Publishing and Presenting Clinical Research 2012 Warren Browner, MD, MPH warren@cpmcri.org

Publishing and Presenting Clinical Research 2012

Warren Browner, MD, MPH

warren@cpmcri.org

Today's agenda

Talks and slides

Posters

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Making Slides

A few easy lessons

Do’s and don’ts

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PowerPoint Rules

Keep the distractions to a minimum– Fonts, animation, graphics, colors (4-5)

Remember the color-blind

Minimum font size (this is 28)– This is 24

This is 20– This is 18

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Use Explanatory (Results) Titles

Life is Tough

Life is Really Tough for Fellows

Life is Even Tougher for Junior Faculty

Life is Piece of Cake for Senior Faculty

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A Few Points about Figures

Avoid baked goods

Make the message clear

Don’t “distort”

Easy colors

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Causes of neuropathy in 112 primary care patients

Pies = good in bakeries7

Annual risk of hepatoma by age and alcohol consumption.

3D = hard to read

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Hepatoma risk increase with age and alcohol use

A better version

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Mortality by age and sex

Makes modeled results look too real

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Mortality modeled as a function of age and sex

Legend informs the reader11

MediCal is Increasing with Time

12 Warning: Red/green confusion

MediCal is Increasing with Time

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What Do You See?

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More Rules

Maximum of 4-5 colors

Don’t forget the color-blind (cross-hatch)

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Clues that Something is Wrong

It takes you > 10 minutes to make a slide

You have 20 minutes to talk and 40 slides– One slide per minute

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What This Slide Says

I don’t have a point to make I do have too much time my hands I learned how to use animation You're going to have to sit through it

Now what was I trying to say?

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Practicing the Talk

First aim for overall message and time

Then seek input about the slides– Fix slides as you do so

Then seek suggestions about the talk– Get “style” comments in private

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Always

Spell check (F7)

Then print slides (hand-out) and proof-read

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The PowerPoint Show

F5 = start; ESC = end; “X” enter = slide “X”

During the show – B = blackout; W = whiteout– Next = Spacebar, right or up arrow, N, enter, or

left click– Previous = Backspace, down or left arrow, or P

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The Talk Itself

Arrive early Meet the chairs Position friends in the front of the audience Bring a glass of water Don’t get spontaneous until you get good Chuck the laser pointer

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Don’t Read Your Slides

Reading slides is boring and turns people off Most will realize they don't have to pay

attention to what the speaker is saying, and they will stop doing so

People can also read faster than someone can speak (can’t you?)

But don’t ignore what you’ve written

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Responding to Questions

ESL: “Thanks for your attention. I will try to respond to your questions, but English is not my first language. Please speak slowly and simply.”

All: “I'm sorry; I don't understand your question. Perhaps we can discuss this after the session.”

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Responding to Nasty Questioners

Multi-part questions:– Answer what you want to– Then say “What was the other question?”

Hostile or argumentative:– “Perhaps we can discuss this later. Next

question?”

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Posters

Almost always contain WAY too much data and too little information– The abstract is not needed unless mandatory

Put the key stuff at eye level in big fonts or simple tables and figures

Use a (good) template

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Posters, Panel by Panel

Introduction and background Subjects and methods (2-4) Results (3-5)

– With explanatory titles

Limitations Conclusions and implications

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Poster Fonts

Title = 85 point Your name = 56 point Sub-headers = 36 point Text = 24 point Legends, tables = 18 point

Use upper and lower case; left-justified

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Prettifying: Fonts

Two per document or presentation– Serifs (doohickeys) for text– Sans serif for tables, figures, legends, headers

Garamond, Times New Roman, Book Antiqua, Bookman

Arial Narrow, Arial, Tahoma, Trebuchet MS, Verdana

Courier lines up verticallyOne line is under another

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What To Do at a Poster Session

As a presenter: It’s your party!– Meet your neighbors– Invite (famous) strangers– Greet your guests– Offer them a drink– Hang in there

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What To Do at a Poster Session

As a visitor– Spend 5 min. identifying which homes to visit– Don’t look and then decide the party is boring

“I’m a vegetarian”

– Introduce yourself to the host

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That’s all folks…

Questions?

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ConclusionsThe majority of men on active surveillance will be free of treatment at five years. Grade progression is relatively common. Of those who undergo radical prostatectomy, a minority will have adverse pathology. However, early biochemical recurrence free survival appears excellent.

Outcomes of Active Surveillance for Early Stage Prostate Cancer

BackgroundGiven concern about prostate cancer over diagnosis due to the use of PSA – based screening practices, there has been a renewed interest in active surveillance in lieu of immediate treatment. The safety and efficacy of such an approach requires validation.

PurposeThe aim of this study was to describe the results of an ongoing prospective cohort of men with early stage prostate cancer who chose active surveillance as their initial management strategy.

Results (cont)

Jared M Whitson , Sima P Porten, Janet E Cowan, and Peter R Carroll

MethodsThis is a prospective cohort study at a single academic institution of men with prostate cancer who chose active surveillance as their initial management strategy. Men were excluded if they had not yet reached 6 months follow-up after diagnostic biopsy.

Results (cont)

Results

Methods (cont.)Data from the entire cohort are presented and additionally from just those men who underwent radical prostatectomy. The primary outcome in this subset was biochemical recurrence free survival which was defined as PSA < 0.2ng/ml and no second treatment.

Low Leptin is Associated with Increased Mortality and Cardiovascular Events Low Leptin is Associated with Increased Mortality and Cardiovascular Events in Patients with Stable Coronary Artery Disease:in Patients with Stable Coronary Artery Disease:

The Heart and Soul StudyThe Heart and Soul StudyIvy Ku MD, Ramin Farzaneh-Far MD, Beeya Na MPH, Mary Whooley MD

University of California, San Francisco; and San Francisco VA Medical Center

BackgroundBackground

Research QuestionResearch Question

MethodMethodss

ConclusionsConclusions

• Leptin is an adipokine with both protective and harmful effects on the cardiovascular (CV) system

• Studies of association between leptin levels and CV outcomes have yielded conflicting results

Design:Design:Prospective cohort study

Subjects:Subjects: 981 outpatients with stable coronary disease recruited from 12 clinics in the San Francisco Bay Area between 9/00 and 12/02

Predictor:Predictor:Baseline Baseline serum serum leptin levelsleptin levels

Outcomes:Outcomes: Death, myocardial infarction, stroke, adjudicated by review of medical records during 6.3 years of follow-up

PotentialPotentialConfounders: Confounders:

Sex, body Sex, body mass index mass index (BMI), co-(BMI), co-morbidities, morbidities, physical physical activity, activity, smoking, smoking, insulin insulin resistance, resistance, HDL, C-HDL, C-reactive reactive proteinprotein

Potential Potential Interaction:Interaction:

Sex, BMI, Sex, BMI, diabetesdiabetes

Analysis:Analysis: Cox proportional hazards models, adjusted for potential confounders associated with leptin (p < 0.1)

Baseline characteristics of 981 participantsBaseline characteristics of 981 participants Kaplan Meier event-free survival curveKaplan Meier event-free survival curve

LimitationsLimitations

Covariates in model

Hazard Ratio (95% CI)

Low versus High Leptin

P value

Adjusted for age, sex, race

1.30 (1.05 – 1.59) 0.01

Add body mass index

1.26 (0.99 – 1.60) 0.06

Add medical history

1.36 (1.05 – 1.76) 0.02

Add biomarkers 1.40 (1.09 – 1.81) 0.009

• 6397 person-years of follow up, 314 deaths, 118 myocardial infarctions, 56 strokes.

• Low leptin associated with 40% increased rate of CV outcomes (HR 1.40, CI 1.09 – 1.81, p = 0.009)

• Low leptin associated with 37% increased mortality (HR 1.37, CI 1.03 – 1.81, p = 0.03)

• Association between leptin and mortality strongest among patients in lowest BMI tertile (IQR 22 – 25 kg/m2)

ResultsResults

Leptin and mortality stratified by Leptin and mortality stratified by BMIBMI

Association between leptin and combined CV Association between leptin and combined CV outcomesoutcomes

Per SD decrease in log-leptin*

Hazard Ratio (95% CI)

P value

BMI tertile I(IQR 22 – 25)

1.70 (1.30 – 2.24)

< 0.001

BMI tertile II(IQR 27 – 29)

0.91 (0.66 – 1.26)

0.57

BMI tertile III(IQR 31 – 36)

1.07 (0.79 – 1.46)

0.66

• Are leptin levels associated with adverse outcomes in coronary artery disease?

High High leptinleptin

Low Low leptinleptin

Log-rank test p = Log-rank test p = 0.010.01

• Most participants urban men, results may not generalize

• All subjects had stable CAD, leptin effects may differ in healthy and post-MI patients

• Only used baseline leptin levels, does not capture effect of fluctuating levels over time

*(p = 0.01 for leptin*BMI interaction)

• Low leptin predicts subequent CV events and mortality in stable CAD

• This association is independent of known factors affecting leptin, including gender and obesity

• Whether leptin has direct effects on CAD, or functions as a marker of other protective pathways, deserves further study

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