37 results on '"Avik Som"'
Search Results
2. Microwave Ablation as Bridging Therapy for Patients with Hepatocellular Carcinoma Awaiting Liver Transplant: A Single Center Experience
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John DiCapua, Eric Wehrenberg-Klee, Ronald S. Arellano, Raul N. Uppot, Omar Zurkiya, Thomas J. An, Nicholas J. Reid, Avik Som, Rory L. Cochran, and Sanjeeva P. Kalva
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Microwave ablation ,Liver transplantation ,Milan criteria ,medicine.disease ,Single Center ,Ablation ,Surgery ,Transplantation ,Hepatocellular carcinoma ,medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
To determine the pathologic response of computed tomography-guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant, and its subsequent effect on survival. A single-center retrospective analysis was conducted on 62 patients (M:F = 50:12) with mean age of 59.6 years ± 7.2 months (SD). Sixty-four total MWA procedures were performed for hepatocellular carcinomas within Milan criteria as bridging therapy to subsequent orthotopic liver transplant between August 2014 and September 2018. The pathology reports of the explanted livers were reviewed to assess for residual disease. Residual disease was categorized as complete or incomplete necrosis. Patient demographics, tumor/procedural characteristics, and laboratory values were evaluated. Survival from time of ablation and time of transplantation were recorded and compared between cohorts using log rank tests. The mean tumor size was 2.4 cm ± 0.7 cm (SD), (range = 1–4.6 cm). 32 (50%) cases required hydrodissection. Histopathologic necrosis was seen in 66% of cases at time of liver transplantation. Median time to liver transplant post-MWA was 12.6 months. [IQR = 8.6–14.8 months]. The median survival from ablation was 60.8 months [IQR = 45.5–73.7 months], and the median survival from transplant was 49.3 months [IQR = 33.7–60.1 months]. There was no significant difference in survival for patients with complete versus incomplete necrosis from ablation or liver transplant (p = 0.49, p = 0.46, respectively). Computed tomography-guided percutaneous microwave ablation is an effective bridge to orthotopic liver transplantation for patients with hepatocellular carcinoma. Level 3, non-randomized controlled cohort study/follow-up study.
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- 2021
3. Operational Challenges of a Low-Dose CT Lung Cancer Screening Program During the Coronavirus Disease 2019 Pandemic
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Tristan Yeung, Milena Petranovic, Min Lang, Jo-Anne O. Shepard, Amita Sharma, Brent P. Little, Anand M. Prabhakar, Avik Som, Marc D. Succi, Efren J. Flores, Theresa C. McLoud, and Sanjay Saini
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Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,Lung Neoplasms ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Change Management ,Critical Care and Intensive Care Medicine ,LDCT, low dose CT ,Pandemic ,Research Letter ,Humans ,Low dose ct ,Medicine ,Program Development ,Early Detection of Cancer ,COVID-19, coronavirus disease 2019 ,Infection Control ,SARS-CoV-2 ,business.industry ,COVID-19 ,EMR, electronic medical record ,Virology ,Organizational Innovation ,LCS, lung cancer screening ,CT, computed tomography ,Massachusetts ,LR, Lung-RADS ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Lung cancer screening ,Program Evaluation - Published
- 2021
4. The Effect of Preoperative Renal Failure on Outcomes Following Infrainguinal Endovascular Interventions for Peripheral Arterial Disease
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Christopher A. Di Capua, Diego B. Lopez, Ashley J. So, Avik Som, Gregory T. Walker, Thomas J. An, John Di Capua, and Nicholas J. Reid
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Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Kidney ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Renal Insufficiency ,Aged ,Retrospective Studies ,Univariate analysis ,business.industry ,Endovascular Procedures ,Odds ratio ,Critical limb ischemia ,Middle Aged ,United States ,Confidence interval ,Hospitalization ,Exact test ,Treatment Outcome ,030220 oncology & carcinogenesis ,Retreatment ,Cohort ,Current Procedural Terminology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Purpose To analyze the effect of a patient’s renal failure status on acute outcomes after lower extremity endovascular interventions for peripheral artery disease. Materials and Methods A retrospective analysis of the American College of Surgery National Surgical Quality Improvement Program database from 2014 to 2017 was conducted. Patients were included based on current procedural terminology codes. They were divided into renal failure cohorts. Six thousand seven hundred and sixty-five patients were included in the analysis, 11.0% of whom had renal failure. A univariate analysis was performed using chi-squared test or Fischer’s exact test as appropriate. Multivariate logistic regression models were constructed, while controlling for relevant patient factors, to identify the effect of renal failure on several outcomes of interest after the intervention. A sensitivity analysis was performed with a propensity score-matched cohort. Results Patients with renal failure were more likely to have infrapopliteal interventions (38.0% vs 20.9%), critical limb ischemia with tissue loss (73.5% vs 38.9%), diabetes (70.9% vs 52.3%), preoperative wound infection (59.2% vs 30.7%), mortality (5.1% vs 1.3%), prolonged hospital stay (68.5% vs 46.5%), transfusion after the intervention (13.3% vs 9.1%), reoperation (18.3% vs 9.5%), and readmission (24.9% vs 12.6%), compared to patients without renal failure. The multivariate analysis found renal failure to be significant for mortality (odds ratio [OR] = 4.11, 95% confidence interval [CI] = 2.71–6.24), any complication (OR = 2.03, 95% CI = 1.72–2.39), extended length of stay (OR = 1.53, 95% CI = 1.28–1.83), sepsis (OR = 2.37, 95% CI = 1.60–3.51), readmission (OR = 1.89, 95% CI = 1.57–2.29), reoperation (OR = 1.84, 95% CI = 1.48–2.27), major adverse cardiovascular event (OR = 3.50, 95% CI = 2.54–4.84), and major adverse limb event (OR = 1.97, 95% CI = 1.55–2.51). P value was Conclusions Renal failure before the intervention places patients at a significantly elevated risk of morbidity and mortality following endovascular revascularization procedures for peripheral artery disease.
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- 2021
5. Racial and Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed Coronavirus Disease 2019: A Retrospective Cohort Study
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Anand K. Narayan, Matthew D. Li, Francis Deng, Caitlin M Dugdale, Avik Som, Brent P. Little, Emily P. Hyle, Joseph R. Betancourt, Efren J. Flores, Dexter P. Mendoza, Nicholos Joseph, Min Lang, and Nicholas J. Reid
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medicine.medical_specialty ,business.industry ,Hazard ratio ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,Confidence interval ,law.invention ,Pneumonia ,law ,Internal medicine ,Severity of illness ,medicine ,Radiology, Nuclear Medicine and imaging ,Young adult ,business ,Cohort study - Abstract
Background Disease severity on chest radiographs has been associated with higher risk of disease progression and adverse outcomes from coronavirus disease 2019 (COVID-19). Few studies have evaluated COVID-19-related racial and/or ethnic disparities in radiology. Purpose To evaluate whether non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission chest radiographs compared with White or non-Hispanic patients. Materials and Methods This single-institution retrospective cohort study was approved by the institutional review board. Patients hospitalized with confirmed COVID-19 infection between March 17, 2020, and April 10, 2020, were identified by using the electronic medical record (n = 326; mean age, 59 years ±17 [standard deviation]; male-to-female ratio: 188:138). The primary outcome was the severity of lung disease on admission chest radiographs, measured by using the modified Radiographic Assessment of Lung Edema (mRALE) score. The secondary outcome was a composite adverse clinical outcome of intubation, intensive care unit admission, or death. The primary exposure was the racial and/or ethnic category: White or non-Hispanic versus non-White (ie, Hispanic, Black, Asian, or other). Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race and/or ethnicity. Results Non-White patients had significantly higher mRALE scores (median score, 6.1; 95% confidence interval [CI]: 5.4, 6.7) compared with White or non-Hispanic patients (median score, 4.2; 95% CI: 3.6, 4.9) (unadjusted average difference, 1.8; 95% CI: 0.9, 2.8; P < .01). For both White (adjusted hazard ratio, 1.3; 95% CI: 1.2, 1.4; P < .001) and non-White (adjusted hazard ratio, 1.2; 95% CI: 1.1, 1.3; P < .001) patients, increasing mRALE scores were associated with a higher likelihood of experiencing composite adverse outcome with no evidence of interaction (P = .16). Multivariable linear regression analyses demonstrated that non-White patients presented with higher mRALE scores at admission chest radiography compared with White or non-Hispanic patients (adjusted average difference, 1.6; 95% CI: 0.5, 2.7; P < .01). Adjustment for hypothesized mediators revealed that the association between race and/or ethnicity and mRALE scores was mediated by limited English proficiency (P < .01). Conclusion Non-White patients hospitalized with coronavirus disease 2019 infection were more likely to have a higher severity of disease on admission chest radiographs than White or non-Hispanic patients, and increased severity was associated with worse outcomes for all patients. © RSNA, 2020 Online supplemental material is available for this article.
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- 2020
6. Resident-Led Medical Student Radiology Research Interest Group: An Engine for Recruitment, Research, and Mentoring—Radiology In Training
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Daniel B. Chonde, Avik Som, John Di Capua, Rory L. Cochran, and Min Lang
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medicine.medical_specialty ,Students, Medical ,ComputingMilieux_THECOMPUTINGPROFESSION ,business.industry ,Research ,MEDLINE ,Internship and Residency ,Mentoring ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Dogs ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Interest group ,medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Personnel Selection ,business ,Career development - Abstract
A radiology research interest group of medical students, with the necessary infrastructure and resident leadership, may create a productive environment for research and career development for all p...
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- 2021
7. Abdominal Imaging Findings in COVID-19: Preliminary Observations
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Michael A. Blake, Joseph F. Simeone, Mark Anderson, Peter F. Hahn, Matthew D. Li, Michael S. Gee, Susanna I. Lee, Avinash Kambadakone, Amirkasra Mojtahed, Aoife Kilcoyne, Sanjay Saini, Mukesh G. Harisinghani, George C. Velmahos, Theodore T. Pierce, Anthony E. Samir, Debra A. Gervais, David A. Rosman, Denston Carey, Joseph Misdraji, Rajesh Bhayana, Avik Som, Pari V. Pandharipande, and Onofrio A. Catalano
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Gastrointestinal Diseases ,medicine.medical_treatment ,Pneumonia, Viral ,Gastroenterology ,030218 nuclear medicine & medical imaging ,law.invention ,Thoracic Imaging ,03 medical and health sciences ,Betacoronavirus ,Young Adult ,0302 clinical medicine ,law ,Internal medicine ,Laparotomy ,Abdomen ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pandemics ,Original Research ,Aged ,Retrospective Studies ,Aged, 80 and over ,Lung ,Bowel infarction ,business.industry ,SARS-CoV-2 ,Gallbladder ,COVID-19 ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Thrombosis ,Intensive care unit ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cholecystostomy ,Female ,business ,Coronavirus Infections - Abstract
Background Angiotensin-converting enzyme 2, a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019. Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from March 27 to April 10, 2020, who tested positive for SARS-CoV-2 were included. Abdominal imaging studies performed in these patients were reviewed, and salient findings were recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results A total of 412 patients (average age, 57 years; range, 18 to >90 years; 241 men, 171 women) were evaluated. A total of 224 abdominal imaging studies were performed (radiography, n = 137; US, n = 44; CT, n = 42; MRI, n = 1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR], 1.03 per year of increase; P = .001) and intensive care unit (ICU) admission (OR, 17.3; P < .001). Bowel-wall abnormalities were seen on 31% of CT images (13 of 42) and were associated with ICU admission (OR, 15.5; P = .01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT images obtained in patients in the ICU (four of 20). Surgical correlation (n = 4) revealed unusual yellow discoloration of the bowel (n = 3) and bowel infarction (n = 2). Pathologic findings revealed ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles (n = 2). Right upper quadrant US examinations were mostly performed because of liver laboratory findings (87%, 32 of 37), and 54% (20 of 37) revealed a dilated sludge-filled gallbladder, suggestive of bile stasis. Patients with a cholecystostomy tube placed (n = 4) had negative bacterial cultures. Conclusion Bowel abnormalities and gallbladder bile stasis were common findings on abdominal images of patients with coronavirus disease 2019. Patients who underwent laparotomy often had ischemia, possibly due to small-vessel thrombosis. © RSNA, 2020.
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- 2020
8. Comparison of Chest CT Findings of COVID-19, Influenza, and Organizing Pneumonia: A Multireader Study
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Min Lang, Dexter P. Mendoza, Avik Som, Amita Sharma, Allen Heeger, Shaunagh McDermott, Sherief Garrana, Tristan Yeung, Anand K. Narayan, Brent P. Little, Jennifer Febbo, Eric W. Zhang, and Gabrielle S. Ndakwah
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Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Chest ct ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Influenza, Human ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical diagnosis ,Retrospective Studies ,Observer Variation ,business.industry ,SARS-CoV-2 ,COVID-19 ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Pneumonia ,Massachusetts ,Cryptogenic Organizing Pneumonia ,030220 oncology & carcinogenesis ,Radiological weapon ,Organizing pneumonia ,Female ,Radiography, Thoracic ,Radiology ,Differential diagnosis ,business ,Tomography, X-Ray Computed - Abstract
BACKGROUND. Previous studies compared CT findings of COVID-19 pneumonia with those of other infections; however, to our knowledge, no studies to date have included noninfectious organizing pneumonia (OP) for comparison. OBJECTIVE. The objectives of this study were to compare chest CT features of COVID-19, influenza, and OP using a multireader design and to assess the performance of radiologists in distinguishing between these conditions. METHODS. This retrospective study included 150 chest CT examinations in 150 patients (mean [± SD] age, 58 ± 16 years) with a diagnosis of COVID-19, influenza, or non-infectious OP (50 randomly selected abnormal CT examinations per diagnosis). Six thoracic radiologists independently assessed CT examinations for 14 individual CT findings and for Radiological Society of North America (RSNA) COVID-19 category and recorded a favored diagnosis. The CT characteristics of the three diagnoses were compared using random-effects models; the diagnostic performance of the readers was assessed. RESULTS. COVID-19 pneumonia was significantly different (p < .05) from influenza pneumonia for seven of 14 chest CT findings, although it was different (p < .05) from OP for four of 14 findings (central or diffuse distribution was seen in 10% and 7% of COVID-19 cases, respectively, vs 20% and 21% of OP cases, respectively; unilateral distribution was seen in 1% of COVID-19 cases vs 7% of OP cases; non-tree-in-bud nodules was seen in 32% of COVID-19 cases vs 53% of OP cases; tree-in-bud nodules were seen in 6% of COVID-19 cases vs 14% of OP cases). A total of 70% of cases of COVID-19, 33% of influenza cases, and 47% of OP cases had typical findings according to RSNA COVID-19 category assessment (p < .001). The mean percentage of correct favored diagnoses compared with actual diagnoses was 44% for COVID-19, 29% for influenza, and 39% for OP. The mean diagnostic accuracy of favored diagnoses was 70% for COVID-19 pneumonia and 68% for both influenza and OP. CONCLUSION. CT findings of COVID-19 substantially overlap with those of influenza and, to a greater extent, those of OP. The diagnostic accuracy of the radiologists was low in a study sample that contained equal proportions of these three types of pneumonia. CLINICAL IMPACT. Recognized challenges in diagnosing COVID-19 by CT are furthered by the strong overlap observed between the appearances of COVID-19 and OP on CT. This challenge may be particularly evident in clinical settings in which there are substantial proportions of patients with potential causes of OP such as ongoing cancer therapy or autoimmune conditions.
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- 2021
9. Google search volume trends for cancer screening terms during the COVID-19 pandemic
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Ilana S. Nazari, Marc D. Succi, Efren J. Flores, Avik Som, Sean Jang, Brent P. Little, and Austin Snyder
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Male ,medicine.medical_specialty ,Lung Neoplasms ,Coronavirus disease 2019 (COVID-19) ,Information Seeking Behavior ,Colonoscopy ,Information Storage and Retrieval ,Breast Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Cancer Screening Tests ,Pandemic ,Cancer screening ,Medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Early Detection of Cancer ,Vaginal Smears ,medicine.diagnostic_test ,business.industry ,Health Policy ,Public health ,Public Health, Environmental and Occupational Health ,Cancer ,COVID-19 ,medicine.disease ,Search Engine ,030220 oncology & carcinogenesis ,Female ,business ,Lung cancer screening ,Mammography - Abstract
The COVID-19 pandemic has led to delays in cancer diagnosis, in part due to postponement of cancer screening. We used Google Trends data to assess public attention to cancer screening during the first peak of the COVID-19 pandemic. Search volume for terms related to established cancer screening tests (“colonoscopy,” “mammogram,” “lung cancer screening,” and “pap smear”) showed a marked decrease of up to 76% compared to the pre-pandemic period, a significantly greater drop than for search volume for terms denoting common chronic diseases. Maintaining awareness of cancer screening during future public health crises may decrease delays in cancer diagnosis.
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- 2021
10. Infection Control in Interventional Radiology During the COVID-19 Era
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Robert M. Sheridan, Raul N. Uppot, Rory L. Cochran, Avik Som, Anthony Tucker-Bartley, Sanjeeva P. Kalva, Dania Daye, Sara Smolinski-Zhao, and Gabrielle S. Ndakwah
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Telehealth ,Radiology, Interventional ,Article ,030218 nuclear medicine & medical imaging ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Health care ,Medicine ,Infection control ,Humans ,Radiology, Nuclear Medicine and imaging ,Personal protective equipment ,Pandemics ,Personal Protective Equipment ,Infection Control ,medicine.diagnostic_test ,Radiology Department, Hospital ,business.industry ,SARS-CoV-2 ,COVID-19 ,Interventional radiology ,medicine.disease ,Triage ,United States ,Infectious disease (medical specialty) ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Medical emergency ,business - Abstract
The COVID-19 pandemic has challenged the capacity of interventional radiology departments worldwide to effectively treat COVID-19 and non-COVID-19 patients while preventing disease transmission among patients and healthcare workers. In this review, we describe the various data driven infection control measures implemented by the interventional radiology department of a large tertiary care center in the United States including the use and novel re-use of personal protective equipment, COVID-19 testing strategies, modifications in procedural workflows and the leveraging of telehealth visits. Herein, we provide effective triage, procedural, and management algorithms that may guide other interventional radiology departments during the ongoing COVID-19 pandemic and in future infectious disease outbreaks.
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- 2021
11. Hypoxaemia related to COVID-19: vascular and perfusion abnormalities on dual-energy CT
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Avik Som, Josanna Rodriguez-Lopez, Alison S. Witkin, Brent P. Little, Min Lang, Efren J. Flores, Nicholas J. Reid, Jo-Anne O. Shepard, Dexter P. Mendoza, Denston Carey, and Matthew D. Li
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Radiography ,Perfusion Imaging ,Perfusion scanning ,Article ,Fibrin Fibrinogen Degradation Products ,Radiography, Dual-Energy Scanned Projection ,X ray computed ,Medicine ,Humans ,Vascular Diseases ,Hypoxia ,Lung ,business.industry ,SARS-CoV-2 ,COVID-19 ,Pneumonia ,Dilatation ,Infectious Diseases ,Tomography ,Dual energy ct ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,Perfusion - Published
- 2020
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12. Abstract No. 157 Computed tomography–guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant: a single-center experience
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Eric Wehrenberg-Klee, Rory L. Cochran, Nicholas J. Reid, Ronald S. Arellano, Omar Zurkiya, Avik Som, Raul N. Uppot, and Thomas J. An
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medicine.medical_specialty ,Bridging (networking) ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Microwave ablation ,Computed tomography ,Single Center ,medicine.disease ,Awaiting liver transplant ,Hepatocellular carcinoma ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
13. Imaging Volume Trends and Recovery During the COVID-19 Pandemic: A Comparative Analysis Between a Large Urban Academic Hospital and Its Affiliated Imaging Centers
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Efren J. Flores, Avik Som, Marc D. Succi, Tristan Yeung, Susanna I. Lee, Angela L. Lang, Dexter P. Mendoza, Min Lang, Sanjay Saini, Oleg S. Pianykh, and Brent P. Little
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Imaging volume ,Article ,030218 nuclear medicine & medical imaging ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Service locations ,Pandemic ,Urban Health Services ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pandemics ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,COVID-19 ,Radiology operation ,Retrospective cohort study ,Hospitals ,Center volume ,Massachusetts ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Emergency medicine ,Coronavirus Infections ,Volume loss ,business ,Healthcare system ,Volume (compression) - Abstract
Rationale and Objectives While affiliated imaging centers play an important role in healthcare systems, little is known of how their operations are impacted by the COVID-19 pandemic. Our goal was to investigate imaging volume trends during the pandemic at our large academic hospital compared to the affiliated imaging centers. Materials and Methods This was a descriptive retrospective study of imaging volume from an academic hospital (main hospital campus) and its affiliated imaging centers from January 1 through May 21, 2020. Imaging volume assessment was separated into prestate of emergency (SOE) period (before SOE in Massachusetts on March 10, 2020), “post-SOE” period (time after “nonessential” services closure on March 24, 2020), and “transition” period (between pre-SOE and post-SOE). Results Imaging volume began to decrease on March 11, 2020, after hospital policy to delay nonessential studies. The average weekly imaging volume during the post-SOE period declined by 54% at the main hospital campus and 64% at the affiliated imaging centers. The rate of imaging volume recovery was slower for affiliated imaging centers (slope = 6.95 for weekdays) compared to main hospital campus (slope = 7.18 for weekdays). CT, radiography, and ultrasound exhibited the lowest volume loss, with weekly volume decrease of 41%, 49%, and 53%, respectively, at the main hospital campus, and 43%, 61%, and 60%, respectively, at affiliated imaging centers. Mammography had the greatest volume loss of 92% at both the main hospital campus and affiliated imaging centers. Conclusion Affiliated imaging center volume decreased to a greater degree than the main hospital campus and showed a slower rate of recovery. Furthermore, the trend in imaging volume and recovery were temporally related to public health announcements and COVID-19 cases.
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- 2020
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14. The Impact of Physician Exposure to Organized Political Advocacy in the Society of Interventional Radiology
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Junjian Huang, Nicholos Joseph, Theresa M. Caridi, Avik Som, Oleksandra Kutsenko, Christopher Molloy, Andrew J. Gunn, and Raymond W. Liu
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medicine.medical_specialty ,medicine.diagnostic_test ,Human Rights ,business.industry ,Attitude of Health Personnel ,MEDLINE ,Interventional radiology ,Radiology, Interventional ,Radiography, Interventional ,Political advocacy ,Stakeholder Participation ,Family medicine ,Surveys and Questionnaires ,Radiologists ,medicine ,Humans ,Political Activism ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Policy Making ,Societies, Medical - Published
- 2020
15. Intracardiac and aortic thrombi in the setting of SARS-CoV-2 infection
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Brent P. Little, Avik Som, Nicholas J. Reid, Tarik K. Alkasab, Min Lang, Rory L. Cochran, and Denston Carey
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Virology ,Intracardiac injection ,Flashlights - Published
- 2020
16. Detection of Unsuspected Coronavirus Disease 2019 Cases by Computed Tomography and Retrospective Implementation of the Radiological Society of North America/Society of Thoracic Radiology/American College of Radiology Consensus Guidelines
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Matthew D. Li, Brent P. Little, Jo-Anne O. Shepard, Efren J. Flores, Min Lang, Dexter P. Mendoza, and Avik Som
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Demographics ,medicine.diagnostic_test ,business.industry ,Electronic medical record ,MEDLINE ,Computed tomography ,Retrospective cohort study ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Radiology Nuclear Medicine and imaging ,Radiological weapon ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Abstract
PURPOSE: The purpose of this article was to report the utility of computed tomography (CT) for detecting unsuspected cases of Coronavirus disease 2019 (COVID-19) and the utility of the Radiological Society of North America (RSNA)/Society of Thoracic Radiology (STR)/American College of Radiology (ACR) consensus guidelines for COVID-19 reporting. MATERIALS AND METHODS: A total of 22 patients of the 156 reverse transcriptase polymerase chain reaction confirmed COVID-19 patients who were hospitalized between March 27, 2020 and March 31, 2020 at our quaternary care academic medical center and who underwent CT imaging within 1 week of admission were included in this retrospective study. Demographics and clinical data were extracted from the electronic medical record system. Two thoracic radiologists independently categorized each CT study on the basis of RSNA/STR/ACR consensus guidelines. Disagreement in categorization was resolved by consensus discussion with a third thoracic radiologist. RESULTS: At the time of imaging, 16 patients (73%) were suspected of COVID-19, and 6 patients (27%) were not. Common symptoms at presentation were fever (73%), cough (77%), and gastrointestinal symptoms (59%). An overall 63% of suspected COVID-19 patients exhibited shortness of breath, whereas 0 unsuspected COVID-19 patients did (P=0.02). On the basis of the RSNA consensus guidelines, 68%, 18%, 9%, and 5% of studies were categorized as "typical appearance," "indeterminate appearance," "atypical appearance," and "negative for pneumonia," respectively. There was no difference of category distribution between suspected and unsuspected COVID-19 patients (P=0.20), with "typical appearance" being the most prevalent in both (69% vs. 67%, respectively). CONCLUSIONS: It is important to recognize imaging features of COVID-19 pneumonia even in unsuspected patients. Implementation of the RSNA/STR/ACR consensus guidelines may increase consistency of reporting and convey the level of suspicion for COVID-19 to other health care providers, with "typical appearance" especially warranting further attention.
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- 2020
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17. Retrospective evaluation of image-guided cholecystostomy tube utilization and outcomes during the first wave of the COVID-19 pandemic
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Dania Daye, Nicholas J. Reid, Raul N. Uppot, Silvia Salamone, Tristan Yeung, Avik Som, Austin Snyder, and John Di Capua
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General surgery ,Incidence (epidemiology) ,Vital signs ,Interventional radiology ,General Medicine ,medicine.disease ,Tertiary care ,Cholecystostomy ,Pandemic ,medicine ,Cholecystitis ,business - Abstract
Objectives: During the COVID-19 pandemic, there was a perceived increase in the number of cholecystostomy tube placements. We have retrospectively analyzed the incidence and outcomes of cholecystostomy tube placement during the COVID-19 pandemic surge. Material and Methods: Cholecystostomy tube placement and overall interventional radiology (IR) case volume were analyzed at our tertiary care center during the pandemic (March 15, 2020–July 30, 2020) and compared to the same time period in 2019. In addition, an age- and gender-matched control study of outcomes for 40 patients (25 from our home institution and 15 from our affiliated hospitals) grouped by COVID-19 status who received percutaneous cholecystostomy tubes between March 15, 2020, and July 30, 2020, was performed. Results: We observed a significant increase in relative cholecystostomy tube volume during the pandemic, despite a decrease in total IR case volume. There was no significant difference in pre- or post-procedural laboratory data, vital signs, imaging, or mortality between COVID-positive and COVID-negative patients who received cholecystostomy tubes. Conclusion: Percutaneous cholecystostomy tube placement is likely a safe treatment for acalculous cholecystitis in patients with COVID-19 with equivalent outcomes to patients without COVID-19.
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- 2021
18. Abstract No. 490 Predictors for non-home patient discharge following lower extremity arterial interventions
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Dania Daye, Gary V. Walker, Thomas J. An, Avik Som, Nicholas J. Reid, Diego B. Lopez, and J. Di Capua
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Patient discharge ,medicine.medical_specialty ,business.industry ,Physical therapy ,Psychological intervention ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
19. Abstract No. 20 Assessment of pre-emptive multimodal analgesia to reduce post-procedural opioid requirements in patients undergoing liver microwave ablation
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P. Stefanovich, Rafael Vazquez, C. Pau, S. Low, B. Kamdar, N. Joseph, J. Di Capua, Raul N. Uppot, Junjian Huang, Ronald S. Arellano, N. Davis, Avik Som, and M. Omodon
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Opioid ,business.industry ,Anesthesia ,Microwave ablation ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2021
20. Abstract No. 156 Incidence and outcomes of cholecystostomy tubes in COVID-19 patients
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Gloria Salazar, Raul N. Uppot, Avik Som, Tristan Yeung, Silvia Salamone, Dania Daye, Nicholas J. Reid, Marc D. Succi, and Austin Snyder
- Subjects
medicine.medical_specialty ,Microbiological culture ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Acalculous cholecystitis ,Interventional radiology ,Article ,Surgery ,Cholecystostomy ,medicine ,Tube placement ,Percutaneous cholecystostomy ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose: Our goal was to review the incidence and outcomes of cholecystostomy tube placement during the COVID pandemic as compared to matched controls. Materials and Methods: Monthly interventional radiology (IR) case volume was evaluated during the COVID pandemic through July 30, 2020, and was compared to monthly IR case volume during the same time period in 2019. A retrospective review of 40 patients who received percutaneous cholecystostomy tubes between March 2020 and July 2020 (first COVID pandemic peak in Boston, MA) was compared in a propensity matched controlled study. 14 COVID-positive patients were matched to 26 control patients who received a cholecystostomy tube. Outcomes such as positive cholecystostomy tube microbiology, pre-procedural ICU status, and death were evaluated. Results: During March to July 30, 2020, cholecystostomy tube placement constituted 0.43%, average 6 (range 2-10) cases/month of 1389 (range 672-1777) cases/month, whereas in the year prior for the same period it constituted 0.28%, 5.8 (range 4-8) cases/month of 2103 (range 1998-2146) cases/month. We find the average age was 66.5 ± 17.7 (SD) for COVID-negative and 66.0 ± 17.7 (SD) years for COVID-positive patients. Pre-procedure 19% (5/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients were intubated at the time of placement, P = 0.04. Post-procedure, 54% (14/26) of COVID-negative patients and 50% (7/14) of COVID-positive patients had positive cholecystostomy tube fluid microbiology cultures, P = 0.82. 38% (10/26) of COVID-negative patients and 57% (8/14) of COVID-positive patients were in the ICU at the time of placement, P = 0.26. 23% (6/26) of the COVID-negative patients and 36% (5/14) of COVID-positive patients died post-procedure, P = 0.41. 15.4% (4/26) COVID-negative and 14.3% (2/14) of COVID-positive patients had any complications reported, P = 0.93. Conclusions: During the COVID-19 pandemic, we observed a relative increase in the number of cholecystostomy tube referrals despite a drop in total IR case volume. There were no significant differences in post-procedure long-term outcomes and the microbial culture results in our matched control review. Our study suggests that this perceived increase in cholecystostomy tube placements is not secondary to unique COVID pathophysiology, but rather a persistent incidence of acalculous cholecystitis in the setting of chronic ICU stays seen during the COVID pandemic. With the continuation of the pandemic, cholecystostomy tube placement incidence may increase with continued COVID patient care and chronic ICU stays for these patients.
- Published
- 2021
21. Abstract No. 158 Changes in interventional radiology case volumes during the COVID-19 pandemic
- Author
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Avik Som, Sanjeeva P. Kalva, Tristan Yeung, M. Lang, B. Little, Raul N. Uppot, Marc D. Succi, and Dania Daye
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Interventional radiology ,medicine.disease ,Article ,Pandemic ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
22. Pulmonary Vascular Manifestations of COVID-19 Pneumonia
- Author
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Min Lang, Brent P. Little, Efren J. Flores, Nicholas J. Reid, Dexter P. Mendoza, Avik Som, Denston Carey, Jo-Anne O. Shepard, and Matthew D. Li
- Subjects
2019-20 coronavirus outbreak ,Pathology ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pulmonary vessels ,medicine.disease ,respiratory tract diseases ,Hypoxemia ,Pneumonia ,medicine ,Radiology, Nuclear Medicine and imaging ,Vascular pathology ,medicine.symptom ,business ,Perfusion ,Original Research - Abstract
Background Parenchymal findings in COVID-19 pneumonia on computed tomography (CT) have been well characterized. However, the role of pulmonary vascular pathology in COVID-19 pneumonia is still not well understood. Purpose To investigate pulmonary vascular abnormalities on CT pulmonary angiography in patients with COVID-19 pneumonia. Materials and Methods In this retrospective study, 48 patients with RT-PCR confirmed COVID-19 infection who had undergone CT pulmonary angiography between 3/22/20 and 4/5/20 in our large urban health care system were included. Patient demographics and clinical data were collected through the electronic medical record system. Twenty-five patients underwent dual energy CT (DECT) as part of the standard CT pulmonary angiogram protocol at a subset of the hospitals. Two thoracic radiologists independently assessed all studies. Disagreement in assessment was resolved by consensus discussion with a third thoracic radiologist. Results Of the 48 patients, 45 patients required admission, with 18 admitted to the ICU, and 13 requiring intubation. Seven patients (15%) were found to have pulmonary emboli. Dilated vessels were seen in 41 cases (85%), with 38 (78%) and 27 (55%) of cases demonstrating vessel enlargement within and outside of lung opacities, respectively. Dilated distal vessels extending to the pleura and fissures were seen in 40 cases (82%) and 30 cases (61%), respectively. On DECT, mosaic perfusion pattern was observed in 24 cases (96%), regional hyperemia overlapping with areas of pulmonary opacities or immediately surrounding the opacities were seen in 13 cases (52%), opacities associated with corresponding oligemia were seen in 24 cases (96%), and hyperemic halo was seen in 9 cases (36%). Conclusion Pulmonary vascular abnormalities such as vessel enlargement and regional mosaic perfusion patterns are common in COVID-19 pneumonia. Perfusion abnormalities are also frequently observed at DECT in COVID-19 pneumonia and may suggest an underlying vascular process.
- Published
- 2020
23. Abstract No. 701 Assessment of the thermal properties of absorbable gelatin powder for potential use as a tissue separator during microwave ablation procedures
- Author
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A. Kashefi, T. Bochnakova, Kei Yamada, Avik Som, Suvranu Ganguli, Raul N. Uppot, and Ronald S. Arellano
- Subjects
business.industry ,Thermal ,Microwave ablation ,Medicine ,Radiology, Nuclear Medicine and imaging ,Absorbable gelatin powder ,Composite material ,Cardiology and Cardiovascular Medicine ,business ,Separator (electricity) - Published
- 2020
24. Abstract No. 495 Comparative analysis of non-hydrodissection techniques for percutaneous computed tomography–guided thermal ablation of liver neoplasms
- Author
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Raul N. Uppot, Rory L. Cochran, Kei Yamada, Ronald S. Arellano, and Avik Som
- Subjects
Percutaneous ,medicine.diagnostic_test ,business.industry ,Thermal ablation ,Medicine ,Radiology, Nuclear Medicine and imaging ,Computed tomography ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Published
- 2020
25. Effectiveness of a novel, automated telephone intervention on time to hospitalisation in patients with COPD: A randomised controlled trial
- Author
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Ellen Kim, Avik Som, W. R. Ross, Robert Peters, Melvin Blanchard, Kunjan Patel, Jacob Groenendyk, Eric Sink, and Maggie Xing
- Subjects
Male ,Telemedicine ,medicine.medical_specialty ,MEDLINE ,Pulmonary disease ,Health Informatics ,Telehealth ,law.invention ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Randomized controlled trial ,law ,Intervention (counseling) ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,COPD ,business.industry ,Middle Aged ,medicine.disease ,Telephone ,Hospitalization ,Self Care ,030228 respiratory system ,Physical therapy ,Quality of Life ,Female ,business - Abstract
Introduction Owing to its capacity to perform remote assessments, telemedicine is rising as a new force in chronic obstructive pulmonary disease (COPD) management. We conducted an eight month randomised-controlled-trial to study the effect of an automated telemedicine intervention on patients’ time-to-hospitalisation. Methods A total of 168 patients with a diagnosis of COPD in the past 24 months were enrolled to receive the intervention at a primary care clinic. The treatment group received daily phone messages from an automated system asking them to report if they were breathing better than, worse than, or the same as the day prior. Patients reported their breathing status by responding to the text message or call. If a patient reported breathing worse, an alert was sent directly to that patient’s provider within the clinic. The control group received the same daily phone messages as the treatment group. However, no proactive breathing alerts were ever generated to the provider for these subjects. The primary outcome was the subjects’ time-to-first-COPD-related hospitalisation following the start of messages. Results The treatment group’s time-to-hospitalisation was significantly different than the control group’s with a hazard ratio of 2.36 (95% confidence interval 1.02–5.45, p = 0.0443). The number needed-to-treat ratio was 8.62. Subject engagement consistently ranged between 60% and 75%. The treatment group received both proactive monitoring and follow-up care from the providers. Discussion Active monitoring with provider feedback enables the detection of exacerbation events early enough for subjects to avoid admissions. The use of non-smartphone interventions reduces barriers to care presented by more complicated and expensive technologies. This intervention represents a simple, innovative, and inexpensive tool for improved COPD management.
- Published
- 2018
26. Improving Dialysis Adherence for High Risk Patients Using Automated Messaging: Proof of Concept
- Author
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W. R. Ross, Kunjan Patel, T. An, Jacob Groenendyk, Avik Som, Robert Peters, and Gregory M. Polites
- Subjects
Adult ,Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,Science ,medicine.medical_treatment ,030232 urology & nephrology ,MEDLINE ,Article ,law.invention ,Automation ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Renal Dialysis ,law ,Intervention (counseling) ,medicine ,Humans ,030212 general & internal medicine ,Socioeconomic status ,Dialysis ,Text Messaging ,Multidisciplinary ,Cost–benefit analysis ,business.industry ,Attendance ,Middle Aged ,medicine.disease ,3. Good health ,Hospitalization ,Emergency medicine ,Medicine ,Female ,Hemodialysis ,Medical emergency ,business - Abstract
Comorbidities and socioeconomic barriers often limit patient adherence and self-management with hemodialysis. Missed sessions, often associated with communication barriers, can result in emergency dialysis and avoidable hospitalizations. This proof of concept study explored using a novel digital-messaging platform, EpxDialysis, to improve patient-to-dialysis center communication via widely available text messaging and telephone technology. A randomized controlled trial was conducted through Washington University-affiliated hemodialysis centers involving ESRD patients with poor attendance, defined as missing 2–6 sessions over the preceding 12 weeks. A cross-over study design evaluated appointment adherence between intervention and control groups. Comparing nonadherence rates eight weeks prior to enrollment, median appointment adherence after using the system increased by 75%, and median number of unintended hospitalization days fell by 31%. A conservative cost-benefit analysis of EpxDialysis demonstrates a 1:36 savings ratio from appointment adherence. EpxDialysis is a low-risk, cost-effective, intervention for increasing hemodialysis adherence in high-risk patients, especially at centers caring for vulnerable and low-income patients.
- Published
- 2017
27. EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence Tracking System in Community Practice
- Author
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Will Ross, Kavon Javaherian, Christopher Tricarico, Avik Som, and Robert Peters
- Subjects
Pediatrics ,medicine.medical_specialty ,Short Message Service ,020205 medical informatics ,Psychological intervention ,Medication adherence ,02 engineering and technology ,Telehealth ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,0202 electrical engineering, electronic engineering, information engineering ,eHealth ,medicine ,text messaging ,030212 general & internal medicine ,mHealth ,Original Paper ,business.industry ,General Medicine ,medicine.disease ,3. Good health ,medication adherence ,Community practice ,Medical emergency ,business - Abstract
Background: Medication adherence remains a difficult problem to both assess and improve in patients. It is a multifactorial problem that goes beyond the commonly cited reason of forgetfulness. To date, eHealth (also known as mHealth and telehealth) interventions to improve medication adherence have largely been successful in improving adherence. However, interventions to date have used time- and cost-intensive strategies or focused solely on medication reminding, leaving much room for improvement in using a modality as flexible as eHealth. Objective: Our objective was to develop and implement a fully automated short message service (SMS)-based medication adherence system, EpxMedTracking, that reminds patients to take their medications, explores reasons for missed doses, and alerts providers to help address problems of medication adherence in real time. Methods: EpxMedTracking is a fully automated bidirectional SMS-based messaging system with provider involvement that was developed and implemented through Epharmix, Inc. Researchers analyzed 11 weeks of de-identified data from patients cared for by multiple provider groups in routine community practice for feasibility and functionality. Patients included were those in the care of a provider purchasing the EpxMedTracking tool from Epharmix and were enrolled from a clinic by their providers. The primary outcomes assessed were the rate of engagement with the system, reasons for missing doses, and self-reported medication adherence. Results: Of the 25 patients studied over the 11 weeks, 3 never responded and subsequently opted out or were deleted by their provider. No other patients opted out or were deleted during the study period. Across the 11 weeks of the study period, the overall weekly engagement rate was 85.9%. There were 109 total reported missed doses including “I forgot” at 33 events (30.3%), “I felt better” at 29 events (26.6%), “out of meds” at 20 events (18.4%), “I felt sick” at 19 events (17.4%), and “other” at 3 events (2.8%). We also noted an increase in self-reported medication adherence in patients using the EpxMedTracking system. Conclusions: EpxMedTracking is an effective tool for tracking self-reported medication adherence over time. It uniquely identifies actionable reasons for missing doses for subsequent provider intervention in real time based on patient feedback. Patients enrolled on EpxMedTracking also self-report higher rates of medication adherence over time while on the system. [JMIR Res Protoc 2017;6(5):e87]
- Published
- 2016
28. Response in bone turnover markers during therapy predicts overall survival in patients with metastatic prostate cancer: analysis of three clinical trials
- Author
-
Jingjing Liu, Wei Qiao, Shi-Ming Tu, Xuemei Wang, Paul G. Corn, Avik Som, and Christopher J. Logothetis
- Subjects
Adult ,Male ,Oncology ,Cancer Research ,Pathology ,medicine.medical_specialty ,Bone Neoplasms ,Kaplan-Meier Estimate ,bone ,Bone and Bones ,Collagen Type I ,Bone remodeling ,predictive biomarkers ,Prostate cancer ,Internal medicine ,Biomarkers, Tumor ,Overall survival ,medicine ,Humans ,In patient ,Neoplasm Metastasis ,metastases ,Molecular Diagnostics ,Survival analysis ,Aged ,Randomized Controlled Trials as Topic ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Prostatic Neoplasms ,Retrospective cohort study ,Middle Aged ,Prostate-Specific Antigen ,Alkaline Phosphatase ,Prognosis ,prostate cancer ,medicine.disease ,Survival Analysis ,Clinical trial ,Prostate-specific antigen ,Kallikreins ,Bone Remodeling ,Peptides ,business - Abstract
Background: The bone-forming metastases of prostate cancer result from complex stromal–epithelial interactions within the tumour microenvironment. Autocrine–paracrine signalling pathways between prostate cancer epithelial cells, osteoblasts, and osteoclasts stimulate aberrant bone remodelling, and the activity of these three cell populations can be quantitatively measured using prostate-specific antigen (PSA), bone-specific alkaline phosphatase (BAP) and urine N-telopeptide (uNTx), respectively. The purpose of the present study was to test the hypothesis that serial measurements of BAP and uNTx during therapy would facilitate monitoring of disease activity and predict the overall survival (OS) in patients with metastatic prostate cancer receiving therapy. Methods: Radionuclide bone scan, PSA, BAP, and uNTx data were retrospectively analysed from three clinical trials in patients with metastatic prostate cancer conducted at our institution. Qualitative changes in bone scans and quantitative changes in PSA, BAP, and uNTx concentrations during therapy were correlated with OS. Results: Baseline levels of BAP, but not PSA, were prognostic for OS in both androgen-dependent and castrate-resistant disease. A reduction in PSA, BAP, uNTx, or BAP/uNTx on therapy was predictive of improved OS in both patient groups. Conversely, an increase in PSA, or BAP on therapy was predictive of worse OS in both patient groups. Baseline number of lesions and response on bone scan during therapy were neither prognostic nor predictive of OS in either patient group. Conclusion: These observations support the concept that serial measurements of bone turnover metabolites during therapy function as clinically informative predictive biomarkers in patients with advanced prostate cancer and skeletal metastases. PSA measurements and bone scans remain essential to monitor the overall disease activity and determine the anatomic distribution of skeletal metastases.
- Published
- 2012
29. Abstract No. 461 Development of iShadow, an automated shadowing program to expose first year medical students to interventional radiology
- Author
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Olaguoke Akinwande, Avik Som, Raja S. Ramaswamy, Sarah Connolly, and Gretchen Foltz
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Interventional radiology ,Cardiology and Cardiovascular Medicine ,business ,EXPOSE - Published
- 2018
30. 3:18 PM Abstract No. 363 Do liver function scoring systems predict outcomes after portal vein embolization in non-hepatocellular carcinoma liver cancer?
- Author
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Seung Kwon Kim, C. Noda, Raja S. Ramaswamy, Avik Som, and Olaguoke Akinwande
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Hepatocellular carcinoma ,Portal vein embolization ,medicine ,Radiology, Nuclear Medicine and imaging ,Liver function ,Cardiology and Cardiovascular Medicine ,medicine.disease ,Liver cancer ,business ,Gastroenterology - Published
- 2018
31. Abstract No. 585 Cryoablation of low-flow vascular malformations: single-center experience and how to stay out of trouble
- Author
-
Raja S. Ramaswamy, Olaguoke Akinwande, Avik Som, and Carlos J. Guevara
- Subjects
medicine.medical_specialty ,Flow (mathematics) ,business.industry ,medicine.medical_treatment ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cryoablation ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Single Center - Published
- 2018
32. Binocular Goggle Augmented Imaging and Navigation System provides real-time fluorescence image guidance for tumor resection and sentinel lymph node mapping
- Author
-
Suman B. Mondal, Kexian Liang, Avik Som, Samuel Achilefu, Nan Zhu, Viktor Gruev, Ryan C. Fields, Julie A. Margenthaler, Gail Sudlow, Rongguang Liang, Shengkui Gao, and Walter J. Akers
- Subjects
Indocyanine Green ,medicine.medical_specialty ,genetic structures ,Tumor resection ,Mice, Nude ,Article ,Fluorescence ,Mice ,chemistry.chemical_compound ,medicine ,Animals ,Image guidance ,Mice nude ,Vision, Binocular ,Multidisciplinary ,Sentinel Lymph Node Biopsy ,business.industry ,Navigation system ,Neoplasms, Experimental ,3. Good health ,Surgery ,Sentinel lymph node mapping ,chemistry ,Radiology ,business ,Binocular vision ,Indocyanine green - Abstract
The inability to identify microscopic tumors and assess surgical margins in real-time during oncologic surgery leads to incomplete tumor removal, increases the chances of tumor recurrence and necessitates costly repeat surgery. To overcome these challenges, we have developed a wearable goggle augmented imaging and navigation system (GAINS) that can provide accurate intraoperative visualization of tumors and sentinel lymph nodes in real-time without disrupting normal surgical workflow. GAINS projects both near-infrared fluorescence from tumors and the natural color images of tissue onto a head-mounted display without latency. Aided by tumor-targeted contrast agents, the system detected tumors in subcutaneous and metastatic mouse models with high accuracy (sensitivity = 100%, specificity = 98% ± 5% standard deviation). Human pilot studies in breast cancer and melanoma patients using a near-infrared dye show that the GAINS detected sentinel lymph nodes with 100% sensitivity. Clinical use of the GAINS to guide tumor resection and sentinel lymph node mapping promises to improve surgical outcomes, reduce rates of repeat surgery and improve the accuracy of cancer staging.
- Published
- 2015
33. A Novel Patient Engagement Platform Using Accessible Text Messages and Calls (Epharmix): Feasibility Study
- Author
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Avik Som, Kunjan Patel, Tonya An, Kavon Javaherian, Zhuchen Xu, Gregory M. Polites, Melvin Blanchard, Jacob Groenendyk, Robert Peters, Will Ross, and Eric Sink
- Subjects
Telemedicine ,020205 medical informatics ,telehealth ,Psychological intervention ,Medicine (miscellaneous) ,Health Informatics ,02 engineering and technology ,Telehealth ,03 medical and health sciences ,0302 clinical medicine ,mHealth innovations ,Health care ,0202 electrical engineering, electronic engineering, information engineering ,eHealth ,medicine ,030212 general & internal medicine ,mobile health ,Original Paper ,Descriptive statistics ,business.industry ,multiple chronic conditions ,bioinformatics ,medicine.disease ,Digital health ,3. Good health ,Computer Science Applications ,Breastfeeding difficulties ,telemedicine ,Medical emergency ,business - Abstract
Background: Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. One method to improve therapeutic adherence is to improve feedback loops in getting clinically acute events and issues to the relevant clinical providers as necessary (ranging from detecting hypoglycemic events for patients with diabetes to notifying the provider when patients are out of medications). Patients often don’t know which information should prompt a call to their physician and proactive checks by the clinics themselves can be very resource intensive. We hypothesized that a two-way SMS system combined with a platform web service for providers would enable both high patient engagement but also the ability to detect relevant clinical alerts. Objective: The objectives of this study are to develop a feasible two-way automated SMS/phone call + web service platform for patient-provider communication, and then study the feasibility and acceptability of the Epharmix platform. First, we report utilization rates over the course of the first 18 months of operation including total identified clinically significant events, and second, review results of patient user-satisfaction surveys for interventions for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Methods: To test this question, we developed a web service + SMS/phone infrastructure (“Epharmix”). Utilization results were measured based on the total number of text messages or calls sent and received, with percentage engagement defined as a patient responding to a text message at least once in a given week, including the number of clinically significant alerts generated. User satisfaction surveys were sent once per month over the 18 months to measure satisfaction with the system, frequency and degree of communication. Descriptive statistics were used to describe the above information. Results: In total, 28,386 text messages and 24,017 calls were sent to 929 patients over 9 months. Patients responded to 80% to 90% of messages allowing the system to detect 1164 clinically significant events. Patients reported increased satisfaction and communication with their provider. Epharmix increased the number of patient-provider interactions to over 10 on average in any given month for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Conclusions: Engaging high-risk patients remains a difficult process that may be improved through novel, digital health interventions. The Epharmix platform enables increased patient engagement with very low risk to improve clinical outcomes. We demonstrated that engagement among high-risk populations is possible when health care comes conveniently to where they are.
- Published
- 2017
34. Bridging the gap between invention and commercialization in medical devices
- Author
-
Stephen W. Linderman, Joshua S. Siegel, Tauseef Charanya, and Avik Som
- Subjects
Engineering ,ComputingMilieux_THECOMPUTINGPROFESSION ,business.industry ,Biomedical Engineering ,Bioengineering ,Intellectual property ,Applied Microbiology and Biotechnology ,Commercialization ,Intellectual Property ,Article ,Bridging (programming) ,Engineering management ,Technology Transfer ,Equipment and Supplies ,Inventions ,Technology transfer ,ComputingMilieux_COMPUTERSANDEDUCATION ,Molecular Medicine ,Humans ,business ,Biotechnology - Abstract
At Washington University, students and faculty have addressed challenges surrounding biomedical innovation and training through a novel and low-cost platform.
- Published
- 2014
35. Effect of Paget's disease of bone (osteitis deformans) on the progression of prostate cancer bone metastasis
- Author
-
B. Tu, Avik Som, M. H. Lee, S. C. Yeung, Shi-Ming Tu, and C. J. Logothetis
- Subjects
musculoskeletal diseases ,Oncology ,Male ,Cancer Research ,Pathology ,medicine.medical_specialty ,Time Factors ,Colorectal cancer ,Bone Neoplasms ,Prostate cancer ,Breast cancer ,Internal medicine ,otorhinolaryngologic diseases ,Medicine ,Humans ,Aged ,bone metastasis ,business.industry ,Osteitis Deformans ,Bone metastasis ,Prostatic Neoplasms ,Paget's disease ,Middle Aged ,medicine.disease ,prostate cancer ,body regions ,medicine.anatomical_structure ,Paget's disease of bone ,Case-Control Studies ,Clinical Study ,Bone marrow ,Skin cancer ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Background: Patients with prostate cancer tend to die from bone metastases. Until now, no evidence has shown that Paget's disease of bone (PDB) affects the progression of bone metastasis or overall survival of patients with prostate cancer. Methods: We searched our patient database for men who had presented with prostate cancer and PDB between June 1993 and March 2009, and identified best-matched control patients according to stage, grade, age, date of diagnosis, treatment, and race. Results: Among 1346 consecutive patients with prostate cancer diagnosed before 2008, 15 were confirmed to have comorbid PDB. Twenty-six more were identified from the institutional billing search. Including the 41 best-matched controls, our total study population was 82 patients. In the Kaplan–Meier analysis, we estimated median times from diagnosis of prostate cancer to bone metastasis to be 21.5 years for those with PDB and 9.4 years for those without PDB (P=0.044). Median overall survival times were 11.8 and 9.2 years for the two groups, respectively (P=0.008). Conclusion: For the first time, we have obtained evidence that patients with prostate cancer and PDB have delayed time to bone metastases and improved overall survival than do patients with prostate cancer alone.
- Published
- 2012
36. Recurrent seminomas: Clinical features and biologic implications
- Author
-
Avik Som, Louis L. Pisters, Eleni Efstathiou, Shi Ming Tu, Rui Zhu, Angabin Matin, Charles C. Guo, and Li Xiao
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Pathology ,endocrine system diseases ,CD30 ,Urology ,medicine.medical_treatment ,Sialoglycoproteins ,Ki-1 Antigen ,Antineoplastic Agents ,Pilot Projects ,urologic and male genital diseases ,Article ,Human chorionic gonadotropin ,Embryonal carcinoma ,Young Adult ,Testicular Neoplasms ,Internal medicine ,medicine ,Humans ,Chorionic Gonadotropin, beta Subunit, Human ,Neoplasm Metastasis ,Aged ,Retrospective Studies ,Cisplatin ,Chemotherapy ,Ifosfamide ,business.industry ,Proteins ,Seminoma ,Middle Aged ,medicine.disease ,Immunohistochemistry ,Proto-Oncogene Proteins c-kit ,Viscera ,Treatment Outcome ,Antigens, Surface ,Proteoglycans ,Neoplasm Recurrence, Local ,business ,Octamer Transcription Factor-3 ,medicine.drug - Abstract
Objectives Certain patients with seminoma and clinically atypical phenotypes—visceral metastases, elevated levels of β human chorionic gonadotropin (βHCG), and/or recurrent disease—have a poor prognosis. The primary goal of this pilot study was to characterize the clinical characteristics and treatment profile of these rare patients. We also wished to test whether these tumors expressed any specific biomarkers that might distinguish them as a unique subtype of seminoma. Materials and methods We retrospectively identified 25 patients with a history of seminoma plus visceral metastases, βHCG levels >200 mU/ml, and/or recurrent disease. We reviewed these patients' histories for treatment efficacy and clinical outcome. Tissue samples were available from 6 of those patients, and we studied them for expression of the markers OCT 3/4, PLAP, CD30, TRA-1-60, c-kit, and gp200. We compared our results with the expression of those markers in tissue samples from mixed seminoma/embryonal carcinomas and classic seminomas. Results Our analysis suggested that certain chemotherapeutic regimens (such as ifosfamide, paclitaxel, and cisplatin) are efficacious for the treatment of patients with these atypical seminomas. Further, specimens from the atypical seminomas generally had staining profiles that resembled those of classic seminomas and the seminoma components in mixed germ-cell tumors, but the profiles differed from those of the embryonal carcinoma components in the same mixed germ-cell tumors. Conclusions Although these atypical seminomas tend to be resistant to chemotherapy, they may still respond to certain chemotherapeutic regimens. Our pilot immunohistochemical study also suggested that the unique phenotypes associated with these atypical seminomas do not result from any relationship with embryonal carcinomas. More study is needed to confirm these initial findings.
- Published
- 2010
37. Nano-CaCO3 as a pH sensitive theranostic platform
- Author
-
Samuel Achilefu, Limei Tian, Walter J. Akers, Srikanth Singamaneni, Ramesh Raliya, Kvar C. L. Black, Joseph E. Ippolito, Avik Som, and Pratim Biswas
- Subjects
Increase ph ,In vivo ,business.industry ,Nano ,Normal tissue ,Biophysics ,Medicine ,Cancer ,Tumor growth ,Cancer detection ,business ,medicine.disease ,Metastasis - Abstract
Theranostic platforms allow the capability of both diagnostic level imaging and therapy for diseases such as cancer. The decreased pH found in the extracellular environment in cancer is an ideal target for cancer theranostics, because it is both a unique and universal hallmark that distinguishes tumor regions from normal tissue, but also that the decreased pH has been linked to tumor growth and metastasis. We describe herein the development of nano-CaCO3, a novel nanoparticle that can both increase pH in vivo resulting in therapeutic benefit, but also dissolves only at pHs less than 7.4 in vivo, creating a pH sensitivity to the nanoparticle that can be used to detect the more acidic pH ranges in vivo. As a result, nano-CaCO3 is pH sensitive theranostic platform for cancer detection and treatment in vivo.
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