How to Write an Effective Discussion 译
How to Write an Effective Discussion 如何写作一个有效的讨论
Dean R Hess PhD RRT FAARC
Introduction
简介
Elements to Include in the Discussion
讨论需要包含的元素
State the Major Findings of the Study
表述研究的主要结果
Explain the Meaning of the Findings and Why the Findings Are Important
解释这些结果的意思以及它们的重要性Relate the Findings to Those of Similar Studies
把这些结果同那些类似的研究相关联Consider Alternative Explanations of the Findings
考虑一些这些结果的不同解释
State the Clinical Relevance of the Find-ings
阐述这些结果的临床相关性（临床意义）Acknowledge the Study’s Limitations
声明本研究的缺陷
Make Suggestions for Further Research 为进一步的研究提供建议
Give the “Take-Home Message” in the Form of a Conclusion
以结论的形式给出本文的“关键信息”Things to Avoid When Writ-ing the Discussion
讨论部分需要避免的一些东西Overinterpretation of the Results
结果的过度(不合理的)阐释Unwarranted Speculation
毫无根据的猜测
Inflating the Importance of the Findings 夸大结果的重要性
Tangential Issues
偏离主题(乱扯)
The “Bully Pulpit”
Conclusions That Are Not Supported by the Data
没有数据支持的结论
Summary总结
Explaining the meaning of the results to the reader is the purpose of the discussion section of a research paper. There are ele-ments of the discussion that should be in-cluded and other things that should be avoided. Always write the discussion for the reader; remember that the focus should be to help the reader understand the study and that the highlight should be on the study data.
Key words: publishing; writing; manuscripts, medi-cal; communication.
一篇文章的讨论部分的目的就是为了给读者解释结果的意思.讨论部分有一些需要包含的元素, 也有一些需要避免的事情.永远为了读者写讨论;记住你的重点是为了帮助读者理解这篇研究, 重点强调的东西需要建立在研究的数据基础上.
关键词: 发表; 写作; 文稿; 医学; 交流.
[Respir Care 2004;49(10):1238 –1241. ? 2004 Daedalus Enterprises]
Dean R Hess PhD RRT FAARC is affiliated with the Department of Respiratory Care, Massachu-setts General Hospital, and Harvard Medical School, Boston, Massachusetts.
Dean R Hess PhD RRT FAARC presented a version of this article at the RESPIRATORYCARE Journal symposium, “Anatomy of a Research Paper:Science Writing 101,” at the 48th International Respiratory Congress, held October 5–8, 2002, in Tampa, Florida.
Correspondence: Dean R Hess PhD RRT FAARC, Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. E-mail: dhess@https://www.sodocs.net/doc/f24200317.html,.
Translated by Xinxiang Fan, M.D., Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. E-mail: fanxinx2005@https://www.sodocs.net/doc/f24200317.html,.
All rights reserved. Unauthorized reproduction of this translated article is prohibited.
Introduction
You have carefully written the hypothesis. You have designed the study and collected the data. You have conducted the statistical analysis and grouped the summary results into table and graphs. But what does it mean? Explaining the meaning of the results to the reader is the purpose of the discussion section. Although the discussion comes at the end of the pa-per, you should be thinking about what you will write in the discussion section from the moment that the study is conceived. Questions that you will develop in the discussion should be considered from the study ’s outset. Why is the study important? How does this study relate to previous studies? What are the limitations of the study design? There are elements of the discussion that should be in-cluded and other things that should be avoided (Ta-bles 1 and 2). Most important, always write the dis-cussion for the reader; the discussion is not a forum for you to impress others with your knowledge of the subject. You should be trying to convince the reader of the merits of the study results.
简介
你已经认真地写了假设. 你已经设计了研究并且收集了数据. 你已经进行了统计分析, 并且把汇总结果分门别类到表格和图表中. 但是它的意义是什么? 讨论的目的是向读者解释结果的意义.尽管讨论在文章的末尾, 但是你从开始构思研究的时候就要思考你将要在讨论部分写些什么. 你在讨论部分遇到的问题需要在研究的开始就要考虑. 为什么这个研究是重要的? 本研究与先前的研究如何相关? 本研究的缺陷? 讨论部分有一些需要包含的元素, 也有一些需要避免的东西(Tables 1 and 2). 最重要的是, 永远是为了读者写讨论; 讨论不是用你对这个主题的知识给他人以深刻印象的论坛. 你应当试图说服读者研究结果的价值所在.
Elements to Include in the Discussion 讨论需要包含的元素
State the Major Findings of the Study The discussion should begin with a statement of the major findings of the study. This should be the very first paragraph in the discussion. It should be a direct, declarative, and succinct proclamation of the study results. However, it should not include data or reference to the study design. Several examples il-lustrate the point. In a paper by Anton et al 1 the discussion begins with the sentence, “Our results confirm that these nasal and full-face masks are sim-ilarly efficient over 15 min of NPPV with COPD pa-tients recovering from acute hypercapnic respiratory failure. ” This clearly states the most important finding of that study. Fluck et al 2 began the discus-sion section of their paper with the sentence, “Our 陈述研究的主要结果
讨论应该以一个对研究主要结果的陈述来开始. 这应该是讨论部分的第一段. 它应该是对研究结果的一个直接的、陈述性的、简洁的宣告. 然而, 它不应该包含研究数据或者提到研究的设计. 有几个例子可以说明这一点. 在Anton et al的一篇文章中, 讨论以这样一个句子来开始, “我们的结果证实, 在从急性高碳酸血症型呼吸衰竭中恢复的COPD病人接受15分钟的NPPV过程中, 鼻腔面罩和全面罩同样地有效.”这句话清楚的陈述了那篇研究最重要的结果. Fluck et al在他们的文章里以
findings suggest that ambient light has no statisti-cally significant effect on S pO2 readings and that am-bient light’s effect on S pO2 is clinically unimportant.” That is a good example of a direct, declarative, and succinct proclamation of the study results. 这样一句话来开始讨论, “我们的结果提示背景光对S pO2读取的影响没有统计学意义, 背景光对S pO2的影响在临床上不重要. 这也是一个对研究结果的直接的、陈述性的、简洁的宣告的好例子.
Explain the Meaning of the Findings and Why the Findings Are Important
Explain the Meaning of the Findings and Why the Findings Are Important. No one has thought as long and as hard about your study as you have. As the person who conceived, designed, and conducted the study, the meaning of the results and their im-portance seem obvious to you. However, they might not be so clear for the person reading your paper for the first time. One of the purposes of the discussion is to explain the meaning of the findings and why they are important, without appearing arrogant, condescending, or patronizing. After reading the discussion section, you want the reader to think, “That makes perfect sense. Why hadn’t I thought of that? ” Even if your study findings are provocative, you do not want to force the reader to go through the paper multiple times to figure out what it means; most readers will not go to that effort and your findings will be overlooked, disregarded, and forgot-ten.
Relate the Findings to Those of Similar Studies
No study is so novel and with such a restricted focus that it has no relation to other previously pub-lished papers. The discussion section should relate your study findings to those of other studies. Ques-tions raised by previous studies may have served as the motivation for your study. The findings of other studies may support your findings, which strength-ens the importance of your study results. Stoller et al 解释这些结果的意思以及它们的重要性
解释这些结果的意思以及它们为什么重要.对你的研究没有人会像你那样长时间地和努力地思考. 作为这个研究的构思、设计和执行者, 结果的意思以及重要性对你是显而易见的. 然而,对首次阅读你文章的人,它们或许就不是如此清晰. 讨论的一个目的就是解释这些结果的意思以及它们为什么是重要的, 不要显得傲慢, 谦虚, 或者屈尊俯就. 当读完了讨论部分, 你希望读者去想, “这非常有意义. 我为什么没有想到呢?”即使你研究的结果是富有启发性的, 你肯定不想迫使读者反复阅读你的文章来推敲它的意思; 大多数读者不会那么努力,这样的话你的结果就会被忽略, 漠视和遗忘.
把这些结果同那些类似的研究相关联
没有研究会如此的新颖和局限以至于和之前发表的论文没有关联. 在讨论部分,你应当把你的研究结果同别的研究联系起来. 之前研究提出的问题或许是促使你研究的动力. 别的研究结果或许支持你的结果, 这样会增强你的研究结果的重要性. Stoller et al 3 在之前一个研究的背景下讨论了他们的研究结果: “减少更换in-line吸管的频率可以降低费用,并不增加VAP的发生率,我
3 discussed their study results in the context of a previous study by others: “Our finding that changing in-line suction catheters less frequently is associated with lower cost and no higher incidence of VAP rep-licates the findings of a randomized controlled trial conducted by Kollef et al, upon which our amended policy was based.” I t is also important to point out how your study differs from other similar studies. An example can again be drawn from Stoller et al: 3“Certainly, differences in the specific criteria used to define VAP could contribute to the rate differ-ences between the present study and that of Kollef et al. For example, comparison of the criteria for nosocomial pneumonia in our study with the criteria used by Kollef et al shows similar component fea-tures but different rating schemes to establish the diagnosis.”们的结果重复了Kollef et al做的一个随机对照研究的结果, 我们策略的修订也正是基于他们的研究结果.”我们还可以从Stoller et al: 3的研究中来看另外一个例子:“当然, 用来定义VAP的特定标准的差异会引起本研究和Kollef et al的研究之间分级的差异. 例如, 对比我们研究中院内肺炎的标准和Kollef et al采用的标准, 我们就会发现它们有类似的组成特征, 但是确立诊断的分级方案却是不同的.”
Consider Alternative Explanations of the Findings
Despite efforts to remain objective and to main-tain equipoise, it is easy to consider only those ex-planations that fit your bias. It is important to re-member that the purpose of research is to discover and not to prove. It is easy to fall into the trap of de-signing the study to prove your bias rather than to discover the truth. When writing the discussion section, it is important to carefully consider all pos-sible explanations for the study results, rather than just those that fit your biases.考虑一些这些结果的不同解释
尽管我们力图保持客观和均衡, 我们很容易只考虑那些适合我们见解的解释. 研究的目的是去发现而不是证明, 记住这点很重要. 你很容易陷入一个圈套, 那就是设计了这个研究去证明你的一己之见而不是去发现问题的真相. 当书写讨论部分的时候, 认真地考虑关于研究结果的所有可能的解释很重要, 而不要仅是那些符合你个人见解的解释.
State the Clinical Relevance of the Findings 阐述这些结果的临床相关性（临床意义）
The reason we conduct studies is usually to im-prove the care of our patients. Thus it is important to cast the findings of your study in the context of clinical practice. For which patients do the results apply and for which do they not apply? Experi-mental studies conducted in the laboratory usually do not involve human subjects, but the results may have clinical implications, which should be stated. A paper by Swart et al 4 gives an example of a labora-tory study, the clinical relevance of which is overtly stated: “The clinically important measurements, for both screening and monitoring, are predominantly FEV 1 and FVC, and the Spirospec and Masterlab 4.0 showed excellent correlation (r=0.99) and very good limits of agreement for FEV 1 and FVC. For FEV 1 and FVC the Spirospec and the Masterlab 4.0 could be used interchangeably.”4
A cknowledge t he S tudy’s L imitations
All studies have limitations. Unfortunately, the limitations of some studies are fatal flaws that pre-clude publication. However, even the best studies in the most prestigious journals have limitations. It is far better for you to identify and acknowledge your study’s limitations than to have them pointed out by a peer-reviewer or a reader (in a letter to the editor after publication). Fluck et al 2 acknowledged a lim-itation of their study and used it to make a sugges-tion for further research: “We used only healthy white subjects, to minimize confounding variables. Future research should include testing subjects with
我们进行研究的原因通常是为了改进对我们病人的处理. 因此把你的研究结果映射到临床实践中是很重要的. 哪些病人适用这些结果, 哪些不适用? 在实验室进行的实验性研究通常不涉及人类个体, 但是它们的结果或许会给我们一些临床启示, 这点需要陈述一下. Swart et al 4的一篇文章给出了一个实验室研究的例子, 这个研究的临床相关性明确的被表述了出来:“不管是筛查还是监测, 临床上重要的测量指标都主要是FEV 1 和FVC, Spirospec 和Masterlab 4.0显示出极好的相关性(r=0.99), 以及对FEV 1 和FVC很好的相符范围. 对FEV 1 和FVC来说, Spirospec 和Masterlab 4.0可以交互使用.
声明本研究的缺陷
所有的研究都有缺陷. 不幸的是, 一些研究的缺陷是妨碍其发表的致命缺点. 然而, 即使那些最有威望的期刊中发表的最好的研究也会有其缺陷. 自己发现并声明你研究中的缺陷要远好于它们被审稿人或读者(在文章出版后写给编辑的信件中)指出. Fluck et al 2声明了他们研究中的一个缺陷, 并且就此为进一步的研究提出了建议: “为了减少混杂变量, 我们只采用了健康的白人个体. 未来的研究应当纳入并检验深肤色的和氧饱和度低于正常(＜95%)的个体.”
darker skin and subjects whose oxygen saturation is below normal (＜95%).”
Make Suggestions for Further Research Although a study may answer important ques-tions, other questions related to the subject may re-main unanswered. Moreover, some unanswered questions may become more focused because of your study. You should make suggestions for further study in the discussion section. Laboratory experi-mental studies typically lead to suggestions for fol-low-up clinical studies with human subjects. An example comes from a laboratory study of oscillating positive expiratory pressure (OPEP) devices by Volsko et al,5 who wrote, “One subject that remains to be explored is how to determine at the bedside whether a patient can perform OPEP and, if so, which device to select.”为进一步的研究提供建议
尽管一个研究或许回答了一些重要的问题, 和这个主题相关的其它问题或许仍不能解答. 此外, 一些未解答的问题或许因为你的研究而变得更引人关注. 你应当在讨论部分为进一步的研究提出建议. 实验性研究通常为后续的在人体身上的临床研究提供建议. 有一个来自Volsko et al5的关于震荡正呼吸压(OPEP)装置的实验性研究的例子, 他们写道, “有一个问题仍有待探索, 那就是如何在床边决定对一个病人能否实施OPEP, 如果可以的话, 应该选择那个装置.”
Give t he “Take-Home M essage” i n t he Form of a Conclusion
What is the “take-home message”? What do you want the reader to remember from your study? The take-home message should be the first sentence of your conclusions section. In some journals the con-clusions section is a paragraph or subsection at the end of the discussion, whereas other journals (RES-PIRATORY CARE, for instance) require a separate conclusions section. The conclusions section may also provide suggestions for practice change, if ap-propriate. An example of a well-written conclusion comes from a study by Apostolopoulou et al,6 who 以结论的形式给出本文的“关键信息”
什么是“关键信息take-home message”? 你希望读者记得你文章中的什么东西?Take-home message应该是你结论部分的第一句话. 在一些期刊中结论是在讨论结尾的一段或分段, 然而在其它的期刊(例如, RESPIRATORY CARE)要求一个单独的结论部分. 如果合适的话, 结论部分或许也为临床实践的改变提供建议. Apostolopoulou et al 6的研究提供了一个写的很好的结论的例子, 他们写道: “VAP是一种很常见的感染, 某些干预措施或许会影响VAP 的发病率. ICU的医生应当清楚VAP的危险因
wrote: “VAP is a common infection and certain in-terventions might affect the incidence of VAP. ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying pa-tients at high risk for VAP and modifying patient care to minimize the risk of VAP, such as avoiding unnecessary bronchoscopy or modulating enteral feeding. ”素, 这在识别VAP高危病人,以及调整病人治疗措施降低VAP发生危险都非常有用, 比如避免不必要的支气管镜检或者调制的肠内营养.
Things to Avoid When Writing the Discussion 讨论部分需要避免的一些东西
Overinterpretation of the Results
It is easy to inflate the interpretation of the re-sults. Be careful that your interpretation of the re-sults does not go beyond what is supported by the data. The data are the data: nothing more, nothing less. 结果的过度(不合理的)阐释
对结果的阐释很容易过度膨胀. 务必当心你对结果的解读不要超出数据所支持的范围. 数据就是数据: 一点不能多, 一点也不能少,
Unwarranted Speculation
There is little room for speculation in the discus-sion. The discussion should remain focused on the your data and the patients and/or devices in your study. If the subjects in your study had asthma, it is usually not appropriate to speculate about how your findings might apply to other patient populations. If your study used volume-controlled ventilation, it may not be appropriate to speculate about how the findings might apply to pressure-controlled ventila-tion. If you feel compelled to speculate, be certain that you clearly identify your comments as specula-tion: “We speculate that .... ”毫无根据的猜测
讨论部分没有太多推测的空间. 讨论应该始终把精力集中在你研究中的数据、病人和/或设备. 如果你研究中的个体患有哮喘, 推断你的结果如何适用到别的病人群体通常是不合适的. 如果你的研究使用的是定容控制通气, 去推测你的结果如何适用到定压控制通气或许是不合适的. 如果你情不自已的想要推测, 务必要清楚的识别出你的评论是推测的语句: “我们推测.... ”.
Inflating the Importance of the Findings After all of the hard work that goes into a study, it is easy to attribute unwarranted importance to study findings. We all want our study to make an important contribution that will be cited for genera-tions to come. However, unwarranted inflation of the importance of the study results will disgust re-viewers and readers. A measure of humility goes a long way. 夸大结果的重要性
当向研究中倾注了所有努力之后, 你很容易把没有根据的重要性归属到你的结果里. 我们都希望我们研究做出了在未来的年代里都会被引用的重要贡献. 然而, 毫无根据地夸张研究结果的重要性会使审稿人和读者感到厌恶. 适度的谦逊对你大有裨益(谦虚使人进步).
Tangential Issues
It is important to remain focused on the hypothe-sis and study results. Injecting tangential issues into the discussion section distracts and confuses the reader. Tangential issues run the risk of diluting and confounding the real message of the study.偏离主题(乱扯)
始终把精力聚焦在假设和研究结果是很重要的. 把离题的问题带入讨论部分会干扰和迷惑读者. 离题的问题冒有稀释和混淆该研究真正信息的风险.
The “Bully P ulpit”
Do not use the discussion section to criticize oth-er studies. Although you should contrast your find-ings to other published studies, this should be done professionally. Do not use the discussion to attack other investigators. Moreover, never preach to the reader.“天字第一号讲坛”（白宫）
不要利用讨论部分去批评别的研究. 尽管你应该把你的结果和其它已发表的研究相对比, 但是这应该专业地来做. 不要利用讨论区攻击别的研究者. 此外, 永远不要对读者鼓吹说教.
Conclusions That Are Not Supported by the Data
The hypothesis→study→data→conclusions should be a tight package. Avoid the temptation to allow your biases to enter into the conclusions. 没有数据支持的结论
假设→研究→数据→结论应当紧密联系在一起. 避免让你个人的偏见带入结论的邪念.
Summary总结
The discussion section gives you an opportunity 讨论部分给了你一个解释结果意义的
to explain the meaning of your results. When writ-ing the discussion, remember that the focus should be to help the reader understand the study and that the highlight should be on the study data. 机会. 当书写讨论的时候, 记得关注点应当是帮助读者理解这个研究, 研究的亮点应该建立在数据之上.
REFERENCES
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2. Fluck RR Jr, Schroeder C, Frani G, Kropf B, Engbretson B. Does ambient light affect the accuracy of pulse oximetry? Respir Care 2003;48(7):677–680.
3. Stoller JK, Orens DK, Fatica C, Elliott M, Kester L, Woods J, et al. Weekly versus daily changes of in-line suction catheters: impact on rates of ventilator-associated pneumonia and associated costs. Respir Care 2003;48(5):494–499.
4. Swart F, Schuurmans MM, Heydenreich JC, Pieper CH, Bolliger CT. Comparison of a new desk-top spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic. Respir Care 2003;48(6):591 –59
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6. Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for venti-lator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care 2003;48(7):681–688.