医学英语写作课件.ppt

MedicalResearchpaperwriting ChaoMi LOGO MedicalResearchpaperwriting Unit1PlanningandObserving LOGO MedicalResearchpaperwriting LiteratureSearchUsedatabase MEDLAR MEDLINE Focusonstudydesign isyoursuperiortoothers Avoidderivative secondaryworkTeambuildingTalkwithpreviousresearchteamsAwell knowninvestigator blindedsystem Fulltimeresearchnurses detail objective AtalentedwriterAqualifiedstatisticianMethodologyStatingtheproblem thepurposeofyourstudy LOGO MedicalResearchpaperwriting e g Approximately40 ofpatientswithspinalcordinjurydevelopapressureulcerduringtheinitialhospitalization However thereiscurrentlynomethodofquantifyingthisriskthatisaccurateforthispopulation Formulatingthehypothesis StartwithH0thattherearenoconnectionswiththetwovariables smokinghistoryisnotassociatedwiththeincidenceoflungcancer HaistheoppositeofH0 ButuseitwithH0atleast Studydesign Bewarethisisthemostcommontypeofflawthatresultsinoutrightrejectionofamanuscript Categories Observational Quasi experimental Experimental LOGO Reading Examples 1 Researcherscomparenewborninfantsfromtwogroups Inonegroup themothersusedcocaineduringpregnancy Intheothergroup themothersdidnotusecocaineduringpregnancy 2 Researcherscomparetheoutcomeofinfantsbornintwocities Inonecity anewlawwasenactedtotestpregnantwomenforcocaineuseandenrollthosewhohadpositivetestresultsinatreatmentprogram Theothercityhadnosuchlaworprogram 3 Researcherscomparenewbornratsfromtwogroups Inonegroup theresearchershadgiventhemotherscocaineduringpregnancy Themothersoftheratsintheothergroupwerenotgivencocaineduringpregnancy LOGO Reading handoutmaterialreading Case control Cohort Historicalperspective Cross sectional MinimizingBias Selectionbias asystematicdifferencebetweenpeopleinthestudyandpeoplenotselected samearea longperiodandfollow upinformation Responsebias respondentsdiffersystematicallyfromnonrespondents peoplewithcertaindiseasemaytendtorespondtoamailedquestionnaire Informationbias differencebetweenmeasurementsindifferentstudygroups patientswithriskfactorsmaybetestedmorecarefullyandfrequently LOGO Reading Confoundingbias effectofextraneousvariablesthatmustbeadjustedbeforeresearchquestionsareanswered Aninner cityhospitalmayhaveahigherneonatalmortalityratethanthenationalaverage Sotheconfoundingvariablesassociatedwithinner citylifemaycreateaconfoundingbias DataCollection Usequestionswithdefinedchoicesnotopen endedquestionsandcoverallpossibilities Categoricaldataisinferiortocontinuousdata bellcurve Dummyquestionsshouldbeused LOGO Reading FailuretocollectdataonvariablesthatcouldinfluencetheInterpretationofresults outrightrejectionofanarticleSouseothers experience Reliabilityandvalidity Reliability measurementusedonthesamepatientunderthesameconditionwouldyieldthesameresults e g Lowreliability self reporteddurationofexposuretopassivesmokingamongwomenbreastfeedingtheirinfant e g Highreliability nicotineconcentrationinthemothers breastmilk Validity Canatestorproceduremeasurewell e g Malnutritioncouldbeassessedbyaskingpatientstoscoretheirnutritionalintakeonascaleof1to10 butmeasuringtheirserumalbuminlevelismorevalid LOGO Reading Eligibility 适合性 Patientsshouldbehomogeneous includingamixtureofdiseasesorprocedures Ifyouuseamixedsample payattentionto Inclusionandexclusiondecisions Distributionofdiseaseseverityofthepatientsandwhy statisticaladjustmentfordifferencesamongthesepatientsCombiningdifferenttypesofpooroutcomebecauseeachoneissmall Usetheoutcomethatcouldbepredictablebytheindependentvariablesandexplainwhy Alldiagnosesandproceduresmustbeencodedforanalysis ICD TheAMACPTCodeBook e g Indiagnosisfields hipfractureisrepresentedbyICDcodefrom820 00to820 99 usestandard LOGO Reading RandomizationandConfidentialityStrengthenthestudydesignandminimizebias Randomizedclinicaltrial patientsarerandomlyassignedtoeitherreceiveornotreceivetheintervention Double blindeddesign cliniciannotknowingtheactivetreatmentandplacebo Triple blindeddesign evenstatisticiannotknowingwhoreceiveactivetreatmentandplacebo e g Astudyisbeingplannedinwhichfourresearchnursesreviewthehospitalchartsoftraumapatientswhoareadmittedto10hospitals Theyknowthattwoofthenursesaremuchmoreaggressiveinsearchingchartsforcomplications Tominimizethispotentialbias theyusearandomnumbertabletoassignmonthlyblocksofchartstobereviewedatthe10hospital LOGO Reading Althoughthisstudyisnotarandomizedclinicaltrial theuseofrandomizationstrengthensthestudydesignandreducesbias Protecttheconfidentialityofallparticipants AbidebythedocumentationofIRB InstitutionalReviewBoard Patient hospital physician ect casenumber1 2 3 EndpointsandOutcomeUnitsofanalysise g Evaluatingtheaccuracyofscreeningforfetalproblems 1 apregnantwoman 2 aninfant 3 apregnancy 4 asingletonpregnancythatcontinuesbeyond28weeksofgestation ConfoundingfactorsAlltheotherthingsthatcouldexplainyourresults Fromcruderatestoadjustedrates statisticaltransformationhasbeendonetoeliminatedifferencesbetweengroups LOGO Reading Whatiscasemixorpatientmix e g Comparesurvivalratesamonghospitalsforpatientswhounderwentaspecificsurgicalprocedure crudesurvivalratesarealmostmeaningless Theinvestigatormustadjustforconfoundingfactors suchasdifferencesinpatients age preexistingconditions diabetes orwhethertheprocedurewasperformedonanemergencyoranelectivebasis Thesefactorsarereferredto LocateconfoundingfactorsPerformaliteraturesearchtoidentifythembeforedatacollectionisfinished Classificationofvariables continuous bellcurve hematocrit血细胞比容 categorical groups anemia dichotomous just2groups alivevsdead Reading Anexampleofrecodingandcombiningdata Lengthofstayinthehospitalisoftenaskewedcontinuousdependentvariable Soset0forpatientswhosestayislessthanthemedianandsetto1fortheotherpatients Amuchsmallersample butstatisticaltechniquesarebetterapplied DataentryAlwaysquantify Trick useintervalscalewhenpossible Avoidmixingtextandcode UsebignumberforMissingdataorUnknown 9 99 notNA Logicalcoding 0 no 1 yes Illogicalcoding 1 none 2 none 3 two LOGO LOGO Reading Examplesofweakandstrongvariables 1 LowBirthWeightExactBirthWeight2 RespiratorydistresssyndromeLungindex3 NICUadmissionTotalcostofhospitalizationordaysintheNICU 新生儿重症监护室P38 SampleSizeEstimatingSampleSizeIntheplanningphase reviewsamplesizeinsimilarpublishedstudy considerbothcontrolandsubgroup StatisticalPowerTheprobabilityofrejectingthenullwhereitisfalse TakenwithPvalue samplesizeisdeterminedbyusingTableonpage43 Reading PreparingforStatisticalAnalysisLevelsofmeasurement1 Nominal 0 no 1 yes 1 female 2 male 1 white 2 black 3 Asian2 Ordinal 0 nonsmoker 1 lightsmoker 2 moderatesmoker 3 heavysmoker3 Interval Age Hematocrit Serumalbuminlevel cigarsmokedperdayPlanningthefollowing up1 Impressivelengthoffollow up 2 5years 2 Averagetimemaydifferbetweenthetreatmentandcontrolgroup LOGO Reading 3 Intention to treatanalysis datafromallpatientsmustbeincluded notonlywhofinishedthestudy e gactualontherapyanalysis AvoidingCommonCriticisms peers editors DesignofthestudyPoorexperimentaldesign methodologyNoaccountingforconfoundingfactors biaseddatasmallsamplesize improperstatisticalmethodsInterpretationoffindingsUnfounded unsupportedfindingsOverinterpretationofdataInadequatediscussion unexplainedinconsistencies LOGO LOGO Reading ImportanceofthetopicRehashofestablishedfacts unimportanttopicNoreaderinterest notgeneralizableLittleclinicalrelevancePresentationoftheresultsPoorlyfocused organized writtenToolong poorgrammarIntroductionandDiscussiontendtobetoolongMethodsandResultstendtobetooshortCollectingDataPeriodicmonitoringofthestudy sprogressKeepingrecords Reading NotesthatincludesdetailedresearchdecisionsDatacodingconventionsandabstractingguidesDatacollectionformReferenceresearchpaperTheinstructionforauthorfromtargetjournalOnerecentarticlefromtargetjournale g Bothstatisticalandclinicalimplicationsofchangesmustbeconsideredproperly Numberof reasonfor amissingpatient DetectingpotentialproblemsDistinguishbetweenmissingdataandtheanswer no Monitoringthesamplesize reevaluatethesamplesizewithnewrealisticestimates LOGO LOGO Reading StatisticalAnalysisLayingthegroundworkBuildadatabaseforstatisticalanalysis Uselogical easytorememberfieldname Don taskinexperiencedprogrammerormedicalstudenttocustomizeadatabase e g FixedfieldFormatFileCASEGROUPBPsSEXRACEAGELOSICU131201124 62292280230 51513313015 99 9100 LOGO Reading PreparingtheData Clean and freeze thedata1Avoiddifferentunits week month year 2Completethemissingcode asunknown dropthecasewhenessentialdataismissingafterdiscussion 3Documentthechangemadeinthedata4Freezingmeansnodatawillbeaddedorchangedduringnextphaseofanalysis InterpretingthedataPreparingfordataanalysisDonotforcenumberstoproveyourpoint CannotsimplypressabuttonandletPCanalyzeyourdataConsultadataanalystwithadequateexperience Reading Createequal sizedgroupsofpatientsforcontinuousvariablese g Youmaynothaveenoughdataforcertainsubgroupstocarryoutanalysis Groupingofpatientsbyagedecades 0 9 10 19 20 29 mightbereplacedbydeciles 0 6 4 6 5 14 9 15 0 22 7 AvoidcommonproblemsDon tforgettorepeatyourexperiments Controlgroupsshouldnotbepoorlymatched Epidemiologictechniquescanbeusedtostrengthenclinicalresearch Forexamples 1 Person years thenumberofyearsthateachmemberofapopulationhasbeenafflictedbyacertaincondition druguse 2 Survivalanalysisandfollow uplifetables canbeusedtocomparegroupsthatarefollowedupforvaryingperiods LOGO Reading Dose responserelationshipisachangeintheamount intensity ordurationofexposureassociatedwithachangeintheriskofaspecifiedoutcome e g Theincidenceoflungcancerincreaseswiththenumberofcigarettessmokedperday UnivariateAnalysisMostcommonunivariatetestsusedChi squaretestandStudent sT test simplisticbutessentialfirststep UsingChi squaretestTestcategoricalvariables Whethertheactualproportioninthegroupsdifferssignificantlyfromtheproportionexpectedbychancealone LOGO Reading UsingStudent sTtestThistestcanhelpdetectwhetherthemeansforthetwounmatchedgroupsaresignificantlydifferent Bellshapeddata WhenStudent sTtestisnotpreferred a Morethan2groups one wayanalysisofvariance ANOVA b Dataisnotbell shaped nonparametrictest c Skeweddata 2groups Mann WhitneyUtest d Skeweddata 2groups Krushal Wallistest Sometimesmorethanonetestsareusedtogether butneverusetheimproperonetofishforsignificance whichwillleadtofalseconclusions NonparametrictestDatanotnormallydistributedorordinal2groups Mann WhitneyUtest 2groups Krushal Wallistest LOGO Reading 2groups matched Wilcoxonsigned ranktest 2groups matched FriedmanANOVAbyranksMatching Purpose Anefficientwayofcreatingacontrolgroupbasedonconfoundingfactors Bestbeforedataiscollected e g Preventabledeathsintraumacare statisticallycontrollingfortheseverityofinjurywithineachspecificmechanismofinjury Actuallyadjustingbothseverityandmechanismisnotrealistic andeventhiscausesproblems P87 MultivariateAnalysisWhentouse Onedependentvariablevsmultipleindependentvariables Butlookatthefollowingexample LOGO Reading e g ComparetheinfectionrateofpatientsreceivingdrugAwiththatofpatientsreceivingdrugB Afterrandomizingthepatientsintotwogroups youfindonegroupissignificantlyolderthantheother NowyoucanusemultivariateanalysistoadjustfortheageofthepatientsSousemultivariateanalysistodealwithconfoundingfactorsanddomentionthisisdoneinyourpaper Forthis youcanrefertoresearchpapersinyourfieldforvariablesthatarepotentiallyconfoundingfactors LogisticregressionanalysisExaminetheindependentcontributionofmorethanonepredictorvariable Thelogisticregressionmodelshowedthatamongmotherswhosmokedcigarettesduringtheirpregnancy theinfantoutcomecannotbepredictedbytheriskfactorunderstudy LOGO Reading Giveitasecondthoughtbeforeconclude therearenodifferencebetweenthestudygroup Interaction e g Investigatorsfoundthatamongpeoplewithspinalcordinjury bothdiabetesandsmokingweremoderateriskfactorsforpressureulcers However allofthepatientswhohaddiabetesandalsosmokedhadahistoryofpressureulcers Thiseffectfromacombinationoffactorsisaninteraction AlwaystranslatemultivariateanalysisintoplainEnglishbecausereviewersandeditorsarenotstatisticalexperts Presenttheresultsofmultivatiateanalysisinaclinicallyusefulformat Useevidencetosupporteachstepoftheanalysis Usespecificdatatojustproveyourmodel bad LOGO Reading Pvalueisnottheonlystandard considerwhatmakessenseclinically preexistingdiseases injuryseverity time treatment LearnCoxProportional HazardsRegressiontoPublishPapersinaHigh QualityJournal LOGO Reading Unit2TitleandAbstract 1 LOGO Title Principles 1Accuracy准确2Brevity简洁3Clarity清楚4Effectiveness有效5Attractive吸引Mistake1 toobigortoosmalle g Transplantationofcornealstemcellsculturedonamnioticmembraneforcornealburn experimentalandclinicalstudy CMJ 2002 115 5 767 769 experimentalandclinical invitroandinvivo toobig LOGO Title Mistake2 notaccuratee g Experimentalstudyonmechanismandrarityofmetastasesinskeletalmuscle CMJ 2002 115 11 没有把研究对象 问题说清楚 Betternomorethan100characters title subtitle Agoodexample Importanceofreplicationinmicroarraygeneexpressionstudies statisticalmethodandevidencefromrepetitivecDNAhybridization ProcNatlAcadSciUSA Attractiveness 醒目 e g IdentificationofhumantumorinitiatingcellsNature 2004 11 18 432 7015 396 401对比 Mechanismofligustraziniagainstthrombosis CMJ Toogeneral LOGO Reading 两个省略不当的例子 1 Adhesionkinasecontrolsactinassembly2 Mousebehavior LOGO Reading Correct AdhesionkinasecontrolsactinassemblyviaaFERM mediatedinteractionwithArp2 3complex 介词 AndrogenAdministrationtoagedMaleMiceIncreasesAnti AnxietyBehaviorandEnhancesCognitivePerformance verb LOGO Reading 几点注意事项 1 PlainEnglish2 NounderlineorItalics3 OnlyStandardAbbr4 Capitalizetheinitialletterofeachword5 Seldomuse TheStudyof or TheResearchon e g ThestudyofArgonaute2inmammaliangastrulationandpropermesodermformationArgonaute2isessentialformammaliangastrulationandpropermesodermformation LOGO Reading 句法结构 词序非常重要 多由名词性短语构成 动名词或分词 少用陈述句 如 你想表达B7 H4蛋白主要表达在非增生性肿瘤细胞中 其中一部分为肿瘤肝细胞 修改前 B7 H4mostexpressesonKi67negativebriantumorcellsandcanexpressonsomebraintumorstemcells 修改后 LOGO Reading 句法结构 词序非常重要 多由名词性短语构成 动名词或分词 少用陈述句 修改后 B7 H4ispredominantlyrestrictedtoKi67 negativebraintumorincludingasmallsubpopulationofbraintumorstem likecells LOGO Reading 结构类型 国内较高水平级期刊 1 短语型 1 名词短语 a 名词 介词短语用食管镜检查以预计曲张静脉出血b 定语 名词原发性肝癌二级预防的随机分组前沿性研究c 名词 分词短语何杰金病放射治疗引起的甲状腺癌 LOGO Reading 结构类型 国内较高水平级期刊 1 短语型 1 名词短语 a 名词 介词短语用食管镜检查以预计曲张静脉出血Predictionofvaricosehaemorrhagebyesophagealendoscopyb 定语 名词原发性肝癌二级预防的随机分组前沿性研究Randomizedcontrolledprospectivestudyofsecondarypreventionforprimarylivercancerc 名词 分词短语何杰金病放射治疗引起的甲状腺癌ThyroidcarcinomainducedbyirradiationforHodgkin sdisease LOGO Reading 2 动名词短语 心房纤颤患者中风预防 3 介词短语 原发性肝癌临床诊断探讨句子型 1 陈述句 人类hR24L基因参与DNA切除修复和重组修复的研究 2 疑问句 常见于评述性文章 尚未解决的问题 饮酒者冠心病少吗 LOGO Reading 2 动名词短语 心房纤颤患者中风预防Preventingstrokeinpatientswithatrialfibrillation 3 介词短语 原发性肝癌临床诊断探讨Onclinicaldiagnosisofprimarycarcinomaofliver句子型 1 陈述句 人类hR24L基因参与DNA切除修复和重组修复的研究HumanhR24LgeneisinvolvedinDNAexcisionrepairandrecombinationrepair 2 疑问句 常见于评述性文章 尚未解决的问题 饮酒者冠心病少吗 LOGO Reading Unresolvedissue Dodrinkershavelesscoronaryheartdisease 中心词的使用 一般放在句首 e g 针疗对冠心病心绞痛患者左心功能状态的影响e g 氟烷麻醉治疗新生儿受损肺功能 LOGO Reading Unresolvedissue Dodrinkershavelesscoronaryheartdisease 中心词的使用 一般放在句首 e g 针疗对冠心病心绞痛患者左心功能状态的影响Theacupunctureeffectonleftventricularfunctioninpatientswithcoronaryheartdiseaseandanginapectorise g 氟烷麻醉治疗新生儿受损肺功能Halothaneanesthesiarebuildsimpairedpulmonaryfunctioninnewborns 麻醉专家 Impairedpulmonaryfunctioninnewbornsanesthetizedwithhalothane 儿科专家 LOGO Reading Practice 1 探讨 discussionof on aprobeinto investigationof 心源性猝死51例临床病理探讨2 意义 significance importanceof in at血清肌浆球蛋白临床评价对诊断急性心肌梗塞的意义3 观察 报告 结果 anobservationof on in 有时可略去 窒息后多器官功能受损新生儿细胞内外钙水平观察4 调查 实验 surveyof on test trial慢性肾功能衰竭的甲状腺切除疗法38例调查 LOGO Reading Practice 1 心源性猝死51例临床病理探讨 Suddencardiacdeath clinicopathologicinvestigationof51cases2 血清肌浆球蛋白临床评价对诊断急性心肌梗塞的意义 Significanceofclinicalassessmentofserummyosininthediagnosisofacutemyocardialinfarction3 窒息后多器官功能受损新生儿细胞内外钙水平观察 Levelsofplasmacalcuimandredcellcalcuiminnewbornswithmulti organdamageafterasphyxia 4 慢性肾功能衰竭的甲状旁腺切除疗法38例调查 Surveyof38casesofparathyroidectomyinchronicrenalfailure LOGO Reading 5 总结 experience experienceof35例恶性高血压治疗总结6 报告 areportof on青少年桡骨远端骨骺损伤附51例报告7 技术 特征 模式等 technique characteristics model 结肠腺癌细胞线SW620生物特征8 药物 治疗 A治疗B AtreatmentofB大量剂氨甲喋呤治疗急性淋巴细胞性白血病 LOGO Reading 5 35例恶性高血压治疗总结Treatmentformalignanthypertension Anexperienceof35cases6 青少年桡骨远端骨骺损伤附51例报告Distalepiphysisinjuryofradiusinadolescence Areportof51cases7 结肠腺癌细胞线SW620生物特征BiologicalpropertiesofhumancolonicadenocarcinomacelllinesSW6208 大量剂氨甲喋呤治疗急性淋巴细胞性白血病Treatmentofacutelymphocyticleukemiawithhighdosemethotrexate LOGO Reading 9 非药物 治疗 A治疗B AinthetreatmentofB左心室部分切除术治疗晚期原发性扩张性心肌病10 诊断 A诊断B theapplicationofAtothediagnosisofB用放射性免疫法测定血清17 羟孕酮诊断与治疗先天性肾上腺增生 LOGO Reading 9 左心室部分切除术治疗晚期原发性扩张性心肌病Partialleftventriculectomyinthetreatmentofend stagedilatedcardiomyopathy 10 用放射性免疫法测定血清17 羟孕酮诊断与治疗先天性肾上腺增生Theapplicationofserum17 OH progesteroneradioimmunoassaytothediagnosisandmanagementofcongenitaladrenalhyperplasia progestation 受孕 sterone 酮 hyper 超过 plasia 增长 LOGO Abstract Structure 1 Oneparagraph 2 Motivation problemstatement Whatdidyouinvestigateandwhy 3 Methods Procedure Approach Whatdidyoudo 4 Results findings Whatdidyoufindout 5 Conclusion implicationWhatdoyourresultsmeanandsowhat ImportantThings 1 200 300Words LOGO Abstract 2 Less数学表达式 化学结构式 角标 希腊文 3 Thefirstsentenceisthemostimportant 4 Beoriginal 5 AvoidusingconfusingAbbrorterminology6 Noliteraturereferenceortoomuchbackgroundinfo7 Lessnumbers Tense 阐述研究的主要目标现在时 客观 或现在完成时 趋势 描述使用方法过去时扼要说明最重要的结果过去时阐述主要结论现在时 LOGO Abstract Skills Startwritingthispartafterotherpartshavebeenfinished YoucanextractKeySentencesandKeyWordsfromeachpartandthencombinetheminalogicalway Usesimplewords Conclusion Tothepoint constructive original Howtomakeyourwordssimpleandneat 1 去掉不必要的字句 Itisreported Extensiveinvestigationsshowthat Theauthordiscusses 2 物理单位和通用词的简化3 Lessornobackgroundinformation4 Onlynewtrendsbutnoorlesspastevents5 Donotmentionyourfutureplans6 简化措辞和重复语 LOGO Abstract 扩展与延伸1 指示性摘要 IndicativeAbstract 100字左右 1 2个句子 医学简报 专题讨论 技术方法 例 论原发性胃肠道淋巴瘤本文综述了原发于胃肠道淋巴瘤主要经验 并就该病的临床 病理及治疗等问题进行了讨论 LOGO Abstract 扩展与延伸1 指示性摘要