EVIDENDE BASED NURSING

By : Rizaldy Achmad K – 20151660089 /Skep VIB

1. Clinical Question : How many people suffer from post

traumatic stress after an accident? What and how the most
important handling should be done by health personnel?
How much is the comparison before or after the action?
How is the condition of patient after the action?
2. Population : 50 patients with osteosarcoma
3. Intervention : The functions of the affected limb were
evaluated using the revised MSTS93 system. The Kaplan-
Meier method was used for survival analysis.
4. Comparison : 18 patients were treated with the MMIA
(high-dose methotrexate (HD-MTX), adriamycin (ADR),
ifosfamide (IFO)) and cisplatin (DDP), and 32 patients were
treated with the DIA (DDP, ADR and IFO).
5. Outcome : The results showed that marginal resection can
be performed in patients with osteosarcoma who obtain
clinically favorable responses to chemotherapy. Patients
had a good clinical course and there was no negative effect
on rates of survival or local recurrence.
6. Time : Between December 1999 and October 2008
7. List of Article’s :
 Xu Ming, dkk. (2014). Marginal resection for
osteosarcoma with effective neoadjuvant
chemotherapy: long-term outcomes. Xu et al.
World Journal of Surgical Oncology 2014,
12:341.
 Wang Bing, dkk. (2016). Effct of Unplanned
Therapy on
the Prognosis of Patients with Extremity
Osteosarcoma. Orthopedic Department, The
General Hospital of Jinan Military Commanding
Region, Jinan, P.R.China.
 Correspondence and requests for materials
should be addressed to X.Y: | 6:38783 | DOI:
10.1038/srep38783.
 Salah Samer, dkk. (2013). The infl uence of
pulmonary metastasectomy on survival in
osteosarcoma and soft-tissue sarcomas: a
retrospective analysis of survival outcomes,
hospitalizations and requirements of home
oxygen therapy. Interactive CardioVascular and
Thoracic Surgery 17 (2013) 296–302.
doi:10.1093/icvts/ivt177.
 Fernandez-Pineda Israel, dkk. (2012). Patients
with osteosarcoma with a single pulmonary
nodule on
computed tomography: a single-institution
experience. J Pediatr Surg. 2012 June ; 47(6):
1250–1254.
doi:10.1016/j.jpedsurg.2012.03.033.
 Guillon Maud AM, dkk. (2011). Clinical
characteristics and prognosis of osteosarcoma
in young children: a retrospective series of 15
cases. Guillon et al. BMC Cancer 2011, 11 :407.
 8. Table of Critical Appraisals :

List of CA’s 1 2 3 4 5
Quest
1. Why was For reviewed the To compare the To compare these To determine if To enhance knowledge
this study records of 50 prognosis between modalities for the patients with on the clinical
DONE ? patients with patients with subset of patients osteosarcoma (OS) characteristics and
osteosarcoma who extremity with resectable with metachronous prognosis of
underwent marginal osteosarcoma who metastases. metastatic osteosarcoma in
resection following received unplanned Furthermore, the pulmonary disease young children, we
effective therapy and those outcomes for presenting with a reviewed the medical
preoperative who received patients with single pulmonary records and histology
chemotherapy standard treatment. unresectable lung nodule of all children
metastases are (SPN) on computed diagnosed with
reported. tomography (CT) osteosarcoma before
were found to have the age of five years
other lesions at the and treated in SFCE
time of (Société Française des
thoracotomy. Cancers et leucémies
de l’Enfant) centers.

2. What is the This journal does Due to the small This journal does not This journal does This journal does not
sample SIZE ? not include the sample size, it was include the sample not include the include the sample
sample size not possible to size sample size size
assess the
association between
individual surgical
methods and local
recurrence rate in
 our study

3. Are the In this journal there In this journal there In this journal there In this journal In this journal there
measurement are variables and are variables and are variables and there are variables are variables and
s of major instruments that are instruments that are instruments that are and instruments instruments that are
variable valid clearly stated. This clearly stated. This clearly stated. This that are clearly clearly stated. This
and reliable ? journal also journal also journal also stated. This journal journal also
incorporates incorporates incorporates also incorporates incorporates
operational operational operational operational operational standards
standards of standards of standards of standards of of osteosarcoma
osteosarcoma osteosarcoma osteosarcoma osteosarcoma nursing intervention.
nursing nursing nursing intervention. nursing Thus, this research
intervention. Thus, intervention. Thus, Thus, this research intervention. Thus, journal can be a
this research journal this research journal journal can be a this research source in refining the
can be a source in can be a source in source in refining the journal can be a next research journal.
refining the next refining the next next research source in refining
research journal. research journal. journal. the next research
journal.

4. How were The Kaplan-Meier The sample size in Analyses were This journal does MG participated in
the data method was used our study was too performed to assess not include how study design
analyzed ? for small to allow the influence of PM the data is
survival analysis. subgroup analysis on analyzed
based on patient survival outcomes for
age, but performing two subsets of
such an analysis will patients; namely,
be important for osteosarcoma and
future non-osteosarcoma
investigations. patients. All analyses
Prospective, large- were performed
 scale, multi-center using SAS version 9.1
clinical studies are (SAS
needed to confim Institute, Inc., Cary,
and extend our NC, USA).
fidings.

5. Were there None to declared in None to declared in None to declared in None to declared None to declared in
any untoward this study. this study. this study. in this study. this study.
events during
the conduct of
the study ?

6. How do the The aims of Wang et al. found Nevertheless, the Open thoracotomy The overall and event-
result fit with marginal rese ction that a lack of apparent favourable can result in free survival rates in
previous of oste osarcoma neoadjuvant survival with PM over substantial this study are difficult
research in are to chemotherapy and chemotherapy could pleural and to interpret, given the
the area ? reduce bone and inadequate surgical be the result of pulmonary small number of
soft-tissue defects margins can result positive selection of scarring, which can patients, but our
and to improve limb in failure of local patients treated with complicate results seem similar to
function, without control and earlier PM and the result of subsequent those reported by
increa sing the risk systemic including patients thoracotomies that Kager et al . It is
of local recurrence tumor metastases with unresectable are often needed noteworthy that 7
or jeopardizing the in patients who metastases in the in these patients. children (45%) died of
patient’s life. Since received unplanned cohorts treated with With improvement their disease.
1987 to 2004, treatment for OS4. non-operative in minimally Currently, the reported
Tsuchiya’s group Our study observed therapy: a fact that invasive surgery, survival rate
have treated 21 that the local leads some authors most among children
patient s with recurrence rate was to question the single pulmonary treated for
osteosarcoma with signifiantly higher in benefit from surgery. lesions depending osteosarcoma is about
intentional margin patients who In the current study, on the nodule 19% for metastatic
 alresection following underwent we compare the location can be patients and 76% at 5
good results from unplanned primary survival outcomes completely years for non
chemotherapy. surgery without following PM with resected by metastatic patients.
neoadjuvant those following thoracoscopy, with
chemotherapy systemic therapy for or without
(37.5%) than in the subset of preoperative
those who patients who have image-guided
underwent standard resectable localization. To
treatment (21.9%). metastases. verify this
Furthermore, the Additionally, we observation, we
mean time to local compare the reviewed our
recurrence was outcomes following experience
shorter in the these two treating patients
unplanned therapeutic with OS who
treatment group. strategies for the presented with a
resectable metachronous SPN
metastasis with that on CT.
of sarcoma patients
with unresectable
metastases.

7. What does The current sta The use of this Details of operative These techniques As this study spans a
this research ndard treatme nt for supplementary or systemic therapy may be helpful to lengthy period,
means for oste osarcoma treatment may have of the metastases facilitate treatment was
clinical includes prevented the were documented. thoracoscopic heterogeneous.
practice ? neoadjuvant unplanned Progression-free resection of However, all the
chemotherapy and treatment survival (PFS), overall deeper seated children who received
limb-sparing from having a survival (OS), days of SPNs, but they do chemotherapy (14 out
surgery. Currently, detrimental effct on hospitalization not overcome the of 15) were treated
two methods of metastasis rate and following discharge missed detection with drugs known to
tumor resection 5-year survival. Ths from the of additional be effective in
exist : wide would be consistent first thoracotomy or subcentimeric osteosarcoma
resection and with a study by Jeon following initiation of nodules. Treatment (HDMTX, ifosfamide,
marginal resection. and colleagues, the first cycle of for the patients cisplatin or
This surgical staging which found that chemotherapy in with OS with doxorubicin). A good
system proposed by limb salvage patients who did not pulmonary tumour response to
Enneking et al. procedures in undergo metastases pre-operative
incorporates patients with metastasectomy, remains a chemotherapy was
margin definitions osteosarcoma, and the combined significant obtained in only 36%
predicting for local initially treated with reporting of challenge. of our patients, while
recurrence based unplanned dyspnoea and any Repeated similar regimens
on the relationship intralesional requirements resections of havebeen reported to
of the surgical procedures, resulted for home oxygen pulmonary give good responses in
margin to the in a disease-free 5- therapy were also recurrences can 56% to 64% of
neoplasm and its year survival documented. lead to extended patients with non-
surrounding comparable to that This study was disease control metastatic
pseudocapsule and of patients approved by the and possible cure osteosarcoma and in
reactive zone. receiving standard institutional review for some patients. 42% of patients with
treatment27. board at our In our experience, metastatic forms. This
However, another institution. patients who would suggest that
possible explanation presented with preoperative
for these single chemotherapy is less
observations is that metachronous effective in younger
our study was pulmonary lesions children.
underpowered to on CT did not have
detect a signifiant other malignant
diffrence between nodules at the
the two groups; it time of
was notable that, thoracotomy.
despite a lack of
 statistical
signifiance, the
metastasis rate was
numerically higher
and the 5-year
survival rate
numerically lower
in the unplanned
therapy group than
in the standard
treatment group.
Ths, additional
studies with larger
sample sizes are
needed to establish
whether unplanned
therapy in patients
with OS is
associated with a
higher incidence
of metastasis or a
lower 5-year
survival rate.

9. Conclusion : Accurate initial diagnosis with the option of appropriate and timely surgery is
important in the management OS of the extremities. Failure to administer neoadjuvant
chemotherapy and inadequate surgical margins can lead to failure of local control in patients who
have undergone unplanned treatment, increasing the local recurrence rate and reducing the time to
 local recurrence. However, it is possible that long-term survival rate and metastasis rate are not
detrimentally affcted in patients who receive unplanned treatment if supplementary therapies, i.e.
standard neoadjuvant chemotherapy and limb salvage surgery, are subsequently administered in a
suffiently timely manner.
10. Clinical Implication : The difference in survival was clinically meaningful (32.0 vs 12.4
months). However, it is possible that the small number of patients was the reason why the
difference did not reach statistical significance (P = 0.09). An important limitation of our study is
that pulmonary function tests were not available for the patients with resectable metastases who
were treated with non-operative therapy; however, these patients were free of documented
pulmonary or cardiac diseases and were of young age (mean age 27.6 years). Furthermore, they
had adequate performance status, which minimize the possible influence of comorbidities,
advanced age and poor performance status on the demonstrated inferior outcomes.