research awareness

1. A.THANGAMANI RAMALINGAM

2. Objectives
 COMPONENTS OF AN ARTICLE
 LEVELS OF EVIDENCE
 HOW TO READ AN ARTICLE
 COMMON SIGNS OF DUBIOUS DATA

3.  Original article – information based on original
research
 Case reports – usually of a single case
 Technical notes - describe a specific technique or
procedure
 Pictorial essay – teaching article with images
 Review – detailed analysis of recent research on a
specific topic
 Commentary – short article with author’s personal
opinions
 Editorial – often short review or critique of original
articles
 Letter to the Editor – short & on subject of interest to
readers
Effective Medical Writing. Peh WCG &, NG K H Singapore Medical
Journal 2008 49(7) 522 smj.sma.org.sg/4907/4907emw1.pdf
(accessed 05 November 2013)

4. I.COMPONENTS OF AN ARTICLE

5. The Usual Sequence
 (Abstract and Key
Terms)
 Introduction
 Methods
 Results
 Discussion
 Conclusion
 Acknowledgements
 (References)
 Most journals use a
conventional IMRD
structure: An abstract
followed by
Introduction, Methods,
Results, and Discussion

6. Features of Abstracts
 Abstracts usually contain four kinds of information:
 Purpose or rationale of study (why they did it)
 Methodology (how they did it)
 Results (what they found)
 Conclusion (what it means)

7. Features of Introductions
Introductions serve two purposes:
 Creating readers’ interest in the subject
 providing them with enough information to
understand the article

8. Features of Methods
 The Methods section tells the reader what experiments
were done to answer the question

9. Features of Results and Discussion
 The Results section contains results—statements of
what was found, and reference to the data shown in
visuals (figures and tables). Normally, authors do not
include information that would need to be referenced,
such as comparison to others’ results.
 The Discussion also functions to provide a clear answer
to the question posed in the Introduction and to
explain how the results support that conclusion.

10. II.LEVELS OF EVIDENCE

11. Systematic
review
Randomized
controlled
trials
Cohort
studies Case series,
Case reports
Ideas
opinions
Levels of Evidence

12. Evidence grading
 1989 USPSTF(United States Preventive Services Task
Force )
 5 levels of evidence
 Other systems:
 CEBM
 ACC
 AAFP (SORT)
 GRADE

13. Grade Definition Suggestions for Practice
A The USPSTF recommends the service. There is high certainty
that the net benefit is substantial.
Offer or provide this service.
B The USPSTF recommends the service. There is high certainty
that the net benefit is moderate or there is moderate certainty
that the net benefit is moderate to substantial.
Offer or provide this service.
C The USPSTF recommends against routinely providing the
service. There may be considerations that support providing
the service in an individual patient. There is at least moderate
certainty that the net benefit is small.
Offer or provide this service
only if other considerations
support the offering or providing
the service in an individual
patient.
D The USPSTF recommends against the service. There is
moderate or high certainty that the service has no net benefit
or that the harms outweigh the benefits.
Discourage the use of this
service.
I Statement The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and harms of the
service. Evidence is lacking, of poor quality, or conflicting, and
the balance of benefits and harms cannot be determined.
USPSTF (as of May 2007)

14. GRADE (a work in progress)
 GRADE classifiesrecommendations as strong or weak
 Strong recommendations
 mean that most informed patients would choose the recommended management
and that clinicians can structure their interactions with patients accordingly
 Weak recommendations
 mean that patients’ choices will vary according to their values and preferences, and
clinicians must ensure that patients’ care is in keeping with their values and
preferences
 Strength of recommendation
 determined by the balance between desirable and undesirableconsequences of
alternative management strategies, quality of evidence, variability in values and
preferences, and resourceuse
http://www.gradeworkinggroup.org

15. SORT

16. Patient or disease oriented?
 Disease-Oriented Outcomes.
 Intermediate, histopathologic, physiologic, or surrogate
results
 Examples: blood sugar, blood pressure, flow rate,
coronary plaque thickness
 May or may not reflect improvement in patient
outcomes.
 Patient-Oriented Outcomes.
 Outcomes that matter to patients and help them live
longer or better lives
 Examples: including reduced morbidity, reduced
mortality, symptom improvement, improved quality of
life, or lower cost

17. III.HOW TO READ AN ARTICLE

18.  1. How are papers organized?
 2. How do I prepare to read a paper, particularly in
an area not so familiar to me?
 3. What difficulties can I expect?
 4. How do I understand and evaluate the contents
of the paper?

19. How are papers organized
 Skim the article and identify its structure.

20. How do I prepare to read a paper
 Read the title and the
abstract
 Choose to read the
background in a review or
textbook, as appropriate.
 If you are very familiar with
the field, the introduction
can be skimmed or even
skipped.
 Interested in a particular
point given in the abstract
often skips directly to the
relevant section of the results
 Interpretation of the
findings
 Most
scientists read
the abstract
first.

21. What difficulties can I expect?
 One major problem is that many papers are poorly written.
 Second, papers are often cluttered with a great deal of
jargon.
 Third, the authors often do not provide a clear road-map
 Many authors do not clearly distinguish between fact and
speculation
 Overstate the importance of their findings, or put a
speculation into the title in a way that makes it sound like a
well-established finding("assertive sentence title“)
 Distinguish main points.

22. How do I understand and evaluate
 What questions does the paper address?
 What are the main conclusions of the paper?
 What evidence supports those conclusions?
 Do the data actually support the conclusions?
 What is the quality of the evidence?
 Why are the conclusions important?


23. Actions to be taken
 Skim the article without taking notes
 Read the “Materials and Methods” and “Results”
sections multiple times.
 Generate questions and be aware of your
understanding
 Take notes as you read. Draw inferences. Write a draft
of your summary
.

24. A Critical Review and Assessment
of the Article
 Include a summary as well as your own analysis and evaluation of
the article.
 Know the article thoroughly.
 Do not include personal opinions.
 Be sure to distinguish your thoughts from the author’s
words.
 Focus on the positive aspects and what the author(s) of the
study learned.
 Note limitations of the study at the end of the essay
o Do the data and conclusions contradict each other?
o Is there sufficient data to support the author’s generalizations?
o What questions remain unanswered?
o How could future studies be improved?

25. IV. DUBIOUS DATA
 Blunders
 Sources(who counted and why)
 Definitions(what did they count)
 Measurements(how did they count)
 Packaging(what they are telling)
 Rhetoric(what they want us to think)
 Debates

26. COMMON SIGNS OF DUBIOUS DATA
 Slippery decimal point(eg:4%-1990,7%-2000)
 Botched translations(25% increase in risk)
 Misleading graphs
 Careless calculation
 Big round numbers(bird window deaths)
 Hyperbole(using superlatives)
 Broad definitions
 Odd units of analysis
 Convenient time frame ,selective comparisions,
misleading samples &statistical adjustments
 Short term benefits are converted to longterm benefits

27. News
Nature 418, 113 (11 July 2002)
| doi:10.1038/418113a
 Dubious data remain in print two years after
misconduct inquiry
Alison Abbott & Johanna Schwarz
Many of the 94 scientific papers listed two years ago by
a German inquiry as likely to contain manipulated
data have yet to be retracted from the
literature, Nature has discovered. The suspect papers
were identified during a high-profile investigation into
misconduct in German cancer research, the results of
which were published in June 2000.

30. Resources
 Effective Medical Writing. Peh WCG &, NG K H Singapore
Medical Journal 2008 49(7) 522
smj.sma.org.sg/4907/4907emw1.pdf
 How to read a scientific article. Mary Purugganan & Jan Hewitt,
Rice University
www.owlnet.rice.edu/~cainproj/courses/HowToReadSciArticle.pd
f
 How to read a scientific paper. John W. Little & Roy Parker--
University of Arizona
www.biochem.arizona.edu/classes/bioc568/papers.htm
 How to read and review a scientific journal article. Duke
University Writing Studio
twp.duke.edu/uploads/media_items/scientificarticlereview.origin
al.pdf

31. Resources
About EBM
 Centre for Evidence-Based
Medicine
(http://www.cebm.net/)
 Agency for Healthcare
Research and Quality
(http://www.ahrq.gov/clinic/
epcix.htm)
Evidence sources
 DynaMed
(www.dynamicmedical.com/)
 Essential Evidence Plus
(www.infopoems.com/)
 Cochrane Library
(www.cochrane.org/)
 Database of Abstracts of
Reviews of Effectiveness
(www.crd.york.ac.uk/crdweb/)
 FPIN (www.fpin.org/)
 Clinical Evidence
(www.clinicalevidence.com/)