Reading and Interpreting Medical Papers Flashcards
Where can we find medical papers?
The library, Internet, and references in articles
The types of articles in paper include original research, case reports, early reports, editorials, commentary, research letters, letters to the editor, correspondence, and reviews. What are three types of reviews?
Meta-analyses, state-of-the-art reviews, and clinical updates
What are the contents of original research?
Abstract, introduction, methods, results, discussion, references
Tell readers crucial information about the article that allows them to decide whether to read the article in its entirety
Abstract
The abstract identifies the
Focus of the study
A problem in an abstract whereby the data given in the abstract is given differently than in the body
Inconsistency
A problem in an abstract whereby data is given in the abstract but not in the body
Omission
If an abstract displays inconsistency, omission, or both, the abstract is deemed
Deficient
What are three types of observational studies you may see in the design of analytical studies?
- ) Cross-sectional (prevalence)
- ) Case-control (retrospective)
- ) Cohort (prospective or retrospective)
Type of observational study where you may look at a group of diseased and non-diseased people and look into their past to see if they were exposed or not exposed to a certain factor
Case-control study
What are two types of clinical trials?
Preventative and therapeutic
Clinical trial where people WITH a disease are randomized and sorted into a treatment group and a control group and studied to see if the treatment is effective at combating the disease
Therapeutic Clinical Trial
Clinical trial where people WITHOUT a disease are randomized and sorted into a treatment group and a control group and studied to see if the treatment prevents the disease
Preventive Clinical Trial
It’s main goal is to combine the results of previous studies to reach summary conclusions about a body of research
Meta-Analysis
Has the following steps:
- ) Identify studies with relevant data
- ) Define inclusion and exclusion criteria
- ) Abstract data
- ) Analyze abstracted data statistically
Meta-analysis
Becoming increasingly important in medical literature
Statistical methods
Gives the findings from the research
-Directed at questions posed in the introduction
Results and Discussion
If you wanted to know how many people in New Jersey currently had a headache, what type of study would you perform?
Cross-sectional study
In peer-review publication, the editor reviews the manuscript and either rejects it, or assigns it to reviewers for
External evaluation
The reviewers then review the manuscript and make recommendations to the
Editor
The editor then decides whether to
Reject the work, modify the work, or publish the work
What is the strongest source of evidence? What is the second strongest?
- ) Systematic review
2. ) RCT
The 2011 OCEBM levels of evidence say that the first level for finding out how common a problem is, is a
Local and current random sample survey
The levels are NOT dismissive of
Systematic reviews
The levels are NOT intended to provide you with a definitive judgement about the quality of
Evidence
The levels will NOT provide you with a recommendation or tell you if you are asking the
Right question
Identifies the best available evidence from within a large body of research
-needed because there are too many papers and too little time
Critical Appraisal
How many articles a day would you need to read to keep up with the current literature?
10,000
Rutgers university libraries, orxford center for EBM, and enhancing the QUAlity and Transparency of health research (EQUATOR) network are all resources for
Appraisal tools
The oxford centre for EMB’s randomized controlled trials critical appraisal sheet is an example of a
Tool for critical appraisal
The first question asked by the RWJMS general article review sheet is
What is the overall design of the study?
The second question asked by the RWJMS general article review sheet is
What is the overall question addressed by the study?
The third question asked by the RWJMS general article review sheet is
What is the the PICO?
The fourth question asked by the RWJMS general article review sheet is
Determine the validity (should I believe the results?)
When determining the validity, you want to look for common sources of
Error (i.e. bias or inadequate blinding)
If error do exist, you must ask yourself if these errors are
Fatal Flaws
When reading an article, you always want to determine the applicability, in other words, can you apply the results to your
Patient
Referral patients tend to be
Sicker
Volunteer patients tend to be
Less sick
You always want to beware of composite and surrogate (non-patient important)
Outcomes
When reading a paper, you always want to ask if the study used was the best study to answer the
Question
The question: was the assignment of patients to treatments randomized? would be answered in
Methods
The question: were the groups similar at the start of the trial? would be answered in the
Results
The question: aside from the allocated treatment, were groups treated equally? would be best answered in the
Methods and results
When you are determining how large the treatment effect was, you want to ask yourself
What is the measure? i.e. RR, ARR, RRR, NNT?
Encompasses various initiatives to alleviate the problems arising from inadequate reporting of randomized controlled trials
CONSORT
Measures how likely that any apparent differences in outcome between treatment and control groups are real and not due to chance.
Statistical Significance
Measures how large the differences in treatment effects are in clinical practice.
Clinical significance
Statistical significance is defined using a
P-value
Clinical significance is defined using
RR, ARR, and NNT
Important resources for obtaining evidences from scientific and clinical research to facilitate practicing evidence-based medicine
Medical Papers
Understanding the key study design (cross-sectional, cohort, RCT), will enable you to better distinguish the
Levels of evidence
What level of evidence is represented by the results of an RCT?
Level I
Obtained from well-designed controlled trials without randomization.
Level II-1 evidence
Obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
Level II-2 evidence
Opinions of respected authorities
Level III evidence
