How to read a scientific article

Dr. Naglaa Arafa Lecturer of Public Health

Learning objectives
By the end of this lecture, the student will be able to: Understand the importance of critically appraising a scientific article. Be able to critically appraise a scientific article.

?What is its importance

Research is carried out to increase scientific knowledge The results are summarised and presented in scientific journals The results may then be used to introduce new treatments or new public health programs

 Not all scientific research is of good quality It is thus essential that we appraise scientific papers to decide what is of worth to us and what is not

Structure of a scientific article

Title Abstract Introduction Aim & specific objectives Subjects and Methods Results Discussion Conclusion

3 basic questions should be answered: 1. What is the central research question? 2. Has an appropriate study design been chosen? 3. Is the interpretation of the data reasonable?

Title
It should be short Clearly indicate the content of paper Accurate and specific

Abstract
The abstract is a summary of the entire paper. It may be structured or unstructured A structured abstract follows the same structure as the paper (introduction, methods, results, discussion and conclusion) Only the main results are presented in the abstract

Introduction
This indicates the importance of the topic It may summarize very briefly the information already known on the topic It should indicate: the magnitude of the problem The importance of the problem The scarcity of studies in the local population (e.g. Egypt) The possible benefit of the study What gaps of knowledge exist and what the researchers hope to add HCV

Study Aim
What is the central research question? a) It should be clearly stated b) Is should reflect up-to-date knowledge c) The hypothesis should be testable The objectives should be SMART

Subjects and Methods

This should indicate in detail how the researchers carried out the study The first question is: What was the choice of study design? Case-control, cohort, cross-sectional, clinical trial? Is it relevant to the research question? The sample size of the study should be indicated. Is it adequate to answer the question? Researchers should state the method of sampling Did they use a random sample?

Subjects
Where was the study population obtained? Was the study population representative of all people with the disease/exposure? i.e. there was no selection bias Was the control group comparable? Are the exclusion/inclusion criteria clearly defined? For a cohort or experimental study: what percentage of subjects completed the study?

Methods
How was the exposure measured? How were the outcomes defined? Were the data collection techniques clearly described? Were those carrying out the measurements blind to the disease/exposure status of the subjects?

Examples of unclear descriptions in the methods section of a paper

What the authors said "We compared a nicotinereplacement patch with placebo." What they should have said/done An example of

"Subjects in the Failure to state intervention group dose of drug or were asked to apply a nature of placebo. patch containing 15 mg nicotine twice daily; those in the control group received identicallooking patches."

Ethical considerations
Clearly identified? Was informed consent obtained? Confidentiality guaranteed?

Results
The main results should be clearly stated The results may be in the form of : tables, graphs or texts

Discussion and Conclusion

The authors should discuss their findings in light of other research in the field Was there any explanation of the findings (in light of the available evidence)? Did the results confirm the findings of other studies? If there was disagreement with other studies, was a convincing explanation of the disagreement offered? Did the authors indicate the implications of their findings? What are the practical application of the findings? Can the results be generalized to the general population? Did they indicate limitations of their study? Did they recommend areas for further research? Was there a clear conclusion?

The liver function profile in PCR-RNA Egyptian HCV-patients and normal controls.

Introduction: No doubt, Hepatitis C virus (HCV) is a real health problem worldwide. Subjects and Methods: The liver function tests (S.ALT, S.AST, Albumin, Total Protein, Total Bilirubin and Direct Bilirubin) were evaluated in 20 PCR-RNA positive HCVpatients and 10 cross matched apparently healthy population.

Results: All the HCV-patients and controls were free from liver helminthes. The results showed that in the HCV-patients, there was elevation in the level of S.ALT (17/20 or 85%), S.AST (20/20 or 100%),Total Bilirubin (7/20 or 35%), and (4/20 or 20%). Besides, there was neither a correlation between sexes nor the degrees of viraemia and the elevation of these four parameters.

However, serum levels of Albumin, and Total Protein were within the normal range. On the other hand, in the controls the levels of the six tests were within the normal range. Nevertheless, only one control subject who had positive HBs-Ag, showed elevated Total Bilirubin and Direct Bilirubin.

Conclusion: Consequently, these tests are indicative as useful and dependable markers in the non-invasive diagnosis of the hepatitis C virus (HCV).

Exposure to environmental tobacco smoke in non-smoking pregnant women as measured by urinary cotinine and birth outcomes
Aim of the work: to assess the relationship between exposure to ETS in nonsmoking pregnant women and the occurrence of low birth weight (LBW) and preterm delivery.

Subjects and methods

A cross-sectional study was carried out on a total sample of 162 pregnant women selected randomly from the attendants of the obstetric dept of a major hospital. Inclusion criteria : Never smoked throughout pregnancy Singleton birth Free from any disease which could affect outcome

 Interview questionnaire to each woman asking about ETS exposure throughout pregnancy, especially third trimester. This included household, workplace and transportation ETS exposure. Urine was collected at time of interview and analyzed for cotinine (a metabolite of nicotine)

(Subjects and methods (cont

:Definition of outcomes
LBW : infants less than 2500g Preterm delivery: delivery before 37 weeks gestation Urinary cotinine levels: No exposure: < 100 ng/ml Low exposure : 100-199 Moderate exposure: 200-399 High exposure : 400-499 Smoker : >500

Results
Exposure Cotinine levels Low Medium High No. = 74 No. = 66 No. = 22 Smoking at home 80.4 % Smoking at work 34.8 % Smoking in transport 41.3 % 100 % 41.5 % 48.8 % 100 % 42.9 % 71.4 %

No. of cigs at all 11.0 places mean SD 5.8

14.5 5.7 21.4 4.6

Relationship between ETS and birth weight

Exposure Smoking at home Smoking at work Smoking in transport Cotinine level mean SD Birth weight < 2500g > 2500 g 100 % 44.9 % 53.6 % 71.9 % 33.3 % 37.5 %

277 121 123 76

Relationship between ETS and gestational age

Exposure Gestational age < 37 weeks > 37 weeks 100 % 38.0 % 47.6 % 256 18 85.2 % 42.6 % 49.2 % 209 14

Smoking at home Smoking at work Smoking in transport Cotinine level mean SD

Conclusions
We found an association of decreasing birth weight and gestational age of newborns among mothers who were exposed to ETS This study revealed unexpected higher exposure rate among pregnant women as all of them had detectable cotinine levels in urine.

???
The rate of LBW births in the among singleton births in the Egyptian population is 10%. Of 162 births, 16 will be LBW Is this sample size sufficient to conduct a study?

Useful links
A series of 10 articles on the BMJ on how to read medical papers

http://www.valpo.edu/library/user/read-medpaper A detailed article on how to read a research paper http://www.childrensmercy.org/stats/journal/jour2003-07.htm