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UNIVERSITY OF COLORADO HOSPITAL QUANTITATIVE RESEARCH CRITIQUE

Facilitator of Journal Club

Name: Miranda Bishop

Date: 2/23/2014

Article Reviewed: Meierhenrich, R., Hock, D., Kuhn, S., Baltes, E., Muehling, B., Muche, R., et al. (2011). Analgesia an !ul"onar# $unction a$ter lung surger#% is a single intercostal ner&e 'lock !lus !atient( controlle intra&enous "or!hine as e$$ecti&e as !atient(controlle e!i ural anaesthesia) A ran o"i*e non(in$eriorit# clinical trial. British Journal of Anaesthesia, +,0(-.
(Facilitator Info: Before you begin your critique, read the critique form to be aware of what questions you should answer after reading the article. Then, read the article for a first o er iew or impression. Finally, read the article again, slowly. !top and answer the questions from the critique form. "ighlight the answers in the article. #lso, on the critique form, write page numbers of where answers can be found to help you when you are leading the discussion at the $ournal %lub. #s you plan for the &ournal club, refer to the 'esearch and ( idence)Based *ractice Manual +nd (dition. %hapter , titled *articipating in a $ournal %lub pro ides step by step ad ice for the process.-

Research Purpose: What is the purpose of the study? o The purpose of the study is to co pare !C"A with sin#le$shot intercostal nerve bloc% co bined with a !CA&

's the research (uestion clearly identified? o )es

Review of Literature/Backgrou !: *o the authors specify a theoretical+conceptual fra ewor% #uidin# the study ,do they provide a -word picture. or visual i a#e of the fra ewor%/? 0pecify the fra ewor%+conceptual odel used: o 1one theoreticl+conceptual fra ewor% used

2iterature reviewed relevant to the study purpose? o yes

Review lo#ically and clearly or#ani3ed? o )es

*oes the review pri arily use current literature? ,published within the last 4 years5 unless a -classic. / o 6ostly older literature but does include a few current literatures

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Were pri ary sources used? ,A pri ary source is written by the person who ori#inated the ideas published/ o )es

Research Desig a ! "etho!s: 'nstitutional review board ,'R8/ approval? )es 1o 1ot What type of desi#n,s/ was ,were/ used? Circle all that apply: <ther:

entioned

Experimental9 :uasi$e;peri ental9 Correlational9 ";ploratory9 *escriptive9 0urvey9 Was sa ple described? )es& What is sa ple si3e? 1=>?@>> 's the sa ple si3e5 selection5 and representativeness ade(uate and appropriate? o

)es ethod was used? Rando i3ed9 Convenien e9 <ther:

What sa plin#

2ist the inclusion and e;clusion criteria: o 'nclusion: !atients under#oin# elective pul onary sur#ery o ";clusion: A1? yr5 contraindication to "*A5 intercostal nerve bloc%5 or to the use of ropivacaine5 orphine5 eta i3ole5 or diclofenac9 and any type of chronic painful condition or current opioid use&

What is the settin# for the study? o 'npatient hospital Can you identify the variable in the study? 2ist %ey variables o 'ndependent ,intervention/: !atients under#oin# lun# sur#ery #et either an epidural or both an 'ntercostal 1erve 8loc% and !CA& o o *ependent ,outco e/: !ain relief *e o#raphics: !atients under#oin# elective pul onary sur#ery&

Data co##ectio $ measureme t$ a ! a a#%sis: *escribe the ethod of data collection: o !ain status was assessed preoperatively& 'ntraoperatively5 type and duration of sur#ery as well as edication ad inistered& !ostoperatively5 pain assess ent 1 hour after arrival to !ACB5 before *C fro !ACB5 in the evenin# of operation and on each ornin# and evenin# for the first 4 postoperative days&

*id they a%e sense to you? o )es Are instru ents+tools used reliable and valid? o )es

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*escribe the ethod of data analysis: o 6ann$Whitney ran%$su test for continuous variable and the FisherCs e;act test for cate#orical variables&

&i !i gs/Resu#ts a ! 'o c#usio s Results or#ani3ed lo#ically and presented clearly? o )es

8riefly describe results and the conclusions drawn fro the & Are the conclusions consistent with the results? *o the answers a%e sense? o !atients of the intercostal nerve bloc% #roup reported hi#her pain and lower pul onary function than the epidural #roup& o The conclusion is consistent with the result and the answers do a%e sense&

Are the conclusions discussed in relation to the theoretical+conceptual fra ewor%? o )es

*oes the researcher place the report in the conte;t of what is already %nown about the research (uestion? ,e&#&5 other studies5 philosophies/ o )es

Are the li itations+biases concernin# enou#h to cause you to (uestion the validity of the results? o 1o

Are su##estions for future research included? 'f so5 what are they? o 1o&

Professio a# co te(t: Are the i plications for practice clearly stated ,i&e&5 how do the conclusions of the study affect y practice/? 2ist the i plications: o The i plication is clearly stated& The article i plies that the use of !C"As on lun# sur#ery patients in the preferred practice for pain control and pul onary function&

0u ari3e one ele ent+findin# in this article that you will+will not use in your practice as a result of readin# this article&

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Althou#h of pul onary doctors often ti es use sin#le shot intercostal bloc%s at the end of sur#ery it would be nice to still have either an epidural or !CA for patient pain control& 'f it is a thoracoto y and we can encoura#e our acute pain service to i ple ent epidurals that would be a practice that would be nice to chan#e& !"at i# t"e level o$ evi%en e $or t"i# #t&%'(

Stron)e#t Evi%en e

Level 1 2 3 # %

Evidence Systematic review & meta-analysis of randomized controlled trials; clinical guidelines based on systematic reviews or meta-analyses One or more randomized controlled trials Controlled trial (no randomization); uasi-e!"erimental Case-control or co$ort study Systematic review of descri"tive studies; systematic review of ualitative studies (metasynt$esis) Single descri"tive or ualitative study (rogram evaluation) researc$ utilization) uality im"rovement "ro*ects; case re"orts (+C sentinel event); benc$mar,ing studies (-.-/0 data) 12C re"orts); or researc$-based clinical "ractice guidelines 4!"ert o"inion (aut$orities and5or re"orts of e!"ert committees) te!tboo,s) clinical "roduct guidelines; non-researc$ based clinical "ractice guidelines

!ea*e#t Evi%en e

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