the inside view on writing for medical journals ppt
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The inside view on writing for medical
journals
Richard Smith
Editor, BMJ
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What I might talk about
Why publish?
What do editors want?
The basics of writing a paper The rudiments of style
Peer review processes
Authorship/contributorship
Conflict of interest
Redundant publication
Good practice in publishing
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Why publish?
Because you have something important to say
To change practice
To promote thought or debate
To allow examination of your work
Fame and the love of beautiful women
Money
Career advancement
To entertain/divert/amuse
To educate
To console
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What do editors want?
Excitement/ wow
Importance
Originality
Relevance to the audience
True Clearly written
Engagingly written
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Utility of information
Utility=relevance x validity x interactivity
work to access
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The basics of writing a paper
1. Before you begin
What do I have to say?
Is it worth saying?
What is the right format for the message?
What is the audience for the message? Where should I publish the message?
How can I best use paper and the web?
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The basics of writing a paper
2. The importance of structure
Structure is everything.
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The basics of writing a paper
3. Possible structures Beginning, middle, end (AA beginning, a muddle, and an
end.@ Philip Larkin)
Tell people what you are going to say, say it, tell them
what you=ve said
Rudyard Kipling: (AI keep six honest serving me, (Theytaught me all I knew), Their names are What and Why and
When, And How and Where and Who?)
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The basics of writing a paper
3. Possible structures continued News story: (Story in the title; story in the first line;
expand slightly on the story in the first paragraph; give the
evidence for the story; give the counter view)
ImraD (Introduction, methods, results, and discussion)
Stream of consciousness
Chronology: diary, autobiography
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The basics of writing a paper
3. Possible structures continued
A list
Something very formal: for example, sonnet, limerick,
haiku
Ulysses
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The basics of writing a paper
4. Still structure
Make sure that readers knowwhere they are, where they are
going, and why.
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The basics of writing a paper
5. IMRaD Introduction--Why did I do it?
Methods--What did I do?
Results--What did I find? Discussion-- What might it mean? What is our overall
finding? What are the strengths and weaknesses of the
study in relation to other studies? Why might we have got
different results? What might the study mean, particularly
for clinicians or policy makers? What questions remain
unanswered and what next?
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The basics of writing a paper
5. IMRaD (Introduction) Why did we start?
What has gone before - ? A systematic review
Why was this study needed?
Be sure that readers understand the importance of
the study-but don=t overdo it short
Don=t try to show readers that you have read
everything
Short, short, short
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The basics of writing a paper
5. IMRaD (Methods) Like a recipe
For informed readers this is the most important section
Describe how subjects were selected and excluded Don=t describe standard methods in detail - use references
Statistics
Ethics
Remember that you can put more detailed methods on theweb--for example, questionnaire
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The basics of writing a paper
5. IMRaD (Results) Stick to what is relevant
Be sure to include basic descriptive data
The text should tell the story
The tables give the evidence
The figures illustrate the highlights
Don=t include just percentages or p values
Include confidence intervals
Think about absolute risk, number needed to treat, etc
Avoid beginning to discuss the implications or strengths and
weaknesses of your study
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The basics of writing a paper
5. IMRaD (Discussion)
Statement of principal findings
Strengths and weaknesses of the study Strengths and weaknesses in relation to other studies,
discussing particularly any differences in results
Meaning of the study: possible mechanisms and
implications for clinicians or policymakers Unanswered questions and future research
Go easy on the last two
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The basics of writing a paper
6. Topping and tailing Title: Include design; Don=t try to be clever
Abstract: Must be structured; Include some
numbers, not all
References: Keep to the essentials
Covering letter: Something very crisp
Authorship, acknowledgements,
competing interests
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The rudiments of style
George Orwell: AGood prose is like a window
pane.@
Somerset Maugham:ATo write well is as hard as
to be good.@
Jonathan Swift: AProper words in proper places
make the true definition of style.@
Matthew Arnold: AHave something to say and
say it as clearly as you can. That is the essence of
style.@
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The rudiments of style I
Short words
Short sentences
Short paragraphs
No jargon
No abbreviations
Prefer Anglo Saxon over the Latin Prefer nouns and verbs to adjectives and adverbs
Cut all cliches
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The rudiments of style II
Avoid figures of speech and idioms
Prefer active to passive
Prefer the concrete to the abstract
Avoid the Anot unblack cat crossed the not
unwide road@
Don=t hector
Be unstuffy
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The rudiments of style III
Don=t be too chatty
Don=t be pleased with yourself
Be careful with slang
Use the scalpel not the sword
AToo many notes, Mozart.@
Add a dash of colour, just a dash
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Peer review processes
As many processes as journals or grant giving
bodies
No operational definition--usually impliesexternal review
Was largely unstudied
Benefits come from improving what ispublished rather than sorting the wheat from
the chaff
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Problems with peer review
A lottery
A black box
Ineffective
Slow
Expensive
Biased Easily abused
Cant detect fraud
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Peer review processes
Stand at the top of the stairs with a pile of
papers and throw them down the stairs.
Those that reach the bottom are published.
Sort the papers into two piles: those to be
published and those to be rejected. Thenswap them over.
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BMJ peer review process I
6000 papers
1000 rejected by one editor: unoriginal, too specialist,
so what, invalid, incomprehensible (standardrejection list)
2500 rejected by two editors
2500 sent to one reviewer, who is revealed to the
authors Discussed at minihang
1000 rejected by reviewer and editors
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BMJ peer review process II
200 accepted as short reports after approval
by statistician
1500 to one of three hanging committees
A hanging committee comprises two
practitioners/researchers, one statistician,
and one editor
300 accepted, almost always after revision
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BMJ peer review process III
Always willing to consider first appeals--
but must revise the paper, refute criticisms,not just say the subject is important
Perhaps 20% accepted on appeal
No second appeals; always ends in tears;
plenty of other journals
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Authorship/contributorship
Who is an author? I
A totally blind haphazard study of the effect of being a Mason on
promotion within medicine
A. Professor Sir Joshua Fulloftosh, president of the university.Raised the grant, got permission for the study from the Masons
B. Professor Michael Halfpenny, British American Tobacco
professor in the joint department of respiratory, Masonic, and
imaginary studies. Suggested the idea for the trial before departing fora six month sabbatical in the Seychelles and handled the
postpublication media coverage by satellite
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Authorship/contributorship
Who is an author? II
C. Dr Alec Fedup, senior lecturer in the department of Masonic
studies. Drew up the protocol, wrote the grant proposal, and then died
in mysterious circumstances.
D. Sir Bloated Corpulent, visiting consultant. Allowed his staff to be
entered haphazardly into the study
E. Dr Alice Holditalltogether, senior registrar. Ran the study,
collected the data and sent them to the statistician, arranged for thewriting up of the study, and negotiated with the editors
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Authorship/contributorship
Who is an author? III
F. Polly Paired-T-Test, statistician. Did all the analysis, prepared the
tables
G. Pamela Poltergeist, editorial adviser to the Masons. Wrote thepaper
E. Professor Avaricious Loadsapesetas, director of the Acapulco
Institute of International Masonic and Financial Studies. Allowed his
name to be added to the paper in exchange for a lucrative consultancy.Unfortunately didn=t have time to read the paper.
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Criteria for authorship of the International
Committee of Medical Journal Editors
Authorship should be based only on a substantial
contribution to:
i Conception and design or analysis and
interpretation of data and
ii Drafting the article or revising it critically for
important intellectual content and
iii Final approval of the version to be published.
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Why does authorship matter? I
Authorship is about credit and responsibility
Academic life revolves around publication - credit
comes from publishing, which implies being anauthor
Publication brings Afame and the love of beautiful
women@
Research evaluation is based on publication
Grants depend on/demand publication
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Why does authorship matter? II
In some parts of medicine you need publications
to get a job You may have a disease named after you - for
example, Crohn=s disease
Authorship means you are accountable; who is the
author of a fraudulent paper?
Authors can be sued for libel
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What are the problems with
authorship? The two basic problems of credit and
accountability
Many authors on papers have done little - do notmeet ICMJE criteria
Gift authorship
People don=t know about the criteria of authorship
People think that the definition is unworkable
People are left off papers
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Options for responding to the
problems of authorship
Status quo
Loosen up the criteria
Enforce the ICMJE criteria more strictly
Tweak the ICMJE criteria - for instance, allow statisticians
to be included
Other ideas--for example, limits on numbers of authors Abandon the idea of authorship - go for film credits,
contributors with a guarantor
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Competing interest
What is conflict of interest?
A person has a conflict of interest when he
or she has an attribute that is invisible to the
reader or editor but which may affect his or
her judgement.
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Competing interest
Why does it matter?
Because it may have a profound effect on
somebody=s judgement.
Because of the perception that a person=s
judgement may be affected--whether it is or
not
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Competing interest: evidence that
it mattersViews of authors with financial relationships with the
pharmaceutical industry on whether calcium-channel
antagonists are safe
Manufacturer Supportive
N = 24
Neutral
N=15
Critical
N=30
P value
for trend
Calcium channel
antagonist
96 60 37
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How should we manage conflict of
interest?
Ignore it--unaceptable
Avoidance - hard
Disclosure - to the editor, author, or reader?
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Problems with conflict of interest
Should it be just financial or personal, academic, political,
religious, anything?
People don=t declare it because a) it implies wickedness; b)
they are confident that their judgement is not affected
Might we avoid these problems by changing Aconflict of
interest@ to Arelevant@ or Acompeting@ interests?
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The best policy on competing
interest
Always declare a conflict of interest,
particularly one that would embarrass you if
it came out afterwards
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Redundant publication I
Happens commonly--perhaps 20% of
studies
Negative studies are often not published;positive studies are more likely be
published more than once
Distorts what the evidence says
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Redundant publication II
There is lots of room for arguing over the
degree of overlap and whats legitimate
Disclosure is the key
Always send copies of overlapping papers
and reference them
The problem is not the publication but thelack of disclosure
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Good publication practice
Read Guidelines on good publication
practice from the Committee on
Publication Ethics (COPE)
Available free at www.publication
ethics.org.uk
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COPE guidelines on good publication
practice cover
Study design and ethical approval
Data analysis
Authorship
Conflicts of interest Peer review
Redundant publication
Plagiarism
Duties of editors
Media relations
Advertising
Dealing with misconduct, including sanctions
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Last advice
Disclosure is almost a panacea.
John Bailar, professor of statistics, University of Chicago