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How to write a scientific manuscript for publication

Giancarlo maria liumbruno, claudio velati, patrizio pasqualetti, massimo franchini.

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Correspondence: Giancarlo Maria Liumbruno, Viale Italia, 19, 57126 Livorno, Italy, e-mail: [email protected]

Received 2012 Oct 31; Accepted 2012 Dec 6.

Keywords: medical manuscript, publication, journal article, review, authorship

Introduction

The origins and development of the scientific and technical press can be traced back to 1665 when the first “modern” scientific papers appeared and were characterized by non standardised form and style 1 . Subsequently, nearly 300 years ago 2 , in an attempt to ensure that articles met the journal’s standards of quality and scientific validity, the peer-reviewed process for scientific manuscripts was born in England and France. Since then, there has been an enormous proliferation of scientific journals and manuscripts so that, at present, the numbers of biomedical papers published annually by over 20,000 journals, at a rate of 5,500 new papers per day, far exceeds 2,000,000 1 , 2 .

Published scientific papers and professional meetings are really essential to disseminate relevant information and research findings. However, most of the abstracts of presentations given at scientific meetings are usually available only in conference proceedings although they have the potential to be subsequently published as articles in peer-reviewed journals.

A recently published Cochrane review showed that only 44.5% of almost 30,000 scientific meeting abstracts were published as articles 3 . No association between full publication and authors’ country of origin was detected. Factors associated with full publication included acceptance vs rejection of abstracts for oral or poster presentations, acceptance for oral presentations rather than poster sessions, “positive” results, using the report authors’ definition of “positive”, randomised trial study design and basic rather than clinical research.

Possible reasons for failed publication include lack of time, research still underway, problems with co-authors and negative results 4 . Undoubtedly, lack of the necessary skills and experience in the process of writing and publishing is another possible contributing factor also in the field of Transfusion Medicine although the specialists in this discipline are currently adopting the principles and research methodologies that support evidence-based medicine 5 , and high-level research is actually being carried out at the same rate as in all medical specialties.

There are three broad groups of manuscripts: original scientific articles, reviews and case reports. Although case reports are part of the evidence hierarchy in evidence-based practice, albeit at a lower level, and case series are incorporated in a significant proportion of health technology assessments 6 , this article will address the multiple steps required in writing original articles and reviews with the aim of providing the reader with the necessary tools to prepare, submit and successfully publish a manuscript.

The anatomy of a paper: from origin to current format

The history of scientific journals dates from 1665, when the French “Journal des sçavans” and the English “Philosophical Transactions of the Royal Society” first began systematically publishing research results 7 . From then on, the initial structure of scientific papers evolved gradually from letters (usually by a single author, with a polite style and contemporarily addressing multiple subjects) and experimental reports (essentially descriptive and presenting experiences and effects in chronological order) to a better structured and more fluent form characterised by an embryonic description of methods and interpretation of results. This evolved way of reporting experiments gradually replaced the letter form.

It was not, however, until the second half of the 19 th century that the method description became fully developed and a comprehensive organisation of the manuscripts known as “theory-experiment-discussion” emerged 1 . At the beginning of the last century a gradual decrease of the use of the literary style coincided with a growing standardisation of the editorial rules that paved the way for the formal established Introduction, Methods, Results, and Discussion (IMRAD) structure of scientific papers, which was adopted in the 1980s.

At present, IMRAD is the format encouraged for the text of observational (i.e. retrospective/descriptive) and experimental (i.e. randomised controlled) studies by the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals” which have become the most important and widely accepted (by over 500 biomedical journals) guide to writing, publishing, and editing in international biomedical publications 8 . The Uniform Requirements are released by the International Committee of Medical Journal Editors (ICMJE), an evolution of the initial group of Journal Editors who met for the first time in Vancouver in 1978 and subsequently issued a number of editorial policy statements and guidelines for manuscript submission.

According to the ICMJE, “this so-called IMRAD structure is not an arbitrary publication format but rather a direct reflection of the process of scientific discovery” 9 . In addition it facilitates modular reading and locating of specific information, which is normally found in pre-established sections of an article 7 .

“Long articles may need subheadings within some sections (especially Results and Discussion) to clarify their content. Other types of articles, such as case reports, reviews and editorials, probably need to be formatted differently” 9 .

This format does not comprise other important and integral parts of the article, such as the Title Page, Abstract, Acknowledgements, Figures and Tables (comprising their legends) and References 8 .

There are often slight variations from one journal’s format to another but every journal has instructions to authors available on their website and it is crucial that authors download and comply with them.

The latest edition of the Uniform Requirements was updated in April 2010; it is available at the ICMJE website and is an essential guideline for all authors writing a biomedical manuscript 9 .

Consolidated standards of reporting trials

Medical science depends entirely on the transparent reporting of clinical trials 10 .

Unfortunately, several reviews have documented deficiencies in reports of clinical trials 11 – 15 .

In 1996, a group of scientists and editors developed the CONsolidated Standards Of Reporting Trials (CONSORT) statement which is intended to improve the reporting of a randomised, controlled trial (RCT), enabling readers to understand the design of a trial, its conduct, analysis and interpretation and to assess the validity of its results 16 . It emphasises that this can only be achieved through complete transparency from authors.

The CONSORT statement was updated in 2001 and after the 2007 meeting the statement was further revised and published as CONSORT 2010 which is the most up-to-date version and can be freely viewed and downloaded through one of the several link to Journals available at the CONSORT website under the section “CONSORT Statement - Downloads” 17 . The statement facilitates critical appraisal and interpretation of RCT and many leading medical journals and major international editorial groups have endorsed it.

The statement consists of a checklist (25 items) and a flow diagram that authors can use for reporting a RCT. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, Discussion and Other information. The flow diagram is intended to depict the passage of participants through a RCT (enrolment, intervention allocation, follow-up and analysis). It is strongly recommended that the CONSORT Statement be used in conjunction with the CONSORT Explanation and Elaboration Document which is available at the CONSORT website under the above mentioned section 17 .

Another major point to consider is the obligation to register clinical trials 9 .

In September 2004 the ICMJE changed their policy and decided they would consider trials for publication only if they had been registered before the enrolment of the first participant. The ICMJE accepts registration in the international registries listed in Table I .

International trial registries acceptable to the International Committee of Medical Journal Editors and relevant websites.

Strengthening the reporting of observational studies in epidemiology

The reporting of observational studies frequently lacks details and is not clear enough 18 , 19 . Consequently the quality is poor although many questions in medical research are investigated in observational studies and overwhelming evidence is also extrapolated from them 20 . In fact, observational studies are more suitable for the detection of rare or late adverse effects of treatments, and are more likely to provide an indication of what is achieved in daily medical practice 21 .

To improve the reporting of observational studies (cohort, case-control or cross-sectional studies) a group of methodologists, researchers and editors developed a useful checklist of 22 items: the StrengThening the Reporting of OBservational studies in Epidemiology (STROBE) Statement 21 . The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, Discussion and Other information sections of articles. The STROBE checklists can be freely viewed and downloaded at the STROBE website under the section “Available checklists” 22 . They also include a draft checklist for conference abstracts (items to be included when reporting observational studies in a conference abstract) pertaining to the content of the following sections: Title, Authors, Study design, Objective, Methods, Results and Conclusion.

The STROBE Statement provides guidance to authors on how to improve the reporting of observational studies, it facilitates critical appraisal and interpretation of studies and is widely supported by reviewers, a growing number of biomedical journal editors and readers.

The STROBE checklist is best used in conjunction with an explanation and elaboration article which discusses each of the 22 checklist items, gives methodological background, publishes examples of transparent reporting and is freely available at the STROBE Statement website under the above mentioned section through the link with the Journals in which the document has been published (PLoS Medicine, Annals of Internal Medicine and Epidemiology) 22 .

As review articles comprehensively cover a specific biomedical topic and justify future research directions, they require that the author extensively review and master the literature and then develop some general statements and conclusions with practical implications for patients’ care 23 , 24 . In addition, they should provide an updated reference for those readers interested in broadening their knowledge of critical issues. Review articles are, therefore, important not only for younger physicians early in their career but also for senior academic staff as they represent a tool for intellectual enrichment and enhancement of the standards of research. Writing a review requires knowledge and continuous improvement of qualifications in line with the accumulation of better and updated scientific literature evidence. For this reason, journals often invite experts on a specific topic to write a review article. However, authors can also ask Editors if they would be interested in publishing a review article on a particular, topical, relevant and debated issue.

As reviews are the most accessed among the various types of articles and contribute substantially to the impact factor of journals, obviously they are welcomed and encouraged by many journals and have become an inseparable part of the writing scientific culture.

The three basic types of literature reviews are narrative reviews (which include editorials, commentaries and narrative overviews or non-systematic narrative reviews), qualitative systematic reviews and quantitative systematic reviews (meta-analyses) ( Table II ) 25 .

Summary of the types of literature reviews.

Editorials, typically written by the editor of the journal or an invited guest, may be a narrative review if the author retrieves and summarises information about a particular topic for the reader 25 . Usually, these types of narrative reviews are based upon a short, select and narrowly focused review of only a few papers. However, editorials may be no more than the editor’s comments regarding a current issue of the journal or a current event in health care and do not, therefore, automatically qualify as narrative reviews.

Commentaries

Commentaries may also be written as a narrative review; however, they are typically written with a particular opinion being expressed 25 . Research methodology is not usually presented in these articles which reflect the author’s biased synthesis of other articles. Commentaries are usually shorter than a full-length review article and the author should be an expert in the content area of the commentary. Usually, the purpose of a commentary is to stimulate academic debate between the journal’s readers.

Narrative reviews

Non-systematic narrative reviews are comprehensive narrative syntheses of previously published information 26 . This type of literature review reports the author’s findings in a condensed format that typically summarises the contents of each article. Authors of narrative overviews are often acknowledged experts in the field and have conducted research themselves. Editors sometimes solicit narrative overviews from specific authors in order to bring certain issues to light. Although the bibliographic research methodology is an obligatory section in systematic reviews and meta-analyses, it is also becoming an inseparable part of narrative literature reviews. Providing information on the databases accessed, terms, inclusion and exclusion criteria and time limits adds objectivity to the main messages and conclusions. It is advisable to use only credible databases (at least two or three) which only select high-quality publications that contain the most up-to-date information (see Table III ) 24 . The best way to organise the analysis of the sources in the main text of a narrative biomedical review is to transform information from the retrieved publications into bibliographic cards with a short description of the main results, level of evidence, strengths and limitations of each study and relevance to each section of the manuscript. Furthermore, the readability of a review can be improved by including a few self-explanatory tables, boxes, and figures synthesising essential information and conveying original messages 24 . We also suggest the use of software packages for reference management, which saves time during the multiple revisions.

Main online libraries, catalogues and databases.

In conclusion, a successful narrative review should have the following characteristics: be well-structured, synthesise the available evidence pertaining to the topic, convey a clear message and draw conclusions supported by data analysis.

Qualitative systematic reviews

Qualitative systematic reviews are a type of literature review that employ detailed, rigorous and explicit methods and are, therefore, a more powerful evidence-based source to garner clinical information than narrative reviews, case reports, case series, and poorly conducted cohort studies. A detailed bibliographic research based upon a focused question or purpose is the peculiar characteristic of a systematic review 27 . These reviews are called qualitative because the process by which the individual studies are integrated includes a summary and critique of the findings derived from systematic methods, but does not statistically combine the results of all of the studies reviewed.

Quantitative systematic reviews

A quantitative systematic review or meta-analysis critically evaluates each paper and statistically combines the results of the studies 28 . The authors of a meta-analysis employ all of the rigorous methodology of qualitative systematic reviews and, in addition, gather the original patients’ data from each of the studies under review, pool it all together in a database and produce the appropriate statistics on this larger sample. While this process leads to a more powerful and generalizable conclusion, which is the strength of the meta-analysis, on the other hand it can pool together studies that are very heterogeneous which is the main drawback of a quantitative systematic review. Nevertheless, well-executed quantitative systematic reviews constitute the highest level of evidence for medical decision making 28 .

The recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement aims to help improve reporting, focusing on systematic reviews of RCT. The Statement consists of a checklist of 27 essential items for transparent reporting and a flow diagram for the phases of study selection and is accompanied by the PRISMA Explanation and Elaboration Document, which, among other things, provides examples of good reporting for the various review sections 29 .

A further guidance on the reporting of systematic reviews has been published by the Cochrane Collaboration, an international organisation that prepares, updates and publishes systematic reviews of the effects of health-care interventions following a standardised format 30 .

Preparing to write a manuscript Background information

The question or hypothesis formulated by the investigator is the common starting point to search the relevant published literature for an answer 31 . Gathering the background information through an extensive literature search relevant to the topic of interest is the subsequent essential step. Peer reviewers are often experts and not citing important articles poses the manuscript at risk of rejection. It is advisable to consult at least two or three credible databases (see Table III ) to identify the crucial relevant articles and to track down “landmark” articles. In addition, avoid using papers published more than 10 years ago and do not rely on just the abstracts but obtain full-text articles. Articles relevant to the research topic and published in the journal in which the paper is to be submitted should be reviewed and cited 32 .

Last but not least, the bibliographical search should also aim at finding recently published articles similar to the one the author intends to submit. In fact, a journal can be less interested in publishing such a manuscript unless the results reflect new or different findings.

Target journal

It can be worth thinking about this issue before starting to write as a proper choice of the journal can affect not only the writing style but also the ease of publication and the prompt dissemination of research. Ideally, the target journal should be the one in which similar work has been published 32 .

Electronic and open-access journals are the latest resources for publishing and data dissemination available on the scientific journal horizon.

It is also worth considering an appropriate level of impact factor or journal quality. The impact factor of a journal is a measure reflecting the average number of citations to recent articles published in science and social science journals. It is determined by the ratio of the number of citations of papers from that journal in the whole of the biomedical literature over a 2-year period. It is frequently used as a proxy for the relative importance of a journal within its field, with journals with higher impact factors deemed to be more important than those with lower ones.

It is also extremely important to read the instructions to authors section of the selected journal carefully. In fact, although there is a general style for most biomedical journals as agreed by the ICMJE in the Uniform Requirements 9 , individual journals may differ slightly in detail.

It is always best to sort out authorship before writing a manuscript as authorship order can be a source of problems once the paper has been written 23 .

Several guidelines relating to authorship are available and this issue has been extensively addressed in a recently published review article by Elizabeth Wager 33 . Most guidelines on the authorship of scientific articles are focused more on creative and intellectual aspects of research than on routine or technical contributions.

Alhough not universally accepted, the authorship criteria suggested by the ICMJE are the ones most widely promoted by medical journals 9 . According to these criteria, co-authors should: (i) substantially contribute to conception and design of the study, acquisition of data, or analysis and interpretation of data; (ii) draft the article or revise it critically for important intellectual content; and (iii) approve the final version.

The authors are listed in decreasing order of their contribution and the senior author, or mentor, should be the last but this convention has never been codified 33 .

It is advisable to provide accurate affiliations and contacts as they will be published on PubMed as well as in the journal but it is also important to agree on the corresponding author who should have full access to the study data and through the provided e-mail address will be the link with the scientific community for the future 1 .

Ethical issues

In addition to the authorship discussed above, there are several ethical issues involved in writing a paper. These include fabrication of data, duplicate publication, plagiarism, misuse of statistics, manipulation of images and inadequate or obviously false citations 31 .

A must-read for all those who are involved in any editorial activity are the guidelines released by the Committee on Publication Ethics (COPE) which is a forum for editors and publishers of peer-reviewed journals to discuss all aspects of publication ethics 34 . COPE provides advice to editors and publishers on all aspects of publication ethics and, in particular, how to handle cases of research and publication misconduct.

Writing the manuscript

Several models for the initial draft exist. A useful algorithm for writing a scientific manuscript is the one recently published by O’Connor and Holmquist 35 . According to these authors, the writing should start with making figures and tables, and then proceed with summary statements (the conclusions summarising the major contributions of the manuscript to the scientific community), identification of the audience, materials and methods, results, discussion, references, introduction, title and conclusion. The aim of this algorithm is to give the structural backbone to the manuscript and is designed to overcome writer’s block and to assist scientists who are not native English speakers.

A further and more general strategy to increase productivity during the early phases of manuscript writing is to ignore at the outset all the details that can be approached later such as structure, grammar and spelling.

The sequence of writing should address the following core sections of the paper in the order from first to last: methods, results, discussion and introduction 31 , 36 , 37 .

“Like every well-written story, a scientific manuscript should have a beginning (Introduction), middle (Materials and Methods), and an end (Results). The Discussion (the moral of the story) puts the study in perspective. The Abstract is an opening summary of the story and the Title gives the story a name” 38 . However, as correctly pointed out by Michael McKay, “writing is not necessarily in the temporal order of the final document (i.e. the IMRAD format)” 39 .

The take-home messages are, therefore: (i) a clear understanding of the essential components of each of these sections is critical to the successful composition of a scientific manuscript; (ii) the proper order of writing greatly facilitates the ease of writing; (iii) the approach to writing can be customised by authors on the basis both of the subject they are dealing with and their personal experience; (iv) the CONSORT 16 , 17 , STROBE 21 , 22 or PRISMA 29 statement must be used as a guidance document for the appropriate reporting of the type of study the authors are dealing with 31 , 32 , 38 .

In the following part of this paper the different sections of a manuscript will be dealt with in the order they are presented in the final document.

Title, keywords and abstract

The title is determinant for the indexing process of the article and greatly contributes to the visibility of the paper. It should reflect the essence of the article, its novelty and its relevance to the biomedical field it deals with 24 . It should be clear, brief, specific, not include jargon or non-standard and unexplained abbreviations, reflect the purpose of the study and state the issue(s) addressed rather than the conclusions 38 . Indicative titles are, therefore, better than declarative ones. Obviously, the title and abstract should correlate with each other.

Available evidence suggests that the presence of a colon in the title positively correlates with the number of citations 40 . In other words, the more specific and accurate the description of the content is, the more chance the manuscript has of being cited 38 .

The title of systematic reviews should ideally follow the participants, interventions, comparisons, outcomes, and study design (PICOS) approach, and include the terms “systematic review”, “meta-analysis”, or both 41 .

The keywords enable the database searching of the article and should be provided in compliance with the instructions to authors. A careful choice from the Medical Subject Headings (MeSH) in the National Library of Medicine (NLM) controlled vocabulary thesaurus used for indexing articles in PubMed greatly increases the chances the paper is retrieved and cited by other authors 42 .

The abstract is the last section to be written but it is the most important part of a paper because it is usually the first to be read and readers use the information contained in it to decide whether to read the whole article or not. It should be a concise summary of the manuscript and no longer than specified in the instructions to authors. Usually, abstracts do not contain references and abbreviations and acronyms are not always allowed. If required, it has to be structured in a specific way. For example, original articles submitted to Blood Transfusion, require an abstract of no more than 2,000 characters (including spaces), structured as follows: Background, Materials and methods, Results, Discussion 43 .

A good abstract should be easy to understand and broadly appealing, informative but not too detailed. It can start with a sentence or two outlining the work; then the disease and/or system studied must be introduced and what was previously unknown has to be stated in order to provide a brief overview of the current state-of-the art knowledge on the issue. The methods must be summarised without too many details; the major findings must be clearly indicated and followed by a sentence or two showing the major implications of the paper that must be consistent with the study conclusions without overestimating their possible relevance 44 . In the abstract the present tense should be used to refer to facts already established in the field, while the findings from the current study should be dealt with in the past tense.

The aim of the introduction is to introduce the topic to the readers in a straightforward way, avoiding excessive wordiness 42 . For this reason it should be short and focused, comprising approximately three paragraphs in one page 37 .

The first paragraph should mention the questions or issues that outline the background of the study and establish, using the present tense, the context, relevance, or nature of the problem, question, or purpose (what is known) 23 , 37 .

The second paragraph may include the importance of the problem and unclear issues (what is unknown).

The last paragraph should state the rationale, hypothesis, main objective, or purpose thus clearly identifying the hypothesis to be treated and the questions addressed in the manuscript (why the study was done).

One of the most common mistakes is the failure to make a clear statement of purpose. This is because many research projects, especially retrospective clinical studies, do not start at the beginning (with the identification of a specific question, followed by methods and data collection) but begin by collecting data without first identifying a specific question to be addressed that must in any case be established before beginning to write 38 . Data or conclusions from the study should not be presented or anticipated in the introduction section.

Writing the introduction at the end of the process prevents any block and it is easier after the methods, results and discussion have been completed.

Materials and methods

The methods section is one of the most important parts of a scientific manuscript and its aim is to give the reader all the necessary details to replicate the study.

CONSORT 16 , 17 , STROBE 21 , 22 and PRISMA 29 statements provide a guideline relevant to the particular type of study 2 , 42 .

The two essential elements of this section are a clear presentation of the study design and the identification and description of the measurement parameters used to evaluate the purpose of the study.

It is, therefore, necessary to provide a thorough explanation of the research methodology, including the study design, data collection, analysis principles and rationale. Special attention should be paid to the sample selection, including inclusion and exclusion criteria and to any relevant ethical considerations. A description of the randomisation or other group assignment methods used should be included, as should be the pre-specified primary and secondary outcome(s) and other variables.

According to the Uniform Requirements 9 , in the case of experimental/clinical reports involving patients or volunteers, the authors must provide information about institutional, regulatory and ethical Committee authorisation, informed consent from patients and volunteers and the observance of the latest release of the Helsinki Declaration 45 .

When reporting experiments on animals, authors should state which institutional authority granted approval for the animal experiments 9 .

Finally, in addition to describing and identifying all the measurement parameters used, it is also important to describe any unusual statistical methodology applied, how subjects were recruited and compensated and how compliance was measured (if applicable).

The results section consists of the organised presentation of the collected data. All measurements that the authors described in the materials and methods section must be reported in the results section and be presented in the same order as they were in that section 35 . The past tense should be used as results were obtained in the past. Author(s) must ensure that they use proper words when describing the relationship between data or variables. These “data relation words” should be turned into “cause/effect logic and mechanistic words” in the discussion section. A clear example of the use of this appropriate language can be found in the article by O’Connor 35 .

This section should include only data, including negative findings, and not background or methods or results of measurements that were not described in the methods section 2 . The interpretation of presented data must not be included in this section.

Results for primary and secondary outcomes can be reported using tables and figures for additional clarity. The rationale for end-point selection and the reason for the non-collection of information on important non-measured variables must be explained 35 .

Figures and tables should be simple, expand text information rather than repeat it, be consistent with reported data and summarise them 23 . In addition, they should be comprehensible on their own, that is, with only title, footnotes, abbreviations and comments.

References in this section should be limited to methods developed in the manuscript or to similar methods reported in the literature.

Patients’ anonymity is essential unless consent for publication is obtained.

The main objective of the discussion is to explain the meaning of the results.

This section should be structured as if it were a natural flow of ideas and should start with a simple statement of the key findings and whether they are consistent with the study objectives enunciated in the last paragraph of the introduction. The strengths and the limitations of the research and what the study adds to current knowledge should then be addressed 42 .

Through logical arguments, the authors should convert the relations of the variables stated in the results section into mechanistic interpretations of cause and effect using the present tense as these relations do exist at present 35 . In addition, they should describe how the results are consistent or not with similar studies and discuss any confounding factors and their impact.

They should avoid excessive wordiness and other commonly made errors such as 38 : (i) including information unrelated to the stated purpose of the article; (ii) repeating detailed data previously presented in the Results section; (iii) not interpreting and not critically analysing results of other studies reviewed and cited but rather just repeating their findings; (iv) presenting new data or new details about techniques and enrolment criteria, and (v) overstating the interpretation of the results.

Another common mistake is to forget to criticise the research described in the manuscript by highlighting the limitations of the study. The value of a scientific article is enhanced not only by showing the strengths but also the weak points of the evidence reported in the paper.

The conclusion is a separate, last paragraph that should present a concise and clear “take home” message avoiding repetition of concepts already expressed 32 . The authors should also avoid excessive generalizations of the implications of the study and remember that except for RCT there can only be testable hypotheses and observed associations, rather than rigorous proof of cause and effect 42 . Possible implications for current clinical practice or recommendations should be addressed only if appropriate.

Finally, the areas for possible improvement with future studies should be addressed avoiding ambiguous comments such as “there is a need for further research” and if there is a real need for further studies on the topic it is strongly advisable to be specific about the type of research suggested.

Acknowledgements

All contributors who do not meet the criteria for authorship should be listed in an Acknowledgements section 9 . The authors should, therefore, add a statement on the type of assistance, if any, received from the sponsor or the sponsor’s representative and include the names of any person who provided technical help, writing assistance, editorial support or any type of participation in writing the manuscript.

In addition, “when submitting a manuscript authored by a group, the corresponding author should clearly indicate the preferred citation and identify all individual authors as well as the group name. Journals generally list other members of the group in the Acknowledgments. The NLM indexes the group name and the names of individuals the group has identified as being directly responsible for the manuscript; it also lists the names of collaborators if they are listed in Acknowledgments” 9 .

The first suggestion is to follow the journal’s policies and formatting instructions, including those for books and web-based references. Other general considerations related to references, including the following ones, can be found in the Uniform Requirements 9 .

References to review articles are an efficient way to guide readers to a body of literature but they do not always reflect original work accurately. Papers accepted but not yet published should be designated as “in press” or “forthcoming” and information from manuscripts submitted but not accepted should be cited in the text as “unpublished observations”.

Avoid using abstracts as references and citing a “personal communication” unless it provides essential information not available from a public source. In this case the name of the person and date of communication should be cited in parentheses in the text. Do not include manuscripts “in submission”

In addition it is important to remember that “authors are responsible for checking that none of the references cite retracted articles except in the context of referring to the retraction. Authors can identify retracted articles in MEDLINE by using the following search term, where pt in square brackets stands for publication type: Retracted publication [pt] in PubMed” 9 . Last but not least, remember that if a reviewer does not have access to any references he or she can ask the author for a full (pdf) copy of the relevant works.

Tips for successful revision of a manuscript

Most papers are accepted after some degree of revision. In some cases, a manuscript may be rejected after internal and editorial review only.

The process of revising a manuscript and successfully responding to the comments of reviewers and Editor can be challenging. Little has been published addressing the issue of effectively revising a manuscript according to the (minor or major) comments of reviewers. This topic was recently extensively and pragmatically covered by James M. Provenzale 46 . The ten principles for revising a manuscript suggested by the author are reported in Table IV .

Ten principles for revising a manuscript suggested by James M. Provenzale 46 .

Many manuscripts are not published simply because the authors have not followed the few simple rules needed to write a good article. We hope that this paper provides the reader with the basic steps to build a draft manuscript and an outline of the process needed for publishing a manuscript. However, in Table V we summarise the ten principles we strongly recommend to comply with in order to improve the likelihood of publication of a scientific manuscript 47 .

Ten principles to improve the likelihood of publication of a scientific manuscript, suggested by James M. Provenzale 47 .

The Authors declare no conflicts of interest.

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Path to An Impactful Paper: Common Manuscript Writing Patterns and Structure

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Table of Contents

English academic papers usually have a standard article structure that must be followed when preparing journal submissions. Elsevier Author Services has compiled a list of sentence structures and patterns to help you with manuscript writing and to increase your chances of publication.

In this issue of “Writing Skills Improvement”, we discuss common sentence patterns to help you write manuscripts that stand a better chance of being published. 

Why are patterns important in manuscript writing?

There are certain standard patterns that appear impressive and crisp while still being easily understood. Using these could increase your chances of publication in a journal of repute, helping your work to reach a larger audience!

But writing a manuscript that is professional yet easy to understand is a nuanced art. It can, however, be simplified by considering two factors:

• The overall structure of your article—maintaining a standard structure makes your article flow logically.
• The structure of individual sentences—concise sentences make the paper easier to understand.

The basic structure and language of a manuscript 1–3

Most journals have strict guidelines regarding the structure of an article. The most common format for academic papers is Introduction, Methods, Results, and Discussion (or IMRAD). According to the International Committee of Medical Journal Editors (ICMJE), “this so-called IMRAD structure is not an arbitrary publication format but rather a direct reflection of the process of scientific discovery”. The following flowchart expands upon this structure:

The primary goal of a research paper is to report your work and its findings concisely and directly. Therefore, a good article uses direct, not flowery, language. Here are some examples of common sentence structures:

• Evaluation of…using… 
• Risk Factors for Oral Cancer in Adults…
• Development of Deep Learning Models to…

Abstract 7–9

• Y is the most common complication among patients post-surgery…
• Artificial intelligence models can perform XYZ function, but they need more training data to be accurate.
• In this study, we assess the safety and efficacy of ABC.

Introduction 10–12

• 1 in 5 adults suffers from…
• The effects of climate change are becoming increasingly evident with time.
• However, we need more evidence to support this claim.
• The aim of this study was to…

Materials and methods 13–15  

• The training data sets included images of…
• Data was analyzed using Python/SPSS/XYZ software…
• FADS1/2 knockout mice were used as test animals, while C5BL6 mice with intact FADS1/2 were used as controls.

Results 16–18

• We found that XYZ negatively regulated…
• The silencing of PQRS led to an increase in XYZ in normal mice…
• The DNN model was accurately able to identify voids in the material and…

Discussion 19,20  

• Therefore, this work suggests that…
• In vivo studies are necessary to confirm the effect of ABC in animals and humans…
• This DNN model can be used to accurately perform XYZ function.

Apart from following these patters, researchers may benefit from using a professional English language editing service for their manuscripts. 

At Elsevier Author Services, experienced editors offer personalized recommendations for your manuscript, while ensuring zero ethical and data privacy issues. Our Language Editing Services could help simplify your publication journey. 

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How to Write and Publish a Research Paper for a Peer-Reviewed Journal

• Open access
• Published: 30 April 2020
• Volume 36 , pages 909–913, ( 2021 )

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• Clara Busse   ORCID: orcid.org/0000-0002-0178-1000 1 &
• Ella August   ORCID: orcid.org/0000-0001-5151-1036 1 , 2  

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Communicating research findings is an essential step in the research process. Often, peer-reviewed journals are the forum for such communication, yet many researchers are never taught how to write a publishable scientific paper. In this article, we explain the basic structure of a scientific paper and describe the information that should be included in each section. We also identify common pitfalls for each section and recommend strategies to avoid them. Further, we give advice about target journal selection and authorship. In the online resource 1 , we provide an example of a high-quality scientific paper, with annotations identifying the elements we describe in this article.

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Introduction

Writing a scientific paper is an important component of the research process, yet researchers often receive little formal training in scientific writing. This is especially true in low-resource settings. In this article, we explain why choosing a target journal is important, give advice about authorship, provide a basic structure for writing each section of a scientific paper, and describe common pitfalls and recommendations for each section. In the online resource 1 , we also include an annotated journal article that identifies the key elements and writing approaches that we detail here. Before you begin your research, make sure you have ethical clearance from all relevant ethical review boards.

Select a Target Journal Early in the Writing Process

We recommend that you select a “target journal” early in the writing process; a “target journal” is the journal to which you plan to submit your paper. Each journal has a set of core readers and you should tailor your writing to this readership. For example, if you plan to submit a manuscript about vaping during pregnancy to a pregnancy-focused journal, you will need to explain what vaping is because readers of this journal may not have a background in this topic. However, if you were to submit that same article to a tobacco journal, you would not need to provide as much background information about vaping.

Information about a journal’s core readership can be found on its website, usually in a section called “About this journal” or something similar. For example, the Journal of Cancer Education presents such information on the “Aims and Scope” page of its website, which can be found here: https://www.springer.com/journal/13187/aims-and-scope .

Peer reviewer guidelines from your target journal are an additional resource that can help you tailor your writing to the journal and provide additional advice about crafting an effective article [ 1 ]. These are not always available, but it is worth a quick web search to find out.

Identify Author Roles Early in the Process

Early in the writing process, identify authors, determine the order of authors, and discuss the responsibilities of each author. Standard author responsibilities have been identified by The International Committee of Medical Journal Editors (ICMJE) [ 2 ]. To set clear expectations about each team member’s responsibilities and prevent errors in communication, we also suggest outlining more detailed roles, such as who will draft each section of the manuscript, write the abstract, submit the paper electronically, serve as corresponding author, and write the cover letter. It is best to formalize this agreement in writing after discussing it, circulating the document to the author team for approval. We suggest creating a title page on which all authors are listed in the agreed-upon order. It may be necessary to adjust authorship roles and order during the development of the paper. If a new author order is agreed upon, be sure to update the title page in the manuscript draft.

In the case where multiple papers will result from a single study, authors should discuss who will author each paper. Additionally, authors should agree on a deadline for each paper and the lead author should take responsibility for producing an initial draft by this deadline.

Structure of the Introduction Section

The introduction section should be approximately three to five paragraphs in length. Look at examples from your target journal to decide the appropriate length. This section should include the elements shown in Fig.  1 . Begin with a general context, narrowing to the specific focus of the paper. Include five main elements: why your research is important, what is already known about the topic, the “gap” or what is not yet known about the topic, why it is important to learn the new information that your research adds, and the specific research aim(s) that your paper addresses. Your research aim should address the gap you identified. Be sure to add enough background information to enable readers to understand your study. Table 1 provides common introduction section pitfalls and recommendations for addressing them.

The main elements of the introduction section of an original research article. Often, the elements overlap

Methods Section

The purpose of the methods section is twofold: to explain how the study was done in enough detail to enable its replication and to provide enough contextual detail to enable readers to understand and interpret the results. In general, the essential elements of a methods section are the following: a description of the setting and participants, the study design and timing, the recruitment and sampling, the data collection process, the dataset, the dependent and independent variables, the covariates, the analytic approach for each research objective, and the ethical approval. The hallmark of an exemplary methods section is the justification of why each method was used. Table 2 provides common methods section pitfalls and recommendations for addressing them.

Results Section

The focus of the results section should be associations, or lack thereof, rather than statistical tests. Two considerations should guide your writing here. First, the results should present answers to each part of the research aim. Second, return to the methods section to ensure that the analysis and variables for each result have been explained.

Begin the results section by describing the number of participants in the final sample and details such as the number who were approached to participate, the proportion who were eligible and who enrolled, and the number of participants who dropped out. The next part of the results should describe the participant characteristics. After that, you may organize your results by the aim or by putting the most exciting results first. Do not forget to report your non-significant associations. These are still findings.

Tables and figures capture the reader’s attention and efficiently communicate your main findings [ 3 ]. Each table and figure should have a clear message and should complement, rather than repeat, the text. Tables and figures should communicate all salient details necessary for a reader to understand the findings without consulting the text. Include information on comparisons and tests, as well as information about the sample and timing of the study in the title, legend, or in a footnote. Note that figures are often more visually interesting than tables, so if it is feasible to make a figure, make a figure. To avoid confusing the reader, either avoid abbreviations in tables and figures, or define them in a footnote. Note that there should not be citations in the results section and you should not interpret results here. Table 3 provides common results section pitfalls and recommendations for addressing them.

Discussion Section

Opposite the introduction section, the discussion should take the form of a right-side-up triangle beginning with interpretation of your results and moving to general implications (Fig.  2 ). This section typically begins with a restatement of the main findings, which can usually be accomplished with a few carefully-crafted sentences.

Major elements of the discussion section of an original research article. Often, the elements overlap

Next, interpret the meaning or explain the significance of your results, lifting the reader’s gaze from the study’s specific findings to more general applications. Then, compare these study findings with other research. Are these findings in agreement or disagreement with those from other studies? Does this study impart additional nuance to well-accepted theories? Situate your findings within the broader context of scientific literature, then explain the pathways or mechanisms that might give rise to, or explain, the results.

Journals vary in their approach to strengths and limitations sections: some are embedded paragraphs within the discussion section, while some mandate separate section headings. Keep in mind that every study has strengths and limitations. Candidly reporting yours helps readers to correctly interpret your research findings.

The next element of the discussion is a summary of the potential impacts and applications of the research. Should these results be used to optimally design an intervention? Does the work have implications for clinical protocols or public policy? These considerations will help the reader to further grasp the possible impacts of the presented work.

Finally, the discussion should conclude with specific suggestions for future work. Here, you have an opportunity to illuminate specific gaps in the literature that compel further study. Avoid the phrase “future research is necessary” because the recommendation is too general to be helpful to readers. Instead, provide substantive and specific recommendations for future studies. Table 4 provides common discussion section pitfalls and recommendations for addressing them.

Follow the Journal’s Author Guidelines

After you select a target journal, identify the journal’s author guidelines to guide the formatting of your manuscript and references. Author guidelines will often (but not always) include instructions for titles, cover letters, and other components of a manuscript submission. Read the guidelines carefully. If you do not follow the guidelines, your article will be sent back to you.

Finally, do not submit your paper to more than one journal at a time. Even if this is not explicitly stated in the author guidelines of your target journal, it is considered inappropriate and unprofessional.

Your title should invite readers to continue reading beyond the first page [ 4 , 5 ]. It should be informative and interesting. Consider describing the independent and dependent variables, the population and setting, the study design, the timing, and even the main result in your title. Because the focus of the paper can change as you write and revise, we recommend you wait until you have finished writing your paper before composing the title.

Be sure that the title is useful for potential readers searching for your topic. The keywords you select should complement those in your title to maximize the likelihood that a researcher will find your paper through a database search. Avoid using abbreviations in your title unless they are very well known, such as SNP, because it is more likely that someone will use a complete word rather than an abbreviation as a search term to help readers find your paper.

After you have written a complete draft, use the checklist (Fig. 3 ) below to guide your revisions and editing. Additional resources are available on writing the abstract and citing references [ 5 ]. When you feel that your work is ready, ask a trusted colleague or two to read the work and provide informal feedback. The box below provides a checklist that summarizes the key points offered in this article.

Checklist for manuscript quality

Data Availability

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Acknowledgments

Ella August is grateful to the Sustainable Sciences Institute for mentoring her in training researchers on writing and publishing their research.

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Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, 27599, Chapel Hill, NC, USA

Clara Busse & Ella August

Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

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Correspondence to Ella August .

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Busse, C., August, E. How to Write and Publish a Research Paper for a Peer-Reviewed Journal. J Canc Educ 36 , 909–913 (2021). https://doi.org/10.1007/s13187-020-01751-z

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Published : 30 April 2020

Issue Date : October 2021

DOI : https://doi.org/10.1007/s13187-020-01751-z

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Structuring your manuscript

A well-structured article helps readers find the information it communicates and to easily follow the authors’ methodologies and arguments. To help do this, most articles follow a common pattern and structure called IMRaD. In this section, we’ll discuss what this means, how to do it, and how it will help your manuscript. 

Overview of IMRaD structure

IMRaD refers to the standard structure of the body of research manuscripts (after the Title and Abstract). This consists of: 

• Introduction
• Materials and Methods
• Discussion and Conclusions

Not all journals use these section titles in this order, but most published articles have a structure similar to IMRaD. This standard structure:

• Gives a logical flow to the content
• Makes journal manuscripts consistent and easy to read
• Provides a “map” so that readers can quickly find content of interest in any manuscript
• Reminds authors what content should be included in an article
• Provides all content needed for the work to be replicated and reproduced

Although the sections of the journal manuscript are published in the order: Title, Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion, this is not the best order for writing the sections of a manuscript. One recommended strategy is to write your manuscript in the following order:

• You can write these first, as you are doing your experiments and collecting the results.
• Write these sections next, once you have had a chance to analyse your results, have a sense of their impact and have decided on the journal you think best suits the work.

Write your Title and Abstract last as these are based on all the other sections. Following this order will help you write a logical and consistent manuscript. Use the different sections of a manuscript to ‘tell a story’ about your research and its implications.

Next : References & Article Types

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Research Manuscript Structure: Understanding Different Parts of a Manuscript

Writing a research manuscript and publishing it in reputed academic journals is an integral part of the research process. Yet, with rejection rates of top-tier journals ranging as high as 80%-95%, this is easier said than done. 1 Research manuscripts need to meet several key submission requirements to even be considered, this includes getting the structure of scientific papers right. However, most researchers find themselves feeling overwhelmed when it comes to writing a manuscript. The lack of formal training on writing a research manuscript, especially how to structure a manuscript effectively makes this a daunting task, especially for early-career researchers.

While there are no quick and easy shortcuts to writing a manuscript for publication, this article explains how researchers can sort their research under different sections and present their findings effectively in a well-structured research manuscript.

Structuring a research paper logically

Presenting research findings in a clear and structured way helps readers quickly understand your work’s significance and potential impact. Writing a manuscript that is worded well in simple English is imperative as you write for a global audience, many of which may not have English as the first language. Experts suggest following the standard and globally accepted IMRaD (Introduction, Methods, Results, and Discussion) structure for research manuscripts. The ideal length for a research manuscript can range from 25-40 pages depending on your journal, with specific lengths for each section. 2

Understanding the key parts of a manuscript 2,3

Breaking down your work into these clear parts of a manuscript allows you to organize your findings more coherently and ensure a logical flow, which makes your research manuscript more engaging for readers.

Introduction – Covers what are you studying and why (1.5-2 pages)

This is an important part of the research manuscript as itstates the purpose of your research and what you want to achieve, existing knowledge on the topic and its limitations, and the significance and usefulness of the work. The introduction should mention the research question, the rationale for the research study, and describe the theoretical framework used. It should also offer a background of the problem and what is known so far and explain how your research contributes to the subject by adding citations to support this view. Avoid adding too many or irrelevant citations here or you may risk losing the plot, which is a red flag for editors and reviewers.

Remember, the introduction must be a concise summary of the work being presented in the research manuscript; do not to go into extensive details at this point. Take care not to mix methods, results, discussion, or conclusion in the introduction section – it’s important to keep these parts of a manuscript separate to ensure a coherent and logical flow between sections.

Methodology – Covers how you conducted the study in about 2-3 pages

One of the most critical parts of the manuscript, the methods section is meant to highlight how the problem was studied and communicates the methods, procedures, and research tools used. Be sure to describe the methodology you followed to conduct the research simply, precisely, and completely. If you’re using a new method, include all the details required for others to reproduce it, but if you’re working with established methods, it is enough to summarize these with key references. Poor methodology, small sample size, incomplete statistical analysis are all reasons why reviewers recommend rejection of a research manuscript, so check and recheck this to ensure it is flawless.

Include accurate statistics and control experiments to ensure experiments are reproducible and use standard academic conventions for nomenclature, measurement units, and numbers. Avoid adding any comments, research results, or discussion points in this part of the manuscript. It’s a good idea to write the methods section in the same flow and order in which you did the research. Supplement the text with visuals like tables, figures, photographs, or infographics that convey complex data, but don’t duplicate the information in the text.

Results – Covers the main findings of your studying in about 6-8 pages

The results section is a key part of the manuscript and isdedicated to presenting the primary and secondary findings of your research study. While writing a manuscript, ensure you spend extra time and attention while drafting the results; after all, this is the most important part of your research manuscript and your entire research effort.

Share your main results as text and use tables and figures to present findings effectively (don’t explain the data again in text). Avoid generalizations and use actual data to explain the results in your research manuscript – for example, instead of saying temperature rose as we applied more pressure, say temperature rose by 10 degrees with a 20% increase in pressure. Be sure to highlight any unexpected findings but avoid using too many technical terms or jargon so it is easy for readers from other research disciplines and non-scientific backgrounds to understand. Most importantly, this part of the manuscript is reserved for your research findings so do not include references to previously published work here.

Discussion – Covers what your research findings mean in about 4-6 pages

This is a crucial part of a manuscript where you interpret the results of your research and showcase its significance. The discussion in your research manuscript is a chance to showcase (not reiterate or repeat) your research results and how they address the original question. Do not suddenly include new information, instead talk about the limitations, whether the data supports the hypothesis or is consistent with previous studies, or if the findings were unexpected.

You may choose to mention alternate ways to interpret the results but avoid interpretations that are not supported by your research findings. Finally, compare your work with previously published studies, highlight what is new and what further research will be required to answer questions raised by the results. A well-written discussion section is essential to help differentiate your work from existing studies, which is what makes it critical to get right.  

Conclusion – Covers learnings from the research study in one short para

Check your journal guidelines before writing the conclusion. For some journals, this is a separate section whereas in others it is the concluding part of the discussion part of the manuscript. This section of the research manuscript should explain the outcomes of the research in relation to the original objective, presenting it from global and specific perspectives. Avoid simply listing the results or repeating the abstract or introduction sections, provide a justification of your work and suggest further experiments and if any of these are in progress.  

Title & Abstract – Covers highlights of the research done

The title and abstract are what readers use to evaluate whether the information provided in the research manuscript is relevant enough for them to read and cite. This is true for editors and reviewers of your research manuscript as well. Spend some time thinking of an interesting title, one that is informative, concise, and unambiguous. Write a well-structured abstract that highlights the objective and purpose of the research, addresses the key results precisely, and briefly describes the conclusion of the study (usually in under 250 words). This is the first and possibly only chance to draw in your readers so keep it simple and specific, avoid using jargon or being repetitive as you’re writing for a wide, varied audience.

In addition to the sections mentioned above, there are other key parts of a manuscript that require deep thought and time to put together. Showcase your findings through tables and figures (one per page) and format the references correctly (2-4 pages) in your research manuscript. Finally, when writing your research manuscript, be sure to follow the guidelines provided by the journal or institute you will be submitting to. Keep to the recommended paper length and journal formats when writing a manuscript for it to be considered and taken forward for publication.

References:

• Khadilkar SS. Rejection Blues: Why Do Research Papers Get Rejected? The Journal of Obstetrics and Gynaecology of India, August 2018. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046667/
• Borja A. 11 steps to structuring a science paper editors will take seriously. Elsevier Connect, June 2014. Available at https://www.elsevier.com/connect/11-steps-to-structuring-a-science-paper-editors-will-take-seriously
• Vadrevu A. Manuscript structure: How to convey your most important ideas through your paper. Editage Insights, November 2013. Available at https://www.editage.com/insights/manuscript-structure-how-to-convey-your-most-important-ideas-through-your-paper

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• How to Write a Research Paper Outline: Simple Steps for Researchers
• Manuscript Withdrawal: Reasons, Consequences, and How to Withdraw Submitted Manuscripts
• Good Writing Habits: 7 Ways to Improve Your Academic Writing
• Supplementary Materials in Research: 5 Tips for Authors

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