Chapter Nine
Professional Writing
Learning Objectives
After completing this chapter, the reader will be able to
• State reasons both for and against writing professionally.
• Describe the various steps of professional writing.
• Identify the order for authors in a professional paper.
• Describe the importance of knowing the audience.
• Describe various writing styles and their differences.
• Explain where to find a publication’s requirements for submission.
• Describe what an article proposal consists of and why it is used.
• Explain the need for continued practice to develop good writing skills.
• List the components of both a research and review paper.
• Explain the general guidelines for writing.
• Describe the peer-review process.
• Explain the absolute importance of revision.
• Explain the steps in creating a newsletter or Web site.
• Describe how to prepare audiovisual materials for a poster or platform presentation and place those items on a Web site.
• Describe techniques for creating an abstract for an article.
• Describe how to correctly cite reference materials.
Key Concepts
Essentially any time a professional takes pen, pencil, word processor, or any other writing implement in hand to fulfill professional duties, it is considered professional writing.
When writing, it is best to keep things as simple and direct as possible.
With the probable exception of policy and procedure documents, the two most important paragraphs in any document are the first and last.
If the information is taken from a particular source, even if it is reworded, the original author should be given credit via footnotes or endnotes.
In many cases, revision of a document will be necessary.
Instead of concentrating on the technology, it is best to concentrate on the message.
Professional writing is a skill necessary for every health professional.
Introduction
A common thought when considering the topic of professional writing is, “That doesn’t apply to me, I’m not writing for a journal.” But professional writing is certainly not limited to journal articles or books. It includes writing evaluations of medications for consideration on a hospital formulary, preparing written policies and procedures for the preparation of an intravenous admixture, reporting the results of the latest sales to the home office, preparing a written evaluation of a technician or clerk, writing in a chart, writing a term paper for a class, preparing slides or posters for a presentation, writing a letter of recommendation,1 and many other things. 
Essentially any time a professional takes pen, pencil, word processor, or any other writing implement in hand to fulfill professional duties, it is considered professional writing. When writing, although the format changes, the general principles remain the same. So whether the objective is to write the ultimate book on the practice of pharmacy or to type a label, a pharmacist must know how to write professionally.
Although some may say the purpose of writing is to keep a job or to pass a course, there are, generally, four larger purposes for the existence of written material. That material serves to inform, instruct, persuade, or entertain. The first three items are those usually considered in professional writing, although including the fourth, whenever possible, will help convince people to read what has been written.
There are also some advantages to professional writing, besides those mentioned above. For example, writing is often used to evaluate an employee for promotion in many jobs. In academia, there is always the concept of publish or perish. Even pharmacy technicians are encouraged to write as a means of advancement.2 Also, writing gives the authors the opportunity to share their knowledge or ideas,3 obtain gratification or satisfaction,4 and improve their knowledge. It may even lead to some fame or notoriety in a field.
Unfortunately, there are disadvantages to professional writing. The major problem is that any significant amount of writing often involves a lot of potentially frustrating work, because few people are natural writers. The author must practice to become proficient at writing, which will involve false starts, numerous drafts, roadblocks, and other problems.5 If that is not enough, writing exposes a person to criticism and possible rejection. Although at one time authors were paid to publish articles, today it is not unheard of that authors may actually have to pay to have their article published.6,7 At best, the direct financial rewards are likely to be few, unless a best-selling novel is produced. Indirectly, writing may lead to pay increases and promotions. However, because writing is a professional necessity, it can be made easier by following the correct procedures, which will be covered in this chapter.
Steps in Writing
As each of the steps in professional writing are covered in this section, the emphasis will be on writing items likely to be encountered in a practice setting, although additional steps that are necessary when writing for publication will be mentioned.
PREPARING TO WRITE
The first step in writing is to know the purpose—why something needs to be written in the first place. It is necessary at this time to have a good idea of the expected endpoint, which is important, no matter what is being done. For example, someone learning to plow a field with a tractor may be concentrating on the ground near the tractor and end up wandering all over the field, thinking he or she is going straight. However, by concentrating on going to a specific point on the far end of the field, rather than looking just in front of the tractor, the row will probably be plowed fairly straight. Throughout this whole process it is necessary to keep in mind that endpoint, to keep from wandering all over the place. If the item being written is for publication, rather than something required for work, it will also be necessary to pick the topic and, perhaps, submit an article proposal (see Figure 9–1). Although the writing is considered to be more important than the idea, it is still essential to have a good idea or topic that is of interest to prospective readers before starting.8 It can even cover an old topic, as long as the topic is covered in greater depth, in a new way, or is addressed to a different group. It should also be pointed out that in the case of clinical trial results, it can be important to publish articles showing that something did not work, although in the past such topics have often been avoided.9
Figure 9–1. Article proposal to publishers.
It is also necessary to decide whether there needs to be a coauthor. This may be easy to resolve, depending on who is working on the project. However, even if no one else has been involved, it may be a good idea to look for a coauthor. An inexperienced writer (e.g., a student or someone early in his or her career) would benefit from working with an experienced author.10 Additionally, working with someone will give a different perspective (especially if working with practitioners from many disciplines) and, hopefully, lessen the work for each person. Finally, it is sometimes a necessity to include coauthors for political reasons (as in “Would you prefer to share the credit or work nights and holidays for the rest of your life?”). Although this last reason should not exist, it does. These may be considered honorary authors and are relatively common,11 although this is considered to be inappropriate.12 A variety of other problems with authorship credit are also seen.13–15 The best outcome is that everyone must do part of the writing16 and that authors be listed in the order of their contributions to the project. This does not always happen.17,18 In some cases, pharmaceutical manufacturers may want ghost writers to write an article for the researchers, but even they agree that original authors must prepare the first draft of editorials or opinion pieces, although non-English speaking authors may be assisted by others after that.19 The ghost writers should also be appropriately acknowledged.9 Although arguments may be made,20–26 there is no valid reason for people to be listed as an author in excess of their contribution to the writing and submission of the work for publication.27–31 The only exception would be if the publisher has other specific rules. For example, some journals may want to list contributors with an explanation of what they contributed (e.g., writing, origination of study idea, data collection). Generally, all of the following must be met for an individual to be given credit as an author30:
• Conception and design of the study, or analysis and interpretation of the data in the study
• Writing or revising the article
• Final approval of the version that is published
Things that do not qualify a person to be listed as an author include29,30:
• Acquisition of funding
• General supervision of the research group
Individuals that do not meet the first qualifications should be listed in the acknowledgments section. Also, the primary author should be able to explain the order the authors are listed in and journals may require one or more authors to be guarantors, who will be taking responsibility for the work as a whole, including legally.31
It should also be mentioned that there can be too many authors and acknowledgments.32 Some scientific papers list many, many authors for a particular paper, and the number of authors has grown over the years.33 It is obvious that 20 authors could not have written a three-page paper. Some of this may be a result of job requirements that include publishing a certain number of articles, leading to demands by individuals to get their names listed on any article they can. Again, authors should contribute to the written work in some significant way, as defined above. In some cases, it may be necessary to just name the group performing the research, with a few of the most responsible individuals specifically named, and list others as acknowledgments, sometimes by group, institution, or type of contribution.23,32,34 Others may be listed as clinical investigators, participating investigators, scientific advisors, data collectors, or other appropriate titles.31 In relationship to authorship, remember the people taking credit are also taking responsibility—they need to make sure that the work is clear and not subject to misinterpretation (i.e., do not write something that is designed to mislead the reader into believing something that has not been proven).35
Before the first word is written, it is necessary to know the audience, which involves knowing the type of person who will be reading the final document and where it will be published. Keep in mind that the word published was picked for a specific reason. Whether the final product appears in The New England Journal of Medicine, the IV Room Policy and Procedure Book, or even the label on a prescription vial, it is published. It is necessary to aim the work at the audience. At a broad level, written work should not be submitted for possible publication in a journal that does not cover the topic; it is no more appropriate to submit an article on preparation of cardioplegic solutions to the Journal of Urology than it is to type a monthly fiscal report on prescription labels. So, be sure to review a journal and its Instructions for Authors before attempting to write an article for submission to that journal.36
More specifically, it is necessary to aim both the writing style and depth of information toward the audience. If something is written for physicians, it is not likely to be understood by lay people. Conversely, items written for lay people may not satisfy the needs of physicians. It is certainly appropriate to have a secondary audience in mind. For example, a report written for physicians may be of interest to pharmacists and nurses. However, make sure the secondary audience is not served at the expense of the primary audience.
In regard to writing style, there are three types commonly used by pharmacists and other health care professionals: pure technical style, middle technical style, and popular technical style (Table 9–1).37
TABLE 9–1. TYPES OF TECHNICAL WRITING
Pure technical style is used by business or technical professionals when they are writing for other professionals in the same or similar fields. For example, an article published in the American Journal of Health-Systems Pharmacy, American Journal of Nursing, or Journal of the American Medical Association would normally be written in this style. There are several characteristics of this style. First, the authors can use technical jargon, because they can expect the readers will understand it. Second, it is written in formal English. Third, it is written in the third person; words such as I, we, us, and you are eliminated. Finally, there is a general lack of slang or contractions. The great majority of writing done by health professionals will be in this style, because it is usually other health professionals who will be reading their work.
Middle technical style is very closely related to pure technical style. This style is used by authors when they are writing for readers with a variety of technical backgrounds, with everyone having some unifying factor. For example, a report regarding a pharmacy department’s quality assurance activities might be presented to the hospital’s pharmacy and therapeutics committee. That committee is made up of physicians, nurses, hospital administrators, and other professionals. Although each has a background that makes their membership on the committee appropriate, not all of them would understand what a HEPA filter is, as would most hospital pharmacists. Therefore, it is necessary to better explain, or sometimes avoid, some technical areas. Otherwise, this writing style is very similar in most respects to pure technical style.
Finally, popular technical style is used in anything meant for the general public. Common language is used throughout. For example, a patient information sheet would need to be written in this style. A widely available example would be the articles on medical subjects that have appeared in Reader’s Digest over the years. Information that is written in this style will use less complicated words and be less formal in its presentation.
It should be pointed out that usual technical writing differs greatly from what most people learn in high school English class or college composition courses. Although there is often a tendency to protest the formality of professional writing styles at first, the reality of the situation is that those styles must be followed for a piece of written material to be accepted.
The next step is to know the requirements of the publisher. Whether the work is for the department’s policy and procedure manual or a journal, chances are that there is a format that needs to be followed. In the case of a journal, directions on the format to follow will be published at least once a year, usually in the first journal publication of the year or on the journal’s Web site. Also, specific guidelines are followed by a number of professional journals, both for general format and statistical reporting. Many journals have approved those guidelines and expect that all work submitted for publication will follow them. They are referred to as the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals.”31 This standardization makes it easier on the prospective author; one style can be learned and followed, regardless of the journal. Other publications that can be helpful are Scientific Style and Format: The CSE Manual for Authors, Editors, and Publishers prepared by the Council of Science Editors, the American Medical Association Manual of Style, the MLA Style Manual, and the Publication Manual of the American Psychiatric Association.
In the case of reports, policy and procedure manuals, and similar documents, it is best to see what has been done in the past. If this is the first time a particular item is being prepared, it is advisable to try to see what has been done in other places, and prepare something similar that meets the perceived needs. If writing something for work, do not be afraid to try to improve the format to make it more usable. However, be aware that it may be necessary to get any changes in format approved by the appropriate individual(s) or committee(s). Whenever possible, follow the Uniform Requirements31 format used by the medical journals, because it is the standard for biomedical writing.
GENERAL RULES OF WRITING
Once the preparation is completed, it is time to start writing. Unfortunately, there is no easy way to learn how to write professionally; it just requires a lot of practice. However, a number of rules can be followed (Table 9–2). This section covers some of the general rules, with information on how to prepare specific items (e.g., introduction, body, conclusion, references, abstracts) being covered later. The first step is to organize the information before starting to write. At risk of sounding like a high school English teacher, it is still true that this step should include preparing an outline.5 In the past, that was an onerous task that few performed. However, with modern word processing software, the outline actually becomes part of the finished product, so it does not amount to any significant extra work. Minimally, the different sections should be listed to create some order to the layout of the work (remember, keep in mind the endpoint). Overall, the goal is to prepare a document that is clear, concise, complete, and correct. The two latter items depend, to a large part, on preparation. The former items, however, can be helped by following some simple rules.
TABLE 9–2. CHECKLIST FOR PREPARATION OF WRITTEN MATERIALS
The first two rules actually apply to the organization step. First, do sufficient research before getting started. Research in this regard, means obtaining whatever information—whether records, articles, performance evaluations, or anything else—necessary to prepare the item. Although, it is likely that additional research will be necessary to fill in the fine points at some point in the process, most information should be gathered ahead of time. It is impossible to be organized if there is nothing collected, and a document that is not organized will generally not be worth much. The second rule is to put oneself in the reader’s position. What does that reader want and how does he or she want it presented?
Although it should not need to be stated, it is very important to use proper spelling and grammar. This is easier than in the past, because word processing programs check both; however, it is still necessary to double check, because the computer is likely to overlook things. For example, a properly spelled, but incorrect, word will be missed (e.g., two instead of to, trail instead of trial, ration instead of ratio). Unfortunately for some writers, appearances count greatly. The writer may know more about a particular subject than anyone else, but if poor grammar and spelling permeate the document, it is unlikely that anyone will read or believe the information presented.38 It will be dismissed as probably wrong, based on grammar and spelling alone. In a case where the finished product will be published in a language other than the writer’s native language, the writer should have the work read and edited by someone for whom the language is their first language. It should also be mentioned that the writing should try to be entertaining. Although professional writing tends to be a bit dry, an attempt should be made to make it as enjoyable and easy to read as possible, although it is necessary to be cautious with humor and stay within limits of professionalism and good taste. It should also be unpretentious, direct, and accurate.39
Related to this, the document should look presentable. Some students are well known for turning in papers that are crumpled, creased, torn, dirty, or coffee stained. That is not professional and must be avoided. The sad truth is that people will assume that if an author was sloppy with the appearance of the document, he or she was probably sloppy with the information. That may not be so, but that assumption will kill a good, but sloppy, document.
When writing it is best to keep things as simple and direct as possible.40–43 This has been referred to as the KISS (Keep It Simple, Stupid) principle. There is a temptation to use big words that sound impressive, but doing so is more likely to confuse than impress. Related to that, keep the paper as short as possible.44 If a document is long, subheadings should be used. This can be part of the outline step mentioned earlier. Also, consider whether tables, figures, or graphs would make the document simpler and easier to understand. This can be particularly useful with documents containing a great deal of data that may be organized through the use of tables.
When writing, avoid using abbreviations or acronyms. If it is necessary to do so, state the full form of the word or term the first time it is mentioned in the document, followed by the abbreviation in parenthesis (e.g., acquired immunodeficiency syndrome [AIDS]). The only exceptions to this rule are units of measurement (e.g., mL, mg). Units of measurement should be expressed in the metric system. Clinical chemistry and hematologic measurements should be in terms of the International System of Units (SI).
Several rules apply to the wording that is used in professional writing.37 First, completely avoid writing in the first person, and avoid the second person wherever possible. It is not a bad idea, at least at first, to ask the word processor to find all occurrences of I, me, we, us, and you. If those words are found, try to rewrite the sentence to avoid them. Also, it is preferable to avoid using the passive voice throughout45; again, a grammar checker can help. Avoid both contractions and slash construction (i.e., and/or, he/she [use he or she], this/that). Finally, in this politically correct era, avoid sexism. That includes words like he or she, although it is not always appropriate or desirable to delete those terms. For example, using he in a case report of a patient with testicular cancer is quite appropriate. It is also inappropriate to use their instead of his or her to get around the problem.
When writing, be sure to give credit where it is due. This does not mean just making sure the listed authors wrote part of the document. It includes using endnotes, or possibly footnotes, for all information obtained from one or a limited number of sources. If there is extensive quoting, permission to do so should be obtained by writing to the person or organization holding the copyright on the material. Endnotes are something everyone dreaded in the past. They waited until the end, because the articles should be cited in the order they appear in the document. By that time it was difficult to go back and do it. Now, however, it is much easier with word processors; it is possible to insert the citations as the document is prepared and let the software worry about making sure they are in the correct order.
Related to the endnotes, everything that is stated should be supported by objective evidence. When writing a paper based on scientific literature, that evidence must be shown in the endnotes. To reemphasize, any unreferenced statement of fact is for all practical purposes worthless. However, it is necessary to make sure information is extracted from the original article and expressed properly. Some writers will improperly twist facts, whether inadvertently or not, to support their assertions.46
Finally, work through the document in whatever order seems easiest.5 In preparing a drug evaluation for a pharmacy and therapeutics committee, a stack of 50 articles might be used. At first, the stack may look like an impossible task, but after sorting the articles into groups that correspond to the sections, start with the shortest stack or the easiest information. By the time the document is finished, the writer may be surprised to find out that they were all fairly short, easy stacks.
At first, a writer should simply try to make sure that all of the information is down on paper.5 Once that occurs, go back and revise, and perhaps reorganize the document. Waiting a few days before revising the document can be very beneficial. After some time away from the project, errors practically jump off the page. It is also a good idea to have someone else who has not been involved with the writing, read the document. Something that seems quite clear to the author may not actually be clear at all. Also, the author may be mentally inserting words or even sentences that were inadvertently omitted. Having someone edit the document can be humbling, but helpful. Be sure to provide the product in a format that will make things easier for the person reviewing the document. A typed, double-spaced manuscript will make it easy to read and provide room for comments. Even better, electronic versions of a document can be reviewed directly on a computer using “comment” or “track changes” features. The reviewer can put in comments or suggested wording changes electronically and then return the document. The writer can then go through the document making changes or simply accepting proposed changes with the click of a mouse. Often, the use of the electronic reviewing mechanism will be quicker, easier, and provide much clearer suggestions.
The three most important things in real estate may be location, location, location, but the three most important things in writing are edit, edit, edit. This can be particularly important when multiple authors have contributed different sections, since it will be necessary to make sure that the various contributions fit well together, including the style of writing.47 It may be best for either the first author or the most senior author to edit for consistency. Also, remember editing includes paring out unnecessary words, sentences, and larger sections. It is not sufficient to settle for good enough—do the best. Look at it this way: the boss or editor is only going to do so much editing before giving up. The trick is to make sure that the document is well prepared and does not need that much editing.
SPECIFIC DOCUMENT SECTIONS
A typical document consists of three main parts—the introduction, body, and conclusion. In the case of a clinical study, it is recommended to follow the IMRAD structure that divides a paper into Introduction, Methods, Results, and Discussion,31 which is the standard for such papers.48 Other parts, such as references, tables, figures, and abstracts may also be necessary. These will be discussed in later sections and in the appendices of this chapter. It should also be noted that a number of the points in Chapters 4, 5, and 8 are applicable to writing of journal articles, as are the contents of the Web sites for the International Committee of Medical Journal Editors (http://www.icmje.org), Consolidated Standards of Reporting Trials (CONSORT) statement (contains a checklist for contents of clinical trial to report when publishing and flow diagram illustrating recruitment, randomization, and analysis of subjects enrolled in a trial) (http://www.consort-statement.org),49–59 Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA)60,61 (http://www.prisma-statement.org/), Conference on Guideline Standardization (COGS) standards (http://gem.med.yale.edu/cogs/), and Good Publication Practice for Pharmaceutical Companies (http://www.ismpp.org/gpp2),62 and should be considered, along with this material. An example question layout that includes an introduction, body, and conclusion section is shown in Appendix 9–1.
Introduction
With the probable exception of policy and procedure documents, the two most important paragraphs in any document are the first and last. It is vital to start out strong, to encourage the reader to continue reading. Otherwise, the work will end up in that stack of articles everyone has that they intend to read someday. That first paragraph should also inform the readers of what they can expect in the rest of the document; it should be similar to a road map that shows what is to be accomplished in the document. The introduction should have a clear objective for the existence of the document. Many people neglect the need to state a clear objective, which leaves the reader to flounder and wonder whether there really is a purpose to the document. In a research article, the introduction will also contain the hypothesis being investigated. In a policy and procedure document, it may simply be a description of what the remainder of the document will cover. The introduction should also contain background information about the topic that provides a good information base for the reader. The amount of background information has to be a balance—enough to show the reader that the writer has done an appropriate amount of research, but yet not so exhaustive as to bore or overwhelm the reader with unnecessary details.63 Overall, the introduction should be short but contain properly referenced background material and show the reader where the document is headed.
The introduction should generally not be a conclusion; some people are so anxious to jump to the end that they put the conclusion first. Admittedly, the BLOT concept (bottom line on top) has its purpose in some documents (e.g., policy and procedures, formulary monographs), but that should be a conscious decision. If the introduction amounts to a conclusion, many people will read no further, making the remainder of the document a waste of time and paper.
Body
The body of the document contains all of the details. In a research article, the body may be divided into the methods, results, and, possibly, discussion sections, although the latter section may be incorporated into the conclusion. Details of what should be included are covered in Chapter 4. In other documents, the body will probably be divided into whatever sections are appropriate or logical. A number of rules can be followed in preparing the body of a document.
The first rule is that, while it is important to be concise, all necessary information must be presented. Again, keep an eye on the desired endpoint, and do not stray from the subject unless it is absolutely necessary. Including unnecessary information, even if it is interesting, will tend to confuse or obscure the important points. Also, be sure to provide a balanced coverage of the material and avoid unsupported bias.9
It is important to cover the information in a logical order, so that it flows easily from one point to another. A common mistake, when learning to write professionally, is to skip back and forth between subjects. For example, someone might insert a point about dosing in the middle of indications, when dosing is discussed at another point in the document.
Material that can identify patients should be left out of any work, unless it is absolutely necessary to include. If that is not possible, informed consent must be obtained31 and pertinent legal procedures must be followed (see Chapter 10). The authors should also disclose any approval of a study by institutional review boards and their following of other rules related to protection of study subjects (both humans and animals).31
Writers should also put the information in their own words. Perhaps out of lack of confidence, a number of professionals are tempted to simply quote other authors word for word. However, by presenting the information in their own words, writers demonstrate that they actually understand the topic. 
Remember, though, that if the information is taken from a particular source, even if it is reworded, the original author should be given credit via footnotes or endnotes.
It is necessary to expand on the topic discussed in the previous paragraph, because there seems to be much confusion about it and there are many cases where the rules against copyright infringement and plagiarism are broken. Plagiarism can be considered the copying of another’s words or ideas, without properly giving credit. Copyright violations consist of copying another’s work, even with appropriate quotations and citation, without permission. They are similar; however, it is possible to commit either plagiarism or copyright violations without committing the other. Self-plagiarism, where an author copies material that he or she previously had published in one journal for something in another journal, is a concern and can lead to copyright violations.64 It appears that plagiarism is becoming more frequent and many people do not understand that it is wrong to copy work without proper attribution, even something from a source written by many anonymous people (e.g., Wikipedia, Yahoo! Answers, and Answers.com).65,66
Sometimes those infractions are rather blatant, such as the cases documented in the newspapers about students downloading papers from the Internet and presenting them as their own or simply retyping a previously published article (an attempt to prevent this can be seen on the Internet at http://www.plagiarism.com, http://www.plagiarism.org, or http://www.turnitin.com67).68 Interestingly, although there might be suspicions that this is more prevalent with online classes, a study found that it was more likely to occur with traditional campus students.69 Another Web site, http://www.ithenticate.com/ is a resource to check if published material is plagiarized. Other times, the infringement is quite accidental. For example, it was once brought to the attention of the famous science fiction writer, Isaac Asimov, that a short story he wrote was similar to an article that had been published 10 years previously.70 Dr. Asimov went back and found the article and read it, realizing as he did so that he had read it when it first came out and had forgotten about it. When he wrote his story 10 years later, he did not realize that portions of it could be considered plagiarism. Although he had no intention of infringing upon the other author’s work, Dr. Asimov made sure that the story was never reprinted and even wrote an article discussing the problem. This shows how easy it is to inadvertently cross the line into copyright infringement or plagiarism, and there are many examples that would fall in between the extremes given above.71 Therefore, it is necessary for the author to be on guard and to try to prevent the problem in the first place. A few general rules can act as a guide.
• When copying wording directly from another’s work, it should be in quotations (or otherwise shown to be a quote) and a citation should appear to give credit to the original author(s). Also, if a significant amount of a work published in the last 100 years is quoted, it is probably necessary to get permission from the copyright holder, which may require paying a fee.72 Exactly what is a significant amount is debatable; however, it would be best to err on the side of asking for permission if a quotation is more than a few sentences. Reproducing an entire chart, table, figure, and so on should normally require asking for permission. A letter to the copyright holder will solve problems; publishers often have forms to request permission. Some special cases need to be mentioned. First, U.S. government documents are not copyrighted, so only quotation marks and citations are necessary. Second, if it is impossible to locate a copyright holder (e.g., the publisher went out of business without transferring copyrights), the writer should at least be able to document a thorough effort to obtain permission. Finally, there are special legal requirements for use of copyrighted materials in online education, covered in the Technology, Education, and Copyright Harmonization (TEACH) Act. Further information on this can be found in Chapter 10.
• Extensive quotations should be avoided. After all, if a writer cannot put something in his or her own words, does that person truly understand the material? In any writing, there really is very little reason to provide quotations. The author should try to put things in his or her own words whenever possible.
• Paraphrased information should have the original publication(s) cited, if it comes from one or a limited number of sources.
• Extensive paraphrasing, particularly without citations, may be considered plagiarism (i.e., copying the ideas of others).
• When citing an article, cite the one that the material comes from. If the material came from a review article, cite that article, not the original study that was not consulted. It is worth mentioning that in the case of unusual information, reading and citing the original study is preferable to just using a review article, because the review may be inaccurate.
• Be sure to follow publishers’ rules or licenses, which may be stricter and may not allow any reproduction of material. Obtain permission from publisher, even if it is author’s original work, for use in a different publication to avoid copyright violations.64
• Remember that it is necessary to always cite others’ work, even on slides.73 Always cite everything, even if it is the author’s own previously published work to avoid self-plagiarism.64
In preparing certain documents (written answers to questions, for example), there may be very little information available. Perhaps only one or two research articles will have been written on the topic. If so, it will often be desirable to summarize the articles in detail, including most of the information presented in an abstract (see Appendix 9–2). In general, the information presented will summarize how many and what type of patients (i.e., inclusion and exclusion criteria), the drug or procedure being investigated, results (e.g., efficacy, adverse effects), and conclusions of authors of referenced articles. It is also important to point out any noticeable flaws in the paper. An example would be:
Smith and Jones performed a double-blind, randomized comparison of the effects of drug X and drug Y in patients with tsutsugamushi fever. Patients were required to be between 18 and 70 years old, and could not have any concurrent infection or disorder that would affect the immune response to the disease (e.g., neutropenia, AIDS). Twenty patients received 10 mg of drug X, three times a day for 15 days. Eighteen patients received 250 mg of drug Y, twice a day for 10 days. The two groups were comparable, except that the patients receiving drug X were an average of 5 years younger (þ <0.05). Drug X was shown to produce a cure, both in terms of symptoms and cultures in 85% of patients, whereas drug Y only produced a cure in 55.5% of patients. The difference was statistically significant (þ <0.01). No significant adverse effects were seen in either group. Although it appears that drug X was the better agent, it should be noted that drug Y was given in its minimally effective dose, and may have performed better in a somewhat higher or longer regimen.
A list of material to be covered in a review of an article similar to that above is found in Table 9–3.
TABLE 9–3. ITEMS TO INCLUDE IN WRITTEN REVIEW OF A JOURNAL ARTICLE
Conclusion
A conclusion should be placed at the end of the body of the document, except for certain documents (e.g., policy and procedures). This conclusion should follow logically from the information presented and should serve to summarize that information. Remember, the conclusion should also correspond with the objective stated in the introduction.74
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