March 13, 2008 UBC Family Practice

1. Abstract writing clinic"I didn't have time to write a short letter, so I wrote a long one instead." - Mark Twain March 13, 2008 UBC Family Practice Janusz Kaczorowski, Colleen Kirkham, Ian Martin, Marisa Collins

2. Overview • Abstracts: An overview (30 min) • CFP & 2008 conferences (10 min) • Break (10 min) • Hands-on abstract clinic (60 min) • Large-group presentations (40 min)

3. What is an abstract • A mini paper • One paragraph • Describes what you are going to discuss, present or write about • Gives reader an overview of your project • Source of new ideas • Gets reader interested (to attend your presentation at a conference or read your paper)

4. Why abstracts are important? • Abstract is the most important part of an article because it is the only part of an article that many people read (apart from your TITLE) • Abstract is also important because it is the only part of an article that many journals will make freely accessible through search engines (PubMed)

5. Why structured abstract? • To force authors to provide basic information that readers need • To impose structure to help readers evaluate whether an article is methodologically sound and applicable to their needs • To improve the retrieval of literature in electronic searches

6. Elements of structured abstract • Depending on the discipline, journal or conference, anywhere from 4 to 10 elements • Word limit (50 to 400 words) • Objective, Methods, Results, Conclusion • Background, Objective, Design, Setting, Patients, Intervention,Measurements and Main Results, Limitations, and Conclusion • Key words • Good title

7. Title • One of the most-read parts of a paper/article • Ideally 10–12 words long • Include the scope of the investigation, the study design and the goal • A description of what was investigated -- not the results or conclusions • Easy to understand • Avoid jargon or unfamiliar acronyms or abbreviations

8. Examples of good titles (BMJ, CMAJ, JAMA) • Birth order of twins and risk of perinatal death related to delivery in England, Northern Ireland, and Wales, 1994-2003: retrospective cohort study • Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis • Anticoagulation for three versus six months in patients with deep vein thrombosis or pulmonary embolism, or both: randomised trial

9. More good titles • Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The A TO Z Weight Loss Study: A Randomized Trial • Alcohol consumption and the use of antidepressants • Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection • Susceptibility to Measles, Mumps, and Rubella in Newly Arrived Adult Immigrants and Refugees

10. Authors • The list of authors should be restricted to those individuals who actually carried out the study, conceived it, designed it, gathered and/or analyzed the data, and wrote the abstract • The author who will present the abstract should be listed first • Every listed author should read and approve the abstract before it is submitted • Make sure that you put it in your CV!

11. Abstract: 5 key questions • Why did you start? • What did you try to do? • What did you do? • What did you find? • What does it mean?

12. Why did you start (introduction / background / context) • BACKGROUND: Summarize, in one sentence, the current state of knowledge in relation to the work you are presenting: • BACKGROUND: The Canadian and American Diabetes Associations recommend the use of an oral glucose tolerance test to screen for abnormal glucose tolerance among women with polycystic ovary syndrome when their fasting plasma glucose level is 5.7 mmol/L or more (Canadian guideline) and 5.6 mmol/L or more (American). • BACKGROUND: Exenatide therapy is effective in combination with metformin or sulfonylureas for treating type 2 diabetes. Thiazolidinediones (TZDs) also are commonly used, but the efficacy of exenatide with a TZD has not been reported. • BACKGROUND: The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women.

13. What did you try to do (aims / objectives) • OBJECTIVE: State the aim of your study or question (including hypothesis) • OBJECTIVE: To compare the effects of exenatide versus placebo on glycemic control • OBJECTIVE: To develop a typology of after-hours care (AHC) instructions and to examine physician and practice characteristics associated with each type of instruction. • OBJECTIVE: To evaluate the effectiveness of a parenting programme as a preventive intervention with parents of preschool children considered to be at risk of developing conduct disorder.

14. What did you do (Methods I) • DESIGN: Describe the basic design of your study. Use descriptors such as double blind, placebo controlled RCT, cohort, case control, survey, case series, cost-effectiveness analysis, focus groups or key inormant interview • DESIGN: Pragmatic randomised controlled trial using a block design with allocation by area. • DESIGN: Cross-sectional telephone survey. • DESIGN: Non-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services and health professionals providing antenatal care.

15. What did you do (Methods II) • SETTING: Describe setting of your study (academic or community family practice, hospital, ED) • SETTING: Women's homes; antenatal and ultrasound clinics in 13 maternity units in Wales. • SETTING: 49 sites in Canada, Spain, and the United States. • SETTING: Six family-practice health centres in Kuwait.

16. What did you do (Methods III) • PARTICIPANTS: State key eligibility criteria and key sociodemographic characteristics of participants. Provide numbers of participants and how they were selected. • PARTICPANTS:233 (exenatide group, n = 121; placebo group, n = 112) patients with type 2 diabetes that was suboptimally controlled with TZD treatment (with or without metformin). Mean (±SE) baseline glycated hemoglobin A1c level was 7.9% ± 0.1%. • PARTICIPANTS: Stratified random sample of family physicians providing office-based primary care. • PARTICPANTS: Childbearing women and health professionals who provide antenatal care.

17. What did you do (Methods IV) • INTERVENTION/INSTRUMENT: Describe key features of your intervention, if applicable. • INTERVENTION: Provision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use. • INTERVENTION: Subcutaneous abdominal injections of 10 µg of exenatide or placebo twice daily, added to a TZD (with or without metformin) for 16 weeks. • INTERVENTION: Behavioral group counseling and 8 weeks of therapy with nicotine nasal spray or transdermal nicotine.

18. What did you do (Methods V) • MAIN OUTCOME MEASURES (if applicable): Describe primary outcome measures • MAIN OUTCOME MEASURES: The primary outcome was change from baseline in hemoglobin A1c level. Other outcomes were fasting serum glucose level, body weight, self-monitored blood glucose level, and any adverse events. • MAIN OUTCOME MEASURES: Participants' views and commonly observed responses during consultations and interviews. • MAIN OUTCOME MEASURES: Form of response (eg, answering machine), content of message, and physician and practice characteristics.

19. What did you find (Results) • RESULTS: Give main results of your study. If research is in progress, state anticipated results.

20. Results (RCT) • RESULTS: Exenatide treatment reduced hemoglobin A1c level (mean difference, –0.98% [95% CI, –1.21% to –0.74%]), serum fasting glucose level (mean difference, –1.69 mmol/L [–30.5 mg/dL] [CI, –2.22 to –1.17 mmol/L {–40.0 to –21.1 mg/dL}]), and body weight (mean difference, –1.51 kg [CI, –2.15 to –0.88 kg]). Sixteen percent of patients in the exenatide group and 2% of patients in the placebo group discontinued treatment because of adverse events. In the exenatide group, 40% (n = 48) of patients experienced nausea (mostly mild [n = 21] or moderate [n = 19]), 13% experienced vomiting, and 11% experienced hypoglycemia. In the placebo group, 15% of patients experienced nausea, 1% experienced vomiting, and 7% experienced hypoglycemia.

21. RESULTS (Survey) • RESULTS: Of 514 after-hours messages from family physicians’ offices, 421 were obtained from answering machines, 58 were obtained from answering services, 23 had no answer, 2 gave pager numbers, and 10 had other responses. Message content ranged from no AHC instructions to detailed advice; 54% of messages provided a single instruction, and the rest provided a combination of instructions. Content analysis identified 815 discrete instructions or types of response that were classified into 7 categories: 302 instructed patients to go to an emergency department; 122 provided direct contact with a physician; 115 told patients to go to a clinic; 94 left no directions; 76 suggested calling a housecall service; 45 suggested calling Telehealth; and 61 suggested other things. About 22% of messages only advised attending an emergency department, and 18% gave no advice at all. Physicians who were female, had Canadian certification in family medicine, held hospital privileges, or had attended a Canadian medical school were more likely to be directly available to their patients.

22. RESULTS (Qualitative) • RESULTS: Health professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use. Time pressures limited discussion, and choice was often not available in practice. A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of "right" and "wrong" choices rather than "informed" choices. Hierarchical power structures resulted in obstetricians defining the norms of clinical practice and hence which choices were possible. Women's trust in health professionals ensured their compliance with professionally defined choices, and only rarely were they observed asking questions or making alternative requests. Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy. The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced.

23. RESULTS (anticipated) • RESULTS: It is anticipated that the post MI group will suffer significantly more guilt than the risk factor group as a result of life style choices, age, and sex. • RESULTS: The findings from this study will identify the behavioral, social and cultural factors that facilitate or hinder the cancer-screening behavior among Japanese adults, and lead to the development of a new culturally appropriate model that could be utilized to facilitate cancer screening among the Japanese people.

24. What does it mean (Conclusions) • CONCLUSIONS: Report only those conclusions that are directly supported by your results, along with any implications for clinical practice. • CONCLUSIONS: Exenatide therapy improved glycemic control, reduced body weight, and caused gastrointestinal symptoms more than placebo in patients with type 2 diabetes that was suboptimally controlled with TZD therapy. • CONCLUSIONS: The way in which the leaflets were disseminated affected promotion of informed choice in maternity care. The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice.

25. Same general advice • Follow the instructions! (you want to be rejected on content and not on technicality) • Use simple sentences • Stay away from abbreviations, acronyms and jargon • Have someone read your abstract

26. Characteristics of a good abstract • Accurate • Self-contained • Concise and specific • Coherent and readable • Write with a non specialist in mind • Different points should be emphasized proportionally with that of the main body of the paper/study

27. CFP guidelines (abstracts) • Quantitative research • Abstracts should be structured: • Objective, Design, Setting, Participants, Interventions, Main outcome measures, Results, and Conclusion and should not exceed 300 words. Up to four key words (MeSH headings) should be included

28. CFP guidelines (abstracts) • Qualitative studies • Abstract should include the headings Objective, Design, Setting, Participants, Method, Main findings, and Conclusion and should not exceed 300 words. Up to four key words (MeSH headings) should be included

29. CFP guidelines (abstracts) • Systematic reviews • Abstracts should be structured under the headings Objective, Data sources, Study selection, Synthesis, and Conclusion and should not exceed 300 words. Up to four keywords (MeSH headings) should be included

30. Family medicine conferences • NAPCRG - North American Primary Research Group • Annual Conference (Oct/Nov: USA/Canada) • 600-800 attendees (most of whom are also presenters) • NAPCRG 2008: Puerto Rico, Nov 15-19

31. NAPCRG 2008 • Great opportunity to attend & present at THE family medicine research conference • Membership + registration • Family physicians = $725 • Residents = $255

32. Abstract instructions (NAPCRG) • Context: The abstract should begin with a sentence or two summarizing the rationale for the study, providing the clinical (or other) reason for the study question. In addition, the author should give a sentence or two about the importance of this work to family medicine/primary care. • Objective: State the objective or study question addressed (eg, to determine whether...). If more than one objective is addressed, the main objective should be indicated and only key secondary objectives stated. • Design: Describe the basic design of the study. Use descriptors such as double blind, placebo controlled RCT, cohort, case control, survey, case series, cost-effectiveness analysis, or qualitative study. For new analyses of existing data sets (secondary data analysis), the data set should be named and the basic study design disclosed. • Setting: Describe the study setting(s) such as general community, a primary care or referral center, private or institutional practice, or ambulatory or hospitalized care. • Patients or Other Participants: State the important eligibility (inclusion and exclusion) criteria and key sociodemographic features of patients. Provide numbers of participants and how they were selected. • Intervention/Instrument (as pertinent): Describe the essential features of any interventions. The intervention should be named by its most common clinical name (eg, the nonproprietary drug name propranolol). • Main and Secondary Outcome Measures (if any): Give the primary study outcome measurements. Measurements that require explanation for a general medical readership should be defined. • Results: Give the main results of the study. The results should be quantified, including confidence intervals (eg, 95%) or P values where appropriate. If research is in progress, state anticipated results. • Conclusions: Report only those conclusions of the study that are directly supported by the evidence, along with any implications for clinical practice. Avoid speculation and overgeneralization. Equal emphasis should be given to positive and negative findings of equal scientific merit. If research is in progress, state methodological or conceptual problem that is being posed. • Word count: Maximum 300

33. Family Medicine Forum 2008 • Toronto, Nov 27-29 2008 • Research day: Nov 26 • Deadline for research posters and papers: April 2, 2008

34. FMF 2008 • When writing your abstract, it is suggested that you follow the format described in ‘guidelines for articles’ at the Canadian Family Physician journal Webpage at http://www.cfpc.ca/cfp/authors/guidelines.asp • The word count is 175 for all abstracts (except qualitative, quantitative and survey research abstracts, for which the word count is 300)

35. Hands-on clinic • Form 4 groups of 3-4 individuals • Each group will be assigned 3-4 abstracts • Work as a group ~10-15 minutes on each abstract • Present revised abstracts to the larger group • Share your written comments/edits with the author(s) • Poster preparation workshop (Fall 2008)?