preparing a scientific manuscript philip greenland, md senior editor, jama (current)...

Preparing a scientific manuscript

Philip Greenland, MDSenior Editor, JAMA (current)Editor-in-Chief, Archives of Internal Medicine (past)

With Thanks to: Fred Rivara, MD; Editor-in-Chief, JAMA Pediatrics; and to Howard Bauchner, MD, Editor-in-Chief, JAMA and The JAMA Network

Structure of an Article• Abstract• Introduction

- 2-3 paragraphs- Brief 300-400 words (Not more than 15 references)- The frame for your study- Be clear what the question is – and why important

• Methods- 3-5 paragraphs- Explain in English and justify use of unusual statistics

• Results- 5 paragraphs- 1st paragraph describe the sample- Text should not duplicate tables/figures

• Discussion (structured)- Principal findings- Strengths and limitations- Strengths and Limitations vis a vis other studies- Meaning of study- Unanswered questions/future research

• References – landmark papers and most recent publications

How do you start?

• Begin with an outline• Have others review your outline• Make sure it is clear what your question is• Outline should not exceed 2 pages

OutlinesUSING AN OUTLINE TO PREPARE YOUR PAPER

What is an outline?

- A logical, general description - A schematic summary - An organizational pattern - A visual and conceptual design of your writing - An outline reflects logical thinking and clear classification

Why make an Outline?

Value of the Outline

• Aids in the process of writing • Helps you organize your ideas • Provides a snapshot of each section of the paper will flow • Presents your material in a logical form • Shows the relationships among ideas in your writing • Constructs an ordered overview of your writing • Defines boundaries and groups

Why make an Outline?

Easiest way to share your “paper” with others before you spend a lot of time writing the paper.

Developing the Outline - 1

Before you begin:

- Determine the purpose of your paper - Determine the audience you are writing for - Develop the thesis of your paper

Developing the Outline - 2

Then:

• Brainstorm: List all the ideas that you want to include in your paper • Summarize the question(s)/problem(s) • List the key points/elements pertaining to the question(s)/problem(s) • Organize: Group related ideas together; place each key point/element in a

separate file • Order: Arrange material in subsections from general to specific or from abstract to

concrete • Make sure the organizing scheme is clear and well-structured • Identify the important details that contribute to each key point/element • Label: Create main and sub headings (IMRAD)• Note the sources pertaining to each detail

A Good Abstract

90% of readers read ONLY the abstractStructuredConcise (300-400 words, 10,000 characters)Keep odd abbreviations to a minimumShow some data Accuracy of data Beware of dataless abstracts

Conclusions

© 2014 American Medical Association Confidential and Privileged

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Importance: More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of heart failure among older persons, are overweight or obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality of life (QOL).

Objective: To determine whether caloric restriction (diet) or aerobic exercise training (exercise) improves exercise capacity and QOL in obese older patients with HFPEF.

Design, Setting, and Participants: Randomized, attention-controlled, 2 × 2 factorial trial conducted from February 2009 through November 2014 in an urban academic medical center. Of 577 initially screened participants, 100 older obese participants (mean [SD]: age, 67 years [5]; body mass index, 39.3 [5.6]) with chronic, stable HFPEF were enrolled (366 excluded by inclusion and exclusion criteria, 31 for other reasons, and 80 declined participation).

Interventions: Twenty weeks of diet, exercise, or both; attention control consisted of telephone calls every 2 weeks.

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Main Outcomes and Measures: Exercise capacity measured as peak oxygen consumption ( o2, V̇mL/kg/min; co–primary outcome) and QOL measured by the Minnesota Living with Heart Failure (MLHF) Questionnaire (score range: 0–105, higher scores indicate worse heart failure–related QOL; co–primary outcome).

Results: Of the 100 enrolled participants, 26 participants were randomized to exercise; 24 to diet; 25 to exercise + diet; 25 to control. Of these, 92 participants completed the trial. Exercise attendance was 84% (SD, 14%) and diet adherence was 99% (SD, 1%). By main effects analysis, peak

o2 was increased significantly by both interventions: exercise, 1.2 mL/kg body mass/min (95% CI, V̇0.7 to 1.7), P < .001; diet, 1.3 mL/kg body mass/min (95% CI, 0.8 to 1.8), P < .001. The combination of exercise + diet was additive (complementary) for peak o2 (joint effect, 2.5 mL/kg/min). There V̇was no statistically significant change in MLHF total score with exercise and with diet (main effect: exercise, −1 unit [95% CI, −8 to 5], P = .70; diet, −6 units [95% CI, −12 to 1], P = .08). The change in peak o2 was positively correlated with the change in percent lean body mass (r = 0.32; P = .003) V̇and the change in thigh muscle:intermuscular fat ratio (r = 0.27; P = .02). There were no study-related serious adverse events. Body weight decreased by 7% (7 kg [SD, 1]) in the diet group, 3% (4 kg [SD, 1]) in the exercise group, 10% (11 kg [SD, 1] in the exercise + diet group, and 1% (1 kg [SD, 1]) in the control group.

Conclusions and Relevance: Among obese older patients with clinically stable HFPEF, caloric restriction or aerobic exercise training increased peak o2, and the effects may be additive. Neither V̇intervention had a significant effect on quality of life as measured by the MLHF Questionnaire.

Dataless AbstractsResults: Mixed-modeling analyses were used to examine

differences in the rate of weight gain over time based on the extent to which children exhibited the ability to self-regulate in the behavioral procedures. Compared with children who showed high self-regulation in both behavioral protocols at ages 3 and 5 years, children who exhibited a compromised ability to self-regulate had the highest BMI z scores at each point and the most rapid gains in BMI z scores over the 9-year period. Effects of pubertal status were also noted for girls.


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Dataless Abstracts Results: Multivariate linear regression analyses showed that increased sugar-

sweetened beverage intake was independently associated with increased HOMA-IR, systolic blood pressure, waist circumference, and body mass index percentile for age and sex and decreased HDL cholesterol concentrations; alternatively, increased physical activity levels were independently associated with decreased HOMA-IR, low-density lipoprotein cholesterol concentrations, and triglyceride concentrations and increased high-density lipoprotein cholesterol concentrations. Furthermore, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing high-density lipoprotein cholesterol concentrations.


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A Good Introduction•Short•Focused•10-15 references•Can almost always be 25% shorter•Avoid criticizing others•Be explicit about your question and the GAP that it fills


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Good Introduction – This one is 195 words


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The use of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) reduces both low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events in patients with and those without cardiovascular disease.(1-4) Intensive statin therapy, as compared with moderate-dose statin therapy, incrementally lowers LDL cholesterol levels and rates of nonfatal cardiovascular events.(5-9) Because of the residual risk of recurrent cardiovascular events and safety concerns associated with high-dose statin therapy,(10) additional lipid-modifying therapies have been sought.(11-14)

Ezetimibe targets the Niemann–Pick C1–like 1 (NPC1L1) protein, thereby reducing absorption of cholesterol from the intestine.(15,16) When added to statins, ezetimibe reduces LDL cholesterol levels by an additional 23 to 24%, on average.(17,18) Polymorphisms affecting NPC1L1 are associated with both lower levels of LDL cholesterol and a lower risk of cardiovascular events.(19) Whether further lowering of LDL cholesterol levels achieved with the addition of ezetimibe to statin therapy leads to a benefit in clinical outcomes is unknown. The Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) evaluated the effect of ezetimibe combined with simvastatin, as compared with that of simvastatin alone, in stable patients who had had an acute coronary syndrome and whose LDL cholesterol values were within guideline recommendations.(20-24)

Introduction

• It is not enough to say: - We report here our experience with our first 50 (100, 500,

1000) patients with disease or condition X,Y, or Z. • Why do you feel your experience is worth reporting? • Relate it to some NEED that the reader will have.

- Even if you identify a gap in the literature, you need to make some statement that indicates that you are “addressing” this gap. Are there conflicting data? Has the problem not been studied in a certain sub-group of people?

- If you address a subgroup, need to ask yourself if this will be of interest to the audience of the journal that you choose.

Major Theme of PaperWhat are your 2-3 important points (that is remembered)Emphasize in results section of the abstractConclusion of the abstract should reflect these points Highlight in results section of paperEmphasize in tablesHighlight in first paragraph of conclusion


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What Do Reviewers Assess ImportanceClarityDesign and analysisShould review abstract, text, tables, figures, references,

acknowledgements/supportMake recommendation to editorOpinions of reviewers are not bindingUsually provide comments to authors and separate comments to

editors


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EditorsReview paperReview comments from peer-reviewMay request statistical helpMake recommendation to and participate in manuscript

review meeting Accept; accept with revision; reject with revision; reject; short report;

research letterDiscussed vis a vis importance and validity


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Responding to ReviewsAnswer completely, answer politely, answer with evidenceMost times the reviewer/editor are correctReviewers provided conflicting suggestions - ask editorYou do not have to respond to every issue, but must articulate

why notFollow directions – i.e. number responses, indicate changes in

manuscript and where they can be foundLong explanations to editor in cover letter is not the same as

modifying the text


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Polite Responses

• We agree with the referee that ---- but…• The referee is right to point out ---- yet…• Although we agree with the referee that…• We, too were disappointed by the low response rate.• We support the referee’s assertion that ---, although…• With all due respect to the reviewer, we believe that this point is not

correct.

Data not words are a better response


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Responding to ReviewsDear Dr. Moyer, We are pleased to resubmit the revision of our A/R - Manuscript 2010-3686, Management of Children with Sickle Cell Disease: A Comprehensive Review of the Evidence” for Pediatrics. We appreciate the valuable and detailed comments provided by the reviewers. In addition to the point-by-point responses, we have provided our responses to the items from the editors below. Please do not hesitate to contact us if you have additional suggestions on improving the paper. Thank you. I. Response to Editors: 1) Your revised paper should not exceed 2700 words (excluding the abstract, acknowledgments, references, tables, figures, and appendices). Response: The word count of this revised manuscript is 2699 words. Minor edits were made throughout this manuscript in order to address the reviewers’ comments. 2) Your main title in the Scholar One title box (see above) is different from your main title on the manuscript itself. They should be the same. Response: We apologize for this confusion. The title in the Title Box now matches the title on the Manuscript, “Management of Children with Sickle Cell Disease: A Comprehensive Review of the Evidence.”


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Prepare for possible rejection:

Even the best work can be misunderstood or under-appreciated…


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Dear God:

Thank you for submitting your paper about “Creating Life.” Your paper was reviewed by external editors and the consensus is that it will not be acceptable in its present form. We were quite concerned about your methodology. The main issue raised by the Reviewers were:

- How do we know Life would not have happened without you. You need better controls. The fact that you did it a few billion times since then does not matter. It was not randomized and might be subject to selection bias. Finally, we need more outcome data about your creation. What is Life supposed to achieve?

Please resubmit addressing all the reviewers concerns point by point. Given the extensive changes required, your paper will be treated as a new submission.

We look forward to seeing more high impact research from you.


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Authorship – ICMJE Requirements

• Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

• Drafting the work or revising it critically for important intellectual content; AND

• Final approval of the version to be published; AND • Agreement to be accountable for all aspects of

the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


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Spin and Boasting

• Exaggeration of Importance- “has reached alarming proportion,” drastic increase”

• Unfairly disparaging previous research- “crisis of credibility, ”methodologic flaws”

• Using words to convince, not illuminate- “these analyses provide clear answers," the robust

association”• Boasting - “findings open new frontiers,” “strong new evidence”


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Common Mistakes

• Circulating a draft before discussing authorship• Rushing the abstract at the end• Poorly referenced paper• Spelling errors in text and references• Data in abstract that are not in the paper• Data in abstract that are different from the paper• Bait and switch – emphasizing secondary rather than primary

outcomes


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Keys to Success

Clarity (abstract)Brevity (2500 words)Novelty (why this journal)Modesty (some)Read the journal (often)


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Getting Articles Published

Revise and revise – 10 draftsSenior colleagues are criticalNever send paper out without internal

review first


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How to Choose a Journal for Submission

•No fool-proof method•No standard approach•Discuss what people have used in the past

•JANE – journal finder tool

preparing a scientific manuscript philip greenland, md senior editor, jama (current)...

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