writing a medical review article

• Search Menu

Sign in through your institution

• Advance Articles
• Editor's Choice
• CME Reviews
• Best of 2021 collection
• Abbreviated Breast MRI Virtual Collection
• Contrast-enhanced Mammography Collection
• Author Guidelines
• Submission Site
• Open Access
• Self-Archiving Policy
• Accepted Papers Resource Guide
• About Journal of Breast Imaging
• About the Society of Breast Imaging
• Guidelines for Reviewers
• Resources for Reviewers and Authors
• Editorial Board
• Advertising Disclaimer
• Advertising and Corporate Services
• Journals on Oxford Academic
• Books on Oxford Academic

• < Previous

A Step-by-Step Guide to Writing a Scientific Review Article

• Article contents
• Figures & tables
• Supplementary Data

Manisha Bahl, A Step-by-Step Guide to Writing a Scientific Review Article, Journal of Breast Imaging , Volume 5, Issue 4, July/August 2023, Pages 480–485, https://doi.org/10.1093/jbi/wbad028

• Permissions Icon Permissions

Scientific review articles are comprehensive, focused reviews of the scientific literature written by subject matter experts. The task of writing a scientific review article can seem overwhelming; however, it can be managed by using an organized approach and devoting sufficient time to the process. The process involves selecting a topic about which the authors are knowledgeable and enthusiastic, conducting a literature search and critical analysis of the literature, and writing the article, which is composed of an abstract, introduction, body, and conclusion, with accompanying tables and figures. This article, which focuses on the narrative or traditional literature review, is intended to serve as a guide with practical steps for new writers. Tips for success are also discussed, including selecting a focused topic, maintaining objectivity and balance while writing, avoiding tedious data presentation in a laundry list format, moving from descriptions of the literature to critical analysis, avoiding simplistic conclusions, and budgeting time for the overall process.

• narrative discourse

Society of Breast Imaging members

Personal account.

• Sign in with email/username & password
• Get email alerts
• Save searches
• Purchase content
• Activate your purchase/trial code
• Add your ORCID iD

Institutional access

Sign in with a library card.

• Sign in with username/password
• Recommend to your librarian
• Institutional account management
• Get help with access

Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:

IP based access

Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account.

Choose this option to get remote access when outside your institution. Shibboleth/Open Athens technology is used to provide single sign-on between your institution’s website and Oxford Academic.

• Click Sign in through your institution.
• Select your institution from the list provided, which will take you to your institution's website to sign in.
• When on the institution site, please use the credentials provided by your institution. Do not use an Oxford Academic personal account.
• Following successful sign in, you will be returned to Oxford Academic.

If your institution is not listed or you cannot sign in to your institution’s website, please contact your librarian or administrator.

Enter your library card number to sign in. If you cannot sign in, please contact your librarian.

Society Members

Society member access to a journal is achieved in one of the following ways:

Sign in through society site

Many societies offer single sign-on between the society website and Oxford Academic. If you see ‘Sign in through society site’ in the sign in pane within a journal:

• Click Sign in through society site.
• When on the society site, please use the credentials provided by that society. Do not use an Oxford Academic personal account.

If you do not have a society account or have forgotten your username or password, please contact your society.

Sign in using a personal account

Some societies use Oxford Academic personal accounts to provide access to their members. See below.

A personal account can be used to get email alerts, save searches, purchase content, and activate subscriptions.

Some societies use Oxford Academic personal accounts to provide access to their members.

Viewing your signed in accounts

Click the account icon in the top right to:

• View your signed in personal account and access account management features.
• View the institutional accounts that are providing access.

Signed in but can't access content

Oxford Academic is home to a wide variety of products. The institutional subscription may not cover the content that you are trying to access. If you believe you should have access to that content, please contact your librarian.

For librarians and administrators, your personal account also provides access to institutional account management. Here you will find options to view and activate subscriptions, manage institutional settings and access options, access usage statistics, and more.

Short-term Access

To purchase short-term access, please sign in to your personal account above.

Don't already have a personal account? Register

Email alerts

Citing articles via.

• Recommend to your Librarian
• Journals Career Network

Affiliations

• Online ISSN 2631-6129
• Print ISSN 2631-6110
• Copyright © 2024 Society of Breast Imaging
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Rights and permissions
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

JAY SIWEK, M.D., MARGARET L. GOURLAY, M.D., DAVID C. SLAWSON, M.D., AND ALLEN F. SHAUGHNESSY, PHARM.D.

Am Fam Physician. 2002;65(2):251-258

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Nonquantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician . First, the topic should be of common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence , or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician , rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.

American Family Physician is particularly interested in receiving clinical review articles that follow an evidence-based format. Clinical review articles, also known as updates, differ from systematic reviews and meta-analyses in important ways. 1 Updates selectively review the medical literature while discussing a topic broadly. An example of such a topic is, “The diagnosis and treatment of myocardial ischemia.” Systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Examples are many of the systematic reviews of the Cochrane Collaboration or BMJ's Clinical Evidence compendium. Meta-analyses are a special type of systematic review. They use quantitative methods to analyze the literature and seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. An example is, “Do beta blockers reduce mortality following myocardial infarction?”

The best clinical review articles base the discussion on existing systematic reviews and meta-analyses, and incorporate all relevant research findings about the management of a given disorder. Such evidence-based updates provide readers with powerful summaries and sound clinical guidance.

In this article, we present guidelines for writing an evidence-based clinical review article, especially one designed for continuing medical education (CME) and incorporating CME objectives into its format. This article may be read as a companion piece to a previous article and accompanying editorial about reading and evaluating clinical review articles. 1 , 2 Some articles may not be appropriate for an evidence-based format because of the nature of the topic, the slant of the article, a lack of sufficient supporting evidence, or other factors. We encourage authors to review the literature and, wherever possible, rate key points of evidence. This process will help emphasize the summary points of the article and strengthen its teaching value.

Topic Selection

Choose a common clinical problem and avoid topics that are rarities or unusual manifestations of disease or that have curiosity value only. Whenever possible, choose common problems for which there is new information about diagnosis or treatment. Emphasize new information that, if valid, should prompt a change in clinical practice, such as the recent evidence that spironolactone therapy improves survival in patients who have severe congestive heart failure. 3 Similarly, new evidence showing that a standard treatment is no longer helpful, but may be harmful, would also be important to report. For example, patching most traumatic corneal abrasions may actually cause more symptoms and delay healing compared with no patching. 4

Searching the Literature

When searching the literature on your topic, please consult several sources of evidence-based reviews ( Table 1 ) . Look for pertinent guidelines on the diagnosis, treatment, or prevention of the disorder being discussed. Incorporate all high-quality recommendations that are relevant to the topic. When reviewing the first draft, look for all key recommendations about diagnosis and, especially, treatment. Try to ensure that all recommendations are based on the highest level of evidence available. If you are not sure about the source or strength of the recommendation, return to the literature, seeking out the basis for the recommendation.

In particular, try to find the answer in an authoritative compendium of evidence-based reviews, or at least try to find a meta-analysis or well-designed randomized controlled trial (RCT) to support it. If none appears to be available, try to cite an authoritative consensus statement or clinical guideline, such as a National Institutes of Health Consensus Development Conference statement or a clinical guideline published by a major medical organization. If no strong evidence exists to support the conventional approach to managing a given clinical situation, point this out in the text, especially for key recommendations. Keep in mind that much of traditional medical practice has not yet undergone rigorous scientific study, and high-quality evidence may not exist to support conventional knowledge or practice.

Patient-Oriented vs. Disease-Oriented Evidence

With regard to types of evidence, Shaughnessy and Slawson 5 – 7 developed the concept of Patient-Oriented Evidence that Matters (POEM), in distinction to Disease-Oriented Evidence (DOE). POEM deals with outcomes of importance to patients, such as changes in morbidity, mortality, or quality of life. DOE deals with surrogate end points, such as changes in laboratory values or other measures of response. Although the results of DOE sometimes parallel the results of POEM, they do not always correspond ( Table 2 ) . 2 When possible, use POEM-type evidence rather than DOE. When DOE is the only guidance available, indicate that key clinical recommendations lack the support of outcomes evidence. Here is an example of how the latter situation might appear in the text: “Although prostate-specific antigen (PSA) testing identifies prostate cancer at an early stage, it has not yet been proved that PSA screening improves patient survival.” (Note: PSA testing is an example of DOE, a surrogate marker for the true outcomes of importance—improved survival, decreased morbidity, and improved quality of life.)

Evaluating the Literature

Evaluate the strength and validity of the literature that supports the discussion (see the following section, Levels of Evidence). Look for meta-analyses, high-quality, randomized clinical trials with important outcomes (POEM), or well-designed, nonrandomized clinical trials, clinical cohort studies, or case-controlled studies with consistent findings. In some cases, high-quality, historical, uncontrolled studies are appropriate (e.g., the evidence supporting the efficacy of Papanicolaou smear screening). Avoid anecdotal reports or repeating the hearsay of conventional wisdom, which may not stand up to the scrutiny of scientific study (e.g., prescribing prolonged bed rest for low back pain).

Look for studies that describe patient populations that are likely to be seen in primary care rather than subspecialty referral populations. Shaughnessy and Slawson's guide for writers of clinical review articles includes a section on information and validity traps to avoid. 2

Levels of Evidence

Readers need to know the strength of the evidence supporting the key clinical recommendations on diagnosis and treatment. Many different rating systems of varying complexity and clinical relevance are described in the medical literature. Recently, the third U.S. Preventive Services Task Force (USPSTF) emphasized the importance of rating not only the study type (RCT, cohort study, case-control study, etc.), but also the study quality as measured by internal validity and the quality of the entire body of evidence on a topic. 8

While it is important to appreciate these evolving concepts, we find that a simplified grading system is more useful in AFP . We have adopted the following convention, using an ABC rating scale. Criteria for high-quality studies are discussed in several sources. 8 , 9 See the AFP Web site ( www.aafp.org/afp/authors ) for additional information about levels of evidence and see the accompanying editorial in this issue discussing the potential pitfalls and limitations of any rating system.

Level A (randomized controlled trial/meta-analysis): High-quality randomized controlled trial (RCT) that considers all important outcomes. High-quality meta-analysis (quantitative systematic review) using comprehensive search strategies.

Level B (other evidence): A well-designed, nonrandomized clinical trial. A nonquantitative systematic review with appropriate search strategies and well-substantiated conclusions. Includes lower quality RCTs, clinical cohort studies, and case-controlled studies with non-biased selection of study participants and consistent findings. Other evidence, such as high-quality, historical, uncontrolled studies, or well-designed epidemiologic studies with compelling findings, is also included.

Level C (consensus/expert opinion): Consensus viewpoint or expert opinion.

Each rating is applied to a single reference in the article, not to the entire body of evidence that exists on a topic. Each label should include the letter rating (A, B, C), followed by the specific type of study for that reference. For example, following a level B rating, include one of these descriptors: (1) nonrandomized clinical trial; (2) nonquantitative systematic review; (3) lower quality RCT; (4) clinical cohort study; (5) case-controlled study; (6) historical uncontrolled study; (7) epidemiologic study.

Here are some examples of the way evidence ratings should appear in the text:

“To improve morbidity and mortality, most patients in congestive heart failure should be treated with an angiotensin-converting enzyme inhibitor. [Evidence level A, RCT]”

“The USPSTF recommends that clinicians routinely screen asymptomatic pregnant women 25 years and younger for chlamydial infection. [Evidence level B, non-randomized clinical trial]”

“The American Diabetes Association recommends screening for diabetes every three years in all patients at high risk of the disease, including all adults 45 years and older. [Evidence level C, expert opinion]”

When scientifically strong evidence does not exist to support a given clinical recommendation, you can point this out in the following way:

“Physical therapy is traditionally prescribed for the treatment of adhesive capsulitis (frozen shoulder), although there are no randomized outcomes studies of this approach.”

Format of the Review

Introduction.

The introduction should define the topic and purpose of the review and describe its relevance to family practice. The traditional way of doing this is to discuss the epidemiology of the condition, stating how many people have it at one point in time (prevalence) or what percentage of the population is expected to develop it over a given period of time (incidence). A more engaging way of doing this is to indicate how often a typical family physician is likely to encounter this problem during a week, month, year, or career. Emphasize the key CME objectives of the review and summarize them in a separate table entitled “CME Objectives.”

The methods section should briefly indicate how the literature search was conducted and what major sources of evidence were used. Ideally, indicate what predetermined criteria were used to include or exclude studies (e.g., studies had to be independently rated as being high quality by an established evaluation process, such as the Cochrane Collaboration). Be comprehensive in trying to identify all major relevant research. Critically evaluate the quality of research reviewed. Avoid selective referencing of only information that supports your conclusions. If there is controversy on a topic, address the full scope of the controversy.

The discussion can then follow the typical format of a clinical review article. It should touch on one or more of the following subtopics: etiology, pathophysiology, clinical presentation (signs and symptoms), diagnostic evaluation (history, physical examination, laboratory evaluation, and diagnostic imaging), differential diagnosis, treatment (goals, medical/surgical therapy, laboratory testing, patient education, and follow-up), prognosis, prevention, and future directions.

The review will be comprehensive and balanced if it acknowledges controversies, unresolved questions, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented. Emphasize an evidence-supported approach or, where little evidence exists, a consensus viewpoint. In the absence of a consensus viewpoint, you may describe generally accepted practices or discuss one or more reasoned approaches, but acknowledge that solid support for these recommendations is lacking.

In some cases, cost-effectiveness analyses may be important in deciding how to implement health care services, especially preventive services. 10 When relevant, mention high-quality cost-effectiveness analyses to help clarify the costs and health benefits associated with alternative interventions to achieve a given health outcome. Highlight key points about diagnosis and treatment in the discussion and include a summary table of the key take-home points. These points are not necessarily the same as the key recommendations, whose level of evidence is rated, although some of them will be.

Use tables, figures, and illustrations to highlight key points, and present a step-wise, algorithmic approach to diagnosis or treatment when possible.

Rate the evidence for key statements, especially treatment recommendations. We expect that most articles will have at most two to four key statements; some will have none. Rate only those statements that have corresponding references and base the rating on the quality and level of evidence presented in the supporting citations. Use primary sources (original research, RCTs, meta-analyses, and systematic reviews) as the basis for determining the level of evidence. In other words, the supporting citation should be a primary research source of the information, not a secondary source (such as a nonsystematic review article or a textbook) that simply cites the original source. Systematic reviews that analyze multiple RCTs are good sources for determining ratings of evidence.

The references should include the most current and important sources of support for key statements (i.e., studies referred to, new information, controversial material, specific quantitative data, and information that would not usually be found in most general reference textbooks). Generally, these references will be key evidence-based recommendations, meta-analyses, or landmark articles. Although some journals publish exhaustive lists of reference citations, AFP prefers to include a succinct list of key references. (We will make more extensive reference lists available on our Web site or provide links to your personal reference list.)

You may use the following checklist to ensure the completeness of your evidence-based review article; use the source list of reviews to identify important sources of evidence-based medicine materials.

Checklist for an Evidence-Based Clinical Review Article

The topic is common in family practice, especially topics in which there is new, important information about diagnosis or treatment.

The introduction defines the topic and the purpose of the review, and describes its relevance to family practice.

A table of CME objectives for the review is included.

The review states how you did your literature search and indicates what sources you checked to ensure a comprehensive assessment of relevant studies (e.g., MEDLINE, the Cochrane Collaboration Database, the Center for Research Support, TRIP Database).

Several sources of evidence-based reviews on the topic are evaluated ( Table 1 ) .

Where possible, POEM (dealing with changes in morbidity, mortality, or quality of life) rather than DOE (dealing with mechanistic explanations or surrogate end points, such as changes in laboratory tests) is used to support key clinical recommendations ( Table 2 ) .

Studies of patients likely to be representative of those in primary care practices, rather than subspecialty referral centers, are emphasized.

Studies that are not only statistically significant but also clinically significant are emphasized; e.g., interventions with meaningful changes in absolute risk reduction and low numbers needed to treat. (See http://www.cebm.net/index.aspx?o=1116 .) 11

The level of evidence for key clinical recommendations is labeled using the following rating scale: level A (RCT/meta-analysis), level B (other evidence), and level C (consensus/expert opinion).

Acknowledge controversies, recent developments, other viewpoints, and any apparent conflicts of interest or instances of bias that might affect the strength of the evidence presented.

Highlight key points about diagnosis and treatment in the discussion and include a summary table of key take-home points.

Use tables, figures, and illustrations to highlight key points and present a step-wise, algorithmic approach to diagnosis or treatment when possible.

Emphasize evidence-based guidelines and primary research studies, rather than other review articles, unless they are systematic reviews.

The essential elements of this checklist are summarized in Table 3 .

Siwek J. Reading and evaluating clinical review articles. Am Fam Physician. 1997;55:2064-2069.

Shaughnessy AF, Slawson DC. Getting the most from review articles: a guide for readers and writers. Am Fam Physician. 1997;55:2155-60.

Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-17.

Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998;47:264-70.

Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract. 1994;38:505-13.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39:489-99.

Slawson DC, Shaughnessy AF. Becoming an information master: using POEMs to change practice with confidence. Patient-oriented evidence that matters. J Fam Pract. 2000;49:63-7.

Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al. Methods Work Group, Third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force. A review of the process. Am J Prev Med. 2001;20(3 suppl):21-35.

CATbank topics: levels of evidence and grades of recommendations. Retrieved November 2001, from: http://www.cebm.net/ .

Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS. for the Cost Work Group of the Third U.S. Preventive Services Task Force. The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med. 2001;20(3 suppl):36-43.

Evidence-based medicine glossary. Retrieved November 2001, from: http://www.cebm.net/index.aspx?o=1116 .

Continue Reading

More in afp, more in pubmed.

Copyright © 2002 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

Title of message

Here is the body of the message. You can remove the title if you don't want it. You can also style the content and add links. Comment out the code not in use.

How to Write a Review Article

• Types of Review Articles
• Before Writing a Review Article
• Determining Where to Publish
• Searching the Literature
• Citation Management
• Reading a Review Article

Practical Rules for Writing a Review Article

• Define a topic and audience.
• Decide the type of review you wish to write and make sure that you are capable of writing (meta-analysis can be difficult for many, for example).
• Search and re-search the literature.
• Organize articles into different categories according to specific issues the articles addressed. 
• Take notes while reading and categorize and organize information into subgroups.
• Keep the review focused with the audience in mind but make it of broad interest.
• Be critical, objective, open-minded, and consistent and do not become biased.
• Organize the flow of the main body of the review so that the reader will be drawn into and guided through it.
• Make use of feedback from your colleagues and reviewers.
• Feel free to include your own relevant research but be objective.
• Be up-to-date, but do not forget older studies that are still relevant
• Do not write a review that does not add anything new to the already published review articles on the same topic

Source:  Pautasso M. Ten simple rules for writing a literature review . PLoS Comput Biol . 2013;9(7):e1003149. 10.1371/journal.pcbi.1003149

Further Reading

Gülpınar Ö, Güçlü AG. How to write a review article?   Turk J Urol . 2013;39(Suppl 1):44-8.  10.5152/tud.2013.054

• << Previous: Before Writing a Review Article
• Next: Determining Where to Publish >>
• Last Updated: May 9, 2024 3:23 PM
• URL: https://library.hmsom.edu/review-articles

How to Write a Review Article

Cite this chapter.

3315 Accesses

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or Ebook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as PDF
• Read on any device
• Instant download
• Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Unable to display preview.  Download preview PDF.

Day RA. How to publish a scientific paper. 5th ed. Westport, CT: Oryx; 1998:163.

Google Scholar  

Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based clinical review article. Am Fam Phys 2002;65:251–258.

Journal of the American Medical Association. Instructions for authors. JAMA 2004;291:125–131. Available at: http://jama. ama-assn.org/ifora_current/dtl.

Harris RP, Helfand M, Wolff SH, et al. Methods Work Group, Third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force. A review of the process. Am J Prev Med 2001;20(3 suppl):21–35.

CAS   PubMed   Google Scholar  

Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Phys 2004;69:548–556.

Download references

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer Science+Business Media, Inc.

About this chapter

(2005). How to Write a Review Article. In: The Clinician’s Guide to Medical Writing. Springer, New York, NY. https://doi.org/10.1007/0-387-27024-8_6

Download citation

DOI : https://doi.org/10.1007/0-387-27024-8_6

Publisher Name : Springer, New York, NY

Print ISBN : 978-0-387-22249-3

Online ISBN : 978-0-387-27024-1

eBook Packages : Medicine Medicine (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Structure for writing an effective clinical review articles

Pre-or post-publication Peer review of Scientific Manuscripts: Thoughts on Pros and Cons

Guidelines to authors in Writing an effective Medical Case Report (MCR)

Clinicians need clinical review articles that have well-organized structure for easy reading and understanding.  Only then it will help them to apply it practically on patients and for further research. Traditional clinical review articles, also known as updates, discuss a topic broadly and selectively review the medical literature.   An excellent structured clinical research article will resolve controversy generated by studies that contradict one another.

Before knowing how to structure a clinical review article, you have to know some background facts on why good structure is crucial for it.

For clinicians to upgrade their knowledge, they rely only on peer-reviewed medical journals. But most studies at best only provide preliminary evidence due to

• Limited scope
• Poor design
• Inefficient execution
• Inadequate sample size to have significant clinical benefits or detection of adverse effects
• Play of chances

Clinicians reading these studies, have to integrate and compare it with existing evidence to conclude, whether the clinical policy had to be changed on the accumulated evidence. Even in the case of original studies, only a portion of the clinical problem is addressed. Hence, most clinicians take a short cut to read the clinical reviews done by others.  These clinic review articles include evidence from available studies on the specific clinical problem.

But the clinical review if not structured properly, will not do justice to the original evidence. And the clinician will end up with false conclusions which will finally be borne by the patients.  In research by Mulrow conducted on 50 published reviews, only one adhered to the specific methods of identifying, selecting, and validating included information.   

Notes: – The word count in the Article structure excludes the Abstract, References, Acknowledgement and figure captions. The word count should be indicated at the foot of the title page. – Keywords (3-6) should be provided at the foot of the abstract.

Now let us see how a clinical research article can be structured:

PRISMA or Preferred Reporting Items for Systematic Reviews and Meta-analyses has issued a statement listing 27 item checklists to make the writing of clinic review feasible.

Though IMRAD (Introduction, Methods, Results, Discussion and Conclusions) structure is the basis of many reviews, there could be variations in guidelines as per the nature of research.  But the general structure for most of the clinic review structure is as follows

Elements of a review article

1. title page :.

• Length: The title should be in a range of 8 -12 words describing the topic and its aspect.

E.g.   The title “Pancreatic Disease” will be too generic. Instead, “Challenges in Diagnosing Subclinical Pancreatic Disease” will describe the concise nature and aspect of the research.

• The title must be short
• The title should have all the critical elements of the subject matter (or informative)
• Order of authors: The first author has done most of the research
• Second and in between authors would have contributed one way or another
• The last author coordinated the project
• Tense: Results: the present tense stresses the general validity and demonstrates that the author is trying to achieve with the article. The paste tense indicates that results are not established yet.
• Citations: None

2. Abstract:

• Citation: No citations needed in the abstract
• Elements: Descriptive Abstract for narrative reviews
• Objectives: Present
• Materials and Methods, results: Past
• Conclusion: Present
• Should include acronyms and abbreviations only if they are used more than once
• Length: It should be written within a range of 200 – 500 words outlining the main points or synthesis in subheadings as per the nature of the review

E.g., Abstract requirements for content and format differ according to the type of review or journal. Some prefer unstructured abstracts, and the others require structured abstracts containing the elements in subheadings.

• Another style needs the subheadings content, evidence, acquisition, results, and conclusions

3. Introduction:

• Tense: Should be written in present tense addressing the research question and the objective purpose of the review
• Citations: Many
• Length: 10% and 20% of the core text
• Note: It should explain why the review of the field or topic essential at this time and what is that you are going to cover in the review

E.g., Review on DMS or deep brain stimulation for Dystonia

However, one must acknowledge that published results obtained with DBS in Dystonia are few and that conclusions from these preliminary reports should be drawn very cautiously. Nonetheless, promising findings are emerging from single case reports or small case series, and the notion that DBS may be of great help in selected cases is progressively growing… . In this review, we discuss the results reported in the literature. Some critical issues regarding the evaluation of the results are also mentioned

4. Materials and Methods

Tense: Should be written in the past tense to provide the reason to repeat the review

Elements: It should include:

• Search strategies
• Criteria of inclusion and exclusion of methods
• Data sources
• Geographical information
• Characteristics of study subjects
• Details of used statistical analyses

Length: Approx. 5% of the core text

Citations: Few (e.g. software and statistical analyses used)

5. Main Body Part of the Review Article

Section Structure: A coherent structure of the topic mentioning their relevance to the objective. Subheadings reflecting the topic organisation and indicate the content in various sections including methodological approaches adopted, theories or models used, critical appraisal of studies, in chronological order

Links: Links the research findings to the research questions

Tense: Three tenses are frequently used: Present tense, when reporting what another author thinks, and writes. Example: It is believed….

Present Perfect, when referring to an area of research with a number of researchers Example: They have found….

while simple past referring to what a specific researcher found, referring to a single study. Example: They found….

Citations: Usually indirect but can also be cited directly

Length: 70 to 90% of the core text

6. Discussion:

Elements: Discuss the results and their significance clearly and concisely. Identify any unresolved questions.

Function: Reiterate the objective and background information

Citations: Few or more

Tense: Present tense

Despite 30 years of continued investigation, the precise mechanism of CD4 T-cell loss induced by HIV infection remains controversial. HIV-mediated destruction of its preferred target, the activated CD4 T cell, is certainly central to HIV pathogenesis, but does not explain why many uninfected cells die or why the host cannot merely replace lost cells.21,22 As first proposed in the 1990s,23 researchers now know that the pro-inflammatory nature of HIV infection is a key part of disease pathogenesis.2,25

7. Conclusions:

• Conclude the review to give the reader a sense of what the review means by discussing the objective mentioned in introduction, including findings and interpretations.
• I should also discuss what the future is by identifying the unresolved questions

Future studies evaluating novel stroke biomarkers should answer questions that address their unique clinical contribution in the diagnosis, management, and risk prediction of stroke: has the patient had a stroke? Is the stroke of ischemic or hemorrhagic etiology? Are symptoms suggestive of additional intensive investigation or thrombolytic therapy? Is the patient at risk for stroke or reoccurrence of cardiovascular events? Modern stroke diagnosis remains heavily reliant on clinical interpretation, and further translational research efforts toward discovery of stroke biomarkers have the possibility to greatly improve patient outcomes and quality of care

8. References:

Length: References should be written in 50 to 100 words and could cite only those in text, and online sources are not allowed.

Plagiarism: Strictly Avoid

The above details will help you to structure your clinical review article and if you need any further assistance seek professional help.

clinical review articles  |  medical literature  |  clinical case  |  Schemantic reviews  |  Meta analysis  |  writing of clinical review  |  clinical review structure

pubrica-academy

Related posts.

Making Sense of Effect Size in Meta-Analysis based for Medical Research

Copy of PUB-Evidence-based analyses to look at cost-effectiveness, cost-benefit information & clinical data from RT-Device Manufacturers

The Role of Packaging Design In Drug Development

PUB - Selecting material for drug development

Selecting materials for medical device industry

Comments are closed.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

How to write a review article?

Affiliation.

• 1 Department of Urology, Faculty of Medicine İbni Sina Hospital, Ankara University, Ankara, Turkey.
• PMID: 26328136
• PMCID: PMC4548566
• DOI: 10.5152/tud.2013.054

In the medical sciences, the importance of review articles is rising. When clinicians want to update their knowledge and generate guidelines about a topic, they frequently use reviews as a starting point. The value of a review is associated with what has been done, what has been found and how these findings are presented. Before asking 'how,' the question of 'why' is more important when starting to write a review. The main and fundamental purpose of writing a review is to create a readable synthesis of the best resources available in the literature for an important research question or a current area of research. Although the idea of writing a review is attractive, it is important to spend time identifying the important questions. Good review methods are critical because they provide an unbiased point of view for the reader regarding the current literature. There is a consensus that a review should be written in a systematic fashion, a notion that is usually followed. In a systematic review with a focused question, the research methods must be clearly described. A 'methodological filter' is the best method for identifying the best working style for a research question, and this method reduces the workload when surveying the literature. An essential part of the review process is differentiating good research from bad and leaning on the results of the better studies. The ideal way to synthesize studies is to perform a meta-analysis. In conclusion, when writing a review, it is best to clearly focus on fixed ideas, to use a procedural and critical approach to the literature and to express your findings in an attractive way.

Keywords: How to write; review; writing.

PubMed Disclaimer

Similar articles

• Rules to be adopted for publishing a scientific paper. Picardi N. Picardi N. Ann Ital Chir. 2016;87:1-3. Ann Ital Chir. 2016. PMID: 28474609
• The Effectiveness of Integrated Care Pathways for Adults and Children in Health Care Settings: A Systematic Review. Allen D, Gillen E, Rixson L. Allen D, et al. JBI Libr Syst Rev. 2009;7(3):80-129. doi: 10.11124/01938924-200907030-00001. JBI Libr Syst Rev. 2009. PMID: 27820426
• Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature. Eddy K, Jordan Z, Stephenson M. Eddy K, et al. JBI Database System Rev Implement Rep. 2016 Apr;14(4):96-137. doi: 10.11124/JBISRIR-2016-1843. JBI Database System Rev Implement Rep. 2016. PMID: 27532314 Review.
• Cervical spondylotic myelopathy: methodological approaches to evaluate the literature and establish best evidence. Skelly AC, Hashimoto RE, Norvell DC, Dettori JR, Fischer DJ, Wilson JR, Tetreault LA, Fehlings MG. Skelly AC, et al. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S9-18. doi: 10.1097/BRS.0b013e3182a7ebbf. Spine (Phila Pa 1976). 2013. PMID: 24026148
• How to write a systematic review. Harris JD, Quatman CE, Manring MM, Siston RA, Flanigan DC. Harris JD, et al. Am J Sports Med. 2014 Nov;42(11):2761-8. doi: 10.1177/0363546513497567. Epub 2013 Aug 7. Am J Sports Med. 2014. PMID: 23925575 Review.
• Impact of Heavy Metal Pollution in the Environment on the Metabolic Profile of Medicinal Plants and Their Therapeutic Potential. Asiminicesei DM, Fertu DI, Gavrilescu M. Asiminicesei DM, et al. Plants (Basel). 2024 Mar 21;13(6):913. doi: 10.3390/plants13060913. Plants (Basel). 2024. PMID: 38592933 Free PMC article. Review.
• Writing a Scientific Review Article: Comprehensive Insights for Beginners. Amobonye A, Lalung J, Mheta G, Pillai S. Amobonye A, et al. ScientificWorldJournal. 2024 Jan 17;2024:7822269. doi: 10.1155/2024/7822269. eCollection 2024. ScientificWorldJournal. 2024. PMID: 38268745 Free PMC article. Review.
• Metabolomics-directed nanotechnology in viral diseases management: COVID-19 a case study. El-Derany MO, Hanna DMF, Youshia J, Elmowafy E, Farag MA, Azab SS. El-Derany MO, et al. Pharmacol Rep. 2023 Oct;75(5):1045-1065. doi: 10.1007/s43440-023-00517-w. Epub 2023 Aug 16. Pharmacol Rep. 2023. PMID: 37587394 Free PMC article. Review.
• Dietary macrominerals: Updated review of their role and orchestration in human nutrition throughout the life cycle with sex differences. Farag MA, Abib B, Qin Z, Ze X, Ali SE. Farag MA, et al. Curr Res Food Sci. 2023 Feb 1;6:100450. doi: 10.1016/j.crfs.2023.100450. eCollection 2023. Curr Res Food Sci. 2023. PMID: 36816001 Free PMC article. Review.
• Research Trends on Pillared Interlayered Clays (PILCs) Used as Catalysts in Environmental and Chemical Processes: Bibliometric Analysis. Macías-Quiroga IF, Rengifo-Herrera JA, Arredondo-López SM, Marín-Flórez A, Sanabria-González NR. Macías-Quiroga IF, et al. ScientificWorldJournal. 2022 Mar 2;2022:5728678. doi: 10.1155/2022/5728678. eCollection 2022. ScientificWorldJournal. 2022. PMID: 35281748 Free PMC article.
• Oxman AD, Cook DJ, Guyatt GH. Users’ guides to the medical 1 literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA. 1994;272:1367–71. - PubMed
• Swingler GH, Volmink J, Ioannidis JP. Number of published systematic 2 reviews and global burden of disease: database analysis. BMJ. 2003;327:1083–4. - PMC - PubMed
• Canadian Institutes of Health Research. Randomized controlled trials 3 registration/application checklist (12/2006) 2006. www.cihrirsc.gc.ca/e/documents/rct_reg_e.pdf (accessed 19 May 2009).
• Mulrow CD. The medical review article: state of the science. Ann Intern Med. 1987;106:485–8. - PubMed
• Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet. 1999;354:1896–900. - PubMed

LinkOut - more resources

Full text sources.

• Europe PubMed Central
• PubMed Central

Other Literature Sources

• scite Smart Citations

Research Materials

• NCI CPTC Antibody Characterization Program
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

•      Language Editing     For Manuscripts    For Response Letter new    For LaTeX    For Annual Review and Tenure    For Books new
•      Scientific Editing     For Manuscripts    For Response Letter new
•      Grant Editing 
•      Translation 
• Publication Support  Journal Recommendation  Manuscript Formatting  Figure Formatting  Data Analysis new  Plagiarism Check  Conference Poster  Plain Language Summary
• Scientific Illustration  Journal Cover Design  Graphical Abstract  Infographic  Custom Illustration
• Scientific Videos  Video Abstract  Explainer Video  Scientific Animation
• Ethics and Confidentiality
• Editorial Certificate
• Testimonials
• Design Gallery
• Institutional Provider
• Publisher Portal
• Brand Localization
• Journal Selector Tool
• Peer Review Status Check new
• Learning Nexus

On the Writing of Medical Review Articles

Introduction.

Medical review articles are increasingly popular and necessary. The need for review articles stems from the huge volume of scientific publications that confront researchers and clinicians. “Keeping up with literature” has become an insurmountable task for many. As the magnitude of reviews has increased, the importance of quality and reliability of the reviews also has increased. An honest review article describes its sources of information and methods of selection; clarifies the types and strength of evidence for key statements; and declares the provenance, findings and competing interests.[1]

Kinds of medical review articles

This treatise discusses only medical review articles; it does not discuss reviews in other areas of science, such as basic molecular and cellular biology. The various kinds of medical review articles include traditional clinical reviews, also known as updates; systematic reviews; and meta-analyses.[2] Non-quantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment; meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. The traditional clinical reviews are the most common kind of review and are the focus of this document. Such reviews can provide readers with powerful summaries and sound clinical guidance.[2]

Topic selection

Often, clinical review articles are requested by journals or publishers, but authors themselves may choose to write a review. In either case, the topic should be chosen with the interests and specialty of the audience foremost in mind, represent an important aspect of the field of inquiry, and focus on a well-defined issue. Some examples are: The diagnosis and management of Barrett’s esophagus; the management of hepatocellular carcinoma in hepatitis C patients; advances in the management of congestive heart failure in the elderly.

Searching the literature

The literature search should first seek evidence-based reviews (systematic reviews and meta-analyses), well-designed randomized control trials, and guidelines for the diagnosis, treatment, or prevention of the disorder being discussed. Some sources of guidelines are the Agency for Healthcare Research and Quality (AHRQ), http://www.ahrq.gov/clinic; the American College of Physicians Journal Club (ASPJC), http://acpjc.acponline.org; and the Centre for Evidence Based Medicine (CEBM), http://www.cebm.net. Ideally, research methods, investigated databases, and key words should be described in the review’s final report. Different databases are used according to the topic analyzed. In most of the clinical topics, Medline should be surveyed, but several other databases can be appropriate, such as Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Google Scholar, ISI Proceedings, JSTOR Research, Scopus, and Web of Science. [3]

In recent years, the concept of patient-oriented evidence that matters (POEM) vs. disease-oriented evidence (DOE) has emerged. POEM deals with outcomes of importance to patients, such as changes in morbidity, mortality, or quality of life. DOE deals with surrogate end points, such as changes in laboratory values or other measures of response. [2] In traditional clinical reviews, POEM-type evidence is generally preferred over DOE-type evidence because of its direct clinical relevance. In literature searching, anecdotal reports and hearsay of conventional wisdom should be avoided. [2]

Evaluating the literature

Readers will need to know the quality of evidence supporting any recommendations made through a clinical review. Various rating systems for the levels of evidence have been put forth, but none has been uniformly used. Siwek, et al.[2] use an A, B, C rating, with level A designating randomized controlled trials and meta-analyses; level B designates well-designed nonrandomized clinical trials, such as clinical cohort studies and case-controlled studies with non-biased selection of study participants; and level C designates consensus/expert opinion. Gulpinar and Guclu[3] use a descending hierarchical rating system consisting of systematic review, randomized controlled trial, non-randomized experimental study, and case series. Those authors also emphasized that an essential part of the review process is differentiating good research from bad and leaning on the results of the better studies. Authors of reviews should evaluate the quality of articles by a strategy of their choice or design.

When authors of a review cite their own work they run the risk of creating a conflict of nterest.[4] They must be cautious and objective, neither overstating nor understating the importance of their work, and they must strictly avoid self-promotion.

The discussion may address topics such as etiology, pathophysiology, clinical presentation, diagnostic evaluation, differential diagnosis, treatment goals, prognosis, and future directions.[2] The discussion should acknowledge controversies, unresolved questions, recent developments, other viewpoints, and possible conflicts of interest or bias that may have affected the strength of the evidence presented.[2]

Conclusions or summary

Whenever possible, the clinical review should contain summary recommendations based on the findings of the review. If that is not possible, the authors should explain the reason(s), such as, “The result of thorough, critical review of articles published on the subject of inquiry do not permit definitive recommendations to be made. Additional well-designed studies, with sufficient study-population size, are needed.”

Format of the review

• Introduction. Define the topic and purpose of the study.
• Methods. Indicate how the literature search was conducted and what major sources of evidence were used.
• Discussion. Cite the major achievements in the reviewed field, methodological problems, areas of debate, and questions for future research.
• Recapitulation, take-home message(s).

Reference list

The references should be selective and not exhaustive. They should emphasize evidence-based recommendations, meta-analyses, and landmark articles. They should include the most current sources of information, but older, well-substantiated, time-honored studies may be valuable inclusions. In the current age of accelerated publication of scientific papers, authors of reviews should closely follow electronic lists of papers in press, as it can take months before these appear in scientific databases.[4]

References for this treatise

1. Groves T. Fundamentals of good medical writing. bmjopen.bmj.com/site/about/resources/Fundamentals_of_Good_Medical_Writing.ppt 2. Siwek J, Gourlay ML, Slawson DC, et al. How to write an evidence-based clinical review article. Am Fam Physician. 2002 Jan 15;65(2):251-8. 3. Gülpınar Ö, Güçlü AG. How to write a review article? Turk J Urol. 2013 Sep;39(Suppl 1):44-8. 4. Pautasso M. Ten simple rules for writing a literature review. PLoS Comput Biol. 2013;9(7):e1003149.

Quick Links

• Language Editing Service
• Expert Scientific Editing Service
• Professional Translation Service
• Formatting Service
• Figure Preparation Service

Intentional Space Tag

Contact us  

Your name *

Your email *

Your message *

Please fill in all fields and provide a valid email.

© 2010-2024  ACCDON LLC 400 5 th Ave, Suite 530, Waltham, MA 02451, USA Privacy • Terms of Service

© 2010-2024 United States: ACCDON LLC Tel: 1-781-202-9968 Email: [email protected]

Address: 400 5 th Ave, Suite 530, Waltham, Massachusetts 02451, United States

• Research Process
• Manuscript Preparation
• Manuscript Review
• Publication Process
• Publication Recognition
• Language Editing Services
• Translation Services

Writing a good review article

• 3 minute read
• 87.2K views

Table of Contents

As a young researcher, you might wonder how to start writing your first review article, and the extent of the information that it should contain. A review article is a comprehensive summary of the current understanding of a specific research topic and is based on previously published research. Unlike research papers, it does not contain new results, but can propose new inferences based on the combined findings of previous research.

Types of review articles

Review articles are typically of three types: literature reviews, systematic reviews, and meta-analyses.

A literature review is a general survey of the research topic and aims to provide a reliable and unbiased account of the current understanding of the topic.

A systematic review , in contrast, is more specific and attempts to address a highly focused research question. Its presentation is more detailed, with information on the search strategy used, the eligibility criteria for inclusion of studies, the methods utilized to review the collected information, and more.

A meta-analysis is similar to a systematic review in that both are systematically conducted with a properly defined research question. However, unlike the latter, a meta-analysis compares and evaluates a defined number of similar studies. It is quantitative in nature and can help assess contrasting study findings.

Tips for writing a good review article

Here are a few practices that can make the time-consuming process of writing a review article easier:

• Define your question: Take your time to identify the research question and carefully articulate the topic of your review paper. A good review should also add something new to the field in terms of a hypothesis, inference, or conclusion. A carefully defined scientific question will give you more clarity in determining the novelty of your inferences.
• Identify credible sources: Identify relevant as well as credible studies that you can base your review on, with the help of multiple databases or search engines. It is also a good idea to conduct another search once you have finished your article to avoid missing relevant studies published during the course of your writing.
• Take notes: A literature search involves extensive reading, which can make it difficult to recall relevant information subsequently. Therefore, make notes while conducting the literature search and note down the source references. This will ensure that you have sufficient information to start with when you finally get to writing.
• Describe the title, abstract, and introduction: A good starting point to begin structuring your review is by drafting the title, abstract, and introduction. Explicitly writing down what your review aims to address in the field will help shape the rest of your article.
• Be unbiased and critical: Evaluate every piece of evidence in a critical but unbiased manner. This will help you present a proper assessment and a critical discussion in your article.
• Include a good summary: End by stating the take-home message and identify the limitations of existing studies that need to be addressed through future studies.
• Ask for feedback: Ask a colleague to provide feedback on both the content and the language or tone of your article before you submit it.
• Check your journal’s guidelines: Some journals only publish reviews, while some only publish research articles. Further, all journals clearly indicate their aims and scope. Therefore, make sure to check the appropriateness of a journal before submitting your article.

Writing review articles, especially systematic reviews or meta-analyses, can seem like a daunting task. However, Elsevier Author Services can guide you by providing useful tips on how to write an impressive review article that stands out and gets published!

What are Implications in Research?

How to write the results section of a research paper

You may also like.

Descriptive Research Design and Its Myriad Uses

Five Common Mistakes to Avoid When Writing a Biomedical Research Paper

Making Technical Writing in Environmental Engineering Accessible

To Err is Not Human: The Dangers of AI-assisted Academic Writing

When Data Speak, Listen: Importance of Data Collection and Analysis Methods

Choosing the Right Research Methodology: A Guide for Researchers

Why is data validation important in research?

Scholarly Sources: What are They and Where can You Find Them?

Input your search keywords and press Enter.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• J Minim Access Surg
• v.15(3); Jul-Sep 2019

How to write an article: An introduction to basic scientific medical writing

Anil sharma.

Department of Minimal Access, Metabolic and Bariatric Surgery, Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Healthcare Institute Ltd., Saket, New Delhi, India

An original scientific article published in a peer-reviewed professional journal of repute provides great personal satisfaction, adds stature and endows professional respectability to contributing authors. Various types of surgical publications that exist nowadays are case report, cohort study, case–control study, randomised controlled trial narrative review, systematic review, Cochrane review, meta-analysis, editorials and leading articles. A study/research protocol is a standardised document, common to all research projects that typically comprise study objectives, study design, selection of participants, study intervention, study evaluations, safety assessments, statistics and participant rights committees. Once the study protocol is completed and reviewed, it is submitted to the local Institutional Review Board/Institutional Ethics Committee for approval. An outline of the levels of evidence and grades of recommendation is available from the Centre for evidence-based medicine at the University of Oxford. A standardised, structured template exists for scientific presentations in the field of medicine which is also followed in medical writing and publications Introduction Methods Results And Discussion (IMRAD). Instructions to authors would normally include reference to International Committee of Medical Journal Editors and Committee on Publication Ethics guidelines for good and ethical publication practice. It is strongly advised to follow the recommended guidelines appropriate for the published study.

INTRODUCTION

The impact of the published article in a scientific journal of repute is powerful and protracted for as Kenneth Rothman states, ‘The written word reaches the widest audience and constitutes the archival message’. Authorship in a scientific journal implies that the authors have critically analysed and presented a scientific work of merit. ‘Reading maketh a full man, conference a ready man and writing an exact man’, (Francis Bacon). With scientific publishing, surgeons make their contributions to the profession for wide dissemination within their community and in the process create intellectual property that will be preserved down the ages. ‘The universal object of men of letters is reputation’, said John Adams.

A majority of practicing surgeons would not write and would remain engaged in busy surgical practices, bread winning and increasing administrative responsibilities. However, an increasing segment of surgeons in training and academic surgeons now feel the need to write and publish. The reasons for writing and publishing are both egoistic and altruistic.[ 1 ] Egoistic motives are the desire to progress academically and professionally, improve status and develop professional contacts. Altruistic motives are dissemination of knowledge and a moral obligation to publish a significant novel observation in the larger interest of better patient care. In several institutions, for academic appointments and promotions, the pressures to publish are sometimes inordinate. In many teaching institutions, to progress academically to whatever academic title one aspires, one's published output must constantly grow in number and quality. However, good-quality writing and publishing are not just in the domain of academic institutions. Several astute clinicians with clarity of vision from non-academic institutions have made significant contributions to surgical literature. It is imperative that contributions to surgical literature are derived from surgeons (academic and non-academic) at various locations (different continents, regions and nationalities) and workplaces (urban, semi-urban and rural). Such literature would be more relevant to the real world as opposed to surgical practice in highly sophisticated ivory towers. In the final analysis, an original scientific article published in a peer-reviewed professional journal of repute provides great personal satisfaction adds stature and endows professional respectability to contributing authors.

MANUSCRIPT TYPES

‘You don’t write because you want to say something; you write because you have something to say’, (Scot Fitzgerald). The essence of fine surgical writing is to write what you as a surgeon would want to read. Enumerated below is a list of various types of surgical publications that exist nowadays arranged in the order of increasing complexity.

• Letter/communication to the Editor

Case report

Cohort study (non-randomised, observational study), case–control study (non-randomised, observational study).

• Randomised controlled trial (RCT)

Narrative review

Systematic review and cochrane review, meta-analysis.

• Editorials and leading articles.

Letter/communication to the editor

This would be with reference to an article that has previously been published. The letter should be polite, constructive and should provide comments that offer a novel perspective of the published article. The comments should add, detract or critically review the contents of the published article in a fair and reasonable manner. The objective is to closely focus on and examine critical issues that may not have been appropriately addressed.

Many esteemed surgical writers, even journal editors, began a literary career with a time-honoured case report.[ 2 ] The humble case report would probably be the first step that an aspiring surgeon takes in surgical writing. Unfortunately, pressure of space and editorial policies directed at enhancing the impact factor of individual journals have reduced the opportunities for publication of case reports.[ 3 ]

The cohort study, case–control study and RCT constitute ‘original articles’ in surgical publications. The narrative review, systematic review and meta-analysis are ‘review articles’.

A cohort study is when patients are followed forward and assessed from time of exposure until time of consequences of exposure (target outcome). An example is ‘initial experience with single incision laparoscopic cholecystectomy.’

A case–control study is when patients are selected once they have the target outcome or not and researchers look backward to try to determine the factors of exposure. An example is ‘bile duct injury with single incision laparoscopic cholecystectomy.’

Randomised controlled trial

An RCT is performed when investigators want to assess treatment effects, usually considered to be beneficial. An example is ‘an RCT comparing recurrence rates between laparoscopic hernioplasty and Shouldice repair for groin hernias’.

A cohort study is feasible when randomisation of exposure is not possible. A case–control study overcomes temporal delays and may only require small sample size. However, both these studies are susceptible to bias and therefore have limited validity. The advantage of an RCT is that it provides the highest level of evidence. It is therefore useful to disprove efficacy which is important in the present era of technology-driven surgery. There is immense pressure from the manufacturers to use devices and procedures, many of which may not measure up to the scientific scrutiny of a well-conducted RCT. The design and execution of an RCT in surgery, however, is fraught with several difficulties and challenges. The nature of treatment by surgical intervention may lead to ethical issues that make design of the study difficult. Moreover, surgical skills and competence may vary from one hospital and surgeon to another making comparison odious. In most surgical studies, blinding of procedure from assessor is very difficult, and therefore, bias is inevitable.

A narrative review is usually written by invitation to an expert. The expert objectively reviews the subject in a concise and impartial manner. He/she addresses new developments and summarises recent literature. A narrative review leaves an imprint of the approach and thought process of the expert on the subject.

A systematic review involves more rigorous compilation of evidence. A systematic review is designed to present complete and unbiased evidence on the subject that presently exists in the literature. Strict adherence to follow and complete all components of a clearly defined protocol is mandatory.

A meta-analysis is a type of systematic review that uses statistical methods to combine and summarise the results of clinical trials. A meta-analysis must always include a formal examination of heterogeneity as an indicator of similar or divergent results.

Editorials and leading articles

These are usually written by invitation on a specific research area. The opinion and judgement of the editor do not only be based on review of literature but also carry the imprimatur of his/her personal beliefs and experience.

EVIDENCE-BASED MEDICINE

We live in an era of evidence-based medicine where increasingly an evidence-based approach to surgical practice would dictate the refining of systems and processes of patient care. Evidence-based practice is the, explicit and judicious use of the current best evidence in making decisions about the care of individual patients’.[ 4 ] An outline of the levels of evidence and grades of recommendation is available from the Centre for evidence-based medicine at the University of Oxford[ 5 , 6 ] Table 1 describes the levels of evidence for therapeutic studies.[ 7 ]

Levels of evidence for therapeutic studies

CONSTRUCTING THE MANUSCRIPT

‘If you can’t explain it simply, you don’t understand it well enough’, (Albert Einstein).

At the outset, formulation of the study/research protocol is required. The study/research protocol is a standardised document, common to all research projects that should be available in teaching institutions. The protocol template typically comprises the following.

• Study objectives
• Study design
• Selection of participants
• Study intervention
• Study evaluations
• Safety assessments
• Participant rights
• Committees.

Once the study protocol is completed and reviewed, it is submitted to the local Institutional Review Board (IRB)/Institutional Ethics Committee (IEC) for approval. Written consent is obtained and the study is registered at the Clinical Trial Registry of India at www.ctri.in .

‘If you don’t know where you are going, you will end up someplace else’, (Yogi Berra).

A standardised, structured template exists for scientific presentations in the field of medicine, and this is also followed in Medical writing and publications Introduction Methods Results And Discussion (IMRAD).

• Introduction: Why did we start?
• Methods: What did we do?
• Results: What did we find?
• Discussion: Hence, what does it mean?

Enumerated below are the constituent segments and contents therein in an original article of a scientific medical manuscript.

Introduction (two paragraphs)

The Introduction commences with a brief lesson on the subject as described in literature. Current knowledge, insights and recent developments on the subject are briefly stated. A lacuna or gap in knowledge or incomplete information on some aspect of the subject forms the basis and reason to perform the present research/study. The last line in the Introduction section normally reads ‘The aim of this study was…’, ‘We report… or ‘We reviewed…’.

Methods (seven paragraphs)

The Methods section narrates the story of what the authors did. The narration is arranged in a logical framework of time. A logical sequence for presentation is ethical approval, patient selection, surgical intervention, outcome assessments and statistical methods employed.

Results (six paragraphs)

The Results Section is an overall description of the major findings of the study. The Results section presents measurements and data on all stated end-points (primary and secondary) of the study. Data presentation should be clear and concise.

Discussion (seven paragraphs)

The Discussion section summarises the article and presents a perspective of the message in the article. The first paragraph provides a summary of the main aim, methods and results of the study. The last paragraph provides a tentative answer to the research question posed in the study and also a suggestion for future research in a related area of the study. The limitations of the present study are discussed (e.g. nature of study, numbers of patients and limited follow-up). The strengths of the present study, if any, may be enumerated. Similar studies in the literature are discussed and how the present study fits in is analysed. The implications of the present study are discussed in terms of future research, change in patient management policies and suggested amendments to clinical practice.

The title should be descriptive yet concise while conveying the essential features of the contents of the article. The title should contain words that will make the article accessible to workers in the field. Clarity, brevity and above all human interest are the hallmarks of a good title.

Titles and abstracts are freely available to browse across a wide array of databases on the Internet. An attractive title and a concise abstract serve to attract the attention of readers. The abstract serves as a stand-alone summary that describes the major contents and message of the article. The abstract is structured (IMRAD) with a strict word limit. It serves as a quick reference and shortcut for busy researchers.

Keywords are short phrases that capture the main topics of the article. These follow the abstract in the article. Keywords assist in cross-indexing and literature search.

Most journal editors subscribe to guidance from the International Committee of Medical Journal Editors (ICMJE)[ 8 ] also known as the Vancouver group. Contributors who meet all four of the below-mentioned criteria qualify for authorship.

• Substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data for the work
• Drafting the work or revising it critically for important intellectual content
• Final approval of the version to be published
• Agreement to be accountable for all aspects of the work.

Acknowledgements

Those whose contributions do not justify authorship may be acknowledged and their contributions should be specified (e.g., ‘served as scientific advisors’, ‘critically reviewed the study proposal’, ‘collected data’, ‘provided and cared for study patients’ and ‘participated in writing or technical editing of the manuscript’).[ 8 ]

Conflict of interest

The ICMJE states that ‘a conflict of interest exists when professional judgement concerning a primary interest (such as patient's welfare or the validity of research) may be influenced by a secondary interest (such as financial gain)’. Public trust in the scientific process and the credibility of published articles depend in part on how transparently conflicts of interest are handled during the planning, implementation, writing, peer review, editing and publication of scientific work. Financial relationships (such as employment, consultancies, stock ownership or options, honoraria, patents and paid expert testimony) are the most easily identifiable conflicts of interest and the most likely to undermine the credibility of the journal, the authors, and science itself.[ 8 ]

A reference to articles serves to guide readers to a connected body of literature. Conference abstracts should not be used as references. They can be cited in the text, in parentheses, but not as page footnotes. References to papers accepted but not yet published should be designated as ‘in press’ or ‘forthcoming’. Information from manuscripts submitted but not accepted should be cited in the text as ‘unpublished observations’ with written permission from the source. Avoid citing a ‘personal communication’ unless it provides essential information not available from a public source, in which case the name of the person and date of communication should be cited in parentheses in the text.[ 8 ]

INSTRUCTIONS TO AUTHORS

It is mandatory to read and follow ‘Instructions to Authors’ provided by the journal where the manuscript is being sent for evaluation. Journals require electronic submission of manuscripts through specially designed editorial software (e.g. edition manager, manuscript central). The instructions provide detailed submission guidelines to Authors for submission of manuscripts. Instructions would normally include reference to ICMJE what an editor expects…pg 1124[ 9 ] and Committee on Publication Ethics (COPE) Guidelines[ 10 ] for good and ethical publication practice.

REPORTING GUIDELINES

It is strongly advised to follow recommended guidelines appropriate for the published study. These guidelines set international standards for reporting different types of research studies. A good checklist is provided for preparing the publication. The guidelines standardise trial design, facilitate accurate reporting and correct interpretation of results [ Table 2 ].[ 11 ]

Reporting guidelines for main study types

ROLE OF BIOSTATISTICIAN

The biostatistician provides invaluable input, advice and suggestions in construction of the manuscript. He/she should be consulted right from the concept and planning stage. He/she assists in protocol development with study design and study evaluations. He/she plans data management by confirming assessment of data on primary and secondary end-points of the study. He/she supervises data collection, archival and analysis. He/she implements and monitors the study on a periodic basis to its conclusion. Finally, the biostatistician assists with reporting results during writing of the manuscript.

DATA MANAGEMENT

Data management is the strategy used for collecting, organising and analysing data. The ultimate aim of conducting a study is to generate data to provide answers to the research question. The quality of data generated plays an important role in the outcome of the study. It follows that if primary data collection and entry are not considerate and meticulous, subsequent data analysis for outcome measures would not be satisfactory. Data need to be ultimately stored in electronic data capturing systems for ease of data management and analysis.

Several data analysis software systems are available that provide statistical results when data are fed into then in a predetermined format (Analyse-it, SPSS, WINKS SDA, Stata, Vitalnet).

WRITING STYLE

An effective writing style is easy to read and simple to understand. The connoisseur writer filters out unnecessary details and distills the essence of his/her communication in the manuscript. A short manuscript presented clear and lucidly is the most effective. Simple sentences in straightforward language convey the most information. A short sentence is easier to read and comprehend than a long rambling one, short, simple and familiar words are more reader-friendly than longer complicated phrases (replace ‘illustrate’ with ‘show’, ‘fundamental’ with ‘basic’ and ‘remainder’ with ‘rest’). A spell check and grammar check are mandatory after completing the manuscript.

New information is provided in a new paragraph. The main point appears at the start and should be clear, succinct and easy to find. The author consciously needs to avoid elitism/triumphalism in the article (the first report, the only study, the largest cohort). Exclamation and quotation marks are avoided in a formal medical manuscript. Proper punctuation marks such as full stops and commas are mandatory.

Text verbatim (copy and paste) from a previously published article or book must be marked as reference source. The author needs to follow the reference style required for submission to the journal. The Vancouver system[ 12 ] is the most commonly used. Abbreviations (INR – international normalised ratio, PT – prothrombin time) and acronyms (IMV – inferior mesenteric vein) should always be defined the first time they are used in the text. Abbreviations are useful to avoid unnecessary and frequent use of long phrases in the text. However, their use should be restricted in the text and never used in the title and abstract. In figures, abbreviations need to be explained in the legend and for tables in the footnote.

Tables and figures must be sufficiently clear, well labelled and interpretable without having to refer to the text. These should be placed in the text as near as possible to the place where they are referred to. Tables should not be used when data can be summarised in text (e.g. population sizes, sex ratios) or where data are better represented in graphs and figures. The legend carries descriptive information on the tables and figures to make them understandable as stand-alone segments. Table legends are placed above the body of the table, and figure legends are placed below the figures. Footnotes in a table explain abbreviations and P values.

PUBLICATION ETHICS

The COPE was founded in 1997 as a voluntary body to attempt to define best practice in the ethics of scientific publishing. The COPE guidelines on good publication practice are useful for authors, editors, editorial board members, readers, owners of journals and publishers. They address study design and ethical approval, data analysis, authorship, conflicts of interest, peer-review process, redundant publication, plagiarism, duties of editors, media relations, advertising and how to deal with misconduct.

• Study design and ethical approval: Good research should be well justified, well planned appropriately designed and ethically approved. To conduct research to a lower standard may constitute misconduct
• Data analysis: Data should be appropriately analysed, but inappropriate analysis does not necessarily amount to misconduct. Fabrication and falsification of data do constitute misconduct
• Authorship: There is no universally agreed definition of authorship although attempts have been made. As a minimum, authors should take responsibility for a particular section of the study

They may be personal, commercial, political, academic or financial. ‘Financial’ interests may include employment, research funding, stock or share ownership, payment for lectures or travel, consultancies and company support for staff

• Peer review: Peer reviewers are external experts chosen by editors to provide written opinions, with the aim of improving the study. Working methods vary from journal to journal, but some use open procedure in which the name of the reviewer is disclosed, together with the full or ‘edited’ report
• Redundant publication: Redundant publication occurs when two or more papers, without full cross-references, share the same hypothesis, data, discussion points, or conclusions
• Plagiarism: Plagiarism ranges from the unreferenced use of others published and unpublished ideas, including research grant applications to submission under ‘new’ authorship of a complete paper, something in a different language. It may occur at any stage of planning, research writing or publication: It applies to print and electronic versions
• Duties of editors: Editors are stewards of journals. They usually take over their journal from the previous editor(s) and always want to hand over the journal in good shape. Most editors provide direction for the journal and build a strong management team. They must consider and balance the interests of many constituents, including readers, authors, staff, owners, editorial board members, advertisers and the media
• Media relations: Medical research findings are of increasing interest to the print and broadcast media. Journalists may attend scientific meetings at which preliminary research findings are presented, leading to their premature publication in the mass media
• Advertising: Many scientific journals and meetings derive significant income from advertising. Reprints may also be lucrative.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

• The Chestertown Spy
• Advertising Terms & Conditions
• Editors & Writers
• Dedication & Acknowledgements
• Code of Ethics
• Chestertown Spy Terms of Service
• Technical FAQ
• The Arts and Design
• Local Life and Culture
• Community Opinion
• Donate to the Chestertown Spy
• Free Subscription
• Cambridge Spy
• Support the Spy
• About Spy Community Media
• Advertising with the Spy

Chestertown Spy

Nonpartisan and Education-based News for Chestertown

It’s a Go: Final Regulatory Hurdle Passed for New Shore Regional Medical Center

July 11, 2024 by Spy Desk Leave a Comment

Today, the Maryland Health Services Cost Review Commission (HSCRC) unanimously approved the rate application request from University of Maryland Shore Regional Health (UM SRH), a member organization of the University of Maryland Medical System (UMMS), for the new Shore Regional Medical Center in Easton. HSCRC’s approval helps offset interest and depreciation for the construction of the new facility and represents the final step needed for site preparation work to begin at 10000 Longwoods Road later this month

“We are incredibly excited and grateful for what this new hospital means for residents of the region,” said Ken Kozel, UM SRH President and CEO. “This marks the largest healthcare project in the history of UM SRH and one of the largest projects ever for the Mid-Shore region.”

 “This is a historic day for healthcare delivery and improving rural health care on the Eastern Shore,” said Mohan Suntha, MD, MBA, President and CEO of UMMS. “UMMS and UM SRH have been at the forefront of providing health care access points with over $150 million invested during the last decade across the Mid-Shore’s five counties, The new regional medical center in Easton will serve as a health care hub to meet the needs of residents across the region

Late in 2023, the Easton Planning Commission approved sketch plans for the new hospital and within the past year, UM SRH received approval for the project’s Certificate of Need (CON) and approvals from the UM SRH board and the UMMS board. “The HSCRC’s rate approval is the last part of the regulatory approval process, and we are thrilled that our vision of expanding access to high-quality care in a modern facility is now coming to fruition,” Kozel added.

The next phase of the project involves several pre-construction activities, including working with the Maryland State Highway Administration to relocate Route 662, site preparation that will include the arrival of heavy equipment to level and grade the field, and other approvals for the 230+ acre site

Groundbreaking for the new UM Shore Regional Medical Center is anticipated in the summer of 2025, with construction of the hospital anticipated to be completed at the end of summer 2028. The $540 million estimated cost of the project will be covered by bonds and cash flow, state funding, public and private philanthropy, and federal grants.

“In our enthusiasm for achieving this latest milestone, we are eternally grateful for the longstanding support and engagement of our state and county elected officials, UMMS board members and executive leadership, the UM Memorial Hospital Foundation board, and our partners in the project — Covalus, HKS, Whiting-Turner, the legal team from GEJ, and the many UM SRH team members involved in the regulatory applications and the design and pre-construction phases,” said Kozel. “This has been and will continue to be a strong collaboration between health care professionals, government and civic leaders and the stakeholders throughout our five counties for whom access to quality health care in our region is an important priority.”

The Spy Newspapers may periodically employ the assistance of artificial intelligence (AI) to enhance the clarity and accuracy of our content.

Write a Letter to the Editor on this Article

We encourage readers to offer their point of view on this article by submitting the following form. editing is sometimes necessary and is done at the discretion of the editorial staff., leave a reply cancel reply.

Your email address will not be published. Required fields are marked *

Full Name *

Save my name, email, and website in this browser for the next time I comment.

Make a Donation Maybe later