Reading Research Papers-A Basic Guide to Critical Analysis Dr. Rijo Mathew Choorakuttil May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Evidence Based Research Practitioners have to integrate best research evidence into clinical patient care to provide the most optimal experience for the patient Identifying the best research evidence is not easy There are many scientific journals and many research papers There are many conferences and scientific talks There are many Continuing Medical Education (CME) programs May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Identifying Applicable Research Research papers in Scientific Journals are among the most common sources of information for practitioners There are several Journals for each Medical Discipline There are a lot of research articles addressing a variety of research questions There is plenty of information out there We need to look for the best quality research May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Reading a Research Paper There are several points to consider while reading a research paper Are the results of the study valid and reliable? Is the research of a high quality? Can the results be applied to the patients I take care of? Which Results should I believe? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Parts of a Research Paper A Research Title An abstract (a summary of the results) An Introduction ( establishes the rationale for doing the study) Material and Methods (What was studied, How was it studied, What was used for the study) Results (What was found) Discussion ( Interpretation of the Results) May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Research Title The title of a paper is what we first see and should give you a fair idea of what the research is about Is the title precise, focused and clear? Precise, focused research leads to papers with precise, focused and clear titles The title can be a measure of the clarity and focus of the research More often than not, you choose to read a paper further based on the title. Vague, not so clear titles make you ignore a paper and move on. May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

The Introduction What are the essential parts of an Introduction? Is there a clear statement (hypothesis) or question (research question) on what the researchers are studying or aim to prove/disprove? Do the researchers provide a brief, but clear, rationale for the question or hypothesis? Do the researchers explain, in brief, what is currently known about the research area? Do the researchers explain, in brief, what gaps in current knowledge the research addresses? Note: We do not usually need more than 8-10 lines for a clear introduction. May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Material and Methods The Material and Methods section has few non negotiable and important functions Describe in detail about the methods and material used to find the answer to the research question Provide enough information that allows other research teams to replicate the study and validate the results Provide a reassurance that the research was performed in conformance to standard ethical principles May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Material and Methods When was the study done? Where was the study done (characteristics of the study institute or location that make it ideal to answer the research question) What study design was used- Is that appropriate to answer the research question? For example, did they use a randomized design to compare effectiveness of interventions? Description of subjects in the study- Who were included, Who were excluded. Do they give a rationale for inclusion and exclusion? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Material and Methods How were subjects for the study selected? When were they selected? Who selected them? The process and criteria used for selection. For example, were consecutive subjects chosen, were subjects chosen randomly, randomization process, if any. May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Material and Methods Is there a clear description (or reference to) definitions used? Are standard acceptable definitions used? Is there a clear description of the technical details of methods? For example, instrumentation, position, image resolution etc. Are standard acceptable methods used for the measurements? Is there a clear description of any interventions used? Is there a clear, standardized, and acceptable description of outcomes studied including the methods used to measure them? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Material and Methods Has informed consent been sought from research participants? Did subjects have the freedom to refuse participation? Were any incentives offered for participation Was the study protocol approved by a regulatory body (Scientific Committee, Institutional Review or Ethics Board) May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Material and Methods Is there a clear description of the statistical tests, if any, used? Is there a description of why these tests were chosen? What software, if any, was used to analyze results? What was considered as statistical or clinical significance? Is there a description of the sample size estimates that determined how many subjects were studied? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Results How many subjects were studied? Are they described in appropriate terms (demographics, clinical characteristics etc) Is there information on drop outs, exit from the study or refusal to participate? Have the researchers mentioned in the methods how they measured each of the results presented? Are ranges around point estimates presented? The nature of the results presented will depend on the research question. May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Discussion Have the researchers interpreted their results (not the same as writing the results in different words). Do they tell you what it means? Do they tell you the strengths of their study? Do they tell you the limitations of their study? Do they tell you how the strengths and limitation may have influenced or impacted their results? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Discussion Do they compare their results with other studies? Do they explain why their results are similar to or dissimilar to other studies? Do they provide recommendations for further research? Do they tell you how these results can be applied to clinical practice or patient care? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Conflicts of Interest Do the researchers disclose conflicts of interest? Do the researchers disclose any financial considerations? Will these influence the conduct of the study and the presentation of results? May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Abstract The abstract provides a brief summary of the introduction, material and methods, results and conclusions The abstract provides a birds eye view of the research It can be used to determine if you want to read the full paper. Do not base your conclusion on the abstract alone- sometimes, abstracts do not reflect the contents of the research in complete terms May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Summarizing the Essentials There should be a clear research hypothesis or question The methods used and described should be appropriate to answer this particular question The process used to reach each result should be adequately described. The results presented should be relevant to the research question or hypothesis The results are discussed in the light of current knowledge. The research adheres to high standards of ethics May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

How Do We Use This Information? We have gone through a basic checklist. How do we use this information? Practice. Use the checklist as you read research papers. Read more research papers. As you practice and become more comfortable with the use of the checklist, you will become more comfortable in identifying strengths and weaknesses in research studies May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE

Reading Research Reading Research is like Art. The Checklist gives you a guide to collect information. You have to merge that with your experience and interpret the information in that context That requires practice and more practice. As you practice more, your experience improves and your interpretations change. Keep an open mind. Respect the efforts of the researchers to try to find an answer and communicate that. Let us not judge them but focus on how we can take the best of it to help our patients. May 7, 2018 AMMA Center For Education and Research-A UNIT OF amma Center for DIAGNOSIS AND PREVENTIVE mEDICINE