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The systematic review of randomised controlled trials of
interventions involving nurses as key practitioners in the delivery of a
variety of types of interventions for the care of patients with chronic
obstructive pulmonary disease (COPD) provided no information whatsoever on
care delivery in the control group. This makes it difficult if not
impossible to draw any conclusions about best practice. More importantly
there were no statistically significant differences between the nurse
delivered interventions and usual care. In addition, it is highly unlikely
that there would be sufficent participants in the study that used
mortality as an end point for statistical power to detect differences
between control and intervention groups. A more appropriate conclusion
would be that nursing interventions were as good as those provided in the
control group.
The authors highlight that 'most of the trials had potential
methodological limitations' concluding that 'the data are too sparse to
exclude clinically relevant benefit/harm'. A more fitting recommendation
from the review would be that more studies are required before the
effectiveness of nurse-led programmes for COPD management can be
determined and these should address the methodological limitations of
those already conducted.
Misleading interpretaion of the evidence
The systematic review of randomised controlled trials of
interventions involving nurses as key practitioners in the delivery of a
variety of types of interventions for the care of patients with chronic
obstructive pulmonary disease (COPD) provided no information whatsoever on
care delivery in the control group. This makes it difficult if not
impossible to draw any conclusions about best practice. More importantly
there were no statistically significant differences between the nurse
delivered interventions and usual care. In addition, it is highly unlikely
that there would be sufficent participants in the study that used
mortality as an end point for statistical power to detect differences
between control and intervention groups. A more appropriate conclusion
would be that nursing interventions were as good as those provided in the
control group.
The authors highlight that 'most of the trials had potential
methodological limitations' concluding that 'the data are too sparse to
exclude clinically relevant benefit/harm'. A more fitting recommendation
from the review would be that more studies are required before the
effectiveness of nurse-led programmes for COPD management can be
determined and these should address the methodological limitations of
those already conducted.
Competing interests:
None declared
Competing interests: No competing interests