what this presentation is not about: its about how to most easily put together the best possible...

What this presentation is not about:

Its about how to most easily put together the best possible presentation of your ideas, questions, data and findings.

How to have good ideas

How to obtain good data that address the ideas/questions

How to enjoy a rich and fulfilling life...

How to find good questions

And the process can improve your

ideas

questions

data

(for the medical literature)Strategies in Writing

Disclaimer

Don't ask me about:parts of speech,past participles,or split infinitives.

I have no idea what these words mean.

Pop Quiz How do you start writing?

a. make a cup of coffee

b. make two cups of coffee

c. straighten up your desk

d. see if the basement doesn’t need cleaning...

I wonder if anything good is on TV?|¶

Strategies in Writing

#1 - Write smartmake use of efficient frameworks Get feedback

Simple, directly related to finding

ABSTRACT

Context:

Objective:

Methods:

Results:

Conclusion:

Motivate the reader Why should the I care about your findings and conclusions?

Must be supported by result above

Must explain how result below was obtained, not other analyses in the paper.

Primary findingWhat is the one piece of data you want people to walk away with?

To describe the frequency of cervical cancer screening in the United States.

To determine the prevalence of cancer screening of the cervix in the United States.

To consider the amount of cervical cancer screening in the United States.

To consider the amount of cancer screening of the cervix in the United States.

ABSTRACT

We obtained the1998 Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (CDC)which is a cross sectional survey of a random sample of American women. Sample Frame Women aged 18 and older living in households with telephones (86,715 respondents). Our main outcome measures were: time since last Pap smear; the estimated number of American women receiving Pap smear at various screening intervals.

The vast majority (YY%) of American women report having had at least one Pap smear in their lifetime. Among women who have not had a hysterectomy and who have been screened at least once, ZZ% report having had a Pap smear within the past three years, XX% within the past two years and 73% within the past year. Based on these data, we estimate that 45 million American women undergo Pap smear screening annually and only 6 million are screened using a 3-year interval.

The majority of American women are being screened for cervical cancer too frequently. Lengthening the screening interval would not only reduce the number of pelvic exams, but would also reduce follow-up testing for abnormal smears and the volume of specimens that cytotechnologists are required to read.

Context:

Objective:

Methods:

Results:

Conclusion:

Most US professional medical societies and the national health systems of all other industrialized nations now recognize that most women need not undergo Pap smear screening annually. There are no data, however, regarding the frequency at which women actually undergo screening in the United States.

Based on these data, we estimate that 45 million American women undergo Pap smear screening annually and only 6 million are screened using a 3-year interval. The vast majority (YY%) of American women report having had at least one Pap smear in their lifetime. Among women who have not had a hysterectomy and who have been screened at least once, ZZ% report having had a Pap smear within the past three years, XX% within the past two years and 73% within the past year.

Women aged 18 and older living in households with telephones (86,715 respondents). Our main outcome measures were: time since last Pap smear; the estimated number of American women receiving Pap smear at various screening intervals. We obtained the1998 Behavioral Risk Factor Surveillance System of the Centers the frequency of cervic for Disease Control and Prevention (CDC)which is a cross sectional survey of a random sample of American women. Sample Frame

The majority of American cytotechnologists are being screened for cervical cancer too frequently. Lengthening the screening interval would not only reduce the proportion of pelvic exams, but would also reduce follow-up testing for abnormal smears and the volume of specimens that cytotechnologists are required to read.



Most professional medical societies and the national health sysms of all other industrialed nations now recognize that most women need not underghkjhko Pap smear screening annually. There are no data, however, kk the frequency at which women actually undergo screening in the Unjlkjljited States.




what you are really doing is figuring out the basic structure(as well as the basic point) of the paper

Get feedbackIt is a lot easier to get good feedback on 1 page

than on an entire paper

To determine the prevalence of cancer screening of the cervix in the United States.

To consider the amount of cervical cancer screening in the United States.

To consider the amount of cancer screening of the cervix in the United States.

ABSTRACT

Context:

Objective:

Methods:

Results:

Conclusion:

To describe the frequency of cervical cancer screening in the United States.

We obtained the1998 Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (CDC)which is a cross sectional survey of a random sample of American women. Sample Frame Women aged 18 and older living in households with telephones (86,715 respondents). Our main outcome measures were: time since last Pap smear; the estimated number of American women receiving Pap smear at various screening intervals.

The vast majority (YY%) of American women report having had at least one Pap smear in their lifetime. Among women who have not had a hysterectomy and who have been screened at least once, ZZ% report having had a Pap smear within the past three years, XX% within the past two years and 73% within the past year. Based on these data, we estimate that 45 million American women undergo Pap smear screening annually and only 6 million are screened using a 3-year interval.

The majority of American women are being screened for cervical cancer too frequently. Lengthening the screening interval would not only reduce the number of pelvic exams, but would also reduce follow-up testing for abnormal smears and the volume of specimens that cytotechnologists are required to read.

Most US professional medical societies and the national health systems of all other industrialized nations now recognize that most women need not undergo Pap smear screening annually. There are no data, however, regarding the frequency at which women actually undergo screening in the United States.






Most professional medical societies and the national health sysms of all other industrialed nations now recognize that most women need not underghkjhko Pap smear screening annually. There are no data, however, kk the frequency at which women actually undergo screening in the Unjlkjljited States.




Special topic: Abstract numbers

2. Be clear about denominators

So the reader doesn’t struggle with the So the reader doesn’t struggle with the questionquestion

“% of what?”“% of what?”

1. Be clear about the comparison

““The risk of prostate cancer in men with a The risk of prostate cancer in men with a higher BMI was lower than that in men higher BMI was lower than that in men with a lower BMI, but only if they were with a lower BMI, but only if they were younger (RR = 0.52)”younger (RR = 0.52)”

““The risk of prostate cancer in men with a The risk of prostate cancer in men with a higher BMI was lower than that in men higher BMI was lower than that in men with a lower BMIwith a lower BMI

““The risk of prostate cancer in men with a The risk of prostate cancer in men with a higher BMIhigher BMI

3. Provide data on the magnitude of the effect, not just ratios.

“ “ 2.4%2.4% of men who were current smokers developed of men who were current smokers developed prostate cancer compared to prostate cancer compared to 1.2%1.2% of those never of those never smoked (smoked (RR 2.0RR 2.0, 95% CI 1.4-2.8)”, 95% CI 1.4-2.8)”

Introduction

Methods

Results

Discussion

Efficient framework for the rest of the text

Introduction

Methods

Results

Discussion

1. What’s the current situation?

2. What's the the problem (or gap)?

3. How will this study help?

¶ Question


Introduction

Methods

Results

Discussion

• make sure there is a method for every result• use subheads to force structure


OverviewSettingExclusionsExposure/InterventionOutcomeSecondary OutcomesAnalysis

The provf of phoek soboh flod increased expenditure index has bodforden implications for grondening mawqork. Boferman etal findgrom of exceddernon elevated resource use is potermanford per norm. High intensity bodterformes koster mauk be sdlamon and forwoz bedforn.

- names for things (or ideas) that appear repeatedly in text.

patient questionnaireinterim questionnaire6-month questionnaire

return intervalrevisit intervalvisit interval

controlusual careroutine care

Assertion: a specific thing (or idea) should always have the same name.

Special topic: Labels

non-randomized trialsobservational studiesbefore-after studies

Make sure labels are consistent across abstract, text, tables and figures.

Make sure labels are consistent across abstract, text, tables and figures.

Clear ≠ Dull

Introduction

Methods

Results

Discussion

• short and to the point• driven by your figures and tables


Introduction

Methods

Results

Discussion1. What’s the central finding?

2. Could it be wrong?

3. What does it mean?

Three Questions



#2 - Write less

#1 - Write smartmake use of efficient frameworks

focus on high-visibility components

Get feedback

Get feedback

Pop QuizHow do you read?

a. in bed, for about half hour before I go to sleep

b. in bed, for about 5 minutes before I go to sleep

c. in bed, naked

d. I don't read, I look at the pictures instead...

Think like your target audience;

write for them, not for yourself.

Write less - focus on high-visibility components

Focus on what readers look at:

Abstract and Titlethe first (and often, the only) part of your paper that will be read.

Figures and Tablesprobably the second most examined part of a paper.

Figures: The most efficient way Figures: The most efficient way to quickly communicate a to quickly communicate a “feel” for your findings“feel” for your findings

Tables: The most efficient way Tables: The most efficient way to provide the relevant detailsto provide the relevant details

Write less - focus on high-visibility components

Communicate your Communicate your major finding(s) major finding(s)

using figuresusing figures

Communicate your Communicate your major finding(s) major finding(s)

using figuresusing figures

Figure Basics

Rat

e p

er 1

00,

000

1. Simple axes1. Simple axes

2. Simple keys2. Simple keys

0

25

50

75

100

0

50

100

40

30

20

10

60

70

80

90

MarylandIndiana

Lung Colon Breast MelanomaProstate

Column graphs for categoriesColumn graphs for categories

Figure Basics

Rat

e p

er 1

00,

000

Year

1986 1991 1996 2001


2. Simple keys2. Simple keys(or none at all)(or none at all)

0

25

50

75

100

1986 1991 1996 20011987198819891990 1992199319941995 1997199819992000

IncidenceIncidence

MortalityMortality

Early-stage incidenceEarly-stage incidence

Late-stage incidenceLate-stage incidence

Line graphs for continuous dataLine graphs for continuous data

Figure Basics

Rat

e p

er 1

00,

000

Year

1986 1991 1996 2001


2. Simple keys2. Simple keys(or none at all)(or none at all)

3. Legend in text3. Legend in text

0

25

50

75

100IncidenceIncidence

MortalityMortality

Early-stage incidenceEarly-stage incidence

Late-stage incidenceLate-stage incidence

Figure 1: Melanoma incidence and mortality in the population age 65 and older for 9 SEER areas (1986-2001). Early-stage refers to in-situ and local disease; late-stage refers to regional and distant disease.

Line graphs for continuous dataLine graphs for continuous data

0%5%10%15%Follow-upMammogram

Biopsy

Rate of follow-up mammography and biopsy for 186 radiologists (in the 8 months following screening mammography).

Special settings: As a vehicle to communicate individual data points

Mean revisit intervals for the 30 providers enrolling patients in the VA Cooperative Study of Telephone Care..

Site Mean

Other Provider

Staff Physician(all internists)

0

5

10

15

20

25

Mean Revisit Interval (weeks)

Site 1 Site 2 Site 3

Special settings: As a vehicle to communicate individual data points

Sample FrameHIV+, CD4 ≤ 200

male veterans(n=123)

Control(n=11)

Intervention(n=11)

Eligible patients(n=42)

Exclusionsdjflssjjf (n=51)djflkjdfljflk (n=12)bvcmxz sd (n=4)

Final sample(n=22)

Did not consent(n=20)

Special settings: As a vehicle to communicate sample selection

And it doesn’t have to be a randomized trial

History of prostate cancerProstate biopsy (past month)Rectal exam (past week)Current prostate infection/inflammation Cystoscopy (past month)

63 82620 8

Missing data 179

Not eligible for PSA test* 114

Any of eligibility criteria missing**PSA missing

139 40

* 11 people answered yes to more than 1 criteria** Generally men who did not attend the physician examination where the 5 eligibility items were collected

Random sample of men 40 and older

(n=1,601)

Eligible for PSA test(n=1,487)

Eligible with complete data(n=1,308)

NHANES Target PopulationNon-institutionalized,

civilian Americans

Special settings: As a vehicle to communicate sample selection

Special settings: As a vehicle to communicate methods

Overview of the task presented to a woman completing the survey and our measures of her ability to accurately apply risk reduction information

Get feedbackA good figure (and legend) should

be understandable on its own

Exhibit 4 Characteristics of sample *

n=203*

DemographicsMean age (range) 52 years (30-91)

Age distribution 30-39 25% 40-49 20% 50-64 26% 65+ 29%

Female 65%

Education Less than high school 15% High school graduate 25% Some college 14% College graduate 25% Some graduate school or degree 22%

Total household income <$25,000 37% $25,000 - $49,999 19% $50,000 - $99,999 26%

>$100,000 18%

Medication useDo you take any medicine to...**

prevent heart attack or stroke 36%treat any arthritis/joint pain 34%

Attention to drug adsPaid attention to any advertisements for prescription drugs in

past 3 months 50%

Row headers

• subheads

• indents

• spacing

1. organize into logical groups2. make groups visually distinct

Table Basics


n=203*

DemographicsMean age (range) 52 years (30-91)


Female 65%


Total household income <$25,000 37% $25,000 - $49,999 19% $50,000 - $99,999 26%

>$100,000 18%




past 3 months 50%

Table Basics

Give exact survey question whenever possible

Disease-specific mortality(per 10,000 person-years)

All-cause mortality(per 10,000 person-years)

Screening ScreeningScreened Control benefit Screened Control benefit Inconsistency

(a) (b) (b-a) (c) (d) (d-c)

Mammograph y

HIP (17) 5.1 6.5 1.4 73.7 75.4 1.7 -

Swedish Two-county (18) 2.6 3.8 1.2 120.4 120.3 -0.1 Direction

Malmo (19) 3.0 3.0 0.0 95.4 96.7 1.3 Direction

Gothenburg (20) 1.3 2.4 1.1 29.6 30.1 0.6 -

Edinburgh (21) 2.9 3.5 0.6 102.9 123.2 20.3 Magnitude

Canadian NBSS1 (22) 1.4 0.8 -0.5 7.4 7.3 -0.1 -

Canadian NBSS2 (23) 3.4 3.5 0.1 28.6 27.0 -1.7 Direction

Fecal Occul t B lood

Minnesota (24) 5.4 6.6 1.2 183.6 183.6 0.0 Direction

Nottingham (25) 6.0 7.0 1.0 211.0 210.0 -1.0 Direction

Funen (26) 6.5 8.2 1.7 221.0 224.0 3.0 -

Ch est X-ray

Czechoslovakian trial (27) 33.6 24.7 -9.0 179.2 153.9 -25.4 Magnitude

Mayo Lung Project (28) 43.9 39.5 -4.4 324.8 318.5 -6.3 -

Row headers

• subheads

• indents

• spacing

1. organize into logical groups2. make groups visually distinct

Table Basics




(a) (b) (b-a) (c) (d) (d-c)

Mammograph y

HIP (17) 5.1 6.5 1.4 73.7 75.4 1.7 -


Malmo (19) 3.0 3.0 0.0 95.4 96.7 1.3 Direction

Gothenburg (20) 1.3 2.4 1.1 29.6 30.1 0.6 -


Canadian NBSS1 (22) 1.4 0.8 -0.5 7.4 7.3 -0.1 -





Funen (26) 6.5 8.2 1.7 221.0 224.0 3.0 -

Ch est X-ray



Column headers

• subheads

• spacing

1. organize into logical groupsand make groups visually distinct

2. make algebra explicit

Table Basics


n=203*DemographicsMean age (range) 52 years (30-91)

Age distribution 30-39 25.4% 40-49 20.1% 50-64 26.9% 65+ 29.3%

Female 65.2%

Education Less than high school 15.5% High school graduate 25.8% Some college 14.7% College graduate 25.2% Some graduate school or degree 22.3%

Total household income <$25,000 37.2% $25,000 - $49,999 19.9% $50,000 - $99,999 26.7% >$100,000 18.5%


prevent heart attack or stroke 36.4%treat any arthritis/joint pain 34.5%


past 3 months50.1%

Table body

1. right align data(i.e. on decimal point)

2. avoid excessive precision

Table Basics

Male 34.8%


n=203*DemographicsMean age (range) 52 years (30-91)


Female 65%


Total household income <$25,000 37% $25,000 - $49,999 19% $50,000 - $99,999 26% >$100,000 18%




past 3 months50%

Table Basics

Male 35%

Table body

1. right align data(i.e. on decimal point)

2. avoid excessive precision

3. remove redundant data




(a) (b) (b-a) (c) (d) (d-c)

Mammograph y

HIP (17) 5.1 6.5 1.4 73.7 75.4 1.7 -


Malmo (19) 3.0 3.0 0.0 95.4 96.7 1.3 Direction

Gothenburg (20) 1.3 2.4 1.1 29.6 30.1 0.6 -


Canadian NBSS1 (22) 1.4 0.8 -0.5 7.4 7.3 -0.1 -





Funen (26) 6.5 8.2 1.7 221.0 224.0 3.0 -

Ch est X-ray



When the table body is complex…

Table Basics …consider helping the reader with a summary column

Special settings: As a vehicle to present prior work

Table 2: Guidance for reporting the results of multivariate analyses which assume a continuousrelationship between exposure and outcome

Step Purpose Expression ofexposure

1. Provide crude rates for discretecategories

Communicate the relationshipthat is actually observed in thedata

Categorical

2. Provide fully adjusted rates for discretecategories

Communicate observedrelationship adjusted for allrelevant confounders

Categorical

3. Provide summary measure (e.g. slope)or illustration (e.g. graph) of continuousrelationship

Communicate hypothesizedrelationship between exposureand outcome

Continuous

4. Superimpose continuous on categoricalresults

Communicate both categoricaland continuous relationships

Both

Special settings: As a vehicle to highlight major points or suggested actions

Table 3: Expected change in 5-year survival, mortality and incidence under various conditions.

Expected change in:Condition 5-year survival Mortality Incidence

More effective treatment of existingdisease

↑ ↓ no change

More cas es found earl yand

earl y treatmen t is effective

earl y treatmen t is not effective

↑

↑

↓

no *change

↑

↑

Increase i nthe tr ue occurrence of disease(assumin gn ochang ein tumor aggressivene )ss

no change ↑ ↑

Special settings: As a vehicle to summarize the effect of a change on multiple outcomes

Clinic VisitsTotalWith Study ProviderMedical/Surgical SubspecialitiesAncillary Providers*All OtherOutpatient RadiologyTotalPlain FilmsAdvanced ImagingOutpatient Laboratory Tests**Inpatient utilizationHospital admissionsAverage length of stay1.00.51.52.001.00.51.52.002.717.415.44.75.15.34.45.23.12.22.82.02.01.51.50.50.523.926.60.50.56.78.0TelephoneCareUsualCare

Ratio (95% CI)Less utilization withtelephone care

More utilization withtelephone careUtilization per Patient

Table/Figure combinationsBase ratesBase rates RRs and CIsRRs and CIs


#2 - Write less

#1 - Write smart

#3 - Write againin response to feedback from others

make use of efficient frameworks


Get feedback

Get feedback

Get feedback

Good papers are made, not born.

They are the product of multiple revisions,revisions made in response to the criticisms of others.

Get help:1. General reviewer - whose primary job is to determine whether your writing can

be understood.

2. Expert reviewer - whose primary job is to help prepare you for external review.

A “content" expert to scrutinize specific technical or theoretical issues.

A "hostile friend" who will look hard for flaws.

Write again - in response to feedback from others

Tactics to get useful help

InternalReviewer

Author

Tactics for eliciting feedbackTactics for eliciting feedbackTactics for receiving feedbackTactics for receiving feedback1. Get an explicit commitment2. Clarify the review purpose

1. Have a conversation2. Don't be defensive3. Focus on understanding problems4. Judge suggestions critically

• General• Expert

3. Simple courtesies

Use these tactics to get feedback for

the “guts” of your paper:ABSTRACT

TABLESFIGURES


#4 - Write now

#2 - Write less

#1 - Write smart

#3 - Write again

don't wait until you think you're done

in response to feedback from others



Get feedback

Get feedback

Get feedback

Write now

It's easier to revise than write from scratch

The earlier you start the easier it is to find time to allow yourself to step back, digest, and read your

work with a fresh perspective

Introduction Clarify the motivation; helps you identify a context in which to place your work

Methods Avoid having to reconstruct subtle details of the analysis long after they occurred.

DummyFigures &

Tables

Focus the analytic effort

Abstract Organize the entire package

Bite sizetask Helps:

Write now - don't wait until you think you're done

Write now

Even if it's a work of fiction

Get feedback


#4 - Write now

#2 - Write less

#1 - Write smart

#3 - Write again





Get feedback

Get feedback

Get feedback


#4 - Write now

#2 - Write less

#1 - Write smart

#3 - Write again





Get feedback

Get feedback

Get feedback

Get feedback

what this presentation is not about: its about how to most easily put together the best possible...

Documents

pap smear screening

american women report

majority of american

writing slide

good data

prevalence of cancer

united states

feedback slide