Structure for writing an effective clinical review articles

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.   

Article Type	Description	Abstract Structure	Abstract Word count	Article Structure	Article Word count
Full length Articles	Original research and/or clinical studies. Please note, as described in the instructions for authors, papers with only present data specific to a particular geographical area or country which are not novel or surprising from a worldwide perspective, are unlikely to be published.	–Background -objectives -study design -Results -Conclusions	250	–Background -objectives -study design -Results -Discussion (Acknowledgement)COI	2500
Short communication	Original research and/or clinical studies that do not require a full paper, but are completed studies, may be submitted as Short Communications. These papers may detail a smaller number of observations or may include a smaller number of patients. They may also add a small amount of new information but which is still considered important.	-Background  -Objectives -Study design  –Results  -Conclusions	250	-Background -Objectives -Study design -Results  -Discussion (acknowledgements) COI	1250
Case Reports	Short articles of a clinical nature which illuminate an underlying principle of a disease state, its diagnosis, or its therapy			-Why this case is important -Case description -Other similar and contrasting cases in the literature  -Discussion and references	1500
My Favourite Assay	This offers an opportunity for researchers to present an assay that they have developed and that they feel would be useful for others			-Reasons for developing the assay -Methods used in designing the assay  -Protocol -Validation data	500
Letters to the Editor	Comments on previously published articles or any other items of interest to clinical virologists				500
Guidelines and clinical algorithms	Documents that have been locally or internationally approved and contain general principles that may benefit others in their clinical practice or in writing their own algorithms or guidelines				No limited
Commentaries and points of view	Please contact one of the Editors -in -Chief to check on the suitability of your topic				750
Review articles	Reviews should give a succinct overview of a particular topic. Please contact one of the Editors in-Chief to check on the suitability of your topic	Unstructured abstract	250		3000
Meeting reports, News &Announcements: – Meeting reports	Summary of a relevant symposium, workshop, etc.				1500
VIROQAS	This should be a clinical case that presents a diagnostic dilemma that will impart an important learning point			– Part I: Case presentation. Questions for readers at end (bold) – Part II: Evidence-based opinion. Each subsection starts with question from Part I – Page break between Part I and II	1250

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)
• List of authors: Declare intellectual ownership of the work, provide contact
  information: Author name &affiliations
  • 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
• Tense: Present
  • 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.

• Journal of Clinical
  chemistry reviews require a structured abstract with subheadings
  background, content, and summary
  • 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

E.g.

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

E.g.

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.

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