Corso di clinical writing

1. Corso di clinical writing

2. What to expect today? Core modules • Introduction • Generalprinciples • Specifictechniques • Title/Abstractdrafting • Finding out relevantliterature, and Introductiondrafting • Nuts & boltsofstatistics and Methodsdrafting • Practicalsession 1 – Appraisalof a publishedarticle

3. Choiceof English

4. Choiceof English Whyisthispresentation in English?

5. Choiceof English Whyisthispresentation in English? Questa presentazione è stata preparata in lingua inglese per permettervi di familiarizzarvi con la terminologia e gli approcci alla scrittura in lingua inglese, e anche perché così il relatore ha potuto risparmiare tempo e parole, ed essere più chiaro. (single sentence, 39 words) Thispresentationwasprepared in English toenableyoutofamiliarizewith English terms and approaches. Moreover, the speaker couldthussavetime and words, beingalsoclearer. (twosentences, 28 words)

6. Clinicalresearchwriting Is writing a clinical research paper easy?

7. RememberGrossman’s words I have not found…writing one bit easier today than it was 30 years ago. I still have to work at it very hard and make many revisions, with a rare exception… because the saying of Francis Bacon has always been deeply impressed in my mind..”Writing [maketh an] exact man.”Morton Grossman (>400 scientific papers, 134 editorials, and 71 books or book chapters)

8. ParaphrasingGrouchoMarx… The more you write, the better writer you will become… …and if I can write in ENGLISH, most of you can!

9. But life istoo short • Is the paper worth writing? • Have similar findings been reported? • Is there a need for another report? • Are your findings more convincing? • Is the paper important? • Apply the “so-what” test

10. Reasonsforwriting a paper A clinician can write a paper for several reasons: -divertissement -build up the CV -self-advertising -increase collective knowledge

11. Otherreasons • No publication, no project • Make information available for others • No publication, no promotion • Yardstick of productivity • No publication, no funding • What have you done for me lately?

12. Otherreasons I would urge you to write, not because it is a good thing, not because it is nice to see your name in print,… but rather because you will really get to know a field only if you contribute to itMahoney MJ, Psychology of the Scientist 1979

13. Disclaimer • This talk will not help you if you have nothing to write about: • Ability to ask a good question • Commitment to career development • Willingness to or experience in research • Ability to protect your time

14. Whogets the credit? In science, the credit goes to the man who convinces the world, not to the man to whom the idea first occurs. ─ Sir Francis Darwin

15. Advice: keepenjoyingwriting

16. Advice: bring the draft wherever it suits you

17. Advice: maintain a global view as well as a…

18. …focused, structured and analyticapproach What landscape should I paint? Which color for her eyes? Is she a she or a he? Am I in love with her? Who cares about this painting? In a few years nobody will see it!

19. Gestational period for a clinical paper START PROTOCOL/IRB 2-4 months STUDIES/ EXPERIMENTS 4-24 months 14-44 Months! WRITE AND SUBMIT 2-4 months REWRITE AND RESUBMIT 2-4 months 2-4 months WAIT 2-4 months PUBLISHED! BEST GUESS

20. Time to publication • More realistic time from submission to publication projections in the WWW era: • Letters to the Editor 4-12 weeks • Editorials 3-6 months • Reviews 6-12 months • Case reports 6-12 months • Non-RCT clinical studies 6-18 months • RCTs 6-18 months • Ground-breaking RCTs <6 months

21. Settinggoals • First author papers in major journals • First author papers in secondary journals • Total papers • Non-first author papers • Secondary journals • Book chapters or review papers (AVOID [?])

22. Trackinggoals • Every 3-6 months, tabulate: • Published papers in past year (Ppub) • Number of papers under review (Prev) • Number of papers in preparation (Pprep)

23. Probableannual production (PAP) Ppub+ Prev+ Pprep PAPraw= 3

24. Barrierstogoals • Extrinsic • - Major teaching responsibility (Tr) • - Major committee assignments (C) • - Personnel disputes (Pers) • - Grants (Gr) • Intrinsic

25. AdjustedProbableAnnual Production (PAPadj) PAPadj= PAPraw– 2 * (Grn + Persn) – (Tr + C)

26. Intrinsiccausesofwritingproblems • Internal censors • Fears of failure • Perfectionism • Procrastination

27. Censors • “Watchers at the Gate” • - Internal censors • - Internal critics • Induce bad feelings about writing • Undermine ability to generate ideas

28. Censors When you hear him, the internal critic speaks in a shrill tone- rational, often pessimistic, alerts only to the dangers of the world around us, and therefore to the shortcomings in our work.Assuming the voices of parents, teachers, and other authority figures, he whispers and sometimes shouts that our writing is bad…He edits words and thoughts before we have a chance to put them on paper, and thus creates a blank page panic.

29. Intrinsicblockstowriting • Inability to start writing: • - “First, there is the difficulty of writing at all” • D. BrandeBecoming a Writer • - Perfectionism, self-consciousness, procrastination

30. Howtoincrease and sustainproductivity • Time management • Stimulus control • Contingency management • Limit and deadline setting

31. How to increase and sustain productivity • Work: • Daily • 30 minutes to one hour • Do not pay attention to structure, grammar, spelling • Jump from project to project

32. Spontaneouswriting • “You can’t think and hit at the same time” Y. Berra • Learn to write: • Without feeling “ready” • Without feeling fully in control • Without awaiting inspiration • “Learning to write at a gallop leaves one’s internal critics behind” V. Woolf • Once under way, writing builds its own momentum

33. Best timetowrite • Morning • Afternoon • Evening • Night • Pick a time and protect it!!!

34. Inabilitytofinishwriting • Multiple revisions • Multiple analyses • “Each time I think I am finished, I see there is a lot more to do” • Similar roots as inability to start (perfectionism) • Different people • Lack of insight

35. Whichmanuscript?

36. Whichmanuscript? Before beginning writing, you need to choose the manuscript type/design

37. Choosing a manuscripttype Manuscript type Effort Reward Abstract for scientific meeting ± ± Letter to the Editor ± ± Editorial + + Book chapter + + Qualitative review + + Systematic review ++ ++ Case reports or Images ±± Case series + + Non-RCT study ++ ++ RCT +++ +++

38. Levelsofarticles Primary: Peer Reviewed Secondary: Not peer reviewed Primary Secondary

39. Levelsofpeer-reviewedarticles Primary: original research Secondary: review articles Tertiary: textbooks, summaries Primary Secondary Tertiary

40. Parallelhierarchyof CV research Qualitative reviews Case reports and series Observational studies Systematic reviews Observational controlled studies Meta-analyses from individual studies Randomized controlled trials Meta-analyses from individual patient data Multicenter randomized controlled trials Biondi-Zoccai, Ital Heart J 2003

41. Whataboutevidence-based medicine? Excerpt from a 1990 leaflet for internal medicine resident at McMaster University (Hamilton, Canada): “…goal of evidence-based medicine is to be aware of the evidence on which one’s practice is based, the soundness of the evidence, and the strength of inference the evidence permits. The strategy employed requires a clear delineation of the relevant question(s); a thorough search of the literature relating to questions; a critical appraisal of the evidence, and its applicability to the clinical situation; and a balanced application of the conclusions to the clinical problem.” Guyatt and Rennie, Users’ guide to the medical literature, 2002

42. Evidence-based medicine (EBM) Definition: The coscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic search. Guyatt and Rennie, Users’ guide to the medical literature, 2002

43. Rebuttaltocriticsof EBM Evidence alone is never sufficient to make a clinical decision: decision makers must always trade the benefits and risks, inconvenience, and costs associated with alternative management strategies, and in doing so consider the patient’s values! Guyatt and Rennie, Users’ guide to the medical literature, 2002

44. EBM hierarchyofevidence • N of 1 randomized controlled trial • Systematic reviews of randomized trials • Single randomized trial • Systematic review of observational studies addressing patient-important outcomes • Single observational study addressing patient-important outcomes • Physiologic studies (eg blood pressure, cardiac output, exercise capacity, bone density, and so forth) • Unsystematic clinical observations Guyatt and Rennie, Users’ guide to the medical literature, 2002

45. Editorial Chen, Surg 2008

46. Qualitative review Visser et al, Am J Surg 2008

47. Qualitative review Visser et al, Am J Surg 2008

48. Systematicreview Siddiqui et al, Am J Surg 2008

49. Systematicreview Siddiqui et al, Am J Surg 2008

50. Image in surgery Lough et al, Am J Surg 2008