1. How to Read a Journal Article

2. Basics Always question: – Does this apply to my clinical practice? – Will this change how I treat patients? – How could the authors be wrong? Wrong hypothesis Wrong patient population Wrong statistical calculation Bias Read each section of the article carefully Not all articles are equal – Different Quality – Different Importance

3. Talk Outline Review each section of an article – What should be in included in this section – What questions should you be asking yourself in each section Apply principles to a specific article

4. General Article Outline Each article divided into six sections – Abstract – Introduction / Background – Methods – Results – Discussion / Conclusions – Citations Each section has a purpose Redundancy

5. Abstract First section of article Provides a brief summary of article – Can be subdivided into 4 sections Background Methods Results Conclusions Should include background information – Why is this topic important? Briefly explain how the study was conducted Briefly reveal the results Give a one sentence conclusions

6. Abstract Questions Does this study apply to my patients or my practice? What is the primary outcome? – Primary outcome Point of the study Clinical question Study is built to answer the question Are the results significant? – Statistically – Valid? – Clinically important DO NOT ASSUME THE FINDINGS IN THE ABSTRACT ARE VALID

7. Abstract Example Background – Gives definitions Methods – Random study – 6 hours of treatment – Primary Outcome Results – Is primary outcome statistically significant Conclusion – One sentence Does this study apply to my patients or my practice? What is the primary outcome? Are the results significant?

8. Introduction Should provide necessary background information to understand article. – Provide definition of terms Should explain why this study is necessary Last paragraph should have – Hypothesis or Clinical Question

9. Introduction Questions Does this study apply to my patients? Do I understand enough of the background to understand results of study? What is their hypothesis?

10. Introduction Example Does this study apply to my patients? Do I understand enough of the background to understand results of study? What is their hypothesis?

11. Methods Most important section of an article Describes how the study was conducted Outline patient criteria – Inclusion criteria – Exclusion criteria – How patients were randomized Describe treatments and protocols List primary and secondary outcomes Describe statistical analysis used

12. Methods Questions How was the study conducted? – Randomized? – Duration of treatment time? – Dose? Does this study apply to my patients? – Inclusion Too many versus too few Correct characteristics? – Exclusion Too many versus too few – How long did it take to enroll? Very long = not as relevant? What are the study outcomes?

13. Methods Example How was the study conducted? Does this study apply to my patients? – How were patients chosen? – Inclusion criteria – Exclusion criteria

14. Methods Example What were the study outcomes? – Primary outcome – Secondary outcome Explanation of statistics

15. Results Authors will present all of their data Authors will present primary outcome Authors will present secondary outcome

16. Results Questions Look at Table 1 first – Are both groups of patients the same? Are all the enrolled patients accounted for? – Poor Follow Up – Treatment not working? – Treatment causing too many side effects? – Treatment causing harm? Was the Primary Outcome statistically significant? Was the Secondary Outcome statistically significant?

17. Results Examples TABLE 1 Compare characteristics of control group with experiment group at beginning of study Want to make sure the study is comparing to equal groups – “Apples to Apples”

18. Results Examples Are all the patients accounted for?

19. Results Examples Was the primary outcome statistically significant? Was the secondary outcome statistically significant?

20. Conclusions / Discussion Start with a background focusing on why this topic is important – Cost – Death – Lots of patients Compare study results with previous similar studies Authors should explain why they think they got the results they did Should hi-light strengths and weaknesses of the study

21. Discussion Examples First paragraph describes importance of SEPSIS Last paragraph summarizes the results of their study and how it applies to practice

22. Things to remember Research articles are divided into sections – Abstract – Introduction – Methods – Results – Discussion Each section has a purpose No study is perfect When reading a study always think – Does this study apply to my patients? – Will this change the way I practice medicine? – Could the authors be wrong? How?