Clinical Writing for Interventional Cardiologists

1. Clinical Writing for Interventional Cardiologists

2. What you will learn - hopefully! • Introduction • General principles for clinical writing • Specific techniques • Practical session: critical review of a published article • Writing the Title and the Abstract • Bibliographic search and writing the Introduction • Principles of statistics and writing the Methods • Practical session: writing the Abstract • Writing the Results • Writing the Discussion • Writing Tables and preparing Figures • Principles of peer-review • Principles of grant writing/regulatory submission • Clinical writing at a glance • Conclusions and take home messages

3. What you will learn • Bibliographic search and writing the Introduction • methods of bibliographic search • most popular databases, including Google Scholar, PubMed, Web of Science • goals of Introduction • effective tips for Introduction

4. What you will learn • Bibliographic search and writing the Introduction • methods of bibliographic search • most popular databases, including Google Scholar, PubMed, Web of Science • goals of Introduction • effective tips for Introduction

5. What to choose for a bibliographic search? or … fast but tough? Simpleand easy-going

6. Seniors, juniors, and colleagues

7. Textbooks

8. Medical journals

9. World wide web

10. 1st step: framing the question

11. 1st step: framing the question • Population:who are the relevant patients? • Intervention or exposure:what are the management strategies we want to appraise or the relevant harmful exposure we want to study? • Outcome:what are the patient-relevant consequences of the exposure in which we are interested?

12. 2nd step: determining question type

13. 2nd step: determining question type • Therapy:determining the effect of different treatments on improving patient function and avoiding adverse events • Harm:ascertaining the effects of potentially harmful agents on patient function, morbidity, and mortality • Diagnosis:establishing the power of an intervention to differentiate between those with and those without a target condition or disease • Prognosis:estimating the future course of a patient’s disease

14. 1st step: example • All-purposequestion:are 1st generation DES safe? • Improved (searchable) question: • Population: patientswith acute or chroniccoronarydiseaseundergoing PCI • Intervention/Comparison:implantationof 1st generation DES (Intervention) vs BMS (Comparison) – randomizedallocation • Outcome(s):death, myocardialinfarction, stroke, repeatrevascularization, stent thrombosis, rehospitalizations, costs

15. 2nd step: example • Therapy:which embolic protection device is more effective and safe? • Harm:what is the risk of stent fracture with DES? • Diagnosis:can I recognize which angiographically-intermediate coronary lesions are functionally significant? • Prognosis:can I predict which patients are more likely to develop stent thrombosis if treated with DES?

16. What you will learn • Bibliographic search and writing the Introduction • methods of bibliographic search • most popular databases, including Google Scholar, PubMed, Web of Science • goals of Introduction • effective tips for Introduction

17. WWW resources • BioMedCentral: www.biomedcentral.com • Clinical Trial Results: www.clinicaltrialresults.org/ • Clinicaltrials.gov: www.clinicaltrials.gov • DARE: www.york.ac.uk/inst/crd/crddatabases.htm • EMBASE: www.embase.com • Google Scholar: scholar.google.com • Medscape: www.medscape.com • meta Register of Controlled Trials (mRCT): www.controlled-trials.com/mrct/ • PubMed: www.pubmed.gov • The Cochrane Library: www.cochrane.org • UpToDate: www.uptodate.com • WebMD: www.webmed.com • Web of Science: isiknowledge.com

18. WWW resources • BioMedCentral: www.biomedcentral.com • Clinical Trial Results: www.clinicaltrialresults.org/ • Clinicaltrials.gov: www.clinicaltrials.gov • DARE: www.york.ac.uk/inst/crd/crddatabases.htm • EMBASE: www.embase.com • Google Scholar: scholar.google.com • Medscape: www.medscape.com • meta Register of Controlled Trials (mRCT): www.controlled-trials.com/mrct/ • PubMed: www.pubmed.gov • The Cochrane Library: www.cochrane.org • UpToDate: www.uptodate.com • WebMD: www.webmed.com • Web of Science: isiknowledge.com

19. BioMedCentral

20. BioMedCentral • BioMedCentral is provided by a private UK company (the same that provides mRCT) • It mostly contains open access journals or conference proceedings • It may be a useful and cheap (it’s free!) starting point, but to date its content is limited • In the future however it should vastly expand

21. Clinical Trial Results

22. Clinical Trial Results • CTR is provided for free by C.M. Gibson (the author of the TIMI frame count and TIMI myocardial perfusion grade) • It contains pre-publication data from recent clinical trials • However, it is not comprehensive and its scope largely reflects the interests of its developer (ie coronary disease)

23. clinicaltrials.gov

24. clinicaltrials.gov • clinicaltrials.gov is the FDA-supported and recommended registry of prospective studies • It contains protocols of ongoing or recently completed trials • Registration in clinicaltrials.gov or similar registries is now mandatory to be eligible for publication of prospective studies in major journals

25. DARE

26. DARE • The Database of Abstracts of Reviews of Effectiveness is provided for free by the University of York • It contains titles and abstracts of systematic reviews of effectiveness • Each item contained (ie systematic reviews) is a very good starting point to get info on a topic • However, some hits are obsolete and no papers on prognosis, diagnosis, or pathophysiology are included to date

27. EMBASE

28. EMBASE • EMBASE is a comprehensive archiving site, provided for a fee by Elsevier • Its scope is similar but greater and largely non-overlapping with MEDLINE/PubMed • It may be useful for sophisticated researchers and systematic reviewers • However, it’s expensive and rarely needed, as most important papers will be already in MEDLINE/ PubMed

29. Google Scholar

30. Google Scholar • Scholar Google is provided for free by Google • It contains citations and direct links to abstracts or full text articles • In addition, it enables citation analysis, thus forward and backward snowballing • It’s not yet very structered, and highly relevant citations might not be included or missed because buried among thousands of non-relevant ones

31. MEDSCAPE

32. MEDSCAPE • A freely surfable website providing disparate content, now owned by the WebMD company • The Cardiology section is often updated and may provide recent data on trials or other news • It is not developed or maintained systematically, and thus lacks comprehensiveness

33. mRCT

34. mRCT • The meta Register of Controlled Trials is a freely searchable website containing data on registered trials • It is provided by the owner of BioMedCentral • It’s a good source on recent or ongoing (thus unpublished) trials • While interesting for the clinical researcher or meta-analyst, it’s scope is limited to RCT

35. PubMed

36. PubMed • PubMed is the web (and free) version of MEDLINE (provided by the US National Library of Medicine) • It contains data on articles printed every day in several thousands medical journals around the world, even if there is some bias toward US and English-language publications • It is reasonably comprehensive and sophisticated, especially for the expert user • Nonetheless, many papers can still be missed by the MEDLINE indexers, and using PubMed requires some expertise

37. PubMed: tips and tricks • There are 4 basic ways to search PubMed: • Free text searches • Searches with descriptors (Medical Subject Headings, MeSH) • Clinical queries (specific filters for studies or topics) • Limits (enable the searcher to select several characteristics, such as language, article type, study type, and so forth) • History • The ideal search combines one or more of such instruments to obtain precise and concise answers to the clinical question

38. Free text searches

39. MeSH

40. Limits

41. Clinical queries

42. History

43. Where to learn how to use PubMed?

44. The Cochrane Collaboration

45. The Cochrane Collaboration • The Cochrane Collaboration provides abstracts of systematic reviews for free and full texts and additional services for a fee • It contains the most rigorous systematic reviews available to date on treatment • No comprehensive systematic reviews are yet available for other topics • Many reviews, while highly valid and pertinent, might be outdated because of infrequent updates

46. UpToDate

47. UpToDate • UpToDate is provided for a fee by an American company • It provides qualitative reviews of most topics, with the specific features that reviews are updated very frequently • No strict methodology for review production or update is enforced • In addition, it might seem superficial and not detailed enough for experts of a topic

48. WebMD

49. WebMD • WebMD is a comprehensive website for healthcare professional, that can be accessed upon fee subscription • It is relatively comprehensive but unstructured • Resembles (albeit with less cardiovascular focus) www.crtonline.org, www.medscape.com, www.theheart.org, and www.tctmd.com

50. Web of Science