Writing, Publishing, and Reviewing Papers

Writing, Publishing, and Reviewing Papers
Howard Bauchner, MD Editor-in-Chief, JAMA and The JAMA Network Senior Vice President, AMA Professor of Pediatrics and Public Health Boston University School of Medicine

Talking Points JAMA Brief Biography Writing and Publishing
Peer-Review Process Other Issues © 2014 American Medical Association Confidential and Privileged

JAMA First published in 1883 General medical journal
Appears 48 times per year Occasional theme issues Flagship publication of AMA Editorial independence Importance of the brand

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330,000 subscribers 150,000 MDs read weekly content in CMJ 575,000 weekly eTOCs 900,000+ weekly online first alerts 105,000 registrants of TJN Reader 25M PDF/HTML downloads per year JAMA Pediatrics 3M PDF/HTML per year 20,000 MDs view content on Univadis weekly 1000 subscribers to daily (monthly hits ~9000) Social Networkers Twitter 125,000+ Facebook 190,000+ 18,000 listen weekly to EICs weekly podcast 2,000 listen to weekly author VP reading 5,000 listen to other podcasts Viewers 2,000 view our weekly author videos 20,000,000 see weekly JAMA report videos Learners 2,000 participate in weekly CME quizzes completed 2,600 readers responses to Clinical Challenge We touch ~ 1M physicians each week with our content © 2014 American Medical Association Confidential and Privileged

Archives of Dermatology Archives of Facial Plastic Surgery
JAMA Archives of Dermatology Archives of Facial Plastic Surgery Archives of General Psychiatry Archives of Internal Medicine Archives of Neurology Archives of Ophthalmology Archives of Otolaryngology—Head & Neck Surgery Archives of Pediatrics & Adolescent Medicine Archives of Surgery JAMA JAMA Dermatology JAMA Facial Plastic Surgery JAMA Psychiatry JAMA Internal Medicine JAMA Neurology JAMA Ophthalmology JAMA Otolaryngology—Head & Neck Surgery JAMA Pediatrics JAMA of Surgery © 2014 American Medical Association Confidential and Privileged

Brief Biography Training BUSM, BCH (BMC), Yale-New Haven
Pediatrician and Hospitalist Training in Epidemiology and Biostatistics Division Chief, Vice-Chair, Mentor Sabbatical at Packard Foundation and AHRQ Editor in Chief of ADC Editor in Chief of JAMA 2011- © 2014 American Medical Association Confidential and Privileged

Writing and Publishing
Theme and organization Abstract, introduction, methods, results, discussion Keys to success First draft and common mistakes Submitting your paper Responding to peer-review © 2014 American Medical Association Confidential and Privileged

Major Theme of Paper What are your 2-3 important points (that is remembered) Emphasize in results section of the abstract Conclusion of the abstract should reflect these points Highlight in results section of paper Emphasize in tables Highlight in first paragraph of conclusion © 2014 American Medical Association Confidential and Privileged

Structure of an Article
Introduction 2-3 paragraphs Brief words The frame for your study Invoke higher authority 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 © 2014 American Medical Association Confidential and Privileged

Follow the Instructions!
Article type – original, review, etc. Cover page – title, word count Length – critical issue (less is more) Abstract – single most important page Cover letter – concise statement of importance Speak with editor(s) first – although often generates a standard response © 2014 American Medical Association Confidential and Privileged

A Good Abstract 90% of us read ONLY the abstract Structured
Concise ( words, 10,000 characters) Keep odd abbreviations to a minimum Some data Accuracy of data Beware dataless abstracts Conclusions Best to have outside reader © 2014 American Medical Association Confidential and Privileged

Dataless Abstracts!!! Results 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. l 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. © 2014 American Medical Association Confidential and Privileged

Poor Abstract Purpose: To determine the prognostic value of early electroencephalograms (EEGs) in full-term neonates suffering from hypoxic ischemic encephalopathy (HIE) exposed to whole body hypothermia (cooled group), compared to neonates treated conventionally (control group). Design: This retrospective observational study included all full-term neonates born at Grenoble Hospital between 2000 and 2006 with symptoms of HIE. The first two EEGs were reviewed retrospectively and classified according to current electrophysiological criteria. EEGs in the cooled group were performed at a mean body temperature of 33°C. Neurological outcome was correlated with EEG pattern. Results: An EEG pattern of inactivity (stage 4) on the first EEG was associated with death in 60% of the control group, while all survivors had neurological sequelae. In the cooled group, this EEG pattern was only predictive of death in 40% and all survivors but one had a normal outcome. Mild abnormalities on the first EEG correlated with a good prognosis in both groups. The second EEG had a high predictive value, particularly in the cooled group. Persistence of stage 4 three days after birth was always associated with death. Implications: Early EEGs are good prognostic indicators of outcome in neonates with HIE. Stage 4 EEGs may not always indicate a poor prognosis in neonatal HIE treated with hypothermia. © 2014 American Medical Association Confidential and Privileged

A Good Introduction Short Focused Evoke higher authority
10-15 references Can be 25% shorter Criticize others with care © 2014 American Medical Association Confidential and Privileged

Good Introduction Artemisinins are established antimalarial agents with an excellent safety profile.1 Artemisinin-based combination therapies are now recommended by the World Health Organization (WHO) as first-line treatment of uncomplicated falciparum malaria in all areas in which malaria is endemic.2 Replacing ineffective, failing treatments (chloroquine and sulfadoxine–pyrimethamine) with artemisinin-based combination therapies has reduced the morbidity and mortality associated with malaria.3,4,5 Parenteral artesunate is replacing quinine for the treatment of severe malaria.6 Recently, there have been signs that the efficacy of artemisinin-based combination therapy and artesunate monotherapy have declined in western Cambodia.7,8,9,10 Artemisinin resistance would be disastrous for global malaria control. To characterize treatment responses to artemisinin derivatives and provide evidence for planning containment-measure strategies, WHO and the National Malaria Control Programmes of Cambodia and Thailand established a multipartite task force. The trials reported here were conducted as part of this initiative. © 2014 American Medical Association Confidential and Privileged

Methods Clarity and details Hypothesis and outcomes
Describe the study – who, what, where, when Measurement Use common methodological and statistical terms Understanding what happened to a single patient © 2014 American Medical Association Confidential and Privileged

Statistics Details Power and sample size
Describe all tests and assumptions Details on model building and assessment Describe uncommon statistics Treatment of missing data © 2014 American Medical Association Confidential and Privileged

Results Describe the sample Primary outcome Secondary outcome
Exploratory outcome Text vs Tables and Figures Supplemental Data © 2014 American Medical Association Confidential and Privileged

Discussion Very difficult to write Summarize key findings
Place results in greater context (other research, societal issues) Meaning of study Other issues Limitations © 2014 American Medical Association Confidential and Privileged

Keys to Success Clarity (abstract) Brevity (2500 words)
Novelty (why this journal) Modesty (some) Read the journal (often) © 2014 American Medical Association Confidential and Privileged

Your First Draft Just write! Do tables or abstract first
Circulate as a full paper Double space except for tables/references Do not list authors without talking with senior author Date all drafts, number pages Prompting your co-authors Get examples of similar papers © 2014 American Medical Association Confidential and Privileged

Oops! 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 © 2014 American Medical Association Confidential and Privileged

Common Mistakes (con’t)
Relative vs absolute differences Too many messages and comparisons Inconsistencies Lack of clarity Exaggeration of findings Methodological/statistical clarity © 2014 American Medical Association Confidential and Privileged

Submitting Paper Choosing Journal Suggesting Reviewers Cover Letter
© 2014 American Medical Association Confidential and Privileged

Is it the Correct Journal?
This is a critical issue for authors and journals Can be subjective decision by journal Beware of case-reports Is the topic timely Most journals can reject without review Review the journals you are considering Is it worth shooting high, but failing (impact factor) Must read journal prior to submission © 2014 American Medical Association Confidential and Privileged

Impact Factors* - 2013 AIM 16 (5266/327) BMJ 16 (9696/592)
Cell (24936/753) Health Affairs 4.3 (2277/527) JAMA (13735/452) JAMA-IM 13 (4093/309) JAMA-Neuro 7.0 (2558/365) JAMA-Peds 4.3 (1162/274) JAMA-Psych 14 (3423/249) Lancet (23093/589) Nature 42 (72420/1710) NEJM (38584/709) PLOS (3374/241) Science 31 (53605/1703) *No. of citations/no. substantive reports previous 2 years © 2014 American Medical Association Confidential and Privileged

Cover Letter Correct name and spelling of editor Short and Sweet
Why this journal Why is paper important Recommend (or not) specific reviewers © 2014 American Medical Association Confidential and Privileged

Peer-Review Processing of Manuscript Peer-Review
Rejection without Review © 2014 American Medical Association Confidential and Privileged

Manuscript Processing at JAMA
Triaging Editor (paper can be rejected) Associate Editor (paper can be rejected) Assigned to 2-5 Peer-Reviewers (paper can be rejected) Triaged to Manuscript Meeting (stats review mandatory) Rejected or Revised or ERBR Manuscript Returned to Author for Revision Returns to Manuscript Meeting ACCEPTED or REJECTED !!! © 2014 American Medical Association Confidential and Privileged

Rejection without Review
Usually editors/sometimes committee JAMA – Pediatrics (2014) 1142 original research reports 66% rejected without review Acceptance rate 9% JAMA – Neurology (2014) 1227 original research reports 81% rejected without review Acceptance rate 12% JAMA – Internal Medicine (2014) 1703 original research reports 87% rejected without review © 2014 American Medical Association Confidential and Privileged

JAMA – 2014 Key Data 4846 research submissions - ~4% accepted
66% rejected without review – within days ~1650 papers sent out for review - decision in 2-3 months ~ 220 papers revision requested ~ 85% accepted ~ 4% acceptance rate No delay from acceptance to publication Late-breakers - ~ 46 published in 2013 1500 VPs submitted - ~12% accepted 125 editorials solicited – vast majority accepted © 2014 American Medical Association Confidential and Privileged

Rejection without Review – Why?
Wrong journal – journals have specific missions Incorrect format (editors are sensitive beings) Data too old to be relevant Not new or novel Poorly written abstract Poorly designed/wrong analysis Sweeping conclusion Case-report You did not read the journal Editor having a bad day (this happens) !!! © 2014 American Medical Association Confidential and Privileged

Paper Accepted for Review
Assigned to editor (not EIC) Most editors have areas of expertise Editors may send article out for review (rejection without review can occur here) No magic number of reviewers – 2-5 At JAMA every research paper undergoes statistical review prior to manuscript meeting © 2014 American Medical Association Confidential and Privileged

Peer-Reviewers You can recommend reviewers to editor (and individuals not to review – plus/minus) Recommended reviewers rate paper the same as others, but more often recommend acceptance Chosen from “list” of reviewers that journal generally uses Some subject areas difficult to find reviewers – editors search reference list or Medline Process takes 1-3 months © 2014 American Medical Association Confidential and Privileged

Peer-Review Little science – a fair amount of research
Quality varies, best reviewers are 35 to 45 Time – 2-4 hours depends upon manuscript Not much difference between blinded and unblinded reviews Increasing concern about biases/conflicts of interest of reviewers Transparency being debated © 2014 American Medical Association Confidential and Privileged

What Do Reviewers Assess
Importance Clarity Design and analysis Should review abstract, text, tables, figures, references, acknowledgements/support Make recommendation to editor Opinions of reviewers are not binding Usually provide comments to authors and separate comments to editors © 2014 American Medical Association Confidential and Privileged

Editors Review paper Review comments from peer-review
May request statistical help Make recommendation to and participate in manuscript review meeting Accept; accept with revision; reject with revision; reject; short report; research letter Discussed vis a vis importance and validity © 2014 American Medical Association Confidential and Privileged

Responding to Reviews Answer completely, answer politely, answer with evidence Most times the reviewer/editor are correct Reviewers provided conflicting suggestions - ask editor You do not have to respond to every issue, but must articulate why not Follow directions – i.e. number responses, indicate changes in manuscript and where they can be found Long explanations to editor in cover letter is not the same as modifying the text © 2014 American Medical Association Confidential and Privileged

Responding to Comments
Dear Dr. Moyer, We are pleased to resubmit the revision of our A/R - Manuscript , 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.” © 2014 American Medical Association Confidential and Privileged

Data not words are a better response
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 © 2014 American Medical Association Confidential and Privileged

We look forward to seeing more high impact research from you.
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. © 2014 American Medical Association Confidential and Privileged

Other Issues Authorship Ethics Fabrication and Falsification
Plagiarism Duplicate publication Honorary authors Ghost authors Conflicts of interest Spin and boasting Common mistakes © 2014 American Medical Association Confidential and Privileged

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. © 2014 American Medical Association Confidential and Privileged

Ethics Always seek ethics committee approval
Researchers should never decide for themselves if IRB approval is necessary Quality improvement versus research © 2014 American Medical Association Confidential and Privileged

Fabrication and Falsification
Fabrication – making up data or results and recording or reporting them Falsification – manipulating research materials, equipment, or processes, or changing or omitting data or results such that the reach is not accurate represented in the research record © 2014 American Medical Association Confidential and Privileged

Plagiarism Definition: Types:
To steal and pass off (the ideas or words of another) as one's own To use (another's production) without crediting the source To commit literary theft To present as new and original an idea or product derived from an existing source. Types: Ghost author – author turns in another’s work, word-for-word Photocopy – writer copies significant portions of text straight from a single source Self-stealer – borrows generously from previous work (self-plagiarism) Forgotten Footnote – writer mentions user’s name, but neglects the reference Too-Perfect Paraphrase – writer properly sites source, but neglects quotation marks * last accessed March 20, 2011 © 2014 American Medical Association Confidential and Privileged

Duplicate Publication
Definition: is the publication of a paper that overlaps substantially with one already published. Both papers need not be identical to be considered a duplicate/redundant publication. Other terms that have been used include dual, divided, republication, fragmented, prior, repetitive, and salami slicing. It is especially inappropriate when an author does not notify the editors nor reference the similar/redundant work in the body of the submitted paper Types: Identical articles or articles with identical paragraphs Highly similar articles with similar data, patients, experiments Segmented articles where “salami slicing” produced several articles when one would have been appropriate Sequential research articles based on previously methodology with no new concepts Ask/Inform the editor – it is not worth it! last accessed March 20, 2011 © 2014 American Medical Association Confidential and Privileged

Honorary Authors Definition: individuals who are named as authors but have not met ICMJE authorship criteria Substantial contribution to conception and design, or acquisition of data, or analysis and interpretation of data; AND Drafting and revising it critically; AND Final approval of version submitted for publication 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. Approach: Authorship should be discussed at start of project Never circulate a draft with names without discussion © 2014 American Medical Association Confidential and Privileged

Ghost Authors Definition: individuals who have made a substantial contributions to the work reported in an article but are not named as authors Wislar et al (BMJ, 2011): queried 896 authors of research and review articles and editorials published in JAMA, AIM, Lancet, Nature Medicine, NEJM in 2008 630 responded (70.3%) 21% had honorary or ghost authorship or both 17.6% had honorary authorship 7.9% had ghost authorship © 2014 American Medical Association Confidential and Privileged

Conflicts of Interest “For an investigator, a conflict of interest exists when the prospect of some personal advantage is strong enough to pose a realistic possibility that he or she might compromise the researcher’s primary obligation to adhere to sound scientific procedures in an unbiased search for the truth.” Cohen J, Academic Medicine, 2001 “Conflicts of interest are ubiquitous and inevitable in academic life. The challenge for academic medicine is not to eradicate them, which is fanciful and would be inimical to public policy goals, but to recognize and manage them sensibly and effectively.” Korn D, JAMA, 2000 © 2014 American Medical Association Confidential and Privileged

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” © 2014 American Medical Association Confidential and Privileged

Getting Articles Published
Revise and revise – 10 drafts Senior colleagues are critical Good luck – it feels great!!! © 2014 American Medical Association Confidential and Privileged

Writing, Publishing, and Reviewing Papers

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