concise academic writing mark i. langdorf, md, mhpe, facep, faaem, rdms professor and chair...

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Concise Academic Writing Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair Professor and Chair University of California, Irvine University of California, Irvine Editor, Editor, Western Journal of Emergency Medicine Western Journal of Emergency Medicine

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Page 1: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Concise Academic WritingConcise Academic Writing

Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMSMark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMSProfessor and ChairProfessor and Chair

University of California, IrvineUniversity of California, IrvineEditor, Editor, Western Journal of Emergency MedicineWestern Journal of Emergency Medicine

Page 2: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Choosing a target journalChoosing a target journal

35 general and subspecialty journals in EM35 general and subspecialty journals in EM 11 indexed in Medline (National Library of 11 indexed in Medline (National Library of

Medicine)Medicine) most established and prestigiousmost established and prestigious most discriminatingmost discriminating

Rough order: most discriminating to least Rough order: most discriminating to least are:are: Most: Annals, Academic Most: Annals, Academic Middle tier: Journal of, American Journal of, Middle tier: Journal of, American Journal of,

Canadian Journal of, European Journal of, Canadian Journal of, European Journal of, Journal of Accident and EM, EM Journal Journal of Accident and EM, EM Journal (formerly Journal of Accident and EM)(formerly Journal of Accident and EM)

Lower tier: Internal and EM (Italy), Lower tier: Internal and EM (Italy), EM EM Australasia (formerly EM), Journal of Trauma: Australasia (formerly EM), Journal of Trauma: Injury, Infection and Critical CareInjury, Infection and Critical Care

Page 3: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

20 Non-Medline EM Journals20 Non-Medline EM Journals

Author pays for publication:Author pays for publication:BMC Emergency Medicine ($1860 if BMC Emergency Medicine ($1860 if

accepted)accepted)World Journal of Emergency Surgery World Journal of Emergency Surgery

($1665)($1665) Brand new (2007-08):Brand new (2007-08):

Western Journal of EMWestern Journal of EMInternational Journal of EMInternational Journal of EM

Electronic only:Electronic only:Internet Journal of EMInternet Journal of EM

Page 4: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Emergency Medicine ConventionsEmergency Medicine Conventions Emergency physician (EP)Emergency physician (EP) Emergency department (ED)Emergency department (ED) Emergency medicine (EM)Emergency medicine (EM) Not:Not: emergency room physician, emergency room, emergency medicine emergency room physician, emergency room, emergency medicine

physician, ER physician, EM physician or even ED physicianphysician, ER physician, EM physician or even ED physician

First time use: spell them out, and then, in First time use: spell them out, and then, in parentheses, abbreviateparentheses, abbreviate

Then use abbreviation throughout paperThen use abbreviation throughout paper Except for tables and figuresExcept for tables and figures

Abstract stands aloneAbstract stands alone

Page 5: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Rules of the RoadRules of the Road

Be brief!Be brief! Journal editor wants as much content in as few pages as Journal editor wants as much content in as few pages as

possiblepossible Strunk and White, 1918, Strunk and White, 1918, The Elements of StyleThe Elements of Style::

““Vigorous writing is concise. A Vigorous writing is concise. A sentence should contain no sentence should contain no unnecessary words, a paragraph no unnecessary words, a paragraph no unnecessary sentences, for the same unnecessary sentences, for the same reason that a drawing should have no reason that a drawing should have no unnecessary lines and a machine no unnecessary lines and a machine no unnecessary parts. This requires not unnecessary parts. This requires not that the writer make all his sentences that the writer make all his sentences short, or that he avoid all detail and short, or that he avoid all detail and treat his subjects only in outline, but treat his subjects only in outline, but that every word that every word telltell.”.”

Page 6: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

The Structure of DNAThe Structure of DNAWatson and Crick, Watson and Crick,

NatureNature, 1953, 1953

Page 7: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Follow the instructions to authors completely.Follow the instructions to authors completely. Follow the instructions to authors completely.Follow the instructions to authors completely. Follow the instructions to authors completely.Follow the instructions to authors completely. Follow the instructions to authors completely.Follow the instructions to authors completely. Follow the instructions to authors completely.Follow the instructions to authors completely. Get the picture?Get the picture?

How to Get Your Paper ReviewedHow to Get Your Paper Reviewed

Page 8: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Other Tips and RequirementsOther Tips and Requirements

Avoid complicated medical terms and jargonAvoid complicated medical terms and jargon Not, “juxtaposed,” but “adjacent” or even “next to.”Not, “juxtaposed,” but “adjacent” or even “next to.”

Use medical terms only when the appropriate lay Use medical terms only when the appropriate lay term is not precise enough.term is not precise enough.

Expect active voice almost all the time.Expect active voice almost all the time. Use the template to include all vital elementsUse the template to include all vital elements Avoid using the same word twice in a sentenceAvoid using the same word twice in a sentence

Page 9: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Avoid redundant hyperboleAvoid redundant hyperbole ““extremely arachnophobic,extremely arachnophobic, ““close proximity”close proximity” ““summarize briefly”summarize briefly” ““very deep”very deep” ““overcrowded”overcrowded” ““very precarious”very precarious”

Vary sentence lengthVary sentence length Avoid run-on sentencesAvoid run-on sentences Use no more than one parenthetical phrase per sentenceUse no more than one parenthetical phrase per sentence Alternate short sentences with long ones.Alternate short sentences with long ones.

Other Tips and RequirementsOther Tips and Requirements

Page 10: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Rules of the RoadRules of the Road

Paragraphs need to have at least three Paragraphs need to have at least three sentences:sentences: a topica topic an explanationan explanation some sort of conclusion. some sort of conclusion.

If there are only two, incorporate this If there are only two, incorporate this thought into the paragraph before.thought into the paragraph before.

Paragraphs should not generally have Paragraphs should not generally have more than six sentences.more than six sentences.

Page 11: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Rules of the RoadRules of the Road

Someone not in EM, or not even in Someone not in EM, or not even in medicine, should understand the paper. medicine, should understand the paper.

A college graduate should be able to A college graduate should be able to understand much of medical writingunderstand much of medical writing

If they would be lost, the paper needs If they would be lost, the paper needs more workmore work

Goal is to Goal is to NOTNOT write in a language called write in a language called “medicine,” but rather in English“medicine,” but rather in English

Page 12: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Rules of the RoadRules of the Road

Avoid politics in the paperAvoid politics in the paper Little room for opinion in a scientific paperLittle room for opinion in a scientific paper Facts speak for themselvesFacts speak for themselves Discussion section: Allow the author to Discussion section: Allow the author to

opine a bit, for maybe 2-3 sentences, if at opine a bit, for maybe 2-3 sentences, if at allall

Assure such opinions, are clearly marked, Assure such opinions, are clearly marked, such as, “we believe.”such as, “we believe.”

If the concept is provocative, it probably If the concept is provocative, it probably doesn’t belong in a research paper.doesn’t belong in a research paper.

Page 13: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Reviewing PapersReviewing Papers

Helps gain experience in academic writingHelps gain experience in academic writing Flips your perspective from author to Flips your perspective from author to

consumerconsumer Provides insight into common problems and Provides insight into common problems and

mistakes mistakes Time consuming; good review = two hoursTime consuming; good review = two hours Will dramatically improve the quality of the Will dramatically improve the quality of the

journaljournal Ultimate Medline indexing depends on thisUltimate Medline indexing depends on this

Page 14: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

The TitleThe Title

Answer the question posed by the paper in the Answer the question posed by the paper in the titletitle

Type of study belongs in the title: retrospective, Type of study belongs in the title: retrospective, randomized controlled trial, cohort study, randomized controlled trial, cohort study, before and after, case report, case seriesbefore and after, case report, case series

120 character limit for 120 character limit for WestWestJEMJEM Strike balance between brevity and accuracy Strike balance between brevity and accuracy Spell out all abbreviations.Spell out all abbreviations.

Page 15: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Structured AbstractStructured Abstract

Introduction: two sentences maxIntroduction: two sentences max Objective: one sentenceObjective: one sentence Methods: 2-3 sentencesMethods: 2-3 sentences Results: as many as you have, but major onlyResults: as many as you have, but major only Conclusion: one sentenceConclusion: one sentence Parallel the rest of the paper in content and orderParallel the rest of the paper in content and order Limit for Limit for WestWestJEM: 300 wordsJEM: 300 words Normally, abstract written first, then paperNormally, abstract written first, then paper Must assure consistency with body of the paper Must assure consistency with body of the paper

Page 16: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Internal ConsistencyInternal Consistency

Sample size, numbers, resultsSample size, numbers, results Make sure these are the same in Abstract, Make sure these are the same in Abstract,

Methods and Results Methods and Results Nothing brands a paper as amateurish Nothing brands a paper as amateurish

than inconsistenciesthan inconsistencies Casts doubt in the reviewer’s mindCasts doubt in the reviewer’s mind What else is wrong if they can’t even get What else is wrong if they can’t even get

this right?this right?

Page 17: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

IntroductionIntroduction

Typically four paragraphsTypically four paragraphs Not a literature reviewNot a literature review Cite references in the introduction that set Cite references in the introduction that set

stage for the problem or hypothesisstage for the problem or hypothesis All other citations belong in the discussion All other citations belong in the discussion

(except methods description from previous (except methods description from previous work)work)

Last sentence: Last sentence: We hypothesized….We hypothesized…. Our objective was….Our objective was…. We sought to….We sought to….

Page 18: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

MethodsMethods Describe setting Describe setting How inclusive was the sampleHow inclusive was the sample Specific inclusion/exclusion criteriaSpecific inclusion/exclusion criteria What was the intervention?What was the intervention? How were subjects identified?How were subjects identified? How was data gathered and recorded?How was data gathered and recorded? How was it analyzed?How was it analyzed?

What tests?What tests? Have statistician or senior mentor write or Have statistician or senior mentor write or

reviewreview What computer program, version, What computer program, version,

manufacturer, corporate headquarters….manufacturer, corporate headquarters…. Make and model of all equipmentMake and model of all equipment Goal of methods is to enable replicationGoal of methods is to enable replication

Page 19: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Methods: Retrospective Chart ReviewMethods: Retrospective Chart Review

Adhere to seven elements of methods Adhere to seven elements of methods described in Gilbert and Lowenstein, described in Gilbert and Lowenstein, Annals Emerg MedAnnals Emerg Med, 1996, or, 1996, or

Worster and Bledsoe, Worster and Bledsoe, Ann Emerg MedAnn Emerg Med. . 2005;45:448-451 with 12 criteria for a 2005;45:448-451 with 12 criteria for a proper methods section:proper methods section:

Page 20: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

WorsterWorster and Bledsoe and Bledsoe

Page 21: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

ResultsResults

Present primary outcome measure first, Present primary outcome measure first, followed by secondary followed by secondary

Graphs easily visible in black and white, with Graphs easily visible in black and white, with different patterns, not colorsdifferent patterns, not colors

For more than 4-5 related results, use tableFor more than 4-5 related results, use table Tables are easier to digestTables are easier to digest Don’t repeat results from a table in textDon’t repeat results from a table in text Instead refer to general synopsis of the Instead refer to general synopsis of the

tabular resultstabular results

Page 22: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Results: Statistical and Reporting Results: Statistical and Reporting ConventionsConventions

All results in absolute not relative termsAll results in absolute not relative terms ““The The absolute risk reductionabsolute risk reduction from a mortality of from a mortality of

4% to 2% was 2%,” rather than, “The 4% to 2% was 2%,” rather than, “The relative relative risk reductionrisk reduction was 50%.” was 50%.”

Relative changes inflate the magnitude of the Relative changes inflate the magnitude of the effect artificially.effect artificially.

To compare two groups, use p values with 95% To compare two groups, use p values with 95% confidence intervals AND calculate NNT/NNH confidence intervals AND calculate NNT/NNH from the absolute difference in outcomesfrom the absolute difference in outcomes

Gives information to gauge clinical import Gives information to gauge clinical import

Page 23: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Results: Diagnostic TestsResults: Diagnostic Tests

Use likelihood ratios in addition to Use likelihood ratios in addition to sensitivity, specificity, and sensitivity, specificity, and positive/negative predictive valuespositive/negative predictive values

Allows reader to change probability of a Allows reader to change probability of a given condition after the diagnostic testgiven condition after the diagnostic test

Pre-test probability modified by likelihood Pre-test probability modified by likelihood ratio = post-test probability by the Fagan ratio = post-test probability by the Fagan nomogramnomogram

Page 24: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Pulmonary Embolism and d-DimerPulmonary Embolism and d-Dimer

PE + PE - Total

d-D + 30 42 72

d-D - 3 30 33

Total 33 72 105

Sensitivity = 91% Specificity = 42% LR Pos = (30/33) / (42/72) = 1.5LR Neg = (3/33) / (30/72) = 0.22

Heit JA, et al. Arch Path Lab Med. 1999;123:235-240

Page 25: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Plain LanguagePlain Language

A negative d-dimer is 0.22 times as likely A negative d-dimer is 0.22 times as likely to occur in patients to occur in patients with PEwith PE than in than in patients patients without PEwithout PE

A negative d-Dimer is 4 ½ times A negative d-Dimer is 4 ½ times less likelyless likely to occur in patients to occur in patients with PEwith PE than in than in patients patients without PEwithout PE

Page 26: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

FaganNomogram

Page 27: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

FiguresFigures

Even if it seems obvious, annotate figures Even if it seems obvious, annotate figures and pictures with arrows (point to the and pictures with arrows (point to the brain hemorrhage or appendicitis)brain hemorrhage or appendicitis)

High resolution, at least 300 dpiHigh resolution, at least 300 dpi Low resolution images “pixel out.”Low resolution images “pixel out.”

Page 28: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Legends for Tables and FiguresLegends for Tables and Figures

Tables and Figures with their legends are Tables and Figures with their legends are separate pages, not imbedded in text of separate pages, not imbedded in text of paperpaper

Must stand alone and be very descriptiveMust stand alone and be very descriptive Must spell out all abbreviations used each Must spell out all abbreviations used each

timetime Must be large and clear (little white space)Must be large and clear (little white space) Make sure they are numbered in proper Make sure they are numbered in proper

orderorder

Page 29: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

DiscussionDiscussion

Most important findings firstMost important findings first Same order as results sectionSame order as results section Then secondary outcome measuresThen secondary outcome measures This is the place for opinion, though quite This is the place for opinion, though quite

limitedlimited How could or should this change clinical How could or should this change clinical

care?care? Discussions should be limited to 5-6 items, Discussions should be limited to 5-6 items,

each with one to two paragraphseach with one to two paragraphs

Page 30: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

ConclusionsConclusions

Don’t allow overstatementDon’t allow overstatement Definitive study is almost impossibleDefinitive study is almost impossible Insist on words such as, “it appears,” or “from Insist on words such as, “it appears,” or “from

these data.”these data.” Always call for further investigationAlways call for further investigation Retrospective studies cannot show causation, only Retrospective studies cannot show causation, only

associationassociation Make conclusion specific enough to stand alone. Make conclusion specific enough to stand alone.

Include, “in adults,” or “in emergency department Include, “in adults,” or “in emergency department patients with a chief complaint of chest pain.”patients with a chief complaint of chest pain.”

Page 31: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

LimitationsLimitations

Limit to 1-2 paragraphsLimit to 1-2 paragraphs Should acknowledge:Should acknowledge:

Small sample size/underpowered studySmall sample size/underpowered study Incomplete patient enrollmentIncomplete patient enrollment Lost to follow upLost to follow up Retrospective designRetrospective design Lack of blindingLack of blinding Lack of generalizabilityLack of generalizability

Author should be honest about Author should be honest about shortcomings and biases, or appears naïve shortcomings and biases, or appears naïve

Page 32: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

ReferencesReferences

Consistent format, adherent to journal Consistent format, adherent to journal requirementsrequirements

Citations go at end of sentence, unless Citations go at end of sentence, unless sentence compound and citation applies only to sentence compound and citation applies only to first partfirst part

Need to be up to date: look at most recent Need to be up to date: look at most recent referencereference

Lit review from two years ago is out of dateLit review from two years ago is out of date Suggest new references as your expertise Suggest new references as your expertise

dictates dictates

Page 33: Concise Academic Writing Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS Professor and Chair University of California, Irvine Editor, Western Journal of

Questions?Questions?