How To Publish in Biomedicine 500 Tips For Success

How to Publish in
Biomedicine
500 tips for success
Jane Fraser
Foreword by
Richard Horton
Editor
The Lancet
Radcliffe Medical Press

1997 Jane Fraser
Reprinted 2002, 2003, 2004
Radcliffe Medical Press Ltd

18 Marcham Road, Abingdon, Oxon OX14 1AA, UK
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise
without the prior permission of the copyright owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN 1 85775 193 0
Library of Congress Cataloging-in-Publication Data is available.
Typeset by Advance Typesetting Ltd, Oxon

Printed and bound by TJI Digital, Padstow, Cornwall
Contents
Foreword v
About the author vii
About this book ix
Acknowledgements xi
1 What do you want to write? 1

2 Understanding the publishing process 5
3 Original research - what can be published? 13
4 Selecting the right journal 17
5 Planning your writing 25
6 Research papers and reviews: titles 31
7 Research papers: abstract 35
8 Conference abstracts 41
9 Research papers: introduction 45
10 Research papers: methods 51
11 Research papers: results 57
12 Research papers: figures 63
13 Research papers: tables 69
14 Research papers: photographs 77
15 Research papers: discussion and conclusions 81
16 References 87
17 Checking your manuscript 91
18 Research papers and reviews: writing a covering letter and
submitting your manuscript 95
19 Dealing with the editor's and reviewers' comments 103
20 Review articles and book chapters 107
21 Theses and dissertations 115
22 How to write a book 121
23 Informal science writing 125
24 Clear writing: sentences 133
25 Clear writing: words 139
iv Contents
26 Clear writing: paragraphs, headings and lists 145

27 Correct writing: common errors of grammar and idiom 151
28 Overcoming writer's block 157
29 Managing your time for writing and revising 163
30 Using your word processor more effectively 167
31 Useful software and hardware for writers 173
32 Writers' resources on the World Wide Web 179
33 Selected further reading 183
Appendix 1: Uniform requirements for manuscripts submitted to

biomedical journals 185
Appendix 2: Manuscript checklist 201
Index 205
Foreword
The Author's Revenge

There was an old editor (your foe),
Who usually preferred to say no,
He ranted and railed,
Till his heart nearly failed,
He died lonely and broken - ho, ho!
Anon, 1823
Such is the miserable life of a journal editor.

First things first. Read this book. It is all true. Beautifully written. Brilliantly
argued. You would be a fool to ignore the wise words it has to offer.
If, however, you are pressed for time (and unless you are working at a London
teaching hospital, you will be), here is a summary. Structured, of course.
The three A's to acceptance are:
Approach. The covering letter is vital. Editors are showered with manuscripts
daily (25 at The Lancet). We cannot possibly read through every page of every paper.
Nor would we want to. A brief, gently hyperbolic account of what you have done
and why it should be irresistible to the editor is a sure way to get noticed. But ...
Appeal. I am assuming rejection (which, be honest, is the likely outcome). The
editor's decision is never final. Editors are jitteringly insecure about their judgements.
No one wants to pass up the scientific equivalent of an actor's role in Jurassic Park. If
your paper has not been peer reviewed, claim tragic injustice and a terrible missed
opportunity. If a reviewer's pen has led to editorial refusal, claim undisclosed bias
and a poverty of intellect on the part of the advisor. In other words, appeal to the
editor's better nature - namely, greed for a higher impact factor.
Attitude. Be quick in your rebuttal of the editor's decision. We have short
memories. No recollection of your paper means no chance. And, in all your
correspondence, be polite. I have a growing pile of incredibly irate letters from well-
known Professors of medicine, all of whom are too used to people saying yes to
vi Foreword
them. Here is the latest on my desk: 'Although I have not argued the toss with the
last three rejections from The Lancet of papers in which I have been involved, I think
this decision is extremely unfair and certainly I find it very difficult to accept based
on the rather meagre contents of your letter. I am becoming increasingly confused
about your editorial policy. I really can't accept a rejection ...' (etc, etc). You can
imagine that these sort of wails generate billowing gasps of laughter at The Lancet
and consign the feted Professor's paper to unrecoverable obscurity. Charm, by
contrast, works wonders.
Writing is hard, it is true. But when writing is done with others, it can be reward-
ing - perhaps even pleasurable. Is this not a worthy end in itself, irrespective of the
capricious editor?
In all of this publishing palaver, authors should remind themselves that, contrary
to their expectations, editors like to be liked. We want to publish your work. So, put
your pen down, put your feet up, pour yourself a large vodka, and read on. Even this
Foreword was rejected first time around.
Richard Horton
July 1997
About the author
Dr Jane Fraser started her career as a research scientist, but moved into publishing
when she realized that 'I liked writing about the experiments more than I liked
doing them'. Her long career in biomedical publishing has given her plenty of
opportunities both to write herself and to edit the work of scientists and clinicians.
She has worked as editorial director of two international medical communications
companies and, since 1991, has been a freelance writer and writing-skills trainer.
She is also a consulting tutor to the University of Oxford's Continuing Professional
Development Centre, where she enjoys helping scientists from many different
countries to write more effectively and get their papers published.
More information about open and in-company biomedical writing courses can be
obtained from:
Ms Anna Turner,
Oxford University Continuing Professional Development Programme,
Department for Continuing Education,
67 St Giles,
Oxford OX1 3LU,
UK
Tel: +44 (0)1865 288169
Fax: +44 (0)1865 288163
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About this book
Publishing in scientific journals is the true end-product of scientific research. Long

after all the presentations are made, and all the details debated, only the publication
remains. Studies carried out, but not written up, moulder away in filing cabinets,
and are forgotten. Science only exists when it is published in some permanent form,
available to all who enquire. At present, that form is usually the printed, peer-
reviewed, scientific journal. In the very near future, biomedical papers may also be
routinely published in electronic form - there are already a few electronic journals
around.
Today, the pressure on scientists to publish is stronger than ever before. Despite
the many complaints about the exploding number of journals and papers, a long
list of publications in prestigious journals is taken as a sign of worth. The ability
of scientists is judged not only on the quality of their studies, but on the number
and quality of their publications. There is a whole science of scoring publications,
with the aim of enabling objective decisions about job appointments and grant
applications.
Yet, despite the injunction to 'publish and flourish', most scientists have little
training in writing papers. A few of us are lucky enough to have a mentor who knows
not only how to write, but how to teach. The rest learn to write papers by doing it,
and by making mistakes. We waste valuable time submitting papers, only to have
them rejected.
Often, these rejections could have been avoided if we had been more thoughtful
about where we submitted the paper, or the format we chose. Some rejections are a
result of unclear or disorganized writing. While good writing can never compensate
for a badly designed study, bad writing can actually obscure good science.
This book is designed to help you get your biomedical papers published. It is based
on many years of experience, not only of writing papers, but of teaching scientists
from a wide range of backgrounds and many different countries. They have taught
me what scientists really want to know about writing and publishing papers.
There are already plenty of comprehensive textbooks around on scientific writing,
but this book is different. It is intended to answer the commonest questions about
scientific writing, and to help you avoid the most frequent problems and pitfalls. It
x About this book
is designed to be very practical, and to be used when you are actually writing. You
do not have to read it straight through from beginning to end. Just dip into any
chapter and you will find a range of tips relevant to the section you are working on
right now.
This book is also very realistic, in that it recognizes that you may not have very
much time for writing. So it includes chapters on managing your time for writing
and revising, overcoming writer's block and using technology to make your writing
more efficient.
I hope that everyone who reads this book will find useful hints that they can use
again and again to help ease the process of writing and publishing papers. There is
no reason why this process should always be long and painful. As with all other
walks of life, when you know what you are trying to achieve, you will be able to use
the skills you already have to maximize your potential. You might even have time to
do some research. Good luck!
Jane Fraser
July 1997
Acknowledgements
This book grew out of the questions and suggestions of participants in all the courses
I have taught on scientific writing and publishing. Special thanks are therefore due
to Anna Turner at the University of Oxford's Continuing Professional Development
Programme, and to the Staff Development Centre, University of Oxford, for provid-
ing the platform for many of these courses.
I am grateful also to many publishing companies and their staff, including Adelphi,
Exerpta Medica, Franklin Scientific Projects, Medical Action Communications,
Oxford Clinical Communications, PPS Europe Ltd, Synergy and The Medicine
Group.
Additional thanks are due to the numerous pharmaceutical companies who
have kindly invited me to teach courses, especially Astra, Eli Lilly, Glaxo-Wellcome,
Howmedica, Novartis, Pharmacia & Upjohn, Sanofi, Xenova, Zeneca, and the Paul
Janssen Medical Institute.
Sincere thanks also go to Liz Wager for her many helpful suggestions on the
manuscript. Finally, I would also like to express my gratitude to the countless friends
and colleagues who have contributed over the years to my store of tips. Without
them, this book could not have been written.
Jane Fraser
July 1997
1
What do you want
to write?
If you want to publish something in a biomedical journal or magazine, you will need
to decide on the right format for what you have to say. This section defines some of
the commonest types of publication, to help you decide into which category your
publication fits.
Use these definitions in conjunction with the advice on choosing a journal in
Chapter 4. The important thing is to choose the right format for the information you
wish to convey, and to send your paper to a journal or magazine that accepts that
format.
A Describe an experimental or observational study in

an original research paper...
Full-length original research papers are the main category of paper included in any
peer-reviewed journal. Think, however, about whether your paper might have a
better chance of publication as a short communication (see below). Chapters 5-9 give
more advice on how to prepare an original research paper.
A ... Or a 'short communication'

Some journals also publish 'short communications' or 'brief communications'. These
are abbreviated descriptions of original research studies, with a strict limitation on
the number of words or pages allowed (see Chapter 4).
2 How to publish in biomedicine
A Describe an unusual case in a case report

Only some journals accept case reports - descriptions of one or more patients that
illustrate some novel clinical problem or its solution. Be sure that your case history
is really as interesting as you think it is - it will have to tell a story that has not been
told before. Case reports are most likely to be published if they describe:
a previously unknown disease or syndrome (it still happens occasionally)
a previously unsuspected causal association between two diseases
a new and unexpected variation in the usual pattern of a disease
a hitherto unreported adverse drug reaction or interaction.
A Use a letter to the editor to give a brief

description of a study ...
One way of publishing data that would not make a full-length paper is as a letter to
the editor in a journal that accepts this format. Some journals, such as The Lancet,
have a separate section for 'research letters'. Keep your letter brief and to the point.
When describing original research in a letter, you can usually include a couple of
references, but no figures or tables. Note that if you publish something as a letter to
the editor you will not be able to publish the same study again as a full paper. Bear
in mind also that only a few letters ever get indexed in Medline, so although your
letter will be citeable as a research publication, it will be less likely to be identified
and read than a full paper.
A ... Or to comment on other studies the journal

has recently published
You may wish to comment on a study recently published in the journal, and amplify
the comment with a few lines reporting your own findings, e.g. 'In their recent paper
(Elderly Issues 1997; 36: 2-7), Smith and Brown reported that gerontazole is an
effective treatment for Portillo's disease in elderly patients. In our own pilot study in
six women aged 95 years or older, we found that...'
A ... Or simply to state your point of view on

a topical issue
Lastly, the letter to the editor can simply give your opinion or state some relevant
facts on any topical issue. For a young scientist, having a letter published in a top
What do you want to write? 3
journal can be a useful career boost. The chief criterion for acceptance of this kind
of letter is that it should be of interest to the journal's readers. Make sure that, in
commenting on someone else's research or practice, you do not inadvertently say
anything that could be construed as libellous - keep it as impersonal as possible.
Make it clear in the letter that you give your permission to publish (some letters are
written for the eyes of the editor only).
A Write a review article to summarize the literature

or a series of studies
Only some journals accept review articles. They are often commissioned by the
editor, so a review article submitted with no prior notice may be courting rejection.
However, editors of journals that publish review articles are always open to new
ideas, so contact them first to see if your suggested topic is welcome. For more about
review articles, see Chapter 20.
A Write an editorial to put forward a new or controversial

point of view
Look closely, and you will see that 'editorials' and similar articles are not always
written by the editor of the journal, but also by invited contributors, well-known and
well-respected in their field. You are unlikely to get an editorial accepted if it is
submitted speculatively. However, if you have something really important to say, it
is worth approaching the editor to see if they would consider inviting you to write
an editorial.
A Write an informal article to reach a wider audience,

to describe recent events or to tell a personal story
You may find that not everything you want to say fits into the categories described
above. A few journals include informal articles alongside peer-reviewed research
papers. These 'news-and-views' articles do not carry the academic kudos of a peer-
reviewed paper, but they can still help attract attention to you and your institution.
They can also be fun to write. For example, you might want to write about something
'newsy' like 'How our geriatric unit cut antibiotic costs' or "The Global Congress of
Gastroenterology 1997: a surgeon's view'. You might also want to write something
more personal, or even humorous - 'Medicine at 30 000 feet'.
Opportunities for informal writing may also be available in magazines and news-
letters for your fellow professionals or the general public. For example, you might
have a suitable idea for the New Scientist, Scientific American or Trends in Plwrmaceutical
Sciences. If you are unsure whether the article you have in mind would be appro-
priate, you can contact the editor for advice. Advice on writing informal scientific
and medical articles is given in Chapter 23.
2
Understanding the
publishing process
If you do any kind of biomedical research, you are going to become very familiar
with the process of publishing scientific papers. For better or worse, the success of
your research career will depend on your ability to get your research published in
peer-reviewed journals. So, it pays to be familiar with the process and the people
involved.
A Familiarize yourself with the publishing process

Figure 2.1 outlines the typical progress of a paper from submission to publication.
You submit your paper to the editor. Often, the editor will perform a preliminary
screen on all papers that are submitted to the journal, before sending 'possibles' out
for peer review. The editor then makes the decision to accept or reject your paper,
on the advice of the reviewers (referees). Usually, you will have to make some
amendments, taking into advice the reviewers' comments. Once your paper is
accepted, it will be edited to conform with journal style, and proofs returned to you
for correction. Only then will it finally be ready for publication.
A Understand the roles of the people involved

At different stages of the publication process, you may find yourself dealing with:
the editor
reviewers (also known as referees)
the managing editor
copy-editors (also known as sub-editors or desk editors).
Figure 2.1 The publishing process - a simplified view.

Understanding the publishing process 7
Each has a specific role to play in publishing the journal. Let's look at their roles one
by one.
A The editor decides whether to accept or reject papers

The editor of a peer-reviewed journal is always an eminent scientist with many years
of experience. The biggest and most prestigious journals often have full-time editors
- for example, the editors of The Lancet, New England Journal of Medicine and Nature
are paid professionals, with a distinguished academic career behind them. However,
the editors of smaller, specialized journals are almost always part-time and unpaid,
fitting in their editorial role alongside the demands of research, teaching and clinical
responsibilities. The editor is usually advised by an editorial board of other eminent
scientists or clinicians, who may sometimes also act as reviewers (see below).
A The reviewers advise the editor

Reviewers may be members of the editorial board, personal contacts of the editor, or
simply chosen from a database of suitably qualified people. Editors are constantly
adding to the pool of reviewers. Sometimes, they will remove from the pool those
who do not provide reviews on time, or do not meet the journal's standards for
scientific stringency and attention to detail. The details of the peer-review process
vary slightly between journals, but the general principle remains the same. Typically,
the editor will send out copies of the paper to two reviewers simultaneously. Others
may use a single reviewer to screen the paper, followed by a second reviewer if the
paper is deemed worthy of further consideration. A third reviewer may be called in
if the first two disagree, as sometimes happens. Many journals also now send papers
out for a separate statistical review - in fact, statistical inadequacy is one of the
commonest reasons for rejection. The reviewers do not actually make the decision to
accept or reject the paper - they merely advise the editor.
A The managing editor oversees the day-to-day running

of the journal
Most larger journals employ a managing editor to oversee the day-to-day running of
the journal and supervise the work of the copy-editors (see below). The managing
editor is often the easiest person to contact if you have questions about non-scientific
matters (for example, a request for a copy of the Instructions to Authors, or a query
about when your paper is to be published). However, queries regarding the scientific
content of your paper must always be addressed to the editor.
A Copy-editors (also known as sub-editors or desk editors)

edit your paper to journal style
Once a paper has been accepted for publication it will go through a process known
as copy-editing. Most journals employ copy-editors. The copy-editor will make
small changes to the paper so that it conforms exactly to the journal's 'house style'.
The house style lays down rules on everything from the size of headings to the
abbreviations allowed to the formatting of references. The copy-editor will also
correct grammatical and spelling errors, improve poorly constructed sentences and
paragraphs and generally polish the manuscript to publication standard.
A Remember that credibility depends on peer review

In peer-reviewed journals, original research papers or review articles are only pub-
lished if they meet the standards set by one or more independent expert reviewers.
Publication in peer-reviewed journals means that your work has been given a 'seal
of approval' by the scientific community.
A Peer review acts as 'quality control' for the scientific

content of papers
Readers will assume that peer-reviewed papers have been checked for:
a logical starting hypothesis, in the light of existing knowledge
appropriate experimental design and statistical analysis
complete and precise description according to a standard scientific format
reasonable conclusions supported by your own experiments and those of others.
A Peer review has its limitations

Of course, publication in a peer-reviewed journal is no guarantee that the conclu-
sions drawn in a paper are the ultimate answer to any particular scientific question.
Biomedical research is not like that - it deals in probabilities rather than absolute
proofs. Even papers by the most respected scientists are regularly revealed to have
been 'wrong' in the light of further research. What's more, the peer review process
is undoubtedly imperfect - it can be cumbersome, time-consuming and open to bias.
However, it is the best method so far devised for 'quality control' in science.
A Remember that reviewers are very

busy people
Reviewers give many hours of service to scientific journals - usually completely free
of charge. Without their goodwill the whole system would collapse. Most scientists
feel it to be their duty to their fellow researchers to take part in the peer-review
process. Most say that they find it interesting and educational. However, because the
best reviewers are constantly in demand, the time they can devote to reading and
commenting on each paper is limited. So, it pays to make sure that your paper is
written clearly and concisely, so that the reviewer can make a swift evaluation of the
scientific content without having to struggle with impenetrable writing.
A Expect your paper to be 'blinded' when it is sent to

the reviewers...
In order to make the reviewing process more fair, most journals adopt a policy of
'blinding' - the front sheet bearing the authors' names is taken off the paper so that
the reviewer does not know where the paper comes from and can therefore make an
unbiased assessment of its merits. In the same way, the reviewers' names are usually
not included on the list of comments sent to authors (so that the reviewers can be as
frank as they like without fear of complaint).
A ... But do not expect always to be assured anonymity

Of course, blinding can never be controlled completely - it may be obvious to the
reviewer from the text and references which research group carried out the study.
In a specialized area of research, where everyone knows everyone else, the data
may already have been discussed at conferences and informal meetings, and both
reviewer and author will be able to make an informed guess about each other's
identity. Authors may also know the identity of one of the reviewers if they actually
suggested them to the editor.
A Normally, you will not have to pay to have your

paper published ...
The vast majority of peer-reviewed journals cover their expenses by selling sub-
scriptions and advertising. In the case of society journals, the journal is at least
partially funded by membership fees. Authors are not normally charged for the
publication of their papers. This is as it should be - any other system would benefit
richer institutions and countries at the expense of the poor ones.
A ... Except under certain specific circumstances

The only exceptions to the 'no payment' rule are:
some journals may ask you to pay for the reproduction of photographs (particularly
colour photographs), which are expensive to print
a few journals publish short papers free, but expect authors to pay a 'page rate'
for papers over a certain length. This is not the same as being a 'pay journal' (see
below)
there are a small number of 'pay journals' that require the author to pay for
publication. Some of these operate a system of peer review, others do not. In
general, they are considered to be of lower status than the standard type of peer-
reviewed journal.
A Be prepared to make revisions

Once the reviewers have commented on the paper, the editor will write telling you
the fate of your paper. You may be told that it:
has been rejected outright
has been accepted (usually subject to at least minor revisions)
has been rejected, but may be reconsidered if various revisions can be made.
It is very unusual for a paper to be accepted exactly as it stands. Reviewers are
normally asked to provide detailed comments, either to help the author understand
the reasons for rejection or to explain the revisions required. Some reviewers are more
helpful than others in explaining what changes will make the paper 'publishable'.
A Do not expect the publishing process to be fast

The publishing process can be extremely lengthy. A wait of six months to a year from
submission to publication is typical - some journals may take longer. This is not
surprising when you consider that the peer-review process may take three or four
months, and the journal's editing and production processes another three or four
months. Some journals do not appear very often, so there may also be a backlog
of accepted papers waiting to be published. For advice on how to speed up the
publishing process, see Chapter 4.
A Be prepared to answer the copy-editor's queries promptly

and courteously
The copy-editor does not criticize the scientific content of a manuscript, but will try
to pick up any ambiguities or inconsistencies - for example, if the numbers given in
a table and those given in the text do not match exactly. After editing your paper, the
copy-editor will often submit a list of queries for your attention. If these queries
sometimes seem niggling, remember that the copy-editor is there to help you - by
detecting errors, however trivial, they protect the journal's reputation for accuracy,
saving you from potential embarrassment.
A It is your responsibility to check proofs carefully

After your manuscript has been copy-edited, it will be typeset and page proofs
returned to you for approval. This will be the last chance you have to see your paper
before it is published, so you will have to read the proofs carefully. It is your
responsibility to ensure that there are no errors, so be sure to check crucial elements
like numbers especially carefully. You must return the proofs on time to ensure that
you do not forfeit your place in the queue for publication.
3
Original research -
what can be published?
The importance of publication as a measure of career success leads many scientists

to try to publish as much as possible. On the other hand, editors and other pub-
lishing pundits constantly complain that readers are being overwhelmed by too
many papers. Here are some tips about what is permissible, and what is not. For
more information, see 'Redundant or duplicate publication' in Appendix 1.
A Generally speaking, you cannot publish the

same data twice
Journals are very strict about 'repetitive' or 'multiple' publication. This means that
you cannot publish the same data twice. When you submit your paper, it is
important to state in your covering letter that the content of your paper has not been
published elsewhere.
A An exception may be made for papers previously published

in another language
If your paper was previously published in another language, a translated 'second-
ary' version may be accepted by another journal, provided that:
the editors of both journals are kept fully informed
the papers are published at least two weeks apart
the secondary version faithfully reflects the data and interpretation of the original
(i.e. is a translation rather than a rewrite)
the secondary version is written for a different group of readers

the secondary version informs the audience of that fact and gives a reference to the
original.
A Publication of an abstract or poster does not count

as prior publication...
You can publish your data as an abstract or poster at a conference without pre-
judicing publication in a journal. Note that when you do publish your study in a
journal, you may add data or change your analysis or interpretation; this is perfectly
acceptable. You can usually present the same data at more than one meeting. How-
ever, a few large meetings stipulate that the data should not have been previously
presented at another meeting.
A ... Nor does an oral conference presentation

Oral presentation of your data at a conference does not count as prior publication.
Nor does a report of your presentation in a newspaper, unless it contains additional
data, tables or illustrations. You should, however, be cautious about giving press
interviews before you have published your study (see below).
A Do not pre-empt publication by releasing data to

the press
There have been cases where information from a study that had been accepted but
not yet published was released to the popular media. This is a violation of the
policies of many journals. Very occasionally, early release of data may be acceptable
- for example, to warn the public of health hazards. In this case, the release of data
must be negotiated with the editor of the journal in question.
A Do not try to slice your data too thinly

'Salami publication' or 'divided publication' are terms sometimes used to describe
studies that are sliced very thinly in order to obtain several publications from
the same data set. Sometimes, this seems justifiable. For example, some very large
Original research - what can be published? 15
studies contain so much data they take years to analyse. The full story could fill a
book. It is surely reasonable to publish such studies in segments. Other examples are
more debatable. For example, there is a tendency for individual centres involved in
large, multicentre trials to want to publish their own data, especially if they foresee
a long wait until the whole study is published. However, many leading clinical
journals have said that they disapprove of this practice, and that it could jeopardize
the final (full) publication.
4
Selecting the
right journal
The first rule of successful publication is to send your paper to the right journal.
However good the science is, however well written the paper, it can fail at the first
hurdle if it is sent to the wrong place. So let us take a look at how you select the right
journal for your paper.
A Draw up a shortlist of possible journals in

order of preference
You can save yourself time and trouble if you know where you are submitting your
paper before you begin to write. So think about this early - even before you complete
the research. Then you can do a little homework to make sure that you are sending
your paper to an appropriate journal.
A Think carefully about who will want to read your paper

The whole point of scientific publishing is to communicate your research to the right
audience. So start by thinking about who you want to read your paper. For example,
if it is a medical paper of interest to doctors in a wide range of specialties, you may
want to choose a general clinical journal. On the other hand, if you are conducting
superspecialized research that is of interest to only a few hundred scientists world-
wide, you may want to choose a superspecialized journal that is read only by those
people. Most papers will come somewhere in the middle, and will find a place in
journals that cover a broad area such as neuroscience, genetics or cardiology.
A Ask your colleagues for advice

Your fellow researchers will be able to tell you about their experiences with different
journals - which ones they think are most prestigious, which are most difficult to get
into, which publish fastest, and so on. You could also ask your librarian for his or her
opinion on which journals are the 'best' and most frequently used.
A Look first at the journals you read yourself

The first journals to consider are those that you and your colleagues read regularly.
If you look in these journals to find the studies that interest you, your own study is
likely to fit in well with the journal's policies and preferences. In some areas of
research the right journal will be obvious. If you are working in a very specialized
field there may be only a handful of specialist journals to which you would consider
sending your manuscript.
A Check whether your learned society publishes a journal

Check out the scientific societies to which you and your colleagues belong. If your
society publishes a journal, the chances are that your paper will fit into their prefer-
red spectrum of subjects.
A Review the literature to see where similar

papers are published
If you are new to a field, or if your research does not fit neatly into any journal with
which you are familiar, you can still check where papers on a similar topic have
been published. You will almost certainly have done a computer search to look for
relevant references, so check which journals come up time and time again on your
reference list - they can be assumed to be receptive to your particular topic.
A Consider all the journals whose readers might be

interested in your work
There is no need to be confined to your own narrow field. For example, as a
geneticist, you might be most familiar with genetics journals, but your paper on the
genetics of cystic fibrosis might find a wider readership in a clinical journal such as
Lung.
Selecting the right journal 19
A Remember that a full-length, original research paper

may not be your only option
If you have conducted a piece of original research, you will probably want to report
it in a full scientific paper with abstract, introduction, methods, results, discussion
and conclusions. Not everything published in scientific journals is a full, formal
research paper, however. Many journals also publish 'short communications' (a sort
of mini-paper), case reports and letters to the editor (see Chapter 1).
A Check that the journal accepts papers in the

format you have chosen
Look at a complete copy of the journal for guidance. If you do not have the journal
in your library you can contact the subscriptions department or the managing editor
for a sample copy, or you can simply ask 'Do you have a format for short com-
munications?' or 'Do you accept case reports?'
A Using the 'short communication' format may increase

your chances of acceptance
It is quite common for journals to send back a full paper and suggest that it be
rewritten as a short communication - so think about whether it should be written as
a short communication in the first instance! The short communication format is
particularly appropriate for small studies, pilot studies, or studies using standard
methodology that need not be described in great detail. Using the short communica-
tion format may increase your chances of acceptance and/or rapid publication (see
below).
A Put your shortlist of journals in rank order, from

first choice to last choice
All journals are not equal. Some are acknowledged leaders, while others are middle
of the field and some also-rans. Everyone would like to have their research pub-
lished in the 'top' journals, as this implies that it is of the best quality. You will
probably already have formed an idea of which journals are the 'best' in your field.
If not, ask your colleagues for their opinions, If you are still not sure, look at where
the most important and influential papers in your field have been published in the
last few years. Although seminal work does sometimes appear for the first time in
little-known journals, world opinion leaders usually publish their work in the 'best'
journals.
A For a quantitative measure of a journal's status,

look at the impact factor
Every year, league tables' are published for scientific journals by the Institute for
Scientific Information. The best known of the various measures they use is the
'impact factor'. This is the number of times articles from the journal were cited in
the previous two years. This gives an indication of how many people read articles in
the journal, and how important they think they are. Impact factors can be used to
compare journals, but only within the same scientific field, as they are influenced by
the popularity of the subject matter as well as the quality of the journal. Nowadays,
particularly in the USA, academic institutions attach considerable importance to
whether job or grant applicants have published papers in journals with high impact
factors. Impact factors are published in Current Contents and also in Journal Citation
Reports. Your librarian will be able to give you further information, or write to:
Institute for Scientific Information Institute for Scientific Information

3501 Market Street European Branch
Philadelphia Brunei Science Park
PA 19104 Brunei University
USA Uxbridge
Tel: +1 215 386 0100 UBS 3PQ
Fax: +1 215 386 2911 UK
Tel: +44 (0)1895 270016
Fax: +44 (0)1895 256710
A Think carefully about whether your paper is really

likely to be accepted by the top journals in your field
No reputable peer-review journal accepts every paper it receives, but there are wide
differences in journals' rejection rates. Leading journals such as the New England
Journal of Medicine (NEJM) accept as few as 10% of the papers that are submitted to
them. The NE/M's criteria for acceptance are tough - not only does the science have
to be excellent but the findings have to have the potential to change clinical practice.
Other top journals are similarly demanding.
A Consider the implications of rejection from

a top journal
You may feel that your paper is of the highest quality and that it is worth trying
to get it published in, say, Nature, The Lancet, the Journal of the American Medical
Association (JAMA) or the NEJM. The worst that can happen is a delay while your
paper is considered, during which time you cannot send it anywhere else. Publica-
tion in such a journal will certainly be a feather in your cap. On the other hand, you
may prefer to lower your sights just a little and send your paper to a specialist, but
still prestigious, journal where it will have a better chance of acceptance - say 40%.
Or you may decide that you would rather minimize your risk of rejection and send
your paper to a less demanding journal where you have a higher chance of
acceptance - say 80%.
A Remember that most journals will happily tell you their

rejection/acceptance rates
How do you know what a journal's acceptance/rejection rate is? Well, you can ask
them - some will be quite happy to give you that information. If not, you can usually
get an adequate idea from the prestige of the journal (see above) and the experiences
of any of your colleagues who have submitted papers to the same journal.
A If you are anxious to reach a large number of readers,

look at the journal's circulation
It may be important to you that your paper reaches a large number of readers. On
the other hand, you may not care too much as long as the right few hundred people
get to know about your findings. If you are interested, the advertising department
of your chosen journal will usually be able to tell you about the circulation of the
journal (how many copies are sold). They may also be able to give you a breakdown
of the readership by specialty and by country - they produce these statistics to help
them sell space to advertisers. By law, US journals print their circulation in the
journal. The highest circulation journals are usually the leading general clinical
journals and the journals of large societies.
A Find out how fast your paper is likely to be published

Journals vary widely in the time taken from submission of a paper to its eventual
publication. Speed of publication can be affected by:
how fast the editor and reviewers get round to looking at papers. Some journals
set strict time-limits for review while others are more relaxed
how often the journal is published. Generally speaking, your paper will take
longer to come out in a journal that is only published twice a year than in one that
is published every month
whether the journal has a large backlog of papers waiting to be published. Journals
vary in how many accepted papers they have queuing up for publication.
Most journals will happily give you an estimate of the average time from submission
to publication (or at least from acceptance to publication), though few will offer any
guarantees.
A Choose your journal carefully if you want fast publication

There may be certain circumstances in which rapid publication is important to you.
For example, in an extremely competitive field of research, you may want the kudos
of being published before a rival group (no-one said that science was entirely fair
and objective). If this is the case, the three strategies described below may help
(though none are guaranteed to work).
A Rapid publication strategy 1: Submit your paper

to a prestigious weekly journal
Being published frequently, journals like Nature or The Lancet tend to have short
lead-times and will usually let you have an accept/reject decision quickly. On the
other hand, they reject most of the papers submitted to them. You will have to decide
if your study is interesting enough and of sufficiently good quality to stand a chance
of being seriously considered, let alone accepted.
A Rapid publication strategy 2: Try a journal that

specializes in rapid publication
A small number of journals specialize in rapid publication. For example, the Rapid
Science group of journals guarantees a fast accept/reject decision and publication
within a specified time. (Rapid Science Publishers, 2-6 Boundary Row, London
SE1 8HN, UK. Tel: 0171 865 0198; Fax: 0171 928 6293; e-mail: rapid@rapidcom.co.uk.)
A Rapid publication strategy 3: Keep it short

Editors usually have a specific number of pages to fill every month. So a compact
three-page paper may stand more chance of finding an empty slot than a 15-page
monster. Some journals actually include a short communication format; others
simply have a mix of shorter and longer papers. There is no reason why you should
not enquire whether shorter papers are likely to be published more rapidly. How-
ever, do not expect any guarantees, especially before the editor has even seen the
paper.
A Discuss your choice with your co-authors

If your paper is to have more than one author, make sure that all co-authors agree on
which journal is to be your first choice, and on the fall-back options in case of
rejection. If there are any differences of opinion, it is important to resolve them as
early as possible, so that you can write the paper to meet the requirements of the
target journal.
5
Planning your writing
Just as careful planning underlies all good research projects, it is also essential to
good scientific writing. When reviewers complain that something is badly written,
often what they mean is that it is badly organized. Without good organization it
is impossible to write clearly or concisely. This section will help you to plan your
writing for greater clarity and readability.
A Planning is essential, especially in large documents

Careful planning is especially important with longer pieces of writing, such as a
thesis, a review article or a book. It is also crucial in the discussion and introduction
sections of original research papers. Without good organization, readers and re-
viewers will be unable to follow the logic of your argument, and may underestimate
the importance of your paper.
A Take time to plan

If you have a deadline looming, you may feel under pressure to start writing. But try
not to be tempted to jump right in without planning your writing first. Time invested
at this stage is well worthwhile - it will save you time later. The proportion of your
writing time that should be spent in planning will naturally vary with the type of
project and your personal working habits, but could be as much as a third of your
total writing time.
A Organize your writing to help your readers

Readers expect to see a logical flow in any piece of writing. If no structure is imposed
by the writer, the reader will be confused. When writing a scientific document, you
should aim to do all the sorting and classifying of information for your readers. You
need to provide them with a route map through your paper. Think carefully about
your readers' needs and how you can organize your writing to meet those needs.
A Remember to plan at different levels within your document

You need to plan and organize within:
the document as a whole (although the main sections of an original research paper
are already dictated by the IMRAD format - introduction, methods, results and
discussion)
the main sections
subsections dealing with different ideas or arguments
paragraphs
sentences.
A Try mind-mapping
Mind-mapping is a technique developed by psychologist Tony Buzan. It is based on
the idea that people do not naturally think in rigid hierarchies or lists. Instead, the
human mind darts around from subject to subject, moving naturally and creatively
from one topic to another, 'growing' one idea from another. Mind-mapping is a way
of capturing this 'radiant thinking' in a visual form, which can then be used to develop
a more rigid structure. Figure 5.1 shows a mind map for a review article. I used
mind-mapping when writing this book, and find it a very useful technique. Books
on mind-mapping and mind-mapping software are listed in Chapters 31 and 33.
A Try the 'yellow sticky' note technique for organizing ideas ...
Another way of making sense of a large number of ideas is to jot and key topics in
note form on 'yellow sticky' Post-it notes. You can then lay these out on your desk
- or even the wall or floor - and move them around until an appropriate plan emerges.
You can combine this technique very effectively with mind-mapping (see above).
A ... And their associated references

Another way of using the 'yellow sticky' approach is to write one Post-it note for
each reference, noting the author and title of the reference and the key points you
want to extract from it. You can then move these around as before - a great way of
planning introductions, discussions and whole review articles (see Chapters 9, 15
and 20).
Figure 5.1 Sample mind-map for a review article, prepared using MindMan software.
A Try building pyramids of ideas

A pyramid consists of a single brick at the top (the 'big idea' of the article). Under
this are several bigger bricks (supporting facts or ideas), and under these still more
smaller bricks (smaller facts or ideas). Make sure that you introduce the big bricks
first, before going on to support them with the smaller bricks. Never have piles of
little bricks lying around with no discernible structure.
A Try using the outline function on your word processor

Most well-known word-processing programs, including Word and WordPerfect,
have an outline function that will allow you to organize your ideas as a hierarchy
of headings. An outline of this kind will help you to define your main sections,
subsections and sub-subsections. However, it is often best to precede this phase of
planning with a more open phase such as mind-mapping, to make sure you do not
get stuck in the rut of straight-line thinking.
A Set yourself a word or page budget

A word or page budget is a plan allocating a certain number of words or pages for
the whole document and for each section within it. Setting such a budget will help
you to:
avoid wasting time by writing more than you need
assign the right amount of text to each section.
If you have ever written a 1000-word introduction to a 2000-word paper, or tried to
cut your thesis from 60 000 words to meet a statutory limit of 50 000 words, you will
understand why a word or page budget is necessary.
A Do not forget the journal may have length limits

Many journals will lay down limits in the instructions to authors not only for the
maximum length of different kinds of paper (pages or words), but also for the num-
bers of tables and figures. Check these limits before you start to write your paper.
Planning your writing 29
A Organize at the micro- as well as at the macro-level

Meticulous planning will allow you to organize your writing in advance, as far
as the paragraph level if you like. However, at least some of your organization will
have to be done as you write - or rather, as you edit what you have written. Chapters
24 and 26 tell you more about how to organize your sentences and paragraphs.
6
Research papers
and reviews: titles
Some people might say that the title is the most important part of a paper. After all,
how do you decide which papers to read? Probably by scanning down a journal's
title page or a list of titles downloaded from an on-line database. So it pays to think
carefully about the title of your paper and how you can use it to attract readers.
A Get the length right

As always, consult the Instructions to Authors, issued by the publisher. Many
journals are quite specific about the length of titles and their format. Length may be
specified in number of lines, number of words, or even in number of characters. If in
doubt, limit the title to not more than two lines of printed text.
A Get the format right

The Instructions to Authors may contain rules about how they would like the title
to be written. If in doubt, look at the journal for examples of its usual style. For
example, some journals specify that the title should consist of a single sentence;
others allow subtitles. Still others allow colons or dashes to join two parts of the title.
Some like the use of questions in the title; others do not. The NEJM does not like
titles in the 'declarative' format (see below), while others are quite happy to accept
this style.
A Make the title reader friendly

Make sure that the title contains all the information that you would like when
deciding whether or not to read a paper. Think about what would be relevant to your
readers. Thus, for an original paper, 'Efficacy of grottomycin and scabicillin in
sinusitis in adults' would be better than 'Antibiotic treatment of upper respiratory
tract infections'. Titles that are too general can be misleading.
A Include the keywords that readers will be searching for

Think about which words your target readers will be looking for when deciding
whether or not to read an article and remember all the people who conduct a titles-
only search as a way of narrowing down the number of items retrieved by on-line
searching. That is why it would be important to have 'grottomycin and scabicillin'
in the title, instead of something vague like 'macrolides and penicillins'.
A Include all key information

As E J Huth says in Medical Style and Format, 'The title should be as informative of
the article's content as possible within a reasonable length'. So, in an original research
paper, it is helpful to your readers to include, where relevant, information on:
independent and dependent variables involved
the species, subjects or patient group studied
condition of animals/subjects/patients
the experimental approach.
Thus, it would be even more helpful to readers to add key experimental details to
the title of the antibiotic study: 'Efficacy of grottomycin and scabicillin in sinusitis in
adults: a double-blind trial'. If your chosen journal dislikes the 'title : subtitle' format
you could try 'A double-blind comparison of the efficacy of grottomycin and scabi-
cillin in sinusitis in adults'. However, this would have the defect of leaving the key-
words until late in the title (see below).
A Make sure the most important keywords are near

the beginning of the title
Readers' concentration tends to be highest towards the beginning of a sentence, so it
will help to attract their attention if you put the most important word or words near
the beginning. For example, readers are more likely to be looking for the names
Research papers and reviews: titles 33
of the antibiotics 'grottomycin' and 'scabicillin' than they are for 'double-blind trial'.
Even though the experimental detail is relevant and useful, in this example it would
be more reader friendly to leave it until last.
A If the journal allows it, consider giving the conclusion

in the title
Some journals will encourage you to use declarative titles - that is, titles that give the
key result of the study, e.g. 'Grottomycin is more effective than scabicillin in sinusitis
in adults'. Declarative titles can be helpful to readers when you have a single, strong,
clear conclusion. However, some journals, such as the NEJM, prefer indicative
titles - titles that state what the study is about, but stop short of giving the key
conclusion. Their argument is that it is up to the readers to decide whether the
conclusion is justified on the basis of the results presented.
A If you do state the conclusion in the title, think

carefully about how 'aggressive' it sounds
Titles worded in the active voice, such as 'Metoprolol inhibits progression of athero-
sclerosis in cholesterol-fed rabbits', sound 'stronger' than those worded in the
passive voice, such as 'Inhibition of progression of atherosclerosis by metoprolol in
cholesterol-fed rabbits'. It all depends on whether you want the tone to be vigorous
and challenging or mild and restrained.
A Avoid wasting words

Phrases like 'in the treatment of, 'studies on', 'report of a case of can often be
omitted with no loss of meaning. Readers will exercise their common sense. Often,
depending on the style of the journal, you can use a more 'telegraphic' style, getting
rid of words such as 'the' and 'a'. For example, if you were restricted to 12 words,
'Efficacy of grottomycin and scabicillin in sinusitis in adults: a multicentre, randomized
double-blind trial' could become 'Grottomycin and scabicillin in sinusitis: a multi-
centre double-blind trial'. While it is quite effective to begin with 'Efficacy', it can be
safely left out in this example. After all, most readers would assume that a multi-
centre double-blind trial of antibiotics would be about efficacy, and that it would be
randomized.
A Avoid abbreviations in titles

Abbreviations could lead to the paper being missed in on-line searches, and may be
confusing to readers unfamiliar with the subject. Most journals will not allow any
abbreviations in the title (apart from the abbreviations for SI units).
A Do not forget your running title

The running title (sometimes called a running head) is a short phrase that appears at
the top or bottom of every page or every other page. It is designed to help readers
find their way around the journal, so that if they open it in the middle of a paper they
know what it is about. A running title is usually requested in the journal's Instruc-
tions to Authors, and is usually given on the title page. It should be recognizable as
a short version of the title, focusing on key terms. Abbreviations are usually perfectly
acceptable in running titles. Thus the running title of a paper entitled 'Separation and
identification of growth hormone variants with high-performance liquid chromato-
graphy techniques' could be 'HPLC separation of GH variants'.
7
Research papers
abstract
Nearly all original research papers have an abstract - a brief summary of the paper.
It is the basis on which readers decide for or against reading the whole paper.
A Polish the abstract until it is just right

The abstract is usually the first part of a paper that editors and reviewers read. It is
also the first, and sometimes the only, part of your paper that will be read by other
scientists and clinicians. If the abstract is not clear, concise and informative, readers
may not feel inclined to look any further into your paper. Therefore it pays to spend
some time getting the abstract right - a well-written abstract may help get your
paper published.
A Write the abstract after you have completed the paper

Usually, it is only after you have completed the paper that will you have thought
sufficiently deeply about your key findings and their interpretation; so you will
probably find it easiest to write the abstract last.
A If you do write the abstract first, revise it later

Some people find that writing a draft abstract before they sit down to write their
paper helps them to plan the paper more effectively. Or you may already have
written an abstract for a poster or presentation, and later write up the same data into
a full paper. In that case, do not forget to revise the original draft abstract before you
submit the paper - you will almost certainly want to make some changes.
A Do not exceed the stipulated length

Most Instructions to Authors stipulate a maximum length for the abstract - usually
about 150-200 words. Even if no length is stipulated, keep it short. Some on-
line databases cut off ('truncate') the abstract at 250 words, so anything longer is
wasted.
A Check to see whether the journal uses

structured abstracts
Some journals, such as JAMA, use a structured abstract format. Subheadings are laid
down by the journal, and might include, for example:
Objective
Design
Setting
Patients
Primary outcome measures
Results
Conclusions.
A Use the structured abstract format to help you

plan any abstract
If you need help deciding what to put into your abstract, and in what order, you can
use the structured abstract format to help you plan. Then, when you have done this,
just take the headings out and you have a well-planned ordinary abstract. However,
don't try submitting a structured abstract to a journal that does not use this format
- the copy-editor will simply take the headings out anyway.
A Write your abstract as one paragraph, unless it is

a structured abstract or the Instructions to Authors
say otherwise
Even though it might be more logical to divide up your abstract into paragraphs,
most journals require abstracts (other than structured abstracts) to be written as one
paragraph.
Research papers: abstract 37
A Think about what you, as a reader, would like to

find in the abstract
What are the most important questions you would want the abstract to answer? As
Maeve O'Connor says in How to Copy-edit Scientific Papers: 'An abstract should
answer the questions why did you start, what did you do, what answer did you get,
and what does it mean anyway?'
A Make sure the abstract is self-contained ...

The abstract should stand alone, without reference to the main body of the paper -
remember, it will be read in isolation when it appears in a database.
A ... And faithfully reflects the content of the paper

Never give any information in the abstract that is not included in the body of the
paper.
A Always state the objective of the study

You will often see abstracts that jump straight into the study design. However, it is
essential that readers know the objective of the study. What question were you
asking when you began? As explained in Chapter 10, the objective and the method
used to achieve it can be included in the same sentence, e.g. 'A randomized, placebo-
controlled, double-blind study was conducted to determine ...'
A If you have space, give a sentence or two of

background before the objective
If you can afford the space, just one or two sentences establishing the context of the
study will be helpful to readers who are unfamiliar with the current state of
knowledge. For example, you could put 'Previous studies have shown ... However,
it is not known whether ...' That would be just two sentences to set the scene. You
could then go on to state the objective of the study: 'We therefore carried out a
randomized, placebo-controlled, double-blind study to determine ...' But do not
waste space telling readers things they would almost certainly know, like 'Coronary
heart disease is one of the commonest causes of death in the industrialized countries'.
A Give relevant details about the substances, tissues,

species, subjects or patients included
To make an evaluation of the paper, readers need to know about the substances, tis-
sues, species, subjects or patients used. They also need to know about their condition
and, where appropriate, the sample size (e.g. '21 anaesthetized rats' or '205 diabetic
men aged 16-65 years').
A Unless it is a 'methods' paper, keep the methods in

the abstract brief
Unless the whole point of the paper is to describe a new method, detail should be
kept to the minimum necessary to understand the results. But make sure you give
the key information, without which the results would be meaningless (e.g. doses of
drugs, duration of the study).
A The results of the study should comprise the bulk

of the abstract
Readers are most interested in what you found in answer to the question you asked.
So, in most abstracts, the results should take up most of the space. Think about
which are the most important results and put them first. Pick out the most important
pieces of data and use them, but beware of overwhelming the reader with endless
strings of numbers.
A If you give percentages, make sure you also give the

sample size
Readers need not just percentages but the sample size in order to make an informed
judgement of the validity of the data. If the sample size does not vary, you need give
it only once. If the sample size varies within the study, make this clear when you give
the relevant data.
Research papers: abstract 39
A If you give p values, make sure you give the

actual data as well
It is not enough just to say 'Significantly more patients recovered in the treatment
group than in the placebo group (p < 0.05)'. You need to give the actual data as well:
'Significantly more patients recovered in the treatment group than in the placebo
group (86% vs 56%, p < 0.05).
A At the end of the abstract, briefly state the main conclusion

It helps the readers to know the 'bottom line', if there is one, e.g. This study shows
that grottomycin is more effective than scabicillin in sinusitis in adults. It therefore
offers a valuable new option in the management of this common condition'.
A State any important implications (optional)

If your findings are genuinely likely to change clinical practice, or change the whole
way scientists look at the topic, there is no reason why you should not say so in the
abstract. Otherwise, there is no need to say anything.
A Avoid non-standard abbreviations

All journals will allow you to use the standard abbreviations for SI units without
spelling them out the first time they are used (e.g. g, L, cm). Most journals also have
a standard list of other abbreviations which can be used without being spelled out
(e.g. DNA, t.i.d.). Otherwise, only abbreviate a long term:
if it is a widely recognised abbreviation
if it is used repeatedly within the abstract.
For example, it is appropriate to abbreviate 'positron emission tomography' to 'PET'
if it is used repeatedly in the abstract. This abbreviation is well known and saves
a useful amount of space if it is used repeatedly. However, most journals would
prefer you to spell out 'cefotaxime' rather than to abbreviate it to 'CTX', which is
non-standard and saves very little space. If you use non-Si abbreviations, always spell
them out the first time you use them, e.g. 'positron emission tomography (PET)'.
A Do not cite references in the abstract

Most journals have an absolute rule against citing references in the abstract. Very
occasionally, you might be able to persuade them to make an exception, if citing a
reference really does make life easier for the readers. For example, if the publication
is a re-analysis of data from an earlier study, or a modification of a previously
reported method, a reference would be useful. Note that the no references rule does
not always apply to conference abstracts (see Chapter 8).
A Edit your abstract to eliminate wordiness

The first draft of your abstract is likely to be too long. Do not worry - thoroughly
editing it according to the principle of clear, concise writing outlined in Chapters
24-26 will help you to reduce the number of words without losing any of the meaning.
Use short sentences.
Use short, simple words.
Be very specific in your choice of words.
Edit out all 'waste' words.
Use the active voice wherever appropriate.
Do not be afraid to use 'we'.
A Apply this reviewer's checklist to your abstract

Does the abstract:
Q briefly establish the context, if space allows?
Q state the main question you set out to answer?
Q state the population or material studied?
Q state the experimental approach or protocol used?
Q state the most important results in logical order?
Q state the main conclusion (the answer to the question)?
Q give adequate data to support the conclusion?
Q state any important implications (optional)?
Q give a good overall impression - is the study well-conducted, interesting, worth-
while?
8
Conference abstracts
Most researchers will want to submit abstracts to scientific conferences to gain

acceptance for an oral or poster presentation. These abstracts will be published in the
form of an abstract book, which may itself be a part of a journal (and as such citeable
as a reference).
Nearly all the rules given for writing abstracts as part of an original research paper
apply to writing abstracts to appear in conference abstract books. However, there are
some special points to note, as follows.
A A well-written abstract may help get your

contribution accepted...
The content of the abstract will determine whether or not your contribution is
accepted by the organizing committee. Some conferences have a policy of accepting
nearly all abstracts submitted for publication in the abstract book, but also use
abstracts to decide which contributions should be presented as posters or orally. The
better the abstract, the better your chances of being asked to give a presentation.
Selection committees look for good science - but if the abstract is confusingly written
or incomplete, the standard of the research may be underestimated. A well-written
abstract allows the scientific quality of a study to be assessed objectively.
A ... And stimulate interest in your presentation

or poster
During the conference itself, a clearly written abstract also encourages people to
come to your talk or look at your poster.
A Get a copy of the instructions for submission of

abstracts, and follow them carefully
Failure to follow the rules could result in your abstract being immediately returned
to you for amendment, wasting the organizer's time and your own. Your abstract
could even be rejected. Usually, conference abstracts are typed within a box of a
predetermined size. This ensures that all abstracts look similar, and can be photo-
reduced to fit the abstract book (usually four on a page). Recently, some conference
organizers have asked for abstracts to be submitted electronically, by disk or e-mail,
so that desktop publishing software can be used to produce a uniform appearance
for all abstracts.
A Make sure your abstract fits inside the box

If you are asked to type your abstract into a box, do not imagine that a couple of
extra lines outside the box will be all right. The best you can expect is that the
abstract will be returned to you for amendment. If the editor of the abstract book is
in a less generous mood, your 'extra' lines could even be cut off during the pro-
duction process, resulting in the publication of a truncated abstract. The easiest way
to ensure that your abstract fits is to set up the margin settings on your word
processor to match the box, then type in the predetermined space.
A Edit your abstract thoroughly to make it fit

Ruthless editing for 'waste' words is often all you need to make a too-long abstract
fit inside the box. Start by editing to eliminate any single-word or very short lines
which waste a lot of space.
A Consider adjusting the type size slightly to fit in excess words

Using your word processor, you can often make a tiny adjustment in point size that
will allow you to fit your abstract within the box. For example, a reduction from
12-point to 11.5-point type may be all you need to fit in an extra line or two. But do
not break the organizer's rules (some specify a type size) and do not use type so
small no one will be able to read it when photo-reduced.
Conference abstracts 43
A A tiny adjustment in line spacing can

also help
Most word processors will allow the adjustment of line spacing in small increments.
Reducing the line spacing from 1.0 to 0.9 can help you lose a line or two without
making the abstract any more difficult to read.
A Use the 'make it fit' function on your word processor,

if it has one
Some of the more sophisticated word processors such as WordPerfect and Word will
automatically adjust type size and line spacing to make a block of type fit in a
predetermined space (see Chapter 30).
A Consider using a graph or table if allowed

Journal abstracts never contain graphs or tables, mainly because these features
cannot be included in on-line databases. However, many conference organizers are
happy for you to include a graph or table in your conference abstract, provided it fits
within the box. This can be a nice way of displaying your data. If you use a graph,
make sure the labelling is large enough to withstand photo-reduction - the labels
should be about the same type size as the body text. Note that abstracts submitted
electronically should not contain graphs or tables.
A You can use references in conference abstracts,

if you really want to
In contrast to journal abstracts, there is no reason why you should not include one
or two key references in a conference abstract, if you feel it is a worthwhile use of
your limited space.
A Do not overdo the use of abbreviations

You have more leeway to use abbreviations in conference abstracts than in journal
abstracts. Basically, you can use any abbreviation you like as long as you spell it out
the first time it is used. However, spare a thought for your poor readers and do not
over-use them. Abbreviations coined for the purpose of the abstract should be
intuitively recognizable and not open to confusion with standard abbreviations.
(Don't you hate the kind of conference abstract that says TDQ was used to compare
the OP of ABC and XYZ at D3 in HB'?)
A Without results, your conference abstract may not

be accepted...
It used to be common to see conference abstracts in the 'indicative' format. This
format tells you what question the study was designed to answer, and something
about the methods, but no results. You will probably have seen abstracts that begin
'Results will be presented for ...' This gambit can be very useful for studies that are
incomplete at the time of submission of the abstract. However, many organizing
committees now refuse to accept such abstracts. They want to guard against the
possibility that no results will be available for the meeting, and the abstract will have
to be withdrawn. If you want to use an indicative abstract, it is advisable to check
the organizing committee's policy.
A ... But you can give interim results if necessary

It is, however, usually acceptable to give interim results - for example, for a small
number of patients, or for just some of the parameters you measured. If the
organizers can be convinced that you will be in a position to present the full results
at the meeting, they will be satisfied.
9
Research papers:
introduction
The introduction describes why the research was done, and provides a context for
the later discussion of the results. It allows readers to understand the background to
the study, without having to consult the literature themselves.
A Remember that the introduction 'sells' the study

After reading the introduction, your readers should be convinced that your research
is the next logical scientific step, and be keen to read on. As always, do not forget that
readers include editors and reviewers as well as the wider scientific community. A
well-written introduction can help to get your paper published by giving a good first
impression, establishing your scientific credibility.
A Do not get stuck on the introduction

It is common for novice paper-writers to waste a lot of their time trying to get the
introduction right before moving on to the rest of the paper. Ever spent hours trying
to think of the first sentence? Many experienced authors write the introduction after
the other main sections for two reasons:
1 it is easier to be clear-minded about why the study was necessary after you have
put your own results in context with previous work in the discussion
2 writing the introduction last means that you are less likely to make it too long. No
one wants to work hard writing text and then have to cut it.
A Limit the length of the introduction

Editors often complain that introductions are too long. You only need provide
enough information to help readers understand the reasons for the study. The intro-
duction is not a wide-ranging review of your field of research. Look at your chosen
journal to check the typical length of introduction relative to the rest of the paper.
Often, it will be no more than one-eighth or one-tenth of the total length. Half a
printed page or 400-500 words is also a good guide.
A Do not overinflate the introduction at the expense of

the discussion
Do not forget that in the discussion you will have the opportunity to compare and
contrast the findings of your study with those of other researchers . If you go into too
much detail about other researchers' findings in the introduction, you will end up
repeating yourself in the discussion.
A Select references carefully

Cite only those references that are truly relevant. This is not your PhD thesis - you
do not need to prove how well read you are.
A Use the present tense for generalizations

Use the present tense for generalizations, and a past/present combination for specific
findings that are now established fact. For example:
generalization: 'Repetitive strain injury (RSI) is [present tense] one of the com-
monest complications of writing a thesis.1'
specific finding: "The Postgraduate Writers' Trial has shown [past tense] that use
of a wrist rest reduces [present tense] the risk of RSI.2'
In both of these examples, the use of the present tense is a convention to indicate
established fact. In effect, it means that we are convinced that the findings of the
Postgraduate Writers' Trial are valid.
Research papers: introduction 47
A Use the past tense for specific findings with which you
are about to take issue
It is acceptable to use the past tense for specific findings of others that are not con-
sidered established fact, e.g. 'Smith and Brown reported [past tense] that the moon
was made of green cheese.3 However, other studies have not confirmed this finding.4"5'
A Begin the introduction with what is known

Start off by briefly summarizing relevant current knowledge of the topic, supporting
your statements with references as necessary.
A Move on to what is not known (or a problem with the known)

Having summarized the established facts, move on to areas where there is less or no
knowledge, or where the evidence is conflicting.
A End the introduction by stating the question

Every study sets out to answer a specific question, which is stated explicitly in the
introduction. Make sure the question follows logically from the preceding sentences.
State the question carefully because you will be coming back to it later when you
show how your results answer the question.
A State the question in a new paragraph

Stating the question in a new paragraph - the last paragraph of the introduction -
attracts attention. Readers naturally look to the last paragraph of the introduction to
find the question.
A Use 'signalling' words and phrases to highlight the question

Examples include:
'However, it is not known whether ...'
To answer this question we ...'

To clarify the role of A in B, we ...'
To determine whether ...'
To compare the efficacy of X and Y in Z, we ...'
Note the use of active verbs such as clarify, determine, compare, establish, verify, find out
in the statement of the question.
A Very briefly, state how you set out to answer

the question
After stating the question, give very brief details of how you set out to answer it -
this will help emphasize the rationale for the study, and set the scene for the methods
section to follow. Mention the experimental method and the species, material or
patient group as appropriate.
A The question and what was done to answer it can

often be combined
Often, you can go straight on from the question to the experimental method, e.g. To
compare the efficacy of grottomycin with scabicillin in sinusitis, we conducted
a multicentre, double-blind randomized trial in adults'. But beware of writing
excessively long sentences.
A Always state the question in the present tense and

what was done to answer it in the past tense
To determine whether X is effective in Y, we conducted a double-blind, placebo-
controlled study in ...'
A Clearly separate minor questions from the

main question
There may be subsidiary questions that you set out to answer. If so, state these in one
or more separate sentences, e.g. 'We also investigated the effects of C on D'.
Research papers: introduction 49
A The introduction tells a story - make sure it has

a logical flow
The introduction needs to provide a convincing justification for your reasearch.
Make sure your readers understand the connections between one part of the story
and another. Underline the logic with signalling words and phrases such as:
'Thus, it appears that ...'; 'It was previously believed that ...'; 'However, recent
studies have shown ...'
A Do not be afraid to say what is new and important

about the study
Your introduction helps to 'sell' the paper to readers and reviewers; so do not be
afraid to state what is new or important about it. There is no need to be boastful -
just state the facts, e.g. 'Placebo-controlled pilot studies have shown grottomycin to
be clinically and microbiologically effective in acute sinusitis in adults, but so far
no comparisons with other agents have been reported. We therefore conducted a
multicentre, double-blind randomized trial to compare the efficacy of grottomycin
with that of the standard treatment, scabicillin'.
A Apply this reviewer's checklist to your introduction

Does the introduction:
Q identify a gap in scientific knowledge?
Q show why the study was necessary?
Q state the question clearly?
Q briefly summarize the approach?
Q show what is new and important about the study?
Q 'sell' the study?
10
Research papers
methods
This section of a research paper may be entitled just Methods, or Materials and methods
or Patients and methods, depending on the journal. Its function is to allow interested
readers to judge the validity of your results in the context of the methods used. It is
equivalent to a 'recipe' for the investigation.
A Remember the 'acid test' - repeatability

The classical test of a methods section is that it should be sufficiently detailed to
allow competent investigators to repeat the study, should they wish to do so. This
means that the methods should be comprehensive, while avoiding fussy, irrelevant
detail.
A Write the methods section first

Usually, the methods section is the easiest to write - you may even have some of it
ready-written in the form of a protocol. Writing the easiest part of the paper first will
begin to focus your mind on the results linked to the methods. It will also give you
confidence, as you will have got a substantial part of the paper finished, usually
quite quickly and easily.
A Make the methods as long as they need to be -

but no longer
To meet the criterion of repeatability, the methods section often has to be quite long.
This is not necessarily a problem - it is common for the methods to take up a third
or more of the paper. However, if you find they are more than half the length of the
paper, you should consider whether all the detail is strictly necessary. You might
well decide that it is justified - it all depends on the type of study.
A Just summarize the methods if they have been

described in another paper
Occasionally, the methods of your study will have already been described in detail
in another publication. For example, some large, multicentre clinical studies publish
their methods in a separate paper at the outset of the study. Subsequent papers
originating from such studies should just give a brief summary of the methods -
enough to enable readers to understand the content of the paper - and a reference.
A Describe only methods for which you later

give a result
List only those methods for which you will later give a result. In this respect, the
methods of a research paper differs from that of a thesis or clinical trial report, in
which everything you either did or planned to do may be described for complete-
ness - even if no result was obtained. In a paper, you can leave out a method if it
yielded no result for some technical reason. You cannot of course leave out a method
simply because the result did not fit in with your hypothesis!
A Write the methods in a logical order

The convention usually used is:
1 materials, animals, subjects or patients
2 study design (including randomization)
3 observational and experimental methods
4 statistical methods used to evaluate the significance of the results.
Research papers: methods 53
If you think about it, this is more or less the same sequence in which research is
carried out - you cannot start until you have decided which animals, subjects or
patients to work on, you cannot undertake any observations or measurements until
you have designed the study and so on.
A Clinical trials also follow the standard order

Clinical trial reports also follow the standard order, which may be further broken
down into:
1 patient recruitment
2 inclusion/exclusion criteria
3 method of randomization
4 primary efficacy measure
5 secondary efficacy measures
6 adverse events monitoring
7 statistical methods
8 statement of compliance with ethical regulations.
A Prefer logical order to strict chronological order

Although you write the methods in roughly the same order as you did the research,
there is no need to follow a strict chronological order. This is unnecessary and may
be confusing. Often, we do things in a certain order simply for convenience. For
example, you may only have been able to gain access to equipment at certain times.
The methods section should flow logically, rather than being simply a diary of what
you did.
A Use subheadings if needed

Long methods sections benefit from the use of subheadings to help readers find their
way around. Most journals provide for the use of subheadings of your own choice,
such as Study design, Patient selection, Treatments, Outcome measures, Statistical methods
and so on.
A Use tables or flow charts if required

There is no reason why tables and flow charts should be confined to the results
section - most journals will let you use them in the methods if you need to. For
example, a flow chart may be useful in describing a complex study design, or a table
in listing strains of micro-organisms and their origin. Remember, however, the rules
for using tables and illustrations given in Chapters 12 and 13. Journals will not
accept them if they feel the information could have been presented just as well in the
text.
A Answer the questions readers (and reviewers)

Will want to ask
Imagine the questions that would be going through an informed colleague's mind
about 'How many?', 'How much?' and 'How long?', and aim to provide precise
answers.
A Write the methods in the past tense

As you are describing what you did, rather than stating established fact, it is correct
to use the past tense throughout the methods.
A 'We' is usually acceptable and adds variety

Most journals are happy for you to use 'we' (meaning the researchers) in an active
construction, e.g. 'We measured lower leg growth using a knemometer' as an altern-
ative to the traditional passive construction 'Lower leg growth was measured using
a kemometer'. This can add variety to the methods section. Beware, however, of
writing something that sounds like a child's description of a day at the seaside: 'We
did this. We did that. We did something else.'
A Do not describe established techniques in detail

Novel techniques, or variants on old ones, should be described in detail. However,
if you followed an established method, you only need to describe it briefly. Use your
judgement regarding whether a reference is necessary - do readers need a reference
to enable them to look up and follow the technique? There is no need to discuss or
provide references for statistical techniques unless they are unusual.
Research papers: methods 55
A In clinical trials, distinguish between primary and

secondary outcome measures
It is usual to have one primary measure of efficacy and perhaps a number of second-
ary ones. For example, in a trial of corticosteroids in asthma, the primary outcome
measure might be 'percentage change in morning peak expiratory flow rate (PEFR)
compared with baseline'. Secondary outcome measures might include 'use of bron-
chodilators' and 'patient's subjective rating of efficacy of treatment'. Primary outcome
measures (sometimes called primary efficacy variables) are always described before
secondary measures.
A In studies on humans, remember to state compliance

with ethical regulations
This statement conventionally goes at the end of the methods section. A typical state-
ment would be: The trial protocol was approved by the Ethical Committee of the
University Hospital of Wherever, and the trial was conducted in accordance with the
Tokyo Amendment of the Declaration of Helsinki. All patients gave informed consent.'
A Include relevant statistical information

Make sure you include all the relevant statistical information:
statistical tests. You need not give references for common tests, but you should give
references for any unusual techniques
method of randomization. This often used to be omitted, but many journals now
require it. You can be very brief, e.g. 'Patients were allocated to treatment and
placebo groups using a blinded randomization list'
power of the study. Where appropriate, describe any power calculations you carried
out to determine appropriate sample sizes for your study
p value taken to indicate statistical significance. Although it is often assumed that a p
value of 0.05 or less indicates statistical significance, statisticians prefer you to
make this absolutely clear.
A In clinical trials, patient baseline data go in the results,

not the methods
One common mistake of which editors complain is the inclusion of patient baseline
data (sometimes called demographic data) in the methods section. Example of such
data include age, weight, gender and so on. Usually a comparison is made to find
out if there were any significant differences in baseline characteristics between

groups at the start of the study. All these observations, measurements and calcula-
tions are made on patients who you have already decided to include in the study
and are therefore results and not methods.
A Use 'measured', 'calculated' and 'estimated' precisely

Be precise about what you actually did to obtain the numbers given in the results.
You can use 'determined' to cover the mixed process of measuring and calculating.
Avoid the use of vague terms like 'evaluated' when there is a more precise alternative.
A Make relationships between parts of the sample clear

If you only performed certain measurements or procedures on part of the sample,
make this clear, e.g. 'PET scanning was performed on four of the 11 subjects in the
drug treatment group and five of the 13 subjects in the placebo group'.
A Be concise
The methods section may be quite long, but that does not mean that you can afford
to waste space. Avoid 'waste' words, repetition and fussy detail that is not relevant
to the repeatability of the study.
A Apply this reviewer's checklist to your methods

Do the methods:
Q clearly describe how the question was approached?
Q give necessary detail about any animals used, e.g. species, housing, age, weight?
Q state the method of randomization (often neglected)?
Q state group sizes?
Q give inclusion and exclusion criteria for patients or subjects?
Q give necessary details of materials?
Q state precise drug dose regimens?
Q use up-to-date and appropriate techniques?
Q use an appropriate means of statistical analysis (chosen a priori)!
Q give an estimate of the power of the study?
Q state the p value used to disprove the null hypothesis?
Q make clear which question is addressed by which method?
Q provide sufficient information to allow repetition by another scientist?
11
Research papers:
results
The function of the results section is to present the data obtained during the study.
The results section is the 'core' of the paper, even though it can be quite short. It is
often the first place that readers familiar with the topic will look (after the title and
abstract). Readers expect the results to provide them with enough data to draw their
own conclusions about the answer to the question posed in the introduction.
A Match the results to the methods

For every result that you describe, there should be a method and vice versa. Check
each section and make sure that there are no 'unmatched' results or methods. The
results follow the same order as the methods - if you have ordered your methods
logically, the results will also be in logical order.
A The results usually follow a standard order

The typical order of the results, which mirrors the standard order of the methods, is:
1 baseline data
2 effectiveness of randomization
3 observational and experimental data from most important to least important.
An expanded version of this standard order is given for the results of clinical trials
(see below).
A There is a standard way of presenting the

results of clinical trials
In clinical trials, the standard order of the results is usually as follows:
1 baseline data (sometimes called demographic data)
2 effectiveness of randomization
3 patients included in the analysis (intention to treat/fully evaluable patients)
4 primary outcome measures
5 secondary outcome measures
6 adverse events
7 deaths.
There are exceptions, of course - for example, a trial might compare two agents of
equal efficacy in terms of their side-effects, in which case 'adverse events' would be
the primary outcome measure.
A Use subheadings in long results sections

As in the methods section, subheadings can help readers to find their way around
a long results section. You might like to use separate subheadings to distinguish
between outcome measure, e.g. 'Five-year survival', 'Costs of treatment'. Smaller
subheadings can be used where necessary for further subdivision, e.g. 'Control
group', Treatment group' or 'Men, Women'.
A Match results subheadings to methods subheadings

If you used subheadings in your methods section, you can go on to use the same
subheadings (within reason) in the results.
A Focus on results that help to answer the question

Your results should be mainly composed of data that help to answer the question
posed in the introduction. This means that you must report your predetermined
primary and secondary outcome measures.
A You do not have to include every piece of data you obtained

You do not have to report all the data collected, only that which is relevant and
representative. The mere fact that you measured something does not force you to
Research papers: results 59
include it in your results. Data that do not help to answer the question can be
excluded, or summarized in a sentence or two. For example, most drug trials collect
extensive biochemical and haematological data. If nothing untoward is observed, it
is usually enough to say 'No clinically relevant abnormalities were seen in routine
biochemical and haematological testing'.
A Include results whether or not they support your hypothesis

Although it is permissible to select results in terms of leaving out irrelevant or in-
complete data, it is certainly not permissible to leave out results simply because they
do not give you the answer you want.
A Use tables and figures wherever appropriate, especially

for important results
Many readers look at the tables and figures first to try and get the gist of the results;
so, if data can be presented more effectively in tables or figures, do so. There are four
good reasons for using a table or figure:
1 it is the only reasonable way of presenting the data (e.g. you cannot describe a
three-dimensional graph)
2 it is the easiest way to understand the data (e.g. change over time)
3 it is the most space-efficient way of presenting the data (e.g. large tables would
require a great deal of text space to describe their content)
4 it highlights the most important findings (e.g. a bar chart to demonstrate dramatic
differences between study groups). Many editors do not regard 'emphasis' as
sufficient reason to use a figure or table.
A Do not submit more tables and graphs than the

journal is likely to accept
Many journals have a rule that you cannot use tables or graphs to represent data that
could have been given more concisely in the text. As E J Huth says in How to Write
and Publish Papers in the Medical Sciences: 'Editors must hold down numbers of tables
and illustrations because of their high cost and potential difficulties in layout.' So be
prepared to select among the many tables and graphs that could be used to illustrate
your results, and choose those that are essential. Look at the journal to see what ratio
of figures and tables to text seems acceptable - some journals actually specify 'no
more than X figures or tables' in the Instructions to Authors.
A Do not repeat large amounts of data from tables

and graphs in the text
Most journals' Instructions to Authors warn against repetition of data from tables
and graphs in the text.
A Make general statements, then back them up

with specific data
Do not be afraid to state the 'obvious'. This saves work for the reader, and helps
them to distinguish the key points in your paper. For example, it is more helpful to
say 'Mean time to recovery was significantly faster in the treatment group than in the
placebo group (6.5 vs 14.1 days, p < 0.05)', rather than just 'Mean time to recovery
was 6.5 days in the treatment group and 14.1 days in the placebo group'.
A If there were no significant differences, there is

no need to give p values
It is usually enough to say There were no significant differences between the treat-
ments for outcome measures A, B and C' rather than to give p values for each com-
parison. However, if you were including p values in a table, you would include them
whether or not they showed significant differences.
A Emphasize important differences

You can report percentage change or percentage difference as well as (but not instead
of) exact data.
A Give results for experimental groups before those

for control groups
It is conventional to give results for experimental groups first, to make comparison
easier for readers. Thus, you would put: The mean clinical cure rate at two weeks
was 98% in the treatment group and 54% in the placebo group' and not The mean
clinical cure rate at two weeks was 54% in the placebo group and 98% in the
treatment group'.
Research papers: results 61
A Remember to give confidence limits/standard deviation

and sample size
When comparing means, it is usual to give confidence limits (CI)/standard deviation
(SD) and sample size as well as p values. Check past copies of the journal for how
confidence limits and standard deviations should be expressed. If in doubt, take
advice from a statistician.
A If the sample size varies, give actual numbers

after percentages
Even if readers could work out the sample size from information given elsewhere in
the text, it is helpful for them to see it next to the data, e.g. 'Of the patients receiving
scabicillin, 46% (17/37) reported one or more adverse events'.
A Always refer to figures and tables in the text

Make sure that every figure and table you include is mentioned in the text. The
standard practice is to put figure and table citations in brackets at the end of the first
sentence stating the relevant result, e.g. The mean clinical cure rate at two weeks
was 98% in the treatment group and 54% in the placebo group (Figure 1)'. Do not put
'see Figure 1' or 'Figure 1, below' - if you do, the journal's copy-editor will edit out
the excess words.
A It is acceptable to put data in brackets after stating

the result they support
Giving a general statement of the result, followed by specific data in brackets, is an
economical way of presenting results. For example, you could put: 'The incidence of
diarrhoea was significantly lower in the grottomycin group than in the scabicillin
group (14% vs 38%, p = 0.021).'
A Generally speaking, readers will assume 'significant'

refers to statistics
Just say 'significant difference' or 'significantly different' to denote statistical signi-
ficance; there is rarely any need to say 'statistically significant difference'. Generally
speaking, editors do not like the use of the term 'clinically significant', as it has the
potential to cause confusion. Prefer 'clinically relevant' or 'clinically important' instead.
A Avoid vague comparisons, or those that make value judgements

Be specific - what does 'increased markedly' really mean? It would be better to put
'increased by 100%', or 'doubled' or 'twice the effect'.
A Write all of the results in the past tense

The results describe what was found in one particular study rather than established
fact, and should all be in the past tense.
A Do not be tempted to discuss the results

However tempting it may be to give each result and then to discuss what it means,
this is not the norm in biomedical papers. A strict distinction should be drawn
between saying what you found and discussing what it means. You should not
attempt to draw conclusions, nor to relate your findings to the work of others.
A Do not include references in the results section

Since the results must only report what you found, it is not appropriate to refer to
the work of others.
A Apply this reviewer's checklist to your results

Do the results:
Q establish the comparability of groups?
Q give both the size and significance of differences?
G give means to no more than one decimal point than that of original measurement?
Q give means with sample size, range, SD and/or CI where appropriate?
Q give analyses of variance with degrees of freedom and F values where appropriate?
Q include appropriate figures and tables?
Q not repeat data given in figures and tables in text (except for key data)?
Q present but not discuss data?
Q avoid misleading statements (e.g. 'X was larger than Y but the difference failed to
achieve statistical significance')?
12
Research papers
figures
The term 'figures', as used by biomedical journals, may include:

graphs (e.g. line graphs, scattergrams)
charts (e.g. vertical or horizontal bar graphs, pie charts)
photographs (black and white or colour)
micrographs/electron micrographs
electrophoretograms
polygraph recordings (e.g. ECG, EEG)
line drawings (e.g. flow charts, surgical procedures).
Photographs have their own separate list of tips (see Chapter 14).
A Remember that figures are often the first thing

that readers look at
Readers (including reviewers) often look at figures first to make a preliminary
assessment of the results, so they have to make a good first impression.
A Avoid unnecessary figures

Do not use a figure if the data could be represented by a simple sentence or two. For
example, a bar chart with only two bars may be acceptable as a slide, but if you
included the same chart in a paper, many journals would reject it on the grounds
of space. They would argue that the same data could have been more concisely
represented in the text.
A Be prepared to be selective
Even if you have half-a-dozen relevant, interesting figures, the journal may not be
prepared to publish them all. Some journals set limits on the number of figures they
will accept, others leave it to your discretion. As a rough guide, one figure or table
per 1000 words of text will probably be accepted without quibbling.
A Do not expect the journal to publish the same data

in both figure and table form ...
Submit your data in whichever form is most appropriate.
A ... But be prepared to submit backup data for figures

Some journals now request that figures be backed up with tables showing the raw
data used to construct them. This is to save reviewers the trouble of trying to estab-
lish values for data points that are just represented as spots on a graph. Just because
you have to supply the raw data, however, does not mean that it will be published.
Look at the Instructions to Authors to see whether this requirement applies.
A Provide figures in the format requested by the journal

Check the Instructions to Authors for acceptable formats for figures. Most request
camera-ready figures - that is, in a format that can be photographically reduced and
incorporated directly into the journal without redrawing. Only a few journals
redraw the figures to their house style. In the past, most journals required glossy
photographic prints of your figures. Nowadays, most accept laser-printer output,
which reproduces well. In the future, journals will probably accept figures in
electronic form, but this is still the exception rather than the rule.
A Do not try to fit too much information onto one graph

Think about how much information the readers will be able to take in. For example,
line graphs with more than four lines are likely to be too difficult to read, especially
if the lines overlap.
Research papers: figures 65
A On camera-ready figures, make sure the lettering

is large enough
Think about how much your figure will have to be photo-reduced to fit into a single
column. Then work out what the reduced height of the letters will be. Usually, the
reduced size of a lower-case letter without ascenders or descenders should be no less
than 2 mm, or it will be too difficult to read.
A Make sure that symbols will still be distinguishable

after reproduction
Remember that it may be difficult to tell the difference between microscopically
small circles, squares or triangles. Make sure that they will be at least 2 mm high
after reduction. The standard symbols used by most journals are circles (/O),
usually followed by triangles and squares.
A Emphasize the data, not the axes

The thickest lines should be used for curves or plots, thinner lines for axes and error
bars. Most scientific graphics programs will take care of this for you.
Do not extend the axes too far

The X and Y axes should extend only to the next 'tick mark' on the axis after the
maximum values for the data. Again, your graphics programme will probably take
care of this for you.
A Indicate significant differences between

points with asterisks
It is standard practice to draw attention to significant differences on graphs with
asterisks, the meanings of which are defined in footnotes. A standard series is
*p < 0.05; **p < 0.01; ***p < 0.001, but check with the journal.
A Check where keys to symbols should be placed

The Instructions to Authors usually include advice on where to put the keys to
symbols used on your graphs. Usually, the key is given on the graph itself, but a few
journals put them in the figure title (also known as the figure legend).
A Define abbreviations if used

Generally, figure legends should be understandable without reference to the text.
Usually, abbreviations used in figures should be defined below the figure title even
if you have already defined them in the text, but check with the Instructions to
Authors. If you use the same abbreviations in several figures, it is common practice
to define them in the first one and then cross refer, e.g. Tor abbreviations, see
Figure 1', or 'Abbreviations as in Figure I'.
A Supply figure titles on a separate sheet

Figure titles must be supplied on a separate sheet from the figure itself as they will
go through separate production processes. Figure titles follow a similar format to
that for tables (see Chapter 13).
A If you use someone else's figure, it is your responsibility

to get written permission
If you want to reproduce a figure first given by another author in an original
publication, you will have to get permission in writing. It is your responsibility to do
this, not the publisher's. You should write to the managing editor of the journal in
which the figure first appeared, asking permission to reproduce it. Say where you
plan to reuse it. The journal will usually respond giving you permission, and stating
a set form of words to be used for acknowledgement, e.g. 'Reproduced with per-
mission from ...' Often, you will be asked to write to the original author as well. A
few journals may ask for payment for reproduction of figures, and some impose
rules on whether they can be redrawn or adapted in any way.
A Make sure your figure is referred to in the text

Check that for every figure, there is a reference in the text ('Figure 1' or 'Fig. 1'), and
vice versa. You should also indicate to the editor approximately where the figure
should appear, by a note in the margin.
Research papers: figures 67
A Apply this reviewer's checklist to your figures

Do the figures:
Q show data in the most appropriate and efficient way?
Q show important data?
Q show what the text says they show?
Q have appropriate explanatory titles?
Q explain any abbreviations, symbols and shading used?
Q avoid distracting extraneous detail?
Q include error bars where appropriate?
13
Research papers:
tables
Use tables to demonstrate the relationships between numerical and/or descriptive

data. A good table can compress a lot of information into a small space, yet make the
meaning crystal clear.
A Avoid unnecessary tables

Do not use a table if the data could be presented better as a graph, or if they could
be given more concisely in the text - if you use unnecessary tables, the journal may
well edit them out.
A Follow the Instructions to Authors carefully

Most journals give detailed instructions on how tables are to be set out.
A Type each table and its title on a separate page

To make life easier for the journal's production department, each table should
appear on a separate page, which goes at the back of the manuscript, along with the
figures. The title should be typed above the table. Even though you may think it
more logical to insert tables in the text - do not - most journals will send your paper
straight back to you.
A Use the tables function on your word processor,

if the journal allows
The tables function in word-processing software such as Word and WordPerfect
makes the creation of tables a painless process. However, check the Instructions to
Authors - a few specify that if you are submitting the paper on a floppy disk you
should use the old-fashioned system of tabs and spaces instead, because their
typesetting software is incompatible with your word processor's tables function.
A Use horizontal lines to define key areas of the table

Most journals require you to use horizontal lines to separate the column headings
from the body of the table, and to delineate the top and bottom of the table. It is also
permissible to use horizontal lines to separate column headings from subheadings.
Within the body of the table, use spaces rather than lines to mark groups of row
headings.
A Do not use vertical lines in tables in papers

Most journals do not permit you to use vertical lines within tables, however useful
you think they may be. This is really a hangover from older systems of typesetting
that meant that setting of vertical lines was difficult and time-consuming. Although
setting vertical lines is easier nowadays, you should always follow the journal's
instructions.
A Do not try to pack too much data into one table

You do not have to include every variable that you measured. Select those that
readers need to know in order to evaluate the answer to the question. Each table
should represent just one key idea or message.
A Arrange tables so that important comparisons are

made from left to right
Most readers are accustomed to reading tables from left to right, not top to bottom.
This makes the table easier to read and understand (see the example below).
Research papers: tables 71
This way ...
Grottomycin Scabicillin P
50 mg b.d. Sgt.i.d.
(n = 108) (n = 111)
Clinical cure (%) 87.9 60.3 p < 0.05

Microbiological cure (%) 79.6 59.4 p < 0.05
... rather than this way
Clinical cure (%) Microbiological cure (%)
Grottomycin 50 mg b.d. (n = 108) 87.9 79.6

Scabicillin 5 gt.i.d. (n = 111) 60.3 59.4
P <0.05 <0.05
A Align the column and row headings according to

the journal's requirements
Usually, the row headings should be aligned flush left, and the column headings
centred. The contents of the columns are usually centred over the decimal point.
A Make the table self-contained

Readers will often look at the tables first to get the key points of the results without
having to plough through lots of text. So make sure that the table and its title contain
the key information the reader needs.
A Keep column headings short

A maximum of two lines is a good general rule. If necessary, use abbreviations and
define them in footnotes (but see below).
A Make sure you include units of measure,

where appropriate
Column and row headings should include units of measure (SI), usually in brackets
(check with the journal for the correct style).
A Use non-Si abbreviations only if necessary, and define

them in a footnote
Readers do not want to search through your paper looking for the meaning of
abbreviations. So, even if you have abbreviated a term elsewhere in the paper, try to
spell it out where it is used in the column or row headings, unless it is very long. If
you have to use non-Si abbreviations, define them in a footnote to the table.
A Do not let footnotes take over your table

If your list of footnotes is taking over the table, think again. Readers do not want
to have to fight their way through a mass of abbreviations to understand your
table. Could you spell out at least some of the shorter terms instead of abbreviating
them?
A Define abbreviations in the first table, then cross-refer

(but check journal style)
If you use the same abbreviations in several tables, it is common practice to define
them in the first one and then cross-refer, e.g. 'For abbreviations, see Table 1', or
'Abbreviations as in Table 1'.
A Indent row subheadings

Row subheadings should be indented, as in the next tip.
A Give row headings and subheadings a logical order

Rather than just put your row headings down in the order you first thought of, think
about what order will make the data easiest to interpret. If you have a lot of row
headings, grouping them will make the data easier to understand. For example:
Drug costs
Anti-emetics
Sedatives
Administration costs
Disposables
Physician time
Nursing time
A Use only meaningful decimal places

Ask yourself how accurately you measured each variable. Means should be given to,
at most, one decimal place more than in the original measurements.
A Be consistent with decimal places

Use the same number of decimal places in all values for one variable. Use the same
number of decimal places in standard deviations, standard errors or confidence
intervals as in the mean.
A Be careful about the use of percentages

The use of percentages is particularly helpful when sample size varies between
groups. However, some journals only allow percentages for sample sizes of 50 or
more. Others require that the sample should be as large as 100. Check with the
Instructions to Authors for guidance.
A You can give both numbers and percentages in

the same column
For the reader's convenience, it is often appropriate to include both numbers and
percentages in the same column, like this.
Clinical cure at 4 wk
n (%)
47/58 (81)
A Do not leave cells blank

Leaving cells blank leaves the reader guessing - was the value zero, or was it just not
successfully measured? Follow the journal's style for missing data. A typical style is:
0.0 the value was zero
- the value was not measured or is not
given for some other reason.
Other abbreviations you may see are:
ND the value was not determined
NA the value is not available
Any abbreviations or symbols used should be defined in footnotes.
A You can indicate statistical significance with

p values or footnote indicators
You may want to give p values in a separate column (see above). Alternatively,
you can save space if you use asterisks, defined in footnotes. A standard series is
*p < 0.05; **p < 0.01; ***p < 0.001, but check with the journal.
A Use the journal's standard hierarchy of

footnote indicators
As mentioned above, asterisks are usually used to denote statistical significance.
Other footnote indicators are sometimes also used. These may be:
Symbols e.g. t, k , 11,1, #, **, tt
a b c
Letters , ,
Numbers ', 2 , 3 (normally only used where the
journal style does not include numbered
references).
A Check and recheck your numbers

Make sure columns that are supposed to add up to 100% do so. Make sure that all
parts of the sample are accounted for.
A Make sure all data given in tables coincide with

values given in the text
It is annoying to readers to find a value of 27% given in a table and 26% given in the
text, yet it is all too easy to make amendments to the tables without amending
the text and vice versa. Check which numbers are correct and try to be absolutely
consistent.
A Give the table a descriptive title

The reader should be able to understand the table without searching for the relevant
section of text. The table title should typically include:
independent variable(s)
dependent variable(s)
species or patients studied
Thus a typical table title might be 'Table 2. Clinical and microbiological efficacy of
grottomycin and scabicillin in adults with sinusitis'.
Tables containing other types of data will not have all these components in the
title, but should follow a similar pattern, e.g. Table 1. Baseline characteristics of
patients at randomization'.
A Keep the table title short - usually

Most journals prefer titles of one to three lines. However, a few put more emphasis
on the 'tables must be self-contained' principle than on brevity - in Nature, for ex-
ample, the table titles contain so much information they may take up more space
than the table itself. Follow the usual style of the journal, but be as concise as you can
- do not waste words, even in a long table title.
A Think about how many columns the table will occupy

Look at the journal, and think about whether your table will occupy just one text
column, or whether it will take the full width of the page. This may influence the
number of columns you decide to include in the table. If you have just a little too
much data for one column, it can look rather thinly spread over two.
A Use 'sideways' tables only if they are very important

You will sometimes see tables taking up a whole page on their own, laid out at right
angles to the rest of the text. Use this format only if the table is very important, and
you are sure the journal will allow it. In review articles, for example, this may be the
most efficient way of comparing a number of different studies. Some journals will
insist that all tables have to be read from the top to bottom of the page in the normal
way. If they think you have too much data in a large table, they may ask you to edit
some out or subdivide the table.
A Make sure your table is referred to in the text

Check that for every table there is a reference in the text (Table 1'), and vice versa.
You should also indicate to the editor approximately where the table should appear,
by a note in the margin.
A Apply this reviewer's checklist to your tables

Do the tables:
Q match journal style?
Q each deal with a specific question?
Q have a clear and uncomplicated layout?
Q show what the text says they show?
Q include appropriate explanatory titles?
Q give actual data as well as percentages?
Q avoid using excessive numbers of decimal points?
Q avoid irrelevant detail?
Q include SD, CI and p values where appropriate?
Q add up correctly (i.e. no missing or extra numbers)?
Q explain abbreviations and symbols used?
14
Research papers
photographs
You may want to include photographs in a paper or article. For example, you may
have clinical photographs showing the manifestations of a disease (perhaps before
and after treatment). You may also want to publish radiographs or scans, photo-
micrographs or electronmicrographs.
A Preparing photographs correctly saves

time and errors
Knowing how to prepare photographic images in a form acceptable to the journal
will save unnecessary exchanges of letters between you and the managing editor,
and thus avoid delays in publication. It will also help to ensure that photographs
appear exactly as you intended.
A Supply photographs in the format requested

by the journal
Most journals request glossy prints of black and white photographs. In the past, they
always asked for colour slides (transparencies), but scanning technology is now so
good that some will accept glossy colour prints. In future, electronic output from
digital cameras is bound to become acceptable, so check with the journal if you are
already using this technology.
A Check whether the journal accepts colour photographs,

and on what terms
Most journals accept black and white photographs, but some do not accept colour
photographs at all. Others limit the number of colour photographs you can submit,
while some expect you to pay a fee for each colour photograph (even though you do
not pay a fee for publication of the paper itself). Paying for colour photographs is
common, for example, in histology journals.
A Make sure photographs are clearly labelled on the back

Labelling photographs on the back will help to reduce the likelihood of mix-ups.
This is especially important if several similar photographs are submitted. For
example, photographs captioned 'Figure 1. a Before treatment; b After treatment' are
only too likely to be inadvertently transposed if your instructions to the journal are
not clear. Use sticky labels rather than writing on the photograph itself - if you do
write on it pressure marks could appear on the front of the photograph, and these
marks would then be reproduced.
A Indicate the top of the photograph on the label

The label on the back of the photograph should include a little arrow pointing
towards the top, with the word 'top' printed beside it. I once saw a photograph of a
pair of knees printed upside down (i.e. with the calves above and the thighs below).
It took a while to work out what was wrong with it!
A Make sure cropping is clearly indicated

on photographs
If you only want part of a photograph to be printed, indicate which part. You can do
this conveniently by sticking a flap of tracing paper over the photo and marking the
cropping on it, or supplying a photocopy with the cropping clearly marked.
A Indicate any masking required on photographs

In most journals, it is standard practice to put a black bar across patients' eyes to
avoid identification. If so, either do the masking yourself with Letraset, or indicate
clearly where it is to appear (again, on tracing paper or on a photocopy).
Research papers: photographs 79
A Obtain a signed consent form from patients and pass

it on to the journal
Most journals request that you obtain permission from patients to use their photo-
graphs, whether or not their faces appear, and whether or not their eyes will be
masked. It is your responsibility to obtain this permission in writing from the patient
(or, in the case of a child, their parent or legal guardian). Failure to do so could result
in costly legal action at a later date. How would you like it if someone used your
photograph without permission to illustrate a disease?
A Remember to remove patients' names from radiographs

and scans
Cut off patients' names when they appear on radiographs or scans.
A Remember to mark arrows and labels as requested

The Instructions to Authors will usually specify whether they want you to mark
arrows or labels such as A, B on the actual photograph, or whether they are to be
indicated on a photocopy or tracing paper. Make your instructions explicit - the
person preparing the photograph for reproduction will probably not be a scientist
and is unlikely to understand instructions like 'please label basement membrane'.
A Do not use paperclips on photographs

Any pressure on the photograph could lead to scratches that would spoil repro-
duction. Keep photographs in separate, labelled envelopes, packed flat between
sheets of card.
A Type titles on a separate page

As with all figure titles, titles of photographs should be included with the figure
legends at the back of the manuscript. The title always begins with a figure number,
e.g. 'Figure 1. Cross-section of ...'
A Make sure your photograph is referred to

in the text
Make sure that for every photograph there is a reference in the text ('Figure I'),
and vice versa. You should also indicate to the editor approximately where the
photograph should appear, by a note in the margin.
15
Research papers:
discussion and
conclusions
The functions of the discussion section of an original research paper (sometimes
divided into discussion and conclusions) are to:
answer the question posed in the introduction
explain how the results support the answer
put the results into context.
A Write your discussion to anticipate the readers'

and reviewers' questions
The discussion acts like a dialogue with interested readers, answering all the
questions they are likely to ask. It is important to write the discussion carefully,
because papers have been known to be rejected because of a poor discussion. As one
reviewer said: 'If authors do not know what their own results mean, it is not my job
to tell them.'
A Plan your discussion logically

The discussion needs to be well structured if it is to be convincing to readers and
reviewers. You can use the planning techniques in Chapter 5 to construct a discus-
sion that is logical and easy for the reader to follow. This will give the best possible
support to your results.
A Begin by stating the answer to the question,

i.e. the conclusion
You should begin the discussion by answering the question (i.e. stating the con-
clusion) in exactly the same way that you asked it. For example:
Introduction: 'We conducted a double-blind, placebo-controlled study to compare
inhaled thingerol, 50 g b.d., with inhaled wotsiterol, 200 mg q.i.d., in the control of
nocturnal symptoms in asthma.'
Discussion: This double-blind, placebo-controlled study shows that inhaled thing-
erol, 50 g b.d., is more effective than wotsiterol, 200 mg q.i.d., in controlling the
nocturnal symptoms of asthma.'
A Answer subsidiary questions in order of importance

If there is more than one question to be answered, answer them in order of import-
ance - for example, primary outcome measures before secondary outcome measures,
efficacy before side-effects.
A Go on to support the answer using your own

results and those of others
Do not repeat your results in detail. Simply give selected data in order to back up the
general points that you make. When supporting the answer, again organize the
topics from the most important to the least important.
A Then explain how the answer fits in (or does not fit in)
with other published results
Again, you should address topics in order of importance. Highlight similarities
between the results of your study and other well-respected studies, but do not be
afraid to draw attention to differences.
A Do not ignore 'inconvenient' results

It is important to explain (as far as you can) any unexpected findings, or any results
that are not consistent with your answer. If you do not, the reviewer may assume
Research papers: discussion and conclusions 83
that you have not noticed the problem. If you can offer no reasonable explanation for
an inconsistent result, it is acceptable to say so. Do not be tempted into wild flights
of fancy in order to justify an apparently inexplicable finding.
A Do not be afraid to defend your conclusion

If you have done a good study, you should be prepared to defend your conclusion
against attack. What about others who did not get the same answers? You may be
able to offer explanations for the discrepancies between your study and theirs. For
example, other researchers may have used different methods or studied different
populations. If justified, you can highlight shortcomings in their studies compared
to your own (see below).
A Be respectful towards other studies

It is accepted practice to dissect the shortcomings of other studies, but please be as
courteous as possible while you are doing it. Your own results will be subjected to
similarly severe scrutiny by your research rivals. Furthermore, there is always
the chance that the reviewer was involved in the research that you are criticizing, or
is a personal friend of the researchers in question. Be scrupulously objective and
polite.
A Explain any limitations of your methods or

study design
Every study has its limitations - do not be afraid to address yours. It is better for you
to note limitations rather than lead the reviewer to believe that you simply have not
noticed them.
A Finish your discussion by restating the conclusion ...

In longer discussions it is conventional to briefly restate the answer at the end,
sometimes in a separate section headed 'Conclusions'. Although repetitious, this can
be helpful. The last paragraph is, after all, where many readers will look to find the
'bottom line' of the study. Use a different form of words from that with which you
began the discussion, to make it more interesting for the reader. In a short discussion
(half a page or less), there may be no need to restate the conclusion.
A .... And any important implications

If your study is new or particularly important, it is acceptable to say so, using
modest language. If your study has implications for future research or for clinical
practice, it is also appropriate to describe these at the end of the discussion. How-
ever, if you have nothing particularly interesting to say about the implications of the
study then stop after restating the answer. Conclusions that say 'further research is
necessary' tend to sound a bit lame. Further research is always necessary in science.
A Be careful with tenses

It is likely that you will use a mixture of past and present tenses in the discussion.
You should use the present tense for the answer. Use the past tense for your results
and those of others, but present tense for established fact. For example, you could
say: 'Smith et al. found that X was associated with Y, but our results suggest that this
is not the case. We found that X was correlated only with Z'.
A Choose your 'proving' words carefully

according to strength
Trove' is the strongest word we can use about our findings, but it can rarely be used
in biomedical studies. Here are some others, in descending order of strength. Think
about which one matches the strength of your conclusions. Can you think of any
others?
show
demonstrate
indicate
suggest
imply.
A Be cautious...
Very little is incontrovertible in science. It is accepted and appropriate to use
'hedging' words such as:
maybe
might be
Research papers: discussion and conclusions 85
could be
probably
possibly
A ... But not excessively so

However, do not 'hedge' so much that you show little confidence in your results.
'These results suggest that the cause of X is Y' is acceptable.
'These results suggest that the cause of X may be Y' is weaker, but may be
appropriate if you are being very cautious.
'These results suggest the possibility that the cause of X may ultimately be deter-
mined to be Y' is ridiculously overcautious.
A Make the logic of your argument clear to the reader

Use 'signalling' words to underline the logic of your argument. For example:
This study shows ...
The evidence is that ...
For example, ...
Contrary to our expectation, ...
Surprisingly, ...
To summarize, ...
In conclusion, ...
A In a very long discussion subheadings may be helpful

In very long papers, in which results fall into several categories that must be discussed
separately, some journals will aDow the use of subheadings. However, in a typical
original research paper, the discussion should not be so long that subheadings are
necessary.
A Save some of your references for the discussion -

do not put them all in the introduction
There is a temptation to mention all the relevant references in the introduction. This
can leave you with the feeling that you have nothing new to say when you get to the
disussion. In fact, only the references that are relevant to understanding the question
should go in the introduction. The references that are relevant to understanding the
answer should go in the discussion. Some are, of course, relevant to both. Since the
references relevant to the answer are more important than the general background,
the discussion is likely to be longer than the introduction. Readers are more inter-
ested in the results of your study than in generalizations.
A If using the author-year system, minimize repetition

of authors' names in the text
If the references in your paper are according to the author-year system, there is no
need to repeat the authors' names in the main text. For example: 'Several studies
have shown an association between X and Y (Smith 1987, Brown 1991, Dupree 1995)'
is preferable to 'Smith, Brown and Dupree have shown an association between X and
Y (Smith 1987, Brown 1991, Dupree 1995)', as it avoids unnecessary repetition.
A If using numbered references, mention authors'

names in the text only very selectively
If you are using numbered references, there is still no need to mention the names of
all the authors to whose studies you are referring unless you specifically want to link
the author with the results. Thus it is perfectly acceptable to say 'Several studies
have shown an association between X and Y15"17' but you might sometimes want to
say 'Our results differ from those of Brown,16who found that ...'
A Apply this reviewer's checklist to your discussion

Is the discussion:
Q logical and succinct?
Q well referenced (not too many)?
Q accurate and fair regarding other studies' findings?
Q an interpretation rather than a restatement of the results?
Q free of far-fetched hypotheses?
Q free of vague or unsubstantiated statements?
Q frank in acknowledging anomalies?
Q able to explain most anomalies?
16
References
Whether you are writing a thesis, an original research paper or a review article, you
will need a list of references. Typing and organizing these references can be a major
chore, but fortunately there are a number of techniques you can use to make things
easier. Here are some tips on dealing with references as efficiently as possible.
A Use reference management software

If you have to work with references all the time, as most scientists do, you will find
that reference management software removes a lot of the drudgery. This software
allows you to enter the various parts of each reference into a standard form, creating
a permanent database. You can then paste temporary citations from this database
into your word processing program, in such a way that they will be automatically
formatted into a correctly-ordered reference list at the end. You can specify that they
be formatted into any one of a wide range of journal styles, or even program your own.
If you add or delete a reference or move chunks of text around, the programme will
take care of reordering the references. Reference management software is discussed
in more detail in Chapter 31. Examples include EndNote, Reference Manager and
Papyrus.
A Format references correctly according to guidelines

All journals will have a standard format for references that will be described in the
Instructions to Authors. For a thesis there will normally also be rules laid down by
your institution. If the references in a journal article are not in the correct format, you
run the risk of having the article sent back to you for amendment before the editor
will look at it.
A Make sure you understand the instructions regarding

each part of the reference ...
For example, there will be instructions for:
how many authors to list
whether you include the title of the paper
whether you can abbreviate the journal title
where you put the dates
whether you give the journal part number
how you cite the page range
how you punctuate the reference
whether certain parts are in bold or italic type.
A ... And how to cite it in the text

The commonest ways of citing references are:
Numbered. 'As various authors have shown [1,2] ...'or 'As various authors have
shown,"'. The reference list at the end is in numerical order. Check to see whether
superscript numbers or brackets are to be used. Usually it is best to put reference
numbers at the end of the sentence to which they refer. When superscript refer-
ence numbers are used, they go after the full stop, whereas numbers in brackets
go before the full stop.
Author-date. 'As has been shown (Smith & Jones, 1985)'. The reference list is in
alphabetical order. Check to see how the authors are cited in the text - for example,
whether you use 'and' or '&', how you use et al. and whether you put a comma
before the date.
Alphabetic-numeric. You may still come across this rather odd system in which the
references are numbered in the text but the reference list is given in alphabetical order.
A Become familiar with the Vancouver style

The commonest format for references nowadays is the Vancouver style (see the
Uniform Requirements in Appendix 1):
For journals: Maclntyre PB, Pemberton JH. Pathophysiology of colonic motility
disorders. Surg Clin North Am 1993; 73: 1225^3.
For books: Burks TF. Actions of pharmacological agents on gastrointestinal func-
tion. In: Kumar D, Wingate D, eds. An illustrated guide to gastrointestinal motility.
London: Churchill Communications Europe, 1993: 144-61.
References 89
However, do not assume that you can always use this style - some journals use
different formats.
A Check how many authors' names your journal requires

you to give
Some journals require you to give all the authors for each reference. Others will
instruct you that when a reference has six or more authors (sometimes five or more),
you should give only the first three, and replace the remaining names with et al. If
you are using reference management software, enter all the authors' names into the
database whether you need them or not at the time. Then, if you ever have to
reformat the references for a journal that gives all names, they will be in the database
and you will not have to go looking for them.
A Be thoughtful about how many references you give

In a thesis it is appropriate to give a large number of references to show that you
have read all the relevant literature on the subject. However, in an original research
paper you are not trying to show how well read you are. You should only give those
references that are immediately relevant to the reader's understanding of the paper.
A medium-sized research paper in the biomedical sciences will probably have no
more than about 20-30 references. Short papers will have fewer. Long papers may
have more. Some journals will tell you how many references are acceptable in the
Instructions to Authors. Review articles typically have many references - after all,
they are a review of the literature and do need to be comprehensive.
A Prefer recent references unless there is a good reason

References should be relevant and recent (except in historical reviews or where
there are no recent references). Well-conducted studies are to be preferred to poorly
conducted studies.
A Prefer references that the reader will be able to obtain

You should also choose references that will be available to the normal reader. In
general, this means you should prefer journal articles, books or published conference
proceedings. Theses, conference abstracts and unpublished conference proceedings
may be more difficult to obtain and therefore should only be used when there is no
better way of referencing the data.
A In journal articles, you cannot cite papers that have

not been accepted...
If you really must, you can cite an unpublished, submitted paper in the text '(Smith
E. Personal communication)' or 'Smith E. Unpublished data'. However, you cannot
include it in the reference list. Check the Instructions to Authors to see exactly how
unpublished material should be cited.
A ... But you can cite papers that have been accepted
but not yet published
It is acceptable to cite a paper that has been accepted in the reference list like this:
Smith E. A randomized, double-blind, placebo-controlled study of the efficacy and

safety of hairolol in male-pattern baldness. Journal of Industrial Trichology. In press
1997.
Some journals require a copy of the acceptance letter to prove that a paper cited in
this way has really been accepted. Again, check the Instructions to Authors for the
preferred format.
A Be exact when citing references

It is very frustrating for readers to send for a paper, only to find that the authors'
names are wrong, there is no such paper in that journal or the page range is wrong.
One survey showed that as many as 4 out of 10 references had something wrong
with them. So check your references carefully against the original paper. Do not
assume that because you copied them from a published paper they will be right (see
below).
A Always obtain original references for every

paper you cite
It is tempting to take the word of other authors regarding the content of well-known
papers in your field. However, it is your responsibility to be sure that each paper
says exactly what you say it does. Surveys have shown that many papers cited as
supporting a particular point do not actually do so. Even though it may take some
time and trouble, it is worth getting hold of the originals of all the papers you cite,
and checking exactly what it is they say.
17
Checking your
manuscript
At last your manuscript is finished. But is it? You will need to check very carefully
before you send your paper to a journal or have your thesis bound. You will almost
certainly find things you want to change, from small errors of grammar or punctua-
tion to moving, adding or deleting whole sections. A carefully prepared manuscript
gives a good first impression, which will gain the attention and interest of the editor,
reviewers or examiner.
The tips in this chapter are based on professional editorial techniques, and will
help you to turn in a polished manuscript.
A Take a break between writing and checking

your manuscript
To find the errors in your manuscript you need to distance yourself from it somehow.
Ideally, you should put it away for a few days, then look at it again. If, as somehow
always seems to happen, you are up against a deadline, at least go and do something
else for a few hours.
A Take your time

It is impossible to check your manuscript if you are in a hurry. If you work slowly
and methodically you are much more likely to find errors. A skimpy check is hardly
worth the effort.
A Take regular breaks

Checking requires intense concentration. You simply will not be able to concentrate
hard for hours at a stretch, so take regular breaks. Ten minutes break in every half
hour is a good rule. Make sure you get away from your desk - move around, talk to
someone, have a cup of coffee, listen to some music - anything to take your mind off
letters and numbers.
A Do not expect to find all the errors in your own work

You will be so used to your manuscript that you will never be able to find all the
mistakes. A fresh 'eye' will be enormously helpful in:
spotting any scientific problems on which the reviewers may comment
checking the overall structure and content from a reader's point of view
finding small errors of English and typing mistakes.
You will be amazed at the errors that can be found by someone who is new to the
manuscript.
A You need someone to check the science ...

It is often useful to have two or more other people read your manuscript. You need
at least one qualified scientist to check the scientific content and overall structure.
You could call on your boss, supervisor or research colleagues.
A ... And someone to check the English ...

You also need someone to check for minor errors of English, punctuation and so on.
If your scientific 'checker' is also very meticulous and good at English he can do this
as he goes along. However, scientists (including native speakers) are not always
good at English! Nor do they necessarily have the meticulous mind-set needed for
this work. You may want to get a second 'checker', who need not necessarily be
scientifically qualified. If you are lucky, your partner or a member of your family
may be a good 'checker'.
A ... but one person (you) has to take overall responsibility

If your manuscript has several authors, or has been checked by several people, there
may be differences of opinion about what is the best way to write up certain ideas.
Checking your manuscript 93
There may also be quibbles about more minor matters of writing style. In the end,
someone - normally you, as first author - has to arbitrate disputes and make a final
decision about disputed points.
A Remember that journals have copy-editors for

accepted papers...
You can expect journal copy-editors to correct small matters of English once your
paper is accepted for publication. Copy-editors can be especially helpful if you are
not a native English speaker. They will also make sure your manuscript complies
with the journal's house-style rules, though they will expect you to have made a
good attempt at meeting the requirements set out in the Instructions to Authors.
A ... But do not expect them always to spot mistakes

in the science
Journal copy-editors cannot, however, be expected to find errors such as the wrong
numbers given for your results, or statements that do not say what you meant to say.
In practice they are very good at spotting inconsistencies and raising queries, but
every such query causes an infinitesimal delay in the progress of your paper towards
publication.
A Do not try to check every aspect of your manuscript

in one reading
Several 'passes' through your manuscript are usually necessary - you will find more
mistakes if you concentrate on one thing at a time. Some passes may take some time,
others can be accomplished very quickly. You can work at your own way of doing
this. I would normally do separate passes for:
general impression - structure, suitability
completeness
headings
figures and tables
references
journal style
spelling, grammar etc.
A Use a checklist
You will be less likely to miss errors if you check systematically, using a checklist. An
example is given in Appendix 2, but you may want to draw up your own.
A Get a different perspective

You may find it easier to detect mistakes in a manuscript that looks different from
the way you are used to seeing it. If you have been reading it on the computer screen,
try printing it out. If you are used to seeing it on white paper, try printing it out on
different coloured paper or use a different font (e.g. Ariel instead of Times).
A Try checking spelling and grammar line by line

It may help you to concentrate on small details of spelling and grammar if you use
a ruler or piece of paper placed over the page. This will help you focus on one line
at a time.
A Use your spell checker carefully

The spell checker on your word processor is very helpful, but it will not find all
errors. For example if you write 'two' as 'tow', it will not be able to tell the difference,
because 'tow' is also a word. In addition, there will be many scientific words that are
not in the spell checker's dictionary. If you add such words to the dictionary as you
encounter them, this will speed up spell-checking in the long term. You can also use
a specialized spell checker, such as Stedman's Medical Dictionary (US spelling only),
which can be integrated into your word processor (see Chapter 31).
A Do not expect too much from your grammar checker

Well-known word-processing programmes like Word and WordPerfect come with a
built-in grammar checker. These are getting better all the time, but at the moment are
not good enough to pick up all the grammatical errors in your manuscript. More-
over, they will sometimes tell you there is a problem where none exists. They are in-
teresting to use as a learning exercise, but there is no substitute at present for human
intelligence. If your grammar is not very good, then try to get someone with more
expertise to read your manuscript.
18
Research papers and
reviews: writing a
covering letter and
submitting your
manuscript
When you submit a paper to a journal, you will send it with a covering letter (Figure
18.1). Because the covering letter is the first thing the editor sees, it plays an
important part in creating a good first impression for your paper. A carefully written
covering letter can have a small, but important, effect in increasing your chances
of publication. A carelessly written covering letter might even result in your paper
failing to receive the consideration it deserves.
A Include all essential components

Use this checklist to see if you have missed anything out:
Q the name of the editor, title of the journal and its address (check the address for
correspondence)
Q the name, address, phone, fax and e-mail numbers of the submitting author
Dr A Trollope
Senior Lecturer
UNIVERSITY OF University of Barsetshire
BARSETSHIRE Department of Medicine
University Boulevard
Barchester BA24 OEG
UK
Department of
Tel: 44196876998
Medicine Fax: 44 196876997
e-mail: troll@barset.co.uk
7 March 1997
Professor C Dickens
Editor
Journal of Medical Botany
PO Box 7770
Flatville
NJ I001
USA
Dear Professor Dickens.
Camomile tea in tension headache: a double-blind placebo-controlled study
Enclosed are three copies of the above paper by A Trollope, WM Thackeray and
C Dodgson, to be considered for publication as a full paper in the Journal of Medical Botany.
The paper has not been published elsewhere, nor is it currently under consideration by
another journal.
As far as we are aware, this study is the first placebo-controlled trial to show a therapeutic
effect of camomile tea in tension headache, classified according to WHO criteria. It was
conducted as a result of our questionnaire survey among camomile users, reported as a
Short Communication in your journal last year (J Med Bot 1996:24:36-7).
I confirm that this paper has been read and approved by all the co-authors, and that if it is
accepted, we are willing to sign over copyright to the Journal of Medical Botany.
Correspondence and phone calls about the paper should be directed to A Trollope at the
above address.
Yours sincerely,
A Trollope
WM Thackeray
C Dodgson
Figure 18.1 A well-written covering letter.

Research papers and reviews: submitting your manuscript 97
the name, address, phone, fax and e-mail numbers of the author to whom corres-
pondence should be addressed (if different from the submitting author)
the title of the paper
whether the paper falls into a particular category (e.g. short communication,
review article) or section of the journal
the names of all the authors (their affiliations are not necessary as they appear in
the paper)
an appropriate statement that the content of the paper has not been published
elsewhere, nor is it currently under consideration by another journal
the signatures of all the authors (see below).
A Consider these additional optional components

Depending on the circumstances, you may also wish to include the following:
Q a few words about the content of the paper (see below)
Q a brief note on why you selected the journal
Q a statement regarding optional components (e.g. colour photographs, detailed
methods)
G a note of any material submitted that is for information rather than publication
(i.e. tabulated data to back up graphs)
Q suggestions for reviewers (see below)
Q any conditions on publication (try to make these as few as possible)
Q any restrictions on copyright transfer (see below)
Q a note regarding your willingness to pay any charges that may be relevant (e.g.
the cost of colour illustrations).
A It is sometimes helpful to say why you selected

the journal
Often it will be obvious why you chose the journal - for example, it may simply be
the best in its field. There is no need to try to flatter the editor by saying so - that
would be embarrassing and artificial. Sometimes, however, the editor may be a little
surprised by your choice of journal if the paper is somewhat outside its usual remit.
For example, if you submit a paper on molecular biology to a general clinical journal,
it would be appropriate to point out that you believe your results have important
implications for clinical medicine.
A You can draw attention to key features of your paper -

but be brief
It is acceptable to draw the editor's attention to any features of your paper that
readers are likely to find interesting. This may be genuinely helpful to a busy editor.
However, be very careful not to overstate your case. Just one or two modestly
worded sentences will be enough. Editors do not like to feel that you are trying to
'sell' your paper like a used car.
A Make sure you address the issues of repetitive publication ...

It is important to state that the content of your paper has not been published else-
where. If any part of your paper has been published elsewhere, and for some reason
you consider that repetitive publication is justified, you need to explain why. For
example, if your paper was previously published in another language in a local
journal, you will need to explain that you consider publication in English in an inter-
national journal important, in order to make the data available to a wider audience.
A ... And duplicate submission

A paper can only be sent to one journal at a time. You cannot send your paper to two
journals at once in the hope of accelerating the publication process. Editors are
unwilling to spend time on papers if there is a danger of them being subsequently
withdrawn because of acceptance elsewhere. After all, no one likes to be second
choice. You should include a statement that your paper is not currently under
consideration by any other journal.
A If you will not be able to transfer copyright to

the journal, say so
Most journals expect that you will sign over copyright of your paper to them when
it is accepted. If for any reason you cannot do this (e.g. because your employer does
not permit it), you should say so in the covering letter.
A There is no need to give the paper's rejection history

If your paper has already been rejected by another journal (or journals) there is no
need to say so. Indeed, there is no reason why the editor should not assume that his
or her journal was your first choice. It is important to reformat your paper in line
with the new journal's Instructions to Authors. Editors become easily annoyed, if,
for example, the references have clearly been formatted for another publication.
A It is often helpful to suggest one or more reviewers

Although journals maintain databases of reviewers, the editor will often be open to
suggestions from authors. In fact, in very specialized areas, the author is often the
best person to identify a suitable expert to comment on the paper. If you suggest one
or more reviewers, it is appropriate to add that they have not been involved in the
study or the preparation of the paper.
A If you really must, you can ask that certain reviewers

be avoided
There may be some circumstances in which you are anxious that a particular person
should not review your paper. For example, you may feel that a rival research group
should not have access to your results before publication. Or you may feel that a
certain reviewer is unduly prejudiced and will not give your paper a fair chance.
You have the right to ask the editor not to send your paper to certain specified
individuals, but you must be prepared to withdraw if the editor is not happy with
this arrangement. 1 would prefer that my paper not be reviewed by Dr X of the
University of Y. If you are unable to meet this request, I would rather withdraw
my paper from submission to this journal.' Although requesting that one or two
reviewers be avoided is acceptable, a long list is unreasonable and makes you look
paranoid.
A Tell the editor if any of the contents of the package

are provided for information only ...
Some journals request the original data from which graphs are plotted. This is for
the benefit of the reviewers who will assess the paper. If you have included
such material, it is important to say so, and to distinguish it clearly from the paper
itself.
A ... Or for optional publication

If you would like the journal to publish all of your manuscript, but would be willing
for it to miss out certain parts (e.g. large tables, detailed methods, photographs),
explain this in the letter. Some journals will be willing to archive certain parts of your
paper, and supply them to interested readers on application.
A Note that the address for correspondence may not be

the same as that of the first author
Do not leave the editor to assume that correspondence should automatically be
addressed to the first author at the same address as that given on the paper. There
are many circumstances in which this is not the case. For example, the first author
may have moved to another institution and will want to receive correspondence at
his or her new address; or the first author may have retired, and another of the
authors may be taking over responsibility for progressing the paper to publication.
Include the address for correspondence in the covering letter to make the situation
absolutely clear.
A Check you have included everything

When you are ready to post off your manuscript, check that you have included:
Q covering letter
Q copies of the manuscript as requested by the journal (usually three)
Q floppy disk, if required
G photographs or slides; one envelope per manuscript
Q copies of permission letters from patients or guardians, if required
Q copies of permission letters from other journals to reproduce figures, if required
Q copies of permission letters to quote unpublished data, if required.
A Pack your manuscript carefully

Pack your manuscript in a padded envelope ('air-kraft' or Jiffy-bag) for safety, with
extra pieces of card to protect photographs and slides. Ordinary Manila envelopes
are too flimsy.
A Enclose a stamped addressed envelope or postcard

for acknowledgement
If the journal does not automatically send out acknowledgements (and many do
not), enclose a stamped addressed envelope or postcard. It will add greatly to your
peace of mind if you are sure your manuscript has reached its destination.
Alternatively, use registered mail or a courier service.
19
Dealing with the editor's
and reviewers'
comments
Let us imagine that you have submitted your paper to a journal, and it has been
returned to you with the editor's and reviewers' comments. How you are feeling
now will depend on whether you have been told that your paper has been:
rejected outright as unsuitable for that journal
rejected, with an invitation to resubmit if certain amendments can be made
accepted, subject to minor revisions.
If your paper has been accepted, congratulations! If not, here are some suggestions
on what to do next.
A Remember that the editor's decision is final

If the editor rejects your paper outright, with no hope for resubmission, there is
nothing you can do. Often, the reason given will be that your paper 'does not fit
within the journal's current remit' or something similar. You may sometimes find
this explanation rather thin, especially if you have seen the journal publish other
papers on the same subject. However, it may be that the editor has accepted too
many papers on this subject already, and is looking for something different. Or it
may be a diplomatic way of saying 'not interesting enough for us'. In any event, you
have no option but to send your paper elsewhere.
A Look carefully at why your paper has been rejected

Whether you decide to revise and resubmit your paper to the same journal or give
up and go elsewhere depends on why it was rejected and if it is practical to correct
the problem. The commonest reasons for rejection, other than unsuitability for the
journal, are:
problems with experimental design
problems with statistical analysis
omissions in reporting
errors of inference (i.e. a poor discussion).
A Revise and resubmit your paper to the same journal if the

problem can easily be corrected
It makes sense to revise your paper and resubmit it to the same journal if:
it was rejected mainly because it was too long
missing data can be added
misinterpretation of the data can be corrected
the data can be re-analysed to improve the statistics
additional research can be done without too much difficulty
the editor or reviewers made encouraging comments.
A Revise and resubmit your paper elsewhere if the problem

is beyond correction
If your paper is rejected on the grounds of study design, or other irrevocable errors,
you can still submit it elsewhere. If you choose another journal that does not set such
stringent standards, you may be fortunate enough to get it published in spite of its
defects.
A Remember you do not have to agree with all the

reviewers' comments
It is very unwise to argue aggressively with the reviewers. However, if you
genuinely feel that they have misunderstood or misinterpreted your paper, it is
Dealing with comments 105
acceptable to write to the editor, stating your point of view. However, unless you are
very convinced that you are right, and very determined to get published in that par-
ticular journal, you are likely to find that entering into a protracted correspondence
is not worthwhile.
A Watch out for disagreements between reviewers

You may find that the the reviewers (usually there are two) do not agree with each
other. Usually, the editor will act as arbitrator. If the editor has not already addressed
any disagreement, and simply sends you the two conflicting sets of comments, it is
usually a good idea to write back, stating your own point of view and asking for the
editor's advice.
A Have a contingency plan ready

However confident you are, you should always be prepared for the possibility of a
rejection that cannot be salvaged. It pays to have a second choice of journal in mind,
and a copy of the Instructions to Authors at the ready. Then, if your paper is rejected,
you will soon be ready to resubmit it elsewhere.
A Remember that about 80% of papers eventually get

published somewhere
Rejection from your first choice of journal does not mean you should give up. If you
thought your study was good enough to write up in the first place, try to have some
confidence in your own judgement. You may have taken a gamble in pitching your
choice of journal too high, but could still have a good chance of acceptance by
another, less prestigious but still respectable, journal.
A If you resubmit elsewhere, make sure you revise your

paper to the style of the new journal
It is very annoying for editors to receive a manuscript that has obviously been
prepared for another journal. Still worse is the manuscript that looks as though it
has been crumpled by several journeys in the post, and passed across many desks.
Revise your paper carefully to fit the new journal's Instructions to Authors.
A Make what use you can of the reviewers' comments,

even if sending your paper to a different journal
Take due note of the comments made by the journal that rejected your paper, and do
what you can to improve it. You may not be able to do anything about the study
design, but you may want to defend it pre-emptively in the discussion. There may
be other errors of omission or interpretation that you can easily correct.
A Remember these rules for how to get your

paper published
Your paper is likely to be published if you:
conduct a good study
choose an appropriate journal
prepare the manuscript carefully
anticipate the reviewers' comments
write a positive/informative covering letter
recognize you cannot control all the factors
have a contingency plan in case of rejection.
20
Review articles and
book chapters
All of us rely to some extent on review articles and books to keep up to date. The
scientific literature is so vast that no one could possibly read everything relevant to
their subject. The problem is most acute for people working in clinical medicine, who
are fully stretched just seeing their patients without trying to read everything that
could possibly be relevant to them. Review articles and review chapters in books
therefore play an essential role in keeping clinicians and researchers up to date, and
alerting us to important shifts in opinion or practice.
A A review article or book chapter can help get

your name known
A good review article or book chapter not only benefits your fellow scientists - if
you are a young scientist, it also benefits your career. It can bring your name to the
attention of a much wider audience than would a single piece of original research,
and helps to establish you as an expert in your field.
A Do not underestimate the amount of work involved

Writing a review article or book chapter is very worthwhile, provided it is ap-
proached in a systematic and objective way. But it is not usually a quick or easy task.
However well you know your subject, it is a mistake to think that a review article or
book chapter can be 'dashed off in a few days. Generally speaking, it is considerably
more difficult and time-consuming than writing an original research paper.
A If the review is commissioned, get a good brief

Usually, a review will be commissioned by the editor of a journal or book. If you
receive a letter asking you to write a review, you may well find that an outline of the
proposed content is enclosed.
A If in doubt, ask plenty of questions

If you have not been thoroughly briefed by a commissioning letter, it is your job to
ask some important questions before you start to write. For example:
who is the intended audience?
which topics should you include?
which topics should you exclude?
should you stress a particular point of view?
how long should the review be?
how many figures and tables are required?
how many references would be appropriate?
when is your deadline?
Of course, the editor may say that you have a free hand - it is up to you. But often
you will find that they do have a preconceived idea of what your review should
cover, and in how much detail.
A If other authors are involved, beware of overlap

In a multi-author book, there is often potential for overlap between the chapters.
Check with the editor who else is contributing, and whether there are likely to be any
areas of overlap. If so, ask how this should be managed. The editor may lay down
some boundaries, or invite you to contact the other author(s) and work with them to
'carve up' the subject between you. On the other hand, some editors may take the
view that more than one viewpoint on the same subject will add something useful
to the book.
A If the review is your idea, check it out with your

intended journal
Some journals only accept commissioned reviews. Others sometimes accept reviews
submitted speculatively. However, it would be a big gamble to take the time and
trouble required to write a good review, without knowing whether it fits in with the
Review articles and book chapters 109
journal's publication policy. If you have an idea for a review, it is a good plan to
telephone the editor of the journal to see whether he or she would be interested. The
editor may ask you to submit a detailed outline. Of course, they are unlikely to agree
definitely to publish without seeing the completed review - among the top journals,
peer review is usually just as important for review articles as it is for original
research papers.
A Decide what kind of article you are going to write

Reviews and book chapters come in many different shapes and sizes. For example,
they may be:
comprehensive - everything there is to know about a particular topic
selective - deliberately excluding particular topics or approaches
descriptive - simply outlining what has been done
evaluative - highlighting 'good' studies
argumentative - supporting one point of view against another.
A Decide where you are going to get your information

Many reviews and book chapters are based exclusively on material available in the
'scientific literature' - published papers, abstracts and theses. Others include un-
published data from the author's own studies (sometimes used rather cynically as a
way of publishing data that would not make a paper on its own).
A Consider whether true meta-analysis is possible ...

Some review articles are based on meta-analysis, not only reviewing the data in the
literature, but combining and reanalysing it, sometimes including unpublished data.
The current popularity of 'evidence-based medicine' means that such reviews are likely
to be well received, but they require a lot of work and considerable statistical knowledge.
A ... Or whether a less statistically rigorous

approach is required
Even in reviews that do not include meta-analysis, it is appropriate to show that you
have looked at all the published studies, excluded those that do not meet specified
criteria, and objectively assessed the implications of the rest.
A Search the literature carefully

For a review to be authoritative, it is important to consider all the relevant papers.
To do this, you need to conduct a careful literature search. Depending on the topic,
you may need to consult more than one database. You will probably find it helpful
to consult a scientific information specialist in order to devise a foolproof search
strategy.
A Get copies of all the references and read the

relevant parts
As mentioned in Chapter 16, it is your responsibility to check that each reference
says what you say it says. Inadvertent misrepresentation of the contents of scientific
papers is quite common, and can be perpetuated from one review article to another.
Make sure that this does not apply to you. You do not usually have to read all of
every paper - often just the abstract will give you a good idea of the main points.
Then you can read the whole of just the most relevant papers.
A Have a 'big idea'

Every piece of writing should have a 'big idea'. Nowhere is this more important than
in a review. Sometimes your idea may be very big, e.g. 'Everything known about the
causes, diagnosis and treatment of X'. More often, however, it will be something
more specific, e.g. 'Based on the available evidence, the best way of treating X in
elderly patients is the ABC method'. If you cannot write your big idea down in a
single sentence, you are not ready to start writing the article.
A Draw up a detailed plan

Planning is all-important when writing long and complex documents. If you are
working to a detailed outline, you will be confident that you are not missing out
essential parts of your argument or story. You will also be able to draw up a time-
table ensuring that you meet your deadline. Surprise your publisher by being one
of the few authors who send their manuscripts in on time! To draw up your plan, try
the techniques listed in Chapter 5.
A Try writing a card or sticky note for each reference ...

The 'yellow sticky' technique described in Chapter 5 is particularly useful for review
articles. To recap, you write one or more sticky notes or file cards for each reference,
and arrange them in a logical order to create the plan for your article.
A ... Or photocopy just the top half of each first page ...
An alternative to the 'yellow sticky' technique is to photocopy just the top half of the
front page of each paper. This enables you to reduce the amount of paper you have
to deal with, and allows you to arrange references in logical groups. (Thanks to Liz
Wager of Janssen-Cilag for introducing me to this tip.)
A ... Or just arrange the references in folders by topic

You can also arrange your references in folders (or piles on the floor) by topic. One
disadvantage of this is that some references may come under more than one heading
and you therefore want to put them in more than one file. You can, of course, over-
come this by combining the 'files' and 'yellow sticky' techniques, and just write cards
or sticky notes for those references you want to have in two files at once. A second
disadvantage is that files are physically unwieldy - unlike sticky notes, it is hard to
spread all the references out and see the whole picture at once.
A Use standard structures where appropriate

Some review articles have standardized structures. For example, if you were writing
a comprehensive review of a new drug, it might follow this sort of structure:
the disease area
previous treatments
chemistry
pharmacology
pharmacokinetics
toxicology
animal models of disease
dose-ranging studies
efficacy in humans (vs placebo and vs comparators)
adverse effects in humans
conclusions and recommendations.
A Include a statement of how you got your information

Nowadays, it is customary to give some information in your review about how
you obtained the references, e.g. 'We searched MedLine and Embase for English-
language papers published between 1917 and 1997, using the search terms ...'
A Think carefully about which studies you include

To paraphrase George Orwell, all studies are equal, but some are more equal than
others. Usually, you will want to ascribe more weight to the 'best' studies. You may
decide not to mention seriously flawed studies at all, or to mention them but not
discuss them in detail. Just as you would describe how you selected subjects or
patients for an experiment, you should include inclusion and exclusion criteria for
papers in your review. For example, did you only evaluate blinded studies, or did
you include open studies as well? Why?
A Within sections and paragraphs, double-check

for logical order
Readers expect to see logical order in your writing. Note that you may need to use
different kinds of logical order in different parts of your review. For example:
chronological - early studies to recent studies
order of importance - best studies first, minor studies last
structural - by body system or geographical area
deductive - e.g. saturated fat is bad for us, sausages are full of saturated fat,
therefore we should avoid eating sausages.
A Structure your arguments carefully

Still on the subject of logic, remember that readers must be able to follow the devel-
opment after your argument. Make sure that every statement you make is supported
by the evidence. Never assume that it is obvious. You also need to make sure that
readers do not lose sight of the argument - a summary sentence or paragraph every
now and then is a good idea.
A Prepare yourself for peer review

Even if your review is commissioned, it may still be subject to peer review. Here is a
checklist of criteria used to examine review articles:
Q was the purpose of the review stated?
Q how was the literature selected?
Q how were the articles assessed?
Q were differences in study findings analysed and explained?
Q were studies grouped appropriately?
Q were the conclusions supported by data?
Q were directions for future research specified?
A Write an informative abstract or summary, if the

format allows
For readers, an abstract or summary that outlines the main points of the article or
chapter is very useful. When a review-article title is downloaded from an on-line
database, searchers tend to feel cheated if they do not find an abstract attached. So,
assuming that the format of the journal or book allows it, provide an informative
abstract or summary. Try to avoid the sort of summary that says 'Recommendations are
made for approaches to ...' This leaves readers still wondering what the recom-
mendations are.
It is harder to write an informative summary of a long article, but very worth-
while.
21
Theses and
dissertations
Although there is a lot more to postgraduate research than writing, your thesis or
dissertation is undoubtedly the end-product. Your examiners will use it to judge the
quality of your research - since they could not be there watching you, it is all they
have to go on.
For many people, the writing of the thesis is a more daunting prospect than all the
rest of the research put together. Yet, writing a thesis need not be such a Herculean
task if you follow these common-sense tips. (Note: the term 'thesis' is used here to
cover both theses and dissertations.)
A Check the rules and regulations before you start

Begin by obtaining and studying the regulations for your degree in your university.
Most universities lay down detailed rules governing the length, organization and
presentation of theses. The detail may extend to such fine points as abbreviations,
reference style, margins, spacing, typeface, type of paper and binding. Failure to
follow these regulations could result in a delay in your thesis being examined.
A Start writing early

It is usually best to start work on your thesis as early as possible. While it may be
tempting to wait until all your experimental work is completed, this is rarely pract-
ical. It is preferable to write up individual experiments as you complete them. You
can then amalgamate sections as appropriate when you get to the completion phase
of your thesis. In any case, you will probably want to write papers for publication
as your research progresses. You may also be required to submit regular progress
reports.
A Be organized about storage of data, references

and manuscripts
Writing your thesis will be much easier if you have swift access to everything
you need. This applies to your raw data, references and previous draft manuscripts.
Work out a system for storing your references in files. You might like to store them
alphabetically or by number, tied in to the numbering system of your reference
management programme (see below).
A Use a computerized reference management system

from day one
As described in Chapter 31, with reference management software you only ever
have to type a reference once - or maybe not at all, if you download it from a data-
base. Using one of these systems from the very first day of your research programme
will make your life immeasurably easier, and greatly speed the writing of your thesis.
A Use 'downtime' to do some writing

There will be times when you are not able to get on with the practical side of your
research. Perhaps you are waiting for an experiment to finish; maybe your equip-
ment is out of service; or maybe you are simply stuck for what to do next. You can
use these 'downtimes' to write up your methods, results of completed experiments
or parts of your introduction.
A Plan carefully
As said elsewhere in this book, planning is the foundation of effective writing.
Planning your thesis is a formidable task. Yet, you can apply exactly the same rules
to your thesis as you would to other major writing projects. Try approaches such as
mind-mapping and the 'yellow sticky' technique (see Chapter 5).
Theses and dissertations 117
A Set a page budget and interim deadlines

As described in Chapter 5, for any big piece of writing, it is important to decide in
advance approximately how long each section should be. You do not want to spend
many hours polishing your introduction, only to find that it is far too long relative
to the length of your other sections. You should also budget your time, so that you
know you will be able to complete the writing painlessly in the hours, days or weeks
available. For more information on setting page budgets and managing your time,
see Chapters 5 and 29.
A Decide on whether the 'big paper1 or 'mini-papers'

approach is appropriate
There are two main approaches to writing a thesis based on experimental work:
1 like a single, gigantic paper, organized into the introduction, methods, results and
discussion
2 like a series of papers, with a global introduction and discussion drawing them all
together.
Which you choose will depend on the type of research you have done, and the
regulations of your university.
A Look at other theses for ideas

It can be helpful to look at other people's theses, especially those from your own
department. Choose examples that you know were well received by the examiners.
You can glean many useful ideas on organization, layout and illustrations. However,
be sure that any bright ideas you borrow from other theses meet the statutory
requirements of your university.
A Finish writing early

If starting writing early is a good idea, finishing early is an even better idea. You will
need the remaining time to revise your draft, seek comments from your supervisor
and colleagues, incorporate those comments, proofread your thesis, check refer-
ences, get illustrations prepared and finally have your thesis printed and bound. You
may even need to do some additional experimental work or statistical analyses to fill
in any gaps that you noticed when writing up your results.
A Get your supervisor's Input early

Once you have developed a plan for your thesis, check it out with your supervisor.
Then, get your supervisor's comments on each section as soon as it is completed.
Finally, ask your supervisor to read through the whole thesis to make sure it hangs
together. Obtaining comments in easy stages will:
make sure that you have time to take advantage of any suggestions your super-
visor may make regarding content, organization or presentation
improve the quality of your supervisor's comments - the more time you allow, the
more detailed and carefully considered their comments will be.
A Prepare your figures in easy stages

You will probably have many graphs and charts in your thesis, and possibly photo-
graphs or other illustrations. It is a good idea to prepare these as you go along, to
save a rush at the last minute. Even though preparing illustrations is now much
faster than it was in the days of pen and ink, computer-generated illustrations still
take time to perfect.
A Make sure you use a standard style for

figures and tables
You should decide early on a standard style for details such as axes labels, units,
abbreviations etc. in figures and tables. Write down this style and stick to it. Check
that it is compatible with university regulations.
A Be obsessed with backups

When writing a thesis, your data are your most precious possession. Your second
most precious possession is any writing in progress or completed. Make sure that
you have up-to-date backups of both in case of disaster. One copy, whether on paper
or on disk, is certainly not enough. Make copies of everything and store them in two
places. That way, if the university or your home goes up in flames, or your computer
is stolen, all is not lost. You may have access to a portable backup device for your
computer, but if not, floppy disks will do the job just as well.
Theses and dissertations 119
A Give your abstract and introduction an extra polish

The abstract and introduction are the first parts of your thesis the examiners will
read. These parts of the thesis set the tone for everything that is to come. Just as a
person makes an indelible impression on you in the first 30 seconds, a good abstract
can 'sell' your thesis, whereas a bad one can put examiners off. Although examiners
will conscientiously read every bit of your thesis, it is very hard to wipe out these
first impressions. So make sure your thesis gives an excellent impression, starting on
the first page.
A Ask a friend to help with proofreading

As discussed in Chapter 17, it is impossible to find all the mistakes in your own work
- you are just too close to it. Your supervisor will probably also find it difficult to spot
mistakes in something so familiar, and is in any case more concerned with the sci-
entific content. You need a another 'eye' - perhaps a colleague or fellow student with
a good eye for detail. Or you could press a partner or friend into service. You could
offer a reward - perhaps a celebratory meal on completion of the thesis. Or you
could simply offer to reciprocate by proofreading their thesis when the time comes.
A Never trust hardware

Your word-processing and graphics programs are unlikely to let you down. Personal
computers are usually fairly reliable, though networks may not be. But you would
be well advised to plan for problems when it comes to printers, plotters and photo-
copiers; they always seen to break down or run out of consumables when you are in
a hurry.
A Allow plenty of time for printing, copying and binding

Allow plenty of time for printing out and photocopying your thesis. If you take it to
a copy shop for copying and binding, check each photocopy before it is bound to
ensure that all the pages are there. It is not unknown for pages to be missing or
bound in the wrong order.
22
How to write a book
Writing a book is not very different from other kinds of scientific writing - there is
just a lot more to write. You may already have some experience of contributing
chapters to books or writing long reviews. You may also have written a PhD thesis,
many of which are book-length. So, if you want to write a book, do not be daunted
by the scale of the project. These tips will help you cut it down to a manageable size.
A Have a good idea

You will feel much more confident and motivated if you start with a very clear idea
of what the book will be about and who will want to read it. Ask yourself:
has this been said before?
if so, how recently has it been said?
have I something new to say, or a different approach?
who would want to read this book?
If you have something new to say, or a new approach to an old subject, you are more
likely to be able to sell your idea to a publisher than if you have a 'me too' idea.
A Be sure that you really want to do it

Writing a book will take many weeks of your valuable time, for very modest
rewards. If you are doing it for the love of it, go ahead. If you are doing it to enhance
your academic career, there may be easier ways of doing so.
A Find a publisher early

You can start looking seriously for a publisher once you have completed an outline
and maybe two or three sample chapters. There is no point in waiting until you have
completed the entire manuscript - at worst, you could find yourself putting in
months of work on an unsaleable idea.
A Choose the right kind of publisher for the book

you have in mind
If you take on the task of finding a publisher yourself, look carefully at the different
companies that publish in your chosen area. Are they a mainstream or specialist
publishers? What other books do they have on their list? Does your book appear to
complement their existing list? How would they distribute your book?
A For non-academic books, get an agent

It is usual for authors of academic books to approach publishers direct. But if your
book is for a wider audience (e.g. a book for patients or the general public), and
you would like to place it with a mainstream publisher, it is best to get an agent. Pub-
lishers pay attention to book proposals submitted by agents, whereas those sub-
mitted directly by authors tend to sink to the bottom of the pile. The agent will
negotiate with the publisher on your behalf, and may well be able to get you an
advance against royalties. They will take a commission of about 10% - well worth it
for the effort saved. You can find an agent through the Writers' and Artists' Yearbook
(available from public libraries).
A Write a 'book proposal'

A book proposal is a document designed to sell your idea to a publisher. It can also
help to convince an agent to take you on. A typical proposal will contain:
a one-page synopsis describing what the book is about and what kind of readers
it can be expected to attract
a market analysis, briefly summarizing what other recently published books are
available on the topic and why yours is different
an expanded table of contents showing exactly what will be in each chapter
two or three sample chapters, chosen to be as interesting as possible.
A Give yourself enough time

If you are writing the book in your 'spare' time, think how long you will need to
complete it. For a typical book of 50-70 000 words, a year of spare-time writing is
probably realistic. Double that if your spare time is already very busy.
How to write a book 123
A Set yourself interim deadlines

You will avoid a last minute panic if you try to write a little every week, or even
every day. Just think - an easy 200 words a day could result in a book in a year.
A Get help where you can

You do not need to go it alone - colleagues and friends will usually be flattered to be
asked to review specific chapters and suggest improvements. You might even want
to co-opt them as co-authors (acknowledged and recompensed as appropriate).
A Do not expect to make a lot of money

Unless you are lucky enough to write a best seller, or a textbook that makes it onto
school syllabuses, your book is unlikely to make you rich. In non-fiction publishing,
an advance of around 1000 is considered generous, and more often there is no
advance at all. If you do get an advance, this will be deducted from any subsequent
royalties. Royalties are 10-12% of the purchase price of the book, so you will have to
sell a lot of copies before you start to make a return on your investment of time and
energy. Nevertheless, having a book published can have many non-financial bene-
fits. In addition to the personal satisfaction it gives you, it can enhance your credibility
as a scientist and communicator.
A Once your book is published, help sales in

any way you can
Your publishers will make their own efforts to maximize sales of your book - for
example, by sending out review copies. However, you can help to increase sales
yourself. For instance, you can write related articles for the popular or professional
press, give talks and get yourself interviewed by the newspapers or radio.
23
I nformal science
writing
Not all scientific articles have to be written for peer-reviewed journals. There are many
opportunities to write articles for journals, magazines and newsletters, perhaps
communicating with a wider audience. We will call these 'informal' articles, though
in practice their formality varies widely according to the publication. They can be
aimed at a wide range of audiences, including the lay public, and can be great fun to
write. While not adding the same lustre to your publications list as a peer-reviewed
article, informal articles help to get your name and your research better known.
A Get a commission or check out your idea first

You may be commissioned to write such an article by the editor of the publication.
Or you may have a good idea - in which case it is wise to write or telephone first to
check whether your contribution would be appreciated. Magazine or newsletter
editors are likely to be cautious about undertaking to publish an article they have
never seen, but will usually tell you honestly about what they think of your sug-
gestion. That way, you can tailor your article to suit their readers.
A Write to suit your readers - not yourself

The first rule of any kind of factual writing is to write to meet your audience's needs.
You do this when you write to meet demands of scientific journals for clarity, brevity
and scientific accuracy. Writing to meet your audience's needs is even more import-
ant in informal articles. No one has to read an article in a magazine or newsletter -
they read because they want to. Your article has to meet the 'what's in it for me'
criterion.
A Know your readers

If you are writing for your fellow clinicians or researchers, you may already have
a fairly clear idea of your readers' interests, likes and dislikes. Often, however,
informal articles will be written for people with a different background, knowledge
and interests from your own. For example, if you are a molecular biologist, you
could find yourself explaining the clinical implications of your work to doctors, or
trying to interpret them for the lay public. Before you even begin to plan your article,
ask yourself:
what are my readers interested in?
why should they be interested in what I have to say?
what do my readers know already?
what information is essential in order to understand the 'big idea'?
what information is peripheral ('nice to know' versus 'need to know')?
what terminology will be familiar to my readers?
what terminology will put them off?
what do I want my readers to think, feel, decide or do as a result of reading this
article?
Only when you have put yourself in your readers' shoes and answered these
questions will you be ready to start writing.
A Get the basics right

All the rules for clear, concise, accurate writing, listed in Chapters 24-27, apply to
informal science writing just as much as to formal papers and reviews. In informal
writing, it is even more important to make your prose easy to read, because readers
who become tired or confused can easily stop reading and look elsewhere for their
information or entertainment.
A Pitch your article at the right level

Think carefully about the technology and concepts that your readers will be used to.
Even scientific audiences may not know the technical words used in areas outside
their expertise. The general public will certainly not be familiar with many scientific
terms. Thus, for lay people you would usually write about 'high blood pressure'
instead of 'hypertension'. On the other hand, lay people may be very knowledgeable
in certain areas; for example, the parents of children with asthma probably already
know quite a lot about the condition and some of the terminology used. It all comes
down to knowing your audience.
Informal science writing 127
A Say something new

People will always be more interested in your article if it tells them something they
do not already know. Articles describing recent scientific discoveries are likely to
attract more attention than those restating well-known facts. The topic does not have
to be brand new, however. It only has to be new to your audience, or a new angle on
a familiar topic.
A Find the conflict

People are always interested in reading about conflict. This applies not only to
conflict between individuals or groups (the race to put a man on the Moon), but to
conflict between ideas, between man and disease, or science and ignorance. Finding
and emphasizing the conflict in your story can add interest to informal articles.
A Look for the human interest

People are often at least as interested in the human protagonists in a story as they
are in the story itself. Thus, when describing a Nobel Prize-winning discovery, talk
about the person who won the prize, as well as about the science.
A Add quotes for interest and endorsement

Read any news story and you will see that direct quotes are used liberally through-
out. Quotes demonstrate very clearly how the person speaking feels about the
subject. '"Over my dead body - I'll fight it to the last," said Dr Jones' is a far more
convincing demonstration of Dr Jones's feelings than if the journalist just wrote 'Dr
Jones disapproves of the proposed hospital closure'. Remember that you can quote
not only things people have said, but things they have written - for example, in a
presentation or scientific paper.
A Separate 'nice to know' from 'need to know'

Some information in your article may be useful but not essential. For example, some
readers may need background information, while others may not. You can get around
this situation by separating out 'nice to know' information in a box or other clearly-
defined area on the page. This means that the logical flow of the main article is not
disrupted. You will often seen this done in popular science magazines like New
Scientist. For example, in an article about the medical applications of growth factors,
you might include a box showing how growth factors are cloned and produced in
usable quantities.
A Put your best strawberries at the top of the basket

Lord Beaverbrook, the newspaper tycoon, advised journalists to 'put your best
strawberries at the top of the basket'. In other words, do not save your conclusion
until the end - put it at the beginning. Remember that only a minority of readers will
be patient enough to read your article from beginning to end. It usually plays to dive
straight in at the beginning with your main conclusion, then support it with the
evidence. Nowhere is this more true than in news stories (see below).
A For news items, follow the standard structure

If you want to write an article describing recent events, follow the standard news
story structure, used by journalists everywhere:
Headline. A short, active statement of what happened, in the present tense, e.g.
'Oldalol cures Alzheimer's'
Intro. The whole story captured in just one or two sentences, e.g. 'Oldalol can
arrest or reverse the progression of Alzheimer's disease, according to a study pub-
lished in the Lancet today. A single daily dose improves mental performance by at
least 50%'
Facts. More details of the story in descending order of importance, e.g. 'Researchers
at the State University of Oldsville in Kentucky, USA treated more than 500
nursing-home residents with oldalol for one year. Another group received placebo
treatment. After just three months, tests of short-term memory showed a marked
improvement in the oldalol group, compared with a slight decline in the placebo
group'
Background. 'Nice to know' rather than 'need to know' information comes at the
end of the story, e.g. 'Alzheimer's disease affects more than one in ten people over
the age of 75'
Quotes. Spread throughout to add interest, e.g. The leader of the research team,
Professor Harold Higgins (aged 74) said "This is the biggest breakthrough since
tacrine'"
No conclusion. In a news story, the conclusion comes at the beginning, not at the
end. Journalists realize that most readers will not make it to the end of the story.
A Be generous with headings and lists

In informal articles, you have a much wider choice of headings and lists than in
the IMRAD structure (information, methods, results and discussion) of a scientific
paper. Use headings generously to help your readers find their way around. Bullet-
point lists will also act as signposts to important information.
A Make headings and subheadings informative

Remember that headings in informal articles can be more informative than those in
a scientific paper. For example, whereas in a formal article describing a study you
would have the heading 'Methods', in an informal article this could become 'At last
- a model for migraine'.
A Be generous with illustrations

Most informal articles benefit from having plenty of illustrations. Any figures or
tables previously used in scientific papers should be simplified to suit the audience
of the informal publication. In contrast to scientific papers, informal articles can
use illustrations simply because they are interesting or attractive. So if you have
a nice photograph of your experiment in action, this is the place to use it. Many
journals also have access to picture libraries, so if you do not have a suitable picture
yourself you can suggest one and ask if they can obtain it. For example, if the article
is about hypertension, they will probably be able to obtain a picture of a doctor
measuring blood pressure.
A Ask rhetorical questions

In informal writing (and sometimes in formal writing), it is an accepted technique to
ask questions to which you are then going to give the answer (i.e. a rhetorical ques-
tion). You can use rhetorical questions in headings or in the main text of your writing.
A few rhetorical questions scattered widely throughout your article can add interest,
but beware of making it read like an interrogation, unless you are deliberately
writing in question and answer format.
A Use examples and case histories

Dry technical detail can be made real by using examples, either real or invented, to
suit the occasion. For example, in medical articles, both the general public and health
professionals usually find patient case histories fascinating.
A Make statistics real

Numbers have far more impact if readers can relate them to their everyday experi-
ence. For example, you might say 'Epilepsy is common, affecting as many as one in
every 130 people in the UK. This means that in a crowd of 30 000 people watching a
first-division football match, over 200 may have epilepsy'.
A Do not give people too much to remember

Studies in the 1950s showed that most people can hold no more than seven items in
their short-term memories. This means that, when giving lists of items or ideas, it is
best to include no more than seven items. If you have a very long list, try to break it
up into subcategories to make it more memorable. Incidentally, the most memorable
number seems to be three - which is why orators and advertising copywriters con-
tinually use the rule of three (Julius Caesar: 'I came, I saw, I conquered'; advertising
slogan: 'A Mars a day helps you work, rest and play').
A Use alliteration in moderation

Alliteration is the term used to describe the use of words beginning with the same
letter or sound in close proximity (such as 'pedantic professor', or 'I came, I saw, I
conquered'). You will often encounter alliteration used consciously in newspaper
headlines or radio reports. We seem to have a liking for alliteration, perhaps because
of the rhythm it adds to sentences. When we create neologisms in biomedicine they
are often alliterations (e.g. 'big bad baby syndrome'). There is no reason why you
should not use alliteration, if it comes naturally. However, try not to use it either
excessively or inadvertently.
A Use metaphors and similes, where they help the reader

A metaphor is a figure of speech in which you say something is something else, e.g.
The brain is a computer with an infinite hard disk'. A simile is a figure of speech in
which you say something is like something else, e.g. 'Writing is like driving: we all
like to think we are good at it, and are ashamed to say we are not'.
A Be positive
Positive writing means replacing 'It is not impossible that...' with 'It is possible that
...' Similarly, avoid 'Professor Smith is not unimpressed ...' and use 'Professor Smith
is impressed ...'
A Avoid hedging
Avoiding hedging means that, wherever scientifically credible, you should write, for
example, The experiment showed that oldalol improves cognitive function' instead
of The experiment suggested that oldalol may improve cognitive function'. (See
Chapter 15 for more information on hedging.)
24
Clear writing
sentences
The purpose of scientific writing is to transmit information - quickly, clearly and

convincingly. Common sense tells us that a well-written paper - and that means a
clearly written paper - is more likely to be accepted for publication because:
important findings will stand out and catch the editor's attention
there is less likelihood of key points being misunderstood
editors and reviewers are likely to feel more positive about papers that are easy to
read and therefore do not waste their time.
So, here are some tips to help you write more clearly and effectively.
A Clear writing might help to get your paper accepted

Quality of preparation is likely to be especially important in major journals that re-
ceive thousand of papers each year, and reject as many as nine in ten of them. Good
writing cannot compensate for poor research, but unclear writing can sometime
obscure good research, and hence delay publication.
A Do not assume that because science is complex you have to

write about it in a complex way
Some newcomers to scientific writing may have the impression that the 'correct'
style for scientific papers is rather elaborate, using words and expressions that you
would never use in everyday speech. While it is true that you will come across many
papers that are written in this style, that does not mean that it is correct. Scientific
writing can be formal without being elaborate or pompous. For example, there is no
reason to write:
'An extensive review of the literature available at the present time leads us to the
inescapable conclusion that hypertension shows a statistical association with the all
too common problem of obesity.'
when you could write:
'Most studies have shown an association between obesity and hypertension'.
The second version is easier to read and has lost no essential information.
A Write in your natural voice

Few people are naturally convoluted or pompous in their speech, but far more adopt
this style in their writing. One of the easiest ways to make your writing clearer is to
write in your natural voice. How would you explain something to a scientific
colleague? Good scientific writing flows naturally, like speech, only with no 'urns' or
'ers' or slang expressions, and always in a logical order.
A Stick to one idea per sentence

The golden rule is that a sentence should express a single thought. Often, if you write
a long sentence, you will find that it contains more than one idea and can be easily
split into two sentences (see below). If you have a very small thought, do not be afraid
to write a short sentence.
A Check to see if very long sentences can be split

Ease of reading is related to two principal factors, sentence length and word length.
Shortening your sentences is a simple way to make your writing easier to read.
Often, you can split a long sentence into two or three shorter ones. For example:
The efficacy and safety of grottomycin was studied in 27 patients aged 16-67 years,
who had radiologically confirmed acute sinusitis with symptoms present for at least
two weeks, and had not received any other antibiotics in the two weeks before the
study.' (42 words)
could easily be rewritten as:
'The efficacy and safety of grottomycin was studied in 27 patients aged 16-67 years.
All had radiologically confirmed acute sinusitis, with symptoms present for at least
Clear writing: sentences 135
two weeks. None had received any other antibiotics in the two weeks before the
study.' (14 + 14 + 13 = 41 words)
The total number of words is similar, but splitting the text into three sentences has
made it easier to read. Note that you can also shorten sentences by editing out wordy
and redundant phrases (see Chapter 25).
A Sentences of more than 30 words can usually be split

Sentence length tends to be stretched in scientific writing because we often have to
include elements such as data in brackets, p values and so on. This makes it all the
more important to keep sentence length within bounds. Sentences of up to 20 words
are usually easiest to read. Look carefully at any sentences of more than 30 words to
see if they can be shortened by editing out waste words or split into two. Do not
forget that you can use short sentences - an eight-word sentence is easy to read.
A Vary sentence length for readability

Text that consists of nothing but long sentences is hard to read. On the other hand,
text that consists only of eight-word sentences can read like machine-gun fire. The
most readable combination is a mixture of short and long sentences (though that
does not give you an excuse for that 45-word sentence!).
A If you use a long sentence, punctuate it carefully

Long sentences should be carefully punctuated to make their meaning clear. How-
ever, if your sentence has more than two commas in the middle and a full stop at the
end, you can probably make it clearer by dividing it into two sentences.
A Use 'joining' words to clarify relationships

between ideas...
The use of 'joining' words can help the reader to see the relationships between
sentences and paragraphs. Examples of 'joining' words include:
and
but
however
therefore
in addition
also
despite
in contrast
in conclusion
to summarize.
How many others can you think of?
A ... But do not join unrelated ideas

If two parts of a sentence are connected by a 'joining' word such as 'and' or 'but',
make sure that there is really a logical connection between them.
In this sentence, 'and' has been used inappropriately to join two ideas:
'Asthma is an inflammatory condition of the airways and is more common in boys
than girls.'
It would be better to write two separate sentences, even though both would be quite
short:
'Asthma is an inflammatory condition of the airways. It is more common in boys
than girls.'
A Construct your sentences carefully to

avoid confusion ...
If you stick to the 'short sentences' and 'one idea per sentence' rule, you are less
likely to end up with odd sentences like this one:
'Inhaled corticosteroids are widely used in the treatment of inflammatory disorders,
including asthma, and may also be administered by the oral route, though this may
be associated with a greater risk of side-effects.'
The indiscriminate use of 'and' in this sentence results in the implication that inhaled
corticosteroids can be given by the oral route, which is clearly not what the writer
intended - he meant to say 'Corticosteroids can also be administered by the oral
route ...'.
However, even short sentences can be confusing (or amusing) if not carefully
constructed, as in 'We treated the patients using anticholinergics'. We do not know
if the writer means 'We treated those patients who used anticholinergics' or 'We
treated the patients with anticholinergics'.
'I have discussed the question of feeding the rats with Professor Smith.' (Most labs
prefer a more conventional diet.) This kind of mistake is known as a 'misplaced
modifier'.
Clear writing: sentences 137
A Put the most important words or phrases near the

beginning of the sentence
Studies of reading behaviour show that readers' attention peaks at the beginning of
a sentence, with another, usually smaller, peak near the end. So it pays to put the key
words or phrases near the beginning of the sentence. To illustrate this, ask yourself
which of these two sentences you find easier to understand.
To be successful, a new drug must not only be discovered, but thoroughly tested.'
'A new drug must not only be discovered, but thoroughly tested, to be successful.'
Most people find the first example easier, because it gives them a clue where they are
going, rather than taking them on a 'mystery tour'.
A Use the active voice where appropriate ...

Greater use of the active voice is a simple strategy to make your writing simpler and
clearer. If you have not encountered the idea of active versus passive voice before,
this is what it means. When the active voice is used, the subject of the sentence
performs an action. In other words, the subject is the 'doer'.
Here are some examples of the use of the active voice:
Sir James Black [subject] received [verb] the Nobel Prize [object]
Aspirin [subject] reduces [verb] inflammation [object]
When the passive voice is used, on the other hand, the object goes at the beginning
of the sentence and is acted upon.
The Nobel Prize [object] was received [verb] by Sir James Black [subject]
Inflammation [object] is reduced [verb] by aspirin [subject]
You will notice two things about the passive voice.
1 It uses more words to say the same thing.
2 It often sounds duller.
Preferring the active voice also ties in with the idea that the most important words
or phrases in a sentence should go near the beginning - provided the subject is at
least as important as, or more important than, the object.
A ... But use the passive voice when you want to

stress the object
There are three situations in which it is better to stress the object by putting it first:
1 When the subject is unknown or unimportant. It would be silly to say 'Some builders
built the laboratory in 1991'. You would just say The laboratory was built in 1991'.
2 When you want to empJiasize the object. You might want to say 'This unique process
has been patented' rather than 'We have patented this unique process'.
3 If you would rather not say who performed the action. The dose was miscalculated.'
Let us hope that you have no need of this last example!
A You can use the active voice while still remaining

formal and impersonal
Some people object that you cannot use the active voice in formal writing about
science, because scientific writing must be impersonal. This is a misconception. As
the example 'Aspirin reduces inflammation' shows, you can use the active voice
without using a person's name or personal pronoun (T or 'we'). In fact, nowadays,
there is no reason why you should not use 'we' in formal science writing.
A Use parallel structures

Within sentences, you can use parallel structures to make your writing clearer. A
parallel structure is a series of word groups with the same kind of structure. Using
parallel structures reflects logical thinking, and helps satisfy the reader's need to see
order in your writing. For example, while it is grammatically correct to say:
This educational programme will encourage people to eat healthily, drink a sensible
amount and take regular exercise.'
you might prefer to try a more elegant version of the sentence with parallel structure:
This educational programme will encourage people to eat healthily, drink sensibly
and exercise regularly.'
My favourite example of a parallel structure comes from the pen of Francis Bacon,
and seems particularly appropriate for scientific writers:
'Reading maketh a full man; conference a ready man; and writing an exact man.'
(My thanks to Martin Mackay for first introducing me to this quote.)
25
Clear writing
words
Clear writing depends on selecting the right words to get your message across,
precisely and economically. You need to choose words that say exactly what you
mean, without taking up unnecessary space.
A Use simple everyday words for simple everyday things

Studies of reading difficulty show that, even for educated readers, short, familiar
words make writing easier to understand. The more long, multi-syllable words a
sentence contains, the harder it is to understand. So, if you want to be clear, prefer
short, simple words for simple everyday things. Now, this does not mean that you
cannot use scientific language. You need specific scientific terms to make your writ-
ing precise. But it does mean that you should be extra careful with your non-
scientific language. Why say 'It is evident that there is a discrepancy of considerable
magnitude ...' when you can say 'It is clear that there is a large difference ...'.
A Try these simple alternatives

The following list gives some examples of common long words and their shorter
alternatives. None of these words is 'wrong'- in fact they can add some variety to
your writing. However, (but) if you use the shorter words, say, half the time, you will
have taken an important step towards clearer writing.
Instead of: Why not use:
purchase or acquire buy
quantify measure
Instead of: Why not use:

communicate write/speak
following after
permit let
however but
utilize use
manufacture make
sufficient enough
demonstrate show
necessity need
advantageous helpful
concerning about
discontinue stop
endeavour try
evident clear
location place
magnitude size
participate take part
regarding about
remainder rest
request ask
requirement need
subsequent next
A Cut out unnecessary words

Even worse than the 'long words habit' is the 'wordy phrases habit'. Unlike long
words, which sometimes have their place, wordy phrases are seldom justified. They
make you seem pompous, and obscure your message. Here are a few of the com-
monest examples. If this is one of your writing problems, make your own list of
'favourite phrases' and ruthlessly eradicate them when you edit your own work.
Avoid: And use:
as a means of to
ask the question ask
at the present time now
during the time that while
in order that so that
with regard to about
prior to before
with the exception of except for
a considerable number of many
Clear writing: words 141
Avoid: And use:

at a rapid rate rapidly/quickly
a certain amount of some
for the reason that because
referred to as called
at an early date soon
in view of the fact that because
during the course of during/while
A Watch out for 'smothered' verbs

A 'smothered' verb is a particular kind of wordy phrase. A verb is 'smothered' when
we take a perfectly good verb and make it into a noun by adding another verb, like
'make', 'take', 'give' and so on. Some examples are given in the list below. Usually,
we can restore the original verb with no loss of meaning. Why not 'decide' (not
'come to a decision') to eradicate them from your writing.
Instead of: Use:
make a decision decide
come to the realization realize
take into consideration consider
make an estimate estimate
give an explanation of explain
make a presentation of present
is indicative of indicates
place an emphasis on emphasize
come to a conclusion conclude
undertake an investigation investigate
give a description of describe
A Avoid redundancy
There are some wordy phrases that you should never use, because they say the same
thing twice. There is no point in saying the difference was Targe in magnitude' (or
even Targe in size'). It was large, that is all you need to say. Here is a list of some
common redundant phrases.
Instead of: Use:
absolutely complete complete
completely finished finished
try and endeavour try
meet with meet
true facts facts
Instead of: Use:

advance plan plan
basic essentials basics or essentials
current status status
estimate approximately estimate
past history history
large in size large
few in number few
A Do not be so concise that you lose the linking

words and phrases
Linking words and phrases make your writing clearer by showing the connections
between words, phrases, sentences and paragraphs. Examples include:
When you add one point to another: and, in addition, moreover, furthermore
When indicating similarity: likewise, similarly, in the same way
When contrasting: but, in contrast, however, on the contrary, on the other hand,
nevertheless, although, even so, in spite of/despite
When showing how one thing results from another: so, therefore, hence, thus, as a
result, consequently, accordingly
When summing up: in conclusion, in summary, to summarize, to conclude, in brief,
in other words.
A Use the precise word for what you mean

Be careful when choosing among scientific terms, and try to use the most specific
term possible. 'Quantify/ for example, is vague. Did you 'measure', 'count', 'estimate'
or 'calculate' it?
A Watch out for common errors of meaning

If you do not know what a word means, it is a bad idea to use it. The trouble is, some
words are so commonly misused, or confused with similar-sounding words, that
we think we know what they mean, and misuse them unknowingly. Here are some
commonly confused pairs:
abrogate abdicate
repeal or cancel out decline to take responsibility
affect effect
verb: to act upon; noun (in psychiatry): verb: to bring about; noun: outcome
outward appearance of emotion
Clear writing: words 143
alternately alternatively
every other offering a choice
appraise apprise
form a judgement inform someone
compliment complement
to praise something to mutually complete or add value
continual continuous
happening over and over again happening without interruption
definitive definite
stands as a definition of something precise
disinterested uninterested
unbiased by personal advantage does not find the subject interesting
dose dosage
quantity administered at one time quantity administered per unit time
infer imply
draw a conclusion give a hint
mitigate militate
make less serious or severe argue against
oral verbal
spoken word only spoken or written word
practical practicable
workable, effective feasible, i.e. capable of being done
principle principal
a rule the most important thing; the head of an
educational institution
regime regimen
a system of government a system of therapy
refute repudiate
prove falsity claim falsity, deny
26
Clear writing:
paragraphs, headings
and lists
Paragraphs, headings and lists are part of the 'route map' that allows readers to find
their way around your document. Once you have a clear structure in your mind (as
described in Chapter 5), you need to make that structure clear to the reader by laying
it out on paper.
Here are some tips to help you do this.
A Break up long documents with headings ...

In a scientific paper, the main headings will be dictated by the IMRAD structure
(introduction, methods, results and discussion). In other kinds of scientific writing
(e.g. review articles) you will have a more-or-less free hand with the headings, so do
not be afraid to use them generously to help readers find their way around the
document.
A ... And subheadings

Under your main headings, you can use subheadings. These are appropriate in most
kinds of scientific writing - even in letters or memos. In original research papers,
most journals will let you use subheadings within the main sections. They can be
very helpful to readers, especially within long methods and results sections. You
may be able to match up the methods subheadings with the results subheadings.
A But do not use too many levels of heading

It may be tempting, especially in a long and complex document, to use multiple
levels of heading - right down to sub-sub-sub-subheadings. But this can be con-
fusing for the reader - not to mention the writer. Usually, three levels of heading will
be enough - the title or chapter heading, section headings and subheadings. If you
really feel you need additional levels of headings, do not forget that you can use
bulleted lists, and emboldened keywords at the beginning of sentences.
A Only use numbered headings if there is a good reason

Some types of document, for example, a thesis or a drug regulatory report, may have
a statutory requirement for numbered headings (1.0. 1.4, 1.3.8 and so on). If so, you
must comply. However, when considering introducing numbered headings into
other types of document (e.g. a book or manual), ask yourself if they are really
needed. Are you going to have cross-references from one section to another? Are you
going to refer to the numbered sections in the index? If readers do not need the num-
bers to navigate the document, do not put them in. You will only be making extra
work for yourself when you add new sections. If you do decide to use numbered
headings, your word processor will probably be able to number and cross-reference
them for you automatically (see Chapter 30).
A Match the style of your headings to the tone

of the document
Formal scientific papers and reports will require formal headings - 'Methods,'
'Results' and so on. Subheadings will need to be brief and objective, e.g. 'Animal
studies', Tharmacokinetics'. In other kinds of scientific writing, e.g. a magazine
article, you may decide to use main headings or subheadings that actually summarize
what is in the text, e.g. 'Colon cancer - the silent killer' or 'Six simple ways to cut
computer costs'. In very informal writing, particularly news articles or press
releases, you may decide to use headings simply to attract attention, e.g. '"It's a
jungle out there," says Professor Smith'.
A Use plenty of paragraphs

Paragraphs are used to:
group related thoughts
provide visual relief.
Clear writing: paragraphs, headings and lists 147
Too many scientific papers are so mean in their use of paragraphs that you cannot
see where one group of thoughts stops and the next one begins. There is no good
reason for this - when you start a new topic, you should always start a new
paragraph.
A Do not be afraid of short paragraphs

If your paragraph includes more than five to seven sentences, ask yourself whether
it contains more than one group of ideas. The chances are that it does. Could it be
more effectively split into two? Do not worry if you end up with two- or three-
sentence paragraphs. There is nothing wrong with short paragraphs - not every
train of thought can be extended into several sentences.
A One-sentence paragraphs are not wrong -

but use them sparingly
Contrary to what you may have been taught at school, there is nothing grammatic-
ally wrong with a one-sentence paragraph. If you have only one thing to say on a
particular topic, you can say it in a one-sentence paragraph.
But such paragraphs do draw attention to themselves.
So you should use one-sentence paragraphs only occasionally, for ideas that
deserve emphasis. For example, the last paragraph of your paper might be a one-
sentence conclusion, if that is all you have to say. One-sentence paragraphs are also
useful for lists and instructions, where you want every point to stand out clearly and
carry equal weight. However, if your one-sentence paragraph contains only a minor
idea, you might like to merge it with an adjacent paragraph.
A Use topic sentences to introduce paragraphs

It is very helpful to readers if the first sentence in the paragraph gives some idea of
where the paragraph is going. For example, you might say:
'Wound healing consists of three distinct phases, [topic sentence] First, an acute
inflammatory phase occurs. Next, collagen synthesis repairs the wound. Finally,
remodelling restores the skin's structural integrity.'
As you can see, starting with 'the bottom line' is much more effective than writing
the paragraph the other way round:
'Wounding is followed by an acute inflammatory phase. Next, collagen synthesis
repairs the wound. Finally, remodelling processes restore the skin's structural
integrity. Thus, there are three phases to wound healing.'
A Use lists wherever they help readers and are

allowed by the journal
In formal journal articles you may be able to use numbered lists. For example, you
could list the steps in a procedure. In some journals, and in less formal scientific
writing (for example a magazine article), you may also be able to use bullet-point
lists. For example, the Lancet uses bullet-point lists of key points in articles. I have
used lots of bullet-point lists in this book.
A Arrange items in lists in logical order

When you give a list, readers will assume that there is some logic in its order. If you
list items in random order you will be confusing the reader. So think carefully about
the order of items in your list. Often, the best way is to list items in order of
importance, or you may want to list them in chronological or hierarchical order.
Use parallel structure in lists where appropriate

If each item in the list contains several kinds of information it is appropriate to
arrange them in the same order each time. A parallel structure of this kind will help
readers to find their way around the list. For example:
'Wound healing consists of three phases:
1 The acute inflammatory pliase occurs over the first few days. Neutrophils and
macrophages migrate into the wound.
2 The collagen synthesis pliase lasts for several weeks. Fibroblasts from the surround-
ing dermis migrate into the wound, synthesizing new collagen.
3 The modelling phase lasts many months. Collagen cross-linking, collagenolysis and
collagen synthesis occur simultaneously, strengthening the wound.'
A Be consistent about capitals and full stops in lists

Different publications have their own formats for lists. In draft manuscripts and
internal documents, the important thing is to be consistent about the use of capitals
and full stops. The usual rule is:
For list items that are full sentences, begin with a capital letter and end with a full
stop.
Clear writing: paragraphs, headings and lists 149
For list items that are not full sentences, but a word or phrase, begin with a lower
case letter and do not use a full stop, except for the last item in the list. It is as if
the list was a sentence with a full stop at the end.
For example:
'There may be various reasons why PhD theses are not submitted on time.
The research is not complete.
Problems may occur with data analysis.
Writing may go more slowly than expected.
The student may have started work on another project.'
Or:
'PhD theses may not be submitted on time because of:
incomplete research
problems with data analysis
slowness in writing
conflicting work commitments.'
27
Correct writing:
common errors of
grammar and idiom
The first duty of a scientific writer is to write clearly, concisely and accurately. You
are not necessarily expected to be an expert on English, especially if it is not your
first language. If you are submitting your work to a journal or book publisher, it
will be checked carefully by a sub-editor to make sure that there are no mistakes
of English grammar, idiom or spelling. The important thing is to make sure your
meaning is clear, so that the sub-editor does not inadvertently misrepresent what
you have to say. Note, however, that theses, conference abstracts, study reports
and many other types of document are not sub-edited, so there will be no second
chance to correct your mistakes before your work reaches the wider scientific
community.
A You do not have to be an expert

This book is not a textbook of correct English. Moreover, it recognizes that most
readers will be far too busy with scientific matters to spend much time perfecting
their knowledge of grammar and idiom. But, bearing in mind the negative effect
poor English can create, I do urge you to try to avoid unnecessary mistakes. In pract-
ical terms this means that if you are not confident in your use of English, you should
get an expert to check your work before you submit it to an editor or examiner.
A careful reading by a native speaker with excellent grammatical knowledge can
save many embarrassing errors - this person need not necessarily be a scientific
expert.
A Fewer allowances will be made for native English speakers

Theoretically, reviewers, thesis examiners and conference organizers should not be
influenced by small mistakes in English - their job is to comment on the science.
However, even trivial mistakes can be distracting, especially if they lead to confusion
in meaning. Reviewers will usually make more allowances for writers for whom
English is a second language than they will for native speakers. If English is your
mother tongue, it may seem merely careless not to use it correctly.
A Find your own 'blind spots'

Many of us have just a few 'blind spots' which prevent us from producing correct
copy. If so, some of the common errors listed below may help you perfect your
English and make a better impression on colleagues and reviewers. Identify those
that apply to you and try to memorize the correct usage.
A Use 'compare with' when looking for differences ...

Use 'compare with' when you are looking for differences between things. Since
science is so often based on looking for differences between experimental and
control groups, 'compare with' is almost always correct.
Correct: 'We compared grottomycin with scabicillin.'
Incorrect: 'We compared grottomycin to scabicillin.'
A ... And 'compare to' when you are likening one thing
to another...
Occasionally, you may want to say something is like something else, in which case
you use 'compared to', e.g. 'Shall I compare thee to a summer's day?'; 'The heart
may be compared to a pump'.
A ... But do not use 'compared with' where you can use 'than'
Avoid the misuse of 'compared with' as in this example.
Incorrect: 'We found a higher recovery rate in the treatment group compared with the
control group.'
Correct writing: grammar and idiom 153
Correct: 'We found a higher recovery rate in the treatment group than in the control
group.'
A Prefer'different from'
'Different from ...'is the modern way.
'Different to ...' is the old-fashioned form, which has more or less died out.
'Different than ...'is acceptable only in the USA.
A Use 'fewer' when referring to countable nouns ...

Correct: 'Fewer psychiatric beds are needed since the introduction of care in the
community' (because you could, at least in theory, count the beds).
Incorrect: 'Less psychiatric beds are needed since the introduction of care in the
community.'
A ... But 'less' when you are referring to things that

are not measured in numbers
Correct: 'There is less need for psychiatric beds since the introduction of care in the
community' (because you cannot count 'need').
Oddly enough, people often use 'less' where they should use 'fewer', but they
hardly ever use 'fewer' when they should use 'less'. You would never write:
Incorrect: There is fewer need for psychiatric beds since the introduction of care in
the community.'
A Use 'which' for a commenting clause ...

'Which' is used in a 'commenting' or 'parenthetical' clause. If there are a pair of
commas, or a pair of brackets, it is a fair bet that you should be using 'which'.
'The Thames, which flows through London, is England's largest river.'
You could take out the material starting with 'which', and the sentence would still
be true. The 'which flows through London' is just giving you some extra, non-
essential information.
Similarly, you would say: The method, which is described in detail in Appendix 1,
was developed by Professor Smith.' Again, if you take out 'which is described in
detail in Appendix V, the sentence still retains the original meaning.
A ... And 'that' for a defining clause

That' is used in a 'defining' clause (i.e. before a clause that could not be taken out
without destroying the meaning of the sentence).
The Thames that flows through London is heavily polluted.'
Notice, no commas, and the material after the 'that' is essential if we are to make
sense of the sentence.
Similarly, you would say: The method that Green and White used in their first
study was first described by Smith in 1996.'
A Watch out for verbless sentences ...

Normally, sentences must have a verb.
Incorrect: 'All good scientific papers have certain qualities in common. Such as
clarity, accuracy and conciseness.'
Correct: 'All good scientific papers have certain qualities in common, such as clarity,
accuracy and conciseness.'
Also correct: 'All good scientific papers have certain qualities in common. These
include clarity, accuracy and conciseness.'
A ... But you can miss out verbs when writing notes, or in
items in lists
You can, however, miss out verbs when you are writing in note form, or in items in
lists.
'All good scientific papers have certain qualities in common:
clear sentences
accurate word choice
concise construction.'
Verbless sentences are sometimes also used in informal writing for dramatic effect.
You may be able to spot one or two in this book. Like this one.
A Watch out for mixed singular and plural

verbs and nouns
The solutions was mixed ...' is obviously wrong. Other singular/plural problems
are more difficult to spot.
Correct writing: grammar and idiom 155
Incorrect: 'Each of our lecturers have a postgraduate degree.'

Correct: 'Each of our lecturers has a postgraduate degree' (because you are referring
to each lecturer, not the lecturers as a group).
But: 'All our lecturers have postgraduate degrees' (because you are referring to all
the lecturers).
A Remember that companies are singular

Singular verbs are used with the names of companies, thus:
Incorrect: 'Megapharm are developing bradykinin antagonists.
Correct: 'Megapharm is developing bradykinin antagonists.'
A Use apostrophes carefully in possessives

Put the apostrophe before the 's' when you are talking about something belonging
to just one thing, or to a person, e.g. The university's records' (belonging to just one
university); 'Professor Smith's experiment' (belonging to Professor Smith). But put it
after the 's' when you are talking about something belonging to more than one thing,
e.g. The universities' records' (more than one university).
A Remember that there are special rules for 'it'

The exception to the rule above is the apostrophe used with 'it'. 'It's' is short for 'it
is', e.g. 'It's usually warm in summer' (i.e. the abbreviated form of it is). 'Its' for
'belonging to it' has no apostrophe, e.g. The reading was twice its usual value'
(belonging to it).
A There are no apostrophes in plurals

There is no place for the apostrophe when you are simply using the 's' to denote a
plural.
Incorrect: 'Supervisor's should help their students.'
Correct: 'Supervisors should help their students.'
A Avoid contractions such as 'it's' and 'don't' in

formal science writing
In informal writing or reported speech, an apostrophe can be used to replace a
missing letter, as in 'don't' (short for 'do not') and 'here's' (short for 'here is'). How-
ever, it is better to avoid them in formal science writing.
A Split infinitives only if there is no better way of

writing the sentence
Split infinitives are widely regarded as an error in UK English, though they are not
considered so in US English. 'Split infinitive' means putting an adjective or adverb
between 'to' and the infinitive form of the verb. The classic example is from Star
Trek: 'To boldly go where no man has gone before.'
Another example: 'It is essential to fully evaluate all the programs before making
a decision.'
The non-split version would be: 'It is essential to evaluate all the programs fully
before making a decision.'
Any UK grammar textbook will tell you that splitting an infinitive is not a true
grammatical error, but that it is very widely disliked. To avoid annoyance, do not use
split infinitives. However, split rather than write an ugly sentence.
A Beware 'false' split infinitives

Note that, contrary to what some people imagine, the following example does not
contain a split infinitive, because 'we' are doing the evaluating. The infinitive 'to
evaluate' is not used, and therefore there is nothing to split: 'We will fully evaluate
all the programs before making a decision.'
28
Overcoming writer's
block
Have you ever spent hours staring at a blank screen or piece of paper, unable to get
started? This phenomenon is known as writer's block. We all experience it once in a
while, but for some people it becomes a frequent problem, reducing their writing
productivity.
Everyone has their own way of beating writer's block, and the list of tips below is
made up of helpful suggestions from many sufferers. Among these ideas, you may
find the right one to help you.
A Plan carefully
It is impossible to overemphasize the importance of planning. Meticulous prepara-
tion not only determines the quality of the finished product, it also affects your
psychological approach to writing. If you have planned the whole of your project in
advance, and broken it down into manageable chunks, you will:
know what you are going to say in each section
have confidence in your ability to complete it on time
be able to start anywhere in the project, as convenient.
A Start with the easy bits

It will help to build your confidence, and speed up your writing, if you start wherever
seems easiest. You can do this if you have a good plan. Often, in an original research
paper, the methods and results sections are the easiest places to start. You may
well already have a written protocol for the methods. For the results, there will be
relatively little choice about what you have to say, and again you will already have
it written down in your lab book or a study report.
A Go with the flow

Perhaps the most important advice is 'If it ain't broke, don't fix it'. If your work is
going well, and the writing flows in a continuous stream, do not stop until you begin
to run out of energy or enthusiasm. When you do begin to flag, take a break (see
below).
A Take a break when you feel you need one ...

You may need quite frequent breaks when concentrating hard - a ten-minute break
every hour, or even every half-hour, is not too much. Taking a short break will not
disrupt your concentration - in fact, it will help you to focus on the task in hand.
A ... But not for too long

Studies show that short breaks are the most effective in aiding concentration. Long
breaks (say 20 minutes or more) do not provide any additional benefit, and may
simply indicate that you are procrastinating.
A Get away from it during breaks

When you take a break, do not just sit there - move around, go and talk to someone,
or get some fresh air or exercise - you might even want to use your ten minutes to
take a brisk walk, indoors or out, or even ride an exercise bike or do some exercises
in your office.
A Sleep on it if stuck
If you are stuck, and a short break does not help, it may be time to stop and do
something else. Sleep on the problem, and in the morning you may come back to it
with fresh ideas and enthusiasm.
Overcoming writer's block 159
A Talk to someone
It may help to ask a colleague for help. Even simply talking about the problem to
someone else, without looking for any particular advice, may be beneficial. Often, an
'outsider' will be able to provide a fresh viewpoint that gives you the impetus you
need to get going again.
A Write a letter to Auntie'

If you are stuck trying to explain a complex concept, it can be helpful to imagine that
you are writing to a non-expert about the topic. You might choose a favourite aunt,
who is very interested in everything you do, but is not scientifically qualified. If you
can explain your point to an interested lay person, you can be sure that you will have
expressed yourself clearly. Then all you have to do is reintroduce the scientific ter-
minology into your clear explanation, and you have suddenly solved your problem.
A Read around the subject

Sometimes, you can get a fresh perspective by reading about the topic. There is
nothing wrong with looking at how other writers have tackled the same problem.
You can borrow ideas and approaches without using the same words.
A Clear your desk

If other projects are cluttering up your desk you will have two problems:
1 you won't be able to find all the papers you need for your current project
2 the clutter will distract you - it too is waiting for attention.
So, clear your desk of everything except the project in hand. If you have an in-tray,
put it behind you, or in a cupboard, out of sight.
A Think positively
This book is based on the belief that all scientists can learn how to write. Some of us
may have more natural talent than others but, with a little encouragement and
tuition, everyone can do it reasonably well. If, due to negative past experiences, voices
tend to play in your head saying 'I'm no good at this' or Til never be able do it
in the time I have left', try to replace them with positive thoughts. Think: 'I can do
this, I just have to complete all the sections of my plan' or 'You only have to finish
one section today'.
A Do not try to get everything right first time

You can get hopelessly stuck and dispirited if you keep going over and over the
same sentence, trying unsuccessfully to get it just right. For most people, it is better
to try to get something down for every section, even if you know it is far from
perfect. Then you can go back and revise - having completed the first draft quickly,
you will have plenty of time for revisions.
A If stuck, just write

A standard technique for overcoming writer's block involves simply writing the
first thing that comes into your head, however ludicrous. The important thing is
that it gets you started on the physical process of writing. You will soon find that
your random musings turn into comprehensible thoughts about the subject in
hand.
A Write around missing information

If, in the middle of writing, you find that you do not have all the facts or references
you need, do not waste time thinking or worrying about it, or break your concentra-
tion to go looking for them. Make a note to yourself in the manuscript about the
missing information. You can use the hidden text feature of your word processor to
do this. Then you can save your queries up to be answered in a single trip to the
library or on-line session.
A Do not stop when you are winning

Even when you come to the end of a section, do not automatically stop. Sometimes
it helps to get down the first few sentences of the next section. That way, when you
come back to it the next day, you will have the confidence-building feeling of having
already made a start on the next task.
Overcoming writer's block 161
A Set crazy deadlines ...

In Chapter 29, we will talk about setting real-life deadlines for your project.
However, if you have writer's block, it can also help to set yourself crazy, short-term
deadlines. For example, you may say to yourself 'I have to get 200 words written by
3 o'clock'.
A ... And reward yourself for meeting them

You can offer yourself rewards for meeting your crazy deadlines. 'If I have written
200 words by 3 o'clock I will have a cup of coffee/go for a walk/telephone a friend.'
It is tempting to offer yourself rewards in the shape of food, but this can prove
unhealthy in the long term, especially if you are writing a large thesis or a book!
29
Managing your time for
writing and revising
Writing can be a time-consuming process. Many scientific and technical professionals

feel overwhelmed by the amount of time needed to write 'essential' documents such
as papers, theses, reports and grant proposals - not to mention 'optional' tasks such
as reviews, book chapters and magazine articles.
Yet, writing is so essential to a successful scientific career that we simply must find
ways of doing it efficiently. Here are some tips that will help you to make the most
of your writing time, and feel better about your productivity.
A Remember the 'one-third rule'

For major writing projects, a good rule of thumb is 'one-third planning, one third
writing, one-third revising'. It may seem daunting to spend so much time on
planning your work, but it will pay dividends. When you do sit down to write, you
will be so confident of what you want to say that progress will be very fast. At first
glance, you may also think that a third of your time spent revising is too much.
Realistically, however, you are unlikely to produce your best work without spending
a considerable time revising your first draft.
A Draw up a writing schedule

For a big project, it will help to divide the work up into manageable chunks, and set
interim deadlines. When you draw up your writing schedule, remember to include
time to:
obtain references
plan the project
write the first draft

revise the first draft
circulate the manuscript to your colleagues or boss
incorporate comments into a second draft
prepare figures, photographs and any other illustrative materials
obtain any necessary final approvals or sign-offs.
A Break your work down into manageable chunks

'An elephant is easier to eat if you slice it first.' A 50 000 word thesis seems like a
terrifying amount. However, it is only 200 words a day for a year (excluding week-
ends, of course). Or, if you start very late, it is 2000 words a day for a month. Both
would be perfectly manageable - all you need is motivation and organization.
A Block out writing time in your diary

Writing time is just as important as research time or meetings time. The danger is
that it will be squeezed out by other duties. While some of us do find time to write
in the minutes in between appointments, many people find that they need to write
in chunks of at least an hour, especially when writing the first draft. It takes time to
remember where you left off, and what you want to say next. Blocking time out in
your diary shows that you take your writing commitments seriously.
A Make sure your colleagues are organized too

If you are writing a paper with co-authors (see below), make sure that everyone
books writing and revising time into their diaries. Otherwise, you may find that just
when you need a colleague's advice or input on a particular section, he or she is too
busy or away at a conference.
A When writing as part of a team, define responsibilities

If several people are to take part in writing a document, make sure that the
responsibilities of each member of the group are clearly defined. If you want people
to actually write particular sections, make sure they know exactly what is required
in terms of content and length. If you want people to comment, make it clear
(preferably in a note attached to the typescript) whether you want advice on the
scientific content, the writing style, spelling and grammar, or all of these.
Managing your time for writing and revising 165
A Be realistic about how fast you write

It may help to time-check how many words you can write in an average hour or day.
We all have our different ways of writing, and some individuals are more productive
than others. While it is possible to improve your productivity by writing more
efficiently, as outlined in Chapter 5, it is also important to be realistic. Even when
things are going well, and you have no distractions or other commitments, you are
unlikely to be able to write more than a couple of thousand words of carefully
considered prose in a day. Trying to write a 10 000-word dissertation overnight is just
not going to be feasible.
A Make sure you have the right tools for the job
Writing is likely to go much faster if you have the right tools, such as:
references and background materials
dictionaries, abbreviations lists and other reference books
a good, modern word processor with spell-check
reference management programme (see Chapter 31)
software for drawing graphs and diagrams.
If you work in a company or academic institution, it is worth persuading your
department to invest in the best tools it can afford, so that you can write more
efficiently and have more time to get on with the rest of your work.
A Use spare moments for non-creative tasks

You may need peace and quiet and time to think in order to write your best prose.
However, you may not need such 'quality time' to perform more mundane tasks,
such as revising your work or typing references into your reference management
database. Make yourself a list of tasks you can accomplish when you have a spare
ten minutes.
A Make use of travelling time

In today's busy world, often the only time we get to be alone and think is on a long
journey, by train or by plane. This can be good writing or revising time. Try taking a
manuscript with you to revise. Or take your lap-top or palm-top computer with you.
Make sure you have extra batteries to allow you to work for several hours on a long
journey.
A Do not waste time looking for things

All writers should recognize that the average person can spend up to half an hour
each day just looking for the documents or other items needed to do their work.
Have an efficient filing system for your references, notes and other documents. Make
sure that each draft is dated so that you can distinguish between multiple copies of
your latest writing project. Some word processors will automatically insert a date in
a 'footer'. What applies to your filing cabinet also applies to the hard disk of your
computer - make sure that you put all the files relating to a particular project in a
logical place - one folder (directory) per project is a good general rule.
30
Using your word
processor more
effectively
Nowadays most of us will be writing using a word-processing program. This has
undoubtedly made writing much easier for most people. It seems amazing that when
word processors were first introduced, there were dire warnings that the standards
of writing would drop. On the contrary, standards of writing and presentation have
improved. Because it is so easy to make corrections, and to move text around using
a word processor, scientists' manuscripts are probably more polished than ever
before.
A Build up a personal list of hints

The tips in this section will get you started. You will undoubtedly discover many
more from colleagues, articles in computer magazines and manuals. Do not confine
yourself to the manuals that came with the program - published books such as the
Idiot's Guide and ... for Dummies series are often more informative and user-friendly.
A Get to know your own word processor

A little time spent practising and experimenting with your word processor will pay
long-term dividends, by making your writing more efficient and freeing you to con-
centrate on other tasks. The tips given here apply to most of the commonly used
word processors, such as Word or WordPerfect. If you use a different program, check
your manual or on-line help to see whether your word processor offers these features.
A Programme your word processor to finish

complicated words
Many word processors have a function whereby you can automatically finish certain
words or phrases. For example, you could programme the word processor so that
every time you type 'fluv ...'it will finish the word as 'fluvoxamine'. However, this
only works if the first few letters are unique to your chosen word. A better technique
for words beginning with common letters would be to be programme short-cut keys
(see below).
A Programme short-cut keys for complicated

words and phrases
You can programme your own short-cut keys so that you can easily insert long or
difficult-to-type phrases such as 'oc2-adrenergic agonist' by just typing, for example,
'Alt-X'.
A Learn your word processor's short-cut keys for

frequently used symbols
If you have to use Greek characters or mathematical symbols frequently, it will pay
you to learn the relevant short-cut keys, rather than selecting characters from a
menu. If there is no key-stroke short cut for the character you want, you can create
one (see above).
A Use search-and-replace to insert complicated

words and phrases
If you cannot programme short-cut keys or finish words automatically, you may be
able to use the search-and-replace function of your word processor to do the same
job. For example you could type 'bq' (a combination of letters you would never other-
wise use) and then automatically replace every 'bq' with 'cx2-adrenergic agonist'.
However, if you mistype the 'bq' anywhere in the document, it will be missed in
the search-and-replace and appear as a typing error (which your spell checker will
pick up).
Using your word processor more effectively 169
A Use auto-correct for frequently mistyped words

If you always type 'the' as 'teh', for example, you can programme your word proces-
sor to recognize this mistake every time it occurs and correct it automatically.
A Use the right spell checker

If you are writing for a US publication, it is helpful to use a US English spell checker,
and a UK English spell checker for a UK publication. Otherwise, you will have to be
alert to differences between US and UK spelling.
A Customize your dictionary

When you use a technical word that your spell checker does not recognize, add it to
your dictionary. That way, it will recognize the word in the future.
A Use your grammar checker selectively

Grammar checkers are useful under some circumstances - for example, you may
find it helpful to calculate the readability index of your writing, or percentage of
active versus passive voice. However, grammar checkers are no substitute for careful
reading by a native speaker. They do not pick up all mistakes, and sometimes
indicate a mistake where none exists. They are also frustratingly slow.
A Customize your tool bar (in Windows programs)

You can customize your tool bar so that functions you use frequently can be accessed
quickly and easily, while functions you never use can be hidden away.
A Get to know the tables function

The tables function included in the more sophisticated word processors, such as
Word or WordPerfect, can save you hours of time. Not only can you format tables in
a wide range of styles, you can also use tables as mini-spreadsheets. However, some
journals that accept manuscripts on disks will not accept tables prepared with
the tables function. This is because some desktop publishing software is not compat-
ible with tables prepared in this way. Check the journal's Instructions to Authors
to see whether it says anything about this. If not, go ahead and use the tables
function.
A Get a fresh view

Changing the way in which you view your document may help you to write more
effectively. For example, even if you are writing a manuscript that must be double
spaced, you may prefer to work on it single spaced, so that you can see more of the
text. Double spacing can then be specified at a late stage, when you are happy with
the rest of the document. When polishing your document, viewing it in whole-page
mode (also known as print preview) will enable you to detect problems such as
headings that appear on the last line of the page, with their associated text on the
next page.
A Use hidden text to write notes to yourself

When writing your first draft, you may want to insert notes and queries to remind
you to address certain issues later. You can insert these as hidden text, so that you
can print off clean copies for others to see. Do not forget to remove the hidden text
at a later date. If you are submitting the document to a journal on disk, hidden text
may confuse its desktop publishing systems.
A Use automatic formatting features ... cautiously

You can automatically format headings, subheadings, sub-subheadings and so on.
This is particularly useful in long documents with many headings. However, be
aware that some journals like you to put in as little formatting as possible. This is
because there may be an incompatibility between your word-processing program
and their desktop publishing software. Check the Instructions to Authors to see
whether headings should be underlined, emboldened or otherwise distinguished.
A Generate contents lists automatically

Automatic formatting also allows you to generate contents lists - again, a useful
feature in long and complicated documents.
Using your word processor more effectively 171
A Create your own templates for standard documents

If you have to write documents with standard sections of text, for example, official
letters or reports, you can create a 'form' or template that will both stop you from
missing sections and allow you to 'drop in' standardized text automatically.
A Be your own desktop publisher

For documents that are not going to be typeset by a journal, but simply printed
in your office (for example, a thesis, report or manual) consider using the desktop
publishing features of your word processor. This will enable you to produce smart-
looking documents without having to go to the trouble of learning to use a specialist
desktop publishing program. For example, Word provides a range of standard
formats for reports, letters, faxes, theses and newsletters.
A Use the 'make it fit' or 'shrink to fit' function for

one-page documents
WordPerfect has a 'make it fit' function and Word a 'shrink to fit' function that will
make automatic adjustments to stop text from running over on to a second page.
This can be very useful when trying to fit a conference abstract into a box of specified
size. You can use the same function to make text fit neatly onto one page in a letter
or summary.
31
Useful software and
hardware for writers
In addition to word processors, other programs and peripheral devices have also
revolutionized the way we prepare scientific manuscripts. This section lists just
some of the programs and peripherals I have found most helpful for writing.
A Reference management software

As described in Chapter 16, reference management software helps you deal with
references more efficiently. This is especially important if you are writing a document
with many references, such as a review article or thesis. Each reference is inserted
in a database using a standard form. This way, you never have to type the same
reference more than once. You do not even have to type it if you download it from
MedLine or another on-line service. Once your references are in the database, you
can simply insert them into your paper as temporary citations, and then format
it according to various standard journal styles. You can programme your own styles
if you need to, but the programs include so many that you will probably never need
to do this. Reference management programs make light work of renumbering or
reordering your references when you make changes to a document.
The commonest programs are EndNote, Reference Manager and Papyrus.
EndNote
In the UK:
Cherwell Scientific Publishing Ltd,
The Magdalen Centre,
Oxford Science Park,
Oxford OX4 4GA,
UK
Tel: +44 (0)1865 784800

Fax: +44 (0)1865 784801
E-mail for general information: sales@cherwell.com
E-mail for technical support: endnote@cherwell.com
Web: www.cherwell.com
In the USA:
Niles & Associates, Inc.,
800 Jones Street,
Berkeley,
CA 94710
USA
Tel: +1 510 559-8592
Fax: +1 510 559-8683
Reference Manager
In the UK:
Research Information Systems,
Brunei Science Park, Building 1,
Brunei University,
Uxbridge UB83PQ,
UK
Tel: +44 (0)1895 813544
Fax: +44 (0)1895 237313
uksales@ris.risinc.com
In the USA:
Research Information Systems,
Camino Corporate Center,
2355 Camino Vida Roble,
Carlsbad,
CA 92009,
USA
Tel: +1 800 722-1227 or 619 438-5526
Fax: +1 619 438-5573
E-mail: sales@ris.risinc.com
Useful software and hardware for writers 175
Papyrus
Web: http://www.rsd.com/~rsd/
Research Software Design,

2718 SW Kelly Street, Suite 181,
Portland,
OR 97201,
USA
Tel: +1 503 796-1368
Fax: +1 503 241-4260
E-mail: info@rsd.com
A Mind-mapping software
As described in Chapter 5, mind-mapping is a technique that will help you plan
documents and presentations. It can be easier to prepare a mind map on your com-
puter than on paper, as you can drag and drop items from one part of your mind
map to another, instead of writing items then scribbling them out. Mind-mapping
software also allows you to create a formal outline from your finished mind map,
and to add notes to each item in the map. At least two programs are available:
MindMan and MindMap.
MindMan
You can order MindMan through the Internet or CompuServe.
English version: Future Communication Systems, Inc.
via Internet: fcs@mindman.com
via CompuServe: 70461,1117
French version: R.E.S. Software
via Internet: res@mindman.com
German version: PD-Profi Zottlein
via Internet: pdprofi@mindman.com
Further information can be obtained from the MindMan website:
http://www.mindman.com/
MindMap
Buzan Centres Ltd,
37 Waterloo Road,
Bournemouth BH9 1BD,
UK
Tel: +44 (0)1202 533593
Fax: +44 (0)1202 534572
A Voice recognition software

Most of this book was written using voice recognition software. These programs
have only recently become suitable for general use, but look set to have a big impact
on the way we write. The programs come with an inbuilt vocabulary, to which you
can add new words. You can also buy extra vocabulary for some programs - a
medical vocabulary can be added to both IBM VoiceType and Dragon Dictate.
If you find typing difficult, or you make a lot of mistakes, voice recognition will
help you improve your productivity. You need a computer with a sound card and
speakers, plus a microphone to speak into. The programs recognize about 90% of
what you say straight out of the box, but you can improve recognition by training
them. When the program fails to recognize a word you can either select a word from
a list given, or type in a replacement word.
At present, the best programmes are expensive, but the price is likely to fall as they
become more popular. The only disadvantage is that you have to speak each word
distinctly, rather like a robot. The best known programs are IBM VoiceType and
Dragon Dictate.
IBM VoiceType
Web: http://www.ibm.com/
In the UK:
IBM United Kingdom Ltd,
PO Box 41,
North Harbour,
Portsmouth,
Hampshire PO6 3AU,
UK
Tel: +44 (0)1705 492249
Useful software and hardware for writers 177
In the USA:
IBM North America,
1133 Westchester Avenue,
White Plains,
NY 10604
USA
E-mail: ibm_direct@vnet.ibm.com
Tel: +1 520 574-4600
Dragon Dictate
Web: http://www.dragonsys.com/
In the UK:
Dragon Systems Ltd,
Millbank,
Stoke Road,
Bishops Cleeve,
Cheltenham GL52 4RW,
UK
Tel: +44 (0)1242 678575
Fax: +44 (0)1242 678301
In the USA:
Dragon Systems, Inc,
320 Nevada Street,
Newton,
MA 02160,
USA
Tel: +1 617 965-5200
Fax: +1 617 527-0372
E-mail: info@dragonsys.com
A Stedman's electronic medical dictionary

This is the electronic version of the popular Stedman's Medical Dictionary. Versions are
available for both Word and WordPerfect (US spelling only).
In the UK:
Waverly Europe Ltd,
Broadway House,
2-6 Fulham Broadway,
London SW6 1AA,
UK
Tel: +44 (0)171 385 2357
Fax: +44 (0)171 385 2922
In the USA:
Waverly International,
351 West Camden Street,
Baltimore,
Maryland 21201,
USA
Tel: +1 410 528-4223
Fax: +1 410 528-8550
A Scanner and optical character recognition

(OCR) software
You will probably be familiar with the flatbed or sheetfeed scanners used to scan
whole pages of text or pictures into your computer. Scanning whole pages of text
and then converting them to a word processor file using OCR software can help you
avoid a lot of retyping. OCR software does a good job of converting scanned images
to text, but it is by no means perfect, particularly when the original image is of poor
quality (e.g. a fax). Contact any computer hard ware/software dealer for further
information.
A Pen scanner for small pieces of text

If you only want to scan a few lines - a reference for example - you may find a pen
scanner more useful. This device comes with OCR software, and allows you to scan
directly into your application (e.g. your word processor or reference management
programme). The only pen scanner I am aware of is the Trimax Datapen'. I have one
and find it more useful than my page scanner. Contact your local hardware dealer
for further details.
32
Writers' resources on
the World Wide Web
It would be impossible to list all the pages of interest to biomedical writers on the
World Wide Web. Just a few personal favourites are listed here - most have links to
other interesting resources. Many biomedical journals now publish their Instructions
to Authors on the Web - use any search engine to track down the journal of your
choice. The Uniform Requirements also appear on the Web on the Canadian Medical
Association Home Page (see below and Appendix 1).
A BioMedNet
http://www.biomednet.com
The worldwide club for the biological and medical community.' Contents include:
on-line magazine, HMS Beagle
full text library
job exchange
meeting rooms, discussion groups, news.
A Healthgate
http: //www.healthgate.com
'Online source for health, wellness and biomedical information.' Free access to
Medline.
A Canadian Medical Association Home Page

http://www.cma.ca/mwc/index.html
Includes a copy of the Uniform Requirements, and various articles on biomedical
writing and publishing.
A Martindale's The Reference Desk'

http://www-sci.lib.uci.edu/~martindale/Ref.html
A wide range of biomedical reference books and links to many journals.
A Strunk & White's Elements of Style

http://www.columbia.edu/acis/bartleby
The well-known style guide on-line.
A Electronic Reference: Reference and

Information Services
http://www.lib.utk.edu/refs/dictionaries.html
This page lists English-language dictionaries and thesauri, including Webster's
Dictionary and Roget's Thesaurus.
A Yale Medical Library: Writing, Publishing or

Presenting Papers, Dissertations, Theses and
Grant Proposals
http://www.med.yale.edu/library/reference/publications/writing.html
A page of useful links and reference books.
Writers' resources on the World Wide Web 181
A WelchWeb (Johns Hopkins University)

http://www.welch.jhu.edu/
Information on writing, reference management software, on-line reference books
and much more besides.
A American Medical Writers Association (AMWA)

http://www.amwa.org/amwa
The American Medical Writers Association (AMWA), founded in 1940, is a non-
profit organization of professionals engaged in medical communications. AMWA
provides a forum for the exchange of ideas and the improvement of professional
writing skills. Services and activities include meetings and conferences, seminars
and workshops, and a quarterly journal.
AMWA,
9650 Rockville Pike,
Bethesda,
MD 20814,
USA
Tel: +1 301 493-0003
A European Medical Writers Association (EMWA)

http://www.netlink.co.uk/users/emwa
The European Medical Writers Association is a chapter of the American Medical
Writers Association (AMWA). As well as the benefits of belonging to AMWA, EMWA
members receive a newsletter several times a year and have the opportunity to
attend the EMWA conference which is held in a different European location each
Spring. EMWA's membership includes academics and professionals working in-
house or freelance for pharmaceutical and medical communications companies and
research institutes, or in the wider field of journalism. For membership, contact
Gerald Wilson at 101632.2654@compuserve.com.
A Canada Chapter - American Medical Writers' Association

http://www.cma.ca/mwc/amwa-canada
Contains many useful links.
33
Selected further
reading
Listed below are some of the books I have found most useful.
A Biomedical writing
Albert T (1997) Winning tlw Publications Game. Radcliffe Medical Press, Oxford.
Davis M (1997) Scientific Papers and Presentations. Academic Press, San Diego.
Day R A (1996) How to Write and Publish a Scientific Paper. Cambridge University
Press, Cambridge.
Hall G M (1994) How to Write a Paper. BMJ Publishing Group, London.
Huth E J (1990) How to Write and Publish Papers in the Medical Sciences. Williams &
Wilkins, Philadelphia.
Matthews J R, Bowen J M and Matthews R W (1996) Successful Scientific Writing.
Cambridge University Press, Cambridge.
O'Connor M (1986) How to Copyedit Scientific Books and Journals. ISI Press,
Philadelphia.
O'Connor, M (1991) Writing Successfully in Science. Chapman and Hall, London.
A Biomedical style manuals

American Medical Association (1989) AMA Manual of Style. Williams & Wilkins,
Philadelphia.
Council of Biology Editors (1994) Scientific Style and Format. Cambridge University
Press, Cambridge.
Huth E J (1987) Medical Style and Format. ISI Press, Philadelphia.
A Planning techniques
Buzan T (1993) The Mind Map Book. BBC Books, London.
Minto B (1987) Tlie Pyramid Principle. Logic in Writing and Thinking. Pitman, London.
A Use of English
Burchfield R W (1996) The New Foivler's Modern English Usage. Clarendon Press,
Oxford.
Cowers E (1987) The Complete Plain Words. Penguin, London.
Perttunen J M (1990) The Words Between. A Handbook for Scientists Needing English,
with Examples mainly from Biology and Medicine. Kustannus Oy Duodecim, Helsinki.
Strunk W and White E B (1979) The Elements of Style. Macmillan, New York and
London. (Still in print.)
Appendix 1:
Uniform requirements
for manuscripts
submitted to
biomedical journals
A small group of editors of general medical journals met informally in Vancouver,

British Columbia, in 1978 to establish guidelines for the format of manuscripts
submitted to their journals. The group became known as the Vancouver Group. Its
requirements for manuscripts, including formats for bibliographic references devel-
oped by the National Library of Medicine, were first published in 1979. The Van-
couver Group expanded and evolved into the International Committee of Medical
Journal Editors (ICMJE), which meets annually; gradually it has broadened its
concerns.
The committee has produced five editions of the Uniform Requirements for Manu-
scripts Submitted to Biomedical Journals. Over the years, issues have arisen that go be-
yond manuscript preparation. Some of these issues are now covered in the Uniform
Requirements; others are addressed in separate statements. Each statement has been
published in a scientific journal.
The fifth edition (1997) is an effort to reorganize and reword the fourth edition to
increase clarity and address concerns about rights, privacy, descriptions of methods,
and other matters. The total content of Uniform Requirements for Manuscripts Submitted
to Biomedical Journals may be reproduced for educational, not-for-profit purposes

without regard for copyright; the committee encourages distribution of the material.
Journals that agree to use the Uniform Requirements (over 500 do so) are asked to
cite the 1997 document in their instruction to authors. It is important to emphasize
what these requirements do and do not imply.
First, the Uniform Requirements are instructions to authors on how to prepare
manuscripts, not to editors on publication style. (But many journals have drawn on
them for elements of their publication styles.)
Second, if authors prepare their manuscripts in the style specified in these
requirements, editors of the participating journals will not return the manuscripts
for changes in style before considering them for publication. In the publishing
process, however, the journals may alter accepted manuscripts to conform with
details of their publication style.
Third, authors sending manuscripts to a participating journal should not try to
prepare them in accordance with the publication style of that journal but should
follow the Uniform Requirements.
Authors must also follow the instructions to authors in the journal as to what
topics are suitable for that journal and the types of papers that may be submitted -
for example, original articles, reviews or case reports. In addition, the journal's in-
structions are likely to contain other requirements unique to that journal, such as the
number of copies of a manuscript that are required, acceptable languages, length of
articles, and approved abbreviations.
Participating journals are expected to state in their instructions to authors that
their requirements are in accordance with the Uniform Requirements for Manuscripts
Submitted to Biomedical Journals and to cite a published version.
A Issues to consider before submitting a manuscript

Redundant or duplicate publication
Redundant or duplicate publication is publication of a paper that overlaps sub-
stantially with one already published.
Readers of primary source periodicals deserve to be able to trust that what they
are reading is original unless there is a clear statement that the article is being
republished by the choice of the author and editor. The bases of this position are
international copyright laws, ethical conduct and cost-effective use of resources.
Most journals do not wish to receive papers on work that has already been
reported in large part in a published article or is contained in another paper that has
been submitted or accepted for publication elsewhere, in print or in electronic media.
This policy does not preclude the journal considering a paper that has been rejected
by another journal, or a complete report that follows publication of a preliminary
report, such as an abstract or poster displayed for colleagues at a professional
Appendix 1 187
meeting. Nor does it prevent journals considering a paper that has been presented at
a scientific meeting but not published in full or that is being considered for
publication in a proceedings or similar format. Press reports of scheduled meetings
will not usually be regarded as breaches of this rule, but such reports should not be
amplified by additional data or copies of tables and illustrations.
When submitting a paper, the author should always make a full statement to the
editor about all submissions and previous reports that might be regarded as redund-
ant or duplicate publication of the same or very similar work. The author should
alert the editor if the work includes subjects about which a previous report has been
published. Any such work should be referred to and referenced in the new paper.
Copies of such material should be included with the submitted paper to help the
editor decide to handle the matter.
If redundant or duplicate publication is attempted or occurs without such notifica-
tion, authors should expect editorial action to be taken. At the least, prompt rejection
of the submitted manuscript should be expected. If the editor was not aware of the
violations and the article has already been published, then a notice of redundant or
duplicate publication will probably be published with or without the author's
explanation or approval.
Preliminary release, usually to public media, of scientific information described
in a paper that has been accepted but not yet published violates the policies of many
journals. In a few cases, and only by arrangement with the editor, preliminary re-
lease of data may be acceptable - for example, if there is a public health emergency.
Acceptable secondary publication

Secondary publication in the same of another language, especially in other coun-
tries, is justifiable and can be beneficial provided all of the following conditions
are met.
1 The authors have received approval from the editors of both journals; the editor
concerned with secondary publication must have a photocopy, reprint, or manu-
script of the primary version.
2 The priority of the primary publication is respected by a publication interval of at
least one week (unless specifically negotiated otherwise by both editors).
3 The paper for secondary publication is intended for a different group of readers;
an abbreviated version could be sufficient.
4 The secondary version faithfully reflects the data and interpretations of the
primary version.
5 A footnote on the title page of the secondary version informs readers, peers,
and documenting agencies that the paper has been published in whole or in part
and states the primary reference. A suitable footnote might read: This article is
based on a study first reported in the [title of journal, with full reference].'
Permission for such secondary publication should be free of charge.
Protection of patients' rights to privacy

Patients have a right to privacy that should not be infringed without informed con-
sent. Identifying information should not be published in written descriptions, photo-
graphs, and pedigrees unless the information is essential for scientific purposes and
the patient (or parent or guardian) gives written informed consent for publication.
Informed consent for this purpose requires that the patient be shown the manuscript
to be published.
Identifying details should be omitted if they are not essential, but patient data
should never be altered or falsified in an attempt to attain anonymity. Complete
anonymity is difficult to achieve and informed consent should be obtained if there
is any doubt. For example, masking the eye region in photographs of patients is
inadequate protection of anonymity.
The requirement for informed consent should be included in the journal's instruc-
tions for authors. When informed consent has been obtained it should be indicated
in the published article.
A Requirements for submission of manuscripts

Summary of technical requirements
Double space all parts of manuscripts
Begin each section or component on a new page
Review the sequence: title page, abstract and key words, text, acknowledgements,
references, tables (each on a separate page), legends
Illustrations, unmounted prints, should be no larger than 203 x 254 mm (8 x 10
inches)
Include permission to reproduce previously published material or to use illustra-
tions that may identify human subjects
Enclose transfer of copyright and other forms
Submit required number of paper copies
Keep copies of everything submitted.
Preparation of manuscript
The text of observational and experimental articles is usually (but not necessarily)
divided into sections with the headings Introduction, Methods, Results and Discus-
sions. Long articles may need subheadings within some sections (especially the
Results and Discussion sections) to clarify their content. Other types of articles, such
as case reports, reviews, and editorials are likely to need other formats. Authors should
consult individual journals for further guidance.
Type or print out the manuscript on white bond paper, 216 x 279 mm (9.5 x 11
inches), or ISO A4 (212 x 297 mm), with margins of at least 25 mm (1 inch). Type or
Appendix 1 189
print on only one side of the paper. Using double spacing throughout, including for
the title page, abstract, text, acknowledgments, references, individual tables and
legends. Number pages consecutively, beginning with the title page. Put the page
number in the upper or lower right-hand corner of each page.
Manuscripts on disks
For papers that are close to final acceptance, some journals require authors to
provide a copy in electronic form (on a disk); they may accept a variety of word-
processing formats or text (ASCII) files.
When submitting disks, authors should:
1 be certain to include a print-out of the version of the article that is on the disk
2 put only the latest version of the manuscript on the disk
3 name the file clearly
4 label the disk with the format of the file and the file name
5 provide information on the hardware and software used.
Authors should consult the journal's instructions to authors for acceptable formats,
conventions for naming files, number of copies to be submitted and other details.
Title page
The title page should carry:
the title of the article, which should be concise but informative
the name by which each author is known, with his or her highest academic
degree(s) and institutional affiliation
the name of the department(s) and institution(s) to which the work should be
attributed
disclaimers, if any
the name and address of the author responsible for correspondence about the
manuscript
the name and address of the author to whom requests for reprints should be
addressed or a statement that reprints will not be available from the authors
source(s) of support in the form of grants, equipment, drugs, or all of these
a short running head or footline of no more than 40 characters (count letters and
spaces) at the foot of the title page.
Authorship
All persons designated as authors should qualify for authorship. Each author should
have participated sufficiently in the work to take public responsibility for the content.
Authorship credit should be based only on substantial contributions to (1) concep-
tion and design, or analysis and interpretation of data; and to (2) drafting the article
or revising it critically for important intellectual content; and on (3) final approval of
the version to be published. Conditions (1), (2) and (3) must all be met. Participation
solely in the acquisition of funding or the collection of data does not justify author-
ship. General supervision of the research group is not sufficient for authorship. Any
part of the article critical to its main conclusions must be the responsibility of at least
one author.
Editors may ask authors to describe what each contributed; this information may
be published.
Increasingly, multicentre trials are attributed to a corporate author. All members
of the group who are named as authors, either in the authorship position below the
title or in a footnote, should fully meet the above criteria for authorship. Group
members who do not meet these criteria should be listed, with their permission, in
the Acknowledgments or in an appendix (see Acknowledgments).
The order of authorship should be a joint decision of the co-authors. Because the
order is assigned in different ways, its meaning cannot be inferred accurately unless
it is stated by the authors. Authors may wish to explain the order of authorship in a
footnote. In deciding on the order, authors should be aware that many journals limit
the number of authors listed in the table of contents and that the US National Library
of Medicine (NLM) lists in MEDLINE only the first 24 plus the last author when
there are more than 25 authors.
Abstract and key words

The second page should carry an abstract (of no more than 150 words for unstruc-
tured abstracts or 250 words for structured abstracts). The abstract should state the
purposes of the study or investigation, basic procedures (selection of study subjects
or laboratory animals; observational and analytical methods), main findings (giving
specific data and their statistical significance, if possible) and the principal conclu-
sions. It should emphasize new and important aspects of the study or observations.
Below the abstract authors should provide, and identify as such, three to 10 key
words or short phrases that will assist indexers in cross-indexing the article and may
be published with the abstract. Terms from the Medical Subject Headings (MeSH)
list of Index Medicus should be used; if suitable MeSH terms are not yet available for
recently introduced terms, present terms may be used.
Introduction
State the purpose of the article and summarize the rationale for the study or obser-
vation. Give only strictly pertinent references and do not include data or conclusions
from the work being reported.
Methods
Describe your selection of the observational or experimental subjects (patients
or laboratory animals, including controls) clearly. Identify the age, sex, and other
important characteristics of the subjects. The definition and relevance of race and
Appendix 1 191
ethnicity are ambiguous. Authors should be particularly careful about using these
categories.
Identify the methods, apparatus (give the manufacturer's name and address in
parentheses) and procedures in sufficient detail to allow other workers to reproduce
the results. Give references to established methods, including statistical methods
(see below); provide references and brief descriptions for methods that have been
published but are not well known; describe new or substantially modified methods,
give reasons for using them and evaluate their limitations. Identify precisely all drugs
and chemicals used, including generic name(s), dose(s) and route(s) of administration.
Reports of randomized clinical trials should present information on all major study
elements, including the protocol (study population, interventions or exposures,
outcomes and the rationale for statistical analysis), assignment of interventions
(methods of randomization, concealment of allocation to treatment groups) and the
method of masking (blinding).
Authors submitting review manuscripts should include a section describing the
methods used for locating, selecting, extracting and synthesizing data. These methods
should also be summarized in the abstract.
Ethics
When reporting experiments on human subjects, indicate whether the procedures
followed were in accordance with the ethical standards of the responsible committee
on human experimentation (institutional or regional) and with the Helsinki Declara-
tion of 1975, as revised in 1983. Do not use patients' names, initials or hospital
numbers, especially in illustrative material. When reporting experiments on animals,
indicate whether the institution's or a national research council's guide for, or any
national law on, the care and use of laboratory animals was followed.
Statistics
Describe statistical methods with enough detail to enable a knowledgeable reader
with access to the original data to verify the reported results. When possible,
quantify findings and present them with appropriate indicators of measurement
error or uncertainty (such as confidence intervals). Avoid relying solely on statistical
hypothesis testing, such as the use of p values, which fails to convey important
quantitative information. Discuss the eligibility of experimental subjects. Give
details about randomization. Describe the methods for and success of any blinding
of observations. Report complications of treatment. Give numbers of observations.
Report losses to observation (such as drop-outs from a clinical trial). References for
the design of the study and statistical methods should be to standard works when
possible (with pages stated) rather than to papers in which the designs or methods
were originally reported. Specify any general-use computer programs used.
Put a general description of methods in the methods section. When data are
summarized in the results section, specify the statistical methods used to analyze
them. Restrict tables and figures to those need to explain the argument of the paper
and to assess its support. Use graphs as an alternative to tables with many entries;
do not duplicate data in graphs and tables. Avoid non-technical uses of technical
terms in statistics, such as 'random' (which implies a randomizing device), 'normal',
'significant', 'correlations' and 'sample'. Define statistical terms, abbreviations and
most symbols.
Results
Present your results in logical sequence in the text, tables and illustrations. Do not
repeat in the text all the data in the tables or illustrations; emphasize or summarize
only important observations.
Discussion
Emphasize the new and important aspects of the study and the conclusions that
follow them. Do not repeat in detail data or other material given in the introduction
or the results section. Include in the discussion section the implications of the find-
ings and their limitations, including implications for future research. Relate the
observations to other relevant studies.
Link the conclusions with the goals of the study but avoid unqualified statements
and conclusions not completely supported by the data. In particular, authors should
avoid making statements on economic benefits and costs unless their manuscript
includes economic data and analyses. Avoid claiming priority and alluding to work
that has not been completed. State new hypotheses when warranted, but clearly
label then as such. Recommendations, when appropriate, may be included.
Acknowledgments
At an appropriate place in the article (the title-page footnote or an appendix to the
text; see the journal's requirements), one or more statements should specify:
contributions that need acknowledging but do not justify authorship, such as
general support by a departmental chair
acknowledgments of technical help
acknowledgments of financial and material support, which should specify the
nature of the support
relationships that may pose a conflict of interest (see 'Conflict of interest').
Persons who have contributed intellectually to the paper but whose contributions do
not justify authorship may be named and their function or contribution described -
for example, 'scientific adviser', 'critical review of study proposal', data collection',
or 'participation in a clinical trial'. Such persons must have given their permission to
be named. Authors are responsible for obtaining written permission from persons
acknowledged by name, because readers may infer their endorsement of the data
and conclusions.
Technical help should be acknowledged in a paragraph separate from that
acknowledging other contributions.
Appendix 1 193
References
References should be numbered consecutively in the order in which they are first
mentioned in the text. Identify references in text, tables and legends by Arabic
numerals in parentheses. References cited only in tables or figure legends should be
numbered in accordance with the sequence established by the first identification in
the text of the particular table or figure.
Use the style of the examples below, which are based on the formats used by the
NLM in Index Medians. The titles of journals should be abbreviated according to the
style used in Index Medicus. Consult the List of Journals, Indexed in Index Medicus,
published annually as a separate publication by the library and as a list in the
January's issue of Index Medicus. The list can also be obtained through the library's
web site (http://www.nlm.nih.gov).
Avoid using abstracts as references. References to papers accepted but not yet
published should be designated as 'in press' or 'forthcoming'; authors should obtain
written permission to cite such papers as well as verification that they have been
accepted for publication. Information from manuscripts submitted but not accepted
should be cited in the text as 'unpublished observations' with written permission
from the source.
Avoid citing a 'personal communication' unless it provides essential information
not available from a public source, in which case the name of the person and date of
communication should be cited in parentheses in the text. For scientific articles,
authors should obtain written permission and confirmation of accuracy from the
source of a personal communication.
The references must be verified by the author(s) against the original documents.
The Uniform Requirements style (the Vancouver style) is based largely on an ANSI
standard style adapted by the NLM for its databases. Notes have been added where
Vancouver style differs from the style now used by NLM.
Articles in journals
1 Standard journal article:
List the first six authors followed by et al. (Note: NLM now lists up through 25
authors; if there are more than 25 authors, NLM lists the first 24, then the last author,
then et al.)
Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with an increased risk
for pancreatobiliary disease. Ann Intern Med 1996 Jun 1:124 (ll):980-3.
As an option, if a journal carries continuous pagination throughout a volume (as

many medical journals do) the month and issue number may be omitted. (Note: for
consistency, the option is used throughout the examples in Uniform Requirements.
NLM does not use the option.)
Vega KJ, Pina I, Krevsky B. Heart transplantation is associated with an increased risk
for pancreatobiliary disease. Ann Intern Med 1996;124:980-3.
More than six authors:

Parkin DM, Clayton D, Black RJ, Masuyer E, Friedl HP, Ivanov E, et al. Childhood
leukaemia in Europe after Chernobyl: 5 year follow-up. Br J Cancer 1996;73:1006-12.
2 Organization as author.
The Cardiac Society of Australia and New Zealand. Clinical exercise stress testing.
Safety and performance guidelines. Med J Aust 1996;164:282-4.
3 No author given:
Cancer in South Africa [editorial]. S Afr Med J 1994;84:15.
4 Article not in English:

(Note: NLM translates the title to English, encloses the translation in square brackets
and adds an abbreviated language designator.)
Ryder TE, Haukeland EA, Solhaug JH. Bilateral infrapatellar seneruptur hostidligere
frisk kvinne. Tidsskr Nor Laegeforen 1996;116:41-2.
5 Volume with supplement:

Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational
lung cancer. Environ Health Perspect 1994;102 Suppl 1:275-82.
6 Issue with supplement:

Payne DK, Sullivan MD, Massie MJ. Women's psychological reactions to breast
cancer. Semin Oncol 1996;23(1 Suppl 2):89-97.
7 Volume with part:

Ozben T, Nacitarhan S, Tuncer N. Plasma and urine sialic acid in non-insulin
dependent diabetes mellitus. Ann Clin Biochem 1995;32(Pt 3):303-6.
8 Issue with part:

Poole GH, Mills SM. One hundred consecutive cases of flap lacerations of the leg in
ageing patients. NZ Med J 1994;107(986 Pt l):377-8.
9 Issue with no volume:

Turan I, Wredmark T, Fellander-Tsai L. Arthroscopic ankle arthrodesis in rheuma-
toid arthritis. Clin Orthop 1995;(320):110-4.
10 No issue or volume:
Browell DA, Lennard TW. Immunologic status of the cancer patient and the effects
of blood transfusion on antitumor responses. Curr Opin Gen Surg 1993;325-33.
11 Pagination in Roman Numerals:

Fisher GA, Sikic BI. Drug resistance in clinical oncology and hematology. Intro-
duction. Hematol Oncol Clin North Am 1995 Apr;9(2):xi-xii.
Appendix 1 195
12 Type of article indicated as needed:

Enzensberger W, Fischer PA. Metronome in Parkinson's Disease [letter]. Lancet 1996;
347; 1337. Clement J, De Bock R. Hematological complications of hantavirus nephro-
pathy (HVN) [abstract]. Kidney Int 1992;42:1285.
13 Article containing retraction:

Garey CE, Schwarzman AL, Rise ML, Seyfried TN. Ceruloplasmin gene defect
associated with epilepsy in EL mice [retraction of Garey CE, Schwarzman AL, Rise
ML, Seyfried TN. In: Nat Genet 1994;6:426-31]. Nat Genet 1995;11:104.
14 Article retracted:
Liou GI, Wang M, Matragoon S. Precocious IRBP gene expression during mouse
development [retracted in Invest Ophthalmol Vis Sci 1994;35:3127]. Invest Ophthal-
mol Vis Sci 1994;35:1083-8.
15 Article with publislwd erratum:

Hamlin JA, Kahn AM. Herniography in symptomatic patients following inguinal
hernia repair [published erratum appears in West J Med 1995; 162: 278]. West J Med
1995;162:28-31.
Books and other monographs

(Note: Previous Vancouver style incorrectly had a comma rather than a semicolon
between the publisher and the date.)
16 Personal author(s):
Ringsven MK, Bond, D. Gerontology and leadership skills for nurses. 2nd ed.
Albany (NY): Delmar Publishers; 1996.
17 Editor(s), compiler(s) as author:

Norman IJ, Redfern SJ, editors. Mental health care for elderly people. New York:
Churchill Livingstone; 1996.
18 Organization as author and publisher:

Institute of Medicine (US). Looking at the future of the Medicaid program.
Washington: The Institute; 1992.
19 Chapter in a book:
(Note: Previous Vancouver style had a colon rather than a 'p.' before pagination.)
Phillips SJ, Whisnant JP. Hypertension and stroke. In: Laragh JH, Brenner BM,
editors. Hypertension: pathophysiology, diagnosis, and management. 2nd ed. New
York: Raven Press; 1995. p. 465-78.
20 Conference proceedings:
Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiology. Pro-
ceedings of the 10th International Congress of EMG and Clinical Neurophysiology;
1995 Oct 15-19; Kyoto, Japan. Amsterdam: Elsevier; 1996.
21 Conference paper.
Bengtsson S, Solheim BG. Enforcement of data protection, privacy and security in
medical informatics. In: Lun KC, Degoulet P, Piemme TE, Rienhoff O, editors.
MEDINFO 92. Proceedings of the 7th World Congress on Medical Informatics; 1992
Sep 6-10; Geneva, Switzerland. Amsterdam: North-Holland; 1992. p. 1561-5.
22 Scientific or technical report:

Issued by funding/sponsoring agency: Smith P, Golladay K. Payment for durable
medical equipment billed during skilled nursing facility stays. Final report. Dallas
(TX): Dept. of Health and Human Services (US) Office of Evaluation and Inspections;
1994 Oct. Report No.: HHSIGOEI69200860. Issued by performing agency: Field MJ,
Tranquada RE, Feasley JC, editors. Health services research: work force and educational
issues. Washington: National Academy Press; 1995. Contract No.: AHCPR282942008.
Sponsored by the Agency for Health Care Policy and Research.
23 Dissertation:
Kaplan SJ. Post-hospital home health care: the elderly's access and utilization
[dissertation]. St. Louis (MO): Washington Univ.; 1995.
24 Patent:
Larsen CE, Trip R, Johnson CR, inventors; Novate Corporation, assignee. Methods
for procedures related to the electrophysiology of the heart. US patent 5,529,067.
1995 Jun 25.
Other published material

25 Newspaper article:
Lee G. Hospitalizations tied to ozone pollution: study estimates 50,000 admissions
annually. The Washington Post 1996 Jun 21; Sect. A:3 (col. 5).
26 Audiovisual material:
HIV+/AIDS: the facts and the future [videocassette]. St. Louis. (MO): Mosby-Year
Book; 1995.
27 Legal material:
Public law:
Preventive Health Amendments of 1993, Pub. L. No. 103-183,107 Stat. 2226 (Dec. 14,
1993).
Appendix 1 197
Unenacted bill:
Medical Records Confidentiality Act of 1995, S. 1360, 104th Cong., 1st Sess. (1995).
Code of Federal Regulations:

Informed Consent, 42 C.F.R. Sect. 441.257 (1995).
Hearing:
Increased Drug Abuse: the Impact on the Nation's Emergency Rooms: Hearings
Before the Subcomm. on Human Resources and Intergovernmental Relations of the
House Comm. on Government Operations, 103rd Cong., 1st Sess. (May 26, 1993).
28 Map:
North Carolina. Tuberculosis rates per 100,000 population, 1990 [demographic map].
Raleigh: North Carolina Dept. of Environment, Health and Natural Resources, Div.
of Epidemiology; 1991.
29 Book of the Bible:

The Holy Bible. King James version. Grand Rapids (MI): Zondervan Publishing
House; 1995. Ruth 3:1-18.
30 Dictionary and similar references:

Stedman's medical dictionary. 26th ed. Baltimore: Williams & Wilkins; 1995.
Apraxia; p. 119-20.
31 Classical material:
The Winter's Tale: act 4, scene 1, lines 13-16. The complete works of William
Shakespeare. London: Rex; 1973.
Unpublished material
32 In press:
(Note: NLM prefers 'forthcoming' because not all items will be printed.)
Leshner AI. Molecular mechanisms of cocaine addiction. N Engl J Med. In press
1996.
Electronic material
33 Journal article in electronic format:
Morse SS. Factors in the emergence of infectious diseases. Emerg Infect Dis [serial
online] 1995 Jan-Mar [cited 1996 Jun 5];1(1):[24 screens]. Available from: URL:
http://www.cdc.gov/ncidod/EID/eid.htm
34 Monograph in electronic format:

CDI, clinical dermatology illustrated [monograph on CD-ROM]. Reeves JRT,
Maibach H. CMEA Multimedia Group, producers. 2nd ed. Version 2.0. San Diego:
CMEA; 1995.
35 Computer file:
Hemodynamics III: the ups and downs of hemodynamics [computer program].
Version 2.2. Orlando (FL): Computerized Educational Systems; 1993.
Tables
Type or print out each table with double spacing on a separate sheet of paper. Do not
submit tables as photographs. Number tables consecutively in the order of their first
citation in the text and supply a brief title for each. Give each column a short abbre-
viated heading. Place explanatory matter in footnotes, not in the heading. Explain in
footnotes all non-standard abbreviations that are used in each table. For footnotes
use the following symbols, in this sequence:
Identify statistical measures of variations, such as standard deviation and standard

error of the mean.
Do not use internal horizontal and vertical rules.
Be sure that each table is cited in the text.
If you use data from another published or unpublished source, obtain permission
and acknowledge them fully.
The use of too many tables in relation to the length of the text may produce
difficulties in the layout of pages. Examine issues of the journal to which you plan
to submit your paper to estimate how many tables can be used per 1000 words
of text.
The editor, on accepting a paper, may recommend that additional tables contain-
ing important backup data too extensive to publish be deposited with an archival
service, such as the National Auxiliary Publication Service in the United States, or
made available by the authors. In that event an appropriate statement will be added
to the text. Submit such tables for consideration with the paper.
Illustrations (figures)
Submit the required number of complete sets of figures. Figures should be profes-
sionally drawn and photographed; freehand or typewritten lettering is unaccept-
able. Instead of original drawings, x-ray films and other material, send sharp, glossy,
black-and-white photographic prints, usually 127 x 173 mm ( 5 x 7 inches) but no
larger than 203 x 254 mm (8 x 10 inches). Letters, numbers, and symbols should be
clear and even throughout and of sufficient size that when reduced for publication
each item will still be legible. Titles and detailed explanations belong in the legends
for illustrations not on the illustrations themselves.
Each figure should have a label pasted on its back indicating the number of the
figure, author's name and top of the figure. Do not write on the back of figures or
scratch or mar them by using paper clips. Do not bend figures or mount them on
cardboard.
Appendix 1 199
Photomicrographs should have internal scale markers. Symbols, arrows or letters

used in photomicrographs should contrast with the background.
If photographs of people are used, either the subjects must not be identifiable or
their pictures must be accompanied by written permission to use the photograph.
Figures should be numbered consecutively according to the order in which they
have been first cited in the text. If a figure has been published, acknowledge the orig-
inal source and submit written permission from the copyright holder to reproduce
the material. Permission is required irrespective of authorship or publisher except
for documents in the public domain.
For illustrations in colour, ascertain whether the journal requires colour negatives,
positive transparencies, or colour prints. Accompanying drawings market to indi-
cate the region to be reproduced may be useful to the editor. Some journals publish
illustrations in colour only if the author pays for the extra cost.
Legends for illustrations

Type or print out legends for illustrations using double spacing, starting on a separ-
ate page, with Arabic numerals corresponding to the illustrations. When symbols,
arrows, numbers or letters are used to identify parts of the illustrations, identify and
explain each one clearly in the legend. Explain the internal scale and identify the
method of staining in photomicrographs.
Units of measurement
Measurement of length, height, weight and volume should be reported in metric
units (metre, kilogram or litre) or their decimal multiples.
Temperatures should be given in degrees Celsius. Blood pressures should be given
in millimetres of mercury.
All hematologic and clinical chemistry measurements should be reported in the
metric system in terms of the International System of Units (SI). Editors may request
that alternative or non SI units be added by the authors before publication.
Abbreviations and symbols

Use only standard abbreviations. Avoid abbreviations in the title and abstract. The
full term for which an abbreviation stands should precede its first use in the text
unless it is a standard unit of measurement.
A Sending the manuscript to the journal

Send the required number of copies of the manuscript in a heavy-paper envelope,
enclosing the copies and figures in cardboard, if necessary, to prevent the photographs
from being bent. Place photographs and transparencies in a separate heavy-paper

envelope.
Manuscripts must be accompanied by a covering letter signed by all co-authors.
This must include:
information on prior or duplicate publication or submission elsewhere of any part
of the work as defined earlier in this document
a statement of financial or other relationships that might lead to a conflict of
interest
a statement that the manuscript has been read and approved by all the authors,
that the requirements for authorship as stated earlier in this document have been
met and that each author believes that the manuscript represents honest work
the name, address, and telephone number of the corresponding author, who is
responsible for communicating with the other authors about revisions and first
approval of the proofs.
The letter should give any additional information that may be helpful to the editor,
such as the type of article in the particular journal that the manuscript represents and
whether the author(s) would be willing to meet the cost of reproducing colour
illustrations.
The manuscript must be accompanied by copies of any permissions to reproduce
published material, to use illustrations or to report information about identifiable
people, or to name people for their contributions.
Ann Intern Med. 1997;126:36-47. Annals of Internal Medicine is published twice

monthly and copyrighted 1997 by the American College of Physicians.
Appendix 2:
Manuscript checklist
1 Is the content appropriate for the intended audience?

2 Is the structure logical and does it cover all relevant aspects?
3 Is there any superfluous material that should be edited out?
4 Is it complete? Check:
Q title page, if required
Q authors in correct order with initials, degrees, affiliations etc. in correct journal
style
Q name and address of corresponding author indicated
Q contents page, if required - entries should match headings exactly
Q abstract, if required
Q all sections of main text
Q references
Q acknowledgements
Q appendices
Q tables
Q figures
Q figure legends.
5 Are pages numbered?
6 Headings
Q Are first- second- and third order headings used correctly and clearly distin-
guished? (It often helps to write them all down on a separate sheet of paper.)
Q Are they in a logical order?
Q Are they consistently worded, and are capitals used consistently and according
to journal or house style?
Q No full stops at the end of headings.
7 Tables
Q Is their layout clear and not unnecessarily complicated?
Q Do they duplicate information in the text?
Q Are they all referred to in the text, in correct numerical order?
Q Do they show what the text says they show?
Q Does the title explain what is in the table?
Q Does the title follow the correct style for the journal?
Q Are abbreviations explained?
Q Are footnote indicators correctly used, and attached to the right footnote?
Q Do totals in columns add up correctly?
Q Is their approximate location indicated in the text?
8 Figures
Q Do they duplicate information in the text?
Q Are they all referred to in the text, in correct numerical order?
Q Do they show what the text says they show?
Q Does the title explain what is in the figure?
Q Does the legend follow the correct style for the journal?
Q Does shading or colour on keys correspond to the figure?
Q Are abbreviations explained?
Q Are footnote indicators correctly used, and attached to the right footnote?
Q Is cropping indicated on photographs?
Q Is their approximate location indicated in the text?
9 References
Q Are all references cited in the text in the reference list and vice versa?
Q Do numbered references refer to the right reference?
Q Does each reference contain all the necessary elements?
Q Are they cited in the correct style?
Q Are standard journal abbreviations used (Index Medicus)?
10 Are cross-references to other chapters, section numbers etc. correct? Are cross-
references to page numbers marked for completion after typesetting?
11 Abbreviations
Q Only used when needed.
Q SI abbreviations need not be spelt out.
Q Others spelt out on first mention in the body text (not just the abstract).
12 Spelling
Q English or American?
Q Must read as well as running a computer spell check.
Q Check names of drugs, organisms etc. carefully.
Appendix 2 203
13 Grammar - watch out for:

Q incomplete sentences
Q dangling participles
Q subject-verb mismatches
Q wrong use of tenses.
14 Punctuation
Q Brackets and quotation marks - do they come in pairs?
Q Are commas, semicolons etc. correctly used?
I ndex
abbreviations wordiness, elimination of 40

in abstracts 39-40 written after completion of paper 35
in conference abstracts 43-4 see also conference abstracts
in figures 66 acceptance rates 21
in tables 72 acknowledgements
in titles, avoidance 34 Uniform Requirements 192
Uniform Requirements 199 active voice 54,137-8
abstracts address for correspondence 100
abbreviations 39-40 agents 122
background 37 alliteration 130
checklist 40 alphabetic-numeric citation system 88
conclusion 39 American Medical Writers Association
draft, before writing paper 35 (AMWA) 181
important implications 39 arrows on photographs 79
length stipulations 36 articles see informal writing; review
methods 38 articles and book chapters
objective of study 37 audience type 17
p values 39 authorship
percentages and sample size 38 number of names 89
polishing 35 Uniform Requirements 189-90
previous publication 14 author-year citation system 86, 88
readers' requirements 37 automatic formatting 170
references 40
reflecting content of paper 37 background, in abstracts 37
relevant details 38 backups, theses and dissertations 119
results 38 bibliography 183-4
review articles and book chapters 113 'big paper' approach, theses and
self-contained 37 dissertations 117
as single paragraph 36 binding, theses and dissertations 119
structured 36 BioMedNet 179
theses and dissertations 119 blank cells, tables 74
Uniform Requirements 190 'blinding' 9
206 Index
books sentences 133-8

agents 122 subheadings 145
book proposals 122 words 139-43
good idea required 121 clinical trials
help 123 methods section see methods section
interim deadlines 123 standard presentation method 58
money 123 co-authors
motivation 121 agreement on journal 23
non-academic 122 organization of 164
review chapters see review articles and colleagues' advice 18
book chapters colour photographs 78
royalties 123 columns in tables 71, 75
publishers comments on studies recently published 2
finding 121-2 complex writing 133-4
right kind 122 conclusion 82
sales, helping 123 in abstracts 39
time 122 defending 83
breaks from writing 158 in informal writing 128
brief communications see short restating 83-4
communications in titles 33
see also discussion section
camera-ready figures 65 conference abstracts
Canada Chapter - American Medical abbreviations in 43-4
Writers Association 181 content 41
Canadian Medical Association Home Page electronic submission 42, 43
180 graphs in 43
case histories, informal writing 130 indicative format 44
case reports 2,19 instructions for submission 42
charts see figures interim results 44
checklists purpose 41
abstracts 40 references in 43
discussion section 86 results in 44
figures 67 size 42-3
for introduction 49 tables in 43
manuscripts 201-3 conference presentation, previous
methods section 56 publication 14
results section 62 confidence limits/standard deviation 61
tables 76 contents lists, word processing 170
chronological order contingency plans 105
methods section 53 control groups results 60
circulation of journals 21 copy-editors
citation see references manuscript checking 93
clear writing queries from 11
headings 145-6 roles 8
lists 148-9 copying, theses and dissertations 119
paragraphs 146-7 copyright 98
Index 207
covering letters logic of argument, making clear 85

address for correspondence 100 past tense, use of 84
avoidance of reviewers 99 planning 81
checking everything included 100 present tense, use of 84
copyright 98 'proving' words 84
duplicate submission 98 readers' and reviewers' questions,
essential components 95-7 anticipation of 81
example 96 references 85-6
information only parts 99-100 respect for other studies 83
key features of paper 98 'signalling' words 85
optional components 97 stating the answer 82
optional publication parts 100 subheadings 85
reasons for selection of journal 97 subsidiary questions, answering 82
rejection history 99 supporting the answer 82
repetitive publication issues 98 Uniform Requirements 192
suggesting reviewers 99 disks, manuscripts on
cropping of photographs 78 Uniform Requirements 189
Current Contents 20 dissertations see theses and
dissertations
data 'divided publication' 14
backup for figures and graphs 64, draft abstracts 35
99-100 Dragon Dictate, addresses 177
emphasis in graphs 65 duplicate publication
inclusion in results 58-9, 61 Uniform Requirements 186-7
storage, theses and dissertations 116 duplicate submission 98
table values agreeing with text 75
decimal places 73 editorials 3
declarative titles 31, 33 editors
desk editors see copy editors decision final 103
desktop publishers 171 letters to 2-3, 19
diarizing time for writing 164 roles 7
dictionaries, word processing 169 Electronic Reference: Reference and
differences, emphasizing 60 Information Services 180
discussion section 62 electronmicrographs see figures;
caution 84-5 photographs
checklist 86 electrophoretograms see figures
conclusion 82 EMWA (European Medical Writers
defending 83 Association) 181
restating 83-4 EndNote, addresses 173-4
fit of answer with other published English
results 82 checking, manuscripts 92
'hedging' words 84-5 use of, bibliography 184
implications 84 errors
'inconvenient' results 82-3 of grammar and idiom 151-6
limitation of methods or study design of meaning 142-3
83 ethical regulations, compliance 55
208 Index
ethics in conference abstracts 43

Uniform Requirements 191 data emphasis 65
European Medical Writers Association information amount 64
(EMWA) 181 results section 59-60
examples, use of in informal writing 130 significant differences 65
experimental groups results 60 symbols 65
keys to 66
figures theses and dissertations 118
abbreviations 66 see also figures
backup data 64
camera-ready 65 hardware
checklist 67 problems, theses and dissertations 119
format 64 for writers 178
permission for use of another author's headings 145
66 informal writing 129
referrals in text 66 levels of 146
results section 59, 61 numbering 146
selectivity 64 style 146
symbols 65 tables 71
or tables 64 Healthgate 179
theses and dissertations 118 hedging 84-5,131
titles 66 hidden text, word processing 170
Uniform Requirements 198-9 horizontal lines in tables 70
unnecessary, avoidance of 63 How to Copy-edit Scientific Papers (Maeve
see also graphs; photographs O'Connor) 37
filing system efficiency 166 How to Write and Publish Papers in the
flatbed scanners 178 Medical Sciences (E J Huth) 59
flow charts human interest, informal writing 127
methods section 53-4
footnotes IBM VoiceType, addresses 176-7
indicators 74 1CMJE (International Committee of
tables 72 Medical Journal Editors) 185
format idiom, errors of 151-6
figures 64 illustrations
papers 19 informal writing 129
photographs 77 Uniform Requirements 198-9
references 87-8 see also figures
titles 31 impact factor 20
implications, in abstracts 39
grammar 'inconvenient' results 82-3
checking 94 Index Medicus 193
errors of 151-6 indicative format, conference abstracts 44
grammar checkers, word processing 94, indicative titles 33
169 informal articles 3-4
graphs informal writing
axes 65 alliteration 130
Index 209
basics 126 Uniform Requirements 190

case histories 130 writing after other sections 45
commissioned 125
conclusion at the beginning 128 JAMA (Journal of the American Medical
conflict 127 Association) 21, 36
examples, use of 130 Journal Citation 20
headings 129 Journal of the American Medical Association
hedging, avoidance of 131 (JAMA) 21,36
human interest 127 journal selection
illustrations 129 audience type 17
lists 129 authors' own preferred journals 18
memory limitations of readers 130 case reports 19
metaphors and similes 130-1 circulation 21
news items 128 co-authors' agreement 23
pitching at right level 126 colleagues' advice 18
positive writing 131 consideration of all journals
quotes 127 whose readers might be
readers, writing to suit 125-6 interested 18
rhetorical questions 129 format acceptance 19
saying something new 127 impact factor 20
separating 'nice to know' from 'need to league tables 20
know' 127-8 learned society journals 18
statistics 130 letters to the editor 19
subheadings 129 likely acceptance 20
Institute for Scientific Information literature review 18
addresses 20 options other than full-length original
interim deadlines research papers 19
theses and dissertations 117 quantitative measure of journals'
writing books 123 status 20
interim results in conference abstracts 44 rapid publication requirements 22
International Committee of Medical rejection/acceptance rates 21
Journal Editors (ICMJE) 185 rejection implications 21
Internet, writers' resources on 179-81 short communications 19, 23
introduction section short lists
checklist 49 possibles 17
current knowledge of topic 47 rank order 19-20
limiting length 46 speed of publication 22
logical flow 49
new and important points of study 49 key words
overinflation of 46 inclusion in titles 32-3
past tense, use of 47 Uniform Requirements 190
present tense, use of 46
references 46 Lancet, The 21, 22
selling the study 45 large documents, planning 25
stating the question 47-8 league tables, journals 20
theses and dissertations 119 learned society journals 18
210 Index
length methods
abstracts 36 in abstracts 38
conference abstracts 42-3 Uniform Requirements 190-1
introduction 46 methods section
limits of journals 28 active construction 54
methods section 52 checklist 56
titles 31 chronological order 53
letters to the editor 2-3,19 clinical trials
limitation of methods or study design 83 patient baseline data 55-6
line drawings see figures primary and secondary outcomes 55
lists 148-9 standard order 53
informal writing 129 conciseness 56
literature review 18 established techniques 54
literature searches ethical regulations, compliance 55
review articles and book chapters first to be written 51
110 flow charts 53-4
logic of argument, making clear 85 length 52
logical order 52-3
macro-level organization 29 novel techniques 54
'make it fit' function, word processing 43, past tense, use of 54
171 precision of terms used 56
managing editors 7 readers' questions, answering 54
manuscripts repeatability 51
checking 91-4 results, matching methods 52, 57
checklist 201-3 sample parts, relationship between 56
preparation statistical information 55
Uniform Requirements 188-9 subheadings 53
sending to journal summarizing, if described in another
Uniform Requirements 199-200 paper 52
storage, theses and dissertations 116 tables 53-4
submitting micro-level organization 29
acknowledgement of receipt 101 micrographs see figures
covering letters see covering letters mind-mapping 26, 27, 28
information only parts 99-100 software 175-6
packing carefully 100 MindMan, addresses 175
uniform requirements see Uniform MindMap, address 176
Requirements for Manuscripts 'mini-paper' approach, theses and
Submitted to Biomedical Journals dissertations 117
Martindale's 'The Reference Desk' 180 multiple publication 13
masking photographs 78
materials and methods see methods N Engl J Med see New England Journal of
section Medicine
Medical Style and Format (E J Huth) 32 National Library of Medicine (NLM)
memory limitations of readers 130 185
meta-analysis 109 Nature 21, 22, 75
metaphors 130-1 NEJM see New England Journal of Medicine
Index 211
New England journal of Medicine (NEJM) 20 methods section 54

declarative titles 31, 33 results section 62
New Scientist 128 patient baseline data
'news and views articles' 3-4 methods section 55-6
news items 128 patients
NLM (National Library of Medicine) consent forms from, publication of
185 photographs 79
numbered references system 86, 88 names, radiographs or scans 79
numbers in tables, checking and rights to privacy, protection of 188
rechecking 74 patients and methods see methods section
pay journals 10
objective of study, in abstracts 37 paying to have papers published 9-10
OCR (optical character recognition) peer review
software 178 review articles and book chapters 113
'one-third rule' 163 see also publishing process; reviewers
optical character recognition (OCR) pen scanners 178
software 178 percentages
original research papers 1 in abstracts 38
abstracts 14 in tables 73
conference presentation 14 photographs
in another language 13-14 arrows 79
posters 14 colour 78
previous publication 13-14 consent forms from patients 79
releasing data to the press 14 cropping 78
repetitive or multiple publication 13 format 77
rules for getting published 106 labelling 78
slicing data too thinly 14-15 labels 79
see also conclusion; discussion section; marking 'top' 78
figures; introduction section; masking 78
methods section; photographs; paperclips 79
results section; tables patients' names 79
outline function of word processors 28 paying to have published 10, 78
preparing 77
p values referrals in text 80
in abstracts 39 titles 79
methods section 55 Uniform Requirements 199
results section 60 photomicrographs see photographs
tables 74 planning
page budgets 28,117 bibliography 184
paperclips 79 discussion section 81
Papyrus, address 175 large documents 25
paragraphs 146-7 review articles and book chapters 110
passive voice 138 theses and dissertations 116
past tense, use of writer's block, overcoming 157-8
discussion section 84 writing
introduction 47 importance 25
212 Index
large documents 25 review articles 3

length limits of journals 28 short communications 1
micro- and macro-level organization topical issues, opinions or facts on
29 2-3
mind-mapping 26, 27, 28 publishers
organizing writing for readers' needs finding 121-2
25-6 right kind 122
outline function of word processors publishing process
28 familiarizing with 5, 6
page budgets 28 lengthiness 10
pyramids of ideas 28 paying to have papers published 9-10
references, organizing 26 peer review
time, need for 25 'blinding' 9
within each section 26 credibility depending on 8
word budgets 28 limitations 8
'yellow sticky' Post-it note as 'quality control' 8
technique 26 reviewers 7, 9
polygraph recordings see figures proof checking 11
positive thinking 159-60 revisions 10
positive writing 131 roles of people involved 5-7
Post-it note technique 26, 111 copy-editors 8
posters queries 11
abstracts see conference abstracts editors 7
previous publication 14 managing editors 7
power of study, methods section 55 reviewers 7
present tense, use of pyramids of ideas 28
discussion section 84
introduction 46 quality control, peer review as 8
press, the, releasing data to 14 quantitative measure of journals' status 20
previous publication 13-14 quotes in informal writing 127
primary outcomes, clinical trials 55
printing, theses and dissertations radiographs see photographs
119 randomization methods 55
proofreading 11 rapid publication requirements 22
theses and dissertations 119 Rapid Science group of journals 22-3
'proving' words 84 redundant publication
publication types Uniform Requirements 186-7
case reports 2 Reference Manager, addresses 174
comments on studies recently references
published 2 in abstracts 40
editorials 3 alphabetic-numeric 88
informal articles 3-4 author-date 88
letters to the editor 2-3 authors' names, number required 89
'news and views articles' 3-4 availability 89
original research papers 1 checking originals 90
research letters 2 in conference abstracts 43
Index 213
discussion section 85-6 matching results to methods 52, 57

exactness 90 p values 60
format 87-8 past tense, use of 62
in introduction 46 references 62
management software 87,173-5 sample size 61
theses and dissertations 116 standard order 57
number of 89 statistics 61-2
numbered 88 subheadings 58
organizing 26 tables 59-60, 61
recent 89 vague comparisons 62
relevance 89 review articles and book chapters 3
results section 62 abstract 113
review articles and book chapters acceptability 108-9
110-11 'big idea' 110
storage, theses and dissertations 116 briefing 108
Uniform Requirements 193-8 career benefits 107
to unpublished material 90 commissioned 108
Vancouver style 88-9 inclusion and exclusion criteria 112
rejection information sources 109,112
implications 21 kind of article 109
rates 21 literature searches 110
reasons for 104 logical order 112
repetitive publication 13, 98 meta-analysis 109
research letters 2 objective assessment of studies 109
research papers see original research overlap with other authors 108
papers peer review 113
res ub mission 104 planning 110
revision of style for new journal 105 references 110-11
results standard structures 111
in abstracts 38 structuring arguments 112
in conference abstracts 44 timetable 110
methods producing 52 work involved 107
Uniform Requirements 192 'yellow sticky' Post-it note technique
results section 111
checklist 62 reviewers 7, 9
clinical trials, standard presentation avoidance of 99
method 58 comments
confidence limits/standard deviation 61 disagreement with 104-5
control groups results 60 use of 106
data inclusion 58-9, 61 disagreement between 105
differences, emphasizing 60 suggesting 99
discussion of results 62 revisions 10,104,105
experimental groups results 60 rhetorical questions, informal writing
figures 59, 61 129
general statements 60 row headings and subheadings, tables
graphs 59-60 71-3
214 Index
royalties 123 standard deviation 61

rules and regulations statistical information, methods
theses and dissertations 115 section 55
running titles 34 statistical significance, tables 74
statistical tests, methods section 55
'salami publication' 14 statistics
sample parts, relationship between 56 informal writing 130
sample size results section 61-2
in abstracts 38 Uniform Requirements 191-2
results section 61 Stedman's electronic medical dictionary,
scanners 178 addresses 177-8
scans see photographs structured abstracts 36
scientific content checking 92 Strunk & White's Elements of Style 180
Scientific Information, Institute for studies recently published, comments on
addresses 20 2
search and replace, word processing 168 style manuals 183
secondary outcomes, clinical trials 55 sub-editors see copy editors
secondary publication subheadings 145
Uniform Requirements 187 discussion section 85
selection of journal see journal selection informal writing 129
sentences methods section 53
active voice 137-8 results section 58
confusion avoidance 136 tables 72-3
ideas in 134 symbols
important words or phrases 137 in figures 65
'joining words' 135-6 graphs 65
length 134-6 keys to 66
parallel structures 138 Uniform Requirements 199
passive voice 138
topic 147 tables
unrelated ideas 136 abbreviations 72
sheetfeed scanners 178 blank cells 74
short communications 1,19, 23 checklist 76
short-cut keys, word processing 168 columns
short lists of journals 17,19-20 number 75
'shrink to fit' function, word processing headings 71
171 comparisons arrangement 70-1
sideways tables 76 in conference abstracts 43
'signalling' words 85 data values agreeing with text 75
similes 130-1 decimal places 73
slicing data too thinly 14-15 descriptive title 75
software for writers 173-8 or figures 64
spare moments 165 footnotes 72
speed of publication 10, 22 indicators 74
speed of writing 165 horizontal lines 70
spell checkers, word processing 94,169 methods section 53-4
Index 215
numbers, checking and rechecking 74 storage of data, references and

p values 74 manuscripts 116
percentages 73 supervisor's input and comments
referrals in text 76 118
results section 59-60, 61 tables 118
rows time management see writing time
headings 71, 73 management
subheadings 72, 73 title page
selectivity 70 Uniform Requirements 189
self-contained 71 titles
separate pages for 69 abbreviations in, avoidance 34
sideways 76 aggressiveness 33
statistical significance 74 conclusion in 33
theses and dissertations 118 declarative 31, 33
title 69, 75 figures 66
Uniform Requirements 198 format 31
units of measure 72 indicative 33
unnecessary, avoidance of 69 key information 32
vertical lines 70 keywords 32-3
word processor tables function 70, length 31
169-70 photographs 79
team writing, responsibilities 164 reader-friendliness 32
templates for standard documents, word running titles 34
processing 171 tables 75
tenses, use of see past tense, use of; present wasting words, avoidance 33
tense, use of titles-only searches 32
theses and dissertations tool bar customization, word processing
abstract 119 169
backups 118 tools for the job 165
'big paper' approach 117 topical issues, opinions or facts on 2-3
'downtime', use for writing 116 travelling time 165
figures 118
finishing writing early 117 Uniform Requirements for Manuscripts
graphs 118 Submitted to Biomedical Journals
hardware problems 119 185-6
ideas from other theses 117 duplicate publication 186-7
interim deadlines 117 patients' rights to privacy, protection of
introduction 119 188
'mini-paper' approach 117 redundant publication 186-7
page budget 117 secondary publication 187
planning 116 sending manuscript to journal 199-200
printing, copying and binding 119 submission requirements
proofreading 119 abbreviations 199
reference management systems 116 abstract 190
rules and regulations 115 acknowledgements 192
starting writing early 115-16 authorship 189-90
216 Index
discussion 192 spell checkers 94, 169

disks, manuscripts on 189 tables function 70,169-70
ethics 191 templates for standard documents
figures 198-9 171
illustrations 198-9 tool bar customization 169
introduction 190 words
key words 190 common errors of meaning 142-3
methods 190-1 'hedging' words 84-5
photographs 199 'joining' words 135-6
preparation of manuscript 188-9 linking words 142
references 193-8 precision in scientific terms 142
results 192 'proving' words 84
statistics 191-2 redundancy avoidance 141-2
symbols 199 'signalling' words 85
tables 198 simple 139-40
technical 188 'smothered' verbs 141
title page 189 unnecessary 140-1
units of measurement 199 wasting 33
units of measurement World Wide Web (WWW), writers'
tables 72 resources 179-81
Uniform Requirements 199 writer's block 157-61
writing schedules 163
Vancouver Group 185 writing time management
Vancouver style 88-9,193-8 co-authors, organization of 164
vertical lines in tables 70 diarizing time for writing 164
voice recognition software 176-7 filing system efficiency 166
manageable chunks, breaking work into
WelchWeb (Johns Hopkins University) 164
181 'one-third rule' 163
word budgets 28 schedule 163
word processors spare moments 165
automatic formatting 170 speed of writing 165
contents lists 170 team writing, responsibilities 164
desktop publishers 171 tools for the job 165
dictionaries 169 travelling time 165
effective use 167-71 WWW (World Wide Web), writers'
fresh view 170 resources 179-81
grammar checkers 94,169
hidden text 170 Yale Medical Library: Writing, Publishing
'make it fit' function 43,171 or Presenting Papers,
outline function 28 Dissertations, Theses and Grant
search and replace 168 Proposals 180
short-cut keys 168 'yellow sticky' Post-it note technique 26,
'shrink to fit' function 171 111

How To Publish in Biomedicine 500 Tips For Success

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How to Publish in

Radcliffe Medical Press

Reprinted 2002, 2003, 2004

Radcliffe Medical Press Ltd

British Library Cataloguing in Publication Data

ISBN 1 85775 193 0

Library of Congress Cataloging-in-Publication Data is available.

Typeset by Advance Typesetting Ltd, Oxon

1 What do you want to write? 1

26 Clear writing: paragraphs, headings and lists 145

Appendix 1: Uniform requirements for manuscripts submitted to

The Author's Revenge

Such is the miserable life of a journal editor.

Publishing in scientific journals is the true end-product of scientific research. Long

A Describe an experimental or observational study in

A ... Or a 'short communication'

A Describe an unusual case in a case report

A Use a letter to the editor to give a brief

A ... Or to comment on other studies the journal

A ... Or simply to state your point of view on

A Write a review article to summarize the literature

A Write an editorial to put forward a new or controversial

A Write an informal article to reach a wider audience,

A Familiarize yourself with the publishing process

A Understand the roles of the people involved

Figure 2.1 The publishing process - a simplified view.

A The editor decides whether to accept or reject papers

A The reviewers advise the editor

A The managing editor oversees the day-to-day running

A Copy-editors (also known as sub-editors or desk editors)

A Remember that credibility depends on peer review

A Peer review acts as 'quality control' for the scientific

A Peer review has its limitations

A Remember that reviewers are very

A Expect your paper to be 'blinded' when it is sent to

A ... But do not expect always to be assured anonymity

A Normally, you will not have to pay to have your

A ... Except under certain specific circumstances

A Be prepared to make revisions

A Do not expect the publishing process to be fast

A Be prepared to answer the copy-editor's queries promptly

A It is your responsibility to check proofs carefully

The importance of publication as a measure of career success leads many scientists

A Generally speaking, you cannot publish the

A An exception may be made for papers previously published

the secondary version is written for a different group of readers

A Publication of an abstract or poster does not count

A ... Nor does an oral conference presentation

A Do not pre-empt publication by releasing data to

A Do not try to slice your data too thinly

A Draw up a shortlist of possible journals in

A Think carefully about who will want to read your paper

A Ask your colleagues for advice

A Look first at the journals you read yourself

A Check whether your learned society publishes a journal

A Review the literature to see where similar

A Consider all the journals whose readers might be

A Remember that a full-length, original research paper

A Check that the journal accepts papers in the

A Using the 'short communication' format may increase

A Put your shortlist of journals in rank order, from

A For a quantitative measure of a journal's status,

Institute for Scientific Information Institute for Scientific Information