Dr Anoop Nigwekar
MD (Hom), MBA, Adv. Dip. Mgmt (AIMA, N. Delhi)
Member, Research Core Committee, ICR group of Organizations
Introduction:
Synopsis a brief presentation which describes the purpose of research and method of conducting research. Research is a systematic objective analysis and recording that may lead to controlled observations that may lead to the development of generalization, principles o r theories, resulting in prediction and possibly ultimate controll of events.
Dissertation contributes in creation of new knowledge, it helps the candidate to develop scientific attitude, helps develop attitude o f critical reading. It is a first step from here one goes on to become an author – authorship develops. It is a part of curriculum in most of the Post graduate and doctoral level studies.
Why write:
It is useful in developing an ability to critically think on the subject under study. It makes us utilize the past body of published knowledge and create a synthesized document. It makes us write in a manner that demonstrates sound theoretical ration ale. One can address to the issue if how to represent the need to utillise appropriate method for undertaking study. It makes us to create a team by developing better communication skills.
Steps of writing a research proposal
Step one:
Choosing a research question
As said by Theobald Smith ““I always take up the problem that lies before me, chiefly because of easy access of material, without which research is crippled”. A well defined question will make a good protocol easier to write, enable to focus data collection and manipulation, and facilitate clearer conclusion.
Characteristic of good research question
It should be interesting to you, to your guide, for the science and finally should have utility of the world.
It should be relevant to you, to your science and of course to your subject under study.
It should be novel and not mere duplication
It should be feasible, in terms of time available with you for study, there should be material
available to conduct the study, there should be expertise available around who can guide you on the topic.
It should be ethical from point of view of patient, research and also society.
How to arrive at the question:
This arises from your observations and after making due references on the available literature knowledge available on the subject as of now. One should discuss the though that gets generated with the guide and generate possible questions that your study can address. After generating the questions one need to evaluate id it is really possible to raise these questions and then finally choose the appropriate question which this study desiresto seek answers to .
Developing a research question
Spend time it is most important aspect – give adequate time to developing the research question after addressing all the above questions. Time spent on this aspect will pay the maximum dividends in better quality project and less time wasted in performing project.
Question should general questions and then come down to specific aspects.
Process of developing question
a. write down all the ideas that get generated in your mind
b . build upon your ideas and be creative
c. don’t get influenced by others suggestions
d . be realistic about time
How does one evaluate:
A check list noted below helps to evaluate
Yourself
Design suits your personality
Build current knowledge and skill
Further career / goals
Interest – yours
Literature
Literature base?
Recent literature interest?
Un answered questions?
Other resources
Subject availability
Material expertise?
Reason – likely to stop the project
You can raise questions in the subjects of –
Materia medica
Organon
Repertory
Medicine
Pediatric
Psychiatry
Writing style:
The words that you mean should be written , they should not mean anything more or less then what you desire to express.
Be careful in the word you choose, loose use of words can mean distortion of actual meaning – terminology should be taken care o ff.
The writing should be logical and scientific, we should be alert that we are creating a documents that will be analyzed by peers and also utilized by them to enhance the knowledge base.
Choice of tense, it is advisable to use past tense when one writing on literature review, present tense when thinking about the current process of thin king, future tense when common ting on future actions.
Preferably it should be in third person.
Main features of Synopsis writing:
These can vary based on the academic organization seeking research document. Bu t the general trends in the current academic circles suggest the following heads. I am sharing with you my preferred list.
A. There should be first page / cover page should spell out the title, name of candidate with his registration number, name of guide, subject / department to which the candidate belongs along with the address, telephone and email of the institute where the project is being undertaken.
B. Title : this gives the first impression to the reader, it should be concise, it should reflect nature of study and relation ship between hypothesis and guiding question.
Eg: “Exploring role of constitutional prescribing in acute disease”
C.Introduction: It should be short but informative. It should be direct to the point.
Avoid using technical terms. Be clear in stating your problem. There should be logic in progression from identification of problem o f raising formal question.
Why the topic is significant – this can be raised and answered based on your experience, prevalence in the current scenario and also mention the impact on the community of the study. You can also justify your interest in the topic in the introduction.
D.Literature review : As said by Sir Issac Newton: I can see further because I stand on the shoulder of my predecessor”. It is impo rtant that you study all the currently available literature befo re initiating proposal. This give an adequate knowledge of the topic, it helps to have critical appraisal of ideas n ad hypothesis that are raised in the literature and also those th at get generated in your mind. It helps to random scanning of the various ideas. This actually helps in design of protocol of the study. It also informs you if the topic has been researched in past and which aspect was researched. It also gives an idea to which was the methods and procedures utilized in those studies as against the one you are thinking.
When writing about findings and work done use past tense, when you are addressing to the stud y question use present tense. Be clear that you have defined the boundaries of your stud y o r else you will be gathering a lot of information which is of no significance to your study. The range of literature study should be from significant past to most recent inputs on the subject under study.
Literature review should give information which supports the study and method utilsied in the study. It should conclude a summary and at the same time be critique on the past literaturee and its data. It should state a critique on the method undertaken by past students on the subject.
The in formation source can be from journals – review articles, textbooks of medicine, internet, colleagues, mentors, experts, seminars etc.
E.Objectives: After one has gone through the above process he can spell out the objectives of study. It is putting down steps by which one will attempt to achieve answers to the questions that made the study must for the researcher. They should be listed in the order of importance, in chronological order and they should be consistent with hypothesis. The objectives should be certainly in tune with the title of the study.
F.Hypothesis : It is a statement declaring true expectation of the result. It can be experimental in nature or correlation studies. The current practice that is prevalent is “to reject null hypo thesis”. It can “directional hypothesis” in which the direction of difference is predicted. It can be “non – directional hypothesis” in which one merely states that there will be difference.
G. Method : As motto of nasa goes “ meticulous attention to the minutes details”. This is the longest section of the proposal, it describes the subjects / participants,it states the research design and procedure.
Subject / participant : We have to spell out the method of choosing the participant. We have to based on the nature of study have to definee the sample size and also we should be able to justify the need for the sample size. Here we need to state the inclusion criteria, exclusion criteria and withdrawal criteria of the samples under study.
Procedure : There are two ways of going ahead
Retrospective study: this should be able to spell out the number of cases, source of the cases. The procedure of data collection in the form of cases should be spelt out clearly. It can be understanding the diseases and patient as a person. The tools of analyzing these cases have to be defined and utilized.
Prospective study: the study involves conducting study on sample size in which the data is recorded for the first time. This means we have to define the venue of where the study will be undertaken. How the study will be done in a chronological sequence addressing to questions of what is to be studied, when will the sample be studied, how will be the sample data recorded and by whom. It also demands we stating the sampling technique.
F. References / Bibliography :It is important component o f the study. We have to state the sources from where we have been able to create purposese of the study. It has to be written in a particular format, alphabetical order of the author’s last name who have been referred, followed b y the publication, publisher and edition etc. internet reference should be stated along with complete URL address and the date, and time of surfing for referencing, journals have to be referred with authors last name in alphabetical order, article referred, journal name and volume details. There other method used is in sequencing the references as they appear in the stud y.
A representative synopsis is presented below to illustrate the concept in practice.
TITLE OF THE TOPIC
ESTABLISHING THE RELATIONSHIP BETWEEN CLINICAL SYMPTOMATOLOGY IN ACUTE VIRAL HEPATITIS AND THE NATURE OF THE SUSCEPTIBILITY WITH MIASMATIC CORRELATIONS
Brief resume of the intended work:
NEED FOR STUDY:
Four million people in India suffer form Hepatitis every year. Cases of Hepatitis in underdeveloped countries are seen in all forms like sporadic cases, epidemic form, and in some regions it is present as an endemic problem (Park, 1 991)
Hepatitis is a common man’s problem in underdeveloped countries seen in all ages and in both the sexes. Hepatitis is the infection of liver caused by more than half a dozen viruses. More common are Hepatitis Viruses A, B, C, D, E and G. Although human cases are the only reservoir of infections, control over it and prevention is difficult for the following reasons (Park, 1991). Fecal shedding of virus occurs during incubation period, a large number of sub-clinical cases, because of poor hygiene and sanitations facilities and absence of any specific treatment in conventional modern medicine. This further accentuates the problem for common man to whom affordability of the treatment matters.
Hepatitis can cause deaths and also can incapacitate patients for more than few weeks. Homoeopathy has a very good scope in treating acute viral hepatitis since it is simple to administer and also cost effective. Homoeopathic literature is rich in the therapeutics o f liver diseases. A numbers o f authors have contributed to its enrichment.
Yet the problem that the practitioner faces is in evolving standardized approach in the management of a case of viral hepatitis. This involves no t on ly selecting the right remedy but also selecting the right potency and repetition, predicting the prognosis and planning
the ancillary measures. In my experience, the key to this process is to understand the susceptibility and influence o f the miasm in every case. Susceptibility is the individual’s inherent capacity to react to internal and external stimuli. Miasms play an important role in influencing the susceptibility and thereby influencing the course of the disease. Hence evolving a standardized approach to assess these parameters and their interrelationship is important for homoeopathic management.
Review of Literature:
Liver is an independent and discrete organ that performs various functions which are interrelated to each other and at the same time. Liver lobule is the basic functional unit of the liver. Liver lobule is constructed around the central vein and connects to Inferior Vena Cava via hepatic vein. Cellular unit in a lobule is made up of hepatic plates. There are hepatic sinusoids and hepatic arterioles. Hepatic sinusoids are lined by endothelial cells and Kupffer cells. There are large pores in the endothelium that allows plasma and protein to freely move in the space of disse (Guyton, 1998).
Liver basically performs the vascular function of storage and filtration of blood, metabolism of carbohydrates, fats and protein, storage of vitamins, irons and coagulators. It also performs secretory an d excretory functions responsible for formation of bile (Guyton, 1998 ). When the liver is affected, its functions get disturbed depending upon the type and extent of the micro tissue involved. This in turn determines the clinical presentation of the disease. Thus triad of structure, function and form reflects the dominant miasm and its influence on the state of susceptibility (Kasad, 2003) Hepatitis is the inflammation of the liver mainly caused by infection of viruses of w ich Hepatitis A virus and Hepatitis E virus are enterically transmitted (Agarwal, 2003). Hepatitis viruses B, C, D & G are parentally transmitted (Amarapurkar, 2003). Incubation period for Hepatitis B virus is 15 -180 days and fo r Hepatitis A virus is 15 –50 days. Hepatitis A virus mainly affects children (50% cases) and usually p resents as acute viral hepatitis with full clinical recovery. Only 0.1 % cases go into acute fulminated hepatic failure. Hepatitis B virus mainly affects adults and yo ung as an acute or a chronic hepatitis infection with the risk of cirrhosis and hepato-cellular carcinoma as its complication (Amarapurkar, 2 003)
In immuno-compromised patients, Epstein Barr virus, Rubella virus and Adenoviruses also cause hepatitis. Modern medicine drugs are also cap able of causing drug-induced hepatitis (Park, 1 991). Pathological changes in the liver due to hepatitis virus infection ranges from diffuse liver cell damage, with isolated necrosis and balloon degeneration to periportal and portal infiltrates, piecemeal necrosis to b ridging necrosis, ground glass cells and liquifactive necrosis. Each of these pathological features represents varying degree of reversibility and irreversibility and pace of evolution of disease vary from slow to very rapid (Cotrans, 1994).
Varying clinical pictures emerge depending on the involved structure, the pathology, the causative organism and the reaction o f the host (susceptibility of host) These will range from asymptomatic carrier state, Acute anicteric hepatitis, Icteric Hepatitis, Acute fulminant hepatitis, Chronic active hepatitis to Chronic persistent hepatitis (Dienstag, et al, 2001). Susceptibility is defined as inherent capacity of living organism to react to external and internal stimuli (Roberts, 1989). Since no two individuals are exactly similar the susceptibility is highly individual specific. Susceptibility varies in degree in different persons and at different times in the same person. Assessment of susceptibility in cases of hepatitis will help in individualizing one person from other suffering from the same disease.
Susceptibility as a force draws itself to the disease which is on the same plane of vibration to correct the miasmatic deficiency. Susceptibility is greatly accentuated during sickness. It can be increased, diminished or destroyed (Roberts H., 1989) .Thus as a homoeopath our objectives would be to recognize these altered, exaggerated or diminished states of susceptibility through clinical information, pathological investigation, study of the patient as a person and unraveling the miasmatic influences (Dhawale, 2000). Prescribing a similar remedy in the right potency and with adequate repetition can alone satisfy this state of susceptibility and establish the healing process and shore up the natural immunity in the patient (Close Stuart, 2004).
Miasm is an obnoxious disease-producing agent inimical to life and is dynamic in nature. Hahnemann mentions about three miasms classified into venereal and non- venereal in its origin. The syphilitic and the sycotic as the one from venereal origin and psora as the real fundamental cause of various illnesses. It is Dr. Allen who introduced the tubercular miasm in the latter part of the evolution of this concept. Each miasm has got a peculiar evolution in terms o f predisposition, disposition, diathesis and disease, which influences the course of illness and its peculiar form which has the stamp of its miasmatic activity (Boericke, 1988)
CLINICAL FEATURES (Criteria A):
Constitutional features like anorexia nausea, vomiting, fatigue, malaise, arthralgia, weakness, headache, photophobia, cough and croyza. Onset of jaundice with dark coloured u rine, skin pruritis and white coloured stool. There is weigh t loss, pain in right hypochondrium and discomfort (Dienstag, et al, 2001)
On examination fever, weight loss, icterus, tender and enlarged liver and in some cases enlarged spleen (Dienstag, et al, 2001).
Lab investigations: CBC, SGOT, SGPT, S. Bil, S. Alk. Phos, Hbs Ag. In some cases prothrombin time (Dienstag, et al 2001).
The study o f the sick individual from all these points of view, clinical, pathological and individual characteristic in given time dimension will give us the totality (Kasad,2003 ).
These will form the parameters for assessment of the susceptibility. Judgment of susceptibility will help in the selection of remedy, potency and repetition and will give us insight into miasm and prognosis of the case (Dhawale, 2000).
Rastogi (1999) has mentioned about the usefulness of Carica Papaya in Hepatitis B in the early stages especially when jaundice has not developed. He has also mentioned about Cardus and Chellidonium
Crompton J. Burnet (1990) mentions about the usefulness of remedies like Cardus, Chellidonium, Thlapsi Bursa etc. as organ remedies and prescribed on basis of stage of disease.
Master (2002) tells us about the diet management in Hepatitis.
OBJECTIVES OF THE STUDY:
1. To identify the clinical, pathological and individualizing characteristic parameters guiding us in the assessmen t of susceptibility in hepatitis.
2. To identify the role of susceptibility in assessing various components in homoeopath ic management of the patient like miasm, posology and prognosis.
MATERIALS AND METHODS
SOURCES OF DATA:
30 Cases of hepatitis as mentioned in criteria above attending OPD & IPD of the Dr. M. L. D. Trust’s Rural homoeopathic Hospital, Palgh ar and other branches of institute.
Cases of hepatitis of all age groups and of either sex will be taken up for studies.
METHOD OF COLLECTION OF DATA: (INCLUDING SAMPLING PROCEDURE IF ANY)
Data for case taking will be obtained from the patient, patient’s attendants, physician’s observations and examin ation find ings.
Investigation: CBC, SGOT, SGPT, S. Bil, S. Alk. Phos., HBs Ag, Urine – routine will confirm the diagnosis.
METHOD OF STUDY:
1 ) Studying the clinical presentation of each patient in terms of location, sensation, modalities, and concomitants with emph asis on the intensity of symptoms, pace of the disease and their peculiar association.
2 ) Studying the individualizing characteristics of the patient, both at mental and physical level.
3 ) Studying the past history and family history of disease.
4 ) Studying the environmental conditions and addictions of the patients in order to ascertain the maintaining factors.
5) Correlating the clinical presentations with the investigation s and examination findings to evolve comprehensive clinico-pathological correlation.
6 ) To note changes required in diet and regime and ancillary measures required during the course of illness.
INCLUSION CRITERIA:
Patient fitting into diagnostic criteria of hepatitis as defined above (criteria A) will be taken up.
EXCLUSION CRITERIA
1. Patients with significant systemic diseases such as renal failures, diabetes, neoplasm, valvular heart disease, cardiac failure.
2. Immuno-compromised patient either iatrogen ic or due to HIV infection.
3. Drug induced Hepatitis.
4. Hep atitis caused by Epstein Barr, Rubella and adenovirus.
5. Hep atitis B carrier state, chronic active hepatitis, chronic Persistent hepatitis.
DOES THE STUDY REQUIRE ANY INVESTIGATIONS FOR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMAL? IF SO, PLEASE DESCRIBE BRIEFLY
No.
HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3
Not applicable.
LIST OF REFERENCES:
1. Agarwal Rakesh (2003) API Textbook of Medicine 7th ed, Section XII, Chapter 6, Pg. 595, Pub: Association of Physician of India.
2. Allen J.H (2003), The Chronic Miasms , Pub: B. Jain Publishers PVT LTD
3. Amrapurkar Deepak (2003) API Textbook of Medicine 7ed, Section XII,th Chapter 7, Pg. 597 , Pub: Association of Physician of India.
4. Boericke W. (Trans) (1988), Hahnemann ’s Organon of medicine, 6ed, Pub: B.Jain Publishers PVT LTD.
5. Burnett. J. Compton, (Reprint edition 1990) The Diseases of the Liver , Pub: B. Jain Publishers Pvt. Ltd, New Delhi.
6. Close Stuart (2004), The Genius of Homoeopathy , Chapter XVI, The Logic of Homoeopathy, pg. 266; Pub: Indian Books and Periodicals Publishers, New Delhi.
7. Cotrans S. Ramzi, Vinay Kumar, Tucker Collins, (1994) Robbins Pathologic basis of disease , 6 th ed, Pub: A Harcourt Asia PTE LTD, Company, Sin gapore.
8. Dewey. W. A (2002), Essentials of Materia Medica and Pharmacy , Pub: B. Jain Pub lishers Pvt. Ltd , New Delhi
9. Dhawale. M.L (2000), Principles and Practice of Homoeopathy Part1, 3 ed,rd Chapter 3, Symptomatology from the standpo in t of homoeopathic practice, Pg.43; Pub: Institute o f Clinical Research, Bombay.Etc….
Courtesy : Similima team thanks the ‘Asian Journal of Homeopathy’ for allowing us to reproduce this article published in Nov.2007 issue
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