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Corso di clinical writing
What to expect today?
Core modules
•
Introduction
•
Correction of abstracts submitted by participants
•
Practical session 2 – Abstract drafting
•
Results drafting
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Discussion drafting
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Tables and Figures drafting
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Peer review and publication
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Synthetic example – database creation, analysis and
Results drafting
Abstract
What makes a good abstract?
First you need to ask yourself
what an abstract is for!
Abstract
The abstract is like
the whole body
of a woman
It may mislead, but it
is decisive in making the
choice for reading the
full-text of the article
Abstract
A good abstract should:
1. State the principal objectives and scope
of the investigation
2. Describe the methods employed
3. Summarize the results
4. State the principal conclusions
Following the rules
Concise as possible, but brisk!
– Body length determined
• ~175 Words (shorter)
• ~300 Words (longer?)
– It may be difficult to comply, especially if very
structured (eg JAMA, Annals of Internal Medicine)
IMRAD algorithm
Introduction (± Aim)
2-3 phrases
Methods
2-3 phrases
Results
3-5 phrases
And
Conclusions
1-3 phrases
Details of hypothetical trial
Design: prospective
Population: patients with persistent or recurrent righ lower-quadrant pain
(>3 months), either continuous or with at least one attack in the month
before inclusion, excluding those with a history of chronic back pain,
previous abdominal surgery (with the exception of diagnostic
laparoscopy or a laparoscopic sterilization), specific gastrointestinal
disorders (such as inflammatory bowel disease) and gynecological
disease (all female patients had consulted a gynecologist)
Intervention: elective laparoscopic appendicectomy
Comparison: no surgery
Allocation: randomized
Setting: single center
Time: September 1994 to November 2004
Details of hypothetical trial
Primary outcomes: the primary outcome measure was pain scored by the
patient at 6 months after operation in the presence of the surgical
resident. At each follow-up appointment patients were instructed to
score pain on a three-point scale, comparing the current situation with
the degree of pain before surgery based on the patient's own original
pain dairy notes. Pain scores were: 1, pain unchanged (or even worse);
2, improvement with a remarkable reduction of pain, but not completely
pain free; and 3, completely pain free, no more right lower abdominal
complaints. After the 6-month pain assessment, the operation carried
out was revealed to the patient. Those who still experienced abdominal
complaints and had the appendix in situ were offered a second
laparoscopic procedure for intended appendicectomy
Details of hypothetical trial
Secondary outcomes: the secondary outcome investigated was the
relationship between clinical improvement and histopathological
findings of the removed appendices. A scoring system for the
histological investigation of the appendices was developed. Appendices
had either signs of acute (endo)appendicitis (infiltration of granulocytes
into the epithelial mucosal layer or deeper), or signs thought to be
compatible with chronic or recurrent appendicitis. The presence of
fecostasis or fecoliths was noted. Finally, based on the overall findings,
the pathologist scored the appendix as normal or having signs of
appendicopathy. Cases that showed inconsistencies between
pathology scoring and the final conclusion were re-evaluated by both
pathologists, and a consensus reached
Details of hypothetical trial
Results (1): Eighty-eight patients with chronic or recurrent right lowerquadrant pain of unknown origin were evaluated. Forty-six patients
were excluded. Remarkably, during the 3-month observation period
before inclusion in the trial, two potential candidates had surgery for
suspected acute appendicitis. Forty-two patients signed a consent form
but, during the diagnostic part of the laparoscopy, two were judged to
have convincing pathology explaining the chronic pain syndrome and
were not included in the trial. Of 40 patients finally randomized, 18
patients (14 female and four male), of median age 25 (range 17-40)
years, were allocated to appendicectomy. Twenty-two patients (19
female and three male) with a median age of 29 (range 15-45) years
were allocated to inspection without removal of the appendix.
Details of hypothetical trial
Results (2): Pain scores 6 months after operation showed that a
significantly higher proportion of patients in the appendicectomy group
than in the inspection-only group had an improvement in pain (14 of 18
versus seven of 22; P = 0.005). The relative risk was 2.4 (95 per cent
confidence interval 1.3 to 4.0, p<0.05), indicating that patients who had
an appendicectomy had a 2.4-fold greater chance of experiencing an
improvement in pain. The number needed to treat was 2.2 (95 per cent
confidence interval 1.5 to 6.5, p<0.05). One man in the inspection-only
group, who had a pain score of 1 at 3-month follow-up, underwent
emergency laparotomy for an acutely perforated gangrenous appendix
4 months after investigative laparoscopy. Eleven patients with ongoing
or recurrent complaints opted for a second laparoscopic procedure with
removal of the appendix. Appendicectomy was carried out more than a
year after diagnostic laparoscopy in one of these patients. Eight
patients reported that they had become pain free.
Details of hypothetical trial
Results (3): Postoperative complications comprised one urinary tract
infection and one superficial wound infection in two patients in the
appendicectomy group. There were no complications after the trial
laparoscopy in the inspection-only group. However, one of the 11
patients who eventually had a laparoscopic appendicectomy developed
intra-abdominal abscesses, and had a protracted and complicated
postoperative course.
Details of hypothetical trial
Details of hypothetical trial
Details of hypothetical trial
Remember:
Introduction (± Aim)
2-3 phrases
Methods
2-3 phrases
Results
3-5 phrases
And
Conclusions
1-3 phrases
And now let’s move on…