Dr Julian Randall
Retired GP, Dudley, W. Midlands,
Co-editor “The Writer”, journal of the SOMW
Co-founder & late Vice-chair Dudley CCG
Foreword
Having retired in 2013, after spending the previous decade in GP
commissioning rather than research, I realised I would have to
quickly update myself on the modern “journal-scape” when given
this topic for my talk. Thus I was in much the same position as a
new doctor in training who has to orientate to academic writing.
What follows is a combination of my past experiences with what
I was able to re-discover using modern internet resources . It is
inevitably incomplete and prejudiced by my own curiosity, but it
can be taken as an example of what any new medical writer can
quickly discover for themselves without too much difficulty.
Created by John Shaw
Billings (1838-1913), head
librarian, Surgeon General's
Office, US Army.
 became the US National Library of Medicine
 MeSH (Medical Subject Headings) introduced
by NLM in 1960
MEDLARS
(Medical Literature Analysis and Retrieval System)
Honeywell 800 computer
 1958 design
 Memory 128 k!
 Tape storage of bulk data
(Meanwhile, ARPANET went online, October 29th 1969)
MedLine (MEDLARS on-line)
-239 initial journals; capacity for up to 25 users simultaneously
(all medical libraries)
- Libraries conducted searches at request of researchers;
it took days to get the print-outs
1975: Upgrade to MEDLARS -II
 New IBM 370/168 !
 20 databases on tape storage
 Home computers increasingly cheap & powerful from 1982 onwards,
 WWW proposed by Berners-Lee 1989, went public August 23rd 1991
 Michael DeBakey’s other claim to fame: Campaign to put Medline in the public
domain. Hence...
1996 – present:
Grand opening to public, 1997 (by Al Gore):
• PubMed (Medline search-engine)
• PubMed Central (database/indexing & archiving
repository)
• (And there’s a PubMed Mobile app)
 Based in Bethesda, Maryland, USA; counterparts in UK &
Canada,
 pooled data acts as mirror copy/backup
 in 2,407 active journals, & 3,200 archived journals
(some 6,000-12,500 others fail PubMed inclusion criteria)
Today:
On-line & open access
- Exponential growth of journal numbers & data, now beyond FEASIBLE
hard copy archiving & retrieval.
- Web publishing & archivg essential; facilitates publishing, made fee-forpublication possible, reduces printed data and facilitates rapid
dissemination.
- Risks: Plagiarism (theoretical); “data-rot” (loss due to storage media
becoming obsolete, data corruption due to repeated copying to newer
media)
- See XKCD’s infographic:
https://theoceanofknowledge.files.wordpress.com/2014/05/infographic.jpg
So, what are the differences
between journals ?
 Not so great as you might think:
 Historical
IMRaD format for scientific papers descended directly
from structure of Aristotelian rhetorical debates .
 Modern globalisation & standardisation:
- International Committee of Medical Journal Editors
(ICMJE)
- Consolidated Standards of Reporting Trials
(CONSORT) checklist
http://www.consort-statement.org/about-consort
- Committee on Publication Ethics (COPE)
ICMJE members:
Annals of Internal Medicine
New England Journal of Medicine
British Medical Journal
New Zealand Medical Journal
Canadian Medical Association
Revista Médica de Chile,
Journal
Chinese Medical Journal,
Ethiopian Journal of Health Sciences
JAMA
Nederlands Tijdschrift voor
Geneeskunde (Dutch Medical
Journal)
The Lancet
The U.S. National Library of
Medicine
World Association of Medical
Editors (WAME - “Whammy”) ,
represents >1,000 other journals)
ICMJE Standardisation:
Download from: http://www.icmje.org/icmje-recommendations.pdf
(NB: 17 pages; ©  no unauthorised reproduction or distribution)
Does your journal comply? See:
http://www.icmje.org/journals-following-the-icmje-recommendations/
(not all compliant journals have requested listing)
1:
2:
3:
4:
5:
6:
Identification/registration
Rationale, hypothesis & objective
Trial design & Method
Patient eligibility & location
Interventions, details for replication
Pre-specified 1ry & 2ry outcome
measures, post hoc changes
7: Sample size determination, interim
analyses, stop criteria
8: Randomisation method
9: Randomisation implementation
& concealment
10: Randomising personnel
11: Randomisation-blind personnel,
assessors & assessment methods
12: Statistical methods.
13: Randomisation outcome, exclusions
& losses, & reasons
14: Follow period, trial end & reason
15: Baseline demographics table
16: Numerical n data; changes to grouping
17: Numerical outcome data & precision
level
18:Tertiary analyses & subgroups
19: Significant unintended effects &
harms
20: Limitations, biases, imprecision,
multiple analyses
21: External “generalisability” & validity
22: Consistency between outcomes &
analysis
23: Registration number
24: Location where protocol can be
scrutinised
25: Funding sources
AllTrials Campaign:
 Which journals does your paper cite? - By definition your subject will interest
other readers (& therefore editors) of the same journals, and you can see the
preferred style & format.
 Refer to mission statements of the proposed journals for scope and expectations
of readers. These will link to submission guidelines for preparing your
manuscript.
 Do your own peer review prior to submission – run your paper by trusted friends
& colleagues to eliminate typos, contradictions & waffle.
 Rejection isn’t the end. There are thousands more journals. – but take note of
reasons for rejection & revise your manuscript before submitting elsewhere.
You may have to reformat & re-reference.
 Assume everything will take twice as long as you think. (Your professor,
however, will still expect it done yesterday.)
The Obvious;  generic considerations for all journals:
 Appropriate to your specialty, or Generalist?
 Niche interest → specialist journal
 Relevance to many specialties → BMJ/Lancet/Nature Medicine; J. Med. Ethics
(GP is a speciality, but consider overlap with social science & mental health)
 Relevance extends outside medicine → Nature/PLOS-ONE
 Basic science → Cell, Acta Biochimica etc
 National or international?
 Location & Language (if English is 2nd language, or if migrating/returning
to a homeland, consider whether to publish where you intend to practice)
 High impact or niche journal?
 Originally proposed by Eugene Garfield in 1955
 2 or 5 year average of :
Citations
_________________________________
Articles published
 Data collected by Institute for Scientific Information* (founded
by Garfield in 1960) & published annually in Journal Citation
Reports
 In 2008 *ISI was acquired by Thomson-Reuters;
‒ © enforced since
Alternative ranking systems:
• http://www.eigenfactor.org/
• http://www.proquest.com/products-services/Ulrichsweb.html
• Australian research council (next listing due for publication Autumn 2015)
• There are many journals, but they are owned
by far fewer publishers.
• A dozen or so publishing houses account for
the majority of high-impact journals.
• So you need only learn about 12 house-styles.
• These are already similar, and converging as
standardisation gathers pace.
Journal houses:
BMJ Group: 56 Journals,
Oxford UP: 118 journals,
Incl. BMJ + 12 specialist editions,
Incl. British Journal of Anaesthesia, Brain,
Drug and Therapeutics Bulletin, Gut, Heart
British Medical Bulletin, Family Practice
33 Blogs incl. Postgraduate Medical Journal Cambridge UP: 10 journals, Incl.
Lancet Group:
Cambridge Quarterly of Healthcare Ethics
The Lancet + 10 specialist editions,
Cogora: Pulse, Nursing in Practice,
2 Blogs
Management in Practice
American Medical Association:
Haymarket: 12 Journals,
JAMA+ 10 specialist editions, 2 Blogs
Incl. GP Magazine, MIMS, Medeconomics,
Massachusetts Medical Society:
NEJM, Journal Watch
Public Library of Science:
PLOS ONE, PLOS Medicine,
PLOS Genetics, PLOS Neglected Tropical
Diseases, PLOS Pathogens
Royal Colleges:
BJGP,
Annals of the Royal College of Surgeons
Commissioning Today
Nature Publishing Group: 109 journals
Incl. NATURE+ 26 specialist editions, BDJ,
BJ Cancer, Scientific American
Wiley-Blackwell Ltd: 171 health journals,
+ Wiley On-Line Library*: ‒ 16 Medical
specialty sections accessing all the journals.
*Hosts the Cochrane Library
There are many Style Guides,
but only a few* are relevant to medicine:
ACS Style Guide
*AMA Manual of Style
AP Stylebook
*APA style
The ASA Style Guide
Bluebook [for legal citation]
The Business Style Handbook
The Chicago Manual of Style
*Citing Medicine (NLM)
The Elements of Style
The Elements of Typographic Style
Fowler's Modern English Usage
IEEE style [engineering]
*ISO 690:2010[
Manual for Writers of Research
Papers, Theses, and
Dissertations (“Turabian”)
MHRA Style Guide [social sciences]
Microsoft Manual of Style
MLA Handbook
MLA Style Manual
New York Times Manual
*Oxford Guide to Style/New Hart's
Rules Scientific Style and Format
(CSE style)
The Sense of Style
Wikipedia Manual of Style
House Styles:
All major journals now require on-line submission .
 Most require & accept manuscripts in MS *.docx or *.rtf or Adobe *.pdf
formats.
 Stay within length-limits (Usually 3,000 words & 30 references)
 Use prescribed font & size for text (e.g. TNR for serif, Arial for sans-serif)
 Direct or third-party submission portals? [ScholarOne ™]
Follow preferences in:
 Referencing style – Vancouver or Harvard
 Heading styles & hierarchy arrangement
 Bulleting & numbering format
 Present tabular data clearly & comply with required positioning in text.
 Graphs must be validated by providing raw data
 Punctuation !
Some House Style Guides:
BMJ Group: http://www.bmj.com/about-bmj/resources-authors/house-style
BJGP:
http://bjgp.allentrack.net/cgi-bin/main.plex?form_type=display_auth_Instructions
&j_id=102
Lancet group:
http://download.thelancet.com/pb/assets/raw/Lancet/authors/lancet-information-forauthors.pdf
Nature Group: http://www.nature.com/nature/authors/gta/
NEJM: https://cdf.nejm.org/misc/authors/
PLOS: http://blogs.plos.org/plos/2015/01/streamlined-formatting-plos-article/
Wiley-Blackwell:
http://authorservices.wiley.com/bauthor/House_style_guide_ROW4520101451415.pdf
Avoiding writer’s block :
Pedant [noun]:
1: A person who makes an excessive or inappropriate display of learning.
2: A person who overemphasizes rules or minor details.
3: A person who adheres rigidly to book knowledge without regard to common sense.
—Dictionary.com
- so keep it relevant & sensible, & don’t show off.
Obsessive-Compulsive (Anankastic) Personality Disorder:
Is a disorder, not a virtue: “…characterized by feelings of doubt, perfectionism,
excessive conscientiousness, checking and preoccupation with details, stubbornness, caution,
and rigidity.” —ICD.10
- most doctors are like this to a degree, and if applied wisely it produces meticulous work,
but know when to stop: Optimise, don’t maximise. It is the end that counts, not the means.
- “Le mieux est l'ennemi du bien.” (Voltaire) - Perfection is the enemy of the good enough.
It is easy to write badly, hard to write well, but nobody writes a perfect first draft.
It is better to write something, even if it’s a dire first draft, and keep editing until it’s right,
than to attempt immediate perfection & write nothing at all.
Getting past Peer Review
“…the system of peer review is biased, unjust, unaccountable,
incomplete, easily fixed, often insulting, usually ignorant,
occasionally foolish, and frequently wrong.”
—Richard Horton, Editor, The Lancet
Wooing the Reviewers
 Ethically compliant
 Impeccable data, clearly presented*
 Sound rationale & logical progression**
 Succinct argument
 Unambiguous grammar & syntax
 Conclusive message
 *Falsifiability principle
 **eliminate pseudoscientific arguments
Falsifiability Principle:
(Charles Peirce, 1870; Karl Popper 1966)
Criterion of scientific validity: If a hypothesis is false, it can be
shown to be false by designed experiment.
“…for a hypothesis to have credence, it must be inherently
disprovable before it can become accepted as a scientific
hypothesis or theory.”
“…no theory is assumed to be completely correct, but if
experimental observation cannot not falsify it, then it can be
accepted as probably correct.”
Perhaps a better way of looking at it:
If you need to falsify your data to prove your hypothesis, then
your hypothesis is disproved.
Top 10 historical Logical Fallacies in Medicine
10: Non sequitur (“Does not follow”):
- “Statins lower cholesterol & reduce thrombotic events, therefore statins prevent
thrombotic events by lowering cholesterol.” (Not proven)
9: Appeals to Emotion (Emotional Blackmail):
- “It is unethical not to fund Kostzabomimab therapy because dozens of cancer
patients will die without it.” (The resource implications may kill many more.)
8: Syllogism Fallacies (“Pie-chart” misinterpretations):
- Inferring 2 groups overlap with each other because both overlap with a third.
-Do not presume how much they overlap; - find out.
7: Post hoc ergo propter hoc (“the former therefore the latter”):
“All autistic children have teddy-bears, therefore teddy-bears cause autism.”
- Do not infer causation from correlation or coincidence .
6: Argument from Authority (“Pingelhandl et al say it’s so, therefore it is so…”):
- The paper may pre-date evidence-based medicine, or may have proposed a
hypothesis not yet proven.
Refer instead to the evidence in the paper’s results.
Top 10 historical Logical Fallacies in Medicine
5: Tergiversation (“Weasel words”):
- Making an assertion without taking responsibility for it, by attributing it to
anonymous third parties: “It is believed that…” Quote your sources.
4: Appeal to Common Practice (“You can’t break with tradition) :
- This was the basis of the medico-legal “Bolam” test as a criterion for acceptable
practice; it has been superseded by the “Bolitho” test, requiring even longstanding practice to have a scientific rationale to be acceptable.
3: Ad Populum (Appeals to Popularity) : - “Everyone else accepts this theory, therefore so must you.”
- Fact is not democratic. Dissenters from dogma have a habit of being right.
2: Sanctimony:
- “Our institution is more excellent that all the rest. Our interpretation must be
accepted because there is no higher authority to contradict it.”
- Seniority & authority are irrelevant to the logic of an argument.
1: Cherry Picking:
- “Data that isn’t consistent with the hypothesis is wrong, & can be ignored.”
- Conclusions must be based on evidence, not the other way round.
Referencing
Bibliography software:
Plenty avaliable
Aigaion
Bebop
BibBase
Docear
EndNote
JabRef
RefDB
Reference Manager
Referencer
BibDesk
Biblioscape
BibSonomy
Bibus
KBibTeX
Mendeley
Paperpile
Papers
RefWorks
SciRef
Sente
Wikindx
Bookends
Citavi
CiteULike
colwiz
Pybliographer
Qiqqa
ReadCube
refbase
WizFolio
Zotero
(But MS Word Footnote/Endnote function works just fine.)
Referencing
Vancouver or Harvard?
Rule of thumb:
 Physical science journals use numerical (Vancouver based)
citation, therefore so do clinical medical journals ;
 Philosophical journals use bracketed in-text citation (Harvard –
based), therefore so do medico-legal, ethical, social science &
mental health journals.
 Vancouver-based AMA style or similar is standard in USA
& UK (esp. BMJ), but with idiosyncratic preferences for
positioning references in text (inside/outside sentence,
Sub/superscript, bracketing etc) – check your chosen journal.
Referencing
Punctuating citations
Use ICMJE recommended commonalities in formatting citations:
Format:
Author Surname [space] Initials without spaces/stops) [comma/&/stop]
Title [stop] Italicised ISO690.2010 -approved journal abbreviation [stop]
Date [semicolon] Volume or Edition (Number or chapter) [colon] Page range
[stop] Publisher if book [stop]
Hence:
Randall J, Obeid ML & Blackledge GR. Haemorrhage and perforation of
gastrointestinal neoplasms during chemotherapy. Ann R Coll Surg Engl. 1986
Sep; 68(5): 286–289.
 List up to 6 author names; if >6 authors, use first two followed by “et al”.
Reviews, Essays & Book Chapters:
1) You’re the author; with a free hand. IMRaD format is not
compulsory but still good discipline for structuring your article.
2) Circulate an early draft for self-peer review to confirm you’re
addressing real educational need . Change or add to it if need be,
but make sure you do address it.
3) If working with multiple authors, confer to ensure consensus,
and leadership, but beware GroupThink.
4) Keep it your own article; don’t re-hash past-masters’ prior works
unless a neglected point needs reviving or an unjustified one
needs demolishing.
Reviews, Essays & Book Chapters:
5) Once your goal is identified use Triple Repetition ‒ a writer’s trick
across many genres: In the Intro define the scope & what you
intend your readers to learn. State it fully in the methods section.
Finally reiterate it in the results section. Then, when you lead
logically & fluently to your conclusion, your readers will
remember your rationale.
6) Write from a fully cited evidence-base. There will be many papers
& need for review arises from chaos & contradictions. Your
purpose is to impose order, so students & researchers can navigate
via your bibliography & needn’t reinvent it in future.
7) Don’t make unsupported assertions, but if positing a new
hypothesis to invite comment or recruit colleagues to research it,
then say so. Don’t let it become dogma by default.
Other considerations
Heading formats:
– Oxford style capitalises major words in main title, not in sub-headings.
– Numbers in text & headings should be as text, not numerals, up to ten.
 Check journal house-style for numbering/bulleting formats.
 Use heading hierarchies:
E.g. APA style – 5 levels to avoid using large fonts:
1:
Centred, Bold, Capitalised [ colon]
2: Aligned left flush, Bold, Capitalised [ colon]
3: Aligned left indented, bold, lower case [stop]
4: Aligned left indented, bold-italic, lower case [stop]
5: Aligned left indented, italic, lower case [stop]
Statistical outcomes:
– How does the journal want these expressed?
p-values? Χ2? Confidence intervals? Something else? – Check policy
Include a professional statistician in your pre-submission peer review.
Medical photography hazards
‒ CONSORT-compliant consent & ethical
approval
‒ Anonymisation
‒ Quality
‒ File & pixel size
‒ Copyright & Trade-mark

Our journal, my
cover-photo &
SOMW
copyright:
- No permission
needed for
use in lecture.
Burkitt DS & Randall J, Urethral Trauma.
Nursing Times, October 28, Vol 83, No 43, 1987
↑ My paper but NT copyright, so citation
needed.
- Dow-Corning objected to use of “Silastic”™,
as another brand was inadvertently supplied
to medical photography
Editor’s plea:
Sentence & Paragraph breaks: No double spaces, especially after punctuation marks (use
Justify function). Tab/Indent to start new paragraphs, not multiple spaces (easy in
Word) . Hanging paragraphs to segregate list entries.
Minuses, Hyphens & Dashes: In order of size, use hyphens (-) to join or break words (no
spaces), a minus sign (−) for negative numbers in text, an en dash (–) for numerical
ranges & an em dash () in place of parentheses or commas (no spaces). An en-dash
with spaces ( – ) is also acceptable for this & looks better.
Infernal inverted commas: Use double quotation marks (“rhubarb”).
For the sake of your spelling checker don’t use single quotation marks except for
quotes within quotes “He said ‘rhubarb’ for no good reason.”
Ellipsis...  I.e. Three dots, no more, no less.
Use italics for emphasis: - Exclamation marks & CAPITALISED TEXT are vulgar &
loud! They have NO place in science, or even prose, & must be exterminated! !!!
Aberrant apostrophes: Unless denoting possession or abbreviation, kill them too.
Cancerous commas:
Unless you’re vigilant they metastasise everywhere. All style guides agree,
keep commas to a minimum. Use them only to separate lists, consecutive
adjectives, and clauses, or in place of parentheses.
Most journals , alas, want the serial (“Oxford”) Comma 
“Blood samples were taken for FBC, U&E, LFTS, & ESR.”
“Blood samples were taken for FBC, U&E, LFTS & ESR.”
In its favour:
“...highlights of his [Peter Ustinov’s] global tour include encounters
with Nelson Mandela, an 800-year-old demigod and a dildo collector.”
―The Times
“...highlights of his global tour include encounters with Nelson Mandela, an
800-year-old demigod, and a dildo collector.”
Fail

The Oxford comma
“There are people who embrace the Oxford comma and those who don't,
and I'll just say this: never get between these people when drink has been
taken.”
―Lynne Truss, “Eats, Shoots & Leaves: The Zero Tolerance Approach to
Punctuation.”
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