Research Report Writing

Sudigdo Sastroasmoro

Editor-in-Chief, Paediatrica Indonesiana

Editor, Medical Journal of Indonesia
International Advisory Editor, Pediatric Cardiology (Chicago)
 Research report writing ….
Last job in research activity
All research results should be published, otherwise
publication bias will occur (and it occurs!)
Publish or perish
Publishing is equally important as planning and
conducting the study
New trend: Registration of all RCT with commitment to
publish whatever the results will be
Theses, dissertations are considered unpublished until
they are published in the journal
 Publication bias
Investigators tend to submit studies with positive
(statistically significant) than negative results
Editors tend to accept studies with positive than negative
results
Positive results: submit to international journals
Negative results: submit to local journals
Many negative results are product of studies with small
sample size
Inference by manufacturers!
Literature mainly consist of reports with positive results
Anatomy of research reports
Title
Byline: Authors & Institutions
Abstract & keywords
Contents: IMRAD
v Introduction
v Methods
v Results
v Discussion
Acknowledgments
References
Appendices
 IMRAD
Introduction - Why did I start?
Methods - What did I do?
Results - What did I find?
Discussion - What do they mean?

(Some journals put the Methods section separately or

at the end of the article - IRDAM?)
 Note:
The following discussion may not be applicable
in all journals
If you want to submit your research report to a
journal, examine carefully ‘Instructions to
Authors” and the latest issues of the journal for
‘In-house style’. Then follow them rigidly;
otherwise your manuscript will be rejected even
before seen by the Editor
“The only absolute dictator in this century is the
Journal EDITOR”
 Title
Most read part of the report
Represents contents of the article: The fewest
possible words that adequately describe the
content of the paper
Avoid too long or too broad title
Include time & place only when the study applies
for the specified time and place
Preferably written in positive ‘sentence’
Title is a label rather than a complete sentence
Avoid abbreviations and acronyms
 Older journals: Long titles (1)
Observation on the etiologic relationship of achylia
gastrica to pernicious anemia; the effect of the
administration to patients with pernicious anemia of
beef muscle after the incubation with normal human
gastric juice
31 words
[Am J Med Sci. 1929;178: 764]

Control study of comparative efficacy of isoniazid,

streptomycin-isoniazid, and streptomycin-para-
amninosalycilic acid in pulmonary tuberculosis therapy.
III. Repart on twenty-eight-week observations on 649
patients with streptomycin-susceptible infection
[Am Rev Tuberc. 1953;67:539-543] 33 words
Omit the following word(s)
Observation on …
Study on …
Investigation of …
An opening ‘A’, ‘An’, ‘The’
Penelitian tentang …., etc
 Short titles

Antibiotic and typhoid fever

Socio-cultural impact of globalization

Comment: Too general, looks more like titles

of a review article than of an original research
Title is label – not necessarily a complete sentence
with subject, predicate, object. Be careful with the
syntax (word order)

Lumbar anesthesia in dogs using halothane

Dogs using halothane?
Study of bacteria using electron microscope
Really? Bacteria use microscope?
Mechanism of suppression of non-transmissible
pneumonia in mice induced by Newcastle Disease Virus
Can mice induce bacteria?
Bila ada orang-orang yang mengancam para petani,
pihak keamanan akan membantu mereka
Lima puluh massa demonstran berunjuk rasa
memprotes pelecehan seksual yang akhir-akhir ini
marak di depan Mabes Polri
Menyadari pentingnya Standar Pelayanan Medis
(SPM), maka dibentuklah tim untuk menyusun SPM
yang berlaku di RSCM oleh Direktur Pelayanan
Dalam perundingan yang berjalan alot sampai
beberapa minggu tersebut menyimpulkan bahwa tata
laksana pasien flu burung harus dilakukan secara
terpadu dengan memperhatikan hak azasi manusia
 Types of Titles
of Scientific Articles
Title indicating the results of the study

Preserve breastfeeding, not antibiotics, can

prevent recurrent diarrhea
Routine antibiotic administration for acute
diarrhea is useless

Comment: Recommended by some journals,

declined by the others
 Title with question mark
Can antibiotic decrease length of hospital stay
in children with measles pneumonia?

Seeing Race and Seeming Racist? Evaluating

Strategic Colorblindness in Social Interaction

Comment: Not usually recommended for original articles,

frequently used for opinion or review articles
 Fair Title
Effect of antidepressant QRS in children with
Attention Deficit Hyperactivity Disorder – a
meta-analysis of clinical trials
Comparison of the efficacy of root Echenacea
extract with placebo in elderly with insomnia –
a randomized double blind trial
Risk factors for Parkinsonism in rural area
 • You completed your study on the effect of global financial
crisis on palm farmers in South Sumatra Province. Your data
support the hypothesis that the crisis has a bad influence on the
palm farmers.

Effect of global financial crisis on palm farmers

in South Sumatra Province

Does global financial crisis affect palm farmers

in South Sumatra Province?

Global financial crisis affects crude palm oil farmer

in South Sumatra Province

Most journals probably prefer the first option, but some prefer
the 2nd or the 3rd. To make sure, please refer to Instructions to Authors
and the latest issues of the journal
 Title: Inclusion of place and time
Results of new antiepileptic drug X in patients with
temporal lobe epilepsy in Cipto Mangunkusumo
Hospital, Jakarta

Comparison between the efficacy of oral vs. injected

iron in women with anemia in Sumber Sehat Hospital
in 2007

Comment: Do not include time and place

when the results are supposed
to be inferred and applied in a larger population
 Title: Inclusion of place and time
Results of 5-year surveillance of hospital-acquired
infections in Bunda Sayang Clinic, Jakarta, 2000-
2004

Results of bone marrow transplantation in children

with leukemia in Dr. Sutomo Hospital, Surabaya,
2000-2007

Comment: Appropriate when the results are applied

to the specified location and cannot be inferred
into the larger population
 Title: How long is too long?

Number of words or characters are not usually stated

explicitly in most books on Guideline of Scientific Writing
Prof. Rifai:
ü Max 12 words or 90 characters (incl. spaces)
ü English: 10 words
ü German: 8 words
This rule are violated or not followed by many
 Prevention of cardiovascular events and death
with pravastatin in patients with coronary heart
disease and a broad range of initial
cholesterol levels
N Engl J Med. 1998;339:1349-57.

22 words, 129 characters without spaces, 151 with spaces

 Elicitation of prior distributions for a phase III
randomized controlled trial of adjuvant
therapy with surgery for hepatocellular
carcinoma
Control Clin Trials. 2003;24:110-21.

19 words, 123 characters without spaces, 142 with spaces

Title should maintain balance between
interesting and indifference

Drug ABC gives excellent results in lymphoma

malignum!
Intractable diarrhea? Use Formula XYZ!

Advertisement?!
 Title: Inclusion of design
Implementing Evidence-Based Practice in
Undergraduate Teaching Clinics: A Systematic
Review and Recommendations
Ridker RD. Low-Dose Aspirin in the Primary
Prevention of Cardiovascular Disease in
Women - a Randomized Controlled Trial.

Comment: Recommended where appropriate

 Title

DI SINI DIJUAL IKAN SEGAR

(TERMASUK IKAN AIR TAWAR YANG ADA DI ALIRAN
SUNGAI BRANTAS DARI HULU KE HILIR)

NN
 Title

DI SINI DIJUAL IKAN SEGAR

NN
 Title

DI SINI DIJUAL IKAN

NN
 Title

DIJUAL IKAN

NN
Title

IKAN

NN
Title

IKAN
??

NN
 Examples of appropriate titles
Efficacy of handrubbing with alcohol based-solution
versus standard handwashing with antiseptic soap:
randomised clinical trial
Probiotics in prevention of antibiotic associated
diarrhoea: systematic review and meta-analysis
Smoking reduction with oral nicotine inhalers: double
blind, randomised clinical trial of efficacy and safety
Long-term prognosis of acute low back pain in patients
seen in general practice: a 5-year prospective follow-up
study
Authorship
Authorship credit should be based on
1. substantial contributions to conception and design, or
acquisition of data, or analysis and interpretation of
data;
2. drafting the article or revising it critically for
important intellectual content; and
3. final approval of the version to be published.
Authors should meet conditions 1, 2, and 3

International Committee of Medical Journal Editors, 2006

 Authors’ names
Should be: First - (Middle) - Surname
Examples:
Togu Mangara Lumbantobing
Widjojo Nitisastro
Syahriar Rasad

Incorrect:
Lumbantobing TM, Nitisastro W, Rasad S
One name only
• Sukarno
• Suharto

No family name
Endang Diana Lestari

Endang D Lestari
Endang Diana L
Endang DL
E D Lestari
 Abstract
Second most read after Title
Contains IMRAD
Re-establish the topic of the research
Gives the research problem and/or main objective
of the research (this usually comes first)
Indicates the methodology used
Presents the main findings
Presents the main conclusions
Brief and easy to read
No abbreviations or acronyms
 Abstract

One-paragraph abstract
Structured abstract (increasingly used)
 One-paragraph abstract
One complete paragraph consisted of complete
sentences with proper connecting word(s) or
phrase(s)
Contains IMRAD
No more than 250 words (use word count, please)
Avoid:
Too long or too detail
Incomplete paragraph / sentences
• Abstract: The objective of this project was to identify an effective methodology of
approaching and implementing evidencebased principles in undergraduate teaching
clinics to promote evidence-based dentistry in future clinical practice. A systematic
review was undertaken to examine evidence-based clinical teaching and faculty
continuing education. Research published from 1996 to 2002 was retrieved by
searching several databases and the Internet, along with conducting hand searches
and reviewing bibliographies maintained by faculty experts. Qualitative checklists for
different types of studies were created to evaluate the literature. Relevant studies
were selected if they met all four predetermined essential criteria and a minimum of
two out of three desirable criteria. Systematic reviews were chosen if they met all five
essential criteria. Data from selected articles were extracted, and study quality was
assessed. We found that three systematic reviews and nine original research articles
were deemed methodologically acceptable. Problem-based learning and evidence-
based health care interventions increased student knowledge of medical topics and
their ability to search, evaluate, and appraise medical literature. Dental students in a
problem-based learning curriculum, emphasizing evidence-based practices, scored
higher on the NDB I (National Dentistry Boards, Part I) than students in traditional
curricula. While effective modules in implementing theoretical evidence-based
principles exist, very few high-quality studies are available that examine these
principles in dental undergraduate teaching clinics. No methodologically appropriate
studies on the education of faculty in the implementation of evidence-based
principles are available. Some studies promote promising theories and
methodologies of teaching evidence-based care; based on these theories, a
comprehensive model is proposed in this article. Considering the strength of
evidence in the reviewed literature, we concluded that an evidence-based approach
to clinical care is effective.
Abstract
• Asymmetric division of adult stem cells generates one self-renewing stem cell
and one differentiating cell, thereby maintaining tissue homeostasis. A
decline in stem cell function has been proposed to contribute to tissue
ageing, although the underlying mechanism is poorly understood. Here we
show that changes in the stem cell orientation with respect to the niche
during ageing contribute to the decline in spermatogenesis in the male germ
line of Drosophila. Throughout the cell cycle, centrosomes in germline stem
cells (GSCs) are oriented within their niche and this ensures asymmetric
division. We found that GSCs containing misoriented centrosomes
accumulate with age and that these GSCs are arrested or delayed in the cell
cycle. The cell cycle arrest is transient, and GSCs appear to re-enter the cell
cycle on correction of centrosome orientation. On the basis of these findings,
we propose that cell cycle arrest associated with centrosome misorientation
functions as a mechanism to ensure asymmetric stem cell division, and that
the inability of stem cells to maintain correct orientation during ageing
contributes to the decline in spermatogenesis. We also show that some of the
misoriented GSCs probably originate from dedifferentiation of spermatogonia.
 Structured abstract

Subheadings Subheadings Subheadings

Background Background Aims
Objective Methods Setting
Setting Results Methods
Design Conclusions Intervention
Methods Results
Main results Conclusions
Conclusion
Exercise induced bronchospasm in male athletes at Karachi
BACKGROUND: Exercise is one of the most common precipitant of acute
asthma encountered in clinical practice. To determine frequency of Exercise-
induced Bronchospasm (EIB) in male athletes, who had represented or were
aspiring to represent at national and/or international level. Athletes of
different departments and institutes and attending training camps at
Karachi during November 2000 to January 2002 were included.
METHODS: A 21-item structured and pre-tested questionnaire was given for
personal, biological and environmental information and an acquaintance
session was conducted with each athlete to explain the procedure. Six
minutes of competitive field free running Peak expiratory flow (PEF) rate,
pulse rate and oxygen saturation were measured at 5-min, 15-min and 30-
min. A player was considered EIB positive based on a post exercise
decrement in PEF rate > or = 15% at any defined point of time.
RESULTS: The mean age of participating athletes was 27 +/- 6 years. Out
of the one hundred and seventy-nine (n = 179) athletes who participated in
the study, 13 (7%) were found to be EIB positive.
CONCLUSION: Our findings indicate that a significant number of our
athletes suffer from EIB. It is suggested that either the department or
national sports body should take the responsibility of screening for EIB
making it a part of their training sessions.
 Common problems
Too long. If your abstract is too long, it may be rejected - it is
usually a specified maximum number of words. Abstracts are
often too long because people forget to count their words.
Too much detail. The abstract is not the place for detailed
explanations of methodology or for other details
Too short. Shorter is not necessarily better. If your word limit
is 200 but you only write 95 words, you probably have not
written in sufficient detail. Many writers do not give sufficient
information about their findings
Failure to include important information. Often people do not
cover all of them because they spend too long explaining,
for example, the methodology and then do not have enough
space to present their conclusion.
 Abstract
Results 104 patients entered the trial; no drop out
was noted. There was no difference in the baseline
characteristics between the treatment and placebo
groups in terms of prognostic factors. At the end of
the trial, there was a significant difference
between total cholesterol levels between
treatment and placebo groups (P 0.0034), a
significant difference in LDL levels between the
groups (P 0.002), but no significant difference of
HDL levels between the groups (P 0.062) ……
 Abstract
Results 104 patients ……….. At the end of the
trial, there was a significant difference between
total cholesterol levels between treatment and
placebo groups (mean difference 24 [95%CI 18 to
30] mg/dl, P 0.0034), and a significant difference
in LDL levels between the groups (mean difference
16 [95%CI 12 to 20] mg/dL, P 0.002), but there
was no significant difference of HDL levels between
the groups (mean difference 4 [95%CI -2 to 10]
mg/dl, P 0.062]). …………
 Keywords

Follow the Abstract

For medical subjects use Medical Subject
Headings (MeSH)
Usually 4-8 words
Useful for indexing (and searching)
 Introduction
(Why did you start)?
Concise, no lengthy descriptions
Justification for doing the study
Usually 1-2 paragraphs
v Objectives / hypotheses

v How the study was performed

No more than 1 page

Appropriate / strong references
Avoid:
Too long introduction
Lack of appropriate references
Malaria Journal
 Methods
(what did you do?)
Avoid
Design • Improperly mentioned
Time & place • Not mentioned
Population & sample • Unclearly stated
Sampling technique • Not mentioned
Sample size • Not mentioned
Randomization, blinding • Improperly mentioned
Inclusion & exclusion • Not sufficiently mentioned
Details of technique used • Not sufficiently written
Defini tions of terms • Not mentioned
Plan of data management • Not mentioned
Stat. analyses, CI, p value • Not properly stated
Computer program(s) • Improper use of program
 Results
(What did you find?)

Most important part, frequently the shortest part,

most neglected
Describe findings WITHOUT comments
Write clearly in complete sentences with
appropriate introductory phrases
Words, phrases, sentences, paragraphs: should
be written carefully
Brief but complete
 Results
Avoid:

Comments on findings, either by using references or

personal opinion, or both

Telegraphic sentences, e.g.,

This was a descriptive study. There were 39

patients available, 20 boys and 19 girls. etc
 Results: Tables

Simple, legible
Limit the number of tables, approx 1 table per
1000 words (for 8 page long article, 3-4 tables
are appropriate
Tables should provide presentation more clear
Indicate the presence of tables in the text (!wild
tables)
 Results: Tables

Avoid:

Complicated, long tables

Too many tables
Unnecessary tables
Not indicated in the text (“wild table”)
 Results: Figures

Simple, easily readable

Least preferred by editors
Limit to minimum
Professionally drawn and ready to print
Warning: color figures allowed?
Indicate the presence of figures in the
text
 Results: Figures

Avoid
Complicated figures
Too many figures
Unnecessary figures (data have been
presented in text or tables)
Not indicated in the text (“wild figures”)
 Example: Unnecessary table
Our series consisted of 30 newborn babies, 20 of them
had a body weight of less than 2500 grams. See Table 1.

Table 1. Distribution of subjects according to body weight

BW (grams) n %
>2500 10 33.33%

<2500 20 66.67%

Total 30 100.00%
 Correct format
Omit vertical & inner horizontal lines

BW (grams) Boys Girls

>2500 60 40

<2500 42 37

Total 102 77
 Incorrect format

BW (grams) Boys Girls

>2500 60 40

<2500 42 37

Total 102 77
 Results: Presenting percentages
& numbers

Use percentages only for large number of

subjects (definitely if >100, ‘reasonable’ if >40)
Usually 1 decimal
Mean value: one decimal more than the original
SD: one decimal more than mean
 Presenting characteristics of study subjects
characteristics in clinical trials
Table 1 of Results almost always describe
the characteristics of study subjects

Experimental Control P value

Sex (M/F) 43/32 40/45 NS

Age,mean (SD) 34 (12) 33 (9) NS
Weight kg (SD) 59 (3.5) 57 (4.1) NS
DBP mean (SD) 84 (9) 86 (7.5) NS
Chol mean (SD) 223 (32) 221 (26) NS
 Clinical importance vs. statistical significance

Cholesterol level, mg/dl

Standard
treatment
300 200
mg/dl
n=10000
R Clinical
n=10000
New 300 197
treatment mg/dl

t= df = 9998 p = 0.00002
Statistical
Clinical significance vs. statistical significance

Cured Died

Standard Rx 0 10 (100%)

New Rx 3 7 (70%)

Absolute risk reduction = 30% Clinical

Fischer exact test: p = 0.211 Statistical

 Confidence intervals
Mean (95% CI): 223.2 (210.2 to 253.2) mg/dl
Mean (95% CI): 54 (40 to 68) mcg/l

SD, SE
Avoid this format: 50 + 12 mcg/L
Ø May be read: + 1 SD, 2 SD, 1 SE, 2 SE

Preferably:
Ø 50 (SD 12) mcg/L

Ø 42.3 (SE 4.73) mcg/L

 Results: p values & CIs

Exact p value, e.g., p = 0.023 instead of p

<0.05
Include confidence intervals when appropriate,
esp. for main results
Do not repeat p values or CIs in the text if
they have been presented in tables
 Discussion
Explain the meaning of the findings by:
§ comparing with previous studies
§ relating its implications on current practice
Do not repeat frequently findings that have
been described in Results section.
Address study limitations
 Discussion
Avoid
Excessively repeat things that have been
written in Results section
Insufficient comparison to previous studies
Do not relate to current practice
“Hiding” study weakness or limitations
 Discussion

Conclusions
Should answer all previously stated
research question(s)
Must be supported by own data
 Discussion
Common errors
Answers not previously stated question(s)
Conclusions are not based on own data (e.g.,
based on literature review)
‘Other findings’ are included as conclusions
 References
‘Vancouver style’ (see example) vs. ‘Harvard style’
Refer to: ICJME (International Committee of Medical
Journal Editors (last amendment: October 2008)
Abbreviations of Journal’s name: refer to NLM-NIH
In-house style may modify standard style
Should 100% match between citation numbers in
the text & reference list
 Journal article

• Journal article, 6 or less authors:

– Winichagoon P, Fucharoen S, Chen P, Wasi P. Genetic
factors affecting clinical severity in b-thalassemia
syndromes. J Pediatr Hematol Oncol. 2000;22:573-80
• Journal article, >6 authors.
– Sogut A, Altin R, Uzun L, Ugur MB, Tomac N, Acun C, et
al. Prevalence of obstructive apnea syndrome and
associated symptoms in 3-11 year-old Turkish children.
Pediatr Pulmonol. 2005;39:251-6.
 Books
• Book / Monogram:
– Madden R, Hogan T. The definition of disability in Australia:
moving towrds national consistency. Canberra: Australian
Institute of Health and Welfare; 1997. p 267-73.
• Book with edition:
– Renton M. Compendium of good writing. 3rd ed. Milton: John
Wiley & Sons; 2004.
• Chapter of the book:
– Blaxter M. Social class and health inequalities. In: Carter C,
Peel J, editors. Equalities and inequalities in health. London:
Academic Press, 1976; p. 369-80.
 Others
• Thesis or dissertation:
– Wood MA. A study of the perception of the impact of
modeling on the development of commitment to action in
decision conferencing [PhD Thesis]. Perth (WA): Curtin
University of Technology; 2004.
• Electronic materials:
– Pettinger R. Global organizations [monograph online]. Oxford:
Capston Publishing; 2002 [cited 2004 Sep 28]> available
from: http://www.netlibrary.
• Conference Proceeding.
– Hamden P, Joffe JK, Jones WG, editors. Germ cell tumors V.
Proceeding of the 5th Germ Cell Tumor Conference; 2001 Sep
13-15; Leeds, UK. New York: Springer; 2002.
 English language

Tenses:
Introduction - Present tense, because it
refers to general truth
Methods - Past tense, because it
address completed actions in
the past
Results - Past tense
Discussion - Swinging between present &
past, depending on the issue
discussed
 English language
Spelling:

‘American English’
v anemia vs. anaemia
v color vs. colour
v randomized vs. randomised
v leukocytes vs. leucocytes
Always use spell checker!!!! (easy & very useful)
 English language
Effective English vs. wordy expressions
Subject – predicate agreement
Use commonly used phrases or terms, e.g.
potassium - hyperkalemia
sodium - hyponatremia
platelets - thrombocytopenia
Appropriate use of connecting phrases
Punctuations: full stop, comma, colon, semicolon,
brackets are typed without space
Full stop (26.4%) instead of comma (26,4%) for
decimal separation
 Use more active than passive voices
• The patients were randomized to either receive
……. or …..
– We randomized the patients to either receive …
• Subjects who had spinal abnormality, those with
history of seizures, or those with chromosomal
abnormality were excluded …
– We excluded subjects with spinal abnormality,
those with history of seizures, …
 Crucial!!!
Alignment of

Title

Research Questions / Hypotheses

Methods

Conclusions
 Crucial!!!
Read carefully
“Instructions to authors”
word by word!!

Use check-list!!
 Importantl!!!
Read and re-read,
Revise and re-revise,
Ask all authors to read
Ask other colleagues to read
Keep the manuscript in your drawer for a few days
Read and re-read
Revise and re-revise
Make sure that all meet journal requirements
Before asking your secretary
to send the manuscript!!!
Brief and clear: brevity and clarity is a must
Avoid jargons!!:
– a considerable amount of - much
– absolutely essential - essential
– as a consequence of - because
– at an earlier date - previously
– at this point of time - now
– despite the fact that - although
– for the purpose of - for
– in a satisfactory manner - satisfactorily
– new initiatives - initiatives
For theses or dissertations: reasonably much
more pages than journal format, but “the
thicker the better” is wrong, dead wrong
Huth: Most >150-page long theses pages
usually have only 50 pages that scientifically
needed
 Important concepts in life are usually
expressed in short words:
• hidup - mati • life - death
• siang - malam • day- night
• cinta - benci • love - hate
• sehat - sakit • healthy - sick
• susah - senang • sad - joy
• lapar - kenyang • hungry - full
• kaya - miskin • rich - poor
• gelap - terang • dark - bright
Guidelines for reporting (ICMJE)
Clinical Trials: CONSORT (1996/2001)
Diagnostic studies: STARD (2003)
Prognostic studies: REMARK (2005)
Etiological studies: STROBE (2007)
Meta-analysis:
§ Trials: QUOROM (1999)
§ Non-exp studies: MOOSE (2000)

www.icjme.or
Thank you