Suggestions for Improving the Reporting of Clinical Research: The Role of Narrative

From first ideas to study to conclusions: a schematic. This schematic documents the transformation of an idea into a study from which conclusions are drawn. Constraints prevent the design and execution of a study that would require only modest assumptions to logically support definitive conclusions (see text). Instead of reporting the modest conclusions supported by the actual study, investigators often offer more expansive claims. To do this, they make additional “bridging” assumptions (the right side of the Figure). Because the validity of these stronger conclusions is wholly dependent on the validity of the bridging assumptions, it is essential that investigators explicitly define and justify them.

Model of factors related to frequent ED visits. This graphic depicts factors thought to affect whether someone uses the ED with high frequency. We matched 3 control (1 to 5 visits/year) subjects to each case (>8 visits/year) on the green variables (see text for matching algorithm). We were particularly interested whether narcotic administration is associated with frequency of visits but included all bold variables in the model. Variables in regular typeface are potentially important but were not measured. An explanation of how variables were entered into our model is contained in Figure 3. SES, Socioeconomic status; PMD, private medical doctor.