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How to Write a Manuscript*
*And get it published

Jonathan M. Samet, MD, MS
Professor and Flora L. Thornton Chair
Department of Preventive Medicine
Director, ECDE, SC CTSI
Career Development Seminar Series
Feb 10, 2014
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Objectives
•  To provide an overall framework of the
structure of a manuscript.
•  To provide a section-by-section guide to a
manuscript presenting research findings.
•  To provide strategies for efficiently writing a
manuscript.

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Overall Structure
•  Introduction: Why the study was done.
•  Methods: How the study was done.
•  Results: What did the study find.
•  Discussion: What do the results mean.

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
EXAMPLE OF A PAPER

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Introduction:
The two paragraph model
•  Paragraph 1:
–  A description of the problem to be addressed
–  A characterization of the state of evidence on
the problem and gaps to be addressed

•  Paragraph 2:
–  A description of the study question
–  A brief characterization of the study and the
evidence generated by the study
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Introduction: Para 1
•  First paragraph
“In spite of decades of research, ___
remains a challenging problem for clinicians
and patients.” or
“Worldwide, __ remains a substantial clinical
and public health problem with over __
affected and __ deaths annually.”

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Introduction: Para 2
•  Second paragraph
“To address this gap in understanding of __,
we carried out___”
“Using patients from ____, we carried out a
follow-up study___”
“To better understand underlying
mechanisms, we developed an animal
model using XXXY knockout mice…”
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Introduction

Statement of Problem
= Obesity + Mortality

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Introduction

Need data on Asians

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Introduction
What we did

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Exercise
•  You have carried out a study on metabolic
characteristics of Hispanic persons with
diabetes at LAC-USC.

Write the first sentence of the paper

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Methods: Translational Study
•  Overall description of the study design
•  Description of population criteria and
ascertainment
•  Description of data items and methods of
data collection, including QA/QC
•  Analytical strategy, covering analytical
variables and methods
•  Statistical software used
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Methods: Laboratory Study
•  Approach used: adequate description of
the experimental system.
•  Assays used: description and/or sufficient
references.
•  Data QA/QC
•  Statistical analyses

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Methods NEJM Paper
• 
• 
• 
• 

Study Population
Data Collection
Follow-up and Outcome Classification
Statistical Analysis

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Methods

Overall Analytical
Strategy

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Methods

Modification

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results
•  Description of population (Table 1)
•  Initial analyses: Univariate or stratified
analyses
•  Main modeling results
•  Analyses directed at subsets/modification
•  Sensitivity analyses

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Results
Do not say Table x shows
Population
Description

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
General Problems with Tables
•  Poorly labeled: title should make purpose
clear
•  Mixing types of data
•  Putting Ns into all cells (only need for
column)
•  Providing p values rather than using
symbols
•  Not providing units
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Results: Table 1

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results

Basic Results

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: Possible Confounding

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: Key Findings

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: Stratified

Sex-stratified
findings: Males

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: Sex Stratified

Sex-stratified
findings: Females

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: By Cause

By Cause of Death

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: By Cause

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results

Interaction

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: By Sex

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results
Modification and
Confounding

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Results: Addressing Confounding

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion Topics
•  Summary of findings (always first)
•  Findings in context of prior knowledge—
what is added.
•  StudyPick the bestaddressed
limitations and how order
•  Generalizability of findings
•  Implications of findings—next steps
(always last)

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Discussion: First Paragraph

Summary

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: Comparison

Comparison to
Other Studies

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: Variation in Findings

Sensitivity Analysis

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: Generalizability

Generalizability

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: CVD

Cardiovascular
Disease

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: Cancer

Cancer

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: Age Modification

Effect Modification
by Age

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion

Implications +
Further Research

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion: Asians

Asian
Populations

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Discussion

Recommendations

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

Jee et al. NEJM 2006;355(8):779-87
Last Paragraph
• 
• 
• 
• 

Hard to write!
Avoid starting with: “In summary…”
Do not making too sweeping statements
Comment on consequences of knowledge
gained:
–  Guidelines implications
–  Further research
–  Other policy consequences
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
General Points 1
•  Use the active voice at times (WE…)
•  Avoid priority claims
•  No lengthy literature reviews in the
Introduction
•  Do not repeat findings that are in tables
and figures
•  Watch that last paragraph
•  Avoid temptation—of cutting and pasting!
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
General Points 2
•  What general (to be continued) but should
have the journal in mind when writing.
•  What audience is relevant?
•  “Just do it”
•  Use input from collaborators but need one
voice

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
EXERCISES

Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health
Southern California
Clinical and Translational Science Institute
Translating Science into Solutions for Better Health

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How to Write a Manuscript: Useful Tips

  • 1. How to Write a Manuscript* *And get it published Jonathan M. Samet, MD, MS Professor and Flora L. Thornton Chair Department of Preventive Medicine Director, ECDE, SC CTSI Career Development Seminar Series Feb 10, 2014 Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 2. Objectives •  To provide an overall framework of the structure of a manuscript. •  To provide a section-by-section guide to a manuscript presenting research findings. •  To provide strategies for efficiently writing a manuscript. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 3. Overall Structure •  Introduction: Why the study was done. •  Methods: How the study was done. •  Results: What did the study find. •  Discussion: What do the results mean. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 4. EXAMPLE OF A PAPER Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 5. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 6. Introduction: The two paragraph model •  Paragraph 1: –  A description of the problem to be addressed –  A characterization of the state of evidence on the problem and gaps to be addressed •  Paragraph 2: –  A description of the study question –  A brief characterization of the study and the evidence generated by the study Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 7. Introduction: Para 1 •  First paragraph “In spite of decades of research, ___ remains a challenging problem for clinicians and patients.” or “Worldwide, __ remains a substantial clinical and public health problem with over __ affected and __ deaths annually.” Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 8. Introduction: Para 2 •  Second paragraph “To address this gap in understanding of __, we carried out___” “Using patients from ____, we carried out a follow-up study___” “To better understand underlying mechanisms, we developed an animal model using XXXY knockout mice…” Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 9. Introduction Statement of Problem = Obesity + Mortality Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 10. Introduction Need data on Asians Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 11. Introduction What we did Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 12. Exercise •  You have carried out a study on metabolic characteristics of Hispanic persons with diabetes at LAC-USC. Write the first sentence of the paper Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 13. Methods: Translational Study •  Overall description of the study design •  Description of population criteria and ascertainment •  Description of data items and methods of data collection, including QA/QC •  Analytical strategy, covering analytical variables and methods •  Statistical software used Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 14. Methods: Laboratory Study •  Approach used: adequate description of the experimental system. •  Assays used: description and/or sufficient references. •  Data QA/QC •  Statistical analyses Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 15. Methods NEJM Paper •  •  •  •  Study Population Data Collection Follow-up and Outcome Classification Statistical Analysis Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 16. Methods Overall Analytical Strategy Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 17. Methods Modification Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 18. Results •  Description of population (Table 1) •  Initial analyses: Univariate or stratified analyses •  Main modeling results •  Analyses directed at subsets/modification •  Sensitivity analyses Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 19. Results Do not say Table x shows Population Description Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 20. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 21. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 22. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 23. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 24. General Problems with Tables •  Poorly labeled: title should make purpose clear •  Mixing types of data •  Putting Ns into all cells (only need for column) •  Providing p values rather than using symbols •  Not providing units Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 25. Results: Table 1 Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 26. Results Basic Results Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 27. Results: Possible Confounding Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 28. Results: Key Findings Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 29. Results: Stratified Sex-stratified findings: Males Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 30. Results: Sex Stratified Sex-stratified findings: Females Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 31. Results: By Cause By Cause of Death Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 32. Results: By Cause Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 33. Results Interaction Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 34. Results: By Sex Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 35. Results Modification and Confounding Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 36. Results: Addressing Confounding Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 37. Discussion Topics •  Summary of findings (always first) •  Findings in context of prior knowledge— what is added. •  StudyPick the bestaddressed limitations and how order •  Generalizability of findings •  Implications of findings—next steps (always last) Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 38. Discussion: First Paragraph Summary Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 39. Discussion: Comparison Comparison to Other Studies Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 40. Discussion: Variation in Findings Sensitivity Analysis Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 41. Discussion: Generalizability Generalizability Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 42. Discussion: CVD Cardiovascular Disease Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 43. Discussion: Cancer Cancer Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 44. Discussion: Age Modification Effect Modification by Age Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 45. Discussion Implications + Further Research Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 46. Discussion: Asians Asian Populations Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 47. Discussion Recommendations Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health Jee et al. NEJM 2006;355(8):779-87
  • 48. Last Paragraph •  •  •  •  Hard to write! Avoid starting with: “In summary…” Do not making too sweeping statements Comment on consequences of knowledge gained: –  Guidelines implications –  Further research –  Other policy consequences Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 49. General Points 1 •  Use the active voice at times (WE…) •  Avoid priority claims •  No lengthy literature reviews in the Introduction •  Do not repeat findings that are in tables and figures •  Watch that last paragraph •  Avoid temptation—of cutting and pasting! Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 50. General Points 2 •  What general (to be continued) but should have the journal in mind when writing. •  What audience is relevant? •  “Just do it” •  Use input from collaborators but need one voice Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 51. EXERCISES Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health
  • 52. Southern California Clinical and Translational Science Institute Translating Science into Solutions for Better Health