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How to get your research published
Dr Trish GrovesDeputy editor, BMJ
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What I aim to cover
Research Publication IssuesPlanning researchResearch ethics The research question and study designHow to write a paperRole of professional writersPublication ethicsHow to get published in the BMJ
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Manuscript problems
Seldom Occasionally Frequently
Poorly written, excessive jargon
Inadequate/inappropriate presentation
Poor description of design
Excessive zeal and self promotion
Rationale confused, contradictory
Essential data omitted, ignored
Boring
Important work of others ignored
Questionnaire to 50 JAMA reviewers and 67 editors in 1995. Questionnaire to 50 JAMA reviewers and 67 editors in 1995. Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998
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Why conduct and publish research?
Say something important Share your workChange practicePromote thought or debateEducateGet into high impact journalAdvance your career Keep your jobMake moneyEntertain/divert/amuse
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How to publish in a high impact journal I
• use literature to focus the research question and ensure it is important, new, & relevant internationally
• enlist co-authors, statistician, supervisor
• design the study, develop the methods, check ethics
• write the proposal, get funding and ethics approval
• conduct the study well
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How to publish in a high impact journal II
• use clear, simple language to fully report the study
• follow rules on publication ethics
• choose the right journal
• communicate effectively with editors
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Impact Factor
Impact factor over time for the General Medical Journals
0
5
10
15
20
25
30
35
40
45
50
55
60
2003 2004 2005 2006 2007 2008 2009
JCR Year
Imp
act
Fac
tor
BMJ
Lancet
JAMA
Annals of Internal Med
NEJM
PLoS Med
CMAJ
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For how long are articles cited?
Cited Half-Life over time for the General Medical Journals
0
1
2
3
4
5
6
7
8
9
10
2003 2004 2005 2006 2007 2008 2009
JCR Year
Cit
ed
Ha
lf-L
ife
BMJ
Lancet
JAMA
Annals of Internal Med
NEJM
PLoS Med
CMAJ
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Research ethics
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Rules for ethical research with humans
Declaration of Helsinki (2008)
Guideline for Good Clinical Practice (1996) from theInternational Conference on Harmonisation ofTechnical Requirements for Registration ofPharmaceuticals for Human Use (ICH)
Bionet recommendations on ethicalgovernance of Sino-European biological and biomedical research (2010)
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Declaration of Helsinki
Updated in 2008 by World Medical Association, and now
states that:
• every clinical trial must be registered in a publicly accessible database before recruitment of the first subject
• each potential subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of interest, institutional affiliations of the researcher, the anticipated benefits and potential risks of the study and the discomfort it may entail, and any other relevant aspects of the study
http://www.wma.net/en/30publications/10policies/b3/index.html
• http://www.wma.net/en/30publications/10policies/b3/index.html
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Ethical issues – the wider aspects
• what information will you give participants beforeseeking their consent?
• how much will the study deviate from currentnormal (accepted, local) clinical practice?
• what full burden will be imposed on participants?• what risks will participants/others be exposed to?• what benefit might participants or others receive? • how might society/future patients benefit in time?• might publication reveal patients’ identities?
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The research question
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What is a research question?
The researcher asks a specific question and tests aspecific hypothesis
The question may also be called an objective or aim
Calling it a question helps to focus the hypothesis and
helps to find an answer
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What makes a poor research question?
A question that matters to nobody, even you
Hoping one arises from routine clinical data or records
• patients’ records will be biased and confounded• they may not allow you to answer your question reliably,
as they were collected for another reason
Gathering data and hoping a question will emerge: this
is like a fishing expedition
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Good research questions
What impact has China’s New Rural Cooperative Medical Scheme
had on village health clinics? BMJ 341:doi:10.1136/bmj.c5617 (21 October 2010)
How effective is the Shenzhen antenatal syphilis screeningprogramme at identifying infants at high risk?Sex Transm Infect 2010;86:280-284 doi:10.1136/sti.2009.038893 (24 June 2010)
Are IL-23R polymorphisms associated with susceptibility to Behcet's
disease in a Chinese Han population?Ann Rheum Dis 2010;69:1325-1328 doi:10.1136/ard.2009.119420 (7 April 2010)
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Turning a research question into a proposal
Who am I collecting information from?What kinds of information do I need?How much information will I need? *How will I use the information?How will I minimise chance/bias/confounding?How will I collect the information ethically?
* sample size – ask a statistician for help
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Minimising bias and confounding
Chance - measurements are nearly always subject to randomvariation. Minimise error by ensuring adequate sample size andusing statistical analysis of the play of chance
Bias - caused by systematic variation/error in selecting patients,measuring outcomes, analysing data
Confounding - factors that affect the interpretation of outcomesand should be measured tooeg people who carry matches are more likely to develop lung cancer, but smoking
isthe confounding factor
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Which study design will answer your question?
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PICO
Patients– disease or condition– stage, severity– demographic characteristics (age, gender, etc.)
Intervention– type of intervention or exposure – experiment or
observation?– dose, duration, timing, route, etc.
Comparison– treatment or risk– placebo or other active treatment
Outcome– frequency, risk, benefit, harm– dichotomous or continuous– type: mortality, morbidity, quality of life, etc.
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Study designs
Population (P) Outcomes (O) Interventions (I) or Exposures (E)
Centre for Evidence Based Medicine, Oxford, UK www.cebm.net
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Case series
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Cross sectional study
Glycated haemoglobin A1c fordiagnosing diabetes inChinese population: crosssectional epidemiological
survey
Yuqian Bao, Xiaojing Ma, Huating Li, Mi
Zhou, Cheng Hu, Haiya Wu, JunlingTang, Xuhong Hou, Kunsan Xiang,Weiping Jia.BMJ 2010;340:c2249 (Published 17 May 2010)
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Case-control study
Potentially modifiable riskfactors associated withmyocardial infarction in China:the INTERHEART China study.
K K Teo, L Liu, C K Chow, X Wang, S Islam, L Jiang, J E Sanderson, SRangarajan, S Yusuf, for theINTERHEART Investigators in China. Heart 2009;95:1857-1864doi:10.1136/hrt.2008.15579628 May 2009
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Cohort study
Frailty and type of death among
older adults in China:prospective cohort study.
Dupre ME, Danan Gu, Warner DF, Zeng Yi BMJ 338:doi:10.1136/bmj.b11759 April 2009
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Randomised controlled trial
BMJ 2008;337:bmj.a2001
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Systematic review
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Agree authorship before starting the study!
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Authorship and contributorship
These denote credit and accountability
But many authors on papers have done little
People’s names are left off papers
Authors do not know the authorship criteria
Contributorship is also used by some journals
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Authorship: ICMJE criteria
Authorship credit should be based only on substantial contribution to:
• conception and design, or data analysis and interpretation • drafting the article or revising it critically for important
intellectual content • and final approval of the version to be published All these conditions must be met. Participation solely in the acquisition of funding or the collection of
datadoes not justify authorship [no guest authors]. All authors included on a paper must fulfil the criteria [no ghost
authors]. No one who fulfils the criteria should be excluded.
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Role of medical writers
European Medical Writers Association policy:
• medical writers have a legitimate role in assisting named authors in developing manuscripts for peer-reviewed journals and presentations
• such contributions and funding information should be openly acknowledged
• not ‘ghostwriter’, which wrongly implies something secretive• experts in scientific communication, data presentation,
journal and congress requirements of journals, and publication ethics
• may therefore raise the standard of publications and accelerate the process
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Writing a research paper
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General guidance on writing papers
International Committee of Medical Journal Editors Uniform Requirements
For Manuscripts submitted to Biomedical Journals www.icmje.org Reporting guidelines for research, at the EQUATOR network www.equator-network.org
Centre for Evidence Based Medicine, Oxford www.cebm.net
BMJ advice to authorsresources.bmj.com/bmj/authors
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equator-network.org/resource-centre/library-of-health-research reporting
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Writing a paper1. The message
What…is the research question?…is the right article format for your
study?…does the audience need to know?
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Writing a paper2. Title: style
descriptive: Number of heads in adults: auditdeclarative: Most adults have one head journalistic: Heads you winquestioning: How many heads do adults have?
To ensure your paper’s title is in the right style follow the journal’s instructions to authors - and other articles
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Writing a paper3. IMRaD
Introduction: why ask this research question?
Methods: what did I do?
Results: what did I find?
And…
Discussion: what might it mean?
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Writing a paper4. The introduction
Brief background for this audience3-4 paragraphs onlyWhat is known, and what is not, about your research
questionAvoid boring readers, editors, reviewersDo not boast about how much you have read
The research questionState it clearly in the last paragraph of the introductionSay why it matters
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Writing a paper5. Methods
Like a recipeMost important section for informed readers
Describe: • inclusion and exclusion criteria• outcome measures• intervention or exposure
Give references for standard methods Follow reporting guidelines www.equator-
network.org/ Explain ethics issues
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Writing a paper6. Results
Basic descriptive data
Text for story, tables for evidence, figures for highlights
Essential summary statistics and confidence intervals
Leave out non-essential tables and figures
Do not start discussion here
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Writing a paper7. Structured discussion
Do not simply repeat the introduction
Include:• statement of principal findings • strengths and weaknesses of the study • strengths and weaknesses in relation to other studies
(especially systematic reviews), and key differences• meaning of the study: possible mechanisms and
implications for clinicians or policymakers • unanswered questions and future research
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Abstract: general rules
Important
All authors mustapprove it
Editors may screen by
abstract
for BMJ:
usually 300-400 words use active voice p values need data too%s need denominatorsno referencestrial registration details
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How to choose a journal and survive peer review
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5 key questions when choosing a journal
Whom do I want to reach (target audience)?
How do I intend to reach the desired audience?
How will readers access my article? *
What type of journal will best meet my needs?
How soon do I want or need to publish the data?
* Can I afford the publication fee at an open access journal?
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Journal factors
Rejection rateIndexing (Medline)Time to acceptance; time to publicationImpact FactorWord limitTypes of article typically publishedPolicy on industry sponsored workPolicy on acknowledged medical writing assistanceCharges for pages, publication, colour figures or open
accessFast track peer review or publication
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BMJ (impact factor 13.66)
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BMJ peer review process
4-5000annually
3-4000rejected
Approx1000 foropenreview
500 thenrejected
500 withEditor andadviser,statisticia
n,BMJ team
4-7% with
OpenaccessNo wordlimitsBMJ picoEditorials
ScreenResearch submitted
External review
Editorial meeting
Accept
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BMJ appeals
Serious appeals welcomed
Criticisms addressedUp to 20% accepted
But only one appealMake it good
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Publication ethics
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Misconduct in research and publication
Fabrication: making up data or results and recordingor reporting them (through publication or presentation)
Falsification: manipulating research materials,equipment, or processes, or changing or omitting dataor results such that the research is not accuratelyrepresented in the research record
Plagiarism: the appropriation of another person'sideas, processes, results, or words without givingappropriate credit
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Publication ethics
• avoid misconduct• protect patients’
identities• report informed
consent and wider ethics issues
• declare competing interests
Stating approval by an ethicscommittee or institutionalreview board may not suffice
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Competing interests
A person has a competing interest when he or she has an attribute that is invisible to the reader or editor but which may affect his or her judgment
Always declare a competing interest, particularly one that would embarrass you if it came out afterwards
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Tool to detect plagiarism: CrossCheck
Web based tool which searches for overlapping content:
• prepublication• postpublication
Specialist search engine (iThenticate) uses “text fingerprinting” and “string matching”
Gets behind access controls (free tools can’t do this)
9 billion articles in CrossRef database, and counting
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CrossCheck to find plagiarism
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