I could use some advice on a research question about getting published

[crocshagreen]

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This thread will probably let everybody know how clueless I am about research, but that's okay.

I am interested in doing a case study using the patients (and charts) of a local physician in town. I have the project in mind already, but what I don't know is what I will do when I get it done.

Does anybody know the steps I would need to take to get it published? How do I decide what journal it goes to? Do I need any special kind of approval to do a case study (something similar to IRB approval?) It would be an Ophthalmology paper, not that it matters. The physician that I work for has no interest in research and has no idea. And neither do I.

If anybody has an idea, or has any websites that would explain this to me, it would save me probably hours of googling. Thanks!

 

[WellWornLad]

You should really find someone at your school/hospital who does ophthalmology research to be a mentor. That's not to say they need to plan your study for you, but they can provide 3 critical services:

1) A mentor can tell you if the problem is interesting or not. Usually, that's the job of the PI/last author, but seeing as you don't really have one I'd be very worried whether the project you've chosen covers a problem (and is structured and executed in such a way) that is of relevance to the field. It's not as clear-cut as it sounds. Sometimes (most times?) people end up replicating results, do not go deep enough into a question, or use questionable methods that render the conclusion (and all your hard work) meaningless.

2) A mentor can read your manuscript and help edit from the perspective of a reviewer. If you don't get some serious input from someone knowledgeable before you submit your manuscript, you are going to get rejected. Scientific peers who review your manuscript during the publishing process are there to challenge the validity of your paper, not to be editors, and a manuscript in need of editing will be rejected despite wonderful ideas.

3) A mentor knows the literature and knows what journals are the best fit for submitting your manuscript. They also know people in the field. As part of the submission process, you usually have to provide a list of people who you think would make good reviewers for your particular paper, people whom the journal will contact and ask to review your manuscript. If you don't know anyone, you're going to be left scratching your head, and the journal is not going to find you very credible.

A mentor can also explain the publication process in more detail to you. Basically, you have to decide where to submit your manuscript, look up the format guidelines for that journal and make sure your manuscript is in adherence. Manuscripts basically follow a formula of

Introduction/Background
Methods
Results
Discussion/Conclusion
References

The manuscript draft is usually double-spaced, with 1" margins, 12 point font, with figures included at the end. Tags are used to indicate in the draft where figures go (e.g., [INSERT FIGURE 1 HERE]). There are a lot of other little details, you should google it or pick up an APA style book.

Once you have a manuscript, and you've edited it about 100 times or so, you'll submit to a journal. These days that can usually be done online, but it's possible that you may have to mail something in. Again, consult the journal that you're applying to.

Once the journal has your manuscript, they will enlist several people to review your manuscript. This can take a while, and you will not be able to submit your manuscript to other journals while it is in review - it is a serial process, one journal at a time. One of three results are possible:

1) Rejection. It happens, usually outright, but it can rarely occur after #2 below if people feel that you're not making progress.

2) Reviewer critiques. If the journal editors and reviewers feel that there is some merit to your study, but that it is lacking somehow, you will end up with a list of reviewer comments that you must address. So here you go back to the drawing board, trying to make the reviewers happy. Usually you have a deadline to complete changes. Resubmit your updated manuscript, this time with a separate document that addresses, point by point, each reviewer comment and how you addressed it (or why you didn't address it). You can disagree with a reviewer comment, but you had better have a good reason.

Almost every published paper goes through option #2. Further, once you send in your revised document, you can get a list of new critiques that you must then address in the same way.

3) Accepted. Very, very rarely happens without #2, usually only so if the work is just so damned important that it can't wait. If you struggle through #2, you should get here eventually. Just sit back and wait for the proofs to arrive. Go over the proofs carefully and identify any errors, cause that's the last time you have to really correct embarrassing typos.

IRB stuff should all happen before the research starts, and is the responsibility of yourself and whatever physician you are working with to get straight. If you're dealing with and/or seeing any sort of patient personal information (names, birthdates, SSNs) you will likely need IRB approval and human subjects training certification. In the manuscript you may write something like "This research was conducted under the approval of our IRB," but that's as far as it will go on the publication side of things.

 

[URHere]

I agree that if you have limited research experience, your chance of success is fairly slim without a mentor. As for the other issues you have mentioned, here is my opinion:

-First of all, if you are using several patients in your case study, you shouldn't run into HIPAA issues as long as you don't include any identifying information in your article. Mentioning an age group, disease, etc is almost always perfectly acceptable.

-As for the IRB, I am fairly certain that you would be exempt from review because your study will use pre-existing data. I would check the IRB website just to be sure.

-As for getting your study published, you may run into just a few hurdles.

1) If all of your data is coming from the records of one individual physician, the scope of your research is going to be very, very narrow. The papers with the best chance of publication cover a large group (the population of a state) or a widely applicable subgroup (medical professionals in a certain area).

2) It sounds awful, but several journals will be easier or harder when reviewing a paper depending on the name associated with it. Papers with the name of big shot researchers tacked on have a higher success rate, and that is not always because of the quality of the papers. It is just that reviewers tend to assume that established researchers have taken care of details even when they may leave them out of the manuscript. They do not make the same assumption for others.

3) Unless you have a strong background in epidemiology and statistics, you may need to find someone to help you out with that analysis. The majority of your effort should be spent on selecting appropriate controls for your study and doing their right analysis to compare them to your subjects of interest. This is another area where a mentor would be beyond helpful.

4) You need to figure out which journal you want to submit to. In almost every field, there are tiers of journals - everything ranging from the mecca of journals to the barely reputable. The lower you aim, the better your chances are to publish, but the less impact your work will have. You need to weigh those two factors carefully depending on how solid you think your research is. Also, some journals require a hefty fee even to submit an article for review, so be prepared for that.

5) You should probably present your work in a forum or poster setting before writing it up. This is an excellent chance to get real criticism, and to find out where your study's weak points are. It is invaluable to anyone who hopes to publish.

Anyway, I would suggest finding a mentor and checking out some Optho journals to see exactly what kinds of studies are being published. That will give you some idea of what to expect. Good luck!

 

[URHere]

Double Post.

 

[crocshagreen]

Wow those were some great responses. Thanks a lot. The process is a lot more clear now, although it also makes my idea seem less feasible. I guess the best thing for me to do would be to find someone already established in research and help them out, or have them help me. Realistically if I try to do it all by myself it probably won't work and I'll end up wishing in the end I had done things differently. Thanks again for the informative responses.

 

[Mr hawkings]

Wow those were some great responses. Thanks a lot. The process is a lot more clear now, although it also makes my idea seem less feasible. I guess the best thing for me to do would be to find someone already established in research and help them out, or have them help me. Realistically if I try to do it all by myself it probably won't work and I'll end up wishing in the end I had done things differently. Thanks again for the informative responses.

Let me offer some encouragement here. All the above posters would be right about finding someone established to attach yourself to if we were talking about basic science or clinical research.

You specifically asked about a case study. I have one published case study and have just submitted a second one. For both on them i was just a student that was shadowing a physician who pointed out some unique presentation of a disease state which is rarley seen. I asked if i could write a case study and i was granted permision. I just had to list the physician who helped me as a second author.
The format is a bit different from your typical research paper. You have an intoduction (optional depending on the journal) where you give a brief history of the disease and describe its usual presentation. This requires you to do a quick literature review and provide citations.

Then there the case presentation itself. Here, you describe the case and point out what makes this presentation unique or what treatment you used that was different from what is usually done and how it worked.
Of course, as long as you dont iclude any patient identifiers in your report, you should be fine. If you use any images, make sure that the patient info is not on it. If the patient's face is shown, then you need the patient to sign a consent form (ask the good folks at the hospital for this).

thats pretty much it.

Now, case reports are eitehr easy or hard to publish depending on the journal. So what you can do is, as you browse the journal website, somewhere on the homepage, they will have a "decription of the journal". included here will be an IMPACT FACTOR number. The lowe the mipact factor, the better your chance is to get something published as a student. You want something with an impact factor below 2. it might not be a sexy journal like NEJM but hey, they cant all be.

 

[URHere]

OP, just out of curiosity, were you planning to do a case study or a case control study?

I assumed that you wanted to do a case control study because you mentioned multiple patients, but if you are really only interested in discussing one or two patients with an unusual condition, then Mr. Hawkings' advice is probably more applicable to you.

Either way, good luck!

 

[bigpharmD]

1st...you will have to get IRB approval. It deals with patients charts.
2nd...decide what journal you want to try to publish in...look at their requirements (ie references, words, ets)

 

[crocshagreen]

Mr Hawkings:

Thanks for your reply. I hadn't even thought about doing that (case study involving one patient, rather than multiple), but it sounds like a great idea! And to be honest it sounds more interesting to me than digging through hundreds of patient charts.

And to all the others, I say again that I appreciate the advice. You took a lot of time to give me detailed responses, so thanks.