How to perform an efficient literature review

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1 How To Write An Abstract And Perform An Efficient i Literature Review Langhorne Waterhouse, MLIS Mukta Panda, MD, FACP University of Tennessee College of Medicine Chattanooga Goals How to write an abstract: For a case report For a scientific research paper How to perform an efficient literature review

2 Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead ~ Gene Fowler Case Reports What is a case report? Why write a case report? When to write case report?

3 Where do case reports fit in an evidence-based world? Case reports are a necessary complement to the aims of evidencebased medicine The First Line of Evidence - Recognize the unexpected - Report a rare event How do you know it is novel?? Professor Archibald Leman Cochrane, ( )

4 How do you know it is novel?? How to perform a literature search PubMed use Limits (reviews) clinical queries The Cochrane Library National Guideline Clearinghouse (AHRQ) How do you know it is novel?? How to perform a literature search PubMed use Limits (reviews) clinical queries The Cochrane Library National Guideline Clearinghouse (AHRQ)

5 Objectives of an Abstract To provide a document which contains sufficient information to enable readers to: Assess the observations you made Repeat the experiment if they wish Determine whether the conclusions drawn are justified by the data Present a single message very clearly Emphasize why the message is important Underscore what the message teaches Does it affirm or contradict ct a previously cherished ed truth? if so, explain how Stress the unexpected association, if present Most Important!! Diagnose your Audience!!

6 Title Four Basic Parts of an Abstract Follow the IMRAD format: -Introduction (What is question/ message) -Methods -Results -And -Discussion (How was it studied / identified) (What was found / concluded) (What do the findings mean) The Title The simpler, the better Be brief short titles are clearer and more arresting Concise summary of abstract Demonstrate that the work is important, relevant and innovative Consider the target readership Avoid excessive adjectives and noun strings Do not be a sensationalist

7 Short, Descriptive, Eye- Catching An epidemiological geographically based study of the quantity of ionizing radiation received by male employees of a nuclear reprocessing plant and nearby male residents working elsewhere in the same vicinity shows an increased risk of childhood leukemia in the children of the nuclear workers only. OR An epidemiological study of radiation received by male employees of a nuclear plant and other residents in the vicinity and its relation to the incidence of childhood leukemia. Be Brief, Be Interesting! Radiation to residents near a nuclear reprocessing plant and its relation to childhood leukemia: an epidemiological study. OR Nuclear reprocessing, radiation exposure, and childhood leukemia: an epidemiological study.

8 Be striking! Ventricular fibrillation, a cardiac arrhythmia caused by ingestion of poke weed salad in a patient with no underlying cardiac history. Poke weed salad associated cardiac arrhythmias. Not all salads are good for the heart. Introduction Before beginning, answer the following questions (Be brief!) 1. What do I have to say? 2. Is it worth saying? 3. What is the right format for this message? 4. What is the audience for this message? 5. What is the journal for this message?

9 Introduction State clearly the question you tried to answer Do not put a review of the literature in the introduction Tell the readers why you have undertaken the study Clarify what your work adds Introduction, cont d Several studies have shown that regular Ecstasy use creates anesthetic difficulties, and several others have shown that it does not. We report 2 further patients, one of whom experienced problems and one of whom did not, and review the literature. Many studies have addressed the problem of Ecstasy and anesthesia.

10 Introduction, cont d Two previous studies have reported that t regular Ecstasy use may give rise to respiratory problems during anesthesia. These studies were small and uncontrolled, used only crude measurements of respiratory function, and did not follow up the patients. We report a larger, controlled study, with detailed measurements of respiratory function and two year follow up. Four Basic Parts of an Abstract Introduction (What question/ message) Methods (How was it studied / identified) Results (What was found / concluded) Discussion i (What do the findings mean)

11 Methods How was the study designed: Keep the description brief Say how randomization was done How was the study carried out: How subjects were recruited and reasons for exclusion Consider mentioning ethical features Give accurate details of materials used Give exact drug dosages, form of treatment or unusual apparatus How were the data analyzed: Give the exact tests used for statistical analysis (chosen a priori) Four Basic Parts of an Abstract Introduction (What question/ message) Methods (How was it studied/identified) Results (What was found/concluded) Discussion (What do the findings mean)

12 Results Provides the answers to the questions you pose in the introduction Tell the story of how you arrived at the answers Develop the story in a number of ways, add tables and illustrations when necessary State and explain the unexpected results Statistical presentation-so much information so little space, present enough for the intelligent reader to believe what you are saying Four Basic Parts of an Abstract Introduction (What question/ message) Methods (How was it studied/identified) Results (What was found/concluded) Discussion i (What do the findings mean)

13 Discussion State the main findings Highlight any shortcomings of the methods Compare the results with other published findings Discuss the implications of the findings Authorship All authors should have made substantial contributions to all three of the following: 1. The concept and design of experiment or analysis 2. Drafting of article or revising it critically 3. Final approval of the version to be published

14 Submission Diagnose your audience!!!! PHYSICIAN ATTITUDES AND BELIEFS REGARDING PATIENTS WITH CHRONIC PAIN: M Panda 1, M Menon 2 for the 4P Group (Patient-Physician Perception of Pain) 1 University of TN- Chattanooga, University of Pittsburg Objective Worldwide, chronic pain is the most frequent cause of suffering and disability. Despite great interest in the study of pain, chronic pain is under treated by clinicians. The objective of our study is to assess physician attitudes and beliefs towards patients with chronic pain. Methods The 4P study is a multi-center, structured survey of patient and physician attitudes and preferences regarding their perceptions of patients pain. A patient- physician perception of pain survey was developed and administered to 325 physicians at nine university centers in the United States. The survey contained questions on communication, comfort, and satisfaction. Demographic data were also obtained. Besides the compilation of descriptive data, we also performed bivariate analyses looking for associations with more positive physician attitudes. Regression analysis was then performed to control for possible confounders. Results We report preliminary data based on the first 325 surveys returned. Eightysix percent of respondents were general internists, 7% family practitioners, and 7% medical or surgical subspecialists. Participants ages ranged from 24 to 74 yrs (mean 35 yrs), 58% were male and 18% reported a history of suffering from chronic pain. Seventy four percent of physicians agreed that caring for chronic pain patients was frustrating, 92% felt that chronic pain patients took more time than their other patients and only 34% agreed that they were comfortable caring for chronic pain patients. Physician comfort level was associated with the belief that patients with chronic pain usually get better (62%) and want frequent appointments, while a history of suffering from chronic pain was not. In multivariate analysis the association of the belief that patients with chronic pain want to get better remained significant after adjustment for demographic variables and other beliefs (p=0.000). Conclusion Though primary care physicians believe that their patients with chronic pain want to get better, they harbor negative attitudes that could adversely affect their care of chronic pain patients. Interventions that improve these attitudes such as educational programs, discussion groups and academic detailing should be considered.

15 A CASE OF RECURRENT ACUTE URINARY TRACT INFECTION (UTI) AND PROSTATITIS THE VALUE OF A DETAILED HISTORY J. SHAH 1 ; M. PANDA 2. 1 University of Tennessee, Chattanooga, Chattanooga, TN; 2 University of Tennessee at Chattanooga, Chattanooga, TN. (Tracking ID # ) LEARNING OBJECTIVES: Recognize the differential diagnosis and workup of recurrent UTI in males and the importance of a detailed sexual history CASE: A23-year-old male with a one-day history of dysuria, fever, chills and flank pain. He had acute prostatitis 16 months prior. Cystoscopy then revealed an inflamed prostatic urethra. Exam revealed a febrile tachycardic male; abdomen was soft, no costovertebral angle or suprapubic tenderness. Rectal exam: enlarged, tender, boggy prostate. WBC-16.6 TH, normal BUN/Cr. Urine analysis: ph 5.5, large albuninuria, leukocyte esterase, blood, WBC s, gram-negative rods. Culture: pseudomonas aeruginosa. Kidney ultrasound: normal. Patient was treated with IV antibiotics. He was afebrile in 48 hours and was placed on 6 weeks oral antibiotics. Due to recurrent urinary tract infection, after repeated direct inquiry, the patient admitted to using different types and sizes of objects as anal toys. DISCUSSION: Prostatitis, i a lower urinary tract infection i occurs by retrograde entry of organisms into the prostatic ducts via urethra from oral, anal, genital intercourse or masturbating practices, by hematogenous spread from other foci, or lymphatic extension from infected kidneys. Diagnosis is made from history, tender prostate on exam with pyuria, positive urine culture and leukocytosis. Common organisms are E. coli, proteus, enterococci, staphlylococcus aureus and epidermidis. Antibiotic treatment should be given for 4-6 weeks to assure eradication. In our patient, repeated trauma by use of anal toys increased his risk for urinary tract infection. This case helps to remind physicians of the value of detailed sexual history even though it can be embarrassing. PHYSICIAN ATTITUDES AND BELIEFS REGARDING PATIENTS WITH CHRONIC PAIN: M Panda 1, M Menon 2 for the 4P Group (Patient-Physician Perception of Pain) 1 University of TN- Chattanooga, University of Pittsburg Objective Worldwide, chronic pain is the most frequent cause of suffering and disability. Methods The 4P study is a multi-center, structured survey of patient and physician attitudes and preferences regarding their perceptions of patients pain. A patientphysician perception of pain survey was developed and administered to 325 physicians at nine university centers in the United States. The survey contained questions on communication, comfort, and satisfaction. Results We report preliminary data based on the first 325 surveys returned. Eightysix percent of respondents were general internists, 7% family practitioners, and 7% medical or surgical subspecialists. Participants ages ranged from 24 to 74 yrs (mean 35 yrs), 58% were male and 18% reported a history of suffering from chronic pain. Conclusion Though primary care physicians believe that their patients with chronic pain want to get better, they harbor negative attitudes that could adversely affect their care of chronic pain patients. Interventions that improve these attitudes such as educational programs, discussion groups and academic detailing should be considered.

16 PHYSICIAN ATTITUDES AND BELIEFS REGARDING PATIENTS WITH CHRONIC PAIN: M Panda 1, M Menon 2 for the 4P Group (Patient-Physician Perception of Pain) 1 University of TN- Chattanooga, University of Pittsburg Objective Worldwide, chronic pain is the most frequent cause of suffering and disability. Methods The 4P study is a multi-center, structured survey of patient and physician attitudes and preferences regarding their perceptions of patients pain. A patient-physician perception of pain survey was developed and administered to 325 physicians at nine university centers in the United States. The survey contained questions on communication, comfort, and satisfaction. Results To follow Conclusion To follow References RB Hayes, MD, PhD; CD Mulrow; More Informative Abstracts Revisited GM Hall MD; How to write a paper JR Hoffman, MA, MD; Rethinking Case,, ; g Reports

17 Summary Care for your Readers, your Editors, and Yourself! Remember the following points: Provide short interesting titles Painstakingly construct concise readable, and informative abstracts Share the credit but ensure that all co- authors contributed Conclusion Making the simple complicated is commonplace; making the complicated simple, awesomely simple, that s CREATIVITY! Charles Mingus