Dear colleagues, we thank you for your interest in our meeting dedicated to scientific writing. It's our first meeting, but we hope that in future it will be some projects. Many thanks to Dr. Ramirez, one of the world-leading gynecologic oncologists, for his support to our Ukrainian doctors. It's really a great honor for us. Thank you very much. So, today we have colleagues not only from Kyiv, but from many regions, from Ukraine. You see our map. It's Central, Western, Southern Ukraine, Sumy, Kyiv, Lviv, Odessa, Dnipro, Vinnytsia. Many, many regions and huge interest not only from oncologists, but from general surgeons, from otolaryngologists. And we hope maybe some other specialties will be interesting in our scientific webinar. And I pass the floor to my colleague, Olga. Welcome, everyone. It's a big pleasure to have Professor Padre Ramirez with us. And we're also very grateful for the support of the American Eurasian Cancer Alliance and its Executive Director, Dr. Sophia Michelson. Sophia. Yes. Hi. Thank you so much. It's an absolute pleasure to be working with Alina and Olga for several months, creating this excellent access of great knowledge that Dr. Ramirez will be delivering today to so many regions, to so many oncology centers, hospitals around Ukraine. I'm extremely grateful for this access and for the fact that we are able to connect to all of you guys. And some of you will see in Ireland. I know Irina is here, Ami is here. So looking forward to that. I appreciate everybody's effort and now award to the star of this event and somebody who actually was able to make it happen, whose dedication to the Ukrainian tumor boards as well as to the Ukrainian program on scientific writing is amazing. Dr. Ramirez, your word. Thank you so much, Sophia. Thank you, Alina. Thank you, Olga, for this introduction and certainly for the invitation. I am really honored, obviously, to be part of this program. And I want to thank each and every one of you who has joined from all over Ukraine to participate in this discussion. During the course of the presentation, what I hope to share with you is a topic that I think is really relevant and critical for any physician who is in academic medicine, any physician who wants to develop a professional career in publication and research. And of course, obviously, we know that as gynecologic oncologists or specialists, even in other disciplines, certainly for us, we make a significant contribution to medicine by the care that we provide to our patients. But also, I think a broader contribution also comes from the publications and the research that we do as investigators. And I think, obviously, that's critically important as well so that we will be able to provide some input into the standard of care of our patients as well. So with that, then, I wanted to share with you what I consider are some important tools and tips for success in publication. I am currently the editor-in-chief of the International Journal of Gynecological Cancer, which obviously is one of the key leading journals in our field. And I have been editor-in- chief since 2018. Since that time, we have seen a significant improvement on the impact factor of our journal. As many of you know, obviously, an impact factor is one of the main key determinants of the quality of a journal. And in that role, then, certainly, I oversee the processing of all of the manuscripts that are sent to our journal, the processing of the selection of reviewers, how those reviewers select those specialists within the field to determine who can provide the best review for those manuscripts. And then subsequently, again, of course, obviously, the editing of the final manuscripts before it goes out to publication. And I think, certainly, as an editor-in-chief, we have a really important role because, obviously, we have an opportunity to shape the type of research that is published and to enhance a lot of, obviously, the literature and the knowledge that is key and critical to our field. So the objectives that I wanted to talk to you about is today, specifically, as an investigator, how do we find the topic of interest? And many times, those young investigators, trainees, residents, fellows, young faculty, oftentimes, they will come to me and they'll say, what is that? What's an interesting topic? How do I get a journal to be interested in a work that I can do so that I can ultimately publish? So hopefully, I'll share with you some of those key elements. In addition to that, I think also, once you find that topic of interest, once you have done the research, and we'll talk a little bit about, actually, the actual performing of the research, but obviously, writing the manuscript is critically important. And many times, actually, in the journal, we see that the science of a manuscript is actually fairly good and sometimes actually really good, but it has not been written well. And then therefore, oftentimes, the papers are going to be rejected. And it's not because the science is a poor science, but it's just it hasn't been presented in the best manner possible for a successful publication. So obviously, it's critically important to have key tips as to what are some of the elements that are very important for the editors of a journal to consider that a manuscript is high quality. I think also, editing the manuscript is critically important. As you have written the manuscript, obviously, there are certain components that are very important in terms of getting the input from other investigators, your co-authors as well. So I think that's key in the success of that manuscript. And then additionally, then, once you have found the ideal topic for research, once you have written the manuscript, once you've edited the manuscript, then it's the decision, which is the best journal for this paper? And ideally, obviously, you want to be successful your first time around. You don't want to actually have to submit it to two or three or four journals. Ideally, you want to find the best home for that paper. Hopefully, I'll provide some key clues as to what could be the strategies to determine what's the best fit for your paper. And then I'll talk a little bit more about editorial tips and tricks and things that I think that are also helpful to those who are writing the manuscript, so those who are doing research, so that they can hear from the other side, from the side of the editors, the editors-in-chief, as to what are some of those tips and tricks. And certainly, I will also preface it by saying that this is not the only method of a successful publication. But certainly, I think that this presentation will cover a lot of the key topics on how to successfully publish a manuscript. Now, I think when it comes to the finding the topic of interest, and I think this is also a question that we've all had in academic medicine, and particularly also, you know, certainly when I was a resident or when I was a fellow, I would always ask is like, so what's interesting? What's a good topic? So I think, you know, some of the basic principles is obviously looking at what's been published in the literature to assure that what your area of interest might be hasn't been published already. So obviously, whenever you have a thought on a particular project, if you say, well, I want to look at the role of isolated tumor cells in sentinel lymph node mapping in endometrial cancer, you might want to obviously look at the literature and say, well, what has not been published? Because obviously, you want to publish something that is new, or something that offers some level of novelty, rather than just, oh, I repeated the same paper that somebody else already published, because oftentimes, this is not very much of interest to the community of the editors and the journals as well. Review the current literature. And this, I think, is also very important, because you might have an idea where you say, well, you know, it seems that nothing has been published so far on this topic, and perhaps that, you know, certainly you've gone to conferences, and you really feel that this is a question that still needs to be answered. I think, you know, certainly before you embark on a major project, look at the last month or few months of the main journals. So if you have an idea in gynecologic oncology, go to the International Journal, go to Gynecologic Oncology, go to the American Journal of Obstetrics and Gynecology, and look through their table of contents, and look to see, to make sure that no one has recently published, because you don't want to start working on a project, and then all of a sudden, somebody say to you, oh, did you see the paper that was published this month in the International Journal? It's exactly what you're doing. So then obviously, then you want to be at least alert as to what is happening currently in the literature. I think it's also very important to discuss it with an expert or someone who has some strong knowledge of that topic, because many times, you know, as investigators, and particularly investigators who are starting in our academic career, we will often obviously discuss it with a friend in the field, a colleague in the field, and say, oh, what do you think about this idea? And many times, of course, obviously, if somebody who's a friend will say, oh, I think that's great, or, you know, I think that that's really good, and I think that that would be published, but that person may not be an expert in that area. So for example, obviously, somebody who's working on ovarian cancer routinely, or somebody who primarily does ovarian cancer surgery, asking them about vulvar studies may not be the ideal person to actually sit down and discuss that. And you might say, well, you know, in my institution, there is nobody that is an expert in that area, and therefore, I don't have anybody to actually ask and discuss. I think this is an opportunity, either through the national or international forums, where you might be in a webinar, or you might be at a particular conference, and you may reach out to that particular speaker, or someone who presented in that topic, and they just run this by them, and say, you know, you have a few minutes, I'd like to just discuss a topic with you, or a project with you, and what are your thoughts? And oftentimes, you know, certainly, we get asked this all the time. I go to conferences, and somebody says, hey, you know, I'm thinking about doing the study on cervical cancer and, you know, surgical approach in this low-risk population. Can you tell me what your thoughts are in that setting? So, always trying to find somebody that will give you really good input, and even sometimes, obviously, and it's happened many times to me, when I bring up an idea that I thought it was a really great idea to somebody who is really familiar with the topic, and they might say, I don't think that's going to get published, and here are the reasons why. And of course, obviously, it's not the answer we want to hear, but obviously, they're doing you a favor by allowing you to then look at potentially a different topic, so you don't waste all of this time working on a particular area that's already been published. Always attempt to capture the missing element, and I stress this very much, because when we look at the letters that are sent to the journal with the manuscript, the one thing that we're looking at in that letter is, this is the question that hasn't been answered that this paper is going to help answer, or this is the contribution that our paper is making to the literature. This is the gap in knowledge, and this is how we are addressing this topic. So we always want to know, what is it that is going to be different about this paper? What is it that either our readers or patients are going to find it and say, we didn't know that, and that's really interesting that they actually looked at that. And again, it doesn't have to be a prospective randomized trial. It doesn't have to be a phase two cohort, a prospective study. It could be a retrospective study, but if it isn't something that had not been addressed, then of course, then that's of interest, and the journals are definitely going to be interested in that, and also the reviewers. The first thing that reviewers are going to do, they're going to look at the abstract, they're going to look at the conclusion, and they're going to say, is this new? And if it's not new, then typically, obviously, they're not going to be interested. The other thing is also, many times when you go to conferences, or when you go to webinars or seminars, the speakers will usually say, well, the limitation of our study was this. We didn't look into this, or we were not able to capture that. And take note of that, and just basically say, you know, it's interesting. Obviously, they did the study. It was a really important study, but they didn't look at that point, or they didn't answer that question. So let me write that down, and let me see, perhaps that will be the next study that will be of interest. So always be cognizant of the study limitations, and in those presentations, when the speakers will say, well, this is what was missing, and yeah, we should have looked at that, but we didn't. That's a point where you can say, I'm going to actually look that up, and perhaps I can do a study to answer that particular question. I think also, it's very important to take that walk in the meetings, and look at the abstracts that have been accepted in that meeting, the posters that have been accepted in that meeting. Because many times, you will say, and one thing is that you will look at those abstracts and say, oh, somebody else is already working on exactly the same thing I'm working on. So let me actually expedite my work. So hopefully, we'll get our work to that journal first. Or you may actually look at posters that may give you some guidance as to what are the things you need to add to your study that is related to that topic. And you may walk around a poster and say, oh, that's interesting. They looked at this, and this, and this, but ah, they also looked at nutritional status, and we haven't looked at that in our study. They found that there was a difference in nutritional status, and then I need to look at this. So try to get, you know, as much information from these meetings as possible. And then also, I think it's very important, and particularly for institutions where there are multiple services or multiple individuals doing research, you will be surprised that in many institutions, and even within a department, you may find that there may be two investigators working on the same thing, and neither one knew about the other one working on that same project. So we always encourage, and we actually, in fact, have what is called the monthly research meeting. And in the monthly research meeting is a requirement in the department where anyone who's going to do any research, even if it's retrospective research, has to present at that meeting just to make sure that work is not being duplicated, and also to provide feedback to that individual. So, you know, obviously, if, Alina, you have worked on a project with one of your colleagues, and you were really excited about the project, and then you bring it to the group discussion, and you learn that there are at least five or seven other variables that you should have been evaluating, that's incredibly helpful, because you're still able going to, you know, bring that information to your manuscript, and you can discuss it in that group, and you often learn a lot about what else to do in your study or what not to do in your study. So then you have found the topic, you agree that this is a really fantastic research, and you proceed and have a discussion about proceeding with that research. I think also, and I should say, as part of that process, before you embark on gathering the data and looking at the variables that you're going to be studying, always, always speak with a statistician before you start the study, so that you will be able to then have adequate numbers for your study, or that they will be able to clearly be able to make a comparison between groups, so that that way you have a sense from the beginning as to what are going to be the requirements. And then, of course, obviously, it's either gathering the data, analyzing the data, and then subsequently, of course, once you have your results, then writing the manuscript. And I should say, one thing is also very important, is that although we have a hypothesis for every study that we do, and in our mind we say, oh, wouldn't it be great if it showed this? Well, sometimes it doesn't show that, and sometimes you might be somewhat disappointed in like, oh, there was no difference. And in fact, you were expecting a difference, or the opposite. You were not expecting a difference, and there is a difference. Obviously, even if it's a negative study, it may contribute to the literature. It may provide excellent information for patient care. So don't worry so much about like, oh, it's a positive study, or it's a negative study, as long as it provides input into the literature that's critically important. So writing on the manuscript, that's very key to the success of the publication of that manuscript. One thing that I would suggest, because I've seen it where oftentimes a group of authors will get together and say, oh, this is our work, this is our research. So then therefore, Alina, you write the introduction, Olga, you write the methods, so-and-so will write the results, and so-and-so will write the discussion. Not a good idea in my mind. I think that even though certainly you have all collaborated, I think it's critically important that one person take the leadership of writing the manuscript. You know, obviously there's going to be expected input from all the other authors, but it should always be one person who leads the writing of the manuscript. So then the introduction, and oftentimes, you know, I particularly see it with young investigators, oftentimes residents or fellows. I did it myself also. When you write the introduction and you start writing, many times it's like four pages long, because you feel that you want to put in all of this information that is so, so key, and the more the better, and actually is quite the opposite. You want to keep it as simple as possible, but you want to drive at the message as strongly as you can. So generally, I tell the fellows or the residents, I say three paragraphs, only three paragraphs. The first one is background information, and again, ideally, again, not a paragraph that is like two pages long, a simple paragraph that provides the background information. So that if you're writing the introduction to the setting of, as an example, the SHAPE trial, you would talk about the fact that in patients with low-risk cervical cancer, the likelihood of parametrial involvement is low with these references, and then therefore, perhaps radical hysterectomy is associated with much greater morbidity than potentially a more conservative approach, simple hysterectomy or cronization. Then that's the background. So you don't have to go into like, you know, cervical cancer is the most common type of cancer worldwide. It kills as many people. Cervical cancer is HPV-derived. Cervical cancer has squamous, adenocarcinoma, adenosquamous. All of that is wasted word count, because you're going to need the word count to obviously provide information about the methodology, about the results, and that's information that every gene oncologist knows. So oftentimes when you write about ovarian cancer, you say it's the deadliest type, there are 17,000 patients that die each year, most patients have advanced ovarian cancer. Every G1 oncologist knows that, so you don't have to write all of that. So the pertinent background information. Then it's the relevance of the subject of interest, like why is this important, and what has been the brief literature that we've learned so far on this topic. And then the third paragraph should be the gap in knowledge. So in other words, let's say now with the SHAPE trial, again, going back to the SHAPE trial, everybody's asking, well, in patients who have a simple hysterectomy, can you do open or minimally invasive surgery? And then you can say, well, you know, we had results of the LAC trial showed minimally invasive surgery is worse than open surgery. Now the SHAPE trial shows that simple hysterectomy is the equivalent to a radical hysterectomy in patients with low-risk disease. What we don't know is if you're going to do a simple hysterectomy, do you do it open or do you do it minimally invasive? So the goals of our study was we evaluated everybody that had a simple hysterectomy with low-risk cervical cancer, and we looked at recurrence rate. So then therefore, there's your gap in knowledge, and there's your goal of the study. The other thing also is that the reviewers like to see things simple. So when you write, the goals of my study were to look at recurrence rate, disease-free survival, overall survival, complications, adverse events, then you're like, oh my God, which is the actual goal of your study? You basically studied everything about this patient population. We want to know, like, what's your main goal of the study? And oftentimes, when you meet with a statistician, that's the first question they're going to ask you. They're going to ask you, like, what's your primary objective? I want to look at recurrence rates in one arm versus the other. Perfect. That's a simple objective of the study, and that's what the reviewers want to see. You can say, well, as a secondary objective, we looked at overall survival, we looked at quality of life, we looked at adverse events, but as a primary objective, recurrence rates in one arm versus the other. The methods, I think, is the most important part of the manuscript. And oftentimes, when I've spoken to other editors-in-chiefs of other journals, and we say, if you can eliminate any part of the papers, right now, if you can just get rid of any part of the paper, which parts would you get rid of? And consistently, all of the editors-in-chiefs say, get rid of the introduction, get rid of the discussion. We would love papers to just be methods and results. And certainly, the methods is incredibly important. And one of the things that I always highlight to our residents and fellows is that, if you go to any high-impact factor journal, like New England Journal of Medicine, JAMA, Lancet, take a look at the sections. Take a look at the introduction, take a look at methods, take a look at results, and take a look at discussions. Consistently, consistently, the longest section is the methods in these very high-impact factor journals. Sometimes you're reading, and you're like, did I miss the results? Because I'm just going through and going through. You're still in the methods. Sometimes the methods are like a page and a half, two pages, and then the results. So the methods is obviously critically important. Make sure that there is a statement as to the IRB approval. Sometimes there will be papers where they'll say, oh, the IRB in my institution said it wasn't needed, because in my institution in Ukraine, they don't think the IRB approval was needed for the study. When you say that, be able to provide a document that says from the IRB, on this study, we don't need IRB approval. Because you can't just say, oh, there was no need for IRB approval, because the journals will ask you and say, well, show me the letter that says that the IRB said there was no need for approval. The data that was collected is critically important. So always provide information as to what you collected, because that's the information that you're also going to be looking at in the results. So if you say, we stratified by BMI, we looked at information on quality of life, we looked So the reader, the reviewer, is going to look at the methods and say, I'm going to check for each of these things in the results. So if you say you were going to be collecting complications, grade 1, grade 2, grade 3 complications, and in the results, you only give grade 1 complications, then the reviewer is going to be like, what about grade 3? You said you were going to collect it. So I'm going to look for it now in the results. Now also, who was the study group, the inclusion and exclusion criteria? And try to be as detailed as possible with this, right? So oftentimes, we will edit the manuscripts and send it back to the authors and say, well, you have to give us more information about this patient population, because it would say, well, we studied patients at Institution X from June of 2020 to April of 2023 with cervical cancer, and we excluded patients who did not have cervical cancer. And it's like, well, well, you know, but so wait, so what stages, what histology? Was this like primary diagnosis patients or patients with primary diagnosis and recurrence? So be as detailed as possible in your inclusion criteria. And also, when you write your exclusion criteria, don't write the opposite of the inclusion. So basically, if you say, you know, we included patients who had squamous adenocarcinoma or adenosquamous carcinoma, and the exclusion criteria was patients who didn't have squamous adenocarcinoma or adenosquamous carcinoma, and say, well, yeah, but give me a little bit more, you know, was it clear cell? Was it papillary serous? So try to be as detailed as possible. Then provide the details for the ease of replication. So in other words, let's say you're doing a database study, a large database, national database study. You have to say, these are the criteria that we put into that database to give the information that we got. So provide the keywords, any element that you use to abstract that information, you have to provide that in the methods as well. And then, of course, obviously, the statistical analysis. And you'll see, of course, in prospective studies, this is often the longest part of the methods, because the journals, particularly the higher impact factor journal, always one of your reviewers is going to be a statistician. So they will send it to three or two medical reviewers and one statistician. And particularly, this is done for all prospective studies. And the statistician is going to want to see the statistical plan. So what that means is that when you started the study, you have a statistical plan from the statistician that says, these are the things that we're going to collect, and these are the things that we're going to analyze. And these are the tools that we're going to use to analyze it. Because they want to make sure that through the course of that study, based on what was happening in that study, that you didn't change your mind as to what you were going to evaluate. So that if you say, well, we're seeing no difference in recurrence rates. So we're going to actually now change it to complications. So no, you want to, and particularly also, obviously, in a prospective study, all of this has to be detailed up front. So the statistician is going to say, show me the statistical plan from back in 2018 when you started this study. And that's really very, very important. And then of course, obviously, the consent process, if the patient is alive, or if it's a prospective study, of course, you're going to have consent for those patients. One of the other things also we highlight is, reviewers get very mad if somebody says, this is a prospective study, and it clearly is a retrospective study. Because basically, they know that the author is trying to fool them into thinking that this is a better study than what it is. And then sometimes you'll see, this is prospective study because it was prospectively collected data. But that's not a prospective study. So for example, if Olga starts an enhanced recovery program, or Alina starts an enhanced recovery program in 2020 in your hospital. And from the first day, January 2020, you start collecting data prospectively. Of course, yeah, you're putting data every day. But then in April of 2024, you say, hey, let's look back to see what was our compliance with antibiotic regimen at the time of anesthesia. That's not a prospective study. You're basically looking back four years later to look at what the compliance with an antibiotics on anesthesia. So again, it's not a prospective study. It is a retrospective study of prospectively collected data. So clearly highlight that, and don't try to say it's prospective when it's not. In the results, as I mentioned, the results should reflect all that was collected in the methods. Because the reviewer is going to be looking at the results and saying, okay, I see that they collected this, they collected that, but they said they were going to collect these three things, and there's nothing here in the results that says that. So always be conscientious of that. Ideally, I think, you know, certainly we always want to see what are the number of patients in the study. Because oftentimes you will see that in the results, it'll say the median follow-up was 59 months. There were 67% of patients who were squamous carcinoma, 33% who were adenocarcinoma, and you're like, wait, but like how many patients is this? And then you shouldn't have to go from the abstract down, all the way down to the results to see like what the number of patients was. So I think it's a good way of starting the results. A total of 647 patients were included in the analysis. And then from there moving forward. I think also it's very important to present the data chronologically. And what I mean by that is that, you know, sometimes on a study that is looking at surgical site infections after laparotomy for ovarian cancer, the results will start with the median time of surgery was this, then the blood loss was this, then the median age of the patients was this, and the patient's medical comorbidities, 73% had medical comorbidities, 25% had past surgical history of previous laparotomy. And then the length of stay was this, and basically it's all out of order. So basically present the demographics first, the median age, the median BMI, comorbidities, past surgery, then you get into the OR, the OR time was this, the complications intraoperatively with this, the length of stay was this, the patients already left the OR, they're going to the floor, length of stay was this, postoperative complications within 30 days was this. So then it has like a sequence of how things happen, and then it's easier to follow. One of the things that certainly some reviewers will look at is the numbers matching, and if they don't, they don't even read the paper. I know some reviewers that will look at a paper and say, we'll go to the table first, and if you say my total number of patients was 133, in squamous carcinoma there were 90 patients, out of the carcinoma there were 10 patients, and out of squamous carcinoma was 3 patients. And they say, wait, that adds up to 103, not 133. Okay, let me go see the number of lymph nodes. The number of lymph nodes was positive in 100 patients, and negative in 156 patients. Wait, that's 156, that's not 133. So when the numbers don't match, they say, I'm not even going to waste time reading this paper, because the authors are providing data that doesn't make sense, so then therefore I'm going to reject it. So don't give the reviewers an easy reason to reject your paper, and make sure that all your tables add up to it. And you might say, well, we have information on only 103 patients. Well, then say that 30 patients is other, or unidentified, or put an asterisk and say information on histology was only available for 103 patients in the footnotes. So then therefore, you have provided that information to the reviewers. So always, always, always make sure that all the numbers add up. The other thing is also, in the results, never interpret your own data. In fact, actually, one of the things that I always say to the authors, in any paper, in any part of the paper, don't interpret your own data. Don't say, remarkably, the blood loss was only five cc's, or interestingly, we found that we had no complications at all, or surprisingly, we found that patients went home two days later. Don't use those words that could be interpreted differently. So your blood loss, your blood loss was 200 cc's, just say it was 200 cc's. Don't say, unbelievably, we only had 200 cc's in an exenteration. Yeah, I mean, that would be amazing that you had 200 cc's blood loss in an exenteration. But that should be the reaction of the reader, not your own interpretation. And then finally, coming on to the discussion, we, in the journal, in the International Journal, we have it by sections. So basically, we start with the summary of main results. And what that is, is a simple paragraph, where we ask the authors, just give me a statement about your overall findings. And it shouldn't be a repeat of the p-values, it shouldn't be a repeat of the results. It's just, in our study, evaluating patients who underwent open versus minimally invasive surgery for simple hysterectomy with low-risk cervical cancer, we found that the surgical approach did not impact recurrence rate, period. That's the finding of your study. So always start with a simple statement that provides, encompasses all the information. Place in context of the previous literature. So I think certainly, it's of value to then look at, these are my results, and how does this compare to before? So you might say, well, you know, this is showing that minimally invasive surgery is safe in the setting of simple hysterectomy, and where does that tie in with what we knew so far? In the SHAPE trial, they had shown that simple versus radical is the same, but in simple, they didn't know whether it was laparoscopy or open. So then, therefore, this is what we found. So it kind of like ties it into what has been published before. Also, very important, include references to major articles, because a lot of times, you know, the residents of the fellows will say, yeah, but there's like 49 papers written about this finding. Yes, there may be 49 papers, but there's only one paper that looked at this perspective randomly. So for example, approach to cervical cancer, you got to talk about the LAC trial. Conservative management of cervical cancer, you got to talk about the SHAPE, the CONSERVE trial. Lymphadenectomy in the setting of ovarian cancer, advanced ovarian cancer, you have to reference back to the LIONS trial. Neonatural chemotherapy, you have to talk about the EORTC trial. You have to talk about the CORAS trial. So you can't just reference a retrospective study of like 49 patients versus 30 patients when there's a prospective randomized trial of 500 patients versus 600 patients. Also, include the strengths and weaknesses of the study. And one of the things that we actually value as an editor is when the author provides a long list of limitations. A lot of times, the authors will think, well, I'm going to tell them how strong this paper is, but I'm not going to talk so much about the limitations. Because then, of course, obviously, I don't want to highlight why my paper is weak. And in fact, it should be the opposite. Again, you can say, well, the strengths of these studies are the fact that we have now the largest number of patients that has been reported based on the evaluation of this database. We have 6,000 patients with stage 1A1 lymphovascular invasion. So that's a strength because, of course, obviously, no other study has that number of patients. But also, then, the limitations are that based on the information that we gathered from this database, the database does not provide disease-free survival. So then, therefore, we only have data on overall survival. And the other element is that given the nature of the study, we were not able to capture quality-of-life elements, which are critically important in a study about sentinel lymph node mapping versus lymphadenectomy. So it gives the reader and the reviewer an understanding that you, as the author, you see what the limitations are, and you provide a reason as to why you don't have those. So ideally, again, you need to provide some level of detail. Because if you say, yeah, a limitation of our study is that we didn't have quality-of-life, and it's like, well, yeah, I mean, right, but, like, so what do you think? And, well, we didn't provide quality-of-life because this is a retrospective study of three institutions of 600 patients, but it's retrospective. We could not go back to those patients and ask them about their quality-of-life pre-surgery. So it's very important. And then also provide details on future directions that are realistic. So oftentimes, one of the things that is discouraging to an editor or a reviewer is, well, if you say, well, until we have a prospective randomized trial on this topic, we won't know the answer, and your topic may be cervical neuroendocrine carcinoma, and you say, well, there will never be a prospective randomized trial on cervical neuroendocrine carcinoma because it's an exceedingly rare disease. So then, therefore, it kind of makes the author look like they really don't know what they're talking about because they say, well, how can you even propose a prospective randomized on something that is so exceedingly rare? Also provide details as to why this is contributing to the literature and not contributing to the literature of, like, this is the most important paper that has ever been written in Ukraine. I mean, yeah, I mean, that may be your personal opinion, but it's not a fact. So provide information as to what is an example of how this paper is actually contributing to patient care. And again, do not make editorial statements as, like, this is the most important contribution to the field of gynecologic oncology in the last 50 years. You know, I mean, that's your opinion, but that is not going to be the opinion of most. Now I want to end on a few things. Sometimes we get the question, it's like, hey, can I use artificial intelligence to write my paper? And the answer, simple answer to that is yes, you can. Now, you have to disclose that to the journal and say, I used artificial intelligence, I used chat GPT or whatever to improve the quality of the language of the paper, to improve the quality of the articulation of the language of the paper. But obviously, you can't use artificial intelligence to, like, either make up data or to analyze the data. So you have to just be forthcoming in that setting. Very quickly, in terms of manuscript editing, when you get the paper back, so say, for example, your paper was reviewed and they actually are willing to look at your responses, so assure that you have the appropriate word count, that it is compliant for instructions with authors, spelling and all grammar is correct, all references are in sequence and accurate, and please make sure that you do that because it's also a simple reason why some reviewers will reject it. When they see a reference that goes from 1, 2, 3, 4, 5, 12, 17, 19, 8, 9, and it say, whoa, whoa, whoa. I mean, this is unreadable. We cannot follow any of this sequence. So, make sure that that's the case. As I mentioned, all numerical results match the abstracts and have all the authors provide input and true input. And one of the things that I always say to the collaborators in our studies is that I don't want to send you a paper. I have been working on it for six months for you to tell me, it looks great, and that's it. And then say, well, I want some level of input that will be of value to assuring that this paper gets published. And consider always actually before submitting it to sending it to a non-author and say, can you read this and see what your thoughts are? So, which journal? Of course, obviously, we have many, many choices. Always have realistic expectations. You know, if you have a retrospective study, you're not going to send it to the New England Journal of Medicine. Always have the expectations, and you can talk to a colleague that is in academic medicine to see what is the best journal target for you. Determine the target audience. And of course, obviously, for example, you may do a study that looks at factors related to surgery in ovarian cancer, and you may say, I'm going to send it to JAMA Surgery, as opposed to the international journal, Gynecologic Cancer. Yeah, I mean, JAMA Surgery, of course, is great, but it may not be the main audience that you want to reach. So, always think about that as well. Evaluate the scope of the journal, because for example, a journal like the Journal of Clinical Oncology, very, very high impact factor, very reputable, but most of the articles they publish are medical therapeutic articles. So, articles on antibody drug conjugates, articles on immunotherapy, and they're very, very selective as to which surgical trials they publish. So, always look at what else does that journal publish. And then of course, obviously, the impact factor, which is, as I mentioned, the level of quality that we often look for in terms of different journals. Reasons why manuscripts get rejected. The topics already has been published many, many times. So, if you write a paper that says, laparoscopic approach to endometrial cancer is safe. We know that already. It's been, there's like hundreds, if not thousands of papers that have been published in that. The lack of a clear aim of the study. If the reader has to really look and start questioning us, like, what's the, I don't get it, like, what's the aim of the study? That may easily reject the paper. Disconnected from the projected audience. So, again, the introduction and the discussion, key and very important. Poor methodology and study design. Probably this is the most common reason why papers get rejected. When you look at the methods and you say, well, this is really not the right study to answer this question. This was not the right design. That often is a reason for rejection. And then discussion flaws. So, disjointed, without flow, biased. If you basically are saying, no matter what your study results show, if you're basically saying, retroperitoneal lymph node dissection in locally advanced cervical cancer is great, and we should all do it, and it's the best thing for our patients, and your results show that there is no difference in outcomes, there is no difference in recurrence, it has a higher complication rate, then it's like, you know, as a reader, you're like, of course this person just loves retroperitoneal lymphadenectomy, and regardless of what their study shows, they're just continuing to push that mentality. Proper, lack of proper selection of key literature. And here I will highlight, if, for example, you're writing a paper about a topic that a particular individual has written a lot about. So, trachelectomy, radical trachelectomy. If you don't put references on the work that has been done by people like Nadima Verrostum, then it's gonna seem like, does this author really know this topic? Because it's like, the person that has written the most about this, and you don't reference that person at all, then that may actually also make the reader say, they're not really experts in this area, or they don't really know this topic as well. Self-gratifying, as I mentioned, don't write anything like, this is the best paper that's ever been published, and unrealistic proposals, as I mentioned, prospective randomized trial on a super rare vulvar cancer. And always be compliant with the instructions for authors. And I'll highlight this because sometimes you will see that authors will submit a paper in the format of a completely different journal that we also know. So, you basically are saying, this person got that paper rejected from that other journal. They didn't even wanna put the effort into changing it to the format of our journal. And they just said, just send the same thing and see what happens. So obviously, that's not recommended. And with that, of course, obviously, I want to thank you all for your time, your attention. Happy to answer any questions. And again, I hope you found this of help. Thank you. Thank you. Thank you, Professor Roth. I think it's really fundamental points for us, for every young scientist. And I have one question. You mentioned about the statistician at all. And we had the discussion with our colleagues about the role of medical doctor in statistical analysis. Should the medical doctor analyze and calculate, for example, a survival rate or a cancer rate, or it's work only for a statistician? I think it's a very good question, Olga. Thank you. And I think that it really depends on the type of training that that physician has in statistical analysis. So, certainly there are physicians that either during their medical school or during their fellowship, they actually had a degree in statistical analysis. So that's very different than someone who says, well, I'm just gonna see how I can find the basic principles of analysis and then try to do my own statistics. So it depends on what kind of expertise you as a medical physician with statistical background is bringing to that scenario. I personally feel that even if you are very well-versed in statistics, I think it's always a good idea to actually consult with a formal statistician to actually run the statistical analysis that you're planning on doing by that statistician. Because oftentimes we have seen where somebody's like, oh, yes, no, I feel comfortable. And then you bring it to a statistician and they're like, that's not the method that I would have used. And actually, that's not the right formula to evaluate this as well. And then also depends on the type of study that you're doing. If you're doing a prospective study, I would strongly, strongly suggest to actually have a formal statistician. Because also, oftentimes when that study is looking to be published, then they're gonna ask, who is a statistician on this study? And that way we wanna have communication with that person as well. Thank you, thank you a lot. And if you don't mind, I have one question for my colleague who is absent for now. Should we have more than one primary point in a retrospective trial? Or it's important to have more than one primary point? Yeah, generally, by definition, generally, the primary objective is one. Whereas this is the main question that we're asking. There are some studies where you will say, well, we were looking at progression-free survival and overall survival. But generally, as the study quality goes up, then the number of primary objectives gets smaller and smaller. So generally, typically, as you will see in the key trials that were published recently, LAC trial, LIONS trial, SHAPE trial, there's usually one primary objective. Because also the thing is that when you go to the statistician to have a discussion as to what answer you want, what question are you trying to answer, the statistician's gonna say, what's your primary objective? And that's how I'm going to draw on the evaluation of the power of the study. That's how I'm gonna determine how many patients need to be evaluated. Because if you say, well, my primary objective is progression-free survival, and I also wanna look at overall survival, they may say, well, if you have a high recurrence rates in this patient population, but at the time of recurrence, the treatment is very, very successful, then the overall survival events, meaning deaths, is gonna be very rare, because the treatment at recurrence is so successful. But the recurrence rate is high. So you might want to actually just evaluate recurrence rate, because you're gonna need less patients. Because to see a difference in the two interventions in overall survival, when you don't have death events, is gonna be very difficult. So then you go from a study that might have required 300 patients, to a study that requires 2,000 patients. So then you want to also have that discussion with your statistician, say, so what are your thoughts? And sometimes the statisticians will tell you, look, if you look at recurrence rate, you're gonna need 250 patients. If you wanna look at overall survival, you're gonna need 870. Which one you wanna do? So then it's like, okay, well, I wanna do recurrence rates. So it really depends on the question you're asking. And primarily, I would encourage, particularly for ease and clarity, to maintain it to one primary objective. Thank you, Alex. Thank you. I have one question too. Thank you very much for inspiring presentation. And my question is about literature searching and literature. May you advise some sources for literature searching? We know PubMed, of course. Maybe some, another sources for literature. Yeah, so one of the things that I do is that, you know, when I'm looking at whether something has been previously published or something may be of interest, one of the things that I will do, of course, obviously, I'll look at PubMed. But I actually look at the journals. The typical journals where we would publish. So as an example, if there's a topic that I'm interested in exploring, I will look at first the International Journal. Then I will look at Gynecological Oncology. I will look at Obstetrics and Gynecology. I will look at the American Journal of Obstetrics and Gynecology, the European Journal of Cancer, and look at their table of contents for the last five or six months. And I'll start looking in there to see, okay, well, you know, what has been published in this area? And then, of course, obviously, I think that there's always a gain from going to speak to somebody who is in that field and say, you know, this is a topic that I'm interested in. What do you think are like the key publication in this area? And, you know, recently, actually, also, one of our visiting medical students asked, how do I know that a paper is good? Because, you know, I say, well, let's look up normalthermia in the setting of laparotomy and enhanced recovery. And, you know, she comes back with all these papers, and I'll say, no, don't look at that one. Don't look at that one. Oh, yeah, this is an interesting one. And she was like, how did you like so quickly know? And, you know, one of the things, of course, obviously, is the impact factor. So if you have a journal that has an impact factor of 0.7, then likely that's not an ideal manuscript. And then, also, obviously, like, you know, looking at where it was published, where it was potentially presented, if it hasn't been published. So that may give you a gauge of like the quality of those papers. Thank you. Maybe someone has some questions, please. You may have an opportunity to ask Professor Ramirez. I have one, if I can. Yeah. Okay. For now, I'm writing the discussion for my article according to retrospective trial. And my colleague said that the discussion is similar to literature review. May you give me some advice? How can I avoid the literature review and present a discussion? Yeah, no, absolutely. And I will, let me just answer this text because I'm supposed to, and it's totally fine, but I'm supposed to be doing a podcast for our journal in a few minutes. But let me just tell them to hold off. Okay. Which actually, I also wanna speak about opportunities for improving your writing in the journal as well. So, but yeah, so to your question, yeah, no, it should definitely not be a literature review because if you wanted to write a literature review, you would write a literature review, which is very different from your topic. So, when you're looking at writing the discussion, and again, in the discussion, one of the things that I would advise is also look at the instructions for authors in the international journal, Gynecologic Cancer. That doesn't mean, certainly we would welcome your paper if it is related to gynecologic oncology in our paper, in our journal, but just look at the instructions for the discussion because basically it has a summary of main results, one paragraph. Results in the context of a public's literature, that should be about three to four paragraphs. Strengths and weaknesses, and then how this will impact future research, and then conclusions. But what we wanna see in the discussion is your results as it pertains to the context of the topic. So, if you are writing, if you don't mind, what is the topic that you're writing about? Sentinel lymph node in intermittent high risk. Okay, perfect. So, exactly, perfect. So, in that setting, then I would highlight the fact that sentinel lymph node mapping has been shown to be safe and feasible based on previous prospective studies, which included the Sentiendo, which is a study that evaluated this, and this, and this. Subsequently, additional data was confirmed that the sentinel lymph node mapping had a low false negative rate based on the results of the FIRES trial. And then subsequent to that, we learned that certainly in the setting of patients with high risk endometrial cancer, a study out of MD Anderson by Pam Solomon and colleagues demonstrated that the false negative rate in patients with high risk endometrial cancer was low, and the bilateral detection rate was 90%. So, therefore, reaffirming that endometrial cancer high-risk patients may also benefit from sentinel lymph node mapping without requiring the morbidity of the lymphadenectomy. Our study supports these findings by blah, blah, blah, blah. There's your discussion. Thank you. Thank you very much. It was wonderful. Oh, and that way you don't have to go into every single detail of sentinel lymph node mapping, and you do ultrastaging, and ultrastaging is good, and you have low, less lymphedema, and all that. I mean, we know that. So just focus on why it is important to support the fact that in high-risk endometrial cancer patients, you don't have to do a full lymphadenectomy. You have the results of the FIRES trial, you have the results of Sentiendo, you have the results of the MD Anderson study, and it shows that you still have excellent bilateral detection rate, you have very low false negative rates, and then, therefore, this reaffirms that you don't need to do a lymphadenectomy in these patients. And then, at the end, always, I think if there is an opportunity of doing so, say what the NCCN guidelines say about the patient population that you studied. So, in addition to this, current NCCN guidelines from 2024 indicate that even in the setting of patients with high-risk endometrial cancer, sentinel lymph node mapping is an acceptable approach. Thank you, Ed. Thank you. The other thing also that I was gonna mention is that in the International Journal, we have a fellowship, and actually, all four applications is open now, and the fellowship is basically, it has multiple components, but one of the components of the fellowship is that it shows young faculty or trainees an opportunity on how to be able to analyze papers, how to appropriately write papers, how to be critical about the different parts of a manuscript. So, if anyone is certainly interested, we encourage you to apply as well, because obviously, we're looking for global representation. Excellent. So, our participating clinicians here are able to apply for your fellowship, correct? Yeah, yeah, yeah. Absolutely. Maybe you have some link, and we will send it to all our participants. Yes, yeah. Sofia, I will send you, let me make a note of that. I will send you the link, and I'll copy Tom and Arthur, and perhaps you can share it with everybody. Absolutely. Thank you very much. And was it the same fellowship? We had one Ukrainian representative, one Ukrainian. Yeah, that's right, a long time ago. That's right. A long time ago. Oh, it's a fantastic fellowship. I'll work with you guys. Excellent opportunity. Excellent. And she was very productive, that link. That's right. Yes. So, I'll make a note to send you. Yeah, send it to me, and then we'll work all together with leadership of the society and everybody. Yeah. One additional thing that I wanted to mention to all of you is that oftentimes, the authors, rather than, you know, obviously going through all of the preparing of the manuscript for a particular journal, before doing so, this is completely acceptable, and also depends on the journal, but most journals are okay with this. The authors will write to the editor-in-chief and say, I'm wondering if this topic would be of interest to your journal, and here's the abstract. And therefore, many times for us, we'll say, yeah, I mean, we're interested, send it. Of course, obviously, we're not gonna say, yeah, we guarantee that this is gonna be published, but we'll say, yeah, prepare it. And then therefore, the author doesn't have to waste time and then preparing this and then sending it. And then they say, okay, no, it's rejected without review because we're not interested. So, or equally, of course, obviously the editor-in-chief might say, no, this is out of the scope of our journal. So then therefore, thank you for considering us, but we're not gonna send this out for review. And that saves you oftentimes a lot of time so that you don't have to prepare it for this one particular journal. And then they say, not interested. And then it's like, oh God, I have to change the whole format now and change it to another journal, so. Excellent. All right, well, I hope that was useful to you and the audience. And thank you again for the invitation. Thank you very much. Thank you so much. Thank you. It was very useful. We have a wish just to stand up and write some article. Thank you so much. We will follow up. We will create a follow-up with Ukrainian Society on this event. Yeah. And we'll discuss it in Dublin and we will also send it all to you. Good luck with your podcast. We don't wanna- Thank you. I look forward to seeing you all in Dublin. Yes, thank you so much. Thank you. Bye-bye. Bye-bye, Olga. Bye. Thank you very much.

scientific writing

Ukrainian medical professionals

Dr. Ramirez

American Eurasian Cancer Alliance

research publication

International Journal of Gynecological Cancer

statistical analysis

fellowship opportunity

cancer research

international collaboration