6 results on '"Janosky, Janine E."'
Search Results
2. Frequency and outcome of cervical cancer prevention failures in the United States.
- Author
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Raab SS, Grzybicki DM, Zarbo RJ, Jensen C, Geyer SJ, Janosky JE, Meier FA, Vrbin CM, Carter G, and Geisinger KR
- Subjects
- Colposcopy standards, Diagnostic Errors standards, Female, Humans, Mass Screening standards, Neoplasm Staging, Patient Care Management statistics & numerical data, Reproducibility of Results, Uterine Cervical Neoplasms prevention & control, Vaginal Smears standards, Colposcopy statistics & numerical data, Diagnostic Errors statistics & numerical data, Mass Screening statistics & numerical data, Papanicolaou Test, Predictive Value of Tests, Uterine Cervical Neoplasms diagnosis, Vaginal Smears statistics & numerical data
- Abstract
We measured the frequency and outcome of cervical cancer prevention failures that occurred in the Papanicolaou (Pap) and colposcopy testing phases involving 1,646,580 Pap tests in 4 American hospital systems between January 1, 1998, and December 31, 2004. We defined a screening failure as a 2-step or greater discordant Pap test result and follow-up biopsy diagnosis. A total of 5,278 failures were detected (0.321% of all Pap tests); 48% and 52% of failures occurred in the Pap test and colposcopy phases, respectively. Missed squamous cancers (1 in 187,786 Pap tests), glandular cancers (1 in 19,426 Pap tests), and high-grade lesions (1 in 6,870 Pap tests) constituted 4.1% of all failures. Unnecessary repeated tests or diagnostic delays occurred in 70.8% and 63.9% of failures involving high- and low-grade lesions, respectively. We conclude that cervical cancer prevention practices are remarkably successful in preventing squamous cancers, although a high frequency of failures results in low-impact negative outcomes.
- Published
- 2007
- Full Text
- View/download PDF
3. Use of a new method in reaching consensus on the cause of cytologic-histologic correlation discrepancy.
- Author
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Raab SS, Stone CH, Wojcik EM, Geisinger KR, Dahmoush L, Garcia FU, Grzybicki DM, Janosky JE, Meier FA, and Zarbo RJ
- Subjects
- Humans, Models, Statistical, Pathology, Surgical standards, Reproducibility of Results, Single-Blind Method, Consensus, Diagnostic Errors, Observer Variation, Pathology, Surgical methods, Quality Assurance, Health Care methods
- Abstract
Pathologists exhibit very poor agreement in adjudicating the cause of cytologic-histologic correlation discrepancies, which contributes to problems in designing interventions to reduce discrepancy frequency. In this observational study, we developed a visual method of adjudicating discrepancy cause, termed the No-Blame Box method, which consisted of initially assessing specimen interpretability by separately evaluating specimen quality and the presence of tumor. Five pathologists blindly adjudicated the cause of discrepancy in pulmonary specimens from 40 patients. The kappa statistic of all pathologist pairs in adjudicating discrepancy cause using the No-Blame Box method ranged from 0.400 to 0.796, indicating acceptable to excellent agreement. Pathologists ranged in their assessment of specimen interpretability from 13% to 20%, and in no case did all 5 pathologists concur that a specimen was interpretable. Most discrepancies resulted from pathologists diagnosing noninterpretable samples. Pathologists who used the No-Blame Box showed significant agreement in the adjudication of discrepancy cause.
- Published
- 2006
- Full Text
- View/download PDF
4. Effectiveness of Toyota process redesign in reducing thyroid gland fine-needle aspiration error.
- Author
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Raab SS, Grzybicki DM, Sudilovsky D, Balassanian R, Janosky JE, and Vrbin CM
- Subjects
- Humans, Process Assessment, Health Care, Reproducibility of Results, Sensitivity and Specificity, Thyroid Diseases classification, Biopsy, Fine-Needle standards, Diagnostic Errors prevention & control, Efficiency, Organizational, Quality Assurance, Health Care methods, Thyroid Diseases pathology, Thyroid Gland pathology
- Abstract
Our objective was to determine whether the Toyota Production System process redesign resulted in diagnostic error reduction for patients who underwent cytologic evaluation of thyroid nodules. In this longitudinal, nonconcurrent cohort study, we compared the diagnostic error frequency of a thyroid aspiration service before and after implementation of error reduction initiatives consisting of adoption of a standardized diagnostic terminology scheme and an immediate interpretation service. A total of 2,424 patients underwent aspiration. Following terminology standardization, the false-negative rate decreased from 41.8% to 19.1% (P = .006), the specimen nondiagnostic rate increased from 5.8% to 19.8% (P < .001), and the sensitivity increased from 70.2% to 90.6% (P < .001). Cases with an immediate interpretation had a lower noninterpretable specimen rate than those without immediate interpretation (P < .001). Toyota process change led to significantly fewer diagnostic errors for patients who underwent thyroid fine-needle aspiration.
- Published
- 2006
- Full Text
- View/download PDF
5. The "Big Dog" effect: variability assessing the causes of error in diagnoses of patients with lung cancer.
- Author
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Raab SS, Meier FA, Zarbo RJ, Jensen DC, Geisinger KR, Booth CN, Krishnamurti U, Stone CH, Janosky JE, and Grzybicki DM
- Subjects
- Bronchi cytology, False Negative Reactions, Humans, Lung Neoplasms pathology, Observer Variation, Diagnostic Errors, Lung pathology, Lung Neoplasms diagnosis
- Abstract
Purpose: The frequency of diagnostic error in patients who have a lung mass and a pathology specimen is as high as 15%. This study examined the role of inter-pathologist agreement in identifying the cause of error in these patients., Methods: Pathologists from six institutions reviewed the slides of 40 patients who had a pulmonary specimen false-negative diagnosis. The initial assessment of error cause arose from cytologic-histologic correlation slide review of discrepant diagnostic samples in patients who had both a bronchial brushing cytologic and surgical specimen. The cause of error was attributed either to clinical sampling (diagnostic material obtained in one but not the other sample) or interpretation (pathologist failed to identify the salient diagnostic features). The pairwise kappa (kappa) statistic was used to calculate interobserver agreement between the review and original diagnoses and between the separate review diagnoses., Results: The pairwise kappa statistic ranged widely from -0.154 to 1.0, and the pairwise kappa statistic of the slides from one institution was undetermined because that institutional pathologist never made the assessment that error was secondary to interpretation. Agreement for observers within the same institution was better than agreement between observers from different institutions., Conclusion: Pathologists exhibit poor agreement in determining the cause of error for pulmonary specimens sent for cancer diagnosis. We developed a psychosocial hypothesis (the "Big Dog" Effect) that partially explains biases in error assessment. This lack of agreement precludes confident targeting of these errors for quality improvement interventions with prospects of success across a variety of institutions.
- Published
- 2006
- Full Text
- View/download PDF
6. Clinical impact and frequency of anatomic pathology errors in cancer diagnoses.
- Author
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Raab SS, Grzybicki DM, Janosky JE, Zarbo RJ, Meier FA, Jensen C, and Geyer SJ
- Subjects
- Female, Humans, Male, Observer Variation, Diagnostic Errors statistics & numerical data, Neoplasms diagnosis, Pathology, Surgical standards, Quality Assurance, Health Care
- Abstract
Background: To the authors' knowledge, the frequency and clinical impact of errors in the anatomic pathology diagnosis of cancer have been poorly characterized to date., Methods: The authors examined errors in patients who underwent anatomic pathology tests to determine the presence or absence of cancer or precancerous lesions in four hospitals. They analyzed 1 year of retrospective errors detected through a standardized cytologic-histologic correlation process (in which patient same-site cytologic and histologic specimens were compared). Medical record reviews were performed to determine patient outcomes. The authors also measured the institutional frequency, cause (i.e., pathologist interpretation or sampling), and clinical impact of diagnostic cancer errors., Results: The frequency of errors in cancer diagnosis was found to be dependent on the institution (P < 0.001) and ranged from 1.79-9.42% and from 4.87-11.8% of all correlated gynecologic and nongynecologic cases, respectively. A statistically significant association was found between institution and error cause (P < 0.001); the cause of errors resulting from pathologic misinterpretation ranged from 5.0-50.7% (the remainder were due to clinical sampling). A statistically significant association was found between institution and assignment of the clinical impact of error (P < 0.001); the aggregated data demonstrated that for gynecologic and nongynecologic errors, 45% and 39%, respectively, were associated with harm. The pairwise kappa statistic for interobserver agreement on cause of error ranged from 0.118-0.737., Conclusions: Errors in cancer diagnosis are reported to occur in up to 11.8% of all reviewed cytologic-histologic specimen pairs. To the authors' knowledge, little agreement exists regarding whether pathology errors are secondary to misinterpretation or poor clinical sampling of tissues and whether pathology errors result in serious harm., (Copyright 2005 American Cancer Society)
- Published
- 2005
- Full Text
- View/download PDF
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