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01 Jan 1970

Introduction

Plain language is grammatically perfect, with an entire sentence structure and precise word usage. Clear, to-the-point writing improves communication and takes less time to read and comprehend. There is an increasing desire for non-technical audiences to have access to current medical research in simple language formats(1). Thus, to communicate clinical research to a non-technical audience, best-practice approaches in the form of plain language summaries (PLSs) are necessary(2).

Clinical trial results that are presented in simple, stand-alone factual summaries have the potential to improve public awareness and participation in pharmaceutical research (3). PLSs, in particular, are intended to improve research participants' comprehension of trial processes and outcomes to improve their overall clinical trial experience(4). According to research spanning a variety of therapeutic indications, people who have taken part in clinical trials want to know the outcomes as soon as possible.

Furthermore, the PLS process could provide a significant opportunity for sponsors, contract research organizations (CROs), and sites to express their gratitude to patients for participating in their studies regularly, potentially increasing patients' trust and confidence that the study sponsor will actively protect their privacy and maintain the confidentiality of their data(5).

Policies and guidelines

A PLS is not simply a modified or rephrased version of the paper abstract. There are few policies and guidelines specified, to make scientific data accessible to the general public and develop their knowledge about ongoing research and its outcomes. Some of the very basics are as follows:

·         Be clear and concise.

·         Break documents into separate topics.

·         Use short paragraphs.

·         Use shortlists and bullets to organize information.

·         Use more headings with fewer sub-headings.

Need for PLS in science communication

u  Simplifying science through PLS

Simplicity, clarity, and transparency are the keys to communicating science effectively (1).PLS use non-technical language to explain the motivation, methods, and findings of a scientific investigation, allowing non-expert audiences to appropriately comprehend scientific findings(6). Scientific abstracts, on the other hand, are written for an audience of experts. Sharing a PLS with study participants has been found to improve public desire to participate in clinical trials.PLS has received endorsements from several international working groups and professional organizations. Even though the legislation has not yet been implemented, several sponsors have already begun to produce these documentations. The motivation has been altruistic rather than regulatory compliance.

u  Disseminating clinical trial data in PLS

The dissemination of study data is essential for clinical trials to be completed, and it is primarily intended to aid in the translation of evidence into policy and practice(7). Other academics and healthcare professionals, policymakers, funders, and the general public are among the audiences to whom scientists convey their findings(8). The possible advantages and burdens of research involvement must be considered at each stage of the trial procedure to improve the trial experience. Clinical trial research burdens entail psychological, physical, and financial consequences that occur both during follow-up and after participation is completed(7),(8). Failure to foresee or minimize the negative consequences of participation may have an impact on future clinical research participation and the desire to give time to longitudinal cohorts.

u  PLS in improving health literacy and vaccine awareness

Vaccines have demonstrated their ability to prevent vaccine-preventable diseases from causing illness, disability, and death(9). Vaccination and immunization are supported by a large body of evidence, the most recent examples being the COVID-19 vaccines. "The capacity of individuals to obtain, process, and understand basic health information and services needed to make appropriate health decisions" is defined as health literacy (10). It is a comprehensive notion that refers to people's abilities to handle the complicated demands of modern health(9). Plain language summaries can be used to inform the general public either directly or indirectly (via healthcare professionals) and may aid in the development of trust and vaccine confidence(11), (12).

 

Recommendations for plain language summaries for the following types of publications

u  Peer-reviewed medical journal publications

PLSs of peer-reviewed medical journal papers are a way to share research with a wide range of audiences, and they may promote medical research transparency, accountability, accessibility, discoverability, and inclusion(13). There is currently an industry-wide effort underway to establish consensus on plain language summaries, and initiatives have already been put in place to provide detailed guidance on plain language best practice, co-creation methods, patient-focused content, graphic and digital considerations, and publisher-specific guidelines(14). However, a basic set of suggestions is still needed to supplement existing projects and specify the minimal procedures required to provide PLSs that are trustworthy, credible, and of high quality.

u  Publications of company-sponsored medical research

Lay audiences are interested in medical advancements. Evidence supports the use of PLS for effectively communicating research to these broader lay audiences and demonstrates that PLS can improve understanding of research results(15). Understanding the implications of new data can help patients and their healthcare teams put research into context and can facilitate shared decision-making. Effective communication via PLS may broaden the scope of medical research by assisting in the avoidance of misunderstanding and misinterpretation of complex data, as well as the combating of misinformation.

u  Abstract plain language summary for Scientific congress

Many individuals are interested in learning about the most recent scientific advancements in the field of medicine. Clinical data, on the other hand, is often complex and difficult to comprehend if one is not a scientist. Developing plain-language summaries for research results given at medical conferences to enable interested non-scientists better comprehend the newest research. These are referred to as "abstract plain language summaries" (APLS).

  Benefits and challenges of PLSs

Benefits

Challenges

§  Allows researchers to reach a broader audience.

§  Serves as a tool for disseminating findings beyond a small group of scientists.

§  Helps explain research findings in easy words that are understandable to people who are not part of the scientific community.

§  Fewer chances of misinterpretation.

§  Allows for public participation which may improve the chances of research findings being funded, a priority for research funding authorities.

§  Regulations prohibit pharma companies from communicating directly with patients.

§  Difficult to maintain a balance between transparency and promotion.

§  Fear of spread of misinformation when disclosing early clinical trial results to patients.

§  Sometimes, conveying technical terms in plain language is tough.

§  Lack of robust and structured patient advocacy groups.

 

Future of PLS: Prospects and Perspectives

u  Scope of improvement

Plain language summaries (PLS) can spread medical knowledge to a wider audience and combat health misinformation, which is a major issue highlighted by the COVID-19 pandemic(11). Open Pharma guidelines(13), a 'how-to' guide for multi-stakeholder insights from Patient Focused Medicines Development, and PLS of Publication (14), a new journal article type from the Future Science Group, are examples of the recent breakthrough in PLSs. Despite these advancements, PLS have been reluctant to gain traction as supplements to medical papers, and there are no standardized methods for their creation or dissemination.

u  Key questions to address

The following questions need to be addressed to ensure formulating a proper PLS(15):

1.      What information must, and must not, be included in a PLS?

2.      Who are the target audiences for PLSs, and why are they important?

3.      What format(s) for a PLS is/are the best?

4.      What is the best process to design, review, and approve a PLS?

5.      What must be done to guarantee that PLSs are regarded as proper vehicles for accompanying scientific articles beyond medical education or promotional materials?

6.      To achieve maximum reach and discoverability, where and how should PLSs be published?

7.      How can the reach, quality, and value of PLSs be quantified?

8.      To avoid the sponsor's perception of selection bias, what approach should be used to choose articles that will have a PLS?

9.      What requirements should be followed while creating a PLS for a previously published article?

 

u  Scope of PLS according to geographical location

Assuming that every PLS and relevantquery submitted to an information retrieval (IR) system is geography-dependent is a significant concept(15). If the geographical scope of an article can be determined, this information can be utilized to improve the precision with which persons, places, and organizations named in the article can be located(16). More crucially, by tuning relevance ranking and query expansion algorithms using scope metadata, geographical scopes of documents can be used to reach out to readers against geography-dependent user queries.

Conclusion

PLSs are meant to give readers a clear, nontechnical, and easily accessible overview of medical and scientific literature; nevertheless, audience preferences for specific PLS formats have yet to be completely studied. By optimizing content and structure, the PLS can improve health literacy and, as a result, raise pharmaceutical knowledge and confidence as part of a larger integrated communication strategy(11). An industry-wide effort is underway to create consensus on PLSs. Even though the legislation has not yet been implemented, several sponsors have already begun to produce these documentations. The motivation behind simplifying science is more altruistic rather than regulatory compliance.

 References

1.         Chari D, Arnstein L, Passador L, Biegi T, Stones S, Matthews P, et al. Defining a process for developing and disseminating abstract plain language summaries for scientific congresses: A case study. 2020.

2.         RUDD RE, KAPHINGST K, COLTON T, GREGOIRE J, HYDE J. Rewriting Public Health Information in Plain Language. J Health Commun. 2004 May 1;9(3):195–206.

3.         Penlington M, Silverman H, Vasudevan A, Pavithran P. Plain Language Summaries of Clinical Trial Results: A Preliminary Study to Assess Availability of Easy-to-Understand Summaries and Approaches to Improving Public Engagement. Pharm Med. 2020 Dec 1;34(6):401–6.

4.         Martínez Silvagnoli L, Shepherd C, Pritchett J, Gardner J. Optimizing Readability and Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey Study. J Med Internet Res. 2022 Jan 11;24(1):e22122–e22122.

5.         Wilcox CS, Franceschi L, Simmons A. Layperson/Plain Language Summaries: Can Sponsors, CROs, and Sites Deliver in 2020? Innov Clin Neurosci. 2020 Jul 1;17(7–9):41–4.

6.         Stricker J, Chasiotis A, Kerwer M, Günther A. Scientific abstracts and plain language summaries in psychology: A comparison based on readability indices. PLOS ONE. 2020 Apr 2;15(4):e0231160.

7.         Dormer L, Walker J. Plain Language Summary of Publication articles: helping disseminate published scientific articles to patients. Future Oncol. 2020 Sep 1;16(25):1873–4.

8.         Degaga TS, Weston S, Tego TT, Abate DT, Aseffa A, Wayessa A, et al. Disseminating clinical study results to trial participants in Ethiopia: insights and lessons learned. Malar J. 2020 Jun 8;19(1):205–205.

9.         Lorini C, Santomauro F, Donzellini M, Capecchi L, Bechini A, Boccalini S, et al. Health literacy and vaccination: A systematic review. Hum Vaccines Immunother. 2017/12/06 ed. 2018 Feb 1;14(2):478–88.

10.       Biasio LR. Vaccine hesitancy and health literacy. Hum Vaccines Immunother. 2016/11/03 ed. 2017 Mar 4;13(3):701–2.

11.       Penlington M, Goulet P, Metcalfe B. Improving knowledge and trust in vaccines: A survey-based assessment of the potential of the European Union Clinical Trial Regulation No 536/2014 plain language summary to increase health literacy. Vaccine. 2022 Feb 7;40(6):924–33.

12.       Michel J-P, Goldberg J. Education, Healthy Ageing and Vaccine Literacy. J Nutr Health Aging. 2021 May 1;25(5):698–701.

13.       Rosenberg A, Baróniková S, Feighery L, Gattrell W, Olsen RE, Watson A, et al. Open Pharma recommendations for plain language summaries of peer-reviewed medical journal publications. Curr Med Res Opin. 2021 Nov 2;37(11):2015–6.

14.       Smith R. Improving and spreading plain language summaries of peer-reviewed medical journal publications. Curr Med Res Opin. 2021 Nov 2;37(11):2017–8.

15.       Lobban D, Gardner J, Matheis R. Plain language summaries of publications of company-sponsored medical research: what key questions do we need to address? Curr Med Res Opin. 2022 Feb 1;38(2):189–200.

16.       Andogah G, Bouma G, Nerbonne J. Every document has a geographical scope. Data Knowl Eng. 2012 Nov 1;81–82:1–20.

 

First To Commnet
 

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The pandemic has educated us with a bunch of new terminologies with the addition of black fungus to the new terror list. First of all, these demons have always resided in microbiology textbooks and acted like a terror for Microbiology students like us. So, they are nothing new. There are Zillions of viruses, bacteria, fungi, and parasites around to nail us to death. They were always there in textbooks, research papers, and clinical notes, it’s just that the pandemic has brought them to newspapers and TV channels. Thanks to mother nature and our immune system we are still alive even with a co-existence with them. Once the immune mechanism is compromised we become prey to those microscopic demons.


*We are not the same*

However, the preface is just to clear confusion about the overlap of two terminologies in news these days. The terms Black fungus disease and mucormycosis are being used interchangeably in popular articles and media. *Unfortunately, these two are entirely different disease that shares some similarities in the pathophysiology and presentation.* The prominent point that misguided us is their ability to attack immunocompromised patients at more or less similar target organs as in the case of COVID-19 infection. Moreover, no scientific literature has mentioned the term “ Black fungus” while describing research on mucormycosis and vice versa. Let us have a quick look at some dissimilarities of these two diseases:

*Different etiological agents*

Blank fungi or sometimes known as black yeasts fall into the class of Dematiaceous fungi that are responsible for a wide variety of infectious syndromes. They are often found in soil and rotten plant materials and are generally inhaled by most if not all individuals. However, its pathogenicity becomes significant in immunocompromised individuals.

The clinical nomenclatures caused by these black fungi are mycetoma, chromoblastomycosis, phaeohyphomycosis, and NOT mucormycosis which is of entirely different origin. The causative genera for these clinical manifestations are Exophiala dermatitidis, Cladophialophora-, Fonsecaea- and Ramichloridium-like strains, known in humans as agents of chromoblastomycosis.

On the other hand, the causative agents for mucormycosis are certain fungi, especially Rhizopus and mucormycetes, which are common contaminants of laboratory cultures. Some of the fungi that are responsible for mucormycosis are Rhizopus species, Mucor species, Rhizomucor species, Syncephalastrum species, Cunninghamella bertholletiae, Apophysomyces species, and Lichtheimia (formerly Absidia) species.

*What is BLACK in it*

At this point, this is clear that the causative agents are completely different for these two types of diseases.  Let us take a break from finding the differences between these two clinical manifestations and concentrate on a more interesting question.

*Why these Dematiaceous fungi are called “BLACK” fungus?*

Interestingly, these fungi possess unique pathogenic mechanisms attributed to the presence of melanin in their cell walls, which imparts the characteristic dark color to their spores and hyphae. On contrary, no such characteristic features are consistently prominent in the microscopic observation of all fungal species that are mucormycosis-causing organisms. Of note, Mucormycosis causes tissue blackening by devitalizing its blood supply, and this black appearance has been misinterpreted, misreported, and misdiagnosed as a black fungus by the media.

*We are on the right path*

Fortunately, despite the confusing terminology, our able physicians have detected the correct disease in COVID-affected individuals- it is Mucormycosis NOT anything caused by black fungus. Therefore, they are predominantly treated by IV amphotericin B and some azoles. Of note, itraconazole and voriconazole demonstrate the most consistent in vitro activity against black fungi (except S. prolificans, which are resistant to azoles) whereas voriconazole is completely ineffective in mucormycosis. Whereas, fluconazole and echinocandins exhibit limited or no activity against both types of diseases.

There are many other similarities in the pathogenesis and presentation that lead to the overlap of the terminologies. Sources for both the etiological agents are the same: soil, composts, rotten woods, and decaying organic matter. Mucormycosis has rhinocerebral, ocular, pulmonary, and gastrointestinal involvements. The blank fungus affects similar organs with less severity than mucormycosis. Mucormycosis is a more morbid condition than diseases involving black fungus. It often requires multiple surgeries even involving enucleation (Complete removal of the eye).

*Final Words*

I am not discussing the co-morbidities that trigger the mucormycosis infection as it is now a well-known topic. Just to mention that there is no scientific evidence that oxygen pipes, oxygen flowmeter, or humidifier are responsible for its spread or origin. Unlike Covid-19, it is not contagious and does not spread from one person to another. Finally, the causative agents are co-existing with us in nature and it is not going to be fatal to you unless you are being treated with high steroids and your diabetes is not under control during your COVID infections days.

References

Baker, R. D. (1957). Mucormycosis—a new disease?. Journal of the American Medical Association, 163(10), 805-808.

Baker R.D. (1971) Mucormycosis. In: The Pathologic Anatomy of Mycoses. Handbuch der Speziellen Pathologischen Anatomie und Histologie (Atmungswege und Lungen), vol 3 / 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80570-7_22

Hoog, G. S. de, Queiroz-Telles, F., Haase, G., Fernandez-Zeppenfeldt, G., Angelis, D. A., H. G. Gerrits van den Ende, A., … Yegres, F. (2000). Black fungi: clinical and pathogenic approaches. Medical Mycology, 38(s1), 243–250. doi:10.1080/mmy.38.s1.243.250

McGinnis MR, Hilger AE. Infections Caused by Black Fungi. Arch Dermatol. 1987;123(10):1300–1302. doi:10.1001/archderm.1987.01660340062020

https://www.cdc.gov/fungal/diseases/mucormycosis/treatment.html

Revankar SG. Dematiaceous fungi. Mycoses. 2007 Mar;50(2):91-101. doi: 10.1111/j.1439-0507.2006.01331.x. PMID: 17305771.

 
First To Commnet
 

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In the realm of scientific and medical communication, the roles of medical writers and scientific writers are often conflated, with some assuming they are interchangeable positions. However, each of these professions carries distinct responsibilities, skills, and purposes. This article will delve into the nuances that set medical and scientific writers apart, shedding light on their unique contributions to medicine, science, and healthcare.

Medical Writers: Bridging the Gap Between Science and the Public

Medical writers play a crucial role in translating complex medical and scientific information into clear, accessible content for a broad audience. They serve as intermediaries between healthcare professionals, researchers, and the general public. Key responsibilities of medical writers include:

»       Clinical Trial Documents: They are tasked with preparing documents such as clinical trial protocols, informed consent forms, and investigator brochures. These documents are essential for ensuring clinical trials' ethical and regulatory compliance.

»       Patient Education Materials: They develop patient-focused content, which includes pamphlets, brochures, and online resources. This content helps patients better understand their medical conditions, treatment options, and healthcare choices.

»       Regulatory Submissions: They collaborate with pharmaceutical companies to prepare regulatory submissions to health authorities, such as the FDA. Accuracy and precision in these documents are paramount to gaining approval for new drugs and therapies.

»       Scientific Manuscripts: They assist researchers in preparing manuscripts for submission to medical journals, ensuring the research findings are presented clearly and coherently.

»       Continuing Medical Education (CME): They create educational materials for healthcare professionals, enabling them to stay updated with the latest advancements in medicine and patient care.

Scientific Writers: Communicating Complex Science

Scientific writers, on the other hand, focus on the broader spectrum of scientific communication. Their primary role is to convey complex scientific concepts to other scientists, researchers, and experts within their respective fields. Here are some of the key responsibilities of scientific writers:

»       Research Articles: They craft research articles, review papers, and scientific reports that are submitted to peer-reviewed journals. These articles contribute to the dissemination of scientific knowledge and the advancement of research.

»       Grants and Proposals: They assist researchers and scientists in writing grant proposals, helping secure funding for their projects. Effective proposal writing is essential for gaining financial support.

»       Technical Manuals: They create technical manuals and documentation for laboratory equipment, software, and experimental procedures. This ensures that research protocols are accurately followed.

»       Conference Materials: They develop abstracts, posters, and presentations for scientific conferences, enabling researchers to share their findings with their peers.

»       Publications for Niche Audiences: They may produce content for specialized audiences, such as research institutions, scientific societies, or academic institutions.

Key Differences

While both medical writers and scientific writers deal with complex information, there are notable distinctions between their roles:

·       Audience

o   The primary audience for medical writers includes patients, healthcare professionals, regulatory agencies, and the general public. They aim to translate complex medical and scientific information into easily comprehensible language for these non-expert audiences. Their content often focuses on patient education, clinical trial information, and regulatory compliance.

o   Scientific writers primarily communicate with experts and professionals within their respective scientific fields. Their target audience comprises researchers, scientists, academics, and specialists who are well-versed in the subject matter. The content they produce is characterized by its technical depth and scientific rigor.

·       Content Complexity

o   Medical writers are skilled in simplifying and summarizing complex medical and scientific concepts. They break down technical jargon and present information in a clear, concise, and non-technical manner. The goal is to make healthcare information accessible and easily understood by patients and healthcare providers.

o   Scientific writers deal with intricate scientific content, including in-depth research findings, methodology, and data analysis. They are responsible for producing highly specialized content that meets the standards of peer-reviewed journals and other scientific publications. Their work requires a deep understanding of the subject matter and often involves complex data interpretation.

·       Regulatory Focus

o   Medical writers frequently work within the framework of healthcare regulations and guidelines. They ensure that documents such as clinical trial protocols, informed consent forms, and regulatory submissions comply with ethical and legal standards. Ensuring accuracy and adherence to regulatory requirements is a crucial aspect of their work.

o   While scientific writers are concerned with accuracy, their focus is less on regulatory compliance and more on contributing to the body of scientific knowledge. They emphasize the proper presentation of research findings and adherence to the conventions of scientific publishing, including citation and referencing.

·       Purpose

o   The primary purpose of medical writing is to inform, educate, and empower patients and healthcare professionals. They aim to improve patient outcomes by providing clear, reliable information about medical conditions, treatments, and healthcare choices.

o   Scientific writing serves the purpose of advancing scientific knowledge. It contributes to the academic and research community by disseminating research findings, encouraging collaboration, and fostering innovation. The goal is to expand the understanding of a particular scientific discipline.

·       Collaboration

o   Medical writers often collaborate with healthcare professionals, pharmaceutical companies, clinical researchers, and regulatory experts. They work closely with subject matter experts to ensure the accuracy and relevance of their content.

o   Scientific writers collaborate with researchers, scientists, and academic institutions. They assist in preparing research manuscripts, grant proposals, and technical documentation. Their collaboration is focused on advancing scientific research and publication.

·       Skill Set

o   Key skills for medical writers include medical knowledge, communication skills, regulatory understanding, and the ability to simplify complex information. They must also excel in patient-centered communication.

o   Scientific writers require a strong background in the specific scientific discipline they are writing about. They need skills in scientific research, data analysis, technical writing, and a deep understanding of research methodologies.

The Overlap and Collaboration

It is important to note that there is a degree of overlap between medical writers and scientific writers, especially in fields like medical journalism and health communication. In many cases, professionals in these roles collaborate to bridge the gap between scientific research and the broader public. Collaboration between these two roles strengthens the communication of scientific and medical information, ensuring that it effectively reaches both expert and lay audiences.

For example, a medical writer may collaborate with a scientist to translate their research findings into patient-friendly language for a press release or health website. Conversely, a scientific writer may team up with a medical writer to produce educational materials for healthcare professionals based on the latest research developments.

Conclusion

In the world of healthcare, medicine, and science, effective communication is paramount. Medical and scientific writers play essential roles in facilitating this communication, but their responsibilities and target audiences differ significantly. Recognizing and appreciating the distinctions between these two professions highlights the value they bring to the fields of medicine and science and underscores the importance of clear, accurate, and accessible communication in advancing healthcare and scientific discovery.
First To Commnet
 

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Review articles play a crucial role in analyzing existing research, providing valuable insights, and guiding researchers and practitioners in various fields. However, the process of getting a review article published in a reputable journal can be challenging. Many well-intentioned authors see their submissions rejected due to avoidable mistakes. This article will explore the common pitfalls that often lead to the rejection of review articles and provide guidance on how to avoid them.

Lack of a Clear and Focused Research Question

One of the fundamental mistakes authors make when writing a review article is failing to establish a clear and focused research question. A review article is not simply a summary of existing literature; it should address a specific question or problem and offer a comprehensive overview of the current state of knowledge on that topic.

How to Avoid This: Before starting your review article, define a clear research question or objective. Consider what gaps or controversies exist in the literature and how your review can contribute to resolving them. A well-defined research question will provide structure to your article and guide your literature search.

Inadequate Literature Search and Selection

Another common mistake is conducting an insufficient literature search or failing to select and filter the literature included in the review adequately. A comprehensive and systematic literature search is essential to ensure your review is exhaustive and unbiased.

How to Avoid This: Use reputable databases, library resources, and search engines to conduct your literature search. Employ relevant keywords, controlled vocabulary terms, and Boolean operators to refine your search. Be transparent about your search strategy and criteria for including or excluding studies in your review. Utilize tools like PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to enhance the rigor of your literature search and selection process.

Lack of a Structured and Coherent Narrative

A well-structured narrative is vital for a review article's success. Some authors make the mistake of presenting a disjointed and disorganized collection of studies without a coherent storyline. A review article should guide readers through the literature, highlighting key findings, trends, and debates.

How to Avoid This: Organize your review article into logical sections, such as an introduction, methods, main findings, discussion, and conclusion. Within these sections, provide a clear and concise summary of each study, emphasizing its relevance to your research question. Use subheadings and topic sentences to facilitate readability and navigation. Create a narrative flow that links studies and concepts, helping readers follow your argument.

Ignoring Quality Assessment and Critical Appraisal

Review articles are expected to critically appraise the quality and relevance of the studies they include. Neglecting to assess the methodological rigor of the studies can undermine the credibility and usefulness of your review. Failing to consider the limitations and biases of the included research is a common mistake.

How to Avoid This: Develop a systematic approach to assess the quality of studies included in your review. Consider factors such as study design, sample size, data collection methods, and statistical analysis. Be transparent about the strengths and weaknesses of each study and how these limitations may affect the interpretation of results. A critical appraisal of the literature enhances the reliability and trustworthiness of your review.

Insufficient Analysis and Interpretation

Perhaps one of the most critical mistakes in writing a review article is merely summarizing studies without providing meaningful analysis and interpretation. A review should present what has been found in previous research and offer insights, patterns, and implications for future work.

How to Avoid This: Go beyond summarizing individual studies by synthesizing the evidence and identifying overarching themes, trends, or controversies in the literature. Discuss the implications of these findings for theory, practice, or policy. Consider how the reviewed studies contribute to a broader understanding of the topic and highlight areas where further research is needed. Engage in critical analysis and offer your perspective on the state of knowledge in your field.

Failure to Address Conflicting Evidence

Some authors overlook or downplay conflicting evidence within the literature. This can weaken the review's credibility, as it fails to acknowledge the complexity of the topic and the ongoing debates within the field.

How to Avoid This: Acknowledge conflicting findings and controversies in your field. Discuss the reasons behind discrepancies in research results. Consider the potential implications of conflicting evidence and how they might inform future research directions.

Overly Descriptive vs. Analytical Approach

A common pitfall is adopting an overly descriptive approach instead of an analytical one, often resulting in a review article lacking depth and original insights.

How to Avoid This: Strive for an analytical approach that goes beyond summarization. Provide interpretation and critique of the studies, highlighting their contributions and limitations. Engage in comparative analysis, identifying patterns, outliers, and gaps in the literature.

Conclusion

Writing a successful review article requires careful planning, rigorous research, and effective communication. By avoiding these common mistakes – lack of a clear research question, inadequate literature search and selection, a lack of structured narrative, ignoring quality assessment, and insufficient synthesis and interpretation – you can significantly improve the chances of your review article being accepted for publication.

It is important to remember that the peer-review process for review articles is rigorous, and journals seek articles that summarise existing research and provide valuable insights and guidance to the academic and professional community. By addressing these common pitfalls and adhering to best practices in review article writing, you can increase the likelihood of your work being recognized, appreciated, and published in reputable journals, ultimately contributing to advancing knowledge in your field.


What Do You Think is the Most Common Reason for Desk Rejection?

A. Poor Language and Grammar

B. Journal Scope Mismatch

C. Plagiarism

D. Poor choice of topic
First To Commnet
 

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Writing a thesis is a formidable task that often marks the culmination of years of academic dedication and research. It is a crucial milestone that demands precision, dedication, and an in-depth understanding of the subject matter. While some students embark on this journey enthusiastically, others find themselves overwhelmed by the complexity of the task. In such cases, seeking professional assistance for thesis writing can be wise. This article will explore several compelling reasons why hiring a professional for thesis writing assistance can make a significant difference.

English as a Non-native Language

For many students pursuing advanced degrees, English is not their native language. While they may have a strong grasp of the subject matter, expressing complex ideas in English can be challenging. A professional thesis writer can bridge this language gap. They are well-versed in academic writing standards and can ensure that your thesis is written in clear, concise, and grammatically correct English. This not only enhances the quality of your work but also ensures that your research is easily understood and respected by your peers and professors.

Time Constraint

Completing a thesis requires a substantial amount of time and effort. Many students, especially those who are also juggling part-time jobs or other responsibilities, struggle to find the necessary time to devote to their thesis. Hiring a professional writer can help alleviate this time constraint. These experts are experienced in managing their time efficiently and can work on your thesis while you focus on other important aspects of your life, ensuring that you meet your deadlines.

Formatting and Language Improvement

The formatting and language quality of your thesis are essential factors that can significantly impact your evaluation. Thesis formatting can be complex and time-consuming, with different institutions and academic fields having specific requirements. Professional thesis writers are well-versed in these formatting standards, ensuring that your thesis meets all the necessary guidelines. Additionally, they can improve the overall language quality of your work, making it more coherent and scholarly.

Grammar and Language Proficiency

Flawless grammar and language proficiency are paramount in academic writing. Even native English speakers can struggle with grammar and language issues in their writing. Professional thesis writers are meticulous in their grammar and language usage. They can identify and rectify errors in your thesis, ensuring that your work is polished and error-free. This attention to detail enhances the overall quality of your thesis and reflects positively on your academic abilities.

Image Quality

A thesis often includes charts, graphs, and images to support research findings. The quality of these visual elements is crucial in conveying information effectively. A professional thesis writer can assist in enhancing the quality of these images, ensuring they are clear, well-labelled, and visually appealing. This not only improves the overall presentation of your research but also aids in conveying your findings to your readers more effectively.

Cost of Software

Thesis writing often requires access to various software tools, such as plagiarism checkers, reference managers, and image processing software. These tools can be expensive, and students may not have the financial resources to invest in them. However, professional thesis writers typically have access to these tools as part of their services. This eliminates the need for you to purchase expensive software and ensures that your thesis benefits from the use of these valuable resources.

Plagiarism Detection

Plagiarism is a serious academic offence that can have severe consequences, including the rejection of your thesis and damage to your academic reputation. Professional thesis writers are well-versed in the importance of originality and can use plagiarism detection software to ensure that their work is entirely free of plagiarized content. This provides peace of mind and helps you maintain academic integrity throughout the process of involving a professional for thesis writing assistance.

 Reference Management

Managing references and citations is a critical aspect of thesis writing. Different academic fields have their citation styles, and keeping track of sources can be challenging. Professional writers are experienced in using reference management software to correctly organise and format citations, assisting in thesis writing. This saves you time and ensures that your thesis adheres to the required citation style consistently.

 Image Processing Software

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Endomyocardial fibrosis (EMF), also known as Loffler and Davies disease, is a mysterious heart condition characterized by fibrosis in the heart's chambers, leading to severe damage and valve issues. It primarily affects impoverished communities in tropical Africa, where diagnostic tools and medical care are scarce.(1)

The disease's progression involves inflammation, necrosis, thrombosis, and eventually fibrosis. The exact cause remains unclear, with factors such as ethnicity, diet, poverty, infection, and eosinophilia playing potential roles. Although cerium and malnutrition have been considered, their direct link to EMF is unconfirmed. Parasites like microfilaria and malaria are associated with EMF, suggesting their involvement in its pathogenesis.(2)

Diagnosing endomyocardial fibrosis can be challenging due to its rarity and the lack of standard diagnostic criteria. However, there are key clinical and imaging methods that can aid in its identification.(3)

Advancements in diagnosing endomyocardial fibrosis

Traditionally, researchers relied on post-mortem examinations and angiography for diagnosing EMF. However, recent advancements in diagnostic methods, such as echocardiography and cardiac magnetic resonance (CMR), have significantly improved the accuracy of EMF diagnosis. Mocumbi and colleagues have introduced a scoring system to assess EMF severity. The scoring system is more effective in population-based surveys where early disease stages can be detected.(2)

      I.          Clinical Stages of EMF

The early symptoms of EMF are often nonspecific and can resemble febrile illnesses, including lymphadenopathy and occasionally splenomegaly. This similarity often leads to provisional diagnoses of malaria, which is prevalent in the same regions as EMF. Unfortunately, EMF becomes more apparent in its advanced stages of heart failure. Alderman described the disease's initial clinical presentation and stages:

·       The necrotic stage with fever and lymphadenopathy

·       The thrombotic stage with thrombotic emboli and splinter haemorrhages

·       The fibrotic stage characterized by restrictive myopathy

Most EMF patients are diagnosed late, presenting with advanced heart failure, gross ascites, anorexia, weight loss, and occasional chest pain. Tense ascites is a common feature in EMF cases, and it is often associated with mild or no oedema, reflecting a systemic impact of the disease.(2)

    II.          Cardiac findings in EMF from ECG and chest X-ray

Electrocardiogram (ECG) and chest X-ray findings play a crucial role in diagnosing EMF, although they often lack specificity.(3)

·       ECG: This usually reveals non-specific abnormalities. Sinus tachycardia is observed in approximately 22% of cases, while 43% show signs of atrial abnormality. First-degree heart block is identified in 39% of patients, and atrial fibrillation is present in 13%. However, these findings are not exclusive to EMF, making it challenging to rely solely on them for diagnosis.

·       Chest X-rays: This tends to display non-specific features. Cardiomegaly, an enlargement of the heart, is a common finding in EMF patients. Additionally, pericardial effusion, the accumulation of fluid around the heart, is present in 87% of cases. Though, they do not provide a definitive diagnosis of EMF.

 III.          Haemotalogical investigations

·       Iron deficiency anaemia is a common feature in EMF patients, with haemoglobin levels as low as 5g/dL and depleted iron stores.

·       Absolute eosinophilia is not typically seen in patients who present late with heart failure. High eosinophil counts characterize the early phases of the disease.

·      Leukocytosis, an increase in white blood cells, is not a prominent feature of EMF.

·       Hypomagnesemia has been reported in several EMF patients. This condition has been considered a potential risk factor when combined with Cerium, an element found in diets rich in tubers.(4)

 IV.          Echocardiography as a key diagnostic tool (1)

Echocardiography has emerged as the gold standard tool for diagnosing EMF. This diagnostic method involves examining the heart from various angles using five standard echocardiographic views:

Five primary diagnostic echocardiographic features of EMF are commonly observed together:

·       Apical fibrosis

·       Ventricular wall fibrosis

·       Significant atrial enlargement

·       Atrioventricular valve regurgitation

·       Obliteration of the ventricular cavity

The second group of features, though not present in all patients, can provide further confirmation of the diagnosis. These include:

·       Pericardial effusion

·       Formation of an endocardial fibrous shelf (EFS) which extends into the posterior left ventricular wall recess and engulfs the posterior mitral valve leaflet.

Furthermore, the presence of pericardial calcification has been noted, leading to a form of constrictive pericarditis known as endomyocardiopericarial fibrosis (EMPF). Three echocardiographic types of EMF have been recognized:

·       Left ventricular (53%)

·       Right ventricular (18%)

·       Biventricular (29%)

These echocardiographic findings correlate well with intraoperative and postmortem findings, including the three layers within the myocardium, the formation of a line of cleavage utilized in surgical procedures, and the characteristic enlargement of the atria.

    V.          Cardiac magnetic resonance

CMR has taken precedence over cardiac catheterization as the primary diagnostic tool for EMF. CMR employs various imaging techniques, including cine imaging, first-pass contrast-enhanced perfusion, and Late Gadolinium Enhancement (LGE), to identify the presence of EMF. Through CMR, physicians can visualize critical diagnostic features of EMF, such as the obliteration of the ventricle, apical dimples, thrombi, grossly dilated atria, and regurgitant atrioventricular valves. Furthermore, CMR images commonly reveal pericardial effusion and ascites, characteristic findings in EMF cases.(1)

 VI.          Cardiac catheterisation

Cardiac catheterization plays a crucial role in EMF patients, particularly in procedures like excision biopsy of the endocardium. Histological examination of EMF reveals distinctive features, including:

·       Reactive fibrosis

·       Deposition of type-1 collagen

·       Subendocardial infarction

·       Eosinophil infiltration in the upper myocardium

·       Thrombus formation

·        Mild inflammatory infiltrates, primarily composed of lymphocytes, are frequent

Cardiac catheterization offers the opportunity for direct sampling of endocardial tissue, allowing for precise histological assessment and contributing to our understanding of EMF's underlying pathological processes.(2)

Conclusion

The diagnosis of EMF relies on advanced imaging techniques, notably echocardiography and cardiac magnetic resonance. These tools reveal characteristic features such as apical fibrosis, ventricular wall fibrosis, atrial enlargement, valve regurgitation, and ventricular obliteration. Cardiac catheterization can offer histological insights. Early diagnosis is critical to improve the management of this enigmatic and often devastating cardiac condition.

Cover Image Credit: 

M. P. M. Graham-Brown, A. S. Patel, D. J. Stensel, D. S. March, A.-M. Marsh, J. McAdam, G. P. McCann, J. O. Burton, "Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities", BioMed Research International, vol. 2017, Article ID 5453606, 14 pages, 2017. https://doi.org/10.1155/2017/5453606

References

1.         Khalil SI. Endomyocardial Fibrosis: Diagnosis and Management. JVD. 2020 Feb;Volume 8:1–9.

2.         Duraes AR, de Souza Lima Bitar Y, Roever L, Neto MG. Endomyocardial fibrosis: past, present, and future. Heart Fail Rev. 2020 Sep;25(5):725–30.

3.         de Carvalho FP, Azevedo CF. Comprehensive Assessment of Endomyocardial Fibrosis with Cardiac MRI: Morphology, Function, and Tissue Characterization. RadioGraphics. 2020 Mar;40(2):336–53.

4.         Grimaldi A, Mocumbi AO, Freers J, Lachaud M, Mirabel M, Ferreira B, et al. Tropical Endomyocardial Fibrosis: Natural History, Challenges, and Perspectives. Circulation. 2016 Jun 14;133(24):2503–15.

What is the gold standard tool for the diagnosis of endomyocardial fibrosis?

  1. Echocardiography
  2. Cardiac catheterization
  3. Cardiac magnetic resonance
  4. Electrocardiography
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Sexual assault is a deeply traumatic experience, and survivors often turn to medical professionals for support and evidence collection in the aftermath. The medical examination conducted in these cases plays a critical role in both the survivor’s recovery and the pursuit of justice. This guide is meticulously designed to serve as an essential tool for medical practitioners, providing a step-by-step overview of the procedures involved in conducting a medical examination for sexual assault.

Prioritizing Sensitivity: A Trust-Building Foundation

·       Establishing Trust:

Initiate the examination process by introducing yourself and clarifying your role. Prioritize the survivor’s comfort and autonomy, ensuring transparent communication about each step in the examination.

·       Trauma-Informed Care:

Acknowledge and understand the potential impact of trauma on survivors. Utilize non-triggering language, creating a calm and supportive environment. Empower survivors by offering options and involving them in decision-making about their care.

Initial Assessment: Gathering Crucial Information

ǂ   Patient History:

Gather a detailed medical and psychological history, demonstrating sensitivity and empathy when inquiring about the details of the assault.

ǂ   Consent:

Transparently explain the purpose of the examination and obtain informed consent. Address any concerns the survivor may have, fostering open communication.

Thorough Physical Examination: Identifying Signs of Trauma

o   Head-to-Toe Assessment:

Conduct a comprehensive physical examination, paying special attention to areas commonly affected during sexual assault, such as the genitals, breasts, and face.

o   Genital Examination:

Employ a standardized approach to examine the genital area, documenting injuries or abnormalities. Collect samples for evidence preservation, including swabs for DNA analysis.

o   STI Screening:

Perform a detailed screening for sexually transmitted infections (STIs), providing prophylactic treatment based on established protocols.

Evidence Collection: Preserving Critical Information

§  Clothing and Personal Belongings:

Secure and label the survivor’s clothing and personal items for forensic analysis. Document any visible stains, tears, or foreign materials.

§  Body Fluids and Samples:

Collect swabs from relevant body areas to capture potential DNA evidence. Preserve samples in appropriate containers to maintain the chain of custody.

§  Photographic Documentation:

Take clear and detailed photographs of visible injuries or physical evidence, following a standardized protocol for consistency.

Post-Examination Care: Addressing Immediate Needs

»       Medical Treatment:

Address immediate medical needs, such as treating injuries or providing emergency contraception. Offer referrals for ongoing medical and psychological support.

»       Emotional Support:

Provide survivors with resources for counseling and support groups. Emphasize the importance of seeking emotional assistance in coping with trauma.

Collaboration with Forensic Experts: Maximizing Expertise

Ä Forensic Nurse Examiners:

Collaborate with forensic nurse examiners, leveraging their specialized training in sexual assault examinations. Seek guidance from forensic experts on evidence collection and preservation.

Ä Law Enforcement Coordination:

Establish clear communication with law enforcement to ensure a seamless transfer of evidence. Provide timely and accurate documentation for legal proceedings.

Visual Tools for Guidance: Enhancing Communication

ð Timeline of Evidence Collection:

Visualize the chronological order of evidence collection, emphasizing the importance of prompt action. Highlight key milestones like the initial assessment, physical examination, and evidence preservation.

ð Anatomical Diagrams:

Create infographics illustrating areas commonly affected during sexual assault. Clear, labeled diagrams aid practitioners in identifying and documenting injuries.

ð Checklist for Comprehensive Examinations:

Develop a concise checklist outlining essential steps, including patient history, consent, physical examination, evidence collection, and post-examination care.

ð Communication Tips with Survivors:

Design a visual guide with bullet points on trauma-informed communication. Emphasize the use of non-triggering language, maintaining sensitivity, and prioritizing survivor autonomy.

ð Referral Resources:

Provide a list of resources for medical, psychological, and legal support. Include contact information for counseling services, support groups, and legal advocacy organizations.

Other Considerations: Empowering a Survivor-centered Care

Ø  Inclusivity and Cultural Sensitivity:

 

Recognize and respect diverse backgrounds and experiences. Tailor the examination process to be culturally sensitive, considering factors such as religious beliefs, language barriers, and cultural norms.

Ø  Communication Beyond the Examination:

Extend communication strategies beyond the examination room. Maintain open lines of communication with survivors post-examination, ensuring they are aware of available resources and follow-up appointments. Provide guidelines on how to sensitively discuss ongoing care and potential legal proceedings.

Ø  Documentation and Record-Keeping:

Emphasize the importance of meticulous documentation. Detail-oriented record-keeping not only aids in legal proceedings but also contributes to the survivor’s comprehensive care. Follow templates or guidelines for documenting injuries, evidence collection, and post-examination care to ensure consistency and accuracy.

Ø  Continued Education and Training:

Acknowledge that sexual assault examination protocols evolve. Participate in ongoing education and training to stay abreast of the latest research, forensic techniques, and trauma-informed practices. Facilitate a culture of continuous learning within healthcare institutions.

Ø  Self-Care for Practitioners:

Address the emotional toll that conducting sexual assault examinations may have on healthcare professionals. Adhere to resources and guidance on self-care strategies, emphasizing the importance of seeking support and recognizing signs of burnout or vicarious trauma.

Ø  Empowering Survivors in Decision-Making:

Enhance the understanding of trauma-informed approaches to decision-making. Facilitate open dialogue with survivors, ensuring they are active participants in determining the course of their care. Respect survivors’ choices and autonomy throughout the entire process.

Ø  Interdisciplinary Collaboration:

Work closely with social workers, mental health professionals, and legal experts to provide comprehensive care. Foster a collaborative approach to address the multifaceted needs of survivors beyond the immediate medical examination.

Ø  Technology and Telehealth Considerations:

Recognize the role of technology in providing remote support and examinations. In instances where in-person examinations may pose challenges, consider the use of telehealth solutions while maintaining the utmost sensitivity and privacy. Follow guidelines for ensuring secure and confidential virtual interactions.

Summary

In cases of sexual assault, medical practitioners play a pivotal role in supporting survivors and contributing to the pursuit of justice. A well-executed medical examination not only ensures proper evidence collection but also plays a crucial role in the survivor’s recovery process. This comprehensive guide, crafted with sensitivity and a commitment to trauma-informed care, serves as an indispensable tool for healthcare professionals. The suggested visual aids, infographics, and bullet points enhance communication, guiding practitioners through each crucial step. By following this guide, medical practitioners can navigate the complexities of sexual assault examinations with professionalism, empathy, and a focus on survivor-centered care, fostering healing and empowerment.

Key messages

ü  Survivor-Centered Care: Prioritize survivors’ autonomy, well-being, and choices throughout the examination, fostering a safe and supportive environment.

ü  Continuous Education: Stay updated on evolving protocols, trauma-informed practices, and interdisciplinary collaboration to provide the best possible care.

ü  Compassion and Self-Care: Acknowledge the emotional toll on practitioners, emphasizing self-care and compassionate communication to support survivors effectively and sustain a resilient healthcare community.

References

a.      GUIDELINES & PROTOCOLS Medico-legal care for survivors/victims of Sexual Violence. Ministry of Health & Family Welfare, Govt. of India.

b.     Manual for Medical Examination Sexual Assault, Centre for Enquiry into Health and Allied Themes, Mumbai, India.

 

How can medical practitioners promote cultural sensitivity during a sexual assault examination?

    1. Ignore cultural differences for objectivity
    2. Tailor the examination process to cultural norms
    3. Discourage communication about cultural beliefs
    4. Apply a one-size-fits-all approach to care


 Image credit: Freepik

 
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