How To Read A Journal Article

How to read a journal article
By Mick Draper
Last update August 2016
Contents
Peer Review ........................................................................................................................................ 1
Assessment of Articles ........................................................................................................................ 2
The Article Aims Section ................................................................................................................. 2
Types of Study ..................................................................................................................................... 3
The Article Introduction Section ..................................................................................................... 5
The Article Methods Section ........................................................................................................... 6
The Article Results (Outcomes) Section .......................................................................................... 8
The Article Discussion (Conclusions) Section .................................................................................. 9
One of the most difficult things you will have to do in your course is to read journal articles
and critically evaluate them. This takes practice but you will get better at deciding on the
worth of articles. You’ll to read and evaluate a wide range of article types. This document
will help you to critically review articles. The information below should help you to read
‘scientific’ and social sciences articles.
Peer Review
Most academic journals focus on articles that report original research, or review the literature.
The editorial board of an academic journal is established to ensure the quality of the
published articles. Core journals in pharmacology, life sciences, medicine and most other
disciplines also use experienced academics in the discipline to assess the value of articles
submitted for publication. This is called peer review. With occasional exceptions this system
works well to provide authors with advice about changes that will improve articles before
they are published. Peer review is an established quality control method that aims to ensure
that only quality articles are published in reputable journals.
Journals that don’t use peer review are considered less reliable. Most articles submitted to
prestigious core journals are rejected. If the editorial board and the peer reviewers are
working well together those articles that are published should be of high quality.
1
Characteristics of Quality Articles
There are ten major characteristics of quality academic journal articles.
If the article you are reading doesn't have all ten then it isn't a first rank article, but it may still
contain useful information.
High quality articles:

1 Examine important issues.
2 Are original, or compare particular interventions for efficacy, or join studies together to
increase the reliability of results (or make a significant review of the literature).
3 Are well written to be comprehensible.
4 Are written by authors who have no conflict of interests.
With the exception of review articles they

5 Have a testable hypothesis.
6 Actually test the hypothesis.
7 Have an adequate sample size.
8 Have adequate controls.
9 Use an appropriate statistical analysis performed correctly.
10 Draw justified conclusions.
Most science based articles use the AIMRaD format
Abstract, Introduction, Methods, Results, and Discussion.

There will be a list of references cited, at the end of the article.
Assessment of Articles
The Article
Aims Section
Why was the study done, and what hypotheses were tested?
This may determine whether you want to continue to assess the article or not. There should
be short comments early in the abstract or introduction that makes clear the background of
the article and its aim. The title of the article should give you a strong indication of what
you’ll find in the article.
Hypotheses
The hypothesis should be a concise, specific and testable statement of the purpose of the
article. Some authors might use the null hypothesis, the contention that something tested will
not produce any result beyond that expected by chance. An example might be something like
this
Biopsies of nasopharyngeal cancers are not representative of the entire cancer.
Authors don't necessarily believe the null hypothesis, but set up a hypothesis that can be
falsified to test its validity. Evidence based practice articles usually don’t use a null
hypothesis but have a statement of objective that asks if there is evidence of efficacy for a
particular intervention.
2
Types of Study
Primary studies
These report actual research such as laboratory experiments. These are usually test tube type
experiments that can lead to experiments on living organisms. Authors may use the term in
vitro to indicate that their work is a test tube study.
Animal experiments
These look at the effect of interventions on whole organisms. Animal experiments can often
indicate whether human trials are warranted Authors may use the term in vivo for these sorts
of studies.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=pubmed&term=25059539
Trials
Phase I trials
These early trials are usually conducted on small numbers of healthy volunteers to look for
adverse effects of interventions.
Phase II trials
These use small numbers of selected patients, or a series of patients often without a control
group to examine the outcome of an intervention.
Phase III trials

Large, long term trials on patients, often with randomised control, double or single blinding,
placebos etc.
Patients in a randomised control trial (RCT) are randomly assigned to the treatment group, or
the control group. Those in the control group either receive no treatment, sham treatment or a
placebo. Both groups are followed for a set time and analysed for outcomes. On average the
two groups should be identical except for differences produced by the treatment. Ideally
RCTs should be double blind trials with neither the patients nor the researchers knowing who
is receiving treatment.
Phase IV trials
These are usually post marketing trials on very large numbers of patients to gauge the long
term safety and find rare adverse effects of interventions.
There are non-randomised controlled trials conducted when random allocation is impossible,
difficult, or unethical.
Observational Studies
These studies are often used when intervention isn’t possible or ethical and often if it is
unnecessary. No ethics committee would approve of asking people to smoke tobacco to test
whether it’s unhealthy.
3
Cross Sectional Surveys
These examine the study characteristic and the outcome at the same time. In looking at a
diagnostic test, a cross sectional study would be concerned to find such things as the number
of patients with a condition not picked up by the test, and the number of patients without the
condition who were given false positive readings.
Cohort Studies
Two or more groups are selected on the basis of their differing exposure to some agent such
as an environmental pollutant, a drug of abuse or an intervention. Groups are followed to
measure whether the subjects develop a particular disease or other outcome. Cohort studies
often run for long periods because diseases such as cancer can take many years to develop.
Case Control Studies

Patients with a particular disease or addiction are identified and matched with controls such
as the general population, neighbours, relatives, etc. Data on exposure to agents from the
patients' past that might cause disorders are then collected. Case control studies are usually
appropriate in rare diseases where there are not enough patients for a cohort study.
Secondary Studies use the results of previous research.
(non-systematic) Reviews
These are summaries or syntheses of primary studies, often by 'experts'.
Systematic Reviews
These are articles that bring together all the objective studies on certain interventions for
particular conditions. Sometimes authors do this to compare interventions, and sometimes to
join study results to increase the size of the population tested (Meta-analysis).
Clinical Practice Guidelines/Decision Analyses

Guidelines and decision analysis trees should be evidence based serial statements to assist in
diagnosis and treatment of particular conditions. These should not be based only on expert
opinion which comes from received wisdom rather than unbiased evidence.
If it isn’t possible to find good evidence for every step of a guideline or a decision tree, then
the article should make this clear.
4
The Article
Introduction Section
The introduction should tell you why the research is important.
Opiate addiction relapse is devastating for individuals and the community.
This should be followed by a review of the existing knowledge of the subject. Ideally this
will place the current work in the appropriate context. It’s important that authors have read
widely and not missed any of the important literature in the field.
The introduction should become more specific as you read it.

Naloxone is a relatively safe treatment for some addictions and isn’t itself a drug of abuse.
Naloxone and buprenorphine are safe to use in combination and each has a different mode of
action.
At the end of the introduction you should know why the author(s) did the study.
No study has yet examined the efficacy of naloxone and buprenorphine used together in
reducing the incidence of opiate addiction relapse.
You should be able to check this quickly using the major health sciences databases such as
PubMed, Embase, and PsycINFO.
[This means that being able to use these databases is a clinical skill!]
You should ask yourself

Did this study add value to the literature?
Original studies usually do. Other studies that check the validity of earlier work, or add to the
population tested may have value. Perhaps a later study was continued for longer, used a
bigger or different population (gender, ethnicity, age, medical history, etc.), or had a more
rigorous methodology, or some other factor that makes a significant contribution to
knowledge in the discipline.
Did the author(s) find the significant existing literature in the field?
This will be a challenge when you’re just getting started. You probably won’t know the
important articles, but be encouraged because there are databases and librarians who can help
you find them. When you are just getting started, looking at articles that review the literature
in a particular field can be very helpful in pointing you at the important research.
If the authors of the articles you are reading don’t mention important work in the discipline
should you continue to read the article? We hope that rigorous peer review will make sure
that significant past work was examined by the article authors. Check the bibliography to
make sure such work is included.
5
The Article
Methods Section
You should spend most of your energy on examining the methods section of articles.
You should ask yourself

Are the methods clearly defined?
It should (usually) be possible for others to repeat the study by following the methods
described in the article.
Make sure there is sufficient information on

 the population examined
 the experimental design
 the techniques used
 the results measured
 how bias was avoided
 the statistical analysis
Population (human or not)

Is the population in the study sufficiently defined?
How were they recruited, and was there bias in this method?
What were the age, sex, ethnic, illness, and medication characteristics of the population in the
study?
Who was excluded from the study?
Design
Is the experiment/intervention described in detail?
Is the study design appropriate?
Are there details of dose, frequency, follow up period etc.?
Are there details of what was done with any control group?
The best design options vary with the type of study. Here are some studies and their best
designs.
Diagnosis
Checking the validity and reliability of a new diagnostic test would best use a cross sectional
survey in which both the new test and the current best test are performed and compared.
Screening
Studies that check the value of tests for application on large populations should normally use
a cross sectional survey method.
Therapy
Experiments that test drug treatments, surgery, patient education and other interventions are
best tested using randomised controlled trials.
6
Prognosis
The preferred study design is a longitudinal cohort study. These studies must be continued for
long enough to measure the outcomes.
Causation
These studies determine whether an agent such as an environmental pollutant is related to
illness.
The preferred study design is a cohort or case control study depending on the rarity of the
condition.
Qualitative Research
Qualitative articles should still include clearly defined methods and populations. The authors
should tell you how they selected participants and the differences between groups of
participants studied. Were people paid to be involved? Were there time limits on interviews?
Was there follow-up of groups? Often qualitative articles will not test hypotheses but
generate them. You should ask yourself if any such hypothesis is important. Are these
hypotheses testable?
Objectivity
Bias is anything that can distort conclusions.
Bias is usually associated with the differences in groups that are compared.
The groups at the start should be as much like each other as possible.
You should make sure that the article you are reading gives sufficient detail of treatment and
control groups to show they are the same except for the intervention. Confounders are aspects
of the study that can make them less objective. Were some of the patients smokers, have
chronic disorders, very young, or very old etc.?
Bias in Cohort Studies

Cohort studies usually can’t produce similar groups.
The researchers should use some sort of complex statistical analysis to adjust for baseline
differences. The authors should explain clearly what they have done.
Bias in Case Control Studies

The major source of bias is whether an individual is a case or not.
Articles on case control studies should detail how the diagnoses were made and the reliability
of the methods.
Bias in Trials; Blind Assessment

Researchers tend to find what they expect to find.
Clinicians are more likely to recheck an unexpected outcome if they know the patient is in the
intervention group.
To avoid bias, studies should be double blind where possible, so that neither the patients nor
those who examine them know who is receiving the intervention.
7
The Article
Results (Outcomes) Section
What outcomes were measured and how?
Is there evidence that the outcomes are valid?
Are the outcomes measured significant for the patients; do the patients live longer, have
better quality of life, get cured etc.?
Do the authors present the results in a way that’s easy to understand? Are the graphs and
tables clear?
You might like to think about whether you want to look at the raw data from the article.
Some journals now require authors to make their data available to readers.
Statistics
Preliminary Statistical Questions
Was the sample size big enough for appropriate statistical analysis?
In a trial the population tested should be big enough to be reasonably sure that if a
worthwhile benefit or adverse effect of the intervention exists it will be found.
Authors should complete a 'Power Analysis' before beginning their study. Authors may refer
to this as ‘Statistical Power’. This will tell them how many patients (etc.) need to be tested
to detect a clinically significant effect. The chance of detecting a difference in the treatment
group and the control group should be 80 to 90%. An article describing a RCT should have a
sentence or two that states that the authors ran a preliminary analysis to find the number of
patients required for the trial. If the article doesn't tell you this detail you could do the
calculation yourself.
Check in a basic statistics book to see if the tests used are standard for the sort of data
collected. If authors have used an unusual test they should explain why, especially if the data
collected is what you’d expect and the collection method isn't unusual.
You'll need to develop some basic statistical knowledge to make sure that you can tell when
appropriate tests are used in an appropriate manner. You may, on occasion, need to consult an
expert on statistics to do this.
What was the duration of follow up?

The study must be continued for long enough to see the effect of the intervention or the
manifestation of an exposure, and to see if the effect continues.
The reasons patients drop out of clinical trials are often significant for the trial results.
All the patients in both the intervention and control groups should be included in the analysis
whether they completed the trial or not. If dropouts are ignored this biases the study.
8
The Article
Discussion (Conclusions) Section
You must be convinced that the conclusion(s) reached by the author(s) are valid being
supported by the methods and the results.
In this section the authors will interpret their results.

Look at the language to see if the authors are confident of their interpretation. If they aren't
should you be?
Are the results consistent enough to justify the conclusions?
Are the conclusions biologically sound?
Is there a dose-response relationship in the results?
Can the results be extrapolated to other situations or other patients?
Are there areas that the study should have addressed but weren’t?
How is the hypothesis looking now?
Often the question for you to ask is "Can I use this result?"
Is the work going to be applicable for a different set of patients in a different environment?
For example is a particular medication available to the patients or is it too expensive, or not
approved by the government.
Are there practitioners who are capable of managing patients under the regime described in
the article?
Is it culturally appropriate to use a particular intervention?
For more detail look at the

Critical Appraisal Skills Programme (CASP) Checklists
http://www.casp-uk.net/#!casp-tools-checklists/c18f8
These are appraisal tools for deciding on the value of research articles including
Systematic Reviews, Randomised Controlled Trials, Cohort Studies, Case Control Studies,
Economic Evaluations, Diagnostic Studies, Qualitative studies and Clinical Prediction Rule.
Joanna Briggs Institute Critical Appraisal Tools

Published in 2016, this document is a set of checklists for reading different
article types. You’ll find explanatory notes for each of the checklist items.
There are currently 13 article types included.

How To Read A Journal Article

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How to read a journal article

High quality articles:

With the exception of review articles they

Most science based articles use the AIMRaD format

Abstract, Introduction, Methods, Results, and Discussion.

Phase III trials

Case Control Studies

Secondary Studies use the results of previous research.

Clinical Practice Guidelines/Decision Analyses

The introduction should become more specific as you read it.

You should ask yourself

You should ask yourself

Make sure there is sufficient information on

Population (human or not)

Bias in Cohort Studies

Bias in Case Control Studies

Bias in Trials; Blind Assessment

What was the duration of follow up?

In this section the authors will interpret their results.

For more detail look at the

Joanna Briggs Institute Critical Appraisal Tools

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