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Topics
- Antibiotics (1)
- Anxiety (1)
- Behavioral Health (1)
- Blood Clots (1)
- Cancer (1)
- Cancer: Lung Cancer (1)
- Care Management (1)
- Children/Adolescents (3)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (3)
- COVID-19 (1)
- Decision Making (3)
- Depression (1)
- (-) Diagnostic Safety and Quality (23)
- Emergency Department (4)
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- Imaging (5)
- Implementation (1)
- Infectious Diseases (1)
- Influenza (1)
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- Pneumonia (5)
- Practice Patterns (2)
- Provider (1)
- Provider: Clinician (1)
- Provider: Physician (1)
- Quality Improvement (1)
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- Research Methodologies (1)
- (-) Respiratory Conditions (23)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 23 of 23 Research Studies DisplayedBaghdadi JD, O'Hara LM, Johnson JK
Diagnostic stewardship to support optimal use of multiplex molecular respiratory panels: a survey from the Society for Healthcare Epidemiology of America Research Network.
This study’s objective was to explore current and future approaches to diagnostic stewardship of multiplex polymerase chain reaction (PCR) respiratory panels. The authors conducted a survey of the Society for Healthcare Epidemiology of America Research Network, with 41 sites completing the survey (response rate, 50%). Results of the survey were that multiplex PCR respiratory panels were perceived as supporting accurate diagnoses at 35 sites (85%), supporting more efficient patient care at 33 sites (80%), and improving patient outcomes at 23 sites (56%). Additionally, 24 sites (58%) had implemented diagnostic stewardship, with a median of 3 interventions (interquartile range, 1-4) per site. The interventions most frequently reported as effective were structured order sets to guide test ordering (4 sites), restrictions on test ordering based on clinician or patient characteristics (3 sites), and structured communication of results (2 sites), with 3 sites reporting that education was “helpful” but with limitations.
AHRQ-funded; HS028854.
Citation: Baghdadi JD, O'Hara LM, Johnson JK .
Diagnostic stewardship to support optimal use of multiplex molecular respiratory panels: a survey from the Society for Healthcare Epidemiology of America Research Network.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1823-28. doi: 10.1017/ice.2023.72..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Evans NJ, Arakkal AT, Cavanaugh JE
The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: a population-based cohort study.
This study’s objective was to estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. The authors used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001-2020), and Multi-State Medicaid (2014-2018) databases. They estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays, including the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. They identified 20,828 patients meeting inclusion criteria. On average, delay duration was 12 days, and patients had almost 2 missed opportunities prior to diagnosis. The duration of delays increased considerably with age from an average of 5.6 days for patients aged less than 2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included recent prescriptions for antibiotics not effective against pertussis, emergency department visits, and telehealth visits.
AHRQ-funded; HS027375.
Citation: Evans NJ, Arakkal AT, Cavanaugh JE .
The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: a population-based cohort study.
Infect Control Hosp Epidemiol 2023 Oct; 44(10):1629-36. doi: 10.1017/ice.2023.31..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality
Campbell JI, Sandora TJ, Haberer JE
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
This literature review looked at current studies on the diagnosis and treatment of pediatric latent tuberculosis infection (TB infection), commonly known as the TB infection care cascade. The authors conducted a systematic search of several medical databases and included articles and meeting abstracts that studied children and adolescents 21 years or younger who were screened for or diagnosed with TB infection. They identified 146 studies examining steps in the pediatric TB infection care cascade, including 31 in children living in low- and middle-income countries. Most literature described the final cascade step, which is treatment initiation to completion. Strengths and gaps were identified and future research in examining cascade steps upstream of treatment initiation was recommended.
AHRQ-funded; HS000063.
Citation: Campbell JI, Sandora TJ, Haberer JE .
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
BMJ Glob Health 2021 May;6(5). doi: 10.1136/bmjgh-2020-004836..
Keywords: Children/Adolescents, Respiratory Conditions, Diagnostic Safety and Quality, Treatments, Care Management, Evidence-Based Practice
Miller AC, Arakkal AT, Koeneman S
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
Missed opportunities to diagnose tuberculosis are costly to patients and society. In this retrospective cohort study, the investigators (1) estimated the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determined the risk factors for experiencing a diagnostic delay. The investigators found that many patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis.
AHRQ-funded; HS027375.
Citation: Miller AC, Arakkal AT, Koeneman S .
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
BMJ Open 2021 Feb 18;11(2):e045605. doi: 10.1136/bmjopen-2020-045605..
Keywords: Respiratory Conditions, Diagnostic Safety and Quality, Risk
Shipe ME, Deppen SA, Sullivan S
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Granulomas caused by infectious lung diseases can present as indeterminate pulmonary nodules (IPN). This study aimed to validate an enzyme immunoassay (EIA) for histoplasma immunoglobulins G and M (IgG, IgM) for diagnosing benign IPN in areas with endemic histoplasmosis. The investigators concluded that this study confirmed that histoplasma EIA testing could be useful for diagnosing benign IPN in areas with endemic histoplasmosis in a population at high risk for lung cancer.
AHRQ-funded; HS026122.
Citation: Shipe ME, Deppen SA, Sullivan S .
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Ann Thorac Surg 2021 Feb;111(2):416-20. doi: 10.1016/j.athoracsur.2020.05.101..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Joshi RP, Pejaver V, Hammarlund NE
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
This retrospective case-control study investigated whether the use of a prediction tool based on complete blood count results and patient sex can better allocate testing for SARS-CoV-2 PCR testing in hospital emergency departments. Participants were emergency department patients who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California, Seattle, Washington, Chicago Illinois, and South Korea. A hypothetical scenario of 1000 patients requiring testing was developed, but in this scenario testing resources are limited to 60% of patients. This tool would allow a 33% increase in properly allocated resources.
AHRQ-funded; HS026385.
Citation: Joshi RP, Pejaver V, Hammarlund NE .
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
J Clin Virol 2020 Aug;129:104502. doi: 10.1016/j.jcv.2020.104502..
Keywords: Emergency Department, COVID-19, Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality, Clinical Decision Support (CDS)
Higgins TL, Deshpande A, Zilberberg MD
Assessment of the accuracy of using ICD-9 diagnosis codes to identify pneumonia etiology in patients hospitalized with pneumonia.
Researchers assessed the validity of ICD-9 organism-specific administrative codes for pneumonia using microbiological data as the criterion standard, using data from 178 US hospitals in the Premier Healthcare Database. They found that, in this study, ICD-9 codes did not reliably capture pneumonia etiology identified by laboratory testing; because of the high specificities of ICD-9 codes, however, administrative data may be useful in identifying risk factors for resistant organisms. The low sensitivities of the diagnosis codes may limit the validity of organism-specific pneumonia prevalence estimates derived from administrative data.
AHRQ-funded; HS024277, HS025026.
Citation: Higgins TL, Deshpande A, Zilberberg MD .
Assessment of the accuracy of using ICD-9 diagnosis codes to identify pneumonia etiology in patients hospitalized with pneumonia.
JAMA Netw Open 2020 Jul;3(7):e207750. doi: 10.1001/jamanetworkopen.2020.7750.
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Keywords: Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Kotok D, Yang L, Evankovich JW
The evolution of radiographic edema in ARDS and its association with clinical outcomes: a prospective cohort study in adult patients.
The authors assessed the longitudinal evolution of radiographic edema using chest X-rays in patients with Acute Respiratory Distress Syndrome (ARDS) and examined its association with prognostic biomarkers, ARDS sub-phenotypes, and outcomes. They found that the Radiographic Assessment of Lung Edema (RALE) score was easily implementable with high inter-rater reliability. They concluded that the longitudinal RALE scoring appeared to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and could potentially predict prolonged need for mechanical ventilation.
AHRQ-funded; HS025455.
Citation: Kotok D, Yang L, Evankovich JW .
The evolution of radiographic edema in ARDS and its association with clinical outcomes: a prospective cohort study in adult patients.
J Crit Care 2020 Apr;56:222-28. doi: 10.1016/j.jcrc.2020.01.012..
Keywords: Respiratory Conditions, Imaging, Diagnostic Safety and Quality
Dugas AF, Hsieh YH, LoVecchio F
Derivation and validation of a clinical decision guideline for influenza testing in 4 US emergency departments.
This study looked at which patients should be tested for influenza among adult emergency department (ED) patients with fever or respiratory symptoms who met criteria for antiviral treatment per 2013 CDC guidelines. A prospective cohort study was conducted at 4 US EDs from November 2013 to April 2014. All 1941 enrolled participants were tested for influenza using polymerase chain reaction (PCR), and 183 patients (9.4%) had influenza. The CDC clinical decision guidelines (CDGs) for influenza testing includes new or increased cough (2 points), headache (1 point), subjective fever (1 point), and triage temperature >100.4F degrees. The CDG had a sensitivity and specificity of 94.1% and 36.6% respectively in the derivation set and the validation set.
AHRQ-funded; HS009699.
Citation: Dugas AF, Hsieh YH, LoVecchio F .
Derivation and validation of a clinical decision guideline for influenza testing in 4 US emergency departments.
Clin Infect Dis 2020 Jan;70(1):49-58. doi: 10.1093/cid/ciz171..
Keywords: Guidelines, Decision Making, Influenza, Respiratory Conditions, Emergency Department, Evidence-Based Practice, Diagnostic Safety and Quality
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Sjoding MW, Hofer TP, Co I
Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis.
This study sought to examine the interobserver reliability of the Berlin acute respiratory distress syndrome (ARDS) definition and examine strategies for improving the reliability of ARDS diagnosis. It concluded that the reliability of the Berlin ARDS definition is moderate. Combining independent reviews by multiple clinicians or improving methods to identify bilateral infiltrates on chest imaging are important strategies for improving the reliability of ARDS diagnosis.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Hofer TP, Co I .
Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis.
Chest 2018 Feb;153(2):361-67. doi: 10.1016/j.chest.2017.11.037.
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Keywords: Diagnostic Safety and Quality, Quality of Care, Respiratory Conditions
Brown SM, Duggal A, Hou PC
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
The objective of the study was to validate the superiority of nonlinear imputation of PaO2/FIO2 (a clinical indicator of hypoxaemia) among mechanically ventilated patients and understand what factors influence the accuracy of imputation. It concluded that in mechanically ventilated patients, nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 seems accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputations cannot be recommended.
AHRQ-funded; HS021456.
Citation: Brown SM, Duggal A, Hou PC .
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
Crit Care Med 2017 Aug;45(8):1317-24. doi: 10.1097/ccm.0000000000002514.
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Keywords: Diagnostic Safety and Quality, Respiratory Conditions, Intensive Care Unit (ICU), Emergency Medical Services (EMS)
McGrath SP, Pyke J, Taenzer AH
Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.
This study explored the technical and logistical aspects of augmenting pulse oximetry-based patient surveillance systems with continuous respiratory rate monitoring and offers some insight into the impact on patient deterioration detection that may result.
AHRQ-funded; HS024403.
Citation: McGrath SP, Pyke J, Taenzer AH .
Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.
J Clin Monit Comput 2017 Jun;31(3):561-69. doi: 10.1007/s10877-016-9884-y..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Sjoding MW, Cooke CR, Iwashyna TJ
Acute respiratory distress syndrome measurement error. Potential effect on clinical study results.
This study investigated how the degree of variability in acute respiratory distress syndrome (ARDS) measurement commonly reported in clinical studies affects study power, the accuracy of treatment effect estimates, and the measured strength of risk factor associations. It found that lower reliability measurement of ARDS during patient enrollment in randomized controlled trials seriously degraded study power and effect size estimates of clinical studies.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Cooke CR, Iwashyna TJ .
Acute respiratory distress syndrome measurement error. Potential effect on clinical study results.
Ann Am Thorac Soc 2016 Jul;13(7):1123-8. doi: 10.1513/AnnalsATS.201601-072OC.
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Keywords: Diagnostic Safety and Quality, Research Methodologies, Respiratory Conditions
Brodsky MB, Suiter DM, Gonzalez-Fernandez M
Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis.
This study evaluated screening accuracy of bedside water swallow tests used to identify patients at risk for dysphagia-associated aspiration, finding that currently-used tests offer sufficient screening.
AHRQ-funded; HS022331.
Citation: Brodsky MB, Suiter DM, Gonzalez-Fernandez M .
Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis.
Chest 2016 Jul;150(1):148-63. doi: 10.1016/j.chest.2016.03.059.
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Keywords: Respiratory Conditions, Diagnostic Safety and Quality, Pneumonia
Thompson CF, Price CP, Huang JH
A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis.
Researchers hypothesized that appropriate chronic rhinosinusitis (CRS) subclassification would increase homogeneity of baseline symptoms, and identify characteristic symptoms of each subtype. They found that subclassifying CRS with symptoms alone is difficult with neither polyp status nor eosinophilia giving a distinctive clinical symptom profile. However, certain symptoms may help otolaryngologists identify CRS subtypes, which may help guide future treatments.
AHRQ-funded; HS023011.
Citation: Thompson CF, Price CP, Huang JH .
A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis.
Int Forum Allergy Rhinol 2016 May;6(5):500-7. doi: 10.1002/alr.21687.
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Keywords: Chronic Conditions, Diagnostic Safety and Quality, Respiratory Conditions
Kelly MS, Smieja M, Luinstra K
Association of respiratory viruses with outcomes of severe childhood pneumonia in Botswana.
The authors examined whether detection of respiratory viruses predicts acute lower respiratory tract infection (ALRI) outcomes in low- and middle-income countries. They found that respiratory viruses were detected from most children hospitalized with ALRI in Botswana, but only respiratory syncytial virus (RSV) and human metapneumovirus were more frequent than among children without ALRI. Further, detection of RSV from children with ALRI predicted a protracted illness course but lower mortality compared with non-RSV viruses.
AHRQ-funded; HS020939.
Citation: Kelly MS, Smieja M, Luinstra K .
Association of respiratory viruses with outcomes of severe childhood pneumonia in Botswana.
PLoS One 2015 May 14;10(5):e0126593. doi: 10.1371/journal.pone.0126593.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Pneumonia, Respiratory Conditions
Linder JA
Sore throat: avoid overcomplicating the uncomplicated.
In this editorial, the author described issues involving sore throat diagnosis and delineated various points concerning an article within the same journal issue, concluding that physicians should remember that the prevalence of group A streptococcus in adults with a sore throat is approximately 10%; and that they should use the Centor scoring criteria; selectively use rapid antigen-detection testing; limit antibiotic treatment to patients most likely to have group A streptococcus; and most of the time when prescribing antibiotics, use penicillin.
AHRQ-funded; HS018419.
Citation: Linder JA .
Sore throat: avoid overcomplicating the uncomplicated.
Ann Intern Med 2015 Feb 17;162(4):311-2. doi: 10.7326/m14-2899.
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Keywords: Antibiotics, Diagnostic Safety and Quality, Infectious Diseases, Medication, Pneumonia, Respiratory Conditions, Practice Patterns
Smith SS, Ference EH, Evans CT
The prevalence of bacterial infection in acute rhinosinusitis: a systematic review and meta-analysis.
The primary objective of this systematic review of 29 studies was to assess the prevalence of bacterial infection in adults with clinically diagnosed acute rhinosinusitis (ARS) who undergo culture from antral puncture or endoscopically directed middle meatus culture. The review provides evidence that the prevalence of bacterial infection in patients with clinically diagnosed ARS remains poorly defined, but is likely greater than the 0.5% to 2% figure previously widely quoted.
AHRQ-funded; HS000078.
Citation: Smith SS, Ference EH, Evans CT .
The prevalence of bacterial infection in acute rhinosinusitis: a systematic review and meta-analysis.
Laryngoscope 2015 Jan;125(1):57-69. doi: 10.1002/lary.24709..
Keywords: Diagnostic Safety and Quality, Imaging, Respiratory Conditions
Deppen SA, Blume JD, Kensinger CD
Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
The purpose of this study was to estimate the diagnostic accuracy of positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) for pulmonary modules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the accuracy in regions where such disease is rare. It found that the accuracy of FDG-PET was extremely heterogeneous.
AHRQ-funded; HS021554.
Citation: Deppen SA, Blume JD, Kensinger CD .
Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
JAMA 2014 Sep 24;312(12):1227-36. doi: 10.1001/jama.2014.11488..
Keywords: Cancer, Cancer: Lung Cancer, Diagnostic Safety and Quality, Respiratory Conditions, Imaging