Belling Ruth, McLaren Susan, Woods Leslie
Institute of Strategic Leadership & Service Improvement, London South Bank University, 103 Borough Road, London, UK, SE1 0AA.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006597. doi: 10.1002/14651858.CD006597.pub2.
The number, type and roles of specialist nurses dedicated to the care and management of patients with inflammatory bowel disease is increasing. Despite this increase, there has been little evidence to date to demonstrate the effectiveness of specialist nursing interventions. This review aims to identify and evaluate the impact of specialist nursing interventions on management of inflammatory bowel disease, access to treatment, remission, morbidity and quality of life.
To identify and evaluate the impact of specialist nursing interventions for improving the care and management of patients with inflammatory bowel disease (IBD).
A comprehensive search of databases including the Cochrane Library, MEDLINE, and British Nursing Index was carried out to identify trials. References from relevant papers were searched and hand searching was undertaken of relevant publications including gastroenterology conference proceedings to identify additional trials (date of last search 30 September 2008).
Randomised controlled trials, controlled before and after studies and interrupted time series studies of gastroenterology and IBD specialist nurses intending to improve access and outcomes for patients with ulcerative colitis and Crohn's disease were considered for inclusion.
Two investigators independently extracted data and assessed trial quality. Any discrepancies were resolved by consensus.
One randomised controlled trial of 100 IBD patients receiving a specialist nurse delivered counselling package (n = 50) or routine outpatient clinic follow-up (n = 50), with assessments at entry and six and 12 months, was included in this review. This study was of low methodological quality. Disease remission, patient compliance, clinical improvement, utilisation of nurse-led services, patient satisfaction, hospital admission, outpatient attendance, progression to surgery, length of hospital stay and cost effectiveness data were not reported. Pooled mean mental health scores at 6 months were higher in patients who received nurse-led counselling compared to patients who received routine follow-up. However, this difference was not statistically significant (WMD 3.67; 95% CI -0.44 to 7.77; P = 0.08). Other pooled assessments of physical and psychological well-being showed no statistically significant differences.
AUTHORS' CONCLUSIONS: Although specialist nurse counselling interventions might provide benefit for IBD patients the one included study was of low quality and the results of this study should be interpreted with caution. Higher quality trials of gastroenterology and IBD specialist nursing interventions are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.
致力于炎症性肠病患者护理与管理的专科护士数量、类型及作用正在增加。尽管数量有所增加，但迄今为止几乎没有证据能证明专科护理干预的有效性。本综述旨在确定并评估专科护理干预对炎症性肠病管理、治疗可及性、缓解情况、发病率及生活质量的影响。
确定并评估专科护理干预对改善炎症性肠病（IBD）患者护理与管理的影响。
对包括Cochrane图书馆、MEDLINE和英国护理索引在内的数据库进行全面检索以识别试验。检索相关论文的参考文献，并对包括胃肠病学会议论文集在内的相关出版物进行手工检索以识别其他试验（最后检索日期为2008年9月30日）。
纳入旨在改善溃疡性结肠炎和克罗恩病患者治疗可及性及治疗结果的胃肠病学和IBD专科护士的随机对照试验、前后对照研究及中断时间序列研究。
两名研究者独立提取数据并评估试验质量。任何差异通过共识解决。
本综述纳入一项针对100例IBD患者的随机对照试验，这些患者接受专科护士提供的咨询套餐（n = 50）或常规门诊随访（n = 50），在入组时以及6个月和12个月时进行评估。该研究方法学质量较低。未报告疾病缓解情况、患者依从性、临床改善情况、护士主导服务的利用率、患者满意度、住院情况、门诊就诊情况、手术进展、住院时间及成本效益数据。与接受常规随访的患者相比，接受护士主导咨询的患者在6个月时合并的平均心理健康评分更高。然而，这种差异无统计学意义（加权均数差3.67；95%可信区间-0.44至7.77；P = 0.08）。对身体和心理健康的其他合并评估未显示出统计学上的显著差异。
尽管专科护士咨询干预可能对IBD患者有益，但纳入的这一项研究质量较低，该研究结果应谨慎解读。需要开展更高质量的胃肠病学和IBD专科护理干预试验，以评估专科护理干预对炎症性肠病患者护理与管理的影响。
