Common Mistakes When Writing Peer Reviewed Papers

Writing a scientific paper invariably requires a lot of work.  Great science does not necessarily make for a great paper.  Having published and reviewed hundreds, if not thousands, of papers over the course of my academic medical career it strikes me that getting a few things right makes for a much more impactful publication.  Avoid the following mistakes and your paper will not be ignored.

1)    As a first principle, real science demands the scientific method.  Consequently, don’t forget to structure your manuscript around the scientific method.  Almost any topic in medical science can be explored through this process.  Nothing drives me crazier as a reviewer, than working through a paper with no hypothesis.  Ask an interesting question, answer it with your data and before you know it your paper will start to write itself.

2)    In junior high school you were taught to value your writing by the number of pages generated.  Now that you are a professional, break the habit!  Rambling introductions, endless discussions and ever more detailed descriptions of results lose readers and your message, as well as consuming your precious time.  Tell your story with the fewest possible words.  Wherever possible condense prose into appropriate tables or figures.  If you want your scientific writing to be impactful, less really is more.  From the famous book on concise writing: Strunk & White “Make every word tell.”

3)    By all means write about clinical topics that interest you, but tell the “science” from the reader’s vantage point.  Strip out extraneous stuff that your reader doesn’t really care about.  Meanwhile, statistics can strengthen your argument but a blizzard of statistical measures can actually obscure the central idea of a paper.  Sometimes it can be hard to see past a thicket of statistics and figure out the primary point of a paper.  What a waste!

4)    To the eyes of a reviewer and reader, nothing detracts from the quality of a paper, more than careless errors.  In this day of automated word processing checking tools, there is no excuse for spelling and grammatical errors.  If an author fails to invest literally a few minutes to clean up a manuscript, how can a reader/reviewer have confidence in the much bigger challenge of the actual writing?  Don’t be lazy!!

5)    Just because your immediate scholarly interest is not Nobel Prize material, this is no reason to not publish.  Most potential authors are much too shy about reporting findings that interest them, especially in the clinical domain.  Some physicians literally sit on their hands and data for a lifetime.  If a topic interests you, chances are it interests someone else somewhere in the world, and with online search, they can now find your report.  Therefore, write early, write often!!

When all is said and done, the processes of Cureus.com makes peer reviewed scientific publishing easier than ever.  Therefore, get to work, publish your ideas and experiences, and change the world!

Reviewing on Cureus

Reviewing a medical paper is a big responsibility and reviewing can be a difficult process; but it is critical to evolving the field of medicine.  Cureus aims to make the review process as pain-free as possible.  Moreover, we actively feature and promote reviewers as recognition for their important contribution to the field of medicine.

Today we introduce a video tutorial to highlight our reviewing tools and process. I also want to share a few thoughts for reviewers in this post.

The Cureus.com review process is designed to help the author publish the best paper possible.  Except in the case of fraud or gross negligence, we do not reject papers.  Formidable papers over the decades have been buried by errant reviewers. We believe it is unacceptable that a reviewer looking briefly at the scientific work that has taken many hours, days, weeks or months can decide whether or not a paper gets published.  Only the author can decide whether his work is strong enough for publication or not.

Once published, our SIQ scoring process is activated and the wisdom of the network will determine the relative value of a paper in the form of a score.  Reviewers on Cureus.com are the first to score a paper (SIQ score) and their score holds the most weight….so a low SIQ score might result if authors fail to take reviewer feedback into consideration.  While an author is not under obligation to modify a paper based on the feedback of the reviewers, it is in their best interest if they want to maximize their paper score.

httpvh://youtu.be/76PtlKk9n4A

Publishers Under Fire

For the vast majority of us, the world of medical academic publishing is a mystery. Physicians and scientists work amongst the inner sanctum of academia in which the “publish or perish” mantra is alive and well. Tenure is heavily driven by both the volume of one’s publishing activity and the collective Impact Factor of the journals in which one is able to get published. The presumption is that Impact Factor has a strong correlation to the importance of the works.

What is less known about academic publishing is the extent to which it influences all of healthcare. Reimbursement guidelines, choices of which drugs and devices to use and much more are all influenced by this body of authors who are doing the cutting edge research and providing the industry thought leadership. Given the importance of this work, academic papers have historically been sacrosanct and largely immune to criticism. The peer-review process was almost untouchable except for occasional retractions.

Times have changed and the critical world of peer-reviewed medical journals is not only under fire for outdated processes and models, but the ethics of some of the leading journal publishers are being called to the mat.

In Friends Don’t Let Friends Publish in Elsevier Journals, the author Henry Farrell discusses a particularly troublesome practice in which Elsevier bundled papers from industry and packaged them to look like standard peer-reviewed journals. It also appears any disclosures were either entirely absent or minimal. The post is worth a look and that smoke we are starting to see in the academic publishing world is an indication of a much bigger fire on the near horizon.

Journal Consumption by Tablet

I will be in Boston tomorrow speaking at the iMedicine and Mobile Life Sciences World Summit and I expect the recently released report from Manhattan Research on physicians use of mobile technology to be a source of conversation.

The report confirms what most anyone working with physicians observes on a regular basis… that iPad is the dominant tablet platform with 62% of physicians claiming to use one for professional purposes. What’s a little surprising is the rate of adoption — use has nearly doubled since just 2011.

“Physicians are evolving in ways we expected — only faster,” said Monique Levy, vice president of research at Manhattan Research. “The skyrocketing adoption rates of tablets alone, especially iPads, means healthcare stakeholders should revisit many of their assumptions about reaching and engaging with this audience.”

Other points from the survey that really shouldn’t surprise anyone: over 85% of physicians use a smartphone, and growth of physician use of social networks is not only flat, but limited in scope.

While there remain impediments to more widespread adoption of tablets in the clinical care environment, tablets are clearly becoming the preferred method of content consumption. Even in the early stages, Cureus users are notably reading journal papers on tablets as much as the desktop/laptop. When taking into account that initial introduction and sign up on Cureus is mostly taking place on a desktop/laptop, the fact that papers are being read on the tablet means users are switching platforms when they get into reading mode.

Cureus has leveraged two technologies to help ensure the site translates equally well on all platforms. First, we use Scribd in the background to render our papers using their patent-pending document conversion tool. The Scribd technology configures a paper into proper dimensions whether viewing on a large monitor or an iPhone. Second, we use Twitter Bootstrap to manage our user interface which means the site design is more easily managed and modified for multiple platform environments.

Over the coming months we’ll report on more specific trends, but just as Amazon Kindle has shifted the entire book, magazine and newspaper reading industry, we expect tablets to be a primary vehicle for medical journal consumption.

Medical Publishing Change Underway in Europe

There is mounting evidence that the world of academic medical publishing is entering a period of major change.  Decades and even centuries old processes and capital models just don’t make sense; and its time they get a massive makeover that better serves physicians and patients alike.

The groundswell for this movement is underway in America but the following article demonstrates that the tide is very similar in Europe:

Science Research May Be Freed From Journals Unhealthy Paywalls by Robert Andrews [PaidContent/GigaOM] 5/3/12

The UK government has told academic journal publishers it will make freely available online the publicly-funded research they currently charge for, labelling “paywalls” as “deeply unhealthy”.

This news will prove unpopular with academic publishers, which license and peer-review researchers’ work and charge libraries to make it available.

“As taxpayers put their money towards intellectual enquiry, they cannot be barred from then accessing it,” science minister David Willetts said in a speech to the Publishers Association on Wednesday (transcript).

“They should not be kept outside with their noses pressed to the window – whilst, inside, the academic community produces research in an exclusive space.”

Read the rest of the article.

Cureus People – Rod Oskouian, M.D.

Cureus met with Rod Oskouian, M.D., a neurosurgeon at Swedish Neuroscience Institute who specializes in the diagnosis and treatment of complex spinal disorders. He talked to us about the sometimes lengthy process of peer-reviewed medical publishing.

“One of the reasons why I got involved in Cureus and why I’m on the editorial board is pretty simple – I want to have open access to journals, be able to publish journals and review journals in a timely fashion so it doesn’t take two years to get a paper out.” – Dr. Rod Oskouian, told Cureus.

httpvh://www.youtube.com/watch?v=2Ee89PlWN-g

“I think the younger generation we’re all using mobile applications, going online a lot – the traditional journals where you have to subscribe to some obscure article that costs the institution thousands of dollars in some corner of the library that you have to go look up is not happening.” – Dr. Oskouian added.

Why publish peer-reviewed literature?

What makes a physician decide to publish in peer-reviewed literature? The stock answer to that question is the pursuit of scientific truth. But even a superficial glance at peer-reviewed medical literature today shows that only a small proportion of it involves “pure science”, that is, research with the scientific method at its core.

So if not for pure science, why do physicians publish? One reason is that those within the professoriate are expected to publish for academic advancement – alongside patient care and teaching, written scholarship is one of the three pillars of academia. Articles written by academic physicians may generally be pedantic and unimaginative, but the pressures within academia to produce them are unlikely to change, and we can expect such papers to continue to appear in great numbers.

But most physicians reside outside of academia and do not face pressure to publish. So why should they? Many reasons! To start with, writing an article for peer review requires a physician to review the existing literature, which helps keep him up to date with current medical practices. Secondly, the writing process forces a physician to analyze patient outcomes critically and report results in a disciplined way. This type of self-analysis opens up opportunities for improving patient outcomes.

Additionally, publishing papers is a crucial way for a physician to communicate his clinical abilities to the wider world, to both referring physicians and potential patients. The writing of articles is one of the best way of marketing a clinical practice, and this is a factor that motivates some of the articles in medical journals today. Academics tend to view this practice with cynicism, but provided a paper’s content is worthy, this type of “marketing” is preferable to promoting one’s practice through glossy brochures or highway billboards – especially in terms of reaching other physicians.

It is my belief that Cureus.com will make the process of publishing easier than ever – and not just easy but fun. Isn’t it time you got to work on your next paper?

Cureus interviews Garnette Sutherland, M.D.

Garnette Sutherland M.D.

Garnette Sutherland, MD recently published a paper on Cureus.com entitled: Surgeon at a Workstation: Information Age Surgery. I had the chance to talk to Dr. Sutherland about his work and robotics in particular.

Q. How many papers have you published?

A. About 180 peer-reviewed papers, 25-30 book chapters and 10-20 patents.

Q. When did you know you wanted to be a physician?

A. As an undergrad in chemistry and physical chemistry I enjoyed investigating molecular structure and during this time I decided to apply to medical school. Professors suggested I could always come back to chemistry if the doctor thing didn’t work out. During my summer breaks I returned to the lab for work.

I was particularly influenced to become a neurosurgeon by eminent figures such as Dwight Parkinson, MD, Theodore Rasmussan, MD and Bill Feindel, MD. I was drawn to Ontario by Charles Drake, MD – one of the grandmasters of neurosurgery. He performed thousands of challenging cases but he always took great care examining x-rays when things didn’t go well…not just when procedures were a success. When I began my practice, I continued his tradition. This inspired me to bring imaging into the operating room.

Q. Your paper describing the potential and current usage of robots in surgery and involving brain tumors in particular is fascinating. Give us a little background as to how project neuroArm came about.

A. While having intraoperative images obtained during surgery is wonderful, the process of acquiring the images disrupts surgical rhythm. So I thought it would be great to have a machine that could acquire images during surgery without such a disruption. Essentially, I wanted a machine that could operate within the image as it is acquired. NeuroArm is a step towards this goal.

Q. You mention the system has been used on over 30 cases to date. What have been the primary learnings from these instances?

A. One of the early requirements was to create a workstation that recreates the sight, sound and touch of surgery. The learning curve of using such technology is relatively steep, taking 20 cases to become confident using the unfamiliar tools of the workstation. It became clear that the workstation would be an ideal platform to bring the various technologies of the operating room to a single console.

However, the workstation is not yet perfect. While technology is quickly advancing, it cannot yet perfectly replicate complex human senses like touch. There is still some ways to go in order to understand and replicate touch. As this technology improves, so will the workstation’s ability to transmit the sensations of surgery back to the surgeon.

Garnette Sutherland, M.D. operating NeuroArm

Q. If you were telling a patient why a robotic procedure is optimal for their particular circumstance, what would be the typical drivers for that recommendation? How should a patient weigh their decision?

A. We had to go through normal ethics and regulatory approval processes which includes informed patient consent. The primary indicators for the use of the robot were brain tumor, cavernous angioma, and infection. Patients with these conditions were approached about robotic surgery. Patients were informed that the robot would be integrated in a safe and graded manner. If the situation would not be ideal for robot use, we would revert to conventional procedure. Effective treatment always takes precedence over the experimental use of the robot.

Q. What are some of the bigger challenges associated with getting published?

A. Getting a paper into the review process is not simple. Each journal has different style and formatting requirements, and look for different content. Top journals have a rapid initial review which will determine if the paper is appropriate for their publication. My major critique is that once you submit for peer review and it goes through the process of revisions and resubmissions and so forth it is not uncommon to take a year. This can result in publications that are not timely, and do not accurately reflect current advances.

As a case in point, I have a paper in the queue based on the first 35 robot cases, and by the time it’s published, we will have likely performed 80 robot surgeries. The paper may be out of date before it’s even published. Unfortunately, in the academic world there is a lot of emphasis on publication volume, which might interfere with the research process. This creates a conflict between the length of time it takes for publication and the required output of a career academic.

Writing a Cureus-ly Good Paper

Writing a scientific paper is hard work and takes considerable time. We at Cureus are here to make your publication process as quick and painless as possible. After publication your contribution will be rated by the community (SIQ). You should keep in mind these important steps when you prepare your manuscript.

Do you have something worth publishing? If so, here are the main criteria to consider:

  • Significance: Why was this work done? Did you solve an important problem of current interest or is it an obscure or obsolete problem?
  • Originality/Novelty: Is your approach novel or is it tried-and-true? Did you need to develop new tools, either analytical or physical?
  • Completeness: Have you tested a wide range of scenarios, or is this just a simple proof-of-concept?
  • Correct: Is your solution technically sound or are there errors?

It is important to consider your audience. It should be written to an audience that knows generally about your field but does know what you have done. In addition, before you begin your process you should research and read similar scientific papers that have been written in the format you plan to use.

Write clear and concise content

The main assumptions and results should be explained clearly. If there are multiple assumptions, present them together. Do not bury them in long paragraphs.

Define every symbol when it is first introduced. Otherwise, your peer reviewers will be frustrated. That can negatively affect your SIQ score. Clearly state the contributions of the paper in the concluding remarks.

Focus on the Material and Methods section first

When writing a report, it is often a good idea to begin by writing the Materials and Methods section. This section is usually straightforward. Writing it first helps to establish the proper thought process and understanding of the work. This will allow the rest of the report to flow more smoothly.

Next, it is generally recommended to write the Results section, followed by the Discussion, and finally the Introduction. Although this recommendation may seem illogical at first, many have found this approach to be very effective.

Limit your references

An inexperienced writer rarely resists the temptation to cite all papers that have been written on the subject. This may be appropriate for a doctoral dissertation, but not for a journal paper. An ideal number of references is a dozen. A practical upper limit is twenty.

Design your tables and figures clearly and intuitively

A (good) figure is worth a thousand words. Do not use too many curves, lines, or labels. Ten years after publication, readers may not remember equations or derivations, or anything else about a paper. But they may remember a figure.

As a general rule, a paper should not contain more than two figures – rarely more than three. Too many figures suggest that the paper represents a low-tech research effort. Tables and figures should be put into a contextual framework in the corresponding text. They should typically summarize results, not present large amounts of raw data. When possible, the results should provide some way of evaluating the reproducibility or statistical significance of any numbers presented.

Following these tips will make your paper highly valuable and guarantee high SIQ scores. This ensures wide distribution of your work and will serve in  adding significant value to your professional reputation.

Why We Founded Cureus

The world of medical journals is broken. After 25 years of active engagement in academic medicine, I have come to this inescapable conclusion. This dysfunction is manifest in the fact that over 85% of peer reviewed journals including the most prestigious journals, remain locked up behind pay walls — inaccessible to a majority of physicians and nearly all patients. As both an author and reviewer I have learned firsthand how political and slow the existing method for scholarly review and publication can be. Interesting but controversial research papers can take years to get published.

The glacial pace, with which many medical journals publish important research, contrasts with new physics journals like ArXiv which enable instantaneous publication of cutting edge research and lively post publication scientific discourse. Although the protectors of the status quo argue that this inefficiency is necessary to ensure quality, ever more frequent scientific misconduct is being reported in even the so-called “best medical journals”. In an otherwise rapidly accelerating world of communication that is enabled by the internet, standard peer review processes have become an antiquated practice largely sustained by centuries of tradition.

John R Adler M.D.

What perpetuates the status quo? Money, and even more money. Modern peer reviewed journals exist to maximize revenue for sponsoring medical societies and the international corporate publishing conglomerate.

Medical journals are a primary source of revenue for nearly all medical societies. The largest publisher of all, Reed Elsevier, routinely reports annual profits in excess of a billion dollars. The scientific journal industry has become rich off the backs of societal funding of medical research AND the hundreds of thousands of “volunteered” hours that are contributed annually by physician authors and reviewers. Arrogant self-serving medical publishing complex, is willfully neglecting their societal duty to efficiently disseminate scientific truths.

Frustrated and thoroughly unimpressed with the existing world of medical publishing we are challenging a 200 year old system with the launch of Cureus.com. And not a moment too soon.

Our story is a little like David vs. Goliath. Having offices in Silicon Valley we are constantly reminded of the power of technology, and the advantages of being small and agile. That agility coupled with precise aim gives us an edge over the giant(s).

Maybe it is time you too joined the revolution in peer-reviewed medicine. Register with Cureus.com today.