In the Beginning-There Is the Introduction-and Your Study Hypothesis.

Writing a manuscript for a medical journal is very akin to writing a newspaper article-albeit a scholarly one. Like any journalist, you have a story to tell. You need to tell your story in a way that is easy to follow and makes a compelling case to the reader. Although recommended since the beginning of the 20th century, the conventional Introduction-Methods-Results-And-Discussion (IMRAD) scientific reporting structure has only been the standard since the 1980s. The Introduction should be focused and succinct in communicating the significance, background, rationale, study aims or objectives, and the primary (and secondary, if appropriate) study hypotheses. Hypothesis testing involves posing both a null and an alternative hypothesis. The null hypothesis proposes that no difference or association exists on the outcome variable of interest between the interventions or groups being compared. The alternative hypothesis is the opposite of the null hypothesis and thus typically proposes that a difference in the population does exist between the groups being compared on the parameter of interest. Most investigators seek to reject the null hypothesis because of their expectation that the studied intervention does result in a difference between the study groups or that the association of interest does exist. Therefore, in most clinical and basic science studies and manuscripts, the alternative hypothesis is stated, not the null hypothesis. Also, in the Introduction, the alternative hypothesis is typically stated in the direction of interest, or the expected direction. However, when assessing the association of interest, researchers typically look in both directions (ie, favoring 1 group or the other) by conducting a 2-tailed statistical test because the true direction of the effect is typically not known, and either direction would be important to report.