An educational column by

Keeping abreast of scientific literature is mandatory for vascular access specialists (VAS) and clinicians. The importance for clinicians is acutely relevant because they implement evidence-based practice at the bedside. If the VAS does not keep up-to-date with current literature, they cannot competently serve their patients. Unfortunately, little time is spent teaching “how” to read and vet the literature. Numerous types of articles are found throughout the literature spectrum such as original or research articles, case reports (and case series), reviews, commentaries, editorials, and letters to the editor.1 Original or research articles will be the focus of this article and should consist of an introduction, methods, results, and discussion (Sometimes referred to as IMRAD). Before we talk about the original or research article, briefly, let’s talk about other papers. Case report (and case series) articles describe a unique case, or cases, with the purpose of teaching and comminicating how similar cases should be handled. As such, case reports should have a short, unstructured, abstract (if abstract is present), a brief introduction, the report of the case itself, and a discussion of what can be learned from the case.1 Reviews consolidate and highlight the material on one topic. As such, they should have an unstructured abstract, introduction with subheadings, and perhaps a discussion synthesizing the literature reviewed.1 Commentaries, editorials, and letters to the editor are all good ways for the novice or experienced VAS to get their feet wet in terms of contributing to the literature. All will be somewhat unstructured and not have an abtract, and all communicate the article author’s opinion. It is the goal of this paper to present a general approach to reading the literature with a focus on original or research articles.Reading the literature is a learned skill which improves with deliberate practice. Competence gives way to expertise, leading to understanding and synthesizing literature to support clinical decision-making. Developing this expertise allows the systematic reading of the literature to become a habit, and the time invested in developing this skill set reaps numerous benefits supporting clinical practice. We hope the information found in this article provides a starting point and foundation to guide the interprofessional group of VASs who find themselves reading the clinical literature. Reading the literature can be a complex task, but it can be broken down into smaller components making the skill easier to learn and readily attainable with intentional practice.Before the VAS embarks the literature and chooses an article, she or he should identify and understand their goal. A new aspect of vascular access? Increased understanding of a specific vascular access procedure? Maybe you were asked to review the article as a peer reviewer or by your supervisor. The VAS’s goal for assessing the article should influence how she or he reads the article.2 After choosing an article of interest, you should initiate reading the article efficiently and methodically.Begin by evaluating the authors’ goals for investigating and communicating the results. First, identify the type of article being read. The type of article influences how different information is presented. By realizing the authors’ goals, you will better understand why the data are presented.2For example, assuming you have chosen a title related to vascular access, does it have keywords of interest? Assuming the article being read includes keywords of interest, you are ready to move on to the next step – reading the abstract and conclusions. First, critically evaluate the following: are the aims and objectives clear-cut, and is the research hypothesis, purpose, or goal well-defined. Think in terms of a patient/population, intervention, comparison and outcomes (PICO) question.3 Next, assess the conclusions to determine if they are clear and accurate. Finally, ask yourself if the article’s aims, hypothesis, and conclusions relate to your situation or practice.4 If the answer is yes, spend time reading the article from the beginning, starting with the title and abstract, keeping in mind that even the most skilled readers often read and re-read articles of interest multiple times.Most articles are broken into five sections: Introduction, Literature Review, Materials & Methods, Results, and Discussion. Therefore, you should take a purposeful approach to reading each section.The Introduction presents background material and represents processes before the research occurs. It provides a rationale or the “why” for starting the study.4 This section must outline the knowledge gap and is critical because it demonstrates the originality of the research and why it was undertaken. Analyzing the knowledge gap ensures the reader that the authors have done due diligence and are adding to the literature in a meaningful way.5Best practice dictates an educational framework or theory must be applied and briefly discussed or explained for articles reporting on educational studies. There is no one particular educational framework or theory, but the author should choose one because it informs and frames the entire process for the educational research undertaken. Finally, the aims or purpose of the study should be included as the last line of the introduction; for example, “The purpose of this study was to compare X to Y vascular access products and their patient outcomes.”The Literature Review section is sometimes integrated into the Introduction. However, it is a critical part of the reporting process of any investigation. The Literature Review provides and supports the context of the research being done and the authors’ interpretation of the study’s results. In general, the Literature Review should identify and briefly review the cornerstone or foundational literature as well as the more recent literature (preferably within the last five years) to support the aims or purpose of the study.More precisely, Templier & Paré suggest six components be evident in the literature review6: Formulating the research question(s) and objective(s)Searching the existing literatureScreening for inclusion and relevanceAssessing the quality of primary studiesExtracting dataAnalyzing dataIn the case of educational studies, the Literature Review must also provide references identifying and supporting the educational framework or theory foundational to the research conducted, as well as the authors’ interpretation of their results.The Materials & Methods section provides the technical details of how the investigation was implemented. In a perfect world, all the investigation details would be included so the study could be repeated. Unfortunately, due to practical constraints, this is rarely done; however, enough information should be included to determine clearly how the study was conducted.7The sample size and mention of a power analysis should be included as well as sampling methods, a summary of inclusion and exclusion criteria, statistical methods, and statistical software. The use of spreadsheet software (e. g., Microsoft Excel, Google Workspace, Apple Numbers, LibreOffice Calc) for statistical analysis is considered insufficient and represents a red flag to the validity of the evaluation. Spreadsheet software is designed for accounting and organizing data, but it should not be used for statistical analysis.8–11 Instead, look for names like R, S-Plus, SAS, SPSS, and STATA, which are typical statistical packages. We also recommend the serious reader acquire and use statistical references to bolster their understanding of statistical methods, such as PDQ Statistics.12The Results section details the outcomes of the study. This section should be distinct from the Discussion section. It is often one of the shortest sections of an article because it represents only the results without bias. Take the time to study each table and figure. Unpack the information in each and fully comprehend what the authors of the article are trying to communicate.2 This is the up-close-and-personal examination of the data. The primary demographics of the sample should be presented by treatment groups, if applicable, but the baseline characteristics of the groups should not be tested.13–16 Statistical tests should not be applied to see if there is statistical evidence of a difference between treatment groups.The easiest way to see this is in a Consolidated Standards of Reporting Trials (CONSORT)-like diagram (Figure 1).17 In reporting results, you should not only make sure there is a P value reported, but some effect size should be reported. For example, the Common Language Effect Size (CLES) should be reported for a paired analysis or two-sample test.18 There are many different effect sizes in the literature, and some more common ones include r (the correlation coefficient), relative risk, odds ratio, hazard ratio, and number needed to treat (NNT). Others have more cryptic names like d and eta-squared.19 We will talk about effect sizes in general and more specifically in future articles.The Discussion is the article’s most important and arguably most interesting section. There are critical elements vascular access specialists should look for in the discussion section. Usually, the discussion begins with a brief synopsis of the results, followed by the article authors’ interpretation. In educational studies, the results must be interpreted through the lens of the a priori framework or theory i.e., the framework or theory specified before beginning the study.Simply reporting and interpreting a study’s result is insufficient; results must be compared and contrasted with the existing literature presented in the introduction or literature review sections. Additionally, the contribution of the current work previously mentioned should be included in this section.Finally, the study’s limitations must be presented, including the limitations potentially impacting the study and any extrapolation of the results across a broader context. Simply mentioning the limitations that were present is not acceptable (e.g., “The sample size was limited and only included patients identifying as white.”) Instead say, “Unfortunately, one limitation of the study was it only included patients identifying as white. This limited the generalizability of the study beyond this institution and even to patients of other races at this intitution. Another study with a more diverse sample will be needed to see if the results of the intervention are seen in other races.” The discussion section should conclude with a short paragraph labeled “Conclusions” with the study’s take-home message. The possible topics for future research should be presented in the concluding paragraphs. It is essential to remember the material presented in the discussion section is the article authors’ interpretations and opinions; readers are free to conclude what they will from the data presented.4In this article we outlined one approach to developing the skills for reading an article. The approach here represents one of many approaches to support competency and skill mastery associated with reading the literature for vascular access specialists. Carey et al., suggests readers ask six questions of articles being read.2 Subramanyam offers 40 questions readers may find useful when developing the skill of reading an article.4 Several questions are presented for each section. Questions and comments are encouraged regarding this article. Should you have questions or comments please contact AVA Foundation Director at Large Dr. Gregory E. Gilbert at SigmaStatsConsulting@gmail.com. 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