Nurse-led hepatocellular carcinoma surveillance clinic provides an effective method of monitoring patients with cirrhosis
Nurse-led hepatocellular carcinoma surveillance clinic provides an effective method of monitoring patients with cirrhosis
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DOI：
10.1111/ijn.12472
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发表时间：
2016-07-01
影响因子：
1.9
通讯作者：
Cheng, Wendy
中科院分区：
文献类型：
--
作者：
Nazareth, Saroj;Leembruggen, Nadine;Cheng, Wendy
本研究的目的是检查护士主导的肝细胞癌（HCC）监测门诊在肝硬化/晚期纤维化高危患者中的可接受性和有效性。HCC的早期发现与更好的治疗结果和改善的生存率相关。国际指南建议对有发生HCC风险的患者进行6个月的监测。建立了护士领导的HCC监测方案，以支持患者遵守监测方案。采用回顾性文献分析法。回顾性分析2009年8月至2015年12月期间转诊至诊所的患者的医疗记录。提取的数据包括门诊就诊、血液检测、超声或其他成像以及结局。30.3%的病例在6个月内进行了超声检查，71.2%的病例在7个月内进行了超声检查。护士主导的诊所预约，超声波扫描和血液检测之间的平均时间不超过9个月。第一年82.9%（63/76）的患者参加了FibroScans; 42例患者接受了内窥镜检查，35例（83.3%）患者参加了内窥镜检查。16例患者（21.5%）发现病变，2例患者诊断为HCC。1例患者死于HCC，1例死于硬膜下血肿。护士引导的HCC监测是监测肝硬化患者发生HCC的高风险的有效方法。定义明确的方案能够及时识别HCC或肝功能失代偿患者，以便立即实施管理策略。本研究确定的潜在益处需要进一步严格评估。
The aim of this study is to examine the acceptability and effectiveness of a nurse-led hepatocellular carcinoma (HCC) surveillance clinic in high-risk patients with cirrhosis/advanced fibrosis. Early detection of HCC is associated with better treatment outcomes and improved survival. International guidelines recommend 6-monthly surveillance of patients at risk of developing HCC. A nurse-led HCC surveillance protocol was established to support patients in adherence to surveillance protocols. The design used was retrospective document analysis. Retrospective analysis of healthcare records of patients referred to the clinic between August 2009 and December 2015. Extracted data included attendance of clinic visits, blood testing, ultrasound or other imaging, and outcomes. Ultrasound was attended within 6months in 30.3% of cases and within 7months in 71.2% of cases. The median time between Nurse-Led Clinic appointments, ultrasound scans and blood testing did not exceed 9months. First year FibroScans were attended by 82.9% (63/76) patients; endoscopy was indicated for 42 and attended by 35 (83.3%) patients. Lesions were identified in 16 patients (21.5%) and HCC diagnosed in two patients. One patient died because of HCC and one to sub-dural haematoma. Nurse-led HCC surveillance was an effective method of monitoring patients with cirrhosis at high risk of developing HCC. Well-defined protocols enable timely identification of patients with HCC or hepatic decompensation so that management strategies can be implemented without delay. The potential benefits identified by this study warrant further, rigorous evaluation.