169 results on '"John A. Kaufman"'
Search Results
2. Analysis of Costs and Payments for Inferior Vena Cava Filter Retrieval in the Medicare Population
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Jay Giri, Younes Jahangiri, Michael R. Jaff, John A. Kaufman, Ido Weinberg, and Timothy C. Huber
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medicine.medical_specialty ,Vena Cava Filters ,media_common.quotation_subject ,Ivc filter ,Inferior vena cava filter ,Vena Cava, Inferior ,Medicare ,Inferior vena cava ,Margin (machine learning) ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Device Removal ,Reimbursement ,Aged ,Retrospective Studies ,media_common ,business.industry ,Payment ,United States ,Surgery ,Pooled variance ,medicine.vein ,Medicare population ,Cardiology and Cardiovascular Medicine ,business - Abstract
Over the past decade, inferior vena cava (IVC) filter retrieval has been increasing, in part due to Food and Drug Administration recommendations and legal pressure. The costs and margin of IVC filter removal are poorly understood. Medicare claims data from 2016 for the 103 highest volume centers for IVC filter retrieval were examined. Pooled mean charges, costs, payments, and margin were calculated by institution. Mean ± SD charges, costs, and payments were $14,138.00 ± $8,400.48, $3,693.28 ± $2,294.27, and $1,949.82 ± $702.91, respectively. Average (range) margin was -$1,706.18 (-$7,509.93 to $362.77). The margin was negative in 99 of the 103 (96%) institutions evaluated. The most significant contributors to the total procedure cost were operating room, supplies, and recovery (44.5%, 23.5%, and 10.4%, respectively). While IVC filter retrieval is often medically indicated, it is typically associated with a financial loss under current reimbursement structure.
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- 2021
3. Birth outcomes associated with paternal polybrominated and polychlorinated biphenyl exposure
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Lawrence S. Redmond, John A. Kaufman, Metrecia L. Terrell, Melanie A. Pearson, Hillary Barton, Martha Scott Tomlinson, and Michele Marcus
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Male ,Polybrominated Biphenyls ,Infant, Newborn ,Infant ,Biochemistry ,Polychlorinated Biphenyls ,Fathers ,Semen ,Birth Weight ,Humans ,Premature Birth ,Environmental Pollutants ,Female ,Child ,General Environmental Science - Abstract
In 1973-74, a polybrominated biphenyl (PBB) flame retardant mixture was shipped to Michigan livestock feed mills in place of a nutritional supplement and contaminated the food supply. Following the accident, the Michigan PBB Registry was established to study the long-term health effects of halogenated compounds and is now led by a community-academic partnership. PBB exposure is associated with altered DNA methylation in sperm, which may lead to adverse birth outcomes in children whose fathers have increased levels of serum PBB or polychlorinated biphenyl (PCB). Paternal PBB and PCB levels of men enrolled in the Michigan PBB Registry (n = 155) were analyzed against matched offspring birthweight and gestational age (n = 336). Birthweight and gestational age were dichotomized at the 25th percentile and 37 weeks, respectively, and paternal PBB and PCB levels were examined as continuous measures and divided into tertiles. Associations of offspring birthweight and gestational age with paternal PBB and PCB serum concentrations were modeled using multivariable linear spline and log-risk regression, adjusting for family clustering, paternal health and lifestyle factors, maternal PBB, and PCB serum concentrations, sex, and offspring gestational age (for birthweight). Fathers in the middle and upper PBB and PCB tertiles had increased risks for lowest quartile birthweight compared to the first tertile, with adjusted risk ratios (aRR) = 1.67 (95% CI: 0.93, 2.99) and aRR = 2.06 (95% CI: 1.12, 3.79) for PBB, and aRR = 1.47 (95% CI: 0.79, 2.75) and aRR = 1.34 (95% CI: 0.70, 2.54) for PCB, respectively. Elevated paternal PBB levels were not associated with an increased risk for preterm birth, while PCB levels were associated with a small, but not significant, decrease in gestational age, β = -0.37 (95% CI: -0.76, 0.03) weeks per log unit increase PCB. The findings suggest that increased paternal PBB and PCB levels negatively impact offspring birthweight, and paternal PCB levels may negatively impact gestational age.
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- 2022
4. Antithrombotic Therapy After Venous Interventions
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Sirish, Kishore, Minhaj S, Khaja, Bartley, Thornburg, Aditya M, Sharma, M-Grace, Knuttinen, Fadi, Shamoun, Simon, Mantha, Kush R, Desai, Akhilesh K, Sista, Stephen A, Black, Gerard J, O'Sullivan, John A, Kaufman, Lawrence V, Hofmann, and Ronald S, Winokur
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Venous Thrombosis ,Treatment Outcome ,Fibrinolytic Agents ,Humans ,Stents ,Vascular Diseases ,Iliac Vein ,Vascular Patency ,Retrospective Studies - Abstract
Interventions for thrombotic and nonthrombotic venous disorders have increased with technical advances and more trained venous specialists. Antithrombotic therapy is essential to clinical and procedural success; however, postprocedural therapeutic regimens exhibit significant heterogeneity due to limited prospective randomized data and incomplete mechanistic understanding of the critical factors driving long-term patency. Postinterventional antithrombotic therapy for thrombotic venous disorders should adhere to existing venous thromboembolism management guidelines, which include 3-6 months of therapeutic anticoagulation at minimum and consideration of extended therapy in patients with higher risk of thrombosis because of procedural or patient factors. The added benefit of antiplatelet agents in the acute and intermediate period is unknown, having shown improved long-term stent patency in some retrospective studies. Dual- and/or triple-agent therapy should be limited based on individual risks of thrombosis and bleeding. The treatment of nonthrombotic disorders is more heterogeneous, though patients with limited flow, extensive stent material, or underlying prothrombotic states such as malignancy or chronic inflammation may benefit from single-agent or multiagent antithrombotic therapy. However, the agent, dose, and duration of therapy remain indeterminate. Future prospective studies are warranted to improve patient risk stratification and standardize postprocedural anti-thrombotic therapy in patients receiving venous interventions.
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- 2022
5. Locoregional Challenges for Interventional Radiology Practice: USA
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John A, Kaufman
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Geography ,Humans ,Radiology, Interventional - Published
- 2022
6. Classification System for Inferior Vena Cava (IVC) Appearance Following Percutaneous IVC Filter Retrieval
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Ningcheng Li, Roberto Galuppo, Maxwell Cretcher, Dennis Barbon, Cameron Loudill, Dominik Prosser, Greg Rufener, Mckinna Tillotson, Joseph O’Sullivan, Ramsey Al-Hakim, Khashayar Farsad, Younes Jahangiri, and John A. Kaufman
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Vena Cava Filters ,Humans ,Reproducibility of Results ,Radiology, Nuclear Medicine and imaging ,Vena Cava, Inferior ,Cardiology and Cardiovascular Medicine ,Device Removal ,Retrospective Studies - Abstract
There is no classification system for describing inferior vena cava (IVC) injuries. The objective of this study was to develop a standardized grading system for venographic appearance of the IVC following percutaneous IVC filter retrieval.A classification system for the appearance of the IVC on cavograms following percutaneous IVC filter removal was developed consisting of two grading elements; luminal characteristics and extravasation. Luminal narrowing from 0% up to 50% from any cause is grade 1; narrowing between 50 and 99% is grade 2; occlusion is grade 3; and avulsion is grade 4. Absence of extravasation is grade A, contained extravasation is grade B, and free extravasation is grade C. This system was then applied retrospectively to pre- and post-IVC filter retrieval cavograms performed at a single institution from October 2004 through February 2019.546 retrieval attempts were identified with 509 (93.2%) filters successfully retrieved. 449 cases (88.2%) had both pre-retrieval and post-retrieval imaging appropriate for application of the proposed classification system. Inter-rater reliability was 0.972 for luminal characteristics, 0.967 for extravasation, and 0.969 overall. Consensus grading demonstrated a distribution of 97.3% grade 1, 1.3% grade 2, 1.3% grade 3, and 0.0% grade 4 for post-retrieval luminal characteristics. For extravasation classification, 96.4% of the cases were classified as grade A, 2.7% grade B, and 0.9% grade C.A classification system was developed for describing IVC appearance after IVC filter retrieval, and retrospectively validated using a single center dataset.
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- 2022
7. Transjugular Intrahepatic Portosystemic Shunt Creation Using a Radiofrequency Wire: Prospective Clinical Safety and Feasibility Trial in Cirrhosis
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Lori Russell, Khashayar Farsad, Evan Narasimhan, and John A. Kaufman
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,Catheters ,Time Factors ,Cirrhosis ,medicine.medical_treatment ,Operative Time ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Liver disease ,Postoperative Complications ,0302 clinical medicine ,Primary biliary cirrhosis ,medicine ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Ultrasonography, Interventional ,Aged ,Radiofrequency Ablation ,medicine.diagnostic_test ,business.industry ,Stent ,Middle Aged ,medicine.disease ,Surgery ,Catheter ,Treatment Outcome ,030220 oncology & carcinogenesis ,Feasibility Studies ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,Portosystemic shunt ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Purpose To assess the safety and feasibility of using a radiofrequency (RF) wire for portosystemic shunt creation. Materials and Methods Ten patients undergoing elective creation of a transjugular intrahepatic portosystemic shunt (TIPS) or a direct intrahepatic portosystemic shunt (DIPS) were prospectively enrolled. Primary outcomes were the safety and feasibility of RF wire used for the creation of TIPS and DIPS. Median age was 66.5 ± 6.1 years. Causes of liver disease included alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), hepatitis C virus (n = 1), primary biliary cirrhosis (n = 1), autoimmune hepatitis (n = 1). The median score for model for end-stage liver disease was 11 ± 4.3. The Rosch-Uchida TIPS set was used with intravascular ultrasonography guidance in all cases. A 0.035-inch RF wire was used in lieu of the trocar needle through the 5-F TIPS set catheter to create a track between the hepatic vein and the portal vein. All shunts were created using stent grafts. Results Technical success rate was 100%. In 7 of 10 patients, portal vein access was achieved with a single pass. A DIPS was created in 2 patients based on anatomic favorability. Median fluoroscopy time was 13.3 ± 3.8 min, and median total procedure time was 102 ± 19 min. The wire passed through parenchyma without subjective deflection. There was 1 case of extracapsular puncture with no clinical consequence. The RF wire was too stiff to curve into the main portal vein, requiring wire exchange in all but 1 case. Mean portosystemic gradient decreased from 13.9 ± 3.3 to 5.9 ± 2.1 mm Hg. No immediate complications were encountered. Shunt patency was 100% at 30 days. Conclusions Creation of TIPS and DIPS using an RF wire was safe and feasible, enabling creation of an intrahepatic track without subjective deflection in cirrhotic patients.
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- 2020
8. Effectiveness of Transarterial Embolization in Treatment of Symptomatic Hepatic Hemangiomas: Systematic Review and Meta-analysis
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Younes Jahangiri, J. Li, Pooya Torkian, and John A. Kaufman
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medicine.medical_specialty ,medicine.medical_treatment ,Bleomycin ,030218 nuclear medicine & medical imaging ,Hemangioma ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Pingyangmycin ,business.industry ,Incidence (epidemiology) ,Liver Neoplasms ,medicine.disease ,Embolization, Therapeutic ,Confidence interval ,Treatment Outcome ,chemistry ,Meta-analysis ,Lipiodol ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
To evaluate the current evidence for the effectiveness of transarterial embolization (TAE) in treatment of symptomatic hepatic hemangiomas. A systematic literature review was conducted in PubMed, CINAHL and Scopus databases to identify studies of hepatic hemangiomas treated with transarterial embolization. Main outcome was defined as the mean difference between pre- and post-TAE hemangioma diameters. Treatment agents were categorized as Lipiodol based [bleomycin (L + BE), pingyangmycin (L + PYG) or ethanol (L + ethanol)] and non-Lipiodol based (polyvinyl-alcohol-only). Conventional random-effect meta-analysis technique was applied to analyze data. Of 3080 initially inspected publications, 21 studies were included in the meta-analysis comprising of 1450 patients with total of 1871 hemangiomas (36.2% male, mean age: 46.3 ± 3.6 years). One hundred and twenty-six, 1666, 41 and 38 lesions were treated with L + BE, L + PYG, L + ethanol and PVA, respectively. Median follow-up time after embolization was 12 months. Lipiodol-based treatments showed significant effect in reducing hemangioma size after TAE compared to PVA (P
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- 2020
9. Prevalence of Musculoskeletal Symptoms in Interventional Radiologists
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John A. Kaufman, Albert Jiao, Younes Jahangiri, Sean Robinson, and James J. Morrison
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Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Demographics ,MEDLINE ,Radiography, Interventional ,Occupational safety and health ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Radiologists ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Musculoskeletal Diseases ,Occupational Health ,Response rate (survey) ,business.industry ,Mean age ,Middle Aged ,Health Surveys ,Occupational Diseases ,Job Description ,030220 oncology & carcinogenesis ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Purpose To investigate the prevalence of musculoskeletal symptoms, defined as aches, pains, discomfort, or numbness, by using a validated assessment tool among interventional radiologists. Materials and Methods A Web-based survey using the Nordic Musculoskeletal Questionnaire was disseminated to interventional radiologist members by email in November 2015. Musculoskeletal symptoms were evaluated in 9 body areas. Information regarding participant demographics, practice details, use of radio-protective equipment, and exercise routines was also gathered. Univariate and multivariate analyses were performed to determine risk factors associated with more severe symptoms. Results Of 4,096 SIR members at the time of the survey, 640 completed the questionnaire in its entirety (16% response rate). Respondents consisted of 69 females (11%) and 571 males (89%), with a mean age of 47.5 ± 10.2 years old, a mean body mass index of 25.5 ± 3.9 kg/m2, and a mean practice length of 17.1 ± 9.8 years. Prevalence of musculoskeletal symptoms was 88% in the 12 months preceding the survey. For those reporting musculoskeletal issues, 58% attributed the symptoms to work-related activities. Lower back (61%), neck (56%), and shoulder complaints (46%) were the most common. Symptoms prevented 21.2% of respondents from being able to work over the same time period. Multivariate analysis identified female gender, above-normal body mass index, and a practice length of 10 years or more as factors associated with a higher risk of moderate-to-severe symptoms. Conclusions Musculoskeletal symptoms are prevalent among interventional radiologists, the majority of which are attributed to work-related causes.
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- 2020
10. Management of Phlegmasia Cerulea Dolens with Percutaneous Mechanical Thrombectomy
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John A. Kaufman, Ramsey Al-Hakim, Alexander Boscanin, and David D. Prosser
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medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Embolectomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,High severity ,Thrombectomy ,Phlegmasia cerulea dolens ,Leg ,Ultrasonography, Doppler, Duplex ,business.industry ,Middle Aged ,Thrombophlebitis ,medicine.disease ,Alternative treatment ,Surgery ,Mechanical thrombectomy ,Pedal pulses ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Advanced cases of phlegmasia cerulea dolens (PCD) with absent pedal pulses, sensory/motor deficits, and/or venous gangrene likely require more rapid restoration of flow compared to cases without these factors to prevent progression and associated morbidity/mortality. We present a case of PCD with absent pedal pulses and sensory deficit managed successfully with emergent percutaneous mechanical thrombectomy using Inari ClotTriever (Inari Medical, Irvine, CA) with immediate clinical resolution, including restoration of pedal pulses ~ 45 min after thrombectomy. Percutaneous mechanical thrombectomy with the ClotTriever device has the ability to immediately restore venous flow reversing the pathophysiology of PCD in a short time period similar to surgical embolectomy and may be an alternative treatment strategy in patients with phlegmasia cerulea dolens of high severity.
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- 2020
11. Diagnostic Water-Soluble Contrast CT Lymphangiogram on Conventional CT Scanner with Local Anesthetic for Therapeutic Planning
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Ningcheng, Li, Alex, Dabrowiecki, Brett C, Sheppard, and John A, Kaufman
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Contrast Media ,Humans ,Lymphography ,Water ,Anesthetics, Local ,Tomography, X-Ray Computed - Published
- 2021
12. Determinants of oil-spill cleanup participation following the Deepwater Horizon oil spill
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Zachary E. Goldman, Matthew O. Gribble, John A. Kaufman, Amy Wolkin, and J. Danielle Sharpe
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Adult ,Male ,medicine.medical_specialty ,010501 environmental sciences ,01 natural sciences ,Biochemistry ,Article ,Odds ,Environmental hazard ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,medicine ,Humans ,Petroleum Pollution ,030212 general & internal medicine ,Environmental Restoration and Remediation ,Aged ,0105 earth and related environmental sciences ,General Environmental Science ,Aged, 80 and over ,Estimation ,Gulf of Mexico ,Emergency management ,business.industry ,Public health ,Odds ratio ,Louisiana ,humanities ,Geography ,Deepwater horizon ,Oil spill ,Alabama ,Florida ,Female ,business - Abstract
Background On April 20, 2010, the Deepwater Horizon oil rig exploded, spilling over 4.9 million barrels of oil in the Gulf of Mexico over an 87-day period and developing into a long-term environmental disaster that affected people living in Gulf Coast states. Engagement of community members in recovery efforts is important for mitigating adverse effects of disasters and accelerating the rebuilding process for impacted communities; however, few studies have explored factors that determine participation in oil spill cleanups. Methods We analyzed data from the Gulf States Population Survey (GSPS) to study the determinants of participating in the Deepwater Horizon Oil Spill cleanup. The GSPS was a random-digit dialing survey conducted on 38,361 adults in counties and parishes in Alabama, Florida, Louisiana, and Mississippi impacted by the oil spill. Using survey estimation to account for the complex survey design, we estimated the probability of cleanup participation and used logistic regression to examine the association between sociodemographic factors and cleanup participation. Results Approximately 4.7% of residents in affected Gulf communities participated in the cleanup. Most participants were young, men, non-Hispanic white, and employed. Living in an affected coastal county was associated with higher odds of participation (unadjusted odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28–2.24), as was having excellent or very good physical health (OR: 2.05; 95% CI: 1.11–3.81). Older persons were less likely to participate in the cleanup (OR for 65+ age group vs. 18–24 age group: 0.14; 95% CI: 0.05–0.36). Conclusions Understanding the demographics of cleanup participants may help inform civilian recruitment for future oil spill responses.
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- 2019
13. Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet: A Policy Statement From the American Heart Association
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Sue Duval, Aruna D. Pradhan, Philip P. Goodney, Shipra Arya, Mark A. Creager, Laurie P. Whitsel, Kunihiro Matsushita, J. Antonio Gutierrez, Joshua A. Beckman, Amy W. Pollak, John A. Kaufman, and Karen E. Joynt Maddox
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Chronic Limb-Threatening Ischemia ,Male ,medicine.medical_specialty ,Time Factors ,Arterial disease ,Statement (logic) ,medicine.medical_treatment ,Disease ,030204 cardiovascular system & hematology ,Amputation, Surgical ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,medicine ,Humans ,030212 general & internal medicine ,Aged ,business.industry ,Public health ,General surgery ,American Heart Association ,United States ,Medical expenditure ,Policy ,Treatment Outcome ,Lower Extremity ,Amputation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Nontraumatic lower-extremity amputation is a devastating complication of peripheral artery disease (PAD) with a high mortality and medical expenditure. There are ≈150 000 nontraumatic leg amputations every year in the United States, and most cases occur in patients with diabetes. Among patients with diabetes, after an ≈40% decline between 2000 and 2009, the amputation rate increased by 50% from 2009 to 2015. A number of evidence-based diagnostic and therapeutic approaches for PAD can reduce amputation risk. However, their implementation and adherence are suboptimal. Some racial/ethnic groups have an elevated risk of PAD but less access to high-quality vascular care, leading to increased rates of amputation. To stop, and indeed reverse, the increasing trends of amputation, actionable policies that will reduce the incidence of critical limb ischemia and enhance delivery of optimal care are needed. This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation. Among the actions recommended are improving public awareness of PAD and greater use of effective PAD management strategies (eg, smoking cessation, use of statins, and foot monitoring/care in patients with diabetes). To facilitate the implementation of these recommendations, we propose several regulatory/legislative and organizational/institutional policies such as adoption of quality measures for PAD care; affordable prevention, diagnosis, and management; regulation of tobacco products; clinical decision support for PAD care; professional education; and dedicated funding opportunities to support PAD research. If these recommendations and proposed policies are implemented, we should be able to achieve the goal of reducing the rate of nontraumatic lower-extremity amputations by 20% by 2030.
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- 2021
14. Defining the Value of Interventional Radiology to Healthcare Stakeholders: Proceedings from a Society of Interventional Radiology Research Consensus Panel
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Frank Dubeck, Sarah B. White, C. Matthew Hawkins, Richard Duszak, Jeremy C. Durack, Mark B. Canada, David A. Kooby, Andrew Resnick, Katharine L. Krol, Raymond W. Liu, Danny R. Hughes, and John A. Kaufman
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Value (ethics) ,Medical education ,Consensus ,medicine.diagnostic_test ,business.industry ,Specialty ,MEDLINE ,Interventional radiology ,Research needs ,Radiology, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Health care ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Delivery of Health Care ,Strengths and weaknesses - Abstract
Interventional radiology (IR) has collectively struggled to articulate and prove its value to several external stakeholders. The goal of this research consensus panel was to provide a summary of the existing knowledge, identify current gaps in knowledge, identify the strengths and weaknesses in existing data, and prioritize research needs related to the value of IR. Panelists were asked to identify the critical relationships/alliances that should be fostered to advance the prioritized research and determine how the Society of Interventional Radiology and the Society of Interventional Radiology Foundation can further support these initiatives. Following presentations and discussions, it was determined that proving and quantifying how IR decreases the length of stay and prevents hospital admissions are the most salient, value-related research topics to pursue for the specialty.
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- 2020
15. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine
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John A, Kaufman, Geoffrey D, Barnes, Rabih A, Chaer, Joseph, Cuschieri, Robert T, Eberhardt, Matthew S, Johnson, William T, Kuo, Susan, Murin, Sheena, Patel, Anita, Rajasekhar, Ido, Weinberg, and David L, Gillespie
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Prosthesis Implantation ,Consensus ,Treatment Outcome ,Vena Cava Filters ,Risk Factors ,Humans ,Patient Safety ,Venous Thromboembolism ,Radiology, Interventional ,Prosthesis Design - Abstract
To provide evidence-based recommendations on the use of inferior vena cava (IVC) filters in the treatment of patients with or at substantial risk of venous thromboembolic disease.A multidisciplinary expert panel developed key questions to address in the guideline, and a systematic review of the literature was conducted. Evidence was graded based on a standard methodology, which was used to inform the development of recommendations.The systematic review identified a total of 34 studies that provided the evidence base for the guideline. The expert panel agreed on 18 recommendations.Although the evidence on the use of IVC filters in patients with or at risk of venous thromboembolic disease varies in strength and quality, the panel provides recommendations for the use of IVC filters in a variety of clinical scenarios. Additional research is needed to optimize care for this patient population.
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- 2020
16. Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions
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Ningcheng Li, John A. Kaufman, James C. Anderson, Khashayar Farsad, Aly Aly Elbarbary, A. Gabr, and Ryan C. Schenning
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medicine.medical_specialty ,Canada ,Quality management ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Radiology, Interventional ,Article ,030218 nuclear medicine & medical imaging ,Education ,03 medical and health sciences ,Virtual training ,Betacoronavirus ,0302 clinical medicine ,COVID-19 Testing ,Artificial Intelligence ,Pandemic ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Pandemics ,Neuroradiology ,COVID ,Case volume ,medicine.diagnostic_test ,IR/DR Residency ,business.industry ,Clinical Laboratory Techniques ,SARS-CoV-2 ,COVID-19 ,Internship and Residency ,Interventional radiology ,Quality Improvement ,Test (assessment) ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Female ,Augment ,business ,Coronavirus Infections - Abstract
Rationale and Objectives To assess the immediate impact of the COVID-19 pandemic on Diagnostic and Interventional Radiology education, and to propose measures to preserve and augment trainee education during future crises. Materials and Methods Diagnostic Radiology (DR) studies and Interventional Radiology (IR) procedures at a single tertiary-care teaching institution between 2015 and 2020 were reviewed. DR was divided by section: body, cardiothoracic, musculoskeletal (MSK), neuroradiology, nuclear medicine, pediatrics, and women's imaging. IR was divided by procedural types: arterial, venous, lymphatic, core, neuro, pediatrics, dialysis, cancer embolization or ablation, noncancer embolization, portal hypertension, and miscellaneous. Impact on didactic education was also assessed. ANOVA, t test, and multiple comparison correction were used for analysis. Results DR and IR caseloads decreased significantly in April 2020 compared to April of the prior 5 years (both p < 0.0001). Case volumes were reduced in body (49.2%, p < 0.01), MSK (54.2%, p < 0.05), neuro (39.3%, p < 0.05), and women's imaging (75.5%, p < 0.05) in DR, and in arterial (62.6%, p < 0.01), neuro IR (57.6%, p < 0.01) and core IR (42.6%, p < 0.05) in IR. IR trainee average caseload in April 2020 decreased 51.9% compared to April of the prior 5 years (p < 0.01). Utilization of online learning increased in April. Trainees saw significant increases in overall DR didactics (31.3%, p = 0.02) and no reduction in IR didactics, all online. Twelve major national and international DR and IR meetings were canceled or postponed between March and July. Conclusion Decreases in caseload and widespread cancellation of conferences have had significant impact on DR/IR training during COVID-19 restrictions. Remote learning technologies with annotated case recording, boards-style case reviews, procedural simulation and narrated live cases as well as online lectures and virtual journal clubs increased during this time. Whether remote learning can mitigate lost opportunities from in-person interactions remains uncertain. Optimizing these strategies will be important for potential future restricted learning paradigms and can also be extrapolated to augment trainee education during unrestricted times.
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- 2020
17. Broadening Stakeholder Perspectives on Maintenance of Certification Research
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Toby A. Gordon, John A. Kaufman, and Donald J. Flemming
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Knowledge management ,Certification ,business.industry ,Stakeholder ,General Medicine ,United States ,Maintenance of Certification ,Radiography ,Radiologists ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,business ,Radiology - Published
- 2020
18. Exercise Intolerance in Patients with Chronic Iliocaval Venous Occlusion: Initial Experience with Noninvasive Exercise Testing before and after Intervention
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Jessica Ballin, Ivan P. Dimov, Alex Kanable, Kerry S. Kuehl, and John A. Kaufman
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Male ,medicine.medical_specialty ,Time Factors ,Response to therapy ,Vena Cava, Inferior ,Exercise intolerance ,Iliac Vein ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Oxygen Consumption ,Predictive Value of Tests ,Intervention (counseling) ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Aged ,Retrospective Studies ,Venous Thrombosis ,Exercise Tolerance ,Venous occlusion ,business.industry ,Endovascular Procedures ,VO2 max ,Cardiorespiratory fitness ,Recovery of Function ,Middle Aged ,medicine.disease ,Thrombosis ,Treatment Outcome ,Cardiorespiratory Fitness ,030220 oncology & carcinogenesis ,Chronic Disease ,Cardiology ,Exercise Test ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with chronic iliocaval occlusions after thrombosis often present with exercise intolerance, which improves after venous reconstruction. Three male patients with chronic iliocaval occlusions underwent a cardiorespiratory fitness test before and 2.5-11 months after venous reconstruction using stents. After the intervention, average absolute oxygen consumption increased by 29.5%, maximal oxygen consumption relative to body weight increased by 38.7%, total work at maximum exercise increased by 74.4%, and exercise time increased by 18.7%. The cardiorespiratory fitness test may be a useful noninvasive tool to objectively evaluate exercise intolerance due to chronic venous occlusions and response to therapy.
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- 2020
19. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep vein thrombosis
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Susan R. Kahn, Jim A. Julian, Clive Kearon, Chu-Shu Gu, David J. Cohen, Elizabeth A. Magnuson, Anthony J. Comerota, Samuel Z. Goldhaber, Michael R. Jaff, Mahmood K. Razavi, Andrei L. Kindzelski, Joseph R. Schneider, Paul Kim, Rabih Chaer, Akhilesh K. Sista, Robert B. McLafferty, John A. Kaufman, Brandt C. Wible, Morey Blinder, Suresh Vedantham, Michael Sichlau, Athanasios Vlahos, Steven Smith, Quinn Thalheimer, Nisha Singh, Rekha Harting, John Gocke, Scott Guth, Neel Shah, Paul Brady, Marvin Schatz, Mindy Horrow, Peyman Markazi, Leli Forouzan, Terence A.S. Matalon, David Hertzog, Swapna Goday, Margaret Kennedy, Robert Kaplan, Thomas Campbell, Jamie Hartman, Elmer Nahum, Arvind Venkat, Venkataramu Krishnamurthy, John Rectenwald, Peter Henke, Jonathan Eliason, Jonathon Willatt, Guillermo Escobar, Shaun Samuels, Barry Katzen, James Benenati, Alex Powell, Constantino Pena, Howard Wallach, Ripal Gandhi, Joseph Schneider, Stanley Kim, Farrah Hashemi, Joseph Boyle, Nilesh Patel, Michael Verta, Daniel Leung, Marc Garcia, Phillip Blatt, Jamil Khatri, Dave Epstein, Randall Ryan, Tom Sweeny, Michael Stillabower, George Kimbiris, Tuhina Raman, Paul Sierzenski, Lelia Getto, Michael Dignazio, Mark Horvath, Heather Gornik, John Bartholomew, Mehdi Shishehbor, Frank Peacock, Douglas Joseph, Soo Hyum Kim, Natalia Fendrikova Mahlay, Daniel Clair, Sean Lyden, Baljendra Kapoor, Gordon McLennon, Gregory Pierce, James Newman, James Spain, Amanjiit Gill, Aaron Hamilton, Anthony Rizzo, Woosup Park, Alan Dietzek, Ira Galin, Dahlia Plummer, Richard Hsu, Patrick Broderick, Andrew Keller, Sameer Sayeed, Dennis Slater, Herb Lustberg, Jan Akus, Robert Sidman, Mandeep Dhami, Phillip Kohanski, Anca Bulgaru, Renuka Dulala, James Burch, Dinesh Kapur, Jie Yang, Mark Ranson, Alan Wladis, David Varnagy, Tarek Mekhail, Robert Winter, Manuel Perez-Izquierdo, Stephen Motew, Robin Royd-Kranis, Raymond Workman, Scott Kribbs, Gerald Hogsette, Phillip Moore, Bradley Thomason, William Means, Richard Bonsall, John Stewart, Daniel Golwya, Ezana Azene, Wayne Bottner, William Bishop, Dave Clayton, Lincoln Gundersen, Jody Riherd, Irina Shakhnovich, Kurt Ziegelbein, Thomas Chang, Karun Sharma, Sandra Allison, Fil Banovac, Emil Cohen, Brendan Furlong, Craig Kessler, Mike McCullough, Jim Spies, Judith Lin, Scott Kaatz, Todd Getzen, Joseph Miller, Scott Schwartz, Loay Kabbani, David McVinnie, John Rundback, Joseph Manno, Richard Schwab, Randolph Cole, Kevin Herman, David Singh, Ravit Barkama, Amish Patel, Anthony Comerota, John Pigott, Andrew Seiwert, Ralph Whalen, Todd Russell, Zakaria Assi, Sahira Kazanjian, Jonathan Yobbagy, Brian Kaminski, Allan Kaufman, Garett Begeman, Robert DiSalle, Subash Thakur, Marc Jacquet, Thomas Dykes, Joseph Gerding, Christopher Baker, Mark Debiasto, Derek Mittleider, George Higgins, Steven Amberson, Roger Pezzuti, Thomas Gallagher, Robert Schainfeld, Stephan Wicky, Sanjeeva Kalva, Gregory Walker, Gloria Salazar, Benjamin Pomerantz, Virenda Patel, Christopher Kabrhel, Shams Iqbal, Suvranu Gangull, Rahmi Oklu, Scott Brannan, Sanjay Misra, Haraldur Bjarnason, Aneel Ashrani, Michael Caccavale, Chad Fleming, Jeremy Friese, John Heit, Manju Kalra, Thanila Macedo, Robert McBane, Michael McKusick, Andrew Stockland, David Woodrum, Waldemar Wysokinski, Adarsh Verma, Andrew Davis, Jerry Chung, David Nicker, Brian Anderson, Robert Stein, Michael Weiss, Parag Patel, William Rilling, Sean Tutton, Robert Hieb, Eric Hohenwalter, M. Riccardo Colella, James Gosset, Sarah White, Brian Lewis, Kellie Brown, Peter Rossi, Gary Seabrook, Marcelo Guimaraes, J. Bayne Selby, William McGary, Christopher Hannegan, Jacob Robison, Thomas Brothers, Bruce Elliott, Nitin Garg, M. Bret Anderson, Renan Uflacker, Claudio Schonholz, Laurence Raney, Charles Greenberg, John Kaufman, Frederick Keller, Kenneth Kolbeck, Gregory Landry, Erica Mitchell, Robert Barton, Thomas DeLoughery, Norman Kalbfleisch, Renee Minjarez, Paul Lakin, Timothy Liem, Gregory Moneta, Khashayar Farsad, Ross Fleischman, Loren French, Vasco Marques, Yasir Al−Hassani, Asad Sawar, Frank Taylor, Rajul Patel, Rahul Malhotra, Farah Hashemi, Marvin Padnick, Melissa Gurley, Fred Cucher, Ronald Sterrenberg, G. Reshmaal Deepthi, Gomes Cumaranatunge, Sumit Bhatla, Darick Jacobs, Eric Dolen, Pablo Gamboa, L. Mark Dean, Thomas Davis, John Lippert, Sanjeev Khanna, Brian Schirf, Jeffrey Silber, Donald Wood, J. Kevin McGraw, Lucy LaPerna, Paul Willette, Timothy Murphy, Joselyn Cerezo, Rajoo Dhangana, Sun Ho Ahn, Gregory Dubel, Richard Haas, Bryan Jay, Ethan Prince, Gregory Soares, James Klinger, Robert Lambiase, Gregory Jay, Robert Tubbs, Michael Beland, Chris Hampson, Ryan O'Hara, Chad Thompson, Aaron Frodsham, Fenwick Gardiner, Abdel Jaffan, Lawrence Keating, Abdul Zafar, Radica Alicic, Rodney Raabe, Jayson Brower, David McClellan, Thomas Pellow, Christopher Zylak, Joseph Davis, M. Kathleen Reilly, Kenneth Symington, Camerson Seibold, Ryan Nachreiner, Daniel Murray, Stephen Murray, Sandeep Saha, Gregory Luna, Kim Hodgson, Robert McLafferty, Douglas Hood, Colleen Moore, David Griffen, Darren Hurst, David Lubbers, Daniel Kim, Brent Warren, Jeremy Engel, D.P. Suresh, Eric VanderWoude, Rahul Razdan, Mark Hutchins, Terry Rounsborg, Madhu Midathada, Daniel Moravec, Joni Tilford, Joni Beckman, Mahmood Razavi, Kurt Openshaw, D. Preston Flanigan, Christopher Loh, Howard Dorne, Michael Chan, Jamie Thomas, Justin Psaila, Michael Ringold, Jay Fisher, Any Lipcomb, Timothy Oskin, Brandt Wible, Brendan Coleman, David Elliott, Gary Gaddis, C. Doug Cochran, Kannan Natarajan, Stewart Bick, Jeffrey Cooke, Ann Hedderman, Anne Greist, Lorrie Miller, Brandon Martinez, Vincent Flanders, Mark Underhill, Lawrence Hofmann, Daniel Sze, William Kuo, John Louie, Gloria Hwang, David Hovsepian, Nishita Kothary, Caroline Berube, Donald Schreiber, Brooke Jeffrey, Jonathan Schor, Jonathan Deitch, Kuldeep Singh, Barry Hahn, Brahim Ardolic, Shilip Gupta, Riyaz Bashir, Angara Koneti Rao, Manish Garg, Pravin Patil, Chad Zack, Gary Cohen, Frank Schmieder, Valdimir Lakhter, David Sacks, Robert Guay, Mark Scott, Karekin Cunningham, Adam Sigal, Terrence Cescon, Nick Leasure, Thiruvenkatasamy Dhurairaj, Patrick Muck, Kurt Knochel, Joann Lohr, Jose Barreau, Matthew Recht, Jayapandia Bhaskaran, Ranga Brahmamdam, David Draper, Apurva Mehta, James Maher, Melhem Sharafuddin, Steven Lentz, Andrew Nugent, William Sharp, Timothy Kresowik, Rachel Nicholson, Shiliang Sun, Fadi Youness, Luigi Pascarella, Charles Ray, Martha-Gracia Knuttinen, James Bui, Ron Gaba, Valerie Dobiesz, Ejaz Shamim, Sangeetha Nimmagadda, David Peace, Aarti Zain, Alison Palumto, Ziv Haskal, Jon Mark Hirshon, Howard Richard, Avelino Verceles, Jade Wong-You-Chong, Bertrand Othee, Rahul Patel, Bogdan Iliescu, David Williams, Joseph Gemmete, Wojciech Cwikiel, Kyung Cho, James Schields, Ranjith Vellody, Paula Novelli, Narasimham Dasika, Thomas Wakefield, Jeffrey Desmond, James Froehlich, Minhajuddin Khaja, David Hunter, Jafar Golzarian, Erik Cressman, Yvonne Dotta, Nate Schmiechen, John Marek, David Garcia, Isaac Tawil, Mark Langsfeld, Stephan Moll, Matthew Mauro, Joseph Stavas, Charles Burke, Robert Dixon, Hyeon Yu, Blair Keagy, Kyuny Kim, Raj Kasthuri, Nigel Key, Michael Makaroun, Robert Rhee, Jae−Sung Cho, Donald Baril, Luke Marone, Margaret Hseih, Kristian Feterik, Roy Smith, Geetha Jeyabalan, Jennifer Rogers, Russel Vinik, Dan Kinikini, Larry Kraiss, Michelle Mueller, Robert Pendleton, Matthew Rondina, Mark Sarfati, Nathan Wanner, Stacy Johnson, Christy Hopkins, Daniel Ihnat, John Angle, Alan Matsumoto, Nancy Harthun, Ulku Turba, Wael Saad, Brian Uthlaut, Srikant Nannapaneni, David Ling, Saher Sabri, John Kern, B. Gail Macik, George Hoke, Auh Wahn Park, James Stone, Benjamin Sneed, Scott Syverud, Kelly Davidson, Aditya Sharma, Luke Wilkins, Carl Black, Mark Asay, Daniel Hatch, Robert Smilanich, Craig Patten, S. Douglas Brown, Ryan Nielsen, William Alward, John Collins, Matthew Nokes, Randolph Geary, Matthew Edwards, Christopher Godshall, Pavel Levy, Ronald Winokur, Akhilesh Sista, David Madoff, Kyungmouk Lee, Bradley Pua, Maria DeSancho, Raffaele Milizia, Jing Gao, Gordon McLean, Sanualah Khalid, Larry Lewis, Nael Saad, Mark Thoelke, Robert Pallow, Seth Klein, Gregorio Sicard, Heather L. Gornik, Jim Julian, Stephen Kee, Lawrence Lewis, Elizabeth Magnuson, and Timothy P. Murphy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Mechanical Thrombolysis ,medicine.medical_treatment ,Catheter directed thrombolysis ,030204 cardiovascular system & hematology ,Iliac Vein ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Quality of life ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Internal medicine ,Epidemiology ,Medicine ,Humans ,In patient ,Thrombolytic Therapy ,030212 general & internal medicine ,cardiovascular diseases ,Thrombus ,Venous Thrombosis ,business.industry ,Thrombolysis ,Femoral Vein ,Middle Aged ,medicine.disease ,United States ,humanities ,3. Good health ,Venous thrombosis ,Treatment Outcome ,Quality of Life ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.Of 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P .0001) and 6 months (8.8; P .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.
- Published
- 2020
20. Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting
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Kenneth J. Kolbeck, Keng Wei Liang, Yasufumi Ohuchi, Robert E. Barton, Masahiro Horikawa, Masayuki Endo, John A. Kaufman, Younes Jahangiri, Khashayar Farsad, and Ryan C. Schenning
- Subjects
Adult ,Diagnostic Imaging ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Vena Cava, Inferior ,Iliac Vein ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Occlusion ,Antithrombotic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Vascular Patency ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Venous Thrombosis ,Aspirin ,business.industry ,Warfarin ,Anticoagulants ,Stent ,Middle Aged ,equipment and supplies ,medicine.disease ,Clopidogrel ,Thrombosis ,Surgery ,Stenosis ,surgical procedures, operative ,Drug Therapy, Combination ,Equipment Failure ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
To examine the effectiveness of antithrombotic medications to prevent venous stent malfunction for iliocaval occlusive disease. A retrospective analysis was performed on 62 patients who underwent technically successful endovascular iliocaval stent placement between May 2008 and April 2017. Clinical records were reviewed for demographic information, procedure details, post-stenting antithrombotic prophylaxis and stent patency on follow-up. Stent malfunction was defined as > 50% stenosis or occlusion at follow-up. Risk factors for stent malfunction were assessed with univariable and multiple Cox proportional hazard models. The median follow-up period was 11.6 months (range 0.1–76.4). Overall primary and secondary cumulative patency rates at 12 months were 70.0% and 92.4%, respectively. After stent placement, 97% of patients received anticoagulation with warfarin, enoxaparin or a factor Xa inhibitor. In addition, 61% received antiplatelet prophylaxis with aspirin, clopidogrel or a combination. In multiple Cox regression analysis, post-stenting antiplatelet use remained significantly associated with primary stent patency (HR = 0.28, P = 0.022). After iliocaval venous stenting, stent patency was best predicted by concomitant antiplatelet and anticoagulation therapy rather than anticoagulation alone. This novel finding warrants further research underlying mechanisms leading to venous stent thrombosis, and has implications for optimal medical management after venous stenting.
- Published
- 2018
21. Evaluation and Management of Intermediate and High-Risk Pulmonary Embolism
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Bishoy Zakhary, Ramsey Al-Hakim, Ningcheng Li, John A. Kaufman, Khashayar Farsad, Ryan C. Schenning, Stephanie Nonas, and Brandon C. Maughan
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medicine.medical_specialty ,medicine.medical_treatment ,Embolectomy ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thrombolytic Therapy ,Thrombus ,Evidence-Based Medicine ,business.industry ,Treatment options ,General Medicine ,Thrombolysis ,medicine.disease ,Right ventricular dysfunction ,Pulmonary embolism ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Cardiology ,Systemic anticoagulation ,business ,Pulmonary Embolism ,Hemodynamic instability - Abstract
OBJECTIVE. The evidence regarding pulmonary embolism treatment has greatly advanced over the past 10 years, particularly in patients with right ventricular dysfunction or hemodynamic instability. Treatment options include systemic anticoagulation, systemic thrombolysis, catheter-assisted thrombus removal (mechanical with or without catheter-directed thrombolysis), and surgical embolectomy. CONCLUSION. This article will review the data available for treatment options and summarize the evidence-based guidelines on treatment of intermediate- or high-risk pulmonary embolism.
- Published
- 2019
22. Long-Term Toxicity after Transarterial Radioembolization with Yttrium-90 Using Resin Microspheres for Neuroendocrine Tumor Liver Metastases
- Author
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Ryan C. Schenning, Y. Tomozawa, Younes Jahangiri, Khashayar Farsad, John A. Kaufman, Priya Pathak, and Kenneth J. Kolbeck
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tare weight ,medicine.medical_treatment ,Neuroendocrine tumors ,Radiography, Interventional ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ascites ,medicine ,Humans ,Yttrium Radioisotopes ,Radiology, Nuclear Medicine and imaging ,Embolization ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Microspheres ,Survival Rate ,Neuroendocrine Tumors ,Treatment Outcome ,030220 oncology & carcinogenesis ,Toxicity ,Portal hypertension ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose To evaluate long-term effects of yttrium-90 (90Y) transarterial radioembolization (TARE) for unresectable hepatic metastases of neuroendocrine tumors (NETs). Materials and Methods Retrospective analysis of 93 patients (47 women, 46 men; mean age 59 y) who underwent resin-based 90Y TARE was performed. Variables associated with overall survival were analyzed using univariate and multivariate models. Changes in serologic values and imaging characteristics were assessed with long-term follow-up. Results Unilobar TARE was performed in 48 patients, and staged bilobar TARE was performed in 45 patients. In multivariate analysis, ascites (P = .002) and extrahepatic metastases (P = .038) at baseline were associated with poor survival. Among 52 patients who had > 1 year of follow-up, significant increases in alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were observed; however, only 4 patients experienced grade 3 serologic toxicities. Imaging signs of cirrhosis-like morphology and portal hypertension were observed in 15 of 52 patients, more frequently in patients treated with bilobar TARE compared with unilobar TARE. Patients treated with bilobar TARE exhibited significantly increased hepatobiliary enzymes and decreased platelet count. Sustained increases in liver enzymes were observed in patients with > 4 years of follow-up. No radioembolization-related liver failure or grade 4 toxicity was observed. Conclusions 90Y radioembolization using resin microspheres demonstrated a high safety profile for NET liver metastases, with low-grade, although sustained, long-term liver toxicity evident > 4 years after treatment. Bilobar treatment suggested a trend for treatment-related portal hypertension. Ongoing research will help define parameters for optimizing durable safety and efficacy of radioembolization in this setting.
- Published
- 2018
23. Another Step Toward Rational Application of Inferior Vena Cava Filters
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John A. Kaufman
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Inpatients ,Vena cava filters ,medicine.medical_specialty ,Vena Cava Filters ,business.industry ,Bariatric Surgery ,medicine.disease ,Inferior vena cava ,Pulmonary embolism ,Treatment Outcome ,medicine.vein ,medicine ,Humans ,Radiology ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
24. IR Trainees and Their Value in Academic Medical Centers
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John A. Kaufman
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Academic Medical Centers ,medicine.medical_specialty ,business.industry ,MEDLINE ,Internship and Residency ,Workload ,Radiology, Interventional ,Radiography, Interventional ,Education, Medical, Graduate ,Radiologists ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Cardiology and Cardiovascular Medicine ,business ,Value (mathematics) - Published
- 2021
25. Yttrium-90 Radioembolization for BCLC Stage C Hepatocellular Carcinoma Comparing Child-Pugh A Versus B7 Patients: Are the Outcomes Equivalent?
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Nima Nabavizadeh, Kenneth J. Kolbeck, Susan L. Orloff, Willscott E. Naugler, Adel Kardosh, Younes Jahangiri, Y. Tomozawa, Ramsey Al-Hakim, Kevin G. Billingsley, Dekey Lhewa, John A. Kaufman, Joseph Ahn, Erin Maynard, Ryan C. Schenning, Khashayar Farsad, C. Kristian Enestvedt, Skye C. Mayo, and Qingquan Zu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Brachytherapy ,MEDLINE ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Yttrium Radioisotopes ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Treatment Outcome ,Hepatocellular carcinoma ,Female ,Radiology ,BCLC Stage C Hepatocellular Carcinoma ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate yttrium-90 (Y90) radioembolization outcomes across Child-Pugh scores in patients with advanced hepatocellular carcinoma (HCC).From April 2005 to December 2018, 106 consecutive patients with BCLC Stage C HCC who underwent Y90 radioembolization were retrospectively analyzed. Exclusion criteria included additional malignancy (n = 7), death unrelated to liver disease (n = 2), metastases (n = 2), or lack of follow-up data (n = 4). Ninety-one patients were analyzed. Overall survival (OS) was calculated using the Kaplan-Meier method and compared between groups with the log-rank test. Cox regression modeling was used to evaluate the prognostic factors for survival.Mean age was 63 years and 85.7% were male. HCV infection was the most common etiology of liver disease (58.2%). Sixty-four (70.3%) patients were Child-Pugh A, 19 (20.9%) patients were B7, and eight (8.8%) patients were B8-9. Median OS after radioembolization was 20.2 [95% confidence interval (CI) 13.0-27.4], 6.0 (95% CI 4.4-7.6), and 5.5 (95% CI 2.5-8.5) months for Child-Pugh A, B7, and B8/9 groups, respectively (P 0.001 for B7 vs. A; P = 0.537 for B7 vs. B8/9). The multivariable Cox regression analysis showed that Eastern Cooperative Oncology Group (ECOG) score (P 0.001), Child-Pugh class (P = 0.005), tumor morphology pattern (P = 0.012), and Y90 delivery location (P = 0.020) were significant independent predictors of overall survival.Outcomes from Y90 for BCLC C HCC for Child-Pugh B7 patients were equivalent to B8/9 patients and significantly worse compared to Child-Pugh A patients. Although further research is warranted, these results suggest continued cautious patient selection for radioembolization in advanced HCC.
- Published
- 2019
26. Effects of increased minimum wages by unemployment rate on suicide in the USA
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Leslie Salas-Hernández, Kelli A. Komro, John A. Kaufman, and Melvin D. Livingston
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Adult ,Male ,Epidemiology ,media_common.quotation_subject ,Poison control ,Public Policy ,Suicide prevention ,Treatment and control groups ,03 medical and health sciences ,0302 clinical medicine ,Injury prevention ,Medicine ,Humans ,030212 general & internal medicine ,Minimum wage ,Socioeconomic status ,media_common ,business.industry ,Salaries and Fringe Benefits ,Public Health, Environmental and Occupational Health ,Middle Aged ,Educational attainment ,United States ,030227 psychiatry ,Suicide ,Socioeconomic Factors ,Unemployment ,Income ,Educational Status ,Demographic economics ,Female ,business - Abstract
BackgroundSocial welfare policies such as the minimum wage can affect population health, though the impact may differ by the level of unemployment experienced by society at a given time.MethodsWe ran difference-in-differences models using monthly data from all 50 states and Washington, DC from 1990 to 2015. We used educational attainment to define treatment and control groups. The exposure was the difference between state and federal minimum wage in US$2015, defined both by the date the state law became effective and lagged by 1 year. Models included state and year fixed effects, and additional state-level covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, and estimated predicted suicide counts under different minimum wage scenarios.ResultsThe effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels.ConclusionMinimum wage increases appear to reduce the suicide rate among those with a high school education or less, and may reduce disparities between socioeconomic groups. Effects appear greatest during periods of high unemployment.
- Published
- 2019
27. Early Venous Stent Failure Predicted by Platelet Count and Neutrophil/Lymphocyte Ratio
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Khashayar Farsad, Younes Jahangiri, Ramsey Al-Hakim, Masayuki Endo, and John A. Kaufman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Neutrophils ,medicine.medical_treatment ,Constriction, Pathologic ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Occlusion ,medicine ,Humans ,Platelet ,030212 general & internal medicine ,Platelet activation ,Lymphocyte Count ,Treatment Failure ,Aged ,Proportional Hazards Models ,medicine.diagnostic_test ,business.industry ,Platelet Count ,Stent ,Complete blood count ,Thrombosis ,General Medicine ,Middle Aged ,medicine.disease ,Blood Cell Count ,Stenosis ,Angiography ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
BACKGROUND Inflammation and platelet activation have been shown to be involved in acute thromobogenicity following venous occlusive conditions. The aim of this study was to identify the association of baseline platelet count and neutrophil/lymphocyte ratio (NLR) with venous stent failure. Methods and Results: Patients who underwent technically successful iliocaval venous stent placement with available baseline complete blood count and follow-up stent patency data were selected (n=50). Stent failure was defined as >50% stenosis or occlusion at follow-up angiography, contrast-enhanced CT, MRI or duplex US. Median patient age was 49.5 years (range, 13-76 years), and 62% were female. Median follow-up time was 10.2 months (range, 0.1-76.4 months). Stent failure occurred in 13 patients (26%) after a median of 1.2 months (range, 1 day-76.4 months). On multivariable-adjusted Cox modeling, baseline platelets (HR, 2.28; P=0.004) and WBC count (HR, 2.03; P=0.013) were significantly associated with stent failure on follow-up; neutrophils (HR, 16.10; P=0.050); and NLR (HR, 12.19; P=0.050) had borderline significance. Compared with patients without stent failure, those with early, but not late, stent failure had higher baseline platelets (P=0.031) and neutrophils (P=0.025), and NLR (P=0.026). CONCLUSIONS Baseline platelet count and NLR are associated with early but not late failure of iliocaval venous stents. This suggests different pathophysiologic mechanisms and a role for both platelet activation and inflammatory mechanisms in early rather than late stent thrombosis. Future research is needed to better explain this novel finding.
- Published
- 2018
28. Arsenic, blood pressure, and hypertension in the Strong Heart Family Study
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Ana Navas-Acien, Walter Goessler, Claire Mattison, Maria Tellez-Plaza, Jason G. Umans, Amanda M. Fretts, Ying Zhang, V. Saroja Voruganti, Matthew O. Gribble, Lyle G. Best, John A. Kaufman, and Shelley A. Cole
- Subjects
chemistry.chemical_element ,Physiology ,Blood Pressure ,Urine ,010501 environmental sciences ,01 natural sciences ,Biochemistry ,Article ,Arsenic ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Generalized estimating equation ,0105 earth and related environmental sciences ,General Environmental Science ,business.industry ,Incidence (epidemiology) ,Arizona ,Oklahoma ,Environmental Exposure ,medicine.disease ,United States ,Cross-Sectional Studies ,Blood pressure ,chemistry ,Hypertension ,South Dakota ,Cohort ,Indians, North American ,business ,Cohort study - Abstract
BACKGROUND: Arsenic has been associated with hypertension, though it is unclear whether associations persist at the exposure concentrations (e.g.
- Published
- 2021
29. Unemployment insurance program accessibility and suicide rates in the United States
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Melvin D. Livingston, Kelli A. Komro, and John A. Kaufman
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Male ,Epidemiology ,media_common.quotation_subject ,Population ,Public policy ,01 natural sciences ,Recession ,Article ,Health Services Accessibility ,Insurance ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,0101 mathematics ,Risk factor ,education ,media_common ,education.field_of_study ,business.industry ,010102 general mathematics ,Confounding ,Public Health, Environmental and Occupational Health ,Quarter (United States coin) ,United States ,Educational attainment ,Suicide ,Economic Recession ,Unemployment ,Demographic economics ,business - Abstract
Unemployment is a risk factor for suicide. Unemployment insurance is the primary policy tool in the United States for alleviating the burden of unemployment on individuals. Our objective was to estimate the effect of state unemployment insurance accessibility on suicide rates, and effect modification by sociodemographic factors and unemployment rate. We used quarterly data from all 50 U.S. states and Washington, DC from 2000 to 2015, for a total of 3264 state-quarter units of analysis. The exposure was the quarterly unemployment insurance recipiency rate, i.e. the percentage of unemployed persons who received unemployment insurance. The outcome was the state-quarterly suicide rate per 100,000 population. Linear regression models included state, year, and calendar quarter fixed effects, state time trends, and state-level economic covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, educational attainment, age, gender, and race. Based on fully adjusted models, potential protective effects of higher unemployment insurance recipiency rates appear to be small and restricted to demographic groups at higher risk of suicide including men, non-Hispanic White Americans, and those 45–64 years of age. These groups also generally have higher UI recipiency rates, therefore differences in subgroup estimates may reflect variations in eligibility policies and accessibility of UI programs.
- Published
- 2020
30. Disinfection By-Product Exposures and the Risk of Specific Cardiac Birth Defects
- Author
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John A. Kaufman, J. Michael Wright, Michael G. Narotsky, Amanda Evans, and Zorimar Rivera-Núñez
- Subjects
0301 basic medicine ,Heart Defects, Congenital ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,030105 genetics & heredity ,010501 environmental sciences ,01 natural sciences ,03 medical and health sciences ,Environmental health ,Epidemiology ,medicine ,Humans ,Trichloroacetic Acid ,0105 earth and related environmental sciences ,Chemical toxicity ,Chemistry ,Water pollutants ,Research ,Public Health, Environmental and Occupational Health ,Case-control study ,Disinfection by-product ,Disinfection ,Epidemiologic Studies ,Increased risk ,Massachusetts ,Maternal Exposure ,Case-Control Studies ,Female ,Water Pollutants, Chemical ,Disinfectants ,Trihalomethanes - Abstract
Background: Epidemiological studies suggest that women exposed to disinfection by-products (DBPs) have an increased risk of delivering babies with cardiovascular defects (CVDs). Objective: We examined nine CVDs in relation to categorical DBP exposures including bromoform, chloroform, dibromochloromethane (DBCM), bromodichloromethane (BDCM), monobromoacetic acid (MBAA), dichloroacetic acid (DCAA), trichloroacetic acid (TCAA), and summary DBP measures (HAA5, THMBr, THM4, and DBP9). Methods: We calculated adjusted odds ratios (aORs) in a case–control study of birth defects in Massachusetts with complete quarterly 1999–2004 trihalomethane (THM) and haloacetic acid (HAA) data. We randomly matched 10 controls each to 904 CVD cases based on week of conception. Weight-averaged aggregate first-trimester DBP exposures were assigned to individuals based on residence at birth. Results: We detected associations for tetralogy of Fallot and the upper exposure categories for TCAA, DCAA, and HAA5 (aOR range, 3.34–6.51) including positive exposure–response relationships for DCAA and HAA5. aORs consistent in magnitude were detected between atrial septal defects and bromoform (aOR = 1.56; 95% CI: 1.01, 2.43), as well as DBCM, chloroform, and THM4 (aOR range, 1.26–1.67). Ventricular septal defects (VSDs) were associated with the highest bromoform (aOR = 1.85; 95% CI: 1.20, 2.83), MBAA (aOR = 1.81; 95% CI: 0.85, 3.84), and DBCM (aOR = 1.54; 95% CI: 1.00, 2.37) exposure categories. Conclusions: To our knowledge, this is the first birth defect study to develop multi-DBP adjusted regression models as well as the first CVD study to evaluate HAA exposures and the second to evaluate bromoform exposures. Our findings, therefore, inform exposure specificity for the consistent associations previously reported between THM4 and CVDs including VSDs. Citation: Wright JM, Evans A, Kaufman JA, Rivera-Núñez Z, Narotsky MG. 2017. Disinfection by-product exposures and the risk of specific cardiac birth defects. Environ Health Perspect 125:269–277; http://dx.doi.org/10.1289/EHP103
- Published
- 2016
31. A Scoping Review of Capacity-Building Efforts to Address Environmental Justice Concerns
- Author
-
Na'Taki Osborne Jelks, John A. Kaufman, Candis M. Hunter, Michelle C. Kegler, Matthew O. Gribble, Dayna A. Johnson, Kelli A. Komro, Dana H. Z. Williamson, and Emma X Yu
- Subjects
Capacity Building ,Health, Toxicology and Mutagenesis ,lcsh:Medicine ,Community change ,Review ,03 medical and health sciences ,0302 clinical medicine ,Political science ,social justice ,Humans ,030212 general & internal medicine ,environmental justice ,mobilization ,Community organizing ,Environmental justice ,advocacy ,030505 public health ,Scope (project management) ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,Capacity building ,Public relations ,Social justice ,community capacity ,Leadership ,Cross-Sectional Studies ,Work (electrical) ,community organizing ,Environmental Pollution ,0305 other medical science ,business ,Inclusion (education) - Abstract
Environmental justice (EJ) efforts aimed at capacity building are essential to addressing environmental health disparities; however, limited attention has been given to describing these efforts. This study reports findings from a scoping review of community–academic partnerships and community-led efforts to address environmental inequities related to air, water, and land pollution in the United States. Literature published in peer-reviewed journals from January 1986 through March 2018 were included, and community capacity theory was applied as a framework for understanding the scope of capacity-building and community change strategies to address EJ concerns. Paired teams of independent analysts conducted a search for relevant articles (n = 8452 citations identified), filtered records for content abstraction and possible inclusion (n = 163) and characterized selected studies (n = 58). Most articles implemented activities that were aligned with community capacity dimensions of citizen participation (96.4%, n = 53), community power (78%, n = 45), leadership (78%, n = 45), and networks (81%, n = 47); few articles identified a direct policy change (22%, n = 13), and many articles discussed the policy implications of findings for future work (62%, n = 36). This review synthesizes three decades of efforts to reduce environmental inequities and identifies strategic approaches used for strengthening community capacity.
- Published
- 2020
32. Palmar Warming for Radial Artery Vasodilation to Facilitate Transradial Access: A Randomized Controlled Trial
- Author
-
Younes Jahangiri, J. Cody Hedge, Ramsey Al-Hakim, Roberto Galuppo, Khashayar Farsad, and John A. Kaufman
- Subjects
Adult ,Male ,Left radial artery ,Vasodilation ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,Oregon ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine.artery ,Catheterization, Peripheral ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Treatment effect ,Single-Blind Method ,Prospective Studies ,Radial artery ,Ultrasonography ,business.industry ,Repeated measures design ,Hyperthermia, Induced ,Middle Aged ,Hand ,Confidence interval ,Healthy Volunteers ,030220 oncology & carcinogenesis ,Anesthesia ,Radial Artery ,Female ,Analysis of variance ,Cardiology and Cardiovascular Medicine ,business - Abstract
PURPOSE To investigate the efficacy of palmar warming to induce radial artery vasodilation. MATERIALS AND METHODS After informed consent was obtained, healthy volunteers (n = 45) were randomized 2:1 in palmar warming and control groups, respectively, for this prospective, randomized, single-blind clinical trial (NCT03620383). The palmar warming group was given a warm, commercially available, air-activated heat pack (Kobayashi Consumer Products LLC, Dalton, Georgia) to hold in the left hand for palmar warming. The control group was given a deactivated version of the same heat pack. Left radial artery cross-sectional area (CSA) measurements were obtained at baseline and in 5-minute intervals up to 20 minutes in both groups. Differences in the trends of changes in the radial artery CSA between palmar warming and control groups were examined with the age- and sex-adjusted repeated measure analysis of variance. Propensity score-matched treatment effect analysis was conducted to quantify the effect of heat on radial artery CSA. RESULTS The palmar warming group and the control group were significantly different in terms of subject sex (males/females: 7/23 and 10/5, respectively; P = .005) and baseline CSA (2.5±0.2 mm2 vs 3.2±0.3 mm2, respectively; P = .014). Radial artery CSA showed an increasing trend over time in the palmar warming group compared to a stable trend over time in the control group (P < .0001). Propensity score-matched comparison showed a 43.9% increase (95% confidence interval: 34.1%-53.8%) in CSA in the palmar warming group compared to the control group (P < .0001). CONCLUSIONS The palmar warming technique is effective at dilating the radial artery and may be a beneficial technique to facilitate transradial access.
- Published
- 2018
33. Ambient ozone and fine particulate matter exposures and autism spectrum disorder in metropolitan Cincinnati, Ohio
- Author
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Julia S. Anixt, Glenn Rice, J. Michael Wright, Natalia Connolly, John A. Kaufman, and Katherine Bowers
- Subjects
medicine.medical_specialty ,Autism Spectrum Disorder ,Air pollution ,010501 environmental sciences ,medicine.disease_cause ,Logistic regression ,01 natural sciences ,Biochemistry ,Article ,03 medical and health sciences ,0302 clinical medicine ,Ozone ,Pregnancy ,Air Pollution ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Child ,Air quality index ,0105 earth and related environmental sciences ,General Environmental Science ,Ohio ,Air Pollutants ,business.industry ,Confounding ,Odds ratio ,Environmental Exposure ,medicine.disease ,Case-Control Studies ,Female ,Particulate Matter ,business ,Environmental epidemiology ,Demography - Abstract
BACKGROUND: Epidemiological studies report fairly consistent associations between various air pollution metrics and autism spectrum disorder (ASD), with some elevated risks reported for different prenatal and postnatal periods. OBJECTIVES: To examine associations between ASD and ambient fine particulate matter (PM(2.5)) and ozone concentrations during the prenatal period through the second year of life in a case-control study. METHODS: ASD cases (n=428) diagnosed at Cincinnati Children’s Hospital Medical Center were frequency matched (15:1) to 6,420 controls from Ohio birth records. We assigned daily PM(2.5) and ozone estimates for 2005–2012 from US EPA’s Fused Air Quality Surface Using Downscaling model to each participant for each day based on the mother’s census tract of residence at birth. We calculated adjusted odds ratios (aORs) using logistic regression across continuous and categorical exposure window averages (trimesters, first and second postnatal years, and cumulative measure), adjusting for maternal- and birth-related confounders, both air pollutants, and multiple temporal exposure windows. RESULTS: We detected elevated aORs for PM(2.5) during the 2(nd) trimester, 1(st) year of life, and a cumulative period from pregnancy through the 2(nd) year (aOR ranges across categories: 1.41–1.44, 1.54–1.84, and 1.41–1.52 respectively), and for ozone in the 2(nd) year of life (aOR range across categories: 1.29–1.42). Per each change in IQR, we observed elevated aORs for ozone in the 3(rd) trimester, 1(st) and 2(nd) years of life, and the cumulative period (aOR range: 1.19–1.27) and for PM(2.5) in the 2(nd) trimester, 1(st) year of life, and the cumulative period (aOR range: 1.11–1.17). DISCUSSION: We saw limited evidence of linear exposure-response relationships for ASD with increasing air pollution, but the elevated aORs detected for PM(2.5) in upper exposure categories and per IQR unit increases were similar in magnitude to those reported in previous studies, especially for postnatal exposures.
- Published
- 2018
34. VIDEO: Technique to Restrict the Gore Viatorr Stent-Graft for TIPS Reduction
- Author
-
Khashayar Farsad, Younes Jahangiri, Hans A. Timmermans, John A. Kaufman, Masahiro Horikawa, Yindee Geeratikun, and Barry Uchida
- Subjects
0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Blood vessel prosthesis ,medicine ,Bare metal ,Prosthesis design ,Humans ,Radiology, Nuclear Medicine and imaging ,Reduction (orthopedic surgery) ,business.industry ,Stent ,General Medicine ,equipment and supplies ,Surgery ,Blood Vessel Prosthesis ,surgical procedures, operative ,030104 developmental biology ,030220 oncology & carcinogenesis ,Stents ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
OBJECTIVE. The Viatorr stent-graft (W. L. Gore and Associates), specifically made for transjugular intrahepatic portosystemic shunt (TIPS) creation, has significantly improved TIPS patency compared with bare metal stents. Post-TIPS hepatic encephalopathy (HE), however, remains relatively common after TIPS creation. We describe a technique to secondarily restrict a Viatorr stent-graft to treat post-TIPS refractory HE and maintain use of the Viatorr device. CONCLUSION. We show a simple technique to modify the Viatorr stent-graft for TIPS reduction.
- Published
- 2018
35. Associations Between Disinfection By-Product Exposures and Craniofacial Birth Defects
- Author
-
Zorimar Rivera-Núñez, John A. Kaufman, Michael G. Narotsky, Amy Meyer, Amanda Evans, and J. Michael Wright
- Subjects
Adult ,Male ,medicine.medical_specialty ,Haloacetic acids ,Cleft Lip ,010501 environmental sciences ,Acetates ,01 natural sciences ,Article ,Water Purification ,Craniofacial Abnormalities ,Dietary Exposure ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Medicine ,Humans ,Abnormalities, Multiple ,030212 general & internal medicine ,Eye Abnormalities ,Young adult ,Craniofacial ,Trichloroacetic Acid ,0105 earth and related environmental sciences ,Dichloroacetic Acid ,business.industry ,Obstetrics ,Drinking Water ,Public Health, Environmental and Occupational Health ,Case-control study ,Infant, Newborn ,Disinfection by-product ,Ear ,Odds ratio ,medicine.disease ,Cleft Palate ,First trimester ,Pregnancy Trimester, First ,Case-Control Studies ,Prenatal Exposure Delayed Effects ,Female ,Chloroform ,business ,medicine.drug ,Disinfectants ,Trihalomethanes - Abstract
The aim of this study was to examine associations between craniofacial birth defects (CFDs) and disinfection by-product (DBP) exposures, including the sum of four trihalomethanes (THM4) and five haloacetic acids (HAA5) (ie, DBP9).We calculated first trimester adjusted odds ratios (aORs) for different DBPs in a matched case-control study of 366 CFD cases in Massachusetts towns with complete 1999 to 2004 THM and HAA data.We detected elevated aORs for cleft palate with DBP9 (highest quintile aOR = 3.52; 95% CI: 1.07, 11.60), HAA5, trichloroacetic acid (TCAA), and dichloroacetic acid. We detected elevated aORs for eye defects with TCAA and chloroform.This is the first epidemiological study of DBPs to examine eye and ear defects, as well as HAAs and CFDs. The associations for cleft palate and eye defects highlight the importance of examining specific defects and DBPs beyond THM4.
- Published
- 2018
36. Inferior Vena Cava Filters: Current and Future Concepts
- Author
-
John Andrew, Kaufman
- Subjects
Vena Cava Filters ,Humans ,Vena Cava, Inferior ,Equipment Design ,Pulmonary Embolism ,Forecasting - Abstract
The inferior vena cava filter clinical environment is notable for the degree of controversy, uncertainty, and fear associated with these devices by both physicians and the public. This article reviews some of the more important current issues with these devices as well as emerging and future trends.
- Published
- 2017
37. Primary Creation of an Externally Constrained TIPS: A Technique to Control Reduction of the Portosystemic Gradient
- Author
-
Frederick S. Keller, Kenneth J. Kolbeck, Robert E. Barton, Khashayar Farsad, and John A. Kaufman
- Subjects
Adult ,Liver Cirrhosis ,medicine.medical_specialty ,medicine.medical_treatment ,Hydrothorax ,Portosystemic shunting ,Ascites ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Polytetrafluoroethylene ,Hepatic encephalopathy ,business.industry ,Stent ,General Medicine ,Middle Aged ,medicine.disease ,Shunt (medical) ,Surgery ,Hepatic Encephalopathy ,Female ,Stents ,Radiology ,Portasystemic Shunt, Transjugular Intrahepatic ,medicine.symptom ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
OBJECTIVE. Transjugular intrahepatic portosystemic shunt (TIPS) creation increases the risk of hepatic encephalopathy due to overshunting. Techniques exist to secondarily reduce the shunt for refractory encephalopathy. The purpose of this article is to describe a technique for primary TIPS restriction using a balloon-expandable stent within the transvenous hepatic track followed by deployment of a self-expanding polytetrafluoroethylene–lined stent-graft within the balloon-expandable stent to create the TIPS. CONCLUSION. This technique enables control over the degree of portosystemic shunting in elective TIPS creation.
- Published
- 2015
38. The Interventional Radiology/Diagnostic Radiology Certificate and Interventional Radiology Residency
- Author
-
John A. Kaufman
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,Certification ,Organizational innovation ,Specialty board ,Advisory Committees ,Specialty ,Radiology, Interventional ,Specialty Boards ,Medical imaging ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Fellowships and Scholarships ,medicine.diagnostic_test ,business.industry ,Internship and Residency ,Interventional radiology ,Certificate ,Organizational Innovation ,United States ,Education, Medical, Graduate ,Clinical Competence ,Curriculum ,Radiology ,Clinical competence ,business - Abstract
The approval of the new certificate in interventional radiology (IR) and diagnostic radiology (DR) by the American Board of Medical Specialties was a notable event for two reasons: The basic training schematic in IR was changed from a 1-4-1 pattern (years of internship-years of DR-years of IR) to a 1-3-2 pattern, and IR was recognized as a primary specialty of the American Board of Radiology.
- Published
- 2014
39. Arteriopathy after transarterial chemo-lipiodolization for hepatocellular carcinoma
- Author
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K. Hashimoto, Masahiro Horikawa, Y. Tomozawa, Y. Matsui, Y. Jahangiri Noudeh, John A. Kaufman, A. Figi, and Khashayar Farsad
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Adolescent ,Antineoplastic Agents ,Arterial Occlusive Diseases ,Logistic regression ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Ethiodized Oil ,Hepatic Artery ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Young adult ,Chemoembolization, Therapeutic ,skin and connective tissue diseases ,Aged ,Retrospective Studies ,Aged, 80 and over ,Radiological and Ultrasound Technology ,business.industry ,Incidence (epidemiology) ,Incidence ,Liver Neoplasms ,Mean age ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Hepatocellular carcinoma ,030211 gastroenterology & hepatology ,Female ,business ,Epirubicin ,medicine.drug - Abstract
Objectives The purpose of this study was to investigate the incidence of and the risk factors for arteriopathy in hepatic arteries after transarterial chemo-lipiodolization in patients with hepatocellular carcinoma and the subsequent treatment strategy changes due to arteriopathy. Patients and methods A total of 365 arteries in 167 patients (126 men and 41 women; mean age, 60.4 ± 15.0 [SD] years [range: 18–87 years]) were evaluated for the development of arteriopathy after chemo-lipiodolization with epirubicin- or doxorubicin-Lipiodol® emulsion. The development of arteriopathy after chemo-lipiodolization was assessed on arteriograms performed during subsequent transarterial treatments. The treatment strategy changes due to arteriopathy, including change in the chemo-lipiodolization method and the application of alternative therapies was also investigated. Univariate and multivariate binary logistic regression models were used to identify risk factors for arteriopathy and subsequent treatment strategy change. Results One hundred two (27.9%) arteriopathies were detected in 62/167 (37.1%) patients (45 men, 17 women) with a mean age of 63.3 ± 7.1 [SD] years (age range, 50–86 years). The incidence of arteriopathy was highly patient dependent, demonstrating significant correlation in a fully-adjusted multivariate regression model (P Conclusion The incidence of arteriopathy after chemo-lipiodolization is 27.9%. Among them, 29.4% result in a change in treatment strategy.
- Published
- 2017
40. Tumor Dose Response in Yttrium-90 Resin Microsphere Embolization for Neuroendocrine Liver Metastases: A Tumor-Specific Analysis with Dose Estimation Using SPECT-CT
- Author
-
Akira Adachi, Y. Matsui, Kenneth J. Kolbeck, Younes Jahangiri, Yindee Geeratikun, Khashayar Farsad, Orapin Chansanti, Jeffrey S. Stevens, and John A. Kaufman
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Single-photon emission computed tomography ,Multimodal Imaging ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Dose estimation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Yttrium Radioisotopes ,Embolization ,Technetium Tc 99m Aggregated Albumin ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Dose-Response Relationship, Radiation ,Radiotherapy Dosage ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Microspheres ,Dose–response relationship ,Neuroendocrine Tumors ,Treatment Outcome ,Response Evaluation Criteria in Solid Tumors ,030220 oncology & carcinogenesis ,Absorbed dose ,Hepatocellular carcinoma ,Female ,Radiology ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Tomography, X-Ray Computed ,Progressive disease - Abstract
Purpose To evaluate dose-response relationship in yttrium-90 ( 90 Y) resin microsphere radioembolization for neuroendocrine tumor (NET) liver metastases using a tumor-specific dose estimation based on technetium-99m–labeled macroaggregated albumin ( 99m Tc MAA) single photon emission computed tomography (SPECT)-CT. Materials and Methods Fifty-five tumors (mean size 3.9 cm) in 15 patients (10 women; mean age 57 y) were evaluated. Tumor-specific absorbed dose was estimated using a partition model. Initial (median 2.3 months) follow-up data were available for all tumors; last (median 7.6 months) follow-up data were available for 45 tumors. Tumor response was evaluated using Modified Response Evaluation Criteria in Solid Tumors (mRECIST) on follow-up CT. Tumors with complete or partial response were considered responders. Mean tumor absorbed dose was 231.4 Gy ± 184.3, and mean nontumor liver absorbed dose was 39.0 Gy ± 18.0. Results Thirty-six (65.5%) and 30 (66.7%) tumors showed response at initial and last follow-up, respectively. Mean absorbed doses in responders and nonresponders at initial and last follow-up were 285.8 Gy ± 191.1 and 128.1 Gy ± 117.1 ( P = .0004) and 314.3 Gy ± 195.8 and 115.7 Gy ± 117.4 ( P = .0001). Cutoff value of ≥ 191.3 Gy for tumor-specific absorbed dose predicted tumor response with 93% specificity, whereas P = .007). Conclusions Tumor-specific absorbed dose, estimated with a partition model, was significantly associated with tumor response in NET liver metastases. An estimated dose ≥ 191.3 Gy predicted treatment response with high sensitivity and specificity.
- Published
- 2017
41. Inferior Vena Cava Filters
- Author
-
Michael R. Jaff, Ido Weinberg, and John A. Kaufman
- Subjects
medicine.medical_specialty ,Vena Cava Filters ,Deep vein ,venous thromboembolism ,Inferior vena cava filter ,Risk Assessment ,Inferior vena cava ,deep vein thrombosis ,inferior vena cava filter ,Prosthesis Implantation ,Risk Factors ,medicine ,Humans ,In patient ,Device Removal ,Venous Thrombosis ,business.industry ,Patient Selection ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Surgery ,Venous thrombosis ,Treatment Outcome ,medicine.anatomical_structure ,medicine.vein ,Practice Guidelines as Topic ,Guideline Adherence ,Radiology ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism - Abstract
Venous thromboembolism is common. Most pulmonary emboli arise as thromboses in the deep veins of the lower extremities and may result in serious complications. Inferior vena cava filters (IVCF) are intended to prevent the passage of deep vein thrombosis to the pulmonary arteries. Accepted indications for IVCF placement include the presence of acute venous thromboembolism with inability to administer anticoagulation medication or failure of anticoagulation. Despite these clear indications, IVCF have been commonly placed in patients for primary prevention of pulmonary emboli in patients deemed to be at high risk, along with several other “soft” indications. As a result, IVCF use has been rising over the past 2 decades, especially given the retrievable nature of modern devices. Nonetheless, IVCF are not free of complications, which may occur during implantation and retrieval and while retained in the body. Despite this increase in use, the long-term efficacy remains unclear, and the management of patients with retained filters is often controversial. Finally, filter retrieval in eligible patients is relatively infrequent, suggesting that systems must be in place to improve appropriate filter use and to increase retrieval.
- Published
- 2013
42. Transjugular Intrahepatic Portosystemic Shunt Creation Using Intravascular Ultrasound Guidance
- Author
-
Kenneth J. Kolbeck, Robert E. Barton, Paul C. Lakin, Cristina Fuss, Khashayar Farsad, John A. Kaufman, and Frederick S. Keller
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Portal vein ,Inferior vena cava ,Young Adult ,Hypertension, Portal ,Intravascular ultrasound ,medicine ,Humans ,Fluoroscopy ,Radiology, Nuclear Medicine and imaging ,Thrombus ,Image guidance ,Ultrasonography, Interventional ,Aged ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Thrombosis ,Treatment Outcome ,Surgery, Computer-Assisted ,medicine.vein ,Female ,Radiology ,Portasystemic Shunt, Transjugular Intrahepatic ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Purpose To describe the use of intravascular ultrasound (US) guidance for creation of transjugular intrahepatic portosystemic shunts (TIPSs) in humans. Materials and Methods The initial 25 cases of intravascular US–guided TIPS were retrospectively compared versus the last 75 conventional TIPS cases during the same time period at the same institution in terms of the number of needle passes required to establish portal vein (PV) access, fluoroscopy time, and needle pass–related complications. Results Intravascular US–guided TIPS creation was successful in all cases, and there was no statistically significant difference in number of needle passes, fluoroscopy time, or needle pass–related complications between TIPS techniques. Intravascular US–guided TIPS creation was successful in cases in which conventional TIPS creation had failed as a result of PV thrombosis or distorted anatomy. Intravascular US guidance for TIPS creation was additionally useful in a patient with Budd–Chiari syndrome and in a patient with intrahepatic tumors. Conclusions Intravascular US is a safe and reproducible means of real-time image guidance for TIPS creation, equivalent in efficacy to conventional fluoroscopic guidance. Real-time sonographic guidance with intravascular US may prove advantageous for cases in which there is PV thrombus, distorted anatomy, Budd–Chiari syndrome, or hepatic tumors.
- Published
- 2012
43. Josef Rösch, MD
- Author
-
Frederick S. Keller and John A. Kaufman
- Subjects
Male ,business.industry ,MEDLINE ,Historical Article ,Biography ,History, 20th Century ,History, 21st Century ,United States ,Czechoslovakia ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,business ,Radiology ,Classics - Published
- 2016
44. Vascular Access Tracking System: a Web-Based Clinical Tracking Tool for Identifying Catheter Related Blood Stream Infections in Interventional Radiology Placed Central Venous Catheters
- Author
-
James J. Morrison and John A. Kaufman
- Subjects
medicine.medical_specialty ,Catheterization, Central Venous ,Databases, Factual ,Dashboard (business) ,Vascular access ,Bacteremia ,Radiology, Interventional ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Catheters, Indwelling ,medicine ,Web application ,Central Venous Catheters ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Intensive care medicine ,Internet ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Tracking system ,Interventional radiology ,medicine.disease ,Computer Science Applications ,Catheter ,Catheter-Related Infections ,Medical emergency ,business ,Blood stream ,Blood drawing - Abstract
Vascular access is invaluable in the treatment of hospitalized patients. Central venous catheters provide a durable and long-term solution while saving patients from repeated needle sticks for peripheral IVs and blood draws. The initial catheter placement procedure and long-term catheter usage place patients at risk for infection. The goal of this project was to develop a system to track and evaluate central line-associated blood stream infections related to interventional radiology placement of central venous catheters. A customized web-based clinical database was developed via open-source tools to provide a dashboard for data mining and analysis of the catheter placement and infection information. Preliminary results were gathered over a 4-month period confirming the utility of the system. The tools and methodology employed to develop the vascular access tracking system could be easily tailored to other clinical scenarios to assist in quality control and improvement programs.
- Published
- 2016
45. Design and Rationale of the Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST‐CLI) Trial
- Author
-
Michael D. Dake, Diane M. Reid, Kenneth Rosenfield, George Sopko, Flora S. Siami, Mark A. Creager, Michael R. Jaff, Matthew T. Menard, Richard J. Powell, Christopher J. White, John A. Kaufman, Alik Farber, Michael S. Conte, Susan F. Assmann, and Niteesh K. Choudhry
- Subjects
Comparative Effectiveness Research ,Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,law.invention ,surgery ,0302 clinical medicine ,Superiority Trial ,Randomized controlled trial ,Ischemia ,law ,Clinical Studies ,030212 general & internal medicine ,Original Research ,Cardiovascular Surgery ,Quality and Outcomes ,Anastomosis, Surgical ,Endovascular Procedures ,cost‐effectiveness ,3. Good health ,Treatment Outcome ,quality ,outcome ,endovascular ,Stents ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,critical limb ischemia ,medicine.medical_specialty ,Comparative effectiveness research ,Equivalence Trials as Topic ,Revascularization ,Amputation, Surgical ,Peripheral Arterial Disease ,03 medical and health sciences ,stent treatment ,medicine ,Humans ,Intensive care medicine ,business.industry ,Extremities ,Critical limb ischemia ,Clinical trial ,Peripheral Vascular Disease ,Amputation ,atherosclerosis ,business - Abstract
Background Critical limb ischemia ( CLI ) is increasing in prevalence, and remains a significant source of mortality and limb loss. The decision to recommend surgical or endovascular revascularization for patients who are candidates for both varies significantly among providers and is driven more by individual preference than scientific evidence. Methods and Results The Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST‐CLI) Trial is a prospective, randomized, multidisciplinary, controlled, superiority trial designed to compare treatment efficacy, functional outcomes, quality of life, and cost in patients undergoing best endovascular or best open surgical revascularization. Approximately 140 clinical sites in the United States and Canada will enroll 2100 patients with CLI who are candidates for both treatment options. A pragmatic trial design requires consensus on patient eligibility by at least 2 investigators, but leaves the choice of specific procedural strategy within the assigned revascularization approach to the individual treating investigator. Patients with suitable single‐segment of saphenous vein available for potential bypass will be randomized within Cohort 1 (n=1620), while patients without will be randomized within Cohort 2 (n=480). The primary efficacy end point of the trial is Major Adverse Limb Event–Free Survival. Key secondary end points include Re‐intervention and Amputation‐Free‐Survival and Amputation Free‐Survival. Conclusions The BEST ‐ CLI trial is the first randomized controlled trial comparing endovascular therapy to open surgical bypass in patients with CLI to be carried out in North America. This landmark comparative effectiveness trial aims to provide Level I data to clarify the appropriate role for both treatment strategies and help define an evidence‐based standard of care for this challenging patient population. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 02060630.
- Published
- 2016
46. Obituary
- Author
-
Frederick S. Keller and John A. Kaufman
- Subjects
Czechoslovakia ,Male ,Humans ,Radiology, Nuclear Medicine and imaging ,History, 20th Century ,Cardiology and Cardiovascular Medicine ,Radiography, Interventional ,History, 21st Century ,United States - Published
- 2016
47. Novel Image Guidance Techniques for Portal Vein Targeting During Transjugular Intrahepatic Portosystemic Shunt Creation
- Author
-
John A. Kaufman and Khashayar Farsad
- Subjects
medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Portal vein ,Hepatic Veins ,Magnetic Resonance Imaging, Interventional ,Radiography, Interventional ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Vein ,Image guidance ,Portography ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Portal Vein ,Phlebography ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Fluoroscopy ,cardiovascular system ,Radiology ,Portasystemic Shunt, Transjugular Intrahepatic ,Cardiology and Cardiovascular Medicine ,business ,Transjugular intrahepatic portosystemic shunt ,Magnetic Resonance Angiography - Abstract
The most challenging part of transjugular intrahepatic portosystemic shunt creation is arguably the transvenous access from the hepatic vein to the portal vein. As experience and technology have evolved, the image guidance aspect of this critical step in the procedure has become more robust. Improved means to target the portal vein include both direct and indirect methods of portal vein opacification, cross-sectional imaging for both targeting and access, and novel use of transabdominal and intravascular ultrasound guidance. These techniques are described herein.
- Published
- 2016
48. Radiofrequency Endovenous ClosureFAST versus Laser Ablation for the Treatment of Great Saphenous Reflux: A Multicenter, Single-blinded, Randomized Study (RECOVERY Study)
- Author
-
Paramjit S. Chopra, Raymond G. Makhoul, Jeffrey K. Raines, Christian Wenzel, Tim Richards, Jose I. Almeida, Daniel F. Hoheim, John A. Kaufman, Martin T. Evans, and Oliver Göckeritz
- Subjects
Male ,medicine.medical_specialty ,Ecchymosis ,Comorbidity ,law.invention ,Varicose Veins ,Randomized controlled trial ,Quality of life ,law ,medicine ,Humans ,Single-Blind Method ,Radiology, Nuclear Medicine and imaging ,business.industry ,Great saphenous vein ,Reflux ,Middle Aged ,medicine.disease ,United States ,Surgery ,Tenderness ,Treatment Outcome ,Venous Insufficiency ,Catheter Ablation ,Female ,Laser Therapy ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,After treatment - Abstract
Purpose The present study was designed to address the hypothesis that radiofrequency (RF) thermal ablation, as represented by the ClosureFAST system, is associated with improved recovery and quality-of-life (QOL) parameters compared with 980-nm endovenous laser (EVL) thermal ablation of the great saphenous vein (GSV). Materials and Methods Eighty-seven veins in 69 patients were randomized to ClosureFAST or 980-nm EVL treatment of the GSV. The study was prospective, randomized, single-blinded, and carried out at five American sites and one European site. Primary endpoints (postoperative pain, ecchymosis, tenderness, and adverse procedural sequelae) and secondary endpoints (venous clinical severity scores and QOL issues) were measured at 48 hours, 1 week, 2 weeks, and 1 month after treatment. Results All scores referable to pain, ecchymosis, and tenderness were statistically lower in the ClosureFAST group at 48 hours, 1 week, and 2 weeks. Minor complications were more prevalent in the EVL group ( P = .0210); there were no major complications. Venous clinical severity scores and QOL measures were statistically lower in the ClosureFAST group at 48 hours, 1 week, and 2 weeks. Conclusions RF thermal ablation was significantly superior to EVL as measured by a comprehensive array of postprocedural recovery and QOL parameters in a randomized prospective comparison between these two thermal ablation modalities for closure of the GSV.
- Published
- 2009
49. Percutaneous management of chronic deep venous reflux: review of experimental work and early clinical experience with bioprosthetic valve
- Author
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Josef Rösch, Frederick S. Keller, John A. Kaufman, Monica T. Hinds, Dusan Pavcnik, and Barry Uchida
- Subjects
medicine.medical_specialty ,Percutaneous ,Chronic venous insufficiency ,Deep vein ,medicine.medical_treatment ,Prosthesis Design ,Veins ,Blood Vessel Prosthesis Implantation ,Blood vessel prosthesis ,medicine ,Animals ,Humans ,Bioprosthesis ,business.industry ,Stent ,medicine.disease ,Venous Valves ,Blood Vessel Prosthesis ,Surgery ,Transplantation ,Catheter ,Treatment Outcome ,medicine.anatomical_structure ,Lower Extremity ,Venous Insufficiency ,Chronic Disease ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Lower extremity chronic deep venous insufficiency (CDVI) is common and remains a major health problem worldwide. Selected patients benefited from direct deep vein valve surgical repair or valve transplantation. A major limitation of this approach is that most of the patients are not candidates for these procedures due to obstructions or residual thrombus throughout the vein. The past 15 years have witnessed experimental efforts at catheter-based management of CDVI. This review describes the initial designs and experimental evolution of a mechanical and bioprosthetic venous valve that can be implanted by using a transcatheter technique. These valves consisted of single, double, or triple cusp leaflets made of synthetic or biological materials attached to a carrier or frame. All described devices for percutaneous transcatheter valve placement rely on some form of a vascular stent for valve attachment.
- Published
- 2008
50. Traumatic Thoracic Aortic Transection in Small-Diameter Aortas: Percutaneous Endograft Repair
- Author
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Bruce Ham, Howard K. Song, John A. Kaufman, and Matthew S. Slater
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Small diameter ,Adolescent ,Aorta, Thoracic ,Iliac Artery ,Femoral sheath ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Radiology, Nuclear Medicine and imaging ,Percutaneous repair ,business.industry ,Middle Aged ,Blood Vessel Prosthesis ,Surgery ,Radiography ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Heart Injuries ,Male patient ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
The authors describe percutaneous repair of traumatic aortic transection in small-caliber aortas by using iliac extender stent-grafts in three patients (two female and one male patient; average age, 29.3 years). The average aortic diameters were 18.7 mm proximal and 16.4 mm distal to the tear. Iliac limb extenders (55 mm in length, 20-22 mm in diameter) were transferred from their 55-cm long delivery sheaths into 80-cm 16- or 18-F sheaths. The long sheaths enabled the percutaneous delivery of multiple stent-grafts to the thoracic aorta via a single femoral sheath. The transections were successfully treated in all patients without complication.
- Published
- 2007
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