Mater Misercordiae Hospital annual report 1996
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Authors Mater Misercordiae University Hospital
Publisher Mater Misercordiae University Hospital
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2 f NOV 1997
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MATER MISERICORDIAE HOSPITAL
ANNUAL REPORT 1996 • Cover painting reproduced with the kind permission of Mr. Thomas Ryan, R.H.A.
Annual Report designed and printed by Future Print M ATER MI SER I CORDIAE H OSP I TAL A NNUAL R EPORT 1996
CONTENTS
Page No. Board of Management ...... 6 Executive Council ...... 6 Executive Committee of the Medical Council ...... 7 Address of the Archbishop of Dublin - Annual General Meeting ...... 8 Address of the Executive Chairperson of the Board of Management ...... 10 Report of Chairman of the Executive Council ...... 13 Financial Report and Accounts for 1996 ...... 19 H.I.P.E. Unit ...... 34 Management Services Department ...... 36 Mater Foundation ...... 40 Occupational Health Department ...... 42 Safety, Health & Welfare Un it Report ...... 43 Schools Education Programme ...... 45 Statistics ...... 46 Department Reports: Accident & Emergency ...... 55 Adult Psychiatry ...... 56 Anaesthesia and Intensive Care ...... 60 Chaplaincy Department ...... 71 Child and Family Psych iatry ...... 73 Clinical Cardiology ...... 74 Diabetes/Endocrine ...... 82 Dietetics ...... 84 Gastrointestinal Unit ...... 86 Infection Control Committee ...... 89 Institute of Radiological Sciences ...... 90 Medical Social Services ...... 96 Nephrology ...... 97 Neurophysiology ...... 99 Nursing ...... 00 Ophthalmology ...... 07 Otolaryngology/Head & Neck Surgery ...... 10 Orthopaedics ...... 18 Department of Pathology ...... 20 Histopathology ...... 20 Biochemistry ...... 25 Microbiology ...... 29 Physiotherapy ...... 3 I Radiology ...... 33 Rheumatology ...... 37 School of Nursing ...... 38 School of Physiotherpy ...... 44 Speech and Language Therapy ...... 47 Surgery: General ...... 148 General Colorectal ...... 15 I Gynaecology ...... 153 Vascular Surgery ...... 155 Hospital Staff ...... 156 Sisters of Mercy ...... 16 1
3 M ATER MI SERICORD IAE H OSP IT AL ANN U AL R EP O RT 1996
REMINDER
The Mater Misericordiae Hospital is a public voluntary hospital which. for many years. has been helped. in striving towards maintaining the highest standards in the provision of medical care and medical research, by the generosity of many members of the public. In order to continue to maintain such levels, the Board of Management of the hos pital wishes to request all those who read this report which reflects the work of so many individuals in the hospital in their pursuit of excellence in the provision of patient care, to consider the hospital and its on-going needs. All contributions and donations would be appreciated.
When arranging the details of your will you might wish to include t he hospital as a beneficiary.
4 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
Mater Misericordiae Hospital Eccles Street Dublin 7
Proprietors Sisters of Mercy, Mercy Generalate, Eblana Avenue, Dun Laoghaire, Co. Dublin.
Congregational Leader Sr. Dervilla Byrne
Provinicial Leader South Central Province Sr. Helena O 'Donoghue
Leader of the Community of the Sisters of Mercy, Sr. Therese Brophy Mater Misericordiae Hospital
Foundress of the Venerable Catherine McAuley Congretation of the Sisters of Mercy Born: 29th September 1778 Died: I I th November 1841
5 M ATER MI SER I CORD I AE H OSP ITAL A NNUAL R EPORT 19 96
BOARD OF MANAGEMENT
Chairman Most Rev. Dr. Desmond Connell Archbishop of Dublin
Executive Chairman Sr. M. Margherita Rock
Secretary Mr. DJ O'Flynn
Members Ms. D. Bernal Sr. M. Bernarde Mr. EA Clarke Professor J.T. Ennis Sr. M. of the Incarnation Sr. M. Joseph Professor J. Kelly Dr. P. Kelly Mrs. E. Lovatt-Dolan Mr. M. Lucey Mr. G. Magee Professor D. Moriarty Sr. E. McAuliffe Mr. J. O'Connor Mr. E. O'Malley Dr. D. Sugrue
EXECUTIVE COUNCIL
Chairman Mr. M. Cowley
Members Professor J.T. Ennis Sr. M. Margherita Sr. M. of the Incarnation Mr. K. O'Malley Mr. EA Clarke Mr. B. Conlan
6 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
EXECUTIVE COMMITTEE OF THE MEDICAL COUNCIL Chairman Professor J.T. Ennis
Vice-Chairman Professor D. Moriarty
Hon. Secretary Mr. K. O 'Malley
Members Dr. M. Behan Dr. P. Kelly Dr. B. Keogh Dr. H. McCann Mr. G. McEntee Mr. F. McManus Dr. B. Otridge Dr. D. Phelan Professor D. Powell
7 M ATER MI SER I CORD I AE H OSP I TAL ANN UAL R EPORT 1996
ADDRESS OF THE MOST REVEREND DESMOND CONNELL, D.D., ARCHBISHOP OF DUBLIN
TO THE ANNUAL GENERAL MEETING ON MONDAY, 2ND SEPTEMBER 1996
he recently published Report of the Constitution Review Group, in its commentary on Article 44 of the Constitution, asks the following question: 'Is it permissible for a publicly funded hospital to decline, for what amounts to religiOUS reasons, to perform what is a lawful operation?'(p.377). On the answer to this Tquestion will depend the survival of Catholic hospitals. It is a question that could profitably be taken in conjunction with an article entitled: 'Medicine in a Moral Vacuum' by Ms. Patricia Redlich in the Sunday Independent (18 August, 1996, p.28). Nobody would say that either Ms. Redlich or the Sunday Independent holds any brief for the interests of the Catholic hospitals. But she is rightly shocked by recent examples of procedures in reproductive medicine that are lawfully performed in Great Britain. She rejects the assumption that a procedure is morally acceptable simply because advances in medical science and technology have rendered it possible and a demand for the procedure exists. That is the moral vacuum to which the title of her article refers.
One might, of course, argue that Ms. Redlich's position is an ethical stance and admissible in the context of secular affairs whereas the Report refers to what amounts to religious reasons'. In doing so it suggests an opposition between religious and ethical reasons. But one can hardly suppose that a reason that may properly be described as ethical when proposed in a non-religious context ceases to be such when the motive for accepting it is reinforced by religious considerations. The State, indeed, is concerned with secular affairs, but that is not the same thing as promoting the secularization of society.
As I mentioned here on a former occasion, the Catholic ethos is sometimes viewed exclusively in terms of what it forbids. But the basic principle of that ethos is respect for the dignity of every human person: when it forbids a particular medical procedure that is because of the conflict it detects between the procedure and the personal dig nity of the patient. Respect for personal is a religious value when it is seen in the light of creation and redemption, but because it is demanded by the very nature of the human person it is likewise a value that contributes profound ly to the secular welfare of society. To suppose that the secular must be opposed to the religious is the assumption of a secularizing philosophy. This is not just alien to the convictions of the overwhelming majority of our people but it fails to appreciate how the weakening of religious moral motivation is injurious to the secular welfare for which the State is responsible.
Ms. Redlich does not feel constrained to qualify her views by the fact that the procedures to which she takes exception are permitted by law in Britain. For the Report on the other hand it is a fundamental consideration that the procedure accords with the law. But unless one accepts that whatever the law permits is morally acceptable, one has to ask by what right the law could impose what a hospital would regard as immoral as a condition of the support it is entitled to expect in virtue of the principle of subsidiarity. Surely there is something anomalous about a Constitutional provision that would oblige the State to impose that kind of penal conditions on the funding of Catholic hospital that would rapidly cause their destruction. With our memory of centuries of unjust discrimina tion against our faith we might in that case be pardoned for thinking that the more we change the more we find ourselves where we were.
The example chosen by the Report - sterilization - presents the problem in a superficially seductive way. Because the Catholic Church is perhaps a lonely voice in speaking out against direct sterilisation, it is easy to suppose that it has simply adopted this stand 'for what amounts to religious reasons' and thereby to insinuate that there are no
8 M ATER MI SERICORD I AE H OSPITAL AN NUAL R EPORT 1996
rational grounds for its objection. Yet, here as elsewhere in the field of medical ethics, the Church is simply refus ing to participate in the violation of a patient's personal dignity. Nothing could be more consonant with reason than that. The human body, after all, is not a mere biological mechanism after the manner of a piece of property that one can use or abuse without moral harm to oneself. Our philosophy never accepted the now discredited view that the body is a machine mysteriously attached to some separate inner centre of personal life. The body is the living flesh and blood in which our personal self grows and develops, expresses itself, enters into relations with the world of persons, and eventually suffers and dies. As one treats the patient's body so one treats the very per son of the patient: an indignity inflicted on the patient's body is a personal affront.
One might have expected the contemporary appreciation of the profound significance of the sexual constitution of the human person to have prompted new caution about the moral acceptability of the mutilation involved in steril ization. This procedure attacks what enters deeply into the constitution of sexual identity as if doing so could be reckoned as a good that offers no offence to personal dignity. Such are the rational groups for the objections against sterilization.
It is regrettable that the Report should have confined its attention to sterilization. Examples of procedures that would be even more objectionable to a Catholic hospital were declared to be 'lawful operations' by recent judge ments of the Supreme Court: it would have been helpful to mention them in seeking to expose the issue with which the Report was concerned. Moreover, it would indeed by rash to deny continuity between procedures per mitted by Supreme Court decisions and the road already travelled in Britain that has aroused Ms. Redlich's con cern. Moral issues are also raised by aspects of reproductive technology already practised in Ireland. If the law should give its approval to procedures that a Catholic hospital must regard as immoral is it to lose the funding it receives from the State? Is it to be secularized?
The Report presents its answer to this question by making the following Recommendation: 'A majority of the Review Group considers that Article 44 should be amended to provide that institutions which retain a religious ethos should not be debarred from public funding, provided that they do not dis criminate on grounds of religiOUS practice of belief, save where this can be shown, in any given case, to be necessary to maintain its own religiOUS ethos'
The intention of this Recommendation may be presumed to be sympathetic toward the general point I am making. It is not clear, however, what proportion of the Group composed the minority, what views the minority expressed or whether these views retain any relevance. No text for the recommended amendment that would enable us to judge its import is offered. The recommendation concerns itself exclusively with discrimination - presumably unjust discrimination - on the part of 'institutions which retain a religious ethos' but places no obligation on the State to refrain from unjust discrimination in favour of its own institutions.
This is a matter of the greatest importance. We are told that ' .... institutions which retain a religious ethos should not be debarred from public funding', but there is nothing in this form of recommendation to prevent the State from starving voluntary institutions of funds. The phrase 'save where this can be shown, in any given instance, to be necessary in order to maintain their own religiOUS ethos' imposes a test which is far from clear. The recom mendation is haunted by a spectre of unjust discrimination on the part of religious bodies; consequently it is nega tive and grudging in style. It expresses a truly extraordinary attitude towards those who have done and continue to do so much for which the Group acknowledges the State's indebtedness. A positive recommendation would have acknowledged the right of such institutions to exist and to receive the funding from the State on which their existence depends.
9 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
ADDRESS GIVEN BY SISTER MARGHERITA
EXECUTIVE CHAIRPERSON ON THE OCCASION OF THE TWENTY-FOURTH ANNUAL GENERAL MEETING OF THE BOARD OF MANAGEMENT
t is my pleasure to welcome you all to the Twenty-Fourth Annual General Meeting of the Board of Management of the Mater Misericordiae Hospital. In presenting the Annual I General Report, I am aware of its potential readership and of the variety of approaches likely to be adopted both in evaluat ing it and in examining the profile it projects of the hospital.
One sector of that readership might look to the range of patient services and activity levels as yardsticks. Another might choose instruments such as financial performance and cost con trol. Some might look for evidence of individual, organisational, and/or inter-departmental initiatives or perhaps might examine the range of opportunities provided for staff growth and learn ing. The manner in which the hospital anticipates and manages change and adapts its protocols and procedures accordingly might be the determining factor for yet another group of read ers. The key question however is: which of these offers that rare behind-the-scene glimpse of how a major organisation such as the Mater Hospital aligns its commitment to excellence in the delivery of its services with its accountability for the man agement of its resources in an environment which palpably reflects its ethos and mission. • Sr. Margherita Rock. Executive Chairperson of the Board of Management. Irrespective of which yardstick the reader may use, the Report certainly projects the Mater as a living institution with a strong vibrant history and an identity whose hallmark is synonymous with compassionate caring and professional excellence. This is supported by the facts presented in the Report. These are indeed impressive and all due credit is given to those who delivered the service and those who recorded it.
Several new initiatives were implemented and consolidated. However, several other proposals, while expertly planned and presented for implementation, are still awaiting the necessary funding to become available before they can be introduced.
Highlighted as a matter of extreme urgency is the hospital's capital development programme, the brief for which was successfully completed and reported on at last year's Annual General Meeting. While the programme of ongo ing refurbishment continues throughout the various departments and patient areas, the aspiration to fully restore the structure and fabric of the original building is gradually being realised.
During the year, the work of the various sub-committees which constitute the management infra-structure of the hos pital, continued unabated. Several additional committees were established not only to oversee new projects but to ensure the involvement of staff, to avail of their expertise and to build shared responsibility for the hospital's future.
The Mater's commitment to education and research is in striking evidence in the report. The hospital continued throughout the year to provide a venue for a number of specialist conferences, seminars, and training events. Staff
10 MAT ER MI SER I CORD I AE H OSP ITAL A NNUAL R EPORT 199 6
continued to avail of personal development as well as professional courses mounted by the various disciplines in the hospital. Of special note are the many publications and scientific presentations made by our staff both at home and abroad.
It has been said that the best way to anticipate the future is to understand the present. Observing and inter preting the implications of demographic shifts, changing social patterns of behaviour, rapid technological and scientific advances, are important if we are to be in a position to forecast future trends and to know which ser vices and systems will best meet the health needs of the population. Here, the commitment of our staff to ongoing research is recognised and duly noted. We acknowledge the contribution of the Mater Hospital College of Post-Graduate Education and Research which encourages and supports the academic and research interests of both staff and students.
The extent of the Mater's commitment to patients at national, regional and local level is immense. The quality of the service delivered is mirrored in the many tributes received by staff on an ongoing basis. To maintain this stan dard, to ensure that it is not compromised by constraints in resources - human, financial , or otherwise - is the most all-abiding and taxing challenge of hospital management at the present time. The support of our Chairman, Archbishop Desmond Connell, and the members of the Board of Management in anticipating, adapting, and gener ating ways of facing this challenge is greatly appreciated. Their individual expertise and cumulative experience pro vide a stable anchor for the hospital in a period of change while enabling the Executive Council to proceed in confi dence with the implementation of their policies and strategies.
To the members of the Executive Council under the chairmanship of the Chief Executive, Mr. Martin Cowley, to the Executive Committee of the Hospital's Medical Council under the chairmanship of Professor Joe Ennis, to the Nursing Executive and Nursing Council under the chairmanship of the Director of Nursing, Sr. Mary of the Incarnation, and to the members of the Management/Administration team, I wish to express my appreciation for the depth of their commitment and the generosity with which they make their talent and time available to the task of managing the day-to-day affairs of the hospital. On behalf of the Board of Management, I congratulate you on all that you have achieved in assuring the delivery of the required service to the patients and in maximising in a most cost-effective and responsible fashion the financial and human resources available.
I wish to record my appreciation of the service provided by the staff of the Finance Department under the direction of Mr. Brian Conlan, Mr. Gerry Hurl and staff of the Management Services Department, Mr. Tom Kehoe and staff in Patient Services, Mr Martin Igoe and staff in General Services, Mr. John Sadlier who is respon sible for the Technical Services Department, to the Heads of Departments and Clinical Divisions, and the mem bers of the various sub-committees who contribute so generously of their time and expertise and on whom the hospital depends so much.
Our thanks to the Minister for Health for the level of funding allocated to the hospital, and to the officials of the Department of Health for their advice and support.
To the President of University College, Dublin and to the Dean of the Faculty of Medicine of University College Dublin, we extend our appreciation for their continued interest and practical encouragement. Our thanks also to the staff of the many other agencies and professional bodies with which the Mater is associated.
The Board of Management continually aims to improve the hospital's facilities for patients and to provide an envi ronment where both the Patient's Charter and the objectives of the National Health Strategy are implemented.
At a time when Government funding is largely limited to the cost of the service delivery, the fundraising efforts of the Mater Foundation are particularly appreciated. Under the chairmanship of Mr. Dedan McCourt and managed by Mr. Joe McAvin, the Mater Foundation and its various sub-committees work arduously to raise funds for the hospital. Their voluntary commitment, their energy, creativity, and resourcefulness deserve our deepest admiration and appreciation.
11 MATER MIS ER ICORDIAE H OSPITAL A NNUAL R EPORT 1996
I should like to express our gratitude for the support given us by our Legal Advisors (Arthur O 'Hagan, Solicitors), our Auditors (R.J. Kidney & Co.), our Property Consultants (Messr. Harrington Bannon), our Insurers (Sedgwick Dineen Ltd.), our Public Relations Consultants (Slattery Public Relations Ltd.), the Manager and Staff of the Bank of Ireland, Dorset Street, the Gardai and the many other local agencies which make their services so readily available when needed.
I should like to take this opportunity to acknowledge the leadership, inspiration and support given us by our Provincial Leader, Sister Helena O'Donohue. Her ability to tune into every aspect of the many and varied min istries undertaken by the Sisters of Mercy is truly amazing, and particularly our own, which is probably the most complex of all. We thank her and wish her continued success in all her endeavours. Our thanks too to the local community of Sisters in the Mater who under the leadership of Sr. Therese Brophy, support the hospital in such generous and practical ways.
May I conclude this address with a few final thoughts; another year has passed, another Annual Report is in print. Admissions and discharges, attendances and return visits, procedures and treatments, all are presented in statistical format - and one asks is this the whole of it? What of all that remains unrecorded? What of those providers of the service whose names do not appear? What of the silent struggles and personal bur dens carried by those whose unnamed contributions colour and enrich the continuous ebb and flow of the hospital's service. It is that which remains unrecorded. It is that which can never be measured - at least in human terms - and because it can never be measured, it so often passes unrecompensed either in financial terms, by promotion, or a word of recognition. It has been said that:
"Silence reveals and silence heals".
In the midst of an extraordinary wealth of talent, skill, and professionalism, may we in this hospital always recog nise, acknowledge and be thankful for the contributions of those whose work is hidden, away from the limelight, and missed only in absence.
Sister Margherita Rock, Executive Chairperson, Board of Management. 3rd October 1997
12 MAT E R MI SE RI CORDIA E H OSP ITAL AN N U AL R EPORT 1996
REpORT OF THE CHAIRMAN OF THE EXECUTIVE COUNCIL
Introduction:
n many respects 1996 was a comparatively uneventful year, with much of the Executive Council's efforts devoted to balancing the budget and resolving other day to day problems, particularly those relating to bed Imanagement. I would like to take this opportunity of thanking my col- leagues on the Executive Council for their co-operation and help during the year. At the end of the day we achieved our objective of delivering on our service plan (almost) within budget.
The hospital not only had the highest percentage of Accident & Emergency admissions of the four major hospitals in Dublin but it also treated the most complex cases in the country. Consequently, the Executive Council feels strongly that the Mater delivers an effective, cost-efficient service to the publiC, despite problems with its basic infrastructure and its rapidly deteriorating plant. The work ethic of the voluntary sector is "alive and well" at the Mater • Mr. M. Cowley, but I fear that the patience of the staff cannot last forever unless progress is Chief Executive, achieved in resolving at least some of our core problems. Chairman of the Executive Council.
On the academic side, relations with U.CD. are excellent. In this context I would like to acknowledge the co-operation of Prof. Ronan 0' Regan, Dean of the Medical Faculty particularly on the provision of much needed facilities for medical students on the hospital site (Situated in the old Mater Private building). The arrival of Prof. Hugh Brady, Professor of Medicine, will conSiderably enhance the academic and teaching aspects of the hospital and I would like to wish him every success in his post in the years to come.
Delivery of Service:
The following key statistics emerged in respect of 1995 and 1996 1995 1996 Total Inpatient Discharges 17,044 16,635 Day Cases 15,617 16,619 Total Bed Days 170,244 169,594
The above represents, in overall terms an increase of almost 2% in the number of patients discharged, (counting both inpatients and day cases).
The following were the busiest specialities in terms of number of patients discharged and day cases Ophthalmology 3,906 General Medicine/GI 3,480 General Medicine/Cardiology 2,649 Oncology/Haematology 2,411 E.N.T. 2,342
In 1996, the number of patients admitted through the Accident & Emergency Department as a percentage of the total was higher than the corresponding figure for 1995. The following are the details:
13 M ATER MI SERICORDIAE H OSP [ TAL AN NUA L R EPORT 1996
1995 1996 Accident & Emergency 43% 49% Other Emergencies [4% 8% E[ective Cardiac Surgery 6% 7% Other E[ective 37% 36%
The above percentages exclude day cases but include social admissions in the Accident & Emergency Department. This reflects the continuing problems encountered by the hospital and its consultants in admitting elective patients including those requiring urgent treatment. The following are the total number of patients on the Waiting Lists from [992 to 1996.
December, 1992 3,786 December, [993 3,001 December, 1994 2,968 December, 1995 3,622 December, 1996 3,573
Of the 3,573 patients on the Waiting List at the 31 st December, 1996, 1,534 were in respect of Cardiac Surgery.
In an attempt to resolve the bed problem in the hospital a multi-disciplinary Bed Utilisation Committee was formed with executive powers. One of the initiatives of this committee was to protect two beds for each surgeon. This worked for part of the year but eventually ward closures and other factors led to its demise.
In previous years, the pattern was for emergency admissions to peak during the Winter months. However the graph on page 48, which sets out the number of patients admitted through the Casualty Department on a weekly basis, clearly demonstrates that peaks in emergency admissions now occur at all times of the year. The Mater's catchment area com prises a large percentage of elderly people which is part of the reason for the hospital's heavy emergency workload.
The Bed Utilisation Committee considered many options to resolve the problem including the creation of a departure lounge, a medical assessment unit, a same day admissions policy, early discharge planning and other initiatives. Given the general lack of resources, it quickly emerged that most of these initiatives could not in fact be implemented.
As in earlier years, one of the main problems that emerged was the lack of resources within the community and the gen eral shortage of stepdown and longstay facilities.
The number of casualty attendances in 1996 was 66,264 as compared to 65,964 for 1995. The Mater continues to have the highest number of A&E attendances in the country albeit in very poor conditions.
However, in March 1996, additional places came on stream to allow elderly and chronic sick patients in the Dublin acute hospitals to transfer to levels of care more appropriate to their medical needs. 31 places were allocated to the Mater but in the long term this had little impact on the solution to the hospital's problems.
At year end, the hospital bed complement was 534 which is more than it ever was in the past. However, despite the increase in beds, the hospital continues to experience difficulties in fulfilling its commitment to its patients both national ly and at local level.
Despite the many problems indicated, it must be borne in mind that the Mater had the highest patient casemix index in Ireland in 1995 which means that we are treating more complex cases than any other hospital. Further details of the DRG/HIPE analysis is contained elsewhere in this annual report.
During the year, the Executive Council decided to close 6 Paediatric beds and replace them with an equivalent number of adult ENT beds which would be managed on a 5 day basis.
14 M ATER. MI SER. I COR.D I AE H OSP I TAL ANN UAL R EPOR.T 1996
Developments - 1996:
The number of developments finalised in 1996 was very disappointing in comparison with previous years. The following are the details:
New Oncology Day Unit in St. Vincents Ward Extension to the G.1. Unit (temporary arrangement) 5 additional beds in St. Bernards Ward (Infectious Diseases Unit) E.H.B. funded physiotherapy service for GP's in Mater Catchment Area Continuation of the Management Training Programmes including in-house programme for the National Diploma in Healthcare Management Publication of Community Newsletter Approval of Post-Graduate Courses for Diabetes and Cardiovascular (associated with the opening of the Nursing Post-Graduate Centre -P.R.EN.D.) Opening of Medical Student facilities in old Mater Private Hospital (funded by U.C.D.) Asthma Day Centre (minor funding provided).
Pending Developments:
A number of developments were initiated in 1996 but will not be finalised until 1996 or later.
Completion of construction of new theatre for specialised surgery Refurbishment of 59 Eccles Street (funded by Medical Council) Re-Engineering of services in St. Paul's Hospital, Beaumont Preparing for new Pre-Registration Nursing Diploma in conjunction with U.C.D. (to be implemented in 1996) Negotiating arrangements for Neuro-surgery service with Beaumont Hospital Creation of Renal Dialysis Unit and Nephrology service for the new Professor of Medicine, Prof. Hugh Brady. Formulation of plans for an integrated Adult Psychiatry Unit in Eccles Street Announcement by the Minister for Health regarding the restructuring of the Health Services in Dublin (this will have significant implications for voluntary hospitals such as the Mater).
Cardiac Surgery:
As indicated earlier in this report, the Waiting List for Cardiac Surgery stood at 1,534 as at 31 st December, 1996. This showed a slight reduction due to the outsourcing of cases to the Blackrock Clinic and the Mater Private Hospital.
In order to alleviate the Waiting List, the Department of Health requested 4 hospitals to tender to undertake 500 additional cases each year. The submission will be assessed by the Department of Health Cardiac Surgery Option Appraisal Committee. In the latter part of the year, the hospital formulated a well thought out submission. It is the hospital's view that the Mater should undertake additional basic cardiac surgery in conjunction with implementing a heart/lung and lung transplant programme.
Hospital Development Programme:
The Executive Council continues to be disappointed at the lack of progress in relation to the commencement of the Hospital Development Programme despite Minister Noonan's assurance that he had approved the Development Programme for the hospital on the occasion of his visit to the Mater in January, 1996. Earlier Chief Executive reports have referred to the very poor infrastructure of the hospital particularly the Accident & Emergency and Outpatient departments. The construction of a car park (for staff, patients and visitors) as a self-funding project is vital before work on the actual facilities commences. As a longterm objective, the transfer of the Children's Hospital, Temple Street to the Mater site continues to be a significant component of the hospital's overall strategy.
1 5 M ATER MI SE RI CORDIA E HOSPITAL ANNUAL REPORT 1996
The Executive Council recognises the need to formulate a long term strategic plan for the hospital in conjunction with revising the Hospital Constitution and formulating a Mission Statement. It is hoped that this work will be undertaken in 1996 and 1998.
The Executive Council would also like to improve the management structure of the hospital. During the year, a detailed management structure proposal was formulated incorporating new arrangements for nursing, medical and general man agement. On the medical side, the elected system will continue to prevail, as this has proved to be a success in the Mater over the years.
There continue to be serious problems with the general fabric of the hospital including the need for replacement equip ment. During the year, the hospital submitted a list of capital requirements to the Department of Health totalling £ I ,602,000. In essence this is the "tip of the iceberg" as it represents only a fraction of what is required to bring the facilities of the hospital up to an acceptable modern standard. The main area of concern of the Executive Council in 1996 was the need to replace the angiographic equipment in the X-Ray Department.
Hospital Committees:
The Mater Hospital to a large extent operates by wave of consensus not by autocratic dictat. For this reason, there are many committees throughout the hospital with the stated objective of involVing as many staff as possible in the decision making process.
During the year, the following new committees were set up or reconstituted:
I . The Ethics Committee was revamped with a view to providing it with terms of reference beyond its remit as a vehicle to pass drug trials under the Control of Clinical Trials and Drugs Act 1990.
2. A new Environment Committee was formed to improve the overall ambience of the hospital. The purpose of this multi-disciplinary committee was to suggest ways and means of improving the general decor of the hospital with out necessarily incurring major expenditure. It has also formulated specific proposals to engage a volunteer corps within the hospital which hopefully will commence in 1996 at least on a pilot basis.
3. A No-Smoking Committee was formed under the chairmanship of the Occupational Health Physician. A no-smok ing policy has been in existence in the hospital for some years, but the experience is that this is very difficult to implement.
4. A Cardiovascular Committee was formed comprising the medical interests in the various specialties treating and diagnosing cardiovascular disease in its various forms.
5. An Outpatient Committee was formed under the chairmanship of Mr. Martin Walsh, Consultant OrthopaediC Surgeon to review the operation of the outpatient clinics.
Needlestick Injuries:
The total needlestick incidents for 1996 was 39.
I am very concerned at the proliferation of needlestick injuries within the hospital. A needlestick injury policy has been put in place but unfortunately it has been very difficult to implement workable solutions which will reduce the risk of infection resulting from needlestick injuries. The Risk Management Forum (comprising I I Dublin hospitals) has formed a number of sub-committees which will look at various risk factors within the acute hospitals including a needlestick injury sub-committee. This committee organised a needlestick poster competition, the prizes for which were presented at a special function held at the Mater Hospital during the year.
16 MATER MI SER I CORD I AE H OSP ITA L A NNUAL R EPORT 1996
StafIIng Levels:
The following is an analysis of the staff complement as at 3 I st December, 1996.
CATEGORY Permanent Permanent Temporary Locum Part-Time Sessional Training Total Full Time Job Share 180.00 9.00 20.00 2.00 1.3 30.00 0.00 212.33
27.00 0.00 0.00 3.00 33.80 0.88 141.00 205.68 386.00 34.50 59.00 31.00 4.13 0.32 319.00 833.95 94.00 11 .00 23.00 3.50 6.60 0.49 9.002 47.59 195.00 2.50 24.00 35.50 6.79 0.00 1.002 64.79 34.00 0.00 0.00 0.00 0.00 0.00 0.00 34.00
Tot.]1 1016.00 57.00 126.00 75.00 52.65 1.69 470.00 1798.34
The approved staff complement was 1,666 which means that the hospi tal employed 132 staff in excess of the ceiling approved by the Department of Health at the 31 st December, 1996. However, the Executive Council is satisfied that this excess is necessary in order to enable the hospital to achieve its service commitment to the Department of Health.
In addition it is our contention that the basis upon which the ceiling is ...-ived at is incorrect. Many departments in the hospital are under staffed which makes it very difficult for the hospital to deliver a high quality service to its patients.
Staff in many areas are working under very stressful circumstances due to these shortages. Accident & Emergency is an example of a depart ment which is at the "coal face" looking after a significant patient load while a the same time dealing with bed shortages and inadequate staff IMImbers.
Consultant Appointments 1996:
Prof. Hugh Brady, Professor of Medicine and Therapeutics (replacement for Prof. Garret Fitzgerald who resigned in 1994).
Hr. John D. Russell, Consultant E.N.T. Surgeon (replacement for Mr. • Prof. Hugh Brady William Grant who retired in late 1995).
Hr. James O. Small, Consultant Plastic Surgeon (new appOintment).
Dr. Kevin D. Carson, Consultant Anaesthetist (new appOintment).
Dr. Brian Marsh, Consultant Anaesthetist.
Dr. Cormac P. Redahan, Consultant Anaesthetist (new appOintment).
Dr. Bryon Sweeney, Consultant Psychiatrist with a special interest in drugs misuse (new appOintment).
17 M ATER M ISER I CORD I AE H OSP ITAL ANNUAL R EPORT 1996
Dr. Conor John McCarthy, Consultant Physician/Rheumatologist (replacement for the late Dr. Ciaran Barry).
Dr. William D. Boyd, Consultant Obstetrician/Gynaecologist (replacement for Dr. Peter McKenna, now Master of the Rotunda Hospital).
Dr. John Murray, Consultant Radiologist (replacement for Dr. P. McCann following his retirement).
Irish Nurses Organisation:
The hospital was honoured that Ms. Anne Cody, Theatre Sister, was elected President of the Irish Nurses Organisation.
Word of Thanks:
On behalf of the Executive Council, I would like to thank the following: I. Staff at all levels as well as Religious Sisters for their commitment and loyalty to the hospital.
2. The Department of Health Officials for their continuing support for the hospital.
3. The suppliers, contractors and various professional advisors, all of whom have Significantly contributed to the Mater Hospital success story.
4. The Mater Foundation, for the significant funds raised for the hospital on a voluntary basis.
5. The Medical Executive and Consultant Staff as well as the Nursing Executive for their co-operation in helping man agement achieve a balanced budget.
Martin Cowley, Chairman, Executive Council.
18 M ATER. M ISER. I COR.DIAE H OSP I TAL A NNUAL R EPOR.T 1996
FINANCIAL REpORT AND ACCOUNTS FOR 1996
Summary:
Hospital Expenditure net of income for 1996 was £56.255m. compared with a final allocation of £56.086m. This left an operating deficit of £ 169,000 equivalent to 0.3% of net expenditure.
1996 Financial Year:
On 29th December 1995 the hospital was notified of its Budget 1996. The sum provided was £52.591 m. which included £ 150,000 for Oncology Developments, £ I 00,000 for Plastic Surgery and £50,000 for each of the following specialties: Ophthalmology; Spinal Injuries; Dermatology Day Care and Diabetes Clinic. It also included a positive casemix adjustment of £230,000, which is a reflection of the intensity and complexity of the work undertaken by the Mater, the only hospital in Dublin which received additional funding under this heading. A sum of £5 10,000 was deducted as savings representing I % of net expenditure.
During the year the hospital received additional revenue under a number of headings as follows:-
(a) Waiting List: £ 1.123m. was provided to reduce Waiting Lists in Ophthalmology, ENT, Urology, Plastic Surgery and Cardiology.
(b) Hepatitis 'C': To enable the hospital continue it Hepatitis 'C' Programme, a sum of £330,000 was provided.
(c) Accident & Emergency: A sum of £300,000 was provided to improve facilities and conditions in the Accident & Emergency Department. This sum included the extension of Digitised Imaging facilities to the Accident & Emergency Department.
(d) New Technology Medicine Initiative: Funding of £ I 03,000 was provided under this heading to purchase equipment for the X-Ray Digitised Imaging Project and for the supply of new drugs for HIV infected patients.
(e) Other: Further funding was provided for Clinical Waste Disposal following the closure of the hospital's incinerator, increased funding for Oncology Drugs and for new procedures in Cardiac Surgery (Cardioplegia).
A summary of the additions to the Base Allocation is as follows:- £'000 Base Allocation 52,591 Additions: Waiting list Initiative 1,123 MPH Cardiac Surgery 375 Hepatitis 'C' 330 Technology Inflation 103 Accident & Emergency 300 Payroll Amendments 687 Other 577 Final Allocation: 56,086
19 M ATER MI SER I CORD I AE H OSP I TAL AN NUAL R EPORT 1996
Despite the overrun of £ 169,000, much credit must go to staff at all levels in the hospital for their patience and support as well as sacrifices made during the year.
1996 Capital Programme
The hospital received approval for £ 1.021 m. in Capital Grants in 1996. This was utilised to upgrade hospital accommodation and to purchase items of equipment such as Telephone System, Vitrecto my Equipment for Ophthalmology, Sonos Echo System for ITU, EEG Machine and the finalisation of the Cardiac Catheterisation Laboratory. Included also was an Information Technology Grant to further develop the Imaging System and addi tional costs associated with the Computer Disaster Recovery and Healthlink Projects.
In addition, there was a Capital Grant of £300,000 approved for Fire Preventio n works.
1996 Service Plan
The hospital more than met its 1996 Service Commitments as agreed with the Department of Health. In addition. the hospital delivered on it Waiting List targets for the year. The foll owing table summarises the 1996 activity lev els (including Waiting List):-
Actual Plan Variance In-Patient 16,635 17,70 1 (1,069) Day Case 16,619 14,797 1,507 33,254 32,498 438
Included in the above figure are 1,480 additional cases which were funded thro ugh the Waiting List Initiative.
Other Features
Clinical Budgeting There was continued development and enhancement ofthe Clinical Budgeting System in 1996. It is envisaged that this will be launched in 1997.
Cash Flow There are continuing cash flow problems resulting in extended credit being taken from the Hospital Suppliers. They were caused by budgetary problems throughout the year, exacerbated by unpaid past deficits (overruns) not funded by the Department of Health amounting to £ l.3m.
The effort to reduce expenditure resulted in considerable inconvenience to both patients and staff as a conse quence of the various measures which were adopted by the Executive Council. The following measures were put in place during the course of the year to reduce expenditure:-
Theatres were closed on a rotational basis throughout the summer months. St. Laurence's (General Medical/Surgical Ward) was closed for 4 months. I Day and 5 Day Wards closed on alternate weeks for 5 months. 2 ITU beds were closed for second half of year. CT Scanner was closed for approximately 3 months.
Budgetary pressures in the Cardiology Department resulted in delays in procuring the necessary consumables for Angioplasty treatment and other interventional procedures.
There was also loss of semi-private beds due to logistic circumstances beyond the control of the hospital which also resulted in the reduction of income.
20 M ATER MI SERICORD I AE H OSP I TA L AN NUAL R EPORT 199 6
At the end of the day, but for the provision of substantial once-off funding towards the latter part of the year, the financial position of the hospital would have been much worse. In essence, the savings of £510,000 (I % net of expenditure) imposed by the Department of Health at the start of the year was unrealistic and could not be achieved under present circumstances.
21 MATER MIS ER ICORDIAE HOSPITAL ANNUAL REPORT 1996
MATER MISERICORDIAE HOSPITAL FINANCIAL STATEMENTS Year Ended 31st December 1 996 INDEX
Page
Statement and Responsibilities of the Board ...... 23
Auditors' Report ...... 24
Balance Sheet ...... 25
Capital Statement ...... 26
Cash Flow Statement ...... 27
Notes to the Financial Statements ...... 28-32
Detailed Income and Expenditure Statement ...... 33
22 M ATER M rSERICORD I AE H OSPITA L A NNUAL R EPORT 199 6
Mater Misericordiae Hospital RESPONSIBILITIES OF THE BOARD OF MANAGEMENT
The Board of Management are required by the Sisters of Mercy and the Department of Health to prepare financial state ments for each financial year which give a true and fair view of the state of affairs of the hospital and of the surplus or deficit for that period.
In preparing the financial statements, the Board of Management is required to:
Select suitable accounting policies and apply them consistently;
Make judgements and estimates that are reasonable and prudent;
Prepare financial statements in accordance with the Standard Acccounting Policy Guidelines of the Department of Health.
The Board is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the hospital and to enable them to ensure that the financial statements comply with the Standard Accounting Policy Guidelines.
They are responsible for safeguarding the assets of the hospital and for taking reasonable steps for the prevention and detection of fraud and other irregularities.
Statement of the Board of Management
The Annual Financial Statements for the year ended 31 st December 1996 including the Balance Sheet, Income and Expenditure Account etc. comprising pages 24 to 32 inclusive, were presented to and approved by the Board.
To the best of our knowledge these accounts have been compiled in accordance with both the Standard Accounting Policy Guideline requirements and conditions attached to the Allocation Letter of the Department of Health.
Signed: Sr. Margherita Rock Signed: ______Martin Cow/ey ___ Executive Chairperson Chief Executive
Date: _/S_t_h....::....l_u/....::....y_/_9_9_7 ____
23 M ATER M ISERICORDIAE H OSPITAL ANN UAL R EPORT 1996
Mater Misericordiae Hospital AUDITORS' REPORT
TO THE SISTERS OF MERCY AND THE DEPARTMENT OF HEALTH
We have audited the financial statements on pages 25 to 32 which have been prepared under the historical cost conven tion. as modified by the revaluation of certain fixed assets. the Standard Accounting Policy Guidelines of the Department of Health and the accounting policies set out on pages 28 and 29.
Respective responsibilities of the Board of Management and Auditors As described on page 23 the Board of Management are responsible for the preparation of financial statements. our responsibility to form an independent opinion. based on our audit. on those statements and to report our opinion to you.
Basis of opinion We conducted our audit in accordance with Auditing Standards issued by the Auditing Practices Board. An audit includes examination. on a test basis of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the sign ificant estimates and judgements made by the Board of Management in the prepa ration of the financial statements. and of whether the accounting policies are appropriate to the hospital's circumstances. consistently applied and adequately disclosed.
We planned and performed our audit so as to obtain all the information and explanations which we considered neces sary in order to provide us with sufficient evidence to give reasonable assurance that the financial statements are free from material misstatement. whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.
Opinion In our opinion the financial statements give. in so far as concerns the Department of Health. a true and fair view of the state of the hospital's affairs at 3 I st December 1996 and of its result for the year then ended and have been properly prepared in accordance with the Standard Accounting Policy Guidelines of the Department of Health.
We have obtained all the information and explanations we consider necessary for the purposes of our audit. In our opinion. proper books of account have been kept by the hospital. The financial statements are in agreement with the books of account.
Robert J. Kidney & Co. Chartered Accountants & Registered Auditors, 12 College Greene, Dublin 2. 15th July 1997
24 M ATER M ISERICORDIAE HOSPITAL ANNUAL REPORT 1996
Mater Misericordiae Hospital
BALANCE SHEET
at 31 st December 1996
1996 1995 Note IR£'OOO IR£'OOO
2 122,117 124,578 3 1,148 1,073 4 6,453 5,894 5 3,575 3,419
133 ,293 134,964
Uabilities Accounts Payable 6,880 6,838 Leasing Commitments 6 1,235 835 Bank Overdraft 11 4,850 3,909 76 100
13,041 11,682
Net Assets 120,252 123,282
Represented by: Capital Statement (Page 26) (1,538) (1,369) Capital Reserve 7 121,790 124,651
120,252 123,282
ON BEHALF OF THE BOARD Sr. Margherita Rock £ncutlve Chairperson
Mr. James W. O'Connor Board Member
The notes on pages 28 to 32 fo rm part of these financial statements.
25 M ATER MI SER I CORDIAE H OSP I TAL A N N UA L R EPORT 1996
Mater Misericordiae Hospital
CAPITAL STATEMENT
Year Ended 31 st December 1996
1996 1995 Note IR£'OOO IR£'OOO
Net Expenditure (56,255) (53,474) Revenue Grants Receivable 56,086 53,440
Operating Expenditure over Allocation (169) (34)
Non-Grantable Expenditure: Provision for Doubtful Debts 8 ( 172)
Total Expenditure over Allocation ( 169) (206) Prior Years' Deficits Received 442 Balance brought forward (1,369) (1,605)
Balance carried forward (1,538) (1,369)
ON BEHALF OF THE BOARD Sr. Margherita Rock Executive Chairperson
Mr. James W. O'Connor Board Member
The notes on pages 28 to 32 form part of these financial statements.
26 M ATER. M ISER. I COR.O I AE H OSPITAL A NNUAL R EPOR.T 1996
Mater Misericordiae Hospital
CASH FLOW STATEMENT
Year Ended :) I st December I 996
1996 1995 Note IR£'OOO IR£'OOO
Net Cash Flow from Operating Activities 9 (56,161 ) (51,519)
Returns on Investment and Servicing of Finance - Dividends Received 7 7 - Interest Paid on Loans and Overdraft (52) (30) - Interest Paid on Finance Leases ( 143) (87)
Net Cash Flow from Returns on Investments and Servicing of Finance (188) (11O)
Investing Activities - Assets Purchased by Revenue Grants ( 193) (493) - Assets Purchased by Capital Grants (1,506) (1,595) - Proceeds from Sale of Properties 335
Net Cash Flow From Investing Activities (1,364) (2,088)
Net Cash Flow before Financing (57,713) (53,717)
Financing - Department of Health Capital Grants 1,332 1,853 - Department of Health Revenue Grants 55,701 51,580 - (Decrease)/lncrease in Bank Short Term Loan (24) 29 - Finance Lease Capital Repayments (237) (269)
56,772 53,193
(Decrease)/lncrease in Cash and Cash Equivalents 10/11 (941) (524)
The notes on pages 28 to 32 form part of these financial statements. 27 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 1996
Mater Misericordiae Hospital
NOTES TO THE FINANCIAL STATEMENTS
Year Ended 3 I st December I 996
NOTE I. ACCOUNTING POLICIES
(a) Basis of Accounting
The Financial Statements are prepared in accordance with the historical cost convention, as modified by revaluation of certain fixed assets. Income and expenditure of the hospital, whether of a capital or re nature, are written off to the Income and Expenditure Statement in the year they arise with the excep· the following:-
Fixed Assets
- Land and Buildings
Land and Buildings are shown in the accounts at the insurance value as at 31 st December 1991 . Subseq additions are included at cost.
- Equipment
A fixed asset register was prepared to 3 I st December, 1992 and cost, depreciation and net book values shown at that date. Subsequent additions are included at cost.
- Depreciation
Depreciation is provided over the assets as follows:
Buildings - 2.5 % reducing balance Equipment - Over the estimated useful life
Retrospective Pay Awards
The expense is charged in the year in which the Department of Health allows the corresponding reve allocation and therefore not necessarily in the year to which the expense relates.
Out Patient and Road Traffic Accident Income
This income is accounted for on a cash receipts basis.
28 M ATER MI SER I CORDIAE H OSP I TAL A NNUAL R EPORT 1996
Mater Misericordiae Hospital NOTES TO THE FINANCIAL STATEMENTS
Year Ended 3 I st December I 996
NOTE I. ACCOUNTING POLICIES (Continued)
(b) Government Grants - Capital
Government Grants in respect of the capital expenditure which are unpaid at the accounting date are accrued and shown as being receivable.
(c) Government Grants - Revenue
Government Grants in respect of revenue expenditure are shown as recoverable only to the extent that they have not exceeded the agreed allocation.
(d) Stocks
Stocks on hand at the year end are included in the Financial Statements at average cost.
These are comprised of pharmaceutical stocks in the Pharmacy and Wards, stocks in the Orthopaedic, Anaesthetic and Cardiovascular Theatre and in the Central Surgical and Central Supplies Departments. All other stocks are held on an ongoing basis and are not included in the accounts.
NOTE 1. FIXED ASSETS
Buildings Equipment Total IR£'OOO IR£'OOO IR£'OOO
At Cost & Revaluation At I st January 1996 130,576 18,979 149,555 Additions during year 733 1,105 1,838 Disposals during year (85) (85)
At 3 I st December 1996 131,224 20,084 151,308
Depreciation At I st January 1996 15,321 9,656 24,977 Charge to Capital Reserve 2,900 1,335 4,235 Disposals during year (21 ) (21 )
At 3 I st December 1996 18,200 10,991 29,191
Net Book Value At 3 I st December 1996 113,024 9,093 122,117
At 31 st December 1995 115,255 9,323 124,578
29 M ATER MI SERICORDIAE H OSP I TAL A NNUAL R EPORT 199 6
Mater Misericordiae Hospital NOTES TO THE FINANCIAL STATEMENTS
Year Ended 31 st December 1996
NOTE 3. STOCKS
1996 1995 IR£'OOO IR£'OOO
Pharmacy Stock 535 458 Medical and General Supplies 237 248 Orthopaedic Supplies 165 140 Anaesthetic Supplies 44 52 Cardiovascular Stock 115 123 Surgical Supplies 52 52
1,148 1,073
NOTE 4. GRANTS RECEIVABLE
1996 1995 IR£'OOO IR£'OOO
Revenue Grants - Current Year 5,752 5,367
Capital Grants 701 527
Balance due at 3 I st December 6,453 5,894
NOTE S. ACCOUNTS RECEIVABLE
1996 1995 IR£'OOO IR£'OOO
Patient Debtors 736 738 Other Debtors and Prepayments 2,839 2,681
3,575 3,419
30 M ATER MI SER I CORO IAE H OSPITAL A NNUAL R EPORT 19 96
Mater Misericordiae Hospital NOTES TO THE FINANCIAL STATEMENTS
Year Ended 11 st December I 996
NOTE 6. LEASING COMMITMENTS
1996 1995 IR£'OOO IR£'OOO
Finance lease repayments, net of interest: Amounts due within one year 293 237 Amounts due after more than one year 942 598
1,235 835
NOTE 7. CAPITAL RESERVE
1996 1995 IR£'OOO IR£'OOO
Opening balance 124,651 127,233
Fixed asset additions 1,838 1,497 Fixed asset disposals (85) (5) Depreciation charge (4,214) (4,261) Finance lease (commitments)/repayments (400) 187
Closing Balance 121,790 124,651
NOTE 8. PROVISION FOR DOUBTFUL DEBTS
This charge represents a provision for debts which are in excess of one year old at the year end.
31 MATER MISERICOROIAE HOSPITAL ANNUAL REPORT 1996
Mater Misericordiae Hospital NOTES TO THE FINANCIAL STATEMENTS
Year Ended 3 I st December I 996
NOTE 9. NET CASH FLOW FROM OPERATING ACTIVITIES
1996 1995 IR£'OOO IR£'OOO
Net Expenditure (56,255) (53,474)
Dividends received (7) (7) Interest paid 52 30 Stocks (75) (93) Accounts receivable ( 156) 922 Accounts payable 42 426 Provision for doubtful debts (172) Assets charged to revenue and capitalised 193 493 Finance lease interest payments 143 87 Finance lease capital repayments 237 269 Proceeds from sale of properties (335)
Net cash flow from operating activities (56,161) (51,519)
NOTE 10. ANALYSIS OF THE CHANGES IN CASH AND CASH EQUIVALENTS
1996 1995 IR£'OOO IR£'OOO
At I st January (3,909) (3,385) Net Cash (Outflow)/Inflow (941) (524)
At 3 I st December (4,850) (3,909)
NOTE I I. ANALYSIS OF THE BALANCE OF CASH AND CASH EQUIVALENTS
Change 1996 1995 IR£'OOO IR£'OOO IR£'OOO
Cash at Bank (543) 5 548 Bank Overdraft (398) (4,855) (4,457)
(941) (4,850) (3,909)
NOTE 11. FINANCIAL STATEMENTS APPROVAL These Financial Statements were approved on behalf of the Board of Management on 15th July 1997.
32 M ATER MI SER I CORD I AE H OSP I TA L A NNUAL R EPORT 1996
Mater Misericordiae Hospital DETAILED INCOME AND EXPENDITURE STATEMENT
Year Ended 11 st December I 996
1996 1995 IR£'OOO IR£'OOO
EXPENDITURE
Pay Administ rative 3,430 3,423 Medical 9,544 8,848 Nursing and Allied 14,290 13,662 Para-Medical 6,048 5,622 Catering, Housekeeping & Portering 2,975 2,780 Maintenance 838 723 Other 144 129 Superannuation 1,119 1,071 Employers' Social Welfare 1,947 1,726
40,335 37,984
Non-Pay Medical Expenses 14,179 13,466 Provisions 972 868 Maintenance, Power & Clearing 3,731 3,556 Finance Charges 744 788 Office Overheads 2,428 2,305
22,054 20,983
62,389 58,967
INCOME
Payroll Deductions 1,909 1,744 Cafeteria Income 716 656 Sundry Income 285 251 Patient Income 2,889 2,842 Sale of Properties 335
6,134 5,493
Net Expenditure 56,255 53 ,474
Revenue Grants Receivable 56,086 53 ,440
Operating Expenditure Over Allocation 169 34 33 MATE R MISERI COROIAE HOSPITAL ANNUAL RE PORT 1996
H.r.p.E. UNIT
linical information in relation to in-patients and day cases is reported monthly to the Department of Health through the Hospital In-Patient Enquiry (HIPE) System. The overall capture rate of data for patients discharged in 1996 was 99.7%. The quality assurance exercise involving measuring the completeness of discharge sum Cmaries and the accuracy of ICD coding is ongoing. The main objective of the HIPE Unit is to ensure that the data accurately represent the casemix of the hospital..
The casemix index was 1.52 which was the highest in the country. It increased from 1.48 the previous year. The adjust ment to the budget on the basis of casemix was +£212,823 which rewarded this hospital for its efficiency relative to the other major hospitals with whom it was compared. The Mater Hospital was the only Dublin hospital to have a positive casemix adjustment.
A major issue during the year was the high level of staff turnover, necessitating complex and time consuming training of new staff. Diversion of the remaining staff to other administrative areas remains a concern.
The following is a list of the top 30 Diagnostic Related Groups (DRGs) for in-patients in 1996. The number, average length of stay, bed days and average age are stated for each DRG. They represent 35% of the total in-patients discharged.
34 MATER M ISERICORD I AE HOSPITAL ANNUAL REPORT 1996
Top 10 DRGs in 1996 by Volume
DRG Description Total Alos Bed Days Av. Age d 107 Coronay Bypass w/o Cardiac Cath 594 14.508 8618 59.774 88 Chronic Obstructive Pulmonary Disease 421 10.413 4384 68.739 39 Lens Procedures 379 4.319 1637 71 .369 183 Esophagitis. Gastroent & Misc. Digest> 17 w/o C/C 347 5.648 1960 50.594 112 Percutaneous Cardiovascular Procedures 331 12.124 4013 59.505 243 Medical Back Problems 245 7.367 1805 45.061 14 Specific Cerebrovascular Disorders 235 20. 183 4743 72.851 182 Esophagitis. Gastroent & Misc. Digest> 17 w C/C 210 8.200 1722 59.014 105 Cardiac Valve Procedures w/o Cardiac Cath 210 17.390 3652 59.281 127 Heart Failure & Shock 96 12.653 2480 74.673 410 Chemotherapy withou;t Acute Leukemia 88 3.548 667 40.947 125 Circulatory Disorders Except AMI . W Card 78 10.652 1896 59.399 403 Lymphoma & Non-Acute Leukemia W CC 73 11.231 1943 52.277 132 Atherosclerosis with CC 70 7.782 1323 67.688 42 Intraocular Procedures Except Retina 59 7.748 1232 59.585 89 Simple Pneumonia & Pleurisy Age> 17 with C/C 51 11.815 1784 72.026 119 Vein Ligation & Stripping 40 1.921 269 51.986 47 Other Disorders ofthe Eye Age> 17 W/O C/C 39 5.906 821 54.360 162 Inguinal & Femoral Hernia Procedures Age 36 2.596 353 47.360 219 Lower Extrem & Humer Proc > 17 W/O C/C 34 7.716 1034 41.313 59 Tonsillectomy &Ior Adenoidectomy only 33 2.556 340 25.805 122 Circulatory Disorders W AMI W/O c.v. C/C 24 10.290 1276 65.355 82 Respiratory Neoplasms 22 14.221 1735 65.746 73 Other Ear. Nose. Mouth & Throat 18 3.288 388 47.068 148 Major Small & Large Bowel Procedures 16 26.595 3085 6 1.414 229 Hand or Wrist Proc. Except Major Joint 13 1.708 193 32.487 140 Angina Pectoris 13 7.478 845 67.965 124 Circulatory Disorders except AMI . W card 13 15.442 1745 62.257 167 Appendectomy W/O C/C 10 4.209 463 25.864 40 Extraocular Procedures except Orbit> 17 06 4.575 485 51 .358
Total 5904 9.136 56891 55.771
35 ·"..
M ATER M ISERICORD I AE H OSP I TAL A N N UAL R EPORT 1996
MANAGEMENT SERVICES DEPARTMENT computer Professionals of the Year
he Hospital's Management Services Department were the winners of Ireland's premier Computer Award the Memorex Telex Computer Professionals of the Year Award for 1996, presented in association with the magazine Business and Finance. Previous sinners of the award, which has been presented for the past Ttwelve years have included E.S.B., Bord Failte, D.H.L., and Allied Irish Banks. The Management Services Department who received a special merit award in the 1993 award ceremonies, received their award from Mr. Pat Rabitte, T.D., Minister for Commerce, Science and Technology, at a ceremony held in the Berkeley Court Hotel on I I th December 1996. The runners up in this year's competition were Allied Irish Banks, Scottish Amicable Insurance Company, and First Call Direct Insurance Company. The board of adjudi cators comprising of industry professionals, Ernst and Young, Management Consultants, K.P.M.G., Management Consultants, and the Irish Management Institute gave the award for, in the words of their citation:
"for excellence and innovation in the design and development of Medical Information Technology Systems enabling access to integrated clinical data and diagnostic images at al/ points in a patient's treatment".
The adjudicators paid particular reference to the Healthlink project, which, together with the integrated imaging system, has been developed by the Management Services Department and funded by the Department of Health. The Healthlink system, which was initially designed to facilitate access to clinical and administrative data by General Practitioners, has been extended to allow access and interaction in regard to all clinical data and images by all healthcare professionals. The Department of Health have indicated that this will be the standard system for linking hospital computer systems, with computer systems operated by health care professionals in the community and outside the hospital environment.
• John Brennan, Business and Finance, Sean Hickey, Management Services, Oeirdre Hyland, Management Services, Kevin Peyton, Management Services, Mr. Pat Rabbitte, T.O., Minister for Commerce, Science and Technology, Gerard Hurl, Management Services Officer, Robert Stuart, Managing Director, Memorex Telex Ireland and Sean Doyle, Management Services.
36 M ATER M ISERICORD I AE HOSPITAL A NNUAL R EPORT 1996
The award was received by Mr. Gerard Hurl, Management Services Officer, and members of the team who were present at the award ceremony included Mr. Sean Hickey, System Development Officer, Ms. Deirdre Hyland, Application Support Officer, Mr. Kevin Peyton, Project Manager - Healthlink Project, Mr. Sean Hickey, nalystlProgrammer - Healthlink Project. Unfortunately, unable to attend was Mr. John MacEnri, Project Manager - Imaging Project. Also attending the award ceremony were Sr. M. Margherita, Executive Chairperson, Mr. M. Cowley, Chief Executive and Professor J.T. Ennis, Chairman of Executive Committee of the Medical Council.
Information Technology Strategy - National Breast Screening Programme
As a result of the publication of the National Cancer Strategy and the establishment of the National Breast Screening Programme, the Management Services Department were appointed by the Department of Health to project manage the development, implementation and support of the information technology strategy and system for the National Breast Screening Programme.
Nursing Systems
The work associated with the introduction and implementation of patient dependency and the undertaking of a quality assurance programme based on "Criteria for Care" and "Monitor 2000" methodologies as part of the nurs ing project continued throughout the year. The introduction of the computerised patient dependency analysis as a major element of the project to introduce structured processes to support nursing care throughout the hospital commenced in October. This system enables on line data entry, review and analysis of dependency status of patients throughout the hospital.
Hospital Information System
During the latter half of 1996, specification work commenced on a number of hospital departments with a view to implementing the order communication/result reporting facilities. These included theatre, vascular and cardio-vas cular departments. The development and introduction of integrated hospital wide scheduling facilities also com menced.
Institute of Healthcare Informatics
The first formally credited course in Healthcare Informatics in Ireland, was introduced during 1996 by the Institute of Healthcare Informatics. This course is the Higher Diploma in Healthcare Informatics, a post-gradu ate course, undertaken by students utilising a training programme specifically designed for home study using die Internet. This is one of the first such courses introduced and implemented throughout the world, and has attracted a significant academic interest in regard to the methodologies used to implement and support the programme.
Integrated Imaging System
On 25th September, Ms. Mary Cadwell, Chief Executive, Shared Medical Systems (SMS), officially launched the European version of SMS's clinical imaging system. This system, which has been developed jointly by the hospital and SMS has been operating successfully in the Intensive Care and Radiology Departments for the last eighteen months and is currently being extended to the Accident & Emergency Department.
Pharmacy System
It was decided that resources within the Management Services Department would be utilised to design, develop, Implement and introduce an integrated Pharmacy System. A pharmacy project group representing all areas and dis dplines involved was established and specification work commenced. 37 M ATER. MI SER.ICOR.D I AE H OSP ITAL ANN UA L R EPOR.T 1996
Papers and Presentations
Practical Teleradiology for MRI and CT Examinations. Royal College of Surgeons in Ireland, Annual Imaging Meeting, Dublin, January 1996. J. MacEnri, B. Coburn, G. Hurl, J. T. Ennis.
Teleradiology System for Emergency CT Reporting. Association for Physical Sciences in Medicine, Annual General Meeting, Athlone, November 1996. J. MacEnri, B. Coburn, K. Peyton, J. T. Ennis .
Cost-Effective Teleradiology Cover for Emergency MRI and CT Examinations. Radiological Society of North America, Annual Scientific Meeting, Chicago, December 1996. J. MacEnri, G. Hurl, J. T. Ennis, B. Coburn.
The impact of DICOM 3.0 on the Implementation of an Integrated Imaging System. Healthcare Informatics Society of Ireland, Annual General Meeting, Dublin, 1996. J. MacEnri.
Compression Techniques in Digital Medical Imaging. School of Diagnostic Imaging, Digital Imaging Seminar, Dublin, March 1996. J. MacEnri, N. Ph elan.
Nursing and Information Technology. Senior Nurse Management Seminar, South Eastern Health Board, Waterford, 1996. R. Murnane.
Nursing and Informatics - The Nursing Professions Response to Ensuring Technology Cares. Healthcare Informatics Society of Ireland Conference, October 1996. R. Murnane.
Implementing Structured Information Processes to Manage Nursing Resources. Healthcare Informatics Society of Ireland, October 1996. H. Dunne, G. Wyer.
Healthlink, A Patient centred electronic Healthcare Network. Presentation to European Board for E.D.1. Standardisation, Expert Group 9, Healthcare, January 1996. S. Hickey.
The Virtual Study Centre. Presentation to the International Conference on Multimedia in Health Sciences Education, Copenhagen 1996. S. Hickey, M. Davies.
The Virtual Study Centre. Proceedings of the 2nd International Conference on Distance Education in Russia, 1996. S. Hickey, M. Davies.
The Virtual Study Centre. 12th Annual Conference on Distance Teaching and Learning. University of Wisconsin-Madison, USA, 1996. S. Hickey, B. Coburn.
38 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 199 6
Medical Education - The Impact of Multimedia and Distance Education. Healthcare Informatics and the Web Seminar, in conjunction with the Annual Conference of the Association of Clinical Biochemists in Ireland, 1996. S. Hickey.
Multimedia Intranet and Internet - The implications for Medical Education. Technology and Training Seminar, University College Dublin, 1996. S. Hickey.
Using Multimedia and the Internet. Technology in Education, Educational Media Association of Ireland, 1996. S. Hickey.
Bilateral Temporal Lobe Spectroscopy in Monozygotic Twin Sets Discordant for Schizophrenia. Radiological Society of North America, Chicago, December 1996. P. Gil/igan, D. Cotter, D. Wa/sh, B. Coburn, C. Larkin, E. O'Cal/aghan, j. Waddington, j. T. Ennis.
Bilateral Localised Temporal Lobe Proton Spectroscopy in Monozygotic Twin Sets Discordant for Schizophrenia. p. Gil/igan, D. Cotter, D. Wa/sh, B. Coburn, C. Larkin, E. O'Cal/aghan, j. Waddington, j. T. Ennis.
Pre-Surgical Assessment of Breast Lesions using Proton Spectroscopy. Magnetic Resonance Materials in Physics, Biology and Medicine, June 1996. P. Gil/igan, F. F/anagan, B. Coburn, M.P. O'Sullivan, O.M. Redmond, j. Ennis.
Proton Spectroscopy in Pre-Pathological Assessment of Breast Lesions, 1996. Eurospin Annual 1995-1996. Symposium on Lipid Metabolism and Function in Cancer. P. Gilligan, F. F/anagan, B. Coburn, M.P. O'Sullivan, O.M. Redmond, j. Ennis .
Pre-Surgical Assessment of Breast Lesions using Proton Spectroscopy. British Journal of Radiology, May 1996. P. Gi/ligan, F. F/anagan, B. Coburn, M.P. O'Su/livan, O.M. Redmond, j. Ennis.
Localised Bilateral Temporal Lobe Proton Spectroscopy in Monozygotic Twin Sets Discordant for Schizophrenia.
Imaging Symposium, Albert Theatre, The Royal College of Surgeons in Ireland, March 1996. B. Coburn, P. Gil/igan, D. Cotter, E. O'Cal/aghan, C. Larkin, j. Waddington, j. Ennis .
39 MATEft MI SEft l COftDIAE H OSPITAL ANNUAL R EPOftT 1996
THE MATER FOUNDATION
he Mater Foundation continued its main fund raising for the Out-Patient Department and the Accident & Emergency Development Project. recognising the fact that when this comes on stream. the funds will provide Tthe Hospital with most up to date facilities. The Foundation are deeply appreciative of the work of the various committees; the Events Committee who each year run a very successful Bridge Morning. a concert and a Walk in the Park. the proceeds of which help fill the coffers of the ever increasing fund for the Accident & Emergency and Out-Patients Departments. The Mater Charity Shop in Dorset Street could not function without the support of the Events Committee whose members staff the shop daily on a volun tary basis under the guidance of Sr. Gerard.
A special word of thanks must be extended to the Friends of the Mater Committee. who each year organise the Art Exhibition. and this year put together their 20th Exhibition. Not alone is this a very successful fundraiser. but. it is also one of the big social occasions of the year.
The Retired Committee have taken the Car Raffle under their wing and have done a splendid job during the last two years. The next car draw will take place in June of this year.
The Mater Foundation have had their usual two Golf Classics - one for the Foundation and the other for the Cardiovascular Unit - both successful as well as enjoyable events.
The Annual "Help Us Fix It" badge campaign in aid of the proposed "Heart House" was. once again . run very successfully in February.
The Mater Foundation continues to be the main contributor to the Catherine McAuley Day Care Centre and the Summer Students Research Projects.
Other areas which required funding during the year were the maintenance and upkeep of the Car Park. the erection of the lights on the Christmas Tree in the Park and the funding of the "Heart of the Mater" magazine.
During the last ten years there has been. at times. certain unjustified criticism of the Foundation regarding the dispersal of funds. To alleviate any fears. it was decided to issue a Newsletter which has been widely welcomed. This Newsletter illustrates the work being carried out by the Foundation for many areas of the Hospital but. in particular. outlines the huge benefits received by the Cardiac and Breast Screening areas.
Fundraising has become a very commercialised business and we have. at all times. attempted to keep our overheads to a minimum. We should be very proud of the fact that all our helpers are volunteers.
A special word of thanks should be paid to the Corporate Committee who have the unenviable task of trying to prize large amounts of monies from Corporate "friends" and. again. our thanks to the guiding and firm hand of our Chairman. Mr. Declan McCourt. who has devoted so much of his valuable time to the future of the Mater Hospital.
The follOWing are areas in the Hospital which have benefitted from the work of the Foundation.
40 M ATEIt MI SElt l COItOIAE H OSPITAL A N N UAL R EPOltT 1996
ECCLES BREAST SCREENING PROGRAMME: ••••••••••••••••••••••••••••••••••••••••••••••• f800,000 Ireland's first and only Breast Screening Programme, initiated by the Foundation, where over 18,000 women were screened free of charge. The Government has now committed to extending the project countrywide.
CARDIAC PULMONARY RESUSCITATION UNIT: ...... 1.17,500 This unit, which is of most importance in a teaching hospital, was opened by the Foundation in 1988. Over 2,500 staff have been trained in resuscitation to date.
CANCER UNIT: •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ." 26,000 The Mater Foundation, through various fund-raising projects, has donated over £26,000.
THE CATHERINE MCAULEY DAY CARE CENTRE: •••••••••••••••••••••••••••••••••••••••••••••• I. 65,000 This centre, which was opened in 1989, caters for the elderly living alone within the precincts of the Hospital.
MEDICAL STUDENTS RESEARCH PROGRAMME: •••••••••••••••••••••••••••••••••••••••••••••••• I. 28,500 This unique programme has produced a substantial amount of original and valuable information on wide ranging subjects. The Foundation provides the major portion of the funding reqUired.
THE "HELP US FIX IT" CAMPAIGN: ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 1.560,000 This campaign was first organised by the Mater Foundation in 1992 to increase cardiac surgical operations and to improve facilities in this area. Over £65,000 was spent to establish the Cardiac Rehabilitation Programme and over 500 patients have benefitted to date.
"HEART HOUSE": ••••••••••.••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ", I 00,000 This is an ongoing campaign in support of the Cardiovascular Department to establish a centre for families to be screened and counselled where there is evidence of heart disease.
INTENSIVE CARE AND HIGH DEPENDENCY UNIT: ••••••••••••••••••••••••••••••••••••••••••• 1.172,800 The upgrading and refurbishment of this unit was carried out with help from the Foundation and enabled the Hospital to increase the bed capacity in these vital areas.
ACCIDENT & EMERGENCY AND OUT-PATIENTS DEVELOPMENT FUND: •••••••••••• 1.417,000
OPHTHALMIC DEPARTMENT: ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 1.10,3 11
41 M ATER MI SER I CORD I AE H OSP I TAL AN NUAL R EPORT 19 96
OCCUPATIONAL HEALTH DEPARTMENT
Staff
he Occupational Health Department has now completed its first full year of service. The staff have increased from one part-time Occupational Health Physician to a full time Occupational Health Nurse and Secretary. The TOccupational Health Physician's hours have been increased to a daily basis (Monday to Friday). Activities
Our workload mainly concerns: pre-employment medicals sickness absence medicals staff occupational injuries (dermatitis, back injuries, respiratory problems associated with work, etc.)
We also give advice and hold educational meetings regarding Hepatitis B vaccination, TB and help with giving up smoking (see photographs "Open Day on Smoking Cessation Programme" which was held on Wednesday, 9th October 1996 on the link Corridor as part of the Hospital's Health and Safety at Work Week).
Protocols
Protocols have been put into place regarding needlestick injury reporting, Hepatitis B vaccination, violence at work and anti-viral therapies.
Vaccinations
One to the primary hazards associated with major hospitals, these days, is the risk of members of staff becoming infect ed with Hepatitis B or indeed passing Hepatitis B on to a patient. This can be minimised by ensuring that as many staff as possible are vaccinated against Hepatitis B. In the past year, 932 personnel have been vaccinated against Hepatitis B by the Occupational Health Department.
Premises
The Occupational Health Department has moved into new premises at the back of 398 North Circular Road. The,se much improved facilities will allow staff to sit in comfortable surroundings whilst awaiting their appointment with the Doctor or Nurse. Health promotion literature and videos are available whilst waiting.
Plans for I 997
In the coming year we will be looking further to increase the percentage of staff who receive the Hepatitis B vaccination. We will also be commencing Mantoux testing of members of staff as an assessment of their susceptibility to TB. We also hope to carry out some Health Promotion on all members of staff on a regular basis throughout the year.
A major new direction for the Occupational Health Department is the looking after the manual handling in the hospital along with the accident reporting. We hope that 1997 will see full computerisation of the department. With this we will be able to send reminders to all staff on a regular basis with regard to any further healthcare intervention required that would decrease their exposure to hazards at work.
42 M ATE R MI SER I COR DI AE H OSP I TA L AN NUAL R EPORT 1996
SAFETY, HEALTH & WELFARE AT WORK ACT, 1989
Introduction
he 1989 Safety. Health and Welfare at Work Act. 1989 obliges every employer to provide not only a safe place of work for those employed but also a safe system of work. The increasing level of litigation due to accidents in work and the resulting awards of compensation by the Courts highlights the vital importance of keeping the Tworkplace safe. The Irish Business Employers Confederation (I.B.E.C) launched an initiative which is designed to promote a safety cul ture in every workplace. This policy requires that good standards of health and safety are aimed for and are integrated into the main stream of an organisation and managed in the same way as other matters vital to the operation of the busi ness. The safety culture represents a mix of shared values. attitudes and patterns of behaviour that give the whole business its particular character. Negative attitudes which accept that a certain level of accident is inevitable are fatal and a belief in total safety is equally negative. We must all accept that most accidents are preventable and that while a certain level of risk is inevitable the approach must be to reduce the risk to the lowest reasonably practical level though risk assessment and the implementation of remedies. The committed involvement of all employees is an integral part and absolute necessity of any safety culture.
This initiative by I.B.E.C is described as the four Cs:
Control within the enterprise where safety must be managed.
Co-operation from and between individuals who work together - based on consultation and participation.
Communication - safety requires an effective level of communication skills including external communication and information.
Competence - decisions and tasks to be carried out by persons properly trained.
Consultation
Since the enactment of the aforementioned legislation the Hospital has in place a joint Safety Committee which is made up of staff members appointed by the Board of Management and members elected or selected from each of five staff groupings together with some ex-officio members. In addition to the statutory requirement for consultation with staff. the Act also empowers employees to electlselect from among their staff members a Safety Representative or Representatives. Mr. Tom Moloney has filled that role most effectively since his election in 1992.
Monthly meetings are held of the joint Safety Committee and this allows for open discussion on pertinent matters regarding health and safety and where risks are identified the remedial actions necessary are discussed and formulated.
During 1997 it is proposed to appoint a Safety Warden in each department who will carry out regular audits on safety matters including Fire Safety. These wardens should add another layer of involvement in the maintenance of a safe place of work and the further development of the safety culture among us all.
Safety Awareness Programme
The Health and Safety Week was held from Monday. October 7th to Friday. October I I th 1996 inclusive. On the Monday. the Technical Services and Safety Manager. Mr. j.A. Sadlier. outlined the Responsible Persons their role in staff
43 M ATER MI SER I CORD I AE H OSP ITAL ANN UAL R EPORT 1996
safety. The main theme of this presentation was to highlight the statutory obligations on all Responsible Persons to con tinuously identify all potential hazards in the workplace and work activities of their department and to arrange for the elimination where possible of these hazards and where it is not possible to provide the necessary precautions and train ing of staff.
On Tuesday, 8th October, Mr. Sean Hickey, ofthe Information Technology Department, spoke on the safety informa tion available on Computer and Microfiche. Wednesday, 9th October was devoted to Healthy Living and Dr. Eimear Shelly, who was Leader of the Kilkenny Health Project, gave a very stimulating talk on same. During that day stands and information on support available to those interested in giving up smoking were located in the Link Corridor to the IA Ward Block.
Mr. Sadlier and Mr. Moloney launched the "Safety Statement for Contractors working in the Hospital" at two sessions. These were well attended with approximately fifty contractors present. Following on the enactment of the Construction Regulations it is essential that all persons undertaking work on behalf of the Hospital are properly qualified and that the Responsible Person for each contract is fully satisfied with the competence of those involved in all matters.
The subject for the last day, Friday I I th, was staff health promotion under the title "Care for the Carer". Dr. Dominick Natin and some Consultants from the Hospital spoke at two sessions, early morning and lunchtime, to two well attend ed audiences. During the week a hands-on demonstration of the first aid fire extinguishers used in the Hospital was held at various times on each of the days. A fire safety audit was carried out on a number of the outside properties and in some cases an evacuation drill was conducted.
Staff Training
The training course for Student Nurses was continued with two sessions of each of the three modules presented which comprise one full day and two half-day presentations. As part of the induction of the interns and new N.C.HD.s a short introduction to Safety, Health and Welfare was presented in July.
44 ...... II ~.. ~ )~"~.... ~ ...... -
M ATER. MI SER. I COR.D I AE H OSP I TAL AN NUAL R EPO R. T 19 96
INTRODUCTION TO HOSPITAL LIFE SCHOOLS EDUCATION PROGRAMME
hiS programme was initiated in 1994 by the Medical Executive to meet the increasing number of requests from schools for "work experience" in the hospital for their transition year (4th Year) pupils. There was concern that these school children might not be adequately supervised within the hospital. A structured programme was formulated to provide a broad range of exposure to the different types of occupations Tavailable within the hospital and to introduce the students to its distinctive environment. The hospital was also conscious of the need to avoid exposing the school pupils to inappropriate or possibly traumatising experiences, and also to clearly identify them and distinguish them from hospital employees or medical or paramedical students. Thus on presentation to the hospital pupils are photographed and receive an I.D. Card and a distinctive grey coat which they are required to wear for the duration of their time in the Mater.
The programme offered by the hospital caters for groups of up to nine pupils who spend one week in the Mater. Many individuals in different areas kindly volunteer their time and efforts to provide a comprehensive and interest ing series of talks and demonstrations of their particular skills, as well as fam iliarising the pupils with their depart ment and its role in the hospital. The pupil's day begins at 10.30 a.m. and ends at 4.00 p.m. and they rotate through different areas of the hospital. They are provided with lunch in the hospital canteen daily. They are expected to write a short evaluation of their experience in the hospital, and many schools request a report on the pupil's inter est and behaviour while on the programme .
• A group of pupils prepare for their "placement' in the Mater on the "Introduction to Hospital Life' Programme.
45 - ~----
MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
The areas through which the transition year programme rotates include:
Accounts Ms. Maureen Dempsey Accident & Emergency Dr. Peter O'Connor/Sr. O. McDonald Administration Mr. Pat Bruen Cardiac Investigation Dr. Declan Sugrue/Sr. M. Keane Computers Ms. Rosaleen Murnane Dietician Ms. Berna Keenan Endoscopy Dr. John Crowe/Sr. P. White Laboratory Mr. Tom Moloney Nursing Sr. M. of the Incarnation/Ms. R. Ruddy/Mrs. A. Carrigy Out-Patients Mr. Frank McManus Pharmacy Mr. Ciaran Meegan Photography Mr. G. Scully/Ms. F. Grehan Physiotherapy Ms. Diane Bernal Radio Mater Mr. P. Doyle Social Work Ms. E. O'Leary/Ms. S. White Theatre Sr. Betty Curtin X-Ray Ms. M. Coakley
In 1996, 145 pupils were accommodated in 17 different weekly programmes. There were many different schoo represented, as can be seen from the following list of schools whose pupils have attended the programme to da
I. Alexandra College, Milltown. 2. Ard Scoil Ris, Griffith Avenue. 3. Ashfield College, Templeogue. 4. Belvedere College, Great Denmark Street. 5. Castleknock College, Castleknock. 6. Catholic University School, Lower Leeson Street. 7. Colaiste Chiaran, Leixlip. 8. Colaiste Mhiure, Cearnog Pharnell. 9. Colaiste Phadraig, Lucan. 10. Coolmine Community School. I I. Dominican College, Griffith Avenue. 12. Franciscan College, Gormanstown, Co. Meath. I 3. Gonzaga College, Sandford Road. 14. Hartstown Community School. 15. High School, Rathgar. 16. High School, Rathmines. 17. Holy Child, Killiney. 18. Holy Faith, Clontarf. 19. Holy Faith, Glasnevin. 20. Holy Family, Newbridge. 21 . Loreto College, Balbriggan. 22. Loreto College, Beaufort, Rathfarnham. 23. Loreto College, Fermoy. 24. Loreto College, St. Stephen's Green. 25. Loreto College, Swords. 26. Manor House, Raheny. 27. Margaret Aylward c.c., Whitehall. 28. Maryfield College, Dublin 9. 46 M ATER MI SER I CORD I AE H OSPITAL A NNUAL R EPORT 199 6
29. Mount Anville, Dublin 14. 30. Mount Sackville, Leixlip. 3 I. Mount Temple, Malahide Road. 32. Muckross Park College, Donnybrook. 33. Notre Dame des Missions, Churchtown. 34. Our Lady's Grove, Goatstown. 35. Our Lady's School, Templeogue. 36. Our Lady's School, Terenure. 37. Pobal Scoil Neasain, Baldoyle. 38. Pobal Scoil losa, Malah ide. 39. Portmarknock Community School. 40. Presentation School, Blackrock. 41. Presentation School, Terenure. 42. Rockford Manor, Blackrock. 43. Roscrea Vocational School, Roscrea, Co. Tipperary. 44. Rosemount Park School, Blackrock. 45. Sacred Heart, Drogheda, Co. Louth. 46. Santa Sabina, Sutton. 47. Santa Maria College, Rathfarnham. 48. Sion Hill, Blackrock. 49. Sligo Grammar School. 50. St. Raphael's, Stillorgan. 5 I. St. Joseph's Secondary School. 52. St. Vincent's C.B.S., Glasnevin. 53. St. Joseph of Cluny, Killiney. 54. St. Paul 's, Raheny. 55. St. Gerard's, Bray. 56. St. Dominic's College, Cabra. 57. St. Mary's College, Rathmines. 58. St. Fintan's College, Sutton. 59. St. Andrew's College, Booterstown. 60. St. Conleth's College, Clyde Road. 61 . St. John of God, Artane. 62. St. Anne's Secondary School, Tipperary. 63. Stratford College, Rathgar. 64. Terenure College. 65. The Teresian School, Stillorgan. 66. Ursuline College, Sligo.
The feedback from the pupils and schools is extremely positive and the great interest and enthusiasm of the pupil s is obvious to all those who generously give of their time and effort to make this programme successful. There is an enormous and increasing demand for places and in 1996 we had, unfortunately, to turn down man pupils who applied at a late stage. Already we have schools and pupils applying fo r the programme beginning in Autumn 1997. There is no doubt that this programme will not have the capacity to absorb the demand for places. It is hoped that other hospitals will introduce similar programmes in the new future.
47 ------~~------
MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
Mater Misericordiae Hospital Accident & Emergency Admissions • AlE Admissions 1996
250
200~
150~
..C 0 '..;;; 'E ..~ 100 J- 0 0 Z
50 ~
0
1234567 8 9 10 11 12 13 14 1516 17 18 19 20 21 2223 242526 272829 30 31 3233 34 35 36 3738 39 40 41 4243 44 45 46 474849 50 51 5253 Week Number
Accident & Emergency Date Week A&E Date Week A&E (Week Ending) Number Admissions (Week Ending) Number Admissions 7 January 1996 I 192 7 July 1996 27 193 14 January 1996 2 176 14 July 1996 28 152 21 January 1996 3 197 21 July 1996 29 157 28 January 1996 4 207 28 July 1996 30 193 4 February 1996 5 139 4 August 1996 31 206 I I February 1996 6 196 I I August 1996 32 163 18 February 1996 7 176 18 August 1996 33 193 25 February 1996 8 196 25 August 1996 34 180 I September 1996 3 March 1996 9 169 35 169 8 September 1996 36 197 I 0 March 1996 10 182 15 September 1996 37 170 17 March 1996 11 153 22 September 1996 38 171 24 March 1996 12 145 29 September 1996 39 169 3 I March 1996 13 160 6 October I 996 40 168 7 April 1996 14 149 13 October 1996 41 170 14 April 1996 15 168 20 October 1996 42 206 21 April 1996 16 164 27 October 1996 43 170 28 April 1996 17 141 3 November 1996 44 145 5 May 1996 18 166 10 November 1996 45 173 12 May 1996 19 141 17 November 1996 46 182 19 May 1996 20 150 24 November 1996 47 149 26 May 1996 21 146 I December 1996 48 198 2 June 1996 22 148 8 December 1996 49 180 9 June 1996 23 150 15 December 1996 50 186 16 June 1996 24 157 22 December 1996 51 152 23 June 1996 25 155 29 December 1996 52 222 30 June 1996 26 145 30-3 I December 1996 53 89 48 M ATER MI SER I CO R D IAE H OSP I TAL ANN UAL R EPORT 1996
IN-PATIENT ACTIVITY I 996
Speciality Bed Days Used In-Patients Discharges Day Cases
Cardiac Surgery 17019 1269 101 Dermatology 1996 141 2090 E.N.T. 6049 1038 1304 Gen/Colo-Rectal Surgery 4352 469 472 Gen/Hepato-Bilary Surgery 5173 576 281 GenNascular Surgery 10279 1027 359 General Medicine/Cardiology 19842 1552 1097 General Medicine/Endocrinology 11545 930 13 General Medicine/G.I. 13359 1355 2125 General Medicine/Respiratory 7912 681 280 Gynaecology 3012 435 381 Infectious Diseases 3874 316 I Medical Professional Unit 5459 502 I Medicine for the Elderly 7247 316 372 Nephrology 1688 193 I Neurology 56 9 0 Oncolgy/Haematology 7555 842 1569 Ophthalmology 5754 1041 2865 Oral Surgery 408 138 34 Orthopaedics 14693 1427 387 Other 346 37 357 Plastic 2663 455 940 Psychiatry 2121 92 0 Psychiatry Adult 2719 168 0 Rheumatology 4745 388 346 Surgical Professional 5987 773 885 Urology 3741 465 358
Total 169594 16635 16619
DEPARTMENTAL ACTIVITY SUMMARIES
Accident & Emergency 1993 1994 1995 1996 New 48070 50730 52998 55459 Return 19067 15972 12966 10805
Total Attendances 67137 66702 65964 66264
Out-Patient Clinics Total Attendances 114510 118694 116955 114051
Clinical Nutrition & Dietetics Dietician Consultations 14603 15986 15490 13105
Pulmonary Laboratory Patients 1330 1348 895 1634 Tests 6752 6754 4466 8400
49 M ATER. MI SER.ICOR.D I AE H OSP I TAL A NNUAL R EPOR.T 1996
THEATRE ACTIVITY
1993 1994 1995 1996 General 2173 2020 2118 2001 G.U. 1169 1122 1788 1523 Orthopaedic 1454 1469 1515 1361 Vascular 405 406 386 272
Cardiac Surgery Open Heart Surgery 729 796 958 967 Pacemakers 30 36 39 13 Miscellaneous 185 166 140 103 Transplants 9 15 19 10 Endoscopies 36 37 90 187 Thorscic 81 86 84 89
Dermatology 199 302 Ophthalmic 2129 1980 2088 1823 E.N.T. 2067 1836 1498 1421 Gynaecology 807 756 741 809 Dental 167 169 218 198 Minor 1846 1795 1954 1555 Plastic 812 749 1468 1378 Miscellaneous 120 17 15 44
Total 14219 14883 15318 14056 Total Major 10329 9853 9900 9288 Total Minor 3890 5030 5418 4768
DEPARTMENT OF CHILD AND FAMILY
1993 1994 1995 1996 New Patients 772 708 699 627 Total Attendances 14153 15461 15815 15486
Social Work Sessions 2021 2039 2429 2118 Social Work Attendances 3503 3752 4934 4417
Psychology Sessions 2608 2854 2308 2641 Psychology Attendances 3969 4545 4199 3867
Psychiatric Attendances 3540 3671 3937 4398
Speech & Language Therapy Sessions 1069 1241 1142 1146 Speech & Language Therapy Attendances 2662 3147 2565 2624
Remedial, Educational and Social! Perceptual Training Sessions 72 56 50 59 Attendances 479 346 180 180
50 M ATER MI SER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
OCCUPATIONAL THERAPY DEPARTMENT
1993 1994 1995 1996 In-Patients 884 1020 1004 1017 Out-Patients 480 591 709 630
Total 1364 1611 1713 1647
PHYSIOTHERAPY DEPARTMENT
1993 1994 1995 1996 Patients Department 9840 10075 9026 7684 Orthopaedic 13743 14030 13491 13909 Neurological 6741 6547 6550 6861 Chest Unit 23567 33979 35916 34872 Ultra Violet 3144 3175 2864 2212 Hydrotherapy 3436 2655 2236 2403 Geriatrics 2502 3576 3375 3360 School 3717 4628 4536 5025 M.R.SA 3306
Total 66690 79902 81565 79632
Treatments (Time Units) Department 26932 27629 25669 19030 Orthopaedic 36734 37059 37048 38570 Neurological 19785 20407 21642 20801 Chest Unit 38930 53986 52053 51695 Ultra Violet 5457 3290 2864 2212 Hydrotherapy 7489 6633 5942 6308 Geriatrics 3703 7362 6824 6157 School 9401 10369 10039 10902 M.R.SA 6469 6597
Total 148431 167539 168550 162272
E.E.G. UNIT
1993 1994 1995 1996 In-Patient 203 187 149 145 Out-Patient 432 424 566 534
Total 635 611 715 679
Department 465 592 697 657 Portable 20 24 21 22 Anorectal Physiology 13 16 18 9 Brain Stems 3 7 0
51 M ATER M ISERICORDIAE H OSPITAL A NNUAL R EPO RT 19 96
DEPARTMENT OF CLINICAL PHOTOGRAPHY
1993 1994 1995 1996 Lecture, Demonstrations, Publications - Slides 15427 19722 19875 22356 - Prints 5255 4867 5480 5295
Cl inical Patient Slides/Retinal Slides, Angiograms 5416 5725 6400 7232
Total 26098 30314 31755 34883
E.C.G. UNIT
1993 1994 1995 1996 In-Patients 10859 12095 13944 15588 Out-Patients 7657 6759 6612 8472 Effort Tests 1229 1248 1749 2294 Pacemaker Checks 1269 1371 1975 included in effort tests Rehab Stress Tests 20 196 181 280
Total 21034 21699 24461 26634
SOCIAL WORK DEPARTMENT
1993 1994 1995 1996 Total Interviews 8809 8756 9219 9828
New Patients 3019 2924 3473 3448 Return Patients 1283 1144 1298 1720
Total 4302 4068 477 -=--1 __ 5168
52 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
RADIOLOGY DEPARTMENT
1993 1994 1995 1996 Main Department General Work 53652 57579 63623 61276 Specials 1633 1197 1414 1436 Barium Meals 2263 1951 1537 1598 Barium Enemas 1086 789 708 649 1.y.P.s 1330 1128 972 836 G.B.s 329 233 234 183 Scanning 4614 6075 6852 7087 Ultrasound 6043 6006 6478 6620 Nuclear Medicine 3052 3463 3255 3921 Orthopaedic O.P.D. 9134 8952 10183 Dopplers 195 346
Total 74002 87555 94220 94135
Cardiovascular X-Ray Patients 1901 1742 2210 2456 Procedures 5314 4829 6424 7147
Accident & Emergency Department X-Rays 33860 34163 34120 33797
Grand Total 113176 126547 134764 135079
53 M ATER MI SER I CO R D I AE H OSP I TA L ANN UA L R EPORT 1996
ANALYSIS OF OUT-PATIENT ATTENDANCES FOR 1996 BY HEALTH BOARD
Speciality EHB NEHB SEHB MHB NWHB MWHB WHB SHB UNKN TOTAL Anaesthesiology 63 17 4 I I I 2 0 90 Anti-D Total 201 60 23 8 8 3 2 307 CardiacIThoraic 760 156 74 72 98 61 142 19 2 1384 Dermatology 5507 712 255 292 69 95 96 29 3 7058 DiabetiC/Endocrinology 3654 369 325 205 49 47 71 14 o 4734 Endocrinology 2594 351 204 154 61 49 62 12 I 3488 ENT Surgery 4918 1055 229 85 96 66 40 2 9 6519 Fracture 9801 385 104 101 37 44 45 18 29 10564 Gastroenterology 2823 229 113 52 70 33 11 7 3 3341 General Medicine/Cardiology 6523 851 330 345 201 162 128 50 6 8596 GeneralNascular Surgery 1265 117 35 33 14 7 14 2 o 1547 General Surgery 6780 598 154 131 92 41 28 16 I 7841 Gynaecology 2604 169 38 33 35 7 8 7 3 2904 Haematology 1380 446 81 93 36 37 17 o o 2090 Hepathology 443 66 26 21 7 10 2 o 2 577 Infectious Diseases 886 31 11 2 3 12 o 16 o 961 Infertility 235 42 24 22 18 8 14 o o 363 Medical Professional Unit 911 41 2 5 o o 2 o o 961 Medical 1653 43 26 16 I 9 3 3 o 1754 Medicine for the Elderly 1402 4 2 6 o o o o o 1414 Nephrology 384 97 30 27 7 10 8 9 2 574 Neurology 298 21 8 10 5 4 2 o 349 Oncology 1875 486 176 169 167 376 108 44 I 3402 Ophthalmology 13150 5674 355 494 207 115 177 46 24 20242 Orthopaedic 5194 615 320 243 127 103 155 41 11 6809 Plastic Surgery 3324 311 76 97 32 46 53 9 10 3958 Psychiatry 1461 51 9 15 5 4 o 3 o 1548 Rehab & Physical Medicine 3536 347 138 90 10 21 25 2 3 4172 Respiratory Medicine 2951 149 65 40 33 16 7 3 4 3268 Urology 1639 302 38 90 14 14 11 5 2114 Urology/General 1016 214 48 49 18 4 10 5 1365
Grand Total 89231 14069 3323 2994 1521 1407 1243 384 122 114294
S4 M ATER M ISER I CORD I AE H OSPITAL A NNUAL R EPORT 199 6
ACCIDENT & EMERGENCY DEPARTMENT
he Accident & Emergency Department continued to provide the usual service to its catchment area. Seasonal problems concerning bed supply were again experienced. Delay in admission to hospital placed a huge strain on the meagre resources of the Accident & Emergency Department. All staff. but Tparticularly the nursing staff. worked heroically in the face of almost overwhelming odds to maintain a safe and efficient service.
It is hoped in the near future to remove the Dressing Clinic from the remit of the Accident & Emergency Department thus freeing up vital space within the Department. This should allow us to re-deploy our nursing staff more evenly through the 24 hours.
1996 saw the appointment of Ms. Louise Kavanagh as Liaison Nurse to improve communications between referring doctors and the Department. This position is seen to improve the safety of patients who are transferred back to the care of their general practitioner in the community.
Statistics tell us that our patient numbers continue to increase. The graph of this rise has been now upwards for a number of years. Medical staffing resources have remained static. It is becoming apparent that some improvement in staffing resources will be necessary should the upward trend of patient attendances continue.
55 M ATER MI SE RI CORD I AE H OSP I TA L A N N UAL R EPO RT 1996
DEPARTMENT OF PSYCHIATRY
he Academic Department of Psychiatry provides a service to the Mater Misericordiae Hospital. It also provides a sec tor service to a geographically defined area in Phibsboro/Cabra under the terms of the 1945 Mental Treatment Act and provides a tertiary referral service on a national basis. Fifteen acute beds are available on St. Aloysius Ward divid Ted between ten for the sector and five for liaison and tertiary referral patients. The service is provided by three con sultant psychiatrists. Dr. John Sheehan is the Consultant in Liaison Psychiatry, Dr. Miriam Gannon is a Locum Consultant pro viding service to the sector and Professor Patricia Casey who is the administrator of both the clinical and academic aspects of the Department. In addition, there is one Clinical Psychologist, two Community Psychiatric Nurses, four S.H.O.s/Registrars in Psychiatry and two Special Lecturers augment the service provided by the Consultants.
The service provides five out-patient clinics each week and two special interests i.e. pain and somatization once per month each.
During 1996, Dr. Gannon developed a system in the Sector Service for monitoring Lithium Therapy. A review of out patient attenders has been instituted which has to date developed treatment plans for 90% of the out-patient attenders and is ongoing. Dr. Gannon has allocated a weekly slot for family meetings to increase the doctors' knowledge of the background of patients and encourage family involvement in patient care.
The Department of Psychiatry is also the academic base for teaching psychiatry to medical students attached to the Mater Hospital. Each year it provides teaching in this subject to 70 students in blocks of two months.
A third aspect of the Academic Department of Psychiatry is the organisation of a rotational training scheme in psychia try. This provides training for doctors specialising in psychiatry and this is administered from the Mater Hospital. This training scheme entitled the UCD/Mater Hospital Rotational Training Scheme in Psychiatry also includes St. Vincent's Hospital, Fairview; St. Brendan's Hospital; St. Brigid's Hospital, Ardee; St. Davnett's Hospital, Monaghan; Cavan General Hospital and Baggot Street Hospital, Dublin.
In addition, Ms. Terri Gallagher, Senior Clinical Psychologist, provides placement for three psychologists on the UCD Clinical Psychology Training Course and provides academic input to the course.
Special Interests
The Liaison Psychiatry service provides a specialist service to physician and surgeons within the hospital. In addition, Dr. Sheehan has a special interest in the psychiatric aspects of refractory pain and in stomatization disorder. He and Ms. Terri Gallagher, Senior Clinical Psychologist, established a Cognitive Behavioural Treatment programme for people with chronic pain in 1995. Dr. Sheehan has also assisted the Accident & Emergency Department staff in organising a Staff Support Group and is conducting a survey of work stress with Dr. Dominick Natin, Occupational Health Physician. Professor Casey has a special interest in the management of refractory depression and research (see below).
New Developments
Dr. Kevin Malone has recently been appointed as a Statutory Lecturer in Psychiatry. He will cover the Sector Service as well as expanding the academic aspects of the department.
The recent expansion of the department has necessitated the appointment of a second secretary to provide a back-up to both the Sector and Liaison Service.
Ongoing Research Projects
Professor Casey has recently received an EU Grant as one of the six centres throughout Europe investigating the preva-
56 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 199 6
lence of depressive disorders in the community. This will be the first project of this kind in Ireland and the multi-centre study represents the first project of its kind in Europe. Two research assistants have been appointed to this study.
Professor Casey in conjunction with Dr. Michael Kearney of Our Lady's Hospice, Harold's Cross, has received a grant from the Hospice Foundation to investigate the distinction between depressive illness and sadness in the hospice popula tion. This is the first project of its kind in this area of palliative care worldwide.
Other research projects include an investigation of religioSity and suicide intent in deliberate self-harm; patients' atti tudes to psychiatry; childhood sexual experiences in psychiatric patients; medical students performance in psychiatry (gender related); alexythymia and parasuicide.
Dr. Sheehan has collaborated with Dr. Crowe and Gastro-Enterology Department investigating depression in Crohn's Disease. Dr. Tim O'Neill, in conjunction with Dr. Sheehan, conducted a study of patients' knowledge of General Practitioners prescribing entitlements.
The nursing team is currently working towards establishing a Nurse Development Unit, incorporating accreditation with 1.s.0. 9002 Quality Management System.
Presentations and Publications
BOOKS
A Guide to Psychiatry in Primary Care. 2nd Edition 1997. Publisher: Wrightson BioMedical Petersfield. Author: P. Casey.
Applied Psychiatry in Law. 1997. Publisher: Oaktree Press. Author: P. Casey.
Parasuicide in the General Hospital Setting. P. Casey in "Psychiatry in Medical Practice". Editors: C. Katona, M. Robertson. 1997.
"The Treatment of Personality Disorders" in Seminars in Psychiatry in Psychiatry. Gaskell. Editors: Wilkinson and Stein. In press.
National Report in Informed Consent in Psychiatry, 1997. European Perspectives of Ethics, Law and Clinical Practice; Koch, HG, Reiter-Theil, S/Helmchen, H. Nomos, Baden-Baden.
"Personality Disorder" in Seminars in Psychiatry. Editors: Wilkinson and Stein. Gaskell. In Press.
ARTICLES
A Simple Case of Depression? Irish Medical News, 1997. C. McDonough, P. Casey.
The Psychiatric and Social Background to Suicide - The Problem of Prevention. Irish Medical journal. jan/Feb Vol. 90 No. I. P. Casey.
Attitudes toward Psychiatry among Irish Final Year Medical Students.
Litigation and the Toxicity Drugs. Irish journal of Psychological Medicine 1996, September 13 (3): 89-90. P. Casey.
57 M ATER MI SER I CORD IAE H OSP I TAL ANN UAL R EPORT 1996
Compliance with Medications in Depressive Illness. Irish Medical News, 1997. A. Collins.
Use of ECT in Severe Depression. Irish Medical News, 1997. A. Collins, J. Sheehan. r PAPERS
Reliability of General Practitioners in the Diagnosis of Depressive Illness. Fitzpatrick and Casey. Accepted for publica tion in the Journal of Primary Care. ..
Anti-depressant prescribing in General Practice. 1995. Accepted for publication in Primary Care Psychiatry. D. Fitzpatrick, P. Casey.
Assessment of Personality in a Clinical Setting. Advances in Psychiatric Treatment. April 1997. P. Casey.
What cost Chronic Pain? Irish Medical Journal, 1996; 89(6):218-219. J. Sheehan, J. McKay, M. Ryan, N. Walsh, D. O'Keeffe.
Admissions to a day hospital and to a general hospital psychiatric unit in a new community psychiatric service. Irish Journal of Psychological Medicine, 1996; 13(4): 149-1 5 I. A. joseph, R. Loane, J. Sheehan.
Suicide in Kildare. A five year follow up study. Irish Journal of Psychiatry, 1996; 14:8-10. D. Walsh, S. McGauran, R. Loane, J. Sheehan, B. O'Donnell.
Liaison Psychiatry. Irish Journal of Psychological Medicine. 1996; 13 (4): 130-131. J. Sheehan.
Absent without leave - can we predict those who go AWOL. Irish Journal of Psychological Medicine. 1996; 13:28-30. B. Farragher, MA Gannon, I. Ahmed.
A follow up study of new longstay patients. Irish Journal of Psychological Medicine. 1997; 14:24-25. MA Gannon, D. Meagher, L Waters.
Use of Aliases in Psychiatric Patients. Accepted for publication in Psychopathology. A. Collins, D. Meagher.
The Management of Depression in General Practice. Irish Medical Times. August 1996. A. Horgan, P. Casey.
The Diagnosis and Management of Postnatal Depression. Accepted by the Irish Medical Times. A. Horgan, J. Sheehan.
Multiple Personality Disorder - A Case Study. Accepted by Irish Journal of Psychiatry. A. Horgan, M. McCourt.
Atypical eating disorder in Insulin Dependent Diabetes Mellitus. Submitted to the British Journal of Psychological Medicine. A. Horgan, J. Sheehan.
58 M ATER MI SER I CORD I AE H OSP I TAL ANNUAL R EPORT 1996
PRESENTATIONS
Postnatal Depression. AWARE, Sligo. April 1996. Dr. John Sheehan.
Postnatal Mental Illness. Annual Residential Conference, General Psychiatry Section, Royal College of Psychiatrists, Malahide. May 1996. Dr. John Sheehan and Dr. M. Oates.
Supportive Psychotherapy. Samaritans, Annual Meeting, Dublin. September 1996. Dr. John Sheehan.
Liaison Psychiatry - Training. Psychiatry Tutors Conference. Birr, Co. Offaly. October 1996. Dr. John Sheehan.
The use of the Mental Treatment Act in the Accident & Emergency Department. I.N .O . Conference, Dublin. October 1996. Dr. John Sheehan.
New Developments in Liaison Psychiatry. Academic Programme, Dublin. October 1996. Dr. John Sheehan.
Liaison Psychiatry - What's That? Mater Hospital Study Day. December 1996. Dr. John Sheehan.
The Management of Dangerousness. Autumn 1996 to Accident & Emergency Nurses, Mater Hospital. Dr. Ann Horgan.
Cancer and Psychiatric Illness. Spring 1996 to Mater Private Hospital Nurses. Dr. Ann Horgan.
Psychiatric Medication. Spring 1996 to Mater Private Hospital Nurses. Dr. Ann Hogan.
Childhood sexual abuse in female addicts. Presented to Autumn meeting of the Irish Branch Royal College of Psychiatrists, Belfast, 1996. Dr. Ann Horgan, Dr. c.E. Cassidy.
59 M A T ER MI SER I CORDIA E H OSP I TAL A NNUAL R EPORT 19 9 6
DIVISION OF ANAESTHESIA AND INTENSIVE CARE Introduction
he Department has a wide range of activities which are interlinked with most hospital functions. Anaesthesia-related skills and background play a T large role in the smooth operation of a major mod ern hospital and medical school. All Consultants and Senior NCHDs take part in an active undergraduate and postgradu ate education programme.
The range of activities outlined below involves clinical anaesthesia and a range of other services which include Pain Management (acute and chronic), Intensive Care Medicine (incl. Parenteral Nutrition), CPR ServicelTraining, Research and Administration. • Dr. Kevin Carson • Dr. Cormac Redahan Strategic Planning Report This report was prepared during this year at the request of the hospital. Mater Health Care developments which have led to an increased service demand were Pain Management and Intensive Care subspecialisation, the National Spinal Injury Service, the Cardiac Transplant service, increased surgical tertiary referral practice e.g. head and neck and hepatobiliary surgery, the new plastic surgery regional service, the acute psychiatric (including ECT) service and servicing the increasingly broad-based advanced cardiac life support training service. The division is fully sup portive of these advances and development but regrets that a negative consequence has been an increasing and undue dependence on consultant cross- cover and on "supernumerary" NCHDs. These NCHD positions are mainly staffed by non E.U. "scholarship funded" doctors.
Services and activities in need of implementation or planned development are day surgery, out-patient pre-opera tive assessment and heart-lung transplantation. The development of regional anaesthesia as a strength at the Mater is suggested by pattern of surgical practice i.e. ophthalmology, upper limb surgery, plastiC surgery and G.U. surgery and there is an opportunity for increasing linkage with the University Department at U.C.D. The immediacy of developing Pain Management at the hospital has been advanced via a separate submission which emphasises its cross-disciplinary nature, drawing on and providing facilities for psychiatry and neurology for example.
CLINICAL ANAESTHESIA Clinical anaesthesia is the core activity and consumes the major service and teaching responsibilities of the Department. The surgical workload of approximately 14,500 cases per year is generated by 31 consultant surgeons and 28 Registrars. The current consultant anaesthetic staff is equal to I lA whole time equivalents (WT. E.). This is made up of 17 Consultants, the majority of whom have joint appointments with other hospitals in the North Dublin Hospitals Group (Temple Street Children's Hospital, Cappagh Orthopaedic Hospital and the Rotunda Hospital).
There are three major theatre areas requiring anaesthesia input: I. Main Theatres (Theatres 1,2 and 3; also minor OT) 2. Cardiac Theatres (Theatres 4 & 5) 3. Theatres, Phase I A (Theatres 1,2 and 3)
There is also a significant non-theatre requirement for anaesthesia services in radiology, gastroenterology, cardiology and for electroconvulsant therapy (ECT).
6 0 M ATER MI SERICORD I AE H OSPITAL ANN UAL R EPORT 1996
The increasing tertiar:-y referral nature and diversifying surgical activity in the hospital is welcomed and support ed. The need for extra theatre, anaesthetic and recovery facilities is evident as is the need to maintain and improve operating theatre efficiency. The need to bring the new operating theatre in the Phase I A on stream is a high priority and is the need to effect corresponding new efficiencies. We have made particular effort also to support the Hospital Environment Committee in prioritising an improvement in the post anaesthesia recovery room in the main theatre block.
PAIN MANAGEMENT UNIT The Pain Management Unit has evolved from within the Department of Anaesthesia & Intensive Care and is responsible for the co-ordination and provision of the acute and chronic pain service within the hospital and for patient referrals both locally and nationally. The chronic pain component is primarily outpatient based with empha sis on day case procedures. However there is an increase in demand for day ward and diagnostic facilities. Currently there are three outpatient clinics per week with plans for expansion which are contingent on the provi sion of full-time secretarial assistance.
Plans are currently in evolution to provide full time secretarial assistance and a dedicated RegistrarITutor. To date the NCHD allocation to the Pain Management Service has been provided from within the Department of Anaesthesia allocation.
The improved staffing levels will facilitate the running of the acute pain service with both intravenous PCA and epidural infusions which are used routinely. There are daily inpatient ward rounds.
We provide a national referral service for patients with chronic pain syndromes which in some selected instances may require the use of advanced technology such as intrathecal infusion therapies and Spinal Cord Stimulators. We are optimistic that the Department of Health will provide funding for these devices in selected cases. In summary we provide a comprehensive pain service to all inpatients in the Mater Hospital together with treating approxi mately 1,000 outpatients. We provide both a regional and national referral basis.
STATISTICS 1996
I. INPATIENT ACTIVITY SPECIALTY: IN-PATIENT DAY CASES: DISCHARGES Pain Management 406
1. WAITING LIST INPATIENT OUT-PATIENTS PAIN MANAGEMENT 3 months 3 months
J. DEPARTMENT ACTIVITY SUMMARIES PAIN MANAGEMENT CLINIC Outpatients = 826 Day cases (incl. nerve blocks & facets) = 406 Inpatients = 2,000 - PCA's = 430 - Epidurals = 268 Combined Pain/Psychiatric Clinics = 24
61 M ATER MI SER I CORD I AE H OSP I TAL ANN UAL R EPORT 1996
INTENSIVE CARE
The arrival of Dr. Brian Marsh in January 1996 has increased the number of fully qualified Consultant Intensivists in the Mater Hospital to three. This has supplemented the consultant cover and led to a welcome improvement in the overall profile of the Intensive Care Unit within the hospital.
The first Diploma in Intensive Care Medicine examination was held in June 1996. The ICU staff in the Mater Hospital provided active support for a Refresher Course for the examination which was organised by the Irish Board of Intensive Care Medicine.
The reduction in elective operating room activity in 1996 was associated with a decrease in demand for ICU beds dur ing the latter part of the year. The reduced activity coincided with the temporary closure of two ICU beds. Despite these changes, there was minimal cardiothoracic surgery cancellations during the year. Finding sufficient beds in the gen eral hospital for patients who have already been discharged from the ICU or HDU remains a persistent problem.
There was continued difficulty in recruiting new ICU nursing staff. The Postgraduate Intensive Care Nursing Course has continued throughout 1996 and remains the main source for new nursing staff.
The demand for beds in the High Dependency Unit has remained extremely high. Although the facilities in the HDU are very satisfactory, there is an urgent need to expand the complement of senior nursing staff if the Unit is to continue to provide the service demanded.
We are indebted to the staff in the Microbiology Department for their attentive support throughout the year. Our daily radiology review using the digital imaging system has continued to provide a focus for activity in the Unit. The rounds have been greatly augmented by the regular attendance of a Consultant Radiologist. The Department of Radiology has provided a very complete diagnostic imaging service for our patients both in the ICU and the Radiology Suite.
In conjunction with Mr. Tony Colgan, Mr. Andrew Kennedy has provided a dedicated biomedical technical service for the Intensive Care Unit. Mr. Kennedy has assumed responsibility for the routine service of ICU equipment and provided an invaluable on-site repair service. This has resulted in substantial cost savings to the hospital.
Patients in the ICU and HDU continue to benefit from the energetic service provided by the Physiotherapy Department. Members of the physiotherapy staff have been instrumental in advancing our experience with non-invasive mechanical ventilation. This may become increaSingly important as we contemplate a lung transplantation programme.
Accurate audit for our clinical activity is essential not only for the ICU/HDU staff but also to ensure satisfactory funding for the complexity of care required by our patients. We urgently require a minimum of one full time secre tary to support this ongoing activity in the ICU/HDU.
Patient Audit Intensive Care Unit - 1996 Total no. of admissions 1545 High Dependency Unit - 1996 Total no. of admissions \259 Meetings I Audit I Education : Senior Staff/Audit meeting - monthly. : Clinical Case Conference -weekly (Fri.07.30). : Joint Critical Care/Cardiothoracic Case Conference - monthly (FrL07.30) : Intensive Care Nursing Diploma course (twice yearly). : Undergraduate Medical Lectures (Carton/Phelan/Marsh). Approach to critically ill (resp failure/shock) Brain death/organ donation
62 M ATER. MI SER. I COR.DIAE H OSP I TAL AN NUAL R EPOR.T 1996
Parenteral Nutrition Service There were 142 requests for Parenteral Nutrition, covering 1,463 TPN days. There were 281 central and 14 peripheral lines with an average feeding time of 12.7 days. The line sepsis rate averaged out at 2.3 per 100 line days. Now in its seventh year, this ICU-based service is well established with SN. Jane Bourke the trouble-shooter and central point of reference. The broadly based T.P.N. Committee meets every two months to review prescribing and consider audit problems, in particular infections.
Parenteral Nutrition is included in the Departmental audit and apart from highlighting complications, useful infor mation is emerging on prescribing for particular diseases and deficiencies. This may provide standard bag types and should reduce the unit cost. It should be possible to identify with more certainty "true" line sepsis.
CARDIOPULMONARY RESUSCITATION TRAINING CENTRE
Resuscitation Training Figures - 1 996: - BCLS certified for one year 236 - BCLS certified for two years 86 - ACLS certified for two years 41 - Heartsaver and other courses 45
TOTAL 408
In addition, approximately 400 staff practised in the CPR training Centre during 1996.
Other in-services provided to hospital staff using equipment funded by the Mater Foundation: - Checking and reassembly of bag-valve-mask (Ambu) device - Dysrhythmia recognition - Cardiac arrest management
Cardiac arrest trollies and equipment are monitored from the CPR Training Centre and replacement equipment following cardiac arrest is provided by CPR. Ms. Glenna Woods was invited to instruct on a variety of courses throughout the year. Basic Cardiac Life Support Instructor Course, JCM Hospital, Blanchardstown, January to March 1996. Basic Cardiac Life Support Provider Course, INO, March 1996. Advanced Cardiac Life Support Provider Course, Beaumont Hospital, February 1996. Advanced Cardiac Life Support Provider Course, JCM Hospital, Blanchardstown, March 1996. Irish Emergency Nurses Association Study Day, Dublin, September 1996. Advanced Cardiac Life Support Provider Course, Beaumont Hospital, December, 1996. Advanced Cardiac Life Support Provider Course, University Hospital, Galway, December, 1996.
General Anaesthetic Administration Outside Operating Theatre - 1996:
Cardiovascular 2 G.I. Unit 5 CT 13 ECT 79
TOTAL 99
63 M ATER Ml SER I CORD IAE H OSPITAL ANN UA L R EPORT 1996
UNIVERSITY DEPARTMENT OF ANAESTHESIA
Teaching Undergraduate Attachments, Resident Year and Student Projects. Postgraduate courses in Physiology and Pharmacology in association with UniverSity College Dublin, participation by members of the Department in Faculty Fellowship courses.
Research University College Dublin Mater Hospital/Dept. Physiology. Effects of General and Local Anaesthetics on Evoked Excitatory Post Synaptic Potentials in the Rat Hippocampus. Frizelle H, O'Connor J, Moriarty De.
University College Dublin Mater Hospital/Dept. Pharmacology. In Vitro Screening for Volatile Anaesthetic Induced Teratogenesis in Neural Cell Cultures. O 'Leary G, O'Regan C, Moriarty De.
Trinity College Dublin Mater Hospital/Department of Clinical Pharmacology. A Study of Plasma Protein Drug Binding in different Intensive Care Patient Population. Browne J, Feely J, Blunnie Wp, Moriarty De.
University College Dublin Mater Hospital/Dept. Pharmacology. The effects of Propofol on Behavioural and Molecular aspects of memory. O 'Gorman D, O 'Regan C, Moriarty De.
Mater Hospital/Dept. Sleep Medicine. Defining anaesthetic depth at induction with sevoflurane using clinical eye signs and EEG polysomnography. Power C, Crowe C, Higgins P, Moriarty De.
Visiting Professorships Un iverSity of the West Indies June, 1996. North Western University, Chicago, USA.October, 1996. University of the West Indies December, 1996.
Chairman, Examination Committee Faculty of Anaesthetists, R.e.S.1.
Extern Examiner University of the West Indies.
Undergraduate Lectures Introduction to Anaesthesia Prof. D.e. Moriarty Pharmacology of Anaesthetic Agents Prof. D.e. Moriarty Peri-operative Management of Patients Prof. D.e. Moriarty
Undergraduate Projects Student Projects: Does the use of EMLA cream reduce the pain associated with local anaesthetic blocks for cataract surgery? Masood U, Browne J, Blunnie Wp, Moriarty De.
64 M ATER MI SER I CORD I AE H OSPITAL A N N UAL R EPORT 19 96
Current status of knowledge of epidural anaesthesia amongst parturients. Fleming F, Blunnie WP, Moriarty DC.
Plasma Protein Binding of acidic and basic drugs in critically ill patients. Morris B, Browne j, Blunnie Wp, Feely j, Moriarty DC.
A study of patient knowledge of anaesthesia in North-West Ireland. McCafferty Cj, Smith j, Moriarty DC.
A comparison of the effects of oral omeprazole and ranitidine on gastric pH and volume in patients undergoing emergency surgery. Nolan S, Bergin A. Blunnie Wp, Moriarty DC.
Intravenous infusion of doclofenac sodium coupled w ith patient-controlled analgesia (PCA) for pain relief post lumbar discectomy. Talbot R, McCoy D, Franklin R, Bergin A. Blunnie Wp, Moriarty DC.
65 M ATER MI SER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
PRESENTATIONS
Invited Lectures Advances in Pain Management. Pain & Nociceptive Group (PANG). London. Jan 1996. Mac$ullivan R.
Medical Training Issues. Medical Manpower in Acute Hospitals. Consultative Conference. Castletroy Park Hotel. Limerick. March 1996. Moriarty D.C
Mobile Intensive Care Ambulance Service - A New Service in Ireland. Irish Association of Critical Care Nurses, Annual Congress, March 1996. Ph elan D.
Advances in Transport of the Critically III in Ireland. 8th Annual NE Conference, Cork, April 1996. Phe/an D.
Pre-eclampsia in the 90's. Spring Meeting, Faculty of Anaesthetists, RCSI. May 1996. Bowen M.
Ethics in Critical Care Practice. Joint Annual Congress, Intensive Care Society of Ireland and Irish Society Clinical Microbiologists. June 1996. Phe/an D.
Intra-Articular Administration of Opioids. European Society of Regional Aanesthesia, Nice, France. Sept 1996. McCarroll M.
Advances in Pain Management. Palliative Care meeting. Killiney. Sept. 1996. Mac$ullivan R.
Anaesthesia for Ophthalmology Procedures. Hungarian Society of Anaesthesiology and Intensive Care. Siofac, Hungary. Sept. 1996. B/unnie WP.
Ionised magnesium in cardiac surgery patients - a study of the influence of pre-operative diuretic therapy on peri operative ionised magnesium levels. National Winner of International Federation of Clinical Chemistry - AVL award for significant advances in Critical Care Testing. Mater Hospital, September 1996. Leonard I, Harte B, Maguire $, Collier j, Phe/an D. IL
European Academy of Anaesthesiology. CME Course. Budapest, Nov. 1996. Surgical Antibiotic Prophylaxis in Antibiotic Treatment in ICU. Ph elan D.
Ethics of Withdrawal of Medical Interventions. Phe/an D.
Transport of the Critically Ill. Phe/an D.
Registrar's Prize. Faculty of Anaesthetists, RCSI. Dec. 1996. Anaesthesia for Minimally Invasive Coronary Artery Surgery. Franklin R, Day F, O'Leary G, Wood AE and Moriarty DC
Blunt trauma to the neck - airway problems. O'Connor P and Moriarty DC
Scientific-Free Papers/Posters Acute Myocardial Infarction and Multi-organ Failure after Blunt Chest Trauma. Registrar's Prize. Case Presentation. Royal Academy of Medicine in Ireland. February 1996. Naughton P, Chambers F.
Acute Thyrotoxicosis Complicating Upper Airway Obstruction - A Case Report. Western Anaesthetics
66 MATE R MI SE RI CO RDIA E H OSP ITA L ANN UA L R EPORT 1996
Symposium, Galway, March 1996. Naughton P, Chambers F.
Nefiracetam prevents Propofol induced amnesia: a possible adjuvant in management of anaesthesia. Delaney Medal Competition. Faculty of Anaesthetists, RCSI. March 1996 O'Gorman DA, O'Connel/ AW, Regan CM and Moriarty DC
Short Term Mortality Rates in ICU - A twelve month audit. National Medical Scientific Meeting, March 1996. Naughton P, Ph elan D, Carton E.
Intrathecal Morphine vs. Intrathecal Fentanyl for post caesarean analgesia - "can it be both effective and economic? Obstetric Anaesthetists Association. March 1996. Glasgow. Golden Band Bowen M.
Epidural and Intravenous Clonidine do not attenuate hypoxic pulmonary vasoconstriction in anaesthetized swine. National Scientific Meeting. Royal College of Physicians of Ireland. April 1996. Power M, Carey M and Moriarty DC
Annual Scientific Meeting, Faculty of Anaesthetists, ReSI. May 1996. Hypoxic pulmonary vasoconstriction in anaesthetized swine. Power M, Carey M, O'Regan Rand Moriarty DC
Unilateral Paralysis following Epidural Anaesthesia. McKeague H, Lyons B, McCarrrol/ M, Phelan D.
Investigation of the effects and intravenous clonidine hypoxic pulmonary vasoconstriction in anaesthetized swine. European Academy of Anaesthesiologists. Copenhagen. Aug. 1996. Power M, Carey M, McLoughlin P, O'Regan Rand Moriarty DC
Ionised magnesium in cardiac surgery patients - a study of the influence of pre-operative diuretic therapy on peri operative ionised magnesium levels. European Congress of Intensive Care Medicine - Glasgow, Sept. 1996. Leonard I, Harte B, Maguire S, Collier j, Phelan D.
Ionised magnesium in cardiac surgery patients - a study of the influence of pre-operative diuretic therapy on peri operative ionised magnesium levels. Annual Meeting of Association of Clinical Biochemists in Ireland (ACBI). Dublin, October, 1996. Leonard I, Harte B, Maguire S, Collier j, Phelan D.
A Six Year Audit of Central Venous Catheter Sepsis in TPN Patients. Mater Hospital Research Symposium. October 1996. Young C, O'Leary G, Bourke j, Harte B, Chambers F, Phelan D.
Fulminant Neuroleptic Malignant Syndrome. South of Ireland Anaesthetic Meeting. Killarney. Oct. 1996. O'Connor P, Lyons Band Moriarty DC
Anaesthetic management of a parturient with uncorrected complex congenital heart defect. PGA - The New York State Society of Anaesthesiologists. Postgraduate Assembly in Anaesthesiology. Dec. 1996. Naughton P and Bowen M.
Intrathecal morphine vs. Intrathecal Fentanyl for post-caesarean analgesia. Winter Meeting, Faculty of Anaesthetists, RCSI - December, 1996. Golden Band Bowen M.
The effects of Propofol on behavioural and molecular aspects of memory. New York Postgraduate Assembly. New York, U.SA Dec. 1996. O'Gorman D, Regan CM and Moriarty DC
Neutrophic agents as adjuvants to anaesthesia memory sparing effects. New York Postgraduate Meeting. Dec. 67 M ATER. MI SER. I COR.D I AE H OSP I TAL A NNUAL R EPOR.T 1996
1996. O'Gorman D, O'Connel/ A, Regan CM and Moriarty DC.
Registrar's Prize. Faculty of Anaesthetists, RCSI. Dec. 1996. Anaesthesia for Minimally Invasive Coronary Artery Surgery. Franklin R, Day F, O'Leary G, Wood AE and Moriarty DC.
Blunt trauma to the neck - airway problems. O'Connor P and Moriarty DC.
Under- and Postgraduate Teaching Programme Workshop on Local Anaesthesia. Annual Scientific Meeting, Faculty of Anaesthetists. Undergraduate Teaching Programme. May 1996. Mac$ullivan R.
FFA Pre-Exam Part III Course - Co-ordimtor. Mac$ullivan R.
Workshop on Local Anaesthesia. Annual Scientific Meeting, Faculty of Anaesthetists. Undergraduate Teaching Programme. May 1996. B/unnie WP.
Head Injury and Brain Death. Critical Care Postgraduate Nursing Course. June 1996. Phe/an D.
Transport of the Critically Ill. FFA Course. September 1996. Phe/an D.
Eastern Regional Training In-Service. September 1996, Rotunda Hospital. Gardiner j, Carton E, Bowen M.
TPN Complications. Eastern Regional Training In-Service. October 1996. Phe/an D.
Undergraduate UCD Medical Curriculum - 1996 Severe Brain Injury / Brain Death / Organ Donation / Adult Respiratory Distress Syndrome. Marsh B.
Enteral & Parenteral Nutrition. Phe/an D.
Ventilatory Strategies / Haemodynamic Monitoring in the Intensive Care Unit . Carton E
68 M ATER MI SERICORD I AE H OSPITAL AN NUAL R EPORT 1996
PUBLICATIONS
Abstracts/Letters/Book Reviews Pattern of ionised and total magnesium levels in peri-operative cardiac surgery patients - a prospective controlled study of the influence of pre-operative diuretic therapy. Intensive Care Medicine 1996; 22 : S346. Leonard I, Harte B, Collier). Maguire S, Phe/an D.
The effects of the anaesthesia agent Propofol on behavioural and molecular aspects of memory : are neurophic agents possible adjuvants to anaesthesia treatment with memory sparing effects? Irish Journal Medical Science 1996; 165. O'Gorman D, O'Connel/ A, Regan C and Moriarty DC
Critical Care Abstracts. Hospital Doctor of Ireland 1996; 2 : 10-12. Phe/an D, O'Cal/aghan G.
Sedation and Analgesia in the Critically Ill. Irish Journal Medical Science 1996; 165: 240. MothefWay C, Phe/an D.
Journal Articles European Nosocomial Infection Survey: Analysis of Irish Data. Irish Medical Journal 1996; 89 (3) : 96-98. Marsh B, Hone R, White M, Phelan D, Fabry J and the Irish Intensive Care Nosocomia/ Pneumonia Service Group.
Pulmonary Artery Catheter: arterialisation of aspirated wedge blood confirms the wedge position in pulmonary hypertension. Clinical Intensive Care 1996; 7 : 39-41. Power CK, Marshal/ SE, Phe/an DM, Burke CM .
The efficacy of single dose Aprotinin 2 million KIU in reducing blood loss and its impact on the incidence of deep venous thrombosis in patients undergoing total hip replacement surgery. Journal of Clinical Anaesthesia 1996; 8 : 357-360. Hayes A, Murphy D, McCarrol/ M.
Anaesthesia 1970 - 1995. Modern Medicine in Ireland, Feb. 1996. Moriarty DC
Laparoscopic assisted colectomy and myastenia gravis. Min. Invas. Ther. and Allied Technol. 1996; 5 : 405. Horgan PG, Fynnes H, Moriarty DC, O'Connel/ PR.
Intrathecal morphine: one year's experience in cardiac surgical patients. Journal of Cardiothoracic and Vascular Anaesthesia 1996; 225-8. Taylor A, Healy M, McCarrol/ M, Moriarty DC
Manpower requirements in Irish Medicine. Journal of the Institute of Irish Management. Oct. 1996. Moriarty DC
Cardiothoracic Anaesthesia. West Indies Medical Journal. Nov. 1996. Moriarty DC
Modification of pain on injection of Propofol - a comparison of Pethidine and Lignocaine. Anaesthesia 1996; 5 I : 394-5 . Lyons B, Lohan D, Flynn C, McCarrol/ M.
Pattern of colonising and pneumonic organisms in intubated ICU patients - a prospective analysis. Clinical Intensive Care 1996; 7 : I 1-15. Chambers FA, White M, Hone R, Ruddy R, Phe/an D.
Pain relief following cardiac surgery - a review. Irish Journal Medical Science, 1996; 165: 1-6. Tay/or A, Phe/an D, McCarthy JR. 69 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 1996
Intra-articular administration of opioids. Highlight in Pain Therapy and Regional Anaesthesia 1996. Permanyer Publications. McCarroll M.
Pseudomonas Stuzeri Septicaemia - a case report. Anaesthesia & Intensive Care 1996; 24 : 710-715. Priestly PS, Holland j, Marsh B, Wilson R.
Anaesthesiological Manpower in Europe. Europ. J. Anaesthesiology 1996; 13 : 325-332. Rolly G, MacRae WR, Blunnie WP, Dupont N, Sherpereel P.
Withdrawal of futile interventions in Intensive Care - an everyday ethical/critical care issue. The Medico-Iegal Journal of Ireland 1996; 2 : 49-5 I. Phelan D, Kinirons B.
Short term mortality rate for patients over 80 years admitted to the Intensive Care Unit. Ir J Med Sci 1996; vol 165 Page I I. Naughton P, Phelan D.
70 M A T ER MI SER I CORD I AE H OS PI TA L ANN UAL R EPORT 1996
CHAPLAINCY DEPARTMENT
What is Pastoral Caret "/ believe in the Sun - even when it does not shine; I believe in Love - even when it is not shown; I believe in God - even when God does not speak."
This testimony to faith was scratched on a basement wall by one of the victims of the Holocaust. It speaks to the spiritual dimension of all our lives and it is to this aspect of living that the Pastoral Care Staff is most attentive.
We, Chaplains, continue the compassionate ministry of Jesus who reached out to the sick and powerless. We do this by believing that human life is sacred and that suffering and death have meaning. Our presence is a reminder of God's and the community's loving concern for each person. Acceptance, hope, forgiveness, peace, healing and love are the traits we seek to call forth in people's lives.
Who Are Wet The Chaplains at the Mater are a diverse group of ordained and non-ordained men and women. They have engaged in academic preparations and clinical training for this specialized ministry of healing. Our ecumenical approach enables us to serve the diverse needs of the patients, families and staff. We work to empower others to draw upon their spiritual resources for wholeness and health.
Why are We Heret We are here in response to God's and the church's call as part of the healthcare team recognising that the spiritual dimension of our lives needs healing just as our body need healing.
CHAPLAINCY SERVICES are available to the patients, families and staff at the Mater on a 24 hour basis, 7 days a week. As staff chaplains we are each assigned to various wards in the hospital and are also available to other areas on request.
Ministry to Patients/Families: - Special concern for the critically ill, the dying patient and those preparing for surgery; - Listening presence; - Prayer, sacraments and worship services; - Participation in interdisciplinary ward meetings.
Ministry with Staff: - Co-Operation with staff members in the care of patients and their families; - Availability for staff support; - Prayer, sacraments and worship services e.g. Mass at I p.m. daily.
Sacramental Ministry: - Daily Mass is relayed from the Hospital Chapel to the Wards each morning follwed by distribution of Holy Communion throughout the Hospital. - Sacrament of Reconciliation and Anointing of the Sick available on request.
Other Eucharistic Celebrations: (i) on First Friday of the month as support for the bereaved; (ii) each year, two broadcasts from the Hospital Chapel via R.T.E. for the sick and housebound; 7 1 M ATER MI SERICORD I AE H OSPITAL A N N UAL R EPORT 1996
(iii) the annual "Heartbeats" remembrance and thanksgiving Mass, organised by the Mater Hospital Transplant Club.
Education: Involvement with pastoral training of students from various theological colleges including the Church of Ireland.
Supervision of students in pastoral care formation in a theological college.
Pursuit of further studies by a member of the team.
Involvement in: (i) Student Nurse and Ward Attendant training; (ii) Post Registration Courses i.e. Accident & Emergency, Operating Theatre, Intensive Therapy, Diabetes and Back to Nursing Programme.
Ongoing Project: Each year three basic units of Clinical Pastoral Education are conducted at the hospital to prepare students for chaplaincy ministry.
Special Intersts: Membership of the National Association of Hospital Chaplains. One chaplain is an elected member of the Executive Committee.
Membership of the Diocesan Hospital Chapliancy Association. Two chaplains are on the Executive Committee.
72 MATER MI SER I CORD IAE HO SPITAL ANNUAL R EPORT 1996
DEPARTMENT OF CHILD & FAMILY PSYCHIATRY
Psychology - Educational Assessment The demand for this service by Primary Schools in the North Dublin catchment area continued.
All of those pupils referred during first term 1995/'96 were attended to. Some 10% were considered suitable for full time remediation because of specific learning difficulty and were referred to one of the full-time, two year pro grammes provided by the Department of Education. Approximately half of the remainder met the criteria for admission to special class/special school and were recommended accordingly. In each case where a placement referral or recommendation was made, parents were also provided with a report of the assessment.
New referrals received during the period September to end December 1996 reached a level (n=74) exceeding the number which could ordinarily be seen before the end of 1996/'97. Collaboration with the Department of Education School Psychology Service identified a smaller priority group amongst some of these. The prospect of a project input involving psychologists in training may make it possible to include the remainder.
It is now clear, after three years operating this reduced service to schools, that a very strict protocol must be observed to continue this work. In future only those referrals requesting a placement recommendation should be accepted.
73 M ATER MI SER I CORD I AE H OSPlTAL A NNUAL R EPORT 199 6
DEPARTMENT OF CLINICAL CARDIOLOGY
Introduction:
isease of the heart and circulation remain the leading cause of death in our society. The burden of disease and concomitant demands for cardiac services continues to grow. This is so because of an ageing popula tion; more patients with heart disease living longer due to improvement in therapies and because of the D unique demographics of the Mater catchment area (higher proportion of elderly with greater social depri- vation than catchment areas of other major Dublin hospitals). The Cardiology Department has the highest case-mix index among non-surgical specialities at the Mater.
In-Patient Activity
1995 1996
c.C.U. Admissions 794 826 Bed Days Used 19106 19845 In-Patient Discharges 1483 1551 Day Cases 1050 1093 Consultations 1576 2105
Out-Patient Statistics (Dr. McCann, Dr. McCarthy, Dr. Sugrue)
1995 1996
New Patients 1140 2274 Return Patients 6990 6320 Anticoagulant Clinic (approximate) 8640 10640
Out-Patient Clinic Monday 2 p.m. General Cardiology. Valvular Heart Disease Tuesday 9 a.m. Chest Pain Evaluation. Cardiomyopathy. Tuesday 2 p.m. General Cardiology. Arrhythmia. Wednesday 2 p.m. Anti-coagulant Clinic. Thursday 2 p.m. General Cardiology. Adult congenial heart disease. Daily: Walk in E.C.G. Service. Pacemaker follow-up.
Special Services
Non-invasive laboratories ECG; treadmill effort tests; pacemaker follow up; ambulatory blood pressure monitoring; ambulatory ECG moni toring; transthoracic, transoesophageal and dobutamine stress echocardiography.
Invasive laboratories Diagnostic and interventional.
Cardiac Rehabilitation
New Developments I. Specialised services: Specialised clinics have been developed to manage patients with arrhythmias, valvular heart
74 1111
M ATER. MI SER. I COR.D I AE H OSP I TAL A NNUAL R EPOR.T 1996
disease. cardiomyopathy and adult congenital heart disease.
2. A Capital Grant has been received to develop a second state of the art Cardiac Catheterisation Laboratory. This should help to reduce waiting times for invasive cardiac procedures.
3. A dobutamine stress echocardiography service has been developed. This will help in the non-invasive assessment of many patients with coronary heart disease.
4. A cardiovascular nurse co-ordinator has been appointed in order to streamline in- patient and out-patient ser vices and to help reduce waiting times for diagnostic and interventional procedures.
Medical Education
Undergraduate: Lectures: 13 resident year. 10 final medical year senior clinics. Clinical rotations: approximately 40 resident students; 20 final year students. Teaching ward rounds, bed side tutorials: daily-weekly.
Post-Graduate:
Monday 8.15 a.m. Research in progress meeting.
Thursday 8.15 a.m. Cardiac Catheterisation Laboratory Conference.
Thursday 9.30 a.m. Cardiac Lecture Series; data interpretation.
Friday 8.15 a.m. Regular contributions to GP educational fora, occasional lectures, participation in post-graduate educational activities; specialised courses for allied health professionals; invited lectures.
Clinical Research Activities
(See Publications)
A. Health Services Research:
(i) Interventional Cardiology/Database - several hundred thousand data items. Audit, outcome analysis, health economic studies, multiple clinical research studies.
(ii) CCU Database; multiple clinical research studies.
B. Dilated Cardiomyopathy: various clinical research protocols (completed and ongoing).
C. Clinical Trial/Device Assessment. Current Trials:
The Carvedilol Hibernation Reversible Ischaemia Trial: A double-blind, randomised, multi-centre study of oral carvedilol versus placebo in patients with chronic stable heart failure due to systolic left ventricular dysfunction, with or without hibernating myocardium. 5 patients, randomised.
GUARDIAN Trial: A double-blind, placebo controlled, multinational trial to investigate the effect of the NA+/H+ exchange inhibitor HOE 642 (cariporide) on all cause mortality and M.1. patients at risk of myocardial necrosis due to acute coronary syndrome related to the disease process or to an inter ventional cardiac procedure.
75 M ATER MI SER I CORD I AE H OSPITAL ANN UAL R EPORT 1996
B.I.R.D. Study: A prospective, multi-centre, double blind, parallel group study evaluating the safety and efficacy of saruplase given i.v. either as an 80 mg bolus or as a 20 mg bolus and a I hour infusion of 60 mgs in patients with an acute myocardial infarction.
N.A.P. Study: Double-blind parallel group study to evaluate the efficacy and tolerability of mibefradil compared to Diltiazem retard or patients with angina pectoris. Protocol M30047.
D. Cardiovascular disease epidemiology; establishment of National Centre for Cardiovascular Statistics.
E. Summer Student Research Projects:
"Cost of managing acute myocardial infarction in the thrombolytic era".
"Epidemiological factors in non fatal stroke and audit of investigations in these patients".
F. Doctoral Research:
MD Thesis (Dr. Terence e. Hennessy): "Dobutamine stress echocardiography in the non invasive assessment of coronary artery disease: value and limitations in particular patient subgroups." Submitted to University College Dublin.
MD Thesis (Dr. Charlie McKenna): "The aetiology of idiopathic dilated cardiomyopathy: Alcohol intake, familial prevalence and HLA types." Submitted to University College Of Edinburgh.
MSc M. Med Sci (Dr. The Sweh Hoe): "Cardiomyopathy."
Meetings Attended:
January 1996 Advanced Coronary Stent Symposium. Leeds General Infirmary.
February 1996 Transcatheter Therapeutics. Washington D.e.
March 1996 American College of Cardiology Annual Scientific Sessions. Orlando, Florida, USA.
May 1996 British Cardiac Society Annual General Meeting. Glasgow, United Kingdom.
June 1996 The Third International Echocardiography Today and Tomorrow Symposium: Echocardiography and Clinical Decision Making. Ashford, Kent, United Kingdom.
August 1996 18th Congress of the European Society of Cardiology. Birmingham, United Kingdom.
October 1996 7th International Course on Peripheral Vascular Intervention. Nancy, France. Irish Cardiac Society Annual General Meeting. Newcastle, Co. Down.
November 1996 69th Annual Scientific Session of the American Heart Association.
76 M ATER. MI SER. I COR.D I AE H OSP I TAL A NNUAL R EPOR.T 19 96
New Orleans, U.S.A.
Chest. World Congress. San Fransisco, U.S.A.
December 1996 3rd Annual Coronary Stent Symposium. Thorax Centre, Erasmus University, Rotterdam.
Heart Failure. European Heart House, Sophia Antipolis, France.
Meetings Organised
March 1996 2nd Annual Mater Study Day in Cardiovascular Disease.
Invited Lectures
May 1996 Management of the Cardiac Patient with Hyperlipidaemia. (Prescot Symposium, Dublin). Cardiology Update. (Laois Clinical Society).
June 1996 Management of Acute Myocardial Infarction. Uoint Mayo Clinic/RCSI Meeting, Dublin).
September 1996 Nilvadil Symposium (Kilkenny)
October 1996 Interventional Cardiology, past, present, future. (Dublin).
November 1996 Management of Angina. Wexford Clinical Society.
Oral Presentations: National Meetings
Irish Cardiac Society/national Scientific Medical Meeting
Infective Endocarditis: National trends in age-adjusted mortality and clinical profile.
Influence of smoking on the prevalence of Coronary Heart Disease in the very young (age <35).
Frequency of left ventricular failure following Acute Myocardial Infarction in the Thrombolytic Era.
Coronary angioplasty in the very elderly.
Evolving experience with abrupt closure during PTCA: a ten year experience. The aetiology of idiopathic dilated cardiomyopathy: alcohol intake, familial prevalence and HLA types.
The continuing need for emergency coronary by-pass surgery in interventional cardiology.
Coronary stenting in a clinical practice: patient profile, immediate outcome, clinical outcome and angiographic follow-up in 147 consecutive patients.
Percutaneous transvenous mitral commissurotomy: immediate and one year follow up.
Detection of ischaemia by dobutamine stress echocardiography is critically dependent on the a priori probability of disease. 77 M ATER MI SEfUCORO I AE H OS PI TAL A N N UA L R EPORT 1996
Complications associated with dobutamine stress echocardiography: experience in 309 patients.
A comparison of the costs of percutaneous transvenous mitral commissurotomy and open surgical valvotomy.
Value of dobutamine stress echocardiography in detecting myocardial ischaemia in patients with diabetes mellitus.
Coronary artery bypass grafting in patients with isolated LAD Stenosis who smoke: can we refuse surgery?
Percutaneous transvenous mitral commissurotomy: an alternative to surgical valvuloplasty in appropriately selected patients.
Functional evaluation of patients with abnormal resting electrocardiograph: value of dobutamine stress echocardiography.
Comparison of bi-plane x-ray contrast ventriculography and cross sectional echocardiographic wall motion abnormalities in patients with coronary artery disease.
Survival and its predictors following surgery for isolated stenosis of the left anterior descending coronary artery.
Assessing suitability for percutaneous transvenous mitral commissurotomy: a role for transoesophageal echocardiography.
Frequency and prognosis of acute myocardial infarction presenting with ST segment depression.
Procedural details and clinical and angiographic follow-up following Palmaz-Schatz coronary stent insertion.
Subacute coronary stent thrombosis: uncommon but not benign.
Irish Endocrine Society:
Predictors of coronary artery disease and its severity in patients with diabetes mellitus.
Irish Thoracic Society:
Thoracic aortic dissection/aneurysm: clinical presentation, imaging and management in a tertiary referral centre.
Oral Presentations: International Meetings
Long term outcome post by-pass grafting for isolated stenosis of the left anterior descending coronary artery. (American Heart Association, New Orleans)
Clinical presentation, imaging and management of thoracic aortic dissection/aneurysm in a tertiary referral centre. (American College of Chest Physicians, San Fransisco) Clinical and angiographic follow-up of coronary stenting in 243 patients. (American College of Chest Physicians, San Fransisco)
Determinants of survival in patients post by-pass surgery for isolated stenosis of the left anterior descending coronary artery. (European Congress of Cardiology, Birmingham, United Kingdom)
The growing burden of congestive heart failure in Ireland. (International Society of Heart Failure, Jerusalem, Israel) 78 M ATER. MI SER. I COR.D I AE H OSP I TAL AN NUAL R EPOR.T 1996
The aetiology of idiopathic dilated cardiomyopathy (DCM): familial prevalence and HLA types. (International Society of Heart Failure, Jerusalem, Israel)
The aetiology of idiopathic dilated cardiomyopathy (DC M): the first alcohol case control study. (International Society of Heart Failure, Jerusalem, Israel)
Frequency of left ventricular failure following acute myocardial infarction in the thrombolytic era. (International Society of Heart Failure, Jerusalem, Israel)
Publications - I 996
Bailout Palmaz-Schatz stenting for iatrogenic dissection of the left main coronary artery. J Invasive Cardiol 1996;8: 450-2. TG Hennessy, HA McCann, DD Sugrue.
Women's dietary fat and sugar intakes: implications for food based guidelines. Eur J Clin Nutrition 1996; 50: 713-9. MAT Flynn, DD Sugrue, MB Co dd, M) Gibney.
Lipid profile, haemostatic variables and angiographically-defined coronary artery disease: a cross-sectional study in an Irish population. Ir J Med Sci 1996; 165(2): 129-132. J. Galvin, MB Codd, S. Leavy, DD Sugrue.
Cholesterol levels in normal Irish Adults: the Mater Hospital Cholesterol Screening Survey. Ir J Med Sci 1996; 165(3): 177-81. )F Collier, S. Maguire, P. McGing, MB Codd, F. Kyne, E. Wright, K. Halton, D. UaChonail, DD Sugrue .
International trials and national practice: a questionnaire survey of current physician practice in the treatment of acute myocardial infarction. Ir J Med Sci 1996; 165(3): 157-8. C) McKenna, MB Codd, HA McCann, DD Sugrue.
Risks of longterm oral anticoagulation in a non-trial medical environment. Ir J Med Sci 1996; 89: 144-5. CJ McKenna, J. Galvin, HA McCann, DD Sugrue.
Serial changes in cardiac output during normal pregnancy: A doppler ultrasound study. Eur J Obstet and Gynaecol & Reproductive Biology 1996; 70(2): 177-22. T. Hennessy, D. MacDonald, M. Hennessy, M. Maguire, S. Bloke, H. McCann, DD Sugrue.
Thoracic aortic dissection/aneurysm: clinical presentation, diagnostic imaging and initial management in a tertiary referral centre. Ir J Med Sci 1996; 165(4): 259-62. I Hennessy, D. Smith, H. McCann, C. McCarthy, DD Sugrue.
Coronary Stenting in clinical practice: patient profile, immediate outcome, clinical and angiographic follow up in 243 consecutive patients. J Invasive Cardiol 1996;8:450-2. I Hennessy, M. Codd, H. McCann, C. McCarthy, DD Sugrue.
Abstracts
Influence of smoking on the prevalence of Coronary Heart Disease in the very young (age <35). Ir J Med Sci 1996; 165(4):70. NG Mahon, C. O'Rourke, MB Co dd, H. McCann, DD Sugrue.
Frequency of left ventricular failure following Acute Myocardial Infarction in the Thrombolytic Era. Ir J Med Sci 1996; 165(2): 9. NG Mahon, C. O'Rourke, MB Co dd, HA McCann, DD Sugrue. 79 M ATEFt MI SEFt I COFtD I AE H OSP ITAL AN NUAL R EPOFtT 1996
Detection of ischaemia by dobutamine stress echocardiography is critically dependent on the a priori probability of disease. Ir J Med Sci 1996; 165(2): 9. G. Kane, T. Hennessy, M. Codd, DD Sugrue, HA McCann.
Predictors of coronary artery disease and its severity in patients with diabetes mellitus. Ir J Med Sci 1996; 165(2): 43. K. Nikookam, T. Hennessy, DD Sugrue, N. O'Meara, H. McCann, R. Firth.
Complications associated with dobutamine stress echocardiography: experience in 309 patients. Ir J Med Sci 1996; 165(2): 8. G. Kane, T. Hennessy, MB Codd, DD Sugrue, HA McCann.
A comparison of the costs of percutaneous transvenous mitral commissurotomy and open surgical valvotomy. Ir J Med Sci 1996; 165(2): 8. T. Hennessy, B. Egan, MB Codd, H. McCann, DD Sugrue.
Determinants of survival in patients post by-pass surgery for isolated stenosis of the left anterior descending coronary artery. Eur Heart J 1996; 17: Abstr. Suppl. 138. T. Hennessy, MB Codd, HA McCann, DD Sugrue.
Clinical presentation, imaging and management of thoracic aortic dissection/aneurysm in a tertiary referral centre .. Chest 1996; I 10: 4: I 17S. T. Hennessy, D. Smith, HA McCann, C. McCarthy, DD Sugrue.
Clinical and angiographic follow up of coronary stenting in 243 patients. Chest 1996; I 10: 4: I 19S. T. Hennessy, MB Co dd, C. McCarthy, HA McCann, DD Sugrue.
Long term outcome post by-pass grafting for isolated stenosis of the left anterior descending coronary artery. Circulation 1996; 8: 1537-8. T. Hennessy, MB Codd, S. Donnelly, C. McCarthy, HA McCann, DD Sugrue.
Value of dobutamine stress echocardiography in detecting myocardial ischaemia in patients with diabetes mellitus. Ir J Med Sci 1996; 165(4): 84. T. Hennessy, G. Kane, HA McCann, DD Sugrue.
Coronary artery by-pass grafting in patients with isolated LAD stenosis who smoke: can we refuse? Ir J Med Sci 1996; 165(4): 75. T. Hennessy, MB Codd, S. Donnelly, A. Hennessy, C. Hartigan, H. McCann, DD Sugrue.
Percutaneous transvenous mitral commissurotomy: an alternative to surgical valvuloplasty in appropriately selected patients. Ir J Med Sci 1996; 165(4): 76. T. Hennessy, C. McCarthy, H. McCann, DD Sugrue.
Thoracic aortic dissection/aneurysm: clinical presentation, imaging and management in a tertiary referral centre. Ir J Med Sci 1996; 165(4): 76. D. Smith, T. Hennessy, HA McCann, DD Sugrue.
Assessing suitability for percutaneous transmural mitral commissurotomy: a role for transoesophageal echocardiography. Ir J Med Sci 1996; 165(4). N. Mahon, T. Hennessy, C. O'Rourke, DD Sugrue. The growing burden of congestive heart failure in Ireland. 8 0 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
J Heart Failure 1996; 3( I): 17. MB Codd, P. Diamond, HA McCann, DD Sugrue.
The aetiology of idiopathic dilated cardiomyopathy: the first alcohol case control study. J Heart Failure 1996; 3( I): 100. Cl McKenna, MB Codd, HA McCann, DD Sugrue.
The aetiology of idiopathic dilated cardiomyopathy: familial prevalence and HLA types. J Heart Failure 1996; 3( I): 91 . Cl McKenna, MB Codd, Ha McCann, DD Sugrue.
81 M ATE R MI SER I CORD IAE H OSP I TAL AN NUAL R EPORT 1996
DEPARTMENT OF D lAB ETE si EN Doe RI N E
Scope of Service
he Diabetes/Endocrine Unit continued to provide a comprehensive service throughout 1996. In all, 648 new patients were seen in the out-patient department with a total number of patients of 6,870. In addition there were 5,978 patient visits to the Diabetes Day Centre, which is now really working at the limit of its current T capacity allowing for size, patient numbers and staffing quotas. The teaching and academic role of the Department on a national basis continued to be developed throughout 1996. The Higher Diploma in Nursing Studies (Diabetes) commenced in September 1996. It is a two year pro gramme organised by U.C.D. in conjunction with the Diabet~s Unit and the Post Registration Education Nursing Department, Mater Hospital. Two of our nurses have commenced their studies for this Diploma. The Unit would like to thank both hospital and nursing management for their ongoing support and encouragement during the plan ning and development of this accredited specialist nursing course.
One of the big highlights of the year was the success of Dr. Margaret Griffin in winning the D.K. O'Donovan medal for the outstanding scientific presentation at the Irish Endocrine Society where she presented her research looking at the problems of early identification of new patients who develop diabetes during pregnancy. As always the Unit has maintained its close links with the National Maternity Hospital, Coombe Women's Hospital and the Rotunda Hospital where additional clinics are held on a weekly basis.
Dr. Richard Firth during 1996 took over as Chairperson of the Diabetes section of the Irish Endocrine Society and this has enhanced the role of the Unit in developing and co-ordinating a treatment strategy for diabetes throughout this country.
The Unit offers a full range of services to diabetes patients including psychiatric counselling, podiatry, dietetic, ophthalmological and surgical support.
Podium and Poster Presentations Gestational Diabetes Mellitus - The Value of Universal Screening. Oral Presentation at the Irish Endocrine Society Meeting, Dublin, November 1996 and 4th International Conference on Gestational Diabetes. Winner of the 1996 DK O 'Donovan Gold Medal of the Irish Endocrine Society. M.E. Griffin, M. Coffey, P. Scan/on, H. Johnson, M. Fo/ey, J. Stronge, N. O'Meara, R. Firth.
Lipolytic Activity in Mononuclear Cells from hypertriglyceridaemic subjects. Oral presentation at the Irish Endocrine Society Meeting, Dublin, November 1996. G. Creedon, D. Sexton, M.E. Griffin, N. O'Meara, P. Collins .
Lipoprotein Lipase mRNA expression in hypertriglyceridaemic subjects. Poster Presentation at Nutrition Society, Biochemical Society & Royal Society of Medicine, London, October 1996. In Press. G. Creedon, D. Sexton, M.E. Griffin, N. O'Meara, P. Collins.
Lipoprotein Lipase in Human Monocyte Derived Macrophages isolated from Type 11 Diabetic subjects. Oral Presentation at Biochemical Society Annual Meeting, Coleraine, September 1996. G. Creedon, D. Sexton, ME Griffin, N. O'Meara, P. Collins. 82 I
M ATER MI SER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
Asymptomatic Heart Disease in Nephropathic IDDM patients - the use of Dobutamine Stress Echocardiography. Poster Presentation at the 32nd Annual Meeting of EASD, Austria, September 1996. Diabetologia 1996;39: (Suppl 1:284) M. Griffin, K. Nikookam, T. Hennessy, M.M. Teh, H. McCann, N. O'Meara, R. Firth.
Down Syndrome, Insulin Dependent Diabetes Mellitus and Hypothyroidism. Poster Presentation at the British Endocrine Society Meeting, Dublin, March 1996. Journal of Endocrinology 1996; I 48(S):225. M. Griffin, K. Nikookam, R. Firth, N. O'Meara.
Dobutamine Stress Echocardiography in the detection of Asymptomatic Ischaemic Heart Disease in patients with IDDM and Nephropathy. Poster Presentation at the British Diabetic Association Meeting, Dublin, March 1996. K. Nikookam, M. Griffin, M.M. Teh, H. McCann, N. O'Meara, R. Firth.
Hyperglycaemia: a risk factor for Peripheral Vascular Disease but not Cerebrovascular Disease in Non-insulin dependent Diabetes. Poster Presentation at the British Diabetic Association Medical and Scientific, Spring Meeting, Dublin, March 1996. Diabetes Medicine 1996; 13 (SuppI3). K. Nikookam, P. Keenan, D. Cregan, R. Firth, N. O'Meara.
Sex differences in prevalence rates of peripheral vascular disease in Type I Diabetes: results from the Mater Hospital Diabetes Database. Poster Presentation at the British Diabetes Association, Autumn Meeting, Harrogate, September 1996. K. Nikookam. P. Keenan, D. Cregan, R. Firth, N. O'Meara.
Insulin Dependent Diabetes Mellitus and Down Syndrome. Poster Presentation at the Irish Endocrine Society Meeting, Belfast, November 1995. Irish Journal of Medical Science 1996; 165 S4:85. M. Griffin, K. Nikookam, T. Fulcher, R. Acheson, R. Firth, N. O'Meara.
Polyglandular Endocrinopathies - an unusual presentation. Poster Presentation at the Irish Endocrine Society Meeting, Belfast, November 1995. Irish Journal of Medical Science 1996; 165 S4:86. M. Griffin, K. Nikookam, N. O'Meara.
Publications Book Chapter: Insulin Therapy in Pregnancy. Diabetes and Pregnancy - an International Approach. Hadden and Dornhorst (eds). Wiley and Sons 1996. R. Firth.
£
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DEPARTMENT OF CLINICAL NUTRITION & DIETETICS
Scope of Service
he Department of Clinical Nutrition and Dietetics provides a service to patients referred by Mater Hospital Consultants in both an in-patient and out-patient capacity. In 1996 a total of 8,585 in-patients and 4,520 out-patient consultations were recorded. While provision of a service to patients remains our pri T mary goal , we also endeavour to increase the awareness of all health care professionals of the importance of nutrition in both the aetiology and management of disease. In 1996, during National Healthy Eating Week, we were available to fellow staff for general advice on the subject of nutrition. We have been involved in giving formal lectures throughout the year.
Lectures Given - to Student Nurses - 'Nutrition Support in Hospitalised Patients'.
- to PREND Nurses - 'Diet in the Management of Diabetes' and 'The Role of Diet in Cardiovascular Disease'.
- UCD 2nd Medical Students - Clinical Case Presentations.
- ARC - Nutrition and Cancer.
- Irish Association of Nurses of Oncology - 'Nutrition & Cancer'.
Mater Community News - Healthy Eating.
As a further commitment to education, we have been involved in the Mater Hospital course for transition year students from September 1996. We are also accredited to TCD for 6 months clinical training of Clinical Nutrition and Dietetic Students. One final year student from 1996 was awarded first place for her clinical performance in final exams. For 1997 we plan to increase our involvement in student training and thereby double our quota of students to four.
Membership Involvement All Mater Hospital Dietitians are members of the Irish Nutrition and Dietetic Institute, which is the representative body for dietitians in Ireland. Two department members were elected to the executive council of the INDI, but all members give an extra time commitment through involvement with INDI sub-committees (Clinical Budgeting, Medical Nursing Education, Dietary Social Welfare Supplements) and INDI special interest groups (Enteral, Diabetic, Cardiac, Geriatric, TPN and Sports Nutrition).
Other Organisations include: British Dietetic Association American Society of Parenteral and Enteral Nutrition British Association of Parenteral and Enteral Nutrition Irish Endocrine Society Irish Association of Cardiac Rehabilitation
Meetings/Conferences/Courses attended during I 996 - ESPEN '96 European Society of Enteral & Parenteral Nutrition Congress on Clinical Nutrition & Metabolism. Geneva, Switzerland. September 1996. 84 illlt
MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
- 'Treating Obesity Seriously' Multidisciplinary meeting Belfast. February 1996. - National TPN Group/Parenteral and Enteral Nutrition Group joint symposium on 'Parenteral & Enteral Nutrition in Practice'. Warwick, July 1996.
- Interdisciplinary Dysphagia Conference. St. James' Hospital, March 1996.
- Diabetes Study Day (INDI). September 1996.
- Irish Nutrition Society & Royal College of Physicians of Ireland joint symposium 'Malnutrition in our Midst'. nd Dublin, February 1996.
ce - Enteral feeding, System Production. Sligo, March 1996.
- IDNI Annual Study Conference. April 1996.
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ism.
85 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 199 6
GASTROINTESTINAL UNIT
he Gastrointestinal Unit (G .!. Unit) consolidated its position among the leading gastroenterology units in the country. Both local and tertiary referrals comprise the day cases with particularly increased numbers for spe cialised intervention including ERCP. and the initiation of Endoscopic Ultrasound service which is a major Tinnovation in tumour staging. Research Both clinical and basic science research projects are ongoing with the department achieving high profile at both national and international meetings including the European Gastroenterology Week and the American Gastroenterology Association (see abstracts and papers in publication).
The topics of interest include Colorectal Cancer. Molecular Genetics. Hepatitis C. Bile Duct Stones (interventional endoscopy) and Biliary Manometry.
Two of our training registrars have commenced M.D. thesis with post admission dates being 1997 and 1998 respectively. The introduction of a Clinical Psychologist and an additional PhD student has further consolidated this strong research base.
Current Developments I. Computerised endoscopic reporting. 2. G.1. Unit going on web site - Internet. 3. Collaboration with the Professorial Unit and Department of Pharmacology in UCD on Lipozin Biosynthesis and activity in inflammatory Bowel Disease. 4. Proposals for a new Hepato-Biliary Unit incorporating Hepatitis C Service. 5. Initiation of new Gastrointestinal Oncology Group with specific G.1. Cancer Co- Ordinator.
Dr. Padraic MacMathuna and Dr. John Crowe are reviewers for the following international journals: GUT American Journal of Gastroenterology Gastrointestinal Endoscopy Endoscopy Irish Journal of Medical Science.
Papers and Publications Biliary Endoprosthesis in Elderly Patients with " Defiant" Stones in the Common Bile Duct: An Evaluation of Long Term Outcome. Irish Journal of Medical Science (1996). Vol 165, Supplement I Pg 12. S. Pathmakanthar, E. Ciarke, P. MacMathuna,}. Lennon, j. Crowe.
Clinical and Biochemical Expression of the Genetic Abnormality in Hereditary Haemochromatosis. Irish Journal of Medical Science (1996). Vol 165, Supplement I Pg 15. M. Kelly, E. Ryan, S. Pathmakanthan, j.C O'Keane, P. MacMathuna, j. Crowe.
ProgreSSive Fibrosis in Chronic Hepatitis C is related to the Severity of Periportal, not Lobular Inflammation. Irish Journal of Medical Science (1996). Vol. 165, Supplement I. Pg20. j.C O'Keane, j. Crowe.
Increased Retinoblastoma Protein (Prb) Expression occurs throughout the Adenoma- Carcinoma Sequence in the Large Bowel and is associated with, but does not parallel increased Proliferation. Irish Journal of Medical Science (1996). Col. 165, Supplement 4. Pg 14. H. Lemass, E. ryan, J.C O'Keane, P. MacMathuna, j. Crowe. 86 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 19 9 6
Cyclosporine Therapy and Fistula Closure in Crohn's Disease. Irish Journal of Medical Science (1996). Vol. 165, Supplement 4. Pg5. j. O'Neill, S. Pathmakanthan, j. Goh, S. Costello, P. MocMathuna, j. Crowe, j. Lennon.
Small Cell Carcinoma of the Oesophagus: A Ten Year Experience 1986-1996. Irish Journal of Medical Science (1996). Vol. 165 , Supplement 4 Pg8. j. Goh, H. Fene/on, C. O'Keane, D. Carney, j. (rowe, P. MacMathuna.
Increased Cyclin D I Expression occurs throughout the Aden Carcinoma Sequence in the Colon but does not par allel increased Retinoblastoma Protein (Prb) Expression. Irish Journal of Medical Science (1996). Vol. 165, Supplement 2 Pg 10. L Soffe, H. Lemass, E Ryan, P. MacMathuna, j. (rowe, C. O'Keane.
Chronic Hepatitis C Genotype I b Infection: Hepatic and Clinical Status Nineteen Years Post- Inoculation. Irish Journal of Medical Science (1996). Vol. 165, Supplement 2 Pg 14. j. Quinn, j. Goh, S. Sachithanadan, G. Ciarke, K. Ennis, G. Calagy, j.c. O'Keane, j. Crowe.
Outcome in Barrett's Oesophagus 10 to 16 years following diagnosis. Irish Journal of Medical Science. (1996) Yol. 165, Supplement 2 Pg20. K. Ennis, j. O'Neill, S. Sachithanandan, j. Goh, E Ciarke, P. MacMathuna, j . Crowe, j. Lennon.
The Relationship between P-53 and Cytokeratin Expression in regional Lymph Nodes and survival in Duke's B Colorectal Cancer. Irish Journal of Medical Science. (1996) Vol. 165, Supplement 2. Pg20. G. Ciarke, E Ryan, j. Goh, j.c. O'Keane, j. Crowe, P. MacMathuna.
Enhanced Cd44v6 Expression is a Prognostic Indicator in Dukes' B Colorectal Cancer. Irish Journal of Medical Science. (1996) Vol. 165, Supplement 2 Pg20. G. Gormley, G. Ciarke, G. Ciarke, H. Lemass, j. Goh, E. Ryan, j.c. O'Keane, P. MacMathuna.
Mirizzi Syndrome: A Diagnostic Dilemma. Irish Journal of Medical Science. (1996) Vol. 165, Supplement 2 Pg 21. j. Goh, M. Morrin, G. McEntee, S. Sachithanandan, j. Lennon, P. MacMathuna.
Cyclosporine Therapy and Fistula Closure in Crohn's Disease. Gut 1996. 39 (Suppl 3) A0935. j. O'Neill, S. Pathmakanthan, j . Goh, S. Costello, P. MacMathuna, j. Crowe, j. Lennon.
Increased Retinoblastoma Protein (Prb) Expression occurs throughout the Adenoma- Carcinoma Sequence in the Large Bowel and is associated with, but does not parallel increased Proliferation. Gut 1996. 39 (Suppl 3) A0285. H. Lemass, E Ryan, j.c. O'Keane, P. MacMathuna, j. Crowe.
Relationship between HLA Genotype and Phenotype Expression in Irish Families with Genetic Haemochromatosis. Gut 1996. 39 (Suppl 3) AO 124. E Ryan, M. Kelly, S. Pathmakanthan, P. MacMathuna, j.c. O'Keane, K. Ennis, j. Crowe.
RIBA Positive, PCR Negative Irish Patients have min imal liver inflammation and fibrosis, not predicted by number of positive RIBA Bands. Gut 1996. 39(Suppl 3) A0629. N. Kiernan, G. Ciarke, P. MacMathuna, A. Sullivan, G. Callagy, j.c. O'Keane.
Interferon-Ribavirin Combination Therapy for Chronic Hepatitis C, Type I B in a Unique Irish Cohort 18 years post inoculation. Gut 1996. 39 (Suppl 3) A0630. G. Ciarke, A. Sullivan, P. MacMathuna, G. Callagy, P. Kelly, j. Crowe. 87 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 1996
Small Cell Carcinoma of the Oesophagus: A Ten Year Experience 1986-1996. Gut 1996. 39 (Suppl 3) A0036. J. Goh, H. Fene/on, J.c. O'Keane, D. Carney, J. Crowe, P. MacMathuna.
Temporary and Long Term Biliary Stenting for Retained Common Bile Duct Stones in an Irish Cohort. Gut 1996. 39 (Suppl 3) A 1255. S. Pathmakanthan, J. Goh, E C/arke, J. Lennon, P. MacMathuna, J. Crowe.
AGA Interferon-Ribavirin Combination Therapy for Chronic Hepatitis C, Type I B in a Unique Irish Cohort 18 years post inoculation. Gastroenterology Supplement. April 1996. A276. G. C/arke, A. Sullivan, P. MacMathuna, G. Callagy, P. Kelly, J. Crowe.
Lansoprazole Versus Ranitidine Maintenance Treatment for prevention of Duodenal Ulcer. Gastroenterology Supplement. April 1996. A538. K.d. Bardhan, J. Crowe, R.P.H. Thompson, P. Trewby, P.N. Kneeling, D. Weir, K. Dixon.
RIBA Positive, PCR Negative Irish Anti-D Hepatitis C Patients have minimal Liver Inflammation and Fibrosis, not predicted by number of positive RIBA Bands. Gastroenterology Supplement. April 1996. A 1894. N. Kiernan, G. C/arke, P. MacMathuna, A. Sullivan, G. Callagy, J.c. O'Keane .
The Correlation Between Genetic Haemochromatosis and Proband Haplotype in Irish Families. Gastroenterology Supplement. April 1996. A3208. E Ryan, M. Kelly, S. Pathmakanthan, G. C/arke, P. MacMathuna, G. Callagy, J.c. O'Keane, J. Crowe.
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INFECTION CONTROL COMMITTEE
he Infection Control Committee is a sub-committee of the Hospital Executive Council. The members meet on a regular basis. Problems related to nosocomial infection are documented, discussed and rel evant action recommended. Hospital policies in relation to patient management are formulated and Tcirculated. The following hospital policies have been prepared and collected into a manual entitled "Policy for the Control of Infection in Hospitalised Patients". This manual has been circulated to all wards and departments.
I. Recommended disinfections and detergents in wards and departments.
2. Guidelines on Intravenous Therapy: (a) Management and care of long intravenous lines (b) Management and care of Hickman Catheters.
3. Urinary Catheterization.
4. Guidelines on the care of patients infected with: (a) Tuberculosis (b) Viral Hepatitis (c) Enteric Pathogens (d) Varicellalzoster (e) Multiple Resistant Staphylococcus Aureus (f) Acquired ImmunoDeficiency Syndrome.
5. Guidelines on the care of: (a) Patients undergoing Cardiac Surgery (b) Patients undergoing Cardiac Transplantation (c) Patients in the Intensive Care Unit (d) Patients in the Operating Theatre (e) Endoscopic Procedures (f) Ophthalmic Procedures (g) Respiratory Equipment (h) Cardiopulmonary Resuscitation Equipment.
6. Hepatitis B Vaccination Programme for Staff and Students.
7. Policy on the Management of Needlestick Injuries.
8. A Guide to the use of Antimicrobial Drugs compiled by Dr. Hone is circulated to all Non Consultant Hospital Doctors.
Conferences Surgical Conferences Twice yearly. Orientation course for Non Consultant Hospital Doctors Each July
Courses Six month Post-Registration Course for Nurses Dr. Hone and Sr. Ruddy Monthly orientation course for newly appointed Nursing Staff Sr. Ruddy Health and Safety Courses for all new staff Dr. Hone Introduction to Asepsis - 4th Year Medicals Dr. Hone and Sr. Ruddy 89 M ATER. MI SER. I COR.D I AE H OSP I TAL A N N UA L R EPOR.T 1996
THE INSTITUTE OF RADIOLOGICAL SCIENCES, MATER MISERICORDIAE HOSPITAL, PROFESSORIAL DEPARTMENT OF RADIOLOGY, UNIVERSITY COLLEGE DUBLIN
Departmental Introduction
n October 1985 the Board of Management of the Mater Misericordiae Hospital agreed to the formation of the Institute of Radiological Sciences to develop and foster education and research in Diagnostic Radiology. In the 10 years since its formation the Institute of Radiological Sciences has contributed significantly to radiological develop I ments by undergraduate education at University College Dublin Medical School in Post Fellowship Radiology training and in research into Functional Imaging.
The objective of the Institute was to create an environment for academic excellence for young Radiologists and sci entific training to maximise their academic potential and to stimulate an interest in prospective radiological research.
Facilities The principle research developments have been in relation to Functional Imaging using advanced Radionuclide tech nologies and Magnetic Resonance Spectroscopy. The introduction of dual-headed Gamma Camera with the possi bility of high energy collimation (51 I KeV) introduces the concept of imaging metabolic agents using Positron emit ters. The future developments of functional and metabolic imaging in M.R.1. offers opportunities to ascertain func tional abnormalities prior to morphological changes.
In the 10 year period, the Institute has published over 140 scientific papers and made over 200 scientific presenta tions on a national and international level. Numerous prizes have been won by trainee.s radiologists at national and international levels.
The main technological developments that have taken place in Diagnostic Imaging in the Mater Hospital have revolved around rapid acquisition of information with the ability to image functional changes and the understanding that in the age of information, computerisation of Radiology Departments is inevitable.
The introduction of a dual-headed Genyses Gamma Camera to image functional parameters and the acquisition of Spiral CT together with the functional capability of M.R. has provided the Mater with a unique opportunity to develop research at the highest level.
The Unit has continued to contribute to and evaluate the role of the Radiological Sciences in 1994 especially in the areas of Oncology and Neurology. The facilities available in the Institute.s Laboratory now include: a Sun Workstation with console and I gigabyte hard-drive and CD ROM Drive. A Lap- Top Computer for transferring images from a number of modalities is also available. The Sun Workstation contains a number of software plat forms. These include Digital Mammography software, a three dimensional and high performance general purpose image processing package, ANALYZE and signal processing package, Matlab.
More recently Siemens Limited Ireland presented the Institute of Radiological Sciences/University College Dublin/Mater Misericordiae Hospital with an MR/CT Image Processing platform, Magic View. Magic View enables high speed processing of three dimensional data from the Mater Campus.s CT and MR facilities.
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M ATER MI SER I CORD I AE H OSP ITA L A N N UAL R EPORT 1996
The facilities in the Laboratory have enabled the Unit to continue their contribution to the Schizophrenia Unit of the Health Research Board. The Schizophrenia Research Unit has funded Mr. Declan Walsh for a Research Fellowship investigating Three Dimensional Brain Morphometry in Monozygotic Twins Discordant for Schizophrenia. Characterisation of metabolism in these twin sets has been performed using Magnetic Resonance Spectroscopy and signal processing facilities in the Laboratory. The Unit continues to develop new techniques in imaging breast disease and reducing radiation dose in breast screening. Three Dimensional Image Processing tech niques for pre surgical localisation have been developed in the Unit.
Teaching Responsibilities.
MSc Course in Radiological Sciences The curriculum for the 1996 MSc Course has been up-dated to include workshops and lectures on key topics in Radiology. These included areas undergoing rapid change such as three dimensional volumetric imaging. Speakers will be invited from a number of Universities and Hospitals to talk about advances in areas relevant to the Radiological Sciences such as oncogenetics and three dimensional image processing Hands-on workshops in Digital Imaging and Magnetic Resonance Spectroscopy will be given using the facilities in the Mater Campus and facilities available in the Institute,s Radiological Sciences Laboratory.
The results of the 1995-1996 MSc Course are: Helen Fenlon - 2nd Class Honours Simon Blake - Pass Patrick Kiely - Pass Mary O'Malley - Pass
Eithne Bell received her MSc degree through her thesis entitled ,Analysis of tumours and their response to chemotherapy using in-vivo and in-vitro 31 P magnetic resonance spectroscopy,.
Medical Students Teaching Second Year Medical Students was done by introducing them to the CD ROM version of Radiological Anatomy. Two hours were spent demonstrating the approach and operation of the CD Rom disc. After the intro duction, the students were given access to computers to use the CD disc in University College Dublin so that they d can learn the radiological anatomy at their own pace. Quiz programmes were included in the CD disk for self assessment and to make learning more interesting.
The Resident Students were divided into groups and attended the Radiology Department to observe the radiologi g cal procedures and also the reporting sessions. They spent one week each in the Department.
The Final Year Students were divided into four groups for tutorials in Radiology. Each group spent two and half hours a day for two days. Different radiological investigations applicable for the clinical problems were discussed. The Students were shown varying pathology diagnosed through various radiological investigations.
Current Research Mr. P. Kenny began a PhD project in the overlay of Three Dimensional CT Lung Images and Three Dimensional Nuclear Medicine Lung Images in the assessment of pulmonary emboli. Mr. P. Gilligan initiated a project in new techniques in pre pathological prognosis in breast cancer. Mr. N. Phelan began an MSc project investigating the link between image quality and digital data compression. Staff and patient radiation doses in medical X-Ray examina tions, and the impact of new technology, such as digital radiology, in reducing these doses looked at. The Unit,s Laboratory is fully integrated into the Hospital,s Information System. Staff from the Institute are developing the complete electronic medical record in association with SMS Medical Systems and the Computer Centre in the Mater Hospital.
The Institute has remained committed to information technology, developing internet teaching tools, a Digital
91 M ATER MI SER I CORD I AE H OSP I TAL AN NUAL R EPORT 1996
Mammography Library and CD ROM inter-active teaching facilities for Radiological Anatomy.
The Institute contributed to a Mater Hospital Study Day for General Practitioners entitled " Computerised Radiology - The Gateway to the Future". The staff from the Institute gave a demonstration of Three Dimensional Image Processing on Telecommunications and their role in Radiology.
Scientific Presentations Scintigraphic Assessment of Sympathetic Neural Regeneration in the Transplanted Heart Using 123-1 MIBG. Radionuclide Imaging Update: Overview of Current Trends. UCD School of Diagnostic Imaging, January 1996. N. Phe/an.
Low Dose Imaging of the Hips in Infants with DDH using Computed Radiography (CR). Presented to the Faculty of Radiology (Royal College of Surgeons) Imaging Symposium, Dublin, February 1996. N. Phe/an, P.AKenny, V. Donoghue, M.P. O. Sullivan, J. I Ennis.
Absolute Imaging Sympathetic Neural Regeneration in the Transplanted Heart Using 123-1 MIBG. Presented to the Faculty of Radiology (Royal College of Surgeons) Imaging Symposium, Dublin, February 1996. H.M. Fen/on, N. Phe/an, P. Owens, J.H. Horgan, J. I Ennis.
Quantification of Local In Vivo Brain Metabolism. Imaging Symposium, Albert Theatre, The Royal College of Surgeons in Ireland, March 1996. P. Gilligan, J. I Ennis
Localised Bilateral Temporal Lobe Proton Spectroscopy in Monozygotic Twin Sets Discordant for Schizophrenia. Imaging Symposium, Albert Theatre, The Royal College of Surgeons in Ireland, March 1996. B. Coburn, P. Gilligan, D. Cotter, E. O. Cal/aghan, C. Larkin, J. Waddington, J. I Ennis. Institute of Radiological Sciences / University College Dublin, Mater Private Hospital & Cluain Mhuire Family Centre, Blackrock (Dublin).
Scintigraphic Assessment of Sympathetic Neural Regeneration in the Transplanted Human Heart Using 123-1 MIBG. Imaging Symposium, Albert Theatre, The Royal College of Surgeons in Ireland, March 1996. H.M. Fen/on, N. Phe/an, P. Owens, JH Horgan, J. I Ennis. Institute of Radiological Sciences /University College Dublin, Mater Private Hospital & Department of Cardiology, Beaumont Hospital (Dublin).
The Present Standards of Image Quality and Machine Performance for Mammography. Imaging Symposium, Albert Theatre, The Royal College of Surgeons in Ireland, March 1996. DJ. Dowsett, O.M. Laird, J. I Ennis.
Imaging of Benign and Malignant Breast Disease Using 99m-T c Tetrofosmin Scintigraphy. Presented to Symposium Mammographicum, Brighton, UK, March 1996. H.M . Fen/on, N. Phe/an, S. Tierney, I Gorey, J. I Ennis.
The Development of an Integrated Medical Imaging System. Imaging Symposium, Albert Theatre, The Royal College of Surgeons in Ireland, March 1996. J. MacEnri, S. Hickey, Computer Centre.
Alterations in Femoral Vein Duplex Sonography with Intra Operative Orthopaedic Traction. Combined Spring Meeting, The Radiological Society of Ireland and The Radiology Section of the Royal Academy of Medicine in Ireland. Faculty of Radiologists Meeting, Killarney, April 1996 AM. (ohill, H.M. Fen/on, A Devitt, M. Behan. 92 - .: ill'
M AT ER M ISER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
Advances in PET Imaging Study Day on Advances in Nuclear Medicine. June 1996 P.GiIIigan.
Quantitative Metabolic and Morphological Characteristics of Breast Lesions. First Irish Magnetic Resonance Users Meeting, Hillsborough, Belfast, October 1996. P. Gil/igan, F. Flanagan, M.P. 0, Sullivan, O.M. Redmond, J. I Ennis.
Quantitative Metabolic and Morphological Characterisation of Schizophrenia. First Irish Magnetic Resonance Users Meeting, Hillsborough, Belfast, October 1996. P. Gil/igan, F. F/anagan, M.P. 0, Sullivan, O.M. Redmond, J. I Ennis.
Breast Cancer Screening, Conference on Breast Cancer Awareness, Royal Hospital, Donnybrook, October 1996. Professor J. I Ennis.
An Assessment of the Value of 99mTc Tetrofosmin in the Detection of Hibernating Myocardium. Presented to the Registrars Prize Meeting, R.C.P.I., Dublin, December 1996. M. Maher, N. Phelan, I Hennessy, P. Diamond, C.O,Keane, J. Hurley, M. Co dd, H. McCann, D. Sugrue, J. I Ennis.
Scientific Publications Scintigraphic Assessment of Sympathetic Neural Regeneration in the Transplanted Human Heart Using 123-1 MIBG. Abstract: Nuclear Medicine Communications (1996) 17,4. H.M. Fen/on, N. Phelan, P. Owens, JH Horgan, J. I Ennis . Institute of Radiological Sciences I University College Dublin, Mater Private Hospital & Department of Cardiology, Beaumont Hospital (Dublin).
Scintimammography Using 99m-T c Tetrofosmin in the Evaluation of Malignant and Benign Breast Disease. Abstract: Nuclear Medicine Communications (1996), 17,4. H.M. Fen/on, N. Phelan, A. Adams, J. I Ennis
Scintimammography Using 99m _Tc Tetrofosmin in the Evaluation of Malignant and Benign Breast Disease. Abstract: Nuclear Medicine Communications (1996), 17,4. Presented to the Annual Meeting of the BNMS, Brighton UK, April 1996. N. Phelan, H.M. Fenlon, P. Owens, J.H. Horgan, J.T. Ennis.
Low Dose Imaging of the Hips in Infants with DOH using Computed Radiography. Abstract: B.J.R. (1996) 69, Supplement. Presented to Radiology UK, Birmingham, May 1996. N. Phe/an, P.A. Kenny, V. Donoghue, M.P. 0, Sullivan, J. I Ennis.
Role of SCintimammography and MR Mammography in Evaluating Malignant and Benign Breast Disease. Abstract: B.J.R. (1996) 69, Supplement. Presented to Radiology UK, Birmingham, May 1996. H.M. Fen/on, N. Phe/an, M.P. 0, Sullivan, M. Morrin, A. Adams, J.P. Stack, J. I Ennis.
Cardiac MIBG SCintigraphy as an Indicator of Sympathetic Neural Regeneration Following Orthotopic Cardiac Transplantation.
93 M ATER MI SER I CORO I AE H OS P ITAL A N N UA L R EPORT 1996
Abstract : B.J.R. (1996) 69, Supplement. Presented to Radiology UK, Birmingham, May 1996. H.M. Fen/on, N. Phe/an, P. Owens, j.H. Horgan, j. I Ennis.
Pre Surgical Assessment of Breast Lesions Using Proton Spectroscopy. British Journal of Radiology, Vol. 69, May 1996, 18(P). P. GiIIigan, F. F/anagan, B. Coburn, M.P. 0, Sullivan, O.M. Redmond, j. I Ennis
31 MRS in the Assessment of Superficial Tumours. Magnetic Resonance Materials in Physics, Biology and Medicine. Vol.IV No. 2, June 1996, 246(P) E. Bell, O.M. Redmond, K. G/ass, P. GiIIigan, D.N. Carney, j. I Ennis
Bilateral Localised Temporal Lobe Proton Spectroscopy in Monozygotic Twin Sets Discordant for Schizophrenia. Magnetic Resonance Materials in Physics, Biology and Medicine. Vol.IV No.2, June 1996, 23 I (P). P. Gilligan, D. Cotter, D. Wa/sh, B. Coburn, E. 0 , Callaghan, J.L Waddington.
Pre-Surgical Assessment of Breast Lesions Using Proton Spectroscopy. Magnetic Resonance Materials in Physics, Biology and Medicine. VoLlV No.2, June 1996, I 19(P). P. Gilligan, F. F/anagan, B. Coburn, M.P. 0 , Sullivan, O.M. Redmond, j. I Ennis .
Proton Spectroscopy in Pre-Pathological Assessment of Breast Lesions, I 996.Eurospin Annual 1995-1996. Edited by Podo, Bovee et al. (Rome Instituto Superiore Di Sanita). Symposium on Lipid Metabolism and Function in Cancer. P.221 . P. Gilligan, F. F/anagan, B. Coburn, M.P. 0 , Sullivan, O.M. Redmond, j. I Ennis.
Scintimammography and MR Mammography as Adjuncts to Screen-Film Mammography in the Evaluation of Benign and Malignant Breast Disease. Abstract: Radiology (1996) 20 I Supplement. Presented to RSNA, Chicago, December 1996. H.M. Fen/on, N.Phe/an, M.P. 0, Sullivan, I Gorey, j. I Ennis.
Duplex Sonographic Assessment of Alterations in Femoral Vein Flow and Caliber Due to Intraoperative Orthopedic Traction. Abstract: Radiology (1996) 20 I Supplement Rad iological Society of North America, Chicago, December 1996. AM. Cahill, H.M. Fen/on, A Devitt, M. Behan.
Bilateral Temporal Lobe Spectroscopy in Monozygotic Twin Sets Discordant for Schizophrenia. Abstract: Radiology ( 1996) 20 I Supplement Rad iological Society of North America, Chicago, December 1996. P. Gilligan, D. Cotter, D. Wa/sh, B. Coburn, C. Larkin, E. 0, Callaghan, j. Waddington, j. Ennis. Institute of Radiological Sciences I University College Dublin, Mater Private Hospital & Cluain Mhuire Family Centre, Blackrock (Dublin).
Comparison of the Cost and Diagnostic Efficacy of Three Intravenous Contrast Media Used in Helical Thoracic CT. Abstract, Radiology ( 1996) 20 I Supplement. Presented to RSNA, Chicago, December 1996. IA Toma, M. Morrin, E. Breatnach. 94 M ATER MI SER I CORDIAE H OSPITAL A NNUAL R EPORT 1996
Cost Effective Teleradiology Cover for Emergency MR Imaging and CT Studies. Abstract, Radiology (1996) 20 I Supplement. Presented to RSNA, Chicago, December 1996. J. MacEnri, B. Coburn, G. Hurl, J. T. Ennis.
A Comparison of Contrast-Enhanced MR Mammography and Tc-99m Tetrofosmin Scintimammography in the Evaluation of Palpable Breast Lesions. MSc Thesis in Radiological Sciences/ University College Dublin 1996. He/en M. Fenlon.
A Comparison of Volume Estimation Methods (Tracing, Thresholding and Point Counting Stereology) in MRI. MSc Thesis in Radiological Sciences/ University College Dublin 1996. Patrick Kiely.
An Evaluation of the Effect of Radiologist Grade on Clinical Patient Dose in Fluoroscopy. MSc Thesis in Radiological Sciences/ University College Dublin 1996. Mary Jane a,Mal/ey.
Photo-Stimulated Functional MR Imaging of the Optical Cortex: A Study of Multiple Sclerosis Patients Having Optic Atrophy or Neuritis. MSc Thesis in Radiological Sciences/ University College Dublin 1996. Simon P. Blake
95 M ATER MI SER I CORDIAE H OSPITA L A NNUA L R EPO RT 1996
MEDICAL SOCIAL SERVICES DEPARTMENT
he Social Work Department continues to expand to meet the psychosocial needs of the hospital's population. During 1996, approximately 4,000 new patients were seen with a total of over 9,600 social work sessions Tbeing provided during the year. Our work continues to focus on addressing the social impact of the illnesses that hospital patients experience. We particularly concentrate on assessing how the patients' lives who have been affected by their illness and how they will manage when they return to their home environment. Providing support through the initial crisis and connect ing them with local services on discharge is of particular importance.
We continue to meet major social problems, such as unemployment, poverty, drug use, alcoholism, AIDS, and particularly the problems of the isolated elderly population that the hospital serves in its catchment area.
In October 1996, a specialist Social Worker/Counsellor post was created in the Oncology Department. This post is being funded on a three year basis by the Irish Cancer Society. The role of the Social Worker/Counsellor in Oncology is to provide counselling support to individuals with cancer and to their famil ies. This is to help them come to terms with their diagnosis and to provide support/counselling throughout their illness. Much time is also spent in grief and loss work.
It is expected that the challenges that lie ahead for the Social Work Department in 1997 will match and perhaps exceed those faced by the Department in 1996.
Lectures Given Social Work in Different Media Settings. E. O'Leary, C. Beaumont, N. Martin.
AM. Jones - Lectures to physiotherapy students
The role of the Medical Social Worker. E. O 'Leary, S. White, AM. Jones - Lectures to final year student nurses.
Transition Year Courses: Input from Social Work Department. Clinical Pastoral Education: Input from Social Work Department. Oncology Courses: Nicky Martin. Mental Health in Elderly: Sheighle Sheridan. Psychological Debriefing Training: E. O'Leary, M. Mclnerney, S. White, S. Sheridan.
96 M ATER. MISER.ICOR.DIAE HOSPITAL AN NUAL REPOR.T 1996
NEPHROLOGY DEPARTMENT
Scope of Service on. he Department fulfils an intensively consultative role together with a wide range of elective nephrologic evaluation. The workload includes the care of patients with acute renal problems and in particular, for cases with acute renal failure. In this latter respect, there is instant on site availability of acute haemodial Tysis therapy, acute peritoneal dialysis, and the newer form of renal replacement therapy, continuous veno-venous haemodiafiltration (CVVHD).
This latter type of acute dialysis is being applied more frequently in the intensive care setting. It is particularly well suited to the needs of the critically ill and 'unstable' patient. It facilitates the safe removal if relatively large volumes of fluid to provide adequate 'space' for the administration of parenteral nutrition. Two CWHD Monitor Pumps and two state of the art haemodialysis machines are available for the provision of acute dialysis services.
A developing area of activity for the nephrology service is the pre and post-operative renal management for chronic dialysis patients referred for coronary artery bypass or valve replacement surgery to the Mater from outside Renal Units.
The cardiac transplantation programme has involved the nephrology service both in the immediate post operative period, as well as in the longer term monitoring of the effects of immunosuppressive therapy on renal function in these patients. s There is an active renal biopsy service. This procedure is routinely performed using ultrasound imaging. Biopsies are carried out on regular Wednesday sessions which facilitates our own Department and the Department of Radiology. Emergency renal biopsies are performed when necessary.
With the welcome appointment of the Professor of Medicine this year, a new Haemodialysis Unit is planned for 1997. This will be staffed by trained dialysis nurses and will be constructed and equipped to the highest standards. Through his association with Beaumont Hospital, the nephrologist will arrange full access for these Mater Misericordiae Hospital patients to the National Transplantation Unit.
Special Interests Acid-base and electrolyte problems. Renal hypertension and renovascular disease. Diabetic nephropathy.
Research Activities in Progress I. Prevention of progressive renal failure in diabetes. J. Donohue, R. Firth, N . O'Meara. 2. Salvage of functional renal tissue through revascularisation. T. Corrigan, J. Donohue.
Conferences/Study Days: Renal biopsy review conference (in association with Beaumont Hospital). Mondays, 12.00 - 1.00 p.m.
Clinical nephrology conference. Wednesdays, 1.00 - 2.00 p.m.
Journal review group Fridays, 1.00 - 2.00 p.m.
97 M ATER. M ISER.ICOR.D I AE H OSPITAL A N N UAL R EPOR.T 1996
Nephrology Out-Patient Clinic: Mondays, 2.00 - 5.00 p.m.
Podium and/or Poster Presentations were made at the following Meetings: Advances in Immunosuppression: Cellcept, Dublin, March 1996.
Diabetic Nephropathy: Tabuk, Saudi Arabia, March 1996.
Renal Hypertension: Tabuk, Saudi Arabia, March 1996.
Side Effects of Immunosuppressive Drugs: Irish Kidney Association, Dublin, April 1996.
Scleroderma and the Kidney: Corrigan Club, Dublin, April 1996.
Irish Nephrological Society Annual Meeting: RCPI, Dublin, May 1996.
Chairman, Erythropoietin Update: St. Vincent's Hospital, Dublin, May 1996.
Acute Renal Failure: RCSI/Mayo Clinic Joint Meeting, Dublin, June 1996.
Advances in Acute Dialysis Therapy: Blackrock Clinic Intensive Care Symposium, Dublin, August 1996.
UCD Medical Graduates Association: Northeastern Chapter, Boston, September 1996.
Renal Aspects of Diabetic Retinopathy: Ophthalmology Conference, Mater Hospital, Dublin, September 1996.
Publications Recurrence of primary focal segmental glomerular sclerosis in renal transplant patients. Proceedings, Irish Nephrological Society Meeting, 1996. M. Hogan, R. Falconer, D. Hickey, A. Dorman, E. Campbell, O. Browne, D. Hickey, A. Dorman, E. Campbell, O. Browne, D. O'Neill, J. Donohue.
Allograft nephrectomy with 'rapid' re-transplantation. Proceedings, Irish Nephrological Society Meeting, 1996. M. Hogan, R. Falconer, D. Hickey, D. Dorman, A. O'Neill, J. Donohue.
Predictors for the recurrence of IgA disease following renal transplantation. Proceedings, Irish Nephrological Society Meeting, 1996. A. Stack, E. CAmplbell, O. Browne, T Dorman, J. Donohue.
Vascular cell adhesion molecule (VCAM-I) expression in transplanted kidneys. Proceedings, Irish Nephrological Society, 1996. C. Killeen, O. Browne, M. Carmody, J. Donohue.
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NEUROPHYSIOLGY DEPARTMENT
E.E.G.IE.M.G.
Scope of Service
aily E.E.G . clinics. Three out-patient E.M.G. clinics weekly. E.E.G. and E.M.G. testing of in-patient and out patient consultations. Clinical Neurological services including electroencephalography, electromography, visual evoked potentials, brain stem auditory evoked potentials. The department is also involved in electro D diagnostic work with the Ophthalmic Department and the EN.T. Department. In conjunction with the Colo-Rectal Surgeon, Mr. R. O'Connell, we have set up an anal manometry service, including pudendal nerve stimulation.
Equipment Full range of clinical neurophysiological equipment including a portable 10 channel E.E.G. machine and we acquired two Nicolet Voyager Digital machines. A Dantaec E.M.G. machine and nerve conduction equipment, and a Digitrapper with a pressure transducer for anal manometry. Equipment related to evoked responses including audi tory click stimulator.
Research Projects The E.E.G . Department was involved in a six month project in association with the Department of Anaesthesiology.
Special Interests Dr. B.C. O'Moore is a member of the American Association of Electromyography and Electro-Diagnosis and is also a member of the Association of British Clinical Neurophysiologists.
Meetings
Neuro-Pathology Meeting - Carrick on Shannon, March 1996. B.C. O'Moore.
American Association of Electro-Diagnostic Medicine - Minneapolis September 1996. B.C. O'Moore.
Spring EPTA Irish Branch Meeting, Royal Children's Hospital, Belfast - April 1996. K. Plaisted.
Autumn EPTA Irish Branch Meeting, St. Vincent's Hospital, Elm Park, Dublin - October 1996. K. Plaisted.
99 M ATER MI SER I CORD IAE H OSPITA L ANN UA L R EPORT 1996
DEPARTMENT OF NURSING
Nurse Complement Within the Nursing Complement we have the following specialist nurses:
• Infection Control Sister
• Anaesthetic/Resuscitation Training Sister
• Specialist Nurse for Parenteral Nutrition
• Stoma Care Nurse
• Cardiac Transplant/Counsellor Nurse
• Cardiac Rehabilitation Nurse
• Oncology Nurses
• Bed Manager
• Hepato-Biliary Nurse
• Cardiac Research Nurse
• Nurse Co-Ordinator of Computer Services
• Haematology Nurse
• Liaison Junior Sister - Accident & Emergency Department
• Nursing Practice Development Co-Ordinator
• Occupational Health Nurse.
Applications for General Nurse Training: The number of applications processed for General Nurse Training from the year ending 3 I st December 1996 was 1876.
Special Interests
Higher Diploma in Healthcare Risk Management Mrs. Anne Carrigy, Deputy Director of Nursing was awarded a Higher Diploma in Healthcare Risk Management from University College Dublin in 1996.
This was the first year of this course, which is run by Dr. Denis Cusack, Department of Legal Medicine in University College Dublin.
Mrs. Carrigy was appointed to the post of Deputy Director of Nursing at the Mater Hospital in January 1989. She undertook her general nurse training in the Mater Hospital followed by and Intensive Care Post Registration
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Nursing Course. Mrs. Carrigy has suc cessfully completed the following cours ealthcare diplomas are presented es: Administration Course for Ward Sister, U.C.D.; Certificate in Management and Certificate in Counselling from St. Patrick's College, Maynooth; Diploma in Industrial Relations from the National College of Industrial Relations. She is currently studying for a Masters in Medical Science (Nursing) Degree in the Department of Nursing Studies, University College Dublin. Lynch , Maura Lewls . Davida de la Harpe , Mary Power, Helen Sweeney, Calherine Farrell and Anthony Cunningham; (Iront) Bridget Hogan, Anne Carrigy, Prolessor Ronan O'Regan, dean 01 the Faculty 01 Medicine; Or Denis Cusack , course director; the Reg islrar, Or Caroline Hussey; Maev. Doyl. and Imelda
• Anne Carrigy, second from left, receiving diploma.
Fellow of the Faculty of Nursing, Royal College of Surgeons in Ireland Ms. Noreen Keane, Assistant Director of NurSing, became a Fellow by examination of the Faculty of Nursing, Royal College of Surgeons in Ireland in 1996.
Ms. Keane undertook her general nurse training, followed by an Intensive Therapy Nursing Post Registration course at the Mater Hospital. She studied midwifery in the Coombe Women's Hospital and then proceeded to complete here paediatric nurse training in Our Lady's Hospital, Crumlin before returning to the Mater Hospital in 1984 to take up the post of Night Sister. She was appointed to the post of Assistant Director of Nursing in 1992.
Nursing Practice Development Unit - Pre-Registration Diploma in Nursing In October 1996 Ms. Catherine Guihen, B.N.S., R.G.N., R.M., R.N.T. took up the post of Nursing Practice Development Co-Ordinator. Irish Nursing in line with other European countries is moving to university in order to have nursing education accredited. Since 1994, in Ireland, a IIImber of pre-registration nurse education programmes have been accredited at Diploma level. To advance this ilitiative and successfully integrate nursing education and the new programme in the clinical area, the Department of Health has funded several new posts. The role of the Nursing Practice Development Co-Ordinator is one of 1hese. As it is envisaged that student nurse education in the Mater Misericordiae Hospital will link with University College Dublin in Autumn 1997, this new post is particularly timely to co-ordinate the many preparations involved.
The aims of the Nursing Practice Development are to enhance patient care through nursing practice, which is based on researched evidence, of its effectiveness .
. She (i) To establish a NurSing Practice Development Unit, to evaluate, develop, implement and monitor Nursing
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Practice in all areas of the hospital.
(ii) To manage the nursing services quality improvement programmes in such a way as to support and ensure the delivery of the highest standard of nursing care through the hospital.
(iii)Ensure that the clinical areas in the hospital to which students are assigned for clinical placements provide an optimum teaching and learning environment.
The first project, Introducing an Individualised Approach to Nursing, documentation is in progress.
Ms. Guihen is currently in her final year of a M.Sc. in Management of Education and Training in Dublin City University.
Occupational Health Nurse Ms. Richella Cassidy was appointed to the post of Occupational Health Nurse in September 1996. Ms. Cassidy graduated from Surrey University in 1991 with a Higher Diploma in Occupational Health and since qualifying has gained experience • Catherine Guihen in a variety of different Occupational Health settings both with in private industry and the health care environment.
Ms. Cassidy works with the Occupational Health Physician and department secretary in the newly established Occupational Health Department which is located at 398 North Circular Road. Occupational Health aims to promote and maintain the physical, mental and social well being of all Mater Hospital employees. Services provided by the department include the provision of vaccination clinics, conducting pre-employ ment medical assessments, health surveillance, biological monitoring, accident and injury follow up, counselling, co ordination of the hospital manual handling training pro gramme and advice on all matters relating to staff welfare at work.
Post Registration Education Nursing Department The Post Registration Education Nursing Department (PREND) which was opened in 1995 is continuing to meet the challenge of advanced nursing practice in an everchang ing healthcare environment.
Two of our Post Registration courses have been awarded Higher Diploma status - The Higher Diploma in Nursing Studies (Cardiovascular Nursing) and The Higher Diploma in Nursing Studies (Diabetes Nursing).
Since September 1996 these courses are run in conjunction with the Department of Nursing Studies, UniverSity College • Richella Cassidy Dublin.
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• November 1998 Finalists, Ms. R. Smyth, Ms. K O'Reilly, Ms. T. O'Callaghan, Ms. W. Ross and Ms. J. Crehan with Sr. Ursula Courtney who raised funds for St. Vincent's Oncology Ward.
At present, three Category 11 courses: Intensive Therapy, Theatre Technique and Accident & Emergency and two Category I courses: Diabetes Care and "Teaching and Assessing Clinical Practice" are facilitated from the centre.
Furthermore a Back to Nursing course is run twice yearly in February and September.
The team comprises of five clinical co-ordinators an one tutor (Ms. Regina Browne) collaborate together (in constant liaison with clinical staff) to achieve the aforementioned aim.
40 Staff Nurses successfully availed of the three Post Registration Courses during 1995 in Theatre Technique, Coronary Care and Intensive Therapy. 28 Staff Nurses successfully availed of the Post Registration Course in Diabetes Care which was run in November 1996.
In 1996 Mrs. Laserina O'Connor was seconded from her post as Course Tutor at the Post Registration Education Nursing Department, for a period of three years, to undertake an Assistant Lecturer's post in the Department of Nursing Studies, University College Dublin. Mrs. O 'Connor was awarded a Masters in Medical Science (Nursing) Degree from University College Dublin in 1996.
Oncology Day Unit An Oncology Day Unit was established in St. Vincent's Ward in May 1996. Its objective is to treat oncological and haematological malignancies in an out-patient setting thus being able to maintain a semblance of normality for can cer patients. The unit caters for 10 - 20 patients daily and is used to deliver a wonderful services with chemothera py infusions, blood product transfusions, and certain diagnostic investigations like bone marrow aspiration and lum bar punctures. Routine mid-cycle blood testing is also carried out ant the presence of an Oncology/Haematology physician provides continuous medical support.
The nursing staff of St. Vincent's Ward have endeavoured to maintain a high quality nursing practice with on-going post graduate education. There are three Staff Nurses in their final year of Diploma in Oncology Nursing at
103 M ATER MI SER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
University College Dublin and a further two commenced this course in 1996. Other Staff Nurses have undertaken a total of five courses at the RCSI.
A wonderful family and caring feeling continues to support and care for all patients in St. Vincent's Ward. This is achieved by team work, co-operation and flexibility of all grades of staff in ensuring comfort, spiritual peace and love for all patients in St. Vincent's Ward.
Haematology Nurse Ms. Mary Edger, Haematology Nurse was invited to give a talk on "Peripheral Blood Progenitor Cell Transplantation" to the Irish Association for Nurses in Oncology (Cork Branch) in the Bon Secours Hospital, Cork on 25th January 1996. Ms. Edger was also invited to speak on "The Role of the Haematology Nurse and Peripheral Blood Stem Cell Transplantation" in Our Lady's Hospital, Crumlin on 7th February 1996.
Ms . Edger attended the National Blood Transfusion Service Board Symposium in Jury's Hotel, Dublin on 7th March 1996 and the Baxter Healthcare User Group Symposium in Leeds on 25th and 26th November 1996.
Diabetes Care Ms. Deirdre Cregan, Sister in Charge, Diabetic Day Centre travelled to Kuwait in February in order to participate in the third Diploma Course in Diabetes for Medical Personnel there.
Sr. Cregan was asked to join the Executive Committee of the Federation of European Nurses in Diabetes, this is a new organisation for nurses working in Diabetes in Europe. Sr. Cregan attended the first meeting on 22nd February 1996 in Brussels.
The British Diabetic Association Spring Meeting was held on 28th and 29th March 1996 in Belfield, Dublin. Sr. Cregan, Sr. Dehaene, SINs Duffy and O 'Shea attended.
Sr. Cregan was asked to give a talk on the "Management of the Diabetic Patient" in St. Vincent's Hospital, Fairview on 21 st March 1996 and also asked to speak at a Post Graduate Study Day, on 29th April 1996 in Our Lady of Lourdes Hospital in Drogheda on the "Management of the Patient with Diabetes". Sr. Cregan spoke on the Day to Day Management of Diabetes to course practice nurses in R.C.S.1. on 9th May 1996.
Sr. Cregan attended the European Association for the study of Diabetes in Vienna from I st to 6th September 1996.
Annual Reunion The Annual Reunion of the Past Mater Nurses was held on Saturday, 15th June 1996. The attendance was high, and all Past Mater Nurses enjoyed the day very much. Catering fro the occasion was excellent as usual.
In-Service Training Programme Requests from Health Boards, Hospitals and other Health Service Agencies for In-Service Training of Personnel were met during the year under review:-
University College Dublin - Nurses undertaking the Diploma in Oncology Nursing attended St. Vincent's Ward for experience.
National Heart Foundation - Nurses undertaking the Coronary Care Course attended the Coronary Care Unit for experience.
Study Days Study days entitled "Teaching and AsseSSing in the Clinical Area" were held on 13th and 14th February for all
104 M ATER M ISERICORDIAE H OSPITAL A NNUAL R EPORT 1996
Ward/Departmental Sisters and Staff Nurses. This study day was repeated on 17th and 18th September 1996. Mrs. Laserina O'Connor facilitated these study days.
Mrs. Roberta Burton, Nursing Development and Research Facilitator at the Royal Hospital in Belfast gave a lecture entitled "Has Nursing lost its art?" on 14th May 1996.
A study day on Psychiatry was held on 5th June 1996. The theme of this day was the nurse- led innovations and developments within Area 7 Psychiatric Services.
Proficiency Assessment Form workshops were held on 15th and 16th October 1996.
A Management Day for Ward/Departmental Sisters was held on Tuesday, 19th November 1996. The theme was "Stress Management in Hospitals" and was facilitated by Dr. Ciaran O'Boyle, Professor of Psychology, R.C.S.1.
The Staff Orientation Programme continued this year for new and newly qualified nursing staff. This pro gramme includes: General Information, Health an Safety, Infection Control, School of Nursing, Occupational Health, Information Technology, Manual Handling, LV. Policy Training/Certification and C.P.R. Training/Certification.
Continuous training in Basic Cardiac Life Support continued during the year for all staff in the Hospital. Advanced Cardiac Life Support course ran from 8th to 10th February 1996 and again from 8th to 10th August. 1996.
Manual Handling and Patient Lifting training continued throughout the year.
Among the Conferences/Seminars/Courses Attended:
Conference/Course/Seminar Date Held A.O.RN. Conference for Theatre Sisters held in Dallas, U.S.A. I stl8th March
15th Annual Nursing and Research Conference in R.C.S.1. 29th Feb/I st March
Oropharyngeal Dysphagia Conference in St. James' Hospital, Dublin. 29th/30th March
An Bord Altranais National Conference for Nurse Tutors and Cl inical Teachers 21 stl22nd March
A.O. Orthopaedic Course - Cappagh Hospital 28th/30th March
"Care and Management of people affected by H.l.Y./A.I.D.S. - St. James' Hospital 25th March/6th April
Aspects of Psych iatric Nursing Faculty of Nursing, R.C.S.1. 19th April
"Blood Diseases and Oncology: Haematology Issues" - Cardiff, Wales 30th April
Care Advanced Trauma Nursing Course Newcastle, Co. Down May
Teaching and Learning for Cl inical Staff University College Dublin, Department of Nursing Studies May/June
I.S.EN. Conference in Limavady, N.1. 31st May
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Palliative Care Course - Marymount Hospice 10/ 14th June
European Resuscitation Council Conference June
British Dermatology Nursing Conference in Bournemouth, England. 4th/6th July
9th International Conference on Cancer Nursing - Brighton. 12th/ 15th August
British Diabetic Association Education Section Meeting in Exeter, England. 18th/20th September
Endoscopy Course for Nurses held in St. James' Hospital 7th/25th October
Irish Cardiac Society Study Day in Newcastle 24th October
European Conference for Crohn's Disease and Ulcerative Colitis in Germany 28th/30th October
European Society of Gastroenterology and Endoscopy Nurses in Paris 4th/6th November.
106 M ATER. MI SER. I COR.D I AE H OSP I TA L AN NUAL R E POR.T 1996
DEPARTMENT OF OPHTHALMOLOGY
Meetings Attended
Royal Academy of Medicine in Ireland, Ophthalmic Section 8th March 1996, Sir Samuel Irwin Lecture Theatre, Royal Victoria Hospital, Belfast. P. Eustace, C. Saidlear, I. Flitcroft, J. O'Reilly. r The Queen's University, Belfast, Friday 22nd March 1996. Guest Lecturer, P. Eustace.
Joint ICO/SOS meeting, Galway 21-24th May 1996. P. Eustace, C. Saidlear, I. Flitcroft, A. Mulvihill , I. Doyle.
11th Meeting of the International Neuro-Ophthalmological Society, 14-16 August 1996, Sydney, Australia. Prof. P. Eustace.
Chaired "Chiasmal and Retrochiasmal Problems" 11th Meeting of the International Neuro-Ophthalmological Society, 14-16 August 1996, Sydney, Australia. Prof. P. Eustace.
Annual General Meeting of RP Ireland - Fighting Blindness 14th September 1996, Westbury Hotel, Dublin. Prof. P. Eustace.
Irish College of Ophthalmologists Continuing Medical Education "Diabetes and the Eye". Postgraduate Lecture Theatre, Mater Hospital, 27th September 1996. Prof. P. Eustace.
Irish College of Ophthalmologists Continuing Medical Education "Refractive Surgery Update Meeting" Institute of Ophthalmology, UCD, 60 Eccles Street, Dublin. 26th September 1996. Prof. P. Eustace.
Op hthalmological Society of New Zealand, 50th Anniversary Meeting, Wairakei Report Hotel, I 7th-2 I st October 1996. Visiting Professor and Guest Speaker.
B.l.N.O.C. 12-15th November 1996. Bath. England. Prof. P. Eustace.
Presentations Shotgun Pellets in the orbit and cavernous sinus. Royal Academy of Medicine in Ireland (Ophthalmic Section). 8th March 1996, Royal Victoria Hospital, Belfast. A. Mulvihill, P. Eustace.
Manipulation of the AC/A ratio by very low dose mydriatics; theory and practice. Royal Academy of Medicine in Ireland (Ophthalmic Section). 8th March 1996, Royal Victoria Hospital, Belfast. I. Flitcroft, C. Saidlear, P. Eustace.
Preattentive Vision Testing: a new technique for investigation of glaucomatous damage. JO int ICO/SOS Meeting, Galway 2 I-24th May 1996. I. Flitcroft, A. Doy/e, P. Eustace.
The changing pattern of perforating eye injuries in Ireland. Joint ICO/SOS Meeting, Galway 21-24th May 1996. A. Mulvihill, P. Eustace.
107 M ATER MI SER I CORD I AE H OSP I TAL A N N UAL R EPORT 199 6
Oculomotor Nerve Palsy with cyclic spasms. Joint ICO/SOS Meeting, Galway 2 I-24th May 1996. P. Eustace, N. Abdulla.
Evaluation of the Surgical Techniques in photoreceptor transplantation in the mouse. Joint ICO/SOS Meeting, Galway 2 I-24th May 1996. I. Flitcroft, D. Keegan, P. Eustace, R Acheson.
Nustagmus. E.U.P.P. IX course for residents, Athens, 23-25th June 1996. Prof. Peter Eustace.
A proposed neuroanatomical and neurophysiological basis for WEBINO. I I th meeting of the International Neuro-Ophthalmological Society, August 14-16th 1996, Sydney, Australia. I. Flitcroft, C. Said/ear, j.P. Stack, P. Eustace.
Preattentive Vision Testing in patients with diabetic retinopathy. Mater Research Symposium, 29th October 1996, MMH. L Crowley, I. F/itcroft, P. Eustace.
Infrared oculographic studies of reading and writing. Ophthalmological Society of New Zealand 50th Anniversary meeting, Wairakei Resort Hotel, 17 -21 st October 1996.
Pontine Control of eye movements - new studies. Ophthalmological Society of New Zealand 50th Anniversary meeting, Wairakei Resort Hotel, 17-21 st October 1996.
Nystagmus, an update. Ophthalmological Society of New Zealand 50th Anniversary meeting, Wairakei Resort Hotel, 17 -21 st October 1996.
Ireland, land of Saints and Scholars. Ophthalmological Society of New Zealand 50th Anniversary meeting, Wairakei Resort Hotel, 17-21 st October 1996.
Sympathetic ophthalmitis - what more can we do? Combined Ophthalmic Section of the Royal Academy of Medicine in Ireland and the Irish American Ophthalmological Society meeting, 4th November 1996. Davenport Hotel, Dublin. RM. Corner, R W Acheson.
Planoscan versus multizone in PRK. Combined Ophthalmic Section of the Royal Academy of Medicine in Ireland and the Irish American Ophthalmological Society meeting, 4th November 1996. Davenport Hotel, Dublin. I Fulcher, M. O'Keefe.
Ocular Neuromyotonia. B.I.N.O.C. Meeting, 12-15th November 1996, Bath, England. P. Eustace.
An overview of Neuro-ophthalmology. Presented at Frontiers of Vision; Towards the 21 st Century. Department of Optometry, University of Bradford. December 1996. P. Eustace.
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Poster Presentations Ocular Manifestations of Paraneoplatic Syndromes. The Royal College of Ophthalmologists Annual Congress, Edinburgh. 7th May 1996. B. Beigi, A. Mulvihill, P. Eustace.
Impact of carotid endartrectomy on pulsatile ocular blood flow and assessment of the potential role of ocular blood flow in the management of carotid disease. Mater Research Symposium, October 29th 1996, MMH. ). Ferguson, C. Saidlear, I. Flitcroft, A. Early, P. Eustace.
Publications Anatomy of the extraneural blood supply to the intracranial oculomotor nerve. B.J.O. 1996; 80: 177-181. Mark Cahill, John Brannigan, Peter Eustace.
Association of HLA type with pseudoexfoliation of the lens capsule. British Journal of Ophthalmology, May 1996, Vol. 80, No. 5, Pages 402-404. ).S. FitzSimon, A. Mulvihil/, S. Kennedy, A. Finch, LMT Col/urn, P. Eustace.
Absent Meibomian Glands: a marker for EEC Syndrome. Eye (1996) 10,335-361 . Royal College of Ophthalmologists. £. Bannar, P. Logan, P. Eustace.
Early changes in the Choroidal Vasculature of Rats occurring with experimentally induced hypertension. Ophthalmic Research 1996; 28: 255-259. I Fulcher, B. Beigi, P. Eustace, j. Bannigan.
Accommodation in Binocular Contour Rivalry. Vision Res. Vol. 37, No. I.pp 121-125. 0.1. Flitcroft, j. W Morley.
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DEPARTMENT OF OTOLARYNGOLOGy/HEAD AND NECK SURGERY
Scope of Service
he Department of Otolaryngology/Head and Neck Surgery is one of the most dynamic and progressive within its field in this country. It provides a full and comprehensive range of surgery. 1996 has seen devel opments in endoscopic sinus surgery, benign laryngeal and airway laser surgery and voice rehabilitation or T thyroplastic surgery. Over the past five years, the Department has established itself as the premier head and neck cancer unit. Acting as a tertiary referral centre, it receives patients with a wide variety of head and neck malignancies and in particular floor of mouth pathology.
The audiovestibular unit has at its disposal the full range of audiovestibular tests including one of the most exact and modern vestibular systems currently available. Tinnitus counselling and hearing aid fitting are now available on site.
In conjunction with the National Rehabilitation Board (NRB) a programme for the fitting of the new bone anchored hearing aid device (BAHA), initially starting in 1995 it has continued through 1996 with the successful implantation of further patients.
On the educational front, a post-graduate registrar training scheme is run under the auspices of the Royal College of Surgeons, the Mater Hospital and the Mater/Temple Street axis, receiving three such trainees each six months from the scheme. A Senior Registrar rotates on a yearly basis. The ENT Consultant Staff have submitted a modular teaching plan to UCD in an attempt to provide a more interactive and concentrated teaching programme for the students attending this hospital.
The Consultant Staff are active members of the RCSI Training Committees, act as examiners in the Undergraduate Examinations of University College Dublin, Trinity College Dublin, examine the final FRCSI in Otolaryngology/Head and Neck Surgery, and the intercollegiate FRCS.
Special Interests
Otology a. The surgery of chronic suppurative otitis media, by both the open and closed technique. b. Middle ear microsurgical reconstruction. c. Otosclerosis surgery.
Head and Neck Surgery a. Radical cancer surgery. b. Reconstruction, including free-flap transfer. c. Benign disease. d. Post-traumatic conditions.
Skull-Base Surgery (in co-operation with Neurosurgeon) a. Temporal Bone Resection. b. Anterior Skull-Base (Hypophysectomy) • John Russell
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Nasal and Sinus Surgery Rhinoplastic and functional endoscopic sinus surgery.
Voice Pathology (in co-operation with the Department of Speech and Language Therapy) Voice clinics with stroboscopic evaluation of laryngeal voice disorders.
Rehabilitative Surgery a. Blom-Singer valve insertion for voice rehabilitation. b. Bone anchored Hearing Aid implantation.
New Developments/Equipment The acquisition of the new KTP/S32 laser, a state of the art modality, makes available a whole range of surgical options hitherto restricted including: Laser tonsillectomy, laser turbinectomy, oral cancer surgery, otological laser surgery and uvulopalatopharyngoplasty for snoring.
The Hummer high speed rotating blade system for the extirpation of nasal polyps and disease renders this surgery more efficient and safe.
The advent of the acoustic rhinomanometer gives and objective assessment of the patency of the nasal airway both pre and post operatively.
Finally the acquisition of the Thomassin Endoscopic Microsurgical instrumentation from France, opens up the new field of endoscopic otological microsurgery.
From a clinical point of view since starting in post in January of 1996, Mr. J. Russell has introduced a twice-monthly voice clinic. This is a specialised clinic with input from a singing teacher, Speech and Language Therapist, Consultant Psychiatrist and Consultant Otolaryngologist. In 1997 the voice laboratory as such is due to be set up and we hope to have the latest software for assessing voice quality. The ENT Department has also recently acquired a new implant for restoring patients voices following vocal cord palsy.
Again in 1997, Mr. J. Russell intends to start a specialised Rhinology Clinic for the specialised assessment of nasal function incorporating the newly acquired acoustic rhinomanometer and endoscopic facilities which will become available in our Out-Patient Clinic in February of 1997.
Afurther new development on the surgical front consists of combined surgery between Mr. Michael O 'Keefe, our Ophthalmological colleague, and Mr. J. Russell who are now performing joint laser dacrocystorhinostomies togeth er on a regular basis. This form of combined surgery represents a significant advance, in this country, currently, uniquely available in the Mater Hospital.
Ongoing Research Projects
Mr. l.D. Russell The effects of prolonged otitis media with effusion on the tympanic membrane. University College Dublin.
Voice research, based in the Department of Speech and Language Therapy, Mater Misericordiae Hospital, in con junction with the Speech Therapy Department with the aim of setting up a data base of voice disorders coupled with the utilisation of the newly acquired voice pathology software.
Mr. T. O'Dwyer A predictive essay of chemoradiotherapy in Head and Neck squamous cell carcinoma. Work performed in conjunc tion with the Department of Radio-Oncology, Kevin Street College of Technology (Dr. C. Mothersill) and St. Luke's Hospital (Dr. lan Fraser).
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Mr. A. W. Blayney Middle ear biomechanics in conjunction with Dr. Henry Rice and Dr. P. Prendergast (Dept. of Mechanical Engineering, T.C.D.), Dr. K.R. Williams (University of Cardiff), with current support from The Royal Society, London, EOLAS/British Council, Medisolve and Xomed, this project took on another full time post graduate engineer to continue the development of a finite element model of the middle ear, reproducing the middle ear biomechanics and acting as a model for the optimisation of middle ear implants including construction design, composition etc.
Symposia/Meetings Organised and Attended Second National Voice, The Mater Hospital, 1996. Organising Committee: Mr. J. Russell, Ms. C. Dempsey, Ms. C. Lenihan, in co-operation with other members of the Department of Otolaryngology/Head and Neck Surgery, and Speech Therapy.
This is the second National Voice Symposium, took on an international flavour with overseas visitors attending and a live operative demonstration of thyroplastic surgery with a direct link up from Theatre Phase I A to the Conference Room. Advertised internationally for the first time, this Symposium has secured a place on a biennial basis in the international calendar of Speech/LanguageNocal Rehabilitation.
Meetings Attended The Meeting of the Collegium O.R.L.AS. Committee (by invitation) S-8th February, 1996 New York City - AW Blayney.
Medicolegal aspects of noise induced hearing loss. Postgraduate Education Centre, Nottingham. Thursday, 7th March, 1996 - AW Blayney.
The Royal Society of Medicine, February Meeting, 1996 Sections of Otology and Laryngology - AW. Blayney.
Collegium Oto/rhino/laryngologicum Amicitiae Sacrum Vancouver, British Columbia, 24-28th August, 1996 - AW. Blayney.
International Workshop on Middle Ear Mechanics and Research in Otosurgery Dresden, Germany (by invitation) 19-22nd September 1996 - AW Blayney.
Annual Meeting of the Portmann Foundation coupled with the Annual Meeting of the French Society of Otorhinolaryngology/Cervico/Facial Surgery. Paris, S-8th October 1996 - AW Blayney.
The Nottingham Endoscopic Surgery Course 20-22nd November, 1996 - AW. Blayney.
Academy of Medicine, Section of Otolaryngology March 1996, Sligo - T. O'Dwyer.
Management of the Dysphagic patient. March 1996, Dublin -T. O 'Dwyer.
4th International Head and Neck Surgery Meeting.
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August 1996, Toronto, Canada - T. O'Dwyer.
European Society of Surgical Oncology. September 1996, Dublin - T. O 'Dwyer.
European Society of Childhood Disability. September 1996, Dublin - T. O 'Dwyer.
2nd National Voice Symposium. September 1996, Dublin - T. O 'Dwyer.
Irish Otolaryngological Society Annual Meeting. October 1996, Belfast - T. O'Dwyer.
British Association of Paediatric Otolaryngology Annual Meeting. October 1996, Bristol - T. O 'Dwyer.
Presentations Acoustic Analysis of Voice 2nd Mater Voice Symposium, September 1996. J. Russell.
Otitis Media with Effusion , an experimental study. The Irish Otolaryngological Society, Belfast. October 1996. J. Russell.
Effects of prolonged otitis media with effusion on the pars f1accida in the rat. III st Extraordinary Conference in Otitis Media with Effusion. June 1996. Copenhagen, Denmark. J. Russell.
The Westaby TY stent for relief of tracheo-bronchial obstruction. Irish Academy of Medicine (Otolaryngology Section) P. Lacy, J. Fenton, T. O'Dwyer, M. Walsh, C. Timon. Mater, Beaumont, and St. James' Hospital, Dublin, May 1996.
The Facial Nerve Monitor in Mastoid Surgery Training. Irish Otolaryngological Society, Belfast. October I 996 j. Fenton, M. Benamer, D. Smyth, A. Curran, L. Viani , M. Walsh.
Transphenoidal Hypophysectomy. Irish Otolaryngological Society, Belfast. October 1996. j. Hughes, J. Fenton, P. O'Neill, T. O 'Dwyer.
Congenital C.S.F. Fistulae of the Ear. Irish Academy of Medicine (Otolaryngology Section). December 1996. O. De Souza, J. Fenton, A. Blayney.
Lemierre's Syndrome. Irish Academy of Medicine (Otolaryngology Section). December 1996. j. Hughes, j. Fenton, G. Sheehan, J. Russell.
Bilateral Facial Schwannomas. 2nd International Skull Base Congress and 7th Annual Meeting of the North American Skull Base Society,
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San Diego. July 1996. J. Fenton, M. Smail, O. Sterks, J.m. Sterkers.
Otologic Management of Otogenic Brain Abscess. 2nd International Skull Base Congress and 7th Annual Meeting of the North American Skull Base Society, San Diego. July 1996. J. Fenton, D. Smyth, A Curran, L. Vian i, M. Walsh.
Hearing preservation and tumour recurrence in acoustic neuroma surgery. 2nd International Skull Base Congress and 7th Annual Meeting of the North American Skull Base Society, San Diego. July 1996. J.M. Sterkers. J. Fenton, M. Smail, O. Sterkers, R. Weit.
Skull Base Surgery of the Jugular Foramen. 2nd International Skull Base Congress and 7th Annual Meeting of the North American Skull Base Society, San Diego. July 1996. M. Atlas, J. Fenton, A Sh irazi, H. Brake, M. Mendelsohn, P. Fagan.
Delayed facial palsy after cerebellopontine angle tumour surgery. 2nd International Skull Base Congress and 7th Annual Meeting of the North American Skull Base Society, San Diego. July 1996. J. Fenton, M. Atlas, A Shirazi, P. Fagan.
Middle Ear Prostheses - Materials and Designs. Bioengineering Design Forum, Trinity College, Dublin, February 1996 (by invitation). AW Blayney.
Biomaterials in Otology an update. ENT Symposium, St. Thomas's Hospital, January 1996 (by invitation). AW Blayney.
A new method for determining middle ear impedance. ENT Symposium, St. Thomas's Hospital, London, January 1996 (by invitation). AW Blayney.
A dynamic and harmonic damped finite element analysis model of stapedotomy. Collegium ORLAS meeting, Vancouver, British Columbia, Canada. 24-28th August 1996. AW Blayney, K.R. Williams, H.J. Rice.
Otological Electrophysiology. Co-Chairman of Session with Professor P. Bernard. Collegium ORLAS meeting, Vancouver, British Columbia, Canada. 24-28th August 1996. AW. Blayney.
A DynamiC and harmonic damped finite element model of stapedotomy - Keynote Lecture (by invitation). International Workshop, Middle Ear Mechanics in Research and Otosurgery. Dresden, Germany. September 19-22nd 1996. AW Blayney, K.R. Williams, H.J. Rice.
Ultrasonography in the evaluation of neck abscesses in children .. British Association of Paediatric Otorhinolaryngology. Bristol, 19th October 1996. (Poster) M.S. Quaraishi, D.R. O 'Halpin, AW. Blayney.
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Bioengineering Design Forum. University of Limerick. Royal Academy of Medicine in Ireland. President of Section. 28th September 1996. A.W. Blayney.
The value of cephalometric radiology in patients with snoring and sleep apnoea. Academy of Medicine Meeting. Sligo, May 1996. T. O'Dwyer. Predicting mandibular invasion in intra oral squamous carcinoma. European Society of Surgical Oncology. Dublin, September 1996. T.O'Dwyer.
long Term Results of surgery for drooling. European Society of Childhood Disability. Dublin, September 1996. (Invited Guest) T.O'Dwyer.
Aetiology and investigation of vocal cord palsy. 2nd National Voice Symposium. Dublin, September 1996. (Invited Guest). T. O'Dwyer.
Transphenoidal Hypophysectomy. The Mater Hospital Experience. Irish Otolaryngological Society. Belfast, October 1996. T. O'Dwyer.
Prophylactic antibiotics post tonsillectomy: Are they of benefit. British Association of Paediatric Otolaryngology Annual Meeting. Bristol, October 1996. T. O'Dwyer.
PublicationS An experimental technique for determining middle ear impedance. ACTA Otolaryngoica, (Stockh) 1996, I 16:201-204. A. W Blayney, GJ. McAvoy, HJ. Rice, KR. Williams.
A3D finite analysis of the natural frequencies of vibration following stapedotomy. Proceedings of the Otorhinolaryngolical research society. Clinical Otolaryngology, 1996, 21 : 377. A. W Blayney, KR. Williams, IH. Lesser.
Development of a finite model of the middle ear. Rev. Laryngol. Otol. Rhinol 1996: I 17 (3 ,359-264). KR. Williams, A. W Blayney, H.R. Rice.
Tympanic membrane damage and repair as analysed by the fin ite element method. Proceedings of the 3rd International Symposium on Transplants and Implants in Otology, bordeaux, France. Editor M. Portmann, Kugler Publications, Amsterdam, 1996. 57-63. KR. Williams, A. W Blayney, T.H.L Lesser.
A dynamic and harmonic damped finite element analysis of a stapes prosthesis replacement reconstruction of the middle ear. Proceedings of the 3rd International Symposium on Transplants and Implants in Otology, Bordeaux, France. Editor M. Portman. Kugler Publications, Amsterdam, 1996 p.p. 65-73. A. W Blayney, KR. Williams.
Quantifying healthy ear canal geometry using magnetic resonance imaging. Proceedings of the 3rd International Symposium on Transplants and Implants in Otology, Bordeaux, France. Editor M. Portman. Kugler Publications, Amsterdam, 1996 p.p. 7-14. A. W Blayney, j.P. Stack, GJ. McAvoy, HJ. Rice.
Assessment of External Ear Canal Geometry by magnetic resonance imaging.
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Proceedings of the Irish Otological Society. Report of the 36th Annual Meeting. Published 1996. Page 28 (abstr, P.D. Lacy, J.P. Stack, GJ. McAvoy, HJ. Rice, A. W Blayney.
Determination of Middle Ear Impedance: A new experimental technique. Proceedings of the Irish Otological Society. Report of the 36th Annual Meeting. Published 1996. Page 34 (absm A. W Blayney, GJ. McAvoy, HJ. Rice, K.R. Williams.
Clearance of recalcitrant psoriasis after tonsillectomy. Clinical Otolaryngology, December 1996. 21 (6) 546-548. S. W Hone, MJ. Donnelly, F. Powell, A. W Blayney.
A Dynamic and harmonic damped finite element analysis model of stapedotomy. Acta Otolaryngol, (Stockh). Accepted for publication October 1996. A. W Blayney, K.R. Williams, HJ. Rice.
Ultrasonography in the Evaluation of neck abscesses in Children. Clinical Otolaryngology, Accepted for publication November 1996. MS Quairshi, D.R. O'Halpin, A. W Blayney.
The widened retrolabyrinthine approach: A new concept in acoustic neuroma surgery. Journal of Neurosurgery, Accepted for publication November 1996. V. Darrouzet, J. Guerin, N. Aquad, J. DutkiewiCl A. W Blayney, J.P. Bedear.
Prophylatic antibiotics post tonsillectomy: Are they of benefit. Proceedings of the Irish Otolaryngological Society, Report of the 36th Annual Meeting, Published 1996. Page 32- (abstract). M. Co/reavy, T.P. O'Dwyer, A. W Blayney, M. Donnelly, D. Naman, M. Benamer.
Chapter Authored. Vestibular disorders. A. W Blayney. (by invitation) Chapter Scott Brownes text book of Otolaryngology. Paediatric Otolaryngolo and forthcoming paediatric audiology volume, Chapter 12, pages 1-29. 1996 Butterworth Heinemann, London.
FESS - A quality assurance study. Proceedings of the Irish Otolaryngological Society. Report of the 36th Annual Meeting. Published 1996, Page 34. (abstract). J.D. Russell, M. Malick, C. Timon.
Laryngeal nerve injury during thyrOid surgery. Irish Journal of Medical Science. Vol. 165 No. 4 303-304. MJ. Donnelly, T.P. O'Dwyer.
The management of drooling in the disabled child. Proceedings of the Irish Otolaryngological SOCiety. Vol. 36, 36-38. T.P. O'Dwyer, B. Conlon.
Prophylactic antibiotics post tonsillectomy: Are they of benefit? Proceedings of the Irish Otolaryngological Society. Vol 36 Page 32. M. Co/reavy, T.P. O'Dwyer, A. W Blayney, M. Donnelly, D. Nanan, M. Benamir.
Distinctions - Awards to Departmental Members Mr. T. O 'Dwyer elected as Secretary of the Irish Society of Surgical Oncology and the Section of Otorhinolaryngology/Head and Neck Surgery of the Royal Academy of Medicine of Ireland.
Mr. J.D. Russell elected on to the editorial board of the Folia Phoniatrica Logopaedica and the E.N.T. News.
Mr. A.w. Blayney:
Incoming President of the International Protmann Society, Paris, France.
116 M ATER. M ISER. I COR.D I AE H OSP I TAL A NNUAL R EPOR.T 19 96
President of the Section of Bioengineer ing of the Royal Academy of Medicine in Ireland.
Elected as founding member of the New European Academy of Otology and Otoneursurgery.
Elected on the international committee of the Collegium ORLAS.
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DEPARTMENT OF ORTHOPAEDIC SURGERY
Introduction
he Department of Orthopaedic Surgery provides the full range of orthopaedic and trauma services in the hos pital. The primary focus is on the management of acute musculoskeletal trauma. The Spinal Injuries Unit, desig nated as the National Centre in 1988 is becoming increasingly busy. Originally planned to deal with 60 cases T per year, the unit dealt with 210 patients in 1996. Scope of Service Fracture clinics are held every morning in a dedicated suite which includes a cast application area. A physio therapy service is available in the fracture clinic to commence the patient,s rehabilitation programme as soon as possible.
Elective orthopaedic Clinics are held in the afternoon in the same area. The department has been increasing the emphasis on sub-specialisation in these clinics. Special clinics in the following areas are held every day from I p.m.: Spinal, Foot & Ankle, Hip & Knee, Upper Limb and Sports Injuries clinics.
In close co-operation with the National Rehabilitation Hospital at Rochestown Avenue, the National Spinal Injuries Unit provides investigation, treatment and management of patients with these potentially devastating injuries.
Medical Education Undergraduates from University College Dublin are given lectures and tutorials by the staff. Students attend the out-patients department, ward rounds and operating sessions to familiarise them with all aspects of Orthopaedic Surgery.
Postgraduate trainees are taken at the Basic and Higher Surgical Trainee grade.
The Consultant staff act as trainers and examiners at undergraduate and postgraduate level including the Fellowship and the Intercollegiate Examination in Orthopaedic Surgery.
Publications Bicycle Spoke Injuries. Foot & Ankle. March 1996.
Spontaneous rupture of the extensor hallicus tendon. Foot & Ankle March 1996.
Limitation of lateral cervical x-rays in patients with spinal injuries. International Orthopaedic Trauma. April 1996
Diagnostic and therapeutic ankle arthroscopy. Irish journal of Medical Science. April 1996.
ORIF of supracondylar fractures of the elbow. j. Paediatric Orthopaedics. May 1996
Surgical correction of Simian Foot. Foot & Ankle. May '996.
Nodular Faseitis of the fibula. The Foot. September 1996.
Scaphoid osteochondroma mimicking carpal coalition. j. Hand Surgery. December 1996.
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Factors Affecting Neurological Recovery Following Spinal Cord Injury. Submitted to Injury.
Prediction Of Motor Segment Recovery Using Pin Prick Sensory sparing following Spinal Cord Injury. Submitted to JBJS
Chymopapain Chemonucleolysis: A Review of 105 Cases. Submitted to the European Spine Journal.
os Functional and Social Outcome after Spinal Cord Injury. Submitted to Spinal Cord. esig es Book Chapter. Compression Neuropathies: Radial. Surgery of the Upper Extremity. Peimer (Ed). 1996.
Presentations. The effect of Traction on Femoral Vein Blood Flow assessed by Duplex Scanning. lOA May 1996. on Anterior Ankle Impingement. lOA. May 1996
e Effect of talo-calcaneal coalition resection on sub-talar motion. lOA. May 1996. .m. : A new screw fixation technique for ankle arthrodesis. Freyer Meeting. Sept 1996. uries Evaluation of syndesmosis screw in Weber C fractures. lOA October 1996.
Primary union of ankle arthrodesis. lOA. October 1996.
e Conferences attended dic British Soc. for Children,s Orthopaedic Surgery. London & Oxford 1996.
American Academy of Orthopaedic Surgeons. Atlanta. 1996
Irish Orthopaedic Association Meeting. May 1996.
Spinal Research Society. July 1996.
Cornell University Knee Course. New York 1996.
European Soc for Motion Analysis. Dublin September 1996.
British Orthopaedic Association. September 1996.
Irish Orthopaedic Association Meeting. October 1996. 96 Paediatric Orthopaedic Surgery Association. October 1996.
British Orthopaedic Foot Society. U.K. Nov 1996.
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DEPARTMENT OF PATHOLOGY
HISTOPATHOLOGY DEPARTMENT
Scope of Service
Workload for 1996:
Surgical Cases 8801 Surgical Blocks 22409 Frozen Sections 792 Cytology 2928 Immunocytochemistry Cases 609 Immunohistochemistry Slides 6050 Surgical/PM Blocks 23831 PM Blocks 1422 PM Cases 385
Workload increased once more in 1996. In particular, requests for frozen sections and for post mortem histology increased by 109% and 48% respectively.
The Department provides a comprehensive service. Diagnostic immunohistochemistry, enzyme histochemistry and electron microscopy are available on site.
The UCD Academic Department of Pathology is located in the Mater Hospital, Earlsfort Terrace and the Biotechnology Centre (Belfield). Medical students also attend autopsies and surgical pathology demonstrations dur ing term. Medical students attend tutorials and clinicopathological conferences in the hospital. Doctors O'Keane and Kelly and the non consultant house doctors participate in undergraduate training through lectures, tutorials and demonstrations. Doctors O'Keane and Kelly participate in the Fourth Year of Medicine University Examinations. The Department participates fully in postgraduate training.
A programme of Quality Assurance has been instituted in preparation for clinical laboratory accreditation and in association with the Hospital Quality Initiative. The Department is recognised for higher training by the Royal College of Pathologists. A joint postgraduate training programme in association with Temple Street, National Maternity Hospital and Beaumont Hospital is attracting candidates of excellent calibre.
Histopathology work is managed by the Telepath computer system. All histopathology reports are SNOME
The Department provides a histopathology service for St. Mary's Orthopaedic Hospital, Cappagh (the largest source of primary bone tumours in the country) and St. Mary's Hospital, Phoenix Park, and in addition provides a specialised immunohistochemistry service to many outside hospitals.
On site training for medical laboratory students is provided.
Departmental Conferences: I. Oncology/Pathology/Radiology 2. Postgraduate Surgical Pathology 3. Dermatopathology/Dermatology 4. Ophthalmology/Pathology 5. General Medicine
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6. General Surgery 7. Radiology/Gastroenterology/Surgery/Pathology 8. Radiology/Respiratory Medicine/Pathology 9. Interhospital Soft Tissue Tumour Review Panel 10. Urology/Pathology 11. ENT/Pathology 12. Hepatitis C/Hepatology/Pathology.
Committees/Offices Held:
Professor Peter Dervan National: Cancer Committee of the Medical Research Councilllrish Health Research Board Cancer Research Advancement Board (Committee Member) Chairman of Scientific Committee ECCLES Breast Screening Programme Chairman of Mater College of Postgraduate Education and Research.
International: EC International Biomed 2, Cancer Committee/Reviewer EU Breast Pathology Working Group (Irish Representative) UK Breast Pathology Working Group (Irish Representative) European Prototype Reference Standard Slides Project (Irish Representative) CATAI Telemedicine Working Group (Irish Representative)
Professional Bodies: Faculty of Pathology, Royal College of Physicians of Ireland (Member and Past Secretary) Irish Association of Clinical Cytology Irish Association of Dermatology Irish Association for Cancer Research Dublin Soft Tissue Sarcoma Panel (monthly meetings) Arthur Purdy Stout Society of Surgical Pathologists (USA) College of American Pathologists American Society of Clinical Pathologists US Canadian Academy of Pathology Association of Clinical Pathologists Society of Hematopathology (USA) European Society of Haematopathology International Academy of Pathology (UK Division)
Dr. Conor O'Keane Inspector, Laboratory Accreditation Programme, College of American Pathologists Pathology Group, National Hepatitis C/Anti-D Programme faculty of Pathology Subcommittees on Laboratory Accreditation and Coroners System Committee Irish Society of Gastroenterology Committee.
Dr. Peter Kelly Chairman and Administrator of the Department Board of Faculty of Pathology, RCPI. Education Committee, Faculty of Pathology, RCPI Regional Advisor for Republic of Ireland, Royal College of Pathologists Irish Representatives, UEMS Board of Pathology Pathology Group, National Hepatitis C/Anti-D Programme.
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Professional Bodies Faculty of Pathology, Royal College of Physicians of Ireland (Fellow & Past Vice-Dean) Irish Association of Clinical Cytology Dublin Soft Tissue Sarcoma Panel (monthly meetings) Association of Clinical Pathologists International Academy of Pathology (UK Division) The Royal Academy of Medicine, Ireland (Fellow) Royal College of Pathologists.
Dr. Michelle Harrison Member Royal College of Pathologists Irish Medical Organisation Irish Society for Clinical Cytology The Royal Academy of Medicine Ireland (Fellow) Irish Association for Cancer Research International Journal of Cancer (Reviewer) Centre for Medical Education (Pathology Representative)
Editorial Boards/Reviewer:
Prof. Peter Dervan Irish Journal of Medical Science (Subeditor of Laboratory Section) American Journal of Surgical Pathology (Editorial Board) International Journal of Surgical Pathology (Editorial Board) Electronic Journal of Pathology and Histology (Editorial Board) Journal of the European Academy of Dermatology and Venereology (Reviewer) Journal of the Irish College of Physicians and Surgeons (Reviewer).
Abstracts Published: Genomic Alterations in Non-Hodgkin's Lymphomas. Irish Journal of Medical Science 165(2): 16, 1996. M. Butler, N. Corbally, P.A Dervan, D.N. Carney.
Heterogeneity of DClS comparing cytonuclear and architectural classifications. Laboratory Investigations, Jan 1996, 74, I :82 and Modern Pathology Jan 1996, 9, I :82. M. Harrison, J. Coyne, T. Gorey, P. Dervan.
Comparison of Chromosome I Aneusomy Detected by Interphase Cytogenetics and DNA Ploidy in Breast Carcinoma. Irish Journal of Medical Science 165(3): 16, 1996. M. Harrison, H. Magee, J. O'Loughlin, T. Gorey, P. Dervan.
Chromosomes I and 17 in Mammographically Detected Ductal Carcinoma In-Situ (DClS) - An Interphase Cytogenetic Study. Irish Journal of Medical Science 165(3): 16-17, 1996. M. Harrison, H. Magee, J. O'Loughlin, T. Gorey, P. Dervan.
Biallelic expression of the IGF2 gene in human breast disease. Irish Journal of Medical Science 165(2):4, 1996. A McCann, N. Miller, A O 'Meara, I. Pedersen, K. Keogh, T. Gorey, P. Dervan.
Analysis of IGF2 Genomic Imprinting in Human Breast and Wilm's Tumours. Irish Journal of Medical Science 165(2):5-5,1996. N. Miller, AH. McCann, A O'Meara, D.T. Croke, P.A. Dervan.
Loss of IGF2 genomic imprinting in human cancers.
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British Journal of Cancer, March 1996, 73 (supplement XXYI) ;48. N. Miller, A.H. McCann, A. O'Meara, K. Keogh, P.A. Dervan.
Suitable DNA from Archival Clinical Material for DOP-PCR and CGH. Irish Journal of Medical Science 165(2): 13-13,1996. E. Moore, H. Magee, H. Lamass, P.A. Dervan. c-erbB-2 Amplification in Ductal Carcinoma In-Situ (DCOS) of the Breast: Detection by In- Situ Hybridization. Irish Journal of Medical Science 165(3): 14,1996. J. O'Loughlin, M. Harrison, H. Magee, P. Dervan.
A Comparative Interphase Cytogenetic Study of Paget's and Bowen's Disease. Irish Journal of Medical Science 165(2): 14,1996. J. O'Loughlin, C Loftus, H. Magee, P.A. Dervan.
Papers Presented:
Irish Association Cancer Research Grading of Soft Tissues Sarcomas - Evaluation of Essential Parameters. E.W. Kay, J.C O'Keane, E.F. Gaffney, R. Thomas, K, Sheahan, Dublin Soft Tissue Tumour Panel (Beau mont, Mater, St. James's Hospital)
Ten Year Review of Non-Hodgkins Lymphoma (NHL) of the Gastrointestinal Tract (GIT) in the Mater Hospital. S. Ryan, J.C O'Keane, P.A. Dervan, D.N. Carney.
Increased Retinoblastoma Protein (pRb) Expressions Occurs Throughout the Adenoma- Carcinoma Sequence in the Large Bowel and is associated with, but does not parallel, increased proliferation. H. Lemass, E. Ryan , P. MacMathuna, J. Crowe, J.C O'Keane.
Testicular Cancer - A Review of 107 Cases. M. O'Connor, J. Fitzpatrick, S. Smith, J.C O'Keane, D.N. Carney.
Long Term Follow-Up of Patients with Osteogenic Sarcoma treated with Neoadjuvant Chemotherapy. S. Ryan, P.A. Dervan, B. Hurson, M. Codd, D.N. Carney (Mater Hospital and Cappagh Orthopaedic Hospital).
DBA44, A Sensitive and Specific Marker of Hairy Cell Leukaemia in combination with BCL2 can distinguish Hairy Cell Leukaemia, Low Grade Lymphoma and Combined Hairy Cell Leukaemia/Low Grade Lymphoma.
National Scientific Medical Meeting, RePI, Dublin, March 1996 PCR Negative Hepatitis patients have minimal inflammation and fibrosis. Irish Journal of Medical Science; 1996, Yol 165, Supplement 2, P39. Gastroenterology 1996; I I O:A 1232. S. Pathmakanthan, G. Clarke, P. MacMathuna, A. Sull ivan, G. Callagy, J.C O'Keane, J. Crowe.
A Correlation of Haplotype with Phenotype expression in Irish Haemochromatosis Patients. Irish Journal of Medical Science; 1996, Yol.165, Supplement 2, P.39. E. Ryan, H. Delaney, S. Pathmakanthan, J.C O'Keane, P. MacMathuna, J. Crowe.
Clinical and Biomechanical Expression of the Genetic Abnormality in Haemochromatosis. Irish Journal of Medical Science; 1996, Yol. 165, Supplement 2,P39. Gastroenterology 1996; I IO:A 1308. E. Ryan, M. Kelly, S. Pathmakanthan, G. Clarke, P. MacMathuna, G. Callagy, J.C O'Keane, J. Crowe.
US/Canadian Academy of Pathology 1996 K-ras Mutations and Epithelial Proliferation levels in Colorectal Adenomas. Mod. Pathol. 1996; 9: 69A. Shi Yang, J.c. O'Keane, S. Nikulasson, P.C Shroy, M.J . O'Brien (Mallory Institute of Pathology, Boston Univ. Sch. of Med., Boston, and Mater Misericordiae Hospital, Dublin, Ireland).
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Papers Published BCL-6 and other genomic alterations in Non-Hodgkin's Lymphoma (NHL). In Press. M. Butler, N. Corbally, P.A. Dervan, D.N. Carney.
Comparison of chromosome I aneusomy detected by interphase cytogenetics and DNA ploidy in carcinoma of the Breast. Histopathology. 1997, 30;221-226. M. Harrison, j. Magee, j. O'Loughlin, I Gorey, I Coyne, P.A. Dervan.
Comparison of oestrogen receptor assessment in frozen and paraffin sections. Pathology, Research, Practice, 1996, 192;919-924. M. Fee, B. Tobin, h, Magee, M. Harrison, I Gorey, P.A. Dervan.
Comparison of cytomorphological and architectural heterogeneity in mammographically detected ductal carcinoma in situ. Histopathology 1996,28;445-450. M. Harrison, j.D. Coyne, I Gorey, P.A. Dervan.
Biallelic expression of the IGF2 gene in human breast disease. Human Molecular Genetics 1996,5(8); I 123-1 127. A.H. McCann, N. Miller, A. O'Meara. I. Pedersen K Keogh, I Gorey, P.A. Dervan.
Anti-Clostridium difficile Bovin Immunoglobin Concentrate inhibits Cytotoxicity and Enterotoxicity of C. difficle Toxins. Antimicrobial Agents and Chemotherapy; 1996,373-379. c.P. Kelly, C. Pothoulakis, F. Vavva, I. Castagliuolo, EF. Bostwick, j.c. O'Keane, S. Keates, j. I Lamont
Kaposi's Sarcoma in Women with AIDS. AIDS: (In Press). IP. Coo/ey. LR. Hirschhorn, j.c. O'Keane.
Dermatologic Presentation of Nasal Lymphomas: A report of two cases. Journal of American Academy of Dermatology: (In Press) A. Murphy, j.c. O'Keane, A. W Blayney, F. Powell.
Conferences/Workshops Attended:
Professor Peter Dervan European Education Conference, Brussels, October 1996.
EC Working Group on Breast Screening Pathology, London, January 1996.
CATAI Telemedicine Meeting, Tenerife, January 1996. Reading/London, October 1996.
Dr. Peter Kelly International Academy of Pathology, Budapest, October 1996.
Dr. J. Conor O'Keane Organiser and Speaker: Dermatopathology Update; Irish Assc. Dermatology Annual Meeting 1996. US/Canadian Academy of Pathology, Washington, March 1996. Irish Society of Gastroenterology. National Scientific Med ical Meeting, RCPI, Dublin, March 1996. Irish Association for Cancer Research, Limerick, April 1996
Dr. Michelle Harrison Irish Association for Cancer Research, Limerick, 1996. United States and Canadian Academy of Pathology, Washington, March 1996.
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BIOCHEMISTRY LABORATORY
Scope of Service f The Biochemistry Laboratory carried out I, I 17,000 tests in 1996, a 15% increase on 1995. This is a continua tion of the very large increases on previous years, as shown below. Staffing levels have remained static in that time interval.
Year Number of tests performed
1970 98,000 1980 405,000 1985 594,000 1990 625,000 1994 884,000 y, 1995 975,000 1996 1,117,000
It is worth noting that since 1990 the number of tests performed have almost doubled. In addition to the routine service, the laboratory continued to provide a twenty-four hour emergency service. ick, 1996 saw an increase in the range and number oftests carried out on Stat machines in the Intensive Care Unit and the High Dependency Unit. The Stat Profile 9, Nova 8 and ABL520 machines offered the following range of tests pH, pC02, p02, cooximetry, sodium, potassium, chloride, glucose, lactate, ionized calcium and ionized magnesium. The staff of the Biochemistry Laboratory play a very active role in the maintenance and quality control of these machines.
Demand for tumour markers continues to grow and this was met by the acquisition of a new automated analyser, the Abbott Axsym. The computerisation of the Biochemistry Laboratory has been complete for some time. The increasing use of the Order Communications system from the wards, and its extension to the Accident & Emergency Department, made a significant difference to the time spent in Request Entry and in responding to tele phone enquiries in the Biochemistry Laboratory. The pneumatic chute system means that samples from Intensive Care, Accident & Emergency, Coronary Care, etc. can be delivered quickly to the laboratory. The Biomen HA- 8140 Haemoglobin AIC Analyser was acquired in November 1996 as an update of equipment to monitor glucose homeostasis in diabetic patients. An assay for determination of hepatic iron content was developed to investigate patients with haemochromatosis. A new assay for Bence Jones Proteins in urine was introduced, using a gel elec trophoretic system; this has the advantage that it gives a greater sensitivity and does not require the concentration of urine specimens beforehand.
Biochemists in the Republic of Ireland are now eligible to join the Continuing Medical Education Scheme run by the Royal College of Physicians of Ireland. Technical staff are members of Professional Enhancement Programme of the Academy of Medical Laboratory Society.
Special Interests
I. Computing. 2. Cyclosporine Monitoring in Transplant Patients (Reference Centre for HPLC analysis). 3. Ionized Magnesium. 4. Investigation of Creatine Kinase Isoenzyme variants. S. Lipoprotein analyses. 6. Tumour Markers. 7. "Stone" Analysis.
125 M ATER MI SER I CORDI AE H OSP I TAL A NNUAL R EPORT 19 96
Research Activities
I. Reference Ranges for Ionized Magnesium
John Collier and Dr. Sean Maguire are currently undertaking a number of studies in the Intensive Therapy Unit with Dr. Dermot Phelan, Dr. Irene Leonard and Dr. Brian Harte. Reference ranges for ionized calcium and magnesium using ion-selective electrodes have been determined. The clinical value of blood ionized versus total magnesium has been evaluated in patients post cardiac surgery.
2. Cyclosporine Assay
Frank Kyne and Dr. Sean Maguire continued research on cyclosporine, the anti- rejection drug used in transplant patients. The laboratory now provides a reference service for the cyclosporine assay to many major hospitals in Ireland covering all transplant types.
3. Effect of Nitroprusside on Glucose Assay
Dawn Kennedy looked at the effect of nitroprusside therapy (an anti-hypertensive drug) on the mea· surement of glucose and lactate on the Nova 9 blood gas analysers in ITU and HDU. Cyanide, a metabolite of the drug, interferes with glucose measurement on these instruments yielding falsely ele· vated results. These samples must be sent to the Biochemistry Laboratory for glucose analysis.
4. Tumour Markers
During 1996 research on tumour markers focused on a continuing investigation of the clinical value of CA 125 in monitoring treatment and predicting prognosis for patients with epithelial ovarian cancer. The prognostic value of AFP half-life measurement in patients undergoing treatment for testicular can· cer was also investigated. A study of a new free-PSA assay is being undertaken in patients with possible cancers of the prostate.
S. Reference Ranges
The laboratory concluded its large study to determine reference ranges for cholesterol in the Irish population, based on a study of 1,000 blood donors. John Collier, Dr. Mary Codd and Dr. Sean Maguire co-operated on the Mater Hospital Screening Survey which was published in 1996. Arising from this study, data on calcium and albumin changes with age is currently being prepared for publication.
Courses and Meetings Attended Myra O'Keane obtained a distinction in the Certificate Course on Safety and Health at Work (UCD). She is cur· rently a member of the Safety Advisory Board (SAB) of the Academy of Medical Laboratory Science and the National Irish Safety Organisation (NISO). A Safety Awareness Week was organised during February, and Safety Seminars in February, October and November 1996.
The staff of the Laboratory, in particular Mr. Edwin Wright, Chief Technologist, were actively involved in the train ing of students studying for their degrees in Biomedical Sciences. For the third year of the B.Sc. in Biomedical Sciences, students rotate between the various pathology departments including biochemistry. Dr. Peadar McGing lectured to the final year students on tumour markers and was involved in the setting and correction of examina· tion papers.
Helen Forde attended a training course for the Abbott Axsym, a recently acquired analyser which is used for the measurement of digoxin and tumour markers. She also evaluated an assay for microalbumin on the Beckam Array analyser.
126 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
Committees D. UaConaill Secretary, Mater Hospital Computer Committee Chairman, Pathology Computerisation Project Group Member, Mater Hospital Costing Committee Member, Pathology Committee
F. Kyne Member, Professional Affairs Committee of the ACB.1. Member, Professions Supplementary to Medicine Liaison Group
S. Maguire Editor, Clinical Biochemistry News (ACBI/ACB Newsletter)
P. McGing Member, Mater Hospital T.P.N. Committee Member, ACB.1. Council Member, ACB.1. Scientific Affairs Sub-Committee on Education Member, ACB.1. Professional Affairs Sub-Committee on Tumour Markers. Sub-Editor, Clinical Biochemistry News. Regional Tutor, ACB. Republic of Ireland Region. Co-Ordinator, IEQAS CK-MB Scheme.
E. Wright Member, Kevin Street College of Technology Fellowship Examination Committee.
Poster and Podium Presentations were made at the following meetings: National Scientific Medical Meeting, RCPI March 1996. P. McGing, Poster Judge.
Association of Clinical Biochemists (UK). National Meeting. World Conference May 1996. P. McGing and F. Kyne poster. le The Annual Conference of Association of Clinical Biochemists of Ireland, Davenport Hotel, October 1996. S. Maguire poster, P. McGing session chairman.
A.C.B.1. Meeting on Critical Care, Mater Hospital, September 1996. S. Maguire gave lecture, D. UaConaill chaired meeting. re Annual Conference of Academy of Medical Laboratory Sciences. Bundoran, November 1996. M. O 'Keane organ ised safety seminar.
Papers Cholesterol levels in normal Irish adults: The Mater Hospital Cholesterol Screening Survey. Ir J Med Science 1996; 165: 177-81. J. Collier, S. Maguire, P. McGing, M. Co dd, F. Kyne, E. Wright, K. Ha/ton, D. UaConaill, D. Sugrue.
Sarstedt monovettes falsely increase total calcium results. Clin Chem 1996; 42: 1722. J. Collier, S. Maguire, F. Kyne.
Calcium and magnesium homeostasis in out-patient cardiac transplant patients. Proceedings of the 19th Annual Conference, Association of Clinical Biochemists, Dublin, 20- 21 October 1996. S. Maguire, J. Collier, F. Kyne, M. Kavanagh, D. Phe/an.
Perioperative calcium homeostasis in cardiac surgery. y Proceedings of the 19th Annual Conference, Association of Clinical Biocehmists, Dublin, 20- 21 October 1996. j. Regan, B. Lyons, S. Maguire, J. Collier, D. Phelan.
127 M ATER MI SER I CORD I AE H OSP ITAL A NNUA L R EPORT 19 9 6
Clinical Significance of the combined use of CA 125 and TPS in ovarian cancer. Preliminary results of a multicentre study. Abstracts of I.S.O.B.M. meeting, November 1996, San Diego, U.S.A. A. Van Dalen, H. de Bruijn, D. Fink, P. McGing, et al.
Development of an automated total enolase assay for lung cancer monitoring. Proceedings of the XVI International Congress of Clinical Chemistry. London, 8-12 July 1996. P. McGing, D. Egan, K O'Byrne, F. Kyne, D. Carney.
Enzymes Profiles for Myocardial Infarction Diagnosis. Submitted to the Irish Journal of Medical Sciences. P.F. Lai, D. UaConaill, D. Sugrue, F. Kyne, D.N. Ca rn ey.
Elevated total serum enolase levels in patients with cancer. Proceedings of the Annual Conference of the Irish Association for Cancer Research 1996. K.j. O'Byrne, D. Egan, P. McGing, D.N. Carney.
Protamine sulphate used in combination w ith thrombin removes fibrinogen prior to electrophoresis of plasma. Journal of Biomedical Sciences 1996 (in press). E. Wright, M. Briscoe, P. McGing, S. Maguire.
Comparison of the IMx B 12 and folate assays with the ICN Simultrac-LP Boil Method. Journal of Biomedical Sciences 1996 (for submission). H. Forde, P. McGing, O. Lanigan.
128 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
Idy. DEPARTMENT OF MICROBIOLOGY al.
Scope of Service K. The workload has continued to increase again this year, reflecting the increase of activity in many departments within the hospital and also the ongoing screening programme required to control the spread of infection with Methicillin Resistant Staphylococcus Aureus (MRSA) amongst patients and staff.
Year Total Samples
1993 60,030 1994 65,443 1995 69,006 1996 71,834
The Microbiology Department provides both a laboratory and clinical service. A comprehensive range of tests are used in the isolation and identification of bacterial, fungal and parasitic infections associated with disease. Antimicrobial sensitivity test are carried out to a large number of antibacterial agents. Laboratory control of antibi otic therapy is provided by the antibiotic assay service. This specialised service is availed of by other Dublin Hospitals and also by many hospitals around the country. The department provides a Legionella Serology Service for hospitals in Dublin and throughout the country.
Clinical consultations on diagnosis and antimicrobial therapy of patients is provided by the Consultant Microbiologist and the Microbiology Registrar at ward level. Daily participation in the Intensive Care Unit and the High Dependency Unit ward rounds, the Infectious Disease and the Oncology Services ward rounds are undertak en by the Medical Microbiology staff.
Special Interests Rapid diagnostic techniques for identification and sensitivity testing of Mycobacterium Tuberculosis have been developed. Dr. N . Corbally and Mr. A. Murray are working on direct identification of Mycobacterium in clinical specimens using PCR techniques. Identification of other micro-organisms by this technique have also been perfect ed.
Fungal infections in immunosuppressed patients have been encountered with increased frequency. Identification of these organisms and sensitivity testing to a range of antifungal agents is ongoing.
Monitoring and advising on the appropriate use of antibiotics in the treatment of infected patients has been a par ticular interest for many years. Dr. Hone, in her capacity of Chairman of the Pharmacy Sub-Committee of the Hospital, piloted the first edition of the Hospital Formulary which also incorporates the 'Guidelines on the Use of Antimicrobial Agents. This booklet is circulated to all doctors in the Hospital.
Committees
Dr. R. Hone Dean Faculty of Pathology of the Royal College of Physicians. Chairman Infection Control Committee, Mater Misericordiae Hospital. Chairman Pharmacy Sub-Committee of the Medical Executive Committee, Mater Misericordiae Hospital. Member Health and Safety Committee, Mater Misericordiae Hospital. Member Intensive Care Committee, Mater Misericordiae Hospital. Member Total Parenteral Nutrition Committee, Mater Misericordiae Hospital. Member Department of Health Working Party on Prevention of MRSA Infections.
129 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 1996
Member Department of Health and Comhairle na nOspideal Advisory Body on Virology Services in Ireland. Member North Eastern Health Board Infection Control Working Group. Member Medical Council of Ireland. Member Infectious Disease Committee, Medical School, U.CD.
Conferences/Meetings Attended Telepath Users' Group Meeting. Birmingham, January 1996. L. Dyke. Antimicrobial Susceptibility Testing Update Course. Bristol, July 1996. J. Cullen. NEQAS Parasitology Course. Cork, July 1996. R. McWade, P. Owens. Molecular Medicine in the New Millenium Lecture Series. Dublin, September 1996. N. Corbally, A. Murray.
Presentations/Abstracts Susceptibility of Urinary Pathogens to Antimicrobial agents - Thirteen Years On. National Scientific Meeting. Dublin. March 1996. A. Murray, R. Hone.
Identification and Sensitivity Testing of Candida species isolated from patients in the Intensive Care Unit. National Scientific Meeting. Dublin. March 1996. C Yearsley, M. Murtagh, A. Murray, R. Hone.
The Prevalence of Chlamydia and Mycoplasma in Children with Recurrent Acute Tonsillitis. National Scientific Meeting. Dublin. March 1996. S. Hone, N. Corbally, J. Moore, P. O 'Sullivan, D. McShane, R. Hone.
Use of a Commercial Rapid Molecular Test for the Early Detection of Mycobacterium Tuberculosis. Joint Meeting of the Irish Society of Clinical Microbiologists and the Intensive Care Society of Ireland. Dublin. June 1996. N. Corbally, A. Murray, R. Hone.
The Introduction and Development of a Data Management System to a Routine Microbiology Laboratory. Healthcare Informatics Society of Ireland. Dublin, October 1996. L. Dyke.
Actinobacillus species in Endocarditis - A Case Study. Warwick University. November 1996. J. Cullen, L. Dyke, A. Murray.
Medical Student Projects The Incidence of Methicillin Resistant Staphylococcus Aureus in Residents of Long Stay Institutions. Mater Hospital Research Symposium. September 1996. C McDonagh, R. Hone. C McDonagh received a grant from the Health Research Board.
Screening of Elderly Patients for Methicillin Resistant Staphylococcus Aureus in an Orthopaedic Rehabilitation Hospital. mater Hospital Research Symposium. September 1996. A. McGeary, R. Hone.
C McDonagh and A. McGeary were awarded prizes for their presentations.
A Seven Year Audit of Central Venous Catheters Sepsis in Total Parenteral Nutrition Patients. Mater Hospital Research Symposium. September 1996. C Young et al.
Publications European Nosocomial Infection Survey: Analysis of Irish Data. I.M.J . 1996, 89,96-99. B. Marsh, R. Hone, M. White, D. Phelan, J. Fabry.
Staphylococcus Aureus Sensitivity to Various Antibiotics - A National Survey in Ireland 1993. I.J .M.S. 1996, 165, 40-43. E. Moorhouse, L Fene/on, R. Hone, E. Smyth, J. McGahon, M. Dil/on.
130 M ATER MI SER I CORD I AE H OSP ITA L ANN UAL R EPORT 1996
PHYSIOTHERAPY DEPARTMENT
Scope of Service
he Physiotherapy Department provides patient care service to a wide variety of specialities: Cardiac Surgery, General Medicine, Respiratory, Cardiology, Oncology, Gynaecology, Endocrinology, Rheumatology, Orthopaedics, Accident & Emergency, Dermatology, Geriatrics, General Surgery, Infectious Diseases and TPlastic Surgery. The demand for the service is ever increasing and because of the large in-patient caseload, out-patient services to Orthopaedics, Accident & Emergency and Rheumatology operate at all times with a waiting list. This results in less effective and efficient patient care and follow up.
The Department is also involved with U.C.D. Physiotherapy students. There can be up to twenty during college term time, between 3rd and 4th level students facilitating their clinical placement.
Post Graduate Training Courses The physiotherapy staff are involved in on-going post graduate training courses, with weekend seminars, work shops etc. These are organised by specific Interest Groups within the Chartered Society of Physiotherapists.
G.P. Pilot Scheme On I st May 1996 a G.P. Direct Referral Pilot Scheme was established in conjunction with the G.P. Unit of the Eastern Health Board. A Physiotherapist has been appointed for an initial two year period. Thirty Six G.P.s in the catchment area of the Mater Hospital have direct access to physiotherapy services for GMS patients requiring treatment of musculoskeletal disorders.
In keeping with the National Health Strategy the project is being evaluated to determine the net benefit to the patient from the service. Ms. Edwina Mullen, Research Assistant with the Eastern Health Board G.P. Unit, has been assigned to the project. The service is currently being fully utilised by the G.P.s and although final results of the evaluation are not yet available. Feedback from both patients and referring doctors has been very positive.
Neurological/Rehabilitation In addition to the daily work in meeting the rehabilitation needs of both in and out patients, staff in this section have been involved in ongoing education.
Lectures and practical instructions have been given to Student Physiotherapists and Student Nurses in addition to our regular involvement in the hospital's manual handling and patient lifting programme.
During 1996 Physiotherapists upgraded their skills by attending many varied courses. This included two therapists completing a Bobath Course on the treatment of the Adult Hemiplegic Patient and another continuing on a Diploma Course in U.C.D. (Health, Safety and Welfare at Work (Physiotherapy».
Ms. Mary Loughnane is completing research on the metabolic and kinematic implications of augmenting the seat tube angle on the standard racing bicycle as par of an M.Sc in Sports Medicine Degree in Trinity College Dublin.
Cardio Respiratory Section The Senior Physiotherapists in Respiratory Care organised a one month post graduate course for two qualified physiotherapists, from hospitals in Tullamore and Tralee.
Plastic Surgery A new service for patients following surgery to the upper limb commenced in October 1996. A part-time physio-
131 M ATER MI SER I CORO I AE H OSP I TAL A N N UAL R EPORT 1996
therapist was employed. Ms. Margaret McMahon, who has extensive experience in this field , is involved in the care of these patients.
Publications Physiotherapy and nasal intermittent positive pressure ventilation. Non-Invasive Respiratory Support. Edited by Anita K. Simmonds. Published by Chapman and Hall Medical 1996. Ms. Fidelma Moran co-authored the chapter.
132 M A T ER MI SER I CORDIAE H OSP I TAL A NNUAL R EPORT 1 996
DEPARTMENT OF RADIOLOGY
Introduction
ctober 1996 saw the retirement of Dr. Paddy McCann, who serviced the needs of the Cardiovascular Unit since the Mater Hospital became the National Centre for Cardiac Surgery. He procured the first biplane cine cardiac angiography unit in the country, also the first automatic processor. He has been succeeded by O Dr. John Murray who has returned from Cleveland, U.S.A. with a special interest in cardiac imaging. Dr. Eamann Breatneach became President of the Radiological Society of Ireland.
Services The Department provides a wide range of radiological investigations for in-patients, out- patients and general prac titioners. The total workload increased by 0.3% over the previous year. The range of services includes Spiral Computed Tomography, Doppler Ultrasonography, Angiography and Angioplasty, SPECT Radionuclide Imaging including Cardiac Studies, Transvaginal and Transrectal Ultrasound and Mammography with Steriotaxic Biopsy. All Mammography is performed at the Breast Screening Unit in Eccles Street.
Developments A B & K Endorectal Ultrasound unit was acquired and is dedicated to the investigation of faecal incontinence, mainly in post partum women. This facility also provides a service to the National Maternity Hospital, Holies Street.
Training The department was inspected in January 1996 by the Royal College of Radiologists, London and approval was given for the higher training programme required for the new specialist reg ister, in addition to the existing Fellowship training scheme.
Future Planning The corridor between the Reception and the examination rooms is to be re-designed and a new Reception for in-patients installed at the entrance from the Link Corridor.
Publications Bilateral recurrent tension pneumothorax complicating combi nation chemotherapy for soft tissue sarcoma. Clin. Radiol 1996. 5 I :302. H.M. Fene/on, D.N. Carney, E Breatnach.
High Resolution chest c.T. in Systemic Lupus Erythematosis. A.J.R. 1996: 166:30 I. H.M. Fene/on, M. Domn, S.M. Sant, E Breatnach.
Imaging of small cell carcinoma of the oesophagus. Clin. Radiol. 1996. 50:634. H.M. Fene/on, L O'Keane, D.N. Carney, E Breatnach.
Effects of contrast concentrations on thoracic helical c.T. Scanning. Diagnostic Imaging 1996. 24:34. I Toma, E Breatnach. • Dr. John Murray 133 MATEIt MISEItICOItDIAE H OSP I TAL ANNUAL REPOItT 1996
High Resolution CT. Scanning in Ankylosing Spondylitis. AJ.R. April 1996. H.M. Fenlon, £ Breatnach.
Transvaginal Sonography. Modern Medicine Feb. 1996. H.M . Fenlon, £ Breatnach. Endosonographic assessment of post partum anal sphincter injury using a 120 Degree Sector Scanner. Clin. Radiol. 1996. 51, 559-561 . D.M. Campbell, M. Behan, V.S. Donnelly, C. O'Herlihy, p.R. O'Connell.
Low femoral artery puncture: cause of diagnostic error. Clin Radiol 1996; 51 :515. ).G. Murray, AL Brown, R.A Wilkins.
Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT. AJR 1996; 166: 1035. ).G. Murray, £ Caoili, ).F. Gruden, et al. Also presented AM. Roent. Ray Soc Meeting, San Diego CA, May 1996.
Intraocular silicone oil for retinal detachment in AIDS: CT and MR appearances. Clin Radiol 1996; 51 :415. ).G. Murray, AD. Gean, Rm Barr.
Imaging of acute head injury. Semin US CT MR 1996; 17: 185. ).G. Murray, AD. Gean, SJJ. Evans.
Complications of lung transplantation: radiologic findings. AJ R 1996; 166: 1405. AJ. Murray, H.P. McAdams, jJ. Erasmus et al.
Juvenile chronic arthritis of the hip: value of contrast enhanced MR imaging. Clin. Radiol. 1996; 51 :99. ).G. Murray, N. IF. Ridley, N. Mitch ell et al.
Listings of Presentations at Radiology Meetings 1996
I. Annual Scientific Meeting, Faculty of Radiologists, R.e.S.I., October 1996. Role of pre-operative thin section CT. of the larynx in thyroplasty patients. M. Morrin, J. Russell, J. Stack, Departments of Radiology and E.N .T., Mater Misericordiae Hospital.
Radiological review of imaging in acute pyelonephritis. AM. Cahill, D.O. Halpin, V. Donohue, Department of Radiology, Mater Hospital and Temple Street Childrens' Hospital.
Mirizzi's Syndrome: A rare cause of Obstructive Jaundice. M. Morrin, J. Goh, G. McEntee, J. Lennon, P. MacMathuna, D. O'Connell. Departments of Radiology and Gastroenterology, Mater Misericordiae Hospital.
2. British Institute of Radiology, Annual Meeting, Birmingham May 1996 Comparison of the diagnostic efficacy and cost of three intravenous contrast media used in Helical Thoracic CT. T.Toma, M. Morrin, E. Breatnach, Department of Radiology, Mater Misericordiae Hospital.
Assessment of computed radiography on 2K work stations versus laser images. M.P. O'Sullivan, Am. Cahill, E. Breatnach, J. MacEnri, J.T. Ennis, Institute of Radiological Sciences, Mater Misericordiae Hospital.
Variations in femoral venous blood flow during intraoperative orthopaedic traction and the effect of employing a venous foot pump in the prevention of thromboembolism. AM. Cahill, H.M. Fenelon, A Devitt, M. Behan, Departments of Radiology and Orthopaedics, Mater Misericordiae Hospital.
Proton spectroscopy in pre-pathological assessment of breast lesions. P. Gilligan, F. Flanagan, O. Redmond, B. Coburn, M.P. O 'Sullivan, J.P. Stack, D. Carney, J.T. Ennis, Institute of Radiological Sciences, Mater
134
n M ATER MI SER I CORD I AE H OSP I TAL ANN U AL REPORT 1996
Misericordiae Hospital and Department of Cardiology, Beaumont Hospital.
Cardiac MIBG sCintigraphy as an indicator of sympathetic neural regeneration following orthopotic cardiac trans plantation. H.M. Fenelon, N. Phelan, M.P. O'Sullivan, M. Morrin, A. Adams, J.P. Stack, J.T. Ennis, Institute of Radiological Sciences, Mater Misericordiae Hospital. Low dose imaging of the hips in infants with DDH using computed radiography. N . Phelan, P.A. Kenny, V. Donohue, M.P. O'Sullivan, , J.T. Ennis.
Evaluation of acute and long term effects of Radiotherapy on pulmonary tissue using Thoracic High Resolution CT. H.M. Fenelon, M. Maher, D. Carney, J. Ennis, E. Breathnach, Departments of Radiology and Oncology, Mater Misericordiae Hospital.
3. Radiological Society of North America, Chicago, December 1996 (RSNA) Comparison of the diagnostic efficacy and cost of three intravenous contrast media used in Helical Thoracic CT. T. Toma, M. Morrin, E. Breatnach, Department of Radiology, Mater Misericordiae Hospital.
Duplex sonographic assessment of alterations in fermora vein flow and clibre due to intraoperative orthopaedic traction. AM. Cahill, H.M. Fenelon, M. Morrin, A Devitt, M. Behan, Departments of Radiology and Orthopaedics, Mater Misericordiae Hospital.
Thoracic thin section CT. findings in Ankyosing Spondylitis. I. Casserly, S. Sant, E. Breatnach. Departments of Radiology and Rheumatology, Mater Misericordiae Hospital.
SCintimammorgaphy and MR mammography as adjuncts to screen-film mammography in evaluation of benign and malignant breast disease. H.M. Fenelon, N. Phelan, M.P. O'Sullivan, T. Gorey, J.P. Stack, J.T. Ennis, Institute of Radiological Sciences, Mater Misericordiae Hospital.
4. Society of Thoracic Radiologists, Hawaii, February 1996. Clinical Significance of Subtle H.R.CT. Findings. E. Breatnach.
Miscellaneous Meetings I. Evaluation of Ferriseltz in MRI of the Upper Abdomen of the Seriously Ill; European Society of Gastrointestinal and Abdominal Radiologists, Greece. J.P. Stack.
2. M.R.1. of the Knee. Irish Society of Orthopaedic Medicine, Orthopaedic Sportsmedicine Symposium, Dublin. J.P. Stack.
3. Advances in M.R.1. Annual Meeting Southern Radiologists, Cork. J.P. Stack.
4. The role of radiology in pain control. Interventional Radiology Symposium, R.CS.1. March 1996. D. O 'Connell.
Radiolography Staff Qualifications
Higher Diploma Medical Ultrasound, UCD Clare Gallagher Fiona O 'Donoghue
Higher Diploma in Computerised Tomography, UCD Owen Brady
Diploma in First Line Management, NCIR Adrian Adams Margaret Keane SRN,RM
135 M ATER. MI SER. I COR.D I AE H OSP I TAL ANN UA L R EPOR.T 1996
Special Appointments Adrian Adams was appointed as Special Lecturer in RadioNuclide Imaging (RNI) in the School of Diagnostic Imaging UCD. Louise Rainford, Course Co-Ordinator of the RadioNuclide Imaging Higher Diploma.
Lectures/Presentations Computed Radiography Annual Conference of the Irish Branch of the College of Radiographers. Cord, May 1996. jacky Wright, jeanne Donoghue.
Budgeting in Radiology. Management Seminar for Superintendent Radiographers. UCD School of Diagnostic Imaging. September 1996. joy Riordan.
A comparison in the use of MRI and CT in the diagnosis of cervical spine injuries. Annual Conference of the Irish Branch of the College of Radiographers. Cork, May 1996. julianna O'Hal/oran.
Mater experience of CR. Fuji CT users day: Bedford, England. September 1996. jacky Wright
3D and Spiral CT Imaging. CT Higher Diploma, UCD School of Diagnostic Imaging. Marie Smith.
CT Imaging of Thorax. CT Higher Diploma, UCD School of Diagnostic Imaging. Marie Smith.
Endocrine Imaging in RNI. Higher Diploma in RNI, UCD School of Diagnostic Imaging. Ann Do/an.
Endocrine Imaging in RNI. Cardiac Imaging in RNI. BSc Course, UCD School of Diagnostic Imaging. Ann Do/an.
New Professional Body A new Irish Professional Body was inaugurated in 1996 called The Irish Institute of Radiography. Ms. Joy· Riordan was elected as a National Member and Vice President of the organisation. The objectives of the Institute are to develop the science and practice of radiography and all disciplines related to diagnostic imaging. It will safeguard professional interests at national and local level. It hopes to promote the importance of ongoing education for ra ographers liaising with educational bodies communicating via its publication Wavelength.
136 M ATER M ISER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
RHEUMATOLOGY DEPARTMENT
Introduction/Scope of Service
Dr. Conor McCarthy was appointed as Consultant Rheumatologist in November 1996, having trained previously in the University of Michigan Medical Centre and the Bristol Royal Infirmary. The Rheumatology Department had been run effectively over the preceding four years by a number of Locums.
The location of the Rheumatology Department next to Occupational Therapy and Physiotherapy provides an excellent opportunity for the multidisciplinary care of patients with rheumat ic disease. One of the department's goals over the coming year is to strengthen these links. In addition we plan to work closely with Orthopaedics and hope to develop specialist clinics with regard to difficult upper limb and lower limb problems.
Recent Initiatives We are stratifying our out-patient cl inics to meet the needs of our population. It is clear that musculoskeletal problems are particularly prevalent in the elderly population and hence one of our out patient clinics will focus on patients over the age of 65. A second clinic will be for the younger group of patients who have inflamma tory joint disease. The third clinic will be for new patients and the fourth clinic will be for patients with predominantly soft tissue problems.
We have initiated a quality survey with our current population of patients to assess their needs.
Another initiative will include a procedures clinic where joint and soft tissue injections, muscle, synovial and salivary gland biopsies can be performed. • Dr. Conor McCarthy Research Activities The Department has a particular interest in the use of Ultrasound in the diagnosis of soft tissue problems. In other countries an ultrasound machine is available for use by the Rheumatologist both in the assessment of jo int swelling and to assist with joint aspiration/injection.
The Department is also interested in the recent development of newer non-steroidal anti- inflammatory drugs that i- appear to have a better safety profile. We currently have plans for a number of collaborative studies with nephro lo gy and gastro-enterology to assess these newer compounds.
The mechanism of inflammation in rheumatoid arthritis, particularly in relation to cyclooxygenase is another area of current research interest.
137 M ATER MI SER I CORDIAE H OSP I TA L ANN UA L R EPORT 1996
SCHOOL OF NURSING
Educational/Activities
e wish Mrs. Laserina O 'Connor every success in her new post as Lecturer in Department of Nursing Studies, University College, Dublin. WMiss Regina Browne was appointed Nurse Teacher to Post Registration Education (PREND), Eccles Street Ms. Lorna Nangle is currently studying for a Diploma in Management and Industrial Relations in the National College of Industrial Relations, Ranelagh.
Mrs, Catherine Marnane is on full-time study leave in UCD from 1996 until 1998 taking her BNS Degree.
Sr. Margaret Brophy is on leave of absence from the School of Nursing to continue her studies in Psychiatric Counselling.
Miss Catherine Guihen was appointed to the new post of Nursing Practice Development Co Ordinator in line with developments and introduction of the Nursing Diploma in UCD.
Miss Catherine Guihen continues to study for (MSc.) in Education and Training Management at Dublin City University, now in her second year of the two year programme.
Miss Margaret Kilkenny and Miss Rose McCabe have been granted study leave to take (Msc.) Degree in Nursing at University of Wales, Bangor.
We welcome Nurse Teachers Miss Frances Farrelly and Mrs. Lucy Canning to the Tutorial Staff, who joined us in the School of Nursing last year, having completed BNS degrees in UCD.
All first year student nurses successfully completed Intermediate Assessments, so can continue into second year of Nurse Education. As part of their education, student nurses continue to be seconded to St. Mary's Hospital, Phoenix Park for Geriatric Nursing, to St. Vincent's Hospital, Fairview for Psychiatric Nursing, to the National Maternity Hospital Holies Street for Obstetric Nursing and to St. Joseph's Children's Hospital, Temple Street for Paediatric Nursing.
Nursing Certificates and Annual Awards:
For the year ending on 31 st December 1996, a total of 95 student nurses were successful in the Registration Examinations of An Bord Altranais. Nurses were presented with their Certificates following a special Graduation Class November 1996 "Mass of Thanksgiving" offered in the Hospital Chapel by Chaplain Rev. T. Smith, OS. Cam., Rev. P. O 'Brien OS. Cam. and also assisted by Fr. D. Brennan OP. The student nurses, their parents and friends were wel comed to the Auditorium by Sr. M. of the Incarnation, Director of Nursing.
The Awards and Prizes Ceremony was attended by Management, Sr. M. Margherita, Executive Chairperson, Board of Management, Sr. M. of the Incarnation, Director of Nursing, Mrs. A. Carrigy, Deputy Director of Nursing, Nursing Administration Staff, Miss Patrice O 'Sullivan, Principal Tutor and Nurse Teaching Staff. Before the distribution of certificates and awards Miss Patrice O 'Sullivan addressed the audience, congratulating the newly qualified nurses on their achievements and speaking to the graduates on "The Role of the Nurse in Healthcare Reform" and the "Concept of Professionalism".
A special thanks to Ms. Aine Monaghan of 3M Company for awards given annually to student nurses. A buffet function was held in the afternoon in the Hospital Restaurant.
138 M ATER MI SER I CO R D I AE H OSP I TAL A NNUAL R EPORT 199 6
Nursing Awards
Margaret Harrold Memorial Prize, 1996 Sr. Nora McCarthy Mother Catherine MacAuley Prize, 1996 Ms. Barbara Conway Gold Medal Award, 1996 Mrs. Mary Judge Silver Medal Ward, 1996 Ms. Janet Masterson Gold Badge, 1996 Ms. Selene Moran Prize for 2nd Place in Registration Examinations, 1996 Ms. Helen Broderick et. Student Nurse Prizes for 1996 to: Ms. Assumpta Casserley Ms. Carmel Ginnell of Ms. Ailish Deegan Ms. Colette Treacy Ms. Emily Flynn.
Student Nurses were very active in fund raising in the past year and November 1998 Finalists donated a cheque of £ 1,403.00 to St. Vincent's Oncology Ward for day patient's treatment and care.
Nurse Teacher's Committees and the Development of Diploma in Nursing
Nursing education and practice continues to change rapidly and all Nurse Teachers have worked extremely hard in the past year in the planning and preparation for the Diploma in Nursing (for under-graduates) in UCD/Mater. Together with Dr. Pearl Treacy, her staff in UCD and our Curriculum Committee, we have planned the curriculum, educational facilities and the costing of the whole programme.
We continue to facilitate Tutor Students of the BNS Degree from UCD for experience in classroom teaching, ward cl in ical teaching and Nursing Education Administration.
Nurse Teachers and Nursing Staff have taken the "interpersonal Skills Courses", course for "Teaching and Assessing in the Clinical Areas" and now "The Reflective Nursing Practice" course, all within University College, Dublin.
In the past year Nurse Teachers have been involved full time in association with Ward Staff on the Clinical Objectives ital, Committee. This work aims to ensure that best clinical placements be made available for Student Nurses for the future Diploma in Nurse Training and is closely linked to the Research Study on Patient/Nurse Dependence Ratios being car ried out by Sr. R. Murnane and her colleagues in the Management Services and Technological Department, and with Ms. C. Guihen, Nursing Practice Development Co-Ordinator.
Ms. P. O'Sullivan is a member of the "Libraries for Nursing" R.C.N. Committee, and all are involved to ensure our s Library has a qualified Librarian employed full time and that our Computer Centre is functioning before the Diploma in Nursing commences.
Ms. Patrice O 'Sullivan, Principal Tutor, participated in the assessment and selection of student nurses for the General Nursing Registration/Diploma Programme. These interviews, organised by the NurSing Applications Centre, Galway, and evaluated by Institute of Public Administration, were held over a two week period in Dublin City University in July and August 1996.
We were visited by Prof. H. Si mons, Janice Clarke, Senior Researcher and their staff from the University of Southampton in November 1996. The Nurse Teachers and student nurses participated with them in the independent external evaluation of the new nurse education and training programme (Diploma in NurSing), as requested by the Department of Health. n We enjoyed facilitating two nursing students from Finland on EU assignments in clinical practice areas in June/July 1996.
139 M ATER MI SER I CORD I AE H OSP ITAL ANN U AL R EPO RT 1996
In-Service Nurse Education
Nurse Teachers have co-operated with Nursing Administration in providing Lectures, Seminars for Hospital Sisters and Staff Nurses on a continuous basis i.e. Orientation Programmes for New Staff Nurses. Study Days on Systematic Approach to Nursing Care. Study Days on Teaching and Assessing in Clinical Practice. Study Days on Management for Wards/Departmental Sisters. Study Days for the Assessment of Student Nurses for proficiency in Clinical Nursing Skills.
Health and Safety Regulations Nurse Teachers continue to have whole time involvement in the instruction to student nurses and staff in:
Manual Handling and Patient Lifting Training.
Basic Cardiac Life Support (C.P.R.) Training.
I.v. Policy, Drug Therapy Training and Certification.
Information Technology and Computer Training.
Conferences/Seminars attended by staff from the School of Nursing
Irish Guild of Catholic Nurses Annual Mass and Blessing of Hands in Carmelite Church, Whitefriar Street on 14th May 1996.
Ms. P. O'Sullivan attended the plenary meeting of the ACTN Committee in Brussels in April 1996.
Ms. P. O'Sullivan gave a lecture on 'The Impact of the EU on Nursing in Ireland" to the Diploma in Management Students at Faculty of Nursing, R.C.S.1. on 26th February 1997.
Irish Cancer Society - Celebration of Life, an Ecumenical Service, St. Anne's Church, Dawson Street, 14th January 1996.
Research - The Basis of Innovation in Nursing Practice. Annual Conference in FN RCSI in February 1996.
Power, Politics and Participation in Health Care. Department of Nursing Studies, 5th Annual Conference in University Industry Centre, 9th March 1996 An Bord Altranais National Conference for Nurse Teachers "Change in Nurse Education - Meeting the Challenge". March 21 st and 22nd.
Team Approach to Effective Health Care. Seminar for Nurse Teachers, Dublin City University, 29th March 1996.
Irish Association fo r Nurses in Oncology, Day Seminar in RCSI , I I th March 1996.
The Launch of the Hong Kong Hike, Pillar Room, Mater Hospital, March 1996.
Study Days on "The Role of the Nurse in Pain Assessment, Reassessment and Documentation" for Ward and Departmental Sisters. Spring and Autumn 1996.
Proficiency Assessment Forms Workshop, School of Nursing, February and October 1996.
Breast Cancer Support and Healing. Conference in Freeman Auditorium, Mater Hospital. May 1996.
Irish Nurses' Organisation AGM and Annual Conference in Limerick, May 9th and 10th, 1996.
140 M ATER MI SER I CORDIAE H OSPITAL A NNUAL REPORT 1996
Lecture on "Has Nursing Lost its Art?" by Roberta Burton, The Royal Hospital Belfast. Held in Conference Room, Phase IA, 14th May 1996.
Information Day for Post Registration Diploma Nurses, UCD, 21 st May 1996.
Reception by Prof. R. O'Regan, Dean of Medicine Faculty, UCD to celebrate unveiling of Medical Faculty Dean's Portraits, Earlsfort Terrace, May 23 rd 1996.
Psychiatry Study Day "Nurse led innovations/developments within Area 7, Psychiatric Services", Conference Room, Phase IA. 5th June 1996.
Radiation Safety Course in Beaumont Hospital, June 8th 1996.
Roller Blade Run, Mater Hospital Diabetes Research Development, Phoenix Park, 15th June 1996.
libraries for Nursing Seminar, RCN, London, 13th June 1996 .
• MAY 1996 FINALISTS
Front Row: (left to right) Niamh Geary, Sonya Bowen, Sara Maguire, Aideen Walsh, Rachel Scallon, Anne Marie Kirwan, Margaret Wickham, Molly Byrne, Michelle Adams.
Second Row: Sr. Nora, Alice E.nright, Keelin McCarthy, Sadie Coyle, E.lizabeth Crowley, Unda Conry, Mary Dolan, Louise Scally, Pat O'Sullivan.
Third Row: Denise Considine, Noreen Cussen, Aisling Kiely, Hilary Ward, Ruth Gaye, Catherine Marnane, Collette Grant, Helen Broderick.
Fourth Row: Concepta O'Connell, Niamh O'Dwyer, Helen Neville, Debbie Bryan, Heather Hughes, Aileen Delahunt, Croia Sherwin, Nicola Conroy, Suzanne Moffitt, Usa Sex, Breda Hogan.
Fifth Row: Aoife Cleere, Aileen Carroll, f/ma Brennan, Caitriona Bernie, Ceara Daly, Patricia Donovan, Gower, Siobhan Lawlor.
Back Row: Oonagh Furey, Mairead Julian, Tracey Gribben, Alison Gallagher, Deirdre O'Shea, Mary Jones, Dympna McMullen, Phil Walshe.
Missing from Photo: Patricia Kiernan and Janet Masterson.
141 M ATER MI SER I CORD I AE H OSP I TAL A NNUAL R EPORT 1996
INO Student Seminar, Sligo General Hospital, 26th June 1996.
Interviewing Seminar in Institute of Public Administration, Dublin, 4th/5th July 1996.
Presentation of Nursing Certificates, UCD/St. Luke's Hospital, 25th July 1996.
Irish Nursing Research Interest Group (INRIG) Annual General Meeting and Annual Conference "Promoting Evidence - Based Practice through Research" in Health Sciences Centre, St. James' Hospital, 12th September 1996.
Association of Nurse Teachers Annual Conference, "Nursing Theory Exploring the Issues", 19th/20th September 1996.
An Bord Altranais Study Day for Nurse Teachers on Examinations 10th September 1996.
Presentation of Certificates and Prizes to Nurses in Our Lady's Hospital for Sick Children. I st October 1996.
• NOVEMBER 1996 FINALISTS
Front Row: (left to right) P.J. Cooke, Regina Mulhall, Sinead Shannon, Marian Moloney, Anne O'Reilly, Sinead Flood, Lorraine Drois, Dermot ,7C ". , O'Connor. (.:\ C":\ 0 0 ',- Second Row: Lorraine Sheridan, Eloine McNamara, Ade/e t Hanevy, Niah Hegarty, '. Patricia Duffy, Rita Curran, Hazel O'Loughlin, Mary Joe Regan, Caroline Hopkins.
Third Row: Niamh O'Dwyer, Siobhan O'Keeffe, Mary Kavanagh, Deborah Duffy, Sandra Hinchin, Olivia Hetherton, M. Kilkenny (Nurse Tutor), Ann Louise Liddy, Heather Cruise.
Fourth Row: Maura Twomey, Anne Mounsey, Ciara Wo Ish, He/en McDonnell, Sandra Brennan, Lorna Kissane, Aisling Cronin, Catriona Daly, Barbara Moron.
Fifth Row: Lorraine O'Connor, N. O'Callaghan (Nurse Tutor), Maura Roche, Caroline McNicholas, Roisin Gill, Valeria Mangan, Mary Lynch, Sr. Margaret Brophy (Nurse Tutor).
Sixth Row: A. O'Donoghue (Nurse Tutor), Geraldine O'Ryan, Sr. Nora McCarthy (Nurse Tutor), P. Wa/she (Nurse Tutor), Mary Judge, Mairead Byrne, Denise Curtin, M. Corbet (Nurse Tutor).
Missing from photo: Se/ene Moron.
142 iD
M ATER M ISERI CORD I AE H OSP I TAL A NNUAL R EPORT 199 6
Irish Cancer Society Conference, "Early Detection, the Key to Successful Treatment of Skin Cancer", 9th October 1996.
The National Kidney/Pancreas Transplant Centre, 3rd Symposium "Organ Donation and Transplantation", 18th October 1996.
Introduction to "No Smoking Policy" - Dr. D. Natin, Occupational Health Physician, Freeman Auditorium, 23rd October 1996.
Irish Association of Critical Care Nurses Annual Conference, Sligo, I st November 1996.
The Quality Assurance in Nursing Association, 8th Annual Conference, "Audit and Evaluation", 14th November 1996.
An Bord Altranais "Continuing Professional Education for Nurses". National Conference, Burlington Hotel, Dublin 26th November 1996.
Irish Association for Nurses in Oncology, Conference on Lung Cancer, Diagnosis and Treatment, 16th November 1996.
• The May Finalists 1999 Class - Change to New Uniforms in June 1996.
143 M ATEft MI SEftlCOftD I AE H OSP I TA L ANNUAL R EPOftT 1996
UNIVERSITY COLLEGE DUBLIN, AND MATER MISERICORDIAE HOSPITAL SCHOOL OF PHYSIOTHERAPY
REPORT ON EXAMINATIONS FOR THE BACHELOR OF PHYSIOTHERAPY, NATIONAL UNIVERSITY OF IRELAND
Summer and Autumn Examinations I 996
st Year: Thirty four students entered for the summer examination. Seven gained second class honours grade I, fourteen gained second class honours grade 11, five students passed, eight students repeated in the autumn and all 1passed. 2nd Year: Thirty five students entered for the examination. Ten gained first class honours grade I, fifteen gained second class honours grade 11, six passed, four failed. Four students repeated in the autumn and failed.
3rd Year: Thirty six students entered for the examination. Two students obtained first class honours grade I, twenty eight obtained second class honours grade I, five passed and one failed. One student repeated in the autumn and passed.
4th Year: Thirty six students entered for the examination. Four students obtained first class honours grade I, eleven students obtained second class honours grade I, eighteen obtained second class honours grade 11 , and two passed. One student sat the examination in the autumn and passed.
MMEdSc.Mode 11 Degree (part taught, part research) Two candidates graduated with First Class Honours. One candidate entered for the examination and passed.
Overseas Students
The first Botswana student Ms. Joyce Pelowetse graduated with a Second Class Honours Grade I Degree in Summer 1996.
Three overseas students were admitted from Botswana at undergraduate level. The School also had three undergradu ate students entering second year, one undergraduate entering third year and one undergraduate entering fourth year from Botswana.
Graduate Employment
All graduates were successful in obtaining employment.
Report on Post Graduate Studies
Five students were registered for the M.Med.Science Degree (Mode I I), one of whom is from Saudi Arabia and one from Qatar. Two candidates graduated with First Class Honours, two candidates were successful in their examinations.
One student registered for the M.Med.Science Mode I (by research only). Four students registered for the modular M.Med .Science - Mode 11 (Sports Physiotherapy)
Course Development
Mater of Medical Science (Sports Physiotherapy) was established in co-operation with Dr. Noel McCaffrey and the Department of Human Anatomy and Physiology. Four students registered. Modules on Work Hardening, and
144 MATER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
Physiotherapy for Victims of Torture were introduced to the final year Bachelor of Physiotherapy degree programme.
Research Activity - Involvement with European Community
CAMARN Computer Aided Movement Analysis in a Rehabilitation Network. The Human Performance Laboratory in the School of Physiotherapy forms part of a recognised network of movement analysis laboratories in Europe. The fund ing was £37,000.
VISITING FELLOWS: Mr. Bart Van Hemelrijk was appointed as CAMARN Research Fellow for the period August to December 1996. A graduate of the Katholieke Universiteit, Leuven, Mr. Van Hemelrijk was a licensed Physiotherapist with distinction from the University of Leuven. He had previously carried out research techniques at the Laboratory for Motor Control at the Karolinska Institute in Sweden. While at the UCD School of Physiotherapy, his research, in col laboration with Dr. Garrett, focused on an examination of the relationship between H-reflex and level of walking handi cap in normal healthy elderly compared with stroke patients. The results of this research were presented by Mr. B. Caulfield at the Winter meeting of the Royal Academy of Medicine in Ireland, held in Dublin on 3-4 January 1997, and d accepted for publication as an abstract in the Irish Journal of Medical Science.
Extern Examining ed. Dr. Mary Garrett Queen's College Glasgow University of Manchester Dr. Mary McAteer University of Ulster. e Involvement in Professional Activities, Physiotherapy & University Teaching
Dr Mary Garrett served as a member of:
University College Dublin Academic Council, Registrar's Disciplinary Committee, Medical Faculty, Faculty of Medicine Executive, Medical Faculty Heads of Departments Committee, Internal Structures Committee, Faculty of Medicine Sub Committee on Marks & Standards, Semesterisation, FTE's, Medical Faculty Hospital Affiliation Committee, Registrar's 6. Committee on Equality in participation in Irish Education and Council Member of Biomedical Section, Royal Academy of Medicine in Ireland. She served as member of Education Committee for the Irish Society of Chartered Physiotherapists. Dr. u- Garrett was elected Vice-President of the European Network of Physiotherapists in Higher Education (EN PH E). Dr. Mary McAteer completed her period as President of the Irish Society of Chartered Physiotherapists in September 1996.
Dr. M. Hanly retired on 31 August 1996. Dr. Hanly served as a member of Education Committee for the Irish Society of Chartered Physiotherapists, and was a Council member of the ISCP. She also served on the Examination Panel of the Chartered Society of Physiotherapists. Dr. Hanly was the representative for the School of Physiotherapy on the UCD "Open Day" Committee.
She represented UCD on the Schools Liaison Committee and was responsible for the departmental participation in ERASMUS. She was Lecturer in Anatomy of the Spine for the National Fire and Safety Training Centre, Dublin; Lecturer in Anatomy for the Institute of Industrial Engineers; Lecturer in Anatomy for the National Ambulance Training School, ns. Phoenix Park, Dublin.
Meetings, courses and conferences attended - Dr. Mary Garrett
DUBLIN - Royal Academy of Medicine in Ireland meeting at University of Ulster, Coleraine, 5 January 1996.
GLASGOW - Meeting of European Network of Physiotherapists in Higher Education, 26-28 January 1996.
LOUTH - Financial Management & Research Design Nuremore Hotel, 16-17 February 1996.
145 M ATER MI SERICORD I AE H OSPITAL A NNUAL R EPORT 1996
BOTSWANA - Invited by the Botswana High Commission to visit Ministry of Health, University of Botswana and a variety of hospital with a view to sending Irish students on clinical placement. 22-30 March 1996.
GLASGOW, CAMARN (Computer Aided Movement Analysis in a Research Network) meeting, 26-28 March 1996.
BELGIUM, European Network of Physiotherapists in Higher Education, Katholieke Universiteit, Leuven 22-23 June 1996.
BELFAST, Royal Academy of Medicine in Ireland, Queen's University, Belfast. 27-28 June 1996.
SALFORD, Acting as Extern Examiner. 17-18 July 1996.
THE NETHERLANDS, European Network of Physiotherapists in Higher Education, Utrect. 3-5 October 1996.
USA - SAN DIEGO, Gait Analysis Interpretation Course (Drs. J. Perry & D. Sutherland), The Children's Hospital, San Diego, 7-1 0 October 1996.
BELGIUM, European Network of Physiotherapists in Higher Education, Katholieke Universiteit, Leuven 20-22 December 1996.
Future Meetings
The Winter meeting of the Biomedical Section of the Royal Academy of Medicine in Ireland will be held at the Mater Misericordiae Hospital on 9 January 1998. Organiser - Dr. M. Garrett.
Publications
Modulation of the Hoffman Reflex of Soeus during the walking cycle in stroke patients and associated control of ankle joint movement. In Pedotti, a,; Ferrarin, M., Riner, T., eds Neuroprosthetics from basic research to clinical application. Springer-Verlag; Berlin pSI-58. Garrett, M., Caulfield, B.
Physiotherapy Management of Pain. In Johansson, H.; Sjolander, P.; & Lorentzon, R., eds. Neuro-Muscular Systems and Muscle Pain. Arbete och Halsa; Umea, 1996. p 121-123. Garrett, M.
Books
University College Dublin: eds. Garrett, M. & Fleming, H. Proceedings of the Final CAMARC 11 CONFERENCE AND WORKSHOP 'Experiences and Perspectives' Dublin 25-26 February 1995. CEC Programme AIM PROJECT a-2002 CAMARC 11. No. pages 131 , Tecno Biomedica S.pA. Rome. Published 30 July 1995.
Public Relations
A World Wide Web page was set up for the School of Physiotherapy 1996. Address as follows: www.ucd.ie/-physio/physio.htm.
146 M ATER M ISERICORD I AE H OSPITAL A NNUAL R EPORT 1996
a DEPARTMENT OF SPEECH AND LANGUAGE THERAPY
Scope of Service e he Department of Speech and Language Therapy provides a service to both in-patients and out-patients who present with communication and/or swallowing difficulties - referrals are accepted for patients under the care of TMater Hospital Consultants. A service is provided to the following assigned groups. (i) Patients with communication/swallowing difficulties due to acute of progressive neurological impairment.
(ii) Patients with speech/swallowing difficulties following Head and Neck Surgery.
(iii) Patients with disorders of voice.
(iv) Patients with communication difficulties associated with tracheostomy or ventilator dependence.
The trend for increasing referrals to the Speech and Language Therapy Service continues with a 10% increase in overall referrals from 1995 to 1996, this in addition to a 30% increase in referrals in the previous year. This has meant an increase in out-patient waiting times to even months. In-patient waiting times have also increased and frequency of ther apy sessions for individual patients has decreased. The Department is still awaiting sanction for a further two Speech and Language Therapy Posts, which would alleviate these difficulties in service provision.
Ms. Fiona Delaney is currently on a leave of absence. Ms. Yvonne Loftus has taken up post as a Locum until March of 1998.
A big event in the 1996 calendar was the joint organisations of a National Voice Symposium, together with the ENT Department. The conference was extremely well attended and was a very successful event.
Courses Attended:
(i) National Dysphagia Conference, St. James' Hospital, Dublin.
(ii) Voice Conference, Kilkenny.
(iii) Motor Neurone Disease Information Day, Hospice, Raheny.
(iv) Symposium on Parkinson's Disease, Galway.
(v) National Voice Symposium, Mater Hospital, Dublin.
147 M ATER MI SER I CORDIAE H OSPITAL ANNUAL REPORT 1996
DEPARTMENT OF SURGERY PROFESSOR JOHN M. FITZPATRICK
Publications
Kontinente Vesikostomie Mittels Submukos versenktem Boari-Rohr: Tierexperimentelle Studie in Schweinmodelle. Akt. Urol. 26: 106. j. Fichtner, M. Fisch, GE Voges. j.M. Fitzpatrick, R. Hohen(ellner (1995)
Combined androgen blockade is not the treatment of choice for patients with advanced prostate cancer. European Urology 29 (Suppl. 2): 37. j.M. Fitzpatrick.
Tamsulosin: The first prostate-selective alpha I A-adrenoceptor antagonist for the treatment of symptomatic benign pro static hyperplasia. Drug Bulletin 32:259. X. Rabasseda, j.M. Fitzpatrick.
Inguinal lymph node metastases from testicular tumour. Brit. J. Urol. 77:923. H.M. Corby, T.H. Lynch, j.M. Fitzpatrick, j.M. Smith.
Methods of renal blood flow measurement. Urological Research 24: 149. LS. Young, M.C. Regan, M.K. Barry, j.G. Geraghty, j.M. Fitzpatrick.
Laparoscopic-Assisted Rectopexy using a Novel Hand-Access Port. j. Laparoendoscopic Surgery. 6:325. T.F. Gorey, M.G. O'Riordain, S. Tierney, D. Buckley, j.M. Fitzpatrick.
Video-assisted Nissen's fundoplication using a hand-access port. Min. Invas Ther & Allied Technol. 5:364. T.F. Gorey, S. Tierney, D. Buckley, M. O'Riordain,j.M. Fitzpatrick.
The role of fibroblasts in stricture formation in inflammatory bowel disease. Surgical Forum 43:203. B.M. Flavin, M.C. Regan, j.M. Fitzpatrick, P.R. O'Connell.
Combined hand access with laparoscopic pneumoperitoneum in intraperitoneal adhesiolysis. Ir. J. Med. Sci. 165: 297. T.F. Gorey, S. Tierney, M. O'Riordain, D. Buckley, N. Gibbons, j.M. Fitzpatrick.
The International Terazosin Trial: a multi centre study ofthe long-term efficacy and safety of T erazosin in the treatment of benign prostatic hyperplasia. European Urology 30:369. F.MJ. Debruyne, w.p J. Witjes, j.M. Fitzpatrick, R. Kirby, D. Kirk, D. Prezioso.
Continent vesicostomy with submucosally embedded bladder tube. J. Urol. I SS: 482A. j. Fichtner, A. Macedo, M. Fisch, G. Voges, R. Hohen(ellner, j. Thuroff, j. M. Fitzpatrick.
Prostaglandins do not mediate increased cortical blood flow post-nephrectomy. J. Urol. I SS : 562A. P. Sweeney, L Young, K. Barry, M. Regan, j.M. Fitzpatrick.
Sodium bicarbonate protects against the vascular injury of renal ischaemia as measured by autoradiography. J. Urol. I SS: 564A. L Young, P. Sweeney, M. Regan, M. Ryan, j.M. Fitzpatrick.
Higher Resolution of renal blood flow measurement with microautoradiography. J. Urol. I SS: 565A. P. Sweeney, L Young, K. Barry, M. O'Riordain, j.M. Fitzpatrick.
Transurethral needle ablation for the treatment of symptomatic BPH. J. Urol. 155: 709A. IH. Lynch, I. Eardley, J. Frick, B. Galdwasser, J. Raman, P. Wiklund, j.M. Fitzpatrick.
148 M ATER M ISER I CORDIAE H OSPITAL A N N UAL R EPORT 1996
Autoradiographic study of renal blood flow during ureteric obstruction. Brit. J. Urol. 77 (Suppl. I): 6. P. Sweeney, L Young, j.M. Fitzpatrick.
Improved resolution of renal blood flow measurement using autoradiography and microantoradiography. Brit. J. Urol. 78: 153. P. Sweeney, L Young, j.M. Fitzpatrick.
Clinical Research Criteria In , The Third International Consultation on Benign Prostatic Hyperplasia. Edited by AT.K. Cockett et al.; Published by SCI, Paris pp. 451-467. Y. Aso, C Abbou, P. Abrams. R Ackermann, MJ. Barry, L Boccon-Gibod, P. Boyle, F. Calais da Si/va, EC Carlton, A TK Cockett, Lj. Denis, j.M. Fitzpatrick, j.E Fowler et al.
The medical management of BPH with agents other than hormones or alpha blockers. In, The Third International Consultation on Benign Prostatic Hyperplasia. Ed ited by AT.K. Cockett et al.; Published by SCI, Paris pp. 487-495. j.M. Fitzpatrick, K. Dreikorn, j. Braeckman, L Denis, P. Perrin, S. Khoury, R Levin.
Other Non-Medical Therapies. In , The Third International Consultation on Benign Prostatic Hyperplasia. Edited by AT.K. Cockett et al.; Published by SCI, Paris. pp. 573-613. P. Smith, P. Conort, j. de la Rosette, M. Devonec, j.M. Fitzpatrick, U. jonas et al.
Phytotherapeutic Agents. In , Textbook of Benign Prostate Hyperplasia. Edited by R.S. Kirby, J.o. McConnell, J.M. Fitzpatrick, e.G. Roehrborn, P. Boyle. Published by Isis Medical Media, Oxford. pp. 331-341. j.M. Fitzpatrick, T.H. Lynch.
Shared care for benign prostatic hyperplasia. In, Textbook of Benign Prostatic Hyperplasia. Edited by R.S. Kirby, J.o. McConnell, J.M. Fitzpatrick, e.G. Roehrborn, P. Boyle. Published by Isis Medical Media, Oxford. pp.537-543. RS. Kirby, j.M. Fitzpatrick, M.G. Kirby, A Fitzpatrick.
Genitourinary Disorders. In , Clinical Surgery. Edited by A Cuschierie, T.P.J. Hennessy, R.M. Greenhalgh, 0.1. Rowley, PA Grace. Published by Blackwell Science pp. 365-421 . j.M. Fitzpatrick, T. Creagh, AA Sarazen.
Books
Textbook of Benign Prostatic Hyperplasia. Published by Isis Medical Media. Edited by RS. Kirby, j.D. McConnell, j.M. Fitzpatrick, C Roehrborn, P. Boyle.
T.F. Gorey - Publications
Laparoscopic assisted rectopexy using a novel hand-access port. Journal of Laparoendoscopic Surgery, 1996, 6: 325-8. T.F. Gorey, M.G. O'Riordain, S. Tierney, D. Buckley, j.M. Fitzpatrick.
Qualitication of Regional Renal Blood Flow after Nephrectomy using an Autoradiographic Technique. I.J .M.S. 1996, 165: 16. MK Barry, LS. Young, M.C Regan, j.G. Geraghty, T.F. Gorey, j.M. Fitzpatrick.
Advances in Breast Cancer: Clinical and Biological Lessons from Screening. I.J.M .S. 1996, 165: 143-50. T.F. Gorey.
149 M ATER MI SERICORO I AE H OSPITAL A NNUAL R EPORT 1996
Resection for Oesophageal Cancer is Good: Palliation and Cure is Possible. I.J .M.S. 1996, 165: 13. ED. Mulligan, M. O'Riordain, M. Duggan, P. MacMathuna, j. (rowe, j. Lennon, T.F. Gorey.
Pathology and Localisation of one hundred cases of Parathyroidectomy. I.J .M.S. 1996, 165: 26. M. Grannell, M. Regan, M. Stokes, D. Powell, j.M. Fitzpatrick.
Laparoscopic Nissen's Funoplication using a Hand Access Port. Minimally Invasive Therapy & Allied Technol. 1996, 5: 264-6. T.F. Gorey, S. Tierney, D. Buckley, M. O'Riordan, j.M. Fitzpatrick.
Palliation in Oesophageal Carcinoma - Surgery -V- Laser Therapy. I.J.M.S. 1996, 165: 52. ED. Mulligan, MK Barry, MJ. O'Riordain, M. Duggan, j.M. Fitzpatrick, T.F. Gorey.
Editorial towards earlier detection of colorectal cancer. I.J.M.S. 1996, 165: 141-2. MJ. O'Riordain, T.F. Gorey.
Case Report: Combined hand access with laparoscopic pneumoperiton in intraperitoneal adhesiolysis. I.J.M.S. 1996, 165: 397-8. T.F. Gorey, S. Tierney, M. O'Riordain, D. Buckley, N. Gibbons, j.M. Fitzpatrick.
Development of a novel hand access laparoscopic port. I.J.M.S. 1996, 165: 29. DJ. Buckley, S. Tierney, M. O'Riordan, j.M. Fitzpatrick, T.F. Gorey.
150 MATER MISERI CORD IAE HO SP ITAL ANNUAL REPORT 1996
COLORECTAL/GENERAL SURGERY UNIT
996 proved a very successful year for the Colorectal Surgery Unit. The Department of Health's approval was obtained for appointment of a permanent Stoma Therapist. Ms. Valerie Dowley was appointed and took up her post on I st February 1996. This appointment released funds for the appointment of a full-time 1Research/Continence nurse and Ms. Mary Cassidy took up her appointment on I st December 1996. 1996 was a busy year for research in the unit. A collaborative research project with UCD Department of Obstetrics and Gynaecology at Holies Street Hospital was awarded a HRB Grant. Dr. Michelle Fynes was appointed a full time Research Fellow and took up her appointment on I st January 1996. Ms. Maeve Duffy completed her third year as a PhD student in the surgical research laboratory at the Mater Misericordiae Hospital and Dr. Brian Flavin completed work on an M.Sc project in collaboration with Mr. Mark Regan, Senior Registrar. The resulting research was recognised by pre sentations at the American Gastroenterological Association, the Surgical Research Society and the American College of Surgeons. Dr. Brian Flavin was awarded the Registrar's Prize at the Surgical Section, Royal Academy of Medicine, Ireland. Mr. R. O'Connell was appointed to the Editorial Committee of the British Journal of Surgery.
The clinical workload of the department remained at a constant level. Regrettably closure of the one day and five day wards in late 1996, due to budgetary cutbacks, reduced the number of cases performed during 1996 to 652.
The special interests of the department continue to be management of inflammatory bowel disease, colorectal cancer and faecal incontinence. The unit continues to provide a busy clinical service with a major academic interest.
Presentations to Learned Societies
Serosal Fibroblasts promote stricture formation in Crohn's Disease. O 'Halloran Meeting, Limerick, March 1996. (Awarded Best Poster Prize)
Enteric Mucosal Metabolism is reduced in Ileal Reservoir Mucosa. O'Halloran Meeting, Limerick, March 1996.
Serosal Fibroblasts promote stricture formation in Crohn's Disease. Royal Academy of Medicine in Ireland, March 1996. (Awarded Registrar's Prize)
Enteric Mucosal Metabolism is reduced in Ileal Reservoir Mucosa. American Gastroenterological Association, San Francisco, May 1996.
Colonic Substrate Utilisation in Crohn's Disease. American Gastroenterological Association, San Francisco, May 1996.
Serosal Fibroblasts promote stricture formation in Crohn's Disease. Surgical Research Society (Plenary SeSSion), Birmingham, June 1996.
Mucosal Substrate Utilisation in Crohn's Disease. Surgical Research Society, Birmingham, June 1996.
The role of Fibroblasts in stricture formation in Inflammatory Bowel Disease. Surgical Forum, American College of Surgeons, San Francisco, October 1996.
Cyclosporine in treatment of Crohn's Fistulae. 5th United European Gastroenterology Week, Paris, November 1996.
Colonic Substrate Utilisation in Crohn's Disease. Irish Society of Gastroenterology, November 1996.
151 M ATER MI SER I CORD I AE H OSP I TAL AN NUA L R EPORT 1996
Invited Presentations
Management of rectovaginal fistula in Crohn's Disease. International Tripartite Meeting of Colorectal Surgeons. London, 3rd July 1996.
Obstetrical determinants of postpartum anal sphincter injury. Society of Pelvic Surgeons. Trinity College Dublin, 19th September 1996.
The role of surgery in management of Colorectal Cancer. Annual Meeting Faculty of Radiology, RCSI. RCSI, 16th November 1996.
Laparoscopic versus open surgery in Colorectal Disease. Charter Day Meeting, RCSI , 7th February 1997.
Publications
Vitello-Intestinal Remnant, Complicating Laparoscopic Cholecystectomy. Ir J Med Sci , 1996; 165: 164. G.C Durkan, K.S. Cross, P.R. O'Connell.
Postpartum Anal Sphincter Endosonography using a 120 Sector Scanner. Clin. Radiol, 1996; 51 :559-561 . D.M. Campbell, V.s. Donnelly, D. O'Connell, M. Behan.
Serosal Fibroblasts promote Stricture Formation in Crohn's Disease. Surg Forum 1996; 47: 203-205. B. Flavin, M. Regan, J.M. Fitzpatrick, P.R. O'Connell.
Morphology, Histochemistry and Crypt Cell Kenetics of Ileal Pouch Mucosa: An Experimental Model. Int J. Colorectal Dis, 1996; 11 :52-55. J.M. O'Byrne, P.R. O'Connell, N. Nolan, D. O'B Hourihan, F.B. Keane, W.A. Tanner.
Laparoscopic assisted Colectomy and Myasthenia Gravis. Min Ivas Ther & Allied Technol, 1996; 5:405. P.G. Horgan, P.R. O'Connell.
Stercoral Perforation Associated with Parathyroid Adenoma. Ir Med J, 1997; 90:20. Y.A. Gul, DJ. Waldron, P.R. O'Connell.
Anal Canal Pressures are low in women with Postpartum Anal Fissure. Br J Surg 1997; 84: 86-88. H. Corby, V.S. Donnelly, C O'Her/ihy, P.R. O'Connell.
The Influence of Oestrogen Replacement on Faecal Continence in Post Menopausal Women. Br J Obstet Gynaecol, (1997, in press). V.s. Donnelly, P.r. O'Connell, C O'Herlihy.
Completion Proctectomy in Ulcerative Collitis. Br J Surg, 1997 (in press). D.s. O'Riordain, P.R. O'Connell.
152 M AT ER MI SERI CORDIAE H OS PI TAL A NNUAL R EPORT 19 96
DEPARTMENT OF GYNAECOLOGY
Waiting Lists
In-Patient 7 months Out-Patient I month
Theatre Activity
1993 1994 1995 1996 807 756 741 809
Gynaecology/Gynaecology Oncology/Fertility and Infertility Clinics
Mr. Malachy Coughlan (Gynaecology) Tuesday & Friday 9.00 a.m. Mr. Bill Boyd (Gynaecology) Wednesday 9.00 a.m. Mr. Bill Boyd (Gynaecologic Oncology) Tuesday 9.00 a.m. STD Female Clinics Tuesday 4-7.00 p.m. Thursday 3-4.00 p.m. Prof. O'Herlihy/Prof D Powell (Combined Clinic) Wednesday 2.00 p.m. Mr. Bill Boyd (Colposcopy Clinic - Rotunda) Thursday 10 a.m.- I p.m.
Scope of Services Routine gynaecological services. Gynacologic Oncol?gy. Fertility - Endocrinology. Colposcopy - Cytology. Laser and LLETZ surgery. Gyn-urology - Urodynamics - Laparoscopic Burch Colposuspenion Minimal Invasive Surgery - TCRE (Trans-urethral resection of the endometrium) - Thermal Balloon Ablation of the endometrium - Laparoscopic Burch Colposuspenion - Laparoscopic Pelvic Lymphadenectomy - Laparoscopic treatment of ovarian cysts, ectopic pregnancies etc.
Special Equipment The Gynaecology Department has updated the laparoscopic equipment which is needed for laparoscopic lumphadenectomy, as this is now used more and more, to help reduce the surgical morbidity from the traditionally large abdominal scars used in gynaecological cancer surgery. We are also in the process of updating the instru ments used for radical vaginal surgery.
New Consultant AppOintment Mr Bill Boyd, FRCSI, MRCOG, started as a consultant in July 1996. He has recently returned from a two year Fellowship in gynae-oncology in Toronto. He is also experienced in advanced laparoscopic surgery, particularly where it applies in gynae-oncology, and has introduced laparscopic lymphadenectomy and radical vaginal Schauta hysterectomy for early cervix cancers, which has a much lower surgical morbidity than the traditional open method. The Mater has been the first • Mr. Bill Bayd
153 M ATER. MI SER.ICOR.D I AE H OSPITAL ANN UA L R EPOR.T 1996
hospital in Ireland to perform this surgery and will continue to develop this area. With this appointment, the Mater will now become the hosptial on the north side of Dublin where all radical gynaecological cancer surgery will be performed.
Ongoing Research Projects I. Assessing the efficacy of out-patient treatment of postmenopausal bleeding using hysteroscopy, pipelle endometrial sampling, D&C and transvaginal ultrasound measurement.
2. Assessing the efficacy and feasibility of laparoscopic Burch colposuspension over the tradition open technique.
3. Review of the menstrual function of young women after chemotherapy for lymphoma.
Presentations/Publications Abdominal pain in young women presenting to Casualty. Presented at the Junior Obstetricians and Gynaecologists Society GOGS) 1996. R. O'Mahony, B.M. Cough/an.
Hysterectomy in an Irish Population. Presented to Obstetrical Section of the Royal Academy of Medicine in Ireland 1996. S. Ong, M. Codd, B.M. Cough/an, C. O'Herlihy.
Anal canal pressures are low in women with postpartum anal fissure. British J Surg 1997, 84, 86-88. H. Corby, VS Donnelly, C. O'Herlihy, P.R. O'Connell.
The influence of oestrogen replacement on faecal incontinence in postmenopausal women. Br J 0 & G March 1997 (in press). VS Donnelly, P.R. O'Connell, C. O'Herlihy.
Endoscopic assessment of postpartum anal sphincter injury with a 120 degree sector scanner. Clinical Radiology 1996, 5 I ,559061. D. Camp bell, M. Behan, v.s. Donnelly, C. O'Herlihy, P.R. O'Connell.
Statistics for I 996 Despite the problems with bed closures in 1996, the Gynaecology Department performed 809 procedures. of which 303 of these were major surgical procedures. The case mix of the gynaecology workload has increased as there has been an increase in the number of cancer patients and high risk patients being referred. Three patients were diagnosed with recurrent cervix in 1996. An exenteration was attempted in all. Two patients had an anterior exenteration performed and now at six months follow up are free of disease. One patient had a positive para-aortic nodes and the procedure was abandoned.
In 1996. 78 patients were diagnosed with a gynaecological cancer, and it is anticipated that this number will increase as the Mater specializes more in this field .
Mr. Coughlan Colposcopy Combined Rotunda/Mater Clinic New Patients 656 Return Patients 1061 New Patients 307 Return Patients 900 Professor O'Herlihy New Patients 43 Return Patient 144
Mr. Boyd New Patients 394 Return Patients 640
154 M ATER M ISER I CORD I AE H OSP ITAL A NNUAL R EPORT 1996
DEPARTMENT OF VASCULAR SURGERY
Scope of Service
The Department of Vascular Surgery is responsible for a 24 hour service for both acute and elective vascular problems. This service is provided by two consultant surgeons and the support staff includes a senior registrar, two senior house officers and three interns. Theb vascular laboratory is directly under the supervision of the Department of Vascular Surgery. A full range of arterial and venous surgical procedures are performed inluding combined procedures with the Cardiac Surgery Department.
Special Interests:
The particular interest of the department is the prevention of stroke through arotid artery re-vascularisation. This area has now become a major part of the workload of the department with over one hundred such procedures being per formed last year. Other interests include aneurysm surgery, venous procedures and surgery for hyperdrosis.
New Developments:
The department is planning to initiate endovascular procedures and a fluoroscopy unit for use in the operating theatre has recently been purchased. The vascular laboratory, which opened in 1994, continues to develop. This laboratory accepts referrals from within the hospital, the immediate catchment area and from peripheral hospitals. The number of procuedures being performed in this department is now in excess of one hundred and fifty per week.
155 ------~~------
M ATER MI SER I CO R D IAE H OSPITAL ANN UAL R EPORT 1996
HOSPITAL STAFFING CONSULTANT MEDICAL STAFF
Mr. R. Acheson Ophthalmology Doctor M. Anglim Child Psychiatrist Doctor M. Behan Radiology Mr. A.W. Blayney E.N.T. Surgery Doctor W . Blunnie Anaesthesia & Intensive Care Mr. R. Bowell Ophthalmology Doctor M. Bowen Anaesthesia Doctor W.D. Boyd Obstetrician/Gynaecologist Professor H. Brady Professor of Medicine Doctor E. Breatnach Radiology Doctor C. Breslin Anaesthesia & Intensive Care Doctor C. Burke Respiratory Physician Doctor N. Byrne Child Psychiatry Doctor DN. Carney Oncology Doctor K.D. Carson Anaesthesia Doctor E. Carton Anaesthesia & Intensive Care Professor P. Casey Professor of Psychiatry Doctor F. Chambers Anaesthesia & Pain Management Doctor L.P. Claffey Anaesthesia & Intensive Care Mr. T.P. Corrigan GeneralNascular Surgery Mr. M. Coughlan Gynaecology Doctor j. Crowe Gastroenterology Doctor M. Delargy Rehabilitation Medicine Professor P. Dervan Professor of Pathology & Histopathology Doctor j. Donohoe Nephrology Doctor j. Duggan Geriatrician Mr. M.j. Earley Plastic Surgery Professor j.T. Ennis Radiology Professor P. Eustace Neuro-Ophthalmology Doctor R.G. Firth DiabeticlEndocrinology Doctor j.M. Fitzpatrick Professor of Surgery Doctor M. Floyd Anaesthesiology Doctor I. Fraser Rad iotherapy Doctor j. Gardiner Anaesthesia Mr. T. Gorey Consultant Surgeon Doctor N. Healy Child Psychiatry Doctor R. Hone Microbiology Doctor j. Horgan Cardiology Mr. j. Hurley Cardiothoracic Surgeon with a special interest in transplantation. Mr. D.E. Hynes Orthopaedics Doctor P. Keelan General & Respiratory Medicine Doctor B. Keogh Respiratory Medicine Doctor P. Kelly Histopathology Doctor j.A. Kirrane Consultant Pathologist Doctor j. Lavan Geriatrician Doctor D. Lawlor Plastic Surgery Doctor D. Legge Radiology
156 "d
MATER MISERI CORD IAE HO SP ITAL ANN UAL R EPORT 1996
HOSPITAL STAFFING CONSULTANT MEDICAL STAFF
Doctor J. Lennon Gastroenterology Ms. P. Logan Ophthalmology Mr. D. Luke Cardio-Thoracic Surgery Doctor H.A. McCann Cardiology Doctor M. McCarroll Anaesthesia Doctor C. McCarthy Cardiac Physiology Doctor C. McCarthy Rheumatology Mr. G.P. McEntee General Surgery/Hepatobiliary Ms. E. McGovern Cardio-Thoracic/Cardiac Surgery Doctor R. MacSullivan Anaesthesia & Pain Management Mr. F. McManus Orthopaedics Doctor P. MacMathuna Physician/Gastroenterologist Doctor P. McQuaid Child Psychiatry Doctor B. Marsh Anaesthesia & Intensive Care Doctor J. Magner Anaesthesia Doctor A. Mohan Consultant Psychiatrist Doctor D. Moriarty Anaesthesia & Intensive Care Mr. N. Mulvihill OrthopaediC Surgery Doctor G. Murphy Dermatology Doctor S. Murphy Neurology Doctor J. Murray Radiologist Doctor P. Murray Rehabilitation Medicine Mr. M. Neligan Cardio-Thoracic Surgery Doctor J. Noel Geriatrics Professor T. O'Brien Orthopaedic Surgery Doctor D. O'Connell Radiology Mr. R. O'Connell General Surgery Doctor P. O'Connor Accident & Emergency Mr. T. O'Dwyer EN.T. Professor C. O'Herlihy Gynaecology Doctor C. O 'Keane Histopathology Mr. M. O'Keefe Ophthalmology Doctor S. O'Loughlin Dermatology Mr. K. O'Malley General Surgery with a special interest in Vascular Surgery Mr. N. O'Meara Endocrinology Doctor B.C. O'Moore E.M.G . Doctor S. O'Neill Respiratory Physician Doctor B. Otridge Haematology Doctor D. Ph elan Anaesthesia & Intensive Care Professor D. Powell Endocrinology/Acting Professor of Medicine Doctor F. Powell Dermatology Doctor c.P. Redahan Anaesthesia Mr. J.D. Russell EN.T. Mr. D. Ryan Oral & Maxillo Facial Surgery Doctor G. Sheehan Infectious Diseases Doctor J. Sheehan Adult Psychiatry Doctor E.M.P. Siung Child Psychiatry
157 MAT ER MISERICORDIAE HOSPITAL ANNUAL REPORT 1996
HOSPITAL STAFFING CONSULTANT MEDICAL STAFF
Mr. J.O. Small Plastic Surgery Mr. J. Smith Urology Doctor J. Stack Radiology Mr. M. Stephens Orthopaedic Surgery Doctor D. Sugrue Cardiology Doctor D. Tyrrell Anaesthesia Mr. M.G . Walsh Orthopaedic Surgery Mr. AE. Wood Cardio-Thoracic Surgery Doctor M. Wrigley Psychiatry
158 M ATER M ISER I CORD I AE H OSPITAL A NNUAL R EPORT 1996
MANAGEMENT STAFFING
Executive Chairperson Sr. Margherita Rock
Chief Executive Mr. M. Cowley
FINANCE DEPARTMENT:
Financial Controller Mr. B. Conlan Systems Accountant Mr. R. McCutcheon Financial Accountant Mr. P. Martin Management Accountant Ms. K. Hamill
CHAPLAINCY SERVICES:
Chaplains Rev. T. Smith, O .S. Cam Rev. P. O 'Brien, 0.5. Cam Rev. B. Conway, O .S. Cam
GENERAL SERVICES:
General Services Officer Mr. M. Igoe Catering Superintendent Mr. O . Sheedy Housekeeping Services Mrs. A. Dillon Mr. C. Farmer Portering Services Officer Mr. D. O'Neill Deputy Portering Services Officer Mr. P. Drumm
HOSPITAL DEVELOPMENT:
Acting Project Administrator: Mr. M. Igoe
MANAGEMENT SERVICES:
Management Services Officer Mr. GA Hurl
NURSING ADMINISTRATION:
Director of Nursing Sr. M. of the Incarnation
Deputy Director of Nursing Mrs. A. Carrigy
Assistnat Director of Nursing Sr. M. Joan Sr. Nora Ms. N. Keane
Principal Tutor Miss P. O 'Sullivan
159 M ATER MI SERICORD I AE H OSP I TAL AN NUAL R EPORT 19 96
MANAGEMENT STAFFING
PATIENT SERVICES:
Patient Services Officer Mr. T. Kehoe Medical Records Officer Ms. F. Fahy Bed Manager Ms. M. Raftery Bed Management Officer Ms. S. O'Neill
PERSONNEL:
Personnel Officer Mr. P. Bruen
PURCHASING DEPARTMENT:
Purchasing Manager Ms. P. Cannon
TECHNICAL SERVICES DEPARTMENT:
Technical Services Manager Mr. J.A. Sadlier Maintenance Supervisor Mr. S. Maher
160 M ATER MI SERICORD I AE H OSPITAL AN NUAL R EPORT 19 96
HOSPITALS OF THE SISTERS OF MERCY THROUGHOUT THE WORLD
IRELAND
County and City Name and Type of Hospital Year Beds Cork: Cork Mercy Hospital 1857 255
Dublin: Dublin Beaumont Convalescent Home 1900 129 Dublin Mater Misericordiae Hospital 1852 456 Dun Laoghaire Our Lady of Lourdes Hospital 1918 139 Dun Laoghaire St. Michael's Hospital 136
Longford: Edgevvorthstovvn Our Lady's Nursing Home 25
UNITED STATES OF AMERICA
State and City Name of Institution Year Beds
Alabama Daphne Villa Mercy-chronic & convalescent 1949 29 Mobile Blessed Martin de Porres Hospital 1950 35
Arizona Phoenix St. Joseph's Hospital 1894 617
Arkansas Brinkley Mercy Hospital 1953 46 El Dorado Warner Brovvn Hospital 1920 130 Fort Smith St. Edvvard's Mercy Hospital 1905 339 Fort Smith Mercy villa-convalescent & chronic 25 Hot Springs St. Joseph's Hospital 1888 317 Waldron Mercy Hospital 100
California Alturas Mercy-Modoc Medical Centre 28 Bakersfield Mercy Hospital 1910 267 Carmichael Mercy San Juan Hospital 211 Folsom Mercy Hospital of Folsom 34 Merced Mercy Hospital 93 Oxnard St. John's Hospital 1912 250 Red Bluff St. Elizabeth's Hospital 1908 51 Redding Mercy Hospital 1944 200 Sacramento Hospital 1895 355 San Diego Mercy Hospital 1855 485 San Francisco Notre Dame Hospital 1946 150
161
• ::. M ATER M ISERICORDIAE H OSPITAL A NNUAL R EPORT 1996
State and City Name of Institution Year Beds Colarado Denver Mercy Hospital 1901 386 Durango Mercy Hospital 1882 110
Connecticut West Hartford St. Agnes' Maternity Home 1914 8
Florida Fort Lauderdale Holy Cross Hospital 478
Georgia Atlanta St. Joseph's Infirmary 1881 291 Savannah St. Joseph's Infirmary 1875 306
Idaho Nampa Mercy Hospital 1919 162 Pocatello St. Anthony's Mercy Hospital 1918 100
Illinois Aurora Mercyville Sanitarium 1915 172 Aurora St. Joseph's Mercy Hospital 1911 104 Aurora Mercy Centre for Health Care Serv. 353 Chicago Mercy Hospital 1852 526 Chicago Misericordiae Home - Maternity & Paediatric 1912 80 DeKalb St. Mary's Hospital 1922 54
Indiana Dyer Our Lady of Mercy Hospital 1942 264 Hammond St. Anne's Home - convalescent & chronic 1936 120
Iowa Algona St. Ann's Hospital 1949 40 Anamosa Mercy Hospital 1893 34 Ceder Rapids Mercy Hospital 1900 479 Centerville St. Joseph's Mercy Hospital 1903 45 Clinton St. Joseph's Mercy Hospital 1884 146 Duduque Mercy Health Centre 506 Council Bluffs Mercy Hospital 903 333 Council Bluffs St. Bernard's Hospital 887 208 Cresco St. Joseph's Mercy Hospital 911 35 Davenport Mercy Hospital 869 265 Des Moines Mercy Hospital 894 500 Des Moines Bishop Drumm Home for Aged-Chronic 939 90 Duduque St. Joseph's Mercy Hospital 879 348 Dubuque St. Joseph's Sanitarium 887 155 Fort Dodge St. Joseph's Mercy Hospital 908 175 Iowa City Mercy Hospital 878 240 Marshalltown Mercy Hospital 902 84 Mason City St. Joseph's Mercy Hospital 916 318 Olewein Mercy Hospital 926 58 Sioux City St. Joseph's Mercy Hospital 890 425
162 M ATER. MI SER. I CORD I AE H OSP I TAL A NNUAL R EPOR.T 1996
State and City Name of Institution Year Beds Iowa Waverly St. joseph's Mercy Hospital 1904 46
Kansas Fort Scott Mercy Hospital 1887 165 Fredonia St. Margaret's Mercy Hospital 1950 42 Hutchinson St. El izabeth's Mercy Hospital 1920 107 Independence Mercy Hospital 1927 93
Kentucky Morganfield Our Lady of Mercy Hospital 1945 25 Owensboro Our Lady of Mercy Hospital 1948 102
Louisiana New Orleans Mercy Hospital 1924 225
Maine Houlton Madigan Memorial Hospital 1915 54 Portland Mercy Hospital 1918 200
Maryland Baltimore Mercy Hospital 1874 348 Govans Mercy Villa-chronic & convalescent 1920 22
Michigan Ann Arbor Mercywood Sanitarium 1925 125 Ann Arbor St. joseph's Mercy Hospital 1911 297 Ann Arbor Catherine McAuley Health Centre 558 Battle Creek Leila Y.Post Montgomery Hospital 1927 228 Bay City Mercy Hospital 1899 303 Cadillac Mercy Hospital 1908 175 Detroit Mt. Carmel Mercy Hospital 1939 597 Detroit St. joseph's Mercy Hospital 1923 225 Detroit Samaritan Health Centre 425 Grayling St. Mary's Hospital 1893 346 Grayling Mercy Hospital 130 Grand Rapids Mercy Hospital 1911 45 Grand Rapids St. Mary's Hospital 370 Grant Grant Hospital 32 jackson Mercy Hospital 1915 125 Lansing St. Lawrence's Hospital 1920 450 Man istee Mercy Hospital 1889 100 Muskegon Mercy Hospital 1903 238 Pontiac St. joseph's Mercy Hospital 1927 531 Port Huron Mercy Hospital 1954 119
Minnesota Ivanhoe Divine Providence Hosp. & Home 79
163
.'" M ATER MI SERICORDIAE H OSP I TAL A NNUAL R EPORT 1996
State and City Name of Institution Year Beds
Mississippi Vicksburg Mercy-Street Memorial Hospital 1943 180
Missouri joplin St. john's Hospital 1899 325 Mansfield Mercy Hospital - Tri County 51 St. Louis St. john's Hospital 1871 892 Springfield St. john's Hospital 1891 1,016 Springfield Mercy Infirmary - Convalescent 1952 175
Montana Kalispell Kalispell General Hospital 1910 66
Nebraska Loup City Sacred Heart Hospital III Omaha St. Catherine's Hospital 1910 200 Omaha St. Vincent's Home for Aged-Chronic 1953 200 Omaha Archbishop Bergan Mercy Hospital 739
Newhampshire Manchester Sacred Heart Hospital 1892 146 Manchester Our Lady of Grace Convalescent Home 1953 200
New Jersy Sea Isle City Mercy Hospital 1953 25
New York Albany St. Peter's Hospital 1869 437 Batavia St. jerome Hospital 1917 110 Buffalo Mercy Hospital 1904 383 Gabriels Sanitouium Gabriels 1895 75 Gabriels St. Margaret's Home - convalescent & chronic 56 Hornell St. james's Mercy Hospital 1890 144 Kenmore Kenmore Mercy Hospital 1949 244 Portjervis St. Francis Hospital 1915 57 Spring Valley St. Vincent de Paul Convalescent Home 1902 30 Tupper Lake Mercy General Hospital 1918 54 Watertown Mercy Hospital 1894 222
North Carolina Ashville St. joseph's Hospital 1900 283 Charlotte Mercy Hospital 1906 427
North Dakota Carrington Carrington Hospital 66 Devils Lake Mercy Hospital 1902 110 New Rockford City Hospital 26 Park River St. Ansgar's Hospital 25 Valley City Mercy Hospital 1928 75 Williston Mercy Hospital 1920 110
164 MATER. MISER.ICOR.DIAE HOSPITAL ANNUAL REPOR.T 1996
State and City Name of Institution Year Beds
Ohio Batavia Clermont Mercy Hospital 109 Cinncinnati Our Lady of Mercy Hospital 1942 159 Coldwater Our Lady of Mercy Hospital 1950 40 Hamilton Mercy Hospital 1892 317 Lima St. Rita's Hospital 1918 405 Oregon St. Charles Hospital 342 Springfield Mercy Hospital 1950 337 Tiffin Mercy Hospital 1913 95 Toledo Mercy Hospital 1918 350 Toledo St. Charles Hospital 1953 201 Urbana Mercy Memorial Hospital 1951 68
Oklahoma Oklahoma City Mercy Hospital Oklahoma City General 1916 ISO Oklahoma City Mercy Health Centre 356
Oregaon Coos Bay McAuley Hospital 1939 74 North Bend Mercy Home for Aged & Convalescent 1906 40 Ontario Holy Rosary Hospital 92 Portland Mt. St. Joseph's Home for the Aged and Chronic 1901 165 Roseburg Mercy Hospital 1909 III
Pennsylvania Darby Thomas M. Fitzgerald - Mercy Hospital 1933 370 Darby Mercy Catholic Medical Centre 700 Downington Villa St. John vianney 1946 14 Du Bois Du Bois Hospital 1898 95 Johnstown Mercy Hospital 1910 227 Philadelphia Misericordiae Hospital 1918 280 Pittsburgh Mercy Hospital 1847 619 Sacranton Mercy Hospital 1917 352 Sacranton St. Mary's Hospital 1916 70 Wilkes-Barre Mercy Hospital 1898 300
South Dakota Gettysburg Gettysbury Memorial Hospital 28 Pierre 86 Waterstown St. Ann's Hospital 60
Tennessee Knoxville St. Mary's Memorial Hospital 1930 525
Texas Brownsville Mercy Hospital 1917 90 Laredo Mercy Hospital 1894 288 Slaton Mercy Hospital 1929 31
165 l1li M ATER. MI SER. I COR.O I AE H OSP ITA L ANN UA L R EPO R. T 1996
State and City Name of Institution Year Beds
Wisconsin Janesville Mercy Hospital 1907 200 New Richmond Holy Family Hospital 60
REST OF THE WORLD
State and City Name of Institution Year Beds
NEWFOUNDLAND St. John's St. Clare's Mercy Hospital 1922 140
ENGLAND Derbyshire Ednaston, Brailsford St. Mary's Nursing Home 1948 20
Essex Clacton-on-Sea St. Michael's Convalescent Home 1946 48
London London Hospital of St. John & St. Elizabeth 1856 175
SCOTLAND Glasgow Baillieston St. Catherine's Home 1953 24
NEW ZEALAND North Island Auckland Mater Misericordiae Hospital 1900 148 Palmerston Mater Misericordiae Hospital 1950 45
South Island Dunedin Mater Misericordiae Hospital 1936 23
AUSTRALIA New South Wales Albury Mercy Hospital 1944 21 Cootamundra Sacred Heart & St. Catherine'sHospital 1925 68 Forbes Mater Misericordiae Hospital 1951 11 Sydney Mater Misericordiae Hospital 1906 353 Waratah Mater Misericordiae Hospital 1922 247 Young Sacred Heart Hospital 1923 72 Young St. Joseph's Hospice 1920 15
Queensland Brisbane Mater Misericordiae Hospital 1906 405 Bundabery Mater Misericordiae Hospital 1946 43 Mackay Mater Misericordiae Hospital 1925 76 Rockhampton Mater Misericordiae Hospital 1934 123 Townsville Mater Misericordiae Hospital 1945 29
166 M ATER MI SER I CORD I AE H OSP I TA L ANN UA L R EPORT 1996
State and City Name of Institution Year Beds
Victoria Melbourne Mercy Hospital 1935 173
Western Australia Perth St. Anne's Hospital 1937 141
SOUTH AMERICA British Guiana Mahaica Leprosarium 1935 360 Georgetown St. Joseph's Mercy Hospital 1945 124
India Jameshedpur Dalal Memorial Hospital 1952 80
AFRICA East Africa Nairobi Mater Misericordiae Hospital 1963
167
• ARnCLE 5 - Evaluation de stage • ARnCLE 7
Le IIvret de suivi pedagoglque, dans sa partie Le ou la staglaire s'engage avec I'organisme evaluation de stage pratique en entreprise, d'accueil et I'INFA a respecter les dispositions permet au tuteur et au responsable de de la presente convention, celles du formation de 11NFA, lors de ses visites dans reglement interieur en vigueur a I'INFA, ainsl I'entreprise ou I'organlsme d'accueil, de noter que le reglement Interieur de I'entreprise et/ou d'evaluer le (la) staglalre sur la d'accueil. progression en cours et les apprentlssages restant a effectuer.
Ce IIvret est rempli par les differentes parties et rapporte a I'INFA au retour du stage
• ARnCLE 6 - Conditions particulieres
L'organlsme d'accuell s'engage, dans la mesure de ses posslbllltes, a aider le ou la stagiaire a trouver de bonnes conditions d'hebergement et de restal}ration.
Signature de I'entreprise*
Signature de I'organisme de formation*
Signature du ou de la stagiaire* Faita~- ~- ~ , le ~/~/~ • ~2.
Convention etablle en 3 exempla/res -: - 1 exemplaire signe a conserver par I'organlsme d'accueil - 1 exemplalre slgne a remettre au staglaire - 1 exemplalre signe a retourner a 11NFA
* toute signature imp/ique que la convention a eM lue et approuvee