The First Words are the Hardest

Strategies for successful manuscript development

Gavin Leslie

Andrea Marshall

Why write for publication?

• To communicate information

• Expand the literature

• Contribute to nursing as a profession

• Intrinsic factors

Developing the paper

• The idea– Write about something you know– Consider

• What am I writing about?• Who am I writing for?• Why am I telling them this?

– Focus/slant– Timing

Developing the paper

• The writing team

• Who do you work with?

• Authorship guidelines– NHMRC– ICMJE

ICMJE author guidelines

1. Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data

2. Drafting the article or revising it critically for important intellectual content

3. Final approval of the version to be published

*Authors should meet conditions 1, 2 AND 3

Developing the paper

• Type of paper– Original research– Literature review

• Traditional• Systematic• Meta-analysis

– Case study– Book report– Letter to the editor

Developing the paper

• The journal– Impact factor– Publication lag– Accessibility– Review editions of the journal in

question• Scope of the journal• What do they publish?

– Author guidelines

Developing the paper

• Searching the literature– CINAHL– Medline/PubMed– Embase– Google Scholar– Reference lists

• Identifying key works – MeSH terms

Organising the manuscript

• Organising the literature– Bibliographic software

• Overall structure and flow of the paper

• Building your argument

• Leading to the “take home message”

“It has long been known ...”

I didn’t look I didn’t look up the up the original original referencereference

“Typical results are shown ...”

Understanding scientific writing

This is the This is the prettiest graphprettiest graph

“A definite trend is evident ...”

These data are These data are practically practically meaninglessmeaningless

“In my experience …” onceonce

“In case after case …”

Understanding scientific writing

twicetwice

“In a series of cases …”

thricethrice

Writing tips - language

• Sentence fragments

Enabling them to conduct the research in the ICU.

This enabled them to conduct the research in the ICU.

Preparing and Focussing Author Orientation

Allocating author prominence …Choice of style is influenced by:• the degree of importance

attached to the author (“guru”)• the conventions of the discipline• the conventions of the reference

style• for variety in writing

Preparing and Focussing “Strong” Author Orientation

• primary focus on what the

authors / researchers did or

said

• author takes prominent

position in the sentence

Preparing and Focussing “Strong” Author Orientation

Example:

Elliott (1997) stated that a comparison of previous ICU costing studies was problematic because of varying study methodologies.

Preparing and Focussing “Weak” Author Orientation

• information is still presented as the author doing it or writing about it

• author details are not placed in the grammatical structure of the sentence

• ‘someone has said this is fact’; or this is some controversy

Preparing and Focussing “Weak” Author Orientation

Example:A comparison of previous ICU costing studies was shown to be problematic because of varying study methodologies (Elliott, 1997).

Preparing and Focussing “No” Author Orientation

• information is presented as fact, with author details outside the grammatical structure of the sentence

Preparing and Focussing “No” Author Orientation

Example:A comparison of previous ICU costing studies was problematic because of varying study methodologies (Elliott, 1997).

Writing tips – Two-Part construction

They said they could complete the research, although they warned it would take some time.

OR

They said they could complete the research, they warned it would take some time.

Writing tips – Two-Part construction

1. Whereas obtaining spare parts for a new ventilator is much easier.

2. Whether they operate on the patient today or tomorrow.

Writing tips – relative pronouns

• Which study do you mean?

• Which she studied as well.

Writing tips – sentence structure

• Nurses need to provide a safe environment, this only occurs when the required knowledge, skills and attitudes are developed in individuals.

• Nurses need to provide a safe environment, however this only occurs when the required knowledge, skills and attitudes are developed in individuals.

Writing tips – subject verb agreement

• Verb must agree with its subject– The patients in this intensive

care unit are too critically ill to be moved.

– The installation of high speed internet access in the ICU has made finding resources much faster.

Writing tips - tenses

• First, decide whether you need to be writing in the past (recommended), present, or future

• Stay consistent within the sentence AND the document

Writing tips - apostrophes

• Contractions in academic writing

• Words ending with s, x, and z– Don’t use s’s– Do use x’s and z’s

Eats, shoots and leaves

Writing tips - punctuation

Writing tips – topic sentences

• Play three crucial roles– Introduces a controlling idea– Links the controlling idea clearly

to a preceding idea in the text– Orients the reader to the content

in the paragraph

Writing tips – structuring paragraphs

• How to control the ideas contained in the topic sentence

• Paragraphs can– Describe– Exemplify– Analyse– Challenge– Persuade– Use supporting evidence

Writing tips – writing persuasively

• Argue a case and present your case persuasively to support your position

• Descriptive – lists information without showing relationships. No interpretation

• Analytical – shows relationships between concepts but no position stated

• Persuasive analytical – shows relationships, states a position and argues it its support

Writing tips – writing cohesively

• A clear flow of ideas that enables the reader to move smoothly through your text

• Need to clearly connect ideas to those which precede and follow it

• Confused readers will give up

• Reviewers will reject!

Tables and figures

• Must be referred to in-text• Must be referred to prior to the in-text

reference• Must appear as soon as practically

possible and take less than a page in space

• Only discuss the relevant data in the table / figure. Its meant to tell a 1,000 words

• Often requested to be submitted at the end of the text or as separate files

Preparing and Focussing Summary Tables

• Initial review of papers

• Select column headers and develop table (sections or themes)

• Critique articles in sections or themes

• Questions / gaps identified in reading

Summary Tables

Paper method sample findings

Leslie et.al 1996.Anticoagulation… ICM.

RCT 22 circuits No benefitadding diluteheparinproximally inCVVHDF.

Baldwin et.al1998. Circuitmonitoring…KInt.

Retrospectivereview

77 circuits Noanticoagulantnecessary in27% ofcircuits.

Writing tips – introductions and conclusions

• Introduction – orients the reader to the scope of the paper. The reader should have a good idea what to expect and be compelled to continue reading. The last sentence should clearly convey the intent of the article.

• Conclusion – a summing up of the main points. It should concisely convey your overall view.

Getting Past the First Hurdle - Abstract Preparation

• Abstracts are critical– Used to determine acceptance /

rejection of presentations / posters

– Only published record– Often accessed more widely– Used by reader to judge value of

contents

Getting Past the First Hurdle - Abstract Preparation

• Abstract preparation -– Do the paper first– Then summarise the content– 4 part rule

• introduction (aim)• methods• results• Conclusions / recommendations

Abstract Preparation

• Introduction– 2 to 3 sentences which

summarise the background / rationale

– Links to the aim of the study project

– Ends with the aim of the study or project

– This maybe under a separate subheading

Abstract Preparation - Introduction

Enteral tubes are frequently used in the critically ill patient for feeding and gastric decompensation. Although enteral feeding is beneficial for intensive care unit (ICU) patients, as with most healthcare interventions, there are risks and potential adverse events associated with administration devices and nutrition delivery.

Nursing standards, policies and procedures have been established to facilitate the care of ICU patients with enteral feeding tubes and minimise the risk of complications. Many of these standards, policies and protocols have not been based on current research, but on ritual and opinion. Using a computerised literature search and an evidence-based classification system as described by the National Health and Medical Research Council (NHMRC), a comprehensive systematic review was undertaken of enteral tube management to guide the development of clinical guidelines policies and procedures.

Abstract Preparation - Introduction

Enteral tubes are frequently used in the critically ill patient for feeding and gastric decompensation. Although enteral feeding is beneficial for intensive care unit (ICU) patients, there are risks and potential adverse events associated with administration devices and nutrition delivery. Using a computerised literature search and an evidence-based classification system as described by the National Health and Medical Research Council (NHMRC), a systematic review was undertaken of enteral tube management to guide the development of clinical guidelines policies and procedures.

Abstract Preparation – Introduction (aim)

Enteral tubes are frequently used in the critically ill patient for feeding and gastric decompensation. Although enteral feeding is beneficial for intensive care unit (ICU) patients, there are risks and potential adverse events associated with administration devices and nutrition delivery. Using a computerised literature search and an evidence-based classification system as described by the National Health and Medical Research Council (NHMRC), a systematic review was undertaken of enteral tube management to guide the development of clinical guidelines policies and procedures.

Abstract Preparation – Methods

• Explains how the project was done.

Using a computerised literature search and an evidence-based classification system as described by the National Health and Medical Research Council (NHMRC), a comprehensive review was undertaken of enteral tube management.

Abstract Preparation – Methods

Using a computerised literature search and an evidence-based classification system as described by the National Health and Medical Research Council (NHMRC), a systematic review using the method described by the Cochrane Collaboration was undertaken of enteral tube management. An OVID search of Medline and CINHAL limited to 1983 and English using keywords, gastric tubes, nasogastric tubes, enteral tubes / feeding / placement was carried out. All reference list from relevant articles were cross checked.

Abstract Preparation – Results

• Report what has been found and any related statistical data/information.

• Keep it brief, limit to major findings.

Abstract Preparation – Results

Safety issues include verification of enteral tube positioning to minimise the risk of aspiration. The “gold standard” is an As compared to an abdominal x-ray. Bedside methods to verify enteral tube position have all been reported as unreliable indicators of placement and have been associated with an increased risk of aspiration.

Despite few randomised controlled trials being conducted into the management of gastric residual volumes, Although studies are limited, current research supports continuing of feeding if aspiration volumes are not excessive. Feeding is often withheld more than is necessary due to perceived excessive gastric residual volumes. Randomised trials support the use of prokinetics to aid in gastric emptying. The frequency of checking gastric residual volumes varies greatly and is based on opinion. Other supported practices findings included use of the semi recumbent position, maintaining adequate airway cuff pressure and minimising the contamination of feeds and equipment through meticulous handling, continuous rather than intermittent feeding and closed rather than open feeding systems.

Abstract Preparation – Results

Thirty nine articles were retrieved including 8 randomised control trials and 31 quasi experimental studies. Safety issues include enteral tube positioning to minimise the risk of aspiration. As compared to an abdominal x-ray. Bedside methods to verify enteral tube position have all been reported as unreliable indicators of placement. Although studies are limited, current research supports continuing of feeding if aspiration volumes are not excessive. The frequency of checking gastric residual volumes varies greatly and is based on opinion. Randomised trials support the use of prokinetics to aid in gastric emptying. Other supported practices included use of the semi recumbent position, maintaining adequate airway cuff pressure and minimising the contamination of feeds and equipment through meticulous handling, continuous rather than intermittent feeding and closed rather than open feeding systems.

Abstract Preparation – Conclusions / recommendations

• Short sentence or two pulling together main outcomes.

• Keep it focused on your findings, don’t get too carried away.

• Don’t say will be reported, will be discussed in greater depth, is covered in the article/paper.

Abstract Preparation – Conclusions / recommendations

• What is evident from conducting this review is that there is little high quality evidence to guide nursing. Further research is needed to ensure that patients receive the best care in the management of enteral tubes.

Abstract Preparation

• Follow the guidelines for authors -

• word count

• content guide

• abbreviations

• headings

• references

• key words

• font size and type

• photo ready preparation

• method of presentation -disc, word processing

• submission date• get an experienced

proof reading

Preparing and Focussing Referencing Formats

Most nursing journals use variations of two referencing styles:

• Author-Date - “Harvard” system

• Number - “Vancouver” system

format and punctuation may vary ...

check journal guidelines

Preparing and Focussing “Author-Date” Referencing

• References are identified in-text by surname of author(s) and publication year

• References are listed in alphabetical order

• Example Format: American Psychological Association (APA)

www.apa.org

Preparing and Focussing “Author-Date” Referencing:

ExamplesElliott, D. (1999). Measuring the health

outcomes of general ICU patients: a systematic review of methods and findings. Australian Critical Care 12:132-40.

Elliott, D., Burr G., Rose-Grippa K., Gorney-Moreno, M.J. (2000). Study guide to accompany nursing research (1st Australasian edition). Sydney: Harcourt Mosby.

Preparing and Focussing “Number” Referencing

• References are numbered in the order in which they appear in the text

• Indicated by bracketed or superscript numerals

• Example Format: “Uniform requirements for manuscripts submitted to biomedical journals” (Vancouver)

Preparing and Focussing “Number” Referencing: Examples

1. Elliott D. Measuring the health outcomes of general ICU patients: a systematic review of methods and findings. Aust Crit Care 1999;12:132-40.

2. Elliott D, Burr G, Rose-Grippa K, Gorney-Moreno MJ. Study guide to accompany nursing research (1st Australasian edition). Sydney: Harcourt Mosby, 2000.

Critical friends

• Finding someone to critically read– For content– With an eye for editing

• Who do you choose?

• Working with the feedback

The submission process

• Electronic submission

• EES

• Monitoring your manuscript’s progress

• Corresponding authors

Illustrations

• Original work

• Reproducing from another published work

• Technical drawings

• Photographs– Pt consent

Practical tips

• Managing the information– Hard copy– Electronic copy

• Version control

• Referencing software