Adapting a manuscript to another journal's format
Journals differ in the references, word counts, illustrations, structure and style they require, so a manuscript that moves to another journal has to be reworked before it can be submitted again. The cost falls unevenly across those requirements, some publishers' schemes already reduce it, and a harmonised template has been proposed to remove it.
The lack of a common standard
As of 2018, no guideline existed that ensured harmony within journal publications and conference presentations across the globe. The ICMJE recommendations and the American Medical Association's (AMA) manual of style are the most followed, but neither covers harmonised structure and format beyond some recommendations, and ICMJE does not mandate that its recommendations be followed. The ICMJE journals follow its recommendations, which creates harmony within that group, and there is a standard format for reporting conflicts of interest, but many other journals do not abide by the recommendations. Some journals do not follow the AMA style guide either, and have their own formatting and styling guidelines. The structure and content of the regulatory documents used in clinical research have been harmonised, while scientific publications have not received the same attention.
The cost of resubmission
Many manuscripts must be submitted to several journals before being accepted, and each submission means following different guidelines and formatting styles. Two experienced publication professionals argue that this variability drains time and resources and imposes a barrier to the timely presentation of data, and that good data is many times rejected because of formatting, styling and structure. The variability, they hold, dilutes authors' and writers' ability to focus on science and medicine.
The four requirements that differ between journals
Those two professionals rank the four by the extent of their impact on authoring and repurposing a publication: referencing and citation comes first, and its variability may be found even between journals belonging to the same publisher. Word count comes second: limits on the abstract and on the manuscript by type, word or character counts for congress abstracts, and whether acknowledgements, disclosures and similar sections count towards the allowed words. Illustrations come third: journals differ in how many tables and figures they permit, supplementary illustrations are not always permitted, colour is not always permitted or affordable so figures may have to be redrafted to avoid hard-to-read greyscale, and creating figures in the journal's format raises technical challenges. Structure and style come fourth: whether the IMRAD structure is required, what is specified for reviews, which headings and sections an abstract must include, and the presentation style for conference abstracts, such as landscape or portrait.
Reducing the word count of a draft the author team has already approved can be especially annoying, and in industry publications, where several stakeholders review, re-drafting, re-reviewing and re-approving is sluggish enough to undermine the purpose of publication, disseminating results to healthcare and research professionals as early as possible. For the abstract, a limit of 250 to 300 words seems appropriate, because a lower limit may not convey a comprehensive summary of a study, especially a complicated one. A manuscript limit of 1,500 words could be constraining unless lean publications are adopted, with the introduction and discussion limited to essential points, the methods giving enough for reproducibility, and the results confined to key findings described in tabular form. A character limit may seem attractive because it forces shorter words, but it can lead to unfamiliar and hard-to-remember abbreviations that might reduce readability. Character limits are often found in conference abstract submissions, where the count in a word processor often does not match the count on the conference website, leaving authors to make last-minute adjustments.
Journals often recommend six illustrations, but there is large variability. Resubmitting to a journal that allows fewer illustrations can be overwhelming, especially where supplementary illustrations are not permitted, because some figures must be eliminated or revised, which delays the manuscript while figures are redrawn, reviewed and approved; figure formatting can also raise challenges of colour or greyscale and typeface.
As of 2018, structure was the aspect most in sync across journals, since most used the IMRAD format, which ICMJE recommends and its member journals follow. Some journals still require results and discussion to be merged and others use a non-IMRAD structure, abstract sections vary, with some journals asking for details such as setting and design under separate headings that others group under methods, and review articles may not strictly follow the structure, with the required headings varying.
Format and style vary widely: font, line spacing, page setup, page numbering, raised midline periods for decimals and the number of decimal places, and an illustration file format that may be EPS, JPEG, TIFF or PDF. Some journals have started asking for social media messages, and some for a take-home message for patients in simple language, and many such requirements are not clearly stated in the instructions for authors and come as a surprise at submission. Copyeditors are often deployed to meet these requirements, at a cost in time, money and resources. Rejection for not complying with the recommended style guide is less likely, but the requirements still hamper the publication process and delay publication.
Format-free submission and transfer between journals
Under Elsevier's "Your Paper, Your Way" initiative, authors can submit a paper as one combined PDF and apply style and formatting after acceptance, which spares them the fear of rejection on those criteria; the remaining effort is formatting after acceptance, which may involve meeting word and illustration limits and changing the reference style. Journals of the same publishing house are harmonised among themselves, so a manuscript can be transferred from one to another with a single click, which addresses the formatting and restyling challenges, although those journals are not necessarily specialty-specific and may not be the authors' preferred choice or have the circulation in the authors' region.
A harmonised template
One proposed template for harmonising publications sets out structure, limits, style and referencing. Structure: an abstract of 250 to 300 words giving background, methods, results and conclusion; an introduction giving the background, lacunae and hypotheses, and the study objectives; methods covering the study design, participants with eligibility and sample size, study endpoints and their assessment, statistical analysis, and ethical considerations with the NCT number; results covering primary and secondary efficacy analysis data and safety data; a discussion of key findings against other studies; and a take-home message with key points for professionals and key points for patients and the public. Limits: a manuscript body of 2,500 to 3,000 words, up to 8 illustrations, up to 5 supplementary files and up to 45 references. Style: AMA style, Times New Roman at 12 points, left aligned, double spaced, with numbered pages and line numbers, and illustrations cited using Roman numerals. Referencing: in-text citation by author and date, or by PubMed ID alone, which shows the author and year when the mouse hovers over it, with hyperlinks; Vancouver reference format; and a reference list arranged alphabetically or by PubMed ID.
A harmonised template, its proponents hold, would let authors choose a journal on its technical content rather than on the amount of text and illustrations it allows. It could be issued with guidance or sample text, with the flexibility of the ICH E3 template for clinical study reports, and its formatting and styling recommended or mandated so that a manuscript can be submitted to any journal without reducing its word count or changing its format and style. Until a template is agreed, its proponents hold that harmonising format and style, reference citation above all, is the most important issue, a bottleneck in a publication process that sometimes takes up to a year to print, and that whatever format and style is chosen should be implemented globally. Their "blue sky" future sets a harmonised, template-based and lean structure against the variable, exhaustive and comprehensive structure of 2018, and a harmonised, guideline-based format and style against the variable format and style of 2018. The best way forward, in their view, is lean publications and a template format with specifications used globally.
The template's proponents urge ICMJE, perhaps with ICH and the International Society for Medical Publication Professionals (ISMPP), to consider, implement and mandate harmonisation across scientific publications, at least of style and format. They urge ICMJE, AMA, ISMPP, EMWA, AMWA and publishers to agree on a template. Harmonisation and lean writing, they hold, will be realised only with efforts from all stakeholders, including authors, writers, sponsors and journal publishers, and EMWA, ICH, ICMJE, AMA, ISMPP and AMWA.