Towards Standardizing the Alcoholism Evaluation Of Potential Liver Transplant Recipients
Towards Standardizing the Alcoholism Evaluation Of Potential Liver Transplant Recipients
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DOI：
10.1093/alcalc/agx104
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发表时间：
2018-03-01
影响因子：
2.8
通讯作者：
Lucey, Michael R.
中科院分区：
文献类型：
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作者：
Beresford, Thomas P.;Lucey, Michael R.
目标：对于世界各地的团队来说，酒精性肝病患者是申请肝移植的最大且临床上最具争议的群体。然而，对他们的评估决策仍然因地区而异。方法：针对标准化评估，我们提供了移植团队应寻求哪些信息、从哪些来源以及如何最好地利用这些信息的指南。本报告重点关注“做什么以及如何做”，为这一复杂的患者群体提供适当的评估。结果：适当的评估包括（a）从患者和所需的第三人处获取临床病史，（b）评估患者的认知，（c）建立酒精/物质使用诊断以区分酒精依赖、滥用和多物质依赖，（d）评估原发性酒精成瘾的矛盾心理，（e）测量社会稳定性和（f）使用威能的戒断预后因素。结论：尽管资源、可用专业知识和决策实践存在差异，但如果应用得当，这六个因素将在大多数情况下实现跨项目的标准化选择。简短摘要：本报告重点介绍转诊接受肝移植的“酗酒”者的精神/行为评估的要点。对这些要点的关注可以实现不同地区移植项目的临床标准化。
Aims: For teams around the world, alcoholic liver disease patients comprise the largest, and clinically most controversial, group applying for liver transplant. And yet evaluation decisions for them remain highly variable by locale.Methods: Targeting standardized assessment, we provide guidelines on what information the transplant team should seek, from what sources, and how best to make use of it. This report focuses on 'what to do and how to do it' in providing appropriate assessments for this complex patient group.Results: Proper evaluation includes (a) taking the clinical history from the patient and a required, corroborating third person, (b) assessing patient cognition, (c) establishing alcohol/substance use diagnosis to differentiate alcohol dependence, abuse and polysubstance dependence, (d) assessing ambivalence in primary alcohol addiction, (e) measuring social stability and (f) using Vaillant's factors for abstinence prognosis.Conclusions: Properly applied, these six factors will allow standardized selection in most cases taken across programs despite differences in resources, available expertise and decision practices.Short Summary: This report focuses on the essentials of the psychiatric/behavioral evaluation for 'alcoholic' persons referred for liver transplant. Attention to those essentials offers clinical standardization across transplant programs in different locales.