Research Critique Work Sheet
Quantitative Research
Prepared by Polly Ryan
Title of Study
Isopropyl Alcohol Inhalation Treatment: Alternative Treatment of Postoperative
Nausea and Vomiting
Year of Publication
2002
Authors (list first two)
Merrit, B. Okeye, C. Jasinski
__X___ Clinical experience
_____ Research expertise
_____ Prior publications
__X__ Funding
_____ Non-federal funding
_____ Federal funding
_____ Non US governmental funding
Purpose
Evaluate the effect of IPA inhalation for rescue treatment of POVN in adult same day
surgery patients who underwent general anesthesia.
Review of Literature
__X___
Logical
__X___
Clarity
__X___
Current and comprehensive references
__X___
Pros/Cons presented
__X___
Gaps in knowledge identified
__X___ Importance of study
Comments:
Starts with overview of the vomiting reflex. States lack of actual known
pathways. Mentions previous studies on what influences nausea and
vomiting. Then proceeds into current drug therapies, alternative
therapies. Background of use of isopropyl alcohol, lack of risks, unknown
mechanism, short acting. References from 1976-1999. Articles vary in
topic: children, post operative nausea, isopropyl alcohol in rats, antiemetic
intravenous medication use and risk factors. No studies were used that
previously looked at the use of isopropyl alcohol.
Research Question/Hypothesis
Patients treated with inhalation of IPA would have decreased nausea and vomiting in
the immediate postoperative period; Inhalation treatment would be more effective in
decreasing nausea and vomiting than standard rescue treatment; IPA inhalation would
decrease post anesthesia care.
Study Design
___
Experimental/Randomized Clinical Trial
___X__
Quasi-Experimental
_____ Correlation
_____ Descriptive
_____ Program Evaluation
____ Other
Sample and Setting
General description of participants (age, gender, etc.)
111 participants. Only 40 studied. 19-80 years old, average of 43. Surgery types
included intra-abdominal, orthopedic, perineal, and neuro-skeletal. 36% had post
operative nausea, 84.6% got prophylactic anti-emetics.
Important Inclusion and Exclusion Criteria:
Patients admitted from same day surgery. Must have had general anesthesia,
ability to breathe through the nose, 18 years of age or greater, ASA physical status of 1,
2, or 3. Also had to be able to read and write in English.
Could not have allergy to IPA, alcohol abuse, recent history of nausea/vomiting
in last 8 hours, no recent intake of cefoperazone, antabuse, metrondazole, must have
ability to communicate in recovery room, regional anesthesia, and monitored anesthesia
care.
Groups
_____ True control group
_____ Usual care group
__X___
Intervention group(s)
Name or brief description of group:
Experimental: received inhalation treatment; three deep sniffs with the
pad once inch from the nose. Repeated every five minutes for three doses. If not
relieved in three doses, intravenous drug was given.
Name or brief description of group:
Control: Did not receive inhalation treatment. Just received intravenous
anti-emetic.
Type of Sample
Probability
_____ Simple Random Sampling
_____ Stratified Random Sampling
_____ Cluster
_____ Systematic
Non-Probability
__X___ Convenience
_____ Quota
_____ Purposive
_____ Snowball
Instruments
Measurement Tool
What did it measure?
Information about the
measure: # or type
questions; reliability or
validity; inter-rater
reliability; other
DOS score
Perception of nausea and
vomiting, scale 0-10.
Reliability/validity not
measured. Similar to VAS
scores. Self reported data
from patient.
Detailed Description of the Intervention
Specific Steps of the intervention
The patient reported score of nausea/vomiting, either the inhalation treatment or
intravenous treatment was given.
Knowledge and skills needed to deliver intervention (education, licensure, etc)
Assume intervention was given by RNs.
Time to deliver/use the intervention
Time spent was in recovery room. Three five minute interventions or usual
intervention. Time spent in recovery room was basic.
How frequently does it need to be delivered and what is the time interval in
between delivery?
Three, five minute interventions
IRB Approval
__X___
Yes
_____ Does not mention
Threats to Validity
Threats to Internal Validity
_____ History
_____ Maturation
__X___ Testing
_____ Instrumentation
_____ Mortality
_____ Selection Bias
Threats to External Validity
__X___
Novelty effects
_____
Interaction of history and
treatment
__X___ Experimenter effect
_____ Measurement effect
Results
Of the 21 given the intervention: 11 had relief after first dose, and 10 needed at least one
intervention of standard medication.
Of the 18 in the control group: 13 had relief after the first dose of standard anti-emetic.
Five had no relief.
Results not significant regarding differences in IPA being superior to standard
medications.
IPA group had average cost of 9.75. Control had average cost of 17.08. This is
significant.
Major Findings
Few actually had PONV due to aggressive premedication. PONV could be related to
pain. This study does suggest IPA is clinically important. However, does not prove to
be more effective. This study points to other explanations for PONV and the associated
risk factors.
Strengths and Weaknesses of Study
Strength
Looked at the direct use of IPA for PONV
treatment.
Appropriate area to have intervention
Uses self report for nausea scale
Leaves door open for future research,
Weakness
Small sample size.
Uses self report in patients coming out of
anesthesia
Didn’t break down by surgical type (more
significant in abdominal surgeries?)
supports previous research.
Didn’t address dose, times of intervention.
Ranking of Scientific Merit
Agency for Health Care and Research
Evaluate each study – Assign a quality number to the study
Evaluate all articles within the collection of studies reviewed – Assign
a Letter
•Types of Evidence
____ Level 1 = meta-analysis
____ Level II = experimental studies
__X__ Level III = well-designed, quasi-experimental studies
____ Level IV = well designed, non-experimental studies
____ Level V = case reports and clinical examples