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Welcome to the webinar. This is an event. This event is part of the new educational schedule jointly delivered by the Department of Surgery in the department, medical education. A bit of housekeeping. Before we start, if you have any questions, kindly pop them in the chat and we will have uh breaks a big break in the middle. So answers can be given. And of course, in the end, we'll have a conversation. So definitely don't be shy. Um Also you'll be able to download your certificate of attendance signed by Mister G Rowhani's and Dr Parag Green. And also if you have a couple of minutes after the end of the presentation to give us feedback, which we value a lot, it will help us improve and deliver better sessions. Uh So I'm thrilled to introduce our special uh speaker, our guest, Mr Stavros add a new Stavros is a consultant general surgeon at Papa. You're you hospital in Thessaloniki. Uh and apart from his heart as a surgeon, he also is a researcher. He's uh in particular in evidence synthesis expert and a certified guideline methodology ist and uh he's actually one of the top experts in creating surgical guidelines. Uh he says uh he serves as a chair of the guidelines committee of the European Association of Endoscopic Surgery and has published numerous articles in high profile journals and he served in the editorial board of Surgical Endoscopy and the John of abdominal surgery. Um And apart from anything, everything else, apart from being an accomplice surgeon and researcher, he's also one of the nicest guys I've met. So today he's here to share his knowledge and experience on how to write a research paper, especially in the field of surgery. And without further delay, let's give him a world. Well, well, let's give him a warm welcome. And Stavros, the floor is yours. Thank you. Bye dot And thank you for everyone who joined. So I think it's, it's a good thing that we're a few people because, you know, I was thinking that so if, if we are indeed, then we can, you know, in case you have any questions throughout, feel free to uh to interrupt me or just drop a short message. And uh I know you guys can, uh, can forward the question. Uh So let me show my screen. So let's uh jump directly to the uh to the presentation, uh the slides which are going to facilitate the preservation. The topic is writing for publication. So I'm going to uh sorry Banjo too because I, I cannot see the chat in case there are any questions, uh, please uh please let you know. Right. So, uh I'm going to give this talk primarily as uh in my function as subjected to and surgical endoscopy appear review journal in the field of uh scopic surgery. Uh And uh you know, I, when, when I started uh you know, writing publications, I was wondering how uh how I should do it. Right. So I uh first thing I did is I read through many, many articles published in high quality journals, but also some attitudes published in, you know, lesser impact journals. And what I found out is that I, you know, the what I, I read in lower impact journals did not really help me and perhaps confused me a little bit. Uh So I thought it would be reasonable to uh you know, to give a presentation uh right on this topic, writing for publication uh on in my function as uh subject it and surgical endoscopy. I uh read through literally hundreds of articles in, within the past four or five years. Afraid truly uh thousands of articles. Uh I had to handle how uh thousands of uh submissions. So there are some, some uh parameters that will, you know, that will draw my attention. And this is true, I think for all uh editors uh and other things that when I see them in a title er in the abstract, then I will not move forward to read the full article, the full submission. Uh So this will be a presentation of some practical tips on how to uh to increase the quality of your manuscript before you submit it for publication in uh in the period you journal. So the structure of uh today's presentation we're going to discuss about some general uh general things with regard to how to, how to write your articles, your uh your studies. And then we're going to get into a little bit more detail in the field in each specific section of the introduction. Methods, results discussion conclusion, then the abstract and the title and this is intentional. So intentionally, I put the abstract and the title at the end because uh this is how you you should write your article so abstract and probably the title also at the end because the abstract is really the summary of your article before you write your article, it is you cannot write the summary of it, right? Or perhaps you can. But uh if you write the article beforehand, then the abstract should be a piece of cake. So what is the purpose of publications first to communicate research funding? So you have an information to communicate to other people uh primarily to inform clinicians and researchers. Uh before. So because your audience is very specific, you need to adapt your style and language, consider that your audience are practicing physicians and even more more surgeons who are very limited time. Uh And uh therefore, it is critical that you write concisely and very specifically. So you do not use any scientific jargon, etcetera. It's not necessary, not anymore in the field of uh academic writing. So you need to be very concise and specific, don't need lengthy documents, very short documents with supplements, etcetera. And before, because your audience is also international, you need to write as simple as possible. So general principles, scientific documents need to be showed comprehensive, clear and informative. So you need to avoid scientific jargon. You supplements whenever you think uh you know that extensive information uh should be provided comprehensive, it's work matters. And uh my personal suggestion is to to, to have this uh this uh message before you. Whenever you write a scientific and not only scientific document, uh each word matters, so do not. So choose your words very, very carefully. Uh It is really important that you, that each one of the sentences delivers a very clear message so clear, right? Simple and informative, provide almost set information and deliver a clear message. You have to uh start by writing the protocol. This may not be very uh pleasant to you. Uh It is to me, to be honest, but it is nowadays the first step before uh embarking on uh study. All right, the protocol engages participants, participants are going to collaborate in conducting the study encase it engages uh participation of uh the group increases credibility of your study uh myself and probably many other editors will not consider a scientific document very credible if it does not provide uh reference and uh link to the protocol. Uh And this is true even for a retrospective study. So a study does not have to be prospective in order to have a protocol retrospective studies before you go dig into the data, uh need to be the study needs to have a protocol written advance. It also serves as a reference to you. Uh So in uh many occasions, you will, you will not be you not remember what you have, what you had planned in advance and what you had discussed with your uh with your collaborators. So your supervisor, so it serves as a reference in order to uh move to the next step. And it is also important to register your protocol. There are now uh public registries where you can just register your protocol if it's uh if it's a systematic review, for example, it's prospero if it's a prospective or a retrospective study, you can just upload the protocol on uh public repository such as uh OSF uh And uh you know, many, many other sites out there. So the protocols should state the problem. So what, what is the, what is the question that needs to be addressed in the study? Defined the end of the study, provide the context? So where is this? Uh So what is norm's so far? Uh Why is this study needed? Why uh how, how is this information addressed by other studies and insufficient, insufficiently address you need to explain. So what's the quality of the information that is provided by the other studies defined the contributions in the uh in the study? So all collaborators should have, should have a defined very defined function uh when conducting the study. But this is uh this outside the uh context of this talk, detail the methodology that you're going to follow and address any challenges you may find. If you're in experiencing research, you may not be aware of the challenges, but uh but try to do so. And uh the protocol uh needs to address the most common challenges such as, you know, the collaborators will not contribute as uh as much as expected. Uh etcetera also provide the statistical analysis plan. Uh you know, statistics is, is really a uh is a very extensive sciences. We we are told some statistics in medical school and you know, courses, etcetera, but it's really a sciences. So personal suggestion is to collaborate with a statistician uh before you uh before you, even before you write the protocol. So you need to have uh it is useful to have the contribution of a statistician uh at this stage. So let's move to the manuscript. Uh introduction should be really short, I cannot, I cannot uh over uh over stress this. So it should be really short, very, very specific information, 34 paragraphs marks uh just uh explaining to the audience, what is known so far, what is not known? And what is the aim? The aim is to uh to uh investigate what is not known and how is this going to be done? Uh important is that uh the introduction, uh every sentence of the introduction should have a reference or almost every sentence in the introduction. Uh This is because the introduction provides the context and the context is something that, that that exists. And you need to uh to provide the references in order to uh to let the two. Yeah, to let the people know that this information exists, it is out there. Okay. So one visual clue for someone who reads your manuscript is is the introduction referenced. If yes, great. If not, then there's there's a problem. So with regard to what is known, you need to uh search first for evidence summaries, for example, systematic reviews or some physical synthesis, uh systematic reviews such as meta analysis. If these are not existent, then our cities. And if these are not existing cohort studies, uh what is not known? This is the evidence cap and what is the aim to fill that gap? Right? And this cap should be filled by framing a question. And this question is best framed using the uh the peak of framework, patient's uh intervention comparator outcomes. Uh But there are some other frameworks as well depending on the study designed, for example, diagnostic test security studies at a different framework. If you cannot frame your question, if you struggle to frame your question, you need to question yourself whether the study is well designed, whether the study design should be redefined. So you might need to clarify this with your supervisor or an experience researcher. Yeah. So this is this is also what we, what we see in the introductions as the last sentence of the introduction should be a people question, right, or any kind of uh question framework. For example, the study and the examples I'm going to bring car for our from uh from submissions we have received in our journals in a journal. This study aimed to assess the impact of an open or laparoscopic approach. So uh intervention, open comparator laparoscopic on the incidence of meta Chromos peritoneal metastasis. Uh So uh the outcome is uh the incidence of metal cross peritoneal metastases in patient's from there was surgical treatment for correct cancer in the population based cohort. Uh So you see the author's in uh this of this study they provided provided the peak of framework with the D at the end or the sorry, the study design. Uh PICO S uh they also defined the study design which is a population based corporate, this is a perfectly framed question. Uh Then you move to the methods that the introduction section should be very straightforward. Uh So the study design needs to be uh mentioned uh right at the beginning of the methods. So that if it is not, it has not been mentioned in the introduction, so that either needs to know what kind of study uh what kind of study design you're using. Uh And there are different kinds of self designs. Uh So in general, there are randomized studies, experimental studies, apologies for the background uh noise. Uh So there are randomized studies, experimental studies and observational studies, right. So there are these two broad categories, uh randomized studies which are experimental studies, always perspective and observational studies. Observation of studies are divided into cohorts studies. In a cohort study, you have a cohort of patient's who are followed over over time and these patient's are this population is exposed to um uh two is exposed to a factor in in most surgical studies. It is uh an operation or they are not exposed to an operator or they are exposed to a different kind of operation. We use the term exposed because it is an observational study. It is not an experimental study. So we do not intervene. Uh So cohort studies are uh corporate studies is the most common study design in the field of surgery. Case control studies are not studies with two patient groups who are followed over time. I'm not going to elaborate on that but be very careful in the use. So in the use of uh the term case controlled studies because case control studies are very rare in the surgical literature before you define, define your study design. I suggest you go through the types of uh study designs in order to make sure that you you described correctly your your study. So most commonly, so typically you're going to report on a corporate study and then you also need to report on the protocol and the registration and give the registration number. Uh So the study design can be systematic review with or without a meta analysis, randomized controlled study, cohort cohort study or a case control study. So rarely or a case series, right? So cohort study in case series, our uh our observational studies which can be prospective or can be retrospective. It's not just to uh just to mention this because it's also very important. It is a common uh it is a common mistake to define a study solely as a prospective or or a retrospective study. This information regarding whether studies, prospective or retrospective is also important. But more most importantly, you need to define whether it's that the studies experimental or not. So whether it is a clinical trial or not, and if not, if it is an observational study, uh you need to report whether it is a cohort study or a case series. So in the case series, you do not have a comparative arm, right? Uh a low hanging fruit in, you know, medical writing is using reporting standards, reporting standards are guidelines on how to, how to write your manuscript and there are different reporting reporting standards for different study desires. Where for example, there's Christmas 2020 for systematic reviews, Consort for uh randomized trials and Strobe and uh Strokes. 2021 is specifically designed for surgical observation, I'll studies. So stroke is in general for cohort studies in any, any field of uh medicine. You can browse through uh equator network dot org. Uh This is a website which contains all available reporting guidelines out there. So you need to select the type of the study design that you are using and you can find the appropriate reporting tool. And this is also like a scenic juan um in uh in an academic document. So there are no reporting standards cited in a manuscript. Then an edit er would would probably not proceed with considering your manuscript uh for publication. You need to define the setting. So where is the study conducted? And what's the uh what's the experience of the surgeons, how many surgeons performed the operations? Uh And you know, all this information that will allow for uh the leaders to assess what we call the external validity of the study. So whether the findings of a of your study can be extrapolated to my uh reader patient population need to define the eligibility criteria. Uh And so which patient's were considered eligible for uh for inclusion, the primary outcome of the secondary outcomes. The primary outcome is the outcome that you're going to focus on in your study. Uh And typically, sample size calculation is based upon the primary outcome, secondary outcomes are not necessarily surrogate outcomes. But uh this may be outcomes that are not, uh for example, may not be patient important and always, always search for uh problems first. So patient reported outcome measures whether there are any problems available in the literature before you define your outcomes at the protocol stage, of course, and you need to detain the statistical analysis that you're going to use. Uh important to provide the statistical analysis plan or provide the reference to the statistical analysis plan or provide as uh as a supplementary fine. Again, very important to collaborate with a statistician if possible or someone or a colleague who is very very experienced in uh statistical analysis uh perhaps with post graduate studies in the field. And you need to also to report whether expertise was available right among the authors group in statistical analysis. And I found this very interesting. It is an opinion, I cannot remember where I found, found it, but it's very true and mistake in the operating room can threaten the life of one patient. A mistake in statistical analysis or interpretation can lead to hundreds of early deaths. So it's all that when we allow doctor to conduct surgery. After uh few years of training, we give S P S S or we allow the offers of uh scientific manuscripts to perform the uh the analysis themselves. So some tips with regard to the methods, everything that you uh that you report in the methods, everything that you describe in the method should be reported under results. Okay, so that the results need to correspond to the methods. Uh and uh not uh not very rarely. We, we find ourselves in uh you know, we we encounter manuscript where the offers uh report on many statistical analysis. It and then you go to the resolve section, there's nothing there. The method section should be uh should be uh analytical enough in order to allow full replication. So this is probably the only section of the manuscript that should not be uh very concise or it can be concise and you can provide the uh full uh full methodology in a supplementary file. Uh And you know, just provide the summary other methods in the main manuscript, but the method checks section should allow full replication of your study. And this is one of the cornerstones of uh uh science, right? Every study needs to be uh replicable. You supplements uh and use as many supplements as you wish. This is not, this is not a drawback, this is rather a strength of the article. And it's also going to uh look well to uh to the editors. Uh and uh your supplements need also to be very carefully written as well because editors to go through the supplements uh of course leaders period viewers and readers as well. So the results are moving to the results section. Uh so you need to define the patient characteristics or the study characteristics. Uh If we deal with uh if we're talking about the systematic review, uh you need to provide the results in uh within tables. And uh this is uh this is a rule, right? Except you know, if, if we're talking about a K series, a very simple case series, otherwise the results should be uh calculated and you need to provide uh so the text should provide some information about the primary, some uh you know, the most important results uh with regard to the primary outcome in the second body outcomes. But the main, the main uh let's say uh part of the results section is not in, in the manuscript, the main part is in the tables, right? And so typically in, if we, if we have or any type of study, even if it's a randomized control trial or an observational study, the first table, so table one should be patient characteristics. And if we're talking about a comparative study, we need to provide the comparative baseline characteristics of the two patient's group, patient groups separately, you need to avoid P values, right? So there's a very uh uh famous statement by the American uh Statistical Association about the uh overuse of uh P values and how we need to abstain from using P values, etcetera. Uh We have surpassed the era of P values. Uh And you, I guess most of the, of, of uh researchers do not know that, but P values should be rarely used instead. And in order to justify that, consider the following, I'm not, I'm not, I don't know if you are familiar with, with such plots. So uh this a plot of the hopes ratio of the intervention. So what are the comparative odds uh for the intervention or the comparator uh to uh resulting or to be associated with an outcome? This is the no effect line and this is the confidence interval of the odds ratio. Uh So the true effect, the true comparative effect of the intervention, the comparator is somewhere between 1.1 and 1.3. So somewhere between these uh two dots, since this line, the confidence interval does not overlap within no effect line, the result is statistically significant, right. So this one is statistically significant. If we uh we cannot see the slide, I think it's stuck on the previous one unless you have. Yeah. Uh shall I uh let me sorry. Right. So what about what about now? Yeah. Yeah. Right. So uh okay. Very briefly, there's the no effect line uh intervention comparator and this is a confidence in her bod. If there's no overlap between, there's no overlap of the confidence interval interval with the no effect line, the result is statistically significant. If we translate it into absolute difference depending on the baseline risk. So that the risk of presenting with this outcome in in the comparator group. Uh So if we have some, some more numerical information, this confidence interval of the odds ratio may be translated into a difference of between three and eight patient's per 1000. This is another confidence interval between 5.8 and 7.2. I guess that physically significant further away from the no, no effect line because it's a higher odds ratio. And this difference may be translated to an absolute difference of 5.2 to 8.8, uh 100 patient's right. So both the results are statistically significant but they may not be clinically significant. Okay. So such a difference maybe uh statistically significant. So this this order issue may indicate a difference which is statistically significant but not clinically significant. Uh And consider this one, a notary issue between 0.9 and 2.4. So they correspond to the difference uh absolute difference between three fewer patient's to 28 more patient's per 1000. This may not be statistically significant. But if the outcome is mortality, it may be clinically significant. Okay, although statistically insignificant and we have such a wide confidence intervals uh with wide absolute differences. And this may uh this may suggest this usually suggest uh significant uncertainty about the true comparative effect, right. So what I'm trying to, what I'm trying to highlight is that values are uh not recommended uh by statisticians anymore. Instead you need to provide a relative effect estimates such as also ratio risk ratio, risk difference, hazard ratio. And ideally also the absolute difference in order to give an idea to your readers, what we are talking about, what what is the size of the of the effect we were talking about. So reporting the relative effect estimates uh such as also is consultation and the conflicts, interpol's and absolute effect estimates. So it is not sufficient to report a difference. Or uh let me say an incidence of uh the incidence of the outcome in the intervention group in the comparative comparative group 5% versus 8%. You also need to provide the uh interval estimates of uh these point values. Uh So you can report a difference of eight patient's per 100 with the respective confidence in their back. You need to be objective when you report your results try to use neutral language. So not uh so you, you need to be asked right? As simple as possible. Uh You may, you can give a different tone in the discussion if you, if you want and uh you know, give the sense of a personal appeal or a group's opinion. But up to the results section, you need to use a completely neutral language, just reporting the results. Uh For example, I can remember my script uh I read last week uh that uh that uh where there was phrase we found only only three patient's with with this outcome. Okay, the word only is very critical here has no place in the results. Let's go to the discussion. Apologies if, if this is uh this has taken too long discussion should be also short 4 to 6 paragraphs. Although uh with some flexibility, if you, if you think that more information is needed, the first paragraph of the discussion should summarize the most important findings. You do not need to replicate what you, what you wrote in the results. But here you can give a more uh more uh or you can write more freely. So we found in this study, we found that uh this intervention was effective, especially in this particular group of patient's etcetera. So summarizing the most important findings in the first paragraph of uh the discussion, for example, patient's who underwent open resection of the primary tumor had a significantly higher risk of developing meta Chromos uh correct uh peritoneal metastasis and patients who underwent laparoscopic resection. This final contributes the growing support of the laparoscopic approach given it's superior sort um outcomes, for example, etcetera, right? I need to discuss the findings in context. So this does not mean that you have necessarily to compare your uh your findings with the findings of other offers, which is, which can be found typically in the discussion section of other articles. But you need to provide another insight uh consider that you cannot, you cannot always compare directly your results with other authors results because there may be fundamental mental differences in your study populations, for example, uh or in the in the interventions over in the perioperative management, you need to, to provide another insight to uh to your either. So okay, you can report that your findings were different compared to some uh some key uh studies on the topic. But you may need to justify or to explain these difference in findings if you cannot just report so, but you know, uh it is really not always, not always important or not always necessary to compare your findings with other studies because every study has different features and every study may uh may provide different information in a different context, discuss whether the the evidence gap was addressed. So whether the study uh objective was reached, it is okay to state that it it was not reached, it is really fine to state that we, we we could not get there, right. So this country so that the edit er we would really appreciate that. So you need to, you need to, to uh to uh to provide your, you know, to provide your results and you know, a company or you know, explain the uncertainty uh that should accompany these results. And if this uncertainty uh is uh is uh is very large, then you need to be transparent about this and report. Uh a study may not be uh may not provide sufficient information to investigate a clinical uh clinical question, to address a clinical question. But it can be used by other studies to direct their study design or it can be used to, you know, synthesize the the results of many studies, for example, meta analysis, right. So your results, your findings are triple important, but you need to uh to give information to which extent you are certain about the findings of your stuff, discuss what remains unanswered uh and uh report the limitations and the potential potential effects. So this relates to the previous comment and how, how you addressed any limitations you, you may have uh encountered, the discussion should be also structured. Uh You may also give, you may also have uh you know, sub sub uh like uh subsections in the discussion section such as in the results section, etcetera, implications for practice, implications for research and implications for policy making if any if any right, uh perhaps the implications for research is the most important part of the vast majority of uh scientific studies because they may not have a direct direct implication for practice. Uh unless they, they find a very, you know, something very remarkable and the quality of the studies exceptional. But usually uh it's a study provides a context for further research. So discussion is no free text narration. As apparently many offers may think it is an integral part of the manuscript and it needs to be structured, have a context and use dense, dense language and clear messages such as the rest of the manuscript. Uh Again, the discussion does not have to be long, can be really short 34 paragraphs that needs to be, to provide very specific information. It needs one of the paragraphs needs to provide a very specific information. Uh For example, first paragraph, uh main findings, second paragraph, what other studies have found. And if there's a significant uh difference between your findings, if not, what maybe the reasons for that third uh limitations. Uh fourth uh like any other information you but so implications for issues, for example, but need to be really structured and deliver a clear message and the conclusion. This is unfortunately what many leaders focus on. And this is uh this is what I also focus on because I, I sometimes I I or usually I do not have the time to read the full uh full logical to see the uh the abstract and the conclusion. Uh and the conclusion needs to be reliable. For this very reason, the conclusion needs to be reliable. Uh The awarding of the conclusion depends on your study design, if it's an evidence synthesis or if it's a, a primary study. So in a primary study, you must use a past the past tense and make the study, make the uh conclusion study specific. If you not do not use the past tense, your study may be accepted by a lower impact Jermell. It will not be accepted by a high impact journal. Uh and by high impact I uh there are also some high impact journals at least in the feet of surgery which do not, not uh about this rule, but in general primary studies, uh the conclusion needs to use past tense. For example, this is a study published in the New England Journal of Medicine. In conclusion, this is the results. Uh this is the conclusion of a randomized trial, a conclusion for patient's referred to our clinics, for heartburn, unrelieved by PPI S. Uh systematic workup revealed that heartburn was truly PPA refractory etcetera. And that highly selected group that prescription isn't an application was significantly superior to medical therapy, right? So this is a randomize controlled trial published in the New England Journal of Medicine. The authors use a past tense. I think there is all very study specific for patient's referred to our clinics for heartburn unrelieved by PPI S in the highly selected group of patient's, right? So really, really important in order not to for, for the leader, not to have the uh you know, not to, to to pass the message that the results can be generalized hands down. But there are several considerations before you know, uh before uh taking the message provided in a conclusion and using it for clinical practice. Uh This is a very poorly written conclusion. L CBD with P D C should be performed as a priority alternative compared two T T D for called the whole thesis, right. So first of all, the conclusion should not contain a recommendation. So providing a recommendation is a task of qualified uh guideline development groups. Uh but the conclusion needs needs to provide objectively the findings of the study and that specific context in evidence synthesis studies. So in systematic reviews and meta analysis, we need to provide an informative statement. For example, selective inter operative Common Geography may not be figured to root in inter operative common geography. In the profession of bile duct injuries. See the uncertainty here may not be inferior. This uncertainty reflects what we call uh the certainty of the evidence. And further information is provided in this uh great uh paper uh from the series of great articles in the journal of Clinical Epidemiology, informative statements to communicate the findings of systematic reviews of the adventures and the abstract. You need to write that the end is the face of the paper. This is so many or uh spiritually, all editors will just read the abstract and based on the abstract, they may go through through the full manuscript and consider for further uh for period view uh or discussed it right away. You need to provide just a very short sentence, uh some information with regards to the background, the objective one sentence, the methods, you need to define the outcomes, the primary and probably also the secondary outcome measures in the results section, you need to provide uh the results of the most important outcomes. You may not have enough space to uh provide the results across outcomes. And the conclusion that needs to be in line with the abstract content. So the conclusion needs to be supported by the results, the results need to be uh based upon the methods. So this is uh is the structure of the abstract, the background or sorry. The objective needs to be supported by the background. So there needs to be a rationale for conducting the study. The methods need to be uh backed up by the objectives or they need to be appropriate in order to address the objective, the results need to uh I need to um to be supported by by the methods. So what the methods report report, they should be reported in the result and the conclusion needs to be uh supported by the results. Uh The abstract has to be a standalone can be or should be structured in such a way in order to be a standalone document. Okay. So no further information should be uh should be required in order to deliver a clear message, right. So the results need to be based upon the methods, the conclusion uh needs to be justified by the results. Uh And then you can write your uh title. Uh It may be informative or it may be descriptive, you may need to, you know, this may depend on the uh the style of uh the journal informative title reads. Evidently, decision frameworks enabled structured and explicit development of healthcare recommendations. Uh descriptive title states, laproscopic or open writing, collecting for cancer propensity match work or study when general title should be short, avoid lengthy title's. Uh they provide, they, they, they are confusing and uh they make the paper not attractive operative morbid for example, cognitive ability and quality of life after laproscopic can open, right? In collecting patient, other question of of the right comic over study of uh 152 patient's from a tertiary care center. So this may uh this may appear scientific uh but it, you know, in, in the era of uh constant flow of information, uh this is not effective. You need to provide a very short title, Informative for descriptive title just to inform the reader about what they, what they are going to read if they choose to read through the abstract and or the main text of your mind script and some uh specific tips, apologies for the background. Uh Okay. Uh First writing, writing, first person, we calculated the meantime and standard deviation for each group of searchers uh instead of the meantime required to perform T me was calculated for each group of surgeons, um split sentences, right? For interest group of surgeons. The meantime, a standard deviation were calculated procedures lasting more than once other division of both. The average were to find a difficult complex TME. We calculated the meantime, a standard deviation for each group of surgeons, we defined complex T M E T M as procedures lasting more than one South application above the average, clearly concisely avoid abbreviations. This is really a headache for editors and peer reviewers and readers alike. Uh look at this uh this uh this paragraph, 123456789 abbreviations. Uh you know, sometimes they are needed indeed. But to be honest, when I write an uh an article and no articles published in high impact journal, I do not publishing high journals of course, but uh authors of high impact journals really use abbreviations. I if I if I'm talking about random ass controlled trials throughout the manuscript, I for example, in guidelines where we, when, when we very frequently use the term are CTS a randomized trials. Just a couple of words. It does not, it does not, it makes rather the manuscript simple rather than using our cities throughout or several our cities may be understandable but there are some other abbreviations which which, which you know, you need to uh you need to think hard. What, what does he offer me? Let's go back to see the definition of the abbreviation that said the experience of the abbreviation. Uh what the edit er wants to see. They need to see a structured document well written that provides a clear message or clear messages, you need to check for typos. There's nothing worse on, you know, uh, receiving a submission with Typos throughout, with annotations, etcetera. And it is always useful, although not necessary to provide, to accompany a short message to the edit. Er, why should they consider the study? The edit, er, might not be content, a content expert. So I may receive a study on, uh, adrenal surgery or I don't do any address surgery. I'm going to, to, to forward it either to another subject. Ator who doesn't have a surgery or directly to period here. So are experts in the uh in this field. So the edit er needs to, needs to know in a couple of sentences why they should consider the study. And I think this is the last slide. Uh this is a very strong message by Professor Doug Altman who has passed away a few years ago. He was a pioneer of evidence based medicine. And a famous quote is we need less research, better research and research done for the right reasons about them using the number of publication as a measure of ability would be stopped. And I, I could not agree more with, with this statement. We do not need more research. We need research very well done research truly affects patient care. And if, if aesthetic study is not properly conducted, uh then uh it may provide misleading information and this misleading information is translated into bad practice. Uh It's not, of course, it's not related to, you know, uh 22 V reporting of the study. But this is a general message that you need to, uh, that, that, that you need to consider before embarking on uh stuff. Every study understand that especially in the UK, you need to, uh you need to engage with research as part of your curriculum. But if you do so try to do it perfectly. Uh If you, if for any, for any reason, you cannot uh involve other people who are, who have experiencing a research in order to properly design uh conduct and report your study. Thank you and apologies for thinking too about an hour college for that. The initial plan was uh for it to, to last about 40 minutes. So my apologies and uh having any questions, Taveras, congratulations. I think it was uh very, very nice talk. Uh I had I have some questions but before that, I would like to highlight the fact for the trainees who um who are seeing this or watching this. Uh You can see how Stavros conducted his, his presentation. Few lines in its slide. Uh A lot of talk between them and not a lot of information on the slides. Just the topics is the perfect type of presentation and this you should mimic him. And then it was quite simple even though uh has Mr your organs froze? Uh Stavros. Yeah, probably. Yeah. So in the meantime. Uh Yeah, yeah, in the meantime, until he reconnects, shall I? So I see, I see a question by uh by your honest should, and should I address this or should I go? Uh one moment to connect? But in the mean guy, in the meantime, guys, if anybody has a question, please, I mean, uh there are no stupid questions, feel free to ask. I mean, if you establish, if you see the poll, most people are uh more than 50%. No, actually exactly 50% have very little experiencing the 16 have none, which is perfect because this is our audience. If they were proficient and experts, um probably then they shouldn't be part of this talk. They already know what you said they are. But um yeah, so guys, you have a unique opportunity. You're speaking with a person that uh is really committed to that and values quality. So he will give you some very valuable insight. Hi for uh the other education um education fellow and we run the education scheduled together. He's a registrar in Kingston. Hi, Mr Jurgens. Uh Sorry, I think, I think my connection was poor. Uh I don't know if uh if you had me about my comments, uh it stopped where you said about, he gave clear messages, how to present. Yeah, I mean, the established slides were very simple and easy to see. So these are some recommendation for our train is how to make their presentation and also it was a difficult subject and make it so clear and so easy to understand. And uh I'm sure that even though some of you, you're not at all experience this subject, you understood a lot of things. So thank again, uh Stavros and also been a Godsend for it, for uh having this initiative to uh to invite Sabratha with us. So I have some questions. Uh Do you want to uh to coordinate this? Yeah. Yeah. So uh let's start with the first question. Uh And I have a couple of as well. So I get uh we can do some very, very good talk and I think Fareed might have something to ask. Uh So um uh first question by Mr Hogan, is it acceptable to use same sentences from the main manuscript in the abstract or we should change that? So I think uh Mr Gurganus means that since the abstract uh is based on the manuscript, the main body, how much different or same should we basically not copy paste in a way that it doesn't make sense? But should it be different? Wording that that should be acceptable, should be acceptable. But you know, I, I uh to be honest, I uh to me it is completely uh completely justified to have uh to have a conclusion, the same conclusion in the abstract in the main text. But if we, if we're talking about the rest of the manuscript and you know, the introduction and to the background, objective methods results in the manuscript. Uh So in the abstract, uh you know, the information should be that dense that even even if, if you would like to do so, it would be difficult to, you know, to, to use uh phrases exactly as in the main, as in, in the main text. It is it is acceptable. It may not look nice, too many, too many editors, I would not have a problem with that. Uh But it may not not look nice, but it is acceptable. Yeah, so some some minor changes would be more recommended, just change the wording a little bit but don't change the meaning. Yeah. Yeah. So the most important exercise is to, to learn how to, how to, to convince your, your how to, to make, to provide very dense information. And uh yeah. So this is this is challenging but you know, I think given that given that the the the abstract, the abstract is really short. I I think there, there are no uh in most situations, there's no option to, to take a part of the manuscript. And uh you know, put it in, in the abstract, in most situations you need to, you need to adjust somehow. Um Also uh just to make it uh to be on the same uh context, should the title include always the type of study or the methodology scenes? Um um Mr Kerrigan's has like does it always have to say a cohort study around the most controlled trial uh systematic review? I mean for systematic review, the priest definitely says, yeah, yeah. So yeah, so this, this is a little, there's a little bit, this is uh this is a little bit difficult but for me to say that, but this may, so this part of the reporting standards uh may not be justified for some so that the title uh needs to provide the study needs to define the study design. Uh It has to do with the journal. Uh First, I would, I would look at the journal style. And if you know if we're talking about, about search endoscopy, we we we, we look for title's which are really catch a very short, provide a very clear message and they do not need to define the study design. Also, if you look at a very, very few systematic reviews published in uh the New England Journal of Medicine, they do not specify that they are systematic reviews. But I think this does not incur a problem to the to the leader because they, you know, if, if the if the title is interesting, they will just go to the abstract and the abstract always defines the study design. So in my opinion, it does not, does not need to be defined in the title. Um Yes. So um one message from that ulcer is do your research on the journal. Uh So uh you don't, you, you comply with the, with what the journal looks for the style of the journal. Uh I mean, I, I don't know how has uh for example, surgical endoscopy and no B J s has adopted more linea more relaxed manuscript submission standards. So you can submit something that's not very um they don't have very strict standards in the beginning and then you, if they accept, you can modify it. But uh yeah. Yeah. Yeah. Yeah. So this is, there's probably something that, that I should, I should got in this, in this presentation, I should not waste any time in uh you know, adjusting the their entrances in the sight in the type of the journal I asked for, asked for etcetera. So this the type of the type of the style of the references will not define the decision on whether to, you know, have the, the article accepted or forwarded for peer review, etcetera. So I would not waste any time of that, to be honest with you, I think this was a question about right? So the general style is that correct for your uh not just just um um my message would be in to do before you submit to a journal, do your research and, and read the instructions to the authors uh do your homework and don't send something unprepared because some journals maybe strict and they want everything to be um ready for like ready for publication. Other ones say, okay, let's read it. Let's see if we accept and then you can do the, the formatting of the title's or the references. Uh Because now they, and also another message would be to, for people to learn how to use the reference manager because it makes all the difference in the world because I see, I still see people doing it manually. Uh And uh we are in 2023 we have a, I have all that. I mean, people could avoid. There are lots of programs out there. So uh just to mix it up and ask um from um uh carried um how to find more stages to practice research, work more intense. Uh Do you want to elaborate on that because it's not very clear for me. Do you mean how to practice writing? Hi. Uh First, um if I can thank Doctor Stavro for uh this uh informative presentation, it's really helpful for all of us. So, I mean, we, we um we will need to practice more research and writing uh to, to achieve the target of uh of such a presentation. So how can we find more stages uh to uh to brag more for more research? More than 10? Yeah. Yeah. I don't think there are a lot of resources out there to be honest. Uh So what, what, what I, I recommend to uh to our trainees and two other people who approach me you know, to collaborate, research, etcetera is uh select some high impact journals, not only surgical journals, but also, you know, uh medical journals and uh read through 10 2030 50 articles uh and different study designs. At the beginning, you will not get, you know, you will not get how the article structure, etcetera. But if you read through 50 articles, you will see a common pattern and uh similar, you know, uh some similar characteristics, some common characteristics shared by uh studies of high quality. So I to sum up, I don't think there are a lot of resources, resources out there, there may be some surgical journals should do some, some, you know, some webinars, etcetera. Uh I do not have any information about that, but I my recommendation for someone who now who is junior in the field of research is read through many articles published in high impact journals. Um I couldn't, I couldn't agree more Star Wars. And as you said, you, I mean from reading and in academia, you kind of imitate without we're not talking about stealing, but you imitate what you read and you find those journals, you had very good examples of what is not good to how to write properly and how to phrase your question or your conclusion and what not to do. I would also advise people to keep like a folder of articles that they like their right because you know, it is a more structured way of writing but every person has their style. So and their voice, which it's not as free as in uh of course, in literature here, it's more structure, scientific writing, but they might like a style or adjourn a paper how it's written. So use like keep it like a freight as a phrase bank. Basically the papers that you like how they are written. Um I don't know if established if you have anything to uh as for resources. Um I can say not because Stavros is present. I've seen a few resources. I mean, there are a few online. Um they're the only um formal one in one on Coursera, which is called writing in the sciences, but it's not very focused on medicine. It gives a lot of messages that Stavros said about the style but not the structure so much. And the other one is the newly launched uh course writing in surgery by the British Journal of Surgery and the University of Edinburgh that um I'm currently attending, I don't have an uh and also the bridge general Surgery has webinars free online on how to write. But within one hour, this is the most and I'm not, it's not the same list, plug, it's the most condensed and to the point information you could see. So um thank you Stavros because you were very on point. And I can say for having seen a lot of resources how to write. This was very informative. So another question um from Ferrous, he's one of our trainees, apart from involving a statistician in our studies, what basic tips can you implement to make our research more statistically valid? Um Which is, of course, it's before the stage of writing, but definitely, uh um yes, it saves you a lot of heartbreak, not preparing and not doing your homework before studying, starting a project. Uh I was, I was hoping you, you'd skip that question because I, I don't have a real answer. To be honest. I, I was enough to, to uh to find, you know, a group of statisticians who, who just do it for, for fun, who like to do research and do it for fun. And uh you know, if my, my advice would be to, you know, just try to network with, with statisticians whenever you can and, you know, share your ideas and see whether they. Uh so I was, I never liked this professional, this uh yeah, professional collaboration with statisticians. So it's just like uh pay for services just like the correct term. Pay for service. Yeah. Make it very commercial and not scientific collaboration. Yes, I, I don't have a uh an advice. What I can say is that, uh you know, I've read through many books on medical statistics, etcetera, etcetera, etcetera. Uh My father also attended uh master's degree program, Public Health where there was very intensive work on, you know, courses on medical statistics, the information is too extensive in order to make sure that you're not going to, to do fundamental errors. Uh So I I do not have an answer to that. Uh My apologies for us, but my, my recommendation is, you know, try to be friends with statisticians and uh guys, it's the same thing. You, you cannot be good at everything. I mean, um you are, we know how to operate, we know how to take care of patients'. We know how to write. Uh You can have uh there is a limit to the skills you have. You can be what we call a golden um uh like a jack of all trades. But in order to properly be good and to publish in high impact journals, you need to be very good at what you do. So for example, Stavros is collaborating with uh some statisticians that are correct are the best of what they do, but this is their profession, this is what uh we wouldn't ask on these people to operate. So it's the same. Uh we have a working knowledge of statistics, but we definitely cannot do everything just to, just to, to, to, to provide you the context I've experienced in evidence synthesis of over over 10 years. And I'm collaborating with, with this group of statisticians since about four years, I remember correctly. Uh And they truly provide a different insight in whatever we work on together. So if you know the collaboration with statisticians going to to open up a whole other world to you. So strong strong recommendation to collaborate with statisticians. Um Also it's something simple similar to what for Asseri well mentioned in the beginning the protocol. So whoever you involve statistician methodology ist also if you do evidence synthesis or um secondary research, meta research uh and information specialist, there have been examples for example of randomized trials that there is an inpatient. This because you know the famous Johns Hopkins randomized are there is adding a patient this because they didn't do a proper literature research. So involved all the stakeholders and you are not useless. You are talking to the to the trainees, they are clinical content expert. So you are equally as important to the statistician who is not a clinician uh involve them before riding the protocol because otherwise you will have issues. Um for example, let's say your Excel document your data collection form, having issues uh with cleaning with that that then you'll do double or three times the work. Uh But if you had somebody from the beginning, they would have given you the proper guidance on how to collect data exactly. So this is this is an excellent tip. It's an excellent tip. Do involve them from the very beginning of the study uh from the product, from the idea stage, all groups or, or you know any any group of stakeholder that that you, that you intend intend to involve uh just make them part of the team and make them feel important because actually they are important. You may not, you may not understand how important they are at the at this stage, but they are extremely important, make them feel so and uh believe me, they will, they will ask you to collaborate again in other projects. And uh you know, this, this may be a start of a great collaboration. Uh And it doesn't work note in high because you said something about high impact journals, high impact journals involving the statistician is like a pre prerequisite, right? So there's no, there's no other. Um So um uh Man Aceta uh said um one question, um uh I just have a question when looking for a subject or topic to do research. What are the kind of things we should consider? I'm very new to the world of research and feel like I have not yet developed that line of analytical thinking and quite and feel quite over well when thinking of the topics that the research could be conducted on. Um Yeah. Uh So this is probably the question of a novice how to start. Um And yeah, starving if you can enlighten. This is very, very good question. This is a very good question. And this is a question I had uh you know, when, when, when I, I started, you know, uh you know, being involved in research. Uh So I there are several ways. Uh, first option is to, to go to someone senior and you know, ask them what, what is missing and what is feasible, what can be done in our center. Uh, and second, uh, you need to be aware of the literature on a specific topic in order to, to identify, uh, evidence gaps. Right. So first option going to someone senior, see what, what can be done, make sure that the topic is of interest to you do not uh do not become involved in something you have no interest on because you will not be motivated, you will not deliver. Uh but you know, ask someone senior what uh what is missing, what you know, what, what kind of ideas you have and what, what, what can we do here? And second being aware of the literature on a specific topic. Uh of note, very simple study. Designs are extremely important. For example, uh there's uh there are very few uh case series out there. K series are extremely important. They provide the baseline risk for the baseline effect of an intervention, for example. Uh Do we, do we know? I think your upper gi, right? Uh You mean Mr Gurganus, we our trainees? So uh Mr Gurganus guesses up upper an emergency surgery and focuses on abdominal bariatrics. So do we know really know the risk of mess erosion when using a mess in Hiatal hernia repair? We do not have the exact figures. If you, you know, if, if you, if you use Mess, for example, if you use Mess in your department, you identify another, you know, uh 10 departments in, in the UK who do use mesh. Uh then you can just do a K series. Very important. I guarantee if, if well conducted well reported, uh then it will get published even in higher impact journal. So simple studies are the most attractive studies studies. If a study is has a, you know, has a complex topic and you know, uh not very clear aim, etcetera, there may be problems. So very simple question start with, you know, you you have a clinical or you, you question yourself with regard to what you do in clinical practice, just go to uh search department see whether their safety is out there. If not just you know, go from there, I think you you get the point, right? Um Yeah, that's very important now that's why we see the rise of those multinational or multi center collaborative or um those like global surge or all those uh collaborative projects where they just collect data and they establish uh with the use of big data that they established the risk or on very simple questions. What are, for example, there's one we run right now at Kingston Apollo which is from which is the emergency presentation of colorectal cancer. And it is very simple. We know it presents but what is the actual statistics or what is the actual management? Um Yes, we and also, of course, if it was a question that has been answered by randomized control trials and we had and we need to then go up to the pyramid of evidence. But uh example, I like to say, uh is HIV was discovered in a, in a small, either case report or a small case series. A small group of uh men in New York in the eighties that started having those opportunistic infections, somebody spotted that published and then so everything has its place, uh, depending on what is out there. Exactly. If I make, I just because I, I saw, I saw somewhere a question but I, I'm not sure about predatory journals, I think. Uh, yeah, I just wanted to mix it up. Yeah, about predatory journals. Yes. So this is a very good question and, you know, it is not, it is not well defined. What, what's the predatory journal? It cannot be defined? Really? What's a predatory journal, right? Uh, but, you know, just, uh, just as an information, there's, uh, I think it's called the Bills Bills List or something like the B E A L A list of predatory journals, which was, you know, I don't think what, what kind of criteria they use, etcetera. But in general I would or, yeah, I would personally go for the major publishers like Elsevier's Finger, uh, Worlders, etcetera. Uh, there may be other journals, you know, published by, you know, I don't know, frontiers, etcetera where, you know, it was, at least in the past it was questionable whether, uh, publishing practices we're, uh, we're okay. But in general I would avoid, this is personal opinion. Right. I would avoid publishing in a general, uh, that asks for a publication fee. Uh, that's a gold open access journal exclusively and that's not, that does not offer the, uh, the possibility of uh protocol services subscription based. Uh But yeah, on the other hand, if, if there, if we're talking about the hybrid journal, so hybrid journals, usually our cake hybrid journals are goes that where the copyright, you know, goes to the, to the publish. Er but on the other hand, if you wish you can pay the the artery processing charges and publish open access. This usually okay. This is a hybrid model which is probably the most common model. Uh in that case, most major publishers out there uh do have agreements with most UK institutions and you should be able to publish open accessing the journals and publish open access because we really need uh open, you know, uh free access to information and, and, and there is a big movement, you know, to push for open access. Uh I would also add um peer review. So something might be open access and offer good peer review. For example, B J S Open, even though they charge they will not accept your general, your manuscript just because you paid for it. They may as well reject that. But I would these people that don't do it good peer review and basically you want good peer review, they're not against you. The good peer reviewers are to improve the quality of your manuscript with constructive it but not, I mean, I've seen this paper is not good or you know, that's not constructive. Um and you want the journals that will make your paper good. Uh And I don't think your paper is a failure because they gave you some corrections actually will make your manuscript better. Um So I would say predatory General definitely doesn't have a good peer review system. It's, you know, paper, um, paper publication now well severe, I think had some last, last back uh recently about charging because they've moved to the open access model. But, you know, I think it's quite a, it's quite a big topic because it is an industry even for major publishers, they make money out of it but, and a lot and a lot of money, um I would say stick also to the journals, not the publishers that, you know, do a good job. For example, we know, uh for example, surgical endoscopy has a good peer review and staff has been part of the editorial board. Um, bridging of surgery has a good uh quality. Also, I would also say to look at the how long it takes for a decision because if you have something very hot as a, as a finding you don't want to delay. So you, you should see how long it takes. If it takes six months to give you a decision, it may, yeah, I mean, I don't know if it's, it's not that absolute, but it is a good indicator in general because we have, we have a flow in our work in general. You don't want any, any delays in this process. It takes a minimum, invariably, it takes a minimum of 1.5 to 2 months. Uh You know, I had a had a submission kept about 10 years ago, kept in a journal for nine months and then it was rejected was really, I've never submitted something to them again. So it's really, you know, as you know, uh the more you get involved in it is a general message for, for everyone who's still attending, you know, the more you're involved in research, the more, you know, things run automatically write you. So you write the article and you, you do not have to think where am I going to submit it? You, you know, uh as you, you get into, you just know where to submit it. You not have to think about what, what to write in the cover letter. For example, it was a question as well. You just write a very short message in a very friendly tone, informal. Uh to the edit er just uh this a work. There was one time where, where I was, where I I conducted, this is Matt Caribbean and network that analysis if I remember correctly, where I put a lot of efforts on it, a lot of efforts. And I provided the results with, with very much uncertainty because there was uncertainty and uh I submitted to uh to a journal and uh it got rejected. I was really frustrated because the comments were not really anyhow submitted to, to another journal. And I just wrote to the edit er in chief in the cover letter. Uh These are the results and we had to be very conservative with regard to our to our conclusions because, you know, there are inherent limitations in, in evidence into some mechanized etcetera. So we tried our best to deliver a message but to provide the to to to to let the reader know that there we cannot be completely certain about that. And apparently he appreciated that and he he accepted the study. So just a short message, very friendly told is always useful. Um Yeah, I completely agree with that. Um So another question by Mr Giuliani's uh is if not on the topic of the cover letter, if it is the senior author or who should write the cover letter, um the senior clinician. I so I I would say whoever feels, feels comfortable and if, if the senior author, for example, has a personal communication with, uh, or knows personally the, the editors in chief, then I, I would just say, just say, uh senior offer because I, yeah, I find it more, you know, you know, it makes more sense. Yeah. But if there's, there's no communication with the, with the editors in chief, then I don't know, it doesn't, doesn't play a major, major role. Both names would be fine or the whole group can, can under sign, you know, everything and, and on the topic of something relevant, I, I saw some people recommending that. What would you say on the topic of pre submission inquiries? So sending it for those who don't know it is sending a letter. We've done this. Would you be interested in uh sending you the manuscript? So what do you think about pre submission inquiries? I, yeah, so I, I have done that to be honest in the past. Uh I, uh you know, editors are really, really, really busy. So I'm not sure, I'm not sure you will get a response and you, you will probably uh waste your time, uh you know, sending this inquiry. Uh So I would, I would just, I would just suggest submitting away the manuscript and, you know, hoping that you will get a response within 1.5 months or so. And uh if you, if two months have passed and you have not had the response, just, just move ahead. Uh So I it's a good idea. You can give it a shot. But I, you know, I don't think that theaters in Chief would, will have the time to respond to that. Okay. Okay. Um Let me see. I think we've answered most of the questions. Uh And guys, the word of academic publication is like a whole um field. So um definitely as you go along, you'll have questions. Um I would say uh another um messages find people that will give. So as you said, find a senior author, a senior clinician, but a clinician that would be a good mentor. And not, I, I think the worst thing somebody can tell you after you've written something is it's okay send it without reading it or they have to properly scrutiny. I've sent uh once I sent something to Stavros just to get his opinion on the actual protocol and he ripped it apart and uh he told me I did a good job but he gave me comments, bullets and I really like that because sent any was just to give me his feedback on um on the methodology. I didn't, it was something in unofficial for my master's and I really appreciate the time and uh he had no vested interest in me. So he took his personal time and really corrected everything. Find those people because they will make your writing your research better. Don't uh If I can, if I can sorry to interrupt, if I can transform the message is you know, be that people, right become that people. Uh because this is this the way to go. You need to be in, in whatever whatever you do, you need to be as meticulous as possible. If you are meticulous in how you write your manuscript, if you don't use double space is if you don't making characters, if you double triple check with diapers, etcetera, you will also be meticulous in the, in the way you operate, you will always be meticulous in how, how closely you observe the patient post operatively. So try to be as obsessive as possible in whatever you do. And this is probably one of the one of the features of talented academic writers, I guess. Uh this is, you know what, this is my opinion and a message I I wanted to pass. And the second is that, you know, at a certain time point, if you get involved in research a lot, uh at a certain time point, you're going to, you're going to want more and more uh try not to, to, to take the easy path and just write and write a study just very quickly in order to publish something quickly, uh just dedicate yourself from to something in order to, to make the best out of it, give yourself to dedicate yourself. But from a certain time point on, you will want to do more and more and this is a time. So it's like a jar of honey. It's, I think I'm not sure if this is just a Greek expression. Uh, it's just a job. So you want more and more, but this is a critical time point where you have the choice to, you know, to, to go this way or give equal or more weight to your surgical education. And I, you know, the most important you need to be a good surgeon and then be a good researcher. Uh And the second is not a clear requisite in order to be a good surgeon. Yeah, I completely agree because you can get derailed for research and yeah, um that, that's also very important because we don't want to forget where in the end of the day we're so, I mean, you can become only an academic but most of us want came, became surgeons because we want to perform surgery. Um Guys, I mean, I know we have um uh two people left. So I think it's um uh and a few others from the moderators. So I think it's a good time to uh hung up again. Thank you to staffers for dedicating his time and his afternoon to enlyte us. I think it was uh I swear to be honest. Sorry. I it was a pleasure and I really, I really liked, I enjoyed the disc. Yeah, and, and please let us know in the team, me and Faried if you want any other topics on the mother uh Oliver, one of our academic trainings will deliver uh introduction on systematic reviews. Uh He's doing that lesson in Kings established if you want to join us uh during the teaching, if you are not in theater because it will be in the morning, but we have more stuff coming up. Great. OK. If somebody else wants to say anything, otherwise I think we can um hang up. No. OK. That's great. Um So have a good night everyone and um please take a moment to uh I think we have uh probably it's to say by. Uh Yes, yes. Thank you very much. Thank you for us. Goodnight everyone. Uh Thank you, thank you. Uh thank thank you. Thank you. Bye. Have a good night. Bye.