The Good, the Bad, and the Ugly of Scientific Writing

1
The Good, the Bad, and the Ugly of Scientific
Writing

• Mark H. Ebell MD, MS

2

• To quote Dave Barry, I didnt make any of this
  stuff up

3
Avoid stilted language

• Chest pain is often a harbinger of disease
  that can threaten the life of the organism. So,
  when a patient presents with significant chest
  pain, the prudent examiner is at once poised to
  exclude dangerous disease.

4
Concise, clear, active voice

• Before
• It has been shown that rye, wheat, and barley, as
  well as multiple processed products containing
  gluten, may in some cases elicit this immune
  response.
• After
• Rye, wheat, and barley, and many processed foods
  contain gluten and may elicit this immune
  response.

5
Concise, clear, active voice

• Before Though the spiral computed tomogram (CT)
  has revolutionalized the management of emergent
  abdominal pain (2, 3, 4), the currency of this
  approach remains the judicious application of a
  focused history and physical exam.
• After Even with access to advanced diagnostic
  imaging studies, a careful history and physical
  examination helps the clinician interpret the
  results of these studies and remains a critical
  part of the evaluation.

6
Simplecleardont use fancy words.

• There have been several randomized controlled
  trials that have evaluated the effectiveness of
  mammography as a screening modality.
• Several randomized controlled trials have
  evaluated mammography as a screening test.

7
Examples of good and bad style

• Really bad (wordy, stilted, passive voice)
• It has been proposed that chest radiography
  should be considered
• Bad (passive voice, weasel words)
• Chest radiography should be considered
• Good
• Order a chest radiograph if

8
Examples of good and bad style the dreaded
parenthetical fever

• Bad Admission was less likely in patients
  taking the cephalosporin (43) than in those
  taking placebo (32), a difference that was
  statistically significant (p 0.03).
• Good Admission was significantly less likely in
  patients taking the cephalosporin than in those
  taking the placebo (42 vs 32, p 0.03).

9
A case of commarhea

• Chronic kidney disease and more severe stages of
  CKD, can affect not only glomerular blood flow
  and filtration, but also tubular secretion and
  reabsorption, and renal bioactivation and
  metabolism.
• Chronic kidney disease and more severe stages of
  CKD can affect not only glomerular blood flow and
  filtration, but also tubular secretion and
  reabsorption and renal bioactivation and
  metabolism.

10
Any problems with this?

• Because the differential diagnosis of
  abdominal pain is extensive and includes multiple
  disease entities that can be placed into the
  broad categories of abdominal and extra-abdominal
  disorders and sub-divided as follows Abdominal
  disorders include four categories of
  intraperitoneal conditions (inflammatory,
  mechanical, malignancy, and vascular disorders)
  and a limited list of extraperitoneal conditions.
  
• Run-on (and on and on) sentence
• Lets rewrite it

11
edited into three sentences

• Because the differential diagnosis of abdominal
  pain is extensive, it is helpful to organize it
  anatomically into abdominal and extra-abdominal
  disorders.
• First, recognize that abdominal disorders can be
  intraperitoneal or extraperitoneal.
• Intraperitoneal disorders can be further divided
  into four categories (inflammatory, mechanical,
  malignancy, and vascular disorders), each of
  which is further subdivided by whether they
  affect hollow, solid, or pelvic viscera or the
  mesentery

12
Anything wrong here?

• Chest Pain can be defined as an unpleasant
  sensation perceived in or on the anterior trunk
  (costal margin to clavicles) resulting from
  actual or potential tissue damage that may be
  unrelenting, causing the patient to seek the
  advise of a Physician.
• Non-standard capitalization. Rules are just like
  those for any other writing!

13
Say it well and say it once avoid repetition

• Data from the 2000 U.S. National Center for
  Health Statistics reveals an incidence of
  abdominal pain of 63/1000 emergency department
  (ED) visits with admission rates for abdominal
  pain varying from 18 to 42 percent, with rates as
  high as 63 percent reported in patients over 65
  years of age (6). While in 2002, there were
  approximately 15 million office visits to
  Physicians and approximately 7 million emergency
  department visits for abdominal complaints in the
  United States, almost all of them were due to
  abdominal pain

14
Proofreading! Internally inconsistent and just
plain wrong

• The physical examination is unremarkable between
  attacks so this entity has been termed biliary
  colic. Additionally, the patient is afebrile with
  significant right upper quadrant tenderness and
  positive Murphys sign.
• Cant be both unremarkable and with positive
  Murphys sign! And Murphys sign is
  cholecystitis, not gallstones.

15
Unclear headings

• Pathophysiology and differential diagnosis
• Pathophysiology
• The pathophysiology
• Differential diagnosis
• The differential diagnosis is
• Hard to tell what is a heading and what is text,
  and what hierarchy is intended.

16
Use clear heading indicators

• ltH1gtPathophysiology and Differential Diagnosis
• ltH2gtPathophysiology
• Blah, blah, blah
• ltH2gtDifferential diagnosis
• The differential diagnosis for chest pain
  includes

17
How would you rewrite this?

• Before The clinically relevant pathophysiology
  of significant abdominal pain is based on whether
  pain is parietal or visceral in nature.
• Dont state the obvious
• After The pathophysiology of significant
  abdominal pain is based on whether pain is
  parietal or visceral.
• If it wasnt clinically relevant why would you
  be talking about it in a clinical article? Also,
  in nature adds nothing.

18
Anyone see a problem here?

• Before Patients with suspected gallbladder
  disease have been traditionally thought of with
  the terms of fat, forty, fertile, and female.
• Dont offend your readers!
• After Gallbladder disease is more common in
  women, obese patients, and it becomes more common
  as adults age.

19
Dont name authors in text

• Before According to Jensen (8), many patients
  for whom this diagnostic code is chosen have
  irritable bowel syndrome, muscle strains, ovarian
  cysts, or any of the other conditions listed in
  the table (Table xx).
• After Many patients for whom this diagnostic
  code is chosen actually have irritable bowel
  syndrome, muscle strains, ovarian cysts, or one
  of the other conditions listed in Table xx (8).

20
Dont name books in text

• Before According to Oslers Medical Handbook
  (1), the approach to evaluating abdominal pain
  includes separating potential emergency and
  urgency from low risk or chronic disease and
  acting accordingly.
• After Although most patients do not have a
  serious condition, and in many cases a final
  diagnosis is never made, it is always important
  to exclude serious or life-threatening disease
  (1).

21
Vague statements that reflect traditional wisdom

• Patients on beta-blockers sometimes complain of
  fatigue and difficulty concentrating
• Patients with depression or sleep disorders may
  be adversely affected by all adrenergic blocking
  agents, including clonidine, beta-blockers,
  methyldopa, and reserpine
• Sexual dysfunction has been ascribed to all of
  the antihypertensive medications, particularly
  beta-blockers.

22
Replaced with evidence

• It is important to note that beta-blockers have a
  much better tolerability profile than previously
  thought. A meta-analysis of 15 trials involving
  35,000 patients found no significant increase in
  the risk of depression and only small increases
  in the risk of sexual dysfunction (NNH 200 per
  year) and fatigue (NNH 57 per year).(78)

23

• Do not cite other reviews except as a last
  resort.
• Do cite
• Original research
• Systematic reviews and meta-analyses
• Authoritative or evidence-based guidelines.

24
Traditional wisdom or evidence?

• Before Beta-blockers may trigger bronchospasm in
  patients with asthma or chronic obstructive lung
  disease
• After While it has been conventional wisdom that
  beta-blockers are contraindicated in patients
  with asthma or chronic obstructive lung disease
  because they might trigger bronchospasm,
  cardioselective beta-blockers have proven to be
  safe in such patients and should be prescribed
  when indicated.(63, 64)

25
Avoid weasel words

• It has been suggested that
• Some might consider
• There is growing evidence that
• Preliminary evidence suggests that

26

• So much for grammar and style
• on to formatting

27
Properly format your article

• Double space all articles submitted to a journal
• Adequate margins, i.e. 1 to 1.5
• Insert hard page breaks after title page,
  abstract, body of paper, and each table
• Ctrl-Enter
• Do not use hard line breaks (i.e. Enter) except
  for a new paragraph
• DEMO WITH WORD

28
Properly format your article

• Use appropriate subheadings
• ltH1gtMain heading
• ltH2gtSubheading
• ltH2gtSubheading
• ltH1gtNext main heading
• Use a nice font (not Courier!)
• Arial
• Times New Roman
• Courier

29
References

• Dont bury me with references ( 30 is a good
  target)
• Dont cite 5 randomized trials when a single
  systematic review or meta-analysis will suffice
• Dont use other review articles or monographs
  leads to medical gossip
• Do use original research, meta-analyses,
  evidence-based guidelines, and systematic
  reviews.

30
References

• Use proper format
• AMA style
• Authors. Title. Journal Year Volume Page range.
• Ebell MH, Barry HC. POEMs in the medical
  literature. J Fam Pract 1998 43 341-4.
• For Web citations include URL and date last
  cited.
• Journals in social sciences use APA style

31
I have seen

• No abstract
• No title page
• Single-spaced
• No references
• 10 or more spelling, grammatical, or
  typographical errors on the first page
• Handwritten!

32

• Follow the author instructions!!!
• Be concise overall.
• One idea per sentence
• Write clearly and in a conversational tone
• Use active voice
• Remember, if it doesnt sound like something you
  could say in the hall to a colleague or in a
  lecture, you probably shouldnt write it.

33
Good luck!