Evaluating research quality standards in health care delivery literature

¶ … Annals of Emergency Medicine, in 2014, and is titled Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service." The article studies a new technique that was introduced in 2011, to see if that technique has proven effective at meeting its objectives.

The Wimalasena (2014) article does not have a literature review. It moves straight from the introduction to the materials and methods. The background section of the introduction serves the purpose of a literature review to some extent. There is no problem statement written into this section. The problem statement can be found in two other places, however. First, it is in the abstract under "study objective": "We evaluate the association between the introduction of apneic oxygenation and incidence of desaturation during rapid sequence intubation in both out-of-hospital and interhospital retrievals." This is rephrased for the box "editor's capsule summary," so taking the two together the problem statement is fairly clear, even though it is not included in what is de facto the literature review.

The purpose statement is therefore clear -- the purpose of the research is to determine whether this technique of apneic oxygenation is associated with less desaturation during intubation, as noted in the editor's capsule summary. This is also elaborated in "goals of this investigation" which says much the same thing, about why this study is warranted. They have introduced a new technique and are checking back a few years later to see if it has been effective at delivering the desired and expected outcomes.

The research question is the same as the purpose statement, or more specifically the research question can be obtained by restructuring the purpose statement for grammar. This is never actually phrased in the form of a question, but the research question is quite clear. There is, however, no hypothesis stated. It is possible that this is not an oversight -- the study is retrospective, so there is no point in having a hypothesis to either confirm or not confirm. The study's results are what they are. However, it is also reasonable to suggest that the study should have a clear hypothesis. This is because the data will still need to be validated for statistical strength. It is important, given the nature of the study, to understand whether the findings are sufficiently robust to guide future policy. Having a clear hypothesis should help with that. The fact that this study lacks a clear hypothesis despite having a clear research question should be taken as a fault.

There are sample sizes clearly stated. The patients affected were divided into different categories, but there is a sample size for each. The total number of samples was n=728. This was actually not a sample, as the entire population was used. The authors note that the population was "all patients who had rapid sequence intubation delivered by Greater Sydney Area Helicopter Emergency Medical Service staff during out-of-hospital or interhospital missions." Arguably, these findings should apply to other populations as well, assuming that the techniques used in Sydney are applicable elsewhere. But the authors do not frame it this way.

The setting is clearly mentioned as well, being all of the above patients. The only patients who were excluded from the study were those who were "intubated by referring health care staff before the arrival of the service team and any patients intubated as part of cardiac arrest management." So for the most part, the setting is clear, and the patient population is clear. There was no specific attempt to sample from this population, as data is easily obtainable on the entire population. If anything, the Sydney team represents a sample that can be extrapolated to other settings, though little detail is provided on what other settings might apply.

The article was published in 2014. It is timely to the standard of medical care presently delivered. The technique was initiated in 2011, and the report is studying the effectiveness of this new technique over the first three years of its use.

The article practical and reasonable. It describes a specific technique, used in a specific setting. This is a recently-developed technique in emergency medicine, which is the subject of the journal in question. It is always fair game to evaluate the effectiveness of relatively recent techniques, once they have been in use long enough to develop a credible real world dataset. There is sufficient detail that those who are engaged in medical practice will be able to determine the degree to which these findings can be applied to their own operations. The findings are based on quantitative analysis, which means that they can be investigated by external parties to ensure their validity. There does not appear to be overreach on applying the findings, either, so the conclusions and article overall are practical and reasonable.