Publishing your manuscript

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Publishing your manuscript

• Joost PH Drenth

Department of Gastroenterology and Hepatology
Radboud University Nijmegen Medical Center The
Netherlands
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Buzz word the 3 Cs

• Clear, Correct and Concise, but also
• Structure

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Research Reporting

• Proposal
• Research
• Submission
• Decision

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The basics of writing a paper Before you begin

• What do I have to say?
• Is it worth saying?
• What is the right format for the message?
• What is the audience for the message?
• Where should I publish the message?

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Basic principle

• Make sure that readers know where they are, where
  they are going, and why
• So
• The best is that you, as author know where you
  want to go and why

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Why publish?

• Expand medical knowledge
• Hey, you want some brownies!
• Career prospects
• It is nice to be the expert
• 4 articles on Proflox in peptic ulcer disease
  make you the world expert
• Research not published not done
• If it is not listed in Pubmed, consider it not
  done

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Why publish?

• Because you have something important to say
• To change practice
• To promote thought or debate
• To allow examination of your work
• Fame and the love of beautiful women
• Money
• To entertain/divert/amuse
• To educate
• Career advancement

Smith R. www.bmj.com
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Why publish?

• Papers are important in Academia
• 236 applicants for GI fellowships
• 53 applicants had published a paper
• But.

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Why publish?

• Papers are important in Academia
• 236 applicants for GI fellowships
• 53 applicants had published a paper
• But.
• 30 published in non existing journals or
  published non existing articles

Sekas, Ann Int Med 1995 123 38-41
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Writing an article

• Try to align the content presentation of your
  paper with the Journals interest aim well
• Know your stuff, check the journal
• A clinical study is unlikely to end up in J Biol
  Chemistry
• The case report healing of reflux esophagitis
  with pantoprazol is unlikely to be published now
  in NEJM

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Writing and submitting is marketing

• How does my baby sell?
• Editors buy Authors sell
• Its E-bay, buddy!!

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What do editors want?

• Excitement/ wow
• Importance
• Originality
• Relevance to the audience
• True
• Clearly / Engagingly written

Smith R. www.bmj.com
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Publish your paper

• Crap in Crap out principle
• A clear Hypothesis is key
• A solid research question
• Biological plausibility
• KISS

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KISS

• Keep it simple, stupid

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Ideal paper

• Correct
• Consistent
• Concise
• Well organised
• Clearly written
• Accessible

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Title page

• Careful in selection of the title
• Factual, caption of the results
• Infliximab for Induction and Maintenance Therapy
  for Ulcerative Colitis
• Chromosome 1p and 11q deletions and outcome in
  neuroblastoma.
• Avoid acronyms
• Ambient BTEX and MTBE in the neighborhoods of
  different industrial parks in Southern Taiwan
• Dont try to be funny
• Not Bign Fat junk in the trunk
• But Behavorial intervention in moderate obesity
  absence of a clinical effect

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Abstract

• This is what editors or referee are likely to
  read first
• first hit is worth a dollar!
• Keep the Journals format
• Word count
• Structured or not
• No abbreviations

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Abstract

• Provide the real meat
• Do not overinterprete
• Conclusion is supported by the data

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Article consist of 4 key sentences

• First sentence of he introduction
• miniseminar
• Last sentence of the introduction
• What you actually did
• First sentence of the discussion
• What you found
• Last sentence of the discussion
• What it means

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How to do it an example
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Famotidine for the Prevention of Gastric and
Duodenal Ulcers

• First sentence of he introduction
• Gastroduodenal damage can be seen on endoscopy in
  20 to 40 percent of people who take NSAIDs.
• Last sentence of the introduction
• We compared two doses of famotidine (20 mg twice
  daily and 40 mg twice daily) with placebo to test
  the hypothesis that famotidine provides
  protection against NSAID-associated gastric and
  duodenal ulcers.

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Famotidine for the Prevention of Gastric and
Duodenal Ulcers

• First sentence of the discussion
• The results of this study show that treatment
  with a high dose of famotidine significantly
  reduces the cumulative incidence of both gastric
  and duodenal ulcers in patients with arthritis
  receiving long-term NSAID therapy.
• Last sentence of the discussion
• High doses of famotidine were well tolerated and
  effective in preventing both gastric and duodenal
  ulcers in patients with arthritis receiving
  long-term NSAID therapy.

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Introduction

• Three types of introduction
• Discussion
• The optimal therapy for peptic ulcer disease is
  under debate
• Alarmist
• Peptic ulcer is a devastating disease and a major
  killer in the western world
• Seminar
• Peptic ulcer disease is a major public health
  burden

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Introduction

• Be accurate
• No misrepresentation of literature
• Avoid selective referencing
• Avoid tailoring introduction to the results
• Concise and to the point
• Put the potential results of the study in
  perspective with the literature
• Do not give an elaborate review of the literature
  here

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Methods

• Concise but complete
• Do not repeat complex methods
• If your lab discovered alpha pipelemic acid
  measurement in 1985, do not list the complete
  method here
• Describe controls
• Provide statistical methods
• Provide Medical Ethical Committee approval

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Results

• Clear and Concise
• Do not repeat data from figures in the text
• Stick to the relevant issues
• Be sure to include basic descriptive data
• Do not overdo with tables and figures
• Figures tell the story
• Tables give the evidence
• Do not discuss strengths / weaknesses of your
  study (here)

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Discussion of scientific papers

• Statement of principal findings
• Strengths and weaknesses of the study
• Strengths and weaknesses in relation to other
  studies, discussing particularly any differences
  in results
• Meaning of the study possible mechanisms and
  implications for clinicians or policymakers
• Unanswered questions and future research

Smith R BMJ 19993181224-1225 ( 8 May )
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Discussion

• Again be concise
• Do not restate results or introduction
• Explain differences from other studies
• How does your data further the field (what this
  study adds)
• Place your results in perspective with other
  results
• Sell but be aware of overstating
• Mention limitations

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Discussion

• Last sentence
• Another puzzle solved
• It is clear that proflox 40 mg o.d enables
  healing of Forest II peptic ulcer even in
  geriatric patients
• More research is needed
• Further studies are needed to determine the
  optimum dosage and duration of therapy
• Perhaps possibly
• Proflox may well heal peptic ulcers, but other
  treatments may be as effective and it is unsure
  whether peptic ulcers in geriatric patients need
  treatment at all

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References

• Avoid abstracts
• Avoid selective referencing
• Mention the co-discoverer
• Self citations
• Dr. X is a big proponent of self citation. Out of
  the 24 references he elects to cite 9 (38) of
  his own studies. These 9 represent all Dr. Xs 9
  first author papers on Pubmed
• Check for duplicates (happens!)
• Political referencing
• Reviewers (references to likely reviewer)
• Editors (references to Journal)

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Submission

• Check, check, double check
• Watch MS Office spell check!
• Favors non-medical above medical terms
• sprue -gt spree or spruced
• We look forward to you reply
• Keep the journals format
• Title page OK?
• Abstract OK?
• Background Aims vs. Introduction
• References OK?
• SI units
• mg/dl vs. mmol/l

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Writing style

• Active
• Short
• Plain

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Write active

• Not
• Histological analysis by Dr. X of nicely cut
  liver samples by the very able technician Y
  revealed moderate steatosis and hepatitis in the
  liver of rat A and B but rat C had only minor
  steatosis and rat D displayed severe hepatitis
• But
• At eight weeks livers showed a variable degree of
  steatosis and hepatitis

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Words editors prefer

• About gt approximately
• Has gt possesses
• More gt additional
• Raised gt elevated
• Start gt initiated
• Study gt investigation

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Plain is better

• If you can cut out a word do so
• Never use long words when short one will do
• Never use a foreign phrase if there is an
  everyday English equivalent
• Never use passive when active will do
• The finger of the physician was inserted into the
  rectum
• The physician inserted her finger in the rectum

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Journal

• Take care in selecting a journal right platform
• Try to aim accurately Donald Duck or NEJM
• A letter of inquiry to the Editor might help
• Follow the specific requirements
• References
• Use an automatic reference programme
• Check the cover letter
• Is the Editor in Chief still in place
• In case of resubmitting reference to the other
  journal deleted?

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Submission

• Dry run at a (local) scientific meeting
• Jot down the questions
• See what might be improved

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Cover Letter 1

• Your cover letter sells your article
• Introductionary sentence
• Please find enclosed our manuscript "Proflox
  improves peptic ulcer healing " intended for
  publication in Gastroenterology.
• Caption of your study
• As already outlined, peptic ulcer disease is a
  devastating disease with a high mortality in the
  elderly. Current therapy includes proton pump
  inhibition.Although this is an effective therapy,
  some patients fail. Proflox is a new
  alpha-pipelimic acid inhibitor that specifically
  inhibits gastric acid production.

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Cover letter 2

• What you actually did
• We performed a 24-week randomised clinical trial
  in 1256 subjects and show that Proflox is a very
  effective peptic ulcer healing drug, especially
  in the elderly.
• USP
• This is a solid result and we would like to
  emphasize that randomised drug trials are rare,
  if ever done, in peptic ulcer disease. In
  clinical practice peptic ulcer patients are
  randomly exposed to various drug regimens, all of
  them completely uncontrolled. We believe that it
  is in the interest of these patients and
  physicians alike that these results are
  disseminated. For these reasons we therefore
  sincerely hope that our manuscript merits
  publication in Gastroenterology

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Cover letter 3

• Potential reviewers
• Reviewers you pick give a better score than
  random ones
• Obligatory stuff
• The contents of this manuscript have not been
  published elsewhere, and likewise the manuscript
  is not being submitted elsewhere. There is no
  potential conflict of interest for the individual
  authors. We would prefer to be contacted by
  e-mail. Thank you for your consideration.

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Decision

• Revision requested
• Accept with grace and humility
• Respond with grace and humility
• Do provide a point to point review
• Yeah
• Mark your changes in the manuscript
• Use the track mechanism in Word
• Do not be confrontational
• It is a game and these are the rules

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Rejection

• That is a bummer
• S happens
• Sit down, sigh and move on
• Do not write an angry response
• Did I aim at the wrong target?
• Can you do something with the criticism raised by
  referee?

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Case report

• And now something completely different

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Case reports are bad

• New ideas from case reports are not sustained on
  further research
• Contain "misleading elements" in clinical
  presentation
• More harm than good by emphasizing the bizarre
• Editors do not like it
• Sloppy reviewing (nice observation)
• Get few citations
• Few Journals publish case reports
• Lowly status in the medical literature

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Hierarchy of evidence
Systematic review
Randomised trial
Case control
Cohort studies
Case series
Case reports
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Case reports in Journals

• Lancet (1)
• Netherlands Journal of Medicine (3)
• Digestive Liver Disease (2)
• Gut (0-1)
• Am J Gastroenterol (0-3)
• Eur J Gastroenterol Hepatol (4-7)
• Dig Dis Sci (10)
• J Clin Gastroenterol (3-4)

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Case Report Journals

• Case Reports and Clinical Practice Review (CRCPR)
  
• www.crcpr-online.com
• Grand Rounds
• http//www.grandrounds-e-med.com/

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Merits of a Case report

• Description of new disease
• mitochondrial diabetes
• Study of mechanism
• Clotting abnormality in a family
• Recognition of a rare manifestation of a common
  disease
• Extraintestinal manifestation of Crohn
• Therapy
• New indication for drugs
• Side effects of drugs
• Education
• If you see this, think of that
• Do not make the stupid mistake we made

Vandebroucke 1999 J Roy Soc Med 159-163
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How to case report?

• Why is this observation important?
• What does it teach us?
• Is it contrary to common thinking
• If so, explain Does it run counter to some
  particular cherished truth? (spell it out) this
  truth and explain the reader how and why it is
  contradicted.
• Does it strike the "prepared mind"?
• Yeah, that we did not think of this
• Is it an unexpected association?
• What was expected?
• Is it a rarity that could be missed?

Vandebroucke 1999 J Roy Soc Med 159-163
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Case report

• Case reports often introduce readers to new
  clinical techniques and allow them so see how
  treatment can be made more efficient and
  effective
• The writer (or narrator) should lay bare his or
  her thought process, as crisply and pointedly as
  possible, because that it the only way to impress
  and strike a chord with the reader

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The anatomy of a case report

• Introduction
• Explaining what is the paper is about
• We are presenting a case of. . . , which is
  instructive because. . . .
• Basic description of syndrome
• Case summary
• Focus of the manuscript
• Provides detail to make the case
• Include an illustrative figure!!
• Exclude crap
• Seek advice / consult with expert
• Discussion
• Emphasises unique or important aspects
• Starts with a brief statement why we reported the
  case
• Followed by concise description of the disease
• What sets it apart , differential diagnosis
• Finish with a concise statement of the lesson to
  be learned
• References
• Provide additional general information
• Back up specific points

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Practice Run

• Introduction
• Explaining what is the paper is about
• Drug-related acute pancreatitis remains an
  uncommon clinical entity.. We report a case that
  is unique in that acute pancreatitis occurred
  after many years of treatment with TMP/SMX.
• Case summary
• Focus of the manuscript
• A 53-year-old woman presented with epigastric
  pain, radiating to the back. Elevated amylase.
  Prolonged (20 yrs) prophylactic TMP/SMX.

Versleijen et al. Neth J Med 2005 63 275
www.njmonline.nl
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Practice Run
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Practice Run

• Discussion
• Emphasises unique or important aspects
• Here, we report a patient who developed acute
  pancreatitis after having taken TMP/SMX for many
  years as prophylaxis. Known causes of acute
  pancreatitis were ruled out. Discontinuation of
  TMP/SMX improved symptoms and we observed a
  relapse of acute pancreatitis within four days of
  restarting.
• Absence of a rash did not support
  hypersensitivity as a cause.
• Prolonged TMP/SMX use (20 yrs) can result in
  pancreatitis.