How to Write a Patient-Oriented Research Manuscript

1. How to Write a Patient-Oriented Research Manuscript A guide for preparing a patient-oriented research manuscript. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:307-15 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

2. Introduction Writing a patient-oriented research paper is a straightforward exercise that translatesdata into a clear, practical lesson for the clinician. Patients’ data Manuscript 1 Manuscript 2

3. Introduction Aphorisms guiding manuscript preparation: ● There is no such thing as a paper that is too short ● Write short declarative sentences; they contain more meaning than long convoluted ones ● All studies, no matter how complicated, can be simplified into a 2  2 table

4. Introduction Aphorisms guiding manuscript preparation: Using your computer monitor as an X-ray viewing box. BJOMFS 2008;46:512-4

5. Introduction Aphorisms guiding manuscript preparation: Examples of tortured English Tortured English Meaning Excessive interposed adipose tissue Fat Mobility of the leg was present The leg moved In the author’s opinion I think On account of the fact that Because One out of every two Half Surgical procedure Operation Exogenous nutrient elements Food

6. Introduction Aphorisms guiding manuscript preparation: Superfluous words (in red) Positive action Distinct possibility Active consideration Absolute end Inactual fact Personal opinion Real danger Agonising reappraisal Diametrically opposed

7. Introduction Aphorisms guiding manuscript preparation: ● You have, at most, 60 s to get a doctor’s attention, but only 30 s for a surgeon’s ● The purpose of writing a research manuscript is to communicate what you have learned to the reader ● Don’t make the reader guess your study purpose

8. Introduction Aphorisms guiding manuscript preparation: ● It is easier to write when you have something to say ●Avoid passive voice; the use of first person is okay ● You treat patients and do research with subjects ● A good paper is one that you would like to read For example: “The skin was incised” is shorter and clearer than “An incision was made through the skin”. Use simple words: ”do“ is better than ”perform“ or ”carry out

9. Introduction A manuscript submitted for journal publication is not a thesis. A thesis is an often excessively long-winded document reviewed by a committee, bound, filed in the library, and usually never again seen. A scientific paper should be topically focused with clearly delineated observations and recommendations.

10. Introduction A patient-oriented research paper has 7 elements: title, introduction, materials and methods, results, discussion, conclusion, and abstract. The title has to grab the reader. The introduction should be short and focus the reader quickly and efficiently on the goals of the study. The materials and methods section needs to be only as long as necessary to cover the elements of the study.

11. Introduction A patient-oriented research paper has 7 elements: title, introduction, materials and methods, results, discussion, conclusion, and abstract. Writing the results section is straightforward, and more so if you do the tables first. The discussion is variable in length, but the structure is formulaic. The conclusion is short. Write the abstractlast. ● It may be the only element of your paper the reader reads. ● Given the space constraints, it may be the most challenging aspect of the manuscript to write. ● Word count limitations preclude wasted words.

12. Salivary gland malignancy with divergent differentiation. Is it a teratocarcinosarcoma? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104: 82-8. Avian Influenza: Should China be alarmed?Yonsei Med J 2007; 48: 586-594. Elements of a patient-oriented manuscript Element 1: The title The title should be short and entice the reader to continue to read. A title composed of a declarative sentence or a question, rather than a technically correct but verbose title. e.g., instead of “Mortality in Pharmacologically Treated Older Adults With Diabetes: The Cardiovascular Health Study 1989-2001” consider “Diabetes Is an Important Risk Factor for Cardiovascular and Other Diseases in Older Adults.”

13. Elements of a patient-oriented manuscript Element 1: The title Another example, “Can Gene Expression Predict the Severity of Normal Tissue Damage After Radiation?” instead of “Analysis of Gene Expression Using Gene Sets Discriminates Cancer Patients With and Without Late Radiation Toxicity”. After writing the manuscript and internalizing the study, you will think of multiple, better titles and you can choose the best one.

14. Elements of a patient-oriented manuscript Element 2: The introduction Purpose: provide enough information to hook the reader. Focused, short, & should be 500 words or less (about half an A4 page). • Address the following questions: • Why is this clinical problem of interest? • What are the deficiencies in the current literature? • What is the purpose of this paper? Composed of as few as 2 to 3 paragraphs is able to answer these 3 questions well.

15. Elements of a patient-oriented manuscript Element 2: The introduction The most important part is the paragraph summarizing the study purpose. The purpose paragraph has 3 elements: (1) A statement of purpose (2) A hypothesis statement (3) Specific-aims statements.

16. Elements of a patient-oriented manuscript Element 2: The introduction Two different techniques to state the study purpose. Conventional technique: state the purpose literally: The purpose of this study is to measure the efficacy of prophylactic antibiotics in preventing postoperative complications in patients undergoing third molar removal.

17. Elements of a patient-oriented manuscript Element 2: The introduction Two different techniques to state the study purpose. Alternative approach: in form of a clinical question by using PICO - patient (P), intervention (I), control or comparison (C), & outcome (O). Reformulated as a clinical question: Among patients with impacted third molars (patient sample), does the use of prophylactic antibiotics (intervention of interest), when compared with a placebo control (control group or treatment), reduce the frequency of postoperative infections (outcome of interest)? Case series have the purpose stated in the form of a clinical question, without the C component.

18. Elements of a patient-oriented manuscript Element 2: The introduction Hypotheses statements can be formal or informal. • Formal hypothesis statements: • The frequency of postoperative infections in the treatment group • equals (or does not equal) the frequency of infections in the • control group. • This statement implies a 2-tailed test of hypothesis. • (2) The frequency of postoperative infections in the treatment group • is lower than the frequency of infections in the control group. • This statement implies a 1-tailed test of hypothesis.

19. Elements of a patient-oriented manuscript Element 2: The introduction Hypotheses statements can be formal or informal. • Less formal hypothesis statements : • There exists a set of 1 or more factors that can be • manipulated by the clinician to improve implant survival. • (2) Giant cell lesions are vascular tumors and treatment with • antiangiogenic products can decrease the risk of recurrence.

20. Elements of a patient-oriented manuscript Element 2: The introduction Specific aim(s) statement: tell, unambiguously, the reader what you did in the study. Commonly used terms: measure, design, identify, implement, estimate, compare, or identify. Examples of specific aims: ● To measure the length of hospitalization in a sample undergoing orthognathic surgery and identify factors associated with decreased length of stay ● To estimate the 1-year survival rates of implants loaded immediately and of implants loaded in a delayed manner

21. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. The first sentence unambiguously states the study design, e.g.: the investigators designed and implemented a double-blind, placebo-controlled, randomized clinical trial.

22. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. Choices of study design (in descending levels of validity)—Randomized clinical trial (multi-institutional or single institutional, double-blind or single-blind, placebo-controlled), cohort (prospective or retrospective), case-control, cross-sectional, case series (prospective or retrospective), & case series or report.

23. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. The second sentence summarizes the parametersused to select the study sample. Include the population from which the sample is derived and inclusion and exclusion criteria. The study sample was derived from the population of patients who presented to the Department of Oral & Maxillofacial Surgery at the Massachusetts General Hospital for evaluation and management of mandibular fractures between January 1, 1998 & December 31, 2000.

24. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. Variables can be categorized as predictor, outcome, & other. In most patient-oriented research, the goal is to establish an association/relationship between the predictor (independent) and outcome (dependent) variables. These include exposures, risk or prognostic factors, or treatments of interest, e.g., treatment(active vs. placebo), age (25 years vs. 25 years), implant loading(immediate vs. delayed), or radiation dose (cGy).

25. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. May be numerous outcomes of interest, but the study should be designed to measure 1 primary outcome of interest, e.g., postoperative inflammatory complication (yes/no), duration of implant survival (months), or development of osteoradionecrosis (yes/no). Clear to the reader which variables are primary and which are secondary outcomes of interest

26. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. Data collection: information regarding the details of randomization, how the standard and experimental treatments rendered, how subjects are managed, or details of how data are abstracted from charts. Data collection: information regarding methods used to assess intraexaminer and interexaminer variability and standardization of examiners, or processes for data collection or abstraction.

27. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. Data management: include information regarding who and how data were input and stored, what software was used for data storage and analyses, methods used to assure accurate input (e.g., double-entry techniques or checks for erroneous inputs) and how missing data were managed.

28. Elements of a patient-oriented manuscript Element 3: The material and methods section Four major components : (1) study design, (2) sample identification & selection, (3) variables, (4) data analyses. Data analyses:a brief description of analytic methods used & specification of level of  error (i.e., P value) Descriptive statistics (mean, frequency, range, standard deviations) were computed for each study variable. Bivariate analyses (e.g., chi-square, t test) were computed to measure the association between any 2 variables of interest (e.g., treatment type and age or treatment type and sex).

29. Elements of a patient-oriented manuscript Element 4: The results section The easiest way to write the results section is to complete all of the tables first. The text flows naturally from the tables. All studies should include at least 2 tables (Tables I & II): Using descriptive statistics, Tables I & II summarize for the reader the characteristics of the study sample. Unless the sample size too small and the sample’s characteristics are summarized in the text, e.g.: the sample was composed of 3 cases with ages ranging from 10 to 14 and 2 subjects were female.

30. Elements of a patient-oriented manuscript Element 4: The results section

31. Elements of a patient-oriented manuscript Element 4: The results section

32. Elements of a patient-oriented manuscript Element 4: The results section

33. Elements of a patient-oriented manuscript Element 4: The results section

34. Elements of a patient-oriented manuscript Element 4: The results section

35. Elements of a patient-oriented manuscript Element 4: The results section

36. Elements of a patient-oriented manuscript Element 4: The results section

37. Elements of a patient-oriented manuscript Element 4: The results section

38. Elements of a patient-oriented manuscript Element 4: The results section

39. Elements of a patient-oriented manuscript Element 4: The results section

40. Elements of a patient-oriented manuscript Element 4: The results section

41. Elements of a patient-oriented manuscript Element 4: The results section

42. Elements of a patient-oriented manuscript Element 5: The discussion The most challenging aspect of the preparation of the paper: 4 sections The goal of the first section: limited to a single paragraph - draw the reader’s attention back to the goal of the study. 3 sentences: The first sentence restates the study purpose, the second summarizes the hypothesis, and the third recapitulates the specific aims.

43. Elements of a patient-oriented manuscript Element 5: The discussion The most challenging aspect of the preparation of the paper: 4 sections The second section summarizes the key results relate to the study purpose or hypothesis. e.g.: The results of this study confirm the hypothesis that antibiotics administered after the surgical procedure are as effective as no antibiotics in preventing postoperative inflammatory complications. The frequency of complications in the antibiotic and no-antibiotic groups were 6.2% & 5.8%, respectively . Based on the results of this study, the post-operative use of oral antibiotics is unwarranted & is associated with an increased risk of undesirable side effects such as nausea, allergic reactions, & unnecessary patient expense.

44. Elements of a patient-oriented manuscript Element 5: The discussion The most challenging aspect of the preparation of the paper: 4 sections The third section (in lieu of having a literature review in the introduction) summarizes how the results of this study compare to other studies published on the topic. The fourth section summarizes the weaknesses and strengths of the study. Addressing a study weakness and how it was offset or neutralized by a strength, e.g., a study design or analytic method. If the weakness persists, outline how it may affect the reader’s interpretation of the results.

45. Elements of a patient-oriented manuscript Element 6: The conclusion Summarize the key findings of the study. Similar to an abbreviated second paragraph of the discussion. A brief outline of future research questions that have been raised by the current study.

46. Conclusions 多閱讀： 勤於閱讀自己領域有關之雜誌，累積靈感，了解各雜誌之特色、屬性與狀況 (是否屬SCIE、IF?; 是否缺稿、某類文章是否已數度刊登、不接受病例報告、……) (是區域性或國際性雜誌、審稿時間是否很長、…….)。 多了解： 徹底了解自己文章的特色，加以發揮。 多嘗試： 勇於執筆與投稿，累積經驗 (需熟讀instruction to authors, reference formats, ....)。 不畏懼： 不害怕失敗(退稿)，鍥而不捨，一而再，再而三。

47. Conclusions Case Report/Clinical Techniques An Aiming Device for an Extraoral Radiographic Technique Chia-Hue Chen, Shui-Hui Lin, Hui-Lin Chiu, Yu-Ju Lin, Yuk-Kwan Chen, Li-Min Lin J Endod 2007;33:758–60 Newman ME, Friedman S. Extraoral radiographic technique: an alternative approach. J Endod 2003;29:419 –21

48. Conclusions Tuberculosis of the head and neck: a review of 20 cases Table I. Summary of data relating to the 13 patients with oral tuberculosis in the present study aPatients have been ordered according to the chronological sequence of presentation during the series; bMultiple involvement; M: Male; F: female; NA: not available

49. Conclusions Tuberculosis of the head and neck: a review of 20 cases Table II. Summary of data on the seven patients identified with tuberculosis in the neck aPatients have been ordered according to the chronological sequence of presentation during the series; M: Male; F: female; NA: not available

50. Conclusions Tuberculosis of the head and neck: a review of 20 cases Table III. Presenting symptoms of patients found to have oral TB in the present study