Reading a research paper

By Robert Ball

This session will form the basic format of the journal club
When a research article is published by a journal it is usually laid-out in a customary format to allow clear and concise understanding through 4 main sections: 1) Aim(s)/Hypothesis 2) Methods 3) Results and 4) Discussion

General features
Before reading the paper there are a number of features you can take note of including the reputation of the journal and/ or author(s) and the age of the paper. The title may give an indication of the study aim and results.

1) Aim(s)/Hypothesis
Within the introduction segment the author should identify a gap in the literature which justifies the research, as well as potential problems. The aim is a vital part of the paper. What question(s) does the researcher want to answer? This will give you a clearer idea of how to identify strengths and weaknesses of the paper.

2) Methods
STUDY DESIGN a) What type of study is it? b) Is the choice of study design appropriate for answering the authors question? Randomized How, why? Blinding - Can blind? Cant blind? Wont blind? Control group c) Any ethical considerations? POPULATION AND SAMPLE a) Who is the target population? What are the inclusion and exclusion criteria? How is the sample selected? Consecutive, selective etc. Does their study population represent the target population? b) If it is a controlled study How are the controls selected? Are they selected and matched from an identified population ie casecontrolled? If so, are they using historical controls? c) Sample size See GEMS notes for Medical statistics section 7 for power calculation INTERVENTION AND INVESTIGATIONS a) How was the intervention administered? dose, timing, route, protocol etc

b) How were the patients assessed? The gold standard method? Feasible in medical practice? END-POINTS a) What is the Primary End-point? Clear, appropriate, quantifiable? b) Is there a Secondary End-point? c) Study duration Is the duration of the study sufficient to answer the question? How complete is the follow-up?

BIAS- Is there bias: In the population recruitment process? Selection Bias In the running of the clinical trial? Performance Bias During the data collection? Measurement Bias Could the researchers have avoided the bias?

OTHER CONSIDERATIONS Is the study original (that is, has anyone done this before)? Could the study be repeated from the available information? Do the methods allow for the aim to be achieved?

3) Results
Appropriate statistical analysis? All important results declared, especially primary endpoints Was analyses intention-to-treat (even those who dropped out are included)?

4) Discussion
Do results match conclusions authors draw from their research? Both strengths and weaknesses identified by authors? Future research required? CONCLUSIONS Is this paper worth reading? Would you consider changing your clinical practice based on result of the paper?