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Roche AF, Voborsky M, Meighan V, O'Connor G, Eppich WJ, Condron CM. Developing a clamshell thoracotomy training model to support hybrid teaching in simulation-based education. Emerg Med Australas 2024. [PMID: 38418385 DOI: 10.1111/1742-6723.14398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Thoracotomy is an acute, time-sensitive procedure. Simulation-based education provides a safe-learning platform to learn these techniques under close supervision. METHODS We used the spiral model and concepts of functional fidelity to guide the evolutionary design and fabrication of a hybrid thoracotomy simulator. RESULTS This model simulates a clamshell thoracotomy that physically integrates with bespoke manikins and adds a high-fidelity technical skills element to immersive team-based simulation training. CONCLUSIONS We describe the creation of a thoracotomy simulation model that allows trainees to practice these techniques in a safe-learning environment.
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Affiliation(s)
- Adam F Roche
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Miroslav Voborsky
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Victoria Meighan
- Emergency Department, Tallaght University Hospital, Dublin, Ireland
| | - Gerard O'Connor
- Emergency Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Walter J Eppich
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire M Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Sullivan CC, O'Leary DM, Boland FM, Condron CM, Mulhall CM, Eppich WJ. A comparative analysis of student, educator, and simulated parent ratings of video-recorded medical student consultations in pediatrics. Adv Simul (Lond) 2024; 9:10. [PMID: 38365837 PMCID: PMC10874056 DOI: 10.1186/s41077-024-00282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Simulation-based education (SBE) affords learners opportunities to develop communication skills, including those related to pediatrics. Feedback is an integral part of SBE, and while much research into feedback from multiple sources exists, the findings are mixed. The aim of this comparative study was to replicate some of this work in a novel area, pediatric medical education, to better understand how multisource feedback (self, educator, and simulated parent) may inform learning and curriculum design. METHODS During their pediatric rotation, medical students participated in a consultation with a simulated parent, engaged in video-assisted self-reflection, and received feedback from both an educator and the simulated parent through an e-learning platform. The Pediatric Consultation Skills Assessment Tool (PCAT) was used for self-assessment and educator feedback, and the Consultation and Relational Empathy (CARE) measure was used for simulated parent feedback. RESULTS Our results showed that high-performing students underrated their performance, and low-performing students overrated their performance. Feedback from multiple sources helps to identify both areas of weakness in student performance and areas of weakness in student self-appraisal. Overall, general areas of weakness identified for the learners related to making contingency plans and providing easy-to-understand explanations for simulated parents. Some simulated parent feedback did not align with educator and student ratings, highlighting the value of including the simulated parent perspective. Our findings question whether a third party can reliably judge the simulated parent's level of understanding. CONCLUSION Multisource feedback allows students to develop layered insights into their performance and supports self-appraisal. Aggregating feedback through an e-learning platform allows educators to gain greater insights into the strengths and weakness of students and design a more tailored teaching plan to support student needs.
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Affiliation(s)
- Clare C Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Daire M O'Leary
- Department of Pediatrics, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Fiona M Boland
- Data Science Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Claire M Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Claire M Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Walter J Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
- Department of Medical Education & Collaborative Practice Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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Roche AF, Kavanagh D, McCawley N, O'Riordan JM, Cahir C, Toale C, O'Keeffe D, Lawler T, Condron CM. Collating evidence to support the validation of a simulated laparotomy incision and closure-training model. Am J Surg 2024:S0002-9610(24)00110-7. [PMID: 38402084 DOI: 10.1016/j.amjsurg.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND It is essential to evaluate the functionality of surgical simulation models, in order to determine whether they perform as intended. In this study, we assessed the use of a simulated laparotomy incision and closure-training model by collating validity evidence to determine its utility as well as pre and post-test interval data. METHOD This was a quantitative study design, informed by Messick's unified validity framework. In total, 93 participants (surgical trainees = 80, experts = 13) participated in this study. Evaluation of content validity and the models' relationships with other variables was conducted, along with a pre and post-test confidence assessment. RESULTS The model was deemed realistic and useful as a teaching tool, providing strong content validity evidence. In assessment of relationships with other variables, the expert group out-performed the novice group conclusively. Pre and post-test evaluation reported a statistically significant increase in confidence levels. CONCLUSION We present strong validity evidence of a novel laparotomy incision and closure simulation-training model.
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Affiliation(s)
- Adam F Roche
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Dara Kavanagh
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh McCawley
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - J M O'Riordan
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Caitriona Cahir
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Conor Toale
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dara O'Keeffe
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tim Lawler
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire M Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Abstract
INTRODUCTION Health care simulation technicians (HSTs), also referred to as simulation operations specialists, are essential to the delivery of simulation-based education. The HST role draws on a broad range of knowledge, skills, and attitude competencies. However, because of the neoteric nature of the HST role and the ambiguity surrounding the core responsibilities of the position, it has proved difficult to identify the competencies required to perform this role successfully. This study aims to identify the knowledge, skills, and attitude competencies required by HSTs. METHODS A mixed methods approach was used in this study. Data were collected from (1) online searches of HST job descriptions and (2) semistructured interviews about the competencies required by HSTs with 10 HSTs, 10 health care simulation educators, and 10 health care simulation center managers/director. The data from the job descriptions and interviews were analyzed using thematic analysis, using a framework method to guide the coding. RESULTS A total of 59 competencies were identified from the job descriptions and 65 competencies from the interviews. This analysis resulted in the identification of 9 competency domains: 3 knowledge domains (technical, clinical, and pedagogic), 4 skills domains (resourcefulness, pedagogic, team, and technical), and 2 attitudes domains (professional and "can-do" mentality). CONCLUSIONS The identification of the competencies required by HSTs will support the selection of candidates with the attributes that will allow them to be successful in this role and guide continuous professional development opportunities for current and future HSTs.
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Sullivan C, Condron CM, O'Connor L, Pawlikowska T, Murray JM. Their OSCE, not your Oscar: Simulated Patients' Perspectives. Clin Teach 2021; 18:596-601. [PMID: 34313380 DOI: 10.1111/tct.13400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulated patients (SPs) are involved widely in the support of health care education for communication and consultation skills teaching. This study aimed to explore SPs' perspectives of their role and contribution to health professions education. METHODS A qualitative approach was used. Twenty-two SPs (actor and non-actor) involved in teaching at the Royal College of Surgeons Ireland (RCSI) participated in one of four focus groups, which were audiorecorded. Two focus groups involved professional actors (n = 7), and two focus groups involved non-actor SPs (n = 15). Transcribed data were analysed using thematic analysis. RESULTS The first theme 'Reward of Contribution' highlights how the SP role is situated in a position of mutual benefit for both SP and student. The second theme 'Multiple Personas' demonstrates the complexity of SP role portrayal. The third theme 'Culture and Communication' is a new finding and demonstrates the role SPs feel they have in helping to change the culture of health care practice. The fourth theme 'A touchy subject' addresses the preferences of SPs concerning involvement in both intimate and nonintimate physical examination. CONCLUSIONS SPs believe they have an important role to play in health care education and they also learn from their involvement. SPs' perspectives need to be considered to ensure they feel supported in their role and that their unique insights remain beneficial for student learning.
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Affiliation(s)
- Clare Sullivan
- Simulation, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire M Condron
- Dept. of Surgery, Beaumont Hospital, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Laura O'Connor
- Summer Research School, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - James M Murray
- Simulation, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Offiah G, Ekpotu LP, Murphy S, Kane D, Gordon A, O’Sullivan M, Sharifuddin SF, Hill ADK, Condron CM. Evaluation of medical student retention of clinical skills following simulation training. BMC Med Educ 2019; 19:263. [PMID: 31311546 PMCID: PMC6632214 DOI: 10.1186/s12909-019-1663-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/11/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Adequate clinical skills training is a challenge for present day medical education. Simulation Based Education (SBE) is playing an increasingly important role in healthcare education worldwide to teach invasive procedures. The impact of this teaching on students along with retention of what is taught is not fully understood. The purpose of this study was to evaluate the retention levels of practical skills taught and assessed by SBE and to explore the degree of re-training required to restore decayed performance. In exploring this aim, the study further investigates how skilled performance decays over time and which dimensions of clinical skills were more likely to decay. METHODS Study participants were 51 final year medical students. They were provided with online pre-course videos and procedural guides asynchronously with repeatedly access. 7 of the skills taught over 2 years using task trainers were selected. Following demonstration from faculty, students practiced in small groups with faculty facilitated supervision and peer support prior to formal testing. Score sheets with itemised procedure checklists detailing the minimum passing standard (MPS) for each skill were designed. To test retention of skills, 18 months later, there was an unannounced test to demonstrate proficiency in the skills. Students were asked to complete a questionnaire indicating how many times and where they had practiced or performed the skills. RESULTS 55% of the students were deficient in 3 or more skills and 4% were not competent in 5 or more skills. A significant number of students had never practiced some skills following the initial teaching session. A relationship was noted with the number of times students self-declared that they had practiced and their performance. Decay is evident in both psychomotor and cognitive domains of the skills. CONCLUSION A curriculum with deliberate practice significantly increases the competence of students in defined clinical skills. Deliberate practice of clinical skills, under supervision of an engaged instructor, is a key component of the mastery model. Experiences and assessments in the clinical setting need to be augmented with focus on direct observation and focused feedback to reinforce the skills acquired in the simulated setting.
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Affiliation(s)
- Gozie Offiah
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Lenin P. Ekpotu
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Siobhan Murphy
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Daniel Kane
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Alison Gordon
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Muireann O’Sullivan
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Sue Faye Sharifuddin
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - A. D. K. Hill
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Claire M. Condron
- Department of Surgery, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
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Shannon AM, Bouchier-Hayes DJ, Condron CM, Toomey D. Correction of anaemia through the use of darbepoetin alfa improves chemotherapeutic outcome in a murine model of Lewis lung carcinoma. Br J Cancer 2005; 93:224-32. [PMID: 15999100 PMCID: PMC2361545 DOI: 10.1038/sj.bjc.6602685] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Darbepoetin alfa (Aranesp®, Amgen) is a novel erythropoiesis-stimulating protein with a serum half-life longer than recombinant human erythropoietin (Epo), used in the treatment of cancer-associated anaemia. Anaemia is known to adversely affect prognosis and response to treatment in cancer patients. Solid tumours contain regions of hypoxia due to poor vascular supply and cellular compaction. Although hypoxic stress usually results in cell death, hypoxia-resistant tumour cells are genetically unstable and often acquire a drug-resistant phenotype. Increasing tumour oxygenation and perfusion during treatment could have the doubly beneficial outcome of reducing the fraction of treatment-resistant cells, while increasing drug delivery to previously hypoxic tissue. In this study, we examined the effect of darbepoetin alfa on chemotherapy sensitivity and delivery in an in vivo model of Lewis lung carcinoma, shown here to express the Epo receptor (EpoR). We identified that weekly darbepoetin alfa treatment, commencing 10 days before chemotherapy, resulted in a significant reduction in tumour volume compared to chemotherapy alone. This was mediated by the prevention of anaemia, a reduction in tumour hypoxia and a concomitant increase in drug delivery. Darbepoetin alfa treatment alone did not modulate the growth of the EpoR-expressing tumour cells. This study identifies an important role for darbepoetin alfa in increasing the therapeutic index of chemotherapy.
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Affiliation(s)
- A M Shannon
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - D J Bouchier-Hayes
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - C M Condron
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - D Toomey
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
- Department of Biochemistry, Trinity College, Dublin 2, Ireland. Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland. E-mail:
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Barr MP, Byrne AM, Duffy AM, Condron CM, Devocelle M, Harriott P, Bouchier-Hayes DJ, Harmey JH. A peptide corresponding to the neuropilin-1-binding site on VEGF(165) induces apoptosis of neuropilin-1-expressing breast tumour cells. Br J Cancer 2005; 92:328-33. [PMID: 15655556 PMCID: PMC2361857 DOI: 10.1038/sj.bjc.6602308] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
There is increasing evidence that vascular endothelial growth factor (VEGF) has autocrine as well as paracrine functions in tumour biology. Vascular endothelial growth factor-mediated cell survival signalling occurs via the classical tyrosine kinase receptors Flt-1, KDR/Flk-1 and the more novel neuropilin (NP) receptors, NP-1 and NP-2. A 24-mer peptide, which binds to neuropilin-1, induced apoptosis of murine and human breast carcinoma cells, whereas a peptide directed against KDR had no effect. Both anti-NP1 and anti-KDR peptides induced endothelial cell apoptosis. Confocal microscopy using 5-(6)-carboxyfluorescein-labelled peptides showed that anti-NP1 bound to both tumour and endothelial cells, whereas anti-KDR bound endothelial cells only. This study demonstrates that NP-1 plays an essential role in autocrine antiapoptotic signalling by VEGF in tumour cells and that NP1-blockade induces tumour cell and endothelial cell apoptosis. Specific peptides can therefore be used to target both autocrine (tumour cells) and paracrine (endothelial cells) signalling by VEGF.
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Affiliation(s)
- M P Barr
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - A M Byrne
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - A M Duffy
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - C M Condron
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - M Devocelle
- Centre for Synthesis & Chemical Biology, Department of Pharmaceutical and Medicinal Chemistry, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
| | - P Harriott
- Centre for Synthesis & Chemical Biology, Department of Pharmaceutical and Medicinal Chemistry, Royal College of Surgeons in Ireland, St Stephen's Green, Dublin 2, Ireland
- School of Biology and Biochemistry, Medical Biology Centre, Queen's University of Belfast, Northern Ireland
| | - D J Bouchier-Hayes
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - J H Harmey
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland. E-mail:
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Condron CM, Toomey DM, Casey RG, Creagh T, Bouchier-Hayes DJ. Taurine protects against PMN dysfunction and death in urine. ACTA ACUST UNITED AC 2004; 32:338-45. [PMID: 15160258 DOI: 10.1007/s00240-004-0420-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 03/12/2004] [Indexed: 11/26/2022]
Abstract
The polymorphonuclear neutrophil (PMN) is the primary pro-inflammatory cell in the host response to bacterial infection and, as the first line of defence, is the principal cell responsible for the recognition, phagocytosis and killing of bacteria. PMN function is known to be defective in the urine. High osmolarity is physiologic in the urine and this hypertonic environment has been shown to compromise neutrophil function. In this study, PMN function was found to be suppressed in urine. This correlated with significant cell death, both by apoptosis and necrosis. The amino acid taurine down regulated PMN cell death and preserved function in the urine, suggesting taurine as a therapeutic option for urinary tract infection.
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Affiliation(s)
- Claire M Condron
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland.
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Abstract
Tissue hypoxia occurs where there is an imbalance between oxygen supply and consumption. Hypoxia occurs in solid tumours as a result of an inadequate supply of oxygen, due to exponential cellular proliferation and an inefficient vascular supply. It is an adverse prognostic indicator in cancer as it is associated with tumour progression and resistance to therapy. The expression of several genes controlling tumour cell survival are regulated by hypoxia, e.g., growth factors governing the formation of new blood vessels, and hypoxia-responsive transcription factors modulating the expression of genes, which promote tumour cell survival. This review outlines some of the pathways by which tumour hypoxia leads to chemotherapeutic resistance, directly due to lack of oxygen availability, and indirectly due to alterations in the proteome/genome, angiogenesis and pH changes. Some innovative therapies are also detailed which may potentially minimise or eliminate these problems associated with targeting solid tumours.
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Affiliation(s)
- Aoife M Shannon
- Department of Surgery, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, 9, Dublin, Ireland.
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Barry MC, Condron CM, Watson RW, Redmond HP, El Jack M, Watson RG, Bouchier Hayes D. Pre-operative neutrophil and monocyte activation state predicts post-operative neutrophil and monocyte function. Eur J Surg 1997; 163:739-45. [PMID: 9373224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To find out if the in vitro responses of neutrophils (PMN) and monocytes preoperatively can predict their activation postoperatively. DESIGN Prospective open study. SETTING Teaching hospital, Ireland. SUBJECTS 46 Patients (32 men, 14 women, mean age 65 years, range 33-85) who were to undergo elective major vascular or gastrointestinal operations for benign (n = 18) or malignant (n = 28) diseases. INTERVENTIONS Measurement by flow cytometry of functional (PMN and monocyte respiratory burst activity) and phenotypic (expression of PMN CD 11b adhesion receptors and monocyte CD14 receptors) markers of activation. MAIN OUTCOME MEASURES Correlation between mean channel fluorescence (MCF) preoperatively and postoperatively. RESULTS In 24 patients PMN respiratory burst activity was increased before operation and had decreased significantly (p < 0.01) on postoperative day 1 (high responders group). In the remaining 22 patients (low responders group) respiratory burst activity was low before operation and had increased significantly (p < 0.05) on postoperative day 1. PMN CD 11b activity followed a similar trend. Monocyte activity responded similarly (in the high group mean (SEM) MCF preoperatively was 69.14 (13.15) compared with 58.23 (10.8) on day 1, and in the low group the corresponding figures were 38.5 (7.01) and 8.43 (5.2). Expression of CD14 did not differ between the groups and was less postoperatively than preoperatively. The groups did not differ in age, sex, APACHE 11 scores, smoking habits or types of disease and there was no major infective complications in either group. CONCLUSION There are two distinct patterns of PMN and monocyte responses to injury that are independant of age, sex and severity of operation. These may be associated with the degree of stress preoperatively or with genetic factors.
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Affiliation(s)
- M C Barry
- Department of Surgery, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin
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12
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McCarthy JE, Redmond PH, Duggan SM, Watson RW, Condron CM, O'Donnell JR, Bouchier-Hayes DJ. Characterization of the defects in murine peritoneal macrophage function in the early postsplenectomy period. The Journal of Immunology 1995. [DOI: 10.4049/jimmunol.155.1.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
Postsplenectomy bacterial sepsis may be fatal, due to defects in both cellular and humoral immune responses. The objective of this study was to assess the efficacy of peritoneal macrophage antibacterial function in the early postsplenectomy period. Murine models of splenectomy and sham operation were characterized and peritoneal macrophages were harvested 24 h to 1 wk after surgery. Cells from splenectomized animals demonstrated a nonsignificant delay in phagocytosis of Escherichia coli at 24 h with, however, significantly impaired killing of intracellular organisms at 24 h and 1 wk compared to the sham group. Paradoxically, the production of the macrophage antibacterial product superoxide anion was not impaired at either time point in the splenectomy group compared with sham-operated and control mice. Nitric oxide release was significantly lower in the splenectomized group (p = 0.006), a possible explanation for reduced bacterial killing. Mortality from bacterial peritonitis was significantly higher with concomitant splenectomy than in the sham splenectomy group at 24 h (p < 0.02). The production of TNF from macrophages was up-regulated immediately following splenectomy, a cytokine which may contribute to mortality from bacteremic shock. Local defects in macrophage antimicrobial function may contribute significantly to bacteremia and to subsequent mortality in the early postsplenectomy period.
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Affiliation(s)
- J E McCarthy
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - P H Redmond
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - S M Duggan
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - R W Watson
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - C M Condron
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - J R O'Donnell
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
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13
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McCarthy JE, Redmond PH, Duggan SM, Watson RW, Condron CM, O'Donnell JR, Bouchier-Hayes DJ. Characterization of the defects in murine peritoneal macrophage function in the early postsplenectomy period. J Immunol 1995; 155:387-96. [PMID: 7602113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postsplenectomy bacterial sepsis may be fatal, due to defects in both cellular and humoral immune responses. The objective of this study was to assess the efficacy of peritoneal macrophage antibacterial function in the early postsplenectomy period. Murine models of splenectomy and sham operation were characterized and peritoneal macrophages were harvested 24 h to 1 wk after surgery. Cells from splenectomized animals demonstrated a nonsignificant delay in phagocytosis of Escherichia coli at 24 h with, however, significantly impaired killing of intracellular organisms at 24 h and 1 wk compared to the sham group. Paradoxically, the production of the macrophage antibacterial product superoxide anion was not impaired at either time point in the splenectomy group compared with sham-operated and control mice. Nitric oxide release was significantly lower in the splenectomized group (p = 0.006), a possible explanation for reduced bacterial killing. Mortality from bacterial peritonitis was significantly higher with concomitant splenectomy than in the sham splenectomy group at 24 h (p < 0.02). The production of TNF from macrophages was up-regulated immediately following splenectomy, a cytokine which may contribute to mortality from bacteremic shock. Local defects in macrophage antimicrobial function may contribute significantly to bacteremia and to subsequent mortality in the early postsplenectomy period.
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Affiliation(s)
- J E McCarthy
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
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