3-MedicalWriting IMRADManuscriptStructure PDF

( C linical Research Skills Training & Events)
IMRAD: Manuscript structure
Anne John Michael

Medical Writer
Page breakdown
Introduction: 1 page
Methods: 2-3 pages (or longer)
Results: 2-3 pages About 3,000
words for each
Tables and figures: 3-6 article
Discussion: 2-4 pages
Acknowledgement : 1 paragraph
References: 20-35
Copyright: Unauthorised use without the consent of the author is not allowed. (pg. 1 of 45)
Content breakdown
Introduction: What is the problem?

Methods: How did I solve the problem?
Results: What did I find out?
Discussion: What does it mean?
Acknowledgement : Who helped me out?
References: Whose work did I refer to?
Introduction
Is not the first section to be written
1. Methods
2. Results
3. Introduction
4. Discussion
Only 1 or 2 reference per point
Spencer S. Scientific Writing and Publishing for International

Journals. Presented in Elsevier Vit E Programme; 5 April 2009.
Singapore
Introduction
Section 1
What is the problem?
Example
The decision to change chloramphenicol from a prescription-only
medicine to availability under the supervision of a pharmacist
followed the MHRA protocol for such a change, with widespread
consultation.7 The decision, however, contradicted the important
public education message that antibiotic prescribing to children in
particular should be avoided,8 because unnecessary antibiotic use
in a community setting is a potentially important driver for
resistance.9,10
Davis H, et al. British Journal of General Practice 2009; 59: 897900.
Introduction
Section 2
What others have said?
Example
The authors own study, in children, showed that while the majority
of cases were due to bacterial infection, and antibiotic use
increased pathogen eradication, topical antibiotics
did little to speed clinical resolution (the median time to resolution
in both arms of the trial was 5 days).1 The other two community-
based trials reported similar findings in studies that included
adults.2,3
Introduction
Section 3
How your research will solve the problem you identified?
Example
This paper reports the studys best estimate of the relative effect of
these conflicting drivers for chloramphenicol use in England since 2005.
Methods
It is the first section to be written

1. Methods
2. 2. Results
3. 3. Introduction
4. 4. Discussion
Start writing while you are doing your research
Reference common methods

Singapore
Methods
Use subheadings (Participants, Apparatus,

Procedures, etc)
Has sufficient details to enable others to reproduce

your study
Written in a logical order
Explains the use of any sophisticated analytic

techniques
Methods
Section 1
Participants: size and characteristics of sample
Example
The Prescription Pricing Authority provided monthly figures of
chloramphenicol prescriptions dispensed in England from March 2003 to
December 2007 from the ePACT (Electronic Prescribing Analysis and
Cost) database, which includes all FP10 prescriptions that have been
issued, dispensed, and submitted to pricing authorities for payment. It
does not include prescriptions issued by hospitals or dental
practitioners.
Methods
Section 2
Special equipments: laboratory techniques, scales,
software, assessment tools
Example
During a home visit, the first hour was devoted to completing a
questionnaire administered by an interviewer. The questionnaire
included the following hypertension related items:1. Are you known
to have high blood pressure? 2. Have you ever been told by a doctor
or other health personnel that you had high blood pressure?
Lim TO, et al. Singapore Med J 2004; 45:2027
Methods
Section 3
Procedures: Describe what you did and said
Example
A detailed audit was conducted of all consultations that had taken place
for acute conjunctivitis within one pre-2005 and one post-2005 year in
each practice, by examining the medical notes for each individual
consultation. In two practices the chosen pre-2005 year was 2003, but
in the other two practices data were collected for 2000 because these
practices had taken part in the trial of chloramphenicol use in
conjunctivitis which started in 2001; 2007 was used as the post-2005
year in all practices.
Methods
Section 3
Procedures: Provide details about the variables
Example
Visomat (OZ 30 was used for patients with arm size 22-32 cm and
Visomat (OZ 2 for obese patients with arm size more than 32 cm.
The cuff was placed on the respondents right arm 2-3 cm above the
antecubital fossa. Two BP measurements were taken with an interval
of three minutes apart.
Lim TO, et al. 2004. Singapore Med J; 45:2027
Methods
Section 3
Procedures: Describe basis for classification & with
ref
Example
Hypertension was defined as a mean systolic blood pressure (SBP)
>140 mmHg, mean diastolic blood pressure (DBP) >90 mmHg or
on current treatment for hypertension with medications (9). Blood
pressure levels were further categorised as optimal, normal, high
normal, stages 1, 2, 3 and 4 hypertension according to the
classification system recommended by the Joint National Committee
on Detection, Evaluation and Treatment of High Blood Pressure(9).
Lim TO, et al. 2004. Singapore Med J; 45:2027
Methods
Section 3
Procedures: Give reasons for manipulation of
methods
Example
The decision to use electronic devices instead of the mercury
sphygmomanometer was based on the assumption that the electronic
device ought to be more robust. Survey field work can be difficult
especially in outlying parts of the country. A previous national
health survey in 1986 had encountered problems with mercury
leaking rendering the device unusable or measurements unreliable.
Methods
Section 4
Statistical analysis
Example
Prevalence estimates and standard errors were calculated by a
method appropriate to the complex sampling design(17,18).The
sampling weights were adjusted for household non-response using
adjustment cells formed by state and urban/rural residence.
STATA(20) software package was used for analysis.
Methods
Tables
Methods
Studies of humans or animals need formal review

and approval by an IRB or ethics committee, and this
must be described in the "Methods."
Results
Is the second section to be written

1. Methods
2. Results
3. Introduction
4. Discussion
Not just numbers and statistical tests
Spencer S. Scientific Writing and Publishing for International Journals.

Presented in Elsevier Vit E Programme; 5 April 2009. Singapore
Results
Report the test and describe the findings
Which group was higher than the other?
Was the pattern consistent with your prediction?
Avoid repeating in text what is featured in tables and

figures
Report on each item in methodology (Do not indicate

items not described in methodology)
Results
Section 1
Describe study sample
Example
A total of 8541 households were identified. Interviews were
possible in 8136 (95.3%) households, with 3004 (36.9%) of these
having eligible children ages 7 to 15 years. A total of 5528 children
were enumerated, ranging from 61 to 423 across the 34 study
clusters. The age, gender, and ethnicity of enumerated children are
shown in Table 1. Males constituted 51.4% of the total.
Goh PP, et al. Opthalmology 2005;112: 678685
Results
Section 2
How many participants had what
Example
Measurements were not possible in 12 of the examined children.
(Ten had delayed mental development and could not understand
the testing process, and 2 were not cooperative.) Uncorrected
visual acuity 20/32 or better in at least 1 eye was found in 3833
(82.9%) children. Seven hundred eighty-nine (17.1%) children had
visual impairment in both eyes (20/40), with 94 (2.0%) of these
blind (20/200) in both eyes.
Goh PP , et al. Opthalmology 2005;112: 678685
Results
Flowchart
Zhu JR, et al. Current Medical Research and Opinion 2007;23:3055-3068
Results
Section 3
What is the relationship between the outcome and
explanatory variables?
Example
On the basis of enumeration interviews, 625 (13.5%) of the
examined cohort wore glasses, with 115 wearing them only
occasionally. At the examination, 443 (9.6%) children were
wearing spectacles (Table 2). Among the 789 with visual
impairment in both eyes based on uncorrected visual acuity, 390
(49.4%) were wearing spectacles.
Goh PP , et al. Opthalmology 2005;112: 678685
Tables
In tables, when everything stands out, nothing

stands out.
Table comparisons should run horizontally, as we

read.
Tables better than text and figures for exact values,

quick read of the story.
If a table is large or exceedingly complex, consider

separating the data into 2 or more simpler tables.
Tables
If several tables share a footnote, succeeding tables

may refer back: "Exclusions are explained in the
first footnote to Table 1.
Longer tables benefit from headings, which help

establish hierarchy and improve readability
Results
Tables
Simple descriptive title
Formatted
Tables better combined or split?
Error/variation included
All cited in text

Singapore
Figures
Figures: statistical graphs, maps, algorithms,

illustrations, computer-generated images and
photographs
If a figure contains error bars, explain whether they

represent standard deviations, standard errors,
ranges, or confidence limits.
Results
Figures
Do they make the point clearly
Are all axes, lines, bars etc labelled?
Do all figures have a legend?
Do they complement the text?
Is the format appropriate?

Singapore
Discussion
Is the last section to be written

1. Methods
2. Results
3. Introduction
4. Discussion
Support your findings with references

Singapore
Discussion
Section 1
What did the study show?
Example
The CUSUM analysis in our study showed an acceptable learning
curve by trainee was achieved after 23 procedures, with <25%
primary failure rate. We also demonstrated the importance of self
monitoring and quality control as we were able to pick-up
Goh BK, et al. Seminars in Dialysis 2008; 21: 561566
Discussion
Section 2
Strengths and weaknesses of methods
Example
However, in view of the fact that this procedure, peritoneoscope
Tenckhoff catheter implantation by interventional nephrologists, is
still perceived to be relatively new, investigational and many
nephrologists and surgeons alike remain skeptical of the value of
this recent option, we advocate that quality control of Tenckhoff
catheter insertion is performed using CUSUM charting as described
to monitor for primary catheter dysfunction
Discussion
Section 3
Discuss how the results support the current
literature or refute current knowledge
Example
We demonstrated that a successful Tenckhoff catheter insertion
programme can be run by nephrologists (1).
Discussion
Section 4
Future directions and impact on current thinking
or practice
Example
We propose that future Tenckhoff catheter insertion programs in
Malaysia will adopt the same quality assurance program and
standards set.
Goh BK, et al. 2008. Seminars in Dialysis; 21: 561566
Preparing the abstract
Abstract
Introduction: 2 sentences
< 250 words
Methods: 3-4 sentences
Results: 3-4 sentences
Discussion: 2 sentences
State the studys

purpose
basic procedures (selection of study subjects or
laboratory animals, observational and analytical
methods)
main findings (giving specific effect sizes and their
statistical significance, if possible)
principal conclusions
Provide the context or background for the study
Emphasize new and important aspects of the study

or observations
Stick to the word limit
Abstracts are the only substantive portion of the

article indexed in many electronic databases and
the only portion many readers read. So you need to
accurately reflect content of the article
Abstracts are standalone
The format for structured abstracts differs from

journal to journal, prepare abstracts in the format
specified by the journal chosen.
Unstructured abstract
Structured abstract
Abstract for conference
Same format and style as abstract for journal
But for conference, there is a deadline for submission
If you have presented in a conference, you may present

the same data in a paper for journal
Refer to the instructions from the conference organiser
Dont keep your data as conference

abstract alone
Title
Short & simple

Use keyword
Avoid abbreviations
Title page should include

Article title.
Authors names and institutional affiliations.
The name of the department(s) and institution(s) to which
the work should be attributed.
Disclaimers, if any.
Contact information for corresponding authors..
The name and address of the author to whom requests for
reprints should be addressed or a statement that reprints
are not available from the authors.
Source(s) of support in the form of grants, equipment,
drugs, or all of these.
A running head.
The number of figures and tables.
Cover letter?
Use the editors name

State the importance of the question
State the importance of the findings
Why have you chosen this journal
Can you suggest impartial reviewers
Competing interests?
Other information
Know your journal
What kind of papers are featured?

Is it a specialty journal?
How are the references cited?
Read the Instruction to authors
How is the submission process? Online?
Do journal editors look at
references?
Yes, manuscripts with references that are inappropriate,
inaccurate or in the wrong format have been rejected.
Why?
Because it gives a bad impression.
Editors may perceive other sections to be just as sloppy.
Editors may assume the paper was earlier submitted to a
different journal.
Singapore Medical Journal: Effective medical writing

http://smj.sma.org.sg/5007/5007emw1.pdf
Accepted but with amendments
Amendments mean your paper was not rejected. Even

the most published scientists have been rejected.
Positive outlook: comments and feedback are ways to

improve your manuscript
Cover letter for revision must address each of the

comments indicated by reviewers
Accepted but with amendments
You can disagree with their comments but give reason
Sometimes, they may ask for major changes such as

changes to study design and sampling. You have the
choice to address these issues or submit to another
journal.
Why BMJ rejects so many

papers
They receive more research articles than they can
publish, and send fewer than half for external peer
review. Rejection rate = 93%.
Decisions based mainly on suitability of the specific

research question and study design
A study with negative results will be published if its

research question was sufficiently important and well
answered.
From submission to publication
Reasons for Top reasons for rejections

1. Wrong or incomplete statistical analysis*
acceptance 2. Stating more than the results indicated*
1. Significant problem 3. Wrong instrumentation
2. Good writing 4. Insufficient number of subjects or biased
3. Good study design sampling
5. Ideas in manuscript not explained clearly
6. Insufficient problem statement
7. Wrong or inconsistent results
8. Wrong, insufficient or outdated literature
review
9. Insufficient data
10.Major flaws in tables and figures
*Still can be fixed

Bordage G. Acad Med 2001;76:889-896
What journal editors want?
Is the research question important ?
Would it be interesting to our readers?
Is it valid and a scientifically sound study?
What journal reviewers want?
Short, clear, precise title

Good abstract
Good design and methods
Clear conclusions
Keep it simple, write for your readers, not for
your fame
One paragraph for one major topic
Instructions to Author: Example
The AJCN encourages authors to provide the

names, fields of interest, addresses, telephone
and fax numbers, and e-mail addresses of 46
unbiased and qualified potential
expert reviewers from outside the authors'
institutions.
The manuscript should be formatted as follows:

216 x 279 mm (8 x 11 in) or ISO A4 (212 x 297
mm), with margins of at least 2.5 cm; use double-
spacing and 12-point type throughout.

The title page should contain:
the names of all authors (first name, middle

initial, last name) and their departmental and
institutional affiliations at the time the research
was done. Indicate which authors are
associated with which institutions by listing the
appropriate author initials in parentheses after
each affiliation listed.
The title page should contain:
a short running head of not more than 50

characters (count letters and spaces);
a list of abbreviations and their definitions for
all abbreviations used in the text if there are 3
or more; and
The title page should include a word count for text

only (eg, not including abstract, acknowledgment,
or references)
Titles can occupy no more than three lines of

type. Each line should contain no more than 38
characters, including spaces.
Up to five keywords or phrases suitable for use in

an index (it is recommended to use MeSH terms).
An abstract should contain no citation to other

published work
Do not use abbreviations in the title or abstract

and limit their use in the text. Expand all
abbreviations at first mention in the text.
Text
Use active voice whenever possible. Use past

tense when describing and discussing the
experimental work on which the article is
based. Reserve present tense for reference to
existing knowledge or prevailing concepts and
for stating conclusions from the experimental
work.
British spellings to be used throughout.
The Discussion should not exceed 4 typewritten

pages except in unusual circumstances as
approved by the Editor.
The Discussion should explain the significance of

the results and place them into a broader context.
It should not be redundant with the Results
section. This section may contain subheadings and
can in some cases be combined with the Results
section.
When drafting your paper, please remember that

we have a worldwide readership.
We ask all authors to structure the Discussion

section with sub-headings as follows: Main finding
of this study, What is already known on this topic,
What this study adds, Limitations of this study
Use nonproprietary names of drugs, devices, and

other products, unless the specific trade name of
a drug is essential to the discussion
Abstracts from scientific meetings not published in

peer-reviewed journals may not be used as
references.
Unpublished observations and personal
communications (written, not oral) may
not be used as references but may be inserted in
parentheses with the names of the responsible
researchers and the year of the observation or
communication. Authors are responsible for
obtaining written permission from everyone so
cited and for providing to the Editor a copy of the
permission, if requested.
Doctoral dissertations may be used as references.
Include manuscripts accepted but not yet

published; designate journal name followed by
"(in press)."
References. Up to six authors can be listed; if

the number exceeds six, quote the first three
followed by et al.
Where more than one reference is cited, separate

by a commafor example, [1, 4, 39]. For
sequences of consecutive numbers, give the first
and last number of the sequence separated by a
hyphenfor example, [22-25].
Tables must be on separate pages after the

reference list, and not be incorporated into the
main text. Figures should be uploaded as separate
figure files.
Double-space tables (including any footnotes) and

provide a title for each. Extensive tables or
supplementary material may be published on
the Journals Web site only.
If photographs of patients are used, either they

should not be identifiable or the photographs
should be accompanied by written permission to
use them.
Please make sure your final manuscript:

Meets our length restrictions of 55,000
characters, including spaces, and seven figures
and/or tables
Editors may request authors to shorten a

submitted manuscript when in the opinion of the
Editorial Board, the content does not justify the
length.
During the submission process you must enter the

full title, short title of up to 70 characters and
names and affiliations of all authors. Give the full
address, including email, telephone and fax, of
the author who is to check the proofs (the
'corresponding author').
Authors will be charged $1000 for the first color

figure and $275 for each additional color figure.
Figures may be resized during the production
process.
PDF proofs will arrive via email about 2 weeks

prior to publication and need to be returned with
vital corrections no more than 24 hours after
receipt.
The Lancet will not publish any articles unless we

have the signatures of all authors
The editors encourage authors to post a Word-

processed version of their peer-reviewed,
accepted, and edited article on their personal or
institutional websites any time after publication in
print or online. Your document should indicate the
articles citation and a link to The Lancets
homepage.
100 offprints of Articles, Case Reports, and

most types of review papers will be provided free
of charge
Authors may be required to provide the rawdata

for research papers when they are under review
and up to 10 years after publication in The Lancet
Authors are able to make their articles freely

available online, immediately on publication, for a
fee, using the Unlocked service. This service is
available to any author publishing original
research in a BMJ Journal for a fee of
1,700(+VAT)/2,515(+VAT)/$3,145.
Any change in authorship after submission must

be approved in writing by all authors.
Use the covering letter to explain why your paper

should be published in The Lanceta leading
international general medical journalrather than
elsewhere (eg, a specialty journal)

3-MedicalWriting IMRADManuscriptStructure PDF

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

3-MedicalWriting IMRADManuscriptStructure PDF

Diunggah oleh

Hak Cipta:

Format Tersedia

( C linical Research Skills Training & Events)

IMRAD: Manuscript structure

Anne John Michael

Introduction: What is the problem?

Only 1 or 2 reference per point

Spencer S. Scientific Writing and Publishing for International

Davis H, et al. British Journal of General Practice 2009; 59: 897900.

Davis H, et al. British Journal of General Practice 2009; 59: 897900.

Davis H, et al. British Journal of General Practice 2009; 59: 897900.

It is the first section to be written

Start writing while you are doing your research

Reference common methods

Spencer S. Scientific Writing and Publishing for International

Use subheadings (Participants, Apparatus,

Has sufficient details to enable others to reproduce

Written in a logical order

Explains the use of any sophisticated analytic

Davis H, et al. British Journal of General Practice 2009; 59: 897900.

Lim TO, et al. Singapore Med J 2004; 45:2027

Davis H, et al. British Journal of General Practice 2009; 59: 897900.

Lim TO, et al. 2004. Singapore Med J; 45:2027

Lim TO, et al. 2004. Singapore Med J; 45:2027

Lim TO, et al. Singapore Med J 2004; 45:2027

Lim TO, et al. Singapore Med J 2004; 45:2027

Lim TO, et al. Singapore Med J 2004; 45:2027

Studies of humans or animals need formal review

Is the second section to be written

Not just numbers and statistical tests

Spencer S. Scientific Writing and Publishing for International Journals.

Which group was higher than the other?

Was the pattern consistent with your prediction?

Avoid repeating in text what is featured in tables and

Report on each item in methodology (Do not indicate

Goh PP, et al. Opthalmology 2005;112: 678685

Goh PP , et al. Opthalmology 2005;112: 678685

Zhu JR, et al. Current Medical Research and Opinion 2007;23:3055-3068

Goh PP , et al. Opthalmology 2005;112: 678685

In tables, when everything stands out, nothing

Table comparisons should run horizontally, as we

Tables better than text and figures for exact values,

If a table is large or exceedingly complex, consider

If several tables share a footnote, succeeding tables

Longer tables benefit from headings, which help

Spencer S. Scientific Writing and Publishing for International

Figures: statistical graphs, maps, algorithms,

If a figure contains error bars, explain whether they

Spencer S. Scientific Writing and Publishing for International

Is the last section to be written

Support your findings with references

Spencer S. Scientific Writing and Publishing for International

Goh BK, et al. Seminars in Dialysis 2008; 21: 561566

Goh BK, et al. Seminars in Dialysis 2008; 21: 561566

Goh BK, et al. Seminars in Dialysis 2008; 21: 561566

Goh BK, et al. 2008. Seminars in Dialysis; 21: 561566

Preparing the abstract

State the studys

Provide the context or background for the study

Emphasize new and important aspects of the study

Stick to the word limit

Preparing the abstract

Abstracts are the only substantive portion of the

Abstracts are standalone

The format for structured abstracts differs from