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Fitzgerald N, Moylett E, Gaffney G, McCarthy G, Fapohunda O, Murphy AW, Geoghegan R, Hallahan B. Undertaking a face-to-face objective structured clinical examination for medical students during the COVID-19 pandemic. Ir J Psychol Med 2024; 41:61-67. [PMID: 35575056 DOI: 10.1017/ipm.2022.19] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND AIMS Objective structured clinical examinations (OSCEs) play a pivotal role in medical education assessment. The Advanced Clinical Skills (ACS) OSCE examines clinical skills in psychiatry, general practice, obstetrics and gynaecology and paediatrics. This study examined if the 2020 ACS OSCE for fourth year medical students attending the National University of Ireland, Galway, was associated with any significant result differences compared to the equivalent 2019 OSCE. Additionally, we assessed students' satisfaction and explored any organisational difficulties in conducting a face-to-face OSCE during the COVID-19 pandemic. MATERIALS AND METHODS This study compared anonymised data between the 2019 and 2020 ACS OSCEs and analysed anonymised student feedback pertaining to the modified 2020 OSCE. RESULTS The mean total ACS OSCE result achieved in 2020 was statistically higher compared to the 2019 OSCE [62.95% (SD = 6.21) v. 59.35% (SD = 5.54), t = 6.092, p < 0.01], with higher marks noted in psychiatry (p = 0.001), paediatrics (p = 0.001) and general practice (p < 0.001) with more students attaining honours grades (χ2 = 27.257, df = 3, p < 0.001). No difference in failure rates were found. Students reported feeling safe performing the 2020 OSCE (89.2%), but some expressed face-mask wearing impeded their communication skills (47.8%). CONCLUSION This study demonstrates that conducting a face-to-face OSCE during the pandemic is feasible and associated with positive student feedback. Exam validity has been demonstrated as there was no difference in the overall pass rate.
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Affiliation(s)
- N Fitzgerald
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - E Moylett
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Paediatrics, University Hospital Galway, Ireland
| | - G Gaffney
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Obstetrics and Gynaecology, University Hospital Galway, Ireland
| | - G McCarthy
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Sligo-Leitrim Mental Health Services, Sligo University Hospital, Ireland
| | - O Fapohunda
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Otolaryngology, University Hospital Galway, Ireland
| | - A W Murphy
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - R Geoghegan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Paediatrics, University Hospital Galway, Ireland
| | - B Hallahan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
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Sun S, Dutson EP, Geoghegan R. A Novel Sensor for Tissue Mechanical Property Detection During Robotic Surgery. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:4834-4838. [PMID: 36086573 DOI: 10.1109/embc48229.2022.9871202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Haptic feedback relays important tissue mechanical properties to surgeons during open surgery. However, this information is lost during Robot-assisted Minimally Invasive Surgery (RMIS). Here we present a proof-of-concept for a novel instrument-integrated sensor that uses fiber Bragg grating (FBG) arrays to identify tissues based on mechanical properties. Subjects were tasked with sorting tissue phantoms based on hardness. When using a conventional surgical robot, the average error for novices (N=5) and the expert user was 22.5% and 12.5% respectively. This reduced to 2.5% and 0% when sorting with direct palpation by hand. In contrast, the senorized instrument with automated analysis was able to perform the task without any error across all trials. Clinical Relevance - The proposed sensor has the potential of identifying different tissues based on mechanical properties and thus characterize tumors and other relevant structures. It is envisaged that this will improve decision making process during RMIS and also provide useful sensory information for autonomous surgery.
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Geoghegan R, Zhang L, Priester A, Wu HH, Marks L, Natarajan S. Interstitial Optical Monitoring of Focal Laser Ablation. IEEE Trans Biomed Eng 2022; 69:2545-2556. [PMID: 35148260 PMCID: PMC9371599 DOI: 10.1109/tbme.2022.3150279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Focal laser ablation is a minimally invasive method of treating cancerous lesions in organs such as prostate, liver and brain. Oncologic control is achieved by inducing hyperthermia throughout the target while minimizing damage to surrounding tissue. Consequently, successful clinical outcomes are contingent upon achieving desired ablation volumes. Magnetic resonance thermometry is frequently used to monitor the formation of the induced thermal damage zone and inform the decision to terminate energy delivery. However, due to the associated cost and complexity there is growing interest in the development of alternative approaches. Here we investigate the utility of real-time interstitial interrogation of laser-tissue interaction as an inexpensive alternative monitoring modality that provides direct assessment of tissue coagulation without the need for organ specific calibration. The optical contrast mechanism was determined using a Monte Carlo model. Subsequently, four interstitial probe designs were manufactured and assessed in a tissue mimicking phantom under simultaneous magnetic resonance imaging. Finally, the optimal probe design was evaluated in ex vivo bovine muscle. It was found to be capable of providing sufficient feedback to achieve pre-defined ablation radii in the range 4-7mm with a mean absolute error of 0.3mm. This approach provides an inexpensive monitoring modality that may facilitate widespread adoption of focal laser ablation.
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Geoghegan R, Ter Haar G, Nightingale K, Marks L, Natarajan S. Methods of monitoring thermal ablation of soft tissue tumors - A comprehensive review. Med Phys 2022; 49:769-791. [PMID: 34965307 DOI: 10.1002/mp.15439] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/30/2020] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
Thermal ablation is a form of hyperthermia in which oncologic control can be achieved by briefly inducing elevated temperatures, typically in the range 50-80°C, within a target tissue. Ablation modalities include high intensity focused ultrasound, radiofrequency ablation, microwave ablation, and laser interstitial thermal therapy which are all capable of generating confined zones of tissue destruction, resulting in fewer complications than conventional cancer therapies. Oncologic control is contingent upon achieving predefined coagulation zones; therefore, intraoperative assessment of treatment progress is highly desirable. Consequently, there is a growing interest in the development of ablation monitoring modalities. The first section of this review presents the mechanism of action and common applications of the primary ablation modalities. The following section outlines the state-of-the-art in thermal dosimetry which includes interstitial thermal probes and radiologic imaging. Both the physical mechanism of measurement and clinical or pre-clinical performance are discussed for each ablation modality. Thermal dosimetry must be coupled with a thermal damage model as outlined in Section 4. These models estimate cell death based on temperature-time history and are inherently tissue specific. In the absence of a reliable thermal model, the utility of thermal monitoring is greatly reduced. The final section of this review paper covers technologies that have been developed to directly assess tissue conditions. These approaches include visualization of non-perfused tissue with contrast-enhanced imaging, assessment of tissue mechanical properties using ultrasound and magnetic resonance elastography, and finally interrogation of tissue optical properties with interstitial probes. In summary, monitoring thermal ablation is critical for consistent clinical success and many promising technologies are under development but an optimal solution has yet to achieve widespread adoption.
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Affiliation(s)
- Rory Geoghegan
- Department of Urology, University of California Los Angeles, Los Angeles, California, USA
| | - Gail Ter Haar
- Department of Physics, Institute of Cancer Research, University of London, Sutton, UK
| | - Kathryn Nightingale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Leonard Marks
- Department of Urology, University of California Los Angeles, Los Angeles, California, USA
| | - Shyam Natarajan
- Departments of Urology & Bioengineering, University of California Los Angeles, Los Angeles, California, USA
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5
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Pensa J, Brisbane W, Priester A, Sisk A, Marks L, Geoghegan R. A System for Co-Registration of High-Resolution Ultrasound, Magnetic Resonance Imaging, and Whole-Mount Pathology for Prostate Cancer. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:3890-3893. [PMID: 34892082 DOI: 10.1109/embc46164.2021.9630404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In order to evaluate the diagnostic accuracy of high-resolution ultrasound (HRUS) for detection of prostate cancer, it must be validated against whole-mount pathology. An ex-vivo HRUS scanning system was developed and tested in phantom and human tissue experiments to allow for in-plane computational co-registration of HRUS with magnetic resonance imaging (MRI) and whole-mount pathology. The system allowed for co-registration with an error of 1.9mm±1.4mm, while also demonstrating an ability to allow for lesion identification.Clinical Relevance- Using this system, a workflow can be established to co-register HRUS with MRI and pathology to allow for the diagnostic accuracy of HRUS to be determined with direct comparison to MRI.
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Downes M, Keenan L, Duane Y, Duffy K, Fortune G, Geoghegan R, Conroy H, McMahon C. Executive function in children with sickle cell anemia on transfusion: NIH toolbox utility in the clinical context. Clin Neuropsychol 2020; 36:1573-1588. [PMID: 33200651 DOI: 10.1080/13854046.2020.1847325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to establish the utility of the NIH Toolbox as a cognitive screener of executive functions in the clinical context. Additionally, we aimed to investigate whether age and time on transfusion were related to executive function performance. Method: Twenty-eight children and adolescents with sickle cell anemia (SCA) between 8 and 18 years (M = 13.28, SD = 3.05) on transfusion treatment were included. Participants completed five NIH Toolbox tasks (three executive function tasks and two non-executive function control tasks). Results: Mean scores on one of the three executive function measures (inhibitory control) fell below the average range (M = 81.36, SD = 14.01) with approximately 70% of children from both groups below the average range. Scores for processing speed (M = 86.82, SD = 22.01) and cognitive flexibility (M = 85.75, SD = 12.67) were low averages. As expected, scores on non-executive measures (language and memory) fell within the average range. No significant differences were observed between children with silent stroke and no stroke on executive function measures. Older age (p < .01) and length of time on transfusion (p < .05) predicted lower inhibitory control scores. Conclusions: Findings provide evidence for poor development of inhibitory control with age in this patient population. As the NIH Toolbox successfully highlighted expected deficits in this patient population, this study supports the use of this tool as a brief screening measure for children with SCD. The clinical and theoretical implications of the findings are discussed.
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Affiliation(s)
- M Downes
- School of Psychology, University College Dublin, Dublin, Ireland
| | - L Keenan
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Y Duane
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - K Duffy
- School of Psychology, University College Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - G Fortune
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - R Geoghegan
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - H Conroy
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - C McMahon
- Children's Health Ireland at Crumlin, Dublin, Ireland
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Geoghegan R, Priester A, Zhang L, Wu H, Marks L, Natarajan S. Monitoring Focal Laser Ablation with Interstitial Fluence Probes: Monte Carlo Simulation and Phantom Validation. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5272-5275. [PMID: 33019173 DOI: 10.1109/embc44109.2020.9176370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Focal laser ablation offers a minimally invasive method of treating solid organ tumors via hyperthermia. Real-time monitoring of the induced tissue damage is critical for clinical success, and is typically accomplished using thermal measurements and Arrhenius models. In this manuscript, the utility of interstitial fluence probes in assessing coagulation directly in real-time was assessed through a Monte Carlo simulation and an experimental study in tissue mimicking prostate phantoms. In the simulation results, fluence increases greater than 100% were observed inside the coagulation zone, as coagulation effectively acts as a 'light trap'. Moreover, the passing of the coagulation boundary at any given point was shown to correspond with an inflection in fluence with a mean absolute difference of 0.1mm and 0.4mm observed for the simulation and phantom respectively. These results suggest that interstitial fluence probes may be capable of providing real-time feedback during focal laser ablation.
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Mendelsohn AH, Kim C, Song J, Singh A, Le T, Abiri A, Berke GS, Geoghegan R. Transoral Robotic Surgical Proficiency Via Real-Time Tactile Collision Awareness System. Laryngoscope 2020; 130 Suppl 6:S1-S17. [PMID: 32865822 DOI: 10.1002/lary.29034] [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: 05/14/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES In 2009, the Food and Drug Administration approved the use of the surgical robotic system for removal of benign and malignant conditions of the upper aerodigestive tract. This novel application of robotic-assisted surgery, termed transoral robotic surgery (TORS), places robotic instruments and camera system through the mouth to reach recessed areas of the pharynx and larynx. Over the successive decade, there was a rapid adoption of TORS with a surgical growth rate that continues to increase. Despite the rapid clinical acceptance, the field of TORS has not yet seen substantive changes or advances in the technical shortcomings, the lack of which has restricted objective TORS-specific surgical skills assessment as well as subsequent skills improvement efforts. One of the primary technical challenges of TORS is operating in a confined space, where the robotic system is maneuvered within the restrictive boundaries of the mouth and throat. Due to these confined boundaries of the pharynx, instruments can frequently collide with anatomic structures such as teeth and bone, producing anatomic collisions. Therefore, we hypothesized that anatomic collisions negatively impact TORS surgical performance. Secondarily, we hypothesized that avoidance of unwanted anatomic collisions could improve TORS surgical proficiency. METHODS Design and fidelity testing for a custom TORS training platform with an integrated anatomic collision-sensing system providing real-time tactile feedback is described. Following successful platform assembly and testing, validation study using the platform was carried through prospective surgical training with trial randomization. Twenty otolaryngology-head and neck surgery residents, each trainee performing three discrete mock surgical trials (n = 60), performed the initial system validation. Ten of the 20 residents were randomized to perform the surgical trials utilizing the real-time feedback system. The remaining 10 residents were randomized to perform the surgical trials without the feedback system, although the system still could record collision data. Surgical proficiency was measured by Global Evaluative Assessment of Robotic Skills (GEARS) score, time to completion, and tumor resection scores (categorical scale ranging 0-3, describing the adequacy of resection). RESULTS Major anatomic collisions (greater than 5N of force) negatively affected GEARS robotic skills. A mixed model analysis demonstrated that for every additional occurrence of a major collision, GEARS robotic skills assessment score would decrease by 0.29 points (P = .04). Real-time collision awareness created significantly fewer major (> 5 N) anatomic collisions with the tactile feedback system active (n = 30, mean collisions = 2.9 ± 4.2) as compared with trials without tactile feedback (n = 30, mean collisions = 12.53 ± 23.23) (P < .001). The second assessment measure of time to completion was unaffected by the presence of collisions or by the use of tactile feedback system. The third proficiency assessment was measured with tumor resection grading. Tumor resection scores was significantly (P = .02) improved with collision awareness system activated than trials without collision awareness. CONCLUSION In order to test our primary hypothesis, a novel TORS training platform was successfully developed that provides collision force measurements including frequency, severity, and duration of anatomic collisions. Additionally, the platform was modulated to provide real-time tactile feedback of the occurrence of out-of-field collisions. Utilizing this custom platform, our hypothesis that anatomic collisions during TORS diminishes surgical performance was supported. Additionally, our secondary hypothesis that subsequent reduction of anatomic collisions improves TORS proficiency was supported by the surgical trial. Dedicated investigation to characterize the effect size and clinical impact is required in order to translate this finding into training curriculums and into clinical utilization. LEVEL OF EVIDENCE II (Randomized trial) Laryngoscope, 130:S1-S17, 2020.
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Affiliation(s)
- Abie H Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A.,Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Christine Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Jonathan Song
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Aadesh Singh
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Tyler Le
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Ahmad Abiri
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Gerald S Berke
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Rory Geoghegan
- Department of Surgery, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine, Los Angeles, California, U.S.A
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Geoghegan R, Santamaria A, Priester A, Zhang L, Wu H, Grundfest W, Marks L, Natarajan S. A tissue-mimicking prostate phantom for 980 nm laser interstitial thermal therapy. Int J Hyperthermia 2020; 36:993-1002. [PMID: 31544549 DOI: 10.1080/02656736.2019.1660811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose: To develop a phantom with optical and thermal properties matched to human prostate. This phantom will provide a platform for the development and characterization of 980 nm laser interstitial thermal therapy (LITT) systems. Methods: A polyacrylamide gel was doped with Naphthol Green B, Intralipid, and Bovine Serum Albumin (BSA). The necessary concentration of each ingredient was determined by measuring the optical properties via fluence measurements and light diffusion theory. LITT was then performed under the same conditions as a previous clinical trial in which temperature was monitored via a thermal probe. The thermal data and induced coagulation zone were compared to clinical data to illustrate the similarity between the phantom and patient. LITT was also performed under magnetic resonance thermometry (MRT). Results: The requisite concentrations of Naphthol Green B, Intralipid and BSA were found to be 0.144% (w/v), 8.06% (v/v) and 31.4% (v/v) respectively. In the native state, the absorption coefficient and reduced scattering coefficient ( μs' ) were found to be 0.66 ± 0.06 cm-1 and 8.27 ± 0.50 cm-1 respectively, with μs' increasing to 17.63 ± 1.41 cm-1 after coagulation. The thermal response of the phantom was similar to that observed clinically with maximum thermal probe measurements of 64.2 °C and 66.9 °C respectively. The shape of the induced coagulation zone was qualitatively and quantitatively similar to the MRT zone of elevated temperature and the coagulation zone observed clinically. Conclusions: A phantom which simulates optical and thermal response to 980 nm LITT was constructed and demonstrated to be similar to human prostate.
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Affiliation(s)
- R Geoghegan
- Department of Bioengineering, University of California , Los Angeles , CA , USA
| | - A Santamaria
- Department of Urology, University of California , Los Angeles , CA , USA
| | - A Priester
- Department of Bioengineering, University of California , Los Angeles , CA , USA.,Department of Urology, University of California , Los Angeles , CA , USA
| | - L Zhang
- Department of Radiological Sciences, University of California , Los Angeles , CA , USA
| | - H Wu
- Department of Bioengineering, University of California , Los Angeles , CA , USA.,Department of Radiological Sciences, University of California , Los Angeles , CA , USA
| | - W Grundfest
- Department of Bioengineering, University of California , Los Angeles , CA , USA
| | - L Marks
- Department of Urology, University of California , Los Angeles , CA , USA
| | - S Natarajan
- Department of Bioengineering, University of California , Los Angeles , CA , USA.,Department of Urology, University of California , Los Angeles , CA , USA
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Geoghegan R, Song J, Singh A, Le T, Abiri A, Mendelsohn AH. Development of a Transoral Robotic Surgery Training Platform .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5851-5854. [PMID: 31947182 DOI: 10.1109/embc.2019.8856971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transoral robotic surgery (TORS) presents unique challenges due to difficulty manipulating surgical instruments within the tight confines of the oral cavity. Collisions between the end effectors and anatomical structures can be visualized through the endoscope; however, instrument shaft collisions are outside of the field-of-view. Acquiring the requisite skill set to minimize these collisions is challenging due to the lack of an appropriate training platform. In this paper, we present a TORS training platform with an integrated collision sensing system and real-time haptic feedback. Preliminary testing involved the recruitment of 10 Otolaryngology residents assigned to `feedback' (N=5) and `no feedback' (N=5) groups. Each trainee performed three mock surgical procedures involving the resection of a tumor from the base of the tongue. Superior surgical performance was observed in the feedback group suggesting that haptic feedback will enhance the acquisition of surgical skills.
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11
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Killeen Á, Geoghegan R, Flaherty G. Documentation and follow-up of anthropometric measurements of hospitalised patients. Eur J Prev Cardiol 2018; 27:1004-1006. [PMID: 30354742 DOI: 10.1177/2047487318809496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Á Killeen
- School of Medicine, National University of Ireland Galway, Ireland.,National Institute for Preventive Cardiology, Ireland
| | - R Geoghegan
- School of Medicine, National University of Ireland Galway, Ireland
| | - G Flaherty
- School of Medicine, National University of Ireland Galway, Ireland.,National Institute for Preventive Cardiology, Ireland
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Walsh Ó, Wynne M, O’ Donnell M, O’Hara MC, Geoghegan R. The Perceptions of Patients, their Parents and Healthcare Providers on the Transition of Young Adults with Type 1 Diabetes to Adult Services in the West of Ireland. Ir Med J 2018; 111:787. [PMID: 30520613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim This study aims to describe the perceptions of young adults’, parents of young adults’ and health care professionals’ (HCPs) of the transition process for young adults with Type 1 Diabetes in the West of Ireland. Methods Thematic analysis of semi-structured interviews conducted with the three stakeholder groups was performed. Results Young adults hardly noticed the transition, with many of them seeing it as a physical move, whereas parents were more anxious and felt their involvement was still needed but not accommodated. Both groups perceived the young adults’ ability to manage their diabetes as a facilitator, as well as the continuity of care provided by the diabetes nurse. Resource limitations and an inability of a young adult to self-manage were identified as barriers to smooth transition by parents, whilst HCPs were experiencing problems with non-attendance and a lack of a psychology service. Conclusion This study highlights the importance of encouraging adolescents’ autonomy in the years leading to transition. A key healthcare professional link between both services appears to facilitate smooth transition. Being flexible and supportive of both parents and adolescents including the provision of mental health services are other important considerations.
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Affiliation(s)
- Ó Walsh
- Paediatric Department, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - M Wynne
- School of Medicine, National University of Ireland Galway, University Road, Galway, Ireland
| | - M O’ Donnell
- Academic Department of Medicine, National University of Ireland Galway, University Road, Galway, Ireland
| | - M C O’Hara
- Research and Development, HSE Strategic Planning and Transformation
| | - R Geoghegan
- Academic Department of Medicine, National University of Ireland Galway, University Road, Galway, Ireland
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13
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Elkhoury F, Natarajan S, Priester A, Jones T, Geoghegan R, Delfin M, Felker E, Sisk A, Raman S, Pantuck A, Grundfest W, Marks L. MP30-04 MRI-GUIDED BIOPSY FOLLOWING FOCAL LASER ABLATION OF PROSTATE CANCER: SUBSEQUENT OUTCOMES OF 2 CLINICAL TRIALS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Natarajan S, Jones TA, Priester AM, Geoghegan R, Lieu P, Delfin M, Felker E, Margolis DJA, Sisk A, Pantuck A, Grundfest W, Marks LS. Focal Laser Ablation of Prostate Cancer: Feasibility of Magnetic Resonance Imaging-Ultrasound Fusion for Guidance. J Urol 2017; 198:839-847. [PMID: 28396184 DOI: 10.1016/j.juro.2017.04.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Focal laser ablation is a potential treatment in some men with prostate cancer. Currently focal laser ablation is performed by radiologists in a magnetic resonance imaging unit (in bore). We evaluated the safety and feasibility of performing focal laser ablation in a urology clinic (out of bore) using magnetic resonance imaging-ultrasound fusion for guidance. MATERIALS AND METHODS A total of 11 men with intermediate risk prostate cancer were enrolled in this prospective, institutional review board approved pilot study. Magnetic resonance imaging-ultrasound fusion was used to guide laser fibers transrectally into regions of interest harboring intermediate risk prostate cancer. Thermal probes were inserted for real-time monitoring of intraprostatic temperatures during laser activation. Multiparametric magnetic resonance imaging (3 Tesla) was done immediately after treatment and at 6 months along with comprehensive fusion biopsy. RESULTS Ten of 11 patients were successfully treated while under local anesthesia. Mean procedure time was 95 minutes (range 71 to 105). Posttreatment magnetic resonance imaging revealed a confined zone of nonperfusion in all 10 men. Mean zone volume was 4.3 cc (range 2.1 to 6.0). No CTCAE grade 3 or greater adverse events developed and no changes were observed in urinary or sexual function. At 6 months magnetic resonance imaging-ultrasound fusion biopsy of the treatment site showed no cancer in 3 patients, microfocal Gleason 3 + 3 in another 3 and persistent intermediate risk prostate cancer in 4. CONCLUSIONS Focal laser ablation of prostate cancer appears safe and feasible with the patient under local anesthesia in a urology clinic using magnetic resonance imaging-ultrasound fusion for guidance and thermal probes for monitoring. Further development is necessary to refine out of bore focal laser ablation and additional studies are needed to determine appropriate treatment margins and oncologic efficacy.
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Affiliation(s)
- Shyam Natarajan
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Tonye A Jones
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Alan M Priester
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Rory Geoghegan
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Patricia Lieu
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Merdie Delfin
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Ely Felker
- Department of Radiology, University of California-Los Angeles, Los Angeles, California
| | | | - Anthony Sisk
- Department of Pathology, University of California-Los Angeles, Los Angeles, California
| | - Allan Pantuck
- Department of Urology, University of California-Los Angeles, Los Angeles, California
| | - Warren Grundfest
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California
| | - Leonard S Marks
- Department of Urology, University of California-Los Angeles, Los Angeles, California; Center for Advanced Surgical and Interventional Technology, University of California-Los Angeles, Los Angeles, California.
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15
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McGrath R, Burke H, Curley F, Nelson J, Geoghegan R. Re: "Is the NHS Best Practice Tariff for Type 1 Diabetes Applicable in the Irish Context"? Ir Med J 2015; 108:220-221. [PMID: 26349357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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16
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Affiliation(s)
- R Geoghegan
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway, Ireland
- Department of Paediatrics, National University of Ireland, Galway, Ireland
| | - C Kelly
- Department of Health Promotion, National University of Ireland, Galway, Ireland
| | - F M Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway, Ireland
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17
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Gouda P, Fanous S, Gouda J, Boland J, Geoghegan R. Paediatric learning in a clinical attachment: undergraduate medical students' perspectives. Ir J Med Sci 2015; 185:413-21. [PMID: 25904344 DOI: 10.1007/s11845-015-1302-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/11/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The clinical environment in paediatrics presents many unique challenges for medical students to achieve clinical proficiency. AIMS Our study aimed to explore how different elements of the paediatric rotation aid medical students in achieving learning outcomes at the undergraduate stage. METHODS Using a small-scale exploratory case study, three focus group interviews were conducted with 19 participants by an independent facilitator. Students' self-reported levels of achievement of module learning outcomes were also analysed. Qualitative data were recorded, transcribed and thematically analysed. Open coding was initially employed; codes were then refined into categories and grouped. Themes were identified, reviewed and defined. RESULTS Students highlighted several key themes including trainee factors, teacher factors and environmental factors that were associated with positive learning environments. These included the opportunity to contribute to the patient care, feeling like part of the team. CONCLUSIONS A clinical learning environment that allows medical students to become actively involved in patient care and to contribute as members to the clinical team can enhance their learning experience.
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Affiliation(s)
- P Gouda
- School of Medicine, National University of Ireland Galway, Clinical Science Institute, Newcastle Road, Galway, Co. Galway, Ireland.
| | - S Fanous
- School of Medicine, National University of Ireland Galway, Clinical Science Institute, Newcastle Road, Galway, Co. Galway, Ireland
| | - J Gouda
- School of Medicine, National University of Ireland Galway, Clinical Science Institute, Newcastle Road, Galway, Co. Galway, Ireland
| | - J Boland
- School of Medicine, National University of Ireland Galway, Clinical Science Institute, Newcastle Road, Galway, Co. Galway, Ireland
| | - R Geoghegan
- School of Medicine, National University of Ireland Galway, Clinical Science Institute, Newcastle Road, Galway, Co. Galway, Ireland
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18
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Gibbons C, Geoghegan R, Conroy H, Lippacott S, O'Brien D, Lynam P, Langabeer L, Cotter M, Smith O, McMahon C. Sickle cell disease: time for a targeted neonatal screening programme. Ir Med J 2015; 108:43-45. [PMID: 25803954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ireland has seen a steady increase in paediatric sickle cell disease (SCD). In 2005, only 25% of children with SCD were referred to the haemoglobinopathy service in their first year. A non-funded screening programme was implemented. This review aimed to assess the impact screening has had. All children referred to the haemoglobinopathy service born in Ireland after 2005 were identified. Data was collected from the medical chart and laboratory system. Information was analysed using Microsoft Excel. 77 children with SCD were identified. The median age at antibiotic commencement in the screened group was 56 days compared with 447 days in the unscreened group, p = < 0.0003. 22 (28%) of infants were born in centre's that do not screen and 17 (81%) were over 6 months old at referral, compared with 14 (21%) in the screened group. 6 (27%) of those in the unscreened group presented in acute crisis compared with 2 (3%) in the screened population. The point prevalence of SCD in Ireland is 0.2% in children under 15 yr of African and Asian descent. We identified delays in referral and treatment, which reflect the lack of government funded support and policy. We suggest all maternity units commence screening for newborns at risk of SCD. It is a cost effective intervention with a number needed to screen of just 4 to prevent a potentially fatal crisis.
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19
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Casey R, O'Hara MC, Cunningham A, Wall D, Geoghegan R, Hynes L, McGuire B, Gately M, Bell M, Dinneen SF. Young adult type 1 diabetes care in the West of Ireland: an audit of hospital practice. QJM 2014; 107:903-8. [PMID: 24925824 DOI: 10.1093/qjmed/hcu103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is well recognised that management of young adults with type 1 diabetes (T1DM) poses difficult challenges for physicians and health care organisations as a whole. In Ireland and in particular the west of Ireland there has been little audit or research on young adults with T1DM and the services available to them. DESIGN In 2011 a retrospective review of this patient population in our territory referral centre was carried out. RESULTS The average glycaemic control in this population was poor at 81mmols/mol and diabetes related complications were present in 32%. Engagement by this population with services was poor with an average of 3 missed clinic appointments over a 24 month period. CONCLUSION These results have prompted a re think of how health care professionals can deliver a service that better suits the needs of this challenging patient group.
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Affiliation(s)
- R Casey
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M C O'Hara
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - A Cunningham
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - D Wall
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - R Geoghegan
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - L Hynes
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - B McGuire
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Gately
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Bell
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - S F Dinneen
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
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20
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Oshea J, Smith O, O'Marcaigh A, McMahon C, Geoghegan R, Cotter M. Breaking bad news--parents' experience of learning that their child has leukaemia. Ir Med J 2007; 100:588-590. [PMID: 18196882] [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: 05/25/2023]
Abstract
This study aimed to seek parents' experiences of how they learned their child had leukaemia and therefore identify ways of improving this process. To achieve this task a questionnaire was designed to ask parents about specific elements of the initial interview and give them opportunity to add their thoughts and feelings on the subject. All children with a diagnosis of leukaemia over an eighteen-year period were identified and parents of those children still alive were invited to partake in the study. 49 out of 50 families agreed to participate of which 35 (72%) returned completed questionnaires. The majority 29 (83%) expressed overall satisfaction. Their replies confirmed some findings of previous studies, and also offered some new insights. Examples of new findings or expansion on previous findings include observations on the presence of young children at the initial interview; the importance of the language used in conveying the diagnosis and prognostic information, and a preference for actuarial terms when discussing prognosis. Telling parents their child has leukaemia is a challenging and important task. The experience of parents gives us valuable insights into our own communication skills and highlights areas of possible improvement in this difficult area.
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Affiliation(s)
- J Oshea
- Department of Paediatrics, Cork University Hospital, Cork.
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21
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Pandey RC, Kalita CC, Aszalos AA, Geoghegan R, Garretson AL, Cook JC, Rinehart KL. Field desorption mass spectrometry in structural studies of polyene macrolide antibiotics: isolation and early identification of a pentaene macrolide antibiotic. Biomed Mass Spectrom 1980; 7:93-8. [PMID: 6775705 DOI: 10.1002/bms.1200070302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Isolation of a pentaene macrolide antibiotic (NSC-277813) from Streptomyces griseus (FCRC-21) fermentation broth is described. Using field desorption mass spectrometry and high resolution field desorption mass spectrometry on the intact and derivatized antibiotic and degradation products, the antibiotic was identified as fungichromin. The application of field desorption mass spectrometry in the identification of polyene antibiotics is discussed.
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Donnelly D, Geoghegan R, O'Brien C, Philbin E, Wheeler TS. Synthesis of heterocyclic-substituted chromones and related compounds as potential anticancer agents. J Med Chem 1965; 8:872-5. [PMID: 5885091 DOI: 10.1021/jm00330a037] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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