Guest Editorials

2016 is a special year for the Department of Otorhinolaryngology. This marks the 55th anniversary of the birth of ORL as an independent department of the Philippine General Hospital.

Through the years, our department has produced more than two hundred diplomates serving throughout the country and abroad. Wherever they practice, our graduates carry with them the seal of excellence that has produced leaders in all aspects, whether as presidents of international organizations, editors-in-chief of peer-reviewed journals, researchers, or directors of their respective communities and hospitals.

The faculty, especially our first graduates and longest-serving active consultant, Dr. Mariano Caparas, encourage us to become innovators to provide quality service despite financial constraints. As the department chair, I have encouraged and promoted the role of our consultants and residents as researchers producing original studies relevant to the Filipino community. This special issue is a testament to our desire for excellence, particularly in the field of research.

May God bless us all!
 

Alfredo Q.Y. Pontejos, Jr., MD
Professor and Chair
Department of Otorhinolaryngology

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It is indeed an honor to contribute this editorial for this special issue of Acta Medica Philippina. Featured herein are researches of the faculty and residents of the Department of Otolaryngology. This is the third time in three decades that a special issue has been dedicated to Otolaryngology-Head and Neck Surgery and rightfully so.

As part of the celebration of the 55th anniversary of the department and the 60th founding anniversary of the Philippine Society of Otolaryngology-Head and Neck Surgery, it marks another milestone in the rich history of the department and the specialty. The former chairman of the department, Dr. Tierry Garcia passed away in 2016 at age 96. He worked tirelessly to have the UP Board of Regents approve the separation of the Department of Otolaryngology from the Department of EENT in 1961 and the department relentlessly pursued the path of excellence in this field and even set up a fellowship in ORL- Head and Neck Oncologic surgery. He has set up a PGH ENT Endowment Fund to help our indigent patients undergo much needed surgery. It is but fitting to dedicate this special issue to him who by his great wisdom and inspiration laid the path for our specialty to be so recognized not only in this country but in the international front.

Now with more than 700 fellows, the PSOHNS has been led mostly by honorable graduates from the Department following the footsteps of Dr. Tierry Garcia. The increased subspecialization and the increasing depth of scientific and applied clinical research that has been the hallmark of the specialty’s development in the past 55 years will be clearer upon closer examination of the papers published in this issue. The tradition of honor, service and excellence lives on among its alumni and clinician-scientists. When ”glocal” was not coined yet, the department has already produced locally research with global impact such as in newborn hearing screening, tuberculous otitis media, rare rhinosinus and esophageal or pediatric airway conditions, and genetics of otitis media to name but a few.

Rich in tradition of being at the forefront of the specialty and its subspecialty fields, this issue will surely be followed still by other issues but as this comes on the heels of its 55th founding anniversary, it allows the readers to peek at a window in time of its history with much of the work to be reflective of the passion for excellence and relevance that has marked the great history of the specialty of otolaryngology-head and neck surgery in our country. We pay tribute to former Vice Chancellor Joselito Jamir who was responsible for the first special issue in ORL published in 1990, Chairman of the department Dr. Alfredo Pontejos, Jr. for his guidance and leadership in producing the second special and this issue. Last but not least while we dedicate this to Dr. Tierry Garcia and celebrate his life dedicated to the betterment of ORL care in this country, we are cognizant that this humble offering only mirrors our great respect for this person whose example we find well to emulate in our daily practice. Our thanks also go to Acta’s Editor-in-Chief Dr. Jose Ma. Avila for his support and Dr. Ryner Carillo who mainly steered to reality this special issue you now have in your hands.
 

Charlotte M. Chiong, MD, PhD
55th Anniversary Organizing Chair
President, Philippine Society of ORL-HNS, 2016

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From Shadows into Light: Formulating a Researchable Question

The Chinese proverb “It is far better to light the candle than to curse the darkness,”1 first used in English by the Wesleyan minister William Lonsdale Watkinson, aptly describes the attempt by many investigators to frame a research question. Dimly flickering in the dark, it casts more shadows than light. One need not look far for examples; such weak questions engender multiple general and specific objectives that muddle more than clarify issues. A research question is not necessarily researchable. A researchable question is “an uncertainty about a problem that can be challenged, examined and analyzed to provide useful information.”2

While “an optimal research question sets out what the investigator wants to know,” and “not what the investigator might do, nor what the results of the study might ultimately contribute,”3 what a researcher wants to know must be clear and focused. Igniting a torch – in Filipino, kahit “sindihan muli natin ang sulo ng karunungan”4 – or turning on an incandescent light bulb will not elucidate the study problem any better. The diffuse light, though brighter, shines in all directions and casts myriad shadows as well. A cross-sectional survey of 258 articles found that 65% of research questions were not formulated as to “what knowledge was being sought,” and 30% “required reworking.”3 Moreover, “the designs which most often had poorly formulated research questions were randomized trials, cross-sectional and measurement studies.”3

A well-formulated, researchable question is more like a beam of light, or better yet, a laser beam that focuses sharply on one point with hardly any shadow. It needs extreme specificity and preciseness that guides the formulation of the methodology, keeping in mind the study variables and participants or subjects being studied. The PICOT approach “may be helpful in defining and clearly stating the research question.”5 Elements of this approach are the population, patient, participants, phenomenon or problem; an intervention or exposure, treatment or test; a comparator, control or context; the outcomes and a time frame. While this approach may facilitate quantifying the relationship between, or simply describing variables, such variables must be operationally defined.

A researchable question should also be subjected to FINER6 criteria, and be feasible, interesting, novel, ethical and relevant. Feasibility entails sufficient resources, an appropriate study design, manageable scope and adequate sample size. The question should be interesting for the researchers and their future reviewers and readers. Novelty requires that new knowledge will be generated, or that previous knowledge will be extended or built on. Ethical guidelines include obtaining institutional review board approval, conforming to the Declaration of Helsinki7 and (where applicable) health research registration. Finally, it must be relevant and translatable to clinical practice and policy as well as further research.

Such researchable questions are not that easy to develop. Participation in research seminars and workshops do not guarantee the ability to produce such questions. A review of educational “interventions to increase the quality of questions … produced mixed results” and “the sustainability of effects from educational interventions for question formulation are unknown.”8 Moreover, research advisers and mentors may themselves be unable (or may not know how) to formulate appropriate questions. Compounding the problem, dated research protocol and final paper requirements and policies subvert appropriate question formulation instead of empowering the generation of researchable questions (and consequently, quality papers). In this regard, why persist in requiring traditional thesis or dissertation formats for research protocols instead of adopting journal publication-ready formats?

The faculty are “responsible for the research mentoring and leadership training of our students to ensure that graduate and undergraduate education in UP, in addition to foundational and general education, and rote and iterative learning, is infused with a strong orientation towards research, innovation, creativity and problem-solving.”9 Let us begin by formulating focused researchable questions and emerge from shadows into the light.
 

José Florencio F. Lapeña, Jr., MA, MD
Professor of Otorhinolaryngology and University Scientist III
University of the Philippines Manila

References

  1. Watkinson WL. The Invincible Strategy. In: Watkinson WL. The Supreme Conquest: And Other Sermons Preached in America. Michigan: Robert Culley; 1907. pp. 206-218.
  2. Wood MJ, Ross-Kerr JC. Basic steps in planning nursing research: From question to proposal. 7th ed. Sudbury, MA: Jones and Bartlett Publishers; 2006.
  3. Mayo NE, Asano M, Barbic SP. When is a research question not a research question? J Rehabil Med. 2013 Jun; 45(6):513-8. PMID: 23571720 DOI: 10.2340/16501977-1150.
  4. Anonymous. “Dakilang Hamon” In: “Pambansa, Siyentipiko at Makamasang Kultura (Nationalist, Scientific and Mass-Oriented Culture): Koleksyon ng rebolusyonaryo at progresibong sining at panitikan” [cited 2016 Nov]. Available from http://rebolusyongpangkultura.blogspot.com/2016/03/dakilang-hamon.html#h....
  5. Thabane L, Thomas T, Ye C, Paul J. Posing the research question: not so simple. Can J Anaesth. 2009 Jan; 56(1):71-9. PMID: 19247780 DOI: 10.1007/s12630-008-9007-4.
  6. Cummings SR, Browner WS, Hulley SB. Conceiving the research question. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, editors. Designing clinical research. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2007. pp. 17-26.
  7. World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27; 310(20):2191-4. PMID: 24141714 DOI: 10.1001/jama.2013.281053.
  8. Horsley T, O’Neill J, McGowan J, Perrier L, Kane G, Campbell C. Interventions to improve question formulation in professional practice and self-directed learning. Cochrane Database Syst Rev. 2010 May12; (5):CD007335. PMID: 20464753 DOI: 10.1002/14651858.CD007335.pub2.
  9. Concepcion GP. Introduction. In: Almoro PF, Dimalanta CB, Morta AR, editors. Towards Excellence in Science Research: A UP Research Guidebook Version 1.2. Diliman, Quezon City: Office of the Vice President for Academic Affairs; 2016. p. 7.