How to Write a Cover Letter & Respond to Reviewers Dr Sharmini Selvarajah MBBS, MPH, MSc Clinical Epidemiology, PhD Fellow Clinical Epidemiologist Clinical Research Centre, HKL Contents • • • • • Submission process Editor’s requirements Items in a Cover Letter & real-life examples Journal decisions Responding to Reviewers & real-life examples Writing and submitting is Marketing – How does my baby sell? – Editors buy Joost PH Drenth, Nijmegen Medical Center, The Netherlands Authors sell Submission Process Cover Letter is Key http://www.editage.com/resources/art5.html Responding to Reviewers is Key What do editors want? • • • • • • Excitement/ “wow” Importance Originality Relevance to the audience True Clearly / Engagingly written Smith R. www.bmj.com Items in a Cover Letter • Introductory sentence • Study details Note: – Caption of your study Some journals have their own instructions – What you of what has to beactually covered indid the Cover Letter (Obligatory Items). – Summation of paper ALWAYS read Instruction to Authors •carefully Potential reviewers . Your cover letter sells your article • Obligatory items Cover Letter contents 1 • Introductory sentence – Please find enclosed our manuscript "Proflox improves peptic ulcer healing " intended for publication in Gastroenterology. • Caption of your study – As already outlined, peptic ulcer disease is a devastating disease with a high mortality in the elderly. Current therapy includes proton pump inhibition. Although this is an effective therapy, some patients fail. Proflox is a new alpha-pipelimic acid inhibitor that specifically inhibits gastric acid production. Joost PH Drenth, Nijmegen Medical Center, The Netherlands Cover letter contents 2 • What you actually did – We performed a 24-week randomised clinical trial in 1256 subjects and show that Proflox is a very effective peptic ulcer healing drug, especially in the elderly. • Selling point – This is a solid result and we would like to emphasize that randomised drug trials are rare, if ever done, in peptic ulcer disease. In clinical practice peptic ulcer patients are randomly exposed to various drug regimens, all of them completely uncontrolled. We believe that it is in the interest of these patients and physicians alike that these results are disseminated. For these reasons we therefore sincerely hope that our manuscript merits publication in Gastroenterology Joost PH Drenth, Nijmegen Medical Center, The Netherlands Cover letter contents 3 • Potential reviewers – Reviewers you pick give a better score than random ones • Obligatory stuff – The contents of this manuscript have not been published elsewhere, and likewise the manuscript is not being submitted elsewhere. There is no potential conflict of interest for the individual authors. We would prefer to be contacted by e-mail. Thank you for your consideration. Joost PH Drenth, Nijmegen Medical Center, The Netherlands What NOT to do Introductory sentence Dear Professor Ulf de Faire, Please consider the attached manuscript entitled “Cardiovascular risk factor treatment targets and renal complications in high risk vascular patients” (3945 words) for publication in an up-coming issue of the Journal of Internal Caption of study Medicine. In this manuscript, we highlight that current European clinical practice guidelines for the prevention and treatment of cardiovascular disease can concurrently reduce the risk of renal disease. Thank you for your kind consideration. I look forward to receiving your response. Warm regards, Sharmini Selvarajah What to do Dear Dr. William M. Bennett, Introductory sentence “Cardiovascular risk factor treatment targets and renal complications in high risk vascular patients” I would be grateful if you would consider this manuscript for publication in the Clinical Nephrology section Selling point of the Clinical Journal of the AmericanCaption Society of&Nephrology. In this manuscript, we highlight that the risk of renal outcomes in patients at high risk of cardiovascular disease can be reduced by simple adherence to clinical practice guidelines on cardiovascular disease management. The attainment of as few as any two treatment targets for cardiovascular risk factors was found to reduce renal risk. As such, although controlling all risk factors in clinical practice is preferable, clinicians and patients may be relieved with the knowledge that even when starting small, benefits are seen. These findings have not been published previously. Results from this study have been presented at the AsiaLink Closing Conference: Clinical Epidemiology and Evidence-based Medicine in a Global Perspective in Bali, Indonesia recently. All the authors have read the final manuscript and have given their approval for it to be presented in its present form. On behalf of all authors, I also hereby transfer, assign or otherwise convey all copyright ownership to the CJASN in the event this manuscript is published. Thank you for your kind consideration. I look forward to receiving your response. Warm regards, Sharmini Selvarajah What NOT to do Dear Dr. Anthony N. DeMaria, “External validation of the TIMI risk score for ST-Elevation Myocardial Infarction in a multi-ethnic Asian country” I would be grateful if you would consider this manuscript for publication in the Journal of the American College of Cardiology. Caption In this manuscript, we validated the TIMI risk score in a multi-ethnic Asian population. We found that it can be used to accurately risk stratify and estimate prognosis for patientsSelling presenting point with ST-elevation myocardial infarction. We feel that this study is of importance because cardiovascular disease (morbidity and mortality) forms the leading burden of disease in the developing world. Acute cardiac care is costly and in developing countries with scarce resources, it is challenging to provide the recommended treatment strategies according to international guidelines. Directing the more resource intensive strategies for those who will benefit the most is of major importance. We show that the TIMI risk score is valid and therefore can be applied to guide clinical decision making in a multi-ethnic developing country. Dear Dr. William C. Roberts, What To Do Caption of study “An Asian Validation of the TIMI risk score for ST-Segment Elevation Myocardial Infarction: Results and Implications for Cardiac Care in a Developing Country” We would be grateful if you would consider this manuscript for publication in the American Journal of Cardiology. We feel this manuscript can be of importance to the readers of this journal for three reasons. Firstly, there is a burgeoning increase in cardiovascular diseases in developing countries, including Malaysia. We have found that those presenting with ST-segment elevation myocardial infarctions in our country are much younger, have a more severe index event and FirstDespite Sellingthese points are treated later than their western counterparts. clinical differences, the TIMI risk score was found to be valid. Secondly, acute cardiac care is costly, and in developing countries with limited resources, it is challenging to provide the recommended treatment strategies according to international guidelines. Directing the more resource intensive strategies for those who will benefit the most is of major importance. We show that the TIMI risk score, a cheap and noninvasive bedside tool, created prior to the era of primary percutaneous coronary intervention, can still accurately risk stratify and prognosticate patients with ST-segment elevation myocardial infarction. We feel these findings will be beneficial to other clinicians in developing countries faced with similar resource constraints. Thirdly, the setting of this study in a multi-ethnic Asian country provides evidence to cardiologists in other Asian Finalsuch Selling point countries, especially those with similar ethnicities, as India and China, that this risk scoring tool may be directly applicable to their patients. We appreciate that the TIMI risk score is not new and has been validated before. However, it has not been validated in a multi-ethnic Asian population. Aside from this, newer validated ST-segment elevation myocardial infarction risk stratification scores require more intensive resource utilisation. Clinicians from developing countries who unfortunately cannot keep pace with international changes need to know that older risk scores may not necessarily be outdated. We feel that our manuscript provides a practical view on risk stratification for myocardial infarctions in developing countries. We sincerely hope this manuscript will be considered for publication. Decisions • Revision requested • Rejection – That is a bummer – S… happens – Sit down, sigh and move on – Do not write an angry response – Did I aim at the wrong target? – Can you do something with the criticism raised by referee? Joost PH Drenth, Nijmegen Medical Center, The Netherlands Revision Requested How to Respond to Reviewers Revision requested • Accept with grace and humility • Respond with grace and humility • Do provide a point to point review – Yes…..must be done • Mark your changes in the manuscript – Use the track mechanism in Word – Highlight/ different font style/ colour • Do not be confrontational – It is a game and these are the rules Joost PH Drenth, Nijmegen Medical Center, The Netherlands Response to Reviewers eg1 1st Reviewer's report: 3)Diabetes and vascular disease are different entities because diabetes affects mainly small vessels (retinopathy, nephropathy) whereas vascular disease affects large arteries. Similarly, the hard end-point ESRD may be caused by both micro and macrovascular disease, whereas intervention to the renal vascular disease reflects merely macrovascular disease. Response: The reviewer has mentioned that the pathophysiological mechanisms of the endpoints are different. We agree with the reviewer and have added this as a strength of the study detailed below. This is because for an individual patient of high risk, goals for prevention of CVD are set by clinical practice guidelines. Doctors aim to achieve treatment targets, without the knowledge of the type of complication a patient will suffer in the future. Therefore, irrespective of the pathophysiological mechanism, these treatment targets are beneficial in reducing renal complications. “These hard endpoints reflect different pathophysiological mechanisms. End stage renal failure may be caused by both micro and macrovascular changes whereas renal vascular disease is caused by macrovascular changes. Despite these differing pathophysiological mechanisms, these findings are suggestive that the same treatment targets reduce their risk of development.” Response to Reviewers eg2 1st Reviewer's report: 4) Although beta blockers have lost popularity, only these drugs and ACE inhibitors have been associated with treatment targets achieved. Please comment. Which beta blockers was used? Response: The reviewer was concerned that use of beta blockers and RAS inhibitors were associated with treatment targets being achieved. The use of beta blockers in this case is associated with the higher rates of coronary artery disease (Baseline Table 2). In this study, about 47% of those prescribed beta blockers had ischaemic heart disease. Only 12% of those prescribed beta blockers were due to hypertension. Aside from this, up to 50% of the study population were recruited before 2004. This may help explain the use of beta blockers as well. These values given here hopefully explain the values seen in the baseline table. In the original manuscript, we had not described in detail the specific types of drugs used to achieve targets. Unfortunately, we do not have information on the types of beta blockers used. The following sentence has been added to the results section describing the reasons for beta blocker prescription; “About 47% of those prescribed beta blockers had ischaemic heart disease. Only 12% of those prescribed beta blockers were due to hypertension.” Response to Reviewers eg3 2nd Reviewer's report: This was a prospective cohort study based on participants either living with a pre-existing cardiovascular disease (CVD) or at high risk of developing vascular complications. The investigators set out to determine if recommended treatment targets, as specified in clinical practice guidelines for the management of CVD, reduces the risk of future renal (and renovascular) complications in this populations. - Major Compulsory Revisions: 1. Apparently the investigators retained people with renal insufficiency and renal artery stenosis at entry. It would be interesting to see (even as a subsidiary analysis) how the associations are if these individuals with baseline renal insufficiency are excluded. Response to Reviewers eg3 Response: The reviewer has suggested a major revision of the analysis excluding patients with renal insufficiency or atherosclerosis to determine if similar decreases in risk of renal outcomes are seen with increasing treatment targets. We agree that this is an important area that requires further research. However, this cohort study had a median duration of 4.21 years. We have noted that this duration may be insufficient for ESRF development. The UKPDS study showed that only 0.8% of their study population developed ESRF after a median of 10 years. We feel that changing the main analyses to exclude patients without renal insufficiency would be beyond the scope of this manuscript for the following reasons: Excluding renal insufficiency patients would lead to a severe reduction in events (since these are rare outcomes). The strength of this study is that, even in patients with renal insufficiency, time to endpoints can be delayed with attainment of two or more targets. Final tips • Cover Letter – AIM to SELL your paper so that it gets through the 1st hurdle • Response to reviewer – Be very courteous and seriously consider ALL points by reviewer • Already almost past the door & on your way to acceptance. Internet resources • Response to reviewers – Full response for examples given: http://www.biomedcentral.com/14712261/11/40/prepub – Other BMC websites Any Questions? Thank You!