Section 2b. Logically communicating your ideas in your manuscript: titles and abstracts

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1 Section 2b Logically communicating your ideas in your manuscript: titles and abstracts

2 Customer Service Marketing your work Title and abstract Your title & abstract summarize your study Relevance of your aims Importance of your results Validity of your conclusions First impression of paper: clear/concise/convincing It sells your work: Readers judge your style & credibility Often first/only part that is read by readers & reviewers

3 Customer Service Marketing your work Your title Important points Only the main idea Accurate, simple Population/model Include keywords Fewer than 20 words Hanging title: method/study type Avoid Unneeded words ( A study of ) Complex or sensational words Complex word order Abbreviations New or novel

4 Customer Service Marketing your work Your title Interrogative Question form Assertive/ Declarative* Key finding Indicative/ Descriptive* Key topic/aim * + Method (subtitle) Can ischemic preconditioning improve prognosis after coronary artery bypass surgery? Ischemic preconditioning improves prognosis after coronary artery bypass / Improved prognosis after coronary artery bypass by ischemic preconditioning Prognostic effects of ischemic preconditioning in coronary artery bypass patients Xxxxxxx: randomized controlled trial

5 Customer Service Marketing your work Structured abstract Context Background, problem, aim Methods Results Conclusion Patients/materials/animals Treatments, measurements Outcomes, effects, properties, statistics Relevance, implications Learning points, future No references, unusual abbreviations, figures/tables Clinical: funding & trial registration number after abstract

6 Customer Service Marketing your work Structured abstract Background EASY-Care Two step Older people Screening (EASY-Care TOS) is a stepped approach to identify frail older people at risk for negative health outcomes in primary care, and makes use of General Practitioners (GPs) readily-available information. We aimed to determine the predictive value of EASY-Care TOS for negative health outcomes within the year from assessment. Methods A total of 587 patients of four GP practices in and around Nijmegen (The Netherlands) consented to participate in a longitudinal primary care registry based cohort study Results Follow up information was available for 520 of 587 participants. In the non-frail group 9% showed any negative health outcomes (death, ADL decline, institutionalisation, too ill to undergo assessment), against 30 % in the frail group (95 % confidence interval of the difference (CI): 14 % 28 %). Area under the receiver operating curve (AUC) of the EASY-Care TOS frailty judgement for a composite of negative health outcomes mentioned was 0.67 (95 % CI: ). Conclusions GPs applying the EASY-Care TOS procedure, where they only perform additional assessment when they judge this as necessary, can predict negative health outcomes in their older populations efficiently and almost as accurately as a complete specialist CGA. Modified from: Van Kempen et al. BMC Medicine. 2015;13:287.

7 Customer Service Marketing your work Unstructured abstract Numerous systemic treatment options exist for patients with mycosis fungoides (MF) and Sézary syndrome (SS); however, the comparative efficacy of these treatments is unclear. We performed a retrospective analysis of our cutaneous lymphoma database to evaluate the treatment efficacy of 198 MF/SS patients undergoing systemic therapies. The primary end point was time to next treatment (TTNT). Patients with advanced-stage disease made up 53%. The median follow-up time from diagnosis for all alive patients was 4.9 years (range ), with a median survival of 11.4 years. Patients received a median of 3 lines of therapy (range 1 13), resulting in 709 treatment episodes. Twentyeight treatment modalities were analyzed. We found that the median TTNT for single- or multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] ), with few durable remissions. α-interferon gave a median TTNT of 8.7 months (95% CI ), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI ). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < and P =.01, respectively). In conclusion, this study confirms that all chemotherapy regimens assessed have very modest efficacy; we recommend their use be restricted until other options are exhausted. Modified from: Cannegieter et al. Blood. 2015; 125:

8 Customer Service Marketing your work Unstructured abstract Why did you do the study? Numerous systemic treatment options exist for patients with mycosis fungoides (MF) and Sézary syndrome (SS); however, the comparative efficacy of these treatments is unclear. We performed a retrospective analysis of our cutaneous lymphoma database to evaluate the treatment efficacy of 198 MF/SS patients undergoing systemic therapies. The primary end point was time to next treatment (TTNT). Patients with advanced-stage What did you do? disease made up 53%. The median follow-up time from diagnosis for all alive patients was 4.9 years (range ), with a median survival of 11.4 years. Patients received a median of 3 lines of therapy (range 1 13), resulting in 709 treatment episodes. Twentyeight treatment modalities were analyzed. We found that the median TTNT for singleor multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] ), with few durable remissions. What α-interferon did you find? gave a median TTNT of 8.7 months (95% CI ), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI ). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < and P =.01, respectively). In conclusion, this study confirms that all chemotherapy regimens assessed have very modest efficacy; we recommend How their does use be restricted your study until other contribute options are exhausted. to your field? Modified from: Cannegieter et al. Blood. 2015; 125:

9 Customer Service Marketing your work Keywords Search Engine Optimization Identify 7 8 keywords (try to use standard terms*) Use 2 in your title, 5 6 in the keyword list Use 3 keywords 3 4 times in your abstract Use keywords in headings when appropriate Be consistent throughout your paper; include synonyms Cite this work later; cite your previous publications when relevant *Or standard terms from PsycINFO, BIOSIS, ChemWeb, ERIC Thesaurus, INSPEC, GeoRef, MeSH etc

10 Customer Service Marketing your work Keywords Examples Predictive validity of a two-step tool to map frailty in primary care Frailty assessment, Primary health care, General practice, Available information, Predictive value Successful external validation of a model to predict other cause mortality in localized prostate cancer Life expectancy, Clinical decision support, Prediction, Radical prostatectomy Source: BMC Medicine

11 Activity 2 Please see Activity 2 in your workbook

12 Section 3 Avoiding common mistakes in clinical manuscripts

13 Modern scientific writing Keep it simple! Use short sentences words; one idea per sentence Prefer simpler/shorter words Use active voice Simpler, more direct, and easier to read Most writing style guides and journals prefer it Nature journals prefer authors to write in the active voice

14 Keep it simple 1 Avoid Adequate Apparent Ascertain Commence Endeavor Magnitude* Retain Subsequent to Sufficient Terminate* Utilization Prefer Enough Clear Determine Begin Attempt, Try Size Keep After Enough End Use *OK in certain fields (magnitude of earthquakes, to terminate gene expression)

15 Keep it simple 2 Delete extra words! It is well known that most Most of the trial participants... As a matter of fact, such a an This adverse adverse drug drug reaction A number of studies have shown that the The new regimen... That is another thus another reason reason why, why we believe Therefore, we believe...as described previously in our previous in our study. previous study....at a flow rate of 1.0 ml/min.

16 Keep it simple 3 Avoid At a concentration of 2 g/l At a temperature of 37 C In order to In the first place Four in number Green color Subsequent to Prior to Future plans; past history Extremely unique At the present time Prefer At 2 g/l At 37 C To First Four Green After Before s; history Unique Now

17 Improving readability 1 Which sentence suggests that you will get funding? 1. You deserve the funding, but the study design is not perfect. 2. The study design is not perfect, but you deserve the funding.

18 Improving readability 1 Readers focus at the end of the sentence for what is important. Information in this stress position can also introduce the topic of the next sentence (useful for explanations and processes). Stress position The study design is not perfect, but you deserve the funding. The grant will be awarded in two stages. Topic position

19 Improving readability 1 sentence idea idea idea idea Topic link The local government has been striving to introduce Information and Communication Technology (ICT) in education. In medical education, technology was introduced through the ICT-Connect-TED project. The program aimed at improving the quality of lecturers through the use of ICT. ICT-Connect-TED recently provided computers and a networking infrastructure to all medical colleges. Adapted from: Kafyulilo et al. Educ Inf Technol. 5 May 2015; DOI /s

20 Improving readability 1 Topic sentence Almost all participants indicated a high level of satisfaction with the content, sequence and relevance of the ICT professional development program they attended. Only a few lecturers reported that the duration of the professional development program was too short. However, the majority of the lecturers reported that they developed an understanding of what TPACK is, and the way technology can enhance teaching and learning of difficult medical concepts Supporting through sentences the collaborative design of technologyenhanced clinic sessions in teams. I developed an understanding of how TPACK can be applied in the design and teaching of a technology-enhanced lesson said one of the preservice lecturers. A lecturer from College C said if it was not the professional development he attended, he would not know how to use technology in teaching. Topic sentence Stress sentence The pre-service lecturers had the opportunity to further develop learning about technology integration in teaching after the professional development program had finished. They were invited to use their TPACK knowledge in workshops organized by the Ministry of Education and Vocational Training Adapted from: Kafyulilo et al. Educ Inf Technol. 5 May 2015; DOI /s

21 Improving readability 2 Information in the topic position can introduce the topic of the next sentence (useful for definitions, descriptions, and narratives). idea idea idea idea Topic link Lecturers were positive about the effectiveness of technology in teaching. They reported the effectiveness of technology on students learning, and on simplifying their teaching process. Most of the lecturers reported to be comfortable and satisfied with the outcomes of the technology-integrated lessons they had developed and taught during the professional development program. One of the lecturers from College A said, Adapted from: Kafyulilo et al. Educ Inf Technol. 5 May 2015; DOI /s

22 Improving readability 3 Information in the stress position can introduce the topic of the next few sentences (useful for lists and describing whole/parts). idea idea idea idea Topic link Findings in this study are presented in four sections. The first section presents the continuation of technology use in teaching. The second section presents the factors affecting the continuation of use of technology in teaching among lecturers who participated in the study. The third section presents the college management view on the impact of the professional development program and the institutional challenges on using technology in teaching. Finally, the enabling and hindering factors affecting the continuation of technology are summarized. Adapted from: Kafyulilo et al. Educ Inf Technol. 5 May 2015; DOI /s

23 Improving readability 4 Sequential Causal Adversative Conditional Logical connectors Until, After, Before, While, Since, When, Then, Next, First/Second/Third, Finally, Because (of), To (+verb), Owing to, So that, Therefore, Thus, Hence, Consequently, Although, Even though, Whereas, However, In contrast, Despite (+noun or verb -ing), If, Even if, Unless, Whether (or not), Except, Provided that, Until, Without, Otherwise,

24 Avoid mistakes Don t hide verbs inside nouns! Estimate Decide Assess Estimation Decision Assessment We made a/an We conducted a/an Extra verb We decided Clear, short, and direct

25 Avoid mistakes Compared with is for saying how things are different The toxicity of the new scaffold was reduced compared to the previous scaffold. The toxicity of the new scaffold was reduced compared with that of the previous scaffold. The toxicity of the new scaffold was lower than that of the previous scaffold.

26 Common mistakes in the Introduction Ideas are not logically organized Why study needs to be done? Important topics in the Introduction are not mentioned again in the Results/Discussion Keep focused Important topics in the Results/Discussion are not mentioned in the Introduction Write last Cited studies are not up-to-date Cited studies are geographically biased <5 years International

27 Common mistakes in the Methods Transparency in study design Sample size not large enough (no power calculation, 1-b) Consult a statistician Patient enrollment, exclusion, & randomization unclear Use flowchart Interventions and assessments not clearly described Reproducibility Unclear how missing data (lost to follow-up) were handled Imputation methods Ethical approval and informed consent not clear Always required

28 Common mistakes in the Methods Wrong statistical tests Distribution of data affects analysis and presentation Parametric tests (e.g., t-test and ANOVA) can be used only with continuous & normally distributed data with a large enough sample size Use the mean ± SD only for normally distributed data Simple guide: If SD is mean, most likely not normally distributed If SD is > 0.5 mean, may not be normally distributed Use Shapiro-Wilk s W test for normality

29 Common mistakes in the Methods 2 categorical endpoints Paired (within sample) McNemar s test Unpaired (between sample) Fisher s exact test 2 treatment groups Chi-square test* >2 treatment groups *for sample sizes > 60 du Prel et al. Dtsch Arztebl Int 2010; 107:

30 Common mistakes in the Methods Continuous endpoints Parametric Nonparametric Paired Unpaired Paired Unpaired 2 groups: Paired t test >2 groups: Repeatedmeasures ANOVA 2 groups: Unpaired t test >2 groups: ANOVA (F test) 2 groups: Wilcoxon signedrank test >2 groups: Friedman one-way ANOVA 2 groups: Mann Whitney U test (Wilcoxon rank-sum test ) >2 groups: Kruskal Wallis test Lang and Secic 1997; 71.

31 Common mistakes in the Results Statistical significance does not equal clinical significance! When possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty (such as confidence intervals). Avoid relying solely on statistical hypothesis testing, such as P values, which fail to convey important information about effect size and precision of estimates.

32 Common mistakes in the Results Statistical significance does not equal clinical significance! Drug A significantly reduced LDL cholesterol by 28% (p<0.05). Therefore, Drug A is effective in reducing cholesterol levels How much is 28%? Is this clinically relevant? How does this effect generalize to the population? What is the 95% CI?

33 Common mistakes in the Results Drug A significantly reduced LDL cholesterol levels from 4.7±0.3 mmol/l to 3.4±0.6 mmol/l (p=0.02, 95% CI: ). Because a minimal reduction of 1.4 mmol/l is required to be clinically effective, the efficacy of Drug A is still unclear. Use absolute values State exact P-value State 95% CI and minimal clinically relevant difference

34 Common mistakes in the Discussion Do not restate your results We showed that tumor volumes in Groups A, B, and C were 34.6, 74.2, and 53.9 mm 3, respectively, after a 4-month drug treatment, reflecting only a 8.6% decrease. However, after a 12-month drug treatment, the tumor volumes in Groups A, B, and C were 16.3, 18.7, and 16.9 mm 3, respectively, which reflects a 45.2% decrease (p<0.05). The results demonstrate that 12 months of treatment is necessary for Drug X to effectively reduce tumor size among the three groups. The results presented in this study demonstrate that Drug X more effectively reduces tumor size after 12 months of treatment (45.2% reduction) than it does after 4 months (8.6% reduction).

35 Common mistakes in the Discussion Do not overgeneralize your findings Result: Drug A reduced breast cancer cell growth in vitro In this study, we demonstrated that Drug A effectively reduced tumor growth. Therefore, this drug should have therapeutic applications in breast cancer treatment. In this study, we demonstrated that Drug A effectively reduced the growth of various breast cancer cell lines. Our findings suggest that this drug may have therapeutic applications in breast cancer treatment.

36 Common complaints Statistics Don t misuse statistical words! Patient parameters improved significantly; it is significant that X was correlated with Y The risk* of developing X in this case-control study Patient variables improved considerably/markedly; it is important that X was associated with/related to/linked to Y The odds of developing X in this case-control study * OK in a retrospective study if disease is rare and causality is assumed; risk=x/total, odds=x/(total x)

37 Activity 3 Homework Please see Activity 3 in your workbook

38 Be an effective communicator Your goal is not only to be published, but also to be widely read and highly cited Preparing well S Logically communicating your ideas in your manuscript Avoiding common mistakes

39 Any questions? Thank you! Julian Tang: Trevor Lane: edanzediting.co.jp/gunma1603 Download and further Follow us on Twitter facebook.com/edanzediting Like us on Facebook