At the very onset, we want to mention that we are no experts writing thesis or papers. But as somebody has correctly mentioned that in our discipline it is time and more time that makes you wise. (hey sorry we don’t have a reference for this). It’s a humble effort on our part to share our experiences with our fellow colleagues, with the hope that it may be helpful to some of them.
As the modern lexicon goes Publish or Perish. Unfortunately, it is true. Someday or the other we must write papers, maybe for thesis or for conferences and for somebody just to build up his CV. So we really have to start someday. The toughest part is to begin it.
We can really break up it into number of small steps and will be discussing them as we go along.
Deciding on a topic
It goes without saying that this is the most important part. For many beginners, it is really baffling how to decide on a topic. (more so because of the fact most of the undergraduate curriculums in our country do not really expose us to the area of scientific writing). It is a good idea to go through the previous titles (thesis) of your institute just to get a hang of things. If you are planning to write a paper the first decision that you need to make that whether you want to do a prospective study or a retrospective study. It goes without saying that prospective studies are much better than retrospective ones but the flip side is that they require much intricate planning and are time-consuming. So obviously if you quickly want to finish a paper (say for example for a national conference) the obvious choice has to be a retrospective study. Then again retrospective studies are possible only in institutes that have at least a decent medical record system. Sorry friends!! For thesis, there is no short cut it has to be a prospective one.
A good way to start of topic search is to go through the previous issues of IJO and also you must have a look at the AIOS proceedings. After that you look at the subspecialty journals (like Cornea, Retina …Visitour journalopedia section) Advice of your consultant always comes handy. (Never forget the two golden rules: Rule 1 Your boss is always right. Rule 2 if ever your boss is wrong vide rule number 1. ) Don’t waste lot of your time in searching for something new. You can present old things in new context or you can present them as Indian data or your regional data (trust me there are regional variations in which diseases present and respond to treatment). While choosing a topic stay in touch with reality. For example it wouldn’t really be good idea to do something on diabetic macular edema if your institute doesn’t have an OCT.
After you have roughly decided on a topic the next important step is to do a pub med search on it.(Pubmed search is available in our website at top of windows,type your topic and click to serach the pubmed) After the search, it is a good idea to take a print out and go to your library to get the full text of the articles.(sorry folks abstracts don’t tell the whole story) You must go through the full text. Now let’s see what all we must watch out when we are going through an article.
1. Start with year of publication
2. Look the design of the study- like whether prospective or retrospective,Interventional or non interventional, No of patients recruited
3. Materials and methods: Look for inclusion criteria. It is very important to clearly define the inclusion criterion. For example if you are looking into the results of patients with endophthalmitis you must clearly define factors like – what type of endoph post op or endogenous or post traumatic etc. Then you must clearly state how do diagnose endoph like whether it’s a clinical diagnosis or microbiological one.
You should also clearly define your study group like adult or pediatric( don’t forget pediatric age group is less than 18 years according to NPCB year document ). I mean to say you can do a study on pediatric post op endophthalmitis or on adult endogenous endophthalmitis. Its essential to define the study age group because in some cases they respond differently to treatment and if you club them together they will confound your final results and all your hard work will go in vain. Also look for the parameters they have evaluated as that would help you to formulate your own proforma. It comes handy if you define an anatomical and functional end point for example Va greater then 3/60 at final follow up as a successful functional outcome and Attached retina with clear media and healthy disc as successful anatomical outcome. Look out for the period of follow up. Look at the statistical analysis (we shall come into it in details later on and will try to make sense of the numbers they put and big names they give ala Wilcoxons Sign Rank Test).Now go through the results and discussion part carefully. Go through their conclusion and go through their references. Study the shortcomings of their studies that they have mentioned and find out what you have detected.
Hope you are initiated now ….. At least you have started thinking.
How to make a proforma
Now hoping that you have got started the next thing you need to do is start the work itself. Sounds easy but wait still few crucial steps remaining. Most important being preparing a proforma. A proforma is a not only a data repository it may be verified at any point in time by the concerned authority. So it must not only be filled properly but also be kept secure throughout the study period.
It is always a good idea to prepare an extensive proforma.The idea being when you encounter the patient get the maximum data entered into your proforma. The same holds true when you are doing a retrospective study that is filling up your proforma from a file. You can always delete the unnecessary details when you start analyzing.
Type your proforma neatly in MS WORD and take print outs. Don’t forget to store the soft copy of the proforma. Mailing it to own mail account is a very safe storage method that we regularly practice. Don’t forget to get it approved by your guide.
There are many formats in which proforma can be filled. You can do it any way in which you feel comfortable. The document below is the example of a proforma that we used. Hope it helps in formulating your own.
Click here to download a demo proforma.
I would like to highlight some of the salient points of the below given proforma. In the first page of the proforma we have mentioned the inclusion and exclusion criteria. It is not a must but it keeps on reminding you the goals of your study. Though the following proforma is about clinical profile of ARMD patients but the it can easily be modified by you according to your needs as it records both anterior segment and posterior segment findings. I would like to draw your attention to the method of recording your findings in the form of yes /no format – because it will really help when you export this data to your excel sheet. We will come to that in our next section.
Materials and Methods
This section is meant for the description of the design of your study, the complete methodology, how the data was accumulated, and finally how the analysis was done. You should always keep in mind that it should be thorough to the extent that it is reproducible by another investigator. Try to pen down this section early so that you can pick up any methodological flaw in your study and hence can correct them beforehand.
A good way to start this section would be to mention the design of your study. Mention whether it is a treatment study or an observational study. Treatment studies could be randomized or non-randomized. Again randomized studies could be double-blinded or single-blinded. Mention which type your study fits in. Describe the method of randomization, if done.
The name of the institute and the department in which the study was carried out should be stated. It is better to mention in what type of institute you have carried your work --- It is important because this gives an idea about the patient population from which the recruitment was done. Patient profile from a tertiary care institute will see much more end-stage diseases whether cases from other institutes are likely to have much more fresh cases. Though we can never generalize like this some times this holds true.
Next patient population should be described (opd based study/in patient analysis)Ethical consideration holds immense importance in present day. It is of paramount importance in prospective studies. Before starting your study get a consent form printed and approved by your institutions ethics committee. Explain clearly the whole purpose of the study to every patient before enrolling him. Finally mention your ethics committee and patients consent in this section. At times you may be asked to submit the patient consent form and ethics committee approval. Be prepared at all times.
Mention the inclusion and the exclusion criteria
- Explain the reason for including and excluding patients. Now this is pretty important because here the reader gets an idea behind the logic of patient selection in your study.
- Enumerate all the procedures that the patients underwent when he was enrolled like BCVA, Applanation, Color vision, Slit lamp, Fundus…….
- Mention details like … BCVA (Snellen/ETDRS), Color vision (Isihara/FM 100), Slit lamp (illumination), Fundus (IO/78D/90D)
- State the investigations patient underwent and the reasons for performing the investigation. (..like ultrasound for opaque media)
- If your study involves primarily investigational modality mention the complete details like if your study is on ERG mention … Commercial name of the equipment, software used and settings for recording like time for dark adaptation etc.
- If any medication was used mention the generic name and the complete dose like prednisolone (1mg/kg/bwt).
- Mention the follow up visits, number of visits, what parameters were assessed in follow up visits.
- Clearly define a anatomical outcome (like retina attached , media clear , no glaucoma ….in final outcome of endophthalmitis cases)
- Similarly define functional outcome like Vn > 3/60
- Statistics: Mention the test used, software used like SPSS, which version, p value.