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5.HowtoWriteDiscussion5.HowtoWriteDiscussionContents5.1GeneralPrinciples5.2StructureofDiscussion5.3DevelopingDiscussion•5.1GeneralPrinciples•Discussionshouldfocusontherelevantfindings,besupportedwithevidenceandendwithaconcludingcomments.•5.1Statethemajorfindingsofthestudy•Thediscussionshouldbeginwithastatementofthemajorfindingsofthestudy.Thiscouldbetheveryfirstparagraphinthediscussion.Itshouldbeadirect,declarative,andsuccinct简洁的proclamation声名,宣言ofthestudyresults.However,itshouldnotincludethedetailsofdataorreferencetothestudydesign.•“Ourresultsconfirmthatthesenasalandfull-facemasksaresimilarlyefficientover15minofNPPVwithCOPDpatientsrecoveringfromacutehypercapnicrespiratoryfailure.”•Comments:•Thisclearlystatesthemostimportantfindingofthatstudy.•“Ourfindingssuggestthatambient•lighthasnostatisticallysignificanteffectonSpO2readingsandthatambientlight’seffectonSpO2isclinicallyunimportant.”•Comments:•Thatisagoodexampleofadirect,declarative,andsuccinctproclamationofthestudyresults.•Oneofthepurposesofthediscussionistoexplainthemeaningofthefindingsandwhytheyareimportant,withoutappearingarrogant,自大的condescending,俯就的orpatronizing.神气十足的•Afterreadingthediscussionsection,youwantthereadertothink:•“Thatmakesperfectsense.”•“Whyhadn’tIthoughtofthat?”•Evenifyourstudyfindingsareprovocative,煽动性的youdonotwanttoforcethereadertogothroughthepapermultipletimestofigureoutwhatitmeans;mostreaderswillnotgotothateffortandyourfindingswillbeoverlooked,看漏,忽略disregarded,藐视andforgotten.•5.2Relatethefindingstothoseofsimilarstudies•Nostudyissonovelandwithsucharestrictedfocusthatithasnorelationtootherpreviouslypublishedpapers.•Thediscussionsectionshouldrelateyourstudyfindingstothoseofotherstudies.Questionsraisedbypreviousstudiesmayhaveservedasthemotivationforyourstudy.Thefindingsofotherstudiesmaysupportyourfindings,whichstrengthenstheimportanceofyourstudyresults.•Example•“Ourfindingthatchangingin-linesuctioncatheterslessfrequentlyisassociatedwithlowercostandnohigherincidenceofVAPreplicatesthefindingsofarandomizedcontrolledtrialconductedbyKollefetal,uponwhichouramendedpolicywasbased.”•………•Anexamplecanagainbedrawn•“Certainly,differencesinthespecificcriteriausedtodefineVAPcouldcontributetotheratedifferencesbetweenthepresentstudyandthatofKollefetal.Forexample,comparisonofthecriteriafornosocomialpneumoniainourstudywiththecriteriausedbyKollefetalshowssimilarcomponentfeaturesbutdifferentratingschemestoestablishthediagnosis.”•5.3Consideralternativeexplanationsofthefindings•Despiteeffortstoremainobjectiveandtomaintainequipoise,平衡itiseasytoconsideronlythoseexplanationsthatfityourbias.个人兴趣和偏好Itisimportanttorememberthatthepurposeofresearchistodiscoverandnottoprove.Itiseasytofallintothetrapofdesigningthestudytoproveyourbiasratherthantodiscoverthetruth.•5.4Statetherelevanceofthefindings•Thereasonweconductstudiesisusuallytoimprovesomething.Thus,itisimportanttocastthefindingsofyourstudyinthecontextofpracticeorapplication.Butdon’texaggerate过分强调thefindings．.•5.5Acknowledgethestudy’slimitations•Allstudieshavelimitations.Unfortunately,thelimitationsofsomestudiesarefatalflawsthatpreclude阻止publication.•However,eventhebeststudiesinthemostprestigious声誉高的journalshavelimitations.Itisfarbetterforyoutoidentifyandacknowledgeyourstudy’slimitationsthantohavethempointedoutbyapeer-reviewerorareader(inalettertothe•editorafterpublication).•Examples•“Weusedonlyhealthywhitesubjects,tominimizeconfoundingvariables.Futureresearchshouldincludetestingsubjectswithdarkerskinandsubjectswhoseoxygensaturationisbelownormal•(_95%).”•5.6Makesuggestionsforfurtherresearch•Althoughastudymayanswerimportantquestions,otherquestionsrelatedtothesubjectmayremainunanswered.•Someunansweredquestionsmaybecomemorefocusedbecauseofyourstudy.Youshouldmakesuggestionsforfurtherstudyinthediscussionsection.Laboratoryexperimentalstudiestypicallyleadtosuggestionsforfollow-upstudies•Example•“OnesubjectthatremainstobeexploredishowtodetermineatthebedsidewhetherapatientcanperformOPEPand,ifso,whichdevicetoselect.”•5.7Problemstobeavoided•UnwarrantedSpeculation•Thereislittleroomforspeculationinthediscussion.Thediscussionshouldremainfocusedontheyourdataand/ordevicesinyourstudy.Ifyoufeelcompelledtospeculate,becertainthatyouclearlyidentifyyourcommentsasspeculation:“Wespeculatethat....”•InflatingtheImportanceoftheFindings•Afterallofthehardworkthatgoesintoastudy,itiseasytoattributeunwarrantedimportancetostudyfindings.•Weallwantourstudytomakeanimportantcontributionthatwillbecitedforgenerationstocome.However,unwarrantedinflationoftheimportanceofthestudyresultswilldisgust使厌恶reviewersandreaders.•TangentialIssues离题•Itisimportanttoremainfocusedonthehypothesisandstudyresults.Injectingtangentialissuesintothediscussionsectiondistractsandconfusesthereader.•The“BullyPulpit”讲道•Donotusethediscussionsectiontocriticizeotherstudies.Althoughyoushouldcontrastyourfindingstootherpublishedstudies,thisshouldbedoneprofessionally.Donotusethediscussiontoattackotherinvestigators.Moreover,neverpreach布道，讲道tothereader.Expressionsforconcludingsentences•Therefo