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医院服务和疾病早期检测的新维度:英国"柳叶刀"杂志委员会对肝病的审查

Roger Williams ¹, Charles Alessi ², Graeme Alexander ³

¹Institute of Hepatology, Foundation for Liver Research, London, UK.
²Public Health England, Leeds, UK.
³UCL Institute for Liver & Digestive Health, Royal Free Hospital, London, UK.
⁴Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁵Department of Gastroenterology & Hepatology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
⁶National Institute of Health Research, UCLH Biomedical Research Centre, London, UK.
⁷NIHR Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Gastrointestinal and Liver Services, Queen Elizabeth Hospital Birmingham at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁸Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK.
⁹Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK.
¹⁰NIHR Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹¹Bart's Liver Centre, Queen Mary University of London, London, UK.
¹²Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, UK; Alcohol Health Alliance, London, UK.
¹³Unit of Health Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
¹⁴Gastroenterology Department, Hampshire Hospitals Foundation Trust, Winchester, UK.
¹⁵Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, Birmingham, UK.
¹⁶Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹⁷Liver Unit, Royal Victoria Hospital, Belfast, UK.
¹⁸Emergency Department, West Middlesex University Hospital, London, UK.
¹⁹British Society of Gastroenterology, London, UK.
²⁰School of Public Health, Imperial College of Science & Technology, London, UK.
²¹Swansea University Medical School, Swansea, UK.
²²Department of Social and Policy Sciences, University of Bath, Bath, UK.
²³NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
²⁴Institute of Alcohol Studies, London, UK.
²⁵UCL Institute for Liver & Digestive Health, Royal Free Hospital, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK.
²⁶Aneurin Bevan University Health Board, Newport, UK.

⁰Institute of Hepatology, Foundation for Liver Research, London, UK.

Lancet (London, England) +

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2021年三月14日

在PubMed上查看摘要

概括

综合性肝脏服务对于降低高患者死亡率至关重要. 这项计划建议与地区医院建立区域肝脏中心, 改善医疗服务和早期诊断, 以获得更好的结果.

科学领域

肝病学
公共卫生政策
医疗管理

背景情况

住院治疗急性肝病患者的高死亡率需要改善服务.
现有的中风医疗服务模式为整合性肝脏护理提供了一个模板.
COVID-19 疫情凸显了灵活和可访问的重症监护单位的需要.

研究的目的

为肝病患者提供综合性临床服务提出总体规划.
提倡加强对重症监护和高依赖性病房的接入.
推政策干预措施减少肥胖和酒精消费以改善肝脏健康.

主要方法

建立与地区总医院相关的区域肝脏中心.
在急症医院任命主管临床医生,负责24小时全天候的肝脏患者护理.
建立酒精治疗小组,改善与急性医疗服务的联系.
使用便颜色图用于早期诊断胆管缩和便携式FibroScan用于初级护理检测纤维化.

主要成果

试点研究显示,在初级保健中早期诊断严重纤维化和肝硬化是有前途的.
数字技术可以增强临床咨询和查计划.
解决因饮酒而加剧的肥胖和糖尿病等并发症对于减少死亡率至关重要.

结论

综合区域肝脏中心和改善急性护理的机会对于减少肝脏疾病死亡率至关重要.
通过新的方法及改善的公共卫生措施进行早期诊断至关重要.
针对肥胖和酒精消费的政策干预对于长期改善公共卫生和减少肝病负担是必要的.