Explanation & Elaboration

2. Abstract

• Summarizes precisely all key information from various sections of the text using the abstract format of the intended publication

Example

(a)  "Background: Inadequate blood pressure control is a persistent gap in quality care.

Objective: To evaluate provider and patient interventions to improve blood pressure control.

Design: Cluster randomized, controlled trial.

Setting: 2 hospital-based and 8 community-based clinics in the Veterans Affairs Tennessee Valley Healthcare System.

Patients: 1341 veterans with essential hypertension cared for by 182 providers. Eligible patients had 2 or more blood pressure measurements greater than 140/90 mm Hg in a 6-month period and were taking a single antihypertensive agent.

Intervention: Providers who cared for eligible patients were randomly assigned to receive an e-mail with a Web-based link to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines (provider education); provider education and a patient-specific hypertension computerized alert (provider education and alert); or provider education, hypertension alert, and patient education, in which patients were sent a letter advocating drug adherence, lifestyle modification, and conversations with providers (patient education).

Measurements: Proportion of patients with a systolic blood pressure less than 140 mm Hg at 6 months; intensification of antihypertensive medication.

Results: Mean baseline blood pressure was 157/83 mm Hg with no differences between groups (P _ 0.105). Six-month follow-up data were available for 975 patients (73%). Patients of providers who were randomly assigned to the patient education group had better blood pressure control (138/75 mm Hg) than those in the provider education and alert or provider education alone groups (146/76 mm Hg and 145/78 mm Hg, respectively). More patients in the patient education group had a systolic blood pressure of 140 mm Hg or less compared with those in the provider education or provider education and alert groups (adjusted relative risk for the patient education group compared with the provider education alone group, 1.31 [95% CI, 1.06 to 1.62]; P _ 0.012).

Limitations: Follow-up blood pressure measurements were missing for 27% of study patients. The study could not detect a mechanism by which patient education improved blood pressure control.

Conclusions: A multifactorial intervention including patient education improved blood pressure control compared with provider education alone." [15]

Example

(b) "Background: Performing a lumbar puncture in an unwell child can cause anxiety in both the parent and the junior doctor. There is increasing evidence of post-lumbar-puncture complications in this age group.

Aims: To improve the documentation, consent for and technical performance of paediatric lumbar punctures to 100% of the required standard within 3 months.

Setting: The paediatric emergency department of a the Royal North Shore Hospital (University of Sydney, Sydney, Australia).

Participants: Paediatric emergency staff, including residents, registrars and consultants.

Methods: Medical records of 40 consecutive children who had undergone a lumbar puncture in the 6 months before the introduction of the lumbar-puncture proforma were reviewed. After introduction of the proforma, the records of 25 consecutive patients were reviewed to assess changes in the outcome measures. Before introduction of the proforma, junior medical staff were instructed in the procedure using specialised lumbar puncture manikins (Baby Stap; Laerdel, USA).

Results: Before introduction of the proforma, the median number of documented indicators was 4, out of a maximum of 12. There was almost no documentation of parental consent, patient complications and analgesia. Introduction of the proforma resulted in a highly marked increase to a median of 12 documented indicators per patient (p<0.01, 95% confidence interval 6 to 8).

Conclusions: The introduction of a lumbar-puncture proforma and formal teaching sessions using a paediatric manikin led to a marked improvement in the documentation of paediatric lumbar-punctures. Lumbar-punctures can be performed only by accredited medical officers who have achieved competency on the lumbar-puncture teaching manikin." [16]

Elaboration

The purpose of an abstract is to summarize the essentials of the work that was done, so readers can decide whether it is relevant to their practice or research. Abstracts are the only information included in electronic search databases such as Medline. Moreover, many readers never venture beyond the abstract; in fact, readers often start reading the abstract by reading the "bottom line," that is, the conclusions section, and read the rest only if that catches their interest. For these reasons, the abstract - particularly the conclusions section - must be clear, succinct, and accurate. To assist readers in locating articles that are of interest to them, abstracts should contain key words that allow librarians to accurately classify the work into searchable categories.

Different journals have different requirements, so the above examples illustrate how the critical elements can be effectively incorporated into the abstract. Despite format differences, both abstracts clearly indicate that the paper reports the results of a quality improvement project.15, 16 The aim and/or primary objective of the project is clearly stated as well as the existing quality gap. A brief description of the setting and participants is also provided. The methods section describes the initial strategy for improvement while the results describe the impact of the changes. The evolution of the intervention may be difficult to convey in the limited space of an abstract, but should at least be mentioned if possible. The conclusion summarizes the project and describes the "generalizable" lessons learned. Both of these abstracts are clearly written, so the reader is able to evaluate the contents of the entire manuscript quickly and intelligently.

References

15. Roumie CL, Elasy TA, Greevy R, et al. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial. Annals of Internal Medicine. 2006;145(3):165-175.
16. Taitz J, Wyeth B, Lennon R, et al. Effect of the introduction of lumbar-puncture sticker and teaching manikin on junior staff documentation and performance of paedeatric lumbar punctures. Qual Saf Health Care. Oct 2006;15:325-328.

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