Clinical Writing for Interventional Cardiologists

1. Clinical Writing for Interventional Cardiologists

2. What you will learn • 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 • Principles of peer-review • methods for peer-review • replying & surviving the review process

4. How do you submit? Instructions for authors

5. How do you submit?

6. How do you submit? Internet submission

7. How do you submit?

8. Once the paper is submitted… • Editorial process: • the paper is registered • The paper is read by an editor who decides if it deserves peer-review • If yes, it is sent to referees (peer-reviewers) • Decision-making (the editor decides, not the referees) • Decision: acceptance, rejection, de novo submission, major revisions, minor revisions

9. Once the paper is submitted… Acceptance:PARTY!! Rejection:We need to send our paper to another journal… De novo submission: The paper needs extensive revisionsThe editor thinks it can be published but usually at least 1 reviewer has been very negative over the paper Usually at the second submission the reviewers are different from the first submission (in particular the negative reviewers are excluded from a second review by the editor)

10. Once the paper is submitted… Major revisions:The consensus of the editor and the reviewers is that the paper can be published pending modifications and changes in the paper according to the points and issues raised by the reviewersThese issues may affect the overall structure of the paper, potentially changing some of the messages presentedThe paper can still be rejected at second revision… Minor revisions: The paper can be published after minor corrections, usually and mainly related to English spelling or minor editing issues present along the text

11. Peer-review process • Principles of peer-review • ConfidentialThe author does not know who the reviewers are but the reviewers know who the author is…Double blind (or fully open) peer review implemented in some journals… • Providing guidance to editors The peer-reviewers do not reject, they only advice…The editor rejects • Constructive commentsThe aim of the peer review is to improve the manuscript • Can be challengedPeer-reviewers are not always right…

12. Peer-review process • General guidance for reviewers: • Is the subject of the paper important? • Does the paper add enough to existing knowledge? • Does the paper read well and make sense? The goal of peer-review is to give comments and references to help: - editors taking a right decision - authors improving their paper

13. Peer-review process • For research papers: • Originality:Does this work add enough to what is already published?If so, what is it? • Importance to readers:Does the paper matter to clinicians, patients, teachers, policymakers? Is this journal the right place?

14. Peer-review process • For research papers: • Scientific reliabilityResearch question (clearly defined and answered?)Overall design of the study (adequate?)Participants studied (adequately described?)Methods (adequately described? ethical?)Results (answer to the research question? credible?)Interpretation and conclusions (warranted by the data?)References (up to date and relevant?)Abstract (reflects accurately what the paper says?)

15. Self-criticisism while “studying a study” BMJ scoring tool for peer-reviewers (www.bmj.com): Schroter et al, JAMA 2006

16. What you will learn • Principles of peer-review • methods for peer-review • replying & surviving the review process

17. Ms. Ref. No.:  AJC-D-08-00411 Title: Comparison of Assessment of Native Coronary Arteries by Standard versus 3-Dimensional Coronary AngiographyAmerican Journal of CardiologyDear Dr. Agostoni, I would like to publish your manuscript in the "AJC" if you will do the following:  1) respond to the comments of each of the 2 reviewers by revising your manuscript appropriately; 2) shorten your manuscript from its present 13.6 to no more than 9.0 text pages (those before the references but including the title page); 3) incorporate my editing changes into your revision (See manuscript marked "WCR" which will be faxed through to you.); 4) try not to repeat the data in your tables again in the text, and; 5) correct the technical deficiencies.  Please format the title of your manuscript as shown above.  Your introduction can be shortened to the single paragraph on your present page 4.  Please type your manuscript continuously beginning with the introduction.  Your discussion can be shortened (see edited copy).  Thank you for preparing your references well.  I think your tables can be improved slightly (see edited copy):  the percentages in table 1 should be rounded-off; the abbreviations in the variable column in table 3 should be spelled out.

18. Reviewer #1: The authors have studied a further improvement of the anatomy of the coronary tree. As shown, a three dimensional reconstruction was highly feasible and accurate using a marker guidewire as a reference. This reviewer has additional comments:1: the cranial / caudal angulation for measurements was chosen using different angles. Please specify how this was chosen, and what was used as the reference method. Did the authors compared different angulations?2: some segments were skipped. Inform why they were skipped. Who made the selection? This might have introduced a bias.3: were any aneurysms or tortuous arteries involved?4: was the difficulty of acquiring data related to the BMI?5: please give an example of a stent as a figure.

19. Reviewer #2: This article by Agostoni et al explores the possible application of 3D rotational coronary angiography to overcome the limitation of traditional 2D angiography. It elucidates in a discrete population the reliability of this new technique considering as "gold standard" for any anatomical measurement the "guidewire measurements". This manuscript is well written, and the topic of interest.General comment: I would suggest to further discuss the issue of contrast, radiation and procedural time compared to traditional 2D angiography. After addressing this point and the others listed, this manuscript would be worth of publication.Minor/ Major comments:1. Abstract, line 5:..."which is" automatically generated...2. Abstract: I would suggest to specify that the guidewire measurement has been considered as "gold standard"; it would add clarity for the non-expert audience.3.Intro, line 2: instead of "cardiovascular disease" I would write "ischemic heart disease". 4.Intro, line 5: please delete "simple". The acquisition of several views under different angles still allows a very good spatial resolution and reliable reconstruction of the anatomy even if the aim of the present study is to demonstrate that the 3D technique is more reliable.

20. Reviewer #2 (cont’d)9.Methods (rotational angiography section): as the angulation of the gantry has been left to the operator's discretion I wonder which is the implication of this in terms of time, contrast agent, radiation as the aim of the 3D technique is to have a positive impact on these issues. It is conceivable that the time, contrast and radiation used to appreciate the best angulation would reduce the advantage of the technique. Please add some thoughts in the discussion section. (Major comment)10.Methods (quantitative analyses, rotational angiography section): the qualitative grade has been assessed. Please add some insights about possible downsides of the technique according to this issues (time consuming, contrast, radiation.) in the discussion section (Major comment). 11.Methods (quantitative analyses, marker guidewire measurement): an interpolation has been made using the QCA. I wonder how this "shortcut" might affect the final measurement as the "gold standard", i.e., the guidewire measurement has been integrated with a technique that has been compared with the "gold standard" itself afterwards. I would expand the sentence added in the limitation section as the non-expert reader might possibly miss this point. It is important to make clear that even the "gold standard" is sometimes undermined by the clear limitation of interpolation (Major comment).

21. Rebuttal letter

22. Rebuttal letter Reply point-by-point (help the reviewer, rewriting his/her comments first) Always consider that the reviewers are experts in the field, consider seriously their comments If their comment is adequate, modify your paper accordingly If you think you are right and the point of the reviewer incorrect, state politely, but firmly your reasons Quote references if needed

23. Rebuttal letter You can use figures, graphs, tables (that will not be published afterwards) to reinforce your thesis Highlight in the modified manuscript all the changes you made (and repeat them also in the rebuttal letter) While there is a word limit for a paper to be published (usually around 5000 words), there is no limit for the rebuttal letter… use this space to support your theories!

24. Questions?

25. For further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html