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The Anatomy of a Scientific Article: IMRAD format

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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.

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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

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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

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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.

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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.

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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

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