How to get your research published

1. How to get your research published Dr Trish Groves Deputy editor, BMJ

2. What I aim to cover Research from China: trends Planning research Research ethics The research question and study design How to write a paper Role of professional writers Publication ethics How to get published in the BMJ

3. Manuscript problems 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 Seldom Occasionally Frequently Questionnaire to 50 JAMA reviewers and 67 editors in 1995. Byrne DW, Publishing Medical Research Papers, Williams and Wilkins, 1998

4. Research from China

5. Medical research publications:huge increase from China

6. Medical research publications:but Chinese work lacks impact

7. Say something important Share your work Change practice Promote thought or debate Educate Get into high impact journal Advance your career Keep your job Make money Entertain/divert/amuse Why conduct and publish research?

8. 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

9. 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

10. 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

11. Other BMJ articles from Chinese authors in 2010 Research Methods & Reporting: Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses. Xin Sun (Center for Clinical Epidemiology and Evidence Based Medicine, West China Hospital, Sichuan University, Chengdu) and colleagues from Canada. 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-Japan Friendship Hospital, Beijing). BMJ 340:doi:10.1136/bmj.c2262 Research: Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. Sarah D McDonald, Zhen Han (First Affiliated Hospital of Xi’an Jiao Tong University, Department of Obstetrics and Gynecology, Xi’an, Shaanxi Province) and colleagues from Canada. BMJ 341:doi:10.1136/bmj.c3428

12. Impact Factor

13. For how long are articles cited?

14. Research ethics

15. Rules for ethical research with humans Declaration of Helsinki (2008) Guideline for Good Clinical Practice (1996) from the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Bionet recommendations on ethical governance of Sino-European biological and biomedical research (2010)

16. 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

17. Ethical issues – the wider aspects • what information will you give participants before seeking their consent? • how much will the study deviate from current normal (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?

18. The research question

19. What is a research question? The researcher asks a specific question and tests a specific 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

20. 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

21. 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 screening programme 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)

22. 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

23. Minimising bias and confounding Chance - measurements are nearly always subject to random variation. Minimise error by ensuring adequate sample size and using 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 outcomes and should be measured too eg people who carry matches are more likely to develop lung cancer, but smoking is the confounding factor

24. Which study design will answer your question?

25. 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.

26. Study designs Population (P) Outcomes (O) Interventions (I) or Exposures (E) Centre for Evidence Based Medicine, Oxford, UK www.cebm.net

27. Case series

28. Cross sectional study Glycated haemoglobin A1c for diagnosing diabetes in Chinese population: cross sectional epidemiological survey Yuqian Bao, Xiaojing Ma, Huating Li, Mi Zhou, Cheng Hu, Haiya Wu, Junling Tang, Xuhong Hou, Kunsan Xiang, Weiping Jia. BMJ 2010;340:c2249 (Published 17 May 2010)

30. Case-control study Potentially modifiable risk factors associated with myocardial infarction in China: the INTERHEART China study. K K Teo, L Liu, C K Chow, X Wang, S Islam, L Jiang, J E Sanderson, S Rangarajan, S Yusuf, for the INTERHEART Investigators in China. Heart 2009;95:1857-1864 doi:10.1136/hrt.2008.155796 28 May 2009

31. 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.b1175 9 April 2009

32. Randomised controlled trial BMJ 2008;337:bmj.a2001

33. Systematic review

34. Agree authorship before starting the study!

35. 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

36. 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 data does 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.

37. 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

39. Writing a research paper

40. 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 authors resources.bmj.com/bmj/authors

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

44. 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

45. CONSORT 2010CONsolidated Standards of Reporting Trials

46. Writing a paper1. The message What …is the research question? …is the right article format for your study? …does the audience need to know?

47. Writing a paper2. Title: style descriptive: Number of heads in adults: audit declarative: Most adults have one head journalistic: Heads you win questioning: 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

48. 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?

49. Writing a paper4. The introduction Brief background for this audience 3-4 paragraphs only What is known, and what is not, about your research question Avoid boring readers, editors, reviewers Do not boast about how much you have read The research question State it clearly in the last paragraph of the introduction Say why it matters

50. Writing a paper5. Methods Like a recipe Most 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