Transcript Slide 1

Pediatric Subspecialty Fellows’
Manuscript Writing Workshop
Mary Anne Jackson, MD
Christopher Harrison, MD
January 20, 2011
Goals and objectives
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To evaluate types and forums for scientific
publication
To review authorship criteria with discussion of
ethical principles
To outline the process and expectations of most
journals
To discuss the reasons that manuscripts fail to be
published
To establish principles for increasing the likelihood
of publication
Outline
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MAJ
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Why write?
Types of publication
Authorship criteria
Journal selection
 Impact factor
The basics: includes interactive writing
Principles to improve likelihood of acceptance
CJH
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Realistically building a timeline
Using reference manager or endnotes/citation manager
Interactive submission to electronic website
Why We Write
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Michelle Biros, MS, MD; Editor-in –Chief
Academic Emergency Medicine
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To disseminate information
To share ideas, discoveries, and perspectives to a
broader audience
Job security, requirements
Personal satisfaction, prestige
Research completion
To develop a fundable track record
“Meaningful Accomplishment of Research”
the ABP requirements
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Participation in a core curriculum in scholarly activities
Engagement in hypothesis driven projects or in
projects “of substantive scholarly exploration and
analysis that require critical thinking”
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Basic, clinical, or translational biomedicine
Health services
Quality improvement
Bioethics
Education
Public policy
https://www.abp.org/abpwebsite/certinfo/subspec/eligibil/gencrit.htm
“Work products”
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A peer-reviewed publication in which a fellow played
a substantial role
An in-depth manuscript describing a completed
project
A thesis or dissertation written during pursuit of an
advanced degree
An extramural grant application either accepted or
favorably reviewed
A progress report for projects of exceptional
complexity, such as a multi-year clinical trial
Manuscripts may include
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Reports of original data-the backbone
Review articles
Descriptive articles-less rigor, unique
observations
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Case reports, special articles, special
communications
Consensus statements and CPG
Articles of opinion
Correspondence
Reviews of books, journals, other media
BEFORE WRITING
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Decide on journal
Decide on authorship
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Who deals with revisions and interaction with
journal editor
Know manuscript requirements of the journaland follow to the “T”
How do I know if it is publishable?
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Development of testable idea
First note of new phenomena
Critical interpretation of review/assembled data
Development of study design, methodology, data
collection and interpretation
Writing of first draft or critically important revision
Ability to justify the conclusions of the paper
JAMA Authorship Responsibility,
Criteria, and Contributions
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Involved in
 conception and design
 acquisition of data analysis
 interpretation of data
Participated in
 drafting of the manuscript
 critical revision of the manuscript for important intellectual content
One of the following:
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statistical analysis
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obtaining funding
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administrative, technical, or material support
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supervision
http://www.icmje.org/ethical_1author.html
Authorship is not defined by
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An administrative relationship, acquisition of
funding, collection of data, or general
supervision of a research group
Avoid guest, gift or ghost authors….
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Guest authorship
 Out of appreciation or respect for an individual
 Or in the belief that expert guest will increase the likelihood of
publication
Gift authorship
 Offered from a sense of obligation, tribute, or dependence
Ghost authorship
 Failure to identify as an author, or anyone who made substantial
contributions to the research or writing of a manuscript
 Could be an unnamed individual who participated in writing the
manuscript
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Ghost authorship includes authors for hire with the
understanding that they will not be credited, to major
contributors not named as an auth
Different from ghost writers (increasingly common) or
AMA Manual of Style pg 131-132
First Draft Basics
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Prepare outline
Identify how you want to indicate citations
and make it easy and quick
Identify each draft so you can access
electronically easily (animal bites maj rev 2
dec 2010)
Scientific Prose
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Fluent
Clear
Accurate
Concise (no more words than needed)
“With grace” (humane terms, standard formal
language-no jargon)
AMA Manual of Style pg 408
Title
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Read the 'Table of contents' of several issues of the
journal you have chosen to get a feel for their style
of titles
Make up a couple of possible titles
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Examples from AMA Manual of Style
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ask for feedback from those who know the journal
Use of Gastric Acid-Suppressive Agents and Risk of
Community Acquired Clostridium difficile-Associated
Disease
Gastric Acid-Suppressive Agents and the Risk of
Community-Acquired Clostridium difficile-Associated
Disease
Exercise #1-to reformulate titles
Formulate 2 titles for each study
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Literature review of clinical studies on
prevalence and manifestations of migraine in
children focusing on comorbidities
National Electronic Injury Surveillance
System of USCPSC to look at 43,562 car
seat-related injuries that occurred in infants
outside of the car.
Pediatrics August 2010
Writing Basics
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Pitfalls
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Indistinct or absent core message
Weak or missing action words
Redundancy in sentence structure
Medical style and format: an international
manual for authors, editors and publishers
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Exercise #2 to revise a case presentation
Consent
 Avoid “superfluous details”
 Degree of specificity depends on importance to case
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Abstract
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Summarizes how you carried out your research and
what you learned
A structured abstract includes Objective, Design,
Sample/setting/interventions, Main outcome
measures, Results, and Conclusion
Mistakes to avoid
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Don't go beyond what is established in your paper: offer no
nonsignificant results, no speculation.
Don't omit articles and other parts of speech to achieve
brevity
Don't go over the abstract size limit set by the journal
Structured Abstract
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First sentence explains the importance of the study question
Objective “to determine whether”
Study design include years and f/u duration
Setting
 General community, primary care or referral center, private or
institution, ambulatory vs hospital care
Patients/participants include clinical disorders, eligibility, key
demographics
 Random sample vs population-based, referred sample,
consecutive sample, volunteer sample, convenience sample
Interventions
Main outcome measure(s)
Primary results
Principal conclusions
Trial registration (name, number and URL)
Many journals ask for keywords
Getting started: The introduction
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Think of the funnel
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What is known
What is unknown
State the study question
Outline experimental approach
Methods
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Describe your study site
Describe your study population (source, inclusion,
and exclusion criteria)
Describe your recruitment methods in detail
Describe your intervention (if an interventional
study)
Describe the data that you collected and how you
collected them
Describe your data analysis in detail (dependent
variables, independent variables, comparisons,
primary and secondary analyses, statistical methods
used, P value accepted as significant)
Results
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Write this section first
Describe your subjects: numbers approached,
enrolled, excluded, characteristics
Don’t repeat table data -- describe the table data in
qualitative terms, where possible
Describe main analysis results
Describe secondary analysis results
Be ready to drop a result which colleagues or
reviewers suggest is unimportant, even “though it
seems like a wondrous and magical thing to you”
Visual presentation of material
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Text
Tables-examples from Manual of Style
Figures
 Line graphs
 Survival plots
 Scatterplots
 Histograms and frequency polygons
 Bar graphs
 Pie chart
 Dot graph
 Diagrams
 Flow chart
 Decision tree
 Other: algorithm, pedigree, map, illustrations,
photographs/images
Consent for identifiable patients
Jargon
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Unintelligible to other scientists
Not translatable
“the mark of the careless and uncultured
person” Morris Fishbein, MD
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Words and phrases. In : Fishbein M. Medical
Writing: The Technic and the Art. Chicago, IL:
American Medical Association; 1938: 46.
Exercise 3:Re-write
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A 2 year old patient was admitted to the floor
for epiglottitis, arrested and was coded for 25
minutes. He was bolused with steroids, got
IV ampi, he was tubed and bagged prior to
being scoped by ENT. Lack of knowledge
regarding patient care for the kid and failure
to follow the CPG led to a bad outcome.
Exercise 4:Re-write
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A 16 year old presented with severe anemia with a
low BP. This sickler’s parents reported he went
ballistic after a disagreement with them, and blew off
his last period at school because he wanted to catch
the pm showing of “Inception”. After he became
angry, they thought he might have taken some
meds of unknown type and he was later found to be
somnolent. His exam at admit showed pinpoint
pupils but was otherwise normal except BP was
mildly low and he was tachycardic. Initial labs
showed a low crit of 21 and no evidence of reticking.
Statistical Analysis
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Usually independent; by author, institution
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Independent statistical reviwe of the data was
performed by Stuart Pocock, PhD, and Duolao
Wang, of the London School of Hygiene and
Tropical Medicine
If industry sponsored, journals like JAMA
require independent oversight
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All study data was transferred from Sanofi-Aventis
to the Department of Pediatrics at Children’s
Mercy Hospital for independent analysis by
Christopher Harrison, MD.
Discussion: usually 2-3 take home points
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Start with the most important take-home point
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Tackle the second most important take-home point and
discuss it and so on
List and discuss the study's limitations
Write down your conclusions
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What do you want the reader to remember?
Do not merely repeat the results
Provide commentary based on prior relevant studies
Use of headings when permissible by journal
usually a repeat of take-home point #1
Give future directions/speculation
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often the next study you want to do
Limitations paragraph:
mistakes to avoid
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“Don't be ingratiating”
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don't apologize
don't promise to avoid these mistakes in the future
don't offer excuses
http://www.parint.org/isajewebsite/bookimages/isaje_2nd_edition_chapter5.pdf
Expectations once your manuscript is
complete
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All authors have reviewed
Submission letter is formulated
Last review of manuscript with illustrations,
figures, tables
Copyright form filled out
Permission for images
Acknowledgments
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Individuals who may have made some
contribution to a publication, but who do not
meet the criteria for authorship
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staff, editorial assistants, medical writers, or other
individuals
list in an acknowledgement and/or contributorship
section of the work
Funding/support required: clear and complete.
Include grant or contract numbers where applicable
JAMA Acknowledgment Statement
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The corresponding author signature requirement
 I certify that all persons who have made substantial contributions
to the work reported in this manuscript (eg, data collection,
analysis, or writing or editing assistance) but who do not fulfill the
authorship criteria are named with their specific contributions in
an Acknowledgment in the manuscript
 I certify that all persons named in the Acknowledgment have
provided me with written permission to be named
 I certify that if an Acknowledgment section is not included, no
other persons have made substantial contributions to this
manuscript
The Cover Letter
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Title
For publication in what particular journal
listing (eg brief observations vs original
research)
State why it is of interest to readers
Include the correspondence info
Samples distributed
Principles to Increase Likelihood of
Manuscript Publication
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Organize
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Concise discussion
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Study question and rationale
Systematic explanation of methods/design
Why your findings are important
Avoid overinterpretation
Explain limitations
Incorporate fully reviewers’ comments
James M. Provenzale, MD; Duke University AJR 2007; 188:1179-1182
What will result in manuscript rejection?
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Incomplete Reporting
 Enough information to allow others to reproduce their work
Improper Use of Statistics
 May lead the reader to conclude there is a meaningful difference, or
no difference, when in fact the opposite may be true
 Knowingly, or intentionally skewing statistics is research misconduct
Selective Reporting
 Ignoring evidence that is contrary to your findings
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It is unethical: never omit or inaccurately represent relevant literature,
methodology, data, and/or results from their manuscripts
Unnecessarily splitting data into multiple publications
 Generally discouraged
 Wastes resources, falsely creates the impression of greater
productivity
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minimizes the scientific contribution of the work
Journal reviewer functions
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Consider who will review
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Make sure you include their publications in your references
Check with your senior author re: suggestions
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To judge whether the manuscript merits publication
(usually after revisions) by providing a global
rating—
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Who are the “good guys”? (CJH)
“Accept,” “Accept Pending Revisions,” “Reconsider After
Major Revisions,” or “Reject.”
To provide constructive criticisms for the authors
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regardless of whether the manuscript is deemed acceptable for eventual
publication
Addressing reviewers’ comments
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After your BP comes down (CJH)
Be nice
Be complete
“Pick your battles”
Summarize
The Timeline
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First Corollary of Timelines
 Everything takes longer than it does.
Rules of the Timeline
 Be firm but flexible with yourself and co-authors
 Have initial planning meeting to discuss with contributors
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Who does what?
Set realistic goals.
Weekly contact with each co-author
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Progress to date with each person’s assignment
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Problems to date
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Remind and encourage
Need for discussions among co-authors?
Summary to all of overall progress and issues
Consider re-assignments if contributor repeatedly missing goals
Timeline 1
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Decide on journal
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Remember the Instructions to Authors
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Confirm authorship and positions
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Role: First author writes first draft
But….. OK to assign portions to co-authors
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That’s your new best friend
May actually be essential
e.g. stats or technical methods section
Did you have a poster or verbal presentation?
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Use as starting point
The Results Have it
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Lay out tables and figures
Confirm statistical analysis
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Is it clinically important?
5 point difference in CSF protein
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Develop text in Results section
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May be statistically significant
But is not clinically significant
From Tables and Figures
Develop Discussion from Results section
Recheck references
Expect 2 Months on Average
Poster or slide presentation
Introduction
Existing
Product
Methods
Planning Results
meeting Section
References I
Discussion
Main Story
Re-check
Special
Data
Assignments
References II
Essential
Components
1st Draft
Outside
Review
Submit
2nd Draft 3rd Draft
Circulate to co-authors
and integrate suggestions