20160926 edanz ramathibodi_landing

Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

26 September 2016

Writing Research Manuscripts That Have Impact

Download at: edanzediting.com/ramathibodi2016

Trevor Lane, PhDEducation Director, Edanz

Be an effective communicator

Your goal is not only to publish, but also to be widely read and highly cited

Plan well before you begin writing Understand IMRaD manuscript structure Know IMRaD manuscript language Edit your work carefully Edanz–Ramathibodi Hospital collaboration:

services available to you

Planning well

Section 1

Researchers face challenges on the path to publication success

Preparation

Journal Selection

WritingSubmission

Peer Review

Publication Success

• Read/manage references

• Write outline• Authorship• Peer feedback• Present at

conferences

• Assess research impact

• Compare journals/publishers

• (Pre-)Submission strategy

• Write/edit in English without plagiarism

• Writing process• Follow journal

& reporting guidelines

• Publication ethics

• Display items, supplemental material

• Ethics declarations

• Abstract & cover letter

• Select reviewers• Navigate

submission systems

• Navigate review process

• Understand editor & reviewers

• Revise paper• Respond to

reviewers, point by point

• Resubmit or submit elsewhere

• Archive/share• Promote work

to (non)-academic community

• Next project/budget/grant

• Collaborators• Track citations

and altmetrics• Technology

transfer• Update CV

Researchers need continued help on the path to publication

success

Preparation

Journal Selection

WritingSubmission

Peer Review

Publication Success

• Training in reading papers, ethics, writing, presenting

• Expert Scientific Review

• Journal Selection & submission strategy

• Training in ethics, writing, presenting

• Revising• Editing• Reformatting

• Training inethics, writing

• Editing• Abstract

Development• Cover Letter

Development• Reviewer

Recommendation

• Training in navigating peer review

• Review Editing• Point-by-point

checking• Response Letter

Development• Reformatting

• Press release, news writing

• Media & presentation training

• Training for early and mid career researchers

• Training in writing grant proposals

• Grant proposal editing

Patenting Engagement

Planning well Publishing plan (1)

1. Identify trends: reviews, editorials, theme issues, Calls for papers, “most read”…organize journal clubs

2. Read the primary literature

3. Identify an important question, or incorrect or incomplete knowledge/evidence• Do you have the expertise/resources?• Is the question focused?• What is new? How is the study useful?• What is the best/most practical study design?

Planning well Impact and study design

Systematic reviews of RCTs

Randomized controlled trials (RCTs)

Non-randomized controlled trials

Observational studies (cohort, case-control, surveys/audits/interviews, diagnostics)

{Secondary research

Primary research{ }Experimental

(exposure assigned)*

} Non-experimental

Register clinical trials in advance!Use international reporting guidelines!

Case studies, case series, technical notes,computer models (in silico), animals (in vivo), in vitro

Planning well Evaluating impact

Assess your findings objectively

How new/important are your findings? How strong is the evidence?

How large is your scientific advancement?Low or high impact journal

Novelty

How broadly relevant are your findings?International or regional journal

General or specialized journal

Relevance/Application

Planning well

Is my study novel?

Trial registries/ databases

Medical forums,

websites

Medical & general online

searches

Use ICD codes from WHO or MeSH keywords for consistency, but also try synonyms

Sign up for eTOCs and eAlerts

Publishing plan (2)

Planning well

Get feedback at conferences• Check novelty, relevance, interest level• Check methods, data, illustrations, conclusions

Pre-submission “publication” OK if:• Abstracts in conference proceedings• Clinical trial summaries in online registers• Own web? Preprint servers (bioRxiv)?

Dissertation/thesis? Check the target journal!

• Organize pre-submission peer review• Know what editors are looking for

Publishing plan (3)

Planning well What editors are looking for (1)

Submissions

No plagiarism

No data manipulation

Authorship

Submit to only one journal; do not republish an article; no salami; do not manipulate peer review

Paraphrase/summarize/synthesize & cite all sources

Do not fabricate or falsify dataDo not manipulate parts of images

(1) Study design or data acquisition/analysis; (2) Writing/revising; (3) Approval; (4) Accountability

Conflicts of interest

State funding source and any financial/personal relationships that could bias the work

Safety Ethics board approval; for humans: signed consent, data privacy; animal & environmental safety

Planning well

Always follow ethics guidelines

Committee on Publication Ethics, COPE

Good Publication Practice 3, GPP3

International Committee of Medical Journal Editors , ICMJE

What editors are looking for (2)

Planning well

Declare in your cover letter…

Not submitted to other journals

Research ethics

All authors agree and contributed

Original and unpublished

Funding & potential conflicts of interest Possible reviewers

Clinical journals: authorship, COI, ethics approval & consent, ©

Planning well

“Journal Impact Factor” = No. citations ÷ No. articles

Original and novel research

Well-designed,well-reported,

transparent studyNews, importance,

innovation, timelinessHigh scientific & technical quality,

sound research & publication ethics

Logical, engaging contents; correct

formattingHigh readability &

interest, informative

Useful message

Clear, real-world relevance, influence

Planning well Choosing a journal

Which factor is most important to you?

Aims & scope, Readership

Publication speed/frequency

Online/Print,Open access

Indexing, Rank,Impact factor

Acceptance rate/criteria

Article type / evidence level

“Luxury” / Traditional / Megajournal

Subscription / Open access / Hybrid

Planning well

THINK Trusted and appropriate?

SUBMIT Only if OK

thinkchecksubmit.org

CHECK Do you know the journal?

Trustworthy journals

Planning well Journal Selectorwww.edanzediting.com/journal_sele

Insert your proposed abstractor keywords

Matching journals

Filter/Sort by:• Field of study• Impact factor, SCI• Open access• Publishing

frequency

Journal’s aims & scope, IF,

and publication frequency

ctor• Author guidelines• Journal website

Are they currently publishing similar articles?

Similar published articles

Have you cited any of these articles?

Planning well Choose your journal first!

Author guidelines• Manuscript structure• Word limits, References • Format, Procedures

Aims and scope• Topics• Readership• Be sure to emphasize

• Check journal requirements• Check relevant references• Check novelty, importance & usefulness

Planning well Always cite

• Cite at end of relevant word/phrase/sentence in ( ): Harvard = (Name, year) or Vancouver = (Ref. No.)

• Can put Author name in sentence, but avoid “lists”; name up to 2 surnames (but only one, “Author1 et al”, if >2 authors); for Harvard, papers of same year use letters: “Author et al (2016a, 2016b, 2016c) reported…”

• Quote if exact words or sentence; use … to omit words and [sic] to note wrong/special words (“…use the write [sic] order”)

• Check journal guidelines or past papers for quoting; e.g., indent paragraph for a block quote of >3 sentences

• Prefer paraphrasing, summarizing, synthesizing

Planning wellReference

management software

EndNote Most established*Styles easy to find on journal websites

Which one to use?

RefWorks Web-based*Widely used

Mendeley Newer (and free!)*Allows collaborations

Papers Easy-to-use interface (like iTunes)Great for article management

*Has plug-in app for MS WordOthers: Docear, Zotero, Citavi…

Activity 1

Please see Activity 1 in your workbook

Section 2

Understanding manuscript structure

Manuscriptstructure

Link your ideas logically

General background

Methodology

Results and figures

Summary of findings

Conclusion/implications

Relevance of findings

Problem in the field

Current state of the fieldIntroduction

Methods

Results

Discussion

Manuscriptstructure

What reviewers are looking for

The science

The manuscript

Relevant hypothesis Good experimental design Appropriate methodology Good data analysis Valid conclusions

Logical flow of information Manuscript structure and formatting Appropriate references High readability Peer review is a positive process!

Manuscriptstructure Drafting process

Where to start?

Your findings form the basis of your manuscript

First organize your findings

Logic, then English language

Figure 1

Figure 2

Table 1

Figure 3

Logical flow• Time order• Most least

important• General specific• Simple complex• Whole parts

Is anything missing?

?Additional analyses?

Manuscriptstructure Writing 1st outline

1. Important reason for study

2. Research Q / Hypothesis

3. Aim & approach4. Main methods5. Display items &

key findings6. Major conclusion

Write down key ideas in bullet points (topic sentences)

Then, draft a very rough title/abstract

Use the Edanz Journal Selector to find similar articles

Manuscriptstructure Writing 2nd outline

1. IntroductionA. General backgroundB. Related studiesC. Problems in the fieldD. Aim & approach

2. MethodsE. Subjects/Samples/MaterialsF. General & specific methodsG. Statistical analyses

3. ResultsH. Key points about Figure 1I. Key points about Table 1J. Key points about Figure 2

4. DiscussionK. Major conclusionL. Key supporting findingsM. Relevance to published studiesN. Limitations; unexpected resultsO. ImplicationsP. Future directions

Expand on ideas, as bulletsDraft article using IMRaD Get feedback & revise each

sectionRevise content/logic before

language

List information from your reading in the appropriate section: Paraphrase with citations!

Manuscriptstructure

How does your study contribute to your field?

What did you find?

What did you do?

Why did you do the study?

Title/Abstract

Introduction

Methods

Results

Discussion

Drafting your manuscript

Manuscriptstructure

Drafting your manuscript

Title/Abstract

IntroductionMethods (can be at end or

mostly online or in legends)

Results

Discussion(=IMRaD)

Title/Abstract

Methods

Results

Discussion

Introduction

Abstract /Title

Manuscriptstructure

International reporting guidelines

http://www.equator-network.org/

PRISMA Systematic reviews & Meta-analyses

STROBE Observational studies

CARE Case reports

CONSORT Randomized controlled trials

ARRIVE Animal studies

QOREC Qualitative studies

Register trials in advance, at:clinicaltrials.gov; who.int/ictrp/network/en; controlled-trials.com; www.clinicaltrials.in.th

Manuscriptstructure Title and abstract

First impression of paper:clear/concise/convincing

Importance of your results

Validity of your conclusions

Relevance of your aims

Promote your work: Readers judge your style & credibility

Gain attention and encourage readers to read full version

Your title & abstract summarize your study

Important points

Only the main idea Accurate, simple Include keywords Fewer than 20 words Include key variable,

population, model, or study type

Unneeded words (A study of)Complex or sensational wordsComplex word orderAbbreviations“New” or “novel”

QuestionCan ischemic preconditioning

improve prognosis after coronary artery bypass surgery?

Topic / Variables

Prognostic effects of ischemic preconditioning in coronary artery

bypass patients

…. + Method (hanging title)

Xxxxxxx: randomized controlled trial

Statement of conclusion

Ischemic preconditioning improves prognosis after coronary artery

bypass

Check journal style

Context Background, problem, aim

Results Outcomes, effects,properties, statistics

Conclusion Relevance, implicationsLearning points, future

Methods Patients/materials/animalsTreatments, measurements

No references, unusual abbreviations, figures/tablesClinical: usually “structured abstract” with subheadings

& funding & trial registration number after abstract

Abstract

Manuscriptstructure

“Unstructured” abstract

Numerous systemic treatment options exist for patients with mycosis fungoides (MF) and Sézary syndrome (SS); however, the comparative efficacy of these treatments is unclear. We performed a retrospective analysis of our cutaneous lymphoma database to evaluate the treatment efficacy of 198 MF/SS patients undergoing systemic therapies. The primary end point was time to next treatment (TTNT). Patients with advanced-stage disease made up 53%. The median follow-up time from diagnosis for all alive patients was 4.9 years (range 0.3‒39.6), with a median survival of 11.4 years. Patients received a median of 3 lines of therapy (range 1‒13), resulting in 709 treatment episodes. Twenty-eight treatment modalities were analyzed. We found that the median TTNT for single- or multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] 3.2‒5.1), with few durable remissions. α-interferon gave a median TTNT of 8.7 months (95% CI 6.0‒18.0), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI 4.0‒6.1). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < .00001 and P = .01, respectively). In conclusion, this study confirms that all chemotherapy regimens assessed have very modest efficacy; we recommend their use be restricted until other options are exhausted.

Modified from: Cannegieter et al. Blood. 2015; 125: 229‒235.

Use signal phrases and IMRaD order

Manuscriptstructure

“Unstructured” abstract

Modified from: Cannegieter et al. Blood. 2015; 125: 229‒235.

Numerous systemic treatment options exist for patients with mycosis fungoides (MF) and Sézary syndrome (SS); however, the comparative efficacy of these treatments is unclear. We performed a retrospective analysis of our cutaneous lymphoma database to evaluate the treatment efficacy of 198 MF/SS patients undergoing systemic therapies. The primary end point was time to next treatment (TTNT). Patients with advanced-stage disease made up 53%. The median follow-up time from diagnosis for all alive patients was 4.9 years (range 0.3‒39.6), with a median survival of 11.4 years. Patients received a median of 3 lines of therapy (range 1‒13), resulting in 709 treatment episodes. Twenty-eight treatment modalities were analyzed. We found that the median TTNT for single- or multiagent chemotherapy was only 3.9 months (95% confidence interval [CI] 3.2‒5.1), with few durable remissions. α-interferon gave a median TTNT of 8.7 months (95% CI 6.0‒18.0), and histone deacetylase inhibitors (HDACi) gave a median TTNT of 4.5 months (95% CI 4.0‒6.1). When compared directly with chemotherapy, interferon and HDACi both had greater TTNT (P < .00001 and P = .01, respectively). In conclusion, this study confirms that all chemotherapy regimens assessed have very modest efficacy; we recommend their use be restricted until other options are exhausted.How does your study contribute to your field?

What did you find?

What did you do?

Why did you do the study?

Activity 2

Any questions?

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Section 3

Writing the Methods section

Methods Methods

How the study was done

• Processes, treatments, measurements

• Variables (direct/proxy)• Outcome/endpoints (1o, 2o)

• Data conversions• Statistical tests (& P level)• Consult a statistician

Who/what was studied

• Design rationale; “power”, N• Participants, controls; sampling• Materials, surveys, ethics

Data analysis

Describe all aspects of the design

Methods Methods

Established techniques

• Cite previously published studies• Briefly state modifications• Use flow chart/table* if needed

• Give rationale; systematically evaluate• Give enough detail for reproducibility• Use Supplementary Information

Organization• Arrange in (titled) subsections• Keep parallel to the display items• Use topic sentences

New techniques

*Summary of study settings, flow of participants, data/text selection, variables, chronology of analyses…

Methods

CONSORT

http://www.equator-network.org/

International reporting guidelines

• Trial design• Participant eligibility• Setting• Interventions• Outcomes• Sample size• Randomization• Blinding• Statistics

Methods

Johansen et al. BMC Psychiatry. 2013;13:201.

Figure 1 Study data flow of participant contact points.

Method flow chart

Methods

Transparency in study design

Sample size not large enough (no power calculation, 1-b)

Patient enrollment, exclusion, & randomization unclear

Interventions and assessments not clearly described

Unclear how missing data (lost to follow-up) were handled

Ethical approval and informed consent not clear

Consult a statistician

Use flowchart

Reproducibility

Imputation methods

Always required

Common mistakes in the Methods

Methods

Distribution of data affects analysis and presentation

• Parametric tests (e.g., t test and ANOVA) can be used only with continuous & normally distributed data with a large enough sample size

• Use the mean ± SD only for normally distributed data

Simple guide:• If SD is ≥ mean, most likely not normally distributed• If SD is > 0.5 × mean, may not be normally distributed

Use Shapiro-Wilk’s W test for normality

Wrong statistical tests

Use appropriate tests

Methods

2 categorical endpoints

Paired (within sample)

Unpaired (between sample)

McNemar’s test

Fisher’s exact test2 treatment groups

Chi-square test>2 treatment groups

du Prel et al. Dtsch Arztebl Int 2010; 107: 343–8.

Methods

Continuous endpoints

Parametric Nonparametric

Paired Unpaired Paired Unpaired

2 groups:Paired t test

>2 groups:Repeated-

measures ANOVA

2 groups:Unpaired t test

>2 groups:ANOVA (F test)

2 groups:Wilcoxon signed-

rank test>2 groups:Friedman

one-way ANOVA

2 groups:Mann–Whitney U test (Wilcoxon

rank-sum test )

>2 groups:Kruskal–Wallis

Lang and Secic 1997; 71.

Methods Ensure high readability

Use short sentences15–20 words

One idea per sentence; use short words

Use active voiceSimpler, more direct, and easier to read

Recommended by most writing style guides and journals!“Nature journals prefer authors to write in the active voice”

(http://www.nature.com/authors/author_resources/how_write.html)

Methods

To ascertain the efficaciousness of the program, all of the program participants were interrogated upon

participant program completion.

To determine the efficacy of the program, we interviewed all participants.

Prefer active voice and shorter words/sentences

Methods

“A number of studies have shown that the new regimen...”

“...as described in our previous study.”

“...at a flow rate of 1.0 mL/min.”

“As a matter of fact, such an adverse drug reaction…”

“That is thus another reason why, we believe…”

“It is well known that most of the trial participants...”“It is well known that Most of the trial participants...”

“As a matter of fact, such a This adverse drug reaction…”

“A number of studies have shown that The new regimen...”

“That is thus another reason why Therefore, we believe…”

“...as described previously in our previous study.”

“...at a flow rate of 1.0 mL/min.”

Delete unnecessary words

Methods Delete unnecessary words

AvoidAt a concentration of 2 g/LAt a temperature of 37CIn order toIn the first placeFour in numberGreen colorSubsequent toPrior to

PreferredAt 2 g/LAt 37CToFirst FourGreenAfterBefore

Methods Avoid complex words

PreferredEnoughClearDetermineBeginTrySizeKeepEnoughUse

AvoidAdequateApparentAscertainCommenceEndeavorMagnitude*RetainSufficientUtilization

*OK in certain fields (magnitude of earthquakes)

Methods Active voice

Sentences written in the active voice are:

simple direct clear easy to read

The mechanisms regulating enzyme activity were investigated.Passive

We investigated the mechanisms regulating enzyme activity.Active

Methods Passive voice

(1) The doer is not important or not known; making generalizations [English is spoken in many countries]

(2) Avoiding We...We...We... in Methods (3) If the authors did not themselves do a step in the Methods

(but a technician did, and is named in the Acknowledgments)

(4) Some journals use passive in the Methods or Abstract(5) Avoiding top-heavy subjects [All patients were examined by

the same specialist, who had been thoroughly trained in the modified X method]

When to use the passive

Methods Use strong verbs

Avoid nominalizations: Find verbs inside nouns

Estimate EstimationDecide DecisionAssess Assessment

We made a/an… We conducted a/an…Extra verb

We decided… Clear, short, and direct

Methods

“We used grounded theory methodology to explore the mentoring process among medical students.”

Wename of

technique investigate

name of process/

issue.study

measure

confirmdetermine

used to

Method------------------------------Purpose

Method – Purpose

Purpose statements

Methods

“To explore the mentoring process among medical students, we used grounded theory methodology.”

wename of

technique.

Purpose-----------------------------Method

Purpose – Method

investigate

name of process/

issue,study

measure

confirmdetermine

Purpose statements

Methods Describing processes

PVA solutionTitanium and

niobium powder

Dry body

The PVA and water were mixed to form a PVA solution.

Implant

The PVA solution and titanium and niobium powder were mixed to form a mixed paste.

The mixed paste was dried to form a dry body.

The dry body was heated to produce the orthopedic implant.

Mixed paste

Methods Describing processes

A PVA and water solution (10 mL, 1:1 v/v ratio) was mixed with titanium and niobium powder (Ti:Nb 4:1, 2 g) to form a paste. The paste was stored overnight at 25°C to form a dry body, which was then heated at 450°C for 8 h to produce the orthopedic implant.

Add full details

The PVA and water were mixed to form a PVA solution. The PVA solution and titanium and niobium powder were mixed to form a mixed paste. The mixed paste was dried to form a dry body. The dry body was heated to produce the orthopedic implant.

Avoid redundancy

Add manufacturer’s details for special products: (company, city, [state,] country)

Activity 3

Section 4

Writing the Results section

Results Results

• Efficacy/safety• Group/subgroups• Uni-/bi-/multivariable

• Each (titled) subsection relates to one figure/ method

• 1o, 2o ; check figure Nos.

• What you found, not what it means

• Upload as Supplementary Materials

• Data accessibility

Logical presentation

Subsections

Factual description

Present results logically and factually

Results Display items

Time trends, relationships

Comparisons of values, rangesProportions of

Process

Line graph, scatter plot

Bar graph/chart, histogram (parametric); box plot (non-parametric)

Pie chart, stacked bar chart

Flow chart, (process) flow diagram, schematic

Appearance Photograph, drawing, exploded-view diagram, map, medical image

Specific numbers Table (especially with multiple groupings)

Results FiguresClear, objective figure legend

Kindlin-2 knockdown and focal adhesion localization. Confocal immunofluorescent microscopy with anti-β1 integrin and anti-paxillin on C2C12 cells transfected with RNAi and then changed to differentiation media for 2 days. Control cells show linear staining consistent with localization to costameres (arrows), as well as punctate focal contact staining (arrowheads). Focal contact proteins in the kindlin-2 RNAi cells fail to form linear structures and instead are concentrated in unusual appearing puncta (*). (Scale bar = 20 μM).

Dowling et al. BMC Cell Biol 2008; 9:36.

Clear indicators

Title of the experiment

Brief methodology

Key findings

Results Tables vs. graphs

Type A Type B Type C012345678

AluminumGold

Figure 1. Additional 50-year projected life expectancy

Who will have a longer life in 50 years’ time?

Country 1 Country 2 Country 3

Results Tables vs. graphs

Type A Type B Type C012345678

AluminumGold

What is the highest number of projected additional years?

Figure 1. Additional 50-year projected life expectancy

Country 1 Country 2 Country 3

Results

Country Population No. of yearsCountry 1 Women 4.3Country 2 Women 3.4Country 3 Women 6.7Country 1 Men 1.4Country 2 Men 2.4Country 3 Men 3.8

Tables vs. graphs

Table 1. Additional projected life expectancy in the next 50 years

What is the highest number of projected additional years?

Results

Independent variables

Table formatting

Raj et al. PLoS ONE. 2014; 9: doi:10.1371/journal.pone.0106210.

Symbols defined

Dependent variable;

N numbers given

Table 1. Demographic profile of ever-married women aged 20–24 years for most recent Demographic Health Survey data from Bangladesh, India, Nepal, and Pakistan.

Clear and concise table title

Results What’s wrong with this line graph?

Results Line graphs

Kennedy et al. Reprod Health. 2011;8:11.

Figure 2. Proportion of births to women aged 15-49 spaced less than 18 months for A. 'ever-married women' and B. 'all women' (married and unmarried) (%). Cambodia, Marshall Islands, Nauru, Samoa, Solomon Islands, Tuvalu and Vietnam do not include data for adolescents for this indicator because of too few non-first births in the 15-19 age group.

Use colors and shapes to differentiate lines

Figure title and notes usually go below

Independent variable

Dependent variable

Results Bar graphs

Modified from: Waters et al. SAGE Open. 2014; doi: 10.1177/2158244014529779.

Figure 3. Impediments to choosing elective music versus sport. Note. Impediment items were phrased in negative where appropriate, meaning that a high mean (SD) score indicates strong agreement with the opposite valence compared with strong agreement with the corresponding item. *p < .05.

Dependent variable

Independent variable

Statistical significance

Error bars

Results Box plots

Hijikata et al. Hum Genetics. 2012; 131: 675−682.

Figure 2 Dual luciferase reporter assays. The ratios of Firefly luciferase activity (signal S) to Renilla luciferase (control C) are displayed using box and whisker plots…

Minimum25%

Median75%

Maximum

Results Sentence logic (1)

Check the logic of punctuation

The GFP tags appeared green and blue, yellow and green and yellow and blue.The GFP tags appeared green and blue, yellow and green, and yellow and blue.

The patient said he admired his parents, Prince Charles and Lady Diana.

The patient said he admired his parents, Prince Charles, and Lady Diana.

The variables included family size, personal and household incomes.

The variables included family size and personal and household incomes.

Use parallel terms

The values were higher in group 1 than for group 2.

The values were higher in group 1 than in group 2.The values were higher for group 1 than for group 2.

Writing involves many skills: planning, preparing, drafting, and you need to check carefully.

Writing involves many skills: planning, preparing, drafting, and careful checking.

Use “respectively” for parallel lists

The two values were 143 and 21, respectively.

The values for groups A and B were 143 and 21, respectively.

The two values were 143 and 21.

Results

Drug A reduced tumor volume by 32.7%, increased blood pressure by 12.3%, and increased the patient’s weight by 7.3 kg.

Drug B reduced tumor volume by 22.3%, increased blood pressure by 15.6%, and increased the patient’s weight by 2.4 kg.

Drug C reduced tumor volume by 38.1%, increased blood pressure by 6.9%, and increased the patient’s weight by 9.2 kg.

Describe relationships among your results

Results

Patients treated with Drug C showed the greatest reduction in tumor volume (38.1%) compared with those treated with Drug A (32.7%) or Drug B (22.3%).

Drug C also had the lowest increase in blood pressure (6.9%) compared with that seen after treatment with Drug A (12.3%) or Drug B (15.65).

However, patients treated with Drug C had the highest weight gain among the three groups (Drug A, 7.3 kg; Drug B, 2.4 kg; Drug C, 9.2 kg).

Describe relationships among your results

Results Common mistakes in the Results

1 2 3 4 505

101520253035404550 Over 5 days of blood pressure

monitoring during the new diet, the daily rise in resting blood pressure increased from 32 ± 10 mmHg to 43 ± 17 mmHg (Figure 2). This rise in blood pressure may be explained by…

Do you agree with this interpretation?

Time (days)

Is this real?

“Drug A significantly reduced LDL cholesterol by 28% (p<0.05). Therefore, Drug A is effective in reducing cholesterol levels…”

• How much is 28%? Is this clinically relevant?

Statistical significance does not equal clinical significance!

“Drug A significantly reduced LDL cholesterol levels from 4.7±0.3 mmol/L to 3.4±0.6 mmol/L (p=0.02, 95% CI: 0.8–1.8). Because a minimal reduction of 1.4 mmol/L is required to be clinically effective, the efficacy of Drug A is still unclear.”

• Use absolute values• State exact P-value• State 95% CI and minimal clinically relevant difference

Results

Patient parameters…improved significantly; it is significant that…X was caused by YThe risk of developing X in this case-control study…

Patient variables…improved considerably/markedly; it is important that…X was associated with/related to/linked to YThe odds of developing X in this case-control study…

Don’t misuse statistical words

Common mistakes in the Results

Activity 4

Any questions?

Section 5

Writing the Discussion section

Discussion Discussion

Summary of findings

Relevance, importance

Conclusion

Similarities/differencesUnexpected/negative resultsLimitations; unanswered/new Q

Implications

Previous studies

Currentstudy

Future studies

Specific

General

How do you advance your field?

DiscussionDiscussion:

beginning and end

This randomized, open-label, Phase 3 controlled trial compared PFS rate in pre-menopausal women with ER-positive advanced breast cancer after 24 weeks of treatment with 3-monthly goserelin 10.8 mg or monthly goserelin 3.6 mg. The results of the primary efficacy analysis showed that goserelin 10.8 mg demonstrated non-inferiority to goserelin 3.6 mg….

Re-introductionMain finding

Future & importance

Modified from: Noguchi et al. Breast Cancer. 9 Sept 2015; doi:10.1007/s12282-015-0637-4.

In conclusion, this study demonstrated that 3-monthly goserelin 10.8 mg is non-inferior to monthly goserelin 3.6 mg in pre-menopausal women with ER-positive advanced breast cancer by assessment of PFS rate at 24 weeks. As such, this formulation may represent an alternative and more convenient treatment option for pre-menopausal women with ER-positive advanced breast cancer.

Conclusion in context

Why is your study important?

Discussion

Discussion: beginning

for a long paperState the major conclusion of the study

Most health professionals, including dental students, require rudimentary introduction to health economics. The pedagogical challenges of teaching health economics in dentistry arise from the fact that health economics is a nondental subject that requires deep understanding. In this study, we found that debate when used to teach health economics to dental students enhanced their interest and reinforced their knowledge of the topic and improved organizational thinking.

Re-introduction

Conclusion

Modified from: Khan et al. J Dent Educ. 2012;76: 1675–1683.

Problem

Discussion

Compare your findings with those published by others

Discussion: middle

Modified from: Rimfeld et al. Transl Psychiatry. 2015;5:e638.

Comparison with previous studies

Current finding

Potential reasons

We found that most individual differences in second language achievement are accounted for by genetic differences, rather than school, family, and other environmental influences. Our heritability estimates are higher than those in our earlier study [3], which might be because different measures were used. In the present study we used standardized examination scores at the end of compulsory education, as compared with teacher ratings of academic achievement in our earlier report.…

Discussion

What do you want people to remember?

Conclusion

May be a separate section

May be a “Future work” section

We have demonstrated here that genes explain a larger proportion of differences between children in second language achievement than do shared environmental influences of school and home. Our bivariate results for twins demonstrate a general genetic factor of language achievement in the sense that achievement in English and second language is influenced to a large extent by the same genes. It is important to note that genes not only influence aptitude and achievement, but also appetite for knowledge. Such genotype–environment correlation may be increasingly important during adolescence. Our future research thus involves longitudinal study of second language achievement.

Conclusion

Key finding

Implications

Future directions

Modified from: Rimfeld et al. Transl Psychiatry. 2015;5:e638.

Discussion

Describe limitations and negative results

Reporting transparency• Allows complete evaluation of your study• Prevents others from repeating those experiments• Allows others to modify those experiments• Prevents funding agencies from wasting money

Data repositories

Discussion: middle

Discussion

Readers use sentence structure to determine emphasis

• Stress position• Main clause vs. subordinate clause• Clause length

Useful in the Discussion Vary emphasis of your interpretations

Contrasting ideas

Discussion Contrasting ideas

Main vs. subordinate clause

Although the study design is not perfect, you deserve funding.Subordinate Main

Linking word• Although• Even though• Whereas(Despite/inspite of)

Subordinate clauses say 2 things:

• Idea may not be important• There is a contrasting idea coming

Discussion Discussing limitations

Although this study was limited by its small sample size, our survey demonstrates that women commonly cite experiencing signs and symptoms of postnatal depression within the first 6 months of delivery.

Although our survey demonstrates that postnatal depression is common, the study was limited by its small sample size.

Bad news = Subordinate clause at the start

Bad news = Main clause in stress position

Bad news = Subordinate clause at startGood news = LONG main clause in stress position

Discussion

Do not restate your results

We showed that tumor volumes in Groups A, B, and C were 34.6, 74.2, and 53.9 mm3, respectively, after a 4-month drug treatment, reflecting only a 8.6% decrease. However, after a 12-month drug treatment, the tumor volumes in Groups A, B, and C were 16.3, 18.7, and 16.9 mm3, respectively, which reflects a 45.2% decrease (p<0.05). The results demonstrate that 12 months of treatment is necessary for Drug X to effectively reduce tumor size among the three groups.

The results presented in this study demonstrate that Drug X more effectively reduces tumor size after 12 months of treatment (45.2% reduction) than it does after 4 months (8.6% reduction).

Common mistakes in the Discussion

DiscussionCommon mistakes in the Discussion

Do not overgeneralize your findings

In this study, we demonstrated that Drug A effectively reduced tumor growth. Therefore, this drug should have therapeutic applications in breast cancer treatment.

In this study, we demonstrated that Drug A effectively reduced the growth of various breast cancer cell lines. Our findings suggest that this drug may have therapeutic applications in breast cancer treatment.

Result: Drug A reduced breast cancer cell growth in vitro

Use appropriate “hedging” words

Discussion Comparisons

Compared with is for saying how similar things are different

The toxicity of the new scaffold was reduced compared to the previous scaffold.

The toxicity of the new scaffold was reduced compared with that of the previous scaffold.

The toxicity of the new scaffold was lower than that of the previous scaffold.

Discussion Comparisons

Compared to is for saying how different things are similar

The extracellular matrix can be compared with a scaffold.

The extracellular matrix can be compared to a scaffold.

Discussion

Fix stacked and misplaced modifiersThe final analyzed test sample only appeared blue temporarily because we had added the especially

prepared reagent that we were testing slowly.

The final sample that we analyzed appeared blue only temporarily, because we had slowly added the test

reagent.

Avoid ambiguity

Discussion Avoid ambiguity

Be careful of time wordsWhile many people read e-books, some still prefer real books.Although/Whereas many people read e-books, some still prefer real books.

The patient had no appetite since he had eaten breakfast.

The patient had no appetite because he had eaten breakfast.

The plants were harvested as they flowered.

The plants were harvested because/once they had flowered.

Activity 5

Section 6

Writing the Introduction section

Introduction

Current state of the field

Background information

Specific aim/approach

Previous studies

Currentstudy

General

Specific Importance, Research Q/ hypothesis, variables

Worldwide relevance?Broad/specialized?

Recent, InternationalNot too many self-cites

Why is your study needed?

Introduction

“Health workforce shortages may be felt most keenly by developing nations, but are a concern for all. Developed nations are particularly worried about the number of general practitioners (GPs) available to service their ageing populations…”

BMC Family Practice: Worldwide relevance

Dwan et al. BMC Fam Prac. 2014; 15: 154.

International journal – Writing the Introduction

Effect of ageing populations on healthcare workforce

Introduction

“All citizens in Japan are covered by a national health insurance system in which there are no official “gatekeepers”. Patients can freely choose between attending a local physician’s office (clinic) or a hospital and Japanese physicians can freely practice internal medicine. But recently, Japan has faced the problems of a rapidly aging population…”

Asia-Pacific Family Medicine: Regional focus

Tsukamoto et al. Asia Pac Fam Med. 2014; 13: 9.

Regional journal – Writing the Introduction

Effect of ageing populations on healthcare workforce

Introduction

Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in the developed world, and atherosclerosis is the central underlying pathology. Atherogenesis is a life-long process involving a range of mechanisms including lipid peroxidation and inflammation affecting the vascular wall. The clinically most relevant results of this pathology are myocardial infarction and stroke. Evidence for acute cardiovascular effects of air pollution has substantially increased in recent years…

PLOS ONE: ‘atherosclerosis and pollution’

Künzli et al. PLoS ONE 2010; 5: e9096.

Broad-focused journal – Writing the

Introduction

Broad background information Important for context

Introduction

Atherosclerosis is an inflammatory disease that accounts for nearly 50% of deaths in western societies. Initiation of atherosclerotic plaque formation is a complex process. It involves secretion of chemokines such as the Monocyte Chemoattractant Protein–1 (MCP-1) and expression of adhesion molecules on the surface of monocytes and endothelial cells. Circulating monocytes are recruited to sites of injured endothelial cells, adhere to them, and migrate into the subendothelial space. Monocytes in the arterial wall differentiate into activated macrophages…

BMC Cardiovascular Disorders: ‘atherosclerosis and pollution’

Adar et al. BMC Cardiovas Disord. 2013; 10: e1001430..

Specialized journal – Writing the Introduction

Broad background information not necessary

Introduction Background

Scaffold-based tissue engineering involves the combination of cells, bioactive factors and structural scaffolding materials to promote repair and regeneration of tissues.1-3

Field of research

Use citations appropriately

Materials for scaffolds must have appropriate mechanical properties for specific injury sites. The scaffold should support cell attachment and growth.

Aspects that you will focus on

General background

Specific background

Beginning should demonstrate relevance/interest

Match journal’s Aims and Scope

Introduction

Integrating electrospun scaffolds with cells remains challenging. It is often difficult for cells that are cultured on electrospun fibers to penetrate into pores.

Indicating problems

difficult

howeverexpensivetime consuming

problemalthough

General Problem

challengedespite

challengingdifficulty

Introduction Indicating problems

However, the fabrication of these scaffolds was complex and very sensitive to the reaction conditions giving irreproducible results.

Pack et al. have achieved promising cell penetration results in poly(glycolic acid) scaffolds after surface modifications.6

Discuss most recent and relevant primary literature

Potential solution

There is still a problem

Previous work

Problems in previous work

Cite relevant work from journal

Introduction Problem/knowledge gap

However, …an alternative approach… …a challenge…a need for clarification… …a problem/weakness with……has not been dealt with… …remains unstudied…requires clarification …is not sufficiently (+ adjective)

…is ineffective/inaccurate/inadequate/inconclusive/incorrect------------------------------------------------------------------------------------------Few studies have… There is an urgent need to…There is growing concern that… Little evidence is available on…It is necessary to… Little work has been done on…

Key phrases

Introduction Writing the purpose

Your aims must directly address the problem 1

So far, most research has focused on the negative psychological impact of myocardial infarction. However, trauma can also produce psychological benefits. The identification of factors associated with post-traumatic growth after myocardial infarction is of importance.

AimsThe present study investigated the relative contribution of three possible factors to post-traumatic growth after myocardial infarction: personality, psychological health, and cognitive coping.

Problem

Modified from: Garnetski et al. J Clin Psychol Med Settings. 2008; 15:270–277 .

Introduction Writing the purpose

Your aims must directly address the problem 2

Currently, the standard procedure used to evaluate hepatic steatosis is the histopathological examination of cross-liver sections… …this is an invasive practice that presents inherent risks...Therefore, it is essential to establish new non-invasive approaches to accurately determine hepatic fat concentration…

The purpose of our prospective study…was to evaluate the potential of multi-echo MRI to quantitate the hepatic triglyceride concentration.

Problem

Jiménez-Agüero et al. BMC Med. 2014; 12:137.

Introduction Common mistakes in the Introduction

Ideas are not logically organized

Too long, like a literature review; aim is unclear

Topics in the Introduction do not match topics in the Results/Discussion

Cited studies are not up-to-date

Cited studies are geographically biased

Why study needs to be done?

Keep focused

Write last

<5 years

International

Introduction Link your ideas logically

General background

Methodology

Results and figures

Summary of findings

Final solution & Implications

Evaluation of findings

Current state of the fieldIntroduction(2-4 para)*

Methods(5-10 para)*

Results(5-10 para)

Discussion(8-12 para)**

*10 Refs

Evidence for a

Solution

Evaluation/Comment

Title & Abstract

End matterReferences, Acknowledgments, Funding, Conflicts of interest, Previous publication/presentation, Ethics/Data sharing

Situation/Problem

Introduction

…predictive signatures through meta-analysis of publicly available gene-expression signatures are needed…

…few tests predict the probability of short-term prognosis following neoadjuvant chemotherapy…

…we identified two prognostic and TP53 mutation-driven signatures in breast cancer and one specific for prognosis prediction in patients with ER-negative tumors.

Background

Problem

Conclusion

Discussion

Introduction

Modified from: Lehmann et al. BMC Cancer. 2015; 15: 179.

To analyze the prognostic and predictive value of publicly available signatures, we performed a large-scale meta-analysis of cancer signatures…

Aim & Approach

Linking manuscript sections

Activity 6

Any questions?

Section 7

Editing your work

Editing Revising & Editing

Write your manuscript section-by-section– Get feedback after each section; set deadlines– Easier for your colleagues to review– Less stressful for everyone

Revise for content & overall logic (reporting guidelines)Revise for journal style (see guidelines/past papers)Edit for conciseness, clarity, consistency & accuracy:

read aloud / print out / search for common errorsGet feedback from pre-submission peer reviewGet language assistance

Editing Tips for editing Edit in multiple rounds Macro-edit

o Variables are consistent; check overall logico Paragraph messages are clear; sentences flowo Data match between text and figureso Abstract matches main text (without copying)

Micro-edito Spelling, punctuation, grammar, sentence logic (“it”)o Journal style; formality; no jargon or clichés; no repetitiono Headings, legends, references

Have a rest, then read the manuscript as a fresh reader: check readability, validity/reliability, certainty

Editing Tips for editing

Be aware: language has different levels of meaning Syntax and structureAt day end, we can’t rely on his study, Author1 et al (2015) was careless and forgot to include controls. =>

At the end of the day, Author1 et al (2015) were careless and forgot to include controls, so we can’t rely on their study.

Sentence meaningUltimately, Author1 et al (2015) failed to include controls, so the research community cannot rely on that study.

Social meaning (appropriate among researchers)There is only one published study on this topic (Author1 et al, 2015), but the lack of controls reduces the validity of that study’s conclusions.

Editing

Readers expect… verbs to closely follow their subjects Bottom heavy (not top heavy) sentences

Subject

The viral infection that was caught by the patient on a trip to an outbreak-prone area in Africa spread among the hospital staff quickly.

The patient caught a viral infection on a trip to an outbreak-prone area in Africa. This infection spread quickly among the hospital staff.

Improve readability

Editing Improve readability

1. You deserve the funding, but the study design is not perfect.

Which sentence suggests that you will get funding?

2. The study design is not perfect, but you deserve the funding.

The study design is not perfect, but you deserve the

funding. The grant will be awarded in two stages.

Stress position

Topic position

Readers focus at the end of the sentence for what is important. Information in this stress position can also introduce

the topic of the next sentence (useful for explanations and processes).

The local government has been striving to introduce Information and Communication Technology (ICT) in education. In medical education, technology was introduced through the ICT-Connect-TED project. The program aimed at improving the quality of lecturers through the use of ICT. ICT-Connect-TED recently provided computers and a networking infrastructure to all medical colleges.

idea ideaideaidea

Topic link

sentence

Adapted from: Kafyulilo et al. Educ Inf Technol. 5 May 2015; DOI 10.1007/s10639-015-9398-0

Editing Improve flow (1)

Almost all participants indicated a high level of satisfaction with the content, sequence and relevance of the ICT professional development program they attended. Only a few lecturers reported that the duration of the professional development program was too short. However, the majority of the lecturers reported that they developed an understanding of what TPACK is, and the way technology can enhance teaching and learning of difficult medical concepts through the collaborative design of technology-enhanced clinic sessions in teams. “I developed an understanding of how TPACK can be applied in the design and teaching of a technology-enhanced lesson” said one of the pre-service lecturers. A lecturer from College C said if it was not the professional development he attended, he would not know how to use technology in teaching.

The pre-service lecturers had the opportunity to further develop learning about technology integration in teaching after the professional development program had finished. They were invited to use their TPACK knowledge in workshops organized by the Ministry of Education and Vocational Training…

Topic sentence

Stress sentenceTopic sentence

Supporting sentences

Lecturers were positive about the effectiveness of technology in teaching. They reported the effectiveness of technology on students’ learning, and on simplifying their teaching process. Most of the lecturers reported to be comfortable and satisfied with the outcomes of the technology-integrated lessons they had developed and taught during the professional development program. One of the lecturers from College A said,…

idea ideaideaidea

Topic link

Information in the topic position can introduce the topic of the next few sentences

(useful for definitions, descriptions, and narratives).

Findings in this study are presented in four sections. The first section presents the continuation of technology use in teaching. The second section presents the factors affecting the continuation of use of technology in teaching among lecturers who participated in the study. The third section presents the college management view on the impact of the professional development program and the institutional challenges on using technology in teaching. Finally, the enabling and hindering factors affecting the continuation of technology are summarized.

idea ideaideaidea

Topic link

Information in the stress position can introduce the topic of the next few sentences

(useful for lists and describing whole/parts).

Editing

Logical connectors

Sequence

Cause-Effect

Contrast Although, Even though, Whereas, However, In contrast, Despite (+noun or verb -ing),…

Because (of), To (+verb), Owing to, So that, Therefore, Thus, Hence, Consequently,…

Until, After, Before, While, Since, When, Then, Next, First/Second/Third, Finally,…

Condition If, Even if, Unless, Whether (or not), Except, Provided that, Until, Without, Otherwise,…

Addition Furthermore…, In addition…, Additionally…, Moreover

Improve flow (4)

Editing

Making readers think other people’s words or ideas are your own

Copying published text without “ ” or indenting(even with a citation)

Stating ideas of someone else without citing the source

Plagiarism

Avoid self-plagiarism…If you use text that you have published before, you need to paraphrase, use “ ”, or indent, and give a citation; …or else, readers think you are presenting new ideas

Editing

Expressing published ideasusing different words (but cite as well!)

Paraphrasing

Tips on paraphrasing:

• Write the text first into another language, and then later translate back into English

• Verbally explain ideas to a colleague or record yourself

• Name a published method and cite it• Consider text location

– Introduction (general) vs. Discussion (data)

Editing Good paraphrasing

24. Llovet et al. N Engl J Med. 2008; 359: 378 –390.

“This trial shows that sorafenib improves overall survival by nearly 3 months in patients with advanced hepatocellular carcinoma.”

Sorafenib improves survival by almost 3 months in patients with advanced hepatocellular carcinoma.24

Sorafenib has been shown to prolong survival among hepatocellular carcinoma patients. 24

Editing Paraphrasing tips

How to vary sentence structure and avoid “listing”

Change voice, rhythm, style

Separate/join sentences

Discourse markers Coincidentally; Also in agreement; Indeed

Join 2 sentences (semicolon, colon for a reason/list, or by subordination);

alternate short/long sentences

Active passive, negative positive, invert word or sentence order

Sentence logic Either/or; Neither/nor; Not only,…but also

Introductory phrase According to X’s method,…; In X’s study,…; X showed/reported…; When X…

Change word class An altered direction -> A directional changePrefer to summarize several sources and find relationships

Editing Avoid mistakes (1)

Fix run-ons (comma splices) and fragmentsInefficiency is related to energy flow, however not all losses are because of energy flow.

Inefficiency is related to energy flow; however, not all losses are because of energy flow. (Or…However,)

Our modified assay rapidly screened many cDNA libraries. Which is why it should be a useful high throughput method.

Our modified assay rapidly screened many cDNA libraries. Hence, it should be a useful high-throughput method. (Or…Because our modified assay rapidly screened many cDNA libraries, it should be…)

Editing

Don’t use numbers to start a sentence

506 patients were recruited.

We recruited 506 patients. / In this study, 506 patients were recruited.

Five hundred and six patients were recruited.

Avoid mistakes (2)

Editing

Don’t use informal language

We didn’t get round to doing a review of everything!!

We did not perform an exhaustive review.

Avoid mistakes (3)

Editing Correct verb tense

Present simple

Present perfect

Past simple

Stating an accepted factor current implications

Referring to past studies that are still relevant

Reporting an account of what you did/showed

IntroductionDiscussion

MethodsResults

“Hydrogels are a promising material for...”“Our findings have implications for…”

“Group therapy has been shown to increase...”“In this study, we have shown that…”

“We used RT-PCR to investigate gene expression…”“Sorafenib prevented tumor growth in HCC patients...”

Editing

[New paragraph] “We previously took the Raman profiles of…”

Referring to previous studies in the Introduction

“We have previously studied/reported the Raman profiles of…”

[Next sentence] “A red shift in the G and 2D peak positions is observed…”

“A red shift in the G and 2D peak positions was observed…”

“We observed a red shift in the G and 2D peak positions …”

Correct verb tense – Case study

Editing

“This result suggested that these peaks are from…”Referring to your implications in the Discussion

“This result suggests that these peaks originate from…”“This result suggests that these peaks originated from…”

“These Raman spectroscopy results confirmed that…”

“These Raman spectroscopy results confirm that…”

Signal words for implications of results: confirm, demonstrate, show, reveal, support, indicate, suggest, imply

Correct verb tense – Case study

Human report verbs: conclude, report, state, find, demonstrate, show, advise, recommend, suggest, argue, claim, contend

Activity 7

Be an effective communicator

Your goal is not only to publish, but also to be widely read and highly cited

Plan well before you begin writing Understand IMRaD manuscript structure Know IMRaD manuscript language Edit your work carefully Edanz–Ramathibodi Hospital collaboration:

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