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The management of diagnostics pulmonary tumours in ambulatory conditions


Author: Valeriu Bîlba
Degree:doctor of medicine
Speciality: 14.00.14 - Oncology and Radiotherapy
Year:2007
Scientific adviser: Victor Cernat
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Institution:
Scientific council:

Status

The thesis was presented on the 5 December, 2006
Approved by NCAA on the 18 January, 2007

Abstract

Adobe PDF document0.43 Mb / in romanian

Thesis

CZU 616.24 – 006 – 07 : 616.27 - 07

Adobe PDF document 1.04 Mb / in romanian
154 pages


Keywords

central lung cancer, peripheral lung cancer, mediastinal neoplasm’s, diagnostic algorithm, medical management

Summary

The continuous efficiency improvement of timely diagnostic and treatment directed lung tumors is one of the preoccupations of permanent actuality in oncology, and the presented study was proposed a modulation of a more effective diagnostic management program of lung tumors in ambulatory conditions.

For this was delimited a sample of patients to reflect most faithfully the pathology case totality and was estimated a selective number with pathology patients - 287. All of these ware investigated by inquest, being divided into 3 clinic groups: central lung cancer, peripheral lung cancer, extraorganic mediastinal tumors.

For each group of patients in inquest was notified the data of 10 exams more frequently practiced in the same cancer diagnosis in medical service at regional, municipal, republican levels. The inquest delimited 142 features of every patient was included in study, and all this signs was codified and accumulated information was processed for statistico-mathematic diagnostic algorithm modulations, namely the specification of most suggestive and applicable by cost investigation techniques for all forms of lung cancer.

Thus for peripheral and central lung cancer at deferent administrative levels was proposed the following diagnostic algorithm: at regional level – chest X ray microfilms exam, chest X ray exam films in 2 projections, chest linear tomography films; at municipal diagnostic service level – chest X ray microfilms exam, chest X ray exam films in 2 projections, chest linear tomography films, bronchoscopy; at the republican level - chest X ray microfilms exam, chest X ray exam films in 2 projections, chest linear tomography films, bronchoscopy, abdominal organs, lymphatic ganglions, thorax ultrasound diagnoses, computer tomography and surgery.

For diagnoses, spreading appreciation and morphologic verification of extraorganic mediastinal neoplasm’s in condition of ambulatory medical institution was established the algorithm: at regional level – chest X ray microfilms exam, chest X ray exam films in 2 projections, chest linear tomography films; at municipal diagnostic service level – chest X ray microfilms exam, chest X ray exam films in 2 projections, chest linear tomography films, abdominal organs, lymphatic ganglions, thorax ultrasound diagnoses; at the republican level - chest X ray exam films in 2 projections, chest linear tomography films, bronchoscopy, abdominal organs, lymphatic ganglions, thorax ultrasound diagnoses, computer tomography, puncture of lymphatic ganglions and surgery.

The second step of efficiency improvement of timely diagnostic of lung cancer based on data from “The unified tariffs catalog for medico-sanitary service granted by republican, municipal, regional public medico-sanitary institution” estimated the cost of “investigated case” in ambulatory conditions at different level assistance.

Using the international technology of book-keeping and cost appreciation of medical service tariffs was elaborated an algorithm for real cost estimation of laboratory diagnostic investigation used for lung cancer diagnoses, innovation which clarify the general financial costs, which would stimulated the calculation activity of this type of service in policlinic condition.

In addition the algorithm was conceived especially for each institution performing medical service, and all the information included by it can be easily in computer program transposed, which would permit the rapid calculation of all the costs. At the last it could be affirmed that through this algorithm could be monitoring evaluation process of service granted by medical institution.