Primary Care Research Leader

Workshop

Manuscript Writing & Publishing

Primary Care Research

Cindy L.K. Lam, MD (HK) Department of Family Medicine and Primary Care

The University of Hong Kong

September 24, 2011

Pre-Workshop Reading

1. Sample manuscript WM

2. Sample manuscript CM

3. Chipperfield L et. al. Authors’ Submission Toolkit: A

practical guide to getting your research published.

Current Medical Research & Opinion 2010; 26(8).

1968-82.

4. European Association of Scientific Editors. EASE

Guidelines for Authors and Translators of Scientific

Articles to be Published in English. 2011.

Goal of Medical Research

To discover facts and new

knowledge to inform practice for the

enhancement of health and medical care

To serve the Purpose - Manuscript

• Documentation of work

• Record of the facts (results)

• Interpretation & implication for practice

• Dissemination of knowledge

• Publication (journal or book)

• Conference presentation

• Report

• Public media

• Personal communication/ letters

Manuscript – a means of communication

• Useful messages

• Credible

• Coherent

• Clear & easy to read

• Interesting

• Precise

• Concise (2000-3000 words)

Manuscript – Continuation of the research protocol

• Authors

• Declaration

• Title

• Introduction

• Subjects and

Methods

• Results

• Discussion

• Conclusion

• Acknowledgement

• References

• Abstract

“ The Jewels are in the details”

Courtesy of photolibrary@hku.hk

Content Checklists (EQUATOR Network: http://www.equator-network.org/ )

• RCT : CONSORT (25-items + flow diagram)

• Diagnostic : STARD (25-items + flow

diagram)

• Observational studies : STROBE (22 items)

• Qualitative : COREQ (32-items)

• Meta-analysis & systematic reviews of RCT:

PRISMA (27-items + flow diagram)

• Meta-analysis observational studies:

MOOSE (35 Items)

Authors • Significant contribution (declared) to

– conception, planning and execution of

the research

– data analysis & interpretation

– Writing and revision of the manuscript

• All authors must endorse & are

responsible for the manuscript

• Avoid gift / hidden authors

Declaration & Acknowledgement

• Funding source (ref no.)

• Conflict of interest, industry sponsorship

• Ethics approval (ref no.)

• Trial registration no.:

www.ClinicalTrials.gov.

• Consultants, advisors, mentors,

colleagues, service providers, research

assistants

• Previous or concurrent publications

Title – what it is about?

• Reflects the focus & boundary of

the manuscript

• Succinct summary of answer to

the research question

• Succinct summary of the P.I.C.O.

• States the design & method

• Interesting

Title – Appraisal

Reflecting the content of manuscript

WM: Effectiveness of Western medicine

outpatient consultations in primary care - a

comparison with Chinese medicine

CM: A comparison of the effectiveness

between Western medicine and Chinese

medicine outpatient consultations in

primary care

Introduction

• Rationale & justification

• The problem and its importance

• What is known (literature review)

• What is the knowledge gap (need of

study)

• State clearly the research aim,

question, objectives, hypothesis

Introduction – Appraisal

Coherence between justification

(importance of TCM in PC) & aim

WM: evaluate effectiveness of WM

consultations in improving HRQOL … &

compare it with CM

CM: evaluate effectiveness of TCM

consultations in improving HRQOL … &

compare it with WM

Objectives – Appraisal Base of the results & discussion

•To investigate whether WM consultations

…. could improve HRQOL ….

•To compare the effectiveness of WM and

TCM consultations in improving HRQOL

and health condition

•To investigate factors …. that may affect

the effectiveness of WM consultations in

primary care

Methods (1) • Setting

• Place, culture, system, organization

• Study design

• Subjects

• sampling frame, criteria & method

• sample size with justification

• Response & completion rates

• Representativeness / bias/ group diff

Methods (2) • Clear pre-study definitions of

• Primary & secondary outcomes

• Confounding variables

• Data collection/extraction method

• Study instruments (validity & reliability)

• Tests (accuracy)

• Case record form (CRF)

• Who, when , where & how

• Justification & quality assurance

Methods (3) – Data Analysis

• How & what, to answer each objective &

hypothesis (subheadings)

• Specific statistical tests & programmes

used, with justification

• State dependent and independent

variables in explanatory analyses

• Standards of significance, statistical &

clinical

• Sub-group/ post-hoc analysis

Methods – Appraisal

Clarity & relevant to aim

Subject recruitment: Figures 1 & 2

WM: Prospective studies … 2 WM clinics &

1 CM clinic… The WM … clinics were used

as controls.

CM: Prospective studies ….1 TCM … & 2

WM clinics….. The WM … clinics were used

as comparison groups for the TCM clinic

Results • Data quality, deviation from protocol

• Answers to the research question and

objectives (sub-headings)

• Descriptive statistics of outcomes (95%

C.I) , & independent & confounding

variables

• Comparative results, p values, r, OR

• Tables & figures, title, legend & footnotes

• Highlight important/ unusual findings,

don’t repeat

Results - Appraisal

• Answers to objectives 2 & 3

WM: Factors … that had significant

independent effects on changes in HRQOL

scores .. Baseline HRQOL score…. The

specific clinic had an effect ……

CM: Linear regression analysis found that

specific clinic had an effect ….. Baseline

HRQOL score…..

Discussion

• What is important? –key findings (KISS)

• What is new? – compare & contrast with

other studies

• Is it true?- justify results, confounding

• What is the implication for practice ?

• What are the limitations (methods,

subjects, data scope & quality)?

• Don’t repeat introduction/ results

Discussion - Appraisal

• Systematic, coherent & convincing

• WM: The ideal methodology …. RCT

but ….. The effectiveness of WM &

TCM … was compared…

• CM: The study showed that HRQOL

…. Improved after TCM & WM

consultations ….

Conclusion

• Succinct summary of the answer to the

research question

• Achievement of aim of study

• Recommendation for policy/practice

• Recommendation for further research

• Be specific, avoid empty or over-

statements

Conclusion - Appraisal

Answer to the research question ?

WM: More people used WM than TCM as

the 1st primary care …WM ….

Significant improvement in HRQOL ….

No difference between WM & TCM

(abstract).

CM: Both TCM & WM …. Improvement in

HRQOL….. No difference between TCM

& WM … support the role of TCM as an

alternative primary care. (abstract)

References • Numbered (Vancouver style) or by

authors (Harvard style)

• Published refereed journal articles

• Cite primary source

• Avoid unpublished work,

newspapers, magazines, personal

communication

• Be up to date & selective

Ready to submit

Courtesy of photolibrary@hku.hk

Publishing -Dissemination

• Thesis/ dissertation

• Refereed journals

• Indexed (Index medicus)/ non-

indexed

• International/ local

• Books

• Conference proceedings

• Report

Choosing the right journal

Journal Website address IF

Lancet http://www.thelancet.com/ 32.50

BMJ http://www.bmj.com 13.47

Ann of Fam Med http://annfammed.org/ 4.46

Family Practice http://fampra.oxfordjournals.org/ 1.71

BMC- Family

Practice

http://www.biomedcentral.com/bmcf

ampract

1.47

HK Practitioner http://www.hkcfp.org/

HK Medical J http://www.hkmj.org/

Chinese Med J http://cmj.org/ 0.98

Choosing the right journal (2) Journal Website address IF

BMC – Health Serv

Res

http://www.biomedcentral.com/bmch

ealthservicesresearch

1.72

BMC – Public Health http://www.biomedcentral.com/bmcp

ublichealth

2.36

Social Sci and

Medicine

http://journals.elsevier.com/02779536

/social-science-and-medicine/

2.74

Medical Education www.mededuc.com 2.64

Medical Teachers http://www.medicalteacher.org/ 1.98

BMC – Med Educ http://www.biomedcentral.com/bmcm

ededuc

1.20

Revisions • Average 7 versions from draft to press

• Re-submit after revision

– good chance of acceptance

– Point-by-point response, cross-ref to

manuscript

– Receptive to suggestions

– Disagree tactfully

– Don’t argue with the editor or reviewer

– ASAP

Rejections

• Never ever again!

• Success of failure – keep trying

– Another journal

– Another focus

– Other analyses

– Other conclusions

“ Research is not a very

difficult task but it requires the

ability to ask the right question,

and to think clearly and in an

organized way.” John G. R. Howie 1989

Useful References

• BMJ. Resources for Authors- Article Requirements.

http://resources.bmj.com/bmj/authors-

submission/article-requirements.

• BMJ. Resources for Authors- Research Articles

http://resources.bmj.com/bmj/authors/types-of-

article/research

• Wagner, P.D., Writing up your research results for

publication. Chest, 2009. 136(2): p. 639-642.

• Wells, W.A., Me write pretty one day: how to write a

good scientific paper. The Journal of Cell Biology,

2001. 165(6): p. 757-756.

References

• Alpert, J.S., Learning to write: a personal

reflection. The American Journal of Medicine,

2010. 123(8): p. 671-672.

• Neil, U.S., How to write a scientific masterpiece.

The Journal of Clinical Investigation, 2007.

117(12): p. 3599-3602.

• Tong A., et. al. Consolidated criteria for reporting

qualitative research (COREQ): a 32-item checklist

for interviews and focus groups. Int J Quality in

Health Care 2007; 19: 349-357.