Pulling it Together: Writing Your CI

1. Clinical Inquiries Pulling it Together: Writing Your CI

2. Sections of a CI • 1. Question • Ours or yours, but must be approved • 2. Evidence-Based Answer (50-100 words) • Bottom line conclusion based on best available evidence • Most people only read this and the table • With rare exception, each sentence should be followed by a Strength of Recommendation (SOR) of A, B, or C, followed by the reason for the designation (Ex: SOR = A, based on a well done meta-analysis; or SOR = C, based on pathophysiologic reasoning, case series and clinical opinion).

3. Sections of a CI • 3. Evidence Summary • This section should explain the evidence-based answer, and support the answer with available and pertinent evidence. • Present patient-oriented outcome data such as pain, functional status, quality of life, or morbidity and mortality. • The evidence summary should contain 3 to 5 paragraphs. In general, each paragraph in the summary should relate to one of the sentences in the answer. Each paragraph should describe in detail 1 or 2 of the studies (evidence sources) used. Typically authors can describe each study in a few sentences. • If you are over the word count, consider presenting the data in a table. This can leave more room to describe the actual studies.

4. Sections of a CI • 4. Recommendations from Others (75-125 words) • One to three recommendations that are important for clinicians to know • Official guidelines from Dept. of Health and Human Services, medical societies, and recognized advocacy groups preferred • 5. Authors and Coauthors • You did it, take credit • Name, degree, institutional affiliation, city and state

5. Sections of a CI • 6. References • Maximum of 10 • Level of Evidence notation after each in parentheses • Format according to AMA style • 7. Table • Cite sources and get permission if not original • Make sure table referred to in correct place in text • Avoid duplicating material in the text and table • 8. Word Count • Goal of 750 including references

6. Writing the Evidence-Based Answer • The Evidence-Based Answer (EBA) is: • A brief summary (the “bottom line” answer) • Akin to an abstract • 3 to 5 sentences (summary statements); between 50 and 100 words • Each summary statement is followed by a strength of recommendation (SOR A, B, or C) • Each SOR is followed by the basis for the recommendation (e.g. SOR A, based on a meta-analysis) • 90% of readers only read EBA and table

7. Writing the Evidence Summary • The Evidence Summary (ES) explains the Evidence-Based answer and supports it with available evidence • Ideally the ES contains a paragraph for each sentence (summary statement) in the EBA • Background or introductory information should be limited to 1 to 3 sentences • For each article summarized, the ES should include the study type (e.g. meta-analysis, RCT, etc.) and a brief description of the methods (number of patients, age range, gender, etc.)

8. Writing the Evidence Summary • The ES should include outcomes data, especially patient-oriented data such as pain, functional status, quality of life, morbidity and mortality. • Ideally outcomes should be accompanied by clinically useful statistics such as Likelihood Ratios, Odds Ratios, or Numbers Needed to Treat • Outcome measures should include effect sizes with 95% confidence intervals • P values by themselves are rarely informative for clinical decision making at the point of care

10. Recommendations from Others • Give recommendations (in order of preference) from guidelines, consensus statements or textbooks. Examples: • Centers for Disease Control and Prevention Advisory Committee on Immunization Practices • Joint National Committee • American Academy of Family Physicians • American Heart Association • Harrison’s Principles of Internal Medicine • Think of the most authoritative source, what do they recommend?

11. Authors • Remember to list authors and coauthors • Name, Degrees • Institutional affiliations • City and State • In addition, at the very beginning of the CI list authors, degrees, and email addresses • Example: • Katie Smith, MD Email: smithk@aol.com

12. Permissions • Clinical Inquiry contributors should obtain permission from authors and publishers for the use of quotes, tables, and other materials taken from previously published works not in the public domain. • Electronic or paper letters of permission should accompany the manuscript as separate attachments • Please mention the original source in the figure legend or table footnote.

13. References: Limit of 10 • Number references consecutively in the order in which they are cited, not alphabetically. Identify references in text, tables, and legends by Arabic numerals, using a superscript. Don’t use embedded footnotes • Avoid references in the Evidence-Based Answer section-the citations can be put in the Evidence Summary section • Look at published CIs, and examine references • Download authors instructions and citation format on FPIN website for detailed information on writing references. • Be sure to show the references to your librarian-co author. He or she is available to help with formatting.

14. Tables Make sure tables are easy to read, self explanatory, and organized

15. Formatting • Times New Roman, 12 pt. double-spaced • Bold Headings (Question, Evidence-Based Answer, Evidence Summary, Recommendations from Others, Authors, References, Table and Word Count) • Total Word Count: 750 max, including references • Complete the Final Review Tool to avoid common errors made by authors

16. Questions? Contact the CI Project Manager CI@fpin.org (573) 256-2066