160326 Edanz Gunma

Julian Tang, PhD Trevor Lane, PhD

Author Success Workshop:

Effectively Communicate Your Research 1

Gunma University

26 March 2016

Skills needed on the path to publication success

Preparation

Journal Selection

Writing

Submission

Peer Review

Publication Success

• Training in reading papers, ethics, writing, presenting

• Expert Scientific Review

• Expert Scientific Review

• Journal Selection & submission strategy

• Training in ethics, writing, presenting

• Revising • Editing • Reformatting

• Training in ethics, writing

• Editing • Abstract

Development • Cover Letter

Development • Reviewer

Recommendation

• Training in navigating peer review

• Review Editing • Point-by-point

checking • Response

Letter Development

• Reformatting

• Press release, news writing

• Media & presentation training

• Training for early career researchers

• Training in writing grant proposals

• Grant proposal editing

S

Be an effective communicator

Your goal is not only to be published, but also to be widely read and highly cited

Preparing well

Logically communicating your ideas in your manuscript

Avoiding common mistakes

Section 1

Prepare well: clinical research design & ethics

Coverage and Staffing Plan Prepare well

Increase impact

High quality research

Logical, engaging, useful message for

readers

Original and novel research

Well-designed, well-reported,

transparent study News value, importance, timeliness

What editors want

High scientific & technical quality, appropriate & clear methods,

sound research & publication ethics

High readability & interest; clear, real-

world relevance

Impact factor (past 2 years) = No. of citations / No. of articles


Know your impact and study design

Systematic

reviews of RCTs

Randomized controlled

trials (RCTs)

(Non-randomized) Controlled

studies/trials

Observational studies (cohort, case-control,

surveys/audits/interviews, diagnostics)

Hypothesis

testing

{ Descriptive/

Qualitative/

Hypothesis

generating

Methodological {

{

Secondary

research

Primary

research

{ } Experimental (exposure assigned)*

}

} Non-

experimental

*

Register clinical trials in advance!

Case studies, case series, technical notes,

computer models (in silico), animals (in vivo), in vitro


Know your impact and study design

+/– Exposure

Controlled trial (treatment) or

prospective cohort study (risk factor)

? Exposure Case-control study

(retrospective study)

Disease ?

+/– Disease

+/– Exposure Retrospective

parallel cohort study Disease ?

Coverage and Staffing Plan Prepare well Use reporting guidelines

PRISMA Systematic reviews & Meta-analyses

STROBE Observational studies

CARE Case reports

CONSORT Randomized controlled trials

ARRIVE Animal studies

http://www.equator-network.org/

QOREC Qualitative studies

Coverage and Staffing Plan Prepare well Use reporting guidelines

CONSORT

http://www.equator-network.org/


Where to start?

Your findings form the basis of your manuscript

First organize your findings

Logic, then English language

Figure 1

Figure 2

Table 1

Figure 3

Logical flow • Chronology • Most to least

important • General to

specific • Whole+parts

Is anything missing?

? Additional analyses?

Your illustrations guide your story

Coverage and Staffing Plan Prepare well Prepare an outline

I. Introduction A. General background B. Related studies C. Problems in the field D. Aims

II. Methods A. Subjects/Samples/Materials B. General methods C. Specific methods D. Statistical analyses

III. Results A. Key points about Figure 1 B. Key points about Table 1 C. Key points about Figure 2 D. Key points about Figure 3 E. Key points about Figure 4

IV. Discussion A. Major conclusion B. Key findings that support conclusion C. Relevance to published studies D. Limitations E. Unexpected results F. Implications G. Future directions

Write key ideas in bullet points, as IMRaD (=Introduction, Methods, Results and Discussion)

No need for full sentences Use reporting guidelines Draft title/abstract; draft article by

IMRaD section; get feedback Revise content/logic before language Get help: presubmission peer review

& editing by a native English speaker

When using information from other articles:

Paraphrase with citations!


Submissions

Plagiarism

Data manipulation

Authorship

Submit to only one journal at a time; do not republish the same paper; no salami

Paraphrase and cite all sources

Do not fabricate or falsify data Do not manipulate parts of images

Study design or data acquisition/analysis; Writing/revising; Approval; Accountability*

Publication ethics

Conflicts of interest

Disclose funding and any financial/personal relationships that could bias the work

Safety Ethics approval; animal & environmental

safety; humans: signed consent, data privacy

* http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html


Fabrication, Falsification & Plagiarism

Sun S, Zhang G, Wu Z, Shi W, Yang B, Li Y (2014) MicroRNA-302a Functions as a Putative Tumor Suppressor in Colon Cancer by Targeting Akt. PLoS ONE 9(12): e115980. doi:10.1371/journal.pone.0115980 Published: December 26, 2014

Zhang G-M, Bao C-Y, Wan F-N, Cao D-L, Qin X-J, Zhang H-L, et al. (2015) MicroRNA-302a Suppresses Tumor Cell Proliferation by Inhibiting AKT in Prostate Cancer. PLoS ONE 10(4): e0124410. doi:10.1371/journal.pone.0124410 Published: April 29, 2015


Singapore Statement on Research Integrity 2nd World Conference on Research Integrity, 21-24 July 2010

Principles of research integrity

• Honesty in all aspects of research • Accountability in the conduct of research • Professional courtesy and fairness in working with

others • Good stewardship of research on behalf of others

http://www.singaporestatement.org/downloads/singpore%20statement_A4size.pdf

Coverage and Staffing Plan Prepare well Studies with participants

Human studies need:

• Approval from ethics board (institutional review board, IRB)

• For studies with prospective assignment: trial registration before enrollment

• Informed consent for enrollment • Informed consent for publication

Safety, transparency & publishing conflicting data

clinicaltrials.gov; who.int/ictrp/network/en; controlled-trials.com; umin.ac.jp/ctr

Coverage and Staffing Plan Prepare well Studies with participants

Participants need to be informed of:

• Study objectives (and freedom to leave) • Potential benefits or risks involved • Confidentiality

This is usually written informed consent

Human safety/benefit, not exploitation Nuremberg Code 1947, Declaration of Helsinki 1964

Templates: http://www.who.int/rpc/research_ethics/informed_consent/en/


Science is “self-correcting”…

Responsible conduct of research

• Helps society/humanity • Objective search for Truth • Tests hypotheses; adjusts theories • Relies on transparency & reproducibility • Responsible use of resources • Based on trust and honor code • Based on publishing in peer-reviewed journals:

Correction notices made public and linked


Flawed/fraudulent articles are retracted, with permanently linked public Retraction notices

Guidelines of the Committee on Publication Ethics, COPE Good Publication Practice 3, GPP3 International Committee of Medical Journal Editors , ICMJE) Responsible Research Publication: International Standards for

Authors*

Always follow ethics guidelines

Consequences of unethical behavior

• Unable to publish • Rejection/retraction • Public notices • Repay grants • Loss of employment

*http://publicationethics.org/files/International%20standards_authors_for%20website_11_Nov_2011.pdf


How does your study contribute to your field?

What did you find?

What did you do?

Why did you do the study?

Introduction

Methods

Results

Discussion

Transparency & complete reporting

Participants/materials, appropriate techniques, appropriate analyses (full protocol online?)

Including unexpected/negative results; data records & accessibility!

Including similarities and differences, limitations

After doing a thorough literature review

Coverage and Staffing Plan Prepare well Share negative results

Negative results are useful?

Yes!

• Allows complete evaluation of your study

• Prevents others from repeating those experiments

• Allows others to modify those experiments

• Prevents funding agencies from wasting money

Supplementary info; Data repositories / Data journals

Pitfalls on the path to publication

Preparation

Journal Selection

Writing

Submission

Peer Review

Publication

• No ethics board approval

• Human trial unregistered

• No consent • Citation

stacking/cartels • Fabrication • Falsification

• Questionable journals

• Hijacked journals

• Questionable publishers

• Guest/gift/ ghost authorship

• Plagiarism • Undisclosed

conflicts of interest

• Undisclosed funding

• Non-transparent/ incomplete reporting

• Simultaneous/repeated submissions in same or other language

• Salami slicing • Presubmission

publication • Questionable

conferences • Publicizing too

early

• Self-review • Fake review • Peer review

rings • Editor/

reviewer conflicts of interest or plagiarism

• Publicizing too early

• Multiple publication in same or other language

• Exaggerating claims to public / funder

• Undisclosed conflicts of interest of post-publication reviewer


Makes readers think others’ words or ideas are your own

Copying published text even with a citation

Stating ideas of someone else without citing the source

Text plagiarism


Copying text that you have published before into your manuscript

Self-plagiarism

May violate copyright

Makes readers think you are presenting something new


Expressing published ideas using different words

Paraphrasing

Tips on paraphrasing:

• Write the text first in first language, and then later translate back into English

• Verbally explain ideas to a colleague • Always cite the source in your notes • Name and cite published methods

Coverage and Staffing Plan Prepare well Good paraphrasing

24. Li et al. PLoS ONE. 2013; 8: e68372.

“The magnitude of the change in carbon storage depends on how physical, chemical, or biological processes are altered over time under different land uses.”

The size of the carbon storage change depends on how physical, chemical, or biological processes are changed over time under different land uses.24

How differing land uses gradually affect biological, chemical, or physical processes determines how much carbon can be stored.24

• Nouns verbs • Prepositional phrases Adverbs • Passive Active voice

• Synonyms, word order

Coverage and Staffing Plan Prepare well Paraphrasing tips

Vary sentence structure to avoid patchwriting or listing

Change voice, rhythm, style

Separate/join sentences

Discourse markers Coincidentally; Also in agreement; Indeed

Join 2 sentences (semicolon, colon for a reason/list, or by subordination); alternate short/long sentences

Active to passive, or passive to active; negative to positive, or positive to negative;

invert word, phrase, or sentence order

Sentence logic Either/or; neither/nor; not only, but also

Introductory phrase According to X’s method,…; In X’s study,…; X

showed/reported…; When X…

Change word class An altered direction -> A directional change

Please see Activity 1 in your Workbook

Activity 1: Publication ethics

Section 2a


Manuscripts with impact The ‘write’ order

How does your study contribute to your field?

What did you find?

What did you do?


Title/Abstract

Introduction

Methods

Results

Discussion

Manuscripts with impact

Title/Abstract

Introduction

Methods

Results

Discussion

Title/Abstract

Methods

Results

Discussion

Introduction

Abstract /Title

write

The ‘write’ order

Manuscripts with impact Introduction


Current state of the field

Background information

Specific aim/approach Aim

Problem in the field

Previous studies

Current study

General

Specific Specific problem/solution;

importance/hypothesis

Worldwide relevance? Broad/specialized?

Recent, International references Not too many self-cites


“Health workforce shortages may be felt most keenly by developing nations, but are a concern for all. Developed nations are particularly worried about the number of general practitioners (GPs) available to service their ageing populations…”

BMC Family Practice: Worldwide relevance

Dwan et al. BMC Fam Prac. 2014; 15: 154.

International journal – Writing the Introduction

Effect of ageing populations on healthcare workforce


“All citizens in Japan are covered by a national health insurance system in which there are no official “gatekeepers”. Patients can freely choose between attending a local physician’s office (clinic) or a hospital and Japanese physicians can freely practice internal medicine. But recently, Japan has faced the problems of a rapidly aging population…”

Asia-Pacific Family Medicine: Regional focus

Tsukamoto et al. Asia Pac Fam Med. 2014; 13: 9.

Regional journal – Writing the Introduction

Effect of ageing populations on healthcare workforce


Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in the developed world, and atherosclerosis is the central underlying pathology. Atherogenesis is a life-long process involving a range of mechanisms including lipid peroxidation and inflammation affecting the vascular wall. The clinically most relevant results of this pathology are myocardial infarction and stroke. Evidence for acute cardiovascular effects of air pollution has substantially increased in recent years…

PLOS ONE: ‘atherosclerosis and pollution’

Künzli et al. PLoS ONE 2010; 5: e9096.

Broad-focused journal – Writing the Introduction

Broad background information Important for context


Atherosclerosis is an inflammatory disease that accounts for nearly 50% of deaths in western societies. Initiation of atherosclerotic plaque formation is a complex process. It involves secretion of chemokines such as the Monocyte Chemoattractant Protein–1 (MCP-1) and expression of adhesion molecules on the surface of monocytes and endothelial cells. Circulating monocytes are recruited to sites of injured endothelial cells, adhere to them, and migrate into the subendothelial space. Monocytes in the arterial wall differentiate into activated macrophages…

BMC Cardiovascular Disorders: ‘atherosclerosis and pollution’

Adar et al. BMC Cardiovas Disord. 2013; 10: e1001430..

Specialized journal – Writing the Introduction

Broad background information not necessary

Manuscripts with impact Problem/knowledge gap

However, …an alternative approach… …a challenge …a need for clarification… …a problem/weakness with… …has not been dealt with… …remains unstudied …requires clarification …is not sufficiently (+ adjective) …is ineffective/inaccurate/inadequate/inconclusive/incorrect ------------------------------------------------------------------------------------------ Few studies have… There is an urgent need to… There is growing concern that… Little evidence is available on… It is necessary to… Little work has been done on…

Key phrases

Manuscripts with impact Writing the Introduction

Currently, the standard procedure used to evaluate hepatic steatosis is the histopathological examination of cross-liver sections… …this is an invasive practice that presents inherent risks... Therefore, it is essential to establish new non-invasive approaches to accurately determine hepatic fat concentration…

Aims

The purpose of our prospective study…was to evaluate the potential of multi-echo MRI to quantitate the hepatic triglyceride concentration.

Problem

Jiménez-Agüero et al. BMC Med. 2014; 12:137.

The aims should directly address the problem


How the study was done

• Processes, treatments, measurements, follow-up

• Variables (direct/proxy) • Outcome/endpoints (1o, 2o)

• Conversions/calculations • Statistical tests (& P level) • Consult a statistician

Who/what was studied

• Participants, controls • Enrollment, N & “power” • Materials, databases

How the data were analyzed

What did you do?

Methods

Manuscripts with impact Methods

Established techniques

• Cite previously published studies • Briefly state modifications • Use flow chart/table* if needed

• Explain purposes; justify choices • Give enough detail for reproducibility • Use Supplementary Information

Organization • Arrange in (titled) subsections • Keep parallel to the display items • Use topic sentences

New techniques

*Summary of study settings, flow of participants, text selection, variables, chronology of analyses…

Manuscripts with impact Results

• Efficacy/safety • Group/subgroups • Uni-/bi-/multivariable

• Each (titled) subsection corresponds to one figure and method

• Describe factually what you found, not what it means

• Use Supplementary Information

• Data accessibility

Logical presentation

Subsections

Factual description

What did you find?


Drug A reduced tumor volume by 32.7%, increased blood pressure by 12.3%, and increased the patient’s weight by 7.3 kg. Drug B reduced tumor volume by 22.3%, increased blood pressure by 15.6%, and increased the patient’s weight by 2.4 kg. Drug C reduced tumor volume by 38.1%, increased blood pressure by 6.9%, and increased the patient’s weight by 9.2 kg.

Describe relationships among your results


Patients treated with Drug C showed the greatest reduction in tumor volume (38.1%) compared with those treated with Drug A (32.7%) or Drug B (22.3%). Drug C also had the lowest increase in blood pressure (6.9%) compared with that seen after treatment with Drug A (12.3%) or Drug B (15.65). However, patients treated with Drug C had the highest weight gain among the three groups (Drug A, 7.3 kg; Drug B, 2.4 kg; Drug C, 9.2 kg).

Describe relationships among your results

Manuscripts with impact Discussion

Summary of findings

Relevance

Conclusion

Similarities/differences Unexpected/negative results Limitations (validity, reliability)

Implications

Previous studies

Current study

Future studies

Specific

General

How do you advance your field?


During a period when ART was routinely available in England, persons diagnosed with HIV had a 4.8-fold increased risk of invasive meningococcal disease compared with individuals not known to be HIV infected. This increased risk was almost entirely in adults aged 16–64 years (23-fold increased risk) and was significant for Men C, W and Y, while MenB was only significant in those aged 16–24 years…. These findings are consistent with the most recent study from New York City…

[Conclusion section: This study provides evidence that HIV-positive children and adults are at increased risk of invasive meningococcal disease…]

State the main findings of the study

Short Discussion – Beginning

Modified from: Simmons et al. BMC Medicine 2015;13:297.


GPER is an E2 binding, G-protein coupled membrane receptor that was reported to be overexpressed in breast, endometrial, ovarian and thyroid cancers. However, it is currently unclear if different types of lung cancers including adenocarcinomas, squamous cell carcinoma and large cell carcinomas express higher GPER than normal lung tissue. Here, we demonstrate for the first time that GPER is overexpressed in lung tumors and lung adenocarcinoma cell lines relative to normal lung and immortalized normal lung cell lines, although the expression of GPER transcript in HPL1D cells is higher than HBECs.

Re-introduction

Answer the study question = main conclusion

Modified from: Rao Jala et al. BMC Cancer 2012; 12: 624.

State the conclusion of the study

Restate problem / study question

Long Discussion – Beginning


Important limitations of our study include an inadequate sample size and duration to detect differences in the incidence of diabetes complications, such as myocardial infarction, stroke, or death. The protocol specifies further follow-up at 5 years for all patients, which should allow additional assessment of even longer-term efficacy and safety. Despite these limitations, we conclude that bariatric surgery represents a potentially useful strategy for the management of type 2 diabetes, allowing many patients to reach and maintain therapeutic targets of glycemic control that otherwise would not be achievable with intensive medical therapy alone.

Identify limitations

Discussing limitations

Modified from: Schauer et al. New Engl J Med. 2014; 370: 2002–2013.

Address limitations

End positively: put the bad news first


Important limitations of our study include an inadequate sample size and duration to detect differences in the incidence of diabetes complications, such as myocardial infarction, stroke, or death. The protocol specifies further follow-up at 5 years for all patients, which should allow additional assessment of even longer-term efficacy and safety. Despite these limitations, we conclude that bariatric surgery represents a potentially useful strategy for the management of type 2 diabetes, allowing many patients to reach and maintain therapeutic targets of glycemic control that otherwise would not be achievable with intensive medical therapy alone.

Identify limitations

Modified from: Schauer et al. New Engl J Med. 2014; 370: 2002–2013.

Address limitations

End positively: Good news last & in long, main clause!

Discussing limitations

Manuscripts with impact Making claims

Chiswick Chap, https://commons.wikimedia.org/wiki/File:Toulmin_Argumentation_Example.gif, CC-BY-SA-3.0

Toulmin model of argumentation

Qualifier


Patients’ perspective of safety incidents showed both overlaps and additional aspects from outpatient care professionals’ opinions….Patients’ statements brought insight on…

Most of the included studies have been conducted in US-American outpatient care settings; thus, the transferability of results to other health care settings is limited…. Integrating patients’ perspective broadens the existing understanding of adverse events in outpatient care and should therefore be considered as a complimentary measuring tool….

Start of Discussion: summary of findings

Conclusions: main conclusion & implication

Modified from: Lang et al. BMC Family Practice 2016; 17: 6.

Match extent, confidence, precision

Limitations

Making claims

Data

Claims

Qualifier

Rebuttal

Warrant

Manuscripts with impact Discussion – End

In conclusion, we found an independent, graded association between lower levels of the estimated GFR and the risks of death, cardiovascular events, and hospitalization. These risks were evident at an estimated GFR of less than 60 ml per minute per 1.73 m2 and substantially increased with an estimated GFR of less than 45 ml per minute per 1.73 m2. Our findings support the validity of the National Kidney Foundation staging system for chronic kidney disease but suggest that the system could be further refined, since all persons with stage 3 chronic kidney disease (GFR, 30 to 59 ml per minute per 1.73 m2) may not be at equal risk for each outcome. Our findings highlight the clinical and public health importance of chronic kidney disease that does not necessitate dialysis.

Conclusion

Key result

Implications

Future directions

Importance

Go et al. N Engl J Med. 2004; 351: 1296–1305.

Why is your study important?

Manuscripts with impact Story line and consistency

General background

Aims

Methodology

Results and illustrations

Summary of key results

Conclusion & implications

Relevance of findings

Problem in the field

Current state of the field Introduction

Methods

Results

Discussion

Solution

Situation/Problem

Evaluation/Comment

Section 2b

Logically communicating your ideas in your manuscript:

titles and abstracts

Customer Service Marketing your work Title and abstract

First impression of paper: clear/concise/convincing

Importance of your results

Validity of your conclusions

Relevance of your aims

It sells your work: Readers judge your style & credibility

Often first/only part that is read by

readers & reviewers

Your title & abstract summarize your study

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”

Customer Service Marketing your work Your title

Interrogative Can ischemic preconditioning

improve prognosis after coronary artery bypass surgery?

Indicative/ Descriptive*

Prognostic effects of ischemic preconditioning in coronary artery

bypass patients

* + Method (subtitle)

Xxxxxxx: randomized controlled trial

Assertive/ Declarative*

Ischemic preconditioning improves prognosis after coronary artery

bypass / Improved prognosis after coronary artery bypass by ischemic

preconditioning

Question form

Key finding

Key topic/aim

Customer Service Marketing your work Structured abstract

Context Background, problem, aim

Results Outcomes, effects,

properties, statistics

Conclusion Relevance, implications Learning points, future

Methods Patients/materials/animals Treatments, measurements

No references, unusual abbreviations, figures/tables Clinical: funding & trial registration number after abstract

Customer Service Marketing your work Structured abstract

Modified from: Van Kempen et al. BMC Medicine. 2015;13:287.

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: 0.62-0.73)…. 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.

Customer Service Marketing your work Unstructured abstract

Modified from: Cannegieter et al. Blood. 2015; 125: 229‒235.

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 0.3‒39.6), 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. Twenty-eight treatment modalities were analyzed. We found that the median TTNT for single- or multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] 3.2‒5.1), with few durable remissions. α-interferon gave a median TTNT of 8.7 months (95% CI 6.0-18.0), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI 4.0‒6.1). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < .00001 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.

Customer Service Marketing your work

Modified from: Cannegieter et al. Blood. 2015; 125: 229‒235.

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 0.3‒39.6), 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. Twenty-eight treatment modalities were analyzed. We found that the median TTNT for single- or multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] 3.2‒5.1), with few durable remissions. α-interferon gave a median TTNT of 8.7 months (95% CI 6.0‒18.0), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI 4.0‒6.1). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < .00001 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. How does your study contribute to your field?

What did you find?

What did you do?


Unstructured abstract

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

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

Activity 2

Please see Activity 2 in your workbook

Section 3

Avoiding common mistakes in clinical manuscripts

Coverage and Staffing Plan Writing skills

Keep it simple!

Use short sentences 15–20 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”

www.nature.com/authors/author_resources/how_write.html

Modern scientific writing

Coverage and Staffing Plan Writing skills Keep it simple 1

Prefer Enough Clear Determine Begin Attempt, Try Size Keep After Enough End Use

Avoid Adequate Apparent Ascertain Commence Endeavor Magnitude* Retain Subsequent to Sufficient Terminate* Utilization *OK in certain fields (magnitude of earthquakes, to terminate gene expression)


“A number of studies have shown that the new regimen...”

“...as described in our previous study.”

“...at a flow rate of 1.0 mL/min.”

“As a matter of fact, such an adverse drug reaction…”

“That is another reason why, we believe…”

“It is well known that most of the trial participants...”

Keep it simple 2

Delete extra words!

“It is well known that Most of the trial participants...”

“As a matter of fact, such a This adverse drug reaction…”

“A number of studies have shown that The new regimen...”

“That is thus another reason why Therefore, we believe…”

“...as described previously in our previous study.”

“...at a flow rate of 1.0 mL/min.”


Avoid At a concentration of 2 g/L At a temperature of 37C 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 37C To First Four Green After Before Plans; history Unique Now

Keep it simple 3


1. You deserve the funding, but the study design is not perfect.

Which sentence suggests that you

will get funding?

2. The study design is not perfect, but you deserve the funding.

Improving readability 1


The study design is not perfect, but you deserve the

funding. The grant will be awarded in two stages.

Stress position

Topic position

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).



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.

idea idea idea idea

Topic link

sentence

Adapted from: Kafyulilo et al. Educ Inf Technol. 5 May 2015; DOI 10.1007/s10639-015-9398-0



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 through the collaborative design of technology-enhanced 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 pre-service 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.

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…

Topic sentence

Stress sentence Topic sentence

Supporting sentences




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,…

idea idea idea idea

Topic link


Information in the topic position can introduce the topic of the next sentence

(useful for definitions, descriptions, and narratives).



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.

idea idea idea idea

Topic link


Information in the stress position can introduce the topic of the next few sentences

(useful for lists and describing whole/parts).


Coverage and Staffing Plan Writing skills Improving readability 4

Logical connectors

Sequential

Causal

Adversative Although, Even though, Whereas, However, In contrast, Despite (+noun or verb -ing),…

Because (of), To (+verb), Owing to, So that, Therefore, Thus, Hence, Consequently,…

Until, After, Before, While, Since, When, Then, Next, First/Second/Third, Finally,…

Conditional If, Even if, Unless, Whether (or not), Except, Provided that, Until, Without, Otherwise,…


Estimate Estimation

Decide Decision

Assess Assessment

We made a/an… We conducted a/an… Extra verb

We decided… Clear, short, and direct

Avoid mistakes

Don’t hide verbs inside nouns!


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.

Avoid mistakes


Common mistakes in the Introduction

Ideas are not logically organized

Important topics in the Introduction are not mentioned again in the Results/Discussion

Important topics in the Results/Discussion are not mentioned in the Introduction

Cited studies are not up-to-date

Cited studies are geographically biased

Why study needs to be done?

Keep focused

Write last

<5 years

International


Transparency in study design

Sample size not large enough (no power calculation, 1-b)

Patient enrollment, exclusion, & randomization unclear

Interventions and assessments not clearly described

Unclear how missing data (lost to follow-up) were handled

Ethical approval and informed consent not clear

Consult a statistician

Use flowchart

Reproducibility

Imputation methods

Always required

Common mistakes in the Methods


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

Wrong statistical tests



2 categorical endpoints

Paired (within sample)

Unpaired (between sample)

McNemar’s test

Fisher’s exact test 2 treatment groups

*for sample sizes > 60

Chi-square test* >2 treatment groups

du Prel et al. Dtsch Arztebl Int 2010; 107: 343–8.



Continuous endpoints

Parametric Nonparametric

Paired Unpaired Paired Unpaired

2 groups: Paired t test

>2 groups: Repeated-

measures ANOVA

2 groups: Unpaired t test

>2 groups: ANOVA (F test)

2 groups: Wilcoxon signed-

rank 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.



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).”

http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html

“Avoid relying solely on statistical hypothesis testing, such as P values, which fail to convey important information about effect size and precision of estimates.”

Common mistakes in the Results


“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?

Statistical significance does not equal clinical significance!



“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: 0.8–1.8). 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



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 mm3, 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 mm3, 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).


Common mistakes in the Discussion

Do not overgeneralize your findings

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.

Result: Drug A reduced breast cancer cell growth in vitro


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…

Don’t misuse statistical words!

Common complaints – Statistics

* OK in a retrospective study if disease is rare and causality is assumed; risk=x/total, odds=x/(total–x)

Activity 3

Homework…Please see Activity 3 in your

workbook

S

Be an effective communicator

Your goal is not only to be published, but also to be widely read and highly cited

Preparing well


Avoiding common mistakes

Thank you!

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Julian Tang: [email protected] Trevor Lane: [email protected]