Title, Authors, and Abstract

REVIEW CRITERIA The title is clear and informative. The title is representative of the content and breadth of the study (not misleading). The title captures the importance of the study and the attention of the reader. The number of authors appears to be appropriate given the study. The abstract is complete (thorough); essential details are presented. The results in the abstract are presented in sufficient and specific detail. The conclusions in the abstract are justified by the information in the abstract and the text. There are no inconsistencies in detail between the abstract and the text. All of the information in the abstract is present in the text. The abstract overall is congruent with the text; the abstract gives the same impression as the text. ISSUES AND EXAMPLES RELATED TO THE CRITERIA When a manuscript arrives, the reviewer immediately sees the title and the abstract, and in some instances—depending on the policy of the journal—the name of the authors. This triad of title, authors, and abstract is both the beginning and the end of the review process. It orients the reviewer, but it can be fully judged only after the manuscript is analyzed thoroughly. Title The title can be viewed as the shortest possible abstract. Consequently, it needs to be clear and concise while accurately reflecting the content and breadth of the study. As one of the first “outside” readers of the manuscript, the reviewer can judge if the title is too general or misleading, whether it lends appropriate importance to the study, and if it grabs the reader's attention. The title of an article must have appeal because it prompts the reader's decision to study the report. A clear and informative title orients the readers and reviewers to relevant information. Huth1 describes two key qualities of titles, “indicative” and “informative.” The indicative aspect of the title tells the reader about the nature of the study, while the informative aspect presents the message derived from the study results. To illustrate, consider the following title: “A Survey of Academic Advancement in Divisions of General Internal Medicine.” This title tells the readers what was done (i.e., it is indicative) but fails to convey a message (i.e., it is not informative). A more informative title would read “A Survey of Academic Advancement in Divisions of General Internal Medicine: Slower Rate and More Barriers for Women.” The subtitle now conveys the message while still being concise. Authorship Reviewers are not responsible for setting criteria for authorship. This is a responsibility of editors and their editorial boards. When authors are revealed to the reviewer, however, the reviewer can help detect possible “authorship inflation” (too many authors) or “ghost authors” (too few true authors). The Uniform Requirements for Manuscripts Submitted to Biomedical Journals2 covers a broad range of issues and contains perhaps the most influential single definition of authorship, which is that Each author should have participated sufficiently in the work to take public responsibility for the content. Authorship credit should be based only on substantial contributions to (a) conception and design, or analysis and interpretation of data; and to (b) drafting the article or revising it critically for important intellectual content; and on (c) final approval of the version to be published. Conditions (a), (b), and (c) must all be met. Furthermore, “Any part of an article critical to its main conclusions must be the responsibility of at least one author,” that is, a manuscript should not contain any statement or content for which none of the authors can take responsibility. More than 500 biomedical journals have voluntarily allied themselves with the Uniform Requirements standards, although not all of them accept this strict definition of authorship. Instead, they use different numbers of authors and/or combinations of the conditions for their definitions. Also, different research communities have different traditions of authorship, some of which run counter to the Uniform Requirements definition. The number of authors per manuscript has increased steadily over the years, both in medical education and in clinical research. Dimitroff and Davis report that the number of articles with four or more authors in medical education is increasing faster than the number of papers with fewer authors.3 Comparing numbers in 1975 with those in 1998, Drenth found that the mean number of authors of original articles in the British Medical Journal steadily increased from 3.21 (SD = 1.89) to 4.46 (SD = 2.04), a 1.4-fold jump.4 While having more authors is likely to be an indication of the increased number of people involved in research activities, it could also signal inflation in the number of authors to build team members' curricula vitae for promotion. From an editorial standpoint, this is “unauthorized” authorship. More and more journals are publishing their specific criteria for authorship to help authors decide who should be included in the list of authors. Some journals also require each author to complete and sign a statement of authorship indicating their significant contributions to the manuscript. For example, the Annals of Internal Medicine offers a list of contribution codes that range from conception and design of the study to obtaining funds or collecting and assembling data, as well as a space for “other contributions.” The contribution codes and signed statement are a sound reminder and acknowledgement for authors and a means for editors to judge eligibility of authorship. Huth argues that certain conditions alone do not justify authorship. These conditions include acquiring funds, collecting data, administering the project, or proofreading or editing manuscript drafts for style and presentation, not ideas.5,6 Under these conditions, doing data processing without statistical conceptualization is insufficient to qualify for authorship. Such contributions can be recognized in a footnote or in an acknowledgement. Other limited or indirect contributions include providing subjects, participating in a pilot study, or providing materials or research space.7 Finally, some so-called “contributions” are honorary, such as crediting department chairpersons, division chiefs, laboratory directors, or senior faculty members for pro forma involvement in creative work.8 Conversely, no person involved significantly in the study should be omitted as an author. Flanagin et al.8 found that 11% of articles in three large-circulation general medicine journals in 1996 had “ghost authors,” individuals who were not named as authors but who had contributed substantially to the work. A reviewer may suspect ghost authorship when reviewing a single-authored manuscript reporting a complex study. When authors' names are revealed on a manuscript, reviewers should indicate to the editor any suspicion about there being too many or too few authors. Abstracts Medical journals began to include abstracts with articles in the late 1960s. Twenty years later an ad hoc working group proposed “more informative abstracts” (MIAs) based on published criteria for the critical appraisal of the medical literature.9 The goals of the MIAs were threefold: “(1) assist readers to select appropriate articles more quickly, (2) allow more precise computerized literature searches, and (3) facilitate peer review before publication.” The group proposed a 250-word, seven-part abstract written in point form (versus narrative). The original seven parts were soon increased to eight10,11: objective (the exact question(s) addressed by the article), design (the basic design of the study), setting (the location and level of clinical care or education), patients or participants (the manner of selection and numbers of patients or participants who entered and completed the study), interventions (the exact treatment or intervention, if any), main outcome measures (the primary study outcome measure), results (key findings), and conclusions (key conclusions including direct clinical or educational applications). The working group's proposal was published in the Annals of Internal Medicine and was called by Annals editor Edward Huth the “structured abstract.”12 Most of the world's leading clinical journals followed suit. Journal editors anticipated that giving reviewers a clear summary of salient features of a manuscript as they begin their review would facilitate the review process. The structured abstract provides the reviewer with an immediate and overall sense of the reported study right from the start of the review process. The “big picture” offered by the structured abstract helps reviewers frame their analysis. The notion of MIAs, or structured abstracts, was soon extended to include review articles.13 The proposed format of the structured abstract for review articles contained six parts: purpose (the primary objective of the review article), data identification (a succinct summary of data sources), study selection (the number of studies selected for review and how they were chosen), data extraction (the type of guidelines used for abstracting data and how they were applied), results of data synthesis (the methods of data analysis and key results), and conclusions (key conclusions, including potential applications and research needs). While there is evidence that MIAs do provide more information,14,15 some investigators found that substantial amounts of information expected in the abstract was still missing even when that information was present in the text.16 A study by Pitkin and Branagan showed that specific instructions to authors about three types of common defects in abstracts—inconsistencies between abstract and text, information present in the abstract but not in the text, and conclusions not justified by the information in the abstract —were ineffective in lowering the rate of defects.17 Thus reviewers must be especially attentive to such defects.