How to Read a Clinical Research Article Pt. 2

Title: How to read clinical journals: Why to read them and how to start reading them critically

Author: D.L. Sackett

Journal: Clinical Epidemiology Rounds

Year of Publication: 1981

I for one have always been a sucker for “classics.” Classic cars, classic fashion staples, classic movies on a rainy night. The reason why I’m drawn to classic things is because they tend to withstand the test of what we find the enemy these days–time. When you see the LBD or true-and-tested model revived and reshaped to fit the current era, it’s really a piece of history you’re looking at.

So I found it comforting in Sackett’s article to find that we, as speech-language pathologists, are not alone in the classic fight to keep up with and be informed of research literature.

“This series of Clinical Epidemiology Rounds  article review has been prepared for those clinicians who are behind in their clinical reading.”           

(Sackett, p. 1; edited with my emphasis)


Back in the 1980s once you get past the crimped hair and acid-washed jeans everywhere, apparently it was difficult for medical professionals to keep up with “10 leading journals in internal medicine,” and they would have to “read more than 200 articles and 70 editorials per month.” Fast forward to almost FOUR DECADES LATER, and can you imagine what the exponential rate would be given the burst of technological advances since then? I literally couldn’t even begin to compute this no matter how much I wanted to search the current number of direct/indirectly related journals for our field. Even back then there was an overabundance of literature compared to the time it took to find, read, and interpret it.

So why are we either so hard on ourselves to keep up with ‘The Einsteins’ or look the other way and turn our back on it altogether? I don’t believe it has to be a one-or-the-other kind of attitude, and this article, focusing on efficiency, validity, and applicability, helped me understand some new ways to develop this new appreciation.

wheat chaff how to read journals 2

I’ll admit that even though I grew up in the midwest, I don’t quite know what a chaff is that the article makes reference to for separating out something. But I do know these days it’s as hard as ever to constantly be sorting out fact from fiction, in almost any area of life. We are also bombarded with information 24/7, that by the time we actually do feel like we’re catching up, some newer version is already being introduced.

Sackett suggests we can either a) let information find us by subscribing to selected journals/organizations, being aware in conversations with colleagues and peers, or being given a resource by another; or b) we can find information we want to use for specific purposes.

Should we rely on one more than the other? No.

Are we alone in this internal struggle? No. The medical community shares this burden of information overload as well:

“a continuing challenge to the practice of medicine: the necessity to recognize and respond to the need to change our diagnostic and therapeutic maneuvers so that they remain consistent with valid new knowledge is critical.”  p. 555


So how do we balance this duty to know more but not too much? And also know the “right” information?

The table presented in the first “How-To” Read a Research Article Blog Post was actually referencing Sackett’s original work (think I did this backwards…), so I won’t repeat all the reasons why clinicians read journals again that’s mentioned.

Before moving on and skipping over some other continued points from “How-To” Read a Research Article Blog Post, now could be a nice time to take a moment to reflect on why YOU go to research? Why do YOU want to be and do better? What do YOU want to know more about? How does research help YOUR patients’ recovery? If we’re not asking ourselves questions,

“we may not simply be behind in our reading; we may be falling short in our clinical practice.”  p. 555

Would you want to see a physician who uses a technique everyone and their mother knows for certain has been disproved and not effective in the slightest? Would you trust a dentist who even though best practices state one thing, he/she ‘swears by’ using this rock and string to extract that molar?


Instead of deconstructing a clinical research article, Sackett’s approach gives more of a “quick-and-dirty” plan of attack for reading research. A simpler version, but similar to the chart in “How-To” Read a Research Article Blog Post, is also included in the full article, so I suggest referencing either if desired.

Disclosure: These strategies assume the readers are “already behind in their reading and that they will never have more time to read than they do now.” So, if you’re planning on having loads more time with less distractions in the near future, a more detailed and comprehensive method may be better for you. 😉

        1. Look at the title

Okay, yes it’s probably the easiest and most common sense thing to do. Just easing you in first, okay? Sackett even says to go to the hockey rink if the title doesn’t spark interest or relevance for you! So cross this off your To-Do list, pat yourself on the back for coming this far, and keep moving along!

        2. Review the list of authors

This one I’m personally a fan of and try to go a step further by skimming over the references provided (you know, that tiny font list at the end you might sometimes choose not to waste ink to print?). Doing so can give you even more related information that you may actually need to know to understand the current article (and thereby giving me more to read for you guys!). The good part about glancing over the authors is, no matter what topic you are focusing on—aphasia, dysphagia, voice, child langauge—we all know the “big names” in that area, and that can tell you the significance and/or quality of the study. However, 2 BIG CAUTIONS: sometimes even the “big names” may *gasp* produce lesser quality studies, and researchers at one point are all new and/or unknown, so

“like the work of unknown sculptors, that of unknown authors deserves at least the following passing glances.”  p.557

        3. Read the summary

This may seem like another “common-sense” one, BUT did you know that the summary (typically nicknamed Abstract these days) used to be at the end of a research article?!  While you can’t necessarily always evaluate if every part of the article is valid from this opener, within seconds you can decide if it’s worth more investigating and time. So I wanted to reiterate it again merely to really appreciate what is now the norm for us busy clinicians 😉 .

        4. Consider the site

I’ve thought about the ‘site’ by lumping multiple parts together–the location/facility where the study was held (e.g. hospital, clinic, skilled nursing, etc.); the technologies/experiences the investigators used (e.g. sEMG, VFSS, deep-brain stimulation, etc.); and the population the study looks at such as healthy vs disordered, young vs elderly, etc.

The bigger questions come when trying to see if all of these parts are similar to your environment. Would it be helpful reading a study that focuses on critically acute patients if your setting is different? Would you have access to some of the equipment used, or experience with certain interventions? If an article describes using standardized, lengthy measures to achieve the results you are wanting, but you’re in a setting without these available, would the results still be applicable to you?

On the other hand, JUST BECAUSE something does not match up perfectly, does NOT mean it cannot be relevant. You might be a clinician without available testing materials, but maybe that article is the way to show your administrators why you need these to achieve similar results! Basically, it’s super important to be critical of the background of an article, but also be open-minded enough and understand just what it is you are looking for.


So now that you may have a couple more tools to use for—as Ernest Hemingway is quoted in the article, your “crap detector,” and can take in stride that us SLPs are fighting the good fight with many others, it’s on to “Easy Street,” right? Sorry.

thats now how this works meme

BUT–you are ONE STEP CLOSER to being more informed!! A final caution is to always be aware of journals and how articles are published in general. Like with articles, there are more renowned journals that may have higher standards than others, which can affect the quality of articles within the journal. Truth be told, some journals may only publish articles that show “true” or “significant results,” but may not look further into how these results came about or were used the correct way.

I’ll also give you a quick heads up that, after completing all the above tips—there will be more to read and interpret 😮 . And even though the shortcuts above may be a good starting point, the nitty gritty really can be in the details (aka the Methods and Results section). As Sackett put it, “the ‘Conclusion’ giveth, but the ‘Materials and Methods’ taketh away.” 

How can you use this article?!?

Can’t wait to go out and get your hands on some articles to use all these tips and tricks?!?! If so, great, I CANNOT WAIT to hear what was helpful or what you realized you may have already been doing!! If not, don’t sweat it. Go listen to some classical music before chatting up your friend in the medical field about how they stay on top of the latest research 😀

sophaces desire to learn

Stay tuned for more reviews on “How-To” Research (think systematic reviews, meta-analysis, and implementation) !!!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Article referenced: [FREE ACCESS]

How to read clinical journals: I. why to read them and how to start reading them critically. Can Med Assoc J. 1981;124(5):555-8.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705173/pdf/canmedaj01477-0031.pdf

 

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