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Int. J. Oral Maxillofac. Surg.

2011; 40: 1342–1345


doi:10.1016/j.ijom.2011.11.012, available online at http://www.sciencedirect.com

Editorial
§
Getting published in peer-reviewed journals
Abstract. Writing a paper for publication ideas that could be added to what was to undergo a new surgical procedure based
in a peer-reviewed journal is a reward- already known. According to Warsh7, on a hypothesis or animal study. When it
ing experience but a very difficult journal articles may be used to announce comes to randomised clinical trials, it is
undertaking that requires years of new discoveries, to comment on or criti- virtually impossible to undertake sham
experience, determination and patience. cise the discoveries of others, and to operations to prove whether the procedure
The exponential rise of knowledge has synthesise and seek to build consensus in question is more effective than a pla-
resulted in the exponential rise of manu- about what is known. Having mentioned cebo response. Furthermore, feasibility
scripts submitted for publication in the the reasons for publishing, we also need to and compliance with random allocations
various peer-reviewed journals all over understand the motivation behind the of various study groups in surgery is
the world. Potential authors are not only desire to publish. Writing papers for pub- extremely difficult. Nevertheless, unlike
having to write high-quality papers to lication in peer-reviewed journals may physicians, surgeons generally see little
get published, but also have to compete form part of the essential training require- need for randomised controlled studies
with other authors for the limited journal ments for postgraduate students, in parti- and are often willing to accept weaker
space available to publish their papers. cular those who are undertaking a higher evidence5.
The purpose of this article is to highlight degree. In the academic world, publishing Despite the weaker evidence found in
some of the ways of making the task of is an essential means of furthering one’s many of the surgical publications, case
getting published in peer-reviewed jour- career aspirations, particularly for those reports and technical notes are still popu-
nals easier to achieve. seeking promotions. Publishing may also lar. However, there is a push by the more
be used as a means of attracting depart- respected surgical journals to attract more
Writing a paper for publication in a mental funding, or at least help attract research papers with surgical implications.
peer-reviewed journal is a rewarding outside interest to a department’s research The type of manuscript produced will
experience. Even though there are no or clinical activities. Finally, and not depend on the activities of a department,
direct financial incentives for publishing uncommonly, we all have the urge to and the head of department is largely
in peer-reviewed journals, thousands of see our name in print. responsible for directing the quality and
manuscripts are produced each year which quantity of publishable material. The level
compete for the limited journal space of evidence (Table 1) produced in the
What to publish?
available worldwide. In other words, there output of manuscripts will depend on
is a sense of pride and achievement behind According to LAU & SAMMAN2, about whether the department has the resources
every published journal article that has its 30% of articles published in the oral and to employ research staff in addition to
own rewards for which money plays no maxillofacial (OMF) surgery literature
role. Getting published in a peer-reviewed were either case reports or technical notes.
journal is a difficult undertaking so the aim About half the articles published in OMF
of this article is to highlight some of the surgery journals were classified as non- Table 1. Hierarchy of levels of evidence.
ways of making the task easier to achieve. evidence-based literature. As far as evi- 1. Randomised clinical trials
dence-based medicine is concerned, the a. Multicentre
b. Single centre
vast majority of published evidence-based
So why publish? 2. Cohort clinical study
practice in OMF surgery were retrospec- a. Large case series
Journals first appeared in the late 17th tive case series (Level 5 evidence) while b. Meta-analysis of multiple case series
century in an effort to convey fragments of only 10% of articles published were either 3. Animal study
randomised controlled (Level 2 evidence) 4. Laboratory study
§
A version of this paper is also available or non-randomised controlled (Level 3 5. Comprehensive review
on the website of the International Associa- evidence) studies2. 6. Case report
tion of Oral & Maxillofacial Surgeons, The problem with surgical trials is that 7. Technical note
www.iaoms.org. it is generally difficult to persuade patients 8. Personal opinion – letter to editor

0901-5027/1201342 + 04 $36.00/0 # 2011 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons.
Editorial 1343

clinical staff. It is very unlikely, for exam- worth a try, although the chances of suc- ques that are likely to harm the patient will
ple, to extract any high-level research cessfully publishing in these journals are be swiftly rejected. As far as old ideas are
from a surgical department that depends very slim indeed. concerned, unless something new has been
on surgical trainees for publications. An important measure of a journal’s discovered, or a new use for an old tech-
quality is its impact factor. The journal nique has been conceived, then it is unli-
impact factor is a measure of the fre- kely to be published. Repeating old
Where to publish?
quency with which the average article in experiments may be useful if it will add
There are three main vehicles for pub- a journal has been cited in a particular something new to the existing body of
lishing clinical ideas: magazines, journals year. Unfortunately, the impact factor can knowledge. As an example, using a dif-
and books. As far as magazines are con- be misleading because the citation rate ferent drug to inject into the TMJ during
cerned, articles are accepted more for their does not discriminate between articles arthrocentesis and recording its outcome
entertainment value rather than as a true with good quality research and articles may be publishable, provided the drug has
scientific publication and often there may of little scientific value. Therefore, while never been used before for this procedure.
be commercial interests backing the ‘clin- it is important, we cannot totally rely on It is essential that old ideas are cited with
ical opinion’ of the author who may be the impact factor as the only measure of their original source, otherwise it may be
paid by the magazine to write the article. quality of a journal6. easily misinterpreted as a new idea which
Peer review journals are, by their very Perhaps another good measure of jour- may destroy the reputation of the author(s)
nature, publications that critically analyse nal quality is the calibre of experts who who deliberately fail to disclose or at least
all contributions and accept only those sit on the editorial board. The editorial acknowledge the original source of the
articles which fulfil the requirements of board comprises expert reviewers who idea(s).
objective proof and sound results that are are at the peak of their profession. The English is the international language of
measurable and repeatable by others. inside cover of each journal often pub- science. If the aim is to disseminate work
Academic book publishers, on the other lishes the names of the expert reviewers throughout the world, English is the lan-
hand, are more likely to favour authors with and their area of special interest which guage in which the manuscript must be
a track record of previous successful pub- will readily reflect the power and pres- written. Poor English skills are no excuse
lications and are unlikely to attract tige of the journal in attracting only the for plagiarising slabs of text from pre-
unknown authors unless they are closely best articles for publication. The tradi- viously published articles. All academic
supported by well known ‘celebrity’ tion of refereeing ensures that each new institutions should have English depart-
authors. Therefore, books are less inclined contribution to the literature is honest ments so it is best for manuscripts from
to report new ideas and focus mainly on and original and therefore maintains the non-English speaking countries to be thor-
packaging current knowledge in one or high standard expected of such academic oughly checked by persons with good
more easy-to-read volumes. Many years pursuits. English skills before being submitted to
of hard work goes into preparing a book a journal. When writing for a clinical or
with much of the information contained in scientific journal the language must be
What makes a good manuscript?
the book at risk of becoming out of date by kept simple, and to the point. There are
the time the book is released. Therefore, the Quite often, the instruction to authors, no prizes or literary awards for long ram-
most practical and respectable way to con- published as an appendix in each journal, bling sentences in science as there are in
vey new information to professional col- does not provide authors with anything fiction writing. Science is simply the
leagues is through peer-reviewed journals. other than technical guidance which is search for the truth, and it does not require
specific to each journal. Therefore, one highly descriptive superlatives or emotive
cannot get a clear idea of what makes a language to convey a message. There are
Which journal to select?
good manuscript based on the instructions many instances where whole paragraphs
The most appropriate journal to submit to authors. can be abridged to a single sentence and
a manuscript will depend on the subject There are a number of factors that make yet convey the same information. A direct
matter and the intended audience. If the a good manuscript (Table 2) which will be and succinct style of writing (Table 3) will
subject matter is of interest to a general looked upon favourably by the editorial always keep the attention focused on the
audience, such as safeguarding against board1,3. The most important factor is central idea the author is attempting to
nerve damage in third molar surgery, then originality. While original ideas are convey to his or her readers. A journal
perhaps the British Dental Journal would looked upon very favorably by journal reviewer will look less favourably on a
be appropriate. If it is a highly complex reviewers, the ideas should be practical, submitted manuscript that is heavily bur-
and specialised idea such as an aberrant pragmatic and simple to understand. Wild dened with long rambling sentences and a
course of the auriculotemporal nerve, then or fanciful ideas that appear out of this convoluted discussion that fails to get to
an anatomical journal would be the place world, or overly complex ideas or techni- the point.
to submit it to. If the anatomical aberration
has important clinical implications, say in
TMJ surgery, then an oral and maxillofa-
cial surgery journal may be worth a try. If Table 2. What makes a good manuscript.
the idea to be published is too important to Originality – adds new information to existing body of knowledge
be buried in the pages of a local or spe- High level of evidence – proper scientific methodology
cialised journal (e.g. cure found for oral Clear aim(s)
cancer) and needs an international reader- Simple English – correct grammar and succinct style
ship that includes people outside the pro- Clear pictures and diagrams which are relevant to the paper
fession, then a more prestigious journal Robust discussion supported by a balanced review of recent literature
such as Nature or The Lancet may be A conclusion which is supported by the results
1344 Editorial

Table 3. Example of succinct style of writing. to compare the outcomes on such a hetero- satisfactorily met. The conclusion must
Original version (39 words) geneous group. accurately summarise the findings of the
The literature contains arguments for and It is essential that all technical details of study. If the conclusion does not reflect
against the use of routine antibiotic prophy- the experimental methodology, including the stated aim(s) of the paper then it is
laxis in third molar surgery, and the main ethics clearance where appropriate, are unlikely to be accepted for publication.
source of controversy is the lack of reliable
accurately recorded since any omission For example, if the stated aim of the paper
and sensitive clinical criteria for identifying
postoperative infection in these patients. of vital details, such as the statistical is to ‘determine the benefits of TMJ
method used to validate the claims, will arthrocentesis over TMJ arthroscopy’
Succinct version (12 words) make it impossible for the reviewers to and the conclusion is ‘TMJ arthrocentesis
The routine use of antibiotic prophylaxis in assess and may result in rejection of the is a safe procedure for the treatment of
third molar surgery is controversial.
paper. It is also important to remember closed lock’ then there will be lots of
that age, sex and diagnosis belong to the readers scratching their heads as to what
Materials and Methods section and not the the real purpose of the paper was.
Results section.
The ‘IMRD’ approach
In the Results section, it is essential to
How many references?
All full-length articles must follow the lay out all the raw experimental data in a
fundamental IMRD formula, i.e. Introduc- table format with accompanying graphs The question often asked by authors is
tion, Materials and Methods, Results and that provide a pictorial view of the ana- how many references should be used in
Discussion4. lysed data. The text should be brief and not their paper. The answer is simple: as many
The Introduction should establish a rea- a convoluted description of data that is as it takes to support a discussion. While
son for why the article was written in the already laid out in a table or graph. The many journals place strict limits on the
first place. A brief review of the pertinent reader simply needs some basic guidance number of references, particularly for
literature should build up a scenario which as to how to read the tabulated data or small technique-type articles, it is essen-
backs the purpose of the paper. The final interpret the graphs, diagrams or photo- tial that the latest articles are cited. If there
sentence in the introduction should be a graphs which cannot be adequately are two articles in the literature on a
statement outlining the aim(s) of the paper described with a brief caption set out similar topic, one published in 1985 and
and should ideally begin with the words under each table, graph, picture or dia- the other in 2001, it is best to use the 2001
‘The purpose of this study is to . . .’ The gram. It is essential to provide a summary article as it will most likely have more up-
aim(s) give the reader a good indication as of the facts and figures without commen- to-date information that will be most use-
to why the paper was written and sets the tary, which should be placed in the dis- ful to the reader. Besides, if the articles are
theme for the entire manuscript which cussion section. Pictures help supplement similar enough then the 2001 article will
should be strictly adhered to. the text and provide additional proof to an also cite the earlier 1985 article. Therefore
The Materials and Methods section idea. Diagrams are useful where pictures it makes little sense to cite every article
must be clear enough to enable indepen- are not entirely clear, especially when it ever published on a particular topic just to
dent third parties to repeat the experiment. comes to technique papers. Poor-quality prove a point or to support a statement.
A properly designed scientific methodol- photographs or images that do not con- The exception is when reviewing the lit-
ogy is essential in boosting the credibility tribute any further information to the erature for previously published reports on
and level of evidence of a study. In clinical paper will provoke a negative reaction, rare cases or pathology, for example,
studies, inclusion and exclusion criteria especially from the Editor who has to chondrosarcomas of the mandibular con-
are necessary to clearly define the group comply with limited journal space. For dyle. Authors must be aware that each
being studied and to allow comparisons to example, a fuzzy or blurred orthopanto- journal has a different style and method
be made with other closely matched stu- mogram that fails to show the lesion in of citing and listing references so the
dies. Flaws in the materials and methods question is unacceptable, as are multiple instructions to authors must be carefully
section will invalidate all the results and clinical pictures basically showing the followed.
render the paper unacceptable for publica- same pathology or technique in different
tion. For example, the lack of matched individuals.
What about case reports?
control groups with which to compare The Discussion should be a commen-
outcomes make it difficult to pronounce, tary of the Results with appropriate refer- While case reports are usually of little
with any certainty, that a particular pro- ences made to similar studies published scientific value, they are useful as an
cedure is more effective than no treatment in the same field that may either support incremental part of a series of cases pub-
at all. Presentation of follow-up data on a or refute the Results. It is important to lished over the years which, when com-
single technique will be considerably include a balanced array of previously bined, help build up a collective picture of
weaker than a study which compares published papers that not only agree with the rare disease or unusual disorder that
two or more methods or techniques. the findings, but papers that may also cannot be obtained from one centre alone.
Furthermore, follow up of small numbers disagree. A robust Discussion is really When a case report is being considered for
of patients who have undergone a large the ‘icing on the cake’, so to speak, and publication, it must contain some new
number of different surgical procedures gives the reviewer an opportunity to information that has not been previously
will invariably not be accepted. This is properly assess the author’s scientific reported. This new information, which
especially problematic in studies on reasoning and strength of argument in should be highlighted in the conclusion,
orthognathic surgery where some of the critically analyzing their results. An arti- can then be added to the existing body of
patients have undergone single jaw osteo- cle without a conclusion is like a story knowledge. For example, while TMJ
tomies, and some have had two jaw osteo- without an ending. Failure to provide a synovial chondromatosis is still a rare
tomies, while others have had conclusion leaves the readers wondering disorder, further case reports are unlikely
genioplasties, which makes it impossible whether the aim(s) of the paper have been to be published unless the author(s) can
Editorial 1345

show a new or novel way of diagnosing that are both accepted and rejected. An add new information to the existing body
and/or treating these disorders that have essential aim of the reviewing process is to of knowledge are highly regarded and
never been previously reported. Alterna- highlight the weaknesses of each paper so are more likely to be considered for
tively, a new aspect of the disease may be that the authors can improve the quality of publication3.
presented, such as a 20-year follow-up of a their submissions3. Authors should care-
previously treated patient, or analysis of fully absorb and analyse the reviewer’s G. Dimitroulis*
the recurrence potential of the disorder reports, especially when papers are Department of Surgery, St Vincent’s
that has important implications in the rejected, as this is often the only oppor- Hospital, Melbourne, The University of
management of this condition. tunity authors will get to learn from their Melbourne, Australia
A case report is simply a case report so mistakes and how to improve their E-mail address: geodim25@gmail.com
it must be kept simple and succinct. A chances of getting future papers success-
brief introduction of no more than one fully published. References
paragraph is essential and the case report Every year there is an increasing num-
1. Bayne SC, McGivney GP, Mazer SC.
should be limited to a succinct description ber of articles produced by authors
Scientific composition and review of manu-
of the patient, pertinent history and clin- worldwide. A typical OMF surgery jour- scripts for publication in peer-reviewed
ical presentation, any results of investiga- nal with 12 issues a year may be able to dental journals. J Prosthet Dent 2003: 89:
tions, treatment and outcome. Adding an accommodate about 150–180 articles a 201–218.
easy to read table summarizing the litera- year. Unfortunately, when annual sub- 2. Lau SL, Samman N. Levels of evidence
ture of previously reported similar cases missions run to about 700 manuscripts, and journal impact factor in oral & max-
with a brief discussion of the new findings there is still a shortfall of about 75%. illofacial surgery. Int J Oral Maxillofac
will improve the likelihood of publication. That means that even if all articles were Surg 2007: 36: 1–5.
of an acceptable standard for publication, 3. Radford DR, Smillie L, Wilson RF,
about 75% of submissions would have to Grace AM. The criteria used by editors
Discussion of scientific dental journals in the assess-
be rejected just to satisfy the timing and ment of manuscripts submitted for
Producing papers for publication in space constraints of the journal. So not publication. Br Dent J 1999: 187:
peer-review journals is a difficult exercise only do potential authors have to submit 376–379.
that not only requires a great deal of skill high quality papers, but they must also 4. Sollaci LB, Pereira MG. The introduc-
and experience, but also patience. compete against other authors for the tion, methods, results, and discussion
limited journal space available. Since (IMRAD) structure: a fifty year survey.
Authors need to be aware that a clear
case reports and technical notes form J Med Libr Assoc 2004: 92: 364–367.
message and original ideas will be the 5. Solomon MJ, McLeod RS. Should we be
two most important factors that will deter- the vast majority of articles submitted
to surgical journals, they are also the performing more randomised controlled
mine the difference between acceptance trials evaluating surgical operations? Sur-
and rejection of their papers in peer- most likely to be rejected. Therefore,
gery 1995: 118: 459–467.
reviewed journals. to increase the likelihood of publication, 6. Szklo M. Impact factor: good reasons for
The editorial boards of most journals it is better to submit more substantial concern. Epidemiology 2008: 19: 369.
are well aware of the competition to attract papers with high levels of evidence 7. WARSH D. Knowledge and the Wealth of
the best papers, so every effort is made to (Table 1) backed by a sound scientific Nations. A Story of Economic Discovery.
convey constructive criticism to all papers methodology. Original contributions that New York: Norton & Co. 2007: 14.