This is a traditional technique and widely accepted. Thus, the authors in this paper studied if the comfort levels vary in the two techniques.
The authors use students with no experience what so ever as nurses in this study. They claim that it is important to have un-experienced candidates as nurses as they do not have any preferences towards the bevel up or bevel down technique. They call these nurses as having no "psychomotor skills". Is it a good idea to have nurses with no skills to test the technique
The authors do not discuss on the effect of the technique on the cause itself. A bevel down injection might result in the medicine flowing into the lower layer of the dermis. Thus, a bevel up injection may be better as it is important to get the medicine deposited in the upper layer of the dermis. It might not have any effect but still some discussion on the effect of the technique on the cure would have helped.
One of the most important factors of the experiment was to measure the size of the wheal. The reason is that it is a scientific factor to evaluate the effectiveness of a given technique. The size of the wheal probably correlates with the effectiveness of the technique. May be the wheal is not at all necessary for the effect to take place. This is necessary in-order to evaluate the results better.
Page 2Page 278 "Please rate on a scale of 1 to 5 your comfort when receiving the intradermal injection, with one (1) being no discomfort and five (5) being 'hurts a lot'." Below this sentence was a row of five numbers with "no discomfort" above the "1" and "hurts a lot" above the "5." The subject circled a number. The form was then taken by the investigator, and the subject was given a second form with the same content for the second injection. In addition, it asked "Which injection was better" followed by"
This is more or less the procedure used to analyze the technique. i.e., psychological analysis to differentiate between the two scientific methods - bevel up and bevel down methods of intra-dermal injections. This should have been the title of their paper. Apart from the psychological analysis, the authors should have evaluated the technique based upon some scientific tests. Unfortunately, they have not even mentioned any such experiments. This is a major draw back of the paper.
Page 278 ".45 administered the intra-dermal injection bevel up the first time and 53 of them used the bevel-down technique the first time." And then on the page 279 "Subjects administered the bevel-up injection