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A veteran medical writer shares some thoughts...

 

 

How to Write an Article for Publication
in a Western Scientific Journal:
Advice for Non Native English Speakers
from an American Medical Writer

 

Tom Lang, MA

 


Introduction

 

Science cannot be separated from writing.  In science, publication is the final stage of research; if you do not publish your research, you might just have well not done it.  Further, if you have experimented on animals or patients, it may be unethical if you don’t publish your research.  That is, you have a moral obligation to make your research public through publication, especially if any living thing has suffered or been put at risk.  Thus, because you have chosen to do medical research, you have also chosen to be a writer about that research.


Writing is hard for everyone.  Better writers just enjoy writing more than weaker ones or are more willing to spend the time to explain and to document their research.  Writing about science in a foreign language is even harder.  Not only are you writing in a different language, you are writing about science, which few people are trained to do in any language. 


The purpose of this article is to give you the most important information you will need to write a good scientific article for publication in a Western scientific journal.  It will make your job as a writer easier, but not easy.  You must be as careful in your writing as you were doing your research.   Remember that the published article is all most people will ever know about your research.  Once published, your article is in the literature forever, with your name on it.  Learning how to write a scientific article is thus very important to your reputation, as well as to the advancement of science.

 

What Journal Editors Want

 

A well written article, although important, is not enough to get your article accepted by a leading Western journal.  To get published, you must do good science. 


Journal editors want to publish research that is 1) new, 2) true, 3) important, and 4) well written.  New science is science that adds something different to what is known about a topic.  Although confirming someone else’s findings is important, answering a question that has already been answered is not likely to interest a leading journal.  True science is science that has been well conducted; it has controlled for bias; it has minimized sampling and measurement error; and it has analyzed and interpreted the data appropriately.  Its conclusions are sound and believable.  Important science is science that changes the way medicine is practiced; it makes a difference.  Finally, well written science is science that is completely and clearly reported; science that can be understood and evaluated by readers.


The two questions most journal editors ask when considering a new manuscript for publication are 1) “So what? and 2) “Who cares?”  That is, is this research a contribution to science, and will it interest the people who read my journal?  The secret to doing good,  publishable research is to answer these questions before you start your research.  It cannot answer them, don’t start; find another question to answer.

 

What Else Journal Editors Want

 

Journal editors also want something else.  What they want is the most important advice I can give you for publishing your article:


 Read the Journal’s Instructions for Authors!!


The journal’s instructions for authors will tell you what kind of articles the journal publishes, what topics it wants to publish, and who reads the journal.  Make sure your article is appropriate for the journal before you submit it; you can save yourself and the journal much time and effort if you choose carefully.  The guidelines will also tell you how to prepare an article for the journal and how to submit it for publication. See: http://mulford.meduohio.edu/instr/ for links to the guidelines for authors for most biomedical journals.

 

How to Write the Title

 

            The title is the most important part of the scientific article.  It is the part of the article most often read and often the only part read.  For this reason, you should spend the time needed to write a good title.


            Especially in clinical journals, the title should usually identify the relationship that was studied.  Thus, for articles reporting epidemiological or clinical research, try to put as many of the following six elements in the title as you can: intervention, endpoint, patients or species or tissue, comparator group(s), study setting (for clinical studies), and design.  These elements can be remembered by the acronym SPICED (Setting, Patients, Intervention, Comparator, Endpoint, Design).  In the example below, a poorly written title describes a study of the relationship between a low-air-loss bed (a special type of bed) and pressure ulcers:


A Randomized Trial of Low-Air-Loss Beds
for Treatment of Pressure Ulcers


            However, the article actually compared the effect of low-air-loss beds on the healing of pressure ulcers with that of foam mattresses.  This title also does not tell us which patients were studied, or where the study took place.  Adding this information greatly improves the title:


Low-Air-Loss Beds vs. Foam Mattresses for Treating Pressure Ulcers
in Nursing Home Patients: A Randomized Trial

 

            Most clinical journals do not allow the results of the study to be given in the title (“Low-Air-Loss Beds Prevent the Formation of Pressure Ulcers in Nursing Home Patients” is not a good title, for example).  Although this type of title is common, especially in basic science journals, such titles can be misleading because they are simplistic; they state a conclusion that should not be accepted without knowing the details of the research.

 

How to Write the Introduction

 

            The introduction should be an important part of the article, but so few people know how to write good introductions that their value is usually overlooked.


I suggest writing a four-part introduction consisting of:


1. A background statement that provides the context for understanding the problem and your approach to it
2. A problem statement that describes the nature, scope, severity, or importance of the problem that stimulated your research
3. A task statement that indicates the research question, hypothesis, approach, or activities that you undertook to investigate the problem
4. A forecasting statement that tells readers what they will find if they continue to read the article.

 

An abbreviated example:


[Part 1: Background Statement] In patients with atherosclerotic vascular disease, aspirin is widely recommended to prevent myocardial infarction, graft occlusion after coronary artery bypass surgery, and stroke.  [Part 2: Problem Statement] However, aspirin is also associated with prolonged bleeding.  Patients are often asked to stop taking aspirin for several days before undergoing bronchoscopy, to reduce the presumed risk of bleeding.  The effectiveness of this practice has never been tested, but it does mean that patients must, for a short while, stop taking a medication with proven benefits, and it can also delay the planned bronchoscopy if aspirin use is not stopped soon enough.  [Part 3: Task Statement] Thus, we sought to determine whether aspirin really does increase the risk of bleeding after bronchoscopy.  [Part 4: forecasting Statement] In this article, we describe a prospective trial of 138 consecutive patients undergoing bronchoscopy in which we compared the number and severity of bleeding events in those taking aspirin with those who were not. 

 

Weak background and problem statements are the most common shortcomings of introductions.  Many authors assume, incorrectly, that readers will know what the problem is and why their research is important.  Others begin the introduction with a task statement because it describes their first step in actually conducting the research.  They forget the steps that precede research activities: finding and characterizing a problem and justifying the time and resources needed to address the problem.    

 

How to Write the Materials and Methods

 

The materials and methods section is usually the easiest part of the article to write because it simply describes what you did in your research.  (For this reason, I recommend that you write this section first.)  Several specific aspects of the study should be reported; among the most important are: 


• A statement that the study was approved by the appropriate institutional review board (IRB)
• A statement that animals were treated according to ethical guidelines
• A complete description of the intervention or treatment being studied
• A statement of the other explanatory or potentially confounding variables studied (for example, age, sex, disease severity, or comorbidities), including how they were measured
• A statement of the primary and secondary outcome variables, including how they were measured
• A description of the study design (for example, a cohort study or a randomized trial)
• A description of the patient population of interest
•  A description of the study setting
• The eligibility criteria used to select patients
• The method used to assign patients to experimental groups (random assignment, case definitions)
• The dates of data collection

 

Many other explanations may be required to convince readers that your research was well designed and conducted.  [See: How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers, Second Edition (by Lang and Secic, American College of Physicians, 2006) for complete guidelines on reporting case-control, cross-sectional, cohort, and randomized trials.]


A common subheading in the Methods section is Statistical Methods.  Here, you should identify the statistical comparisons you made and any analyses you performed.  You may need to tell readers how the sample size was determined by giving the details of a “power calculation.”  You also need to state the level of statistical significance (usually 0.05), and report the name of the statistical software package used in the analysis. 
If possible, begin working with a statistician when you start to plan the study.  Statisticians are trained in research design as well as in statistical analysis and can be helpful at every stage of the research.  Do not wait to talk with a statistician until you have collected data; it may be too late for them to fix mistakes!

 

How to Write the Results

 

            The Results section tells readers what happened during the study and presents the data you collected. 
Report the actual (absolute) change or difference between groups (the “estimated treatment effect” in clinical articles) and a 95% confidence interval for each estimate. Be careful when reporting percentages; in small samples, small numbers can appear larger when expressed as percentages.  (“In all, 33% of the rats lived, 33% died, and the last one got away.”)  The numerators and denominators of all percentages should be readily identifiable.


Other details that may need to be reported in the results include:

 

  • The dates or time periods of data collection
  • Any unplanned or unanticipated events that could affect the results
  • Any adverse events and their timing with respect to the treatment protocol
  • A complete accounting of all subjects or observations and explanations for any missing data or lost patients
  • The names of specific statistical tests or procedures used in the analysis
  • Assurance that the assumptions of the statistical analyses were met by the data
  • Justification for any unplanned secondary, subgroup, or exploratory analyses conducted after the results were analyzed as planned or after they were known.

 

 

            Discrepancies in information presented in the methods, results, and discussion are a common problem in reporting research.  Make sure that all the data described in methods section are reported in the results and addressed in the discussion and that method of data collection is described for all the data reported in the results. 

 

How to Write the Discussion

 

 

In the discussion, discuss your research!  Place your research in context, interpret your results, and explain their implications and, hopefully, their importance.  In other words, you have to answer the same two questions journal editors will ask: "So what?" (Is this research new, true, and important?) and "Who cares?" (Who needs to know about it?)


Consider the following organization for the discussion:


1. Briefly summarize the study and the main results in a paragraph or two. Be sure you answer the research question you posed in the introduction.
2. Interpret the results and suggest an explanation for them. What do they mean?  Do they support your hypothesis? Can you attribute them to a specific biological mechanism?
3. Describe how the results compare with what else is known about the problem; review the literature and put the results in context. Rather than summarizing the literature in one portion of this section and interpreting your research in another portion, address each point in your research one at a time. Introduce your point and then tell what other researchers have found that is relevant to this point.
4. Suggest how the results might be generalized. Would they apply to other types of cells? Other diseases? Different populations?
5. Discuss the implication of the results. Will they change patient care? Do they suggest another hypothesis or follow-up experiments? How should your results be used? Could they lead to the development of a new therapy?
6. Under a separate subheading, state the limitations of the study, their possible effects on the results, and, if possible, the steps taken to minimize their effects.  All studies—even yours—have limitations.  Authors who acknowledge limitations tend to be seen as honest, careful researchers.  Readers who find unacknowledged limitations may conclude that the author was at best careless and a worst, deceptive.
7. Under a separate subheading, list your conclusions. Describing each conclusion individually will force you to be more specific and will aid readers in understanding your research. 

 

The most common problems in the discussion are:


1) Not answering the research question that was posed in the introduction
2) Repeating the results rather than discussing their implications
3) Confusing statistical significance with biological or clinical importance
4) Not distinguishing between supported conclusions and speculation.

 

How to Write the Abstract

 

Although the abstract is the first part of the article to be read (after the title), it should be the last part to be written.  The abstract is the second most important part of the article; after the title, it is the part of the article most often read and often the only other part read.  Its purpose is to help readers decide whether to read the article.  This decision is more important than it seems, when you consider how much time readers spend reading.   


Abstracts for most research articles will be “informative abstracts” that have 4 parts: an Introduction, Methods, Results, and Conclusions.  Some journals require “structured abstracts” that have more headings: such as Context, Objective, Design, Setting, Participants, Intervention, Outcomes, Results, and Conclusions. Structured abstracts usually use complete sentences only in the Results and Conclusion.


Writing abstracts is challenging because you have to select carefully both your facts and your words. Try to avoid using abbreviations but define them if you use them.   Do not cite references or refer to the full article; abstracts are often separated from the full article and so must be understandable without reference to it.


One of the most common errors in scientific publishing is an abstract that contains information missing from or inconsistent with the rest of the article. In particular, the conclusions given in the abstract should match those given in the article. Other common problems occur when the problem statement is not distinct from the details of the background or when a background or a problem statement is omitted entirely.

 

How to Prepare the References

 

            The journal’s instructions for authors will tell you how to prepare the references.  With luck, the journal will accept what are called the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.  These requirements include a simple reference style that is accepted by several hundred life-science journals around the world.  (The website given above has a link to the Uniform Requirements.)

 

Examples of Uniform Requirements style:


1. Lang T. Systematic reviews as research assignments for training physicians.  Acad Med 2004;79:1067-72.
2. Lang T, Hodge P, Olson V, Romano P, Kravitz R. Nurse-patient ratios and patient, nurse employee, and hospital outcomes: a systematic review.  JONA 2004;34:326-37.
3. Lang T, Secic M.  How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers.  Philadelphia: American College of Physicians, 1997.

 

            Many reference lists have errors!  Often, authors do not take the time to make sure that names are spelled correctly, that the title is complete and accurate, that journal titles are abbreviated correctly, or that the year, volume, and page numbers are accurate.   Careful authors will verify the information for each reference against the original publication.  Often, references can be verified by looking them up on MEDLINE, the database of the US National Library of Medicine and accessed under PubMed: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi.

 

Final Thoughts

 

            After you have written your article, put it aside for several days, then read it again.  Also, have your colleagues read it closely and discuss their comments with you.   You will be surprised at how your article may change from doing these things!


The Bibliography lists some important reference books that will help you prepare your article.  They are important enough that you or your library should try to obtain them; they are worth the money.


            Remember: publication is the final stage of research.  Preparing your article for publication is usually the shortest and least expensive research activity, but it is also among the most important.  A well written article will make good research better. 

 


Bibliography

 

American Medical Association. AMA Manual of Style, 10th Ed.   New York: Oxford University Press, 2007.
Briscoe MH.  Preparing Scientific Illustrations. 2nd edition.  New York: Springer-Verlag, 1996. 
Council of Science Editors, Style Manual Committee. Scientific style and format: the CSE manual for authors, editors, and publishers. 7th Ed.  Reston, VA: The Council; 2006.
Huth EJ.  Writing and Publishing in Medicine.  Baltimore: Lippincott, Williams & Wilkins, 1999.
Lang T, Secic M.  How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers.  Philadelphia: American College of Physicians, 1997. National Library of Medicine.  List of Journals Indexed in Index Medicus, 2001.  

National Institutes of Health Publication Number 01-267. [See http://www.nlm.nih.gov/tsd/serials/lji.html.]

Schwager E.  Medical English Usage and Abusage. Phoenix: Oryx Press, 1991.

 


About the Author


Tom Lang, MA, has been a medical writer since 1975.  He is a Past President of the Council of Science Editors and a Fellow of the American Medical Writers Association, from whom he received the 2002 Harold Swanberg Award for Distinguished Contributions to Medical Communications, as well as the 1994 Golden Apple Award for Outstanding Workshop Leader.  Formerly the Manager of Medical Editing Services for the Cleveland Clinic in Cleveland, Ohio, he is the author of How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers (Second edition, American College of Physicians, 2006) and of How to Write, Publish, and Present in the Health Sciences: A Guide for Physicians and Laboratory Researchers.  He is a member of the CONSORT Group for reporting randomized clinical trials, an adjunct faculty member on the University of Chicago’s Medical Writing and Editing Program, and Adjunct Professor of Medical Writing at the University of the Sciences in Philadelphia.  As a consultant in scientific publications, he has taught widely in North America, Asia, and Europe.