings of altered level of serum cortisol at night agrees with Crofford et al (7) report of disturbed level of night cortisol level and on the other hand it differs from the study of Klerman et al (19), who found no difference in the circadian variation of cortisol in patients with FMS. Moreover, results of our study did not match with the findings of Nees (20) and Izquierdo et al (21), who reported decreased cortisol levels in FMS patients. However, this discrepancy cannot be explained except to note our use of a substantially larger sample size and repeated measures of serum cortisol over time within patients and control groups. • There have been reports of moderate to severe fatigue in FMS patients, (22,23) however, we report a significant difference in morning fatigue and pain in patients with FMS than in control population. Morning stiffness, headache, anxious and other symptoms of FMS were increased in patients group, but showed no circadian pattern in either study group. These findings suggest that the abnormalities in circadian phase do not account for the reported abnormalities in the symptoms of fatigue, sleep disturbances, pain etc. that occur in patients with FMS. • The aim of the study is to assess the circadian rhythm disturbances in serum cortisol level in female patients with FMS. It is proved that female patients with FMS exhibit alterations in circadian rhythm of serum cortisol secretion. This increase in nocturnal serum cortisol in patients group suggests dysregulated circadian patterns which may explain in part the patient complaint of unrefreshing sleep. However, the findings of the present study may be a very small step put forward. Further studies are necessary to confirm, evaluate and replicate this study in a larger sample size with different ethnicities.