Research Critique Work Sheet
Quantitative Research
Prepared by Polly Ryan
Title of Study
Comparison of Inhaled Isopropyl Alcohol and Intravenous Ondansetron for Treatment
of Postoperative Nausea
Year of Publication
2003
Authors (list first two)
Winston, A. Rinehart, R. Riley, G.
__X___ Clinical experience
_____ Research expertise
_____ Prior publications
__X___
Funding
_____ Non-federal funding
__X___
Federal funding
_____ Non US governmental funding
Purpose
Compare the efficacy of inhaled isopropyl alcohol and IV ondansetron for the treatment
and control of PON in groups of women undergoing outpatient
gynecological laparoscopic procedures.
Review of Literature
__X___
Logical
_X____
Clarity
__X___
Current and comprehensive references
_____ Pros/Cons presented
_____ Gaps in knowledge identified
_____ Importance of study
Comments:
The review of literature focused on why PONV happens, the physiological
mechanisms. The authors barely touched on previous research done.
Overviewed the IV antiemetic chosen. Did mention cost of POSN, time
spent in the PACU. How it could be beneficial to investigate this but it
was brief and non specific. References were from 1987 to 2002. All
references looked specifically at nausea and vomiting. Very brief
introduction before the study was introduced.
Research Question/Hypothesis
Is the use of inhaled isopropyl alcohol more beneficial in reducing PONV than IV
ondansetron.
Study Design
__X_
_____
_____
_____
_____
____
Experimental/Randomized Clinical Trial
Quasi-Experimental
Correlation
Descriptive
Program Evaluation
Other
Sample and Setting
General description of participants (age, gender, etc.)
100 women older than 18, ASA status I or II, undergoing a diagnostic
laparoscopic, operative laparoscopy, or laparoscopic bilateral tubal occlusion.
Important Inclusion and Exclusion Criteria:
Exclusion: sensitivity to IPA or ondansetron, inability to breathe through nose,
pregnant, using disulfiram, preexisting nausea, alcoholism.
Groups
_____ True control group
_____ Usual care group
___X__
Intervention group(s)
Name or brief description of group:
Control: received 4mg IV ondansetron, maybe be repeated times one.
Name or brief description of group:
Intervention: use of an alcohol prep pad, 3 consecutive deep breaths
through the nose. May be repeated times one.
Type of Sample
Probability
___X_ Simple Random Sampling
_____ Stratified Random Sampling
_____ Cluster
_____ Systematic
_____
_____
_____
_____
Non-Probability
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
Numeric rating scale
Degree of nausea
experienced on a 1 to 10
scale
Not mentioned. Most
commonly used scale for
self report. Relies on self
report.
Detailed Description of the Intervention
Specific Steps of the intervention
Either put in ondansetron group or alcohol group when first reporting nausea in
the PACU. Intervention was standardized in both groups.
Knowledge and skills needed to deliver intervention (education, licensure, etc)
Giving IV medications require a MD, RN. Inhalation treatment does not require
any specific skills.
Time to deliver/use the intervention
Time was that spent in the PACU.
How frequently does it need to be delivered and what is the time interval in
between delivery?
Alcohol: 3 consecutive deep breaths, up to two treatments
Ondansetron: 4mg IV every 15 minutes for up to two doses.
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
_____ Experimenter effect
_____ Measurement effect
Results
Demographic characteristics were similar in both groups, equal number of surgical
procedures between groups. 41 of 100 experienced nausea. 29 in alcohol, 12 in control.
No statistically significant differences in mean verbal NRS scores except at 5, 10 and 15
min mark. Time of reduced nausea of 6.3(alcohol) vs. 27.7(ondansetron). Did not
influence total time spent in PACU. Alcohol group did report more episodes of nausea
at home during first 24 hours. 8 of inhalation and 2 of ondansetron did not receive any
relief from their intervention, other means were used.
Major Findings
Decrease in nausea faster in inhalation group. Not better long term effects. No impact
on PACU stay.
Strengths and Weaknesses of Study
Strength
Specific surgical population
Randomized
Consistent and regular interventions
Practical day to day setting
Weakness
Small sample size
No blinded study intervention
Self reported data
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
__X__ Level II = experimental studies
____ Level III = well-designed, quasi-experimental studies
____ Level IV = well designed, non-experimental studies
____ Level V = case reports and clinical examples