Submited on: 01 Feb 2014 09:44:52 PM GMT
Published on: 03 Feb 2014 05:30:05 AM GMT

  • What are the main claims of the paper and how important are they?

    This paper focuses on the improvement of patient safety in their Day Oncology Care Unit (DOCU).

    The article claims that it:

    (1) Studied the most common causes of Adverse Drug Events (ADE) in the DOCU

    (2) Subsequently provided nursing education to more properly treat and prevent ADEs.

    (3) Discusses the positive effects that the additional education had on the quality of care and actions taken in the DOCU. These include: the number of ADE's pre and post education, the time spent on each phase of attending to ADE's, and the time taken to detect the symptoms pre and post education. 


    These claims are important in furthering the emphasis of patient-focused care, and learning to prevent adverse reactions from oncology drugs. 

  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    These claims are not necessarily novel. Below are a few articles that have similar research and conclusions:


    (1) Sharma A, Kumari KM, Manohar HD, Bairy KL, Thomas J. Pattern of adverse drug reactions due to cancer chemotherapy in a tertiary care hospital in South India. Perspectives in Clinical Research. 2015;6(2):109-115. doi:10.4103/2229-3485.154014.


    (2) Chopra D, Rehan HS, Sharma V, Mishra R. Chemotherapy-induced adverse drug reactions in oncology patients: A prospective observational survey. Indian Journal of Medical and Paediatric Oncology?: Official Journal of Indian Society of Medical & Paediatric Oncology. 2016;37(1):42-46. doi:10.4103/0971-5851.177015.


    However, the similarity of this research to others does not discredit the importance of the work. The implementation of improved patient care based on the results of this study has great impact on the patients that are and will be treated in the Day Oncology Care Unit described in the article. 

  • Are the claims properly placed in the context of the previous literature?

    Yes, as mentioned, these claims of improvement in Adverse Drug Reaction care and prevention were very specific to the DOCU in which the research was conducted. They made similar claims to other literature about the importance of pharmacovigilance to improve patient safety. 

  • Do the results support the claims? If not, what other evidence is required?

    Yes, results seem to support claims. One example is that hypersensitivity reactions went down 36% after the implementation nurse education. Pharingo-laryngeal dysesthesia and acute extravasation events also decreased after the education. There was also a slight decrease in the amount of time used to address the complications of drug administration associated with an ADR after the education. Finally, results showed that the time taken to detect the symptoms of the various ADRs decreased significantly after education. 


    To vastly improve the quality of this research, it would be beneficial to give much more detail on how data was collected to produce these results. How many patients were in the study? What were the demographics of the patient population? What defined the amount of time spent in each phase of addressing complications of drug administration? Could there be other factors (such as how busy the Day Oncology Care Unit was at a given time) that might be influencing the data besides the nursing education? 


    Additionally, figures need to include sufficient labels - what are the units of time on the y axis in figures 2,3, and 4? Minutes? Hours? 

  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Protocol of the initial data collection is not given.

    Protocol is not given for implementation of nursing education. Readers only know, "A copy of all these clinical protocols were provided after a meeting with the nursing supervisor and staff nurses. They were also informed about the most usual drug reactions, the importance of a prompt action, the possible consequences and potential prevention strategies."

    Protocol for data collection post-nursing education is not given


    This research article could be improved greatly by adding some of these details, especially for use of other cancer treatment clinics to implement policies to decrease and better treat ADRs. 

  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    This study could not be repeated due to lack of detail in the procedures for collecting data, implementing nurse education, and collecting data after the nurse education was carried out. The general methodology that was described seems valid, but much more detail of the study is needed for a full assessment of validity. 

    As mentioned, it might be beneficial for other cancer treatment clinics to implement nurse education as described in this research if results were positive like this article has described. Therefore including protocol details would greatly improve the article. 

  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    To improve this paper, it might be beneficial to implement the same nurse education at a different Day Oncology Care Unit to increase the sample size of the results. This might take substantial time, but would prove that the nursing education can help improve many different sites, and that the results are repeatable. 

    A more immediate way to improve the article is to provide the exact protocol for the data collection and provide details (possibly in an appendix) of all of the nursing education that was shared with the staff. 

  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    More quantitative data is needed and further details of study protocols are needed before this could be considered outstanding. 

  • Other Comments:

    It might be interesting to see how patient care and nurse response to ADRs change over a long time period, such as a few years. How often (if at all) should staff be given a repeat or refresh of the education course? 

  • Competing interests:
  • Invited by the author to review this article? :
  • Have you previously published on this or a similar topic?:
  • References:


  • Experience and credentials in the specific area of science:

    Experience with cancer patient care while working in pediatric cancer clinic. Strong scientific background.

  • How to cite:  Daley E .A review of An Oncology Nursing Intervention to Reduce Adverse Drug Events in Ambulatory Cancer Patients[Review of the article 'An Oncology Nursing Intervention to Reduce Adverse Drug Events in Ambulatory Cancer Patients ' by Alonso P].WebmedCentral 2016;7(11):WMCRW003327
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