editing process

Breaking It Down

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When you pick up a book you haven’t yet read, do you immediately turn to page 1 and begin reading? Or, do you check out the front cover design to see if the book looks interesting? What about the back cover?

Most stories are broken down in many ways to hook the audience. It’s fairly standard that a book has a promotional blurb on the front cover, a tagline, a 1-sentence summary on the back, a slightly longer summary on the back, and, yes, more promotional blurbs on the back and inside the front cover. Perhaps you learned of the book through a social media post or through a review. What grabs your attention may not grab someone else’s, so breaking a story down in various ways makes it appeal to a larger audience.

The same can be done with scientific research articles. The main text typically follows the IMRAD format (introduction, methods, results, and discussion) to clearly and fully tell the story. The authors detail why they performed the research, how they did it and among whom, what they found, and what it means.

That story is condensed into an abstract, a brief summary that allows readers to determine whether they may find the full article interesting or useful. Should an abstract be too long or technical to pull a reader in, an article can have an even briefer key points section. This could be a bulleted list of important findings or, as in the JAMA Network journals, a list of the question, findings, and meaning of the research.

For social media, perhaps a single summary sentence is needed to fit the constraints of a character limit. For readers who prefer a more visual summary, especially through social media, a visual abstract can be useful. These are eye-catching depictions of the research, often using icons and very brief wording.

Twitter, JAMA (JAMA_current), January 17, 2020.

Medical editors may be tasked with reviewing, editing, or even writing some of these pieces. In doing so, a few tips might be helpful.

First, make sure the shorter piece is consistent with the main article. Numbers should match and any data in the shorter piece should be included in the main article.

Second, make sure the trimmed text doesn’t overstate the study’s results. For example, “This study suggests that X is associated with Y” is different from “X affects Y.”

Third, make sure the most important information is emphasized: “This [study type] examines [primary outcome] in [population].”

Fourth, remember the audience. The short items should be able to draw someone in to read the more technical information in the main article.

A journal article may be the culmination of an investigator’s life’s work or the end of a trial that has cost millions of dollars, which may make an article’s 1-sentence blurb seem measly. However, a patient may search social media to find information on a rare disease, and a post could bring the patient to the full article. A physician may scan key points to see if an article looks interesting enough to read fully. A student could review abstracts to find articles that are helpful for a research project. An investigator might use the full article to replicate the study or as a springboard for further research.

Each breakdown serves a purpose, promoting the right information to the right audience.–Shannon Sparenga

ME Without the MD

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One of the occupational hazards of being a medical editor is the inevitability of occasionally working on a highly technical, highly detailed manuscript on a topic about which you know nothing. You don’t need to have a medical degree to be a medical editor, but how do you edit a paper when you’re not sure whether the item under discussion should treated as a plural, or even as a noun?

Of course, an excellent place to start is the AMA Manual of Style, which can provide a general overview sufficient to navigate the complexities of many topics.

For example, you don’t need to know much about respiratory physiology as long as you remember to check section 15.16 (Pulmonary, Respiratory, and Blood Gas Terminology). You’ll be sprinkling cryptoglyphs like V̇, Pb, and v̅ in no time!

You also don’t need to know how to conduct an F test to know that when you see an F score, it should also include the numerator and denominator of the degrees of freedom in subscript (section 20.9, Glossary of Statistical Terms).

In addition to the searchable AMA Manual of Style, the modern age has also bestowed the gift of internet search engines to help decrypt topics of which you may have no knowledge (and had never previously needed knowledge of, for that matter). If you find yourself looking at a topic you’ve never heard of and the Manual doesn’t cover it, a few minutes perusing sites such as Google, PubMed, and Wikipedia can give you tentative grounds on which to make your stand.

But sometimes even all the treasures of the internet and your trusty AMA Manual of Style combined can’t help and you’re adrift on a sea of statistics, biochemistry, gene expression, or whatever your topical Achilles heel may be.

In such cases, it can be useful to think of a sentence like a math equation—you don’t need to know what the subject means, but if you can look at a sentence and know where the subject is, where the object is, and what kind of verb tense you need, you’re more than halfway there.

And, as always, you can and should rely on the author to clarify and correct as needed. The ultimate goal of your work is to improve the author’s work, and that can only be truly accomplished through teamwork.–Rebecca Palmer

Resources for References

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Sometimes editing requires a little detective work, especially when the manuscript you’re working on has several incomplete references. You could query the author for the missing information, but with minimal time and effort, you may be able to the find the information you need using 2 free resources: PubMed and Worldcat. Both of these resources have extensive features, and editors can use the basic search interface to find missing reference information.

PubMed is an essential resource for medical editing—I use it nearly every day. If you need to fact-check data from a published journal article or online book, find an abstract for background information on a study cohort, or search for a missing volume or issue number for a journal reference, PubMed is the tool for the job. Let’s use it to find the missing volume and last page of the article in this reference:

Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA: a Cancer Journal for Clinicians. 2018;_(5):356.

We’ll start by typing in the author names in the PubMed search field and hitting enter.

Let’s see what we get!

Voila! Now we have the complete reference, and we can even update the journal title. As an added bonus, the full-text article is available with a click of a button on this page. If I need to do any fact-checking, I can access the article directly from PubMed.

That was quick and easy, but PubMed doesn’t index print books. No problem! Worldcat, the world’s largest library catalog, is another free resource that editors can use to find missing publication information. Worldcat allows you to search the collections of libraries around the world; it’s a great resource for materials published in languages other than English. I primarily use it to find chapter titles and publication information for print books. Let’s give it a try with this incomplete reference:

Erinnerungen, Träume, Gedanken von C.G. Jung 1961; Carl Gustav Jung and Aniela Jaffé.

Although I’m almost certain that this is a reference for a book, I’m going to select the “Everything” tab in the Worldcat search field to capture all of the potential results.

This yields 130 results, but in this case, the first result is a close match for the title and authors. The year doesn’t match the information in the incomplete reference, but if we click the “View all editions” link underneath the reference, we can narrow the results even further.

This is what we get:

This looks like a good match! The title and authors match those listed in the incomplete reference. The year doesn’t quite match, but it’s close. I can now ask the author to confirm the complete reference.

Searching for complete publication information for journal articles and books is quick and simple with PubMed and Worldcat. Although these free databases offer many more features, I use the basic search feature most often. Give them a try, and, of course, always check with the author to confirm that the information that you have is correct.–Juliet Orellana

102 Things Journal Publishers Do

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I recently came across an interesting post on The Scholarly Kitchen titled Focusing on Value — 102 Things Journal Publishers Do. Originally posted in 2012, it’s been updated every couple years as journal publishing changes and becomes more complex. Working at JAMA Network, I’ve been amazed at the breadth of skills needed to publish our array of journals. As a copyeditor, I only experience a narrow part of the publishing process, so I appreciate the overview and seeing how all the pieces fit together.-Heather Green

How Many Is They?

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Since I’ve been a manuscript editor, JAMA Network journals have published a few articles about health care for transgender patients. I’ve had the good luck to edit a few—they are always interesting—but this week, I realized that there is a grammatical issue in editing these articles that I have never heard fully addressed.

The issue is not what pronouns to use for transgender individuals—that question is well-known. Because the English language uses gendered pronouns, people who change their gender expression or whose gender isn’t accurately defined by labels are faced with several choices: should they go by she, he, a singular they, or a neologism, such as xe?

The news media has addressed this, including The New York Times articles in 2016 and 2017, with another written by transgender English professor Jennifer Finney Boylan in 2018. These articles often make the same points: that people can get confused by this transformation of language, but that people who want to use pronouns that reflect a gender different from their assigned sex should have their wishes respected. This squares with the approach used in JAMA Network journals.

But it also raises a question rarely addressed: what about verb conjugation? In the present tense, English applies a letter s to the third-person singular (he, she, or it runs) but not to the first-person singular, first-person plural, second-person singular, and third-person plural (I, we, you, and they run). So, if an article uses a singular they, should it be conjugated like the third-person plural (run) or like the third-person singular (runs)?

While editing, I have realized that the default method of using the singular they along with someone’s name (or a descriptor, such as the patient) involves flip-flopping between singular and plural verb conjugations (eg, “The patient is receiving gender-affirming treatment, and they are pleased with the outcome thus far”). A consistent use of the singular they would seem to require using third-person singular conjugations throughout (“The patient is receiving treatment…. They is pleased…”) or plural conjugations throughout (“The patient are receiving treatment…. They are pleased….”). Is either approach correct?

The public discourse on pronouns has not provided much insight. It has prompted the argument that we all use forms of singular they-series pronouns in casual language, in sentences such as “If someone wants gender-affirming treatment, that is their choice” or “Give them an injection.”

But that is distinct from the current issue. In these usages, the pronoun is usually objective (them) or possessive (their or theirs), and the verb is conjugated in the third-person singular alongside another subject. (In the example sentences, these are “someone” and “that,” and in the command, an unspoken “you.”) When the singular they is placed immediately before the verb, the question of conjugation instantly reappears.

Weighing “they run” vs “they runs,” I looked for guidance in the AMA Manual of Style. It offered a few relevant thoughts: “In an effort to avoid both sex-specific pronouns and awkward sentence structure, some writers use plural pronouns with singular indefinite antecedents… Editors of JAMA and the Archives Journals prefer that agreement in number be maintained in formal scientific writing.”

But that seemed short of clear instructions. Still uncertain if constructions like “they is pleased” would please anyone, I reached out to Jennifer Finney Boylan, the New York Times contributor whose article on pronouns was published in 2018.

A quick email to her university address got an equally quick response. “I’m not certain about this,” she wrote. “I want to endorse ‘they is’ because the non-specific pronoun is still referring to a singular individual. On the other hand, ‘they are’ sounds better to my old, English professor ears.”

That seemed similar to how our society is handling the matter. On her authority, I decided to stick with conjugations that shift from singular to plural and let the matter rest until a thoughtful body of grammarians, popular opinion, and perhaps the next edition of the New York Times’ article series on pronouns weigh in with a definitive answer to conjugating verbs after a singular they.—M. Sophia Newman

Follow Instructions!

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It was my first day of high school, and the bell had just rung announcing first period. There I sat in Mrs Ruth’s earth science class at a desk on the opposite side of the room from the blackboard, but not so far away, I hoped, that it was obvious I was trying to make myself invisible among the other wide-eyed freshmen. The desks were arranged in clumps, and as Mrs Ruth introduced herself, she stopped at each one, licking her thumb and counting out worksheets.

“Read the instructions,” Mrs Ruth said, “and then complete the worksheet. It shouldn’t take you more than 2 minutes.”

Two minutes?! I thought. A list of bullet points ran the length of the page. I looked to see if anyone else was feeling similarly overwhelmed, but my new classmates were already scribbling away as fast as they could, so I followed their lead. Per Mrs Ruth’s directions, I read the instructions—“Write your name neatly in the top right-hand corner, and read every question before answering any.”—and moved on to the first bullet point.

  • How many sides does a triangle have?

Three, duh. I scrawled the answer. The second bullet point told me to, from memory, list as many dinosaurs as I could. The class was quiet except for pencils dutifully scratching answers. These questions were a breeze. Maybe this worksheet would only take 2 minutes after all.

  • What is the capital of Ohio?

Columbus!

  • What is Will Smith’s character’s name on The Fresh Prince of Bel-Air?

Will Smith—he plays himself!

And before I knew it, I reached the last bullet point, which, surprisingly, wasn’t a question at all.

  • Do not answer any of the previous questions. Make sure your name is written neatly, and hand in a blank worksheet.

Groans rippled across the room as other students arrived at the last bullet point. When all our pencils were down and our cheeks were red with embarrassment, Mrs Ruth asked who’d read the instructions. Of course, we all raised our hands. But Mrs Ruth corrected us: no, we hadn’t. Reading the instructions meant more than glancing the words. It meant understanding and acting on them; if we’d written anything on the page other than our names, we’d already failed our first high school assignment.

The AMA Manual of Style is, at its core, a gigantic set of instructions, and on top of the style guide, the websites for JAMA and the journals comprising the JAMA Network each contain links to lengthy Instructions for Authors that explain everything from how manuscripts should be formatted to the number of tables, figures, references, words, etc, individual article types allow. A large part of the job of a manuscript editor is to make sure articles follow the instructions they’re supposed to in preparation for publication, and on a surprising number of occasions, I’ve worked with authors who have argued or rejected fundamental style points or have ignored instructions on the website specific to the journal that’s publishing their research. The instructions aren’t arbitrary, and the AMA Manual of Style exists to help ensure the reporting of research and data is rigorous, lucid, and consistent.

I think back to Mrs Ruth and my first day of high school often: if you don’t read, understand, and follow the instructions, you’ve failed before you’ve even begun.—Suzanne Walker

Talk to Me

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Imagine this scenario: it’s 4:30 pm on a Friday, you’ve been stalking your Outlook account for 7 straight hours, your deadline is coming up fast, and STILL the corresponding author of the article you’ve been working on for the whole week hasn’t gotten in touch via email or phone or passenger pigeon to answer your one SIMPLE QUERY that you probably already know the answer to but for the sake of best practices have to receive from them.

So with the prospect of being late for a much-needed end-of-the-week happy hour hanging over you, you consider your options. Do you ring for reinforcements? Do you call in the cavalry?

Sound familiar?

Communicating with authors is one of the most important and challenging parts of being a manuscript editor. There might be an impulse to jump to stereotypes about physicians when speculating why an author isn’t getting back to you (eg, Mr/Ms Ivory Tower can’t stoop to take time from being important and well-known to speak to Plebeian You) but the truth is that there are myriad reasons why authors can fall behind on their communication. While nobody wants to be the jerk who is insensitive to a busy schedule with patients, family emergencies, or a vigilant spam folder, you also have a job to do. If your work performance is at least partially based on meeting deadlines, you may want to consider one or a few of the following strategies to encourage a response.

1. Round up the gang. If a corresponding author isn’t responding to you in a timely way, you may want to reach out to some of the article’s other authors to enlist their help. You could do this in a simple, relatively nonconfrontational way by copying them on correspondence you share with the corresponding author, or you can give them a quick call. This may give you an uncomfortable feeling that you are tattling on the author (I’m not sure what the editorial version of “snitches get stitches” is–maybe “nerds get words”?), but remember that they also have a professional obligation to you. By reaching out you may be giving them an opportunity to re-delegate responsibilities in light of things going on behind the scenes.

2. Phone a friend. Manuscript editors are often only dealing with articles after they’ve been accepted, but it is likely that the authors have talked to multiple people affiliated with the journal along the article’s journey toward publication. If your journal has an editorial office that has shared correspondence with the author or somebody who worked with them during the peer review process, reaching out to them to ask if they can contact the author might yield a result. Some people are more comfortable communicating with people they’ve already dealt with, and a roundabout way of getting the information you need is a better alternative than radio silence.

3. Appeal to a higher power. In a perfect world titles wouldn’t matter, but let’s be real: they do. If the lack of author communication has gotten to the level where it is seriously gumming up the works, and if you can assess that it’s worthy of your supervisor’s time, escalating the situation upward might be your best option. It is truly astonishing how the words “Executive” and “Senior” can expedite a response!

4. Deploy the Shame Lady from Game of Thrones.

(Just kidding.)

So the next time you find yourself with a failure to communicate, don’t despair and whimper “Why won’t you talk to me?” to the computer screen—consider using one of these strategies to get the conversation rolling, the deadline met, and yourself to happy hour.—Amanda Ehrhardt

Dictionaries: An Editor’s Best Friend

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Part of the fun of editing medical content is learning all about the newest treatments and scientific advances, but as someone without a science background, I find myself looking for resources that can help me understand some of the more technical terminology.

You may ask, “What about Google?” Google offers the collective knowledge of the Internet right at our fingertips, right? Well, sort of. Sometimes I don’t have the time to sort through all of the results. I want the correct answer now! Subject-specific medical dictionaries are just the thing when I’m in a hurry (which is almost always because DEADLINES).Two resources that I use are A Manual of Orthopaedic Terminology (print) and the National Cancer Institute (NCI) dictionaries (web).

In the days when I edited orthopaedic surgery manuscripts, A Manual of Orthopaedic Terminology (Nelson FR, Blauvelt CT. A Manual of Orthopaedic Terminology. 8th ed. Philadelphia, PA: Elsevier Saunders, 2015) was my go-to resource for terminology related to musculoskeletal disease, brief descriptions of imaging techniques, and common orthopaedic abbreviations. The section on fracture classifications saved me from sifting through a ton of search engine results. Don’t even get me started on the eponymous procedures and approaches! As much as I love this resource, it’s not comprehensive. My heart sank when I used this book to look up surgical approaches for hand surgery and saw “Surgical approaches are too numerous and complicated to describe here. Refer to Canale ST, Beaty J, 2013.”Um, okay.

I found the web-based NCI dictionaries one day when I was working on an oncology manuscript and found myself turning to Google for the 10th time in 2 hours (I love you, Google, but this is ridiculous!). Enter the NCI Dictionary of Cancer Terms and the NCI Drug Dictionary to save the day. Of the 2 dictionaries, I use the Dictionary of Cancer Terms the most. The definitions aren’t too technical, and new terms and definitions are added monthly. Right now, 8386 terms are included. The search interface is easy to use, and allows you to search for partial terms.

As you might expect, the definitions and descriptions in the NCI Drug Dictionary are more technical than those in the Dictionary of Cancer Terms. In addition to definitions, the Drug Dictionary entries include alternate drug names and hyperlinks to more information on each drug (such as active clinical trials using the drug). The NCI Drug Dictionary was useful when I recently came across a table with an alphabet soup of chemotherapy regimens. What exactly is the FOLFIRI regimen?

Let’s use the NCI Drug Dictionary to break this down. A search of FOLFIRI returns 4 results (click for larger):

Those definitions seem pretty straightforward. They even include the trade names for some of the regimens (FOLFIRI-Avastin). The NCI Drug Dictionary seems like a good place to begin a search, but it may be a good idea to cross-check some of the drug names using the USAN Council website; “5-fluorouracil” may not be the preferred name. Clicking on the link for the regimen will redirect you to a page that lists the full definition and another link to the NCI Thesaurus. In this case, the full definitions are short and are right here in the search results—no need to click on another link!

Subject-specific dictionaries can be a reliable alternative to wading through thousands of Google results. What about you? Do you use any subject-specific resources? Tell us in the comments.—Juliet Orellana

Patient Privacy

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Sometimes before I go to bed, I like to check in on one of my favorite YouTubers, Dr Pimple Popper (the nom de internet of dermatologist Sandra Lee), who posts videos of dermatologic procedures and skin care treatments. I particularly enjoy watching videos of dilated pore extractions, and I don’t mind watching lipoma extractions either (although I do sometimes fast-forward through the excisions). I know these types of videos can get viewers’ stomachs churning a bit, but I think it’s no worse than various photographs in medical journals I have worked at over the years. And because of my occupation, I do wonder about patient privacy and anonymity.

Patients featured on this YouTube channel may have a cyst near their eye or ask for blackheads to be removed from their cheek, and their faces are clearly visible. In many videos, Dr Lee chats with her patients, and although she sometimes edits out personal details, some of it stays. Dr Lee says that patients do sign consent forms before videos are published.

Similarly, when manuscript editors of medical journals encounter photographs of patients, we must review whether the photograph might intrude on patient privacy. Authors must obtain written permission from patients (or their legally authorized representatives) for any descriptions, photographs, or videos of patients or identifiable body parts and indicate that such consent was obtained in the Methods or Acknowledgment section. When I started in this field as an editorial assistant, I processed a manuscript that described a skin lesion on a patient’s back. In an accompanying photograph, the patient’s distinctive tattoo was visible, and I needed to ask the author to either obtain patient consent or have the photograph cropped because the patient (as well as anyone who knew he had that tattoo) would be able to identify himself. Results of imaging studies and photos of laboratory slides may also have identifying information that should be removed.

Protecting patient privacy also extends to what is in the text of an article. When editing case descriptions, case reports, and personal essays, nonessential identifying data (eg, sex, specific ages, race/ethnicity, occupation) should generally be removed unless the author has permission or the information is clinically or scientifically relevant and important. Authors and editors should not falsify or fictionalize details; doing so may introduce false or inaccurate data.

Read more about patient’s rights to privacy and anonymity in section 5.8.2 of the AMA Manual of Style.—Iris Y. Lo

Transitions of Note, As Such

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I come to praise the lowly transition, the chemical drain opener of scientific writing. A transition unclogs copy. Just pour it in and it works.

In our daily responsibilities, time does not always allow for an examination of language functionality at that level of detail.  More pressing concerns prevail.

In processing a manuscript into final article form for JAMA Network journals, an editor applies several rounds of detailed attention to the information. The process involves many musts. The title must not be declarative or give away the conclusion. The abstract must be complete. The type of study must be specified. The results section must include appropriate data. The methods section must identify ethical or institutional review board approval or waiver as well as informed patient consent. The statistical analysis section must specify the statistical tests used and not present P values alone without comparative data. Figure and table elements must be complete. Abbreviations must be tracked for consistent use. The discussion must include a paragraph about the limitations of the study type. The conclusions must not be overstated or absolute.

Along with including these musts, the copy must follow JAMA Network style conventions, from the picayune (no period after “vs”) to the consequential (wording presents patient first: patients with diabetes instead of diabetics). The end matter also has to follow the author contribution, conflicts of interest disclosures, and identification of funding requirements.

The introduction, methods, results, and discussion format for scientific articles lead readers from section to section. Within those sections, subheads guide readers from one major topic to another.

What about finer divisions of thought than can be accommodated by subheads? In the dash to process 3000 words according to scientific format and AMA style directives, something often gets lost in the shuffle: the utility of the transitions used to move the reader within and between paragraphs of a subsection. One could argue that if transitions go unnoticed then they have done their job. Readers have gone from point A to point B, and no one has gotten hurt.

There is no must for transitions, but the AMA Manual of Style lists 6 functions of a transition with standard examples that perform those functions.

When I review a proof after the list of musts has been confirmed, I am sometimes startled that a conjunction or transition at the paragraph level appears several times in rapid succession. Three uses of of note occur at the end of the discussion section. Four occurrences of as such appear as an opening phrase. Even that being said has slipped by although no one is actually talking. A couple of buts might more properly be ands. Suddenly I am surrounded by however, furthermore, in addition or additionally, and therefore. A little CTRL + 4 action shows 7 however, 4 furthermore, and a walloping 9 additionally uses all within a 9-page original investigation.

Gliding across all-purpose transitions is quite easy as one goes about identifying and focusing on the musts. An all-purpose transition works because it is a transition regardless of whether it functions specifically.  When faced with rapid-succession infelicities, I strike them, perhaps keeping the first. Items of note are apparent from their inclusion. As such in most cases has no actual antecedent. A congenial and from a misbegotten but adds to readability. A quick note to the author usually begets a response ranging from “ok thanks” to something a little more effusive but not overboard.

We have become accustomed to reading right past transitions perhaps because we are not striving for literary awards. No one throws a parade to celebrate a sentence whose dispatched as such has hit the bricks.

Why note how transitions are used? I’m not advocating parades, which would eat significant processing time. Accurate transition use is part of a standard of completeness. Every movement toward specificity is worthwhile to give readers a clearer view of the author’s point. With this in mind, every transition, as such, is of note.—Timothy Gray