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Improving the likelihood of manuscript
acceptance; a primer for trainees and
young investigators
Michael Chen,1 Felipe Albuquerque,2 Joshua Hirsch,3 Robert W Tarr4
OVERVIEW
Since our inception, over the past 4 years,
JNIS manuscript submissions have
doubled in number to almost 500 a year.
Out of necessity, the journal has become
increasingly selective viz a viz the manu-
scripts that are ultimately published. As a
result, this is an opportune time to
address elements of the manuscript review
process, and to suggest common practices
that generally improve the likelihood of
manuscript acceptance. Specific sugges-
tions pertaining to each of the original
research manuscript components are
made. It is our hope that neurointerven-
tionalists in training and young investiga-
tors find this editor’s comment useful in
putting together future articles for JNIS.
Title
The title should be as concise and unam-
biguous as possible. It should contain key
words and, if possible, give the main
result of the study. The title sets the tone
of the manuscript and is the initial data
point which is used by the reader to
decide whether or not to proceed with
reading the paper. Examples of well con-
structed titles include ‘Admission neutro-
phil–lymphocyte ratio predicts 90 day
outcome after endovascular stroke
therapy’1 and ‘ASPECTS decay during
inter-facility transfer predicts patient out-
comes in endovascular reperfusion in
ischemic stroke’.2
Introduction
The introduction should establish the
context of the manuscript. Prior evidence
based knowledge regarding the research
hypothesis should be briefly referenced.
1
Department of Neurological Sciences, Rush University
Medical Center, Chicago, Illinois, USA; 2Division of
Neurological Surgery, Barrow Neurological Institute,
Phoenix, Arizona, USA; 3NeuroEndovascular Program,
Massachusetts General Hospital, Boston,
Massachusetts, USA; 4Department of Radiology,
University Hospitals Case Medical Center, Ohio, Ohio,
USA
Correspondence to Dr M Chen, Department of
Neurological Surgery and Neurological Sciences, Rush
University Medical Center, 1725 West Harrison Street,
Suite 855, Chicago, IL 60612, USA;
michael_chen@rush.edu
Chen M, et al. J NeuroIntervent Surg Month 2015 Vol 0 No 0
This should be followed by a clear state-
ment conveying why the present work
under consideration was conducted. Next,
the hypothesis, or study aims, should be
carefully constructed and distilled down to
a relationship between well defined inde-
pendent and dependent variables. Hulley
et al3 suggests the use of the FINER cri-
teria in designing research questions,
which should be feasible, interesting,
novel, ethical, and relevant. Attali et al,4 in
a paper on follow-up imaging after flow
diverter treatment, provide a concise illus-
tration of an effective introduction.
The introduction should answer the fol-
lowing questions: What is being studied?
Why is it important to study this issue?
What is known about this subject prior to
the study under consideration? How will
this study advance our knowledge and
help patients?
Methods
The methods section should include suffi-
cient detail to allow reproducibility of the
study. The details of selection criteria and
data collection tools should be clarified.
Any new tests or measurement tools
should have some description of how they
were validated. All relevant variables,
including controls, intervention groups,
and outcome measures, must be clearly
defined. Additional measures taken to
minimize bias in selection criteria and
data gathering should be described. Data
collection protocols should be presented
and justification should be made for the
use of surrogate markers for dependent
variable.
The descriptive statistics used, including
qualitative analyses and/or statistical proce-
dures to determine significance, should be
concisely explained. With regard to statis-
tical analysis, it may be useful to engage a
trained statistician during the initial
research planning stage as well as during
the data analysis stage to ensure that appro-
priate statistical tests are being utilized.
Documentation of how research sub-
jects were protected and if the local ethics
board approved the study should be pro-
vided. Funding sources must be disclosed,
in addition to commercial biases.
Ladner et al,5 in a case series of spinal
Commentary
tumor embolization using a balloon cath-
eter, present a clearly written and suffi-
ciently detailed methods section.
The methods section should answer the
following questions: What study popula-
tions were evaluated? How was this study
designed? How were the data obtained?
How were the data analyzed?
Results
The results section is the most important
section of the manuscript. In this section
key results should be reported in a logical
fashion, beginning with the results which
are most important to the hypothesis
which is being tested. Negative results,
which are pertinent to the hypothesis
being tested, should also be reported.
Redundancy in the text should be avoided
by summarizing means and percentages
rather than reporting raw data that are
already presented in tables or figures.
Interpretation of the data should be
avoided in this section. Data should be
described in sufficient detail and appropri-
ately analyzed without rendering an
opinion about the meaning of the data.
For example, it may be insufficient to call
two groups significantly different.
It would be preferable to quantitatively
state the direction and magnitude of the
difference, including ORs, CIs, etc. Sun
et al2 present their results on radiographic
determinants of ischemic stroke outcomes
in a clear fashion with helpful statistical
analyses.
The results section should answer the
following questions: What are the results?
Are the results sufficient to answer the
hypothesis? Are the results presented in a
clear and simple fashion? Are the results
of statistical significance?
Discussion
The discussion section is where the results
should be interpreted, specifically in light
of what is already known about the
research question. This section should
begin with a summary of the study’s find-
ings. Next, how the results modify or
support what was previously understood
about the problem should be stated. The
discussion continues the argument that
was developed in the introduction and
uses the results to reach new conclusions.
A careful literature review yields import-
ant information that aids in data interpret-
ation. Therefore, citations are an expected
and necessary component in the discus-
sion. Ideally, a single paragraph should
contain the study limitations. Contrasting
the limitations with the study strengths
may make the overall results more accept-
able. Andersson et al’s6 article describing
1
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Commentary
their experience with mechanical thromb-
ectomy of acute basilar artery occlusions
includes a discussion that illustrates several
of the points mentioned above.
The discussion section should answer
the following questions: Did the results
accurately answer the hypothesis? Does
this research concur with what others
have shown? What are the study limita-
tions? Given the conclusions, what is the
new understanding of the problem? What
next steps may be warranted given these
conclusions?
Conclusions
In this section, findings are interpreted at a
higher level of abstraction than in the dis-
cussion section. The study’s significance
should not be overestimated. A conclusion
is a little different than a summary section
in that the writer is encouraged to state the
conclusions that are inferable from the
manuscript rather than simply restating the
results in an abbreviated form.
Things to avoid
In a large survey of BMJ editors, the most fre-
quently cited problems with inadequate
manuscripts were, in order: poorly written,
excessive jargon, inadequate/inappropriate
presentation, poor description of design,
excessive zeal and self-promotion, rationale
2 Chen M, et al. J NeuroIntervent Surg Month 2015 Vol 0 No 0
confused, essential data omitted, boring, and
important work of others ignored.7 Other
reasons for rejection in stroke journals
include: inappropriate or incomplete statis-
tics, over interpretation of results, inappro-
priate or suboptimal instrumentation, a
sample too small or biased, difficult to follow
writing, insufficient problem statement,
inaccuracy or inconsistency of the data
reported, incomplete, inaccurate, or outdated
review of the literature, insufficient data pre-
sented, and defective tables or figures.8
Minimizing these flaws while maximiz-
ing a clear and concise description of the
hypothesis being tested, the methods of
testing, the results of testing, and the
meaning of the results in the context of
prior knowledge will increase the likeli-
hood that the manuscript will be accept-
able for publication in JNIS.
Competing interests None.
Provenance and peer review Commissioned;
internally peer reviewed.
To cite Chen M, Albuquerque F, Hirsch J, et al.
J NeuroIntervent Surg Published Online First: [ please
include Day Month Year] doi:10.1136/neurintsurg-
2015-011670
Accepted 21 January 2015
J NeuroIntervent Surg 2015;0:1–2.
doi:10.1136/neurintsurg-2015-011670
REFERENCES
1 Brooks SD, Spears C, Cummings C, et al. Admission
neutrophil-lymphocyte ratio predicts 90 day outcome
after endovascular stroke therapy. J Neurointerv Surg
2014;6:578–83.
2 Sun CH, Connelly K, Nogueira RG, et al. ASPECTS
decay during inter-facility transfer predicts patient
outcomes in endovascular reperfusion for ischemic
stroke: a unique assessment of dynamic physiologic
change over time. J Neurointerv Surg 2015;7:22–6.
3 Hulley S, Cummings S, Browner W, et al. Designing
clinical research. 3rd edn. Philadelphia, PA: Lippincott
Williams and Wilkins, 2007.
4 Attali J, Benaissa A, Soize S, et al. Follow-up of
intracranial aneurysms treated by flow diverter:
comparison of three-dimensional time-of-flight MR
angiography (3D-TOF-MRA) and contrast-enhanced
MR angiography (CE-MRA) sequences with digital
subtraction angiography as the gold standard.
J Neurointerv Surg Published Online First: 28 Oct
2014. doi:10.1136/neurintsurg-2014-011449
5 Ladner TR, He L, Lakomkin N, et al. Minimizing
bleeding complications in spinal tumor surgery with
preoperative Onyx embolization via dual-lumen
balloon catheter. J Neurointerv Surg Published Online
First: 16 Dec 2014. doi:10.1136/neurintsurg-2014-
011505
6 Andersson T, Kuntze Soderqvist A, Soderman M, et al.
Mechanical thrombectomy as the primary treatment
for acute basilar artery occlusion: experience from
5 years of practice. J Neurointerv Surg 2013;5:221–5.
7 Byrne DW. Publishing medical research papers.
Philadelphia: Williams and Wilkins, 1998.
8 Alexandrov AV. How to write a research paper.
Cerebrovasc Dis 2004;18:135–8.
 Downloaded from http://jnis.bmj.com/ on November 14, 2015 - Published by group.bmj.com

Improving the likelihood of manuscript

acceptance; a primer for trainees and young
investigators
Michael Chen, Felipe Albuquerque, Joshua Hirsch and Robert W Tarr

J NeuroIntervent Surg published online February 9, 2015

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