Critique of a Journal Article: “Color of Bile Vomiting in Intestinal Obstruction in the Newborn”
In this critique, Walker’s (2006) article “Color of bile vomiting in intestinal obstruction in the newborn: Questionnaire study” that was published in BMJ journal is critically analyzed. The critical Analysis explores the article’s hypotheses, subjects chosen, sampling method, data collection method, statistical analysis, study design and finally the discussion.
A case of bilious vomiting is an indicator of intestinal obstruction in newborns. Cases of bilious vomiting require urgent referral and intervention of pediatricians and neonatologists before any operation maneuverer can be organized. It is characterized by green or yellow color and initial detection is through the color of vomit observed by nurses, mothers to the baby’s, medical practitioners and midwives. It has however been noted that there is no clear-cut response on the color of bilious vomit. At Glasgow, it was noted that recent referrals cases of intestinal obstruction had a history of green vomitus as opposed to yellow. Yellow vomitus was largely associated with mechanical obstruction in newborns, though it could be as a result of intestinal obstruction. The study tested the hypotheses on which color represented bile in vomit of newborns as perceived by different groups.[“Write my essay for me?” Get help here.]
Comments: Purpose of the study was in line with the problem. Purpose of the study was also limited to researchers’ capabilities and resources available for the study. Findings from the study could be used in hypotheses testing on perceptions on the color in bilious vomit.
This was a qualitative study that involved case reports design during the research. There was no involvement of controls during the study. Questionnaire was the only tool for data collection used during the study. These questionnaires basically comprised of 8 colors, ranging from yellow through to dark green, that were numbered and from which respondents were to choose from.
Comments: There was no pilot study conducted. Testing of instruments to be used in data collection was not performed, something that resulted in some questionnaires not being returned from some general practitioners.
General practitioners, nurses, midwives and mothers of babies and infants were purposively selected for the study due their experience with newborns. Convenience sampling technique was then used in the distribution of questionnaires among individuals in the different sample groups selected. Individuals taking part in the study were therefore chosen on their availability during the study.
Comments: There is no clear sampling technique illustrated in sample selection. Information about how they arrived at their sample sizes is also missing.
Subjects used in the study included general practitioners at Glasgow, specialist nurses from the baby unit department, mothers who had infants and babies and midwives. Practitioners, nurses and midwives were obtained from the staff at Glasgow. Mothers to babies and infants were obtained from the local society. A total of 165 respondents comprising, of 29 nurses, 41 mothers, 48 midwives and 47 (although 80 questionnaires had been administered) practitioners, took part in the study.[Need an essay writing service? Find help here.]
Comments: Selection of respondents is not provided. We only see questionnaires being administered. Information about the subject as a representation of the bigger community is also missing.
Data Collection Method
Questionnaires were administered to the respondents. 80 questionnaires were given to the general practitioners, 48 to midwives, 29 to nurses and 48 to mothers. Questionnaires for the general practitioners clinics were delivered by hand while in stamped envelopes with addresses. Mothers, nurses and postnatal midwives received their letters through hand. A large envelope was however left behind for collection to ensure anonymity. Respondents were expected to choose a color that represented a newborn’s vomit with bile. Respondents were allowed to choose more than one color for this. The next task involved respondents choosing only one color matching that of bile.
Comments: The study did maintain consistency in the method of study used, for instance all participants were given a large envelope for collecting questionnaires except for those from general practitioners. This resulted into 42 % of general practitioners failing to return their questionnaires. Questions on the questionnaires were limited, there was need to include questions on any history of bilious vomiting and what solution was provided.
Responses obtained from returned questionnaires were grouped into two categories of green and yellow. Percentages of responses about the color of a newborn’s vomit with bile and those for responses on a color similar to bile were calculated. Information obtained was then tabulated. Percentage for the number of questionnaires returned from the different groups of participants was also obtained.
Comment: Analysis in percentage form is given for each finding in the study, however descriptive statistics was missing as it was the case with inferential statistics. Hypothesis testing was not done after analysis of findings.
Relationship between the anatomy of the small intestine at the duodenum and bile duct is well illustrated in the discussion. The mechanism for the presence of bile in the vomit is attributed to the obstruction below the level of bile duct into the duodenum. Conditions associated with intestinal obstruction are also provided.
Conclusion on the findings of the study is also provided. General practitioners and nurses did not match the expectation of the researchers during the study. A significant number showed their uncertainty when it came to matters of the best color for bilious vomit. A summary on already known information about bilious vomit and additional information provided by the study is also provided. Recommendations were also included in the discussion; it was recommended that yellow vomitus should not be ruled out as an indicator of intestinal obstruction and a study including newborns found to have had yellow vomitus should be conducted.
Comments: The discussion was based on findings and was stated logically. Theoretical information about bilious vomiting was also provided.
Walker, G. M. (2006). Colour of bile vomiting in intestinal obstruction in the newborn:
Questionnaire study. Bmj, 332(7554), 1363-0.