APAME Convention 2013
August 04 2013

Ten Keeps of Writing Medical Articles

Sung-Tae Hong, MD
Editor, Journal of Korean Medical ScienceSeoul National University, Korea
This presentation material is licensed under a Creative Commons
Attribution License.

Why TEN Keeps?
• To prepare the better manuscript and bepublished for Authors• To review manuscripts easier for Reviewers• To select and edit manuscripts efficientlyfor Editors

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Purpose of Publication• Scientific contribution for professionals• Transition of private new knowledge topublic known knowledge• Public offer to agree and cite publications• Academic benefits
Write manuscripts based on the purposeof publication: Easy to read and tounderstand → TEN Keeps
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Ten Keeps 1, 2
1. Keep Design of Articles: Design article structure
before writing– Scientific contents and conclusion– Target journal: factors considered– Authors in order and Contributors– References

2. Keep Uniform- Keep journal’s format in details

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Ten Keeps 3, 4, 5
3. Keep Consistency: Keep flow in the same order ofconcepts and words throughout the manuscript
4. Keep Rapid Drafting and Slow Cooking: Drafting
as soon and cook it slowly and repeatedly
5. KESSS! Keep Sentences Simple and Sexy: Makesentences short within 30 words in a sentence

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Ten Keeps 6, 7
6. Keep Scientific Confidence: Authors should beconfident for their results and make clear conclusions.
7. Keep Rule of TEN 1: Only 10% of title readers read
abstract after screen articles by title. Attractive titles
invite readers.

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Rule of TEN 1• Titles must be attractive to readers: Professional• Simple, Clear, Specific → SEXY!
• Inclusion of key words: answers to questions• Important one first

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Title Principle• Title form:– Phrase– Sentence– Title and subtitle• Within 12-15 words, 100 spaces• ‘A’ Effects of ‘B’ (Drugs, Materials, Methods)
on ‘C’ (Diseases, Patients, Diagnosis, Findings,…) in ‘D’ (Area, Time, Population…)• Follow any instruction of target journal
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Writing Tips for Titles 1• Clear expression• Avoid– Serial number– Abbreviations– Commercial brand names• Inadequate expression to avoid: The, A -, Of, On,Results, Study (Studies), Notes on, An approach to,
A study of, Some aspects of, Investigation of,Observation on, A novel method for, The effect of….
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Title Example 1• 2004년 서울에서 발생한 비정형성 폐염 67례의보고• Report of 67 cases of atypical pneumonia in Seoul,
2004• Epidemic atypical pneumonia: Sixty-seven cases
in Seoul in 2004
• Epidemic atypical pneumonia in Seoul: 67 cases
experienced in 2004

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Title Example 2• Clinical analysis of 67 atypical pneumonia casesin an epidemic occurrence in Seoul in 2004
• Epidemiological aspects of atypical pneumonia inSeoul, 2004
• Epidemic occurrence of atypical pneumonia inSeoul in 2004
• Sixty-seven cases of atypical pneumonia ofepidemic occurrence in Seoul in 2004

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Ten Keeps 8
8. Keep Rule of TEN 2: Only 10% of abstract readers
read the text. Finally only 1% of title readers read thetext.
**Attractive title and informative abstract may callcitation. We should try to raise the readers’proportion over the 1%.

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Rule of TEN 2• Clear and understandable, essential core contents• Structured or Unstructured• Length limit: 250 words• Abstract swims alone through the web• Most readers read abstract only with Tables orFigures and decide citation

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Abstract Writing Tip 1• Writing Flow: Question to Answer
 Background or Purpose How? Materials and Methods
 What? Results
 So what? Conclusion• Avoid reviewing, reference citing• Follow guidelines if any

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Abstract Writing Tip 2• Describe core results in detail with numeric data.
• Avoid numbering of results• Explain abbreviations.
• Conclusion is essential and same with in the text.

SUNG-TAE HONG, SEOUL NATIONAL UNIVERSITYExample of Structured Abstract: Radiology

Ureterolithiasis: Value of the Tail Sign in Differentiating Phleboliths from UreteralCalculi at Nonenhaced Helical CT
PURPOSE: To determine the value of the tail sign in differentiating phleboliths fromureteral calculi at nonenhanced helical computed tomography (CT).
MATERIALS AND METHODS: The enhanced helical CT scans in 82 patients with aconfirmed diagnosis of pelvic urolithiasis were retrospectively reviewed. Each
calcification along the ureter was classified as a phlebolith or a ureteral calculus on thebasis of clinical and imaging findings and was analyzed for the presence of a tail sign.
RESULTS: Eighty-two patients each had a single ureteral calculus. None of thesecalculi were associated with a positive tail sign. Sixty-nine phleboliths were present in
35 patients. Forty-five phleboliths (65%) were associated with a positive tail sign. Of
the remaining 24 phleboliths, 17 (25%) were associated with a negative tail sign andseven (10%) were indeterminate. The tail sign has a sensitivity of 65% (45 of 69; 95%
Cl: 53%, 75%) and a specificity of 100% (82 of 82; 95% Cl: 96%, 100%) indifferentiating phlebolith from ureteral calculi.
CONCLUSION: The tail sign is an important indicator that a suspicious calcification
represents a phleboith. Absence of the tail sign indicates that the calcification remains
indeterminate.

Example of Structured Abstract: Lancet

Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma andoligodendroglioma in adults: the EORTC 22845 randomised trial
BACKGROUND: Postoperative policies of "wait-and-see" and radiotherapy for low-grade glioma arepoorly defined. A trial in the mid 1980s established the radiation dose. In 1986 the EORTCRadiotherapy and Brain Tumor Groups initiated a prospective trial to compare early radiotherapy
with delayed radiotherapy. An interim analysis has been reported. We now present the long-term
results. METHODS: After surgery, patients from 24 centres across Europe were randomly assigned toeither early radiotherapy of 54 Gy in fractions of 1.8 Gy or deferred radiotherapy until the time ofprogression (control group). Patients with low-grade astrocytoma, oligodendroglioma, mixed
oligoastrocytoma, and incompletely resected pilocytic astrocytoma, with a WHO performance status 02 were eligible. Analysis was by intention to treat, and primary endpoints were overall and progressionfree survival. FINDINGS: 157 patients were assigned early radiotherapy, and 157 control. Medianprogression-free survival was 5.3 years in the early radiotherapy group and 3.4 years in the control
group (hazard ratio 0.59, 95% CI 0.45-0.77; p<0.0001). However, overall survival was similar between
groups: median survival in the radiotherapy group was 7.4 years compared with 7.2 years in thecontrol group (hazard ratio 0.97, 95% CI 0.71-1.34; p=0.872). In the control group, 65% of patients
received radiotherapy at progression. At 1 year, seizures were better controlled in the earlyradiotherapy group. INTERPRETATION: Early radiotherapy after surgery lengthens the period
without progression but does not affect overall survival. Because quality of life was not studied, it is notknown whether time to progression reflects clinical deterioration. Radiotherapy could be deferred forpatients with low-grade glioma who are in a good condition, provided they are carefully monitored.

Example of Structured Abstract: JAMA

Comparison of a Strategy Favoring Early Surgical Resection vs a Strategy Favoring
Watchful Waiting in Low-Grade Gliomas
CONTEXT There are no controlled studies on surgical treatment of diffuse low-grade gliomas (LGGs), andmanagement is controversial. OBJECTIVE To examine survival in population-based parallel cohorts of LGGs from 2
Norwegian university hospitals with different surgical treatment strategies. DESIGN, SETTING, AND PATIENTSBoth neurosurgical departments are exclusive providers in adjacent geographical regions with regional referralpractices. In hospital A diagnostic biopsies followed by a "wait and scan" approach has been favored (biopsy andwatchful waiting), while early resections have been advocated in hospital B (early resection). Thus, the treatment
strategy in individual patients has been highly dependent on the patient's residential address. Histopathology
specimens from all adult patients diagnosed with LGG from 1998 through 2009 underwent a blinded histopathologicalreview to ensure uniform classification and inclusion. Follow-up ended April 11, 2011. There were 153 patients (66from the center favoring biopsy and watchful waiting and 87 from the center favoring early resection) with diffuse
LGGs included. MAIN OUTCOME MEASURE The prespecified primary end point was overall survival based onregional comparisons without adjusting for administered treatment. RESULTS Initial biopsy alone was carried out in
47 (71%) patients served by the center favoring biopsy and watchful waiting and in 12 (14%) patients served by thecenter favoring early resection (P &lt; .001). Median follow-up was 7.0 years (interquartile range, 4.5-10.9) at thecenter favoring biopsy and watchful waiting and 7.1 years (interquartile range, 4.2-9.9) at the center favoring earlyresection (P = .95). The 2 groups were comparable with respect to baseline parameters. Overall survival was
significantly better with early surgical resection (P = .01). Median survival was 5.9 years (95% CI, 4.5-7.3) with theapproach favoring biopsy only while median survival was not reached with the approach favoring early resection.
Estimated 5-year survival was 60% (95% CI, 48%-72%) and 74% (95% CI, 64%-84%) for biopsy and watchful
waiting and early resection, respectively. In an adjusted multivariable analysis the relative hazard ratio was 1.8 (95%CI, 1.1-2.9, P = .03) when treated at the center favoring biopsy and watchful waiting. CONCLUSIONS For patients in
Norway with LGG, treatment at a center that favored early surgical resection was associated with better overall
survival than treatment at a center that favored biopsy and watchful waiting. This survival benefit remained after
adjusting for validated prognostic factors.

Example of Structured Abstract: JAMA

Association between use of lung-protective ventilation with lower tidal volumes and clinicaloutcomes among patients without acute respiratory distress syndrome: a meta-analysis
CONTEXT:
Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes ofpatients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also
benefits patients who do not have ARDS.

OBJECTIVE:
To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not haveARDS.
DATA SOURCES:MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials up to August 2012.
STUDY SELECTION:
Eligible studies evaluated use of lower vs higher tidal volumes in patients without ARDS at onset of mechanical ventilation and reported
lung injury development, overall mortality, pulmonary infection, atelectasis, and biochemical alterations.
DATA EXTRACTION:
Three reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus.
DATA SYNTHESIS:
Twenty articles (2822 participants) were included. Meta-analysis using a fixed-effects model showed a decrease in lung injury
development (risk ratio [RR], 0.33; 95% CI, 0.23 to 0.47; I2, 0%; number needed to treat [NNT], 11), and mortality (RR, 0.64; 95% CI,0.46 to 0.89; I2, 0%; NNT, 23) in patients receiving ventilation with lower tidal volumes. The results of lung injury development weresimilar when stratified by the type of study (randomized vs nonrandomized) and were significant only in randomized trials for pulmonary
infection and only in nonrandomized trials for mortality. Meta-analysis using a random-effects model showed, in protective ventilationgroups, a lower incidence of pulmonary infection (RR, 0.45; 95% CI, 0.22 to 0.92; I2, 32%; NNT, 26), lower mean (SD) hospital length ofstay (6.91 [2.36] vs 8.87 [2.93] days, respectively; standardized mean difference [SMD], 0.51; 95% CI, 0.20 to 0.82; I2, 75%), higher mean(SD) PaCO2 levels (41.05 [3.79] vs 37.90 [4.19] mm Hg, respectively; SMD, -0.51; 95% CI, -0.70 to -0.32; I2, 54%), and lower mean (SD)pH values (7.37 [0.03] vs 7.40 [0.04], respectively; SMD, 1.16; 95% CI, 0.31 to 2.02; I2, 96%) but similar mean (SD) ratios of PaO2 tofraction of inspired oxygen (304.40 [65.7] vs 312.97 [68.13], respectively; SMD, 0.11; 95% CI, -0.06 to 0.27; I2, 60%). Tidal volume
gradients between the 2 groups did not influence significantly the final results.
CONCLUSIONS:
Among patients without ARDS, protective ventilation with lower tidal volumes was associated with better clinical outcomes. Some of thelimitations of the meta-analysis were the mixed setting of mechanical ventilation (intensive care unit or operating room) and the durationof mechanical ventilation.

Example of Unstructured Abstract:
Characterization of Mycobacterium tuberculosis complex isolates from Greek
patients with sarcoidosis by Spoligotyping.
A, B) Spoligotyping was undertaken with 38 Mycobacterium tuberculosis isolates
from Greek sarcoidosis patients and 31 isolates from patients with tuberculosis. C)

Fifty percent of the isolates from sarcoidosis patients and 16.13% of the isolates frompatients with tuberculosis were represented by a unique pattern, whereas theremaining isolates belonged to seven shared types. D) Interestingly, half of theisolates from sarcoidosis patients did not resemble the spoligotypes of the isolates
from patients with tuberculosis, most of which pertained to shared spoligotypes.

Example of Unstructured Abstract:

Low risk of mother-to-child transmission of hepatitis C virus in Yaounde,CameroonA, B) To assess mother-to-child transmission (MTCT) of hepatitis C virus (HCV)in Cameroon, 5,008 pregnant women were screened for HCV antibodies. C)
Eighty-nine (1.8%) were HCV-antibody (HCV-Ab) positive. Among these, 7(7.9%) were HBsAg positive, 6 (6.7%) HIV-positive, and one (1.1%) was coinfected by both hepatitis B virus (HBV) and HIV. Sixty-eight (76%) out of 89
HCV-Ab positive pregnant women were HCV-RNA positive. The HCV genotype
determination indicated the predominance of genotype 4 (45.3%), followed by
the genotypes 1 (28.1%) and 2 (26.6%). The mean HCV-RNA levels of 41 womenat the time of delivery was 4.8 (range 0.06-34.7) x 10(6) RNA copies/mL. Finally,
35 women delivered 36 live children. None of those screened at 6 weeks and 6months of age were HCV-RNA positive. D) The failure to detect HCV verticaltransmission suggests that the mother-to-child transmission (MTCT) is not amajor route of HCV transmission in Cameroon.

Ten Keeps 99. Keep Rule of First and Last: Organize text
structure by Topic at the first and Conclusive atthe last. Topic Paragraph & Conclusive Paragraph.
Topic Sentence & Conclusive Sentence

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Scheme of Text Structure• IMRAD Text• Introduction & Discussion• Paragraph Scheme– 2-3 Paragraphs in introduction– 4-6 Paragraphs in discussion– First: Topic paragraph– Middle: Extension paragraph– Last: Conclusion paragraph• Sentence Scheme– More than 2 sentences in a paragraph– First: Topic sentence– Middle: Extension sentences– Last: Conclusive sentence

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Ten Keeps 1010. Keep Connecting Words: Connect sentences by
repeating common words within a paragraph. Thatkeeps fluent flow of reading and understanding.

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Topic Paragraph& Connecting Words
Praziquantel has been used comprehensively inboth clinics and field as a broad-spectrum anthelmintic
for the treatment of trematode or cestode infections.
Though it is regarded as safe generally, the comprehensive
use of praziquantel inevitably induces several common
adverse reactions, such as, abdominal pain, diarrhea,dizziness, sleepiness, and headache.1 Most of these adverse
reactions are transient and rapidly subside without specifictreatment. In addition to these common adverse reactions
an anaphylactic reaction may occur, but it is very rare andneglected usually. A search of the literature revealed that
two cases of anaphylactic shock have been attributed topraziquantel.2-3
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Slow Cooking• Slow Cooking of Manuscripts: Trim manuscripts
more attractive– KESSS– Rule of TEN 1– Rule of TEN 2– Rule of First and Last
– Connecting Words

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Thank You for Attention!
Good Articles Make GoodJournals!

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