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Biomedical subjects

Michael Byrne

Publications and source records attributed to Michael Byrne.

7 recordsLinked to original sources
PubMed2006

Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer.

PURPOSE: Etoposide and cisplatin (EP) has been a standard treatment for extensive-disease small-cell lung cancer (SCLC). An earlier phase III trial reported improved survival for patients receiving irinotecan plus cisplatin (IP) versus EP. Our trial was designed to determine if a modified weekly regimen of IP would provide superior survival with less toxicity than EP. PATIENTS AND METHODS: The primary objective was to compare overall survival in extensive-disease SCLC patients randomly assigned to receive IP (n = 221) or EP (n = 110). Patients were randomly assigned in 2:1 ratio to cisplatin 30 mg/m2 intravenously (IV) + irinotecan 65 mg/m2 IV on days 1 and 8 every 21 days, or cisplatin 60 mg/m2 IV on day 1, and etoposide 120 mg/m2 IV on days 1 to 3 every 21 days for at least four cycles, until progressive disease, or until intolerable toxicity resulted. RESULTS: Selected grade 3/4 toxicities for IP/EP were: neutropenia (36.2% v 86.5%; P < .01), febrile neutropenia (3.7% v 10.4%; P = .06), anemia (4.8% v 11.5%; P = .02), thrombocytopenia (4.3% v 19.2%; P < .01), vomiting (12.5% v 3.8%; P = .04), and diarrhea (21.3% v 0%; P < .01). There was no significant difference in response rates (48% v 43.6%), median time to progression (4.1 v 4.6 months), or overall survival (median survival time, 9.3 months v 10.2 months; P = .74). CONCLUSION: Treatment with this dose and schedule of IP did not result in improved survival when compared with EP. Fewer patients receiving IP had grade 3/4 anemia, thrombocytopenia, neutropenia, and febrile neutropenia compared with patients receiving EP, but more had grade 3/4 diarrhea and vomiting.

Adult↗
PubMed2002

Wiskott-Aldrich syndrome protein is required for NK cell cytotoxicity and colocalizes with actin to NK cell-activating immunologic synapses.

The Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disorder caused by a mutation in WAS protein (WASp) that results in defective actin polymerization. Although the function of many hematopoietic cells requires WASp, the specific expression and function of this molecule in natural killer (NK) cells is unknown. Here, we report that WAS patients have increased percentages of peripheral blood NK cells and that fresh enriched NK cells from two patients with a WASp mutation have defective cytolytic function. In normal NK cells, WASp was expressed and localized to the activating immunologic synapse (IS) with filamentous actin (F-actin). Perforin also localized to the NK cell-activating IS but at a lesser frequency than F-actin and WASp. The accumulation of F-actin and WASp at the activating IS was decreased significantly in NK cells that had been treated with the inhibitor of actin polymerization, cytochalasin D. NK cells from WAS patients lacked expression of WASp and accumulated F-actin at the activating IS infrequently. Thus, WASp has an important function in NK cells. In patients with WASp mutations, the resulting NK cell defects are likely to contribute to their disease.

Actins↗
PubMedDate not supplied

The implications of Herzberg's "motivation-hygiene" theory for management in the Irish health sector.

Given that they create what it sells, employees are the Irish Health service's most valuable asset. They are increasingly being asked to embrace change on many different levels. In order to facilitate this process, it behooves management to actively promote employee motivation. Herzberg et al's "motivation-hygiene" theory of motivation proposes that certain "motivator" and "hygiene" factors can respectively affect job satisfaction and dissatisfaction. Considering "motivators," better on-the-job performance may increase motivation. However, work overload can become a dissatisfier. Devolving equal levels of authority and responsibility and providing appropriate recognition may also serve to motivate. Likewise, providing opportunities for promotion and personal growth may maintain motivation, as might re-engineering of jobs so that work remains meaningful. Over time both salary and incentives may come to be viewed as entitlements and lose their ability to motivate. Other "hygiene" factors such as organizational policy and administrative structure, relations with others, job insecurity, physical working conditions, and quality of supervision can lead to job dissatisfaction. Hence, the theory of Herzberg et al usefully highlights many factors that may serve to motivate or demotivate employees. However, this theory does not reflect some of the realities of the modern health care work environment.

Health Care Sector↗
PubMedDate not supplied

Implementing performance management in the Irish Health Sector.

To realize the goals of successive health strategies, managers in the Irish Health Sector will have to proactively facilitate optimal employee performance in line with policy objectives. Along with developing employee and teams' capabilities, these managers have begun to implement performance management to achieve the latter. However, there typically are a variety of foundational organizational characteristics required for the successful implementation of performance management. These include providing top-down support for line management buy-in, providing ongoing managerial and performance management training so that trusting relationships and a culture of consensus and cooperation are developed, and appropriately managing expectations. Agreement on employee role definitions and provision of team-based conflict resolution training is also needed to facilitate performance management. There is a need for negotiated performance indicators that are of various types, specific, measurable, and aligned with strategy objectives. Associated reward systems need to be holistic and imaginative, and personal development plans need to have a broader focus than merely improving current job skills and performance. Performance review needs to be ongoing, conducted in a transparent manner, and allocated sufficient discussion time. Managers also need to be mindful of managing overperformance.

Cooperative Behavior↗