Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 87
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
J Vasc Interv Radiol ; 35(8): 1097-1103, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38685470

RESUMO

Genicular artery embolization (GAE) is an emerging, minimally invasive therapy to address the global burden of knee osteoarthritis (OA) and the unmet needs for medically refractory disease. Although total knee arthroplasty has been a standard intervention for severe cases, GAE is developing into a promising alternative, particularly for patients ineligible for or unwilling to undergo surgery. GAE targets the inflammatory cascade underlying OA pathophysiology by arresting neoangiogenesis and preventing pathological neoinnervation, offering potential pain relief. Although early studies have established safety and short-term effectiveness, ensuing studies are needed to validate long-term safety, durability, and comparative effectiveness and to optimize patient selection, embolic agent selection, and administration techniques. Standardized reporting guidelines are therefore essential to enhance transparency and reproducibility across clinical trials, facilitating data aggregation and comparison. This Society of Interventional Radiology (SIR)-endorsed reporting standards consensus document provides a framework to harmonize future research efforts and to improve the interpretation of outcomes.


Assuntos
Consenso , Embolização Terapêutica , Osteoartrite do Joelho , Humanos , Embolização Terapêutica/normas , Embolização Terapêutica/efeitos adversos , Resultado do Tratamento , Osteoartrite do Joelho/terapia , Osteoartrite do Joelho/diagnóstico por imagem , Projetos de Pesquisa/normas , Radiografia Intervencionista/normas
2.
Respir Res ; 24(1): 17, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650544

RESUMO

BACKGROUND: Molecular testing can detect actionable genomic alterations and tumor cell surface proteins in patients with non-small cell lung cancer (NSCLC). However, utilization remains suboptimal, representing missed treatment opportunities. This study aimed to identify challenges and potential solutions to obtaining percutaneous lung needle biopsy specimens for successful molecular testing in patients with advanced NSCLC. METHODS: This interdisciplinary qualitative study included ten radiologists and four pathologists from academic and community settings across the United States who routinely perform and analyze percutaneous lung needle biopsies. Participants underwent semi-structured one-on-one interviews (Phase 1). Interview questionnaires were constructed based on a literature review of key lines of inquiry and conducted by professional market researchers using the theoretical domains framework. Primary barriers to molecular testing were identified using thematic analysis. Subsequently, multidisciplinary focus groups were convened to identify potential solutions (Phase 2). RESULTS: Four themes emerged as barriers to molecular testing and were matched to the clinical workflow: (1) biopsy request, (2) biopsy procedure, (3) specimen analysis, and (4) communication. The nineteen potential solutions included adding a "checkbox" to indicate molecular testing in the biopsy request, leveraging pre-procedural imaging to guide biopsies, conserving tissue through appropriate allocation strategies and next generation sequencing panels instead of sequential single-gene assays, instituting reflex-molecular testing upon NSCLC diagnosis, tracking and communicating biopsy outcomes at multidisciplinary tumor boards, and improving integration of radiologists and pathologists into oncology care teams. CONCLUSIONS: Potential solutions exist to increase successful molecular testing of lung needle biopsy specimens in patients with advanced NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Estados Unidos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Biópsia por Agulha , Biópsia , Técnicas de Diagnóstico Molecular
3.
Radiology ; 301(3): 533-540, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34581627

RESUMO

There is currently no consensus regarding preferred clinical outcome measures following image-guided tumor ablation or clear definitions of oncologic end points. This consensus document proposes standardized definitions for a broad range of oncologic outcome measures with recommendations on how to uniformly document, analyze, and report outcomes. The initiative was coordinated by the Society of Interventional Oncology in collaboration with the Definition for the Assessment of Time-to-Event End Points in Cancer Trials, or DATECAN, group. According to predefined criteria, based on experience with clinical trials, an international panel of 62 experts convened. Recommendations were developed using the validated three-step modified Delphi consensus method. Consensus was reached on when to assess outcomes per patient, per session, or per tumor; on starting and ending time and survival time definitions; and on time-to-event end points. Although no consensus was reached on the preferred classification system to report complications, quality of life, and health economics issues, the panel did agree on using the most recent version of a validated patient-reported outcome questionnaire. This article provides a framework of key opinion leader recommendations with the intent to facilitate a clear interpretation of results and standardize worldwide communication. Widespread adoption will improve reproducibility, allow for accurate comparisons, and avoid misinterpretations in the field of interventional oncology research. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Liddell in this issue.


Assuntos
Técnicas de Ablação/métodos , Neoplasias/cirurgia , Consenso , Humanos , Reprodutibilidade dos Testes , Sociedades Médicas
4.
6.
J Vasc Interv Radiol ; 28(10): 1432-1437.e3, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28757285

RESUMO

PURPOSE: To develop a new adverse event (AE) classification for the interventional radiology (IR) procedures and evaluate its clinical, research, and educational value compared with the existing Society of Interventional Radiology (SIR) classification via an SIR member survey. MATERIALS AND METHODS: A new AE classification was developed by members of the Standards of Practice Committee of the SIR. Subsequently, a survey was created by a group of 18 members from the SIR Standards of Practice Committee and Service Lines. Twelve clinical AE case scenarios were generated that encompassed a broad spectrum of IR procedures and potential AEs. Survey questions were designed to evaluate the following domains: educational and research values, accountability for intraprocedural challenges, consistency of AE reporting, unambiguity, and potential for incorporation into existing quality-assurance framework. For each AE scenario, the survey participants were instructed to answer questions about the proposed and existing SIR classifications. SIR members were invited via online survey links, and 68 members participated among 140 surveyed. Answers on new and existing classifications were evaluated and compared statistically. Overall comparison between the two surveys was performed by generalized linear modeling. RESULTS: The proposed AE classification received superior evaluations in terms of consistency of reporting (P < .05) and potential for incorporation into existing quality-assurance framework (P < .05). Respondents gave a higher overall rating to the educational and research value of the new compared with the existing classification (P < .05). CONCLUSIONS: This study proposed an AE classification system that outperformed the existing SIR classification in the studied domains.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde/normas , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/normas , Radiologia Intervencionista/normas , Humanos , Sociedades Médicas
8.
J Vasc Interv Radiol ; 27(3): 307-21.e2, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26803573

RESUMO

A meta-analysis was performed to assess randomized controlled trials comparing local endovascular therapy (with and without intravenous thrombolysis) versus standard care (intravenous thrombolysis alone when appropriate) for acute ischemic stroke. Local endovascular therapy showed a significant improvement in functional independence versus standard care (odds ratio, 1.779; 95% confidence interval, 1.262-2.507; P < .001). This benefit strengthened further on subgroup analyses of trials in which a majority of cases used stent retrievers, trials with intravenous thrombolysis use in both arms when appropriate, and trials that required preprocedural imaging of all patients. There were no significant differences between arms in terms of mortality, hemicraniectomy, intracranial hemorrhage, and cerebral edema rates (P > .05). In conclusion, in the treatment of acute ischemic stroke, local endovascular therapy leads to improved functional independence compared with standard care.


Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Administração Intravenosa , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Circulação Cerebrovascular , Avaliação da Deficiência , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Fibrinolíticos/efeitos adversos , Humanos , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Resultado do Tratamento
9.
AJR Am J Roentgenol ; 207(4): W53-W57, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27440526

RESUMO

OBJECTIVE: Checklists are tools commonly used to help confirm that certain tasks of a process are completed. Within the health care industry, medical checklists are recognized as a means to improve patient safety. CONCLUSION: Recent application of checklists to image-guided interventions has shown positive outcomes; however, there are limited published studies. We review the literature regarding checklist use as a safety measure and focus on implementation of checklists for image-guided interventions.

11.
J Vasc Interv Radiol ; 26(4): 459-73.e4; quiz 474, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25703839

RESUMO

PURPOSE: To perform a meta-analysis of randomized controlled trials (RCTs) of drug-eluting balloon (DEB) angioplasty and drug-eluting stents (DESs) for infrainguinal peripheral arterial disease. MATERIALS AND METHODS: Systematic searches were performed for all relevant RCTs. RESULTS: Eight RCTs for DEB angioplasty and 12 RCTs for a DES in peripheral arterial disease were identified. Meta-analysis demonstrated statistically significant superiority of DEB over plain balloon angioplasty of femoral-popliteal disease for late lumen loss, restenosis, and target lesion revascularization, with no benefit in major amputation or mortality. Statistically significant superiority of DEB over percutaneous transluminal angioplasty (PTA) was demonstrated for infrapopliteal disease for restenosis and target lesion revascularization. Drug-eluting stents showed statistically significant superiority over bare metal stents (BMSs) of femoral-popliteal disease for late lumen loss and restenosis, with no benefit in mortality or amputation. Drug-eluting stents showed statistically significant superiority over BMSs of infrapopliteal disease restenosis and target lesion revascularization, with no benefit in amputation or mortality. CONCLUSIONS: Drug-eluting balloon angioplasty and DESs demonstrated superior outcomes compared to PTA and BMS, with no difference in amputation or mortality.


Assuntos
Angioplastia com Balão/mortalidade , Stents Farmacológicos/estatística & dados numéricos , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/terapia , Idoso , Angioplastia com Balão/estatística & dados numéricos , Feminino , Artéria Femoral/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Taxa de Sobrevida
14.
Radiology ; 273(1): 241-60, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24927329

RESUMO

Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article .


Assuntos
Técnicas de Ablação/métodos , Neoplasias/cirurgia , Radiografia Intervencionista , Projetos de Pesquisa/normas , Terminologia como Assunto , Humanos , Neoplasias/patologia
15.
J Vasc Interv Radiol ; 25(11): 1777-84, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25161128

RESUMO

PURPOSE: To survey the status quo of ancillary staffing in predominantly hospital-based interventional radiology (IR) suites and to assess interventional radiologist attitudes toward current IR procedure room staffing availability and appropriateness. MATERIALS AND METHODS: Invitations to an online survey composed of 26 questions focused on levels of IR suite ancillary staffing as well as operators' opinions of current IR procedure room staffing were sent via email to 2,284 active Society of Interventional Radiology members. RESULTS: There were 777 survey responses. Nurse staffing count per IR room was at least one in 90% (n = 699) during regular hours and 93.6% (n = 730) during off-hours, respectively. A second technologist was frequently used during regular hours and, to a lesser extent, during on-call hours (n = 341 [43.9%] and n = 122 [15.7%]), respectively. Ten and 15% of IR respondents believe staffing support is inadequate for most interventional procedures requiring moderate sedation during normal business hours and off-hours/weekends, respectively, and 69% and 56% of IR respondents believe anesthesia support is inadequate during normal business hours and during off-hours, respectively. CONCLUSIONS: The number of technologists used per IR suite varies across practices and frequently exceeds that of earlier American College of Radiology recommendations, whereas use of IR suite nurse staffing is consistent with approximately one per suite and constant. However, there is dissatisfaction among surveyed interventional radiologists with availability and appropriateness of staffing of the IR procedure room, particularly during on-call hours and weekends, as well as with anesthesia support for emergent cases. No evidence-based guidelines for staffing the IR suite currently exist. This underscores the need for further investigation with the ultimate goal of creating such guidelines.


Assuntos
Atitude do Pessoal de Saúde , Coleta de Dados/métodos , Departamentos Hospitalares , Corpo Clínico Hospitalar/estatística & dados numéricos , Médicos/estatística & dados numéricos , Radiologia Intervencionista , Coleta de Dados/estatística & dados numéricos , Humanos , Sociedades Médicas , Estados Unidos , Recursos Humanos
16.
J Vasc Interv Radiol ; 25(11): 1691-705.e4, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25442132

RESUMO

Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.


Assuntos
Ablação por Cateter/métodos , Neoplasias/cirurgia , Radiologia Intervencionista/métodos , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA