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Corso di clinical writing

Corso di clinical writing. What to expect today?. Core modules. Introduction General principles Specific techniques Title/Abstract drafting Finding out relevant literature , and Introduction drafting Nuts & bolts of statistics and Methods drafting

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Corso di clinical writing

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  1. Corso di clinical writing

  2. What to expect today? Core modules • Introduction • General principles • Specific techniques • Title/Abstract drafting • Finding out relevantliterature, and Introductiondrafting • Nuts & boltsofstatistics and Methodsdrafting • Practicalsession 1 – Appraisalof a publishedarticle

  3. Resources for finding the literature • Seniors, juniors, and colleagues • Textbooks • Medical journals • World wide web

  4. Whattochoose? or … fast but tough? Simple and easy-going

  5. Seniors, juniors, and colleagues

  6. Textbooks

  7. Medicaljournals

  8. World wide web

  9. 1st step: framing the question

  10. 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?

  11. 2nd step: determiningquestiontype

  12. 2nd step: determiningquestiontype • 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

  13. 1st step: example • All-purposequestion:is laparoscopic surgery for colon cancerbeneficial? • Improved (searchable) question: • Population: patientswith colon cancerwithanindicationtosurgicalresection • Intervention:attempt at laparoscopic resectionof colon cancer • Outcome:cancer-freesurvival, mortality, positive resectionmargins, localrecurrence, wound-siterecurrence, blood loss duringsurgery

  14. 2nd step: example • Therapy:whichtechniqueis more effective and safe for thydoidsurgery? • Harm:whatis the riskof positive resectionmarginswith laparoscopic surgery for colon cancer? • Diagnosis:can I recognizewhich CT normallyappearingappendices are inflammed? • Prognosis:can I predictwhichpatientsundergoingmajroabdominalsurgery are more likelytodeveloppulmonarythromboembolism?

  15. WWW resources • BioMedCentral: www.biomedcentral.com • 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 RegisterofControlledTrials (mRCT):www.controlled-trials.com/mrct/ • PubMed: www.pubmed.gov • The CochraneLibrary: www.cochrane.org • UpToDate: www.uptodate.com • WebMD: www.webmed.com • Web of Science:isiknowledge.com

  16. WWW resources • BioMedCentral: www.biomedcentral.com • 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 RegisterofControlledTrials (mRCT):www.controlled-trials.com/mrct/ • PubMed: www.pubmed.gov • The CochraneLibrary: www.cochrane.org • UpToDate: www.uptodate.com • WebMD: www.webmed.com • Web of Science:isiknowledge.com

  17. BioMedCentral

  18. BioMedCentral

  19. 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

  20. Clinicaltrials.gov

  21. Clinicaltrials.gov • Clinicaltrials.govis a comprehensive and free collectionofpast, present and future clinicaltrials • Itcontainsdesigns, objectives, selectioncriteria and enrolment status of the mostimportantclinicaltrialsworldwide • However, itisnotthatcomprehensive (missesmanysmallstudies) and oftenresults are missing

  22. DARE

  23. DARE • The Database ofAbstractsofReviewsofEffectivenessisprovided for free by the Universityof York • Itcontainstitles and abstractsofsystematicreviewsofeffectiveness • Each item contained (iesystematicreviews) is a verygoodstartingpointtoget info on a topic • However, some hits are obsolete and no papers on prognosis, diagnosis, or pathophysiology are includedto date

  24. EMBASE

  25. EMBASE • EMBASE is a comprehensivearchiving site, provided for a feebyElsevier • Its scope issimilarbutgreater and largelynon-overlappingwith MEDLINE/PubMed • Itmaybeuseful for sophisticated researchers and systematicreviewers • However, it’s expensive and rarelyneeded, asmostimportantpaperswillbealready in MEDLINE/ PubMed

  26. MEDSCAPE

  27. MEDSCAPE • A freelysurfable website providing disparate content, ownedby the WebMD company • The Surgerysectionisoftenupdated and mayproviderecent data on trials or other news • Itisnotdeveloped or maintainedsystematically, and thuslackscomprehensiveness

  28. mRCT

  29. mRCT • The meta RegisterofControlledTrialsis a freelysearchable website containing data on registeredtrials • Itisprovidedby the ownerofBioMedCentral • It’s a good source on recent or ongoing (thusunpublished) trials • Whileinteresting for the clinicalresearcher or meta-analyst, its scope islimitedto RCT

  30. PubMed

  31. PubMed • PubMedis the web (and free) versionof MEDLINE (providedby the US National Libraryof Medicine) • Itcontains data on articlesprintedeveryday in severalthousandsmedicaljournalsaround the world, evenifthereis some biastoward US and English-languagepublications • Itisreasonablycomprehensive and sophisticated, especially for the expert user • Nonetheless, manypapers can stillbemissedby the MEDLINE indexers, and usingPubMedrequires some expertise

  32. PubMed: tips and tricks • There are 4 basicwaystosearchPubMed: • Free text searches • Searcheswithdescriptors(MedicalSubjectHeadings, MeSH) • Clinicalqueries(specificfilters for studies or topics) • Limits(enable the searchertoselectseveralcharacteristics, suchaslanguage, articletype, studytype, and so forth) • The idealsearchcombinesone or more ofsuchinstrumentstoobtain precise and concise answersto the clinicalquestion

  33. Free text searches

  34. MeSH

  35. Limits

  36. Clinicalqueries

  37. History

  38. Tutorials

  39. Scholar Google

  40. Scholar Google • Scholar Google isprovided for free by the Google company • Itcontainscitations and directlinkstoabstracts or full text articles • In addition, itenablescitationanalysis, thusforward and backwardsnowballing • It’s notyetverystructered, and highlyrelevantcitationsmightnotbeincluded or missedbecauseburiedamongthousandsofnon-relevantones

  41. The CochraneCollaboration

  42. The CochraneCollaboration • The CochraneCollaborationprovidesabstractsofsystematicreviews for free and full texts and additionalservices for a fee • Itcontains the mostrigoroussystematicreviewsavailableto date on treatment • No comprehensivesystematicreviews are yetavailable for othertopics • Manyreviews, whilehighlyvalid and pertinent, mightbeoutdatedbecauseofinfrequentupdates

  43. UpToDate

  44. UpToDate • UpToDateisprovided for a feebyan American company • Itprovides qualitative reviewsofmosttopics, with the specificfeaturesthatreviews are updatedveryfrequently • No strictmethodology for review production or update isenforced • In addition, itmightseemsuperficial and notdetailedenough for expertsof a topic

  45. WebMD

  46. WebMD • WebMDis a comprehensive website for healthcareprofessional, that can beaccesseduponfeesubscription • Itisrelativelycomprehensivebutunstructured • Resembles (albeitwithlessclinical focus) www.medscape.com, and www.tctmd.com

  47. Web of Science

  48. Web of Science • Provided for anexpensivefeebyThompson-Institute for ScientificIndexing, is the basis for the computationof impact factors and citationindexes • Containstitles and abstractsfromseveralthousandsjournals • In addition, itenablesforward and backwardsnowballing • However, itlacks the comprehensivenessof EMBASE or PubMed

  49. Impact factor • Measureshowmanycitations are received in 2 yearsby a specific journal (times the articlespublishedeveryreferenceyear)

  50. Impact factors in surgery (2006)

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