EVIDENCE-BASED NURSING

I.

Clinical Question Among patient who have chronic myeloid leukaemia, which one is more effective to have a therapeutic imatinib levels, is it responders who take imatinib regularly or responders who take imatinib intermittently? II. Citation Singh, N. et.al., Drug monitoring of imatinib levels in patients undergoing therapy for chronic myeloid leukaemia: comparing plasma levels of responders and nonresponders, Received: 3 October 2008 / Accepted: 15 January 2009 / Published online: 12 February 2009. III. Study Characteristics a) Patients included

A total of 40 chronic myeloid leukaemia patients in the chronic phase of the disease were recruited and placed into two groups of 20 patients

b) Intervention Imatinib mesylate is used as first line therapy in the treatment of chronic myeloid leukaemia. Imatinib responders vs. imatinib non-responders (20 patients per group). c) Outcome Monitored The mean plasma imatinib levels in the imatinib non-responders were significantly lower than those in the imatinib responders

d) Does the study focus on a significant problem in clinical practice? Yes, because it is all about treatment of the person who have chronic myelocytic leukaemia, it can help to improve their plasma level. Imatinib mesylate is used as first line therapy in the treatment of chronic myeloid leukaemia. .

IV.

Methodology / Design a) Methodology used Each blood sample was taken 24 h after and immediately prior to taking a 400 mg oral dose of imatinib. Drug levels were detected by high-performance liquid chromatography.

Jose, Maria Aece D.

BSN222/GROUP87

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b) Design This study was designed to study the correlation of plasma levels of imatinib with response to the therapy. c) Setting Chronic myeloid leukaemia patients in chronic phase (CP) attending the outpatient clinic of the Department of Medical Oncology at our institute between January 2005 and July 2006 d) Data sources The MannWhitney rank-sum test was used to compare the significance in the plasma concentration of imatinib in both imatinib responders and non-responders. SigmaStat soft-ware (Jandel Scientific, San Rafael, CA) was used to perform the statistical analysis.

e) Subject selection a. Inclusion criteria (1)patients without hepatic dysfunction, i.e. those in whom serum bilirubin, serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase were normal at baseline; (2) patients in whom serum creatinine was normal. b. Exclusion criteria (1)patients with hepatic dysfunction, i.e. those in whom serum bilirubin, serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase were more than twofold higher than the upper limit of normal at baseline; (2) patients in whom serum creatinine was more than twofold higher than the upper limit of normal. f) Has the original study been replicated? No, not yet, because it was just been approved in the year 2009. g) What were the risks and benefits of nursing action / intervention tested in the study? The risk can be about the ethical issues for conducting the study but he study was approved by Institute Ethics Committee, and written informed consent was taken from each patient after explaining the risks and benefits of the study before recruitment. The intervention tested in the study is therapeutic monitoring to check the optimum therapeutic levels should be considered as a routine practice in patients with an inadequate or sub-optimal response.

Jose, Maria Aece D.

BSN222/GROUP87

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V.

Results of the Study

The mean plasma imatinib levels in the imatinib non-responders were significantly lower than those in the imatinib responders (0.70 vs. 2.34 M, respectively; p=0.002). VI. Authors Conclusion / Recommendations

Plasma levels of imatinib were correlated with response to the therapy, so routine monitoring of the therapeutic levels of the drug should be carried out specifically in treatment-resistant cases for determining dose escalation. a) What contribution to client health status do the nursing action / intervention make? Like what I have said it can help to maintain the therapeutic plasma level of the patient who have a chronic myelocytic leukaemia. The intervention make in the study is therapeutic monitoring to check the optimum therapeutic levels should be considered as a routine practice in patients with an inadequate or sub-optimal response to achieve the desired objective.

b) What overall contribution to nursing knowledge does the study make? The overall contribution to nursing knowledge is we know what we have to do to make a certain thing to improve the patient condition. We gained knowledge about the plasma level in patient who have leukaemia and what are the possible nursing intervention that we can do for our patient.

Applicability a) Does the study provide a direct enough answer to your clinical question in terms of type of patients, intervention and outcome? Yes, because the study reflect or answer my clinical question. b) Is it feasible to carry out the nursing action in the real world? Yes, because we just have to routine monitoring of the therapeutic levels of the drug should be carried out specifically in treatment-resistant cases for determining dose escalation.

Jose, Maria Aece D.

BSN222/GROUP87

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VII. Reviewers Conclusion / Commentary My conclusion is that we should do routine monitoring of the therapeutic levels of the drug should be carried out specifically in treatment-resistant cases for determining dose escalation. It is said to the study that the patient who take imatinib drug have a higher plasma level compare to those who do not take it regularly. EVALUATING NURSING CARE PRACTICES 1. Safety During the study, safety of the people is acquired. Because they make several test which is only appropriate to a specific person. The study has a safety analysis which is important in conducting a research study because safety of the client is the extremely important. 2. Competencies of the Care Provider I can say that the care providers who conducted the study are competent because all of them are expert in their chosen field. 3. Acceptability The study conducted was acceptable because the research or study provide all the necessary information regarding the study, So I can conclude that the study is acceptable. 4. Effectiveness I can say that the study is effective because the study verify and provide all the answers readers will question in their mind. The study was complete and prcised. 5. Appropriateness During the study, appropriateness is considered because the only take people in the study which is appropriate for their research. 6. Efficiency I can say that the study is efficient because consumption of resources are attained like the time and gathering of specific clients. 7. Accessibility I can say that the research or study is accessible because the study conducted where accessible for the people.

Jose, Maria Aece D.

BSN222/GROUP87

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Jose, Maria Aece D.

BSN222/GROUP87

Page 5