That friend
may not be there at all times for all of us; therefore, you need to
ensure that what catches the eye first, needs to be inviting. The Title,
Abstract and the Introduction are the face of any research paper, and
hence need to be dressed in such a way as to enthrall the readers [1].
Getting the Title Right
The title is the first part of any manuscript that is
seen by the editors, reviewers, as well as readers. It is also what
appears on the contents page of the journal issue, and serves as a
window to the research paper [2]. A strong title pulls readers into it,
making it memorable and encouraging for people to read. A weak title
dulls the readers’ expectations and could negatively affect the views on
your research work, no matter how good it is.
Most electronic databases and search engines, and
journal websites, use the words in the title or the keywords provided by
the authors to retrieve the scientific paper during online searches.
Therefore, title plays a crucial role in ensuring the access of your
paper to its readers. Busy editors often decide the eligibility of a
manuscript for publication and peer-review based on their initial
impression after a scrutiny of the manuscript’s title and abstract [3].
Therefore, having a good and inviting title should be a priority.
How to Write a Good Title ?
Keep it Concise
If the title is too long or complicated, it may put
off the readers right at the onset. Use of about 10-12 words in the
title will enable you to bring out the essence of the research work
(patient/species, intervention done, any comparisons, and outcome).
Consider the following title:
"A novel study on the usefulness of NS1 antigen
detection test in the diagnosis of dengue fever in children: analysis of
clinical features and comparison with ELISA test and viral culture with
clinical follow-up in 100 patients of dengue fever at XYZ Hospital,
Delhi." This would take ages to read. Not many people will have the
patience to go through this with a clear head! Now consider: "NS1
antigen test for the diagnosis of Dengue fever". Obviously, this
title is better because it is clear and concise. It permits the reader
to proceed onto the next section within his/her attention span. To make
the title concise, we need to avoid unnecessary phrases. Consider the
following titles:
• Role of steroids in aplastic
anemia
• Effects of antenatal exercises on
birthweight of baby
• A study on efficacy of beta-blockers in
heart failure
The underlined words in these titles do not add to
the information provided, and by simply omitting these superfluous
words, the title is as informative and definitely sharper.
Keep it Specific
Let us consider another title: "Vitamin D and
Pneumonia."
Despite being extremely concise, this title is still
lacking the power to engage the reader as it is too general and vague.
It does not lead the reader in any particular direction. Instead, it
leaves the informative work to the abstract and the paper itself, which,
as we know, not many people go over. Consider replacing it with "Vitamin
D deficiency and risk for severe pneumonia in under-five children."
This is longer but definitely more specific.
Whether to include Place of Study
Sometimes, a given study, if conducted with the same
methodology, by the same researcher but in a new setting, may yield
completely different results. Consider a study on prevalence of
hypertension in young adults in Mumbai. Here the location of the study
is vital to the study itself. The prevalence of hypertension at a
certain geographical location is dependent on its prevalent lifestyle
habits, which in turn are affected by the economic status and cultural
and social practices. So, inclusion of the place of study in the title
for this study would be desirable for sake of completing of information.
Now consider the following titles:
• "Daily vs. weekly iron supplementation in
adolescent girls in Delhi"
• "Methylprednisolone vs. Cyclosporine for
treating Childhood Aplastic Anemia in Manchester"
The study of iron supplementation in adolescent girls
in Delhi will not be very different from the study of iron
supplementation in adolescent girls elsewhere. The affecting factor here
is not the socio-economic or political environment, but evolutionary
build-up of a species, which will not differ even if we change the
geographical location of the study. Same applies to the second study.
The results obtained in the Manchester study are also applicable to
other geographical locations. In such studies, the name of place becomes
redundant in the title.
Placing the Keywords towards the beginning
The important words and terms related to your study
should be placed towards the beginning of the title. For example, "Rituximab
for Treatment of Autoimmune Hemolytic Anemia" is a better title than
"Treatment of Autoimmune Hemolytic Anemia with Rituximab".
Let us take the example of a study being conducted to
ascertain the differences in the prevalent trends of obesity between men
and women. The title for this study can be composed in two ways:
"Prevalence of Obesity in Adults by Gender" or "Gender
Differences in Prevalence of Obesity in Adults". Both titles are
concise, specific, and bereft of unnecessary phrases, yet these are
inherently different in their approach. In this example, the focus of
the study is not prevalence of obesity per se, but the
male-female comparison of prevalence of obesity. Therefore, the second
title, which emphasizes the focus of the study by placing it in the
beginning, is more appropriate.
Use of Colon in the Title
It is important to note that the study design is
usually preceded by a colon in the title. For example, "Azithromycin
for treatment of enteric fever: a randomized controlled trial".
Use a Descriptive/Neutral Title
A descriptive title has all the elements of the
research work (Patient, intervention, outcome, comparison), yet it does
not reveal the main findings of the study or its conclusion. Using too
amusing or loud titles should be avoided and as far as possible use a
neutral title [4]. For example, "Seven Days versus Ten Days
Antibiotic Therapy for Culture-Proven Neonatal Sepsis: A Randomized
Controlled Trial".
Avoid Declarative Titles
A study title which states the main findings of the
study is said to be a declarative one. It reflects the intrinsic bias on
the part of the researcher regarding the interpretation of the data.
"Seven Days Antibiotic Therapy is better than Ten
Days Antibiotic Therapy for Culture-Proven Neonatal Sepsis: A Randomized
Controlled Trial" is a declarative way of writing the title for the
previously mentioned study.
"Cryptosporidium is the Most Common Enteric
Pathogen in HIV-infected Children with Diarrhea" is another example.
"Prevalence of Cryptosporidium in HIV-infected Children with Diarrhea"
is a more appropriate title as it lets the reader approach the subject
with an open mind and retains the curiosity of the reader.
Avoid Query/Interrogative Titles
Introducing the subject of research in the form of a
query can be distracting, and is best avoided. Consider the query
version of the previous example: "Is Seven Days Antibiotic Therapy
Better Than Ten Days Antibiotic Therapy for Treating Culture-proven
Neonatal Sepsis?"
Query titles tend to sensationalize the subject and
can sometimes be used for review articles. A research by Jamali and
Nikzad [5] revealed that articles with query titles tend to get
downloaded more frequently, yet they are cited less frequently.
Avoid Abbreviations/Acronyms in the Title
As far as possible, refrain from using
abbreviations/acronyms in titles. Consider the title: "Diagnosis of
ARF in Children". Here, the abbreviation ARF could imply acute renal
failure or acute rheumatic fever, and hence abbreviations are best
avoided in titles. Now consider another title: "IVIG for treatment of
PANDAS". Here, IVIG is used for intravenous immunoglobulin and PANDAS
denotes Pediatric Autoimmune Neuro-psychiatric Disorders associated with
Streptococcal Infections. A reader unaware of their meaning may skip
this article altogether.
However, abbreviations are sometimes useful for long,
technical terms in scientific writing. The use of abbreviations that
appear as word entries in Webster’s Collegiate Dictionary is acceptable.
For example: Use of abbreviations like HIV, AIDS, NADPH, and ATP, may be
acceptable.
Ingredients of a Good Title
A balanced title needs to be "SPICED" [6]. The
acronym here refers to the six key elements of a title, i.e., Setting,
Population, Intervention, Condition, End-point, and Design.
Setting. This refers to the situation in
which the research takes place in. It could be community-based,
home-based, school-based, hospital-based, or laboratory-based. Within
the hospital itself, it could be amongst out-patients or inpatients, or
in the emergency room. Likewise, it could be a rural or urban setting.
It is important to mention the setting in the Title if results are not
generalizable to other settings, or if the setting reflects the
magnitude of your research. For example: "Mortality in Severe Acute
Malnutrition in Under-five Children: A Hospital-based Study." Here
it is important to mention the setting because mortality in severe acute
malnutrition will be different in under-five children admitted to the
hospital and those in the community.
Population. The population is the target of the
research work and needs to be explicitly stated (age and/or sex, where
necessary). For example: "Prevalence of Depression in the Elderly"
and "Prevalence of Osteoporosis in Post-menopausal Women." In the
first title only age is specified because sex may not be important. The
latter title includes both age and sex, because of their relevance.
Intervention. Intervention (therapeutic or
preventive) is a key element of any clinical trial. For example "Vitamin
D Supplementation in Children with Severe Asthma: A Randomized
Controlled Trial". The study here could evaluate the effect of
supplementation of Vitamin D on the severity of the asthma episode
(therapeutic effect) or the occurrence of recurrent episodes of asthma
(Preventive). The title should be able to clarify the type of study (see
Design below) and the type of intervention, if it was planned. A still
better title would be "Therapeutic Effect of Vitamin D
Supplementation in Children with Severe Asthma: A Randomized Controlled
Trial".
Sometimes, research may only be observational with no
intervention whatsoever. For example – "Serum Vitamin B
".
Condition. It refers to the clinical condition of
the subjects. "Serum Folate Levels in Pregnant Indian Women: An
Observational Study", here the condition is pregnancy.
Endpoint. Outcome is sparingly used in the title,
unless we wish to use a declarative title. It refers to the change or
type of change the condition undergoes after being subjected to
intervention.
Design. Including the study design in the title
itself makes the title complete and it is usually placed after a colon
or an em dash.
Box 1 summarises the tips for writing a good
title.
Box 1. Seven Secrets to Writing the Title
of a Research Paper
• Keep it Concise.
• Keep it Specific.
• Decide regarding Place of
Study.
• Use a Descriptive/Neutral
title.
• Appropriately ‘SPICED’
content.
• Avoid Interrogative or
declarative titles.
• Avoid acronyms/abbreviations in the title.
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When to Write the Title?
A rough title should be written when planning a
study, keeping in mind at least five of the SPICED elements (except
endpoint). This can be tailored after the completion of the study
depending upon what we wish to highlight from the study.
Crafting a Running Title
Many journals ask for a "running title" or "running
head" or "short title" to be included in the submitted manuscript. This
an abridged form of the main title, which is usually placed at the top
left in the header of the published page of an article. The running
title enables the reader to keep track of the article as he goes through
loose printed pages of the article. Most journals would ask for a
running title of no more than 50 characters including the spaces. To
make the title still shorter, standard abbreviations could be used, and
articles and study design be omitted. For example, the running title for
a research paper titled "Pulse Oximetry Screening to Detect Cyanotic
Congenital Heart Disease in Sick Neonates in a Neonatal Intensive Care
Unit" can be written as "Pulse Oximetry Screening for Cyanotic CHD".
Choosing the Key Words
The keywords you choose are important as these are
used for indexing purposes [7]. Keywords are listed below the abstract
text. It is important to not duplicate the "keywords" and "words used in
the main title" as both enable accession and hence citation of your
research work. Using the right keywords will speed up the internet
retrieval of your work [8]. In order to determine the keywords, read
through your paper and list the terms, phrases and abbreviations used
frequently. Try to include variants of a term/phrase already used in
your title as keywords; e.g. sepsis and septicemia, renal and
kidney, tumor and cancer. Now refer to an indexing standard like the
Medical Subject Headings (MeSH) database of the US National Library of
Medicine [9]. Check if these terms are listed therein. The MeSH uses two
tools to determine keywords:
• MeSH on demand
• MeSH browser.
‘MeSH on demand’ is a simple tool available from
https://www.nlm.nih.gov/mesh/MeSHonDemand.html, which automatically
deciphers the keywords from text such as an abstract or summary. MeSH
Browser is a tool available from
https://www.nlm.nih.gov/mesh/MBrowser.html, which allows for
searches of MeSH terms, text-word searches of the Annotation and Scope
Note, and searches of various fields for chemicals. Another way to
identify keywords is to search similar research work from PubMed and
then ascertain the MESH headings assigned to them. The keywords are not
necessarily single words but may be two words. For example, "breast
cancer" is listed as keywords in MeSH.
Before you finally submit your article, check if the
keywords are appropriate. Type the keywords into the search engine and
see if the search results resemble your research work.
Writing the Abstract
The abstract is a concise statement of the major
elements of your paper. It is usually the last section written by the
authors, but is the first section of your paper that is read by the
editors and reviewers. It should therefore provide a snapshot of the
research undertaken by you. In addition, it should be comprehensive yet
crisp [10]. The abstract should highlight the selling point of your
research work and should lure the readers to read the whole paper.
Besides determining selection of the paper, abstracts are also important
for indexing. When searching online for research work, most databases
would display the title as well as the abstract. This would enable the
readers to determine if they really need to go through the full text of
your research paper. However, it is important to remember that for your
article to be picked up during an online search, it must contain the key
words that a potential researcher would use to search.
What Should the Abstract Contain?
The abstract should be a window to your research and
should effectively convey all the elements of the research work. The
abstract essentially has four elements (Box 2).
Box 2. Elements of the Abstract
Purpose Why this work?
What was aimed?
Methods How was it
achieved?
Results What are the findings?
Conclusion What is the inference?
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Abstracts cover all the aspects of the research
including the background, objectives, methods, results, conclusions, and
recommendations. They, however, do not provide a critique of the
research. These are usually around 300 words or about 10% of the length
of the manuscript.
Format of an Abstract
Abstract can be written in running text without the
use of subheadings (Unstructured abstract) or it may be in a structured
format with use of subheadings. A structured abstract may be a 4-point
abstract or a detailed traditional 8-point abstract. A 4-point abstract
has four subheadings, usually, (1) Background and/or Objectives,(2)
Methods, (3) Results, and (4) Conclusions. An 8-point abstract has eight
subheadings, viz, (1) Objectives, (2) Study-design, (3)
Study-setting, (4) Participants, (5) Methods/Intervention, (6) Outcome
measures, (7) Results, and (8) Conclusions. You will have to choose the
format of the abstract after checking the "Instructions to Authors" of
the journal you wish to submit your research to.
The 4-point abstract is easy to write as the elements
are distinct entities. They are:
Background - It should be brief and limited to
two or three sentences, where you need to specify what is already known
and why you conducted the study. The objectives of study should also be
mentioned.
Methods - This is usually the longest section of
the abstract and should give enough information to the reader to
understand what and how was your study done. The important aspects that
need to be covered here include the study design, study setting,
clinical diagnosis of participants, sample size calculation, sampling
methods, intervention done, duration of the study, research instruments
used, and define the primary and secondary outcome measures and how
these were assessed.
Results - This is the most important and
difficult section to write in an abstract. The results should mention
the exact number of participants including the drop outs, and adverse
effects, if any. The results of the analysis of the primary objectives
and the salient secondary objectives should be presented in words as
well as numbers including P values. An abstract should present
the results of your research as data (mean, standard deviation, 95%
confidence interval, mean difference, P value, median, and
interquartile range, where applicable). Merely stating the
interpretation of results in sentences without numerical results is
inappropriate. Consider the following examples:
"Response rates differed significantly between
hypertensive and non-hypertensive children." A better way to state
your results is "The response rate was higher in non-hypertensive
than in hypertensive children (50% vs 20%, respectively; P<0.01)."
Another example where results of a study evaluating
the role of probiotics in diarrhea are presented:
"The time for resolution of diarrhea, and the
recovery in terms of resolution of diarrhea and need for hospitalization
was similar in the probiotic and placebo groups."
Or
"The median time for resolution of diarrhea was 54
hours in both the probiotic and the placebo group. Recovery in the
probiotic group was marginally better but not statistically significant
for resolution (hazard ratio = 0.91, 95% CI 0.60-1.31), rehydration
(hazard ratio = 0.91, 95% CI 0.64-1.39) and hospitalization (hazard
ratio = 0.94, 95% CI 0.67-1.34)."
The latter way of presenting the results in the
abstract is better and more informative.
Conclusions - The conclusions need to state the
‘take home message’ and any other salient findings which need to be
considered. The conclusions must always take into account your
hypothesis and research question and must be written so as to answer the
same in the light of your results. Additionally, you may present your
perspective in this section of the abstract. Box 3 depicts some
examples of writing the conclusions section of the abstract.
Box 3. Examples of the Conclusions
Section of Abstract
• Daily zinc supplementation (40mg for 14
days) in children aged five to 12-year with acute dehydrating
diarrhea did not shorten the duration of diarrhea or reduce
subsequent episodes. Further community-based trials with
adequate sample sizes are needed.
• Pyomyositis is a specific and potentially
fatal infection, which is common in India and must be
differentiated from intermuscular abscess. A high index of
suspicion and early institution of specific antibiotics followed
by surgery can be lifesaving.
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The 8-point abstract ensures completion of all
aspects of the research; however, there is a significant overlap between
the methods and results section. Therefore, it needs to be drafted very
carefully. For example, under the subheading "participants", you will
not only need to specify the inclusion/exclusion criteria (part of
methods section), but also need to mention the exact number recruited in
your study (part of results).
Attributes of a Good Abstract
A well-written abstract is characterized by the four
Cs, viz. it should be complete, concise, clear and cohesive.
A good abstract should be complete. It should
be a stand-alone document and cover all the major parts of the research
in addition to bringing out its novelty.
A good abstract should be crisp and free from
excessive wordiness or unnecessary information. For example, "X
stimulates Y" will be a better choice of words than "X produces a
stimulatory effect on Y". A good abstract should avoid too much
background information. You should refrain from using empty phrases like
"It was interesting to note that ….". Cliché statements like "More
research is needed" should be avoided. If there are implications, then
you must state them clearly.
The abstract should be clear, i.e., readable,
well-organized, and not too jargon-laden. The abstract should be written
in the past tense. Abstract written in active voice provides greater
clarity. So, we may write "We conclude that…" instead of "It was
concluded that….". The findings of your research should not be discussed
in the abstract, and any discussion should only be done in the main text
of your research paper. The abstract should be free of figures,
diagrams, tables, or images. The abstract should not contain any
references/citations. Avoid use of abbreviations or acronyms.
A well written abstract should be cohesive and
the text should flow smoothly between the parts. The abstract must
follow the chronological order of sections in your main research paper
ensuring a smooth transition. It must read like a story. A direct
cohesiveness needs to be maintained between objectives, main outcome
measures, results and conclusion (example in Box 4).
Box 4. Example of a Cohesive
Abstract [11]
Vitamin D Supplementation for Severe
Pneumonia - A Randomized Controlled Trial.
Objective: To determine the role of
oral vitamin D supplementation for resolution of severe
pneumonia in under-five children.
Design: Randomized, double blind,
placebo-controlled trial.
Setting: Inpatients from a tertiary care
hospital.
Participants: Two hundred children [mean
(SD) age: 13.9 (11.7) months; boys: 120] between 2 months to 5
years with severe pneumonia. Pneumonia was diagnosed in the
presence of fever, cough, tachypnea (as per WHO cut-offs) and
crepitations. Children with pneumonia and chest indrawing or at
least one of the danger sign (inability to feed, lethargy,
cyanosis) were diagnosed as having severe pneumonia. The two
groups were comparable for baseline characteristics including
age, anthropometry, socio-demographic profile, and clinical and
laboratory parameters.
Intervention: Oral vitamin D (1000 IU for
<1 year and 2000 IU for >1 year) (n=100) or placebo
(lactose) (n=100) once a day for 5 days, from enrolment. Both
the groups received antibiotics as per the Indian Academy of
Pediatrics guidelines, and supportive care (oxygen, intravenous
fluids and monitoring).
Outcome variables: Primary: time
to resolution of severe pneumonia. Secondary: duration of
hospitalization and time to resolution of tachypnea, chest
retractions and inability to feed.
Results: Median duration (SE, 95% CI) of
resolution of severe pneumonia was similar in the two groups
[vitamin D: 72 (3.7, 64.7-79.3) hours; placebo: 64 (4.5,
55.2-72.8) hours]. Duration of hospitalization and time to
resolution of tachypnea, chest retractions, and inability to
feed were also comparable between the two groups.
Conclusion: Short-term supplementation
with oral vitamin D (1000-2000 IU per day for 5 days) has no
beneficial effect on resolution of severe pneumonia in
under-five children. Further studies need to be conducted with
higher dose of Vitamin D or longer duration of supplementation
to corroborate these findings.
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Before you finally submit your abstract check it for
consistency; a mismatch between the abstract and main text may
raise doubts on authenticity of your results. Check if the abstract
meets the guidelines to authors in terms of format, word count, etc.
Writing the Introduction
Need for an Introduction
The introduction should aim to set the mood for your
research, acquaint the readers with your research hypothesis, and
motivate the readers to read your paper [12]. It should steer the
readers from why you are doing the research into how you are going to
fill the knowledge gap i.e., into the methods section.
An introduction essentially has three main elements:
1. What is known?
The background of the research topic needs to be
stated right at the onset to enable the readers to understand what is
already known on the subject. This sets the stage for the basis of your
research.
2. What is lacking?
You need to justify "why you are carrying out that
research work", i.e., whether you are building upon previous research,
looking at a novel aspect not evaluated by previous research, or if you
are trying to improve upon a previous research that yielded ambiguous
results.
3. What you aim to do?
You need to briefly state the objectives of your
research. It is also advisable to present a detailed hypothesis at this
juncture only.
How long is too long?
There are no strict word limits for writing the
introduction; generally it is one of the shorter sections of the paper.
Having the readers meander through too much of introduction can be
counterproductive as it may cause them to lose focus and interest. You
should assume that your work is going to be read by someone who has at
least a reasonable knowledge about your research topic, so it is
preferable that you do not beat about the bush. For example, for a study
evaluating the role of probiotics in acute diarrhea in children, there
is no need to discuss definitions and etiology of diarrhea in the
introduction; you could start by commenting upon the well-established
treatment options for acute diarrhea and how your study will add to the
existing knowledge and practice.
How to write the Introduction?
It would be useful to structure your introduction
like an "inverted pyramid" or what could be simply said as "funnel
approach". This implies introducing the topic of the paper and
discussing it in a broad context and then finally narrowing down to the
research problem and hypothesis.
The introduction can be written in about two-to-three
paragraphs. The opening paragraph should be dedicated to introducing the
topic of research; it may also provide an overview of the topic of
research. You must remember that the introduction is not a review of
literature but it should convince the readers that you have thoroughly
researched the topic and built their confidence in your hypothesis. A
thorough literature search is an essential pre-requisite for identifying
and framing the research question. However, a very lengthy literature
review can put-off the readers so it is important to summarize what
research has already been done on that topic, and highlight the lacunae
or controversies regarding the same.
In the second paragraph, you need to identify a
research niche. This can be done by highlighting the lacunae in existing
research or opposing an existing practice or assumption. This will help
you to arrive at your research question. You need to emphasize what
additional knowledge will be gained through your research and how you
aim to bridge the gap in knowledge. An ideal study should focus on a
central question and may be another two or three questions that can be
additionally addressed through your study. It is preferred to use
"open-ended research question". A good research question should yield a
testable hypothesis. It may be necessary for you to clarify any key
terms or concepts in the introduction itself, particularly if you are
dealing with an unfamiliar or new concept. It is also pertinent to
declare any assumptions you are going to make in the research work.
In the third paragraph, you need to articulate your
objectives and hypothesis. The hypothesis should be a tentative
prediction of relationship between two or more variables. It should be
neither too general nor too specific, and is often declarative. While
stating the hypothesis it would be better to state it implicitly rather
than saying that "Our research is based on the hypothesis….". For
example, a research hypothesis can be stated as "10-days duration of
intravenous antibiotics is not inferior to 14-days therapy for treating
neonatal septicemia". The hypothesis should be used to convince the
readers about what results are expected from your research. Also,
remember that a hypothesis is valuable even if proved to be wrong.
And as the phrase goes "Well begun is half done", so
is the story with a research paper. A well drafted abstract and
introduction section with a strong title will help the researcher to win
half the battle.
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