1. The Anatomy of a Scientific Article: IMRAD format
Peter M Nthumba
THE ANNALS OF SURGERY PRECONFERENCE WORKSHOP
7TH DECEMBER 2016

2. Uniform requirements for manuscripts submitted to biomedical journals
International Committee of Medical Journal Editors
A small group of editors of general medical journals met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals – they became the Vancouver Group – which later expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually; gradually it has broadened its concerns.

5. IMRaD
Introduction – justify and specify the question that you are addressing – “why you are addressing your particular research question”
Methods – telling how the answer was sought – “what you did”
Results – giving the findings – “what you found” and
Discussion – saying what the findings mean and giving your answer to the study question – “what it means”.
REMEMBER – there is a WORD COUNT – every word must COUNT

7. Writing Order – not standard
Introduction (brief literature review)
Ghost Tables/Figures (analytic plan)
Methods
Tables/Figures
Results
Discussion
Abstract
Title page
Acknowledgements
IMRaD - Authors do not necessarily write in this order – it depends on the way they have been taught and the method they find easiest.

8. INTRODUCTION What we know What we don’t know What we need to find out
Limit to only pertinent references
What we don’t know
What we need to find out
Primary and secondary research objectives
Preplanned subgroup analyses

9. Number of paragraphs per section:
Introduction - 2
Methods - 7
Results - 7
Discussion - 6

10. INTRODUCTION
ESTABLISH what gaps exist in knowledge, that this new research will answer
Most authors follow one of a few approaches to the INTRODUCTION:
The SEMINAR approach
The ALARMIST approach
The MUCH DISCUSSED RECENTLY (MDR) approach

12. INTRODUCTION and ETHICS
The Declaration of Helsinki states that biomedical research involving people should be based on a thorough knowledge of the scientific literature.
It is unethical to expose humans unnecessarily to the risks of research.
Some clinical trials have been shown to have been unnecessary because the question they addressed had been or could have been answered by a systematic review of the existing literature.
Thus, the need for a new trial should be justified in the introduction.
Ideally, it should include a reference to a systematic review of previous similar trials or a note of the absence of such trials

13. INTRODUCTION OBJECTIVES
State specific objectives, including any pre-specified hypotheses.
Objectives are the detailed aims of the study.
Well crafted objectives specify populations, exposures and outcomes, and parameters that will be estimated.
They may be formulated as specific hypotheses or as questions that the study was designed to address.

14. METHODS section ANSWERS THE QUESTION, 'What did you do?'
Describes the methods that you used.
The scientific process is based on methods that are explicit, open to criticism, and reproducible by other investigators.
The methods used should be in enough detail to enable your readers to:
judge whether the methods were appropriate for answering the study question
judge any weaknesses in methodology that could influence the interpretation of the results
repeat the study if they wish to do so.

15. METHODS

16. METHODS Participant selection
Variables and procedures for each primary and secondary objective
Analytic methods
Study design – Case report/series/Review/RCT/Meta-analysis etc
Subject selection
Source population
Inclusion criteria
Exclusion criteria
Rationale for inclusion/exclusion criteria

17. METHODS
When data are summarized in the Results section, specify the statistical methods used to analyze them.
Restrict tables and figures to those needed to explain the argument of the paper and to assess its support.
Use graphs as an alternative to tables with many entries; do not duplicate data in graphs and tables.
DON’T repeat all data from tables in text

18. METHODS
Avoid nontechnical uses of technical terms in statistics, such as ``random'' (which implies a randomizing device), ``normal,'' ``significant,'' ``correlations,'' and ``sample.'' Define statistical terms, abbreviations, and most symbols

19. RESULTS section Should give a factual account of what was found:
the recruitment of study participants,
the description of the study population
the main results and ancillary analyses.
Should be free of interpretations and discursive text reflecting the authors’ views and opinions.

20. RESULTS
Decisions in presenting the results stem from the following questions:
which data should be presented (and which omitted)?;
in what sequence should the data be presented?; and
what should be stated in the text vs tables and figures?
In general, the most important results should be shown first, the least important last.

21. Tables and Figures Purpose May aim for about 3-4 total
Concise display of information
Provide several levels of detail
Reduces length of text
May aim for about 3-4 total
Table 1: Patient characteristics
Table 2-4: one for each research objective

22. Results NOT all data collected may need to be reported.
Present only those data that have a direct bearing on the interpretation of the study and that will therefore show up somewhere in the discussion.
Having a list of objectives is extremely useful – as it will help direct your results
Present your results in logical sequence in the text, tables, and illustrations.
Do not repeat in the text all data in the tables or illustrations; emphasize or summarize only important observations.

23. DISCUSSION
The discussion section addresses the central issues of validity and meaning of the study.
Surveys have found that discussion sections are often dominated by incomplete or biased assessments of the study’s results and their implications, and rhetoric supporting the authors’ findings
Structuring the discussion may help authors avoid unwarranted speculation and over-interpretation of results while guiding readers through the text.

24. DISCUSSION
E.g., Annals of Internal Medicine recommends that authors structure the discussion section by presenting the following:
(1) a brief synopsis of the key findings;
(2) consideration of possible mechanisms and explanations;
(3) comparison with relevant findings from other published studies;
(4) limitations of the study; and
(5) a brief section that summarizes the implications of the work for practice and research.

25. DISCUSSION - Paragraphs
Summarize main finding
Summarize supporting findings
What are the implications
How does it change/impact practice?
Limitations
Summary/conclusion

26. Discussion
It is good practice to begin the discussion with a short summary of the main findings of the study
Emphasize the new and important aspects of the study and the conclusions that follow from them.
Do not repeat in detail data or other material given in the Introduction or the Results section.
Include in the Discussion section the implications of the findings and their limitations, including implications for future research.
Relate the observations to other relevant studies.

27. Discussion
Link the conclusions with the goals of the study but avoid unqualified statements and conclusions not completely supported by the data.
In particular, authors should avoid making statements on economic benefits and costs unless their manuscript includes economic data and analyses.
Avoid claiming priority and alluding to work that has not been completed.

28. DISCUSSION Limitations:
Discuss limitations of the study, taking into account sources of potential bias or imprecision.
Discuss both direction and magnitude of any potential bias.
Interpretation: Give a cautious overall interpretation considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence.

29. DISCUSSION
The heart of the discussion section is the interpretation of a study’s results.
Over-interpretation is common and human: even when we try hard to give an objective assessment, reviewers often rightly point out that we went too far in some respects.
When interpreting results, authors should consider the nature of the study, potential sources of bias, including loss to follow-up and non-participation.

30. DISCUSSION
Generalizability: Discuss the generalizability (external validity) of the study results - the extent to which the results of a study can be applied to other circumstances.

32. Summary Introduction Methods Results Discussion What we know
What we don’t know.
What we did to find out
Methods
Participant selection
Variables and procedures for each primary and secondary objective
Analytic methods
Results
Patient recruitment and characteristics
Evidence for first objective
Evidence for second objective
Evidence for third objective
Discussion
Summarize main finding
Summarize supporting findings
What are the implications/how does it change practice?
Limitations
Summary/conclusion