The Anatomy of a Scientific Article: IMRAD format

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 • 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 • 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 • 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