Clinical Writing for Interventional Cardiologists

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

Introduction (± Aim)

Methods

Results

And

Discussion

IMRAD algorithm

Introduction (± Aim)

Methods

Results

And

Discussion

IMRAD algorithm

Where are the title

and the abstract?

Title and Abstract

The are the “business card“of the whole paper…

What you will learn• Writing the Title and the Abstract

– goals of Title– goals of Abstract– effective tips

Title

What makes a good title?

First you need to ask yourself what a title is for!

Title

The title is like the eyes of a woman

Title

The title is like the eyes of a woman

They may mislead, but they are decisive in making the choice for having a glance at the article

Title A good title should:

1. Accurately, completely, and specifically identify the main topic

2. Be unambiguous

3. Be concise

4. Begin with an important word to attract intended readers

5. Include independent and dependent variables and species, if not human

6. Be a label suitable for indexing

Title Avoid:

– Too scholarly or too “cute” titles– Acronyms– Roman numerals– Abbreviations– Noun clusters

• Complement fixation laboratory techniquefor adult rhesus monkey antigen isolation

– Questions (sometimes they can be used in a “provocative” way)

Don’t use “jargon” or “phrases”

Keep word order simple

Mauri et al, Circulation 2005

Agostoni et al, AJC 2006

Title “Provocative” questions

Versus

Valgimigli et al, JAMA 2008

Title Subtitles

Try to minimize them

Fajadet et al, Circulation 2006

Title

• Write it first, as soon you develop your hypothesis

• Try to state the “idea” behind the study in the title

• Be specific but catchy

• On the other end, do not make it too specific, or

people might not read or cite it

Title • Optimally:

–Very brief summary of research

•Omits “A study of,” “Investigations of,”…

•Put subjects studied (eg octuagenarians)

•Put limiting information

•Avoid “cute” or abbreviations

–May or may not give results

•Topic – Effects of distal protection on the risk of

periprocedural stroke during carotid stenting

•Conclusive – Distal protection reduces periprocedural

stroke during carotid stenting

Title • Topic

• Conclusive

BIMODAL DISTRIBUTION OF LATE LUMINAL LOSSIN SIROLIMUS AND PACLITAXEL-ELUTING STENTS:

A DETAILED ANGIOGRAPHIC ANALYSIS

Agostoni et al, AJC 2007

Title

CONSORT for RCT

STARD for diagnostic studies

QUOROM and MOOSE for meta-analysesReport in the title the word “systematic review” or “meta-analysis”

Title

• A Randomized Comparison of Zotarolimus-Eluting Versus Paclitaxel-Eluting Coronary Stents

• Improved Event-Free Survival After Drug-Eluting Stenting in Patients with Unprotected Left Main Disease

• Long-Term Clopidogrel Administration Prevents Late Drug-Eluting Stent Thrombosis

• Abnormal TIMI Frame Count as a Predictor of Unfavorable Remodeling After Primary Angioplasty

What you will learn• Writing the Title and the Abstract

– goals of Title– goals of Abstract– effective tips

Abstract

What makes a good abstract?

First you need to ask yourself what an abstract is for!

Abstract

The abstract is like

the whole body

of a woman

It may mislead, but it is decisive in making the

choice for reading the full-text of the article

Abstract

A good abstract should:

1. State the principal objectives and scope

of the investigation

2. Describe the methods employed

3. Summarize the results

4. State the principal conclusions

Abstract

1. It's by far the most important part of the paper (because most people only read this…)

2. Write it before the rest of the paper, not after

3. Rewrite it after you finished the rest of the paper

4. Start with a rationale for the study: state why you

did it, not what you did

5. Include as much detail of methods as possible

6. Include magnitudes of effects in the results

Abstract

7. End with the main conclusion: state why or how

it's useful, not a rehash of what you found

8. It should be within a few words of the prescribed

length (usually between 200 and 300)

9. Be as economical with words as possible, but do

not compromise grammar

10. Minimize abbreviations here

11. Do not include references, figures, or tables

Abstract

IMRAD

Introduction (± Aim)

Methods

Results

and

Discussion (Conclusions)

Abstract

Introduction (± Aim) 2-3 phrases

Methods 2-3 phrases

Results 3-5 phrases

(And)

Conclusions 1-3 phrases

Abstract • Abstracts are short but time-consuming

• Very information-dense, but simply formatted

• Write “long” and pare down if needed

• Analyze one sentence at a time

– Each sentence has purpose

– Each sentence logically follows another

• Use plain English wherever you can

• Use active voice when you can

• State only your most important conclusion(s)

• There is not good writing, only good rewriting

Abstract - Introduction

• What is the general topic you were

investigating and why is it important?

• Provide supporting information for title

• Generally max 3 sentences

• General information to specific

Abstract - Aim

• What are the specific questions you

are addressing with this project?

• Sometimes you need two

sentences, but one is better

Abstract - Methods

• How did you do this experiment?

• One or two sentences are needed for

short abstracts (200 words). Three or

four for longer (300 words).

• Just to give general idea

• No statistical analysis

• No vendor info needed

Abstract - Results

• What did you find out?

• Two sentences might be enough: state only

you main point(s).

• Include your most important data that

influenced your conclusion:– mean values, standard deviations, p values, confidence

intervals, number of samples you studied, etc.

Abstract - Conclusions

• Sometimes called Discussion or

Interpretation

• How did hypothesis turn out?

• What is the big point that you want to

take home?

• One sentence may be enough

• Be bold, yet not overconfident

Abstract The more structured, the better

SORT OUT II, JAMA 2008

Abstract

TAPAS 1 year, Lancet 2008

Abstract The less structured, the worse

ENDEAVOR II, Circulation 2006

Tips

Title drafting

-keep focused and precise but catchy!

Abstract drafting

-every phrase is a battle, and the whole abstract is your war, win or loose!

-follow the IMRAD approach

-never tell lies, better (slightly) conceal the truth

Expanded IMRAD algorithmIntroduction Background

Limitations of current evidenceStudy hypothesis

Methods DesignPatientsProceduresFollow-upEnd-pointsAdditional analysesStatistical analysis

Results Baseline and procedural dataEarly outcomesMid-to-long term outcomesAdditional analyses

Discussion Summary of study findingsCurrent research contextImplications of the present studyAvenues for further researchLimitations of the present studyConclusions

Expanded IMRAD algorithmIntroduction Short background

(Limitations of current evidence)

Study hypothesisMethods Design

PatientsProceduresFollow-upMain End-pointsAdditional analysesStatistical analysis

Results Most important baseline/procedural data

Main outcomesEarly Mid-to-long term outcomesAdditional analyses

Discussion (Rapid summary of study findings)Current research contextImplications of the present studyAvenues for further researchLimitations of the present study

Conclusions

Remember the KUQE approach!

Take home messages

• Known

• Unknown

• Question

• Experimental approach

Remember the KUQE approach!

Take home messages

And now a brief break…

For further slides on these topics please feel free to visit the

metcardio.org website:

http://www.metcardio.org/slides.html