Guidelines for Protocol and

Dissertation Writing

Prof. San Hlaing

Head of Orthopedic Department
University of Medicine, Magway
 Introduction

Introductions consists of
1.1 Background information & statement of the problem

1.2 Justification
1.1 Background information & statement of the problem

Background information

- The introduction is necessary to review the relevant literature briefly.

- It should be brief.

- State clearly the questions that you try to answer in the study.

- Cite references that are essential to justify the proposal study.

Contents

- A knowledge of the problem based on personal and collective experience.

- A literature search and evaluation in terms of meaningful meta-analysis. -

Systematic review give appropriate value to the problem that you have

decided to study.
What is the problem

Problem is a discrepancy between the existing and the expects.

It is the difference between the actual and the intended conditions.

A problem is a gap between what is and what should be.

Statement of the problem

Problem statement include:

“what is the problem,

its nature , its size and distribution”

An analysis of the major factors influencing the problem should also be

included.

The possible causes of the problem, importance of problem, effects of the

problem if solved should be stated.

1.2 Justification
It should answer the question of why and what:

Why the research needs to be done and

What will be its relevance.

A brief description of the most relevant studies published on the

subject should be provided to support the rationale for the study.

The rationale asks:

why a particular topic was chosen

what had been done before

what needs to be done to bridge the gap

How it will improve the underlying condition or further the knowledge

in the specific area of research.
 Rationale requires prior knowledge and includes probability and

expectation.

However, do not use the phrase, “there was no previous study in

Myanmar” easily. Search the literature thoroughly, especially those

who are authorities in your field of study.

Mention a key reference study similar to conditions in Myanmar

with the evidence of benefit or difference with intended intervention

or test.
 Why do you study the research problem?
 What are the contributions that will be made by the present
study?
Hypothesis

A hypothesis is an educated guess about how things work.

After having thoroughly researched your question, you should have some educated
guess about how things work. This educated guess about the answer to your question
is called the hypothesis.

Eg: Raising the temperature of a cup of water(temperature is the independent variable)

will increase the amount of sugar that dissolves ( the amount of sugar is the dependent
variable).

A hypothesis is a prediction of a relationship between one or more factors and the

problem under study.

Hypothesis is important because it guides the research and helps an investigator to

collect the right kinds of data needed for the investigation. Investigator will formulate
a hypothesis based on the problem(research question). In research, investigator is able
to either support or reject a hypothesis.
Hypothesis is not required in descriptive study.
Two types of Hypothesis

(1) Null Hypothesis (negative declaration)

(Hypothesis of no difference)
(between drugs, treatment, method, etc.)
Ho: A=B
eg: The action of drug A is similar to drug B. It states that there is no
differences(negative declaration).

(II) Alternative Hypothesis (positive declaration)

H1: A not equal to B
A> B
B>A
eg: The impact of insecticide treated bednets is superior to residual
spraying of houses in the reduction of malaria morbidity and mortality.
Errors in drawing conclusion of hypothesis testing

Type I Error
-Reject the null hypothesis(Ho) when it(Ho) is actually true.

Type II Error
- Fail to reject the null hypothesis when it is actually false.

Decision Actual Situation

Null hypothesis Type I error No error
rejected
Null hypothesis not No error Type II error
rejected
2. LITERATURE REVIEW

It is a critical review of literature relevant to the filed of study.

It is not a list in which summaries of various articles are strung

together in a random fashion.

There must be a systematic and logical structue of ides, not authors.

Reasons for writing literature review

-To provide a review of the current knowledge in a particular field

-To provide a solid background for a research paper’s investigation

-To provide a description of previous studies

- To provide meand through which previous studies can be compared

and contrasted

-To outline gaps in current knowledge and identify emerging

theoretical issues

-To provide comprehensive knowledge of the literature of the field

Literature review
 Should review current knowledge in the fields relevant to the
dissertation/ thesis
 Relevant literature must be tied to the aims of the investigation.
 Describe the characteristics of previous studies in the area, including
who conduced them, where they were conducted, who were the
participants, what protocols were followed and what were the findings
and conclusions. Summarize and evaluate past research.
 Compare and contrast relevant studies and findings.
 Show similarities and differences in previous studies.
 There may be agreement and disagreeent in the literature.
 Comment and overview on their strengths, controversies and limitations
of the relevant studies and findings.
Step of Literature review

A. Informative

B. Evaluative

C. integrative

D. Organizing
Writing style

Review all relevant international and national studies and critically

evaluate past work in your own words, don’t just copy and paste.

Write clearly and correctly. Keep it simple.

Use short sentences and avoid complex grammatical construstions.

Try to avoid the passive tense as much as possible in writing

literature review

Use a variety of verbs instead of using one verb repeatedly.

Generally size of the literatures review should be:
 Master thesis 20-30 pages (5000-7500 words)
 PhD thesis 30-40 pages (7500-10000 words

Literature review should answer the following questions.

 What do we already know in the area converted?
 What are the characteristics of the key concepts or the main factors or variables?
 What are the relationships between these key concepts, factors or variables?
 What are the existing theories?
 Where are the inconsistencies or the other shortcomings in our knowledge and
understanding?
 What views need to be (further) tested?
 Why do you study the research problem?
 What are the contributions that will be made by the present study?
How do you Write a Review of Literature?

 Appropriateness of the methodology

 Important aspects of the study and

 How information from the study can be used in your research

Objectives

The objectives of a research summarize what is to be achieved by the study

in

general terms and should be closely related to the statement of the problem.

The research objectives are usually expressed as:

(a) General objectives (Aim, purpose)

(b) Specific objectives

General objectives

What is expected to be achieved by the study in general terms.

Specific Objectives

Breakdown of the general objective onto smaller logically connected parts. In

general, the more specifically the objectives are stated, the easier it will be to

plan the study,

Specific Objectives of the study have to fulfill 5 criteria, SMART

 Specific

 Measurable

 Achievable

 Relevant

 Time bound
Specific
Objectives have to state clearly, concisely and specifically what is to be
achieved at the end of the study
Measurable
Target & indicators have to be spelled out from the beginning so that it
is measurable at the end
Achievable
Your research must be achievable / doable within the allotted resources
& time frame.
Relevant
The study & its activities have to be relevant to the main goal (title), and
research method or study design.
Time bound
Mention the time frame within which the research has to be completed.
Objectives:
- Should be clear, precise and unambiguous statements, listed numerically
- Should be beginning with “To” and followed by action verbs or action-
oriented words
- Followed by specific and measurable variables and time, place and
person phrase

Action verbs to be used-

To achieve, To analyze, To ascertain, To compare, To correlate, To describe,

To determine, To develop, To establish, To evaluate, To explore, To find out,

To formulate, To identify, To interpret, To increase, To justify, To measure,

To

prove the hypothesis that, To reduce, To verify

Verbs of No value

Compile, demonstrate, differentiate, discuss, illustrate, know, recall,

show, understand

Low value verbs

Answer, carry out, define. Draw, establish, label, list, name, outline,

recognize, state

Verbs of medium value

Apply. assess, choose, conduct, construct, criticize, describe, distinguish,

elicit, identify, investigate, manage, perform, plan, record, relate, select,

study, summarize
No value verbs and low value verbs must be avoided. If possible, try to
use high value verbs. Medium value verbs can be used if no better verb
can be identified.
Selected Verb should be relevant to research design.
• “explore”, “fine out” and “determine” used in descriptive study.
• “to compare or correlate or find out” used in analytic study.
• “to prove the hypothesis” in clinical trial or experimental study.
Examples of objectives
• To find out (action verb) the maximal acid output level (measure
variable) after vagotomy in chronic duodenal ulcer cases (person phrase)
admitted to the Surgical ward of Magway Teaching Hospital (place
phrase)
• To determine (action verb) the cause of death (measurable variable) in
closed abdominal injury cases (person phrase) admitted to the Surgical
ward of MRGH (place phrase)
5. RESEARCH METHODOLOGY
5.1 Study Design
Investigator assigns exposure of the study

Yes No

Experimental study Observational study

Random Allocation Comparison Group

Yes No Yes No

RCT NRC Analytical Study Descriptive Study

Cross-sectional Study Case-Control Study Cohort Study

i. Interventional studies (exposure assigned actively)
(a) Experimental studies
Individuals are randomly allocated to at least two groups.
One group is subjected to an intervention and the other group is not.
e.g. supply note books to only one group of House officers
The outcome of intervention is obtained by comparing the two groups
(e.g. increased knowledge scores after 3 months)
It has three characteristics (manipulation, control, randomization)
(b) Quasi-experimental studies
At least one characteristics of a true experiment is missing, either
randomization or control group.
Manipulation always included.
(c) Pre-experimental studies (Before – after study)
Although there is intervention, lacks randomization and use of control
group. It uses only one group on which an intervention is carried out. The
situation is analyzed before and after the intervention to test the effect of
ii. Observation studies (Exposure not assigned)
(a) Descriptive Study( simple observation of occurrence)
Cross-sectional descriptive studies:
Aim at quantifying the distribution of variables in study population
at one point of time.
E.g. the behavior of people and the knowledge, attitude, beliefs and
opinions that may help to explain that behavior (KAP studies).

Case Series:
Case series and case reports are potential ways to suggest an
association. They report the findings on a case by case basis.
(b) Analytical Study( compare the effect of an exposure)
Cross-sectional comparative studies:
Focus on comparing as well as describing groups.
E.g. a survey on Rheumatoid arthritis patients may wish to establish:
- The percentage of bone erosion/ deformity in RA patients of
certain duration
- Socio-economic, physical, treatment, functional variables that
influence the deformity
The researcher will not only describe these variables, but by comparing
deformed and non-deformed patients, he will try to determine
which socio-economic, physical or other independent variables
have contributed to erosion.
At the same time he has to watch out for confounding or intervening
variables. (analyzed by variable tests followed by multivariate tests
for selected significant variables)
Case-control studies

Compare one group among whom a problem is present (e.g. deformity)

with another group, called a control group, where the problem is absent, to

find out what factors have contributed to the problem.

Cohort studies:

A cohort study is much like a RCT except that the intervention in an

RCT

is investigator controlled, while in a cohort study the intervention is a

naturally occurring phenomenon.

Follow up of a defined population for long term to see the effect of an

exposure. E.g. to follow up beer drinking and non-drinking house-officers up

to end of the year to compare raised ALT levels to determine the causal
A cohort study assembles a group of subjects and follows them over
relationship.
time. One follows these subjects to the development of an outcome.

Then, compares the characteristics of the subjects with and without

the outcome.
Diagram of a cohort study

PRESENT FUTURE
(Prospective study, looking forward)

Problem present
exposed to
risk factor
Problem not present

compare

Problem present
Not exposed to
risk factors
Problem not present
Diagram of a case-control study

PAST PRESENT
(Retrospective study, looking backward)

Risk factor present

Case

Risk factor absent

compare

Risk factor present

Control

Risk factor absent

Sampling

Sampling involves the selection of a number of study units from a defined population.
Study population – a group from which we want to draw a sample
eg. According to age, sex and residence

Study unit – each study population consists of study units

Eg. Problem – High drop-out rates in contraceptive users in Township A.

Study population – all MWRAs using contraceptive in Township A
Study unit – one MWRA in Township A

Sample size calculation

As a general rule, it can be said that the desirable sample size is determined
by the expected variation in the data: the more varied the data, the larger the sample
Size needed to attain the same level of accuracy.
Formulae can only be used if you have rough idea about prevalence of the
Disease proportion of the endpoint in patients with the disease (outcome) of the
Study.
1. Determine if the study is descriptive or analytical.
2. Use one sample formulas for descriptive study.
Use two sample formulas for analytical study
3. Adjust sample size to available resources
Sample size for one sample (proportional)

To determine prevalence of hypertension among adults among within 5%

(margin of error) of its actual prevalence of hypertension with 95% confidence level
Type of study = descriptive
So, use Sample size for one sample
Type of variable = categorical
So, use Sample size for one sample (proportion)
Eg:
• P (expected percent of adults with HT) = 20%
• Margin of error = 5%
• Confidence level = 95% : So, Zα = 1.96
Sample size = Z2 α x P(1-P)/d2
= [1.962 x 0.2 x (1-0.2)]/0.052
= 246
Data collection
Using a available information (records/reports)
1. Observing
2. Face to face interviewing
3. Administering written questionnaire
Factors to beConsidered in Data Collection
Bias in Information Collection
BIAS in information collection is a distortion that results in the information
not being representative of the true situation.
Possible Sources of Bias
. Defective instruments
. Observer bias
. Effect of interview on the informant
Control of Bias

. Pretesting questionnaire

. Standardization of instrument

. Training of trainers

Methodology
Start from the very beginning. Describe all procedures in detail – how to
recruit objects, taking history, doing physical examination, how to collect
samples, detailed procedures of interventions or testing procedures of
samples, follow-up findings, interpretation of the data and data analysis. Use
flow-chart if necessary.
The Material and Methods section is very specific and very descriptive
and the methodology must be reproducible.
Variable

A variable is a characteristic of a person, object, or phenomenon that can take different

values.

(a) Numerical variables – Those can be expressed in numbers.

weight (lb, kg), Distance (mile, kilometer), Income (kyat)

(i) Continuous Scale – scaled continuously in range eg: weight in kg, height in cm

(ii) Ordinal Scale – rank the categories eg: income-high, middle, low

(b) Categorical variables – Those can be expressed categories. .

color (red, blue, green, etc), outcome of disease (recovery, chronic illness, death)

(i) NOMINAL naming variables where no ranking order eg: color(red,blue,...)

(ii) ORDINAL there is some order to the categories

eg: disability – no disability, partial disability, total disability,

Dependent and Independent Variables

Dependent variable –use to describe or measure the problem under study

Independent variables –use to describe or measure the factors that are

assumed to cause or at least to influence the problem.

Determined by the statement of problem and objective of study

Eg: Effect of Income on Nutritional Status?

Nutritional Status => Dependent

Income => Independent

Effect of Nutritional Status on Income?

Income => Dependent

Nutritional Status => Independent

Confounding variables – is a variable that is associated with the problem

and with possible causes of the problem. May either strengthen or

weaken apparent relationship between the problem and a cause.

Cause => Effect/outcome

(independent variable) (dependent variable)

Other factors
(confounding variables)
Eg: Mother’s education => Malnutrition

Family income(CV)
Working definitation
Working definitions are very important for a study and you must state
Clearly before starting the real work.
Even for hypertension, there are different cut-off points WHO definition.
American definition (CDC), European difinition differs from each other
in some points. So you have to mention different approaches in literature
review. However, if the hypertension is one of the key variables in your study,
you have to state which definition you will use throughout your study in
Materials & Methods chapter.
Definitions for main variables expressed in aim and objectives must be
clearly spelled out. The end points to measure the fulfillment of objectives
must be clearly defined. Working definitions for inclusion criteria and
exclusion criteria are essential.
 For protocol, in explanation of materials and methods, it should be
in future tense. E.g. the patients attending the rheumatology OPD, YGH will
be included in the study.
For the dissertations/thesis, materials and methods should be
explained in past tense because you had already completed the study and you
are now presenting your findings. Don’t just copy and paste the protocol to
\your dissertations/thesis. E.g. the patients who attended the rheumatology
OPD, YGH were included in the study.
Statistical Analysis

Statistical analysis itself can be complex. Simple experiments can be

managed with means, standard deviation or standard errors and t-test. Once

the experiment goes into three or four groups, analysis of variance is used.

The statistical test used to evaluate significance should be specified,

certainly in the materials and methods section and in the tabular or text results.

As a general rule, if the investigator is not sure of the statistical validity of

the tests being used, then consultation with statistician should be obtained.
 CHOICE OF APPROPRIATE SIGNIFICANT TEST
No
Normal distribution Non-parametric Test
Yes
Parametric Test

Count Measure
Proportions Means

1 group 2 groups >2 groups

1 group 2 groups >2 groups

Z Chi2
Pop Sd Unpaired Paired ANOVA

Unpaired Paired
Z t Pop Sd Paired t

Z or X2 McNemar X2
Z t
 Choice of basic statistical methods
Condition Non-parameteric test Patametric test
(Equivalent)
Before and after a single Wilcoxin Signed Rank One sample t-test
treatment in the same Test
idividuals

Two treatments groups Mann-Whitney U-test Two sample t-test

consisting different
individuals

Three treatments groups Kruskal-Wallis Test One way ANOVA

consisting different
individuals

Repeated measures in the Friedman rank Test ANOVA of randomized

individual block design
Association between two Speaman Rank Pearson correlation
variables Correlation coefficient
WHAT STATISTICAL TEST DO I NEED?

Deciding on appropriate statistical methods

for your research

• What is your research question?

• Which variables will help you answer your research question and which is the
dependent variable?

• What type of variables are they?

• Which statistical test is most appropriate?

• Should a parametric or non-parametric test be used?

Research Question
A research question addresses what the investigator would like to know.

Criteria for a good research question(FINER)

Feasible (F)
-Adequate number of subjects
- Adequate technical expertise
- Affordable in time and money
- Manageable in scope

Interesting to the investigator (I)

Novel (N)
-Confirms or refutes previous findings
- Extends previous findings
- Provides new findings

Ethical (E)

Relevant (R )
-To scientific knowledge
- To clinical and health policy
- To future research directions
Statistical Method

Mean, Median, Mode

Mean – Average of all numbers.

Median – Middle number in a sequence of numbers.

To find the median, organize each number in order by size, the number in
the middle is median.

Mode – The number that occurs most often within a set of numbers.

Range – Difference between the highest and lowest values within a set of numbers
Normal Distribution (Gaussian Distribution)
The normal distribution is a symmetric distribution with no skew. The tails are exactly
the same.
- Mean = Median = Mode
- Centered
- Symmetrical
- Continuous
- Fixed Score Distribution
- Skewness = 0
- Unimodal => which means only one peak in distribution
- 50% lies above the mean and 50% lies below the mean

The "Bell Curve" is a Normal Distribution and the yellow histogram shows some data
that follows it closely, but not perfectly.
Eg: heights of people, errors in measurement, blood pressure
Standard Deviation

Standard deviation measure how far the data is spread from the mean.

- Low SD means values are close to the mean

- High SD means values are spread out over a large range

68% of score fall between one SD above and

one SD below the mean

95% of score fall between two SD above and

two SD below the mean

99.7% of score fall between three SD above and

three SD below the mean
Skewed Distribution (Non-normal Distribution)
A distribution is skewed if one tail is longer than another. These distributions are
sometimes called asymmetric or asymmetrical distributions as they don’t show any
kind of symmetry.
Mean is not usually in the middle. There is no center.

A left-skewed distribution has a long left tail. Left-skewed distributions are also
called negatively-skewed distributions. That’s because there is a long tail in the
negative direction on the number line. The mean is also to the left of the peak.
Mean < Median < Mode
A right-skewed distribution has a long right tail. Right-skewed distributions are also
called positively-skewed distributions. That’s because there is a long tail in the
positive direction on the number line. The mean is also to the right of the peak.
Mode < Median < Mean
T-test (Student T-test)

T-test checks if two means(average) are reliably different from each other.
This test is used for comparing the means of two samples (or treatments), even if they
have different numbers of replicates.

A big t-value = different groups

A small t-value = similar groups

t = difference between groups

sampling variability
Sample size = 6
Eg: 45
t = difference between groups
40 sampling variability
35
t = (40 – 22)/ 6 = 18/6 = 3/1
30
Therefore, drug can help
25
20 Column2lowering cholesterol level.
15
10
5
0
Test Group Control Gp
Types of T-test
P value

P value is the probability that data in the sample could be produce by random.

p = 0.1, there is 10% chance of difference

p = 0.05, there is 5% chance so there is no real difference.

p = 0.02, there is 1% chance so there is no real difference.
p less than 0.05 = statistically significant (or) reliable

P value for each t value depends on sample size.

Bigger samples make it easier to detect differences.
Type of test stastics
- Parametric test
- Non-parametric test

Parametric test
Assumption are met
- Random independent samples
-Normal distribution
- Independence (one group did not influence the other)
- Homogeneity (the variances within each group are similar)
Parametric tests are more powerful, more likely to detect a difference that truly exists
and less likely than non-parametric test to make a type II error.

Non-parametric test
Assumption are met
-Random independent samples
- Non-normal distribution (skewed distribution)

Non-parametric tests are more conservative, less statistical power, less able to detect
a differences is truly there and more likely than parametric test to produce type II
error.
Comparing: Dependent variable Independent variable Parametric test Non-parametric test
(Dependent variable is
normally distributed)

The means of two Continuous/ scale Categorical/ nominal Independent t-test Mann-Whitney test
Independent groups

The means of 2 paired Continuous/ scale Time variable Paired t-test Wilcoxon signed rank
(matched) samples e.g: ( time 1= before, test
weight before and after time 2= after)
of a diet for one group of
subjects
The means of 3+ Continuous/ scale Categorical/ nominal One way ANOVA Kruskal-Wallis test
Independent groups

The 3+ measurements on Continuous/ scale Time variable Repeated measures Friedman test
the same subject ANOVA

Relationship between 2 Continuous/ scale Continuous/ scale Pearson’s Correlation Spearman’s Correlation
continuous variables Coefficient Coefficient (also use for
ordinal data)

Predicting the value of Continuous/ scale Any Simple Linear

one variable from the Regression
value of predictor
variable

Assessing the Categorical/ nominal Categorical/ nominal Chi-squared test

relationship between two
categorical variables

Note: The table only shows the most common tests for simple analysis of data.
Ethical considerations
For a research project that should be considered ethical, the following
conditions should be fulfilled-
• The individual is invited to participate in the research, and that
participation is voluntary.
• The individual is free to refuse to participate and will be free to withdraw
from the research at any time without penalty or loss of benefits to which
he or she would otherwise be entitled.
• For controlled trials, the individual has been explained about the features
of the research design (e.g. Randomization, double-binding).
• The potential subject has been explained and understands following:
- the expected duration of participation
- any foreseeable risks, pain or discomfort, or inconvenience
- expected benefit to the subjects from participating of research
- confidentiality of records in which subjects are identified
Results
 The result and discussion are very important major component of a research.
 The result section answers the questions “What was found?”
It reports the results of the investigations described in the method sections.
It usually does not contain interpretation of data or statements that require
referencing.
It is composed of words (they tell the story), table (that summarize the
evidence), illustrations (that highlight the main findings), and statistics (that
support the statements).
 Pay special attention to two pieces of general advice.
Firstly, keep the results section as brief and uncluttered as possible. The
reader must be able to see the wood for the tree.
Reports only the results that are relevant to the question and hypothesis.
 Secondly, organize the presentation of results.

Design the text as if you were telling the reader a story.

Start chronologically and continue logically to the end.

Lead the reader through the story by using a mixture of text, tables, and

illustrations.

 Sub-heading could be used to break up the results into logical segments.

 It should be presented in a logical sequence to answer the research

questions, to explain the argument or to assess its support and to provide

base-line information to draw recommendation.

 Result in tables
- Title –on top of the table; clear, concise and to the point
- Data should be arranged in a logical manner
- Codes, abbreviations or symbols used should be explained in detail in
a foot note
- Each row and column should be labeled concisely and clearly
- The table should be self-explanatory and simple
 Result in graphic presentation
- Title- simple and effective; below the figure
- Self – explanatory
- Appropriate graph mainly depends on the measurement scales of
variables
- Types- line graph, bar graph, pie chart, histogram, frequency polygon,
cumulative frequency curve
Discussion

The discussion section should contain an analysis of the result together with a
review of the relevant literature.

The important element is the interpretation of the result. It should also show
how previous studies relate to the present study and whether the hypothesis has been
proven or rejected.

In Discussion, don’t just copy the results, but also compare with previous local
and international studies which may agree or disagree with your own.

Data being reported should always be compared with landmark studies and if it
differs markedly from earlier ones, a plausible explanation should be provided.

If you find differing points from others or unexpected endings, discuss possible
explanation for non-uniformities.

Criticize the weakness/limitations and strength of your work and other studies in
terms of design, technique and results to find out the reason for the differences or
recommend further research on this topic.
 For controversial findings, it is worthwhile to provide extra evidence as support.
It is not always possible or necessary to resolve conflicts.

Where no adequate or tangible explanation is possible, one can just say “there is
currently no explanation for the disparate results as found in this study until further
research can clarify the issue”.

Discuss all results including negative ones. Negative results need discussion and
not omission because they can raise specific research questions which can be used for
further research. Avoid being biased, speculative or unrealistic.

Never falsify(conceal the truth) your results. This is a breach of research as well
as professional ethics and do not think you will not be found out.

In the last paragraph of the Discussion section should outline the conclusions that
have been reached, and possibly indicate where the author intends to go from there.
Some authors put this paragraph in a separate section – Conclusions.
Conclusion

Link the conclusion with the goals of the study but avoid unqualified statement
and conclusions not adequately supported by the data.

State new hypothesis when warranted, but label them clearly such as:

• What is the strongest and most important statement that you can make from your
observations.

• Refer back to problem posed and describe the conclusions.

• Include the broader implications(effects or consequences that may happen in the

future) of your results.
Recommendation

Recommendations should include

• Remedial action (for further improvement) to solve the problem

• Further research to fill in gaps in the understanding

• Directions for future investigations on related topics

Reference

The Harvard reference system (author-date system) should be used.

Citations in the body of your writing should give the author’s surname
with the year of publication.

The full details of all these references should be listed alphabetically

by author name as a reference list at the end of your writing.

Citing References in the Reference List or Bibliography

References list: is a list of all the sources that you have cited within
your work

Bibliography: is a list of everything that you have cites and

everything that you have consulted to help improve your
understanding of the topic.
General

Author (s) surname followed by initials, (Year), Title of article, Name of

journal: volume number: page numbers of article. Indent half inch starting
from second line for each reference.

e.g. Reilly, J.J.,Dorosty,A.R (1999), Epidemic of obesity in UK children.

Lancet:354; 1874-5.

Do not include degrees like MB, Phd,- Do not use et al., but write all the
author’s names
Journal articles
Author surname, initials. (Year) Title of article, Journal Title.
Volume number (issue or part number), pp. first and last page numbers.
Gilbert, D. A and Hayes, E. (2009) Communication and outcomes of
visits between older patients and nurse practitioners. Nursing Research.
58(4), pp. 283-293

Conference papers
Author surname, initials. (Year) Title of conference paper. In:
conference proceedings title, including date. Place of publication:
Publisher.
Webb, N. L. (2004) Mathematics education reform in California. In:
Science and mathematics education in the United States: eight
innovations: proceedings of a conference, Paris, 2000. Paris: OECD.
Thesis of dissertation

Most dissertations and theses are unpublished, so they need a special

citation method; Jones, J.B. (1974) The piano and chamber works of

Gabriel Faure. Dissertation. Cambridge University.

If a dissertation or thesis is published, it should be cited as a book.

Newspapers
Journalist surname, initials. (Year) Title of news item. Name of
newspaper. Day, Month, pp, first and last page numbers.

Peters, R. (2009) Picking up Maxwell’s bills. Independent. 4 June, P. 28

Edited bookwith Chapter Authors

Chapter author surname, initials, (Year) Title of chapter. In: Editor’s

surname, initials. (ed.) Title of book. Edition. Place of publication:
Publisher, first and last pagenumbers.

Woolrich, C. (2009) Principles of prefessional practice. In: Hinchliff,

S., Norman, S. and Schober, J. (eds) Nursing practice and health care:
a foundation text. 5th ed.
London: Hodder Arnold, pp. 89-113.

Note: that ‘in’ is used to link the chapter to the book and the use of
page numbers. The year of publication is only given once.
Book volume
Author/editor surname, initials. (Years) Title. Edition. Volume Place
of publication: Publisher.
Bowling, A. (2009) Research methods in health: investigating health
and health services. Volume. Maidenhead: Open University Press.

E-book
Author/editor surname, initials. (Years) Title [online]. Place of
publication: Publisher. Available from: URL. [Accessed date].

Hutcheon, L. (2004) Politics of postmodernism [online]. London:

Routledge. Available from: http:// reader.eblib.com/Reader.aspx?p=
181639&o [Accesed 3rd August 2009).
Government publications

Government Department/ Institute. Subdivision of department/

institute (if known). (Year) Title of document. (Name of chairperson if

it is a committee). Place of publication: Publisher.

Department of Health and Social Services. (2000) Inequalities in

health: report of a research working group. (Chairman: Sir Douglas

Black.) London: DHSS.