How to write a scientific paper in medicine?

1. How to write up a paper?
Professor Mohamed A. Imam
MD, MSc (Orth)(Hons), D.SportMed, Ph.D., FRCS (Tr. and Orth.)
Consultant Trauma and Upper Limb Surgeon, Rowley Bristow Orthopaedic Unit, Chertsey
Professor and MD, Smart Health Academic Unit, University of East London, London, UK
Email: Info@theArmDoc.co.uk
@MoAImam

2. Who wants to publish?

3. What is this?

4. Who did this?

5. Where is this?

6. What is its relation to Shoulders?

7. What is its relation to me?

8. How to publish?
1. Identifying the topic to investigate
2. Explaining the idea
3. Allocating the team
4. Literature review
5. Agreeing a timetable
6. Agreeing a strategy to get the data required for the study
7. The first PowerPoint presentation
8. Redefining the questions
9. Revised PowerPoint presentations
10. Structuring the paper
11. The first draft
12. Team review of the draft
13. The re-write
14. Editing the paper
15. Journal submission

9. What is the question?
Is it clearly defined?
Is it a good question?
Is research ethics required?
Is statistical input required?
What data is required?
Do we have the data and in which format?
Has a journal for publication been identified?
Where to save the data?
Has it already been answered?
Can we answer the question using the data we have in
my institution?
Is this topic of strategic importance to my institution?
Do we have the core competencies required for this
study?

11. The Idea

12. Research Question
Detailed
Explicit
Answerable
Thought through
Housed
Supported
Important
chanGes Practice
Non Self Serving

13. Explaining the idea

14. Allocating the project

15. Literature review
Has anyone told this story?

16. Redefining the questions

18. The fun part!

20. Structuring the paper - 3000 words
• Introduction 500 words
– What is the problem being addressed 100 words
– What is the current knowledge on this subject 250 words
– Last sentence to state what the study will be about 150 words
• Patients and methods 1000- 1500 words
• Results
– Maximum of five Tables Graphs or images 500 words
• Discussion 1000 words
– Critical analysis of our data 250 words
– How do our results compare with previous work 250 words
– What do our results tell us that is new? 300 words
– What further work should be undertaken 200 words

21. • Shortest but most critical
• State the issues and formulate the
rationale for those issues or
questions.
• Should be compatible with the
type of study
Novel Findings
Confirmation
Study
Address
Controversy

22. Structuring the paper - 3000 words
• Introduction
– What is the problem being addressed 100 words
– What is the current knowledge on this subject 300 words
– Last sentence to state what the study will be about 150 words

23. • Paragraph 1: Introduction of the introduction--- general topic
or problem and suggest its importance
• Paragraph 2 and 3: the rationale
• Paragraph 4 (Final): the questions, hypotheses, or purposes.

24. • If A, B, and C,
then
D, E, or F.
Aristotelian logic
A, B, and C= accepted facts (Published Data)
D, E, or F = logical outcomes or predictions.

25. • Avoid in the final paragraph of the Introduction
purposes such as, “. . . we report our data. . .”
Such statements fail to focus the reader’s (and
writer’s!) attention on the critical issues (and do
not include mention of study variables).

26. Introduction Checklist
• Background given
• The question being
asked/hypothesis tested
included
• Study design stated

27. Structuring the paper - 3000 words
• Introduction 500 words
– What is the problem being addressed 100 words
– What is the current knowledge on this subject 250 words
– Last sentence to state what the study will be about 150 words
• Patients and methods 1000- 1500 words

28. Example

29. Imam et al, Three-year functional outcome of transosseous equivalent, double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded
randomized controlled trial, JSES, 2020.

30. • Longest Section
• Reproducible
• institutional review
board or ethics
committees
• Population and
demographics.
• Eligibility Criteria
• Statistical Analysis
section

31. Methods Checklist
• How many patients and why clearly stated
• Was a power study carried out? If so, include the details
• How were the patients chosen? Inclusion/exclusion criteria
clearly stated
• Were they randomised? How?
• Demographics included
• What tests were carried out? State measurements/units used
• What outcome scores were used? Were they validated?
• State who recorded results, were they blinded?

32. Methods Checklist
• How were the controls chosen?
• Explicitly state the number of patients, cases, joints involved etc
• Information regarding bilateral cases included
• Where percentages are quoted, ensure that the absolute numbers
have been given
• Details of patients lost to follow-up included, details given
• What period of time does the study cover? Why?
• Include life table/survival analysis included where appropriate
• State ethical approval/informed consent received if needed

33. Stats Checklist
• State the tests used and include references
• Exact p values included for all statistical values,
and the test stated
• State the level of significance

34. Imam et al, Three-year functional outcome of transosseous equivalent, double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded
randomized controlled trial, JSES, 2020.

35. Imam et al, Three-year functional outcome of transosseous equivalent, double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded
randomized controlled trial, JSES, 2020.

36. Structuring the paper - 3000 words
• Introduction 500 words
– What is the problem being addressed 100 words
– What is the current knowledge on this subject 250 words
– Last sentence to state what the study will be about 150 words
• Patients and methods 1000- 1500 words
• Results
– Maximum of five Tables Graphs or images 500 words

37. • Not too long.
• Paragraph 1 and 2: Persuade the reader of the
validity of the methods
• Paragraph 3: addressing each explicitly raised
question or hypothesis
• Paragraphs 4, 5, etc: report new and unexpected
findings.

38. • Results either in text or in tables/graphs
• The first (topic) sentence of each paragraph
should state the point/ answer the question.
• Authors’ interpretation of the data, not the data.
• Outcome is increased or decreased, p (or other
statistical) value.
• Use Actual P values convey more information
than stating a value less than some preset level.

39. Results Checklist
• State absolute number where percentages are quoted
• Means and ranges, or medians and interquartile ranges
stated
• Presented clearly and in a logical order
• Numbers/outcomes/tests/follow-up all match text and
tables/figures
• Units given for any results

40. Figures and Tables
• Figures and tables complement,
not duplicate
• Present information, which
would be difficult to describe in
text form.
• Prefer text to them
• Well constructed tables are self-
explanatory and require only a
title.

41. Figures and Tables
• Figures, however, may need
some explanation, including
meaning of symbols
• Figure legend should contain
the major point within the
framework of the questions
raised; explanations should be
written in complete sentences.

42. IMPORTANT
• A reader should be able to read the questions
in the last paragraph of the Introduction, and
then find the answers in the first sentence of
each paragraph in Results and in the figure
legends.

43. Tables Checklist
• Do not repeat results presented in the text,
only new or additional information
• Ensure the legends comprehensive and clearly
state what the table shows

44. Figures Checklist
- Check the maximum number as stated by the journal
- Ensure legends are comprehensive and clearly state what
the figure shows and state what any additional notes or
lettering represent
- Ensure that all axis labels have been applied to all charts
or graphs
- If histology figures: mention stains used and Magnification
given

45. Imam et al, Three-year functional outcome of transosseous equivalent, double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded
randomized controlled trial, JSES, 2020.

46. Imam et al, Three-year functional outcome of transosseous equivalent, double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded
randomized controlled trial, JSES, 2020.

47. Imam et al, Three-year functional outcome of transosseous equivalent, double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded
randomized controlled trial, JSES, 2020.

48. Discussion
1. Restatement of the problem or
question
2. Exploration of limitations and
assumptions
3. Comparison and/or contrast with
information (data, opinion) in the
literature
4. Synthesis of the comparison and the
author’s new data to arrive at
conclusions.

49. Discussion
• Quantitative comparisons
• Discrepancies
• Conclusions

50. Discussion Checklist
• It is appropriate to the question?
• State if / how strongly your results support your
conclusion? How strongly?
• State how your results fit into the current
knowledge
• Will your results change clinical practice? If so,
state how

51. Abstract 200 words
• Last part to write
• Might be the only part read by your target
audience
• Your marketing tool to encourage readers to
read the whole article

52. Abstract 200 words
• A compelling Abstract
contains the questions or
purposes, the methods, the
results (most often
quantitative data), and the
conclusions.
• Each of these may be
conveyed in one or two
statements.

53. Abstract 200 words
• Avoid comments such as,
“. . . this report describes .
. .” Such statements
convey no substantive
information for the reader.
• Avoid references and
statistical values in the
Abstract.

54. Abstract Checklist
• Instructions to authors
• level of evidence
• Clear hypothesis/question asked
• The design and the results briefly
described
• Where this paper fits into the current
knowledge stated

56. 1. Direct Message

57. Aerosol Generating Procedures In Trauma And
Orthopaedics In The Era Of The
Covid-19 Pandemic; What Do We Know?
2. Descriptive

58. • Instructions to authors
• Only peer-reviewed journals, textbooks or
monographs
• Online links: well-accepted and stable
electronic sources (eg, NIH, NICE, NJR or
FDA Websites).
• Accepted articles in press in peer-review
journals may be used if the anticipated date
of publication is within a time frame
• Abstracts and submitted articles

59. References Checklist
• Are they from studies within the last 10 years?
• Are they inclusive?
• Reduce bias wherever possible!
• Reduce the number cited to only those that
are fully relevant

60. Identify the Journal

61. The first draft

62. Team review of the draft

63. The re-writes

65. Journal submission
- Interested Journal
- Relevant Topic
- Relevant Quality
- Instructions to authors
- Quick

68. ?Unpopular opinion
• Be thankful of the reviewer
who sends you a 10 page
report with criticism &
comments: that person has
spent a lot of time and
effort on your work (and it
may be a major name, who
might start referring to
your work) even if they
reject your paper!

70. Acceptance

71. • Ensure the Word Count is right
• Ensure that all abbreviations have been spelt out at
first use
• The manuscript has been blinded and any institutional
or author names removed
• Reading is needed be a better writer.
• Practice writing
• Make it fun to read
• Cut ruthlessly. It's hard to cut your own words, but you
have to learn how to not become too attached to your
own words= cutting clutter.

72. • Decrease passive voice
• Avoid long sentences
• Avoid salami slicing
• Stop waiting for inspiration
• Avoid acronyms
• Avoid turning verbs into nouns

73. Research is fun!
Publish and flourish! (it’s a game
really)
Writing up requires patience &
perseverance: it is worth the effort!
Nobody is perfect: everybody
sweats!

75. Now what is this really?

77. Ramses II’ Arm Doc et al, Shoulder relocation technique, J of Ipuy’s tomb in Thebes. 2593 BC.

79. Email: Info@TheArmDoc.co.uk