Sandeep B Bavdekar

Workshop at Institute of Research in Reproduction, IRR

11th August 2010
 Research advancement
 Knowledge building
 Experience sharing
 Thought stimulation
Career advancement
 Appreciation by colleagues
 Enhances curriculum vitae
 Financial benefit
 All the thinking, all the textual analysis, all the
experiments and data gathering aren’t upto
anything until we write them up. In the world of
scholarship, we are what we write.
Donald Kennedy, 1997
What do I have to say?

Is it worth saying?

What is the right format for the message?

Who is the message for?

 Case Reports
 Letter to Editor
 Research articles/ Original articles
 Editorial
 Review articles
 Commentary
 Viewpoint
 What is it?
A scientific communication providing
information to the medical world about a rare
or unreported feature, condition, complication,
association or treatment
The best teaching of Medicine is that
taught by the patient himself
William Osler
 A simple form of medical communication
 In vogue for a long time
 A form of descriptive study
 A form of publication and study not dependent
on large resources or research infrastructure
 Can be interesting, accessible and readily
digestible for readers
 Convey the ‘art’ of medicine
 Not all research questions are amenable to RCT
 An expedient way of communicating new ideas,
syndromes, treatments and adverse reactions
 Example Underlying Mechanism

Hepatocellular adenoma Exposure to high-dose oral

in young women contraceptives
Blindness in newborn High ambient oxygen
infants concentrations in incubators
Kaposi’s sarcoma in Infection with HIV-1
young men
Angiosarcoma of the Industrial exposure to vinyl
liver in employees chloride
Cataracts, heart defects Maternal Infection with
and deafness in rubella during pregnancy
neonates
Why did you start,
What did you do,
What answer did you get, and
What does it mean anyway?
This seems to me to be a logical order for a
scientific paper.
Austin Bradford Hill, 1965
I Introduction
MMethods
R Results
And
D Discussion
Introduction: Why did you start?
Methods: What did you do?
Results: What did you get?
And
Discussion: What does it mean anyway?
 Dos
 Describe current state of
knowledge
 Enlist gaps in knowledge
 Provide enough information
for the reader to judge the
need to conduct the study
[Provide rationale]
 State the aim
 Dos Don’ts
 Describe current state of  History starting from
knowledge ‘Adams’
 Enlist gaps in knowledge  Details of previous
 Provide enough studies
information for the reader  Provide conclusions
to judge the need to
conduct the study [Provide
rationale]
 State the aim
It should be brief and arresting
Chronic low back pain (CLBP) is an important
health issue. It is the chief complaint amongst
12% patients visiting general practitioners1 and in
6% patients referred to Pain Clinics.2 Although
several medications have been shown to be
efficacious, there is no unanimity amongst
experts regarding the standard treatment to be
instituted.3 As the information regarding
effectiveness, usually effective dose and safety
profile of drug ‘m’ in Indian population is limited;
we conducted a study to elucidate these issues.
 Three Questions:
What has been done?
What did you look for?
How was it done?
 Dos
 Study design: prospective/ retrospective
 Setting
 Who is the study about: Participants and
controls, how selected; inclusion and
exclusion criteria
 What did you do?: Intervention, follow-up
 What did you look for?: Outcome measure,
how was the effect assessed
 Statistical methods and Ethical
considerations
 Dos Don’ts
 Study design: prospective/ retrospective  Providing
 Setting observations!
 Who is the study about: Participants and
controls, how selected; inclusion and
exclusion criteria, recruitment strategies
 What did you do?: Intervention, follow-up
 What did you look for?: Outcome measure,
how was the effect assessed
 Statistical methods
 Ethical considerations
Provide enough details for other informed
investigators to reproduce the study!
 Dos
 How many were screened/ found
eligible for participation/
consented to participate?
 How many completed the study?
 Reasons for lack of completeness
 Compliance with therapy or
protocol
 What did you find?
 Dos
 How many were screened/
found eligible for participation/
consented to participate?
 How many completed the
study?
 Reasons for lack of
completeness
 Compliance with therapy or
protocol
 What did you find?
Don’ts
 Introduce new parameters
 Interpretation of results
 Provide references
 Using adjectives (most, some,
many, often..)
 Repeating data in text and
tables
 Not accounting for all subjects/
Errors in data
 Mixing up data, erroneous data
 CONSORT: RCTs (Lancet 2001; 357:1191-4)
 QUOROM: Meta-analysis (Lancet 1999;
354:1896-1900.)
 STARD initiative: Diagnostic tests (BMJ 2003;
320:41-4)
 Economic evaluations (BMJ 1996; 313: 275-83)
Virtues:
 Organization of data

 Good for showing specific results

 Not good for showing trends

 Not for quick communication of ideas

 Tables should not be too large. If there are many

columns or rows, try dividing them into multiple
tables
 Avoid repetition of data in text and tables

 Use only as many tables as are needed to tell the

story
 A figure is worth a million words
An attribute that is very useful while
dealing with “word count”
 Figures catch the Readers’ eye
Type of graph used: Dependent on type of data
 Line diagram: Usually event in relation to time

 Bar diagram: Comparisons

 Pie charts: Parts of a whole

 Histogram: Frequency distribution

 Scatter diagram: Associations between variables

Useful for RCT
Can also be used for
describing other studies
 Summary of key findings: (primary outcome
measures, secondary outcome measures, results
as they relate to a prior hypothesis)
 Why is this study special?
 Provide previously published evidence, for and
against
 Discuss differences in findings and probable
reasons for the same
 Discuss strengths and limitations of the study (study
question, study design, data collection, analysis and
interpretation)
 Relevance to practice
 Interpretation and implications in the context of the
totality of evidence
 What this study adds to the available evidence,
effects on patient care and health policy, possible
mechanisms
 State controversies raised by this study and new
questions it poses
 Provide directions for future research
 Reiterating selected results
 Emphasizing strengths, not weaknesses
 Inflating the importance and generalizability
of findings
 Going beyond the evidence and drawing
unjustified conclusions
 First thing a reader sees
Should know what the study is about
Should interest the reader
Should make the reader curious

 Concise, descriptive, not declarative

 The sequence of the human genome

 Initial sequencing and analysis of the

human genome
 Indicative (states what the paper covers,
not what it says)

 Informative (good to start writing with)

 Effect of asthma on linear growth in children

 Does asthma reduce linear growth?

 Linear growth deficit in asthmatic children

 A succinct, accurate, summary of the paper
Purpose
Helps the reader:
 To know what to expect in the Report
 To decide what details to look for
 Follow IMRaD pattern, 150-250 words
 No information that is not included in the main
body of the paper
 Do not copy sentences from the main body
 Include actual data on primary outcome
measures
 Include the main statistical conclusions
 It is a good idea to write a structured Abstract
 The foundation on which your work is built
 Provides scientific background that justifies the
research undertaken and methods used
 Provide the context in which your research
should be interpreted
• The foundation on which your work is built
• Provides scientific background that justifies the
research undertaken and methods used
• Provide the context in which your research
should be interpreted
References should not be collected, as an
afterthought, when the research ends
Literature search and reading relevant
references: starting point
 Allows the reader to locate the source material
 Accurate, current and complete
 Too many or too few references
 Reference section (Journal article, books,
website)
 Citations in Introduction: Background
information, explain why research was
undertaken
 Citations in Material and Methods: Support
methods and procedures used
 Citations in Discussion: Interpret and explain
your results, defend hypothesis
 Harvard Vancouver
References are References are
 Cited in the text by  numbered consecutively
giving author’s name as they appear in the
and year of publication text
in brackets  Identified by a number in
 Author, reader and the text
researcher-friendly  Librarian friendly. Author
 Provides researcher’s just a number in the text
world view and his/ her and list of references
evolution of thoughts  Ease in indexing
 Follow Instructions/ Guidelines: Format, Number
 Cite the most valid, most important and most recent
literature
 Cite studies that have been rigorous and provide high
quality evidence
 Prefer citing references that give facts, not opinions
 Check original paper
 Avoid: Non-peer reviewed articles and personal
communications
 Style: Choice does not rest with you
 Accuracy of references: Your responsibility
 Inaccurate references: Reviewers tend to be
more critical
 Patel K, Kedia M, Gogtay NJ, Mehta SS,
Kshirsagar NA. Evaluation and economic
burden of adverse events presenting to the
Emergency medical services in a tertiary
referral centre. Drug Safety 2005; 34: 15-19
 Give it sufficient time
 Put it away
 Give it to your enemy/ real friend for review
 Revise, revise and re-revise
The notion that a scientific paper should be
written in a special language is nonsense. It
should be written in good, plain English.
People don’t ambulate and take oral fluids,
they walk and drink.
John Ellard
If the science is bad, no amount of writing skills
will make it publishable.
If the science is good, editors will help you
dress it up.

Rajendra Kale, Editor- Editorials, BMJ

JPGM Goldcon, September 2004