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Sandeep B Bavdekar

Workshop at Institute of Research in Reproduction, IRR 11th August 2010

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Research advancement Knowledge building Experience sharing Thought stimulation Career advancement Appreciation by colleagues Enhances curriculum vitae Financial benefit

All the thinking, all the textual analysis, all the experiments and data gathering aren’t upto anything until we write them up. In the world of scholarship, we are what we write.
Donald Kennedy, 1997

What do I have to say? Is it worth saying? What is the right format for the message?

Who is the message for?

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Case Reports Letter to Editor Research articles/ Original articles Editorial Review articles Commentary Viewpoint

What is it? A scientific communication providing information to the medical world about a rare or unreported feature, condition, complication, association or treatment

The best teaching of Medicine is that taught by the patient himself William Osler

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A simple form of medical communication In vogue for a long time A form of descriptive study


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A form of publication and study not dependent on large resources or research infrastructure Can be interesting, accessible and readily digestible for readers Convey the ‘art’ of medicine Not all research questions are amenable to RCT An expedient way of communicating new ideas, syndromes, treatments and adverse reactions

Example

Underlying Mechanism

Hepatocellular adenoma Exposure to high-dose oral in young women contraceptives Blindness in newborn infants Kaposi’s sarcoma in young men Angiosarcoma of the liver in employees High ambient oxygen concentrations in incubators Infection with HIV-1 Industrial exposure to vinyl chloride

Cataracts, heart defects Maternal Infection with and deafness in rubella during pregnancy neonates

Why did you start, What did you do, What answer did you get, and What does it mean anyway? This seems to me to be a logical order for a scientific paper.
Austin Bradford Hill, 1965

I Introduction MMethods R Results And D Discussion

Introduction: Why did you start? Methods: What did you do? Results: What did you get? And Discussion: What does it mean anyway?

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Dos Describe current state of knowledge Enlist gaps in knowledge Provide enough information for the reader to judge the need to conduct the study [Provide rationale] State the aim

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Dos Describe current state of knowledge Enlist gaps in knowledge Provide enough information for the reader to judge the need to conduct the study [Provide rationale] State the aim

Don’ts History starting from ‘Adams’ Details of previous studies Provide conclusions

It should be brief and arresting

Chronic low back pain (CLBP) is an important health issue. It is the chief complaint amongst 12% patients visiting general practitioners1 and in 6% patients referred to Pain Clinics.2 Although several medications have been shown to be efficacious, there is no unanimity amongst experts regarding the standard treatment to be instituted.3 As the information regarding effectiveness, usually effective dose and safety profile of drug ‘m’ in Indian population is limited; we conducted a study to elucidate these issues.

Three Questions: What has been done? What did you look for? How was it done?

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Dos Study design: prospective/ retrospective Setting Who is the study about: Participants and controls, how selected; inclusion and exclusion criteria What did you do?: Intervention, follow-up What did you look for?: Outcome measure, how was the effect assessed Statistical methods and Ethical considerations

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Dos Study design: prospective/ retrospective Setting Who is the study about: Participants and controls, how selected; inclusion and exclusion criteria, recruitment strategies What did you do?: Intervention, follow-up What did you look for?: Outcome measure, how was the effect assessed Statistical methods Ethical considerations

Don’ts

Providing observations!

Provide enough details for other informed investigators to reproduce the study!

Dos

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How many were screened/ found eligible for participation/ consented to participate? How many completed the study? Reasons for lack of completeness Compliance with therapy or protocol What did you find?

Dos

Don’ts
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How many were screened/ found eligible for participation/ consented to participate? How many completed the study? Reasons for lack of completeness Compliance with therapy or protocol What did you find?

Introduce new parameters Interpretation of results Provide references Using adjectives (most, some, many, often..) Repeating data in text and tables Not accounting for all subjects/ Errors in data Mixing up data, erroneous data

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CONSORT: RCTs (Lancet 2001; 357:1191-4) QUOROM: Meta-analysis (Lancet 1999; 354:1896-1900.) STARD initiative: Diagnostic tests (BMJ 2003; 320:41-4) Economic evaluations (BMJ 1996; 313: 275-83)

Virtues:  Organization of data  Good for showing specific results  Not good for showing trends  Not for quick communication of ideas  Tables should not be too large. If there are many columns or rows, try dividing them into multiple tables  Avoid repetition of data in text and tables  Use only as many tables as are needed to tell the story

A figure is worth a million words An attribute that is very useful while dealing with “word count” Figures catch the Readers’ eye

Type of graph used: Dependent on type of data  Line diagram: Usually event in relation to time  Bar diagram: Comparisons  Pie charts: Parts of a whole  Histogram: Frequency distribution  Scatter diagram: Associations between variables

Useful for RCT Can also be used for describing other studies

Summary of key findings: (primary outcome measures, secondary outcome measures, results as they relate to a prior hypothesis) Why is this study special?

Provide previously published evidence, for and against Discuss differences in findings and probable reasons for the same

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Discuss strengths and limitations of the study (study question, study design, data collection, analysis and interpretation) Relevance to practice Interpretation and implications in the context of the totality of evidence What this study adds to the available evidence, effects on patient care and health policy, possible mechanisms

State controversies raised by this study and new questions it poses Provide directions for future research

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Reiterating selected results Emphasizing strengths, not weaknesses Inflating the importance and generalizability of findings Going beyond the evidence and drawing unjustified conclusions

First thing a reader sees Should know what the study is about Should interest the reader Should make the reader curious Concise, descriptive, not declarative

The sequence of the human genome Initial sequencing and analysis of the human genome

Indicative (states what the paper covers, not what it says) Informative (good to start writing with)

Effect of asthma on linear growth in children Does asthma reduce linear growth? Linear growth deficit in asthmatic children

A succinct, accurate, summary of the paper Purpose Helps the reader:  To know what to expect in the Report  To decide what details to look for

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Follow IMRaD pattern, 150-250 words No information that is not included in the main body of the paper Do not copy sentences from the main body Include actual data on primary outcome measures Include the main statistical conclusions It is a good idea to write a structured Abstract

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The foundation on which your work is built Provides scientific background that justifies the research undertaken and methods used Provide the context in which your research should be interpreted

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The foundation on which your work is built Provides scientific background that justifies the research undertaken and methods used Provide the context in which your research should be interpreted References should not be collected, as an afterthought, when the research ends Literature search and reading relevant references: starting point


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Allows the reader to locate the source material Accurate, current and complete Too many or too few references Reference section (Journal article, books, website)

Citations in Introduction: Background information, explain why research was undertaken Citations in Material and Methods: Support methods and procedures used Citations in Discussion: Interpret and explain your results, defend hypothesis

Harvard References are  Cited in the text by giving author’s name and year of publication in brackets  Author, reader and researcher-friendly  Provides researcher’s world view and his/ her evolution of thoughts

Vancouver References are  numbered consecutively as they appear in the text  Identified by a number in the text  Librarian friendly. Author just a number in the text and list of references  Ease in indexing

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Follow Instructions/ Guidelines: Format, Number Cite the most valid, most important and most recent literature Cite studies that have been rigorous and provide high quality evidence Prefer citing references that give facts, not opinions Check original paper Avoid: Non-peer reviewed articles and personal communications

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Style: Choice does not rest with you Accuracy of references: Your responsibility Inaccurate references: Reviewers tend to be more critical

Patel K, Kedia M, Gogtay NJ, Mehta SS, Kshirsagar NA. Evaluation and economic burden of adverse events presenting to the Emergency medical services in a tertiary referral centre. Drug Safety 2005; 34: 15-19

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Give it sufficient time Put it away Give it to your enemy/ real friend for review Revise, revise and re-revise

The notion that a scientific paper should be written in a special language is nonsense. It should be written in good, plain English. People don’t ambulate and take oral fluids, they walk and drink. John Ellard

If the science is bad, no amount of writing skills will make it publishable. If the science is good, editors will help you dress it up. Rajendra Kale, Editor- Editorials, BMJ
JPGM Goldcon, September 2004