When reading a scientific manuscript, it is common to notice a lack of a core idea throughout the work. This means that the manuscript is composed of different parts that have little relationship with each other, creating a true chimera (a mythological animal made up of parts of different animals).

A research work must have a core idea, a backbone that supports and develops the project. This backbone provides coherence and cohesion to the entire scientific work and should be based on the research question. The research question is the beginning and the most important aspect of the study, and all other components should be structured around it^1,2.

The ideal way to begin a research project is by formulating a question based on our professional experience and literature review. One common mistake is to begin recording data as soon as a certain volume of patients with a particular disease is detected. In this case there is no research question, resulting in lack of valid objectives, for example: “To present our experience in the management of laparoscopic appendectomies”. Furthermore, the question is imprecise and difficult to answer: What does “experience” refer to? Incidence, prevalence, clinical presentation, or epidemiology? What does ‘management’ entail? Work-up, indication for surgery, technique used, complications, or longterm outcomes? This type of objectives has no scientific interest. A research project without a specific research question will never materialize.

However, posing a completely original question is very difficult. Therefore, returning to the previous example, if our center has a lot of experience in laparoscopic appendectomy, we can start by considering what is already known, what questions remain unanswered, and what unique contributions we can make. For example, if our center provides care to a significant number of elderly patients, one might ask: are surgical outcomes comparable among elderly patients? Are there any risk factors that can predict morbidity in this subgroup? Once again, we must review the existing literature on the subject. There may be existing studies on our topic, but we can go further based on the literature review. For instance, while there are studies on the elderly population, they may not have taken into account the concept of frailty, which includes more than just age as a criterion. Finally, the question could be: do frail patients have worse surgical outcomes than non-frail patients? What complications do they develop?

Once we have formulated our research question, which requires some literature review, we need to develop our introduction and objectives. The review will help us create an introduction focused on our work. The objectives should be more specific and answer our question, which in this case would be: To compare the surgical outcomes of laparoscopic appendectomy in terms of morbidity, conversion and length of hospital stay between frail and non-frail patients.

Once we have outlined our research question and objectives, the next step is to work on material and methods³. We must define the most appropriate design to answer our question. For the example of frailty and appendicitis, a retrospective cohort design is adequate. We must also specify how we will measure frailty, morbidity, and the diagnostic and treatment algorithm used. We also need to think about confounders that may be associated with frailty and postoperative complications, such as type of appendicitis, time from symptom onset, etc., and what methods we can use to deal with confounders, such as stratification or use of multiple logistic regression.

The results should be presented in an appropriate and concise manner. In many cases, the authors may be too eager to present all their collected data, which in this example are the surgical outcomes between frail and non-frail patients, causing the most important results to be buried within the manuscript. All results directly related to the objectives must be duly presented, summarized in text and tables, and include all information obtained⁴.

In the discussion, we need to go back to the research question and work out how the results that we have obtained answer that question. We also need to specify: how do the results that we have obtained relate to the rest of the literature? What aspects or new questions have been left unanswered? The last paragraph may include the limitations of the study.

Conclusions are often not drawn from the results of the study, and we must answer the research question again. In this case, the answer could be: “Frailty was associated with greater morbidity and length of hospital stay, mainly due to medical complications, but not to higher rates of conversion and reoperation”. Finally, a future line of work could be added: “In the future, we will evaluate a program to optimize perioperative care for frail patients”.