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How to turn study results into publications

David RossLondon School of Hygiene & Tropical Medicine

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Acknowledgements

Peter Smith LSHTM

Limits of the talkOriginal article reporting the results of a quantitative, epidemiological study

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Publication Strategy What does the sponsor require? eg. Full report (from which

papers can be drawn) Get as much as possible into the main paper Avoid “confetti” publishing Plan the sequence of publication

eg. Major Intervention Trial: • Register Trial • Intervention methods paper • Study methods paper• Main Results Paper• Secondary trial results papers (if any)• Non-trial papers exploiting the data set (eg. Observational questions)

Plan should allow cross-referencing in subsequent papers & to put the study on the map early on)

Allocate responsibilities & deadlines

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Choice of Journal• Choose target journal before you start writing

What is the target audience? • General population (eg. New Scientist)• General health professionals (eg. Lancet, NEJM)• Specialists (eg. AIDS)

How “exciting” are the results?Locally or internationally important?How long will the paper need to be?How quickly does the journal publish?What is the impact factor of the journal?History of publications of this kind in the journal?

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Instructions for Authors• Read them before you start writing

• ttp://www.Instructions4Authors.com >2000 links to medical journals

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Structure of paper

1 Title2 Authors3 Abstract/Summary4 Introduction/Background5 Materials & Methods6 Results7 Discussion8 Acknowledgements9 Contributions10 References11 Tables12 Legends for Figures13 Figures

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Suggested order in which to write the sections

1&14 Title2 Authors10 Abstract/Summary9 Introduction/Background8 Materials & Methods6 Results7 Discussion12 Acknowledgements13 Contributions11 References3 Tables5 Legends for Figures4 Figures

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What parts of a paper are read and by whom?

• The vast majority or readers of a journal will read, at most, the title and may look at the list of authors– Get as much of the paper into the title as you can and try to

make it provoke interest in reading the summary

• A much smaller proportion will read the summary– Get all the key messages into the summary

• A small proportion of readers will scan the tables & figures– Make these comprehensible without having to read the paper

• A tiny proportion of readers will read the whole paper– People in the field/working on same issue

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Title• Try to include the main finding in the title

– eg. “DTP vaccination increases the risk of child death” not “Routine vaccines and child survival”

• Keep short and snappy• Do not be too technical - avoid “jargon”• Start with a provisional title, but review it when the

paper is written• Journal may alter the title to their preferred “house

style” – Review changes carefully to ensure there is no

distortion of the message

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Authorship• All authors have responsibility for contents of a paper

– Published errors are permanent!– Do not be a passenger!

• Many journals require a statement of the contribution of each author to the investigation reported– If in doubt, include an extra author, but not unless justified– Some journals have strict rules on number of authors (eg. SSM)

• Squabbles over authorship (both open and hidden) cause more “blood on the carpet” than any other aspects of a paper!– Decide what papers will be written, who will be authors on each and

who will draft them (probable first author), as early as possible– In multi-institution studies, some representation from all institutions

relevant to the paper’s contents may be desirable– First (second & third) and last author have special significance

• Do not worry too much about order apart from these three positions– Think about who is likely to be offended by omission, and take

conscious decisions

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Tables• Plan tables needed to describe the study and the results

– Most critical part of developing a quantitative paper– Once the tables are there, the paper is largely written

• Description of characteristics of study population

• Main results

• Secondary findings

• Your findings in the context of other studies

• Ensure that the title of each table is an adequate summary of its content

• Work out complete description of the results through tables (and figures), even if later you might incorporate smaller findings into the text

• Minimize duplication of data in tables and in figures

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Tables (cont…d)

• Plan the tables and figures such that paper can be largely “read” based on these alone

• Keep them as simple as possible; avoid unnecessary data– Two simple tables better than one complicated table– Put numbers and percentages only if referenced in text

• Label very clearly and avoid abbreviations where possible• Not too many digits (significant figures)

– eg. odds ratio = 4.7 (not 4.735)– Relate to size of confidence interval

eg. 1.2 (95%CI: 0.1, 9.7) - not 1.23 (95%CI: 0.13, 9.68)

• Get a colleague to explain your tables to you!

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Figures• Keep legends separate from the figures• Label all axes and give units in figure or legend• Keep as simple as possible, but if too simple, question if

necessary• Ask why a point is better made with a figure than a table -

use one or other, rather than both• Maps and similar diagrams

– give key to all symbols used– show scale graphically (not 1cm = 1km, as journal may shrink figure)– show North on maps

• Ask a colleague to explain to you what a figure shows• Use colours only if really necessary (expensive)

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Results• Description of the results should follow directly from the

tables & figures – Summarise with appropriate reference to them

• Start off with the most simple analyses - e.g. simple description of differences, without adjustment for confounding factors, etc.

• Develop and describe more sophisticated analyses, as appropriate

• Comment on all data shown in each table, even if very briefly

• Present point estimates with 95%CIs (or p-values)

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Discussion• Focus initially on your own results and summarise your

overall findings• Discuss the possible limitations and biases that could

have influenced the results and discuss how you have tried to minimise them

• Put your findings in the context of other studies - summarising those studies as necessary, possibly in tabular or figure form.

• Draw overall conclusions from your and other studies• Make recommendations for public health action, further

research, etc.

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Materials & Methods• Descriptions of:

– study area (relevant features)– study design adopted (e.g. RCT, case-control, cohort)– study population– sample size determination– methods of selection/exclusion– randomisation methods (if any)– informed consent procedures– measurement methods– laboratory assays– follow-up methods– computing & statistical packages used– statistical methods employed– ethical approval (& DSMB)

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Introduction & Background

• Keep brief– Give minimum necessary background information to explain current

controversies and why the present study was conducted – This is NOT a PhD thesis!

• Reference to recent review papers wherever possible, rather than a huge list of original articles (NOT a PhD!)

• Specify the hypotheses that the study was designed to evaluate - in explicit and, where possible, quantitative terms

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Abstract• Some journals prescribe the structure – follow it!• Very brief introduction to the issue addressed and

the reason for addressing it (usually one or two sentences)– Keep historical background very brief

• Concise summary of your results– Use the maximum words allowed (but not more)– Make every word count– Include as many of the key findings as you can -

including summary estimates, confidence intervals and P-values

• Implications of the results

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Acknowledgements• If “in doubt” acknowledge!• Does not cost you anything – even the words don’t count!

– Funding agencies - check required wording– Local authorities– Study participants– Field workers– Laboratory workers– Other study staff (computing, drivers, etc)– Local implementers (eg. Health staff)– Originator of idea (unless an author; acknowledging an author is rude!)– Special assistance provided - advisors & consultants– DSMB, Steering Cmte members

• Detail the specific contribution to the study of each author - required by some journals & good idea anyway as justifies the authors (and helps show non-authors why they weren’t included)

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References• Avoid trying to impress with how widely read you are

– Don’t list 10 papers where one will do– Stick to key references relevant to the point being made– Use recent reviews where possible

• Where possible, select references from more accessible journals

• Make sure all your references are complete & accurate– Check using EndNote, MEDLINE or PubMed

• Read the references you quote – don’t believe someone else’s review of them!

• Pay strict attention to journal instructions on format• Invest in a good reference management system

– eg. ENDNOTE, REFERENCE MANAGER– Learn how to search and download from MEDLINE or PubMed

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Suggested order in which to write the sections

1&14 Title2 Authors10 Abstract/Summary9 Introduction/Background8 Materials & Methods6 Results7 Discussion12 Acknowledgements13 Contributions11 References3 Tables5 Legends for Figures4 Figures