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两周等待期的误报?对头颈部癌症转诊的两周等待期进行的前瞻性调查。

Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals.

作者信息

Hong B, Shaikh Z, Adcock S, Aldallal S N

机构信息

Oral and Maxillofacial Department, Royal Cornwall Hospital, Truro.

Manchester Medical School, University of Manchester, UK.

出版信息

Br Dent J. 2016 May 27;220(10):521-6. doi: 10.1038/sj.bdj.2016.376.

Abstract

Objectives i) To prospectively explore patients' experience through the two-week wait (2WW) referral process; ii) To compare the relative true malignancy diagnostic rate between general medical practitioners (GMPs) and general dental practitioners (GDPs) over a six-month period; iii) To compare management of 2WW referral cases between GMPs and GDPs before the referral and during the 2 weeks in regards to symptomatic support, investigations in primary care, and information communicated to patients and secondary care clinicians; iv) To investigate the benign conditions that comprise 2WW referrals by finding out the final diagnoses of all cases included in the study.Method The patient inclusion criteria were all 2WW referral patients who attended consultation clinics during the six-month study period in Royal Cornwall Hospital NHS Trust. We prospectively distributed patient questionnaires and clinician's referral assessment forms. We obtained the final diagnoses of all participants electronically, and also identified all malignancies diagnosed via routine referral route during the study period from the cancer services team.Results Two hundred and twenty patients referred via 2WW pathway participated in the study. Of these, 148 referrals were from GMPs and 72 from GDPs. The overall malignancy diagnostic yield was 6.2%; markedly higher from GMPs (9.5%) than GDPs (1.4%), and higher number than those from routine pathway. The GMPs and GDPs showed similar levels of clinical management and information exchange judging from the participants' responses. We also identified the top nine most commonly urgently referred benign conditions.Conclusion We reiterate the need for improved communication between clinicians and patients and between clinicians. We also suggest more focus on education in commonly encountered conditions as well as malignant lesions. The number of 2WW referrals we received from GMPs was nearly twice as many as those from GDPs, highlighting the importance of delivering oral medicine education to medical students, trainees and GMPs.

摘要

目标

i) 前瞻性地探究患者在两周等待期(2WW)转诊过程中的体验;ii) 比较六个月内全科医生(GMPs)和全科牙医(GDPs)之间的相对真实恶性肿瘤诊断率;iii) 比较GMPs和GDPs在转诊前及两周等待期内对2WW转诊病例的管理情况,包括症状支持、基层医疗检查以及向患者和二级医疗机构临床医生传达的信息;iv) 通过查明研究中所有病例的最终诊断结果,调查构成2WW转诊的良性疾病。方法:患者纳入标准为在皇家康沃尔医院国民保健服务信托基金六个月研究期间到会诊门诊就诊的所有2WW转诊患者。我们前瞻性地分发了患者问卷和临床医生转诊评估表。我们通过电子方式获取了所有参与者的最终诊断结果,并从癌症服务团队中确定了研究期间通过常规转诊途径诊断出的所有恶性肿瘤。结果:通过2WW途径转诊的220名患者参与了研究。其中,148例转诊来自GMPs,72例来自GDPs。总体恶性肿瘤诊断率为6.2%;GMPs的诊断率(9.5%)明显高于GDPs(1.4%),且高于常规途径的诊断率。从参与者的回答来看,GMPs和GDPs在临床管理和信息交流水平上相似。我们还确定了最常紧急转诊的九种良性疾病。结论:我们重申临床医生与患者之间以及临床医生之间需要加强沟通。我们还建议更多地关注常见病症以及恶性病变的教育。我们从GMPs收到的2WW转诊数量几乎是GDPs的两倍,这凸显了对医学生、实习生和GMPs进行口腔医学教育的重要性。

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