NEWS AND VIEWS FROM LATIN AMERICA
A Practical Roadmap for Writing of Medical
Scientific Publications
Manuel Francisco Ugarte-Gil, MD, MSc*† and Graciela S. Alarcón, MD, MPH, MACR‡§
Abstract: In this article, we are providing a general description of the pro-
cess of moving a research project from completion to publication; we are
describing the process of assigning authors, the drafting of the manuscript,
the review process, and how to respond to comments received from
reviewers and editors. This roadmap is meant to stimulate the scientific
productivity of junior researchers across the continent.
(J Clin Rheumatol 2018;00: 00–00)
ublications are said to be the “currency” for academic
P advancement. That is particularly the case in the United
States1; in general, most authors learn how to write publishable
material as they advance professionally.2 However, this is a
daunting undertaking for the uninitiated. There are numerous
publications about the importance and the modalities of teach-
ing scientific writing at different stages of training (medical
school, residency, fellowship, professional)3–8 and how to bet-
ter accomplish this task; however, which one works best is still
an unsolved matter.9 In such context, we would like to provide a
practical roadmap as to how to approach this objective, that is,
how to move from the finished research study to a publishable
manuscript (extended or concise reports). Other types of publi-
cations such as reviews, editorials, case reports, among others
are not considered in this article.
PRELIMINARY STEPS
By and large, most research studies being conducted today
are the result of a team effort. It is the team leader's responsibil-
ity, generally a senior faculty/researcher, to assign different as-
pects of the first draft writing to its members; this should
include a time table of deliverables. Matters such as authorship
and the order of the authors should be discussed at the outset of
the research project, but, if not done, or reconsiderations need
to be made based on the effort actually place in the project by
the different members of the team, this is the time to make final
decisions about this; this consensual process will prevent or
avoid potential problems between the authors. When the re-
search effort carried out by more than one of the team members
is comparable, all of them deserve to be recognized as “first
From the *Universidad Científica del Sur; †Department of Rheumatology,
Hospital Guillermo Almenara Irigoyen, EsSalud; ‡“Alberto Hurtado”
School of Medicine, Universidad Peruana Cayetano Heredia, Lima,
Perú; and §Division of Clinical Immunology and Rheumatology,
Department of Medicine, School of Medicine, The University of
Alabama at Birmingham, Birmingham, AL.
This article was partially based on a presentation at the XX PANLAR Congress,
Buenos Aires, Argentina, April 2018.
The authors declare no conflict of interest.
Correspondence: Manuel F. Ugarte-Gil, MD, Department of Rheumatology,
Hospital Guillermo Almenara Irigoyen, EsSalud, Av. Grau 800, La Victoria,
Lima 13, Lima, Perú. E‐mail: manuel_ugarte@yahoo.com.
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 1076-1608
DOI: 10.1097/RHU.0000000000000944
JCR: Journal of Clinical Rheumatology • Volume 00, Number 00, Month 2018
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
authors”10; the order in which their names will appear in the ar-
ticle should be decided at this time rather than later preventing
any discord between them. Another important consideration at
this point is to follow the guidelines for responsible authorship
as noted by the International Committee of Medical Journal
Editors.11 In this context, to give “honorary authorship” to in-
dividuals who have not been involved in the project, regardless
of their academic or institutional ranking,12,13 violates the rules
mentioned; likewise, collecting data, on and by itself, does not
qualify a team member for authorship. At this point also, the
group should select who will be the corresponding author, an
assignment most times given to the first author, which is usu-
ally the intellectual driving force of the research team or a
senior researcher, which usually is the last or senior author.14
Before the drafting of the manuscript starts, the group
must review all the data available and, on that basis, decide
on the message(s) to be conveyed, its importance, and rele-
vance. At this point, as well, the proper title of the manuscript
should be decided; the title should be concise, neither going be-
yond the data being presented nor being speculative, as it may
occur with abstracts presented at congresses. In fact, the title of
the manuscript does not have to be the same as the one in the
corresponding abstract. This is also the time to identify the tar-
get journal (national, regional, or international) for the manu-
script being drafted. Once the journal is chosen, the group
needs to be sure to follow the instructions for authors from
the selected journal and thus prevent some unintentional mis-
haps (ie, number of words or of references), which may result
in an automatic rejection without a review of the manuscript.
The number of potential journals has grown disproportionally
over the last decade or so; unfortunately, a significant number
of new journals fall within the category of “predatory,” that
is, they are not indexed, the manuscripts are, oftentimes, not
peer reviewed, and they charge for the publication.15 Needless
to say, publishing in such journals does not offer the authors
any points for their academic advancement.
THE DRAFTING PROCESS
How to next proceed with the writing is a matter that the
group should decide, but in our experience, the outline presented
in Table 1 has quite effectively served us for this purpose. In gen-
eral, drafting tables and figures should be the first step to be done
as the results are discussed by all group members. Both tables
and figures should be sufficiently informative, so they stand
out by themselves; once they are completed, drafting the actual
manuscript follows.
For the most part, we start the draft with the Results sec-
tion by describing the tables and figures (if any); such de-
scription should be quite parsimonious avoiding unnecessary
repetitions; the text should follow between and within the ta-
bles' sequence. The Methods section comes next and should
be clear and complete, yet concise. In clinical studies or sys-
tematic literature reviews, a flow chart is quite helpful to
clearly convey why and how many patients (or articles) were
www.jclinrheum.com 1
Ugarte-Gil and Alarcón JCR: Journal of Clinical Rheumatology • Volume 00, Number 00, Month 2018
TABLE 1. Systematic Approach for the Write Up of the First Drafta
– Choose the appropriate title
– Organize results in tables and figures
– Write the first draft (in this order):
• Results section (describe tables and figures)
• Material (Patients) and Methods
• Introduction section
• Discussion section
• Abstract
– Generate references (preliminary)
a methods are poorly described. Other reason that may prompt
Personal experience.
included or excluded. Only after this section is completed, we
follow with the Introduction, in which the purpose of the study
should be clearly established at the end of this section, and the
pertinent literature justifying the study prominently noted. The
Discussion section is next and should reinforce the study's re-
sults and place them in the context of the available literature;
very important components of this section are a listing of the
study's strengths and limitations; the discussion should end
up with conclusions, which should be data-driven rather than
being speculative; however, new studies can be suggested. Ab-
breviation overuse should be discouraged because it can make
it difficult to read the manuscript.
At this point, the References, which it is assumed are
well known to all team members, are assembled; they should
only be taken from the original sources. Unfortunately, that is
not always the case, and references taken from an erroneous
citation are not uncommon, an error that tends to be perpetu-
ated. In fact, in a study published years ago, it was reported
that up to 77% of the references were not cited from the orig-
inal source.16 We suspect that with the availability of search
engines, this should not be a problem at the present but have
no data to validate this assertion. Furthermore, the availability
of computerized programs such as Reference Manager or End-
note has facilitated the way in which all references are pre-
sented in a manuscript. As a rule, references that are not
retrievable using available search engines should not be in-
cluded as the reader will not be able to verify the information
being cited; this includes unpublished theses, personal commu-
nications, and out of print books or periodicals. Reliable Web
sites can be cited; in this case, the URL address and the date
when the site was accessed should be noted. At this stage, it
is also important to do an extensive, last-minute search to deter-
mine if new information related to the study has been pub-
lished. This may require modifying the Introduction and
Discussion sections. In addition, the style for citing the refer-
ences should be selected based on the intended journal.
The quasi-final step is to write the Abstract, which, if the
manuscript follows a previous meeting presentation, may be al-
ready written; however, the requirements for what is allowed in
a congress' abstract and what is allowed for a journal may be quite
different, and modifications should be made accordingly. At this
point, the manuscript is ready for submission; however, in our ex-
perience and that of other researchers, it is better to let the manu-
script sit for a few days and then re-read it; only then some
problems (syntax, grammar, style, etc), which were not “visible”
before, may become quite obvious. This is also the time to recruit
the assistance of a respected colleague, not a member of the group,
asking him/her to read the manuscript critically; this “unofficial
2 www.jclinrheum.com
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
reviewer” may provide valuable insight, and allow the group to
make some changes before the manuscript is actually submitted.
THE REVIEW PROCESS
Once the article is submitted, the authors and their work
enter the field of the editor and reviewers.17 Most journals
nowadays reject manuscripts outright, that is without sending
them out for review. Reasons for this could be purely of a
technical nature (incomplete manuscript, grammar and syntax
problems, exceeding number of words, and/or references
allowed, among others), because the manuscript does not fall
within the scope of the chosen journal, or because the
a rejection without review has to do with the ability to easily
verify similarities between the submitted manuscript and previ-
ously published articles; this could be autoplagiarism when
copying and pasting from the authors' own work or plain pla-
giarism when doing it from the work of others. We have also
encountered manuscripts written by commercial editing ser-
vices, which fail this check; moreover, it has been described
that using these services decreases the likelihood of publishing
in a high impact factor journal.18 If the manuscript is rejected
without review, the time from submission to decision may be
a few days to a week. For a full first review, it may take 2 to
3 months to receive the editorial decision, although now most
editors try to shorten this time; this is not always possible be-
cause the editors depend on the reviewers acting promptly,
which, unfortunately, is not always the case. If a rejection oc-
curs being at that point or after a full review, the group needs
to decide what is the next step on the process of publishing
the work. It should be noted that nowadays some journals only
accept 10% or less of submitted manuscripts19; however, up to
50% of rejected manuscripts are eventually published,20 and, in
general, the authors may choose a less prestigious journal
(lower impact factor) for their publication.
RESPONDING TO EDITORS AND REVIEWERS
Once the comments are received, they need to be exam-
ined very carefully by all members of the research group. It
has been recommended to not immediately address the com-
ments received, particularly if they are quite negative. Like
with the original manuscript, the comments should be exam-
ined carefully and then proceed to address them in a timely
manner. However, if the manuscript is to be submitted to a
different journal altogether, the authors need to decide if they
want to address or not the points raised by the reviewers. If
resubmitting to the same journal, addressing all points, even
those that the authors feel they are not valid, is a must. Again,
TABLE 2. Seven Capital Sins in the Preparation of a Scientific Articlea
– Manuscript does not follow the instructions for the specific journal
being considered
– Conflicts of interest
– Plagiarism
– Duplication
– Autocitations
– Data manipulation
– Individuals not fulfilling criteria for authorship are included
a
Modified from: Svad I. The seven deadly sins writers of academic pa-
pers should avoid. European J Gen Pract. 2017;23:254–256.
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
JCR: Journal of Clinical Rheumatology • Volume 00, Number 00, Month 2018
the authors should work under the assumption that “the editor
and the reviewers are always right.”
Most journals allow 8 to 12 weeks for a revised manu-
script to be received, although they may allow more time under
extenuating circumstances. During this time, the group should
decide if additional analyses are needed, execute them if that is
the case, and then proceed to modify the manuscript accord-
ingly. In our experience, it is better to work side by side on
both, the letter of response to the editor(s) and reviewers and
the manuscript itself, rather than to modify the manuscript
and then write the response letter. The other alternative is to
draft first the response letter, and then work on the manuscript,
but consistency between both documents should be double
checked. Once the revised manuscript is accepted, the authors
are responsible for checking its accuracy; to that end, the corre-
sponding author receives the galley proofs, which should be
carefully checked. Special attention should be given to tables
and figures as well as to the references. Once the article is pub-
lished, it is made available to the author(s) as a PDF (portable
document format); it is recommendable to, in turn, make this
PDF available to the research community using a portal such
as Research Gate or others, but this should be done responsibly,
in line with copyright. Of note, this has rendered reprints obso-
lete to say the least; they, by and large, are no longer used
or requested.
As final comments, there are several no's regarding publi-
cations; they have been called capital sins21 (Table 2), and they
should be completely avoided. The major sin, and one which
has brought disgrace to some investigators, is plagiarism, as
discussed previously; another which has had the same effect
in researchers, particularly to senior authors publishing work
from their graduate students or trainees which has not been ad-
equately supervised, is the publication of fake or fraudulent
data or experiments/trials, which have never taken place to be-
gin with.22 This has resulted, over the last few years, in an
increase in the number of retractions being published.23 Like-
wise, there are 7 major steps to consider for the successful
way to move research into a publication.24 They are noted in
Table 3. In addition, there needs to be protected time for writing
just like there should be to conduct research; such time should
be free of interruptions, so the researcher can concentrate on
this task.25
TABLE 3. Seven Steps to Follow to Publish a Scientific Articlea
– Be sure the manuscript is ready
– Select the appropriate journal
– Carefully revise the instructions for authors for the chosen journal
– Be sure the title of the manuscript reflects the work done
– If possible, have the manuscript reviewed by a native speaker
(if publishing in a different language) and for someone not involved
in the project
– Prepare a letter emphasizing what is important about the manuscript
being submitted
– Finally, respond appropriately to the comments from the reviewers
a
Modified from: Seven steps to publishing in a scientific journal.
Elsevier. Available at: https://www.elsevier.com/connect/7-steps-to-pub-
lishing-in-a-scientific-journal. Accessed June 4, 2018.
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Writing of Medical Scientific Publications
CONCLUSIONS
Presenting the results of a research project at national or in-
ternational congresses provides some visibility to the research
group but has no lasting effect unless the presentation is followed
by a publication, which for the uninitiated can be a daunting task.
In this article, and based on our own personal experience, we pro-
vide a practical roadmap on how to move from the finished
research project to a publishable manuscript.
ACKNOWLEDGMENTS
The authors thank Renato D. Alarcón, MD, MPH, for his
comments to an earlier version of this manuscript.
REFERENCES
1. León-de la O DI, Thorsteinsdóttir H, Calderón-Salinas JV. The rise of
health biotechnology research in Latin America: a scientometric
analysis of health biotechnology production and impact in Argentina,
Brazil, Chile, Colombia, Cuba and Mexico. PLoS One. 2018;
13:e0191267.
2. Mbuagbaw L, Morfaw F, Kunda JE, et al. Tips for charting the course of
a successful health research career. J Multidiscip Healthc. 2013;
6:163–168.
3. Azer SA, Dupras DM, Azer S.Writing for publication in medical
education in high impact journals. Eur Rev Med Pharmacol Sci. 2014;
18:2966–2981.
4. Honeycutt K, Latshaw S. Incorporating a structured writing process into
existing CLS curricula. Clin Lab Sci. 2014;27:194–203.
5. Ariail J, Thomas S, Smith T, et al. The value of a writing center at a medical
university. Teach Learn Med. 2013;25:129–133.
6. Hesselbach RA, Petering DH, Nerg CA, et al. A guide to writing a scientific
paper: a focus on high school trough graduate level student research.
Zefrafish. 2012;9:246–249.
7. Corrales-Reyes IE, Dorta-Contrears AJ. Students scientific production:
a proposal to encourage it. Medwave. 2018;18:e7166.
8. Hoogenboom BJ, Manske RC. How to write a scientific paper. Int J Sport
Phys The. 2012;7:512–517.
9. Mazmanian PE, Coe AB, Evans JA, et al. Are researcher development
interventions, alone or in any combination, effective in improving
researcher behavior? A systematic review. Eval Health Prof. 2014;
37:114–139.
10. Akhabue E, Lautenbach E. “Equal” contributions and credit: an
emerging trend in the characterization of authorship. Ann Epidemiol.
2010;20:868–871.
11. Uniform requirements for manuscripts submitted to biomedical journals.
International Committee of Medical Journal Editors. New Eng J Med.
1991;324:424–428.
12. Kalichman MW. Overview: underserved areas of education in the
responsible conduct of research: authorship. Sci Eng Ethics. 2011;
17:335–339.
13. Gasparyan AY, Ayvazyan L, Kitas GD. Authorship problems in
scholarly journals: considerations for authors, peer reviewers and
editors. Rheumatol Int. 2013;33:277–284.
14. Tscharntke T, Hochberg ME, Rand TA, et al. Author sequence and credit
for contributions in multiauthored publications. PLoS Biol. 2007;
5:e18.
15. Gasparyan AY, Yesirkepov M, Gerasimo AN, et al. The pressure to
publish more and the scope of predatory activities. J Korean Med Sci.
2016;31:1874–1878.
16. Ball P. Paper trail reveals references go unread by citing authors. Nature.
2002;420:594.
www.jclinrheum.com 3
Ugarte-Gil and Alarcón JCR: Journal of Clinical Rheumatology • Volume 00, Number 00, Month 2018

17. Yarris LM, Gottlieb M, Scott K, et al. Academic primer series:
key papers about peer review. West J Emerg Med. 2017;
18:721–728.
18. Paiva CE, Araujo RL, Paiva BS, et al. What are the personal and
professional characteristics that distinguish the researchers who
publish in high- and low-impact journals? A multi-national
Web-based survey. Ecancermedicalscience. 2017;11:718.
19. Denial A. What are the characteristics of a manuscript acceptable for
publication. Optometric Education. 2014;39:98–99.
20. Ray J, Berkwits M, Davidoff F. The fate of manuscripts rejected
by a general medical journal. Am J Med. 2000;109:131–135.
21. Švab I. The seven deadly sins writers of academic papers should avoid.
Eur J Gen Pract. 2017;23:254–256.
22. Dingel JD. Shattuck Lecture-Misconduct in medical research. N Engl J
Med. 1993;328:1610–1615.
23. Steen RG. Retractions in the scientific literature: do authors deliberately
commit research fraud? J Med Ethics. 2011;37:113–117.
24. Shaikh AA. Seven steps to publishing in a scientific journal. Elsevier.
Available at: https://www.elsevier.com/connect/7-steps-to-publishing-
in-a-scientific-journal. Accessed June 4, 2018.
25. Sackett DL. On the determinants of academic success as a
clinician-scientist. Clin Invest Med. 2001;24:94–100.

4 www.jclinrheum.com © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.