Reporting of numerical and statistical differences in abstracts: improving but not optimal

Twelve tips on writing abstracts and titles: How to get people to use and cite your work

The authors share 12 practical tips on creating effective titles and abstracts for a journal publication or conference presentation. When crafting a title authors should: (1) start thinking of the title from the start; (2) brainstorm many key words, create permutations, and ask others for input; (3) strive for an informative and indicative title; (4) start the title with the most important words; and (5) wait to finalize the title until the very end. When writing the abstract, authors should: (6) wait until the end to write the abstract; (7) copy and paste from main text as the starting point; (8) start with a detailed structured format; (9) describe what they did; (10) describe what they found; (11) highlight what readers can do with this information; and (12) ensure that the abstract aligns with the full text and conforms to submission guidelines.

Confidence in outcome estimates from systematic reviews used in informed consent

OBJECTIVES

Evidence-based dentistry now guides informed consent in which clinicians are obliged to provide patients with the most current, best evidence, or best estimates of outcomes, of regimens, therapies, treatments, procedures, materials, and equipment or devices when developing personal oral health care, treatment plans. Yet, clinicians require that the estimates provided from systematic reviews be verified to their validity, reliability, and contextualized as to performance competency so that clinicians may have confidence in explaining outcomes to patients in clinical practice.

ANALYSIS WITH RESULTS

The purpose of this paper was to describe types of informed estimates from which clinicians may have confidence in their capacity to assist patients in competent decision-making, one of the most important concepts of informed consent.

METHODS

Using systematic review methodology, researchers provide clinicians with valid best estimates of outcomes regarding a subject of interest from best evidence. Best evidence is verified through critical appraisals using acceptable sampling methodology either by scoring instruments (Timmer analysis) or checklist (grade), a Cochrane Collaboration standard that allows transparency in open reviews. These valid best estimates are then tested for reliability using large databases. Finally, valid and reliable best estimates are assessed for meaning using quantification of margins and uncertainties.

ANALYSIS

Through manufacturer and researcher specifications, quantification of margins and uncertainties develops a performance competency continuum by which valid, reliable best estimates may be contextualized for their performance competency: at a lowest margin performance competency (structural failure), high margin performance competency (estimated true value of success), or clinically determined critical values (clinical failure).

CONCLUSIONS

Informed consent may be achieved when clinicians are confident of their ability to provide useful and accurate best estimates of outcomes regarding regimens, therapies, treatments, and equipment or devices to patients in their clinical practices and when developing personal, oral health care, treatment plans.

Effects of presenting risk information in different formats to cardiologists. A Latin American survey

OBJECTIVE

Previous publications demonstrated that the presentation of treatment benefits in terms of relative risk reduction (RRR) rather than in terms of absolute risk reduction (ARR) or number of patients to treat (NNT) might favor the perception of outcome effectiveness. The objective was to perform a cognitive evaluation to assess how the manner in which risks and benefits of screening methods and treatments are presented can affect medical care decision-taking in a sample of cardiologists.

METHODS

Four-hundred and six Latin American cardiologists answered a questionnaire reporting the results of clinical trials presented as RRR, ARR or NNT, associated or not to biased graphs.

RESULTS

Cardiologists' decision-taking was different when comparing treatment benefits presented as RRR (62.2%) vs. ARR (40.4%) (p=0.000000), and as RRR vs. NNT (44.4%) (p=0.000000). However, their decision-taking was similar when information was presented as NNT or ARR (p=0.073). The inclusion of biased graphs was misinterpreted as an actual data difference (RRR: 61.6% vs. ARR: 14.0%, p=0.000000).

CONCLUSIONS

This study demonstrated that Latin American cardiologists could misinterpret statistical data when information of clinical trials is presented in terms of RRR. We emphasize the need to enhance cardiologists' training in quantitative techniques, to improve medical care decision-making.

Endpoint selection and relative (versus absolute) risk reporting in published medication trials

BACKGROUND

The use of surrogate and composite endpoints, disease-specific mortality as an endpoint, and relative (rather than absolute) risk reporting in clinical trials may produce results that are misleading or difficult to interpret.

OBJECTIVE

To describe the prevalence of these endpoints and of relative risk reporting in medication trials. DESIGN AND MAIN MEASURES: We analyzed all randomized medication trials published in the six highest impact general medicine journals between June 1, 2008 and September 30, 2010 and determined the percentage using these endpoints and the percentage reporting results in the abstract exclusively in relative terms.

KEY RESULTS

We identified 316 medication trials, of which 116 (37%) used a surrogate primary endpoint and 106 (34%) used a composite primary endpoint. Among 118 trials in which the primary endpoint involved mortality, 32 (27%) used disease-specific mortality rather than all-cause mortality. Among 157 trials with positive results, 69 (44%) reported these results in the abstract exclusively in relative terms. Trials using surrogate endpoints and disease-specific mortality as an endpoint were more likely to be exclusively commercially funded (45% vs. 29%, difference 15% [95% CI 5%-26%], P = 0.004, and 39% vs. 16%, difference 22% [95% CI 6%-37%], P = 0.007, respectively). Trials using surrogate endpoints were more likely to report positive results (66% vs. 49%, difference 17% [95% CI 5%-28%], P = 0.006) while those using mortality endpoints were less likely to be positive (46% vs. 62%, difference -16% [95% CI -27%--4%], P = 0.01).

CONCLUSIONS

The use of surrogate and composite endpoints, endpoints involving disease-specific mortality, and relative risk reporting is common. Articles should highlight the limitations of these endpoints and should report results in absolute terms.

[CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration]

BACKGROUND

Clear, transparent, and sufficiently detailed abstracts of conferences and journal articles related to randomized controlled trials (RCTs) are important, because readers often base their assessment of a trial solely on information in the abstract. Here, we extend the CONSORT (Consolidated Standards of Reporting Trials) Statement to develop a minimum list of essential items, which authors should consider when reporting the results of a RCT in any journal or conference abstract.

METHODS AND FINDINGS

We generated a list of items from existing quality assessment tools and empirical evidence. A three-round, modified-Delphi process was used to select items. In all, 109 participants were invited to participate in an electronic survey; the response rate was 61%. Survey results were presented at a meeting of the CONSORT Group in Montebello, Canada, January 2007, involving 26 participants, including clinical trialists, statisticians, epidemiologists, and biomedical editors. Checklist items were discussed for eligibility into the final checklist. The checklist was then revised to ensure that it reflected discussions held during and subsequent to the meeting. CONSORT for Abstracts recommends that abstracts relating to RCTs have a structured format. Items should include details of trial objectives; trial design (e.g., method of allocation, blinding/masking); trial participants (i.e., description, numbers randomized, and number analyzed); interventions intended for each randomized group and their impact on primary efficacy outcomes and harms; trial conclusions; trial registration name and number; and source of funding. We recommend the checklist be used in conjunction with this explanatory document, which includes examples of good reporting, rationale, and evidence, when available, for the inclusion of each item.

CONCLUSIONS

CONSORT for Abstracts aims to improve reporting of abstracts of RCTs published in journal articles and conference proceedings. It will help authors of abstracts of these trials provide the detail and clarity needed by readers wishing to assess a trial's validity and the applicability of its results.

CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration

BACKGROUND

Clear, transparent, and sufficiently detailed abstracts of conferences and journal articles related to randomized controlled trials (RCTs) are important, because readers often base their assessment of a trial solely on information in the abstract. Here, we extend the CONSORT (Consolidated Standards of Reporting Trials) Statement to develop a minimum list of essential items, which authors should consider when reporting the results of a RCT in any journal or conference abstract.

METHODS AND FINDINGS

We generated a list of items from existing quality assessment tools and empirical evidence. A three-round, modified-Delphi process was used to select items. In all, 109 participants were invited to participate in an electronic survey; the response rate was 61%. Survey results were presented at a meeting of the CONSORT Group in Montebello, Canada, January 2007, involving 26 participants, including clinical trialists, statisticians, epidemiologists, and biomedical editors. Checklist items were discussed for eligibility into the final checklist. The checklist was then revised to ensure that it reflected discussions held during and subsequent to the meeting. CONSORT for Abstracts recommends that abstracts relating to RCTs have a structured format. Items should include details of trial objectives; trial design (e.g., method of allocation, blinding/masking); trial participants (i.e., description, numbers randomized, and number analyzed); interventions intended for each randomized group and their impact on primary efficacy outcomes and harms; trial conclusions; trial registration name and number; and source of funding. We recommend the checklist be used in conjunction with this explanatory document, which includes examples of good reporting, rationale, and evidence, when available, for the inclusion of each item.

CONCLUSIONS

CONSORT for Abstracts aims to improve reporting of abstracts of RCTs published in journal articles and conference proceedings. It will help authors of abstracts of these trials provide the detail and clarity needed by readers wishing to assess a trial's validity and the applicability of its results.

A systematic review of titles and abstracts of experimental studies in medical education: many informative elements missing

CONTEXT

Informative titles and abstracts facilitate reading and searching the literature.

OBJECTIVE

To evaluate the quality of titles and abstracts of full-length reports of experimental studies in medical education.

METHODS

We used a random sample of 110 articles (of 185 eligible articles) describing education experiments. Articles were published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education and Teaching and Learning in Medicine. Titles were categorised as informative, indicative, neither, or both. Abstracts were evaluated for the presence of a rationale, objective, descriptions of study design, setting, participants, study intervention and comparison group, main outcomes, results and conclusions.

RESULTS

Of the 105 articles suitable for review, 86 (82%) had an indicative title and 10 (10%) had a title that was both indicative and informative. A rationale was present in 66 abstracts (63%), objectives were present in 84 (80%), descriptions of study design in 20 (19%), setting in 29 (28%), and number and stage of training of participants in 42 (40%). The study intervention was defined in 55 (52%) abstracts. Among the 48 studies with a control or comparison group, this group was defined in 21 abstracts (44%). Study outcomes were defined in 64 abstracts (61%). Data were presented in 48 (46%) abstracts. Conclusions were presented in 97 abstracts (92%).

CONCLUSIONS

Reports of experimental studies in medical education frequently lack the essential elements of informative titles and abstracts. More informative reporting is needed.

A meta-analysis of the effects of presenting treatment benefits in different formats

PURPOSE

The purpose of this article is to examine the effects of presenting treatment benefits in different formats on the decisions of both patients and health professionals. Three formats were investigated: relative risk reductions, absolute risk reductions, and number needed to treat or screen.

METHODS

A systematic review of the published literature was conducted. Articles were retrieved by searching a variety of databases and screened for inclusion by 2 reviewers. Data were extracted on characteristics of the subjects and methodologies used. Log-odds ratios were calculated to estimate effect sizes.

RESULTS

A total of 24 articles were retrieved that reported on 31 unique experiments. The meta-analysis showed that treatments were evaluated more favorably when the relative risk format was used rather than the absolute risk or number needed to treat format. However, a significant amount of heterogeneity was found between studies, the sources of which were explored using subgroup analyses and metaregression. Although the subgroup analyses revealed smaller effect sizes in the studies conducted on physicians, the metaregression showed that these differences were largely accounted for by other features of the study design. Most notably, variations in effect sizes were explained by the particular wordings that the studies had chosen to use for the relative risk and absolute risk reductions.

CONCLUSIONS

The published literature has consistently demonstrated that relative risk formats produce more favorable evaluations of treatments than absolute risk or number needed to treat formats. However, the effects are heterogeneous and seem to be moderated by key differences between the methodologies used.

Better reporting of randomized trials in biomedical journal and conference abstracts

Well reported research published in conference and journal abstracts is important as individuals reading these reports often base their initial assessment of a study based on information reported in the abstract. However, there is growing concern about the reliability and quality of information published in these reports. This article provides an overview of research evidence underpinning the need for better reporting of abstracts reported in conference proceedings and abstracts of journal articles; with a particular focus in the area of health care. Where available we highlight evidence which refers specifically to abstracts reporting randomized trials. We seek to identify current initiatives aimed at improving the reporting of these reports and recommend that an extension of the CONSORT Statement (Consolidated Standards of Reporting Trials), CONSORT for Abstracts, be developed. This checklist would include a list of essential items to be reported in any conference or journal abstract reporting the results of a randomized trial.

Introductory course on getting to know journals and on "browsing" a research paper: first steps to proficiency in scientific communication

AIM

To evaluate the effectiveness and appropriateness of a course that promotes familiarity with biomedical periodicals and teaches efficient reading skills.

METHODS

A 16-hour course was designed to help inexperienced readers gain confidence navigating the contents of a research paper (instead of reading only abstracts), and make the first steps to critical appraisal. The course consisted of short lessons and small group work in which research papers were read and presented to the class. Participants learned a method called "browsing" that guides the first, superficial reading of a research paper and substitutes abstract reading. The course was administered to 15 hospital physicians and 40 graduate students of molecular medicine, in 4 separate sessions.

RESULTS

At course entry, 45 of 55 participants normally read the abstract before consulting the body of a research paper. An end-of-course questionnaire, completed by 47 participants, revealed that only 3 would still read the abstract first, while 33 would perform browsing, 7 would scan figures and tables, and 4 would consult another section of a paper outside of their research interests; similar responses were given for a research paper within their fields. For 43 participants, the course was effective in developing reading skills. On a final comprehension test, participants had a median score of 69% correct responses (interquartile range, 56%-80%).

CONCLUSION

This introductory course on reading scientific articles is effective in overcoming abstract-only reading and in developing confidence with the research literature. Considering participants' subjective evaluation and test scores, the course contents are appropriate for both physicians and young researchers.

Quality of structured abstracts of original research articles in the British Medical Journal, the Canadian Medical Association Journal and the Journal of the American Medical Association: a 10-year follow-up study

BACKGROUND

We compared the quality of structured abstracts of original research articles from the British Medical Journal (BMJ), Canadian Medical Association Journal (CMAJ), and the Journal of the American Medical Association (JAMA) from 1991 to 1992 and 2001 to 2002 between journals.

METHODS

A random, stratified sample of 54 abstracts from 2001 to 2002 in BMJ, CMAJ, and JAMA was compiled and coded. Two blinded raters reviewed 27 abstracts each against 33 objective criteria, separated into eight categories (purpose, research design, setting, subjects, intervention, measurement of variables, results, and conclusion). The quality score was the proportion of criteria present (range = 0-1).

RESULTS

The overall mean quality score (0.74) for 2001-2002 was significantly higher than the 1988-1989 unstructured abstracts (mean = 0.57; p<0.001) but not different from the 1991-1992 structured abstracts (mean = 0.74; p>0.05). In 2001-2002, abstracts of CMAJ and JAMA (both means = 0.76) improved significantly over 1991-1992 (p<0.05) and scored significantly higher than BMJ (mean = 0.71; d.f. = 16, p<0.05). Some individual criteria scores (intervention, statistical information) improved but information was found consistently under-represented in areas that imply shortcomings of the studies.

INTERPRETATION

We found a consistency in abstract quality regardless of the precise format used by different journals. This indicates that the framework for research articles already in place should be maintained and further modification of the framework may not necessarily improve the abstract quality.

Examining empathy in medical encounters: an observational study using the empathic communication coding system

Educators, researchers, clinicians, and patients often advocate empathy in the physician-patient relationship. However, little research has systematically examined how patients present opportunities for physicians to communicate empathically and how physicians respond to such opportunities. The Empathic Communication Coding System was used to investigate empathic opportunity-response sequences during initial visits in a general internal medicine clinic. This study focuses on 100 visits during which patients created at least 1 explicit empathic opportunity. Overall, patients presented 249 empathic opportunities in these 100 visits; physicians most often responded by acknowledging, pursuing, or confirming the patient's statement. The mean length of empathic opportunity-response sequences was 25.8 sec; sequences tended to be longer in duration when the physician used a more empathic response. Positively valenced empathic opportunities generated a more empathic response than did negatively valenced empathic opportunities. However, there was no relation between the emotional intensity of empathic opportunities and the level of empathy in subsequent physician responses. Further research should examine patient preferences and outcomes associated with varying levels of empathic responses.

The 107th Congress' legislative proposals concerning end-of-life care

PURPOSE

The current health care system cannot reliably meet the needs of patients with eventually fatal chronic illnesses near the end-of-life. Enduring change requires improved public policy, in part because most paid care for serious illness at the end of life now relies on federal programs. This project reviews the legislation proposed in the 107th Congress (2001-2002) related to improving end-of-life care.

METHODS

We searched THOMAS, the search engine of the Library of Congress, to identify all bills relating to end-of-life care introduced in either house of the U.S. Congress during the 2001/2002 legislative period. Using explicit criteria intended to find any that received serious attention and incorporating recommendations of political consultants, the initial 563 bills narrowed to 22. We summarize their status as of October 24, 2002.

RESULTS

The 22 bills identified dealt with the following topics: demonstration or research projects (9), palliative care or hospice (8), caregivers (7), chronic illness generally (5), care coordination (2), and long-term health care (3). Dementia, graduate medical education, nursing, and pain appeared in 1 bill each. Congress enacted only 1 of the bills. Only 7 bills had more than 10% of either house as sponsors.

CONCLUSIONS

While Medicare reform and health care costs are prominent topics among policymakers, Congress is considering essentially no fundamental changes that would remedy the problems associated with health care for the elderly who are seriously ill near the end-of-life. The mismatch between the urgency of policy reform and the lack of vehicles and momentum to achieve reform calls for consensus and leadership from those concerned with hospice and palliative care.