Transcript – BJUI Podcast - Kilian Mellon

Kilian Mellon John, many thanks for the invitation to participate in this session. It‟s a real pleasure. I have been asked to talk about how you prepare your paper for submission and hopefully some of the things that I have to say will be obvious to people who are just embarking on that process. So, your paper needs to tell a good story and most of you will recognize Ronnie Corbett, who in the „70s and the „80s, used to sit on his chair and tell a good story, and that always had a good punch line. And your paper should have a good punch line or have a message, but unlike Ronnie, you shouldn‟t long-winded and there‟s some data to suggest that, that‟s a constant problem with lots of papers that are submitted. So, it can be daunting, getting started to write your papers, here‟s the chap, you know, going through the endless drafts of his first publication. And one of the reasons why I think its daunting is because this is a, sort of, writing that lots of junior people do for a number of years, once they‟ve come out of medical school. So everything is in note form, you know, we‟ve got abbreviations for this, that and everything else we‟re talking about. Hypertension, we‟re talking about LKKS, we never write sentences, whenever we‟re junior doctors and then suddenly you have to produce something which is suitable for submission to a biomedical journal and it‟s a very, very strange thing to be confronted with. So whenever you start out and you do prepare something for submission and you give it to your senior colleague, you don‟t be surprised if it comes back full of red marks, red ink bits scored out, bits rearranged, that‟s to be expected whenever you start on this process. Not now it‟s more likely to be rather than a hard copy in red ink, it‟s more likely to be something which has been done on Microsoft Word with lots of changes tracked on it and as its topical these days, there‟s all the important bits have blacked out at the top, so you can work on it to all the essential detail. I‟m not sure if you can see this very well, but the first thing you do whenever you want to write a paper is you go to the guidelines for the authors and this is the guidelines for authors from the BJU International, not the British Journal of Urology International, but the BJU International and if you want to maximize your chances of getting your paper accepted, you‟ve got to adhere to the letter of the law, you‟ve got to follow all of these instructions and if you just focussed your eye on the bit on the right hand side, here are where the instructions related to references are. You‟ve got to adhere to every single last letter of the law, so that means if you look at the Vancouver style of reference in here, which is recommended by the BJU International that means, you lay out all your references in this format. And when it comes to the citation, it has to be absolutely identical. So, this is from 1986, well this is an old reference, when it was the British Journal of Urology, but there‟s a space there in the 1986, followed by a colon, followed by a space, followed by the volume in bold, no space colon, no space 183 dash 7, no full stop. It should be as precise as that. And just one another point to make, one of the things I think people struggle with whenever they start to write in the first instance, they struggle with this et al. lots of people these days have go to medical school, having never studied Latin, et al is short for “et alia” the Latin and others. So its et al. and I certainly come across lots of junior doctors, who aren‟t familiar with that. So essentially, what I am saying is that the end of the process of getting your manuscript ready, you need to have something which is Word Perfect and before I used Microsoft Word, like everybody else, we used to use a software package called Word Perfect. Your manuscript needs to be Word Perfect and its absolutely remarkable how little attention people pay to that when they start writing in the first instance. And just one other helpful, I hope, hint at this stage is whenever it comes to trying to get your document ready for submission online or in the process of whatever you‟re doing, try proof reading that backwards, its easier to pick up mistakes that way. If you read it the conventional way, you don‟t see the mistakes. So, that was a tip given to me many years ago. Now, if you want to spend a long time, learning about how you prepare your manuscript for submission, you can go to Google and you‟ll find lots and lots and lots of web sites, where you can go to get helpful advice. Most journals will provide helpful advice, but this is quite a good one;

it‟s the web site of the International Committee of Medical Journal Editors and John will be very familiar with this web site. The web address is icmje.org and it‟s got sections relating to all these things, but in the middle there it talks about manuscript preparation. And you can get lots and lots of helpful information about preparing your manuscript. The whole document is about 38 pages long, but well worth a visit, if you‟re new to the whole process of getting documents ready for submission. So the next few slides are really taken from that web site and most of you will be aware of the fact that most papers being submitted to biomedical journals these days, use the IMRAD structure and that‟s not just been arrived at randomly. This is something which is a direct reflection of the process of scientific discovery and IMRAD stands obviously for Introduction Methods Results and Discussion. Some of the general principles - double space all sections of your manuscript. Nobody who starts writing this comes through our department and later realises that there should be two spaces between sentences and that‟s something that has to be pointed out. A generous margin should be left so that the reviewers John sends the papers to, have plenty of room to write comments and make alterations; number all your pages including the title page and make every single word meaningful. Have no redundancy whatsoever within your paper and at the beginning, you people not familiar with writing use lots and lots of redundancy. So we‟ll run through a few slides with some of the helpful hints from this web site. Let‟s start with the title page, make your article title very concise, make it very meaningful, have all the key words in them, make sure that whenever somebody does a search for that particular subject, your paper shows up. This is probably the most important line on the slide, make sure you include all of the author‟s names, and the institution of affiliations but be aware the author list and the author order can cause huge embarrassment. It‟s terribly, terribly easy and I think we‟ve probably all done it; it‟s very, very easy to upset somebody, often a senior colleague who has been omitted from an author list. So just be very, very careful about that and whenever you produce your first draft, make it very, very clear to everybody that it‟s a draft author list. Put in any disclaimers if there are any, the contact information for corresponding author, the email address for reprints and that‟s pretty much all hyped now, because everything has done online and everybody having loose copies, the source of support in forms of grant, the running head and the word count; the word count should refer only to the abstract, the text with the abstract acknowledgments, references and legends. The abstract, the abstract is an interesting part of your document because it‟s the thing you write last but it‟s the thing that you add first and it may be the only thing that‟s read by lots and lots of people. And that‟s the portal that influences the readership as to whether they want to read your whole paper, it should provide the following - the content or background to the study, really the IMRAD‟s bits, the studies purpose, the basic procedures, the main findings and the principal conclusions. And this is something that I only came across recently, reports of clinical trials supposed to be contained in the abstracts that include items of the CONSORT group has identified as essential. Now the CONSORT group that stands for Consolidated Standards of Reporting Trials and you can go to this web site and there‟s a check list of 22 items that need to be completed or thought about before you report on the clinical trial. Then the introduction should provide a context or background for the study and it should state the specific purpose, the research objective or the hypothesis tested, it should clearly outline the main and secondary objectives, it should only have pertinent references in there and then in your introduction, don‟t give the game away, don‟t include data or conclusions from the work that you‟re reporting. The methods section obviously you should describe the selection of participants, whether that is patients, animals and don‟t forget about your controls, list the inclusion and the exclusion criteria, you need to give all your technical information, identify the methods and list the apparatus that you‟ve used. If you mention some bit of apparatus you are supposed to put the manufacturer‟s

name and addresses in parentheses afterwards, give sufficient detail for others to reproduce the methods, give references to establish methods and identify all drugs and chemicals you used. I am not going to say a lot about statistics but in terms of the statistics you should describe enough detail to allow a knowledgeable reader with access to the original data to verify the reported results. You should quantify findings with appropriate measures of uncertainty, differences in your confidence intervals, don‟t rely solely on statistical hypothesis tasking such as P-values because that fails to convey the important information about effect size and specify the software you used. For the results section- present your results in logical sequence and text, tables and illustrations. Give the most important findings first. Do not repeat all the data in tables and figures; that‟s a common mistake at the outset; lots of supplementary materials can be included in the appendix, give both numeric results not only as derivatives like percentages but also as the absolute numbers and use graphs as alternatives to tables with many entries. Now if the study result is disappointing not what you had hoped for, you can always resort to this journal, the Journal of Negative Results. This is a journal which is dedicated to the advancement of all those disappointed about the outcome but this is a very, very important journal and you know in my experience people who have done a set of experiments which have resulted in negative findings, you know sometimes think, we can‟t even publish this, well that‟s clearly not the case. Results are results; negative results, I daresay are almost as good as positive results and I have said here the impact factor can be very high for this journal, the Journal of Negative Results. Editors to look for any graphs for that one. Your discussion section should emphasize the new and important aspects of the study and the conclusions will follow on. The biggest mistake that people make whenever they start writing papers is they repeat the results section, the first page or two of the discussion is the data duplicated. You should compare and contrast the results with other relevant studies, state the study limitations, explore the implications or findings of a future research and clinical practice and avoid this, avoid unqualified statements and conclusions not adequately supported by the data and finally avoid claimant priority. There‟s a lot of papers say, this is the first study of this that and the other, when quite honestly that‟s not the case. Reference section, you should use direct references to original work rather than review articles and have small numbers of references to key original papers often serve as well as more exhaustive lists; try to avoid using abstracts as references; avoid citing a personal communication unless it provides essential information not from a public source and authors are responsible for checking none of the references cited have been retracted. Now this is an interesting paper which appeared in a journal called Science Editor in 2000 and it looks at the common reasons for rejecting manuscripts at medical journals by a chap called Daniel Byrne and what he did was in 1995 he sent an 8-page questionnaire that contained 83 questions to a random sample of 50 peer reviewers for JAMA and the details in there somewhere. He also sent it to 67 Editors-in-Chiefs of sample of prominent medical journals and 25 Nobel laureates, who were in Physiology or Medicine and these are some of the findings from that study, so if you looked at the general deficiencies in medical manuscripts, what‟s the single most common type of flaw that results in out right rejection of the manuscript, by far way the biggest flaw was the design of the study, followed by interpretation of the findings which was misrepresentative, the importance of the topic and none of the people said that the presentation of results was the cause for rejection. And to be fair to lots and lots of journals and lots of Editors, Associate Editors and Reviewers will be reasonably tolerant of deficiencies in spelling and grammar and allows somebody to take on the burden of correcting that and it‟s very, very rare, that something that‟s very good but very badly written, somebody will probably go to the trouble of getting that corrected. What section usually gets the most flaws will be based on the fact that the study design is the most common reason for rejection. Over half were rejected because of problems with methods and then over 20% discussion and results and I guess the last question

pretty much parlay all that, which section is the most responsible for rejection. Methods were over half the cases, results 28%, discussion 21%. This is quite an important slide. This is from Daniel Burn‟s book and it looks at the four IMRAD sections Introduction Methods, Results, and Discussions, and looks at which are too long and too short and you might predict this. The introduction is by and large usually too long, methods are usually too short, results is usually too short, discussions is usually too long, so bear that in mind. And this is some data on the writing deficiencies - commonest writing deficiency, too wordy, too much redundancy. Make every word meaningful. And just to finish on the slightly latter note, this is my personal view. These, what I have suggested is try to avoid studies, suitable for publication in these journals and I should add none of these journals appear on Medline, first journal is the Journal of Anecdotes, second journal is the Journal of Duplication or its sister journal The Journal of Duplication, the third journal is the Journal of Small Studies Warranting further Investigation which we are not prepared to do and the fourth journal is Studies Completed Many Years Ago but I have been studying for the FRCS (Urol). (Applause) John Fitzpatrick Just two, sort of cover one or two things there, I think that was really, extremely helpful, particularly the length of the discussion being too long, the methodology being flawed all of this. This is something that is very important and often what‟s wrong is the statistics are wrong and we do send papers for a statistical review to a statistician and we pay them for it. In relation to the English or whatever, if English is not your first language don‟t worry, because we have technical editors who will correct the paper and believe me they correct papers written by people for whom English is their first language as well and so all of this is done and it‟s free. It‟s, we‟re the only journal that actually gives this service. Okay, oh! By the way one thing I want to say about starting a paper, often in your career you‟ll get writers block and it can be unbelievably difficult and suddenly you say, I can‟t start. Well you don‟t have to start at the beginning. If you feel that you know you‟ve got say the results section. That‟s the easiest thing for you to start on, start on it. Write that down and then you fill in the other blocks afterwards. Start on the section that for you is the easiest section. Okay Kilian, we‟ve plenty of time for questions. So right you‟ve got them the thing over there. So let‟s see who wants to ask him other questions. Oh! Good there… (Name) My question is, how do you select your MeSH terms that are from the key words, is there any trick to that? Kilian Mellon Yeah, John do you want to deal with that? John Fitzpatrick Well, I mean, yeah you have to remember the key words are the things that will appear on PubMed that‟s the answer to your questions. So you pick whatever keywords, whatever so in other words, you want as many people as possible to read your paper. So what happens is you then say right well who are the people who are going to be looking for, if you want to do a literature search how do you do it, when you go to PubMed you put BPH PDE-5 inhibitors, well then that‟s an example of what your key words will be, just you got to think who do you want to read your paper and that‟s what will guide. Yep, Markus. Markus Drake The importance of publishing papers with the Negative Results is pretty fundamental because one of these, sort of, I suspect you‟ll come up with a sort of ethical issue of the temptation to massage it and mysteriously piece 0.5 up 0.05, how can we actually make sure that something with a negative result does receive the due credibility and prospect of actually getting published.

Kilian Mellon Yeah, I guess it depends on the importance of the subject but I guess the point I tried to make here, Markus was that some genuine people are completely put off from even submitting the manuscript because they‟ve got a negative result. Well, I think that‟s the first hurdle to overcome and negative result is a very valid result and thereafter you have to take your chance in terms of which journal you submit your paper to and in terms of trying to get it published, but I would you know if I would keep going with trying to get a study with a negative result published. John Fitzpatrick Yeah Roger. Roger Kirby Kilian, I liked your slide of getting started, I actually would do a little survey of the audience. Put your hands up those of you who have published a paper? Hands up, okay put your hands up who have published 10 papers, 100 papers, 200 papers, 300 papers. John Fitzpatrick Keep it going, bring it off. Roger Kirby Yeah, the point I was going to make is that getting started is the key, so the first paper I remember I wrote, I was an SHO and moved to Hampton and I wrote the first case report, it took ages and ages to write, so difficult I found it, if I had looked it now I thought I could do it in about 10 minutes now, but once you‟ve done the first one and you get it published then that‟s such a positive thing, okay you‟ve got to do another one and it‟s so exciting to see something in print. So yeah just get started, send in and if it gets rejected okay then send in another one because you are what you publish in medicine, you have to keep publishing. John Fitzpatrick Okay questions, any questions from the audience. I said I would be back. Tell us who you are? (Name UNCLEAR) (Name UNCLEAR 20:32) SpR, you alluded to author order. Kilian Mellon Yes. (Name UNCLEAR) Can you just elaborate on it, who should go first and who should goes second and what is the significance of each? Kilian Mellon Yeah, my personal view and you may want to argue with this, there are certainly two crucial positions in the author list and that‟s the first and the last. And if you are the person who has been involved in doing a lot of the experimentation and has taken the trouble to sit down in front of the computer and write the paper, under those circumstances it is going to be little argumentative that you go as the first author. Some journals will now allow dual authorship, so the first two people will be recognized as the first author and that that will be clearly indicated in some papers. And it is certainly still traditional and I think reasonable that somebody who is senior very instrumental in the study design and the concept of the study, a bit like that John Blandy example earlier on, John Blandy was probably the senior author and the last author on that paper and that‟s a reasonable thing to do, so sometimes first and last can be easy but then everybody else who is involved in the paper are somewhere in the middle and still sees some sort of hierarchy the middle and will be upset because they are fourth rather than the second and my advice is simply don‟t overlook that aspect at the beginning and even with the very, very early

draft of the paper which you circulate to colleagues be very careful about the author order on that and try and be as, try not to be politically naïve when it comes to that. John Fitzpatrick I think this is very important and I would also say and sure Kilian would agree do it at the very beginning, the very, very beginning, because otherwise when it happens later on it‟s too late and in fact so the key numbers are first and last but also third because you will have noticed that if there are six authors you do name all six and if there are more than six it‟s the first three et al., and so number three there fore becomes the key player because his name is last. Kilian Mellon On occasions John I have seen where a junior person has written a paper so the first draft of the paper comes back with the title one author who is the junior member of the team and corresponding author same person, the address or the person for reprint the same person and absolutely nobody else is given any credit for having been involved in the study because they think it‟s their project that‟s it‟s their baby and they are the only person who is going to get credit but they have to learn fairly, fairly quickly after that. Roger Kirby John we‟ve got the Chairman of the Office of Education and let‟s ask him is it still as important as it used to be when I was a young lad to publish papers in terms of getting on in your career. Chairman I think it is becoming increasingly important committees that I have sat with over the past two years for appointments like we went through quite a long period in terms of SpR producing papers but as their job markets got more competitive, unfortunately people feel that they have to do more work and present more work and publish more work. But I think that the point that John was making earlier on in terms of the fun doing this it‟s tremendous fun right, you would say this is well Rogers so I would actively encourage people to participate and to write. John Fitzpatrick Good, terrific. Yep question out, two questions. I was going to start, Kilian, sorry, I took you away, but you want to go back. Roger do you want to pass it, the person is at the back. (Name Unclear) (Name Unclear 24:35) Given that Kilian‟s slide showed that the two sections that are most often over done are the introduction and the discussion, but you limit the references to 30, what guidance can you give to writers in deciding what requires a reference and what does not say for example prostate cancer is a common problem, we know that surely we do not need to reference that. Where do you draw the line at which point you say that it needs a reference. Kilian Mellon Yeah, something which is completely refutable I don‟t think needs to be referenced and I will just go back to my slide with some tips about references, you know one of the issues raised in this web site is that small numbers of references to key original papers often serve as well as most exhaustive lists. This I guess if you were writing something on DNA fingerprinting, you know how many papers are there on DNA fingerprinting, thousands upon thousands upon thousands, but go back to Alec Jeffreys‟ paper in the early 1980‟s is probably all you need rather than ten of the others. So going back to original articles is important in terms of keeping to within the number but something that you can easily defend does not need to be referenced. Something which relies on information from other things should be referenced. Terry Browning I am Terry Browning from Lakefield. Two things, the one is do you think that if you are writing an article and it‟s the first time or the second time you‟re doing it, it is good to speak to someone who has published a lot because you get the impression that people who publish a lot perhaps know

which journals to target the article for and your chances of getting published are perhaps greater in terms of targeting for a specific journal rather than going through the whole process where rejection is almost certain. And the second thing is a practical point and it gets back to your point but how we all write in shorthand is medics and one of the things I always find really difficult is when you are doing the discussion and it‟s often in an essay type form and because of our jobs we only have perhaps an hour or an hour and an half and we don‟t have three or four or five hours where you can sit down gather all your thoughts and write something that flows really well. Do you have any tips where you‟re perhaps writing for now and you have to go often do something and you could actually come back and pick up the thought processes, do you have a process where it‟s helpful for you to sort of you know to do that. Kilian Mellon If you work for a brief period and something regardless of what you‟re doing and you go away and you come back you‟ve lost the momentum, you have lost time and that takes you some time to get back to where you were and I don‟t think there is any way of getting around that process and I think it‟s just human nature. In terms of selection of the journal to submit your paper to, I think if people were being honest to point that, I think you have to decide which readership you really want to target, and you should put other things aside and if you work in universities it may not be possible to do this but I think you should ignore things like impact factor, etc., I think you should target a particular readership and if you want to get the message to urologists you go for a urology journal, even if you could have published your paper in a cancer journal or something else. And that‟s my own personal view but I do have to acknowledge that there is pressure from within universities to consider things like impact factor in addition.