Deconstructing an Article

Today’s Class• Review RCT summary assignment• Deconstructing an article• This week’s homework

RCT Summary Titles Examples of What

Worked

• “Research Findings Favor Pre-birth Surgery for Myelomeningocele”

• “Treatment Option for Spina Bifida Presents Benefits, Risks”

RCT Summary Leads Examples of What

Worked• “A new study published in The New England Journal of Medicine may provide hope to pregnant women who are carrying a baby with spina bifida.”

• “The results of a study funded by the National Institutes of Health and reported in the New England Journal of Medicine showed that babies with the most serious type of spina bifida, myelomeningocele, could have fewer serious or lifelong problems when their spinal defects are repaired during, rather than after, pregnancy.”

• “Performing surgery in the womb can lower health risks in babies born with a form of spina bifida, according to a recent study.”

RCT Summary Closing Examples of What

Worked• “So, while this study presents prenatal surgery as an improved option for treating spina bifida, it must be approached with caution given the risks.”

• “You can learn more about spina bifida at March of Dimes, and at the Spina Bifida Association. You can learn more about this study at New England Journal of Medicine.”

RCT Summary - Learning Points

• Use percentages when comparing absolute rates across groups– At 12 months, 40% (vs. 31 of 78) of infants in the prenatal group needed a shunt, compared to 82% (vs. 66 of 80) in the postnatal group.

• Provide absolute event rates for risks, as well as benefits

• Look to simplify language– prenatal vs. before birth– postnatal vs. after birth

• Know that you can’t always fit everything in

Deconstructing an Article

• Begin effectively• Explain well• Provide orientation• Provide points of entry• Present numbers and sizes effectively• Build interest• End strongly• Provide access to further information

Begin Effectively• A good beginning, or lead, engages the audience and makes clear what the piece is about.– “Simple lessons for midwives and other birth attendants in how to help a newborn start breathing and how to keep it warm could save one million babies a year, according to a study published last week.”

Begin Effectively:About Leads

• A lead, or hook, lures readers, but must be related to the theme

• Direct leads should be one or two sentences and have a strong noun and compelling verb– “Americans ate X hamburgers last year.”

• Delayed lead length varies, but could be up to a few paragraphs– Usually followed by a “nut graph”

• “On a road to the beach…something caught my eye…fast food…”

• Details that back-up the lead are the heart of the story

Begin Effectively:Example Leads

“Up to a quarter of all women suffer from depression during pregnancy, and many are reluctant to take antidepressants. Now a new study suggests that acupuncture may provide some relief during pregnancy, even though it has not been found to be an effective treatment against depression in general.”

Begin Effectively:Example Leads

“Jonathan Nunez was 8 months old when a liver transplant saved his life. Three years later, his body rejected the transplant, attacking it so fiercely that it wasted away and vanished, leaving barely a trace.That result, seemingly a disaster, was exactly what his doctors had hoped for. They had deliberately withdrawn Jonathan’s antirejection medicine because he no longer needed the transplant. His own liver had, as planned, regenerated.”

Activity• Write two leads for your consumer article• Write two leads about the lymph node study

– Axillary lymph node dissection (ALND) has been standard of care.

– A randomized trial compared sentinel lymph node dissection (SLND) alone with SLND and ALND in women with breast cancer and SLN metastisis.

– Results of the trial showed that 5-year overall survival was similar between the two groups (91.8% vs. 92.5%).

– ALND can cause arm stiffness, pain, paresthesia, and lymphedema.

• Exchange with a partner for feedback

Lymph Node Leads

“Removing many lymph nodes may not be necessary in women with early breast cancer who also undergo a lumpectomy to remove the mass, followed by radiation.”– HealthDay News

Lymph Node Leads

“Women with early breast cancer and positive lymph nodes lived just as long whether they had sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND), results of a large randomized trial showed.”– MedPage Today

Lymph Node Leads“Among patients with early-stage breast cancer that had spread to a nearby lymph node and who received treatment that included lumpectomy and radiation therapy, women who just had the sentinel lymph node removed (the first lymph node to which cancer is likely to spread from the primary tumor) did not have worse survival than women who had more extensive axillary lymph node dissection (surgery to remove lymph nodes found in the armpit), according to a study in the February 9 issue of JAMA.”– Newswise

Lymph Node Leads

“A new study finds that women with early breast cancer do not need a painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit.”– New York Times

Lymph Node Leads“Some women with early breast cancers can safely opt for less surgery, greatly reducing the risk of painful long-term complications, according to a new study that’s already changing standard medical practice.”– USA TODAY

Lymph Node Leads

“Many women with early breast cancer do not appear to need removal of their lymph nodes, as is often recommended, according to a federally-funded study released Tuesday.”– The Washington Post

Explain Well• Present the concept before the term

– Ease understanding and help keep from intimidating readers• “bone-forming cells called osteoblasts”

• Remind the reader periodically of meanings of new terms

• Use analogies– “Cardiac catheter looks like a spring in a ball point pen.”

• Counter misconceptions with “transformative explanation”

Explain Well (continued)

• But not with these sensational, overused words– Breakthrough– Miracle– Cure– Promising– Dramatic– Victim– Hope

Provide Orientation• The lead or nut graf should provide initial orientation

• Use transitional words (“also,” “therefore,” “finally”)

• Use headings• Provide overviews before details

– “…this process has three steps. First…”)

Provide Points of Entry

• Headline or title• Headings• Lead• Quotations set apart• Editorial Filler

An Aside: Editorial Filler

• Examples include: quizzes, trivia, Q&A, sidebars

• Conveys info through a different format• Visual relief; adds white space• Provides another point of entry to an article

• Engages readers more directly

http://harpers.org/index/

Filler Functions• On-line quizzes - encourage interactivity and return visits

• Sidebars - summarize info and/or add overflow content

• Trivia - may provide a good lead, or add interest in the body of the story

• Q&A / Interviews - mimics conversation, may inject a more casual style

• Test questions - Learning device for CME, training manuals, textbooks, etc.

Filler Function - Quizzes

• A favorite device for certain types of articles/publications– Formats include:

•True/False•Multiple choice (one correct response)•Multiple response (pick all that apply)•Matching related items in two separate columns

Present Numbers Effectively

• Give a visual– “size of a football field”

• Use comparable forms– 3/4 vs 75%

• Use sparingly• Use comparisons to make numbers more meaningful

• HCV is four times as widespread as HIV• An inhaler is barely larger than a lipstick

Present Numbers Effectively (continued)

• Convert quantities to familiar units– kilograms to pounds– http://ts.nist.gov/WeightsAndMeasures/Metric/metrsty3.cfm

Build Interest

• Raise a question in one paragraph and answer it in the next

• Repeat word or phrase throughout

• Use parallel construction

End Strongly• The end is what readers remember most

• Use second best quote (a common ending that personalizes the story)

• Tie together various themes and people

• Reinforce take-home messages• Present sources for further information, if appropriate

Activity• Read “The Secret in the Marrow.”• In groups, identify and discuss five

techniques the author uses to make the writing clear and interesting.

• Discuss the strengths of the piece and anything you would do differently.

Homework• Writing assignment:

– Finish your 1000-word consumer article. TWO HARD COPIES, double-spaced, due in class next week.

• Reading assignment:– Statement of Principles of the Association of Health Care Journalists. Association of Health Care Journalists, 2009.

– Code of Ethics. Society of Professional Journalists, 1996.

– AMWA Code of Ethics. American Medical Writers Association, 2008.