Stephen S Raab

..To the authors' knowledge, the frequency and clinical impact of errors in the anatomic pathology diagnosis of cancer have been poorly characterized to date...

..The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety...

..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...

..The effectiveness of the long-term monitoring of errors detected by frozen section-permanent section correlation is unknown...

..The use of Papanicolaou (Pap) test cytologic-histologic correlation in quality improvement activities is not well studied...

..At a national meeting in November 2003, root cause analysis was performed to determine causes of errors. The findings of these root cause analyses have been presented at national pathology meetings and are currently being published...

..To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices...

..quot; Few of those analyses have addressed the impact of diagnostic disagreement on patient care; in addition, proposed and effective methods to reduce interpretative variability have only rarely been included...

..Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety...

..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...

..The utility of anatomic pathology discrepancies has not been rigorously studied...

..Most discrepancies resulted from pathologists diagnosing noninterpretable samples. Pathologists who used the No-Blame Box showed significant agreement in the adjudication of discrepancy cause...

..001). Toyota process change led to significantly fewer diagnostic errors for patients who underwent thyroid fine-needle aspiration...

..We conclude that double viewing detects errors in up to 1 of every 37 cases and that biases in the double-viewing process limit error detection...

..Cytohistologic correlation is a useful tool to monitor performance and to identify specimen types prone to error...

..Development of these electronic data abstraction capabilities is critical for efforts to improve patient safety through the examination of pathology diagnostic errors...

..Within the me laboratory, interobserver variability exists in the proportions of HPV positivity for ASCUS and ASC-H interpretations...

..We currently are evaluating the effectiveness of error reduction initiatives that target pre-analytic and analytic portions of the diagnostic pathway...

....

..Surgical pathology examination, including core biopsies of unsatisfactory or suspicious lesions, can further improve the diagnostic yield...

..A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces...

..In conclusion, the use of performing TP and frozen section are complementary and result in increased diagnostic accuracy. For some pathologists, TPs may replace frozen sections in over 50% of cases...

..3 and CD-15, and vimentin may be needed to separate malignant meningioma from metastatic carcinoma. Cytokeratin expression can be a potential pitfall for confusing a malignant meningioma with a metastatic carcinoma...

....

....

....

..36%) and 12 (3.2%), respectively (P < .001). Focused review detects a higher proportion of errors and may be more effectively used for design of error reduction initiatives...

..Misidentified laboratory specimens may cause patient injury, but their frequency in general laboratory practice is unknown...

..5 and 8.7, respectively. CONCLUSIONS: Laboratories record data from the cytologic-histologic correlation process in a number of ways, indicating the lack of standardization of the data collection process...

..Our results support the high degree of diagnostic accuracy of cytology for the diagnosis of Barrett's-associated HGD and/or carcinoma, and moderate sensitivity for BE...

..To evaluate cytologic criteria for separating atypical glandular cells of undetermined significance favor endometrial origin (AGUS-EM), on Papanicolaou-stained (Pap) smears into favor benign and favor malignant categories...

..They aim to highlight the areas where pathology informatics in all of its flavors (production systems provided by vendors as well as research and development efforts) can play a role in promoting patient safety...

..9%) was similar to that for a downgraded ASCUS (11.0%) or AGUS (7.3%). The parameters of downgraded ASCU and AGUS Pap test interpretations are good quality indicators of individual performance and overall laboratory quality...

..Use of a variety of nonphysician personnel for surgical pathology gross examination is generally known to be increasing, although detailed information regarding nonphysician use is currently unavailable...

..However, the current protocols result in potentially reducible errors that lead to unnecessary testing and diagnostic delays...

..Sampling issues had a major role in the misdiagnosis in 31 cases (97%), and recommendations for error reduction include immediate interpretation and the use of transmucosal fine-needle aspiration...

..To measure the economic benefit of a family/general medicine physician assistant (PA) practice...

..The Association of Directors of Anatomic and Surgical Pathology (ADASP) has developed recommendations for the surgical pathology report for primary and metastatic epithelial tumors in the liver. These recommendations are reported herein...

..Pap screening in developing countries is an ethical imperative without a substantial political constituency and will benefit from the engagement of organized cytology...

....

....

..We believe our process is a fundamental step in improving CT performance in Nongynecologic cytopathology and keeps the CT informed of complexities of nongynecologic cytopathology...

..The level and the effect of the standardisation of resident trainee gross tissue examination practices have not been extensively evaluated...

....

..2) R-10% and RPS quality assurance methods detect diagnostic failures caused by different types of cognitive errors...

..Anatomic pathology discrepancy frequencies have not been rigorously studied...

....

..These data indicate that liquid-based and conventional Pap tests are undervalued and that cost-effectiveness studies generally have not taken into account the preference of women for new Pap test technologies...

..Few data currently are available to support an optimal reporting method...

..The worst outcome was seen in patients who expressed both p53 and HER-2/neu, suggesting that these patients might benefit from additional adjuvant therapy...

..ThinPrep provides well preserved, cleaner specimens without significantly altering the morphology. The three key criteria applied in cytospin specimens to diagnose LGUC were reproducible in ThinPrep specimens...

..Considerable opportunity costs, borne by the underserved, are associated with prioritizing research of novel interventions in developing countries when satisfactory interventions already exist...

..Measuring variation in clinician test ordering behavior for patients with similar indications is an important focus for quality management and cost containment...

..http://thyroidfna.cancer.gov/pages/info/agenda/)..

..In particular, the value of double-reading, case conferences, and consultations (the traditional triad of error control in anatomic pathology) awaits objective assessment...

..Geographic and temporal variation in cervical cancer rates among Vietnamese women was associated with the movement of soldiers. These findings may be useful for cervical cancer prevention efforts in Vietnam and in other countries...

..Conference review revealed 40% to 80% of misinterpretations. This taxonomy produced excellent reproducibility and good agreement across institutions...

..We assessed strategies for decreasing the occurrence of these uncommon and yet potentially catastrophic events...

..Opportunity costs, borne by the underserved, are associated with prioritizing research on new approaches in any setting where established preventives are feasible but unavailable...