On Writing: Write the Abstract, and a Manuscript Will Emerge From It!

This is the third in a series of articles on medical writing. This one looks at how to write a meeting abstract and develop a manuscript for publication from it. We will also look at the dos and don’ts of writing a case report.

OK, so now you have a body of data you wish to share with the medical world. What is the best way to do this? A popular method is to present data at a medical meeting, either as an oral presentation or a poster. The abstract selection committee of the society or organization you submit to will decide which format: oral presentations are typically reserved for the very best submissions. Each organization has its own format for submitting a written summary (abstract) of your work. Increasingly, abstract submission is “electronic”. You must pay close attention to the “Instructions to Authors”: improperly formatted abstracts may be rejected without review. For example, as reviewers are typically “blinded” to the source of abstracts, the name of your institution should not appear in the body of the text. As space is severely limited in abstract format, abbreviations are acceptable (e. g. pts for patients, CT for computed tomography, etc.). There is usually a restriction on font size (e. g. no smaller than 10 pt) and the font type may even be specified (e. g. Courier, New Times Roman). In an abstract, we want to follow the Introduction, Patients (or Materials) and Methods, Results and Conclusion (or Discussion) format of a manuscript, but in a much condensed form. Figure [1] is a draft of an imaginary abstract; Figure [2] is this draft edited into abstract format.

Figure 1 Draft abstract.

Figure 2 Abstract.

You can see that the draft abstract is more than half way to being a manuscript for possible publication. The abstract takes some liberties with English, saving space by multiple abbreviations (e. g. TE, Womb, “pts” instead of patients, etc). All mention of the authors’ institution has been deleted from the body of the abstract. The abstract describes the study and its principal finding(s) in as little space as possible, which is the aim of the exercise. Abstract writing is a form of “precis”, the art of cutting out the extraneous. When you get good at putting together abstracts, you will find that it is relatively easy to then “flesh out” an abstract into manuscript form. Indeed, I tell my trainees that once they have written the abstract, they have almost written the paper. Too many abstracts presented at national meetings never make it into manuscript form for publication, which is sad, because there’s a paper in the vast majority of them. The Instructions to Authors of a manuscript are typically more detailed than for an abstract. Often, journals provide a “checklist” for the convenience of authors submitting manuscripts (Figure [3]): it makes sense to use these!

Let’s look at some of the specifics of the various sections. The Introduction should say briefly and succinctly what the paper or abstract is all about. In a manuscript, the Introduction should rarely be more that 250 words (= a double-spaced page in 12 point font). Obviously, in the abstract it can (and must!) be shorter. Learn economy of words: say “use” rather than “utilize”, “invented” rather than “developed a concept from the drawing board to a full-size working model”. For example, compare these two statements for the Introduction of an abstract: “Impressed by the suffering of our fellow human beings afflicted with dry skin on the scalp, we decided to evaluate the medicinal qualities of polychlorinated thrombandinols in a controlled trial, using volunteers aged 40 - 60 years, and lavendar water as a control…”; “We performed a randomized, controlled trial of ‘Druff-Be-Gone™’, a proprietory brand of polychlorinated thanbandiol, versus placebo (lavender water), in 40 - 60 year old male volunteers with dandruff”. You get the idea! The Materials (or Patients) and Methods (M + M) section is just that: it should state, without “frills”, what patient population was looked at, what the inclusion and exclusion criteria were, what drug doses were used and their route of administration, what controls (if any) were used and how the results were collected and analyzed. These days, the M+M section should include a statement confirming that any clinical trial involving patients was reviewed and approved by an Ethics Committee of (in the US) an Institutional Review Board (IRB). Statistical analysis should be mentioned. If a statistical “package” was used to “crunch” the numbers, this should be identified. If a power calculation was performed, it is appropriate to indentify this: e. g. “we determined that 1,500 patients, 750 in each arm of the study, would be needed to identify a 50 % reduction in post-ERCP pancreatitis at a significance level of p < 0.05”. The Results belong in the Results section, and not in the Materials (or Patients) and Methods. The number of patients recruited for the study, the number excluded (with the reason for exclusion), the number who dropped out or were lost to follow-up and those included in the study (or each arm of it) should be identified. The “meat” of the study is typically contained in a short statement about how the study groups differed, and its statistical significance: e. g. “28/750 (3.7 %) patients who underwent ERCP after receiving placebo developed post-ERCP pancreatitis, compared with only 2/750 (0.3 %) who received 50 micrograms of ‘Panc-Be-Gone™’ subcutaneously one hour before ERCP. This difference was highly significant (p < 0.0001)”. The Conclusion in an abstract should be short and to the point: “In a randomized, controlled, double-blind trial against placebo, 50 ug of polychorinated thambulin (‘Panc-Be-Gone™’) administered one hour before ERCP significantly reduced the incidence of post-ERCP pancreatitis.” In a paper manuscript, the Discussion should begin with a similar statement of the outcome, but then allows you the opportunity to discuss the immediate and broader implications of the study result. It is also an opportunity to review and synthesize the relevant literature on the subject. The Discussion is usually the most difficult paper to write: there is a tendency to wander off the subject and to make it too long. There is a definite “art” to Discussion writing. The Discussion should identify both the strengths and the weaknesses of the study, and make suggestions for further studies.

At the end of a manuscript, you may want to identify and thank individuals who have been helpful in performing the study or typing up the manuscript, but who didn’t make it into the author list: e. g. “The authors are grateful to Ms Ella Smith for her unique ability to draw blood from our ferrets, and Ms Wylie Fox for her boundless secretarial skills”. Some journals will publish acknowledgements, others won’t. Typically, a list of Figures and their Legends follows, then a Reference List. It is imperative for authors to follow the journal guidelines for listing and citing references. For example, are the references to be listed sequentially in the text? How many authors are to be cited before “et al.” (three? six?). It is the authors’ responsibility to verify each and every one of the references. If a reference has been cited from another publication, and the original cannot be checked, then it should be identified as “cited in [Current Rumors in Gastroenterology] u etc.”. References are frequently cited incorrectly, which irritates the original authors and makes the job of locating these references difficult or sometimes impossible. For some reason, many authors expend little energy on the task of preparing their reference list. Perhaps this is because it is usually the last thing to be done before finishing a paper. Time spent checking and rechecking references is time well spent.

Figure 3 Checklist for Manuscript Submission. Current Rumors in Gastroenterology.