Transcript Sample Talk

Association of Academic
Dermatologic Surgeons
Content Review date: August 27, 2012
Originally Submitted: September 15, 2007
How to Write a Paper
Timothy M. Johnson MD
Lewis and Lillian Becker Professor
University of Michigan
I have No COI-no relevant relationships with industry
How to Write a Paper ?
Disclaimer: My Perspective. Everyone is
different. These are just guidelines and pearls
that I have found useful.
How to Write a Paper
Why Write?
“Duty vs. Passion”
 To advance knowledge
 Improvement
in management of disease
 To advance your institution
 Academic
accomplishment, prestige, funding
 To advance yourself
 Enhances
clear thinking & scholarship ability
 Promotion, career development, reputation
Benefits often greater to author than reader
The Evidence Pyramid
Systematic Review
& Meta-Analysis
Randomized Controlled
Trial (RCT) Double Blind
RCT
Cohort studies
Case Control studies
Case Series
Case Reports
Ideas, Editorials, Expert Opinion
Animal research, Test tube
Stages in a Research Study
 Planning the study & writing the protocol
 IRB approval
 Funding/Infrastructure
 Executing the study & collecting the data
 Data analysis
 Writing
 Going through the editorial process
Writing a Paper: Getting Started
“The only way to learn to write is to write”
--Peggy Teeters
 No single best way
 Varies from paper to paper
 Background reading--Literature search!
 Identify mentors to understand what
constitutes good versus bad papers
 Decide on authorship
Writing a Paper: Getting Started
 IRB
 Find statistician BEFORE study
 Sample
size
 Power analysis
 Appropiate statistical tests
 Select journal-review guidelines
Writing a Paper
 Fix realistic schedule (Adherence)
 Write by a biological clock
 Need stretch of protected hours or days
 Ideas come while writing
 When time is short: prepare, revise
 Location
Boring
area, nothing to distract
 Maintain momentum
Academicians
rated by what they finish, not
by what they attempt
Parts
of a in
Manuscript--Structure
Write
What Order?
Title
Abstract
Introduction
Methods
Results
Discussion
References
“Writing is a lot easier if you have something to say”
--Sholem Asch
1
Methods I
WHAT DID YOU DO?
For informed readers this is the most important
section
 Past tense
 Precision-study design-like a recipe
 Explicit inclusion/exclusion criteria,
retrospective or prospective, etc.
 Detailed enough so results can be
repeated by others
1
Methods II
WHAT DID YOU DO?
 Ethical approval (IRB)
 Statistical methods
 Subheadings only if necessary-duplicate
in results
 Remember that you can put detailed
methods on the web-i.e., questionnaire
IRB !!
 Start by reading your local IRB website
http://www.med.umich.edu/irbmed/
 PEERRS certification: Program for Education and
Evaluation in Responsible Research and Scholarship
 Fulfills
the NIH requirement for human subjects
training for PIs and "key personnel”
 Trials MUST be enrolled for publication in
the best journals
 http://clincaltrials.gov
 http://prsinfo.clinicaltrials.gov
IRB !!
 Almost every study worth publishing
requires IRB approval
 Determination of exempt status is made
by the IRB
 Exemption
Categories
4. Research, involving the collection or study of
existing data, documents, records, pathological
specimens, or diagnostic specimens, if these
sources are publicly available or if the information
is recorded by the investigator in such a manner
that subjects cannot be identified, directly or
through identifiers linked to the subjects.
2
Results I
WHAT DID YOU FIND?
 Just the facts, in a logical sequence
 Past tense
 Importance of accuracy cannot be overstatedcheck, recheck data/numbers-must add up
 Give numbers and percentages: 1 (10%) of 10…
 P values and confidence intervals
 Avoid discussion of results in this section
2
Results II
WHAT DID YOU FIND?
 Tables & figures-straightforward, concise,
not duplicative, should stand alone
 Table(s) - short specific title at top of
page, footnotes
 Figure(s) - concise legends, QUALTY,
avoid distracters, anonymity
 You can put extra results on the web
Statistical vs. Clinical Significance
Is it real? vs. Is it important?
There are three
kinds of lies:
lies, damned lies, and
statistics.
In God we trust
All others must bring
data.
Mark Twain
3
Discussion I
WHAT DOES IT MEAN?
 Always focus on your results
 Outline 2 or 5 main points that come
from results
 Build a paragraph or two for each point
 Finally permitted latitude to elaborate
and speculate (some)
3
Discussion II
WHAT DOES IT MEAN?
 First answer the question posed in the
Introduction
 Summarize previous work-compare your
results
 Explain what is new without exaggerating,
perspectives, implications
 What do your results mean? - clinical
practice, management, policy
3
Discussion III
WHAT DOES IT MEAN?
 Strengths and weaknesses in relation to
other studies, particularly any differences
in results
 Usually avoid ending with a conclusionssummary section if redundant
 “further studies are required”- usually not
necessary and implies to some you need
to do before submitting
4
Introduction
WHAT IS THE QUESTION/OBJECTIVE?
 Short (3 paragraphs)-1 typewritten page
 First
paragraph
What we know?
Brief background-establish context, relevance,
nature of the problem/question/purpose
 Second
paragraph What we don’t know?
Importance of the problem and unresolved issues
 Last
paragraph Why we did the study?
Rationale: state hypothesis/main objective/purpose
Abstract
 Critical part of paper
 Determines if paper will be read
 Is distributed freely in databases
 Structured per format
 Avoid acronyms and abbreviations
 Write and rewrite until flawless
 Clear and concise - stand alone
References
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Errors reflect scholarship-check & recheck
Be selective-cite only those vital
Relevant and recent (or seminal)
Balance
Read the references
Do not misquote
Use correct style for journal
Title
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Determines how paper gets indexed
Often determines whether paper gets read
Should describe and identify subject matter
Avoid long title-impossible to comprehend
at a glance
 Avoid abbreviations
 Question: may be easier to understand,
more impact?
First Draft
What works for me?
 Write as quickly as possible
 Get everything down
 Ignore spelling, grammar, style
 Skip troublesome words
 Correct and rewrite only when the whole
text is on paper
 Do not split the manuscript among the
co-authors
Style and Authorship
 Follow ICMJE* criteria:
 Uniform
Requirements for Manuscripts
Submitted to Biomedical Journals
http://www.icmje.org/index.html#top
 Order:
 First
author-primarily responsible for collecting
& analyzing data, and writing
 Last author-usually an established
investigator, assumes overall responsibility
 Middle authors-list in order of contribution
* International Committee of Medical Journal Editors
Style
Accuracy, Clarity, Brevity
 Proper words in proper places make the true
definition of style. --Jonathan Swift
 Have something to say and say it as clearly as
you can… the essence of style. --Matthew Arnold
 If writing is unclear, meaning unintelligible
readers and reviewers won’t understand
 Use concrete over vague language
 Multiple mistakes in spelling and syntax,
suggests similar sloppiness in the project
 Check and double check data
Style
Accuracy, Clarity, Brevity
 Use active voice whenever possible
Active voice: the subject is performing the verb
Passive voice: the subject receives the action
expressed in the verb
 Avoid overusing there is, there are, it is, it was, etc.
Active: Scientists have conducted experiments to test the hypothesis
There are treatment guidelines for Merkel cell
Passive:
Experimentsthat
have were
been conducted
by scientists
to test the hypothesis
carcinoma
reported
by Bichakjian,
et al.
Passive
(more wordy) Active (more concise)
Correction: Treatment guidelines for Merkel cell
carcinoma were reported by Bichakjian, et al.
Style
Accuracy, Clarity, Brevity
 All first drafts have too many words
 Next drafts: prune vigorously, avoid repetition,
wordiness, long sentences, excessive
adverbs/adjectives
 Strip every sentence
 Writing improves in proportion to deletion of
unnecessary words
 When you have the choice of two words, use
the simpler one
 The most valuable of all talents is that of never
using two words when one will do. --Thomas Jefferson
Simplify
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a majority of = most
a considerable amount of = much
a number of = several/some
on account of = because
“Those who
referred to as = called
have the most
has the capacity to = can
to say usually
it is clear that = clearly
say it with the
at the present time = now
fewest words”
give rise to = cause
is defined as = is
subsequent to = after
Style
Accuracy, Clarity, Brevity
Abbreviations and Acronyms
 Liked by authors, disliked by readers
 Reading should not require a glossary
 Unwieldy word occurring > 10 times
 Avoid using colloquial language
Troublesome Terms
 And/or: and or or alone usually suffices
 Diabetic as a noun may be condescending
to some, patient with diabetes
 Significant means statistically significant
 “Firstness”-provide details if true, rarely
needed
Getting Help
 Get co-author and mentor help
 Experts are good
 Non-experts may also be good
 “I got lost here” is more important than
“oncololy is misspelled”
 Learn from editing changes
Revise, Revise and Revise
 You may not be a very good writer, but
be an excellent rewriter
 Always look from a distance--see your
paper as the reviewer will see it
 Polish the writing style
 Double check spelling, look for typos
 Double check references
 Every fat paper has a thin one trying to
get out
“Deadly Sins”
Publish and Perish
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Data manipulation, falsification
Duplicate manuscripts
Redundant publication
Plagiarism
Humans use concerns
Animal use concerns
Author conflicts of interest
Failure to discose conflict of interest
What is Redundant Publication?
Happens more commonly than expected
Data in conference abstract? No
Same data, different journal? Yes
Data on website? Maybe
Data included in review article? OK if later
Expansion of published data set? Probably
Redundant Publication
 Problem is not the publication but the lack
of disclosure--disclosure is key
 Always send copies of overlapping papers
and reference them
 Negative studies are often not published;
positive studies are more likely be
published more than once-creates BIAS
 Distorts what the evidence says
Submission
 Read “Instructions for Authors” thoroughly
 Conform to “Instructions” precisely
 Write cover letter (suggest reviewers)
 Know the journal, its editors, and why you
submitted the paper there
 Avoid careless mistakes
What Editors Like About Papers
 Originality
 Interesting to readers, important,
messages that matter
 Clear questions, correct methods
 Brevity, clear presentation (style)
 Good grammar and spelling
Editors and reviewers spend hours reading
manuscripts, and greatly appreciate receiving
papers that are easy to read and edit!
What Editors Dislike
 Very long papers (> 3,000 words)
 Second-rate Style
 Conclusions not justified by data,
sweeping conclusions
 Inability to follow “Instructions to Authors”
 Splitting versus lumping
What Happens Next?
The Review Process
 Acceptance
 Revision
 Rejection
If at first
you don’t
succeed,
you’re about
average!
The Post Review Phase-Revision
Listen to your reviewers
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Study reviews objectively and dispassionately
Read every criticism as something you could
explain more clearly
Resist temptation to respond “you brainless
person, I meant X”. Fix the paper so that X is
apparent even to the most brainless reader.
Be open to criticism - do not get defensive This is really, really hard, but it is really, really,
really, really important
Responding to Reviewers-Revision
 Carefully prepare your responses
point-by-point:
 Each
comment should be addressed
 Each change should be stated
 Make your changes obvious
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Reviewer may be wrong
Be tactful-next reviewer may be the same
Do not respond to reviewers while upset
Get help from co-authors
Rejection
-disappointing at best
A journey of a thousand miles sometimes
ends very, very badly
Why Papers are Rejected I
The best scientists get rejected and have
to make major revisions
 Number of journal pages available has
not kept pace with number of articles and
authors
 May be nothing basically wrong
 More
confirmatory than original
 Insufficient priority, backlog inventory
 Wrong journal
Why Papers are Rejected II
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Poorly written
Sweeping
conclusions-unjustified
data
Your manuscript
is both by
good
and original,
butnot
the
part that
Ethics
(IRB) approval
obtained
is good
is not
original,
and the
Flawed
or poor
study
design-methods
part
that issample(s)
original is not good.
Unrepresentative

--Samuel
Johnson
Uncontrolled, poor
controls,
nonrandomized interventions
 Sample size too small
 Incorrect statistical analysis
 Hypothesis not adequately tested

The Post Review Phase-Rejection
Honest criticism is hard to take, particularly from a
relative, a friend, an acquaintance, or a stranger.
--Franklin Jones
 Get over it
 Do not get defensive
 Study reviews as objectively & unemotionally
as possible-for resubmission to another journal
 Address all of the reviewers’ concerns
 Next reviewer may be the same
At least 50% of initially rejected articles are
eventually published somewhere else!
The Post Review Phase-Rejection
Appeal Option
 Do not call the editor---usually
 Willing to consider first appeals--but
must revise the paper, refute criticisms,
not just say the subject is important
 Few accepted on appeal
 No second appeals; ends in hostility or
tears; plenty of other journals
Become a Reviewer
Become a Better Writer
 Approach the editors and editorial staff
 The best reviewers are often the best
writers and vice versa
 Apply principles from today
Professor Trisha Greenhalgh:
"How to Read a Paper" Series--BMJ
Introduction to Evidence Based Medicine: Critical
Appraisal and Informed Medical practice
Introduction to Clinical Medicine - Professional Skills January 2005
http://www.health.library.mcgill.ca/ebm/greenhalgh.htm
Professor Trisha Greenhalgh (University College London)
"How to Read a Paper" Series
Getting your bearings (deciding what the paper is about). BMJ 1997;315:243-6.
Assessing the methodological quality of published papers. BMJ 1997;315:305-8.
Statistics for the non-statistician. II: "Significant" relations and their pitfalls. BMJ
1997; 315: 422-425.
Statistics for the non-statistician. I: Different types of data need different statistical
tests. BMJ 1997;315:364-6.
Papers that go beyond numbers (qualitative research). BMJ 1997;315:740-3.
Papers that summarise other papers (systematic reviews and meta-analyses). BMJ
1997;315:672-5.
Papers that tell you what things cost (economic analyses). BMJ. 1997;315:596-9.
Papers that report diagnostic or screening tests. BMJ 1997;315:540-3.
Papers that report drug trials. BMJ 1997;315:480-3.