Journal Of Vascular Interventional Radiology Research Articles

Assessing Antibiotic Adherence and Improving Antibiotic Stewardship in Common Interventional Radiology Procedures

PurposeIn 2018, The Journal of Vascular and Interventional Radiology (JVIR) updated its guidelines regarding periprocedural antibiotics. However, some institutions are slower to adopt these new guidelines. Additionally, antibiotic-resistant bacteria and sepsis are serious concerns due in part to incorrect usage of antibiotics. The purpose of this study is to assess institutional adherence to 2018 JVIR guidelines for the purpose of improving antibiotic stewardship. Materials and methodsA total of 800 cases over a 10-month time period were retrospectively identified and charted following the release of guidelines. Inclusion criteria for the study were adults aged 21 years or older undergoing mediport placement, tunneled central line (TCL) placement, nephrostomy tube exchange, percutaneous biliary drain, or cholecystostomy tube exchange. Exclusion criteria included immunocompromised and pregnant individuals as 2018 guidelines may not fit these patient populations. Guideline adherence for each procedure was recorded as a percentage; the timing of the antibiotic usage was also recorded and compared to the guidelines (within 60 minutes before incision). ResultsIn total, 49 mediport placements, 118 tunneled central line placements – 44 hemodialysis (HD) catheters and 74 nonhemodialysis (non-HD) catheters, 100 nephrostomy exchanges, and 82 biliary tube exchanges were included. Antibiotics were used in 83.6% (41/49) of mediport patients, 11.3% (5/44) of non-HD TCL patients, 20.5% (15/74) of HD TCL patients, 55% (55/100) nephrostomy tube changes, and 65.4% (55/84) of biliary or cholecystostomy tube exchanges. Out of those given prophylaxis, guideline-recommended antibiotics were used in 100% (41/41) of mediport, 100% (20/20) of TCL (both HD and non-HD catheters), 9% (5/55) of nephrostomy tube exchanges, and 1.8% (1/55) of biliary tube exchanges. Guideline-recommended timing was followed in 75.3% across all cases (ranging from 72.2% in mediports to 79.3% in biliary exchanges). ConclusionThis study of antibiotic practices at a single university-based academic institution revealed that antibiotic usage is not fully up to date with 2018 guidelines. For mediports, non-HD TCL placements, and nephrostomy tube exchanges, institutional changes should be made to reduce periprocedural antibiotic use, as antibiotics are no longer recommended for these procedures. For HD TCL and biliary exchanges, proper adherence to recommended prophylactic antibiotics should be followed. In addition, education about the correct antibiotic timing should be emphasized to increase compliance with guidelines.

Potential Bias in Image-Guided Procedure Research: A Retrospective Analysis of Disclosed Conflicts of Interest and Open Payment Records

PurposeTo assess the prevalence of positive conflicts of interest (COI) disclosures in United States–based interventional radiology (IR) research as well as the level of agreement between disclosed financial relationships and Open Payment Data for top-cited image-guided procedure research. Materials and MethodsAll publications in volume 30 (2019) of the Journal of Vascular and Interventional Radiology (JVIR) were reviewed to estimate the prevalence of COI disclosures in IR research. Publications were categorized as primary research, systematic review, or other. The prevalence was subsequently compared across JVIR publication subtypes and categories and on the basis of whether they were device-focused publications using χ2 tests. Additionally, the Web of Science database was searched for the top 10 most cited studies of 10 common image-guided procedures with available U.S. physician payment data. The payments were categorized as historical (>1 year prior to publication) or active (<1 year prior to publication) and compared with the disclosed financial COIs using 1-way analysis of variance. ResultsPositive COI disclosures were present in 114 (29%) of the 397 publications in JVIR volume 30. Positive COI disclosures were most prevalent in standards of practice (50%, P = .01) and more prevalent in device-focused publications (54% vs 23%, P < .01). Among the 396 authors of 100 United States–based top-cited image-guided procedure publications, 383 (97%) failed to disclose at least 1 active financial relationship, with an average of $57,937 in undisclosed payments per publication. ConclusionsCOI are prevalent in IR, similar to other areas of healthcare research, and COI in top-cited image-guided procedure research are often underreported.

Pulmonary Arteriovenous Malformation Embolization: So Much Left to Learn

Embolization of pulmonary arteriovenous malformations (PAVMs) has been utilized effectively for more than 40 years. Initially performed using conventional coils and/or detachable balloons in the era of cut-film angiography, currently, there is an armamentarium of embolic devices and methods for effecting therapy. Two studies in this issue of the Journal of Vascular Interventional Radiology compare traditional feeding artery embolization with venous sac (“nidal”) embolization, and in both, sac embolization appeared to improve the occlusion rate of lesions (1,2).

Abstract No. 98 Relationships between conflicts of interest and publication type: the importance of managing bias in interventional radiology research

To characterize the relationships between disclosed conflicts of interest (COIs) and publication type in the Journal of Vascular and Interventional Radiology (JVIR) to identify opportunities to support the integrity of interventional radiology (IR) research.

Does Social Media have an Impact Factor?

Introduction: Social media is now an everyday part of modern life including medicine. There are an increasing number of healthcare professionals and institutions using social media in their clinical and academic practice1. One study alone in 2011 showed 90% of doctors used social media personally and 65% professionally2. Twitter provides a platform for signposting users to the most current and useful material and provide scope for alternative metrics. Historically, a healthcare professional would use the journal impact factor (JIF) of a journal to select the most appropriate to subscribe to and read, however in today's digital society, Twitter provides the ability to see updates across a range of journals and for the clinician to select what is most relevant for them. We therefore performed an observational study to assess whether there was a correlation between Twitter follower numbers (TFN) and JIF. Methods: A search of 10 popular general medicine, general surgery, vascular surgery and interventional radiology journals was performed, namely: Nature, The New England Journal of Medicine, The Lancet, The British Medical Journal (BMJ), The British Journal of Surgery, Circulation, European Journal of Vascular and Endovascular Surgery, Journal of Vascular Surgery (JVS), Journal of Vascular Interventional Radiology and CardioVascular and Interventional Radiology (CVIR). The 2017 JIF stated on their website as of 4th April 2019 was recorded. Of these 7 cited 2017 Journal Citation Reports3 as the source. The JVS and CVIR both stated a JIF that matched 2017 Journal Citation Reports3 but did not cite the source on website. The BMJ had a published 2017 JIF (23.562) that did not match the Journal Citation Reports (23.259)3 [Table 1]. A search of the journals on Twitter was made and the number of followers as of 15:15 GMT on 5th April was noted. Bivariate regression analysis of the TFN as a function of the JIF was undertaken using Minitab 18 statistical software. For the purpose of the analyses the JIF as per the journal website was used, as the minor variations indicated would be likely to have any major impact on the outcomes. Results: There was a visible impression that the higher the JIF the higher the TFN [Table 1]. However, there was low correlation between the JIF and number of followers (adjusted R-sq= 20.76%, p=.104; Graph 1), with occasional low JIF journals also having a large number of followers as noted in the graph outliers. Conclusion: Whilst journals with high JIF clearly had higher TFN, we could find no causal link to suggest that social media following was indeed impacted upon by the impact factor directly. This is likely due to confounding factors particularly the fact that the number of followers will be from a varied background and much higher than that of the number of actual directly contributing authors who are also journal followers, which then via individual and subsequently journal citation impact may possibly have a more direct correlation, but that is outside of the scope of the current analysis.Table 1Journal Impact Factors and Twitter followingGraph 1Scatterplot: correlation between TFN.and JIF.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

Abstract No. 486 Scholarly trends in interventional radiology: an analysis of U.S. female authorship in the Journal of Vascular and Interventional Radiology

To assess trends in U.S. female authorship of scientific articles published in a high-impact interventional radiology (IR) journal. A review of scientific articles published in the Journal of Vascular and Interventional Radiology (JVIR) from 2009-2018 was performed. Articles published over the last decade were reviewed for their authorship characteristics, including gender of the first and last authors, total number of female authors, total number of authors, and level of training of the female authors. From January 2009 to August 2018, 999 scientific articles were published in JVIR. Of these, 579 articles (58.0%) had at least one female author, while 997 articles (99.8%) had at least one male author. The average number of male authors per article outnumbered the average number of female authors per article when compared on a yearly basis. Over the last ten years, there has been an average of 5.7 male authors for every female author. 118 (11.8%) of all articles had a female first author and 79 (7.9%) had a female last author. When exclusively looking at the 579 articles having a female author, 118 (20.4%) had a female first author while 79 (13.6%) had a female last author. Training level was also examined with 663 (62.6%) of the 1059 female authors having an MD and 149 (14.1%) having a PhD. Although approximately 12% of all interventional radiologists are female, recent studies suggest there is an increasing number of women entering the field, particularly after the institution of the Integrated IR residency. However, female authorship of scientific articles in a leading IR journal has remained relatively stagnant over the past decade, while the number of female first and last authors remains disproportionately low. Further research which identifies barriers to scholarly involvement of females in IR will be essential as more females join the field and proportional representation in future academic contributions will be of critical importance.

Bridging the Gender Gap in the Society of IR: A Benchmark Study

PurposeTo evaluate the evolving representation of women in the Society of Interventional Radiology (SIR). Materials and MethodsA retrospective review of the available gender demographic data of various SIR subgroups between 2008 and 2017 was performed. The gender makeup of the following groups was analyzed: SIR membership, SIR Executive Council members and officers, Annual Meeting invited speakers, committee chairs, Journal of Vascular and Interventional Radiology (JVIR) first and senior authors, JVIR editorial board, IR Quarterly (IRQ) authors, and active interventional radiology (IR) residents and fellows. ResultsFrom 2008 to 2017, the percentage of female representation in SIR members doubled (from 6% to 13.1%). In the same period, female representation also significantly increased in Executive Council members (0% to 20%) and officers (0% to 50%), SIR Annual Meeting presenters (5.1% to 15.4%), and JVIR first authors (10% to 14.5%) and senior authors (7.1% to 11.9%). From 2012 to 2017, there were increases in female representation among SIR committee chairs (21% to 28%) and IRQ authors (4.5% to 27%). However, the percentage of female IR residents and fellows did not significantly change between 2008 and 2017 (11% vs 16.2%; P = .51). ConclusionsWomen interventional radiologists are underrepresented within SIR, representing only 9.2% of active IR physicians. There has been a steady increase in female representation within most areas of SIR evaluated in this study. Although these trends are reassuring, efforts toward increasing recruitment and retention of women in IR need to improve in light of the infancy of IR as a residency program.

Abstract No. 469 Representation of developing countries in interventional radiology research

The developing world accounts for greater than ¾ of the global population, yet prior studies have shown a disproportionately low representation of developing countries in the medical literature. No prior study has assessed the participation of authors from the developing world in interventional radiology (IR) journals. The purpose of this study was to determine the representation of studies from developing countries in two influential IR journals. We reviewed all articles published from January 2014 through December 2016: 1) Journal of Vascular and Interventional Radiology (JVIR) and 2) CardioVascular and Interventional Radiology (CVIR). The country of origin of the first author was identified for each study. Each country was grouped into either “developed” or “developing” based on designations provided by the International Monetary Fund. We compared representation of developing countries by journal and year using Chi-Square tests with Freeman-Halton extension, as appropriate. 1300 articles were reviewed from 2014 to 2016, of which 153 (12%) were from developing countries. The most prevalent developing country was China with 88 articles (58%), followed by Turkey with 24 (16%), India with 13 (8%), and Brazil with 9 (6%). Excluding China, only 5% of articles were from Developing countries. In contrast, the United States accounted for 462 articles (36%), followed by Japan with 113 (9%). There was significantly less representation of developing countries in JVIR (9%) compared with CVIR (15%) (p = 0.003). There was no significant difference in representation of developing countries between the years (p = 0.3). Developing countries are disproportionately under-represented in two influential IR journals. Further study is needed to determine reasons for this low representation and to develop strategies to increase the number of IR publications from parts of the world where the disease burden is greatest.

Impact Is Everything

June marked the month that Thomson Reuters released the impact factors for scientific journals. The Journal of Vascular and Interventional Radiology (JVIR) had a notable and very significant jump this year to 2.409 (from 2.149). As an editor, I’m interested in this and other quantitative measures, such as article half-lives, immediacy indices, and Eigenfactors (1). The impact factor is calculated from the mean of citations per manuscript in a calendar year divided by the total papers published in the two preceding years. Despite its dominant position in the world of journal metrics, the impact factor is a single partial metric that captures but one aspect of an academic journal’s universe, the scope of its scientific inquiry, and its vision or goals. We treat, and publish on, nearly every aspect of medicine and

JVIR Celebrates 25 Years of Innovation. Part 2: 1995–2000

The first editorial change for the Journal of Vascular and Interventional Radiology (JVIR) was nearly seamless. This development should come as no surprise, as the new Editor, Daniel Picus, MD (Fig 1), had been the Deputy Editor for the Journal since its inception. An editorial in his first issue (July–August 1995) (1) aptly laid out for the readership the goals for his tenure as the second JVIR Editor:The first is to make JVIR the most widely recognized forum for original scientific publications in our specialty.

JVIR Celebrates 25 Years of Innovation. Part 1: 1989–1995

For 25 years, the Journal of Vascular and Interventional Radiology (JVIR) has served as a leading global forum for the publication of innovative, impactful, and inquisitive medical science in the field of vascular and interventional radiology. As the official journal of the Society of Interventional Radiology (SIR), JVIR experienced solid growth and recognition, which have paralleled and showcased the growth and recognition of the Society as well as of the specialty.

Refrain, Recover, Replace

In this issue of Journal of Vascular Interventional Radiology, two articles address the removal of fractured retrievable vena cava filters after prolonged dwell times ( 1 Dinglasan L.A.V. Trerotola S.O. Shlansky-Goldberg R.D. Mondschein J. Stavropoulos S.W. Removal of fractured inferior vena cava filters: feasibility and outcomes. J Vasc Interv Radiol. 2012; 23: 181-187 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar , 2 Vijay K. Huges J.A. Burdette A.S. et al. Fractured Bard Recovery, G2, and G2 express inferior vena cava filters: incidence, clinical consequences, and outcomes of removal attempt. J Vasc Interv Radiol. 2012; 23: 188-194 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar ). Both of these articles shed light on the next steps in the management of fractured vena cava filters. As is often the case when business and legal implications cloud the waters of clinical practice, scientific reporting lends clarity to physicians and patients facing daunting treatment decisions. The two main issues that continue to challenge physicians and patients who have received a retrievable filter are as follows: (i) Is the filter durable over a prolonged time? (ii) If it is not durable, can it be removed safely years after its implantation? Fractured Bard Recovery, G2, and G2 Express Inferior Vena Cava Filters: Incidence, Clinical Consequences, and Outcomes of Removal AttemptsJournal of Vascular and Interventional RadiologyVol. 23Issue 2PreviewTo increase the understanding of risks of inferior vena cava (IVC) filter fracture and embolization and the safety of removing fractured filters via retrospective review of a prospectively collected database of fractured IVC filters. Full-Text PDF Removal of Fractured Inferior Vena Cava Filters: Feasibility and OutcomesJournal of Vascular and Interventional RadiologyVol. 23Issue 2PreviewTo examine the feasibility and outcomes of removing retrievable inferior vena cava (IVC) filters that have fractured. Full-Text PDF

Quality of Interventional Radiology Journals and Papers

Quality of Interventional Radiology Journals and Papers

Letter From the Editor

Recently, the editors and staff of the Journal of Vascular and Interventional Radiology (JVIR) launched the first of what we hope will become a series of “virtual collections.” Such collections gather together the electronic versions of articles related to a focused topic in an organized manner, obviating the need for interested readers to search them out and access them individually.

Introduction

Six years ago, the Journal of Vascular and Interventional Radiology (JVIR) published a supplement based on the many documents developed to that point by the Standards Division of the Society of Interventional Radiology (SIR). These documents were products of a laudable intent on the part of SIR leadership to improve the quality of clinical care and published research relevant to the practice of interventional radiology. As is clear from the supplement you are now reading, the Standards Division has resisted any tendency to stand still since publication of the initial collection, and has continued to develop new content as well as to revise older documents as appropriate. The output has been prodigious in terms of both volume and quality, and SIR should be justly proud of the Standards Division efforts. I wish to acknowledge and personally thank the many members of the Standards Division for the tremendous amount of thought and labor that has gone into these documents. In particular, I would like to express my gratitude to John F. Cardella, MD, FSIR, FACR, FAHA, the Standards Division Councilor, who has shepherded these documents through their development, and who serves as the guest editor for this supplement. By way of introduction, in the Table of Contents to this supplement, readers will notice three new icons used to designate specific types of articles. The CPG icon refers to Clinical Practice Guidelines under which fall Quality Improvement Guidelines, Safety Guidelines, Consensus Documents, Credentialing Statements, and Policy and Position Statements. The SIR develops Clinical Practice Guidelines in an attempt to define practice principles that generally should assist in producing high quality patient care. The RS icon refers to Reporting Standards, which are developed by the SIR Technology Assessment Committee. Reporting Standards serve as important guidelines for industry and the FDA in the evaluation of new devices during pre-market trials and development. Finally, the ET icon refers to Emerging Technologies, documents written about new and emerging technologies used in the practice of interventional radiology. These icons will appear in future regular issues of the journal to help readers readily identify articles. Sincerely,

JVIR Turns 20!

an THIS year, 2009, marks the 20th anniversary of publication of the Journal of Vascular and Interventional Radiology (JVIR), a milestone commemorated by the added logo on the Journal cover. While still relatively youthful as medical periodicals go—the New England Journal of Medicine, for example, the oldest continuously published medical journal in the world, is nearly 200 years old—a lot has happened in our field during the past 2 decades. Indeed, in one sense, the Journal is even older than the subspecialty itself, as formal recognition of our discipline’s training programs, and of our practitioners through the granting of Certificates of Added Qualification, did not occur until after volume 1 of JVIR was published. It seems fitting, then, to devote some time and a few pages during the year to look back at the past 20 years and to provide some perspective with regard to the Journal’s growth and evolution. So, to start, a brief overview of the Journal’s history: In 1987, our society (then SCVIR, the Society of Cardiovascular and Interventional Radiology) formed a Journal Committee with the goal of establishing a regular publication dedicated to our subspecialty. The Committee partnered with the Radiological Society of North America (RSNA), producing three RSNA-SCVIR “Special Series” issues from 1987 to 1989. When these met with a favorable response, plans for a separate journal commenced. In November 1990, the inaugural issue of JVIR was published with Gary Becker as the Editor-in-Chief and Cathy Mendelsohn as the Managing Editor. Growth and recognition of the Journal paralleled the growth and recognition of the subspecialty during the next several years. In the same year (1992) that “interventional radiology” was first defined in Dorland’s Illustrated Medical Dictionary, the National Library of Medicine selected JVIR to be included in the Index Medicus (1). Despite a small but significant “bump in the road”—the destruction of the JVIR editorial office in Miami by Hurricane Andrew in August of the same year, JVIR had moved to bimonthly publication by 1993. Two years later, in 1995, Daniel Picus took over as Editor-in-Chief of the Journal. During the 1st year of his tenure, JVIR published its first supplement issue, which was dedicated to “Thrombolytic Therapy in Peripheral Vascular Disease.” In 1996, Lippincott became the publisher for JVIR, a partnership that would last a decade. As the number of submitted manuscripts steadily increased (Figure), the Journal moved to 10 issues per year in 1999 and began monthly publication in 2001. In November 2000, Karim Valji became the Editor-in-Chief for JVIR. Under Dr Valji’s guidance, JVIR moved into the electronic age. In February 2001, full-text articles of the Journal became available online, and, 3 years later, JVIR launched its online manuscript submission and review system. Figure. Graph illustrates the growth of m

Endovascular stents for intermittent claudication.

Endovascular stents have been suggested as a means to improve the patency of arteries after angioplasty in patients with intermittent claudication. The null hypothesis to be tested by this review is that for individuals with claudication, the use of an endovascular stent in addition to percutaneous transluminal angioplasty, does not improve symptoms of life-style limiting claudication, when compared to percutaneous angioplasty alone. We searched the Specialised Register of the Cochrane Peripheral Vascular Disease Group, (last searched October 2002), and the Cochrane Central Register of Controlled Trials (CENTRAL), (last searched Issue 3, 2002). We also searched MEDLINE and EMBASE (up to and including January 2001); bibliographies of published data, and hand searched the Journal of Vascular Interventional Radiology (1990-2001). Enquiries were made to stent manufacturers for unpublished trial data. Randomised trials comparing angioplasty alone, versus angioplasty with endovascular stents, in subjects with intermittent claudication. Both reviewers independently assessed trial quality and extracted the data. Only published trial data were used. Effectiveness was measured by pre-defined primary outcome measures: restenosis / reocclusion rates and maximum walking distance. Two trials were included with a total sample size of 104 subjects. Both trials included only individuals with femoro-popliteal disease and compared angioplasty and stenting with the Palmaz stent against angioplasty alone. Although one study showed a slight statistical advantage in arterial patency after angioplasty alone, this was not found when the two studies were combined. No differences in the secondary outcomes in either study were detected. The small number of relevant trials identified, together with the small sample sizes and methodological weaknesses, severely limit the usefulness of this review in guiding practice. Larger multicentre trials are needed.