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Systems Theory: A Modified Extracorporeal Circuit to Attenuate Systemic

Inflammatory Response Syndrome
by
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#amantha (%ein $"A $ean #choo% of "ub%ic #er)ice Leadership
A $issertation "resented in "artia% Fu%fi%%ment
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Acknoled!ments
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!@A"TER C. INTRO$&!TION C
C.C Introduction to the "rob%em +@it Tab to enter page numbers, C
C.0 Bac<ground of the #tudy
C.0.C #IR# 6 "athophysio%ogy
C.4 #tatement of the "rob%em
"urpose of the #tudy
Rationa%e
Research Duestions
#ignificance of the #tudy
$efinition of Terms
Assumptions and Limitations
Nature of the #tudy +or Theoretica%?!onceptua% Framewor<,
OrganiEation of the Remainder of the #tudy
!@A"TER 0. LITERAT&RE REFIEA
Add %e)e% C headings
!@A"TER 4. MET@O$OLO/'
Research $esign
)
#amp%e
#etting +if appropriate,
Instrumentation?Measures
$ata !o%%ection
$ata Ana%ysis
Ethica% !onsiderations
!@A"TER 2. RE#&LT#
NOTE TO ARITER. There is considerab%e )ariabi%ity in !hapter 2 headings. The first
e;amp%e shows suggestions for a *ua%itati)e study. A%so see !hapter
2 in this temp%ate.
#ite $escription
$escription of #amp%e
Research Methodo%ogy App%ied to $ata !o%%ection and Ana%ysis
Ana%ysis #ynthesis and Findings
$ata !o%%ection Ana%ysis "rocedures
Themes
#ummary
NOTE TO ARITER. Fo%%owing are four e;amp%es of possib%e !hapter 2 headings for a
*uantitati)e study. A%so see !hapter 2 in this temp%ate.
Introduction
$escription of the #amp%e
#tatement of Resu%ts
$etai%s of Ana%ysis
Bi)ariate Re%ationships
)i
Research Duestion C
Research Duestion 0
Research Duestion . . .
#ummary
NOTE TO ARITER. E;amp%e 0 for the organiEation of a *uantitati)e !hapter 2. A%so see
!hapter 2 in this temp%ate.
Introduction
Research Duestion and @ypotheses
$ata Ana%ysis #trategy and OrganiEation of #tatistica% Resu%ts
$escription of #amp%e
"re%iminary $ata #creening and !%eanup
Interaction Fariab%e
Mu%tico%%inerity
$escripti)e #tatistics
"arametric Assumptions
$etai%s of Ana%ysis and Resu%ts
!onc%usion
NOTE TO ARITER. E;amp%e 4 for the organiEation of a *uantitati)e !hapter 2. A%so see
!hapter 2 in this temp%ate.
Introduction
$escription of the #amp%ed $ata
Research Methodo%ogy and $ata Ana%ysis
@ypothesis
"resentation of $ata and Resu%ts of the Ana%ysis
)ii
@ypothesis $ata Ana%ysis
#ummary
NOTE TO ARITER. E;amp%e 2 for the organiEation of a *uantitati)e !hapter 2. A%so see
!hapter 2 in this temp%ate.
Introduction
$escription of the #amp%e
Research Duestion and @ypotheses
#tatement of Resu%ts
!@A"TER 5. $I#!&##ION IM"LI!ATION# RE!OMMEN$ATION#
NOTE TO ARITER. There is considerab%e )ariabi%ity in !hapter 5 headings. The
fo%%owing are suggestions for a *ua%itati)e study. A%so see !hapter 5
in this temp%ate.
Introduction
Re)iew of the Research "rob%em and "urpose
#ignificance
Ana%ysis #ynthesis and E)a%uation
Imp%ications of Findings
$iscussion of the !onc%usions in Re%ation to the Literature in the Fie%d
Limitations of the #tudy
Recommendations
#ummary
NOTE TO ARITER. The fo%%owing are three e;amp%es for possib%e !hapter 5 headings for
a *uantitati)e study. A%so see !hapter 5 in this temp%ate.
#ummary of Resu%ts
$iscussion of the Resu%ts
)iii
Research Duestion C
Research Duestion 0
Research Duestion . . .
$iscussion of the !onc%usions in Re%ation to the Literature in the Fie%d
Limitations
#ummary
Recommendations for Future #tudy
!onc%usions
NOTE TO ARITER. E;amp%e 0 for the organiEation of a *uantitati)e !hapter 5. A%so see
!hapter 5 in this temp%ate.
Introduction
#ummary of Resu%ts
$iscussion of Resu%ts
$iscussion of the !onc%usions
Imp%ications for "ractice
Limitations
Recommendations for Further Research
!onc%usion
NOTE TO ARITER. E;amp%e 4 for the organiEation of a *uantitati)e !hapter 5. A%so see
!hapter 5 in this temp%ate.
Introduction
#ummary of Resu%ts
$emographic Ana%ysis
"opu%ation $ata
i;
$iscussion of the !onc%usions in Re%ation to the Literature
Recommendations for Further #tudy
Limitations and Recommendations
!onc%usions
REFEREN!E#
NOTE TO ARITER. #ome common appendi;es are noted be%ow.
A""EN$IG A. A$$ TITLE +data co%%ection instruments such as sur)eys and
inter)iew protoco%s,
A""EN$IG B. A$$ TITLE +additiona% data charts tab%es,
;
"ist of Tables
Tab%e C. Add tit%e +sing%e6space tab%e tit%e7 doub%e6space between entries,
;i
"ist of #i!ures
Figure C. Add tit%e +sing%e6space figure tit%e7 doub%e6space between entries,
NOTE TO ARITER. $o not remo)e the section brea< that fo%%ows this paragraph.
;ii
C$A%TER &' I(TR)D*CTI)(
.
&'& Introduction to the %roblem
This chapter considers the e;istence of prob%ematic issues encountered within
!ardiopu%monary Bypass surgery. !"B surgery is performed for the more comp%e;
cardiac operations and is sti%% the preferred methodo%ogy in this fie%d of c%inica% practice
+/unaydin Mc!us<er H Fi8ay 011I,. According to this and other studies #ystemic
Inf%ammatory Response #yndrome is pro)o<ed when !"B is uti%iEed as a c%inica%
procedure +Fohra Ahistance Modi H Ohri 011I7 /unaydin et a%. 011I7 "intar H
!o%%ard 01147 Laffey Boy%an H !heng 0110,. Moreo)er Laffey et a%. +0110, a%so find
that )igorous inf%ammatory response has 9important c%inica% imp%ications: and further
refers to 9postoperati)e comp%ications: +p. 0C5,. Furthermore research suggests that J.(.
(ir<%in first to referred to this #IR# phenomenon as a 9who%e body inf%ammatory
response: +Boy%e and #ung CIIK,. In addition
Accepting the %imitations of !"B due in part to negati)e outcomes deri)ed from
#IR# this study %oo<s at the possibi%ity of reducing the impact of this inf%ammation on
the patient. The 9"innac%e #ystem: is an inno)ati)e patented in)ention that primari%y
targets reducing the abi%ity of #IR# to ad)erse%y affect the reco)ery of patients
C
undergoing more comp%icated cardiac surgery. By imp%ementing the 9"innac%e #ystem:
rather than the more con)entiona% 9#tandard #ystem: uti%iEed within the fie%d of cardiac
surgery the prob%em posed by the e;istence of #IR# can be reduced7 thereby a%%owing
the patient to reco)er o)er a shorter time6frame +/unaydin et a%. 011I,. The prob%em
%oo<s at the abi%ity of the 9"innac%e #ystem: to de%i)er measurab%e reduction of #IR# as
opposed to the abi%ity of the e;isting 9#tandard #ystem: to effect such reduction. The
prob%em a%so assumes that a *uic<er post6operati)e reco)ery time wi%% positi)e%y
contribute to the patient>s o)era%% return to fu%% hea%th and we%%6being.
&'+ ,ack!round of the Study
In CI54 !ardiopu%monary bypass was performed for a young fema%e to rectify
cardiac issues. #ince that time !"B has become the methodo%ogy of choice for cardiac
surgeons wor%dwide. !ontinuing ad)ancement in technica% e;pertise and ongoing
de)e%opment of medica% e*uipment has %ed to a uni)ersa% acceptance within the fie%d of
cardiac surgery that this methodo%ogy is re%ati)e%y safe. Moreo)er the number of
fata%ities arising from heart bypass operations has been reduced to acceptab%e %e)e%s
+Fohra Ahistance Modi H Ohri 011I,.
@owe)er due to the genera% increase in %onge)ity cardiac surgery and the
a)erage age of the patient wi%% ine)itab%y rise7 thereby increasing the %i<e%ihood and ris<
of comp%ications to o%der patients. According to $enau%t +011I, between C.111.111 to
0
C.051.111 cardiac operations are performed annua%%y wor%dwide. Referring to these
statistics he noted that the o%der patient is significant%y e;posed to ris< due to 9increased
co6morbidities: and 9the pre)a%ence of coronary artery disease: +$enau%t 011I p. 2,.
Additiona%%y it is a%so recorded that chi%dren constitute an increasing number of !"B
operations in which around fifty percent are infants7 many of which are newborns
+/unaydinC Mc!us<er Fi8ay #ari #argon Onur (oca<u%a< /urpinar TeEcaner H
Lor%utuna 0115,. @owe)er one prob%em associated with cardiac surgery and
cardiopu%monary bypass is the ine)itab%e reaction of #IR# which 9initiates a
who%e body inf%ammatory reaction: +Fromes /ai%%ard "onEio !hauffert /erhardt
$e%euEe H Bica% 0110 p. 50K,. This study turns to detai% #IR# its re%e)ance and
cha%%enge to cardiac surgery as a contributing factor to the prob%em.
The American !o%%ege of !hest "hysicians and #ociety of !ritica% !are Medicine
+A!!"?#!!M, origina%%y introduced the term #IR# as a means to determine the
significant impact of 9endogenous mediators of systemic inf%ammation: +NystrMm CIIN
p. C, in microbia% infection +sepsis,. It was accepted during this period that #epsis was not
on%y deri)ed from factors pertaining to organisms found in microbia% pathogenicity but
a%so by inf%ammatory factors. NystrMm +CIIN, found that the simi%arity between both of
these syndromes %ed to a broader )iewpoint regarding some of the infectious and
inf%ammatory cha%%enges encountered in cardiac surgery rather than )iewing them as
separate c%inica% issues.
4
According to NystrMm +CIIN, the A!!"?#!!M consensus conference pub%ished
a paper which defined #IR# as a 9response to a )ariety of se)ere c%inica% insu%ts: +p. 4,.
The response becomes e)ident when two or more conditions materia%iEe.
Temperature 4NO! or 43O!7 heart rate I1 beats?min7 respiratory rate 01 breaths?min or
"a!O0 40 torr + 2.4 <"a,7 AB! C0111 ce%%s?mm4 2111 ce%%s?mm4 or C1P immature
+band, forms +Bone Ba%< !erra $e%%inger Fein H (naus CII0,.
NystrMm +CIIN, further defined #epsis?#IR# as a se*uence of three processes7
name%y a trigger fo%%owed by a mediator which resu%ts in a response. Bacteria or
endoto;in initia%%y act as a trigger. &pon a trigger being acti)ated pro6inf%ammatory
mediators which are <nown both as cyto<ines or a%arm cyto<ines are initia%%y pro)o<ed
and materia%iEe within the b%ood. Inc%uded within this second process are other factors
which contribute as mediators. The combination of these two processes or se*uences %ead
to the response in which ce%% popu%ations are stimu%ated and a%so secondary cyto<ines
appear. @e further points out that the presence of these cyto<ines is of brief duration as
they ha)e 9short ha%f6%i)es: +p. 2,7 a%beit sti%% responsib%e for the ine)itab%e response
despite their short %onge)ity. NystrMm +CIIN, maintains that these mediators primari%y
e;ist in areas of the body which are sub8ected to inf%ammation issues yet the
aforementioned response in)ariab%y affects the who%e body +Mc!us<er 01C1,.
"re)enting this ad)erse inf%ammatory response is critica% +!o%%i FernandeE
$e%gado Romero !amara H Ruyra 011I, due to issues surrounding post6operation and
thereafter. These inc%ude factors such as 9fe)er f%uid shifts: +Mc!us<er 011I p. C,
2
9se)ere respiratory fai%ure rena% dysfunction b%eeding disorders and mu%tip%e organ
fai%ure: +!o%%i FernandeE $e%gado Romero !amara H Ruyra 011I p. 5N4-. #uch
mu%tip%e organ fai%ure is percei)ed to be direct%y connected by the duration of #IR#7
thereby determining the manifestation of post6trauma mu%tip%e organ dysfunction
syndrome +MO$#, in the body +/ando NanEa<i H (emmotsu CIII7 Afessa /reen
$e%<e and (och 011C,. &nder%ying the *uestion posed by the research prob%em is the
e;istence of #IR# both during the enactment of cardiac surgery and in the post6operation
setting. Fo%%owing are re%e)ant aspects pertaining to #IR#7 its structure and inf%uence on
the patient undergoing cardiac surgery.
&'+'& SIRS . %athophysiolo!y of response
Tissue damage or disease resu%ting from cardiac surgery instigates functiona%
changes within the human body. These changes are )iewed as a response and described
as 9rapid high%y amp%ified contro%%ed humora% and ce%%u%ar response: +Laffey Boy%an H
!heng 0110 p. 0C5,. Ahi%st #epsis is primari%y )iewed in a c%inica% setting as a
condition deri)ed from infection #IR# is seen as the response to a different trigger7
tissue damage or in8ury. Laffey et a%. +0110, suggest that the appearance of sepsis and
#IR# are simi%ar %e)e%s of outcomes pertaining to morbidity and morta%ity remain
consistent7 thereby %eading to the perception and understanding that these two syndromes
ha)e mu%tip%e common denominators.
5
Furthermore they maintain that functiona% changes deri)ed from disease or
infection +sepsis, or from inf%ammation +#IR#, co%%ecti)e%y fa%% within the same
c%assification as genera% inf%ammatory response +a%beit infection,7 not a%%ocated to any
specific causation rather a continuation of trigger mediator and response process to
genera% causes re%ating to both inf%ammation and infection. Laffey et a%. +0110, go on
further to say that #IR# is 9independent of the causati)e factors: +p. 0C5,7 rather a series
of steps that once triggered create a process yet the appearance can be diagnosed as
many different conditions inc%uding sepsis or septic shoc<. @owe)er #IR# is sti%%
considered to be sensiti)e to in8ury yet does not indicate its specific origina%ity.
Notwithstanding #IR# can be pro)o<ed not on%y within c%inica% operations
associated with cardiac issues but a%so obstetric patients who ha)e been admitted to an
Intensi)e !are &nit. Referring to this category of patients Afessa /reen $e%<e and
(och +011C, suggests that 9#IR# de)e%ops in most hospita%iEed patients: +p. C0K5,. They
further note that the incidence of #IR# is triggered primari%y by infectious causation and
on%y triggered by non6infectious c%inica% outcomes in 5P of hospita%iEed obstetric
patients. Additiona%%y they maintain that there is a %i<e%ihood that the presence of #IR# in
critica%%y i%% obstetric patients resu%ts in an increased duration within the c%inica%
en)ironment7 thereby a%%owing the deduction that the presence of #IR# is widespread
within many different c%inica% cha%%enges. These abo)e factors ha)e perhaps in part
8ustified the introduction of the Q"innac%e #ystem> as a contribution to a so%ution posed by
the prob%em in)estigated by this study.
3
Fo%%owing are some of the many triggers or causes that pro)o<e the appearance of
#IR# within the human body.
Infectious causes.
R Bacteria% sepsis
R Burn wound infections
R !andidiasis
R !e%%u%itis
R !ho%ecystitis
R !ommunity6ac*uired pneumonia
R $iabetic foot infection
R Erysipe%as
R Infecti)e endocarditis
R Inf%uenEa
R Intra6abdomina% infections +eg di)erticu%itis appendicitis,
R /as gangrene
R Meningitis
R Nosocomia% pneumonia
R "seudomembranous co%itis
R "ye%onephritis
R #eptic arthritis
R To;ic shoc< syndrome
R &rinary tract infections +both ma%e and fema%e,
Non6infectious causes.
K
R Acute mesenteric ischemia
R Autoimmune disorders
R Burns
R !hemica% aspiration
R !irrhosis
R $ehydration
R $rug reaction
R E%ectrica% in8uries
R Erythema mu%tiforme
R @emorrhagic shoc<
R Intestina% perforation
R Medication side effect +eg theophy%%ine,
R Myocardia% infarction
R "ancreatitis
R #ubstance abuse +stimu%ants such as cocaine and amphetamines,
R #urgica% procedures
R To;ic epiderma% necro%ysis
R Transfusion reactions
R &pper gastrointestina% b%eeding
R Fascu%itis
Abo)e %ist e;tracted from Q#ystemic Inf%ammatory Response #yndrome> +Burdette
"ari%o H Bai%ey 01C1,. Fo%%owing are factors that determine the se)erity of inf%ammatory
response.
N
&'+'+ SIRS . Influencin! factors determinin! se/erity
Laffey et a%. +0110, point out that %itt%e is <nown +as of 0110, regarding factors
that inf%uence the se)erity of #IR#. The e;tent its impact on the patient is determined by
contributing factors such as 9incidence se)erity and c%inica% outcome: +p. 0C3,. In
addition attention is drawn to such se)erity which e;tends to potentia% fata%ity
encountered during surgica% procedure. &nderstanding a%beit %imited suggests such an
ad)erse outcome can be attributed to se)era% different )iewpoints. The first consideration
concerns the interaction or participation between mo%ecu%es that either faci%itates
inf%ammation or negates it.
Another consideration is presented by Laffey et a%. +0110, who maintain that post6
operati)e cha%%enges are posed when sma%%er mo%ecu%es +cyto<ines, which are a%so pro6
inf%ammatory and anti6inf%ammatory inf%uence c%inica% outcome. Moreo)er factors such
as perioperati)e )ariab%es se)erity of the syndrome or 9patterns of cyto<ine re%ease: +p.
0C3, inherent%y affect abnorma% #IR# response. The inabi%ity to pre6determine the %e)e%s
of such ad)erse inf%ammation is a contributing factor to the ris<s of fata%ities or se)ere
comp%ications7 especia%%y within the cardiac operating en)ironment.
Ne;t their study points out that a patho%ogica% condition resu%ting from #IR#
de)e%ops subse*uent to perioperati)e surgery materia%iEes in which a series of negati)e
e)ents such as infection or restricted f%ow of b%ood through the affected organ occurs. It is
the combination of such mu%tip%e e)ents that may change the outcome from a contro%%ed
I
process to that of an Qout of contro%> actions7 thereby negating the abi%ity of the organ to
function.
A%though #IR# is broad%y )iewed as an infectious and pro6inf%ammatory
syndrome7 thereby inc%usi)e of e;pected response during perioperati)e and postoperati)e
surgery it is on%y one of many responses encountered during and after such surgery.
Research by Laffey et a%. +0110, indicates other responses triggered by surgery may be
)iewed as anti6inf%ammatory or <nown as compensatory in their composition. The se%f6
correcting tendencies of these responses assist in the enab%ement an ad8ustment within
sing%e or mu%ti6ce%%u%ar organisms. This process faci%itates ad8ustment within such
organisms or attempt ba%ance between the ce%%s that ha)e suffered from
immunodeficiency or perhaps more common%y <nown as immunosuppression. From this
scenario conf%ict ta<es p%ace between different responses to surgica% in)asion e)ents
such as cardiac surgery.
!ompetition between opposing responses is another factor that direct%y inf%uences
the patient>s abi%ity to estab%ish homeostasis. !ardiopu%monary Bypass surgery pro)o<es
the suppression of the immune system within the human body )ia triggering the onset of
ad)erse inf%ammatory processes. Opposing this response syndrome is the body>s own in6
bui%t mechanism designed to combat foreign intrusion. The cu%mination of such opposing
inf%uences resu%t in an 9intermediate mi;ed response: +p. 0C3,7 thereby )a%idating the
)iew that #IR# is on%y one of many responses a%beit common%y ac<now%edged as a
C1
primary contributor to ris<s posed during perioperati)e and post6operati)e cardiac
surgery.


A. Bac<ground of the "rob%em +Introduction, +0.C,
Identifies the wider issues under%ying the research prob%em and *uestion. Essentia%%y a
brief synopsis of the %iterature re)iew +fu%%y de)e%oped in !hapter Two of the
dissertation, about the prob%em itse%f and the theoretica% framewor< the researcher has
chosen to e)a%uate the prob%em and the e)entua% data obtained about it.
#ince the beginning of this century e;citing inno)ati)e de)e%opments ha)e %ed to further
impro)ement of !"B7 thereby resu%ting in the reduction of #IR# and accompanying
comp%ications on the patient. These de)e%opments ha)e been in part directed to 9%imiting
CC
the b%ood6air interface decreasing the surface area of artificia% materia% and optimising
the surface coating of components: +Fohra et a%. 011I p. C,.

.
This is in part re%ated to the interface of b%ood
components air and artificia% surfaces within the !!"B
apparatus Fohra Ahistance Modi H Ohri 011I
In considering the many aspects pertaining to the o)era%% prob%em of combining
cardiac surgery and e;isting cardiopu%monary bypass methodo%ogy it is suggested that if
the #ystemic Inf%ammatory Response #yndrome +#IR#, can be reduced there is
sufficient e)idence that the patient can e;pect a *uic<er reco)ery7 thereby %eading to an
o)era%% better outcome.
C0
!ardiopu%monary bypass +!"B, sti%% remains the <ey techno%ogy for more
comp%e; cardiac operations. $espite tremendous progress since its introduction into
c%inica% practice !ardiopu%monary bypass is sti%% far from perfect and hence continuous
efforts are sti%% essentia% in order to faci%itate ongoing impro)ement within this fie%d of
study. Impro)ing hemo6compatibi%ity of both the conduct and components of
!ardiopu%monary bypass are crucia% to impro)ed patient care. The prob%em can be
perhaps further defined by ac<now%edging that cardiac surgery in con8unction with
cardiopu%monary bypass in its current form and practice restricts the patient>s abi%ity to
reco)er sufficient%y enough so as to e;it the hospita% in %ess than the current e;pected 56K
day time period. It is a%so <nown that con)entiona% standard bypass triggers the re%ease of
inf%ammatory mediator which e%ongates patient>s %ength of stay.
The Q"innac%e #ystem> tric<s red b%ood ce%%s p%ate%ets proteins and
inf%ammatory mediators that they ha)e ne)er %eft the body7 therefore it is suggested that
this no)e% patented surgica% de)ice is a true physio%ogic bypass system which drastica%%y
attenuates the #ystemic Inf%ammatory Response #yndrome.
To date no research has compared patient outcomes between these two
systems and this study wi%% use secondary data to e;amine this *uestion.
C4
Statement of the %roblem
%urpose of the Study
Rationale
Research 0uestions
Si!nificance of the Study
Definition of Terms
Assumptions and "imitations
(ature of the Study 1or Theoretical2Conceptual #rameork-
)r!ani3ation of the Remainder of the Study
C2
C$A%TER +' "ITERAT*RE RE4IE5
Add headings as necessary.
C5
C$A%TER 6' MET$)D)")78
NOTE TO ARITER. &se these headings as needed and as directed by the mentor.
Research Desi!n
Sample
Settin!
Instrumentation2Measures
Data Collection
Data Analysis
Ethical Considerations
C3
C$A%TER 9' RES*"TS
NOTE TO ARITER. There is considerab%e )ariabi%ity in !hapter 2 headings. The heading
suggestions be%ow show one e;amp%e for a *ua%itati)e study and four e;amp%es for a
*uantitati)e study.
Dua%itati)e E;amp%e
Site Description
Description of Sample
Research Methodolo!y Applied to Data Collection and Analysis
Analysis: Synthesis: and #indin!s
Data Collection Analysis %rocedures
Initial Data Analysis
Descripti/e Data Analysis
Themes
CK
Theme &
Theme +
Summary
Duantitati)e E;amp%e C
Introduction
Description of the Sample
Statement of Results
Details of Analysis
,i/ariate Relationships
Research 0uestion &
Research 0uestion +
Summary
CN
Duantitati)e E;amp%e 0
Introduction
Research 0uestion and $ypotheses
Data Analysis Strate!y and )r!ani3ation of Statistical Results
Description of Sample
%reliminary Data Screenin! and Cleanup
Interaction 4ariable
Multicollinerity
Descripti/e Statistics
%arametric Assumptions
Details of Analysis and Results
Conclusion
CI
Duantitati)e E;amp%e 4
Introduction
Description of the Sampled Data
Research Methodolo!y and Data Analysis
$ypothesis
%resentation of Data and Results of the Analysis
$ypothesis Data Analysis
Summary
Duantitati)e E;amp%e 2
Introduction
Description of the Sample
Research 0uestion and $ypotheses
01
Statement of Results
0C
C$A%TER ;' DISC*SSI)(: IM%"ICATI)(S: REC)MME(DATI)(S
NOTE TO ARITER. There is considerab%e )ariabi%ity in !hapter 5 headings. The
heading suggestions be%ow show one e;amp%e for a *ua%itati)e study and three e;amp%es
for a *uantitati)e study.
Dua%itati)e E;amp%e
Introduction
Re/ie of the Research %roblem and %urpose
Si!nificance
Analysis: Synthesis: and E/aluation
Implications of #indin!s
Research 0uestions
Conclusion &
Recommendation &
Conclusion +
00
Recommendation +
Recommendations for #uture Research
Discussion of the Conclusions in Relation to the "iterature in the #ield
"imitations of the Study
Recommendations
Summary
Duantitati)e E;amp%e C
Summary of Results
Discussion of the Results
Research 0uestion &
Research 0uestion +
Discussion of the Conclusions in Relation to the "iterature in the #ield
04
"imitations
Summary
Recommendations for #uture Study
Conclusions
Duantitati)e E;amp%e 0
Introduction
Summary of Results
Discussion of Results
Discussion of the Conclusions
Implications for %ractice
"imitations
Recommendations for #urther Research
02
Conclusion
Duantitati)e E;amp%e 4
Introduction
Summary of Results
Demo!raphic Analysis
%opulation Data
Discussion of the Conclusions in Relation to the "iterature
Recommendations for #urther Study
"imitations and Recommendations
Conclusions
05
RE#ERE(CES
+References shou%d be sing%e6spaced with a doub%e6space between entries. &se the ru%er
to create a hanging indent.,
03
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