How To Write A Manuscript (2008)

Guillermo Umpierrez, M.D.Professor of Medicine

Division of EndocrinologyEmory University School of Medicine

How do you write a scientific manuscript?

Consultants

Number of consultants 8

Years in practice 26 (11 - 50)

Clinical/basic research Clinical: 7, basic: 1, both: 2

Number of publications 316 (41 – 1300)

Number of peer-review papers 104 (41 – 250)

What do medical scientist write?

• Scientific abstracts

• Research papers (original investigation)

• Reviews

• Textbook chapters

Before You Write

• Effective writing has more to do with logical thinking than with “style”

• “ . . . the preparation of a scientific paper has less to do with literary skill than with organization. A scientific paper is not literature.”

• A paper with good data almost writes itself

– The most important part of the manuscript begins with planning the project.

“Instructions to authors”

• Read instructions before you start writing!

• All journals have a house style• Length of abstract and document• Figures and Tables• Reference format

The BMJ insists all papers are written in (active) first person

– I demonstrated that….

Choosing a Target Journal

Consider:• Citation databases: Medline (Pubmed), Web of

Science

• Favor journals with rapid publication

• Impact factor:• NEJM (51.29), Nature (30.98), Science

(29.78), Annals of Inter Med (14.8), Circulation (12.563)

– Diabetes Care (7.851) ranked 4th out of 92 journals in the field of endocrinology/metabolism IF = average number of times articles from the journal published in the past two years have been cited

in the journal citation report year. IF = 1.0 means that, on average, the articles published one or two year ago have been cited one time

Authorship

• Who should be an author?• Uniform requirements for publication in

biomedical journals (www.icmje.org)

Authorship qualifications (1 – 2 – 3)

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

Manuscript Structure

• Title • Abstract• Introduction• Research Design and Methods• Results• Discussion• References• Acknowledgments

Title

• Does your title summarize the main point of your paper?

• Be concise (100 characters)

• Avoid:

• Too scholarly or too “cute” title subtitles

• Acronyms*

• Abbreviations* Word form from the initials letters of other words (NATO)

Abstract

• Summary of Manuscript (200-300 Words)

• Background and purpose of research

• Methods

• Results

• Conclusion

Abstract Background statement:

• 1-2 sentences define the fundamental question being addressed in the study

Material and Methods:

• short and to the point!

Results:

• describe major points

• results in the abstract has to be consistent with the information in the rest of the paper

Conclusions:

• the conclusion must relate to the fundamental question

Introduction

• Keep it brief (1–2 pages)

• Brief background information• Need for study

• Summary of problem (selling point)• Make the gap obvious

• State the fundamental question

• Use the present tense

• Use the past tense for previous findings

The “Fundamental” Question

“Few clinical trials have focused on the optimal management of inpatient hyperglycemia in the non-critical setting. Accordingly, we conducted this prospective, randomized study to compare the efficacy and safety of a basal/bolus insulin regimen to SSI in patients with T2DM admitted to general medicine wards.”

Umpierrez et al, Diabetes Care 30:2181–2186, 2007

Material and Methods

How was the problem studied?

• Subjects• Sample preparation techniques• Sample origins• Field site description• Data collection protocol• Data analysis techniques• Any computer programs used• Description of equipment and its use

Give full details of the protocol/procedures

Include a clear statement of study design:“The Rabbit study was a randomized, open labelstudy … designed to compare the efficacy and safety of …”

Include a statement about IRB approval, informed consent, or compliance with animal welfare regulations:

“The protocol was approved by the institutional review board, and all patients gave informed consent …”

Material and Methods

– State primary and secondary outcomes:• “The primary end-point was to determine differences

in glycemic control as measured by mean daily blood glucose concentration between treatment groups. Secondary outcomes…”

– Write in a logical order • usually chronological

– Describe analytical methods

Material and Methods

68 subjects with DKA

IV Glulisine insulin therapyuntil resolution of DKA

Transition to SC glargine once daily and glulisine before meals

Insulin Analogs(n= 34)

Human Insulin(n= 34)

IV regular insulin therapyuntil resolution of DKA

Transition to SC NPH and regular insulin twice daily

Insulin Analogs versus Human Insulin in the Treatment of Patients with DKA

Umpierrez et at, Diabetes Care 30:1699-1703, 2003

Study Protocol

Results

• Logically answer the research question• Correlate with the methods• Use data from this study only (exact P values,

confidence intervals)• Present all the representative data• Use tables, graphs, photographs for data

Supplement rather than repeat data in visuals and tables

Tables

• Should stand alone for comprehension

• Should complement the text

• Not too much information

• Not too many abbreviations

• Common errors:

• discussing results, missing data

• Disagreement with data given in other sections and visuals

Umpierrez et al, Diabetes Care 27:1873-1878, 2004

Tables

Figures should stand alone for comprehension

Umpierrez et al, Diabetes Care 30:2181–2186, 2007

The importance of the abstract, figures and figure legends

• The editor/reviewer should be able to evaluate the paper based on the abstract, tables, figures and the figure legends alone

Discussion

Beginning:What do these findings mean? Give your main result first Begin with a signal:

• We found that…• Blood pressure increased in patients who …

• Give your conclusions based on your results

Briefly summarize and discuss—don’t merely repeat—the results

Middle:• Interpret your results• Discuss key studies—only those relevant to your

work• Compare your work with others’ work• Present ambiguous results and discrepancies

with others studies objectively• Explain unexpected findings• Describe limitations briefly

Discussion

End:• Write a strong conclusion

– Begin with a signal: “In summary.. In conclusion..

• Suggest future work, if necessary

• Use present tense except

• Common errors: – too much information, too many studies, no

transitions

Discussion

Other Important Items

Acknowledgements:

• For reagent gifts

• For technical help

• For funding source

• For advice on content or manuscript

Conflict of interest:

• List any consulting/lecture honoraria or research funding that could have any direct or indirect link with the current study

References

• Check referencing style of journal• Include only significant, published work• Use EndNote whenever possible• Check original sources• Common errors:

– typos, inaccurate references

Review Process

Paper Submitted

Initial Decision by Editor

Confirmation of Receipt

Rejection Decide to Review

Assign Reviewers

Reviews Completed

RejectAccept

Notification to Author

Revise

AcceptRevise

Reasons for Rejection

• The research does not address an important question

• The results do not make a “discernible point”• The results are not novel• Problems with experimental design• Problems with the quality of the data

Replying to Reviewers

• Remember your goal is to be published not to demonstrate that you are smarter than the reviewers

• You should respond to every comment even if you don’t do everything requested

Additional Tips!

• The first sentence of your paragraphs signals what the rest of the paragraph is about. • Each sentence that follows should reflect

back on that lead sentence.• Do your percentages add up to 100?• Do your percentages and raw numbers agree?• If English is not your first language, find a native

English speaker to review the content and language of the paper

• Regardless of primary language, find a colleague or editor to review the content and language of the paper

Additional Tips!

• Organize the sections of the manuscript so that they tell a story

• Schedule time to write• Set a timetable• Be sure that you have done an appropriate

review of the literature so that you can compare your findings with those of others

• Try out the manuscript presentation in a conference or seminar • your colleagues will often have extremely

valuable suggestions

Additional Tips!

• Use only recent references unless earlier references are seminal or key for making a point

• use the background section of your recently funded grant as a starting point

• Set up a team of collaborators to write paper • have a senior colleague• involve a colleague, 2 people have a more than

additive effect on quality.• involve fellows, residents, and medical students

Additional Tips!

What additional recommendation(s) would you give to a busy clinician on how to write manuscripts?

Do not procrastinate – just do it

Acknowledgement

Faculty:

Nadine Kaslow, Ph.D.

Bobby Khan, M.D., Ph.D.

Jeff Lennox, M.D.

Jeff Sands, M.D.

Peter Wilson, M.D.

Nanette Wenger, M.D.

Thomas Ziegler, M.D.