How To Get Your Research Published in the BMJ

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  • Please ensure that the structured abstract is as complete, accurate, and clear as possible—but not unnecessarily long—and has been approved by all authors. We may screen original research articles by reading only the abstract. For randomised controlled trials please provide all the information required for a CONSORT style abstract.
  • And title, authors, reference/doi, corresponding author’s email BMJ pico is our one page abridged format for research papers in the print journal, which some authors volunteered to help us pilot. We have designed BMJ pico with evidence based medicine experts to succinctly present the key evidence from each study, to help minimise delay between online and print publication, and to enable us to publish more research in each week’s print BMJ.  There is no need for authors to prepare a BMJ pico to submit along with their full research article. Authors produce their own BMJ pico, using a template from us, only after the full article has been accepted. Examples at: http://resources.bmj.com/bmj/authors/article-submission/bmj-pico-abridged-research-articles
  • This applies to trials which commenced after 1 July 2005: for older trials retrospective registration will be acceptable, but only if completed before submission of the manuscript to the journal. Eligible trials have been defined by ICMJE since 1 July 2008 as "where human participants are prospectively assigned to one or more health-related interventions [including health services and behavioural interventions] to evaluate the effects on health outcomes", and before that were defined more narrowly as trials "where human participants are prospectively assigned to investigate the cause and effect relationship between a medical intervention and health outcome". This means that: trials randomising human participants to investigate the cause and effect relationship between a medical intervention and a health outcome that commenced before 1 July 2005 can be registered retrospectively, but this must be done before submission to the BMJ trials randomising human participants to investigate the cause and effect relationship between a medical intervention and a health outcome that commenced after 1 July 2005 must have been registered prospectively, ie before enrolment of any participants trials randomising human participants or groups of humans to one or more health-related interventions [including health services and behavioural interventions] to evaluate the effects on health outcomes and that commenced after 1 July 2008 must have been registered prospectively, ie before enrolment of any participants
  • Groves T. Mandatory disclosure of trial results for drugs and devices. BMJ 2008;336:170 US Food and Drug Administration. Law strengthens FDA. 2007. www.fda.gov/oc/initiatives/advance/fdaaa.html .
  • Example from a real BMJ paper
  • US Office of Research Integrity http://ori.dhhs.gov/misconduct/definition_misconduct.shtml The Council of Science Editors defines plagiarism as "a form of piracy that involves the use of text or other items (figures, images, tables) without permission or acknowledgment of the source of these materials."
  • Scientists behaving badly Brian C. Martinson, Melissa S. Anderson and Raymond de Vries Nature 435, 737-738(9 June 2005) doi:10.1038/435737a Editor's Summary 9 June 2005 Own up In a questionnaire-based survey of US biomedical researchers, respondents admitted to a range of dubious practices. Transgressions included failing to present data contradicting one's own research (6%) and ignoring data based on a 'gut feeling' that it was wrong (15%). Writing on the survey, Martinson et al . call this picture of misbehaviour "striking in its breadth and prevalence".
  • CrossCheck developed jointly by iThenticate and Cross Ref How does iThenticate compare to Turnitin? iParadigms developed both solutions. iThenticate is designed to accommodate corporate organizations, while Turnitin is designed for classroom use in educational institutions. Since 1996, our company has provided the most widely used verification technology, and established itself as expert in the promotion of content integrity. iThenticate is a web-based application. Users can access their accounts from any Internet-ready computer by logging in at our website. This has proved extremely advantageous for customers who have multiple locations, various dispersed departments working on projects, or employees working remotely.
  • COPE = Committee on Publication Ethics http://publicationethics.org/
  • 4-5000 research papers, 4-7% accepted approximate numbers at each stage: 1000 sent to two reviewers; 500 more rejected 500 to weekly manuscript meeting attended by the Editor, an external editorial adviser (a specialist or primary care doctor) a statistical editor, and all BMJ research editors 250-300 research articles accepted, usually after revision value added by commissioned editorials and commentaries; often written by reviewers
  • Most papers end up being published somewhere. See: Lock, S. A difficult balance: editorial peer review in medicine. London: BMJ, 1991. 68% of papers rejected by the BMJ during 7 months of 1979 were eventually published elsewhere, most in specialist journals. A quarter, however, remained unpublished. Relman AS. Are journals really quality filters? In: Goffman W, Bruer JT, Warren KS, eds. Research on selective information systems. New York: Rockefeller Foundation, 1980. Random sample of 300 papers rejected by NEJM in 1975. Questionnaire showed that, among the 55% who replied, four fifths of authors said their papers had been published elsewhere. Only a fifth of these, however, had been revised according to peer review comments received before submission to final journal. Must interpret these findings cautiously. Both studies are old - things may have changed since.
  • How To Get Your Research Published in the BMJ

    1. 1. Why do researchers want to publish? <ul><li>say something important </li></ul><ul><li>share your work </li></ul><ul><li>change practice </li></ul><ul><li>promote thought or debate </li></ul><ul><li>educate </li></ul><ul><li>get into high impact journal </li></ul><ul><li>advance your career </li></ul><ul><li>keep your job </li></ul><ul><li>make money </li></ul><ul><li>entertain/divert/amuse </li></ul>
    2. 2. Which journal should you choose? <ul><li>audience </li></ul><ul><li>generalists or specialists? </li></ul><ul><li>national or international? </li></ul><ul><li>impact </li></ul><ul><li>not just Impact Factor </li></ul><ul><li>not just prestige </li></ul><ul><li>will people read your work? </li></ul><ul><li>respond to it? debate it? </li></ul><ul><li>replicate it? tell others of it? </li></ul><ul><li>will anyone use it? </li></ul><ul><li>will it reach the public? </li></ul>
    3. 3. What do editors want? <ul><li>importance </li></ul><ul><li>originality </li></ul><ul><li>relevance to the audience </li></ul><ul><li>real potential to improve decision making </li></ul><ul><li>truth and transparency </li></ul><ul><li>clear writing that people want to read </li></ul><ul><li>excitement/ “wow” factor </li></ul>
    4. 4. Why does BMJ publish? <ul><li>Pure academic interest isn't </li></ul><ul><li>enough for most BMJ readers, </li></ul><ul><li>who mainly comprise doctors – </li></ul><ul><li>- whether they're practising </li></ul><ul><li>clinical medicine, working in </li></ul><ul><li>public health, developing and </li></ul><ul><li>implementing health policy, or </li></ul><ul><li>working mostly as researchers </li></ul><ul><li>We aim to provide our readers </li></ul><ul><li>with articles that will help them </li></ul><ul><li>to make better decisions </li></ul>
    5. 5. What does BMJ ask authors to do? <ul><li>All explained at: </li></ul><ul><li>bmj.com </li></ul><ul><li>resources for authors </li></ul>
    6. 6. Writing a research paper
    7. 7. General guidance on writing papers <ul><li>International Committee of Medical Journal Editors uniform requirements for manuscripts submitted to biomedical journals </li></ul><ul><li>http://www.icmje.org/ </li></ul><ul><li>reporting guidelines for research, at the EQUATOR </li></ul><ul><li>network resource centre </li></ul><ul><li>http://www.equator-network.org/ </li></ul>
    8. 9. Writing a paper 1. The message <ul><li>What </li></ul><ul><li>… is the research question? </li></ul><ul><li>… is the right article format for your study? </li></ul><ul><li>… does the audience need to know? </li></ul>
    9. 10. Writing a paper 2. Title: style <ul><li>descriptive: Number of heads in adults: audit </li></ul><ul><li>declarative: Most adults have one head </li></ul><ul><li>journalistic: Heads you win </li></ul><ul><li>questioning: How many heads do adults have? </li></ul><ul><li>Carefully check the journal’s instructions to authors and </li></ul><ul><li>look at other articles in that journal </li></ul>
    10. 11. Writing a paper 2. Title: study design <ul><li>cross sectional survey </li></ul><ul><li>audit </li></ul><ul><li>case series </li></ul><ul><li>case control study </li></ul><ul><li>cohort study (retrospective or prospective?) </li></ul><ul><li>clinical trial (controlled? randomised? crossover?) </li></ul><ul><li>systematic review/meta-analysis </li></ul><ul><li>economic evaluation (cost of illness? cost effectiveness? </li></ul><ul><li>cost benefit? modelling?) </li></ul>
    11. 13. Writing a paper 3. IMRaD <ul><li>Introduction: why ask this research question? </li></ul><ul><li>Methods: what did I do? </li></ul><ul><li>Results: what did I find? </li></ul><ul><li>Discussion: what might it mean? </li></ul>
    12. 14. Writing a paper 4. The introduction <ul><li>brief background for this audience </li></ul><ul><ul><li>3-4 paragraphs only </li></ul></ul><ul><ul><li>what’s known, and what’s not, about your research question </li></ul></ul><ul><ul><li>don’t bore readers, editors, reviewers </li></ul></ul><ul><ul><li>don’t boast about how much you have read </li></ul></ul><ul><li>the research question </li></ul><ul><ul><li>state it clearly in the last paragraph of the introduction </li></ul></ul><ul><ul><li>say why it matters </li></ul></ul>
    13. 15. Writing a paper 5. Methods <ul><li>like a recipe </li></ul><ul><li>most important section for informed readers </li></ul><ul><li>describe: </li></ul><ul><ul><li>inclusion and exclusion criteria </li></ul></ul><ul><ul><li>outcome measures </li></ul></ul><ul><ul><li>intervention or exposure </li></ul></ul><ul><li>give references for standard methods </li></ul><ul><li>follow reporting guidelines as explained at </li></ul><ul><li>( http://www.equator-network.org / </li></ul><ul><li>explain ethics issues </li></ul>
    14. 16. Writing a paper 6. Results <ul><li>include basic descriptive data </li></ul><ul><li>text for story, tables for evidence, figures for highlights </li></ul><ul><li>confidence intervals </li></ul><ul><li>essential summary statistics </li></ul><ul><li>leave out non-essential tables and figures </li></ul><ul><li>don’t start discussion here </li></ul>
    15. 17. Essential summary statistics <ul><li>clinical trial:  </li></ul><ul><ul><li>absolute event rates among experimental and control groups </li></ul></ul><ul><ul><li>relative risk reduction </li></ul></ul><ul><ul><li>NNT or NNH (number needed to treat or harm) and its 95% confidence interval (or, if the trial is of a public health intervention, number helped per 1000 or 100,000) </li></ul></ul><ul><li>cohort study:  </li></ul><ul><ul><li>absolute event rates/time for exposed and non-exposed groups </li></ul></ul><ul><ul><li>relative risk reduction </li></ul></ul><ul><li>case control study:  </li></ul><ul><ul><li>odds ratio for strength of association between exposure and outcome </li></ul></ul><ul><li>study of a diagnostic test:  </li></ul><ul><ul><li>sensitivity and specificity </li></ul></ul><ul><ul><li>positive and negative predictive values </li></ul></ul>
    16. 19. Writing a paper 7. Structured discussion <ul><li>don’t simply repeat the introduction </li></ul><ul><li>include </li></ul><ul><ul><li>statement of principal findings </li></ul></ul><ul><ul><li>strengths and weaknesses of the study </li></ul></ul><ul><ul><li>strengths and weaknesses in relation to other studies (especially systematic reviews), and key differences </li></ul></ul><ul><ul><li>meaning of the study: possible mechanisms and implications for clinicians or policymakers </li></ul></ul><ul><ul><li>unanswered questions and future research </li></ul></ul><ul><li>go easy on the last two </li></ul>
    17. 20. Abstract: general rules <ul><li>important </li></ul><ul><li>all authors must </li></ul><ul><li>approve it </li></ul><ul><li>editors may screen by </li></ul><ul><li>abstract </li></ul><ul><li>for BMJ: </li></ul><ul><li>usually 300-400 words </li></ul><ul><li>use active voice </li></ul><ul><li>p values need data too </li></ul><ul><li>%s need denominators </li></ul><ul><li>no references </li></ul><ul><li>trial registration details </li></ul>
    18. 21. Structured abstract <ul><li>objectives - research question </li></ul><ul><li>design –prospective, randomised, placebo controlled, case control, etc </li></ul><ul><li>setting – primary or secondary care? number of centres, country </li></ul><ul><li>participants – entry and exclusion criteria, numbers entering and </li></ul><ul><li>completing the study, sex, ethnic group as appropriate </li></ul><ul><li>interventions - what, how, when and for how long </li></ul><ul><li>main outcome measures - those planned, those finally measured </li></ul><ul><li>results - main results, 95% confidence intervals, statistical significance, </li></ul><ul><li>number need to treat/harm  </li></ul><ul><li>conclusions – primary conclusions, implications; don’t go beyond data </li></ul><ul><li>trial registration - registry and number (only for clinical trials) </li></ul>
    19. 22. BMJ pico abridged articles for print BMJ <ul><li>eg Cohort study </li></ul><ul><li>study question </li></ul><ul><li>summary answer </li></ul><ul><li>participants and setting </li></ul><ul><li>design, size and duration </li></ul><ul><li>main results and the role of chance </li></ul><ul><li>bias, confounding, other cautions </li></ul><ul><li>generalisability to other populations </li></ul><ul><li>study funding/competing interests </li></ul>
    20. 23. Clinical trial registration and results reporting
    21. 24. Clinical trial registration – ICMJE rules <ul><li>drug/device trials* that started </li></ul><ul><li>after July 2005 must have been </li></ul><ul><li>registered before participants </li></ul><ul><li>are recruited </li></ul><ul><li>for older trials retrospective </li></ul><ul><li>registration is OK, as long as it’s </li></ul><ul><li>before submission to the journal </li></ul><ul><li>for trials of non-drug interventions </li></ul><ul><li>the rules started in 2008** </li></ul><ul><li>trials* since 1 July 2005: </li></ul><ul><li>&quot;where human participants are </li></ul><ul><li>prospectively assigned to </li></ul><ul><li>investigate the cause and effect </li></ul><ul><li>relationship between a medical </li></ul><ul><li>intervention and health outcome&quot;. </li></ul><ul><li>trials** since 1 July 2008: </li></ul><ul><li>“… prospectively assigned to one or </li></ul><ul><li>more health-related interventions </li></ul><ul><li>[including health services and </li></ul><ul><li>behavioural interventions] to </li></ul><ul><li>evaluate the effects on health </li></ul><ul><li>outcomes&quot; </li></ul>
    22. 25. FDA rules on results posting: FDA Amendment Act 1. Which trials? <ul><li>any ongoing trial of a </li></ul><ul><li>drug, biological product, </li></ul><ul><li>or device regulated by </li></ul><ul><li>FDA must be registered at </li></ul><ul><li>clinicaltrials.gov </li></ul><ul><li>from September 2008 the </li></ul><ul><li>results of such trials must also </li></ul><ul><li>be posted there </li></ul><ul><li>applies to all trials except phase </li></ul><ul><li>I drug trials and small feasibility </li></ul><ul><li>studies of devices </li></ul>
    23. 26. FDA Amendment Act 2. Which results have to be posted online when? <ul><li>When: within 1 year of seeing last patient in trial </li></ul><ul><li>What: </li></ul><ul><li>two tables of results for main outcome measures - 2008 </li></ul><ul><li>two tables of harms – 2009 </li></ul><ul><li>lay summary of results – 2010?? </li></ul>
    24. 27. FDA Amendment Act 3. Penalties <ul><li>If trial results aren’t posted: </li></ul><ul><li>US $10K per infringement, with </li></ul><ul><li>no upper limit </li></ul><ul><li>naming and shaming with non </li></ul><ul><li>compliance notice at </li></ul><ul><li>clinicaltrials.gov </li></ul>
    25. 28. Publication ethics
    26. 29. Transparency and integrity <ul><li>BMJ’s transparency policy will help you to report work honestly and fully </li></ul><ul><li>resources.bmj.com/bmj/authors/editorialpolicies/transparency-policy </li></ul>
    27. 30. Ethics aspects of the study <ul><li>Does the paper: </li></ul><ul><ul><li>risk revealing patients’ identities? </li></ul></ul><ul><ul><li>explain fully informed consent? </li></ul></ul><ul><ul><li>explain any deviation from current normal clinical practice? </li></ul></ul><ul><ul><li>explain the full burden imposed on participants? </li></ul></ul><ul><ul><li>state the total risks posed to participants or others? </li></ul></ul><ul><ul><li>discuss benefits for participants, other patients, society? </li></ul></ul><ul><li>It’s not always enough to state that the study was approved by an ethics committee or IRB </li></ul>
    28. 31. Who did what and why? <ul><li>authors </li></ul><ul><li>contributors </li></ul><ul><li>… and competing interests </li></ul>
    29. 32. Authorship <ul><li>Authorship credit should be based only on substantial contribution to: </li></ul><ul><li>conception and design, or data analysis and interpretation </li></ul><ul><li>drafting the article o r revising it critically for important intellectual content </li></ul><ul><li>and final approval of the version to be published </li></ul><ul><li>All these conditions must be met. </li></ul><ul><li>Participation solely in the acquisition of funding or the collection of data does not justify authorship.  </li></ul><ul><li>All authors included on a paper must fulfil the criteria </li></ul><ul><li>No one who fulfils the criteria should be excluded </li></ul>
    30. 33. Contributorship <ul><li>contributors (not all necessarily authors) who took part </li></ul><ul><li>in planning, conducting, and reporting the work </li></ul><ul><li>guarantors (one or more) who accept full </li></ul><ul><li>responsibility for the work and/or the conduct of the </li></ul><ul><li>study, had access to the data, and controlled the </li></ul><ul><li>decision to publish </li></ul><ul><li>researchers must decide among themselves the precise </li></ul><ul><li>nature of each contribution </li></ul>
    31. 34. Who did what? <ul><li>Helen C Eborall , post-doctoral research fellow 1, Simon J Griffin , programme leader 2, A Toby Prevost , medical statistician 1, Ann-Louise Kinmonth , professor of general practice 1, David P French , reader in health behaviour interventions 3, Stephen Sutton , professor of behavioural science 1 </li></ul><ul><li>Contributors: SS, DPF, ATP, A-LK, and SJG conceived and designed the original protocol. All authors were involved in amending the protocol. HCE coordinated the study throughout. Data entry was carried out by Wyman Dillon Ltd, Lewis Moore, and HCE. HCE cleaned the data and ran preliminary analysis with input from Tom Fanshawe. ATP analysed the data. ADDITION trial data were supplied by Lincoln Sargeant and Kate Williams. HCE wrote the first draft of the manuscript with ATP and SS. All authors contributed to subsequent and final drafts. HCE is guarantor of the paper. </li></ul>
    32. 35. Scientific misconduct
    33. 36. Misconduct: the human element <ul><li>“Scientists are people. Some are straightforward; others </li></ul><ul><li>are devious, confused, lazy, careless. Try as we might, I </li></ul><ul><li>don’t think we will ever cure that.” </li></ul><ul><li>William James, Nature 1997 </li></ul>
    34. 37. What amounts to misconduct? <ul><li>Research misconduct means fabrication, falsification, or </li></ul><ul><li>plagiarism in proposing, performing, or reviewing </li></ul><ul><li>research, or in reporting research results </li></ul><ul><li>Fabrication: making up data or results and recording or reporting them Falsification: manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record Plagiarism: the appropriation of another person's ideas, processes, results, or words without giving appropriate credit Research misconduct does not include honest error or differences of opinion </li></ul>
    35. 39. New tool to detect plagiarism: CrossCheck <ul><li>web based tool which searches for overlapping content: </li></ul><ul><li>prepublication </li></ul><ul><li>postpublication </li></ul><ul><li>specialist search engine (iThenticate) </li></ul><ul><li>uses “text fingerprinting” and “string matching” </li></ul><ul><li>gets behind access controls (free tools can’t do this) </li></ul><ul><li>9 billion articles in CrossRef database, and counting </li></ul>
    36. 41. Editors’ role in tackling misconduct <ul><li>managing peer review (warning! it’s poor at spotting fraud) </li></ul><ul><li>helping to prevent misconduct </li></ul><ul><ul><li>talking with authors </li></ul></ul><ul><ul><li>providing clear information for authors on writing papers </li></ul></ul><ul><li>detecting and referring cases of misconduct </li></ul><ul><ul><li>asking authors for explanation/raw data </li></ul></ul><ul><ul><li>referring unresolved and proven cases to author’s institution/licensing </li></ul></ul><ul><ul><li>body/COPE/journal ethics committee </li></ul></ul><ul><ul><li>publishing notices of concern </li></ul></ul><ul><ul><li>retracting articles </li></ul></ul>
    37. 42. How to please editors and reviewers and maximise your chances of acceptance
    38. 43. Before you start your study <ul><li>have a clear research question </li></ul><ul><li>seek statistical advice </li></ul><ul><li>use the right study design </li></ul><ul><li>keep an open mind and minimise bias </li></ul><ul><li>agree who will be principal investigator </li></ul><ul><li>agree who will be authors and contributors </li></ul><ul><li>agree to publish even negative results </li></ul>
    39. 44. How to please editors <ul><li>choose the right journal </li></ul><ul><li>read the journal </li></ul><ul><li>follow advice to authors </li></ul><ul><li>submit online and follow instructions </li></ul>
    40. 45. How to please editors and peer reviewers <ul><li>make sure the message is clear in the paper and </li></ul><ul><li>abstract, not just in the cover letter </li></ul><ul><li>include extras eg STROBE checklist </li></ul><ul><li>cite (and send) any closely related papers </li></ul><ul><li>send previous peer review reports </li></ul><ul><li>communicate clearly and promptly </li></ul>
    41. 46. What happens during peer review <ul><li>BMJ ask reviewers to sign their reports and declare any </li></ul><ul><li>competing interests relevant to manuscripts </li></ul><ul><li>reviewers advise the editors, who make the final </li></ul><ul><li>decision (aided by an editorial manuscript committee </li></ul><ul><li>meeting for some articles, including original research) </li></ul>
    42. 47. BMJ peer review process 4-5000 annually 3-4000 rejected Approx 1000 for open review 500 then rejected 500 with Editor and adviser, statistician, BMJ team 4-7% with Open access No word limits BMJ pico Editorials Screen Research submitted External review Editorial meeting Accept
    43. 48. What we ask reviewers to do <ul><li>be open and honest </li></ul><ul><li>be constructive, and help the authors to improve the </li></ul><ul><li>paper even if the BMJ rejects it </li></ul><ul><li>most importantly, reviewers advise editors on: </li></ul><ul><li>the article’s originality </li></ul><ul><li>the article’s importance </li></ul>
    44. 49. BMJ appeals <ul><li>Serious appeals welcomed </li></ul><ul><li>Criticisms addressed </li></ul><ul><li>Up to 20% accepted </li></ul><ul><li>But only one appeal </li></ul><ul><li>Make it good </li></ul>
    45. 52. Thanks [email_address]

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