9. PECULIARITIES OF MEDICAL WRITING.

Writing an article review

 

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Medical writing is the activity of producing scientific documentation by a specialized writer. The medical writer typically is not one of the scientists or doctors who performed the research.

A medical writer, working with doctors, scientists, and other subject matter experts, creates documents that effectively and clearly describe research results, product use, and other medical information. The medical writer also makes sure the documents comply with regulatory, journal, or other guidelines in terms of content, format and structure.

Medical writing as a function became established in the pharmaceutical world because the industry recognized it requires special skill to produce well-structured documents that present information clearly and concisely. A growing number of new drugs go through the increasingly complex process of clinical trials and regulatory procedures that lead to market approval. This drives a demand for well written, standards-compliant documents that science professionals can read and understand easily and quickly.

Types of medical writing

Medical writing for the pharmaceutical industry can be classified as either regulatory medical writing or educational medical writing.

Regulatory medical writing means creating the documentation that regulatory agencies require in the approval process for drugs, devices, and biologics. Regulatory documents can be huge and are formulaic. They include clinical study protocols, clinical study reports, patient informed consent forms, investigator brochures, and summary documents (e.g. in Common Technical Document [CTD] format) that summarize and discuss the data a company gathers in the course of developing a medical product.

Educational medical writing means writing documents about drugs, devices and biologics for general audiences, and for specific audiences such as health care professionals. These include sales literature for newly launched drugs, data presentations for medical conferences, medical journal articles for nurses, physicians, and pharmacists, and programs and enduring materials for continuing education (CE) or continuing medical education (CME).

Regardless of the type of medical writing, companies either assign it to an in-house writer, or "outsource" it to an external medical writer or medical writing service.

Medical writing organizations

Several professional organizations represent medical writers around the world. These include:

These organizations provide a forum where medical writers meet and share knowledge and experience. They promote professional development and standards of documentation excellence, and help writers find career opportunities. All these organizations offer fundamental medical writing training.

Finally, though not a medical writing organization, the Drug Information Association (DIA) provides many resources, including training and career opportunities (via their job board) for medical writers. Also, the University of the Sciences in Philadelphia offers a master's degree in biomedical writing; the program offers courses online.

 

INTRODUCTION
Primary purpose of any publication is to advance knowledge to communicate the results of the authors work to their colleagues and contemporaries. Sometime scientific personnel are under pressure to publish papers before getting job or grants renewed. Added to this, lack of training in scientific methods and sentiments of English style makes presentation of majority of write up not up to the mark in spite of good material. Purpose of this write up is to give a guideline to the inexperienced authors and to have information at hand for others while writing a paper. Attempts have been made to highlight the important aspects of scientific paper writing which may serve some purpose particularly with the beginners. Even senior people some time are not careful in presenting data in its right perspective.

How to present your article

Before submitting an article to a journal an author should ask himself the following questions: Have I made any point(s) clear and understandable for the audience? Is it entertaining (or at least readable) as well as instructive? At last, but not the least, am I saving my time at editorial expense, but not attending to the details of presentation? If the answers to all these questions are favourable, the hopeful author may not be an Oslar or a Churchill, but his paper will be published!

The first step

For most doctors writing a paper is a fairly important step in their professional lives. It should therefore, be treated like other important steps. At the initial stage to many writing a scientific paper is a tedious duty and a dull job to perform. However, when the subject of an article is important it is not much to do with its dullness. If a man has something to say which interests him, and he knows how to set it, then he need never be dull. [2]

The search for information

The first question anybody outside the project will ask "what has been done before"? Good sources of information are leading articles in journals, review articles of the kind published in reputed journals. Current contents is a valuable source, quarterly journal of medicine is another source. One has to consult the index medicus of the last four to five years to fill in the gaps. The list of review articles published in the index every month may be short cut to getting references on a subject, while books such as year book and progress in series and medical annual may be used to have a final check that no important original work on the subject has been missed. Currently, a series of review journals are published giving upto date information of the subject which may be a short cut in the review of literatures e.g. current opinion published on various subjects. Next, one can approach the librarian with material already collected for further help; which has become a simple job with internet system available in many libraries.

Types of medical writings

Publications consist of many types, each type has got its own design.

Original articles : Authors who write original articles really do not have a varied readership in mind. On the contrary, they use concepts, language, symbolism and methodological descriptions that will attract and impress the co-experts. Acceptability of the article for publication will be judged first by reviewers who are specialists and then by similarly qualified and hypercritical readers. Though clinical research is more glamorous and may appeal to the practical doctor, it is much less certain to yield suitable material than rat work. A carefully designed laboratory study should be guaranteed to produce original results for an MD thesis and a good piece of research could easily provide material for a PhD thesis. This may provide several papers published in conference proceedings and two or three original articles of reputed journals. [3]

Clinical research

Too many clinicians in different institutions spend years recording everything imaginable; for example, height, weight, age, sex, blood pressure, urine analysis, retinal appearances, ECG and chest X-ray from patients taking one or two established drugs. The findings of such a study are predictable, in most cases such work has been done before even if they differ from all earlier works, then very good reasons will be needed to convince the editor and his answers that the results are reliable. One should keep in mind that usually only positive findings are of interest.

Investigations should be kept as simple as possible, but studies of biochemical value in groups of patients must be properly constructed, so that the results are scientifically reliable. This usually means that the correct control group must be studied and a statisticians advice is valuable here, and that the right ethical decisions are taken before one starts the work. Occasionally, original work of scientific interest is turned down by a good journal on the grounds that the study was unethical.

Drug trial

If preliminary screening of a drug is published there is a grave temptation to clinical trial. Poor trials are easy, good ones are time consuming and difficult to arrange. If the pilot study suggests that the trial is likely to give positive results, then speed is important as trial may be done in several centres at the same time. The first two or three papers on the subject will find much readier acceptance. A perfectly designed and scrupulously performed double blind cross over study is of negligible interest if two or three reports have already appeared. Any body undertaking a drug trial may consult the text book of pharmacology by Lawrence4 which gives a detailed concise check list of all the items that should be considered.

Case Reports

Case reports usually are best reported in a short letter to the editor. However, one has to spend a lot of effort searching references and writing up a long discussion of earlier cases of the same kind, but the chances of publication are reduced if the editor is reminded that large number of such cases have been reported already.

Rare conditions are however, seen rarely but an account of an unfamiliar condition is more reliable if based on several cases. An alternative to writing up the case at once is to present it at an appropriate meeting of a local medical society, when there is fair chance that other clinicians will come forward with similar cases and a more authoritative paper can then be written by several authors together.

Adverse drug reaction

Reports of side effects of drugs are frequently submitted to medical journals. The first thing the editor does is to check with the latest edition of the excperta medica and side effect of drugs where every reported side effects of all common drugs is listed and if there is more than one listing, the chances of a single report being published are very poor. Even if the report is original, it should be kept short, what matters is that the adverse effect should be recorded so that others may look out for it. If it is serious then any evidence supporting the link between drug and danger should be quoted. But as with case reports single patient events rarely make more than letters.

New technique

Sometime a new technique is devised mostly for experimental purpose or for improved medical care. Articles of this type must be description of truly new inventions and that one has successfully used them. The article however, should be very short.

Selection of journals

Before writing an article one should decide where to send it and should go through a copy to see the pattern of presentation and then go through the instructions to the authors.

Among reputed journals published globally mention may be made of two popular British journals which publish papers from outside, the British Medical Journal and Lancet.

British Medical Journal (BMJ) is firmly rooted in clinical medicine, articles are both original and highbrow; most of them have fairly, obvious and immediate application to the patient. Section for original includes short reports (limited to 600 words, 5 references and a table or figure) and side effects. It also contains a medical practice section, which includes unsolicited review, articles and papers on the organization of medical care and the supplement, which may print, talking point; articles on medico political topics. Because it is committed to referring almost any article potentially suitable for publication, the BMJ takes a little longer times for publication. Articles are often regretted not for their poor scientific quality but because they are quite unsuitable for that journal as regards subject matter or treatment.

By and large, if one has some original work concerned more or less directly with human disease and the account is fairly brief without much abbreviation, it is advisable to try BMJ.

Lancet : because they usually do not believe in referring articles, the editors usually let you know very quickly whether they are about to publish the article or not and after acceptance they publish it within few weeks. The lancet has a section for middle articles which covers a wide variety of subjects, while many scientific findings may be published as long letters to the editor.

Lancet publishes very preliminary work, often in animals with potential clinical implications. This means that an important but exciting experimental work in animals if wanted to be put to a wide audience at an early stage, the lancet probably is the best to try first.

Two more journals of repute Brit. Journal of Physiology and Brit. Journal of Pharmacology and experimental therapeutics publish mostly outstanding experimental works.

Other journals

Post graduate medical journal, again from Great Britain publishes well written piece of general interest, that does not report original findings. British journal of clinical practice is another journal of interest with trying if the material is clinical including clinical trial. The quarterly journal of medicine contains a mixture of original and review articles. Journal of American Medical Association (JAMA) having largest circulation of any medical journal in the world publishes articles mostly from USA and Australia, New England Journal of Medicine, sometime does not publish work from outside.

Indian journals

Among the various journals published from India, standard ones have review committees and are referred to various referees who take quite sometime to assess. Once it is accepted publication also takes its own time depending on the papers already pending, such journals are J. of Indian Council of Medical Research (ICMR) publishing wide variety of scientific studies primarily aided by ICMR; Indian journal of physiology and pharmacology and Indian journal of pharmacology primarily publish experimental works. Ind. J. of pharmacology also publishes works on clinical pharmacology, however, Ind. J. Clin. Pharmacology and therapeutics primarily publishes clinical evaluation of drugs and review articles.

There are however, number of journals mainly publishing clinical works, original articles as well as review articles; reputed ones are Journal of Association of Physicians of India (JAPI) and Journal of Indian Medical Association (JAMA). There are quite a few specialised journals i.e. J. of Neurology of India, Diabetes, Journal of surgery, Anaesthesia, which publish works on respective fields. Others are journal of chest diseases, psychiatry, paediatric, allergy and immunology etc.

Review Journals

There are three types - those that publish only review articles, those publish articles proper and a few original articles or case reports and others that publish articles which are both a review of the literature and a report of a series of personally studied patients. The prototype of first category is the current opinion. The second type of review journal is typified by practitioner and the third type by the quarterly journal of Medicine, American Journal of Medicine and Annals and Archives of Internal medicine etc. The character of all of those particularly the first, differs considerably from the other types., that an author is usually given enough space to present his findings in the perspective of earlier ones. These articles are frequently the standard reference on a particular topic. To be accepted, therefore, an article of this type must deal either with many patients with a fairly common disease, studied from a particular aspect or with a rare condition studied intensively.

How to present an article

Simplicity and clarity are the features of good scientific writing. No body is asking to write great literature, but the meaning must be readily understood. Good points to remember are that doctors not working in the subject should be able to understand the article, clear thought can be expressed clearly; and a man with something of value to say has no need to pad out bore editors (who are likely to reject them) and bore their readers (who are unlikely to finish them). In other words, most writers are failing to communicate the object writing in the first place. [5]

The structure of a scientific paper is well established to accommodate the "why" of the project (the introduction), the "who", "when", "where" and "how" (the methods) and the "what" (the results). The discussion (the "so what") should be in three parts - discussion and explanation of results, disputation and disquisition (implications for practice and for future work). [6]

In any article there are five critical features which consciously or unconsciously will influence an uncommitted reader to read the article and the editor to accept it for publication. These are : the total length of the article, the title, the introduction, the first few sentences, the discussion and the summary.

Summary

Although most articles begin with a summary, this section is usually written after the rest of the paper. By this time one tired of the rest of the whole article only want to be rid of it. This may explain why submitted summaries are almost universally bad, whatever the authority or capabilities of the author. All too often an editor will find out more about the work from a covering letter or from the first four sentences of the discussion than he will from a summary.

Title

An ideal title to a medical article demands the impossible. The object is to give the reader as much specific and intelligible information as you can in as few words as possible.

The Introduction

Introduction should be short except when writing MD or Ph. D. thesis (because the examiner expect it) or a review article, indicate the aim and scope of the paper. This should answer "why the work was started, if this cannot be said in a few sentences it is unlikely to have been worth doing. Except for the review journals, a long survey of the literature, is almost always out of place in this section. Explain how investigations move forward from closely related previous work on the same subject.

Material and Methods

Unless the overall experimental design or theoretical approach is already obvious from the introduction, describe it in broad out line before giving details of the method. This should aim mainly to answer the question : what has been done? Detail is necessary only if the method is original, otherwise reference will do. Never mix comment with this section or with the results. The word material should be used only in articles dealing with laboratory work or animal experiments. When the article deals with patients, the heading should be called patients and methods. You should never refer to your patients as case material.

Results

This section answers the question : what answer did you get? It should be presented in logical order chronologically or in the order of the complexity of the test. Try to put as many results as possible into tables. Numbers given in the text should agree with those in the table and figures. Finally the statistics; do not quote statistical jargon unless it is correct.

Tables and Figures

Many journals print some instructions to authors in each of their issues and usually quite definite about the way in which they want tables and figures, so if you intend to send an article to a particular journal you should follow any instructions it gives. The Lancet publishes a leaflet on writing for the Lancet while BMJ publishes instructions to authors in the first issue of every year.

Tables should be used to present facts in the clearest possible way. They should not repeat information that is already in the test. The information that you finally put in to a table should be unambiguous. Variable measures should be spelled in full e.g. serum protein mg/100 ml, serum alkaline phosphatase, king Armstrong units etc. The editor may insert abrreviations if his house style uses them, but manuscript must be clear. Do not include units in the body of the table. If the paper has only one table, it should not be numbered and should be referred to it in the text as table. Otherwise, each table should be numbered usually in Roman numbers. Every table should be typed on a separate sheet and should have a title, patients should be described by letters or numbers, but not by their own initials.

Figures should also be used sparingly and for a definite purpose, which cannot be obtained with a table and most graphs and histograms can be better Most accepted system, is to name first three authors followed by et al for the subsequent authors. However, one must study the way the journal in question cites its references and give a full bibliography in the list of references.

Advices for Reprints; Acknowledgements

Many journals now ask for the name and address of the person to whom readers may write for information and for reprints, and its a good idea to include these routinely in any article.

One should not forget to thank people who have really helped including technicians, colleagues, whose patients have been studied and the patients and volunteers themselves if the study was an experimental one. A good rule is to thank anybody who has done more than the routine work for which they are employed.

Acknowledgement can be written on a separate page at the end of the paper before the references, unless the journal prefers them as foot note or elsewhere.

Who Writes the Article and How?

Most articles carry names of two or more authors; either each author can write the draft of one or more sections or one person can do the job. The latter method usually produces a better article. One solution is to give this task to the first authors (who has done major portion of the work) and make others particularly who did least work on the subject to collect upto date references, but it is important that everybody approves and signs the final version. For a post graduate student or a beginner, it is the usual practice that the senior author usually the guide makes the final write up which forms the part of teaching programme and his name should come last among the authors.

It is a sound advice to begin by concentrating on the title, the summary and the tables (how many, their designs; their content). This method will expose any errors or omissions in the work itself and provide a frame work for the rest of the article.

Finally one should remember that no article is likely to read well unless it has been through atleast five revisions. Good writing is deceptively simple; but best ones have to go though many drafts.3

Better English Style

Any text book of English grammar will tell the six rules of writing clear English; choose the correct word (i.e. anticipate as expect; assist as help; commence as begin or start; due to as owing to; demonstrate as show; greater as more; elevated as raised; excess of as above; approximately as about; reveal as disclose; limb upper as arm; limb lower as leg; large number as many; majority as most etc.), prefer the simple word to the circumloculating, prefer the short word to the long, prefer the word derived from Anglo-saxon to that derived from Roman and the use of active rather than passive voice.

Other simple advice is to use short simple sentences; write with nouns and verbs and not with adjectives and adverses and avoid the few obvious howlers such as floating particles and less than happy constructions such as separating a subject too far from its verb.

Using short simple words and sentences one can write in clear prose. Good prose is like a windowpane.8

Commas

Wrong use of commas is a frequent error and one of the more important sources of confusion. Commas cannot be used in defining clauses but must be used in commenting clauses; one of a commonest causes of flabby writing is too many words (e.g. instead of toddler age child, toddler can be used). Construction of a sentence is also important. The use of verbs where one will do is a common cause of dead writing.

How to Present Article

Care and time spent in the actual presentation of an article are well worth while. You must send the article to only one journal at a time, but the fact that a paper has been presented to a conference does not prejudice its chances of being accepted if it fulfills the journals criteria for acceptance which in any case is likely to be rewritten for publication possibly with additional material for which there was no time at the conference. However, in this case you should use the formula based on a paper read to the international conference (year on).

Covering Letter

Every article should be accompanied by a letter to the editor. It is always good to say in your letter why you think article should be printed. Many journals ask for a statement in the covering letter that the material in the article is not already published and that it is not being simultaneously submitted for publication elsewhere.

What to Do If Article is Rejected

Once the article has been submitted, editors reply will state either the paper has been accepted or rejected or that it will be accepted or reconsidered if you revise it in ways suggested by the editor or referees. However, it is unusual for a paper to be accepted without queries of any sort. But if it happens you are lucky and wait until the proofs reach you except perhaps write a note thanking the editor.

More often than not your paper will be returned by the editor of the first journal you sent it to. They do this usually on the advice of referees mainly because the articles do not meet the criteria for publication or because they are unsuitable for their journal. If the editor says that the paper will be accepted or reconsidered if the changes are made, consider the suggestions carefully, modify or rewrite sentences or sections as necessary, retype the article before you return the paper to editor, but enclose the original corrected copy. On the other hand if it is a profile no or a sincere suggestion that you should try another type of journal, have another look at it, rewrite and send it to another journal, good work usually gets taken up by least one of the general journals.

Letters to The Editor

A general journal nearly always includes a correspondence column especially where the journal is a weekly. On an average week both the Brit. Medical Journal and the Lancet devote atleast 12,000 words to letters to the editor and Nature has a large correspondence section for the biological sciences. As such the chances are much better, rejection rate for letters being much lower than for formal articles. Almost all monthly journals in India have columns for letters to editor. It is better to try to publish preliminary data in this column if the results are good.

Letters that are infact short articles or case reports should be presented with the same care as a full version. Yet for some reasons, doctors who would never think of writing anything that had not been fully checked in an article will do so in a letter. A letter to the editor may be trickier than an original article. To make their points in 300 or 500 words (the usual length), most letter need some sort of formal structure, even though this is much less obvious than in a formal original article. This will make the task of writing a lot easier and help the reader as well.

State in your first sentence what you are talking about? Does it refer to a previous article or letter (in which case give the reference) or is it a statement about something in its own right? Next, state your point of view : are you refuting a previous claim or modifying it and is your evidence personal experience or other peoples published work? If you really need to give a case history, or use a figure, do so, be brief and confine to what is really relevant.

There is usually no need to send a letter to the editor with note requesting publication. Letters must be published quickly and editors realise this better than authors. However, if the letter does not appear in a reasonable time (which depends on the type of journal and the country of publication) there is no harm in asking why. But write polite letter rather than telephone. Nobody has the right to get anything published and letters to the editor are no exceptions. But, after all, editors are interested in good outspoken, fighting letters and your approach may be at fault if they decline to publish yours.

The MD Thesis

Unlike an examination which is essentially a test of knowledge, pursuing MD or Ph. D by thesis judges a candidates ability to investigate a problem in depths. The thesis must show a high standard of scientific and scholastic excellence and reveal not only the candidates knowledge of the subject but his powers of deduction and reasoning. This involves a thorough study of the literature, careful recording and analysis of collected data, followed by discussion and conclusions which show candidates complete command on the subject. [9]

Preparation

The way in which one should approach the thesis is little different from that in an article. Having decided on your subject you should start by asking : what am I trying to find out; what has been done before; and what is going on in this subject at present?

Before starting the work you should check thoroughly using review articles, reference books, index medicus and finally taking help of medline service if available.

Formal Structure

The easiest way of creating a structure is to go through several successful thesis and copy down what they have done.

As in journal articles, never mix comments with facts. This is why so many subheadings may be needed in the discussion section, so that you may consider each aspect of your findings in turn. A typical order might be as follows. [3]

1.     Title page : title, your name and degrees and the year.

2.     Outline of work done : Object of the work and the method used (not exceeding 60 words).

3.     Review of literatures : This pertains with survey of other publications in considerable depth, with everything relevant mentioned, even if some of the previous work was wrong.

4.     Material and methods : This includes details of definition and methods used and should be described in full. Patients studied and case histories are given here.

5.     Results : Presentation of data in chronological order or in order of complexity, this is the one place in medical writing where nobody minds if you repeat the results in the table form and in figures.

6.     Discussion : State briefly what you set out to do, and what you found, then discuss each topic under a separate heading.

7.     Summary : A fairly full (400-600 words) account of your findings and conclusions.

8.     Conclusion : A brief summing-up, putting your present work into perspective.

9.     References : Authors (upto three and then et al); title in full, journal, year, vol. page (first and last), cited reference should include the source.

Lastly the final version must be read by several people including the guide. You must not leave any obvious answerable questions unanswered otherwise an examiner may raise them or thesis may not be accepted. The copies must be immaculately bound, in the style prescribed by your university. Once your thesis has been accepted you have a fairly rich source of journal articles and papers for conferences.

Papers At Meetings

Most medical meetings are dull. Many of the doctors who regularly attend them do so out of a sense of duty to meet colleagues or to start their holiday cheaply. [3]

You should know by heart what you are going to say, yet be ready to introduce new sentences on the spar of the moment to deal with points made by other speakers. However, nervousness mostly among the beginners or real lack of time for learning one may some time have to read a script.

The Audience

Remember you are speaking on deaf morons. [10] It emphasizes that material which to you was familiar, even stale, was to your audience new perhaps difficult. If so speak slowly to the extent of not exceeding the time limit.

 

The Paper

The entire pattern of your paper should depend on what you are asked to do. If you have to talk for an hour, then the paper can be of the form : Themes, exposition, development recapitulation etc. The emphasis here should be on repetition, driving your points home various ways. But most contributors at the conferences are limited to about ten minutes, one of these is lost at beginning (people talking, coughing and coming late); another is taken up at the end, summarising, what you have said and yet another may be lost in turning the lights up and down and in waiting for the next slide. So you have only seven minutes to get your ideas across. The BBC recommends that only one new idea should be introduced every three minutes. [3] Only by careful planning you can make the presentation worthwhile and your paper a real contribution. Most of the best speakers who appear to talk spontaneously at meetings spend hours in detailed planning rewriting and rehearsal. Whatever your audience, you should devote much time and effort to what you want to say.

Delivery should aim at adaptability to audience (maximal speaking and limited writing) with arresting introduction (no writing) and visual aids (relevant slides/or minimum table and figures). Jokes (minimum) may be desirable and the delivery should be over little before time.

Contributing Chapters to Text Books

Most text books are now written by several authors and if you are asked to write a chapter or two, ask for a careful brief. You need to know whom your message is aimed at (undergraduate or post graduate, general or specialist audience) and to know exactly what the other contributors are going to deal with. Most editors now send detailed frame work, length, content etc. including maximum number of references as well as tables and figures allowed and the dead line of submission. There is nothing ruder in medical writing than being two years late with a chapter that quotes references upto the month. [11]

Medical Ethics

Research combined with treatment is ethical if it is justified by its therapeutic value for the patient. It cannot be ethical, if it entails withholding the best treatment from the patient. It is justifiable to conduct a controlled trial of a new drug if, first, there is established evidence that the new drug is likely to be least as effective as conventional treatment; and secondly that the control patients are treated with orthodox drugs.

A trial that uses placebo treatment should be done only with the consent which should always be obtained if possible. Occasionally it is not consistent with good management to ask for consent from a patient or his relatives as this might distress them.

Consent

If the research is of the kind that requires full and informed consent, it should be obtained in writing and the fact should be recorded in the paper describing the work. Should patients or subjects refuse consent, their fact should also be recorded and if the work is ethically objectionable then it should not be done.

Patients must be fully capable of assessing choice. Children and mentally defective cannot give consent (nor can others on their behalf) to any procedure that is unlikely to be direct benefit to them. Ethical controlled trials using placebo therapy are almost impossible in children.

Any element of risk must be clearly explained to the patient, nature and purpose of all procedures described. The subjects must be free to withdraw from the experiment at any time. Even if the risks are accepted by the subjects, the importance of the objective must be in proportion to the risks, based on scientifically established facts to justify the procedures. [12]

REFERENCES

1.     Rayan P. Cited by medical journal of Australia 1973; 1 : 779.

2.     Asher R. How to present your article. BMJ 1958; 2 : 502.

3.     Stephen Lock Thorness better medical writing, Pitmen Medical, 2nd Ed. 1977; 6.

4.     Lawrence DR, Bennett PN. Evaluation of drugs in man, therapeutic trials. Clinical pharmacology Churchill Livingstone 8th ed. 1977; 44-65.

5.     Luttikhuizen F. The ins and outs of scientific writing Microbiologia 1996; 12 (2) : 477-80.

6.     Fraser HS. Writing a scientific paper. West Indian Med J 1995; 44 (4) : 114-24.

7.     Bradford Hill A. Logical order for a scientific paper. BMJ 1965; 2 : 870.

8.     George Orwell. Collected essays, Secker and Warbug, London. 1968.

9.     Williams WO. British Journal of Medical Education 1969; 3 : 171.

10. Pyke DA. How to write papers. BMJ 1970; 1 : 420.

11. Wilson Edmund A. Atlantic monthly. 1935; 155 : 67.

12. Medical Ethics Today. In practice of philosophy consent and refusal from BMAs ethics. Science and information division, Tavistock

Writing an article review

Learning and Teaching Unit

What is an article review?

The purpose of an article review is to provide readers with an informed and succinct analysis of one or several articles so that they can decide whether the article/s is useful to them. The review:

                     provides a brief description of the purpose and content of one or more articles

                     analyses the strengths and weaknesses of the article/s in terms of their value to a specific field of knowledge

                     shows how the article/s contributes to that field of knowledge.

Article reviews may be as short as 300 words or as long as 1000 words. They are often set as early assessment tasks at university as a way of introducing you to the literature in your field of study. They also provide valuable information about your knowledge of the content area, ability to understand and interpret what you read and your writing skills. First year students may find that lecturers have very specific requirements for a review to allow for limited knowledge of the field. For example you may or may not be required to refer to other literature. Always be sure to check the requirements of the task as described in the course outline.

Staff setting article reviews usually require that you:

                     review particular articles that are identified for you and are readily available

or

                     review one or more journal articles on a particular theme that you identify and select. A number of journals may be recommended. Note that the most useful reviews cover recently published material.

As a reviewer you are usually expected to draw on a broad knowledge of the content area for each article under review.

Article reviews have three main parts or stages

                     a heading which provides all the necessary bibliographic information about the article/s

                     a summary which outlines the article and reports briefly on its purpose and overall argument

                     a critique which uses knowledge of the field to evaluate the quality the article.

The summary and critique follow one another without the use of subheadings. More information about summarising and critiquing is given below.

Steps in writing an article review

When preparing to write an article review you undertake a number of different activities:

                     reading and noting

                     writing the first draft

                     revising and redrafting

                     using feedback

Reading and noting

Before you begin reading your article/s you need to start thinking about yourself as a reviewer. This means you must have a clear idea about your purpose so that you can approach the article and the related readings with useful questions in mind. You may need to allow quite a lot of time for thinking about the topic, reading and analysing the article, and reading more widely.

Brainstorming the topic can be a good starting point before you start your detailed reading. To brainstorm you use a piece of paper to jot down all that you know about the topic and all your questions about it. Ask yourself whether you know about alternative views that have been presented on this topic. This can help you to identify the strengths and gaps in your knowledge and it may prompt questions that will guide your initial reading of the article as well as your wider reading.

Some of the following questions might be helpful in your reading of the article/s:

                     What is the authors stated purpose? Where and how is this stated?

                     Who is the intended audience? Is it a specialised or general audience?

                     What is the main line of argument? Is the main line of argument logical?

                     What arguments does the author use to support the main line of argument?

                     What evidence does the author use to support the main line of argument?

                     Is the evidence well presented, sufficient and convincing?

                     Are there alternative points of view or lines of argument?

                     Where does the author stand in relation to other points of view on this topic?

                     Does the text present or refute opposing lines of argument and evidence?

Clearly some of these questions will be addressed through your wider reading on the topic.

Your notes provide a record of your thinking and they will help in writing your review. Notes on the main article/s should include an outline of the authors argument and the framework of the overall article/s for this forms the basis of your summary. Noting the relevant bibliographic details about all sources (author, date, title, publisher etc) ensures that you have the information you need when you start writing.

Writing the first draft

Remember that you are writing for an audience that is interested in your assessment of the article/s.

Introduction

Provide the required bibliographic information at the beginning: author, title, year of publication, name and number of journal. Inform the reader in clear and concise terms that you are writing about a particular article by a particular author.

Summary

A good summary demonstrates that you understood the article well. In the summary you provide readers with:

                     a clear sense of what the article is describing its main ideas in the same order as in the article

                     an understanding of the authors purpose. This has to be done objectively by providing supporting evidence from the article.

Critique

The critique is your evaluation of the article based on your reading and analysis of the article/s and the related literature. If you take up and critique each of the points made in the summary your critique will mirror the organisation of the summary. As you write about the strength or weakness of the article you need to be explicit about your reasons for forming your views. You need to show your reader evidence that influenced you. For example if you consider that the author presented a biased point of view you need to provide examples of bias from the article.

Make recommendations

Sometimes it is appropriate to offer recommendations. For example you may decide that the article has valuable ideas but they are difficult to find because the article is not well organised. You might want to recommend another authors work on the same topic. You can do this as long as you support your point of view. This enables your readers to make their own decisions about the article in the light of the evidence that you have presented.

Revising and redrafting

As with all written work at university you need to allow time for revision between the completion of the first draft and the final version. Some students find it useful to use this time to seek comment on their first draft. You could ask someone to give you feedback on whether:

                     your meaning is clear

                     the language is error free

                     the presentation meets requirements eg length, layout etc.

Note that your assignment has to represent your workin seeking feedback you should not ask another person to amend or rewrite any part of your work, but you can use their comments as a basis for refining your work.

Using feedback

Use feedback from previous assignments to inform your current work. Staff may indicate your strengths and weaknessesmake good use of the feedback that you receive.

Finding model reviews

If you are writing your first article review you may wish to read a review that someone else has written. Most professional journals for your course have a review section where you can read published reviews on issues relevant to your studies. See the journals recommended by your lecturer or use the Library to locate relevant periodicals.

When you look at a review that could serve as a model, you need to consider the reviews purpose, structure, organisation, and use of language. What does it set out to do and how well does it do it?

Prepositions

Prepositions are short words (on, in, to) that usually stand in front of nouns (sometimes also in front of gerund verbs).

Even advanced learners of English find prepositions difficult, as a 1:1 translation is usually not possible. One preposition in your native language might have several translations depending on the situation.

There are hardly any rules as to when to use which preposition. The only way to learn prepositions is looking them up in a dictionary, reading a lot in English (literature) and learning useful phrases off by heart (study tips).

The following table contains rules for some of the most frequently used prepositions in English:

Prepositions Time

English

Usage

Example

                     on

                     days of the week

                     on Monday

                     in

                     months / seasons

                     time of day

                     year

                     after a certain period of time (when?)

                     in August / in winter

                     in the morning

                     in 2006

                     in an hour

                     at

                     for night

                     for weekend

                     a certain point of time (when?)

                     at night

                     at the weekend

                     at half past nine

                     since

                     from a certain point of time (past till now)

                     since 1980

                     for

                     over a certain period of time (past till now)

                     for 2 years

                     ago

                     a certain time in the past

                     2 years ago

                     before

                     earlier than a certain point of time

                     before 2004

                     to

                     telling the time

                     ten to six (5:50)

                     past

                     telling the time

                     ten past six (6:10)

                     to / till / until

                     marking the beginning and end of a period of time

                     from Monday to/till Friday

                     till / until

                     in the sense of how long something is going to last

                     He is on holiday until Friday.

                     by

                     in the sense of at the latest

                     up to a certain time

                     I will be back by 6 oclock.

                     By 11 o'clock, I had read five pages.

Prepositions Place (Position and Direction)

English

Usage

Example

                     in

                     room, building, street, town, country

                     book, paper etc.

                     car, taxi

                     picture, world

                     in the kitchen, in London

                     in the book

                     in the car, in a taxi

                     in the picture, in the world

                     at

                     meaning next to, by an object

                     for table

                     for events

                     place where you are to do something typical (watch a film, study, work)

                     at the door, at the station

                     at the table

                     at a concert, at the party

                     at the cinema, at school, at work

                     on

                     attached

                     for a place with a river

                     being on a surface

                     for a certain side (left, right)

                     for a floor in a house

                     for public transport

                     for television, radio

                     the picture on the wall

                     London lies on the Thames.

                     on the table

                     on the left

                     on the first floor

                     on the bus, on a plane

                     on TV, on the radio

                     by, next to, beside

                     left or right of somebody or something

                     Jane is standing by / next to / beside the car.

                     under

                     on the ground, lower than (or covered by) something else

                     the bag is under the table

                     below

                     lower than something else but above ground

                     the fish are below the surface

                     over

                     covered by something else

                     meaning more than

                     getting to the other side (also across)

                     overcoming an obstacle

                     put a jacket over your shirt

                     over 16 years of age

                     walk over the bridge

                     climb over the wall

                     above

                     higher than something else, but not directly over it

                     a path above the lake

                     across

                     getting to the other side (also over)

                     getting to the other side

                     walk across the bridge

                     swim across the lake

                     through

                     something with limits on top, bottom and the sides

                     drive through the tunnel

                     to

                     movement to person or building

                     movement to a place or country

                     for bed

                     go to the cinema

                     go to London / Ireland

                     go to bed

                     into

                     enter a room / a building

                     go into the kitchen / the house

                     towards

                     movement in the direction of something (but not directly to it)

                     go 5 steps towards the house

                     onto

                     movement to the top of something

                     jump onto the table

                     from

                     in the sense of where from

                     a flower from the garden

Other important Prepositions

English

Usage

Example

                     from

                     who gave it

                     a present from Jane

                     of

                     who/what does it belong to

                     what does it show

                     a page of the book

                     the picture of a palace

                     by

                     who made it

                     a book by Mark Twain

                     on

                     walking or riding on horseback

                     entering a public transport vehicle

                     on foot, on horseback

                     get on the bus

                     in

                     entering a car  / Taxi

                     get in the car

                     off

                     leaving a public transport vehicle

                     get off the train

                     out of

                     leaving a car  / Taxi

                     get out of the taxi

                     by

                     rise or fall of something

                     travelling (other than walking or horseriding)

                     prices have risen by 10 percent

                     by car, by bus

                     at

                     for age

                     she learned Russian at 45

                     about

                     for topics, meaning what about

                     we were talking about you