给编辑:
预后指数代表了临床医生和科学家改善患者护理的最佳意图。索引的发展隐含在于,它们将使他们可以更好地了解与潜在疾病有关的患者的需求。慢性阻塞性肺疾病(COPD)是一种慢性呼吸系统疾病,对患者的福祉,医疗保健利用和死亡率有很大影响[1]。迄今为止,自2004年发表BODE(体重指数,阻塞,呼吸困难和运动)以来,已经报告了15个COPD患者的预后指数[2-14]。除一个指数以外的所有指数均已开发或增强以供临床使用。但是,在当前的COPD指南中,气流阻塞仍然是指导临床医生进行治疗决策的唯一结构化措施,以及有关患者访问时的主观健康信息的信息。
eSteban等。[[15] developed a potentially useful prognostic instrument for COPD patients to predict their mortality: COPD classification and analysis tree (CART). Their validation method was fairly good due to the use of a separate validation cohort, analysing both COPD-CART’s discriminative potency and accuracy, and comparing COPD-CART with some previously reported indices (BODE, HADO (health, activity, dyspnoea and obstruction) and ADO (age, dyspnoea and obstruction)) [16]。但是,为了重视其附加的预测质量,我们想知道该新索引如何与经典的标准测量相比,IE。obstruction, in their validation cohort.
一种bove all, it is essential to justify the utilisation of indices before recommending that practitioners use them. Since COPD-CART was developed for clinical utilisation and claims to be of better use than existing indices, our most important question does not concern its validity but whether this instrument will indeed affect patient care. The英国医学杂志此前发表的一系列预后斯图dies, with an emphasis on the need for impact studies that demonstrate improvement of decision making and patient outcome when using an index to guide patient management [17]。尽管对COPD预后量仍在增加的各种验证方法,但这些指数尚未揭示其在日常实践中的影响。布丁的证据在于饮食:良好的意愿可能比预期的要小,甚至可能弊大于利。
Footnotes
支持声明
The PhD project of W.D. van Dijk was supported by a university grant (RvB08.066.51196/GE) from Radboud University Nijmegen Medical Centre (Nijmegen, the Netherlands).
statement of Interest
T.R.J.感兴趣的声明Schermer和C. Van Weel可以在www.www.qdcxjkg.com/site/misc/statements.xhtml
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