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

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

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…

The IntroductionThe Introduction

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.

The MethodsThe Methods

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.

The ResultsThe Results

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!Results!

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

The DiscussionThe Discussion

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 & FiguresTables & Figures

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

This requires a table!

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.

Patient Disposition (Results)Patient Disposition (Results)

Complex Study Design Simplified

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

From The JournalFrom The Journal

Editor’s PerspectiveEditor’s Perspective

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!