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Biomedical Writing


Biomedical Writing
INSTRUCTOR: CAI HEBING MARCH 25, 2014

The IMRAD Structure
Introduction Methods Results Discussion

Writing the Introduction
Qualities of a good introduction
?Defining the nature and extent of the problem studied. ?Relating the research to previous work by a brief review of the literature, whose authority, relevancy and recency are out of question. ?Explaining the objectives and method of investigation, including, if necessary, the reason why a particular method was chosen. ?Introducing the logical order of discussion that will be followed in the rest of the paper. ?Defining any specialized terms or abbreviations to be used in what follows.

WRITING THE INTRODUCTION

Writing the Introduction
The Pattern or Sequence
?Move 1 presenting background information
? Showing centrality by interest or by importance ? Stating current knowledge

?Move 2 reviewing related research
? Relating to the work ? Identifying its limitations ? Establishing a niche for you to occupy

?Move 3 stating the current research
? Stating the purpose ? Describing present research

WRITING THE INTRODUCTION

Writing the Introduction
Can you identify the moves in the Sample Introduction?
A

Increasing numbers of parents are choosing to delay or refuse one or more of the recommended childhood vaccines.1–4 B When children are unvaccinated, the protection afforded by herd immunity wanes.5 C In fact, resurgence of diseases such as measles in the United States and Europe has been recently documented,6–10 and parental refusal of pertussis, varicella, and pneumococcal vaccinations has been associated with increased risks of these infections in children.11–13 D The trend of increasing parental concern regarding childhood vaccines may be due to conflicting information parents receive about the safety and risks of vaccines. E Several groups including the Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) have developed online tools for providers and parents to find accurate information regarding childhood vaccines.14,15 F However, other sources widely available on the Internet question the safety and effectiveness of vaccines. G It is unclear whether parents are able to determine which publicly available information is trustworthy and based in science; H therefore, it is increasingly important that parents are directed to accurate information so that they can make an informed decision regarding childhood vaccinations.
I Earlier

studies have shown that most vaccine-hesitant parents prefer to receive information about childhood vaccines from their health care providers before the first vaccine visit.16,17 J However, given time restrictions on clinic visits, it is logistically challenging for providers to comprehensively answer all questions.18 K The goal of our pilot study was to develop an effective educational tool to address the most common concerns about childhood vaccines for vaccine-hesitant parents that could be implemented in the clinic. L We hypothesized that providing vaccine information to vaccine-hesitant parents at the time of the 2-week office visit would improve parental attitudes regarding childhood vaccines in this population.
(SOURCE: WILLIAMS, S. E. ET AL. A RANDOMIZED TRIAL TO INCREASE ACCEPTANCE OF CHILDHOOD VACCINES BY VACCINE-HESITANT PARENTS: A PILOT STUDY. ACADEMIC PEDIATRICS VOLUME 13, ISSUE 5, PAGES 475-480, SEPTEMBER 2013)

Writing the Methods
Purposes of the Methods Section ?To allow others to replicate what you did
? In order to test it ? In order to do further research

?To allow others to evaluate what you did
? To determine whether the conclusions seem valid ? To determine whether the findings seem applicable to other situations of interest

WRITING THE METHODS

Writing the Methods
Basic Information to Include
? In most cases, overview of study design ? Identification of (if applicable)
? Equipment, organisms, reagents, etc used (and sources thereof) ? Approval of human or animal research by an appropriate committee ? Statistical methods

Writing the Methods
Amount of Detail to Use

?For well-known methods: name of method, citation of reference
?For methods previously described but not well known: brief description of method, citation of reference

?For methods that you yourself devise: relatively detailed description

Writing the Methods
Methods: The Words and More
?Should be written in past tense ?In some journals, may include subheads (which can be helpful to readers) ?May include tables and figures—for example:
? Flowcharts ? Diagrams of apparatus ? Tables of experimental conditions

Writing the Methods
Generic subheadings for the Methods Section
Animal Studies Materials Animals Preparation Study Design Interventions Methods of Measurement Calculations Analysis of Data Clinical Studies Study Subjects (Patients) Inclusion Criteria Exclusion Criteria Study Design Interventions Methods of Measurement Calculations Analysis of Data

Writing the Methods
True or False?
?The Methods section include references.
?The Methods section does not include results. ?The Methods section usually contains tables and figures. ?For drugs, state the brand name instead of the generic name. ?Detailed description of each step you did must be provided. ?For animals, state the species and weight, and also the strain, sex and age, if they are important. ?Study Design can be a subsection in the Methods section. ?Methods are reported in past tense.

Writing the Results
Critical appraisal ?Article Title: Long-Term Remission and Alleviation of Allergy and Crohn’s Disease Symptoms
? Check the math: 9 + 12 = 21, not 17. ? How long is “long-term”? How long was the follow-up period and how often were patients assessed for symptoms? ? What symptoms were relieved and how were they assessed? ? What is an “alleviation effect”? ? What were the results of the control group?

Writing the Results
Critical appraisal ?Aspirin and Coumadin after Acute Coronary Syndromes
? Final sample size appears to be 993. are the 6 missing patients accounted for? ? What was the median follow-up time? Is this period long enough for the treatment effects to occur? ? How were major and minor bleeding defined? ? Why, and when, and from which groups, did the patients discontinue the study? ? Intention-to treat analysis should be mentioned in the Methods, not the Results.

Writing the Results
Interesting perspectives of statistics
?“Most researchers use statistics like a drunk uses a lamppost: for support, not illumination.” ?“If you torture your data long enough, they will tell you whatever you want to hear.” ?“Statistics are like a skimpy bathing suit: generally revealing… but never completely so.”

?“Statistical Buddhism: To those who know, no explanation is necessary. To those who do not know, no explanation is possible.”

Writing the Results
Graphic images
?Charts
? Show relationships among categorical variables (e.g., pie, bar charts)

?Graphs
? Show relationships between continuous variables (e.g. line graphs, distributions)

?Diagrams
? Show whole processes, structures, or functional relationships

?Maps
? Show locations, positions, areas, spatial relationships

?Illustrations
? Depict reality at various levels of detail

Writing the Results
Components of charts and graphs ?Data field ?Data

?Vertical scale and label
?Horizontal scale and label ?Figure number ?Caption (or legend)

Writing the Results

Writing the Results
Characteristics of a good graphic image
?Legible (lines and data points are distinct) ?Understandable (relationships are clear) ?Conveys a message ?Allows data to be readily located ?Easily linked to related information in the text ?With its caption, can be understood without reference to the text ?“Graphical excellence is that which gives the viewer the greatest number of ideas in the shortest time with the least ink in the smallest space.”—Edward Tufte

Writing the Results
Problems with graphic images
?“Chart junk” and “eye wash” ?Unnecessary words, lines, or symbols that hinder interpretation of the image. ?Optical effects that obscure or detract from the relationships shown in the image ?Misleading features that visually misrepresent the relationships in the data

Writing the Results

Writing the Results

Writing the Results
Useful tips
?While you are preparing an illustration, bear in mind that what shows in your computer can be different from what comes out in printing. Therefore, the choice of font size is crucial. ?Normally, the Results section does not include statements that need to be referenced, such as comparison with others’ results. However, if a brief comparison (one or two sentences) would not fit smoothly into the Discussion, it can be included in the Results section.

Writing the Results
Useful tips
?Although the primary information in the Results section is results, not every result that you obtained from your experiments or observations needs to be reported. ?Control results, both for baseline and control series, should be described along with or after experimental results whenever possible. ?If baseline or control data are reported in a figure or table, they do not usually need to be reported in the text.

Writing the Results
Result or Data?
?In the 20 control subjects, the mean resting blood pressure was 85 ± 5 (SD) mm Hg. In comparison, in the 30 tennis players, the mean resting blood pressure was 94 ± 3 mmHg. ?The mean resting blood pressure was higher in the 30 tennis players than in the 20 control subjects [94 ± 3 (SD) vs. 85 ± 5 mmHg, p < 0.02].

?Results include data, but results are different from data.

Writing the Discussion
Dos and don'ts
?Try to present the principles, relationships, and generalizations shown by the results. And bear in mind, in a good discussion, you discuss—you do not recapitulate —the results.

?Point out any exceptions or any lack of correlation and define unsettled points. Never take the high-risk alternative of trying to cover up or fudge data that do not quite fit.
?Show how your results and interpretations agree (or contrast) with previously published work. ?Don’t be shy; discuss the theoretical implications of your work, as well as any possible practical applications.

Writing the Discussion
Dos and don'ts
?State your conclusions as clearly as possible.

?Summarize your evidence for each conclusion.
?Don’t make unwarranted speculation. ?Don’t overinterpret the results. ?Don’t inflate the importance of the findings.

Writing the Discussion
Two stories of unwarranted conclusion
The “Worm in the Jin” story The “Fleas Hear with legs” story

Methods

Results

Introduction

Discussion

IMRAD


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