How To Select Medical Journal

How to select
medical journal?
Surat Tanprawate, MD, MSc(Lond.), FRCPT
Division of Neurology, Department of Medicine
Chaing Mai University
Tuesday, 31 May 2011

The failure of common
sense

sense
• I shake a tree, an apple falls out, now I
can eat

sense
can eat
• I give antibiotics for sinusitis, the patient
gets better, I’m doing a good job as a
doctor

sense
can eat
• I give antibiotics for sinusitis, the patient
gets better, I’m doing a good job as a
doctor
• I just saw a patient with tumor lysis
syndrome, I will start looking for it more
and maybe I’ll find it more

“Where is the wisdom we have lost
in knowledge,
and the knowledge we have lost in

information?”
Three levels of reading
1. Browsing, in which we flick through books and journals
looking for anything that might interest us.
2. Reading for information, in which we approach the

literature looking for answers to a specific question, usually
related to a problem we have met in real life.
3. Reading for research, in which we seek to gain a

comprehensive view of the existing state of knowledge,
ignorance, and uncertainty in a defined area.

WFME Global Standards
for PG Medical Education
• Basic Standard
• The trainee must … … become familiar
with EBM and critical clinical decision
making
• Quality Development
• The trainee should have formal teaching
about critical appraisal of literature,
scientific data and EBM …
Evidence based medicine requires you
not only to read papers but to read
the “right papers” at the
“right time”
Then to alter...
your behaviour (and, what is often more
difficult, the behaviour of other people) in
the light of what you have found
Essential step
1. Patient problem
2. Clinical question
3. Search for evidence
4. Critical appraisal of the evidence
5. Apply the results
Sackett DL, Haynes B. Evidence based Medicine

1995; 1: 4–5.
Before we start:
“formulate the problem”

The Answerable Question

Forming a searchable public
health question
• The PICO framework used in evidence-
based medicine can also be used to create
a searchable question in public health
• P Patient, population, problem
• I Intervention (program or treatment
or screening test)
• C Comparison (if any)
• O Outcome
Search of
evidence

Every day …
• the results of ~ 46 randomised clinical trials are

published
• ~ 1000 new Medline articles
• ~ 6,000 new articles in biomedical journals
Every year …
• ~ 3 million articles published in ~ 30,000 journals

• Not all of this information is valid or useful
for patient care
• a little more than 1% is both rigorous and

clinically relevant

Source of information
• Primary: searches of journal databases:

Medline, Psychinfo
• Secondary: Cochrane, Bandolier, Clinical
Evidence
• National Electronic Library for Health

Primary Journal Database

Secondary Journal Database

EBM Databases
Evidence Based Medicine Reviews
(EBMR)
-Commercially available thru OVID
-Searches a variety of databases
Cochrane Database of Systematic Reviews
ACP Journal Club
Medline
-Links databases together

PubMed Search Consolidation
Search Strategy
Selection of search terms
• Keywords
• Phrases
• Synonyms
Combination of search terms

• Boolean logic
Application of limits
• Occurrence of search terms
• Title, Title/Abstract, All fields
• Types of articles
• Age groups
• Etc.
Boolean logic
• AND: Combines terms to limit your search as both
concepts must be present in all retrieved articles
• Example: osteoarthritis AND knee*
• OR: Widens your search as either term can be present

in all retrieved articles
• Example: osteoarthritis OR arthritis
• NOT: Limits your search by excluding a concept as

one term must be present and the second term must
not be present
• Example: osteoarthritis NOT hip

Three preliminary questions to get
your bearings
• Question 1:Why was the study done

and what hypothesis were the authors
testing?
• Question 2:What type of study was

done?
• Question 3:Was this design appropriate

to the broad field of research addressed?

Types of “paper” research evidence
Primary studies
Case studies
Experiments
Surveys
Clinical Trials
Secondary studies
Non‐systema6c reviews
Systema0c reviews
Meta‐analyses

Guidelines

Decision analyses
Economic analyses

Topics of Primary Study and Types of Study Design
Phenomena
Observation / qualitative studies
Etiology
Cohort studies (or Case-control studies)
Diagnosis and screening

Cross-sectional analytical studies
Prognosis
Cohort studies
Intervention
Randomised Controlled Trials

Choosing a paper
• Relevance for the purpose
• Purpose may be clinical problem-solving;
informing about new treatment or
diagnostic test
• Search efficiently
• Recent and best available paper
• Avoid case reports
Where do i find the
information?

Where do i find the
information?
• Title, Abstract or final paragraph of

the Introduction should clearly state the
question

Where do i find the
information?
• Title, Abstract or final paragraph of

the Introduction should clearly state the
question
• If you still cannot ascertain what the
focused question is after reading these
sections, search for another paper

ABSTRACT
Should I Spend My Time
Reading This Paper ?
States the Purpose of Article, Major Procedures

and Methods, Main Findings, and Conclusions
More and More Journals are using

Structured Abstracts

Avoid !
• The study did not examine an important scientific
issue
• The study was not original – that is, someone else has
already done the same or a similar study
• The study did not actually test the authors’

hypothesis
• A different study design should have been used
• Practical difficulties (for example, in recruiting

subjects) led the authors to compromise on the
original study protocol
• The sample size was too small

Avoid !
• The study was uncontrolled or inadequately controlled
• The statistical analysis was incorrect or inappropriate
• The authors have drawn unjustified conclusions from

their data
• There is a considerable conflict of interest (for

example, one of the authors or a sponsor might benefit
financially from the publication of the paper and
insufficient safeguards were seen to be in place to
guard against bias)
• The paper is so badly written that it is

incomprehensible

Essential step
1. Patient problem
2. Clinical question
3. Search for evidence
4. Critical appraisal of the evidence
5. Apply the results
Sackett DL, Haynes B. Evidence based Medicine

1995; 1: 4–5.
Case scenario

A case scenario
• A 60-year old patient, known hypertensive,

presents with sudden onset headache,
vomiting, left hemiplegia and altered
consciousness starting 3 hours ago

CT Scan

• Patient problem
• Intracerebral hemorrhage with cerebral
edema
• Clinical question
• Surgical role

Surgery of ICH
• Cerebellar: >3 cm in diameter and

altered sensorium
• Hydrocephalus: External drainage
• Supratentorial

Supratentorial ICH

Prasad K et al.Surgery
Prasad Kfor primary supratentorial
et al.Surgery intracerebral
for primary supratentorial haemorrhage.
intracerebral haemorrhage.
Cochrane Database of Systematic
Cochrane Database ofReviews 2008,
Systematic Issue
Reviews 4. Art.
2008, IssueNo.:
4. Art. No.:
CD000200. DOI:CD000200. DOI: 10.1002/14651858.CD000200.pub2.
10.1002/14651858.CD000200.pub2.

Prasad K et al.Surgery for primary supratentorial intracerebral haemorrhage.
Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.:
CD000200. DOI: 10.1002/14651858.CD000200.pub2.

Medicine Neurology

Greenhalgh T. How to Read a Paper:
The Basics of Evidence-based
Medicine. London; BMJ; 2006.
Clear and concise. Book based on a
series of papers published in the
British Medical Journal (see course
web page for PDFs)
Elwood MJ. Critical Appraisal of

Epidemiological Studies and
Clinical Trials. London; Oxford
University Press; 2007.
Thorough coverage of epidemiological
principles as well as providing a nice
approach for critical appraisal.
One of the best epi books ever written.

Thank you for your
attention
My Deepest Gratitude to Dr. Siwaporn Chankrachang

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How to select

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011

and the knowledge we have lost in

2. Reading for information, in which we approach the

3. Reading for research, in which we seek to gain a

Tuesday, 31 May 2011

Sackett DL, Haynes B. Evidence based Medicine

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011

• the results of ~ 46 randomised clinical trials are

• ~ 1000 new Medline articles

• ~ 6,000 new articles in biomedical journals

• ~ 3 million articles published in ~ 30,000 journals

Tuesday, 31 May 2011

• a little more than 1% is both rigorous and

Tuesday, 31 May 2011

• Primary: searches of journal databases:

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Combination of search terms

• Example: osteoarthritis AND knee*

• OR: Widens your search as either term can be present

• Example: osteoarthritis OR arthritis

• NOT: Limits your search by excluding a concept as

• Example: osteoarthritis NOT hip

Tuesday, 31 May 2011

• Question 1:Why was the study done

• Question 2:What type of study was

• Question 3:Was this design appropriate

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Diagnosis and screening

Tuesday, 31 May 2011

Tuesday, 31 May 2011

• Title, Abstract or final paragraph of

Tuesday, 31 May 2011

• Title, Abstract or final paragraph of

Tuesday, 31 May 2011

States the Purpose of Article, Major Procedures

More and More Journals are using

Tuesday, 31 May 2011

• The study did not actually test the authors’

• A different study design should have been used

• Practical difficulties (for example, in recruiting

• The sample size was too small

• The statistical analysis was incorrect or inappropriate

• The authors have drawn unjustified conclusions from

• There is a considerable conflict of interest (for

• The paper is so badly written that it is

Tuesday, 31 May 2011

Sackett DL, Haynes B. Evidence based Medicine

Tuesday, 31 May 2011

• A 60-year old patient, known hypertensive,

Tuesday, 31 May 2011

Tuesday, 31 May 2011

Tuesday, 31 May 2011