1. How to write & publish a scientific paperF. Javier Rodriguez-VeraDepartment of Internal Medicine. Hospital do Barlavento Algarvio. Portimo. Portugal. EU

2. How many articles are sent to a journal?How many are rejected?Why are they rejected?How many are reoriented to another journal? 3. How to write & publish a scientific paperI. Before start writingII. Writing the articleIII.Making the article to be published 4. Why an article is published?It says something new: OriginalIt is well plotted: IMRADIt was timely sent to the appropriate publication:MARKETEDBlock I. Before start writing 5. Block I. Before start writing 6. What we need to write an article?a) Knowledgeb) Norms of publicationc) Hardware and softwared) MatterBlock I. Before start writing 7. a) Knowledgeb) Norms of publicationc) Hardware and softwared) Matter Block I. Before start writing 8. Select a group of journals of interest and readthem periodically:-Updated-Get the tempoFor General Internal Medicine:NEJMBMJArch Int MedMed ClinBlock I. Before start writing 9. To know how to perform an up-to-dateAre you really discovering anything new? State of the Art Block I. Before start writing 10. Give overview of a topic; print textbooks, electronictextbooks, narrative reviews in journals1. Harrisons Online2. Scientific American Medicine Online3. MD Consult4. Medline articles a. Ovid b. PubMedBlock I. Before start writing 11. Knowledge of medical writing:it is concise, usually uses the passive form. Theasseverations are based on other articlespublished. The conclusions are based on the resultsof the studyInductive thinking Block I. Before start writing 12. The situation with respect the subject A is 1(references ofbibliography)We have done a study to clarify the point Bwhich was not clear. To do it, we have measured theparameters C, D and F with the device G. The results werethat C had a value of 2, D had a value of 3, and F had a valueof 4. We conclude that the point B has been clearedBlock I. Before start writing 13. a) Knowledgeb) Norms of publicationc) Hardware and softwared) Matter Block I. Before start writing 14. Norms of publicationMake a list of target journalsMake a folder with the norms of publication of yourtarget journals Block I. Before start writing 15. a) Knowledgeb) Norms of publicationc) Hardware and softwared) MatterBlock I. Before start writing 16. PC.Internet.Word processorMicrosoft Word.lnkBlock I. Before start writing 17. a) Knowledgeb) Norms of publicationc) Hardware and softwared) MatterBlock I. Before start writing 18. MatterClinical caseSeries of clinical casesObservational studyTrialRandomizedNon randomizedReviewMetanalysisOpinionBlock I. Before start writing 19. We are ready to start writingWe have an interesting subjectWe know this finding had not been publishedbeforeWe have a state of the art vision of thematterWe have a word processor and a web linkLET START WRITING! Block I. Before start writing 20. I. Before start writingII.Writing the articleIII.Making the article to be published 21. The titleOnce of the most important items to publish anarticle. It has to have catch upFirst impressions are strong impressions; a title oughttherefore to be well studied, and to give, so far as itslimits permit, a definite and concise indications of whatis to comeT Clifford Allbutt Block II. Writing the article 22. Do:Write the results of the article: Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart DiseaseWrite the aim of the study: Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the ElderlyAsk a question: Exposure to Lead in Children How Low Is Low Enough?Block II. Writing the article 23. DontUse very long titles: On the addition to the method of microscopic research by a new way of producin colour-contrast between an object and its background or between parts of the object itselfUse metaphoric sentences Block II. Writing the article 24. Structure IMRADoIntroductionoMaterial and MethodoResultsoAndoDiscussion Block II. Writing the article 25. IntroductionIt has the aim of giving a brief vision of the state-of-art of the matter and justifying the study.The situation about the matter is A.....There is ablank of the knowledge with respect to B......so...wedid C All the asseverations will have to be supported by bibliographical referencesBlock II. Writing the article 26. Rheumatoid arthritis is a systemic autoimmune disease that affects approximately 1 percent of the adultpopulation.1 It is characterized by chronic inflammation in the synovial membrane of affected jointsthat ultimately leads to loss of daily function due to chronic pain and fatigue. The majority of patientsalso have deterioration of cartilage and bone in the affected joints, which may eventually lead topermanent disability. Rheumatoid arthritis is associated with increased morbidity and mortality.2Although the precise pathogenesis of rheumatoid arthritis remains unclear, it has been postulated thatmultiple exogenous or endogenous antigenic triggers, or both, act in the presence of a backgroundgenetic predisposition to initiate a self-perpetuating series of autoimmune responses in the synovialcompartment.3,4 Many cell populations, including monocytes, macrophages, B cells, T cells, endothelialcells, and fibroblasts, participate in the ongoing inflammatory process.3 The precise contribution of Bcells to the immunopathogenesis of rheumatoid arthritis is not fully understood, although a number ofmechanisms have been proposed.4,5,6 However, strong evidence for a critical role of B cells in rheumatoidarthritis came from a small open-label study of rituximab in combination with cyclophosphamide andcorticosteroids.7Rituximab is a genetically engineered chimeric anti-CD20 monoclonal antibody that is approved for thetreatment of relapsed or refractory, low-grade or follicular, CD20+ B-cell non-Hodgkins lymphoma.CD20 is a B-cell surface antigen that is expressed only on pre-B and mature B cells. It is not present onstem cells and is lost before differentiation of B cells into plasma cells. Therefore, rituximab causes aselective transient depletion of the CD20+ B-cell subpopulation.7 To confirm the role of B cells inrheumatoid arthritis, we evaluated the effect of rituximab in patients with active rheumatoid arthritis ina multicenter, randomized, double-blind, controlled study.Block II. Writing the article 27. Says what is known about the diseaseRheumatoid arthritis is a systemic autoimmune disease that affectsapproximately 1 percent of the adult population. 1 It is characterized bychronic inflammation in the synovial membrane of affected joints thatultimately leads to loss of daily function due to chronic pain and fatigue.The majority of patients also have deterioration of cartilage and bone inthe affected joints, which may eventually lead to permanent disability.Rheumatoid arthritis is associated with increased morbidity andmortality.2Highlights the importance of a fact Block II. Writing the article 28. Always backed by bibliographical referencesBlock II. Writing the article 29. Blank in the knowledgeAlthough the precise pathogenesis of rheumatoid arthritis remains unclear,it has been postulated that multiple exogenous or endogenous antigenictriggers, or both, act in the presence of a background genetic predispositionto initiate a self-perpetuating series of autoimmune responses in the synovialcompartment.3,4 Many cell populations, including monocytes, macrophages,B cells, T cells, endothelial cells, and fibroblasts, participate in the ongoinginflammatory process.3 The precise contribution of B cells to theimmunopathogenesis of rheumatoid arthritis is not fully understood,although a number of mechanisms have been proposed.4,5,6 However, strongevidence for a critical role of B cells in rheumatoid arthritis came from asmall open-label study of rituximab in combination with cyclophosphamideand corticosteroids.7Transition to the so...Block II. Writing the article 30. Rituximab is a genetically engineered chimeric anti-CD20monoclonal antibody that is approved for the treatment of relapsedor refractory, low-grade or follicular, CD20+ B-cell non-Hodgkinslymphoma. CD20 is a B-cell surface antigen that is expressed only onpre-B and mature B cells. It is not present on stem cells and is lostbefore differentiation of B cells into plasma cells. Therefore,rituximab causes a selective transient depletion of the CD20+ B-cellsubpopulation.7 To confirm the role of B cells in rheumatoid arthritis,we evaluated the effect of rituximab in patients with activerheumatoid arthritis in a multicenter, randomized, double-blind,controlled study So...What we did?Block II. Writing the article 31. Material and Method How we did it?A short paragraphMust include:-What subjects we included,-Definitions-What parameters were assessed,-What instrumentation was used to assess-Was there a statistical study? What kind? Block II. Writing the article 32. We studied the patients with the characteristicsA and excluded those with the item B. Wemeasured C, D and F. We defined F as C+D. Tomake the measurements we used the device ABC.To study if there were statistical differencebetween the patients, we did the test X... Block II. Writing the article 33. Inclusion criteriaDefinitionsPatientsPatients were recruited from 26 rheumatology centers in 11 countries (Australia,Canada, Israel, and 8 European countries). Eligible patients were at least 21 yearsof age, fulfilled the revised 1987 American Rheumatism Association criteria, 1 andhad active disease despite treatment with at least 10 mg of methotrexate per week.Active disease was defined by the presence of at least eight swollen and eighttender joints and at least two of the following: a serum C-reactive protein level ofat least 15 mg per liter, an erythrocyte sedimentation rate of at least 28 mm perhour, or morning stiffness lasting longer than 45 minutes. In addition, eligiblepatients were seropositive for rheumatoid factor, as defined by a plasmarheumatoid factor level of at least 20 IU per milliliter.Patients were excluded if they had an autoimmune disease other than rheumatoidarthritis (except concurrent Sjgrens syndrome), American RheumatismAssociation functional class IV disease,).Exclusion criteriaBlock II. Writing the article 34. What was done?Study ProtocolTherapy with Patients were randomly assigned to receive one of fourtreatments: oral methotrexate at a dose of 10 mg or more per weekplus placebos for rituximab and cyclophosphamide (control group),rituximab plus placebos for methotrexate and cyclophosphamide,rituximab plus cyclophosphamide in an intravenous infusion of 750 mg ondays 3 and 17 plus placebo for methotrexate, and rituximab plusmethotrexate at a dose of 10 mg or more a week plus placebo forcyclophosphamide. In all three groups that received rituximab(MabThera, Roche; Rituxan, Genentech and IDEC Pharmaceuticals),rituximab was administered as a 1000-mg intravenous infusion on days1 and 15. Investigators and patients remained blinded to the assignedstudy medications.Clinical assessments were performed at baseline (day 1) and at weeks12, 16, 20, and 24 according to the American College of Block II. Writing the article 35. What instrument was used?Rheumatology (ACR) core set of disease-activity measures. Theseconsisted of a count of swollen joints (66 joints evaluated),... andlaboratory evaluation of acute-phase reactants (serum C-reactiveprotein level and erythrocyte sedimentation rate).Laboratory assessments (including complete blood counts and serumbiochemical analyses) were performed at screening (three weeksbefore baseline), on days 1, 3, 15, and 17, and at weeks 4, 8, 12,16, 20, and 24. ...DefinitionsBlock II. Writing the article 36. What do we study-measure?Clinical Outcome MeasuresThe primary end point of the study was the proportion ofpatients with an ACR 50 response at week 24. ...and thevalue for one acute-phase reactant (either serum C-reactiveprotein level or erythrocyte sedimentation rate).9Secondary outcomes included ACR 20 and ACR 70 responses(20 percent and 70 percent improvement, respectively,according to the ACR criteria), ... 10 and the responseaccording to the criteria of the European League againstRheumatism (EULAR response).11Block II. Writing the article 37. What tools we use to detect differences? Statistical Analysis Sample-size calculations were based on the assumption..... On the basis of these assumptions and with the use of Fishers exact test with a two-sided significance level of 0.05, we calculated that a sample of 40 patients per treatment group would provide the study with 82 percent power to detect a difference between the two proportions.How the assessed parameters were statistically treated Block II. Writing the article 38. ResultsShort and concise paragraphAnswers the questions on the section Material and MethodWe might write it in the same order than it was in thesection Material and Method.Never try to explain the results or take any conclusionBlock II. Writing the article 39. N patients were studed. A were included. B wereexcluded for having 1, demographical features being D,E and F. With respect to the parameter A the resultwas 1, with respect to B, the result was 2. With respectto C, the result was D.... Block II. Writing the article 40. Of the 4164 hospital admissions sampled from theparticipating hospitals, 3745 patient charts (89.9%) wereeligible for a full screening by the stage 1 reviewers (Fig. 1).Of these, 1527 (40.8%) were assessed as positive for 1 ormore screening criteria (Table 1)... Included & excludedBlock II. Writing the article 41. Enumerates results...the physician reviewers identified a total of 1133 injuries orcomplications in 858 charts. In 401 (46.7%) of these chartsthe injuries resulted in death, disability at the time ofdischarge or prolonged hospital stay. In 255 of the charts oneor more of the AEs were rated 4 or higher on the 6-pointcausation scale (Box 1). Block II. Writing the article 42. Statistical analysis (if necessary)There was a trend for AEs to occur more frequently in theteaching hospitals than in the large community or smallhospitals (Table 2). The trend was significant for AEs acrossthe 3 hospital types (p < 0.001) but not for preventable AEs (p= 0.8)...Block II. Writing the article 43. DiscusionHighlights the importance of the subject. It may startwith a short review.Gives an explanation of the resultsCompares the results with those of other studiesResult-comparation-explanationSigns limitations of the studyA review of the state of the art can be done Block II. Writing the article 44. Is an extended version of the introduction,followed by a summary of the results, comparisonwith those of other studies, and what our resultsmean.Starts where the introduction endedIt is the place for new hypotesisBlock II. Writing the article 45. A is a very important parameter to determine B, as other studies have shown. Ours showed that A hadthe characteristics 1, 2 and 3, which is similar toother studies carried out to this respect.Nevertheless, It had the characteristic 4, which was different. We think that it may be due to...Block II. Writing the article 46. Incident rates of endometrial cancer vary more than 10-fold worldwide.18In addition to host susceptibility, dietary factors may play an importantrole...In our study population, the average intake of isoflavones from soya foodwas about 25 times that reported in a Western population....11 Some ofthese previous studies were not specifically designed to investigate therole of soya food...The sample sizes of the previous studies were relativelysmall, which limited the statistical power ...This population based case-control study... indicates that usual consumption of soya foods by adults, ...is associated with a significantly reduced risk of endometrial cancer....Although not all associations were statistically significant in subgroupanalyses, the different measurements produced similar results....Studies with measured oestrogen concentrations are needed to betterunderstand the joint effect of soya and endogenous oestrogen onendometrial cancer risk.Block II. Writing the article 47. Incident rates of endometrial cancer vary more than 10-fold worldwide.18 In addition tohost susceptibility, dietary factors may play an important role... Review Results of our studyIn our study population, the average intake of isoflavones from soya food was about 25times that reported in a Western population....11 Some of these previous studies were notspecifically designed to investigate the role of soya food...The sample sizes of theprevious studies were relatively small, which limited the statistical power ...Thispopulation based case-control study... indicates that usual consumption of soya foodsby adults, ... is associated with a significantly reduced risk of endometrial cancer.... Conclusion/Hypotesis Comparison with respect to other studiesAlthough not all associations were statistically significant in subgroup analyses, thedifferent measurements produced similar results. Limitations of the study...Studies with measured oestrogen concentrations are needed to better understand thejoint effect of soya and endogenous oestrogen on endometrial cancer risk.Block II. Writing the article 48. AND IF IT IS A CLINICAL CASE?IntroductionClinical caseConclusions Block II. Writing the article 49. Introduction: Usually based on rarity.Clinical case:A N yr-old (wo)man was admitted for a featureof....his/her clinical history was....in the physical examinationthe laboratory findings showedtheradiological techniques wereTo exclude athe A test was asked, with the result 1. With the suspect of a B, test B,was asked.Thus, we diagnosed the pathology PBlock II. Writing the article 50. A 28-year-old man was admitted to the hospital because of abdominal pain and fever.The patient had been well until 10 days earlier, when mild epigastric pain developed.Two days before admission...On physical examination, the patient did not appear to be in severe pain, and therewas...The urine was positive (+) for ketones; the sediment contained.......Radiographs of the abdomen obtained both while the patient was supine and while hewas upright showed ..... A cystic mass, 1.5 cm in diameter, was contiguous with thehead and neck of the pancreas. The remainder of the pancreas was unremarkableOral intake was stopped. The patient was given fluid and electrolytes as well asranitidine, metronidazole, ampicillin, minidose heparin, and morphine, which wasadministered...Block II. Writing the article 51. I. Before start writingII. Writing the articleIII.Making the article to be publishedBlock III. Making the article to be published 52. The article has been written And now....?Cover page Be sure it has the conditions required by thejournal (length, structure....)Submit it to the editorUndergo the review processBlock III. Making the article to be published 53. Writing the first pageIt is a cover with the name of the article, thenames of the authors and the institution, and inthe lower left corner, coreespondence to... Block III. Making the article to be published 54. Tamponade as the clinical onset of a cardiacangiosarcoma 55. Be sure it has the conditions required by thejournal (length, structure....)Submit it to the editorUndergo the review process Block III. Making the article to be published 56. Get the folder target journalsBe sure that this subject is at least occasionally treatedin this publicationSelect the section were it fits better (Original papers,clinical case, letters to editor)Verify that the article has the structure required for thisformatVerify (once again) with the tool of counting words thatthe whole do not exceed the maximum number ofcharactersVerify that once again that the article has to do with histitleBlock III. Making the article to be published 57. The document is readyLets send it:By conventional mail: Use first class paper First class mail Presentation letter Original and 3 copies Diskette 3 . Copy of photographs Block III. Making the article to be published 58. By e-mail:-Letter of presentation-Attached file with text-Attached file with photographs Block III. Making the article to be published 59. Presentation letter:Dear Dr.:Enclosed are two complete copies of a manuscript by .and.Titled . which is going to be submitted for possiblepublication in the section of the (name of the journal)This manuscript is new, is not being considered elsewhere andreports new findings that extends results we reported earlierin (name of the Journal). An abstract of this manuscript waspresented earlier ( write Congress)Sincerely yoursAuthor A Author B Author C Author DBlock III. Making the article to be published 60. Delays:a) To the notification of receiving the article: a) 1-7 daysb) To the rejection letter: a) 2-3 weeksc) To the acceptation letter: a) 3-8 weeksd) To the publication a) Up to 2 yearsBlock III. Making the article to be published 61. The reviewing processBlock III. Making the article to be published 62. The reviewer CHECK POINTSYes No 1. Does the paper fall within the scope of a general interest quality assurance journal? 2. Is this a new and original contribution? 3. Is the title suitable and well worded? 4. Is the abstract clearly written and free of abbreviations? 5. Are the keywords concise and appropriate to the material? 6. Are the methods sound and adequately described? 7. Are the concepts appropriately defined and used? 8. Is the statistical treatment adequate? 9. Are the points of interpretation clearly separated from the results? 10. Are the conclusions and interpretations sound and justified by the data? 11. Are the figures adequate? 12. Are the tables adequate? 13. Is the article unnecessarily long? 14. Are all the references necessary? 15. Is the English acceptable? 16. Is the paper addressed to an international audience? 63. OVERALL RECOMMENDATION1 Accept2 Minor Revision - reassessment not required3 Major Revision - reassessment required4 Reject - Fair, but contributing little5 Reject - Not acceptableIn the event the manuscript is revised, would you like to serve as reviewer?YesNoBlock III. Making the article to be published 64. REVIEWER GUARANTEE: - IMPORTANT: PLEASE COMPLETE THISSECTIONI, guarantee that, to the best of my knowledge, I have no conflict ofinterest in reviewing this paper that might influence the comments I haveprovided on these pages. YesNoPRIORITY OF PUBLICATION Merits rapid publication No urgency Low priority Block III. Making the article to be published 65. Are all acceptations equal? 66. Kinds of acceptation: The negotiationa) Unconditional acceptation: Dear Dr....We have read the article titled...and we have considered it acceptable for publication....In 4 weeks you will be sent the printing proofs for correctionb) Conditioned acceptation.We have read the article and have found the following points that have to be set 1.. 2.. 3. Consider it published. Make the corrections suggested 67. Conditioned acceptation (cont)After the corrections, verify that the article has the allowedlength and send a letter:Dear editor. Thank you for your kind suggestions withrespect to the articlewith reference number.Following yourinstructions, the next points were restructured:1. Write the point 1 of the letter 1 and write what youdid: 1. As it was suggested, the epidemiology of Salmonella was updated, the newresult being..2. Do the same with all the points.Thank you again for these suggestions that have contributedto improve the quality of the article.Sincerely yoursBlock III. Making the article to be published 68. Modified acceptation:The article is accepted but to be published in another s e c t i o n .We have read your article and we considered it a Block III. Making the article to be published c 69. Rejectiona) Absolute rejection:We have read with interest your articlesince wehave to ponder many papers, yours has not beenselected for publicationb) Relative rejection: We think your article is not appropriate to be published in our journal since it has the defects A, B and CBlock III. Making the article to be published 70. What to do with a relative rejection?Option A. Make the corrections the editor pointed toreject the article and resend the article as if it were aConditioned acceptation. 80% new rejections.Option B. Dont desperate. Get advantage of thecommentaries and send to another publication (thereviewers are sometimes the same and they will like tosee the corrections they suggested done)Block III. Making the article to be published 71. Resending the articleMost articles are not published for a lack of persistanceThink that once the article has been written making it tobe published is only a question of time.Look for another publication, make changes (if neccesary)to fit the requirements and send it againBefore sending the article for the first time, it has to beset that it will have to travel through a spiral of impactfactor before being published Block III. Making the article to be published 72. After an average of 3-4 tries, your article willbe accepted for a publicationBlock III. Making the article to be published 73. The printing proofsOnce the article has been accepted, a preliminarversion is sent to the authorDont modify or add contentsDont make modifications on grammarIt is only done to correct ortographySent them back as soon as possible, since they areussually sent just before being publishedPreferable to be sent by FaxBlock III. Making the article to be published 74. Epilogue.After the publicationSeparatasLetters about your articleAfter publication 75. SeparatasNumber depending on the publicationsOnly in originalsYou can buy separatasAfter publication 76. Letters about the articleIn the fisrt two months after the publication ofthe article.Possitive or negative commentaries on the studyThe author of the study has the right to answerthe questions of the letter, but the authors arerarely allowed to reply.A letter of the editorial together with theletter commenting the article is sent two monthsbefore the publication