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St. Vincent’s Healthcare Group Limited Review 2006 St. Vincent’s Healthcare Group Limited incorporating St Vincent's University Hospital St. Vincent's Private Hospital and St. Michael's Hospital 2 3 St. Vincent’s Healthcare Group Limited Contents Reports Mission Effectiveness Ethics and Medical Research Hospital Development Health and Safety Review 5 7 8 10 ERC Lecture Series 2006 45 ERC Journal Club 2006 46 Prestigious Invitations/Honours for E.R.C. Researchers 47 Prizes, Awards 2006 49 Publications Reviews and Personnel Review by Medical Director, Education & Research Centre, Dr. Doug Veale & Director, Research Laboratories, 13 Principal Investigators - 2006 15 Research Laboratories – Personnel 2006 16 Publications 50 Chapters in Books 55 Grants Active Grants Active in 2006 56 Research Activities Research Activities 2006 Department of Rheumatology 17 18 Bioinformatics and Molecular Evolution Group 23 St. Michael's Hospital Innate Immunity Group 24 St Michael’s Hospital Overiew Liver Research Group 26 Organisational Structure Department of Endocrinology & Diabetes Mellitus 29 Thyroid Eye Disease Research Group 30 St. Vincent's Private Hospital Obesity Research Group 31 St. Vincent's Private Hospital Overivew 67 Respiratory Sleep Research 31 Service Developments and General Improvements 67 61 Department of Neurology Research in Multiple Sclerosis 32 Consultant’s Forum 68 Centre for Colorectal Disease 34 Management Team and Executive Committee 68 Breast Cancer Research Group 37 New Hospital Development 69 Mental Health Research 38 Postgraduate Department Postgraduate Department 39 Academic Activities Academic Activities VIBE (Virtual Institute of Bioinformatics) 42 Intellectual Property Workshop 43 DMMC/ Conway Institute 44 Finance Division 70 Nursing Division 71 Corporate Services Division 77 Allied Health Division Human Resource Division 80 83 Support Services Division 87 Organisation Structure 92 4 Annual Review 2006 Contents St Vincent's University Hospital Departmental Review Department of Anaesthesia, Intensive Care and Pain Medicine BONE & 94 Department of Surgical Professorial Unit 179 Department of Urology 182 Department of Vascular Surgery 185 JOINT UNIT Department of Rheumatology 101 Department of Rehabilitation Medicine 107 Department of Orthopaedics 109 Department of Cardiology 111 Clinical Audit Year-End Report 2006 114 Department of Dermatology 118 Department of Emergency Medicine 122 Department of Endocrinology and Diabetes Mellitus 124 Liver Transplant Programme & Liver Unit 130 Department of Medical Oncology incorporating Lios Aoibhinn Cancer Support Centre 132 Medical and Surgical Gastroenterology incorporating the Centre for Colorectal Disease 134 Department of Medicine for the Elderly 139 Department of Metabolism 142 Department of Nephrology 144 Department of Neurology 146 Department of Clinical Neurophysilogy Department of Nursing Bed Management 149 150 156 Department of Ophthalmology Allied Health Professional and Support Services Chaplaincy/Pastoral Care Department 189 Information, and Communication Technology Department 192 Library and Information Service 196 Medical Physics and Clinical Engineering Department 199 Medical Social Work Department 202 Department of Nutrition and Dietetics 204 Occupational Health 207 Occupational Therapy Department 212 Pharmacy Department 214 Physiotherapy Department 219 Department of Preventive Medicine & Health Promotion 222 Speech and Language Therapy Department 226 Service Departments Catering Department 231 General Services Department 233 157 Human Resources Department 235 Operating Theatre Department 159 Department of Palliative Medicine 162 Medical Records/ Patient Services Department 238 Purchasing and Procurement Department 239 Department of Pathology and Laboratory Medicine 164 Technical Services Department 241 Department of Plastic Surgery 168 Hospital Sterile Services Department - HSSD 243 Department of Psychiatry and Mental Health Research Hospital Hygiene Services 244 169 Department of Old Age Psychiatry 171 2006 Healthcare Group Committees 245 Department of Radiology 173 Department of Respiratory Medicine 177 St. Vincent’s Healthcare Group Limited 5 Mission Effectiveness Our philosophy & values were clearly a priority during the year as staff members worked together developing new policies and organising various celebrations & events. On-going Education Units 1 & 2 of Mission Effectiveness Programmes were held on a regular basis throughout the year. They were well attended despite shortages of personnel in many areas placing a significant strain on staff. The participation of staff from the three hospitals in the group was very encouraging. The advantages of coming together as a group improves working relationships, gives staff a deeper understanding and sense of what our identity is and the true meaning & benefits of Mission. It was also an enjoyable experience. Feedback from the group discussions was presented at Heads of Departments’ meetings and addressed by the Group Chief Executive. All new staff including our overseas nurses, junior medical staff, CPE students and Back to Nursing group received input on our Mission & Values. Mission Committee Meetings The meetings were very well attended during the year and guided important events. These collaborative efforts promote the compassionate care that is the core of our Mission. We express our gratitude to the committee members who contribute so much to the Mission. We welcomed four new members this year. Celebrations Opening of New Clinical Services Building Considerable efforts were made in organising the liturgy, singing and catering for the opening of the new Clinical Services Building - A vision that was fulfilled and celebrated this year. On September 27th feast of St Vincent de Paul senior Chaplain Fr Tom Noone and our Church of Ireland Chaplain Rev Ted Ardis blessed the building. Senior pharmacy technician, Carmel Bogue, conducted the hospital choir and music played by Ger McGuirk from purchasing department added to the solemnity of the event. Staff celebrated the event with pride and enjoyed meeting their retired colleagues. Catering was organised by the hospital catering staff. It was truly a memorable occasion. Return to contents Annual Review 2006 6 Mission Effectiveness Bereaved Staff Liturgies for bereaved staff were organised by the Mission Committee on a number of occasions throughout the year and in a special instance the funeral service for one of our long serving staff members took place from the hospital chapel. Christmas Celebration Staff, visitors and patients enjoyed a selection of Christmas Carols at lunchtime on a number of occasions during the Christmas season. The Hospital Choir entertained the group in the Atrium of the new clinical services building where the acoustics are excellent. History Panels An additional four panels updating the history of the hospital were added this year. New Crib A new Crib adorned the atrium of the Clinical Services building and signified the true meaning of Christmas. Our thanks to Nicky Jermyn, Group Chief Executive who agreed to fund this very beautiful setting. Group Mission Statement The final draft of St Vincent’s Healthcare Group Mission Statement was presented at a recent Board of Director’s meeting, It is hoped to have the statement framed and in place in the three hospitals in the near future. We are now operating in an ever-changing healthcare environment embracing many nations, religions and cultures. The Mission & values challenge us to assess how best to serve the needs of our patients and staff and to ensure that all are treated in a loving and caring environment. Photos below Blessing & Celebration of Clinical Services Building Return to contents 7 St. Vincent’s Healthcare Group Limited Ethics and Medical Research The St. Vincent’s Healthcare Group Ltd., (SVHG) Ethics and Medical Research Committee (EMRC) operated as a designated recognised ethics committee acting for the whole state in compliance with the EU directive entitled: “European Communities Clinical Trials on Medicinal Products for Human Use”(Regulations 2004). Following the implementation of the EU directive (2004) the purpose of which was to harmonise and standardise approval for clinical trials by regulatory authorities and ethics committees across all EU member states, a document entitled “Guidance on the application for recognised ethics committee opinion and the ethical review of clinical trials on medicinal products for human use” was issued in December 2005. It is a requirement that each clinical trial must obtain one single ethics committee opinion for the conduct of the trial within the state in keeping with Directive There were a total of 12 Committee Meetings held from 1st January 2006 to 31st January 2006. Clinical Trials Reviewed SVHG EMRC are the responsible Ethics Committee for the following Number of Clinical Trials re-reviewed for single opinion. 16 Pharmaceutical Sponsored Trials Number Issued a Favourable Opinion 16 Investigator Led Trials 7 Number of New Clinical Trial Proposals Considered: 11 Pharmaceutical/Investigator Led, External Sites only 8 Number Issued a Favourable Opinion: 11 Number of New Medical Device 26 Total 41 Research Studies Proposals Considered: 3 Number Issued a Favourable Opinion: 3 Total Research Studies Reviewed Total Approved 94 94 Amendments Total 30 Total Number of Clinical Trial Amendments Reviewed and Approved 90 Quarterly/Annual/Termination Reports Total Number of Reports Reviewed and Noted 73 During 2006 we have re-revised our standard participant information leaflet and consent form template as one unified document in addition to our revised application forms. Two forms are now used (i) for clinical trials of medicinal products for Human Use or for trials of Medical Devices and (ii) for investigator-driven and non-invasive research studies. The committee have also produced an information leaflet entitled “Is Clinical Research for you?” which is available to all departments. Copies of all documents are available electronically and in hard copy from Ms Joan McDonnell, Ethics Office, ext: 4117 ([email protected]). Dr. D. Veale, Chairman. Return to contents Annual Review 2006 8 Hospital Development St. Vincent’s University Hospital Redevelopment Project During the year Operational Commissioning of the new 5-storey building was carried out commencing with the Emergency Dept with associated Emergency Radiology Services on 18th January 2006. The following departments also became operational in the new building during 2006 Department of Radiology July 06 to Dec 06:• PACS • Gamma Cameras Nuclear Medicine • Mammography • CT Scanning & Ultrasound • MRI • Interventional Radiology • General Rooms • Bone & Joint Radiology Department of Pathology March to Sept 06 :• Biochemistry • Microbiology • Haemateology • Endocinology • Histology • Blood Bank • Nuclear Medicine • Phlebotomy • Infection Control Ambulatory Day Care Centre:-March to Dec 06 • General Medical & Surgical Clinics • Department of Neurology • Department of Gastroenterology • Diabetes Centre • Liver Unit • ENT • Bone & Joint Unit • Dept. of Rehabilitation • Dept. of Rheumatology • Dept. of Trauma & Orthopaedics • Dialysis Centre • TSSUs Feb 06 • ICU Oct 06 The final phase of operational commissioning will take place in 2007 and will involve the transfer of the a number of Out Patient Clinics i.e. Department of Urology, DXA Scanning, Vascular Laboratories & Clinics, Extra Mural Theatre and existing Operating Theatres into the new suite. Procurement of equipment is ongoing as is work on developing resources and transfer plan to facilitate these moves in 2007 and this will complete the Phase 1 Development Plan. Return to contents St. Vincent’s Healthcare Group Limited 9 Hospital Development Work has been ongoing with regards to the Phase 1A Development Plan which involves refurbishment of vacated areas in the existing building and we are well advanced with agreeing layouts for a 23 Bed Day Care Ward in the old Radiology Dept and provision of an additional 4 Operating Theatres. In August 2006 work commenced on a major refurbishment of vacated space into the old Out Patient Department building to provide accommodation for Dermatology Services transferred in from Hume Street as well as those Out Patient facilities provided on the St.Vincent’s site in temporary accommodation. The new Dermatology facility became operational on 1st November 2006. During the later part of the year plans were finalised to facilitate the opening of the Basement Car Parking facility which will bring the total number of car parking spaces up to just over 600. It has to be acknowledged that there has been a magnificent effort made by all staff involved in the operational commissioning process, whilst maintaining existing services both on a local and regional basis. I would therefore like to take this opportunity to formally thank everyone involved in the development, or their continued support and commitment. Return to contents Annual Review 2006 10 Health and Safety Review St Vincent’s University Hospital (SVUH) continues to place significant emphasis on the management of Health and Safety within the workplace. The hospital recognises its responsibility to provide a safe environment for patients, relatives, visitors and staff members. This is achieved by meeting and exceeding our statutory requirements and through adherence to best practise. The Safety Management system is primarily managed day to day by the hospitals Health and Safety Coordinator with senior management assistance. This is supplemented by an active Health & Safety Committee. The Committee comprises of representatives of local safety groups working with key resource personnel from functions such as Back Care and Ergonomics, Occupational Health, Security, Technical Services, Risk Management and General Management The SVUH staff safety representative elections took place in 2006 and Margaret Britton was re-elected for a second term. The staff safety representative forms part of our commitment to consultation in line with section 25 of the Safety,. Health and Welfare at Work Act, 2005. With the Safety, Health and Welfare Act being revised in late 2005, 2006 was a year of updating and reviewing compliance and nine safety statement were accordingly updated and released during our annual European Health and Safety Week Breakfast information morning. Protective and preventative safety management is a key objective of the new legislation, with this in mind 14 risk assessments were also completed internally in 2006, which was a significant improvement on the previous year. Fire safety management was an important focus in 2006 for the hospital and many new policies and systems were introduced. The hospitals smoke free policy was updated in line with current standards and practices. A fire alarm activation report template was initiated along with an activation register to assist in the management of nuisance activations. One result of such a review resulted in the ban on aerosols in the hospital in order to minimise nuisance activation. The hospitals emergency number was also changed in 2006 from 4144 to 112 in line with the European emergency number. A number of fire safety audits were also conducted during the year to aid compliance. Our commitment to invest in focused training programs continued throughout 2006 with significant participation in programs in key areas such as fire safety, moving and handling, non-violent crisis intervention and sharps awareness. Medical gas safety training and a new chemical safety awareness programme were also available to staff in 2006. 2006 also saw the introduction of a new fire marshal training programme aimed at all senior staff members to assist in fire safety management and prevention and to ensure that senior staff are competent to act appropriately in the event of a fire incident. Regina Rooney, Health and Safety Coordinator Return to contents Education & Research Centre Annual Review 2006 EDUCATION & 12 RESEARCH CENTRE Contents Reviews and Personnel Review by Medical Director, Education & Research Centre, Dr. Doug Veale & Director, Research Laboratories, Prof. Cliona O’Farrelly Principal Investigators - 2006 Research Laboratories – Personnel 2006 13 15 16 Research Activities Research Activities 2006 Department of Rheumatology Bioinformatics and Molecular Evolution Group Innate Immunity Group Liver Research Group Department of Endocrinology & Diabetes Mellitus Thyroid Eye Disease Research Group Obesity Research Group Respiratory Sleep Research Department of Neurology Research in Multiple Sclerosis Centre for Colorectal Disease Breast Cancer Research Group Mental Health Research 17 18 23 24 26 29 30 31 31 32 34 37 38 Postgraduate Department Postgraduate Department 39 Academic Activities VIBE (Virtual Institute of Bioinformatics) Intellectual Property Workshop DMMC/ Conway Institute Immunobiology & Inflammation Course 2006 Lecture Series 2006 ERC Journal Club 2006 Education & Outreach Prestigious Invitations/Honours for E.R.C. Researchers Prizes, Awards 2006 42 43 44 45 46 46 47 49 Publications Publications Chapters in Books 50 55 Grants Active Grants Active in 2006 56 Return to main contents St. Vincent’s Healthcare Group Limited EDUCATION & 13 RESEARCH CENTRE Review by Medical Director, Education & Research Centre, Dr. Doug Veale & Director, Research Laboratories, Prof. Cliona O’Farrelly We have seen significant change through 2006 with some very positive developments in clinical and biomedical research at SVUH. These include: • Development of research strategy; & prioritisation; • Infrastructural Development • Funding • Adminstration which all involve and impact on the Education and Research Centre of St Vincent’s Healthcare Group, the Clinical Research Centre (previously known as the Genomics Research Unit), the Conway Institute at UCD, the broader academic community within UCD and its associated teaching hospitals. Research Prioritisation and Strategy A major undertaking during 2006 initiated by the Research Advisory Board and chaired by Prof Pat Fottrell was an international review of clinical and biomedial research at SVUH. An International panel [Prof. Bill Powderly, Prof John Atkinson, Prof. Adrian Hayday, Prof. Patrick Johnson, Prof. Patrick H. Maxwell and Prof. Carol North] were invited to visit the hospital to meet with investigators including clinical and scientific research staff to review detailed research assessments of the major research groups. Each group had an opportunity to make a detailed presentation outlining the background, current activity and plans for the future. The groups have been organised under the themes, proposed by the Research Advisory Board: • inflammation and infection, • cancer • suicidal depression. All investigators engaged fully with this initiative which lead to a report formulated by the International Review Panel and submitted to the Research Advisory Board and hence to the Board of the hospital, UCD and the PI’s. The outcomes of this exercise have been positive but also provide significant changes for the academic community for the hospital and for UCD. They have given clear guidance on organisational, structural, governance and space issues which will allow for the development of a clear and comprehensive research strategy. Infrastructural Development With the opening of the new building to the front of the hospital and the transfer of the routine microbiology labs to the new building, the third floor of the Education and Research Centre was vacated and it was agreed by the Research Advisory Board and the hospital that this area should be refurbished as a state of the art research laboratory space with specific areas designated according to the type of research activity which will be undertaken. I am pleased to say that we have been working closely with the architects Kavanagh & Fitzgerald (who refurbished the CRC) to develop plans for this work that will begin imminently. A significant positive development occurred in November/December 2006 with the agreement between the hospital and UCD/DMMC to establish a combined management team to ensure coordinated development of facilities between the ERC, CRC, hospital and the university campus. This combined management team has made significant strides which is under the joint chairmanship of Risteárd Ó Laoide, Chairman of the Medical Board and Prof William Powderly, Prof of Medicine and Head of the School of Medicine and Medical Science. It is such that the CRC will receive its first patients in the beginning of March 2007. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 14 Review Funding A number of research achievements throughout 2006 are worth particular note. A new Research Laboratory Coordinator Dr. Emer Bairéad was recruited from UCC. The first Translational Medicine Research Award from the Health Research Board worth over €1.5 million was obtained by a multidisciplinary group from rheumatology, colorectal and the vascular biology group, based at SVUH in collaboration with the researchers in the Conway Institute. The innate immunity group were also awarded grants in excess of €1.5M. Additional awards were made in the areas of hepatitis, cancer and suicidal depression bringing the total of active grants in 2006 to more than €14M. All principal investigators, senior scientists, post-doctoral scientists, clinical fellows, post-graduate students and research assistants deserve huge congratulations as the Education and Research Centre have achieved over 50 publications in peer reviewed journals and 6 higher degrees were awarded. This could not be achieved without the dedicated enthusiasm and hard work from each and every researcher, as well as the superb support of the Laboratory Coordinator, the administration team of Ger Lanigan Ryan & Louise McCormack as well as the ever cheerful Alan. The future holds a number of significant challenges with further development and integration with the CRC, the Conway Institute and the wider academic community and we believe that there is currently a very positive momentum in this regard. This poses a number of challenges in terms of: Administration, coordination, space infrastructure and personnel. Dedicated funding for research support and activities from the hospital in addition to that from the University. Permanent career track appointments for senior scientists in line with the International Review of Research. Integrated research strategy UCD/SVHG/MMH Establishment of core resources including admin/accounts, technical and IT/bioinformatics staff. These aspects are actively being reviewed and it is hoped that the PI’s, hospital management and UCD, through the Research Advisory Board will support the cohesive strategic plan being developed by SVUH research staff within a realistic time frame. Dr. Doug Veale, Prof Cliona O’Farrelly. Medical Director, Director, Research Laboratories E.R.C. E.R.C. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 15 RESEARCH CENTRE Principal Investigators - 2006 Prof. Barry Bresnihan Prof. Aongus Curran Prof. Joe Duffy Dr. Ursula Fearon Prof. Oliver FitzGerald Dr. Charles Gallagher Mr. Justin Geoghegan Prof. John Hegarty Dr. Andrew Lloyd Prof. Kevin Malone Prof. T.J. McKenna Prof. Walter McNicholas Dr. Hugh Mulcahy Prof. Diarmuid O’Donoghue Prof. Cliona O'Farrelly Prof. Niall O’Higgins Dr. Donal O’Shea Dr. Jacintha O’Sullivan Dr. Kieran Sheahan Dr. Tom Smith Prof. Oscar Traynor Dr. Niall Tubridy Dr. Doug Veale Return to contents Annual Review 2006 EDUCATION & 16 RESEARCH CENTRE Research Laboratories – Personnel 2006 Director, Research Laboratories: Prof. Cliona O'Farrelly Research Technology Facilitator: Dr. Emer Bairead Senior Scientists & Post Doctoral Fellows Jacintha O’Sullivan Andrew Lloyd Sinead Nic an Altaigh Ursula Fearon Margaret O’Brien Kieran Meade Brid Ryan Jean Fletcher Aisling Pierce Eadaoin McKiernan Research Assistants Lorna Gallagher Emma McGrath Jennifer McCormick Geraldine Scaife Sarah Cahalane Dermot Bowden Fernando Narciandi Miriam Tosetto Monika Biniecka Gerard Moloney M.D. Adrian Gibbs Tariq Tajuddin Chin Teck Ng Alan Coss Juliette Sheridan Ceara Walsh Eliza Pontifex Gavin Rush Garret Cullen Joe Marry Dave Kevans Jean O’Connell Kavin Nanda Diarmuid Manning PhD Students (Post Grads) Rowan Higgs Lydia Lynch Jane Culleton Patricia McGowan Ronan Shaughnessy Lucille Kavanagh Sheeona Gorman Paul Cormican Aoife O’Donovan Tom Cawood Martina Gogarty Ellen Moran Aisling Kennedy Ronan Mullan Mary Connolly Eszter Nemeth Aspinas Chapwanya Jody Madigan MSc. Kirsty O’Brien Catherine Sweeney Elizabeth Ryan Edward Fox Wei Gao Research Associates John Garvey Marion Rowland Silke Ryan Julie Gorman MCh. Mohammad R. Zaman Chin Lim Hong Under Graduate Students Emer Dowling Grace Burch Research Nurses Ciara O’Dwyer Blathnaid Nolan Catherine McEvoy Helen Vaughan Lisa Gribbin Rita Barros Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 17 RESEARCH CENTRE Research Activities 2006 Inflammation, Infection and Immunity Dept. of Rheumatology Bioinformatics & Molecular Evolution Group Innate Immunity Group Liver Research Group Dept. of Endocrinology & Diabetes Mellitus Thyroid Eye Disease Research Group Obesity Research Group Respiratory Sleep Research Dept. of Neurology Research in Multiple Sclerosis Cancer Centre for Colorectal Disease Breast Cancer Research Suicide and Depression Dept. of Psychiatry & Mental Health Research Return to contents Annual Review 2006 EDUCATION & 18 RESEARCH CENTRE Research Activities 2006 Department of Rheumatology Principal Investigators Professor Barry Bresnihan Dr Ursula Fearon (Senior Scientist) Professor Oliver FitzGerald Specialist Registrar Dr Shafeeq Alraqi Registrar Dr. John Paul Doran Clinical Research Fellows Dr Douglas Veale Dr Orla Killeen Dr Ronan Mullan Dr Ceara Walsh Dr Chin Teck Ng Dr Laure Brulhart Dr Rita Barros Dr Eliza Pontifex Dr Adrian Gibbs Graduate Students Mary Connolly Ellen Moran Martina Gogarty Aisling Kennedy Nursing Staff Mrs Marie O’Rourke Mrs Phil Gallagher Mrs Felicitas Froehlich Grimm Mrs Connie Walsh Administration Staff Ms Mary White Ms Patricia Garvey Ms Jeanine Fagan Mrs Chris Walsh Research Activities The coordinated Rheumatology Research group includes five Principal Investigators - Prof Barry Bresnihan, Prof Oliver FitzGerald, Dr Doug Veale, Dr Ursula Fearon and Dr Orla Killeen. This truly translational research group has a primary clinical focus on early, inflammatory arthritis (RA, PsA and juvenile arthritis) and a scientific focus on mechanisms of inflammation and joint damage. The group has developed and established novel models of analysis using serum, synovial fluid, synovial tissue and cartilage to search for biomarkers of disease, examine mechanisms of angiogenesis, novel mediators/ cytokines and cartilage destruction in the study of pathogenesis of arthritis. The research plan for the next five years is to develop the current expertise and extend our local, national and international collaborations to elucidate predictors of response to therapy, predictors of remission and to examine the mechanisms of disease. We have consolidated our use of novel human models of disease, in partnership with GlaxoSmithKline and Cambridge Antibody Technology, which funded drug development studies (€ 0.5m; €100k respectively) for novel monoclonal antibodies and small molecular inhibitors. We have in 2006 embarked on a major state-of–the-art clinical research programme to identify clinical biomarkers of therapeutic response, to identify therapeutic remission for early arthritis, to examine mechanisms of disease, and identify novel targets for new therapies for inflammatory disease. We have established new collaborations with colleagues in SVUH, UCD (The Conway Institute, School of Public Helath and Epidemiology) and the wider DMMC. Our vision, shared with our patients, medical and scientific colleagues, is to develop a centre of excellence for Inflammation and Immunotherapeutics Research funded through partnership with industry, HRB, SFI. The group has also just concluded negotiations on a research contract with Wyeth pharmaceuticals to examine biomarkers, novel cytokines in the explant models and proteomics of tissue prior to and following treatment with biologics worth €380k for 2007. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 19 Research Activities 2006 Specific ongoing projects (1) Remission study and Rituximab therapy for resistant arthritis Withdrawal of anti-TNFα·therapy in patients with rheumatoid arthritis in clinical remission: can maintenance of remission be predicted? The primary goal of this trial is to determine if clinical remission can be maintained in patients with RA following withdrawal of their anti-TNFα· therapy, by substituting optimal DMARD therapy. We propose to identify predictive markers of relapse and identify a genetic profile associated with relapse. Dr Ceara Walsh (clinical fellow), led by Prof Barry Bresnihan and Dr Ursula Fearon, is examining the role NK/NKT/NKR+ cells in the patients with active RA compared with those in remission following anti-TNF· therapy. To date results have shown an expansion of inhibitory receptor CD94/NKG2A in remission associated with an increase in the CD8+ T cell population. Loss of this expansion may predict disease relapse and therefore allow modification of dosing schedule with important health-economic and patient related benefits. Furthermore we are showing a distinct population in the joint of RA and PsA patients compared to the peripheral circulation with expansion of CD56high NK cells with an activated phenotype (upregulation of activatory CD69 and HLA-DR and inhibition of CD158 KIR and apoptotic CD57). This upregulation of CD56high NK cells has increased immunomodulatory function with a significant increase in proinflammatory cytokine release (interferon-gamma and tumour necrosis factor-alpha) from T cells and increased cytotoxicity of synovial fluid derived CD3+ cells against the leukaemia cell line K562 compared with matched peripheral blood..Furthermore we are also examining the immunological effects of kineret monotherapy and kineret in combination with anti-TNFα· therapy (SPECTRA) and comparing this to anti-TNFα· monotherapy. Rituximab is a recently licensed therapy, targeting CD20+ B cells, which is increasingly used in the treatment of refractory RA. We have demonstrated the presence of CD20+ cells in the synovium of patients with RA resistant to anti-TNFα· therapies. Complete depletion of synovial B cells following treatment with rituximab is associated with an excellent clinical response. Early depletion of synovial B cells precedes a decrease in local inflammation leading to clinical improvement. (2) Hypoxia and altered mitochondrial bioenergetics in the inflamed joint. This major programme funded by a Translational Research Award from The HRB (2006-2011) to Dr Doug Veale, Dr Ursula Fearon, Dr Jacintha O’Sullivan and Dr Cormac Taylor, hypothesizes that vascular morphology and synovial invasiveness within the inflamed joint and response to therapy, may be dependent on activation of mitochondriaderived, hypoxia-induced transcriptional and non-transcriptional pathways and alterations in genome stability. By incorporating novel techniques, we are measuring the oxygen tension directly in lining membrane of inflamed synovial joints using a special probe to measure PO2 and temperature. We also record the macroscopic vascular changes, and we intend to measure blood flow and glucose metabolism by dynamic imaging (MRI and PET), while paralell cellular changes in mitochondrial respiration will be analysed. We have purchased two hypoxia chambers to establish cellular responses to graded hypoxia, focusing specifically on mitochondrial regulation of inflammatory pathways in vitro. Dr Chin Teck Ng, clinical research fellow has successfully established a clinical protocol to recruit patients commencing biologic therapy to undergo arthroscopic examination and hypoxic measures. Aisling Kennedy, graduate PhD student, is examining the effect of hypoxia on the angiopoietins/Tie2 pathway, blood vessel morphology and cell survival in the joint. Preliminary data has demonstrated differential expression of Angiopoietin 2 and VEGF from different synovial cell types. Ashling has shown that exposure of cells to graded hypoxia induced VEGF and MMP-1 production, in contrast Ang 2 showed minimal change. Increased VEGF secretion from whole tissue synovial explants followed exposure to 1% hypoxia, however Ang2 was induced only in the presence of TNFα. Currently Aisling is dissecting the pathways that mediate hypoxia-induced growth factor expression, specifically NFκB and HIF1α· (in collaboration with Dr Cormac Taylor), in addition to the downstream role of genomic instability (in collaboration with Dr Jacintha O’Sullivan). Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 20 Research Activities 2006 Upstream triggers with specific focus on mechanical forces, sonic hedgehog and neuropeptides are also being examined. Initial results show increases in VEGF secretion from explants stimulated with Substance P. VEGF mRNA and Ang 2 protein expression are increased in EC’s exposed to high flow. In 2006, Aisling achieved an oral presentation at the DMMC Science conference, she also presented this work at the ISR AGM and the Conway Festival. Ashling was awarded a Seed Funding travel bursary from UCD on the basis of her research work. (3) The molecular mechanisms of dysregulated angiogenesis are fundamental to the pathogenic changes in articular cartilage. This translational programme aims to link cytokine mediators, growth factors with key degradative enzymes in arthritis patients. Using novel imaging technology and basic science, led by Dr Doug Veale and Dr Ursula Fearon. Arthroscopy and dynamic imaging (MRI/PET) will be used to determine macroscopic vascularity, microscopic angiogenesis measures to predict cartilage degradation in arthritis patients - pre/post biologic therapy. Recent targeted biologic therapies, including anti-TNF and IL-1 blocking drugs are effective, but may not be effective in 30% or more patients. The increasing evidence shows that complex cytokine networks do not operate in isolation to promote new blood vessel formation, synovial hyperplasia and joint destruction. The effects of TNFa and IL-1b alone and in combination with novel cytokines including Oncostatin M (OSM), IL-17, acute serum amyloid A (A-SAA) and Angiopoietins is being examined in the inflammatory process. (i) Oncostatin M and IL-17 Work published in 2006 by the group led by Dr Ursula Fearon demonstrated, for the first time in human cells and co-culture models of disease, that OSM promotes adhesion, angiogenesis, cell migration and matrix degradation in primary synovial cultures. Using whole tissue synovial explants and co-culture cartilage models (which more closely reflect the in vivo environment) a dramatic synergistic reaction between OSM and IL-1 in promoting matrix degradation and cartilage degradation was found. Ellen Moran, graduate PhD student is examining interactions between TNFa, OSM and IL-17. Ellen has shown in normal human cartilage that IL-17 potentiates the effects of OSM on MMP-1 production and proteoglycan release, little further effect in primary fibroblasts. These results demonstrate differential cytokine signalling pathways within the joint, dependent on cell type. The IL-17 and TNFa combination had no effect on MMP-1 production, whereas OSM potentiated the TNFa effect on MMP-1 production in primary fibroblasts. High IL-17 expression in the RA joint with significant decreases in IL-17 serum levels after 3 months of anti-TNF therapy has also been shown by Ellen,. Biomarkers of cartilage breakdown in paired serum/synovial fluid from inflammatory arthritis patients show the neoepitope CS846 significantly higher in synovial fluid with no significant difference in levels of C2C. Ellen is currently examining MMP-1 & -13 gene expression in human chondrocytes in response to TNFa, OSM and IL-17 alone and in combination. Ellen won best oral presentation at the 2006 ISR/BSR AGM for her work. Ellen was awarded a Seed Funding Grant from UCD to present her work at the European workshop of Rheuamtology Research and Eular, Barcelona, 2007. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 21 Research Activities 2006 (ii) Serum Amyloid A (A-SAA) The role of A-SAA in the pro-inflammatory response is an on-going project theme of the unit over the past 10 years continued by Dr Ronan Mullan and Mary Connolly, graduate PhD student under the direction of Dr Ursula Fearon, Prof Barry Bresnihan and Dr Doug Veale. Dr Ronan Mullan’s paper demonstrating that A-SAA-induces adhesion molecule, angiogenesis and matrix metalloproteinase expression through the NFÎB pathway was published in Arthritis and Rheumatism, January 2006 and won the best Rheumatology paper at the recent IJMS awards Ronan furthermore demonstrated increased matrix turnover in whole cartilage explants, along with correlation of A-SAA with serum biomarkers of cartilage breakdown in patients pre/post biologic therapy, suggesting that targeting ASAA, or its signaling pathways, may represent a realistic therapeutic approach. Mary Connolly continues to progress this work, specifically, examining the A-SAA effect on cell migration and invasion, cartilage metabolism and the related transcriptional pathways. Mary has demonstrated that A-SAA stimulates chemokine expression, endothelial cell invasion, neutrophil transendothelial migration and b1-integrin adhesion. Using an ex-vivo synovial explant model Mary has shown high spontaneous release of A-SAA in synovial tissue, supporting a pathological role for SAA locally in the joint, and has confirmed A-SAA induced IL-8 and MCP-1 expression is mediated in part through the NFkB and PI3k pathways. Furthermore, Mary has elucidated that A-SAA specifically alters cytoskeletal rearrangement in RA synoviocytes producing filopodia protrusion and migration. Currently she is examining the effect of SAA on MMP production and GAG release in human primary chondrocytes, synovial fibroblasts and synovial tissue. Mary and Ronan have both won first prize for best oral presentations for their research at national meetings, in addition Mary was awarded an international SIAR travel scholarship to present her work at the American College of Rheumatology, San Diego. (iii) Endothelial cell survival and blood vessel regression. One of the main interests of the group is the role of angiogenesis in the pro-inflammatory response, with specific interest in the pathways of blood vessel maturity and survival. This work will provide novel insights into the complex mechanisms mediating growth factor activation within a synovial EC model. It will further identify downstream signalling pathways involved in regulating cell fate decisions (in particular EC survival). Previous work identified key synerigistic reactions between VEGF and the Angiopoetin/Tie2 pathways associated with differential blood vessel morphology in the inflamed joint. Dr Catherine Sweeney (postdoctoral fellow) continued this work and demonstrated that VEGF synergistically interacts with Angiopoietin 2 to promote EC proliferation, migration and tubule formation in vitro. Along with this, Catherine showed that VEGF and Ang 2 promotes the expression of survival proteins specifically the Notch and XIAP (survivin) families in synovial biopsies. Furthermore she has demonstrated using Confocal microscopy a mixture of immature and mature blood vessel within the inflamed tissue. This is important for determining which cell types may be possible targets for future therapies in established arthritis. A number of models to examine the effects of blocking these pathways on blood vessel regression including a SCID mouse model (in collaboration with Prof. Costantino Pitzalis, London). Catherine has decided to return to college to study pharmacy and we wish her every success in the future, however we are very pleased to welcome Dr Wei Gao, who joined the group in November 2006. Wei has a PhD in Biotechnology from DCU, School of Biotechnology, with experience in cell culture, molecular biology, western blotting, transfection and flow cytometry. He is continuing the work on the role of angiopoietins and downstream signalling pathway in inflammatory arthritis. This project will examine the role of the Notch signalling pathway in mediating VEGF/Angiopoietin regulation of angiogenesis and cellular invasion in arthritis. Sinead Nic An Ultaigh joined the Rheumatology research group as a new post doctoral scientist in November 2006. Sinead completed her PhD in Molecular Parasitology in UCD, School of Biology and Environmental Sciences and has experience in molecular biology, western blotting, Elisa and zymography. She is currently working on the elucidation of both up-and down-stream cytokine pathways in Rheumatoid arthritis. The aim of this study is to examine the levels of novel T-cell derived cytokines in inflammatory arthritis pre/post biologic therapies and to examine their functional significance. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 22 Research Activities 2006 (4) Psoriasis/Psoriatic Arthritis There are 3 main areas of interest within Ps/PsA: (i) Genetics: In collaboration with Prof. Robert Winchester at the University of Columbia in New York, blood samples have been obtained and lymphoblastoid cell lines have been established from a cohort of 270 probands with PsA of varying disease-duration from the same Irish population as well as from >100 patients with psoriasis alone and >90 normal control subjectsThe initial focus has been the detailed molecular genotyping of the HLA-B and -C loci using sequence-based typing. This has now been completed and detailed analysis strongly suggests that PsA is not genetically a simple subset of psoriasis. HLA-Cw*0602 is present in 62% of patients with psoriasis alone but in only 27.9% of patients with psoriatic arthritis. It is planned to expand the numbers in the Ps and PsA cohorts to a minimum of 500 probands in each, since this number of subjects will be required for the establishment of a cross-validation cohort as well as to facilitate stratification-based analyses. Together with Dr Brian Kirby, a new clinical fellow has just been appointed to undertake this task. (ii) Biomarkers of Biologic Treatment Response: As part of investigator-originated, single-arm protocols looking at mechanisms of effect of biologic therapies, 6mm skin biopsy (uninvolved at baseline only; leading edge of Ps lesion at baseline and follow-up) and synovial membrane (obtained under local-anaesthetic at mini-arthroscopy pre-and post-biologic therapy) samples are available for study following infliximab (n=15), IL-1Ra (n=12) and etanercept (n=15,). Comparisons of immunohistochemical (IH) changes will be made with standard clinical measures and with MRI changes in the affected knee joint. The IH and semi-quantitative MRI (collaboration with Dr. Robin Gibney) analysis has now been completed and comparisons are being made with clinical response markers. In addition, with Prof Patrick Brennan’s group from Imaging UCD, a more quantitative measure of synovitis is being developed. Finally, funded by Abbott, a new post doctoral scientist has been appointed who will be analysing differential protein expression in these patient-derived samples together with Prof Steve Pennington from UCD. (iii) Expression and Regulation of Transcription factors in Ps/PsA: Together with Dr. Evelyn Murphy and Dr. Brian Kirby, the expression and regulation of NURR proteins pre-and post-treatment is being explored. Findings have established the aberrant expression and distribution of the orphan nuclear receptor NURR1 in psoriasis and suggest that clinical benefits of TNF-α inhibition may be mediated through altered NURR1 activity. In addition, a recent paper suggests a key regulatory role for the AP1 transcription complex in Ps/PsA. We are further exploring the possible link between TLR engagement and AP1 transcription function. Preliminary data indicates that JunB is upregulated in inflamed synovium with expression reduced following anti-TNF therapy. (iv) T cell Receptor Phenotype: Following on previous publications in PsA, the observations are currently being extended, in collaboration with Prof Bob Winchester, to ankylosing spondylitis where the patients are carefully HLA-matched. Preliminary results indicate significant clonal expansion within both the CD4 and CD8 populations. Other projects: Establishing a carefully characterised cohort of patients with inflammatory arthritis and setting up a DNA bank. Together with DMMC investigators and Dr. Seamas Donnelly, DNA from more than 300 RA patients has now been collected. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 23 Research Activities 2006 Bioinformatics and Molecular Evolution Group Personnel Principal Investigator: Professor Cliona O’Farrelly, PhD Graduate student: Paul Cormican M.Sc. Senior scientists: Andrew T. Lloyd PhD Invited talks Immunogenetics Workshop TCD “Bioinformatic Identification of Novel Bovine β ‚Defensins” Paul Cormican. October 2006 International Congress of Immunogenomics & Immunomics, Budapest. “In-silico discovery of TLR15, in-vivo significance” Professor O’Farrelly Posters July 2006. Immunology Masterclass. Maynooth “Bioinformatic Identification of Novel Bovine β‚-Defensins” Paul Cormican & Andrew Lloyd September 2006. Irish Society of Immunology & British Society of Immunology. Belfast. “Bioinformatic identification of novel bovine beta-defensins” Paul Cormican & Andrew Lloyd Research The FIRM III project, funded by the Department of Agriculture, continues to investigate innate immunity in chickens by characterising the genes mobilised after Campylobacter jejuni infection. We have further developed the bioinformatic discovery pipeline for analysing the frequency of Single Nucleotide Polymorphisms (SNPs) in chickens and classifying SNP-rich genes in its genome. We started two new projects in 2006, one in collaboration with Prof Dan Bradley, TCD, is extending FIRM III by investigating the population genetics of innate immune genes. The other is studying the immune response to the diseases of mastitis and metritis in cattle. We have identified 40 putative antimicrobial peptides in the Bovine genome mapped them and shown their syntenic relationships with human, mouse and dog. Education and outreach May 2006. Review of "Immunological Bioinformatics" by Lund, Nielsen, Lundegaard, Kesmir & Brunak” BioMedical Engineering OnLine 2006, 5:32. Andrew Lloyd October 2006 - Introduction to Core Research Skills Conway, UCD. Talks: 1. Laboratory Work Organisation & Management, 2.Good Laboratory Practice, 3.Communicating Science. Professor O’Farrelly & Andrew Lloyd. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 24 Research Activities 2006 October 2006. Irish Society for Immunology Schools Presentation, 2006, RDS. “Good Bugs, Bad Bugs: What do they look like? Can your body tell the difference?” Professor O’Farrelly October 2006. E.R.C. Schools Career Talk. Andrew Lloyd Consultancy and collaboration The Bioinformatics Group is available to consult with and advise other research groups in the ERC about all aspects of bioinformatics and molecular evolution. Andrew Lloyd continued his collaboration with the Colon Cancer Group in analysing Microarray Comparative Genome Hybridisation (Array CGH) data. Paul Cormican has helped the Rheumatology and Breast Cancer groups with DNA sequence analysis. The group has helped supervise undergraduate project students. Andrew Lloyd started devising and teaching a 60 contact hour web-based course in bioinformatics at Carlow Institute of Technology, which is available for workers at SVUH. Innate Immunity Group Personnel Principal Investigator: Professor Cliona O’Farrelly, PhD Senior scientists: Andrew T. Lloyd PhD, Post-doctoral researcher: Rowan Higgs (finished May 2006). Graduate students: Paul Cormican M.Sc. Ronan Shaughnessy (started October 2006) Aspinas Chapwanya (started September 2006), Research Associates: Sarah Cahalane, Fernando Narciandi (started September 2006) Graduations Rowan Higgs received his PhD from UCD in June 2006. Kieran Meade PhD Invited talks Feb 2006 VIDO, Saskatoon. “Comparative Immunomics – defining pathogen associated immune response signatures (PAIRS) of host infection” Kieran Meade April 2006 VIBE, SVUH “A Bioinformatic Approach to Detecting Selection in the Chicken Genome.” Tim Dowling Immunogenetics Workshop TCD “Bioinformatic Identification of Novel Bovine‚Defensins” Paul Cormican. May 2006 Workshop on chicken genomics & development. CSHL, New York “A Population Genomics Approach to Detecting Selection in the Chicken Genome.” Tim Dowling October 2006 International Congress of Immunogenomics & Immunomics. Budapest. “In-silico discovery of TLR15, in-vivo significance” Professor O’Farrelly International Visits February 2006. VIDO, Saskatoon and Keystone Conference on Innate Immunity. Banff Canada. Kieran Meade. Posters July 2006. Immunology Masterclass. Maynooth “Bioinformatic Identification of Novel Bovine‚ β Defensins” Paul Cormican & Andrew Lloyd September 2006. Irish Society of Immunology & British Society of Immunology Belfast. “Bioinformatic identification of novel bovine beta-defensins” Paul Cormican & Andrew Lloyd September 2006. 2nd European Veterinary Immunology Workshop Paris Transcriptional profiling of peripheral blood mononuclear cells from tuberculosis infected and healthy control cattle; identification of a gene expression signature of infection. Kieran Meade Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 25 Research Activities 2006 September 2006. ARK-Genomics 6th Farm Animals Functional Genomics Workshop. Cambridge UK. Distinct transcriptional profiles of bovine peripheral blood mononuclear cells stimulated with Myco-bacterium bovis antigens in vitro. David MacHugh. October 2006. International Congress of Immunogenomics & Immunomics. Budapest. Distinct transcriptional profiles of bovine peripheral blood mononuclear cells stimulated with Myco-bacterium bovis antigens in vitro. Kieran Meade Research The FIRM III project, funded by the Department of Agriculture, continued to investigate innate immunity response in chickens to Campylobacter jejuni by setting up an animal infection model. This model was used to track the time course of infection. Over a defined time-course we have built a biobank of tissue samples for measuring DNA and RNA of immune specific genes and analysed the make-up of the cell population. We have further developed our bioinfoirmatic discovery pipeline for analysing the frequency of Single Nucleotide Polymorphisms (SNPs) in chickens and classifying SNP-rich genes in its genome. In parallel, we are measuring the effectiveness of native and modified anti-microbial peptides (AMPs) against a range of pathogens. We started two new projects in 2006, one in collaboration with Prof Dan Bradley, TCD, is extending FIRM III by investigating the population genetics of innate immune genes. The other is studying the immune response to the diseases of mastitis and metritis in cattle. We have identified 40 putative anti-microbial peptides in the Bovine genome mapped them and shown their syntenic relationships with human, mouse and dog. Education and outreach. March 2006. “The chicken comes first”. Lead chapter in Flashes of Brilliance by Dick Ahlstrom. Royal Irish Academy Press. April 2006.. “Chickens to crack the code” The Irish Scientist. Sarah Cahalane. May 2006. Review of "Immunological Bioinformatics" by Lund, Nielsen, Lundegaard, Kesmir & Brunak” BioMedical Engineering OnLine 2006, 5:32. Andrew Lloyd September 2006. “Immune genes: highly variable, exquisitely sensitive” Relay eNewsletter: Issue 7 September 2006 (www.relayresearch.ie). Professor O’Farrelly. October 2006. Ethical Dilemmas in Pandemics RDS, Dublin, Ireland. Talk: Infectious Disease Pandemics: a scientific overview. Professor O’Farrelly October 2006 Introduction to Core Research Skills Conway, UCD. Talks: 1. Laboratory Work Organisation & Management, 2. Good Laboratory Practice, 3. Communicating Science. Professor O’Farrelly & Andrew Lloyd. October 2006. Irish Society for Immunology Schools Presentation, 2006, RDS. “Good Bugs, Bad Bugs: What do they look like? Can your body tell the difference?”. Professor O’Farrelly October 2006. ERC Schools Career Talk. Andrew Lloyd November 2006. Molecular genetics - the future for animal breeding. Irish Veterinary Journal - Vol. 59(11): 634-638. Kieran Meade. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 26 Research Activities 2006 Liver Research Group Liver Research Group - Liver Transplantation, Malignancy & Hepatitis C Principal Investigators: Prof. Cliona O'Farrelly Prof. John Hegarty Research Personnel 2006: Senior Scientists: Elizabeth Ryan Margaret O'Brien (also currently final year Medical Student) Research Assistant: Emma McGrath, Lorna Gallagher Geraldine Scaife Research Fellows: Tariq Tajuddin Badar Zaman, Kavin Nanda Postgraduate Student: Jody Madigan, Eszter Nèmeth The Liver Research Group operates a four-stranded research programme based on Liver Transplantation, Hepatic Malignancy, Hepatitis C Viral Infection and Basic Immunology of the Liver. Liver Transplantation The Liver Transplant team at St. Vincent’s hospital performs 50-60 transplants per year. A successful transplantation program depends on a steady supply of donor organs. Our research is focused on trying to find out ways of preventing damage to the donor organ due to a lack of oxygen. We have found that a transcription factor, NRF2 that regulates cytoprotective pathways is up-regulated in the livers of younger donors and that increased expression of this transcription factor means a better outcome post-transplant. Badar Zaman, Martin Leonard (Conway Institute, UCD), Elizabeth Ryan, Cormac Taylor (Conway Institute, UCD), Justin Geoghegan, Cliona O’Farrelly. Hepatic Malignancy CD1d is a restriction element for natural killer (NK) T cells, a sub-population of lymphocytes expressing a T cell receptor together with NK cell markers. CD1d molecules bind and present lipids to these NKT cells resulting in activation and production of cytokines. Immune regulatory functions such as development of tolerance, regulation of autoimmunity, and potent antitumour and antiviral activities have been ascribed to NKT cells. The aim of this study is to investigate the role of CD1d isoforms in regulating immune responses to malignancy. Margaret O’Brien, Jody Madigan, Emma McGrath, Cliona O’Farrelly Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 27 Research Activities 2006 Does chronic HCV infection increase the risk for the development of Osteoporosis? Osteopenia (thin bones) and osteoporosis (brittle bones) are common among patients with chronic liver disease. The purpose of this study is to investigate the frequency of bone disease in a group of women infected with hepatitis C virus (HCV) via contaminated anti-D. The underlying mechanisms by which chronic HCV may cause osteoporosis are not fully understood, but individuals chronically infected with HCV have ongoing inflammation. We want to determine if this inflammation causes an increase in bone breakdown. Bone mineral density and markers of inflammation in individuals with persistent infection will be compared to those who have cleared the infection. Kavin Nanda, Elizabeth Ryan, Barbara Murray, Malachi McKenna, John Hegarty, Cliona O’Farrelly IL-10 and TGF-β‚ mediated suppresion of antigen-specific Th1 and Th17 responses during HCV infection We have shown that antigen-specific IL -10-secreting regulatory T (Treg) cells are induced in patients chronically infected with HCV. We found that HCV nonstructural protein 4 (NS4) induces IL-10, and inhibits IL-12 production by monocytes. We also found that PBMC from HCV infected patients secreted significant concentrations of IL-10, but low concentrations of IFN-γ and IL-17 in response to NS4. Addition of a neutrailizing antibody to IL-10 significantly enhanced NS4-specific IFN-γ, but not IL -17 production. In contrast, IL-17 was enhanced by neutralisation of TGF-β. Our findings suggest that HCV subverts virus-specific Th1 responses through the induction of IL-10 from monocytes and Treg cells and suppresses Th1 and Th17 cells through TGF-β. production. This may in part explain the failure to clear the chronic infection. Aileen Rowan (TCD), Elizabeth Ryan, John Hegarty, Cliona O’Farrelly, Kingston Mills (TCD) Cytokine and chemokine signatures predictive of the response of HCV patients to therapy IFN-α in combination with Ribavirin is the current standard treatment for chronic HCV infection. However, more than 50% of patients do not respond to this combination therapy and suffer significant side effects unnecessarily. We propose to design an assay based on these characteristic signatures that will be used to predict the potential efficacy of IFN-α/ Ribavirin therapy on an individual patient basis, prior to commencement of treatment. Chemokines and cytokines that are over- or under-expressed in non-responders will be potential targets for the rational development of novel therapies. Analysis of variations (polymorphisms) in the IFN-α and IFN-α response genes and the resulting difference in response to interferon alpha may help us determine patients who are most likely to respond to therapeutic interferon alpha. Tariq Tajuddin, Emma McGrath, Elizabeth Ryan, John Hegarty, Cliona O’Farrelly. Regulation of DC-SIGN by IFN-α DC-SIGN is a C-type lectin receptor expressed by dendritic cells (DC) that binds to a HCV envelope protein. DC-SIGN expression can be reduced following exposure to IFN-α. In this study we aim to determine the importance of the expression of this receptor to the outcome of IFN-α/Ribavirin therapy. Elizabeth Ryan, Cliona O’Farrelly, John Hegarty The characterisation of T cell subsets in normal and diseased liver T regulatory cells (CD4+CD25+FoxP3+) that secrete anti-inflammatory cytokines, such as IL -10 and TGF-β, can prevent effective cellular responses. By carefully characterising this population in normal and diseased human liver tissue we aim to determine their importance in controlling the immune response in the liver. Previous work in Prof. Kingston Mills’ Laboratory has shown that Fasciola hepatica infection of mice can lessen the severity of Experimental Autoimmune Encephalitis (EAE). We aim to characterise liver T regulatory cells in this model to determine their role in mediating the suppression of inflammation. Eszter Nèmeth, Miriam Brady (TCD), Cliona O’Farrelly, Kingston Mills (TCD) HCV Research Consortium The cohort of Irish women infected in 1977 with HCV contaminated anti-D provide an important opportunity for analysis of host genetic factors in HCV as this group is homogenous for time of infection, route of infection, racial Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 28 Research Activities 2006 background, gender and viral subtype. Resolution rates in this cohort have been significantly better than the average reported rates of approximately 20% and several preliminary studies of these patients have suggested genetic influences including association between HLA and viral clearance and also an association between MMP3 and chronicity. The Consortium will investigate the contribution of KIR genotype and/or phenotype to resolution of HCV in the Irish population. The HCV Consortium was established to conduct research into different aspects of HCV infection in this cohort. The Hepatitis C virus is an important cause of chronic liver disease, including cirrhosis and liver cancer: Over the next 10-20 years chronic Hepatitis C is predicted to become a major burden on the health care system. Patients who are currently asymptomatic with relatively mild disease progress to end-stage liver disease and develop hepatocellular carcinoma. There is no vaccine for HCV. The best weapon against HCV is a combination therapy (interferon (IFN)-α with ribavirin), but success rate is at best 40-60%, and it has severe side effects. Profs O’Farrelly and Hegarty coordinate the HCV Research Consortium; which is composed of Irish clinicians who have a research interest in HCV infection. John Crowe, Mater Hospital Orla Crosbie, Cork Frank Murray, Beaumont Hospital Suzanne Norris, St. James Susan McKiernan, St. James Consortium Members: Prof. Cliona O'Farrelly, Chairperson, St. Vincent's University Hospital Dr. John Crowe, Mater Misericordeae Hospital Prof. Dermot Kelleher, St. James Hospital Prof. John Hegarty, St. Vincent's University Hospital Dr. Orla Crosby, Cork University Hospital Dr. Frank Murray, Beaumont Hospital Dr. Suzanne Norris, St. James Hospital The group has been awarded a grant from the HRB of €234,473.60 for “An Investigation of KIR genotypes in the resolution of HCV infection”. Post Doctoral Researcher, Dr Megan Dring was appointed to work in collaboration with the HCV Research Consortium and Dr. Clair Gardiner of TCD on this immunogenetic study. In this study, the contribution of genes coding for NK cell receptors (Killer-cell immunoglobulin-like receptors) to the resolution of HCV infection will be studied. NK cell receptor genotyping will be performed together with and some preliminary phenotyping. In particular, this new data will be correlated with HLA data previously collected to confirm a potential role of KIR receptors in influencing the prognosis and outcome of HCV infection. Megan Dring, Clair Gardiner, Cliona O’Farrelly Oral Presentations EJ Ryan, J. Hegarty, C. O’Farrelly. IFN-alpha reduces DC-SIGN expression on dendritic cells; Implications for the treatment of HCV patients. Liver Immunology Session at the 16th European Congress of Immunology Sept 6-9, 2006 – Paris. Poster Presentations MB Zaman, M Leonard, EJ Ryan, D Maguire, O Traynor, J Hegarty, J Geoghegan, C O’Farrelly. Activation of Nrf-2 following Ischemia-reperfusion of donor organ in the setting of orthotopic liver transplantation is clinically beneficial for the patients. Meeting of the American Association for the Study of Liver Diseases (AASLD), Boston, Oct 2006 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 29 Research Activities 2006 EJ Ryan, J. Hegarty, C. O’Farrelly. IFN-α down-regulates DC-SIGN expression on blood myeloid dendritic cells in vitro; implications for HCV patients undergoing treatment with pegylated IFN-α / ribavirin combination therapy. Meeting of the American Association for the Study of Liver Diseases (AASLD), Boston, Oct 2006 Department of Endocrinology & Diabetes Mellitus Consultants: Professor T.J. McKenna, Dr Malachi McKenna, Dr Donal O’Shea Lecturers: (Department of Medicine, U.C.D).: Dr Marie-Louise Healy Dr Deirdre Blake. Specialist Registrars: Dr Shazli Yusof, Dr Conall Dennedy Registrars: Dr Tomás Ahern, Dr Maeve Hutchinson Research Registrar: Dr Tom Cawood Endocrine Laboratory, Principal Biochemist: Dr. Tom Smith Research-Graduate Students: Research Nurse: Lucille Kavanagh Ciara O’Dwyer Research Projects: Macroprolactin (Lucille Kavanagh) Lucille Kavanagh is supported by a grant from the Health Research Board to support her elucidation of the nature of macroprolactin. Prolactin is a hormone which comes from the pituitary gland. High levels of prolactin is the underlying cause in approximately 25% of patients who present with failure of ovulation. This affects approximately 12% of all women. Our studies have highlighted the fact that the laboratory finding of approximately 10-20% of measurements indicating high levels or prolactin may be misleading. This is due to the presence of macroprolactin. Macroprolactin is a form of prolactin which, although measured in the assays, is not active in patients. This department has previously published extensively on laboratory techniques which may eliminate macroprolactin and also on the clinical consequences of failure to undertake routine screening for macroprolactin. While routine screening is generally undertaken in Ireland as a consequence of this laboratory’s research and in 80% of laboratories in the United Kingdom and to a lesser extent in Europe, screening is the exception rather than the rule in the United States. Further publications from this laboratory in the leading American laboratory and clinical journals is attempting to address this situation. The renowned Mayo Clinic laboratories have recently announced the provision of a service which screens for macroprolactin. In launching the service, the Mayo Laboratories Communique cited six scientific articles, four of which were from this department. Although clinical observations have been consistent with the concept that macroprolactin is not active in the body, laboratory bioassays have indicated that macroprolactin retains bioactivity. The classical bioassay for prolactin uses Nb2 cells derived from rat lymphoma which have been shown to multiply when exposed to prolactin. When macroprolactin was added to Nb2 cells, multiplication occurred over a period of 72 hours. Lucille Kavanagh has now demonstrated that during incubation with the cells, the prolactin/antibody complex dissociates freeing up prolactin in its active state, monomeric, and thus provides bioactive prolactin. This explains why macroprolactin appeared to be bioactive in the Nb2 cells and indiates that this bioassay is inappropriate for macroprolactin. In further studies, Lucille Kavanagh has demonstrated that while macroprolactin is usually due to a combination of prolactin and an antibody to prolactin, it is not associated with other disorders associated with the production of antibodies against normal body tissues i.e. autoimmunity. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 30 Research Activities 2006 Dr Malachi McKenna is a member of the Editorial Board for the journal, Osteoporosis International. Dr Marie-Louise Healy was appointed Consultant Endocrinologist in St James’s Hospital. Abstracts: Cassidy M, Smith TP, Barrett N and McKenna TJ. Haemoglobinopathies may lead to grossly inaccurate reporting of HbA1c levels. Irish Journal of Medical Science, Volume 175 Number 4 Supplement 2: 35, 2006. Draman MS, Ahern T, Smith TP and O’Shea D. Selective intra-arterial calcium stimulation with hepatic venous investigation of hyperinsulinemic hypoglycaemia. Irish Journal of Medical Science, Volume 175 Number 4 Supplement 2: 40, 2006. Kavanagh L, Smith TP and McKenna TJ. The Nb2 bioassay is unsuitable for assessing the bioactivity of macroprolactin. Irish Journal of Medical Science, Volume 175 Number 4 Supplement 2: 38, 2006. McKenna TJ, Kavanagh L, Fahie-Wilson MN, Gibney J and Smith TP. Specificity and Clinical Utility of Methods for the Detection of Macroprolactin. The Endocrine Society’s 88th Annual Meeting, Boston, 24-27th June 2006, Poster P2534. Thyroid Eye Disease Research Group Personnel: Dr. Donal O’Shea & Dr. Tom Cawood Dr Cawood has continued his studies on the potential role of anti-cytokine therapies in thyroid eye disease, and has also investigated the link between smoking and thyroid eye disease. This in vitro work, funded by a Clinical Research Training Fellowship from the Health Research Board, has suggested that Interleukin 1 may be an attractive therapeutic target as Interleukin promotes numerous pathological processes in thyroid eye disease (including inflammation, glycosaminoglycan production and adipogenesis). Interleukin 1 also acts in synergy with cigarette smoke extract to promote adipogenesis, which may help explain why smoking worsens thyroid eye disease. Dr Cawood was awarded the O’Donovan Medal by the Irish Endocrine Society, and the Novartis Endocrinology Registrar Research Medal for this work and will be submitting his Ph.D. thesis in 2007. Abstracts: Cawood TJ, Moriarty P, O'Farrelly O, O'Shea D. Smoking and Thyroid Eye Disease, a Novel Explanation of the Biological Link. Irish Journal of Medical Science, Nov 2006, Vol 175, No 4, Suppl 2. OC6. Hutchinson M, O'Shea D & Cawood TJ. The unrecognised use of alternative treatments for thyroid disorders. Irish Journal of Medical Science, Nov 2006, Vol 175, No 4, Suppl 2, P34. Cawood TJ, Moriarty P, O'Farrelly O, O'Shea D. Interleukin 1: the Optimal Cytokine Target in Thyroid Associated Ophthalmopathy? European Congress of Endocrinology, Endocrine Abstracts April 2006, Vol. 11, OC58. Oral Presentations of Research Irish Endocrine Society, Galway, Ireland, November 2006 European Congress of Endocrinology, Glasgow, UK, April 2006 Poster presentations of Research: Irish Endocrine Society, Galway, Ireland, November 2006 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 31 Research Activities 2006 Obesity Research Group Personnel: Dr. Donal O’Shea, Dr. Jean O’Connell & Dr. Lydia Lynch Laboratory work is underway investigating the metabolic and immunological links between obesity and its consequences, such as type 2 diabetes and non-alcoholic fatty liver disease. A Newman Scholar post is being funded by Sanofi-Aventis, and the Diabetes Federation of Ireland and the Medical Research Charities group have recently awarded funding for a 3-year project entitled ‘Adipocyte size and type 2 diabetes; a study of patients undergoing bariatric surgery’. Dr.O’Connell has been awarded a HRB training fellowship to pursue this project. Respiratory Sleep Research Principal Investigator: Prof.Walter McNicholas Summary of Research Activities: The Respiratory Sleep Research Laboratory at St. Vincent’s University Hospital continues a varied clinical and basic science research programme with a particular emphasis of cardiovascular interactions in obstructive sleep apnoea (OSA). Ongoing collaboration exists with the research group of Prof. Cormac Taylor in the Conway Institute at UCD and the School of Electronic and Electrical Engineering (Prof. Conor Heneghan and Prof. Mark O’Malley), also in UCD. Together with Prof. Taylor we have an ongoing translational research programme that explores the role of intermittent hypoxia (IH) in the pathogenesis of cardiovascular disorders in OSA. In studies of OSA patients, and also a unique cell culture model of IH utilising bovine aortic endothelial and HELA cells, we have demonstrated that IH selectively activates inflammatory over adaptive molecular pathways through the selective activation of the inflammatory transcription factor NFκB. NFκB has been shown to predispose to atherogenesis. We have also demonstrated that the NFκB-dependent gene TNF-a is elevated in patients with OSA and falls to control levels with nasal CPAP therapy. Currently we are engaged in characterizing the numbers and activation state of circulating neutrophils in OSAS patients. Our preliminary data has indicated a significant increase in the number of circulating neutrophils in OSAS patients when compared to controls. The current project includes collating the neutrophil counts of the patients (over 1200 patients) studied to date from the sleep laboratory database in St. Vincent’s University Hospital. Blood samples are being collected from OSAS patients and non-apnoeaic controls in a prospective fashion and the basal activation state and response to stimulation of circulating neutrophils is being assessed. We have established an in vitro model of intermittent hypoxia/reoxygenation to investigate molecular mechanisms by which intermittent hypoxia effects neutrophil activation. Finally we will correlate changes in neutrophil phenotype in OSAS patients with neutrophils exposed to IH to determine common molecular pathways which may represent novel therapeutic avenues. In collaboration with Prof. Heneghan, we have studied the ability to identify sleep apnoea from digital signal processing of the ECG signal, based on characteristic changes in the ECG that accompany apnoea. The measurement of oxygen saturations and heart rate variability has been independently proposed as screening tools in the evaluation of patients with suspected OSAS. In collaboration with Prof. Conor Heneghan’s group we have evaluated a combined electrocardiograph and oximeter recorder in patients simultaneously undergoing polysomnography. Interim analysis of the data to date shows a high correlation (0.94) of the Apnoea-Hypopnoea index by the two techniques suggesting combined holter-oximeter monitoring may provide a suitable device for home screening of OSAS. This finding has been accepted as an abstract for the American Thoracic Society annual meeting in San Francisco in May 2007. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 32 Research Activities 2006 Retrospective analysis of the blood results of patients with severe OSAS from the sleep lab database has demonstrated a higher prevalence of hypothyroidism in women with severe OSAS (38.5%) when compared with both previous published figures for all OSAS patients and men with severe disease in our study population. Varying reports on the prevalence of hypothyroidism in OSAS have generated debate on the need for routine thyroid function screening in OSAS but our data support routine assessment of thyroid function in females with OSAS. This finding has been submitted in abstract form to the European Respiratory Society annual meeting in Stockholm in September 2007. In collaboration with Prof. O’Malley’s group, we have developed new surface electrode configurations to record genioglossus EMG with a view to studying the role of skeletal muscle fatigue in the pathophysiology of OSA. Invited Presentations during 2006: Presentations of original research were given by members of the research team at the annual meeting of the American Thoracic Society in San Diego in May (Dr. Silke Ryan), and the annual meeting of the European Respiratory Society in September (Ms. Geraldine Nolan and Dr. Silke Ryan). Department of Neurology Research in Multiple Sclerosis The Department of Neurology has an international reputation in the field of multiple sclerosis (MS) research for many years thanks to the work of Professor Michael Huchinson and various colleagues. This research has been largely clinically based and in recent years has emphasised the use of disability scales in MS. In 2005, a collaboration was set up with the laboratory of Professor Kingston Mills in Trinity College Dublin with the help of Professor Cliona O’Farrelly of the ERC at St. Vincent’s University Hospital. The aim of the research is to establish a viable translational collaboration between the laboratory and the MS clinics at SVUH. Dr. Jean Fletcher started in August 2005 and is looking at serum samples for people with MS attending the neurology clinics. She is looking at the effect of interleukin -17 in MS in particular and the aim is to try and establish the role of T regulatory cells in this condition. It is ultimately hoped that by establishing a role for such cells in MS it may be possible to develop potential therapies. Jean is also extracting DNA from a second sample for storage which we intend to use in further work at a later stage and to share with other established groups in this area of research. To achieve this, of course, close co-operation is required with the clinical team. Dr. Lisa Costelloe is doing an MD in this area at the Dept of Neurology. A new clinic has been set up in 2005 specifically for people with MS. In 18 months, almost 400 patients with MS and 100 control subjects have been recruited. Lisa Costelloe, Niall Tubridy and Michael Hutchinson assess the patients clinically and document the disease phenotype in each individual seen. This is done in the course of ‘normal’ clinical care. The information gained is data-based on the internationally established iMed database. The work of Lisa Gribben, MS Research Nurse, Lisa McGowan, Research Nurse, and Marguerite Duggan, MS Specialist Nurse, has been integral to the smooth running of this project and the ongoing care our patients. The group has applied for a number of grants to enable this project to continue apace. In addition to immunological research, we have a long-standing interest in the evaluation of clinical outcome measures for MS drug trials. In particular, the health related quality of life of MS patients and its quantification is being examined longitudinally in a large MS cohort attending this hospital. We have established a clinically useful and psychometrically valid “ minimal change score” for one of the widely used MS self – report instruments. Doctor reported MS rating scales are also being evaluated for clinimetric characteristics that would make them effective outcome measures for RCTs (see attached list of publications). Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 33 Research Activities 2006 In 2007 and 2008 we plan a large scale study of the epidemiology of MS in Ireland based in Dublin, Donegal and Wexford. We aim to look at immunological, genetic and vitamin D markers in a large cohort of people with MS and controls in Ireland. Abstracts/Presentations 2006 A quantitative analysis of natural regulatory T cells using FoxP3+ expression in a Multiple Sclerosis (MS) cohort compared to controls. L.Costelloe. J.M.Fletcher, K.H.Mills, C.O’Farrelly, M.Hutchinson, N.Tubridy. Poster presentation, INA meeting, 2006 IL-17 producing T cells and their induction in Multiple Sclerosis. JM Fletcher, L Costelloe, C O’Farrelly, N Tubridy and KHG Mills Poster presentation, ECTRIMS 2006 Does the patient know best; significant change in the physical component of the Multiple Sclerosis Impact Scale (MSIS-29 physical) over four years. L. Costelloe, K. O’Rourke, C. McGuigan, L. Daly, N. Tubridy. M. Hutchinson Poster presentation ECTRIMS 2006 Platform presentation, Diaspora meeting 2006 The relationship between the patient-rated Multiple Sclerosis Impact Scale (MSIS-29) and the physician-rated Multiple Sclerosis Functional Composite (MSFC): a cross-sectional study L.Costelloe, K.O’ Rourke, M.Duggan, L.Gribbin, N.Tubridy, M.Hutchinson Platform presentation, EFNS Young Researchers Competition 2006 Platform presentation, INA meeting 2006 Minimally significant change by patient report: a comparison of two scales. Costelloe L; O’Rourke K; Kearney H; McGuigan C; Gribbin L; Duggan M; Daly L; Tubridy N; Hutchinson M. Poster presentation, ABN 2006 Persistent Neutralising Antibodies (NAbs) to Interferon-beta and clinical outcomes in Multiple Sclerosis patients. L.Costelloe, K.O’Rourke, N.Tubridy, M.Hutchinson Poster presentation, ECTRIMS 2006 Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 34 Research Activities 2006 Centre for Colorectal Disease Clinical & Research Team: Diarmuid O’Donoghue Consultant Gastroenterologist (Director of Centre for Colorectal Disease) Consultant Surgeon John Hyland, Des Winter Consultant Pathologist Kieran Sheahan Consultant Gastroenterologist Hugh Mulcahy Consultant Oncologist David Fennelly Senior Research Scientist Jacintha O’Sullivan Consultant Pathologist David Gibbons Consultant Radiation John Armstrong Oncologist Michael Moriarty Consultant Radiation Genetic Nurse Specialist Denise Keegan Cancer Nurse Coordinator Anne White Nurse Specialist Nikki Smith, Grace McEvoy Senior Medical Scientist Robert Geragthy Research Nurse Blathnaid Nolan Senior Research Scientist Dermot Leahy Research Assistant Miriam Tosetto, Monica Gancarczyk-Biniecka MD research fellow Alan Coss, Dave Kevans Garret Cullen, Joe Marry Postdoctoral Fellow Edward Fox Ph.D student Sheeona Gorman, Juliette Sheridan MSc. Student Julie Gorman MCh fellow Chin Hong Lim New researchers which joined our group in 2006: Three MD research fellows joined our research team in July 2006; Dr. Garret Cullen, Dr. Dave Kevans & Dr. Joe Marry. Garrett is investigating how cigarette smoking and genomic instability may be factors controlling disease progression and treatment sensitivity in inflammatory bowel disease patients. To perform this study he is using an IBD tissue explant model. Joe is examining the role of genomic instability and hypoxia play in governing response to monoclonal antibody therapies. Both Garrett & Joe received Newman Fellowships (details listed below). Dave’s project is focused on validating prognostic gene signatures that distinguish good and bad Stage II cases. In January 2006, we also began working with Almac Diagnostics (Prof. Paddy Johnson & Prof. Paul Harkin) using their specific colorectal array chip to address this question in Stage II colorectal. Dr Monica Gancarczyk-Biniecka joined our group in June 2006 to work on this project in collaboration with Almac Diagnostics. Also, in May 2006 Chin Hong Lim joined the research team as an MCh fellow examining differential expression of markers of the immune system in laparoscopic verses open surgery using cytokine expression arrays. Overall Research Theme The main research goals of the Centre for Colorectal Disease is to achieve a more complete understanding of which biological factors drive the colorectal cancer. We are also interested in determining how the identification of biological markers can help distinguish individuals at high risk of this disease and also identify which individuals will respond to different therapies. Our research projects listed below address these questions. The output of these research Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 35 Research Activities 2006 projects will result in early detection and early medical intervention, ultimately leading to more effective treatment of colorectal cancer. List of some of our current research projects: Role of genomic instability and hypoxia in governing response to therapies using in vitro and ex vivo explant models (Joe Marry & Miriam Tosetto) Role of oxidative stress and DNA damage in CRC (Juliette Sheridan). Role of mismatch repair proficiency analysis in detecting familial cancer (K.Sheahan & Dermot Leahy). Bystanders effects and tumour recurrence in colorectal cancer (Sheeona Gorman) Analysis of chromosomal instability patterns in non-metastatic and metastatic CRC using array comparative genomic hybridization, and validation of novel gene alterations potentially associated with metastasis using fluorescent in situ hybridisation (Alan Coss). Timing and rates of random nuclear and mitochondrial spontaneous mutations in colorectal cancer: implications for early detection and chemotherapy resistance (Edward Fox). Examination of prognostic gene signature in Stage II good and poor survivors (Dave Kevans). Cigarette smoking and genomic instability: factors controlling disease progression and treatment sensitivity in inflammatory bowel disease patients (Garret Cullen) The effect of telomerase inhibitors on colorectal cancer proliferation and response to therapies (Julie Gorman) Examination of Immune modulators involved in laproscopic and open colorectal cancer surgery (Chin Hong Lim) Colorectal Cancer Tissue Biobank for translational research studies: The longstanding colorectal cancer database in St Vincents University Hospital (established in 1983) contains a comprehensive series of clinical details, pathological prognostic indicators and follow-up data for 2,500 patients. Approximately 150 CRC cases are diagnosed each year. In collaboration with Dr Paul Walsh at the National Cancer Registry in Cork we can update our follow up data regularly. All sample collection has been performed using Standard Operating Procedures. Archival paraffin blocks and fresh frozen tumour and normal tissue exist for the majority of cases. Serum and PBMC’s are also routinely banked for every patient since 2004. In addition, we have optimized culture techniques to enable us to culture tumour explant tissue. Invited Scientific Talks at National Conferences: Alan Coss: Novel targets in early stage colorectal cancer. Centre for Colorectal Disease 13th International Meeting, St. Vincent’s University Hospital, September 2006. Alterations of the Topoisomerase II· gene and protein in colorectal cancer. Conway Institute Festival of Research, O’Reilly Hall, UCD, Sept 2006 . Juliette Sheridan: Higher Levels of Oxidative DNA Damage in Sporadic Colorectal Cancer. Irish Society of Gastroenterology, November 2006 Garret Cullen: Infliximab in Crohn’s disease: step-up or top-down? Irish Society of Gastroenterology, November 2006 Juliette Sheridan: Oxidative Damage and Early Stage Colorectal Cancer. Centre for Colorectal Disease 13th International Meeting, St. Vincent’s University Hospital, September 2006. Jacintha O’Sullivan: Predicting reposne to Oncological Therapy. Centre for Colorectal Disease 13th International Meeting, St. Vincent’s University Hospital, September 2006. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 36 Research Activities 2006 Published abstracts Radiation and chemotherapy bystander effects in colorectal cancer cells and in ex vivo tumour and matching normal colorectal explants S Gorman, M Tosetto, O Howe, F Lyng, H Mulcahy, D O'Donoghue, J Hyland, D Fennelly, J Armstrong, , K Sheahan, J O'Sullivan. J Modern Pathology, Supplement, Sept 2006. Localisation of a novel cathepsin L isoform in colorectal cancer Sullivan S, O’Sullivan JN, Coss A, Tosetto M, Wang LM, O’Donoghue DP, Hyland J, Fennelly D, Sheahan K, Mulcahy HE. Endoscopy Nov 2006 Use of array comparative genomic hybridisation to differentiate between metastatic and non-metastatic colorectal cancer Coss A, Fox E, Lloyd A, Sullivan S, O’Donoghue DP, Hyland J, Sheahan K, O’Sullivan JN, Mulcahy HE, Leahy D. Endoscopy Nov 2006 Amplification of the topoisomerase II· gene occurs in colorectal cancer and is associated with more aggressive disease Coss A, Sheahan K, Sullivan S, Fox E, O’Donoghue D, Hyland J, Leahy D, Mulcahy H, O’Sullivan J. J. Mod Pathol Sept 2006. Radiation and Chemotherapy Bystander Effects in Colorectal Cancer S Gorman, M Tosetto, O Howe, F Lyng, H Mulcahy, D O'Donoghue, J Hyland, D Fennelly, J Armstrong, K Sheahan, J O'Sullivan Gut, Supplement 2, April 2006 Effect of Radiation on Levels of DNA Damage in Normal Non-Adjacent Mucosa of Colorectal Cancer Cases. J.A Sheridan, H. Mulcahy, K Sheahan, J Hyland J, J Armstrong, M Moriarty, D. O’ Donoghue, J O.’Sullivan J J. Mod Pathol Sept 2006 Higher Levels of Oxidative DNA Damage in Non-Metastatic vs. Metatstatic Sporadic Colorectal Cancer. J.A Sheridan, H. Mulcahy, E Fox, D. Leahy, K. Sheahan, J. Hyland, D. O’ Donoghue, O.’Sullivan J. Gut, Supplement 2, April 2006 Current National & International Research Collaborators: Prof. Peter Rabinovitch, University of Washington, Seattle, Prof. Larry Loeb, University of Washington, Seattle, Prof. Martin Tenniswood, Notre Dame, Indiana, Dr Orla Howe, Dr. Fiona Lyng, DIT, Kevin Street, Dr. Cormac Taylor, Dr. Katrina Comerford, Conway Institute, UCD, Prof. Kevin Malone, Dr. Douglas Veale, Dr. Ursula Fearon, St Vincents University Hospital, Dublin, Dr. Dermot Leahy, Conway Institute, UCD, Prof. Alan Baird, Vet School, UCD, Dr. Paul Walsh, National Cancer Registry for Ireland, Cork. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 37 Research Activities 2006 Breast Cancer Research Group Principal Investigator: Researchers: Professor Joe Duffy Patricia McGowan, , Dr Eadaoin McKiernan, Dr Aisling Pierce Dr Brid Ryan, Dr Neil O’Brien (currently visiting scientist in the lab of Drs Denis Slamon, University of California at Los Angeles) Collaborators (Local): Professor John Crown, Mr Denis Evoy, Dr Liam Gallagher, Professor F Martin (UCD), Mr Enda McDermott, Professor Niall O’Higgins (SVUH), Professor Steve Pennington, Dr Norma O’Donovan (DCU) Collaborators (International): Drs Denis Slamon/Gottfried Konecny, University of California at Los Angeles; Dr Stan Krajewski, Burnham Institute, La Jolla; Prof Fred Sweep, Nijmegen; Prof Nils Brunner, Copenhagen, Prof Manfred Schmitt, Munich. Research Focus The overall aim of the Breast Cancer Research Group is to develop new molecular markers to aid the early diagnosis of breast cancer, help with prognosis and predict likely response or resistance to specific therapies. Patricia McGowan is working on TACE (ADAM17), a multidomain protein possessing both a protease and an adhesion domain. Using both breast cancer cell lines and human tumors, Patricia has shown that TACE is involved in the progression of breast cancer. TACE is thus a potential new target for the treatment of breast cancer. Aisling Pierce is involved in using proteomics and glycomics for the early detection of breast cancer. She is also investigating the potential role of the breast-specific gene, mammaglobin, in the formation of breast cancer. Eadaoin McKiernan is attempting to identify new markers for predicting the metastatic potential of newly diagnosed breast cancers. This work is being carried out as part of a European Consortium funded by the EU Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 38 Research Activities 2006 Mental Health Research The Department has established a leading National Programme on Suicide Research including projects in basic and applied clinical neuroscience, clinical epidemiology projects as well as leading national community projects in the area of new knowledge and understanding around the problem of suicide in Ireland. The basic and applied clinical neuroscience projects include neuroimaging studies led by Dr Robert Whelan which is focusing specifically on brain pathways involved in modulating suicidal depression. This work is being conducted in collaboration with the Department of Electronic Engineering in UCD as well as the Department of Radiology in St. Vincent’s. Other neuroscience projects include molecular genetic studies of patients with suicidal depression. This collaborative research project is being led by Dr Maria Ryan and includes a study of cases from all the Dublin Teaching Hospitals in collaboration with the Dublin Molecular Medicine Centre. Clinical epidemiology projects include a national study of all suicides by drowning as well as a ten-year study of all deaths on Irish railways over the past decade. This work is being conducted in conjunction with the Irish Water Safety Association and Iarnród Éireann respectively with significant consultation and collaboration with Professor Cecily Kelleher, UCD. New projects include a National Survey of Suicide in Ireland, which is being led by Professor Malone at St. Vincent’s. This project involves detailed interviewing of families who have been bereaved by suicide as well as the treating clinicians of those who have died. The Suicide in Ireland Survey project was significantly enhanced in Autumn 2006 following the awarding of an Ad Astra Scholarship in Suicide Studies as part of this programme. This Scholarship went to Mr. Séamus McGuinness who will conduct a PhD in Suicide Studies through Visual Arts here at St. Vincent’s in collaboration with Professor Malone, and also Professor Janis Jeffries from Goldsmith College in London. In addition to the suicidal depression projects we have established an exciting interdisciplinary collaborative research programme in psychobiology. This research aims to elucidate the biological basis of major depressive disorder, to examine the effects of anti-depressant treatments on biological outcomes, and to discover biological mechanisms by which psychological distress is associated with increased rates of various diseases of ageing (including cancer and heart disease). During 2006, we completed psychobiological projects examining immune system markers in healthy adults, heart failure patients and psychiatric inpatients. Our heart failure work was conducted in collaboration with Dr Kenneth McDonald and colleagues at the Heart Failure Unit, SVUH. Additional projects on treatment effects during depression are being conducted by Dr Gavin Rush who is looking at the anti-inflammatory effects of some of our anti-depressant treatments. This work is being done in collaboration with Dr Jim Lucey in St. Patrick’s Hospital as well as Professor Cliona O’Farrelly at the ERC. These projects are being led by the Multidisciplinary Psychobiology Research Group at SVUH. Members of MPBG include Dr Gavin Rush, Professor Kevin Malone and Ms. Aoife O’Donovan (who is currently in the final year of her Newman Fellowship) from the Department of Psychiatry, as well as Professor Cliona O’Farrelly and Dr Jacinta O’Sullivan from the ERC. Our in-house research personnel include Dr Robert Whelan, Ms. Aoife O’Donovan, Dr Maria Ryan, and Mr. Séamus McGuinness. Our collaborative partners in St. Vincent’s include Professor Cliona O’Farrelly, Professor Cecily Kelleher, Dr Jacinta O’Sullivan, Dr Douglas Veale, Dr Dónal O’Shea, Dr Hugh Mulcahy, Professor Michael Hutchinson from Neurology, and Dr Seán Connolly from Neurophysiology External and international collaborators include Professor Andy Seakin from Dartmouth Hitchcock Medical Centre, Professor John Mann from Columbia University, New York, Professor Annette Beautrais from the University of Otago in New Zealand, Professor Madelyn Gould from the Department of Public Health in Columbia University, New York, Dr Tom Foster and Dr Chris Kelly from Queen’s University Belfast, and Professor Richard Reilly from Electronic Engineering, UCD Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 39 RESEARCH CENTRE Postgraduate Department The Postgraduate Department once again had a very successful and busy year. The meetings organised at postgraduate level for the hospital staff still continue to attract a large attendance from St. Vincent’s University Hospital and are a vital contact for all the NCHDs. Annual Hospital Study Day For the past number of years our Annual GP Study Day has been held during the months of November or December, but in order to avoid clashing with other conferences or sporting events held at that time of year it was decided by the committee to hold the study day on Saturday 3rd March 2007. The educational format will be similar to that of 2005 and will consist of four Poster Sessions, two Interactive Sessions, and a Minor Surgery Session. Full details of this study day will be included in our 2007 report. Medical and Surgical Meetings The Postgraduate Lunch Time Meetings include: Respiratory Colorectal Gastroenterology Surgical Audit Nephrology Rheumatology Palliative Care There are also breakfast meetings as follows: Thursday at 8.00am Medical Conference (Grand Rounds) Friday at 7.30am Cardiology Meeting Friday at 8.00am Respiratory Meeting All of the above meetings are organized by the Postgraduate Department. Lunch or breakfast is provided. Intern Lunch Time Seminars Monday Lunch Time Seminars for Interns consist of Clinical Skills Sessions and Data Interpretation. The Tuesday Lunch Time Seminar is organized by the Medical Intern Tutor in conjunction with the Postgraduate Department. Each week an Intern presents a case to the class with a discussion of same afterwards. Wednesday conferences can be either surgical or medical. Thursday Lunch Time Lectures are on matters relating to all aspects of Surgery and are given by Consultant Surgeons within the hospital. Friday Lunch Time Seminars for the Interns are presented by guest speakers and include Career Guidance, Risk Management, Stress Management and a wide variety of other topics. SHO Teaching Formal ClinicalTeaching: We run a five week intensive programme of bedside tutorials three times per year, January/February, May/June, October/November. These courses are aimed primarily, but not exclusively at the MRCPI examination. These tutorials are all consultant-provided and take place at 5pm to maximize attendance and to allow SHOs in peripheral jobs to attend. Consultants are asked to focus on a short case format (see page 8 of the Postgraduate Medical Training Booklet). At the end of the course feedback from SHOs as to how the course could be improved is analysed. We use the Pyramid discussion method which has recently been successfully implemented for our undergraduate students. Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 40 Postgraduate Department International and National Meetings In addition to the large number of in-house meetings, the Postgraduate Department helped organize the Centre for Colorectal Disease, 13th International Meeting which was held on Friday 8th September 2006. The programme was as follows: Early Colorectal Cancer Session 1 Novel Targets in Early Stage CRC DNA Damage in Early Stage CRC Dr. Alan Coss Dr. Juliette Sheridan Session 2 The Clinical Dilemma Case Presentations to include: A Right Sided Sessile Polyp Cancer in a Polyp Session 3 - Guest Lecture “Endoscopic Ultrasound: Applications in Colorectal Cancer Advanced Colorectal Cancer: Session 4 - Biology Predicting Response to Oncological Therapy Session 5 - The Clinical Dilemma Case Presentations to include: Downstaging of Rectal Cancer and Liver Metastases Synchronous Surgery for Liver Metastases “Surgery for Advanced Disease” The State of the Art Lecture was given by Dr. Gregory Leonard from Memorial Sloan-Kettering, New York and was entitled “Biologic Therapies for Colorectal Cancer”. The meeting was attended by 102 guests. A dinner was held afterwards in the Fitzwilliam Lawn Tennis Club and was attended by 70 people. Sponsorship for this event was provided by the following pharmaceutical companies: Astra Zeneca Sanofi Aventis Johnson & Johnson Healthcare 21 (Tyco) Merck “Get to Know you Function” for Incoming NCHDs: Again in 2006 this proved to be a very successful and enjoyable welcoming lunch for incoming NCHDs. and was held on Wednesday 12th July. This event is an important opportunity to give incoming NCHDs the relevant information about ongoing lectures/ conferences and welcome them to the hospital. It is now an annual event held every year in early July. The Student Summer Project As in other years this is an important part of the hospital’s academic year and in 2006 it was held on Tuesday 14th November. As you know the aim of the project is for the student to develop an interest in research so that he/she will continue to develop this interest at postgraduate level. The judging panel of physicians and surgeons were Dr. John Seery (Chairman), Dr. Kieran Sheahan, Dr. Donal O’Shea and Mr. Denis Evoy. The winner was Namita Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 41 Postgraduate Department Jayaprakash whose project was entitled “Rapamycin Enhances Cytotoxic Effect of Doxorubican in Human Hepatocellular Carcinoma Cells”. Along with the prestige of winning this award the student also receives a monetary amount. The Library The Library is located on the first floor of the Education & Research Centre and is open to all staff of St. Vincent’s Healthcare Group. Its collection includes books, journals and audiovisual material covering all disciplines. Some journals are available online and many more are available via the UCD Library website. There are 17 PCs providing access to databases including Medline, the Cochrane Library and Web of Science. Advanced training on these products is available free of charge. Internet, document-creating, printing, scanning and multimedia projection facilities are also available. Pharmaceutical Representatives The link for the pharmaceutical companies in St. Vincent’s University Hospital is the Postgraduate Department. The companies sponsor the Medical and Surgical Lunch and Breakfast Meetings and in turn the medical representative meets the consultants and NCHDs to discuss their products. This is an important link for both the doctors and medical representatives. Postgraduate Medical Training Booklet This booklet is compiled and circulated bi-annually by the Postgraduate Department. It contains valuable information re conferences / meetings / tutorials that occur in the hospital. Prof. Walter McNicholas Betty McArdle Co-ordinator of Postgraduate Education Administrator Return to contents Annual Review 2006 EDUCATION & 42 RESEARCH CENTRE Academic Activities VIBE (Virtual Institute of Bioinformatics) Spring 2006 Meeting. Wednesday 12 April 2006, E.R.C. St Vincent’s University Hospital Dublin 4 The twice yearly meeting of Researchers in Bioinformatics and Molecular Evolution in Ireland was held on 12th April 2006 in the Education and Research Centre of St. Vincent’s University Hospital. More than 60 people from SVUH, UCD, TCD, DCU, NUIM, UCC, RCSI, U.Ulster, and Teagasc attended. Session I Chair Ken Wolfe 10.00 10.25 10.50 Will we ever have enough data to build the tree of life? Dr. James Cotton. McInerney Group, NUIM. A New Approach to Biclustering of Expression Data. Ken Bryan, Cunningham Group, CS, TCD Defining the molecular bases for the antimicrobial activity of CCL27 and CCL28. Aisling Ni Ruairc, Fares Group, NUIM Session II Chair James McInerney 11.45 12.10 12.35 An approach to detecting selection in the chicken genome. Tim Downing, Bradley Group, Genetics, TCD M-Coffee: multiple multiple alignments. Iain Wallace, Higgins Group, Conway, UCD GRAST: a new way of Genome Reduction Analysis using comparative genomics. Christina Toft, Fares Group, NUIM Session III Chair Aoife McLysaght 2.00 2.25 2.50 The evolution of colour vision in Vertebrates. Dr. Davide Pisani, McInerney Group, NUIM. Independent sorting-out after genome duplication in Kluyveromyces polysporus and Saccharomyces cerevisiae. Devin Scannell, Wolfe Lab, Genetics, TCD. Integrating transcription factor binding site information with expression data sets. Stephen Madden, Higgins Group, Conway, UCD Session IV Chair Mario Fares 3.35 4.00 4.45 Interactions. Denis Shields, himself, Conway, UCD Keynote Talk: Modelling molecular evolution – applications to GPCRs. Richard Goldstein, NIMR, MRC, Mill Hill London. Business, questions from the floor, time and place of next meeting. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 43 RESEARCH CENTRE Intellectual Property Workshop 3.00pm Thursday 27th April 2006 Lecture Hall, Education & Research Centre, St. Vincent’s University Hospital, Elm Park, Dublin 4 Chair: Prof. Cliona O’Farrelly, Director Research Laboratories, E.R.C. S.V.U.H. 3.00-3.20 What is Intellectual Property? Why should Healthcare be Interested? Ciaran O’Beirne, NovaUCD 3.20-3.40 How far have we come? IP Policies and Agreements in SVUH and UCD Rob Corbet, Partner, Arthur Cox 3.40 – 4.00 What does an IP opportunity look like? Maurice Treacy, Director, Biosciences & Bioengineering Directorate, Science Foundation Ireland 4.00-4.20 Coffee Chair: Dr. Ena Prosser, CEO Fountain Healthcare 4.20-4.40 Why and How do you File a Patent? Triona Walshe, MacLachlan & Donaldson 4.40- 5.00 To Market: A Start-Up Company’s Experience Kieran Walshe. Technical Director, Tridelta 5.00- 5.20 Practical Aspects of Managing Intellectual Property John McManus, Enterprise Ireland, Biotechnology Directorate, based at NovaUCD 5.20-5.30 Commercialising Research: From Lab to Market Paul Roben, Director, Biotechnology Commercialisation, Enterprise Ireland 5.30- 6.00 Panel Discussion: Chairs; Speakers; Eamonn Fitzgerald, Group Deputy C.E.O., S.V.U.H. & Doug Veale, Medical Director, E.R.C. Return to contents Annual Review 2006 EDUCATION & 44 RESEARCH CENTRE DMMC/ Conway Institute Immunobiology & Inflammation Course 2006 6 sessions 1st February – 8th March 2006 Venue: Lecture Hall, Education & Research Centre, S.V.U.H. Course Leader: Prof. Cliona O'Farrelly Contributors: Prof. Dennis Reen, Our Lady's Hospital for Sick Children Dr. Elizabeth Ryan, St. Vincent’s University Hospital Dr. John Baugh, Conway Institute. Wed 1 Feb 2006; 10.15-12.45 Introductory Overview Organs, cells and molecules of the immune system – Cliona O’Farrelly Introduction to innate immunity – John Baugh Wed 8 Feb 2006; 10.15-12.45 Innate Immunity Toll like receptors; anti-microbial peptides; complement – John Baugh Cytokines; chemokines – Elizabeth Ryan Wed 15 Feb 2006; 10.15-12.45 Linking Innate and Adaptive Immunity Inflammation; anti-inflammatory mechanisms – John Baugh Antigen processing and presentation; dendritic cells– Elizabeth Ryan Wed 22 Feb 2006; 10.15-12.45 Cellular and Molecular Components of Adaptive Immunity T cells , TCR – Cliona O’Farrelly B cells, antibodies, allergy – Dennis Reen Wed 1 Mar 2006; 10.15-12.45 Effector Mechanisms in Immunology Cytotoxcity, Apoptosis –Cliona O’Farrelly Vaccines – Elizabeth Ryan Wed 8 Mar 2006; 10.15-12.45 Immunological Dysregulation Tumour Immunology, Immunotherapy – John Baugh AutoImmunity - RA/MS Cliona O’Farrelly with Ronan Mullan & Jean Fletcher Objectives of the Course At the end of this course, participants should be familiar with the basic terms and concepts of innate and adaptive immunity and will hopefully be conversant with the names and functions of the main organs, cells, molecules and genes involved in initiating and mediating immune responses. They should be able to explain fundamental immunological concepts and discuss the roles of functional components of the immune system including acute phase proteins, complement, haematopoietic cells, immunoglobulins and cytokines in protecting against disease. They should also understand some basic concepts of immunological dysregulation seen in inflammatory and autoimmune diseases, allergy, malignancy and immunopathogenesis. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 45 Lecture Series 2006 Lecture Series 2006 8th June 2006 Prof Steffan Gay, University Hospital Zurich (pictured below with Rheumatology Research Group) presented a lecture on: ‘Molecular and cellular basis of rheumatoid joint destruction - Lessons from gene transfer’ Fri 29th Sept: “Diurnal rhythm and morning blues in rheumatoid arthritis” Presented by John Kirwan, Professor of Rheumatic Diseases at the Bristol Royal Infirmary, Bristol. Fri 15th Dec: “Glycosylation and Disease” Presented by Professor Pauline Rudd at the Rheumatology Research Meeting Return to contents Annual Review 2006 EDUCATION & 46 RESEARCH CENTRE ERC Journal Club 2006 Schedule: Thurs mornings 9.00-10.00am Venue: Conference Room, E.R.C. Education & Outreach S.V.U.H. Schools One Day Seminars: Laboratory staff in the E.R.C. contribute by giving talks on the workings of the research laboratories to secondary school students. Healthwise Newsletter: Articles from E.R.C. researchers appear regularly in Dept. Preventive Medicine Healthwise Newsletters. The Irish Scientist Yearbook 2006: The E.R.C. contributed two articles to the Irish Scientist Yearbook 2005 “Health Research at St. Vincent’s University Hospital: Better Care Today, Better Cures Tomorrow” and “Chickens to crack the code” In 2006 several UCD undergraduates carried out research for their theses at SVUH, students from TCD Molecular Medicine Science course and several Secondary school students were also accommodated. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 47 RESEARCH CENTRE Prestigious Invitations/Honours for E.R.C. Researchers Prof. Barry Bresnihan Chairman, Arthritis Ireland Chairman, Subcommittee for Academic Support, Arthritis Research Campaign (UK) Vice-Chairman, Scientific Coord. Committee, Arthritis Research Campaign (UK) Co-Chairman, EULAR Synovitis Study Group Co-Chairman, OMERACT Synovial Tissue Analysis Study Group Member Oliver Bird Advisory Body, Nuffield Foundation (UK) Co-Editor, Concepts of Pathogenesis and Emerging Treatments for Rheumatic Diseases Chairman, Scientific Session, ISR/BSR Member International Advisory Bodies Amgen, Abbott, Novartis Editorial Board: Annals of the Rheumatic Diseases, Journal of Rheumatology, Balliere's Clinical Rheumatology Professor Joe Duffy Invited Seminar, Edinburg Royal Infirmary, April 2006, “Breast Cancer Markers: An Overview”, Central European Meeting on Tumor Markers (CECHTUMA), Prague, May 2006, “Markers in Ovarian Cancer, EGTM recommendations”, EMBO Molecular Medicine Conference, Common Molecular Mechanisms of Mammary Gland Development and Breast Cancer Progression, Dublin, 2006, “Prognostic and Predictive Factors in Breast Cancer”. Molecular Staging of Cancer Meeting, Heidelberg, June 2006, “uPA and PAI-1 in Breast Cancer” International Congress on Fibrinolysis and Proteolysis, San Diego, August 2006, “uPA and PAI-1 validated prognostic markers in breast cancer”, ISOBM Meeting on Tumor Biology, Passadena, Sept 2006, “Detection and Therapy, CA 125 in Ovarian Cancer: EGTM Guidelines for Clinical Use”, Dutch Clinical Chemistry Meeting on Tumor Markers in Solid Tumors, Utrecht, Sept 2006, “Serum Markers in Breast Cancer”. Prof. Oliver FitzGerald Member of HSE working group on Arthritis and Allied conditions representing the Irish Society for Rheumatology Board member Arthritis Ireland Steering committee member of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) Organizing Connor committee member for combined Irish and British Societies for Rheumatology meeting entitled “Advancing Rheumatology”, UCD September Member of Abbott International Immunology Advisory Board Invited lecturer: Dept Of Rheumatology, University Of Liverpool, January International Therapy Update, Monte Carlo, February Psoriatic Arthritis, Sydney, April North Shore Jewish Hospital, New York, September Prof. T. J. McKenna Professor T J McKenna completed his three year term as President of the Royal College of Physicians of Ireland in October 2006. He has been appointed Chairman of the Irish Committee for Higher Medical Education. Professor McKenna is a member of the Editorial Boards for the journals Clinical Endocrinology (Oxford) and The Endocrinologist (United States). He is a member of the Student Affairs Committee of the Endocrine Society (United States). Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 48 Prestigious Invitations/Honours for E.R.C. Professor Walter McNicholas Professor McNicholas was elected Chair of a EU COST Action (B26) on obstructive sleep apnoea and is the founding President of the newly formed Irish Sleep Society. Prof. McNicholas gave invited lectures at the Annual meeting of the European Respiratory Society in Munich (September), the European Society of Hypertension in Madrid (June), the British Sleep Society in Cambridge (September) in addition to International Meetings in Copenhagen (November) Prof. Cliona O’Farrelly Cliona was appointed Chairperson of Cancer Research Ireland 2006-2009 Organiser of Hepatitis C International Conference, Dublin Castle June 2006 ‘In silico discovery of TLR15; in vivo significance’ International Immunogenomics Conference, Budapest 2006 “Infectious Disease Pandemics: a Scientific Overview” at Irish Council for Bioethics Conference “Ethical Dilemmas in a Pandemic” RDS, Dublin 2006 “Hepatitis C Prospectus Future and Promises” BASL pre-meeting, T.C.D. 2006 “Good Bugs Bad Bugs: What do they look like? Can your body tell the difference?” Irish Society for Immunology Schools Presentation RDS Dublin 2006 Dr. Donal O’Shea Dr Donal O’Shea is Secretary of the Irish Endocrine Society. He is a member of the National Taskforce on Obesity and Chairman of the Detection and Treatment Subgroup. Dr O’Shea is Chairman of the Nutrition Council of the Irish Heart Foundation and Chairman of the St Vincent’s Healthcare Group, Drugs and Therapeutics Committee. Dr O’Shea is a member of the Council of the Royal College of Physicians of Ireland. Dr Doug Veale Medical Director, Education & Research Centre, SVUH Chairman, SVGH Ethics & Medical Research Committee Member of Medical Executive, SVUH Postgraduate Programme Committee, UCD Chairman, Arthritis Action Ireland HRB ‘Cellular & Molecular’ Review Panel Irish Medicines Board - Medicines Committee Member of Seed Funding Committee, UCD Co-Editor, E-Medicine Web-based learning tool Advisory Boards – Wyeth Pharmaceuticals, Schering-Plough/Centocor, Novartis, Actelion, 2006 University of Newcastle. Royal Mineral Hospital, Bath Wyeth MMMD San Francisco Feb 2006 Lecture Tour of Australia July 2006 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 49 RESEARCH CENTRE Prizes, Awards 2006 Dr. Jean Fletcher awarded a HRB Post Doctoral Fellowship for research into M.S. Brid Ryan was awarded a Health Research Board/National Cancer Institute (USA) Fellowship in Preventative Oncology. This Fellowship will allow Brid to work at the world famous National Cancer Institute in the US. Dr Tom Cawood, Research Fellow, working under the direction of Dr Donal O’Shea was awarded the O’Donovan Medal, 2006, by the Irish Endocrine Society for the presentation entitled ‘Smoking and Thyroid Eye Disease; a Novel Explanation of the Biological Link’. Dr Tom Cawood was awarded the Novartis Endocrinology Research Medal, 2006, for the presentation ‘Cytokines and cigarette smoke; potential therapeutic targets in thyroid eye disease’. Dr. Elizabeth Ryan awarded Young Immunologist Travel Award at the 16th European Congress of Immunology September 6-9, 2006 - Paris, France. Dr. Ronan Mullan awarded IJMS Award- Best Rheumatology Published Paper in 2006 “A novel role for Serum Amyloid-A (A-SAA) in Angiogenesis and Adhesion Molecule expression through an NFÎB-dependent signal transduction pathway”. Dr. Ellen Moran won Best Oral presentation at combined Irish/British Society of Rheumatology, Sept. 2006 “Oncostatin M and IL-17 regulate matrix turnover and cartilage degradation in RA synoviocytes and human cartilage explants”. Dr. Lisa Costelloe, winner of Best Poster presentation INA meeting 2006 “Correlation of serum IL-17 and IFNÁ in Multiple Sclerosis (MS) patients”. Sheeona Gorman won Irish Cancer Society: Oncology Scholars Travel Award 2006. Alan Coss won Irish Cancer Society: Oncology Scholars Travel Award 2006. Alan Coss won 2nd prize, Oral Presentation Section, Irish Society of Gastroenterology Spring Meeting, April 2006 Garret Cullen won 2nd Prize Oral Presentation Irish Society of Gastroenterology, Winter Meeting 2006. Ms. Aoife O’Donovan was awarded an International Rotary Ambassador Scholarship and a Fulbright Studentship to study at the University of California, San Francisco during 2007/2008. Dr Gavin Rush was awarded a National Lundbeck Research Bursary in December 2006. Degrees Awarded Rowan Higgs PhD Anna Kelly MD Caitriona Canning MCh Jane Culleton PhD Kieran Meade PhD Shane Sullivan MSc Return to contents Annual Review 2006 EDUCATION & 50 RESEARCH CENTRE Publications Published or Accepted for Publication in International Peer Reviewed Journals 2006 Banville N, Geraghty R, Fox E, Leahy D, Green A, Deegan D, Geoghegan J, O’Donoghue D, Hyland J and Sheahan K. Medullary carcinoma of the pancreas in a man with hereditary nonpolyposis colorectal cancer due to a mutation of the MSH2 mismatch repair gene. Human Pathology 2006, Nov 37(11); 1498-502. Brennan DJ, Jirstrom K, Kronblad A, Milikin RC, Landberg G, Duffy MJ, Ryden L, Gallagher W, O’Brien SL. CA IX is an independent prognostic marker in premenopausal breast cancer patients with one to three positive lymph nodes and a putative marker of radiation resistance. Clin Cancer Res. 2006;12:6421-31. Buggy Y, Maguire TM, McDermott, E, Hill ADK. O’Higgins N, Duffy MJ. Ets2 transcriptional factor in normal and neoplastic human breast tissue. Eur J Cancer 2006 Mar;42(4):485-491. PMID 16380248 Canning C, O'Brien M, Hegarty J, O'Farrelly C. Liver immunity and tumour surveillance. Immunol Lett. 2006 107:83-88. G. Canny, D. Drudy, P. Macmathuna, C. O’Farrelly, AW Baird Toxigenic C.difficile induced inflammatory marker expression by human intestinal epithelial cells is asymmetrical. Life Sci 2006 Jan25;78(9):920-5 PMID 16185718 Cawood TJ, Moriarty P, O’Farrelly C & O’Shea D. The effects of TNF· and IL1 on an in vitro model of thyroid associated ophthalmopathy; contrasting effects on adipogenesis. Eur J Endocrinol 2006 Sep; 155(3):395-403 PMID 16914593 T.J. Cawood, P. Moriarty, C. O’Farrelly, D. O’Shea. Smoking and thyroid associated ophthalmopathy; a novel explanation of the biological link. J. Clin Endocrinol Metab 2006 Oct PMID17047020 Cawood TJ, McKenna MJ, Gallagher CG, Smith D, Chung WY, Gibney J, O’Shea D. Cystic Fibrosis-Related Diabetes in Adults. Irish Medical Journal 2006 March;99(3):83-6. PMID 16700261 Duffy MJ. Serum tumor markers in breast cancer: are they of clinical value? Duffy MJ. Clin Chem 2006 Mar;52(3):345-351. PMID 16410341 Dunne C, McGuigan C, Crowley J, Hagan R, Rooney G, Kelleher J, Hutchinson M, Lawlor E. HLA class II polymorphisms in Irish patients with multiple sclerosis. Tissue Antigens. 2006;68:257-62. Fearon U, Mullan RH, Sullivan S, Markham T, Connolly M, Poole AR, Fitzgerald O, Bresnihan B, Veale DJ. Oncostatin M induces angiogenesis and cartilage degradation in RA synovial tissue and human cartilage cocultures. Arthritis Rheum. 2006 Oct;54(10):3152-62 PMID 17009243 FitzGerald O, McInnes I. Spondyloarthropathy: disease at the crossroads of immunity. Best Pract Res Clin Rheumatol 2006 Oct;20(5):949-67 PMID 16980217 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 51 Publications Fox E, Leahy DT, Geraghty R, Mulcahy HE, Fennelly D, Hyland JM, O’Donoghue DP and Sheahan K. Mutually Exclusive Promoter Hypermethylation patterns of hMLH1 and 06-methylguanine DNA methyltransferase in Colorectal Cancer. Journal Mol Diagn 2006 Feb;8(1):68-75 PMID 16436636 {IF 3.6} Gardner L, Wilson C, Patterson AM, Bresnihan B, Fitzgerald O, Stone MA, Ashton BA, Middleton J. Temporal expression pattern of Duffy antigen in rheumatoid arthritis: Up-regulation in early disease. Arthritis Rheum. 2006 Jun;54(6):2022-6. PMID: 16732566 Garvey J, McNicholas WT. Effect of obesity in patients with coronary artery disease. Lancet. 2006 Nov 11;368(9548):1645. R. Higgs, P. Cormican, S. Cahalane, B. Allan, A.T. Lloyd, K. Meade, J. Tharappel, D. Lynn, L.A. Babiuk, C. O’Farrelly Induction of a Novel Chicken TLR Following Salmonella enterica Serovar Typhimurium Infection Infection & Immunity 2006 Mar;73(3):1692-8 PMID 16495540 {I.F. 4.033} Jasper J. Haringman, Danielle M. Gerlag, Tom J. M. Smeets, Dominique Baeten, Filip van den Bosch, Barry Bresnihan, Ferdinand C. Breedveld, Huib J. Dinant, Francois Legay, Hermann Gram, Pius Loetscher, Robert Schmouder, Thasia Woodworth, Paul P. Tak. A randomized controlled trial with an anti-CCL2 (anti-monocyte chemotactic protein 1) monoclonal antibody in patients with rheumatoid arthritis. Arthritis Rheum 2006. 54;8, 2387-92. PMID 16869001 Kavanagh D, Neary P, Dodd J, Sheahan K, O’Donoghue D and Hyland J. Management of enterovaginal fistulae in a colorectal unit. Tech Coloproctology, 2006. March: 10 (1): 63-4 Kavanagh L, McKenna TJ, Fahie-Wilson MN, Gibney J, Smith TP. Specificity and clinical utility of methods for the detection of macroprolactin. Clin Chem 2006 May 4 52:7 PMID 16675508 Kavanagh L, McKenna TJ, Fahie-Wilson MN, Gibney J and Smith TP. Specificity and Clinical Utility of Methods for the Detection of Macroprolactin. Clinical Chemistry 2006, 52:1366-1372. AM Kelly, L. Golden-Mason, O. Traynor , J. Geoghegan, G. McEntee, J. Hegarty, C. O’Farrelly Changes in hepatic immunoregulatory cytokines in patients with metastatic colorectal carcinoma: implications for hepatic anti-tumour immunity Cytokine 35(2006) 171-179 PMID 16971136 Kenna T, O’Brien M,Hogan AE, Exley M, Porcelli S, Hegarty J*, O’Farrelly C*, Doherty DG.CD1 expression and CD1-restricted T cell activity in normal and tumor-bearing liver. Cancer Immunol Immunother 2006 Aug PMID 16924493 Kevans D, Keegan D, Mulcahy HE, O’Donoghue DP. Infliximab therapy in Crohn’s disease – a pragmatic approach? Aliment Pharmacol Ther 2006 Jul15;24(2):351-9. PMID 16842462 {I. F. 4} Kruithof E, De Rycke L, Vandooren B, De Keyser F, Fitzgerald O, McInnes I, Tak PP, Bresnihan B, Veys EM, Baeten D. Identification of synovial biomarkers of response to experimental treatment in early-phase clinical trials in spondylarthritis. Arthritis Rheum. 2006 Jun;54(6):1795-804. PMID: 16729282 Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 52 Publications M Leonard, N Kieran, K Howell, M Burne, R Varadarajan, S Dhakshinamoorthy, A Porter, C O’Farrelly, H Rabb, C Taylor.Reoxygenation-specific activation of the antioxidant transcription factor Nrf2 mediates cytoprotective gene expression in ischemia-reperfusion injury. FASEB 2006 Oct PMID 17077292 L. Lynch, D.O’Donoghue, J. Dean, J. O’Sullivan, C. O’Farrelly, L. Golden-Mason Detection and characterisation of haematopoietic stem cells in the adult human small intestine J Immunol 2006 May 1; 176 (9): 5199-5204.PMID 16621984 {I.F. 6.7} Markham T, Mullan R, Golden-Mason L, Rogers S, Bresnihan B, Fitzgerald O, Fearon U, Veale DJ. Resolution of endothelial activation and down-regulation of Tie2 receptor in psoriatic skin after infliximab therapy. J Am Acad Dermatol. 2006 Jun;54(6):1003-12. Epub 2006 Mar 20. PMID: 16713454 (IF 3.9) Markham T, Mullan R, Rogers S, Bresnihan B, FitzGerald O, Fearon U, Veale DJ. Downregulation of the inhibitor of apoptosis protein survivin in keratinocytes and endothelial cells in psoriasis skin following Infliximab therapy. Br J Dermatol. 2006 Dec;155(6):1191-6 PMID 17107388 (IF 2.9) Marzo-Ortega H, McGonagle D, Rhodes LA, Tan AL, Conaghan PG, O’Connor P, Tanner SF, Fraser A, Veale D, Emery P. Efficacy of infliximab on MRI determined bone oedema in psoriatic arthritis. Ann Rheum Dis. 2006 Dec 21; PMID 17185324 (IF 6.9) Matthews C, Rogers S, FitzGerald O Development of new-onset prosiasis while on ahti-TNFalpha treatment. Ann Rheum Dis 2006 Nov;65(11):1529-30 PMID 17038454 Matthews C, FitzGerald O Seropositive erosive rheumatoid arthritis (RA) Rheumatology (Oxford) 2006 Sep;45(9):1100. PMID 16943373 McKenna MJ. Paget’s disease of bone. Osteowise 2006; 2(3): 9-14. McKenna MJ. Osteoporosis: A complex case study – management issues. Forum Focus; 2006; 6(10): 11-15. McGuigan C, Hutchinson M. Unrecognised symptoms of depression in a community-based population with multiple sclerosis. J Neurol 2006;253:219-223. McNicholas WT. Optimizing continuous positive airway pressure therapy for obstructive sleep apnea syndrome. Sleep 2006 Apr 1; 29(4):421-3. McNicholas WT, Ryan S. Obstructive sleep apnoea syndrome: translating science to clinical practice. Respirology. 2006 Mar;11(2):136-44. Meade KG, Gormley E, Park SD, Fitzsimons T, Rosa GJ, Costello E, Keane J, Coussens PM, MacHugh DE. Gene expression profiling of peripheral blood mononuclear cells (PBMC) from Mycobacterium bovis infected cattle after in vitro antigenic stimulation with purified protein derivative of tuberculin (PPD). Vet Immunol Immunopathol. 2006 Sep 15;113(1-2):73-89. PubMedID: 16784781 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 53 Publications Mullan R, Bresnihan B, Golden-Mason L, Markham T, O’Hara R, FitzGerald O, Veale DJ, Fearon U. Acute-Phase Serum Amyloid A stimulation of angiogenesis, leukocyte recruitment and matrix degradation in rheumatoid arthritis through a NF-kappaB-dependent signal transduction pathway. Arthritis Rheum 2006 Jan;54(1):105-14 PMID 16385502{I.F. 7.2} Nolan GM, Ryan S, O’Connor TM, McNicholas WT Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. Eur Respir J 2006;28:159-164 PMID 16571610 O'Gorman GM, Park SD, Hill EW, Meade KG, Mitchell LC, Agaba M, Gibson JP, Hanotte O, Naessens J, Kemp SJ, MacHugh DE. Cytokine mRNA profiling of peripheral blood mononuclear cells from trypanotolerant and trypanosusceptible cattle infected with Trypanosoma congolense. Physiol Genomics. 2006 Dec 13;28(1):53 61.PubMedID: 16985010 O’Rourke K, Walsh C, Antonelli G, Hutchinson M. Predicting beta-interferon failure in relapsing-remitting multiple sclerosis. Multiple Sclerosis 2006; 12: 1-7. O’Sullivan J, Risques R, Mandelson M, Bronner M, Brentnall T, Chen L, Pearlman M, Feng Z, Siebert J, Potter J, Rabinovitch P. Telomere lengths in the Colon decline with age: a relation to Colorectal Cancer?. Cancer Epidemiology, Biomarkers & Prevention 2006. Mar;15(3):573-7. Polman CH, O’Connor PW, Havrdova E, Hutchinson M.,Kappos L, Miller DH, Phillips JT, Lublin FD, Giovannoni G, Wajgt A, Toal M, Lynn F, Panzara MA, Sandrock AW, for the AFFIRM Investigators. A randomized, placebocontrolled trial of Natalizumab for Relapsing Multiple Sclerosis. N Eng J Med 2006; 354:899-910. Rathore O, Coss A, Patchett SE, Mulcahy HE. Direct vision stenting: the way forward for malignant oesophageal obstruction. Endoscopy 2006 Apr;38(4):382-4 B. Ryan, G.E. Konecny, S. Kahlert, H-J, Wang, M. Untch, G. Meng, M.D. Pegram, K.C. Podratz, J. Crown, D.J. Slamon, M.J. Duffy Survivin expression in breast cancer predicts clinical outcome and is associated with HER2, VEGF, urokinase plasminogen activator and PAI-1 Annals of Oncology 2006 Apr;17(4):597-604 PMID 16403812 {I.F. 4.335} Ryan S, Taylor CT, McNicholas WT Predictors of Elevated Nuclear Factor-ÎB-dependent Genes in Obstructive Sleep Apnoea Syndrome Am J Respir Crit Care Med 2006 Oct 1;174(7):824-30 PMID 16840748 Savinov AY, Remacle AG, Golubkov VS, Krajewska M, Kennedy S, Duffy MJ, Rozanov DV, Krajewska S, Strongin AY. Matrix metalloproteinase 26 proteolysis of the NH2-terminal domain of the estrogen receptor beta correlates with survival of breast cancer patients. Cancer Res 2006;Mar 1;66(5):2716-2724. PMID 16510592 Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 54 Publications Schunemann HJ, Jaeschke R, Cook DJ, Bria WF, El-Solh AA, Ernst A, Fahy BF, Gould MK, Horan KL, Krishnan JA, Manthous CA, Maurer JR, McNicholas WT, Oxman AD, Rubenfeld G, Turino GM, Guyatt G; ATS Documents Development and Implementation Committee. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med. 2006 Sep 1;174(5):605-14. Smith MD, Baeten D, Ulfgren AK, McInnes IB, Fitzgerald O, Bresnihan B, Tak PP, Veale D; OMERACT synovial special interests group. Standardisation of synovial tissue infiltrate analysis: how far have we come? How much further do we need to go? Ann Rheum Dis. 2006 Jan;65(1):93-100. Epub 2005 Jun 23. Review. PMID: 15975970 Smith D, Crotty TB, Murphy JF, Crofton ME, Franks S, McKenna TJ. A steroid cell tumour outside the ovary is a rare cause of virilization. Fertil Steril 2006 Jan; 85(1):227 PMID 16412760 Y. Volkov, A. Long, L. Golden-Mason, S. Abrignani, C. O’Farrelly, A. Murphy, D. Kelleher The Hepatitis C Envelope 2 protein inhibits LFA-1-transduced Protein Kinase C signaling for T-lymphocyte migration Gastroenterology 2006 Feb;130(2):482-92 PMID 16472601 Williams J, O’Rourke K, Hutchinson M, Tubridy N. The Face-Symbol Test and the Symbol-Digit Test are not reliable surrogates for the Paced Auditory Serial Addition Test in multiple sclerosis. Multiple Sclerosis 2006;12:599-604. Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & 55 RESEARCH CENTRE Chapters in Books C. O'Farrelly & D. G. Doherty Innate Immune Mechanisms in the Liver In ‘Liver Immunology 2nd Edition’ 2006 (in press) (Eds Manns, Vierling & Gershwin) McNicholas WT. Sleep apnea in adults. IN: Encyclopedia of Respiratory Medicine. Editors: Geoffrey Laurent and Steven Shapiro. Elsevier 2006. McNicholas WT. Sleep in Chronic obstructive pulmonary disease. IN: Management of Chronic obstructive pulmonary disease. Editor: N. Siafakas. European Respiratory Monographs 2006; No. 38. O’ Sullivan J & Brentnall T. Molecular Markers- a realistic hope? Challenges in Inflammatory Bowel Diseases. Feb 27, 2006, 22-27 Veal DJ, Fearon U. Inhibition of angiogenic pathways in rheumatoid arthritis: potential for therapeutic targeting. Best Pract Res Clin Rheumatol. 2006 Oct;20(5):941-7. Return to contents Annual Review 2006 EDUCATION & 56 RESEARCH CENTRE Grants Active in 2006 P.I. Name of Study Source of Grant Fund Amount Start Date Finish Date Prof. Walter McNicholas Cell and molecular mechanisms of cardiovascular disease in obstructive sleep apnoea Project Grant HRB €220,000 2005 2008 Prof. Walter McNicholas (with Dr. C. Heneghan UCD) Non-invasive low cost measurements of sleep, sleep disruption and sleepiness. Enterprise Ireland €300,000 2005 2008 Prof. Joe Duffy Role of ADAM17(TACE) in breast cancer Health Research Board €107,600 2003 2006 Prof. Joe Duffy Mamaglobin as a marker for breast cancer Irish Cancer Society €164,000 2003 2006 Prof. Joe Duffy/ Jane Culleton Studies on lipophilin B in breast cancer Irish Research Council for Science, Engineering and Technology (IRSET) €65,000 2002 2006 Prof. Joe Duffy (in collab. With 8 other European Institutions) Epigenetic profiling of breash cancer: prognostic and therapeutic application EU Sixth Framework Programme €2,533,758 total €186,720 2004 2006 Prof. Joe Duffy (with W. Gallagher, F. Martin & P. Dervan) Breast Cancer Metastasis: Biomarkers and Functional Mediators Health Research Board Programme Grant 2005 €1,063,000 2005 2010 Prof Cliona O’Farrelly /Dr. Kieran Meade Identification of genes responsible for naturalhost resistance to Campylobacter colonisationtools to identify and breed genetically resistant chickens Dept. Agriculture FIRM Grant 2006 €935,039 2006 2009 Prof. Cliona O'Farrelly /Dr. Kieran Meade Structural and functional identification of candidate immune genes for resistance to mastitis and metritis Research Stimulus Fund 2006 Dept. Agriculture €770,735 2006 2009 Prof. Cliona O’Farrelly/ Dr. Clair Gardiner TCD Investigation of KIR genotype in the resolution of HCV infection HRB Equipment Grant €17,000 2006 Prof. Cliona O’Farrelly Evolution based approaches to directed alteration of AMPs for improved efficacy against Propionibacterium acnes and MRSA Enterprise Ireland Proof of Concept phase Winter Call 2005 €90,086 2005 to SVUH/UCD 2006 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE Grants Active in 2006 P.I. Name of Study Source of Grant Fund Amount Start Date Dr. Elizabeth Ryan Cytokine signatures to predict the response of Hepatitis C patients to IFN-alpha/ribavirin therapy Enterprise & Commercialisation Seed Funding Scheme UCD €10,000 2006 Prof. Cliona O’Farrelly/ Prof. Dermot Kelleher/ Prof. Kingston Mills/ Dr. Derek Doherty Characterisation Hepatitis C Induced Immunological Subversion and itsImplications for Treatment Response HRB Programme Grant €552,000 2003 2006 Prof. Cliona O’Farrelly/ Prof. Colm O’Herlihy/ Dr. Lucy Golden-Mason Cytokine Milieu, Natural Killer Receptor Positive Cells, Haematopoietic Progenitors in Human Endometrium Enterprise Ireland Basic Research Grant Programme €149,293 2003 2006 Prof. Cliona O’Farrelly Functional immunogenomics in the chicken: relevance to campylobacter jejuni infection. Dept. Agriculture FIRM Grant 2004 €691,286 2004 2007 Prof. Cliona O’Farrelly SFI Research Frontiers Programme 2005 Role of CD1d isoforms €229,766 and reactive cells in regulating immune responses to malignancy 2005 2008 Prof. Cliona O’Farrelly/ Dr. Clair Gardiner HRB Research Project Grant – General 2005 Investigation of KIR genotype in the resolution of HCV infection €234,473.6 2005 2008 Dr. Jacintha O’Sullivan Genomic instability and severe depression UCD Seed Funding €9,000 2006 2007 Dr. Jacintha O’Sullivan Establishment of a colorectal ex vivo biopsy culture model to examine responses to neo-adjuvant radiation therapy in advanced rectal cancers. UCD Seed Funding €15,000 2006 2007 Dr. Kieran Sheahan/ Dr. Dermot Leahy Molecular characterisation of familial colorectal cancers HRB €174,400 2006 2009 G Dr. Edward Fox The frequency of random mutations and genomic instability in colorectal cancer progression NCI/HRB €88,000 2006 2008 HRB Project Grant €165,000 2006 2009 Health Research Board €185,000 2004 2007 Centre for Colorectal Disease Dr. Jacintha O’Sullivan/ Prof. Diarmuid O’Donoghue/Dr. Kieran Sheahan 57 The role of genomic instability in promoting colorectal cancer development in Ulcerative Colitis patients Finish Date Return to contents Annual Review 2006 EDUCATION & RESEARCH CENTRE 58 Grants Active in 2006 P.I. Name of Study Source of Grant Fund Amount Start Date Finish Date Dr. Jacintha O’Sullivan The role of telomeres and telomerase in colorectal cancer growth, progression and metastasis. Cancer Research Ireland €135,000 2004 2007 Dr. Garret Cullen Cigarette smoking and genomic instability: factors controlling disease progression and treatment sensitivity in inflammatory bowel disease patients. Altana – Newman Fellowship €80,000 2006 2008 Dr. Hugh Mulcahy Protease profiling in early Colorectal Cancer and its association with chromosomal abnormalities, anatomical stage and clinical progression. Cancer Research Ireland €135,000 2003 2006 Dr. Joseph Marry The effect of genomic instability on monoclonal antibody therapy response in colorectal ex vivo explants. Merck – Newman Fellowship €138,000 2006 2008 Dr. U. Fearon/ Dr. D. Veale/ Prof B. Bresnihan A-SAA regulates cytoskeletal rearrangement and cell matrix interactions to promote cell migration and cartilage invasion in inflammatory arthritis HRB Project Grant 2005 €140,000 2005 2008 Dr. D. Veale/Dr. P. Cahill/Dr. U. Fearon The role of angiopoietins in driving angiogenesis in inflammation Health Research Board €160,000 2004 2007 Dr. U. Fearon/Dr. D. Veale Studies of novel cytokines Using synovial/cartilage metablism Glaxo Smith Kline plc €250,000 2003 2006 Dr. D. Veale/Dr. U. Fearon/Dr. J. O’Sullivan/ Dr. C. Taylor Hypoxia and altered mitochondrial bioenergetics results in cellular transcriptional and metabolic profiles to drive angiogenesis and the inflammatory response HRB Translational Programme Award €1,500,000 2006 2011 Dr. D. Veale/ Dr. U. Fearon/Dr. R. Mullan The clinical application for Acute phase protein serum amyloid A in RA Health Research Board €109,000 2004 2006 Dr. U. Fearon/ Dr. D. Veale The mechanistic role of cytokines in regulating angiogenesis and cartilage metabolism SFI €162,000 2004 2007 Dr. D. Veale/Dr. U. Fearon/Dr. J. Sullivan Hypoxia chambers and probes HRB Equipment Grant €100,000 2006 Prof. O. FitzGerald Differential expression of VEGF and PIGF and VEGF receptors in inflammatory arthritis HRB Project Grant €165,000 2004 2007 Prof. O. FitzGerald Etanercept in psoriasis and psoriatic arthritis: a single center open label pilot study Wyeth €120,000 2004 2006 Return to contents St. Vincent’s Healthcare Group Limited EDUCATION & RESEARCH CENTRE 59 Grants Active in 2006 P.I. Name of Study Source of Grant Fund Amount Start Date Finish Date Dr. D. Veale/ Prof. O. FitzGerald/ Dr. U. Fearon/ Prof. B. Bresnihan Biomarkers and Novel cytokines Wyeth €350,000 2006 2007 Prof. B. Bresnihan Withdrawal of anti-TNF therapy Health Research Board €175,428 2004 2006 Dr. D. Veale/ Dr. U. Fearon Studies of novel cytokines using synoviaL /cartilage explant cultures GSK €750,000 2006 2008 Dr. D. Veale/ Dr. U. Fearon Proof of Concept Studies GSK €680,000 2006 2008 Prof. B. Bresnihan/ Dr. D. Veale/ Prof. O FitzGerald Autocure EU Consortium EUFP6 €800,000 2006 2011 Prof. B. Bresnihan/ Dr. D. Veale/ Prof. O. FitzGerald Clinical Newman Scholarship Post Doctoral Clinical Fellow Abbott €100,000 2006 2007 Dr. D. Veale Novel therapeutic antibody study Cambridge Antibody Technology €100,000 2006 2007 Prof. O. FitzGerald Prof. Kevin Malone Kineret in Psoriatic Arthritis: A pilot study in 12 patients Amgen €110,000 2006 Dept. Psychiatry & Mental Health Research Psychological Stress, Optimism and Immune System Craig Dobbin Newman Scholarship €85,000 2004 2006 Prof. Kevin Malone Dept. Psychiatry & Mental Health Research Brain Imaging Studies in Suicidal Depression AFSP Distinguished Investigator €100,000 2004 2006 Prof. Kevin Malone Dept. Psychiatry & Mental Health Research Brain Imaging Studies in Suicidal Depression National Neuroscience Network €160,000 2004 2006 Dr. Donal O’Shea/ Prof. Cliona O’Farrelly/ Dr. Tom Cawood Clinical Research Training Fellowship Health Research Board €192,000 2005 2007 Dr. Donal O’Shea Adipocyte size and type 2 diabetes; a study of patients undergoing bariatric surgery. Diabetes Federation of Ireland & Medical Research Charities €180,000 2006 2009 Return to contents St Michael’s Hospital St. Vincent’s Healthcare Group Limited 61 ST MICHAEL’S HOSPITAL St Michael’s Hospital St. Michael’s Hospital since it’s incorporation into the St. Vincent’s Healthcare Group, in 2002, has seen significant progress in relation to the development and integration of service facilities within the Healthcare Group. This progress continued in 2006, whilst on a National basis the Health Service Executive launched it’s transformation programme for delivery of services. In 2006, St. Michael’s Hospital prepared and submitted a Service Plan, in conjunction with St. Vincent’s University Hospital, to the Health Service Executive. This Plan detailed the Hospital’s expenditure, projected activity and service requirements for 2006. During a series of meetings with the HSE the hospital’s performance was monitored and the need for Capital Funding was emphasised. The Link Corridor between the two hospital buildings was completed in April 2006. Work on the Electrical Protective Services was also completed. Capital Funding was allocated to commence works on up-grading the water mains system and Phase II of the fire safety works. The on-going programme of up-grading the Hospital’s infrastructure following the Hygiene Audit continued throughout 2006. Developments continued within the Radiology Department in 2006, with the staff perfecting their skills with the Axiom Sireskop XD Imaging System. At Easter the installation of the Axiom Aristos FX Plus was completed. This system is multi functional and an enormous benefit to staff. The computerised digital system has an enhanced workflow, enabling a more efficient service within the Department for patients. A new DXA Unit was installed and is a welcome new facility for the Department. In the Pharmacy Department a system of continuous temperature monitoring of Drug Fridges with remote alarm system was installed in 2006. New procedures and labelling were introduced to increase safety in the administration of medication. A new policy for the administration of I.V. Medication was introduced, and the policy is being further developed for the administration of medication via other routes. A new drug kardex is under development and will be piloted and introduced in 2007. Laboratory activity continued to increase. The Warfin Clinic was re-structured into a postal system, where patients receive their prescriptions by post. A computerised dose monitoring system was introduced, providing permanent records of all patients’ dosed at the clinic and providing a mechanism for clinical auditing. The computer server was replaced and up-graded allowing the Laboratory to run in a more efficient manner. This new server facilitated the rollout of laboratory results in the wards and clinics. Reese Temperature monitoring was also installed in the laboratory during 2006. A number of Management Meetings were held with our colleagues in the Pathology Department in St. Vincent’s University Hospital, to plan the strategy for the development of Pathology Services within the group. Return to contents Annual Review 2006 62 ST MICHAEL’S HOSPITAL 2006 was a very stable year for Human Resources in St. Michael’s Hospital. We experienced low staff turnover and low absenteeism across all categories of employees. Responses to advertised vacancies were generally of a high quality resulting in a low number of unfilled vacancies at any time during the year. The focus of our investment in Training and Development this year was in Continuous Professional Development, Management Skills and Team Based Performance Management, with over 300 staff participating in various education and training programmes during the year. We implemented a new HR IT system in early 2006. Combined with existing systems and databases, this will facilitate improved record keeping, processing, reporting and monitoring across a range of HR activities and indicators. In addition, further progress was made with our HR colleagues at S.V.U.H. and S.V.P.H. on harmonising HR policies and practice and on quality improvement initiatives. Some of our longer serving staff retired in 2006, including Yvonne Kearney (Medical Laboratory Reception) who retired after 42 years service to St. Michaels, Veronica Condon (Medical Scientist), Flo Clarke (Night Sister), Mary Leahy (Theatre Sister) and Stephanie Hopkins (Ward Secretary). We would like to take this opportunity to acknowledge their service and dedication to St. Michael’s Hospital and our patients, and to wish them a long, happy and healthy retirement. As part of the Hospital’s Accreditation process and in an effort to encourage the support of all staff in maintaining our patient centred approach to the development of services within the hospital the Quality department developed and implemented a Customer Care programme for all staff. These courses, which were delivered to multidisciplinary groups proved to be immensely popular and in the period August to November 180 staff attended, they will be run again in 2007, and have also been incorporated into the hospital induction programme for all new staff. The Accreditation process also encouraged us to update our policies and procedures in Medical Records Management. Having these policies and procedures in place to govern and manage the creation, maintenance, retention, retrieval and destruction of Medical Records is an important component of an efficient quality system and is of considerable assistance in terms of ensuring compliance with requirements of the various acts such as the F.O.I. Act. Our Library facilities have been extended and up-graded to include a patient library. As a result of the National BuyA-Book-for-your-hospital-Campaign a mobile library for the benefit of patients has been introduced, and is operated throughout the hospital by volunteers. In 2006 the Nursing staff in St. Michael’s Hospital continued to provide high quality patient focused care in a caring environment. One of the New Developments in 2006 was the establishment of the educational side of Phase IV of the cardiac rehabilitation programme. This includes Cardiology Risk Factor assessment and review in relation to diet, exercise, stress management and relaxation. This programme will be further extended in 2007. The Diabetes Centre was the first in the Dublin Area to introduce a patient education programme for the commencement of Inhaled Insulin (Exubera). The Infection Control Department led the Hygiene and Decontamination audits in conjunction with various departments throughout the hospital. This resulted in an overall improvement in our rating in the hygiene audit. Return to contents Return to contents Annual Review 2006 64 ST MICHAEL’S HOSPITAL The Nursing Practice Development Unit continued its committed approach to the development of our nursing services in St. Michael’s Hospital by empowering staff in the development and review of new and existing nursing services. They continue to guide, and support nursing students through their clinical training programme by creating and maintaining an optimum clinical learning environment and collaborating with the clinical nursing staff to ensure high quality patient care. Professional development of staff remained of paramount importance and staff were facilitated in maintaining life long learning. 2006 saw the first group of 30 BSc nursing students qualify and graduate in St. Michael’s. A Pre-Nursing adaptation and clinical placement programme continued for overseas nurses in conjunction with the HSE and An Bord Altranais. 2006 was a busy year for the IT Department during which a number of projects were completed. A new high-speed fibre link was installed to connect the hospital to St. Vincent’s University Hospital. This link will facilitate the implementation of the hospital-wide PACs system. 2006 also saw the migration of all PC’s onto Microsoft Active Directory and standardisation to W2K/XP. This system enables effective administration of user accounts and security. Further work was also carried out securing and consolidating the hospital LAN through the upgrading of switches and cabling. Overall 2006 saw the consolidation and enhancement of the IT infrastructure in the hospital. On behalf of the Shareholders, Board Of Directors and the Group Chief Executive Officer, I would like to extend my sincere thanks to all staff in St. Michael’s Hospital. Their continued commitment to and focus on maintaining and expanding services, their dedication and professionalism in their work to meet the needs of both management and patients is acknowledged and highly appreciated. I also acknowledge and thank the members of the Executive Council, the Medical Forum, and the other committees of St. Michael’s Hospital and their members for their assistance and support during 2006. I would like to express my thanks to the Religious Sisters’ Of Charity and the Group Chief Executive Officer for their support during the year. Finally, I extend my personal thanks to every staff member in St. Michael’s Hospital, for their commitment to the Hospital and their delivery of care to the patients and their relatives. Seamus Murtagh, Hospital Manager St. Michael’s Hospital Return to contents St. Vincent’s Healthcare Group Limited 65 ST MICHAEL’S HOSPITAL Organisation Structure Return to contents St. Vincent’s Private Hospital Return to contents St. Vincent’s Healthcare Group Limited 67 ST VINCENT’S PRIVATE HOSPITAL St. Vincent's Private Hospital Overview St. Vincent’s Private Hospital continued to build on the progress made in previous years and recorded an overall surplus of €2.6m in 2006 compared to €1.4m in 2005. The expansion in Radiotherapy activity and the reorganisation of daycare activity, including Endoscopy, Day Surgery, and Urodynamics contributed to the overall financial performance during the year. Our thanks are due to the team leaders, consultants and staff who contributed to the various improvements made during the year which are outlined in this report. The hospital currently has 164 inpatient beds, 36 day care spaces (including daycare oncology), operating theatres for major and minor surgery, endoscopy, diagnostic imaging which includes general radiography, CT, ultrasound and MRI and comprehensive oncology and radiotherapy services. Service Developments and General Improvements A number of developments were completed in 2006 as follows: • Division of the 2nd Floor into two ward units. • The second Linear Accelerator was installed and commenced clinical use in February 2006. • A new MRI Unit, GE Signa HDx, was installed in the Diagnostic Imaging Department in September 2006. • A Daycare Utilisation Programme was implemented, resulting in the more efficient use of daycare beds with increased reimbursement rates. • An Internal Disaster Plan was completed in November 2006. • Security Technology installed a new Closed-Circuit Television (CCTV) System, satellite units were installed on three computers with the main monitor at reception. A more detailed list of improvements is set out in the reports of the Divisional Managers. Patient Activity Inpatient occupancy decreased slightly in 2006 to 85% from 86% in 2005 which reflected a drop in the average length of stay from 5.38 days to 5.32 and a drop of 0.5% in the number of admissions during the year. This also reflects a general trend from inpatient to daycare admissions. The daycare admissions increased by 7%, from 5,233 to 5,592 patients in 2006 and this also reflected an increase in Minor Theatre Procedures of 23% and in Endoscopy Procedures of 9%. The Main Theatres activity dropped slightly by 3% during the year and daycare oncology remained at a similar level to 2005. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 68 Overview Radiotherapy procedures increased by 29% following the installation of the 2nd Linear Accelerator in February 2006. While the number of CT Scans increased by 4%, there was a drop of 12% in the number of MRI Scans, reflecting the provision of two MRI Scanner facilities in St. Vincent’s University Hospital. Ultrasound and Mammography increased by 13% and other diagnostic imaging tests dropped by 7% during the year. Activity levels in the Cardiology and Respiratory Medicine were reduced in 2006 as a result of staffing difficulties arising during the year. A summary of the inpatient and outpatient activity is set out in the Corporate Services Division Report. Consultant’s Forum The Forum continued to provide valuable advice and support on a range of matters including clinical policies/ procedures, clinical service developments and operational issues. Mr. J. Hyland, Mr. E. Kelly, Dr. K. Murphy, Dr. A. McShane and Dr. J. Griffin retired from the forum in 2006. Many thanks are due to these Consultants for participating on the forum with a special thanks to Mr. Hyland, Mr. Kelly and Dr. McShane who have been members of the forum since its inception in November 2000. Professor W. McNicholas, Mr. S. Sheehan, Dr. K. Sheahan, Dr. N. McDonald, Dr. P. Quigley and Mr. D. Quinlan were elected to the forum and Mr. W. Quinlan was re-elected to the forum. Dr. Brian Maurer retired as Chairperson of the Forum and member of the Executive Committee. I would like to acknowledge Dr. Maurer’s significant contribution to the ongoing development of St. Vincent's Private Hospital and for the tremendous support he provided to Management at the hospital. A dinner was held to mark Dr. Maurer’s retirement from the forum, together with the retirement of other long standing Forum members.’ Among the issues discussed by the Forum during the year were the following: • Bed Management Issues • New Hospital Development • Daycare Utilisation • Leave Planning • TPN Guidelines • Claims Processing • Clinical Audit • Medical Records Thanks are also due to Ms. Yvonne Farnan who continues to provide secretarial support to the Forum. Management Team and Executive Committee The Management Team and Executive Committee continued to meet throughout the year to review and monitor progress in relation to the budget and service plans. Professor D. O’Donoghue, Dr. P. Quigley and Mr. D. Quinlan were nominated to sit on the Executive Committee. Professor W. McNicholas and Mr. E. McDermott were nominated to participate on the Best Practice Group. Regular meetings were held with the Team Leaders/ Heads of Departments during the year. At these meetings the Management Team provided updates on the hospital’s clinical and financial performance and on relevant internal and external factors affecting the hospital. The Management Team also provided an induction programme for new staff to familiarise them with the hospital and its policies and procedures. They also produced a number of Newsletters to keep all staff updated on developments during the year. Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 69 Overview New Hospital Development Considerable progress has been made in relation to the design of the New Private Hospital and discussions took place with the local residents prior to the submission of the planning application. It is envisaged that the new hospital will provide accommodation for 230 in-patient beds, General and Oncology Day Care, 4 major operating theatres, a 6 bed high dependency unit, diagnostic imaging services and a wide range of medical and surgical facilities. The planning application together with a detailed environmental impact statement was submitted to Dublin City Council in September 2006 and a decision is awaited. High level Medical Planning / Client Sign Off Work took place with a number of user groups comprising staff and consultants meeting with the design team. Department operational policies have been drawn up to inform the design team in preparing the final drawings. Separate presentations were made to staff and consultants by Scott Tallon Walker and Michael Redmond. Acting Director of Nursing Our thanks are due to Ms. Barbara Murray, Ms. Mary Connolly and Ms. O. Fitzgibbon who acted as Directors of Nursing from 1st January to 15th October 2006. Ms. Therese Carey was appointed Director of Nursing and commenced duty on 16th October 2006. Ms. Carey previously worked as an Assistant Director of Nursing at St. Vincent’s University Hospital. ‘The Clinic’ The hospital was one of the locations for the TV Series ‘The Clinic’ during the summer and thanks are due to all those who facilitated and supported this project. The Main Theatre, Day Care and Radiotherapy were the main hospital focus of attention. The series was screened in the Autumn. Michael Redmond Chief Executive Return to contents Annual Review 2006 70 ST VINCENT’S PRIVATE HOSPITAL Finance Division Management Accounts Mary Kelly, Financial Accountant has brought about major improvements in the patient billing area. This has resulted in patient bills been raised immediately on patient’s departure. In addition, significant improvements have been made to the management accounts, to the fixed asset register and to other areas under Mary's guidance. Patient Billing James Clerkin’s unique knowledge of the VHI coding structure and procedure costing has contributed to our ongoing discussions with the medical insurers regarding reimbursement arrangements. Joan Swan and Fiona Creedon have played major roles in improving the speed at which invoices are produced. Sinead O’Mahony has worked very hard at improving the number of VHI forms signed by patients on admission. Claims Department The staff in the Claims Department are Orla O’Sullivan, Lynn Wiley, Lisa McMenamon, Joan Balfe, Carolyn McArdle, Mary Rose Sweeney, Georgina Masterson (resigned to take up a role in the Consultants Private Clinic in November 2006), Geraldine McTeigue, Ger Milofsky. I would like to welcome Sarah Wardlow, a new staff member to the Claims Department and Ms. Aisling Talbot who is the new Credit Controller. Orla and her team all play a huge role in ensuring all the consultant claims are matched with hospital invoices prior to transmission to VHI. Their commitment is constant, in what can be very demanding work. This team is crucial in assisting the hospital’s in meeting it’s cash flow commitments. Salaries Department Yvonne Casserly and Dorothy Nolan process the payroll for over 400 staff and they have worked constantly at improving processes. Their patience in dealing with all hospital departments should be recognized as they depend on these departments for payroll input. Genuine teamwork at play! Creditors and Stock Administration Department Marie Coyne, Ruth Cullen (joined the Department in 2006) Marie and Ruth have introduced major improvements in the areas of creditors, suppliers and stock records and requisition procedures. This work is very important in improving our overall efficiency. Stores Department The Stores Department which is staffed by Jerry Kennan, Eugene Murtagh, Conn Mooney organise the ordering, receiving and distribution of goods and services. The volumes of activity are very significant and all have been central to the process in improving the requisitioning of goods and services. Work continues in securing value for money and in benefiting from economies of scale through group synergies. Finally but not least many thanks to Yvonne Farnan for her help and support to myself over the past 12 months. All the above team have helped in driving the financial performance forward in 2006. James Crowe Finance Controller Return to contents St. Vincent’s Healthcare Group Limited 71 ST VINCENT’S PRIVATE HOSPITAL Nursing Division Overview The expertise of the highly skilled nurse providing hands-on care will always be a fundamental part of patient care, however ground breaking the latest development in practice. Nursing Division faced many challenges in 2006; the greatest being recruiting qualified nurses to fill vacancies. Thanks to the commitment and dedication of staff, every effort was expended to provide quality patient care and many quality improvement initiatives were instigated with vigour. The • • • • Nursing Division consists of the following: Patient Care areas (8) • Operating Theatres Endoscopy • Day Surgery Pastoral Care/Chaplaincy • Portering Service Nursing Education • Clinical Nurse Specialists • Day Care including Day Care Oncology • Urodynamics • Admissions Recruitment Much energy was expended on recruitment during the year. We were able to replace nurses resigning and maintain the status quo. Staff Recruited: Resignations In 2006 we said goodbye to a number of staff members Staff Nurses 31 Clinical Nurse Manager II 2 Care Assistants 4 Clinical Nurse Manager I 2 Theatre Attendant 1 Staff Nurses TSSD Operative 1 Porters 3 Clinical Nurse Manager II 3 Care Assistants 7 Clinical Nurse Manager I 3 Clerical Assistants 2 Night Superintendent 1 Theatre Attendants 2 Clerical Officer – Admissions 1 Chaplain 1 30 Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 72 Nursing Division Theatre Developments During 2006 the following developments took place within the theatre department: • • • • • • Operating Theatre Lights installed in both Rooms. Smoke Evacuators X 2 were installed in both theatres. A Neoprobe machine was installed. A 2nd Ligature Machine was installed. A new Breast implant service was implemented. A session was sanctioned for Dr. D. O'Keeffe to carry out Spinal Cord Stimulations. Care Assistant Course Last year all of our existing Care Assistants enrolled in the Fetac level 5 training course in the College for Further Education in Dun Laoghaire. The care assistants attend the college 1 day a week and we replaced a number of trainee care assistants from the college. Education and Training A number of committees met regularly throughout 2006 in order to advance staff education within the nursing division. These committees included: • Policy & Procedure Committee • Staff Development Committee. • Study Leave & Funding Committee As with other years many staff commenced higher education courses in 2006. • Derina Keogh - Masters In Health and Safety. • Patricia Beirne – Bachelor in Nursing Studies commenced. • Bernie Brookes – Management Course for Clinical Nurse Managers • Joann Cadogan – Higher Diploma in Health Promotion • Rita Leamy – MSc in Nursing Science • Elizabeth Looney – Diploma in Healthcare Management • Clare Love – Working for Health Course • Ramona Lupei – Bachelor of Science Access Degree • Breege Lynch – Bachelor of Nursing Studies • Therese Lyons – Higher Diploma in Nursing Cancer Studies • Joanne McCarthy – Higher Diploma in Colorectal Nursing • Anne Murphy – MSc in Education & Training • Timothy Oladipo – Sterile Services Management Degree • Mary Quinn – Masters in Clinical Practice • Louise Sharkey – Bachelor of Science Access Degree • Nelson Lebogo – BSc Nursing Management • Anne Tobin – Access Programme in Nursing • Julie McMahon – Occupational Health & Safety Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 73 Nursing Division Annual in-service training took place in the hospital. These included: • • • • Fire Training • Fire Marshall Training Manual Handling • CPR Induction Training In Service Speciality Training including guest lecturers on: - Wound Care (Smith & Nephew) TSSD Decontamination Project 2006 – 2007 Ms. Oonagh Ryan, CSSD Manager, participated as a Member of a Steering Committee. A report was submitted by the Irish Association of Sterile Services Managers to the Department of Health & Children in 2005. The HSE/NHO met with the three authors of the report in January’06. (Oonagh Ryan, St Vincent’s Private Hospital; chairman of the I.ASSM, Niall Greggy, Mater Private Hospital; project co-ordinator I.ASSM and Sheila Sheahan, Mid Western Hospital Limerick, vice chairperson I.ASSM). The HSE/NHO set up a steering committee, which had representation from: HSE/NHO, CSSD/TSSD, Theatre, Endoscopy, Infection control, Microbiology, The Irish Medicines Board (The Competent Authority for the Implementation of the Medical Devices Directive) 42/93/EEC, Director of Nursing; Risk Management, H.P.S.C. (Health Protection Surveillance Centre) formerly known as the National Disease Surveillance Centre. Ms. Ryan will participate, with her colleagues, in the preparation of a National Decontamination Strategic Plan. Redwood Ward New Services Cardiology room 4 protected beds – angioplasty patients are transferred directly back to the floor from the catheterization lab in SVUH. Also facilitates the transfer of patients (private) from CCU to SVPH. The cardiac rehabilitation teams are now visiting the unit and arranging rehab for these patients. The summer initiative program commenced in June and finished in August. New drug press installed for storage of out of hours medications. Education & training Goda McCormick attended a Breast Care-conference in London All staff members attended Cardiology In-service – education days. Including: a. Attendance at the laboratory to observe procedures being performed. b. ECG reading c. Weekly cardiology lectures with Dr MartinQuinn d. Regular day & night sessions with cardiac services on the use of the cardiac monitors Maria Nolan attended ECG interpretation study in the Hammersmith hospital in London. Both our care attendants, Lillian Gleeson and Roisin Walker, attended the HETAC health assistant – course. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 74 Nursing Division Several staff members have attended Wound Care -study days Annette Reilly successfully completed a H-dip in Healthcare Management. Staff Changes Ms Susan Simon was promoted to CNM I Ms Geraldine Ryan transferred to the Hazel unit Ms Karen Kavanagh and Ms Liz Clarke commenced nursing administration Out of Hours –duties Ms Mary Devassey, Ms Jackie O’Reilly and Ms Imelda Tighe commenced employment on Day Duty & Ms Elenita Tan commenced Night Duty. Pilot Studies Pilot study for the ordering of controlled schedule II drugs and night sedation was carried out on the Elm and Rowan wards in 2006, which resulted in a new improved method of ordering these medications throughout the hospital. Audits Elm unit commenced carrying out self audits on ward documentation in 2006 and continue to do audits in 2007 in order to improve standards of care for patients. Hawthorn Ward • • • • Production of Stores Booklet with members of the procurement committee Sanctioning of second CNM I –post Appointment of second CMN I – Louise McCague Launch of guidelines for care of incisional wounds Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 75 Nursing Division • • • • Development of pre & post-op care plan for patients undergoing abdominal surgery Development & launch of advise leaflets for patients undergoing bowel and liver resections. Development of ward specific information leaflets Began to plan the setting up of Hawthorn acute nursing unit (HANU) for the care of post-op colorectal & hepatobilary patients. Commencement of education sessions weekly. • Several nurses have attended a number of one day conferences specific to the ward activities • Poster presentation at the Irish Society for Quality & Safety in Healthcare-conference on patient information • Reviewed update of TPN-guidelines Christmas Staff from all divisions joined together in December to form a choir, which presented a Christmas carol service, which was televised for all the patients and was well received by patients and staff. It is hoped that this talented group will form again for future services. Retirements Ms Freda Delany – Clinical Nurse Manager II Ms Freda Delany retired from her post as Clinical Nurse Manager II at the end of May 2006. Ms Delany was a dedicated and committed member of staff always ensuring the highest quality care was delivered to the patients of St. Vincent's Private Hospital. She worked tirelessly over the years to create a harmonious environment both for patients and nursing staff. On behalf of all the staff we wish her a happy retirement and good health to enjoy her well-earned free time. Bereavements Sadly we lost one of our long-standing, dedicated member of our portering team in August of 2006. Paul Nash will be sadly missed by his many colleagues and friends at St. Vincent’s Private Hospital. He was an excellent employee who deeply touched the lives of all patients and staff. May he rest in peace. Mary Connolly Director of Nursing Return to contents St. Vincent’s Healthcare Group Limited 77 ST VINCENT’S PRIVATE HOSPITAL Corporate Services Division The principal areas of emphasis in the Corporate Services Division relate to Quality & Risk Management, Information Technology, Capital Development and Statistics. During 2006 each element was progressed. Quality and Risk Management Quality and Risk Management are key elements of the normal work of all divisions and departments in the Hospital. The Best Practice Group provides an overarching framework for same. It also draws together the work of the Health & Safety Committee, the Radiation Protection Committee and the Infection Control group. In 2006 the Best Practice Group received regular reports from the newly established Group Clinical Audit Committee and the Hospital participated in a number of the audits undertaken through the year. The Best Practice Group membership comprises the senior management team, two representatives of the Consultants Forum and an external risk advisor. The Health & Safety Committee membership was: Ms Janet Murray Ms Una Nicholson Mr Vincent Lane Mr Denis Scannell Ms Gerada Warnes Ms Helen O Hare Ms Ger O Nolan Ms Yvonne Casserly Ms Annette O Neill Ms Catherine Mehigan Ms Rita Leamy Ms Jennifer Calton Mr Neil Twomey Ms Mary Connolly Ms Ruth Cullen Mr Peter Sheehan The work programme of the Best Practice Group for 2006 included: Development, • BP002 • BP005 • BP004 • BP012 • BP013 • BP015 review and approval of Hospital policies in conjunction with the Health & Safety Committee. Notifiable Infectious Diseases Prescription Criteria for Diagnostic Imaging Procedures Procedure for Evacuation in the eventof an emergency Clinical Uniform Policy Search Policy for patients absent without leave from the Hospital Complaints Policy The Hospital Safety Statement (BP000) was reviewed and updated. The Statement was approved by the Best Practice Group and distributed to staff. The Hospital Internal emergency and contingency plan was developed and approved by the Best Practice Committee. The plan has been tested with a programme of planed evacuations. Development of the Incident Reporting system • A report on incidents was presented monthly to the Best Practice Group, Team Leaders and Heads of Departments • A monthly report of all Medication Incidents was presented to the Best Practice Group • A monthly report of all incidents rated as medium or high risk by the Grading Group was presented to the Best Practice Group • Information sessions for staff were provided in May to raise awareness of the process and the importance of staff participation. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 78 Corporate Services Division • Patient Satisfaction • The satisfaction survey for inpatients, introduced during 2005, was continued in 2006 and was conducted on an ongoing basis. 650 submissions were received with an overall satisfaction rating of 92%. In the latter months of 2006 the survey was extended to the daycare patients. • A monthly report including statistical analysis and commentary was presented to the Best Practice group and actions taken as appropriate by the management team. • In 2006 we introduced a report on a monthly basis to the Best Practice Group on issues of dissatisfaction raised by, or on behalf of, patients. These reports provide information on the cases from initial notification to completion or resolution. • Accreditation Following the first accreditation exercise in 2004 a mid cycle review took place in 2006 with the preparation of updated quality improvement plans and a visit from two surveyors from IHSAB. The mid cycle report was very positive and encouraging for all staff at the hospital in the drive for accreditation in 2007. Information Technology IT development in 2006 concentrated on expansion of the Hospital network and progression of the overall hardware and cabling infrastructure in line with the specifications employed by the Healthcare Group. Cable was installed though the entire hospital which has created a platform for the development of a programme to transmit data and images to all clinical areas. 69 users were added to the network bringing the year end number to 151. The most significant step forward in using the cable infrastructure was to install PCs on all Nursing wards and units with links to the PAS and the pathology reporting and Diagnostic Imaging reporting systems. Capital Development A team incorporating Support Services, Finance, Nursing, Allied Health and Corporate Services manages all major capital projects. Major projects in 2006 included: • Installation and commissioning of a new MRIscanner • Division of 2nd floor into two ward units • Installation and commissioning of new TSSD equipment and plant • Enhancement of Endoscopy Facilities • Replacement of Operating Theatre Lights in both Theatres • Replacement and extension of CCTV security System. An ongoing programme of minor capital development works continued through the year. Return to contents 79 St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL Corporate Services Division Statistics Headline Statistics Jan to December 2005 Jan to December 2006 Patient Discharges Inpatients Inpatient Occupancy Inpatient Bed days Av. Length of stay(Days) Daycases Oncology Daycases 9,081 86.26% 48,884 5.38 5,233 5,524 9,033 84.95% 48,052 5.32 5,592 5,477 -48 -1.31% -832 -0.06 359 -47 -0.53% -1.52% -1.70% -1.18% 7% -0.85% Operating Theatres SVPH Theatres Minor Operating Theatre Endoscopy unit 3,914 3,586 4,986 3,778 4,399 5,417 -136 813 431 -3% 23% 9% Diagnostic Imaging No of Studies 30,605 30,393 -212 -1% Radiotherapy No of Treatments 11,272 14,570 3,298 29% Cardiology No of Procedures 7,669 6,639 -1,030 -13% Respiratory Medicine No of Procedures 2,910 2,749 -161 -6% 438,352 441,053 2,701 1% Pathology Tests No of Procedures Variance Variance % Peter Sheehan Head of Corporate Services Return to contents Annual Review 2006 80 ST VINCENT’S PRIVATE HOSPITAL Allied Health Division Introduction The Allied Health Division incorporates Administration, Cardiology, Dietetics, Diagnostic Imaging (Radiology), Medical Physics, Pharmacy, Physiotherapy, Radiotherapy, Respiratory, and Social Work. Departments provide clinical and/or non-clinical support services to inpatient wards and offer a range of outpatient services. The overall objective of the Division is to provide and develop services to meet the needs of patients and their relatives. This document contains a general overview of key issues, service enhancements and events that took place in 2006. 2006 – An Overview Staff throughout the Division are to be thanked for their hard work, flexible attitude and overall commitment to meeting an increasing number and range of patient needs. This has been particularly challenging in some areas where there have been limitations in staff numbers and treatment facilities. A particular word of thanks is also due to Ms Annette O’Neill, who was Acting Allied Health Manager until April 2006. General The year presented various challenges and opportunities throughout the Division. An overview of key issues that affected Allied Health services are detailed below. 2006 proved to be another busy and demanding year. Departments were faced with greater patient volumes (refer Appendix 1) and, perhaps more significantly, changing patient needs. An emerging trend identified during 2006 was the increasing acuity of patients. This can be attributed to the Hospital’s ability to provide more complex procedures and a reflection of an increasingly older patient profile. One statistic, which demonstrates this, is the increase of patients on TPN by approximately 32% between 2005 and 2006. The arrival of new entrants to the Healthcare market (namely The Beacon Clinic and the Hermitage Medical Clinic) has brought with it, increased competition. Departments offering outpatient services therefore have to identify ways of maintaining existing referral patterns and attractingnew business. Furthermore, the emergence of newservice providers presents additional challenges around the recruitment and retention of qualified and experienced staff. As part of SVPH’s redevelopment pans, staff beganto engage in the planning process for the New Hospital. This involved discussions with architects on department locations and clinical requirements. High turnover of staff in the Pulmonary Function and Sleep Laboratories not only affected the number of patients treated in this area, but had a knock-on effect on referrals to other departments such as Dietetics. Changes in some Medical personnel (through retirements and new appointments), affected referral patterns in some areas. For example, referrals to Physiotherapy for breast surgery patients following reconstructive procedures increased following the appointment of two additional plastic surgeons. Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 81 Allied Health Division Adjustments to funding arrangements impacted on the how some services were delivered. For example, changes in how Endoscopy patients are charged for diagnostic tests associated with their procedure, prompted a review of appointment and billing systems. Insurance companies have also been refining and amending claims processes and criteria for reimbursement. For Allied Health, this has had its most significant impact on departments supporting Oncology and has led to Radiology, Pharmacy and Administration staff working closely with colleaguesin Nursing and Finance to reconcile clinical and administrative requirements. A technical fault experienced in the MRI Scanner led to the activation of the recently formalised Internal Disaster Plan. The emergency response proved effective in dealing with the situation and provided additional learning points for those involved. The concerted efforts of staff in the area, in conjunction with the equipment supplier, ensured that disruption to the service was kept to a minimum. The Radiation Protection Institute Ireland (RPII) carried out inspections in Diagnostic Imaging and Radiotherapy. Formal risk assessments were carried out on diagnostic imaging units as part of their recommendations while, in Radiotherapy, the quality and standard of services were complemented. Allied Health departments participated in Internal Audits in Cash Handling and Maintenance Contracts. This has led to a number of improvements being made to systems and process in several areas. Service Enhancements In addition to the above, a number of service developments were delivered for the benefit of staff. • Introduction of a Triple Assessment Clinic (TAC) for GP referrals for symptomatic breast patients. • Installation of a new MRI Scanner (Approx. €1 million investment). • Installation of Computed Radiography. • Refurbishment of Diagnostic Imaging Reception Area. • Refurbishment of Diagnostic Imaging Clerical Areas. • Completion of the Radiotherapy Project. Second Linear Accelerator went clinical. • Introduction of Omni wedge treatment (Radiotherapy). • First IMRT patient treated. • Service Agreement negotiated for the provision of Medical Physics services to the Hermitage Medical Clinic. • Increase in the number of pace maker devices inserted and introduction of a follow-up Pace maker clinic. • Echo services - improvements in the quality of images with an upgrade of echo/stress testing equipment (Approx. €250k investment). • ResMed PEI (a CPAP and equipment provider) carried out home based diagnostic sleep studies for Professor Mc Nicholas on selected patients and this led to new referrals for CPAP titration. • Establishment of a Satellite Pharmacy at Ward level. • Increase of resources to Chemotherapy Preparation with the appointment of a Chief II Pharmacist. • Introduction of a new MDA system on clinical wards. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 82 Allied Health Division Summary Training/Education & Conference Attendances Education and training is key to the retention and development of staff. Some of the courses/events undertaken in Allied Health over the 12 months include: • General – Induction, Manual Handling, Fire Safety and Fire Evacuations, CPR, Clinical Audit, European Safety Week, Bullying & Harassment. • Diagnostic Imaging – European Congress of Radiology Annual Conference, Symposium Mamographicum, MRI Applications, Multi-slice CT, IV administration, IIR Annual Conference. • Medical Physics – Irish Radiotherapy Physics Conference, Radiation Protection, Quality Assurance on CT, First line maintenance (for linearaccelerators). • Physiotherapy - Internal lectures on Liver and Bowel surgery, Breast reconstruction and Upper Limb bandaging. • Cardiology – Ultrasound and Pace making courses. • Cardiology and Respiratory – junior staff completing compulsory Physiology Degree. • Respiratory – Irish Sleep Society Conference. The above represents an overview of activities across Allied Health Departments during 2006. Further information is available within individual departmental Action Plans. Gerada Warnes Allied Health Manager Return to contents St. Vincent’s Healthcare Group Limited 83 ST VINCENT’S PRIVATE HOSPITAL Human Resource Division Mission / Vision “The Mission of the HR Division is to design and deliver innovative HR services in partnership with the Hospital and the Healthcare Group to ensure a progressive, equitable and challenging environment for staff, and a quality service for patients.” Our Vision is to lead the way in HR expertise, creating a unique environment for our people that will generate success for the Hospital and the Healthcare Group. Our Values include: • Being the guardian of fairness and equity • Valuing all our staff • Listening and responding appropriately • Balancing people and business needs • Learning from our successes and our mistakes • Communicating intentions and expectations clearly • Advising Managers on how to manage performance fairly and firmly. Overview The HR Division continues to manage all of the activities relating to the personnel function, namely - to assist management to enhance the individual and collective contributions of staff in achieving the Mission and Objectives of the Hospital; to advise and assist all line managers on matters relating to staff; to provide information to staff on all employment matters and to carry out the Employee Relations function of the Hospital. The volume of employment legislation continues to grow and the HR Division ensures that the hospital complies with all employment legislation enacted over the last number of years. The main activities that derive from these roles are recruitment and selection; staff development and training; employee relations, implementation of policies and procedures, manpower planning, benefits administration, personnel administration and organisation development. The wide span of activities places an onerous burden on staff and I would like to thank Ms Marian Murphy and Ms Colette McNamara for their commitment and support during the year. Colette joined the staff of the HR Division in January 2006. Occupational Health Service St Vincent’s Private Hospital has entered into an agreement with St Vincent’s University Hospital for the purchase of Occupational Health Services for Private Hospital staff. This service commenced on March 1st 2005, and the main elements of the service are: • Treatment of inoculation injuries and risk management follow up • Immune status evaluation • Pre-employment assessment • Flu vaccination • Management referrals • Pregnancy Risk Assessments • Occupational Psychologist The provision of this service supports our duty of care to staff under Health & Safety legislation, and also assists with Best Practice initiatives. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 84 HR Division 2006 During the year ‘Be Sharp Be safe’ workshops were held on all Nursing floors and Theatre. All were well attended by staff. The Occupational Health Department also participated in Health & Safety Week, orientation days and also at Health Promotion events. Advice was given to managers and staff on issues concerning Health & Safety matters. Overall the feedback from staff has been very positive and it is hoped to expand the service in 2007. I would like to thank Ms Ann O’Reilly and all the staff of the Occupational Health Department for their assistance and support throughout the year. Training & Development Induction training was provided on five occasions during the year for new staff and 40 employees attended. Seminars were held in May on ‘Dignity at Work’, dealing with the whole area of bullying and harassment and 45 staff attended. It is hoped to continue with this programme in 2007. Six staff attended Retirement Planning courses. Customer care training was provided and a total of 21 staff attended two courses. Support was given to a number of staff for courses of study in their own time. This support took the form of financial support and study leave. A number of staff completed the ‘Diploma in First Line Management’ which was provided by the National College of Ireland. 12 Care Assistants completed the FETAC Level Five course. Seminars on Pensions and Additional Voluntary Contributions (AVCs) were also held for staff and delivered by representatives from Mercer and Irish Life. Recruitment, Selection & Retention Recruitment and retention of staff remains a challenge and difficulties continue in sourcing a number of grades of staff including Radiographers, Doctors, Nurses, Pharmacy and experienced Administration staff. Recruitment of staff from overseas continues on an ongoing basis as required. The HR Division assisted other Divisions with the selection of candidates for internal promotion vacancies. Below is a summary of HR activity in respect of Recruitment Personnel Administration In 2006 improvements were made in processes for measuring absenteeism and also for staff census / employment control Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 85 HR Division 2006 The Chart below illustrates the starters and leavers for each division. Number of Starters/Leavers by Division 80 70 60 50 40 30 20 10 0 Allied Health Joiners Leavers 33 29 Nursing HR Support Services Finance SVUH 71 49 13 9 24 20 8 6 3 2 Employee Relations In 2006 the Employees (Information & Consultation) Act 2006 came into force. The Act provided for the implementation of a ‘pre-existing’ agreement with staff. A draft was proposed by management and staff voted in secret ballot by a majority to accept the Agreement. The Agreement is now in force. Discussions on various other issues took place with trade unions and staff representatives throughout 2006. A number of individual staff grievances were also resolved by agreement with the staff members concerned. The HR Division represented the Hospital at various meetings with Rights Commissioners, the Labour Relations Commission and the Labour Court. Throughout the year we worked closely with our colleagues in the salaries office - Ms Dorothy Nolan and Ms Yvonne Casserly. I would like to thank them for their valued assistance. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL Detail HR Division 2006 Jan Feb March April May 5 11 4 4 3 6 3 60 140 63 27 10 28 No of HR Interviews 2 3 7 3 3 No. attended for interview 6 15 33 11 14 No. of Ads placed No of Applications 86 June July August Sept Oct Nov Dec TOTAL 1 3 1 6 1 48 15 22 7 1 29 10 412 3 5 4 6 1 6 1 44 6 10 7 22 3 15 3 145 Medical Records The HR Division also has responsibility for Medical Records (including Floor Secretary staff), and Patient Focus. Storage space for charts and x-ray films continues to be in short supply, and Day Surgery files are now being stored in the Department. Arrangements with ‘Medrex Systems Ireland Ltd’ continue to assist in providing solutions. Ann Marie Kavanagh and Joanne Clark were promoted and took up new posts in Diagnostic Imaging. I would like to thank them both for their contribution to the Medical Records Services. Three new staff joined the Department in 2006. I would like to thank Ms Caitriona O’Connor, Ms Phoebe Kenny O’Neill, Ms Avril Baird, Ms Mary Wolfe, Ms Geraldine Pender, Mr Ciaran O’Callaghan, Ms Ann Pender, Ms Katie Thompson-Chadwick and Ms Ann Cavey for the consistently high level of service they provide to patients and staff. Neil Twomey Human Resource Manager Return to contents St. Vincent’s Healthcare Group Limited 87 ST VINCENT’S PRIVATE HOSPITAL Support Services Division The Support Services Division incorporates Reception, Security, Hygiene Services, Household Services, Maintenance, Projects, Patient and Staff Catering. Reception Margaret English and a staff of nine provide reception and front of house services throughout the hospital. As reception is the first point of call for both patients and visitors the primary function is to promote a friendly and efficient environment. Some of the service improvements during the year were: The process to restructure reception was completed and rosters introduced on May 8th. Reception is now staffed from 7.00am – 10.00pm Monday to Saturday and from 8.00am – 10.00pm on a Sunday. This will provide a more seamless service on reception. New work schedules were also implemented. In March the reception team were involved in a pilot scheme to ensure all medical insurance forms are signed prior to hospital admission. This has been a successful scheme and is now part of the regular reception procedure. A new shift has commenced to incorporate general lock up, surveillance and reception duties. The shift is from 6.30 p.m. – 11.30 p.m. each evening and from 12.00pm – 3.00pm on a Sunday. Security Technology installed a new CCTV System, satellite units were installed on 3 computers with the main monitor at reception. A new taxi requisition book was introduced at reception for patients who need to obtain services outside the hospital while remaining as inpatients. Household Services Yvonne Gleeson, Household Services Officers has a team of 5 who provide a six-day service. The team provides support in relation to hygiene, laundry, and hotel services throughout the hospital. The Household Services Team works closely with the Cleaning Company (Maybin Clean) and Infection Control to provide a safe environment for both patients and staff. Some of the Improvements during the year were: • Black/Yellow tape was laid in corridors to facilitate storage of necessary equipment. • Weekly Inspections/Means of escape routes report forms were updated and are now in operation. • A hospital committee is working with Celtic Linen to review our managed linen service. • A new baler for recycling cardboard was purchased from ACME Ltd and is located in the Backyard. Maintenance Department Currently there are two full time maintenance operatives Eddie Hartland and Rory McElhinney (from William Farrell Electrical Contractors). The electrical contractor also provides a call out service and electricians for project work. We have a total of 87 external contractors who service and maintain equipment on a regular basis. Non-routine work and projects are organised separately by using reputable outside firms who continue to complete the majority of our project work. Approximately 2,684 requisition dockets were completed in 2006. In keeping with Health and Safety Regulations an External Contractors Form is completed by all contractors and kept in the relevant project files. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 88 Support Services Division Projects External and internal maintenance personnel carried out a total of 37 projects. These also required the assistance from our internal facilities staff in household and maintenance and assistance from William Farrell Electrical Contractors Ltd. Some of the projects completed last year include: • Removing the old and installing the new MRI. • Fire Door Upgrades. • Electrical Project Phase II. • Refurbishment of the old Generator Room. • New Kitchen Pot wash. • TSSD Reverse Osmosis Equipment was commissioned with Elga Water. • A new washer/steriliser was installed in the Redwood ward sluice room. • New Theatre lights were installed. • Fixed Air conditioning units were installed in Cardiology and Day Surgery with Environeering Ltd. • Three extractor fans were installed on the roof to facilitate improved air supply to single rooms by Harmon Air Conditioning. • Nurses wash rooms on all 4 floors were upgraded. Fire Prevention Apex Fire have completed the following upgrade works: • Strobe light and fire bell installed in the kitchen. • Strobe light and satellite panel on the lower ground floor. • Nine new alarm bells were installed on the Theatre Corridor, Nurses stations at Redwood Ward, Hawthorn Ward, Rowan Ward & Cedar Ward. • The Fire alarm sound was checked to comply with the 65 decibels regulation. • The Fire Register & Fire Service Folders were reviewed and have been updated. • Michael Slattery Associates Fire Advisor, Brendan Kavanagh assisted the Hospital in carrying out 3 Fire Evacuations on the 1st Floor Maple Unit, Lower Ground Floor (incorporating coffee shop, stores and kitchen) and the 3rd evacuation drill was in the Radiotherapy Department. • Ten combination locks were removed from office areas in accordance with Health & Safety recommendations from Fire Consultant Brendan Kavanagh. Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 89 Support Services Division Car Park Due to the over demand for on site parking a waiting list is now in operation and space has been acquired at Wanderers Rugby Football Club. A Car park audit took place over two weeks in March. The aim was to establish if there was abuse of the Car Park. We are always conscious of trying to make sure as many spaces as possible is kept free for patient use. The 2007 Car Park Policy and Procedures and Car Park Application Forms were distributed to all staff and Consultants. Catering Department The Catering Department services the needs of 162 in-patients, 30 day-care patients and approximately 400 staff and visitors daily here in the Hospital. The Department also caters for various functions throughout the year as well as in - house meetings. There is a team of 64 lead by Yvonne Byrne and Geraldine O Nolan. The Catering Department has a fully implemented HACCP system and an ISO 9001: 2000 IS 343 accreditation. The Kitchen prepares and cooks the food on the day for all areas and is supervised by our Senior Chef Michele Pounch. The Coffee Shop opens from 7.00am – 5.00pm and seats 110 people. Internal Audits February IS 343 Section 4 HACCP Planning /Flow Chart IS 340 Section 1 Hygiene Policy IS 343 Section 3 Prerequisite Programmes IS 340 Section 2 Food Safety March ISO 22000 Section 8 Validation and Verification of the Food Safety Management system ISO 22000 Section 6 Resource Management Samples of cooked chicken and plaice were sent to the Public Analysts Laboratory to check for presence of Bacteria April ISO 22000 Section 7.2 Prerequisite Programme May ISO 22000 Section 4.2 Documentation Requirements ISO 22000 Section 6.2.2 Competence Awareness and Training June Four supplier audits were carried out on the following companies Olhausen (pork & bacon supplier), Terry Giles (fish supplier), Frank Doyle Butchers (meat supplier) and Mc Nally’s (chicken supplier). July Samples of cooked lamb pieces and sausages were sent to the Public Analysts Laboratory for a bacteriological check. August Supplier Audit on Seaview (fruit/vegetable supplier) September A mock recall was carried out using the scenario that Physical Contamination may have occurred. Return to contents Annual Review 2006 ST VINCENT’S PRIVATE HOSPITAL 90 Support Services Division October An Audit took place on Musgrave food services premises. November An Audit on how the Food Safety Management system conforms to the requirements of all sections of ISO 22000: 2005. External Audits May Catercare Audit was carried out on Food Safety Management system. The Scope was from procurement through to service to the customer and clean up. June Dublin City Council sent in a report on the quality of our drinking water. July CVA Initial Registration Audit fro ISO 22000: The Happy Heart Audit took place. August EHO Inspection was carried out. September EHO follow up visit. December Catercare carried out an Audit, the scope was from procurement through to service and clean up. Surveys Surveys were carried out in the following areas day-care oncology, day-care lunch, breakfast on the patient floors, lunch in the coffee shop, staff room service and the bean-to-cup coffee machine. Capital Developments / Improvements Coffee Shop • New Tables & Chairs were purchased. • New flooring was laid in the Cleaning and Food Stores. • A new blast chiller was acquired to keep salads below 5°C. • Two new microwaves were delivered. Return to contents St. Vincent’s Healthcare Group Limited ST VINCENT’S PRIVATE HOSPITAL 91 Support Services Division • A new display fridge was installed. • The sandwich bar and beverage counter was relocated to improve customer flow. Kitchen • A grease shield was installed in the kitchen. • A new pot-wash installed in the Kitchen. Training A training plan is devised annually. It includes mandatory training, such as refresher food hygiene, safe pass, manual handling and fire safety. • • • • • • • • 5 Staff members completed the basic Food Hygiene Course run by Catercare. Yvonne Gleeson and Keith Wickham attended the Waste Management Course. Maree Mathews, Rosemary Woulfe and Helen Dowd attended Basic Computers and Elementary Word Training. Yvonne Byrne attended the IRCA Certified Food Safety Management – Lead Auditor Course. Michelle Pounch and Denise Ryan attended the ISO 22000 Food Safety Internal Auditors Course, Maisie Dixon attended the Dignity at Work Course. Geraldine O Nolan attended the refresher Manual Handling Instructor course. Michele Pounch attended a Calibration course. Staffing • Congratulations to Mary Hagan who has completed 25 years in the Catering department. • Congratulations to Leona Dowd and Stephanie Watson who graduated from The National College of Ireland after completing a Diploma in People Management. • Sinead Conroy and Linda Mulvaney who commenced work as Patient Catering Supervisors in May/June. • Raymond Leahy and Eamon Mc Elwee who commenced in the Coffee Shop. • Joanna Muklewicz and Agata Targanska commenced work in Patient Catering. • Helena Campbell started in September on a 6-month contract. • Thomas Mahon started as Kitchen Porter in October. • Eoin Grogan started in May in the Kitchen. • Welcome to Anne Benson, Ingrid Jansen and Adrienne Harrison who joined our reception team. Janet Murray Support Services Manager Return to contents Annual Review 2006 92 ST VINCENT’S PRIVATE HOSPITAL Organisation Structure Group Chief Executive Chief Executive Nursing Division Human Resource Director of Nursing Assistant Director of Nursing (3) Patients Floors Theatres (2) Endoscopy Daycare Minor Operations Pastoral Care/ Chaplaincy Portering Admissions Nursing Education Nurse Specialists Human Resources Manager Administrative Assistant Recruitment Ward Clerks Medical Records Staff Training & Development Employee Relations Medical Administration Allied Health Division Allied Health Manager Diagnostic Imaging I Radiotherapy Pharmacy Dietetics Cardiology Medical Social Worker Physiotherapy Pulmonary Laboratory Other Allied Health Services Medical Physics Support Services Division Finance Division Financial Controller Patients Accounts Debtors Accounts Creditors Salaries Materials Manager Administrative Assistant Management Accounts Support Services Manager Deputy S Services Manager Reception Catering Coffee Shop Housekeeping Cleaning Maintenance Security Grounds Corporate Services Head of Corporate Services Administrative Assistant Risk Management Information Technology Accreditation Statistics Patient Complaints HIPE Capital Projects Return to contents Departmental Review Return to contents Annual Review 2006 94 Departmental Review Department of Anaesthesia, Intensive Care & Pain Medicine Staff There are currently 27 Consultants Anaesthetists working in St. Vincent’s University Hospital, of which 8 are permanent consultants,10 are part-time Consultants and 9 of our Consultant colleagues are locums. Currently in terms of wholetime consultants in St. Vincent's University Hospital, we have 8 fulltime consultants providing 84 sessions and we have 4 wholetime locum consultants provding 44 sessions. We have a further 22 sessions provided by the other 5 locums. We have 42 sessions provided by our 10 permanent part-time consultants at St. Vincent's University Hospital. 8 fulltime Consultants providing 84 sessions 5 locum consultants at SVUH providing 23 sessions 4 fulltime locums providing 44 sessions 10 part-time consultants at SVUH providing 42 sessions Currently we have 10 operating rooms at St. Vincent's University Hospital, 2 in St. Michael’s Hospital and 1 in St. Michael’s Annexe . We have a further 2 theatres which we cover in St. Vincent’s Private Hospital. We therefore are servicing 15 theatres in the healthcare group. Along with this we also provide anaesthesia services for the Angiography Suite at St. Vincent's University Hospital, Radiology Department. As there are no live in anaesthetic trainees at St. Michaels’s Hospital from 8 p.m – 8 a.m. we have set up a 4th on call roster for retrieval of critically ill patients. All patients who require emergency surgery following previous elective or emergency surgery on the day they are treated are brought back to theatre by the consultant who provided the anaesthetic care on the case. A protocol exists for transferring critically ill patients from St. Michael’s Hospital to St. Vincent's University Hospital during a 24 hour cycle. During the course of 2006 Dr. Robert Plant, Consultant Intensivist returned to his native Cork to become one of the critical care consultants at Cork University Hospital. However this was more than adequately compensated by the arrival of our Senior Lecturer from Duke University in North Caroline Dr. Dara Breslin who has made an immediate impact in both clinical and academic areas since coming to our hospital. Service Development / Activities Activity Report – Operating Statistics 2006 Category SVUH Dental Dermatology E.N.T. Eswl (Lithotripsy) General G.U. Endo G.U. Open Gynaecology Ophthalmology Orthopaedic Pain Plastic Thoracic Vascular TOTALS 55 157 360 2226 1694 148 229 352 1831 610 1026 302 324 9314 St. Michael’s Annexe St. Michael’s Public 133 265 340 217 33 98 72 227 1313 St. Vincent’s Private 1 1093 477 53 4 1 = 91 72 49 90 62 972 Return to contents St. Vincent’s Healthcare Group Limited 95 Department of Anaesthesia, Intensive Care & Pain Medicine Outstanding / Significant Achievements We would like to congratulate Drs. Eilís Condon, Justin Lane, Maya Contreras and Marcus Eller who were successful in passing the Final Fellowship of the College of Anaesthetists (FCA) in 2006 and also to Drs. Nitin Gadgil who passed his Primary Examination in 2006. Resident Merit Awards A gala award ceremony took place on 16th December to celebrate the success of our trainees and to present their prizes. The following were the recipients of prizes: Dr. Eilís Condon - Abbott Gerry Dorrian Memorial Award for best SpR in Anaesthesia Dr. Lucy Borovickova – Dr. Dick Nolan Memorial Award for best BST in Anaesthesia Dr. James O’Leary - Dr Seamus O’Donnell Memorial Award for best SpR in ICU Dr. Kevin McCarthy - Dr. Seamus O’Donnell Memorial Award for best SpR in ICU Dr. Abdul AlMajadi - Napp Pain Medicine Medal for outstanding performance in the Pain Service who was a visiting SpR from the Kingdom of Kuwait and his salary had been funded throughout his stay by the Ministry of Health At this event the department also had an opportunity to welcome our new colleague and esteemed Senior Lecturer Dr. Dara Breslin. The night was a great success and hopefully had a sense of esprit de corps. Significant Publications / Academic Activity Peer Reviewed Publications Publications Dr. D. Breslin took up his position as Senior Lecturer in Anaesthesia. A former transplant fellow, Dr. C. McCaul, was appointed as consultant anaesthetist to the Mater University Hospital. Two Conway Institute fellows, Drs. F. Naughton and A. Nichol, concluded their MSc and PhD studies. Dr. J. Boylan acted as a reviewer for Chest. Peer-reviewed publications Kieran SM. Cahill RA. Browne I. Sheehan SJ. Mehigan D. Barry MC. The effect of perioperative beta-blockade on the pulmonary function of patients undergoing major arterial surgery. European Journal of Vascular & Endovascular Surgery 2006; 32:305-8 Return to contents Annual Review 2006 96 Department of Anaesthesia, Intensive Care & Pain Medicine Abstracts Lynch J. Boylan JF. McCaul C. Kavanagh BP. Magner JJ. Quality of clinical trials on postthoracotomy pain. Anesthesiology 2006; 105: A893 Liver Transplantation 2006 was a very busy year for the Liver Transplantation Group. 65 Orthotopic Liver Transplants took place. Results for 2006 as usual were very good. Transplantation is demanding work for all concerned. All credit to the Anaesthesia Team: Consultant Anaesthetists Dr. Neil McDonald Dr. John Boylan Dr. John Magner Liver Fellows Dr. Mohammad Zafruddin Dr. Abdul Albasha Anaesthetic Nurses Sr Jean McCarthy Karl Perocillo Billie Stafford Dr. Rachel O’Farrell Karen Ann Keating Vascular Access Director Dr. Alan McShane Consultant Dr. Neil McDonald The Vascular Access service has continued to flourish. It is popular both with the services which use it and among the anaesthesia trainees. The last year has seen a decided shift in willingness of both consultants and trainees to avail of the ultrasound device to aid with line placement. The increased proficiency has been obvious and is of great help in difficult clinical situation. Early in the year Drs. McShane, McDonald and Tan attended the Anaesthesia Research Society Meeting in San Francisco. They presented work done in St. Vincent's University Hospital in collaboration with Dr. Conor Heneghan of the Department of Physics in University College Dublin. In addition Dr. McShane again organised a Vascular Access Workshop in the College of Anaesthetists, aided by Dr. McDonald. This year the College of Anaesthetists decide that formal training in Vascular Access is to be a mandatory part of Anaesthesia training. The Health Service Executive (HSE) have given large financial support to the College of promote this aspiration. As a result, the Vascular Access Workshop which was first introduced by Dr. McShane has become a regular part of the College’s Educational Programme. The course is also availed of by non-anaesthesia doctors. P.Hu, K. Tan, S. Redmond, N. McDonald, C. Heneghan, A.McShane. Central Venous Cannulation – a comparison of 3 methods to confirm venepuncture. International Anesthesia Research Society (IARS) 80th Clinical and Scientific Congress, San Francisco, March 24th – 28th 2006 South East Dublin Department of Anaesthesia (SEDDA) Report Co-ordinator Dr. Alan McShane Uncertainties about the much talked - of new Consultants contract, slowed consultant recruitment to SEDDA over the last year. As a result, the clinical services in all constituent hospitals relied heavily on consultant locum services. There were successfully deployed, and we are grateful for the great contribution made by these doctors, sometimes in less than ideal circumstances. Return to contents St. Vincent’s Healthcare Group Limited 97 Department of Anaesthesia, Intensive Care & Pain Medicine Dr. Dara Breslin’s arrival during the year to fill the Lecturer in Anaesthesia position at St. Vincent's University Hospital and University College Dublin is greatly welcomed. The potential educational opportunities thus afforded to all SEDDA doctors are enormous. Unfortunately almost at the same time as Dr. Breslin’s arrival we lost Dr. Robert Plant who successfully applied for a Consultant position at his alma Mater, Cork University Hospital. We wish him well in his continuing career in his homeplace. The numbers applying to the SEDDA training scheme continue to increase. This reflects well on the clinical and educational opportunities available in the scheme. During the year, progress was made in rationalising the night rosters between the constituent hospitals. This was primarily due to the unstinting work of Dr. Richard Assaf. Also during the past year we have lad the benefit of input from Mr. David Hanly. He has been helpful in taking an objective view at our consultant work practices. As a result of his observations we are in the process of altering consultant practices, initially in St. Vincent's University Hospital University Hospital. Intensive Care Unit Medial Director Dr. Kieran Crowley Consultants Dr. Pat Benson Dr. Cathal Nolan Dr. Robert Plant Clinical Nurse Manager III Ms Geraldine Carey Service workload 595 patients were admitted to the ICU in 2005, similar to recent years. 46% of patients stayed 1 day, while 38% stayed 3 days or more, similar to recent years. Average length of stay shortened to 2 days. Average occupancy for the year was 91% (international recommendations are 70%). The ICU had to overflow repeatedly to PACU. The ICU continued to provide the critical care component of the liver transplant programme. The year saw yet another record with 65 transplants. Organ failure rates and organ support rates were similar to recent years: 80% of patients received mechanical ventilation. Overall ICU survival was 78%, with hospital survival of 76%. There is a continuing trend of increasing post-ICU discharge hospital survival. St. Vincent’s supplied an ICU nurse and registrar to staff the transfer of critically ill patients by MICAS (mobile intensive care ambulance service) on a 1:4 roster. Staffing Adequate suitably trained nursing staffing levels remained an issue; several recruitment initiatives were undertaken, with varying degrees of success. Eleven nurses completed the H.Dip in Critical care Nursing and all remained on the staff. It is planned to re-institute a hospital based ICU course during 2007, with a view to opening additional beds. There are two attendants, one shared orderly, one shared technician and a secretary. secretary. The ICU is staffed by a registrar or specialist registrar rotating from the department of anaesthesia, available 24 hours a day. Return to contents Annual Review 2006 98 Department of Anaesthesia, Intensive Care & Pain Medicine Dr. Robert Plant left the consultant staff to return to Cork and was replaced in a locum capacity by Dr. Caroline Hickey. The aim of achieving out-of-hours cover by consultant intensivist staff has not yet been met: this is now achieved for 2/4 of weekends. Developments In October the service transferred to the new ICU, a culmination of 10 years of planning. Of the total of 16 beds in the new ICU initially 8 have been opened, with overflows to 11 beds at times. It is hoped to open more beds incrementally during 2007. As part of the commitment to continuing education, the ICU Nursing Staff hosted their annual educational conference in February 2006 with an excellent attendance. ICU Activity 2006 2005 2004 2003 2002 2001 2000 1999 1998 595 613 516 450 471 421 469 556 551 2 4 6 6 6 5 5 3.4 3.9 Average occupancy 91% 92% 93% 90% 85% 89% 85% 64% 75% Elective surgical 34% 38% 36% 27% 30% 32% 35% 36% 43% Emergency surgical 25% 30% 30% 39% 31% 31% 35% 31% 30% Medical 43% 32% 34% 34% 39% 37% 30% 33% 27% Mechanical ventilation 80% 82% 69% 70% 75% 68% 67% 58% 57% Central venous access 73% 77% 64% 73% 81% 69% 78% 75% 65% Vasoactive infusions 19% 24% 20% 18% 25% 33% 33% 26% 22% Acute renal failure 14% 10% 10% 17% 25% 23% 24% 14% 13% Continuous renal replacement therapy 14% 10% 10% 16% 21% 16% 14% 10% 8% 7% 6% 6% 13% 11% 13% 6% 6% 9% Unplanned ICU discharge 17% 21% 21% 25% 1.5% 11.4% 6% 5% 4% Readmissions 8.1% 12% 8.3% 2.9% 0.9% ICU survival 78% 80% 79% 82% 75% 73% 75% 81% 82% Hospital survival 76% 78% 75% 78% 70% 68% 70% 71% 75% Admissions Average length of stay (days) Tracheostomy 6.3% Return to contents St. Vincent’s Healthcare Group Limited 99 Department of Anaesthesia, Intensive Care & Pain Medicine Pain Medicine 2006 was a year of immense development in the Pain Service in St. Vincent's University Hospital with the setting up of St. Clare’s Ward Walk-In Pain Day Service. It was also a year in which there was a significant increase in patient numbers because of facilities.. The total number of patients treated in theatre was 580 – total number of procedures carried out in St. Clare’s Ward was 557 yielding a total of 1151 procedures carried out in total. Outpatient Activity Tuesday Outpatients saw 3884 patients and in the Wednesday Clinic we saw 850 patients. Our outpatient accommodation changed dramatically as we moved into the latter quarter of 2006. We moved into the new Outpatients development in St. Vincent's University Hospital. We have brand new assessment rooms with increased space. It also facilitates us having a Multidisciplinary Clinic on Tuesday afternoons with our Physiotherapists, Clinical Psychologist and Occupational Therapists. The Tuesday Outpatient clinic run from approximately 12 midday until 6 p.m. The Wednesday Clinic commences at 3 p.m and finishes at 6 p.m . A new initiative was also introduced in 2006 the Wound Clinic and the Walk In Service. This has a huge impact in accident & emergency admission avoidance and prolonged stay at St. Vincent's University Hospital. 2006 was a milestone also in terms of our unit. We implanted for the first time more than 100 spinal cord stimulators i.e. we achieved more than 140 implants. Our 100 implant day was celebrated by the Minister Of Health and Tanaiste at the time Ms Mary Harney on 18th October 2006 during European Week against Pain. 2006 also saw a huge expansion in team members when we had 2 new Nurse Specialists Mr. Rodel Perez and Bency Vaughesse. From January 2006 – June 2006 we had 2 SpRs namely Adul AlMajadi (Subsidized by the Ministry of Health in Kuwait) and Dr. Oleg Ilyinski. From August 2006 – December 2006 we had SpRs Dr.Philip Hu and Dr. Oleg Ilyinski, Dr. Abdul AlMajadi and our visiting Australian college Dr. P. Max Majedi. Dr. Majedi will be continuing to work in our department until the end of June 2007. Dr. Ilyinksi has continued to work in our department as a Locum Consultant Anaesthetist with a Special Interest in Pain whilst he carries out his MD in UCD in conjunction with Dr. Keith Murphy and Dr. Paul Murphy. Dr. Philip Hu is now studying the Effect of treating Neueropathic Pain with SENS under functional MRI in Oxford. 5 Papers were presented by Dr. Ilyinski, x 2 Dr. AlMajadi, Dr. Hu, Dr. Max Majedi x 2 and the NSUKI Meeting in Cork in October 2006. Presentation by Dr Max Majedi to the NSUKI Meeting in Cork entitled Inter-scapular SENS case series. Dr. AlMajadi is now a Locum Consultant Anaesthetist at St. Vincent's University Hospital since 1st January 2007 The Pain Programme, under the Clinical Directorship of Dr. Rosemary Walsh, continued with its cognitive behavioural therapy programme, 3 week programme for patients with chronic pain and new innovations including tailored programmes for patients with special needs, work sustaining rehab programmes for chronic pain patients who work and for improving work function in chronic pain patients and multidisciplinary approaches to neuropathic pain and neuromodulation patients. Finally the total patient interaction in the department was over 5,600 for 2006 Return to contents Annual Review 2006 100 Department of Anaesthesia, Intensive Care & Pain Medicine Significant Publication The Spinal Cord Stimulation in Treatment of Post Surgical Incisional Chronic Neuropathic Pain Case Report Dr Oleg Ilyinski Director Dr. Declan O’Keeffe Consultants Dr. Hugh Gallagher Dr. Ray Victory Dr. Paul Murphy Pain Fellows Dr. Abdul Al-Majadi Dr. Mohammed Zafruddin Dr. Oleg Ilyinski Dr. Ashok Kureel Dr. Philip Hu Dr. Max Majedi Clinical Psychologist Dr. Rosemary Walsh 0.5 WTE Physiotherapist Miss Aoife Caffrey 1.0 wte Occ Therapist Miss Shannon Barr Pain Management Co-ordinator/PA to Director Neuromodulation Co-ordinator Laura Hamilton Niamh Clohessy Activity OUTPATIENT CLINICS Day Consultant Tuesday Dr. O’Keeffe Tuesday Dr. Victory Wednesday Dr. O’Keeffe St. Clare’s Pain Management Procedure Room Wound Clinic 612 55 Total No. of Patients to visit OPD Pain Clinic 3,884 850 Pain Management Programmes Type Programme 3 week 1 Day No. of Courses in 2006 7 1 Total Number of Patients on Course 57 39 Return to contents St. Vincent’s Healthcare Group Limited 101 Departmental Review BONE & JOINT UNIT Department of Rheumatology Staff Consultant Staff Professor Barry Bresnihan Professor Oliver FitzGerald Dr Douglas Veale Dr Orla Killeen Specialist Registrar Dr Shafeeq Alraqi Registrar Dr. John Paul Doran Research Registrar Dr Ceara Walsh Dr Eliza Pontifex Dr Chin Teck Ng Dr Laure Brulhart Dr Rita Barros Dr Adrian Gibbs Ms Catherine Slattery Mrs Alexia Grier Mrs Susan van der Kamp Mrs Miriam Molloy Mrs Marie O’Rourke Mrs Felicitas Froehlich Grimm Mrs Phil Gallagher Mrs Eileen O’Flynn Mrs Connie Walsh Dr Ursula Fearon Dr Catherine Sweeney Dr Wei Gao Ms Jeanine Fagan Mrs Chris Walsh Nursing Staff Scientific Staff Dr Sinead Nic An Ultaigh Administration Staff Ms Mary White Ms Patricia Garvey Service Developments / Activities The major service development in 2006 was the move to the new BONE AND JOINT department in August 2006. After more than 10 years of planning, the Bone and Joint unit finally became a reality. The mission of the Bone & Joint Unit is three-fold: 1. To provide an evidence-based, multidisciplinary care programme to all patients presenting to SVHG with musculoskeletal and rehabilitation-related clinical problems. 2.By coordinating teaching program’s, to provide a unique educational programme for medical undergraduates, postgraduate trainees and for nurses, physiotherapists and occupational therapists wishing to develop specialist musculoskeletal expertise. 3.Again by promoting interdisciplinary cooperation, to further develop and expand the academic and research infrastructure relating to musculoskeletal disease With the new Bone & Joint Unit opening, providing for the first time a combined outpatient clinic service for the Departments of Orthopaedics and Trauma, Rheumatology and Rehabilitation Medicine, additional opportunities for coordinated development arise. The clinics operate on the basis of 3 x 3 hour clinics per day in addition to the daily fracture clinics. Specific care pathways have been developed in areas such as fracture liaison, falls co-ordination (together with the Dept. Care for the Elderly) and back pain. Some initial progress in these areas has been achieved with the recent appointment of our first fracture liaison nurse (Annette Whelan), the agreement to proceed with a Project Facilitator position (Falls co-ordination) and agreement now to proceed with a Back Care initiative targeting initially patients on existing waiting lists. Other significant achievements include: • The appointment of Ireland’s first Consultant Paediatric Rheumatologist between SVHG and Our Lady’s Hospital for Sick Children, Crumlin. Dr Orla Killeen took up her post in July. A structured transitional care programme has been introduced for all adolescents and young adults attending the Bone and Joint unit. Return to contents Annual Review 2006 BONE & JOINT UNIT 102 Department of Rheumatology • Commissioning of SVHG’s first publicly funded DXA scanner in December. The DXA department is co-ordinated by Osteoporosis Nurse Specialist, Susan van der Kamp, together with Dr Malachi McKenna and Prof Oliver FitzGerald. The existing DXA scanner at St. Anthony’s remains fully operational allowing us to address the lengthy waiting list for scanning. • The setting up of a nurse-led Methotrexate clinic by clinical nurse specialists Miriam Molloy and Alexia Grier. • Co-ordinated by Dr. Laure Brulhart, musculoskeletal ultrasound is now available within the Bone and Joint unit. Outstanding / Significant Achievements Consultant achievements Prof Barry Bresnihan • Chairman, Arthritis Ireland • Chairman, Subcommittee for Academic Support, Arthritis Research Campaign (UK) • Vice-Chairman, Scientific Coordinating Committee, Arthritis Research Campaign (UK) • Co-Chairman, EULAR Synovitis Study Group • Co-Chairman, OMERACT Synovial Tissue Analysis Study Group • Member Oliver Bird Advisory Body, Nuffield Foundation (UK) • Co-Editor, Concepts of Pathogenesis and Emerging Treatments for Rheumatic Diseases • Chairman, Scientific Session, ISR/BSR • Member International Advisory Bodies Amgen, Abbott, Novartis • Editorial Board: Annals of the Rheumatic Diseases, Journal of Rheumatology, Balliere's Clinical Rheumatology Prof Oliver FitzGerald • Member of HSE working group on Arthritis and Allied conditions representing the Irish Society for Rheumatology • Board member Arthritis Ireland • Steering committee member of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) • Organizing Connor committee member for combined Irish and British Societies for Rheumatology meeting entitled “Advancing Rheumatology”, UCD September • Co-editor for new textbook on “Psoriatic and Reactive Arthritis” • Member of Abbott International Immunology Advisory Board • Invited lecturer • Dept Of Rheumatology, University Of Liverpool, January • International Therapy Update, Monte Carlo, February • Psoriatic Arthritis, Sydney, April • North Shore Jewish Hospital, New York, September Dr Doug Veale • Medical Director, Education & Research Centre, SVUH • Chairman, SVGH Ethics & Medical Research Committee • Member of Medical Executive, SVUH • Postgraduate Programme Committee, UCD • Chairman, Arthritis Action Ireland • HRB ‘Cellular & Molecular’ Review Panel • Irish Medicines Board - Medicines Committee Return to contents St. Vincent’s Healthcare Group Limited BONE • • • • & JOINT UNIT 103 Department of Rheumatology Member of Seed Funding Committee, UCD Co-Editor, E-Medicine Web-based learning tool Advisory Boards – Wyeth Pharmaceuticals, Schering-Plough/Centocor, Novartis, Actelion Invited Lectures – American College of Rheumatology ‘Invited Professor’, Tour of Australia, University of Newcastle Dr Orla Killeen • Steering committee member of Paediatric Rheumatology European Society (PReS) European Training Committee • Member of Wyeth Pharmaceutical Advisory Board • Committee member of British Society of Paediatric and Adolescent Rheumatology (BSPAR) clinical affairs sub-committee • Member of OLHSC Clinical Research Group Grants Differential Expression of VEGF, PIGF and the VEGF receptors in inflammatory arthritis. HRB Project Grant. €165,000. (3 years) Kineret in Psoriasis and Psoriatic Arthritis: A pilot study in 12 patients. Amgen Grant: £80,000 Etanercept in Psoriasis and Psoriatic Arthritis: A pilot study in 15 patients. Wyeth Grant: € 120,000 Efficacy and safety of switching anti-TNF therapies in patients with rheumatoid arthritis. Abbott Grant: € 64,000 Hypoxia-induced mitochondrial signaling pathways in inflammatory arthritis. HRB Translational Award 2006-2011, €1.5m (PI – Douglas Veale) HRB Equipment award €100k (PI – Douglas Veale) Studies of novel cytokines using synovial/cartilage explant cultures. GlaxoSmithKline 2006-08: €750k (PI – Douglas Veale) Novel therapeutic antibody study Cambridge Antibody Technology 2006-07 €100k (PI – Douglas Veale) The role of Notch in regulating angiogenesis HRB Project Grant 2006-2009, €269k (PI – Douglas Veale) Autocure EU 6th Framework Grant ‘Curing Autoimmune Disease – translational approach’ €212500 over 5 years Newman Scholarship (Abbott Immunology) Return to contents Return to contents St. Vincent’s Healthcare Group Limited BONE & JOINT UNIT 105 Department of Rheumatology Publications Matthews C, Rogers S, FitzGerald O. Development of new-onset psoriasis while on anti-TNFalpha treatment. Ann Rheum Dis. 2006 Nov;65(11):1529-30. No abstract available. PMID: 17038454 PubMed - indexed for MEDLINE] Fearon U, Mullan R, Markham T, Connolly M, Sullivan S, Poole AR, FitzGerald O, Bresnihan B, Veale DJ. Oncostatin M induces angiogenesis and cartilage degradation in rheumatoid arthritis synovial tissue and human cartilage cocultures. Arthritis Rheum. 2006 Oct;54(10):3152-62. PMID: 17009243 [PubMed - indexed for MEDLINE] Gardner L, Wilson C, Patterson AM, Bresnihan B, FitzGerald O, Stone MA, Ashton BA, Middleton J. Temporal expression pattern of Duffy antigen in rheumatoid arthritis: up-regulation in early disease. Arthritis Rheum. 2006 Jun;54(6):2022-6. No abstract available. PMID: 16732566 [PubMed - indexed for MEDLINE] Kruithof E, De Rycke L, Vandooren B, De Keyser F, FitzGerald O, McInnes I, Tak PP, Bresnihan B, Veys EM, Baeten D; OMERACT Special Interest Group on Synovial Analysis in Clinical Trials.Identification of synovial biomarkers of response to experimental treatment in early-phase Clinical trials in spondylarthritis. Arthritis Rheum. 2006 Jun;54(6):1795-804. PMID: 16729282 [PubMed - indexed for MEDLINE] Mullan RH, Bresnihan B, Golden-Mason L, Markham T, O'Hara R, FitzGerald O, Veale DJ, Fearon U. Acutephase serum amyloid A stimulation of angiogenesis, leukocyte recruitment, and matrix degradation in rheumatoid arthritis through an NF-kappaB-dependent signal transduction pathway. Arthritis Rheum. 2006 Jan;54(1):105-14. PMID: 16385502 [PubMed - indexed for MEDLINE] Future Plans To make additional appointments in Rheumatology, in particular at consultant and clinical nurse specialist levels. To further develop care pathways in collaboration with Bone and Joint colleagues in Orthopaedic Surgery and Rehabilitation Medicine. To expand musculoskeletal ultrasound services so as to provide ultrasound on a same-day basis. To develop closer links with primary care services with a view to improving the interface between primary and secondary care. Return to contents Annual Review 2006 BONE & JOINT UNIT 106 Department of Rheumatology Department Statistics Admissions 7 Day 5 Day Day Care A/E Other Urgent Total 4 72 414 24 523 9 Discharges Total 523 Day Care St Marks Ward Extra Mural Theatre 5 67 Total OPD Wednesday St Anthony’s 72 New Patients Return Patients Total 213 25 938 5 17 22 Monday Clinic 478 1,207 1,685 Tuesday Clinic 19 2,077 2,096 Wednesday AM Clinic 140 406 546 Wednesday PM Clinic 58 285 343 Thursday AM 47 177 224 Biologic Clinic 1 341 342 Infliximab 17 435 452 Nurse Led 24 37 61 1002 5,707 6,709 Adolescent Clinic Grand Total Return to contents St. Vincent’s Healthcare Group Limited 107 Departmental Review BONE & JOINT UNIT Department of Rehabilitation Medicine Staff Dr. Nicola Ryall, Consultant in Rehabilitation Medicine Dr. Aine Carroll, Consultant in Rehabilitation Medicine Dr. Kit Mun Tan, SpR Dr. Mary Martin, SpR Service Developments/Activities The Department of Rehabilitation Medicine works closely with various other departments to develop the rehabilitation services across the hospital. These include the Departments of Rheumatology and Orthopaedics as part of the Bone & Joint Unit, and Medicine for the Elderly in developing the Stroke Rehabilitation Service, and the Therapy Departments in the early development of a multidisciplinary rehabilitation team with expertise in treating those under aged 65 years. In particular the team provides expertise on assessment and treatment of spasticity, and challenging behaviour in acquired brain injury, as well as indications and use of specialist orthotic devices. Outstanding/Significant Achievements Dr. Ryall was a key-note speaker at a cross – boarder ‘All Ireland Brain Injury conference. She presented at the International Cerebral Palsy conference on multidisciplinary team management of eating disorders, Tampere, Finland. She also participated on national media to inform individuals about the consequences of drink-driving. Dr. Ryall acted as external examiner on a PhD ‘Measuring Functional Mobility in Lower Limb Amputees’ for the university of Nottingham. Dr. Carroll presented a talk on Spasticity to the Irish Heart Stroke Council 9th Annual Conference, The Burlington Hotel, Dublin. She was awarded a merit award for her presentation of “Pilot Multicentre audit of RCP Rehabilitation standards at BSRM/SRR joint Summer meeting, University of Westminster, London. She presented on Paraneoplastic Stroke at the Irish Association of Rehabilitation Medicine, Belfast and UK Stroke Forum in Horrowgate in England. As National Specialty Director for Rehabilitation Medicine, she was very involved in the generation of the 2nd Generation Curriculum for Rehabilitation Medicine. She looks forward to encouraging juniors to the Specialty as a career option. Significant publications Áine Carroll Rehabilitation following acquired brain injury Modern Medicine, The Irish Journal of Clinical Medicine. 2006:36(11);17-21 Review article Departmental Statistics The department has seen a significant growth in service delivery and activity since it was first formed four years ago, with increasing demand on number of inpatient consultation requests; see Figure 1. Of all the patients referred over half are transferred to the National Rehabilitation Hospital for further treatment; see Figure 2. Return to contents Annual Review 2006 BONE & JOINT UNIT 108 Department of Rehabilitation Medicine Figure1. Number of inpatient referrals 2002-2006 90 80 70 60 50 40 30 20 10 0 2002 2003 2004 2005 2006 45 40 35 30 25 20 15 10 5 0 NRH admission Waiting NRH RHD OPD Other service Misc Future Plans The department has plans to develop a Consultant post with special interest in musculoskeletal rehabilitation, to develop a joint neurospasticity team with the Royal Hospital Donnybrook, and to develop the Orthotic service with the Endocrinology department. The department will continue to develop joint treatment protocols and care pathways for patients attending the Bone & Joint Unit. Return to contents St. Vincent’s Healthcare Group Limited 109 Departmental Review BONE & JOINT UNIT Department of Orthopaedics Admin Orthopaedic Dept. Mr. Sean Dudeney Mr. William Quinlan Mr. Brian Hurson Mr. Garry O’Toole Admin. Staff Ms. Jenni Cross Ms. Frances Dwyer Orthopaedic Ward CNM2: CNM1 CNM1 Ms. Gillian Fields Ms. Rachel Hayden Ms. Andrea Marnell Orthopaedic Theatre CNM2: CNM1: CNM1: Ms. Katrina Lennon Ms. Anna Marie Bos Ms. Sarah Cusack Nurse Specialist CNS Plastering & Splinting: Staff Nurse: CNM 2: Staff Nurse: Ann Camlin Josephine Ubas Natalie Landers Deirdre Kelly Fracture Liason Nurse Annette Whelan Mr. Eamonn Kelly Mr. S. Kieran O’Rourke Consultants – in alphabetical order Service Development The opening of the new hospital development allowed the unit to move to new accommodation. This move coincided with formation of the “Bone and Joint Unit” a coming together of the musculo-skeletal specialities under one umbrella including: Orthopaedics, Rheumatology, Orthogeriatrics and Rehabilitation. It is anticipated that this arrangement will provide an efficient and effective vehicle for the delivery of musculo-skeletal services into the future. From an Orthopaedic point of view it has allowed the development of a dedicated fracture clinic area and separate elective orthopaedic clinics, the efficiency of which are greatly enhanced by the adjacency of an on site musculo-skeletal radiology department linked to the clinic by PAC’s, the computerised x-ray system. As a result of this system we have moved from hard copy to digital computer presentation of imaging throughout the department. The package as a whole has significantly improved the patient experience and journey through the department. This year saw the appointment of Mr. Garry O’Toole as Consultant Orthopaedic Surgeon. Mr. O’Toole completed his training in Orthopaedics in Ireland before travelling to America where he worked on a 2year Fellowship in Memorial Sloan Kettering Cancer Hospital in New York and The Mater Hospital in Sydney. While away he developed a sub-specialist interest in Bone and Soft Tissue Tumour surgery and Arthroplasty. He became our sixth Consultant within the Orthopaedic Department of the Bone and Joint Unit in 1996. Return to contents Annual Review 2006 BONE & JOINT UNIT 110 Department of Orthopaedics Department Activity The Orthopaedic department continues to provide a 24/7 acute trauma service for South Dublin, South county Dublin, Wicklow and the surrounding areas, a population of in excess of 360,000. The Trauma serviced is accessed through the Accident and Emergency Departments of St.Vincent’s, St. Colmcille’s and St. Michael’s. patients likely to require surgical intervention or resuscitation are where possible delivered directly to St. Vincent’s accident and emergency. This by-pass policy and reduced working hours of the accident and emergency department at St. Michael’s hospital expedites the patient’s arrival at the point of delivery of definitive treatment where necessary. In total there were approximately 2000 Patients admitted for surgery during the period. Although every effort is made to accommodate these patients on the daily trauma lists a significant number are treated as on call out of hour’s emergencies. It is clear going into the future in order to provide a prompt and safe service more inpatient beds will have to be made available to avoid the unacceptable scenario of patients queuing for acute treatment. Elective non-urgent surgery for patients attending the orthopaedic clinics is carried out at Cappagh National Orthopaedic Hospital. This is a stand-alone elective orthopaedic facility, which allows for the preoperative assessment and scheduling of the patients without the disruption to patients caused by competition from acute nonscheduled admissions. All of the orthopaedic surgeons in the unit are involved in running both fracture and elective clinics in St. Vincent’s. The trauma (fracture) clinics are daily Monday to Friday. In addition to the general orthopaedic clinics there are subspecialty clinics in joint replacement, hand and upper limb held in St. Vincent’s and orthopaedic oncology held in Cappagh. Out-lying trauma clinics are held in both St. Michael’s and St Columcille’s. A total of 12,600 patients were seen at clinics on the St. Vincent’s campus and including the other locations a grand total of 21,000 patients were seen by the orthopaedic dept. over the year. Publications Byrne AM, Kearns SR, Kelly EP. Posterior compartment syndrome with Clopidogrel therapy followinf trivial trauma. Emerg Med. J. 2006.Sept:23(9):697-8 Return to contents St. Vincent’s Healthcare Group Limited 111 Departmental Review Department of Cardiology Activity within the Department of Cardiology increased substantially during the year. While the numbers for acute and elective admissions remained more or less the same the number of patients seen at the cardiology outpatients totalled 4434 – a 7% rise on the previous year. In addition 485 patients were seen at the GP Open Access Clinic, which represents a 37% increase over the previous year. A total of 17,017 non-invasive procedures (6.25% increase) were carried out. The number of procedures carried out in the Cardiac Cath Lab was 2458. The Cardiac Electrophysiology Services became fully developed at SVUH in 2006 with the arrival of Dr David Keane on staff. Dr David Keane was previously the Director of Interventional Cardiac Electrophysiology at Massachusetts General Hospital. The cardiac electrophysiology service at SVUH is focused on advanced catheter ablation techniques of complex arrhythmias and implantable device therapy. The arrhythmia now most commonly ablated at SVUH is atrial fibrillation. The procedure involves percutaneous (through a blood vessel in the leg) electrical isolation of the pulmonary veins under 3-D CT guidance systems – see figure. The provision of advanced catheter ablation techniques has been further enhanced by the return from Massachusetts General Hospital of Dr Jonathon Dodd, Consultant Radiologist. The provision of a comprehensive implantable device service including cardiac resynchronisation therapy and ICD therapy for the prevention of sudden cardiac death has facilitated the further development of the heart failure service under the direction of Dr Ken McDonald. Heart Failure Unit The Heart Failure Unit continues to provide extensive in-patient and out-patient services for those with, or at risk for heart failure in the community. Last year approximately 4000 patients were reviewed in the Heart Failure Unit encompassing regular review of patients post discharge, the provision of an expanding new Diagnostic Clinic for General Practitioners, as well as providing a same day service for patients who become unwell with symptoms of heart failure thereby preventing such patients from attending the Accident and Emergency Department. The clinic continues to be staffed by two Consultant level Cardiologists, one Clinical Registrar, three Clinical Nurse specialists and two Research Nurses (job-share position) and a part-time service from Physiotherapists, Dietician, Pharmacist and Psychologist. In addition to the clinical service the Heart Failure Unit continues to have a strong research focus, both in the clinical arena, where it is one of six European Centres charged with the duty of developing optimal standard of care for an out-patient management of heart failure, as well as in the basic science area with an emerging collaboration with the Conway Institute in University College Dublin. As a result of the above collaboration, the unit has had ten manuscripts accepted for publication in 2006, including publications and Circulation in the Journal of the American College of Cardiology. There were also numerous presentations at International and National Meetings by members of the heart failure staff. Return to contents Annual Review 2006 112 Department of Cardiology Cardiac Rehabilitation The Cardiac Rehabilitation Service continues to offer four phases to patients recovering from a Myocardial Infarction, Percutaneous revascularisation and Coronary Artery Bypass Surgery/Valve procedures. A total of 448 patients were seen at Phase 1 rehabilitation and 248 at Phase II. Kathryn O’Sullivan has finished her Masters in Cardiac Rehabilitation. Marie Minogue, Veronica O’Neill, Claire Kingston and Catherine Lamont attended the joint Irish and British Cardiac Rehabilitation Association conference in Belfast in September. A follow-up study of patients five years after attending Cardiac Rehabilitation is ongoing and the results are being submitted to International meetings. On a sadder note, 2006 witnessed the retirement of two of the longest serving members of our department, Dr. Brian Maurer who was the Director of Cardiology at St. Vincent’s University Hospital for the last 20 years, and Claire McCowen of our secretarial staff, after over thirty years of service. We would like to thank both of them for their contribution to the department over the years and their contribution to its expansion and success. Papers Published in 2006 Cahill J.M., Ryan E, Travers B, Ryder M, Ledwidge M, McDonald K. Progression of Preserved systolic heart function heart failure to systolic dysfunction – A natural history study. International Journal Cardiology 2006; 106; 95 – 102 McDonald K, Conlon C, Ledwidge M. Disease management programs for the heart failure: not just for the ‘sick’ heart failure population. Eur J Heart Failure, 2006 Jul 5. (EPub ahead of print) Conlon C, O’Loughlin C, Ledwidge M, McDonald K. Community direct access for early clinical deterioration: Effectiveness and Impact on the work load pattern of a hospital based heart failure unit.. Disease Management & Health Outcomes. 2006; 14 (3) 188 – 190. Murphy N, McDonald K .An ageing population and increased MI survival rates are contributing to the increased prevalence of heart failure. Cardiology Professional, 2006 Vol 1(2) pg 21 – 24. Karrupiah S, Graham F, Ledwidge M, Conlon C, Cahill J, O’Loughlin C, McManus J, McDonald K. Elevated BNP with normal systolic function in individuals at-risk for Heart Failure: a marker of diastolic dysfunction and clinical risk. Irish Journal of Medical Science 2006; Vol 175 (4) 5 – 13. Murphy N. Diagnosis and management of heart failure. Forum Distance Learning Project – module 103. - Journal: GP Forum 2006 Return to contents St. Vincent’s Healthcare Group Limited 113 Department of Cardiology Papers In Press from 2006 Travers B, O’Loughlin C, Murphy N.F., Ryder M, Conlon C, Ledwidge M, McDonald K. Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. J Card Failure 2006 (In Press). O’Hanlon R, O’Shea P, Ledwidge M, O’Loughlin C, Lange S, Conlon C, Phelan D, Cunningham S, McDonald K. J. The biological variability of B-type natriuretic peptide and N-Terminal pro-B-type natriuretic peptide in stable heart failure patients. J. Card Failure 2006 (In Press). Murphy N, Mockler M, Ryder M, Ledwidge M, McDonald K. Decomposition of chronic Heart Failure associated with Pregabalin in patients with neuropathic pain. J Cardiac Failure 2006 (In Press). Papers published in 2007 (In Press since 2006) Martos R, Baugh J, Ledwidge M, O’Loughlin C, Conlon C, Patle A, Donnelly S, McDonald K. Diastolic Heart Failure: Evidence f increased myocardial collagen turnover linked to diastolic dysfunction. Circulation 2007 Feb 20: 115 (7) 888 – 95 Ponikowski P, Anker S, Szachniewicz J, Okonko D, Ledwidge M, Zymlinski R, Ryan E, Wasserman S, Baker Nigel, Rosser D, Rosen S, Poole-Wilson P, Banasiak W, Coats A, McDonald K. Effect of Darbepoetin alfa on exercise tolerance in anaemic patients with symptomatic Chronic Heart Failure: a randomised, Double-Blind, Placebocontrolled trial. J Am Coll Cardiol. 2007;49: 753 - 762 Return to contents Annual Review 2006 114 Departmental Review Clinical Audit Year-End Report 2006 2006 was the first full calendar year for the Clinical Audit function in SVHG. It has been a productive year with significant pan-organisational audits completed, many individual speciality-based audits completed or in train, multiple educational lectures delivered and a notable cohort of committed individuals conducting audits and improving patient care across the organisation. Organisational co-ordination One of the primary aims of the Clinical Audit function is to collate existing and new Clinical Audit in SVHG. To this end we have logged 33 new or existing audits in 2006. Compiling an audit database is leading to greater joined-up auditing across disciplines and across clinical areas. Equally, completed audits lead to further auditing building a stronger and more comprehensive foundation and coverage of clinical practices. Lastly the database will provide evidence of organisational governance to the board of the hospital and detail to the upcoming accreditation survey in 2007. Education Education on the principles and practices of clinical audit has been readily embraced by many clinical disciplines. Education leads to better quality and more effective auditing with greater emphasis on improving patient care. Judge Harding Clarke’s observation on the confusion of audit and statistics gathering is unfortunately still relevant to SVHG. This is an area that will continue to receive attention in 2007. Clinical Audit interactive lectures were delivered to • Nursing • The Therapies Group • Anaesthetic Dept. • The intern tutorials and many others • Pharmacy • The Clinical Services Group in SVPH • Laboratory staff group in SMH These sessions cover the rationale and external drivers influencing good clinical audit, the principles and practice of audit, the differentiation between audit and research and examples of clinical audit relevant to the speciality group in question. It has been my experience that these sessions have the added benefit of stimulating one or more clinical staff to begin audits in their daily practice. Continuing education programmes will always be a part of the constant development of clinical audit within the hospital setting and will be a priority in 2007. There are two distinct phases to this educational process; firstly the continual opportunistic possibility of providing education to those groups who have not yet availed of the opportunity and secondly the following-up of those who, having attended the initial education and carried out a clinical audit are interested in expanding their audit horizons and abilities. A significant amount of material has been saved to the intranet for access within the hospital campus. Copies of all lectures, relevant international publications and articles from the literature are presented to give hospital staff (both clinical and administrative) an introduction and further reading on the topic. A leaflet on clinical audit and the practical considerations was compiled during 2006. Copies of this leaflet have now been adopted and adapted by other clinical audit functions across Ireland, once again positioning SVHG as a leader in the field. As St Vincent’s is the only DATHs hospital with a clinical audit function, we have been asked to lecture to postgraduate students in the RCSI on the issues surrounding clinical audit and the practical application of learning in this field. Return to contents St. Vincent’s Healthcare Group Limited 115 Clinical Audit Year-End Report 2006 Presentations During the year, the clinical audit department stimulated and encouraged many staff to present their audit findings at in-house meetings (for instance the launch of the accreditation programme) and at their own relevant national speciality meetings. These poster presentations had a dual role; helping staff to see, in condensed format, the process of clinical audit, and encouraging staff to share their experience of clinical audit with their peers. A useful by-product of this approach has been the increased visibility and acceptance of clinical audit across the clinical specialities. Clinical audit has also persuaded and supported practitioners in sending abstracts to international conferences. While none of these submissions have been so far successful, the learning experience has spurred authors to greater heights in performing clinical audits. Staffing The clinical audit function was successful in filling the second WTE with two skilled and effective part-time personnel. Nora Ellard joined us from the world of finance and Mary Dillon, a nurse with extensive experience in auditing the methadone programme in primary care, has recently joined us from the Irish College of General Practitioners. We will be in a strengthened position to provide more support to practitioners on an ongoing basis. This support will include increased opportunity to advise and help clinical staff in conducting audits. We have also adopted or installed several software packages that will ease the collection, reporting or tracking of audit data and reports. Integration Integration of the three hospital sites is a key goal of the clinical audit department. To this end, we have been working closely with both practitioners and managers in St Vincent’s Private Hospital and St Michael’s in Dun Laoghaire. Both hospitals have conducted clinical audits, some of which have been presented at national conferences. St Vincent’s Private hospital was well represented at the launch of accreditation and our last international speaker delivered a focused lecture to the staff in St. Michael’s. Internal quality assurance Clinical audit was audited itself by the internal audit function during the year. All the recommendations suggested have been implemented or targeted for implementation in the coming months. For instance all clinical audit reports will be tracked with a document management system being currently rolled out and the revised terms of reference for the audit committee will be completed shortly. Return to contents Annual Review 2006 116 Clinical Audit Year-End Report 2006 Loop closure Disseminating clinical audit reports was always going to require ongoing refinement to ensure maximum learning and sharing of information through the organisation. Following discussions with the different committees and stakeholders, better solutions to this are being implemented on a continuing process. Reports are forwarded to the Group executive, the Medical Executive and the Clinical Governance Committee. Audit reports will also be presented to the Medical Executive on a monthly basis in summary form. Additional distribution for specific audit reports is decided on a case-by-case basis during the Audit Committee meetings to ensure the maximum dissemination of audit findings. Clinical Audit Function Audit data/ Audit lead/ Audit sponsor Audit report Clinical Audit Committee Nursing Executive Clinical Governance Committee Hospital Board Medical Executive Group Executive Return to contents St. Vincent’s Healthcare Group Limited 117 Clinical Audit Year-End Report 2006 Grant applications The role of clinical audit in supporting and, in some cases, stimulating funding applications to national bodies has been successful with a large grant to one speciality arising directly out of a direct communication of funding opportunities. Equally, four other detailed but ultimately unsuccessful applications were made to HIQA from St Vincent’s for funding in 2006. Continuing profile building and branding With the significant support of the clinical audit committee and of the CEO, clinical audit ran a successful masterclass during the summer with a faculty of significant senior leaders in the medical and nursing world addressing a large audience of hospital and national healthcare workers on various topics. A programme of visiting international speakers was then started which has, and will continue to be instrumental in incorporating the latest technical and strategic opinions on clinical audit, quality improvement and clinical measurement into the daily practices of St Vincent’s Healthcare Group. In the same vein, but within a different context, we were able to welcome the new CEO of HIQA to St Vincent’s shortly after her appointment to address the staff and the clinical governance committee. Lastly, the clinical audit committee has been an extremely valuable asset to the clinical audit function in the healthcare group. The knowledge, expertise and insight of the committee members as well as their continued drive to support and foster clinical audit has made the first calendar year of the clinical audit function a worthwhile and rewarding accomplishment and I look forward to the advancement of clinical audit across the three sites in 2007. Return to contents Annual Review 2006 118 Departmental Review Department of Dermatology The Department of Dermatology at St Vincent’s University Hospital, together with the City of Dublin Skin & Cancer, Hume Street and St Michael’s Hospital, Dun Laoghaire, together provided dermatology services for patients living in Dublin South-East and Wicklow until the 30th of October 2006. On that day, Hume Street Hospital closed and, since then, the service at SVUH has expanded considerably. Staff Medical Consultants Specialist Registrar (LAT) Registrars Nursing Clinical Nurse Specialist Staff Nurse Clinical Nurse Manager II Dr Sarah Rogers Dr Grainne O’Regan Dr Sinead Field Dr Paul Collins Dr Brian Kirby Dr Ros Hughes Ms Sheila Ryan Ms Nicola Mahon Ms Nora Tracey (FROM NOV) +14 Staff Nurses +1 Nurse’s Aide + Administrative Assistants Ms Eileen Cusack Ms Caroline Lehane Ms Brenda Harte (half time) * (FULL TIME) * FULL TIME FROM NOV Activity In Patient Urgent admissions came through the Accident and Emergency Department under the care of the physician on call. There were seven urgent admissions for conditions including erythrodermic psoriasis, pyoderma gangrenosum and bullous pemphigoid. We also looked after in patients who were in hospital under care of other physicians where skin disease constituted a significant part of their care plan. A total of 448 in patient consultations were seen in 2006, 386 at SVUH and 62 at SMH. Day Care Extramural Theatre Day case surgery, predominantly for non melanoma skin cancer and atypical melanocytic naevi, was performed for 155 patients in EMT. Many had more than one lesion excised. St Mark’s Ward There were 25 patient episodes for IV infusions of infliximab and immunoglogulin, and for phlebotomy as day cases. Dermatology Day Care Unit Phototherapy remained non operational at SVUH throughout 2006 and patients requiring this treatment were treated at Hume Street Hospital until its closure at the end of October. Six hundred and eighty five received various treatments including cryotherapy, dressings, topical therapy, balneotherapy and, also, patient education. Return to contents St. Vincent’s Healthcare Group Limited 119 Department of Dermatology Out Patient Clinics (SVUH & SMH) There were 167 clinics at which 3,901 patients - 1,509 of whom were new referrals - were seen, with approximately two thirds at SVUH and one third at SMH. During clinic time, various investigation and treatment was carried out which included cryotherapy, punch biopsy, four-layer bandaging, wart dressings/ treatments, wound care and light cautery for macrocomedones. Hume Street Hospital remained open until 30th October and clinics and day care activity continued until then. Approximately 200 clinics were conducted in which 4,000 patients were seen, 400 of whom were new referrals. Patients were referred from SVUH and SMH for phototherapy (NB-UVB and PUVA), photodynamic therapy and patch testing. This generated over 10,000 patient episodes. Academic activity Conferences attended Dr Rogers Psoriasis Gene to Clinic meeting, London American Academy of Dermatology annual meeting, San Francisco Irish Association of Dermatologists Spring and Autumn meetings British Association of Dermatologists annual meetimg, Manchester Dr Collins Irish Association of Dermatologists Spring and Autumn meetings Contact Dermatitis course, London Consultants’ Update course, London Dr Kirby Irish Association of Dermatologists Spring and Autumn meetings British Association of Dermatologists, Manchester Psoriasis Meeting, Berlin Publications Ahmad K, Rogers S. Three years’ experience with infliximab in recalcitrant psoriasis. Clin Exp Dermatol 2006; 31: 630-3. Ahmad K, Rogers S. Two years experience with etanercept in recalcitrant psoriasis. Br J Dermatol 2007; 156: 1010-4. Langan SM, Collins P. Photocontact allergy to oxybenzone and contact allergy to lignocaine and prilocaine. Contact Dermatitis 2006; 54: 173-4 Langan SM, O’Brien A, O’Riain C, Collins P. Nodule on the penis – quiz case. Arch Dermatol 2006; 142: 515-20. Hughes R, Harries M, Chalmers RJ, Kirby B. Folic acid supplementation and methotrexate therapy for psoriasis. J Am Acad Dermatol 2006; 55: 366-7. Return to contents Annual Review 2006 120 Department of Dermatology O’Kane M, Murphy EP, Kirby B. The role of corticotrophin-releasing hormone in immune-mediated cutaneous inflammatory disease. Clin Exp Dermatol 2006; 15: 143-53. Presentations 2 years experience with etanercept for recalcitrant psoriasis. K Ahmed, S Rogers. Poster presentation at the Psoriasis Gene to Clinic meeting in London, January 2006. The role of corticotrophin-releasing hormone in immune-mediated cutaneous inflammatory disease. O’Kane M, Murphy EP, Kirby B. Oral presentation at the American Academy of Dermatology (AAD), Registrar’s Forum, and winner of the Everett C Fox Award. Dermatitis Artefacata in Paediatrics, a series of eleven cases Dr R Hughes, Dr A Irvine, Dr B Kirby Poster presentation at the Irish Association of Dermatologists (IAD) meeting April 06 Poster presentation at the British Association of Dermatologists (BAD) meeting, July 2006 The use of Alternative Medicine in Paediatric Patients with Atopic Dermatitis Dr R Hughes, Dr AM Tobin, Dr B Kirby. Poster presentation at the IAD April 06 Poster presentation at the BAD July 06 Poikoilodermatous Subacute Cutaneous Lupus Erythematosus. Dr R Hughes, Dr Brian Kirby. Oral presentation at the BAD meeting, July 2006 Solar Urticaria successfully treated with intravenous immunoglobulin. R Hughes, G Murphy, B Kirby. Oral presentation at the IAD meeting September 2006 Accepted for presentation at the AAD meeting, February 2007 The treatment of pyoderma gangrenosum in the septic patient. R Hughes, J Hyland, K Sheehan, D O’ Donoghue, B Kirby, P Collins. Oral presentation at medical grand rounds SVUH, October 2006 An unusual cutaneous presentation of sarcoid. S Field, S O’Loughlin, Y Mc Donnell, S Rogers. Oral presentation at the IAD meeting, September 2006 Dermatitis artefacta. S Ryan Oral presentation at the Irish Dermatology Nurses meeting, April 2006. (Ms Ryan was the Conference Organiser for this meeting). Cryotherapy Workshop. S Ryan British Dermatology Nurses Conference, Manchester, July 2006 (Ms Ryan was the Module Organiser and Chair) What’s new in psoriasis? S Rogers Primary Care Dermatology Society, Athlone, November 2006 Return to contents St. Vincent’s Healthcare Group Limited 121 Department of Dermatology Appointments Dr Kirby took up his post as Consultant Dermatologist at SVUH in January 2006. Dr Rogers is the Ireland representative on the Board of the European Academy of Dermatology and Venereology. Ms S Ryan is Hon Secretary to the Irish Dermatology Nurses’ Association. From January to June, she was Irish representative to the British Dermatology Nursing Group (BDNG). From July 2006, she is Secretary-Elect to the BDNG. Achievements Dr Marina O’Kane was awarded the Everett C Fox Prize at the Residents’ Forum at the American Academy of Dermatology in San Francisco, February 2006 Ms S Ryan was conferred with an MSc in Nursing Studies (Advanced Practice) In November 2006. Return to contents Annual Review 2006 122 Departmental Review Department of Emergency Medicine Introduction The highlight of the year was undoubtedly the move into our new purpose built Emergency Department in January 2006. The move was achieved efficiently due to the immense co-operation of our colleagues in all departments within the hospital. The move should have allowed us to manage our patients in a more efficient manner and with more dignity and privacy but this was to a large extent compromised by the continuing challenge of departmental overcrowding secondary to admission delay. This has become the main challenge facing all Emergency Departments in the country and will need prompt and innovative action. Service developments The new Emergency Department has allowed us to further develop our concept of “streaming” where each patient can be assigned to a pathway of care depending on their acuity and probable diagnosis. The streaming is initiated at Triage and Rapid Assessment and Treatment (RAT). This area continues to show its value and continues to be strengthened each year. Patients are seen in specific resuscitation, high dependency or ambulatory areas Zones 1, 2 or 3, depending on their acuity and can be further streamed to chest pain, respiratory or thrombo-embolic disease or Clinical Decision Unit as appropriate. The Emergency Department Task Force was set up to reduce Emergency Department wait/ volume capacity/ and optimise patient processing. This allowed the hospital to highlight all the initiates that have been undertaken for admission avoidance in conjunction with other specialities. A weekly clinic to evaluate patients with Transient Ischaemic attacks continues to be very active. Patients with uncomplicated Deep Vein Thrombosis are managed as out-patients. Networking with Rheumatology, Neurology and Gastroenterology has facilitated discharge with focused follow up speciality clinics. Links with the Respiratory and Cardiac Failure Units in St. Michael’s Hospital has allowed direct admissions from the Emergency Department. The Slán Abhaile programme with care for the elderly has allowed early discharge of appropriate patients with community support. These initiatives are further enhanced by the Emergency Departments Chest Pain Evaluation Unit and the Clinical Decision Unit. We are strongly of the opinion that to further enhance patient care the “streamed” pathways of care must continue into the main hospital and can only be achieved by speciality specific admissions combined with the enhancement for care for the elderly and the establishment of a stroke unit with a stroke neurologist and adequate rehabilitation facilities. This will be one of our priorities for the coming year. Publications and presentations Book Chapter Headache J Ryan A Murray Textbook of Paediatric Emergency Medicine. Authors: AM Kelly, P Cameron, G Jelinek. Churchill Livingstone 2006 ISBN 0443073481 Publication Evaluation of the albumin cobalt binding (ACB) assay for measurement of ischaemia-modified albumin (IMA) on the Beckman Coulter LX-20 O Maguire, J O Sullivan, J Ryan, S Cunningham Ann Clin Biochem 2006: 43 494-499 Return to contents St. Vincent’s Healthcare Group Limited 123 Department of Emergency Medicine Scientific Presentations Real Time Information Technology for ED Patient Care: EDIS – Can computers help us to care for patients ? J Ryan Presented at the 10th International Conference on Emergency Medicine June 2006 Availability of Antidotes in Irish Emergency Departments D Menzies, J Ryan Presented at the 2006 Irish Emergency Medicine Association Scientifc Meeting Temporal Trends in Admissions through a University Hospital ED over 20 years 1985-2005 D Menzies, J Ryan Presented at the 2006 Irish Emergency Medicine Association Scientifc Meeting Pain Management in the Emergency Department: a structured approach to quality improvement N Collins, S Kuan, I Callinan, J Ryan, R. McQuillan, D Barton Presented at the 2006 Irish Emergency Medicine Association Scientific Meeting The End of the Line? Comparison of the Visual Analogue Scale with the Verbal Numerical Rating Scale as Pain Assessment Tools in Emergency Department H Mohan, J Ryan, B Whelan, A Wakai Presented at the 2006 Irish Emergency Medicine Association Scientific Meeting A six-month Evaluation of an Emergency Department Clinical Decision Unit in an Urban Teaching Hospital A Nayeem, S O Connell, J Ryan, D Barton Presented at the 2006 Irish Emergency Medicine Association Scientific Meeting Statistics The total number of patient attendances in the Emergency Department was 39,502. The total number of patients that were admitted through the Emergency Department was 9,356. Future Plans Our emphasis for the coming year will be to try and improve patient throughput and clear the departmental blocking induced by admission delay. This will be combined with extending patient streaming into the hospital with speciality specific admissions. We will continue to work towards a fully integrated regional plan for South East Dublin. Return to contents Annual Review 2006 124 Departmental Review Department of Endocrinology and Diabetes Mellitus Staff Consultants: Lecturers: Specialist Registrars: Registrars: Research Registrar: Secretary: Professor T.J. McKenna, Dr Malachi McKenna, Department of Medicine, U.C.D./ Locum Consultants: Dr Deirdre Blake Dr Shazli Yusof, Dr Conall Dennedy Dr Tomás Ahern, Dr Maeve Hutchinson Dr Tom Cawood Geri Daly Dr Donal O’Shea Dr Marie-Louise Healy Diabetes Centre Nurses: Deirdre Gleeson Nora Collis, Phil Shankey Joanne Kildunne Claire Dingle Dietician: Maeve Moran Carmel Quinn Primary Care Liaison Team: Deirdre Hall, Diabetes Nurse Specialist Secretarial Staff: Fiona Whelan Patricia Sinnott Catherine Brady. Moira Haran Jean O’Brien Yvonne Ryan, Dietician Joyce Doyle Endocrine Laboratory Principal Biochemist: Senior Medical Scientist: Acting Senior Medical Scientists: Locum Biochemist: Laboratory Aide: Dr. Tom Smith Ms. Anne Dickinson Ms. Martina Cassidy, Monika Biniecka Mr. Paddy Doran Mr James Connolly Amy Wallace Research-Graduate Students: Lucille Kavanagh. Weekly Departmental Academic Events Diabetes Team Meeting - Monday lunchtime Endocrine Conference - Tuesday Noon Departmental Journal Club - Friday – 11.00 a.m. Laboratory/Research Meeting - Monday - 2.00 p.m. Multi-Disciplinary Thyroid Cancer Group Meeting (Quarterly) Out-patient Clinics 3 Diabetes Clinics per week 1 Joint Endocrinology Clinic (Prof. McKenna and Dr. O’Shea) Weekly multidisciplinary group education sessions for newly diagnosed patients with Type 2 diabetes. Monthly Patient Group Education Session on cholesterol management and diet. Quarterly Group Education Sessions for patients with newly diagnosed impaired glucose tolerance. Endocrine Clinical Services The Endocrine Team provides a comprehensive out-patient and in-patient consultation service. By its nature, the combined Endocrinology/Diabetes Service is predominantly out-patient orientated with the essential goal of avoiding hospital admission and this is particularly the case in avoiding the long-term complications of diabetes mellitus. The out-patient facilities have been greatly advanced by movement to the very fine Day Care facilities. The Return to contents St. Vincent’s Healthcare Group Limited 125 Department of Endocrinology and Diabetes Mellitus move from crowded open plan configuration in the previous out-patient facilities to individual consultation room for each patient has been greatly appreciated by patients and staff alike. Diseases of the thyroid constitute one of the most frequent endocrine referrals nationwide. The development of a quarterly Multi-Disciplinary Team Meeting, Medical Endocrinology, Surgical Endocrinology, Histopathology, Radiotherapy and Radiology) ensures the provision of a co-ordinated service working to approved international guidelines. At this conference patients who have been reviewed by any of the groups are presented and their management discussed and presentations and key aspects of the management of thyroid cancer are reviewed. The Endocrine Team provides a national consultation service in the areas of reproductive endocrinology, adrenal disease, obesity, hypoglycaemia, calcium metabolism and metabolic bone disease. Endocrine Laboratory In May 2006 the Endocrinology Laboratory moved to the 3rd Floor of the new clinical services building. The excellent new facilities provide a state of the art physical environment with welcome additional office space. The year has also seen an overall workload increase of 12%. The laboratory provides regional and, to some extent, national referral centre for the measurement of steroid hormones. This laboratory particularly supports the Endocrine Services specialized provision of care in the areas of reproductive endocrinology and adrenal disorders. Mr Paddy Doran, Laboratory Aide, retired in 2006 after many years of service to this hospital and the Endocrine Laboratory. Diabetes Service The Diabetes Service was initially located on an improvised base in areas which had been converted from other purposes, inappropriate in configuration and inadequate in size. The move to the new Diabetes Centre has been the outstanding development for Diabetes Services in this hospital since the inception of a co-ordinated team approach over twenty years ago. There is now available for the first time adequate space for the nurses, dieticians, secretarial staff and doctors to provide a comprehensive ongoing personalized service required in the provision of modern diabetes care. The goal of the service is to keep well patients well through the linked processes of information, education, counseling and empowerment. The Diabetes Service is probably unique in the extent to which the patients play the central role in the management of frequently complex situations. This service is supported by time committed to telephone contact with patients and the provision of various individual and group educational sessions. For patients who require insulin, there is the “Dose Adjustment For Normal Eating” (DAFNE) programme. This is a detailed continuous five day course for small groups of patients to empower them to tightly link insulin adjustment with carbohydrate intake, exercise and general health status to ensure tight blood glucose levels with the aim of avoiding long-term diabetes complications, while at the same time avoiding the serious consequences of low blood glucose levels, hypoglycaemia. The new Diabetes Centre in the Day Care facility provides the infrastructure on which there will be further comprehensive development of specialized clinics e.g. new patient, young patient, foot and insulin dose adjustment. The Shared Care Programme in which a group of General Practitioners work in partnership with the Diabetes Centre to agreed treatment protocols and facilitated by Liaison Diabetes Nurse Specialists and Dieticians, has expanded further this year. This programme at once expands the base and the provision of expert diabetes care, facilitates the provision of that care nearer to the patient’s home and relieves demands on the hospital based Diabetes Service. Return to contents Annual Review 2006 126 Department of Endocrinology and Diabetes Mellitus Research Projects Macroprolactin (Lucille Kavanagh) Lucille Kavanagh is supported by a grant from the Health Research Board to support her elucidation of the nature of macroprolactin. Prolactin is a hormone which comes from the pituitary gland. High levels of prolactin is the underlying cause in approximately 25% of patients who present with failure of ovulation. This affects approximately 12% of all women. Our studies have highlighted the fact that the laboratory finding of approximately 10-20% of measurements indicating high levels or prolactin may be misleading. This is due to the presence of macroprolactin. Macroprolactin is a form of prolactin which, although measured in the assays, is not active in patients. This department has previously published extensively on laboratory techniques which may eliminate macroprolactin and also on the clinical consequences of failure to undertake routine screening for macroprolactin. While routine screening is generally undertaken in Ireland as a consequence of this laboratory’s research and in 80% of laboratories in the United Kingdom and to a lesser extent in Europe, screening is the exception rather than the rule in the United States. Further publications from this laboratory in the leading American laboratory and clinical journals is attempting to address this situation. The renowned Mayo Clinic laboratories have recently announced the provision of a service which screens for macroprolactin. In launching the service, the Mayo Laboratories Communique cited six scientific articles, four of which were from this department. Although clinical observations have been consistent with the concept that macroprolactin is not active in the body, laboratory bioassays have indicated that macroprolactin retains bioactivity. The classical bioassay for prolactin uses Nb2 cells derived from rat lymphoma which have been shown to multiply when exposed to prolactin. When macroprolactin was added to Nb2 cells, multiplication occurred over a period of 72 hours. Lucille Kavanagh has now demonstrated that during incubation with the cells, the prolactin/antibody complex dissociates freeing up prolactin in its active state, monomeric, and thus provides bioactive prolactin. This explains why macroprolactin appeared to be bioactive in the Nb2 cells and indiates that this bioassay is inappropriate for macroprolactin. In further studies, Lucille Kavanagh has demonstrated that while macroprolactin is usually due to a combination of prolactin and an antibody to prolactin, it is not associated with other disorders associated with the production of antibodies against normal body tissues i.e. autoimmunity. Thyroid Eye Disease (Dr T Cawood & Dr D O’Shea) Dr Cawood has continued his studies on the potential role of anti-cytokine therapies in thyroid eye disease, and has also investigated the link between smoking and thyroid eye disease. This in vitro work, funded by a Clinical Research Training Fellowship from the Health Research Board, has suggested that Interleukin 1 may be an attractive therapeutic target as Interleukin promotes numerous pathological processes in thyroid eye disease (including inflammation, glycosaminoglycan production and adipogenesis). Interleukin 1 also acts in synergy with cigarette smoke extract to promote adipogenesis, which may help explain why smoking worsens thyroid eye disease. Dr Cawood was awarded the O’Donovan Medal by the Irish Endocrine Society, and the Novartis Endocrinology Registrar Research Medal for this work and will be submitting his Ph.D. thesis in 2007. Obesity Research Group (Dr Lydia Lynch, Dr Jean O’Connell & Dr O’Shea) Laboratory work is underway investigating the metabolic and immunological links between obesity and its consequences, such as type 2 diabetes and non-alcoholic fatty liver disease. A Newman Scholar post is being funded by Sanofi-Aventis, and the Diabetes Federation of Ireland and the Medical Research Charities group have recently awarded funding for a 3-year project entitled ‘Adipocyte size and type 2 diabetes; a study of patients undergoing bariatric surgery’. Dr O’Connell has been awarded a HRB training fellowship to persue this project. Return to contents St. Vincent’s Healthcare Group Limited 127 Department of Endocrinology & Diabetes Mellitus Clinical Studies (Dr M L Healy, Dr D Blake, Dr T Smith) For the last ten years that Endocrine Laboratory has screened all blood samples with an elevated prolactin level for the presence of macroprolactin. When macroprolactin was found to account for hyperprolactinaemia, the interpretation was made that when corrected for the presence of macroprolactin, the prolactin level was normal. We have now commenced a study to review the subsequent clinical course of patients whose doctors received this result and interpretation. Questions to be addressed include what additional investigations were undertaken for these patients? What treatments did they received? What were the final diagnoses? What was the final diagnosis? Achievements and Distinctions Professor T J McKenna completed his three year term as President of the Royal College of Physicians of Ireland in October 2006. He has been appointed Chairman of the Irish Committee for Higher Medical Education. Professor McKenna is a member of the Editorial Boards for the journals Clinical Endocrinology (Oxford) and The Endocrinologist (United States). He is a member of the Student Affairs Committee of the Endocrine Society (United States). Dr Donal O’Shea is Secretary of the Irish Endocrine Society. He is a member of the National Taskforce on Obesity and Chairman of the Detection and Treatment Subgroup. Dr O’Shea is Chairman of the Nutrition Council of the Irish Heart Foundation and Chairman of the St Vincent’s Healthcare Group, Drugs and Therapeutics Committee. Dr O’Shea is a member of the Council of the Royal College of Physicians of Ireland. Dr O’Shea has been awarded a project grant (€180,000) over three years from the Diabetes Federation of Ireland and the Medical Research Charities for a project entitled ‘Adipocyte size and type 2 diabetes; a study of patients undergoing bariatric surgery’. Dr Tom Cawood, Research Fellow, working under the direction of Dr Donal O’Shea was awarded the O’Donovan Medal, 2006, by the Irish Endocrine Society for the presentation entitled ‘Smoking and Thyroid Eye Disease; a Novel Explanation of the Biological Link’. In addition, Dr Cawood was awarded the Novartis Endocrinology Research Medal, 2006, for the presentation ‘Cytokines and cigarette smoke; potential therapeutic targets in thyroid eye disease’. Dr Malachi McKenna is a member of the Editorial Board for the journal, Osteoporosis International. Dr Marie-Louise Healy was appointed Consultant Endocrinologist in St James’s Hospital. Ms Phil Shankey was awarded a Higher Diploma in Diabetes from University College Dublin. Ms Joanne Kildunne was awarded a BSc. in Nursing Management from the Royal College of Surgeons. Ms Joanne Kildunne, Diabetes Nurse Specialist, Ms Maeve Moran, Dietician and Dr Donal O’Shea were awarded an Innovation Award, 2006, for Multi-disciplinary Team work for their successful establishment of the DAFNE Programme in St Vincent’s University Hospital. Return to contents Annual Review 2006 128 Department of Endocrinology & Diabetes Mellitus Conferences/Courses/Meetings Attended National Cystic Fibrosis Meeting in Killarney, 3rd-6th February 2006. Annual Abracadabra Diabetes Nursing Conference, London, 3rd–6th March 2006. Diabetes Federation Study Day, Croke Park, Dublin, 10th March, 2006. Irish Endocrine Society Continuing Education Study Day, Dublin, 20th March 2006. Diabetes Technology, Boston. April 2006. Diabetes Federation of Ireland. 10th–19th May 2006. Capetown and Kalahari Desert Trek. The team included Nora Collis, Diabetes Nurse Specialist and Dr Conall Dennedy, St Vincent’s University Hospital. Link Nurse Study Day, 24th May 2006. Held in conjunction with Abbott Laboratories, biochemistry and The Diabetes Centre Staff. Education Session for Staff in Cheverstown. 14th June 2006. The Endocrine Society’s 88th Annual Meeting, Boston, U.S.A. 24-27th June 2006. DAFNE – Collaborate Annual Meeting, Manchester. 6th July 2006. DAFNE Collaborative Meeting, Manchester. 7th July 2007. Nutrition & Diabetes in Patients with Cystic Fibrosis given by Nora Collis and Olive Tully, Dietitian. Diabetes Federation of Ireland – Kids Camp in Bundoran, Co Donegal. 18th–20th August 2006. Joanne Kildunne attended as part of the medical team. Diabetes Nurse Specialist A.G.M. Castletroy Park Hotel. 29th September 2006. American Society for Bone and Mineral Research. Philadelphia, U.S.A. September 2006. Association of Clinical Biochemists in Ireland Annual Meeting, Dublin, 20-21st October 2006. Irish External Quality Assessment Scheme Annual Participant’s Conference, Dublin. 4th October 2006. Irish Endocrine Society 31st Annual Meeting. Galway, 3-4th November 2006. Certified Pump Trainer Course (Medtronic Insulin Pump). Dublin. 23rd November 2006. International Diabetes Federation Conference in Capetown, South Africa. 3rd-7th December 2006. Publications Abuzakouk, L. Barnes, N. O'Gorman, M. J. McKenna, R. Freaney, C. Feighery Dermatitis Herpetiformis: No Evidence of Bone Disease Despite Evidence of Enteropathy. Digestive Disease Sci (in press). Cawood TJ, McKenna MJ, Gallagher CG, Smith D, Chung WY, Gibney J, O’Shea D. Cystic fibrosis-related diabetes in adults. Ir Med J 2006; 99: 83-86. Cawood T, Moriarty P, O'Farrelly C, O'Shea D. Smoking and thyroid associated ophthalmopathy; a novel explanation of the biological link. J Clin. Endocrinol. Metab. 2006; In press. (epub 17tth October) PMID: 17047020 Cawood TJ, Moriarty P, O'Farrelly C, O'Shea D. The effects of TNF· and IL1 on an in vitro model of thyroid associated ophthalmopathy; contrasting effects on adipogenesis. European Journal of Endocrinology 2006 Sep; 155(3):395-403 PMID: 16914593. 16700261. Return to contents St. Vincent’s Healthcare Group Limited 129 Department of Endocrinology & Diabetes Mellitus Healy ML, Smith TP and McKenna TJ. Diagnosis, Misdiagnosis and Management of Hyperprolactinaemia. Expert Reviews in Endocrinology and Metabolism, Volume 1 Number 1: 123-132, 2006. Kavanagh L, McKenna TJ, Fahie-Wilson MN, Gibney J and Smith TP. Specificity and Clinical Utility of Methods for the Detection of Macroprolactin. Clinical Chemistry, 52:1366-1372, 2006. Kelleher FC, McKenna M, Collins CD, Crown JP. A potential anatomic cause of mandibular osteonecrosis in patients receiving bisphosphonate treatment. Mayo Clinic Proceedings 2007; 82: 133-135. Kelleher F, McKenna M, Collins C, Brady G, Collins I, Crown J. Bisphosphonate induced osteonecrosis of the jaws: Unravelling uncertainty in disease causality. Acta Oncologica (in press). McKenna MJ. Paget’s disease of bone. Osteowise 2006; 2(3): 9-14. McKenna MJ. Osteoporosis: A complex case study – management issues. Forum Focus; 2006; 6(10): 11-15. Smith D, Crotty TB, Murphy JF, Crofton ME, Franks S, McKenna TJ. A steroid cell tumour outside the ovary is a rare cause of virilization. Fertility and Sterility 85 (1); 227-229: 2006. Smith T P, Kavanagh L, Healy M L, McKenna T J. Technology Insight: measuring prolactin in clinical samples. Nature Clinical Practice: Endocrinology & Metabolism (3); 279-289: 2007. Waterhouse DF, McLaughlin AM, O’Shea D. There is a correlation between normal range TSH concentrations and cardiovascular risk parameters – a study in healthy women Thyroid 2007;17. Abstracts Cassidy M, Smith TP, Barrett N and McKenna TJ. Haemoglobinopathies may lead to grossly inaccurate reporting of HbA1c levels. Irish Journal of Medical Science, Volume 175 Number 4 Supplement 2: 35, 2006. Cawood TJ, Moriarty P, O'Farrelly O, O'Shea D. Interleukin 1: the Optimal Cytokine Target in Thyroid Associated Ophthalmopathy? European Congress of Endocrinology, Endocrine Abstracts April 2006, Vol. 11, OC58. Cawood TJ, Moriarty P, O'Farrelly O, O'Shea D. Smoking and Thyroid Eye Disease, a Novel Explanation of the Biological Link. Irish Journal of Medical Science, Nov 2006, Vol 175, No 4, Suppl 2. OC6. Draman MS, Ahern T, Smith TP and O’Shea D. Selective intra-arterial calcium stimulation with hepatic venous investigation of hyperinsulinemic hypoglycaemia. Irish Journal of Medical Science, Volume 175 Number 4 Supplement 2: 40, 2006. Hutchinson M, O'Shea D & Cawood TJ. The unrecognised use of alternative treatments for thyroid disorders. Irish Journal of Medical Science, Nov 2006, Vol 175, No 4, Suppl 2, P34. Kavanagh L, Smith TP and McKenna TJ. The Nb2 bioassay is unsuitable for assessing the bioactivity of macroprolactin. Irish Journal of Medical Science, Volume 175 Number 4 Supplement 2: 38, 2006. McKenna TJ, Kavanagh L, Fahie-Wilson MN, Gibney J and Smith TP. Specificity and Clinical Utility of Methods for the Detection of Macroprolactin. The Endocrine Society’s 88th Annual Meeting, Boston, 24-27th June 2006, Poster P2534. Return to contents Annual Review 2006 130 Departmental Review Liver Transplant Programme & Liver Unit The year 2006 was the most successful year to date in the National Liver Transplant Programme (NLTP). A total of 65 liver transplant procedures were performed during the year, a significant increase on the 57 transplants performed the previous year. Over the past five years there has been a significant increased demand for liver transplantation. The NLTP has now performed more than 465 transplants on 400 patients. The overall success rate in the transplant programme is 84%. For the 62 first time transplant patients in 2006 the one year actuarial survival was 91.7% which is in keeping with the best rates achieved in large liver transplant units in the United States and Europe. Organ donation continued at a very satisfactory level during 2006. Ireland is in an almost uniquely favourably position in relation to organ donation. Most transplant units throughout Europe and the United States are struggling to maintain adequate service in the face of decreasing organ donations. We are extremely fortunate to have a population who are well disposed to the concept of organ donation at a time when bereavement and great personal distress. The success of the NLTP over the past 14 years has resulted in an ever increasing pattern of referral of patients with complex medical and surgical problems of the liver which do not necessarily require liver transplantation but who might be treated non surgically or by types of surgery other than transplantation. This referral pattern has had highly beneficial effects on the training for doctors, nurses and allied healthcare professionals at St Vincent’s University Hospital. However, it has also stretched the resources of all hospital departments who are involved in the NLTP. The hospital is currently conducting a comprehensive review of the resource requirements in the NLTP for the years ahead. One of the biggest challenges facing the NLTP over the coming 2-3 years is to maintain an adequate level of resourcing and bed availability for the ever increasing numbers of patients requiring transplantation and assessment of liver disease. Ambulatory day care The liver unit moved to the new ambulatory day care facility in late 2006. As a consequence the number of liver transplant clinics was doubled to two per week. This has significantly reduced waiting times and improved the quality of the service. Fibroscan The unit purchased a fibroscan in 2006, which is currently being evaluated in the hepatitis C clinics. Funding was obtained from the HSE and a generous grant from Roche pharmaceuticals. The fibroscan should reduce the requirement for liver biopsy in patients with hepatitis C. It is hoped to expand the service to include other categories of liver patient e.g. non-alcoholic liver disease. Return to contents St. Vincent’s Healthcare Group Limited 131 Liver Transplant Programme & Liver Unit Meetings The unit hosted the EASL hepatology school in June 2006. EASL is the European Association for the Study of the Liver. The school attracted 38 trainees from across Europe. International speakers included Prof Jenny Heathcote from Toronto, Canada and Dr Rajiv Jalan from London, U.K. Publications Levy G, Grazi GL, Sanjuan F, Wu Y, Muhlbacher F, Samuel D, Friman S, Jones R, Cantisani G, Villamil F, Cillo U, Clavien PA, Klintmalm G, Otto G, Pollard S, McCormick PA. 12-month follow-up analysis of a multicenter, randomized, prospective trial in de novo liver transplant recipients (LIS2T) comparing cyclosporine microemulsion (C2 monitoring) and tacrolimus. Liver Transpl 2006 12:1464-72. Kelly AM, Golden-Mason L, Traynor O, Geoghegan J, McEntee, Hegarty JE, O’Farrelly C. Changes in hepatic immunoregulatory cytokines in patients with metastatic colorectal carcinoma: implications for hepatic anti-tumour immunity. Cytokine 2006;35:171-9. Publications Lyons F, Hopkins S, Kelleher B, McGeary A, Sheehan G, Geoghegan J, Bergin C, Mulcahy FM, McCormick PA. Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy. HIV Med 2006;7:255-60. O’Riordan A, Wong V, McCormick PA, Hegarty JE, Watson AJ. Chronic kidney disease post liver transplantation. Nephrol Dial Transplant 2006;21:2630-. Zaman MB, Hoti E, Qasim A, Maguire D, McCormick PA, Hegarty JE, Geoghegan JG, Traynor O. MELD score as a prognostic model for listing acute liver failure patients for liver transplantation. Transplant Proc 2006;38:2097-8. McCormick PA, Nanda K. Are we losing the battle against liver disease mortality? Ir Med J 2006;99:229-30 Return to contents Annual Review 2006 132 Departmental Review Department of Medical Oncology incorporating Lios Aoibhinn Cancer Support Centre 2006 was a very successful year for the clinical, educational and research activities in the Department of Medical Oncology. The Oncology Day Centre remained the principal focus of our therapeutic activities, and the move from inpatient to outpatient drug treatment of cancer has continued to gather pace. Gratifyingly an increasing percentage of the treatments which we are giving now are molecularly targeted “smart bombs” rather than the “blunderbuss” chemotherapy regimens of old. Highly specific molecular therapy is now routinely used in the management of breast cancer, colon cancer, lung cancer, kidney cancer, lymphoma and other tumours. 2006 was a busy year on the educational front, and in addition to our ongoing commitments to University College Dublin and Dublin City University, members of the staff also delivered invited lectures in Dublin (RCSI Charter Day, Mater Breast Meeting, DCU seminar, Anglo-Celtic Meeting), EBCC Meeting Nice, International Breast Cancer Expert Forum in Vienna, American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO) in Istanbul, and various other cancer meetings in Bucharest, Budapest, and Greece. 2006 was also a productive year on the research front. Professor Crown presented the data from the International BIG study in an oral presentation at the American Society of Clinical Oncology meeting in Atlanta in June. Our participation in an international clinical trial of Lapatinib, a new molecularly targeted treatment for breast cancer resulted in co-authorship of a New England Journal of Medicine paper. Publications Geyer CE, Forster J, Lindquist D, Chan S, Romieu CG, Pienkowski T, Jagiello-Gruszfeld A, Crown J, Chan A, Kaufman B, Skarlos D, Campone M, Davidson N, Berger M, Oliva C, Rubin SD, Stein S, Cameron D. Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med 2006 Dec 28;355(26):2733-43. Malinovszky KM, Gould A, Foster E, Cameron D, Humphreys A, Crown J, Leonard RC; Anglo Celtic Co-operative Oncology Group. Quality of life and sexual function after high-dose or conventional chemotherapy for high-risk breast cancer. Br J Cancer 2006 Dec18;95(12): 1626-31. Ryan BM, Konecny GE, Kahlert S, Wang HJ, Untch M, Meng G, Pegram MD, Podratz KC, Crown J, Slamon DJ, Duffy MJ. Survivin expression in breast cancer predicts clinical outcome and is associated with HER2, VEGF, urokinase plasminogen activator and PAI-1. Ann Oncol 2006 Apr; 17(4): 597-604. Epub 2006 Jan 10. Return to contents St. Vincent’s Healthcare Group Limited 133 Department of Medical Oncology incorporating Lios Aoibhinn Cancer Lios Aoibhinn Cancer Support Centre 2006 will be remembered as a demanding year of challenges, opportunity and consolidation. Client activity levels increased. The provision of quality supportive care can only be achieved with staff cooperation, motivation and creativity. Service Activity In February we said farewell to Ursula Bates, Psycho-oncologist. Ursula had set up the Psycho-oncology service in January 2004. We congratulate and wish her well in her new post as Director of Psychosocial Care, Blackrock Hospice. In January, we welcomed Roseleen Flaherty as Education / Support Facilitator. Roseleen’s appointment represents a further step in the development of the Cancer Support Centre. 475 people used the service on 4,201 occasions. This represents a steady increase in the number of clients attending and overall levels of activity. As well as workshops on different aspects of cancer, 3 new courses (Healthy Menopause and The Treatment has Finished: Continuing the Healing Journey) were developed and facilitated for clients in 2006. As part of her Writer-in -Residency programme with DunLaoghaire Rathdown, Katie Donovan (Poet) facilitated a 9 week Creative Writing course. Such was the response to these courses that they will now continue to be offered as part of the centre’s programme of services. It is evident that while much has been achieved in 2006 and targets have been met, more work is required to continue the development of Lios Aoibhinn Cancer Support Centre. Firm foundations have now been laid which will ensure the continuance of the service to the highest standards. Anne Hayes Director of Services Return to contents Annual Review 2006 134 Departmental Review Medical and Surgical Gastroenterology incorporating the Centre for Colorectal Disease Consultant Medical and Surgical staff Medical Gastroenterology: Professor DP O’Donoghue Dr HE Mulcahy Colorectal Surgery: Mr J Hyland Mr D Winter GI Pathology: Dr K Sheahan Dr D Gibbons GI Diagnostic Imaging: Dr C Collins Dr R Gibney Medical Oncology: Dr D Fennelly Radiation Oncology: Dr M Moriarty Dr D Malone Professor J Armstrong Non-Consultant Medical and Surgical staff Specialist Registrars: Dr O Rathore Dr A Coss Mr F Cooke St. Teresa’s ward Ms A Smyth Ms G O’Neill St. Patrick’s ward Endoscopy Unit Ms A Kiely Mr R Marshall Ms S Steen Ms G Hickey Mr P Ridgeway Clinical Nurse Managers: Research Staff: Senior Research Scientist Dr J O’Sullivan Senior Biochemist and Honorary Lecturer Research Assistants Ms M Tosetto Research Fellows Dr D Kevans Dr G Cullen Research Nurses Ms D Keegan PhD students Mr E Fox MSc. Students Shane Sullivan MCh fellow Chin Hong Lim Dr D Leahy Monica Gancarczyk-Biniecka Dr J Sheridan Dr J Marry Chin Hong Lim Ms B Nolan Ms S Gorman Julie Gorman Dieticians: Medical Gastroenterology Surgical Gastroenterology Ms M Doyle Ms N Bates Specialist support staff Colorectal Pathology Technician Cancer Nurse Co-ordinator Colorectal Nurse Specialists IBD Nurse Specialist Secretary Mr R Geraghty Ms A White Ms G McEvoy Ms D Keegan Ms G O’Neill Ms N Smyth Clinical Medical and Surgical Gastroenterology continues to play a major role in the activities of St Vincent’s Health Care group and to function as a single unit. This is best exemplified by combined outpatient clinics, weekly clinical and audit meetings and the goal of a combined Medical and Surgical Gastroenterology ward. Close to one third of all hospital admissions fit into the category of acute or chronic gastroenterological disease and these integrated services, unique in the country, is clearly appropriate. The move to the Ambulatory Day Care Centre in the new Return to contents St. Vincent’s Healthcare Group Limited 135 Medical and Surgical Gastroenterology incorporating the Centre for Colorectal Disease building has greatly improved access for out-patients and has enabled us to have weekly clinics for patients with Inflammatory Bowel Diseases. The weekly Radiology and Pathology conferences run with our colleagues in Diagnostic Imaging and Pathology, allow for best practice in patient care and provide an excellent source of teaching for NCHD’s. We wish to acknowledge the close clinical and scientific support we receive from our colleagues in Medical and Surgical Oncology and Palliative Care. The Centre for Colorectal Disease (CCD) is an umbrella for clinicians and scientists with an interest in Colorectal Cancer, Inflammatory Bowel Disease and Functional bowel disorders. The aims of the centre are the delivery of state of the art services for our patients, research into causes and treatment and the education of the public. However, the multidisciplinary team would be unable to function successfully without the aid of nursing coordinators and nurse specialists such as Anne White, Grace McEvoy and Denise Keegan who lead patients through the varied and complex pathways of diagnosis, treatment and post-operative stoma care in a way that appears seamless. We also wish to put on record our thanks to our nursing colleagues on St.Teresa’s and St. Patrick’s wards who manage our gastroenterology patients despite major involvement in general Medical and Surgical call. One of the great joys of 2006 was the move to the purpose built and designed 3-roomed Endoscopy unit in the ADCC. Mr Richard Marshall and Ms Grainne Hickey deserve our heartfelt thanks for all the work they put in to the successful move which now benefits patients and staff alike. We wish to thank Ms Nuala Donnelly and staff in St. Mark’s Day ward for all there magnificent work throughout the year and hope they will be successful in their transfer to a new and expanded “St. Marks” in 2007. Research The research arm of the Centre for Colorectal Disease continues to flourish under the guidance of Dr Jacintha O’Sullivan, Senior Research Scientist. The main research goals of the Centre for Colorectal Disease is to achieve a more complete understanding of which biological factors drive colorectal cancer and to determine if different biological markers can distinguish people at high risk and elucidate which subset of patients will response to particular treatment regimes. The goal of these translational research projects, based on unique and exciting explant work, is to determine which cancers require additional treatment and what therapies might be most effective. Such work has the potential for huge financial savings in the management of Colorectal Cancer. The large and detailed databases for patients with Bowel cancer and Inflammatory Bowel Disease enable many of the projects to be achieved. The unit has a very productive collaboration project on going with Dr Paddy Johnston in Coleraine. The research activities and goals of the CCD were highly recommended by the International Research Advisory Board who visited the Hospital and research laboratories during the summer. Drs Garret Cullen, Dave Kevans and Joe Marry joined the unit in 2006 and Research Fellows. Shane Sullivan received his MSc degree for his work on proteases in Colorectal Cancer. We welcome Monica GancarczykBiniecka as research assistant. As always, our collaborations with other research departments both within the UCD campus, the Conway Institute and farther afield has added considerable value to our research and we would especially like to thank Professor Cliona O’Farrelly and Professor Alan Baird amongst others for their continued collaborations. Our Annual International Colorectal Meeting in the Education and Research Centre each September continues to draw large numbers of attendees and is an ideal platform to display the various strengths and activities of the unit. Return to contents Annual Review 2006 136 Medical and Surgical Gastroenterology incorporating the Centre for Colorectal Disease Much of the Centre’s work would not be possible without generous donations for research and education from Mr Bob Joyce, the Anglo Irish Bank and the family and friends of many of our patients. In particular we would like to acknowledge foundations to memory of Ellie Brady, Susie Byrne and Darragh Gibbons. Grants Active in 2006 1. PI Co-applicants: Name of study: Source of grant: Found amount: Start Date: Finish Date: Jacintha O’Sullivan Kieran Sheahan & Diarmuid O’Donoghue Role of genomic instability in promoting colorectal cancer development in Ulcerative Colitis Health Research Board €185,000 October 2004 October 2007 2. PI Jacintha O’Sullivan Co-applicants: Kieran Sheahan & Diarmuid O’Donoghue Name of study: The role of telomeres and telomerase in colorectal cancer development, progression and metastasis Source of grant: Found amount: Start Date: Finish Date: Cancer Research Ireland €135,000 October 2004 October 2007 3. PI Name of study: Source of grant: Found amount: Start Date: Finish Date: Jacintha O’Sullivan Major Depression & Genomic Instability UCD Seed Funding €9,000 May 2006 May 2007 4. PI Jacintha O’Sullivan Name of study: Establishment of a colorectal ex vivo biopsy culture model to examine responses to neoadjuvant radiation therapy in advanced rectal cancers. Source of grant: UCD Seed Funding Found amount: €15,000 Start Date: October 2006 Finish Date: October 2007 5. PI Jacintha O’Sullivan & Prof Larry Loeb Postdoctoral Fellow: Edward Fox Name of study: Frequency of random mutations and genomic instability events during colorectal cancer progression. Source of grant: Health Research Board NCI Cancer Prevention Fellowship Found amount: €85,000 Start Date: Dec 2006 Finish Date: Dec 2008 Return to contents St. Vincent’s Healthcare Group Limited 137 Medical and Surgical Gastroenterology incorporating the Centre for Colorectal Disease 6. PI Dr. Douglas Veale co-applicants: Dr. Ursula Fearon,Dr. Jacintha O’Sullivan & Prof. Cormac Taylor Name of study: Frequency of random mutations and genomic instability events during colorectal cancer progression. Source of grant: Health Research Board Found amount: €1.5 million Start Date: October 2006 Finish Date: October 2011 6. PI co-applicant: Name of study: Source of grant: Found amount: Start Date: Finish Date: Dr. Kieran Sheahan Dr. Dermot Leahy Molecular characterisation of familial colorectal cancers Health Research Board €174,400 October 2006 October 2009 7. Newman Fellowship Newman Fellow: Dr Garret Cullen Supervisors: Dr. Jacintha O’Sullivan & Prof Diarmuid O’Donoghue Title of project: Cigarette smoking and genomic instability: factors controlling disease progression and treatment sensitivity in inflammatory bowel disease patients Source of funding: Altana Found amount: €80,000 Start Date: July 2006 Finish Date: July 2008 8. Newman Fellowship Newman Fellow: Dr Joseph Marry Supervisors: Dr. Jacintha O’Sullivan & Dr. David Fennelly Title of project: The effect of genomic instability on monoclonal antibody therapy response in colorectal ex vivo explants Source of funding: Merck Found amount: €138,000 Start Date: July 2006 Finish Date: July 2008 Return to contents Annual Review 2006 138 Medical and Surgical Gastroenterology incorporating the Centre for Colorectal Disease Invited Scientific Talks at National Conferences Alan Coss. Novel targets in early stage colorectal cancer. Centre for Colorectal Disease 13th International Meeting, St. Vincent’s University Hospital, September 2006. Alan Coss. Alterations of the Topoisomerase II· gene and protein in colorectal cancer. Conway Institute Festival of Research, O’Reilly Hall, UCD, Sept 2006 . Juliette Sheridan. Higher Levels of Oxidative DNA Damage in Sporadic Colorectal Cancer. Irish Society of Gastroenterology, November 2006 Garret Cullen Infliximab in Crohn’s disease: step-up or top-down? Irish Society of Gastroenterology, November 2006 Juliette Sheridan. Oxidative Damage and Early Stage Colorectal Cancer. Centre for Colorectal Disease 13th International Meeting, St. Vincent’s University Hospital, September 2006. Jacintha O’Sullivan. Predicting response to Oncological Therapy. Centre for Colorectal Disease 13th International Meeting, St. Vincent’s University Hospital, September 2006. Diarmuid P O’Donoghue. Infliximab in Crohn’s disease – magic bullet or false dawn. Visiting professor, Aberdeen, Scotland. Nov 2006. Kieran Sheahan. The role of the pathologist in diagnosing familial GI cancer. Boston University School of Medicine. Sept 2006 Kieran Sheahan. Stage II CRC: to treat or not: the value of pathology. All Ireland Colorectal Cancer Conference, November 2006. hn Hyland Laparoscopic Colorectal Surgery Ulster Gastro Soc. Belfast Jan 06 John Hyland Rectal Cancer Bahrain Medical Society Mar 06 John Hyland Rectal Cancer Freyer meeting Galway Sept 06 John Hyland Evidence for Laparoscopic Surgery in Colorectal Cancer Univ. Hull UK Nov06 Manuscripts published in 2006 Infliximab therapy in Crohn's disease: a pragmatic approach? Aliment Pharmacol Ther. 2006 Jul 15;24(2):351-9. Kevans D, Keegan D, Mulcahy H, O’Donoghue DP. Detection and characterization of hemopoietic stem cells in the adult human small intestine. Lynch L, O'Donoghue DP, Dean J, O'Sullivan J, O'Farrelly C, Golden-Mason L. J Immunol. 2006 May 1;176(9):5199-204. O’Sullivan J, Risques R, Mandelson M, Bronner M, Brentnall T, Chen L, Pearlman M, Feng Z, Siebert J, Potter J, Rabinovitch P. Telomere lengths in the Colon decline with age: a relation to Colorectal Cancer?. Cancer Epidemiology, Biomarkers & Prevention 2006. Mar;15(3):573-7. Lynch L, O’Donoghue D, Dean J, O’Sullivan J, O’Farrelly C, Golden-Mason L. Detection & Characterisation of haematopoietic stem cells in adult human small intestine. J Immunology. 2006, May 1: 176(9) 5199-5204 Mehigan B, White A, Winter DC, Sheahan KM, Hyland JM. Laparoscopic colorectal resection: initial experience in a specialist unit. Ir Med J. 2006 Jul-Aug;99(7):211, 213-4. Return to contents St. Vincent’s Healthcare Group Limited 139 Departmental Review Department of Medicine for the Elderly Staff Consultants Dr. Morgan Crowe Dr. J. J. Barry Dr. Diarmuid O’Shea Dr. Rachael Doyle Nursing Mr. Pat Gargan Ms. Imelda Noone Ms. Helen Doolan Ms. Angela Moriarty Ms. Mary Ann Furigay Ms. Maryam Husiam Registrars Dr. Osman Mukhtar Dr. Róisín Purcell (SpR) Dr. Sorcah DeBhaldraithe Dr. Kevin McCarroll (SpR) Social Workers Ms.Michelle Harte Ms.Margaret Cagney Administrative Staff Ms. Lorraine Murray Ms. Cherryle Millo Ms. Joan Magera Divisional Nurse Manager Clinical Nurse Specialist in Stroke CNM2, Our Lady’s Ward CNM2, Carew House Day Hospital CNM1, Our Lady’s Ward CNM1, Our Lady’s Ward Departmental Statistics 2004 2005 2006 2004 2005 2006 Inpatients Admissions 405 445 456 Discharges 429 451 503 Outpatients New 252 221 282 Review 546 498 602 Carew Day Hospital New 571 594 487 Review 774 804 799 Stroke Inpatient Service 256 316 256 Total Attendance New 823 815 771 Review 1320 1302 1401 Service Developments / Activities 2006 was a busy year for the department of Medicine for the Elderly, which continues to provide an in-patient and outpatient consultation service, treatment and rehabilitation, primarily for elderly patients from the hospital’s catchment area in South East Dublin and East Wicklow. Issues continuing to challenge the service include the lack of resources to maintain people in their home with dignity and a consequent increase in the number of people awaiting long-term continuing care. Great credit is due to Ms. Mary Ann Furigay and to Ms Helen Doolan, CNM2 and their team for their continued dedication to the patients on Our Lady’s Ward and meeting the ongoing challenges. The number of in-patients treated is gradually increasing, as is the out-patient attendances. New patient attendance is up from 665 in 2001 to 815 in 2005. This is reflected in the throughput in both out-patients and Carew House Day Hospital. Great credit is due to Ms Angela Moriarty, CNM II, and her multidisciplinary team for the quality of work there. Return to contents Annual Review 2006 140 Department of Medicine for the Elderly In Patient Consultations In 2006 over 900 inpatient consultations were seen in St Vincent’s Hospital by the Elderly Care team. Meetings are held weekly between Dr. O Shea, the elderly medicine registrars and the Medical Social Work Department to facilitate planning of discharge of those elderly patients on whom consultant colleagues have requested advice. Orthopaedic Liaison Service Dr. Rachael Doyle is leading the development of this service with our consultant orthopaedic colleagues. Stroke Service Weekly multidisciplinary meetings are held and chaired by Dr. Crowe. Representatives of the nursing, physiotherapy, occupational therapy, speech and language therapy and other medical departments attend. There are now 9 dedicated beds, on Our Lady’s Ward, for patients with stroke. Ms. Imelda Noone, Stroke Nurse Specialist, is involved in further development of this unit and the introduction of set guidelines and protocols. An active stroke follow-up clinic is now up and running in Suite 4 in the new ADCC. A once weekly, dedicated TIA clinic continues to facilitate assessment and treatment of patients with TIA’s, who do not require hospital admission. This service requires further investment for both infra-structure improvement and improved staffing levels Falls and Syncope Service Space has been provided on Our Lady’s Ward for a falls and syncope service for the hospital and the neurocardiovascular service, which is being run by Dr. Diarmuid O’Shea. In total 120 patients were seen this year (of all age groups). Some progress has been made but the hoped for introduction of a Falls Nurse Specialist will be crucial to the further development of what is currently a rudimentary service. The Royal Hospital Donnybrook The Royal Hospital Donnybrook makes a very important contribution to the rehabilitation of our elderly patients. There are 40 rehabilitation beds in this unit, managed by Ms. Margaret Dwyer, CNM3, of which 12 are now dedicated to stroke rehabilitation. The Day Hospital at the Royal in Donnybrook continues to provide outstanding care and outpatient rehabilitation services to those with multidisciplinary needs. The long established links with long-term care facilities continue to evolve through the dedicated work of Dr Mary Deane, Medical Director. Return to contents St. Vincent’s Healthcare Group Limited 141 Department of Medicine for the Elderly Staffing Close liaison is maintained with St. Columcille’s Hospital, Department of Medicine for the Elderly under the direction of Dr. Morgan Crowe and Dr. Rachael Doyle, with St Michael’s Hospital under the direction of Dr JJ Barry. Additional consultant posts are being looked for, to improve the service delivery in St. Vincent’s University Hospital. Congratulations to Imelda Noone, who was appointed as the first Advanced Nurse Practitioner in Stroke in the Country. We look forward to her continued contribution and work in the ongoing development of the stroke service. Our CNM II on Our Lady’s Ward Helen Doolan left during the year. We wish her well in her new post and thank her for all her hard work. Retirements We would like to wish both Angela Moriarty, CNM II in Carew Day Hospital and Michelle Harte, Social Worker in our department many years of healthy retirement. Their dedication to their work and to care of the older person will serve as a continuing inspiration to those us privileged to work with them. Achievements / Conferences Attended The multidisciplinary team members at Carew House Day Hospital attended The Stroke Information Day, Annual Care of the Elderly Study Day, The Irish Gerontological Society Conference, Parkinson’s Association Meeting, National Council on Ageing and Older Peoples Conference and Creating a Culture of Education in Dementia Care Conference. The Fourth Annual Care of the Elderly Study Day took place on 2nd March, 2006, in the Education & Research Centre, St. Vincent’s Hospital. This year it focused on more general topics and was attended by 90 people. This is now be a regular study day in the teaching calendar. Publications / Abstracts Fatigue Post Stroke In An Irish Population I.Noone, M.Furigay, D.O’Shea, M.Crowe, R.Doyle. Driving Assessments In The Elderly – Experience Within A Day Hospital T Bolger, K McCarroll, C Cooney, D O’Shea Characteristics Of Elderly Admissions To An Acute Orthopaedic Unit S O' Hanlon1, DF Waterhouse2, R McNamara1, K O’Rourke2, E Kelly2, C Fallon1, R Doyle1, Dr. Crowe1, D O'Shea1, Reducing the use of cotsides in an acute hospital: Introducing a risk assessment tool and education programme. N Boyle, I Noone, M Furigay, D O’Shea, M Crowe Pilot Study To Ascertain The Relationship Between Nihss Score Within 24 Hours And Barthel Index At Six Weeks In Patients With Cerebral Infarcts G Sutton, I. Noone, D O’Shea, M. Crowe Return to contents Annual Review 2006 142 Departmental Review Department of Metabolism Staff Medical Director Professor TJ McKenna Principal Biochemist Barbara Murray Senior Biochemist Dr Jennifer Brady Medical Scientist Niamh Watters Laboratory Aide Mairead Moore Secretary Marion Purcell The Metabolism Laboratory provides a comprehensive analytical and consultation service for specialist markers of bone and renal disease for medical and surgical patients at St. Vincent’s Healthcare Group, and acts as a national referral centre. Service Developments / Activities The Metabolism Laboratory achieved ‘Conditional Approval incorporating ISO 15189’ following an inspection by Clinical Pathology Accreditation (UK) Ltd (CPA). The Metabolism Laboratory successfully moved to the new laboratory in the clinical services building in April 2006 and utilised this change as a catalyst for continuous quality improvement and to implement new initiatives. The planning and approach to the move avoided significant disruption and the process of integrating the immunoassay sections of Metabolism, Endocrinology and Nuclear Medicine laboratories into a core immunoassay laboratory was delivered according to plan. The introduction of a new bone resorption marker, tartrate-resistant acid phosphatase 5b isoform, has proven to be most useful to monitor the effect of calcimimetic treatment on bone metabolism in renal patients with secondary hyperparathyroidism. The Metabolism overall workload increased by 14% from the previous year. Research/Future Plans The effect of sub-clinical hypo and hyperthyroidism on bone metabolism is being studied. Bone Biomarkers in a group of women with chronic hepatitis C virus infection are being evaluated in collaboration with the Liver Unit. The study of the early and long term effects of Anti-TNF· therapy on bone turnover markers in patients with Rheumatoid Arthritis and Psoriatic Arthritis in collaboration with the Rheumatology Research Team is near completion. Results to date demonstrate the effects that this disease-modifying drug has on bone turnover. There is an increased use of calcimimetic agents to manage secondary hyperparathyroidism among patients undergoing dialysis. The measurement of bone turnover markers as a non invasive method of assessing both the bone turnover status in the renal patient and the effect of treatment on bone turnover are being studied in selected groups of patients. Return to contents St. Vincent’s Healthcare Group Limited 143 Department of Metabolism The impact of photo protective behaviour and sunscreen use on Vitamin D levels in Cutaneous Lupus is been studied in collaboration with the Dermatology Unit at Beaumont Hospital. The Vitamin D status of community dwelling and institutionalised elderly is been evaluated in collaboration with Department of Medicine for Older persons, Mater and St. Mary’s Hospitals. The Vitamin D status of patients on anti-epileptic drugs is being studied in collaboration with the Department of Neurology at Beaumont Hospital. The Metabolism Laboratory is involved in a project examining and correlating novel Urinary Biomarkers with the established measurement of Albumin/Creatinine Ratio in Diabetic Nephropathy. Oral Presentations 6th International Symposium on nutritional aspects of osteoporosis Lausanne, Switzerland. 4th – 6th May 2006 Murray BF, Smith D, Doyle M, Brady JJ, Cassidy M, Darby M, Malone K, McKenna TJ. Biochemical markers of bone turnover in anorexia nervosa following nutritional rehabilitation. Association of Clinical Biochemists of Ireland Annual Conference Dublin, 20th – 21st October 2006 Brady JJ, Murray BF, McKenna MJ. A Case of Hypophosphataemic Bone Disease due to Tumour Induced Osteomalacia. Publications/Abstracts Murray BF, Smith D, Doyle M, Brady JJ, Cassidy M, Darby M, Malone K, McKenna TJ. Biochemical markers of bone turnover in anorexia nervosa following nutritional rehabilitation. Proceedings of the 6th International Symposium on Nutritional Aspects of Osteoporosis.2006 Murray BF, Smith D, Brady JJ, Healy ML, O’Higgins N, McDermott E, McKenna MJ, McKenna TJ. Bone Turnover Markers in Newly Diagnosed Breast Cancer Patients. Calcif Tissue Int 2006;78:S84 Brady JJ, Murray BF, McKenna TJ. Biochemical indices of bone metabolism demonstrate the effect of parathyroidectomy on bone in patients with primary hyperparathyroidism. Annals of Clinical Biochemistry 2006;43 S1:108 McQuillan R, Watson A, Murray BF. Biochemical markers of bone turnover in a patient on haemodialysis receiving calcimimetic treatment. Proceedings of the International Society of Nephrology. 2006 Murray BF, Smith D, Brady JJ, Healy ML, O’Higgins N, McDermott E, McKenna MJ, McKenna TJ. Bone Turnover Markers in Newly Diagnosed Breast Cancer Patients. Ir. J. Med. Sci 2006;175:4 S2:34 Return to contents Annual Review 2006 144 Departmental Review Department of Nephrology Staff Consultant Nephrologist Dr. Alan Watson, Specialist Registrars Dr. Aisling O’Riordan Registrar Dr. Mohammad Faisal Khan CNM II Martina Kiely CNM I Michelle Mc Quaid Newman Scholar Dr. Aisling O’ Riordan Principle Clinical Engineer Frank Kelly Clinical Nurse Specialists in peritoneal Dialysis Dr. Simon Curran Bairbre Moynihan & Emer Kenny Service Developments A new chronic dialysis facility was opened in September, which is now operating at full capacity. Paper publications Acute renal disease, as defined by the RIFLE criteria, post liver transplant: O’Riordan A, Wond V, McQuillan R, McCormick PA, Hegarty JE, Watson AJ. American Journal of Transplantation, 7, 168 – 176, 2007 Chronic kidney disease post liver transplantation: O’ Riordan A, Wong V, Mc Cormick PA, Hegarty JE, Watson AJ. Nephrology Dialysis and Transplantation, 21(9): 2630-2636, 2006 Abstract publications Using SELDI-TOF-MS, apolipoprotein A1 is a serum biomarker of chronic kidney disease, post orthotopic liver transplantation: O’ Riordan A, McMorrow T, Johnston O, Gallagher W, Maguire P, Cagney G, Hegarty JE, McCormick PA, Watson AJ, Ryan MP, Journal of the American Society of Nephrology, TH-PO186, 17, 145-146A, 2006. Urinary biomarker discovery in chronic kidney disease, post orthotoptic liver transplantation, using SELDI-TOF-MS: O’ Riordan A, McMorrow T, Johnston O, Gallagher W, Hegarty JE, McCormick PA, Watson AJ, Ryan MP. Journal of the American Society of Nephrology, TH-PO187, 17, 146A, 2006. Oral and poster presentations Using SELDI-TOF-MS, Apolipoprotein A1 is a Serum Biomarker of Chronic Kidney Disease, post Orthotopic Liver Transplantation: O’ Riordan A, McMorrow T, Johnston O, Gallagher W, Maguire P, Cagney G, Hegarty JE, McCormick PA, Watson AJ, Ryan MP. Oral Presentation: Renal Cell Study Group, 2006 Poster Presentation: INS, 2006 American society of nephrology (ASN), 2006 Conway International Festival of Science, 2006 Return to contents St. Vincent’s Healthcare Group Limited 145 Department of Nephrology Urinary Biomarker Discovery in Chronic kidney disease, post Orthotopic Liver Transplantation, using SELDI-TOF-MS: O’ Riordan A, McMorrow T, Johnston O’ Gallagher W, Hegarty JE, McCormick PA, Watson AJ, Ryan MP. Poster presentation: INS, 2006 The Role of the “Clinical Engineer” AMNCH Tallaght Regional Hospital Presented Paper Joint meeting BEAI & Engineers Ireland: Kelly F. Poster Presentation for the 35th International Nursing & Midwifery Dublin Ireland. (Royal College of Surgeons of Ireland) Attended Meeting (Royal College of Surgeons of Ireland) ABPM in Haemodialysis Patients: Kelly F. Achievements: Frank Kelly; Conferring of Professional Title Associate Engineer with Engineers Ireland. Departmental Statistics: Total HD Treatments in 2006: Total PD patients in 2006: 8,223 22 Future Plans The development of a Pre-dialysis Programme is the major project for 2007. This will allow for early identification of patients with various stages of chronic kidney disease who may ultimately require dialysis support and/or transplantation. Return to contents Annual Review 2006 146 Departmental Review Department of Neurology The Department of Neurology has continued to substantially expand in 2006 (Table). We still have only two Consultants, Professor Michael Hutchinson and Dr. Niall Tubridy, and we have applied for at least two more to continue the progressive service development. Paula Halpin (Departmental Secretary) has helped bring a greater deal of cohesion and deals with many phone calls from concerned patients and relatives daily. Marguerite Duggan, our Multiple Sclerosis Nurse Specialist continues to provide an excellent service for the MS patients and has been joined by our CNM, Heather Kevelighan, as Parkinson’s Specialist Nurse with the financial support from the Parkinsons’ Disease Society of Ireland. Heather is running the new Parkinson’s Clinics and is already providing a great service for our patients in this area. Lisa Gribbin has done a huge amount of background work in addition to her regular work as the MS Research Nurse. Lisa McGowan joined the Team in 2006 and has continued the work in MS Treatment Trials and in organisation of our research in MS. Drs. Richard Walsh and Lisa Costelloe (Research Registrars) have been an integral part of the Neurology Service and without them the twice-daily clinics would not have been feasible. Jean Fletcher is working on a joint project in Multiple Sclerosis with the Department of Immunology at Trinity College under the supervision of Professor Kingston Mills. She has funding from the SFI for the next three years The Neurology Ward The Neurology Ward (St Vincent’s Ward) continues without “protected” beds which unfortunately results in a long waiting list for admissions. Eilish Funge was appointed Ward Sister and shares our aims to improve all aspects of the in-patient services. Only patients with the most complex problems are admitted to the ward. These patients require skilled, high-intensity nursing and multidisciplinary care from Physiotherapy, Occupational Therapy and Speech and Language Therapy. Many can no longer be managed at home or need special advice about aids at home from these team members and from the Social Work Department. There is a great team spirit in the Department of Neurology with regular multidisciplinary meetings, radiology meetings, the Journal Club, and a six-monthly up-date meeting about recent advances, new therapies and techniques. Service Developments Neurology in the Ambulatory Day Care Centre (ADCC). The move to the new ADCC allowed the development of a new rota of Neurology Outpatient services from March 6th 2006. This involves public neurology clinics twice a day, and has already improved the service dramatically. In 2006 we saw over 5000 out-patients. We reduced the waiting times substantially as part of our continued waiting list initiative. We now have specialist clinics for Parkinson’s Disease, Multiple Sclerosis and a Dystonia/Botulinum Toxin Clinic. We are running Special Therapy Clinics to facilitate patients who otherwise might require hospitalisation. We have a dedicated secretary Orla Bannon to (always cheerfully!) check patients in and we have a number of other initiatives planned to make sure that attendance at the clinics are less stressful. All of this has been made possible only with the help of a variety of people but we would like to thank especially Bernadette Howard and Julija Meirane in OPD, Margaret Boland, Breege Screene, John McDonagh, and June O’Shea (Pharmacy). Return to contents St. Vincent’s Healthcare Group Limited 147 Department of Neurology Tysabri has now been licensed for use in people with MS. It is given by an intravenous infusion every month and so the amount of work required to administer this has greatly increased the demands on our service, particularly our MS Specialist Nurse. We expect the numbers to gradually increase over the next 12 months. We have already reached maximum capacity for this after three months (i.e. >25 people get a monthly infusion and each takes 2-3 hours). To continue to offer this treatment we need another MS Specialist Nurse. We started an e-mail neurology service called ‘Neurolink’ as a pilot project for a selected group of enthusiastic GP practices from April 2006. We are most grateful for their co-operation in what has been a successful venture and has helped further reduce the burden on the Emergency Department, in-patient beds required and, of course, our patient waiting times. In December 2006, we expanded the project to allow access to over 120 GPs in the South Dublin area. Significant Achievements Dr Tom Monaghan (SpR) - best clinical case presentation at the ABN in April 2006. Both Drs. Costelloe and Walsh were short-listed for the “Tournament for Young Neurologists” at the EFNS in September 2006, (2/6 short-listed from all over Europe) and Dr. Walsh won the Uschi Tschabitscher Prize for Young Neurologists. ‘Neurolink’ was short listed for a Health Innovation award and Dr. Tubridy was presented with a Certificate by Mary Harney in October 2006. Significant Publications Dunne et al. HLA class II polymorphisms in Irish patients with multiple sclerosis. Tissue Antigens. 2006;68:257-62. O’Rourke et al. Predicting beta-interferon failure in relapsing-remitting multiple sclerosis. Multiple Sclerosis 2006; 12: 1-7. Polman et al. A randomized, placebo-controlled trial of Natalizumab for Relapsing Multiple Sclerosis. N Eng J Med 2006; 354:899-910. Williams et al. The Face-Symbol Test and the Symbol-Digit Test are not reliable surrogates for the Paced Auditory Serial Addition Test in multiple sclerosis. Multiple Sclerosis 2006;12:599-604. McGuigan and Hutchinson M. Unrecognised symptoms of depression in a community-based population with multiple sclerosis. J Neurol 2006;253:219-223. Future Plans GP-led Migraine Clinic – we plan to have a weekly GP-led migraine clinic for the many thousands of people with migraine in our area and require funding for the GPs sessions, a migraine registrar and a migraine nurse. Such an investment would substantially reduce attendances at A&E and thus hospital admissions. It would have a major impact for our patients in terms of waiting times and overall economic savings would be substantial. Return to contents Annual Review 2006 148 Department of Neurology Audit Consultation service for in-patients of all services: The Neurology service sees 10-20 in-patients with neurological problems each week. Over a 6-month period, 254 referrals were seen. There was a significant change in diagnosis in 55%, and in management in nearly 70%. Neurological referral facilitated earlier discharge for 65% patients. Neurology in the Emergency Department (ED). We performed an audit of the ED admissions at SVUH that had a neurological problem. Between 11 and 13% of all ED admissions had a neurological problem. The most common conditions were headaches (19%), post-traumatic neurological signs (16%), seizures (10%), stroke (17%), loss of consciousness (6%), dizzy/syncope (6%). Annual (March-March) figures for Neurology OPD Sessions New Return Total Appts DNA Walk-in 2003 36 660 2276 2936 3591 719 64 2004 128 928 2669 3597 4426 949 120 2005 130 953 2997 3950 4791 899 58 2006 355 1462 3828 5290 6269 1124 145 A total of 5290 patients were seen in the first 12 months of our new ADCC Neurology OPD clinics. Return to contents St. Vincent’s Healthcare Group Limited 149 Departmental Review Department of Clinical Neurophysiology Consultant Dr Sean Connolly, MD, FRCPI E-mail: [email protected]] Neurophysiology Measurement Technicians at SVUH Ms Brigid Clark (full-time senior, permanent) Ms Anne Bjerke SVUH departmental secretary/manager (full-time senior, temporary) Ms Lesley Bergin The department of Clinical Neurophysiology is part of the South Dublin Clinical Neurophysiology Service, which also includes units at St James’s Hospital and the Meath & Adelaide Hospitals, incorporating the National Childrens’ Hospital (AMNCH) at Tallaght. As this service is currently run by one consultant, it is best to consider this service as a whole. The range of investigative/diagnostic services provided include routine Nerve Conduction Studies (NCS), Electromyography (EMG), Quantitative Sensory Testing (QST), Electroencephalography (EEG) and Visual Evoked Responses (VERs). Research, currently being carried out mainly at the AMNCH and St Vincent’s departments, includes a transcranial magnetic stimulation study in dystonia. There are also research collaborations with the department of electrical and electronic engineering at UCD and with Dr Geraldine Boylan in the department of paediatrics and child health, UCC. Recent Developments Efforts are continuing to appoint more technologists and to provide additional departmental space. Recent Publications Murray DM, Ryan CA, Boylan GB, Fitzgerald AP, Connolly S. Prediction of seizures in asphyxiated neonates: correlation with continuous video-electroencephalographic monitoring. Pediatrics 2006;118(1):41-6 Sowman R, Robinson D, O’Riordan R, Connolly S, O’Neill D. Rapidly deteriorating speech and language in a case of probable sporadic Creutzfeldt-Jakob disease. Aphasiology 2006;20(6):579-592 Ryan A, Mullins G, Scott J, Connolly S, Hardiman O, Yilmaz E, Vincent A, Lynch T. A 45-year history of acquired autoimmune neuromyotonia. Journal of Neurology 2006;10:1-4 Murray DM, Boylan GB, Ryan CA, Connolly S. Early Continuous Video-EEG in Acute Near-Total Intrauterine Asphyxia. Pediatric Neurology 2006;35(1):52-6 Greene BR, de Chazal P, Boylan G, Reilly RB, O’Brien C, Connolly S. Heart and respiration rate changes in the neonate during electroencephalographic seizure. Medical and Biological Engineering and Computing 2006;44(1-2):27-34 Kinirons P, O’Dwyer JP, Connolly S, Hutchinson M. Paraneoplastic limbic encephalitis presenting as lingual epilepsia partialis continua. Journal of Neurology 2006;253:256-7, Epub 2005 Aug 24 Return to contents Annual Review 2006 150 Departmental Review Department of Nursing Introduction I have pleasure in presenting the annual review for St. Vincent’s University Hospital. Nursing Department. The increased level of patient acuity and overall activity in the hospital during the year presented many challenges to the nursing teams. Despite this, I am pleased to report that substantial progress was made in the area of quality improvements in patient care with nursing taking the lead in many of the initiatives that were introduced. The Nursing Human Resources function as planned was successfully promoted and integrated with the central HR Department. Over the last number of years we have been challenged by the dearth in the number of registered nurses available to provide services. This situation was significantly reversed during the year and we are currently in receipt of many requests for positions. Welcome to all staff who joined the nursing department or were appointed to promotional nursing positions. Cultural diversity is an increasing important issue in healthcare and we have benefited greatly from successful international recruitment. In supporting staff development and the development of best practice, nurses continue to avail of financial support and leave to attend various educational programmes and national and international conferences. Nurses working within a number of our specialities organised national conferences held in the Education and Research Centre. Research–based practice is a key factor in providing high quality, cost effective and efficient care and I wish to acknowledge the many nurses who have undertaken research as part of their academic programmes. The Nursing Department continues also to be involved in joint research studies with the School of Nursing and Midwifery in UCD. Clinical Services Building A major achievement for the department of nursing during 2006 was the transfer of services to the state of art care environment provided in the new clinical services building. The safe transfer of services and patients was affected through teamwork and detailed planning. Nursing teams are to be commended on the flexibility and adaptability of their approach to new technology and changing work practices. Congratulations to the teams for their enormous contribution to the successful opening of the units/departments set out below. Return to contents Annual Review 2006 152 Department of Nursing Service Development Dermatology On November 1st we welcomed the team of staff who decided to take up employment with this organisation following the cessation of services at Hume Street Hospital. The new Dermatology Department, which is located in the former Out Patients Department offers a comprehensive outpatient and inpatient service to cater for the dermatological needs of our local population. Services such as daily consultant led outpatient clinics and specialist clinics such as photo-clinic and contact clinic are provided. Furthermore there are daily Clinical Nurse Specialist clinics that focus on patient monitoring, disease management, patient education and health promotion. Hygiene The result of the second National Hygiene audit undertaken by the Health Service Executive (HSE) confirmed that our services did not deteriorate. However, the report identified areas for improvement. The CEO requested the Director of Nursing to sponsor the Hygiene Services Quality Improvement Group to implement the recommendations. Cystic Fibrosis A Patient Liaison Cystic Fibrosis Group was established to assist in the communication of appropriate information between persons with cystic fibrosis and health care professionals in the provision of care. Quarterly meetings, chaired by the Director of Nursing, took place and identified quality improvements have been introduced. Ambulatory Day Care Post Discharge Clinic In the provision of effective and efficient health care for patients with predictable requirements a new post discharge clinic was established in June and is evaluated and monitored on an ongoing basis. Team Based Performance Management During 2006 the Senior Nurse Management team was one of the areas engaged in piloting Team Based Performance Management (TBPM). Twenty-five objectives were agreed, actioned and monitored during the year. Nursing Practice Intravenous Venepuncture and Cannulation Role expansion for nurses continued with the introduction of venepuncture and cannulation. A policy and an education and training programme for this new development was introduced. Registered nurses from Leopardstown Park Hospital were facilitated with education and training in the administration of intravenous medications. This initiative means that elderly patients can receive intravenous medications in their own care environment thereby avoiding transfer to the Emergency Department. Advanced Nurse Practitioners I am very pleased that Ms. Imelda Noone was appointed as the first Advanced Nurse Practitioner (ANP) in Stroke Care in Ireland. Preparatory work intensified on the development of ANPs in other service areas. Site Accreditation for an ANP in the Heart Failure Unit and Chest Pain Evaluation were completed. Tissue Viability The first hospital wide pressure ulcer prevalence audit was carried out on 13th July. On the day a prevalence of 10.9% was identified. The findings were presented to the Clinical Audit Committee and support was provided for Return to contents St. Vincent’s Healthcare Group Limited 153 Department of Nursing standardisation of all hospital foam mattresses to pressure redistributing mattresses and the procurement of lower leg supports. A Pressure Ulcer Quality Improvement group has been established. Education and Training The organisation continued to support continuing professional development by providing financial support and study leave to over 430 nurses and Healthcare Assistants across the organisation to attend conference and persue academic courses relevant to their area of practice. The number of academic courses and conferences undertaken in 2006 was 422 (130 were academic and 292 were conferences). Nurse Education Centre Throughout 2006 the Director and her team continued to lead and provide a wide range of innovative education and training programmes. A sample of some of the many initiatives are set out below: Post-registration Education for Specialist Areas of Practice A significant change took place with the introduction of modularisation and the further development of the specialist higher diploma course to level 9 (Post-graduate) on the NQAI Framework. The staff: of the nurse education centre, relevant specialist areas and UCD worked tirelessly to complete the curriculum reviews and meet the academic timelines for introduction of the programmes in September 2006. Health Care Assistants Further Education and Training Awards (FETAC) A significant development was the introduction of an Activities of Living – Patient Care module to the FETAC level 5 Health Care Support programme. We are very pleased that twenty of our Health Care Assistants commenced the programme as it allows the acquisition of competence to expand the role to engage in more direct patient care for example, taking temperature and blood pressure readings, testing urine and weighing patients. Return to Nursing Practice A project group was established to plan, organise and evaluate a Return to Nursing Practice programme held over six weeks. Two programmes were delivered and many of the participants previously worked in St Vincent’s Hospital and have now been welcomed back on staff. Congratulations to Ms. Margaret Moran, Director of Nurse Education Centre and Ms. Mary Quinn, Clinical Facilitator Oncology, and Ms. Marianne Kelly, Clinical Facilitator Emergency Department who were conferred by UCD with awards of Honorary Lecturer Title. This was in honour of their commitment and contribution to undergraduate and postgraduate clinical education. Return to contents Annual Review 2006 154 Department of Nursing Nurse Practice Development This was an extremely busy year for the department and all are to be congratulated on the many new initiatives introduced to ensure a high standard of care for patients and support for nurses in the clinical environment. An example of some of the work is set out below: • Introduction of Orientation/Induction Programme for newly-qualified BSc Nurses including introduction of Medication Assessment Chart. • Introduction of a Tracheostomy Care Education Programme for ward-based nurses. • Education and training on the new policy for Confirmation of the Placement of Naso-gastric Tube Insertion using pH Strips. • Launch of Oral Hygiene Policy and ward-based education programme to promote utilisation of policy to guide care. • A comprehensive evaluation of the Clinical Learning Environment. • Nursing Record Audit Tool to evaluate the quality of care provided and identify areas for improvement. Staff in clinical areas now self-audit on an ongoing bi-monthly basis. Nursing Graduation The annual event in the nursing calendar took place on the 6th July 2006 and the first group of new nurses (50) were welcomed to the profession. It is most encouraging that the entire group of graduates are all now working within the organisation. The first Department of Nursing Annual Review for 2005 was launched and it reflected the high level of activity and achievements of the year. During the ceremony the following nursing awards were presented: Ms. Angela Moriarty Gold Badge Ms Marianne Kelly Mother Mary Aikenhead Medal Ms Eilish Voyles Mother Mary Bernard Medal Ms. Shirley Ann Collins Nuala Deeney-Brennan Memorial Prize Ms. Geraldine Caroll Cecil King Memorial Prize RCSI Bursary St. Michaels Ward Ms. Josephine Ryan Preceptorship Award (surgical) Ms. Sarah Walshe Preceptorship Award (medical) Ms. Marguerite Lyons Preceptorship Award (specialist) A major nursing conference celebrating the achievement and success of the introduction of the degree programme for nursing was held on the 6th November in Farmleigh. Staff Nurse Jane Byrne from St. Laurence’s Ward gave an excellent presentation entitled My Journey from UCD to Bedside. Seán Clarke, Jane Byrne, Marie Murphy, Ciara Dunne, Eugene McGinely Return to contents St. Vincent’s Healthcare Group Limited 155 Department of Nursing Pre-registration Midwifery and Integrated Children’s General Nursing Programmes. Two new pre-registration degree programmes in Children’s Nursing and Midwifery successfully commenced in September. This is the result of close collaboration between the Nursing Departments at: St Vincent’s; St. Michaels; Our Lady’s Hospital, Crumlin; the National Maternity Hospital and UCD in facilitating the additional students (35) on clinical placements. Future Developments Detailed plans were developed by each nursing division for 2007 an overview of some of the areas are set out below: • Preparation for An Bord Altranais assessment of pre-registration nursing education in February 2007. • Introduction of the DATHs Value for money Nurse Bank Project • Implement the DATHs Nursing Strategy. • Continue to promote and support nursing and interdisciplinary clinical audit across all specialties. • Preparation for the IHSAB Acute Hospital Accreditation in November 2007 and the mandatory Hygiene Services Assessment Scheme. • Participation in the national project being lead by the HSE on the implementation of Nurse Prescribing. • Continue the development of Advanced Nurse Practitioner roles to meet service needs. • Preparation for the first National Review of Decontamination Practices for Reusable Medical Devices. • Transfer of the Operating Department to the new Clinical Services Building. • Introduction of Foundation Courses as a structured mechanism for introducing new staff to specialist areas of practice. Photos Left to Right Jane Byrne and Mary Harney TD Eamonn Doherty, Ciara Dunne, Eugene McGinely, Mary Harney TD, Jane Byrne, Marie Murphy Return to contents Annual Review 2006 156 Departmental Review Department of Nursing Bed Management The function of the Bed Management Department is to oversee all daily admissions, transfers and discharges to and from the hospital. In doing so we aim to balance the demands of the Emergency department with those of urgent/ non-urgent elective work with available beds. The goal of the team working within the Bed Management Department is to optimise the continuum of care by managing the patient effectively throughout the whole of their care episode, from admission into the hospital and back to the community. St Vincent’s University Hospital’s in-patient bed capacity is currently 514. We are the National referral centre for Cystic Fibrosis and for Liver transplants. Our regional specialities include Orthopaedic, ENT and Plastic Surgery, whilst our super-regional specialities are Cardiology and Vascular surgery. We work closely with St Michael’s Hospital, St Vincent’s Private Hospital and with St Colmcilles (Loughlinstown), and many of our consultants have split appointments within the group, resulting in a regular flow of patients between these hospitals. The following initiatives were introduced this year in an effort to try and address the increasing demand for emergency and elective beds: • Additional 11 beds opened on St Clare’s Ward (Former Emergency Department) • Temporary opening of the former ICU during peak in activity • Introduction of the Anticipated Date of Discharge Stamp: allows for improved preparation of patients for discharge and increased efficiency during admission. Primarily it helps the Bed Management Department anticipate bed shortages/availability. • Introduction of the Medically Fit for Discharge Stamp: allows us to identify delayed discharges and their causes. • Process mapping of randomised admissions to identify causes of delayed discharges. • Up-dating of the IT systems within the department • Up-dating of all policies relating to Bed Management • Introduction of a Public Health liaison Nurse/Discharge planner to facilitate safe and appropriate discharge. • Introduction of Post Discharge Clinic to facilitate timely discharge • Provision of a private ambulance for all patients going to Long Term care, so as to ensure transfer is timely and safe. Return to contents St. Vincent’s Healthcare Group Limited 157 Departmental Review Department of Ophthalmology Staff Consultants Mr P Barry Mr W Power St James Ward Sandra Murphy Ophthalmic Theatre Ms Annette Cullen Surgical Registrars Dr Ismail Tuwir Medical Registrar Dr Magdy Nasralla Lecturer in Ophthalmology Dr Jan Shonfeld Orthoptist Ms Nanno Fitzsimons Unit Secretary Ms Jane Caulfield CNM2 Dr E Chacko Esther McCarthy (LOCUM) CNM1 CNM2 Mr Tarik Saddiq The Tables below summarise the department’s activity for the year 2006. Elective cataract admissions continued to be curtailed by the ever-present A & E crisis. Overnight admissions to the ward in ophthalmology were 366 patients for the year compared with 284 admissions from other specialities. This in turn led to cancelled theatre lists and reduction in staff morale. The department has therefore mounted a major change in direction for 2007. This plan entails a reduction in the total number of beds, the initiation of day care cataract surgery and the provision of a “one stop shop” for cataract patient assessment. Whilst the age and co-morbidity of our cataract population mean that few will be eligible for day care we know we cannot return to the pre-NTPF days! In 2006 a YAG-laser delivery system was purchased and its installation is part of the restructuring of the ward. The department continues to participate in the European Cataract Outcome Study. We have done this now for nearly a decade and have accepted an invitation to participate in a similar study comparing surgical quality amongst a number of European centres with centres in the United States. The European Cataract Outcome Study is a unique method of audit which received particular praise from the Accreditation Team. The consultants would like to express their appreciation of the stalwart efforts provided by Ms. Sandra Murphy, Ms. Esther McCarthy and their nursing team in these times of work stress. Their care of the patients is magnificent. We would also particularly thank Ms. Jane Caulfield for her dedicated secretarial role. Without her the system could not work. Finally, Mr. William Power received a distinguished merit award from the American Academy of Ophthalmology and Mr. Peter Barry delivered the Ridley medical lecture to the European Society of Cataract and Refractive Surgeons in London. St. Jame’s Ward Inpatient Admissions 2006 (including transfers) OPHTHALMOLOGY Elective OTHER SPECIALITIES TOTAL 359 71 430 VIA A&E 0 193 193 Other Urgent 7 20 27 Transfers 41 (FROM OTHER WARDS) TOTAL (OPHTH & NON-OPHTH) 366 284 691 Return to contents Annual Review 2006 158 Department of Ophthalmology Opthalmology: St. James Ward 1992 1993 1994 1995 1996 1997 1998 1999 2000 694 701 845 843 790 787 738 732 587 584 488 484 496 49 487 482 443 436 283 527 396 353 374 278 333 345 308 188 188 449 449 788 788 878 878 1196 1196 1406 1406 1708 1708 1491 1491 1526 1526 Done in OPD Done in OPD 611 667 598 563 575 551 573 754 617 746 888 1268 1229 1130 St James In-Patients Ophthalmology Admissions Ophthalmology Discharges St James In-Patients Cataract Procedures St James Day Care Admissions Discharges St James Day Care Orthoptic Total Attendances St James A/E Ophthalmic Patients Total Attendances Accounts for Accounts for A& E Dept. A& E Dept. St James In-Patients Referrals Total Attendances 503 462 479 437 439 388 392 325 361 2948 3360 4118 3302 3120 3015 3180 3121 2651 2001 2002 2003 2004 2005 2006 461 457 458 456 458 451 442 434 365 363 366 362 330 324 310 299 300 331 1611 1611 1846 1846 1994 1994 1729 1729 1647 1647 1536 1536 607 502 927 777 973 281 1153 1261 1016 1064 1157 1204 299 309 327 342 312 334 Ophthalmology Out-Patients New Total Attendances In-Patients Ophthalmology Admissions Ophthalmology Discharges In-Patients Cataract Procedures Day Care Admissions Discharges Orthoptic Total Attendances A/E Ophthalmic Total Attendances In-Patients Referrals Total Attendances Out-Patients New Total Attendances 745 773 781 729 836 742 2372 2398 2475 2245 2262 2075 Return to contents St. Vincent’s Healthcare Group Limited 159 Departmental Review Operating Theatre Department Staff Welcome to the new members of the consultant staff Mr. Desmond Winters and Mr. Garry O’Toole who commenced practice during the year. We wish Dr. Geraldine Kelly good health and happiness in her retirement. Twenty new nursing staff members were recruited at various stages over the year. This resulted in a most welcome increase in the staffing compliment for anaesthetic and PACU nursing in anticipation of the move to the new building. It is a great tribute to the staff themselves their individual preceptors, the Clinical Facilitators and CNMs that all successfully completed their orientation and probation assessment. The following promotional appointments were made: Ms. Marie Ann Bruno, CNM1 PACU; Ms. Antionette Guthrie Acting CNM2 Theatre 9/10; and Ms. Angelina Tabamo, Acting CNM1 Theatre 9/10. Mr. Mervyn Hollywood, Assistant Director of Nursing took leave for further study. Ms. Maureen Flynn, Assistant Director of Nursing assumed responsibility for the operating department on an interim basis from end November 2006. An audit of the PACU staff roster indicated that more cover was required in the evening and at weekends. Arising from this a quality improvement was introduced and the roster changed to incorporate long days therefore meeting patient care demands. Service Developments The first laparoscopic prostatectomy in Ireland was carried out in SVUH in January 2006. This procedure offers less invasive surgery and reduces the patients length of stay in hospital to 2-3 days, an improvement on the current length of stay of a week or longer. While on the 29th March the first patient to undergo endovascular stenting of an abdominal aortic aneurysm was carried out by Dr. David Brophy and Ms. Mary Barry in the Operating Department. Endovascular surgery greatly minimises the physical impact of surgery for patients, their subsequent recovery phase and it necessitates less time if any in the intensive care unit. Following the development of the local policy all PACU staff were educated and their competency assess to administer bolus doses of IV analgesia and antiemetics. This is a significant quality improvement for patients and ensures a speedier response to post operative pain. Theatre reception staff undertook a review of reasons for patient delay over four weeks. The preliminary findings indicated that 81% of patients (124) where on the circulated OT list; 81% had a pre-operative check list completed; 92% had surgical consent and 56% anaesthetic consent completed prior to arrival in the department. The Theatre Users Group agreed a quality improvement plan to address the main areas of concern in December 2006. Theatre Commissioning A multidisciplinary commissioning team was established to plan and execute the move to the new building, throughout the year group meet on a weekly basis. Ms. Lynda Mullen, CNM2 Theatre 9/10 was seconded to the project team. In her role she provided expertise in tendering and evaluation of equipment and an invaluable link between the project team and clinical staff. The first function to take place in the new department was the annual Theatre Christmas Breakfast and crazy hat competition, organised by the social committee and hosted in the new Post-Anaesthesia Care Unit (PACU). Hospital Hygiene Quality Improvement Group A subgroup of the Hospital Hygiene Quality Improvement Group was established for the Operating Department. This group works closely with the existing infection control group. Five additional Infection Control link nurses were trained. A cleaning file was compiled with reference material for each speciality area. Throughout the year four- Return to contents Annual Review 2006 160 Operating Theatre Department hand hygiene audits were undertaken and arising from this two-hand hygiene awareness days were held. A deep cleaning service (over night) for the operating department was commissioned and is being provided by Noonan Services seven days a week. Arising from concerns in relation to the infrastructure theatres five and six were closed for two weeks for essential maintenance and essential repairs. Product Evaluation The Operating Department Product Committee introduced a pathway and formal documentation processes for request, evaluation, review, purchase and introduction of new products to use. Education / Conferences A series of workshops were introduced to support overseas nurses in their orientation to Irish operating department nursing practices in anaesthetics, recovery and surgery. Six PACU staff completed ACLS training. Six staff commenced the diploma in first line management. The nursing journal club was further developed and each speciality group meet simultaneously on a monthly basis. Support for students (nursing and medical) is a fundamental activity for the operating team. This is particularly important, as students are employees of the future. During the year 12 staff nurses completed preceptorship training in order to support them in this function. We are particularly grateful to the staff that guided over sixty nursing students through their theatre placement. Two staff members attended the annual conference of the Association for Perioperative Practice (AfPP) in Harrogate UK and a further two staff attended the Autosuture workshop and Ophthalmology conference. The fourth congress of the European Operating Room Nurses Association (EORNA) On the Shores of Excellence for the first time was held in Dublin from the 25th to the 28th May with over 2,600 attendees from 42 countries. Ms. Caroline Higgins CNM3 in the Operating Department (SVUH) and member of the international organising committee had the honour of thanking the President of Ireland Ms. Mary McAleese on behalf of the delegates. Ms. Maureen Flynn, Assistant Director (SVUH) gave the keynote address Perioperative Nursing: the Finest Art. Ms. Lynda Clarke and Ms. Sheila Bredin were among the fourteen Irish nurses selected to present papers. During the four days of the congress Mr. Mervyn Hollywood, Assistant Director of Nursing (SVUH) took over 6O nurses on a tour of our new operating theatres. Departmental Statistics During 2006 10,070 surgeries were performed, of this 7,745 where planned cases. Twenty three percent (2,325) of all surgery performed in the department was emergency of this 1,286 cases (55%) where performed after hours. see table on following page Sixty-five liver transplant operations were performed during the year – the highest number in the history of the programme. There was also a very significant increase in number of donor retrieval operations now over 85 per year (on average 1.6 per week). This development is accredited to the commitment and support of all staff throughout the department to the National Liver Transplant programme. Pressures on ICU bed availability resulted in the situation were 87 ICU patients were cared for in a PACU trolley space on temporary basis until a bed was available in the unit. Despite this challenge postoperative recovery care was provided for all patients. This would not have been possible with out great flexibility, creativity and cooperation from all staff. Return to contents St. Vincent’s Healthcare Group Limited 161 Operating Theatre Department Future Plans Next year (2007) will be one of the most exciting for the Operating Department team with the planned move to the new Clinical Services Building. The key activities will involve: • Working with the Project Team in commissioning the new facilities. • Developing and agreeing the Theatre Schedule. • Evaluating, selecting, commissioning, training and introducing new equipment to service. • Developing a detailed training and education plan for all members of the multidisciplinary team. • Completing the Standard Operating Procedure for the service in the new Clinical Services Building • Agreeing the Nurse Management Structure for services in the new facility. • Developing a detailed Workforce Plan for the Operating Department Departmental Statistics CATEGORY SVUH SVPH TOTAL 54 1 55 Dermatology 157 0 157 E.N.T. 288 72 360 General 2,505 477 2,982 G.U. Endo 1,641 53 1,694 G.U. Open 144 4 148 Gyncaecology 228 1 229 Ophthalmology 352 0 352 1,740 91 1,831 Pain 538 72 610 Plastic 977 49 1,026 Thoracic 212 90 302 Vascular 262 62 324 9,098 972 10,070 Dental Orthopaedic TOTALS Return to contents Annual Review 2006 162 Departmental Review Department of Palliative Medicine Department of Palliative Medicine Staff Consultant Dr Eoin Tiernan Clinical Nurse Specialist Ms Millie Devenish Ms Siobhan Hollingsworth Ms. Carmel Houlihan (ST. VINCENT’S PRIVATE) Olga Price Ms Barbara Whyte Care of the Dying Project Facilitator Specialist Registrar Registrar Senior Social Worker Principal Psychologist Administrative Support Ms. Pauline Ui Dhuibhir Dr Eileen Mannion - 01/01/06 TO 30/06/06 Dr Gill Gormley – 01/01/06 TO 30/06/06 Ms Aine Canny Ms. Ursula Bates Ms Joan Stokes Dr Brian Creedon – 01/07/06 TO 31/12/06 Dr Brenda O’Connor – 01/07/06 TO 31/12/06 Mr Olajide Ogidan 2006 was another busy year for the Palliative Medicine Department with a total of 931 referrals to the service – this represented a small increase in referrals in St. Vincent’s University Hospital, but incorporates a 41% increase in referrals in St. Vincent’s Private over 2005. The proportion of non-cancer referrals increased significantly for a second consecutive year from 16.7% to 23%. Further progress was made on the “Care of the Dying Project” which was launched in 2004. Following a successful pilot of the care pathway on St. Anne’s Oncology Ward in 2005, the pathway roll-out across the rest of the hospital was commenced in 2006. A “Link Nurse” programme was established, supported by nursing administration. This programme identifies 2 nurses from each ward where the pathway is introduced who act as local “champions”/ resources for the pathway and palliative care issues in general. The palliative care team received a Quality Improvement Innovation Award for the ongoing project from the Healthcare Group in November. During the year, Ursula Bates, who had occupied the post of psycho-oncologist in St. Vincent’s University Hospital, was appointed as Director of Psychosocial & Bereavement Support Services/Principal Psychologist at Blackrock Hospice. As part of this new post, a sessional commitment was established in St. Vincent’s to establish a further link between the two services. Education The team hosted the third annual international palliative medicine symposium on 3rd November. A capacity attendance of approximately 180 professionals attended at the Education & Research Centre for the half-day symposium entitled “Palliative Care for Non-Cancer Patients – Responding to the Challenges”. The international faculty included Professor Julia Addington- Hall (Southampton), Professor Sam Ahmedzai (Sheffield), and dr. James Beattie (Leeds), with the local faculty comprising Dr. Orla Hardiman (Beaumont Hospital), Dr Norma O’Leary, (Blackrock Hospice), Dr. Diarmuid O’Shea (SVUH), and Ms. Gill O’Callaghan, (Our Lady’s Hospital for Sick Children, Crumlin). The team continues to contribute to a wide range of educational programmes for nurses and other professionals both in-house and at national meetings, as well as facilitating clinical placements for nurses undertaking the Higher Diplomas in Palliative Care Nursing and Pain Management from UCD, and undergraduate medical students. Return to contents St. Vincent’s Healthcare Group Limited 163 Department of Palliative Medicine Courses and Conferences attended by members of the team A selection of the educational events attended by members of the team: Bristol Opiod Conference, March 2006, Bristol, U.K. ‘A Considered Approach to Integrated Care’ Clontarf Castle May 2006. 4th Research Forum of the European Association for Palliative Care. Venice, May 2006 Kaleidoscope Conference, Dublin Castle. May 2006. Neuropathic Pain School Masterclass. Royal College of Physicians of Ireland. July 2006. IAPC, AGM 24th November 2006, Dublin. Liverpool Care Pathway International Conference, November 2006, Royal Society of Medicine, London. Presentations at external meetings: A variety of posters were presented by the team at a number of conferences in 2006, including: A Considered Approach to Integrated Care’ Clontarf Castle May 2006, 4th Research Forum of the European Association for Palliative Care, Venice May 2006, Kaleidoscope Conference, Dublin Castle • Our experience of establishing a care of the dying project in a university teaching hospital. Tiernan E, Uí Dhuibhir P, Bates U, Whyte B, Hollingsworth S, Price O, Devenish M, Harnett I, Canny A, Dooley B. • Survey of bereaved relatives of patient who died in an acute general hospital. Whyte B, Hollingsworth S, Price O, Devenish M, Harnett I, Canny A, Bates U, Dooley B, Tiernan E. • An audit of the implementation of the Liverpool Care Pathway for the dying. Hollingsworth S, Uí Dhuibhir P, Tiernan E, Price O, Devenish M, Whyte B, Canny A. • Multidisciplinary pathway education programme and staff satisfaction survey. Hollingsworth S, Uí Dhuibhir P, Tiernan E, Price O, Devenish M, WhyteB, Canny A. • Nurses’ perspective on quality of care for dying patients in an acute hospital setting: questionnaire study. Harnett I, Whyte B, Devenish M, Price O, Hollinsworth S, Canny Á, Bates U, Dooley B, Gleeson A, Twomey M, Tiernan E. Publications Peer-reviewed publications Kirkova J, Davis MP, Walsh D, Tiernan E, O'Leary N, LeGrand SB, Lagman RL, Russell KM. Cancer symptom assessment instruments: a systematic review. J Clin Oncol. 2006 Mar 20;24(9):1459-73. Annual Review 2006 164 Departmental Review Department of Pathology and Laboratory Medicine Service Developments/Activities The major event of 2006 was the move to the new laboratories in the Clinical Services building, which took pace on a phased basis between March and June. The move has resulted in additional laboratory and office space with improved working conditions for all staff. Outpatient phlebotomy moved to the new ADCC, which facilitated the provision of a dedicated phlebotomy service for anticoagulant monitoring. A dedicated phlebotomy service has also been provided to the Haematology and Liver clinics, which has resulted in an improved service for patients. The move to the new laboratories required the commissioning of new analysers with different analytical methods. All test methodologies were validated prior to the move. A new automated pre-analytical system was introduced for Biochemistry/ Nuclear Medicine providing opportunities for consolidation of testing and improved efficiency. The smooth transition of the Pathology Department to the new building was enabled by the commitment of all staff with a long process of planning and training. Other significant developments in 2006 included the following: The Histopathology and Haematology/Transfusion laboratories were granted an award of compliance with Standards for the medical laboratory incorporating ISO 15189; 2003 by Clinical Pathology Accreditation (UK) Ltd (CPA). An award of conditional accreditation was granted to the Biochemistry, Nuclear Medicine, Endocrinology and Metabolism laboratories. It is anticipated that an award of full accreditation will be granted to the above laboratories in 2007 with the addressing of facility issues since the move to the new laboratories. The Microbiology Department has applied to CPA for assessment in 2007. In conjunction with St. Columcille’s Hospital the Blood Bank implemented a blood stock utilisation programme. Under the service level agreement between the hospitals, blood products entering their last week of shelf life in St. Columcille’s are transferred to St. Vincent’s where the units can be utilised preventing wastage. In order to achieve compliance with article 14 of the EU Blood Directive 2002/EC/98 a system was put in place by the Blood Bank to ensure full traceability of all products covered by the directive. To date 100% traceability has been achieved. The weekend phlebotomy service was extended to cover all hospital wards with an increase in phlebotomy personnel from four to six. In conjunction with the IT department, Healthlink was implemented enabling GPs to receive results electronically. The Cryobiology Stem service applied to the Irish Medicine Board for GMP inspection. Return to contents St. Vincent’s Healthcare Group Limited 165 Department of Pathology and Laboratory Medicine • The Biochemistry laboratory performed a number of evaluations:1. The effect of new blood collection tubes on test results. 2. An evaluation of ischaemia modified albumin, a test designed for the early identification of myocardial ischaemia (in collaboration with ED). 3. A study of BNP variability in heart failure patients (in collaboration with the HF Unit). A member of the Nuclear Medicine Lab staff, in collaboration with a number of European investigators, was involved in preparing guidelines for clinical use of CA 125 in ovarian cancer. This document was widely distributed (locally, nationally and internationally) to laboratory staff, clinicians and nurses with an interest in gynaecological oncology. Departmental Statistics Pathology activity increased by 9% in 2005. The Cryobiology group performed 10 Stem cell autografts and harvested 13 donors. Blood product usage increased by 3.4%. Significant Achievements Prof. Dr. Joe Duffy/Nuclear Medicine continued to act as Chairman fo the National Academy of Clinical Biochemistry (USA) panel for the preparation of new guidelines on the Clinical Use of Tumour Markers in Breast Cancer. Professor Duffy was an invited speaker at a number of international conferences. Ms. Geraldine Collier/Biochemistry was successful in the practical examination for Part 1 of the MRCPath and become chairman of the Association for Clinical Biochemistry, Republic of Ireland Region. Dr. Sean Cunningham/Biochemistry is chairman of the Clinical Biochemists Registration Board. Ms. Catherine Kavanagh, Grade V, Pathology Administration, was awarded the Diploma in Front Line Management by the National College of Ireland (NUI). Ms. Ursula Keegan, Ms. Miriam Hogan and Ms. Rhone Barry successfully completed the Phlebotomy Diploma conversion course in DCU. Ms. Gay Wright, Ms. Colette Devlin, and Ms. Sheila Fallon successfully completed the Phlebotomy Monitoring Programme in DCU. Ms. Deirdre Keating/Microbiology successfully completed completed her MSc in Molecular Pathology in D.I.T. and was invited to join the DIT Educational Committee for the MLS degree programme. Ms. Denise Neary/Blood Bank was awarded an MSc in Transfusion and Transplantation Science from Bristol University. Ms. Lesley Hopkins/Blood Bank received her Diploma in First Line Management from the NUI Dr. Karen Murphy presented a lecture in Lisbon in October 2006 on: “Risk Assessment; which safety considerations do we need in the pregnant patient who requires anticoagulation.” Mr Paul O’Brien/Blood Bank recieved a hospital innovation award for developing a website to improve transfusion safety Return to contents Annual Review 2006 166 Department of Pathology and Laboratory Medicine Staffing Dr. Donald McCarthy, Consultant Haematologist, began his term as Director of Pathology in December, 2006. On behalf of all staff in Pathology, Dr. McCarthy wishes to record his thanks to Dr. Tom Crotty for his contribution to Pathology in his tenure as Director. Staff who achieved promotion to higher grades in 2006 included the following; Ms. Mairead O’Leary – Specialist Medical Scientist (Quality Management/Information Technology) Dr Susan Fitzgerald – Research Specialist Registrar,Microbiology. Mr. Brian Reynolds – Acting Senior Medical Scientist, Biochemistry. Ms. Lisa Healy – Acting Senior Medical Scientist, Biochemistry. Ms. Mary Walsh – Senior Medical Scientist, Histopathology. Mrs. Catherine Kavanagh, Pathology Administration – Grade V (Job Sharing) A number of new staff joined the Department including: Ms. Carmel Maguire, Ms. Caroline Walsh, Ms. Louise Scott, Ms. Elaine Keenan, Ms. Anne Lennon, Ms. Rachel O’Brien, Ms. Deirdre O’Shea, Ms. Marie Gunning, Ms. Julie McAndrew (Medical Scientists). Ms. Suzanne Kelly, Ms. Valerie Vickers, Ms. Carol Stapleton, Ms. Dawn Molloy, Ms. Bernadette Walsh, Ms. Jacinta McManus (Clerical/Admin). Future Developments It is planned to commission the new molecular laboratory and introduce molecular testing for a range of disorders including Thrombophilia, Haemochromatosis and the development of ‘real time’ PCR for MRSA and cystic fibrosis. Histopathology intend to introduce a gene amplification test for patients with breast cancer i.e. fluorescence in situ hybridisation (FISH) for Her2 neu. Biochemistry intend to introduce the BNP test for the evaluation of heart failure and also sweat testing for the Adult Cystic Fibrosis Unit. Other areas of development for Biochemistry include the introduction of eGFR, expansion of the drug test menu and evaluation of soluble transferrin receptor in evaluation of anaemic patients. Return to contents St. Vincent’s Healthcare Group Limited 167 Department of Pathology and Laboratory Medicine CPA Surveillance visits are planned for April, 2007 which will result in a major focus on the Quality Accreditation process. Microbiology plans to introduce new antibiotic sensitivity methods (Vitek2) to meet ICLS standards. The main objective for the Blood Bank will be to achieve SIO15180 accreditation for the Blood Transfusion Laboratory and GMP standards for the stem cell laboratory. Publications Fox EJ, Leahy DT, Geraghty R, Mulcahy HE, Fennelly D, Hyland JM, O'Donoghue DP, Sheahan K. Mutually exclusive promoter hypermethylation patterns of hMLH1 and O6-methylguanine DNA methyltransferase in colorectal cancer. J Mol Diagn. 2006 Feb;8(1):68-75. Phelan SM, O'Doherty A, Hill A, Quinn CM. Epithelial Displacement during breast needle core biopsy causes diagnostic difficulties in subsequent surgical excision specimens. J Clin Pathol. 2006 Jul 5; Maguire OC, O’Sullivan J, Ryan J, Cunningham SK. Evaluation of the Albumin Cobalt Binding (ACB) Assay for measurement of Ischaemia Modified Albumin (IMA) on the Beckman Coulter LK-20. Ann. Clin. Biochem 2006; 43:494-9. Buggy Y, Maguire TM, McDermott E, Hill AD, O'Higgins N, Duffy MJ. Ets2 transcription factor in normal and neoplastic human breast tissue. Eur J Cancer. 2006;42:485-91. Educational interventions can improve management of patients with community-acquired pneumonia. Schaffer K, FitzGerald SF, Gonzalez-Sanchez Z, Fenelon LE Journal of Healthcare Quality 2006; 28 (6): 7-12 Return to contents Annual Review 2006 168 Departmental Review Department of Plastic Surgery Staff Consultants Mr Tom O’Reilly Mr Sean M Carroll Ms Margaret O’Donnell Registrars Mr H Ali Shah Ms E Fitzgerald Mr J Curran Occupational Therapist Aine O’Reilly Hand Therapist Catherine Cradock Unit Secretary Alison Kelly Dr. Catriona Lawlor Service Development and Activities The Department of Plastic Surgery provides a general plastic surgery service within the SVUH healthcare group for the southeast of the country. We provide specialised services in breast reconstruction, hand surgery, skin cancer, pressure sore surgery and head and neck reconstruction. St Agnes’s ward remains the nominal Plastic Surgery ward but unfortunately due to the pressure of emergency work we see little increase in the numbers of patients been admitted for elective procedures on to our ward. We never the less acknowledge the dedication and hard work of the Senior Nurses Dolores O’Neill and Josephine Ryan and the other highly competent ward staff. Out patient clinical activity increased further this year. We recognise the expertise and continued positive attitude of the OPD nurses. Multiple new out-patient clinics have been added over the last year. The hand surgery clinic has been moved to Thursday mornings and the Wednesday clinic retained general plastic surgery. A new breast reconstruction clinic has been added on a Monday and the general plastic surgery clinic moved to Thursday. Therefore a total of five Plastic surgery OPD clinics are held per week in SVUH, three of which are general plastic surgery, one Hand Clinic and one breast reconstruction clinic. Mr O’Reilly continues to provide a general plastic surgery service with a special commitment to skin cancer surgery as well as participating in the paediatric plastic surgery service in Crumlin Children’s Hospital. Dr Lawlor and Ms. O’Donnell continue to provide a busy breast reconstruction service and it continues to expand with over one hundred and twenty reconstructions being performed during the year. We have a close working relationship with the Surgical Professorial Unit from where a significant number of patients are referred. We also provide a reconstructive service to Breast Check and many patients now undergo breast reconstruction at the time of their mastectomy. The majority of patients, however, are reconstructed sometime after their reconstruction. The service is complimented by the participation of the Breast Care Nurses and encompasses a Micro-pigmentation (Tattooing) Clinic to complete Nipple-Areolar reconstruction. The hand surgery service continues to flourish with an ever expanding clinical case load and Mr Carroll hopes that when we have our dedicated regional anaesthesia hand surgery list organised in the new theatre block we will be able to offer a first class service. A plastic surgical service continues to be provided for the National Rehabilitation Hospital by Mr Carroll. An outpatients and ward round at NRH is provided on alternative weeks. Agreement was reached during the year that 2 protected beds were to be made available for pressure sore reconstruction in the NRH and this has been an invaluable asset over the last year. The numbers of complex micro vascular reconstructions performed over the last year has increased significantly over previous years. We have been delighted to perform these and have been gratified by the excellent results obtained but feel that in the medium term the unit can not continue to expand without the addition of a permanent fourth consultant. Return to contents St. Vincent’s Healthcare Group Limited 169 Departmental Review Department of Psychiatry and Mental Health Research 2006 was a busy year for Elm Mount Psychiatric Service. The amalgamation of the two services continues and new developments have taken place. In April 2006 the dedicated 6 beds for Psychiatry of Later Life opened, resulting in more focused care to the different patients groups on the unit. Two new CNM 2’s have been appointed. One to Psychiatry of Later Life, and the second as a Link Nurse between Psychiatry and the General Hospital, in particular the Emergency Department. It is hoped to further expand the Liaison Service in the coming year. In September 2006, Dr. Mary Darby retired, having provided a high quality service to St. Vincent’s University Hospital for many years and been an integral part of the development of the new psychiatric unit. We wish her well for the future. In November the new procedures for detention of mentally ill patients commenced, resulting in the most radical change to how psychiatric services are delivered since 1945. All detention of patients are subject of review by the Mental Health Commission with patients being assigned legal representation and an independent Psychiatrist and if detained longer than 21 days, a Mental Health Tribunal to review their detention. Despite the additional workload, the services welcome these additional safeguards for patients. To date, thanks to the appointment of a Mental Health Administrator, and the co-operation of all staff, the new procedures are working well. Mental Health Research The Department has established a leading National Programme on Suicide Research including projects in basic and applied clinical neuroscience, clinical epidemiology projects as well as leading national community projects in the area of new knowledge and understanding around the problem of suicide in Ireland. The basic and applied clinical neuroscience projects include neuroimaging studies led by Dr Robert Whelan which is focusing specifically on brain pathways involved in modulating suicidal depression. This work is being conducted in collaboration with the Department of Electronic Engineering in UCD, Professor Richard Reilly, as well as the Department of Radiology in St. Vincent’s. Other neuroscience projects include molecular genetic studies of patients with suicidal depression. This collaborative research project is being led by Dr Maria Ryan and includes a study of cases from all the Dublin Teaching Hospitals in collaboration with the Dublin Molecular Medicine Centre. Clinical epidemiology projects include a national study of all suicides by drowning as well as a ten-year study of all deaths on Irish railways over the past decade. This work is being conducted in conjunction with the Irish Water Safety Association and Iarnród Éireann respectively with significant consultation and collaboration with Professor Cecily Kelleher, UCD. New projects include a National Survey of Suicide in Ireland, which is being led by Professor Malone at St. Vincent’s. This Return to contents Annual Review 2006 170 Department of Psychiatry and Mental Health Research project involves detailed interviewing of families who have been bereaved by suicide as well as the treating clinicians of those who have died. The Suicide in Ireland Survey project was significantly enhanced in Autumn 2006 following the awarding of an Ad Astra Scholarship in Suicide Studies as part of this programme. This Scholarship went to Mr. Séamus McGuinness who will conduct a PhD in Suicide Studies through Visual Arts here at St. Vincent’s in collaboration with Professor Malone, and also Professor Janis Jeffries from Goldsmith College in London. In addition to the suicidal depression projects we have established an exciting interdisciplinary collaborative research programme around immune factors associated with health and mental illness. These projects are being led by Ms. Aoife O’Donovan who is in the final year of her Newman Fellowship. These projects are being conducted in collaboration with Professor Cliona O’Farrelly and Dr Jacinta O’Sullivan in the ERC. Additional projects on treatment effects during depression are being conducted by Dr Gavin Rush who is looking at the anti-inflammatory response of some of our anti-depressant treatments. This work is being done in collaboration with Dr Jim Lucey in St. Patrick’s Hospital as well as Professor Cliona O’Farrelly at the ERC. Our in-house research personnel include Dr Robert Whelan, Ms. Aoife O’Donovan, Dr Maria Ryan, and Mr. Séamus McGuinness. Our collaborative partners in St. Vincent’s include Professor Cliona O’Farrelly, Professor Cecily Kelleher, Dr Jacinta O’Sullivan, Dr Douglas Veale, Dr Dónal O’Shea, Dr Hugh Mulcahy, Professor Michael Hutchinson from Neurology, and Dr Seán Connolly from Neurophysiology External and international collaborators include Professor Andy Saykin from Dartmouth Hitchcock Medical Centre, Professor John Mann from Columbia University, New York, Professor Annette Beautrais from the University of Otago in New Zealand, Professor Madelyn Gould from the Department of Public Health in Columbia University, New York, and Dr Tom Foster and Dr Chris Kelly from Queen’s University Belfast. Scholarships and Awards Mr. Séamus McGuinness was awarded a four-year Ad Astra Scholarship in Suicide Studies in September 2006. Ms. Aoife O’Donovan was awarded an International Rotary Ambassador Scholarship in November 2006, and Dr Gavin Rush was awarded a National Lundbeck Research Bursary in December 2006. Return to contents St. Vincent’s Healthcare Group Limited 171 Departmental Review Department of Old Age Psychiatry The service has now been in existence for 10 years. 2006 was a very busy year for the Department of Old Age Psychiatry with another significant increase in new referrals seen by the service. The new 6 bed ward for older adults within Elmmount Unit Upper opened in 2006.The introduction of the new Mental Health Act towards the end of 2006, while very welcome, has involved a significant extra workload for the Old Age Psychiatry service. Additional resources will be required to address this increase in workload, the current and anticipated increasing needs of our aging catchment population. Staff The service welcomed a number of new staff to the unit including Dr. Miriam Kennedy, Senior Registrar in Old Age Psychiatry and Brid Flynn who returned to the Department to work as a Community Mental Health Nurse. Congratulations to Alan Doran who has recently been appointed as the Clinical Nurse Manager for the Old Age Unit at Elmmount Psychiatric unit and also to Dr Elaine Dunne who worked as a registrar in the Department and who passed her Membership exams to become a Member of the Royal College of Psychiatrists. Dr Trudy Meehan joined the Department in January 2006 as a basic grade Clinical Psychologist. We wish Catherine Keogh our former Senior Occupational Therapist every best wish in her new post with the Alzheimer’s Society of Ireland. She made a very significant contribution to our service over the years. Service Developments/Activities Just over 700 new referrals were seen in 2006 the highest number in the 10 year history of the Department. The Day Hospital staff ran the Healthy Aging Programme for 3 patient groups in 2006. This programme focuses on active health promotion in older adults through education, goal setting and support. In addition, Deirdre Corrigan (Community Mental Health Nurse) and Catherine Keogh (senior O.T.) ran the Anxiety Group at the Day Hospital and a Depression Group programme was carried out under the supervision of Dr. Trudy Meehan (Psychologist) and Mairead Mc Donnell (CMN2). The Active Rehabilitation Programme, which supports patients with enduring functional mental health problems to remain in the community, has been the subject of a research study by Catherine Keogh, Senior O.T. and Mairead McDonnell CNM 2 since its inception. The findings of this work have been highlighted in a poster Presentation at the Irish Gerontology Society in 2006 and at the St. Vincent’s University Hospital Innovation Awards 2006. Return to contents Annual Review 2006 172 Department of Old Age Psychiatry A needs assessment of a cohort of people with dementia referred to the Old Age Psychiatry service was carried out by Martina Dolan, team social worker, and presented as a poster at the Irish Gerontology Society annual meeting in 2006. A database developed by the Health Research Board and adapted by Dr.Aideen Freyne and Ms Antoinette Copley for the service was introduced in the Department in 2006. This database enables us to collect detailed information about our patients and service activity, ranging form absolute numbers referred and their diagnostic categories, to the numbers of referrals in different age categories. As the population ages we are seeing more nonagenarians referred and this information is very important for further service planning. There is a large demand on the service from nursing home referrals. The Nursing Home education programme will resume in 2007. Maria Brennan, Community Mental Health Nurse, completed the graduate diploma in Older People’s Mental Health. Nursing staff on the team attended courses in Suicide Intervention Skills Training and workshops on the new Mental Health Act Dr. Miriam Kennedy developed an assessment format for family meetings in our long-stay care units Dr. Cooney, as part of the Accreditation process for the hospital, has been involved in a hospital committee developing a restraint policy for the hospital. Publications C.Cooney, Howard, R and Lawlor B. Abuse of patients with dementia by their carers : can we identify those most at risk? Intenational Journal of Geriatric Psychiatry (2006) 21(6); 564-571. C Cooney, O’Shea D. Palliative Care in Dementia. Submitted as a book chapter for a textbook on palliative care. Return to contents St. Vincent’s Healthcare Group Limited 173 Departmental Review Department of Radiology Radiology Management Team Clinical Director of Radiology Dr Conor Collins Radiography Service Manager Sharon Simpson Clerical Supervisor Grade VI Officer Helen O’Reilly Clinical Nurse Manager II Sara Nicholson Service Developments Radiology underwent a metamorphosis in 2006 with completion of the equipping, installation and commissioning of the new department. The ED & Bone & Joint Radiology on the ground floor opened on January 18th and supported the ‘go live’ of the new ED on the same day. Planning continued for the main department move and the implementation of the RiS/PACS. On 3rd July the department went live with general x-ray, CT, MRI and the RiS/PACS within Radiology. Over the following months access to the web browser was extended to cover all areas of the new clinical services building and Ultrasound, Mammography and RNI completed the modality moves. New Technology The learning curve continued in 2006 with the challenge facing all in Radiology. There was new technology in the form of a comprehensive change programme for the imaging equipment and the introduction of the RiS/PACS. A dedicated core team of radiographers, clerical staff, nursing staff and radiologists ensured everything was in place and everyone received the training that was necessary. Return to contents Annual Review 2006 174 Department of Radiology Staff Movement Radiology There were no changes to the consultant staff during 2006. Dr Amjad Iqbal returned to work as locum consultant during 2006. Specialist registrars Drs Lorna Browne FFR and Colm McMahon FFR departed having successfully completed four years of training. We wish them well in their future careers. We welcome Drs. Victoria Chan, Carole Ridge, Shauna McDermott and Chris Hegarty as first year specialist registrars and Dr. Abdul Nasser Alhajeri as our fifth year specialist registrar. Radiography The following Radiographers joined us during 2006: Monica Healy Claire Moran (RETURNED FROM LEAVE OF ABSENCE) Patrick Doherty Justine Naidoo Verna Vengadajellum Purity Mogane Katherine Watson Gareth Jones Claire Kenneally Carol O’Sullivan Jaonne Leamy Ciara Sweeney Marina Venter Anne Marie Smyth (RETURNED FROM LEAVE OF ABSENCE) The following radiographers left the Radiology Department in 2006: Esther Walsh Melanie Hoffmeister Sandra Bolangaro Linda Menyo Daphne Mason Chyke Ohuegbe Anne Marie Smyth Anthony Onwuka Nursing S/N Grainne Byrne completed Batchelor of Nursing Science/Management Degree We welcomed the following new staff nurses who joined the team in 2006 S/N Janeth Ceria S/N Viji Punneghade S/N Priscilla Alcos S/N Aswathy Sivakumary S/N Nishi Bin Kurian We said goodbye and thank you to the nurses & hca who left in 2006 S/N Molly Arackaparambil S/N Deirdre Kelleher HCA Effie Adeji & Margaret Southwaard Clerical This year proved to be one of major change and challenge which involved moving in to a new department and the new RIS/PACS. All clerical staff positively embraced this change. Credit goes to all who put so much effort in to the preparations for this change, particularly Helen O’Reilly, Samantha Alford, Louisa Murphy, Virginia Kirwan and Sylvia Hughes. Return to contents St. Vincent’s Healthcare Group Limited 175 Department of Radiology Patricia Martinez was successful in obtaining a Grade IV position to manage the new MRI service. Anne Sharkey, Mary Peare, Virginia Kirwan and Louisa Murphy have commenced a two year Diploma in First Line Management (NCI). Sylvia Hughes has commenced a two year Certificate in Supervisory Management (IMI). The following staff joined us during 2006: Angela Ormonde Gillian Harmon Kerrie Breeze The following staff left us during 2006: Niamh Clohessy Linda Walsh Kerrie Breeze Fiona Burns Eileen McGinley Ancillary Staff The Radiology Aides have continued to contribute significantly in the workflow of the Radiology Department. Their rota ensures that an Aide is present to assist a radiographer 24 hours a day. Outstanding Achievements Administrative and Academic achievements by consultant radiologists in 2006 Dr Conor Collins hosted the annual meeting and sixth annual teaching course of the International Cancer Imaging Society at the Burlington Hotel, Dublin which was attended by over 350 delegates from 25 countries. Dr O Laoide continued as Chairman of the Medical Board and became Hon. Sec of the Faculty of Radiologists. Dr Dermot Malone was appointed to the editorial board of the prestigious journal Radiology. Specialist Registrar achievements Drs Ronan Ryan, Simon Walsh and Rowland Okello were successful in the primary examination for the Fellowship. Selected Publications Heffernan E, Fennelly D, Collins CD. Multiple metastases to skeletal muscle from carcinoma of the oesophagus detected by FDG PET/CT. Clinical Nuclear Medicine 2006; 31:810-811. Collins CD. PET in Lymphoma. Cancer Imaging 2006;6:S63-70. Ryan ER, Hill AD, Skehan SJ. FGD PET/CT demonstrates the effectiveness of isolated limb perfusion for malignant melanoma. Clinical Nuclear Medicine 2006;31:707-708. Dodd JD, Barry SC, Barry RB, Gallagher CG, Skehan SJ, Masterson JB. Thin section CT in patients with cystic fibrosis: correlation with peak exercise and body mass index. Radiology 2006;240:236-245. Return to contents Annual Review 2006 176 Department of Radiology Conferences All of the major national and international radiology conferences were attended and presentations, such as the following, were made at several of these. PET/CT in identification of female pelvic tumours - Pictoral Essay. Harte SE, Killeen, R, Skehan SJ, Collins CD. Presented at the RSNA 2006 poster exhibition. Future Plans 2007 will see the completion of the electronic access to Radiology, both requesting and reviewing of images. Service delivery will continue to improve and access on a timely basis guaranteed. Departmental Statistics Statistics for the Radiology Department for 2006 are as follows: Modality Type In-patient Other Hospital Dentist Emergency Department Out-patient General Practioner Totals CT 5592 1352 0 3109 3148 112 13313 DR 21015 4616 15 25314 19897 10166 81023 EXT 22 69 1 2 322 0 416 MG 84 165 1 3 3600 696 4549 MR 1218 76 0 144 1874 6 3318 NM 674 1630 0 189 969 116 3578 US 3783 687 3 1293 5151 830 11747 XA 4564 1109 1 118 809 108 6709 36952 9704 21 30172 35770 12034 124653 Total 2006: Total 2005: 116204 Variance 2005 7.20% Variance 2003 18.82% Return to contents St. Vincent’s Healthcare Group Limited 177 Departmental Review Department of Respiratory Medicine Staff Medical Consultants: Professor Walter Mc Nicholas, Dr. Tim Mc Donnell Specialists Registrars: Dr. Stanley Miller, Dr. Boon Beng Shu Registrar: Dr. Senan Glynn Research Registrars: Dr. Silke Ryan, Dr. John Garvey Ms. Geraldine Lawless, Ms. Lee Fahey, Ms. Audrey Russell, Ms. Linda Hayes, Ms. Sonia Eigenheer, Ms Carol Purcell, Ms. Sonia Eigenheer Mr. Paul Byrne, Sleep Nurse Specialists Ms. Valerie Swan Ms Renatta Behan Respiratory Nurse Specialists Ms. Deirdre Donaghy Ms Patricia Jones Pulmonary/Sleep Technicians Chief Pulmonary/Sleep Technician Senior Pulmonary Technician Senior Sleep Technician Pulmonary/Sleep Technician Ms. Lindsey Browne Administration Ms Louise Mc Cague Ms Georgina O’Reilly (TO JULY 2006) Ms Ailish Byrne Ms. Doreen Sheridan (DECEMBER 2006) Louise Bradbury (PART-TIME) Statistics Inpatients:Professor W. McNicholas Admissions 485 Discharges 467 Pulmonary Function Laboratory: Total Patients: 3131 Total tests: 6338. Day Care 65 Sleep Laboratory: Total Admissions: 543 CPAP commencements: 154 Service Developments The pulmonary function laboratory moved in July 2006 to a new temporary location on the ground floor corridor near the cafeteria. The acute NIV unit in St. John’s Ward, which opened in late 2005, has provided a designated base to concentrate the skills related to managing patients in acute respiratory failure requiring pressure support. The unit is the first such dedicated facility in Ireland and has been visited by representatives from other acute hospitals in Ireland. The move to the new ambulatory day care centre has allowed an expansion of outpatient services. In addition to the existing Tuesday morning clinic (which is now exclusively respiratory), there is a new weekly sleep apnoea clinic on Wednesday morning which is expected to considerably improve the ability to assess and follow patients with sleep apnoea. Return to contents Annual Review 2006 178 Department of Respiratory Medicine Pulmonary Function and Sleep Laboratory The Sleep Research Laboratory continues a varied clinical and basic science research programme that has been evolving over several years. Ongoing collaboration exists with the research group of Dr. Cormac Taylor in the Conway Institute at UCD and the Department of Electronic and Electrical Engineering (Dr. Conor Heneghan and Prof. Mark O’Malley), also in UCD. Respiratory Education Centre Patient consult numbers in the Respiratory Education Centre totalled 1,942. Trends indicate a continual rise. In 2006 we concentrated on policy development and audits of our service. A patient satisfaction survey of our Out Patient Service reported 98% satisfaction. The NIV study days co-ordinated by RNS in conjunction with MDT includes a student workbook, formal assessment and evaluative audit. Honours and Distinctions Professor McNicholas was elected Chair of a EU COST Action (B26) on obstructive sleep apnoea and is the founding President of the newly formed Irish Sleep Society. Invited Presentations during 2006 Prof. McNicholas gave invited lectures at the Annual meeting of the European Respiratory Society in Munich (September), the European Society of Hypertension in Madrid (June), the British Sleep Society in Cambridge (September) in addition to International Meetings in Copenhagen (November) Presentations of original research were given by members of the research team at the annual meeting of the American Thoracic Society in San Diego in May (Dr. Silke Ryan), and the annual meeting of the European Respiratory Society in September (Ms. Geraldine Nolan and Dr. Silke Ryan). Selected Publications from 2006 – Prof. Walter McNicholas. Ryan S, Taylor CT, McNicholas WT. Predictors of elevated nuclear factor-kappaB-dependent genes in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2006 Oct 1;174(7):824-30. Epub 2006 Jul 13 Garvey J, McNicholas WT. Effect of obesity in patients with coronary artery disease. Lancet. 2006 Nov 11;368(9548):1645. Ryan S, Nolan G, Hannigan E, Cunningham S, Taylor CT, McNicholas WT. Cardiovascular Risk Markers in Obstructive Sleep Apnoea Syndrome and Correlation with Obesity. Thorax. 2007 Jan 24; [Epub ahead of print] McNicholas WT, Bonsignore MR; the Management Committee of EU COST ACTION B26. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J. 2007 Jan;29(1):156-78. Nolan GM, Ryan S, O'connor TM, McNicholas WT. Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. Eur Respir J. 2006 Jul;28(1):159-64. Epub 2006 Mar 29. Return to contents St. Vincent’s Healthcare Group Limited 179 Departmental Review Department of Surgical Professorial Unit Staff Consultants Professor N. J. O’Higgins Mr. S. Richards (Locum) Mr. E. W. McDermott Mr. J. J. Murphy Senior Registrars Mr. D. Kavanagh Mr. E. Myers Adjunct Professor Professor M. J. Duffy College Lecturers Dr. P.P.A. Smyth Special Lecturers Mr. D. O’Malley Registrar in Breast Diseases: Mr. Haroon Goush Research Fellow: Ms. A. Pierce Clinical Research Nurse: Ms. Helen Vaughan Advanced Nurse Practitioner: Sr. Mary Murray Clinical Nurse Specialists in Breast Care Ms. Marina Nolan Mr. D. Evoy Ms. O. McCormack Ms Breda Dawe Ms. Gillian Webster Breast Cancer Co-ordinator: Ms. Catherine Masterson Senior Executive Assistant: Ms. A. Bergin Ms. Rita McGuigan Executive Assistants: Ms. Elaine O’Sullivan Ms. Hannah Carpenter Senior Laboratory Technician: Mr. Dermot Carty Ms. Maeve Harkin Service Developments/Activities Professor O’Higgins finished his term as President of the Royal College of Surgeons in Ireland in the summer of 2006. He resumed his clinical activities taking over from Mr. James Murphy who was in a locum capacity. • Professor O’Higgins attended and was speaker at the Royal Australasian College of Surgeons’ meeting in Sydney in May. • He was invited speaker at the Europa Donna Meeting in Dublin in May • He was the recipient of the President’s Medal of the Royal College of Surgeons of Edinburgh, a special award given once every three years by the Edinburgh College. • He also received the prestigious award of Honorary Fellowship of the American College of Surgeons in Chicago in October and became of the three Irish surgeons ever to receive this honour. • He was appointed Chairman of the IntercollegiateCancer Committee by the Academy of Medical Royal College with a brief to integrate training programmes for cancer specialists across the United Kingdom and Ireland. Mr. Steve Richards continues as a locum for Mr. A.D. Hill. Professor P. R. O’Connell, Consultant Gastroenterologist in the Mater University Hospital has been appointed as Professor of Surgery at St. Vincent’s University College Hospital and will be taking up his appointment in 2007. The Unit continues its academic output with presentations at major national and international meetings and is continuing to publish extensively in medical literature. Mr Enda McDermott was an invited speaker at Ipsilateral Breast Cancer Recurrence in Cavendish Conference Centre London Professor Joe Duffy continues his research in tumour markers and has been an invited speaker at a number of international meetings. Return to contents Annual Review 2006 180 Department of Surgical Professorial Unit • Edinburgh Royal Infirmary : Breast Cancer Markers: An Overview • CECHTUMA Tumour Marker Meeting, Prague : Markers in Ovarian Cancer, EGTM Recommendations. • EMBO Meeting, Dublin : Prognostic and Predictive Factors in Breast Cancer • Molecular Staging of Cancer Meeting, Heidelberg uPA and PA1-1 in Breast Cancer. • International Congress on Fibrinolysis and Proteolysis, San Diego : uPA and PA1-1 validated prognostic markers in breast cancer. • ISOBM Meeting on Tumour Biology, Passadena: Detection and Therapy, CA125 in Ovarian Cancer: EGTM Guidelines for Clinical Use. • Dutch Clinical Chemistry on Tumour Markers in Solid Tumours, Utrecht: Serum Markers in Breast Cancer. The number of the Symptomatic Breast Clinic continues to increase with a total of 261 new cases of breast cancer in 2006. The National Breast Cancer Screening Programme continues to give high quality service and the figures can be seen in their Annual Report. The academic scientific output continues to be excellent from the Unit. See selection of 5 published articles from a total of 20 from the Unit on PubMed. Besides being published in peer reviewed journsl, the research has been presented at national and international conferences. Significant Publications The following are representative of the publications in peer-reviewed journals produced by the Department during the year: Dillon MF, Quinn CM, McDermott EW, O’Doherty A, O’Higgins N, Hill AD. Needle core biopsy in the diagnosis of phyllodes neoplasm. Surgery. 2006 Nov;140(5) : 779-84. Myers E, Hill AD, Kelly G, McDermott EW, O’Higgins NJ, Young Ls. A positive role for PEA3 in HER2-mediated breast tumour progression. Br J Cancer. 2006 Nov 20; 95(10) : 1404-9. Dillon MF, Hill AD, Fleming FJ, O’Doherty A, Quinn CM, McDermott EW, O’Higgins N. Identifying patients at risk of compromised margins following breast conservation for lobular carcinoma. Am J Surg. 2006 Feb:191(2): 201-5 Buggy Y, Maguire TM, McDermott E, Hill AD, O’Higgins N, Duffy MJ. Ets2 transcription factor in normal and neoplastic human breast tissue Eur J Cancer. 2006 Mar;42(4) : 485-91. Dillon MF, McDermott EW, Quinn CM, O’Doherty A, O’Higgins N, Hill AD. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only. J Surg Oncol. 2006 Jun 1;93(07) : 559-63 Professor Gerald O'Sullivan, President of RCSI presents Professor Niall O'Higgins with the portrait and Ethicon Past Presidents medal. Return to contents St. Vincent’s Healthcare Group Limited 181 Department of Surgical Professorial Unit Departmental Statistics Professor O’Higgins/Mr. Murphy, Mr. McDermott, Mr. Richards, Mr. Evoy Admissions 7 Day 5 Day A/E Other Urgent Subtotal Day Care Total 70 801 57 1,123 928 2,051 Extra Mural OutPatients Endoscopy Day Adm. Total 161 49 3 243 928 195 Day Care St. Marks 472 Discharges (excluding Day Care) Total .. 1,080 Out Patients Department Sessions New Patients Return Patients Total Tues Clinic (Prof. O’Higgins) 47 80 387 467 Tues Clinic (Mr. McDermott) 43 235 860 1,095 Friday (Mr. Evoy) 46 209 795 1,004 Friday (Mr. Richards) 21 15 120 135 157 539 2,162 2,701 New Patients Return Patients Total 899 899 Total Breast Clinics Sessions Breast Care Office General Breast Clinic 50 1,554 2,163 3,717 Triple Assessment Clinic 50 476 11 487 Follow-up Breast Clinic 50 77 1,690 1,767 8 196 204 Nurse-led Clinic Total 150 2.115 4,959 6,175 Grand Total 307 2,654 7,121 9,775 Return to contents Annual Review 2006 182 Departmental Review Department of Urology Staffing Consultants Mr David Quinlan, Mr Gerald Lennon Mr David Mulvin, Senior Registrars Mr Frank O’Brien Mr Gordon Smyth Registrars Dr Catherine Dowling Senior House Officers Dr Brendan O’Daly Interns Dr Eoin Flanagan Dr Paddy Barrett Dr. Niall Davis Dr. Catherine Moran Dr Eoin McDonnell Dr Shane Kelly Dr. Donal O’Connor Dr. Louise Mulvey Ward Sisters Sr Mary Nevin Sr Denise Murray Theatre Sisters Sr Linda Mullen Sr Breda O'Donoghue Antoinette Guthrie Urology Cancer Nurse Coordinator Lisa Cullen Helen Forristal Urodynamics/Urology Nurse Practitioner Siobhan Gardner Inpatient Clinical Coordinator Nuala Kennedy St Charles Ward Secretary Adelah O’Brien Urology Secretaries Fiona Whelan Louise Bradbury (from 01/01/06) (FROM 01/01/06) (FROM 1/01/06) (FROM 01/07/06) Mr. Kevin O’Connor (FROM 1/7/06) Dr. Ingrid Heaslip (FROM 1/7/06) (ST CHARLES') Kirsty Whaley UNTIL 09/06. Margot Hennigan Service Developments/Activities The single most important event in 2005 was moving into the new Ambulatory Day Care Centre. For such a medical discipline dealing with such a sensitive and private area of the body, this provided a long awaited environment to treat patients in a private and confidential setting. In preparation for the move, patients had been given timed appointments for the previous three years. This made the transition to timed appointments easy for Urology patients. With three clinics per day there are time constraints of three hours in which to see patients and this will no doubt limit the numbers seen in outpatient clinics compared to previous years. Having said that, the environment in which patients are seen is far superior to what existed before. The year 2006 otherwise remained a busy year for the Department of Urology. As in 2005 St Charles' Ward continues to have a major throughput mainly due to its protection from admissions from other disciplines from the 1st of March to the 31st of December. This permitted patients on Urological waiting lists, particularly those with Urological malignancies, those needing complex urological surgery, reconstruction or other intervention as well as admisiions for patients who have suffered Urological complications of other malignancies (including gynaecological and colorectal malignancies). One day and five day activity remains vibrant. It must be remembered that the Department of Urology has no dedicated 5 day beds on the campus of St Vincent's University Hospital (having relinquished St Kevin's Ward for five day activity in 2000). Its five-day activity continues to occur off site in the Annexe of St Michael's Hospital. One day activity occurs via St Mark’s Ward, St Michaels Annexe and St Michael’s theatre. Urodynamics remains very active with. As in previous years, male patients presenting for the first time to the outpatients with lower urinary tract symptoms undergo a pre-assessment with Siobhan Gardner consisting of Return to contents St. Vincent’s Healthcare Group Limited 183 Department of Urology urinalysis, renal profile, prostate specific antigen, symptoms score, uroflow and estimation of post void residual. This provides for instant decision making at the patient’s first consultation. Complex urodynamics under the expert guidance of Mr Lennon continue for patients with incontinence and difficult voiding problems. This has been a major advance for the department greatly improving the care of this challenging group of patients. An MSD trial on the overactive bladder has also been undertaken Surgically 2006 has seen the further development of Laparoscopic Urology under the direction of Mr David Mulvin. Laparoscopic nephrectomies and pyeloplasties are now an almost weekly occurrence with improvements in hospital stay and early return to work for the patient. Mr Lennon has continued to expand Urodynamics and Female Urology. Surgery for female incontinence remains strong with use of sling procedures and transobturator tape procedures for stress incontinence and injection of botulinum toxin for refractory detrusor instability. Unfortunately, the Urology Nurse Diploma programme at University College, Dublin and St Vincent's University Hospital which was well established in 2004 was not in a position to continue in 2005 or 2006. This remains a significant disappointment as it is the only programme of its type in the country and a most coveted development by the Department of Urology. It is hoped that it will be re-established in 2006. Departmental Statistics During 2006 there were 9,323 patient presentations (calculated from presentation to outpatients, admissions {includes theatre}, urodynamics and inpatient consults which included: Outpatients: A total of 4,931 out patients were seen by the Urology Department. Three Urological outpatients occur per week on the St Vincent's Campus with 4,142 outpatient attendances. Of these 1,039 were new patient attendances. There were 789 outpatient attendances in St Michael's Hospital seen in one weekly outpatients of which 259 were new patient attendances. Theatre: Surgical procedures totaled 3,250 with 1,784 surgical procedures performed on the St Vincent's Campus, 450 performed at St Michael's Hospital and a further 611 procedures performed in the St Michael's Annexe. It is important to note that 535 cases were performed in the extramural theatre …..this level of activity will need to continue in the new theatre and outpatient building. • Consults: 379 inpatient consultations in 2005. • Urodynamics: There were 904 urodynamic procedures performed. Teaching For the urological trainees there is a major emphasis placed on teaching with academic conferences, teaching in the operating room and research endeavours. Each day starts with an organised teaching session with weekly conferences on: • Research Conference and Journal Review (Monday 8:15AM) • Irish Society of Urology Teaching Conference (Monday 7:00PM) • Uroradiology Conference (Tuesday 8:15AM), • Surgical Conference (Wednesday 8:15AM), • Uropathology Conference (Thursday 8:15AM) • Audit (Friday 8:15AM) Return to contents Annual Review 2006 184 Department of Urology Monthly meetings occur as below: • Multi-Disciplinary Team Meeting (Monthly, Monday 8:15 AM) • University College Dublin Urology Conference (Bi-Monthly on Thursdays 6:30PM between Mater and Vincent's) • Irish Society of Urology Clinical Case Conference (Monthly Wednesdays 7:00PM) Ongoing Clinical Trials: • Atrasentan for prostate cancer (Abbott) • Merck Sharpe & Dohme Overactive Bladder Study Publications Stunnell H, Power RE, Floyd M Jr and Quinlan DM: Genital self mutilation. Int J Urol. 2006 Oct;13(10):1358-60. Future Plans The plans for 2007 will again focus around continued improvements in ward accommodation for inpatients, particularly regarding privacy, shower and toilet facilities. This is an ongoing problem for the two specialties affecting women and men (Gynaecology and Urology) where the highest levels of privacy, hygiene and access to toilet and bathing/showering facilities are required. Plans have been drawn up for improvements and we await their implementation. Urology has the potential to take advantage of its new outpatient setting with the development of “one stop shops” for: • Haematuria Clinics (with same day renal ultrasound and flexi-cystoscopy) • Prostate Clinics (with same day urodynamics, PSA testing etc) • Dysfunctional Voiding / Incontinence Clinics (with same day urodynamics and flexi-cystoscopy) A fourth Urological Consultant has been applied for but that application is on hold pending the outcomes of the new consultants contract. Return to contents St. Vincent’s Healthcare Group Limited 185 Departmental Review Department of Vascular Surgery Staffing Consultants: Denis Mehigan Stephen Sheehan Mary Barry Senior Registrars: Daragh Moneley Graham Roche Nagle Registrars: Mo Atie Elrasheed Osman Senior House Officers: Tom Gallagher Motaz El Khaldy Natasha Mohammed Interns: Barry Hennigan Frank Ward Lisa McGrath Ciara Maguire Assistant Director of Nursing: Maureen Flynn Margaret Cullen Clinical Nurse Managers: Sandra Shea Mary Leamy Fionnuala McCusker Theatre Sisters: Bernadette Farrell Maura McEvoy Carmel Kelly Annette Hughes Plethysmographist: Catherine Kelly Tissue Viability Nurse: Deirdre Cornally Eoin Flanagan CNM3 from Nov. 2006 was another busy year for the Vascular Surgery Unit at St. Vincent’s University Hospital. Bed shortages continue to be a major problem but close cooperation with our referral hospitals has helped to maintain a good volume of elective as well as urgent and emergency work. The acquisition of a new mobile C-arm and contrast pump injector in 2006 has finally facilitated the commencement of our Endovascular Surgery Programme. Close cooperation between the departments of Vascular Surgery and Interventional Radiology have resulted in the introduction of several new minimally-invasive vascular over the last twelve months. In conjunction with Dr. David Brophy of the Interventional Radiology Department the first aortic stent graft procedure was carried out in the hospital in March 2006. Since then seven further cases have been carried out successfully. This is a huge advancement in the treatment of abdominal aortic aneurysm particularly in the older, medically unfit patient. In addition Dr. Brophy carried out the first carotid angioplasty and stent procedure in 2006. Finally, a venous thrombolysis service was introduced which allows for the treatment of certain suitable patients with upper and lower limb deep vein thrombosis. This procedure has allowed for significant improvement in outcomes in this group of patients potentially avoiding the debilitating problems of post-phlebitic syndrome. Staff We hope to move to the new Ambulatory Day Care facility early in 2007. The Vascular Dressing Clinic is also expected to open. In 2006, 55 new patients with leg ulcers were referred and a total of 526 out patient visits were related to management of leg ulcers. Return to contents Annual Review 2006 186 Department of Vascular Surgery Meetings attended by members of the department during the year were: First Topical Negative Pressure Symposium(TNP) Meeting, Dublin 2006 Charing Cross Meeting, London, April 2006 Venous Forum, London, Basic Vascular Ultrasound Course, Newcastle, May 2006. Endovascular Aortic Stenting Course, Utrecht, November 2006 Hamburg Carotid Artery Angioplasty Course, December 2006 Vascular Society, November 2006 Mr. Denis Mehigan as co-ordinator of the Basic Surgical Training at St. Vincent’s University Hospital and is also a member of the Court of Examiners (FRCSI). Mr. Stephen Sheehan is a Member of the Court of Examiners (FRCSI), is an instructor on the Basic Surgical Skills Course and on the Advanced Trauma Life Support Course. Ms. Mary Barry is Chairperson of the South East Dublin Division of Surgery, Secretary of the Basic Surgical Training Committee, RCSI and a faculty member on the Care of the Critically Ill Surgical Patient (CCRISP) Course. Academic Activity Guest Lectures Use of Topical Negative Pressure in the management of lower limb ulceration. Ms. M. Barry First Topical Negative Pressure Symposium, Dublin, March 2006 Presentations Concomitant detection of systemic atherosclerotic disease while screening for abdominal aortic aneurysm. Irish Angiology Society, Dublin. November 2006 Bennett Symposium, St. James’ Hospital, October 2006 Academic award Concomitant detection of systemic atherosclerotic disease while screening for abdominal aortic aneurysm. Ronan Cahill won the 2006 Bennett Lecture Award for Senior Registrars Published Papers Concomitant detection of systemic atherosclerotic disease while screening for abdominal aortic aneurysm. Waterhouse DF, Cahill RA, Sheehan F, Sheehan SJ. World J Surg 2006;30(7):1350-9 Catheter-guided repair of traumatic lower limb arteriovenous fistula. Cahill RA, Kieran S, Cunningham P, Owens A, Sheehan SJ. Eur J Trauma 2006;5:482-4 Return to contents St. Vincent’s Healthcare Group Limited 187 Department of Vascular Surgery The effect of peri-operative beta-blockade on the pulmonary function of patients undergoing major arterial surgery. Kieran SM, Cahill RA, Browne I, Sheehan SJ, Mehigan D, Barry MC. Eur J Vasc Endovasc Surg 2006;32(3)305-8 Aorto-enteric fistula: changing management strategies. Kavanagh DO, Dowdall JF, Younis F, Sheehan S, Mehigan D, Barry MC. Ir J Med Sci 2006;175(1):40-45 The impact of the establishment of a surgical high dependency unit on management of abdominal aortic aneurysm. Cleary M, Cahill RA, Younis F, Sheehan S, Mehigan D, Barry MC. Ir J Med Sci 2006;175(3)9-12 Prospective evaluation of the efficacy of dermal botulinum toxin for primary axillary hyperhidrosis. Hanlon L, Cahill RA, Barry MC. Ir J Med Sci 2006;175(1)57-8 Department Activity 2006 2006 2005 2004 Elective 221 227 7 day 217 216 5 day 4 11 Urgent/Emergency 206 228 Day Care 100 91 527 546 Out patient sessions 120 117 New Patients 528 625 2117 2,335 2645 2960 273 276 316 51 71 78 324 347 394 Admissions Total Out Patient Attendances Return Patients Total Operative Procedures Elective Emergency Total Return to contents Return to contents St. Vincent’s Healthcare Group Limited 189 Allied Health Professional and Support Services Chaplaincy/Pastoral Care Departments Chaplaincy Department The Chaplaincy Department like every other department within the hospital represents a very specific and professional discipline. It works with other professional disciplines in providing an overall or Holistic Service that is geared to total Patient Care and Ministry to the family. The Department is interdenominational in character and all members are professionally trained for their work. The Department has two main functions: • To provide Pastoral & Sacramental Service to Patients, their Families and Staff. • To provide Educational Programmes for the ‘In-Service Training’ of student chaplains. Chaplaincy Staff Since the last annual report, there have been changes in personnel. Jane Mullan was appointed in a temporary capacity to the Chaplaincy team in May. Jane trained in CPE here at St. Vincent’s and was accredited by the Healthcare Chaplaincy Board of Ireland in April. Jane is a very welcome addition to the Chaplaincy team. Service When patients are admitted to hospital in need of healing for a physical or emotional illness, they often bring with them other concerns that range over the psychological and spiritual dimensions of their lives. Being aware of their many concerns the Chaplaincy Department responds at different levels: • In the administration of the sacraments and in providing appropriate spiritual care and counselling to patients. • The need for this care is acutely felt at times of great anxiety such as major surgery and especially terminal illness. • Much time is spent with families of patients, supporting those shattered by the terminal illness of those closest to them, and later in consoling the bereaved. Return to contents Annual Review 2006 190 Chaplaincy/Pastoral Care Departments • The Chaplaincy Department continues to provide a twenty-four hour service in the hospital. The team consists of three full time Roman Catholic priests, three part time priests, one Church of Ireland ordained Minister, three chaplains from the Religious Sisters of Charity and two lay chaplains. The Department is very fortunate to have over forty lay volunteers who serve as Ministers of the Eucharist and assist in bringing the Blessed Sacrament to patients on a daily basis. During the past year the chaplains attended at over seven hundred deaths and made 60-80 pre-operation visits per week to patients who had requested a visit. Added to these were the visits made on a daily basis to the wards. Staff Support The members of the Chaplaincy department work closely with the other health care professionals and are available to provide counsel and support to staff when the need arises. Religious Services The Chaplains provide liturgical services in the main hospital chapel, on the wards, and in the oratory during Advent, Lent and on special occasions. One memorable occasion was the special Mass in February to commemorate the World Day of the Sick. A large number of patients attended with the kind assistance of many staff and volunteers. The Sacrament of the Sick was administered during a very prayerful and moving liturgy. Five Masses were held during the month of November for deceased patients. The next of kin and family members of patients who died during the past year were invited and it gave bereaved families an opportunity to come together and remember their loved ones in a 'Candle Ceremony of Remembrance'. There was a very large attendance at the Masses and bereaved families were very appreciative of the support and consolation they received. For many families, it was their first time back in the hospital since the death of their loved one and they found it brought a sense of closure to their experience. Seminars During the year, seminars on pastoral care were given to the student nurses, at the in service training programmes for Overseas Nurses and at induction programmes for new nurses, and for new employees. The chaplains attended the Annual Conferences of the National Association of Hospital Chaplains and of the Dublin Diocesan Committee of Hospital Chaplains as well as other relevant study days. Professional Bodies At present, a member of our Chaplaincy team sits on the Executive Committee of the Dublin Hospital Chaplains’ Association. Return to contents St. Vincent’s Healthcare Group Limited 191 Chaplaincy/Pastoral Care Departments Clinical Pastoral Education The Clinical Pastoral Education programme is an in-depth graduate level preparation for professional chaplaincy. Initiated in the United States, St. Vincent’s University Hospital was one of the pioneers of this innovative educational opportunity in Ireland. The Healthcare Chaplaincy Board and the Association for Clinical Pastoral Education (Ireland) Ltd. are the accrediting agencies. Organized healthcare systems are continually being challenged to re-invent the services they offer. Certifying and accrediting agencies are also consistently raising the professional bar for spiritual care providers. The healthcare industry continues to demand greater accountability, and so too does spiritual pastoral care as a discipline. Healthcare chaplains are professionally trained and certified for a specific purpose: to attend to the suffering of others through the ministry of presence and theological reflection. Fr. Joe Cahill was Director / Supervisor of Clinical Pastoral Education at SVUH for more than twenty years. Subsequent to his retirement, Sr. Pat O’Donovan assumed that position in June 2006. She came to the position with a keen sense of wanting to honour and build on a tradition of more than twenty years of Clinical Pastoral Education at SVUH. Sr. Pat qualified as a Clinical Pastoral Educator in Chicago. She spent five years as Director / Supervisor of Clinical Pastoral Education with Roper St. Francis Healthcare in Charleston, South Carolina, USA, prior to her appointment to the position at SVUH. Clinical Pastoral Education is an educational methodology that combines knowledge of psychology, with knowledge of theology, with process education, in order to prepare participants to provide interfaith spiritual care amidst the religious and social complexities of contemporary society. Two groups of students engaged the CPE process during 2006. Fr. Joe Cahill supervised a group of six students, January – March. Sr. Pat O’Donovan supervised a group of students, September – December. Five students successfully completed that unit. Mr. Cormac Maloney presented certificates to the students, December 7. CPE students offered spiritual care and emotional support in assigned clinical areas throughout the hospital. Return to contents Annual Review 2006 192 Allied Health Professional and Support Services Information and Communication Technology Department Staffing In cooperation with the HR department we have restructured the ICT department. We have created a much more stratified structure. This will help reduce our staff turnover and where necessary recruit high calibre replacement staff. We have recruited two Deputy Directors of ICT one with a particular responsibility for Operations Neal Mullen and the other for Application Development Jackie Glynn We were sorry to say goodbye to Ailish Lawlor a valued member of staff, but were also very happy to welcome Glen Galbraith, Gerard Murphy (Support Technicians) and Sinead MacDermott, Niall Berwick (Project Managers) to our team. Service Development/Activities A number of projects were completed or commenced in 2006: It was a busy year for the ICT department with the completion of existing projects and the commence-ment of new projects. Our strategy in 2005 was to focus on consolidating our infrastructure, having largely completed this initiative in 2006 we have now switched our focus on building our application portfolio. In conjunction with a multidisciplinary team headed by Radiology we completed the implementation of the Siemens Picture Archiving and Communications system and a Radiology Information system (PACS/RIS). In essence this system provides a film-less radiology solution. We have played a lead role in this project supplying the network infrastructure, data take-on, interfaces and peripherals. We went live in July in radiology only. This phase was very successful with Radiology moving to the new department and going Live with both the radiology information system and PACS imaging system simultaneously. We have now completed phase two of the project, which is the distribution of the Web Viewer to all clinical areas. We are currently commencing the pilot of the Physician Order Entry system in Ed before a rollout throughout the hospital. We are now looking at extending the system to SMH and then to SVPH. We have procured a new Ascribe Pharmacy system. This system offers improved functionality to the Pharmacy department, has links to the Patient administration and Finance system. It provides improved stock functionality (stock management) and reporting capabilities. We are now working with pharmacy on implementing support tools within Ascribe for pharmacists at ward level The Wiztec HR system has been fully installed in the Human Resource department, Nursing HR and Medical Administration. We are working with Nursing on a nurse bank (a combined DATHs initiative) and rostering proposals. We are working with Finance on a new Payroll solution from Northgate to replace the ageing Cara system. Return to contents St. Vincent’s Healthcare Group Limited 193 Information and Communication Technology Department We are supporting the implementation of the East Cost Area Regional Cancer System. This will be based in St. Vincent’s University Hospital Group and will interface to a number of hospitals in the area such as the National Maternity Hospital, St. Luke’s Hospital and St. Columcille’s Hospital. The Healthlink Pathology system is now live in appx. 80 GP practices. We have also implemented a Neurology requesting protocol and are working with Siemens to provide Radiology reports. We are currently adding SMH pathology to Healthlink. Media One a subsidiary of Eircom were selected to carry out the redevelopment of the SVUH Website and the creation of a Group website incorporating SMH and SVP. Final testing is well underway and training on content management has begun. Media One has also been selected to redevelop the format and layout of the Intranet its development will be led by the Website redevelopment. Commissioning of New Development We had a substantial role to play in the commissioning of the Clinical Services development. It required careful planning in establishing requirements, a number of major procurements, a campus wide network rebuild, the transfer of existing and the installation of large volumes of new equipment. We have also implemented a number of clinical initiatives as part of the project development: • RIS/PACS Radiology management and imaging system • Endoscopy Clinical System that captures images, visit details and reports • Draegar High Specification Physiological Monitoring System • Dialysis As part of the project development we have implemented a Dialysis management system in June 2006 that centrally records all dialysis outputs. • ICU clinical Management (installation 2007) This was a very team orientated initiative, which in no small way contributed to its success and we are grateful for the support we received from all our colleagues. Our New purpose built Computer Room came on stream in early 2006, this gives us the capacity to customise how we manage all computerised systems. We have three dedicated Computer Rooms including a Production Room, Disaster Recovery Room and a Backup/Security Room. With the delivery of our new 10 TB Enterprise Storage Solution, two Virtual Servers and two Blade Chasses we have commenced the consolidation of all critical systems. We have also greatly improved our disaster recovery / business continuity solutions using these new systems. With our new Backup/Security Room we now can ensure all systems are being backed up to disk (7.2TB) and tape library (7TB) to ensure data degradation while improving restore times. This has also greatly reduced the backup time thus improving the performance on our network. We have installed a large-scale SAN storage solution; total storage is currently at 17TB and will expand in line with internal storage requirements. We have moved our file and print-sharing servers onto this new environment. Predictive failure and remote monitoring installed. We are currently addressing storage requirements for the ERC, SVPH and SMH. We have implemented a new Storage Area Network, which has improved performance by eliminating bottlenecks. We have upgraded our current Helpdesk System (Service Desk) to link in with our new infrastructure and security systems. We have changed the way calls are logged to provide a more efficient service. Calls are logged to two Return to contents Annual Review 2006 194 Information and Communication Technology Department technicians permanently located in ICT who can remotely takeover desktops to resolve problems. This has dramatically reduced the turnaround time on calls. We are extending this facility to SMH, SVPH and ERC. Radiology Department has now been fully integrated into this design. Our Helpdesk system has been upgraded to Service Desk, which supports improved communication and feedback from users and allows easier deployment of our helpdesk system throughout the group. Network We installed a new fast and resilient physical network in April 2006. Our campus network had a 1gigabyte backbone and 100 megabytes to the desktop. This has been replaced by a 10 gigabyte backbone and 1gigabyte to the desktop in most areas. We have implemented virtual LAN’s (Vlans) on the network to increase network security for end users and to speed up network traffic in the campus. Wireless Network: We are continuing to expand and develop our wireless network in to clinical areas. This will offer fast secure access to systems while on the move within the campus. We have also implemented three network monitoring systems including: • Netflow: designed to identify possible problems • Netwatch: designed to diagnose problems • Netwhere: designed to identify the location of traffic and hardware • Cisco Works: designed to assist in future upgrades of network. We are extending this facility to SMH, ERC and SVPH. We have greatly improved communication methods and connectivity between St. Vincent’s and other hospitals in the past year though the enhancement of our Wide Area Network (WAN): • 1GB Fibre link to SMH with a 100MB Wireless backup • 1GB and 100MB link to SVPH • 100MB link to ERC • 2MB to SLH • 2MB to NMH • improved communication systems between other remote hospitals. • increasing VPN (Internet) bandwidth from 1.4MB to 100MB, with plans to further increase this to 1GB We are migrating our Pathology iLAB system onto an AIX and Cache environment. The new clustered hardware has been installed we have created a copy of the iLAB system on this new environment complete with interfaces and we are currently testing in cooperation with Pathology staff. This clustered system will operate between two separate computer rooms. The Group tasked with developing a Disaster Recovery (DR) and Business Continuity Plan (BCP) have now identified critical systems and we and DR/BCP plans for core systems. We are dejournalling our SVP PAS to our Cache database. We have created a clustered Cache system for our interfaces. We are updating our cache interfaces to ensemble a more functionally rich version of the system. Return to contents St. Vincent’s Healthcare Group Limited 195 Information and Communication Technology Department Planned Initiatives for 2007 Patient Wristbands: Following input from the clinical audit committee we are currently developing a tender for a barcoded patient wristband system. This will produce wristbands with typed rather than handwritten patient details reducing the risk of incorrect identification. The wristband will also include a code 39 and 2D barcode, which will be a cornerstone of initiatives in areas such as Phlebotomy, Pharmacy and Haemovigilance Pathology Order Communications: We are tendering for a solution for Pathology for clinician requesting of investigations. OCM provides for the electronic raising / transmission of orders and the gathering / receipt of results between patient based departments or locations and ancillary departmental systems. Clinical Workstation: We are tendering for a patient centred portal for clinicians. A standardised interface to existing systems such as pathology, radiology and pharmacy. It should provide information aggregated from existing clinical systems but in a filtered manner minimising information overload. That is based on a clinicians profile and preferences they would have access to the information they need rather than having to sift through copious amounts of irrelevant data Return to contents Annual Review 2006 196 Allied Health Professional and Support Services Library & Information Services Department Staff Anne Madden joined the department as Assistant Librarian in January. From March to November, inclusive, she was Acting Head of Library & Information Services to cover Niamh Lucey’s maternity leave. This now bring the number of staff members employed in the Library in St Vincent’s University Hospital to 3 full time and 1 part time. Jenny Collery resigned her post of Evening Library Assistant in May and Mary Flynn took up the reigns in September to provide late opening hours in the academic year 2006/7. Breda Bennett continues to provide a one-person-operated professional library and information service to all healthcare staff in St Michael’s Hospital. Service Developments/Activities SVUH Library recorded 21,521 visits in 2006. Library Refurbishment The addition of a third full time staff member, and the growth in number of undergraduate medical students training at St Vincent’s necessitated the refurbishment of the Library premises in August. An issue desk now provides an “onduty” service to visitors to the department, while allowing other staff to work undisturbed. The number of dedicated study spaces increased to 39, bringing the total number of study spaces to 50, with 17 additional PC spaces. UCD contributed €24,000 to the cost of the refurbishment. The changes have been warmly welcomed by users, though lack of space for students and storage continues to be a problem. In St Michael's Hospital 7 new desks and a table were purchased, as well as book ends, shelf labels and a TV trolley. The photocopier and printer were upgraded. There is now seating for a maximum of 40 persons. All PCs were upgraded and there are 5 available for public use. Heritage Library Management Systen The merged St. Vincent’s University Hospital and St. Michael’s Hospital library database went live in July. Testing and improvements have been carried on since, in readiness for the launch of the online search module on the Group intranet in 2007. Return to contents St. Vincent’s Healthcare Group Limited 197 Library & Information Services Department St Michael's Hospital Usage of the library was constant during the year. There are 388 library members. The Librarian participated in Orientation meetings for NCHDs and nursing students. As a direct result of the Buy-a-Book-for-your-Hospital Campaign, a library service to the patients commenced in September and operates every Tuesday afternoon. St Vincent’s Private Hospital Mr Peter Sheehan continued to represent the Hospital on the Group Library & Information Services Committee. The cabling of the house was completed which will now allow for increased delivery of electronic library resources to the hospital. Collection Development Print Journals: SVUH Library subscribed to 142 journal titles in the areas of medicine, surgery, nursing and allied health, at a cost of €59,000. This is joint funded by the Hospital and UCD. Over 60 titles were also received on donation. SMH Library subscribed to 46 journal titles at a cost of €28,000 and journals from the Pharmacy and the Reading Room were added to the collection. Books: €4,600 was spent on new books for SVUH Library and €4,700 in SMH. Books were donated to SMH Library by the Respiratory Department. Electronic Resources: A series of meeting took place this year to discuss creating Associate Membership a status for hospital staff involved in the training of UCD students. As a result a programme for creating UCD network accounts for hospital staff was piloted with the School of Medicine and Medical Sciences. This is for review in early 2007 when it is hoped to broaden the scope. Through the UCD/ERC server, SVUH Library has access to most healthcare databases and 15,000 fulltext journals. The Group provided access to 76 electronic journal titles. Following a successful trial, an access management tool called SwetsWise was purchased to allow for users to log in to one website and then link out to all the Group’s electronic titles. The Library subscribed to three databases: CINAHL, PyscINFO and BNI. PubMed and the Cochrane Library continue to be freely available on the Internet. A number of groups and individuals availed of the free tutorials provided by library staff on both sites on searching the electronic databases at both sites. Training is now evaluated as part of a continuous quality improvement intiative. Interlibrary Loans SVUH Library: 579 journal articles and books were requested from other libraries: 75 were from the British Library; 329 were from Subito; and 211 from the network of Irish Healthcare Libraries (IHL). The Library supplied 343 to other Hospital libraries nationwide. The overall cost of ILLs for the year was €3,750.11. SMH Library requested 40 journal articles from various libraries. 21 were requested from members of the IHL network and 19 from the British Library. SMH supplied 16 articles to other libraries during the year. Return to contents Annual Review 2006 198 Library & Information Services Department Library & Information Services Committee The Committee met 6 times this year and was chaired by Professor Aongus Curran. Outstanding/Significant Achievements Staff attended the following training events and conferences: Health Sciences Libraries Group Annual Conference – Newpark Hotel, Kilkenny Introduction to Knowledge Management – Trinity College Customer Care in Libraries – Geological Survey of Ireland Introduction to Cochrane – NUI, Galway Copyright & Related Issues for Librarians – National Museum of Ireland Future Plans The following are projects the Library & Information Services Departments will be working on in 2007: Develop electronic resource provision to increase the number of journals and databases available and to provide enhanced delivery, e.g. by remote access. Develop and pilot formal training and education programmes on searching for and critically appraising healthcare information Explore and make recommendations on the development on an Institutional Repository for publications by St Vincent’s Healthcare Group staff Review the scope and purpose of Library & Information Services Committee and make recommendations to Group Executive. Return to contents St. Vincent’s Healthcare Group Limited 199 Allied Health Professional and Support Services Medical Physics and Clinical Engineering Department Richard Bergin, the longest serving member of the department, retired during the year. Richard was one on the remaining staff members who was involved in the transfer of the hospital from St Stephen’s Green to Elm Park. His immense experience was invaluable in the commissioning of the new Clinical Services building. Richard, with his colleagues Stephen McGrath and John Bernard, set up the first Medical Electronics service in the country and created the template on which Clinical Engineering was based. Richard’s passion and commitment to his work was a great inspiration to all in the department. We wish him good health and happiness in his retirement. 2006 was another busy year and presented us with many new challenges. The department continued to be heavily involved in the commissioning and acceptance testing of equipment in the new Clinical Services Building. In addition to our many service responsibilities, staff were also involved in a variety of education and training programmes in the Healthcare Group. Medical Physics The staff compliment remained unchanged again in 2006. The four permanent staff members provided a wide range of routine medical physics services to the Group. These services included: radiation protection, image analysis, quality assurance and quality control, in-vivo and in-vitro testing, research support and teaching . Our involvement in non-ionising radiation work has increased greatly with the introduction of MRI and the expansion of laser services in the hospital. The relocation of the ultraviolet therapy services from Hume Street to St. Vincent’s has also placed a considerable strain on our service capacity. There was active participation of staff members in teaching at undergraduate and postgraduate level in U.C.D. (School of Diagnostic Imaging and Department Of Physics) and also in the Faculty of Radiology of the Royal College of Surgeons. Staff members were committed to professional development in the course of 2006. Jackie McCavana attended the EANM National Delegate Conference (Vienna) in March as the representative of the INMA. We wish to express our gratitude to hospital management for giving staff members the opportunity to attend a wide range of locally organised meetings under the auspices of the INMA and the APSM. Don Carey attended an IPEM meeting on CR and DR in London in April. Clinical Engineering Staff Members Tom Smyth AENG,AMIEI Chief Clinical Engineer Derek Farrell Senior Clinical Engineering Technician Frank Kelly AEng,AMIEI IENG.MIHEEM Principal Clinical Engineer John Harte Senior Clinical Engineering Technician Aidan O’Connor Senior Clinical Engineering Technician Declan Murray MSC Senior Clinical Engineer Return to contents Annual Review 2006 200 Medical Physics and Clinical Engineering Department Service Developments/Activities Actively participating in all aspects of project development, equipping, compiling comprehensive equipment technical specifications. Advising on and evaluating new equipment purchases Continuously updating information on EEC Directives Continuous liaison with health and safety including product alerts Quality control and compliance with international standards. Project decommissioning programme Equipment Library almost complete Equipment Library manager appointed International Meetings T. Smyth November 2006 Medica Dusselldorf Germany A.O’Connor attended the annual Irish Cardiology Society in Killarney November 2006 F. Kelly, “ABPM in Haemodialysis Patients”, Royal College of Surgeons Outstanding/Significant Achievements/Presentations D. Murray with project colleagues developed an automated equipment tender adjudication model. This has been used on the majority of project related tenders and approved by the DOH&C T. Smyth fully equipped and assisted in the successful opening of the new pain management unit. Academic Achievements In March 2006 Frank Kelly was awarded the title of Associate Engineer with Engineers Ireland. In September 2006 Tom Smyth was awarded the title of Associate Engineer with Engineers Ireland. Declan Murray is endeavouring for the title Full Member Chartered Engineer with Engineers Ireland John Harte has undertaken management studies with the National College of Ireland. Presentations F. Kelly, “Clinical implications of poor water quality” Oct 06 F. Kelly, “ The role of the clinical engineer” AMNCH 06 F. Kelly, Poster presentation for the 35th International Nursing and Midwifery, Royal College of Surgeons, Ireland Departmental Statistics The department has succeeded in producing considerable savings in equipment repairs and planned preventative maintenance by adopting the policy of only outsourcing maintenance when absolutely necessary. The department continues with a full equipment management programme. Return to contents St. Vincent’s Healthcare Group Limited 201 Medical Physics and Clinical Engineering Department Future Plans We have introduced a new I.T. solution to our method of equipment management. Also an operational policy has been put in place for the establishment of an equipment library, which is almost complete. We will endeavour to maintain the current level of service within the new project. Training A.idan O’Connor and John Harte attended the “Train the Trainer” for Draeger monitoring systems. Aidan also attended the Interest Based Bargaining course. D. Farrell, Fresenius Dialysis Training Jan 06 D. Farrell, Datex Ohmeda Aug 06 D. Farrell, Prismaflex Dec 06 J. J. J. J. Harte, Criticare Scotland June 06 Harte, Hc21 Sept 06 Harte, Drager Monitoring, Maquet Ventilators Oct/Nov 06 Harte, Trained overseas nurses on Monitoring, infusion devices an Thermometers. F. Kelly, Prismaflex Dec 06 F. Kelly, Recertification of training 4008H Dialysis machines Return to contents Annual Review 2006 202 Allied Health Professional and Support Services Medical Social Work Department Staffing In the past year there have been quite a few changes in the department. Firstly, Michelle Harte who worked in the area of Medicine for Older People retired in November. Fiona Byrne left us in October to travel around the world for a year. Enara Etxebarria took up a position in Dublin City Council also in October. Finally, Louise Morgan was on maternity leave from April to December. We had a number of temporary staff including Anne Marie O’Boyle, Ann Donohoe, Jennifer Allen and Kate McCaffrey who all provided excellent service during the year. Eileen Ni Shuilleabhain started a permanent Social Work position in May and Martina Dolan got upgraded to the status of Senior Social Worker in Psychiatry in August. Service Developments/Activities We as a department were in the forefront of discharge planning for long term care and intermediate care for patients who were not physically or mentally able to return home. Since May 2005 our team has placed 136 patients in “step down” intermediate care. There have also been 212 patients placed appropriately in long term care in the private sector. As a result the long stay list has dropped from 90+ in January of 2006 to the mid 20’s at present. There have also been significant numbers of patients who have taken up home care packages to enable them to go home. Meanwhile we have again provided a bereavement service twice last year to all the relatives of patients who have died in the hospital. In 2006 we invited 756 relatives and 15.2% of these attended, arise of 3% on the previous year. We as a team were part of the Team Based Performance Management Pilot Project for the year and this led to significant developments in the department in terms of looking at our role in the organisation, reviewing our information technology system with the Information Technology Department, putting a training needs analysis for the department on paper and having a review for each team member with the head of department on an annual basis. Outstanding/Significant Achievements. We managed to produce an excellent document on the “Role of a Medical Social Worker in a Hospital Setting”. This was worked on by a sub committee of Senior Social Workers and professionally qualified staff for most of the year. It is now being rolled out to all the key stakeholders in the organisation accompanied by brochures and posters. As stated above we have been in the throes of placing large numbers of patients in care successfully. This is a complex task and requires a lot of skilful negotiations with many parties. In total 348 patients were placed in either intermediate or long term care. Return to contents St. Vincent’s Healthcare Group Limited 203 Medical Social Work Department Departmental Statistics. Total numbers of referrals to the department rose from 5,587 to 6,249 in 2006. The most notable increases were in A&E where 705 were seen in 2006 compared to 369 the previous year. Social Work in Care of the Elderly had 1,533 referrals in 2006 up substantially from 440 in 2005. Also Carew House Day Hospital for Older People referrals were up significantly to 1,131. Among the various specialities Oncology, Gastroenetrology and General Surgery were sources of referrals, each reaching over 7% of the total. Future Plans At present we are due to have a new Senior Social Worker starting in the next month or so in the area of Cystic Fibrosis. This is a very exciting development and will lead to a better service for patients and families. We are also focusing on a staff supervision 6 day course in April and May and 5 Seniors will be trained in the model presently used in the department. Therefore this will ensure standardisation and enhancement of clinical practice. We are continuing to develop the bereavement service and there are 2 more courses to take place this year in April and October. As stated earlier we are embarking upon a modified version of software for the Social Work records this spring. The aim is to get a better return in terms of quality of data and to plan for a paperless scenario eventually. It should help establish where the main areas of need exist and to plan accordingly. Presently we are looking at our policies and procedures with a view to updating those that require modification particularly in the area of Elder Abuse, Child Protection, Domestic Violence, and Homelessness. Return to contents Annual Review 2006 204 Allied Health Professional and Support Services Department of Nutrition and Dietetics Departmental Statistics There was an increase of 9.8% in dietetic consults in 2006 compared with 2005. This was due to an increase in staffing levels in 2006, with additional posts for service provision in cystic fibrosis (one WTE, senior) and nephrology (one WTE, entry-level) and critical care (0.5 WTE, Senior). 10000 2004 2005 8000 2006 6000 4000 2000 0 Inpatients OPD Day Care Patient Groups Staff updates Staff The staff compliment at the end of 2006 was 13.5 WTE Dietitians and one WTE administrator. Geraldine Houlihan joined the Dept as a senior Dietitian in Cystic Fibrosis. Edel Caples and Paul Gough joined as entry-level Dietitians. In the autumn Aisling Glynn took up 0.5WTE position in critical care while Carmel Quinn joined us in a locum capacity. Olive Tully, Senior Dietitian resigned her position in December 2006 after ten years of service in St Vincent’s. Service Developments/Activities A working party with representation from the Speech and Language Therapy Dept, Catering Dept, Nursing Practice Development, and Nutrition and Dietetics introduced a third modified consistency meal option for patients. Moulded meals are specifically for patients with oro-pharyngeal dysphagia. Training of chefs was undertaken in May 2006. Evaluation of the project demonstrated that patients consumed more energy, protein and fibre when compared with the existing modified consistency meal option. In a satisfaction survey patients scored the moulded meal higher for how appetising the meal looked, its texture and overall satisfaction with the meal. A specific weight management clinic was introduced as part of our general OPD service. This clinic is for patients for whom weight management is the primary intervention. A pre-appointment questionnaire is sent to each patient, in order to determine readiness to change. This was introduced to minimise the “failure to attend” rate for this cohort of patients which is now 21%. In general OPD clinics, the failure to attend rate has fallen from 25% to 19.4%. Furthermore, waiting time for OPD appointments have been reduced from 16 to 6 weeks, resulting in improved patient attendance rates. Maeve Gacquin, Senior Dietitian and Joanne Kildunne, Diabetes Specialist Nurse DAFNE (Dose adjusted for normal eating) accredited educators facilitated 3 courses with 24 patients completing the weeklong education programme. This has been so successful that with additional resources now in place we plan to facilitate another 6 programmes in 2007. Another dietitian and nurse will become accredited educators, to support this development. Return to contents St. Vincent’s Healthcare Group Limited 205 Department of Nutrition and Dietetics In association with Physiotherapy, Occupational Therapy and Clinical Nurse Specialists in the bone and joint unit, Dietitians participated in delivering a monthly lecture on diet and bone health to patients with a diagnosis of osteoporosis. An evaluation of this programme will be undertaken in spring 2007. The Occupational Health Department organised an education programme for staff on "Staying Well at Work". A series of lectures were delivered (by different disciplines) in October 2006, this included "Diet in Stress Management" delivered by Margaret Doyle, Senior Dietitian. The Department was one of the pilot sites for Team Based Performance Management training in the hospital in 2006. A number of small teams were formed with specific projects undertaken, which are being evaluated on an ongoing basis. Significant Achievements Under the auspices of the Nutrition Sub Committee a pilot project to implement a ‘Protected Meal and Rest Time’ for patients in St. Vincent’s University Hospital was completed in 2006. The results of the pilot show a significant reduction (from 44% to 18%) in the number of interruptions during the lunchtime meal. Staff and patient questionnaires showed overwhelming support for the protected mealtime initiative. The initiative won an innovation award in November 2006. In 2007 the Sub Committee plans to roll this initiative out throughout the hospital. In March 2006, Julie Dowsett, Secretary of the Nutrition Committee edited and published the Clinical Nutrition Guidelines booklet. A copy was distributed to all wards. We had hoped to launch the guidelines at the annual clinical nutrition study afternoon in March, however this had to be cancelled due to an outbreak of norovirus. The Nutrition Committee, which is a multidisciplinary group representing all personnel with a role in the nutritional care of patients, amended its policy on how to confirm the placement of a naso-gastric feeding tube. This policy was introduced into St Vincent’s in October 2006 and will be rolled out in St Vincent’s Private hospital and St Michael’s Hospital in 2007. A copy can be found in the Clinical Nutrition Guidelines booklet as well as wall posters in all ward areas. Five final-year B.Sc. (Human Nutrition and Dietetics) from DIT, Kevin St and Trinity College students undertook research projects in this hospital between August and November 2006 under the supervision of specialist Dietitians in the Department. Results have been presented to the medical and surgical teams involved. Return to contents Annual Review 2006 206 Department of Nutrition and Dietetics Significant Publications/Presentations Presentations Catherine Lamont, Heart Failure – the role of the Dietitian at the Cardiology Study Day for Dietitians in Northern Ireland (May 2006). Catherine Lamont, Cardiac Cachexia as part of Heart Failure Nursing Study Day, in Dublin (Nov 2006). 6th International Symposium on nutritional aspects of osteoporosis. Lausanne, Switzerland. 4th – 6th May 2006. Biochemical markers of bone turnover in anorexia nervosa following nutritional rehabilitation. Murray BF, Smith D, Doyle M, Brady JJ, Cassidy M, Malone K, McKenna TJ Poster presentation Catherine Lamont and Ruth Maxwell, poster presentation at the ISQSH conference on “Protected Mealtimes”, in Kilkenny (Dec 2006). Publications Catherine Lamont, Diet: a key factor in heart failure management. Cardiology Professional (Autumn 2006) Future Plans - 2007 To support the Nutrition Sub Committee to roll out the protected mealtimes for patients throughout the hospital To host the clinical exams for final-year B.Sc. Human Nutrition and Dietetics, DIT Kevin St and Trinity College in May 2007. To increase the number of DAFNE training weeks for Type1 diabetes to six in 2007. Dietitians will continue to deliver a monthly lecture as part of the MDT, to patients who have had a dexa scan to determine if they have osteoporosis. Return to contents St. Vincent’s Healthcare Group Limited 207 Allied Health Professional and Support Services Occupational Health (OH) Department Staff members Staff members of the OH Department during 2006 were: Occupational Physician Dr. Paul Guéret Dr. Robert Ryan Dr. Jacintha More-O’Ferrall Dr. Elizabeth Walsh Occupational Psychologist Nuala Gannon Clinical Nurse Specialist (CNS) Siobhan Bulfin Ann O’Reilly Justine McGrane Aisling Purcell Orla Seale Karen Murray (Acting position) Administrative support Áine Yap Ciarán O’Reilly Other hospital staff that contributed to OH included the Health and Safety Co-Ordinator and personnel from Risk Management, Infection Control, Health Promotion, Ergonomics, Human Resources and Dietetics areas. Service Developments/Activities 3105 staff members attended the OHD for the following reasons: Reasons for OH attendance 2006 • A webpage was developed to aid the dissemination of information about OH services and activities; • Action has been initiated and developed in the following areas: i.)Policy matters: • A Policy was drafted on steps to support the psychological health and wellbeing of staff; • A Policy was drafted on the management of staff following a Critical Incident or Major Emergency. ii.) Educational presentations were delivered on: • The impact of lifestyle on personal health; • Diet and stress management; • Practical personal stress management techniques; • The role and benefits of physical activity. Return to contents Annual Review 2006 208 Occupational Health (OH) Department iii.) Evaluation matters: the following audits were undertaken: • An audit of Staff Support Service usage and uptake; a Poster presentation was delivered at the Irish Health Promoting Hospitals Annual Conference; • An audit of the immune status of overseas staff; • An audit of staff members’ knowledge of the history of infections in measles, mumps, rubella (MMR) & varicella-zoster virus (VzV) and the correlation of these with OH records of serological results; • An audit of the usage and uptake of the Working Backs Programme (WBP); • A study to investigate the role of interferon-gamma immunological testing in contact tracing of healthcare workers following significant exposure to TB in the course of their work. • A survey of the OH needs of staff in regard to current service provision and expectations. Significant Achievements 1) Significant improvement in the reduction of Needlestick Injury rates; 2) Development of a Staff Survey instrument; 3) Development of an Exit Survey instrument; 4) Continuation of post-graduate education to: • UCD post-graduates - J. McGrane; • TCD and UCD post-graduates - N. Gannon. Needlestick injury prevention An ongoing educational campaign has continued into 2006 to encourage employees to avoid and report on inoculation incidents as early as possible. 10 “Be Sharp Be Safe“ workshops were held; a total of 176 staff members attended. Specific sessions on the prevention and management of inoculation injuries were also provided for 38 staff members from the Pathology Department and 18 Phlebotomy staff. Informal sessions took place in the Emergency Department on the ‘Management of Blood Borne Virus exposure’; 49 staff members attended. An additional 7 ‘Be Sharp, Be Safe’ sessions were held and attended by 62 staff in SVPH. Innoculation Injuries 2001-2006 120 100 Medical and psychological assistance was provided to the 81 staff members who sustained inoculation injuries in 2006. This compares with 94 staff members who sustained similar injuries in 2005. 80 60 40 The prompt reporting of needlestick injuries was emphasised. This facilitated the OHD in monitoring and controlling associated risks. The incidence of such injuries has fallen steadily in recent years – see graph below. 20 0 2001 2002 2003 2004 2005 2006 Annual Rates Sharps/Innoculations Blood splashes Return to contents St. Vincent’s Healthcare Group Limited 209 Occupational Health (OH) Department ‘Working Backs Programme’ (WBP) for staff Ninety-eight staff members attended OH for the treatment of back problems. Fifty-five of these were subsequently referred on to the Physiotherapy Department. Workshops and information packs were provided for managers and clinicians on the evidence-based management of Lower Back Pain (LBP). OH and Physiotherapy staff manned information stands to advertise the WBP programme. Information stands detailing the WBP were also provided during the 2006 European Safety week and on the SVUH Manual Handling training days. Influenza Vaccination Programme Influenza vaccinations were provided to 683 staff in 2006. Uptake of Flue Vaccination 2005-2006 900 800 700 600 500 400 300 200 100 0 2005 2006 Infection Control activities Contact tracing procedures were carried out on the conditions listed below: 1% 1% 3% 2% 3% 3% TB Menigococcal Meningitis Breucella Mumps Scabies Varicella Return to contents Annual Review 2006 210 Occupational Health (OH) Department Stress Management Activities Staff continued to avail of the Staff and Managers Support Services. This is a confidential support service providing immediate and professional support to employees who are experiencing difficulties as a result of a traumatic incident or personal issue. 200 180 160 140 120 100 80 60 40 20 0 Service session April - December 2006 2005 2006 Individual attendance 2005 2006 Manager attendance Staff Education and Training OHD contributed to and provided education and training in the following areas: • Induction to new staff members; • ‘Back-to-Nursing’ information sessions. • The Legal Framework (People Management) programme; • FETAC Programmes; • Safety Management programmes viz.: • ‘Be Sharp, Be Safe’; • ‘The Management of Blood Borne Viruses’; • Blood Borne Virus and Cannulation. • Health Promotion programmes including: • ‘Glove usage among catering staff’; • Stress awareness and education information sessions; • Working Backs Programme Information Stands. • Infection Control • Infection Control liaison link with OHD St Vincent’s Private Hospital (SVPH) The service continues to expand; 194 staff availed of the following services in 2006: • Pre- Employment Health Assessments; • Vaccinations – Hepatitis B, Measles, Mumps, Rubella, Varicella and BCG; • Inoculation Injuries (of which there were 10 needlestick and 3 blood splashes); • Management referrals; • OH Psychology; • Cytotoxic Surveillance. It is planned to expand the service further in 2007. Return to contents St. Vincent’s Healthcare Group Limited 211 Occupational Health (OH) Department Future Plans 1. Strategic • Continuation of the implementation of the new computerised software programme (Healthcare Manager™); • Addressing the opportunities for improvement in the delivery of OH services highlighted in the OH Staff Health Needs Survey, the Staff Survey and theExit Survey; • Continuation of the development of the Policy and Operational review process. 2. Information, training, education • To complete and use the webpage designed to disseminate relevant information; • Develop a training and education plan in the light of OH priorities; • Collaborate with Health & Safety about how best to influence health and safety behaviours and share good OH practice around the organisation. 3. Quality Assurance • Use the Accreditation framework to address common themes to ensure the provision of a safe and healthy work environment for staff. • Undertake Audits in the following areas: • The Pregnancy Risk Assessment process; • Verbal and Physical assaults directed at staff; • The Working Backs Programme; • The OH process for managing work-related stress; • Needlestick injury statistics; • Flu vaccination uptake. Return to contents Annual Review 2006 212 Allied Health Professional and Support Services Occupational Therapy Department Overview St. Vincent’s Public and Private Occupational Therapy services 2006 was another busy year for the Department but despite reduced length of bed stay noted in some areas the Occupational Therapy staff achieved our service goals for the year. Staffing St. Vincent’s The staff compliment remained unchanged, as it has done for some years now however we continued to experience staff stability, which enabled service reviews, developments and initiatives within the department to take place. Staffing remained relatively stable in the following areas with some of the Occupational Therapists moving to a senior grade within the department Medicine for the Elderly Stroke and Neurology Hands and Plastics Rheumatology Adult Psychiatry Pain management A WTE Senior Occupational Therapist was appointed to Orthopaedics, which it is hoped assisted with the high levels of activity in this service. We also are very lucky to have recruited a senior therapist to Old Age Psychiatry with a strong mental health background. Service Developments/ Activities St. Vincent’s Occupational Therapy Department 2006 was a very active time from Occupational Therapy perspective we achieved our service goal with a strong emphasis on improving staff’s awareness to the many roles, which Occupational Therapy has in St. Vincent’s Group from physical to the mental health settings. We held a two day Open day took in September 2006 with great feedback from all who visited our stands. The flexible working hours introduced has hopefully improved the access of patients’ and their family members wishing to avail of Occupational Therapy services. The WTE posts in both Orthopaedics and Pain management have also led both areas to have the Occupational Therapy services here reviewed and improved. Return to contents St. Vincent’s Healthcare Group Limited 213 Occupational Therapy Department The Occupational Therapists were invited and act as representatives at a national level for our profession on the following National Stroke Audit Prevention. National Steering Committee on Fall and Fracture National Arthritis Needs assessment. The Occupational Therapy staff here in St. Vincent’s successfully hosted a National Course for Occupational Therapists on Cognition and Perception. We wish to extend our thanks in allowing Occupational Therapy staff attend the following International Conferences; British Pain Society, Annual Scientific Meeting, Harrogate, England. Significant Achievements/ Presentations As one of the key instigators for the Action Van man / Slan Abhaile initiative St. Vincent’s and St. Michaels came second in our category in the HSE innovation awards ceremony. Departmental Statistics St. Vincent’s Hospital OT Activity Trends 2004 - 2006 Inpatients 12,000 10,000 8,000 6,000 4,000 2,000 0 2004 2005 Inpatients 1:1 2004 2005 2006 8,613 10,890 10,099 Group 1,536 818 7,950 2005 8,171 2006 13,173 2006 1:1 Treatments Groups OT Activity Trends 2004 - 2006 Outpatients 15,00 10,000 Outpatients 2004 1:1 Treatments 8,510 5,000 Group 0 2004 2005 6,023 6,225 189 2006 1:1 Treatments Groups Future Plans The Occupational Therapy Department has the following service plans for 2007 Audits to be completed in a number of key areas within the Occupational Therapy Department Working groups to actively target improved communication ideas between staff and Patients/ Clients. Return to contents Annual Review 2006 214 Allied Health Professional and Support Services Pharmacy Department Service Developments / Activities Major service developments and activities were: Installation of new IT software for stock management and clinical pharmacy applications Management of medication storage and supply issues for the new Clinical Services Building. Set-up, validation and maintenance of new drug infusion database for ICU. Management of pharmaceutical issues resulting from transfer of patients from Hume Street Hospital. Commenced new clozapine dispensing service for Elm Mount outpatients Dispensary Service There was a 10% increase in the number of items issued, as a result of increased service demands from clinical areas. Clinical Service A root and branch review of the clinical pharmacy service commenced in October 2006 and is ongoing. This is a quality improvement initiative aimed at ensuring a minimum standard of clinical pharmacy care for all inpatients. It was prompted by increased workload in all clinical areas e.g. Hepatology (65 transplants in 2006), Cystic Fibrosis (314 patients December 2006). Education Pharmacy staff provided lectures, workshops and presentations for undergraduate and postgraduate medical, nursing and pharmacy educational programmes, in-house training for pre-registration pharmacists and MSc students and a new “clinical skills” training programme for TCD undergraduate pharmacy students. SVHG Prescriber’s Guide and Formulary Work continued on the draft version of the 5th edition of the SVHG Medicines Guide (2007/2008). This is expected to be in print in Spring 2007. Aseptic Service In 2006 the total number of items prepared in the Aseptic Unit (ASU) was 8107, an increase of 3.5% on 2005. Fionnuala Kennedy, of St Vincent’s University Hospital, receives her prize for Excellence in Hospital Pharmacy from John McLaughlin of Sanofi-Aventis, while Minister of State at the Department of Health and Children, Tim O’Malley looks on. Return to contents St. Vincent’s Healthcare Group Limited 215 Pharmacy Department Activity in the Aseptic Unit 2000-2006 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 2000 2001 2002 2003 2004 2005 2006 No Items 5706 6023 7276 6777 6845 7845 8107 % Change in Activity in the Aseptic Unit 2000-2006 50 40 30 No. items (1,000's) 20 % increase on 2000 10 % annual increase 0 -10 No. items (1,000's) % increase on 2000 % annual increase 2000 5.706 0 0 2001 6.023 6 6 2002 7.276 28 21 2003 6.777 19 -7 2004 6.845 20 1 2005 7.845 37 15 2006 8.107 42 3 Year Medicines Information (MI) Time spent supporting the SVHG Drugs and Therapeutics Committee through medication review and complex enquiry answering increased by 60% (67 hours in 2006). The service provided a similar level of direct support to medical staff, as for previous years (31% of enquiries 2006, compared with 33% in 2005). The MI service will be early implementers of a new national database for Medicines Information – MIDatabank®, a custom built database used in the NHS. This database was installed in December 2006, and will be fully implemented during 2007. Breakdown of enquiries by speciality for the organisation, in 2006 are as follows: see next page Risk Management/ Mir Database The Pharmacy Department and Drugs and Therapeutics Committee put together a proposal on a Medication Safety Programme for SVUH, outlining a strategy for promoting medication safety. It was approved and sanctioned by the Group CEO at the end of 2006. Return to contents Annual Review 2006 216 Pharmacy Department Number of enquires by Directorate 01-2006 to 12-2006 Accident & Emergency 3.92% Pregnancy/Brest feeding 1.72% Vascular 1.81% Cardiac 6.88% Urology 0.86% Cystic Fibrosis 2.2% Theatres1.62% Community 0.67% Surgery7.64% Dermatology2.58% Rheumatology 2.96% Diagnostics 0.29% Respiratory 1.81% Dietetics 0.96% Renal 3.44% Drugs and Therapeutics 2.87% Psychiatry 2.39% Pharmacy 8,86% Endocrinology 2.67% Endoscopy 0.1% Palative Care 0.38% Ear, Nose & Throat 0.57% Pain Medicine 1.34% Gastroenterolgoy 1.24% Opthalmology 0.38 Geriatrics 1.43% Oncology 3.44% Occupational Health 0.67% Gynaecology 0.57% Nursing 0.67% Haematology 4.3% Health and Safety 0.38% Nuclear Medicine 0.1% Hepatic 4.2% Neurology 5.73% Herbal Medicine 0.38% Microbiology 2.87% Histopathology 0.195 Medical 6.4% Intensive Care 8.31% Infection Control 0.19% Intensive Care 8.31% Infection Control 0.19% Medical 6.4% Histopathology 0.195 Microbiology 2.87% Herbal Medicine 0.38% Neurology 5.73% Hepatic 4.2% Nuclear Medicine 0.1% Health and Safety 0.38% Nursing 0.67% Haematology 4.3% Occupational Health 0.67% Gynaecology 0.57% Oncology 3.44% Geriatrics 1.43% Opthalmology 0.38 Gastroenterolgoy 1.24% Pain Medicine 1.34% Ear, Nose & Throat 0.57% Palative Care 0.38% Endoscopy 0.1% Pharmacy 8,86% Endocrinology 2.67% Psychiatry 2.39% Drugs and Therapeutics 2.87% Renal 3.44% Dietetics 0.96% Respiratory 1.81% Diagnostics 0.29% Rheumatology 2.96% Dermatology2.58% Surgery7.64% Community 0.67% Theatres1.62% Cystic Fibrosis 2.2% Urology 0.86% Cardiac 6.88% Vascular 1.81% Pregnancy/Brest feeding 1.72% Accident & Emergency 3.92% 0 21 42 63 84 105 Return to contents St. Vincent’s Healthcare Group Limited 217 Pharmacy Department Clinical Audit Three audits were completed in 2006. Two audits examined the accuracy of medication prescribing in emergency and elective admissions in SVUH and the third audit focussed on antibiotic use in the surgical Professorial Unit. Achievements • Fionnuala Kennedy received a national award for “Excellence in Hospital Pharmacy” (see below). The Excellence in Hospital Practice accolade was presented to Fionnuala Kennedy of the Pharmacy Department at St Vincent’s University Hospital in Dublin. Her role as editor of the St Vincent’s Healthcare Group Medicine’s Guide was highlighted, as was her participation in the UK and Ireland Liver Pharmacists Group. Niamh O’Hanlon was invited to speak at the Reducing Medication Errors Conference at the Royal Society of Medicine in London. Amanda Nevin and Edward Crimin were highly commended for their pre-registration projects by the Pharmaceutical Society of Ireland. Caitriona Reilly and Joan D’Arcy won first prize in the pharmaceutical technician’s category of the poster competition at the HPAI Educational Conference. Adele Flynn won first prize in the poster competition at the Annual Conference of the Pharmaceutical Technicians Association of Ireland. Return to contents Annual Review 2006 218 Pharmacy Department Publications and Posters Flynn A, O’Hanlon N. The Role of the Pharmaceutical Technician in Medicines Information. Nevin A. Accident and Emergency: Is there a Need for a Clinical Pharmacist? O’Hanlon N, Kilfeather A, Rourke M, O’Shea J. Medication Incident Reporting at SVUH. Reilly C, D’Arcy J. Read the Label, Understand the Directions. Crimin E. Accuracy of Medication Prescribing in Elective Admission Patients in a Tertiary Referral Teaching Hospital. Conferences All Ireland Cystic Fibrosis Meeting, Killarney, February 2006. C. Keane. Anticoagulation Study Day, St. James’ Hospital, Dublin, March 2006. M. O’Sullivan. HPAI Annual Educational Conference, Dublin, April 2005. ISOPP 10th Annual Conference, Kuala Lumpur, April 2006. AM de Frein. UK CPA Annual Conference, London, April 2006. L. McCabe, L. Hammond. UK Pharmaceutical Technicians Conference, June 2005. C. Bogue, A.Cahill. UKCPA Critical Care study day, London, July 2006. M. O’Sullivan. UK Renal Pharmacists Association Conference, Birmingham, September 2006. K. Feeley. North/South Pharmacy Conference, Cavan, September 2006. N. O’Hanlon, L. McCabe, C. Muldowney, C. Reilly. British Oncology Pharmacist Association (BOPA) Annual Conference, Bournemouth, October 2006. E. Marsden. UK & ROI Liver Pharmacists Group Meetings, Dublin and London. F. Kennedy. Future Plans Develop the MIR Database to facilitate electronic medication incident reporting. Extend the use of the electronic Clinical Pharmacy Worksheet (e-CPW) to facilitate clinical audit and more efficient information transfer. Recruit an Antimicrobial Pharmacist as part of the National SARI initiatives. Implement medication safety programme. Return to contents St. Vincent’s Healthcare Group Limited 219 Allied Health Professional and Support Services Physiotherapy Department Staff Ms Pauline Leahy departed St Vincents University Hospital in September 2006 after 16 successful years as Physiotherapy Manager. The department wishes her every success in her future endeavours. Catherine Toole was appointed to the position. Grainne O’ Hara resigned as Deputy Physiotherapy Manager in May 2006 to be replaced early in 2007. Ruth Gibson, Clinical Tutor was appointed Physiotherapy Manager in the Beacon Hospital and was replaced by Ann Garvey. Avril Craig was appointed Acting Senior in Bone Health (0.4 WTE). Staffing complement in 2006 was 36 WTE. From September to December 2006, staffing levels were reduced temporarily by 1-2 wte. In December 2006, a welcome allocation of 2.5 additional senior physiotherapists to the Cystic Fibrosis service was announced. Service Developments/Activities A 6 bedded NIV (non invasive ventilation) unit was opened in January 2006. Staff education and audits of service were completed by the acting senior physiotherapist in NIV. A pilot service to provide physiotherapy assessment and treatment of patients with Osteoporosis was commenced in May 2006. This is the first such post in the country and it is hoped that it will be continued beyond its initial period. A new tailored 3-day pain management programme was introduced for patients who are unable to participate in the existing 3 week programme. A 0.5 staff grade therapist was appointed to the new ED. This has improved communication and speed of service delivery in the ED but a need for development of service provision in this area has been identified. High numbers of referrals to Neurology Out-patients, Hand Therapy and Incontinence services continue. Community links were commenced with St Michaels School by attendance of Theresa Flynn and Catherine Toole to give presentations on ISCP Move for Health Day 2006. Return to contents Annual Review 2006 220 Physiotherapy Department Outstanding/Significant Achievements Keith Smart was awarded Health Research Board Fellowship for the Therapy Professions Martina Fitzpatrick awarded second MSc 'Quality of Life and Exercise Activity of People with Ankylosing Spondylitis: A Cross-sectional Survey'. Caitriona Cunningham (UCD School of Physiotherapy) completed a PhD on ‘The Implementation of an Evidence Based Management Pathway for Staff with Low Back Pain (The Working Backs Programme)’, in collaboration with the Occupational Health and Physiotherapy Departments. Grainne O’Hara completed HSE Leadership Programme Significant publications Mechanisms-based clinical reasoning of pain by experienced musculoskeletal physiotherapists. Physiotherapy 92: 171-178 Smart K, Doody C . Quality of Life and Exercise Compliance in Patients with Ankylosing Spondylitis: A Cross-sectional Survey, Abstract published in Arthritis and Rheumatism 2006, 54; 9 (supplement). Fitzpatrick M, FitzGerald O, Staines A, Hurley DA. Exercise Activity in Patients with Ankylosing Spondylitis: A Cross-sectional Survey, Physical Therapy Reviews, Vol. 11, p218. Fitzpatrick M, FitzGerald O, Staines A, Hurley DA. Characteristics of Patients with Rheumatoid Arthritis Presenting for Physiotherapy Management in Ireland: A Multicentre Survey, Musculoskeletal Care, Epublication Nov 2006, in press Jan 2007. Kennedy N, Keogan F, Fitzpatrick M, Cussen G, Wallace L. Postoperative exercise programmes following lumbar spine decompression surgery: A systematic review; Physical therapy reviews 2006; 11; 248-262. Jenny Mc Feeley, J. Gracey. Conference Platform Presentations American College of Rheumatology, Washington, November 2006, ‘Quality of Life and Exercise Compliance in Patients with Ankylosing Spondylitis: A Cross-sectional Survey’. Martina Fitzpatrick Rehabilitation and Therapy Research Society Meeting, Dublin, May 2006, ‘Exercise Activity in Patients with Ankylosing Spondylitis: A Cross-sectional Survey’. Martina Fitzpatrick. Irish Society of Chartered Physiotherapists Conference: The effect of an eight week exercise training programme on exercise capacity and activity levels on patients with heart failure. Karen Cradock Return to contents St. Vincent’s Healthcare Group Limited 221 Departmental Statistics 12000 11100 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 Patient Referrals Referrals 2001 2002 2003 2004 2005 2006 Patient Attendances 85000 80000 75000 70000 Attendances 65000 60000 2000 2001 2002 2003 2004 2005 2006 Future Plans Moving of therapy base from St Anthonys Rehabiliation Centre into main building Commence use of new gait trainer in Our Lady’s Gym, audit outcomes Develop neurology, hand therapy and incontinence out-patients services Increase involvement and provision in ED Develop physiotherapy provision to patients with Cystic Fibrosis Increase activity in osteoporosis prevention Formalise NIV education service Commence the development of a community based cardiac rehabilitation service for people following acute care intervention Return to contents Annual Review 2006 222 Allied Health Professional and Support Services Department of Preventive Medicine and Health Promotion Staff Professor Cecily Kelleher Ms Jacinta Barnewell Dr. Anna Clarke MD, FRCPI, MPH, FFPHM, MFPHMI RGN, SCM, ADV. DIP. Montessori (Head of Department) Education (Health Promotion Officer) LRCP&SI, MB, MPH, FRCPI, FFPHMI, FFPH Ms. Denise Comerford RGN, RM (Health Promotion Coordinator) Ms. Frances Conlan (Secretary) Ms. Kirsten Doherty BSC, MPH Ms. Marion Fitzgerald (Health Promotion Officer) BNS, RSCN, RGN (Health Promotion Officer, since August 2006) Ms Irene Gilroy BSc (Health Promotion Officer) Ms. Tina Mooney RGN, Ms. Veronica O’Neill Ms. Carol Pye RGN, RM Ms. Vivien Reid DIP MGT, HDIP HP RGN, RM (Health (Health Promotion Officer, since September 2006) Promotion Nurse) (Health Promotion Officer) MSC, DIP DIET. Ms. Brenda Whiteside (Clinical Specialist Dietitian) RGN, RM (Health Promotion Officer) Allied UCD staff Professor Leslie Daly, MSC, PHD, FFPH Dr. Patricia Fitzpatrick MD, MPH, FRCPI, FFPHMI. Service Developments/Achievements Service to Patients Cardiac Services 24 Hour Ambulatory Blood Pressure Monitoring Service This service is provided for both inpatients and outpatients of hospital consultants and general practitioners. There has been a 23% increase in the number of referrals in 2006. Cardiac Rehabilitation This department’s support of cardiac rehabilitation continues through the monthly cardiac lifestyle information session, which is open to patients and the wider community. This is under review, with view to the development of a Lifestyle Assessment Service. A follow-up study of patients five years after attending Cardiac Rehabilitation was undertaken as part of an undergraduate student dietetic project, in conjunction with Dublin Institute of Technology. Safe & Moderate Alcohol Consumption Project (SMAC) A multidisciplinary group, comprised of representatives from Nursing, A&E, Occupational Health, Psychiatry, Medical Social Work, Liver Unit, and Baggot Street Community Alcohol Treatment Unit, co-ordinated by this department, was set up to develop a multi-pronged approach to safe and moderate alcohol consumption. The aims of SMAC are to develop: • Standardised and accurate charting in relation to alcohol. • Staff training sessions in brief intervention. • A seamless referral pathway to appropriate hospital and community services. • Appropriate health promotion material. Return to contents St. Vincent’s Healthcare Group Limited 223 Department of Preventive Medicine and Health Promotion Communication Strategy Department staff has been working with management on the development of a multimedia communication strategy for the hospital. This will allow the dissemination of health promotion material from the Health Promotion Policy Unit and other organisations to patients and the general public through a digital information system (i.e. hospital channel and hospital website) supported by leaflets and other written material e.g. Healthwise. Smoking Cessation Services There has been an increase of 14% in the number of inpatients and outpatients who have been referred to the service between 2005 and 2006. Several weekly stop smoking courses were run throughout the year, with an average smoking cessation rate of 52%. SVUH was awarded the “European & National Network for Smoke Free Hospitals Silver award” in recognition of its work in smoking management. Smoking Cessation Service Activity 800 700 600 500 400 300 200 100 0 2004 2005 2006 2004 2005 2006 2004 2005 2006 Years Nutrition The Clinical Specialist Dietitian provides an integrated clinical and health promotion service. This includes inpatient and outpatient services and group sessions. A three-day training course to develop and enhance Behaviour Change Skills (Level 1): Interpersonal Skills was provided for Community Dietitians in association with the Health Promotion Unit, DoHC. All HSE areas were represented on the course. Dept. Preventive Medicine and Health Promotion staff out and about on Bike to Work Day -May Return to contents Annual Review 2006 224 Department of Preventive Medicine and Health Promotion Sensory Garden Project Collaborative work was undertaken with final year students from the College of Horticulture Botanic Gardens. They used SVUH grounds to develop a sensory garden. 7 innovative projects were designed and presented to hospital management to be used at a later time to enhance the outdoor environment for patients and staff. Service to Staff • Bi-monthly health promotion education sessions were provided to departments, including medical interns, nursing and general staff induction programmes. • “Healthwise SVUH” was published with contributions from staff and distributed quarterly. • “Bike to Work” for National Health Promoting Hospital Challenge Day, focused on healthy food choices as well as increased physical activity. Those who cycled to work on the day got a free breakfast and entry into a raffle for two bikes, one of which was sponsored by hospital management. • Smoking Cessation Training, Theory & Practice, was provided for staff. • A smoking cessation service was provided to the estimated 18% of staff who smoke. Prof.Risteard Mulcahy, cardiologist, Supported the Bike to Work Day and cycled to SVUH. He is seen here with Phena Doran who won a bike in the Hospital Bike to Work Day raffle. 24 Hour Blood Pressure Monitoring Referrals 2004 - 2006 2000 1722 No. of BP Referrals 1800 1600 1424 1442 2004 2005 1400 1200 886 1000 800 722 721 600 400 200 0 2004 2005 2006 2006 Return to contents St. Vincent’s Healthcare Group Limited 225 Department of Preventive Medicine and Health Promotion Service to the Community Health professionals from all over the country attended a Smoking Cessation Training Workshop, run in conjunction with the Irish Cancer Society. 1,000 transition year students from schools in the catchment area of the hospital attended our seminars on alcohol awareness (x2), cancer awareness, smoking active and passive and healthy eating. New topics offered include “Bugs, Super bugs & Antibiotics” and “Minding your mind”. A smoking awareness stand was set up in the hospital for World No tobacco Day. 50 people had carbon monoxide tests on the day. Health Promoting Hospitals Denise Comerford and Dr Anna Clarke are members of the National Executive of the National Health Promoting Hospital (HPH) Network. Significant Publications Daly L., Gallagher H., Fitzpatrick P., Clarke A., Kelleher CC. Diagnosis or demographics? Predictors of aspirin administration for acute chest pain pre-hospital admission. Proceedings of the ESC Working Group on Acute Cardiac Care, 2006. Prague Oct 2006. Doherty K., Clarke A., Barnewell J., Comerford D., Conlan F., Daly L., Fitzpatrick P., Gilroy I., O’Neill V., Pye C., Reid V., Whiteside B., Kelleher CC. ‘Bike to work’ day – the theme for Hospital Challenge Day 2006 in St. Vincent’s University Hospital. Proceedings of the National Health Promoting Hospital Conference, October 2006. Clarke A., Tan LM., Gilroy I., Pathmadevan R., Daly L., Fitzpatrick P., Kelleher CC., Mulcahy R. Is it time to ban smoking outright on hospital sites? Secular evidence from St Vincent’s University Hospital (SVUH) census blitz surveys 1977-2006. Proceedings of the Faculty of Public Health Medicine Winter Scientific Meeting, Dublin, December 2006. Return to contents Annual Review 2006 226 Allied Health Professional and Support Services Speech and Language Therapy Department Current Level of Service Delivery The Speech and Language Therapy Department provides both an inpatient and outpatient service to over 60 consultants, 23 wards, Carew House, and St. Michael’s Hospital. The following is breakdown of the speech and language therapy treatment units by clinical specialities for 2006. Clinical Specialities/Speech and Language Therapy Treatment units 2006 2,500 2,174 2,000 1,849 1,453 1,500 1,000 823 927 1,016 544 185 257 Rheumatology 208 Endocrinology 500 Clinical Specialities Treatment Units Nephrology / Psychiatry Cardiology Neurology Respiratory Surgical Oncology ENT / Plastics Medicine for the Elderly 0 Gastroenterology 69 Service Development Medicine for the Elderly 1,849 ENT Service ENT / Plastics 1,435 This service moved to their new suite on the first floor of the Ambulatory Day Care building. The speech and language therapists used the Voice Lab room. Oncology 208 Surgical 823 Respiratory 927 Gastroenterology 1,016 Neurology 2,174 Cardiology 69 Endocrinology 185 Rheumatology 257 Nephrology / Psychiatry 544 We continued our weekly Joint Voice/Digital Stroboscopy Clinics with Mr. Russell, Mr. D. Charles and Prof. Curran. Two of the Senior Speech and Language Therapists (ENT and Neurology) participated in the multidisciplinary tracheostomy policy-working group. These guidelines were published in December 2006. Fionnuala Duffy, Speech and Language Therapy Manager is co-leading the DEEPO accreditation team. Return to contents St. Vincent’s Healthcare Group Limited 227 Speech and Language Therapy Department Neurology Service Overall, there was a 20% increase in the number of referrals and clinical treatment units for neurology referrals. It remains our busiest caseload. This is mainly an outpatient service and incorporates both group and individual treatment programmes. Deirdre Kidney, our senior therapist in neurology, represented the profession on the HSE led National Neurology Strategy Group. Link Post with St. Michael’s Hospital Number of new referrals 2006 =235 Specialised Clinic – Swallowing and Voice Videofluoroscopy This specialised clinic is run jointly by the Speech and Language Therapy Department and Dr. Dermot Malone, Consultant Radiologist. It continues to be the only videofluoroscopy service in the East Coast Area Health Board. Referrals are accepted from St. Michael’s Hospital, St. Vincent’s Private Hospital, National Rehabilitation Hospital, and Royal Hospital Donnybrook .The clinic now takes place in the Fluroscopy Unit on the 2nd floor of the Ambulatory Day Care building. We also, have an additional session on a Wednesday morning. 200 180 No. of Patients 160 140 120 100 80 60 40 20 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 Return to contents Annual Review 2006 228 Speech and Language Therapy Department Fees The Speech and Language Therapy Department and the ENT team conduct the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) service jointly. This service commenced in July 2004 and is completed either at the patient’s bedside or in the Voice Lab room. 40 35 30 25 20 15 10 5 0 2004 YEAR 2005 2006 Digital Stroboscopy This service has been running for the past five years and is part of our weekly joint voice clinics. It provides accurate information on the shape, condition and functioning of the vocal cords. It also, allows the team to make a permanent record of the vocal cords vibratory patterns, which may be used to monitor progress and treatment outcome measures. 90 80 70 60 50 40 30 20 10 0 YEAR 2002 2003 2004 2005 2006 Return to contents St. Vincent’s Healthcare Group Limited 229 Speech and Language Therapy Department Quality Innovation Award We were delighted to win an award for our staff education programme ‘Facilitating Aphasia- Friendly Communication – A Multidisciplinary Team Approach’. Training and Development Throughout 2006, the department was involved in a number of presentations both within and outside the hospital. We continue to provide input to nursing and physiotherapy students. The department provided several placements for speech and language therapy students. We, also, continued our extensive in-service training programme, which was particularly useful given the number of new staff in the department. The department completed its research project on ‘Developing and Standardising a Pharyngeal Retention Scale using Videofluroscopy. Significant Courses / Conferences Three members (50%) of the department completed their postgraduate courses and were awarded their Masters degrees. Sharon McNulty was accredited in her basic dysphagia-training course. She also, attended a FEES course in the Mater Hospital (4th & 5th May’06) and Tracheostomy training course, (22nd June’06). Caoimhe McDermott completed her initial dysphagia-training course in Tallaght Hospital (13th –17th Nov’06). Return to contents St. Vincent’s Healthcare Group Limited 231 Service Department Catering Department Staff 2006 was once again a busy year in recruiting Catering Staff. We welcome all new Catering Staff who joined us during the year. Stephen Faughnan and Noeleen Smith have been appointed Catering Supervisors in the Cafeteria while Sandra O’Connor, Jennifer Mc Manus and Ewa Tejszerska have joined the Catering Assistants Team in the Cafeteria. Also Sam Varughese, Lourdes Romero, Ross Crilly, Nicholas Roces, Norma de Guzman, Jusuff Dzulkefli, and David Reidy joined the Catering Assistants on the Wards. Mr. William Kearns, Senior Chef retired in April 2006 after 36 years loyal service to the Hospital. Mr. Kearns who is an accredited Food Hygiene Trainer is working with us on a part-time basis to train all new staff. We are delighted that his association with the Hospital is continuing. Ms. Connie Fox retired after 36 years as a Catering Assistant on the wards. Connie started her career in St. Stephens Green. I wish to thank her for her loyal support and wish her good health and happiness in her retirement. Congratulation to Pauline Coughlan and Paula Grogan, Catering Officers, who got engaged this year and are getting married in 2007. Service Developments/Activities The move of the Ambulatory Day Care Centre to the new Clinical Services Building in August 2006 resulted in the Coffee Shop in the Old Building being closed. However the Catering Staff continue to provide a service to the patients in the new Dialysis Unit and the Bone and Joint Clinic. A full meal service is now offered to all patients awaiting admission to Hospital in the Emergency Department. An out-of-hours snack food service is now available to patients and relatives in the ICU Department, Emergency Department and in the old front hall. A patient information leaflet and individual menu has been piloted on St. Charles and St. Kevin’s Ward. The feedback from these wards was very positive and encouraging and it is hoped to roll out this service very soon to the rest of the hospital. Return to contents Annual Review 2006 232 Catering Department Departmental Statistics The Catering staff provide a full meal service which is cooked and served fresh daily to over 500 in patients and 2,000 Hospital Staff. Catering facilities are also provided for functions, seminars and meetings throughout the hospital. Demands on the Staff Restaurant have increased by over 33% since 2001. Future Plans The modernisation of all ward kitchens is still a priority as it was not possible during 2006 to make any structural changes. The kitchens have benefited from the Stainless Steel Larder cupboards to store foodstuffs, new boiling rings and some kitchens have had their dishwashers replaced. Work in both the main kitchens and ward kitchens is ongoing. Return to contents St. Vincent’s Healthcare Group Limited 233 Service Department General Services Department Telephone and Communication Services The Telephone Service provides switchboard and other communication services to internal and external customers. There are currently 4,000 internal and external call handled per day. This is an increase of 14% on the previous year. The department also co-ordinates the hospitals internal and external fire and emergency communication protocols, and is responsible for maintaining internal directories for the telephony and paging systems. The service operates on a 24-hour basis, and is staffed by a team of 14 full and part-time staff members. The department has faced many challenges during 2006 with the commissioning of departments within the new Clinical Services building. A total of 575 new telephones have been installed during the year. Security Department The Hospital is committed to providing a safe and secure environment for patients, relatives and staff. Our Security Department plays a key role in the co-ordination and delivery of our safety and security activities, with a particular focus on fire safety management and emergency response procedures. The Hospital has continued to invest in the service through the provision of training and additional staff. The commissioning of the new Clinical Services building had increased the scope of service requirements and the department has met the challenge. The roll out of the consolidated ID and access control card system commenced with over 2,000 cards issued during 2006. Portering Services Department The department provides portering services to a broad variety of hospital departments through the provision and supervision of Portering staff. The areas serviced include Theatres, Laboratories, Radiology and Patient Clinics. The department is also responsible for the provision and co-ordination of whole-hospital activities such as waste management, post and patient transport. The staff compliment was 90 in 2006. The commissioning of the new waste marshalling facility was completed with the installation of a cardboard bailer and high pressure washing facilities for bins. The management of waste will receive further attention in 2007 by way of a review of our process with the intention of segregating waste streams at source. Return to contents Annual Review 2006 234 General Services Department The department has faced many challenges during 2006 with accreditation, hygiene quality improvement initiatives and the commissioning of departments within the new Clinical Services building. Cleaning, Hygiene & Household Services The Hospital is committed to achieving and maintaining the highest standards of cleaning and hygiene in support of patient care. All cleaning and hygiene activities are guided by best Infection Control practices. The majority of cleaning activities are provided under contacted services through a number of key suppliers. The Household Services department is responsible for co-ordinating and monitoring these contracts to ensure that the services provided continue to meet developing National standards. A comprehensive review of our cleaning specifications was undertaken in 2006 to facilitate commissioning of the new Clinical Services building. The Household function is also responsible for the management of rest, welfare and accommodation facilities for staff, and patient relatives. This includes the various changing and locker facilities and the doctor’s residence. The department was responsible for co-ordinating a major refurbishment of the doctor’s residence during 2006. Return to contents St. Vincent’s Healthcare Group Limited 235 Service Department Human Resources Department Introduction 2006 was a very active and busy year for the HR function, which saw the development and implementation of new initiatives and building on progress made on a number of important operational and strategic objectives for the year. The HR function continues to strive to ensure that staff are valued and enabled to maintain excellence in patient care while fulfilling their personal and professional development needs. Strategic Developments Through 2006 progress was made on the preparatory work towards developing a HR Strategy, which is closely aligned to the strategic framework for the healthcare group (Framework for the Development of St Vincent’s Healthcare Group 2006 – 2010) and the mission of the Hospital. The development of a HR Strategy is a significant recommendation, which has flowed from the Accreditation process. In relation to the broader HR Accreditation programme, progress continued to be made on a range of key quality improvement plans for the HR function and a mid cycle review took place in January 2006. Significant contributions were made towards the next full accreditation assessment, which is due to take place in late 2007. A HR Management Information System was implemented across all the HR Divisions in 2006 and this has allowed for enhanced integration of all the areas in the HR function through improved information management. Efforts to support the opening of the New Clinical Services Building were a significant feature of the activities of the HR function in 2006 particularly in relation to the recruitment of skilled and motivated staff in a competitive labour market. Partnership Management and trade unions in the Hospital agreed a 2006 Partnership Service Plan, in conjunction with the Heath Services National Partnership Forum and supported a number of key initiatives throughout the year. These initiatives included a comprehensive Training Needs Analysis, Meeting Facilitation programmes, Interest Based Bargaining, Two Person Conflict Resolution training and further roll out and support of the Dignity at Work programme. The roll out of an extensive programme to support the HSE Trust in Care policy, which upholds the dignity of patients / clients and outlines a procedure for managing allegations of abuse, will be rolled out in early 2007, having secured a successful external provider at end of 2006. Partnership also played a role in continuing to maintain a positive industrial relations climate in the Hospital and played a valuable role in fulfilling the Hospitals obligations in the Performance Verification Process, which forms part of the national social partnership agreement (Sustaining Progress). Nursing HR Division It was a very busy and challenging year for the Nursing Division of the HR function. During the course of 2006 the Division worked closely with the Senior Nurse Management team to deliver on significant goals and objectives, which were designed to support the provision of high-class healthcare by all nursing staff. The employee probationary model was reviewed and updated to reflect HR best practice and the nurse competency framework. A range of absence management related initiatives were introduced which resulted in a significant reduction in sickness related absences through the year. It is hoped that further progress can be made in 2007. The Division also conducted a number of internal reviews to ensure continued compliance with employment legislation (e.g. Fixed Term at Work Act 2003) and facilitated the updating of recruitment practices. In relation to nursing Return to contents Annual Review 2006 236 Human Resources Department recruitment, 2006 was another record-breaking year, which was partly attributable to the opening of the new Clinical Services Building. In 2006 there were almost 400 new nursing appointments, 75 of which were at a nurse management level. The sourcing of staff from overseas continued and in total 109 staff joined the Hospital as part of overseas recruitment initiatives. Medical HR Division The Medical HR Division of the HR function which is responsible for the sourcing and administration of over 350 medical staff (Consultants and Non Consultant Hospital Doctors) experienced a very active year. The Division also continued to provide a support service to the Medical Board and Medical Executive Committees of the Hospital. In September Mr Eddie Staddon was appointed as Head of HR Operations for the area. The development of this post was part of the HR function re-structuring programme, which took place the previous year. The main goal of the Division through what was a very busy year was to ensure that the Hospital has a full complement of medical staff at all times in order to maintain the highest level and standards of patient care. This year saw the appointment of 9 permanent Medical Consultants and the recruitment of over 200 Non Consultant Hospital Doctors. Resourcing and Retention Division It was a very busy year for recruitment, which saw a high volume of activity across a wide variety of grades and the move of the Division to newly refurbished offices in the Convent Building. Throughout the year over 230 competitions were facilitated in comparison to 190 the previous year. This reflected the increased staffing requirements as a result of the opening of the new clinical services building. The hospital also continued to experience shortages in certain specialised areas and successful efforts were made to recruit from home and abroad. Despite this increase the recruitment, the advertising budget remained at €380,000. This was achieved through increased efforts to reduce descriptive text in our advertisements and the use of online resources and recruitment methodologies. Preparatory work also commenced for a new recruitment advertising corporate image to role out in 2007. HR Services Division This was a particularly active year for the HR Services Division. The Division led and made significant progress on an electronic document archiving project, which is allowing for more efficient retrieval of archival records and also maximising the use of limited office and storage space in the Department. The Division embraced the implementation of a new HR Management Information System and this system has been used to improve and enhance the standard of service, which will enable us to provide to both Heads of Department and staff. The Division also conducted internal reviews in relation to the appropriate use of different types of contracts of employment (e.g. Fixed Term at Work Act 2003) and changes in employment legislation (e.g. Adoptive, Carers, Parental and Maternity Leave.). Employee Relations Division The Employee Relations Division had a particularly demanding year and continued to work closely with Department Heads and Line Managers in advising on the provisions of employment legislation, managing performance, employee grievances and managing attendance. The Employee Relations Division was closely involved in the successful move of services to the new Clinical Services Building. Good employee relations were maintained, enhanced and promoted throughout the year and there was continued compliance with the industrial relations, consultation and communications provisions of the social partnership agreements (Sustaining Progress and Towards Return to contents St. Vincent’s Healthcare Group Limited 237 Human Resources Department 2016). The Division also coordinated the submission of Performance Verification Reports to the National Health Services Partnership Forum and a successful and positive performance rating was awarded to the Hospital for Phase 6 of the Sustaining Progress Agreement. Learning and Development Division This was an interesting year in Learning and Development with a hospital wide analysis of training needs performed with the support of occupational psychologist Isobel Butler. This will culminate in comprehensive a training plan for 2007 to support the training strategy going forward. Seven pilots for Performance Management (Team based) were run in 2006 and it is expected to add teams and expand this in 2007. The Division ran a series of training courses throughout the year on Customer Care, Middle Managers Programme, Anti Bullying Workshops, internationally accredited Crisis Intervention Training and IPA Interviewing and Recruitment workshops. Along with the normal extensive support of continuous education and professional development, the Division also promoted the first run of the SKILL programme for support grades and managers, which was run in conjunction with the VEC’s. Over 30 staff were on release last year to attend courses aimed at furthering the continuous improvement of professional practises in the support areas. It is planned that the first SKILL project group will complete the program in quarter four of 2007 with the second group starting in quarter three. Also planned for 2007 is an M.Sc. in Creative Leadership with the Royal College of Surgeons with the support of the other Dublin Academic Teaching Hospitals. Pensions It proved to be a difficult year for the HR function in relation to the provision of a service to our current and former staff regarding the hospitals pension scheme (Voluntary Hospitals Superannuation Scheme). There have been a number of recent changes to the scheme, most significant of which was the opening up of access for all part time staff into the scheme. At the end of 2006 there was in excess of 2,600 hospital staff in the scheme. In the latter part of 2006 planning was in place for the re-configuration of the service and the development dedicated Benefits Unit of the HR function. By year-end efforts were well underway to source a Benefits Manager for the area. Return to contents Annual Review 2006 238 Service Department Medical Records / Patient Services Staffing After over 31 years of service Claire Mc Cowan retired on January 6th. Claire’s support and dedication to the hospital and the Cardiology team, with whom she worked for many years, is greatly missed. Ann Mc Kevitt retired on the 28th July after 161/2 years working in the Emergency Department. Ann provided a caring and professional front line reception service and was involved with many changes to the department over the years. Ann is missed very much by her colleagues. The following Grade V appointments were made in 2006: Georgina O’Reilly, Unit Supervisor, Respiratory Louise Bradbury, Unit Supervisor, Urology Throughout the year there were several new Grade IV and Grade III posts approved in conjunction with the development of services within the new building. Recruitment to fill these positions, along with normal vacancies, was on going. These developments opened up several promotional opportunities for staff in the hospital. Service Developments / Activities The move of outpatient clinics into the new Ambulatory Day Care Centre commenced early in March and continued throughout the entire year of 2006. The impact this had on our staff was noteworthy bringing significant changes & challenges for the Outpatient Reception staff and Clinic Secretaries in the Medical Records Filing Room. The monumental task of rescheduling all of the existing clinics which included rebooking & notifying nearly 100,000 patients was brilliantly led by Bernadette Howard who was assisted by her team. The willingness and hard work of all the staff was greatly appreciated. We are now able to provide a more personalised service to our patients in the ADCC and look forward to improving on the changed processes in the coming year. The Bone & Joint Unit opened in the ADCC in August. In conjunction with this was a complete reorganisation of the secretarial / administrative support – to allow for a more streamlined service driven by better utilization of skill mix. Mary White, Grade V Officer, is responsible for the Registration/ Appointments team and Jenni Cross, Grade V Officer, for the Secretarial team. The development of Dermatology Services at SVUH commenced on November 1st 2006 with the transfer of patients from Hume Street Hospital. We are happy to welcome Caroline Lehane, Grade V Officer, who joined our team coming from Hume Street. Another significant change in our services involved the formation of a 7-day roster along with a longer working day for the Intensive Care Unit reception staff on its move to the new building. Marge Larkin and Catherine Reynolds were new recruits to SVUH late in the year and joined up with Mary Carney to form the team responsible for the roster coverage. The new Endoscopy/Gastroenterology Unit opened on 25th September. The secretarial / administrative support for this unit was greatly enhanced as a result of reorganisation of services. Rosemary Byrne transferred into the new Endoscopy role and joined her colleague, Georgina O’Neill, to provide a more comprehensive secretarial support to the multidisciplinary team and patients attending this service. Medical Records / Filing Room – refurbishment work on the old pharmacy was completed and opened as an extension to the main filing room in April. The reorganisation of the filing room space and transfer of charts was orchestrated by a large group of hard-working and dedicated Medical Records staff led by their Supervisor, Ekundayo Badmus. Phase 2 of this project will take place early in 2007. A big thanks to Technical Services for the long awaited refurbishment. Return to contents St. Vincent’s Healthcare Group Limited 239 Service Department Purchasing & Procurement Department Activity & Service Developments 2002 2003 2004 2005 2006 Total Purchase Orders 18,783 17,166 18,217 20,137 21,186 Total Value €21,787,514 €23,943,843 €29,857,219 €44,783,265 €55,616542 (Note : Includes Project Office Procurement for New Hospital Development) Top Up System In December Stock Management rolled out the Top Up system into ICU. It is estimated that in 2007 consumable purchases will be reduced by €70k in the coming year. Medical Gas Supplies Overall in 2006 demand for Medical Gas increased by 12% due mainly to increased activity in the new Hospital building. A new gas storage facility was built in the waste marshalling yard. This purpose built facility gives improved access to all users. Savings 2004 €204,000 2005 €460,730 2006 €550,710 Custom Procedure Trays In July 2006 a phased introduction of Theatre Custom Procedure Trays began. By year end sixteen different packs had been introduced saving up to one hour pre op consumable activity. Procurement During 2006, the Purchasing & Procurement Department raised over 20,000 Purchase Orders, representing purchase of equipment and supplies to a value in excess of €40million. All tenders for the procurement of goods, services and capital equipment are tendered using the Irish Government “e-tenders” procurement portal, which has proved to be extremely efficient. This is an on-line system that allows all tender documents to be uploaded to the site from which suppliers may download them. And eliminates the need to send out Tender Packages. This facility also caters for European Tenders via OJEU website. The department also took part in joint tendering procedures with the Hospital Procurement Services Group. This allowed us to exploit many volume discounts and covered a wide range of product categories and secured contract pricing for the coming years. Return to contents Annual Review 2006 240 Purchasing & Procurement Department While activity increased for the Purchasing Department with the opening of the new clinical building, staff coped well in dealing with the increased workload. The buying team continued to achieve best value for money for goods within their remit through negotiating discounts with vendors in conjunction with their colleagues in Stock Management. Main Stores The Main Stores continues to deal with the increasing volumes of supplies coming into the hospital due to the expansion of the organisation and increases in activity levels. The main challenge this year was the incorporation of the clinical services building into our schedule and providing a service to all of the new departments. We hope to roll out the on-line requisitioning system which will provide advantages for both the supplies department and user departments. We continue to prepare for the eventual move of CSSD over to the main hospital campus. C.S.S.D In 2006 CSSD introduced a real time e-mail ordering system. This replaced the daily collection of manually generated orders from end users within the main hospital campus. With existing resources CSSD has managed to maintain its level of service even though the average number of trolleys delivered on a daily basis has increased from six to nine. New Developments 2007 A roll out of the Theatre Top Up system is planned but this is dependant on additional staff. Investigate further system developments to reduce the time needed to maintain Integra data. Such as new item creation. Return to contents St. Vincent’s Healthcare Group Limited 241 Service Department Technical Services Department Introduction With the introduction of new regulations and codes , 2006 was a challenging year for the Technical Services Department, there were four major key areas within the group which the department was strongly involved. • The new development • Maintain existing plant & equipment • Minor Capital works Projects • Energy & Utility Management New Development Due to the amount, complexity and cost of building services in the new development , Systematic inspections and routine maintenance were devised to ensure continuity of good service and economy of resources. The new maintenance schedules were planned using the manufactures specifications with O&M manuals. As most of the equipment was on a first year schedule, isolation and hazards had to be identified to ensure continuous support to the hospital. All plant was identified and ranked to see how the plant could fail and the risk of such a failure to the hospital, all planned preventative maintenance was planned to avoid disruption to the activities of the various areas it covered, i.e. chillers were maintained in off peak hours The new clinical Research Centre (Genome Building) also came on stream in 2006 which involved the interaction with UCD staff. The process of integrating the new developments into the campus has been a demanding, challenging and interesting and look forward to 2007 when the operating Theatres will come on stream and give full occupancy to the new clinical services building. Minor Capital Works Projects Within the Technical Services Department , the Minor Capital Works Project Team completed a substantial number of new projects with the combination of in-house technical services staff and outside contractors. A summary of the major projects are listed as follows. • Mortuary Embalming Room constructed with new AHU and ventilation exhaust system • Window replacement included Ward isolation cubicles and ancillary areas • Chapel lighting and cameras were upgraded to allow improved viewing for the patients • The old triage room was converted in the Emergency Dept • Library facilities were upgrade in the ERC building. • St Camillus showers were improved to allow easier access. • Installation of HALOX system in the new clinical services building to reduce the risk of legionella. • Office upgrades were completed around the campus. • The old pharmacy was refurbished as file storage space for medical records. • A new TV distribution system was installed in the ward block to allow for an in-house TV data information channel. • Many improvements were completed for the catering Department in the main kitchen including new flooring, and window replacement. Planned & Reactive Maintenance The day-to-day operational maintenance continued within the department, The PEMAC online helpdesk received a record number of requests, which included carpentry, electrical, grounds/gardening, flooring, painting, plumbing, and telephone repairs. All reactive maintenance was prioritised to achieve a quicker and more streamlined response. With the help of our online helpdesk all calls can now be logged & tracked electronically to allow for more positive feedback. Return to contents Annual Review 2006 242 Technical Services Department Planned preventative maintenance programmes were implemented for the engineering plant and building services to eliminate failure and break downs, a brief outline as follows. • Medical Gas Pipeline Systems • Uninterruptible Power Supplies • Emergency Generators • Nurse Call Systems • Emergency Lighting • Fire Alarm System • Fire Suppression Systems • AHU’s & Air Conditioning • Water Chillers • Cleanroom Validation • Boiler Maintenance Energy & Utility Management Energy & utility management continued in 2006, Operating data recorded through a Building Management system was monitored and corrective action was initiated to ensure an efficient energy usage policy. Areas were identified for control upgrades which will allow for more automated control and decreases energy expenses. Water management continued with the sampling and testing of various areas on the campus to ensure the services comply with the relevant standards and decrease the risk of legionella. Due to the new development all utilities usage increased notably the electrical load which is monitored on a daily basis, current readings for the site are 450,000 litres Daily water usage and 2.4 KWT Max Demand Electrical load. Departures & New Appointments Finally in 2006, saw the departure of Mr. Pat McDonnell Technical Services Manager who left to take up a post at Trinity College, Mr. Richard Leonard completed his carpentry apprenticeship, we wish them lots of success in the future. Mr. Alan Smith, plumber retired after a long standing service with Technical Services – we wish him a long, healthy and happy retirement. Also we would like to welcome Anthony Kavanagh, plumber, Gordon Smith plumber, Albert Taylor General operative , Kieran O’Connor , carpenter, John O Neill carpenter, Bernard Groves apprentice electrician, and Michael Ward apprentice painter to the Department. Return to contents St. Vincent’s Healthcare Group Limited 243 Service Department Hospital Sterile Services Department - HSSD Activities In February 2006 the service moved to new state of the art facilities on the 4th Floor of the new Clinical Services Building. As part of the planning for the move the department changed its name from Theatre Sterile Services Unit (TSSU) to Hospital Sterile Services Department to reflect the hospital wide service provided. Despite the logistical difficulties of providing a comprehensive service to our biggest customer – the Operating Theatres, in another building, all the staff that had worked in the previous cramped conditions hugely welcomed the move. The National Hospitals Office has undertaken a national review of standards and practices for decontamination of reusable invasive medical devices in all public acute hospitals. The aim of the review is to improve practice and develop national standards for the provision of this critical service. The review is to be carried out by an independent company, Healthcare Science Ltd., who have vast experience in this field, having previously carried out a similar review for the NHS in England and Scotland. The HSSD manager, Ms Ita Balfe, is the ‘link person’ between the NHO and the hospital, to facilitate a comprehensive consultation process throughout the organisation. Education Ita Balfe attended the annual European Forum for Hospital Sterile Supply in Lilliehammer Sweden in May, and was accompanied to the IASSM annual conference in Malahide by several members of the HSSD team. Stephen Newman and Sinead Moran commenced the Fetac Skills programme Level 6 Programme for supervisors and will graduate in May 2007. Staffing Sinead Moran joined the HSSD team as supervisor and Brian O’Leary replaced David McCleery who left us this year, as Team Leader. Michelle Rankin, Team Leader had a beautiful baby boy in September and Maribel Franco was appointed to Acting Team Leader in her absence. Statistics 2006 saw further increases in activity levels for reprocessing medical devices in HSSD. This is mainly due to an increase in interventional procedures in Radiologyand the move of the Dermatology Service from Hume St. to SVUH. Return to contents Annual Review 2006 244 Service Department Hospital Hygiene Services St. Vincent’s University Hospital is committed to consistently providing a clean and safe environment for patients, visitors, staff and members of the general public as well as continually improving cleanliness standards. In 2006, St. Vincent’s University Hospital participated in two National Hygiene Audits. As a result of these audits, a Hospital Hygiene Quality Improvement Group was established in August 2006 chaired by the Director of Nursing to address the findings of the hygiene audit and to foster a multidisciplinary approach to continually improving hygiene standards. In November 2006, The Irish Health Services Accreditation Board launched the new Hygiene Services Assessment Accreditation Scheme. This replaces the existing HSE National Hygiene Audit and is achieved through selfassessment and peer review. Eight members of the Hospital Hygiene Quality Improvement Group attended the Irish Health Services Accreditation Board Hygiene Assessment Scheme Training in November 2006. The new scheme will commence in January 2007. Ms. Margaret Boland Assistant Director of Nursing and Ms. Alison Maguinness Clinical Nurse Specialist Infection Prevention and Control have been selected to join the national team of surveyors and will conduct surveys in other hospitals in 2007. St. Vincent’s University Hospital continued its partnership with Noonan Services Contract Cleaning Limited. The opening of the New Clinical Services Building in late 2005 resulted in the ongoing review of the cleaning specifications for the whole hospital. The Infection Control team continued a hospital-wide education and training programme. The Infection Control Liaison Nurse Programmes continued in February 2006 and were extended to include Healthcare Assistants and Allied Health Professionals. A Waste Management Policy was drafted in 2006 and training was completed by the Head and Deputy Head of Portering. The Waste Marshalling Yard was commissioned in 2006. An organisational programme for the cleaning of vents and fans and window cleaning was also carried out. The General Services Team continued ‘Walkabout Surveys’ with key stakeholders throughout the year resulting in a programme of minor capital works. The refurbishment of linen rooms in all clinical areas was undertaken to improve storage, and access to clean linen. Colour coding of linen was introduced in line with national standards. A number of standard operating procedures were developed and a decontamination record sheet was introduced for decontamination of all patient equipment in the clinical environment. The first Hygiene Services Annual Report was published and it summarises the activities carried out by the Hospital Hygiene Quality Improvement Group within St. Vincent’s University Hospital during 2006 and is available on the Hospital Intranet site. Return to contents St. Vincent’s Healthcare Group Limited 245 2006 Healthcare Group Committees Board of Directors Group Executive Members Members Finance Committee Membership Professor Noel Whelan (Chairman) Mr. N. C. Jermyn, (Chairman) Mr. Conor Sexton, (Chairman), Director Mr. Nicholas C. Jermyn (Group Chief Executive) Mr. Ken Bale, Ms. Louise English, Director Dr. Brian Maurer (Retired 25th September 2006) Ms. Mary Duff, Dr. Michael Somers Dr. Risteárd Ó Laoide Mr. Conor Sexton Mr. Edmond J. Bergin Mr. Joe Leyden Mr. Michael Meagher Mr. Patrick Meade Mr. William Quinlan Ms. Gemma McCrohan Ms. Louise English Professor Diarmuid O’Donoghue (Appointed 1st October 2006) Professor M. X. FitzGerald Sr. Anne MacEneaney Sr. Eugene Butler Ms. June Stanley, Mr. Cormac Maloney, Mr. Dermot Cullinan, Dr. Risteárd Ó Laoide, Mr. John McPhillips Mr. Michael Redmond, Mr. James Crowe, Dr. Risteard O’Laoide, Director Mr. Nicky Jermyn, Group CEO, Director Mr. Patrick Meade, Director Prof. Diarmuid O’Donoghue, Director. Mr. Peter Sheehan, Mr. Neil Twomey, In Attendance Professor Diarmuid O’Donoghue, Dr. Michael Redmond, CEO, SVPH Ms. Josephine Barrett Ms. Therese Carey, Mr. Ian Maguire, Ms. Seamus Murtagh, Mr. Cormac Maloney, Financial Controller, SVUH Mr. Eamonn Fitzgerald, Group Deputy CEO Mr. James Crowe, Financial Controller, SVPH Mr. James Hussey, Management Accountant, SVUH In Attendance Mr. Cormac Maloney, Financial Controller & Company Secretary Mr. Eamon Fitzgerald, Group Deputy CEO Mr. Michael Redmond, Chief Executive, SVPH Mr. Ken Bale, Financial Controller, SMH Mr. Seamus Murtagh, CEO, SMH Ms. June Stanley, Group Internal Auditor Ms. Mary Duff, Director of Nursing Sr. Thersese Culhane, Director of Mission. Return to contents Annual Review 2006 246 2006 Healthcare Group Committees Audit Committee Membership Group Medical Executive Committee Dr. Michael Somers, (Chairman), Director Dr Risteárd ÓLaoide Mr. Conor Sexton, Director. Honorary Secretary: Mr. Michael Meagher, Director. Dr. Ken McDonald. Mr. Nicky Jermyn, Group CEO, Director. Chairman: Members: Mr. Patrick Meade, Director. Dr Tom Crotty Chairman Department of Pathology In Attendance Dr Seamas Donnelly Rep Academic Department UCD School of Medicine Mr. Cormac Maloney, Financial Controller, SVUH. Mr. Eamonn Fitzgerald, Deputy Group CEO Mr. James Crowe, Financial Controller, SVPH. Mr. Ken Bale, Financial Controller, SMH. Mr. Michael Redmond, CEO, SVPH. Mr. Seamus Murtagh, CEO, SMH. Ms. Aideen O’Riordan, Financial Accountant, SVUH. Ms. June Stanley, Group Internal Auditor Ms. Margaret O’Donnell Elective Representative Dr. Doug Veale Elected Representative Mr. John Ryan Elected Representative Ms. Mary Barry Chairperson South Eastern Dublin Division Surgery Professor Kevin Malone Department of Psychiatry Professor Niall O’Higgins Chair of Surgery Dr. Hugh Mulcahy Chairman Physicians Sub Committee Dr Declan O’Keeffe Chairman Division of Anaesthesia Dr Stephen Skehan Chairman Division of Radiology Mr. Donal Maguire Chairman St Michael Hospital, Forum Mr. Enda McDermott Chairman Oncology Sub Committee Dr. Brian Maurer Chairman SVPH Forum (Retired 5/6/06) Dr. Diarmuid O’Donoghue Chairman SVPH Forum June – Dec Return to contents St. Vincent’s Healthcare Group Limited 247 2006 Healthcare Group Committees Mission Committee Project Team Chairperson Chairman Sr Eugene Butler Board of Directors Mr. Nicholas C. Jermyn, Group Chief Executive Secretary Members Ms Theresa Ward Pathology Mr Eamonn Fitzgerald, Deputy Chief Executive (Sept 2006) Ms Gemma McCrohan Board of Directors Mr Nicholas Jermyn Group Chief Executive Sr M Angela Director of Mission Rev Ted Ardis Church of Ireland Chaplain Mr Ekundayo Badmus Medical Records Ms Barbara Cantwell Medical Student Co-ordinator Dr Michael Casey Principal Physicist, Nuclear Medicine Ms Sarah Cusack CNM 1 Theatre Ms Phil Pyne Daly Psychotherapist, Cardiac Unit Ms Siobhan Devane Catering Supervisor Mr Sean Dudeney Consultant Orthopaedic Surgeon Mr. Gary Wright, Boyd Creed Sweett Mr. Paul Marlow, Director, Boyd, Creed, Sweett Mr. Peter Kerruish, Director, Boyd Creed Sweett Sr. Anne MacEneaney, Sister Superior Ms. Mary Duff Director of Nursing Mr Pat McDonnell, Technical Services Manager Sept 2006) Mr. Peter Mortell, Technical Services Manager Dr. Risteárd ÓLaoide, Chairman, Medical Executive Dr. Lynda Fenelon, Consultant Microbiologist Professor Diarmuid O’Donoghue, Consultant Gastroenterologist Dr. Mary Barry, Consultant Vascular Surgeon, Chairperson Division of Surgery Mr. Justin Geoghegan, Consultant General Surgeon Mr. William R. Quinlan, Consultant Orthopaedic Surgeon Mr. Wilf Higgins, Engineering Advisor, Department of Health & Children Mr. Paul de Freine, Deputy Chief Architectural Advisor, Department of Health & Children Mr. Terry Woulfe-Flanagan, Principal Quantity Surveyor, Department of Health & Children Mr. Brendan McGrath, Structural Engineering Advisor, Department of Health & Children Ms. Louise McMahon, Network Manager, HSE. Health Promotion Committee Ms Nicola Geoghegan Secretary to General Manager, St Michael’s Hospital Chairman Mr John Harraghy Human Resources Secretary Dr. Diarmuid O’Shea Ms. Denise Comerford Sr Margaret Hilliard Chaplaincy Department, St Michael’s Hospital Members Ms. Margaret Boland Ms. Catherine Toole Ms Tanya King Assistant Director of Nursing Dr. Anna Clarke Ms. Ann O’Reilly Ms. Margaret Doyle (to Nov. 06) Ms. Orla Seale Ms. Elaine Hammond Ms. Eilish McGovern Ms. Peggy Lowry Ms. Katie Wedgeworth Dr Diarmuid O’Shea Consultant in Geriatric Medicine Ms Sheila O’Toole Clinical Nurse Specialist Ms. Mary Shore Ms. Barbara Murray Return to contents Annual Review 2006 248 2006 Healthcare Group Committees Ethics & Medical Research Committee Health & Safety Committee Chairman Dr. D. Veale Mary Shore (From Oct 2006) Deputy Chairman Eamonn Fitzgerald (To Sept 2006) Chairperson Dr. M. Moriarty Members Alternate Chairman Dr. K. Crowley Mr Larry Clancy (To Sept 2006) Ms Regina Rooney Expert Members Dr Kieran Sheahan Dr Dermot Malone Mr Eamonn Fitzgerald Ms June O’Shea Dr Eoin Tiernan Ms Tanya King Dr John Ryan Mr. S. Dudeney Co-Opted Member Mr. Michael Redmond Lay Members Mr. Joe Leyden Ms Ciara Murray Ms. Siobhan Reynolds Ms Peter Brady Mr. Leon Newcome Mr. Frank Smith Mr. C. Diamond Ms Niamh McAuliffe (covered for Ms Elizabeth Barry) Ms Eithne Culinan Mr Donal Murphy Ms Liz Barnes Mr Gerry Gorey Ms Emma Curry Mr Peter Mortell (From Sept 2006) Mr. Pat McDonnell (To Sept 2006) Ms Peggy Lowry Mr Pat Gargan Mr Donal Sheeran Dr Lynda Fenelon Ms Theresa Flynn Ms Nuala Gannon Dr Paul Gueret Ms Maragret Brittain Ms Karen Clerkin Mr Jim Mitchell (From Aug 2006) Ms June Stanley (To Oct 2006) In attendance Mr Peter Sheehan SVPH Aon Representative, Typically Colette O’Sullivan Return to contents
