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Writing the Title, Abstract and Introduction: Looks Matter!

Article in Indian Pediatrics · March 2016

DOI: 10.1007/s13312-016-0827-y

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 THE ART AND SCIENCE OF WRITING A PAPER

Writing the Title, Abstract and Introduction: Looks Matter!

POOJA DEWAN AND PIYUSH GUPTA
Department of Pediatrics, University College of Medical Sciences, Delhi, India.
Correspondence to: Dr Piyush Gupta, Professor of Pediatrics, University College of Medical Sciences, Delhi 110 095, India.
[email protected]

I
always avoided eating the pineapple due to its with ELISA test and viral culture with clinical follow-up
tough and spiky exterior, until a friend of mine in 100 patients of dengue fever at XYZ Hospital, Delhi.”
offered me a slice of it.” That friend may not be This would take ages to read. Not many people will have
there at all times for all of us; therefore, you need to the patience to go through this with a clear head! Now
ensure that what catches the eye first, needs to be inviting. consider: “NS1 antigen test for the diagnosis of Dengue
The Title, Abstract and the Introduction are the face of fever”. Obviously, this title is better because it is clear
any research paper, and hence need to be dressed in such and concise. It permits the reader to proceed onto the next
a way as to enthrall the readers [1]. section within his/her attention span. To make the title
concise, we need to avoid unnecessary phrases. Consider
GETTING THE TITLE RIGHT
the following titles:
The title is the first part of any manuscript that is seen by
• Role of steroids in aplastic anemia
the editors, reviewers, as well as readers. It is also what
appears on the contents page of the journal issue, and • Effects of antenatal exercises on birthweight of baby
serves as a window to the research paper [2]. A strong title
• A study on efficacy of beta-blockers in heart failure
pulls readers into it, making it memorable and
encouraging for people to read. A weak title dulls the The underlined words in these titles do not add to the
readers’ expectations and could negatively affect the information provided, and by simply omitting these
views on your research work, no matter how good it is. superfluous words, the title is as informative and
definitely sharper.
Most electronic databases and search engines, and
journal websites, use the words in the title or the Keep it Specific
keywords provided by the authors to retrieve the
Let us consider another title: “Vitamin D and
scientific paper during online searches. Therefore, title
Pneumonia.”
plays a crucial role in ensuring the access of your paper to
its readers. Busy editors often decide the eligibility of a Despite being extremely concise, this title is still lacking
manuscript for publication and peer-review based on the power to engage the reader as it is too general and
their initial impression after a scrutiny of the manuscript’s vague. It does not lead the reader in any particular
title and abstract [3]. Therefore, having a good and direction. Instead, it leaves the informative work to the
inviting title should be a priority. abstract and the paper itself, which, as we know, not many
people go over. Consider replacing it with “Vitamin D
HOW TO WRITE A GOOD TITLE ?
deficiency and risk for severe pneumonia in under-five
Keep it Concise children.” This is longer but definitely more specific.
If the title is too long or complicated, it may put off the Whether to include Place of Study
readers right at the onset. Use of about 10-12 words in the
Sometimes, a given study, if conducted with the same
title will enable you to bring out the essence of the
methodology, by the same researcher but in a new setting,
research work (patient/species, intervention done, any
may yield completely different results. Consider a study
comparisons, and outcome). Consider the following title:
on prevalence of hypertension in young adults in
“A novel study on the usefulness of NS1 antigen Mumbai. Here the location of the study is vital to the
detection test in the diagnosis of dengue fever in study itself. The prevalence of hypertension at a certain
children: analysis of clinical features and comparison geographical location is dependent on its prevalent

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DEWAN & GUPTA WRITING TITLE, ABSTRACT & INTRODUCTION

lifestyle habits, which in turn are affected by the avoided and as far as possible use a neutral title [4]. For
economic status and cultural and social practices. So, example, “Seven Days versus Ten Days Antibiotic
inclusion of the place of study in the title for this study Therapy for Culture-Proven Neonatal Sepsis: A
would be desirable for sake of completing of information. Randomized Controlled Trial”.
Now consider the following titles: Avoid Declarative Titles
• “Daily vs. weekly iron supplementation in adolescent A study title which states the main findings of the study is
girls in Delhi” said to be a declarative one. It reflects the intrinsic bias on
the part of the researcher regarding the interpretation of
• “Methylprednisolone vs. Cyclosporine for treating the data.
Childhood Aplastic Anemia in Manchester”
“Seven Days Antibiotic Therapy is better than Ten
The study of iron supplementation in adolescent girls Days Antibiotic Therapy for Culture-Proven Neonatal
in Delhi will not be very different from the study of iron Sepsis: A Randomized Controlled Trial” is a declarative
supplementation in adolescent girls elsewhere. The way of writing the title for the previously mentioned study.
affecting factor here is not the socio-economic or political
environment, but evolutionary build-up of a species, “Cryptosporidium is the Most Common Enteric
which will not differ even if we change the geographical Pathogen in HIV-infected Children with Diarrhea” is
location of the study. Same applies to the second study. another example. “Prevalence of Cryptosporidium in
The results obtained in the Manchester study are also HIV-infected Children with Diarrhea” is a more
applicable to other geographical locations. In such appropriate title as it lets the reader approach the subject
studies, the name of place becomes redundant in the title. with an open mind and retains the curiosity of the reader.

Placing the Keywords towards the beginning Avoid Query/Interrogative Titles

The important words and terms related to your study Introducing the subject of research in the form of a query
should be placed towards the beginning of the title. For can be distracting, and is best avoided. Consider the
example, “Rituximab for Treatment of Autoimmune query version of the previous example: “Is Seven Days
Hemolytic Anemia” is a better title than “Treatment of Antibiotic Therapy Better Than Ten Days Antibiotic
Autoimmune Hemolytic Anemia with Rituximab”. Therapy for Treating Culture-proven Neonatal Sepsis?”

Let us take the example of a study being conducted to Query titles tend to sensationalize the subject and can
ascertain the differences in the prevalent trends of obesity sometimes be used for review articles. A research by
between men and women. The title for this study can be Jamali and Nikzad [5] revealed that articles with query
composed in two ways: “Prevalence of Obesity in Adults titles tend to get downloaded more frequently, yet they are
by Gender” or “Gender Differences in Prevalence of cited less frequently.
Obesity in Adults”. Both titles are concise, specific, and Avoid Abbreviations/Acronyms in the Title
bereft of unnecessary phrases, yet these are inherently
different in their approach. In this example, the focus of As far as possible, refrain from using abbreviations/
the study is not prevalence of obesity per se, but the male- acronyms in titles. Consider the title: “Diagnosis of ARF
female comparison of prevalence of obesity. Therefore, in Children”. Here, the abbreviation ARF could imply
the second title, which emphasizes the focus of the study acute renal failure or acute rheumatic fever, and hence
by placing it in the beginning, is more appropriate. abbreviations are best avoided in titles. Now consider
another title: “IVIG for treatment of PANDAS”. Here,
Use of Colon in the Title IVIG is used for intravenous immunoglobulin and
It is important to note that the study design is usually PANDAS denotes Pediatric Autoimmune Neuro-
preceded by a colon in the title. For example, psychiatric Disorders associated with Streptococcal
“Azithromycin for treatment of enteric fever: a Infections. A reader unaware of their meaning may skip
randomized controlled trial”. this article altogether.

Use a Descriptive/Neutral Title However, abbreviations are sometimes useful for

long, technical terms in scientific writing. The use of
A descriptive title has all the elements of the research abbreviations that appear as word entries in Webster’s
work (Patient, intervention, outcome, comparison), yet it Collegiate Dictionary is acceptable. For example: Use of
does not reveal the main findings of the study or its abbreviations like HIV, AIDS, NADPH, and ATP, may be
conclusion. Using too amusing or loud titles should be acceptable.

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DEWAN & GUPTA WRITING TITLE, ABSTRACT & INTRODUCTION

Ingredients of a Good Title

BOX 1. SEVEN SECRETS TO WRITING THE TITLE OF A
RESEARCH PAPER
A balanced title needs to be “SPICED” [6]. The acronym
here refers to the six key elements of a title, i.e., Setting, • Keep it Concise.
Population, Intervention, Condition, End-point, and • Keep it Specific.
Design.
• Decide regarding Place of Study.
Setting. This refers to the situation in which the research • Use a Descriptive/Neutral title.
takes place in. It could be community-based, home- • Appropriately ‘SPICED’ content.
based, school-based, hospital-based, or laboratory- • Avoid Interrogative or declarative titles.
based. Within the hospital itself, it could be amongst out-
• Avoid acronyms/abbreviations in the title.
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 Endpoint. Outcome is sparingly used in the title, unless
not generalizable to other settings, or if the setting reflects we wish to use a declarative title. It refers to the change or
the magnitude of your research. For example: “Mortality type of change the condition undergoes after being
in Severe Acute Malnutrition in Under-five Children: A subjected to intervention.
Hospital-based Study.” Here it is important to mention
the setting because mortality in severe acute malnutrition Design. Including the study design in the title itself makes
will be different in under-five children admitted to the the title complete and it is usually placed after a colon or
hospital and those in the community. an em dash.
Box 1 summarises the tips for writing a good title.
Population. The population is the target of the research
work and needs to be explicitly stated (age and/or sex, When to Write the Title?
where necessary). For example: “Prevalence of
A rough title should be written when planning a study,
Depression in the Elderly” and “Prevalence of
keeping in mind at least five of the SPICED elements
Osteoporosis in Post-menopausal Women.” In the first
(except endpoint). This can be tailored after the
title only age is specified because sex may not be
completion of the study depending upon what we wish to
important. The latter title includes both age and sex,
highlight from the study.
because of their relevance.
CRAFTING A RUNNING TITLE
Intervention. Intervention (therapeutic or preventive) is a
key element of any clinical trial. For example “Vitamin D Many journals ask for a “running title” or “running head”
Supplementation in Children with Severe Asthma: A or “short title” to be included in the submitted
Randomized Controlled Trial”. The study here could manuscript. This an abridged form of the main title,
evaluate the effect of supplementation of Vitamin D on which is usually placed at the top left in the header of the
the severity of the asthma episode (therapeutic effect) or published page of an article. The running title enables the
the occurrence of recurrent episodes of asthma reader to keep track of the article as he goes through loose
(Preventive). The title should be able to clarify the type printed pages of the article. Most journals would ask for a
of study (see Design below) and the type of intervention, running title of no more than 50 characters including the
if it was planned. A still better title would be spaces. To make the title still shorter, standard
“Therapeutic Effect of Vitamin D Supplementation in abbreviations could be used, and articles and study
Children with Severe Asthma: A Randomized Controlled design be omitted. For example, the running title for a
Trial”. research paper titled “Pulse Oximetry Screening to
Detect Cyanotic Congenital Heart Disease in Sick
Sometimes, research may only be observational with Neonates in a Neonatal Intensive Care Unit” can be
no intervention whatsoever. For example – “Serum written as “Pulse Oximetry Screening for Cyanotic
Vitamin B12 Levels in Adolescent Indian Girls: An CHD”.
Observational Study”. CHOOSING THE KEY WORDS
Condition. It refers to the clinical condition of the The keywords you choose are important as these are used
subjects. “Serum Folate Levels in Pregnant Indian for indexing purposes [7]. Keywords are listed below the
Women: An Observational Study”, here the condition is abstract text. It is important to not duplicate the
pregnancy. “keywords” and “words used in the main title” as both

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DEWAN & GUPTA WRITING TITLE, ABSTRACT & INTRODUCTION

enable accession and hence citation of your research What Should the Abstract Contain?
work. Using the right keywords will speed up the internet
The abstract should be a window to your research and
retrieval of your work [8]. In order to determine the
should effectively convey all the elements of the research
keywords, read through your paper and list the terms,
work. The abstract essentially has four elements (BOX 2).
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, BOX 2. ELEMENTS OF THE ABSTRACT
tumor and cancer. Now refer to an indexing standard like Purpose Why this work? What was aimed?
the Medical Subject Headings (MeSH) database of the Methods How was it achieved?
US National Library of Medicine [9]. Check if these
Results What are the findings?
terms are listed therein. The MeSH uses two tools to
Conclusion What is the inference?
determine keywords:
• MeSH on demand Abstracts cover all the aspects of the research
• MeSH browser. including the background, objectives, methods, results,
conclusions, and recommendations. They, however, do
‘MeSH on demand’ is a simple tool available from not provide a critique of the research. These are usually
https://www.nlm.nih.gov/mesh/MeSHonDemand.html, around 300 words or about 10% of the length of the
which automatically deciphers the keywords from text manuscript.
such as an abstract or summary. MeSH Browser is a tool
Format of an Abstract
available from https://www.nlm.nih.gov/mesh/
MBrowser.html, which allows for searches of MeSH Abstract can be written in running text without the use of
terms, text-word searches of the Annotation and Scope subheadings (Unstructured abstract) or it may be in a
Note, and searches of various fields for chemicals. structured format with use of subheadings. A structured
Another way to identify keywords is to search similar abstract may be a 4-point abstract or a detailed traditional
research work from PubMed and then ascertain the 8-point abstract. A 4-point abstract has four subheadings,
MESH headings assigned to them. The keywords are not usually, (1) Background and/or Objectives,(2) Methods,
necessarily single words but may be two words. For (3) Results, and (4) Conclusions. An 8-point abstract has
example, “breast cancer” is listed as keywords in MeSH. eight subheadings, viz, (1) Objectives, (2) Study-design,
(3) Study-setting, (4) Participants, (5) Methods/
Before you finally submit your article, check if the Intervention, (6) Outcome measures, (7) Results, and (8)
keywords are appropriate. Type the keywords into the Conclusions. You will have to choose the format of the
search engine and see if the search results resemble your abstract after checking the “Instructions to Authors” of
research work. the journal you wish to submit your research to.
WRITING THE ABSTRACT The 4-point abstract is easy to write as the elements
are distinct entities. They are:
The abstract is a concise statement of the major elements
of your paper. It is usually the last section written by the Background - It should be brief and limited to two or
authors, but is the first section of your paper that is read three sentences, where you need to specify what is
by the editors and reviewers. It should therefore provide a already known and why you conducted the study. The
snapshot of the research undertaken by you. In addition, it objectives of study should also be mentioned.
should be comprehensive yet crisp [10]. The abstract
Methods - This is usually the longest section of the
should highlight the selling point of your research work
abstract and should give enough information to the reader
and should lure the readers to read the whole paper.
to understand what and how was your study done. The
Besides determining selection of the paper, abstracts are
important aspects that need to be covered here include the
also important for indexing. When searching online for
study design, study setting, clinical diagnosis of
research work, most databases would display the title as
participants, sample size calculation, sampling methods,
well as the abstract. This would enable the readers to
intervention done, duration of the study, research
determine if they really need to go through the full text of
instruments used, and define the primary and secondary
your research paper. However, it is important to
outcome measures and how these were assessed.
remember that for your article to be picked up during an
online search, it must contain the key words that a Results - This is the most important and difficult section
potential researcher would use to search. to write in an abstract. The results should mention the

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DEWAN & GUPTA WRITING TITLE, ABSTRACT & INTRODUCTION

exact number of participants including the drop outs, and Attributes of a Good Abstract
adverse effects, if any. The results of the analysis of the
A well-written abstract is characterized by the four Cs,
primary objectives and the salient secondary objectives
viz. it should be complete, concise, clear and cohesive.
should be presented in words as well as numbers
including P values. An abstract should present the results A good abstract should be complete. It should be a
of your research as data (mean, standard deviation, 95% stand-alone document and cover all the major parts of the
confidence interval, mean difference, P value, median, research in addition to bringing out its novelty.
and interquartile range, where applicable). Merely stating
A good abstract should be crisp and free from
the interpretation of results in sentences without
excessive wordiness or unnecessary information. For
numerical results is inappropriate. Consider the following
example, “X stimulates Y” will be a better choice of
examples:
words than “X produces a stimulatory effect on Y”. A
“Response rates differed significantly between good abstract should avoid too much background
hypertensive and non-hypertensive children.” A better information. You should refrain from using empty
way to state your results is “The response rate was higher phrases like “It was interesting to note that ….”. Cliché
in non-hypertensive than in hypertensive children (50% statements like “More research is needed” should be
vs 20%, respectively; P<0.01).” avoided. If there are implications, then you must state
them clearly.
Another example where results of a study evaluating
the role of probiotics in diarrhea are presented: The abstract should be clear, i.e., readable, well-
organized, and not too jargon-laden. The abstract should
“The time for resolution of diarrhea, and the be written in the past tense. Abstract written in active
recovery in terms of resolution of diarrhea and need for voice provides greater clarity. So, we may write “We
hospitalization was similar in the probiotic and placebo conclude that…” instead of “It was concluded that….”.
groups.” The findings of your research should not be discussed in
the abstract, and any discussion should only be done in
Or
the main text of your research paper. The abstract should
“The median time for resolution of diarrhea was 54 be free of figures, diagrams, tables, or images. The
hours in both the probiotic and the placebo group. abstract should not contain any references/citations.
Recovery in the probiotic group was marginally better Avoid use of abbreviations or acronyms.
but not statistically significant for resolution (hazard A well written abstract should be cohesive and the
ratio = 0.91, 95% CI 0.60-1.31), rehydration (hazard text should flow smoothly between the parts. The abstract
ratio = 0.91, 95% CI 0.64-1.39) and hospitalization must follow the chronological order of sections in your
(hazard ratio = 0.94, 95% CI 0.67-1.34).” main research paper ensuring a smooth transition. It must
The latter way of presenting the results in the abstract read like a story. A direct cohesiveness needs to be
is better and more informative. maintained between objectives, main outcome measures,
results and conclusion (example in BOX 4).
Conclusions - The conclusions need to state the ‘take
home message’ and any other salient findings which need Before you finally submit your abstract check it for
to be considered. The conclusions must always take into consistency; a mismatch between the abstract and main
account your hypothesis and research question and must
BOX 3. EXAMPLES OF THE CONCLUSIONS SECTION OF
be written so as to answer the same in the light of your
ABSTRACT
results. Additionally, you may present your perspective in
this section of the abstract. BOX 3 depicts some examples • Daily zinc supplementation (40mg for 14 days) in
of writing the conclusions section of the abstract. children aged five to 12-year with acute
dehydrating diarrhea did not shorten the duration
The 8-point abstract ensures completion of all aspects of diarrhea or reduce subsequent episodes.
of the research; however, there is a significant overlap Further community-based trials with adequate
between the methods and results section. Therefore, it sample sizes are needed.
needs to be drafted very carefully. For example, under the • Pyomyositis is a specific and potentially fatal
subheading “participants”, you will not only need to infection, which is common in India and must be
specify the inclusion/exclusion criteria (part of methods differentiated from intermuscular abscess. A high
section), but also need to mention the exact number index of suspicion and early institution of specific
antibiotics followed by surgery can be lifesaving.
recruited in your study (part of results).

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DEWAN & GUPTA WRITING TITLE, ABSTRACT & INTRODUCTION

text may raise doubts on authenticity of your results. a previous research that yielded ambiguous results.
Check if the abstract meets the guidelines to authors in
3. What you aim to do?
terms of format, word count, etc.
You need to briefly state the objectives of your research.
WRITING THE INTRODUCTION
It is also advisable to present a detailed hypothesis at this
Need for an Introduction juncture only.
The introduction should aim to set the mood for your How long is too long?
research, acquaint the readers with your research
There are no strict word limits for writing the
hypothesis, and motivate the readers to read your paper
introduction; generally it is one of the shorter sections of
[12]. It should steer the readers from why you are doing
the paper. Having the readers meander through too much
the research into how you are going to fill the knowledge
of introduction can be counterproductive as it may cause
gap i.e., into the methods section.
them to lose focus and interest. You should assume that
An introduction essentially has three main elements: your work is going to be read by someone who has at least
a reasonable knowledge about your research topic, so it is
1. What is known?
preferable that you do not beat about the bush. For
The background of the research topic needs to be stated example, for a study evaluating the role of probiotics in
right at the onset to enable the readers to understand what acute diarrhea in children, there is no need to discuss
is already known on the subject. This sets the stage for the definitions and etiology of diarrhea in the introduction;
basis of your research. you could start by commenting upon the well-established
treatment options for acute diarrhea and how your study
2. What is lacking?
will add to the existing knowledge and practice.
You need to justify “why you are carrying out that
How to write the Introduction?
research work”, i.e., whether you are building upon
previous research, looking at a novel aspect not evaluated It would be useful to structure your introduction like an
by previous research, or if you are trying to improve upon “inverted pyramid” or what could be simply said as

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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 DEWAN & GUPTA WRITING TITLE, ABSTRACT & INTRODUCTION

“funnel approach”. This implies introducing the topic of septicemia”. The hypothesis should be used to convince
the paper and discussing it in a broad context and then the readers about what results are expected from your
finally narrowing down to the research problem and research. Also, remember that a hypothesis is valuable
hypothesis. even if proved to be wrong.
The introduction can be written in about two-to-three And as the phrase goes “Well begun is half done”, so
paragraphs. The opening paragraph should be dedicated is the story with a research paper. A well drafted abstract
to introducing the topic of research; it may also provide and introduction section with a strong title will help the
an overview of the topic of research. You must remember researcher to win half the battle.
that the introduction is not a review of literature but it
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