Critical Issues on Full- - Critical Issues on Full Length Articles - - PowerPoint PPT Presentation

Critical Issues on Full Critical Issues on Full-

• Length Articles

Length Articles

Objectives Objectives

• How to Read Scientific Manuscripts

How to Read Scientific Manuscripts

• Critical Issues for Research Articles

Critical Issues for Research Articles

• Appraising Review Articles

Appraising Review Articles

• Exercise

Exercise -

• Link sentences

Link sentences

Why Are Papers Rejected? Why Are Papers Rejected?

• The study

The study

– – did not address an important scientific issue did not address an important scientific issue – – was not original was not original – – did not actually test the authors' hypothesis did not actually test the authors' hypothesis – – was uncontrolled or inadequately controlled was uncontrolled or inadequately controlled

• The statistical analysis was incorrect or

The statistical analysis was incorrect or inappropriate inappropriate

• The authors drew unjustified conclusions

The authors drew unjustified conclusions from their data from their data

• The paper was so badly written that it was

The paper was so badly written that it was incomprehensible incomprehensible

Checklist for Manuscript Appraisal Checklist for Manuscript Appraisal

Appraise Research Articles in this order: Appraise Research Articles in this order:

Introduction Introduction Methods Methods Results Results Discussion Discussion References References

The Title and Abstract are not useful for critical The Title and Abstract are not useful for critical appraisal appraisal

Checklist for Manuscript Appraisal Checklist for Manuscript Appraisal

Appraise Research Articles in this order: Appraise Research Articles in this order:

1 Methods 1 Methods 2 Results 2 Results 3 Discussion 3 Discussion 4 References 4 References 5 Introduction 5 Introduction

The Title and Abstract are not useful for critical The Title and Abstract are not useful for critical appraisal appraisal

Methods are Most Informative Methods are Most Informative

To decide whether a paper is worth reading, To decide whether a paper is worth reading, focus on the design of the Methods section focus on the design of the Methods section

– – Not on the interest of the hypothesis Not on the interest of the hypothesis – – Not on the nature or potential impact of the Not on the nature or potential impact of the results results – – Not on the speculation in the Discussion Not on the speculation in the Discussion

Methods Methods

Is the experimental design appropriate? Is the experimental design appropriate?

– – Sample selection and size Sample selection and size – – Adequacy of controls Adequacy of controls – – Justification for doses/concentrations, etc. Justification for doses/concentrations, etc. – – Timing of measurements Timing of measurements – – Validity and accuracy of measurements Validity and accuracy of measurements

Methods Methods

• Is there enough detail (with judicious use of

Is there enough detail (with judicious use of referencing) for experiments to be repeated? referencing) for experiments to be repeated?

• Are the statistics clearly described and valid?

Are the statistics clearly described and valid?

– – non non-

• parametric tests on skewed data

parametric tests on skewed data – – repeat tests with correction repeat tests with correction

Results Results

• Are the data presented fairly?

Are the data presented fairly?

– – absolute values reported absolute values reported – – uniform scaling between graphs uniform scaling between graphs – – complete data for all experiments complete data for all experiments

• Are the textual statements factually

Are the textual statements factually correct and supported by the statistics? correct and supported by the statistics?

– – cross reference to Figures/Tables cross reference to Figures/Tables

• Is there duplication of material in Figures

Is there duplication of material in Figures and Tables? and Tables?

• Are the statistics biologically meaningful?

Are the statistics biologically meaningful?

• Are any correlations valid and useful?

Are any correlations valid and useful?

Discussion Discussion

• Does it summarise (not re

Does it summarise (not re-

• state) the main

state) the main findings? findings?

• Does it re

Does it re-

• visit the hypothesis/problem?

visit the hypothesis/problem?

• Does it contextualise the study in relation to

Does it contextualise the study in relation to previous work in a fair and balanced manner? previous work in a fair and balanced manner?

• Does it address any unexpected results,

Does it address any unexpected results, discrepancies and sources of error? discrepancies and sources of error?

Discussion Discussion

• Does it make logical (and scientific) sense?

Does it make logical (and scientific) sense?

• Are the overall conclusions justified and

Are the overall conclusions justified and limitations stated? limitations stated?

• Is there over

Is there over-

• speculation?

speculation?

References References

• Are the references from high

Are the references from high-

• quality (high

quality (high impact) journals? impact) journals?

Introduction Introduction

• Is it a fair background, specific to the study

Is it a fair background, specific to the study (not a review)? (not a review)?

• Does it have a statement of the problem

Does it have a statement of the problem and/or a hypothesis to be tested? and/or a hypothesis to be tested?

• Does it outline or summarize how the study

Does it outline or summarize how the study was done? was done?

Abstract and Title Abstract and Title

• You can not critically appraise a paper on the

You can not critically appraise a paper on the basis of the Title or Abstract basis of the Title or Abstract

• However, use these to initially evaluate the

However, use these to initially evaluate the article article

– – is the article of interest to you? is the article of interest to you?

• Does the Abstract state the

Does the Abstract state the aims aims of the study,

• f the study,
• utline the
• utline the methods

methods used, summarise the main used, summarise the main results results and state the and state the conclusion? conclusion?

Common Errors Common Errors

made made by ESL Writers by ESL Writers

Use of Noun and Verbs Use of Noun and Verbs

Use the Verb! Use the Verb!

• Consider the following sentence:

Consider the following sentence:

– – "The low rate of encounters was a reflection of "The low rate of encounters was a reflection of the reduction in population density." the reduction in population density."

• The verbs, "to reflect" and "to reduce" are

The verbs, "to reflect" and "to reduce" are used as nouns, and the sentence is swollen used as nouns, and the sentence is swollen and less direct than when they are used as and less direct than when they are used as verbs: verbs:

– – "The low rate of encounters reflects a reduced "The low rate of encounters reflects a reduced population density." population density."

How to Read Scientific Manuscripts How to Read Scientific Manuscripts

• What is the question (hypothesis)?

What is the question (hypothesis)?

• Did the experiments test it?

Did the experiments test it?

• Were there secondary hypotheses?

Were there secondary hypotheses?

• What are the strengths and weaknesses of the

What are the strengths and weaknesses of the experimental design? experimental design?

• Are the controls appropriate and sufficient?

Are the controls appropriate and sufficient?

Why Was the Study Done, and What Why Was the Study Done, and What Questions Were Addressed? Questions Were Addressed?

• The introductory sentence of a research paper should

The introductory sentence of a research paper should state the background for the research state the background for the research

• The hypothesis that the authors tested should be

The hypothesis that the authors tested should be clearly stated in the Introduction section of the paper clearly stated in the Introduction section of the paper

– – If the hypothesis is presented in the negative, such as "the If the hypothesis is presented in the negative, such as "the addition of metformin to maximal dose sulphonylurea addition of metformin to maximal dose sulphonylurea therapy will not improve the control of type 2 diabetes," therapy will not improve the control of type 2 diabetes," it is known as a null hypothesis it is known as a null hypothesis

What Type of Study was Done? What Type of Study was Done?

• Primary studies report research first hand, and usually

Primary studies report research first hand, and usually fall into one of three categories: fall into one of three categories:

– – Experiments, in which a maneuver is performed on an Experiments, in which a maneuver is performed on an animal or a volunteer in artificial and controlled animal or a volunteer in artificial and controlled surroundings surroundings – – Clinical trials, in which an intervention, such as a drug Clinical trials, in which an intervention, such as a drug treatment, is offered to a group of patients to determine treatment, is offered to a group of patients to determine what happens to them what happens to them – – Surveys, in which something is measured in a group of Surveys, in which something is measured in a group of patients, health professionals, or some other sample of patients, health professionals, or some other sample of individuals individuals

• Secondary (or integrative) studies attempt to draw

Secondary (or integrative) studies attempt to draw conclusions from primary studies conclusions from primary studies

Evaluating Review Articles Evaluating Review Articles

• Did the review address an important question?

Did the review address an important question?

• Were databases and other important sources

Were databases and other important sources explored? explored?

• Was methodological quality assessed and were

Was methodological quality assessed and were the trials weighted accordingly? the trials weighted accordingly?

• How to weigh the numerical results versus

How to weigh the numerical results versus common sense aspects of the problem? common sense aspects of the problem?

Types of Review Articles Types of Review Articles

• Narrative Review

Narrative Review

– – Deal with a broad range of issues related to a Deal with a broad range of issues related to a given topic given topic – – Useful for gaining perspective on a topic Useful for gaining perspective on a topic – – Sometimes opinionated Sometimes opinionated

• Systematic Review

Systematic Review

– – Generated to answer specific clinical questions Generated to answer specific clinical questions – – Usually possess a question in the title, or a Usually possess a question in the title, or a methods section methods section

Differences Between Narrative Differences Between Narrative Reviews and Systematic Reviews Reviews and Systematic Reviews

Narrative Review Narrative Review Systematic Review Systematic Review Question Question Often broad in scope Often broad in scope Often a focused clinical Often a focused clinical question question Sources and Sources and search search Not usually specified, Not usually specified, potentially biased potentially biased Comprehensive sources and Comprehensive sources and explicit explicit Selection Selection Not usually specified, Not usually specified, potentially biased potentially biased Criterion Criterion-

• based selection,

based selection, uniformly applied uniformly applied Appraisal Appraisal Variable Variable Rigorous critical appraisal Rigorous critical appraisal Synthesis Synthesis Often qualitative Often qualitative Quantitative Quantitative Inferences Inferences Sometimes evidence Sometimes evidence-

• biased

biased Usually evidence Usually evidence-

• based

based

Narrative Review Narrative Review

• Appropriate for describing the history of a problem

Appropriate for describing the history of a problem and its management and its management

• Better for describe cutting

Better for describe cutting-

• edge developments if

edge developments if research is scant or preliminary or if studies are very research is scant or preliminary or if studies are very limited by flawed design or execution limited by flawed design or execution

• Useful for discussing data in light of underlying

Useful for discussing data in light of underlying theory and context theory and context

• Can draw analogies and conceptually integrate two

Can draw analogies and conceptually integrate two independent fields of research independent fields of research

– – Such as cancer and the acquired immunodeficiency Such as cancer and the acquired immunodeficiency syndrome (AIDS) syndrome (AIDS)

• Connection between clinical recommendations and

Connection between clinical recommendations and evidence in narrative reviews is often tenuous or evidence in narrative reviews is often tenuous or based on a biased citation of studies based on a biased citation of studies

Systematic Review Systematic Review

• Systematic reviews can define the boundaries of

Systematic reviews can define the boundaries of what is known and what is not known what is known and what is not known

• Help us avoid knowing less than has been proven

Help us avoid knowing less than has been proven

• Systematic reviews can help practitioners solve

Systematic reviews can help practitioners solve specific clinical problems specific clinical problems

• Investigators need systematic reviews to

Investigators need systematic reviews to summarize existing data, refine hypotheses, summarize existing data, refine hypotheses, estimate sample sizes, and help define future estimate sample sizes, and help define future research agendas research agendas

• Aid but do not replace sound clinical reasoning

Aid but do not replace sound clinical reasoning

Systematic Review Example Systematic Review Example

• Title:

Title: Valsartan in chronic heart failure Valsartan in chronic heart failure

• Journal: Ann

Journal: Ann Pharmacother

• Pharmacother. 2005 39(3):460

. 2005 39(3):460-

• 9

9

• OBJECTIVE: To evaluate the evidence for

OBJECTIVE: To evaluate the evidence for valsartan in the treatment of heart failure and valsartan in the treatment of heart failure and determine its need for formulary inclusion determine its need for formulary inclusion

• DATA SOURCES: OVID and

DATA SOURCES: OVID and PubMed PubMed databases databases were searched (1983 were searched (1983-

• June 2004) using the key

June 2004) using the key words angiotensin words angiotensin-

• receptor blocker, heart failure,

receptor blocker, heart failure, valsartan, valsartan, Diovan Diovan, and angiotensin , and angiotensin-

• converting

converting enzyme inhibitor. Only English enzyme inhibitor. Only English-

• language

language literature was selected. literature was selected.

Systematic Review Example Systematic Review Example

• DATA SYNTHESIS: Valsartan, a selective antagonist for

DATA SYNTHESIS: Valsartan, a selective antagonist for angiotensin receptor subtype 1, is the first ARB to be approved angiotensin receptor subtype 1, is the first ARB to be approved for for use in chronic heart failure. Clinical trial data support valsar use in chronic heart failure. Clinical trial data support valsartan as tan as an alternative to angiotensin an alternative to angiotensin-

• converting enzyme (ACE) inhibitors

converting enzyme (ACE) inhibitors in ACE inhibitor in ACE inhibitor-

• intolerant patients with chronic heart failure.

intolerant patients with chronic heart failure. Valsartan is generally well tolerated, with renal impairment, Valsartan is generally well tolerated, with renal impairment, elevated serum elevated serum creatinine creatinine and potassium levels, and dizziness and potassium levels, and dizziness being the most common adverse effects; consequently, patients being the most common adverse effects; consequently, patients experiencing those adverse events while taking ACE inhibitors ar experiencing those adverse events while taking ACE inhibitors are e likely to experience them with valsartan. Although further study likely to experience them with valsartan. Although further study is is needed, differences in effectiveness among races may exist with needed, differences in effectiveness among races may exist with use of valsartan; however, at this time, valsartan is recommende use of valsartan; however, at this time, valsartan is recommended d as an alternative to ACE inhibitors regardless of race. as an alternative to ACE inhibitors regardless of race. Candesartan Candesartan and losartan have been studied in similar settings. and losartan have been studied in similar settings. Candesartan's Candesartan's data support its use in heart failure; however, data support its use in heart failure; however, losartan's losartan's data have data have been less consistent. been less consistent.

Systematic Review Example Systematic Review Example

• CONCLUSIONS: Valsartan is a safe and

CONCLUSIONS: Valsartan is a safe and effective alternative for heart failure patients effective alternative for heart failure patients intolerant of ACE inhibitors. Valsartan has not intolerant of ACE inhibitors. Valsartan has not been shown to be safe and effective when used in been shown to be safe and effective when used in combination with ACE inhibitors combination with ACE inhibitors

How to Write Clearly How to Write Clearly

• Signposts

Signposts give direction to the reader for give direction to the reader for your discussion your discussion

• Specificity

Specificity means using words with precise means using words with precise meanings meanings

– – Replace phrases such as "gives important Replace phrases such as "gives important insight into..." insight into..."

• Flow

Flow is generated when the writer makes is generated when the writer makes connections between adjacent sentences, connections between adjacent sentences, paragraphs, or sections paragraphs, or sections

Suggested Strategy Suggested Strategy

1.

• 1. Outline manuscript

Outline manuscript

̶̶ rearrange and restructure rearrange and restructure

2.

• 2. Identify Topic Statement (Title?)

Identify Topic Statement (Title?) 3.

• 3. Draft manuscript

Draft manuscript 4.

• 4. Link sentences

Link sentences 5.

• 5. Inspect word choices

Inspect word choices

̶̶ remove ‘to verbs’ remove ‘to verbs’ ̶̶ replace definitions with words replace definitions with words ̶̶ eliminate ‘prepositional verbs’ eliminate ‘prepositional verbs’

Linking Sentences and Paragraphs Linking Sentences and Paragraphs

• Sentences contain a single statement or idea

Sentences contain a single statement or idea

• Paragraphs contain a collection of sentences

Paragraphs contain a collection of sentences that explain a more complicated idea that explain a more complicated idea

– – topic sentence topic sentence

• We must link sentences to form paragraphs

We must link sentences to form paragraphs

• We must link paragraphs to form documents

We must link paragraphs to form documents

Linking Sentences Linking Sentences

• Sentences are linked using transitional words

Sentences are linked using transitional words and phrases and phrases

• Transitions indicate relations, whether from

Transitions indicate relations, whether from sentence to sentence, or from paragraph to sentence to sentence, or from paragraph to paragraph paragraph

• Smooth transitions allow the reader to flow

Smooth transitions allow the reader to flow from the first supporting point to the last from the first supporting point to the last

• Let

Let’ ’s consider some transitional words s consider some transitional words… …

Addition Addition

also also besides besides furthermore furthermore in addition in addition moreover moreover again again in fact in fact indeed indeed Example: Example: Several studies, however, in patients with more Several studies, however, in patients with more advanced proteinuria, with and without diabetes, advanced proteinuria, with and without diabetes, have shown a clear relation between proteinuria have shown a clear relation between proteinuria reduction and slowing of renal disease reduction and slowing of renal disease

• progression. Moreover, the type 2 diabetic
• progression. Moreover, the type 2 diabetic

subgroup with microalbuminuria benefits most subgroup with microalbuminuria benefits most from ACE inhibition in terms of cardioprotection. from ACE inhibition in terms of cardioprotection.

Consequence Consequence

according according as a result as a result consequently consequently hence hence

• therwise
• therwise

so then so then therefore therefore thus thus because of because of thereupon thereupon finally finally as a consequence as a consequence Example: Example: Valsartan is generally well tolerated, with renal Valsartan is generally well tolerated, with renal impairment, elevated serum impairment, elevated serum creatinine creatinine and potassium and potassium levels, and dizziness being the most common adverse levels, and dizziness being the most common adverse

• effects. Consequently, patients experiencing those
• effects. Consequently, patients experiencing those

adverse events while taking ACE inhibitors are likely adverse events while taking ACE inhibitors are likely to experience them with valsartan. to experience them with valsartan.

Summarizing Summarizing

after all after all all all in all in all in any case in any case in any event in any event in conclusion in conclusion in short in short to summarize finally to summarize finally indeed indeed Example: Example: underscoring the therapeutic relevance of other underscoring the therapeutic relevance of other mechanisms of action, of which proteinuria lowering mechanisms of action, of which proteinuria lowering is likely to be an important one, of this class of is likely to be an important one, of this class of

• compounds. In conclusion, valsartan significantly
• compounds. In conclusion, valsartan significantly

reduces microalbuminuria in type 2 diabetic patients, reduces microalbuminuria in type 2 diabetic patients, apparently independently of its BP apparently independently of its BP-

• lowering action.

lowering action.

Other Transitional Phrases Other Transitional Phrases

• Diversion

Diversion

– – by the way, incidentally by the way, incidentally

• Contrast and Comparison

Contrast and Comparison

– – contrast, by the same token, conversely, rather, contrast, by the same token, conversely, rather, similarly, nevertheless, in contrast, in spite of, in similarly, nevertheless, in contrast, in spite of, in comparison, whereas comparison, whereas

• Generalizing

Generalizing

– – as a rule, as usual, for the most part, generally, as a rule, as usual, for the most part, generally, generally speaking, ordinarily, usually generally speaking, ordinarily, usually

• Similarity

Similarity

– – likewise, similar, moreover, likewise, similar, moreover, similarly similarly, also, too , also, too

Exercise 2 Exercise 2

• Link sentences

Link sentences See See CriticalIssuesonFullLengthArticlesNovartis.htm CriticalIssuesonFullLengthArticlesNovartis.htm

Use a Thesaurus Use a Thesaurus

• A thesaurus lists words that have similar

A thesaurus lists words that have similar meanings to a specific word meanings to a specific word

• Also, gives the definitions of these words

Also, gives the definitions of these words

• Thus, a thesaurus enables you to select the best

Thus, a thesaurus enables you to select the best word for a particular sentence word for a particular sentence Example: Diminish Example: Diminish

• Reduce

Reduce

• Lessen

Lessen

• Make smaller

Make smaller

• Weaken

Weaken

Correctly Structure Paragraphs Correctly Structure Paragraphs

• A paragraph should begin with a topic

A paragraph should begin with a topic sentence that clearly sets the stage for what sentence that clearly sets the stage for what will follow will follow

– – Make topic sentences short and direct Make topic sentences short and direct

• Build the paragraph from the ideas introduced

Build the paragraph from the ideas introduced in your topic sentence in your topic sentence

• Make the flow of individual sentences follow

Make the flow of individual sentences follow a logical sequence a logical sequence

• Try to finish each paragraph with a sentence

Try to finish each paragraph with a sentence that forms a bridge to the next paragraph that forms a bridge to the next paragraph

Linking Paragraphs Linking Paragraphs

• Effective paragraph linking is closely related to

Effective paragraph linking is closely related to good good organization

• rganization, sequencing of ideas

, sequencing of ideas

7.10

Methods to Link Paragraphs Methods to Link Paragraphs

• Using pronouns

Using pronouns

– – this this… …that that… …these these… …etc. etc.

• Using repetition

Using repetition

– – the same words and phrases the same words and phrases

• Using logical connectors

Using logical connectors -

• links

links

– – however, on the other hand however, on the other hand… …etc. etc.

Using Pronouns to Link Paragraphs Using Pronouns to Link Paragraphs

End of Paragraph A End of Paragraph A Even in the subgroup that achieved BP Even in the subgroup that achieved BP targets, the between targets, the between-

• treatment group

treatment group differences in the reduction of UAER persisted. differences in the reduction of UAER persisted. Beginning of Paragraph B Beginning of Paragraph B These results strongly support the notion These results strongly support the notion that the albuminuria that the albuminuria-

• lowering effects of

lowering effects of valsartan are in addition to and, to a large valsartan are in addition to and, to a large extent, divorced from its antihypertensive extent, divorced from its antihypertensive action. action.

Using Repetition to Link Paragraphs Using Repetition to Link Paragraphs

Using repetition Using repetition – – the same words and phrases the same words and phrases End of paragraph A End of paragraph A These These results results strongly support the notion that the strongly support the notion that the albuminuria albuminuria-

• lowering effects of valsartan are in addition to

lowering effects of valsartan are in addition to and divorced from its antihypertensive action. and divorced from its antihypertensive action. Beginning of paragraph B Beginning of paragraph B Our Our results results add new information to previous studies add new information to previous studies suggesting that lowering of blood pressure in diabetic suggesting that lowering of blood pressure in diabetic patients by ACE inhibition or AT1 receptor antagonism patients by ACE inhibition or AT1 receptor antagonism results in greater reduction of albuminuria than that results in greater reduction of albuminuria than that

• btained with other antihypertensive agents.
• btained with other antihypertensive agents.

Using Logic to Link Paragraphs Using Logic to Link Paragraphs

End of Paragraph A End of Paragraph A Angiotensin II receptor blockade also prevents the Angiotensin II receptor blockade also prevents the loss of nephrin in the glomeruli of the diabetic animal, and loss of nephrin in the glomeruli of the diabetic animal, and recent data suggest that AIIAs may reduce levels of TGF recent data suggest that AIIAs may reduce levels of TGF-

• beta in type 2 diabetic patients with microalbuminuria.

beta in type 2 diabetic patients with microalbuminuria. Beginning of Paragraph B Beginning of Paragraph B There are possible alternative interpretations of our There are possible alternative interpretations of our

• results. (Explain.)
• results. (Explain.)

Exercise 3 Exercise 3– – Linking Sentences Linking Sentences

• In this example, substitute better words and

In this example, substitute better words and phrases to effectively link sentences phrases to effectively link sentences See See CriticalIssuesonFullLengthArticlesNovartis.htm CriticalIssuesonFullLengthArticlesNovartis.htm