Writing The Biomedical Manuscript: A Systematic Approach Christopher Dant Stanford Medical School.
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Writing The Biomedical Writing The Biomedical
Manuscript:Manuscript:
A Systematic ApproachA Systematic Approach
Christopher DantChristopher Dant
Stanford Medical SchoolStanford Medical School
Manuscript WritingManuscript Writing
Part IPart I About writing and what makes a good paperAbout writing and what makes a good paper
Parts of a manuscriptParts of a manuscript
Figures and tablesFigures and tables
Writing strategiesWriting strategies
Part IIPart II Essentials of good writingEssentials of good writing
Sentences-ParagraphsSentences-Paragraphs
Common writing mistakesCommon writing mistakes
Medical Communications TodayMedical Communications Today
Medical science becoming increasing Medical science becoming increasing specializedspecialized
1976: 1976: ~ 5,000~ 5,000 biomedical journals, only in libraries biomedical journals, only in libraries
2006: 2006: >17,000>17,000 biomedical journals, electronic on internet biomedical journals, electronic on internet
SubspecialtiesSubspecialties and and new vocabulariesnew vocabularies has has increasedincreased dramaticallydramatically
over past 20 yearsover past 20 years
Biomedical research moving to Biomedical research moving to interdisciplinary initiatives—interdisciplinary initiatives—
The NIHThe NIH RoadmapRoadmap
Thus, readership increasingly specialized yet interdisciplinary, Thus, readership increasingly specialized yet interdisciplinary,
requiring an approach that is common, clear, simplified.requiring an approach that is common, clear, simplified.
““We must strive to make our articles increasingly ‘reader friendly’ and cross-We must strive to make our articles increasingly ‘reader friendly’ and cross-
discipline in language…”discipline in language…”
Dr. Jerome Kassirer, Former Editor, NEJMDr. Jerome Kassirer, Former Editor, NEJM
A Recognized ProblemA Recognized Problem
““There is no form of prose There is no form of prose
more difficult to more difficult to
understand and more understand and more
tedious to read than tedious to read than
the average scientific the average scientific
paper!”paper!”-Dr. Francis Crick,
1994The Astonishing Hypothesis
The Avoidable DownfallThe Avoidable DownfallYour Your researchresearch Carefully Carefully plannedplanned NovelNovel Flawlessly Flawlessly designeddesigned andand executedexecuted
Your Your paperpaper Poorly designed and written—Poorly designed and written—rejected or delayedrejected or delayed The The loss or delayloss or delay of disseminating important of disseminating important
critical information to the science communitycritical information to the science community
Journal Editors AgreeJournal Editors Agree Good writing signals clear thinking and Good writing signals clear thinking and
an organized approachan organized approach
Clear direct English and logical, Clear direct English and logical, cohesive, organized writing are key to cohesive, organized writing are key to acceptanceacceptance
Even the most novel and well-Even the most novel and well-constructed study will be rejected if the constructed study will be rejected if the writing is flawedwriting is flawed
Writing is an Essential SkillWriting is an Essential Skill
The ability to The ability to communicate clearlycommunicate clearly and and precisely through the written word is an precisely through the written word is an essential skillessential skill for medical researchers for medical researchers
Delayed publicationsDelayed publications and and denial of fundingdenial of funding because of poorly written manuscripts and because of poorly written manuscripts and grants grants continuescontinues to plague researchers to plague researchers
The The careercareer of a researcher can depend of a researcher can depend heavily on this skillheavily on this skill
Key DifficultiesKey Difficulties Many papers are Many papers are poorly constructed and writtenpoorly constructed and written
Some scientists Some scientists have not learnedhave not learned good manuscript good manuscript writing techniqueswriting techniques
Others Others do not enjoy writingdo not enjoy writing, and do not take the time or , and do not take the time or effort to ensure that the prose is clear and logical. effort to ensure that the prose is clear and logical.
Authors are typically Authors are typically so familiar with the materialso familiar with the material that it is difficult to step back and view it from the that it is difficult to step back and view it from the point of view of a reader not familiar with the point of view of a reader not familiar with the sciencescience
Peer reviewPeer review is therefore critical is therefore critical
Manuscript DeficienciesManuscript Deficiencies57 articles evaluated to 57 articles evaluated to Emerg MedEmerg Med—28 accepted, 29 rejected/pending—28 accepted, 29 rejected/pendingOf these 29:Of these 29:Ambiguous methodsAmbiguous methods 77%77%Ambiguous resultsAmbiguous results 68%68%Conclusions not warranted by dataConclusions not warranted by data 72%72%Poor referencingPoor referencing 56%56%Inadequate study design descriptionInadequate study design description 51%51%Unclear tablesUnclear tables 49%49%Overly long discussionOverly long discussion 49% 49% Inadequate definition of termsInadequate definition of terms 49%49%
““Deficiencies in manuscript preparation are more frequent than Deficiencies in manuscript preparation are more frequent than mistakes in study design and execution. Specific training…in mistakes in study design and execution. Specific training…in manuscript preparation is indicated.”manuscript preparation is indicated.”
Taylor and Brown, Emerg Med 13(4):444-50, 2001Taylor and Brown, Emerg Med 13(4):444-50, 2001
Top 10 Reasons Manuscripts Top 10 Reasons Manuscripts RejectedRejected
1.1. Wrong journal, format, preparationWrong journal, format, preparation
2.2. Disorganized study designDisorganized study design
3.3. Defective tables, figuresDefective tables, figures
4.4. Poor organization throughout, writing, spellingPoor organization throughout, writing, spelling
5.5. No hypothesis or problem statementNo hypothesis or problem statement
6.6. No or insufficient conclusionNo or insufficient conclusion
7.7. Overinterpretation of resultsOverinterpretation of results
8.8. Article unfocused, too verbose and longArticle unfocused, too verbose and long
9.9. Inappropriate statistical methods; methods not sufficient to Inappropriate statistical methods; methods not sufficient to repeat studyrepeat study
10.10. Poorly written abstract/titlePoorly written abstract/title
Pierson DJ, Respiratory Care 49(10), 2004 Pierson DJ, Respiratory Care 49(10), 2004
Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998
Avoidable
Avoidable
The PaperThe Paper Writing and editing the paper is the Writing and editing the paper is the last steplast step
in the research processin the research process
The paper The paper tells the storytells the story from study inception, from study inception, through data collection, statistical analysis, through data collection, statistical analysis, findings and and discussionfindings and and discussion
The process of writing the paper should be The process of writing the paper should be analogous to the research process—it requires analogous to the research process—it requires attention to detail, time, and revisionattention to detail, time, and revision
Manuscript ReviewsManuscript Reviews
Receipt of Receipt of manuscript by manuscript by editorial assteditorial asst
Manuscript
EditorEditor
Title & AbstractTitle & Abstract
HeadingsHeadings
ReferencesReferences
Tables/FiguresTables/Figures
Read ThroughRead Through
Journal Journal Decision EditorDecision Editor
Revise-Acceptance ?
Revise-Accepted
Acceptance - Outright
Rejection - Outright
Editor ReportsEditor Reports
Summary of peer reviews
Summary of editor’s review
Appropriate to Appropriate to journal?journal?
Conform to Conform to guidelinesguidelines?
No
- D
OA
Yes
Peer ReviewersPeer ReviewersMasked review
Start with OutlineStart with Outline Outline each segment of the paper using Outline each segment of the paper using
traditional outline: I, II, III, A, B, 1, 2, atraditional outline: I, II, III, A, B, 1, 2, a
Forces logical thought and orderForces logical thought and order
Eliminates unorganized thinking and writingEliminates unorganized thinking and writing
Uncovers flaws in argumentsUncovers flaws in arguments
Reduces wordinessReduces wordiness
Makes writing easierMakes writing easier
Include your draft figures, tablesInclude your draft figures, tables
OutlineOutlineI. Introduction
A. Zinc plays a critical role in biochemical functions in cells
1. Mitochondrial function (Billings)
2. Cell motility (Jones, Smith)
B. Zn concentrations affected by physiological changes in pregnancy (Billings)
C. Zn deficiency increases spontaneous abortions and pregnancy complications
1. Rhesus monkeys (Putter)
2. White rats (Michaels, Reiss)
D. In humans, the role of Zn deficiency in pregnancy outcome is unclear (Brown)
E. Objective: we evaluated whether Zn supplementation during pregnancy is associated with changes in birth outcomes.
Journal Editor: Journal Editor: What’s A Good Manuscript?What’s A Good Manuscript?
TitleTitle descriptive and specificdescriptive and specific
AbstractAbstract descriptive, specific, and correct lengthdescriptive, specific, and correct length
IntroductionIntroduction and background short and strong and background short and strong
Research questionResearch question clearly stated clearly stated
LiteratureLiterature cited is comprehensive and relevant cited is comprehensive and relevant
MethodsMethods descriptive enough to be replicated; appropriate statistical analyses descriptive enough to be replicated; appropriate statistical analyses
Figures and TablesFigures and Tables stand on their own, support conclusions, well constructedstand on their own, support conclusions, well constructed
CitationsCitations relevant to topic relevant to topic
DiscussionDiscussion within boundaries of findings; demonstrate how findings have helped within boundaries of findings; demonstrate how findings have helped
resolve stated problem; implications and future work addressedresolve stated problem; implications and future work addressed
WritingWriting clear, terse, logical clear, terse, logical
ManuscriptManuscript follows journal guidelines follows journal guidelines
The TitleThe Title
First reviewedFirst reviewed by Journal Editors before by Journal Editors before abstractabstract
ShortShort
Specific, Relevant, DescriptiveSpecific, Relevant, Descriptive
Write lastWrite last—your findings and conclusions —your findings and conclusions may alter your titlemay alter your title
Title: Ask YourselfTitle: Ask Yourself What is the single What is the single most important pointmost important point of of
this study?this study?
How would I tell my colleague, in one short How would I tell my colleague, in one short descriptive sentence:descriptive sentence:
what’s this study about?what’s this study about?
A descriptive, specific title perfectly framing A descriptive, specific title perfectly framing your study will be apparent only after you’ve your study will be apparent only after you’ve written the paper and abstract.written the paper and abstract. Start with a short descriptive Start with a short descriptive workingworking title title
Unnecessary Title PhrasesUnnecessary Title Phrases
A Study of… A Study to Determine Results of…A Study of… A Study to Determine Results of…
An Innovative Method…An Innovative Method…
Contributions to (of)…Contributions to (of)…
Investigations on (concerning, about)…Investigations on (concerning, about)…
Observations on…Observations on…
A Trial Comparing…A Trial Comparing…
Title—Specific & DescriptiveTitle—Specific & Descriptive
A Study Involving Medical Imaging with Genetic A Study Involving Medical Imaging with Genetic Patients and Turner’s SyndromePatients and Turner’s Syndrome
MRI Brain Imaging in Children With Turner’s MRI Brain Imaging in Children With Turner’s Syndrome and Other X Chromosome AbnormalitiesSyndrome and Other X Chromosome Abnormalities
Nerve Growth Factors and Sodium Channels in Nerve Growth Factors and Sodium Channels in Pancreatic CellsPancreatic Cells
Nerve Growth Factor Increases Sodium Channel Nerve Growth Factor Increases Sodium Channel Expression in Pancreatic (Beta) Cells: Implications Expression in Pancreatic (Beta) Cells: Implications for Insulin Secretionfor Insulin Secretion
Title—Specific & DescriptiveTitle—Specific & Descriptive Down Syndrome—Where we are today: A ReviewDown Syndrome—Where we are today: A ReviewDown Syndrome: Genetic, Behavior, and Functional Neuroimaging Down Syndrome: Genetic, Behavior, and Functional Neuroimaging
Research 2000-2006Research 2000-2006
Aldosterone and Heart FailureAldosterone and Heart FailureAldosterone Plasma Concentrations Increase with Severity of Aldosterone Plasma Concentrations Increase with Severity of
Congestive Heart FailureCongestive Heart Failure
A study of MI in older Americans 1994-1999A study of MI in older Americans 1994-1999Epidemiological survey of MI in Community-Dwelling American Males Epidemiological survey of MI in Community-Dwelling American Males
Over 65 yearsOver 65 years
Lazarus arise! Life and Death Issues in Intensive CareLazarus arise! Life and Death Issues in Intensive CareEnd-of-Life Care Issues for Critically Ill Patients in Intensive Care End-of-Life Care Issues for Critically Ill Patients in Intensive Care
Hospitals Hospitals
Title—Specific & DescriptiveTitle—Specific & Descriptive Hepatitis C virus associated membranoproliferative Hepatitis C virus associated membranoproliferative
glomerulonephritis: A tale of Mice and Menglomerulonephritis: A tale of Mice and MenMembranoproliferative Glomerulonephritis Associated with Membranoproliferative Glomerulonephritis Associated with
Hepatitis C Virus in F39(b) Nude Mice: Applicability to HumansHepatitis C Virus in F39(b) Nude Mice: Applicability to Humans
Isolated unilateral tubular sclerosis-associated severe late-stage renal Isolated unilateral tubular sclerosis-associated severe late-stage renal cystic disease in neonatescystic disease in neonates
Severe, Late-Stage Renal Cystic Disease in Neonates Associated Severe, Late-Stage Renal Cystic Disease in Neonates Associated with Isolated Unilateral Tubular Sclerosiswith Isolated Unilateral Tubular Sclerosis
Drug trial comparing systemic beta blocker with calcium-Drug trial comparing systemic beta blocker with calcium-channel blocker in CHFchannel blocker in CHF
Open-label Comparison of Altenolol and Propranolol versus Open-label Comparison of Altenolol and Propranolol versus Nifedipine in Patients with CHF: Beta Blocker and Calcium-Nifedipine in Patients with CHF: Beta Blocker and Calcium-Channel Blocker MechanismsChannel Blocker Mechanisms
Don’t Stack AdjectivesDon’t Stack Adjectives
Female but not male Female but not male serotonin reuptake serotonin reuptake transporter (5-HTT) model knockouttransporter (5-HTT) model knockout micemice exhibit bladder instability: Implicationsexhibit bladder instability: Implications
5-HTT female (not male) knockout 5-HTT female (not male) knockout micemice have have unstable bladders: Implications for Stress unstable bladders: Implications for Stress Urinary Incontinence TreatmentUrinary Incontinence Treatment
Good Titles—SentencesGood Titles—Sentences
Intellectual impairments Intellectual impairments occuroccur in children with blood lead in children with blood lead concentrations above 10 mg per deciliterconcentrations above 10 mg per deciliter
Increased 17Increased 17-estradiol -estradiol suppressessuppresses PTHrP gene expression PTHrP gene expression in breast cancer cell linesin breast cancer cell lines
Spinal cord stimulation Spinal cord stimulation attenuatesattenuates visceromotor reflexes in visceromotor reflexes in
a rat model of post-inflammatory colonic hypersensitivitya rat model of post-inflammatory colonic hypersensitivity
Rhinovirus challenge Rhinovirus challenge decreasesdecreases antioxidant enzymes in antioxidant enzymes in
respiratory epithelial cellsrespiratory epithelial cells
Not Sentences But Good TitlesNot Sentences But Good Titles
Comparison of MRI and CT for Detection of Acute Comparison of MRI and CT for Detection of Acute Intracerebral HemorrhageIntracerebral Hemorrhage
Extracranial Thrombotically Active Carotid Plaque as a Extracranial Thrombotically Active Carotid Plaque as a Risk for Ischemic Stroke Risk for Ischemic Stroke
Annual Revaccination Against Influenza and Mortality Annual Revaccination Against Influenza and Mortality Risk in Community-Dwelling Elderly Persons Risk in Community-Dwelling Elderly Persons
Effect of Antihypertensive Agents on Cardiovascular Effect of Antihypertensive Agents on Cardiovascular Events in Patients With Coronary Disease and Normal Events in Patients With Coronary Disease and Normal Blood Pressure. The CAMELOT Study: A Randomized Blood Pressure. The CAMELOT Study: A Randomized Controlled TrialControlled Trial
The AbstractThe Abstract
1st Impression to journal editor and the reader!1st Impression to journal editor and the reader!
Follow the Journal’s GuidelinesFollow the Journal’s Guidelines
Most abstracts are often Most abstracts are often too longtoo long: ≤250 words: : ≤250 words: Cannot Cannot
upload your paper!upload your paper!
Structure it (outline it)Structure it (outline it)
““The abstract is the single most important part of a manuscript, yet the The abstract is the single most important part of a manuscript, yet the
most often poorly writtenmost often poorly written” ” -JAMA Editor-JAMA Editor
The AbstractThe Abstract First looked at by editors/sometimes only thing read by First looked at by editors/sometimes only thing read by
readersreaders
Sometimes only part available electronically—KEY words!Sometimes only part available electronically—KEY words!
Summarizes the main points succinctly:Summarizes the main points succinctly: Background/SignificanceBackground/Significance ObjectiveObjective Study design, methodStudy design, method Primary germane results Primary germane results Principal conclusions, implicationsPrincipal conclusions, implications
Do NOT be vague—be substantive and briefDo NOT be vague—be substantive and brief NOT “The implications are summarized”NOT “The implications are summarized” INSTEAD Summarize the implications!INSTEAD Summarize the implications!
AbstractAbstract EmphasizeEmphasize methods, main results, and conclusion methods, main results, and conclusion
IntroductionIntroduction/purpose: 1 short sentence/purpose: 1 short sentence
Put Put objectiveobjective as imperative style: as imperative style: Objective: To evaluate whether zinc supplementation Objective: To evaluate whether zinc supplementation
during pregnancy affects infant birth measures.during pregnancy affects infant birth measures.
Methods, ResultsMethods, Results: 2-4 sentences: 2-4 sentences
ConclusionConclusion: 1-2 sentences: 1-2 sentences
Structured AbstractStructured Abstract
ContextContext—Summarize the study rationale and provide —Summarize the study rationale and provide clinical (or other) reason for the study question.clinical (or other) reason for the study question.
ObjectiveObjective—State the purpose or question asked. If more —State the purpose or question asked. If more than one objective, state primary objective and key than one objective, state primary objective and key secondary objectives.secondary objectives.
DesignDesign—Describe basic design, including relevant details.—Describe basic design, including relevant details.
SettingSetting—General community, primary care, hospital, etc.—General community, primary care, hospital, etc.
Patient or other Patient or other populationpopulation—describe demographics, —describe demographics, disorders, inclusion/exclusion criteria, etc.disorders, inclusion/exclusion criteria, etc.
InterventionsInterventions—name, dose, dosage—name, dose, dosage
Main outcome Main outcome measure(s)measure(s)
ResultsResults
ConclusionsConclusions
The Effect of Zinc Supplementation on The Effect of Zinc Supplementation on Pregnancy OutcomePregnancy Outcome
Objective—Objective—To evaluate whether zinc supplementation during pregnancy affects infant birth To evaluate whether zinc supplementation during pregnancy affects infant birth measures.measures.
Design—Design—Randomized, double-blind, placebo-controlled trial.Randomized, double-blind, placebo-controlled trial.Setting—Setting—Outpatient clinic at University of Alabama at Birmingham.Outpatient clinic at University of Alabama at Birmingham.Patients—Patients—580 healthy African-American pregnant women with plasma zinc levels below normal 580 healthy African-American pregnant women with plasma zinc levels below normal
levels, randomized at 19 weeks’ gestational age and divided by median body mass of 26 kg/mlevels, randomized at 19 weeks’ gestational age and divided by median body mass of 26 kg/m 22 into placebo and zinc supplement groups.into placebo and zinc supplement groups.
Intervention—Intervention—Women receiving a non-zinc-containing prenatal vitamin tablet were randomized to 25 Women receiving a non-zinc-containing prenatal vitamin tablet were randomized to 25 mg/day zinc or placebo.mg/day zinc or placebo.
Outcome Measures—Outcome Measures—Birth weight, gestational age at birth, head circumference at birth.Birth weight, gestational age at birth, head circumference at birth.Results—Results—Infants from zinc supplement group had greater birth weight (p<0.01) and head Infants from zinc supplement group had greater birth weight (p<0.01) and head
circumference (p=0.02) than those in placebo group. Women with body mass ≤ 26 kg/mcircumference (p=0.02) than those in placebo group. Women with body mass ≤ 26 kg/m 22 had had infants with significantly higher birth weights (median 245 g, p<0.001) and larger head infants with significantly higher birth weights (median 245 g, p<0.001) and larger head circumference (median 0.7 cm, p=0.003). circumference (median 0.7 cm, p=0.003).
Conclusions—Conclusions—Daily zinc supplementation in women with low plasma zinc concentrations in early Daily zinc supplementation in women with low plasma zinc concentrations in early pregnancy is associated with greater birth weights and head circumferences, with the effect pregnancy is associated with greater birth weights and head circumferences, with the effect occurring in women with body mass index ≤26 kg/moccurring in women with body mass index ≤26 kg/m22. The specific effects of zinc on the fetus are . The specific effects of zinc on the fetus are unknown, and future work is focusing on zinc effects on embryonic cells in vitro.unknown, and future work is focusing on zinc effects on embryonic cells in vitro.
192 words192 words
Abstract: Be SpecificAbstract: Be Specific
The principles of reconstruction of the traumatic losses of the external The principles of reconstruction of the traumatic losses of the external
ear are presented, with emphasis on effective treatment of the acutely ear are presented, with emphasis on effective treatment of the acutely
injured ear. The steps necessary for obtaining satisfactory injured ear. The steps necessary for obtaining satisfactory
reconstruction are discussed, including two new techniques.reconstruction are discussed, including two new techniques.
In the past decade, advances in soft tissue surgical techniques have In the past decade, advances in soft tissue surgical techniques have
allowed surgeons to successfully reconstruct detached ears. We present allowed surgeons to successfully reconstruct detached ears. We present
two new surgical reconstruction techniques of the acutely injured two new surgical reconstruction techniques of the acutely injured
detached ear. These include the use of local and distant tissues to detached ear. These include the use of local and distant tissues to
obtain soft-tissue coverage, and the recent use of Silastic cartilage for obtain soft-tissue coverage, and the recent use of Silastic cartilage for
structural support…structural support…
IntroductionIntroduction Why did you carry out this research? State the Why did you carry out this research? State the specific specific
purposepurpose or rationale for the study. or rationale for the study.
What is the existing state of knowledge of this topic? What is the existing state of knowledge of this topic? Synthesize information tracing the development of the Synthesize information tracing the development of the problem and summarize its current state…ie, the problem and summarize its current state…ie, the background. You ask (with citations):background. You ask (with citations):
What’s known?What’s known? What’s unknown?What’s unknown? What are the gaps in knowledge this study will fill?What are the gaps in knowledge this study will fill?
What are you going to do and what do you expect to find? What are you going to do and what do you expect to find?
State your State your hypothesis or question clearlyhypothesis or question clearly (Objectives, Aims) (Objectives, Aims)
Give only strictly Give only strictly pertinentpertinent references. references.
IntroductionIntroduction This is a This is a vital part of your papervital part of your paper—it convinces (or not) the —it convinces (or not) the
reader whether your study:reader whether your study: Has merit and asks important research questionsHas merit and asks important research questions Is focused and supported by relevant recent citationsIs focused and supported by relevant recent citations Is ultimately important to human health and human diseaseIs ultimately important to human health and human disease
Reviewers and editors will Reviewers and editors will judge the paper’s importancejudge the paper’s importance in the in the introduction.introduction.
You will better focus your introduction You will better focus your introduction AFTER you construct your AFTER you construct your findings findings (results)(results) and consider them and consider them (discussion). (discussion).
Your Your research question is the most important partresearch question is the most important part—in your —in your discussion, you will address whether the question or hypothesis discussion, you will address whether the question or hypothesis was answered based on your data.was answered based on your data.
Introduction StructureIntroduction Structure1.1. What is the general problem or current situation?What is the general problem or current situation?
Zinc plays a critical role in many biochemical functions, including nucleic Zinc plays a critical role in many biochemical functions, including nucleic acid metabolism and is critical in early development.acid metabolism and is critical in early development.
2.2. What is the specific problem or controversy? Its significance?What is the specific problem or controversy? Its significance?Zinc deficiency is associated with increase metabolic problems in fetuses. Zinc deficiency is associated with increase metabolic problems in fetuses.
Studies evaluating relationship between zinc intake and pregnancy Studies evaluating relationship between zinc intake and pregnancy outcomes have produced conflicting results for many reasons…outcomes have produced conflicting results for many reasons…
3.3. What are our hypotheses/questions, and how will we answer What are our hypotheses/questions, and how will we answer them?them?
To clarify the relationship between zinc levels in the mother’s diet and To clarify the relationship between zinc levels in the mother’s diet and pregnancy outcomes, we undertook a randomized placebo-pregnancy outcomes, we undertook a randomized placebo-controlled trial of zinc supplementation.controlled trial of zinc supplementation.
Our Our objective objective was to determine if zinc supplementation was associated was to determine if zinc supplementation was associated with higher birth weight.with higher birth weight.
Our findings will help to provide continuing nutritional guidelines in Our findings will help to provide continuing nutritional guidelines in pregnancy.pregnancy.
Methods are Critical: Editors’ Methods are Critical: Editors’ ResponsesResponses
0 5 10 15 20
% Responses
Discussion
Results
Methods
Introduction
What section contains the most flaws?
0 5 10 15 20
% Responses
Discussion
Results
Methods
Introduction
What section responsible for outright rejection?
How frequently do Editors encounter manuscript problems?
Seldom Occasionally Frequently
Poorly written, excessive jargon
Inadequate/inappropriate presentation
Poor description of design
Excessive zeal and self promotion
Rationale confused, contradictory
Essential data omitted, ignored
Boring
Important work of others ignored
Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998
MethodsMethods Editors judge the study on whether your methods Editors judge the study on whether your methods
are are adequate to answer your specific aim or adequate to answer your specific aim or hypothesis hypothesis Rationale for choosing procedures/testsRationale for choosing procedures/tests The pivotal point to judge whether the results are validThe pivotal point to judge whether the results are valid
Don’t suggest a method you have Don’t suggest a method you have no expertise no expertise withwithYour peer reviewer may uncover thisYour peer reviewer may uncover thisUse consultants for methods you have no experience with, stating Use consultants for methods you have no experience with, stating this in paperthis in paper
Methods usually the Methods usually the weakest section weakest section Often Often deficient in detaildeficient in detail, not providing enough information to , not providing enough information to replicate the studyreplicate the study StatisticalStatistical shortcomings shortcomings
MethodsMethods Study design or analysis type and period of studyStudy design or analysis type and period of study
Condition or disease studiedCondition or disease studied
Human subjects approvalHuman subjects approval
Details of sample (number, recruiting methods of study subjects, Details of sample (number, recruiting methods of study subjects, patients, how organized)patients, how organized)
Interventions, outcome measures, statistical analysesInterventions, outcome measures, statistical analyses
Include the locations and times that data were collectedInclude the locations and times that data were collected
Give enough information to replicate the study; don’t assume only the Give enough information to replicate the study; don’t assume only the specialist in your field will read itspecialist in your field will read it
MethodsMethods BalanceBalance between brevity and completeness between brevity and completeness
Sometimes reference an often-used methodSometimes reference an often-used method
Use Use figures and tablesfigures and tables (eg, flow diagram) (eg, flow diagram)
Naming things—be Naming things—be consistentconsistent Acronyms—spell out first time, use consistently throughoutAcronyms—spell out first time, use consistently throughout Specialized tests, terms—use identical name in text, figs, tablesSpecialized tests, terms—use identical name in text, figs, tables
Develop list of Develop list of frequently used termsfrequently used terms
Present in logical order and your subsequent results Present in logical order and your subsequent results should follow that same ordershould follow that same order
Method—ProceduresMethod—Procedures
Method diagrams communicate schedule of procedures, enrollment, study design, mechanisms of action, guidelines, algorithms to reduce text and increase comprehension.
Results—The BeginningResults—The Beginning
The The heart of your paperheart of your paper WriteWrite afterafter figures and tables are constructed figures and tables are constructed
Consider your data criticallyConsider your data critically Construct tables, figures and Construct tables, figures and include them in include them in
outlineoutline Write the resultsWrite the results Use subheadingsUse subheadings
Results determineResults determine Whether you’ve Whether you’ve answered your original answered your original
question(s)question(s) Your direction for Your direction for futurefuture studies studies Both of which belong in the Both of which belong in the discussiondiscussion
Results—The BeginningResults—The Beginning State ALL the findings State ALL the findings
Whether significant or notWhether significant or not Without bias or interpretationWithout bias or interpretation Do not include weaknesses, strengths of study, ie don’t discuss resultsDo not include weaknesses, strengths of study, ie don’t discuss results
List experiments List experiments in order listed in methodsin order listed in methods
Use Use logicallogical headers and group your findings headers and group your findings Characteristics of study subjectsCharacteristics of study subjects Findings in order listed in methodsFindings in order listed in methods General to specificGeneral to specific
Use Use past tensepast tense
Results Results confirm or reject your hypothesisconfirm or reject your hypothesis: they do not prove : they do not prove anything.anything.
ResultsResults ShortShort and to the point—Main or most important and to the point—Main or most important
findings firstfindings first Present only data directly relevant to the study—Present only data directly relevant to the study—focusfocus Don’t repeat methods Don’t repeat methods but you may remind the reader but you may remind the reader
briefly how you measured something.briefly how you measured something. Allow the data to Allow the data to speak for itselfspeak for itself—use tables/figures ——use tables/figures —
construct them first and use as a basis for writingconstruct them first and use as a basis for writing In Tables and Figures, be In Tables and Figures, be descriptive, specificdescriptive, specific. Do not . Do not
repeat the obvious:repeat the obvious: NO:NO: Results of the kidney lead analysis are shown in Table 1. Results of the kidney lead analysis are shown in Table 1. YES:YES: Kidney lead concentrations increased in group 1 over the first 10 Kidney lead concentrations increased in group 1 over the first 10
study weeks (Table 1).study weeks (Table 1). Present Present absolute numbers and percentagesabsolute numbers and percentages so so
reviewers can judge the significance of the findings.reviewers can judge the significance of the findings. Statistical significance Statistical significance ≠≠ clinical significance clinical significance
Results or Data?Results or Data?
ResultsResults
Mean translational movements in the X (left to right), Y Mean translational movements in the X (left to right), Y (back to front) and Z (bottom to top) head directions (back to front) and Z (bottom to top) head directions were 0.10 ± 0.11 mm, 0.16 ± 0.03 mm, and 0.65 ± were 0.10 ± 0.11 mm, 0.16 ± 0.03 mm, and 0.65 ± 0.58 mm, respectively. Mean rotational movements 0.58 mm, respectively. Mean rotational movements about the three axes were 0.44 ± 0.42 degrees, 0.24 about the three axes were 0.44 ± 0.42 degrees, 0.24 ± 0.26 degrees, and 0.18 ± 0.17 degrees, ± 0.26 degrees, and 0.18 ± 0.17 degrees, respectively. Movement was not significantly respectively. Movement was not significantly correlated with age for translation in the X (correlated with age for translation in the X (rr = -0.09; = -0.09; pp = 0.69), Y ( = 0.69), Y (rr = 0.21; = 0.21; pp = 0.35) or Z ( = 0.35) or Z (rr = -1.02; = -1.02; pp = = 0.64) directions. Movement was not significantly 0.64) directions. Movement was not significantly correlated with age for rotation in the X (r = 0.15; correlated with age for rotation in the X (r = 0.15; pp = = 0.51), Y (0.51), Y (rr = -0.20; = -0.20; pp = 0.35) or Z (r = 0.02; p = 0.94) = 0.35) or Z (r = 0.02; p = 0.94) directions.directions.
Results—Don’t Regurgitate DataResults—Don’t Regurgitate Data
As shown in Table 1, the mean age of participants was 20.4 ± 2 years, As shown in Table 1, the mean age of participants was 20.4 ± 2 years, and 80% of patients were Caucasian. Treatment group contained 40 and 80% of patients were Caucasian. Treatment group contained 40 patients, whereas control group contained 45 patients. Table 2 shows patients, whereas control group contained 45 patients. Table 2 shows the demographics of women in these groups. There were 24 women in the demographics of women in these groups. There were 24 women in the control group, and 33 women in the treatment group... the control group, and 33 women in the treatment group...
There were no significant differences in treatment and control patient There were no significant differences in treatment and control patient intake demographics (Table 1), although a significantly greater intake demographics (Table 1), although a significantly greater number of patients in the treatment group dropped from the study for number of patients in the treatment group dropped from the study for a variety of reasons, mostly relating to adverse reactions. However, a variety of reasons, mostly relating to adverse reactions. However, analysis of patients in this group later revealed that those dropped analysis of patients in this group later revealed that those dropped patients had significant disease at intake (Table 2). In comparing the patients had significant disease at intake (Table 2). In comparing the two treatment groups (Figure 1), we found that...two treatment groups (Figure 1), we found that...
Don’t State the ObviousDon’t State the Obvious
Figure 1 is a graph illustrating the plasma zinc levels (µmoL/L) over the 37 weeks versus gestational age in both the zinc supplement group and placebo group. The placebo and the zinc group both decreased over the 37 weeks of the study, but the differences were significant for the zinc group.
State What’s ImportantState What’s Important
We measured mothers’ plasma
zinc levels before randomization
(week 19) and at 26, 32, and 37
weeks’ gestational age (Fig 1).
Beginning as early as 26
weeks and at each timepoint,
differences in plasma zinc levels
between placebo and zinc
supplement groups were
statistically significant (P≤0.05)
after randomization.
Results—Major MistakesResults—Major Mistakes Failure to provide all the data critical to answering the Failure to provide all the data critical to answering the
research questionresearch question
Interpreting or commenting on resultsInterpreting or commenting on results ““Six of the 20 patients required intubation, Six of the 20 patients required intubation, illustrating the seriousness of illustrating the seriousness of
this problemthis problem” (belongs in ” (belongs in DiscussionDiscussion)) “ “Over 40% of treated rats exhibited a decreased inflammatory Over 40% of treated rats exhibited a decreased inflammatory
response, response, an unexpected findingan unexpected finding” (belongs in ” (belongs in DiscussionDiscussion))
Failure to adequately address statistical methodsFailure to adequately address statistical methods
Tables and figures inappropriate, unbalancedTables and figures inappropriate, unbalanced
Tables and figures poorly constructedTables and figures poorly constructed
Discussion ConstructionDiscussion Construction
Summarize major findings—1st paragraphSummarize major findings—1st paragraph Explain how your findings relate to those of Explain how your findings relate to those of
others—what do they mean?others—what do they mean? Clinical relevance of the findings?Clinical relevance of the findings? Limitations and how this influenced your study?Limitations and how this influenced your study?
How will you overcome these in the next studies?How will you overcome these in the next studies?
Explain the implications of findingsExplain the implications of findings What future direction(s) will you take?What future direction(s) will you take?
Discussion: Getting Carried Discussion: Getting Carried AwayAway
Few studies make discoveries changing the course of Few studies make discoveries changing the course of scientific direction, and so authors:scientific direction, and so authors: Attempt to Attempt to overly stateoverly state or the importance of their findings or the importance of their findings Come to Come to erroneous or unsupportederroneous or unsupported conclusions conclusions Uncritically acceptUncritically accept statistical results statistical results
This all This all distractsdistracts from work’s importance and signals to the from work’s importance and signals to the reviewer problems with the researchreviewer problems with the research
Also results in Also results in excessive lengthexcessive length, a common problem, a common problem
Authors should let Authors should let the data speak for themselvesthe data speak for themselves
Discussion—Common MistakesDiscussion—Common Mistakes
1.1. Unwarranted speculationsUnwarranted speculations
2.2. Injecting tangential issuesInjecting tangential issues
3.3. Conclusions not supported by the dataConclusions not supported by the data
4.4. Not suggesting future directions for researchNot suggesting future directions for research
hypothesis hypothesis study study data/results data/results conclusions conclusions
TIGHT PACKAGETIGHT PACKAGE
Sections UnbalancedSections Unbalanced
0 500 1000 1500
Discussion
Results
Methods
Introduction
Abstract
Original
Final
Article 3650 wordsArticle 3650 words
Tables and FiguresTables and Figures
CriticalCritical to a paper—Editors and readers look at these to a paper—Editors and readers look at these before reading the paper! before reading the paper!
Editors judgeEditors judge your paper on how well these are your paper on how well these are constructedconstructed
Stand aloneStand alone and tell a complete story and tell a complete story
Unambiguous—Unambiguous—immediately clearimmediately clear
Eliminate numerical dataEliminate numerical data and long explanations in text and long explanations in text
Figures Figures display display important trends, procedures, simplify important trends, procedures, simplify detailed data, and show basic methodologies.detailed data, and show basic methodologies.
TablesTables
Growth medium aeration was essential for the growth of S. coelicolor. At room temperature (24°C), no growth was measurable in stationary cultures, whereas in aerated cultures, we measured substantial growth (78 Klett units).
This result does NOT require a table!
Tables & ResultTables & ResultIn women with BMI <26 kg/m2, zinc supplementation was associated with a significant increase in birth weight of 248 g (P=0.005), an increase in head circumference of 0.7 cm (P=0.005), and increase in arm length of 0.3 cm (P=0.03). The other outcome measures all favored the zinc supplement group but the differences were not statistically significant (Table 2).
Table & ResultTable & Result
Table 3 shows the mean birth weight by the BMI categories
recommended by the NIH Institute of Medicine. The lower the BMI,
the greater the effect of zinc supplementation on birth weight.
Bar or Line Graphs-Colors?Bar or Line Graphs-Colors?
Journals DO NOT allow color graphs unless they are Journals DO NOT allow color graphs unless they are necessary for understanding the graph necessary for understanding the graph
This graph will appear in the journal like this:
Simple GraphSimple Graph
Use graphing software in word/powerpoint to create: KISSUse graphing software in word/powerpoint to create: KISS No more than 3-4 groupsNo more than 3-4 groups Keep all lines solid, few symbolsKeep all lines solid, few symbols Put in SD and P values if relevantPut in SD and P values if relevant
Prepare Your Manuscript Prepare Your Manuscript CarefullyCarefully
Incorrect style irritates reviewers and editorsIncorrect style irritates reviewers and editors, and , and the wrong style suggests that another journal the wrong style suggests that another journal previously rejected the paper.previously rejected the paper.
Edit carefullyEdit carefully Eliminate spelling, punctuation, and grammar errorsEliminate spelling, punctuation, and grammar errors Good writing requires rewritingGood writing requires rewriting
Check accuracy of references with original Check accuracy of references with original sourcessources Incorrect citations inconvenience the publisher and are a Incorrect citations inconvenience the publisher and are a
disservice to the readerdisservice to the reader Double-check numerical data!Double-check numerical data!
Numbers in abstract, text, tables, figures, ledends, and Numbers in abstract, text, tables, figures, ledends, and text must be consistent and correcttext must be consistent and correct
Avoid RepetitionAvoid Repetition
Do not disclose Do not disclose results in introductionresults in introduction Do not Do not repeat the Introduction in Discussionrepeat the Introduction in Discussion In textIn text
Do not Do not repeatrepeat figure legends, table titles, or contents of the figure legends, table titles, or contents of the tables themselvestables themselves
Use Use tables sparinglytables sparingly Presenting a few facts in text takes less space than a tablePresenting a few facts in text takes less space than a table Do not use tables for presenting simple listsDo not use tables for presenting simple lists
Abbreviations, definitions, symbols in figures and Abbreviations, definitions, symbols in figures and tables must be tables must be explained in legends and footnotesexplained in legends and footnotes Never refer a reader back to text for such informationNever refer a reader back to text for such information
Journal ReviewJournal Review Full review and decision takes ~1 month
Editors make decision based on arguments; they don’t count votes from Peer Reviewers
Most papers undergo 2 rounds before publication
For borderline decisions, a goal is to avoid multiple rounds of review
Pressure to publish quickly may lead to rejection if further experiments are needed
What Helps or Hinders the What Helps or Hinders the Paper?Paper?
What Helps?What Helps? New data — to a pointNew data — to a point Referee or Editor made factual errors (easy to prove)Referee or Editor made factual errors (easy to prove) Careful and accurate response to criticisms (table)Careful and accurate response to criticisms (table) Telling the editor that reviews were helpful in improving the Telling the editor that reviews were helpful in improving the
paperpaper Knowing how to submit to the journal electronically — Practice!Knowing how to submit to the journal electronically — Practice!
What Doesn’t?What Doesn’t? Referees were “unfair” and the criticisms were largely “not valid”Referees were “unfair” and the criticisms were largely “not valid” Guesses at referee identity followed by personal attacksGuesses at referee identity followed by personal attacks Specific evidence of bias by referee (difficult to prove)Specific evidence of bias by referee (difficult to prove) Endorsements or (positive) statements about your standing and Endorsements or (positive) statements about your standing and
reputationreputation
The Paper Is CohesiveThe Paper Is Cohesive
Question (objective, specific aim) is posed in Question (objective, specific aim) is posed in
IntroductionIntroduction
MethodsMethods tell how you propose to answer these aims tell how you propose to answer these aims
ResultsResults presented answer (or not) the question presented answer (or not) the question
DiscussionDiscussion should be within the bounds of the results should be within the bounds of the results
ConclusionsConclusions directly answer the original questions in directly answer the original questions in
the Introductionthe Introduction
Each sectionEach section should refer back to one another should refer back to one another
Evaluate Your PaperEvaluate Your Paper
To understand and evaluate your paper, To understand and evaluate your paper, the the editor will askeditor will ask (and so should you): (and so should you):
What specific What specific questions/aimsquestions/aims does the paper does the paper address?address? Are the Are the methods/designmethods/design adequate to answer adequate to answer your questions?your questions? What are the main What are the main conclusionsconclusions?? What specific What specific evidence (data)evidence (data) supports those supports those conclusions?conclusions? What is the What is the quality of that evidence? of that evidence? Conclusions: what is the study’s Conclusions: what is the study’s significancesignificance……what what insights or new directionsinsights or new directions are evident? are evident?
My SuggestionsMy Suggestions
Put the manuscript awayPut the manuscript away for a couple of days for a couple of days
ReadRead troublesome areas troublesome areas aloudaloud
Don’t try to edit a mangled paragraph—Don’t try to edit a mangled paragraph—delete and delete and
rewrite itrewrite it
Your colleagues Your colleagues reviewsreviews of writing and table/figures of writing and table/figures
are valuable—don’t be defensive about editsare valuable—don’t be defensive about edits
Let go of “academic” writing habits and don’t imitate Let go of “academic” writing habits and don’t imitate
others’ writing. others’ writing. Develop your own clear, direct styleDevelop your own clear, direct style
Writing DeficienciesWriting Deficiencies
Wordiness and Wordiness and
redundanciesredundancies
Poor flow of ideasPoor flow of ideas
Poor syntax and Poor syntax and
grammargrammar
Excessive abstractionExcessive abstraction
Unnecessary complexityUnnecessary complexity
Excessive compressionExcessive compression
Unnecessary qualificationUnnecessary qualification
Cut, condense, combineCut, condense, combine
Outline to catch logic Outline to catch logic
problemsproblems
Consult an editorConsult an editor
Be specific and descriptiveBe specific and descriptive
Keep it simple and directKeep it simple and direct
Do not overly compress Do not overly compress
writingwriting
Qualify statements as Qualify statements as
necessarynecessary
Byrne, D. Science Editor 23:2, 2000
Most commonly cited by journal editorsMost commonly cited by journal editors
SummarySummary OutlineOutline your paper your paper StartStart earlyearly as your data is being analyzed as your data is being analyzed Look at your data and decide Look at your data and decide how to organize and how to organize and
present your resultspresent your results: tables, figures, text: tables, figures, text Patterns and Patterns and clues will emergeclues will emerge to guide your to guide your
argumentargument Start withStart with results results thenthen introduction and introduction and
discussion/conclusionsdiscussion/conclusions Write Write title and abstracttitle and abstract last last Put it away, Put it away, re-readre-read, give to your , give to your colleaguescolleagues to read to read ReviseRevise, revise, and re-revise, revise, and re-revise Adhere toAdhere to journal guidelines! journal guidelines! Critically evaluate Critically evaluate your paper with an editor’s eyeyour paper with an editor’s eye Write Write clearly, logically, and simply!clearly, logically, and simply!
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