How Do I Get a Paper Accepted?—Part 2
this Page, I will present 10 specific recommendations to implement (stratagems) or avoid
(pitfalls) in preparing a paper.
1. Pose a hypothesis. The consensus of the editors is that the best manuscripts
attempt to answer a specific question or achieve a specific goal. If possible, avoid purely
observational or descriptive reports, sometimes referred to as “phenomenology.” Studies
that are primarily descriptive achieve higher priority for publication if they identify a
mechanism or generate a hypothesis.
2. Document novelty. Given the importance of novelty, it follows that good
manuscripts state that they are the first on the topic or emphasize what is new in their
work. If previous studies have been published on the same topic, the editors felt it was
of value to distinguish the results of the present investigation.
3. Describe methodology in detail. The editors agreed that a detailed description
of methodology enhanced the priority for publication. The accuracy of the methods
ought to be validated. Patient acquisition should be addressed in depth, and the
appropriateness of the study group established. The best studies specify how
ascertainment bias was avoided. Control groups are of critical importance. The editors
identified failure to include a control group as one of the most common serious
methodological defects observed in manuscripts. The use of outdated and limited
administrative databases was also recognized as a common flaw.
4. Provide power calculations. All agreed with the importance of providing an
in-depth explanation of how the sample size for a study was calculated. The best
explanations include a specification of the data or assumptions upon which power
calculations are based.
5. Don’t slice the data too thin. The editors emphasized that one comprehensive
paper is much stronger than several smaller ones. Although being too broad and
unfocused results in a lower priority for publication, “salami science,” or the division of
one project into as many “minimal publishable units” as possible is the much more
common error. Given the increasing number of randomized multicenter clinical trials,
this becomes a frequent issue for substudies. In such instances, the best papers make a
strong argument for the importance of the individual subgroups they are reporting.
6. Perform careful analysis. Having asked a novel question and applied excellent
methodology, some manuscripts then suffer from faulty analysis. One of the frequently
encountered problems is the failure to distinguish causality from association. It is
important not to assert causality when only an association has been demonstrated. A
similar pitfall is to fail to recognize and acknowledge the limitations of surrogate end
points, or to assert that a surrogate represents a final end point. Premature ventricular
contractions failed miserably as a surrogate for mortality when their therapy was tested
his is a continuation of last month’s Editor’s Page presenting the consensus
opinions of the Journal of the American College of Cardiology (JACC) editors
regarding how to prepare a manuscript to optimize chances of acceptance. In
Anthony N. DeMaria,
Journal of the American
College of Cardiology
Journal of the American College of Cardiology
© 2007 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 49, No. 19, 2007
in the CAST trial. In the same vein, the best manuscripts are careful to differentiate
statistical significance from biological significance. A prominent p value does not
necessarily imply an important clinical difference.
7. Craft the discussion. There was near consensus that it was of great value for a
manuscript to present all of the important results in the first paragraph of the discussion.
It was felt that this brought focus to the findings and set the tone for the rest of the
discussion. Likewise, the editors agreed that it was a mistake to merely repeat a
recitation of the results in the discussion. This segment of the manuscript should deal
with potential explanations, clinical implications, and so on. In this regard, the best
papers provide a scholarly review of the literature and place the current findings in
perspective. Sometimes simple things matter; the editors stressed that a discussion of
reasonable length and correct grammar and syntax add strength to a manuscript.
8. Create good figures and legends. Although we do not know why, the figures and
legends are often overlooked in the preparation of manuscripts. It is not uncommon for
figures and legends to make or break a manuscript for publication. Illustrations should
unequivocally display the findings alleged. In addition, the findings should be well
illustrated by arrows, labeling, or other designations. Further, legends should clearly
explain the figures. Having said this, it is important to limit figures to those necessary.
9. Package the manuscript. Several aspects of the preparation of the final manuscript
merited comment. The title sets the stage for reading the paper, and the editors
emphasized the importance of selecting an appropriate title. “Too cute” titles or those
that do not convey the true nature or most important aspect of the work detracted from
the perception of the article. A similar statement could be made for the running title
and abstract. These aspects of the paper are often done without the same attention given
to the manuscript, although they are the first parts seen by the reader. After publication
the abstract is (unfortunately) sometimes the only part of the paper that is read. Finally,
the length of the author list is a small thing that can contribute to the impression of the
paper. Those studies in which the number of authors exceeds the number of patients
have difficulty achieving priority for publication.
10. Overrated strategies. A number of actions which are often taken in the belief
that they will enhance the acceptability of a manuscript are greatly overrated. A lengthy
cover letter that describes the novelty or importance of a study is of little value if that
information is not contained in the manuscript. Great emphasis is often given to the
fact that the data were presented at a meeting or supported by a grant. However,
presentations are quite different than the peer-review process, and even prestigious grants
do not guarantee excellent work. As has been mentioned before, cute titles or the
construction of a catchy eponym may reflect positively or negatively upon the paper.
I believe it is well-appreciated by experienced investigators that a published original
research paper involves both science and art. Clearly a well-planned and executed project
will address most potential manuscript pitfalls. However, the preparation of the
manuscript does matter, and it can make the difference between acceptance or rejection.
In these last two Editor’s Pages I have conveyed issues that the editors of JACC have
found of importance in the preparation of a paper. Other editors might well emphasize
different issues. However, all would agree that the thoughtful presentation of a good
project will virtually always result in a manuscript that is accepted for publication.
Address correspondence to:
Dr. Anthony N. DeMaria
Editor-in-Chief, Journal of the American College of Cardiology
3655 Nobel Drive, Suite 400, San Diego, California 92122
JACC Vol. 49, No. 19, 2007
May 15, 2007:1989–90