229 results on '"Swensen, Stephen J."'
Search Results
202. Regional Emphysema Score Predicting Overall Survival, Quality of Life, and Pulmonary Function Recovery in Early-Stage Lung Cancer Patients.
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Dai J, Liu M, Swensen SJ, Stoddard SM, Wampfler JA, Limper AH, Jiang G, and Yang P
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- Aged, Aged, 80 and over, Dyspnea etiology, Female, Forced Expiratory Volume, Humans, Lung Neoplasms complications, Lung Neoplasms pathology, Male, Middle Aged, Neoplasm Staging, Pneumonectomy, Postoperative Period, Predictive Value of Tests, Pulmonary Emphysema complications, Pulmonary Emphysema diagnostic imaging, Quality of Life, Recovery of Function, Retrospective Studies, Survival Rate, Tomography, X-Ray Computed, Vital Capacity, Lung Neoplasms physiopathology, Lung Neoplasms surgery, Pulmonary Emphysema physiopathology, Severity of Illness Index
- Abstract
Introduction: Pulmonary emphysema is a frequent comorbidity in lung cancer, but its role in tumor prognosis remains obscure. Our aim was to evaluate the impact of the regional emphysema score (RES) on a patient's overall survival, quality of life (QOL), and recovery of pulmonary function in stage I to II lung cancer., Methods: Between 1997 and 2009, a total of 1073 patients were identified and divided into two surgical groups-cancer in the emphysematous (group 1 [n = 565]) and nonemphysematous (group 2 [n = 435]) regions-and one nonsurgical group (group 3 [n = 73]). RES was derived from the emphysematous region and categorized as mild (≤5%), moderate (6%-24%), or severe (25%-60%)., Results: In group 1, patients with a moderate or severe RES experienced slight decreases in postoperative forced expiratory volume in 1 second, but increases in the ratio of forced expiratory volume in 1 second to forced vital capacity compared with those with a mild RES (p < 0.01); however, this correlation was not observed in group 2. Posttreatment QOL was lower in patients with higher RESs in all groups, mainly owing to dyspnea (p < 0.05). Cox regression analysis revealed that patients with a higher RES had significantly poorer survival in both surgical groups, with adjusted hazard ratios of 1.41 and 1.43 for a moderate RES and 1.63 and 2.04 for a severe RES, respectively; however, this association was insignificant in the nonsurgical group (adjusted hazard ratio of 0.99 for a moderate or severe RES)., Conclusions: In surgically treated patients with cancer in the emphysematous region, RES is associated with postoperative changes in lung function. RES is also predictive of posttreatment QOL related to dyspnea in early-stage lung cancer. In both surgical groups, RES is an independent predictor of survival., (Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)
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- 2017
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203. Restoring Joy in Work for the Healthcare Workforce. It's more than just reducing burnout.
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Feeley D and Swensen SJ
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- Humans, United States, Burnout, Professional prevention & control, Health Personnel psychology, Personnel Management
- Published
- 2016
204. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort.
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Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN, Sloan JA, Swensen SJ, and Buskirk SJ
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- Adult, Female, Humans, Longitudinal Studies, Male, Middle Aged, Surveys and Questionnaires, United States, Attitude of Health Personnel, Burnout, Professional psychology, Job Satisfaction, Physicians psychology, Professional Competence
- Abstract
Objective: To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort., Participants and Methods: Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction., Results: Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months., Conclusion: Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months., (Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
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- 2016
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205. Impact of organizational leadership on physician burnout and satisfaction.
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Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, Sloan JA, and Swensen SJ
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- Adult, Aged, Attitude of Health Personnel, Female, Humans, Male, Middle Aged, Personnel Management, Burnout, Professional epidemiology, Institutional Practice organization & administration, Job Satisfaction, Leadership, Medical Staff psychology, Physician Executives psychology
- Abstract
Objective: To evaluate the impact of organizational leadership on the professional satisfaction and burnout of individual physicians working for a large health care organization., Participants and Methods: We surveyed physicians and scientists working for a large health care organization in October 2013. Validated tools were used to assess burnout. Physicians also rated the leadership qualities of their immediate supervisor in 12 specific dimensions on a 5-point Likert scale. All supervisors were themselves physicians/scientists. A composite leadership score was calculated by summing scores for the 12 individual items (range, 12-60; higher scores indicate more effective leadership)., Results: Of the 3896 physicians surveyed, 2813 (72.2%) responded. Supervisor scores in each of the 12 leadership dimensions and composite leadership score strongly correlated with the burnout and satisfaction scores of individual physicians (all P<.001). On multivariate analysis adjusting for age, sex, duration of employment at Mayo Clinic, and specialty, each 1-point increase in composite leadership score was associated with a 3.3% decrease in the likelihood of burnout (P<.001) and a 9.0% increase in the likelihood of satisfaction (P<.001) of the physicians supervised. The mean composite leadership rating of each division/department chair (n=128) also correlated with the prevalence of burnout (correlation=-0.330; r(2)=0.11; P<.001) and satisfaction (correlation=0.684; r(2)=0.47; P<.001) at the division/department level., Conclusion: The leadership qualities of physician supervisors appear to impact the well-being and satisfaction of individual physicians working in health care organizations. These findings have important implications for the selection and training of physician leaders and provide new insights into organizational factors that affect physician well-being., (Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)
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- 2015
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206. An appeal for safe and appropriate imaging of children.
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Swensen SJ, Duncan JR, Gibson R, Muething SE, LeBuhn R, Rexford J, Wagner C, Smith SR, DeMers B, Morin RL, Santa J, and Homer CJ
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- Child, Diagnostic Imaging adverse effects, Humans, Radiation, Ionizing, Risk Assessment, Diagnostic Imaging standards, Patient Safety
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- 2014
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207. Trends in computed tomography utilization rates: a longitudinal practice-based study.
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Hess EP, Haas LR, Shah ND, Stroebel RJ, Denham CR, and Swensen SJ
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- Adult, Aged, Causality, Comorbidity, Female, Humans, Longitudinal Studies, Male, Middle Aged, Primary Health Care statistics & numerical data, Radiation Dosage, Radiation Protection statistics & numerical data, Utilization Review, Practice Patterns, Physicians' trends, Primary Health Care trends, Radiation Injuries epidemiology, Tomography, X-Ray Computed statistics & numerical data, Tomography, X-Ray Computed trends
- Abstract
Objectives: Computed tomography (CT) use has increased dramatically over the past 2 decades, leading to increased radiation exposure at the population level. We assessed trends in CT use in a primary care (PC) population from 2000 to 2010., Methods: Trends in CT use from 2000 to 2010 were assessed in an integrated, multi-specialty group practice. Administrative data were used to identify patients associated with a specific primary care provider and all CT imaging procedures. Utilization rates per 1000 patients and CT rates by type and medical specialty were calculated., Results: Of 179,032 PC patients, 55,683 (31%) underwent CT. Mean age (SD) was 31.0 (23.6) years; 53% were female patients. In 2000, 178.5 CT scans per 1000 PC patients were performed, increasing to 195.9 in 2010 (10% absolute increase, P = 0.01). Although utilization rates across the 10-year period remained stable, emergency department (ED) CT examinations rose from 41.1 per 1000 in 2000 to 74.4 per 1000 in 2010 (81% absolute increase, P < 0.01). CT abdomen accounted for more than 50% of all CTs performed, followed by CT other (19%; included scans of the spine, extremities, neck and sinuses), CT chest (16%), and CT head (14%). Top diagnostic CT categories among those undergoing CT were abdominal pain, lower respiratory disease, and headache., Conclusions: Although utilization rates across the 10-year period remained stable, CT use in the ED substantially increased. CT abdomen and CT chest were the two most common studies performed and are potential targets for interventions to improve the appropriateness of CT use.
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- 2014
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208. Improving hypertension control in diabetes: a multisite quality improvement project that applies a 3-step care bundle to a chronic disease care model for diabetes with hypertension.
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Lindsay ME, Hovan MJ, Deming JR, Hunt VL, Witwer SG, Fedraw LA, Sayre JW, Matthews MR, Halling VW, Graber RC, Martin RL, Wright JC, Myers JF, Plate RH, Hruska SM, Huttar KA, Pachuta LS, Resar RK, Edwards FD, Chang YH, and Swensen SJ
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- Adolescent, Adult, Aged, Blood Pressure, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 therapy, Female, Humans, Hypertension etiology, Male, Middle Aged, Models, Organizational, Patient Satisfaction, Quality Indicators, Health Care, Young Adult, Diabetes Complications therapy, Hypertension therapy, Patient Care Bundles methods, Quality Improvement organization & administration
- Abstract
Hypertension in diabetes patients leads to significant morbidity and mortality. Nonetheless blood pressure (BP) control in patients with diabetes remains disappointing. The authors applied a care bundle to decrease the proportion of patients with BP exceeding 130/80. Teams from 4 sites in 3 states (Minnesota, Florida, and Arizona) developed a bundle consisting of a standardized BP process, an order set, and a patient goal. Baseline data were collected in the first 12 weeks, followed by 6 weeks of implementing changes. The final 16 weeks represented the intervention. There was a statistically significant decrease in the proportion of patients with uncontrolled BP in 3 of 4 sites (P < .0001 in all 3 sites demonstrating improvement). There was a statistically significant improvement in the satisfaction survey (P = .0011). Implementing an evidence-based care bundle for hypertension in diabetes mellitus can improve BP outcomes.
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- 2013
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209. Accelerating the use of best practices: the Mayo Clinic Model of Diffusion.
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Dilling JA, Swensen SJ, Hoover MR, Dankbar GC, Donahoe-Anshus AL, Murad MH, and Mueller JT
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- Benchmarking organization & administration, Cooperative Behavior, Evidence-Based Medicine, Humans, Interinstitutional Relations, Leadership, Organizational Culture, Systems Integration, Diffusion of Innovation, Quality of Health Care organization & administration
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- 2013
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210. The business case for health-care quality improvement.
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Swensen SJ, Dilling JA, Mc Carty PM, Bolton JW, and Harper CM Jr
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- Cost Control, Cost-Benefit Analysis, Humans, Job Satisfaction, Medical Errors prevention & control, Patient Satisfaction, United States, Commerce, Efficiency, Organizational, Health Care Costs, Health Care Sector, Quality Improvement economics
- Abstract
The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.
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- 2013
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211. More quality measures versus measuring what matters: a call for balance and parsimony.
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Meyer GS, Nelson EC, Pryor DB, James B, Swensen SJ, Kaplan GS, Weissberg JI, Bisognano M, Yates GR, and Hunt GC
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- Evidence-Based Medicine, Health Care Costs, Hospitals standards, Humans, Medical Errors prevention & control, Organizational Policy, Program Development, United States, Organizational Culture, Quality Assurance, Health Care methods, Quality Improvement standards, Quality Indicators, Health Care economics
- Abstract
External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs.
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- 2012
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212. Quality improvement in interventional radiology: an opportunity to demonstrate value and improve patient-centered care.
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Steele JR, Sidhu MK, Swensen SJ, and Murphy TP
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- United States, Patient-Centered Care standards, Quality Assurance, Health Care standards, Radiography, Interventional standards, Vascular Surgical Procedures standards
- Abstract
The changing healthcare environment offers an opportunity for interventional radiology (IR) to showcase its value-specifically, to demonstrate that IR often offers the better, safer, faster, and less expensive treatment option for various clinical scenarios. The best way to demonstrate the value of IR now and to maintain this value in the future is through implementation of patient-centered care built on standardized care delivery, continuous quality improvement, and effective team dynamics., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)
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- 2012
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213. The Mayo Clinic Value Creation System.
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Swensen SJ, Dilling JA, Harper CM Jr, and Noseworthy JH
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- Hospital Costs statistics & numerical data, Humans, Information Dissemination methods, Leadership, Organizational Objectives, Patient Safety, Program Development methods, Quality Improvement organization & administration, Quality Indicators, Health Care statistics & numerical data, Efficiency, Organizational, Quality of Health Care organization & administration
- Abstract
The authors present Mayo Clinic's Value Creation System, a coherent systems engineering approach to delivering a single high-value practice. There are 4 tightly linked, interdependent phases of the system: alignment, discovery, managed diffusion, and measurement. The methodology is described and examples of the results to date are presented. The Value Creation System has been demonstrated to improve the quality of patient care while reducing costs and increasing productivity.
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- 2012
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214. Controlling healthcare costs by removing waste: what American doctors can do now.
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Swensen SJ, Kaplan GS, Meyer GS, Nelson EC, Hunt GC, Pryor DB, Weissberg JI, Daley J, Yates GR, and Chassin MR
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- Cross Infection economics, Cross Infection prevention & control, Delivery of Health Care economics, Efficiency, Organizational economics, Health Services Misuse economics, Humans, Medication Errors economics, Medication Errors prevention & control, United States, Delivery of Health Care organization & administration, Health Care Costs statistics & numerical data, Practice Patterns, Physicians'
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Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing (deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3) waste within healthcare processes. These challenges know no borders.
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- 2011
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215. Perceptions of lung cancer risk and beliefs in screening accuracy of spiral computed tomography among high-risk lung cancer family members.
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Sinicrope PS, Rabe KG, Brockman TA, Patten CA, Petersen WO, Slusser J, Yang P, Swensen SJ, Edell ES, de Andrade M, and Petersen GM
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- Adult, Female, Humans, Male, Middle Aged, Perception, Risk, Surveys and Questionnaires, Treatment Outcome, Lung Neoplasms diagnostic imaging, Lung Neoplasms psychology, Tomography, Spiral Computed psychology
- Abstract
Rationale and Objectives: Spiral computed tomography (SCT) is being evaluated as a screening tool for lung cancer. Our objective was to describe the effect of participation in SCT screening on participants' risk perceptions, worry, and expectations regarding the accuracy of the screening result., Materials and Methods: We surveyed 60 individuals with lung cancer family history who were participating in an SCT study for the primary purpose of improving genetic linkage analysis at baseline, and then 1 and 6 months post-SCT., Results: Of the 60 participants, 40 received normal results, 19 received non-negative results requiring follow-up, and 1 was diagnosed with lung cancer. At baseline, participants reported high levels of perceived lung cancer risk (64%), were concerned about developing lung cancer (94%), and the majority (84%) were not OK with receiving a non-negative SCT result when they really didn't have cancer. At 1 month post-SCT, those with a non-negative screen (n = 19) had lowered their expectations of test accuracy regarding non-negative results (54%) and reported increased levels in worry/concern (100%) and perceived risk (75%), but these effects diminished over time and returned almost to baseline levels at 6 months., Conclusions: Persons at very high empiric risk for lung cancer expect their SCT screening test to be accurate and present with high levels of lung cancer risk perception and worry/concern overall. Our findings suggest a need for risk counseling and discussion on the limitations of screening tests to accurately detect lung cancer., (2010 AUR. All rights reserved.)
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- 2010
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216. Flying in the plane you service: patient-centered radiology.
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Swensen SJ and Johnson CD
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- Choice Behavior, Diagnostic Imaging economics, Humans, Patient-Centered Care economics, Physician-Patient Relations, Quality of Health Care, Safety, Diagnostic Imaging standards, Patient-Centered Care standards
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If you were about to undergo a radiologic procedure, what 5 things would you want? The authors propose a construct for patient-centered radiology. Five wishes of a prospective radiology patient are described: 1) the information to choose, 2) the right examination, 3) a safe examination, 4) effective communication of correctly interpreted results, and 5) a fair price. The authors posit that the American practice of radiology would be considerably different if our profession practiced patient-centered radiology.
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- 2010
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217. Quality: the Mayo Clinic approach.
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Swensen SJ, Dilling JA, Milliner DS, Zimmerman RS, Maples WJ, Lindsay ME, and Bartley GB
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- Communication, Delivery of Health Care, Integrated organization & administration, Emergency Service, Hospital, Hospital Information Systems, Hospitals, Group Practice organization & administration, Medical Records Systems, Computerized standards, Minnesota, Organizational Culture, Patient Care Team, Safety Management organization & administration, Quality Assurance, Health Care organization & administration
- Abstract
Developing highly reliable care for patients requires changes in some traditional beliefs of medical practice, an evolution toward a "system" of health care, the disciplined application of scientific principles, modifications in the way all future providers are trained, and a fundamental understanding by leadership that quality must become a business strategy and core work, not an expense or regulatory requirement. Quality at Mayo is defined as a composite of outcomes, safety, and service. A 4-part strategic construct focusing on Culture, Infrastructure, Engineering, and Execution has been developed to guide improvement activities and to ensure a comprehensive approach to better patient care. The Mayo Clinic experience has led to a greater understanding of the leadership commitment, organizational challenges, and the breadth of initiatives necessary to achieve highly reliable care.
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- 2009
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218. Feasibility of using a walking workstation during CT image interpretation.
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Fidler JL, MacCarty RL, Swensen SJ, Huprich JE, Thompson WG, Hoskin TL, and Levine JA
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- Humans, Radiology instrumentation, Exercise, Locomotion, Occupational Medicine instrumentation, Physicians, Radiology methods, Tomography, X-Ray Computed methods
- Abstract
Objective: Two-thirds of the US population is overweight or obese. Sedentary lifestyles and occupations are one factor in the development of obesity. Methods to help reduce sedentary work environments may help reduce obesity. The purpose of this study was to determine the feasibility of using a walking workstation during computed tomographic image interpretation., Methods: Two radiologists reinterpreted 100 clinical computed tomographic examinations they had previously interpreted, each while walking at 1 mph on a treadmill using an electronic workstation. Ten cases were reviewed per session. The time period between the initial conventional interpretations and the reinterpretations was greater than one year, to reduce recall bias. Discrepant findings were ranked according to a classification system based on clinical importance on a scale ranging from 1 to 6. Discrepant findings classified as greater than or equal to 3 were considered significant. Detection rates for the initial interpretations and reinterpretations were determined for each reviewer and compared using a paired t-test., Results: A total of 1,582 findings were reported (825 by reviewer 1 and 757 by reviewer 2). There were 459 findings with clinical importance of 3 or higher. For reviewer 1 (91 cases of at least one important finding), the mean detection rates were 99.0% for the walking technique and 88.9% for the conventional interpretations (P = .0003). For reviewer 2 (89 cases with at least one important finding) the mean detection rates were 99.1% for the walking technique and 81.3% for the conventional interpretations (P < .0001)., Conclusion: The use of a walking workstation for the interpretation of cross-sectional images is feasible. Further studies are needed to assess the potential impact on diagnostic accuracy.
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- 2008
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219. Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT.
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Christensen JA, Nathan MA, Mullan BP, Hartman TE, Swensen SJ, and Lowe VJ
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- Adult, Aged, Aged, 80 and over, Female, Humans, Lung Neoplasms diagnostic imaging, Male, Middle Aged, Positron-Emission Tomography, Predictive Value of Tests, Radiography, Sensitivity and Specificity, Tomography, Emission-Computed, Fluorodeoxyglucose F18, Radiopharmaceuticals, Solitary Pulmonary Nodule diagnostic imaging
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Objective: The purpose of this study was to directly compare nodule-enhancement CT and 18F-FDG PET in the characterization of indeterminate solitary pulmonary nodules (SPNs) greater than 7 mm in size., Materials and Methods: Examinations from patients undergoing both nodule-enhancement CT and 18F-FDG PET to characterize the same indeterminate SPN were reviewed. For nodule-enhancement CT, an SPN was considered malignant when it showed an unenhanced to peak contrast-enhanced increase in attenuation greater than 15 H. Fluorine-18-FDG PET studies were blindly reinterpreted by two qualified nuclear radiologists. SPNs qualitatively showing hypermetabolic activity greater than the mediastinal blood pool were interpreted as malignant. These interpretations were compared with the original prospective clinical readings and to semiquantitative standardized uptake value (SUV) analysis. Results were compared with pathologic and clinical follow-up., Results: Forty-two pulmonary nodules were examined. Twenty-five (60%) were malignant, and 17 (40%) were benign. Nodule-enhancement CT was positive in all 25 malignant nodules and in 12 benign nodules, with sensitivity and specificity of 100% and 29%, respectively, and with a positive predictive value (PPV) and negative predictive value (NPV) of 68% and 100%, respectively. Qualitative 18F-FDG PET interpretations were positive in 24 of the 25 malignant nodules and in four benign nodules. Fluorine-18-FDG PET was considered negative in one malignant nodule and in 13 of the 17 benign nodules. This correlates with a sensitivity and specificity of 96% and 76%, respectively, and with a PPV and NPV of 86% and 93%, respectively. Original prospective 18F-FDG PET and semiquantitative SUV analysis showed sensitivity, specificity, PPV, and NPV of 88%, 76%, 85%, and 81% and 84%, 82%, 88%, and 78%, respectively., Conclusion: Due to its much higher specificity and only slightly reduced sensitivity, 18F-FDG PET is preferable to nodule-enhancement CT in evaluating indeterminate pulmonary nodules. However, nodule-enhancement CT remains useful due to its high NPV, convenience, and lower cost. Qualitative 18F-FDG PET interpretation provided the best balance of sensitivity and specificity when compared with original prospective interpretation or SUV analysis.
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- 2006
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220. Quality improvement in radiology: white paper report of the Sun Valley Group meeting.
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Johnson CD, Swensen SJ, Applegate KE, Blackmore CC, Borgstede JP, Cardella JF, Dilling JA, Dunnick NR, Glenn LW, Hillman BJ, Lau LS, Lexa FJ, Weinreb JC, and Wilcox P
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- Humans, Practice Patterns, Physicians' trends, Societies, Medical, United States, Practice Patterns, Physicians' standards, Quality of Health Care, Radiology standards, Reimbursement, Incentive
- Abstract
The Sun Valley Group is an informal assembly of individuals interested in improving quality in radiology. Its first meeting was held in September 2005. The purposes of the meeting was to share quality improvement experiences, consider a strategy for promoting quality improvement initiatives across the radiology profession, and initiate quality benchmarking efforts. Representatives from private practice, academia, national quality programs, and international societies were in attendance. Four main themes were presented: the sharing of leading quality activities in radiology, the future of pay-for-performance systems, programs and future initiatives of professional radiology societies, and health services research guidelines for developing outcome metrics. This white paper summarizes information presented in each of these thematic areas and concludes with the group's plans for future activities. Among these is a formal educational program for all radiologists interested in implementing a quality improvement program within their practice, to be hosted by the ACR.
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- 2006
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221. Radiologic quality and safety: mapping value into radiology.
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Swensen SJ and Johnson CD
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- Delivery of Health Care standards, History, 20th Century, Humans, Quality Assurance, Health Care, Radiology history, Safety Management history, United States, Quality of Health Care, Radiology standards, Safety Management organization & administration
- Abstract
The authors have created a radiology quality map to help understand the opportunities for improvement in the radiologic safety, reliability, quality, and appropriateness of examinations and interventions. It entails 9 steps with dozens of specific opportunities for improving care to patients. The radiology profession has an obligation to robustly document and improve quality and safety in its practice.
- Published
- 2005
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222. Optimizing weekend availability for sophisticated tests and procedures in a large hospital.
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Lee LH, Swensen SJ, Gorman CA, Moore RR, and Wood DL
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- Diagnostic Tests, Routine instrumentation, Health Services Needs and Demand, Laboratories, Hospital organization & administration, Minnesota, Organizational Case Studies, Time Factors, Diagnostic Tests, Routine statistics & numerical data, Efficiency, Organizational, Hospital Administration
- Abstract
The reduced availability of sophisticated tests and procedures in hospitals on weekends (the so-called "weekend effect") delays care. Addressing this problem requires hospital managers to balance the desire for timeliness with the need for efficient operations. We illustrate how a hospital can profile timeliness, demand, and capacity utilization across the week for multiple testing areas. This simple, practical method; using data extracted from the hospital's accounting system, makes visible the pattern and magnitude of delays caused by reduced availability on weekends, while also showing how capacity is deployed. We combined the analytical tool with a process of transparent feedback and local problem solving that engages multiple stakeholders in the hospital. The goal is to optimally configure capacity so as to balance the imperatives of timely availability and efficient resource utilization.
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- 2005
223. Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population.
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Lindell RM, Hartman TE, Swensen SJ, Jett JR, Midthun DE, Nathan MA, and Lowe VJ
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- Carcinoma, Non-Small-Cell Lung epidemiology, Female, Humans, Incidence, Lung Neoplasms epidemiology, Male, Prevalence, Retrospective Studies, Solitary Pulmonary Nodule diagnostic imaging, Solitary Pulmonary Nodule epidemiology, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Lung Neoplasms diagnostic imaging, Mass Screening methods, Positron-Emission Tomography, Tomography, X-Ray Computed
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Objective: The objective of our study was to retrospectively review the PET results of non-small cell lung carcinomas detected on screening chest CT in a high-risk population., Conclusion: PET findings were negative in 32% of the cases of non-small cell carcinomas that were detected on screening CT in a high-risk patient population. These tumors were small, low-grade, or both. The most common histology was bronchioloalveolar cell carcinoma. The role of PET in evaluating screening-detected indeterminate nodules in a high-risk population may be more limited than in a general population.
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- 2005
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224. Alpha1-antitrypsin and neutrophil elastase imbalance and lung cancer risk.
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Yang P, Bamlet WR, Sun Z, Ebbert JO, Aubry MC, Krowka MJ, Taylor WR, Marks RS, Deschamps C, Swensen SJ, Wieben ED, Cunningham JM, Melton LJ, and de Andrade M
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- Aged, Case-Control Studies, Female, Genetic Predisposition to Disease, Genotype, Humans, Leukocyte Elastase genetics, Logistic Models, Lung Neoplasms metabolism, Male, Middle Aged, alpha 1-Antitrypsin genetics, alpha 1-Antitrypsin Deficiency complications, Leukocyte Elastase metabolism, Lung Neoplasms genetics, alpha 1-Antitrypsin metabolism, alpha 1-Antitrypsin Deficiency genetics
- Abstract
Objective: Imbalance between alpha(1)-antitrypsin and neutrophil elastase is an underlying cause of lung tissue damage that may create a favorable host environment for carcinogenesis. We conducted a case-control study to investigate whether genetic variations indicative of alpha(1)-antitrypsin deficiency (A1ATD) or an excess of neutrophil elastase modify lung cancer risk, Design: The case patients were 305 consecutively identified primary lung cancer patients, and the control subjects were 338 community residents. Protease inhibitor-1 (PI1), encoding alpha(1)-antitrypsin, was typed by an isoelectric focusing assay. Neutrophil elastase-2 (ELA2), encoding neutrophil elastase, was typed by two single-nucleotide polymorphism sites. Multivariable logistic regression models tested the independent and interactive effects of PI1, ELA2, tobacco smoke exposure, COPD, and family history of lung cancer, Results: Sex and ethnicity were comparable between case patients and control subjects, but case patients were more likely to be smokers, and to have a history of COPD, environmental tobacco smoke exposure, and a positive family history of lung cancer. Haplotype analysis indicated an overall strong association between the two ELA2 markers and lung cancer risk. Our best-fitting model showed significant and independent effects of the PI1-deficient allele (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 3.0) and the ELA2 T-G haplotype (OR, 4.1; 95% CI, 1.9 to 8.9) on lung cancer risk, and an increased risk (OR, 2.6; 95% CI, 2.4 to 2.8) for individuals carrying both a PI1-deficient allele and a G-G haplotype, Conclusions: Genotypes indicative of A1ATD and/or an excess of neutrophil elastase are significantly associated with lung cancer risk. Our findings may provide opportunities to better understand the mechanisms of lung cancer development and risk reduction.
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- 2005
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- View/download PDF
225. Relation between smoking cessation and receiving results from three annual spiral chest computed tomography scans for lung carcinoma screening.
- Author
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Townsend CO, Clark MM, Jett JR, Patten CA, Schroeder DR, Nirelli LM, Swensen SJ, and Hurt RD
- Subjects
- Age Factors, Aged, Aged, 80 and over, Attitude to Health, Carcinoma diagnostic imaging, Female, Follow-Up Studies, Forced Expiratory Volume physiology, Health Behavior, Humans, Longitudinal Studies, Lung Neoplasms diagnostic imaging, Male, Middle Aged, Motivation, Risk Factors, Smoking physiopathology, Time Factors, Carcinoma prevention & control, Lung Neoplasms prevention & control, Mass Screening, Radiography, Thoracic, Smoking Cessation psychology, Tomography, Spiral Computed
- Abstract
Background: The relation between undergoing a single computed tomography (CT) screening for lung carcinoma and the potential long-term impact on smoking status has been equivocal. Perhaps, recommendations from multiple cancer screenings may promote smoking abstinence among individuals at high risk for lung carcinoma., Methods: The current longitudinal study comprised 926 current smokers and 594 former smokers who participated in 3 annual follow-up low-dose, fast spiral chest CT scan screenings for lung carcinoma. Baseline demographic, pulmonary function, smoking history variables, and previous abnormal findings were evaluated as predictors of self-reported point prevalence smoking abstinence., Results: Among current smokers at baseline, abstinence from smoking during the 3-year follow-up was associated with older age, worse baseline pulmonary function, and abnormal CT finding the previous year requiring interim follow-up. Of participants who received abnormal screens each of the previous 3 years, 41.9% reported smoking abstinence compared with 28.0% with 2 abnormal screens, 24.2% with 1 abnormal screen, and 19.8% with no abnormal screens. Among former smokers, abstinence from smoking was associated with a longer duration of abstinence before the baseline visit., Conclusions: Smokers with abnormal CT findings from multiple CT screens were more likely to be abstinent from smoking at the 3-year follow-up. Multiple low-dose, fast spiral chest CT scan screenings for lung carcinoma may represent teachable moments and opportunities to enhance motivation for smoking abstinence. Further research is needed to continue to investigate how annual screening may enhance motivation for health behavior change.
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- 2005
- Full Text
- View/download PDF
226. Thoracic surgical operations in patients enrolled in a computed tomographic screening trial.
- Author
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Crestanello JA, Allen MS, Jett JR, Cassivi SD, Nichols FC 3rd, Swensen SJ, Deschamps C, and Pairolero PC
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- Aged, Aged, 80 and over, Female, Humans, Lung Diseases epidemiology, Lung Neoplasms epidemiology, Male, Mass Screening, Middle Aged, Thoracic Surgical Procedures statistics & numerical data, Lung Diseases diagnostic imaging, Lung Diseases surgery, Lung Neoplasms diagnostic imaging, Lung Neoplasms surgery, Tomography, X-Ray Computed
- Abstract
Objective: Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical operations performed on patients enrolled in our computed tomographic screening program., Methods: From January 1999 through December 2002, screening computed tomography for lung cancer was performed annually on 1520 participants. All participants were at least 50 years old and smoked more than 20 pack/y. We found 3130 indeterminate pulmonary nodules in 1112 participants (73%). Fifty-five participants (3.6%) underwent 60 thoracic operations for a variety of indications. The medical records of these 55 patients were reviewed., Results: Indications for operation included suspicious pulmonary nodules, mediastinal adenopathy, and a spontaneous pneumothorax. Operations performed included a lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6, video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign disease was found in 10 patients (18.1%), and lung cancer was found in 45 (81.9%), 2 of whom had metachronous lung cancers. Cell types were adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13, squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and undifferentiated non-small cell in 1 case each. Twenty-eight cancers were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications occurred in 27% of patients. Operative mortality was 1.7%., Conclusion: Computed tomographic screening finds a large number of indeterminate pulmonary nodules in smokers 50 years old or older, most of which are observed and not operated on. Although 47 cancers were detected thus far in this highly selected group of patients, this represents only 1.5% of the pulmonary nodules identified.
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- 2004
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- View/download PDF
227. Estimate of lung cancer mortality from low-dose spiral computed tomography screening trials: implications for current mass screening recommendations.
- Author
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Patz EF Jr, Swensen SJ, and Herndon JE 2nd
- Subjects
- Aged, Humans, Lung Neoplasms diagnostic imaging, Middle Aged, Predictive Value of Tests, United States epidemiology, Lung Neoplasms mortality, Lung Neoplasms prevention & control, Mass Screening, Tomography, Spiral Computed
- Abstract
Purpose: Low-dose computed tomography (CT) has been suggested for lung cancer screening. Several observational trials have published their preliminary results, and some investigators suggest that this technique will save lives. There are no mortality statistics, however, and the current study used published data from these trials to estimate the disease-specific mortality in this high-risk population., Patients and Methods: Two nonrandomized CT screening trials were selected from the literature for analysis. The number of trial participants, the number of lung cancers diagnosed per year, and stage distribution of the cancers was recorded. Previously published 5-year survival data were used to calculate the number of predicted lung cancer deaths and estimate the overall lung cancer mortality per 1,000 person-years among participants screened. These statistics were then compared to the previous Mayo Lung Project, which used chest radiographs and sputum cytology for screening high-risk individuals., Results: This study estimates the lung cancer mortality is 4.1 deaths per 1,000 person-years in the Mayo Clinic CT screening trial, and is 5.5 deaths per 1,000 person-years in the Early Lung Cancer Action Program trial. These data are similar to the lung cancer mortality of 4.4 deaths per 1,000 person-years in the interventional arm, and 3.9 deaths per 1,000 person-years in the usual-care arm of the previous Mayo Lung Project., Conclusion: These data suggest that CT screening could produce similar outcomes to prior chest radiographic trials in this high-risk group. Results from randomized trials are required, however, before the true utility of mass screening with CT for lung cancer can be determined.
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- 2004
- Full Text
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228. Bronchiolar disorders.
- Author
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Ryu JH, Myers JL, and Swensen SJ
- Subjects
- Bronchi physiopathology, Bronchial Diseases etiology, Bronchial Diseases physiopathology, Humans, Lung Diseases, Interstitial complications, Lung Diseases, Interstitial physiopathology, Bronchial Diseases diagnosis, Lung Diseases, Interstitial diagnosis
- Abstract
Bronchiolar abnormalities are relatively common and occur in a variety of clinical settings. Various histopathologic patterns of bronchiolar injury have been described and have led to confusing nomenclature with redundant and overlapping terms. Some histopathologic patterns of bronchiolar disease may be relatively unique to a specific clinical context but others are nonspecific with respect to either etiology or pathogenesis. Herein, we present a scheme separating (1) those disorders in which the bronchiolar disease is the predominant abnormality (primary bronchiolar disorders) from (2) parenchymal disorders with prominent bronchiolar involvement and (3) bronchiolar involvement in large airway diseases. Primary bronchiolar disorders include constrictive bronchiolitis (obliterative bronchiolitis, bronchiolitis obliterans), acute bronchiolitis, diffuse panbronchiolitis, respiratory bronchiolitis, mineral dust airway disease, follicular bronchiolitis, and a few other rare variants. Prominent bronchiolar involvement may be seen in several interstitial lung diseases, including hypersensitivity pneumonitis, respiratory bronchiolitis-associated interstitial lung disease, cryptogenic organizing pneumonia (idiopathic bronchiolitis obliterans organizing pneumonia), and pulmonary Langerhans' cell histiocytosis. Large airway diseases that commonly involve bronchioles include bronchiectasis, asthma, and chronic obstructive pulmonary disease. The clinical relevance of a bronchiolar lesion is best determined by identifying the underlying histopathologic pattern and assessing the correlative clinico-physiologic-radiologic context.
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- 2003
- Full Text
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229. CT screening for lung cancer.
- Author
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Swensen SJ
- Subjects
- Aged, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Lung Neoplasms mortality, Lung Neoplasms therapy, Male, Sensitivity and Specificity, Survival Rate, Lung Neoplasms diagnostic imaging, Tomography, X-Ray Computed
- Published
- 2002
- Full Text
- View/download PDF
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