Prakash Adhikari

Final Year Resident (ENT- HNS)

GMS Memorial Academy of ENT and Head and
Neck Studies,
TU Teaching Hospital, Kathmandu, Nepal
 Introduction
 Choosing topic
 Supervisor
 Starting thesis
 Thesis structure
 Further readings
 Take home message
•"a proposition that is maintained by argument"

•“a lengthy, formal treatise, especially one written by

a candidate for the doctoral degree at a university"

•Thesis is a contention or principle of which you

would like to convince your reader

•A dissertation is a written presentation of it.

 An argument
An exposition of an original piece of
research
The product of an apprenticeship
Probably the largest piece of work you’ll
ever do
Something that could be published:

 No
matter how good your research is, you
MUST write a good thesis
 Partof a university degree
 Formal scientific report whose purpose is to
show an original contribution to knowledge
 Cultivatingan inquiring mind
 Encouraging in depth study of common
problems afflicting our people
 Generation of scientific data locally
 Keeping abreast of new developments locally
and abroad
 Understanding the fundamentals of research
 Contestable
 Proposing an arguable point
 A strong thesis is provocative
 Takes a stand and justifies the discussion you
will present.
 Specific and focused.
 Asserts your own conclusion based on
evidence.
 Provides the reader with a map to guide
him/her through your work.
 Anticipates and refutes the counter-
arguments
 Avoids vague language (like "it seems").

Specific topic + Attitude/Angle/Argument = Thesis

What you plan to argue + How you plan to argue it = Thesis
 Selfinterest
 Identify problem and its relevance
 Common problem
 Applicable
 What information is available
 Ethical acceptance
 Methods of data collection
 Analysis of data
 Expected outcome
 Usefulness of your thesis
 www.hinari.com
 Login-nep002
 Password:44374
 www.pubmed.com
 www.google.com
 you must present a thorough review of the
existing literature on the subject, and on
closely related subjects.
 make direct reference to your literature
review
 you must demonstrate that your question
 has not been previously answered
 is worth answering
 the
examiners read your thesis to find the
answers to the following questions:
 What is this student's research question?
 Is it a good question? (has it been answered
before? is it a useful question to work on?)
 Did the student convince me that the question
was adequately answered?
 Has the student made an adequate contribution
to knowledge?
 Maintain regular contact with your supervisor(s)

 You should show sections, or preferably complete chapters

with a reference list, of your thesis to your supervisor(s) at
regular intervals

 At the end of each discussion with your supervisor, make

an appointment for your next meeting.
 Consult with supervisor
 First- thesis protocol presentation in the
Department.
 After approval- Presented to IRB of our
hospital.
 Thesis to be done in following sub-speciality.

Name of Resident Unit

Arun KC I

Robin Acharya I

Shiva Kumar Shahi II

Lit Joy II

Saloni Sinha III

Ramesh Parajuli IV
 Thesis should be presented and started within first six
months of residency
 Completed in 2 ½ of residency
 Submitted at that time

 Total six presentation in the Department

 One presentation in ethical approval committee

 Presentation should be submitted to guides and co-guides::

7- 10 days before presentation
 Timetable and Milestones
 Experience tells us (the supervisors) that
thesis work always takes longer than
expected by the students
Problem / Interest
 To set your research question, first you have to
set the problem you want to deal with.
 You can start from checking those experiences that
you feel unsatisfactory about.

 Or something you feel you are interested in.

 Or something unclear you want to clarify.
 Or something you want to make better.

Important:
 You are not to study the problem
 You are to address one or several of the questions
that explicate the problem.
Problem Questions / Questions of Interest

 Youthen develop problem questions/

statements around the problem.

 Problem questions / statements of what you

want to know about the unsatisfactory
situation.

 Choosefrom the problem questions to form

your research questions.
 Formulating Your Thesis
Topic
Research Question / Thesis Topic

• Select a few of the problem questions

you generated. Integrate them to
form your research question / thesis
topic.

• Refine your research question

concisely to form your thesis title.
 Comparison of once daily mometasone
furoate and fluticasone propionate
aqueous nasal sprays for the treatment of
allergic rhinitis.
 Developing Your Thesis
Purpose / Rationale / Aim
• You need to state the problem /
interest that triggers your research.

• You also need to state, after addressing

the research question, your rationale /
purpose in pursuing that research
question.
Developing Your
Thesis
Hypotheses / Models / Relationships

You have to break down your research question

into a number of hypotheses / relationships to
examine.

Hypotheses are to state your

expectations/affirmations about the nature of
some situation regarding your research question.

They are tentative propositions / models for

investigation.

They are to be confirmed or denied by the

evidence collected from your research inquiry.
Significance & Limitations of Study

Significance of Study is to extend the utility and

value of your study beyond the context you are
studying & applying.

Limitations of Study is to state the boundaries of

your study to stop readers from arguing with you
on something out of your remits or difficult to
carry out in the context of your study.
 Capital letters
 Short, understandable without abbreviations
 Less than 10 words
 Indicative and informative
 COMPARISON OF ONCE DAILY MOMETASONE FUROATE AND
FLUTICASONE PROPIONATE AQUEOUS NASAL SPRAYS FOR THE
TREATMENT OF ALLERGIC RHINITIS.
 Dedicated to my patients
 I would like to express my sincere thanks an
gratitude to various people who have helped
and guided me on my thesis work.
I am indebted to my guide.....................
 Figure 1.
 Figure 2.
 Figure 3.
 Figure 4.
 Figure 5.
 Type one side of paper, double spacing, 12- pint
font
 Leave margin 1 ½ inch on each side
 Write page numbers
 From declaration to abstract – Roman no. (I,II)
 From introduction onwards- Arabic (1,2,3,...)
 Divide into sections
 Begin each section in new page
 Write with a good English
 Short and simple sentence
 Around 20,000 words
 Keep the patient information- confidential
 Take consent from patients/
caretakers/parents
 Measurement – SI unit
 Take ethical approval from IRB
 Verbosity
 Tenses
 singular and pleural forms
 Technical jargon
 Slang terms
 Typically 300 - 350 words
 Concise, short, informative, explanatory,
interesting
 Summarizes thesis research and conclusions
 Structured abstract (IMRC)
 First sentence should introduce the most
important concept
 Last sentence should be the “take home”
message.
 Past tense
 Keywords: 3-7.
IMRAD
 Start with a paragraph outlines the general
theme of the subject and acts almost as a
‘thesis statement’
 Introduce your topic, in a way that indicates
its importance
 Indicate briefly the research that has been
done on the topic
 Identify a gap, problem, controversy, etc., in
the existing research
 Explain how the present research will fill
that gap, solve that problem
– Usually done by an overview of the
relevant literature.
– Be through, but not exhaustive
 Enough information but not too much
 Current status of knowledge
 Review relevant literature both positive and
negative
 Go to the depth of your topic
 Review literature of last 5 years (Preferably)
 If relevant and historical – older references
 If available - local literature
 Reference the other’s literature
 Related to the statement of the problem
 Starts with To.......
 E.g.
 Don’t use vague terms- to study, to
understand etc.
 General objective
 To compare efficacy of once daily mometasone
furoate nasal sprays with that of fluticasone
furoate for treatment of allergic rhinitis.

Specific objectives
 To determine the efficacy of once daily
mometasone furoate nasal sprays for the treatment
of allergic rhinitis.
 To determine the efficacy of once daily fluticasone
propionate nasal sprays for the treatment of
allergic rhinitis.
 To compare efficacy of once daily mometasone
furoate nasal sprays with that of fluticasone
furoate for treatment of allergic rhinitis.
 Make your study powerful
 Past tense
 Follow a logical order
 Correct measurement units
 Study design
 Settings
 Duration of the study
 Inclusion criteria
 Exclusion criteria
 Sampling method
 Sample size calculation
 Patient selection ( Study group/ control group)
 Techniques used- explain it in details.
 Instrument used--------details
 Statistical analysis
 Present it in orderly manner- according to your
objectives
 Express in tables, text or figures
 Number it
 Analyze it with suitable statistical methods and their
significance
 Provide data whether it is significant e.g express p-
value, CI etc.
 Emphasize or summarize important observations but
do not repeat all the data shown in tables or figures.
 Do not give explanation of your result. Do not
describe it
 If patient lost for F/U: mention it
 Legends: in table::above and in figures::below
 LYMPHADENOPATHY CORRELATION

25
25
20 19
No of Patients

20

15 14

9 9 FNAC
10
HPE

0
Tubercular Granulomatous Reactive LN
disease

PATHOLOGY
 GENDER DISTRIBUTION OF LYMPH NODE IN NECK
FEMALE
MALE

23
25
 Revisityour hypotheses
 Were they confirmed or not?
 Interpret your findings in light of your objectives
 Ask and answer the “why” questions
 Discuss implications of your results
 Comment on the limitations of study, if it
warrants it.
 Be very careful here.
 Discuss directions for future research or action.
 Sometimes people end with an conclusion
paragraph.
 Relate your findings with other study
 Weakness of your study
 Future work
 (do not write results again- you compare
with other study, present in a logical flow as
per your aims and results)
 State any new hypothesis, but make it clear
that they are new.
 As per objectives
 Based on your results
 Recommendations for future studies
 Should be in consecutive order in which they
are first mentioned in the text.
 Reference in text should be identified by
Arabic numerals as superscript
 Use Vancouver system.
 Controversial: abbreviation of journal as per
index Medicus. ( But there should be
uniformity)
 Usually,most oesophageal foreign bodies in
children have been removed with rigid
oesophagoscopy under general anaesthesia.1
………………………………………………………………………
……………………………removal by foley’s
catheter, use of balloon catheter in
conjunction with tooth forceps, …………… use
of bougie to advance into the stomach and
surgery apart from a few other innovative
practices.2,3
1. Marrow SE, Bickler SW, Kennedy AP, Syndler
CL. Baloon extraction of esophageal foreign
bodies in children. J Pediatr Surg
1998;33:266-70.
2. Dunlap LB. Removal of an esophageal
foreign body using a foley catheter. Am
Emerg Med 1981;10:101-3.
3. Calkins CM, Christians KK, Sell LL. Cost
analysis in the management of esophageal
coins: endoscopy versus bougienage. J
Pediatr Surg 1999;34:412-4.
 Be consistent in your references
 Use relevant references that: Applies to your
study site(s)
 Supports your argument why your study is
interesting
 Do not over-use or under-use references (e.g.
more than 3 references in 1 sentence is too
many, but don’t
 Make a lot of unsupported statements
 Use the same citation method throughout the
thesis, even for manuscript style thesis.
 All chapter references all go into the back in its
own section. This saves a lot of pages!
1. Adhikari P, Sinha BK, Bhattarai H,
Shrivastav RP. Myiasis infestation in
postoperative mastoid cavity. Nepal Med Coll
J 2007; 9(4): 284-5.
2. Adhikari P, Guragain RPS. Lateral Sinus
Thrombophlebitis: Review of Literature.Int
Arch Otorhinolaryngol 2007; 11: 477-80
 Pramanik T, Adhikari P. Resistance Vs
aerobic exercise- is the later better choice?
(Short communication) Nepal Med Coll J
2006; 89(1): 59-60.
 Sinha BK. Technology transfer for hearing
impaired (Editorial). J Inst Med 2006; 28:1.
 HealthyHuman Society Research Team.
Pattern of ear diseases in rural school
children: Experiences of free health camps in
Nepal. Lancet 2008; 398: 11-20.
 Adhikari
P. School health program: a new
perspective. In: Lennard V. Seebeki, editor.
Leading Edge Health Education Issues (Ist
ed.). Newyork: Nova Publishers 2006: 47-60.
 AdhikariP. Accuracy of references in indexed
journals of Nepal. Nepal Med Coll J (in
press).
 Ethics clearance or whatever key paperwork
that the committee feels should be included
with thesis
 Supporting materials, such as unpublished
analytical methods, long tables of CRM
results.
 Raw data (very useful for future researchers
looking to mine historical data 20 years down
the road!)
 THESIS PERFROMA
Serial No. I.P./OPD No: Date of FNAC: Date of surgery:
Name: Age/Sex:
Address: Occupation:
Ethnic Group: DOA:
Clinical presentation
1. Swelling-a. Onset (Congenital/ acquired)
b. Site: c. Duration
d. Number e. progression
 
2. Associated symptoms
Pain/dysphagia/disfiguring /SOB/chronic cough/fever/weight loss/loss of appetite/hoarseness/hemoptysis
3. Other symptoms: if any
Past history: TB/DM/HTN
Family history:
Socioeconomic history:
Clinical Examination
Site
Shape
Size Number
Surface Consistency
Mobility Tenderness

Clinical Diagnosis:
FNAC Report: (No- )
 
HPE Report: (No- )
Fig:1. Histopathology of LN showing Langhan’s giant cells (40HPF).
SN IP No Name Age/Sex Date of FNAC No. FNAC Dx HPE No. HPE Dx Correlation
surgey

1. 6285 PMJ 51/F 064/5/19 189 RLN 2936 RLN Y

2. 720065 MM 41/F 064/6/2 708 TBL 294 TBL Y

3. 356911 MKT 18/F “ 466 Schwannoma 732 Schwannoma Y

4. 763222 AS 29/F “ 917 TBL 3119 TBL Y

5. 403315 ST 22/F “ 967 GLN 594 TBL N

6. 698706 BS 20/F 064/6/9 581 TBL 2451 TBL Y

7. 355564 THB 42/M 064/6/23 489 Inconclusive 3411 AV malfn N

8. 743270 RB 24/M “ 541 GLN 3123 GLN Y

9. 720121 NA 19/M “ 1121 RLN RLN Y

10. 404412 SM 28/F “ 449 GLN 3732 GLN Y

11. 529234 SS 29/M 064/8/12 1178 Epidermoid 3902 Epidermoid Y

12. 811464 PA 40/F “ 1257 Epidermoid Epidermoid Y

13. 864136 NL 26/F “ TB 4016 TB Y

14. 355563 PMM 40/F 064/6/23 Fibrosarcoma 596 Fibrosarcoma Y

14. 358096 GMR 70/F 064/6/23 470 Warthin 547 Warthin Y

15. 352232 KT 26/M “ 936 Met Sq Cell Ca 547 Met Sq Cell Ca Y

 Look for mistakes
 Start giving to your supervisors in sections
 Mistakes are more found out by others.
 Hard cover binding
 Make ready of electronic version also
 Colour illustrations if possible
8 copies
3 copies- examination section
1 copy guide
1 /2 copy – co- guide/s
1 copy - department
2 copies- authors
 Be constructive (diplomatic) in reviewing
others’ work; don’t blast all previous work,
don’t be dismissive and definitely don’t single
out anyone with scorn. Chances are they are
reviewing your proposal.

BAD: All previous studies are worthless because they failed to

recognize the effect of X on Y. Chen and Smith (1998) tried
but their approach was simply wrong. Ours is the first study
to address this question correctly.

BETTER: Previous studies have made important contributions to

this challenging problem, however none of the published
studies appear to have completely accounted for the effect of
X on Y. A pioneering effort in this direction is described by
Chen and Smith (1998), highlighting the need for additional
investigation of the system properties when the full set of
interacting factors are incorporated in the model.
 A Guide to Research Methodology, Biostatistics and Medical
Writing – CPSP
 How to write thesis- by PR Sharma
 Guidelines of University of Toronto
 Guidelines of Fayetteville State University
 ASEE SEMINAR, 2002. University of Texas
 Writing a thesis. Linda Campbell. Queen’s university
 Start finding your Guide and co- guides
 Start searching a topic
 Try to reach your targeted sample size soon
 Start writing your thesis----never say
tomorrow
THANK YOU