Evidence-Based Practice Paper
Gregory Cahill
Lakeview College of Nursing
July 26, 2012

EVIDENCE-BASED PRACTICE PAPER
	This paper will review the protocol from “Putting Evidence into Practice: Prevention and management of Bleeding in Patients with Cancer”.  Many cancer patients experience bleeding as a direct result of the cancer or as a secondary affect related to treatment.  This protocol evaluates measures to prevent and manage bleeding in cancer patients.  The study reviewed 14 prevention/treatment options focusing on the outcomes of platelet count, morbidity, quality of life and mortality (Damron, Brant, Belansky, Friend, Samsonow & Schaal, 2009).  The study reviewed literature and divided it into three subgroups; antifibrinolytic and pharmacology, blood products and non-pharmacology, and procedures (Damron et al., 2009). The study used two rating systems to rate the strength of the evidence for each intervention from one being the strongest evidence and eight having the least evidence and in the other rating system one was the best evidence and 3 being the least (Damron et al., 2009).  The research was then manufactured into three categories; recommended for practice, likely to be effective and expert opinion.
	Platelet transfusion therapy and mercapto ethane sulfonate sodium (MESNA) are recommended for practice based on the situation of the patient and treatment (Damron et al., 2009).  Most of the interventions fall into the category of effectiveness not established.  These range from ineffective treatments to treatments that are probably effective but do not have enough evidence to put them into the recommended category.  Expert opinions consist of “low-risk interventions that are consistent with sound clinical practice, suggested by an expert in a peer-reviewed publication.” (Damron et al., 2009)  Most literature focusing on preventing or managing bleeding focus on bleeding wounds (Damron et al., 2009).  Nurses should use the standard guidelines for wound or orifice bleeding until more research can be conducted (Damron et al., 2009). 
	Hemorrhage, especially in oncology patients, can be a life threatening incident.  Nurses must be able to assess for bleeding in their patients and should know the risk factors that contribute to bleeding in oncology patients.  Nurses need to know what interventions are appropriate for their clients and should be able to assess when these interventions are recommended.  Nurses are also responsible for teaching patients about self-care and prevention of injury that can lead to hemorrhage (Damron et al., 2009).   
	According to (Berg, van den Bemt, Shantakumar, Bennett, Voest, Huisman, & Egberts, 2011) thrombocytopenia has a frequency of 21.8% and an isolated thrombocytopenia frequency of 6.2% in patients receiving chemotherapy for solid tumors.  The researchers performed a retrospective, hospital-based study at the University Medical Center Ultrecht for the period of January 2004 to December 2006 (Berg et al., 2001).  The researchers mined the data base of the institution for patients that fulfilled their criteria. The sample included all adult receiving chemotherapy for solid tumors in the specified period.  The researchers were trying to determine what the rate and related risk factors of thrombocytopenia in patients receiving chemotherapy for solid tumors (Berg et al., 2011).  The study confirms that thrombocytopenia is of concern in cancer patients and had many of the same risk factors in the evidence-based protocol.
Montero, Estrov, Freireich, Khouri, Koller, & Kurzrock, (2006) studied the interleukin-11 (IL-11) and the effects it had on blood cell production in patients with myelodysplastic syndrome.  35 patients were enrolled in the study but only 32 were available for response to the study (Montero et al., 2006).  	The study assessed the response and toxicity of low dose IL-11 for the treatment thrombocytopenia (Montero et al., 2006).  The researchers gave all participants subcutaneous injections of IL-11 for two weeks then had a two week rest period.  Based on toxicity and response to treatment the dose and frequency was increased or decreased (Montero et al., 2006). “Published guidelines from the World Health Organization (WHO) International Working Group for response criteria in MDS were utilized.” (Montero et al., 2006, p. 2050)  IL-11 has been shown to produce a platelet response of around 30% (Montero et al., 2006).

	

Damron, B., Brant, J., Belansky, H., Friend, P., Samsonow, S., & Schaal, A. (2009). Putting evidence into practice: Prevention and management of bleeding in patients with cancer. Clinical Journal of Oncology Nursing, 13(5), doi: 10.1188/09.CJON.573-583
Montero, A., Estrov, Z., Freireich, E., Khouri, I., Koller, C., & Kurzrock, R. (2006). Phase II study of low-dose interleukin-11 in patients with myelodysplastic syndrome. Leukemia & Lymphoma, 47(10), 2049-2054
Pieszak, S. (2011). Evidence-based interventions for the prevention of bleeding in patients with cancer. Oncology Nursing Society, 6(8), Retrieved from http://www.americannursetoday.com/article.aspx?id=8116&fid=8078
Ten Berg, M., van den Bemt, P., Shantakumar, S., Bennett, D., Voest, E., Huisman, A., & ... Egberts, T. (2011). Thrombocytopenia in adult cancer patients receiving cytotoxic chemotherapy: results from a retrospective hospital-based cohort study. Drug Safety: An International Journal Of Medical Toxicology And Drug Experience, 34(12), 1151-1160. doi:10.2165/11594310-000000000-00000