Annual Review - St Vincent`s University Hospital

Transcription

St. Vincent’s Healthcare Group Limited
Review 2006
incorporating
St Vincent's University Hospital
St. Vincent's Private Hospital
and
St. Michael's Hospital
2
3
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
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
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
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
5
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.
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Annual Review 2006
6
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
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7
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.
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Annual Review 2006
8
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.
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9
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.
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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
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Education & Research
Centre
Annual Review 2006
EDUCATION
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RESEARCH CENTRE
Contents
Reviews and Personnel
Review by Medical Director, Education & Research Centre, Dr. Doug Veale
& Director, Research Laboratories, Prof. Cliona O’Farrelly
13
15
16
Research Activities
Bioinformatics and Molecular Evolution Group
Department of Endocrinology & Diabetes Mellitus
Department of Neurology Research in Multiple Sclerosis
17
18
23
24
26
29
30
31
31
32
34
37
38
39
Academic Activities
DMMC/ Conway Institute Immunobiology & Inflammation Course 2006
Lecture Series 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
56
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EDUCATION
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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.
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Annual Review 2006
EDUCATION
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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.
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EDUCATION
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RESEARCH CENTRE
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
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Annual Review 2006
EDUCATION
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RESEARCH CENTRE
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
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Inflammation, Infection and Immunity
Dept. of Rheumatology
Bioinformatics & Molecular Evolution Group
Dept. of Endocrinology & Diabetes Mellitus
Dept. of Neurology Research in Multiple Sclerosis
Cancer
Breast Cancer Research
Suicide and Depression
Dept. of Psychiatry & Mental Health Research
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Annual Review 2006
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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.
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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).
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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.
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(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.
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(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.
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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”
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.
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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.
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”
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
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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.
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Liver Research Group - Liver Transplantation, Malignancy & Hepatitis C
Principal Investigators:
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
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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
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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
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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
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.
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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.
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
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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.
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.
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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).
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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
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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
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
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
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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.
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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.
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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
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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
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RESEARCH CENTRE
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.
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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
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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
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Academic Activities
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.
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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.
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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.
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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
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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.
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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).
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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)
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
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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
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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
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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
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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
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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
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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.
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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
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
/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
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
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EDUCATION
&
RESEARCH CENTRE
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. 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. 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
Functional immunogenomics in the
chicken: relevance to campylobacter
jejuni infection.
Dept. Agriculture
FIRM Grant 2004
€691,286
2004
2007
SFI Research Frontiers
Programme 2005
Role of CD1d isoforms
€229,766
and reactive cells in
regulating immune
responses to malignancy
2005
2008
Dr. Clair Gardiner
HRB Research Project Grant –
General 2005
Investigation of KIR
genotype in the
resolution of HCV
infection
€234,473.6
2005
2008
Genomic instability and severe depression
UCD Seed Funding
€9,000
2006
2007
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
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Annual Review 2006
EDUCATION
&
RESEARCH CENTRE
58
P.I.
Name of Study
Source of
Grant
Fund
Amount
Start
Date
Finish
Date
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
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EDUCATION
&
RESEARCH CENTRE
59
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 &
Brain Imaging Studies in
Suicidal Depression
National Neuroscience
Network
€160,000
2004
2006
Dr. Donal O’Shea/
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
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St Michael’s Hospital
61
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.
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Annual Review 2006
62
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.
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Annual Review 2006
64
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
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65
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St. Vincent’s Private
Hospital
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67
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.
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Annual Review 2006
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.
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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
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Annual Review 2006
70
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
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71
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
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
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Annual Review 2006
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
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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.
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Annual Review 2006
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
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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
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77
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.
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Annual Review 2006
78
• 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.
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79
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
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Annual Review 2006
80
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.
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81
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.
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Annual Review 2006
82
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
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83
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.
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Annual Review 2006
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
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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.
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Annual Review 2006
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
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87
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.
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Annual Review 2006
88
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.
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89
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.
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Annual Review 2006
90
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.
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91
• 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
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Annual Review 2006
92
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 Manager
Diagnostic Imaging
I
Radiotherapy
Pharmacy
Dietetics
Cardiology
Medical Social Worker
Physiotherapy
Pulmonary Laboratory
Other Allied Health Services
Medical Physics
Finance Division
Financial Controller
Patients Accounts
Debtors Accounts
Creditors
Salaries
Materials Manager
Management Accounts
Support Services Manager
Deputy S
Services Manager
Reception
Catering
Coffee Shop
Housekeeping
Cleaning
Maintenance
Security
Grounds
Corporate Services
Head of Corporate Services
Risk Management
Information Technology
Accreditation
Statistics
Patient Complaints
HIPE
Capital Projects
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Departmental Review
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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
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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
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Annual Review 2006
96
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.
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97
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.
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Annual Review 2006
98
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%
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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
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Annual Review 2006
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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
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101
Departmental Review
BONE & JOINT UNIT
Staff
Consultant Staff
Professor Barry Bresnihan
Professor Oliver FitzGerald
Dr Douglas Veale
Dr Orla Killeen
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.
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Annual Review 2006
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• 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
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BONE
•
•
•
•
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103
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)
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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.
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Annual Review 2006
BONE
&
JOINT UNIT
106
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
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107
Departmental Review
BONE & JOINT UNIT
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.
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Annual Review 2006
BONE
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JOINT UNIT
108
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.
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109
Departmental Review
BONE & JOINT UNIT
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.
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Annual Review 2006
BONE
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JOINT UNIT
110
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
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111
Departmental Review
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.
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Annual Review 2006
112
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
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113
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
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Annual Review 2006
114
Departmental Review
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.
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115
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.
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Annual Review 2006
116
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
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117
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.
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Annual Review 2006
118
Departmental Review
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
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.
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119
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
Contact Dermatitis course, London
Consultants’ Update course, London
Dr Kirby
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.
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Annual Review 2006
120
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
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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.
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122
Departmental Review
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
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123
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
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
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.
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Annual Review 2006
124
Departmental Review
Department of Endocrinology and
Diabetes Mellitus
Staff
Consultants:
Lecturers:
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
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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.
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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.
(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.
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127
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.
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Annual Review 2006
128
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.
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129
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.
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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.
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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
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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.
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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
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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
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:
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
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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.
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Annual Review 2006
136
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.
1. PI
Co-applicants:
Name of study:
Source of grant:
Found amount:
Start Date:
Finish Date:
Kieran Sheahan & Diarmuid O’Donoghue
Role of genomic instability in promoting colorectal cancer development in Ulcerative Colitis
€185,000
October 2004
October 2007
2. PI
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:
Major Depression & Genomic Instability
UCD Seed Funding
€9,000
May 2006
May 2007
4. PI
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
Start Date:
Dec 2006
Finish Date:
Dec 2008
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137
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
€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
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
Start Date:
July 2006
Finish Date:
July 2008
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Annual Review 2006
138
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.
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139
Departmental Review
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
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
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.
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Annual Review 2006
140
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.
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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
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Annual Review 2006
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Departmental Review
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.
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.
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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
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Departmental Review
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
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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.
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146
Departmental Review
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.
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).
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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.
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Annual Review 2006
148
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.
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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
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Annual Review 2006
150
Departmental Review
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.
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Annual Review 2006
152
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
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153
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.
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Annual Review 2006
154
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
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155
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
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Annual Review 2006
156
Departmental Review
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.
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157
Departmental Review
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
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Annual Review 2006
158
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
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159
Departmental Review
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.
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-
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Annual Review 2006
160
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.
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.
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161
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
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
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Annual Review 2006
162
Departmental Review
Department of Palliative Medicine Staff
Consultant
Dr Eoin Tiernan
Ms Millie Devenish
Ms Siobhan Hollingsworth
Ms. Carmel Houlihan (ST. VINCENT’S PRIVATE)
Olga Price
Ms Barbara Whyte
Care of the Dying Project
Facilitator
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.
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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
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.
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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.
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%.
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
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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.
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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
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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.
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Departmental Review
Department of Psychiatry and
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.
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
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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.
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Departmental Review
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.
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.
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Annual Review 2006
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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.
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173
Departmental Review
Radiology Management Team
Clinical Director of Radiology
Dr Conor Collins
Radiography Service Manager
Sharon Simpson
Clerical Supervisor Grade VI Officer
Helen O’Reilly
Sara Nicholson
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.
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Annual Review 2006
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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.
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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.
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Annual Review 2006
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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.
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%
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177
Departmental Review
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
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.
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Annual Review 2006
178
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.
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179
Departmental Review
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
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.
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Annual Review 2006
180
• 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.
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.
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181
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
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Annual Review 2006
182
Departmental Review
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
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
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183
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.
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)
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Annual Review 2006
184
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.
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185
Departmental Review
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.
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Annual Review 2006
186
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
Ronan Cahill won the 2006 Bennett Lecture Award for Senior Registrars
Published Papers
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
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187
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
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189
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.
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Annual Review 2006
190
• 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.
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191
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.
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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.
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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
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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.
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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
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196
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.
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.
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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.
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Library & Information Services Department
Library & Information Services Committee
The Committee met 6 times this year and was chaired by Professor Aongus Curran.
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.
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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
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Medical Physics and Clinical Engineering Department
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
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.
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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
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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.
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.
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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.
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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.
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.
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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.
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.
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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.
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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.
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.
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Annual Review 2006
208
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.
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
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209
‘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
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Annual Review 2006
210
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.
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211
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.
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Annual Review 2006
212
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.
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213
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.
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.
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Annual Review 2006
214
Pharmacy Department
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.
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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.
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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
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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.
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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.
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219
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.
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.
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Annual Review 2006
220
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
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221
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
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Annual Review 2006
222
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)
MSC, DIP DIET.
Ms. Brenda Whiteside
(Clinical Specialist Dietitian)
RGN, RM
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.
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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
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Annual Review 2006
224
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
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225
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.
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.
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226
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.
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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
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Annual Review 2006
228
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
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229
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).
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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.
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.
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232
Catering Department
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.
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Service 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.
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234
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.
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Service 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
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Annual Review 2006
236
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
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237
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.
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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.
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.
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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.
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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.
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Service 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.
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Annual Review 2006
242
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.
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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.
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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.
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245
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.
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Annual Review 2006
246
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
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247
Mission Committee
Project Team
Chairperson
Chairman
Sr Eugene Butler
Board of Directors
Mr. Nicholas C. Jermyn,
Secretary
Members
Ms Theresa Ward
Pathology
Mr Eamonn Fitzgerald,
Deputy Chief Executive (Sept 2006)
Ms Gemma McCrohan
Board of Directors
Mr Nicholas Jermyn
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,
Mr. Brendan McGrath,
Structural Engineering Advisor,
Ms. Louise McMahon,
Network Manager, HSE.
Health Promotion Committee
Ms Nicola Geoghegan
Secretary to General Manager,
Chairman
Mr John Harraghy
Human Resources
Secretary
Dr. Diarmuid O’Shea
Ms. Denise Comerford
Sr Margaret Hilliard
Chaplaincy Department,
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
Ms. Mary Shore
Ms. Barbara Murray
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Annual Review 2006
248
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

Annual Review - St Vincent`s University Hospital

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