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Article ; Online: Development of an Artificial Intelligence Tool for Intraoperative Guidance During Endovascular Abdominal Aortic Aneurysm Repair.

Li, Allen / Javidan, Arshia P / Namazi, Babak / Madani, Amin / Forbes, Thomas L

2023 Volume 99, Page(s) 96–104

Abstract: Background: Adverse events during surgery can occur in part due to errors in visual perception and judgment. Deep learning is a branch of artificial intelligence (AI) that has shown promise in providing real-time intraoperative guidance. This study aims ...

Abstract	Background: Adverse events during surgery can occur in part due to errors in visual perception and judgment. Deep learning is a branch of artificial intelligence (AI) that has shown promise in providing real-time intraoperative guidance. This study aims to train and test the performance of a deep learning model that can identify inappropriate landing zones during endovascular aneurysm repair (EVAR). Methods: A deep learning model was trained to identify a "No-Go" landing zone during EVAR, defined by coverage of the lowest renal artery by the stent graft. Fluoroscopic images from elective EVAR procedures performed at a single institution and from open-access sources were selected. Annotations of the "No-Go" zone were performed by trained annotators. A 10-fold cross-validation technique was used to evaluate the performance of the model against human annotations. Primary outcomes were intersection-over-union (IoU) and F1 score and secondary outcomes were pixel-wise accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The AI model was trained using 369 images procured from 110 different patients/videos, including 18 patients/videos (44 images) from open-access sources. For the primary outcomes, IoU and F1 were 0.43 (standard deviation ± 0.29) and 0.53 (±0.32), respectively. For the secondary outcomes, accuracy, sensitivity, specificity, NPV, and PPV were 0.97 (±0.002), 0.51 (±0.34), 0.99 (±0.001). 0.99 (±0.002), and 0.62 (±0.34), respectively. Conclusions: AI can effectively identify suboptimal areas of stent deployment during EVAR. Further directions include validating the model on datasets from other institutions and assessing its ability to predict optimal stent graft placement and clinical outcomes.
MeSH term(s)	Humans ; Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Aortic Aneurysm, Abdominal/etiology ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/methods ; Treatment Outcome ; Artificial Intelligence ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Stents ; Retrospective Studies ; Blood Vessel Prosthesis
Language	English
Publishing date	2023-10-31
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2023.08.027
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Article ; Online: How prepared are Canadian trauma centres for mass casualty incidents?

Cameron, Andrew / Javidan, Arshia P / Nathens, Avery B / Cleghorn, Graham

Injury

2021 Volume 52, Issue 9, Page(s) 2625–2629

Abstract: Objectives: Mass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response: physical assets (e.g., critical care ... ...

Abstract	Objectives: Mass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response: physical assets (e.g., critical care beds, operating rooms, food, communication devices) as well as operating procedures (e.g., MCI committees, regional coordination, provider training). The purpose of this study is to provide an examination of MCI preparedness according to these categories in Level 1 Trauma Centre across Canada. Methods: This study surveyed all Level 1 Trauma Centres across Canada in order to assess the physical assets and operating procedures they had in place in the event of a hypothetical MCI on one of the busiest days of the year for trauma care. Results: Of the 28 Trauma Centres contacted, 13 completed surveys (46%). Most hospitals had sufficient food (9/13) water (9/13), fuel (7/13), and communication assets (8/13) for a hypothetical MCI. A median of 38 mechanical ventilators could be mobilized. No hospitals mandated physician training for MCIs, and 6/13 centres were certain that they had a Strategic Emergency Management Plan (SEMP). Only 6/13 hospitals had dedicated MCI committees, Overall, 4/13 hospitals had explicit plans developed with community hospitals. Conclusion: This study demonstrated that physical assets are generally less limiting than operating procedures. Four key areas of potential improvement have been identified: 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans.
MeSH term(s)	Canada ; Disaster Planning ; Emergency Service, Hospital ; Humans ; Mass Casualty Incidents ; Trauma Centers
Language	English
Publishing date	2021-06-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2021.06.017
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Article ; Online: A Systematic Review and Bibliometric Analysis of Applications of Artificial Intelligence and Machine Learning in Vascular Surgery.

Javidan, Arshia P / Li, Allen / Lee, Michael H / Forbes, Thomas L / Naji, Faysal

Annals of vascular surgery

2022 Volume 85, Page(s) 395–405

Abstract: Background: Artificial intelligence (AI) and machine learning (ML) have seen increasingly intimate integration with medicine and healthcare in the last 2 decades. The objective of this study was to summarize all current applications of AI and ML in the ... ...

Abstract	Background: Artificial intelligence (AI) and machine learning (ML) have seen increasingly intimate integration with medicine and healthcare in the last 2 decades. The objective of this study was to summarize all current applications of AI and ML in the vascular surgery literature and to conduct a bibliometric analysis of published studies. Methods: A comprehensive literature search was conducted through Embase, MEDLINE, and Ovid HealthStar from inception until February 19, 2021. Reporting of this study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Title and abstract screening, full-text screening, and data extraction were conducted in duplicate. Data extracted included study metadata, the clinical area of study within vascular surgery, type of AI/ML method used, dataset, and the application of AI/ML. Publishing journals were classified as having either a clinical scope or technical scope. The author academic background was classified as clinical, nonclinical (e.g., engineering), or both, depending on author affiliation. Results: The initial search identified 7,434 studies, of which 249 were included for a final analysis. The rate of publications is exponentially increasing, with 158 (63%) studies being published in the last 5 years alone. Studies were most commonly related to carotid artery disease (118, 47%), abdominal aortic aneurysms (51, 20%), and peripheral arterial disease (26, 10%). Study authors employed an average of 1.50 (range: 1-6) distinct AI methods in their studies. The application of AI/ML methods broadly related to predictive models (54, 22%), image segmentation (49, 19.4%), diagnostic methods (46, 18%), or multiple combined applications (91, 37%). The most commonly used AI/ML methods were artificial neural networks (155/378 use cases, 41%), support vector machines (64, 17%), k-nearest neighbors algorithm (26, 7%), and random forests (23, 6%). Datasets to which these AI/ML methods were applied frequently involved ultrasound images (87, 35%), computed tomography (CT) images (42, 17%), clinical data (34, 14%), or multiple datasets (36, 14%). Overall, 22 (9%) studies were published in journals specific to vascular surgery, with the majority (147/249, 59%) being published in journals with a scope related to computer science or engineering. Among 1,576 publishing authors, 46% had exclusively a clinical background, 48% a nonclinical background, and 5% had both a clinical and nonclinical background. Conclusions: There is an exponentially growing body of literature describing the use of AI and ML in vascular surgery. There is a focus on carotid artery disease and abdominal aortic disease, with many other areas of vascular surgery under-represented. Neural networks and support vector machines composed most AI methods in the literature. As AI/ML continue to see expanded applications in the field, it is important that vascular surgeons appreciate its potential and limitations. In addition, as it sees increasing use, there is a need for clinicians with expertise in AI/ML methods who can optimize its transition into daily practice.
MeSH term(s)	Artificial Intelligence ; Bibliometrics ; Carotid Artery Diseases ; Humans ; Machine Learning ; Treatment Outcome ; Vascular Surgical Procedures
Language	English
Publishing date	2022-03-24
Publishing country	Netherlands
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2022.03.019
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Article ; Online: The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary.

Javidan, Arshia P / Hansen, Kim / Higginson, I / Jones, P / Lang, Eddy

CJEM

2021 Volume 23, Issue 1, Page(s) 26–28

Abstract: Objective: To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block.: Methods: Emergency physicians representing 15 countries from all IFEM regions composed ...

Abstract	Objective: To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block. Methods: Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results: A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions: The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.
MeSH term(s)	Consensus ; Crowding ; Emergency Medicine ; Emergency Service, Hospital ; Humans
Language	English
Publishing date	2021-01-14
Publishing country	England
Document type	Journal Article ; Review
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-020-00065-9
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Article ; Online: The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary.

Javidan, Arshia P / Hansen, Kim / Higginson, Ian / Jones, Peter / Lang, Eddy

Emergency medicine Australasia : EMA

2021 Volume 33, Issue 1, Page(s) 161–163

Abstract: Objective: To develop comprehensive guidance that captures international impacts, causes, and solutions related to ED crowding and access block.: Methods: Emergency physicians representing 15 countries from all the International Federation for ... ...

Abstract	Objective: To develop comprehensive guidance that captures international impacts, causes, and solutions related to ED crowding and access block. Methods: Emergency physicians representing 15 countries from all the International Federation for Emergency Medicine (IFEM) regions composed the task force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results: A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the task force. Conclusions: The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.
MeSH term(s)	Crowding ; Emergency Medicine ; Emergency Service, Hospital ; Humans
Language	English
Publishing date	2021-01-13
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.13660
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Article ; Online: The International Federation for Emergency Medicine report on emergency department crowding and access block: A brief summary.

Javidan, Arshia P / Hansen, Kim / Higginson, Ian / Jones, Peter / Lang, Eddy

Emergency medicine journal : EMJ

2021 Volume 38, Issue 3, Page(s) 245–246

Abstract: Objective: To develop comprehensive guidance that captures international impacts, causes and solutions related to emergency department (ED) crowding and access block.: Methods: Emergency physicians representing 15 countries from all International ... ...

Abstract	Objective: To develop comprehensive guidance that captures international impacts, causes and solutions related to emergency department (ED) crowding and access block. Methods: Emergency physicians representing 15 countries from all International Federation of Emergency Medicine (IFEM) regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results: A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions: The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.
MeSH term(s)	Humans ; Crowding ; Emergency Medicine ; Emergency Service, Hospital/standards ; Health Services Accessibility ; Health Services Research ; Time Factors ; Triage ; Waiting Lists ; Practice Guidelines as Topic
Language	English
Publishing date	2021-01-13
Publishing country	England
Document type	Letter
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2020-210716
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Article ; Online: Assessing the robustness of negative vascular surgery randomized controlled trials using their reverse fragility index.

Li, Allen / Javidan, Arshia P / Liu, Eva / Ahmadvand, Aryan / Tam, Derrick Y / Naji, Faysal / Forbes, Thomas L

Journal of vascular surgery

2022 Volume 78, Issue 1, Page(s) 253–259.e11

Abstract: ... result (P ≤ .05).: Results: Of 4187 reports, 49 studies reporting 103 different primary end points ... 38; 95% confidence interval [CI], 0.20-0.54; P < .01), length of follow-up (r = 0.43; 95% CI, 0.26-0 ... 58; P < .01), and sample size (r = 0.28; 95% CI, 0.09-0.45; P < .01).: Conclusions: A small number ...

Abstract	Objective: The reverse fragility index (RFI) describes the number of event conversions needed to convert a statistically nonsignificant dichotomous outcome to a significant one. The objective of the present study was to assess the RFI of vascular surgery randomized controlled trials (RCTs) comparing endovascular vs open surgery for the treatment of abdominal aortic aneurysms (AAAs), carotid artery stenosis (CAS), and peripheral artery disease (PAD). Methods: MEDLINE and Embase were searched for RCTs that had investigated AAAs, CAS, or PAD with statistically nonsignificant binary primary outcomes. The primary outcome for the present study was the median RFI. Calculation of the RFI was performed by creating two-by-two contingency tables and subtracting events from the group with fewer events and adding nonevents to the same group until a two-tailed Fisher exact test had produced a statistically significant result (P ≤ .05). Results: Of 4187 reports, 49 studies reporting 103 different primary end points were included. The overall median RFI was 7 (interquartile range [IQR], 5-13). The specific RFIs for AAA, CAS, and PAD were 10 (IQR, 6-15.5), 6 (IQR, 5-9.5), and 7 (IQR, 5.5-10), respectively. Of the 103 end points, 42 (47%) had had a loss to follow-up greater than the RFI, of which 10 were AAA trials (24%), 23 were CAS trials (55%), and 9 were PAD trials (21%). The Pearson correlation demonstrated a significant positive relationship between a study's RFI and the impact factor of its publishing journal (r = 0.38; 95% confidence interval [CI], 0.20-0.54; P < .01), length of follow-up (r = 0.43; 95% CI, 0.26-0.58; P < .01), and sample size (r = 0.28; 95% CI, 0.09-0.45; P < .01). Conclusions: A small number of events (median, 7) was required to change the outcome of negative RCTs from statistically nonsignificant to significant, with 47% of the studies having missing data that could have reversed the finding of its primary outcome. Reporting of the RFI relative to the loss to follow-up could be of benefit in future trials and provide confidence regarding the robustness of the P value.
MeSH term(s)	Humans ; Randomized Controlled Trials as Topic ; Sample Size ; Vascular Surgical Procedures/adverse effects ; Specialties, Surgical ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/surgery
Language	English
Publishing date	2022-12-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2022.12.029
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Article ; Online: Implementing the IMIST-AMBO tool for paramedic to trauma team handovers: a video review analysis.

Elliott, Cara G / Notario, Lowyl / Wong, Brian / Javidan, Arshia P / Pannell, Dylan / Nathens, Avery B / Tien, Homer / Johnston, Martin / Thomas-Boaz, Will / Freedman, Corey / da Luz, Luis

CJEM

2023 Volume 25, Issue 5, Page(s) 421–428

Abstract: ... implementation, [p < 0.001]). Frequency of parallel conversations and informal handovers improved (61% to 30% and ... 65% to 13%, [p < 0.001], respectively). Interruptions during the handover decreased from 3.05 (± 1.95 ... to 1.5 (± 1.7), p < 0.001. The tool was received favorably among study participants.: Conclusion ...

Abstract	Objective: Patient handover between paramedics and the trauma team is vulnerable to communication errors that may adversely affect patient care. This study assesses the feasibility of a handover tool, IMIST-AMBO (acronym of categories), implementation in the trauma bay and evaluates the degree to which it improves handover metrics. Methods: This is a prospective observational cohort study conducted at Canada's largest level-one trauma center. Feasibility of the tool implementation and improvement in handover metrics were assessed. Strategies for implementation included distribution of an educational video and posters, and point-of-care reminders in the trauma bay. Two reviewers independently assessed video recordings of handovers to evaluate handover metrics. Findings were compared to data obtained during a knowledge gap analysis conducted prior to the initiation of this study at the same institution. Results: Over 13 weeks (August to November 2020), 140 videos were recorded, of which 80 used the IMIST-AMBO tool (compliance of 57%). Paramedic adherence to the handover structure occurred in 70.4% of cases, with greater adherence to the IMIST (82.2%) compared to the AMBO (47.1%) section. The mean (± standard deviation) handover duration was shorter (1 min:58 s ± 0:44 s during implementation vs. 2 min:47 s ± 1:14 s pre-implementation, [p < 0.001]). Frequency of parallel conversations and informal handovers improved (61% to 30% and 65% to 13%, [p < 0.001], respectively). Interruptions during the handover decreased from 3.05 (± 1.95) to 1.5 (± 1.7), p < 0.001. The tool was received favorably among study participants. Conclusion: The IMIST-AMBO tool reduced the frequency of interruptions, parallel conversations, and informal handovers during paramedic-trauma team handovers at our institution. The quality and amount of information communicated per handover improved, all with a decrease in handover duration. The IMIST-AMBO tool may be applied to other trauma centers across Canada, or more broadly on an international scale.
MeSH term(s)	Humans ; Patient Handoff ; Paramedics ; Cohort Studies ; Emergency Medical Technicians ; Communication ; Continuity of Patient Care
Language	English
Publishing date	2023-04-23
Publishing country	England
Document type	Observational Study ; Journal Article
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-023-00503-4
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Article ; Online: Clinical handover from emergency medical services to the trauma team: A gap analysis.

Javidan, Arshia P / Nathens, Avery B / Tien, Homer / da Luz, Luis T

CJEM

2020 Volume 22, Issue S2, Page(s) S21–S29

Abstract: Objectives: There has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be ... ...

Abstract	Objectives: There has been limited evaluation of handover from emergency medical services (EMS) to the trauma team. We sought to characterize these handover practices to identify areas of improvement and determine if handover standardization might be beneficial for trauma team performance. Methods: Data were prospectively collected over a nine-week period by a trained observer at a Canadian level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders and EMS according to a bidirectional Likert scale. Results: 79 formal verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Of all questions asked, 35% were questioning previously given information. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking. There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders. Conclusions: We have identified the need to standardize handover due to poor information content, a lack of structure and active listening, information repetition, and discordant expectations between team members. These data will guide the development of a co-constructed framework integrating the perspectives of all team members.
MeSH term(s)	Canada ; Communication ; Emergency Medical Services ; Humans ; Patient Handoff
Language	English
Publishing date	2020-10-20
Publishing country	England
Document type	Journal Article
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1017/cem.2019.438
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Article ; Online: Factors relating to the publication rate of abstracts presented from 2012 to 2015 at the Society for Vascular Surgery Annual Meeting.

Javidan, Arshia P / Naji, Faysal / Ali, Khatija Pinky / Rapanos, Theodore / Harlock, John

Journal of vascular surgery

2019 , Page(s) 1909–1917

Abstract: ... P < .001).: Conclusions: From 2012 to 2015, 43.0% of VAM abstracts had a corresponding full-text ...

Abstract	Objective: The Society for Vascular Surgery's Annual Meeting acts as a means of disseminating research findings among vascular surgeons through the presentation of research abstracts. Following presentation at the meeting, research is often compiled into a full-text manuscript and submitted to a peer-reviewed journal. However, not all abstracts accepted to the Vascular Annual Meeting (VAM) eventually have a corresponding full-text publication. The objectives of this study were to establish the publication rate of abstracts presented between 2012 and 2015 to the VAM and to identify factors correlating with publication status. Methods: Abstracts presented at the VAM were available through the Journal of Vascular Surgery. Data extracted from eligible abstracts included level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence scheme, type of study (prognostic, therapeutic/harm, diagnostic), sample size, and status of outcome (positive, negative, or descriptive findings). Publication status of the abstracts was determined through a comprehensive literature review of PubMed (MEDLINE), Ovid (MEDLINE), and Embase. A multivariable logistic regression was conducted to determine factors correlating with publication status. Results: The publication rate during the study period was 43.0% with a median time to publication of 9 months, with 412 of the 958 abstracts having a corresponding full-text publication in 48 journals with weighted mean impact factor of 3.40. Eleven journals collectively published 372 (90.3%) of the articles, with the Journal of Vascular Surgery publishing 280 (68.0%) of the manuscripts. Our logistic regression model demonstrated that factors positively affecting publication status were a positive status of outcome (odds ratio, 2.59; 95% confidence interval, 1.56-4.28) and a logarithmic increase in the sample size of the study (odds ratio, 1.35; 95% confidence interval, 1.13-1.60). In addition, studies with a corresponding full-text publication had a greater median sample size (250) compared with those without one (143; P < .001). Conclusions: From 2012 to 2015, 43.0% of VAM abstracts had a corresponding full-text publication, with greater sample size and a positive status of outcome positively correlating with likelihood of publication. Studies with negative findings made up a small proportion of conference abstracts (9.6%) and were the least likely to be published. Given the relatively small size of the specialty of vascular surgery, it may be particularly important to be mindful of publication bias. It may be worthwhile to give additional consideration to acceptance of abstracts or publication of studies with negative results that meaningfully contribute to the literature.
Language	English
Publishing date	2019-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2018.09.034
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