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在紧急诊断和转诊肺癌患者的诊断前初级保健咨询和成像
Marta Berglund1, Becky White2, Matthew Barclay3
1University College London, Research Department of Behavioural Science and Health, London, United Kingdom marta.berglund@ucl.ac.uk.
概括
紧急肺癌诊断是常见的,但通过紧急路线诊断的患者的诊断窗口较短. 通过更好的症状管理和及时成像,对所有肺癌患者来说,更早的检测是可能的.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 肺癌的紧急诊断是经常发生的,并且与患者的治疗结果较差有关.
- 了解诊断前的医疗保健利用对于改善早期肺癌检测至关重要.
研究的目的:
- 通过紧急途径诊断的肺癌患者的诊断前医疗保健使用情况与常规或紧急转诊患者的医疗保健使用情况进行比较.
- 在初级保健咨询和成像中识别导致肺癌诊断的模式.
主要方法:
- 对相关的英语初级保健,住院,成像和癌症登记数据 (2007-2018) 的分析.
- 按诊断路线 (紧急,常规,紧急转诊) 测量每月诊断前咨询和胸部成像率.
- 使用多变量波桑回归来估计路线特定事件率和拐点.
主要成果:
- 在4473名肺癌患者中,有33%的患者被紧急诊断;98%的患者在诊断前一年内咨询了初级保健.
- 咨询和成像率分别在诊断前5个月和4个月上升,紧急诊断患者的诊断窗口较短.
- 与紧急诊断患者相比,转诊患者对咳和胸部X射线使用的诊断前咨询率更高.
结论:
- 对于紧急诊断的肺癌患者,诊断窗口类似或更短,这表明在所有路线上都有早期诊断的潜力.
- 改善非特异性症状的管理,及时的成像随访和增加CT扫描的访问,可以支持更早的肺癌检测.
- 未来的研究应该关注错过的诊断机会,以告知减少紧急肺癌诊断的策略.
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