Is the platelet to lymphocyte ratio a promising biomarker to distinguish acute appendicitis? Evidence from a systematic review with metaanalysis
Is the platelet to lymphocyte ratio a promising biomarker to distinguish acute appendicitis? Evidence from a systematic review with metaanalysis
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血小板与淋巴细胞的比率是区分急性阑尾炎的有希望的生物标志物吗？
DOI：
10.1016/j.ijsu.2019.10.055
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Mei Zubing
中科院分区：
文献类型：
--
作者：
Liu Lianjie;Shao Zhuo;Yu Hang;Zhang Wei;Wang Hao;Mei Zubing
Fan Yang及其同事从英国卫生服务的角度分析了接受急诊腹部手术的患者的国家质量改进（QI）计划与常规护理的成本效益。作者发现，QI计划在试验期间的标准成本效益阈值下不具有成本效益，但对于高风险患者（具有多种手术适应症的患者）可能具有终身成本效益。然而，研究结果似乎很不确定[1]。有限的卫生资源意味着任何国家在设计改进的卫生保健系统时都应考虑成本效益。然而，作为临床医生，主要关注的是延长患者的预期寿命和提高长期生存率。从临床医生的角度来看，在制定健康改善方案时，应首先进行评估，以核实其是否按最初的意图有效实施。自2013年国家紧急剖腹手术审核（NELA）启动以来[2]，对实施过程中遇到的各种问题，如护理人员的培训、熟练程度、观念转变等提出了关注，也被认为对护理成本和护理质量有一定影响。正如作者在文章中提到的，由于工作时间和传统观念等因素，许多参与的临床工作人员对该计划持负面态度。因此，在这种情况下开展的QI是否能够真正反映该计划的有效性并否定其成本效益，还需要进一步考察。本研究也表明，该计划的实施成本并不高，但并未达到预期效果。执行力等主观因素会随着环境和时间的变化而变化。此外，本研究中使用的重要参考指标质量调整生命年（Qs）作为测量方法仍存在争议[3，4]。此外，对于接受潜在治愈手术或急诊手术的患者，最重要的影响因素之一是外科医生的经验和手术质量[5]。虽然护理质量的提高也是一个重要的因素，但要在病人护理的背景水平相同的前提下进行比较。
Fan Yang and colleagues analysed the cost-effectiveness of a national quality improvement (QI) programme for patients undergoing emergency abdominal surgery versus usual care from a UK health service perspective. The authors found the QI programme was not cost-effective at standard cost-effectiveness thresholds within the trial period, but might be cost-effective over a lifetime for high-risk patients (patients with multiple surgical indications). However, the findings appeared quite uncertain [1]. Limited health resources mean that any country should consider cost-effectiveness when designing an improved health care system. However, as a clinician the primary concern is to extend the patient's life expectancy and improve long-term survival. When a health improvement programme is established, from a clinician's perspective, it should be evaluated initially to verify its effective implementation as originally intended. Since the launch of the National Emergency Laparotomy Audit (NELA) in 2013 [2], concerns on various problems encountered in the implementation, such as nursing staff's training, proficiency and concept change, have been raised, which are also considered to have certain impact on nursing cost and nursing quality. As the authors mentioned in the article, many clinical staff involved held negative feelings towards the programme due to factors such as working hours and traditional ideas. Therefore, whether QI carried out under such circumstances can truly reflect the effectiveness of the programme and negate the cost-effectiveness needs further investigation.This study also showed that the implementation cost of the programme was not high, but the expected effect was not achieved. The subjective factors, such as executive force, may change with change in environment and time. Moreover, the quality adjusted life years (QALYs), an important reference index used in this study, is still controversial in serving as a measurement method [3, 4]. Furthermore, for patients undergoing potentially curative surgery or emergency surgery, one of the most important influencing factors is the experience of the surgeons, and the quality of surgery [5]. Though the improvement in nursing quality is also an important factor, comparisons should only be made under the same premise of background level of patient care.