How to get your research published

Dr Trish GrovesDeputy editor, BMJ

What I aim to cover

Research from China: trendsPlanning researchResearch ethics The research question and study designHow to write a paperRole of professional writersPublication ethicsHow to get published in the BMJ

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

Research from China

Medical research publications:huge increase from China

Medical research publications:but Chinese work lacks impact

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

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

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

BMJ submissions from China

In 2008 - 90 submissions (1.2%): 1 accepted

In 2009 – 173 (2.1%): 2 accepted

In 2010 so far – 145 (2.2%): 5 accepted

In 2008 56% submissions were from outside UK:23% from rest of Europe, 18% North America, 9%

Australia/NZ, 6% rest of world

Other BMJ articles from Chinese authors in 2010

Research Methods & Reporting: Is a subgroup effect believable? Updating criteria to evaluatethe credibility of subgroup analyses. Xin Sun (Center for Clinical Epidemiology and EvidenceBased Medicine, West China Hospital, Sichuan University, Chengdu) and colleagues fromCanada. BMJ 340:doi:10.1136/bmj.c117

Letter: Fever as nature’s engine: Adaptive and protective values of symptoms. Ming Yi, Haolin

Zhang (Neuroscience Research Institute, Peking University, Beijing). BMJ 340:doi:10.1136/bmj.c1339

Editorial: Diagnosing diabetes using glycated haemoglobin A1c. Wenying Yang (China-JapanFriendship Hospital, Beijing). BMJ 340:doi:10.1136/bmj.c2262

Research: Overweight and obesity in mothers and risk of preterm birth and low birth weightinfants: systematic review and meta-analyses. Sarah D McDonald, Zhen Han (First AffiliatedHospital of Xi’an Jiao Tong University, Department of Obstetrics and Gynecology, Xi’an,

ShaanxiProvince) and colleagues from Canada. BMJ 341:doi:10.1136/bmj.c3428

Impact Factor

Impact factor over time for the General Medical Journals

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Cited Half-Life over time for the General Medical Journals

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Research ethics

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)

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

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?

The research question

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

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

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)

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

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

Which study design will answer your question?

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.

Study designs

Population (P) Outcomes (O) Interventions (I) or Exposures (E)

Centre for Evidence Based Medicine, Oxford, UK www.cebm.net

Case series

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)

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

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

Randomised controlled trial

BMJ 2008;337:bmj.a2001

Systematic review

Agree authorship before starting the study!

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

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.

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

Writing a research paper

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

equator-network.org/resource-centre/library-of-health-research reporting

Reporting statements

CONSORT for randomised controlled trials

STARD for diagnostic accuracy studies

STROBE for observational studies PRISMA for systematic reviews of trials

MOOSE for meta-analyses of observational studies

CONSORT 2010CONsolidated Standards of Reporting Trials

Writing a paper1. The message

What…is the research question?…is the right article format for your

study?…does the audience need to know?

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

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?

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

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

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

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

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

Structured abstract: BMJ styleobjectives - research question

design –prospective, randomised, placebo controlled, case control, etc

setting – primary or secondary care? number of centres, country

participants – entry and exclusion criteria, numbers entering andcompleting the study, sex, ethnic group as appropriate

interventions - what, how, when and for how long

main outcome measures - those planned, those finally measured

results - main results, 95% confidence intervals, statistical significance,number need to treat/harm 

conclusions – primary conclusions, implications; don’t go beyond data

trial registration - registry and number (only for clinical trials)

BMJ picoabridged articles for print BMJ

Evidence abstract prepared by authors

for the BMJ print journal. The fullresearch article appears on bmj.comwith open access and no word limit.

BMJ pico emphasises:

• the study question • the summary answer • bias, confounding, other cautions • generalisability• study funding/competing interests• the study’s full citation on

bmj.com

How to choose a journal and survive peer review

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?

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

BMJ (impact factor 13.66)

BMJ Chinese edition

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

BMJ appeals

Serious appeals welcomed

Criticisms addressedUp to 20% accepted

But only one appealMake it good

Publication ethics

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

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

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

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

CrossCheck to find plagiarism

Thanks…and good luck!

tgroves@bmj.com