In a series of interviews, we will be previewing this year’s ACPGBI annual meeting in Dublin, 1-3 July. We talked to Professor Ronan O’Connell, Emeritus Professor of Surgery at University College Dublin School of Medicine, and Consultant Surgeon at St Vincent's University Hospital Dublin, Ireland, who discussed what makes a good clinical paper and how they have changed over the years.
“The first point I would make, is that any clinical paper must be relevant so unless there is a question to be answered there is not much that can be said. The best advice I ever got was from an old mentor who told me, ‘always begin a paper with the aim of this study is to…’ and then systematically work out what the aims are,” explained Professor O’Connell. “The author/s must start from a position of equipoise - meaning that the reader has to understand that the writer is approaching the subject from a completely unbiased position – so whatever conclusions are drawn can be seen to be honest and proportionate.”
As the current and previous editor of several prestigious journals - including the British Journal of Surgery, Diseases of the Colon and Rectum and the Annals of Surgery - he stated that in his experience this is unfortunately not always the case, because some authors believe that their surgical technique, approach or outcomes are superior to the current procedures performed.
“A good clinical paper is one that is clinical relevant, starts with an unbiased author/s who approaches it in a systematic way that is easily understood in terms of methodology and with appropriate ethics, power calculations and conforms to the Consolidated Standards of Reporting Trials (CONSORT) guidelines,” he added. “The paper’s results should be presented in a succinct manner that relate to the primary outcomes, sadly, it is quite often the case that the authors have been unable to assess the primary outcomes and the paper meanders into secondary outcomes. The conclusions should truthfully reflect the outcomes, which should be thoroughly discussed in relation to contemporary literature. Finally - and probably most importantly - there must be a clear, transparent and sufficiently detailed abstract, because many of us will not bother to read the paper in full if the abstract does not adhere to those requirements.”
Professor O’Connell stressed that although not all healthcare professionals - be they surgeons or nurses etc - have the ability to write clinical papers, they should have the basic skills to correctly interpret the aims and conclusions of clinical papers.
“In terms of engaging trainees in surgical research, one very important development has been the creation of research collaboratives such as the Clinical Research Network - established through the Royal College of Surgeons (England) – and the National Surgical Research Collaborative led by Tom Pinkey and Dion Morton from the University of Birmingham. This has proved to be a very powerful mechanism to engage trainees in research initiatives and includes some 90 percent of general surgical units in the UK.”
In discussing how clinical papers have evolved over the last few years, he noted that there are far fewer papers on basic science published in surgical journals. These papers have been replaced by papers focusing on cell biology, genomics and metabolomics.
“The emergence of these disciplines and the research methodologies they entail are beyond the remit of most surgical departments. As a result, many units are linking with collaborative groups as very few have the resources or critical mass to generate the data that are required. There is also a lot less animal research with a movement towards cell-based research,” he explained.
In colorectal surgery over the last decade or so, there has been a marked shift towards researching and assessing minimally-invasive, robotic and technological innovations. Another development has been the importance of auditing clinical outcomes, which are particularly valuable when looked at across regional, national or even major international collaborations to show what is actually happening in ‘real world’ clinical practice. This informs what research questions need to be addressed in order to improve surgical outcomes.
Professor O’Connell also highlighted the significance of systematic reviews and meta-analyses, and the ability to carry out such investigations underlines the importance of search engines (eg PubMed, Science Direct, Google Scholar, etc) in facilitating elaborate methods of combining data. The ease of which this can be performed has however, resulted in the creation of a plethora journals many of which charge authors to publish their papers.
“I would say the quality of coloproctology papers has generally improved, but in my view, there are too many ‘pay to publish’ journals now publishing poor to mediocre work. The value of systematic reviews and meta-analyses papers is that one can look at the quality of the primary sources (papers) under discussion. Having said that, too often these papers conclude that there are insufficient data to make any useful recommendations – and this all comes back to author/s not starting with a clinically relevant question, starting from a position of equipoise and conducting the research with a well-structured methodology.”
During his presentation his Dublin, he will highlight some of the most important clinical papers that he believes have changed colorectal practice in relation to rectal cancer, including the Dutch TME trial, the Stockholm I and II studies, the German Rectal Cancer Studies and more recent studies on minimally invasive surgical techniques.
“The meeting in Dublin is the best colorectal meeting in these islands with a comprehensive programme covering all aspects of contemporary colorectal practice and some outstanding guest lectures,” Professor O’Connell concluded. “The meeting offers delegates a unique opportunity to interact with colleagues, to network with contemporaries and make new friends – all in one of the friendliest cities in the world!”