How to write the results of medical research

Step 1: you must develop your skills by reading

As with all skills the ability to write well can be learned. Some find it easy, others hard, but without doubt all can improve and develop their skills. As with all educational experiences there is a relationship between effort expended and rewards. A key ‘educational device' in the school of scientific writing is reading! Read much and widely! Read scientific papers in front rank journals and examine closely the style and approach of authors who have succeeded. Look at the structure and clarity of language. Observe the simple structure of sentences and paragraphs. See how the well-crafted paper is concise and to the point. Notice how good authors use simple language without verbosity and flowery, overly inflated statements. There is much to be gained from time spent reading!

Step 2: you have something to say

There are thousands of journals and perhaps hundreds of thousands of paper published every year. It is a sad fact that the majority of papers are not cited and it is likely that many are not read by more than a handful of people. This then begs the question as to when is something worth publishing? The key point here is ‘have something to say'! Only when you have a clear message should you begin to think about the publication process. Your message should be clear and it should be a significant addition to the literature. Consequently you need to have a good grasp of the relevant literature relating to your message, and also the techniques and methods you have used, their advantages and disadvantages, value and limitations, and the general background of the area.

Step 3:you must understand the structure of a scientific paper

The core structure of a research articles well established. Despite being criticized by some authorities [1] the basic structure was crystallized by Austin Bradford Hill

*2+ In the statement: “Why did you start, what did you do, what answer did you get and what does it mean anyway?” This of course relates to the general paradigm of Introduction, Materials and Methods, Results and Discussion (sometimes referred to as IMRAD). The Introduction should set the scene and in a concise manner define the general background to the subject of investigation. It should not be overly long and should be in proportion to the rest of the manuscript. A useful strategy is to end this section with the question (or hypothesis) that is being posed.

The Materials and Methods of any research paper should contain enough information for the reader to understand exactly what was done. This is crucial. It may be that to save

space extraneous detail might be placed in supplementary information that is only published online. This is now increasingly common but there still needs to be enough information in the paper to explain core methodologies, including patient groups.

The Results section should contain clear statements of all the core data and observations in a logical order. It should not contain interpretation nor materials and methods! Display items and tables should not replicate information provided in text. As with the Materials and Methods it is now common for additional data and results to be placed online and this is entirely appropriate. However, as with the Materials and Methods there should be full disclosure of the key results in the main body of the paper, again sufficient to allow the reader to understand the key data.

In the Discussion, the data should be placed in a broad context and appropriately discussed. It is common for authors to extend discussions into all sorts of tangential areas and to speculate wildly. In my view it is important to stay focused on the point of the paper. However, it should be said that it is good practice to mention and discuss potential problems and caveats of the studies reported and to consider (or at least mention) opposing or alternate views and hypotheses. A balanced paper will consider the field in the round.

A number of other elements are important in papers today. A conflict of interest (COI) statement is important. Conflicts of interest in themselves are not a bar to publication: not knowing about COI is however regrettable. A recent Commentary on this subject has been published [3]. Statements of author contribution are increasingly seen as an important part of good writing and publication practice. Both COPE[4] and the ICMJE [5] have guidelines on what constitutes authorship and a statement of contribution can be useful as this forces authors to think about who has done what and who really should be an author. Clear statements about ethical approval and governance issues should be documented with relevant reference numbers. Other information that needs to be carefully collated will include the affiliations and up to date contact details of all authors as well as sources of funding and relevant acknowledgements and thanks. It is rare for research to be undertaken by one person and the many contributions of others should always be appropriately acknowledged: a ‘thank you' goes a long way!

Step 4:Understand the simple rules of writing

In Step 1 we considered the value of reading widely. There are general rules of writing and George Orwell outlined

these [6]. Drawing from his ideas and those of Tim Albert [7] one can make a number of key points.

Never use a long word where a short one will do If it is possible to cut a word out, then cut it out Keep sentence constructions simple Avoid one-sentence paragraphs

Use simple punctuation

Over and above these rules you can use recommend two ‘tests' that assist in writing. First, the ‘tell it to a friend' test. Can you explain the points you are wishing to make in your paper in simple terms to a colleague or even to a relative who is not an expert? If you are able to do this your understanding of what you wish to convey is excellent. If you cannot then are you sure you have a full grasp of the field? Second, the ‘read it out loud' test. Having written your paper, and once you are very happy with it, take it to a quiet place. Perhaps in an empty room or an empty field. There slowly read it out loud to yourself! You will be amazed how something you have written and looks fine on paper, sounds awful when you read it out loud. The grammatical errors and poorly contrasted sentences will jump out as you speak them!

Finally it is important to get others to read you draft manuscripts. Do not rush to send manuscripts to journals. A few days extra with input and advice from others, from mentors and colleagues can be invaluable. If nothing else they may spot typographical errors and other small points that an author can become blind to after spending days or weeks crafting their magnum opus.

Step 5: How to decide where to send your paper

It is a simple fact that there exists a clear hierarchy of journals: there are those very high profile journals such as the New England Journal of Medicine, The Lancet, Cell, Nature and Science that command huge respect and in whose pages are often (but not invariably) carried research reports, reviews and other articles of major importance. Publishing in such high impact journals is the pinnacle of careers and inevitably few authors achieve this. There lie just below these a wide array of journals whose impact is only slightly less and also carry major impact articles. An important lesson it is to understand the spectrum of possible journals and the bibliometric measures that are used to create a hierarchy of them.

So then how does an author (and his colleagues) decide on where to send a manuscript? High impact journals will inevitably have more exposure and weight than low impact journals. But the Impact Factor is not the only variable to consider. Authors need to ask questions about the appropriateness (or fit) of their work with the journal. They need to read the aims and scope of the journal: does the proposed manuscript ‘fit' in the journal‘s area of coverage? Authors should look at copies of the journals that they are considering and see if they publish the kinds of work that the authors are going to report. Authors need to consider some other important issues such as the time a journal takes to undertake the review process. This can be gleaned from examining published papers and examining the dates of submission and acceptance. Some journals are quick: others notoriously slow. Even when a manuscript has been accepted there is an interval between acceptance and publication: what is this for the journals you are considering? Again there is great variation.

Where do authors make the biggest mistakes? Without question the biggest errors come from (1) manuscripts, figures and tables in the wrong file format (if it says a Word file do not send a PDF), (2) incorrect font and text formats (double spaced means double spaced, not single spaced; no line numbering means no line numbering etc), (3) incorrect format of references in the text or in the bibliography, and (4) incorrect resolution for figures and other display items. With regard to the latter sadly it is the case that many authors do not realize that what looks excellent on a computer screen (resolution 72 dpi) is wholly inadequate for publication purposes, where 300 dpi are often needed. Furthermore the dimensions of an image are important. Regularly one sees figures being submitted which are 300 dpi and seemingly fine, but they are perhaps only 10 by 5 mm: when expanded to fit a full column (86mm wide) or full page (176 mm wide) the resolution falls to unacceptable levels. It seems odd that authors invest considerable time in generating data but fall at the final hurdle when preparing their figures. Again attention to detail and the meticulous following of instructions to authors is crucial to success in publication.

The final group of issues relevant to decisions regarding publication relate to costs and the nature of access. Authors should consider the quality of printing and the quality of the journal website and its online versions. Authors should consider the costs involved: are their submission charges? Are there page charges? What is the cost of color figures? Does the journal charge for supplementary material online? Over and above this author should consider the pros and cons of open access journals thatare journals where the author pays a significant fee (typically in excess of $3000) to have the paper free to all via the Internet. All of these factors will influence the final choice of destination for your manuscript.

Conclusion

Your manuscript has been written and after careful proofreading and worrying about all the issue in the instructions to authors, you and your co-authors are happy. Today nearly all submissions are via some online manuscript handling system. Before you begin this process make sure you have an electronic folder with all the correct files present, in the correct file format and with sensible (preferably unique) file names. Calling you main manuscript file ‘manuscript.doc' is not smart since it is not unique. Use something in naming file that is unlikely to be confused, perhaps including the first author name, a key word, and maybe the date. KAZNMU_VEGF_Public Health_June_2012.doc, for example. Make sure you have the final version available of each relevant file, not draft versions. Make sure track changes and comments are turned off. As with Lesson 6, worry about the detail! Most journals will want the email and relevant other contact details of all authors, so have these to hand. Again such information will be found in the instructions to authors of any reputable journal. Some journals may ask for suggestions of reviewers. If so ensure you have some sensible suggestions to make and you can sometimes suggest reviewers that you do not want to be involved: I would suggest you indicate why you have non-preferred reviewers. When suggesting reviewers avoid colleagues in your own institution or those who have obvious conflict of interest.

 

REFERENCES

  1. Medawar PB. Anglo-Saxon attitudes. Encounter. - 1965. - 25:52-8.
  2. Bradford-Hill A. The reasons for writing. Br MedJ. - 1965. -ii:870-1.
  3. Hall PA, Poulsom R, Wixon J. How does The Journal of Pathology deal with conflict of interest? Journal of Pathology. - 2009. - 219(4):396-9. [PubMed]
  4. COPE Committee on Publication Ethics http:// publicationethics.org/ (accessed October 20th, 2010)
  5. ICJME International Committee of Medical Journal Editors http://www.icmje.org/ (accessed October 20th, 2010)
  6. Orwell G ‘Politics and the English Language' in Orwell G, Shooting an Elephant and other essays, 1950 Secker and Warburg. London
  7. Albert T. London: Wiley-Blackwell. - 2000. -A-Z of Medical Writing.
  8. Chew M, Villaneuva EV, van der Weyden MB. Life and times of the impact factor: retrospective analysis of trends for seven medical journals (1994-2005) and their Editors' views. JRoySocMed. - 207. -100. -P.142-150. [PMCfreearticle] [PubMed]
Year: 2013
City: Almaty
Category: Medicine