1. What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma May 2012Class 8 Introdução à Medicina II

2. SUMMARY I ntroduction J ustification R esearch question A ims M ethods R esults D iscussion C onclusions A cknowledges R eferences What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma May 20122Class 8

3. INTRODUCTION May 20123Class 8 S CIENTIFIC KNOWLEDGE DIVULGATION Scientific journals BooksConferences Governmental reports Technical reports Flyers Online versions What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

4. INTRODUCTION May 20124Class 8 Scientific articles Scientific journals Philosophical Transactions of the Royal Society 1665 Philosophical Transactions of the Royal Society 1665 New England Journal of Medicine 1812 New England Journal of Medicine 1812 published in What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

5. INTRODUCTION May 20125Class 8 Contain… Motivation of the author Experimental design and execution Meaning of the results Conclusions and recommendations Require… Clarity Concision Organization Objectivity Better comprehension More effective way of using its results To accomplish What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

6. INTRODUCTION May 20126Class 8 Average number of times an article published in a given journal was cited in the last two years Comparison between different scientific areas can induce biased conclusions Journal Citation ReportISI Web of Knowledge What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

7. INTRODUCTION May 20127Class 8 Possible biases: Size of the articles IF of the journal in which they are published ISI Web of Knowledge Presented in the end of the academic work, bibliographies or specific indexes What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

8. INTRODUCTION May 20128Class 8 Information for the authors on how they must write their manuscript Scientific Journals No presentation of guidelines Presentation of guidelines (recommendation or obligation) Editing Guidelines Reporting Guidelines External Uniform Requirements STREGA SQUIRE STROBE CONSORT STARD PRISMA GNOSIS TREND ORION COREQ QUORUM REMARK MOOSE Internal What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

9. INTRODUCTION May 20129Class 8 General Reporting Guidelines Vancouver Group (Vancouver, British Columbia, 1978) International Committee of Medical Journal Editors (ICMJE) First statements: 1979 Last update: 2010 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

10. INTRODUCTION May 201210Class 8 Refering to a particular type of study and to other specific aspects of science publication What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma GNOSISGuidelines for neuro-oncology: Standards for investigational studies CONSORTConsolidated Standards of Reporting Trials COREQConsolidated criteria for reporting qualitative research MOOSEMeta-analysis of Observational Studies in Epidemiology PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses QUORUMQuality of Reporting of Meta-analyses of Randomized Controlled Trials REMARKREporting recommendations for tumour MARKer prognostic studies SQUIREStandards for Quality Improvement Reporting Excellence STARDStandards for the Reporting of Diagnostic Accuracy Studies STREGAStrengthening the Reporting of Genetic Association studies STROBEStrengthening the Reporting of Observational studies in Epidemiology TRENDTransparent Reporting of Evaluations with Nonrandomized Designs

11. JUSTIFICATION December 201111Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Medical care is improved by new discoveries and studies that promote a better life perspective for patients. Breakthroughs are published in scientific articles. In order to achieve a better treatment for patients and a good management of resources it is imperative to divulgate the knowledge in the clearest way possible Scientific articles highly effective. May 2012Class 811

12. Depends on… Sientific content Way that it is written May 201212Class 8 JUSTIFICATION Influences… Interest of scientific community Diffusion and applicability of the results What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

13. RESEARCH QUESTION May 201213Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

14. AIMS May 201214Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

15. METHODS May 201215Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Type of study: O bservational study T ransversal study A nalytic study Type of study: O bservational study T ransversal study A nalytic study

16. METHODS May 201216Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma TasksClass 8Class 21 Colect journals of General and Internal Medicine XX Apply exclusion/inclusion criteria X (distribution) X (collection) Colect Impact Factors from 2008, 2009 and 2010 X (distribution) X (collection) Analyse the reporting guidelines X (distribution) X (collection) Colect articles from 2008 and their number of citations X Analyse journals by group X Analyse 6 articles from 2008 for each group X Calculate impact of articles from 2008 and make statistical analyses X

17. May 201217Class 8 Search in ISI Web of Knowledge for journals of General and Internal Medicine. http:// www.isiknowledge.com METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

18. May 201218Class 8 From all the journals found, distribute its primary analysis by the students of the two classes to apply some criteria and collect their Impact Factor of 2008, 2009 and 2010. Inclusion Criteria Journals which have an available web site. Exclusion Criteria Websites not written in Portuguese, English or Spanish. METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

19. May 201219Class 8 Compare the analysis of the journals made by the two reviewers (and third reviewer, when necessary) and select the journals for the study. METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Some statistic analysis using SPSS was done to clarify the motives of exclusion of some journals and to verify how many journals were included in the study.

20. May 201220Class 8 From the included journals, select those with reporting guidelines and verify its type. Go to the website of the selected journals Read the section of the instructions for authors Verify if any guidelines are presented and analyse its type Fill in a database (SPSS) with the information colected 3 reviewers Select journals that present some type of reporting guidelines METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

21. May 201221Class 8 Search for articles of the selected journals which were published in 2008. This information was collected on ISI Web of Knowledge METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

22. May 201222Class 8 Export information about the selected articles to SPSS. Title of the article Authors Number of citations Journal in which it was published METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

23. May 201223Class 8 Calculate the impact for each article. CN – Citation Number IF – Impact Factor of the journal CN – Citation Number IF – Impact Factor of the journal METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

24. May 201224Class 8 Verify if there is an association between the impact of the articles and the type of reporting guidelines used by the journals. METHODS What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma  Separate articles into 3 groups:  Articles published in journals using internal reporting guidelines  Articles published in journals using external reporting guidelines (specifying what type)  Articles published in journals using both types of reporting guidelines  Apply some statistc analysis to answer the question of our work, starting for calculating the median impact of the articles for each group.

25. RESULTS May 2012 25 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma ISI Web of Knownledge Search – 153 journals Appliance of inclusion and exclusion criteria 133 Analysis of the instructions for authors Included – 123 47 – internal reporting guidelines 19 – external reporting guidelines 57 – both types of reporting guidelines Exluded - 20 16 not available website 4 unreadable language Exluded – 10 No presentation of reporting guidelines 57 – Uniform Requirements 27 – CONSORT 15 – STARD 14 – STROBE 12 – PRISMA 38 – Other type

26. RESULTS May 201226Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Advantages and disadvantages of internal and external reporting guidelines found during the analysis of the instructions for authors: Internal reporting guidelinesExternal reporting guidelines Possibility of highlighting specific points that the journal wants the author to focus on. Normally presented on the form of checklists (except Uniform Requirements): Less exhausting Easier to interpretate High level of detail of Uniform Requirements Necessity to read with a high level of attention due to the specific details that change from journal to journal. Loss of individuality of the journal. + -

27. RESULTS May 201227Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma IF: median (interquartile range) 200820092010 Website Not available (n= 12) 0,8 (0,5)0,9 (0,7)0,9 (0,6) Available (n= 90) 1,7 (1,8)1,5 (1,8)1,6 (1,9) English language (n= 88) 1,7 (1,8)1,5 (1,8)1,6 (2,0) Not English language (n=12) 0,7 (-)0,8 (-)1,0 (-) Reporting guidelines Internal (n= 32) 1,5 (1,9)1,4 (1,6)1,4 (2,2) External (n= 12) 1,2 (2,3)1,4 (1,9)1,2 (1,9) Both (n= 40) 1,9 (2,5)2,0 (2,9)2,0 (2,5) None (n=6) 1,5 (2,0)1,6 (1,9)1,6 (2,1) Table 1: Median and interquartile range of the impact factors of 2008, 2009 and 2010 for many categories concerned to the website and the type of reporting guidelines presented by the journal (missing = 13).

28. RESULTS May 201228Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Graphic 1: Number of articles collected in the total and subdivided by different categories: presentation, by the journal in which the articles were published, of external reporting guidelines, internal reporting guidelines or both types of reporting guidelines.

29. RESULTS May 201229Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Graphic 2: Percentage of articles collected which presented an impact equal to zero or different than zero. 3% of the articles did not present impact, because one or more of the values needed to calculated it were missing.

30. RESULTS May 201230Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Graphic 2: Percentage of articles from journals that use internal reporting guidelines, external reporting guidelines or both types of reporting guidelines, within the group of articles with an impact equal to zero.. Because of the values found, the percentage of articles within groups with an impact equal to zero was calculated:

31. RESULTS May 201231Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Table 2: Median and interquartile range of the impact of the articles selected subdivided in groups by the type of reporting guidelines presented and including articles with a zer impact. Reporting guidelines Internal ExternalBoth Impact of the articles: median (interquartile range) 0,00 (1,93)0,00 (1,19)0,07 (1,74) Including the articles with zero impact: Excluding the articles with zero impact: Reporting guidelines InternalExternalBoth Impact of the articles: median (interquartile range) 2,22 (3,67)3,19 (1,46)1,43 (3,28) Table 3: Median and interquartile range of the impact of the articles selected subdivided in groups by the type of reporting guidelines presented and excluding the articles with a zero impact.

32. DISCUSSION May 201232Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Median in journals with available website Median in journals with no available website Median in journals with both types of reporting guidelines Median in journals with no reporting guidelines Comparison between medians of the impact factors for each year Median in journals with external reporting guidelines Median in journals with internal reporting guidelines If the website of a journal is not available, it will be more difficult to access its contents. So, as expected, the impact factor of the journals with an available website is higher. Journals with both types of reporting guidelines assume an identity, but they also follow a pattern, which may be the reason why their impact factor is the higher. Journals which only follow external reporting guidelines may loose creativity and, therefore, the interest aroused in the scientific community is lower.

33. DISCUSSION May 201233Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma The majority of the articles has an impact factor equal to zero. Reasons why this may occur: The current popularity of the particular topics referred to in the articles is very low. The topics covered by the articles are too restricted. Incorrect use of references: not mentioning an article when it was used in the study. Among others.

34. DISCUSSION May 201234Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Majority of articles with an impact equal to zero uses both types of reporting guidelines (48%). Percentage of articles with an impact equal to zero that use internal reporting guidelines (21%) Most articles come from journals using both types of reporting guidelines, so it is expected that if there is no difference between the use of any group of reporting guidelines, the percentage of articles with a citation number equal to zero would be higher in this group, as verified. Percentage of articles with an impact equal to zero that use external reporting guidelines (31%) On the other hand: On one hand: Why? Note that there are more articles from journals using internal reporting guidelines rather than external ones.

35. DISCUSSION May 201235Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Internal reporting guidelines x External reporting guidelines 1 The median of the impact of all the articles of this two categories is the same and it is equal to zero. So, we can not conclude if there are difference in choosing between one type or another. But: The percentage of articles with zero citations is higher in journals that recommend the use of external reporting guidelines Both types x The other 2 groups 2 The median of the impact of all the articles is higher in journals which recommend the use of both types of reporting guidelines. But: This difference is not very high and the percentage of articles with zero citation is highest in journals that recommending both types of reporting guidelines. Excluding the articles with an impact equal to zero 3 Excluding those articles, the medians change. In this case, the best option would be to choose external reporting guidelines and the worst option would be to choose both types of reporting guidelines. But: As this scenario is induced, it should not be taken into consideration.

36. DISCUSSION May 201236Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma Possible motives for the non existence of differences: Incorrect division of the journals through the groups according to type of reporting guidelines presented in the website: the inherent subjectivity of the division may have led to some errors. Existence of financial interests that led to the non citation of the articles. Great amount of articles existing nowadays. Difficulties on the publication of the articles leads to the non accounting of the citation included in the unpublished articles.

37. CONCLUSION May 201237Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma The combination between both types of reporting guidelines should be an option to take into deeper consideration, taking into account the small difference found between the median of the impacts of the articles published in journals that follow this reporting guidelines, when comparing to those from journals that present external or internal reporting guidelines. Within the articles with zero impact, there are comparatively fewer articles that were published in journals that present internal reporting guidelines.

38. CONCLUSION May 201238Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma There was found no strong evidence that a certain group of reporting guidelines is the best choice to achieve a higher impact of the articles published. Therefore, it is up to the journals of General and Internal Medicine to decide which kind of reporting guidelines to use, since all have advantages and disadvantages that lead to no significant difference among groups. A similar study could be done to other areas because, depending on the areas, the results found may be completely different. In fact, the same analysis applied in other subjects may lead to the discovery of unexpected results and to a change on the process of expanding the knowledge.

39. ACKNOWLEGDES March 201239Class 8 We thank our Professor Pedro Pereira for his support throughout the whole year. Moreover, we feel our acknowledgements should also be directed to Professor Altamiro Pereira, whose critics allowed us to improve. Finally, we would like to thank to class 21 for their effort on delivering all the data needed on time. What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

40. Jacinto T. Informação e conhecimento biomédico, pesquisa bibliográfica, bibliotecas digitais [Biomedical information and knowledge, bibliographic research, digital libraries] [slide]. Porto (Portugal): Faculdade de Medicina da Universidade do Porto (PT), Departamento de Ciências da Informação e da Decisão em Saúde; 2011. Portuguese, English. Nahas FX, Ferreira LM. A arte de redigir um trabalho científico [periódico na Internet] 2005;20 Suppl. 2:17-8. Disponível em URL: http://www.scielo.br/acb Nte AR, Awi DD. Writing a scientific paper: getting to the basics. Niger J. Med (2007) Jul-Sep;16(3):212-8. Jacinto T, Morais A, Fonseca JA. How to write a scientific paper - Searching and Managing Biomedical information. Rev Port Pneumol. 2011;17:190-194. Samil LR. Writing and publication of a medical article. Vandenbroucke J P. STREGA, STROBE, STARD, SQUIRE, MOOSE, PRISMA, GNOSIS, TREND, ORION, COREQ, QUOROM, REMARK and CONSORT: for whom does the guideline toll?. Clin Epidemiol. 2009;62:594-596. International Committee of Medical Journal Editors. ICMJE, International Committee of Medical Journal Editors [homepage on the Internet]. [place unknown]: International Committee of Medical Journal Editors; 2009 [cited 2011 Nov 11]. Available from: http://www.icmje.org/ REFERENCES March 201240Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma

41. Rodrigues P. Artigos científicos, aspectos e orientações base [Scientific papers, guidelines and basic aspects] [slide]. Porto (Portugal): Faculdade de Medicina da Universidade do Porto (PT), Departamento de Ciências da Informação e da Decisão em Saúde; 2011. Portuguese, English. CONSORT Group. CONSORT, TRANSPARENT REPORTING OF TRIALS [homepage on the Internet]. [place unknown]: Minervation; [reviewed 2011 May 16; cited 2011 Nov 11]. Available from: http://www.consort-statement.org/ STROBE Group. STROBE Statement, Strengthening the Reporting of Observational studies in Epidemiology [homepage on the Internet]. [Bern (Switzerland)]: ISPM – University of Bern; 2009 [cited 2011 Nov 11]. Available from: http://www.strobe- statement.org/ SQUIRE Group. SQUIRE, Standards for Quality Improvement Reporting Excellence [homepage on the Internet]. [Lebanon (NH)]: [Publisher unknown]; [cited 2011 Dec 1]. Available from: http://squire-statement.org/ STARD Group. STARD Statement, STAndards for the Reporting of Diagnostic accuracy studies [homepage on the Internet]. [Amsterdam (The Netherlands)]: [Publisher unknown]; [reviewed 2008 Apr 22; cited 2011 Nov 11]. Available from: http://www.stard-statement.org/ Stefánsson E, Kivelä T. The ingredients of a good paper. Acta Ophthalmol. 2010; 88:619-621 REFERENCES March 201241Class 8 What to choose: internal reporting guidelines or external reporting guidelines? A step closer to answering this dilemma