Layout 1

eer reviewed publications are neces-

sary for dissemination of research

and scholarship. No discipline can thrive

without creating new knowledge to solve

existing or emerging challenges. All

healthcare professions must strive to im-

prove the health and wellness of our soci-

ety, and pharmacists play a crucial role in

enhancing the quality of pharmacothera-

py. We improve outcomes through re

search, education, and patient care, and

our experiences are shared with the glob-

al community primarily through peer re-

viewed research papers, review articles,

and case reports.

I wrote my first research article for publication during

the completion of a clinical pharmacy residency in 1977.

Having w

ritten a thesis for my undergraduate pharmacy de-

gree and then for MS and PharmD degrees under the guid-

ance of academic advisors gave me some confidence in writ-

ing, and the critical comments of my residency director on

the drafts of the article were important in having it accepted

for publication. I have also had opportunities to serve as a ref

eree for articles submitted to various journals and as an editor

for making decisions about acceptance or rejection of articles

for publication. Through this editorial, I hope to share some

of my experiences and provide some tips about writing arti

cles for publication in peer reviewed journals, especially

The

Annals

. Although the content may appear self-evident to ex-

perienced authors, it should be useful for newer writers.

Why Bother to Publish an Article?

My motivation to write articles for publication has al

ways been the belief that they will contribute to existing

knowledge and thus improve patient care. The principal

reason for many is the desire to share information about

which they are passionate. Sustained contributions to the

literature also bring recognition to an individual and thus

help advance one’s career. A publication record is a key in

receiving competitive grant funding and promotions and

establishing one’

s reputation in the field. Published experts

may also be more likely to be appointed to prestigious na

tional committees and elected to national offices than are

those who have not published. These experiences enrich

professional development and can further strengthen the

standing of the individuals within the discipline. One rea-

son for this recognition is that published authors have de-

fended their arguments through peer reviews and have re-

ceived the endorsement of other authors and experts in the

field.

What is the Key to Successful Writing?

Knowledge of the subject is essential, but the critical re

quirements to become a published author are strong inter-

est or passion; drive and commitment; the ability to work

effectively with, and learn from, experienced authors; and

Tips for Writing and Publishing an Article

Milap C Nahata

Author information provided at the end of the text.

The Annals of Pharmacotherapy

2008 February, Volume 42

273

www.theannals.com

Peer reviewed publications are the primary source of important new information.

This editorial provides tips for writing various sections of research papers, review

articles, and case reports. Additional topics discussed include making decisions

about authorship, selecting a journal for submission of an article, understanding

the peer review process and expectations of editors and reviewers, and revising

the article. Successful authors combine appropriate knowledge and experience,

personal attributes, and effective collaborations to produce insightful and

important contributions to the literature.

KEY WORDS: authorship, peer review, publication.

Ann Pharmacother

2008;42:273-7.

Published Online, 22 Jan 2008,

www.theannals.com

, DOI 10.1345/aph.1K616

persistence. One must also write frequently and regularly

(eg, every few weeks) rather than making one concentrated

effort during each year.

What do Editors and Reviewers Expect?

Regardless of the type of article, authors must clearly

justify the need for its publication.

The Annals’ submis-

sions are reviewed for clinical significance, originality or

uniqueness, accuracy, reproducibility, timeliness, quality,

clarity, and conciseness. The most important questions to

ask before you begin writing are, “What would this article

add to existing knowledge in the literature?”; “How signif-

icant is the message being conveyed by the article to im-

prove the understanding of pharmacotherapy?”; and “How

would this information change patient care?”

Deciding on Authorship

The article’s list of authors and the order in which they ap-

pear should be decided based on relative contributions to the

work, not politics. Most peer reviewed journals, including

The Annals, follow the Uniform Requirements for

Manuscripts Submitted to Biomedical Journals

(www.icmje.

org) for authorship. As described in our Author Guidelines,

authorship is based on the contributions made by authors

to project conception/design; collection, analysis, and/or

interpretation of data; drafting or revision of the article;

and approval of the final version. The person listed first is

considered the primary or lead author and has generally

done more work than the other authors. The corresponding

author is often the senior author (eg, preceptor or program

director), who usually submits the article to the journal, re-

ceives correspondence from the editor, and is responsible

for revision of the article and correction of galley proofs.

The corresponding author is often listed either last or sec-

ond among all authors.

It is critical to decide authorships and specific contribu

tions that each author will make to the project or article be-

fore initiating the work. This does not seem to happen in

many cases because it may be uncomfortable to discuss this

issue, but it will be just as uncomfortable at the end of the

writing process as it is at the beginning. An initial discussion

about authorship should also clarify responsibilities so that

the lead and senior authors can hold colleagues accountable.

Failure to address this issue when the team starts work can

result in unjustifiably listing some collaborators as authors,

while others may not be listed when they should have been.

Although most collaborations are positive experiences, I

have heard a few arguments such as, “You list me in your pa-

per, and I will list you in mine,” “Let’s have a rotating author-

ship order

,” “I need it more than you until I am tenured or

promoted,” “I deserve it because these were my patients,” “I

am the director,” or “I am the principal investigator on the

project,” even though the individual did not meet the require-

ments for authorship of the specific article. Support of certain

individuals who have assisted, but do not meet authorship re-

quirements, can be acknowledged in the report without them

being listed as authors.

Preparing an Outline

Once a topic has been selected, the first step should be

to prepare an outline of sections and subsections of the ar-

ticle. This should be done in consultation with an experi-

enced author and is extremely helpful in defining the arti-

cle’s scope and focus and organizing the content. Experi-

enced authors can envision the finished article before they

begin writing it, and this serves as a guide to new writers.

Writing an Introduction

In this section, The Annals expects you to clearly pre-

sent the rationale and justification for the study to improve

patient care. In 1–2 pages, you must answer questions such

as why the subject is important, what has been done in key

published studies or articles, what the gaps are in current

knowledge, what your rationale was for undertaking this

project, and what your specific objectives were for the

study or article. A hypothesis should be presented for a re-

search study. Similarly, the need for a review article or a

case report, given what has already been published in the

area, should be articulated in this section. Failure to do so

leads one to assume that this is just a “me, too” article, and

this dampens the enthusiasm of a reviewer and editor.

Writing Methods, Results, and Discussion

Sections of a Research Article

A basic principle of science is that findings must not be

due to chance and should be reproducible. This requires a

complete description of the methodology

, types of patients

enrolled, tests, procedures, interventions, analyses, and

outcomes used in the study. Common major problems of a

research paper’s Methods section are: it is incomplete,

sample size (number of patients or observations) is too

small, accuracy and precision (reproducibility) of mea-

surements are not documented, methods or tests used for

data collection or analyses are unclear or inappropriate,

and definitions of outcomes (eg, cure, improvement, fail

ure) are vague. Special mention is needed regarding the

sample size. Reviewers expect that the researcher has in-

cluded a power estimate to increase the likelihood that sta

tistically significant findings will result from the study.

Also, observational studies that use existing databases

should adjust for treatment selection. Of course, institu-

tional review board (IRB) approval of the project should

be documented.

274

The Annals of Pharmacotherapy

2008 February, Volume 42

www

.theannals.com

MC Nahata

The Results section may suffer from incomplete or in-

ppropriate presentation of all relevant data and incorrect

attributions or correlations of data. If the lead or senior au-

thors do not have a statistical background, a statistician

must have been consulted for both design and analysis of

data. Tables and figures are often more effective than a

long text narrative to present certain data, and duplication

between data presented in text and tables/figures should be

minimized. Statistical testing of significance such as p val-

ues, confidence intervals, odds or hazard ratios, or relative

risks should be included as appropriate.

In the Discussion section, one should not present results

again, but rather interpret the results, compare the data

with those in previous studies, highlight the clinical signifi-

cance of the results, and reach defendable conclusion(s).

However, reviewers will not be impressed if the authors

over-interpret the data and fail to consider the study limita-

tions. Finally, the authors should briefly indicate what fu-

ture studies may be undertaken to advance the knowledge

in the area.

Writing a Review Article

One must decide the scope of a review article, such as

“treatment of hypertension” versus “treatment of hyperten-

sion with angiotensin-converting enzyme inhibitors in pa-

tients with type 2 diabetes.” The authors must also ask

questions including, “Why is a review article needed?”;

“How will this review article be unique in comparison

with other published articles?”; and “Would you, along

with coauthors, be able to critically review and interpret

the literature and apply current knowledge to patient

care?” Criteria in selecting articles for review, such as re-

search studies alone or research studies plus meta-analy-

ses, should be clearly explained; the inclusion of case se-

ries or case reports should be justified. After collection of

the literature, I suggest thoroughly reviewing each article,

highlighting the key findings with a yellow marker or un-

derlining, interpreting the results, and then writing a brief

paragraph about its impact on practice.

The next important step before writing the text should

be to prepare table(s) of existing studies. Preparing tables

before writing the text allows for an overview of the exist-

ing literature. Tables should include demographic data on

patients, sample size, study design, drug regimens, concur

rent drugs and diseases, and efficacy and safety outcomes

data along with p values or confidence intervals. The text

should complement tables by interpreting the data and

highlighting the main findings; trends observed; strengths,

weaknesses, and dif

ferences among studies; and their im

pact on patient care. The text should be divided into sec-

tions to improve readability and comprehension. For ex-

ample, an article on a new drug may have sections on in-

troduction, data sources, pharmacology, pharmacokinetics,

clinical trials, adverse effects, drug interactions, precau-

tions and contraindications, dosage and administration,

cost, and summary. Limitations of the literature should be

discussed.

Writing a Case Report

A case report should present a new, unique, or unusual

observation in one or a few patients. The term “case se-

ries” is used when a group or series of patients who had re-

ceived similar treatment are being reported in an article

with detailed information on each patient. It should present

both subjective and objective data about the patients and

events of the clinical courses. The Naranjo scale for assess-

ing an adverse event or the Drug Interaction Probability

Scale (DIPS) for assessing a drug– drug interaction should

be applied as appropriate to ascertain the causality between

the drug and clinical outcome. Approval from the IRB

should be sought if required by the institution (our medical

center requires an approval for a case report because of the

obvious Health Insurance Portability and Accountability

Act concerns).

The Methods and Results sections that appear in a re-

search article are combined and presented under the head-

ing Case Report for this type of article. This section pro-

vides a chronologic account of relevant details of events

and outcomes that occurred in a patient. A table or a figure

may be used to effectively present the course of events.

The Discussion section of a case report is similar to that of

a research article.

Listing of References

The Uniform Requirements for Manuscripts Submitted

to Biomedical Journals

is a set of style and referencing

standards used by most healthcare-related journals, includ-

ing The Annals, as a basis for for

matting reference lists.

Common problems encountered with references include

the following: important studies may have been excluded

or unnecessary studies may have been included, recent ref

erences are not incorporated, references are incorrectly cit-

ed within the text or in the reference list itself, the Discus-

sion section is unclear about which results are attributed to

each reference, and primary references are not cited for

factual statements or specific data. As an example, a review

article may be cited for general background about a disease;

however

, primary references should be cited for statements

comparing efficacy rates of 2 drugs to treat a disease. Refer-

ences cited in tables and figures should also be cited in the

text. “Citing Medicine” is a free online guide published by

the National Library of Medicine for citing published print

documents (eg, jour

nals, books, conference publications, sci

entific and technical reports, dissertations and theses, patents,

newspaper articles), unpublished material (eg, “in press”

Tips for Writing and Publishing an Article

The Annals of Pharmacotherapy

2008 February, Volume 42

275

www

.theannals.com

publications, papers and posters presented at meetings, per-

sonal communications), audio and visual media, and material

on CD -ROM, DVD or disk and the Internet (www.ncbi.nlm.

nih.gov/citingmedicine). The search of references should be

repeated prior to submission of an article and throughout the

manuscript review and revision period to ensure inclusion of

all relevant literature. Authors have the responsibility to en-

sure the accuracy of content of all cited references.

Writing an Abstract

The 2 most common problems I have encountered with

abstracts are: they can be too brief and not present a com-

plete, balanced picture of the article; and the data or claims

can be inconsistent with those presented in the text of the

article. Those first encountering the article usually read the

abstract and then decide whether to read the full article

and/or use it in their own work or manuscript. In a research

article, the Methods and Results sections of an abstract

should comprise the majority of the material. In a review

article, the Data Synthesis portion of the abstract requires

more space than other sections to highlight the critical

analysis and interpretation of the literature. I am often sur-

prised to see that the Conclusions section of an abstract is

larger than its Results or Data Synthesis sections. Finally,

one must always confirm the consistency of data presented

in the abstract, text, tables, and figures. I prefer to write an

abstract after the article itself has been written.

Writing a Letter

If one can briefly describe an observation in a patient,

the results of a pilot study, or comment on an important

professional, scientific, or regulatory issue related to phar

macotherapy in up to about 2 pages, an author’s findings

may be published as a letter

. A letter may also be written in

response to a recently published article in

The Annals if

doing so would add a substantive comment. If the subject

is extensive, it may be considered for publication as a

longer commentary or a special article. The Naranjo and

DIPS probability scales should be used to describe an ad-

verse event and drug interaction, respectively.

Critically Reviewing, Revising, and Reflecting

The quality of all articles can be improved after critical

internal review by coauthors and others. Being “critical” is

the key; you need individuals who can set aside their study

involvement and ask tough questions to improve the paper.

Some authors have a tendency to submit an article prema

turely

, which generally leads to rejection by a jour

nal. In

instances where a revision is required, the authors should

address all questions from inter

nal reviews and highlight

changes in the revised manuscript. After being completely

satisfied with the article, authors should reflect on it for

7–10 days, revise the article again, and address responses

to reviewers as needed. They are likely to find additional

ways to enhance the quality and clarity of the article before

journal submission.

Choosing a Journal

There are many choices when deciding where to submit

an article for publication. Important questions to consider

are: Is the journal peer reviewed? Is it indexed in MED-

LINE? Who needs to read the article to change practice

(eg, if pharmacists need to read the article, select a phar-

macy journal; if the article would benefit cardiologists,

choose a cardiology journal)? Is the journal a good match

for your article? Has the journal published related articles?

How long does it take to get an article published by the

journal? Is the journal well respected in its field? Unless

the journal is readily accessible via common search tools

such as MEDLINE or Google, the article will not be as ac-

cessible to others for use and future citations. Consulting

senior colleagues and coauthors can be helpful, and per-

sonnel at

The Annals can also address certain questions.

Publication in a peer reviewed journal is critical, as you

will receive comments from expert reviewers or referees

and have an opportunity to improve the quality of the arti-

cle. Peer reviewed articles are given more credence after

publication. My articles have always benefited from the

peer review process.

One objective criterion used to assess the quality of a

journal is its impact factor. The most recent impact factors

available for jour

nals are for 2006. These were calculated

by dividing the total number of citations to articles pub-

lished in the journal during 2004 and 2005 by the total

number of articles published by the journal during the

same 2 year period. The higher the number, the better it is

(the impact factor for

The Annals was 1.87 in 2005 com

pared with 2.27 in 2006). Impact factors have important

limitations, including the fact that a journal’s impact factor

alone does not directly indicate the value of a specific pub-

lished article. However, since promotion and tenure pro-

cess and grant application reviews may consider impact

factors in their evaluations, authors should consider such

factors when selecting a jour

nal for publication. Choosing

a specific journal early in the preparation of an article is

helpful in adapting it to that jour

nal’

s for

mat.

Preparing a T

itle Page

Most journals require that the Title Page include a title,

authors, affiliations, sources of support, conflicts of inter-

est, running head (shorter version of a title), key words,

word counts, and contact information about the corre-

sponding author. The title and key words must be chosen

276

The Annals of Pharmacotherapy

2008 February, Volume 42

www

.theannals.com

MC Nahata

carefully so that the article can be identified by searches

through PubMed, MEDLINE, or Google. If an article is

not identified in a literature search, it will not be read, used,

or cited by others.

Submitting to the Journal

A common problem we have encountered at The Annals

is that authors do not always follow the Author Guidelines.

Authors should make certain that the article has been pre-

pared in conformance with the journal’s requirements and

ethical standards. A brief cover letter should be included

with the submission highlighting the importance of the

work, ensuring that the article has not been submitted else-

where, and stating that all authors have approved the arti-

cle. A copyright transfer form signed by all authors must

also be submitted.

The Annals prefers to receive all sub

missions electronically via its Web site except for the

The Review Process for Articles

Each article is first reviewed internally by The Annals’

editors; those of sufficient quality are subsequently sent to

3– 4 exter

nal referees. This process usually takes about a

month and is the basis for making a decision to either ac-

cept the article pending revision or to reject it. In either sit-

uation, after external review, the corresponding author re-

ceives the comments from referees and the editor. When a

revision is required, we request a revised manuscript with-

in a few weeks so that the article can be published in a

timely manner.

Revising the Article

Some comments from referees can be difficult to ad-

dress, but all issues should be taken constructively by the

authors. Here, the advice and support of more experienced

authors or colleagues can be invaluable to put the reviews

in context. The manuscript should be revised to address

referee comments, and authors should provide an explana

tion of how these issues were incorporated, including any

disagreement with reviewers. It is important to be respect

ful of reviewers, as they invest their time voluntarily, and

generally with significant commitment. They share our

goal to publish the highest quality manuscripts to influence

pharmacotherapy and to reflect favorably on both the au-

thors and the journal.

Proofreading and Updating the Galley

After the revised article has been accepted and edited,

the galley proof (edited document) is sent electronically to

the corresponding author; however, all authors should re-

view the galley and provide comments or corrections to

the corresponding author. The galley text is exactly what

the article will say when published, so all corrections need

to be made by the authors at this stage. It is important to

carefully review these documents, including the text, ta-

bles, figures, and reference citations, and answer all ques

tions raised by the editor. Changes made by the manuscript

editor to correct errors or enhance clarity should be accept-

able to authors as long as the meaning of original wording

is unchanged. Extensive changes to the article should not

be made by the authors at this stage; however, any impor-

tant new data published since acceptance of the article

should be added to ensure publication of the most up-to-

date article possible. These final changes should be made

by the authors in a timely manner so that the article can be

finalized and published expeditiously.

In summary, peer reviewed publications are essential for

dissemination of important information through research

papers, review articles, and case reports to improve patient

care. Motivated clinicians have been successful authors

through their personal commitment, ef

fective collabora-

tion, and attention to various steps involved in the publica-

tion process. Each subsequent publication will provide

confidence and professional rewards. We invite you to

consider

The Annals for submission of your manuscripts.

Milap C Nahata MS PharmD, Editor-in-Chief,

The Annals

; Profes-

sor and Division Chair, Pharmacy Practice and Administration, Col-

lege of Pharmacy, and Professor of Internal Medicine and Pediatrics,

College of Medicine, The Ohio State University, 500 W. 12th Ave.,

Columbus, OH 43210, fax 614/292-1335.

Reprints: Dr. Nahata

Tips for Writing and Publishing an Article

The Annals of Pharmacotherapy

2008 February, Volume 42

277

www

.theannals.com