PUBLICATION OF ARTICLES IN SCIENTIFIC JOURNALS:

Even when a manuscript has been rejected,the author should not be discouraged because there is great value derived from the review process.

The Review Process Blinded At least two PEER reviews Constructive criticism

WHICH PAPERS ARE ACCEPTED WHICH PAPERS ARE ACCEPTED? Those that advance our knowledge and especially those that will enhance patient care (new and better treatment of musculoskeletal conditions)

How is this accomplished? Good idea Well designed study Focused, clear report

Should I write it? Is the topic relevant? Will it benefit the orthopaedic patient or community? Is it already in the literature? (Oops!) Does our institution have adequate resources to carry it out? Do I have time to complete the entire project? Does it require the buy in or support of another party?

The single most important characteristic that distinguishes between acceptance and rejection is the prospective nature of a study

We must be moving beyond retrospective reviews and all of their inherent problems to design and conduct prospective studies

PLAN, PLAN, PLAN “Plans are nothing, planning is everything” Have a mentor

KEY ELEMENTS OF A GOOD PROSPECTIVE STUDY

1. A WELL DEFINED QUESTION Relevant

RELEVANCE Find out how relevant your question really is The first step in the peer review process Use colleagues, mentors, cynics, enemies

1. A WELL DEFINED QUESTION Relevant Focused Has a high degree of certainty that an answer will result when study is completed State the hypothesis Write the Introduction

2. Formulate a Study Design What is the best way to address this question (clinical, lab,etc)?

Statistics There will be an adequate number of study subjects to achieve an answer (power) The most simple yet appropriate statistical tools will be used A statistician should always be involved

Useful Measurements Commonly used measurements (do not invent your own) Go beyond xray and physician derived information Use accepted,patient based,outcome measurements for clinical studies

Unbiased assessment Use independent observers to record and evaluate data in a blinded fashion No vested interests : industry, surgeons

3.Do the Experiment Have a finish line and date Have an alternative plan Keep good records Timely and accurate recording (lab notebook)

3.Do the Experiment When data collection nears completion, write Methods (in sufficient detail so that anyone could repeat the experiment) and Materials

4. Present the Results Clear, concise Good graphics Significant only Distinguish statistical and clinical significance

5. Write the Discussion Hypothesis: prove or disprove Compare with other studies in the literature (pro and con) Brief conclusion : A ‘take home message’ Most papers only have one message

6. Write clearly Focused Concise

I have only made this [letter] longer because I have not had the time to make it shorter Pascal,1627

6. Write clearly Focused Concise Timely Follow ‘Instructions to Authors’ Independent review of manuscript before submission

Local Peer Review What is not clear? Heckman test Abjure pride of authorship

The Ideal Study is The Randomized Clinical Trial (RCT)

We are in the age of Evidence Based Medicine

The RCT Represents good science Prospective Currently fashionable (popular,accepted) Enduring credibility Provides basis for metaanalysis Very satisfying for investigator It will get published!!!

Problems with RCTs Cost Time Narrowness of Question Recruitment (patients, physicians,especially surgeons) Institutional resources

Important steps in any RCT Prospective design Randomization (needs statistician) : by patient,by surgeon, or by institution Controls (must follow the Helsinki Agreement guidelines) Multi-institutional Must follow all local IRB and informed consent rules

OBSERVATIONAL STUDIES: better than traditional descriptive studies

OBSERVATIONAL STUDIES Still prospective design Meet IRB approval at the start Comparisons should always be made: historical controls, concurrent(but not random) controls, or case controlled Multi-institutional Use unbiased observers to collect and analyze data

Case Reports and Case Series Must be truly unique Must advance our ability to treat patients Should be interesting to the reader

Authorship Significant ongoing contribution More than technical Can defend entire paper in a public forum No courtesy authorship

HELPFUL HINTS Follow the Instructions to Authors Brevity Focus on Subject Limit speculation/opinion Use easy to read format Use a few key illustrations

The Final Word of Advice Never give up All papers can get published!!!