Why should you always finish your projects?

Having said in my last blog post that starting a project was the most important step, there is a step that is nearly as important. That step is finishing a project.

Why is finishing a project so important?

Finishing a project is important for a number of reasons and some of these are listed below.

  1. If you do not finish you cannot ‘ship’ the work, i.e. it is wasted effort
  2. You only know how successful something has been when it is finished
  3. You do not get to be smug about how you completed something
  4. If it is important it will nag at you until it is done

So how do I ensure I finish projects?

The best way I have found is to break the project down into small manageable chunks that can be ticked off one by one until the project is complete. This way I get a series of small victories to help keep me motivated and can easily determine my progress through a project. Invariably there will be changes to original plans and this should be reflected in timelines and goals at later stages.

For example, for the past month I have been trying to draw a quick sketch of something that I have seen discarded on the street and post it on my Instagram feed. This way I have motivated myself to do some sketching (albeit extremely quick sketches) and each additional day completed encourages me not to fail at the next day. I do not want to break the chain. This is suggested in one of Austin Kleon’s books (I think it might be Show Your Work!: 10 Ways to Share Your Creativity and Get Discovered which is well worth a read). It is alos inspired by Lisa Congdon who has spoken about doing daily self-initiated projects to learn new skills and help create something to show (her books Whatever You Are, Be a Good One: 100 Inspirational Quotations Hand-Lettered by Lisa Congdon is an excellent example of one of these ‘passion projects’. She also wrote Art Inc.: The Essential Guide for Building Your Career as an Artist which is very good).

What if I discover I do not want to finish a project?

I would suggest that you try to finish it to some degree as it might be that you are having a dip in your motivation and that by continuing you may both learn something and also become re-interested in the work. I find this often happens after the initial creative work is complete and it is time to revise and edit a piece of writing. This can be tedious at times, however, perseverance is the key and once this is done there is the excitement of the final push for completion and the joy of seeing the final piece of work.

There may be times when you cannot bear to continue with something and if you have tried several times to complete it, it might be necessary to put it away for a while and do something else, so you can come back to it later re-invigorated. If this does not work you could try to get someone else to input as this can breathe life back into a project. If this fails and you are set on ditching the work then you should try to complete the latest step you are on and get it into a state where it can hibernate. That way if you want to come back to it, it will be there waiting for you.

Why is starting the most important step in any project?

This sounds like a trick question and the response should be ‘of course it is, if you don’t start there is no project’. So why mention it at all?

Why indeed?

If you are anything like me, you will have a number of projects that you would like to initiate. These include writing a short story for my daughters, putting together a zine, selling at least one piece of art and getting another peer-reviewed article published to improve my CV, among other things. I can spend ages coming up with ideas, writing lists and planning them in my head. However, most of them have not happened. Why is this?

Again, why indeed?

It is because, although I have good intentions, I cannot do everything and there are myriad distractions stopping me from starting some of these projects. It might seem more important to do the washing up and tidy out my box of magazines that I keep for collages, rather than putting a piece of art on an online shop. These tasks do not move me closer to my goal, but make me feel like something has been done, they give instant gratification and are a reward unto themselves.

So of you are aware of this procrastination, why not just do what you want?

There is only one reason, and that is fear. Fear that the story might not be perfect, fear that I will try to sell something and nobody will want to buy it, fear of trying something new and learning new skills, fear of meeting new people. All these fears and insecurities are masked by procrastination and the only way to over come them is by taking a small step towards your goal. That one small step will start your journey to your goal. It might be as simple as announcing your intent to your friends and getting them to provide support and nag you into doing something, or putting down a title or setting up an account with an online marketplace. Once you have taken that first step, you need to follow it with a second and by taking those initial small steps, momentum will grow and drive you to completing your goal. So for example, if you want to write something, if you write a small amount consistently every day you will soon have more words written than you expect!

So go, don’t procrastinate with social media or reading blogs, and take teh first baby step towards one of your goals!

What to do now that the references for inclusion in the systematic review have been selected?

You are now nearly ready to write up the systematic review. You have reviewed the full text versions of any references that looked promising for inclusion, culling out those that were inappropriate (remembering to record reasons and numbers). You have read the references that have been selected and are sitting down ready to write about the subject.

For an initial systematic review, it is acceptable to tabulate the relevant data and discuss it, without performing any further analysis. This is a purely descriptive approach and although you will provide your writing groups opinions on the results, you may not want to do any further analysis. However, to get the most out of a systematic review you will probably want to go further. This could involve one of two approaches, either a meta-analysis or a narrative synthesis.

What is a meta-analysis?

If the references detail studies that are similarly designed, with similar duration, populations and study drug/intervention use, then a meta-analysis is possible. Meta-analysis are typically used in medicine and are a statistical approach to estimating the treatment effect. By combining a number of different studies, larger populations can be explored and this can provide insight into rare complications or adverse events, or provide a better overview of clinical efficacy. A good introduction to what a meta-analysis is can be found here.

What is a narrative synthesis?

If the references all include very small study populations, or the study designs are different, for example the study lengths vary widely, then a narrative synthesis may be more appropriate. This approach involves the identification of themes and trends in the research, highlighting aspects that appear to influence outcomes or are important for the intervention. A good introduction to what a narrative synthesis is can be found here.

Do you have any tips of writing a good systematic review?

First off, write the manuscript with the PRISMA checklist next to you, to ensure that all the information that it requires is included. Also, even though it may appear that the conduct of a systematic review is rigid and does not allow any creativity it is important that the final manuscript is not overly dry, otherwise no-one will read it and it is wasted effort. Ensure that the story of why the systematic review was conducted is included and that each step or question builds logically from the previous one. You do not want to make any sudden jumps, as although you may find them intuitive, your readers quite likely will not. They have not been immersed in the review and discussions around it. To avoid this, you should get a colleague who has not been involved in any discussions about the systematic review at any point to review a near-final draft. They are likely to identify any gaps in the narrative and you should listen to them and if you disagree you discuss your reasons with that person. Also, don’t forget to thank them in the acknowledgements.

What should happen after the search is complete, should we immediately start writing the systematic review?

Once you have done the first version of the search, you may find that you have too many results or not many results at all.

Too many results?

If you have too many results it is likely that your search was too broad and that rather than manually checking each reference, using the filters provided by the search engines could help refine the results. Some possibilities for refining the search are to limit it to a specific language (English, for example), or to just searching the abstract and title, rather than the full text.

Too few results?

This might be what you expected and could be the basis for the systematic review, highlighting the need for more studies in a particular area. However, you may want to broaden your search if you feel that not all relevant manuscripts have been captured. This could be done by including additional keywords, or removing limits (e.g. looking for all studies and not just those in humans).

What if the number of results seems fine?

Once you are happy that the search has captured all the appropriate results, you will want to save a list of the results, including references, title and abstract, as well as recording the initial number of results found. You will need to keep track of this for the PRISMA flowchart. These results should then be distributed to the individuals that have been allocated as reviewers and they should review each abstract and decide whether it meets the inclusion criteria defined for the review. These criteria should have been defined before the search and it is important that both reviewers use them. The reason why each abstract is rejected should also be recorded. This can be done according to the PICOS, with abstracts rejected according to not containing appropriate participants, intervention, comparator, outcome or setting, or for another reason which should be recorded.

In a perfect world both reviewers will select the same abstracts at this stage, however, if they do not, an additional reviewer should arbitrate whether the abstract should be kept. If there is confusion, the abstract should be kept, for full text review (the next step).

After the abstracts have been filtered, should we start writing?

No. You will want to get the full version of each reference and these will also need to be reviewed, in a similar manner to the abstracts, to ensure that no inappropriate references are included. At this stage, you can note any manuscripts in the references that also look appropriate for the systematic review. This will enable you to check that they have been included and if not they can be added (and noted on the PRISMA flowchart).

This process of filtering can be long and tedious, however, it should enable all the relevant literature for the systematic review to be identified. It is at this stage that the writing can commence!

Performing the search for the systematic review

I am going to assume that you have developed your basic research question and are frothing at the mouth with anticipation that you will be able to search the literature and get to review possibly thousands of abstracts. Like many people I would suggest that you use PICOS to help determine your search.

What does PICOS mean?

From the capitalization you have probably realised that this is an acronym. It stands for:

Population
Intervention
Comparison
Outcome
Setting

By working your way through each item and defining it, you should be able to clarify your question and also define your search. I feel that the best way to show how to do this is to give an example.

Example

For this example my research question is going to be:
“Based upon differences in microvascular outcomes seen in people of South Asian origin with T2DM compared with the Western population, especially the relationship of outcomes with BMI, would SGLT2 inhibitors be more effective in this population?”

The first step is to define the population being investigated. This is “people of South Asian origin with T2DM”. However, when we perform the search we have to remember that not everyone with use the exact phrase that we have, for example South Asia includes a number of countries and we may want to include the populations of the separate countries and the names of the countries in the search as well. We will also want to add a search term for type 2 diabetes. These can then be combined as a search strategy:
(T2DM OR Type 2 diabetes) AND (South Asian OR South Asia OR India OR Pakistan OR…)

The next step is to define the intervention and for our question it would be SGLT2 inhibitors. The search strategy should also include the names of the individual drugs as well as the class. This would make the following search:
(SGLT2 OR sodium-glucose cotransporter 2 OR sodium-glucose co-transporter 2 OR canagliflozin OR dapagliflozin OR empagliflozin OR sotagliflozin…)

We then move onto the comparison. We are comparing different populations, rather than interventions, so this would be Western people with T2DM. For the first search I would not include this as a search term, and instead would keep it in mind when I was filtering the results following the search. However, the decision to include only studies comparing the two populations would help filter the results.

Next is outcomes which is undefined in our search and so would need discussion amongst the authoring group. Would we be looking at efficacy endpoints or cardiovascular outcomes, for example. Again this could be used for filtering the results and might not be included in the original search.

Finally is setting. This question could include large observational clinical data sets or clinical trial data and both would be interesting. Reviews would not be relevant to teh article but could be a useful way to ensure that all relevant references are found.

What next?

We have now defined our search and also some criteria to filter the results. So the next step would be to perform the search and the databases you use are dependent upon the subject you are researching. For example, in medicine it would include PubMed, Embase, Cochrane reviews and clinicaltrials.gov. It might also include results highlighted in the reference lists for any reviews identified.

The numbers of results should be recorded following teh search and before filtering as this is important for the PRISMA flow diagram.

A good handout to help define a search with PICOS is available from consortiumlibrary.org, which can be found here.

What next for your systematic review – Fully define your research hypothesis or question.

So you have decided that you are going to put together a systematic review and you have managed to persuade some of your colleagues and peers to be co-authors. What might you do next to get the review done?

Have a meeting.

The first thing I would recommend is that you get everyone who is to be involved together to define the problem. This is important because everybody will come to the table with different mind sets and different backgrounds, and also prior knowledge. Together you can make sure that everyone is agreed as to what problem will be addressed.

However, you should not go beyond that in the meeting, rather once the problem has been clarified you should end the meeting and get everybody to think of what hypothesis or question your review will be addressing. This way you will not end up with just the point of view of the most respected author or the person who shouts the loudest. Also, I find that my best ideas come when I am not really thinking directly about them and by leaving time to think you provide the opportunity for people to synthesise what was discussed and come up with any solutions or points that need clarification that were missed during the meeting.

This thinking time should not be extensive and should be defined during the meeting by booking the next meeting in for a couple of days later.

Have another meeting

Everybody has hopefully now thought about the issues and come up with ideas for the hypothesis. At this second meeting you will review everybody’s ideas. Let each person present their ideas in turn without allowing any questions to ensure that people are not intimidated and only present part of what they have come up with.

Once everybody’s ideas have been presented you can then discuss the merits of them all and finesse the hypothesis until you have it agreed by all authors. At this point you will need to discuss any limits people feel will be necessary for the systematic review, will it be limited for example by date, inclusion criteria, size or specific endpoint measures. These limits will be very important once the search has been run as you will typically need to filter huge numbers of abstracts to determine the few that will be included and as suggested by the type of review your process needs to be systematic.

What next?

The next step, once the hypothesis or question has been defined, is to define the search and that will be discussed in the next post.

References

I have taken a lot of the ideas for this post from an Accidental Creative podcast episode I listened to on brainstorming. This episode can be found here and is well worth a listen.

Some thoughts on systematic reviews

I remember that in my first year of university (in 2000) we were taken to the library and shown how to search the Beilstein Handbook of Organic Chemistry to identify previous instances of reactions we might be interested in. There was a wall of books and it was quite intimidating. However, I never had to look at those books because there was also an online searchable database which made the task much easier. I cannot imagine how much time must have been spent by chemists searching for reactions and reaction conditions, that was suddenly freed up by taking the data online.

This has happened with most data sources and we can now search through records of journal publications and patents with ease. This I believe has led to the increase in the publication of the systematic review and the decrease in the importance placed on narrative reviews. It has changed so much that, nowadays, before many research projects are fully initiated, a systematic review is undertaken to explore, among other things, what is already known about the topic and whether the research project is novel. Owing to their inclusion of all available, relevant data systematic reviews are considered the pinnacle of evidence in evidence-based medicine [Wikipedia]. This is, in my mind, embodied by the Cochrane Collaboration, which has a handbook on how to perform systematic reviews for inclusion in their database.

It is, therefore, important that all researchers understand what a systematic review is and how to perform one. In addition, it is important to know what to do with the output. Is it okay to summarize the data, or should it be synthesised in some way, either through meta-analysis or narrative synthesis. Furthermore, we need to be able to judge the quality of published systematic reviews so that we can judge their quality and determine whether there is any bias inherent in them, or flaws in the methods used.

The PRISMA Statement

The PRISMA Statement is a great help, as it details everything to be included in a systematic review and its planning and I have found this useful when planning, performing and writing up systematic reviews, as it provides a useful checklist to bear in mind.

I want to start my systematic review. What should I do?

The very first thing you need to do is ensure you are asking an interesting question that is relevant and that you are asking it in the correct fashion. You should discuss your idea with colleagues who work in the same field and have similar interests, and also read any relevant papers that you are aware off. This might highlight aspects that you are unaware of or have overlooked. It will also provide the groundwork for the next step, which is putting together your hypothesis and developing your search strategy which will identify the references that will potentially be included in the review. You should also work out who your co-authors will be and each person’s role. For example, you will need somebody to do the search and at least two people to go through the results separately and someone to adjudicate any conflicting views about whether or not to include a manuscript in the review.

Once this is done you are ready to think about actually starting work on your systematic review, and I shall offer my thoughts on those steps in the next few posts.

Why we are not uncreative

I have recently got back into listening to podcasts and enjoy those discussing productivity and creativity. This morning I was listening to the Accidental Creative podcast and Keith Sawyer was discussing his book Zig Zag: The Surprising Path to Greater Creativity. One of the points discussed was that about 80% of creativity is learned. This seems surprising at first but when I considered it, it seemed right.

I have read a number of books (including Austin Kleon’s excellent Steal Like an Artist: 10 Things Nobody Told You About Being Creative) that highlight the need for side projects as these encourage creativity. This is because if we focus on one area only we are likely to be stuck in one way of thinking and this can impact our ability to be creative.

Many people (including David Bohm and Steve Jobs) have emphasised that creativity is not just doing art or design. rather it is coming up with something new and making unexpected connections. When we consider creativity in this way, it is odd that some people are ‘creatives’ and others are not. We often do not consider scientists to be creative, when they can be some of the most creative people there are.

Why is there confusion about creativity?

I think that this confusion about creativity, with many people claiming they are not creative, starts at school. We are either classed as academically gifted or creative or persistent or musically-gifted. Often those who decide to do science are not encouraged to do anything artistic, instead focusing on science and maths to the detriment of other studies.

At school, science and maths are about remembering facts and applying equations, rather than trying to prove new things or question established hypotheses. This school-work is not creative and sets a mindset that can last throughout our lives. When we get to university we may do some research and suddenly we are faced with a completely different subject. We have the knowledge that we need to apply, developing experiments that may prove or disprove our hypothesis. If things don’t work, we need to create different experiments to confirm the results or different pathways to what we desire. This is different from at school where if something didn’t work we just needed to redo it, as it was guaranteed to work if we did it correctly.

What do I do to increase my creativity?

I have found that making sure I have a hobby increases my creativity. This means that rather than watching TV in the evening, or sitting reading a book I am trying to develop new skills. I love printed art and zines (Whatcha Mean, What’s a Zine?: The Art of Making Zines and Mini Comics), and would eventually like to put together my own. As such, I am trying out linoprinting and collage, and have for several years been taking photos on my walk to work. These on there own are unlikely to increase my creativity, however, the planning and getting ideas for the prints means that my mind is active and coming up with ideas unrelated to work. These can then eventually lead into ideas for work and for other areas of work.

I cannot say for sure that this works, but it is a lot of fun!

Why should you write less in your presentations?

For work I sometimes get to go to conferences and see many presentations in a few short days. However, when I go to these presentations I often find that everything I need to know is written on the slides and that I do not need to listen to the speaker to fully understand what is being discussed. When this happens I tend to read ahead on the slide and might potentially miss valuable information that is spoken whilst doing so, as well as getting a bit bored whilst waiting for the next slide to appear. I expect that many of you have also experienced this and when you read about presentation technique you frequently get to hear the phrase ‘death by PowerPoint’ which relates to this phenomenon.

What can you do to avoid this?

It might seem drastic, but the way to avoid this trap is to put significantly less text on your slides. Rather than detailing your objective on a slide you could include a prompt (e.g. ‘What was the objective?’) that you would then talk around, or you could include a figure or table but not your thoughts on the table. This way people will have to listen to what you have to say to be able to fully understand what is being presented. An extreme version of this is the Takahashi method where only a single word or short phrase is on each slide to act as a prompt, forcing the speaker to talk about what they are doing and engage with the audience. The Lessig method is similar.

But what if I forget what I am talking about?

It is better to have notes and to practice your presentation to make it as smooth as possible and have it memorable, rather than having a boring presentation. People will forgive you glancing at your notes to remind yourself of a pertinent point and will feel more engaged. These can be included as slide notes in PowerPoint or written separately as a text document.

Where can I find out more about making my presentations better?

I found the book Presentation Zen: Simple Ideas on Presentation Design and Delivery (Voices That Matter) by Garr Reynolds to be extremely informative, and their is a blog by the author this book that is good. It can be found here.

Also slide:ology: The Art and Science of Creating Great Presentations: The Art and Science of Presentation Design by Nancy Duarte is excellent. There is a free multimedia version of her book Resonate online which is about visual storytelling to improve presentations.

Why might networking be beneficial?

I personally find the idea of networking at events to be daunting and when I attend congresses I will be the person standing on their own looking a bit lost. However, when I do talk to people I will find that I will have a great conversation and not be at all terrified. What is holding me back is fear of the unknown and worries like: What if they do not want to talk to me? What if I sound like an idiot? What if I have nothing to say that they want to hear?

This fear of the unknown has held me back at many times during my life. I have not joined clubs that I maybe wanted to; I have not spoken to somebody and regretted it later; I have resisted using a technique that eventually turned out to be extremely beneficial to a project. If I had been courageous enough to do these things, the first time the opportunity presented itself I can safely say that my life would have been completely different. Nowadays, I have taken a few steps towards overcoming this problem, the first of which was admitting to myself the reason why I was not doing things that I wanted to.

Indeed, talking to people I do not know at events has become a bit easier since I realised one thing. That one thing was that many of the people I could talk to at events are in exactly the same position as me. They do not have anyone with them to talk to, but worry about talking to strangers. If they are at the same specialist event as me then we likely share some interests and this can be used to initiate a conversation. If this is a congress and they are presenting a poster, then often you have to be present at least for a while and will often be keen to talk to anybody. The exception to this I always feel is the big names in the area, who will know lots of people and will have lots of people wanting to talk to them. There might not be an opening for you to introduce yourself. Nevertheless, once again there is a way, you can use your own contacts to introduce you. It might be that you have a colleague who knows them, or can introduce you to someone who does. Often specialist communities are quite small and you will likely have some degree of connectivity. Even if you don’t, by talking to other attendees you may meet someone who could eventually introduce you to a person who could change your career.

Networking does not have to be done in person, and can also be done online. If someone has done work that interests you and you have questions you want to ask, you can always write to them and let them know. They will appreciate your effort and if you are discussing the work then they are more likely to respond to you. This can lead to a ‘conversation’ and a connection to someone who you have never met in person.