Standards Division Research Articles

Best practices for interventional pain procedures in the setting of a local anesthetic shortage: A practice advisory from the Spine Intervention Society

Representatives from the Spine Intervention Society (SIS) Standards Division and Evidence Analysis Committee have developed the following best practice recommendations for the performance of interventional pain procedures in the setting of a local anesthetic shortage. The practice advisory has been endorsed by SIS, the American Academy of Pain Medicine, the American College of Radiology, the American Society of Neuroradiology, the American Society of Spine Radiology, the North American Neuromodulation Society, the North American Spine Society, and the Society of Interventional Radiology, who support the following best practice recommendations and statements for the performance of intra-articular, extra-articular, paraspinal, and epidural injections in the setting of a local anesthetic shortage.1.Use of preservative-containing local anesthetics is discouraged in the performance of neuraxial procedures where the injectate may enter the epidural (or intrathecal) spaces.2.When performing procedures with risk of arterial injection, ropivacaine should not be mixed with dexamethasone and injected due to the risk of crystallization and embolization.3.Physicians should not withdraw directly from vials of local anesthetic for multiple patients due to infection risk as per Centers for Disease Control and Prevention (CDC) and Joint Commission guidelines [1].4.Only pharmacists may repackage local anesthetic vials for multiple patients. This must be performed under strict, sterile conditions and only in times of critical need. In such situations, physicians must adhere to the beyond-use-date and storage conditions on the repackaged label [2,3].5.Joint, tendon, bursa, and/or ligament injections may be performed with local anesthetic with or without preservative.6.Interventional pain physicians should weigh the relative chondrotoxicity risks associated with each anesthetic when performing joint injections.7.Topical anesthetics, infiltration with diphenhydramine, and nonpharmacologic therapies (i.e., cognitive behavioral therapy, guided imagery, virtual reality, mechanodesensitization) may be used as alternatives to skin infiltration of local anesthetic for reducing procedural pain.8.Use of small-gauge needles (25 gauge or thinner) mitigates the need for local anesthetic prior to needle insertion.9.For local anesthetic infiltration prior to insertion of large bore needles or incision, 0.5% lidocaine may be as effective as 1%, and for that reason current supplies of lidocaine can be stretched by dilution with normal saline.10.If using an ester local anesthetic due to an amide local anesthetic shortage, interventional pain physicians should be aware (as always) of the potential for an allergic reaction and should be able to respond accordingly.11.Local anesthetic systemic toxicity (LAST) differs between the varying local anesthetics, and interventional pain physicians should be well acquainted with these differences when switching between local anesthetics.Physicians should carefully weigh the risks and benefits of performing procedures without local anesthetic or using an alternative agent in the context of each unique patient's situation and should involve patients in shared decision making before proceeding.Procedures should be performed following Spine Intervention Society Guidelines [4]. The physician should confirm placement of the needle in at least two imaging planes. Please refer to the SIS Practice Guidelines for the full details and standards related to each unique procedure [4].

Washington Hotline

Library of Congress changes immigration subject headings At its regularly scheduled meeting on November 12, 2021, the Policy and Standards Division of the Library of Congress, which maintains Library of Congress Subject Headings, announced the decision to replace the subject headings “Aliens” and “Illegal aliens.” The terms will be replaced with new subject headings “Noncitizens” and “Illegal immigration.”

Comparative Study of Differentially Private Synthetic Data Algorithms from the NIST PSCR Differential Privacy Synthetic Data Challenge

Differentially private synthetic data generation offers a recent solution to release analytically useful data while preserving the privacy of individuals in the data. In order to utilize these algorithms for public policy decisions, policymakers need an accurate understanding of these algorithms' comparative performance. Correspondingly, data practitioners also require standard metrics for evaluating the analytic qualities of the synthetic data. In this paper, we present an in-depth evaluation of several differentially private synthetic data algorithms using actual differentially private synthetic data sets created by contestants in the recent National Institute of Standards and Technology Public Safety Communications Research (NIST PSCR) Division's ``"Differential Privacy Synthetic Data Challenge." We offer analyses of these algorithms based on both the accuracy of the data they create and their usability by potential data providers. We frame the methods used in the NIST PSCR data challenge within the broader differentially private synthetic data literature. We implement additional utility metrics, including two of our own, on the differentially private synthetic data and compare mechanism utility on three categories. Our comparative assessment of the differentially private data synthesis methods and the quality metrics shows the relative usefulness, general strengths and weaknesses, preferred choices of algorithms and metrics. Finally we describe the implications of our evaluation for policymakers seeking to implement differentially private synthetic data algorithms on future data products.

Integrating electronic health records from different sources across the UK: lessons from a record linkage study

BackgroundHarmonisation of different data sources from various electronic health records (EHRs) across systems enhances the potential scope and granularity of data available to health data research.
 ObjectiveTo describe data harmonisation of routine electronic healthcare records in Wales and Scotland linked to a UK longitudinal birth cohort, the Millennium Cohort Study (MCS).
 MethodsComparable secondary care data was linked, with parental consent, to MCS information for 1838 and 1431 children participating in MCS and residing in Wales and Scotland, by assigning, respectively, unique Anonymised Linkage Fields to personbased records in the privacy protecting Secure Anonymised Information Linkage (SAIL) databank at Swansea University, and by the National Health Service (NHS) Information Standards Division. Survey and non-response weights were created to account for the clustered sample, sample attrition and consent to linkage. Heterogeneous variables from the Patient Episode Dataset for Wales, Emergency Department Data Set for Wales, Scottish Medical Record 01 and Accident and Emergency dataset for Scotland were harmonised enabling data to be pooled and standardised for research.
 FindingsOverall linkage to harmonised health care data was achieved for 98.9% (99.9% for Wales and 97.6% for Scotland) of consented MCS participants. 66% of children experienced at least one hospital admission (total 5747 hospital admissions) up totheir 14th birthday, while 60% attended A&E departments at least once (total 5221 attendances) between their 9th and 14th birthday. We managed date granularity by generating random dates of birth, standardising periods of data collection,identifying inconsistencies and then mapping and bridging differences in definitions of periods of care across countries and datasets.
 ConclusionsCombining and harmonising data from multiple sources and linking them to information from a longitudinal cohort create useful resources for population health research. These methods are reproducible and can be utilised by other researchersand projects.

RDA implementation at Casalini

Casalini Libri started cataloguing in the 1960s to ensure that bibliographic information for new scholarly publications in our areas of expertise (works from Italy, France, Spain, Portugal, Malta and Greece) were available to academic libraries worldwide, and we now have a staff of 25 cataloguers. As a member of the Program of Cooperative Cataloguing, Casalini started with day 1 of RDA, April 1, 2013, producing authority records in the format as well as updating existing records. Now, all the bibliographic records we provide are in RDA, approximately 500 books every week, and some of our staff have even worked on the Italian translation of RDA. Casalini Libri is also a contributor to NACO and SACO, submitting subject headings (in RDA) and call numbers, to the revision of the Policy and Standards Division of the Library of Congress.

Use of Relative Speed Zones Increases the High-Speed Running Performed in Team Sport Match Play.

This study investigated the activity profiles of junior rugby league players competing in 3 distinct age groups (Under 13, 14, and 15), and 2 distinct playing standards (division 1 and 4). In addition, we reported global positioning system (GPS) data using predefined absolute speed thresholds and speed thresholds expressed relative to a players' individual peak velocity. Ninety male junior rugby league players, representing 1 of 6 teams competing in the Brisbane junior rugby league competition, underwent measurements of peak velocity (through a 40-m sprint) and GPS analysis during competitive matches. Data were described as both absolute speed zones and relative to the individual player's peak velocity. Absolute measures of moderate-, high-, and very high-speed running distances increased with age with the differences among groups typically small to moderate (effect size = 0.24-0.68) in magnitude. However, when data were expressed relative to a players' capacity, younger players and those from lower playing divisions exhibited higher playing intensities and performed greater amounts of high-intensity activity. Moderate and negative relationships (r = -0.43 to -0.46) were found between peak velocity and the amount of relative high-speed running performed. These findings suggest that individualization of velocity bands increases the high-speed running attributed to slower players and decreases the high-speed running attributed to faster players. From a practical perspective, consideration should be given to both the absolute and relative demands of competition to provide insight into training prescription and the recovery requirements of individual players.

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,

Society of Interventional Radiology clinical practice guidelines.

WELCOME to the 2009 edition of the Society of Interventional Radiology (SIR) Clinical Practice Guidelines Supplement of JVIR, which we hope you will find useful and informative for your day-to-day practice of interventional radiology (IR). Since the last Clinical Practice Guidelines Supplement was published in 2003, there have been many changes in IR practice leading to the publication of new documents from the SIR Standards Division. The intent of coalescing the documents from the Standards Division into one edition is to help members have the Clinical Practice Guidelines in one convenient reference source for daily reference and to bring them to the attention of SIR members and JVIR readers and authors.

Patient Care and Uterine Artery Embolization for Leiomyomata

R. Torrance Andrews, MD, James B. Spies, MD, David Sacks, MD, Robert L. Worthington-Kirsch, MD, Gerald A. Niedzwiecki, MD, M. Victoria Marx, MD, David M. Hovsepian, MD, Donald L. Miller, MD, Gary P. Siskin, MD, Rodney D. Raabe, MD, Scott C. Goodwin, MD, Robert J. Min, MD, Joseph Bonn, MD, John F. Cardella, MD, and Nilesh H. Patel, MD, for the Task Force on Uterine Artery Embolization and the Standards Division of the Society of Interventional Radiology

Recommendations for the Implementation of Joint Commission Guidelines for Labeling Medications

Recommendations for the Implementation of Joint Commission Guidelines for Labeling Medications

Emerging Technologies Articles

THE Society of Interventional Radiology (SIR) recognizes that research and development of new techniques and therapies is vital for the continued success of interventional radiology and medicine as a whole. Dissemination of knowledge of groundbreaking information to potential researchers in interventional radiology is clearly a critical part of this process. Consequently, in 2005, the SIR Operations Committee identified emerging technologies as an important initiative and assigned part of the task of bringing these to the attention of SIR members to the Technology Assessment Committee of the SIR Standards Division.

Conflicts of Interest in the Development of New Interventional Medical Devices

THE Standards Division of the Society of Interventional Radiology (SIR) recently created the Emerging Technologies Workgroup of the Technology Assessment Committee for the “dissemination of knowledge of groundbreaking information to potential researchers in interventional radiology.” Committee members are requested to determine new technologies and innovations that may become of particular importance to interventional radiologists. Many of these innovations are developed, supported, or promoted at least in part by the medical devices industry. Consequently, cooperation between physician researchers and in-

Conflicts of Interest in the Development of New Interventional Medical Devices

THE Standards Division of the Society of Interventional Radiology (SIR) recently created the Emerging Technologies Workgroup of the Technology Assessment Committee for the “dissemination of knowledge of ground-breaking information to potential researchers in interventional radiology.” Committee members are requested to determine new technologies and innovations that may become of particular importance to interventional radiologists. Many of these innovations are developed, supported, or promoted at least in part by the medical devices industry.

Society of Interventional Radiology Position Statement on Percutaneous Radiofrequency Ablation for the Treatment of Liver Tumors

Focal tumor ablation--whether applied percutanously, laparoscopically, or by means of open surgery-is an effective therapy for selected liver tumors. The choice of liver ablation as well as the choice between percutaneous and surgical approaches is dependent on tumor factors, patient factors, and other viable treatment options. Currently, the largest cumulative reported experience is with radiofrequency (RF) ablation of hepatocellular carcinoma and colorectal metastases. This document is a position statement of the Interventional Oncology Task Force and the Standards Division of the Society of Interventional Radiology regarding the use of percutaneous RF ablation for the treatment of liver tumors.

Society of Interventional Radiology Position Statement on Percutaneous Radiofrequency Ablation for the Treatment of Liver Tumors

Focal tumor ablation--whether applied percutanously, laparoscopically, or by means of open surgery--is an effective therapy for selected liver tumors. The choice of liver ablation as well as the choice between percutaneous and surgical approaches is dependent on tumor factors, patient factors, and other viable treatment options. Currently, the largest cumulative reported experience is with radiofrequency (RF) ablation of hepatocellular carcinoma and colorectal metastases. This document is a position statement of the Interventional Oncology Task Force and the Standards Division of the Society of Interventional Radiology regarding the use of percutaneous RF ablation for the treatment of liver tumors.

Integrating learning into a hierarchical vehicle control system

The National Institute of Standards and Technology's (NIST) Intelligent Systems Division (ISD) is a participant in the Defense Advanced Research Projects Agency (DARPA) LAGR (Learning Applied to Ground Robots) Program. The NIST team's objective for t

Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters

Reporting Standards for Inferior Vena Caval Filter Placement and Patient Follow-up: Supplement for Temporary and Retrievable/Optional Filters

Statistical machine translation gains respect

Relatively few researchers have worked on approaches that compare and analyze documents and their already-available translations to determine statistically, without prior linguistic knowledge, the likely meanings of phrases. These statistical systems use this information to translate new documents. For years, because processors were not fast enough to handle the extensive computation these systems require, many experts considered statistical systems inferior to rule-based systems. However, when the Speech Group of the US National Institute of Standards and Technology's Information Access Division tested 20 machine translation technologies, a statistical system developed by Google finished in first place. The NIST test results' significance is that Google and other organizations will invest more time, money, and talent into researching this approach. Meanwhile, faster processors and other advances are making statistical translation technology more accurate and thus more useful. However, the approach must still clear several hurdles - such as still inadequate accuracy and problems recognizing idioms - before it can be useful for mission-critical tasks.

Building an information commons at the National Institute of Standards and Technology Library : a case study

With the advent of the new Knowledge Society, special libraries need to review user zones and services to ensure that they continue to provide features customers want and need. They must now offer spaces and places for people to come together, as in the English Commons of old, to share ideas and technologies. They must heed the call of the open access movement and begin to play a part in it. This article discusses details of the transformation of physical and virtual spaces of the Research Library of the National Institute of Standards and Technology over the past two years into a comprehensive InfoCommons. Introduction The Information Commons is here to stay. New times and user expectations now call for libraries to redraw blueprints and move to innovative service models. We need to adapt, evolve, and reassess to ensure that library spaces—physical and virtual—are useful to users in today’s Knowledge Society. Two years ago, the United States National Institute of Standards and Technology (NIST) Information Services Division and Research Library in Gaithersburg, Maryland began recreating itself to align with a concept of the Information Commons tailored to its customers. Two cross-divisional teams conceived ideas that would optimize the building’s physical space and place digitized NIST documents within the public grasp. A group of reference librarians worked with an advisory board of scientists to add open access journal links to the library’s web site.

Response to the ACC/ACP/SCAI/SVMB/SVS Clinical Competence Statement on Catheter-based Peripheral Vascular Interventions

THE August 16, 2004, issue of the Journal of the American College of Cardiology contains an article titled “Clinical Competence Statement on Vascular Medicine and Catheter-Based Peripheral Vascular Interventions (1).” It is an official multisociety statement from the American College of Cardiology (ACC), the American College of Physicians, the Society of Cardiac Angiography and Interventions, the Society for Vascular Medicine and Biology, and the Society for Vascular Surgery. The statement had its origins in an ACC/American Heart Association (AHA)/American College of Physicians task force and originally included authors from interventional radiology as well. The Society of Interventional Radiology (SIR) had fundamental disagreements with significant portions of the document that prevented endorsement from the Society and resulted in the removal of the names of the interventional radiology authors from the document. When the statement was submitted to a vote by all of the AHA scientific council leaders after open discussion, a narrow majority voted several times to remove the AHA’s name and endorsement from the document. Instead, it was published through the ACC with endorsement from the other listed societies. The document contains two separate parts. The first part is a training curriculum for those who wish to be called vascular medicine specialists. This involves a description of the optimal training to produce a specialist competent to care for patients with any vascular problem of any complexity. The SIR does not disagree with the value of the suggested curriculum, although recognition of medical specialties and creation of training curricula come from the American Board of Medical Specialties and the Residency Review Committee rather than from statements from those within the field. The second part of the document is a revision of the original 1992 AHA minimum training necessary for competence to perform catheter-based peripheral vascular interventions (2). The original AHA training requirements (also adopted by the ACC [3]) were authored by members from interventional radiology, interventional cardiology, and vascular surgery. The requirements were 100 diagnostic peripheral arteriograms, 50 peripheral angioplasty procedures, and 10 cases of percutaneous catheter-directed thrombolysis, of which 50% must be performed as primary operator. The new requirements as stated in the current ACC document have two major changes. There are separate requirements for extracranial cerebral interventions (section 2d in the Table) and there are now categories of competence restricted to individual arterial vascular beds (aortoiliac/brachiocephalic, infrainguinal, and renal; section 3 in the Table). The SIR has fundamental disagreements with these revisions. For competence to perform extracranial cerebral interventions (predominantly carotid artery stent placement), the ACC statement has two training pathways. If the physician is fellowship-trained in peripheral vascular interventions, there are no specific requirements for performance of diagnostic cerebral arteriography or extracranial cerebral interventions. For established physicians without such previous fellowship training in peripheral vascular interventions, the statement requires the operator to have performed 30 diagnostic cerebral arteriography procedures and 25 extracranial cerebral interventions, with at least half of the procedures as primary operator. The diagnostic arteriography procedures and interventions are likely to be performed on the same patient in the same sitting. Therefore, the requirements are only 15 diagnostic arteriograms (as primary operator) and 13 interventions (as primary operator). These cases contribute to the overall requirement of 100 diagnostic peripheral arteriograms and 50 interventions in any vascular bed that the physician must still meet. The document acknowledges that the cerebral vasculature is a unique category beFrom the Department of Radiology, The Reading Hospital and Medical Center, Department of Radiology, Sixth and Spruce Streets, Reading, Pennsylvania 19603; Standards Division Councilor, Society of Interventional Radiology, Fairfax, Virginia. Address correspondence to D.S.; E-mail: davidsacks@pol.net