writing medical manuscripts rebecca teaff, ma senior editor duke clinical research institute durham,...

Writing Medical Writing Medical ManuscriptsManuscripts

Rebecca Teaff, MARebecca Teaff, MASenior EditorSenior EditorDuke Clinical Research InstituteDuke Clinical Research InstituteDurham, NCDurham, NC

““A scientific experiment, no matter how A scientific experiment, no matter how spectacular the results, is not completed spectacular the results, is not completed until the results are published. In fact, the until the results are published. In fact, the cornerstone of the philosophy of science is cornerstone of the philosophy of science is based on the fundamental assumption that based on the fundamental assumption that original research must be published; only original research must be published; only thus can new scientific knowledge be thus can new scientific knowledge be authenticated and added to the existing authenticated and added to the existing database called science.”database called science.”

Robert A. Day—Robert A. Day—How to Write and Publish a Scientific PaperHow to Write and Publish a Scientific Paper

Getting StartedGetting Started

■ Uniform Requirements for Manuscripts Submitted to Uniform Requirements for Manuscripts Submitted to Biomedical Journals Biomedical Journals

■ International Committee of Medical Journal EditorsInternational Committee of Medical Journal Editors

■ Web site: Web site: http://www.icmje.org/http://www.icmje.org/

■ Style manuals for referencing publications; Style manuals for referencing publications; standards and conventions for formatting sources, standards and conventions for formatting sources, including electronic sourcesincluding electronic sources

■ Duke University Medical Center LibraryDuke University Medical Center Library

■ Web site: Web site: http://www.mclibrary.duke.edu/subject/stylehttp://www.mclibrary.duke.edu/subject/style

Getting StartedGetting Started

■ The CONSORT StatementThe CONSORT Statement

■ Moher et al. 2001Moher et al. 2001

■ Web site: Web site: http://www.consort-statement.org/http://www.consort-statement.org/

■ Journal Instructions for AuthorsJournal Instructions for Authors

■ Web site: Web site: http://mulford.mco.edu/instr/http://mulford.mco.edu/instr/

The Target JournalThe Target Journal

■ Choose a target journal for submission.Choose a target journal for submission.

■ Determine types of manuscripts the Determine types of manuscripts the journal will accept.journal will accept.

■ Familiarize yourself with the journal’s Familiarize yourself with the journal’s style and format.style and format.

■ Read the “Instructions to Authors.”Read the “Instructions to Authors.”

The Target JournalThe Target Journal

■ Reader interestReader interest

■ CirculationCirculation

■ Inclusion in Inclusion in Index MedicusIndex Medicus

■ Acceptance rateAcceptance rate

■ Publication lagPublication lag

■ Impact factorImpact factor

Byrne DW. Publishing Your Medical Research Paper. 1998.Byrne DW. Publishing Your Medical Research Paper. 1998.

Kinds of ManuscriptsKinds of Manuscripts

■ Clinical report, clinical study, original Clinical report, clinical study, original research:research: the report of an analysis of data the report of an analysis of data collected to answer a questioncollected to answer a question

■ Review article:Review article: a general overview of a topic, a general overview of a topic, usually summarizes current knowledgeusually summarizes current knowledge

Kinds of ManuscriptsKinds of Manuscripts

■ Special article:Special article: may be requested by the may be requested by the publication, may be an in-depth review of a topic, publication, may be an in-depth review of a topic, a practice guideline, a consensus statementa practice guideline, a consensus statement

■ Brief reports, case reports:Brief reports, case reports: unusual clinical unusual clinical situations, new syndromes or effects of drugssituations, new syndromes or effects of drugs

“…“…[T]he preparation of a scientific [T]he preparation of a scientific paper has less to do with literary skill paper has less to do with literary skill than with than with organizationorganization..

A scientific paper is not literature.”A scientific paper is not literature.”

Robert A. Day—Robert A. Day—How to Write and Publish a Scientific PaperHow to Write and Publish a Scientific Paper

Structure and Content of a Structure and Content of a Biomedical ManuscriptBiomedical Manuscript

■ DiscussionDiscussion

■ ReferencesReferences

■ LegendsLegends

■ Tables Tables

■ FiguresFigures

■ TitleTitle

■ AbstractAbstract

■ IntroductionIntroduction

■ MethodsMethods

■ ResultsResults

TitleTitle

■ The purpose of the title is to state the topic The purpose of the title is to state the topic and attract readers.and attract readers.

■ The title and the abstract often determine The title and the abstract often determine whether your article is read.whether your article is read.

TitleTitle

Elements of an effective Elements of an effective titletitle::

■ Gets the reader’s attentionGets the reader’s attention

■ Uses key words that are appropriate Uses key words that are appropriate for indexes and searchesfor indexes and searches

■ Uses language that is short, Uses language that is short, descriptive, catchy, and jargon-freedescriptive, catchy, and jargon-free

■ Provides a promise of the paper’s Provides a promise of the paper’s contentcontent

TitleTitle

Elements of an effective Elements of an effective titletitle::

■ Uses appropriate words for the journal’s audienceUses appropriate words for the journal’s audience

■ Does not use unexplained abbreviations unless Does not use unexplained abbreviations unless widely understood (e.g., HIV, AIDS, DNA, RNA)widely understood (e.g., HIV, AIDS, DNA, RNA)

■ Indicates the study designIndicates the study design

■ Uses study acronyms to facilitate lit searchesUses study acronyms to facilitate lit searches

■ Does not give conclusionsDoes not give conclusions

TitleTitle

■ A Study ofA Study of

■ A Study to Determine theA Study to Determine the

■ An Innovative MethodAn Innovative Method

■ An Investigation intoAn Investigation into

■ Contributions toContributions to

■ Correlatives ofCorrelatives of

■ Means ofMeans of

■ Observations onObservations on

■ Report of a Case ofReport of a Case of

■ Results ofResults of

■ RetrospectiveRetrospective

■ Studies onStudies on

■ Use ofUse of

■ Investigations onInvestigations on

■ Notes onNotes on

■ Preliminary Studies ofPreliminary Studies of

Words and Phrases to Avoid in TitlesWords and Phrases to Avoid in Titles

TitleTitleExamplesExamples

■ Anorexia Nervosa in Adolescents Affects Anorexia Nervosa in Adolescents Affects Mineral Balance and Bone TurnoverMineral Balance and Bone Turnover

■ Mineral Balance and Bone Turnover in Mineral Balance and Bone Turnover in Adolescents with Anorexia NervosaAdolescents with Anorexia Nervosa

■ Characterization of Bone Turnover in Characterization of Bone Turnover in Adolescents with Anorexia NervosaAdolescents with Anorexia Nervosa

TitleTitleExamplesExamples

■ Medical Publishing 101Medical Publishing 101

■ A Manuscript Editor’s Wish List: A Manuscript Editor’s Wish List: Or “Go Ahead, Make My Day (Please)”Or “Go Ahead, Make My Day (Please)”

■ Sponsorship, Authorship, and a Tale of Two MediaSponsorship, Authorship, and a Tale of Two Media

■ Editorial: Authors and Authorship—Editorial: Authors and Authorship—Reform or Abolition?Reform or Abolition?

■ Writing Is AllWriting Is All

Title PageTitle Page

■ TitleTitle

■ Authors: full names and degreesAuthors: full names and degrees■ Institutional affiliations for all authorsInstitutional affiliations for all authors

■ Funding: all sources of support for the Funding: all sources of support for the research, including grant numbersresearch, including grant numbers

■ Address for correspondence and reprints, Address for correspondence and reprints, including telephone and fax #s, e-mailincluding telephone and fax #s, e-mail

Comparison of Cefuroxime AxetilComparison of Cefuroxime AxetilWith or Without Intranasal Fluticasone PropionateWith or Without Intranasal Fluticasone Propionate

for the Treatment of Rhinosinusitis: the CAFFS Trialfor the Treatment of Rhinosinusitis: the CAFFS TrialRowena J. Dolor MD, MHS, David L. Witsell, MD, MHS,Rowena J. Dolor MD, MHS, David L. Witsell, MD, MHS,Anne S. Hellkamp, MS, John W. Williams, Jr., MD, MHS,Anne S. Hellkamp, MS, John W. Williams, Jr., MD, MHS,

Robert M. Califf, MD, David L. Simel, MD, MHS,Robert M. Califf, MD, David L. Simel, MD, MHS,for the Ceftin and Flonase for Sinusitis (CAFFS) Investigators for the Ceftin and Flonase for Sinusitis (CAFFS) Investigators

Running Header:Running Header: Ceftin and Flonase for Sinusitis Ceftin and Flonase for Sinusitis

Word Count:Word Count: 4,828 4,828

Author Affiliations:Author Affiliations: Durham Veterans Affairs Medical Center and Division of Internal Medicine, Durham Veterans Affairs Medical Center and Division of Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC (Drs Dolor and Simel); Department of Medicine, Duke University Medical Center, Durham, NC (Drs Dolor and Simel); Durham Veterans Affairs Medical Center and Division of Otolaryngology, Department of Surgery, Durham Veterans Affairs Medical Center and Division of Otolaryngology, Department of Surgery, Duke University Medical Center, Durham, NC (Dr Witsell); Duke Clinical Research Institute, Duke Duke University Medical Center, Durham, NC (Dr Witsell); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (Drs Hellkamp and Califf); and South Texas Veterans University Medical Center, Durham, NC (Drs Hellkamp and Califf); and South Texas Veterans Health Care System, Audie L. Murphy Division and Division of General Internal Medicine, Health Care System, Audie L. Murphy Division and Division of General Internal Medicine, University of Texas Health Science Center, San Antonio, TX (Dr Williams).University of Texas Health Science Center, San Antonio, TX (Dr Williams).

Corresponding Author:Corresponding Author: Rowena J. Dolor, MD, MHS, Duke University Medical Center, 2400 Pratt Rowena J. Dolor, MD, MHS, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705. Phone: 919-668-8627. Fax: 919-668-7058.Street, Durham, NC 27705. Phone: 919-668-8627. Fax: 919-668-7058.

(e-mail: [email protected]).(e-mail: [email protected]).

IMRADIMRAD

IIntroductionntroduction

MMethodsethods

RResultsesults

aandnd

DDiscussioniscussion

AbstractAbstract

Based on the Based on the IMRADIMRAD format: format:

■ Introduction:Introduction: Why this study? Why this study?

■ Methods:Methods: What was done? What was done?

■ Results:Results: What was found? What was found?

■ Discussion:Discussion: What does it mean? What does it mean?

Structure and Content of a Structure and Content of a Biomedical ManuscriptBiomedical Manuscript

■ DiscussionDiscussion

■ ReferencesReferences

■ LegendsLegends

■ Tables Tables

■ FiguresFigures

■ TitleTitle

■ AbstractAbstract

■ IntroductionIntroduction

■ MethodsMethods

■ ResultsResults

AcknowledgmentAcknowledgment

Dolor RJ et al. Comparison of Dolor RJ et al. Comparison of Cefuroxime With or Without Intranasal Cefuroxime With or Without Intranasal Fluticasone for the Treatment of Fluticasone for the Treatment of Rhinosinusitis. The CAFFS Trial: Rhinosinusitis. The CAFFS Trial: A Randomized Controlled Trial.A Randomized Controlled Trial.

JAMA JAMA 2001; 286:3097–3105. 2001; 286:3097–3105.

IntroductionIntroduction

What was the question What was the question (problem) of the study?(problem) of the study?


Three purposes to the Three purposes to the introductionintroduction::

■ Orient the reader to your field… Orient the reader to your field… capture the reader’s interest!capture the reader’s interest!

■ Briefly present the findings of others Briefly present the findings of others you will develop or challenge.you will develop or challenge.

■ Present the question/hypothesis your Present the question/hypothesis your paper will address.paper will address.

Writing the IntroductionWriting the Introduction■ Use a funnel type of Use a funnel type of

organization.organization.

■ Present what is known and Present what is known and unknown, leading to the unknown, leading to the question of the study:question of the study:■ The nature and scope of the The nature and scope of the

problemproblem■ The gap in knowledgeThe gap in knowledge■ Previous findingsPrevious findings■ Method of investigationMethod of investigation■ The research question The research question

(hypothesis)(hypothesis)

Introduction—Identifying the GapIntroduction—Identifying the Gap““Investigations of whether intranasal Investigations of whether intranasal corticosteroids promote resolution of symptoms corticosteroids promote resolution of symptoms and prevent recurrences of sinusitis have and prevent recurrences of sinusitis have yielded conflicting results.yielded conflicting results.2–72–7 Previous studies, Previous studies, involving small cohorts of patients with chronic involving small cohorts of patients with chronic bacterial sinusitis and/or nasal polyposis, bacterial sinusitis and/or nasal polyposis, showed a trend toward improvement in patients showed a trend toward improvement in patients who received nasal corticosteroids, but were who received nasal corticosteroids, but were underpowered to show an effect on clinical underpowered to show an effect on clinical outcome. Overall, none of the previous studies outcome. Overall, none of the previous studies unequivocally proved the efficacy or justified the unequivocally proved the efficacy or justified the routine use of nasal corticosteroids in sinusitis.”routine use of nasal corticosteroids in sinusitis.”

Dolor RJ et al. JAMA 2001; 286:3097–3105. Dolor RJ et al. JAMA 2001; 286:3097–3105.

Introduction—Introduction—Signaling the QuestionSignaling the Question

■ Therefore, we tested the hypothesis…Therefore, we tested the hypothesis…

■ The purpose of this study was…The purpose of this study was…

■ Our study had three objectives…Our study had three objectives…

■ This report describes experiments This report describes experiments designed to test whether…designed to test whether…

The Research QuestionThe Research Question

““We assessedWe assessed the effectiveness of the effectiveness of fluticasone propionate nasal spray in fluticasone propionate nasal spray in combination with cefuroxime axetil in acute combination with cefuroxime axetil in acute rhinosinusitis in a diverse population of rhinosinusitis in a diverse population of patients… Cefuroxime has been shown to be patients… Cefuroxime has been shown to be effective in the treatment of acute bacterial effective in the treatment of acute bacterial sinusitis.sinusitis.1212 We examined whetherWe examined whether the addition the addition of fluticasone to cefuroxime could affect the of fluticasone to cefuroxime could affect the speed and rate of recovery in patients with speed and rate of recovery in patients with rhinosinusitis.”rhinosinusitis.”



■ Recommended length:Recommended length: 1 to 2 pages1 to 2 pages

■ Most journals don’t use the section Most journals don’t use the section title “Introduction.” title “Introduction.”

■ Use present tense for what is known.Use present tense for what is known.

■ Use past tense when stating the Use past tense when stating the research question.research question.

■ Repeat key terms from the title.Repeat key terms from the title.

Materials and MethodsMaterials and Methods

How was the How was the problem studied?problem studied?

MaterialsMaterials

■ ChemicalsChemicals

■ Experimental materials Experimental materials (cell lines, tissues)(cell lines, tissues)

■ Experimental animals Experimental animals or human subjectsor human subjects

■ Institutional review and Institutional review and approvalapproval


MethodsMethods

■ Preparation, Preparation, if necessaryif necessary

■ Protocol Protocol (variables and controls)(variables and controls)

■ Methods and apparatusMethods and apparatus

■ Analysis of data and Analysis of data and statistical analysisstatistical analysis


■ Summarize the study design and protocol.Summarize the study design and protocol.

■ Describe the patients and setting.Describe the patients and setting.

■ Include methods used to implement the Include methods used to implement the random allocation sequence.random allocation sequence.


■ Describe the interventions or treatment—what Describe the interventions or treatment—what was done to answer the research question.was done to answer the research question.

■ List the primary and secondary outcome List the primary and secondary outcome measures or endpoints of the study.measures or endpoints of the study.

■ Provide details of analytical/statistical Provide details of analytical/statistical methods.methods.


■ Write methods in a logical order Write methods in a logical order (chronological or most to least important).(chronological or most to least important).

■ Write in the past tense (use active voice).Write in the past tense (use active voice).

■ Provide signals of organization:Provide signals of organization:■ Subtitles, new paragraphsSubtitles, new paragraphs■ Topic sentences, transition phrasesTopic sentences, transition phrases

■ Include appropriate figures and tables Include appropriate figures and tables (study design).(study design).

■ Do not include results.Do not include results.


Summarize the study design:Summarize the study design:

““The Ceftin and Flonase for Sinusitis (CAFFS) The Ceftin and Flonase for Sinusitis (CAFFS) trial was a double-blind, randomized, placebo-trial was a double-blind, randomized, placebo-controlled study designed to determine the controlled study designed to determine the effectiveness of a 10-day course of cefuroxime effectiveness of a 10-day course of cefuroxime combined with a 3-day treatment with combined with a 3-day treatment with xylometazoline with or without a 21-day course xylometazoline with or without a 21-day course of intranasal fluticasone in patients with acute of intranasal fluticasone in patients with acute rhinosinusitis.” rhinosinusitis.”


Materials and MethodsMaterials and MethodsDescribe the patients and setting:Describe the patients and setting:

““Patients 18 years or older presenting with acute Patients 18 years or older presenting with acute sinonasal symptoms and a history of previously sinonasal symptoms and a history of previously diagnosed recurrent or chronic sinusitis that diagnosed recurrent or chronic sinusitis that necessitated antibiotic therapy were eligible for necessitated antibiotic therapy were eligible for enrollment. Subjects were enrolled between October enrollment. Subjects were enrolled between October 1998 and April 2000 from 22 sites (12 primary care and 1998 and April 2000 from 22 sites (12 primary care and 10 otolaryngology). Study sites were chosen from 3 10 otolaryngology). Study sites were chosen from 3 research networks: the Surgeons' Outcomes Research research networks: the Surgeons' Outcomes Research Cooperative in Otolaryngology, the Duke Primary Care Cooperative in Otolaryngology, the Duke Primary Care Research Consortium, and the Primary Care Network.” Research Consortium, and the Primary Care Network.”

Dolor RJ et al. JAMA 2001; 286:3097–3105.Dolor RJ et al. JAMA 2001; 286:3097–3105.

Materials and MethodsMaterials and MethodsDescribe the interventions or treatment:Describe the interventions or treatment:

““Patients were randomly assigned to 2 puffs (total Patients were randomly assigned to 2 puffs (total dose, 200 µg) of either fluticasone propionate dose, 200 µg) of either fluticasone propionate (Flonase, GlaxoSmithKline) or placebo nasal spray, (Flonase, GlaxoSmithKline) or placebo nasal spray, taken once a day in each nostril for 21 days. All taken once a day in each nostril for 21 days. All patients received cefuroxime axetil (Ceftin, patients received cefuroxime axetil (Ceftin, GlaxoSmithKline) 250 mg twice daily for 10 days, as GlaxoSmithKline) 250 mg twice daily for 10 days, as well as 2 puffs of xylometazoline hydrochloride per well as 2 puffs of xylometazoline hydrochloride per nostril twice daily for 3 days, 10 minutes before nostril twice daily for 3 days, 10 minutes before using the study nasal spray.”using the study nasal spray.”



List the primary and secondary outcome measures:List the primary and secondary outcome measures:

■ ““The primary outcome was the proportion of The primary outcome was the proportion of patients in each treatment arm who experienced patients in each treatment arm who experienced clinical success at 10, 21, or 56 days, based on clinical success at 10, 21, or 56 days, based on telephone follow-up…telephone follow-up…

■ Secondary outcomes included differences over Secondary outcomes included differences over time in the sinusitis and general health quality of time in the sinusitis and general health quality of life scores from the Sinonasal Outcome Test-20 life scores from the Sinonasal Outcome Test-20 and SF-12 surveys.”and SF-12 surveys.”



■ Recommended length:Recommended length: as long as necessary to describe as long as necessary to describe what you did.what you did.

■ Provide enough detail to permit Provide enough detail to permit replication.replication.

■ Assume the reader is a trained Assume the reader is a trained investigator with considerable investigator with considerable experience.experience.

ResultsResults

What were the What were the findings?findings?

ResultsResults

Guidelines for reporting Guidelines for reporting resultsresults::

■ Report results that answer the question of the Report results that answer the question of the study.study.

■ Be sure that for every result given, a method Be sure that for every result given, a method has been described.has been described.

■ Ensure that the study is logical—no obvious Ensure that the study is logical—no obvious leaps.leaps.

■ Point out the findings you will develop in the Point out the findings you will develop in the discussion.discussion.

ResultsResults

■ Recommended length:Recommended length: brief and uncluttered.brief and uncluttered.

■ Don’t repeatDon’t repeat contents of figures contents of figures and tables in text.and tables in text.

■ Let the data speak for themselves.Let the data speak for themselves.

ResultsResults““Of the 95 randomized Of the 95 randomized patients, 47 received patients, 47 received fluticasone and 48 fluticasone and 48 received placebo nasal received placebo nasal spray. More than half the spray. More than half the subjects (n = 51) were subjects (n = 51) were enrolled from primary care, enrolled from primary care, with equal proportions of with equal proportions of patients from primary care patients from primary care and otolaryngology and otolaryngology practices in each treatment practices in each treatment arm (Table 1).” arm (Table 1).”

Dolor RJ et al. JAMA 2001; 286:3097Dolor RJ et al. JAMA 2001; 286:3097––3105. 3105.

DiscussionDiscussion

What do the What do the findings mean?findings mean?


Three parts of the Three parts of the discussiondiscussion::

■ Beginning:Beginning: Answer the question and Answer the question and support your answer.support your answer.

■ Middle:Middle: Assess your findings in the Assess your findings in the context of what is known.context of what is known.

■ End: End: Restate the answer. Restate the answer.

Beginning of the DiscussionBeginning of the Discussion

■ Answer the research question.Answer the research question.

■ Signal the reader.Signal the reader.

■ Be sure that conclusions are supported Be sure that conclusions are supported by the results and methods.by the results and methods.

■ Give the strongest result first.Give the strongest result first.

Beginning of the DiscussionBeginning of the Discussion

End of Introduction:End of Introduction:

““We examined whetherWe examined whether the the addition of addition of fluticasonefluticasone to to cefuroximecefuroxime could affect the could affect the speed and rate of recovery speed and rate of recovery in patients with in patients with rhinosinusitisrhinosinusitis.”.”

Beginning of Discussion:Beginning of Discussion:

““We found thatWe found that patients with patients with acute paranasal acute paranasal sinusitissinusitis were more likely to achieve were more likely to achieve clinical improvementclinical improvement when when treated with treated with fluticasonefluticasone and and cefuroximecefuroxime than with than with cefuroxime alone.” cefuroxime alone.”

Use the same key terms that were in the Use the same key terms that were in the statement at the end of the introduction:statement at the end of the introduction:


Middle of the DiscussionMiddle of the Discussion

Interpret results:Interpret results:

““We found that symptom response was greatest We found that symptom response was greatest during the first 5 days in both groups. This may during the first 5 days in both groups. This may have been due to the uniform use of nasal have been due to the uniform use of nasal decongestants during the first 3 days of treatment decongestants during the first 3 days of treatment with differences in clinical response manifesting with differences in clinical response manifesting thereafter. The most important aspect of early thereafter. The most important aspect of early treatment may have been adequate drainage treatment may have been adequate drainage related to reduced nasal congestion…” related to reduced nasal congestion…”



Compare your work with others’ work: Compare your work with others’ work:

““Our study was able to show clinical benefit Our study was able to show clinical benefit with shorter courses of antimicrobial with shorter courses of antimicrobial treatment (10 days vs 3 weeks used in treatment (10 days vs 3 weeks used in previous studies) and intranasal previous studies) and intranasal corticosteroid treatment (3 weeks vs 7 weeks) corticosteroid treatment (3 weeks vs 7 weeks) in acute sinus infections in patients with a in acute sinus infections in patients with a history of recurrent sinus infections or history of recurrent sinus infections or chronic rhinitis.”chronic rhinitis.”



Describe limitations of your study:Describe limitations of your study:

““Limitations to our study design include the Limitations to our study design include the use of patient-derived (ie, subjective) symptom use of patient-derived (ie, subjective) symptom reports to assess clinical improvement instead reports to assess clinical improvement instead of objectively assessing treatment response of objectively assessing treatment response through follow-up radiography or endoscopy. through follow-up radiography or endoscopy. We decided to use diaries and telephone We decided to use diaries and telephone follow-up to assess results for 2 reasons…” follow-up to assess results for 2 reasons…”


End of the DiscussionEnd of the Discussion

■ Explain unexpected findings.Explain unexpected findings.

■ Include speculation if it is appropriate.Include speculation if it is appropriate.

■ Be certain there is a basis for your Be certain there is a basis for your speculation in the results you presented.speculation in the results you presented.

■ Write a strong conclusion.Write a strong conclusion.

■ Mention need for future work, if necessary.Mention need for future work, if necessary.

End of the DiscussionEnd of the Discussion““In conclusionIn conclusion, our study supports the use of , our study supports the use of intranasal corticosteroids with antimicrobial therapy intranasal corticosteroids with antimicrobial therapy for the treatment of acute paranasal sinusitis in for the treatment of acute paranasal sinusitis in patients with a history of recurrent sinusitis or chronic patients with a history of recurrent sinusitis or chronic rhinitis… rhinitis… we recommend that sinusitis treatment we recommend that sinusitis treatment guidelines be emended to include intranasal guidelines be emended to include intranasal corticosteroids as adjunctive therapycorticosteroids as adjunctive therapy. .

The optimal duration of corticosteroid therapy will need The optimal duration of corticosteroid therapy will need further investigation. Additional studies incorporating further investigation. Additional studies incorporating microbial sampling before and after treatment and/or microbial sampling before and after treatment and/or follow-up radiography may also be warranted to further follow-up radiography may also be warranted to further support this recommendation.”support this recommendation.”



■ Recommended length:Recommended length: 2 pages2 pages

■ Don’t repeat the resultsDon’t repeat the results; ; assess them and present their import.assess them and present their import.

Writing TipsWriting Tips


When writing, keep in mind:When writing, keep in mind:

■ Ambiguity is the worst error in medical Ambiguity is the worst error in medical writing.writing.

■ Noncoherence is the second worst Noncoherence is the second worst error, followed by…error, followed by…

■ Excess verbiage.Excess verbiage.

■ Improper tone.Improper tone.


Think before you write:Think before you write:

■ From a dental manuscriptFrom a dental manuscript: We treat : We treat patients at a time when they seem most patients at a time when they seem most susceptible to decay.susceptible to decay.

■ Treatment was to no avail, and the Treatment was to no avail, and the patient disappeared.patient disappeared.

■ At death 14 weeks later, ten animals At death 14 weeks later, ten animals were alive.were alive.

Ahlers JA. J Emerg Nurs 1995;21:457–460.Ahlers JA. J Emerg Nurs 1995;21:457–460.

Effective ParagraphingEffective Paragraphing

■ A paragraph is a group of sentences on a A paragraph is a group of sentences on a single topic. single topic.

■ The goals of a paragraph are to get a message The goals of a paragraph are to get a message across and to make the story behind the across and to make the story behind the message clear.message clear.


A few rules:A few rules:

■ Keep one thought to a sentence.Keep one thought to a sentence.

■ Keep one idea to a paragraph.Keep one idea to a paragraph.

■ Length of paragraph should be 50–100 words.Length of paragraph should be 50–100 words.

■ Ideas in a paragraph must be organized.Ideas in a paragraph must be organized.

■ The relationship between ideas must be clear.The relationship between ideas must be clear.

■ Important ideas should be emphasized.Important ideas should be emphasized.


Classic approach to writing a paragraph:Classic approach to writing a paragraph:

■ Write a topic sentence (stating the topic or Write a topic sentence (stating the topic or “message” of the paragraph).“message” of the paragraph).

■ To identify the topic, use a key term.To identify the topic, use a key term.

■ To state a message, use a verb with a subject and To state a message, use a verb with a subject and a completer.a completer.

■ Write details to support the topic sentence in the Write details to support the topic sentence in the remaining sentences of the paragraph. remaining sentences of the paragraph.

■ Organize these sentences in a logical way.Organize these sentences in a logical way.

ReferencesReferencesVancouver system (citation-by-reference)—Vancouver system (citation-by-reference)—

■ Citation in text:Citation in text: … as previously reported (1). … as previously reported (1).

■ Reference:Reference: 1. Burke RD, Laing EL, Pryor RJ. 1. Burke RD, Laing EL, Pryor RJ. Recent developments… Recent developments… J Psychosom ResJ Psychosom Res 2002;40:201–203.2002;40:201–203.

Harvard system (author-and-year)—Harvard system (author-and-year)—

■ Citation in text:Citation in text: … as previously reported … as previously reported (Burke et al., 1992).(Burke et al., 1992).

■ Reference:Reference: Burke RD, Laing EL, and Pryor RJ. Burke RD, Laing EL, and Pryor RJ. Recent developments… Recent developments… J Psychosom ResJ Psychosom Res 40:201–213, 2002.40:201–213, 2002.

ReferencesReferences

■ For your own sake, insert references For your own sake, insert references as you write; use author/date style in as you write; use author/date style in early drafts.early drafts.

■ Reference abstracts sparingly.Reference abstracts sparingly.

■ Ultimate reference style depends on Ultimate reference style depends on the target journal.the target journal.


■ Never quote a reference you have not read. Never quote a reference you have not read. (Don’t cite secondary sources.)(Don’t cite secondary sources.)

■ Make certain references listed at the end of Make certain references listed at the end of the paper correspond with names or numbers the paper correspond with names or numbers mentioned in the text.mentioned in the text.


Bibliographic databases like Bibliographic databases like Reference ManagerReference Manager make formatting simple.make formatting simple.

■ Note: Journals will request that formatting used Note: Journals will request that formatting used with RefMan and Endnotes be removed from with RefMan and Endnotes be removed from E-copies of submitted manuscripts.E-copies of submitted manuscripts.

TablesTables

■ Give each a short title.Give each a short title.

■ Define all symbols and abbreviations.Define all symbols and abbreviations.

■ Avoid the tendency to present every fact Avoid the tendency to present every fact you gathered. you gathered. Present only data relevant Present only data relevant to the analyses.to the analyses.

■ Keep tables simple to follow, with like Keep tables simple to follow, with like elements reading elements reading downdown, not across., not across.

TablesTables

■ Provide enough information that the meaning Provide enough information that the meaning of the data is apparent without reference to of the data is apparent without reference to the text.the text.

■ Be prepared to drop one or two tables Be prepared to drop one or two tables following journal review.following journal review.

FiguresFigures

■ Laser prints are usually acceptable.Laser prints are usually acceptable.

■ Have complex figures professionally drawn.Have complex figures professionally drawn.

■ Borrowing published figures requires written Borrowing published figures requires written permission (and a credit line).permission (and a credit line).

■ Be simple and concise, but thoroughly explain Be simple and concise, but thoroughly explain figure content.figure content.

LegendsLegends

■ Identify the data that are being displayed Identify the data that are being displayed (axes, units).(axes, units).

■ Define all symbols and abbreviations.Define all symbols and abbreviations.

Ethical Ethical ConsiderationsConsiderations

Ethical ConsiderationsEthical Considerations■ Authorship criteriaAuthorship criteria

■ FraudFraud

■ Plagiarism, copyright infringementPlagiarism, copyright infringement

■ Duplicate publicationDuplicate publication

■ Financial conflict of interestFinancial conflict of interest

■ Privacy and confidentialityPrivacy and confidentiality

■ Protection of human subjects and animals Protection of human subjects and animals in researchin research

SummarySummary■ Before you write a scientific paper, read some.Before you write a scientific paper, read some.

■ Follow a logical order.Follow a logical order.

■ Be clear, concise, and complete.Be clear, concise, and complete.

■ Strive for accuracy.Strive for accuracy.

■ Get to the point quickly, and stick to it.Get to the point quickly, and stick to it.

■ Cite only references that are relevant and necessary.Cite only references that are relevant and necessary.

■ Include only figures and tables that are necessary.Include only figures and tables that are necessary.

■ Use standard abbreviations for units, and be Use standard abbreviations for units, and be consistent.consistent.

Source: Source: http://www.srh.noaa.gov/ftproot/ssd/html/writetip.htmlhttp://www.srh.noaa.gov/ftproot/ssd/html/writetip.html

BibliographyBibliography

Day RA. Day RA. How to Write and How to Write and Publish a Scientific PaperPublish a Scientific Paper. . Sixth Ed. Phoenix, AZ: Oryx Sixth Ed. Phoenix, AZ: Oryx Press. (In press) 2006.Press. (In press) 2006.


Byrne DW. Byrne DW. Publishing Your Publishing Your Medical Research PaperMedical Research Paper. . Philadelphia: Lippincott, Philadelphia: Lippincott, Williams & Wilkins. 1998.Williams & Wilkins. 1998.


Zeiger M. Zeiger M. Essentials of Essentials of Writing Biomedical Writing Biomedical Research PapersResearch Papers. New . New York: McGraw-Hill. 2000.York: McGraw-Hill. 2000.

Thank you!Thank you!

Rebecca Teaff, MARebecca Teaff, MACommunications GroupCommunications GroupDuke Clinical Research InstituteDuke Clinical Research Institute

[email protected]@mc.duke.edu

writing medical manuscripts rebecca teaff, ma senior editor duke clinical research institute durham,...

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