Morten Pilegaard

mpi@termshare.dk
(+45) 26 17 46 22
Two steps: Effective writing for medical science

Rules & conventions matter if you want to publish!

Step 1 1. Consult international reporting guidelines

Know the rules 2. Follow journals (contents) instructions
3. Learn academic writing conventions

1. Reporting guidelines A catalogue of reporting guidelines for health research. Eur J Clin Invest 2010 ; 40(1): 35-53
http://cdn.elsevier.com/promis_misc/Reporting%20Guidelines.pdf

What? International guidelines on contents and style

- reflect experts consensus opinion
- endorsed by journals
- research design-specific checklists & advice
http://www.equator-network.org/
Where?

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Two steps: Effective writing for medical science
Contents Strobe: Observational study Prisma: Systematic review
Design- Grade: Meta-analysis Stard: Diagnostic accuracy
specific Orion: Infection control Consort: Randomized studies

Consort
Introduction
Discussion 2a Background and rationale 20 Limitations (bias, imprecision)
2b Specific objectives/hypotheses 21 Generalizability (validity)
22 Interpretation of results

Contents 1 Nature and scope of problem 1 Principal findings

2 Brief review of pertinent literature
Journal- 3 Rationale of study
specific 4 Purpose of paper
5 Rationale for choice of method
Int. J Oral Maxillofacial Surgery
Check move structure in target journal
if no set move structure is prescribed!
2 Strengths/weaknesses of study
3 Str/weak of results comp to others
5 Meaning of study; implications
5 Unanswered questions
6 Future research
BMJ

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Two steps: Effective writing for medical science
Contents A functional perspective
or what are we doing with words
Conven- 1. Introduce research area
a) Summarize previous research
tions b) Claim general importance
c) Make topic generalization
Moves & 2. Establish research niche
steps a) Indicating gap or
b) Raise question/doubt or
c) Make counter-claim or
d) Claim benefit, take next step
3. Occupy research niche
a) State purpose
b) State main results (some displ)
c) Describe structure (some displ)
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1. Background (optional)
2. Present own results
3. Ex/unexpected outcome (option)
4. Compare with other research
5. Explain result / the unexpected
6. Example supporting explanation
7. Deduct/conclude/claim)
8. Hypothesis (optional)
9. Support for 7-8 (optional)
10. Recommendation (optional)
11. Suggest future work
Repeated for every main finding
 Two steps: Effective writing for medical science
Move structure conventions are genre/subgenre-specific
Conventions are followed at the levels of
Culture/genre-specific schematic structures (general or design-specific moves & steps)
Target language conventions, grammar & usage (tool usage)

Culture Contents/moves
(e.g. Consort)

Spoken/written text Contents/moves

Article 1a. Participant flow
NNSE
Abstract 1b. Losses/exclusions
Receiver
Sender Introduction 2a. Recruitment
NNSE/NSE
Material/method 2b. Reason for stopping
Results
3.Baseline data
4.Numbers analyzed
Discussion
5a. Outcomes, estimates
5b. Binary outcomes
6. Ancillary analyses
Language
NSE: Native speaker of English; NNSE: non-native speaker of English

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Two steps: Effective writing for medical science

Language
1b There was only one Nominal structure
Dichotomies/hierarchies
protocol deviation, in a woman Conventional
Past tense
in the study group. She had an features! No hedging
abnormal pelvic measurement Not cast in iron!
Agent-less passives
and was scheduled for elective Main sentences
caesarean section. However, a Theme/rheme structure
trial of labour was judged Declarative sentences
Lexical cohesion
acceptable; caesarean section
was done when there was no Contents/moves
progress in the first stage of 1a. Participant flow
labour 1b. Losses/exclusions
http://www.consort-statement.org/consort-statement/13-19---
results/item13b_losses-exclusions/ 2a. Recruitment
2b. Reason for stopping
3. Baseline data
4. Numbers analyzed
5a. Outcomes, estimates
5b. Binary outcomes
6. Ancillary analyses
Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22
Two steps: Effective writing for medical science

Language
1b There was only one Nominal structure
Dichotomies/hierarchies
protocol deviation, in a woman
Past tense
in the study group. She had an No hedging
abnormal pelvic measurement Agent-less passives
and was scheduled for elective Main sentences
caesarean section. However, a Theme/rheme structure
trial of labour was judged Declarative sentences
Lexical cohesion
acceptable; caesarean section
was done when there was no Move/step
progress in the first stage of 1a. Participant flow
labour 1b. Losses/exclusions
http://www.consort-statement.org/consort-statement/13-19---
results/item13b_losses-exclusions/ 2a. Recruitment
2b. Reason for stopping
3. Baseline data
4. Numbers analyzed
5a. Outcomes, estimates
5b. Binary outcomes
6. Ancillary analyses
Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22
Two steps: Effective writing for medical science
Theme: What we talk Rheme: What we say
about. In Results about the theme. In
section often sentence Results section often
subject the rest of the sentence
1b There was only one Nominal structure
Dichotomies/hierarchies
protocol deviation, in a woman
Past tense
in the study group. She had an No hedging
abnormal pelvic measurement Agent-less passives
and was scheduled for elective Main sentences
caesarean section. However, a Theme/rheme structure
trial of labour was judged Declarative sentences
Lexical cohesion
acceptable; caesarean section
was done when there was no
progress in the first stage of 1a. Participant flow
labour 1b. Losses/exclusions
http://www.consort-statement.org/consort-statement/13-19---
results/item13b_losses-exclusions/ 2a. Recruitment
2b. Reason for stopping
3. Baseline data
4. Numbers analyzed
5a. Outcomes, estimates
5b. Binary outcomes
6. Ancillary analyses
Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22
Two steps: Effective writing for medical science
Language form suggests function (purpose) of move/step :

Move 1 - Step 1a: Claiming centrality

The growing/emerging use of deep brain stimulation (DBS) to alleviate symptoms of

movement disorders has augmented/ increased /spurred interest in exploring its
use for other conditions. Of particular interest/ urgency/ topicality is how to
foretell/ foresee/ foreshadow/ predict/

Lexis:
Growing/ emerging use
Augmented/ hightened need
Particular interest/ urgency
Syntax (inversion):
Of particular
interest/urgency. is
Other expressions: inversion
Particularly important ...
Especially interesting ....
Rather more significant ...
Especially noteworthy
Of greater concern ...

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Two steps: Effective writing for medical science
Language form suggests function (purpose) of move/step :

Transition: From move 1 to move 2: Step 2b: Indicating a gap

Negative subject

Uncountable However, little information ...

little attention ...
little work ...
little data ...
little research ...

Countable However, few studies ...

few investigations ...
few researchers ...
few attempts

Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22

Writing process: Structured, focused, stepwise
1. Prewriting: Think & plan
2. Writing: Turn plan into words Introduction
3. Post: Check cohesion & grammar

Cancer is the leading cause of death, and the risk of getting cancer before
the age of 75 reaches 30% for men and 26% for women in the Nordic
countries (ref). Lung cancer has a particularly high incidence and mortality
from this disease is largely determined by its stage at diagnosis:
differences in survival between stage 1-2 and stage 3-4 cancers thus
reach 50 percentage points (ref). Danish citizens are generally diagnosed
with cancer at later, more advanced stages than other Europeans and
therefore have inferior cancer survival rates. For lung cancer, for example,
the Danish relative 1-year survival rate was 34.9 compared with 43.6 in
Sweden in 2005-2007. The aim of this study was to

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 3rd move first! Formulate 1 sentence
The aim of this study is to perform a rando-
mized study of lung cancer mortality in Danish..

2nd move next! Formulate 1-2 sentence(s)

However, research into Danish citizens inferior
lung cancer survival rates is entirely non-
existent.
1st move last! List themes; add rheme words
Cancer leading death cause
Cancer risk in men and women
Lung cancer risk incidence
Lung C mortality stage-dependent..
differences

Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22

Check! Think!
Make sure you What statements need references?
follow guidelines What is generally acknowledged fact?
How strongly should I stress pertinence?

This is the product of your how thinking

from step 1!

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 Only now do you turn the product of your
how thinking into running text!

Remember introductions scene-setting

purpose shows in text (cohesion, coheren-
ce), its sentence structure (variation) and
choice of words (expressivity, hedging)!

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 Cohesion and coherence

Sentence coordination

Signal words

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Exercise: Read the below introduction and see if you can trace its first two moves

Introduction 1
Screening for breast cancer is imple- 2
mented in Denmark as a nation-wide 3
program with the purpose of reducing 4
breast cancer mortality.1 Despite an 5
ongoing controversy regarding harms 6
and benefits as well as the effective- 7
ness of the program,2-6 screening is still 8
recommended in many western coun- 9
tries. A high recruitment rate is impor- 10
tant to ensure high efficiency of a popu- 11
lation-based breast cancer screening 12
program. In this effort, health care pro- 13
fessionals and administrators often 14
have to rely on best practice and com- 15
mon sense. There is a need for syste- 16
matic knowledge in this field. In terms of 17
participation, the geographical distance 18
could be an important issue to consider 19
as this may influence the target-popula- 20
tions ability and propensity to partici- 21
pate 22
 Topic sentence
The orginal and a the revised version
Research niche
Original introduction
Screening for breast cancer is imple-
mented in Denmark as a nation-wide
program with the purpose of reducing
breast cancer mortality.1 Despite an
ongoing controversy regarding harms
and benefits as well as the effective-
ness of the program,2-6 screening is still
recommended in many western coun-
tries. A high participation rate is impor-
tant to ensure high efficiency of a popu-
lation-based breast cancer screening
program. In this effort, health care pro-
fessionals and administrators often
have to rely on best practice and com-
mon sense. There is a need for syste-
matic knowledge in this field. In terms of
participation, the geographical distance
could be an important issue to consider
as this may influence the target-popula-
tions ability and propensity to partici-
pate
Topic sentence
compared Research niche
1 Revised introduction
2 Nation-wide breast cancer screening
3 programmes are widely conducted to
4 curb mortality from breast cancer1.
5 Screening is recommended in most
6 Western countries despite controversy
7 over the harms, benefits and effective-
8 ness of such programmes. Screening
9 efficiency requires high recruitment
10 rates in population-based programmes.
11 To ensure high recruitment, health care
12 professionals and administrators often
13 rely on best practice and common
14 sense; yet, little is known about
15 recruitment components critical to
16 efficiency. One critical component of
17 recruitment is geographical distance
18 because it influences the target popu-
19 lations ability and propensity to
20 participate. Geographical distances in
21 Denmark are usually short, and
22
Simple strategy! Write 5-8 one-liners to outline thematic progression
T1: Screening to curb breast cancer
mortality R1 used in Western countries
T1 Screening is R2 recommended
but controversial
T1 Screening R3 requires
high recruitment to be efficient
T2 Recruitment is R1 not
research-based
T2 Recruitment R2 coverage
Depends on geograhy
T3: Geographical distance
R in Denmark
1 Introduction
2 Nation-wide breast cancer screening
3 programmes are widely conducted to
4 curb mortality from breast cancer1.
5 Screening is recommended in most
6 Western countries despite controversy
7 over the harms, benefits and effective-
8 ness of such programmes2-6.Screening
9 efficiency requires high recruitment
10 rates in population-based program-
11 mes. To ensure high recruitment,
12 health care professionals and admini-
13 strators often rely on best practice
14 and common sense; yet, little is known
15 about recruitment components critical
16 to efficiency. One critical component of
17 recruitment is geographical distance
18 because it influences the target popu-
19 lations ability and propensity to
20 participate. Geographical distances in
21 Denmark are usually short, and
22
1. Background (repeat Purpose)
2. Own results (main/part) 5. Conclude on study, context
3. Poss. Resume of result 6. Discuss/assess study
4. Compare/assess results 7. What follows from the study
2. Result (part
Discussion: Hopkins & Dudley-Evans result)
The single patient with biopsy-proved hepatic
4. Compare to other
involvement also had a positive spleen. This is in
research
accord with the original observation of the Stanford
group, who reported no instance of hepatic Own result sup-
involvement without concomitant splenic involvement. ports other research
The liver scan was primarily responsible for 8 of 9 5. Conclusion 1
false-positive liver evaluations. We conclude that as
with the spleen scan, the liver scan has little value in Result
the initial staging of Hodgkin's disease. Since liver Restatement
function tests are also unreliable, it is clear that open 5 Conclusion 2
biopsy is necessary in order to evaluate the liver more 5a Reservation
definitively. Even the latter technique is subject to the Conclusion 2
limitations of sampling procedures. One patient died of Result supports
an acute myocardial infarction three months after reservation (5a)
staging laparotomy with negative liver biopsy. Hepatic
involvement was found at autopsy.

Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22

 1. Background (repeat Purpose)
2. Own results (main/part)
3. Poss. Resume of result
4.4.A Introduction and discussion
4. Compare/assess results
5. Conclude on study, context
6. Discuss/assess study
7. What follows from the study

Language form suggests move/step function: Discussion

Moves:
The single patient with Languagehepatic
biopsy-proved form Verbs: Confirm
involvement also had 2: a State
positiveresults
spleen. This is in Corroborate, verify,
3: Unexpected
accord with the original observation of result
the Stanford tally with, confirm,
group, who reported4:noPrevious
instance research
of hepatic(support) agreement with
Previous research
involvement without concomitant (contradict)
splenic involvement.
Build your own
7: Explain
The liver scan was primarily results / the
responsible for unexpected
8 of 9 Verbs: Contradict
8: SuggestWe
false-positive liver evaluations. hypotheses
conclude that as is not in keeping
disciplinary-specific
with the spleen scan, the Note
liverimplications
scan has little value in with, inconsistent
Comment on findings with, in contrast to
move and phrase bank
the initial staging of Hodgkin's
11:unreliable,
function tests are also
disease.
Suggest future
Since liver
workthat open
it is clear
biopsy is necessary in order to evaluate the liver more Hedge proposition:
definitively. Even the latter technique is subject to the This suggests that..
limitations of sampling procedures. One patient died of X may be evidence
an acute myocardial infarction three months after X led to the
staging laparotomy with negative liver biopsy. Hepatic conclusion that
involvement was found at autopsy.
http://www.phrasebank.manchester.ac.uk/causes.htm

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Two steps: Effective writing for medical science
Step 2: Language matters if you want to publish!
Webster Online http://grammar.ccc.commnet.edu/grammar/
Information from Webster on grammar; linguistic and text composition exercises.

Grammar levels: Word/sentence/paragraph

Discourse levels: Research papers, essays

Drop-down
menus

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Two steps: Effective writing for medical science
Online grammars and writing tools

Webster Online: Transition between ideas - coherence

Addition
Comparison
Concession
Contrast
(howeveritis)
Emphasis
Etc.

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Two steps: Effective writing for medical science
Online grammars and writing tools
Word/sentence level: Subject-verb agreement

The pronouns neither and

Power-point tutorials either are singular and
require singular verbs.

Neither of the two patients is

seriously ill
 Two steps: Effective writing for medical science
Specialized language text banks (corpora)

Springer Exemplar
http://www.springerexemplar.com/

Why use this site?

Quality data bank
Real-life language
Check usage
Find collocations
Link to articles

Verb + noun: to confirm / propose / reach seronegativity

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Two steps: Effective writing for medical science
Language system differences
DK adverb UK adjective

Danglish English

The patient admitted to smoking a The patient admitted to smoking an

cigarette occasionally
Agitation was interrupted occasionally
to allow admixture of fresh medium
Twenty more subjects were admitted to
the trial
occasional cigarette
Occasional interruptions of agitation
allowed addition of fresh medium
Another twenty subjects were admitted
to the trial

Study differences at level of word classes, syntax, grammar:

What are the differences between English and your mother tongue

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Two steps: Effective writing for medical science
Language system differences
DK adverb UK verb
Danglish
This hypothesis may be unverifiable
The shortage of penicillin still gives
cause for concern
The equipment has now been
upgraded so as to include incinerators
Nonlinear equations are unsolvable
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English
This hypothesis resists verification
The shortage of penicillin continues to
cause concern
The equipment has now been
upgraded to include incinerators
Nonlinear equations defy solution
Two steps: Effective writing for medical science
Language system differences
DK preposition UK ing (participle) form
Danglish
The rules for this procedure are
explained in the manufacturer's
instructions
The surgical principle for
abdominorectal incision is ...
An incision was made towards the
anterior aspect
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English
The rules governing this procedure are
explained in the manufacturer's
instructions
The surgical principle underlying
abdominorectal incision is ...
The incision was made facing the
anterior aspect
Two steps: Effective writing for medical science
Language system differences
Develop general rules: Reduce number of prepositions
Danglish English

Prepositional postmodification Adjectival premodification

Individuals without skills Unskilled individuals
Individuals on early retirement Early retirees

Participial construction
The rules for this procedure The rules governing this procedure
An incision was made towards X An incision was made facing X

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Two steps: Effective writing for medical science
Know what you dont know!
Free advice:
Likelihood modal verbs Know your tool box!
Spend 30 min every day

Unknowingly Knowingly
incompetent incompetent
Example: Which ones?
Modal verbs may Can
tell what you May
expect Might

Any difference?
Known knowledge! Might
Unknowingly May + Knowingly
competent Can ~ competent

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Two steps: Effective writing for medical science
Buy and use this book!

331 may and might: possibility

Might is not used as a past form of
may: both may and might are used to
talk about the present or future. Might
is mostly used as a less definite or
more hesitant form of may, suggesting
a smaller chance it is used when
people think something is possible, but
not very likely

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Move stuctures
Two steps: in YOUR
research
Effective culture
papers
writing and- medicine
for YOUR fieldscience
medical
Read, observe & practice

Trace macro- and Note words and

micro structure sentence structure

Make your
own
move &
step recipe

Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22

 Abstract mangler klar trkstruktur (fx
Baggrund,
Baggrundstrk Materiale/metoder, Resultater,
er for lrebogsagtigt.
Konklusion)
Forskning br placeret i aktualiseret ramme
Der sttes bindestreg mellem to adjektiver
medDer eksplicitering
stteshvis af dens
komma relevans
mellem og
helstninger,
or CALL for help! (tillgsord),
betydning i en eller
deres
to
indbyrdes
stninger
relation
erdertt er
ogforbundet
Formlet detbr med
enesignaleres
er konjunktion
afledt eksplicit
af (bindeord
et verbumvha.
fxformuleringen
"and"), med
(udsagnsord) mindre
The aim stningerne er korte
..is.. Jeg synes,
("-ed"/-ent/-ing") du
(mindre
br have end
en5stning
ord) om, hvor meget svin
og menneske ligner hinanden mske med
Focus: tilfjelsen til stningen: We used porcine
HpHb because it exhibits a 82% sequence
- Structure identity with its human counterpart
- Clarity & correctness Denne stning rummer, som jeg ser det,
resultater,
I engelskhvilket
br man bri videst
markeres eksplicit
muligt omfang
- Source language med ord, der viser trkkets function: The
have parallelkonstruktioner,
"-ing"-/"-ed"-former i hvilket vil
bistninger sige
eller biled
interference main results
atskal were
elementernes that two
rkkeflge Hp molecules
og(grundleddet)
form br
kunne finde sit subjektet
dimerize..
vre
ellerden samme
objekt i de led, der
(genstandsled) i str parallelt
Form: hovedstningen
her str dimerize -parallelt
indst med form
"which" som
erstatning for manglende henfrende led
- Track changes
- Notes
- explaining errors
- suggesting change
Two steps: Effective writing for medical science

Design-specific guidelines Appropriate text structure

Journal-specific instructions
Disciplinary move conventions
+ Purposeful language usage
Proper English language

= Publication success !

Comments/questions?
mpi@termshare.dk
+45 2617 4622
Translation, language revision & copyediting,
gostwriting services on demand
Morten Pilegaard mpi@termshare.dk - (+45) 26 17 46 22