E.A.C.H Research

a.     Preparing a Manuscript for Submission to a Medical Journal

General Principles

Manuscripts reporting original research are divided into Introduction, Methods, Results, and Discussion sections – “IMRAD” structure. Individual journals may prefer a different structure; abstracts may be structured, or unstructured. In a structured abstract, the ‘Discussion’ section is often replaced by the ‘Conclusions’ section. Articles may need subheadings within these sections to further organize their content. The type of manuscript will determine the anatomy/ structure of the output: meta-analyses, for example, will have a completely different structure from a paper o original research.  Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.

Most publishers have a word limit for the different types of manuscripts that authors must adhere to. Some manuscripts will have supplementary material that should be submitted and sent for peer review simultaneously with the primary manuscript. With the advent of the internet age, and the open access publishing model, hundreds of thousands – their business model is based on an APC – article processing charges; predatory journals are in it for the money that they can make – they will publish any material for a fee. They send out thousands of spam emails to people soliciting for articles. A number of reputable open-source journals do not charge APCs to authors from LMICs – to try and promote scientific research from these regions.

b.      Reporting Guidelines

               Reporting guidelines have been developed for different study designs; examples include:

·        CARE for case report writing (https://www.care-statement.org/)

·        CONSORT for randomized trials, (http://www.consort-statement.org/)

·        STROBE for observational studies (https://www.strobe-statement.org/index.php?id=strobe-home),

·        PRISMA for systematic reviews and meta-analyses (http://www.prisma-statement.org/),

·        STARD for studies of diagnostic accuracy (https://www.equator-network.org/reporting-guidelines/stard/).

·        SQUIRE – for quality improvement studies (http://www.squire-statement.org/)

·        GRADE for guideline development in health care (https://gradepro.org/)

·        AGREE for practice guideline development and the quality of reporting (https://www.agreetrust.org/)

The EQUATOR Network (https://www.equator-network.org/) has posted almost all guidelines on its website, enabling an author to go through a checklist. The NLM (National Library of Medicine) also has an extensive listing of the Research Reporting Guidelines and Initiatives, by the organization.        (https://www.nlm.nih.gov/services/research_report_guide.html).

c.       The Anatomy of a Scientific Paper: Manuscript Sections

The following are general requirements for reporting within sections of all study designs and manuscript formats.

i)                    Title Page

This will usually present general information about an article and its authors. This page will usually include: the article title, author information, disclaimers, and financial sources of support. Also included may be the word count, and key words. Within the disclaimer is a statement of conflict of interest, and any previous public presentations/ publications of part(s) of the manuscript to be submitted.

The ICMJE has a generic conflict of interest (COI) disclosure form used by ICMJE member journals (http://www.icmje.org/coi_disclosure.pdf); nevertheless a disclosure statement is still required in the manuscript.

ii)                  Abstract

Original research, systematic reviews, and meta-analyses require structured abstracts. The abstract provides the study background, purpose, methods used to conduct the research, and main findings. Important conclusions derived from the study results complete the abstract. Abstracts will usually have a limited number of words determined by each publisher. It is important that the abstract reflects the main manuscript, because it may be the only product of the authors that readers are able to access.  

iii)                Introduction

This section provides a clear background to the rationale for conducting the study. sets the stage for the study and describes its focus. The author should give an overview of what is known on the topic and what gaps in current knowledge are addressed by the study. The objectives of a study are laid down in this section.

iv)                Methods

This section explains how you went about answering your main study question. You should describe the methods that used in enough detail to enable readers to determine whether the methods were appropriate for answering the study question, judge any weaknesses in methodology that could influence the interpretation of the results and repeat the study themselves, if they wished to do so.

Include only information that was available at the time the study protocol was written. This section should also report on compliance with research ethics: IRB approval, and whether or not it was conducted in accordance to the Helsinki Declaration.

a)      Materials (participants)

Describe clearly, the process used in selecting study participants, including inclusion and exclusion criteria, and the population they were taken from. 

b)      Statistics

The statistical methods used to analyze data should be with sufficient detail such that the reader, if using the same raw data, would gain the same results, and come to a similar conclusion. The statistical software package(s) and versions used for data analysis should be reported. Where necessary, differentiate pre-specified analyses from post-hoc analyses.

c)       Results

This section should give a factual account of what was found: from the recruitment of study participants, the description of the study population to the main results and ancillary analyses. It should be free of interpretations and discursive text reflecting the authors’ views and opinions. Your results should be presented in logical sequence in the text, tables, and figures, giving the main or most important findings first.

You should not repeat all the data in the tables or figures in the text; emphasize or summarize only the most important observations. Avoid nontechnical uses of technical terms in statistics, such as “random”, “normal,” “significant,” etc.

d)      Discussion

Consider structuring the discussion to help avoid unwarranted speculation and over- interpretation of results while guiding readers through the text. The Annals of Internal Medicine, for example, recommends that authors structure the discussion section by presenting the following:

·         a brief synopsis of the key findings (emphasize the new and important aspects of your study and put your findings in the context of the totality of the relevant evidence);

·         a consideration of possible mechanisms and explanations;

·         a comparison with relevant findings from other published studies;

·         limitations of the study; and

·         a brief section that summarizes the implications of the work for practice and research (conclusion).  

                  e)   References

Aim to provide direct references to original research sources whenever possible; although references to review articles can be an efficient way to guide readers to a body of literature, review articles do not always reflect original work accurately. The use of referencing software is a critical part of referencing, and will protect your work from unnecessary errors. There is both free and for pay referencing software:  Mendeley (https://www.mendeley.com/?interaction_required=true), Zotero (https://www.zotero.org/) are both free, while Endnote (https://endnote.com/), RefWorks (https://www.refworks.com/refworks2/?), Citationsy (https://citationsy.com/), all come with a price-tag. There are many other referencing products on the market.

v.      Abbreviations and Symbols

Authors are advised to use only standard abbreviations, as use of nonstandard abbreviations can be confusing to readers. Unless the abbreviation is a standard unit of measurement, the spelt-out abbreviation should be followed by the abbreviation in parenthesis on first mention.

d.      Submitting your Manuscript to the Journal

Journals have different requirements, spelt out in the ‘Author Guidelines’ section of their home page. Usually, a cover letter that includes the following information will be required: A full statement to the editor about all submissions and previous reports of the same or very similar work. The cover letter includes a statement to the effect that the manuscript has not been simultaneously submitted elsewhere for consideration.

e.      Conflicts of Interest

A conflict of interest exists when professional judgment concerning a primary interest may be influenced by a secondary interest (such as financial gain). Perceptions of conflict of interest are as important as actual conflicts of interest. Financial relationships, personal relationships, rivalries, academic competition, and intellectual beliefs may all constitute a COI and should be declared as such. Intentional failure to disclose a COI is a form of misconduct.

f.       Scientific Misconduct

Scientific misconduct in research and non-research publications includes but is not necessarily limited to data fabrication; data falsification, including deceptive manipulation of images; purposeful failure to disclose conflicts of interest; and plagiarism.

g.      Predatory or Pseudo-Journals

A growing number of entities are advertising themselves as “scholarly medical journals” yet do not function as such.