This 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 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 The use of outdated and limited administrative databases was also recognized as a common flaw.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 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.