Writing a scholarly paper
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Giuseppe Biondi-Zoccai, MDSapienza University of Rome, Latina, Italy
[email protected]@gmail.com
Writing a scholarly paper
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Learning milestones• Introduction• Writing the Title and the Abstract• Bibliographic search and writing the
Introduction• Writing the Methods• Writing the Results• Writing the Discussion• Writing Tables and preparing Figures• Principles of peer-review
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Why should you write a scholarly paper?
CLINICIAN
RESEARCHER
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Introductory remarks
• Clinical writing is just like PCI: nobody is accomplished at the beginning, but all remarkably improve with practice
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Remember Grossman’s words
I have not found…writing one bit easier
today than it was 30 years ago. I still
have to work at it very hard and make
many revisions, with a rare exception…
because the saying of Francis Bacon
has always been deeply impressed in
my mind..”Writing [maketh an] exact
man.”
Morton Grossman
(>400 scientific papers, 134 editorials,
and 71 books or book chapters)
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Paraphrasing Groucho…
The more you write, the better writer
you will become…
…and if I can write in ENGLISH,
most of you can!
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Who gets the credit?
In science, the credit goes
to the man who convinces
the world, not to the man
to whom the idea first
occurs.
─ Sir Francis Darwin
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Gestational period for a clinical trial paper
START
STUDIES/EXPERIMENTS
WRITE ANDSUBMIT
REWRITE ANDRESUBMIT
WAIT
PUBLISHED!
4-24 months
2-4 months
2-4 months
2-4 months
2-4 months
14-44 Months!
PROTOCOL/IRB 2-4 months
BEST GUESS
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Time to publication
More realistic time from submission to
publication projections in the WWW era:
• Letters to the Editor 4-12
weeks• Editorials 3-6 months• Reviews 6-12
months• Case reports 6-12
months• Non-RCT clinical studies 6-18
months• RCTs 6-18 months• Ground-breaking RCTs <6 months
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Choosing a manuscript type
Manuscript type Effort Reward
Abstract for scientific meeting ± ±
Letter to the Editor ± ±
Editorial + +
Book chapter + +
Qualitative review + +
Systematic review ++ ++
Case reports or Images ± ±
Case series + +
Non-RCT study ++ ++
RCT +++ +++
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1. Title
2. Abstract
3. Introduction
4. Methods
5. Results
6. Conclusion
7. Discussion
Flowchart for paper drafting
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Read a lot…
First tip to effective writing
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What is the message
you want to sell?
Second tip to effective writing
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Who is the audience?
Third tip to effective writing
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No matter what, keep
clear writing!
Fourth tip to effective writing
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Do not mistake the tree
for the forest!!!
Fifth tip to effective writing
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Introduction (± Aim)
Methods
Results
And
Discussion
IMRAD algorithm
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Expanded IMRAD algorithmIntroduction Background
Limitations of current evidenceStudy hypothesis
Methods DesignPatientsProceduresFollow-upEnd-pointsAdditional analysesStatistical analysis
Results Baseline and procedural dataEarly outcomesMid-to-long term outcomesAdditional analyses
Discussion Summary of study findingsCurrent research contextImplications of the present studyAvenues for further researchLimitations of the present studyConclusions
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CONSORT guidelines for RCT
Moher et al, JAMA 2001
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Never throw away a good sentence, but never keep a bad one!
“There is no good writing…
only good re-writing”
Rationale: We are better at editing than writing
Methods of conserving sentences:–Write about the same thing–Use similar methods–Dictation
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Title
The title is like the eyes
They may mislead, but they are decisive in making the choice for having a glance at the article
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Abstract
Introduction (± Aim) 2-3 phrases
Methods 2-3 phrases
Results 3-5 phrases
(And)
Conclusions 1-3 phrases
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Abstract The more structured, the better
SORT OUT II, JAMA 2008
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Abstract The less structured, the worse
ENDEAVOR II, Circulation 2006
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• Known
• Unknown
• Question
• Experimental approach
Remember the KUQE approach!
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What to choose for a bibliographic search?
Simple and easy-going
or …
fast but tough?
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• Population: who are the relevant patients?
• Intervention or exposure: what are the management
strategies we want to appraise or the relevant harmful exposure
we want to study?
• Outcome: what are the patient-relevant consequences of
the exposure in which we are interested?
1st step: framing the question
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• Therapy: determining the effect of different treatments on improving
patient function and avoiding adverse events
• Harm: ascertaining the effects of potentially harmful agents on patient
function, morbidity, and mortality
• Diagnosis: establishing the power of an intervention to differentiate
between those with and those without a target condition or disease
• Prognosis: estimating the future course of a patient’s disease
2nd step: determining question type
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Google Scholar • Google Scholar is provided for free by Google
• It contains citations and direct links to abstracts or full text
articles
• In addition, it enables citation analysis, thus forward and
backward snowballing
• It’s not yet very structered, and highly relevant citations
might not be included or missed because buried among
thousands of non-relevant ones
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• PubMed is the web (and free) version of MEDLINE
(provided by the US National Library of Medicine)
• It contains data on articles printed every day in several
thousands medical journals around the world, even if there
is some bias toward US and English-language publications
• It is reasonably comprehensive and sophisticated,
especially for the expert user
• Nonetheless, many papers can still be missed by the
MEDLINE indexers, and using PubMed requires some
expertise
PubMed
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What question (problem) was studied and
what is your underlying hypothesis?
The answer is in the Introduction.
Introduction
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1. Keep problems open and undecided
2. Use the present tense for what is currently true
3. Use the past tense for previous findings
4. Use past tense to state the question
5. Avoid using names of other investigators
(unless you really want to review your paper)
6. Repeat key terms from the title
Introduction
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Materials and methods
How was the problem studied?
The answer is in the Methods
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• Describe with full details what was done to answer the research question
• In the beginning include a clear statement of study design:“The study was a double-blind, randomized, parallel design … designed to compare the efficacy and safety of …”
• Include also a sentence about IRB approval, informed consent, or compliance with animal welfare regulations:“The protocol was approved by the institutional review board, and all patients gave informed consent …”
Materials and methods
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• State the protocol/procedures. Repeat the
question and the aims:“We tested the efficacy of drug XX administered orally in a dose of XX
mg, given XX times daily for up to XX months.”
“There were 2 primary endpoints. The first was event-free survival at XX
days, with an event defined as…”
• Describe materials/methods or subjects
adequately• Write in a logical order (usually chronological) • Describe analytical methods
Materials and methods
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• Use subheadings (design, patients,
procedures, follow-up, endpoints….)
• Do not include results in Methods
• Include appropriate figures and tables if
useful to graphically explain concepts
• Write in past tense
• Use active voice whenever possible
• Cite references for published methods
• Describe new methods fully
Materials and methods
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• Explain how you handled and reported categorical
and continuous variables
• Explain how you tested for significance at both
univariate and multivariate analysis
• Define tails and threshold p value
• State width of confidence intervals
• Provide sample size computation
• Spell out which software package was used
Quote extensively and be ready to defend
yourself if you use sophisticated analytic tools
Statistics subsection
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What were the findings?
The answer is in the Results.
Results
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1. Logically answer the research question
2. Focus on primary endpoint and on additional
data correlated to it
3. Correlate with the methods
4. Use data from this study only
5. Present all the representative data (with exact P
values and confidence intervals)
6. Use tables, graphs, photographs, and drawings
Results
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What do these findings mean?
The answer is in the Discussion.
Discussion
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Discussion vs Results
Remember:
Results and Discussion sections
should appear as written by
two different people!
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Structuring the Discussion
The usual structure of the Discussion is:
1. Brief summary of the study findings (no need for
heading)
2. Current research context (use as heading)
3. Implications of the present study (use as heading)
4. Avenues for further research (use as heading)
5. Limitations of the present study (use as heading)
6. Conclusions (may use as heading)
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Tables · Tables are useful, especially to clarify important
points for the busy reader
· Try to lump similar data together
· Do not replicate in the text but a few numbers that
you have reported in the Tables
· May be subdivided in: - Baseline (or Patient) characteristics
- Lesion and procedural characteristics
- Outcomes
- Additional (eg multivariable) analyses
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Figures
· Figures are also useful, especially to clarify important
points for the busy reader
· In many cases the figures help you document that
what you say you did is true (eg angiograms,
microscopy, etc.)
· Remember that they should be professionally
prepared
· Bear in mind that color figures may be expensive!
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Once the paper is submitted…
• Editorial process:– the paper is registered– The paper is read by an editor who decides if
it deserves peer-review– If yes, it is sent to referees (peer-reviewers)– Decision-making (the editor decides, not the
referees)– Decision: acceptance, rejection, de novo
submission, major revisions, minor revisions
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Once the paper is submitted…• Acceptance:
PARTY!!
• Rejection: We need to send our paper to another journal…
• De novo submission: The paper needs extensive revisionsThe editor thinks it can be published but usually at least 1 reviewer has been very negative over the paperUsually at the second submission the reviewers are different from the first submission (in particular the negative reviewers are excluded from a second review by the editor)
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Once the paper is submitted…
• Major revisions: The consensus of the editor and the reviewers is that the paper can be published pending modifications and changes in the paper according to the points and issues raised by the reviewersThese issues may affect the overall structure of the paper, potentially changing some of the messages presentedThe paper can still be rejected at second revision…
• Minor revisions: The paper can be published after minor corrections, usually and mainly related to English spelling or minor editing issues present along the text
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• Principles of peer-review– Confidential
The author does not know who the reviewers are but the reviewers know who the author is…Double blind (or fully open) peer review implemented in some journals…
– Providing guidance to editors The peer-reviewers do not reject, they only advice…The editor rejects
– Constructive commentsThe aim of the peer review is to improve the manuscript
– Can be challengedPeer-reviewers are not always right…
Peer-review process
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Peer-review process
• General guidance for reviewers:– Is the subject of the paper important?– Does the paper add enough to existing
knowledge?– Does the paper read well and make sense?
The goal of peer-review is to give comments and references to help:
- editors taking a right decision
- authors improving their paper
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Peer-review process
• For research papers:
– Originality:Does this work add enough to what is already published?If so, what is it?
– Importance to readers:Does the paper matter to clinicians, patients, teachers, policymakers? Is this journal the right place?
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Peer-review process
• For research papers:
– Scientific reliabilityResearch question (clearly defined and answered?)
Overall design of the study (adequate?)
Participants studied (adequately described?)
Methods (adequately described? ethical?)
Results (answer to the research question? credible?)
Interpretation and conclusions (warranted by the data?)
References (up to date and relevant?)
Abstract (reflects accurately what the paper says?)
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Rebuttal letter
• Reply point-by-point (help the reviewer, rewriting his/her comments first)
• Always consider that the reviewers are experts in the field, consider seriously their comments
• If their comment is adequate, modify your paper accordingly
• If you think you are right and the point of the reviewer incorrect, state politely, but firmly your reasons
• Quote references if needed
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Rebuttal letter
• You can use figures, graphs, tables (that will not be published afterwards) to reinforce your thesis
• Highlight in the modified manuscript all the changes you made (and repeat them also in the rebuttal letter)
• While there is a word limit for a paper to be published (usually around 5000 words), there is no limit for the rebuttal letter… use this space to support your theories!
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Don’t ever despair, but learn to enjoy the road…
Abbate et al, Circ 2004;110:46-50 Number of citations 81
Abbate et al, Am J Cardiol 2010;105:1371-7 Number of citations 100
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Take home messages
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Take home messages• Medical writing requires focus on the
message you want to deliver, the audience and the venue or instrument.
• There is no good writing but only rewriting.
• Only by always (but constructively) criticizing yourself you can navigate successfully the process of medical writing, peer-reviewing, and scholarly publication.
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Many thanks for your attention!
For any query:[email protected]
For these and other slides:http://www.metcardio.org/slides.html