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AME循证杂谈05|何为一篇好文章?

Published at: 2015年第1卷第S1期

谷万杰
关键词:

说到好文章,估计我们很多人会想到临床方面的NEJM, Lancet, JAMA等期刊和基础方面的Cell, Nature, Science等杂志上发表的文章。但是问题来了,难道这些杂志上面的每一篇文章都是精华吗?答案是否定的,其实发在这些杂志上的某些文章也存在灌水,甚至出现造假事件。此时,我们有必要去思考一个问题:什么样的文章才是一篇好文章?在找到答案之前,我们先看下面的一个实例。

可以看到,今年不同团队在不同期刊上发表了3篇关于肝素用于脓毒症人群的系统评价。三个团队研究了相同的选题,但发表了三个不同层次的杂志。CCM杂志算是重症的老大,所谓的一区杂志,CC杂志靠后,所谓二区杂志,中华危重病急救医学杂志是国内的重症杂志,我也不知道是几区杂志。那为什么相同研究却命运迥异呢?究其原因,可能是由多方面的因素造成的。今天我们只探讨和我们今天议题最相关的三个要素:临床价值, 研究内容,内容表达。这三篇系统评价的研究选题都是一样的,都具有很好的临床价值,但在临床内容和内容表达上具有一定的差异,有兴趣的朋友可以去看看他们的摘要和全文,进一步比较这三篇系统评价。下面我们一起学习和品读一下CCM上这篇文章的题目和摘要。

The Efficacy and Safety of Heparin in Patients With Sepsis: A Systematic Review and Metaanalysis.

题目的作用是什么呢?是告诉读者这篇文章是关于什么内容的。只是单纯的告知内容吗?需要用一个简洁、准确、真实和具有吸引力的方式告诉读者。什么是简洁?用最少的单词表达完整的内容,去除一些不必要的信息。什么是准确?题目能够准确客观反映文章的内容,不存在过大或者过小。什么是真实?我们做了什么就说什么,没有做的那是不能乱说的,不能表达揣测的东西给读者。做到以上三点,这个题目也自然具有一定的吸引力。比如这个题目,非常到位的根据PICOS原则告知读者研究内容,P: 脓毒症人群; I:肝素; O: 有效性指标和安全性指标; S:系统评价和Meta分析。这个题目告诉读者:作者通过系统评价和Meta分析的方式评价肝素用于脓毒症人群的有效性和安全性。看了题目之后,我就很想去看摘要,作者到底怎么做的 (方法)?发现了什么 (结果)?有什么意义 (结论)?

Objective: To evaluate the efficacy and safety of heparin in patients with sepsis, septic shock, or disseminated intravascular coagulation associated with infection.

Design: Systematic review and metaanalysis.

Data Sources: Randomized controlled trials from MEDLINE, EMBASE, CENTRAL, Global Health, Scopus, Web of Science, the International Clinical Trials Registry Platform (inception to April 2014), conference proceedings, and reference lists of relevant articles.

Study Selection and Data Extraction: Two reviewers independently identified and extracted trial-level data from randomized trials investigating unfractionated or low molecular heparin administered to patients with sepsis, severe sepsis, septic shock, or disseminated intravascular coagulation associated with infection. Internal validity was assessed in duplicate using the Risk of Bias tool. The strength of evidence was assessed in duplicate using Grading of Recommendations Assessment, Development, and Evaluation methodology. Our primary outcome was mortality. Safety outcomes included hemorrhage, transfusion, and thrombocytopenia.

Measurements and Main Results: We included nine trials enrolling 2,637 patients. Eight trials were of unclear risk of bias and one was classified as having low risk of bias. In trials comparing heparin to placebo or usual care, the risk ratio for death associated with heparin was 0.88 (95% CI, 0.77-1.00; I2 = 0%; 2,477 patients; six trials; moderate strength of evidence). In trials comparing heparin to other anticoagulants, the risk ratio for death was 1.30 (95% CI, 0.78-2.18; I2 = 0%; 160 patients; three trials; low strength of evidence). In trials comparing heparin to placebo or usual care, major hemorrhage was not statistically significantly increased (risk ratio, 0.79; 95% CI, 0.53-1.17; I2 = 0%; 2,392 patients; three trials). In one small trial of heparin compared with other anticoagulants, the risk of major hemorrhage was significantly increased (2.14; 95% CI, 1.07-4.30; 48 patients). Important secondary and safety outcomes, including minor bleeding, were sparsely reported.

Conclusions: Heparin in patients with sepsis, septic shock, and disseminated intravascular coagulation associated with infection may be associated with decreased mortality; however, the overall impact remains uncertain. Safety outcomes have been underreported and require further study. Increased major bleeding with heparin administration cannot be excluded. Large rigorous randomized trials are needed to evaluate more carefully the efficacy and safety of heparin in patients with sepsis, severe sepsis, and septic shock.

这篇文章的摘要也是非常经典,值得学习的。在背景目的部分,作者根据PICOS原则用一句话简单明了地交代了本文的研究目的。在方法学部分,有重点交代了数据库检索,文献选择和纳入,数据提取,质量评价,证据分级,尤其是有效性指标和安全性指标的明确定义。在结果部分,我们可以清楚地发现每一个结果都是和方法学部分相对应的,不存在报道方法学没有提及的指标结果,也不存在方法学中提及的指标没有提供结果。在结论部分,前面三句话交代了主要研究结果,为读者提供了一个清晰的认识,最后一句是对以后研究的一个提示。

当然,我也是刚看到这个题目摘要,还没权限下载全文,和大家一起简单学习和品读一些这篇文章的摘要和题目。对于题目和摘要的写作还有很多技巧和注意事项,还待各位去总结。回到上面的问题,什么样的文章才是一篇好文章?从CCM这篇文章我们不难发现,一篇好文章是围绕着读者撰写的,读者是上帝,简洁准确地传递读者想要知道的信息,尽最大的努力满足读者期望看到的东西,当然能做到深入浅出更好,因为读者的水平也是有很大差异的,你的文章可以简单易懂到让学生这样的读者看懂,也能够深入专业到吸引专家大牛这样的读者。说白了一点, 内容是前提,表达是关键 (Content is essential, Presentation is critical, Good content deserves good presentation)。

笔者| 谷万杰,广西医科大学研究生院。

本原创文章由科研时间首要发布,媒体转载请注明科研时间出处。让我们一起爱临床,爱科研,也爱听故事。

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