find primary research article

How to Find Primary Research Articles on Google Scholar

How to Find Primary Research Articles on Google Scholar can be a daunting task. But with the right tips and tricks, you can quickly locate relevant sources to inform your work or study. By leveraging advanced search features like My Library, you’ll be able to stay organized while exploring topics of interest in no time. Let’s dive into how best to find primary research articles on Google Scholar so that you can get started uncovering valuable insights today.

Table of Contents

What is Google Scholar?

Searching for primary research articles on google scholar, tips for effective searches on google scholar, utilizing advanced search features, keeping track of your research with my library on google scholar, additional resources for finding primary research articles on google scholar, faqs in relation to how to find primary research articles on google scholar, how do i search for only primary articles in google scholar, how do i find primary research articles, how do i find research articles on google scholar, how do you tell if an article is a primary or secondary source.

Google Scholar is an online search engine that allows users to find primary research articles. Google Scholar, established in 2004, is a powerful search engine that gives access to scholarly documents including theses, preprints, and books. By using advanced algorithms and natural language processing techniques it offers a more comprehensive view of academic publications than traditional databases or search engines like Google.

How to Find Primary Research Articles on Google Scholar has numerous advantages; it provides a convenient way for researchers to quickly find applicable sources needed for their research without having to browse through many web pages or databases. Secondly, its sophisticated algorithms allow researchers to refine their searches based on relevance and date published to easily narrow down results for specific topics or time periods. Finally, because it indexes content from across the web – including open-access repositories such as PubMed Central – users have access to full-text versions of articles that may not be available elsewhere.

Accessing Google Scholar is easy; simply go to scholar.google.com and start searching with keywords related to your topic area or use the Advanced Search feature if you want more control over your results (e.g., restricting by author name). You can also sign up for an account which will enable you to save searches, create alerts when new content is added that matches your criteria, and organize references into collections known as ‘My Library’ – making tracking progress on a project much more efficient.

Google Scholar is an invaluable resource for researchers looking to access primary research articles. With the right search techniques, you can easily find full-text articles on Google Scholar and maximize your research potential. Next, we’ll explore how to use the search interface and refine results in order to locate these resources more effectively.

“Easily find primary research articles for your #R&D project with Google Scholar. Advanced algorithms and natural language processing make it easier to narrow down results quickly.” #Cypris Click to Tweet

To make the process easier, it is important to understand the search interface and refine your results with filters and preferences.

The first step in searching for primary research articles on Google Scholar is understanding the search interface. This includes learning how to use keywords, Boolean operators (AND, OR, NOT), quotation marks (” “) for exact phrases, and wildcards (*). These search parameters can be employed to refine the results, making them pertinent to your inquiry.

Utilizing filters and personal preferences to narrow down search results can expedite the discovery of what is needed. With advanced features like citation tracking, “My Library” which allows users to save their searches, and “Similar Articles” for discovering related topics within a field of study, the research process is made easier. Additionally, keywords such as Boolean operators (AND, OR NOT), quotation marks (” “) for exact phrases, and wildcards (*) can be used to narrow down results in order to make them more relevant.

Finally, finding full-text articles is key when researching primary research papers on Google Scholar. The platform offers access to free versions of some publications through its “Find Full Text @ Your Library” feature but many require a subscription or purchase fee before viewing them in full detail online or downloading them as PDFs.

Exploring Google Scholar for primary research articles can be laborious, yet with some useful tips and tricks you can enhance your search results. Now that we have an understanding of the search interface, let’s explore how to refine our results and find full-text articles using advanced features such as filters and preferences.

Unlock the power of Google Scholar for primary research papers with advanced features like citation tracking, My Library, and Similar Articles. Use Boolean operators & wildcards to refine your search results. #GoogleScholar #ResearchPapers Click to Tweet

Google Scholar is an invaluable tool for researchers, scientists, and engineers looking to stay up-to-date on the latest research in their field. With its advanced search features, it can help you quickly find primary research articles that are relevant to your project or interests. Here are some suggestions to optimize your utilization of Google Scholar when seeking out primary research papers.

Google Scholar has several advanced search options that allow you to refine your searches and find more specific results. For example, you can limit your search by date range, language, author name, or journal title. Boolean operators, like “AND” and “OR”, can be utilized to form a single query by combining various keywords.

To refine your search even further, you can utilize the filters and preferences available on Google Scholar to narrow down results according to peer-reviewed papers from journals with high-impact factors or exclude certain authors or topics. For instance, if you want only peer-reviewed papers from journals with high-impact factors then simply select those filters before conducting your search. Additionally, if there are certain authors or topics that you would like excluded from your results then this too can be done via the preferences menu within Google Scholar.

Once you have located some applicable articles through basic keyword searches, delving into associated citations and related content can help to expand your understanding of the topic. This is especially helpful if there is not much information available on a particular subject yet, but still offers potential avenues of exploration worth pursuing further down the line. By exploring related articles and citations associated with each article one will often uncover new ideas which could potentially lead them toward interesting discoveries.

By making use of the sophisticated search capabilities, filters, and preferences provided by Google Scholar, one can easily identify primary research material related to their requirements. My Library on Google Scholar is an excellent tool for organizing and tracking your research; let’s explore how it works.

Key Takeaway  Google Scholar provides advanced search features, filters and preferences to help researchers quickly locate primary research articles relevant to their project or interests. By making use of these tools and exploring related articlescitations associated with each article one can uncover new ideas that could lead them towards interesting discoveries. Google Scholar is a great aid in locating pertinent research articles.

My Library on Google Scholar is a great asset for scientists and innovators to monitor their research progress. My Library enables users to construct a personalized repository of scholarly works, which they can organize into categories, export as bibliographies, or share with others.

Setting up a personal library in My Library is easy. To create a personal library, simply click the “My Library” link at the top right corner of any page on Google Scholar and select “Create new library” from the drop-down menu. Once your library has been created, you can start adding articles by clicking the “Save” button next to each article title in your search results list.

Organizing your library is also simple; simply drag and drop articles into different folders within My Library for easy access later on. You can also create collections of related topics or research themes which are great for organizing large amounts of data quickly and easily. Moreover, you can label articles with descriptors to make them easier to locate when needed.

By utilizing My Library on Google Scholar, researchers can easily keep track of their research and stay organized. Additionally, by exploring other databases in conjunction with Google Scholar as well as open-access journals and interlibrary loan services, they can find even more primary research articles to further their studies.

Key Takeaway  My Library on Google Scholar is a great resource for researchers and innovators to stay organized with their research. Creating a library is straightforward – just hit the ‘Create new library’ button in the top right of any page on Google Scholar, and then drag & drop articles into collections or folders to keep them ordered. Moreover, you can assign labels or tags to make it simpler to locate the material when necessary.

It can provide access to a wide variety of sources, including journal articles, books, and conference papers. Nevertheless, in order to broaden one’s search range, other databases and sources can be used alongside Google Scholar.

Using Other Databases in Conjunction with Google Scholar: Many academic institutions have their own subscription-based library databases that can be accessed through the institution’s website or portal. These databases may include full-text versions of some journals not available on Google Scholar as well as more comprehensive indexing than what is available on Google Scholar. Moreover, numerous universities offer access to specialized databases such as Web of Science or Scopus that enable users to search across multiple areas and sources simultaneously.

Open-access journals, which receive funding from sources such as the NIH and Wellcome Trusts, provide free online content under Creative Commons licenses for readers to share or reuse without permission. Open-access journals typically make all content freely available online and often use Creative Commons licenses so readers are free to share and reuse material without permission from the publisher or author(s). While these publications tend to focus more heavily on scientific topics rather than humanities topics they still contain valuable information worth exploring when searching for primary research articles related specifically to science fields such as biology or medicine.

If a desired article cannot be located elsewhere, interlibrary loan services may provide an avenue to acquire it through either physical or digital means. Through this service, users can request copies of materials held by another library either physically (through mail) or electronically (via email). This allows researchers who do not have immediate access to certain materials due to geographical restrictions the ability to acquire them nonetheless, thus greatly expanding their research capabilities beyond what would otherwise be possible with just local resources alone.

Key Takeaway  Google Scholar is a great tool for finding primary research articles, however there are other databases and resources that can be used in conjunction with it to maximize search capabilities. Additionally, open access journals may provide valuable content related to scientific fields while interlibrary loan services can also help researchers acquire materials from libraries located elsewhere.

To search for primary articles in Google Scholar, first, go to the main page and select ‘Advanced Search’. In the Advanced Search window, check off the box that says ‘Only show results from content I can access’ and then select ‘Include Patents’. Finally, click on ‘Search’. This will filter out all secondary sources such as reviews or books, leaving only primary research articles relevant to your query.

Primary research materials can be obtained through multiple avenues, such as searching online repositories, utilizing sophisticated search strategies, and consulting specialists in the discipline. Utilizing PubMed and other online databases, researchers can access an abundance of primary research articles covering a broad range of topics. Advanced search techniques involve combining keywords with Boolean operators (AND/OR) to refine searches for specific results. Consulting experts in the field is also an effective way to locate relevant primary research articles as they have specialized knowledge about certain areas that may not be available from other sources.

Begin your hunt for research articles on Google Scholar by inputting a keyword or phrase in the search field. You can refine your search results by applying filters such as date of publication, author name, and topic area. To further narrow down your search results you can use advanced search features like exact phrases and multiple keywords. Additionally, you may access scholarly literature through library databases that are connected to Google Scholar. Finally, save time by setting up email alerts for newly published papers related to topics of interest.

A primary source is an original document or record that provides first-hand information about a particular topic. Examples of primary sources can include interviews, diaries, letters, articles from when an event occurred, and photos and videos taken during the occurrence. Secondary sources are documents or records created after the fact by someone who did not experience the events firsthand. These may include books, journal articles, and reviews that analyze or discuss research already published by others.

How to find primary research articles on Google Scholar is an essential skill for researchers and innovators. With its advanced search capabilities, My Library feature, and additional resources available online, it can be an invaluable asset in the quest to discover new insights into any given topic. Whether you are looking for one article or hundreds of them on a specific subject matter – Google Scholar is here to help. Use these tips as your guide when searching for primary research articles on Google Scholar so that you can get the most out of this platform’s features.

Discover the power of Cypris to quickly find primary research articles on Google Scholar and unlock insights faster for your R&D and innovation teams. Unlock time-saving solutions with our comprehensive platform that centralizes data sources into one easy-to-use interface.

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Primary research or a primary study refers to a research article that is an author’s original research that is almost always published in a peer-reviewed journal. A primary study reports on the details, methods and results of a research study. These articles often have a standard structure of a format called IMRAD, referring to sections of an article: Introduction, Methods, Results and Discussion. Primary research studies will start with a review of the previous literature, however, the rest of the article will focus on the authors’ original research. Literature reviews can be published in peer-reviewed journals, however, they are not primary research.

Primary studies are part of primary sources but should not be mistaken for primary documents. Primary documents are usually original sources such as a letter, a diary, a speech or an autobiography. They are a first person view of an event or a period. Typically, if you are a Humanities major, you will be asked to find primary documents for your paper however, if you are in Social Sciences or the Sciences you are most likely going to be asked to find primary research studies. If you are unsure, ask your professor or a librarian for help.

A primary research or study is an empirical research that is published in peer-reviewed journals. Some ways of recognizing whether an article is a primary research article when searching a database:

1. The abstract includes a research question or a hypothesis,  methods and results.

2. Studies can have tables and charts representing data findings.

3. The article includes a section for "methods” or “methodology” and "results".

4. Discussion section indicates findings and discusses limitations of the research study, and suggests further research.

5. Check the reference section because it will refer you to the studies and works that were consulted. You can use this section to find other studies on that particular topic.

The following are not to be confused with primary research articles:

- Literature reviews

- Meta-analyses or systematic reviews (these studies make conclusions based on research on many other studies)

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• Finding and Using Primary Sources
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Finding and Using Primary Sources: Getting Started

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Need Help?   Ask a Librarian for help finding primary sources in the library. 

Librarians are available from 9am to 12am most days to help you with your research. You can reach us in person, via chat, phone, or email.

Primary sources are those created contemporaneously to whatever period a researcher is studying. In contrast to secondary sources, they don't provide any analysis on a given topic after the fact; instead, they reflect on information or events as they unfolded (for example, a newspaper article, from the time of a particular historical event, discussing the historical event as it happened). Primary sources are especially useful for researchers because they reveal how certain topics and ideas were understood during a specific time and place. The particular primary sources you might use in your research, as well as how you find them, can vary a lot based on your field of study. This guide aims to provide helpful information on where to go about searching for primary sources, both at Duke and beyond.

Examples of Primary Sources (explore the other tabs for more info):

• Photographs
• Government records
• Pamphlets and other ephemeral material
• Memoirs and autobiographies

Location-Specific Resources

This guide is meant to cover primary sources in a generalized way. Duke Libraries also has a collection of guides that go over primary sources based on location. Check these out if you're looking for primary sources related to a particular history or place! Keep in mind, too, that many of our subject guides also provide some information about accessing primary sources related to specific subjects.

Location-Specific Primary Source Guides at Duke:

• Primary Sources - Africa
• Primary Sources - Asia
• Primary Sources - Global British
• Primary Sources - Latin America/Caribbean
• Primary Sources - Middle East
• Primary Sources - North America
• Primary Sources - Western Europe

Created in 2021 by Anna Twiddy and Kaylee Alexander.

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Methodology

• Primary Research | Definition, Types, & Examples

Primary Research | Definition, Types, & Examples

Published on January 14, 2023 by Tegan George . Revised on January 12, 2024.

Primary research is a research method that relies on direct data collection , rather than relying on data that’s already been collected by someone else. In other words, primary research is any type of research that you undertake yourself, firsthand, while using data that has already been collected is called secondary research .

Primary research is often used in qualitative research , particularly in survey methodology, questionnaires, focus groups, and various types of interviews . While quantitative primary research does exist, it’s not as common.

Table of contents

When to use primary research, types of primary research, examples of primary research, advantages and disadvantages of primary research, other interesting articles, frequently asked questions.

Primary research is any research that you conduct yourself. It can be as simple as a 2-question survey, or as in-depth as a years-long longitudinal study . The only key is that data must be collected firsthand by you.

Primary research is often used to supplement or strengthen existing secondary research. It is usually exploratory in nature, concerned with examining a research question where no preexisting knowledge exists. It is also sometimes called original research for this reason.

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Primary research can take many forms, but the most common types are:

• Surveys and questionnaires
• Observational studies
• Interviews and focus groups

Surveys and questionnaires collect information about a group of people by asking them questions and analyzing the results. They are a solid choice if your research topic seeks to investigate something about the characteristics, preferences, opinions, or beliefs of a group of people.

Surveys and questionnaires can take place online, in person, or through the mail. It is best to have a combination of open-ended and closed-ended questions, and how the questions are phrased matters. Be sure to avoid leading questions, and ask any related questions in groups, starting with the most basic ones first.

Observational studies are an easy and popular way to answer a research question based purely on what you, the researcher, observes. If there are practical or ethical concerns that prevent you from conducting a traditional experiment , observational studies are often a good stopgap.

There are three types of observational studies: cross-sectional studies , cohort studies, and case-control studies. If you decide to conduct observational research, you can choose the one that’s best for you. All three are quite straightforward and easy to design—just beware of confounding variables and observer bias creeping into your analysis.

Similarly to surveys and questionnaires, interviews and focus groups also rely on asking questions to collect information about a group of people. However, how this is done is slightly different. Instead of sending your questions out into the world, interviews and focus groups involve two or more people—one of whom is you, the interviewer, who asks the questions.

There are 3 main types of interviews:

• Structured interviews ask predetermined questions in a predetermined order.
• Unstructured interviews are more flexible and free-flowing, proceeding based on the interviewee’s previous answers.
• Semi-structured interviews fall in between, asking a mix of predetermined questions and off-the-cuff questions.

While interviews are a rich source of information, they can also be deceptively challenging to do well. Be careful of interviewer bias creeping into your process. This is best mitigated by avoiding double-barreled questions and paying close attention to your tone and delivery while asking questions.

Alternatively, a focus group is a group interview, led by a moderator. Focus groups can provide more nuanced interactions than individual interviews, but their small sample size means that external validity is low.

Primary research can often be quite simple to pursue yourself. Here are a few examples of different research methods you can use to explore different topics.

Primary research is a great choice for many research projects, but it has distinct advantages and disadvantages.

Advantages of primary research

Advantages include:

• The ability to conduct really tailored, thorough research, down to the “nitty-gritty” of your topic . You decide what you want to study or observe and how to go about doing that.
• You maintain control over the quality of the data collected, and can ensure firsthand that it is objective, reliable , and valid .
• The ensuing results are yours, for you to disseminate as you see fit. You maintain proprietary control over what you find out, allowing you to share your findings with like-minded individuals or those conducting related research that interests you for replication or discussion purposes.

Disadvantages of primary research

Disadvantages include:

• In order to be done well, primary research can be very expensive and time consuming. If you are constrained in terms of time or funding, it can be very difficult to conduct your own high-quality primary research.
• Primary research is often insufficient as a standalone research method, requiring secondary research to bolster it.
• Primary research can be prone to various types of research bias . Bias can manifest on the part of the researcher as observer bias , Pygmalion effect , or demand characteristics . It can occur on the part of participants as a Hawthorne effect or social desirability bias .

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Chi square goodness of fit test
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Inclusion and exclusion criteria

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

The 3 main types of primary research are:

Exploratory research aims to explore the main aspects of an under-researched problem, while explanatory research aims to explain the causes and consequences of a well-defined problem.

There are several methods you can use to decrease the impact of confounding variables on your research: restriction, matching, statistical control and randomization.

In restriction , you restrict your sample by only including certain subjects that have the same values of potential confounding variables.

In matching , you match each of the subjects in your treatment group with a counterpart in the comparison group. The matched subjects have the same values on any potential confounding variables, and only differ in the independent variable .

In statistical control , you include potential confounders as variables in your regression .

In randomization , you randomly assign the treatment (or independent variable) in your study to a sufficiently large number of subjects, which allows you to control for all potential confounding variables.

A questionnaire is a data collection tool or instrument, while a survey is an overarching research method that involves collecting and analyzing data from people using questionnaires.

When conducting research, collecting original data has significant advantages:

• You can tailor data collection to your specific research aims (e.g. understanding the needs of your consumers or user testing your website)
• You can control and standardize the process for high reliability and validity (e.g. choosing appropriate measurements and sampling methods )

However, there are also some drawbacks: data collection can be time-consuming, labor-intensive and expensive. In some cases, it’s more efficient to use secondary data that has already been collected by someone else, but the data might be less reliable.

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Identify Primary Sources in the Sciences

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Primary Sources in the Sciences

What is a primary source in the sciences.

A primary source is information or literature about original research provided or written by the original researcher. Examples of primary sources include...  

• Experimental data
• Laboratory notes
• Conference Proceedings
• Technical Reports
• Some peer-reviewed scientific journal articles of original research

How can I identify a primary article?

In the primary article, the authors will write about research that they did and the conclusions they made. Some key areas in the article to look for are similar to those found in a lab report including... 

• A research problem statement , or description of what the researchers are trying to discover or determine with their research,
• Background information about previously published research on the topic,
• Methods where the author tells the reader what they did, how they did it, and why,
• Results where the author explains the outcomes of their research   

Sometimes scholarly journals will include review articles, which summarize published research on a topic but do not contain new results from original research. Even though these sources are scholary, they are NOT primary articles.

How do I know if my source is scholarly?

Along with being a primary source, it is frequently important that you know if your source is scholarly and appropriate for academic research. Some traits of scholarly articles are...

• Citations to work done by others
• Language is often serious and technical
• Images are usually charts, graphs, or otherwise informative, rather than glossy photographs or advertisments
• Authors' names are given, along with their affilitions with university, research institutions, etc.
• Date of publication is given, frequently along with the date on which the articles was submitted for peer review
• "About" or "instructions for authors" link on the journal's Web site indicates that the journal is peer reviewed or describes its peer review process

Finding Primary Articles

The best place to look for primary, scientific articles are journal databases provided by the library. These database contain millions of articles, most of them primary articles from scholarly journals. 

 Many of these databases allow you to refine you search to only articles or peer-reviewed journals, however, you still need to look at the article to determine if it is scholarly and contains original research.

• VCU Libraries' Databases List
• Research Guides to Locate Databases by Subject
• Ask Us! Chat, phone, email, or text VCU Libraries for advice on the best databases for your topic.

Secondary Sources in the Sciences

Secondary sources in the sciences are about the research and discoveries of other people, usually with the goal of providing an overview of the topic that allows readers to quickly become familar with topic.

Some examples of secondary sources are...

• Review articles
• Scientific encyclopedias
• Last Updated: Jan 30, 2023 10:09 AM
• URL: https://guides.library.vcu.edu/science-primary-sources

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How to identify peer reviewed journals, how to identify primary research articles.

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• Peer Reviewed Journals Quiz How do I know if a journal is peer reviewed? What is peer review, anyway? Take this short quiz to test your knowledge and perhaps learn something new!
• Primary Research Articles Quiz How do I know if an article is a primary or secondary research article? Are there search techniques that will help me find them? Take this short quiz to test your knowledge and perhaps learn something new!

You must get all answers correct to submit the quiz!

Peer review is defined as “a process of subjecting an author’s scholarly work, research or ideas to the scrutiny of others who are experts in the same field” ( 1 ). Peer review is intended to serve two purposes:

• It acts as a filter to ensure that only high quality research is published, especially in reputable journals, by determining the validity, significance and originality of the study.
• Peer review is intended to improve the quality of manuscripts that are deemed suitable for publication. Peer reviewers provide suggestions to authors on how to improve the quality of their manuscripts, and also identify any errors that need correcting before publication.

How do you determine whether an article qualifies as being a peer-reviewed journal article?

• If you're searching for articles in certain databases, you can limit your search to peer-reviewed sources simply by selecting a tab or checking a box on the search screen.
• If you have an article, an indication that it has been through the peer review process will be the publication history , usually at the beginning or end of the article.
• If you're looking at the journal itself, go to the  editorial statement or instructions to authors  (usually in the first few pages of the journal or at the end) for references to the peer-review process.
• Lookup the journal by title or ISSN in the ProQuest Source Evaluation Aid . 
• Careful! Not all information in a peer-reviewed journal is actually reviewed. Editorials, letters to the editor, book reviews, and other types of information don't count as articles, and may not be accepted by your professor.

What about preprint sites and ResearchGate?

• A preprint is a piece of research that has not yet been peer reviewed and published in a journal. In most cases, they can be considered final drafts or working papers. Preprint sites are great sources of current research - and most preprint sites will provide a link to a later, peer-reviewed version of an article. 
• ResearchGate is a commercial social networking site for scientists and researchers to share papers, ask and answer questions, and find collaborators. Members can upload research output including papers, chapters, negative results, patents, research proposals, methods, presentations, etc. Researchers can access these materials, and also contact members to ask for access to material that has not been shared, usually because of copyright restrictions. There is a filter to limit results to articles, but it can be difficult to determine the publication history of ResearchGate items and whether they have been published in peer reviewed sources.

A primary research article reports on an empirical research study conducted by the authors. The goal of a primary research article is to present the result of original research that makes a new contribution to the body of knowledge. 

Characteristics:

• Almost always published in a peer-reviewed journal
• Asks a research question or states a hypothesis or hypotheses
• Identifies a research population
• Describes a specific research method
• Tests or measures something
• Often (but not always) structured in a standard format called IMRAD: Introduction, Methods, Results, and Discussion
• Words to look for as clues include: analysis, study, investigation, examination, experiment, numbers of people or objects analyzed, content analysis, or surveys.

To contrast, the following are not primary research articles (i.e., they are secondary sources):

• Literature reviews/Review articles
• Meta-Analyses (studies that arrive at conclusions based on research from many other studies)
• Editorials & Letters
• Dissertations

Articles that are NOT primary research articles may discuss the same research, but they are not reporting on original research, they are summarizing and commenting on research conducted and published by someone else. For example, a literature review provides commentary and analysis of research done by other people, but it does not report the results of the author's own study and is not primary research.

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Finding Primary Research Articles in the Sciences: Analyzing a Primary Research Article

• Advanced Search-Databases
• Primary vs. Secondary
• Analyzing a Primary Research Article
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Having trouble? Questions to help you decide if your article is an original research article

• Is the information original/unmediated (primary source) or is it analysis/a summary of findings/an opinion/or otherwise mediated information (secondary source)?
• Does the method section include participants (primary source) or does it describe what databases were searched or how a search was conducted (secondary source)? If the method section describes what databases were searched, most likely it is some type of review or analysis, which is a secondary source (e.g. systematic review, literature review, meta-analysis, scoping review). For more information on types of reviews, please see this page by Duke University medical center library and archives on  Types of Reviews
• Is the study a quality improvement (QI) study, which is designed for a particular setting? While this is original research, it is better to avoid quality improvement studies because the study was done for the benefit (quality improvement) of that particular setting. The external validity (whether or not results can apply to different settings) is poor, and therefore the results may not be generalizable to other situations. For more information, please see this Children's Hospital of Philadelphia Research Institute page on  Quality Improvement vs. Research
• Or do the authors describe the study as a preliminary study or a feasibility study or a pilot study? This type of study is a "study lite” and is designed to test if it is worth doing a full rigorous study.  While this is original research, it is better to avoid preliminary, feasibility, or pilot studies and use a complete study instead. For more information, please see this book chapter on " Preliminary studies and pilot testing ."
• Examples of secondary sources and primary sources

Anatomy of a Research Article

The image below is of the first and last pages of a scholarly article.  Notice the sections for abstract, introduction, conclusion, and references. Scholarly/Research articles may also contain sections titled literature review, materials, methods, results, discussion, etc.

As you search for articles in the library databases the main component to look for is that the authors did original research on a topic. You will want to ignore any items that appear to be news updates, magazine articles, review articles, editorials, book reviews, etc. 

Click the red tab above (Advanced Search-Databases) to learn how you can limit your database search to peer reviewed articles, narrow the dates of your search, and limit to full text articles.

How to Analyze a Research Article

APA Style: Research Article Activity

"This activity will help students learn how to find, cite, analyze, and summarize a scholarly research article. For each step of the activity, type your responses directly into the text fields provided, or copy the questions into your preferred word-processing program and answer them there. Complete this activity multiple times to help you write papers such as literature reviews."

What is a Primary Source?

What is a Primary Source? from NC State University Libraries on Vimeo .

Anatomy of a Scholarly Article

Anatomy of a Scholarly Article from NC State University Libraries on Vimeo .

This video is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States license.

APA Style Printable Handout

APA Style Reference Guide for Journal Articles, Books, Edited Book Chapters

Use the Journal Article template to check your reference citation and make sure it is correct. Note the details for the different sections and the punctuation used between each section. 

Smarter than the Filter Finding the Research Article Among the Imposters

Smarter than the Filter: Finding the Research Article Among the Imposters from NC State University Libraries on Vimeo .

How to Read a Scholarly Article

How to Read a Scholarly Article from NC State University Libraries on Vimeo .

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What is Primary Research and How do I get Started?

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Primary research is any type of research that you collect yourself. Examples include surveys, interviews, observations, and ethnographic research. A good researcher knows how to use both primary and secondary sources in their writing and to integrate them in a cohesive fashion.

Conducting primary research is a useful skill to acquire as it can greatly supplement your research in secondary sources, such as journals, magazines, or books. You can also use it as the focus of your writing project. Primary research is an excellent skill to learn as it can be useful in a variety of settings including business, personal, and academic.

But I’m not an expert!

With some careful planning, primary research can be done by anyone, even students new to writing at the university level. The information provided on this page will help you get started.

What types of projects or activities benefit from primary research?

When you are working on a local problem that may not have been addressed before and little research is there to back it up.

When you are working on writing about a specific group of people or a specific person.

When you are working on a topic that is relatively new or original and few publications exist on the subject.

You can also use primary research to confirm or dispute national results with local trends.

What types of primary research can be done?

Many types of primary research exist. This guide is designed to provide you with an overview of primary research that is often done in writing classes.

Interviews: Interviews are one-on-one or small group question and answer sessions. Interviews will provide a lot of information from a small number of people and are useful when you want to get an expert or knowledgeable opinion on a subject.

Surveys: Surveys are a form of questioning that is more rigid than interviews and that involve larger groups of people. Surveys will provide a limited amount of information from a large group of people and are useful when you want to learn what a larger population thinks.

Observations: Observations involve taking organized notes about occurrences in the world. Observations provide you insight about specific people, events, or locales and are useful when you want to learn more about an event without the biased viewpoint of an interview.

Analysis: Analysis involves collecting data and organizing it in some fashion based on criteria you develop. They are useful when you want to find some trend or pattern. A type of analysis would be to record commercials on three major television networks and analyze gender roles.

Where do I start?

Consider the following questions when beginning to think about conducting primary research:

• What do I want to discover?
• How do I plan on discovering it? (This is called your research methods or methodology)
• Who am I going to talk to/observe/survey? (These people are called your subjects or participants)
• How am I going to be able to gain access to these groups or individuals?
• What are my biases about this topic?
• How can I make sure my biases are not reflected in my research methods?
• What do I expect to discover?

• Student Services
• Faculty Services

Peer Review and Primary Literature: An Introduction: Is it Primary Research? How Do I Know?

• Scholarly Journal vs. Magazine
• Peer Review: What is it?
• Finding Peer-Reviewed Articles
• Primary Journal Literature
• Is it Primary Research? How Do I Know?

Components of a Primary Research Study

As indicated on a previous page, Peer-Reviewed Journals also include non -primary content. Simply limiting your search results in a database to "peer-reviewed" will not retrieve a list of only primary research studies.

Learn to recognize the parts of a primary research study. Terminology will vary slightly from discipline to discipline and from journal to journal.  However, there are common components to most research studies.

When you run a search, find a promising article in your results list and then look at the record for that item (usually by clicking on the title). The full database record for an item usually includes an abstract or summary--sometimes prepared by the journal or database, but often written by the author(s) themselves. This will usually give a clear indication of whether the article is a primary study.  For example, here is a full database record from a search for family violence and support in SocINDEX with Full Text :

Although the abstract often tells the story, you will need to read the article to know for sure. Besides scanning the Abstract or Summary, look for the following components: (I am only capturing small article segments for illustration.)

Look for the words METHOD or METHODOLOGY . The authors should explain how they conducted their research.

NOTE: Different Journals and Disciplines will use different terms to mean similar things. If instead of " Method " or " Methodology " you see a heading that says " Research Design " or " Data Collection ," you have a similar indicator that the scholar-authors have done original research.

Look for the section called RESULTS . This details what the author(s) found out after conducting their research.

Charts , Tables , Graphs , Maps and other displays help to summarize and present the findings of the research.

A Discussion indicates the significance of findings, acknowledges limitations of the research study, and suggests further research.

References , a Bibliography or List of Works Cited indicates a literature review and shows other studies and works that were consulted. USE THIS PART OF THE STUDY! If you find one or two good recent studies, you can identify some important earlier studies simply by going through the bibliographies of those articles.

A FINAL NOTE:  If you are ever unclear about whether a particular article is appropriate to use in your paper, it is best to show that article to your professor and discuss it with them.  The professor is the final judge since they will be assigning your grade.

Subject Guide

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• Harvard Library
• Research Guides
• Faculty of Arts & Sciences Libraries
• Identifying Articles
• PubMed at Harvard
• Searching in PubMed
• My NCBI in PubMed
• Utilizing Search Results
• Scenarios in PubMed

Primary Research Article

Review article.

Identifying and creating an APA style citation for your bibliography: 

• Author initials are separated by a period
• Multiple authors are separated by commas and an ampersand (&)  
• Title format rules change depending on what is referenced
• Double check them for accuracy 

Identifying and creating an APA style in-text citation: 

• eg. (Smith, 2022) or (Smith & Stevens, 2022) 

The structure of this changes depending on whether a direct quote or parenthetical used:

Direct Quote: the citation must follow the quote directly and contain a page number after the date

eg. (Smith, 2022, p.21)

Parenthetical: the page number is not needed

For more information, take a look at Harvard Library's Citation Styles guide !

A primary research article typically contains the following section headings:

"Methods"/"Materials and Methods"/"Experimental Methods"(different journals title this section in different ways)

"Results"

"Discussion"

If you skim the article, you should find additional evidence that an experiment was conducted by the authors themselves.

Primary research articles provide a background on their subject by summarizing previously conducted research, this typically occurs only in the Introduction section of the article.

Review articles do not report new experiments. Rather, they attempt to provide a thorough review of a specific subject by assessing either all or the best available scholarly literature on that topic.

Ways to identify a review article: 

• Author(s) summarize and analyze previously published research 
• May focus on a specific research question, comparing and contrasting previously published research 
• Overview all of the research on a particular topic 
• Does not contain "methods" or "results" type sections
• << Previous: Scenarios in PubMed
• Last Updated: Oct 3, 2023 4:16 PM
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Identifying Primary and Secondary Research Articles

• Primary and Secondary

Primary Research Articles

Primary research articles report on a single study. In the health sciences, primary research articles generally describe the following aspects of the study:

• The study's hypothesis or research question
• Some articles will include information on how participants were recruited or identified, as well as additional information about participants' sex, age, or race/ethnicity
• A "methods" or "methodology" section that describes how the study was performed and what the researchers did
• Results and conclusion section

Secondary Research Articles

Review articles are the most common type of secondary research article in the health sciences. A review article is a summary of previously published research on a topic. Authors who are writing a review article will search databases for previously completed research and summarize or synthesize those articles,  as opposed to recruiting participants and performing a new research study.

Specific types of review articles include:

• Systematic Reviews
• Meta-Analysis
• Narrative Reviews
• Integrative Reviews
• Literature Reviews

Review articles often report on the following:

• The hypothesis, research question, or review topic
• Databases searched-- authors should clearly describe where and how they searched for the research included in their reviews
• Systematic Reviews and Meta-Analysis should provide detailed information on the databases searched and the search strategy the authors used.Selection criteria-- the researchers should describe how they decided which articles to include
• A critical appraisal or evaluation of the quality of the articles included (most frequently included in systematic reviews and meta-analysis)
• Discussion, results, and conclusions

Determining Primary versus Secondary Using the Database Abstract

Information found in PubMed, CINAHL, Scopus, and other databases can help you determine whether the article you're looking at is primary or secondary.

Primary research article abstract

• Note that in the "Objectives" field, the authors describe their single, individual study.
• In the materials and methods section, they describe the number of patients included in the study and how those patients were divided into groups.
• These are all clues that help us determine this abstract is describing is a single, primary research article, as opposed to a literature review.
• Primary Article Abstract

Secondary research/review article abstract

• Note that the words "systematic review" and "meta-analysis" appear in the title of the article
• The objectives field also includes the term "meta-analysis" (a common type of literature review in the health sciences)
• The "Data Source" section includes a list of databases searched
• The "Study Selection" section describes the selection criteria
• These are all clues that help us determine that this abstract is describing a review article, as opposed to a single, primary research article.
• Secondary Research Article

• Primary vs. Secondary Worksheet

Full Text Challenge

Can you determine if the following articles are primary or secondary?

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NUR 3165 - Nursing Research

• Nursing Databases
• Research Article Basics
• - Practice 1

Finding Primary Research Articles - Overview

• - Practice 2
• Quantitative/Qualitative/Mixed Methods
• - Practice 3
• How to Find Full Text Articles
• Terminology

There are several ways to locate primary research articles as you will see in the following practice exercises (see next page). Here are some tips to consider while looking for original research studies:

Tip #1 - Incorporate subject headings into your search

Subject headings are terms that are part of a controlled vocabulary used to describe the contents tagged inside the article record. These terms can be found in each of the CINAHL Detailed Records under Major Subjects and Minor Subjects. So, if you see the ultimate article, look to see what terms it is tagged with and add them to the search in the appropriate line if relevant. For example,(MH "Emergency Service") is the medical subject heading used for Emergency Department!

To search for possible subject headings, try putting a keyword in a new search and check the Suggest Subject Terms  box. The asterisk covers any number of characters (i.e., nurs* yields nurse, nurses, and nurses at the same time). Quotation marks around two or more terms searches them as a phrase.

Try it out! Place the term  Hospital Acquired Infection  in CINAHL, check the Suggest Subject Terms box and click search to see the subject heading for this term!

Tip #2 - Check the research article box

Databases like CINAHL allow you to select Research Article to retrieve research articles in your search.

Tip #3 - Sections of the Research Article to look for

When reading an article, make sure to look inside the abstract (and the full text) and scan for sections contained in many primary research studies such as  Introduction, Participants, Methods, Results and Discussion! Look at those sections to see if the researchers are working directly with the participants and conducting original research.

See the next section for additional tips!

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Educator Resources

Finding Primary Sources for Teachers and Students

Finding primary sources.

Primary Sources from DocsTeach Thousands of online primary source documents from the National Archives to bring the past to life as classroom teaching tools.

National Archives Catalog Find online primary source materials for classroom & student projects from the National Archive's online catalog (OPA).

Beginning Research Activities Student activities designed to help you navigate the National Archives resources and web site.

Online Exhibits Exhibits featuring online documents, photos and primary sources from the National Archives

Our Documents 100 Milestone Documents of American History

Getting Started with Research How to start researching records at the National Archives. Finding your topic, identifying records, planning a visit, and more.

Online Research Tools & Aids Introduction to catalogs, databases, and other online resources.

Citing Primary Sources Citing Records in the National Archives of the United States

Life, Society & Drugs: Appropriate Sources

• What sources are appropriate?
• Scholarly sources and peer review
• Tips for reading scientific papers
• How do I identify a primary research article?
• How do I find an internationally focused article?
• Recommended resources
• How can I cite my sources properly?
• How do I choose or develop a research topic?
• Wrapping up

Understanding Primary Research in the Sciences

• How do I identify a primary research article? This link will take you to the YouTube page where the video is stored. Captions and transcripts are included.

Primary sources in the sciences are typically academic journals. In them, the authors present their "primary" or original research. You may have heard of primary sources before in a history class, and the same idea applies here. A primary source is all about proximity. The authors should have firsthand experience with the content. In the sciences, that means that they conducted the research themselves.

Identifying Primary Research Articles

Here are five common components of primary research articles in the sciences. Check your source for these to help determine if you are looking at a primary source.

1. Written by experts who did the research

In a primary source, the authors report on research they conducted themselves. The best way to determine this is to read the introduction of the paper where the authors will explain what they are presenting. If the authors report only about someone else’s research or a different study, it is not primary. 

2. Reports on original research

This is closely tied to the first component. Did the authors of the article study something "new?" Did they delve into an issue to explore it further? Look for keywords in the abstract and introduction that tell you that the authors studied something. Keywords to look for include: "measured," "analyzed," and "investigated."

3. Describes how the authors did their study

A primary research article will describe the methods used to conduct the study. It ought to be detailed enough that the study could be replicated. Many primary research articles follow a common format with particular section headings. One of these is "methodology" or "methods." The methodology section is where the authors will explain how they did their study. Looking for this section heading is a good way to check for this factor. Even if this specific heading is missing, your article should still explain this to be primary.

4. Describes the study's results

The article should also clearly explain the results or outcomes of the research. Often you will see statistics, graphs, and/or tables in the article. These depictions of data in primary research articles will differ from the "decorative" images you may see in popular sources. Headings to look at for this factor include "results," "findings," and "discussion."

5. Always includes references

Finally, your primary research article will always include references. These could look like footnotes, a references section, or a works cited at the end of the article. Many articles that are not primary research articles - and even some that are not scholarly - include references. Do not make your decision of whether your article is primary or not based on this factor alone.

Primary Source Examples

• Burgo, Jose Luis, et al. “Cost of Provision of Opioid Substitution Therapy Provision in Tijuana, Mexico.”   Harm Reduction Journal , vol. 15, no. 1, May 2018, pp. 1–8.  Directory of Open Access Journals , https://doi.org/10.1186/s12954-018-0234-x.
• Sharma, Shridhar, et al. “Substance Use and Criminality among Juveniles-under-Enquiry in New Delhi.”   Indian Journal of Psychiatry , vol. 58, no. 2, Apr. 2016, pp. 178–182.  CINAHL Complete , https://doi.org/10.4103/0019-5545.183791.

Secondary Source Examples

• Palinkas, Lawrence A. “Opioid Use Epidemic in Mexico: Global Solutions to a Global Problem.”  American Journal of Public Health,  vol. 109, no. 1, Jan. 2019. pp. 26–27.  CINAHL Complete, https://doi.org/10.2105/AJPH.2018.304833
• Szalavitz, Maia, and Khary K. Rigg. “The Curious (Dis)Connection between the Opioid Epidemic and Crime.”   Substance Use & Misuse , vol. 52, no. 14, Dec. 2017, pp. 1927–1931.  APA PsycInfo , https:// doi.org/10.1080/10826084.2017.1376685.

How can I learn more about identifying primary sources?

To learn more about primary research articles in the sciences, watch the University of Wisconsin-Madison Libraries' short video (1 min, 37 sec) on the topic.

• Primary Research Articles in the Sciences This link will take you to the YouTube page where the video is stored. There are closed captions and transcripts included.
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Indigenous Studies

• Background Sources
• Scholarly Articles & Databases

Primary Sources

Subcollections in primary source databases, digital collections, modern news sources, leni-lenape primary sources: colonial narratives, leni-lenape primary sources: oral histories.

• Research and Writing Resources
• Lenni-Lenape Resources

In humanities disciplines like history and literature, a primary source is an item produced from the time you are researching (e.g., photographs, a letters, newspaper articles, government documents).  Looking at actual sources from a specific time helps you get a firsthand account of what was happening then.

In the sciences and social sciences, research data and original research studies are also considered primary sources.

Secondary sources provide analysis of primary sources (e.g., scholarly articles and books).

(Rowan login required)

• History Vault: American Indians and the American West, 1809-1971) (Primary Sources - Proquest) Collections from the U.S. National Archives and the Chicago History Museum, as well as first-hand accounts on Indian Wars and westward migration
• Indian Claims Insight (Primary Sources - Proquest) Legal histories and documents related to Indian claims and compiled histories for Indian Nation/Tribes
• Native Americans in History: Part I: Newspaper, 1728-1922 (Accessible Archives)
• Native Americans in History: Part II: Books, 1663-1928 (Accessible Archives)
• North American Indian Thought and Culture (Primary Sources - Proquest) Primary source materials representing historical moments as experienced by those who lived through them
• North American Indian Drama (Primary Sources - Proquest) Plays by 48 American Indian and First Nation playwrights from the twentieth century. Over half of these works are rare or previously unpublished.
• Indigenous Newspapers in North America (AM Explorer) Two centuries of indigenous print journalism from the US and Canada
• Indigenous Histories and Cultures in North America(AM Explorer) Primary source materials dating from the earliest contact with European settlers to the mid-twentieth century
• Empire Online This link opens in a new window Primary source materials in world history. more... less... This resource brings together manuscript, printed and visual primary source materials for the study of 'Empire' and its theories, practices and consequences. The materials span across the last five centuries and are accompanied by a host of secondary learning resources including scholarly essays, maps and an interactive chronology.
• Ethnic NewsWatch This link opens in a new window News, magazine, and journal articles from the ethnic, minority and native press. more... less... An interdisciplinary, bilingual (English and Spanish) comprehensive full text database of the newspapers, magazines and journals of the ethnic, minority and native press. Coverage begins in 1990.
• HeinOnline This link opens in a new window Comprehensive coverage of more than 2,000 journals and the Congressional Record. more... less... Complete coverage of the U.S. Reports back to 1754, constitutions for every country in the world, classic books from the 18th & 19th centuries, all United States Treaties, the Federal Register and CFR from inception.
• American Indians of the Pacific Northwest Collection Photographs, documents, and maps about the Northwest Coast and Plateau Indian cultures and related essays by anthropologists, histories, and teachers. From the University of Washington.
• Archives Library Information Center: Native Americans (National Archives) Includes digital collections, genealogical resources, laws and treaties, and more.
• Association on American Indian Affairs Records, 1851-2016 (mostly 1922-1995) Physical and digitized materials available from Princeton University. Select "Only show materials containing online content" to limit to digitized materials.
• Chief George Manuel Memorial Indigenous Library Contains documents, reports, and publications from indigenous nations in North America and the world. Established in 1979 as a document repository, in response to a resolution of the Conference of Tribal Governments.
• Chronicling America: Historic American Newspapers - Indians of North America A project of the National Endowmen for the Humanities and the Library of Congress.
• Duke Collection of American Indian Oral History Typescripts of interviews from 1967-1972 with Native Americans in Oklahoma
• Early Americas Digital Archive Texts written in or about the Americas from 1492 to 1820
• First Nations Collection, Southern Oregon Digital Archives Documents, books, and artilces on the indigenous people of the region.
• Images of North Americans Illustrations from rare books, magazines, newspapers, an ephemera; photographs; and other visual materials. Materials reflect European interpretations of Native Americans. From the University of California - Berkeley.
• Indigenous Studies Portal Research Tool (University of Saskatchewan) A database of full text primary and secondary sources focused primarily on Indigenous peoples of Canada and secondarily on North American materials.
• Library of Congress "American Indians" subject search
• Library of Congress: "Native Americans" subject search
• Native American and Indigenous History and Culture, Smithsonian Institute Selected collections.
• Native American Heritage Month: Exhilbitions and Collections Featured archival materials from the Library of Congress, the National Endowment for the Humanities, the Smithsonian Institute, and more.
• Native Voices: Native Peoples' Concepts of Health and Illness Includes exhibition materials, inteviews, and an historical timeline. From the U.S. National Library of Medicine.
• Oklahoma State University Library Digital Collections Many of OSU's digital collections concentrate on Native American history. Search the collections using terms like 'Native American.' (Note: Many of the Lenape people indigenous to New Jersey relocated to Oklahoma.)
• The Trail of Tears through Arkansas Eyewitness accounts, letters, removal claim documents, and background information about the Trail of Tears through Arkansas. From the University of Arkansas - Little Rock.
• Treaties between the United States and Native Americans (The Avalon Project) From Lillian Goldman Law Library, Yale Law School.
• Tribal Treaties Database (Oklahoma State Univeristy Libraries) Includes agreements between tribal nations and the United States (1778-1886). A project of Oklahoma State University Library, the U.S. Department of Agriculture, and the Department of the Interior.
• Tribal Writers Digital Library (Sequoyah National Research Center) Features out-of-print literary works of American Indians, Alaska natives, and First Nations people of Canada
• Indian Country Today An independent news source and public media broadcast serving Indigenous communities
• Indian Country (Al Jazeera)
• Native News Online

• Geographia Americae : with an account of the Delaware Indians : based on surveys and notes made in 1654-1656 by Peter Lindestrom Call Number: Special Collections F167 .L73 Publication Date: 1925

Oral histories are important sources of history and narrative in many Native American cultures and traditions. These examples bring to the forefront Indigenous perspectives and traditions.

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Dylan Ruediger

From Reading to Discovery

Scaffolding Student Engagement with Primary Sources

/ Article Archive

/ From Reading to Discovery

Publication Date

June 14, 2021

Perspectives Section

Perspectives Daily

Asked to describe how they learned to teach with primary sources, one instructor recalled, “I was like a deer in headlights, had no idea what I was doing, so I had to figure it out.” This sentiment, reported in Ithaka S+R’s recent Teaching with Primary Sources project, resonated with my experience designing and teaching an introductory history course. I had minimal instruction and even less supervision while building my first courses as a doctoral student.

A new report from Ithaka S+R found that history instructors need to collaborate with librarians, archivists, and publishers to help students master the skills required to find and use primary sources.  Clay Banks/Unsplash

Few disciplines rely more heavily on primary sources as instructional tools than history, but many of us find that learning to teach effectively with them is difficult. Faculty can turn to a sizable and valuable literature exploring the pedagogy of teaching with primary sources, much of it focused on case studies of single courses or assignments. But part of teaching students to engage with primary sources depends on teaching them how to navigate libraries and archives and use resources like card catalogs, finding aids, and search engines. These skills are difficult to master across a major, let alone within a single course. As historians, we want our students to experience something of the joy we discover in the open exploration of primary sources. But what does it take to get them there?

In Teaching with Primary Sources, Ithaka S+R sought a broad perspective on how universities—particularly, university libraries—can support faculty who teach with primary sources. Working in partnership with ProQuest and 26 institutions, including liberal arts colleges, regional public and private universities, and research universities, the Teaching with Primary Sources project (not to be confused with the Library of Congress project of the same name) generated interviews with 335 faculty (roughly one-third of them historians) who detailed how they and their students discover, access, and use both physical and digital primary sources in upper- and lower-division courses. The resulting report highlights common challenges that instructors face regardless of academic field and offers examples of successful collaborative instructional practices between faculty and librarians. One of the project’s core findings is that primary source pedagogy benefits from collaboration between teachers, departments, librarians, and publishers, each of whom plays an important role in helping students gain experience discovering and interpreting primary sources.

Few disciplines rely more heavily on primary sources as instructional tools than history.

Despite almost unanimously reporting that they began their career as a “deer in the headlights,” most faculty said that they were now fairly comfortable teaching students to interpret primary sources. Typically, this involved assigning students carefully curated materials from readers, open-access or subscription digital collections, and sometimes physical objects held by university archives or special collections. Many instructors used primary sources to provide students with opportunities to understand how historical arguments are made. As one instructor noted, “It’s really [about] teaching students key historical skills to be able to assess evidence and develop arguments based on competing evidence.” To facilitate this learning, instructors invest considerable time creating packages of complementary sources that students used to stage debates.

However successful these practices were at teaching students to engage with primary sources, they fell short when it came to teaching students to find their own primary sources for analysis. This important skill—the ability to locate and sift through “raw” sources and make independent judgments about their value, perspective, and relevance—is at the core of historical research and information literacy. Instructors who had tried to integrate primary source discovery into their courses noted that students struggled to evaluate the quality and relevance of what they found, becoming discouraged or gravitating towards resources that popped up readily through Google searches. Faculty voicing these concerns were not accusing their students of laziness: they recognized that students were juggling many personal and intellectual demands on their time. Nevertheless, there was a palpable sense of frustration among instructors at their lack of success teaching students to conduct open-ended research and find their own primary sources. Faced with these challenges, many faculty, especially those teaching in lower-level courses, settled for providing sources rather than requiring or encouraging students to discover their own.

Evidence emerged of a common curricular gap: instructors felt that teaching research skills was too advanced for their lower-division courses, but also felt that it was something that students in upper-division courses ought to already know. Everyone recognized the importance of students, especially majors, learning these skills along the way, but exactly when they should be taught—and by whom—remained elusive.

Working with primary sources requires significant intellectual dexterity.

Individual faculty cannot bridge this gap alone. They will need to collaborate with librarians, archivists, and publishers. Many of the faculty who were most successful in having students find their own sources had developed long-term collaborative relationships with librarians and archivists with expertise in helping students navigate databases and special collections. Publishers—including digital content providers such as EBSCO and ProQuest—have a role to play as well. They might consider building “sandbox” style collections of primary sources, with enough curation to structure student exploration but sufficient depth and diversity to allow for an authentic discovery experience. Digital collections hosted by major research institutions or museums might consider similar ways of highlighting resources of the right length, genre, and language to be broadly useful for students at various levels.

As historians know, working with primary sources requires significant intellectual dexterity: doing it well demands information literacy, command of search and discovery, and the domain knowledge necessary to contextualize what you find. Perhaps the most significant implication of the Teaching with Primary Sources project is that it takes more than a single course for students to master this mix of skills. If we want students to be ready to practice historical research at the level of a capstone project at the end of their university careers, we should be thinking about how to provide students with incremental opportunities to move from reading a small number of preselected primary sources to finding and evaluating sources on their own. As AHA initiatives like Tuning and History Gateways have shown, history education benefits from approaches that think about individual courses in relation to the curricula as a whole and that emphasize disciplinary competencies that are developed over the course of a degree program. The Teaching with Primary Sources project underscores the importance of this holistic approach and suggests an ongoing need for more conversations about how to scaffold primary source discovery across courses, within the curriculum, and as a core learning outcome for the major.

Dylan Ruediger is a qualitative analyst with Ithaka S+R’s Libraries, Scholarly Communication, and Museums program. He tweets @dylan_ruediger.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Attribution must provide author name, article title, Perspectives on History, date of publication, and a link to this page. This license applies only to the article, not to text or images used here by permission.

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Research Spotlight: Head-to-Head Comparisons of Generative Artificial Intelligence and Internal Medicine Physicians

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Daniel Restrepo, MD , a Mass General Brigham hospital medicine specialist and physician in the Department of Internal Medicine at Massachusetts General Hospital, recently published two research papers comparing the clinical reasoning abilities of large language models (LLMs) to that of physicians. His research was recently published in JAMA Internal Medicine and the Journal of Hospital Medicine .

What led you to research this topic?

Our studies sought to learn whether AI could improve a physician’s ability to diagnose patients. AI might offer some benefits in helping clinicians avoid some of the mental errors in clinical reasoning that can lead to a misdiagnosis. Clinical reasoning refers to the thought processes that allow doctors to reach a diagnosis and is perhaps the most important procedure that physicians perform on a daily basis.

LLMs are a form of AI that can process large amounts of information from sources like the internet and generate answers to questions that read like a conversation. The usefulness of these models at performing certain tasks has been an increasing area of study across the healthcare field.

How did you conduct your study?

We conducted two studies. We performed a live comparison of how a human doctor and an LLM approached a diagnostic mystery and also a separate study comparing the reasoning skills of human doctors to that of an LLM known as GPT4.

In the live comparison study, we wanted to compare and contrast the strengths and strategies taken by both a human internal medicine physician and an LLM, and provide insights into how this technology can help diagnosticians in the future. We provided a case of a 35-year-old man who was referred to the emergency department with low blood pressure and a fast heart rate (tachycardia), and summarized symptoms he had been experiencing – such as recent hearing loss – and tests that were ordered. We then asked the physician to explain their reasoning, and compared each step to the output of the LLM.

Separately, we conducted an investigation that compared the reasoning abilities of 21 resident and 18 attending physicians to that of GPT4. The doctors assessed clinical cases divided into segments of information wherein they were asked to verbalize their reasoning and differential diagnosis as they progressed through sets of clinical information. Differential diagnoses refer to lists of suspected diseases physicians come up with when making a diagnosis. The answers were graded by experts in clinical reasoning who were blinded to whether a human doctor or LLM responded to the case segment.

What did you find?

Our live head-to-head demonstration with an internal medicine physician yielded interesting observations. Both the physician and LLM came up with the correct diagnosis of granulomatosis with polyangiitis, a rare inflammatory disease, but the two went about it in very different ways. The physician relied on clinical reasoning and diagnostic schemas for inflammatory disease categories, whereas the LLM was more focused on matching the patient’s pattern of symptoms to a diagnosis. That in turn led the LLM to be slower to incorporate new test data points introduced during the demonstration. Our comparison suggested AI may have shortcomings in reasoning capabilities.

Our investigation with residents and attending physicians found that GPT performed comparably to both groups in certain measures of clinical reasoning. Specifically, GPT-4 suggested the correct diagnosis about 40% of the time, and the correct diagnosis was included in its initial list of differential diagnoses 67% of the time. GPT however had more frequent instances of incorrect clinical reasoning (~14%) compared to residents (~3%) and attendings (12.5%). Additionally, it is worth noting that one of the central limitations in our study was that the metric used to grade reasoning rewarded verbosity and we found that GPT-4 simply wrote more. This is important given that studies show that experts in clinical reasoning tend to include less, yet more salient features, when distilling what is important in making a diagnosis.

Do your findings suggest AI could one day be used for diagnosing patients?

Misdiagnosis is unfortunately quite common and affects patients worldwide. Many cases of misdiagnosis can be attributable to cognitive errors in the diagnostician's mind, which can occur if a clinician is fatigued, for example. LLM's have been shown by our research and other studies as comparable in many aspects of knowledge and reasoning to physicians. If used correctly, they could augment our abilities as diagnosticians and help keep patients safe.

When and how generative AI is implemented will require significant future study and it would be too premature to offer these tools in patient care. There are numerous considerations to address, including accounting for biases, “hallucinations” (or false information generated by the chatbots), as well as data safety and privacy concerns.

However, our research ultimately suggests that we in healthcare need to change the narrative of diagnosticians versus AI. Instead, we believe that the future of diagnosis is as diagnosticians alongside AI, with the technology augmenting but not replacing the clinical reasoning process.

Authorship:  In addition to Restrepo, Raja-Elie Abdulnour, MD, was a Mass General Brigham co-author on both studies.

Stephanie Cabral, MD; Zahir Kanjee, MD, MPH; Philip Wilson, MD; Byron Crowe, MD Raja-Elie Abdulnour and Adam Rodman, MD, MPH of Beth Israel Deaconess Medical Center co-authored the clinical JAMA Internal Medicine paper, and Dr. Rodman was also a co-author on the Journal of Hospital Medicine live case comparison.

Papers cited:  Cabral et al. “Clinical Reasoning of a Generative Artificial Intelligence Model Compared With Physician” JAMA Intern Med :DOI 10.1001/jamainternmed.2024.0295

Restrepo et al. “Conversations On Reasoning: Large Language Models in Diagnosis” J Hosp. Med. DOI 10.1002/jhm.13378

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About mass general brigham.

Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org .

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Trends in cardiovascular disease incidence among 22 million people in the UK over 20 years: population based study

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• Peer review
• Geert Molenberghs , professor 4 ,
• Geert Verbeke , professor 4 ,
• Francesco Zaccardi , associate professor 5 ,
• Claire Lawson , associate professor 5 ,
• Jocelyn M Friday , data scientist 1 ,
• Huimin Su , PhD student 2 ,
• Pardeep S Jhund , professor 1 ,
• Naveed Sattar , professor 6 ,
• Kazem Rahimi , professor 3 ,
• John G Cleland , professor 1 ,
• Kamlesh Khunti , professor 5 ,
• Werner Budts , professor 1 7 ,
• John J V McMurray , professor 1
• 1 School of Cardiovascular and Metabolic Health, British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
• 2 Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
• 3 Deep Medicine, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
• 4 Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Hasselt University and KU Leuven, Belgium
• 5 Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
• 6 College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
• 7 Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
• Correspondence to: N Conrad nathalie.conrad{at}kuleuven.be (or @nathalie_conrad on X)
• Accepted 1 May 2024

Objective To investigate the incidence of cardiovascular disease (CVD) overall and by age, sex, and socioeconomic status, and its variation over time, in the UK during 2000-19.

Design Population based study.

Setting UK.

Participants 1 650 052 individuals registered with a general practice contributing to Clinical Practice Research Datalink and newly diagnosed with at least one CVD from 1 January 2000 to 30 June 2019.

Main outcome measures The primary outcome was incident diagnosis of CVD, comprising acute coronary syndrome, aortic aneurysm, aortic stenosis, atrial fibrillation or flutter, chronic ischaemic heart disease, heart failure, peripheral artery disease, second or third degree heart block, stroke (ischaemic, haemorrhagic, and unspecified), and venous thromboembolism (deep vein thrombosis or pulmonary embolism). Disease incidence rates were calculated individually and as a composite outcome of all 10 CVDs combined and were standardised for age and sex using the 2013 European standard population. Negative binomial regression models investigated temporal trends and variation by age, sex, and socioeconomic status.

Results The mean age of the population was 70.5 years and 47.6% (n=784 904) were women. The age and sex standardised incidence of all 10 prespecified CVDs declined by 19% during 2000-19 (incidence rate ratio 2017-19 v 2000-02: 0.80, 95% confidence interval 0.73 to 0.88). The incidence of coronary heart disease and stroke decreased by about 30% (incidence rate ratios for acute coronary syndrome, chronic ischaemic heart disease, and stroke were 0.70 (0.69 to 0.70), 0.67 (0.66 to 0.67), and 0.75 (0.67 to 0.83), respectively). In parallel, an increasing number of diagnoses of cardiac arrhythmias, valve disease, and thromboembolic diseases were observed. As a result, the overall incidence of CVDs across the 10 conditions remained relatively stable from the mid-2000s. Age stratified analyses further showed that the observed decline in coronary heart disease incidence was largely restricted to age groups older than 60 years, with little or no improvement in younger age groups. Trends were generally similar between men and women. A socioeconomic gradient was observed for almost every CVD investigated. The gradient did not decrease over time and was most noticeable for peripheral artery disease (incidence rate ratio most deprived v least deprived: 1.98 (1.87 to 2.09)), acute coronary syndrome (1.55 (1.54 to 1.57)), and heart failure (1.50 (1.41 to 1.59)).

Conclusions Despite substantial improvements in the prevention of atherosclerotic diseases in the UK, the overall burden of CVDs remained high during 2000-19. For CVDs to decrease further, future prevention strategies might need to consider a broader spectrum of conditions, including arrhythmias, valve diseases, and thromboembolism, and examine the specific needs of younger age groups and socioeconomically deprived populations.

Introduction

Since the 1970s, the prevention of coronary disease, both primary and secondary, has improved considerably, largely attributable to public health efforts to control risk factors, such as antismoking legislation, and the widespread use of drugs such as statins. 1 2

Improvements in mortality due to heart disease have, however, stalled in several high income countries, 3 and reports suggest that the incidence of heart disease might even be increasing among younger people. 4 5 6 Conversely, along with coronary heart disease, other cardiovascular conditions are becoming relatively more prominent in older people, altering the profile of cardiovascular disease (CVD) in ageing societies. The importance of non-traditional risk factors for atherosclerotic diseases, such as socioeconomic deprivation, has also been increasingly recognised. Whether socioeconomic deprivation is as strongly associated with other CVDs as with atherosclerosis is uncertain, but it is important to understand as many countries have reported an increase in socioeconomic inequalities. 7

Large scale epidemiological studies are therefore needed to investigate secular trends in CVDs to target future preventive efforts, highlight the focus for future clinical trials, and identify healthcare resources required to manage emerging problems. Existing comprehensive efforts, such as statistics on CVD from leading medical societies or the Global Burden of Diseases studies, have helped toward this goal, but reliable age standardised incidence rates for all CVDs, how these vary by population subgroups, and changes over time are currently not available. 8 9 10

We used a large longitudinal database of linked primary care, secondary care, and death registry records from a representative sample of the UK population 11 12 to assess trends in the incidence of 10 of the most common CVDs in the UK during 2000-19, and how these differed by sex, age, socioeconomic status, and region.

Data source and study population

We used anonymised electronic health records from the GOLD and AURUM datasets of Clinical Practice Research Datalink (CPRD). CPRD contains information on about 20% of the UK population and is broadly representative of age, sex, ethnicity, geographical spread, and socioeconomic deprivation. 11 12 It is also one of the largest databases of longitudinal medical records from primary care in the world and has been validated for epidemiological research for a wide range of conditions. 11 We used the subset of CPRD records that linked information from primary care, secondary care from Hospital Episodes Statistics (HES admitted patient care and HES outpatient) data, and death certificates from the Office for National Statistics (ONS). Linkage was possible for a subset of English practices, covering about 50% of the CPRD records. Data coverage dates were 1 January 1985 to 31 December 2019 for primary care data (including drug prescription data), 1 April 1997 to 30 June 2019 for secondary care data, and 2 January 1998 to 30 May 2019 for death certificates.

Included in the study were men and women registered with a general practice for at least one year during the study period (1 January 2000 to 30 June 2019) whose records were classified by CPRD as acceptable for use in research and approved for HES and ONS linkage.

Study endpoints

The primary endpoint was the first presentation of CVD as recorded in primary or secondary care. We investigated 10 CVDs: acute coronary syndrome, aortic aneurysm, aortic stenosis, atrial fibrillation or flutter, chronic ischaemic heart disease, heart failure, peripheral artery disease, second or third degree heart block, stroke (ischaemic, haemorrhagic, or unspecified), and venous thromboembolism (deep vein thrombosis or pulmonary embolism). We defined incident diagnoses as the first record of that condition in primary care or secondary care regardless of its order in the patient’s record.

Diseases were considered individually and as a composite outcome of all 10 CVDs combined. For the combined analyses, we calculated the primary incidence (considering only the first recorded CVD in each patient, reflecting the number of patients affected by CVDs) and the total incidence (considering all incident CVD diagnoses in each patient, reflecting the cumulative number of CVD diagnoses). We performed sensitivity analyses including diagnoses recorded on death certificates.

To identify diagnoses, we compiled a list of diagnostic codes based on the coding schemes in use in each data source following previously established methods. 13 14 15 We used ICD-10 (international classification of diseases, 10th revision) codes for diagnoses recorded in secondary care, ICD-9 (international classification of diseases, ninth revision) (in use until 31 December 2000) and ICD-10 codes for diagnoses recorded on death certificates (used in sensitivity analyses only), the UK Office of Population Censuses and Surveys classification (OPCS-4) for procedures performed in secondary care settings, and a combination of Read, SNOMED, and local EMIS codes for diagnoses recorded in primary care records (see supplementary table S1). 16 Supplementary texts S1, S2, and S3 describe our approach to the generation of the diagnostic code list as well as considerations and sensitivity analyses into the validity of diagnoses recorded in UK electronic health records.

We selected covariates to represent a range of known cardiovascular risk factors. For clinical data, including systolic and diastolic blood pressure, smoking status, cholesterol (total:high density lipoprotein ratio), and body mass index (BMI), we abstracted data from primary care records as the most recent measurement within two years before the incident CVD diagnosis. BMI was categorised as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), and obesity (≥30). Information on the prevalence of chronic kidney disease, dyslipidaemia, hypertension, and type 2 diabetes was obtained as the percentage of patients with a diagnosis recorded in their primary care or secondary care record at any time up to and including the date of a first CVD diagnosis. Patients’ socioeconomic status was described using the index of multiple deprivation 2015, 17 a composite measure of seven dimensions (income, employment, education, health, crime, housing, living environment) and provided by CPRD. Measures of deprivation are calculated at small area level, covering an average population of 1500 people, and are presented in fifths, with the first 20% and last 20% representing the least and most deprived areas, respectively. We extracted information on ethnicity from both primary and secondary care records, and we used secondary care data when records differed. Ethnicity was grouped into four categories: African/Caribbean, Asian, white, and mixed/other. Finally, we extracted information on cardiovascular treatments (ie, aspirin and other antiplatelets, alpha adrenoceptor antagonists, aldosterone antagonists/mineralocorticoid receptor antagonists, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, diuretics, nitrates, oral anticoagulants, and statins) as the number of patients with at least two prescriptions of each drug class within six months after incident CVD, among patients alive and registered with a general practitioner 30 days after the diagnosis. Supplementary table S2 provides a list of substances included in each drug class. Prescriptions were extracted from primary care records up to 31 December 2019.

Statistical analyses

Categorical data for patient characteristics are presented as frequencies (percentages), and continuous data are presented as means and standard deviations (SDs) for symmetrically distributed data or medians and interquartile ranges (IQRs) for non-symmetrically distributed data, over the whole CVD cohort and stratified by age, sex, socioeconomic status, region, and calendar year of diagnosis. For variables with missing entries, we present numbers and percentages of records with missing data. For categorical variables, frequencies refer to complete cases.

Incidence rates of CVD were calculated by dividing the number of incident diagnoses by the number of patient years in the cohort. Category specific rates were computed separately for subgroups of age, sex, socioeconomic status, region, and calendar year of diagnosis. Age calculations were updated for each calendar year. To ensure calculations referred to incident diagnoses, we excluded individuals, from both the numerator and the denominator populations, with a disease of interest diagnosed before the study start date (1 January 2000), or within the first 12 months of registration with their general practice. Time at risk started at the latest of the patient’s registration date plus 12 months, 30 June of their birth year, or study start date; and stopped at the earliest of death, transfer out of practice, last collection date of the practice, incidence of the disease of interest, or linkage end date (30 June 2019). Disease incidence was standardised for age and sex 18 using the 2013 European standard population 19 in five year age bands up to age 90 years.

Negative binomial regression models were used to calculate overall and category specific incidence rate ratios and corresponding 95% confidence intervals (CIs). 20 Models were adjusted for calendar year of diagnosis, age (categorised into five years age bands), sex, socioeconomic status, and region. We chose negative binomial models over Poisson models to account for potential overdispersion in the data. Sensitivity analyses comparing Poisson and negative binomial models showed similar results.

Study findings are reported according to the RECORD (reporting of studies conducted using observational routinely collected health data) recommendations. 21 We performed statistical analyses in R, version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria).

Patient and public involvement

No patients or members of the public were directly involved in this study owing to constraints on funding and time.

A total of 22 009 375 individuals contributed data between 1 January 2000 and 30 June 2019, with 146 929 629 patient years of follow-up. Among those we identified 2 906 770 new CVD diagnoses, affecting 1 650 052 patients. Mean age at first CVD diagnosis was 70.5 (SD 15.0) years, 47.6% (n=784 904) of patients were women, and 11.6% (n=191 421), 18.0% (n=296 554), 49.7% (n=820 892), and 14.2% (n=233 833) of patients had a history of chronic kidney disease, dyslipidaemia, hypertension, and type 2 diabetes, respectively, at the time of their first CVD diagnosis ( table 1 ).

Characteristics of patients with a first diagnosis of CVD, 2000-19. Values are number (percentage) unless stated otherwise

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During 2017-19, the most common CVDs were atrial fibrillation or flutter (age-sex standardised incidence 478 per 100 000 person years), heart failure (367 per 100 000 person years), and chronic ischaemic heart disease (351 per 100 000 person years), followed by acute coronary syndrome (190 per 100 000 person years), venous thromboembolism (183 per 100 000 person years), and stroke (181 per 100 000 patient years) ( fig 1 ).

Incidence of a first diagnosis of cardiovascular disease per 100 000 person years, 2000-19. Incidence rates are age-sex standardised to the 2013 European standard population. Any cardiovascular disease refers to the primary incidence of cardiovascular disease across the10 conditions investigated (ie, number of patients with a first diagnosis of cardiovascular disease). See supplementary table S4 for crude incidence rates by age and sex groups. IRR=incidence rate ratio

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Temporal trends

The primary incidence of CVDs (ie, the number of patients with CVD) decreased by 20% during 2000-19 (age-sex standardised incidence rate ratio 2017-19 v 2000-02: 0.80 (95% CI 0.73 to 0.88)). However, the total incidence of CVD (ie, the total number of new CVD diagnoses) remained relatively stable owing to an increasing number of subsequent diagnoses among patients already affected by a first CVD (incidence rate ratio 2017-19 v 2000-02: 1.00 (0.91 to 1.10)).

The observed decline in CVD incidence was largely due to declining rates of atherosclerotic diseases, in particular acute coronary syndrome, chronic ischaemic heart disease, and stroke, which decreased by about 30% during 2000-19. The incidence of peripheral artery disease also declined, although more modestly (incidence rate ratio 2017-19 v 2000-02: 0.89 (0.80 to 0.98)) ( fig 1 ).

The incidence of non-atherosclerotic heart diseases increased at varying rates, with incidence of aortic stenosis and heart block more than doubling over the study period (2017-19 v 2000-02: 2.42 (2.13 to 2.74) and 2.22 (1.99 to 2.46), respectively) ( fig 1 ). These increasing rates of non-atherosclerotic heart diseases balanced the reductions in ischaemic diseases so that the overall incidence of CVD across the 10 conditions appeared to reach a plateau and to remain relatively stable from 2007-08 (incidence rate ratio 2017-19 v 2005-07: 1.00 (0.91 to 1.10)) ( fig 2 ).

Age standardised incidence of cardiovascular disease by sex, 2000-19. Any cardiovascular disease refers to the primary incidence of cardiovascular disease across the 10 conditions investigated (ie, number of patients with a first diagnosis of cardiovascular disease). IRR=incidence rate ratio

Age stratified analyses further showed that the observed decrease in incidence of chronic ischaemic heart disease, acute coronary syndrome, and stroke was largely due to a reduced incidence in those aged >60 years, whereas incidence rates in those aged <60 years remained relatively stable ( fig 3 and fig 4 ).

Sex standardised incidence of cardiovascular disease in all age groups. Any cardiovascular disease refers to the primary incidence of cardiovascular disease across the 10 conditions investigated (ie, number of patients with a first diagnosis of cardiovascular disease)

Sex standardised incidence of cardiovascular diseases by age subgroups <69 years. Any cardiovascular disease refers to the primary incidence of cardiovascular disease across the 10 conditions investigated (ie, number of patients with a first diagnosis of cardiovascular disease)

Age at diagnosis

CVD incidence was largely concentrated towards the end of the life span, with a median age at diagnosis generally between 65 and 80 years. Only venous thromboembolism was commonly diagnosed before age 45 years ( fig 5 ). Over the study period, age at first CVD diagnosis declined for several conditions, including stroke (on average diagnosed 1.9 years earlier in 2019 than in 2000), heart block (1.3 years earlier in 2019 than in 2000), and peripheral artery disease (1 year earlier in 2019 than in 2000) (see supplementary figure S1). Adults with a diagnosis before age 60 years were more likely to be from lower socioeconomic groups and to have a higher prevalence of several risk factors, including obesity, smoking, and high cholesterol levels (see supplementary table S3).

Incidence rates of cardiovascular diseases calculated by one year age bands and divided into a colour gradient of 20 quantiles to reflect incidence density by age. IQR=interquartile range

Incidence by sex

Age adjusted incidence of all CVDs combined was higher in men (incidence rate ratio for women v men: 1.46 (1.41 to 1.51)), with the notable exception of venous thromboembolism, which was similar between men and women. The incidence of aortic aneurysms was higher in men (3.49 (3.33 to 3.65)) ( fig 2 ). The crude incidence of CVD, however, was similar between men and women (1069 per 100 000 patient years and 1176 per 100 000 patient years, respectively), owing to the higher number of women in older age groups. Temporal trends in disease incidence were generally similar between men and women ( fig 2 ).

Incidence by socioeconomic status

The most deprived socioeconomic groups had a higher incidence of any CVDs (incidence rate ratio most deprived v least deprived: 1.37 (1.30 to 1.44)) ( fig 6 ). A socioeconomic gradient was observed across almost every condition investigated. That gradient did not decrease over time, and it was most noticeable for peripheral artery disease (incidence rate ratio most deprived v least deprived: 1.98 (1.87 to 2.09)), acute coronary syndrome (1.55 (1.54 to 1.57)), and heart failure (1.50 (1.41 to 1.59)). For aortic aneurysms, atrial fibrillation, heart failure, and aortic stenosis, socioeconomic inequalities in disease incidence appeared to increase over time.

Age-sex standardised incidence rates of cardiovascular diseases by socioeconomic status (index of multiple deprivation 2015). Any cardiovascular disease refers to the primary incidence of cardiovascular disease across the 10 conditions investigated (ie, number of patients with a first diagnosis of cardiovascular disease). Yearly incidence estimates were smoothed using loess (locally estimated scatterplot smoothing) regression lines

Regional differences

Higher incidence rates were seen in northern regions (north west, north east, Yorkshire and the Humber) of England for all 10 conditions investigated, even after adjusting for socioeconomic status. Aortic aneurysms and aortic stenosis had the strongest regional gradients, with incidence rates about 30% higher in northern regions compared with London. Geographical variations remained modest, however, and did not appear to change considerably over time (see supplementary figure S2).

Sensitivity analyses

In sensitivity analyses that used broader disease definitions, that included diagnoses recorded on death certificates, that relied on longer lookback periods for exclusion of potentially prevalent diagnoses, or that were restricted to diagnoses recorded during hospital admissions, temporal trends in disease incidence appeared similar (see supplementary figures S3-S6).

Secondary prevention treatments

The proportion of patients using statins and antihypertensive drugs after a first CVD diagnosis increased over time, whereas the use of non-dihydropyridines calcium channel blockers, nitrates, and diuretics decreased over time. Non-vitamin K antagonist oral anticoagulants increasingly replaced vitamin K anticoagulants (see supplementary figure S7).

The findings of this study suggest that important changes occurred in the distribution of CVDs during 2000-19 and that several areas are of concern. The incidence of non-atherosclerotic heart diseases was shown to increase, the decline in atherosclerotic disease in younger people was stalling, and socioeconomic inequalities had a substantial association across almost every CVD investigated.

Implications for clinical practice and policy

Although no causal inference can be made from our data, the decline in rates of ischaemic diseases coincided with reductions in the prevalence of risk factors such as smoking, hypertension, and raised cholesterol levels in the general population over the same period, 22 and this finding suggests that efforts in the primary and secondary prevention of atherosclerotic diseases have been successful. The decline in stroke was not as noticeable as that for coronary heart disease, which may reflect the rising incidence of atrial fibrillation. The variation in trends for peripheral artery disease could be due to differences in risk factors (eg, a stronger association with diabetes), the multifaceted presentations and causes, and the introduction of systematic leg examinations for people with diabetes. 23 24

All the non-atherosclerotic diseases, however, appeared to increase during 2000-19. For some conditions, such as heart failure, the observed increase remained modest, whereas for others, such as aortic stenosis and heart block, incidence rates doubled. All analyses in this study were standardised for age and sex, to illustrate changes in disease incidence independently of changes in population demographics. Whether these trends solely reflect increased awareness, access to diagnostic tests, or even screening (eg, for abdominal aortic aneurysm 25 ) and coding practices, is uncertain. Reductions in premature death from coronary heart disease may have contributed to the emergence of these other non-atherosclerotic CVDs. Regardless, the identification of increasing numbers of people with these problems has important implications for health services, especially the provision of more surgical and transcatheter valve replacement, pacemaker implantation, and catheter ablation for atrial fibrillation. Importantly, these findings highlight the fact that for many cardiovascular conditions such as heart block, aortic aneurysms, and non-rheumatic valvular diseases, current medical practice remains essentially focused on the management of symptoms and secondary prevention and that more research into underlying causes and possible primary prevention strategies is needed. 26 27

These varying trends also mean that the contribution of individual CVDs towards the overall burden has changed. For example, atrial fibrillation or flutter are now the most common CVDs in the UK. Atrial fibrillation is also a cause (and consequence) of heart failure, and these two increasingly common problems may amplify the incidence of each other. Venous thromboembolism and heart block also appeared as important contributors to overall CVD burden, with incidence rates similar to those of stroke and acute coronary syndrome, yet both receive less attention in terms of prevention efforts.

The stalling decline in the rate of coronary heart disease in younger age groups is of concern, has also been observed in several other high income countries, and may reflect rising rates of physical inactivity, obesity, and type 2 diabetes in young adults. 4 6 28 The stalled decline suggests prevention approaches may need to be expanded beyond antismoking legislation, blood pressure control, and lipid lowering interventions to include the promotion of physical activity, weight control, and use of new treatments shown to reduce cardiovascular risk in people with type 2 diabetes. 29 Although CVD incidence is generally low in people aged <60 years, identifying those at high risk of developing CVD at a young age and intervening before problems occur could reduce premature morbidity and mortality and have important economic implications.

Our study further found that socioeconomic inequalities may contribute to CVD burden, and that this association is not restricted to selected conditions but is visible across most CVDs. The reasons behind the observed increase in risk in relation to socioeconomic inequalities are likely to be multifactorial and to include environmental, occupational, psychosocial, and behavioural risk factors, including established cardiovascular risk factors such as smoking, obesity, nutrition, air pollution, substance misuse, and access to care. 30 How these findings apply to different countries is likely to be influenced by socioeconomic structures and healthcare systems, although health inequalities have been reported in numerous countries. 30 One important factor in the present study is that access to care is free at the point of care in the UK, 31 and yet socioeconomic inequalities persist despite universal health coverage and they did not appear to improve over time. Independently of the specificities of individual countries, our findings highlight the importance of measuring and considering health inequalities and suggest that dealing with the social determinants of health—the conditions under which people are born, live, work, and age—could potentially bring substantial health improvements across a broad range of chronic conditions.

Finally, our results reflect disease incidence based on diagnostic criteria, screening practices, availability, and accuracy of diagnostic tests in place at a particular time and therefore must be interpreted within this context. 32 Several of the health conditions investigated are likely to being sought and detected with increased intensity over the study period. For example, during the study period the definition of myocardial infarction was revised several times, 33 34 35 and high sensitivity troponins were progressively introduced in the UK from 2010. These more sensitive markers of cardiac injury are thought to have increased the detection rates for less severe disease. 36 37 Similarly, increased availability of computed tomography may have increased detection rates for stroke. 38 These changes could have masked an even greater decline in these conditions than observed in the present study. Conversely, increased use of other biochemical tests (such as natriuretic peptides) and more sensitive imaging techniques might have increased the detection of other conditions. 39 40 41 The implementation of a screening programme for aortic aneurysm and incentive programmes aimed at improving coding practices, including the documentation of CVD, associated risk factors and comorbidities, and treatment of these, are also likely to have contributed to the observed trends. 25 42 43 As a result, the difference in incidence estimates and prevalence of comorbidities over time may not reflect solely changes in the true incidence but also differences in ascertainment of people with CVD. 44 Nonetheless, long term trends in large and unconstrained populations offer valuable insights for healthcare resource planning and for the design of more targeted prevention strategies that could otherwise not be answered by using smaller cohorts, cross sectional surveys, or clinical trials; and precisely because they are based on routinely reported diagnoses they are more likely to capture the burden of disease as experienced by doctors and health services.

Strengths and limitations of this study

A key strength of this study is its statistical power, with >140 million person years of data. The large size of the cohort allowed us to perform incidence calculations for a broad spectrum of conditions, and to examine the influence of age, sex, and socioeconomic status as well as trends over 20 years. One important limitation of our study was the modest ethnic diversity in our cohort and the lack of information on ethnicity for the denominator population, which precluded us from stratifying incidence estimates by ethnic group. Our analyses were also limited by the unavailability or considerable missingness of additional variables potentially relevant to the development of CVD, such as smoking, body mass index, imaging data, women specific cardiovascular risk factors (eg, pregnancy associated hypertension and gestational diabetes), and blood biomarkers. Further research may also need to consider an even wider spectrum of CVDs, including individual types of valve disease, pregnancy related conditions, and infection related heart diseases. Research using databases with electronic health records is also reliant on the accuracy of clinical coding input by doctors in primary care as part of a consultation, or in secondary care as part of a hospital admission. We therefore assessed the validity of diagnoses in UK electronic health records data and considered it to be appropriate in accordance with the >200 independent validation studies reporting an average positive predictive value of about 90% for recorded diagnoses. 45 Observed age distributions were also consistent with previous studies and added to the validity of our approach. Nevertheless, our results must be interpreted within the context and limitations of routinely collected data from health records, diagnostic criteria, screening practices, the availability and accuracy of diagnostic tests in place at that time, and the possibility that some level of miscoding is present or that some bias could have been introduced by restricting the cohort to those patients with at least 12 months of continuous data.

Conclusions

Efforts to challenge the notion of the inevitability of vascular events with ageing, and evidence based recommendations for coronary heart disease prevention, have been successful and can serve as a model for other non-communicable diseases. Our findings show that it is time to expand efforts to improve the prevention of CVDs. Broadening research and implementation efforts in both primary and secondary prevention to non-atherosclerotic diseases, tackling socioeconomic inequalities, and introducing better risk prediction and management among younger people appear to be important opportunities to tackle CVDs.

What is already known on this topic

Recent data show that despite decades of declining rates of cardiovascular mortality, the burden from cardiovascular disease (CVD) appears to have stalled in several high income countries

What this study adds

This observational study of a representative sample of 22 million people from the UK during 2000-19 found reductions in CVD incidence to have been largely restricted to ischaemic heart disease and stroke, and were paralleled by a rising number of diagnoses of cardiac arrhythmias, valve disease, and thromboembolic events

Venous thromboembolism and heart block were important contributors to the overall burden of CVDs, with incidence rates similar to stroke and acute coronary syndromes

Improvements in rates of coronary heart disease almost exclusively appeared to benefit those aged >60 years, and the CVD burden in younger age groups appeared not to improve

Ethics statements

Ethical approval.

This study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee.

Data availability statement

Access to Clinical Practice Research Datalink (CPRD) data is subject to a license agreement and protocol approval process that is overseen by CPRD’s research data governance process. A guide to access is provided on the CPRD website ( https://www.cprd.com/data-access ) To facilitate the subsequent use and replication of the findings from this study, aggregated data tables are provided with number of events and person years at risk by individual condition and by calendar year, age (by five year age band), sex, socioeconomic status, and region (masking field with fewer than five events, as per CPRD data security and privacy regulations) on our GitHub repository ( https://github.com/nathalieconrad/CVD_incidence ).

Acknowledgments

We thank Hilary Shepherd, Sonia Coton, and Eleanor L Axson from the Clinical Practice Research Datalink for their support and expertise in preparing the dataset underlying these analyses.

Contributors: NC and JJVM conceived and designed the study. NC, JJVM, GM, and GV designed the statistical analysis plan and NC performed the statistical analysis. All authors contributed to interpreting the results, drafting the manuscript, and the revisions. NC, GM, and GV had permission to access the raw data and NC and GM verified the raw data. All authors gave final approval of the version to be published and accept responsibility to submit the manuscript for publication. NC and JJVM accept full responsibility for the conduct of the study, had access to aggregated data, and controlled the decision to publish. They are the guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding: This study was funded by a personal fellowship from the Research Foundation Flanders (grant No 12ZU922N), a research grant from the European Society of Cardiology (grant No App000037070), and the British Heart Foundation Centre of Research Excellence (grant No RE/18/6/34217). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: NC is funded by a personal fellowship from the Research Foundation Flanders and a research grant from the European Society of Cardiology. JMF, PSJ, JGC, NS, and JJVM are supported by British Heart Foundation Centre of Research Excellence. PSJ and JJVM are further supported by the Vera Melrose Heart Failure Research Fund. JJVM has received funding to his institution from Amgen and Cytokinetics for his participation in the steering sommittee for the ATOMIC-HF, COSMIC-HF, and GALACTIC-HF trials and meetings and other activities related to these trials; has received payments through Glasgow University from work on clinical trials, consulting, and other activities from Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardurion, Dal-Cor, GlaxoSmithKline, Ionis, KBP Biosciences, Novartis, Pfizer, and Theracos; and has received personal lecture fees from the Corpus, Abbott, Hikma, Sun Pharmaceuticals, Medscape/Heart.Org, Radcliffe Cardiology, Alkem Metabolics, Eris Lifesciences, Lupin, ProAdWise Communications, Servier Director, and Global Clinical Trial Partners. NS declares consulting fees or speaker honorariums, or both, from Abbott Laboratories, Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; and grant support paid to his university from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics. KK has acted as a consultant or speaker or received grants for investigator initiated studies for Astra Zeneca, Bayer, Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Roche, and Applied Therapeutics. KK is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC). CL is funded by an NIHR Advanced Research Fellowship (NIHR-300111) and supported by the Leicester BRC. PSJ has received speaker fees from AstraZeneca, Novartis, Alkem Metabolics, ProAdWise Communications, Sun Pharmaceuticals, and Intas Pharmaceuticals; has received advisory board fees from AstraZeneca, Boehringer Ingelheim, and Novartis; has received research funding from AstraZeneca, Boehringer Ingelheim, Analog Devices; his employer, the University of Glasgow, has been remunerated for clinical trial work from AstraZeneca, Bayer, Novartis, and Novo Nordisk; and is the Director of Global Clinical Trial Partners. HS is supported by the China Scholarship Council. Other authors report no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.

Transparency: The lead author (NC) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Dissemination to participants and related patient and public communities: Results from this study will be shared with patient associations and foundations dedicated to preventing cardiovascular diseases, such as the European Heart Network and the American Heart Association. To reach the public, findings will also be press released alongside publication of this manuscript. Social media (eg, X) will be used to draw attention to the work and stimulate debate about its findings. Finally, the underlying developed algorithms will be freely available for academic use at https://github.com/nathalieconrad/CVD_incidence .

Provenance and peer review: Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ .

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Biotechnology

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Primary Research Articles

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How Can I Find Primary Research Articles?

Many of the recommended databases in this subject guide contain primary research articles (also known as empirical articles or research studies). Search in databases like ScienceDirect , MEDLINE , and Health Source: Nursing/Academic Edition .

Primary Research Articles: How Will I Know One When I See One?

Primary Research Articles  To conduct and publish an experiment or research study, an author or team of authors designs an experiment, gathers data, then analyzes the data and discusses the results of the experiment. A published experiment or research study will therefore  look  very different from other types of articles (newspaper stories, magazine articles, essays, etc.) found in our library databases. The following guidelines will help you recognize a primary research article, written by the researchers themselves and published in a scholarly journal.

Structure of a Primary Research Article Typically, a primary research article has the following sections:

• The author summarizes her article
• The author discusses the general background of her research topic; often, she will present a literature review, that is, summarize what other experts have written on this particular research topic
• The author describes the study she designed and conducted
• The author presents the data she gathered during her experiment
• The author offers ideas about the importance and implications of her research findings, and speculates on future directions that similar research might take
• The author gives a References list of sources she used in her paper

The structure of the article will often be clearly shown with headings: Introduction, Method, Results, Discussion.

A primary research article will almost always contains statistics, numerical data presented in tables. Also, primary research articles are written in very formal, very technical language.

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