04/22/23

How to Write Good

Daniel Byrne

04/22/23

How to Recognize a Joke

Daniel Byrne

Pop Quiz #1What is the most important

sentence in a paper? Title Abstract Introduction Methods Results Discussion/conclusions References Tables Figures

* Dr. Alastair J.J. Wood

Pop Quiz #2 What is the most efficient order in

which to write a paper? Title Abstract Introduction Methods Results Discussion/conclusions References Tables Figures

* Dr. Alastair J.J. Wood

5 Phases of POWER Principles

1. Planning2. Observing3. Writing4. Editing5. Revising

How successful scientistsbudget their time

Successful Planning – Observing – Writing – Editing – Revising

Unsuccessful

Planning – Observing – Writing – Editing - Revising

PlanningOWER

Key questions:

• What is the research problem?

• What is the plan to study this problem?

• How can this study benefit patient care?

Choosing a Publishable Topic Timely Important Interesting Topical Unique A new twist Long-term follow-up A message

Survey Results

Nobel Prize Winners JAMA Reviewers Medical Journal Editors

Comments Objective data Pop quizzes

How Reviewers Define “A Good Article”

• One that makes the reader wonder: “Why didn’t I think of that?”

• Deals with an important, interesting, and contemporary topic: the aim is clearly stated; the methodology is correct; the study is well presented and has a concise, interesting discussion

• Relevant to the audience and clinical practice• Original• Results should be reproducible

How Reviewers Define “A Good Article”

• Good design of experiments to answer a specific question that has not already been answered in the literature

• Adequate discussion of the shortcomings of the design and conclusion

• Tight, clear organization• Clear, easy-to-read communication that

teaches or stimulates ideas in the reader• Omits irrelevant points

Join or form research team with the right chemistry

Find team members who have a reputation for:• doing their share of the work• avoiding academic politics• working well together• showing respect for colleagues• meeting deadlines• making time for research

Pop Quiz #3What are the six steps of the

scientific method?

1. 2. 3. 4. 5. 6.

The Scientific Method

State the problem Formulate the null hypothesis Design the study Collect the data Interpret the data Draw Conclusions

State the ProblemStep 1

It is unclear whether Drug B is more effective

than Drug A at curing patients with disease X.

Formulate a Null HypothesisStep 2

There will not be a statistically significant difference in the

proportion of patients cured of disease X at 1 year between

patients who received Drug A and those who received

Drug B.

Note: This hypothesis must be testable!

Design the StudyStep 3

Patients meeting the following inclusion criteria will be included in the study:• Diagnosed with disease X• Treated at hospital Y between 1/1/00 and 12/31/00

Patients will be randomized to receive either Drug A or Drug B

One year after being enrolled in the study outcome will be measured using the following protocol...

The sample size required is 90 patients.

Collect dataStep 4

Case (Name) Group Age Sex Confounding factors Outcome

Interpret the dataStep 5

Chi-square test to compare percent cured with Drug A and Drug B.• A 50%

• B 75%

• P=0.001 (Reject the null hypothesis)

Cox proportional-hazard to adjust for differences in the patients.

Draw ConclusionsStep 6

Among patients with disease X, Drug B was

associated with a significantly higher cure rate at

1-year.

Pop Quiz #4What is the single most common

type of flaw that results in outright rejection of a manuscript?

1. Importance of the topic

2. Interpretation of the findings

3. Presentation of the results

4. Study design

The Most Common Type of Flaw

4

4

20

0

0 5 10 15 20 25

Presentation of the results

Importance of the topic

Interpretation of the findings

Study Design

Number of Responses

What is meant by “study design”?• Sample

• large enough• representative of wide population• homogeneous for the topic

• Intervention• randomized• placebo-controlled• blinded

• Outcome• well defined• specific• objective• measured prospectively

Insiders’ Secret #1Avoiding the Common Pitfalls

Study design flaws are the leading cause of rejection.

Before collecting any data, research ways to strengthen your study design.

Spend more time planning a flawless study design.

Consult an experienced biostatistician during the early planning.

Specific Way to Improve the Study Design

Research and plan how you will control for confounding factors.

Research and plan how you will minimize bias. Calculate the sample size and statistical power of

your study before you collect data. Improve your control group.

Designing a data collection form

Short but comprehensive Pilot test it. Think through the statistical analysis. Have a statistician check it before you begin. Record data as mutually exclusive & collectively

exhaustive. Include confounding factors.

Selecting a Target Journal

Scope of the journal Circulation size Impact factor Acceptance rate Prestige factor

Top 10 Most Prestigious Journals

Prestige factor = (circulation size x impact factor)/1,000,000

Impact Factor

http://portal.isiknowledge.com/portal.cgi?DestApp=JCR&Func=Frame

Pop Quiz #5Which Section is Usually Too Short?Which Section is Usually Too Long?

Introduction Methods Results Discussion

Which Section is Usually Too Short?Which Section is Usually Too Long?

-15 -10 -5 0 5 10 15

Discussion

Results

Methods

Introduction

Too Short Too Long

Number of Responses

Insiders’ Secret #2Avoiding the Common Pitfalls

Make the middle two sections longer.

• Methods - add more detail.

• Results - add more convincing evidence

Make the end two sections shorter.

• Introduction - limit to 1 page.

• Discussion - focused, not a literature review.

PObserving

WER

Includes:

• Making observations/conducting the experiments

• Collecting data

• Data entry

• Data analysis

These will be covered in other courses.

PO

WritingER

Key questions to answer in the writing phase:

• Why did you perform the study? Introduction• What did you do? Methods• What did you find? Results• What do your results mean? Discussion

Pop Quiz #6Which section is most often responsible

for outright rejection of a paper?

IntroductionMethodsResultsDiscussion

The Methods section is most often responsible for rejection

6

8

15

0 2 4 6 8 10 12 14 16

Discussion

Results

Methods

Introduction

Insiders’ Secret #3Add more detail to the Methods

Write 3-4 pages of methods, including:• Inclusion and exclusion criteria• How you calculated the sample size• Definitions• Who collected the data• 1 page of statistical methods, software• Have a colleague check if Methods are reproducible

Sections of a Manuscript Title Abstract Introduction Methods Results Discussion/conclusions References Tables Figures

What’s Wrong With These Titles? An Investigation Into Risk Factors for Preeclampsia and

Adverse Neonatal Outcome Among Women with Chronic Hypertension

COPD is a Risk Factor for Preeclampsia and NICU Admission Among Women with HIV, Low IQ and HTN

Risk Factors for Preeclampsia, Abruptio Placentae, and Adverse Neonatal Outcome among Women with Chronic Hypertension

Preeclampsia During Pregnancy

Title Page Byrne, et al. Target Journal = JAMA Date last revised: 1/11/07 Co-author from the Department of Biostatistics = relax Altman showed in a 2002 JAMA paper that having a

biostatistician as a co-author could double the odds of having a paper published.

Grant support:• "Supported in part by grant M01 RR-00095 from the National Center for

Research Resources, National Institutes of Health" 

Abstract

Keep your conclusions specific and conservative.

Your conclusions must be a smooth logical

transition from your data.

Introduction

Common pitfalls:• Verbose• Too much history• “Who Cares?”

Make your Introduction shorter. Do explain the gap in the literature, how your

study fills this gap, and your null hypothesis.

Reader Grabber

http://www.bulwer-lytton.com/ After she realized the man she had fallen in

love with was her long lost twin brother and they must break up immediately, they shared one last kiss that left a bitter yet sweet taste in her mouth--kind of like throwing up after eating a junior mint.

Methods

Most problematic. Make it longer - add more detail Define your variables. Give dates. Test whether it is reproducible. Think of it as a cake recipe.

Statistical Methods

1 page 1 paragraph for a reproducible sample size Avoid “A p value <0.05 was considered

statistically significant.” Use nonparametric methods. Use modern methods and modern software. CIs, CIA

Results

Comprehensive Convincing Add more evidence Anticipate reviewers’ concerns. Demonstrate that the findings hold up after

adjusting for confounding factors.

Use 95% CIs Not P Values as Your Evidence

Treatment X resulted in significant weight loss (P<0.000000000000001).

Participants treated with X had an average weight loss of 12.6 pounds (95% CI, 10.4. to 14.8, P<0.001).

Discussion

Focused Describe the new information that you paper provides. How does your study fill a gap in the literature? How will your findings benefit patients and clinicians? Limitations of this study. Practical considerations and future implications. We found … and this is important because …

Conclusions

Are your conclusions justified by the work in this paper?

Come to the point. End up with conclusions.

References

Budget time for a flawless reference section.

Include several studies from the current and

previous year.

Use the journal’s format precisely.

What is wrong with this table?

Drug A Drug B P ValueAge 56.256 51.061 NS

Cured 50% 75% <0.05

HPQV4 1.2 2 0.00003

Male 90% 10% <0.05

Female 5% 80%

Tables

Double-space No lines Placement after reference – before Figure Legend

page Exact P values CIs

Figure Legend Page

Figure 1. Figure 2. Figure 3. After Tables and before Figures.

What’s Wrong With This Graph?

10

20

3035

0

10

20

30

40

1 2 3 Delivery

Good outcome

Adverse outcome

Good outcomeAdverse outcome

P<0.05

Figure 1. Maternal weight gain by trimester.

Pop Quiz #7Of these 4 problems, which is most often

responsible for outright rejection?

1. Issue outdated or no longer relevant

2. Results of narrow interest, highly specialized

3. Few or no clinical implications

4. Results unoriginal, predictable, or trivial

Results unoriginal, predictable, or trivial

2

3

18

0 5 10 15 20

Issue outdated or no longer relevant

Results of narrow interest, highly specialized

Few or no clinical implications

Results unoriginal, predictable, or trivial

Number of responses

Example of a Trivial Study

The Japanese Meterological Agency spent 7 years

studying whether earthquakes are caused by catfish

wiggling their tails.

Insiders’ Secret #5Show what’s NEW and IMPORTANT

Study the literature to find the gap that your study fills.

Make it easy for reviewers and editors to see that your paper provides clinically useful information.• Larger sample size• More recent data• Randomized controlled trial• Representative of a wider population

POW

EditingR

Key questions to answer in the editing phase:

• Have you said what you intended to say?

• Are you asking too much of the reader?

Editing

Check that each result has a method and each method has a result.

Writing does matter. Rewriting is the key. Put it aside for a week. Read it out loud. Take notes while reading it.

Internal Peer Review

Check if your administrative assistant or spouse

can read it.

Write so we can understand.

Delete Unnecessary Words

Problematic Usage Preferred Usage an excessive number of excessive as the result because at a high risk at high risk at this moment in time now before beginning the study before the study data for all of the variables data for all variables in order to because, to in terms of in, of, for is able to can is know to be Is it would appear that apparently

Do Not Start a Sentence With:

It There However

How to respond to feedback from your colleagues

Thank you very much for taking the time to critique

my writing. I will make all of the changes you

recommended.

Biostatistics Clinic

Every weekday 12-1 PM. Thursdays in GCRC conference room. Other weekdays in D-2221 MCN. Bring a draft of your ms before you submit it. Have internal prereview before you submit. Also consider for grants, presentations, abstracts.

“Science begins only when the worker has recorded his results and

conclusions in terms intelligible to at least one other person qualified

to dispute them.

• - B.M. Cooper, 1964

Make it easier for editors and reviewers to find and understand the following:

The value and scientific validity of the paper. Novelty and importance A flawless experimental design and performance. Freshness Clinical impact Timeliness Worthiness for publication Veracity of the findings Potential interest to the journal’s audience Potential impact on medical practice or biomedical research

The Final Draft Edit the last draft yourself. Check for typos. Are all the pages numbered? Did you follow the publisher’s instructions exactly? Check envelope. Is it complete? 3 copies? Check to make sure that all material required for

submission is included – see “Information for Authors”

POWE

Revising

Key questions to answer in the revising phase:

• What needs to be improved for this paper to receive a

high rating from reviewers?

Avoid clichés like the plague!

They are a dime a dozen.

How do you know when to stop resubmitting your manuscript?

If you can’t get your paper published, you just

don’t have enough stamps.

Should you submit a paper to a prestigious journal first?

Most authors submit their manuscript to a prestigious journal first and if it is rejected resubmit it to a less prestigious journal.

However, a large percent of papers published in the NEJM were previously rejected by another journal. These authors used the less prestigious journals to get feedback and improve their manuscripts.

What is a good source for how to write a review paper?

How to Write & Publish a Scientific Paper

• Robert A. Day

Writing and Publishing in Medicine

• Edward J. Huth

The Take-Home Message

10 Key Principles

1. Invest ample time and money in planning.2. Formulate your study protocol early.3. Describe your methods thoroughly.4. Describe the rationale for the size and

composition of your sample.5. Explain what is new, interesting, and useful about

your results.

10 Key Principles

6. Keep the manuscript short.7. Answer the questions:

“So what?” and “Who cares?”

8. Follow the guidelines and format of the target journal precisely.

9. Edit ruthlessly.10. Write cautious, but perceptive conclusions.

How to remove all evidence that this is your first paper

Double-space the entire manuscript. Submit with proper order with appropriate

information in the proper section. Make each section an appropriate length. Reference questionable claims. Create professional graphs and tables.

How to remove all evidence that this is your first paper

Delete unnecessary words. Present results with sophistication (CI not P

values) Be objective not angry or biased. Make it interesting. Revise based on feedback from at least 10

PIs/mentors who have published in this journal.

04/22/23

How to Right Even Gooder

Daniel Byrne