How to Write a Cover Letter & Respond to Reviewers

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!