Scientific Writing: A step forward

1. Scientific Writing: A step forward Arash Etemadi, MD PhD Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences aetemadi@tums.ac.ir

2. Why Writing Is Important? • No publication, no project • Make information available for others • No publication, no promotion • Yardstick of productivity • No publication, no funding • What have you done for me lately?

3. Setting Goals • First author papers in major journals • First author papers in secondary journals • Total papers • Non-first author papers • Secondary journals • Book chapters or review papers (AVOID)

4. Tracking Goals Every 3-6 months, tabulate: • Published papers in past year • Number of papers under review • Number of papers in preparation

5. Barriers to Goals • Extrinsic • Major teaching responsibility • Major committee assignments • Personnel disputes • Grants • Intrinsic

6. Intrinsic Blocks to Writing (I) Inability to Start Writing • “First, there is the difficulty of writing at all” • D. BrandeBecoming a Writer • Perfectionism, self-consciousness, procrastination

7. How to Start • Daily • 30 minutes to one hour • Do not pay attention to structure, grammar, spelling

8. Stimulus Control • Few regular places to work • Close the door • Unplug the phone • No e-mail • Arrange the site • But do not clean up the office

9. (II) Inability to Finish Writing • Multiple revisions • Multiple analyses • “Each time I think I am finished, I see there is a lot more to do” • Similar roots as inability to start (perfectionism) • Different people

10. Spontaneous Writing • “You can’t think and hit at the same time” Yogi Berra • Learn to write • Without feeling “ready” • Without feeling fully in control • Without awaiting inspiration • “Learning to write at a gallop leaves one’s internal critics behind.” Virginia Woolf • Once under way, writing builds its own momentum

11. An overview

12. Design well • Decide politics • Choose journal • Read instructions to authors/papers • Set framework • Prepare drafts • Distribute • Polish • Submit

13. First Draft • Don’t worry about the quality or quantity of the writing - just get something on paper! • Set daily goals - do a little every day • Write in the format of the journal you have chosen • Use both the instructions for authors and an example of a good paper from the journal as a guide

14. Instructions to the Authors • Guidelines for writing the paper • Usually found in January issue of journal • Almost always found on the web site for the journal

25. The traditional IMRaD • Introduction • Methods • Results • Discussion

26. A full paper consists of: • Title • Authors and Affiliation • Abstract • Introduction • Methods • Results • Discussion • Acknowledgments (optional) • References

27. Mechanics of Writing- Title, Abstract • Title- be as specific as possible; include design • Abstract is a summary of the paper (therefore write last); check for a word limit; structure it.

29. Mechanics of Writing- Introduction • Introduction – Importance, a brief review of the literature, information gaps, statement of hypothesis • Introduction- about 3 to 4 paragraphs

30. What’s known What’s unknown What’s known What’s unknown “This study will answer the question with better methods.” Gaps/limitations of previous studies The relations between excess body weight and mortality, notonly from all causes but also from cardiovascular disease, arewell established.1,2,3,4,5,6 Although we have known for sometime that excess weight is also an important factor in deathfrom cancer,7 our knowledge of the magnitude of the relation,both for all cancers and for cancers at individual sites, andthe public health effect of excess weight in terms of totalmortality from cancer is limited.Previous studies have consistently shown associations betweenadiposity and increased risk of cancers of the endometrium,kidney, gallbladder (in women), breast (in postmenopausal women),and colon (particularly in men).8,9,10,11,12 Adenocarcinomaof the esophagus has been linked to obesity.11,13,14 Data oncancers of the pancreas, prostate, liver, cervix, and ovaryand on hematopoietic cancers are scarce or inconsistent.7,8,9,10,11,15,16,17The lack of consistency may be attributable to the limited numberof studies (especially those with prospective cohorts), thelimited range and variable categorization of overweight andobesity among studies, bias introduced by reverse causalitywith respect to smoking-related cancers, and possibly real differencesbetween the effects of overweight and obesity on the incidenceof cancer and on the rates of death from some cancers.18,19 We conducted a prospective investigation in a large cohort ofU.S. men and women to determine the relations between body-massindex (the weight in kilograms divided by the square of theheight in meters) and the risk of death from cancer at specificsites. This cohort has been used previously to examine the associationof body-mass index and death from any cause.5

31. Mechanics of Writing - Methods • Use subheadings to organize • Details - use sufficient detail for another investigator to be able to reproduce your results • Reference methods used previously • Be precise with respect to measurements and definitions • Statistics

32. The whole article is: 11 pages Title and abstract: 1 page Introduction: half a page Methods: 4 pages Results: 2.5 pages Discussion: 1.5 pages Acknowledgment, references: 1.5 pages

33. Writing methods:verb tenses Report methods in past tense (“we measured”), But use present tense to describe how data are presented in the paper (“data are summarized as means  SD”)

34. Mechanics of Writing-Results • Tell a story • Use the most logical sequence to present the data (not necessarily the order in which you did the experiments) • Just report the data - do not include interpretation or comparison to literature • No duplication of data

38. Present each endpoint: The NEJM example

39. Writing Results: tense Use past tense, except to talk about how data are presented in the paper. e.g.: We found that… Women weremore likely to… Men smoked more cigarettes than… BUT: Figure 1 shows… Table 1 displays… The data suggest

40. The Scientific ManuscriptWriting Results: tense FROM: Jarvis et al. Prevalence of hardcore smoking in England, and associated attitudes and beliefs: cross sectional study BMJ  2003;326:1061 (17 May) Example: Information was available for 7766 current cigarette smokers.Of these, 1216 (16%) were classified as hardcore smokers. Table 1gives characteristics of all the smokers. The moststriking difference was that hardcore smokers were about 10years older on average and tended to be more dependent on tobacco.Significantly more hardcore smokers had manual occupations,lived in rented accommodation, and had completed their fulltime education by the age of 16 years. There was no differenceby sex.

41. Mechanics of Writing- Discussion • Construct parallel to results • Interpretation of data • Relate your results to the findings of other investigators • Summary paragraph at end - include significance of results • Avoid redundancy with results and introduction sections

43. The Discussion: verb tense Verb Tenses (active!): Past, when referring to study details, results, analyses, and background research: • We found that • They lost more weight than • Subjects may have experienced • Miller et al. found Present, when talking about what the data suggest … The greater weight loss suggests The explanation for this difference isnot clear. Potential explanations include

44. References • Aim for about 30 references • Use recent review papers where appropriate to decrease the number • Get a hard copy of every reference in the manuscript and make sure the referenced paper says what you say it does! Don’t use abstracts! • Proof-read the reference list especially carefully as one of your reviewers may be cited! • Use End Note or other bibliographic software • Use the Internet

45. Beware … • Numbers don’t add up • Text and tables are redundant • 3 D graphs for 2D data • IRB not mentioned • Conclusions restate the results • Format is not followed • Cover letter is addressed to another journal

46. Style