Introduction

From Wikipedia

Contents 1 Significance 2 Information gap 3 Literature review in support of information gap 4 Objective and hypotheses

Significance

The first paragraph should state why the topic to be treated in the paper is important. This statement has to convince readers that they should keep on reading the manuscript since it is highly relevant.

• DIVERTICULAR DISEASE is one of the most common disorders of the colon in elderly persons in Western countries. In North America, about one third of the people older than 45 years and two thirds of all persons older than 85 years have diverticular disease,1-2 which leads to approximately 200 000 hospitalizations in the United States per year.3 (Guller, 2003)

• Disabling back pain is common.Back pain is one of the most frequent reasons that patients visit primary care physicians and is the second most common reason for time taken off from work (Carey, 1995).

• The world epidemic of overweight (body mass index [BMI], calculated as weight in kilograms divided by the square of the height in meters, ≥25) and obesity (BMI ≥30) is estimated to encompass about 1.7 billion individuals, and the percentage of overweight adults is highest in the United States. Approximately two thirds of individuals living in the United States are overweight, and of those, almost half are obese. The BMI subgroups experiencing the most rapid growth are 35 or higher (23 million) and 40 or higher (8 million) (Buchwald, 2004).

• In a very important sense, the cholesterol "controversy" is no more. A spate of recent clinical trials using 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) to lower low-density lipoprotein cholesterol (LDL-C) have demonstrated beyond reasonable doubt that coronary events, both morbid and mortal, can be prevented. Post hoc analyses of these trials also strongly suggest that stroke rates may be reduced to about the same degree. Observational epidemiology has not identified hypercholesterolemia as a major risk factor for stroke,9 although these data did not distinguish hemorrhage from atherothrombotic stroke(LaRosa, 1999).

Information gap

This section should state that, despite being relevant as made clear in the previous section, there is an important information gap in the field. It will be clear in the last section of the introduction that this gap is not any gap, but the gap that will be evaluated by this article. In other words, this section should sell the idea of the importance of your paper to the reader.

• In 1991, Fowler and White6 performed one of the earliest laparoscopic sigmoid resections (LSRs). More than a decade later, however, the benefits of LSR are still controversial. (Guller, 2003)

• In the United States, estimates of direct medical costs attributable to back pain are as high as $25 billion annually. Patients with acute low back pain can choose among several types of health care providers. (this indirectly states that in spite of total cost being $25billion and patients visiting various healthcare providers, it is not clear which one is expensive/cheap and helps in relieving back pain) (Carey, 1995).

• There are currently no truly effective pharmaceutical agents to treat obesity, especially morbid obesity.14-15 In 1991, the National Institutes of Health established guidelines for the surgical therapy of morbid obesity (BMI ≥40 or BMI ≥35 in the presence of significant comorbidities), now referred to as bariatric surgery (Buchwald, 2004).

• Most subjects in these studies have been middle-aged men. This led to the suggestion that while elevated LDL-C is a risk factor in women as well as in men and in older as well as in middle-aged individuals, the data from these trials cannot be extrapolated to groups other than middle-aged men. It has been further suggested that, in the absence of such sex- and age-specific data, cholesterol screening is optional except in middle-aged men. This has encouraged some insurers, including Medicare, to refuse funding for cholesterol screening in older individuals. While it is difficult to prove, lack of support even for screening may contribute to the rather poor frequency of prescription of cholesterol-lowering regimens even for women with established coronary disease (LaRosa, 1999).

Literature review in support of information gap

This section reviews the literature on the gap border while pointing to information gap in our current knowledge that will be solved by your paper. Notice that the role of this section is not to review all the knowledge in the field -- that is left for review articles. Instead, the role of this section is to provide readers with the background information necessary to understand the article while constantly emphasizing that no previous article has evaluated the issue that this article will approach. Because the gap is a place where no previous information exists, novice researchers tend to make two mistakes. First, review the literature surrounding the gap while focusing on that literature. For example, if there is no information on laparoscopic appendectomy in the elderly, they will focus on laparoscopic appendectomy in general. This is wrong. The review on laparoscopic appendectomy should focus on reviewing the field in order to point to the gap. Second common mistake is to attempt to run a literature search focusing only on the gap. Although a search attempting to find information on the gap should certainly be the first step, researchers should not find anything on the gap, otherwise it would not be a gap. A gap, by definition, is an area where no previous information is available. In summary, the literature search to support the existence of the gap is a search focused on the surroundings of the gap, while focusing on making that gap evident to the reader. In other words, search for the gap and expect to find nothing, and then start expanding your search to the surroundings of the gap until you find some literature (Figure). Then review that surrounding literature criticizing it for not having yet approached the gap.

• More than 2 decades later, the benefits of LA remain unclear. Most importantly, it is greatly debated whether LA is indicated in elderly patients. In a recent investigation, we provided suggestive evidence that LA has advantages over OA with respect to postoperative morbidity, length of hospital stay, and rate of routine discharge. [8.] The number of events in this patient sample, however, was too small to perform stratified analyses by age. [9. and 10.] (Guller, 2004)

• They may initially visit primary care practitioners, chiropractors, or specialists such as orthopedic surgeons. Care from doctors of chiropractic emphasizes spinal manipulation, which has been shown to be effective in several randomized trials (indirectly these lines point towards the literature supporting info lag by pointing that though patients may visit these healthcare providers and also that earlier studies have revealed doctors and chiropractors to be effective in delivering the care; no study has evaluated the comparative costs and effective care for these various healthcare providers) (Carey, 1995).

• The literature on postoperative weight loss and the problems associated with various bariatric surgical procedures is extensive and has been summarized elsewhere. The literature with respect to comorbidity outcomes of bariatric surgery is also extensive, but has not been systematically reviewed and subjected to meta-analysis (Buchwald, 2004).

• With 1 exception, the major statin cholesterol-lowering trials with clinical event end points have included women and those aged 65 years or older. All have reported similar effects in women vs men and in younger vs older subjects. Two trials have issued expanded reports of their findings (LaRosa, 1999).

Objective and hypotheses

The last section concludes the introduction by stating the main objective of the paper and respective hypotheses. Of importance, the objective fills the information gap previously stated in the second section of the introduction.

• The goal of this investigation was to compare the effectiveness of LSR with OSR in the overall population with diverticular disease, as well as in elderly and nonelectively admitted patients. (Guller, 2003)

• We performed a study to determine the outcomes among patients with acute low back pain seeking care from a variety of practitioners. Specifically, we wanted to determine whether outcomes and charges vary according to the type of provider initially seen for an episode of acute low back pain. (Carey, 1995).

• We have conducted a systematic review of published observational and interventional trials that focus on bariatric surgery. The subsequent meta-analysis has concentrated on the impact of bariatric surgery on 4 selected obesity comorbidities: diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea (Buchwald, 2004).

• Meta-analysis of these studies can provide a more accurate and precise estimate of subgroup effects than can be derived from individual trials. It also provides the opportunity to examine, in the aggregate, the effect of statin-induced cholesterol lowering in men and women across a wide age spectrum (LaRosa, 1999).