Annual Review - St Vincent`s University Hospital

Transcription

St. Vincent’s Healthcare Group Limited - Annual Review 2008
Mission Statement
St. Vincent’s Healthcare Group Limited
St. Vincent’s University Hospital
St. Michael’s Hospital Dun Laoghaire
St. Vincent’s Private Hospital
The values underlying the philosophy of St Vincent’s Healthcare Group in relation to our care
of patients and staff are those of human dignity, compassion, justice, quality and advocacy,
which are based on the mission and philosophy of the Religious Sisters of
Charity, our shareholders.
We strive to maintain excellence in clinical care, education
and research.
We will continue to develop the Healthcare Group in line with the above
principles and with our responsibilities to the wider Irish healthcare system.
Contents
Reports
•
Human Resources
60
Mission & Values Committee
6
•
Nursing
60
Ethics and Medical Research
7
•
Quality & Risk Department
61
Report from Clinical Audit Department
8
•
Chaplaincy
61
•
St. Michael’s Hospital Organisation Structure
62
Education and Research Centre
9 - 56
63 - 94
•
Reviews and Personnel
11 - 14
•
Research Activities
15 - 39
•
St. Vincent’s Private Hospital Report
•
Postgraduate Department
40 - 42
•
Consultant’s Forum
•
Translational Research Seminars 2007/08
43
•
Corporate Services Division
67 - 69
•
Academic Activities
44 - 46
•
Nursing Division
70 - 73
•
Publications
47 - 51
•
Human Resources Division
74 - 76
•
Grants Active
52 - 56
•
Support Services Division
77 - 82
•
Finance Division
•
Allied Health Division
•
St. Vincent's Private Hospital Organisation Structure
St. Michael’s Hospital
57 - 62
64 - 65
66
83
84 - 93
94
•
St. Michael’s Hospital Report
58
•
Radiology
59
•
Pharmacy
59
•
I.C.T
59
•
Library
59
Report from Chaplaincy/ Pastoral Care Department
100
•
Laboratory
60
Report from Library and Information Service
102
Report from Medical Records
106
Reports from the Director of Operations
95 - 262
96
Contents
Allied Health Professionals and Support Services
Reports from the Professor of Medicine
Report from the Professor of Medicine
141 - 194
142
Medical Physics and Clinical Engineering Department
108
Medical Social Work Department
110
Department of Nutrition and Dietetics
113
Department of Anaesthesia, Intensive Care and Pain Medicine
144
Occupational Health (OH) Department
116
Department of Cardiology
150
Occupational Therapy Department
118
Department of Dermatology
152
Pharmacy Department
120
Department of Endocrinology and Diabetes Mellitus
154
Physiotherapy Department
125
Department of Medical Oncology incorporating
Preventive Medicine and Health Promotion Department
128
Lios Aoibhinn Cancer Support Centre
159
Speech and Language Therapy Department
131
Department of Medicine for the Elderly
162
Department of Nephrology
165
Department of Neurology
166
Department of Clinical Neurophysiology
170
Department of Palliative Medicine
171
Department of Respiratory Medicine
174
Bone & Joint Unit
176
Department of Rheumatology
183
Department of Rehabilitation Medicine
193
Reports from the Director of Nursing
4
107 - 133
134
Director of Nursing Report
135
Bed Management
138
Hospital Sterile Services Department
139
Hospital Hygiene Services
140
Report from the Chairman Physicians Subgroup
143
Contents
Reports from the Professor of Surgery
Professor of Surgery Report
195 - 230
Reports from the General Services Manager
231 - 258
196
Reports from the General Services Manager
232
199
Department of Catering
235
Liver Transplant Programme and Liver Unit
200
Department of Fire Safety
236
Department of Ophthalmology
201
Department of Household Services & Cleaning
237
Operating Theatre Department
203
Department of Portering Services
238
Department of Orthopaedics and Traumatology
205
Department of Security
239
Department of Plastic Surgery
208
Department of Technical Services
240
Department of Urology
209
Department of Telecommunications
242
Department of Vascular Surgery
213
Reports from the Chairman of the Surgical Subgroup
Department of Medical and Surgical Gastroenterology
244
incorporating the Centre for Colorectal Disease
215
Reports from Information and Communication Technology Department
250
Report from the Emergency Department
219
Report from Purchasing and Procurement Department
254
Report from the Pathology Department and Laboratory Medicine
222
Report from the Quality, Risk and Consumer Affairs Department
256
Report from the Radiology Department
225
Report from the Clinical Director of Psychiatry
228
Department of Old Age Psychiatry
5
Report from the Human Resources Department
229
2007 Healthcare Group Committees
259
Mission & Values Committee
As we face the many challenges today that are
presented to the hospital group, we maintain the
philosophy of caring which is the very essence of our
mission.
A mission component was also included as part of the
Hospital’s new Corporate Induction Programme which
was launched in March 2008. This introduces new
employees to the Mission and Values in their first few
days in the organisation.
Long Service Awards
Accreditation
Hospital Choir
In preparation for accreditation, quality standards based
on evidence in relation to Mission Integration were
developed and prepared. We continue to liaise with the
Quality, Risk and Consumer Affairs Department to
ensure we are meeting all standards.
The Choir performed in a wonderful and professional
way at all our important celebrations and the Christmas
Carol Service in Stephen’s Green. Staff provided the
music playing - organ, violin, flute & viola. A wonderful
selection of both carols and music was also performed
for staff and patients for the Christmas season. Lunch
breaks were given over to practice and recitals took
place in the Atrium with excellent acoustics. It is indeed
an event worthy of note in this report. Thanks to all
who were so generous with their time and talents.
Long service awards will be presented to staff from the
three hospitals on 23rd January 2009. This is always a
great celebration for the staff and management of the
Group.
Mission Committee
Our thanks to all the members who gave so generously
of their time and shared their creative ideas in seeking
ways to promote the mission. The committee met
every two months and is an integral part of our
organisation’s success.
Mission Education Programmes
Units 1 & 2 of the Mission Effectiveness Programmes
were held on a regular basis throughout the year, all
departments were represented with a total of 208 in
attendance.
It was evident from the responses from the groups that
there was strong support for the mission and efforts
made in all areas to integrate the values.
Feedback was collated and presented at the Mission
Committee.
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Celebrations
• There was a great attendance at the Mass celebrating
our Foundation Day on the 23rd January. Many
enjoyed the refreshments and the interactions
afterwards.
• On the 24th of September 2008, at we celebrated a
mass at 5.00pm for our deceased and bereaved staff.
This celebration was much appreciated.
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). In September 2007, the Department of Health
& Children extended our recognition as a designated
committee for a period of one year and in September,
2008 the recognition was extended for a further year
until September 2009.
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. 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.
The committee with the agreement of the Department
of Nursing decided, that nursing studies involving nurse
to nurse, need only be reviewed/approved by the
Department of Nursing. A study may be referred to the
Chairman if the Department deems a particular study
requires the opinion of the committee.
Revised Forms
Research Studies:
The revised clinical trial application form issued by the
DOHC, was adopted for use by the Committee.
Total Research Studies Reviewed
The SVHG Site Specific Assessment Form has been
revised to ensure all/any financial implications for the
hospital are addressed.
Amendments
Committee
Throughout the year there were a number of changes
in committee membership and new members were
duly appointed.
Quarterly/Annual/Termination Reports
Clinical Trials Reviewed:
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and Approved
Total Number of Reports Reviewed and Noted
10
10
Number of New Clinical Trial Proposals Considered:
Number Issued a Favourable Opinion:
SVHG EMRC are the responsible Ethics Committee for
the following:
Pharmaceutical Sponsored Trials
Investigator Led Trials
Pharmaceutical/Investigator Led, External Sites only
Registries
28
11
8
6
53
82
82
Total Number of Clinical Trial Amendments Reviewed
Copies of all application documents are available
electronically and in hard copy from
Ms Joan McDonnell / Ms Anna Brennan,
Ethics Office, ext: 4117
(joan.mcdonnell@ucd.ie).
(anna.brennan@ucd.ie).
Meetings
There were a total of 11 Committee Meetings held
from 1st January 2008 to 31st December 2008.
Total
7
Total Approved
Dr. B. Kirby, Chairman.
97
119
Report from Clinical Audit Department
Clinical Audit has been formally developed and
supported for the third year in a row and the efforts that
the organisation has put into the programme are being
repaid with greater numbers of clinical audits of higher
quality being presented to the Clinical Audit Committee.
The cultural change that fosters clinical audit activity was
never going to be a quick fix intervention and our
experience has proven that sustained support and
encouragement yields the maximum return and reward.
Audits have been registered from many different areas
of clinical practice and the variety of these audits
testifies to the constant and unfailing drive that
individuals and teams have to improving the care that is
provided to patients before, during and after their stay
with us in the hospitals of the group.
There have been some significant external drivers for
advancing the clinical audit agenda – chief amongst
these being the increased awareness of the Health
Information and Quality Authority as an external agent
and the development of our Clinical Governance
Committee internally.
The Healthcare Group has always striven to be best in
class and it is our belief that we are ahead in harnessing
the internal appetite for clinical audit and clinical
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governance. The clinical audit committee gained a new
chairman in Dr Tom Crotty who has brought his insight
and commitment to the development of the clinical
audit agenda. As part of this commitment he has
successfully encouraged several clinical experts to join
the clinical audit committee and with this widened and
multidisciplinary membership, the committee has
overseen the improvement in the quality and output of
individual audits as well as encouraging greater
collaboration across the three hospitals on audits.
A key feature in clinical audit is the completion or
closure of the clinical audit loop. This element can prove
challenging to the individual and to the organisation but
by harnessing the collective strengths of the committee,
we have achieved both obvious and implicit
improvements in-patient care.
A side effect of clinical audit is the sharing of information
on the process or results of individual audits. Several
audits were featured in poster presentations at
international meetings across the globe and more locally
in Ireland. Some of these presentations won awards at
their respective outings.
The organisation continues to grapple with the possibility
of audit data being accessed in an uncontrolled fashion
and used to the detriment of the organisation’s
reputation. While acknowledging the benefits of the
Freedom of Information Act, the possibility of stage one
and two data being circulated publically before the audit
loop has been closed is a worry to all of us. Conversely,
the organisation has been very proactive in publishing
information and completed audit results in poster
format and in our clinical audit newsletter. To date, we
have had nothing but positive feedback on this
approach. The difference between the two perspectives
lies in the timing of information circulation; in the latter
case, the organisation is proactive in publishing both
positive and less than optimal results, when and where
it has identified a plan of action to address the issue.
The clinical audit function looks forward to 2009, with
plans for increasingly proactive audits, audits that span
the three hospitals and audits that address the tenets
of patient centred care. We plan to engage with patients
and carers through a newly formed patient advisory
panel. We see a very significant role for clinical audit in
the run up to the University Hospital and St Michaels
Hospital application for accreditation by the Joint
Commission International. Continued focus on training
and education will see more staff knowing how to
conduct bigger and better audits and ultimately, I have
no doubt but that patient care will be enhanced.
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CONTENTS
Reviews and Personnel
Review by Director of Translational Research,
Dublin Academic Health Care, Prof. Douglas Veale
11
Principal Investigators – 2008
13
Research Laboratories – Personnel 2008
14
• Postgraduate Department
40
• SHO Teaching
40
• International Meeting
41
• Pharmaceutical Representatives
42
• The Library
42
Research Activities
Translational Medicine Research Group
Inflammation, Infection & Immunity
15
Academic Activities
Translational Research Seminars
43
Workshops/Guest Lectures
44
Journal Club/Education & Outreach
45
30
Honours /Awards/Prestigious Invitations
45
• Respiratory Sleep
30
Higher Degrees
46
• Neurology Research in Multiple Sclerosis
31
• Rheumatology
16
• Liver Research
24
• Obesity
29
• Dermatology
Publications
Papers in International Peer Reviewed Journals
Cancer
• Centre for Colorectal Disease Research
35
• Breast Cancer
37
Grants Active
Grants Active in 2008
Suicide & Depression
• Psychiatry & Mental Health Research
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38
47
52
Review by Director of Translational Research, Dublin Academic Health Care,
Prof. Douglas Veale
Dear Colleagues,
challenges both logistic and financial remain, I believe
We have seen another year of unprecedented change,
that we are a much more robust group following this
with very positive developments in clinical and
development. The DAHC development has already
completed successfully the first year of two new PhD
biomedical research activities across the hospitals, the
provided the infrastructure through the UCD CRC to
programmes in Translational Medicine and
Clinical Research Centre (CRC) and the wider campus
provide essential core resources for clinical trials and
Biopharmaceutical / Pharmacological Sciences funded
including:
research studies which has translated into more clinical
through UCD from PRTLI 4. Interestingly, in light of the
trial activity being attracted to the centre.
recent announcement in relation to PRTLI 5 from the
• Dublin Academic Healthcare Centre (DAHC)
established;
• Appointment of DAHC Directors of Translational
Research and Postgraduate Education
• Funding
• Administration
A key element of the research review was to bring
researchers in St. Vincent’s University Hospital (SVUH)
together in a coordinated programme with colleagues
in University College Dublin (UCD). I am pleased to
report with the development of the DAHC, we
established the first academic medical centre in Ireland,
this goal has been realised. While, undoubtedly
Office of the Taoiseach, in relation to joint UCD/Trinity
Translational Research
College Dublin (TCD) funding of Life Sciences research,
In addition, to funding of specific programmes which
a joint proposal to fund two new Arthritis Chairs in
was maintained at a high level last year, there were a
Ireland was agreed, with one based in UCD. I believe
number of new Translational initiatives. A coordinated
this will provide significant benefits to the research
DAHC scientific journal club meeting was established by
community within the DAHC to create new and exciting
Dr. Jacintha O’Sullivan and Dr. Ursula Fearon which
links with colleagues across the country to enhance our
welcomes researchers from The Mater Misericordiae
international competitiveness.
University Hospital (MMUH) and Conway on a regular
basis. We completed our first series of Translational
Development
Research Seminars and are now planning the second
There was a major investment in research equipment
series. This has led to a number of substantial
made in 2008 to fund critical new technology for the
collaborative projects including Colorectal Cancer,
group based in the ERC. This included a new Lightcycler
Obesity, Medicine for the Elderly and Rheumatology to
480 analyser, Flow cytometer, LuminoSkan and
mention but a few. Finally, in 2008 we established and
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Return to ERC Contents
Review by Director of Translational Research, Dublin Academic Health Care,
Prof. Douglas Veale
Fluoresecnt microscope. A major new development is
reviewed journals and 2 higher degrees were awarded.
the new DAHC Biobank which will be situated in the
This could not be achieved without the dedicated
CRC/ ERC, this will be completed in early 2009,
enthusiasm and hard work from each group, as well as
providing an essential resource for researchers across
the exceptional support of the Laboratory Coordinator,
the DAHC.
Dr. Emer Bairead and the administrative team –
Geraldine Lanigan Ryan, Louise McCormack and
Funding
Geraldine Jordan. I am sorry to report that Alan Garton,
PRTLI 4 funding of €4.5 million in total was received
who was an integral part of the ERC decided to leave
and contributed to the establishment of the new PhD
us, however he has progressed his career and we all
programmes including the Translational Medicine and
wish him the very best in the future.
Biopharmaceutical/Pharmacological Sciences
programmes. The Translational Medicine Research
multidisciplinary group including rheumatology,
Conclusion
colorectal and vascular biology group, based at SVUH
There are significant challenges ahead for the DAHC
and the Conway Institute renewed a contract with
research community in 2009/10, especially in the
GlaxoSmithKline of €390k bringing the total of active
current global economic climate, however I believe that
grants in 2008 to more than €14M. This is a major
we are well positioned after the developments of the
achievement and all the staff including principal
past three years to meet these challenges and to
investigators, senior scientists, post-doctoral scientists,
maximise our opportunities in the future.
clinical fellows, post-graduate students and research
assistants should be very proud. The Education and
Research Centre achieved over 60 publications in peer
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PRINCIPAL INVESTIGATORS – 2008
13
Prof. Barry Bresnihan
Dr. Enda McDermott
Prof. Aongus Curran
Prof. T. J. McKenna
Prof. Joe Duffy
Prof. Walter McNicholas
Dr. Ursula Fearon
Dr. Hugh Mulcahy
Prof. Oliver FitzGerald
Prof. Diarmuid O’Donoghue
Prof. Charles Gallagher
Prof. Cliona O’Farrelly
Mr. Justin Geoghegan
Prof. Donal O’Shea
Prof. John Hegarty
Dr. Jacintha O’Sullivan
Prof. Michael Hutchinson
Prof. Kieran Sheahan
Dr. Brian Kirby
Dr. Niall Tubridy
Prof. Kevin Malone
Prof. Doug Veale
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Research Laboratories – Personnel 2008
Senior Scientists &
Post Doctoral Fellows
M.D.’s
Research Assistants
John Garvey
Anna Kwasnik
Jacintha O’Sullivan
Peter Barry
Emma McGrath
Ursula Fearon
Tariq Tajuddin
Jennifer McCormick
Sinead Nic an Altaigh
Orla Young
Miriam Tosetto
Wei Gao
Chin Teck Ng
Owen Sullivan
Edward Fox
Bernadette Lynch
Aisling Pierce
Juliette Sheridan
Eadaoin McKiernan
Ann Marie Tobin
Monika Biniecka
Eliza Pontifex
Emily Collins
Danny Cheriyan
Lydia Lynch
Gavin Rush
Siun Walsh
Garret Cullen
PhD Students (Post Grads)
Aisling Kennedy
Mary Connolly
Sheeona Gorman
Aoife O’Donovan
Ellen Moran
Jannie Michielsen
Conall Dennedy
Eoin Slattery
Joe Marry
Research Nurses
Taj Saber
Blathnaid Nolan
Dave Kevans
Jean O’Connell
Catherine McEvoy
Helen Vaughan
Lisa McGowan
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Research Activities 2008
TRANSLATIONAL MEDICINE RESEARCH GROUP
INFLAMMATION, INFECTION & IMMUNITY
• Rheumatology
• Liver Research
• Obesity
• Dermatology
• Respiratory - Sleep
• Cystic Fibrosis Research
• Neurology Research in Multiple Sclerosis
CANCER
• Centre for Colorectal Disease
• Breast Cancer
SUICIDE & DEPRESSION
• Psychiatry & Mental Health Research
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Research Activities
Research Activities - Rheumatology
Principal Investigators:
Professor Barry Bresnihan
Dr. Ciaran Duffy
Dr. Ursula Fearon (Senior Scientist)
Professor Oliver FitzGerald
Dr. Orla Killeen
Dr. Anne Barbara Mongey
Professor Douglas Veale
Specialist Registrars:
Dr. Lorraine O’Neill
Dr. Ceara Walsh
Registrars
Dr. John Paul Doran
Dr. Clare Kiely
Clinical Research Fellows
Dr. Bernadette Lynch
Dr. Chin Teck Ng
Dr. Taj Saber
Dr. Aizad Mumtaz
Dr. Eliza Pontifex
Dr. Agnes Szentpetery
Post Doctoral Fellow:
Dr. Monika Biniecka
Dr. Wei Gao
Ms Roisin Adams
Dr. Emily Collins
Dr. Sinead NicUltaigh
Research Assistants
Ms Jennifer Mc Cormick
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Graduate Students
Mary Connolly
Ellen Moran
Aisling Kennedy
Educational Activities
Prof. Anne Barbara Mongey is the Director of the Clinical
Skills Laboratory at UCD, responsible for designing and
conducting workshops in clinical skills for the undergraduate and graduate entry medicine programmes. In
addition, Prof. Mongey is involved in the development
of OSCE examinations, including the use of videotaping,
to evaluate clinical skills. Integration of the teaching of
clinical skills into the 1st and 2nd year of the undergraduate medical programme is also part of Prof. Mongey’s
remit as a lecturer in UCD and the development of
videotapes and handbooks for teaching of clinical skills.
Furthermore, Prof. Mongey is the co-ordinator of the
Advanced Clinical Skills module for the Graduate Entry
Medicine programme and co-ordinator for the Elective
module for undergraduate and graduate entry medical
students.
Research Activities
Mr. Owen O’Sullivan
The Translational Medicine research group includes
close links with other active research groups including
the Centre for Colorectal Disease, Diabetes and Obesity,
Liver Immunology and Psychoimmunology on the ERC
site and investigators based in the Conway Institute,
UCD and in TCD. The Rheumatology Research group
includes Principal Investigators - Prof. Douglas Veale, Dr.
Ursula Fearon and Prof Oliver FitzGerald with a primary
clinical focus on early, inflammatory arthritis and a
scientific focus on mechanisms of angiogenesis,
inflammation and joint damage. The group has established
novel models of analysis using serum, synovial fluid,
synovial tissue and cartilage to search for biomarkers of
disease, examine mechanisms of angiogenesis and
hypoxia, novel mediators/cytokines and cartilage
destruction in the study of pathogenesis of arthritis.
The research plan for the next five years is to develop
new expertise and extend national and international
collaborations to elucidate predictors of response to
therapy, predictors of remission and to examine the
mechanisms of disease. A major step has been achieved
in this regard with the proposal to create a new Centre
for Rheumatological Diseases incorporating clinical and
scientific researchers from UCD and TCD. This initiative
supported by the two universities, Arthritis Ireland and
the Health Service Executive (HSE) has established two
Chairs in Rheumatology.
Research Activities
We have in 2008 commenced a major state-of–the-art
clinical research programme based around UCD CRC
bringing together investigators across the newly formed
Dublin Academic Health Centre. This has included a
DAHC coordinated Research Journal Club, a DAHC
Seminar Series for Translational Research. In support of
this there have been a number of developments
including the appointment of key personnel – Data
coordinator, Laboratory Manager, in addition to
establishing a new UCD CRC Biobank.
Further progress has been made in relation to novel
imaging studies with the first concomitant studies of
PET/CT and MRI in patients with arthritis.
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. She 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. She also demonstrated that Rituximab may
effect depletion of macrophages in the joint suggesting
that synovial B cells precedes a decrease in local
inflammation leading to clinical improvement. Ceara is
currently writing up her PhD thesis.
Biomarkers and predictors of disease
Specific ongoing projects
Remission study and Rituximab therapy for resistant
arthritis
Dr Ceara Walsh finished her research in July 2007
under the supervision of Prof. Barry Bresnihan and Dr
Ursula Fearon. Dr Walsh’s research involved (i) to
identify predictive markers of relapse and identify a
genetic profile associated with relapse (ii) to examine
the effect of Rituximab in-patient’s resistant to anti-TNFα
therapy, (iii) to examine the presence of latent TB in
patients receiving anti-TNFα She demonstrated a
specific expansion of inhibitory receptor CD94/NKG2A
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This work was performed by Dr Eliza Pontifex under the
supervision of Prof Barry Bresnihan and Dr Ursula
Fearon. It is an ongoing collaboration with several
international groups funded by the EU FP6 Autocure
grant, led by the Karolinska Institute, Stockholm and
links with the ‘OMERACT’ international study to develop
new biomarkers for synovial tissue response to
treatment. This work demonstrated that the macrophage
marker - CD68 is good biomarker for response to
therepy, which correlates with disease activity.
Furthermore, she demonstrated a correlation between
results obtained from 2 different centres (Dublin and
Research Activities
Amsterdam), and thus has validated the method of that
staining and quantification of sublining CD68 in RA
making significant progress in standardisation of the
techniques. This data has now been assimilated into
manuscript and is currently in press. Under the
supervision of Prof Oliver FitzGerald and Dr Ursula
Fearon, Eliza is also examining if change in cell
infiltration in psoriatic arthritis (PsA) synovial tissue
correlates with change in DAS28 following initiation of
biologic therapy. Results have shown that change in
CD3+ T-cell infiltration correlates both with change in
DAS28 and also with change in a semi-quantitative MRI
synovitis score of the same knee joint calculated by Dr.
Robin Gibney. In collaboration with Professor Patrick
Brennan’s group from imaging in UCD, a more
quantitative measure of synovitis is being developed.
Finally Eliza is examining the role of TLRs in patients
with PsA. Eliza has demonstrated expression of TLR-2/4
in the endothelial and lining layer regions of the
synovium. Currently she is stimulating primary fibroblasts
from patients with PsA with TLR-2 and 4 +/- cJun
inhibitors and assessing regulation of chemokines.
Hypoxia and altered mitochondrial bioenergetics in the
inflamed joint.
This major programme funded by a Translational
Research Award from The HRB (2006-2011) to Prof
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Doug Veale and Dr. Ursula Fearon hypothesizes that
vascular morphology and synovial invasiveness within
the inflamed joint and response to therapy, may be
dependent on activation of mitochondria-derived,
hypoxia-induced transcriptional and non-transcriptional
pathways and alterations in genome stability. Using a
novel pO2 probe we have demonstrated that the joint
is profoundly hypoxic. Dr. Vincent Ng, clinical research
fellow, has demonstrated for the first time a direct
inverse correlation between tissue (t) pO2 levels and
macroscopic synovitis. Furthermore Dr. Ng has
demonstrated that low tpO2 levels inversely correlate
with microscopic markers of synovial T cells and
macrophages, with no relationship to synovial
proliferation or apoptosis. In vitro exposing synovial
cells to tpO2 levels found in the joint,, resulted in
decreased proliferation, increased cell migration and a
significant relationship with pro-inflammatory cytokines/
chemokines TNFα, IFNg, IL-1b and MIP3a. Together
these results suggest that low tpO2 in the joint driving
inflammation through increased cell migration and
impaired apoptotic pathways. This work was presented
the American College of Rheumatology, San Francisco,
Nov 2008. Currently, Vincent is combining both MRI
and CT/PET imaging to examine the metabolic turnover
in the joint and it’s relationship to tpO2 levels,
angiogenesis and blood flow. Vincent is also working to
identify biomarkers that may predict response to
treatment, specifically A-SAA and cartilage neoepitopes.
Preliminary data has demonstrated that high A-SAA
levels may predict a bad response to biologic treatment
but also may predict increased risk of cardiovascular
disease.
In parallel, Aisling Kennedy, graduate PhD student, is
examining the effect of hypoxia on the angiopoietins/
Tie2 pathway, blood vessel morphology and cell
stability in the joint. Aisling has demonstrated for the
first time a mixture of mature and immature vessels in
the joint. She has demonstrated low NCAM on vessel
with predominantly focal expression, suggesting that the
endothelial-pericyte cell-cell interactions are not intact.
Vessels in this unstable state are more easily targeted,
which may be due to differential expression of VEGF,
Angiopoeitin 1, 2 and PDGF. We have also demonstrated
strong nuclear expression of 8-oxo-DG on the
endothelial cells, further supporting the hypothesis that
vessels in the joint are unstable. Finally Aisling has
demonstrated and inverse relationship between pO2
levels and both macroscopic vascularity and microscopic
blood vessel stability and NOTCH expression. These
results combine with Vincent’s, suggest that while there
is an increase in number of BV within the joint the rate
of synovial expansion is faster, resulting in a high
metabolic turnover and an hypoxic environment. An
abstract of this work was chosen for an oral podium
presentation at the American College of Rheumatology,
Research Activities
San Francisco, November 2008, which Aisling presented
to a great response from the scientific community.
Currently, Aisling is examining the effect of anti-TNF
therapy on blood vessel stability and joint hypoxia. She
has also transplanted synovial tissue into SCID mice
and is examining the effects of blocking NOTCH
signalling on vessel survival.
Dr Monika Binecka is examining the role of genomic
instability in the joint and the effect of hypoxia. She has
demonstrated high oxidative damage in the synovial tissue
of patients with low pO2 levels. She has demonstrated
that tpO2 levels inversely correlate with lipid peroxidation
but not DNA damage. She demonstrated that lip
preoxidation but not DNA damage correlated closely
with angiogenic growth factor expression. Exposing cells
to hypoxia demonstrated a decrease in cell proliferation
and an increase in anaphase bridging. Currently Monika
is examining the effects of tpO2 levels on mitochondrial
pathways.
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(A) 8-oxo DG nuclear staining
(B) Anaphase bridging
Fig 1: Demonstrates oxidative damage in the endothelial
cells and lining layer in RA synovium (stained with 8oxo-dG) (A) and (B) demonstrates Anaphase Bridging
in primary synoviocytes and chondrocytes
Cytokines, angiogenesis and invasion
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 TNFα and IL-1‚ β alone and in combination
with novel cytokines and growth factors, including
Oncostatin M (OSM), IL-17, acute serum amyloid A (ASAA), IL-22, GMCSF, TLRs and Angiopoietins is being
examined in the inflammatory process, lead by Dr.
Ursula Fearon and Dr. Douglas Veale
Oncostatin M, IL-17, IL-22
Ellen Moran, is her final year of her PhD student and is
examining the role of IL-17 on cartilage degradation,
matrix turnover and cell migration. Ellen has previously
demonstrated high levels of IL-17 in the joint and
shown that IL-17 potentiates the effects of OSM and
TNFα on matrix turnover and cartilage degradation.
Ellen has now shown that IL-17 has a profound effect
on cell migration in the joint, possibly mediated through
GRO-alpha and MIP-1. She has demonstrated IL-17
induces angiogenesis and invasion, all mechanism that
contribute to celklular invasion. To examine more
specifically how IL-17 regulates these events, we have
examined it’s effects on cytoskeletal rearrangement,
which is critical for cell movement and shape. We have
demonstrated IL-17 induces cytoskeletal disassembly
and focal adjhesion contacts, an effect that is reversed
through inhibition of RhoGTPases such as RAc1. She
has also shown that IL-17 regulates the upstream
triggers specifically integrins avb3 and B1. Currently
Ellen is elucidating the specific pathways involved in IL17 induced cytoskeletal dynamics.
Dr. Bernadette Lynch was awarded an HRB clinical PhD
fellowship in July 2008, to examine the role of IL-22 in
the joint. She has demonstrated high levels of IL-22 in
synovial fluid compared to serum, and has demonstrated
that biologic therapy reduces its expression. Using synovial
Research Activities
explant cultures and primary fibroblasts Bernadette has
shown that IL-22 has no effect on regulation of many
cytokines or chemokine but appears to regulate matrix
metabolism. Currently Bernadette is examining the
effect of Il-22 in combination with other cytokines, to
assess it’s potential for adjuvant therapy. Finally,
Bernadette has collected a cohort of RA patients, to
assess the relationship between clinical characteristics
and high-resolution ultrasound.
Dr. Taj Saber is an MD clinical fellow and is coordinating
the arthroscopy programme and the biologic clinics. Taj
is currently examining the effects of biologic therapy in
the cohort of inflammatory arthritis patients to establish
features, which may predict remission in these patients.
In addition, Taj is engaged in a laboratory project to
assess the effects of cytokines on MMP production,
proteoglycan release and invasion. Furthermore she will
examine the downstream signalling pathways involved,
specifically the JAK-STAT pathway.
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. Mary Connolly has just submitted her thesis
which examines the effect of A-SAA on cell migration
and invasion, cartilage metabolism and the related
transcriptional pathways. Mary has shown A-SAA has a
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potent migrational effect within the joint. She has
demonstrated that this is mediated through alterations
in cytoskeletal dynamics. Specifically A-SAA differential
regulates RHO-GTPAses with upregulation of Cdc42
and RAC1, which is paralleled by inhibition of RhoA.
Mary demonstrated that A-SAA significantly increased
migration of GFP tagged monocyte into human synovial
tissue in vivo using a novel human RA synovial tissue/
SCID mouse chimera model. Furthermore she has
demonstrated that this effect is only partially mediated
through increased angiogenesis. The final part of Mary
work was to examine the effects of A-SAA on synovial
explants cultures using proteomics. The greatest change
was in proteins that were involved in ECM, apoptosis and
cytoskeletal proteins. These are currently being validated.
Mary had an oral presentation at the American College
of Rheumatology, San Francisco, November 2008. Mary
has demonstrated high A-SAA levels in serum and ASAA induces disassembly of actin filaments in primary
synovial fibroblast, Fig 2.
Intact Actin Filaments
Disassembly of actin
cytoskeleton and
Induction of filopodia
formation
Endothelial cell survival & 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. Dr.
Wei Gao, Jennifer Mc Cormick and Dr. Catherine
Sweeney. One of the key questions is ‘what are the key
survival pathways’; we have shown high expression of
NOTCH signalling components in synovial tissue. We
have demonstrated it’s expression on both endothelial
and pericytes, and VEGF and Ang2 regulate shown
NOTCH1C. Possible upstream triggers of these events
include hypoxia, neutropeptides or mechanical forces.
Dr. Sweeney showed that substance P and mechanical
stress upregulated VEGF, ANg2 and NOTCH 1IC.
Inhibition of NOTCH was demonstrated with anti-Tie or
Research Activities
AntiVEGF antibodies. Currently we are carrying out
experiments to examine if NOTCH blockade results in
vessel regression, and will establish if this only involves
immature vessels or are those vessels with pericye
coverage also targeted. Dr. Gao, has demonstrated low
Po2 levels in the joint upreguates HIf1a and NOTCH1IC
in primary cell cultures. Uisng siRNA to NOTCH we have
shown that VEGF and hypoxia directly regulate NOTCH.
Currently we are trying to elucidate the signalling pathways
involved in hypoxia induced NOTCH expression. Using
NO, DMOG, SiRNA and DAPT we will establish if (i)
hypoxia induced NOTCH 1IC is HIF1a dependent or
independent and (ii) establish the downstream effects
of blocking NOTCH1iC, such as angiogenesis and
fibroblast invasion.
Fig 3: Dual immunoflourescent staining with Factor VIII
(red) and αSMA (GREEN). Blood vessel staining red
are immature and those staining for red and green are
mature. This figure shows there is a mixture of
immature and mature vessels in the joint.
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GMCSF and TLRs
Dr. Sinead Nic An Ultaigh has been examining the role
of Toll-Like Receptors (TLRs) in inflammatory arthritis.
TLRs have been implicated in autoimmune diseases,
and TLR expression has been found in joint tissue and
at the sites of invasion into cartilage/bone of patients
with RA and PsA. Using several primary cell cultures
Sinead has shown differential effects of timulating TL2
and TL4 pathways. She has demonstrated TLR2
agaonist are more effective in regulating cytokines and
matrix turnover in cells isolated from the joint compared
to blood. She has demonstrated using synovial cells,
that TLR2 regulates NOTCH signalling in the joint,
blockade of which downregaultes the pro-inflammaory
response. Recently Sinead has demonstrated that TLR2
may be a possible ligand for A-SAA, which we know, is
a key molecule in driving inflammation in the joint. Finally,
using whole tissue synovial explants Sinead, compared
the effects of blocking TLR2 to known biologic agent
Humira (anti-TNFα). She showed that blocking TLR2,
significantly inhibited many pro-inflammatory cytokines
in the joint, and more importantly showed that this effect
was equivalent to that of Humira. Currently Sinead is
will focusing on the interaction between of Notch, ASAA and TLR 2 signalling.
Proof of Concept Studies
Jennifer McCormick and Owen O’Sullivan are an integral
part of the team and are is involved in a number of
projects in the group. We have developed a number of
partnerships with the drug discovery and translational
teams within industry led by Prof Veale. Jenny, Ursula,
Owen and Sinead carry out these studies using synovial
explant cultures, MSD multiplex assays and
transcriptomics to establish pre-clinical and ‘proof of
concept’ drug development studies of novel bio
therapeutics and small molecular weight candidates.
Currently, we are examining the therapeutic potential of
four new drugs.
Psoriatic Arthritis Blood Vessel Morphology
Aisling Kennedy is also examining the mechanism
involved in the differential blood vessel morphology
observed in PsA. Consistent with previous studies, she
has shown vessels in patients with PsA are tortuous,
elongated and dilated. We have shown this is associated
with increased tpO2 levels and an increased pericyte
coverage. However, we have shown differential
expression of growth factors and NCAM suggesting that
vessels are very dysfunctional. At a microscopic level it
is difficult to examine the close alignment of the
endothelial cells and pericyte, therefore currently Aisling
is using transmission electron microscopy to examine
blood vessel stability, activation and endothelial cell pericyte interactions, parameters such as (i) compactness,
(ii) pinocytic vesicles, (iii) basal lamina, (iv) junctional
Research Activities
complexes, (v) anchoring filaments, (vi) endothelial
cytoplasmic and nuclear shape will be assessed.
Vascularity and blood vessel stability as determined by
TEM will be correlated with both macroscopic and
microscopic assessments. tpO2 levels and blood vessel
pattern stability will also be determined.
Biomarkers of Biologic Treatment Response:
Finally, funded by Abbott, Dr. Emily Collins, supervised
by Prof. Oliver FitzGerald and Dr. Ursula Fearon, is
examining proteomic profiles in PsA patients’ pre/post
biologic therapy with Prof Steve Pennington, Conway,
UCD. We are aiming to identify molecular biomarkers,
which predict response to anti-TNFα therapy, which are
present in the synovium at an early stage of treatment.
Prof FitzGerald and Dr. Fearon in collaboration with the
P.P. Tak group in Amsterdam, and S. Pennington and M.
Dunn of the Proteome Research Centre, UCD. Synovial
tissue has been obtained via arthroscopy at baseline
and 1 month from a cohort of patients, half of whom
were receiving Adalimumab and half placebo injections,
before beginning Adalimumab after 1 month. We are
using proteomics technology (2D- DIGE and mass
spectrometry) to analyse the proteome of these
synovial tissue samples and identify differentially
expressed proteins and potential biomarkers. These
potential biomarkers will then be validated using various
molecular biology methods. A pilot study on a smaller
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cohort has allowed us to optimise the experimental
methodology and identify several interesting proteins.
Psoriasis/Psoriatic Arthritis
There are 4 main areas of interest within Ps/PsA:
Genetics:
In collaboration with Professor Robert Winchester at the
University of Columbia in New York, blood samples have
been obtained and DNA analysed in a cohort of 400
probands with PsA as well as more than 200 patients
with psoriasis alone and 150 normal controlled subjects.
The focus has been on a detailed molecular genotyping
of the HLA-B and -C loci using sequence based typing.
Detailed analysis is ongoing but results suggest that PsA
is not genetically a simple subset of psoriasis. HLACw*0602 is present in 62% of patients with psoriasis
alone and in only 27.9% of patients with PsA.
In collaboration with the newly established GRIPPsA
Consortium, which is an Irish based consortium, DNA
from a large number of patients with psoriasis and with
PsA have been collected. Approximately 500 of these
samples have been contributed to the initial cohort of
patients who were undergoing genome-wide association
studies funded by Welcome. This work is being undertaken locally in collaboration with Dr. Brian Kirby and
with the assistance of Anne-Marie Tobin, Dr. Aizad
Mumtaz and Ms. Phil Gallagher.
Research Activities
Biomarks of Biologic Treatment Response:
As part of investigator-originated, single-arm protocols
looking at mechanisms of effect of biologic therapies,
synovial membrane samples have been analysed for
tissue markers of treatment response to biologic
therapies. Comparisons of immunohistochemical
changes with clinical changes have identified change in
CD3-positive T-cells as correlating significantly with
change in clinical scores. In addition, a semi-quantitative
score of MRI scans undertaken in collaboration with Dr.
Robin Gibney have also correlated significantly with a
change in CD3 synovial tissue counts. In collaboration
with Professor Patrick Brennan’s group from imaging in
UCD, a more quantitative measure of synovitis is being
developed.
Proteomics Studies in Collaboration with Professor
Stephen Pennington and Professor Mike Dunn from the
Proteomic Department at Conway Institute:
Dr. Emily Collins has been trying to identify synovial
biomarkers of treatment response to empty TNF
therapy in patients with PsA. A number of proteins
have been identified, which significantly associate with
clinical response and in addition a number of proteins
have been identified which appear to predict a
response at baseline. These studies are funded by
Abbott Pharmaceuticals and validation of proteins
identified is currently underway. For glycosylation
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changes in inflammatory arthritis patients pre and post
anti-TNF therapy. In collaboration with Professor
Pauline Rudd’s group from the Conway Institute and
with Dr. John Axford from St. George’s Hospital in
London, Dr. Emily Collins is studying immunoglobulin
glycosylation changes, which occur in patients with
inflammatory arthritis and also the effect of anti-TNF
therapies on such changes in a cohort of 65 patients,
glycosylation profiles return towards normal as disease
activity improves following treatment initiation.
Pharma Co Economics of Biologic Therapies in Patients
with Inflammatory Arthritis:
In collaboration with Dr. Michael Barry from the National
Centre of Pharma Co Economics at St. James’s Hospital,
Ms. Roisin Adams is examining the Pharma Co
Economic impact of anti-TNF therapies in patients with
inflammatory arthritis. These studies are utilising data
being collected on a large cohort of inflammatory
arthritis patients currently being followed on anti-TNF
therapy.
Thesis Submissions:
Mary Connolly submitted her PhD thesis (UCD)
examining the role of A-SAA on cell migration,
cytoskeletal dynamics and invasion in the pathogenesis
of inflammatory arthritis, under the supervision of Dr.
Ursula Fearon and Prof Douglas Veale
Research Activities
Liver Research
The Liver Research Group operates a four-stranded
research programme based on Liver Transplantation,
Hepatic Malignancy, Hepatitis C Viral Infection (HCV)
and Basic Immunology of the Liver.
Prof. Cliona O'Farrelly
Prof. John Hegarty
Research Personnel 2008:
Senior Scientists:
Nigel Stevenson
Research Assistants:
Catherine Keogh
Research Fellows:
Kavin Nanda,
Shahzad Sarwar
Postgraduate Students:
Aideen Collins
Elizabeth Ryan,
Margaret O’ Brien
Emma McGrath,
Tanya Dempsey
Tariq Tajuddin,
Masood Iqbal
Eszter Nèmeth,
Nollaig Bourke
Liver Transplantation:
The Liver Transplant team at St. Vincent’s Hospital
performs 50-60 transplants per year. A successful
transplantation programme depends on a steady supply
of donor organs. Our research is focused on trying to
maximize the benefit of liver transplantation to the
patient.
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Patients who undergo liver transplantation due to liver
cirrhosis caused by Hepatitis C virus infection often
experience a severe recurrence of infection post-transplantation. We found that the pre-Liver Transplantation
frequencies of circulating CD56+ lymphocytes were
significantly lower in patients who subsequently
developed severe HCV recurrence, relative to those
patients who developed mild histologic recurrence, as
well as non-HCV controls demonstrating a previously
unappreciated association between pretransplantation
CD56+ lymphocytes and outcome of HCV recurrence
and a possible therapeutic target.
Badar Zaman, Martin Leonard (Conway Institute, UCD),
Elizabeth Ryan, Cormac Taylor (Conway Institute, UCD),
Lucy Golden-Mason*, Hugo Rosen*, Justin Geoghegan,
Cliona O’Farrelly.
*University of Colorado Health Sciences Center, Denver, USA
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 NKT cells resulting
in activation and production of cytokines. We have
found that novel CD1d isoforms are expressed in liver
and colon cancers and we are investigating their role in
regulating immune responses to malignancy.
Margaret O’Brien, Emma McGrath, Cliona O’Farrelly
Research Activities
HCV & its effect on Bone Metabolism
Limited data are available on the contribution of chronic
hepatitis C virus (HCV) infection to the development of
bone disease in postmenopausal women. We studied
whether post-menopausal women with chronic HCV
infection were more at risk of developing osteoporosis.
Our study found that HCV infection alone had no impact
on the risk of developing osteoporosis. However, like all
postmenopausal women, women with hepatitis C virus
need to ensure that their diet has adequate amounts of
calcium and vitamin D and take regular exercise to
protect their bones.
Our findings have recently been accepted for publication
in the journal of the American Gastroenterological
Association ‘Clinical Gastroenterology and Hepatology.’
Kavin Nanda, Elizabeth J. Ryan, Barbara Murray*,
Jennifer Brady*, Malachi McKenna , Niamh Nolan ,
John Hegarty, Cliona O’Farrelly
* Metabolism Laboratory, DXA Unit and Pathology Dept., SVUH.
IL-10 and TGFβ‚ mediated suppression of antigenspecific Th1 and Th17 responses during HCV infection.
IL-17-secreting T (Th17) cells play a protective role in
certain bacterial infections, but they are major
mediators of inflammation and are pathogenic in organspecific autoimmune diseases.
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An examination of patients infected with hepatitis C
virus (HCV) demonstrated that Ag-specific Th17 cells
are induced during infection and that these cells are
negatively regulated by IL-10 and TGF-beta. This may
represent a novel immune subversion mechanism by
the virus to evade host-protective immune responses.
These findings have been recently published in the
Journal of Immunology.
Aileen Rowan*, Jean Fletcher*, Elizabeth J. Ryan,
John Hegarty, Cliona O’Farrelly, Kingston Mills*
*Immune Regulation Research Group, School of Biochemistry and
Immunology, TCD.
Role of G-CSF and GM-CSF in determining the
outcome of IFNa/Ribavirin therapy of chronic Hepatitis
C infection.
The recombinant form of granulocyte colony stimulating
factor (G-CSF) is an effective treatment for alpha
interferon (IFNα)-induced neutropenia in patients with
chronic hepatitis C virus (HCV) infection. However, little
data exist on the effect of IFN-α therapy on
endogenous G-CSF production and its role in IFNinduced neutropenia. We are examining the effects of
IFN-α on the production of G-CSF by peripheral blood
mononuclear cells (PBMCs) in patients with HCV
infection.
GM-CSF:
The development of immune cells of the myeloid
lineage depends on the growth factor, GM-CSF. GMCSF also has potent immunomodulatory effects and
can enhance the immune response. Our preliminary
studies showed that pre-treatment PBMCs of patients
who subsequently achieved sustained virologic
response (SVR) produced higher levels of GM-CSF
compared to non-responders. We are investigating the
effect of GM-CSF on IFN-alpha signalling pathways in
cells isolated from HCV patients.
This work is supported by a Translational Research
Grant Awarded to the HCV Research Consortium.
Elizabeth J. Ryan, Tariq Tajuddin,Tanya Dempsey, John
Hegarty, Cliona O’Farrelly.
Dendritic Cells
Dendritic cells play a key role in the initiation of the
immune response. We are interested in understanding
how these cells can be manipulated to make more
effective vaccines and immune therapies.
We previously characterised a novel C-type lectin-like
molecule expressed by dendritic cells, Dendritic cellassociated lectin-1 (DCAL-1) with Prof Ed Clark,
University of Washington, Seattle. We found that an
antibody directed towards this molecule resulted in the
Research Activities
generation of a ‘tolergenic’ dendritic cell phenotype.
These results were published in the Journal ‘Human
Immunology’.
molecule Osteoprotegerin (OPG) a cytokine that plays
an important role in protecting bone from degradation
by osteoclasts.
The recombinant canarypox virus ALVAC is being
extensively studied as vaccine vector for the
development of new vaccine strategies against chronic
infectious diseases and cancer. Gene profiling analysis
of human monocyte derived dendritic cells (MDDCs)
upon ALVAC infection (Anke Harenburg, Nicolas Burdin
and Franca Spada, Sanofi Pasteur) demonstrated that
the majority of the genes that were up-regulated by
ALVAC belong to the type I interferon signaling pathway,
this may have important implications for the use of this
vaccine system in patients with suppressed IFN
responses such as those with chronic HCV infection.
These results were published in the Journal ‘Vaccine’.
We are also evaluating DC numbers and phenotype in
the blood and liver of HCV patients.
Elizabeth J. Ryan, John Hegarty, Cliona O’Farrelly
Effect of Chronic HCV infection on Dendritic Cell
phenotype and function.
However, to exploit DC targeted therapies in patients
with chronic infections such as HCV or cancer we need
to understand how DCs in these patient groups differ
from those of healthy individuals. We have made a
number of interesting discoveries, such as finding that
Dendritic cells of HCV+ patients do not produce IFNalpha in response to poly(I:C) stimulation. Conversely,
MDDCs from HCV+ patients secrete high levels of the
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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)
How does HCV inhibit IFN-α treatment?
The anti-viral action of IFN-α depends on proteins
within the cell known as the Janus kinases (Jak) and
Signal Transducers and Activators of Transcription (STAT)
that make up the JAK/STAT pathway. Since more than
50% of patients do not respond to IFN-α, we are
investigating how HCV affects this pathway and its antiviral response.
We have discovered that a number of proteins of the
JAK/STAT pathway, essential for an antiviral response,
are absent in many HCV patients. We have also found
that HCV acts to degrade these proteins, which may
explain the lack of response to therapy. We plan to
determine exactly how this virus destroys such
important proteins and in doing so we hope to provide
clinicians with a predictive tool of response and identify
potential targets of for future therapy.
Nigel Stevenson, Nollaig Bourke, Catherine Keogh,
John Hegarty, Cliona O’ Farrelly, Aideen Long (TCD),
Christine Biron (Brown University), Jim Johnston (Queen’s
University, Belfast), Charlie Rice (Rockefeller University)
What role does Suppressors of cytokine signalling
(SOCS) play in HCV resistance to IFN-α treatment?
IFN-α is a powerful intracellular defence system against
viruses and resistance to it is manifested by a reduced
induction of anti-viral genes. SOCS proteins control
cytokine signalling and have been documented to
regulate IFN-α signalling and be triggered by HCV
Research Activities
infection. We hypothesise that HCV may be blocking IFNα signalling by specifically inducing SOCS proteins,
which may reduce anti-viral gene induction. We have
found a difference in SOCS levels between healthy and
HCV infected patients and continue to investigate this
novel area of the immune response to HCV, to further
understand the mechanism of action of HCV and
discover complementary therapeutic targets.
Aideen Collins, Nigel Stevenson, John Hegarty,
Cliona O’ Farrelly
Dr. Frank Murray, Beaumont Hospital
Dr. Suzanne Norris, St. James Hospital
Prof. Dermot Kelleher, St. James Hospital
Dr. Aideen Long, St. James Hospital
Dr. Lelia Thornton, National Disease Surveillance Centre
Dr. Gary Courtney, St Luke’s Hospital Kilkenny
Dr. John Lee, University Hospital Galway
The Consortium met to discuss the current research
projects on the 15th November 2007 and 15th
February 2008.
HCV Research Consortium:
The cohort of Irish women infected in 1977 with HCV
contaminated anti-D is homogenous for time of infection,
route of infection, racial background, gender and viral
subtype, providing a unique opportunity to investigate HCV.
The HCV Research Consortium was established to
conduct research into different aspects of HCV infection
of the Irish cohort of women infected in 1977. Profs O’
Farrelly and Hegarty coordinate the HCV Research
Consortium, which includes Irish clinicians who have a
research interest in HCV infection including:
Prof. Cliona O'Farrelly, Chairperson, Trinity College Dublin
Prof. John Hegarty, St. Vincent's University Hospital
Dr. John Crowe, Mater Misericordeae University Hospital
Dr. Orla Crosbie, Cork University Hospital
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Grants
Research Frontiers Science Foundation Ireland (SFI)
(€165,189) “The role of HCV in regulating STAT protein
expression to evade anti-viral IFN-α responses”.
Prof. Cliona O’Farrelly
Post-Doctoral Fellowship Dr. Nigel Stevenson Health
Research Board (HRB) (€252,069.73), “HCV regulates
STAT protein expression to escape IFN-α responses: A
novel immune evasion strategy for HCV”.
HRB project grant (€299,364) to investigate “SOCS
Protein Involvement in Chronic HCV Infection and
Failure to Respond to IFN-α Therapy
Profs Cliona O’Farrelly and John Hegarty.
Invited Lectures
‘Comparative Immunomics: discovery of new immune
genes and mechanisms’ - the 6th Institute of Molecular
Medicine Lecture, Dublin 2008 – Cliona O’Farrelly
‘What the scientist can contribute over the next ten
years’ at the British Association for the Study of Liver
Disease annual meeting, Edinburgh 2008 – Cliona
O’Farrelly
‘Innate lymphoid cells in the liver’ at the 23rd Erasmus
Liver Day, Rotterdam 2008 – Cliona O’Farrelly
‘Lymphoid cells in human liver’ at the British Society of
Gastroenterology workshop “Liver Immunology”,
Birmingham 2008 – Cliona O’Farrelly
‘Liver: An immunological battleground’. King’s College
Hospital – 2008 Cliona O’ Farrelly
Oral Presentations
Ryan E.J, Nanda K.S, Hegarty J.E & O’ Farrelly C.
Monocyte derived Dendritic Cells isolated from HCV+
patients secrete high levels of Osteoprotegerin (OPG).
Irish Society Immunology Meeting 2008.
Ryan E.J, Tajuddin T, Hegarty J.E & O'Farrelly C. GM-CSF
may modulate the response to IFN-alpha in Chronic
Hepatitis C Virus (HCV) Infection. Keystone Viral
Immunity Conference 2008.
Research Activities
Tajuddin T, Ryan E.J, Keogh C, Norris S & O’Farrelly C.
Hegarty, JE. Suppressed Granulocyte Colony
Stimulating Factor Production in Chronic Hepatitis C
Patients on Interferon –Alpha (IFN-α) Therapy; Possible
Role in IFN-α Induced Neutropenia. Joint International
Congress of ILTS, ELITA & LICAGE 2008, Paris, France.
Nanda K.S, Dempsey T, McGrath E, Hegarty J.E,
O’Farrelly C & Ryan E.J. Elevated levels of circulating
osteoprotegerin (OPG) may limit the effect of chronic
hepatitis C virus infection on bone disease in a cohort
of postmenopausal Irish women.15th International
Symposium on Hepatitis C Virus & Related Viruses
2008, San Antonio, USA.
Poster Presentations
Ryan E.J, Tajuddin T, Hegarty J.E & O'Farrelly C. GM-CSF
modulates IFN-α stimulated gene expression (ISGs) in
peripheral blood mononuclear cells (PBMCs) of
chronically infected Hepatitis C patients. British Society
Immunology Annual Congress 2008, Glasgow, UK.
Ryan E.J, Hegarty J.E & O’ Farrelly C. GMCSF may
modulate the response to IFN-alpha in Chronic
Hepatitis C Virus (HCV) infection. Keystone Viral
Immunity Conference 2008, Keystone, USA.
Nanda K.S, Ryan E.J, Murray B.F, Brady J.J, McKenna M,
O'Farrelly C & Hegarty J.E. Chronic Hepatitis C (HCV)
infection in a cohort of post-menopausal Irish women
contributes to the development of bone fractures.
Digestive Diseases Week (DDW) 2008, San Diego.
Ryan E.J, Tajuddin T, Dempsey T, Hegarty J.E & O’Farrelly
C. GM-CSF modulates IFN-alpha stimulated gene
expression (ISGs) in peripheral blood mononuclear
cells (PBMCs) of chronically infected Hepatitis C
patients. 15th International Symposium on Hepatitis
C Virus & Related Viruses 2008, San Antonio, USA.
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Stevenson N.J, Ryan E.J, Keogh C.A, Lloyd A.T, Cormican
P, Hegarty J.E & O’ Farrelly C. Hepatitis C Virus (HCV)
regulates signal transducer and activator of
transcription (STAT) protein expression to escape
interferon-alpha (IFN-α) responses. Irish Society
Immunology Meeting 2008.
interferon-alpha (IFN-α) responses. 15th International
Symposium on Hepatitis C Virus & Related Viruses
2008, San Antonio, USA.
Research Activities
interferon-alpha (IFN-α) responses. British Society
Immunology Annual Congress 2008, Glasgow, UK.
Nemeth E, Hopkins A.M & Baird A.W.
Neuroimmunology of the liver – methodology in intact
organs. International Neuroimmunology
Symposium, University College Dublin, Dublin,
Ireland, 2008.
Obesity Research
The Obesity Research group is headed by Prof. Donal
O’Shea, Consultant Endocrinologist at St. Vincent’s
University Hospital and Head of the Weight Management
Clinic at St. Colmcille’s Hospital. Dr. Lydia Lynch is the
senior research scientist in the group and Andrew
Hogan is a new postdoctoral scientist with the group.
Lydia is funded by the Health Research Board and
UNESCO-L’Oreal partnership. Andrew recently received
the Sanofi-Aventis Newman Scholarship for his
postdoctoral studies.
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Dr. Jean O’Connell is a 3rd year clinical PhD student
funded by the HRB Clinical Research Fellowship, along
with Dr. Tomas Ahern and Dr. Conall Dennedy who are
starting their clinical PhDs. Ms. Anna Kwasnik is the
group’s research assistant funded by the Diabetes
Federation of Ireland. Ms. Cathy Breen has started in
the group as a research dietician studying the role of
carbohydrate in diabetes. Conall received the ICHMT
Endocrine Research Bursary funded by Sanofi-Aventis.
Lydia Lynch is working on the immune system in
obesity, and asking why are some obese subjects
immune compromised. Obesity is now responsible for
30-40% of certain cancers. She has found that natural
killer cells, the bodies first defense against tumors and
viruses are depleted in the blood of obese patients.
Lydia is also looking at the immune system in the fat, in
particular the omental fat, of obese and lean patients.
She has found that omental fat has its own unique
immune system, different to every other organ in the
body and contains the largest number of potent killer
cells, termed invariant natural killer T cells.
Jean O’ Connell has found that adipocyte size strongly
correlates with metabolic healthy and degree of fatty
liver disease in obese patients. She is now studying the
rate of proliferation and differentiation of preadipocytes
from both healthy and unhealthy obese patients, as
well as the production of pro- and anti-inflammatory
cytokines from the growing cells.
Lydia was awarded the UNESCO-L’Oreal International
Young Woman of Science Fellowship this year, which is
awarded to 15 young women worldwide. This is the
first time Ireland has received this award. This fellowship
will enable Lydia to spend 7 months working in Harvard
Medical School, Boston each year for 2 years, with the
aim of returning to Ireland to establish in St. Vincent’s
University Hospital state of the art techniques learned in
Harvard. Lydia also won ‘Researcher of the Year’ at the
Conway Research Festival, UCD in September 2008.
Lydia was an invited speaker at the International Colorectal
Cancer Society Conference and the Trinity College
Dublin Biochemical Society series of talks.
The Obesity group’s paper entitled “Are natural killer cells
protecting the metabolically healthy obese patient?” was
published in Obesity this year and featured in the Irish
Times. The group has recently submitted their findings
on adipocyte size in the severely obese patient to
Journal of Endocrinology and Metabolism. Jean
O’Connell was also invited to write a book chapter on
Obesity and Cancer.
Research Activities
Dermatology Research
Dr. Anne-Marie Tobin has begun research in the
Education and Research Centre under the supervision
of Dr Brian Kirby and Prof Donal O’Shea. She is
researching the effects of obesity and smoking on
psoriasis in particular their effects on natural killer cells
in psoriasis.
Respiratory Sleep Research
Principal Investigator: Prof.Walter McNicholas
Summary of Research Activities
The Respiratory Sleep Research Laboratory at St.
Vincent’s University Hospital continues a varied clinical
and basic science research programme with a particular
emphasis of cardiovascular interactions in obstructive
sleep apnoea (OSA). Ongoing collaboration exists with
the research group of Prof. Cormac Taylor in the
Conway Institute at UCD and the School of Electronic
and Electrical Engineering (Prof. Conor Heneghan and
Dr. Madeleine Lowery), also in UCD. Dr. John Garvey
and Dr. David McSharry are the Research Fellows
involved.
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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 studying the role of nitric
oxide in modulating the NFκB response to intermittent
hypoxia in an in vitro model and translating the findings
into studies of nitrate levels in OSAS patients and the
responses to CPAP therapy. Two abstracts based on the
findings will be presented at the forthcoming annual
meeting of the American Thoracic Society meeting in
San Diego in May, one of which will be an oral
presentation as part of a mini-symposium.
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. Two original papers based on the
findings have been published in international peerreviewed journals during 2008.
In collaboration with Dr. Lowery, 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.
Dr. David McSharry is carrying this project forward.
Research Activities
Neurology Research
Personnel:
Dr. Niall Tubridy,
Prof. Michael Hutchinson,
Dr. Roisin Lonergan,
Dr. Jean Fletcher,
Ms. Cheryl Sweeney
Summary of Research
The Department of Neurology has an international
reputation in the field of multiple sclerosis (MS) and
research for many years thanks to the work of Professor
Michael Hutchinson 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, Dr Niall Tubridy set up a collaboration 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 (now of
TCD). 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
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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. Jean is working with
Cheryl Sweeney, who is helping with the human work
but also working for her own PhD using animal models.
To achieve this, of course, close co-operation is required
with the clinical team. Drs. Roisin Lonergan (MS research)
and David Bradley (Dystonia) joined us in July 2007. A
new clinic was set up in 2005 specifically for people
with MS. Currently, over 500 patients with MS and 150
control subjects have been recruited. Lisa Costelloe,
Roisin Lonergan, Niall Tubridy and Michael Hutchinson
assessed the patients clinically and document the
disease phenotype in each individual seen. This is done
in the course of ‘normal’ clinical care. The work of Katie
Doyle, MS Research Nurse, Sinead Jordan, Research
Nurse, and Marguerite Duggan, MS Specialist Nurse,
has been integral to the smooth running of this project
and the ongoing care of our patients.
We have also undertaken work in collaboration with Dr.
Margaret O’Brien looking at OAS in MS and plan further
studies in vitamin D receptor genes in 2008 (outlined
below).
In addition to immunological research, we have a longstanding 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).
In 2007 and 2008 we began 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.
The Department of Neurology has continued to
substantially expand in 2008. 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.
The Department was awarded two prestigious HSE
Innovation Awards in 2008 (regional and national) for
Research Activities
their presentation of ‘Neurology-changing the way we
practice’. Health Minister, Mary Harney cited the
Department in the Dail in May 2008 as an example of
excellence in the Health Service.
Significant Achievements in 2008
Innovation awards in 2008 (regional and national) for
practice’
Dr. Roisin Lonergan won Best Poster Presentation at
the INA (Cork) 2008.
Dr. Margaret O’Brien won Best Platform Presentation
at the INA (Cork) 2008.
Drs. Lonergan, O’Brien and David Bradley all
presented papers at the American Academy of
Neurology in Chicago in 2008.
The Dystonia work was also presented at The Dystonia
Europe Congress in Hamburg 2008;
Drs Bradley and Lonergan also presented papers at
the EFNS Madrid 2008
Many of the team presented at the ABN in Dublin in
2008 including Drs. Roisin Lonergan, Margaret
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O’Brien, Laura Williams, Ailin Rogers, Sinead
Murphy and John McHugh.
Dr. J. McNulty also presented a paper at the ABN held
in Croke Park that was hosted by Professor Hutchinson
in March 2008.
Drs. Margaret O’Brien and Anna Heeney presented
papers at the ENS in Nice in June 2008.
Conference abstracts
A reduction in thymically-derived natural regulatory T
cells in patients with multiple sclerosis.
J.M. Fletcher, L. Costelloe, N. Booth, M. VukmanovicStejic, N. Tubridy, K.H.G. Mills
Dr Roisin Lonergan, Neurology Specialist Registrar
presentations at the following meetings (2007-2008):
ABN (Association of British Neurologists) March 2008,
Dublin
AAN (American Academy of Neurology) April 2008, Chicago
INA (Irish Neurological Association) May 2008, Cork
ENS (European Neurological Society) June 2008, Nice
EFNS (European Federation of Neurological Societies), August
2008, Madrid
ECTRIMS- ACTRIMS-LACTRIMS, September 2008,
Montreal
MD Thesis Projects ongoing:
(1) Epidemiology of Multiple Sclerosis (MS) in Ireland:
prevalence study in Dublin, Wexford and Donegal
looking at differences in clinical, genetic, immunological
and vitamin D status nationally
In this multi-centre, cross-sectional study we aim to
examine the following:
(a) Prevalence of MS in South Dublin, Wexford & Donegal.
A previous study from our department suggested
a gradient in prevalence of MS between Donegal
and Wexford. More recent studies suggest that
overall incidence and prevalence of MS is
increasing worldwide. This study arm will
reappraise this in 3 areas in Ireland.
(b) Differences in Vitamin D levels between people with MS
and controls.
Studies suggest a role for vitamin D as a potential
explanation of increased risk of MS as a factor of
distance from the equator. Vitamin D deficiency
often co-exists with established MS and oral
supplementation may be associated with lower
risk of disease. The findings from this study may
justify vitamin D supplementation trials in MS.
Research Activities
(c) The link between Vitamin D and regulatory T cells:
We will examine the correlation between vitamin
D levels and regulatory T cell frequency in the
RRMS cohort of patients. We will also investigate
the functional significance of the regulatory T cell
subsets.
(d) Genetic differences between those with MS in northern
and southern areas of Ireland.
Certain HLA genotypes are know to increase
susceptibility, particularly HLA DRB1*1501. We
aim to see if there is a difference in genotype
between these patient groups. We also plan to
examine vitamin D receptor polymorphisms in
patients and controls.
(e) As part of the study, we have performed a needs assessment
for people with MS in different parts of Ireland, to identify
unmet needs and to maximise benefit from the various
services available.
(2). Examination of OAS 1 (oligo-adenylate synthetase 1)
genotype as a predictor of susceptibility to MS and response of
interferon therapy.
It has been proposed that polymorphisms in the
OAS1 gene could influence susceptibility to
multiple sclerosis (MS). We examined the
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occurrence of a functional single nucleotide
polymorphism of the OAS 1 gene in people with
MS and healthy controls.
This showed that OAS1 AA genotype is over-represented
in MS patients compared with controls, suggesting that
OAS genotype may predict susceptibility to MS.
We then hypothesised that the AA genotype would also
be over-represented in people with suboptimal
response to IFNb therapy: distribution of OAS genotypes
was significantly different between non-responders and
both responders and the rest of the MS cohort.
Thus, a functional SNP in the OAS gene may predict
both susceptibility to MS and response to treatment.
This could be invaluable in avoiding expensive therapy,
and adverse effects, in those unlikely to respond.
We plan to examine OAS genotype as a predictor of
disease activity and to examine genotype in a group of
patients with benign MS.
(3) Study: To prospectively monitor for reactivation of BK virus
in RRMS patients receiving natalizumab for 1 year.
Natalizumab therapy in MS has been associated
with JC virus-induced PML. Reactivation of BK
virus, another polyomavirus, has resulted in
significant morbidity, typically renal (BK VirusAssociated Nephropathy), during other
immunosuppressive therapies.
All patients receiving natalizumab therapy at our
clinic have regular screening blood and urine
samples for polyomavirus PCR, CD4:CD8 ratio
calculation and renal and liver profile. This is done
monthly for the first 3 months and three-monthly
thereafter. BKV subtyping and NCCR sequencing is
carried out on samples demonstrating reactivation
(NVRL).
BK reactivation was observed in a small number
of patients, but all remain well.
The significance of viruria or transient viraemia, in
the absence of renal dysfunction, is unclear. We
plan to continue regular monitoring for BK
reactivation and for renal dysfunction, in addition
to screening for JC virus reactivation, and to
observe for BK reactivation in a matched control
group of MS patients not on natalizumab therapy.
Research Activities
(4) Diffusion Tensor Imaging (DTI) of the Medial Longitudinal
Fasiculus in Multiple Sclerosis patients with Internuclear
Opthalmoplegia
In this study we investigated the relative specificity
of DTI in the detection and quantification of MLF
disruption in MS patients with INO. We
collaborated with Jonathan Mc Nulty and Professor
Patrick Brennan from the UCD School of
Diagnostic Imaging.
We recruited 12 MS patients with INO from our
MS clinic, and compared DTI and standard MRI
sequences (T2 weighted, proton density and
FLAIR) in this group with 12 control subjects.
A neuroradiologist, blinded to study group,
reported MLF findings on standard images.
Diffusion tensor imaging identified areas of
abnormality in the MLF region for all INO subjects,
while the MLF in 50% of INO subjects was
reported as normal following conventional
imaging.
Compared to conventional MR imaging, ADC
values identify areas of abnormality with greater
sensitivity, allowing confirmation of lesions for a
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range of clinical signs. We propose that DTI could
enable more accurate monitoring of disease
progression and response to therapy, and guide
treatment choices.
(5) Cognitive Functioning in MS: A Longitudinal ERP Analysis.
Cognitive impairment (CI) occurs in up to 70% of
multiple sclerosis (MS) patients. Subtle CI is
difficult to detect clinically and correlates poorly
with MRI measures. The Paced Auditory Serial
Addition Test (PASAT) is useful in assessing CI in
MS but may be influenced by anxiety and years of
education.
Event-related potentials (ERPs; time-locked EEGs)
are a non-invasive method of detecting cognitive
activity. Delayed latencies of the P3 wave are a
reflection of impaired cognitive functioning.
The aim of the present study was to assess the
relationship between P3 latency and PASAT
performance in MS patients.
To date we have analysed data on 18 patients. It
shows correlation between P3 latency and PASAT
score was significant, controlling for age and the
P3 latency was independent of EDSS score.
This study demonstrated that P3 latency may be a
reliable, objective test of CI in MS.
Current aim: to examine prospectively in RRMS patients
the relationship over time between ERPs, PASAT, NP
assessment, disability and MRI measures of brain
atrophy, in collaboration with the School of Diagnostic
Imaging in UCD, and the School of Engineering in
T.C.D.
Meetings attended in 2008:
ABN, Spring Meeting, Dublin, March 25th–28th
AAN, Chicago, April 12th–19th
EFNS, Nice, May, 13th-16th
ECTRIMS, Montreal |September 14th.
Research Activities
Centre for Colorectal Disease Research
Dr. Hugh Mulcahy
Mr. John Hyland
Prof. Des Winter
Prof. Ronan O’Connell
Prof. Kieran Sheahan
Dr. David Fennelly
Research Team:
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Senior Research Scientist
Robert Geragthy
Senior Medical Scientist
Blathnaid Nolan
Research Nurse
Dermot Leahy
Senior Scientist
Miriam Tosetto
Senior Research Assistant
Monica Biniecka
Postdoctoral Fellow
Edward Fox
Postdoctoral Fellow (NCI/HRB fellow)
Alan Coss
MD research fellow (thesis submitted)
Dave Kevans
MD research fellow
Garret Cullen
MD research fellow
Joe Marry
MD research fellow
Eoin Slattery
MD research fellow
Danny Cheriyan
MD research fellow
Sheeona Gorman
Ph.D. student
Juliette Sheridan
Ph.D. student
Maciej Milewski
Adriana Michielsen
Ph.D. student
Ph.D. student
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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 co-ordinators and nurse specialists such
as Anne White, Denise Keegan and Grace McEvoy who
lead patients through the varied and complex pathways
of diagnosis, treatment and postoperative stoma care in
a way that appears seamless. The Excelicare database
system is now the backbone of the weekly Colorectal
Cancer audit organised by Anne White, Marian Ward,
Stewart Thompson and Ken Curran.
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 are to
achieve a more complete understanding of which
biological factors that 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 very productive collaborations with both
national and international institutions.
Professors O’Donoghue and O’Connell represent the
Hospital on the National Colorectal Cancer Screening
Committee.
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. Professor Paddy Johnston from
Queen’s University Belfast - with whom the unit has
close research collaborations - was this year’s state of
the art lecturer.
We wish to record our thanks to the many individuals
and groups who raise funds for our research. In
particular we would like to acknowledge foundations to
the memory of Ellie Brady, Susie Byrne and Darragh
Gibbons.
Research Activities
Changes to our research team in 2008
In 2008, Adriana Michielsen joined our team to embark
on her Ph.D. studies which will examine how defects in
the immune system may be important in controlling
treatment response in colorectal cancer patients. This
work is funded by an IRCSET grant for 3 years. Eoin
Slattery and Danny Cheriyan have also begun their MD
research work. Eoin is investigating how cigarette smoking
has a protective role in Ulcerative Colitis. Eoin has been
awarded an Abbott Newman Fellowship (UCD) to
conduct this work. In collaboration Prof. Paul Murphy
(NUI, Galway), Danny is analysing the action of newly
synthesised anti-angiogenetic compounds using our
human tumour explant tissue model.
National and international talks in 2008
Jacintha O’Sullivan: University of Washington, Seattle
‘Predicting treatment response using a novel tumour
explant tissue model’.
Sheeona Gorman: Irish Radiation Research Society
(IRRS), Belfast. ‘Ex vivo bystander effects promote
mitochondrial dysfunction and chromosomal bridge
breakage fusion events in colorectal cancer’.
Joe Marry: Clinical Plenary Session of the Irish Society
of Gastroenterology, ‘Evaluating the effects of monoclonal
antibody therapies on pro-angiogenic growth factors in
individual colorectal cancer explants’.
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Edward Fox: Association for Cancer Research Annual
Meeting, San Diego. ‘Mutator phenotype of sporadic
human colon cancer’.
Poster Presentations in 2008
Sheeona Gorman: IACR: Gamma ray-induced bystander
effects in colorectal cancer: a specific study on anaphase
bridge and micronuclei formations in unirradiated
bystander cells.
Sheeona Gorman: All Ireland Cancer Conference: Ex
vivo bystander effects promote chromosomal instability
through bridge breakage fusion events: telomere
shortening and bridge formations coupled with
mitochondrial dysfunction.
Juliette Sheridan: All Ireland Cancer Conference:
Survival of very elderly patients with colorectal cancer.
Sheeona Gorman: ISG: Ex vivo bystander effects
promote mitochondrial dysfunction and chromosomal
bridge breakage fusion events in colorectal cancer.
Joe Marry: AntiAngio2008, San Diego, CA. Evaluating
the effects of monoclonal antibody therapies on proangiogenic growth factors in individual colorectal cancer
explants.
Garret Cullen: ISG: The effect of cigarette smoking on
cell cycle kinetics and mitogen activated protein kinases
in inflammatory bowel disease: implications for disease
progression.
Garret Cullen: Digestive Disease Week (DDW):
Cigarette smoking in inflammatory bowel disease: cell
cycle arrest may explain the divergent effects in Crohn’s
disease and ulcerative colitis
Edward Fox: Association for Cancer Research Annual
Meeting. Mutator phenotype of sporadic human colon
cancer.
Research Collaborators:
Prof. Peter Rabinovitch, University of Washington, Seattle, USA
Prof. Larry Loeb, University of Washington, Seattle, USA
Dr Orla Howe, Dr. Fiona Lyng, DIT, Kevin Street
Dr. Dermot Leahy, Conway Institute, UCD
Prof. Martin Tenniswood, Notre Dame, Indiana
Dr. Cormac Taylor & Dr. Katrina Comferford, Conway
Institute, UCD
Dr. Amanda McCann, Conway Institute, UCD
Prof. Kevin Malone, St Vincents University Hospital, Dublin
Dr. Ursula Fearon & Dr Doug Veale, Rheumatology, S.V.U.H.
Prof Walter Kolch, Beatson Institute, Glasgow
Prof Patrick Johnson, Almac, Craigavon, Belfast.
Dr. Elizabeth Ryan, Trinity College Dublin.
Research Activities
Breast Cancer Research
Principal Investigator:
Professor Joe Duffy
Researchers:
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.
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 HRB-funded Programme Grant.
Dr Aisling Pierce,
Dr Eadaoin McKiernan,
Dr Siun Walsh,
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 Enda McDermott,
Mr Denis Evoy,
Dr Liam Gallagher
(UCD), Professor
Steve Pennington
(UCD), Professor
F Martin
(UCD),
Dr Norma O’Donovan
(DCU)
Collaborators (International):
Drs Denis Slamon, 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.
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Dr Siun Walsh is investigating new therapeutic targets
for the treatment of an aggressive subtype of breast
cancer, known as the triple-negative subtype. Triplenegative breast cancers are so named as they lack
expression of estrogen receptor (ER), progesterone
receptor (PR) and do not exhibit overexpression or
amplification of the HER-2 gene. Consequently, targeted
therapy is currently unavailable for this subgroup of
patients. Although triple-negative cancers represent a
relatively small minority of invasive breast cancers (1520%), they are responsible for a disproportionate
number of breast cancer deaths. There is thus an
urgent need to identify novel targets and to develop
therapeutic strategies that will improve the prognosis for
this sub-group of breast cancer patients.
Aisling Pierce is involved in using proteomics and
glycomics for the early detection of breast cancer. She is
also investigating the potential role for the breast-specific
gene, mammaglobin, in the formation of breast cancer.
Invited Presentations at International
Meetings
Duffy MJ, 2ndMultidisciplinary Cancer Symposium,
Uludag, Turkey, Title of Presentation: Personalised
Treatment for Cancer: How Biomarkers Can Help.
Duffy MJ, 36th International Society for Oncology and
Biomarkers Conference, Tokyo, Title of Presentation,
The Future of Tumor Markers: New Technologies and
New Approaches.
Duffy MJ, 14th Hamburg Symposium on Tumor
Markers, Hamburg, Title of Presentation, Conformities
and Inconsistencies in the Use of Tumor Markers
Duffy MJ, All-Ireland Cancer Conference, Dublin, Title of
Presentation, uPA and PAI-1 as Validated Biomarkers in
Breast Cancer: From Pilot Studies to Recommendation
for Clinical Use.
Research Activities
Psychiatry & Mental Health Research
100 Lived Lives: A Visual Arts Autopsy Study. (Seamus
McGuinness)
Principal Investigator:
Prof Kevin Malone
I. Suicide Studies in Ireland:
Number of Patient Contacts (2008);
Over 220 relatives have been interviewed in
relation to 104 suicide deaths.
250 Coroners files have also been retrieved for
research study.
Description of Project:
This programme of research focuses on different
aspects of suicide in Ireland. Specifically, the programme
includes 4 major research projects.
The Suicide in Ireland Survey is adopting a novel
psycho-biographical autopsy methods approach to
studying young lives lost to suicide in modern Ireland.
In addition to the Principal Investigator, there are 3
dedicated Ad Astra PhD Scholars working on discrete
aspects of the project. The study aims to recruit 120
cases and 120 living community controls, and will be
the largest and most comprehensive study of its kind in
these islands. The study aims to bring greater
understanding of the problem of suicide in Ireland, and
will inform tailored strategies to guide new intervention
and prevention approaches.
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In addition to talking part in the Suicide in Ireland Survey,
families are also invited to donate belongings of the
deceased to the Visual Arts Autopsy study. The aims of
this project are to provide a greater understanding of
the deceased individuals behind the suicide statistics
through a creative arts practice. 60 families have
participated in this study and donated belongings to the
Visual Arts Autopsy.
Peer effects of young male suicide in Ireland.
(Lorna Sweeney)
The effects of young male suicide deaths on their male
peers is poorly understood. This project aims to
interview 50 affected peers in different communities to
contribute to our understanding about suicide clusters
in youth suicide in Ireland.
The Second Chance Study: A study of high lethality
suicide attempters (Leah Quinlivan)
This project uses similar psychobiographical interview
methods to profile and develop models to provide a
greater understanding of the suicidal process.
Research Activities
II. Psychobiology Studies in Suicidal Depression:
This is an inter-disciplinary research programme of
research exploring biological factors associatred with
stress and depression. Specifically, projects in this
programme have examined the links between stress,
inflammation, cellular aging and depression. The
collaborative group includes Prof. Donal O’Shea, Prof.
Cliona O’Farrelly, Dr. Jacinta O’Sullivan and Prof. Malone.
Dr. Gavin Rush is completing his MD Thesis on the
effects of ECT on inflammatiory markers in depression.
Aoife O’Donovan recently successfully defended her
PhD on “Threat-related psychological variables,
inflammation and cellular aging”. She has just finished a
Fulbright scholarship in UCSF where she is currently a
post-doctoral fellow.
Presentations
Contemporary Textiles,the fabric of fine art. Seamus
Mc Guinness Spaces black dog publishing, London
2008.
Touch, Textiles, Technology; Collaborations across
Europe. McGuinness S & Malone K. CHRRC, Goldsmiths
College, University of London, Sept 2008
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"A Qualitative Exploration of the Perceptions of
Depression in Young Irish men". Lorna Sweeney.
American Men's Studies Association 17th Annual
Conference on Men and Masculinities, April 4th-6th,
2008. North Carolina, USA.
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.
Poster Sessions:
1. Assessment of Cardiac Risk in Young Athletes
Dr. Ken McDonald
2. Is it Asthma – Is it C.O.P.D – How do I manage it ?
Prof. Michael Keane
3. Upper Abdominal Pain – Assessment in General
Practice
Mr. Donal Maguire
4. Benign Anorectal Disease
Prof. Ronan O’Connell
Annual Hospital Study Day
It was agreed by the members of the GP Committee
that the Annual Hospital Study Day be held this year on
Saturday 5th April 2008. This proved to be very
successful. The educational format consisted of two
Poster Sessions and two Interactive Sessions as follows:
Interactive Sessions:
1. Assessment and Management of Upper Limb
Problems
Dr. Bernadette Lynch / Dr. Anne Barbara Mongey
The Postgraduate Breakfast Meetings include:
Colorectal Meeting
at 7:30am every Tuesday in the
Pathology Dept, 3rd Floor
Grand Rounds
at 8:00am every Thursday in
ERC/Old Lecture Theatre
2. Assessment of Headache
Dr. Niall Tubridy
Respiratory SpR Conference at 8:00am every Friday
At 6.30pm there was a Panel Discussion on “What
Hospital Services can the GP Access?”
Later that evening the reception and dinner was held in
the atrium of the Ambulatory Day Care Centre and was
attended by approximately 100 guests.
Medical and Surgical Meetings
The Postgraduate Lunch Time Meetings include:
Intern Report at 1:00pm every Tuesday in the ERC
Nephrology at 1:00pm every Wednesday in the
conference room (beside Juice Bar)
Gastroenterology at 1:00pm every 1st and 3rd
Wednesday of every month in ERC Rheumatology
at 1:00pm every Friday in ERC
Cardiology Meeting
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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.
at 7:30am every Friday
All of the above meetings are organised by the Postgraduate Department. Lunch or breakfast is provided.
Some meetings do not run for the Summer months
Intern Lunch Time Seminars
Monday Lunch Time Seminars for Interns consist of
Clinical Skills Sessions and Data Interpretation.
The Tuesday Lunch Time Seminar is organised 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.
40
Thursday Lunch Time Lectures are on matters relating
to all aspects of Surgery and are given by Consultant
Surgeons within the hospital.
SHO Teaching
Formal Clinical Teaching
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 5.00pm to maximise attendance and to allow
SHOs in peripheral jobs to attend. Consultants are
asked to focus on a short case format
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.
International Meeting
In addition to the large number of in-house meetings,
the Postgraduate Department helped organise the
Centre for Colorectal Disease 15th International
Meeting which was held on Friday 12th September
2008. The programme was as follows:
Session 1
Inflammation and Cancer
Genomic Instability & Disease Progression – Dr. J
O’Sullivan
Immunosuppression & Obesity – Dr. L Lynch
Hypoxia, Inflammation & Cancer – Prof. C Taylor
Session 2
Surveillance for Cancer in IBD
Recommendations and Reality – Prof. D O’Donoghue
Case Presentations
–
Dr. H Mulcahy
Session 3
Risk Stratification of the patient with
Colorectal Cancer
Clinical and Pathological issues – Prof. K Sheahan;
Dr. H Mulcahy
Session 4
State of the Art Lecture
Pharmacogenetics of Colorectal Cancer:
Concept to Reality – Prof. P Johnson
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There were 100 attendees at the meeting.
Dinner was held afterwards at the Fitzwilliam Lawn
Tennis Club.
Sponsorship for this event was provided by the
following pharmaceutical companies:
Astra Zeneca; Healthcare 21; Johnson & Johnson;
Merck Serono; Sanofi Aventis.
The Student Summer Project
As in other years this is an important part of the
hospital’s academic year and in 2008 it was held on
Monday 15th December. As you are aware 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, Prof.
Michael Keane, Mr. Enda McDermott, Mr. Donal O’Shea
and Dr. Kieran Sheahan.
The winner was Josen McGrane whose project was
entitled “Preserved Cognitive Function is Associated
with Suicidal Ideation and Single Suicide Attempts in
Schizophrenia”.
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
representative meets the consultants and NCHDs to
discuss their products. This link is important for both
doctors and medical representatives.
The Library
The Library and Information Service (LIS) facilitates the
staff of the three hospitals in St. Vincent’s Healthcare
Group and all students, resident or on placement. The
LIS supports the information needs of its users and
therefore the clinical practice, education and research
activities of the Group.
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The LIS collections comprise print and electronic
resources including books, journals, reports, databases
etc. The electronic resources can be accessed through
the SVUH IT network and intranet and are also available
remotely with an Athens account, which all staff may
apply for. UCD’s electronic collections are available on
the 17 PCs in the Library. These are strictly for research
or hospital business (e.g. patient care) only. We offer
basic and advanced training on all our electronic
products, by appointment.
Other services include: lending service, document
delivery, photocopying, scanning and printing (b/w and
colour).
Co-ordinator of Postgraduate Education.
Translational Research Seminars 2007/08
A new series of multidisciplinary research seminars
The second seminar in this series, held in the ERC on
Ethics Committee) with the arthritis research group and
were initiated and chaired by the Medical Director of
22nd November 2007 brought together the
Dr Peter Doran, the newly appointed Scientific Director
the Education and Research Centre, Professor Douglas
Professorial Department of Medicine, led by Professor
of the UCD Clinical Research Centres based at the
Veale, over the last year to focus on Translational
Michael Keane, and the wider Respiratory research
Mater and St. Vincent’s University Hospitals. Dr. Doran
research opportunities. The first seminar, held in the
group including cystic fibrosis and sleep disorders along
introduced the concept of developing an integrated
ERC on 28th June 2007, brought together researchers
with the Cardiology group and basic researchers from
research infrastructure across the DAHC, providing core
from the Obesity, Liver and Arthritis groups with
the Conway Institute. The discussion covered common
research support services such as the Distiller database.
researchers from the Conway Institute to discuss joint
mechanisms of inflammation and fibrosis in lung and
Prof. Sarah Rogers was pleased to update the group on
opportunities in these areas. There was a lively
heart disease, especially heart failure. It is recognised
the exciting new developments regarding the Charles
discussion in relation the mechanisms of inflammation
that patients suffering from lung fibrosis and heart
Institute of Translational Research which will be based
and the potential for novel drug development in the
failure may share similar cellular and molecular
on the UCD campus next to the Conway Institute. The
common areas in particular cytokine inhibition.
dysfunction and that researchers in both these areas
groups identified a number of key common
Interestingly, the possibility of novel biomarkers
can work more closely together to understand the
translational research interests and significant progress
common to obesity and arthritis was discussed
pathways involved and possible new therapies to
has already been made to ensure that the efficient
extensively and this has led to a new cooperative
intervene in these diseases in the clinic.
collection of clinical and scientific data especially
relating to patients commencing biologic therapies. It is
research focus. Biomarkers are recognised increasingly
43
to be critical to translational medicine for the
The final seminar of the series held in the ERC on 25th
hoped that further close collaboration between these
identification and monitoring of disease activity and
June 2008 brought together researchers in skin disease
groups will provide a model for integrated,
response to therapies.
led by Professor Sarah Rogers, Dr Paul Collins and Dr
multidisciplinary and translational research in
Brian Kirby (Chairman of the Medical Research and
inflammatory diseases in the DAHC.
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Academic Activities
Bone Workshop 18/01/2008
Education and Research Centre, Seminar Room
St. Vincent’s University Hospital, Elm Park, Dublin 4
Chairperson:
Prof O FitzGerald, St Vincent’s University Hospital
Speaker Schedule
44
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11:30-11:50
Periarticular Osteoporosis in Inflammatory Arthritis
Prof Barry Bresnihan, Consultant Rheumatologist at SVUH and Conway PI
11:50-12:30
Comparison of BMD measurements and bone biomarkers in Rheumatoid Arthritis and Psoriatic Arthritis receiving biologic therapy
Dr Vincent Ng, Research Fellow, SVUH
12:30-13:00
Lunch
13.00-14.00
Prediction of disease progression in rheumatoid arthritis, osteoarthritis and osteoporosis using bone mass measurements.
Prof David M Reid, Chair of Rheumatology and Head of Department of Medicine & Therapeutics at the University of Aberdeen
14:00-14:30
DXA diagnosis of Osteoporosis: fact or fiction?
Dr John Carey, Consultant Rheumatologist and General Physician, University Hospitals Galway
14:30-15:00
Differential diagnosis of high and low bone mass
Dr Miriam Delaney, Consultant Endocrinologist
15:00-15:15
DXA at SVUH-Precision, Prevalence & Problems
Dr Malachi McKenna, Consultant Endocrinologist St. Vincent’s University Hospital
Academic Activities
Guest Lectures
Friday 16th May 2008
Rheumatology Guest Lecture Prof. Patrick Venables, U.K.
“Citrullinated alpha enolase: a novel autoantigen in RA
specific aetiological and immungenetic associations”
ERC Journal Club 2008
Schedule:
Venue:
Thurs mornings 9.30-10.30am
Seminar 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.
In 2008 several UCD undergraduates carried out
research for their theses at SVUH.
Honours/Awards/Prestigious Invitations
Mary Connolly; SIAR Award (Oral Presentation) American College of Rheumatolog, San Francisco, 2008
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M. Connolly1, J. McCormick1, A. Marelli2, M. Blades2,
O. FitzGerald1, B. Bresnihan1, C. Pitzalis2, D. Veale1, U.
Fearon1 A-SAA Induces Rho GTPase-dependent Cytoskeletal
Rearrangement and In Vivo Migration of Fluorochrome
Labelled Monocytic (u937) Cells in A Human RA/SCID
Mice Chimera Model
Aisling Kennedy; (Oral Presentation)- American College of
Rheumatology, San Francisco, 2008
Aisling Kennedy, Monika Biniecka, Chin Teck Ng,
Jacintha N. O'Sullivan, Ursula Fearon, Douglas J. Veale
Oxidative Damage in the Arthritic Joint leads to an
Unstable Environment and Stimulates Abnormal
Angiogenesis in Synovial Tissue
Ellen Moran; Travel Award
Ellen M. Moran, Ronan Mullan, Jennifer McCormick,
Oliver FitzGerald,
Barry Bresnihan, Douglas J. Veale, Ursula Fearon.
IL-17A Expression Is Modulated by Biologic Therapy and
Drives
Inflammatory Cell Migration In The Human RA Joint
Dr. Lydia Lynch awarded UNESCO-L’Oreal
International Young Women of Science Fellowship
Dr. Lydia Lynch won Researcher of the Year, Conway
Festival of Research September 2008
Dr. Andrew Hogan awarded NUI Maynooth Presidents
Gold Medal 2008 for achievements in academia
and sport.
Dr. Margaret O’Brien won Best Platform Presentation
at the INA (Cork) 2008
Dr. Roisin Lonergan won Best Poster Presentation at
the INA (Cork) 2008
Sheeona Gorman, UCD Seed Funding Travel Award,
2008
Dave Kevans, 3rd poster prize, Irish Society of
Gastroenterology
Garret Cullen, 2nd poster prize, Irish Society of
Gastroenterology
Joe Marry, Irish Cancer Society Oncology Scholar
Travel Award
Professor Dr Joe Duffy
Prof. Dubby continued to serve as Chairman of the
National Academy of Clinical Biochemistry (USA) Panel
for the preparation of guidelines on the Clinical Use of
Tumor Markers in Breast Cancer. During 2008,
Professor Duffy also continued to act as Focus Group
Leader of the Gastrointestinal Group of the European
Group on Tumor Markers (EGTM). EGTM is a European
Academic Activities
Expert Group involved in preparing guidelines on the
use of tumor markers in different maligancies.
Prof. McNicholas gave several lectures as part of major
symposia at the following international scientific meetings:
American Thoracic Society, Toronto, May 2008
American Academy of Sleep Medicine, Baltimore, June
2008
European Respiratory Society, Berlin, October 2008
Prof. O’Shea was invited to give a public lecture in the
RDS entitled ‘Obesity; Treating the Epidemic to Prevent
the Pandemic’ for a series on Ireland towards 2030.
Prof O’Shea was the overall winner of the Undergraduate Teacher of the Year in UCD, Medical School.
Prof. O’ Shea was invited to give the Nordisk lecture for
the Irish Endocrine Society in November 2008.
Prof Barry Bresnihan
Co-Chairman, EULAR Synovitis Study Group
Co-Chairman, OMERACT Synovial Tissue Analysis Study
Group
Italian Society of Rheumatology, Catania
Royal Society of Medicine, London, June
Chairman scientific session, EULAR, June
British Bone Society, Aberdeen, July
46
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Prof Douglas Veale
Appointed Director of Translational Research, Dublin
Academic Health Care
Medical Director, Education & Research Centre, SVUH
Director of THERAPI - Translational Research Group
Vice-president, International Scleroderma Clinical Trials
Consortium
Strategic Scientific Committee, Arthritis Research
Campaign, UK
HRB Infection & Immunity Grant Committee
Irish Medicines Board, Medicines Committee
Wyeth Translational Science European Expert Group
Schering-Plough International Advisory Panel
Centocor International Advisory Panel
Co-Chair RCPI Masterclass in Rheumatology
Progress and Promise, Madrid
Prof. Anne Barbara Mongey
Director of the Clinical Skills Laboratory at UCD
Co-ordinator of the Advanced Clinical Skills module for
the Graduate Entry Medicine programme.
Co-ordinator for the Elective module for undergraduate
and graduate entry medical students.
Prof Oliver FitzGerald
Chairman, Arthritis Ireland (Oct-present)
Member of HSE working group on Arthritis and Allied
conditions representing the Irish Society of Rheumatology
Steering committee member for GRAPPA (Group for
Research and Assessment of Psoriasis and Psoriatic
Arthritis)
Member of Abbott International Immunology Advisory
Board
Lead Consultant Bone & Joint Unit, SVUH
Steering committee member of OMERACT Biomarkers
Group
Scientific committee member 3e Initiative in
Rheumatology
Rochester University, Visiting Speaker
Progress and Promise, Munich
Ulster Internal Medicine Association, Belfast
Dr. Ursula Fearon
Senior Scientist Rheumatology
Chairperson Scientific Sesssion of The American College
of Rheumatology,
San Francisco, November 2008
Higher Degrees
Ronan Mullen
PhD
June 2008
Lucille Kavanagh
PhD
Sept 2008
Publications
Alonderis A, Barbé F, Bonsignore M, Calverly P, De
Backer W, Diefenbach K, Donic V, Fanfulla F, Fietze I,
Franklin K, Grote L, Hedner J, Jennum P, Krieger J, Levy
P, McNicholas W, Montserrat J, Parati G, Pascu M,
Penzel T, Riha R, Rodenstein D, Sanna A, Schulz R,
Sforza E, Sliwinski P, Tomori Z, Tonnesen P, Varoneckas
G, Zielinski J, Kostelidou K. Medico-legal implications of
sleep apnoea syndrome: driving license regulations in
Europe. Sleep Medicine 2008 May;9: 362-375 PMID
17765641
Baird AW, Skelly MM, O'Donoghue DP, Barrett KE, Keely
SJ. Bradykinin regulates human colonic ion transport in
vitro. Br J Pharmacol. 2008 Oct;155(4):558-66. PMID
18604228
Beddy D, Hyland J, Winter D, Lim C, White A, Moriarty
M, Armstrong J, Fennelly D, Gibbons D and Sheahan K.
A simplified tumor regression grade correlates with
survival in locally advanced rectal carcinoma treated
with neoadjuvant chemoradiotherapy. Ann Surg
Oncol, 2008, Dec15(12):33471-7 PMID 18846402
Beetz C, Schüle R, Deconinck T, Tran-Viet KN, Zhu H,
Kremer BP, Frints SG, van Zelst-Stams WA, Byrne P, Otto
S, Nygren AO, Baets J, Smets K, Ceulemans B, Dan B,
Nagan N, Kassubek J, Klimpe S, Klopstock T, Stolze H,
Smeets HJ, Schrander-Stumpel CT, Hutchinson M, van
de Warrenburg BP, Braastad C, Deufel T, Pericak-Vance
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M, Schöls L, de Jonghe P, Züchner S.REEP1 mutation
spectrum and genotype/phenotype correlation in
hereditary spastic paraplegia type 31. Brain 2008
April; 131(Pt 4):1078-86. PMID 18321925
Costello L, Thompson A, Walsh, C. Tubridy N, Hutchinson
M. Long term clinical relevance of criteria for
designating Multiple Sclerosis as benign after ten years
of disease. J Neurol Neurosurg Psychiatry 2008 May
13. PMID 18477712
Brennan DJ, Rexhepaj E, O'Brien SL, McSherry E,
O'Connor DP, Fagan A, Culhane AC, Higgins DG,
Jirstrom K, Millikan RC, Landberg G, Duffy MJ, Hewitt
SM, Gallagher WM. Altered cytoplasmic-to-nuclear ratio
of survivin is a prognostic indicator in breast cancer.
Clin Cancer Res. 2008 May 1;14:2681-9. PMID
18451232
Costelloe L, O’Rourke K, McGuigan C, Walsh C, Tubridy
N, Hutchinson M. The longitudinal relationship between
the patient-reported Multiple Sclerosis Impact Scale
and the clinician-assessed Multiple Sclerosis Functional
Composite. Mult Scler 2008 Mar;14(2):255-8. PMID
17942522
Bronner M*, O’Sullivan J*, Rabinovitch P, Crispin D, Chen
L, Emond M, Rubin C, Brentnall T. Genomic Biomarkers
Identify Distant Colorectal Cancer in Ulcerative Colitis.
Am J Pathol. 2008 Dec;173(6):1853-1860.
Cullen G, Keegan D, O'Donoghue D. Safety and
efficacy of cyclosporine therapy in inflammatory bowel
disease. Am J Gastroenterol. 2008 Oct;103(10):26545 PMID 18855861
Joint first authors PMID 18988798
*
Coss A, Tosetto M, Fox E, Sapetto-Rebow B, Gorman S,
Kennedy B, Lloyd, Hyland J, O’Donoghue D, Sheahan K,
Leahy D, Mulcahy H*, O’Sullivan J*. Increased
Topoisomerase II· Expression in Colorectal Cancer is
Associated with Pathologically Aggressive Disease and
Leads to Chemotherapy Resistance via Inhibition of
Apoptosis. * Joint lead investigators. Cancer Lett 2008
Dec 24. PMID 19111388
Doherty LS, Cullen JP, Nolan P, McNicholas WT. The
human genioglossus response to negative airway
pressure: stimulus timing and route of delivery. Exp
Physiol. 2008 Feb;93(2):288-95. PMID: 17951328
Doran JP, Veale DJ. Biomarkers in systemic sclerosis.
Rheumatology (Oxford) 2008 Oct;4. Suppl 5:v36-8.
PMID 18784139
Publications
Duffy M, McGowan P, Gallagher W. Cancer invasion
and metastasis:changing views. J. Pathol 2008
Feb;214(3):283-93 PMID 18095256
Duffy MJ, Crown J. A personalized approach to cancer
treatment: how biomarkers can help. Clin Chem. 2008
Nov;54:1770-9. PMID 18801934
Feighery LM, Cochrane SW, Quinn T, Baird AW, O'Toole
D, Owens SE, O'Donoghue, D, Mrsny RJ, Brayden DJ.
Myosin light chain kinase inhibition: correction of
increased intestinal epithelial permeability in vitro.
Pharm Res. 2008 Jun;25(6):1377-86. PMID 18163202
Fleming F. Sheahan K. Winter D. Concomitant ulcerative
colitis and rectal cancer in a patient with Gorlin
syndrome. Inflamm Bowel Dis. 2008 Aug 4. PMID
18680193
Furst DE, Keystone EC, Kirkham B, Kavanaugh A,
Fleischmann R, Mease P, Breedveld FC, Smolen JS,
Kalden JR, Burmester GR, Braun J, Emery P, Winthrop K,
Bresnihan B, De Benedetti F, Dörner T, Gibofsky A,
Schiff MH, Sieper J, Singer N, Van Riel PL, Weinblatt ME,
Weisman MH Updated consensus statement on
biological agents for the treatment of rheumatic
diseases, 2008. Ann Rheum Dis. 2008 Dec;67 Suppl
3:iii2-25 PMID 19022808
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Golden-Mason L, Madrigal-Estebas L, McGrath E,
Conroy M.J, Ryan E.J, Hegarty J.E, O'Farrelly C & Doherty
D.G. Altered natural killer cell subset distributions in
resolved and persistent hepatitis C virus infection
following single source exposure. Gut. 2008 Aug;
57(8):1121-8. PMID 18567923
Hanein S, Martin E, Boukhris A, Byrne P, Goizet C,
Hamri A, Benomar A, Lossos A, Denora P, Fernandez J,
Elleuch N, Forlani S, Durr A, Feki I, Hutchinson M,
Santorelli FM, Mhiri C, Brice A, Stevanin G. Identification
of the SPG15 gene, encoding spastizin, as a frequent
cause of complicated autosomal-recessive spastic
paraplegia, including Kjellin syndrome. Am J Hum
Genet 2008 Apr;82(4):992-1002. PMID 18394578
Harenberg A, Guillaume F, Ryan E.J, Burdin N & Spada
F. Gene profiling analysis of ALVAC infected human
monocyte derived dendritic cells. Vaccine. 2008 Sep
15;26(39):5004-13. PMID 18691624
Harte S, McNicholas WT, Donnelly SC, Dodd JD.
Honeycomb cysts in idiopathic pulmonary
haemosiderosis: high-resolution CT appearances in two
adults. Br J Radiol. 2008 Dec;81(972):e295-8. PMID:
19029052
Heneghan C, de Chazal P, Ryan S, Chua CP, Doherty L,
Boyle P, Nolan P, McNicholas WT. Electrocardiogram
recording as a screening tool for sleep disordered
breathing. J Clin Sleep Med. 2008 Jun 15;4(3):223-8.
PMID: 18595434
Heneghan C, Chua CP, Garvey JF, de Chazal P,
Shouldice R, Boyle P, McNicholas WT. A portable
automated assessment tool for sleep apnea using a
combined Holter-oximeter. Sleep. 2008 Oct
1;31(10):1432-9. PMID: 18853941
Hutchinson M, Waters P, McHugh J, Gorman G,
O'Riordan S, Connolly S, Hager H, Yu P, Becker CM,
Vincent A. Progressive encephalomyelitis, rigidity, and
myoclonus: a novel glycine receptor antibody.
Neurology 2008 Oct 14; 71(16):1291-2. PMID
18852446
Jarnicki A, Conroy HE, Brereton C, Donnelly G, Toomey
D, Sweeney C, Fletcher JM, Lavelle E, Dunne PJ and
KHG Mills. Attenuating regulatory T cell induction by
TLR agonists through inhibition of p38 MAPK signaling
in dendritic cells enhances their efficacy as vaccine
adjuvants and cancer immunotherapeutics. J.
Immunol 2008 Mar 15; 180(6):3797-806. PMID
18322186
Publications
Keane J. Bresnihan B. Tuberculosis reactivation during
immunosuppressive therapy in rheumatic diseases:
diagnostic and therapeutic strategies. Curr Opin
Rheumatol 2008 Jul;20(4):443-9. PMID 18525359
McHugh JC, Tubridy N, Collins CD, Hutchinson M.
Unusual MRI abnormalities in the anti-Yo positive
“pure” paraneoplastic cerebellar degeneration.
J. Neurol 2008 Jan;255(1):138-9. PMID 17994310
Kennelly R, Kavanagh D, Hogan A, Winter D. Oestrogen
and the colon:potential mechanisms for cancer
prevention. Lancet Oncol, 2008, April 9(4):385-391.
PMID 18374292
McKiernan E, O'Brien K, Grebenchtchikov N, GeurtsMoespot A, Sieuwerts AM, Martens JW, Magdolen V,
Evoy D, McDermott E, Crown J, Sweep FC, Duffy MJ.
Protein kinase C delta expression in breast cancer as
measured by real-time PCR, western blotting and
ELISA. Br J Cancer. 2008 Nov;18;99:1644-50. PMID
19002183
Marnane M, Vincent A, Hutchinson M. New-onset focal
epilepsy with palatal tremor and glutamic acid
decarboxylase antibodies responding to intravenous
immunoglobulin. J Neurol 2008 Oct;255(10):1603-4.
PMID 18758886
McGowan PM, McKiernan E, Bolster F, Ryan BM, Hill
AD, McDermott EW, Evoy D, O’Higgins N, Crown J,
Duffy MJ. ADAM-17 predicts adverse outcome in
patients with breast cancer. Ann Oncol. 2008
19:1075Jan 30 PMID 18238782
McGowan PM, Duffy MJ. Matrix metalloproteinase
expression and outcome in patients with breast cancer:
analysis of a published database. Ann Oncol 2008
Sep:19(9):1566-72. PMID 18503039.
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McNicholas WT Diagnosis of obstructive sleep apnea in
adults. Proc Am Thorac Soc. 2008 Feb 15;5(2):15460 PMID 18250207
McNicholas WT. The nose and OSA: variable nasal
obstruction may be more important in pathophysiology
than fixed obstruction. Eur Respir J. 2008 Jul;32(1):38. PMID: 18591332
McNicholas WT. Diagnosis of obstructive sleep apnea
in adults. Proc Am Thorac Soc. 2008 Feb
15;5(2):154-60. PMID: 18250207
Merkel PA, Silliman NP, Denton CP, Furst DE, Khanna D,
Emery P, Hsu VM, Streisand JB, Polisson RP, Akesson A,
Coppock J, van den Hoogen F, Herrick A, Mayes MD,
Veale D, Seibold JR, Black CM, Korn JH; Validity,
reliability, and feasibility of durometer measurements
of scleroderma skin disease in a multicenter treatment
trial. CAT-192 Research Group; Scleroderma Clinical
Trials Consortium. Arthritis Rheum. 2008 May
15;59(5):699-705. PMID 18438905
Miller DH, Weinshenker BG, Filippi M, Banwell BL,
Cohen JA, Freedman MS, Galetta SL, Hutchinson M,
Johnson RT, Kappos L, Kira J, Lublin FD, McFarland HF,
Montalban X, Panitch H, Richert JR, Reingold SC,
Polman CH. Differential diagnosis of suspected
multiple sclerosis: a consensus approach. Mult Scler
2008 Nov;14(9):1157-74. PMID 18805839
Murphy E, Bresnihan B, Fitzgerald O. Measurement of
periarticular bone mineral density in the hands of
patients with early inflammatory arthritis using dual
energy x-ray absorptiometry. Clin Rheumatol 2008
Feb 21 PMID 18288445
Murphy SM, Rogers A, Hutchinson M, Tubridy N.
Counting the cost of complementary and alternative
therapies in an Irish neurological clinic. Eur J Neurol.
2008; Dec15(12):1380-3. PMID 19049557
Publications
Ng CT, O'Neil M, Walsh D, Walsh T, Veale DJ. Successful
pregnancy after rituximab in a women with recurrent in
vitro fertilisation failure and anti-phospholipid antibody
positive. Ir J Med Sci 2008; Nov 29 PMID 19043774
O’Brien N, O’Donovan N, Foley D, Hill AD, McDermott
E, O’Higgins N, Duffy MJ. Use of a Panel of Novel
Genes for Differentiating Breast Cancer from NonBreast Tissues. Tumour Biol. 2008 Feb5;28(6):312317 PMID 18253069
O’Donovan, A., Lin, J., Tillie, J., Dhabhar, F., Wolkowitz,
O., Blackburn, E., Epel, E. Pessimism correlates with
leukocyte telomere shortness and elevated interleukin6 in post-menopausal women. Brain, Behavior and
Immunity 2008 PMID 191119222
O’Donovan, A. & Hughes, B.M. Access to social support
in life and in the laboratory: combined impact on
cardiovascular reactivity to stress and state anxiety. J of
Health Psychology 2008 Nov; 13(8), 1147-1156
PMID 18987087
O’Kane M, Markham T, McEvoy AN, Fearon U, Veale DJ,
Kirby B, Murphy EP. Increased expression of the orphan
nuclear receptor NURR1 in psoriasis and modulation
following TNF-alpha inhibition. J. Invest Dermatol
2008 Feb;128(2):300-10 PMID 17671512
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O’Loughlin, C., Murphy, N.F., Conlon, C., O’Donovan, A.,
Ledwidge, McDonald, K. Quality of life predicts
outcome in a heart failure disease management
program.
Int J of Cardiology 2008 Oct 12 PMID 18851887
O'Shea U, Abuzakouk M, O'Morain C, O'Donoghue D,
Sheahan K, Watson P, O'Briain, S, Alexander D,
Catherwood M, Jackson J, Kelly J, Feighery C.
Investigation of molecular markers in the diagnosis of
refractory coeliac disease in a large patient cohort. J
Clin Pathol. 2008 Nov;61(11):1200-2. PMID
18955575
O’Sullivan J, Sheridan J, Mulcahy M, Tenniswood M and
Morrissey C. The effect of green tea on oxidative
damage and tumour formation in Lobound-Wistar rats.
European Journal of Cancer Prevention. 2008, Nov;
17(6):489-501. PMID 18941371
Rexhepaj E, Brennan DJ, Holloway P, Kay EW, McCann
AH, Landberg G, Duffy MJ, Jirstrom K, Gallagher WM.
Novel image analysis approach for quantifying
expression of nuclear proteins assessed by
immunohistochemistry: application to measurement of
oestrogen and progesterone receptor levels in breast
cancer. Breast Cancer Res. 2008;10(5):R89. PMID
18947395
Rosen H.R, Doherty D.G, Madrigal-Estebas L, O'Farrelly
C & Golden-Mason L.
Pretransplantation CD56 (+) innate lymphocyte
populations associated with severity of hepatitis C virus
recurrence.
Liver Transplantation 2008 Jan; 14(1):4-6. PMID
18161829
Rowan AG, Fletcher JM, Ryan EJ, Moran B, Hegarty JE,
O’Farrelly C, Mills KH. Hepatitis C virus-specific Th17
cells are suppressed by virus-induced TGF-b.
J. Immunol 2008 Oct1; 181(7): 4485-94. PMID
18802051
Rubio JP, Stankovich J, Field J, Tubridy N, Marriott M,
Chapman C, Bahlo M, Perera D, Johnson LJ, Tait BD,
Varney MD, Speed TP, Taylor BV, Foote SJ, Butzkueven
H, Kilpatrick TJ. Replication of KIAA0350, IL2RA, RPL5
and CD58 as multiple sclerosis susceptibility genes in
Australians.
Genes Immun 2008 Oct; 9(7):624-30. PMID
18650830
Ryan S, McNicholas WT. Intermittent hypoxia and
activation of inflammatory molecular pathways in OSAS.
Arch Physiol Biochem. 2008 Oct;114(4):261-6.
Review. PMID: 18946786
Publications
Sturgeon CM, Duffy MJ, Stenman UH, Lilja H, Brünner
N, Chan DW, Babaian R, Bast RC Jr, Dowell B, Esteva FJ,
Haglund C, Harbeck N, Hayes DF, Holten-Andersen M,
Klee GG, Lamerz R, Looijenga LH, Molina R, Nielsen HJ,
Rittenhouse H, Semjonow A, Shih IeM, Sibley P,
Sölétormos G, Stephan C, Sokoll L, Hoffman BR,
Diamandis EP. National academy of clinical
biochemistry laboratory medicine practice guidelines
for use of tumor markers in testicular, prostate,
colorectal, breast, and ovarian cancers.
Clin Chem. 2008 Dec;54 (12):e11-79. PMID
19042984
Wang L, McNally M, Hyland J and Sheahan K. Assessing
interstitial cells of Cajal in slow transit constipation
using CD117 is a useful diagnostic test.
Am J Surg Pathol, 2008, Jul, 32(7):980-985. PMID
18460978
Usmani N, Murphy A, Veale D, Goulden V, Goodfield M.
Photochemotherapy for localized morphoea: effect on
clinical and molecular markers.
Clin Exp Dermatol. 2008 Nov;33(6):698-704. PMID
18699840
Walsh R, O'Dwyer JP, O'Riordan S, Bradley D, Moroney
J, Hutchinson M. Cervical dystonia presenting as a
phenocopy in an Irish SCA2 family.
Mov Disord 2008 Dec 11. PMID 19086087
Vandooren B, Cantaert T, van Lierop MJ, Bos E, De
Rycke L, Veys EM, De Keyser F, Bresnihan B, Luyten FP,
Verdonk PC, Tak PP, Boots AH, Baeten D Melanoma
Inhibitory Activity, a biomarker related to chondrocyte
anabolism, is reversibly suppressed by proinflammatory
cytokines in rheumatoid arthritis.
Ann Rheum Dis 2008 Jul 16 PMID 18633128
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Walsh CA, Mullan RH, Minnock PB, Slattery C, FitzGerald
O, Bresnihan B.
Consistency in assessing the Disease Activity Score-28
in routine clinical practice.
Ann Rheum Dis. 2008 Jan;67(1):135-6. PMID
18077544
Wang L, McNally M, Hyland J and Sheahan K. Assessing
interstitial cells of Cajal in slow transit constipation
using CD117 is a useful diagnostic test.
Am J Surg Pathol, 2008, Jul, 32(7):980-985. PMID
18460978
Williams L, O’Connell K, Tubridy N. Headaches in a
rheumatology clinic: when one pain leads to another.
Eur J Neurol 2008 Mar;15(3):274-7. PMID 18290847
P.I.
Name of Study
Fund
Start
Finish
Amount
Date
Date
Cell and molecular mechanisms of cardiovascular
disease in obstructive sleep apnoea.
HRB Project Grant
€220,000
2005
2008
(with Prof C. Henegh
an UCD)
Non-invasive low cost measurements of sleep,
sleep disruption and sleepiness.
Enterprise Ireland
€300,000
2005
2008
Research in sleep apnoea
AstraZeneca
€75,000
2007
2009
Prof. Joe Duffy (with W.
Gallagher, F. Martin
& P. Dervan)
Breast Cancer Metastasis: Biomarkers and
Health Research Board Programme
€1,063,000
2005
2010
Functional Mediators
Grant 2005
Prof. Kieran Sheahan/
Dr. Dermot Leahy
Molecular characterisation of familial colorectal cancers
HRB
€174,400
2006
2009
Dr. Edward Fox
The frequency of random mutations and genomic G
instability in colorectal cancer progression
NCI/HRB
€88,000
2006
2008
HRB Project Grant
€165,000
2006
2009
Altana – Newman
Fellowship
€80,000
2006
2008
Centre for Colorectal Disease
Dr. Garret Cullen
52
Source of Grant
Return to Contents
Cigarette smoking and genomic instability: factors
controlling disease progression and treatment sensitivity
in inflammatory bowel disease patients.
P.I.
53
Name of Study
Source of Grant
Fund
Start
Finish
Amount
Date
Date
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. Jacintha O’Sullivan &
Prof. L. Loeb (Seattle) Post
Doctoral Fellow Edward Fox
Frequency of random mutations and genomic instability
events during colorectal cancer progression.
HRB NCI Cancer
Prevention Grant
€110,000
2007
2009
Prof. D. O’Donoghue,
Dr. Jacintha O’Sullivan,
Prof Johnston & Prof. Harkin
Independent validation of a prognostic gene signature
for Stage II colorectal cancer
Almac Diagnostics
€177,000
2006
2008
Centre for Colorectal Disease
The role of dendritic cell function and its role in governing
treatment response to molecular targeted therapies in
colorectal cancer patients
IRCSET
€72,000
2008
2011
Dr. J. O’Sullivan
(co-applicant)
microRNA Regulation of the Spindle Assembly Checkpoint
(SAC): Implications for Cell Cycle Dysregulation in Ovarian
Cancer and Taxol Responsiveness.
Cancer Research Ireland
€224,826
2008
2011
Dr. J. O’Sullivan/
Prof. D. O’Donoghue
The biological effects of nicotine and cigarette smoke extract
in fibroblasts and explants from Ulcerative and Crohns patients
Abbott: Newman Fellowship
€138,000
2008
2010
Dr. J. O’Sullivan/
Prof. K. Sheahan
Radiation Responses in Rectal Cancer Patients
Irish Health Foundation
€80,000
2008
2010
Return to Contents
P.I.
54
Name of Study
Source of Grant
Fund
Start
Finish
Amount
Date
Date
Prof. D. Veale/Dr. U. Fearon
IL-17 regulates cytoskeletal rearrangement and cell matrix
interactions to promote cell migration and cartilage invasion
in inflammatory arthritis.
PRTLI Cycle 4, PhD studentship
in (Bio) Pharmaceutical and
pharmacological sciences
€98,000
2008
2011
Prof. D.Veale/Dr. U. Fearon/
To examine the expression and functional interactions of
IL-22 in the pathogenesis of inflammatory arthritis
and disease outcome
HRB PhD Clinical Fellowship
€250,000
2008
2011
Dr. U. Fearon/Prof. 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
Prof. 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
Studies of novel cytokines using synovial/cartilage
explant cultures
GSK
€750,000
2006
2008
GSK
€680,000
2006
2008
Prof. B. Bresnihan/
Prof. D. Veale/
Prof. O FitzGerald
Curing Autoimmune Disease – translational approach
EU 6th Framework
€800,000
2006
2011
Return to Contents
P.I.
55
Name of Study
Source of Grant
Fund
Start
Finish
Amount
Date
Date
Prof. D. Veale (co-applicant)
Biopharmaceutical/Pharmaceutical Science Programme
PRTLI Cycle 4
€4,600,000
2007
2012
Prof. Doug Veale/
Dr. BernadetteLynch/
Dr. Ursula Fearon.
To examine the expression and functional interactions of
IL-22 in the pathogenesis of inflammatory arthritis and
disease outcome
Health Research Board
PhD Clinical Fellowship
€250,000
2008
2011
Prof. Doug Veale/
Dr. Ursula Fearon
IL-17 regulates cytoskeletal rearrangement and cell
matrix interactions to promote cell migration and
cartilage invasion in inflammatory arthritis
PRTLI Cycle 4, PhD Studentship in
(Bio) Pharmaceutical and
pharmacological sciences
€98,000
2008
2011
Prof. K. Malone
Suicide in Ireland Survey
Turn the Tide of Suicide Charity
National Office for Suicide Prevention
National Lottery
ESB Electric Aid
Be No Afraid
€200,000
€100,000
€200,000
€75,000
€40,000
2006
2010
Prof. K. Malone &
Dr. S. McGuinness
100 Lived Lives
Ireland Funds (Denis Kelleher Ad Astra
PhD Scholarship)
€100,000
2006
2010
Prof. K. Malone &
Dr. L. Sweeney
Peer Effects of Young Male Suicide in Ireland
Turn the Tide of Suicide Charity
(3Ts Ad Astra PhD Scholarship)
€75,000
2008
2011
Prof. K. Malone &
Leah Quinlivan
The 2nd Chance Study
Ireland Funds of Monaco (Ad Astra
Scholarship in Suicide Studies)
€75,000
2008
2011
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P.I.
56
Name of Study
Source of Grant
Fund
Start
Finish
Amount
Date
Date
Craig Dobbin Newman Scholarship in
Mental Health Research
American Foundation for Suicide
Prevention
€75,000
2005
2009
Newman Scholarship (sponsored
by Sanofi Aventis)
Newman Scholarship (sponsored
by Sanofi Aventis)
€100,000
2007
2008
€100,000
2008
2011
Prof. K. Malone,
Prof. C. O’Farrelly,
Dr. J. O’Sullivan,
Dr. G. Rush. Dr. A. O’Donovan
PsychoNeurobiology Studies in Suicidal Depression
Prof. D. O’Shea/
Dr. L. Lynch
Prof. D. O’Shea
Obesity immunity and inflammation
Dr. L. Lynch
Smoking and the development of type 2 diabetes
H.R.B.
€240,000
2008
2011
Prof. D O’Shea/
Dr. M. Dennedy
Mesenchymal Stem Cell properties in obesity and
metabolic health
ICHMT Endocrine Research Bursuary
(funded by Sanofi Aventis)
€50,000
2008
2009
Dr. L. Lynch
The human omentum as an immunological tool
L’Oreal UNESCO International
Women in Science Fellowship
€35,000
2008
2010
Prof. D. O’Shea
Adipocyte size and type 2 diabetes; a study of patients
undergoing bariatric surgery.
HRB Clinical Fellowship
€180,000
2007
2009
Adipocyte size and type 2 diabetes; a study of patients
undergoing bariatric surgery.
Diabetes Federation of Ireland &
Medical Research Charities
€180,000
2006
2009
Return to Contents
Obesity and the Immune System
€100,000
57
St. Michael’s Hospital Report
I am pleased to report on the activity and
hospital’s physical facilities and general infra-structure.
developments in St. Michael’s Hospital during 2008.
Developments included up-grading ward toilets,
We continue to develop services within the Healthcare
bathrooms and kitchens and the completion of the
Group, while on a National basis the Health Service
waste management facility. Work commenced on
Executive continued with its programme of reform.
refurbishing the building beside the doctors’ residence.
St. Michael’s Hospital prepared and submitted a Service
In 2007 approval was granted to appoint a Design
Plan, in conjunction with St. Vincent’s University
Team for a Theatre and a CSSD Up-Grade. In
Hospital to the Health Service Executive (HSE). The
conjunction with the Estates Department of the HSE
Service Plan detailed the hospital’s projected
this work continued in 2008 and a Design Team was
expenditures, patient activity and capital funding
appointed. In late 2008 the economic environment
requirements. This set the agenda for the Monthly
changed and the HSE has to-date not sanctioned
Monitoring Performance Meetings with the Health
Capital Funding to progress to the next stage.
Service Executive.
As part of St. Vincent’s Healthcare Group, we
58
While demand for hospital services increased the
commenced the process of applying for Accreditation
hospital achieved break-even in relation to its non-
with JCI and had our first consultation meeting with JCI
capital allocation. Work continued on addressing the
surveyors.
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Radiology
I.C.T.
In 2008 our Radiology System, commonly known as
RIS/PACs, demonstrated its true potential. This system
is a major departure from traditional radiology systems
and has proven to be of immense benefit to both
patients and clinicians. There has been a steady
increase in the total patient throughput.
In 2008 we rolled out our improved hospital website
which gives the public information about the hospital
and its services. Other completed projects included the
final phase of the digital CCTV security system and
rollout of the latest software for managing large groups
of Windows-based computer systems.
Pharmacy
The pharmacy department has added to hospital
policies and guidelines as part of hospital process of
application for JCI accreditation. An antibiotic audit was
carried out with the microbiologist to monitor appropriate
antibiotic use. Follow-up monitoring of antibiotic
prescribing is being carried out by ward pharmacists,
who liaise with microbiology. A new medication record
is now in use. Future initiatives will include the
introduction of a new medication management policy,
new warfarin information packs and a new medication
incident form.
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2008 also saw the continuous improvement and
consolidation of ICT in the hospital. This included
updating the network infra-structure, updating servers
and desktops, implementing improvements on ICT
security and maintaining high speed links to St Vincent’s
University Hospital. These ongoing activities improve
critical ICT services which support the day to day
activities of the hospital.
Library
The Library was used consistently throughout the year
as study space by groups such as the final year nursing
students, the midwifery students and medical students.
Information services included a monthly current
notification service to Department Heads, Consultants
and Registrars. The heritage on-line catalogue is also
available on the internet and on the general SVHG
electronic resources web-page.
Laboratory
In Pathology the workload increased by 5.5%
compared with 2007. New developments included the
introduction of the “Raid” dose monitoring system to
the warfarin clinic. This introduced uniformity of warfarin
dose monitoring across the Healthcare Group. The
introduction of the electronic issuing of test results to
GP’s in the community commenced. Preparations
continued to meet the EU Directives on Blood. A pilot
blood transfusion service was developed and tested
between St. Vincent’s University Hospital and St.
Michael’s Hospital.
Human Resources
The Human Resources Department hosted a number
of Forum meetings with Department Heads and Line
Managers during the year covering a wide range of
issues and areas of interest including attendance
management, occupational health, performance
indicators, and team based performance management.
Regular updates on HR related issues at national and
local level were also given.
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In January five of our long serving staff received awards
for over 30 years service each at the Annual Service
Awards held in the Education and Research Centre at
St. Vincent’s University Hospital. They are Marian Coyle,
Catherine Fitzpatrick, Marie McBryan, Declan McCallig
and Paul Riesbeck. Betty Langan who had just recently
retired also received an award for over 30 years service.
Congratulations to all of them!
Retirements during 2008 included Mary Hughes and
Pauline Wrixon from Radiography, Nuala Kelly from A&E
and Kathy O’Brien from Nursing Administration.
Eleanor Keane, CNM2 from Theatre also retired.
Eleanor previously worked in the Private Hospital and
also led the development of our Hospital Sterile
Services Department. Our long standing electrician
Tony Pritchard retired also. We would like to wish each
one a long, happy and healthy retirement and to thank
all of them for their service and dedication to St.
Michael’s Hospital and to our patients.
Nursing
The Nursing Staff are proud to be part of the
multidisciplinary team at St. Michael’s Hospital and to
continue in their endeavours to give holistic care to the
patient population from Dun Laoghaire, the surrounding
areas and the many visitors that crossed the threshold
over the past year.
The Nursing Staff welcomed Frances Campbell to the
position of Nurse Practice Development and Karen
Sweeney to the Clinical ADON position.
The Endoscopy Unit had a significant increase in GP
referrals for endoscopy procedures. To facilitate this, Day
Ward patients were accommodated in St. Patrick’s Ward.
The Infection Control Team led the Hygiene Services for
the HIQA Hygiene Services Quality Review throughout
the hospital and they are to be commended for their
hard work and dedication. The Palliative Care Facilitator
introduced the Liverpool Care Pathway in November
and to date patients have been very successfully
managed on the pathway, which encompasses the
physical, psychological, religious/spiritual and social care
of the patient.
We celebrated our student nurses graduation here in
July and a number of the graduates joined the staff of
the hospital on registration and are a very important part
of the nursing team. The Nursing Staff in St. Michael’s
Hospital continue to be advocates for patients and
strive to deliver efficient, effective and focused care to
all they meet each day in a professional manner.
Chaplaincy
Quality & Risk Department
Conclusion
The Quality Department in St. Michael’s Hospital covers
a number of key elements of hospital activity, such as
Quality & Risk Management, Patient Services, Complaints
Management and an input in developing and structuring
policies and procedures. During 2008 developments
took place in each of these areas, the most significant
of which was the successful implementation of the
New National Patient Chart designed by the NHO
Healthcare Records Steering Committee.
I would like to take this opportunity to express my
appreciation and thanks to all hospital staff for their ongoing work and commitment to the provision of quality
service to patients in St. Michael’s Hospital.
Risk Management and Quality systems were further
developed so that more risks are identified and
incidents reported. The introduction of a Monthly Risk
Management Information Report has proved beneficial
in both the sharing and learning from incidents thereby
improving our overall risk management approach.
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In May we said goodbye to our chaplain, Fr. Seamus
Fleming who retired after seven years service and took
a well deserved break in Egypt. We wish Fr. Fleming
well in his retirement. Fr. Hyacinth Nwakuna assisted
over the summer months until September when we
welcomed Fr. Tom McDonald to our staff.
I thank the Religious Sisters’ of Charity and the Board of
Directors’ for their continued commitment to
developing St. Michael’s Hospital.
I thank the Members of the Executive Council, the
Medical Forum and members of the various other
committees within St. Michael’s Hospital for their
support and help throughout the year.
Finally, I would like to conclude by thanking the Group
Chief Executive Officer, Mr. N.C. Jermyn and the HSE for
their support during 2008.
Organisation Structure
62
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63
St. Vincent's Private Hospital
Overview
St. Vincent’s Private Hospital achieved an overall surplus
of €3.3m in 2008 which is in line with budget. This
was a satisfactory result bearing in mind the additional
costs associated with JCI Accreditation, implementation
of the 37.5 hour week and a reduction in average inpatient occupancy. The hospital continued to expand its
day care activity which contributed to the overall
financial outcome. I would like to thank our Heads of
Departments, consultants and staff who contributed to
the various improvements made during the year which
are outlined in this report. An agreement was reached
with VHI for an 18 month agreement which will provide
greater continuity. Agreements were also concluded
with Quinn-Healthcare and Hibernian Aviva for 2008.
While a number of public patients were provided with
radiotherapy treatment as part of a service level
agreement with the Health Services Executive this
agreement concluded at the end of 2008.
The hospital currently has 164 in-patient beds, 36 daycare spaces (including day-care 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. Patient satisfaction with the
hospital’s services remains high as evidenced by the
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results of the Patient Satisfaction Survey (Overall
satisfaction rating of 97.7% for In-Patient and 98.8% for
Day Care Services as outlined in the Corporate Services
Report). Management continued to implement the
strategic action plan which contains a number of quality
improvement initiatives. I would like to thank Professor
Diarmuid O’Donoghue and the members of the
Consultants Forum for their support in relation to a
wide range of issues during the year.
Patient Activity
In-Patient admissions for 2008 amounted to 7,930 a
decrease of 5.1% over 2007. However General Day
Cases were 4.8% up on 2007 as was day care
oncology cases (12.8%). Radiotherapy activity is 2%
lower than activity in 2007 and pathology tests are
16% up overall. A summary of the Patient Activity for
the year is contained in the Corporate Services Section
of the Report.
General Improvements
A number of improvements were made in 2008 as
follows:
• Existing hospital policies updated and stored on
shared directory
• JCI Accreditation Survey carried out in October 2008
with full or partial compliance achieved with 97% of
the measureable elements. A follow up report will be
provided to JCI by the hospital
• Plans agreed and construction commenced in March
2008 of the new 260 bed Private Hospital on the
St. Anthony’s Site
• Quality Improvement and Safety Committee
Structure developed in compliance with JCI
Standards
• Quality Improvement Plan developed and approved
by Executive Committee
• Patient Scheduling System in Day Care Oncology
introduced
• TSSD computerised tracing system introduced
A more detailed list of improvements is set out in the
reports of the Divisional Managers.
Executive Committee / Management Team
New Private Hospital
The Executive Committee and Management Team
continued to meet throughout the year to review and
monitor progress in relation to the budget, service plan
and performance indicators. The Management Team
also participated on the Quality Improvement and Safety
Committee which is responsible for quality and risk
management at the hospital.
Work is progressing with the Design Team in relation to
the design, construction and commissioning of the new
260 bed private hospital on the St. Anthony’s Site. Senior
management participated on the user groups with the
Design Team to finalise the detailed design aspects of
the hospital. The Design Team comprises Scott Tallon
and Walker, Architects, Bruce Shaw, Quantity Surveyors,
Buro Happold, Mechanical and Electrical Engineers and
ARUP, Structural Engineers. Following a tender John Paul
Construction was selected as the Main Contractor for the
project and construction work commenced on 10/3/2008.
Regular meetings were held with the Heads of
Departments and staff 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 provide 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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Michael Redmond
Chief Executive
Consultant’s Forum
The Consultants Forum met on a monthly basis
throughout the year with hospital management. The
Forum includes representation from medicine (3),
surgery (3), anaesthetics (1), Diagnostic Imaging (1),
Pathology and Board nominations (3). Thanks are due
to all of the consultants who participated on the Forum
during the year.
Among the issues considered by the Forum were the
following:
• Development of the New Private Hospital
• Development of IMRT Services
• Admitting Privileges
Professor D. O’Donoghue, Dr. P. Quigley and Mr. D.
Quinlan represent the Forum on the Executive
Committee and Professor W. McNicholas and Mr.
E.McDermott represent the Forum on the Best Practice
Group. Mr. S. Sheehan and Dr. N. McDonald represent
the Forum on the Theatre Utilisation Committee.
Prof. O’Donoghue participated on the Clinical Record
Review Group which was established to ensure that our
clinical records are maintained in accordance with the
HSE Guidelines and JCI Standards. Significant
improvements were made during the year to ensure
compliance with the clinical record policies and
procedures. A number of audits were carried out and
follow up action taken.
• Radiology Reporting
• Review of Hospital Activity Levels
• Development of RIS/PACS
• Patient Medical Record
• JCI Accreditation Survey
• Claims processing working group
• Theatre Utilisation
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Professor Diarmuid O’Donoghue
Chairman, Consultants Forum
The work of the Corporate Services Division comprises
a number of key elements. These include Quality
Improvement, Safety and Risk Management, Information
Technology, Capital Development and Statistics. During
2008 each element was progressed.
Improvement and Safety Committee. This Committee,
reporting to the Chief Executive, provides an overarching
Governance structure encompassing all hospital
committees relating to quality, safety and risk
management. Committees feeding into it include:
• Health & Safety Committee
Quality Improvement, Safety and Risk
Management
Quality Improvement and Safety was a core element of
the entire year, both in the Corporate Services Division
and throughout the Hospital. In February we applied to
the Joint Commission International (JCI) for Accreditation.
Following a consultative survey in April and seven months
of concentrated work, the Hospital was surveyed by JCI
in October. A very positive report was received in
December, with the hospital meeting the vast majority
of the standards. Three areas were highlighted requiring
additional work to reach the required standard and a
report on the hospitals progress in this regard will be
sent to JCI during 2009.
A major strengthening of the Governance structure for
Quality and Safety formed the lynchpin of the hospital’s
drive for accreditation. The existing Best Practice
Committee structure was expanded into the Quality
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• Radiation Safety Committee
• Accreditation Steering Committee
• Incident Reporting Grading Group
• Hygiene Services Group
In addition formal linkage with Group Committees was
established in the following areas:
• Infection Control
• Clinical Audit
• Drugs & Therapeutics
The Quality Improvement & Safety membership
comprises the senior management team and two
representatives of the Consultants Forum.
The work programme of the Committee in 2008
included:
• Development, review and approval of Hospital
policies in conjunction with the Health & Safety
Committee.
• BP001
Moving and Handling
• BP002
Notifiable Infectious Diseases
• BP005
Prescription Criteria
• BP009
Risk Assessment Process
• BP018
Dress Code Policy
• BP013
Search Policy
• BP015
Complaints Policy
The Hospital Safety Statement (BP000) is reviewed
annually and was updated in December 2008. The
Statement was approved by the Quality Improvement &
Safety Committee and distributed to staff.
The Hospital Internal Emergency and Contingency plan
was again reviewed, augmented and approved by the
Quality Improvement & Safety Committee. A response
to major external emergencies in the community was
added. The plan was tested with a programme of
planned evacuations and desktop exercises.
Incident Reporting
• A report on incidents was presented monthly to
the Quality Improvement & Safety Committee
and Heads of Departments.
• A monthly report of all Medication Incidents was
presented to the Committee.
• A monthly report of all incidents rated as
medium or high risk by the Grading Group was
presented to the Committee.
• Information sessions for staff were provided in
October to raise awareness of the process and
the importance of staff participation. All induction
sessions include information on the incident
reporting process.
Patient Satisfaction
• The ongoing satisfaction survey, for in-patients
and day patients, continued in 2008. 54 inpatient submissions were received with an
overall satisfaction rating of 97.7%. 87 daycare
submissions were received with an overall
satisfaction rating of 98.8%. A monthly report
including statistical analysis and commentary was
prepared and actions taken, where appropriate,
arising from patients comments.
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Complaints and Legal Cases
• The management of patient complaints
consumed a considerable amount of the time
and resources of the Corporate Services Division
in 2008. Forty-eight formal complaints were
dealt with and concluded with a combination of
letters, telephone calls and direct meetings with
the complaining parties. At the commencement
of 2008 twelve legal cases were active. During
the year, two cases were cleared and two new
cases were initiated against the hospital, leaving
twelve active cases at year-end.
Infection Control
• The Group Infection Control Committee provides
infection control guidance for the three hospitals
in the St Vincent’s Healthcare Group. The private
hospital is well represented on the committee. In
our Hospital two external audits of the control
and transport of dangerous goods were carried
out and also a hygiene audit. Action plans were
developed from the audit findings and the risk
issues closed out or reduced. From Board level
through the organisation a culture is fostered to
control and reduce infection and this goal is
driven through the Quality Improvement & Safety
Committee. During 2008 our Clinical Nurse
Manager in infection control worked closely with
the Group.
Health & Safety Committee
• The Health & Safety Committee prepared a plan
for 2008 and completed its action points during
the year. Staff training in Fire Safety, CPR, Manual
Handling, Hand Hygiene and Food Hygiene was
actively pursued. The Water Safety Management
and Waste Management Sub-Groups achieved a
programme of work to ensure that the hospital
complies with legislation and safeguards patients
and staff.
Information Technology
The Hospital continued its service level agreement with
the ICT Department of St. Vincent’s University Hospital
in 2008. An additional IT project manager was added to
the team to address a number of the projects which
will take place in the coming year and in preparation for
the new hospital.
Considerable work has been achieved in bringing the
infrastructure of ICT up to a new level and in providing
a secure and robust platform for future development.
The upgrade work is part of an ongoing programme of
development. Key enhancements of the IT structure
were carried out in Pharmacy, Pulmonary Function and
the hospital network.
Patient Discharges
Jan to Dec
2007
Jan to Dec
2008
Variance
Variance
%
8,355
7,930
-425
-5.1%
83.54%
81.30%
-2.2%
-2.7%
46,336
44,967
-1,369
-3.0%
5.55
5.67
0.12
2.2%
Daycases
7,482
7,841
359
4.8%
Oncology Daycases
5,816
6,559
743
12.8%
SVPH Theatres
3,941
3,684
-257
-6.5%
Theatre SVUH
779
991
212
27%
Minor Operating Theatre
4,979
4,671
-308
-6.2%
Endoscopy unit
5,760
5,694
-66
-1.1%
In-patients
In-patient Occupancy
New applications were introduced to provide a patient
scheduling system in Oncology Daycare and TSSD tracing.
In-patient Bed days
Av. Length of stay (Days)
Planning for ICT in the new Hospital continued, with
plans being developed for hardware and applications.
This work will continue to be refined in the next year.
Capital Development
The planning and preparation for the new Hospital
continued in 2008. This exciting project has been
progressed with the design team and the commitment
will continue, through the design and build stages, to
completion in 2009 / 2010.
In 2008 capital expenditure also continued on major
and minor developments to ensure the continued high
level of service in the period prior to the opening of the
new Hospital. Projects completed included:
Daycases
Operating Theatres
Diagnostic Imaging
No of Studies
29,397
29,569
172
0.6%
Radiotherapy
No of Treatments
14,764
14,448
-316
-2%
Cardiology
No of Procedures
6,478
6,572
94
1.5%
Respiratory Medicine
No of Procedures
3,029
3,537
508
17%
Pathology Tests
No of Procedures
466,476
540,097
73,621
16%
• Fire Safety Doors and Fire Sealing work
• Emergency lighting and signage
• Operating theatre Refurbishment
• HANU ward development
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Nursing Division
Overview
Staffing
Nursing Division made substantial progress in 2008 by
Much progress was made in 2008 in the area of
recruitment with nursing complements being filled
consistently throughout the year. Eleven new graduate
nurses were recruited in July and following a very
successful orientation programme integrated very well
into patient care areas.
introducing Quality Improvement initiatives using the
structure of the Joint Commission International
Accreditation process as a focus. We worked in close
collaboration with colleagues in other Divisions. Nursing
is a collaborative profession existing in a complex health
care system facing the familiar challenge in 2008 of
cost versus quality. The availability of qualified nurses to
the labour market allowed us to work towards our goals
with a stable workforce and saw us less reliant on
transient agency nurses.
June saw the introduction of the 37.5 hour working
week for nurses within the agreed criteria.
The summer months saw us engaged in preparations
for JCI survey. Thanks to the tremendous effort by all in
the Nursing Division we were able to successfully
bridge the gaps between the mock survey in April and
the October survey by meeting the criteria outlined in
the JCI Manual.
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Educational, Professional and Personal Development
support was valued. Our Clinical Nurse Specialists
provided expert support and enhanced the quality of
patient care.
Clinical Nurse Managers together with their teams
excelled in their commitment to the hospital most
especially in the weeks prior to the JCI survey.
Our portering team underwent a review of the service
and agreed changes to practice to enhance service
delivery.
Our Chaplaincy team provided much support to
patients and staff.
The Admissions Department remained adaptable in
managing demand for in-patient admissions.
Nursing Division
Service Developments/Activities
Hawthorn Ward
The Hawthorn Acute Nursing Unit (H.A.N.U.) opened in
February to allow for cohorting of patients post major
abdominal surgeries following return to S.V.P.H. from
ITU and HDU. Much collaboration with staffing in SVUH
took place with staff in ITU and with the Outreach
Programme Co-ordinator in order to develop a nurse
education programme with a decision tree algorithm. A
trigger alert system was developed to allow for
appropriate and timely interventions to prevent patients
returning to ITU with complications.
Decontamination Unit
Tracking and traceability system was installed in CSSD in
October. Following an inventory of medical devices
used in St. Vincent’s Private Hospital, almost all items at
ward level are now included in the traceability system.
Day Care Oncology
Day Care Oncology saw the restructuring of seating
arrangements to accommodate more patients. Times of
appointments and opening hours changed to suit
patient / service needs. A new Patient Information
Booklet called ‘Avoiding Infections’ was introduced.
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Haemovigilence
The QI's to date for 2008 Haemovigilance are:
• Successful completion of Irish National Accreditation
Board inspection of Hospital Blood Bank and
Haemovigilance - EU Directive 20002/98/EC.
(Traceability and Haemovigilance)
• Audits - Blood Collection
- Transfusion Documentation
Staff Development & Orientation
Training needs analysis was undertaken in 2008. Both
in-service education programmes and support for courses
were provided. Evaluation on Study Day for night staff
reported high levels of support from management.
Some staff identified to undergo Basic Life Support and
Advanced Life Support Courses in order to train our
staff.
• Continuous surveillance of transfusion practice
• Cannulation Training - Ongoing training and clinical
supervision of staff nurses requiring the skills
Infection Prevention and Control
The following initiatives were carried out in 2008:
a) Infection Control Upgrading of all Bedpan
sterilisers to Washer Disinfectors.
Cardiology
A four-bedded cardiac specific unit on the Redwood
Ward continued to facilitate patients having angioplasty.
Previously private patients had to be nursed for 24 hours
in the University Hospital following the procedure. This
unit is also used as a day unit for cardiac procedures such
as coronary angiogram and transoesophageal echos
and a rapid admission unit for heart failure patients.
b) Upgrade of Hawthorn sluice room and HANU Unit
c) Introduction of Spill kits and Actichlor plus disinfectant
d) Upgrade of dressing sets to improve antiseptic
techniques
e) Public information notice board in main hall
f)
Introduction of new information leaflets
Nursing Division
g) Introduction of infection control manual group wide
h) Completed installation of Danicenters (Glove and
apron holders) outside all patients rooms
i)
r)
s) Change in practice in transportation of blood
samples (introduction of box to carry samples)
Introduction of Wiva Bin Holders in all sluice areas
t)
j)
Programme of installation of hands free silent closing
bins both for domestic waste and clinical waste
k) Installation of air-conditioning units in the Cedar ward
l)
Upgrade of Cleaners Room on 1st floor with plan
to upgrading all such rooms
Installation of hepafiltered system in Daycare
Oncology
Change in practice in transportation and storage of
clinical waste
u) Upgrade of linen transport trolleys to ward areas
v) Replacement of Linen trolleys at ward level
w) Upgrading dressing clinic with suitable storage
system.
m) Installation of air-conditioning unit in Day Surgery
n) Installation of new endoscope washers in Endoscopy
o) Commencement of water testing in Day Care
Endoscopy
p) Upgrading of hand hygiene facilities i.e. soap and
c-fold hand towel dispensers
q) Upgrade of some hand hygiene sinks
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Outstanding/Significant Achievements
In July we celebrated Sr. Sheila’s Golden Jubilee and
honoured her much valued service and support to both
staff and patients. It was fitting that Sr. Sheila’s Golden
Jubilee year also coincided with a special year in the
history of The Religious Sisters of Charity as we
commemorated one hundred and fifty years since
Mother Mary Aikenhead set up the religious order to
care for the poor.
Nursing Division
Ms. Oonagh Ryan (Clinical Nurse Manager 2 – C.S.S.D.)
represented Ireland when invited to speak at the
‘Patient Safety Medical Congress Decontamination and
Sterilisation Conference’ in Abu Dhabi in October 2008
& ‘World Forum of Hospital Sterile Supplies Conference’
in Milan in June.
Mission Effectiveness
A Mass to celebrate 150 Years of the Religious Sisters
of Charity took place on Thursday 19th June 2008 at
4pm in the Coffee Shop.
A country and western themed barbecue for staff took
place on 3rd July 2008 in aid of the Chernobyl
Children’s Project International. €2,723 was raised for
this project and the night was a great success.
The Children’s Christmas Party was held on 20th
December 2008. We had a record number of
attendees and great fun was had by all.
The Endoscopy Department showed an annual 1.1%
decrease due to technical difficulties in January but
maintained a monthly increase for the remainder of the
year.
SVPH and Minor Operating Theatres showed a
decrease in activity for 2008 due to vacant sessions.
Future Plans
• The appointment of Ms. Deirdre Pyne as Nurse
Planner assisted us significantly in preparing for the
Daycases
Jan to December
2007
move to the New Hospital. Deirdre will continue to
liaise with staff and the Project Team in 2009 focusing
on operational policies and human resource
requirements.
• Development of a self-medication policy to improve
quality of care and enhance patients’ knowledge of
their medication.
• Provide clinical placement facilities for undergraduate
student nurses from SVUH and SMH.
• Develop at least one clinical care pathway.
Jan to December
2008
Variance
Variance %
Daycases
7,482
7,841
359
4.8%
Oncology Daycases
5,816
6,559
743
12.8%
Theatre S.V.P.H
3,941
3,684
-257
-6.5%
Theatre S.V.U.H
779
991
212
27%
Minor Operating Theatre
4,979
4,671
-308
-6.2%
Endoscopy Unit
5,760
5,694
-66
-1.1%
Operating Theatres
Departmental Statistics
Activity levels increased consistently in 2008 with both
Day Care and Day Care Oncology increasing throughput
by 24% compared to 2007.
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Mission / Vision
Overview
“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.”
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.
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
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to the Hospital during that time. Earlier in the Year Ms
Colette McNamara left the Department for pastures
new and I would like to thank Colette for her service to
the Department and the Hospital.
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
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 Erin Fitzgerald and Ms Barbara Power for their
commitment and support during the year. Erin joined
the staff of the HR Division in July 2007 and Barbara in
December 2007. After nearly seven years service Ms
Marian Murphy left the Department in September 2007.
I would like to thank Marian for her major contribution
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. 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. The feedback from staff has been very positive. During 2007 the
service was expanded to include Pregnancy Risk
Assessments and the services of the Occupational
Health Psychologist (Ms Nuala Gannon). I would like to
thank Nuala for her support to staff during the year.
I would also like to thank Ms Ann O’Reilly and all the
staff of the Occupational Health Department for their
assistance and support throughout the year.
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. 10
Care Assistants completed the FETAC Level Five course.
Training & Development.
Seminars on Pensions and Additional Voluntary
Contributions (AVCs) were also held for staff and
delivered by representatives from Mercer and Irish Life.
A Management Development Programme was provided
for Department Heads in the Support Services and Allied
Health Divisions. A total of 30 staff attended workshops
in February / March, May & November. Feedback from
staff that have participated in the programme is very
positive This programme will continue in 2009. The
Training was provided by Quantum Training.
75
The Management Team also undertook Management
Development Training in September and this programme
will continue in 2009. Induction training was provided
on five occasions during the year for new staff and 60
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 planned to
continue with this programme in 2009. Four staff
attended Retirement Planning courses. Customer care
training was provided in May and September and a
total of 17 staff attended two courses.
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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.
meetings with Rights Commissioners, the Labour
Relations Commission and the Labour Court.
The HR Division assisted other Divisions with the
selection of candidates for internal promotion vacancies.
Third column is a summary of HR activity in respect of
Recruitment
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 Dorothy and
Yvonne for their valued assistance.
Detail
48
No of Applications
412
No. attended for interview
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
Neil Twomey
Human Resource Manager
Total
No. of Ads placed
No of HR Interviews
Medical Records
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. Three new staff joined the Department in 2006.
I would like to thank Ms Caitriona O’Connor, Ms Aoife
O’Connor, Ms Phoebe Kenny O’Neill, 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.
44
145
Number of Starters/Leavers by Division
Personnel Administration
In 2007 improvements were made in processes for
measuring absenteeism and also for staff census /
employment control
80
JOINERS
70
LEAVERS
60
50
The Chart below illustrates the starters and leavers for
each division
40
30
Employee Relations
A number of individual staff grievances were resolved
by agreement with the staff members concerned.
The HR Division represented the Hospital at various
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20
10
0
ALLIED HEALTH
NURSING
HR
SUPPORT SERVICE
FINANCE
SVUH
The Support Services Division incorporates
Reception,
Security,
Hygiene Services,
Household Services, Maintenance,
• A new emergency phone was installed into the
reception back office for use in the event of a
telephone system breakdown.
• The reception team were involved in compiling a
crisis management plan for the Internal Disaster
and Contingency Plan which incorporated:
Projects,
– Hostage siege situation
Patient and Staff Catering.
– Civil unrest / demonstration
– Discharge of firearms
Reception
Margaret English and a staff of nine provide reception
and front of house services throughout the hospital. Ger
O’Nolan joined the team as Deputy Head Receptionist
after 20 years working in the catering department.
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:
Emergency Management
• New Swipe key for emergency access to SVUH is
now located at reception.
• A new Emergency Link phone to SVUH has been
set up at reception.
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– Suspicious packages
– Building lockdown
Car Park
• A new full time car park attendant/surveillance
operative has joined the reception team.
• There have been ongoing developments in relation
to on site and off site car parking, which is being
monitored by the reception team on a daily basis.
• There is now extra security in Wanderers Car Park
from October. The car park attendant is in the car
park from 7am to 8am and from 4.30pm to 8.30pm.
• A review was carried out on the Car Park Attendant’s
job description in November.
• The Risk Assessment was updated on the car park
in November.
General
• All staff were trained on Microsoft Outlook Express
• Post room was re-organised and new post boxes
were up-graded
Household Services
Yvonne Gleeson, Household Services Officer has a team
of 5 who provide a six-day service. The team provides
support in relation to hygiene, laundry and hotel style
services throughout the hospital. There were a lot of
improvements during the year in preparation for the JCI
audit that included upgrading of furniture and painting
in numerous areas. Other areas that received extra
attention were:
Staffing
• Updated work schedules were issued to all
household staff
Health and Safety
• Skyway installed extra bolts on the roof so Noonan
Services would have access to all windows
• To meet the criteria required for our approved
suppliers list, insurance cover and safety statements
have been checked for all 13 Household Service
Contractors
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• The clean-up week was organised for 25th – 29th
August 2008
• The format of the Access Route Report was changed
in November. The new format will continue to be
discussed at the monthly Health and Safety meetings.
Hygiene Services
• Irish Pest Management replaced 26 bait boxes
(Rodent Monitors)
• A new Linen and Laundry Policy is now in place
Maintenance Department
There are a total of 87 external contractors who service
and maintain technical services equipment on a regular
basis. There are two on-site personnel who work over
six days. Non-routine work and projects are organised
separately by using reputable outside firms. Approximately
2,621 requisition dockets were completed in 2008 with
an average of 240 being completed each month. In
keeping with Health and Safety Regulations, an External
Contractors Form is completed by all contractors and
kept in the relevant project files.
Service Contracts are in place for all necessary equipment
and this is monitored through the support services
administration office.
Projects Completed
External contractors carried out a total of 30 projects. All
projects are monitored through the Projects Team.
Project No
Item
200801 A new Fuse Board was fitted in the Kitchen
200802 The Hawthorn Ward on the 2nd floor now
has the 4 bedded HANU Unit
200803 The Maple Unit got a new Bed Pan Washer /
Steriliser fitted
200804 The Nursing Administration Office was
Restructured
200805 St Joseph’s room was Refurbished to include
lighting, painting and new air conditioning
200806 Repair roof leak on the roof top garden
200807 2 Bicycle Shelters installed
200808 Air Conditioning -- Minor Op Unit
200809 Air Conditioning Units in 4 Kitchenettes
200810 Refurbishment of gents washroom at reception
200811 Refurbishment of ladies washroom at reception
200812 New Smoking Shelter installed at Decking Area
200813 Refurbishment of Radiotherapy treatment
planning room
200814 Refurbishment in Operating Theatre that
included a new Sluice Washer, Flooring,
Painting and new fire doors.
200815 Refurbishment of Cleaning Contractor laundry
in the basement
200816 Refurbishment of Pharmacy lobby
Project No
Item
200817 Essential maintenance in the Heating Plant Rm
200818 Following the JCI mock audit all fire
penetration walls sealed to ensue integrity of
fire compartments
200819 Upgrade works completed in Pulmonary
Function Test Wash Rooms
200820 Air Conditioning in the Linen Room
200821 Following the JCI mock audit the number of
emergency lights were and exit signs were
increased and some of the existing ones
were upgraded.
200822 Refurbishment of the dark room in X- Ray
200823 Safes are now provided in patient areas
200824 New Storage unit installed for Medical Gases
200825 Following an external audit based on Hygiene
Services requirements the Cara Unit/
Preparation Room was refurbished.
200826 A Portocabin was installed to facilitate more
administration space
200827 Following recommendations made from an
external Hygiene Services Audit upgrade
work’s took place throughout the patient
areas in the Hospital
200828 New security cameras installed in the
basement and the Consultant’s Private Clinic
200029 Upgrade of cleaners sluice rooms on the
nursing floors
200030 New Fire Doors installed in the basement
and on the 1st floor
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Catering Department
The Catering Department services the needs of 162 inpatients, 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. The
team consists of 68 staff lead by Yvonne Byrne and
Geraldine O Nolan (to June 2008). In July Keith
Wickham was promoted to Catering Officer from Catering
Supervisor and Richard Connolly joined the team.
The Department has a fully implemented HACCP system
and an ISO 22000: 2005 and 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. This department is very
quality focused and promotes a culture of continuous
improvements through out the year.
Some of the activities for last year are:
• The catering department held their Management
Review Meeting’s in April and October.
• A Healthy Eating week was promoted week
commencing the 4th June.
• In April N.S.A.I. certified the Catering Department to
I.S.O. 22000 standard.
Projects Undertaken
Financial - Cost & Sales Analysis were introduced in Oct.
• A coffee morning was held on the 18th September
in the Coffee Shop and raised €540, which was up
47% on 2007 for the Hospice Foundation.
Catering department Stock Take introduced in November
Food Waste Analysis Sheets introduced in October
Supplier analysis against S.V.U.H. carried out in October
• Complete Laboratory Solutions carried out analysis
on food products and hygiene swabs within the
Kitchen, Patient Catering and Coffee shop.
• In December a raffle was held in the coffee shop
for St Vincent de Paul and €2440.00 was raised.
• There have been 140 updates to policies as part of
the Food Safety Management System.
• The Annual Christmas Party took place in the
Coffee Shop on the 19th of December.
• The Annual Children’s Christmas Party took place
on the 20th December.
All standardised recipes reviewed in October/November
Nutrition - Catering & Nutrition interdepartmental strategic
meeting commenced in October. Catering Department
now attend the Nutrition Interest Group Meetings.
F.O.G. Fats Oils & Grease programme commenced in
September following new legislation.
Equipment - Equipment/Plans for new hospital
continued from 2007
Service Trials - Trials for Patient Service in new hospital
commenced in January.
E.M.R. - Emergency Response Plan was tested in June
on electrical failure.
Theme Day - Vegetarian Theme Day took place in June
and a Polish Theme Day took place in May
Waste Mgt. Food composting introduced to all
kitchenettes
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Equipment
• Preventive Maintenance took place in October
• New Equipment – Upright fridge in Kitchen and
battery operated floor scrubber
• Diet weighing scales
• The Environmental Health Officer carried out audits
of the Catering Department on the 22nd of January
and the 7th & 29th of April.
• Air ventilation carried out audits of the extraction
system in the Coffee Shop in June. Environeering
carried out two follow up audits following changes
in extraction equipment to improve efficiency.
• New curtains for walk in fridges in Kitchen
• New Fan installed in Coffee Shop
• Fly screens installed in Coffee Shop
• Ice Machine in Day Care
• A Hygiene Services audit took place in August and
recommendations were completed in November.
• Buro Happold carried out an audit on the facilities
department and issued an operational and
maintenance strategy report.
• Industrial Water Management takes 15 random
samples quarterly.
• Happy Heart Audit took place in August.
• Compliance Consulting carried out on and Fats, Oils
and Grease Management on behalf of Dublin City
Council in October.
• The Hospital’s Fire Safety Consultant carried out an
audit of the building in April.
Surveys
• A JCI audit was carried out in October.
Audits
• Michele Pounch and Denise Ryan carried out 4
supplier audit visits in August (Pallas Foods,
Glanbia, Olhausen & Seaview).
• Joe Carroll of QMS carried out a systems audit to
ISO 22000 on the 20th of August 2008.
• Cater Care carried out on the 28th of May & 16th
of October.
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• A Mock Recall took place in September on Patient
Food.
• A Country wide pork and bacon recall took place in
December following issues in the food chain.
• Dangerous Goods Safety Advisor carried out two
audit’s in June and December.
• Chemical Risk Assessments on about 70 products
were completed from June – September.
Four surveys were carried out in the Catering Department;
two in the patient catering area and two in the coffee
shop.
Patient Catering: Dietary requirements of patients in
November and Portion sizes and presentation of meals
in May.
Coffee Shop: ‘On the Grab & Go’ in November and
‘Vegetarian Options’ in May
A survey on the standard of cleaning took place in July.
Information is also feed back to Support Services on
the patient satisfaction surveys given out on admission.
External Training
Audit Training – Q.M.S.
– September
Primary Food Hygiene – Cater Care – January/May/October
Refresher Food Hygiene – Cater Care – June/July October
Management Development Training – Quantum Training
– March/April.
Manual Handling Trainer and Risk Assessor –
IBEC – October
Chemical Training – Ecolab – May/September
Hand Hygiene – Ecolab – September/August
Operations Training Techniques – Failte Ireland –
February/September/October
Staff
Management of Food Hygiene – Failte Ireland –
October/November
Richard Connolly and Keith Wickham appointed
Catering Officers in July.
Recruitment & Interviewing Skills –
Quantum Training – February
Yvonne Byrne, Gemma Cushen, Catherine Unal and
Dixie Mosebi all commenced maternity leave.
Motivation Team Work – Quantum Training –
March/April/June
Risk Assessment Training – S.Q.T. – April
Coaching Skills Training – Quantum – June
Margaret English successfully completed a Diploma in
Front Line Management.
Dysphasia workshop
(patients who have difficulty swallowing) – February
Janet Murray
Support Services Manager
ISO – 22000 – Q.M.S.
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Ger O’Nolan joined the Reception Team as Deputy
Head Receptionist in June.
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– August
Finance Division
The financial turnover increased by 7.7% from
€63.5m.in 2007 to €68.4m in 2008. The surplus
reduced from €3.3m in 2007 to €3m in 2008. Pay
costs increases were not fully reimbursed as part of the
agreements with the Medical Insurers.
VHI
Debtors:
Some new VHI on line system should lead to
improvements. We are working hard to contain our non
pay costs which hopefully will increase at a lower %
level that our increase in revenue.
Orla O’ Sullivan,
Lynn Wiley,
Aisling Talbot,
Mary Rose Sweeney,
C. McArdle,
The department is staffed as follows:
G. Milofsky,
Service Development
A new stock system project commenced during 2008
aimed at capturing all stock transactions with the
Supplies Department. The system is due to go live in
Jan/Feb 2009.
Accounting:
The software has been installed and and training has
taken place. We are hopeful the new stock system will
aid receiving units and reduce paperwork.
Patrice Marjollet,
Joan Swan,
Jeffifer Kavanagh.
Michelle O’ Dwyer
Debtors
Neil Abdi,
James Clerkin,
Sinead O’ Mahony,
Payroll:
I believe we have now better procedures in place to
reduce claims outstanding.
J. Balfe, Laura Bertie,
Mary Kelly
Billing:
Debtors days have fallen to 55% by year end which is
a 10% improvement on 2007.
G. Mcteighue,
James Crowe,
Stores:
E. Murdoch,
Yvonne Casserly,
C. Mooney
Dorothy Nolan (50%)
Total
Creditors:
J. Kennan,
25.5
Marie Coyne,
Jason Carson,
James Crowe
Financial Controller
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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 in-patient 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.
During the period 1/9/2008 to 31/12/2008 Ms.
Gerada Warnes, Allied Health Manager was on
maternity leave and the Division came under the direct
responsibility of the CEO over that period. However Ms.
Annette O’Neill represented Allied Health at the
Management Team Meetings and Ms. Una Gilligan
represented Allied Health on the JCI Accreditation
Steering Committee Meetings.
The following contains an overview of activities and
events that took place in 2008.
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Radiology Department
The Radiology Department provides a wide range of
diagnostic imaging examinations and interventional
procedures for both in-patient and outpatient referrals.
Staff work closely with staff at ward level, in day surgery,
theatre and endoscopy to ensure that their imaging
requirements are catered for. The department provides
a key platform service for Consultants within and
outside the hospital. It also provides a service for GP’s
within the catchments area. The department provides
specialised services for a number of specialised
hospitals. These include St. Luke’s Hospital, Royal Victoria
Eye and Ear Hospital, National Maternity Hospital,
Holles Street.
The first quarter of 2008 was difficult for the department
in terms of pressure and workload on a small number
of staff in the specialised areas such as CT and MRI. In
the second quarter of the year the pressure was
reduced as three junior staff were able to provide out
of hours cover for the hospital.
Similarly to 2007 the impact of VHI direct payment for
CT scans on all oncology review patients and the
increase in overall referrals as a result of current best
practice in imaging resulted in a further 10% increase
in the workload in CT. As a result it was necessary to
extend the working day to keep waiting times to a
minimum. This workload was borne by a limited
number of radiographers.
Much time was spent in the third quarter in preparation
for JCI Accreditation. Policies, Procedures and Guidelines
were reviewed and revised where necessary and some
new policies were implemented. New high quality
patient information leaflets were prepared and
distributed to clinics and wards.
There was a significant increase inn the number of
Cardiac and Breast MRI studies carried out in 2008
compared to 2007. In line with best practice a number
of new procedures were introduced in the MRI
department over the last 18 months.
While overall activity in terms of examination numbers
was down in 2008 there are rational reasons for this.
The general numbers are down as fewer Consultants
are referring patient for pre-operative chest x-rays, plain
x-rays of spine and sinuses, in line with current best
practice.
The reduction in bed occupancy in October and
November impacted on the number of in-patient
referrals to our department.
Improvements in Infrastructure
In line with JCI requirements and following Hygiene
Audits major improvements were made in the
department. The old dark room was redesigned as the
main store room in the department. All open shelving
in the Fluoroscopy room was removed and new storage
cupboards were acquired throughout the department.
The viewing room was decorated and old flooring
replaced. The corridor in the general area was painted.
Radiotherapy Department
Activity
2008 saw no increase in patient throughput compared
to 2007. However the number of treatments remained
the same. This was due increase competition in the
market place and specific treatment technique options
in other centres.
Developments
It was agreed at management level that the department
would outsource IMRT to D3. Since this agreement the
hospital purchased IMPAC which is an integrated
management solution to RT and it was decided to
postpone this until impact was installed.
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In 2008 the Radiotherapy Department treated 38
public patients as part of a HSE Agreement. This made
a significant contribution to our treatments. However in
Oct 2008 we were informed that they would no longer
require the service.
A new IMPAC System was purchased. The department
completed the upgraded of its external beam planning
system with the installation of three new fuel based
planning systems. Final verification of the new data was
completed in Jan/08. A new software version (2.16)
was installed in September 08 and subsequently
validated. The necessary documentation was filed with
relevant statutory bodies.
The journal club continues to meet regularly. There were
a number of meetings on various aspects of radiation
therapy with a very successful inaugural meeting on the
use of ionising radiation in the treatment of benign
disease at the end of the year. Both the physics and
the radiography department contributed to the meeting
in poster format.
SVPH is currently treating all breast patients with a field
within field technique. The department explored the
feasibility of introducing inverse planning IMRT for
treatment sites (other than breast). Visits to Manheim in
Germany and an invitation to D3 from the USA to visit
the department were explored with this development in
mind. The decision to pursue the D3 route proved
more attractive with D3 providing technical support and
training to the physics staff at the department.
Refurbishment work on the planning room was
completed in April of this year. The room is now open
plan and can accommodate the extra staff member and
equipment required for a full operational department
including provision of IMRT services.
In-house training accounted for the vast majority of the
training this year owing to the arrival of two new
members of staff. In addition, it is in the hospital
interest that each physics staff member should attend
at least one national and international conference per
year. This is to comply with professional registration and
international recommendations to ensure each staff
member is active and up to date in their area of
expertise. The accreditation process further strengthened
the need for an education and training requirement.
Documented proof in the form of individual training
records were requested as part of the validation
process.
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Pharmacy Department
In 2008 the Dispensary expanded services with the
introduction of the Clinical Pharmacy Service and the
Top Up Stock System on the wards. The introduction of
these services has altered the workflow of the
Dispensary with staff working at ward level and not just
at departmental level.
The setting up of these systems in addition to
preparations for JCI increased the workload of the
dispensary staff.
The workload of the Aseptic Unit continues to remain
high and volume peaked in January 2008 with 847
items. The number of patients receiving intravenous
chemotherapy increased from 5650 in 2007 to 5938
in 2008. This represents an increase of 5%. The
extension of opening hours in the Day Care Oncology
Unit may have contributed to this increase.
Maintaining adequate staff levels continues to be a
challenge for the Aseptic Unit as the number of
technicians dropped to two technicians (who were
appointed on contract) – both of whom were only in
their first year of training in Aseptics. The appointment
of a second senior pharmacist to Aseptics was greatly
welcomed and her training is progressing well.
However, the environmental conditions of the current
facilities are severely limiting preventing any advance
compounding from taking place. Given the volume of
compounding taking place, the lack of a back up to the
current isolator is extremely worrying. This was highlighted when the isolator broke down at the beginning
of February and was out of commission for three days.
The new hospital will address these deficiencies.
The addition of the Mosaiq Scheduling System in Day
Care Oncology has streamlined the scheduling of
patients.
The provision of a Clinical Pharmacy Service
commenced in 2008. Four additional pharmacists were
recruited and filled between April 2008 and July 2008.
The service commenced on Redwood Ward in May
2008 and then was extended to the other wards by
October 2008. Currently, there are three full time
Clinical Pharmacists looking after two wards each. The
Cara Unit Clinical Pharmacy Service is looked after by
the Clinical/Dispensary Manager. The Cedar Ward
Clinical Pharmacy Service is shared between the two
senior pharmacists in Aseptics.
With the commencement of the Clinical Pharmacy
Service it was decided to provide a stock of routinely
used medications to each ward. The individual
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medication needs of each ward were assessed by the
Clinical Pharmacist and Clinical Nurse Manager and
stock medication lists were drawn up. Dedicated
medication presses which could be locked (JCI
requirement) were ordered and installed on each ward.
These presses include a concentrated electrolyte safe
(JCI requirement). Once the initial stock was dispensed
the ward would be visited by a Pharmacy Technician on
a routine basis to replace stock used – Top Up system.
In 2008 a dedicated Medication Incident Report Form
(MIR) was introduced to record incidents or near
misses related to Medications. This form is similar in
content to the Medication Incident Report Form used in
SVUH.
The Admission Medication Record Form, approved by
the consultant’s forum in 2007 commenced use in
2008. It is included with the patient pre-admission
information that is posted out to patients prior to their
admission by the consultant’s secretaries.
New Patient Medication Record
In 2006 the Drugs and Therapeutics Committee set up
a sub-committee to review the medication records used
in each of the three hospitals within the group with a
view to standardising the Medication Record throughout
the group. As a result of this collaborative process a
standardised Medication Record was developed. This
new medication record was launched in July 2008.
The transition to the new Medication Record was very
smooth, aided by the educational sessions/memos that
highlighted the differences between new and old
medication records and the pilot study that took place
on Rowan and Cedar wards in 2007.
JCI
An entire section of JCI is devoted to Medication
Management therefore the Pharmacy Department was
very involved in the JCI process, developing and
collaborating with other departments on procedures
and policies. The accreditation process was a great
mechanism for providing framework and structure in
the development of new services (see above). Other
initiatives included the High Alert and Look Alike, Sound
Alike labelling of medications, and installation of
Concentrated Electrolyte Safes and Secure Medication
Presses.
New Hospital
The plans for the Dispensary have been finalised and
work in continuing on the planning of the Aseptic Unit,
Satellite Pharmacy and Medication Storage in Clinical
Areas.
Respiratory Department
Table 1: Number of tests 2007 vs 2008
Activity
The second PFT lab, which opened June 2007, has
improved the efficiency of the service. This is evident
from increased number of PFT’s being performed.
2007
2008
Total PFT
2473
2878
Outpatients
1794
2268
In-patients
539
610
30
38
217
220
Bronchial provocation
There has been an overall increase in number of sleep
studies carried out in 2008. There was a slight
reduction in scheduled studies in autumn 2008 due to
staff issues. There has been a significant drop in waiting
times in 2008. A number of processes are in place to
ensure that on a sleep night all 4 beds are utilised and
to maintain efficiency. Wait times for initiation of sleep
study treatment have been reduced from 3-4mths to 12 months.
Skin tests
Following advice from infection control, a “Gus cleaning
and disinfection system” has been installed. Space was
also found for cardiology to install their “gus cleaning
system” for Transopesophogeal Endoscopy (TOE) and
Respiratory have agreed to share the facility with them
on Wednesday mornings when they carry out this
procedure. Further refurbishment of room included
installing new sink & cupboards and covering old drain.
Table 2: Sleep study activity;
Total No. studies
Waiting times
(PSG & CPAP)
PSG
2007
412
6-8 mths
2008
495
3-4 mths
PSG - Polysomnography = diagnostic studies;
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All existing guidelines were updated and a number of
Referrals
new guidelinesNo.
were
developed in line with JCI standards.
CPAP
PSG
CPAP
Total No.
referrals
4 mthsResearch 242
158
400
Staff
have
been
actively
involved
in
research
projects
in
1-2 mths
272
180
452
the sleep lab with Prof Mc Nicholas’ team, and a team
CPAP -continuous
positive airways
= based
treatment
studies
of engineers
from a pressure
Nova-UCD
company,
BiancaMed, who are developing novel methods of
screening for sleep apnoea.
The data produced has been presented at the following
conferences in 2008:
• European Sleep Research Society Congress in
Glasgow by Patricia Boyle
• American Thoracic Society in USA by Dr John
Garvey
• European Research Society in Berlin by Dr Caroline
O Connell
Published papers:
1. Heneghan et al: A portable automated assessment
tool for sleep apnoea using a combined holter
oximeter
Sleep 2008; 31(10) 1432-1439,
2. Electrocardiogram recording as a screening tool for
sleep disordered breathing.
Heneghan et al J. Clin sleep medicine 2008;
04(03) 223-228
The Physiotherapy Department provides both in-patient
and outpatients services. In-Patient referrals are received
from a range of specialties including Colorectal, Breast
Surgery, Plastic Surgery, Vascular, Respiratory Medicine,
Liver, Neurology, Orthopaedics, Oncology and Urology.
A number of improvements were introduced in 2008
as follows:
1) Up-to-date leaflets for patient education - back care,
pelvic floor exercises, respiratory care, orthopaedic
etc created by the physiotherapy team and displayed
within the department.
2) Leaflet created to advertise our outpatient service,
which is displayed within the department and
distributed to in-patients in an attempt to increase
out profile.
3) Assessment forms created for detailed assessment
of all patient classifications.
4) Policies, procedures and guidelines updated.
5) Storage areas separated into clinical and
administration rooms.
6) Hygiene: Cloth chairs replaced with plastic covered
chairs.
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7) Bed sheets and pillow cases replaced with paper
towels and disposable pillowcases.
8) New cleaning protocol for the department itself and
equipment implemented.
Hawthorn Ward/ HANU
HANU is now well established. This has had little
impact on the Physiotherapy Service in terms of patient
numbers but because patients are returning in a more
acute condition, physiotherapy staff have benefitted
from the respiratory physiotherapy courses attended last
year.
Multidisciplinary Team
Our role in the MDT
1) Physiotherapy in-patient notes are now filed in the
medical chart from referral to discharge, to aid interMDT communication.
2) Manager meets with MDT - oncology/palliative care
team weekly.
3) On an ad-hoc basis Physiotherapists liaise with
nursing staff, medical staff and family members.
4) Physiotherapy manager partakes in the accreditation
meeting and attends managerial meetings when
scheduled.
5) Department welcomes students at preundergraduate level to visit the department to
shadow physiotherapists to experience their day-today work.
Staff Compliment
WTE Manager.
2 senior physiotherapists who job share creating
one post.
1 senior physiotherapist
1 basic grade physiotherapist
Cardiology Department
Procedures carried out in the Department are
1.
ECG
2.
Echocardiograpahy
3.
Stress Testing
4.
Holter Monitor
5.
Blood pressure Monitor
6.
Pace maker insertion and clinics
Review statistics enclosed as stated previously in the
2007 review it is difficult to expand the above services
as space is a large issue in the department. There are
only two cubicles and only two tests can be carried out
simultaneously. Statistics for the above services have
not increased over the year as the department has had
severe staffing problems. Locum Cardiac Technicians
are very difficult to get to cover sick leave, annual leave,
or study leave etc. This year there has been a problem
with long term sick leave.
Stress testing
Service developing gradually again space is an issue, as
it is cumbersome and time consuming having only two
cubicles limits our capacity to expand an example of
this would be if we increase our stress testing services
our echo service will suffer.
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Chest pain clinic
It was proposed to establish a chest pain clinic in 2008
in consolidation with the Cardiologists. However this
was not feasible at this time due to staffing and space
issues.
The rational for the development was
1. Provide a more comprehensive service to patients
in a cost effective manner.
2. Utilise fully the specific staff mix within the
department.
3. Increase range of invasive cardiac investigations.
4. Increase profile of the Cardiology Department in
SVPH.
5. Increase general access of cardiology services to
general practitioners ie Direct Access
The following items were acquired during the year
• Replaced 2 Holter monitors, and 1 blood pressure
monitor
• New TOE Probe and Gus sterilising system –
shared with Respiratory Department
Social Work Department
This year saw a total of 574 new referrals to the Social
Work Department. Although oncology services account
for the majority of social work referrals the presence of
a second (part time) social worker in the department
has attracted an increase in referrals from other areas of
the hospital.
We continue to work with our medical, nursing and
allied health colleagues towards the provision of holistic
care for our patients. However, the current economic
climate has made our traditional role of linking inpatients due for discharge with community services
more difficult.
Vulnerable elderly patients form a large part of the social
work caseload. Most of our patients return to their own
homes after their hospital stay but may require increased
domiciliary support to remain in the community. We
find access to community programmes providing
rehabilitation opportunities has become more difficult
and financial aid towards nursing home costs is limited.
The cutback in community services for the elderly
inevitably leads to a longer stay in hospital which
presents new challenges for the Social Work
Department.
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The Accreditation process this year has been time
consuming but we trust this process will lead to
ongoing improvement in work practices.
We were pleased to offer observation placements to
two transition year students who are considering a
career in social work.
Training opportunities have been confined to in-house
education sessions and we have worked closely with
colleagues in St. Vincent’s University and St. Michael’s
Hospitals.
We are currently developing information packs advising
patients and staff on practical and legal issues – e.g. the
importance of making a will.
Because of the pressure on resources we anticipate
that this year will present new challenges in the
provision of appropriate services for our patients.
Department of Nutrition & Dietetics
Patient Activity
January – December 2008
Type
In-Patients
Outpatients
New
610
108
Review
2132
137
Total
2742
245
In 2008, the number of patient consults decreased by
5% (⇓162 patient consults), however the time spent
seeing these patients increased by 5% (⇑ 93 hours).
This is evident in the complexity of cases referred to the
department in the past year. In-patient activity
accounted for 92% of clinical work.
Outpatient activity increased by 29% (55 patient
consults). This was due to:
1) A review of the outpatient services and the
implementation of a quality improvement process
2) An increase in staffing levels: 0.5 whole time
equivalent (wte) senior dietitian.
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Oncology Daycare activity was similar to 2007.
44% of in-patients referred to the dietitian were for the
initiation and provision of Parenteral Nutrition (PN),
which accounted for 42% of in-patient time. This
represents an increase of 7% and 2% respectively from
2007, which again highlights the increasing complexity
of patient management and treatment.
Following a review of waiting lists for outpatient
appointments, a quality improvement initiative was
implemented to reduce these waiting times and nonattendance rates at clinics. Waiting times have now
been dramatically reduced. Patients are now offered
appointments on the same week as they are referred.
IT Statistical Analysis Package:
In 2008 PN use increased by 14% from 2007 at a
total cost of €183,553.93.
Staff Complement
2.5 (1.0 WTE Dietician Manager1.5 WTE Senior
Dietitians).
In 2008, the Department of Nutrition & Dietetics
completed more detailed statistical records for patients.
Standardised diagnosis and intervention codes are now
being used and these records are uploaded onto a
modified excel spreadsheet. Activity rates for specialities;
consultants etc can now be easily retrieved using this
database.
Parenteral Nutrition (PN) Audit:
Quality Improvements: 2008
Malnutrition Universal Screening Tool:
A key element of the JCI accreditation process is the
mandatory nutrition screening of in-patients. MUST is a
five-step screening tool developed by the British
Association of Parenteral and Enteral Nutrition (BAPEN)
to identify adults who are malnourished, at risk of
malnutrition (undernutrition), or obese. The tool was
trialed and audited on Hawthorn ward and Hazel Unit
in August 2008. It is planned, to implement it hospital
wide, by April 2009.
In the three year period, from 2005-2008, the use of
Parenteral Nutrition in SVPH increased by 107%. PN
use cost the hospital €183,553.93 in 2008.
In January, an audit of 21 patients receiving PN was
completed (Phase I). This was to identify baseline data
on PN use within the hospital, which could be audited
against. Phase II of the audit is now in operation, which
addresses the appropriateness of PN intervention.
Enteral Nutrition (EN) Wastage Audit:
Prior to the Enteral Nutrition Tender in 2008, a wide
range of nutritional products from a number of
companies, were used in SVPH. Wastage rates were
high. This prompted the initiation of an annual audit
which was carried out over a 3 month period in 2007.
Following the awarding of the EN contract to Nutricia
Clinical in March 2008, the wastage audit was repeated.
EN Wastage had decreased from €270.95/quarter in
2007 to €18.33/quarter in 2008.
In 2008, regular meetings were established within the
department. Weekly team briefings and monthly
department meetings were held to improve
communication. These will continue during 2009.
Monthly SVPH/SVUH joint Nutrition Journal Club
meetings were established in 2008 and will continue
throughout 2009. This is an essential component of our
departments continued professional development, in
addition to strengthening relations with our dietetic
colleagues in the St Vincents Healthcare Group.
The dietitian manager currently participates in
professional supervision with other dietetic managers
within the Irish Nutrition & Dietetic Institute.
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Malnutrition Universal Screening Tool (MUST)
Introduction: The MUST screening tool was trialed on
Hawthorn and Hazel wards over a 6-week period
(August 11th-September 22nd 2008). The Department
of Nutrition & Dietetics provided extensive training on
its use, to nursing staff.
Patients were categorised as:
Low Risk (Score 0)
Medium Risk (Score 1)
High Risk (Score 2 or more)
score recorded, thus making it impossible to
identify whether they were at risk.
- The Nutrition Screening Survey in the UK
(2007): British Association of Parenteral &
Enteral Nutrition (BAPEN) screened 9336
patients on admission to hospital using the
MUST tool. 28% were found to be at risk of
malnutrition. Our figures (assuming the forms
with no score, represented patients at risk) are
comparable.
- Only 78% of patient care plans were completed.
• Whilst the screening tool was not altered, a
comprehensive care plan was devised to address
the needs of each risk group (Appendix I).
• An audit was completed to identify issues which
occurred in its implementation and changes which
were required to the care plan accompanying it.
Results: The main findings from the audit were as
follows:
- 10% of patients had experienced significant
weight loss (>5% of body weight)
- 12% of patients were deemed to be at risk of
malnutrition, however 11% of forms had no
- 5% of forms had no weight and 13% had no
height recorded.
- 38% of forms had %weight loss missing.
Outpatient: Quality Improvement
Primary issue is the waiting lists for outpatients
attending the dietitian in SVPH. Currently these stand at
4-6 weeks:
New Patient
3-4 weeks:
Review Patient
Since November 2007, the DNA (Did Not Attend) rates
for these clinics have been recorded each month. In
the year to date (Jan-Sept 2008), the DNA rate has
been 15%.
Organisation Structure
Group Chief Executive
Chief Executive
Nursing Division
Director of Nursing
Assistant Director
of Nursing (3)
Human Resource
Human Resources
Manager
Patients Floors
Administrative
Assistant
Theatres (2)
Recruitment
Endoscopy
Ward Clerks
Daycare
Medical Records
Minor Operations
Staff Training &
Development
Pastoral Care/
Chaplaincy
Portering
Admissions
Nursing Education
Nurse Specialists
Employee Relations
Medical
Administration
Allied Health
Support Services
DIVISION
DIVISION
Allied Health
Manager
Diagnostic Imaging
Radiotherapy
Deputy Services
Manager
Pharmacy
Reception
Dietetics
Catering
Cardiology
Coffee Shop
Medical Social
Worker
Housekeeping
Physiotherapy
Maintenance
Pulmonary
Laboratory
Security
Other Allied
Health Services
Medical Physics
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Support Services
Manager
Cleaning
Grounds
Corporate Services
Finance Division
Head of Corporate
Services
Administrative
Assistant
Debtors Accounts
Risk Management
Information
Technology
Accreditation
Statistics
Patient Complaints
HIPE
Capital Projects
Patients Accounts
Creditors
Salaries
Materials Manager
Administrative
Assistant
Management
Accounts
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Report from the Director of Operation’s
Bill Maher
I would like to start by thanking staff for their constant
support, enthusiasm and dedication to patient care in
2008. This year has seen us face many changes and
challenges.
2008 saw great changes to the public sector and
healthcare due to the significant downturn in the
economic environment. My approach has always been
to support our clinical services and staff no matter what
stresses we come under.
Hospitals are part of the broader healthcare system and
cannot work in isolation. A significant part of my role,
along with my senior management colleagues, is to liaise
with the HSE and Primary Care to develop services,
improve patient pathways and secure funding. I hope St
Vincent’ University Hospital continues to play a leading
role in modernising services and this will be a key area
for me in 2009.
This report gives a brief overview of key developments
across a number of areas. I hope you find and
recognise a number of our achievements.
Strategic Plans
Estates Strategy
The Estate Strategy group was established in November
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2007 with responsibility for ensuring where possible
that the development is carried out in a planned, effective,
efficient and progressive manner across the campus.
That Group had a busy year in 2008 with 32 projects
completed on target and within budget. Notwithstanding
the financial difficulties facing us in 2009 the Group has
identified a number of key development projects and is
in discussions with the Health Service Executive to secure
funding for such. Included in these are significant projects
such as the new ward block, the additional four theatres
and the Haematology Daycare Unit. There are also
plans to continue with the much needed refurbishment
of bathrooms and kitchens and priority wards.
Perhaps the most significant achievement was the
refurbishment of Our Lady’s Ward. The ward is
unrecognisable from its former self and the feedback
from patient, carer’s and staff has been excellent. I would
like to formally thank all who made this possible and
build on this success to refurbish other wards in 2009.
Financial Position
Our allocation for 2009 will be considerably reduced
and we will no doubt have to make some tough
decisions. The foundations we have laid in 2008 in
terms of efficiency and productively will stand to us in
good stead but it will still need the continued efforts of
all staff to get through what will be a difficult year. I
know that we can count on that. We ended 2008, €1.5
million over spent against our allocation. This is a
tremendous achievement given the increase in activity
in all areas, the reduction of waiting lists and the estates
developments. I would like to thank all staff for their
efforts in achieving this.
Quality and Patient Safety
JCI Accreditation
In May 2008 Joint Commission International (JCI) first
visited SVUH. Based on this visit, they submitted a
report of recommendations to SVUH in order to help us
achieve accreditation. In September 2008, a working
group was established to implement these
recommendations. Read more about this exciting
initiative in the Quality, Risk and Consumer Affairs
Report.
Patient Safety Committee
St. Vincent’s University Hospital, Patient Safety Committee
was established in September 2008. This committee
aims to coordinate, oversee, prioritise and integrate
patient safety, clinical risk management and continuous
quality improvement initiatives across the Hospital.
Bill Maher
The Patient Safety Committee meets on a monthly
basis to review and evaluate patient safety and quality
of care through data gathered through a variety of
means such as audit, service review, incident/near miss
reports, and staff and patient feedback.
Membership of the Patient Safety Committee includes:
• Director of Operations (Chairperson)
• Director of Nursing
• Chairman Medical Executive
• Director of Quality, Risk & Consumer Affairs
• Director of Infection Control
• Head of Pharmacy
• Clinical Services Manager
The Committee receives monthly reports from the
following departments:
• Quality Manager
• Insurance, Risk & Legal Affairs Coordinator
• Consumer Affairs Coordinator
• Medication Safety Coordinator
The Patient Safety Committee will endeavour to promote
a culture in which patient safety, clinical risk, and quality
management will continue to be developed as an
integral and seamless component of the care process.
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Theatres
Perhaps our most significant achievement in 2008/early
2009 was the preparation and transfer for our new
operating theatres. The new theatres provide a 21st
century environment to deliver patient care and the
feedback from staff has been excellent. 2009 will see
the launch of the Theathre Project Group to review
processes, resource development and policy to further
maximise efficiency and throughput.
Development of Effective Reporting Tool – Diver
In spring 2008, the ICT Department successfully
implemented a new Management Information System
(MIS) called Health Diver. The system initially covers
the Patient Administration System (in-patient,
outpatients and waiting list), Emergency Department,
HIPE and Social Work systems. While this data mining
tool provides comprehensive reports and adhoc queries
internally and externally one of its main advantages is
its portal and dashboard capability. This dashboard is
now available to all Heads of Department and is
accessed via the Intranet or desktop icon. It currently
consists of nine KPIs which Diver will automatically
update from legacy systems but is planned to increase
to 12 KPI’s in 2009.
Following the successful of diver, it is planned to
expand the remit of this project and its users in 2009.
Bill Maher
GP Liaison
In summer 2008, the GP Liaison Committee was relaunched to ensure collaboration of SVUH and GPs
(including St. Michael’s Hospital) within constraints and
limitations of the service/provider plan.
The aim of this committee is to develop and improve
robust communication channels between GPs and SVUH
in order to continuously improve and develop services.
Communications initiatives such as a quarterly GP
newsletter continued in 2008 and will be further
developed in 2009. I hope the liaison committee
becomes the forum to modernise patient pathways and
drive service improvements.
Waiting List Management
The Board of Directors identified the In-patient and Outpatient Waiting Lists as two of the Key Performance
Indicators (KPIs) for 2008. Targets were defined with
the In-patient Waiting List (IPWL) set at no patient to
wait over 26 weeks and the Out-patient Waiting List
(OPWL) set at no patient to wait over 12 weeks by
December 2008.
In January 2008 there were 1,079 in-patients waiting
over 26 weeks and 1,491 out-patients waiting over 12
weeks.
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In-patient Waiting List (including Day Cases)
At year-end we have achieved an 82% decrease in the
In-patient Waiting List over 26 weeks and this has been
reduced to 195. The In-patient reduction is a
considerable achievement and the Senior Management
Team wishes to thank all concerned for this excellent
performance. Pain Management accounts for 100 of
this total.
The reduction in the IPWL has been achieved through
additional extra activity, use of the National Treatment
Purchase Fund and effective validation.
National Treatment Purchase Fund (NTPF)
725 in-patients were referred to the NTPF across all
specialties in 2008. Our referral targets were met. NTPF
referrals will continue through 2009 and all eligible
patients waiting over 3 months will be offered
treatment elsewhere.
Validation
Continuous validation proved very successful with
2,910 patients being removed from the waiting list for
various reasons during the year.
From January 2009 Consultants will receive a list of
patients on their waiting list who are waiting over 26
weeks on a monthly basis. These will need to be
addressed promptly and where on-going problem areas
Bill Maher
are identified follow-up meetings will be arranged with
the Director of Operations and the Waiting List Coordinator, to explore issues and agree plans for delivery.
Outpatients Waiting List
At year-end, 2,044 new patients are waiting to be seen
over 12 weeks therefore the target was not met in 2008.
The target will remain the same for 2009 with the aim
being that no patient will wait over 12 weeks by
December 2009. The waiting list for new attendances
has increased by 13.9% compared to December 2007.
The overall total for new patients stands at 6,717. The
three specialties with the highest number of patients
waiting over 3 months are ENT, Orthopaedics and
Respiratory.
The OPWL has grown despite considerable additional
activity, indicating growth in referrals and demand for
our services. To address this a number of initiatives
were instigated during 2008 including the formation of
a Multi-disciplinary Out-patient Waiting List Group
chaired by Liz Barnes ( Dietician Manager). This group
began meeting in November and Terms of Reference
were agreed. Several areas will be tackled in 2009.
DNA Rate
The HSE have set a target of 5% DNA rate for 2009.
In 2008 SVUH had a total of 6,378 new DNA’s and a
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total of 26,878 new and return DNA’s.
A number of measures were agreed including approval
for a SMS texting reminder service to try to reduce the
high number of DNA’s and this will be piloted in the
ENT and Neurology Departments.
A decision was made to revise the patients’
appointment cards stating the importance of cancelling
if unable to attend. An information leaflet will also be
sent with every new appointment with this reinforced.
In addition posters are now in place in all suites in
Ambulatory Day Care Centre and will be updated with
end of year figures to make patients aware of the
importance of cancelling.
Consultants are asked to comply with the DNA policy to
ensure targets are met.
Non-Catchment Area
This will become one of our KPIs for 2009, with an aim
to reduce our out of area treatments (with exception of
our national services) to 10% of our total outpatient
activity.
We have already begun a policy of the deflection of
non-catchment area referrals and to-date Dermatology
and Neurology are implementing this policy. Pain
Management will be deflecting non-catchment area
referrals from January 2009. This will be monitored
closely throughout the year, as SVUH are not funded for
these patients and this will make a significant
contribution to our cost containment plan.
New to Review Ratio
Reducing the New to Review ratio frees up capacity to
see new patients. SVUH have set a target of 1:3 across
all specialities with specific targets for each speciality.
Currently the average new to review ratio is 1:3.4.
Summary
In 2008, we built upon the foundations laid in 2007
which saw a consolidation and evaluation of all our
major systems and processes, aimed at streamlining
pathways and supporting patient care with the aim of
providing clear and consistent approach and
empowering staff at all levels.
2009 will be a very challenging year. SVUH allocation is
expected to be significantly reduced and we will no
doubt have to make some tough decisions to deliver a
breakeven situation. But this said we are a resilient
team who will always strive to achieve excellence for our
patients no matter what economic pressures we face.
Bill Maher
Director of Operations
Chaplaincy / Pastoral Care Department
Chaplaincy Department
Staff
Chaplaincy is a specific and specialised ministry,
profession and discipline within St. Vincent’s University
Hospital. Chaplains work in collaboration with
multidisciplinary colleagues in providing total patient
care and ministry to families and loved ones within the
clinical environment.
Full-Time Permanent Staff
Chaplains are professionally prepared through theological
education and clinical training. The department offers
spiritual care and emotional support to persons of all
faith traditions within a multi-cultural environment that
reflects the current transition in Irish society.
Part Time Staff
Two Main Functions of the Department.
• Provision of Spiritual Care, including Sacramental
Ministry to Patients, their Families and Loved Ones,
and Hospital Staff.
• Through an Accredited Clinical Pastoral Education
Programme, the department facilitates opportunities
for preparation for ministry through experiential
learning for persons pursuing chaplaincy, parish
ministry, and other forms of ministry.
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6: This includes the Interim Lead Chaplain and the
Director of Clinical Pastoral Education.
There is one ordained chaplain in this section and four
non ordained.
11: This includes nine ordained chaplains and three
non ordained.
Assigned Chaplain
One of the full-time chaplains reduced her hours (from
39 to 32), and a second part-time chaplain reduced his
hours to 24.
Service Developments / Activities
The Chaplaincy Department developed a new suite of
policies that are now in the process of being approved
by the hospital management.
The policies address standards for best practice in
chaplaincy within St. Vincents University Hospital.
The Following Policies were developed:
1 Chaplain assigned to hospital by the Church of
Ireland (Anglican Communion)
• Policy on Patient Visiting
Changes in Staffing Levels
• Policy on the Chaplain’s Role in the Care of the
Dying
The Acting Head Chaplain left the Department in May
2008 to take up a position in a parish. The other priest
chaplain assumed his role within the department. He
was appointed to the role of Interim Lead Chaplain.
• Policy on Sacramental Ministry Policy and
Procedures for Volunteer Ministers of Holy
Communion
• Policy on Record Keeping
Three priest chaplains were appointed to temporary
positions. One remained a member of the department
for a three month period and then terminated his
contract to return to the Missions. The other two
chaplains continue as active members of the
department.
• Policy regarding Representatives of Various Faith
Traditions within the Community Who Visit Patients
in SVUH
Chaplaincy / Pastoral Care Department
Significant Achievements
• Restructuring of the Chaplaincy Department and
refurbishing of office space to meet current pastoral
requirements.
• Chapalincy was intentional about developing stronger
links with other departments within the hospital, e.g.
Communications, Quality Assurance, Human
Resources.
• In collaboration with Technical Services Department,
the Chaplaincy Department developed and
maintained a communication system, through
Channel 7 on hospital TV. This enables patients in
the clinical areas to view and participate in liturgies
being celebrated in the hospital chapel.
• Chaplaincy produced a Patient Information Leaflet
regarding the services provided by the Department.
• The Department negotiated a special Patient Census
list for chaplains, with appropriate information to
facilitate more effective chaplain outreach.
• Chaplaincy, in collaboration with Quality Assurance
personnel, developed a process of quantitative
research regarding the professional activities of
chaplains.
• The department planned liturgical celebrations to
mark World Day of the Sick in February. In December
it hosted a Pastoral Visit by Bishop Raymond Field,
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Representative for Health Care of the Irish Bishop’s
Conference.
• Facilitate more effective pastoral outreach to persons
of a diversity of faith traditions, and none.
• Five Memorial Masses were planned for and
celebrated in the hospital chapel during November.
A large number of bereaved family members and
friends participated in each of these special Masses.
The Catering Department organised a reception
after each of the Masses. Family members
appreciated the opportunity to return to the hospital
and reconnect with staff.
• Further improvement and enhancement of End of
Life Pastoral Care.
Significant Publications
Ongoing contributions to Newsround regarding the
philosophy and work of the Chaplaincy Department.
Production and publication of new chaplaincy leaflet.
Articles in Intercom, The Furrow and The Carer.
Future Plans
• Establish a system of documentation for Chaplaincy/
Pastoral Care within the Medical Record.
• Obtain official approval for Chaplaincy/Pastoral Care
Policies. Education and implementation of policies.
• Team Building processes within the department.
Clinical Pastoral Education
The Department offered three Units of Clinical Pastoral
Education during 2008. Each unit was of three months
duration.
Twenty-two students participated in the education
process. Students represented a diverse group of
cultural and faith backgrounds: Ireland, England, Ghana,
Nigeria. They represented Roman Catholicism and
Baptist faith traditions.
Eight graduates of the programme successfully pursued
Certification as Healthcare Chaplains by The Healthcare
Chaplaincy Board.
An Accreditation Site visit by a survey team from the
Healthcare Chaplaincy Board was prepared for during
2008.
A number of graduates are now working as chaplains
within the health service. Others are involved in parish
ministry.
Library & Information Services Department
Staff
SVUH continued to employ 2 librarians, 1 library
administrator and one part time library assistant. Julia
Christopher resigned her post of Evening Library
Assistant in May and was replaced by Gerry McManus
in September to provide late opening hours for the
academic year 2008/9. At the end of the year we
were very sorry to say goodbye to John O’Grady who
transferred to Pensions. John worked in Library &
Information Services for just over three years and was a
highly valued member of the team, extremely competent
and professional in his work. He was well regarded by all
regular users of our service and he is a huge loss to us.
Breda Bennett continued to provide a one-personoperated professional library and information service in
St Michael’s Hospital.
Electronic Library Resources
This year saw significant developments in our policy of
providing access to high quality health information at
clinical point of need as we secured funding to provide
additional core resources. New products purchased in
2008 included: UpToDate, MD Consult; Health and
Psychosocial Instruments; and full text content to our
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CINAHL database. As a result of this expenditure the
Group now has access to over 1,000 e-journals and 10
core health databases, which are available throughout
the three hospital campuses (via the ICT network) and
also remotely via the Athens access management
system, which is available to all staff.
Intranet
We were very excited to work with Claire Finnan, Laura
Coughlan and Michéal Rourke on the development of
the new Group Intranet which launched at the end of the
year. A link to the Library & Information Services page
appears on the Quick Link menu on every page of the
Intranet and we are working on further developing
these pages as the first port of call for SVHG staff who
cannot easily visit the Library.
SVHG network
SVUH library team members were delighted to be able
to connect to the SVHG ICT network for the first time
this year, having previously been located on the UCD
network only. Not only can we now gain access to SVHG
email, Intranet and the technical and ICT helpdesks but,
crucially, we are able to more effectively control and
maintain our electronic library resources. I would like to
express my thanks to Neal Mullen and team for their
work in delivering this service to us and other Hospital
staff working in the ERC.
Training Programme
Anne Madden, Assistant Librarian in SVUH, developed a
series of courses on information literacy skills for staff
on the three sites. Following a successful pilot in March
the first series of training courses were offered in October
and November to all SVHG staff and took place in
SVUH and SMH. Courses included: Introduction to
Library & Information Resources in SVHG; PubMed
Searching; Advanced Internet Searching; Web 2.0 in
Healthcare; Critical Appraisal; etc. The courses were over
subscribed but very well received by those who
attended, who were awarded a certificate of attendance
in conjunction with HR’s Learning & Development Unit.
We intend to offer these and other courses again in
2009.
SVHG Collection Development Policy
A revised edition of this policy, which sets out the
parameters for the collection of print and electronic
resources in the Group libraries, was ratified by the
SVHG Policy Procedures and Guidelines Steering Group
in December.
St Michael's Hospital
The library was used consistently all year as a study
space by nursing, midwifery and medical students, and
was equally well used by hospital staff. There was
significant use of the library book collection and the
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computers. There were frequent requests to allow
access to the library during the librarian’s lunch time
and in the evenings. A new safety rail was installed
beside the ramp.
The library received 3 new PCs, replacing older models,
and now has 7 public computers, and the photocopier
was replaced by a colour printer/copier. A self-pacedlearning programme for the ECDL was installed on 3
library computers during the year.
Information services included a monthly current
awareness service to department heads, to consultants
and registrars, sent electronically. An electronic email
group of Library Friends is used to communicate library
news and events, additions to the library or new library
services.
The library was included in Audit visits, the hospital
Accreditation project and Consultant led inspections for
training accreditation. The librarian participated actively
in the hospital newsletter committee, and 4 issues
were produced. She also participated in the general
induction day for new staff, and in the orientation
meetings for new NCHDs and nursing students and
provided a 30 minute presentation on Preparing a
Good Assignment to a Care Conference for nursing
students.
St Vincent’s Private Hospital
Mr Peter Sheehan continued to represent the Hospital
on the Group Library & Information Services Committee.
Access to the Library premises in SVUH for Private staff
was an issue, due to the swipe-controlled door, and it
remains to be fully resolved in 2009.
Statistics
SVUH Library recorded 16,700 visits in 2008. The drop
in figures compared with other years was due to the
swipe-controlled door to the Library premises. There
were over 2,000 registered library users by the end of
the year in SVUH and 482 in SMH, and over 600 staff
in total had registered for remote access to electronic
library resources (Athens). We produced 3 issues of our
newsletter, Update.
Collection Development
Print Journals: SVUH Library subscribed to 123 print
journal titles in the areas of medicine, surgery, nursing
and allied health, at a cost of approx. €69,000. This is
joint funded by the Hospital and UCD. Over 60 titles
were also received on donation. SMH Library subscribed
to 57 journal titles at a cost of €31,000.
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Books: SVUH Library spent approx. €7,000 on books,
about €3,000 of which was spent on anaesthesia and
pain management titles funded by the Department of
Anaesthesia. We also received a donation of €2,300
from retired Consultant in Plastic Surgery, Mr Seamus O
Riain. SMH purchased 79 books at a cost of €3,852.
Electronic resources: €53,000 was spent on electronic
resources for the Group. SMH contributed €10,500
towards this and SVPH contributed €5,000. Access to
UCD’s vast collection of electronic resources continued
to be accessible from the SVHERC server in SVUH
Library
Interlibrary Loans
SVUH Library: 620 journal articles and books were
requested from other libraries: 80 were from the British
Library; 414 were from Subito; and 126 from the
network of Irish Healthcare Libraries (IHL). The Library
supplied 117 to other Hospital libraries nationwide. The
overall cost of ILLs for the year was €3,840.
SMH Library requested 26 journal articles from various
libraries and supplied 31 articles to other libraries
during the year.
Library & Information Services Committee
The Committee met 6 times this year under the
chairmanship of Dr Ed McKone and continued to be
attended by librarians and representatives from user
groups throughout SVHG. At the end of the year it was
agreed to move the date for future meetings to the
second Tuesday of every second month.
Future Plans
Financial constraints and staffing shortages mean 2009
will be one of the most challenging years for the Library
& Information Services Departments of SVHG. Our core
focus will be on supporting patient care and decisionmaking.
The following are projects the Library & Information
Services Departments will be working on in 2009:
Conferences/Seminars:
• Health Sciences Libraries Group Annual Conference
– Hodson Bay Hotel, Athlone
• Academic & Special Libraries Annual Seminar –
Clarion Hotel, IFSC, Dublin
• Critical Appraisal Skills Workshop – BMA House,
London
• LIR Annual Seminar – Liberty Hall, Dublin
• European Association for Health Information and
Libraries (EAHIL) Conference – Helsinki, Finland
• Review of all print and electronic subscriptions to
reduce costs and maximise usage by clinical staff.
• Carry out an audit to measure impact of library and
information services on patient care and key
decision-making in SVHG.
• Develop our Intranet pages to provide continuously
updated information on the library and information
services and provide a gateway to access our
resources.
• Continue to run certified training programmes on
information literacy and evidence-based practice
skills.
• Improve access to and awareness of the library &
information services for SVPH staff.
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Medical Records / Patient Services
Staffing
A new permanent post was approved for Symptomatic
Breast Services. The successful appointee for the post
of Patient Services Coordinator was an internal
candidate, Dorothy Murray. Dorothy’s previous role in
Secretarial Services was Grade V Unit Manager for
Oncology/Breast Services/Palliative Care/Haematology.
Dorothy takes up her new position on return from
Maternity Leave.
Introduction of the national Healthcare Record (HCR)
began in 2008. Bernadette Howard was appointed
Project Co-ordinator for HCR implementation.
Bernadette commenced her new role in May organising
education and training workshops for all staff, both clinical
and non-clinical. The plan was to implement the HCR
by specialty with the first new record being issued in the
Neurology Unit on August 26th 2008. Workshops and
roll-out carried on throughout the year, proving to be a
challenging but successful venture. Roll-out will continue
into 2009 before it reaches all areas and specialities.
Changes in service provision, with a focus on increasing
day case activity and reducing waiting lists, challenged
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many of our staff to re-organise and take on new roles.
These changes continued in 2008 and many initiatives
were put in place which focused on improving the
hospital’s high level Key Performance Indicators.
An Outpatient Waiting List Project Group was formed
which meets monthly with an aim to meet the hospital’s
KPI targets and oversee implementation of strategies
which will improve the overall operation and
management of outpatient clinics. The committee
membership includes clinical and non-clinical staff
along with a General Practitioner. Nicola Maddock,
Marian Moran and Tricia Mc Donough represent our
services.
A Casemix Review Group was formed which included
representatives from HIPE, Finance, ICT and Clinicians,
as required. Several new initiatives and pilots were
completed, their aim is to facilitate the meeting of
deadlines in a timelier manner and to allow the hospital
achieve a maximum value for each patient’s episode of
care.
Audits commenced in the filing room with the
involvement of the Clinic Secretaries. A regular monthly
audit of the tracer system and chart availability began in
2008 and will continue into 2009.
Future Plans
• During 2009, the Medical Record Audit will be a
major emphasis. Audits on clinical documentation will
commence in conjunction with the Clinical Audit
Team and separate audits will be done on compliance
with the new HCR filing order.
• Late in 2008, a management decision was made to
change the organisational reporting relationship of
Ward Secretaries, who previously reported to Nursing.
The Ward Secretaries officially join the Medical
Records/ Patient Services Department in 2009. We
look forward to forming this new relationship and
integrating Ward Secretaries to our team during 2009.
• A new Digital Dictation System will be introduced
throughout the hospital.
• Plans for a Text Reminder Service are underway and
implementation will commence early in 2009.
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Staff Members
Tom Smyth AEng,
AMIEI
Frank Kelly
AENG, AMIEL; IENG, MIHEEM
Chief Clinical Engineer
Principal Clinical Engineer
• Technical Specifications for all new electro-medical
equipment
• The Department is working towards CPD
registration with Engineers Ireland
Derek Farrell
Principal Clinical Engineering Technician
David Farrell BSc
Senior Clinical Engineering Technician
Academic Achievements
John Harte
Aidan O’Connor
We currently have some members of staff registered
with The Institution of Engineers. This is a professional
representative body for Clinical Engineering in Ireland
and as such by act of the Oireochtas in 1969 are entitled
to award the title of Chartered Engineer, Associate
Engineer and Engineering Technician of the Institution
confined to suitably qualified candidates. We also have
applied for CPD Accreditation with The Institution of
Engineers and are at an advanced stage of the award.
Declan Murray MSc Senior Clinical Engineering Technician
• Preparation for forthcoming projects, equipping
108
Frank Kelly and Aidan O Connor members of the
Consultation Group on Advisory External Defibrillator for
UCD School of Medicine and Medical Science for
Immediate Care Services.
National Pre-Hospital Standards 2008
Achievements
• Continuously updating information on EEC Directives
• Frank Kelly was elected as a Member of Central
Council of Engineers Ireland
• Continuous liaison with health and safety including
product alerts
• John Harte; National Irish Representative for The
Critical Care Society
• Quality control, liaising with Irish Medicines Board
• Frank Kelly; National Treasurer For Biomedical/
Clinical Engineering Association of Ireland
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Frank Kelly and Derek Farrell Poster: "On-Line
Haemodiafiltration a Preferred Modality of Treatment"
9th Annual Interdisciplinary Research Conference Trinity
College School of Nursing and Midwifery Dublin 5th 7th November 2008.
Frank Kelly and Derek Farrell Poster: Annual Scientific
Meeting of The Biomedical / Clinical Engineering
Conference, Tullamore October 2009.
On Line Haemodiafiltration a Preferred Modality of
Treatment. Spectrum Winter 2008
• Compiling comprehensive equipment specifications
• Advising on and evaluating new equipment purchases
Publications
Medical Device Training
Frank Kelly and Derek Farrell attended Training on the
5008 Fresenius Dialysis Machines
John Harte; Physiology Monitor Training in MDI
Meetings attended:
Tom Smyth attended Medica Düsseldorf
Frank Kelly, Derek Farrell and Aidan O’Connor attended
the B.E.A.I. Annual Scientific Meeting in Tullamore
Declan Murray attended:
The department has continuously succeeded in
producing considerable savings in equipment repairs
and planned preventative maintenance by adopting the
policy of only outsourcing maintenance when
absolutely necessary.
1.
Medica Düsseldorf Nov ‘08
2.
Fresenius HDF presentation RDS Apr’ 08
3.
Healthcare Ireland RDS June ‘08
Frank Kelly attended The British Renal Association
Meeting Glasgow
Frank Kelly attended the European 37th European
Dialysis Transplant Association and the European Renal
Care Association Meeting Prague.
John Harte attended Critical Care Society Manchester
Annual Conference
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The department is phasing in, along with the
equipment library, a new I.T. solution to our method of
equipment management. This will serve to greatly assist
the task of equipping all new projects.
The Equipment Library has been introduced and we are
currently collecting stock.
Staff
Firstly the major achievement of the year in terms of
staffing was the elimination of all the temporary positions
in the Department. Presently we have 19 permanent
posts involving a total staff of 23. Also there was one
new Senior Social Work position created during the year
bringing the total to 8. Louise Morgan, who was a Senior
Practitioner, secured the position. Fiona Byrne, who
previously worked as a locum, obtained a permanent
post in August. Nicola Flynn, who was also in a temporary
position, secured permanency at the same time. Finally,
Karen Quinn took up a role in the Emergency
Department in September with a permanent contract.
During the year Enara Etxebarria resigned her position
in order to return home to Spain.
Emer Bissett, who was employed as a locum in the
Emergency Department, obtained a permanent post in
Tallaght Hospital in August.
Naoise Waldron, a former student, provided Social Work
cover during the months of June, July and August for all
the staff on vacation.
Alison Merrigan, provided locum cover for Louise
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Morgan from September until December during the
latter’s maternity leave.
In addition it is important to acknowledge the support
provided by our administrative staff during 2008. There
are 2 positions, covered by three people.
Mary Gaughan joined us this year after Mary Brewer had
resigned her post after 10 years in the role in February.
As can be seen from the statistics we placed 119 patients
in DDI (Delayed Discharge Initiative) beds. Earlier in the
year the hospital funded from its own resources 45
patients in private nursing homes to relieve pressure on
the Emergency Department. The number of patients
requiring long term care had dropped to an all time low
of 8 by the end of December after 30 patients had
been successfully placed during that month. Also it is
significant to note that the length of stay has dropped
significantly to less than 3 months i.e. for the patients
who were longest in the hospital.
We moved into our new suite of offices in July 2008
which includes an interview room, 2 offices and a
conference room for business meetings, family
meetings etc. It has been a wonderful addition to the
department and enables us to see patients and their
families in a pleasant, private environment.
Kiltipper Nursing Home continued to provide “step
down” beds to our hospital in 2008. There was a total
of 119 patients who availed of this resource for the
year. Unfortunately the 6 beds in Our Lady’s Manor
ceased to operate from July due to a number of
reasons beyond our control.
We had a busy and challenging year in 2008 in Social
Work. Firstly our referral rate continued to increase
compared to previous years. We had 7,109 open and
closed cases during 2008.
The reduced budget from the HSE with regard to
support services at home had an impact on our patients.
However despite this we managed in practically all cases
to get people packages of care. The younger chronically
ill patients also had very few allocated resources to
enable them to receive appropriate services. Yet we
Our pivotal role in facilitating discharge for patients to
either home or long term care came sharply into focus.
were able to place patients (for example) in appropriate
residential/nursing home care by using DDI monies.
With regard to other developments, the Old Age
Psychiatry Social Workers were involved in a number of
programmes during the year e.g. Healthy Ageing, Anxiety
Management, Carers Support. A clinical audit was
carried out on the Carers Information meetings and a
poster was presented both at the Clinical Audit Day in
our hospital as well as the National Gerontology
Association Annual Conference in September 2008.
The Bereavement Group ran its two courses during the
year for all relatives/carers of deceased patients in the
hospital. The response from the evaluation from the
participants was positive.
The department also addressed the issue of our role in
a major emergency and we completed a plan and did a
“dummy” run to evaluate its effectiveness.
Eileen O’Donnell, Senior Social Worker, played a major
part in the “roll out” of The Care to Drive” Pilot Scheme
instigated by The Irish Cancer Society in conjunction
with St Vincent’s University Hospital for oncology patients.
It has proved to be a major success and as result will
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be launched nationwide. It involves recruiting and
training volunteers to drive and support these particular
patients to and from hospital.
Total Number of Cases opened & closed
With regard to staff training quite a number of Social
Workers availed of the in-house programmes on offer
e.g. Stress Management. The 7 Habits, “Mindfulness” etc
External training was also availed of by members of the
team e.g. in relation to bereavement and end of life
issues, HIV counselling, and motivational training
associated with taddiction.
There was a review day organised by the department
for clinical supervision for both supervisors and
supervisees. Louise Morgan completed her supervision
training in the autumn after achieving promotion.
We had 7,109 open and closed cases in 2008,
which is an increase from 2007:
We received 119 D.D.I. beds from the H.S.E.in 2008,
which is a decrease from 143 for 2007:
DDI Beds
Future Plans
Given the serious economic constraints that exist at this
present time and for the foreseeable future our
aspirations for the service are quite modest. Firstly we
aim to provide a quality service to all our patients and
the other staff in the hospital. Currently we are looking
at patient satisfaction and how we can measure this and
act upon it. We are looking at making positive changes
with regard to our referral form that will enable us to
glean essential information so that we can do our work
more efficiently from the beginning. We will review this
on a regular basis in consultation with users of the
service.
We are also looking at launching an assessment form
for ourselves that will ensure we are all working to the
same standard and that there is uniformity in its best
sense.
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We are keen to contribute to the accreditation process
currently being undertaken so that what we do as a
profession is clear and transparent to staff and patients.
We are very aware of our key role with “vulnerable”
patients and the need to drive a hospital wide policy
and training to address the issues that can come up
from time to time e.g. elder abuse, child protection,
domestic violence.
We shall continue to focus on Team Based Performance
and setting our indicators for the year. We are presently
working with our professional colleagues both in the
hospital and externally in endeavouring to drive forward
the implementation of the Common Summary
Assessment Record that has been launched by the
HSE.
There was a 3.4 % decrease in in-patient consultations
between 2007 and 2008; however we had a slight
increase in the number of new in-patients referred, with
a decrease in the number of review consultations
undertaken. This probably reflects the reduction in
length of stay (LOS) from 10.6 to 9.3 days in 2008.
There was a 1.4% decrease in OPD consultations both
MDT and Dietetic-led clinics. However in our Dietetic
led OPD clinic we achieved a 3.8% reduction in DNA
rate while offering an urgent appoint within 4 weeks
and standard appointment within 8 weeks. Writing to
patients advising that we have received a referral and
asking them to contact the Dept to make a suitable
appointment has reduced the DNA rate. We already
have a reminder system in place. 56% of patients did
not request an OPD appointment.
As in previous years our Day Case rate has increased
by 2.1% from 2007. There was an increase of almost
500% in the number of staff attending education/
updates in 2008.
Staff
The total staff compliment at the end of 2008 was
maintained at 16 WTE. Niamh O’Sullivan (Senior
Dietitian in Liver Transplant), Nicola Dervan, (Senior
Dietitian ICU) and Aisling Nolan (Entry-level Dietitian)
joined the Dept throughout the year. As part of the cost
containment strategy we had over 5 weeks of unpaid
leave in the Dept without replacement staff, which
contributed to the reduction in activity and costs.
In August a weekly dietitian-led Cardiology clinic was
introduced to meet the needs of patients discharged
from the Cardiology Unit prior to receiving dietary
advice, due to the short LOS and to allow monitoring of
those requiring nutritional support in hospital. This is a
growing area in Cardiology now representing approx
36% of dietary interventions on the Cardiac Unit. The
clinic was designed to be partially booked to allow for
referrals from the Cardiac Clinic on the same day, but
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on review of the service, this was changed to a fully
booked clinic. The DNA rate was 12%, which is lower
than our general clinic.
In summer 2008 a tender for enteral and oral
nutritional supplements was completed with a
projected saving of €30,000 p.a.
Nicola Dervan, Senior Dietitian in ICU undertook an
audit of Nutrition Support practices in ICU. The results
were benchmarked against best practice guidelines and
compared to similar ICU units nationally and
internationally. The findings have been presented at
Intensive Care Education Sessions and the Surgical
Grand Rounds. The results will also be used to identify
areas that need to be targeted in educational updates
and guideline development.
During 2008 an audit of PN (parenteral nutrition)
practice was undertaken on medical and surgical wards
in St Vincent’s University Hospital. This audit observed
the current prescribing, administration and monitoring
of parenteral nutrition practices in St. Vincent’s University
Hospital and was benchmarked against PN guidelines
in the Nutrition and Medicines Guide 2007/2009. An
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educational poster was developed on the rules of safe
practice with parenteral nutrition which is displayed in
treatment rooms on all wards within the hospital and
will be used as an education tool in parenteral nutrition
education sessions in 2009
lack of time and working equipment were highlighted
as barriers to completion of the tool. A small working
group under the auspices of the Nutrition Committee
has been established to implement the MUST tool as a
hospital-wide nutritional screening tool in 2009.
The department facilitated a final year thesis for a BSc.
in Human Nutrition and Dietetics. Laura Keaskin
completed her thesis entitled “An Investigation into the
efficacy of four nutritional risk screening tools in
respiratory patients”. A sample of 50 patients with a
respiratory diagnosis consecutively admitted during a
four-week period were nutritionally screened using four
nutrition risk-screening tools. This was compared to a
full nutritional assessment incorporating anthropometry
and dietary assessment. In addition, current compliance
with the local nutrition-screening tool was examined
and the opinions of nurses in relation to nutrition risk
screening were sought in a short questionnaire. More
than one-third (36%) of the sample were at risk of
malnutrition according to the nutritional assessment.
The Malnutrition Universal Screening Tool (MUST)
performed best in terms of sensitivity (72.2%) and
specificity (93.8%). Almost all (89%) nurses reported
using the screening tool most of the time however, only
28% of patients had their nutrition risk score documented
on admission. Issues such as being unable to weigh the
patient or the patient being unable to answer questions,
In April 2008, there was a hospital wide introduction of
Protected Mealtime followed by an audit to examine its
efficacy in June 2008. Previous work by the Nutrition
Sub-Committee, a sub-committee of the Nutrition
Committee, on this topic in SVUH indicated a reduction
in interruptions during the lunchtime meal on the wards
where protected mealtimes had been implemented. A
Protected Mealtimes policy was then approved as a
hospital guideline and was introduced throughout the
hospital in April 2008. The roll out included
• Poster campaign, information leaflets, information
on the Intranet.
• Information sessions on all wards and with the
Catering Department.
• Presentations at the general Staff Briefing session
and at the Nurse Managers Meeting.
• Information stand in the main hospital concourse.
• Protected Mealtime information was added to the
electronic media link at the entrance to the hospital.
• All-user email sent to all hospital staff.
In order to assess the efficacy of the Protected Mealtimes
a post implementation audit was carried out in June
2008. 129 hospital in-patients’ mealtimes were
audited. This was carried out throughout the hospital
where one six bedded bay from each of the 23 wards
was included. The aims of this audit were
1. To determine compliance with the Protected
Mealtime audit hospital wide.
2. To highlight any issues with the new policy.
3. To report back to all relevant stake-holders.
The results of the audit were encouraging, showing a
similar percentage of interruptions to the smaller pilot
as indicated below
The results have been presented to the Clinical Nurse
Managers and have been included in the hospital wide
newsletter. The Nutrition Sub Committee will depict the
results in a poster for staff and visitors and hope to have
the audit accepted for publication in relevant literature.
Significant Publications/Presentations
Poster presentations
M.C. O’Hara, V. Reid, M. Minogue, D. Walsh and C.C.
Kelleher.
“Profiling patients after cardiac rehabilitation enrolled in
an Irish Heart Foundation-funded randomised cookery
skills intervention: are they compliant with current
health recommendations?“
Irish Association of Cardiac Rehabilitation, Dublin,
November 2008.
4. To make changes as appropriate.
Barnes, EA, McAuliffe, E,
“Exploring the information needs of Irish patients with
colorectal cancer”. Health Policy and Management
Integrated Care: Putting Research into Practice, TCD,
Dublin June 2008
Reilly CM, Keane CM, O'Shaughnessy LM, Hough P,
O'Brien H, Groenewald L, McKeown C, McKone EF,
Gallagher CG.
A retrospective study of End of Life Care in Cystic
Fibrosis.
North American CF conference October 08
Submitted by Liz Barnes,
Dietitian Manager,
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Occupational Health Department
Staff
Breakdown of consultations
Occupational Physician
Dr. Paul Guéret
Dr. Robert Ryan
Dr. Jacintha More-O’Ferrall
Service activities
Nuala Gannon
Clinical Nurse Specialist (CNS)
Aisling Purcell
Ann O’Reilly
Justine McGrane
Siobhan Bulfin (Up to June 2009)
Marie Hennigan (from July 2009)
Barbara Sheridan.
Service activity levels
•
•
•
•
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Management referrals (Total.:411)
Self referrals (Total: 239)
Pre-employment assessments (Total: 868)
Occupational injuries -e.g. needlestick & splash
injuries, slips/trips/falls, MSK (Total: 157)
Vaccinations appointments (Total: 1882)
Backs appointments (Total: 152)
Psychosocial (Total: 613)
Education (Total: 1087)
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1. Vaccination and immune status evaluation
A comprehensive vaccination programme was
undertaken with testing for immune status as
indicated. The programme provided for the
evaluation of and vaccination for Measles, Mumps
and Rubella, Varicella, TB and Hepatitis B titres.
2. Infection control
Administrative support
•
•
•
•
Occupational Health provided a flu vaccination
programme for staff; it was availed of by 656 staff.
• Norovirus
Occupational Psychologist
Áine Yap
Medical (Total: 1338) Psychosocial (Total: 613)
CNS appointments (Total: 1899)
• Influenza
• Exposure Incidents
Occupational Health managed 28 incidents where
staff were accidentally exposed to potentially
infectious blood or body fluids and 98 incidents
where staff received needlestick injuries.
• Contact tracing
Occupational Health managed the process of contact
tracing of staff exposed to patients who contacted
infection diseases such as Measles, Mumps, Rubella,
Varicella, TB and Meningitis. Varicella contact tracings
were undertaken on 26 occasions in 16 areas and
397 staff required OH advice. A number of high
risk groups within the Hospital were identified and
screening for their immune status is ongoing.
There were no outbreaks of the Norovirus in 2008;
however 170 staff with gastrointestinal upset
contacted Occupational Health for advice.
3. Psychological health
The service offered:
• Counselling to all members of staff (Total number: 115).
• Consultative support to Managers and Management
(Total: 73)
• Training and Development in the areas of stress
management and other topics relevant to the
psychological health and wellness of staff (Total: 215).
4. Policy development
The department was involved in:
• The development of hospital-wide policies through
the Committees attended;
• The development and revision of internal
Occupational Health protocols.
5. Education and training
The service delivered training to staff in the following areas:
• Venepuncture and Cannulation study days;
• Induction for new staff;
Occupational Health (OH) Department
• Needlestick injury prevention workshops targeting
specific areas such as Theatre, Laboratories and
some ward areas, and particular staff groups such
as NCHD’s. Some 872 staff attended these
sessions in 2008.
• Workshops and short courses for Managers:
i. ‘How to…manage stress’.
ii. ‘How to…deal with difficult and challenging
behaviour’
iii.‘How to…deal with grief and loss’ – for
clinical and non-clinical staff groups.
• Workshops and short courses for staff:
‘Managing stress’
6. Health Promotion
The Department provided the following staff
information and wellness programmes:
i. The ‘Working Backs’ programme
ii. The ‘Pregnancy At Work’ programme
The service continued to expand with an excess of 200
staff availing of the following services in 2008:
• Pre- Employment Health Assessments;
• Immune status evaluation and vaccination–
Hepatitis B, Measles, Mumps, Rubella, Varicella and
Tuberculosis;
• Management of inoculation injuries (10 needle
stick injuries and 1 blood splash);
• Management referrals;
• OH Psychology service;
• Cytotoxic Surveillance.
• The design, development and implementation of
the ‘Pregnancy at Work’ programme.
7. Committee work
Future Plans - 2009
The OHD was represented on the following hospital
1. Develop the OH website on the Intranet, providing
more information for staff and managers.
2. Further develop an integrated data management
system.
3. Undertake more staff training.
4. Undertake audit and implement change as indicated.
committees:
• Health and Safety Committee
• Infection Control Committee
• Hygiene Services Committee
• Pandemic Influenza committee
• Safety risk quality improvement group
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St Vincent’s Private Hospital (SVPH)
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Overview
Staffing
St. Vincent’s Public and Private Occupational
St. Vincent’s
St. Vincent’s Occupational Therapy Department
Therapy services
We were fortunate to have received an additional post
in 2008. This was an OT splinting and hands post with
specific responsibilities to the following:
We enjoyed almost 100% staffing in all Occupational
Therapy Service Areas throughout the year 2008. This
resulted in our being able to work on key objectives set
for the department, which included the following inline
with the Organisations KPI’s:
• Reducing waiting lists and time of access for both
in-patients and outpatients.
• Tracking and setting targets for the numbers of
patients facilitated monthly by our pilot Discharge
Facilitation Post.
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- 0.5 hands and plastics to make that OT post 1
WTE.
- 0.25 to Hands referrals in ED.
- 0.25 to tackle Neurology outpatient’s waiting list
and target patients with urgent splinting needs.
• Reviewing and introducing risk identification and
systems analysis.
We also were fortunate to be able to continue our pilot
Discharge Facilitation post, which continued to expedite
hospital discharges, which only require Occupational
Therapy intervention.
• Reviewed and updating all our documentation and
non standardised assessments / forms to be easily
identified as Occupational Therapy Specific in line
with the Organisation roll out of the National Patient
Chart.
There was some internal movement within the
Department namely in the areas of Stroke and
Neurology, Orthopaedics and Medicine for the Elderly.
We also had 2 staff members successfully go from
basic grade to acting senior members of staff.
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2008 again was a very successful and productive time
from an Occupational Therapy perspective. We
achieved our departmental goal of reviewing our
standards and completed 4 out of 5 internal audits of
our service.
These audits included:
- Hands and Plastics OT: Audit of Hand Fractures
- Old Age Psychiatry OT: Anxiety Management
Group Programme
- OT dept- Evaluating the Impact of Occupational
Therapy Home Assessments and intervention on
Patient Safety using the SAFER HOME tool as an
outcome measure.
- Adult Mental Health OT: Consumer survey
surrounding Occupational Therapy Interventions.
In-patients Totals 2006 - 2008
Year
New
Return
No. Of Attend.
Units of Contact
2006
897
1065
8851
25742
2007
993
917
9468
25806
2008
1480
770
13281
48656
Outpatients Totals 2006 – 2008
Year
New
Return
Units of Contact
2006
1296
1342
4931
14119
2007
1548
1267
6399
20143
2008
1782
2443
20793
82369
Occupational Therapy Statistics
In reviewing our activity statistics for 2008 we have
seen quite a dramatic increases in the past year and
this can be contributed in part to our levels of staffing
throughout the year 2008.
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No. Of Attend.
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Future Plans
The Occupational Therapy Department has the
following service Objectives for 2009:
Each Occupational Therapy Service Area to have
benchmarked their service against National and
International guidelines and ensure standards set are in
line with National and International evidence.
Pharmacy Department
Aseptic Service
Major service developments and activities were:
There was a 12% increase in the number of items
manufactured in the Aseptic Unit. This was mainly due
to:
• Senior pharmacist allocated to co-ordinate clinical
pharmacy services to surgery
• Senior pharmacist appointed to oncology position
shared between aseptic manufacturing and clinical
service
Dispensary Service
In 2008 there was an increase in activity in dispensary
services including provision of emergency trays and
rolls, non-sterile manufacturing and staff prescriptions.
In October the dispensary took over responsibility for
supplying outpatient prescriptions (controlled and noncontrolled drugs) for all clinical areas.
Clinical Service
The SARI pharmacist, Zulema Gonzalez Sanchez,
organised “Antibiotic Awareness Day” in SVUH in
October 2008. The main objective was to highlight the
problems with antibiotic resistance. Staff were invited to
take part in an antibiotic quiz and information leaflets
were distributed.
Education
Pharmacy staff provided lectures and workshops for
undergraduate and postgraduate medical, nursing and
pharmacy educational programmes.
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• 90% increase in the number of ganciclovir infusion
bags made for patients in the Liver Unit.
• Production of pre-filled syringes of heparin in
support of a new medication safety initiative
• 7% increase in the number of IV chemotherapy
items prepared.
The aseptic service also supported 20 oncology
research projects in 2008.
Activity in the Aseptic Unit 2000-2008
Pharmacy Department
Medicines Information (MI)
Medicines Information (MI) received a total of 1455
queries in 2008, (up substantially from 1090 in 2007).
Two-thirds of this total (998) is made up of queries
relating to administration/dosage, adverse effects and
choice of therapy.
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Users of the MI service work in many different areas
around the hospital. Most frequent users of MI are
pharmacy staff, doctors and nursing staff. Breakdown of
queries by area of origin in 2008 is indicated below.
Pharmacy Department
No. queries by source Jan-Dec 2008
Medication Safety
In Jan 2008, the first Medication Safety Seminar was
held in the ERC with presentations from SVHG and
speakers from the University of South Manchester and
Kings College Hospital, London. Initiatives to minimise
risk to patients, on importance of medical involvement
in patient safety, audit of services to improve medication
and patient safety were presented.
In 2008, medication safety was included in the monthly
nursing induction sessions. Education sessions were
also provided at NCHD induction, to the Emergency
Dept, Theatre staff and UCD final year nursing.
High alert medications
• There was a change in practice in relation to
vincristine reconstitution / administration, in line
with WHO guidelines, to minimise risk of inadvertent
intrathecal administration. SVUH practice changes
were published in the Irish Pharmacy Journal (Feb
2008).
• Heparin infusion policy - a revised heparin infusion
prescription label was introduced.
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Pharmacy Department
High-risk medication processes:
Medication safety reports are provided on a monthly
basis to the Patient Safety Committee. Medication
incident reports (MIRs) are graded using the National
Coordinating Council for Medication Error Reporting and
Prevention (NCCMERP) grading tool. 668 medication
incident and near miss reports were received in 2008,
an increase of nearly 90% (N = 352) on 2007, which
suggests a culture of medication safety is established.
SVUH is actively working to learn from medication
incidents and prevent future ones, through the work of
the Patient Safety and the Drugs & Therapeutics
committees.
SVUH continues to actively partake in national
medication safety initiatives through the Irish Medication
Safety Network.
SVHG Drugs and Therapeutics Committee
The Drugs and Therapeutics Committee introduced a
new in-patient medication record during the year
following a pilot in some clinical areas. The new record
has a highlighted allergy section and includes the
prescription for intravenous fluids.
Multidisciplinary working groups were also convened
and facilitated by the medication safety co-ordinator in
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order to revise guidance and policy in the case of two
high alert medications, potassium (August 2008) and
insulin (November 2008).
The subcommittee facilitating the nurse prescribing
initiative met regularly through the year.
The committee approved and introduced a new
outpatient prescription for SVUH in October 2008.
Achievements
Congratulations to the following members of staff:
Eilis Kearney won first prize at the HPAI Conference
(April 2008) for her poster “An Audit of Oral and
Enteral Liquid Medication Administration Guidance
versus Practice”.
Grant Carroll won the Servier Award (2008) for his
project “Construction of a Patient Medication Card
Database”.
Elena Castilla completed a Diploma in Clinical
Pharmacy (Queen’s University, Belfast).
Annemarie DeFrein completed and received CPD in
Oncology Pharmacy
Eilis Kearney completed a Certificate in Clinical
Pharmacy (Queen’s University, Belfast).
Pharmacy Department
Publications and Posters
Kearney E, O’Hanlon N. An Audit of Oral and Enteral
Liquid Medication Administration Guidance versus
Practice.
Flanagan M, Moran M, Murphy D, O’Hanlon N.
The Use of Trigger Tools to Help Identify Adverse Events.
Kennedy, F. Choice of Antihyperlipidaemic Agents
(chapter in textbook Drugs and the Liver.
Pharmaceutical Press, 2008)
Hammond, L. Audit of Vnous Thromboprophylaxis in
General Surgery Patients on a surgical ward in St
Vincent’s University Hospital.
British Oncology Pharmacists Association (BOPA)
Conference, Liverpool, October 2008. AM DeFrein, G.
Carroll.
BOPA Study Day, May 2008. L. Hammond, C.
Muldowney.
North America CF Conference, Orlando, October 2008.
C. Keane
National Pharmacist Conference, Badajoz, October
2008. Z. Gonzalez Sanchez.
ASHP Mid Year Clinical Meeting; Orlando, December
2007. M. Moran, N. O’Hanlon.
Seminar “Focus on Infection”, Dublin, December 2008.
Z. Gonzalez Sanchez.
Conferences
Nutrition Study day, SVUH, February 2008. A. Shorten,
M. O’Sullivan.
European Congress of Clinical Microbiology and infectious
Diseases, Barcelona, April 2008. Z. Gonzalez Sanchez.
HPAI Annual Educational Conference, Dublin, April 2007.
BMJ Group International Forum on Quality and Safety,
Paris, April 2008. N. O’Hanlon, L. Hammond.
UKCPA Annual Symposium, Hinckley, October 2008. Z.
Gonzalez Sanchez.
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Future Plans
The focus for 2009 will be on medication management
issues and meeting the standards for JCI Accreditation.
A lot of effort is being put into medication policy writing
and review, addressing issues with medication
reconciliation and reducing risks with Sound Alike Look
Alike Drugs (SALAD) or Look Alike Sound Alike (LASA)
medications.
Staff
The WTE complement for 2008 was 39.5 therapists.
Additional posts were sanctioned in Cardiorespiratory
Practice Education (0.5 WTE) and ED (1WTE). Both
positions should result in both enhanced care for
patients and costs savings for the organisation through
more timely provision of care, decreased overtime costs
for on-call physiotherapists and improved discharge
facilitation for ED patients.
• Departmental KPI set developed. Indicators selected
were: number of in-patients referred, number of
outpatients referred, WTE in position, outpatient wait
time, monthly expenditure, number of patient
complaints, weekend hours worked, number of
emergency call ins, DNA rate. These indicators were
chosen as indicating the department’s most relevant
performance indicators and as being in line with the
organisations current strategy.
• Team Based Performance management was
introduced to the 3 clinical service areas within the
department and the first cycle of performance
management was completed.
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• HSEland Professional Development Planning tool was
adopted for all seniors. The use of this tool aids staff
with assessing their current professional development
level and planning future developments to respond to
both individual and organisational needs.
• Summary of Physiotherapy Services revised and
placed on SVUH intranet for enhanced information of
hospital staff.
• Community links enhanced. Increased communication
between Physiotherapy Managers in SVUH and local
PCCC areas was commenced, with each organisation
providing service descriptions and contact information
for their own services.
• ED post sanctioned. Service provision to the Emergency
Department was increased to 1 WTE Senior
Physiotherapist grade in December 2008 with a main
focus on improving in-patient length of stay. Benefits
of this improved service are that patients benefit from
an enhanced level of initial assessment, shorter time
to first assessment and greater assurance of the patient
being treated in the most appropriate environment.
• Back Pain Screening Programme Proposal presented
to Professor Brendan Drumm in February 2008. The
aims of the programme are that the treatment pathway
for patients referred to an Orthopaedic Consultant
with low back pain should be transformed, so that
patients gain access to the most appropriate
healthcare professional in a shorter time frame,
following comprehensive assessment. A 12 month
pilot of the Back Pain Screening Programme was
planned for commencement in 2009.
Ergonomics and Back Care
25 further electrical beds were purchased in 2008,
bringing the number of electric beds up to 120. As
well as Induction and Refresher Manual Handling Training
Sessions, greater emphasis was placed on departmentspecific training in 2008, in line with Health and Safety
standards. Theresa Flynn and Karen Clerkin were main
contributors to the work of The Dublin Hospitals Group
Minimal Handling Advisory Group, who completed
Guidelines for Acute Adult Spinal Handling and
facilitated the first Instructor's course at MMUH in June.
Sheila White and Mairead Dockery successfully
completed the Masters in Manual Therapy (MMT) from
Centre of Musculoskeletal Studies, University of Western
Australia, Perth.
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Sarah O’Driscoll completed first year of UCD’s MSc in
Neuromusculoskeletal therapy, Orla Daly completed first
year of the MBA in Healthcare Management and
Catherine McLoughlin completed first year of the RSCI
MSc in Creative Leadership and Organisational Learning.
Keith Smart continued his HRB sponsored PhD entitled
'The development and preliminary validation of a
mechanisms-based classification of musculoskeletal
pain' at UCD.
John Messitt and Michael Bride commenced the level
five FETAC course in infection prevention and control,
occupational first aid, communication, work experience
and care of the older person.
Karen Cradock presented 2 posters at the ICD
Conference in November ‘The Effect Of Multidisciplinary
Care On Patients Following Implantation Of Cardioverter
Defibrillator.’ Cradock K, O’Malley M, Keogh S, Pyne
Daly P, Cahalane S, Quinn M, Keane D.
‘To Evaluate The Percentage Of Patients Attending The
Heart Failure Unit In St Vincents University Hospital Who
Require Social Work Assessment’. Murray A, Cradock K,
Edwards N, O’Loughlin c, ryder M, O’Neill D, McDonald K.
Clare Reilly and UCD undergraduate student Paul
Nicholas completed research on Thoracic Kyphosis and
its complications in Adult Cystic Fibrosis. This won 1st
prize at the National CF conference in Killarney in
2008. Clare Reilly presented a retrospective study
undertaken by the CF MDT team on End of Life issues
in CF at the North American CF conference in October
2008. Authors: Reilly CM, Keane CM, Hough P, O’
Brien H, O’ Shaughnessy LM, Groenewald L, Mc Keown
C, Mc Kone EF, Gallagher CG.
Margaret Healy appeared in the RTE documentary
‘Living with CF’ in August 2008.
Barry P, Waterhouse D, Reilly C, McKenna T, McKone E,
Gallaghers C (2008)
Androgens, exercise capacity and muscle function in
cystic fibrosis. Chest 134 (6) 1258-64.
Smart, K, Connell N, Doody C, (2008)
Towards A Mechanisms Based Classification Of Pain In
Musculoskeletal Physiotherapy.
Physical Therapy Reviews 13 (1) 1-10
Smart KM, Blake C, Staines A, Doody C (2008)
'Clinical indicators of peripheral neuropathic pain: a
Delphi study of expert clinicians (abstract)'.
Physical Therapy Reviews, 13 (3):211-212.
Future Plans
Implement a computer based patient scheduling
system to replace the existing manual diary system.
Continue streamlining of activities with community
services so that patients can access the most
appropriate level of care in an appropriate environment
Revise tools for team based performance management
and enhance co-ordination with HR on setting of
objectives.
Patient Referrals
Patient Attendances
*NB: A change in statistics definitions with the advancement of Healthstat commanded a change (decrease) to
reporting of two types of patient attendances: double attendances and rounds and conference attendance. This had
an effect of decreasing monthly attendance statistics by 1200 per month from October, or 3,600 for the year 2008.
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Department of Preventive Medicine and Health Promotion
Staff
Allied UCD staff
Professor Cecily Kelleher
MD, FRCPI, MPH, FFPHM, MFPHMI (Head of Department)
Professor Leslie Daly, MSc, PhD, FFPH
Ms Jacinta Barnewell
RGN, SCM, Adv. Dip. Montessori Education
(Health Promotion Officer)
Dr. Anna Clarke
LRCP&SI, MB, MPH, FRCPI, FFPHMI, FFPH
Ms. Denise Comerford
RGN, RM (Health Promotion Coordinator)
Ms. Frances Conlan (Secretary)
Ms. Kirsten Doherty BSc, MPH (Health Promotion Officer)
Ms. Marion Fitzgerald
BNS, RSCN, RGN (Health Promotion Officer, since August 2006)
Ms Irene Gilroy BSc (Health Promotion Officer)
Ms. Tina Mooney
RGN, Dip Mgt, HDip HP (Health Promotion Officer,
since September 2006)
Ms. Veronica O’Neill RGN, RM (Health Promotion Nurse)
Ms. Carol Pye RGN, RM (Health Promotion Officer)
Ms. Vivien Reid MSc, Dip Diet. (Clinical Specialist Dietitian)
Ms. Brenda Whiteside RGN, RM (Health Promotion Officer)
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24 Hour Blood Pressure Monitoring Service
2006 - 2008
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 in-patients 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
Safe & Moderate Alcohol Consumption Project (SMAC)
A multidisciplinary group, comprised of representatives
from Nursing, Emergency Department, Occupational
Health, Psychiatry, Medical Social Work, Liver Unit, and
Baggot Street Community Alcohol Treatment Unit, coordinated 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.
was awarded the “European & National Network for
Smoke Free Hospitals Silver award” in recognition of its
work in smoking management.
• Staff training sessions in brief intervention.
• A seamless referral pathway to appropriate hospital
and community services.
• Appropriate health promotion material.
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
in-patients 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
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Smoking Cessation Service Activity
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.
• “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.
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.
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• A smoking cessation service was provided to the
estimated 18% of staff who smoke.
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.
Celebrating a year since our move to the
Allied Therapy Suite (ATS)
In December’07, the department moved from St.
Anthony’s Rehabilitation Centre to the newly renovated
Allied Therapy Suite on the first floor. It is a major
development for the department to have a base in the
main hospital, so close to many of our key service
areas ENT, Neurology and the Stroke & Care of the
Elderly services. This move has resulted in many
positive benefits for our patients, staff and overall
service. The development of the ATS has allowed for a
more timely, efficient and integrated service model.
Staffing
For the first half of 2008, the department was down
1.5 posts. This improved in June’08 with the return of
Susan McElwee, Senior Speech & Language Therapist in
ENT & Surgery from a career break and Deirdre Kidney,
Senior in Neurology, St. Michael’s Hospital. In July ’08,
Eavan McSweeney was successful in gaining a
permanent basic grade position in the department.
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Current Level of Service Delivery:
The Speech and Language Therapy Department
provides both an in-patient and outpatient service to
over 89 consultants, 23 wards, Carew House, and St.
Michael’s Hospital. The following is a breakdown of the
speech and language therapy treatment units by clinical
specialities for 2008. These figures do not include our
service to St.Michael’s Hospital.
Clinical Specialities 2007
Clinical Specialities 2008
Clinical
Specialities
Treatment
Units 2007
Treatment
Units
Variance
+
Medicine for the elderly
1,928
3,198
+
1,270
ENT / Plastics
1,541
1,853
+
312
-
237
Oncology
359
122
Surgical
803
1,795
+
992
Respiratory
1,235
1,602
+
369
Gastroenterology
1,176
1,285
+
109
Neurology
2,411
3,351
+
940
Cardiology/Gen Med
159
530
+
371
Endocrinology
208
527
+
319
Rheumatology
382
549
+
167
Nephrology/Psychiatry
645
514
-
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Clinical Specialities/Speech and Language Therapy Treatment Units 2007 and 2008
Specialised Clinics – Swallowing and Voice
Videofluoroscopy – Established 10 years
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
videofluroscopy service in the East Coast Area. Referrals
are accepted from St. Michael’s Hospital, St. Vincent’s
Private Hospital, the National Rehabilitation Hospital and
the Royal Hospital Donnybrook. The clinic takes place in
the Flursoscopy Unit on the 2nd floor of the Ambulatory
Day Care building. Two weekly clinics are scheduled on
Wednesday and Friday mornings.
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Fees
The Fiberoptic Endoscopic Evaluation of Swallowing
(FEES) assessment clinic is conducted jointly by the
Speech and Language Therapy Department and the
ENT team. This service commenced in July’04 and is
completed either at the patient’s bedside or in the
Voice Lab room in the ENT OPD suite on the first floor.
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 outcomes measures.
Training and Development
Digital Stroboscopy
This service has been running for the past seven years
and is part of our weekly voice clinics. It provides
Throughout 2008, the department was involved in a
number of presentations both within and outside the
hospital.
Fees
Digital Stroboscopy
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.
Throughout 2008 the department was also involved in
the Tracheostomy Study Days organised in conjunction
with the nursing practice development staff.
Three final year TCD students successfully completed
their clinical placement examinations.
Significant Courses/Conferences
Karen Kirke successfully completed her postgraduate
dysphagia training.
Caoimhe McDermott and Eavan McSweeney both
successfully completed their postgraduate
videofluoroscopy training.
Caoimhe McDermott also completed her
tracheostomy clinical training.
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Reports from the Director of Nursing
134
Report from the Director of Nursing
Introduction
On behalf of the Department of Nursing, I am delighted
to provide an overview of our activity during 2008. Our
focus continues to be our patients, their families and our
objective is to ensure their experience of our service is
one they are satisfied with. Increased level of activity in a
climate of economic change has been very challenging.
Considering this, our staff led on many quality
initiatives, demonstrating the team’s resourcefulness
and commitment to safe patient care.
Our Department continued to develop its proficiency in
utilising Team Based Performance Management as a
tool for aligning its activity with the organisation’s
strategic objectives. The process resulted in activities
which enabled our objectives and the principles of
Transformation “Easy-Access, Confidence and Pride” to
be realised for our patients and staff. Reconfiguration
and development of dedicated bed bases in Respiratory
Medicine, Cystic Fibrosis, Medical / Surgical
Gastroenterology, and Medicine for the Elderly are but a
sample of improvements introduced.
St Vincent’s became a designated Cancer Centre in line
with the National Cancer Control Programme. The
transfer of the Symptomatic Breast Service from
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Portlaoise resulted in further development of existing
services. Nurses embraced the challenge, a new Triple
Assessment Breast Clinic was developed and nursing is
now taking the lead in five clinics in the area. The Cancer
Support Centre, Lios Aoibhinn was re-located to Nutley
Lane with nursing taking the lead in managing and coordinating this initiative.
In ADCC, St Mark’s Ward relocated to a newly refurbished
dedicated Day Services Unit. A nurse-led infusion Therapy
Suite was opened in December to provide treatment
for patients receiving Biological Therapies resulting in
improved access for patients.
A review undertaken during the year of nursing input
into the heart failure service, found that over 3000
patient contacts were specifically with the Advanced
Nurse Practitioners (ANP) or Clinical Nurse Specialists
(CNSs) in the speciality, these included: home visits,
telephone calls, education sessions and in-patient visits.
The Cardiology ANP Review Clinic was introduced in
2008, 140 patients were reviewed by the nurse
appointed to this role.
Nurse Education and Practice Development
In striving to maintain excellence in clinical care, I would
like to acknowledge the continued commitment of all
staff involved in education of staff and patients, practice
and professional development. For the first time, the
national nurse prescribing initiative was introduced in
nine clinical areas in SVUH. The “Protected Meal Times”
initiative was successfully rolled out across the hospital
therefore enabling patients privacy and time to enjoy
their meals uninterrupted. Development of staff through
the provision of ward based education and training
sessions in clinical practice, in line with the development
of guidelines, policies and procedures continued to
provide essential support to staff. Practice Development
facilitated this in conjunction with clinical staff and
members of the multidisciplinary teams. Examples of
areas of focus during the year included tracheotomy
care, continence care and falls prevention. Clinical
placement co-ordinators, allocations and administration
staff continued to work with the nursing staff in the
provision of high standards within the clinical learning
environments for nursing students at undergraduate
and post graduate levels.
The Director and her team in the Nurse Education
Centre delivered seventeen different programmes to
nurses, and health care assistants working in St Vincent’s
University Hospital and the HSE East Coast Area. Sixtysix healthcare assistants employed in the organisation
and within the region graduated with a FETAC Level 5
Healthcare Support Certificate. At the request of the
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office of the Nursing Services Directorate, HSE, the
Education Centre increased the training capacity for
Cannulation and Venepuncture by 50% for nursing
staff. The centre also facilitated the first five day Cancer
Care Course for non-specialist nurses for the Irish
Cancer Society.
Activity in research and audit continued to develop and
expand during the year. The Nursing Department
continues to be involved in collaborative research
studies with the School of Nursing and Midwifery in UCD.
Clinical Audit activity included Hygiene Clinical Waste
and Infection Prevention and Control audits with staff
developing and implementing action plans accordingly.
Nurses specialising in Heart Failure focused on the
impact of their role on care, and evaluation of telephone
calls to patients. The ANP in Cardiology began an audit
in evaluating the frequency and outcomes of CT
Coronary Angiograms for patients in the Chest Pain
Evaluation Unit and is due for completion in 2009. The
ANP and Nurse in Stroke Care focused on reviewing
and reducing patient falls within the clinical areas.
and HCA overtime, agency and bank hours were
introduced and successfully achieved by year-end. The
establishment of a pool of high quality Nurse and HCA
staff provided greater continuity of care and reduced
reliance on agency providers. Additionally and most
importantly there was a marked reduction in the
number of investigations, incidents and complaints
received regarding care issues.
Staffing
I would like to welcome those who joined our team of
nurses and healthcare assistants in 2008 and
congratulate those who were appointed to the following
positions:
Assistant Director of Nursing
Joan Love
Night Superintendant
ADON
Brenda Sheridan
CNM3
Finola Gill Lios Aoibhinn & Oncology Services
Una Nicholson
HSSD
CNM2
Michelle Connell
Clodagh McGuinness
Karina Somers
Vida Noronha
Brid Ni Fhionnagain
Stem Cell
St Mark’s Ward
St Catherine’s Ward
Theatre
Colorectal
CNS
Sally Casey
CAPD
Nurse and HCA Bank Service
The Nurse Bank continued to achieve significant savings
and more efficient use of resources during 2008.
Monthly targets and budgets in the areas of Nursing
Out of hours
Nursing Graduation
Plans for 2009
The annual event in the nursing calendar took place in
June, congratulations to the fifty-seven nursing students
who graduated. Congratulations also to those who
completed post graduate programmes and those who
were awarded prizes during the ceremony:
• Agree a suite of KPIs for the Department of Nursing
Prize
Winner
• Implementation of Nursing Department’s audit plan
Mother Mary Aikenhead Medal
Ms. Mary Bugler
Mother Mary Bernard Medal
Ms. Amanda Ward
Nuala Deeney Brennan Prize
Ms. Eileen O’Flynn
Cecil King Memorial Prize
Ms. Eithne Cullinan
Preceptorship Award (Medical)
Ms. Louise Skerrit
• Introduction of a hospital wide patient falls
programme
Preceptorship Award (Surgical)
Ms. Christin Harnett
• Pilot Clinical Supervision
Preceptorship Award (Specialist)
Mr. Anto Joseph
Jayasundar
• Introduction of Ionising Radiation prescribing
I would also like to thank those who retired from the
organisation for their long and dedicated service and
wish them every happiness in their future: Ms Catherine
Walsh, Post Registration Nurse Tutor, Ms Nuala Donnelly,
Clinical Nurse Manager 2, St Marks Ward, Ms Dolores
Anne O'Neill, Clinical Nurse Manager 2, St Agnes Ward
and Nora Tracey, Clinical Nurse Manager 2, Dermatology.
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• Implementation of External Review of Nurse
Education and Practice Development
• The Education Centre will continue to offer
academic, training and development programmes
• Continue implementation of Nurse Prescribing
• Continue with staff undertaking PDP’s in line with
agreed target
• Continue the implementation of HR Strategy
• Achieve National Hygiene Standard in line with
HIQA recommendations
• Work towards achieving JCI Accreditation
• Implementation of Risk Management Strategy
Mary Duff
Director of Nursing
Bed Management
The main functions of the bed management team are:
• Create capacity to meet the demand for emergency,
urgent and elective admissions.
• Reduce length of stay for all patient groups by
improving access to services and specialist beds for
in-patients, thus increasing throughput through our
acute care beds.
• Improve and promote discharge planning processes
to reduce the number of acute care beds made
inaccessible due to delayed discharges.
TBPM - In 2008, we set Bed Management and
Discharge KPI’s to measure the effectiveness of the
teams functioning in line with the high level set of
performance indicators for the organisation.
DPTF / IDP – The Discharge Planning Taskforce (DPTF)
continued its work on initiatives to improve discharge
processes in the organisation. Towards year end, we
commenced work to meet the standards in the new
code of practice for Integrated Discharge Planning
(IDP). This work is ongoing in conjunction with our
PCCC colleagues and the transformation programme.
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SSG – Speciality Specific Group have been set up for 9
specialities in 2008 and have yielded streamlined care
pathways for those patients, reduced length of stays,
better access for elective patients and improved bed
utilisation.
BMC – The Bed Management Committee revised its
terms of reference and membership in 2008. It
continues to function as a forum to make
recommendations for best utilisation of our beds.
CIT – Through innovation funding, the Community
Intervention Team was expanded to area 2 mid 2008
and has proved effective in improving admission
avoidance and early discharges.
Bed reconfigurations in 2008:
• On St. Patrick’s Ward, we created 6 MOU beds, a 4
bedded bay and 2 single rooms with the capacity for
telemetry and more space to manage patients in the
acute phase of their illness.
• On St. Vincent’s Ward, significant work was
undertaken to improve the ward as the dedicated
bed base for Neurology patients.
• On St. Luke’s 2 Ward, the area that was previously
the ICU was revamped and added 3 more single
rooms to the surgical dedicated bed base.
• A redesign on Our Lady’s Ward has resulted in a 24
bedded dedicated bed base for Care of the Elderly
with greatly improved facilities.
• St. Christopher’s Ward was developed on the site of
the old St. Mark’s Ward as a dedicated bed base for
Cystic Fibrosis and respiratory patients. It comprises
8 single rooms with en-suite facilities. The dedicated
respiratory bed base was agreed as 55 beds in total
on St. Paul’s, St. John’s and St. Christopher’s
• St. Mark’s Day Care Ward moved to the old X-ray
Department. The area was redesigned and
comprises 23 day beds, including 3 single rooms.
• Dedicated 5 day beds for pain patients were
agreed on St. James’s Ward to address an ever
increasing waiting list for pain procedures.
• CDU moved to a redesigned area within the
Emergency Department.
Hospital Sterile Services Department – HSSD
Activities
Statistics
The National Hospitals Office launched the
Decontamination Basics on line training programme in
October 2008. The programme has been rolled out in
departments that carry out decontamination. The
programme is available to all staff on HSE website
(www.hseland.ie).
2008 saw a 6.5% increase on 2007 activity levels for
reprocessing medical devices in HSSD. The department
has taken on the decontamination and reprocessing of
medical devices for the new Dental Service in ADCC.
We continue to sterilize medical devices for St.
Columcille's Hospital, Loughlinstown because of lack of
capacity in their HSSD. The unit sterilized over 5500
pieces for Loughlinstown in 2008. Each day sets are
received, reprocessed and dispatched back sterile to
Loughlinstown Hospital. The unit also has undertaken
external processing of equipment for the Rotunda
Hospital.
Ms Ita Balf, HSSD Manager, retired in January 2008.
The new manager, Ms Una Nicholson, took up her post
in July 2008. Una has a background in sterile services
and infection control.
Ms Maribel Franco, team leader, left the department in
May to take up the post of Sterile Service Manager in St
Michael’s Hospital. May we wish her all the best in her
new position.
Education
• Sinead Moran and Stephen Newman commenced
their 2nd year BSC, in Sterile Services; at the
Institute of Technology; Tallaght. September 2008.
• 7 members of the technical staff undertook the
NHS On-Line decontamination programme. 3 Staff
commenced level 5 Skillvec programme.
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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 November 2008, St. Vincent’s University Hospital
participated in a National Hygiene Audit undertaken by
the Health Information and Quality Authority (HIQA)
and received an overall rating of ‘Fair’, this compares
with a rating of ‘Good’ in 2007. 23.21 % of scores
were A ratings (Exceptional Compliance), 55.36 %
were B ratings (Extensive Compliance), 19.64 % were
C ratings (Broad Compliance) and 1.79 % were D
ratings (Minor Compliance).
The St Vincent’s University Hospital Hygiene Audit Tool
was rolled out in March 2008, the tool is designed to
help CNM’s and other department managers to manage
and improve hygiene practices in their own areas. Two
full rounds of audits were completed in 2008. The
results from these audits have been used to develop
Key Performance Indicators (KPI’S) for hygiene services.
The plan for 2009 is to carry out quarterly audits across
the hospital producing a complimentary set of KPI’s.
The Safety Risk and Quality Improvement Group
continued to meet. A Health and Safety Week seminar
themed ‘Risk Assessment’ was run to assist staff in
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conducting risk assessments. The Hospital Hygiene
Quality Improvement Group continued to meet on a
monthly basis, chaired by the Director of Nursing.
The Infection Prevention & Control team carried out a
review of all education programmes. Enhanced
surveillance of Health Care Associated Infections
(HCAI’s) has been introduced. The Infection Prevention
and Control page on the SVUH intranet has been
redesigned and the liaison programme has continued.
2008 saw the establishment of an Estates Strategy
Group (ESG) to oversee all campus development. A
number of major projects were completed during the
year, notably the new Allied Therapy Suite (January),
new St Mark’s Daycare Ward (June), new 8 bed St
Christopher’s CF Ward (August), St Vincents Ward
upgrade (September) and kitchen, toilet and shower
upgrades in 7 wards (December). Additionally a
number of essential facilities related improvements
were carried out by Technical Services. Unfortunately for
the hospital this significant investment was not reflected
in our scoring during the October Hygiene Audit. Our
overall rating decreased from “Good” to “Fair” and was
not indicative of all the hard work and commitment
shown by staff to improving hygiene standards. It was
also not a true reflection of the work put in by many of
the support services.
Household Services introduced a curtain changing
procedure for all clinical areas in March. Members of
the Household Services staff have been involved in
hygiene auditing of public areas.
A new Waste Marshall was appointed in 2008. The
whole hospital waste policy was reviewed and reissued.
Members of the portering staff have been involved in
hygiene auditing.
The Theatre Infection Control sub group continued to
meet monthly to monitor hygiene standards in the
theatre complex.
Completion of ward kitchen upgrades has ensured they
are now compliant with hygiene standards. The
induction package developed in 2007 has been
reviewed and updated in line with Irish Standard I.S.
340: 2007 – Hygiene in the Catering Sector.
St. Vincent’s University Hospital continued its
partnership with Noonan Services Contract Cleaning
Limited. The cleaning matrix has been amended to
incorporate the new areas of St Christopher’s Ward, the
Allied Therapy Suite and St Marks Day Ward.
Reports from Department of Medicine
141
Report from the Professor of Medicine
Staff
Consultants:
Professor Michael Keane
Medicine was approved for UCD and the first group of
students commenced in 2008.
Dr Seamas Donnelly
Dr John Seery
Specialist Registrars
Dr Emer Kelly
Dr Ruth Lee
Registrars
Dr Michael Pallin
Dr Azhar Jahinger
Special Lecturers
Dr Boon Beng Shu
Dr Shahid Zia
The unit continues to provide a busy clinical service as
evidenced by the in-patient and outpatient activities.
The unit has a tradition of providing a national referral
centre for interstitial lung disease. The unit continues
with its academic activities with both Professor Keane
and Dr Donnelly being active investigators at the Conway
Institute in UCD funded by Science Foundation Ireland.
Professor Keane is on the editorial board of the American
Journal of Respiratory and Critical Care Medicine,
American Journal of Physiology; Lung Cellular and
Molecular Physiology, Fibrogenesis and Tissue Repair.
Dr Ijaz Kamal
Administration Manager/Student co-ordinator
Barbara Cantwell
Service Developments
Curricular reform continues at UCD with significant
changes being implemented in the undergraduate
teaching programme as it moves towards a fully
modular programme. 2007 was the last year when
students would follow the old format of “Res Year” and
they will also be the last group to follow the traditional
“Final Med” structure in 2009. Graduate entry to
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The Dublin Academic Health Centre (DAHC) was
established to foster greater collaboration and
interactions between St Vincent’s University Hospital,
Mater Misericordiae University Hospital and the Medical
School at UCD. This follows the model of academic
medical centres, which have been established
internationally.
UCD continues its links with Penang Medical College
and Professor Keane travelled to Penang in June as an
examiner in the Final Medicine Examination.
Weigt SS, Elashoff RM, Keane MP, Strieter RM,
Gomperts BN, Xue YY, Ardehali A, Kubak B, Fishbein MC,
Saggar R, Ross DJ, Lynch JP, Zisman DA, Belperio JA.
Aletered levels of CC chemokines during pulmonary
CMV predict mortality post lung transplantation.
Am J Transplant. 8(7):1512-22, 2008
Saggar R, Ross DJ, Saggar D, Zisman DJ, Gregson A,
Lynch JP, Keane MP, Weigt SS, Ardehali A, Kubak B, Lai
C, Elashoff D, Fishbein MC, Wallace WD, Belperio JA.
Pulmonary hypertension associated with lung
transplantation obliterative bronchiolitis and vascular
remodeling of the allograft.
Am J Transplant 8(9):1921-1930, 2008.
Keane MP, Belperio JA, Strieter RM. Angiogenesis.
In The Chemokine Receptors.
Harrison JK and Lukacs NW (eds). Humana Press.
Keane MP, Belperio JA, Strieter RM. Chemokines in
Angiogenesis. In Anti angiogenic agents in cancer
therapy. Teicher BA and Ellis L (eds). Humana Press.
Keane MP, Strieter RM. Angiogenesis: major mechanisms
of pulmonary angiogenesis, angiogenesis and cancer.
"Molecular Pathology of Lung Diseases,"
(Cagle, Barrios, Haque, Jagirdar, Popper and Zander, eds.).
Report from the Chairman Physicians Subgroup
Staff
Retirements
Dr Martin Quinn,
Chairman of Physicians Subgroup
Prof Barry Bresnihan retired after many years of
dedicated service to SVUH.
Professor Douglas Veale,
Honory Secretary to Physicians Subgroup
Appointments
This year was a busy year for the Department of
Medicine in St Vincents University Hospital. The
numbers of patients seen and treated continues to
increase. The formation of the Dublin Academic Health
Centre has led to significant collaboration between the
Mater Misericordiae Hospital and St. Vincent’s University
Hospital. Professor Doug Veale was appointed the
Director of Translational Medicine for the DAHC.
Dr Martin Quinn and Prof Doug Veale competed their
terms of office and will be replaced by Prof Michael
Keane and Dr Frances Hayes.
New Developments
Work commenced on a new Medical Observation Unit
and this was completed at the end of 2008 with an
anticipated opening in early 2009. This will provide
significant improvements in the delivery of care to
critically ill medical patients within the hospital.
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Dr Frances Hayes joined the consultant staff in
Endocrinology.
Research and Teaching
The department continues to have a research output of
the highest quality with many publications in
international peer reviewed journals and numerous
international distinctions.
Department of Anaesthesia, Intensive Care & Pain Medicine
2008 brought with it a number significant changes for
the Department. Dr Tom Owens took over as Chairman
of the Department from Dr Declan O’Keeffe in January.
The biggest challenge facing the Department was a
shortage of staff.
The completion of negotiations for the new contract
has meant that the Department could progress any
proposed new posts. The external review has neared
completion at the time of writing. 2008 also saw the
setting up of the Acute Pain Service which is now up
and running, albeit at a basic level. This is seen as
being a significant development in peri-operative care
provided for patients. The Pre-Assessment Clinic has
also been up and running. We have new premises
adjacent to St Mark’s Ward which is a significant
development. In addition to that we have secured the
services of Olga Treacy three days a week in order to
staff the Pre-Assessment Clinic. Again this has been a
significant development for our Department. The PreAssessment Clinic is being supervised by both Dr Alan
McShane and Dr Tom Owens. It is hoped that the
proper and efficient use of the Pre-Assessment Clinic
will result in better and more efficient use the beds in
the hospital along with reduced cancellation rates and
complications for surgery.
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I would like to congratulate Dr Richard Assaf who retired
in October 2008. Dr Assaf has provided our Department
with many years of outstanding professional service in
addition to a commitment to teaching and training. In
many ways the success of our candidates in the Part 1
exam is in no small way due to the efforts of Dr Assaf. I
would like to thank him for the many years of effort he
has put into the training programme and would like to
wish him and his wife, Mary Rose, many happy years
together in their retirement.
Service Development /Activities
Activity Report – Operating Statistics 2008
During 2008 the throughput of surgical cases was 10211
Hosp
Total
39
2
41
264
106
370
GENERAL
2508
671
3179
GU ENDO
1032
128
1160
GU OPEN
151
19
170
GYNAECOLOGICAL
340
1
341
Dr Enda Connolly – Dr Gerry Dorrian
Award for best SpR in Anaesthesia
OPHTHALMIC
357
1
358
ORTHOPAEDIC
1913
79
1992
Dr Gavin Weekes – Dr Dick Nolan
Award for best BST in Anaesthesia
PAIN
560
22
582
1224
75
1299
Dr Stephen Frohlich – Dr Seamus O’Donnell
Award for best SpR in ICU
THORACIC
219
81
300
VASCULAR
338
81
419
8945
1266
10211
Resident Merit Awards
The following residents received medals as follows:
DENTAL
PNH
E.N.T.
PLASTIC
59 liver transplant operations were performed during
the year, with 75 donor retrievals.
Intensive Care Unit
Medial Director
Dr. Kieran Crowley
Consultants
Dr. Pat Benson
Dr. Caroline Hickey
Clinical Nurse Manager III
Ms Geraldine Carey
Service workload
649 patients were admitted to the ICU in 2008,
another record number. 41% of patients stayed 1 day,
while 44% stayed 3 days or more, similar to recent
years. Average length of stay was 4 days. Average
occupancy for the year was 89%. The ICU continued to
provide the critical care component of the liver
transplant programme.
Organ failure rates and organ support rates were similar
to recent years: 60% of patients received mechanical
ventilation. Overall ICU survival was 76%, with hospital
survival of 68%.
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. The
ICU contributed to a national HSE study on organ
procurement. The ICU collected data for the HSE (through
Prospectus) for a nationwide report on ICU services.
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Staff
The ICU ran a Foundation Course with 6 nurses
graduating in March 08 and a Higher Diploma Course,
with 6 nurses graduating in May 08. These courses
greatly assist in providing adequate numbers of suitably
trained nursing staff, which remains an issue. Maureen
Darcy continued in a temporary capacity in the position
of ADON. Dr Caroline Hickey was appointed to a
permanent consultant position, having worked a locum
for the previous two years. For the second half of the
year Dr Oleg Ilyinsky worked in a locum consultant
capacity, filling in for sick leave.
There are two attendants, one shared orderly, one
shared technician and three secretaries. The ICU is
staffed by a registrar or specialist registrar rotating from
the department of anaesthesia. The aim of achieving
out-of-hours cover by consultant intensivist staff has not
yet been met.
Service developments
Of the total of 16 beds in the ICU 10 are open, with
overflows to 13 beds at times. Efforts are being made
to open further beds. The Clinical Information System,
which went “live” in August. In December it was
temporarily suspended to iron out teething problems. In
conjunction with the Emergency Department, Therapeutic
Hypothermia for survivors of out-of-hospital cardiac arrest
was introduced. S/N Dennis Wedgeworth submitted his
report to the Director of Nursing on the needs of
patients after discharge from ICU having completed his
outreach follow-up of these patients for 12 months.
2008
2007
2006
2005
2004
2003
2002
2001
2000
649
628
595
613
516
450
471
421
469
4
4
2
4
6
6
6
5
5
Average occupancy
89%
91%
91%
92%
93%
90%
85%
89%
85%
Elective surgical
25%
29%
34%
38%
36%
27%
30%
32%
35%
Liver Transplantation
Emergency surgical
31%
25%
25%
30%
30%
39%
31%
31%
35%
2008 was a very busy year for the Liver Transplantation
Group. 58 Orthotopic Liver transplants took place. The
results for 2008 were very good. Transplantation is
demanding work for all concerned. All credit to the
Anaesthesia Team:
Medical
43%
46%
43%
32%
34%
34%
39%
37%
30%
Mechanical ventilation
60%
71%
80%
82%
69%
70%
75%
68%
67%
Central venous access
72%
77%
73%
77%
64%
73%
81%
69%
78%
Vasoactive infusions
33%
31%
19%
24%
20%
18%
25%
33%
33%
Acute renal failure
23%
18%
14%
10%
10%
17%
25%
23%
24%
Continuous renal replacement
therapy
22%
18%
14%
10%
10%
16%
21%
16%
14%
Tracheostomy
10%
10%
7%
6%
6%
13%
11%
13%
6%
6%
-
17%
21%
21%
25%
1.5%
11.4%
6%
9.3%
9.7%
8.1%
12%
8.3%
2.9%
0.9%
Brainstem deaths
8
8
7
3
6
8
3
7
4
Organ donors
1
2
5
2
2
1
0
3
0
ICU survival
76%
78%
78%
80%
79%
82%
75%
73%
75%
Hospital survival
68%
77%
76%
78%
75%
78%
70%
68%
70%
Consultant Anaesthetists
Dr Neil McDonald
Dr. John Boylan
Liver Fellows
Dr Nageswaran Narayanan
Dr. Ashit Bardhan
Anaesthetic Nurses
Sr. Jean McCarthy
Billie Stafford
Karl Perocillo
Karen Ann Keating
The transplant anaesthesia group provided coverage for
58 liver transplants, including 52 primary elective
transplants, during 2008. The 60-day survival for primary
146
ICU Activity
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Admissions
Average length of stay (days)
Unplanned ICU discharge
Readmissions
isolated elective transplants was 96%, with median ICU
stay and hospital stay of 1 and 21 days, respectively.
Outcome for primary elective liver transplantation at SVUH
continues to be one of the best in the UK and Ireland.
Peer-reviewed papers
Dr. Alistair Nichol, a former Conway research fellow, was
awarded a PhD for his research project entitled:
“Investigation of the effects of buffered hypercapnia on
the severity of infection-induced lung injury”.
Ó Cróinín D. Nichol AD. Hopkins N. Boylan JF. O’Brien
S. O’Connor C. Laffey JG. McLoughlin P. Sustained
hypercapnic acidosis during pulmonary infection
increases bacterial load and worsens lung injury.
Critical Care Medicine 2008; 36: 2128-35
Editorial
Boylan JF. Kavanagh BP. Emergency airway
management: competence versus expertise?
Anesthesiology 2008; 109:945-7
Correspondence
Boylan JF. Kavanagh BP. The name of the game: no
transfusion (or nontransfusion) by cookbook.
Anesthesiology 2008; 109:745-6.
147
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Abstracts
Naughton FM. Nichol AD. Boylan JF. McLoughlin P.
Ambient hypoxia and hypercapnia alter lung cytokine
kinetics but do not impair lung mechanics.
American Thoracic Society 2008; 177: A329
Nichol AD. Naughton FM. Ó Cróinín D. Boylan JF.
McLoughlin P. Buffered hypercapnia worsens E coli
induced lung injury in vivo. American Thoracic Society
2008; 177: A752
Vascular Access
Director:
Dr. Alan McShane
Consultant:
Dr. Neil McDonald
The Vascular Access service continues to work with a
variety of healthcare groups. The requests include device
placement but consultations are also made to discuss
the options for patients with complicated conditions.
Again we continued to work with the cystic fibrosis
service and the oncology services. Ultrasound usage for
line placement has almost become routine and has
aided the teaching and the safety of line placement.
Formal training in central vascular access is now a training
requirement of the College of Anaesthetists. Drs McShane
and McDonald again organised the Vascular Access
Study Day in the College of Anaesthetists. This course
continues to be popular and oversubscribed. It provides
didactic lectures, live and cadaveric demonstrations and
tuition in the use of ultrasound.
South East Dublin Department of Anaesthesia
(SEDDA)
Chairman:
Dr. Alan McShane
Secretary:
Ms Louise McNicholas
Again in 2008 there was a heavy reliance of the
services of locums to help provide consultant cover in
the constituent hospitals. The service contributed greatly
to the ongoing growth of cold elective surgery for
patients seen in St. Vincent's University Hospital and
carried out in St. Michael’s Hospital Annexe. This model
is a good one, as it allows planning of elective surgery
without the anxiety over bed availability that is a part of
life in the University Hospital because of the unpredictable
effects caused by events in the Emergency Department.
The SEDDA training scheme retains its popularity, with a
constantly increasing number of applications. This reflects
on the individual teaching done by consultants and the
facilities and varied clinical experience available in the
constituent hospitals. Results for trainees taking exams
were good and that is due to the many who contributed
to this success.
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Pain Medicine
2008 was yet another year of vast change in the Pain
Service in St Vincent’s University Hospital, with the
significant move of the Department to the new Pain
Unit located in the Old Convent.
2008 saw the setting up of 2 new clinics in the Pain
Service. Since July 2008, Dr Paul Murphy in his new
Multi -disciplinary Clinic sees all new referrals to the
Pain Service. In this new clinic, the Consultant as well as
the Multidisciplinary Team of a Clinical Psychologist,
Occupational Therapist and Physiotherapist review all
patients.
In order to reduce the number of patients attending the
Tuesday afternoon Pain Clinic, a new Prescription Clinic
has been set up. This Clinic, on a Monday morning, was
set up to prevent patients who only needed prescriptions
from having to wait in the general outpatient Pain Clinic.
This has greatly reduced the numbers attending the
Tuesday afternoon Pain Clinic, and is of great benefit to
those patients who are unable to wait for extended
periods of time in the outpatient clinic.
The transfer of the Allied Therapies to the main body of
the hospital has had a significant effect on the Pain
Management Programme. Now, all elements of the
three-week outpatient programme are deliverable in the
main body of the hospital.
A new diagnostic and therapeutic session was set up in
conjunction with the Department of Radiology. These
sessions were originally on a Monday afternoon and a
Tuesday morning for patients requiring diagnostic block
injections. This enabled the Pain Service to vastly reduce
the waiting list for patients in need of these procedures.
Following discussions with a number of departments
within the hospital, the Pain Service were also granted
4 in-patient beds in St James’ Ward. These beds have
Clinic
2008 was a busy year for Dr O’Keeffe’s, Dr Murphy’s
and Dr Victory’s Pain Management outpatient clinics,
with more than 4,000 patients attending these clinics.
In 2008, David Sommerfield sat his exams and
achieved one of the top marks in the country.
Day
No. of
sessions
New
Return
Total
Dr. O'Keeffe
(Pain Clinic)
Tues
47
214
2,748
2,962
Dr. O'Keeffe
(Prescription Clinic)
Mon
5
0
52
52
(Pain Clinic)
Tues
43
53
321
374
Dr. Murphy (Pain Management Clinic)
Wed
45
73
556
629
Dr. Murphy
Tues
21
90
4
94
10
278
288
440
3,959
4,399
Dr. Victory
(Pain Medicine Clinic)
Dr. O'Keeffe
(Pain Unit)
Total
149
also been combined with theatre space on a Monday
and a Thursday. This has been an important change for
the Department, allowing for more procedures to be
done, and thus reducing the waiting time of patients for
these interventional pain procedures.
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161
During the year a total of 7,801 patients were seen at
cardiology outpatient clinics (including pacemaker clinics),
which represents an increase of 12% over the previous
year. The number of non-invasive tests performed in
the ECG Cardiology Department (echocardiography,
stress tests, holter monitors, ECG’s, pacemaker checks)
numbered 18,790 which represents a slight (2%)
decrease over the previous year.
The Cardiac Catheter Laboratory activity at 2,549
procedures represent a 4% increase over 2007.
Interestingly these figures show a 68% increase in the
number of ICD insertions and a 42% increase in the
number of permanent pacemaker procedures
performed.
Day case admissions numbered 615 which represents
a 10% increase over the previous year. In-patient
discharges remain static at 1,418.
Cardiac Rehabilitation Service
The Cardiac Rehabilitation Service continues to offer
four phases to patients recovering from a Myocardial
Infarction, Angioplasty and Coronary Artery Bypass
Surgery/Valve Surgery.
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Research
A cookery skills course was provided for cardiac
rehabilitation patients in conjunction with the
Department of Preventive Medicine and Health
Promotion, as part of a randomised controlled trial.
Data analyses are in progress.
Conferences
Marie Minogue and Veronica O’Neill attended the
EUROPREVENT conference in Paris in May 2008.
Kathryn O’Sullivan attended The ESC in Munich in
September 2008.
501 patients received Phase 1 and 256 attended
Phase II. 134 patients completed the six-week Phase III
programme and 17 dropped out. Approximately 90
patients attended our Phase IV refresher sessions.
Although the number of patients requiring cardiac
rehabilitation is gradually increasing each year, the cardiac
rehabilitation programme has reached maximum capacity
and is unable to meet this demand.
to take up a full-time position in the cardiac cath lab.
Olajide Ogidan replaced her.
Heart Failure Unit
The Heart Failure Unit (HFU) celebrated its 10th year in
existence in October 2008 at St Vincent’s University
Hospital with a presentation of research work done to
the Minister for Health and Children’s Affairs, Ms Mary
Harney. Patients from the HFU had a chance to discus
their experiences of the service with the Minister and
she commented on how services such as the HFU
600
500
501
463
400
300
227
200
256
141
100
134
70
Staff
Noeleen Day left the cardiac rehabilitation department
0
2007
2008
PHASE I
2007
2008
PHASE II
2007
2008
PHASE III
2007
90
2008
PHASE IV
could reduce the need for in-patient beds in the current
constrained economic climate.
The HFU welcomed 3 new personnel in 2008: Two
nurses, Elaine Tallon, Research and Clinical HF nurse
and Denise Gibson, STOP HF Co-ordinator and Clinical
HF nurse as well as the much needed secretarial
services of Aileen Burke.
A major development contributing to the HFU in 2008
was the association with the new Blood Pressure Unit in
St Michael’s Hospital. Hypertension is the second major
contributor to HF after coronary disease so optimizing
blood pressure management may result in fewer new
HF cases in the future. The STOP HF programme which
is a prospective community GP study of patients with risk
factors for HF and which is in it’s 5th year compliments
this focus on HF prevention.
A new innovative GP referral via the internet using the
SPIRIT HF programme started in 2008 which allows
GPs easier access to HF screening tools such as brain
natruieretic peptide (BNP) as well as rapid access to an
on line consultant opinion of difficult cases.
Workload has continued to expand with 10,867 patient
contacts, of which 2000 were from survivors of severe
HF admissions to hospital with a total of 140 new
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NYHA class IV presentations in 2008 alone. Future
plans are to expand the HF service to in-patients in St
Michael’s so they may benefit from the same level of
HF education and follow up. The expansion of the
Advanced Nurse Practitioner (ANP) role, particularly
with nurse prescribing as well as a home visit pilot
scheme has assisted the HFU’s ability to cope with the
extra workload. Ongoing laboratory research of HF in
the Conway Institute, UCD allows questions to be asked
and explored on a continuous basis.
In conclusion, the world renowned St Vincent’s University
Hospital HFU under the direction of Professor Ken
McDonald is an example of real world translational
medicine; i.e. where clinical research is combined with
laboratory research to the benefit of current and future
heart failure sufferers. The next 10 years however are
crucial as the success of the HFU needs to be solidified
and hopefully expanded to other institutions in order to
deal with the anticipated increase in the country’s HF
burden by 2018!
Anaemia in heart failure: to treat or not to treat?
Mak G, Murphy NF, McDonald K.
Current Treat Options
Cardiovasc Med. 2008 Dec; 10(6): 455-64
Multiple neurohumoral modulating agents in systolic
dysfunction heart failure: are we lowering blood
pressure to much?
Mak G, Murphy NF, Ali A, Walsh A, O’Loughlin C,
Conlon C, McCaffrey D, Ledwidge M, McDonald K.
J Card Failure. 2008 Sept 14(7): 555-60
Diagnosis of new onset heart failure in the community:
the importance of a shared-care approach and
judicious use on BNP.
Mak G, Ryder M, Murphy NF, O’Loughlin C,
McCaffrey D, Ledwidge M, McDonald K.
Ir J Med Sci. 2008 Sept; 177(3):197-203
Need and evolution of need for device therapy in a
community heart failure population.
Sulaiman HM, O’Loughlin C, Daly M, Conlon C,
Ledwidge M, McDonald K.
Eur J Heart Failure. 2008 June; 10(6):601-7.
Outpatient intravenous diuretic therapy; potential for
marked reduction in hospitalizations for acute
decompensated heart failure.
Ryder M, Murphy NF, McCaffrey D, O’Loughlin C,
Ledweidge M, McDonald K.
Eur J Heart Fail. 2008 Mar; 10(3):267-72
St Vincent’s University & St Michael’s Hospital
Ms Caroline Lehane
Staff
Consultants
Grade V
Ms Eileen Cusack
Grade IV
Dr Paul Collins
(9+2 sessions)
Ms Brenda Harte
part time Gr IV
Dr Brian Kirby
(11 sessions)
Ms Niamh Spain
part time Gr IV
Prof Sarah Rogers
WTE 3.8
(11 sessions)
(31 sessions at SVUH, 2 at SMH)
Patients seen and treated 2008
at SVUH + (SMH) Clinics
NCHDs
Spr
Dr Caitriona Ryan
New patients
2,020 + (335 ) = 2,355
Registrars
Dr Aisling Ryan,
Dr Benvon Moran
Return patients
6,890 + (280) = 7,170
SHO
Dr Dmitri Wall
Total patients
8,910 + (615) = 9.525
Research Registrar
Dr Anne Marie Tobin
CNS
CNS
Ms Sheila Ryan
Ms Nicola Mahon
CNM1
Ms Sophie Doyle
Nurses 11 (full and part-time)
Care asssisant
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Ms Maria del Pilar
Nurses 14.26 WTE
Consult review - most reviewed at least once
Nurse led services have increased this year and full
details are contained in the annual Nursing Report.
Publications
Psychological distress but not alcohol intake affects the
time to clearance of psoriasis patients treated with
narrowband UVB.
Kirby B, Dudley J, Tobin AM, O’Brien E, Barry R, Collins
P, Rogers S.
Accepted Clinical an Experimental Dermatology 2008
Adalimumab treatment for severe recalcitrant chronic
plaque psoriasis.
Ryan C, Kirby B, Collins P, Rogers S.
Accepted Clinical an Experimental Dermatology 2008
Treatment/Procedures
Including:
Nursing Staff
152
Administrative Staff
Phototherapy unit
Patch tests
Skin biopsies
Skin excisions
Total no cases
19,443
In-patient consults
406 + (78)
Total no
484
Further experience of using azathiaoprine in the
treatment of severe atopic eczema.
Clinical and Experimental Dermatology 2008;33 :
710-711.
Psoriasis characteristics, psychological effects and
treatment options.
Ryan S,
Br J Nursing 2008; 1765: 284 – 290.
Case Reports
Allergic contact dermatitis to hydroydecyl ubiqinone
(idebenone) following application of anti-aging
cosmetic cream.
McAleer M and Collins P
Contact Dermatitis 2008; 59: 173-4174.
Generalised pustular psoriasis (Von Zumbusch)
following the use of calcipotriol and betamethsone
dipropionate (Dovobet®).
Tobin AM, Langan SM, Collins P, Kirby B.
Clinical and Experimental Dermatology (in press)
An erythematous patch and plaque on the shoulder (a
clinicpathological case).
McAleer M, Sheahan K, Kirby B, Collins P.
Archives of Dermatology 2008; 144: 1217-1222.
The department has presented over 20 presentations at
national and international meetings
153
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Achievements
Dr Paul Collins is Chairman of the Southern group of
Irish Association of Dermatologists, Board member of
the Charles Institute and a member of the building
committee for the same Institute.
Dr Anne Marie Tobin has joined the department as
Research Registrar. Dr Tobin is engaged on working for
a PhD.
Dr Caitriona Ryan, SpR, is going to Baylor University,
Dallas, USA for a one year fellowship in dermatology.
Retirement
Ms Nora Tracey CNM2 retired during the year. Nora
worked in the City of Dublin Skin & Cancer Hospital for
many years and was instrumental in the smooth
transition of the service from Hume Street to SVUH in
2006. She ran the Phototherapy Service in the
department.
Personnel
Primary Care Liaison Team:
Dr Malachi McKenna,
Prof Donal O’Shea,
Dr Ronan Canavan,
Dr Frances Hayes
Consultants:
Lecturers:
Dr. Gianluca Tamagno,
Department of Medicine, UCD
Dr Mensud Hatunic,
Dr. Hood Thabit
Dr Gadintshware Gaoatswe,
Dr. Mohammad Bashir,
Registrars:
Research Registrars:
Dr Jean O’Connell,
Dr Tomas Ahern,
Dr Conall Dennedy
Deirdre Hall, Diabetes Nurse Specialist.
Yvonne Ryan, Dietician
Secretarial Staff:
Fiona Whelan, Patricia Sinnott, Joyce
Doyle, Maura Mahony,
Florence Mhandu, Geri Daly
Weekly Departmental Academic Events
Diabetes Team Meeting
-
Monday 12.45 PM
Endocrine Conference
-
Tuesday 1.00 PM
Multi-Disciplinary Thyroid Cancer Group Meeting
(every 6-8 weeks)
Departmental Journal Club -
Friday 8.00 AM
Out-Patient Clinics
Diabetes Centre
Nurses:
Dietician:
154
Deirdre Gleeson, Nora Collis,
Moira Haran, Joanne Kildunne,
Jean O’Brien, Claire Dingle
Maeve Moran, Carmel Quinn,
Natalie Wallace
Return to Contents
3 Diabetes clinics per week
1 Endocrinology clinic
Weekly multi-disciplinary 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
outpatient and in-patient consultation service. In the
field of thyroid cancer, the development of the
Multidisciplinary Team Meeting comprising 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, have
their management discussed and key aspects of the
management of thyroid cancer are reviewed. A similar
multi-disciplinary team approach to the management of
gut endocrine tumours was established in September
2007 and meets quarterly.
The Endocrine Team provides a national consultation
service in the areas of reproductive endocrinology,
adrenal disease, obesity, hypoglycaemia, gut endocrine
tumours, gender identity disorder, calcium metabolism
and metabolic bone disease.
Diabetes Service
The goal of the Diabetes Service is to keep patients
well through the linked processes of information,
education, counseling and empowerment. The Diabetes
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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 insulin-dependent patients, 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 hypoglycaemia. Detailed
training and accreditation in DAFNE for doctors, nursing
staff and dietitians continues as resources permit.
As St Vincent’s University Hospital is the national referral
centre for adults with Cystic Fibrosis (CF) and allied with
medical advances in treatment, we have seen a large
increase in the number of patients presenting with CFrelated diabetes mellitus as life expectancy for this
condition increases. The treatment and education of
this group form a complex and demanding facet of the
caseload of the Diabetes Nurse Specialist and Endocrine
Medical Team.
A further aspect of the Diabetes service in SVUH is
Liver Transplantation related Diabetes, which continues
to increase our expertise and workload.
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.
Research Projects
Diabetes & Obesity Research Group
Personnel:
Prof. Donal O’Shea,
Dr Jean O’Connell,
Dr Lydia Lynch,
Dr Tomas Ahern,
Dr Conall Dennedy.
The Obesity Research Group is headed by Prof. O’Shea.
Dr. Lydia Lynch is the senior research scientist in the
group and Andrew Hogan is a new postdoctoral scientist
stared with the group. Lydia is funded by the Health
Research Board and UNESCO-L’Oreal Partnership.
Andrew recently received the Sanofi-Aventis Newman
Scholarship for his postdoctoral studies. Dr. Jean
O’Connell is a 3rd year clinical PhD student funded by
the HRB clinical research fellowship, along with Dr.
Tomas Ahern and Dr. Conall Dennedy who are starting
their clinical PhDs. Ms. Anna Kwasnik is the group’s
research assistant funded by the Diabetes Federation of
Ireland. Ms. Cathy Breen has started in the group as a
research dietician studying the role of carbohydrate in
diabetes. Conall received the ICHMT Endocrine
Research Bursary funded by Sanofi-Aventis.
Lydia Lynch is working on the immune system in
obesity, and asking why some obese subjects are
immune compromised. Obesity is now responsible for
30-40% of certain cancers. She has found that natural
killer cells, the bodies first defense against tumors and
viruses are depleted in the blood of obese patients.
Lydia is also looking at the immune system in the fat, in
particular the omental fat, of obese and lean patients.
She has found that omental fat has its own unique
immune system, different to every other organ in the
body and contains the largest number of potent killer
cells, termed invariant natural killer T cells.
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Jean O’ Connell has found that adipocyte size strongly
correlates with metabolic healthy and degree of fatty
liver disease in obese patients. She is now studying the
rate of proliferation and differentiation of preadipocytes
from both healthy and unhealthy obese patients, as
well as the production of pro and anti-inflammatory
cytokines from the growing cells.
Achievements and Distinctions
Dr Donal O’Shea was promoted to Professor of
Medicine in UCD in recognition of his teaching and
research activities. He was invited to give a public
lecture in the RDS entitled “Obesity; Treating the
Epidemic to Prevent the Pandemic” for a series on
Ireland towards 2030. He had the distinction of being
invited to give the Nordisk lecture at the Irish Endocrine
Society in November 2008.
Dr Malachi McKenna is a member of the Editorial
Board of Osteoporosis International.
Dr. Frances Hayes took up the post of Consultant
Endocrinologist and Senior Lecturer in Medicine in July
replacing Professor T J McKenna. She did subspecialty
training in reproductive endocrinology in Boston and
was a Consultant Endocrinologist at the Massachusetts
General Hospital and an Associate Professor of
Medicine at Harvard Medical School prior to her return.
She is a member of the Editorial Board of the Journal
of Clinical Endocrinology and Metabolism.
Dr. Lydia Lynch was awarded the UNESCO-L’Oreal
International Young Woman of Science Fellowship this
year, which is awarded to 15 young women worldwide.
This is the first time Ireland has received this award.
This fellowship will enable Lydia to spend 7 months
working in Harvard Medical School, Boston each year
for 2 years, with the aim of returning to Ireland to
establish in SVUH state of the art techniques learned in
Harvard. Lydia also won ‘Researcher of the Year’ at the
Conway Research Festival, UCD in September 2008.
Lydia was an invited speaker at the International
Colorectal Cancer Society Conference and the Trinity
College Dublin Biochemical Society series of talks.
Conferences/Courses/Meetings Attended
National Cystic Fibrosis Meeting. Killarney, Ireland.
1st February 2008.
Annual Abracadabra Diabetes Nursing Conference.
Birmingham, UK. 29th February 2008.
European NeuroEndocrine Tumour Society.
Paris, France. 6-8th March 2008.
Diabetes Federation of Ireland Multi-disciplinary
Diabetes Study Day. Croke Park. 11th April 2008.
UK & Ireland NeuroEndocrine Tumour Society.
London, UK. 1st December 2008.
5. Dodd JD, Barry SC, Barry RB, Cawood TJ,
McKenna MJ, Gallagher CG.
Bone mineral density in cystic fibrosis: benefit of
exercise capacity. J Clin Densitom. 2008 11:537-42.
Publications
6. McKenna MJ, van der Kamp S, Au-Yeong M,
FitzGerald O.
Improving standards of DXA. Ir Med J. 2008;101;101-2.
Sanofi Aventis Spring Meeting on Mature Onset Diabetes.
Dublin. 16th April 2008.
Insulin Pump Study Day – Roche. Cork. 9th Mary 2008.
American Diabetes Association Annual Meeting,
San Francisco, USA. June 6-10, 2008
American Endocrine Society Annual Meeting.
San Francisco, USA. June 15-18, 2008.
American Society of Bone and Mineral Research
Annual Meeting. Montreal, Canada. September 2008
EASD. Rome, Italy. 26th-27th September 2008.
Irish DAFNE Study Annual Meeting.
Belfast. 10-11th October 2008.
European NeuroEndocrine Association.
Antalya, Turkey. 17-20th October 2008.
American Cystic Fibrosis Conference.
Orlando, Florida. 22-25th October 2008.
Irish Endocrine Society 32nd Annual Meeting.
Maynooth, Ireland. 7th-8th November 2008.
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1. Canavan RJ, Unwin NC, Kelly WF, Connolly VM.
Diabetes- and non-diabetes - related lower
extremity amputation incidence before and after the
introduction of better organized diabetes foot care:
continuous longitudinal monitoring using a standard
method. Diabetes Care. 2008 Mar;31(3):459-63.
2. Dervan E, Lillis D, Flynn L, Staines A, O'Shea D.
Factors that influence the patient uptake of diabetic
retinopathy screening. Ir J Med Sci. 2008
Dec;177:303-8
3. Tuthill A, McKenna MJ, O'Shea D, McKenna TJ.
Weight changes in type 2 diabetes and the impact
of gender. Diabetes Obes Metab. 2008
Sep;10:726-32.
4. Quinn A, Doody C, O'Shea D.
The effect of a physical activity education
programme on physical activity, fitness, quality of
life and attitudes to exercise in obese females. J Sci
Med Sport. 2008;11:469-72.
7.
Morrell MJ, Hayes FJ, Sluss PM, Adams JM, Bhatt
M, Ozkara C, Warnock CR, Isojärvi J.
Hyperandrogenism, ovulatory dysfunction, and
polycystic ovary syndrome with valproate versus
lamotrigine. Ann Neurol 2008 64:200-11.
8. Joffe H, Hayes FJ.
Menstrual cycle dysfunction associated with
neurologic and psychiatric disorders: their treatment
in adolescents. Ann NY Acad Sci 2008;1135:219-29.
9. Cole LW, Sidis Y, Zhang C, Quinton R, Plummer
L, Pignatelli D, Hughes VA, Dwyer AA, Raivio T,
Hayes FJ, Seminara SB, Huot C, Alos N, Speiser
P, Takeshita A, Van Vliet G, Pearce S, Crowley WF
Jr, Zhou QY, Pitteloud N.
Mutations in prokineticin 2 and prokineticin
receptor 2 genes in human gonadotrophin-releasing
hormone deficiency: molecular genetics and clinical
spectrum. J Clin Endocrinol Metab 2008;93:3551-9.
10. Kupelian V, Hayes FJ, Link CL, Rosen R,
McKinlay JB.
Inverse association of testosterone and the
metabolic syndrome in men is consistent across
race and ethnic groups. J Clin Endocrinol Metab
2008;93:3403-10.
11. Pitteloud N, Dwyer AA, DeCruz S, Lee H,
Boepple PA, Crowley WF Jr, Hayes FJ.
The relative role of gonadal sex steroids and
gonadotropin-releasing hormone pulse frequency in
the regulation of follicle-stimulating hormone
secretion in men. J Clin Endocrinol Metab.
2008;93:2686-92.
12. Boepple PA, Hayes FJ, Dwyer AA, Raivio T, Lee H,
Crowley WF Jr, Pitteloud N.
Relative roles of inhibin B and sex steroids in the
negative feedback regulation of follicle-stimulating
hormone in men across the full spectrum of
seminiferous epithelium function. J Clin Endocrinol
Metab. 2008;93:1809-14.
13. Pitteloud N, Dwyer AA, DeCruz S, Lee H,
Boepple PA, Crowley WF Jr, Hayes FJ.
Inhibition of luteinizing hormone secretion by
testosterone in men requires aromatization for its
pituitary but not its hypothalamic effects: evidence
from the tandem study of normal and gonadotropin
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-releasing hormone-deficient men.
J Clin Endocrinol Metab. 2008;93:784-91.
14 Sluss PM, Hayes FJ, Adams JM, Barnes W, Williams
G, Frost S, Ramp J, Pacenti D, Lehotay DC,
George S, Ramsay C, Doss RC, Crowley WF Jr.
Mass spectrometric and physiological validation of a
sensitive, automated, direct immunoassay for serum
estradiol using the Architect. Clin Chim Acta.
2008;388:99-105.
15. Rixhon M, Tichomirowa MA, Tamagno G, Daly
AF, Beckers A.
Current and future perspectives on recombinant
growth hormone for the treatment of obesity. Expert
Rev Endocrinol Metab, 2008 Jan; 3(1): 75-90.
16. Tamagno G, Daly AF, Deprez M, Vroonen L,
Andris C, Martin D, Beckers A.
Absence of hypogonadism in a male patient with a
giant prolactinoma: a clinical paradox. Ann
Endocrinol (Paris), 2008 Feb; 69(1): 47-52.
17. Lelouvier B, Tamagno G, Kaindl AM, Roland A,
Lelievre V, Le Verche V, Loudes C, Gressens P,
Faivre-Bauman A, Lenkei Z, Dournaud P.
Dynamics of somatostatin type 2A receptor cargoes
in living hippocampal neurons. J Neurosci, 2008
Apr; 28(17): 4336-49
Department of Medical Oncology
incorporating Lios Aoibhinn Cancer Support Centre
2008 was an active year in the clinical, education and
academic activities of the Department of Medical
Oncology, St. Vincent’s Healthcare Group.
an emphasis on the development of novel therapeutics
for patients with Her 2 positive disease whose cancer is
resistant to Trastuzumab.
As is common throughout the world, there is an
increasing emphasis on ambulatory/outpatient
treatments which in turn reflects the on-going evolution
of cancer treatments away from traditional cytotoxic
forms of therapy, to specific molecularly targeted
agents. These newer treatments often have much
more manageable side-effect profiles than older
chemotherapy treatments.
One drug which is used in this setting, Lapatinib, was
introduced into routine practice, in North America and
Europe. St. Vincent’s and the Irish Clinical Oncology
Research Group were part of the international team
which helped to develop this useful agent.
It was an extremely active year on the academic front.
Professor Crown commenced his work as an HRB
Clinician/Scientist. The research project supported by
the Health Research Board, spans activities in St.
Vincent’s University Hospital, University College Dublin,
and Dublin City University. The major research focus of
this consortium is novel therapeutics for breast cancer
with particular emphasis on the increasingly recognised
problem of “triple negative” breast cancer (breast cancer
which is negative for oestrogen, progesterone and Her
2 receptor) and on Her 2 positive breast cancer.
Active clinical trials and laboratory programmes are
underway in this programme. The major research
interest on Her 2 positive breast cancer continues, with
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Dr. Neil O’Brien continued his work on a funded
fellowship in the University of California Los Angeles in
collaboration with Dr. Dennis Slamon. Dr. O’Brien’s work
is focused on proteomic analysis of Herceptin resistant
Her-2 positive breast cancer.
The annual St. Vincent’s University Hospital/UCLA
Translational Research Symposium took place in
California is 2008.
In 2008 a total of 143 patients were recruited on
clinical trials.
Professor Crown also was the convenor and inaugural
chairman for the new melanoma and skin cancer
committee of the Irish Clinical Oncology Research
Group and continues in his role as chairman of the
Breast Committee of that group.
Publications
Protein kinase Cdelta expression in breast cancer as
measured by real-time PCR, western blotting and ELISA.
McKiernan E, O'Brien K, Grebenchtchikov N, GeurtsMoespot A, Sieuwerts AM, Martens JW, Magdolen V,
Evoy D, McDermott E, Crown J, Sweep FC, Duffy MJ.
Br J Cancer. 2008 Nov 18;99(10):1644-50. Epub 2008 Oct 28.
Preclinical evaluation of dasatinib, a potent Src kinase
inhibitor, in melanoma cell lines.
Eustace AJ, Crown J, Clynes M, O'Donovan N.
J Transl Med. 2008 Sep 29;6:53.
A personalized approach to cancer treatment: how
biomarkers can help.
Duffy MJ, Crown J.
Clin Chem. 2008 Nov;54(11):1770-9. Epub 2008 Sep 18. Review.
Is risk of central nervous system (CNS) relapse related
to adjuvant taxane treatment in node-positive breast
cancer? Results of the CNS substudy in the intergroup
Phase III BIG 02-98 Trial.
Pestalozzi BC, Francis P, Quinaux E, Dolci S,
Azambuja E, Gelber RD, Viale G, Balil A, Andersson
M, Nordenskjöld B, Gnant M, Gutierrez J, Láng I,
Crown JP, Piccart-Gebhart M;
BIG 02-98 Collaborative Group.
Ann Oncol. 2008 Nov;19(11):1837-41. Epub 2008 Jun 18.
SNIP/p140Cap mRNA expression is an unfavourable
prognostic factor in breast cancer and is not expressed
in normal breast tissue.
Kennedy S, Clynes M, Doolan P, Mehta JP, Rani S,
Crown J, O'Driscoll L.
Br J Cancer. 2008 May 20;98(10):1641-5. Epub 2008 May 13.
ADAM-17 predicts adverse outcome in patients with
breast cancer.
McGowan PM, McKiernan E, Bolster F, Ryan BM, Hill
AD, McDermott EW, Evoy D, O'Higgins N, Crown J,
Duffy MJ.
Ann Oncol. 2008 Jun;19(6):1075-81. Epub 2008 Jan 30.
Pooled analysis of diarrhea events in patients with
cancer treated with lapatinib.
Crown JP, Burris HA 3rd, Boyle F, Jones S, Koehler
M, Newstat BO, Parikh R, Oliva C, Preston A, Byrne J,
Chan S.
Breast Cancer Res Treat. 2008 Nov;112(2):317-25. Epub 2008 Jan
20. Erratum in: Breast Cancer Res Treat. 2009 Jan;113(2):409-10.
A phase III randomized comparison of lapatinib plus
capecitabine versus capecitabine alone in women with
advanced breast cancer that has progressed on
trastuzumab: updated efficacy and biomarker analyses.
Cameron D, Casey M, Press M, Lindquist D,
Pienkowski T, Romieu CG, Chan S, Jagiello-Gruszfeld
A, Kaufman B, Crown J, Chan A, Campone M, Viens
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P, Davidson N, Gorbounova V, Raats JI, Skarlos D,
Newstat B, Roychowdhury D, Paoletti P, Oliva C,
Rubin S, Stein S, Geyer CE.
Breast Cancer Res Treat. 2008 Dec;112(3):533-43. Epub 2008 Jan 11.
Adjuvant chemotherapy with sequential or concurrent
anthracycline and docetaxel: Breast International
Group 02-98 randomized trial.
Francis P, Crown J, Di Leo A, Buyse M, Balil A,
Andersson M, Nordenskjöld B, Lang I, Jakesz R,
Vorobiof D, Gutiérrez J, van Hazel G, Dolci S, Jamin S,
Bendahmane B, Gelber RD, Goldhirsch A, CastiglioneGertsch M, Piccart-Gebhart M;
BIG 02-98 Collaborative Group.
J Natl Cancer Inst. 2008 Jan 16;100(2):121-33. Epub 2008 Jan 8.
Erratum in: J Natl Cancer Inst. 2008 Nov 19;100(22):1655.
Drug metabolism-related genes as potential
biomarkers: analysis of expression in normal and
tumour breast tissue.
Martinez V, Kennedy S, Doolan P, Gammell P, Joyce
H, Kenny E, Prakash Mehta J, Ryan E, O'Connor R,
Crown J, Clynes M, O'Driscoll L.
Breast Cancer Res Treat. 2008 Aug;110(3):521-30. Epub 2007 Sep 27.
Prevalence and prognostic and predictive relevance of
PRAME in breast cancer. Doolan P, Clynes M,
Kennedy S, Mehta JP, Crown J, O'Driscoll L.
Breast Cancer Res Treat. 2008 May;109(2):359-65. Epub 2007 Jul 12.
Lios Aoibhinn Cancer Support Centre
2008 was a year of great change and developments for
Lios Aoibhinn Cancer Support Centre. In February the
centre moved from its location in Herbert House to a
new location at 85, Nutley Lane, opposite the entrance
to St. Vincent’s University Hospital. From its new location,
the centre continues to provide support and information
for people affected by cancer.
Staff
2008 saw the retirement of Ann Hayes, Director of
Services. Ann was instrumental in the establishment of
Lios Aoibhinn and we wish her a healthy and happy
retirement.
In November 2008, Finola Gill was appointed CNM3
for Lios Aoibhinn and Oncology Services.
Clinical Nurse Manager 3:
Finola Gill
Senior Clinical Psychologist:
Dr. Paul D’Alton
Administrative Support:
Caroline Livingstone
Sessional Therapists
• Complementary Touch Therapies: Mary Moriarty
(from March 2008)
• Relaxation & Visualisation/ Stress Management:
Mary Scarff
• Yoga:
Department Statistics
One new course was introduced in 2008. Designed by
St. Luke’s Hospital, Rathgar, ‘Time to Adjust’ is a coping
skills programme designed for women who have
completed treatment for breast cancer and is facilitated
by Alison McGrann, Counselling Psychologist.
During 2008, 399 people used the service on over
2900 occasions. 248 new clients registered with the
centre during 2008. 82% of registrations were people
directly affected by cancer and 18% were relatives and
friends of people with cancer.
During 2008 a review of the services offered by Lios
Aoibhinn Cancer Support Centre was carried out in St.
Vincent’s University Hospital and St. Vincent’s Private
Hospital. For patients attending the service, the centre
was identified as providing an excellent service, helping
patients come to terms with their diagnosis and providing
a safe, calming environment where patients fell supported
and free to talk. Improvements are currently being
made to the referral process to the centre and also
advertisement of the centre in response to the findings
of this review.
289 clients attended for education and support around
dealing with a diagnosis of cancer, its treatment and
living with a cancer diagnosis.
Connie Walsh
• Counselling Psychologist: A lison McGrann
(from August 2008)
Volunteers
Aine Coleman
Ann Douglas
Ann Rooney
Ann Leyden (from September 2008)
Breda Reidy
Eleanor Quinlan (from September 2008)
Fiona Hedigan
Patricia Kennedy
Stephen Dollard
Resignations
In May 2008, Cecilia Keenan, Complementary Touch
Therapist retired
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Publications
Conference Presentations:
The Experiences of Registered General Nurses Caring
for Patients with Cancer on Non-Specialist Wards.
Finola Gill, Haematology Association of Ireland National
Conference, October 16th-18th, 2008.
1452 clients attended our complementary therapies
which included relaxation and visualisation, yoga and
massage.
The Cancer Support Centre underwent a number of
changes and developments during 2008 and continues
to develop to ensure that the service provided meets
the needs of the population it serves.
Staff
Consultants
Dr. Morgan Crowe
Dr. Diarmuid O’Shea
Dr. J. J. Barry
Dr. Rachael Doyle
Dr Graham Hughes (Locum)
Nursing
2006
2007
2008
Admissions
456
414
472
Discharges
503
503
614
In-patients
Ms Sinead Brennan, Divisional Nurse Manager
Ms. Imelda Noone, Advanced Nurse Practitioner in Stroke
Ms. Hilda Markey, CNM II Our Lady’s Ward
Outpatients
Ms. Therese Carey, CNM II, Carew House Day Hospital
New
282
293
339
Ms. Mary Ann Furigay, CNM1, Our Lady’s Ward
Review
602
828
790
Ms. Hepsy John, CNM1, Our Lady’s Ward
Ward Secretary
Ms Doreen Messitt
Registrars
Dr. Aine Fitzpatrick
Dr. Cassandra Janeczko
Carew Day Hospital
New
487
536
524
Review
799
603
687
Dr. Martin Mulroy (SpR)
Dr. Declan Byrne (SpR)
Social Workers:
Stroke In-patient Service
Ms. Alina Popescu
256
251
279
771
829
863
1401
1431
1477
Ms. Margaret Cagney
Administrative Staff:
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Ms. Lorraine Murray
Ms. Joan Magera
Ms. Doreen Brennan
Total Attendance
New
Review
2007 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 and
in hospital with dignity. Major structural work was
carried out on Our Lady’s Ward and we are due to
move back in January 2009.
Great credit is due to Sister Hilda Markey and the staff
on Our Lady’s Ward for their continued championing of
improved health care delivery.
In Patient Consultations
In 2008 over 850 in-patient consultations were seen in
St Vincent’s University 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 referred.
Emergency Department, Carew Day Hospital and
Community Liaison
Dr Graham Hughes, in conjunction with the staff in the
Emergency Department and Carew Day Hospital, is
piloting this new service to facilitate development of
stronger links between the Hospital and Community
Services. He is also looking at strategies for more
efficient integration of Carew Day Hospital and the
Emergency Department. The continued support of Mr
David Walsh in the HSE has been invaluable in this
process.
163
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
infrastructure improvement and improved staffing levels
Orthopaedic Liaison Service
Dr. Rachael Doyle is leading the continued
development of this service with our consultant
orthopaedic colleagues.
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. Carew Day Hospital developments in the future
would help provide a more seamless service with the
Emergency Department and the community in order to
reduce or prevent hospital admission with this service.
Ongoing collaborative work is being done in conjunction
with the Bone and Health Working Group to progress this.
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. The recent National Audit on Stroke report will
guide development in this area. Ms. Imelda Noone,
Advanced Nurse Practitioner in Stroke, 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
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, 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
An additional consultant will be appointed in early 2009
with a view to improving the service delivery between
the community and St. Vincent’s University Hospital.
Currently a Locum Consultant Geriatrician post is being
supported to help develop the liaison strategies between
the acute hospital and the community so that we can
hit the ground running with this new and innovative post.
Achievements / Conferences Attended
Congratulations to Ms. Imelda Noone, our Advanced
Nurse Practitioner in Stroke Care who was appointed as
a Nurse Prescriber in 2008. The post of Clinical Nurse
Specialist in Stroke continues to provide a crucial role
within the service.
Dr. Declan Byrne won 2nd place for his poster
presentation at the 56th Annual Irish Gerontological
Society meeting in Kilkenny – “ Recent discharge to
extended nursing care as a marker of life expectancy –
implications for health care delivery”.
The Sixth Annual Care of the Elderly Study Day took
place in January 2008, in the Education & Research
Centre, St. Vincent’s University Hospital. This year it
focused on more general topics and was attended by
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90 people. This is now be a regular study day in the
teaching calendar. In 2009 the meeting will focus on
Links with the Community
Publications / Abstracts
Presented at Irish Gerontological Society Meeting 2008
and published in Irish Journal of Medical Science
Articles
Recent Discharge To Extended Nursing Care As A
Marker Of Life Expectancy- Implications For Health
Care Delivery. D Byrne, E McDermott, L Murphy, G
Hughes, JJ Barry, R Doyle, M Crowe, & D O’Shea
The Case For Online Geriatric Medicine Consultation
Referrals In A Teaching Hospital. E McGovern, D Byrne,
E Wallace, G Hughes, M Crowe, & D O’Shea.
Complications post stroke: Outcome in those over 80
years. Noone I, Hatton, S, Crowe M, O’Shea,
Publications
Noone, I. O’Shea, D. Crowe, M. Stroke in the Very Old,
Irish Medical Journal 2008; 1: 8-9.
Thrombolysis 3 to 4.5 hours after acute ischaemic stroke.
Fitzpatrick A, Noone I, O’Shea D.
N Engl J Med 2008; 359 (26) : 2839 – 2841 - letter
Department of Nephrology
Staff
Consultant Nephrologist:
Prof Alan Watson
Locum Consultant Nephrologist:
Dr Malik Minhas
Specialist Registrar:
Dr Frank Ward
Registrars:
Dr Faisal Khan
Dr Gamal Hassan Osman
CNM II:
Michelle Mc Quaid
Newman Scholar:
Dr. Simon Curran
Principal Clinical Engineer:
Frank Kelly
Peritoneal Dialysis CNS:
Bairbre Moynihan
Sally Casey
Chronic Kidney Disease CNS:
Department Secretary:
Emer Kenny
Jeni Messitt
Chronic kidney disease programme developed (2 year
trial) run by Emer Kenny.
New Specialist Nurse Sally Casey started in PD.
New specialist PD clinic every Wednesday.
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In March 08 On Line Haemodiafiltration was introduced
as a new modality of treatment for our patients, making
SVUH the first dialysis unit in the Republic of Ireland to
introduce this treatment as standard.
Outstanding/Significant achievements
Bairbre Moynihan completed Nurse Prescribing Course.
Significant publications
Identification of apolipoprotein A1 as a serum
biomarker in chronic kidney disease and liver
transplant recipients, using proteomic techniques.
O’Riordan A, Jonnston O, Watson A.
et al, - Proteomics - clinical applications, 1338-1348
2008.
Investigation of the effects of age and oral intake of
insulin and intra dialytic complications,
Park, L, Brennan L, Younger K, Watson A.;
Journal of Renal Nutrition, Vol.18, no.3, F41 2008.
Investigations of the effects of reducing fluid intake
during dialysis and of other factors in the instance of
intra dialytic complication.
Park E.L, Healy L, Kennedy M.C, Watson A.
Journal of Renal Nutrition Vol.18, no.3, F41 2008.
Poster Presentations
9th Annual Interdisciplinary Research Conference Trinity
College School of Nursing and Midwifery Dublin
5th - 7th November 2008
"On-Line Haemodiafiltration a Preferred Modality of
Treatment"
F.A. Kelly, D.Farrell, M McQuaid, A.Watson
Annual Scientific Meeting of The Biomedical / Clinical
Engineering Conference Tullamore
"On-Line Haemodiafiltration a Preferred Modality of
Treatment"
F.A. Kelly, D.Farrell, M McQuaid, A.Watson
Future Service Developments
Designated renal transplant outpatient programme
Total HD Treatments in 2008:
1132
Total PD patients in 2008:
31
Total Cadaveric Renal Transplants 2008:
15
The Department of Neurology has continued to
substantially expand in 2008. 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.
Innovation Awards in 2008 (regional and national) for
practice’.
Health Minister, Mary Harney cited the Department in
the Dail in May 2008 as an example of excellence in
the Health Service.
Marguerite Duggan, our Multiple Sclerosis Nurse
Specialist, continues to provide an excellent service for
people with MS and has been joined by our CNM,
Heather Kevelighan, as Parkinson’s Nurse Specialist.
Heather is running the new Parkinson’s Clinics and is
providing a great service for our patients in this area.
Dr Graham Hughes, Consultant in Care of the Elderly
with a special interest in Parkinson’s Disease, has also
joined the Clinic recently and is a most welcome
addition to our expanding service.
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Paula Halpin (Departmental Secretary) has helped
bring a greater deal of cohesion and deals with a huge
amount of phone calls from concerned patients and
relatives daily.
Katie Doyle joined us in 2007 and has done a huge
amount of background work in addition to her regular
work as the Neurology Research Nurse. She has been
integral to our studies in epidemiology in MS and in HSP.
Sinead Jordan also joined the Team in 2007 and has
continued the work in MS Treatment Trials and in
organisation of our research in MS. We are now
participating in a number of new trials with oral therapies
in MS and have gradually increased the numbers of
people with MS who have access to Tysabri as a result
of her work.
Drs. Roisin Lonergan (MS Research) and David Bradley
(Dystonia Research) have been an integral part of the
Neurology Service and without them the twice-daily
clinics would not have been feasible. In addition, both
have been extremely productive in their first year of
research with numerous presentations at National and
International meetings.
The Dystonia group was awarded funding from HRB
(Partnership Awards 2008); and both MS and Dystonia
got Enterprise Ireland Grants. We also received the
Lundbeck Neuroscience bursary.
Dr. Margaret O’Brien has also played a critical role in
developing the clinical research in MS and her work on
OAS in MS has already received many plaudits.
Dr. 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 (in-patients)
The Neurology Ward (St Vincent’s Ward) now has
designated beds (since February 2008) and this has had
a huge impact on our in-patient waiting list. The ward
was repainted and the shower area improved in 2008.
Eilish Funge, CMN2 continues to run a great ward 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 Medical Social Work
Department.
There is a great team spirit in the Department of
Neurology with regular multidisciplinary meetings, radiology
meetings, the Journal Club, and up-date meetings
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 in 2006.
This involves public neurology clinics twice a day, and
has already improved the service dramatically. In 2008
we saw over 6000 outpatients. We have reduced the
waiting times substantially as part of our continued
waiting list initiative.
We now have Specialist Clinics for Parkinson’s Disease,
Multiple Sclerosis, Neuroinflammation and a Dystonia/
Botulinum Toxin Clinic.
We are running Special Therapy Clinics to facilitate
patients who otherwise might require hospitalisation.
We saw over 1000 people in the ADCC for procedures
such as lumbar punctures and for administration of
therapies that would previously have required the sue
of Day Ward facilities and thus have contributed to huge
savings for the Hospital and the Health Service as a whole.
The Infusion Unit also began to take patients in late
2008 so this should further improve access for patients
with MS.
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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. Orla has
worked hard with Radiology and Niamh Gaffney to
deal with the long waiting list for outpatient MRIs and
we are employing the NTPF currently to obtain MRI
scans for those outpatients waiting more than 3
months for a scan with great success.
All of this has been made possible only with the help
of a wide variety of people but we would like to thank
especially Bernadette Howard, Margaret Boland,
Sinead Brennan, Catherine Slattery and Breege
Screene.
Our e-mail neurology service (called ‘Neurolink’)
continues to work well and we hope to expand it. St
James’ Hospital, the Mater Hospital and Limerick Regional
have now adopted the project too which is encouraging
and we are grateful to Healthlink for all of their support.
Professor Tom Keane reviewed it on behalf of the
National Cancer Strategy and they are now using an
adapted form of Neurolink nationally. We are most
grateful for the co-operation of the GPs who use it and
it has been a successful venture in that it has helped
further reduce the burden on the Emergency Department,
in-patient beds required and, of course, our patient
waiting times. We have now expanded the project to
allow access to over 120 GPs in the South Dublin area.
We have also introduced a new in-patient referral
service that is intranet-based and allows us to expedite
review of people with neurological issues under the
acre of colleagues in the hospital. This has had a great
impact particularly in the Emergency Department where
patients are seen rapidly and a management plan
formulated to facilitate early discharge. We saw over
1100 in-patient referrals (nearly 50% from the
Emergency Department) in the first year of operation.
The Neurology web-site has been developed over
2008 and has information not just on our Department,
but also links regarding research in MS and clinical
information on Parkinson’s, Epilepsy, Migraine and other
common neurological problems.
Tysabri is being administered 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. >50 people get a monthly
infusion and each takes 2-3 hours). To continue to offer
this treatment we will need another MS Specialist Nurse.
Significant Achievements in 2007/2008
Innovation awards in 2008 (regional and national) for
practice’
Dr. Roisin Lonergan won Best Poster Presentation at the
INA (Cork) 2008.
Dr. Margaret O’Brien won Best Platform Presentation at
the INA (Cork) 2008.
Drs. Lonergan, O’Brien and Bradley all presented papers
at the American Academy of Neurology in Chicago in
2008.
The Dystonia work was also presented at The Dystonia
Europe Congress in Hamburg 2008;
Drs Bradley and Lonergan also presented at the EFNS
Madrid 2008
Many of the team presented at the ABN in Dublin in
2008 including Drs. Roisin Lonergan, Margaret O’Brien,
Laura Williams, Ailin Rogers, Sinead Murphy and John
McHugh.
Dr. J. McNulty also presented a paper at the ABN held
in Croke Park that was chaired by Professor Hutchinson
in March 2008.
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Drs. Margaret O’Brien and Anna Heeney presented
papers at the ENS in Nice in June 2008.
Cervical dystonia presenting as a phenocopy in an Irish
SCA2 family. Walsh R, O'Dwyer JP, O'Riordan S,
Bradley D, MoroneyJ, Hutchinson M.
Mov Disord. 2008 Dec 11. [Epub ahead of print]
Recent Publications
Counting the cost of complementary and alternative
therapies in an Irish neurological clinic.
Murphy SM, Rogers A, Hutchinson M, Tubridy N.
Eur J Neurol. 2008 Dec;15(12):1380-3.
Replication of KIAA0350, IL2RA, RPL5 and CD58 as
multiple sclerosis susceptibility genes in Australians.
Rubio JP, Stankovich J, Field J, Tubridy N, Marriott M,
Chapman C, Bahlo M, Perera D, Johnson LJ, Tait BD,
Varney MD, Speed TP, Taylor BV, Foote SJ, Butzkueven
H, Kilpatrick TJ.
Genes Immun. 2008 Oct;9(7):624-30.
Long-term clinical relevance of criteria for designating
multiple sclerosis as benign after 10 years of disease.
Costelloe L, Thompson A, Walsh C, Tubridy N,
Hutchinson M.
J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1245-8.
Progressive encephalomyelitis, rigidity, and myoclonus:
a novel glycine receptor antibody.
Hutchinson M, Waters P, McHugh J, Gorman G, O'Riordan
S, Connolly S, Hager H, Yu P, Becker CM, Vincent A.
Neurology. 2008 Oct 14;71(16):1291-2.
Differential diagnosis of suspected multiple sclerosis: a
consensus approach. Miller DH, Weinshenker BG,
Filippi M, Banwell BL, Cohen JA, Freedman MS, Galetta
SL, Hutchinson M, Johnson RT, Kappos L, Kira J, Lublin
FD, McFarland HF, Montalban X, Panitch H, Richert JR,
Reingold SC, Polman CH.
Mult Scler. 2008 Nov;14(9):1157-74.
New-onset focal epilepsy with palatal tremor and
glutamic acid decarboxylase antibodies responding to
intravenous immunoglobulin.
Marnane M, Vincent A, Hutchinson
M. J Neurol. 2008 Oct;255(10):1603-4.
Hanein S, Martin E, Boukhris A, Byrne P, Goizet C,
Hamri A, Benomar A, Lossos A, Denora P, Fernandez J,
Elleuch N, Forlani S, Durr A, Feki I, Hutchinson M,
Santorelli FM, Mhiri C, Brice A, Stevanin G. Identification
of the SPG15 gene, encoding spastizin, as a frequent
cause of complicated autosomal-recessive spastic
paraplegia, including Kjellin syndrome. Am J Hum
Genet 2008 Apr;82(4):992-1002.
Beetz C, Schüle R, Deconinck T, Tran-Viet KN, Zhu H,
Kremer BP, Frints SG, van Zelst-Stams WA, Byrne P, Otto
S, Nygren AO, Baets J, Smets K, Ceulemans B, Dan B,
Nagan N, Kassubek J, Klimpe S, Klopstock T, Stolze H,
Smeets HJ, Schrander-Stumpel CT, Hutchinson M, van
de Warrenburg BP, Braastad C, Deufel T, Pericak-Vance
M, Schöls L, de Jonghe P, Züchner S.
REEP1 mutation spectrum and genotype/phenotype
correlation in hereditary spastic paraplegia type 31.
Brain 2008 Apr;131(Pt 4):1078-86.
Williams L, O'Connell K, Tubridy N.
Headaches in a rheumatology clinic: when one pain
leads to another.
Eur J Neurol 2008 Mar;15(3):274-7.
McHugh JC, Tubridy N, Collins CD, Hutchinson M.
Unusual MRI abnormalities in anti-Yo positive "pure"
paraneoplastic cerebellar degeneration.
J Neurol 2008 Jan;255(1):138-9.
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Costelloe L, O'Rourke K, McGuigan C, Walsh C, Tubridy
N, Hutchinson M. The longitudinal relationship between
the patient-reported Multiple Sclerosis Impact Scale
and the clinician-assessed Multiple Sclerosis Functional
Composite. Mult Scler 2008 Mar;14(2):255-8.
Future Plans
GP-led Migraine Clinic – we plan to have a weekly GPled 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 the Emergency Department 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.
Audit
Consultation service for in-patients of all services
The Neurology service sees 20-25 in-patients (from
other services) with neurological problems each week.
Over a 12-month period,1100 referrals were seen in
2007-2008 and the vast majority are seen directly in
the Emergency Department to facilitate early diagnosis
and possible discharge.
Neurology in the Emergency Department (ED).
We previously performed an audit of the ED admissions
at SVUH that had a neurological problem. About 15%
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%), and
dizzy/syncope (6%).
Teaching
The Department has an excellent reputation in teaching
under-graduate and post-graduate students.
The Department runs the MRCP examinations three
times a year.
We also run an annual MRCPI course in Neurology as
well as in hospital MRCP teaching sessions there times
a year.
In 2008, the Team has been working to produce a
video for teaching students and doctors at all levels
with Clinics in Motion and UCD. This will be available in
early 2009.
Department of Clinical Neurophysiology
Staff
Consultant:
Dr Sean Connolly, MD, FRCPI
Neurophysiology Measurement Technicians at SVUH:
Ms Anne Bjerke (full-time senior)
research collaborations with the Department of Neuroengineering at TCD and with Dr Geraldine Boylan in the
Department of Paediatrics and Child Health, UCC.
SVUH departmental secretary/manager:
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 SVUH departments, includes a nerve
excitability study in toxic neuropathies. There are also
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Recent Developments
Efforts are continuing to appoint more technologists
and to provide additional departmental space.
Recent Publications
Murray DM, Boylan GB, Fitzgerald AP, Ryan CA, Murphy
BP, Connolly S.
Persistent lactic acidosis in neonatal hypoxic-ischaemic
encephalopathy correlates with EEG and electrographic
seizure burden. Arch Dis Child Fetal Neonatal Ed.
2008;93:F183-6. Epub 2006 Nov 28. PMID: 17132680
Hutchinson M, Waters P, McHugh J, Gorman G, O’Riordan
S, Connolly S, Hager H, Yu P, Becker C-M, Vincent A.
Progressive encephalomyelitis, rigidity and myoclonus:
a novel glycine receptor antibody.
Neurology. 2008;71: 1291-2. PMID: 18852446
Service Activity
Consultant:
Dr Eoin Tiernan
Clinical Nurse Specialists:
Ms Millie Devenish/
Olga Price
Ms Siobhan Hollingsworth
Ms Barbara Whyte
St. Vincent’s Private Hospital:
Ms. Carmel Houlihan
Ms. Anthea O’Grady (part-time)
Dr Kathleen Cronin 01/01/08 to 30/06/08
Dr Brenda O’Connor –
01/07/08 to 31/12/08
Registrars:
Dr Tim Price –
01/01/08 to 30/06/08
Dr David Ngo –
01/07/08 to 31/12/08
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Principal Psychologist:
Ms. Ursula Bates
(2 sessions per week)
Administrative Support:
Ms Joan Stokes
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The significant increase in referrals seen annually to the
specialist palliative medicine service continued in 2008.
In total 1050 patients were referred. 24% of new
referrals had a non-cancer diagnosis.
1200
1000
As well as the increased numbers of referrals seen over
the years, the service is also seeing definite changes in
the nature of the referrals. Cancer patients are being
referred earlier in their illness, with the Palliative
Medicine Team providing advice and support to greater
numbers of patients who are still undergoing active
oncological therapies. As well as earlier referral, with
newer oncological therapies available, cancer patients
are often receiving chemotherapy at more advanced
stages of their illness. Theses changes have led to the
need for a more integrated model of palliative medicine
and oncology, which is happening in this hospital.
1038
1050
2007
2008
931
800
817
774
REFERRALS
Staff
721
600
400
The number of non-cancer referrals remains high, with
an increasing range of conditions being referred.
Though most of the non-cancer referrals are still for
terminal care in the hospital, an increasing number of
patients with complex multiple symptoms associated
with chronic life-limiting conditions are being referred,
for example, young patients with inflammatory bowel
disease, and, young patients with cystic fibrosis.
200
0
2003
2004
2005
2006
Developments
Increasingly the aforementioned changes we are seeing
in referrals are leading to a need to continuously develop
the role of specialist palliative medicine in the acute
hospital setting and also suggest that the traditional
model of hospice-focused palliative care needs to be
challenged. It is clear that the majority of complex
specialist palliative medicine is delivered in an acute
hospital setting, and services need to develop to reflect
this.
the Palliative Medicine and Oncology Teams in St.
Vincents. Ongoing project and audit work continue to
support enhancement of continuity of care between the
acute and hospice inpatient and home care settings.
A new Palliative Medicine Outpatient Service was
commenced in 2008 in St. Vincent’s University Hospital
to support patients in the community and under the
care of the Hospice Home Care Team.
Education
172
In 2007 the team completed the role-out of the
Liverpool Care Pathway (LCP) for the Dying. However,
the LCP has a very narrow focus on just care in the final
hours/days of life and experience is showing that it has
limited use with only a minority of patients who die
entering onto the pathway. As a consequence, and
following a period of consolidation of the clinical
service, the Palliative Medicine Team began work in
2008 on an innovative proposal to develop a broader
framework to replace the Liverpool Care Pathway. This
innovative work involves new partnerships with
institutions in the US and the UK.
As well as continuing to provide input to a wide range of
educational initiatives for other healthcare professionals,
both in-house and externally, all members of the Palliative
Medicine Department attend to their own continuing
professional development by way of attendance at both
in-house and external educational events.
The close links between our service and Blackrock
Hospice continue to develop with our weekly liaison
meeting between the Hospice Home Care Team and
The team continues to facilitate clinical placements for
nurses undertaking the Higher Diplomas in Palliative
Care Nursing and Pain Management from UCD.
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The clinical nurse specialists continue to facilitate the
Palliative Care Link Nurse Programme involving monthly
meetings with the Link Nurses from the wards with a
structured education programme covering a wide range
of palliative care issues.
Courses and Conferences attended by members
of the team (sample)
In-house: members of the team attended workshops
on presentation skills, medication safety, mindfulness
training, and CPR during the course of the year.
A selection of the external educational events attended
by members of the team:
• Moving Points in Palliative Care (Our Lady’s
Hospice, Harold’s Cross), 3 - 4 April 2008.
• EAPC Research Conference, Trondheim, Norway 29
- 31 May 2008.
• 7th Annual Kalidoscope Conference (St. Francis
Hospice) ‘Pearls & Promises’ 11 -12 June 2008,
Dublin Castle.
• Design & Dignity, Public Lecture Professor Roger
Ulrich Thursday 19th June 2008 (Hospice Friendly
Hospitals Programme).
• Beaumont Palliative Care Study Day, Beaumount
Hospital, 18 Sept 2008.
• Effective Teaching Skills (RCPI) 7 - 8 Oct 2008.
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Achievements
During 2008, Ms. Barbara Whyte, Clinical Nurse
Specialist, was appointed to the Dublin Mid-Leinster
Regional Development Committee for Palliative Care.
Ms. Millie Devenish, Clinical Nurse Specialist, was
appointed to the Nursing Advisory Forum of Irish
Association for Palliative Care.
Publications
Peer-reviewed publications
Stone CA, Tiernan E, Dooley BA.
Prospective validation of the palliative prognostic index
in patients with cancer.
J Pain Symptom Manage. 2008 Jun;35(6):617-22.
O'Leary N, Tiernan E.
Survey of specialist palliative care services for
noncancer patients in Ireland and perceived barriers.
Palliat Med. 2008 Jan;22(1):77-83.
Prof. W. McNicholas, Dr. Tim McDonnell.
Statistics
In-patients:
Pulmonary and Sleep Laboratory
Professor W. McNicholas
Dr. T. McDonnell
Dr. John Seery
Admissions
Discharges
Day Care
The Sleep Laboratory moved to a new location in July
2008 adjacent to the new St. Mark’s Day Centre. This
new location allows for 7 patients per night to be tested
in individual rooms with separate office and a combined
Nurse office/patient education room. However, the
Sleep Laboratory was closed for several months prior to
this move which has resulted in a significant reduction
in patient tests during 2008 when compared with
2007.
640
628
79
Pulmonary Function Laboratory:
Total Patients:
Total tests:
3525
8487
Sleep Laboratory: Total Admissions:
322
Dr David Mc Sharry was appointed to a temporary halftime Consultant post in October 2008 to help deal with
the lengthy waiting lists of referrals relating to suspected
sleep apnoea.
Outpatients Department
No. of
Sessions
New
Return
Total
Prof. McNicholas (General Respiratory)
51
159
756
915
Prof. McNicholas (Sleep Apnoea Clinic)
51
241
714
955
Dr. T. McDonnell
50
96
373
469
152
496
1,843
2,339
Total
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New staff appointed during 2008
The following technician appointments were made in
2008: Sonia Eigenheer, Senior (May 08), Emma Smyth
(Basic split between St Michael’s Hospital + St
Vincent’s University Hospital), transfer of Brigid Clarke
from EEG to Pulmonary Laboratory.
Grade IV secretarial support Catherine Morris appointed
to the Sleep Disorders Unit in December 2008.
Welcome babies Niamh and Sabhdh to Sleep Nurse
Specialists Val and Renata and grandson Jack to
Geraldine. Thanks to Avril locum Nurse Specialist for
2008 covering maternity leave.
Respiratory Education Centre
A total of 1827 consults were undertaken during 2008.
This reflects a 10% increase from 2007.
Staff Education
The NIV study day was attended by 60 candidates. This
included 49 nurses and 11 physiotherapists. Our focus
is to revise the NIV study day, targeting specific clinical
areas to enhance proficiency.
HFCPAP training was commenced in April. 65 nursing
staff have attended the monthly training sessions.
Guideline development
HFCPAP guidelines were devised and launched in
October.
Nebuliser therapy guidelines are subject to review
pending audit recommendations.
Both the Tracheostomy care and NIV guidelines are
scheduled for review 2009.
Audit
A re-evaluation of RNS formal referral system July.
An evaluation of current nursing practice with regards to
nebuliser use in SVUH Sept.
A re-evaluation of RNS telephone advice line in
November.
Publications
Jones, P. (2008)
Management of Exacerbations and Emergencies,
World of Irish Nursing July / August, 16, (7), pp40-42
Brown, L. (2008)
The Management of Adult Asthma,
World of Irish Nursing April, 16, (4), pp45-47
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Invited Lectures
Prof. McNicholas gave several lectures as part of major
symposia at the following international scientific
meetings:
• American Thoracic Society, Toronto, May 2008
• American Academy of Sleep Medicine, Baltimore,
June 2008
• European Respiratory Society, Berlin, October 2008
Selected Publications 2008
Riha RL, Diefenbach K, Jennum P, McNicholas WT;
Management Committee, COST B26 Action on Sleep
Apnoea Syndrome. Genetic aspects of hypertension
and metabolic disease in the obstructive sleep apnoeahypopnoea syndrome. Sleep Med Rev. 2008
Feb;12(1):49-63. PMID: 18201663 [PubMed - indexed
for MEDLINE]
Ryan S, McNicholas WT.
Intermittent hypoxia and activation of inflammatory
molecular pathways in OSAS.
Arch Physiol Biochem. 2008 Oct;114(4):261-6.
Review. PMID: 18946786 [PubMed - indexed for
MEDLINE]
de Chazal P, Heneghan C, McNicholas WT.
Multimodal detection of sleep apnoea using
electrocardiogram and oximetry signals.
Philos Transact A Math Phys Eng Sci. 2009 Jan
28;367(1887):369-89. PMID: 18974035 [PubMed - in
process]
McNicholas WT.
The nose and OSA: variable nasal obstruction may be
more important in pathophysiology than fixed
obstruction.
Eur Respir J. 2008 Jul;32(1):3-8. PMID: 18591332
[PubMed - indexed for MEDLINE]
Doherty LS, Cullen JP, Nolan P, McNicholas WT.
The human genioglossus response to negative airway
pressure: stimulus timing and route of delivery.
Exp Physiol. 2008 Feb;93(2):288-95. Epub 2007 Oct
19. PMID: 17951328 [PubMed - indexed for MEDLINE]
Bone and Join Unit
The St. Vincent’s Healthcare Group (SVHG) Bone and
Joint Unit is comprised of specialities of Orthopaedic
Surgery, Rheumatology and of Rehabilitation Medicine.
The Bone and Joint Unit is the only such unit in Ireland
and the Mission of the Bone and Joint Unit is fourfold.
1. To provide evidence based, multidisciplinary care
programme to all patients presenting to SVHG with
musculoskeletal and rehabilitation related clinical
related problems.
2. By linking closely with community care to devise
programmes of patient management, which are
designed to offer speedy access, early intervention
and discharge back to the community where
appropriate.
The Bone and Joint Unit has been operational since the
summer of 2006. Clinics are provided within the Unit
operating on the basis of three by three clinics per day
in addition to daily fracture clinics. Members of the
Bone and Joint Unit meet on a monthly basis to help
plan and develop the service and to improve the
delivery of care to our patients.
Dr. Aizad Mumtaz
Dr. Eliza Pontifex
Research Registrar:
Dr. Chin Teck Ng
Dr. Taj Saber
Dr. Agnes Szentpetery
Nursing Staff:
Ms. Catherine Slattery
Mrs. Miriam Molloy
Mrs. Phil Gallagher
Mrs. Alexia Grier
Mrs. Marie O’Rourke
Staff
Mrs. Eileen O’Flynn
Consultant Staff:
3. By coordinating teaching programmes to provide a
unique, educational programme for medical
undergraduates, post-graduate trainees and for
nurses, physiotherapists and occupational therapists
wishing to develop specialist musculoskeletal
expertise.
(January-March)
Mrs. Susan van der Kamp
Ms. Bincy Varghese
Dr. Orla Killeen
Sujata
(March-December)
Ms. Imelda Corcoran
Administration Staff:
Mrs. Jenni Cross
Mrs. Linda Collins (January-September)
Mrs. Julie Di Silva
Specialist Registrar:
4. By promoting interdisciplinary cooperation to further
develop and expand the academic and research
infrastructure relating to musculoskeletal disease.
Research Registrar:
Registrar:
Dr. Lorraine O’Neill (June-December)
Mrs. Frances Dwyer
Dr. Ceara Walsh (January-June)
Ms. Saibh Kelly
Dr. John Paul Doran (January-June)
Ms. Ann Claire Nolan
Dr. Claire Kiely (June-December)
Ms. Ann Sharkey
Ms. Mary White
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Bone and Join Unit
Specific programmes, which are operational within the
Bone and Joint Unit, include the Early Arthritis Clinic,
the Adolescent Transitional Clinic, the clinic designated
for patients on biologic therapies and the nurse-led
Methotrexate Clinic. The Fracture Liaison Nurse Service
(FLS) position has been in place throughout 2008
funded by MSD. An audit of this service by FLS nurse
Annette Whelan has confirmed that patients with low
trauma fracture are being identified, fully assessed
including DXA scanning and are being commenced on
appropriate treatment to prevent further fracture. It is
hoped that the funding of this position will be taken up
by the hospital in 2009.
Other significant achievements, within 2008, include
the following:
• The Bone Density Department has expanded with
two DXA scanners on site within the Bone and Joint
Unit. To further coordinated development of DXA
scanning within the St. Vincent’s Healthcare Group,
a Bone Health Users Group has been established.
• Coordinated by Dr. Bernadette Lynch, Dr. Aizad
Mumtaz and Specialist Physiotherapist Martina
Fitzpatrick, musculoskeletal ultrasound continues to
be available within the Bone and Joint Unit. A new
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state-of-the-art musculoskeletal ultrasound machine
including 3D/4D capabilities has been installed.
• Together with the Physiotherapy department, a back
care programme funded for 1 year has been
established.
• Work is well on the way to develop a database for
inflammatory arthritis patients. The database will be
operational by mid-2009. Significant support to
develop this database has been obtained through a
grant received from Abbott Immunology.
• Needle arthroscopy continues to be available within
the department. The arthroscopies are now being
undertaken in the Clinical Research Centre and in
the Bone and Joint Department. Professor Douglas
Veale is coordinating this programme.
Consultant achievements
• Co-Chairman, EULAR Synovitis Study Group
• Co-Chairman, OMERACT Synovial Tissue Analysis
Study Group
Bone and Join Unit
• Chairman, Arthritis Ireland
• Member of HSE working group on Arthritis and
Allied conditions representing the Irish Society of
Rheumatology
• Steering committee member for GRAPPA (Group
for Research and Assessment of Psoriasis and
Psoriatic Arthritis)
• Member of Abbott International Immunology
Advisory Board
– Specialist Registrar Training Group, Northern
Ireland
Prof Douglas Veale
• Appointed Director of Translational Research, Dublin
• Medical Director, Education & Research Centre, SVUH
• Director of THERAPI - Translational Research Group
• Vice-president, International Scleroderma Clinical
Trials Consortium
• Lead Consultant Bone & Joint Unit, SVUH
• Strategic Scientific Committee, Arthritis Research
Campaign, UK
• Medical Director Rheumatology Rehabilitation at
Harold’s Cross
• HRB Infection & Immunity Grant Committee
• Chairman, Scientific Session at EULAR
• Steering committee member of OMERACT
Biomarkers Group
• Irish Medicines Board, Medicines Committee
• Wyeth Translational Science European Expert Group
• Schering-Plough International Advisory Panel
• Scientific committee member 3e Initiative in
Rheumatology
• Centocor International Advisory Panel
• Invited speaker at the following:
• Progress and Promise, Madrid vvisiting Speaker
• Co-Chair RCPI Masterclass in Rheumatology
– Progress and Promise Meeting, Madrid
– Genetic Clinic, London
– Turkish Society of Rheumatology, Istanbul
– Corrigan Club, Keynote Speaker
– GRAPPA meeting, Leeds
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• Director of the Clinical Skills Laboratory at UCD
• Co-ordinator of the Advanced Clinical Skills module
for the Graduate Entry Medicine programme
• Co-ordinator for the Elective module for undergraduate and graduate entry medical students
Dr. Ursula Fearon
• Senior Scientist Rheumatology
• Chairperson Scientific Session of The American
College of Rheumatology, San Francisco, November
2008
Grants
Differential expression of VEGF, PIGF and the VEGF
receptors in Inflammatory arthritis.
HRB Project Grant: ?165,000 (PI-Oliver FitzGerald)
Differential Protein expression in psoriatic arthritis
synovial tissue following
anti-TNF therapy. (PI-Oliver FitzGerald) Abbott: €100,000
Development of Inflammatory Arthritis database.
Abbott: €240,000 (PI-Oliver FitzGerald)
HRB Equipment Grant Award
(PI-Steve Pennington, Co-investor- Oliver Fitzgerald)
Hypoxia-induced mitochondrial signalling pathways in
inflammatory arthritis.
HRB Translational Award 2006-2011, €1.5m (PI-Douglas Veale)
Bone and Join Unit
Autocure EU 6th Framework Grant (PI-Barry Bresnihan)
‘Curing Autoimmune Disease – translational approach’ €212,500
over 5 years
Cytokine Regulation in Synovial explant cultures and
pre/post biologic therapy.
Wyeth Pharmaceuticals ?350k (PI - Douglas Veale)
Adherence to medications in systemic lupus
erythematosus.
Koneru S, Kocharla L, Higgins GC, Ware A, Passo MH,
Farhey YD, Mongey AB, Graham TB, Houk JL, Brunner
HI. J Clin Rheumatol. 2008 Aug;14(4):195-201
Publications
Drug insight: autoimmune effects of medicationswhat's new? Mongey AB, Hess EV; Medscape. Nat
Clin Pract Rheumatol. 2008 Mar;4(3):136-44. Review
Biopharmaceutical/Pharmaceutical Science Programme
PRTLI Cycle 4, €4.6 million (Co-applicant – Douglas Veale)
A CELLMAX® Artificial Capillary System and
Flexercell™ Strain Unit
UCD Research Support Schemes. €35k (PI - Douglas Veale)
Hypoxia-induced mitochondrial signaling pathways in
inflammatory arthritis promote
angiogenesis and synovial invasiveness and may predict
response to therapy.
HRB Translational Award €1.4 million (PI - Douglas Veale)
Hypoxia Chambers and Luminometer
HRB Equipment Grant Award €75k (PI - Ursula Fearon)
In vivo Hypoxic probes and monitor.
UCD Seed Funding €20k (PI - Ursula Fearon)
Proof of concept studies of novel biopharmaceutical
and small molecular
weight inhibitors using whole tissue explant cultures.
GlaxoSmithKline €680k (PI - Douglas Veale)
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Hypoxia activates NF-κB-dependent gene expression
through the canonical signaling pathway.
Kathryn M. Oliver, John F. Garvey, Eoin P. Cummins,
Douglas J. Veale, Ursula Fearon, Cormac T. Taylor.
In Press
A Novel Role for the HDL Receptor, CLA-1 in
Synovial Inflammation via Serum Amyloid-A and
Apolipoprotein A-1.
Mullan Ronan, Mc Cormick Jennifer, Connolly Mary,
Bresnihan Barry, *Veale Douglas James , *Fearon
Ursula. In Press Am J Pathol
Synovial tissue sublining CD68 expression as a
biomarker of therapeutic response in rheumatoid
arthritis clinical trials: consistency across centers.
Barry Bresnihan, Eliza Pontifex, Rogier Thurlings,
Marjolein Vinkenoog, Hani el Gabalawi, Ursula Fearon,
Oliver Fitzgerald, Danielle Gerlag, Terence Rooney,
Marleen van de Sande, Douglas Veale, Koen Vos, PP
Tak
Walsh CAE, Fearon U, FitzGerald O, Veale DJ, Bresnihan
B. Decreased CD20 Expression in Rheumatoid
Arthritis Synovium Following 8 Weeks of Rituximab
Therapy. Clin Exp Rheumatol. 2008 Jul-Aug;26(4):656-8
Updated consensus statement on biological agents
for the treatment of rheumatic diseases, 2008. Furst
DE, Keystone EC, Kirkham B, Kavanaugh A, Fleischmann
R, Mease P, Breedveld FC, Smolen JS, Kalden JR,
Burmester GR, Braun J, Emery P, Winthrop K, Bresnihan
B, De Benedetti F, Dörner T, Gibofsky A, Schiff MH,
Sieper J, Singer N, Van Riel PL, Weinblatt ME, Weisman
MH.Ann Rheum Dis. 2008 Dec;67 Suppl 3:iii2-25
Rheumatoid arthritis: a novel radiographic
projection for hand assessment.
Pearman L, Last J, Fitzgerald O, Veale D, Joyce M,
Rainford L, McEntee M, McNulty J, Thomas E, Ryan J,
McGee A, Toomey D'Helft R, Lowe J, Brennan PC
Bone and Join Unit
Successful pregnancy after rituximab in a women
with recurrent in vitro fertilisation failure and antiphospholipid antibody positive.Ng CT,
O'Neil M, Walsh D, Walsh T, Veale DJ.
Ir J Med Sci 2008; Nov 29
Treatment recommendations for psoriatic arthritis.
Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ,
Helliwell P, Boehncke WH, de Vlam K, Fiorentino D,
Fitzgerald O, Gottlieb AB, McHugh N, Nash PT, Qureshi
A, Soriano ER, Taylor WJ.
Ann Rheum Dis. 2008 Oct 24. [Epub ahead of print]
PMID: 18952643 [PubMed - as supplied by publisher]
Consistency in assessing the Disease Activity Score28 in routine clinical practice.
Walsh CA, Mullan RH, Minnock PB, Slattery C,
FitzGerald O, Bresnihan B. Ann Rheum Dis. 2008
Jan;67(1):135-6. No abstract available. PMID:
18077544 [PubMed - indexed for MEDLINE]
Increased expression of the orphan nuclear receptor
NURR1 in psoriasis and modulation following TNFalpha inhibition. O'Kane M, Markham T, McEvoy AN,
Fearon U, Veale DJ, FitzGerald O, Kirby B, Murphy EP.
J Invest Dermatol. 2008 Feb;128(2):300-10. Epub 2007
Aug 2. PMID: 17671512 [PubMed - indexed for MEDLINE]
Differential expression of syndecans and glypicans
in chronically inflamed synovium.
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Patterson AM, Cartwright A, David G, Fitzgerald O,
Bresnihan B, Ashton BA, Middleton J. Ann Rheum Dis.
2008 May;67(5):592-601. Epub 2007 Jun 1. PMID:
17545191 [PubMed - indexed for MEDLINE]
Biomarkers in systemic sclerosis. Doran JP, Veale DJ.
Rheumatology (Oxford). 2008 Oct;47 Suppl 5:v36-8.
PMID: 18784139 [PubMed - in process]
Validity, reliability, and feasibility of durometer
measurements of scleroderma skin disease in a
multicenter treatment trial.
Merkel PA, Silliman NP, Denton CP, Furst DE, Khanna
D, Emery P, Hsu VM, Streisand JB, Polisson RP, Akesson
A, Coppock J, van den Hoogen F, Herrick A, Mayes MD,
Veale D, Seibold JR, Black CM, Korn JH; CAT-192
Research Group; Scleroderma Clinical Trials Consortium.
Arthritis Rheum. 2008 May 15;59(5):699-705.
PMID: 18438905 [PubMed - indexed for MEDLINE]
Development of a provisional core set of response
measures for clinical trials of systemic sclerosis.
Khanna D, Lovell DJ, Giannini E, Clements PJ, Merkel
PA, Seibold JR, Matucci-Cerinic M, Denton CP,
Mayes MD, Steen VD, Varga J, Furst DE;
Scleroderma Clinical Trials Consortium co-authors.
Ann Rheum Dis. 2008 May;67(5):703-9. Epub 2007
Sep 24.
Photochemotherapy for localized morphoea: effect
on clinical and molecular markers.
Clin Exp Dermatol. 2008 Nov;33(6):698-704.
Abnormal T cell differentiation persists in patients
with rheumatoid arthritis in clinical remission and
predicts relapse.
Burgoyne CH, Field SL, Brown AK, Hensor EM, English
A, Bingham SL, Verburg R, Fearon U, Lawson CA,
Hamlin PJ, Straszynski L, Veale D, Conaghan P, Hull MA,
van Laar JM, Tennant A, Emery P, Isaacs JD, Ponchel F.
Ann Rheum Dis. 2008 Jun;67(6):750-7. Epub 2007 Jul
20.
Updated consensus statement on biological agents
for the treatment of rheumatic diseases, 2008.
Kalden JR, Burmester GR, Braun J, Emery P, Winthrop
K, Bresnihan B, De Benedetti F, Dörner T, Gibofsky A,
Schiff MH, Sieper J, Singer N, Van Riel PL, Weinblatt
ME, Weisman MH.
Ann Rheum Dis. 2008 Dec;67 Suppl 3:iii2-25. No
abstract available. Erratum in: Ann Rheum Dis. 2009
Mar;68(3):452. Kavanaugh, A [added].
Bone and Join Unit
Musculoskeletal Disorders. Eliza Pontifex and Barry
Bresnihan. "Palliative Medicine." Elsevier publishers,
USA. 2008, p1033-1038
Melanoma Inhibitory Activity, a biomarker related to
chondrocyte anabolism, is reversibly suppressed by
proinflammatory cytokines in rheumatoid arthritis.
Verdonk PC, Tak PP, Boots AH, Baeten D.
Ann Rheum Dis. 2008 Jul 16. [Epub ahead of print]
PMID: 18633128 [PubMed - as supplied by publisher]
Tuberculosis reactivation during immunosuppressive
therapy in rheumatic diseases: diagnostic and
therapeutic strategies.
Keane J, Bresnihan B.
Curr Opin Rheumatol. 2008 Jul;20(4):443-9. Review.
Cardiovascular disease in patients with rheumatoid
arthritis: results from the QUEST-RA study.
Naranjo A, Sokka T, Descalzo MA, Calvo-Alén J,
Hørslev-Petersen K, Luukkainen RK, Combe B,
Burmester GR, Devlin J, Ferraccioli G, Morelli A,
Hoekstra M, Majdan M, Sadkiewicz S, Belmonte M,
Holmqvist AC, Choy E, Tunc R, Dimic A, Bergman M,
Toloza S, Pincus T; QUEST-RA Group.
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Arthritis Res Ther. 2008;10(2):R30. Epub 2008 Mar 6.
multicenter treatment trial. Merkel PA, Silliman NP,
Denton CP, Furst DE, Khanna D, Emery P, Hsu VM,
Streisand JB, Polisson RP, Akesson A, Coppock J, van
den Hoogen F, Herrick A, Mayes MD, Veale D, Seibold
JR, Black CM, Korn JH; CAT-192 Research Group;
Scleroderma Clinical Trials Consortium. Arthritis Rheum.
2008 May 15;59(5):699-705.
The development of the L-QoL: a quality-of-life
instrument specific to systemic lupus erythematosus.
Doward LC, McKenna SP, Whalley D, Tennant A,
Griffiths B, Emery P, Veale DJ.Ann Rheum Dis. 2009
Feb;68(2):196-200.
Biological biomarkers in psoriatic disease. A review.
de Vlam K, Gottlieb AB, Fitzgerald O.
J Rheumatol. 2008 Jul;35(7):1443-8. Review
Clues to the pathogenesis of psoriasis and psoriatic
arthritis from imaging: a literature review.
Coates LC, Anderson RR, Fitzgerald O, Gottlieb AB, Kelly
SG, Lubrano E, McGonagle DG, Olivieri I, Ritchlin CT,
Tan AL, De Vlam K, Helliwell PS.
Breast cancer and systemic sclerosis: a clinical
description of 21 patients in a population-based
cohort study. Lu TY, Hill CL, Pontifex EK, RobertsThomson PJ. Rheumatol Int. 2008 Jul; 28(9):895-9
Chapters
• Professor Oliver FitzGerald, co-editor for new etextbook on “Psoriatic and Reactive Arthritis”.
• Dr. Eliza Pontifex, Professor Barry Bresnihan for “In
Palliative Medicine” on “Musculoskeletal disorders”.
In Press.
• Professor Oliver FitzGerald, Psoriatic Arthritis in text
book of Rheumatology. Ed-Firestein et al 2008
Future Plans
To make additional appointments in Rheumatology, in
particular at consultant and clinical nurse specialist levels.
To continue with development of closer links with
primary care services with a view to improving interface
between primary and secondary care.
To further develop care pathways in collaboration with
Bone and Joint colleagues in Orthopaedic Surgery and
Rehabilitation Medicine.
Bone and Join Unit
Department Statistics
OPD
New Patients
Return Patients
Total
Monday Clinic
313
917
1,230
Tuesday Clinic
11
1,306
1,317
Wednesday AM Clinic
227
704
931
Wednesday PM Clinic
191
626
817
70
359
429
Dr. Veale (Knee Clinic AM)
5
8
13
Dr. Veale (Knee Clinic PM)
4
10
14
Adolescent Clinic
16
60
76
Biological Clinic
26
642
668
Mantoux Clinic
14
26
40
Nurse Led Clinic
12
30
42
889
4,688
5,577
Thursday Clinic
Grand Total
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Staff
Principal Investigators
Research Assistants
Dr. Ciaran Duffy
Dr. Ursula Fearon (Senior Scientist)
Dr. Orla Killeen
Graduate Students
Ms Jennifer Mc Cormick
Owen O’Sullivan
Mary Connolly
Aisling Kennedy
Ellen Moran
Educational Activities
Specialist Registrars
Dr. Lorraine O’Neill
Dr. Ceara Walsh
Registrars
Dr. John Paul Doran
Dr.Clare Kiely
Clinical Research Fellows
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Post Doctoral fellow
183
Bernadette Lynch
Aizad Mumtaz
Chin Teck Ng
Eliza Pontifex
Taj Saber
Agnes Szentpetery
Ms Roisin Adams
Dr. Monika Biniecka
Dr. Emily Collins
Dr. Wei Gao
Dr. Sinead NicUltaigh
Return to Contents
Prof. Anne Barbara Mongey is the Director of the
Clinical Skills Laboratory at UCD, responsible for
designing and conducting workshops in clinical skills for
the undergraduate and graduate entry medicine
programs. In addition, Prof. Mongey is involved in the
development of OSCE examinations, including the use
of videotaping, to evaluate clinical skills. Integration of
the teaching of clinical skills into the 1st and 2nd year
of the undergraduate medical programme is also part
of Prof. Mongey’s remit as a lecturer in UCD and the
development of videotapes and handbooks for teaching
of clinical skills.
Furthermore, Prof. Mongey is the co-ordinator of the
Advanced Clinical Skills module for the Graduate Entry
Medicine program and co-ordinator for the Elective
module for undergraduate and graduate entry medical
students.
Research Activities
The Translational Medicine research group includes
close links with other active research groups including
the Centre for Colorectal Disease, Diabetes and Obesity,
Liver Immunology, and Psychoimmunology on the ERC
site and investigators based in the Conway Institute, UCD
and in TCD. The Rheumatology Research group includes
Principal Investigators - Prof. Douglas Veale, Dr. Ursula
Fearon and Prof Oliver FitzGerald with a primary clinical
focus on early, inflammatory arthritis and a scientific
focus on mechanisms of angiogenesis, inflammation
and joint damage. The group has established novel
models of analysis using serum, synovial fluid, synovial
tissue and cartilage to search for biomarkers of disease,
examine mechanisms of angiogenesis and hypoxia,
novel mediators/cytokines and cartilage destruction in
the study of pathogenesis of arthritis.
The research plan for the next five years is to develop
new expertise and extend national and international
collaborations to elucidate predictors of response to
therapy, predictors of remission and to examine the
mechanisms of disease. A major step has been achieved
in this regard with the proposal to create a new Centre
for Rheumatological Diseases incorporating clinical and
scientific researchers from UCD and TCD. This initiative
supported by the two universities, Arthritis Ireland and
the HSE has established two Chairs in Rheumatology.
We have in 2008 commenced a major state-of–the-art
clinical research programme based around UCD CRC
bringing together investigators across the newly formed
Dublin Academic Health Centre. This has included a
DAHC coordinated Research Journal Club, a DAHC
Seminar Series for Translational Research. In support of
this there have been a number of developments
including the appointment of key personnel – Data
coordinator, Laboratory Manager, in addition to
establishing a new UCD CRC Biobank.
Further progress has been made in relation to novel
imaging studies with the first concomitant studies of
PET/CT and MRI in patients with arthritis.
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. She demonstrated the
presence of CD20+ cells in the synovium of patients
with RA resistant to anti-TNF· therapies. Complete
depletion of synovial B cells following treatment with
Rituximab is associated with an excellent clinical
response. She also demonstrated that Rituximab may
effect depletion of macrophages in the joint suggesting
that synovial B cells precedes a decrease in local
inflammation leading to clinical improvement. Ceara is
currently writing up her PhD thesis.
Biomarkers and predictors of disease
Specific ongoing projects:
Remission study and Rituximab therapy for resistant
arthritis
Dr Ceara Walsh finished her research in July 2007
under the supervision of Prof. Barry Bresnihan and Dr
Ursula Fearon. Dr Walsh’s research involved (i) to
identify predictive markers of relapse and identify a
genetic profile associated with relapse (ii) to examine
the effect of Rituximab in-patient’s resistant to anti-TNF·
therapy, (iii) to examine the presence of latent TB in
patients receiving anti-TNF·. She demonstrated a
specific expansion of inhibitory receptor CD94/NKG2A
in remission associated with an increase in the CD8+ T
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This work was performed by Dr Eliza Pontifex under the
supervision of Prof Barry Bresnihan and Dr Ursula
Fearon. It is an ongoing collaboration with several
international groups funded by the EU FP6 Autocure
grant, led by the Karolinska Institute, Stockholm and
links with the ‘OMERACT’ international study to develop
new biomarkers for synovial tissue response to
treatment. This work demonstrated that the
macrophage marker - CD68 is good biomarker for
response to therepy, which correlates with disease
activity. Furthermore, she demonstrated a correlation
between results obtained from 2 different centres
(Dublin and Amsterdam), and thus has validated the
method of that staining and quantification of sublining
CD68 in RA making significant progress in standardisation
of the techniques. This data has now been assimilated
into manuscript and is currently in press. Under the
supervision of Prof Oliver FitzGerald and Dr Ursula
Fearon, Eliza is also examining if change in cell
infiltration in psoriatic arthritis (PsA) synovial tissue
correlates with change in DAS28 following initiation of
biologic therapy. Results have shown that change in
CD3+ T-cell infiltration correlates both with change in
DAS28 and also with change in a semi-quantitative MRI
synovitis score of the same knee joint calculated by Dr.
Robin Gibney. In collaboration with Professor Patrick
Brennan’s group from imaging in UCD, a more
quantitative measure of synovitis is being developed.
Finally Eliza is examining the role of TLRs in patients with
PsA. Eliza has demonstrated expression of TLR-2/4 in
the endothelial and lining layer regions of the synovium.
Currently she is stimulating primary fibroblasts from
patients with PsA with TLR-2 and 4 +/- cJun inhibitors
and assessing regulation of chemokines.
Hypoxia and altered mitochondrial bioenergetics in the
inflamed joint.
This major programme funded by a Translational
Research Award from The HRB (2006-2011) to Prof
Doug Veale and Dr. Ursula Fearon hypothesizes that
vascular morphology and synovial invasiveness within
the inflamed joint and response to therapy, may be
dependent on activation of mitochondria-derived,
hypoxia-induced transcriptional and non-transcriptional
pathways and alterations in genome stability. Using a
novel pO2 probe we have demonstrated that the joint
is profoundly hypoxic. Dr. Vincent Ng, clinical research
fellow, has demonstrated for the first time a direct
inverse correlation between tissue (t) pO2 levels and
macroscopic synovitis. Furthermore Dr. Ng has
demonstrated that low tpO2 levels inversely correlate
with microscopic markers of synovial T cells and
macrophages, with no relationship to synovial
proliferation or apoptosis. In vitro exposing synovial
cells to tpO2 levels found in the joint,, resulted in
decreased proliferation, increased cell migration and a
significant relationship with pro-inflammatory
cytokines/chemokines TNF·, IFNg, IL-1b and MIP3a.
Together these results suggest that low tpO2 in the joint
driving inflammation through increased cell migration
and impaired apoptotic pathways. This work was
presented the American College of Rheumatology, San
Francisco, Nov 2008.Currently, Vincent is combining
both MRI and CT/PET imaging to examine the
metabolic turnover in the joint and it’s relationship to
tpO2 levels, angiogenesis and blood flow. Vincent is
also working to identify biomarkers that may predict
response to treatment, specifically A-SAA and cartilage
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neoepitopes. Preliminary data has demonstrated that
high A-SAA levels may predict a bad response to
biologic treatment but also may predict increased risk of
cardiovascular disease.
In parallel, Aisling Kennedy, graduate PhD student, is
examining the effect of hypoxia on the angiopoietins/
Tie2 pathway, blood vessel morphology and cell
stability in the joint. Aisling has demonstrated for the
first time a mixture of mature and immature vessels in
the joint. She has demonstrated low NCAM on vessel
with predominantly focal expression, suggesting that the
endothelial-pericyte cell-cell interactions are not intact.
Vessels in this unstable state are more easily targeted,
which may be due to differential expression of VEGF,
Angiopoeitin 1, 2 and PDGF. We have also demonstrated
strong nuclear expression of 8-oxo-DG on the endothelial
cells, further supporting the hypothesis that vessels in
the joint are unstable. Finally Aisling has demonstrated
and inverse relationship between pO2 levels and both
macroscopic vascularity and microscopic blood vessel
stability and NOTCH expression. These results combine
with Vincent’s, suggest that while there is an increase in
number of BV within the joint the rate of synovial
expansion is faster, resulting in a high metabolic turnover
and an hypoxic environment. An abstract of this work
was chosen for an oral podium presentation at the
American College of Rheumatology, San Francisco,
November 2008, which Aisling presented to a great
response from the scientific community. Currently,
Aisling is examining the effect of anti-TNF therapy on
blood vessel stability and joint hypoxia. She has also
transplanted synovial tissue into SCID mice and is
examining the effects of blocking NOTCH signalling on
vessel survival.
Dr Monika Binecka is examining the role of genomic
instability in the joint and the effect of hypoxia. She has
demonstrated high oxidative damage in the synovial
tissue of patients with low pO2 levels. She has
demonstrated that tpO2 levels inversely correlate with
lipid peroxidation but not DNA damage. She
demonstrated that lip preoxidation but not DNA
damage correlated closely with angiogenic growth factor
expression. Exposing cells to hypoxia demonstrated a
decrease in cell proliferation and an increase in
anaphase bridging. Currently Monika is examining the
effects of tpO2 levels on mitochondrial pathways.
(A) 8-oxo DG nuclear staining
(B) Anaphase bridging
Cytokines, angiogenesis and invasion
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 TNF· and IL-1‚ ?alone and in combination
with novel cytokines and growth factors, including
Oncostatin M (OSM), IL-17, acute serum amyloid A (ASAA), IL-22, GMCSF, TLRs and Angiopoietins is being
examined in the inflammatory process, lead by Dr.
Ursula Fearon and Dr. Douglas Veale
Oncostatin M, IL-17, IL-22
Fig 1: Demonstrates oxidative damage in the
endothelial cells and lining layer in RA synovium
(stained with 8-oxo-dG) (A) and (B) demonstrates
Anaphase Bridging in primary synoviocytes and
chondrocytes
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Ellen Moran, is her final year of her PhD student and is
examining the role of IL-17 on cartilage degradation,
matrix turnover and cell migration. Ellen has previously
demonstrated high levels of IL-17 in the joint and
shown that IL-17 potentiates the effects of OSM and
TNF· on matrix turnover and cartilage degradation. Ellen
has now shown that IL-17 has a profound effect on cell
migration in the joint, possibly mediated through GROalpha and MIP-1. She has demonstrated IL-17 induces
angiogenesis and invasion, all mechanism that
contribute to celklular invasion. To examine more
specifically how IL-17 regulates these events, we have
examined it’s effects on cytoskeletal rearrangement,
which is critical for cell movement and shape. We have
demonstrated IL-17 induces cytoskeletal disassembly
and focal adjhesion contacts, an effect that is reversed
through inhibition of RhoGTPases such as RAc1. She
has also shown that IL-17 regulates the upstream
triggers specifically integrins avb3 and B1. Currently
Ellen is elucidating the specific pathways involved in IL17 induced cytoskeletal dynamics.
Dr. Bernadette Lynch was awarded an HRB clinical PhD
fellowship in July 2008, to examine the role of IL-22 in
the joint. She has demonstrated high levels of IL-22 in
synovial fluid compared to serum, and has demonstrated
that biologic therapy reduces its expression. Using synovial
explant cultures and primary fibroblasts Bernadette has
shown that IL-22 has no effect on regulation of many
cytokines or chemokine but appears to regulate matrix
metabolism. Currently Bernadette is examining the effect
of Il-22 in combination with other cytokines, to assess
it’s potential for adjuvant therapy. Finally, Bernadette has
collected a cohort of RA patients, to assess the
relationship between clinical characteristics and highresolution ultrasound.
Dr. Taj Saber is an MD clinical fellow and is coordinating
the arthroscopy programme and the biologic clinics. Taj
is currently examining the effects of biologic therapy in
the cohort of inflammatory arthritis patients to establish
features, which may predict remission in these patients.
In addition, Taj is engaged in a laboratory project to
assess the effects of cytokines on MMP production,
proteoglycan release and invasion. Furthermore she will
examine the downstream signalling pathways involved,
specifically the JAK-STAT pathway.
synovial explants cultures using proteomics. The
greatest change was in proteins that were involved in
ECM, apoptosis and cytoskeletal proteins. These are
currently being validated. Mary had an oral presentation
at the American College of Rheumatology, San
Francisco, November 2008. Mary has demonstrated
high A-SAA levels in serum and A-SAA induces
disassembly of actin filaments in primary synovial
fibroblast, Fig 2.
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. Mary Connolly has just submitted her thesis
which examines the effect of A-SAA on cell migration
and invasion, cartilage metabolism and the related
transcriptional pathways. Mary has shown A-SAA has a
potent migrational effect within the joint. She has
demonstrated that this is mediated through alterations
in cytoskeletal dynamics. Specifically A-SAA differential
regulates RHO-GTPAses with upregulation of Cdc42
and RAC1, which is paralleled by inhibition of RhoA.
Mary demonstrated that A-SAA significantly increased
migration of GFP tagged monocyte into human synovial
tissue in vivo using a novel human RA synovial
tissue/SCID mouse chimera model. Furthermore she
has demonstrated that this effect is only partially
mediated through increased angiogenesis. The final part
of Mary work was to examine the effects of A-SAA on
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Intact Actin Filaments
Disassembly of actin
cytoskeleton and Induction of
filopodia formation
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. Dr. Wei Gao,
Jennifer Mc Cormick and Dr. Catherine Sweeney. One
of the key questions is ‘what are the key survival
pathways’; we have shown high expression of NOTCH
signalling components in synovial tissue. We have
demonstrated it’s expression on both endothelial and
pericytes, and VEGF and Ang2 regulate shown
NOTCH1C. Possible upstream triggers of these events
include hypoxia, neutropeptides or mechanical forces.
Dr. Sweeney showed that substance P and mechanical
stress upregulated VEGF, ANg2 and NOTCH 1IC.
Inhibition of NOTCH was demonstrated with anti-Tie or
AntiVEGF antibodies. Currently we are carrying out
experiments to examine if NOTCH blockade results in
vessel regression, and will establish if this only involves
immature vessels or are those vessels with pericye
coverage also targeted. Dr. Gao, has demonstrated low
Po2 levels in the joint upreguates HIf1a and NOTCH1IC
in primary cell cultures. Uisng siRNA to NOTCH we have
shown that VEGF and hypoxia directly regulate NOTCH.
Currently we are trying to elucidate the signalling
pathways involved in hypoxia induced NOTCH
expression. Using NO, DMOG, SiRNA and DAPT we will
establish if (i) hypoxia induced NOTCH 1IC is HIF1a
dependent or independent and (ii) establish the
downstream effects of blocking NOTCH1iC, such as
angiogenesis and fibroblast invasion.
188
Fig 3: Dual immunoflourescent staining with Factor VIII
(red) and ·SMA (GREEN). Blood vessel staining red are
immature and those staining for red and green are
mature. This figure shows there is a mixture of
immature and mature vessels in the joint.
and TL4 pathways. She has demonstrated TLR2 agaonist
are more effective in regulating cytokines and matrix
turnover in cells isolated from the joint compared to
blood. She has demonstrated using synovial cells, that
TLR2 regulates NOTCH signalling in the joint, blockade
of which downregaultes the pro-inflammaory response.
Recently Sinead has demonstrated that TLR2 may be a
possible ligand for A-SAA, which we know, is a key
molecule in driving inflammation in the joint. Finally,
using whole tissue synovial explants Sinead, compared
the effects of blocking TLR2 to known biologic agent
Humira (anti-TNF·). She showed that blocking TLR2,
significantly inhibited many pro-inflammatory cytokines
in the joint, and more importantly showed that this effect
was equivalent to that of Humira. Currently Sinead is
will focusing on the interaction between of Notch, ASAA and TLR 2 signalling.
GMCSF and TLRs
Dr. Sinead Nic An Ultaigh has been examining the role
of Toll-Like Receptors (TLRs) in inflammatory arthritis.
TLRs have been implicated in autoimmune diseases,
and TLR expression has been found in joint tissue and
at the sites of invasion into cartilage/bone of patients
with RA and PsA. Using several primary cell cultures
Sinead has shown differential effects of timulating TL2
Jennifer McCormick and Owen O’Sullivan are an integral
part of the team and are is involved in a number of
projects in the group. We have developed a number of
partnerships with the drug discovery and translational
teams within industry led by Prof Veale. Jenny, Ursula,
Owen and Sinead carry out these studies using synovial
explant cultures, MSD multiplex assays and
transcriptomics to establish pre-clinical and ‘proof of
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concept’ drug development studies of novel bio
therapeutics and small molecular weight candidates.
Currently, we are examining the therapeutic potential of
four new drugs.
Psoriatic Arthritis Blood Vessel Morphology
Aisling Kennedy is also examining the mechanism
involved in the differential blood vessel morphology
observed in PsA. Consistent with previous studies, she
has shown vessels in patients with PsA are tortuous,
elongated and dilated. We have shown this is associated
with increased tpO2 levels and an increased pericyte
coverage. However, we have shown differential expression
of growth factors and NCAM suggesting that vessels are
very dysfunctional. At a microscopic level it is difficult to
examine the close alignment of the endothelial cells
and pericyte, therefore currently Aisling is using
transmission electron microscopy to examine blood
vessel stability, activation and endothelial cell - pericyte
interactions, parameters such as (i) compactness, (ii)
pinocytic vesicles, (iii) basal lamina, (iv) junctional
complexes, (v) anchoring filaments, (vi) endothelial
cytoplasmic and nuclear shape will be assessed.
Vascularity and blood vessel stability as determined by
TEM will be correlated with both macroscopic and
microscopic assessments. tpO2 levels and blood vessel
pattern stability will also be determined.
189
Biomarkers of Biologic Treatment Response: Finally,
Psoriasis/Psoriatic Arthritis
funded by Abbott, Dr. Emily Collins, supervised by Prof.
Oliver FitzGerald and Dr. Ursula Fearon, is examining
proteomic profiles in PsA patients’ pre/post biologic
therapy with Prof Steve Pennington, Conway, UCD. We
are aiming to identify molecular biomarkers, which
predict response to anti-TNF· therapy, which are present
in the synovium at an early stage of treatment. Prof
FitzGerald and Dr. Fearon in collaboration with the P.P.
Tak group in Amsterdam, and S. Pennington and M.
Dunn of the Proteome Research Centre, UCD. Synovial
tissue has been obtained via arthroscopy at baseline
and 1 month from a cohort of patients, half of whom
were receiving Adalimumab and half placebo injections,
before beginning Adalimumab after 1 month. We are
using proteomics technology (2D- DIGE and mass
spectrometry) to analyse the proteome of these
synovial tissue samples and identify differentially
expressed proteins and potential biomarkers. These
potential biomarkers will then be validated using various
molecular biology methods. A pilot study on a smaller
cohort has allowed us to optimise the experimental
methodology and identify several interesting proteins.
There are 4 main areas of interest within Ps/PsA:
(i) Genetics:
In collaboration with Professor Robert Winchester at
the University of Columbia in New York, blood
samples have been obtained and DNA analysed in
a cohort of 400 probands with PsA as well as more
than 200 patients with psoriasis alone and 150
normal controlled subjects. The focus has been on
a detailed molecular genotyping of the HLA-B and C loci using sequence based typing. Detailed
analysis is ongoing but results suggest that PsA is
not genetically a simple subset of psoriasis. HLACw*0602 is present in 62% of patients with
psoriasis alone and in only 27.9% of patients with
PsA.
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In collaboration with the newly established GRIPPsA
Consortium, which is an Irish based consortium,
DNA from a large number of patients with psoriasis
and with PsA have been collected. Approximately
500 of these samples have been contributed to the
initial cohort of patients who were undergoing
genome-wide association studies funded by
Welcome. This work is being undertaken locally in
collaboration with Dr. Brian Kirby and with the
assistance of Anne-Marie Tobin, Dr. Aizad Mumtaz
and Ms. Phil Gallagher.
(ii) Biomarks of Biologic Treatment Response:
As part of investigator-originated, single-arm
protocols looking at mechanisms of effect of
biologic therapies, synovial membrane samples
have been analysed for tissue markers of treatment
response to biologic therapies. Comparisons of
immunohistochemical changes with clinical changes
have identified change in CD3-positive T-cells as
correlating significantly with change in clinical
scores. In addition, a semi-quantitative score of MRI
scans undertaken in collaboration with Dr. Robin
Gibney have also correlated significantly with a
change in CD3 synovial tissue counts. In
collaboration with Professor Patrick Brennan’s group
from imaging in UCD, a more quantitative measure
of synovitis is being developed.
(iii) Proteomics Studies in Collaboration with Professor
Stephen Pennington and Professor Mike Dunn from
the Proteomic Department at Conway Institute:
Dr. Emily Collins has been trying to identify synovial
biomarkers of treatment response to empty TNF
therapy in patients with PsA. A number of proteins
have been identified, which significantly associate
with clinical response and in addition a number of
proteins have been identified which appear to
predict a response at baseline. These studies are
funded by Abbott Pharmaceuticals and validation of
proteins identified is currently underway. For
glycosylation changes in inflammatory arthritis
patients pre and post anti-TNF therapy. In
collaboration with Professor Pauline Rudd’s group
from the Conway Institute and with Dr. John Axford
from St. George’s Hospital in London, Dr. Emily
Collins is studying immunoglobulin glycosylation
changes, which occur in patients with inflammatory
arthritis and also the effect of anti-TNF therapies on
such changes in a cohort of 65 patients,
glycosylation profiles return towards normal as
disease activity improves following treatment
initiation.
(iv) Pharma Co Economics of Biologic Therapies in
Patients with Inflammatory Arthritis:
In collaboration with Dr. Michael Barry from the
National Centre of Pharma Co Economics at St.
James’s Hospital, Ms. Roisin Adams is examining
the Pharma Co Economic impact of anti-TNF
therapies in patients with inflammatory arthritis.
These studies are utilising data being collected on a
large cohort of inflammatory arthritis patients
currently being followed on anti-TNF therapy.
Student Awards and Oral Presentations
Thesis Submissions
Mary Connolly; SIAR Award (Oral Presentation) American College of Rheumatolog, San Francisco,08
M. Connolly1, J. McCormick1, A. Marelli2, M. Blades2, O.
FitzGerald1, B. Bresnihan1, C. Pitzalis2, D. Veale1, U. Fearon1
A-SAA Induces Rho GTPase-dependent Cytoskeletal
Rearrangement and In Vivo Migration of Fluorochrome
Labelled Monocytic (u937) Cells in A Human RA/SCID
Mice Chimera Model
Mary Connolly submitted her PhD thesis (UCD)
examining the role of A-SAA on cell migration,
cytoskeletal dynamics and invasion in the pathogenesis
of inflammatory arthritis, under the supervision of Dr.
Ursula Fearon and Prof Douglas Veale
Aisling Kennedy; (Oral Presentation) - American
College of Rheumatology, San Francisco, 2008
Aisling Kennedy, Monika Biniecka, Chin Teck Ng,
Jacintha N. O'Sullivan, Ursula Fearon, Douglas J. Veale
Oxidative Damage in the Arthritic Joint leads to an
Unstable Environment and Stimulates Abnormal
Angiogenesis in Synovial Tissue
Committees and Invited Talks
• Co-Chairman, EULAR Synovitis Study Group
• Co-Chairman, OMERACT Synovial Tissue Analysis
Study Group
• Italian Society of Rheumatology, Catania
• Royal Society of Medicine, London, June
• Chairman scientific session, EULAR, June
Ellen Moran ; Travel Award
Ellen M. Moran, Ronan Mullan, Jennifer McCormick,
Oliver FitzGerald, Barry Bresnihan, Douglas J. Veale,
Ursula Fearon.
IL-17A Expression Is Modulated by Biologic Therapy
and Drives Inflammatory Cell Migration In The Human
RA Joint
• British Bone Society, Aberdeen, July
Prof Douglas Veale
• Appointed Director of Translational Research, Dublin
• Medical Director, Education & Research Centre, SVUH
• Director of THERAPI - Translational Research Group
190
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Prof Douglas Veale continued
• Vice-president, International Scleroderma Clinical
Trials Consortium
• Steering committee member for GRAPPA (Group
for Research and Assessment of Psoriasis and
Psoriatic Arthritis)
• Strategic Scientific Committee, Arthritis Research
Campaign, UK
• Member of Abbott International Immunology
Advisory Board
• HRB Infection & Immunity Grant Committee
• Lead Consultant Bone & Joint Unit, SVUH
• Irish Medicines Board, Medicines Committee
• Steering committee member of OMERACT
Biomarkers Group
• Wyeth Translational Science European Expert Group
• Schering-Plough International Advisory Panel
• Centocor International Advisory Panel
• Co-Chair RCPI Masterclass in Rheumatology
• Progress and Promise, Madrid
• Director of the Clinical Skills Laboratory at UCD
• Co-ordinator of the Advanced Clinical Skills module
for the Graduate Entry Medicine program
• Co-ordinator for the Elective module for undergraduate and graduate entry medical students.
• Chairman, Arthritis Ireland (Oct-present)
• Member of HSE working group on Arthritis and
Allied conditions representing the Irish Society of
Rheumatology
191
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• Scientific committee member 3e Initiative in
Rheumatology
• Rochester University, Visiting Speaker
• Progress and Promise, Munich
A Novel Role for the HDL Receptor, CLA-1 in Synovial
Inflammation via Serum Amyloid-A and Apolipoprotein
A-1. Mullan Ronan, Mc Cormick Jennifer, Connolly Mary,
Bresnihan Barry, *Veale Douglas James , *Fearon Ursula.
In Press Am J Pathol
Synovial tissue sublining CD68 expression as a biomarker
of therapeutic response in rheumatoid arthritis clinical
trials: consistency across centers.
Barry Bresnihan, Eliza Pontifex, Rogier Thurlings, Marjolein
Vinkenoog, Hani el Gabalawi, Ursula Fearon, Oliver
Fitzgerald, Danielle Gerlag, Terence Rooney, Marleen
van de Sande, Douglas Veale, Koen Vos, PP Tak In press
• Ulster Internal Medicine Association, Belfast
Publications
Adherence to medications in systemic lupus
erythematosus.
Koneru S, Kocharla L, Higgins GC, Ware A, Passo MH,
Farhey YD, Mongey AB, Graham TB, Houk JL, Brunner
HI. J Clin Rheumatol. 2008 Aug;14(4):195-201
Drug insight: autoimmune effects of medicationswhat's new?
Mongey AB, Hess EV; Medscape. Nat Clin Pract
Rheumatol. 2008 Mar;4(3):136-44. Review
Hypoxia activates NF-κB-dependent gene expression
through the canonical signaling pathway.
Kathryn M. Oliver, John F. Garvey, Eoin P. Cummins,
Douglas J. Veale, Ursula Fearon, Cormac T. Taylor.
In Press
Walsh CAE, Fearon U, FitzGerald O, Veale DJ, Bresnihan B.
Decreased CD20 Expression in Rheumatoid Arthritis
Synovium Following 8 Weeks of Rituximab Therapy.
Clin Exp Rheumatol. 2008 Jul-Aug;26(4):656-8
Dr. Ursula Fearon
• Senior Scientist Rheumatology
• Chairperson Scientific Sesssion of The American
College of Rheumatology, San Francisco,
November 2008
Updated consensus statement on biological agents for
the treatment of rheumatic diseases, 2008.
Kalden JR, Burmester GR, Braun J, Emery P, Winthrop K,
Bresnihan B, De Benedetti F, Dörner T, Gibofsky A,
Schiff MH, Sieper J, Singer N, Van Riel PL, Weinblatt ME,
Weisman MH.
Ann Rheum Dis. 2008 Dec;67 Suppl 3:iii2-25
Melanoma Inhibitory Activity, a biomarker related to
chondrocyte anabolism, is reversibly suppressed by
proinflammatory cytokines in rheumatoid arthritis.
Verdonk PC, Tak PP, Boots AH, Baeten D
Rheumatoid arthritis: a novel radiographic projection
for hand assessment.
Pearman L, Last J, Fitzgerald O, Veale D, Joyce M,
Rainford L, McEntee M, McNulty J, Thomas E, Ryan J,
McGee A, Toomey D'Helft R, Lowe J, Brennan PC
Successful pregnancy after rituximab in a women with
recurrent in vitro fertilisation failure and antiphospholipid antibody positive.Ng CT, O'Neil M, Walsh
D, Walsh T, Veale DJ. Ir J Med Sci 2008; Nov 29
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Biomarkers in systemic sclerosis. Doran JP, Veale DJ.
Rheumatology 2008;47: Suppl 5:v36-8
Photochemotherapy for localized morphoea: effect on
clinical and molecular markers.
Clin Exp Dermatol. 2008 Nov;33(6):698-704.
multicenter treatment trial. Merkel PA, Silliman NP,
Denton CP, Furst DE, Khanna D, Emery P, Hsu VM,
Streisand JB, Polisson RP, Akesson A, Coppock J, van
den Hoogen F, Herrick A, Mayes MD, Veale D, Seibold
JR, Black CM, Korn JH; CAT-192 Research Group;
Scleroderma Clinical Trials Consortium.Arthritis Rheum.
2008 May 15;59(5):699-705.
The development of the L-QoL: a quality-of-life
instrument specific to systemic lupus erythematosus.
Doward LC, McKenna SP, Whalley D, Tennant A, Griffiths
B, Emery P, Veale DJ.
Ann Rheum Dis. 2009 Feb;68(2):196-200.
Biological biomarkers in psoriatic disease. A review.
de Vlam K, Gottlieb AB, Fitzgerald O.
Clues to the pathogenesis of psoriasis and psoriatic
arthritis from imaging: a literature review.
Coates LC, Anderson RR, Fitzgerald O, Gottlieb AB, Kelly
SG, Lubrano E, McGonagle DG, Olivieri I, Ritchlin CT,
Tan AL, De Vlam K, Helliwell PS.
Breast cancer and systemic sclerosis: a clinical description
of 21 patients in a population-based cohort study.
Lu TY, Hill CL, Pontifex EK, Roberts-Thomson PJ.
Rheumatol Int. 2008 Jul; 28(9):895-9
Musculoskeletal Disorders. Eliza Pontifex and Barry
Bresnihan. "Palliative Medicine." Elsevier publishers,
USA. 2008, p1033-1038
2008 was another busy year for the Rehabilitation
Medicine Department. The number of referrals
continues to increase and outpatient activity continues
to rise. 119 new referrals were received in 2008 an
increase of over 100% from 2007 and 161 patients
were seen in outpatients, 57 of which were new
patient assessments. Unfortunately this has resulted in
an increased waiting time for new patient outpatient
assessment and the Rehabilitation Medicine Department
look forward to working with hospital management to
try and resolve this issue.
The Rehabilitation Medicine Department welcomed Dr
Andrew Hanrahan to SVUH in early July 2008 as locum
for Dr Nicola Ryall. He completed his Rehabilitation
Medicine training in the Oxford Deanery, UK in March
2008 and has been very actively involved in Hospital
activities since he joined us.
Staff within the Department
Consultant in Rehabilitation Medicine
Dr. Nicola Ryall, FRCPI,
Dr. Andrew Hanrahan,
(current Locum, Consultant in Rehabilitation Medicine)
Strategic Developments
Undergraduate and Postgraduate Education
Rehabilitation Medicine Department Consultants have
been very involved in Strategic developments in 2008.
Dr. Áine Carroll is currently on a Working Group for the
development of a National Strategy for Rehabilitation, the
results of which should be published later this year and
she is also one of 3 Irish Association of Rehabilitation
Medicine (IARM) representatives on the Irish Heart
Foundation Council on Stroke. She is also the current
President of the IARM.
All Rehabilitation Medicine Department Consultants
have been busy with teaching the UCD 3rd year medical
students and we welcomed Damian Townsend, a final
year medical student from Australia in the summer.
Dr. Andrew Hanrahan was also involved in a subgroup
looking at Prosthetic, Orthotic and Limb absence
Rehabilitation.
Dr. Ryall and Dr. Carroll are now Senior Clinical Lecturers
for UCD and participate in the final Medical
Examinations in SVUH.
All Consultants continue to be actively involved in
specialist registrar supervision, NCHD teaching
programmes and medical student teaching and
assessments.
Consultant in Rehabilitation Medicine
Dr. Áine Carroll, MD, FRCPI,
Specialist Registrar in Rehabilitation Medicine
Dr. Jackie Stow,
Clinical Governance
The Rehabilitation Medicine Department was active in
Clinical Governance in 2008. Dr. Carroll carried out a
review of all referrals to the department and the results
are soon to be published in the Irish Medical Journal.
193
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The National Rehabilitation Hospital New Hospital
Project continued to progress and in December, a
representative group from the Hospital Board, including
Dr. Carroll, met with the Minister for Health and
Children to advise the Minister on the importance of
the project for the welfare of the people we serve.
Dr. Hanrahan has been the Consultant lead on a Falls
Prevention and Management Strategy for the NRH in
the light of the recently published Draft Guidelines to the
HSE by the Dublin Hospitals Group Risk Management
Forum in March 2009.
Dr Hanrahan has presented two Medical Grand rounds
at St Vincent’s University Hospital on the Permanent
Vegetative States and Complex Neuro-rehabilitation in
Wilson’s disease.
Dr. Áine Carroll presented on “The Multidisciplinary
management of Spasticity”, Care of the Elderly Study
Day, St. Vincent’s University Hospital, Dublin in February
and on “Rehabilitation and Parkinson’s Disease”
Parkinson’s Patient Information Update in April.
Dr. Carroll also worked with Dr. Eimear Smith and Dr.
Mei in Soon respectively on “Prevalence of low bone
mineral density in patients at a national rehabilitation
centre” Society for Research in Rehabilitation, Oxford,
Platform presentation in May 2008 and “Cerebral
Venous Thrombosis” Spring meeting of the Association
of British Neurologists, Dublin. Poster Presentation
Dr. Smith also presented “A study of bone mineral
density in disabled adults at a national rehabilitation
hospital” at the European Congress of Physical
Medicine & Rehabilitation, Brugge.
Dr. Mei Ming Soon presented a poster on “Cerebral
Venous Thrombosis” at the Irish Association of
Rehabilitation Medicine in Belfast in October.
Congratulations to Dr. Éimear Smith who’s platform
presentation “A study of bone mineral density in
disabled adults at a national rehabilitation hospital”
won 1st Prize at the Irish Association of Rehabilitation
Medicine, Belfast.
Publications
Dr. Carroll: Carroll Á. Book Chapter:
The use of Botulinum Toxin in Neck and Back Pain. In:
The Clinical Use of Botulinum Toxins. Editors:
Michael P Barnes MD FRCP & Anthony B Ward BSc MB
ChB FRCP (Lon) FRCP (Ed):
Publishers: Cambridge University Press. 2008
E. Smith, A Carroll.
Bone Mineral Density in patients with disabilities due
to acquired non-traumatic brain injury.
Abstract Published Clinical Rehabilitation. 2008;22:86-94
Mei Min Soon, Aine Carroll
Cerebral venous thrombosis presenting as a
complication of inflammatory bowel disease
Ir J Med Sci. 2008 Jul 16
E. Smith, A Carroll.
Prevalence of low bone mineral density in patients at a
National Rehabilitation Hospital
Clin Rehabil 2008 22;9:859
Carroll A, Barnes M, Comiskey C.
A prospective randomized controlled study of the role
of botulinum toxin in whiplash-associated disorder.
Clin Rehabil. 2008 Jun;22(6):513-9.
194
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Reports from Surgery
195
Report from the Professor of Surgery
Surgical Professorial Unit
Staff
196
Head of Subject:
Professor P. Ronan O’Connell
University Senior Lecturer:
Mr Enda W McDermott
Clinical Associate Professor:
Professor Des Winter
Clinical Senior Lecturer:
Mr John Hyland
Adjunct Professor:
Professor M Joe Duffy
Special Lecturers:
Mr Farrukh Naseem
Mr Cormac Joyce
Ms Niamh Bambury
Senior Research Associate:
Dr Neil Docherty
Research Fellows:
Dr Colin Pierce;
Dr Michael Cunningham
Dr Fiachra Rowan
Dr Siun Walsh
Dr Aisling Hogan
Dr Rory Kennelly
Ms. Karen Griffin
Ms Maria Buffini
Senior Laboratory Technician:
Mr Dermot Carty
Clinical Research Nurse:
Ms Helen Vaughan
Executive Assistants:
Mrs Patricia O’Shea
Ms. Aine Begley
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The Surgical Professorial Unit at St Vincent’s University
Hospital is responsible for undergraduate teaching of
surgery to students from University College Dublin, coordination of post-graduate learning and supervision of
post-graduate research.
Dr Aisling Hogan won the prize for best paper
presented at the European Society for Surgical Research
in Warsaw in May 2008. Dr Michael Cunningham
presented at the Patey Prize session of the Society of
Academic and Research Surgery.
Professor P. Ronan O’Connell was appointed Head of
the Section of Surgery and Surgical Specialties at UCD.
With his appointment in 2007, the clinical interests of
the Surgical Professorial Unit have been reconfigured
to reflect his clinical interest in colorectal surgery while
maintaining the Unit’s well established interest in breast
and endocrine surgery under the academic leadership
of Mr Enda McDermott, Senior Lecturer. In March 2008,
Professor Des Winter and Mr John Hyland were
recognized by the University by conferment of the title
Clinical Associate Professor and Clinical Senior Lecturer
respectively.
The Final Medical Year students of 2008 did
spectacularly well in their Final Surgical Examination.
The following prizes in Surgery were awarded in 2008
– The O’Farrell Gold Medal in Surgery - Dr. Emily
Stenke, McArdle Prize in Surgery – Dr. Rebecca Fry, and
Tobin Prize in Surgery – Ms. Aoife McKeating.
During 2008 the Surgical Professorial Unit moved to
purpose built accommodation in a link corridor off St
Luke’s Ward on the second floor. The new unit provides
office, administration and teaching accommodation
immediately adjacent to the general surgical wards.
Research from the Surgical Professorial Unit has been
recognised by several national and international awards
in 2008. Dr Rory Kennelly won the Sylvester O'Halloran
prize at the University of Limerick in March 2008 while
Professor O’Connell was invited to speak at several
national and international meetings. The highlights for
2008 were lectures at the Malaysian Colorectal
Conference, the American Society of Colon and Rectal
Surgeons Annual Meeting and the Association of
Coloproctology of Great Britain and Ireland Annual
Meeting.
2008 was a productive year in terms of publications.
Representative articles are listed below. In addition
numerous presentations were made at national and
international scientific meetings.
Books Edited
1. EUROPEAN MANUAL OF COLOPROCTOLOGY,
Herold A, Matzel K, Lehur PA, O’Connell PR eds.
Springer, Frankfurt
2. BAILEY and LOVE’S SHORT PRACTICE OF SURGERY
(25th Edition) Bulstrode C, O’Connell PR, Williams
NS eds. Arnold, London
Book Chapters
1. O’Connell PR
ANAL CANCER in Herold A, Matzel K, Lehur PA,
O’Connell PR eds, EUROPEAN MANUAL OF
COLOPROCTOLOGY, Springer, Frankfurt pp 219224
2. Shields C, O’Connell PR
ELECTROCAUTERY in Trimbos JB, Trimbos-Kemper
TC eds. BASICS OF SURGERY:tools, techniques,
attitude and expertise. 2007 Elsevier, Maarssen,
pp67-77
3. Joyce M, O’ Connell PR
ANO-RECTAL STENOSIS: in Clavien JC, Mortensen
NMcC eds ANORECTAL SURGERY, A PRACTICAL
GUIDE TO MANAGEMENT. Springer, Frankfurt (in
press)
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1. Mahoney RT, Behan M, Daly L, O’Herlihy C,
O’Connell PR
EFFECT OF SECOND VAGINAL DELIVERY ON ANAL
FUNCTION IN PATIENTS AT RISK OF OCCULT
ANAL SPHINCTER INJURY FOLLOWING FIRST
FORCEPS DELIVERY
Dis Colon Rectum 2008; 51:1361-6.
2. Healy CF, McMorrow C, O’Herlihy C, O’Connell PR,
Jones JF
EXTERNAL ANAL SPHINCTER FATIGUE IS NOT
IMPROVED BY N-ACETYLCYSTEINE IN AN ANIMAL
MODEL
Neurogastroenterol Motility 2008; 20: 719-24.
3. Burke JP, Ferrante M, Dejaegher K, Watson RWG,
Docherty NG, De Hertogh G, Vermeire S,
Rutgeerts P, D'Hoore A, Penninckx F, Geboes K, Van
Assche G, O’Connell PR .
TRANSCRIPTOMIC ANALYSIS OF INTESTINAL
FIBROSIS ASSOCIATED GENE EXPRESSION IN
RESPONSE TO MEDICAL THERAPY IN CROHN’S
DISEASE. Inflam Bowel Dis 2008;14:1197-204
4. Healy CF, O’Herlihy C, O’Brien C, O’Connell PR,
Jones JF
EXPERIMENTAL MODELS OF NEUROPATHIC FECAL
INCONTINENCE: An Animal Model of Childbirth
Injury to the Pudendal Nerve and External Anal
Sphincter Dis Colon Rectum 2008;51(11):161926; discussion 1626
5. O'Riordan JM, Healy CF, McLoughlin D, Cassidy M,
Brannigan AE, O'Connell PR.
SACRAL NERVE STIMULATION FOR FAECAL
INCONTINENCE. Ir J Med Sci. 2008; 177: 117-9
6. Beddy D, Hyland JM, Winter DC, Lim C, White A,
Moriarty M, Armstrong J, Fennelly D, Gibbons D,
Sheahan K. A SIMPLIFIED TUMOR REGRESSION
GRADE CORRELATES WITH SURVIVAL IN LOCALLY
ADVANCED RECTAL CARCINOMA TREATED WITH
NEOADJUVANT CHEMORADIOTHERAPY. Annals of
Surgical Oncology 2008;15(12): 3471-3477.
7.
Collins D, Winter DC. ELECTIVE RESECTION FOR
DIVERTICULAR DISEASE: AN EVIDENCE-BASED
REVIEW. World Journal of Surgery 2008;32(11):
2429-2433.
8. Hogan AM, McCormack O, Traynor O, Winter DC.
POTENTIAL IMPACT OF TEXT MESSAGE
REMINDERS ON NON-ATTENDANCE AT
OUTPATIENT CLINICS. Irish Journal of Medical
Science 2008;177(4): 355-358.
9. Hogan AM, Winter DC. DOES PRACTICE MAKE PER
FECT? Annals of Surgical Oncology 2008;15(5):
1267-1270.
10. Hogan BA, Winter DC, Broe D, Broe P, Lee MJ.
PROSPECTIVE TRIAL COMPARING CONTRAST
SWALLOW, COMPUTED TOMOGRAPHY AND
ENDOSCOPY TO IDENTIFY ANASTOMOTIC LEAK
FOLLOWING OESOPHAGOGASTRIC SURGERY.
Surgical Endoscopy 2008;22(3): 767-771.
11. Kennelly R, Kavanagh DO, Hogan AM, Winter DC.
OESTROGEN AND THE COLON: POTENTIAL
MECHANISMS FOR CANCER PREVENTION. Lancet
Oncology 2008;9(4): 385-391.
12.
198
Myers E, Hurley M, O'Sullivan GC, Kavanagh D,
Wilson I, Winter DC. LAPAROSCOPIC PERITONEAL
LAVAGE FOR GENERALIZED PERITONITIS DUE TO
PERFORATED DIVERTICULITIS. British Journal of
Surgery 2008;95(1): 97-101.
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13. Coss A, Tosetto M, Fox EJ, Sapetto-Rebow B,
Gorman S, Kennedy BN, Lloyd AT, Hyland JM,
O'Donoghue DP, Sheahan K, Leahy DT, Mulcahy
HE, O'Sullivan JN. INCREASED TOPOISOMERASE
IIALPHA EXPRESSION IN COLORECTAL CANCER IS
ASSOCIATED WITH ADVANCED DISEASE AND
CHEMOTHERAPEUTIC RESISTANCE VIA INHIBITION
OF APOPTOSIS. Cancer Letters 2009;276(2): 228238.
14. Sheridan J, Wang LM, Tosetto M, Sheahan K, Hyland
J, Fennelly D, O'Donoghue D, Mulcahy H, O'Sullivan
J. NUCLEAR OXIDATIVE DAMAGE CORRELATES
WITH POOR SURVIVAL IN COLORECTAL CANCER.
British Journal of Cancer 2008;100(2): 381-388.
15. Wang LM, McNally M, Hyland J, Sheahan K.
ASSESSING INTERSTITIAL CELLS OF CAJAL IN
SLOW TRANSIT CONSTIPATION USING CD117 IS A
USEFUL DIAGNOSTIC TEST. American Journal of
Surgical Pathology 2008;32(7): 980-985.
16. Dillon MF, Maguire AA, McDermott EW, Myers C,
Hill AD, O'Doherty A, Quinn CM. NEEDLE CORE
BIOPSY CHARACTERISTICS IDENTIFY PATIENTS AT
RISK OF COMPROMISED MARGINS IN BREAST
CONSERVATION SURGERY. Mod Pathol
2008;21(1): 39-45.
17. Dillon MF, Stafford AT, Kelly G, Redmond AM,
McIlroy M, Crotty TB, McDermott E, Hill AD, Young
LS. CYCLOOXYGENASE-2 PREDICTS ADVERSE
EFFECTS OF TAMOXIFEN: A POSSIBLE MECHANISM
OF ROLE FOR NUCLEAR HER2 IN BREAST CANCER
PATIENTS. Endocrine-Related Cancer 2008;15(3):
745-753.
18. McGowan PM, McKiernan E, Bolster F, Ryan BM,
Hill AD, McDermott EW, Evoy D, O'Higgins N,
Crown J, Duffy MJ. ADAM-17 PREDICTS ADVERSE
OUTCOME IN PATIENTS WITH BREAST CANCER.
Ann Oncol 2008;19(6): 1075-1081.
19. McKiernan E, O'Brien K, Grebenchtchikov N, GeurtsMoespot A, Sieuwerts AM, Martens JW, Magdolen V,
Evoy D, McDermott E, Crown J, Sweep FC, Duffy
MJ. PROTEIN KINASE CDELTA EXPRESSION IN
BREAST CANCER AS MEASURED BY REAL-TIME
PCR, WESTERN BLOTTING AND ELISA. British
Journal of Cancer 2008;99(10): 1644-1650.
Reports from the Chairman of the Surgical Subgroup
Chairman of Surgical Subgroup
Mr Sean Dudeney
Secretary to the Surgical Subgroup
Mr Denis Evoy, Hon
2008 was another productive year for the surgical
division. Much of the focus of the year was around
preparation for the subsequent move of much of our
activity to the new theatre block. A truly huge amount
of time and effort has been spent by numerous parties,
both medical and logistics, in fact over many years. We
are indebted to all concerned.
Our vision remains the provision of excellent healthcare
to our patient population. The restructuring of cancer
services in Ireland has led to St Vincent’s being asigned
as one of the future “Centres of Excellence” for certain
cancer subtypes. We look forward to these developments
and to the associated resources which will go towards
making these aspirations a reality. As cancer services
develop we have been careful to focus also on ongoing
development in other surgical services not directly
involved in the treatment of malignant disease.
largely predicatable teething problems the move has
gone well. Four of the original theatres continue to run.
The final plan of four further operating rooms attached
to the new theatre complex remains. Unfortunately the
period of “WonderBra” economics is over and the
current financial reality precludes construction of these
theatres in the immediate future. St Vincent’s still
remains in the unique situation however of having an
abundance of potential operating space. This places us
in a favourable position to be able to provide additional
services with appropriate funding, at a time when the
delivery of cancer services are being restructured.
The development of productive collaboration continues
between St Vincent’s University Hospital Campus and
The Mater Hospital to further consolidate the U.C.D.
Dublin Academic Health Centre.
The building of the new Bed Block remains an
important part of the development plan.
The construction of the new St Vincent’s Private
Hospital building is progressing well
New Developments
After a long period of planning and preparation a
significant subset of surgical practice has moved to the
new operating theatres. With the exception of some
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Retirements
2008 saw the retirement of Mr David Luke, Consultant
Cardio-thoracic surgeon and Dr John Murphy, Consultant
Gynaecologist. After many years of distinguished service
they will be greatly missed. We have been lucky to
have such great colleagues and wish them all the best
for the future.
Resignations
Ms Margaret O’Donnell, Consultant Plastic Surgeon
resigned from St Vincent’s University Hospital in 2008
to enable her to spend more time on her family
commitments. She has provided many years of service
to patients and been an excellent colleague.
Appointments
There were no consultant surgical appointments in the
year 2008.
Research and Teaching
The undergraduate teaching program underwent
significant development this year. Many groups within
the surgical division have had a productive year from a
research perspective. Teaching, Post-graduate training
and Research remain areas of ever greater concern as
we look forward to a period of greater financial
constraint.
National Liver Transplant Programme and Liver Unit
During 2008, a total of 58 liver transplants were
performed for 53 patients at St Vincent’s University
Hospital. There were 48 elective transplants for patients
with end-stage liver failure, 4 emergency transplants for
patients with acute liver failure and 6 retransplants for
patients with recurrent liver problems. A total of 577
transplants have now been performed for just under
500 patients since the programme began in January
1993. The success rate remains excellent with an 86%
one year survival. This figure is very much in keeping
with the best results obtained in large liver transplant
units around the world.
A total of 23 patients were admitted to St Brigid’s Ward
with acute liver failure during 2008. Of these, 18 were
associated with Paracetamol toxicity. Four patients with
acute liver failure required liver transplantation; a further
15 patients recovered without the need for liver
transplantation; and 4 patients died from complications
of acute liver failure.
Organ donation continues to be good in Ireland. A total
of 75 livers were donated in Ireland during 2008.
Ireland continues to have a very strong organ donation
rate compared to most other European countries. The
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organ donation rate in Ireland is 22 per million
population per annum. This compares favourably with
the organ donation rate in the United Kingdom (13 per
million per annum) but still falls short of organ donation
rates in some European countries (e.g. Spain, 36 per
million per annum).
The workload in the Liver Unit continues to increase
each year and there are an increasing number of
patients being referred with hepatobiliary and pancreatic
problems which do not necessarily require liver
transplantation. This has placed a significant burden on
the resources available in St Brigid’s Ward and there is a
need for an expansion in the bed pool for the liver
programme. In particular, there has been a very marked
increase in the number of patients being referred for
assessment and management of primary liver tumours
(hepatocellular carcinoma and cholangiocarcinoma).
These patients are resource intensive, requiring
significant input from surgery, medical hepatology,
medical oncology, interventional radiology, and
radiotherapy.
Staff
Consultants:
St James Ward:
Ophthalmic Theatre:
The Tables below summarise the department’s activity
for the year 2008.
Mr P Barry,
Mr W Power,
Mr N Horgan
Sandra Murphy CNM2
Esther McCarthy CNM1
Ms Annette Cullen CNM2
Medical Research Ophthalmologist:
The department of ophthalmology continues to be
extremely busy with day care attendances exceeding
2,000 for the first time. The majority of these attend
for serial glaucoma monitoring and assessment and
laser treatment for diabetic retinopathy and age related
macular degeneration.
The hospital approved the use of intravitreal Lucentis
for exudative macular degeneration and 150 intravitreal
injections were administered in the first year.
Dr Aideen Hogan
Surgical Registrars:
Medical Registrar:
Dr Princeton Lee
Mr Qasiem Nasser
Dr Shwan Kadare
Orthoptist:
Vacant Post
Unit Secretary:
Ms Jane Caulfield
Ophthalmology
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The department continues to provide services for St.
Vincent’s Private Hospital and the Eye and Ear Hospital
on a reciprocal basis. The senior nurses, Sandra
Murphy and Esther McCarthy continue to provide
superb nursing care and encourage it in their more
junior colleagues.
Other Specialities
Total
ELECTIVE
339
71
410
VIA A & E
0
175
175
OTHER URGENT
3
8
11
TRANSFERS (from other wards)
2
32
34
TRANSFERS (from other hospitals)
0
4
4
344
286
634
TOTAL
201
A & E ( Emergency) attendances in the ward and inpatient consultation referrals continue to expand and,
like everyone else, we need more space.
St. James’ Ward Inpatient Admissions 2008 (including transfers)
Dr Magdy Nasralla
Lecturer in Ophthalmology: Dr Ruaidhri Kirwan
We continue to try to move cataract surgery to day care
which is difficult given the patients’ co-morbidities but it
does maximise the utilisation of hospital beds.
The department continues to participate in the Pan
European Audit of cataract surgery for benchmarking
purposes.
OPHTHALMOLOGY: ST. JAMES WARD
2001
2002
2003
2004
2005
2006
2007
2008
In-patients
Dr. Aideen Hogan continues as medical research
ophthalmologist and Mr. Qasiem Nasser is our current
surgical registrar partnered by Dr. Magdi Nasralla as our
medical registrar. Dr. Shwan Kadare as lecturer looks
after the students.
Ms. Jane Caulfield continues to provide an astonishing
secretarial role.
Mr. William Power continues as Chairman of the
Medical Board of the Royal Victoria Eye and Ear
Hospital and Mr. Peter Barry was awarded the first
Eustace Med. Lecturer of the Royal Academy of
Medicine in Ireland.
We welcome Mr. Noel Horgan as the replacement
consultant for Dr. Geraldine Kelly. His particular interest
in ocular oncology will be a major addition to the
hospital’s services.
In-patients
Day Care
Ophthalmology
Admissions
Ophthalmology Discharges
461
458
458
442
365
366
344
285
457
456
451
434
363
362
344
285
Cataract Procedures
Cataract Procedures
330
–
324
–
310
–
299
–
300
–
331
–
321
–
256
29
Admissions
Discharges
Total Attendances
1611
1611
607
1846
1846
502
1994
1994
927
1729
1729
777
1647
1647
973
1536
1536
282
1649
1649
0
2083
2083
0
Total Attendances
1153
1261
1016
1064
1157
1204
1333
1212
299
309
327
342
312
334
345
323
745
773
781
729
836
742
–
–
2372
2398
2475
2245
2262
2075
2014
2072
Day Care – medical & surgical mix
Orthoptic
A/E Ophthalmic
Total Attendances
In-patients Referrals
New
Outpatients
Total Attendances
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Staff
Promotional appointments;
Maura McEvoy was promoted to CNM 2 grade. Linda
Mullen CNM2 was seconded to the project in preparation
for move to the Clinical Service Building theatres. Vida
Norondha joined the staff as a CNM 2.
Two portering staff members were promoted to
portering supervisor grade in the hospital.
Retirements;
Mr David Luke, thoracic surgeon retired.
A celebratory evening was held in April in the Raddison
Hotel to mark the retirement of Breda O Donoghue
and Bernadette Farrell in December 2007. The
contribution to service at St Vincent’ Theatres of Ita
Balfe and Maeve Nicholson who had left the employ in
2007 was also recognised. Several past and present
members of the multidisciplinary team attended.
Education / Conferences
Staff attended the Operating Theatre National
Conference in Castlebar, three presenting scientific
posters. Eithne Cullinan presented at the Anaesthetic
Nursing conference in Limerick. Several workshops were
held throughout the year in the department. Regular inservice education continued in the department every
Wednesday morning. The Nursing Journal Club was
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further developed and each speciality group meet
simultaneously on a monthly basis. Ms M. McGinley
and Ms E Ellis attended Liver Transplantation meetings.
Caroline Higgins was elected as President of the
European Operating Room Nurses Association.
Support for students (nursing and medical) is a fundamental
activity for the operating team. During the year, 12 staff
nurses completed preceptorship training. Nursing students,
78 pre-registration students undertook four weekly
placements in the department. Feedback from students
on placement was a positive experience and a valuable
educational environment. Members of the theatre aide
and portering teams attended skill vec course.
Developments/ Activities
The inaugural foundation course in perioperative
nursing commenced in Nov 2007 and all but one of
these students completed the course in 2008. The 2nd
course commenced in November 2008.
Theatre Commissioning
A multidisciplinary steering group was formed to coordinate the transfer of services to the Clinical Services
Building. The Extra Mural Theatre undertook further
transfer of its services to ADCC.
Committees
The Health and Safety and Infection Control Groups
met on a regular basis throughout the year. Promotional
events were co-ordinated such as infection control,
health and safety and hand hygiene awareness.
Product Evaluation
The Operating Department Product Committee
continued to meet to streamline the introduction of
new products and equipment to the department.
During 2008 the throughput of surgical cases was 10,211
HOSP
PNH
TOTAL
39
2
41
264
106
370
GENERAL
2508
671
3179
GU ENDO
1032
128
1160
GU OPEN
151
19
170
GYNAECOLOGICAL
340
1
341
OPHTHALMIC
357
1
358
ORTHOPAEDIC
1913
79
1992
560
22
582
1224
75
1299
THORACIC
219
81
300
VASCULAR
338
81
419
8945
1266
10211
DENTAL
E.N.T.
PAIN
PLASTIC
Fifty-nine liver transplant operations were performed during the year, with 75 donor retrievals.
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Staff
Mr. Sean Dudeney
Mr. Brian Hurson
Mr. E.P. Kelly
Mr. S.K. O’Rourke
Mr. G. O’Toole
M. W. Quinlan
SN.
Tumour and Spine
Tumour, Sports Knee Injury,
Adult reconstruction.
Upper Limb
Adult Reconstruction
Tumour and Adult Reconstruction
Rheumatoid Surgery and Adult
Reconstruction.
Administration
Grade V Officer
Grade IV Officer
Ms. Jenni Cross
Ms. Frances Dwyer
Operating Theatre
CNM2
CNM1
Ms. Catriona Lennon,
Ms. Anna Marie Bos,
Ms. Sarah Cusack
Orthopaedic Ward
CNM2
CNM1
Ms. Gillian Fields,
Ms. Rachel Hayden
Ms. Andrea Marnell
Nurse Specialists
CNS
CNM2
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Ms. Ann Camlin
Ms. Natalie Landers
SN.
Ms. Josephine Ubas
Ms. Deirdre Kelly
Fracture Liason Nurse
CNS
Ms. Annette Whelan
The Department of Orthopaedics and Traumatology is
based in the Bone and Joint Unit of St Vincent’s
University Hospital.
The Traumatology Service caters for patients presenting
by ambulance to the Emergency Department of St
Vincent’s University Hospital and also Trauma
presenting to any of the three portals in: St Vincent’s
University Hospital, St Columcille’s Hospital or St
Michael’s Hospital. Over recent years there has been a
focus in delivering the acute and severe trauma directly
to St Vincent’s University Hospital. However, there is still
an access for patients in the two outlying Emergency
Departments. Non-operative cases are followed up in
Fracture Clinics in St Michael’s and St Columcille’s
Hospital, whereas the operative patients are transferred
to St Vincent’s University Hospital for their surgery.
The orthopaedic staff in St Vincent’s University Hospital
provides a twenty-four hour consultant led service.
Patients who present are operated on, where possible,
within the first twenty-four hours following their
presentation. This is facilitated by a daily trauma list
seven-days a week, which allows for more efficient use
of the surgery facilities and this allows a more efficient
turnover of the in-patient beds available to the Unit. The
opening of the new Day Care facility within the hospital
has increased the availability of day beds and further
assisted the turnover of the Unit. In the year 2008
approximately nineteen hundred cases were carried out.
Patients who are referred to the Unit who require
elective surgery by enlarge are operated on in Cappagh
National Orthopaedic Hospital, where all of the
surgeons in St Vincent’s University Hospital have
attachment. In 2008 a total of 671 patients were
operated on in Cappagh National Orthopaedic Hospital
on referral from St Vincent’s University Hospital. This is
a reduction in the year-on- year figures, which reflects
the restriction of activity allowed in Cappagh National
Orthopaedic Hospital for that twelve-month period.
The Outpatient Department operates from the Bone &
Joint Unit in the new extension of St Vincent’s University
Hospital. The development has allowed the Department
to move to a three-session day with separation of
Fracture and Elective Clinics. In the year ending
December 2008 there were 4,500 elective orthopaedic
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patients seen and in the Trauma Clinics there were
10,665 attendances, which is a total of 15, 253 patients
seen in the Outpatients in St Vincent’s University Hospital.
Outside St Vincent’s University Hospital there are three
Fracture Clinics per week in St Michael’s Hospital and
two in St Columcille’s Hospital. These account for a
total of 7,023 outpatient attendances. Together with the
specialty clinics some of which are run in Cappagh
National Orthopaedic Hospital, there is an excess of
22,000 patient attendances at the Unit per year.
Plaster Services
The Plaster Service in St Vincent’s University Hospital
provides back up for the clinics and also ongoing care
for patients who require either supervision of wounds
or specialist casts or splints. This is a very valuable
Service to the patients as they have a point of reference
within the Unit, which is available to them regardless of
which clinic is running. Ms. Camlin, Clinic Nurse
Specialist, is responsible for a number of audits and
development of protocols within the Unit to facilitate
the care of the patients.
Clinic Developments
During the year 2008 physiotherapy led the Back
Assessment Clinic who have been established, initially
on a trial basis to reduce the very considerable waiting
list for back pain and also to audit and manage the
types of referral and their suitability to the clinic. It
would appear to have been a very successful
programme and the figures in respect of same will be
available shortly. It is envisaged that this may be an
ongoing Service. It is a fact that many of these patients
are not appropriate to a surgical clinic and therefore the
availability of surgical facilities to patients is reduced
because of the need to deliver a Service to these sort
of patients. The appropriateness of such a clinic will be
reviewed at the end of 2008.
Training/Education
The Unit continues to be involved in medical education
at all levels. There are organised training student
programmes through St Vincent’s University Hospital
and Cappagh National Orthopaedic Hospital, the Unit
takes trainees from the Basic Surgical Training
Programme through the College of Surgeons, the
orthopaedic trainees are taken from both the Regional
Training Programme and the National Programme for
Higher Surgical Training. All of the Orthopaedic
Surgeons in the Unit are involved and take part in the
Programme devised for the training of the Residents,
both in the hospital, in Cappagh National Orthopaedic
Hospital and nationally at the rotating Core Curriculum
Programme.
Long-term functional outcome in pyogenic spinal
infection.
O'Daly BJ, Morris SF, O'Rourke SK.
Spine (Phila Pa 1976). 2008 Apr 15;33(8):E246-53.
Mr Quinlan has stepped down from his position as
Chair of the Institute of Irish Orthopaedic Surgeons. Mr
Kelly remains as Regional Representative on the
Council and trainer on the Trainers Committee of the
Institute of Irish Orthopaedic Surgery.
Bilateral olecranon fracture as first presentation of
sarcoidosis: case report and review of the literature.
O'Daly BJ, Harty JA, O'Malley N, Killeen R,
McDonnell TJ, Quinlan WR.
J Shoulder Elbow Surg. 2008 Jul-Aug;17(4):e1-5. Epub
2008 Jan 7. Review. No abstract available.
Publications
Cost induced by hip fractures.
Azhar A, Lim C, Kelly E, O'Rourke K, Dudeney S,
Hurson B, Quinlan W.
Ir Med J. 2008 Jul-Aug;101(7):213-5.
“S" Quattro external fixation for complex intra-articular
thumb fractures.
Byrne AM, Kearns SR, Morris S, Kelly EP.
J Orthop Surg (Hong Kong). 2008 Aug;16(2):170-4.
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Isolated proximal tibiofibular joint dislocation in an elite
rugby union player.
MacGiobain S, Quinlan JF, O'Malley N, Brophy D,
Quinlan WR.
Br J Sports Med. 2008 Apr;42(4):306-7. Epub 2007
Nov 29.
The longitudinal relationship between the patientreported Multiple Sclerosis Impact Scale and the
clinician-assessed Multiple Sclerosis Functional
Composite.
Costelloe L, O'Rourke K, McGuigan C, Walsh C,
Tubridy N, Hutchinson M.
Mult Scler. 2008 Mar;14(2):255-8. Epub 2007 Oct 17.
Department of Plastic Surgery
Staff
Consultants
Service Development and Activities
Mr Tom O’Reilly
Mr Sean M Carroll
Dr Catriona Lawlor
Mr Colin Riordan
The Department of Plastic Surgery provides a general
plastic surgery service within the St. Vincent’s Healthcare
Group and drains significant portions of the southeast
of the country. We provide a specialised service in hand
surgery, micro surgery, breast reconstruction, skin cancer
surgery; pressure sore surgery, head and neck
reconstruction, sarcoma reconstruction as well as pelvic
surgery reconstruction.
Our waiting times for skin cancers continue to fall in no
small part to the continuing of use of the Friday
morning list in St. Michaels Hospital as well as maximal
capacity use of the EMT theatre. We are immensely
grateful to the EMT Theatre Nurses for there dedication
and hard work. We now have reached maximal clinical
activity levels and the unit is running very efficiently
because of the continued hard work of the
Consultants, Registrars, Nurses & Therapists.
Registrars
Mr John Curran
Ms Clare Davidson
Mr Yasir Katab
Occupational Therapist
Hand Therapist
Aine O’Reilly
Hand Therapist
Emily Hosford
Unit Secretary
208
Alison Kelly
Return to Contents
St Agnes’s Ward remains the plastic surgery ward as we
await the completion of our new premises due for
commissioning at the end of the year. The expertise of
the staff in St. Agnes’s Ward make the post operative
care of our breast reconstruction patients as well as our
free flap reconstruction as seamless as possible and we
acknowledge the dedication and hard work of the
highly competent ward staff.
Clinical activity at an outpatient level continued to
increase this year. We would not be able to continue to
produce the increases that we do if it wasn’t for the
excellence of the ADCC Nurses. The Hand Surgery
Clinic has received a second Occupational Therapist
and has covered from a second Physiotherapist and
this has improved matters greatly.
Our various sub specialist activities remains as
described before and the service to the National
Rehabilitation Hospital has been continued but
improved by organising immediate access for these
patients to weekly outpatient services in St. Vincent’s
University Hospital rather than the monthly service that
had been provided previously.
The numbers of cases performed continue to increase
as do the complexity of reconstructive procedures both
in head and neck surgery and breast surgery.
Academic output is not being ignored and we have had
multiple publications and presentations throughout the
year.
Staffing
Urology Cancer Nurse Coordinator
Helen Forristal
Consultants
Mr David Quinlan,
Mr Gerald Lennon
Senior Registrars
Registrars
Mr David Mulvin
Siobhan Gardner
Mr Rowan Casey (from 01/01/08)
Mr Stephen Connolly (from 01/07/08)
In-patient Clinical Coordinator
Mr Ivor Cullen (from 01/01/08)
Mr Jawad Ul Islam (from 01/07/08)
St Charles Ward Secretary
Senior House Officers Dr Lisa Smyth (from 01/01/08)
Dr Sheng Fei Oon (from 01/07/08)
Interns
209
Urodynamics/Urology Nurse Practitioner
Dr
Dr
Dr
Dr
Dr
Dr
Dr
Dr
Robert Smyth,
Eric Roche,
Karen O’Connell,
Kathy Rock,
Aine Mitchell,
Caitriona Tiernan,
Louisa O’Neill,
Claire O’Sullivan
Ward Sisters
Sr Mary Nevin
Sr Denise Murray (St Charles' Ward)
Theatre Sisters
Sr Vida Noronha
Sr Angelina Tabamo
Return to Contents
Nuala Kennedy
Krystle Finnegan
Urology Secretaries
Louise Bradbury
Margot Hennigan
During 2008 there were 9,273 patient presentations
(calculated from presentation to outpatients, admissions
includes theatre, urodynamics and in-patient consults)
which included:
• Outpatients: A total of 5120 outpatients were
seen by the Urology Department. Three Urological
outpatients occur per week on the St Vincent's
Campus with 4,338 outpatient attendances. Of
these 857 were new patient attendances. There
were 782 outpatient attendances in St Michael's
Hospital seen in one weekly outpatients of which
287 were new patient attendances.
• Theatre: Surgical procedures totaled 2,817 with
1,973 surgical procedures performed on the St
Vincent's Campus, 330 performed at St Michael's
Hospital and a further 514 procedures performed
in St Michael's Annexe.
• Consults: 424 in-patient consultations in 2008.
• Urodynamics: There were 912 urodynamic
procedures performed.
The year 2008 was again a busy year for the Department
of Urology. As in previous years 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. Between
the 1st of January and the end of February, St Charles’
Ward is available to the Emergency Department for direct
admission of patients from other disciplines. This 10
month protection is invaluable in permitting orderly and
timely admissions of patients on Urological and
Gynaecological waiting lists. From a Urological
perspective, this permitted the treatment of patients with:
• Urological malignancies,
• Need of complex urological surgery
• A requirement for complex Urological reconstruction
or other intervention
• Urological complications of other malignancies
(including gynaecological and colorectal
malignancies).
This would all not be possible without the invaluable
dedication of our Admissions Coordinator, Nuala
Kennedy, who has her office opposite the nurses
station on St Charles’ Ward and makes herself so
available to patients on waiting lists for in-patient care.
Cancer remains a significant focus for the Urology
Department in St Vincent’s University Hospital and has
done so for the last 4 decades. The 2005 Irish National
Cancer Registry figures (the latest figures available)
show that nationally prostate cancer was the commonest
solid organ cancer with 2407 cases, breast cancer was
second at 2379 cases and colorectal cancer third at
2184 cases. If one adds in cancers of the kidney (375),
bladder (504) and testis (162) the total number of
Urological Cancers numbers 3,448 cases. This figure
does not include less common Urological cancers such
as cancer of the ureter, urethra, penis and scrotum
(Table 1).
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Table 1:
Common Cancers in Ireland 2005
(National Cancer Registry)
Cancer
Number of
New Cases
Prostate
2407
Bladder
504
Kidney
375
Testis
162
Total Urological
3448
Breast
2379
Colorectal
2184
St Vincent’s Urology has had a sizeable
contribution to these figures.
Surgically 2008 saw increasing development of
Laparoscopic Urology under the direction of Mr David
Mulvin. Laparoscopic nephrectomies are now a weekly
occurrence with more laparoscopic nephrectomies now
being performed for renal cell carcinoma. This is
providing significant improvements in hospital stay and
early return to work for patients. There has also been
an upsurge in partial nephrectomies for smaller renal
cell carcinomas performed by all three Urological
Surgeons in St Vincent’s. 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.
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 in order to obtain protection
for in-patients on St Charles’ Ward). Its five-day activity
continues to occur off site in St Michael’s Hospital (under
Mr Mulvin), the Annexe of St Michael's Hospital (under
Mr Mulvin and Mr Quinlan) and St Columcille’s Hospital
(under Mr Lennon). One day activity occurs via St
Mark’s Ward, St Michaels Annexe, St Michael’s Hospital
and St Columcille’s Hospital. Also, at St Vincent’s, the
Ambulatory Day Care Unit (ADCC) accommodates 12
to 18 patients per week who are undergoing flexible
cystoscopies in the ADCC.
Urodynamics remains very active. Complex
urodynamics under the expert guidance of Mr Lennon
continue for patients with incontinence and difficult
voiding problems. Urodynamics also provides a
tremendous service for male patients presenting for the
first time to the outpatients with Prostate symptoms.
These men undergo a pre-assessment with Siobhan
Gardner consisting of urinalysis, renal profile, prostate
specific antigen, symptoms score, uroflow and estimation
of post void residual prior to seeing their consultant in
the ADCC. This provides for instant decision making at
the patient’s first consultation and has been invaluable.
The purpose built Urology Unit in the new Ambulatory
Day Care Centre provides an ideal environment in which
to treat Urological patients in a private and confidential
setting. As has been the case now in Urology for the
past five years, patients are given timed appointments
for their clinic visits and every effort is made to see
patients in a timely, courteous and professional manner.
This provides a significant challenge for Urology with only
three clinics per week and the time constraints of three
hours per clinic. The numbers of patients seeking
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Urological appointments now far outstrips the numbers
of available appointments.
2008 also saw the introduction of an annual “Visiting
Professor” with Dr Alan Partin, arriving in July 2008.
Professor Alan Partin is the David Hall McConnell
Professor and Chair of the Department of Urology at
the Johns Hopkins University Hospital. For over two
decades he has been at the forefront of research into
Prostate Cancer. To avail of Prof Partin’s expertise we
had present and past Urology Residents from St Vincent’s
presenting their clinical research papers on Prostate
Cancer topics to Prof Partin for his views and for audience
discussion. This was followed by Professor Partin’s State
of the Art Lecture on “Beyond PSA- 2008” which was
attended by the Minister of Health, Mary Harney T.D.
This was followed by a reception in the ADCC.
In 2008 Mr Quinlan became Chairman Elect of the
Board of the British Journal of Urology. He was also reelected to a second term on the Council of the British
Association of Urological Surgeons.
During 2008 improvements in ward accommodation for
in-patients on St Charles’s ward took place. We were given
new shower and toilet facilities, which have greatly improved
privacy and hygiene for patients. In 2009 we look
forward to more ward refurbishment on St Charles’ Ward.
Publications
O'Connor KM, Davis N, Lennon GM, Quinlan DM,
Mulvin DW.
Can we avoid surgery in elderly patients with renal
masses by using the Charlson comorbidity index?
BJU Int. 2008 Dec 5. [Epub ahead of print]
Dowling CM, O'Brien MF, Gardner S, Lennon G,
Mulvin D, Quinlan DM.
Can pre-assessment of patients with LUTS result in
early discharge from urology clinic?
Ir Med J. 2008 Jul-Aug;101(7):203-4.
Hogan A, Smyth GK, D'Arcy C, O'Brien A, Quinlan DM.
Renal capsular leiomyoma.
Urology. 2008 Jun;71(6):1226.e1-3. Epub 2008 Mar 4.
Connolly SS, Mulvin DW, Quinlan DM, Lennon GM.
Painful hydronephrosis of pregnancy.
Eur J Obstet Gynecol Reprod Biol. 2008
Sep;140(1):145-7.
Collins D, Myers E, Kavanagh D, Lennon G, McDermott
E.:
Mesenteric desmoid tumor causing ureteric obstruction.
Int J Urol 2008 15:261-2
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)
• Uroradiology Conference (Tuesday 8:15AM),
• Surgical Conference (Wednesday 8:15AM),
• Uropathology Conference (Thursday 8:15AM)
• Audit (Friday 8:15AM)
Future Plans
• 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 flexicystoscopy)
• The application for a fourth Urological Consultant
has been reactivaterd following the resolution of
the new consultants’ contract.
Monthly meetings occur as below:
• Multi-Disciplinary Team Meeting (Monthly, Monday
8:15 AM)
Mr Quinlan continues to be the Director of the
Urological Trauma Course at the Annual Meeting of
the British Association of Urological Surgeons.
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• Outpatient numbers pose a difficult problem. The
numbers per clinic must be reduced to provide a
higher quality service to each individual patient.
Demand far outstrips supply of appointments. A
fourth Urological appointment would certainly help.
Novel solutions such as private practice Urologists
being contracted for outpatient sessions may need
to be looked at to cope with the growing volumes
of patients.
Staffing
Consultants:
Mary Barry
Stephen Sheehan
Denis Mehigan
Senior Registrars:
Tony Moloney
Fraser Smith
Noel O’Brien
Registrars:
Bunmi Esam
Tahir Khani
John McCormack
Senior House Officers:
Lange Nqwena
John Bourke
Lucy Belton
Breda Cushion
Claire Leonard
Interns:
Assistant Director of Nursing:
Margaret Cullen
213
Clinical Nurse Managers:
Fionnuala McCusker
Catriona Keogh
Theatre Clinical Nurse Manager:
Maura McEvoy
Plethysmographist:
Catherine Kelly
Tissue Viability Nurse:
Deirdre Cornally
Return to Contents
The Vascular Surgery Unit at St. Vincent’s University
Hospital had another busy year in 2008. The Department
serves a population of up to 750,000 in our catchment
area of Dublin and also the south east of the country.
Bed shortages remain a major problem but effective
cooperation with our referral hospitals has helped to
maintain turnover of a satisfactory volume of elective as
well as urgent and emergency work. The situation has
been somewhat alleviated by the provision of beds and
theatres sessions in St. Michael’s Hospital for five day
cases which has greatly reduced waiting times for
varicose vein surgery and renal access procedures.
The aortic stent programme has continued successfully
technology has allowed us to expand the cohort of
patients suitable for the procedure. This has resulted in
a reduction in the number of patients requiring open
abdominal aortic aneurysm repair with obvious advantages
for patients and for resource use within the hospital.
The Vascular Dressing Clinic run by Deirdre Cornally,
Tissue Viability Nurse Specialist continues to be a success
with growing numbers of patients being treated. Over
time the opening hours of this unit will require to be
expanded to meet demand. The great success of the
latter has already posed its own strains on resources
and plans to extend its hours of operation are under
consideration.
Department Activity 2008
Admissions
2008
Elective
364
7 day
293
5 day
2
Urgent/Emergency
234
Day Care
77
Total
606
Outpatient Attendances
2008
New Patients
874
Return Patients
3018
Total
3892
Operative Procedures
Elective
Emergency
Total
2008
2007
2006
333
317
273
86
97
51
419
414
324
Meetings attended by members of the Department
during the year were:
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•
•
•
•
•
Charing Cross Meeting, London, April 2008
Venous Forum, London, June 2008
European Society of Vascular Surgery, Nice, Sept 08
Vascular Society, November 2008
Veith Vascular Symposium, New York, November 08
Mr. Denis Mehigan is a member of the executive of the
Irish Association of Vascular Surgeons and represents
that body on the Vascular Advisory Committee. He is
also a member of the Court of Examiners (FRCSI).
Mr. Stephen Sheehan is an instructor on the Basic
Surgical Skills Course and is an examiner of the European
Board of Vascular Surgery. He is a member of the
executive of the Irish Association of Vascular Surgery and
represents the RCSI on the Vascular Division of the UEMS.
Roche-Nagle G, O’Donnell DH, Brophy DP, Barry MC
Primary aorto-enteric fistula.
Am J Surg 2008;April;195(4):506-7
Roche-Nagle G, Murphy D, Collins A, Sheehan S.
Frostbite: Management options
Eur J Emerg Med 2008 June;15(3):173-175
Murphy I, Moneley D, Kelly D, Foley B, Sheehan S.
Endoscopic thoracic sympathectomy for long QT
syndrome. Ir J Med Sci 2008 June; 177(2):167-9
Roche Nagle G, Walsh S, Barry MC
Chylous ascites following abdominal aortic aneurysm
repair. Vascular 2008;16:1-3
Ms. Mary Barry is Secretary of the Basic Surgical Training
Committee, RCSI and a faculty member on the Care of
the Critically Ill Surgical Patient (CCRISP) Course.
Roche Nagle G, McGuire C, Ryan R, Brophy D, Mehigan
D.
Postpartum carotid dissection.
Int J Gynaecol Obstet 2008 Oct;103(1):66-67
Academic Activity
Mofidi R, Powell TI, Crotty T, Mehigan D, MacErlaine D,
Keaveney TV.
Angiogenesis in carotid atherosclerotic lesions is
associated with timing of ischaemic neurological
events and presence of computed tomographic
cerebral infarction in the ipsilateral cerebral hemisphere.
Ann Vasc Surg 2008; Mar;22(2):266-72
Publications
Moran D, Roche-Nagle G, Ryan R, Brophy D, Quinlan W,
Barry M.
Pseudoaneurysm of the brachial artery following
humeral fracture.
Vasc Endovasc Surg 2008 Feb. 42(1): 65-8
Medical and Surgical Gastroenterology incorporating Centre
for Colorectal Disease
Consultant Medical and Surgical staff
Medical Gastroenterology:
Prof DP O’Donoghue,
Dr HE Mulcahy
Clinical Nurse Managers:
St. Luke’s Ward 3 CNM2
Ms A Smyth,
Medical Gastroenterology
Ms M Doyle
St. Lukes Ward 2 CNM2
Ms U Power
Surgical Gastroenterology
Ms N Bates
Endoscopy Unit
Mr R Marshall,
Colorectal Surgery:
Mr J Hyland,
Ms F Kavanagh
Prof D Winter,
Research Team
Professor R O’Connell
GI Pathology:
Prof K Sheahan,
Dr D Gibbons
GI Diagnostic Imaging:
Senior Research Scientist
Robert Geragthy
Senior Medical Scientist
Blathnaid Nolan
Research Nurse
Dermot Leahy
Senior Scientist
Dr C Collins,
Dr R Gibney,
Miriam Tosetto
Senior Research Assistant
Prof D Malone.
Dr D Brophy.
Monica Biniecka
Postdoctoral Fellow
Edward Fox
Postdoctoral Fellow
Medical Oncology:
Specialist support staff
Cancer Nurse Co-ordinator
Ms A White
Colorectal Nurse Specialists
Ms G McEvoy
Ms W Hillery
IBD & Genetics Nurse Specialist
Ms D Keegan
IT/Excelicare
Mr S Thompson
Mr K Curran
Ms M Ward.
Secretary
Ms G O’Neill
(NCI/HRB fellow)
Dr D Fennelly
Dave Kevans
MD research fellow
Clinical
Garret Cullen
MD research fellow
Joe Marry
MD research fellow
Eoin Slattery
MD research fellow
Non-Consultant Medical and Surgical staff
Danny Cheriyan
MD research fellow
Sheeona Gorman
Ph.D. student
The recent move of Medical and Surgical Gastroenterology
to a single department in St Luke’s wards 3 & 2 has
been an outstanding success. Patients with acute
gastrointestinal illnesses are admitted to these wards
either via the Emergency Department or off the waiting
lists. This relative protection has greatly improved the
functioning of the unit and allows for a more rapid
throughput of patients. Thus Medical and Surgical
Gastroenterology now encompasses combined
outpatient clinics, weekly clinical and audit meetings
Radiation Oncology:
Prof J Armstrong,
215
Dieticians
Dr S Spensley
Dr A O’Toole
Dr A Al Akkari
Juliette Sheridan
Ph.D. student
Dr C Dunne
Mr C Coffey
Maciej Milewski
Ph.D. student
Mr E Andrews
Mr J O’Riordan
Adriana Michielsen
Ph.D. student
Return to Contents
Medical and Surgical Gastroenterology incorporating Centre for Colorectal Disease
and a shared 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, are clearly appropriate.
The move to the Ambulatory Day Care Centre in the
new building continues to bear fruit with greater numbers
undergoing procedures each year under the excellent
management of Mr Richard Marshall and his team. The
appointment of a GI Registrar to the unit has been of
major benefit to the Endoscopy unit but, more specifically,
to the Emergency Department. We are now in a
position to offer almost immediate endoscopy facilities
to patients in the A&E such that many are able to go
home on the same day and thus free up badly needed
beds. The number of bed days saved by this innovation
has been documented and presented to the HSE.
The dedicated St Luke’s Ward and the additional staff
has allowed the early development of specialty referral
whereby many patients arriving in the Emergency
Department are now seen and taken over by Medical
Gastroenterology, again ensuring a quicker and more
focused admission. 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
junior staff. We wish to acknowledge the close clinical
and scientific support we receive from our colleagues in
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Medical and Surgical Oncology and Palliative Care.
We also wish to put on record our thanks to Ms
Clodagh Maguinness and her staff in the new and
expanded St. Marks Day Ward for all their magnificent
work throughout the year. This facility has greatly
improved the numbers of patients who can avail of the
endoscopy suites. The opening of an infusion suite
under the direction of Ms Catherine Slattery has been
of enormous benefit as regards the speedy delivery of
biologics therapies.
Research and Education
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 co-ordinators and nurse specialists such
as Anne White, Denise Keegan, and Grace McEvoy who
lead patients through the varied and complex pathways
of diagnosis, treatment and postoperative stoma care in
a way that appears seamless. The Excelicare Database
System is now the backbone of the weekly Colorectal
Cancer audit organised by Anne White, Marian Ward,
Stewart Thompson and Ken Curran.
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 are to
achieve a more complete understanding of which
biological factors that 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 very productive collaborations with both
national and international institutions.
Professors O’Donoghue and O’Connell represent the
Hospital on the National Colorectal Cancer Screening
Committee.
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. Professor Paddy Johnston from
Queen’s University Belfast - with whom the unit has
close research collaborations - was this year’s state of
the art lecturer.
We wish to record our thanks to the many individuals
and groups who raise funds for our research. In particular
we would like to acknowledge foundations to the
memory of Ellie Brady, Susie Byrne and Darragh Gibbons.
Papers accepted in 2008
Coss A, Tosetto M, Fox E, Sapetto-Rebow B, Gorman S,
Kennedy B, Lloyd, Hyland J, O’Donoghue D, Sheahan K,
Leahy D, Mulcahy H, O’Sullivan J.
Increased Topoisomerase II· Expression in Colorectal
Cancer is Associated with Pathologically Aggressive
Disease and Leads to Chemotherapy Resistance via
Inhibition of Apoptosis (In press).
Sheridan J, Wang L, Tosetto M, Dave Kevans, Hyland J,
Sheahan K, O’Donoghue D, Mulcahy H & O’Sullivan J.
Nuclear oxidative damage correlates with poor survival
in colorectal cancer. (In press).
Kevans D, Foley J, Tenniswood M, Sheahan K, Hyland J,
O’Donoghue D, Mulchay H and O’Sullivan J.
High clusterin expression correlates with a poor
outcome in Stage II T3NO colorectal cancer (In press).
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O’Sullivan J, Sheridan J, Mulcahy M, Tenniswood M and
Morrissey C. The effect of green tea on oxidative
damage and tumour formation in Lobound-Wistar rats.
European Journal of Cancer Prevention. 2008, Nov;
17(6):489-501.
Wang LM, Kevans D, Mulcahy H, O Sullivan J, Fennelly
D, Hyland J, O Donoghue D, Sheahan K. Tumor
Budding is a Strong and Reproducible Prognostic
Marker in T3N0 Colorectal Cancer. Am J Surg Pathol.
2008 Oct 28. [Epub ahead of print]
Wang L, Kevans D, Mulcahy H, O’Sullivan J, Hyland J,
O’Donoghue D and Sheahan K.
Tumour budding is a strong and reproducible prognostic
marker in T3N0 colorectal cancer (in press). 2008
O'Shea U, Abuzakouk M, O'Morain C, O'Donoghue D,
Sheahan K, Watson P, O'Briain, S, Alexander
D, Catherwood M, Jackson J, Kelly J, Feighery C.
Investigation of molecular markers in the diagnosis of
refractory coeliac disease in a large patient cohort.
J Clin Pathol. 2008 Nov;61(11):1200-2.
Bronner M*, O’Sullivan J*, Rabinovitch P, Crispin D,
Chen L, Emond M, Rubin C, Brentnall T. Genomic
Biomarkers Identify Distant Colorectal Cancer in
Ulcerative Colitis. Am J Pathol. 2008 Dec;173(6):18531860. *Joint first authours
Howe O, O’ Sullivan J, Nolan B, Vaughan J, Clarke C,
Gorman S, McClean B, Lyng F. Do radiation-induced bystander effects correlate to the intrinsic radiosensitivity of
individuals and have clinical significance? 2008, (In press).
Sullivan S, Tosetto M, Kevans D, Coss A, Wang L,
O’Donoghue D, Hyland J, Fennelly D, Sheahan K,
Mulcahy H* & O’Sullivan J*.
Localization of a nuclear Cathepsin L and its
association with disease progression and poor
outcome in colorectal cancer’. Joint lead investigators
(In press).
Cullen G, Keegan D, O'Donoghue D.
Safety and efficacy of cyclosporine therapy in
inflammatory bowel disease. Am J Gastroenterol. 2008
Oct;103(10):2654-5
Baird AW, Skelly MM, O'Donoghue DP, Barrett KE, Keely
SJ. Bradykinin regulates human colonic ion transport in
vitro. Br J Pharmacol. 2008 Oct;155(4):558-66. Epub
2008 Jul 7.
Feighery LM, Cochrane SW, Quinn T, Baird AW, O'Toole
D, Owens SE, O'Donoghue, D, Mrsny RJ, Brayden DJ.
Myosin light chain kinase inhibition: correction of
increased intestinal epithelial permeability in vitro.
Pharm Res. 2008 Jun;25(6):1377-86.
Beddy D, Hyland J, Winter D, Lim C, White A, Moriarty
M, Armstrong J, Fennelly D, Gibbons D and Sheahan K.
with neoadjuvant chemoradiotherapy. Ann Surg Oncol,
2008, Oct 10 (Epub ahead of print).
Wang L, McNally M, Hyland J and Sheahan K.
Assessing interstitial cells of Cajal in slow transit
constipation using CD117 is a useful diagnostic test.
Am J Surg Pathol, 2008, Jul, 32(7):980-985.
Kennelly R, Kavanagh D, Hogan A, Winter D.
Oestrogen and the colon:potential mechanisms for
cancer prevention.
Lancet Oncol, 2008, April 9(4):385-391.
Mc Cormack O, Chung WY, Fitzpatrick P, Cooke F, Flynn
B, Harrison M, Fox E, Gallagher E, Goldrick AM, Dervan
PA, Mc Cann A, Kerin MJ.
Growth arrest-specific gene 6 expression in human
breast cancer. Br J Cancer. 2008 Mar 25;98(6):1141-6.
Epub 2008 Feb 19.
Mc Cormack O, Chung WY, Fitzpatrick P, Cooke F, Flynn
B, Harrison M, Fox E, Gallagher E, McGoldrick A, Dervan
PA, McCann A, Kerin MJ.
Progesterone receptor B (PRB) promoter hypermethylation in sporadic breast cancer: progesterone
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receptor B hypermethylation in breast cancer. Breast
Cancer Res Treat. 2008 Sep;111(1):45-53.
Bielas JH, Vermulst M, Fox EJ, Ericson NG, Loeb KR,
Rubin BP, O'Sullivan JN, True LD, Loeb LA. Nuclear and
mitochondrial mutations in cancer ENVIRONMENTAL
AND MOLECULAR MUTAGENESIS
Volume: 49 Issue: 7 Pages: 562-562 2008
Collins D, Winter DC.
Elective resection for diverticular disease: an evidencebased review. World J Surg. 2008 Nov;32(11):2429-33.
Active Grants in 2008
IRCSET fellowship. 2008-2011. PI. Jacintha O’Sullivan,
Ph.D. student: Ms. Adriana Johanna Michielsen.
Dendritic cell function and its role in governing drug
treatment resistance to molecular targeted therapies in
colorectal cancer. 78,000 euro.
Cancer Research Ireland. 2008-2011, co-applicant Dr.
O’Sullivan. PI: Fiona Furlong. microRNA Regulation of
the Spindle Assembly Checkpoint (SAC): Implications
for Cell Cycle Dysregulation in Ovarian Cancer and Taxol
Responsiveness. 224,826 euro.
Abbott: Newman Fellowship. 2008-2010. PI: Dr. O’Sullivan
& Prof. O’Donoghue. The biological effects of nicotine
and cigarette smoke extract in fibroblasts and explants
from Ulcerative and Crohns patients. 138,000 euro.
Irish Health Foundation. 2008-2010. Radiation Responses
in Rectal Cancer Patients. 80,000 euro. PI’s: Dr.
O’Sullivan and Prof. Sheahan.
Health Research Board Translational Research Grant
2006-2011. PI: Dr. Veale, co-applicants: Dr. Fearon, Dr.
Taylor & Dr. O’Sullivan. The role of hypoxia and genomic
instability in Rheumatoid Arthritis. 1.5 million euro.
Health Research Board NCI Cancer Prevention Fellowship
2006-2008. PI’s: Dr. O’Sullivan & Prof. Loeb (Seattle).
Postdoctoral Fellow: Edward Fox. Frequency of random
mutations and genomic instability events during
colorectal cancer progression. 110,000 euro.
Almac Diagnostics 2006-2010. Prof. O’Donoghue, Dr.
O’Sullivan, Prof. Johnston & Prof Harkin. Independent
Validation of a Prognostic Gene Signature for Stage II
Colorectal Cancer. 166,000 euro.
Nycomed Newman Fellowship 2006-2008. PI’s: Dr.
O’Sullivan & Prof. O’Donoghue. Newman fellow: Dr.
Garret Cullen. 80,000 euro.
Merck Newman Fellowship 2006-2008. PI’s: Dr.
O’Sullivan & Dr. Fennelly. Newman fellow: Dr. Joe Marry.
138,000 euro.
Introduction
The department saw a 3% increase in attendances
compared to last year. This is in spite of an increase in
the alternative venues available for emergency care. On
average 105 patients attend the department on a daily
basis of these 80 are discharged 64% within 6 hours.
Twenty five patients per day are admitted and these
continue to cause a problem due to persisting difficulty
in obtaining in-patient beds. We are grateful to Bed
Management for their efforts to keep the department
free to allow us to attend to new patients. Delay for in
patient admission continues to be our major problem
for efficient patient care and although highlighted during
the inspection by the office of the Auditor and
Comptroller General in August 2008 the situation has
shown no improvement.
Service developments
The Clinical Decision Unit was incorporated back into
the main department during the year and this has
improved its function as a valuable assessment tool
allowing a significant reduction in patient admissions.
Facilities for psychiatric care were improved and
pathways for psychiatric care developed.
The Rapid Assessment and Treatment (RAT) Unit was
enlarged ensuring early senior assessment of patients
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and accurate streaming into appropriate pathways of
care. This has allowed us to liaise with our in-house
colleagues to further develop these pathways to
achieve full speciality specific admissions. Early referral
to Neurology and rapid availability of consultant opinion
has allowed 36% of reviewed patients to be sent to
ADCC, 15% discharged or sent to their G.P. and just
45% requiring immediate admission. The Chest Pain
Evaluation Pathway with the Department of Cardiology
allows 20% of patients to be referred to ADCC, 36% of
patients to be discharged to their G.P. and 28% admitted.
Emergency Department assessment by Care of Elderly
Consultants defers admission for approximately 10
patients per month. Immediate and early access to
endoscopy has allowed 30 patients per month in the
Emergency Department to have endoscopies with less
than a 1% admission rate. The Departmental Social
Worker assesses 40 patients per month and places 4
per month in step-down facilities directly from the
department.
The Emergency Department team has been strengthened
by the appointment of department based staff in
Occupational Therapy, Physiotherapy Pharmacy and
Social Work. This early assessment in their pathway of
care has facilitated early rehabilitation and discharge.
The JCI survey in May 2008 was positive and emphasized
the need to audit all aspects of the patient’s journey to,
through and from hospital. Multidisciplinary integrated
care pathways must be developed and the Emergency
Department would be a focal point for many of these.
Audit related to risk management continues as do the
regular and important hygiene audits. Key Performance
Indicators have been established and will be important
in the future development of work in the department.
'Emergency medicine in conflict zones'.
IAEM Conference Dublin, September 2008
O’Callaghan H.
‘Comparison of blood gas analysis with i-STAT point of
care analyzer.’
Hassan T, Drew D.
Lactate as a confirmatory test in aiding the diagnosis
of epilepsy.
Ryan J, Hassan T.
Publications and presentations
Mr John Ryan chaired the organising committee of the
very successful College of Emergency Medicine meeting
in Dublin 23-25 September 2008.
‘An unusual cause of collapse and neck pain’.
Emerg Med J. 2008 Dec;25(12):857-8.
Buckley M, Kuan S, Barton D.
Presentation: DVT Care Pathway – Entry and Exit Clinics
Medication Safety Seminar, St Vincent’s University
Hospital, Jan 2008
Hosny G, Kidney R.
Medical Practitioners of The Year. Irish Healthcare
Awards, October 2008.
Hosny G, Kidney R.
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‘Bacterial Meningitis vs Cocaine-Induced Cerebral
Vasculitis – a diagnostic dilemma’ Intensive Care
Society of Ireland, Belfast, October 2008
Menzies D, Nix C, Crowley K, Ryan J.
‘Does the LUCAS device increase trauma during CPR’
IAEM Conference Dublin, Sept 2008.
Menzies D, Barton D.
The end of the line? The visual analogue scale and
verbal numeric rating scale as pain assessment tools
in the Emergency Department
Autumn Scientific Conference, IAEM, Dublin, September
2008
H Mohan, J Ryan, B Whelan, A Wakai.
‘How are the presentations and outcomes of patients
presenting to the emergency department with no
primary care physicians different from patients with
primary care physicians?’
Leonard F, Buckley M, Ryan J.
‘Content of General Practice referral letters to the
Emergency Department’ Presentation, IAEMTA
conference, September 2008
Moisey D, Keenan C, Mitchell A, O’Sullivan C.
General Practice referral letters to the Emergency
Department; qualitative analysis for legibility
Moisey D Keenan C Mitchell A O’Sullivan C
The Use of Propofol for Procedural Sedation in
Emergency Departments
Cochrane Database of Systematic Reviews Issue 4,
2008 The Cochrane Library
Cochrane Review ID: 492205121412595497 Protocol
approval stage
Wakai A, Cummins F, O’ Sullivan R - October 2008
‘The Exit Exam’
Irish Emergency Medicine Trainees Association - Spring
Meeting 2008
Cummins F
‘The Stable Upper GIT Bleed Pathway’ presentation at
the Irish Emergency Medicine Trainees Association Spring Meeting 2008
Carr S, Rosyn K, Cummins F, Mc Inerney J.
Case report: Post-dural puncture headache and
treatment with epidural blood patch.
IEMTA meeting in Dublin Autumn 2008.
Hassan T
‘The Stable Upper GI Bleed Pathway’ Poster presented
at the CEM Inaugural Scientific Conference, Chelsea
Football Club, London 14 - 16 May 2008.
Carr S, Rosyn K, Cummins F, McInerney J.
‘Legionella’ Presentation - Munich 2008
Fogarty E
Future plans
‘Major Emergency Alert Systems. Are They Internally
Efficient and Can They Be Improved?’ Poster
presentation Connolly Hospital, Mater Misericordiae
Hospital, St Michaels Hospital, Emergency Management
Office, HSE. Connolly Hospital Annual Audit / Research
Symposium 2008
Molloy MS, Cummins F, Sherif Z, Lawlor B,
O’Connor C, McKeever J
Presentation: ‘A Computer Game to Assist in Medical
Education’
College of Emergency Medicine – Trinity College Dublin,
Autumn Meeting 2008
Carr S, Cummins F
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The emphasis will be on developing new pathways of
care and integrated care pathways with a view of having
a full speciality specific assessment/admission system.
The molecular laboratory was fully equipped and Ms.
Deirdre Keating appointed as a Specialist Senior Medical
Scientist ensuring that planned new development could
proceed. Preparatory work for the molecular identification
of Ps aeruginosa for CF patients was completed.
The Biochemistry Laboratory continued with the
programme of test menu expansion and consolidation
of tests on the main analyser platforms. Analysis of the
therapeutic drugs carbamazepine and valproate was
established in house. The urinary protein:creatinine
ratio was initiated, in line with recent guidelines on
kidney disease.
During 2008 there was a continued emphasis on quality
initiatives, audits and review of procedures. The Hospital
Blood Bank was inspected by the Irish National
Accreditation Board (INAB) in January and was awarded
accreditation to the ISO15189 standards and compliance
with the EU Blood Directive 2002/98/EC for
haemovigilance and traceability. The Microbiology
Laboratory was assessed by CPA (UK) in March and
was awarded full CPA accreditation (incorporating
ISO15189). The Stem Cell Laboratory made further
progress towards full implementation of a Quality
Management System to meet the requirements of the
EU Tissue Directive 1004/23/EC.
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In November 2008 the hospital blood bank laboratory
commenced phase one of the provision of a blood
transfusion service to St. Michael’s Hospital to ensure
compliance with the requirements of the Blood
Directive for the Healthcare Group.
The role of the pathology staff in point of care
continued to expand in 2008. Biochemistry staff were
involved in validation of a new blood gas analysers for
the Emergency Department and St. Brigid’s Ward.
Haematology staff were involved in the commissioning
of Haematology point of care instrumentation for the
new theatres.
The Endocrine Laboratory derived a series of new
gender specific reference ranges for prolactin and
macroprolactin, which have been introduced into
clinical practice.
In the Metabolism Laboratory the clinical utility of
measuring CTX-11 in-patients with rheumatoid and
psoriatic arthritis following anti-TNF-α therapy was
examined and evaluated. The results demonstrate that
measuring CTX-11 can provide both an estimate of the
degree of cartilage destruction in these diseases and
has clinical potential in monitoring response to biologic
treatment.
Key Performance Indicators (KPIs) specific to Pathology
have been developed and the department was an
active participant in the team based performance
management programme. The department also
supported various research trials being carried by
clinical teams in the hospital.
The level of achievement in the above projects could
not have been achieved without the commitment and
team effort of all pathology staff.
Staff
New staff who joined the department included the
following:
Ms. Annette Quinn,
Ms. Ciara Lawless,
Ms. Sarah Jane Ryan
(Grade III Admin Staff)
Ms Emer Harte,
Ms Geraldine O’Brien,
Ms Kate Dillane,
Ms. Mary Casey,
Ms. Michelle Morrin,
Ms. Niamh O’Conell,
Ms. Claire Larkin,
Ms. Abigail Salmon,
Ms. Ruth O’Brien
(Medical Scientists)
Dr. Marie-Claire Greenan (Clinical Biochemist).
Dr. Deirdre Byre,
Dr. Brianan Mc Govern,
Dr. Alido Fe Talento.
Ms. Gillian Schorman, CNM2, anti-coagulant monitoring service.
Ms. Deepu Mathews,
Ms. Lynn Healy,
Ms. Lynsey Doran,
Ms. Kim Hopkins,
Mr. Kieran Kishan
Ms. Jennifer Barr,
(Laboratory Aides)
Ms. Alison Nolan,
Mr. Raise Paul (Phlebotomists).
Staff who achieved promotion to higher grades in 2008
included:
Consultant Microbiologist
-
Dr. Suzy Fitzgerald.
Specialist Medical Scientist
-
Ms. Deirdre Keating
Grade IV Admin
-
Ms. Jemimah Dionela
Grade IV Admin
-
Ms Mireia Giralt Cubi
Senior Clinical Biochemist
-
Ms. Eileen Byrne
Staff who retired include:
Mr. Seamus Connolly,
Ms. Ann Morley,
Ms. Ann Browne
Ms. Geraldine Collier resigned as Senior Clinical
Biochemist to take up a Principal Clinical Biochemist
post in Beaumont.
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Outstanding Achievements
Prof. Dr. Joe Duffy continues to act as Chairman of the
National Academy of Clinical Biochemistry (USA) panel
for preparation of new guidelines on the clinical use of
tumour markers in breast cancer.
Ms. Orla Maguire was appointed Vice-President of the
Association of Clinical Biochemists in Ireland (ACBI) and
continues as Joint Chairman of the SVUH Partnership
Committee.
Dr. Sean Cunningham is Chairman of the Clinical
Biochemists Registration Board.
Mr. Rowland Reece is a member of the Irish Expert
Body on Fluoride & Health.
Dr. Gordon Dixon achieved membership of the
Academy of Medical Laboratory Science.
Dr. Tom Smith represents the Association of Clinical
Biochemists on the Irish External Quality Assurance
Steering Committee.
Ms. Sarah Carroll and Ms. Aoife Prendergast passed
the examination to obtain the special certificate in
Blood Transfusion practices awarded by the BBTS.
Ms. Cara Ward and Ms Aine Lennon achieved a
Higher Diploma in Healthcare Training and Quality
Management.
Prof. Kieran Sheahan was appointed Associate
Professor, University College, Dublin.
Mr. Eddington Permalino, Mr. Alan Byrne, Ms. Antje
Preuss, Ms. Marie Cantwell, Mr. Jerry Noone junior,
completed the DCU Phlebotomy conversion course.
Ms. Jennifer Barr and Ms. Alison Nolan successfully
completed the DCU New Entrants course in Phlebotomy.
Ms. Mairead Moore successfully completed the SkillsVEC programme.
Ms Barbara Murray is a member of the Executive
Committee of Eurachem Ireland
Statistics
Pathology activity increased by 13.5% in 2008.
Publications
Maguire OC, McCarthy D, Cunningham SK.
The effect of plasmapheresis on the concentration of
certain plasma proteins: a case identified by an
inaccurate LDL-cholesterol estimation.
Ann Clin Biochem 2008; 45: 436-9.
McKenna, TJ, Smith, TP
Hyperprolactinemia Due to Macroprolactin: A
Commonly Unrecognized Phenomenon
Causing Misdiagnosis and Mismanagement.
The Endocrinologist 2008; 18: 249-254.
Kennedy S, Clynes M, Doolan P, Mehta JP, Rani S,
Crown J, O'Driscoll L. SNIP/p140Cap mRNA expression
is an unfavourable prognostic factor in breast cancer
and is not expressed in normal breast tissue.
Br J Cancer. 2008 May 20;98(10):1641-5.
Beddy D, Hyland JM, Winter DC, Lim C, White A,
Moriarty M, Armstrong J, Fennelly D, Gibbons D,
Sheahan K.
with neoadjuvant chemoradiotherapy.
Ann Surg Oncol. 2008 Dec;15(12):3471-7.
McMenamin MB, Jackson AD, Lambert J, Hall W, Butler
K, Coulter-Smith S, McAuliffe FM.
Obstetric management of hepatitis C-positive mothers:
analysis of vertical transmission in 559 mother-infant
pairs. Am J Obstet Gynecol. 199:315. e1-5. 2008
Duffy MJ, McGowan P, Gallagher WM. Cancer invasion
and metastasis: changing views.
J Pathol. 2008;214:283-93.
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Future Plans
Develop the molecular laboratory service with the
provision of:
- Molecular typing of Pseudomonas aeruginosa
from CF patients.
- Molecular typing of VRE and C.difficile strains.
- Diagnostic molecular tests for K ras mutation for
colorectal cancer patients to determine optimum
treatment.
- Haemochromatosis genetic testing.
Completion of the transfer of the blood transfusion
laboratory service from St. Michael’s Hospital to St.
Vincent’s University Hospital.
The introduction of the electronic issue of red cells to
reduce the time taken to provide compatible blood to
qualifying patients.
A major focus on accreditation with most labs scheduled
for CPA assessment in 2009. Point –of-care testing will
be included in these assessments and also in the JCI
hospital accreditation process.
Introduce the BNP test for the evaluation of heart
failure and perform certain toxicology tests such as
paracetemol, salicylate and blood alcohol.
Radiology Management Team
Clinical Director of Radiology
Dr Conor Collins
Radiography Service Manager
Sharon Simpson
Clerical Supervisor
Grade VI Officer
Helen O’Reilly
Clinical Nurse Manager II
Sara Nicholson
Over the last year the service delivered by the Radiology
Department has continued to expand and improve.
The state-of-the art equipment available throughout the
department has facilitated the development of a wide
range of exciting new procedures such as Cardiac CT
Angiography and CT Colonoscopy.
New Technology
Throughout 2008 the learning curve continued for
Radiology staff with the introduction of a large number
of previously unperformed procedures. The department
also opened its DEXA unit as part of a HSE funded
initiative to encourage referrals from GPs. DEXA is
located within the mammography and ultrasound area
on the first floor.
Specialist training in a wide range of new examinations
and applications presented a huge challenge for
Radiologists, Radiographers and Nurses in the
department.
All staff in Radiology have shown great commitment to
providing the best service possible by embracing the
new technology installed and adapting to the changes
in workflow which have occurred as a result.
Staff Movement
Rapid advances have occurred in Interventional
Radiology resulting in a large increase in the number
and variety of examinations being performed.
The introduction of Enterprise Wide PACS has greatly
improved clinical access throughout the hospital group.
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Radiology
Dr. Colin Cantwell (special interest interventional radiology)
joined the consultant staff during 2007. Dr. Eric
Heffernan joined the department as Locum Consultant
Radiologist (special interest musculoskeletal radiology).
Fifth Year specialist registrar Dr. David O’Donnell
departed having successfully completed his fifth year of
training. We wish him well in his future career.
We welcome Drs. Ailbhe O’Neill and Jan Gurstenmeir as
first year specialist registrars. Dr Ronan Killeen commenced
his appointment as a fifth year specialist registrar.
Radiography
We were delighted to have the following Radiographers
join us during 2008:
Aine Brennan
Keyna O’Dwyer
Maeve O’Donnell
Bronagh Moynagh
Anna Hayes
Emma Caulfield
Aaron O’Beirne
Linda Tutty
Deborah Sudding
Toun Sillo
Natalie Sweet
In 2008 we said goodbye to the following group of
Radiographers. We were very sad to see them go but
wish them all the best for the future.
Mary Aulin
Patrick Doherty
Maxwell Mkhandawire
Selina NicAirt
Jason Groarke
Joanne Leamy
Verna Vengadajellum
Nursing
We welcomed the following new staff nurses who
joined the team in 2008
S/N Valerie Prado
S/N Lucile Rivera
Clerical
Congratulations to Sylvia Hughes on the birth of her
baby boy (Shane).
The following staff joined us during 2008:
Carol Walsh
Jeasonraj Kanagaraj
Karen Finegan
Liza O’Riordan
Miriam Palfi
Rebecca Noonan
Silvia Sanchis
Elizabeth Sweeney
Eilish McNeill
Magdalena Hering
The following staff left us during 2008:
Emer Timony Nolan
Petrutchka Jack
Lindi Phakoe
Rebecca Noonan
Liza O’Riordan
Fiona Burns
Samantha Alford
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Specialist Registrar achievements
Drs Ingrid Heaslip and Deirdre Moran were successful
in the primary examination for the Fellowship.
Outstanding Achievements
Drs Ronan Ryan and Deirdre Moran were successful in
the FFRRCSI examination.
Administrative and Academic achievements by consultant
radiologists in 2006
Selected Publications
The following appointments were made by UCD. Dr.
Dermot Malone was appointed associate professor, Drs.
Conor Collins, Stephen Skehan and David Brophy were
appointed as clinical senior lecturers and Dr. Jonathan
Dodd was appointed as clinical lecturer.
Heffernan EJ, Dodd JD, Malone DE.
Cardiac multidetector CT: technical and diagnostic
evaluation with evidence-based practice techniques.
Radiology. 2008 Aug;248(2):366-77.
Dr Conor Collins continues as Hon. Secretary of the
International Cancer Imaging Society and delivered an
invited lecture on the Sentinel Node in Breast Cancer at
the 8th annual meeting of the Society in Bath, October
2008.
O'Connell AM, O'Doherty A, Malone DE.
Can ultrasound evaluate axillary lymph node status in
patients with breast cancer?
Can Assoc Radiol J. 2008 Feb;59(1):19-21. Review. No
abstract available.
S/N Stefan Baczkowski
We said goodbye and thank you to the nurses & hca
who left in 2008
S/N Stefan Baczkowski
HCA Anna Moreno
Ancillary Staff
The Radiology Aides have continued to contribute
significantly to the workflow of the Radiology Department.
Dr O Laoide took up the post of Dean at the Faculty of
Radiologists
Dr Skehan continues as examiner to the part II
Fellowship.
Killeen RP, Harte S, Maguire D, Malone DE.
Achievable outcomes in the management of proximal
cholangiocarcinoma: an update prepared using
"evidence-based practice" techniques.
Abdom Imaging. 2008 Jan-Feb;33(1):54-7. Review.
Malone DE.
Evidence-based practice in radiology: what color is
your parachute?
Abdom Imaging. 2008 Jan-Feb;33(1):3-5.
Collins CD.
The sentinel node in breast cancer.
Cancer Imaging. 2008 Oct 4;8 Suppl A:S10-8. Review.
Dodd JD, de Jong PA, Levy RD, Coxson HO, Mayo JR.
Conventional high-resolution CT versus contiguous
multidetector CT in the detection of bronchiolitis
obliterans syndrome in lung transplant recipients.
J Thorac Imaging. 2008 Nov;23(4):235-43.
PMID: 19204467 [PubMed - in process]
Killeen RP, Dodd JD.
RE: Considerations when introducing a new cardiac
MDCT service. Avoiding the pitfalls.
Clin Radiol. 2009 Feb;64(2):219; author reply 219-20.
Epub 2008 Oct 21. No abstract available.
Dodd JD, Kalva S, Pena A, Bamberg F, Shapiro MD,
Abbara S, Cury RC, Brady TJ, Hoffmann U.
Emergency cardiac CT for suspected acute coronary
syndrome: qualitative and quantitative assessment of
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coronary, pulmonary, and aortic image quality.
AJR Am J Roentgenol. 2008 Sep;191(3):870-7.
Ryan R, Abbara S, Colen RR, Arnous S, Quinn M, Cury
RC, Dodd JD.
Cardiac valve disease: spectrum of findings on cardiac
64-MDCT.
AJR Am J Roentgenol. 2008 May;190(5):W294-303.
Review.
Okumu RO, O'Donnell D, McCreery CJ, Luke D, Dodd JD.
Cabrol shunt for iatrogenic aortic dissection: evaluation
with cardiac 64-slice
CT.
Eur Heart J. 2008 Mar;29(5):617. Epub 2007 Oct 24.
No abstract available.
Conferences
All of the major national and international radiology
conferences were attended.
Statistics for the Radiology Department for 2008 are as
follows:
IR Rooms
CT
MRI
DEXA
9957
20044
4354
83
Mammo
6571
RNI
7185
DR
86651
US
14163
TOTAL
149091
This figure represents an 8% increase compared with
2007 (total no. 138305)
Future Plans
2009 will see further upgrades to the PACS in
Radiology in addition to the introduction of electronic
requesting. Further new services provided by
interventional radiology will also be undertaken.
Report from the Clinical Director of Psychiatry
Elm Mount Psychiatric Unit
Elm Mount continued to strive for clinical excellence
during 2008. The Refocusing Project, which started in
October 2007 and continued through 2008, was felt to
be of benefit to the care of all our patients. The
Refocusing Project is a practice development and
change management model sponsored by the
Nursing/Midwifery Planning and Development Unit.
The aim is to:
• Foster effective team work amongst staff
• Collaboration with service receivers
(patients/carers)
• Whole team staff training to share ideas and good
practice
• Have clear targets for change
• Strong leadership to manage and maintain the
changes made
As an approved centre for the detention of patients
under the 2001 Mental Health Act there were 82
involuntary admissions. One detained patient had her
case brought to the High Court by her legal team, the
issue of capacity being central to the case. The lack of
capacity legislation in Ireland impacts on patient care
where the person’s capacity is impaired.
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Following the new Medical Practitioner Act, Irish
Psychiatry which had previously been affiliated to the
Royal College of Psychiatrists in London, had to set up
its own College during 2008. This involved the
amalgamation of the Irish Division of the Royal College,
the Irish Psychiatric Training Committee and the Irish
Psychiatrist Association to form the new Irish College of
Psychiatry of Ireland. Two of our Consultants, Dr
Consilia Walsh as the last Chair of the Irish Division and
Dr Anthony McCarthy as Chair of the Irish Psychiatric
Training Committee were part of the committee which
brought the Irish College into being. Elm Mount is
proud of their contribution to the new College, of which
Dr McCarthy is Vice President.
The Department of Old Age Psychiatry continues its
tradition of providing community-orientated, multidisciplinary mental health care to the catchment area
population of over 34,000 people of 65 and over. The
service produced a comprehensive service development
plan, which was developed through extensive consultation
and circulated to senior management within St Vincent’s
University Hospital and the HSE. This provides a very
useful framework for the development of the service in
the context of an increasing elderly population. We are
committed to its implementation notwithstanding the
constraints of the current economic downturn.
Department last year to take up a senior post. She gave
a valuable contribution to the service and we wish her
well in her new role.
Staff
The Day Hospital plays an invaluable role in the
management of our patients in preventing admissions
and facilitating and supporting early discharge from inpatient care. The Healthy Ageing Course and Anxiety
Management Courses are run at the Day Hospital with
multi-disciplinary involvement from Occupational Therapy,
Medical Social Work, Nursing and Psychology. The
Healthy Ageing Course was expanded from an 8 week
to a 10-week programme. This programme was evaluated
using pre and posttest measures of psychological health
including the Geriatric Depression Scale and the
General Health Questionnaire and significant
improvements for individual patients were found.
The Department welcomed a number of new staff to the
unit including Dr Sarah Prasad, Senior Registrar in Old
Age Psychiatry, Dr Deirdre McNally, Clinical Psychologist,
Therese Woods and Ann O Keefe Assistant Directors of
Nursing who provide ongoing supervision and support
to our nursing staff across the service. Ann Hutton, will
be retiring from the service in 2009. She has provided
outstanding service to our Day Hospital and will be
greatly missed by her colleagues and patients and their
families who have benefited from her wisdom,
compassion and dedication. We would like to thank Dr
Trudy Meehan, Clinical Psychologist, who left the
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Service developments and Activities
There were 2195 medical reviews of patients in 2008.
This included 752 new referrals of which 215 were
liaison consults seen by the service. The commonest
mental problems seen in the hospital is delirium, while
dementia and depression are the two most common
mental health disorders seen in community settings.
There were 1004 attendances at the Day Hospital last
year and 291 attendances at the Group programmes of
the Day Hospital.
A model for a Rapid Response service for nursing home
referrals has been developed and its introduction will
depend on allocation of resources to support this.
Elements of this service have been implemented such
as the introduction of standardised behavioural
assessments. In addition, individual Community Mental
Health Nurses have been assigned to Nursing Homes
in the catchment area. The Department will continue to
develop the Nursing Home Education Programme
with the team Psychologists Dr Aideen Lewis and Dr.
Deirdre McNally playing a lead role in this.
Medical Social Work (Martina Dolan) and Psychology
(Deirdre Mc Nally) are developing and piloting a Needs
Assessment Form Tool to help plan for older persons
with severe dementia moving into long term care. The
instrument is divided into 4 parts, will inform the
planning process and assist in providing the best
possible care for people with severe levels of dementia.
The Medical Social Workers on the team continue to
provide the Carer Information Meetings several times
per year and their audit of the programme has shown
high levels of satisfaction from participants. This Carer
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Support Programme includes a lecture from Dr. Freyne
providing information on dementia to carers and advice
about the caring role. In addition, a Carer Support
Meeting follows two weeks after the Information
Meeting giving carers an opportunity to share their
experiences and to access support in their caring role. A
facilitator from the Alzheimer’s Society attends to
facilitate carers receiving additional support from the
Alzheimer’s Society if required.
The Medical Social Workers continue to refine and
develop the interaction between our service and St
John of God’s Hospital to facilitate seamless working
between our services to maximise benefits for patients.
Teaching and Research
The Department has an active research programme.
There are two main databases in the Department
including the Lithium Clinic Database and the COMCAR
Databases, which have a record of service activity and
patient diagnoses. The Department has several ongoing
studies including research of cognitive function in
patients on lithium treatment, measurement of renal
function in patients on lithium using eGFR, and drug
treatment of delirium.
The Clinical Psychologists co-ordinated a weeklong
programme (Older Adult Specialist Week) for doctoral
students of Clinical Psychology at UCD in November.
The Clinical Psychologists have been active in teaching
within the hospital including presentations and
interactive workshops to the Academic meetings of the
Department of Old Age Psychiatry.
There are a number of research projects ongoing under
the direction of Dr. Aideen Lewis, Principal Psychologist
with the service. Ms. Antionette Copley completed her
Master of Psychological Science on the topic of
“Selfhood in Alzheimer’s Disease” and Ms. Ann Demery
has been researching the topic of Stroke and SelfConcept as part of her training in Clinical psychology
with Trinity College Dublin.
General Services
231
Report from the General Services Manager
General Services
Departments within the General Services portfolio are
responsible for the provision of non-clinical support
services to the hospital along with ensuring a clean and
safe environment for our patients, visitors and staff.
The General Services portfolio consists of the following
key functions:
Catering
Fire Safety
Health & Safety
Household Services & Cleaning
Portering Services
Security
The staff compliment in 2008 has remained constant
when compared with the levels in 2007.
The management of the Health and Safety Department
was greatly enhanced with the introduction of a new
structure during 2007. This new structure amalgamates
the Fire Safety Co-ordinator and the Health and Safety
Co-ordinator roles together. In addition to the improved
day-to-day running of the service, this development
provides a much welcomed structured approach to
health and safety across the campus and has reduced
the duplication of staff attending committees and
meetings with regards to H&S matters. The support and
co-operation received from all staff members during the
implementation of this new structure was appreciated.
Technical Services
Telecommunications
Staffing
Staff within the General Service portfolio of
departments represent a diverse range of skills, which
are directed to providing support to assist core clinical
areas deliver a patient focused service.
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The establishment of an Estates Strategy Group (ESG)
in late 2007 created a foundation for the effective,
efficient and progressive management of major and
minor capital development projects across the campus.
In 2008 the Hospital embarked on an ambitious
programme of development projects designed to
improve hygiene and health & safety standards.
Key Projects Completed in 2008
Patient / Clinical Areas
• New Allied Therapy Suite (January)
• Cancer Support Centre relocated to Nutley Lane
(February)
• Relocation of Pain Management to the SVUH
campus (February)
• St Camillus Ward upgrade (February)
• Additional Dexa Scanner for GP referrals (October)
• St Patrick’s Medical Observation Unit (November)
• Toilet and Showers Upgrade – Phase 1 consisting
of 7 wards (December)
• Ward Kitchen Upgrade – Phase 1 consisting of 7
wards (December)
• Our Lady’s Ward refurbishment (expected
completion January ’09)
• St Monica’s Ward kitchen upgrade (March)
• Emergency Department – 4 new CDU beds (June)
• New Social Work Offices (June)
• Refurbishment of Suite 6 – OPD Dept (June)
• New Emergency Department Offices (February)
• New St Mark’s Daycare Ward (June)
• New Cycle Stands–164 new spaces created (April)
• St Luke’s 2 Ward upgrade (June)
• New Staff Rest Room (May)
• Emergency Department – Extended Triage area
(August)
• ERC chiller replacement (March)
• New 8 bed St Christopher’s (CF) Ward (August)
• HIPE Offices upgraded (June)
• New Histopathology Storage area (August)
• Toilet upgrade basement offices (September)
• Professor of Medicine Suite (September)
• Ward Block signage (Phrase 1 completed)
December)
• Professor of Surgery Suite (September)
• St Vincent’s Ward upgrade (September)
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Staff / Support Services
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• ERC Entrance Doors replaced (April)
• Installation of new boiler (December)
The successfully completion of so many projects on
time and within budget is largely due to the support
and co-operation of all the staff.
In addition to the above projects a number of essential
facilities related improvements were carried out e.g.
improvements to fire detection, mains water supply
contingency, electrical supply improvements, painting,
new blinds, furnishings etc. The window replacement
programme continued and in excess of €200K was
allocated to this project this year alone. Necessary
remedial work to repair flooring across the campus was
initiated and is planned to continue in 2009 finances
permitting.
The department was very disappointed in the results
obtained following a HIQA Hygiene audit of the hospital
in October. The Hospitals’ overall rating decreased from
“Good” to “Fair” and it was felt that this was not indicative
of all the hard work and commitment shown by staff to
improving hygiene standards.
Unfortunately for the hospital and especially for staff
working in the support services under the General
Service’s remit their significant effort and investment
made to addressing hygiene matters and improving
services was not reflected in our scoring. This was not a
true reflection of the work put in by many of the
support services.
I am very proud of all the work that was undertaken by
the staff within the General Services portfolio in 2008
and would like to thank them for all their hard work,
achievements and continued support over the past
year.
• Whole Hospital Policies continued to be developed
for the management of services throughout the
hospital including the updating of the Whole Hospital
Waste Policy in line with new regulations. Other
policies developed include Curtain Changing and
Laundering of non-rental items.
Other Improvements / Initiatives for 2008
included
• Two dangerous goods audits were carried out in
May and Novemeber.
• Following a mock JCI accreditation survey in May
work commenced on addressing the
recommendations made in respect of
Environment and Facility management.
• Energy and Utility management continued.
Monitoring and corrective action was initiated and is
to be a key priority for 2009 as part of cost
containment plans.
• Water management continues to be an important
issue. Technical Services currently work very closely
with Infection Control and Microbiology
implementing policies to minimise risk and meet
legalisive standards.
• Portering and Household Services continued a
programme of decluttering with special emphasis
on the basement and convent areas.
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Achieving JCI Accreditation will become the main focus
for 2009. All Service Departments have commenced
their preparation for the proposed October 2009 audit.
Each of the departments within the General Services
portfolio has had a productive year as can be seen by
the following outline of their role and activities.
Catering Department
Staffing
2008 was a busy year for the staff of the Catering
Department. The long awaited upgrade of the ward
kitchens commenced in September. A lot of time and
effort was put in to getting the design and installation of
the kitchens right. It was only with the co-operation and
goodwill of all the staff involved; Catering, Technical
Services, Nursing, Health Care Assistants, Portering,
Finance, Infection Prevention and Control and the
Environmental Health Officer that this project was
completed on time and without any major hitches.
Thanks is extended to all those who participated and
assisted in this project.
The first phase of the upgrade of the ward kitchens
commenced in September 2008 and was completed
by Christmas. The kitchens in St Paul’s, St Joseph’s, St
Luke’s 1, St Charles’s, St Patricks and Our Lady’s Wards
were completely renovated and fitted with new
stainless steel furniture.
The entrance to each kitchen was reconfigured to open
directly on to the corridor of the ward. The work that
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was carried out has ensured that the kitchens are now
compliant with the relevant food safety legislation.
The cafeteria opening hours were adjusted to facilitate
the change in starting times for nurses when new
rosters were introduced in the summer of 2008.
Breakfast service now commences at 07.00 hours.
A ‘bean to cup’ coffee machine, which produces freshly
brewed coffee on demand, was introduced in April
2008. The service has proved to be so popular that we
are now awaiting the installation of a new machine that
has double the capacity of the current machine.
Fairtrade coffee and a selection of fair-trade teas are
now available in the Cafeteria.
Awards
The Healthcare Food Award from the Irish Heart
Foundation was awarded to the hospital’s staff catering
facility in April 2008.
Future Plans
The second phase in the upgrade of the ward kitchens
is expected commence in early 2009 and be
completed by early summer. The wards in question are
St. Michael’s, St. Luke’s, St. Laurence’s and St. John’s.
Health & Safety and Fire Safety
Management
The role of health and safety has never been busier
especially with the preparations in advance of the
proposed JCI accreditation survey scheduled to take
place in the latter half of 2009. Our Fire Safety Coordinator has taken on the vacant role of Health &
Safety Co-ordinator on an acting basis to ensure that
any safety related recommendations following the mock
JCI survey can be addressed.
Training remains to be a high priority for health and
safety with further sessions to be provided by the
hospital in a number of disciplines. The rollout of
mandatory training for new-starters during corporate
induction has helped tackle the problem of releasing
staff to departments who may have had little or no
understanding of the safety requirements expected by
them within the hospital environment. This training
includes fire safety, manual handling, major emergency
plan, infection control & waste management, occupational
health, risk management, health & safety, and health
promotion.
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Fire training was revamped with a more flexible outlook
so that training sessions can work around individual
departmental arrangements and not those of health
and safety. This approach proved invaluable as it
resulted in less disruption to departmental services and
record attendance figures for fire training being
achieved. Overall a massive increase of 23.2% in
attendance figures was obtained in 2008 compared
with 2007 attendance rates. This is also partly due to
the awareness campaigns that were instigated by health
and safety at the start of the year to encourage
departmental managers to assess their staff training
attendance.
The Hospitals’ Dangerous Goods Safety Auditor
conducted two inspections that once again resulted in
zero non-conformances by the hospital. Special thanks
goes to portering, waste marshalling, stores, labs and
pharmacy for their full co-operation as always. The
DGSA auditor also assisted the hospital by providing a
number of chemical awareness & spills training sessions
to SVUH staff. These sessions proved invaluable to staff
and requests have been made by a number of
departments for further sessions to become available.
On a downside the number of nuisance fire alarm
activations in 2008 was not helpful to the hospital or
the fire service as it increased by over 31.7%. This was
due to two factors – the first being the high volume of
construction works that took place during the year that
involved hot or dusty works. The second factor was the
number of unauthorised toasters that still occupy many
of the staff rest rooms and tea areas. Not only are these
domestic toasters not suited to the volume of usage
that they receive but also the rooms that they are
located in are not designated fire-rated kitchen areas.
A routine inspection by the Health & Safety Authority
took place in September that included a visit to a
number of areas within the hospital. The two inspectors
spent time exploring the hospitals safety statements,
risk management occurrence forms and safety meetings
before visiting Occupational Health, Insurance & Risk,
Pathology, St. Charles Ward, as well as the Waste
Marshal Yard. All in all, the visit proved invaluable as
much praise was expressed by the HSA inspectors to
SVUH staff for the safety systems in place that they had
witnessed throughout the organisation.
Outstanding / Significant Achievements
In October 2008 the European Health & Safety Week
theme was ‘Risk Assessment’. A health and safety
breakfast morning was held by SVUH in the Education
and Research Centre that was open to all staff and
attracted a number of outside agencies, notably the
Health & Safety Authority and Beauchamps Solicitors.
Prizes such as home safety kits were presented to staff
that successfully answered the quiz questions in the
H&S draw which were kindly donated by a number of
the hospitals safety suppliers. Sincere thanks goes once
again to all who participated especially Catering, the
ERC staff, and all the stand promoters.
Staff Safety Representative
Ms. Margaret Britain resigned after 4 years in the role of
Staff Safety Representative and was replaced by Mr.
Joseph Mooney following a ballot of all staff. The
Hospital would like to thank Margaret for her dedication
and many years of service to the role and to wish
Joseph every success in this role.
Future Plans
The Hygiene Audit in late 2008 proved to be
challenging with the demands for the hospital to meet
the extensive and sometimes vague expectations
required by HIQA. Health and Safety along with the
Hygiene Co-ordinator will continue to work together to
ensure that all levels of hygiene are met to the highest
standard. The upgrade of the ward kitchens and toilets
has helped address a lot of the issues that were
expressed by HIQA in this regard.
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Hygiene - Cleaning and Household
Services
visiting public to the Hospital’s appeals was a
tremendous strain on the front line staff including the
Security and Portering Departments.
Cleaning
The Hospital views maintaining the highest standards of
cleaning and hygiene as an integral part of quality
patient care. All cleaning and hygiene activities are
guided by best infection control practices and national
guidelines. The majority of cleaning activities are
provided under a contracted service and the hospital
endeavours to ensure the services provided continue to
meet our ever-changing needs.
It was a big year again for hygiene initiatives across the
campus. The focus remained on expanding staff and
patient awareness of good Hand Hygiene practices and
a number of staff information sessions were held to
educate and promote better hand hygiene practices.
The expansion of communication channels for patients
and staff proved to be very useful in helping us
promote the hygiene messages.
Pressures in the Emergency Department led to
additional beds being opened at various stages during
2008. This proved to be a major challenge in terms of
managing cleaning resources and significantly increased
cleaning costs especially in the last quarter of 2008.
Another challenge faced during the winter months by
the service was the increased demands for second
clean at ward level during the Norovirus outbreaks. The
department worked closely with the Infection Control
Team to help minimise cross infection and to deep
clean affected areas as required. Restricting public
access during times of outbreak was a challenge for all
the support services and the lack of support by the
The review and updating of cleaning specifications
continued in 2008 and was supplemented by the
launch of hygiene audits at ward level. Improving the
hospital’s cleaning standards is expected to continue
and will be developed further in the 2009 Hygiene
Plan. The roll out programme of local audits to general
areas within the hospital will also be a priority in the
coming year.
Cost containment plans and value for money reviews
will be necessary in 2009 if we are to continue to meet
current standards. The planned opening of new services
including the new theatre block and the newly refurbished
St Clare’s Ward in early 2009 is expected to significantly
increase demands on all the services and budgets.
Household Services
The household function provides support services to
ensure the rest, welfare and the accommodation
facilities for the staff and patient’s relatives are
maintained to the highest standards. The team are
responsible for the co-ordination of all contracted
household service providers and work extensively at
local level with departments to ensure services are
delivered in an efficient and proactive manner.
In late September the department bid a fond farewell
to Margaret Beyan, who decided to retire after a
number of years of dedicated service. Ms Kathleen Gill,
Department Supervisor and the all the Household Team
wished Margaret bon voyage with a farewell party,
which was attended by staff from other departments.
The staff compliment for 2008 is currently 35.
In 2008 the department initiated minor refurbishment
projects including the planning and commissioning of
the new Staff Rest Room.
Portering Services
Household Services continued to work in conjunction
with the hospital’s cleaning service providers Noonan
Services Group to monitor cleaning outcomes and
participated in many quality improvement initiatives.
Household Services directed its focus in 2008 to the
preparation by the Hospital for the HIQA Hygiene Audit
and developed new policies and procedures to
supplement the new initiatives introduced within the
department. The department implemented a new
curtain changing procedure and continues to monitor
weekly changes to maintain standards. The Household
staff participated in the Hospitals Hygiene Awareness
Week and found this to be very beneficial and
productive.
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The Portering department provides support services to
a diverse range of departments around the hospital
campus. Departments serviced include complex areas
such as Laboratories, Theatres, Pharmacy, Radiology,
Ambulatory Day Care Clinics and the large Waste
Management Section. The Department continues to
develop its responsibility for the provision and coordination of whole hospital activities such as waste
management, post and patient transport.
Staff
The staff compliment in 2008 was 93. Mr Gerry
Noone, Portering Services Manager retired from the
department after 39 years of dedicated service in
September and we would like to wish him well in his
retirement and acknowledge his dedication and
commitment to the department during his time in the
Hospital.
Congratulations to Mr Donal Sheeran, who has taken
up the role of Acting Portering Services Manager. In
addition there were several career advancements by
staff into supervisory roles and we wish them and all
the new recruits to the department every success in
their new roles. The co-operation received from all
members of the department during the changeover of
management was appreciated.
Demands on the service increased significantly during
2008 due in particular to the commencement of
numerous hospital re-development projects. The
decanting and relocation of departments to facilitate
refurbishment projects was a logistic challenge that the
department confronted with their usual resourceful and
hands on approach. The department looks forward to
continuing to support project developments in 2009.
Following a review of reception services at the main
entrance, a restructured approach was taken to improve
the service to complement the needs of patients and
visitors. Staff participated in customer service focused
training sessions and the desk area was redesigned to
help identify it as a central enquiries point for visitors
and which allowed staff to approach their roles in a
more professional and courteous manner.
Waste management continued to be the focal point for
2008 and the hard work of all the portering staff in the
department was instrumental in achieving top marks in
the bi-annual Dangerous Goods Safety Audits. The
waste management structure was further strengthened
by the appointment of Mr Derek Martin as the new
Waste Marshall. Derek has been working closely with all
the hospital departments and external contractors to
develop initiatives to enhance the management of the
waste stream throughout the hospital and to promote
education of staff.
Staff training continued throughout the year and a total
of 17 staff participated in the ‘Skills Programme’. All
new staff now complete their mandatory training i.e.
manual handling, fire training during the employee
induction programme and this has been very beneficial
for the department.
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Security
The Hospital’s Security Department plays a central role
in the management and co-ordination of our safety and
security activities on the campus. The Hospital is
committed to provide a safe and secure environment
for all employees, patients, visitors and contractors.
The Security Manager was also actively involved (right
from planning stage) of major developments around
the campus. This has proved to be a success in
ensuring security and access control issues are
incorporated into development plans and addressed
prior to work commencing.
The department operates on a 24 hour 7 day a week
basis, with particular focus on fire and emergency
response procedures. The department participates in a
number of quality improvement committees such as
the Safety, Risk and Quality Improvement Group, Fire
Safety Group and the Health & Safety Committee.
Jim Mitchell manages the department and the staff
compliment in 2008 was 16.
The Department participated in review of traffic flow
and parking needs on the campus that led to the
recon-figuration of the staff and public car parks. This
included the creation of an additional 10 designated
disabled parking spaces, which increased the number
permit spaces to 42 across the campus.
2008 was a busy year for the department, particularly
with the commencement of so many building projects.
This was a major challenge for the department from a
traffic management and security aspect. Another major
challenge faced by the department during the year was
staff shortages and meeting services demands at times
was extremely difficult and on occasion was
supplemented by the recruitment of agency staff.
One area that has seen a rise in the demand for
intervention by security personnel is the Emergency
Department. This is due mainly to the growing number
of verbal and physical assaults experienced by staff
from members of the public. Security is present on 24hour 365-day basis within the Emergency Department.
The Security team continue to work very closely with
the medical and nursing staff to ensure staff and patient
safety.
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The department continued to roll out access control in
various departments including Theatre and Liver Unit
and issued approximately 1000 new cards and
reactivated 1500 cards this year alone. Access control
was also introduced to all staff car parks to help control
and improve parking within the campus.
The department continues to facilitate staff participation
in training programmes with emphasis on patient
handling and fire safety.
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 equipment
was identified and ranked to ascertain the impact of a
failure to the hospital. Planned preventative maintenance
was introduced to avoid disruption to the activities of
the various areas covered, i.e. chillers were maintained
in off peak hours. The new Allied Health Department
Refurbishment came on stream in 2007. The process of
integrating new developments into the campus has
been a demanding, challenging and interesting one and
we look forward to implementing the lessons learned
as future projects come on stream during 2009.
Technical Services
Technical Services is responsible for the management,
design, installation and maintenance of engineering
services within the Hospital. It is also involved in the
broader areas of energy management and sustainability
planning. Four key areas of activity in 2007 were:
New Developments
Due to the amount, complexity and cost of building
services in new developments, systematic inspections
and routine maintenance were devised to ensure
continuity of good service and economy of resources.
New maintenance schedules were planned using the
manufactures specifications with O&M manuals. As
Estates Strategy Technical Services Projects
Technical Services was a key stakeholder in the
development of the Estates Strategy Group. Its Projects
Team completed a substantial number of new projects
with the combination of in-house technical services staff
and outside contractors.
A summary of these is:
• Catheterisation Laboratory Recovery Room
Refurbishment
• Window replacement included ward isolation
cubicles and ancillary areas
• Cardiology ECG Offices
• Medical Records Filing Room Refurbishment &
Mobile shelving Replacement
• Dryer & Cleaning Room Refurbishment
• Clinical Services Building Air Conditioning
prioritised to achieve a quicker and more streamlined
response. With the help of our online helpdesk all
requests can be logged & tracked electronically to allow
for more positive feedback. Planned preventative
maintenance programmes were implemented for
engineering plant and building services to eliminate
failure and break downs, a brief outline of areas
maintained is as follows.
• Roof repairs on Ancillary Buildings
Infection Control wall washing
Landscape maintenance
Lock Repairs & Key Replacements
Medical Gas Pipeline Systems
Night-time maintenance / Emergency Call –out
Facility Response
Nurse Call Systems
ICT Network Cabling
• Numerous office upgrades were completed around
the campus
Asset Plant Management
• Bone & Joint Treatment Room
Central Plant Operations
• Ward Courtyard Drainage Revamp
AHU’s and air conditioning
Cleanroom validation
Carpentry Repairs
• HSSD Reverse Osmosis Plant Upgrade
Emergency Lighting Test & Repair
• St. James Ward Room Conversions
Environmental Testing –
• Catering Department new main kitchen flooring and
window replacement
Events Set-up – indoor
Electrical Maintenance & Repairs
Fire Alarm Testing/Management
Fire Hydrant & Sprinkler Testing
Planned & Reactive Maintenance
Day-to-day operational maintenance continued within
the department, the online helpdesk - PEMAC received
over 10,000 requests. All reactive maintenance was
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Flooring Repairs
Generator Maintenance
Glazing Repairs
Painting
Phone Maintenance & Installation
Plumbing Maintenance & Repairs
Roof Repairs
Service Contract Management
Signage Maintenance & Replacement
Site Grounds cleaning and general maintenance
Storm Drainage Maintenance
Uninterruptable Power Supplies
Water Chillers
Water management
Window Repair
Energy & Utility Management
Operating data recorded through a Building Management
System is 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 expense.
Water management continued with the sampling and
testing across various areas on the campus to ensure
the services comply with the relevant standards and
decrease the risk of legionella. The impact of new
developments led to increased loads, notably electrical
which was 2.25 KWT max demand and water which
was 430,000 litres daily.
The Technical Services Manager is Peter Mortell and the
department has a complement of 46 staff. Staff
changes in 2007 were: William Hanlon, Deputy
Technical Services Manager and John Hickey, Electrician
who left to pursue new career paths and we wish them
success. Also we would like to welcome Ciaran Ryan,
Leo Hughes Deputy Technical Service Manager, Facilities
Engineer, Robert Coffey and Derek Kelly, Electricians to
the Department
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Telephone and Communication
Services
The Telecommunication Department provides
switchboard and other communication related services
to internal and external customers. The Switchboard
staff are responsible for handling and dealing with over
1,300,000 internal and external calls per annum. The
department is committed to providing the hospital and
its associated services with a professional and efficient
service at all times.
In addition to our main responsibility as the call centre
for the Hospital the department is also responsible for
all hospital long-range pagers and bleeps. The
department also continues to offer technical assistance
following new developments and refurbishment
programmes. This proved to be a busy facet of the
department in 2008.
Staff
The Telecommunications Supervisor is Bernie Deignan.
The service operates on a 24-hour 7-day basis and is
staffed by a team of 14 full and part time members
who continue to provide a first class service.
The Department is working on a range of strategies to
help reduce the number of calls to the switchboard.
The priority of the Telephony staff in 2008 was to work
towards improving customer service through a
reduction in “call waiting” or ‘speed or answer’ times.
To help eliminate any “unnecessary” directory related
calls looking for contact numbers / extensions etc, work
commenced on the design and specification for a new
Hospital Telephone Directory. Following approval of the
basic layout design by Senior Management, a draft
version was launched on the hospital intranet site. It is
hoped that a fully comprehensive directory should be
completed by mid 2009 and will include key contact
details for the other hospitals in the St Vincent’s
Healthcare Group. The objective of this is to allow the
Telephony staff more time to focus on external calls
thereby improving answer response times.
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The department continued in its role as a key
stakeholder in the co-ordinating of all internal
emergency communications and Major Emergency Plan
activations. The department participated in a simulated
Major Emergency activation, which proved to be a great
learning and productive exercise. The department
implemented all observations and recommendations
following the desktop exercise.
Finally
General Services would like to express our thanks to
staff in all its departments for their hard work and
commitment to the team over the past year. Also to
acknowledge the other departments that work in
association with us in helping us to deliver a quality
service in a customer focused manner.
Introduction
The HR Strategy & Action Plan (2007-2010) was
completed in December 2007, following extensive
consultation, and was formally launched in February 2008.
Since that time the HR team has been working in cooperation with managers and staff across the hospital in
advancing a range of projects, initiatives and activities
linked to the six themes in the Action Plan itself. Some
restructuring and reorganisation has taken place within
the HR function to better position the Department to
address this change agenda.
Significant progress was made on this programme of
work in the first year and we have an overall ‘game
plan’ for the remaining two years. Action areas within
the plan are being progressed by specific Divisions
within the HR Department, others by cross-divisional
HR teams, with appropriate input in both cases from
managers and staff here in the hospital.
The HR function developed a suite of ten HR key
performance indicators (consistent with the nine
hospital wide high level indicator set) which link to key
activities within the plan. These indicators include
managing probation, retention management,
attendance management, staffing levels, overtime
hours, agency hours, average time to fill a vacancy,
pension cases pending, number of teams engaged in
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TBPM and number of staff who have successfully
completed their first PDP discussion. They are monitored
and rated on the ‘RAG’ traffic light system monthly. Below
you will see some of the key areas we are currently
working on and which progressed during the year.
Organisational Development
In line with the corporate and organisational
development strategies of 2006 and 2007, 2008 has
been a year of accelerated development. Moving from
initiation in 2007 to implementation and roll-out in
2008 the organisation has embraced and deepened
performance management, team development,
management development and enhanced internal
communication as part of its culture aligned to the
mission. Learning strategies and events are now aligned
to operational strategies. Key performance indicators in
clinical areas focus on the patient, the service and on the
performance and development of staff and teams who
deliver those services. Continuous improvement initiatives
are beginning to be tracked in association with KPI sets
which facilitates preparation of teams and services for
accreditation and this will become an increasing area
for focus in 2009 as we approach our first JCI audit. Remapping of the reporting structure of the organisation
has commenced and will be completed in 2009. This
area of focus is foundational to the continuous
improvement of manager to team communications and
of individual developmental discussions. Foundations
have also been set for the involvement of multidisciplinary
teams for example in ICU, theatre, in joint setting of
KPIs for 2009. External validation of the efforts of the
hospital in development and continuous improvement
are seen in consistent positive feedback from Healthstat,
PMU and Partnership.
If we examine the Organisational Development template
of 10 action points under the 3 strategic headings
Performance Management, Training Strategy and
Communications Strategy, 9 out of 10 items are
progressing to plan with line manager briefings requiring
renewed impetus especially in preparation for JCI
accreditation.
Partnership
The accomplishments in 2008, of staff, management
and union representatives in this hospital working
together to improve the service to patients in line with
the Mission of the group have been exemplary. In
February 2007 a plan was proposed, supported by
Partnership and brought to reality through the Hospitals
long standing and innovative approach of partnership,
to deliver for our patients on our mission of
“…excellence in clinical care, education and research.
Starting from the 2006 SVHG strategic framework, as a
base, and building step by step, Partnership and the
plans and projects that have been supported by the
HSNPF, have consistently contributed to the kinds of
service improvement seen below:
Feedback from managers at end of year on
training of staff:
• Application of learning to workplace 30% above,
69% met, expectations
• Relevance to the job
23% above, 76% met, expectations
Service improvements
ALOS (length of stay)
from 11.4
Jan 08 to 9.3 in Dec 08
(18%)
MRSA metric
from 238 in 2006 to 136 in 2008
(43%)
In-patient waiting list
• A series of structures, processes and training
interventions
• To transform management processes and
communication processes
• Alignment of Team efforts with Key Performance
Indicators derived from Strategic/Service plans
• Improve the service that we deliver
• Devise training strategy
• Gain support
• Roll-out training strategy
from 1079 Jan 08 to 195 in Dec 08
(62%)
A&E over night stays
20.9 avg 2007 18.7 avg 2008
(11%)
Other KPI’s
• 73 Teams in place under Team Based Performance
Management
• 258 training courses run in 2007 with 3552 staff
• Monitor progress and efficacy to KPI’s
from the SVUH Partnership Service Plan, 19 Feb 2007
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• Contribution to the Team
(82%)
Delayed Discharge
40 in Jan 08 to 15 in Dec 08
• Improvement in work performance
• 353 training courses run in 2008 with 5059 staff
We have built up Partnership (formally) and partnership
on a practical level in this Hospital over many years
with the intention of having closer and stronger
involvement of all of the partners in this organisation in
delivering an excellent service to our patients: present
and future. 2008 has been a year when the tangible
results of the Partnership ways of working, have been
evidenced.
Learning and Development
2008 saw the Learning and Development Division
continue to support the Hospital’s mission of delivering
excellent care to patients by providing and supporting
learning, throughout the organisation. Learning takes
place in SVUH on a continuous basis through teams
giving in-service training, departmental trainers, the Skill
Project, the Nurse Education Centre, the Education &
Research Centre and the Library. The Learning &
Development Division continues to work with trainers
throughout the hospital in the provision of these various
training interventions.
Learning & Development led the development of a new
3 day Corporate Induction Programme which was
launched in March 08 for all new staff joining the hospital.
Other internal programmes available to staff during the
year included: the Legal Framework 1 and 2, The 7 Habits
of Highly Effective People, Team Based Performance
Management, Trust in Care in addition to various
mandatory training programmes. The development of
the “How to Series” of short workshops for managers
continued with the roll out of workshops such as ‘How
to Give and Receive Feedback,’ and ‘How to Manage
Difficult and Aggressive Behaviour.’ Developments for
2009 will include further expansion of the ‘How to
Series’ management development initiatives and the
delivery of ICT training for staff.
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Learning & Development provides information and
support to staff to enable them to complete Personal
Development Plans. These plans are a way of aligning
the individual’s development needs with the
organisation’s goals and objectives. This process allows
individuals to assess their current skills on an online
system and to meet with their manager to discuss their
future personal and professional development plan.
In 2008 we were in a position to support staff undertaking third level courses to further the development of
their professional skills and knowledge. The M. Sc. in
Creative Leadership with the Royal College of Surgeons
(with the support of the other Dublin Academic Teaching
Hospitals) entered its second year in 2008. The objective
of this programme is to develop future leaders of the
hospital and the health service and forms part of our
leadership development and succession planning
strategy.
The hospital continued to support the National SKILL
Programme and achieved the objective of becoming a
critical mass site in 2008. The programme is run in
conjunction with the VECs and is for Support Staff and
Support Staff Managers to improve and develop their
professional skills and practices while achieving FETAC
Certification. There are over 40 Support Staff participating
in this programme.
Employee Relations
For the Employee Relations Division of the HR
Department 2008 was a particularly demanding year.
The Employee Relations Division works closely with
Heads of Service/Line Managers in advising on the
provisions of employment legislation, managing
performance, employee grievances and managing
attendance. In addition it also provides additional
support to the operational areas of HR in relation to
preventing and resolving issues which affect work
situations and service delivery.
Some of the key activities of the division are:
a) Advice: Advice is provided to Heads of Service/
Line Managers on how to address poor performance
and deal with employee misconduct. The provision of
guidance on the application of policies and procedures
on matters such as grievance and disciplinary, disputes,
Dignity at Work, Trust in Care is a key activity.
b) Information: Information is provided to
employees to promote a better understanding of
management's goals, objectives and policies.
Information is also provided to employees to assist
them in correcting poor performance, on or off duty
misconduct, and/or to address personal issues that
affect them in the workplace. Employees are advised
about legislation, applicable employment regulations
and collective bargaining agreements. Employees are
also advised about grievance and disciplinary policies
and procedures and other policies such as Dignity at
Work, Trust in Care and “whistleblower” protections.
c) Representation: Representing the Hospital at
third party hearings involving Equality Tribunal, LRC
Conciliation Service, Rights Commissioner Services
and Labour Court.
Key activities for the Division during 2008 were:
Enhancing, promoting and maintaining positive employee
relations at local level through meaningful engagement
with employees and their representatives regarding
impending/ongoing change. In this context, also
ensuring compliance with the provisions of Towards 2016.
The recruitment of a HR Relationship Manager to work
with the HR Director and Deputy Director in translating
the HR strategy into practical applications which support
the Hospital’s service plan. The HR Relationship Manager
also works closely with the operational Heads of HR in
providing professional HR/ER advice and innovative
solutions which create positive and sustainable outcomes.
Supporting and enhancing the skills of Heads of
Service/Line Managers in employee relations to enable
them to resolve employee problems quickly and
informally whenever possible.
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Responding to expanding body of legislation regarding
employment rights.
Developed and implemented new models for workplace
investigations in line with relevant policies and “best
practice”. In this context the division worked with an
external provider to deliver Investigation Training for
managers involved in investigations conducted under
the Trust in Care Policy.
Participation in initiatives such as HR Strategy
development, Partnership, Accreditation and Smoke
Free Campus.
Participation in national talks in relation to the extended
working day/week under clause 30.4 of Towards 2016.
Delivery of the reports for the Performance Verification
Process Phase 4 (June 2008) under the terms of
Towards 2016.
Monitoring and review of attendance records in line
with national guidelines for Health Service Employers
on Managing Attendance.
Workforce Planning, Resourcing and Information
Management Division
The Workforce Planning, Resourcing and Information
Management Division was formed as a result of re-
structuring in the HR Department in the latter part of
2008. This re-structuring followed from the development
of the HR Strategy. The functions of the Division are in
the main a re-configuration of existing services (e.g.
Resourcing and Retention Division, Employment Control,
HR Systems, Information Management & Pension
Scheme Management – Benefits Unit) which are
provided by the HR Department. However some
elements of the portfolio have been strengthened. For
example integrated organisation wide Workforce Planning
is assuming a new importance and is at a very early
stage of development.
The development of organisation wide and integrated
workforce planning was highlighted as a key priority in
our HR Strategy. It was summarised well in our strategy
as “…. a discipline which is, as yet, at a fairly embryonic
stage in its development and in its application within
the health service in Ireland. It is a very complex
activity, especially when it is multi-disciplinary, as it
involves formalising the assessment of need, skill mix,
numbers, etc. for a given service.”
The Exit Survey Model was reviewed and rolled out
across the Hospital in 2008. The survey is designed to
obtain feedback from employees leaving the hospital
on working conditions and experiences during their
time in St. Vincent’s University Hospital. The information
gathered is used to identify general employment trends,
to support staff retention and to make continuous
improvements in the workplace including improved
employee satisfaction where possible.
The provision of an Employee Benefits service is also a
key element of the Division and this includes the efficient
management of the Hospitals Pension Scheme. The
Benefits Section was successful in meeting its 2008
deadline for the project to assess the eligibility to
reckon prior part time service for our current and
former staff. This resulted in a significant number of
staff, who had previously been excluded from the
pension scheme, gaining access to pension benefits.
Significant progress was also made on the development
of a pensions management module on the Hospitals
payroll system (Northgate).
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Recruitment and Retention
Against the backdrop of the economic changes as the
year progressed, there were still considerable
achievements in key recruitment and retention initiatives
during the year. In total 138 staff joined in 2008, 66 of
which were management level positions. St Vincent’s
University Hospital witnessed an unprecedented number
of applications to the Graduate Nurse Programme and
consequently the standard of applicants considered for
places was higher than ever before. Applications were
received from 12 different universities across Ireland
and the UK and fifty newly qualified nurses commenced
employment on the enhanced Graduate Nurse
Programme in August and November 2009. There was
reduction in overseas recruitment in 2008 with a single
overseas intake in May 2008. Foundation level courses
in Critical Care and Peri-operative were run by the
respective specialist areas in conjunction with the Nurse
Education Centre to assist with recruitment, development
and retention of specialist nurses.
– Assisting the move from a 3rd year 12-month
Rostered Placement for Nursing BSc Students to
a Student Nurse Intern Model.
Supporting Performance Management
In 2008 Nursing HR supported and assisted Nursing
Managers with over a hundred employee relations
issues ranging from managing performance issues, trust
in care, attendance management, grievance and
disciplinary issues.
Nurse and Health Care Assistant Bank
The Nurse Bank was formally established in October
2007 with the appointment of Ms Liz Tuohy, Nurse
Bank Manager and her team. After achieving significant
savings in its first year, the Bank was extended to include
Health Care Assistants in 2008.
HR Operations - Nursing Division
HR Operations - Medical Division
In 2008 the HR Operations in the Nursing Division
worked closely with the Senior Nurse Management
Team to deliver on a number of goals and objectives,
which were designed to support the provision of highclass healthcare by all nursing staff. Key objectives and
achievements include the following:
2008 has been an extremely busy and challenging year
for the Medical HR Division. In terms of recruitment,
Medical HR appointed 275 new doctors to the hospital.
This included the appointment of over 250 Non
Consultant Hospital Doctors, 2 Permanent Consultants
and 19 Locum & Temporary Consultants. The number of
permanent consultants appointed was low in comparison
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Supporting Nurse Developments
The Nursing Division of the HR Department has also
actively supported a number of developments in the
Nursing Division such as:
– Supporting the introduction of nurse prescribing
model
to previous years as the appointment of permanent
consultants was suspended pending agreement of the
new consultant contract.
Agreement on this was finally reached at the end of
July 2008, with permanent consultant interviews taking
place in the last quarter of 2008.
As mentioned the new consultant contract, which is
known as ‘consultant contract 2008’ was finalised in July
2008. Consultants were asked to indicate in writing if
they wished to opt for the new contract or remain on
their existing contract. Consultants who opted for the
new contract were then issued with a personalised copy
which in turn was signed by the Group CEO and any
associated employers. This meant a considerable volume
of work for the Consultant Team who also undertook
the above task for St. Michael’s Hospital consultants.
The close off date for acceptance of the new contract
was 31st December 2008. Out of a total of 173
consultants, 148 accepted the contract, which means
85.5% of consultants employed by the St. Vincent’s
Healthcare Group are now working under the terms
and conditions of the new contract.
The postgraduate administrator role was incorporated
under the remit of Medical HR in June 2008 and has
brought advantages in terms of cross-cover and other
support for this role.
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As Medical Human Resources already has responsibility
for administration of the Post Graduate Medical &
Dental Board Training Fund, as well as the NCHD
Training Grant, this allows Medical Human Resources to
provide an enhanced Learning & Development service
to medical staff.
A review of Post Graduate input into ‘Grand Rounds’
resulted in changes being made to the way these events
are publicised around the hospital. Email notifications
are now sent on a weekly basis and posters are more
widely distributed and displayed. Prizes have also been
introduced for Best Attendance, Best Presentation and
Best Speaker in an effort by Medical HR to increase
attendance, which have been well received.
HR Operations - Clinical Administration and
General Services (CAGS) Division
The HR CAGS Division is an integration of HR
resourcing and retention and HR Services for the
Clinical, Administration and General Services areas of
the hospital.
This integration occurred end September 2008. From
September 2008 the division has developed a
partnership with the relevant Senior Management Team
members with the aim of providing a customer focused
overall HR Service covering clinical, administrative and
general services. This includes:
Recruitment and Retention
The CAGS HR Division continued to promote HR
‘Best Practice’ for recruitment and selection of staff. A
total of 261 clinical (excluding medical and nursing),
administrative and general support staff were
recruited throughout the year filling a wide variety of
temporary, permanent and locum roles.
Supporting Policy Developments
Contributing to the ongoing development and
implementation of HR policies, procedures and
practices, consistent with the development of ‘Best
Practice’ people management in the service.
Supporting Management
Providing ongoing advice and support to the relevant
members of the Senior Management Team and
Heads of Service/Line Managers on all HR matters.
Information and Communication Technology Department ICT
Staffing
In 2008 we were glad to welcome Reno Jacob to the
department as a replacement member to our support
team. We also recruited two additional contract project
managers Janet Daly and Martina Corcoran to support
the implementation of systems both within St. Vincents
University and St. Vincents Private Hospital.
Service Development/Activities
It was a busy year for the ICT Department with the
completion of existing projects and the commencement
of new projects. Our strategy in recent years was to
focus on consolidating our infrastructure creating a
stable platform on which to build our clinical application
portfolio. Having created a stable infrastructure we are
now focused on implementing and enhancing new and
existing systems.
Projects completed in 2008:
Our projects team continued to provide application
support upgrades and enhancements for applications
within the hospital. The team also continued to respond
to change requests/ report requests for systems such
as Emergency Department, Allied Health Systems,
Nurse Bank, and PAS.
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The following projects went live in 2008:
• Breast Symptomatic This system went live in the
last quarter of 2008. An expansion of the Excelicare
system, it supports the entire patient journey
through the breast service.
• In March we implemented the Endorad Endoscopy
System. This not only digitally captures and stores
endoscopy studies but also has a web client for
image distribution and tracks the patient journey
from scheduling to reporting.
• The Clinical Intensive Care Unit Management
System went live in August. This system is
seamlessly linked to medical monitoring equipment
and PAS. A second phase will be implemented in
2009 which will include a full Pathology interface.
• We worked with Media One, a subsidiary of Eircom,
to develop a new SVUH and Group Website which
went live in July and to create a new Group Intranet
which was completed in November 2008. Both of
theses solutions have user friendly content
management systems which will ensure that
information remains up to date. The website and
intranet significantly enhance our internal and
external communications capability.
• A body of changes were implemented on SVUH
PAS to address some data integrity issues and
provide additional functionality.
• DI DIVER –In June we went live with a new version
of our Management Information System (MIS)
called Health Diver. While this data-mining tool
provides comprehensive reports and adhoc queries
on core systems internally and externally, one of its
main advantages is its portal and dashboard
capability. We have used this to deliver the SVUH
Key Performance Indicator and Corporate Dashboard.
• Northgate were engaged during July 2008 to
review management information capability and to
suggest the development of this service moving
forward. Northgate have significant experience of
the delivery of MIS solutions within the UK. The
main areas covered were the current capability an
assessment of the tools at our disposal, advice on
the development of a data quality service and
areas for the next phase of development.
This was a very useful exercise an we will use their
recommendations in our future ICT information
developments.
Initiatives commenced in 2008:
At the end of 2008 we received capital funding to carry
out enhancements to existing systems and for a
number of add on solutions to existing systems.
• Patient Texting: a general texting solution for the
hospital but with the added advantage of integration
to the Patient Administration System. This can
therefore be used as a text reminder tool for
patients.
PAS enhancements:
We are implementing a number of PAS developments
covering functional changes and increased data integrity
measures. This includes:
• Patient Wristbands: a bar-coded patient wristband
system which will produce wristbands with typed
rather than handwritten patient details thus 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.
• Bed Management: a module as an add-on
application to our existing patient administration
system, to improve patient flow from admission to
discharge. This system will help to achieve this by
accurately deriving bed availability, by improving
bed occupancy and automating key elements of
bed turnaround.
Cancer System
We are implementing phase two of the cancer clinical
system using the Excelicare application from Axsys
Technology, this has links to the Patient Administration
System as well as diagnostic systems e.g. Pathology.
Departmental Systems
• We are implementing an Excelicare Framework
System of integrated clinical departmental systems.
This suite of applications will form a clinical data
repository with interfaces to the Patient Administration
System (PAS) and diagnostic systems (such as
Pathology) and advanced reporting tools. The first
example of this will be the Inflammatory Arthritis
System which will go into UAT in January.
• Complaints and FOI Database
• Digital Dictation - we procured the TA+ application
from DictateIT/CBay Systems this year to replace
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our analogue dictation system. This system is fully
integrated to our patient administration system and
can therefore associate voice files with the patient
record. It offers greater flexibility in terms of
recording and accessing dictated records as well as
higher quality digital functionality.
• Healthlink – Radiology Reports to GP’s within our
cachement area.
Operations
Support
2008 was a very busy year for our helpdesk; we
received an increase of 2,317 calls put through our
helpdesk system. Out of these 14,575 calls we
improved our SLA by 9.59% on 2007. Throughout 2008
we closed 89.02% of our calls within our agreed SLA.
Accreditation
Assisted Pathology with their INAB accreditation and
SVPH with their JCI accreditation.
Network
We completed our network upgrade; all areas are now
running at a minimum of 1Gb to the desktop with a
10Gb backbone. We also completed the network
integration between SVUH and SVPH. Completed
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phase one of wireless coverage, 65% of the hospital
campus is covered by Wi-Fi.
Internet Access
Upgraded our old 100Mb single link to the internet to
two 1000Mb (1Gb) links to the internet. This has
greatly improved our connectivity to the internet and
other hospitals. We expanded the number of hospital
and healthcare accessing our network to include National
Maternity Hospital, Our Lady’s Hospice, Beaumont,
Mater, Healthlink, GE Medical (India), Charter Medical
(UK), D3 (USA), St Luke’s Hospital, Breast Check Unit,
Royal Victoria Eye and Ear, NorthGate, National
Rehabilitation Hospital, St. Vincent’s Private Hospital, St.
Michael’s Hospital, Dr Stephen’s Hospital, HSE, Mater
Private and UCD.
Server Infrastructure
Increased our Storage Area Network storage capacity
from 11Tb to 31Tb, we now have 87% of all systems
directly SAN attached. This has greatly improved speeds,
security and disaster recovery solutions from these
systems. Working with SVPH we have now replicated
all of this data to a second identical SAN which will be
moved to the new SVPH building in 2010. We
continued to increase the size of our VMware and
Blade Chassis environment. We now have 68 servers
running on VMware and 37 servers running on Blades.
Security
Our overall security rating has improved from a 3.7 in
2007 to a 1.3 (5 being bad, 1 being good). This security
rating brings the overall hospital security in line with
financial and banking sectors. We have achieved this
through the following programmes
• Laptop Encryption
• USB encryption
• Anti Virus Software Upgrade to include additional
tools like spyware detection, intrusion detection,
network security, desktop security, server security
• Improved password protection
• ICT released 26 SVHG Security Policies
Disaster Recovery & Business Continuity
Designed and implemented an improved backup
strategy. We have used the geographically dispersed
locations of the three hospitals within the group to
ensure all of our backups are located in four locations.
This ensures we have off site disaster recovery options.
We have reused the old PACS equipment to place large
SANs and tape libraries in three different buildings in
SVUH, SVPH and STMH. This has been fully audited
and meets ISO standards. All data is fully encrypted
and secure. This has also greatly reduced the backup
and restoration times for all of our systems.
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We now have 27Tb of SAN for backups located in three
locations in SVUH, 8Tb in STMH and 157Tb of tape
library located in SVUH and SVPH. All backups are now
stored with 1024bit AES encryption. The amount of
data we backup per month has increased from 3.9Tb in
2007 to 14.9Tb per month in 2008.
We developed disaster recovery plans for many of our
core systems and will complete plans for all other
systems throughout 2009.
Archiving
Implemented an archiving solution on our e-mail
system and file servers. This ensures users an
unlimited storage for their e-mails, personal file and
departmental file shares.
System Upgrades
Upgraded server infrastructure of many of our existing
departmental systems including
• Q-Pulse
• Domain Controllers
• Clinical Engineering
• Microbiology
• Pharmacy
• Xcelera
• Payroll
• File Server
• Print Server
Purchasing & Procurement Department
Staff
Project Procurement 2008
Staff in the Supplies Department performed well in
2008 and continue to achieve best value for money for
products within their remit, in conjunction with user
departments and suppliers.
The past year saw the completion of the new Allied
Therapy Suite, St Mark’s Day Care Centre, and St
Christopher’s CF Unit. The equipping programme for
the new Theatres in the Clinical Services Building is
now complete with Theatres due to be commissioned
early in 2009.
The Supplies Department were successful in merging
the CSSD and Main Stores stock management systems
towards the end of 2008. All products from both stores
are now held on one stock master file and are
requisitioned and purchased together.
Due to an upgrade of the Integra Financial System
during 2008, all Purchase Orders for mainstream
suppliers are now automatically emailed once updated,
which has significantly reduced the lead-time from
order date to delivery date.
Web based requisitioning for certain categories of stock
items was also introduced in late 2008 and has proved
to be hugely beneficial to the departments who use
this function.
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Tenders for the 120 Bed Ward Building were issued for
consultancy services, including Project Management and
Design Consultancy. The EU Restricted Process was
employed to invite interested parties to submit for prequalification. A short-list was prepared, with short-listed
candidates being invited to tender for the contracts. The
outcome of this process was the appointment of MCO
Projects Ltd (Project Management) and Scott Tallon
Walker Architects (Design Consultancy) for Stages (i)
and (ii) of the this development. The Restricted Process
has also commenced for the Design Build contractor
who will be responsible for the construction of the ward
building.
as well as consumable supplies. All tenders for the
Procurement of goods, services and capital equipment
are tendered using the Irish Government “e-tenders”
website, which enables staff to upload tender documents
for suppliers and eliminates the need to send out
tender packages. The department also takes part in joint
tendering procedures with the Hospital Procurement
Services Group, which covers a wide range of product
categories to secure contract pricing for the coming years.
Staff continue to increase the amount of call-off and
standing orders to suppliers in order to secure contract
pricing for the term of the order and this also helps to
reduce the amount of orders placed with a given supplier.
Number of Purchase Orders Placed
Total number
Number of GRNs Processed
Total number
Activities
The Supplies Department placed approximately 21,800
orders during 2008, amounting to a spend of €42
million which includes the Purchase of Capital Equipment
21,956
34,689
Purchasing & Procurement Department
Future Plans
Gross Value of Purchases placed
Non stock
€39,148,500
Stock
€5,056,266
Project
€1,592,264
Total
€45,797,030
VFM Achievements
New Product Introduction
Renegotiated Price Increases
The Supplies Department continues to expand the
amount of pre-printed requisition lists to areas not
presently using them. This makes it more efficient for
departments to request non-stock products for purchase,
as all the information required will appear on one list.
Staff will also continue to expand the use of Web based
requisitioning for stock items in early 2009, with a view
to having non-stock items on agreed templates for web
based requisitioning throughout 2009.
Online requisitioning will be rolled out on a phased
basis with the co-operation of user departments.
€380,674
€74,769
• VFM savings plan €1,000,000, monitor and set
targets
To include;
Credit Notes
HPSG
Total
€119,502
€31,780
€606,725
New product introduction,
Product trials,
Supplier price negotiations,
• Roll out Stock Management system in new Theatres
• Install storage and top up solution for St Luke’s
1,2 & 3
• Assist wards in management of stock levels
• Extend exercise in stock removal and redistribution
at ward levels
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IIntroduction
The main components of the Quality Risk and Consumer
Affairs division include; Quality and Accreditation,
Insurance, Risk and Legal Affairs, Communications and
Consumer Affairs. The Department focuses on
engagement with patients and their families and staff
with the objective of patient safety and quality care and
service.
Developments in 2008
Quality Standards
In 2007, the Irish Health Services Accreditation Board
(IHSAB) was integrated into the Health Information and
Quality Authority (HIQA). In late 2007, the St. Vincent’s
Healthcare Group accreditation teams had completed a
self-assessment against the IHSAB standards. In the
absence of a national quality framework, St. Vincent’s
University Hospital decided to review the requirements
of Joint Commission International (JCI) accreditation
standards.
Joint Commission International (JCI) is the most widely
recognised and longest running whole hospital
accreditation scheme in the world and hospitals that
achieve JCI accreditation are recognised as world class
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centres of excellence. In May 2008 three JCI consultants
spent a full week at the hospital conducting “patient
tracers” to assess both clinical and support systems in
place. The Patient tracer methodology used by JCI
aims to be patient focused by following patients
through the hospital system.
Following this visit, the hospital and the Board of
Directors made the decision to become the first
publicly funded hospital in Ireland to undergo JCI
accreditation. The subsequent quality improvement
report and a self assessment against JCI standards
formed the hospital quality improvement action plan
and a JCI Project Group was set up to guide this in
September 2008. During 2008 a considerable amount
of work was done by hospital staff along with the
quality and accreditation team to ensure that the
hospital was meeting JCI standards in preparation for a
full hospital accreditation survey planned for 2010.
Other quality improvement schemes and surveys have
included the hospital assessment in October 2008
against the national standards for breast cancer by the
Health Information and Quality Authority (HIQA). A
breast cancer quality improvement group was set up in
late 2007 and met monthly during 2008 in preparation
for this review.
Hygiene Standards
The Hospital Hygiene Quality Improvement Group
(HHQIG) continued to meet in 2008 to ensure
compliance with the national hygiene standards. A
hygiene audit was undertaken by HIQA in November
2008 resulting in an overall score of ‘fair’ for St. Vincent’s
University Hospital. 2008 also saw the introduction of
internal hygiene auditing and the development of
hygiene key performance indicators (KPIs).
Insurance, Risk and Legal Affairs
The department in collaboration with an external
Training Consultant ran a two day workshop on ‘Root
Cause Analysis’ for senior managers within St. Vincent’s
Healthcare Group. The aim of the course was to teach
staff on how to carry out a systematic review arising
from a serious untoward event. Subsequently, the HSE
provided one-day ‘Systems Analysis Training’ course
which was attended by a number of senior nurse
managers from St. Vincent’s University Hospital. By
year end, approximately 23 managers were trained in
root cause and system analysis.
The Clinical Indemnity Scheme (CIS) operations team
provided great assistance to the SVUH risk management
team in designing a local enterprise bespoke risk
management report in 2008. This provides greater
flexibility for the hospital when running trend analysis
reports for hospital managers and committees.
The Insurance, Risk and Legal Affairs Coordinator
attended the Dublin Hospital Group Risk Managers
Forum in 2008 and other members of the organisation
provided their expertise to assist and participate with
Sub Committees in designing very worthwhile policies
and guidelines.
Consumer Affairs
In 2008, the Consumer Affairs office developed and
implemented a Complaints Management Policy in
keeping with national statutory requirements this
included the provision of guidelines for staff in the local
resolution of complaints, along with templates to
support the complaints investigation process. Information
for patients about the complaints process was
published in leaflet and poster format, and a patient
feedback form was implemented.
The specification for a complaints management
database was completed in 2008 and implemented in
January 2009. This provides us with more meaningful
data and reports about complaints for staff and other
stakeholders.
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Hospital wide quality improvement resulted from many
of the complaints investigated during 2008. Trends in
complaints were analysed along with other quality
indicators and presented for discussion and action to
the Patient Safety Committee, and Clinical Governance
Committee. A number of patient feedback activities
were conducted during 2008 including feedback from
in patients of the SVUH stroke service.
A Customer Care Standard developed during 2008, will
be rolled out through a front line staff education
programme in conjunction with colleague in the HR
Department during 2009.
Communications
Equally, the Communications division continued to grow
and expand in 2008. Work was commisionned in
February 2008 to design and implement a state of the
art and user friendly Intranet for St. Vincent’s Healthcare
Group. The intranet was design and built over a six
month peroid and launched live to the three hospital
sites in December 2008.
The SVUH Website was also totally revised and all
Heads of Department/Service were invited to engage
with the Communications Team to ensure their content
pages contained safe and accurate information.
As per the communications strategy, the GP Liaison
Group was reformed and a quarterly GP newsletter
produced. A GP study day was also held and the SVUH
website was updated with a new subsection that
sought to deliver information that GP’s requested on a
regular basis. This process has aided patients in
receiving a more seamless transition between primary
and secondary care.
• Develop and implement the hospital quality
improvement action plan.
• Commence tracer audits throughout the hospital
to prepare the hospital and staff for a JCI survey.
• Conduct hospital wide communication and
training in relation to the JCI process.
• Prepare the hospital for a JCI Accreditation survey.
Plans for 2009
• Implement the JCI International Patient Safety
Goals.
• Identify and develop organisation – wide quality
improvement initiatives.
• Participate in national accreditation schemes and
continue to self-assess against national quality
standards.
• Implement phase two of the Intranet project.
• Develop organisation–wide quality improvement
initiatives.
• Continue to promote staff and public awareness
of the complaints process.
• Further develop channels for patient / consumer
engagement.
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• Standardise all patient information produced and
design and implement the first Patient Information
Centre/Library for St. Vincent’s.
• Standardise the system for managing and
controlling hospital policies, procedures and
guidelines.
Board Members 2008
Professor Noel Whelan (Chairman)
Professor Bill Powderly
Mr. Edmond J. Bergin
Mr. Nicholas C. Jermyn (Group Chief Executive)
Mr. Patrick Meade
Ms. Louise English
Ms. Gemma McCrohan
Mr. Michael Meagher
Dr. Michael Somers
Sr. Agnes Reynolds
Mr. Joe Leyden
Dr. Risteárd Ó Laoide
Sr. Eugene Butler
Mr. Conor Sexton (retired Dec. 08)
Professor Diarmuid O’Donoghue
Mr. Stewart Harrington
Mr. W. R. Quinlan
In Attendance:
Mr. Cormac Maloney, Director of Finance & Company Secretary
Mr. Bill Maher, Director of Operations, SVUH
Ms. Mary Duff, Director of Nursing, SVUH
Mr. Michael Redmond, Chief Executive, SVPH
Mr. Seamus Murtagh, General Manager, SMH
Sr. Mary Benton, National Director of Mission
St. Vincent’s Private Hospital:
Mr. Michael Redmond Chief Executive
Mr. Seamus Murtagh
General Manager
Mr. Peter Sheehan
Head of Corporate Services
Mr. Ken Bale
Mr. Neil Twomey
HR Manager
Ms. Josephine Barrett
Acting Director of Nursing
Mr. Ian Maguire
Human Resource Manager
Members of the Group Executive 2008
St. Vincent’s University Hospital:
Mr. Nicholas C. Jermyn Group Chief Executive
259
Mr. Bill Maher
Director of Operations
Mr. Cormac Maloney
Financial Controller &
Company Secretary
Ms. Mary Duff
Director of Nursing
Ms. Mary Connolly
Director of Nursing
Mr. John McPhillips
Director of HR
Mr. James Crowe
Mr. Dermot Cullinan
Director of I.T.
Ms. Janet Murray
Head of Support Services
Mr. Frank Smyth
General Services Manager
Ms. Gerada Warnes
Allied Health Manager
Ms. Mary Shore
Director of Quality, Risk
& Consumer Affairs
Mr. Sean Kingston
Group Internal Audito
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Members of the Medical Executive 2008
Mission Committee
Members of Finance Committee 2008
Dr. Risteard Ó Laoide
Chairman
Sr Eugene Butler
(Chair)
Conor Sexton
Dr. Hugh Mulcahy
Honorary Secretary
Mr. Sean Dudeney
Chairperson of the Surgical Division
Ms Theresa Ward
( Hon Secretary)
Mr. David Quinlan
Consultant Urologist Elected Member
Sr M Angela Kelly
Dr. Donal McCarthy
Director of Pathology
Mr Nicholas Jermyn
Mr. Enda McDermott
Oncology Committee Representative
Mr Bill Maher
Dr. Tom Owens
Chairman of the Anaesthetic Division
Ms Gemma Mc Crohan
All above named are external members (board
Sr Margaret Hilliard
directors)
Professor. Diarmuid O’Donoghue
Consultant Gastroenterologist –
Chair of Medical Forum SVPH
260
Louise English
(St Michael’s Hospital)
Ms Niamh Ni Fhlionn (St Michael’s Hospital))
Dr Diarmuid O’Shea
Mr. Donal Maguire
Chairman of Medical Forum,
Dr. Malachi McKenna
Consultant Endocrinologist – SMH REP
Ms Emily Hosford
Dr. Martin Quinn
Chairman of Division of Physicians
Mr Sean Dudeney
Dr. Doug Veale
Consultant Rheumatologist –
Elected Member
Ms Orla Fitzgibbons
(St Vincent’s Private Hospital)
Ms Ann Cavey
(St Vincent’s Private Hospital)
Dr. Conor Collins
Chairman of the Division of Radiology
Ms Geraldine Maddock
Mr. John Ryan
Consultant Emergency Department –
Elected Member
Ms John Delea
Prof. Michael Keane
Chair of Medicine & Therapeutics
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Nicky Jermyn
Cormac Maloney
Consultant Psychiatrist
Prof. Charles Gallagher Consultant Respiratory Physician
Retired as a member of the BOD and as
Chairman of the Finance Committee on
15th December 2008.
Patrick Meade
Dr. Colm Cooney
Prof. Ronan O’Connell Chair of Surgery
(Chairman)
Ms Barbara Cantwell
Sean Kingston
Ms Louise Doyle
Bill Maher
Seamus Murtagh
General Manager, St. Michael’s Hospital
Ken Bale
Financial Controller, St. Michael’s
Hospital
Michael Redmond
CEO, St. Vincent’s Private Hospital
James Crowe
Financial Controller, St. Vincent’s
Private Hospital
Ms Phil Pyne Daly
Ms Tany King
Dr. Risteard O’Laoide
Ms Helen Forristal
Audit Committee 2008
Health and Safety Committee 2008
Dr Michael Somers
Group Clinical Governance Committee
Membership 2008
Mr Michael Meagher
Dr. Risteard O’Laoide, Chair
Ms. Mary Shore
Stewart Harrington
Mr. Edmond Bergin
Director of Quality, Risk & Consumer
Affairs (Chair)
Mr. Frank Smyth
General Services Manager
Ms. Margaret Boland
Clinical Services Manager
Ms. Sinead Brennan
A Senior Nursing Representative
Mr. Joe Leyden
In attendance are
Mr. Nicky Jermyn
Nicky Jermyn
Ms. Mary Duff,
Bill Maher
Mr. Bill Maher
Cormac Maloney
Mr. Dermot Cullinan
Health & Safety Co-ordinator
Seamus Murtagh
Mr. Martin Quinn
Mr. Clive Whyte
Fire Safety Co-ordinator
Ken Bale
Dr. Tom Crotty
Mr. Paul Gueret
Michael Redmond
Mr. Ian Callinan
Occupational Health Physician/
Psychologist/CNS
James Crow
Ms. Mary Shore
Ms. Sarah Mansfield
Sean Kingston
Mr. Sean Dudeney
Insurance, Risk & Legal Affairs
Co-ordinator
Ms. Lynda Fenelon
Consultant Microbiologist/Infection
Control CNS
Mr. Peter Mortell
Technical Services Manager
Mr. John Ryan,
Ms. Karen Clerkin
Ergonomics & Back Care Specialist
Professor Kevin Malone
Mr. Jim Mitchell
Security Manager
Mr. Peter Sheehan
261
Core Resource Group:
Return to Contents
Health and Safety Committee 2008- Continued
Patient Safety Committee 2008
Committee Members
Satellite Groups:
Mr. Bill Maher
Director of Operations - Chairman
AHP
Catering
Nursing
Ms. Mary Duff
Director of Nursing
Pathology
Pharmacy
Radiology
Dr. Risteard O’Laoide
Chairman Medical Executive
Technical Services
General Support Services
Ms. Mary Shore
Theatre
Clinical Care
Director of Quality, Risk & Consumer
Affairs
Ms. Ann Flynn
Infection Control
In Attendance:
Ms. Suzy Fitzgerald
Infection Control
Mr. Peter Sheehan
Representative from SVPH
Ms. Margaret Boland
Clinical Services Manager
Mr. Peter Mansfield
Representative from AON
Ms. June O’Shea
Head of Pharmacy
In Attendance
Ms. Siobhan Reynolds
Quality Manager
Ms. Sarah Mansfield
Insurance, Risk & Legal Affairs
Coordinator
Ms. Niamh O’Hanlon
Medication Safety Officer
Ex Officio
Mr. Nicholas Jermyn
262
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Group Chief Executive Officer

Annual Review - St Vincent`s University Hospital

Transcription

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