Anatomi dan Gaya Penulisan Naskah Ilmiah

1. Anatomi dan Gaya Penulisan Naskah Ilmiah Dr. Sugito Wonodirekso, MS Departemen Histologi FKUI 16 Juni 2005 Ruang Auditorium Departemen Bedah FKUI – Perjan RSCM

2. Pendahuluan • Sekarang ini tulisan ilmiah kedokteran luar biasa banyaknya sekalipun kualitasnya tidak serta-merta meningkat juga • Menulis itu mudah, apalagi sekarang sudah ada komputer sehingga: • Literatur mudah didapat • Format tulisan sudah tersedia • Jenis huruf sangat memadai • Program koreksi sangat membantu • Harus segera dimulai, jangan hanya direncanakan Sugito Wonodirekso

3. Pendahuluan • Menulis merupakan proses berpikir dan belajar • Kesempatan yang baik untuk menggali gagasan • Anda akan sangat paham subyeknya dan menjadikannya milik anda, selamanya • Membantu anda belajar dan memperoleh hak atas ilmu • Dengan mengkomunikasikannya berarti anda juga mengajar • Menulis merupakan cara untuk mengungkapkan isi pikiran • Menulis menghasilkan bacaan • Kemampuan menulis diperlukan untuk kalangan terpelajar Sugito Wonodirekso

4. Pendahuluan • Keterbatasan dan Tujuan • Tak mungkin mahir menulis dalam sekejap • Di sini tidak dibahas perihal peran “Kata – Istilah – Frasa – Kalimat” • Dipercontohkan struktur paragraf • Memicu minat dan memacu bakat menulis secara jelas, lugas, laras dan mudah dicerna. • Disiratkan tiga kiat pandai menulis: • Berlatih • Berlatih • Berlatih Sugito Wonodirekso

5. Anatomi tulisan ilmiah Sugito Wonodirekso

6. Thesis • Title page • Abstract • Acknowledgements • Table of contents • Review of the literature — concluding with a summary • Statement of the problem, aims of the study, hypothesis • Materials and methods (including statistical analysis) • Results • Discussion • Conclusions • Appendices • References Sugito Wonodirekso

7. Research article • Kunci keberhasilan penulisan makalah ilmiah adalah mengenali anatomi atau struktur dasar artikel ilmiah pada umumnya.Makalah ilmiah misalnya artikel riset selalu menyuguhkan pertanyaan atau permasalahan dan sekaligus jawabannya. Setelah pertanyaan dalam riset terperikan secara jelas, menulis artikel riset menjadi lebih mudah. Pada dasarnya struktur artikel riset selalu berupa rangkaian sistematik dan terpadu yang terdiri atas “Introduction, Methods, Results, and Discussion (sometimes abbreviated as IMRAD)”. Setiap bagian mempunyai obyektif atau peran tersendiri. Introduksi digunakan untuk menyatakan masalah yang hendak dijawab (pertanyaan riset). Selanjutnya dalam Metodologi penulis menyampaikan tata langkah sistematis yang hendak dikerjakan untuk menjawab pertanyaan itu. Kemudian dalam Hasil, penulis menyampaikan hasil pengamatannya. Akhirnya dalam Diskusi penulis menyampaikan pendapat atau arti temuannya. Sugito Wonodirekso

8. Research article • Introduction • State why the problem you address is important • State what is lacking in the current knowledge • State the objectives of your study or the research question • Methods • Describe the context and setting of the study • Specify the study design • Describe the ‘population’ (patients, doctors, hospitals, etc.) • Describe the sampling strategy • Describe the intervention (if applicable) • Identify the main study variables • Describe data collection instruments and procedures • Outline analysis methods Sugito Wonodirekso

9. Research Article • Results • Report on data collection and recruitment (response rates, etc.) • Describe participants (demographic, clinical condition, etc.) • Present key findings with respect to the central research question • Present secondary findings (secondary outcomes, subgroup analyses, etc.) • Discussion • State the main findings of the study • Discuss the main results with reference to previous research • Discuss policy and practice implications of the results • Analyse the strengths and limitations of the study • Offer perspectives for future work Sugito Wonodirekso

10. Common mistakes • The research question is not specified • The stated aim of the paper is tautological (e.g. ‘The aim of this paper is to describe what we did’) or vague (e.g. ‘We explored issues related to X’) • The structure of the paper is chaotic (e.g. methods are described in the Results section) • The manuscripts does not follow the journal’s instructions for authors • The paper much exceeds the maximum number of words allowed • The Introduction is an extensive review of the literature • Methods, interventions and instruments are not described in sufficient detail • Results are not reported selectively (e.g. percentages without frequencies, P-values without measures of effect) Sugito Wonodirekso

11. Common mistakes • The same results appear both in a table and in the text • Detailed tables are provided for results that do not relate to the main research question • In the Introduction and Discussion, key arguments are not backed up by appropriate references • References are out of date or cannot be accessed by most readers • The Discussion does not provide an answer to the research question • The Discussion overstates the implications of the results and does not acknowledge the limitations of the study • The paper is written in poor English (Bahasa Indonesia) Sugito Wonodirekso

12. Menulis abstrak yang informatif • ABSTRACTS SERVE 3 IMPORTANT PURPOSES: • They may persuade someone to read the article, • They allow busy readers to learn the main results without reading the entire article, and • They make it easy to capture the main results in computerized databases, such as MEDLINE, which make the results available worldwide. • Given these purposes, it is worth writing an informative abstract. Sugito Wonodirekso

13. Menulis abstrak yang informatif • Objective(s). • State an objective, not necessarily a hypothesis. • Hypothesis testing does not fit the design of many studies and sometimes leads to simplistic thumbs-up or thumbs-down conclusions. One sentence is usually sufficient. • We are convinced that the best articles focus on 1 objective; if you have more than 2, reconsider. • Examples: “To estimate the association between dietary intake of kumquats and school performance.” “To estimate the prevalence of asthma among school children in Iowa.” “To determine whether drug A, a new antiviral agent, reduced morbidity related to the common cold.” Sugito Wonodirekso

14. Menulis abstrak yang informatif • Design. • A few words can usually do the job. • Examples: • “Case-control study.” • “Randomized controlled trial.” • “Prospective cohort study.” • Not every study can be neatly summarized by a widely understood label; a brief description of what you did may be necessary. Sugito Wonodirekso

15. Menulis abstrak yang informatif • Setting. • This is about place and time; where and when the study participants were selected. Try to be specific without being wordy. • Examples: • “The Children’s Medical Center of the Bosporus, a referral hospital, Istanbul, Turkey, from September 1, 2001, to July 31, 2002.” “All public schools in Milwaukee, Wis, during the 2001-2002 school year.” • “Three general pediatric practices in Kansas City, Mo, from January 1990 to December 2001.” Sugito Wonodirekso

16. Menulis abstrak yang informatif • Participants. • Who was studied, and how many were studied? • Describe important eligibility criteria. • The most useful count of subjects may not be obvious. • Refusal to participate, dropouts, and missing information are potential sources of bias. • We encourage authors to be forthright; give the count for the target population and the count of the participants in the data actually analyzed. Sugito Wonodirekso

17. Menulis abstrak yang informatif • Examples: • “All 11041 children in the eighth grade; adequate information was available for 9411 children (85%), who formed the analytic sample.” • “A random sample of children admitted to the intensive care unit for bronchiolitis (N=201).” • “Asthma patients 4 to 15 years of age were randomly assigned to the intervention (n=67) or placebo (n=63) groups. Follow-up data on the outcome were available for 55 intervention and 60 control patients.” • If you did not collect the data, state the data source in this section; for example, “a survey done by the Nationa Center for Health Statistics.” Sugito Wonodirekso

18. Menulis abstrak yang informatif • Intervention(s) or Main exposure(s). • This section may include interventions that were controlled by the investigators or exposures that the investigators measured but did not manipulate, such as smoking, use of a bicycle helmet, or residence in a state with a seat belt law. • Skip this section if there was no intervention or exposure. • Examples: • “Oral acyclovir, 15 mg/kg 5 times per day for 5 days.” • “Drinking alcohol at least weekly.” • “Two hours of school instruction regarding seat belt use.” Sugito Wonodirekso

19. Menulis abstrak yang informatif • Main outcome measure(s). • There is room for choice in this section. Imagine your objective was “To estimate the association of new treatment X with death among infants with sepsis.” Given this objective, the main outcome was death prior to hospital discharge. Suppose the main analysis estimated the adjusted risk ratio for death of those who received the new treatment compared with children who received standard treatment. It would make the results section clearer and shorter if the main outcomes section said, “The main outcome was death in the hospital; adjusted risk ratio for death compared children receiving the new treatment with those given standard treatment.” Sugito Wonodirekso

20. Menulis abstrak yang informatif • Suppose the objective was “To estimate the association between kumquat consumption and school performance,” and there were 5 outcome measures, including grade point average, scores on standardized state tests, and days absent from school. It would save space to say in the outcome section, “Five measures of school performance; estimates of mean difference in each outcome per each additional 4-oz serving of kumquats,” and report the mean differences for each outcome measure in the results. Sugito Wonodirekso

21. Menulis abstrak yang informatif • Results. • The most common problem that we see in abstracts is a failure to give the main quantitative results. Give the main numerical results with estimates of precision, such as confidence intervals. • Examples: • Instead of “Asthma was highly prevalent,” give the proportion of children who had asthma with a confidence interval. Rather than “The intervention arm had better outcomes; P.01 for all comparisons,” show the proportions in each arm with each outcome and the ratios or differences in these proportions with confidence intervals. • Give the results that are thought to be most free of bias; if there was confounding in the study, give the adjusted estimates of association, not the crude estimates. If some outcomes were considered most important prior to the analysis, just report those. Avoid reporting just those outcomes that were statistically significant. Only report results that pertain to the study objective. Sugito Wonodirekso

22. Menulis abstrak yang informatif 8. Conclusion(s). • Conclusions should be related to the results given in the abstract. Suppose a case-control study of life vests and drowning reported in the results, “The risk of drowning was less among children wearing life vests, compared with those without vests (adjusted risk ratio, 0.5; 95% confidence interval, 0.3-0.6).” The conclusion might say, “If the association estimated in our study is causal, our results provide evidence that about half of child drownings can be prevented if children wear life vests.” If the study could not adjust for potentially important confounders, the conclusion might say, “If the association estimated in our study is causal, some drownings can be prevented if children wear life vests. Sugito Wonodirekso

23. Menulis abstrak yang informatif • However, our risk ratio estimate may be biased by confounding due to a lack of information about swimming ability.” But the conclusion should not say, “Laws should require parents to put their children in life vests.” If the study did not examine the effect of a law on either life vest use or drowning rates, laws should not be mentioned. • Don’t use the conclusion section as a soapbox for views that go beyond what you studied. • Avoid clichés such as “more research is needed,” as more research is always needed, especially if it funds your next study. Another platitude is, “This study has important implications for pediatricians.” If there are implications, state them. Sugito Wonodirekso

24. Menulis abstrak yang informatif • Limit the abstract to 250 words. The goal is to have something so short that everyone will read it. • If you use fewer than 250 words, no one will object. • Aim for clarity above all else; if you must choose between our advice and something that would make your abstract clearer, choose clarity and defend your choice. Sugito Wonodirekso

25. Writing an operative note • Poor medical records can jeopardise patient care and prejudice medicolegal cases. Here are some tips on doing it well. • Write clearly and concisely • Use red ink if possible • Document the date and time (24 hour clock) • State the operation performed, including the side (right or left), specific location, type of anaesthesia (general or local), and whether it was an emergency or an elective procedure • Include the names of the surgeons, anaesthetists, and assistants. State their roles and details of supervision (for example, surgeon A—mobilization of colon) • Note the details of the patient’s preparation, including positioning (for example, prone), additional procedures (for example, catheterisation) and prophylaxis (for example, antibiotics, heparin) Sugito Wonodirekso

26. Writing an operative note • This is followed by a full description of the operation (based on the template I, F, P, and C): • Incision type (for example, midline) • Findings. • This should include the pathology discovered during the operation and other unexpected findings, such as anatomical variations • Procedure. • A step by step documentation of the operation should be noted, including major structures preserved, techniques used, intraoperative radiological images and microbiological specimens taken. Diagrams are useful especially in complex operations Sugito Wonodirekso

27. Writing an operative note • Document tissue or bodily fluids removed (such as blood loss). Finally, include the type, size, and serial numbers of prosthesis and sutures used • Closure technique (including type of dressings used). • And finally, equally important, but commonly forgotten: • List the postoperative instructions • Document the name, grade, and signature of person writing the operative note Sugito Wonodirekso

28. Gaya Tulisan Ilmiah Sugito Wonodirekso

29. Informatif Laporan penelitian Laporan operasi Ide baru Data ilmiah Fakta Analisis statistik Persuasif Editorial Surat kepada editor Tinjauan pustaka Proposal riset Tulisan ilmiah populer Tulisan ilmiah Sugito Wonodirekso

30. Tulisan informatif • Apakah subyeknya menjadi fokus utama? • Apakah tujuan utamanya memberikan informasi dan bukan mempengaruhi? • Apakah informasinya lengkap & akurat? • Apakah informasinya dapat disigi-ulang? • Apakah informasi tersusun sistematik dan jelas? • Apakah menarik untuk dibaca? •  unsur bahasa! Sugito Wonodirekso

31. Tulisan persuasif • Apakah isinya sangat diminati pembaca? • Apakah isinya persuasif dan bukan informatif? • Apakah mengandung informasi dan alasan untuk menopang pendapat? • Apakah pendapat itu disokong oleh alasan yang baik dan logis? • Apakah argumentasi tersusun sejara jelas? • Apakah isinya dapat mendorong pambaca untuk berubah atau bahkan membantah? Sugito Wonodirekso

32. Contoh paragraf tulisan persuasif • Sampai sekarang belum pernah ada kajian kohort pada pengidap herpes zoster yang tidak memperoleh terapi. Kalaupun ada, pemantauan yang terlama dilakukan hanya 2 tahun1-10) sedangkan dalam kajian ini pemantauan akan dilakukan selama 5 tahun. Mengingat insidens herpes zozter cukup rendah11-15), akan digunakan sampel total, melibatkan seluruh kasus yang dijumpai di klinik. Penelitian ini bertujuan untuk menilai sifat neuralgia pascaherpes dan pengaruhnya terhadap kegiatan sehari-hari pada pengidapnya serta perjalanan alami penyakit ini. Sugito Wonodirekso

33. Contoh paragraf tulisan informatif • Kajian ini merupakan penelitian komprehensif dengan desain prospektif yang melibatkan seluruh pengidap herpes zoster tanpa terapi. Berdasarkan kepustakaan yang tersedia, kajian kohort ini merupakan yang terpanjang yang pernah ada. Dari data yang diperloleh, terungkap bahwa perjalanan klinis herpes zoster relatif jinak dan neuralgia pascaherpes jarang mengganggu kegiatan sehari-hari. Bila terjadi, neuralgia pascaherpes dapat berlangsung bertahun-tahun, tetapi dapat pula hilang dalam beberapa tahun. Neuralgia pacsaherpes ternyata sangat mengganggu kegiatan sehari-hari penderitanya sekalipun tidak berbahaya. • Coba perhatikan sosok paragraf di atas Sugito Wonodirekso

34. Contoh paragraf tulisan persuasif untuk awam • Herpes zoster, yang sering disebut cacar api atau ‘dampa’, pada umumnya tidak berbahaya dan dapat sembuh sendiri. Jika penyakit ini diobati pada stadium awal, biasanya akan sembuh lebih cepat. Perlu diperhatikan bahwa bila penyakit ini muncul di daerah muka dan pelipis, harus segera ke dokter karena dapat mengenai mata. Kadang-kadang, sekalipun sudah sembuh, rasa sakitnya masih terasa sampai beberapa pekan, bulan atau bahkan beberapa tahun setelah sembuh. Namun demikian umumnya rasa sakit ini hanya sedikit menggagu kegiatan sehari-hari, tidak berbahaya, dan akhirnya akan hilang sendiri. Sugito Wonodirekso

35. Simpulan • Anatomi makalah ilmiah termasuk thesis pada dasarnya sama • Gunakan masing-masing bagian makalah secermat mungkin • Gaya penulisan diperlukan untuk mencapai tujuan penulisan • Keterampilan menyusun paragraf perlu dimahiri • Mahir menulis hanya dapat dicapai melalui latihan Sugito Wonodirekso